[Application of PDCA circulation in reduction of the turnaround time of semen samples in the andrology laboratory].

OBJECTIVE: To reduce the out-of-threshold (OOT) value of the turnaround time (TAT) of semen samples in the andrology laboratory and improve the clinical diagnosis and patients' satisfaction. METHODS: We retrospectively analyzed the defect rate of TAT of semen samples in the andrology laboratory in the first two quarters of 2018. In the second two quarters, we made a table of countermeasures targeting the causes of the defects using plan-do-check-act (PDCA) circulation and the fishbone diagram drawn with the brainstorm method, followed by supervision of the implementation of the measures and observation of the changes in the OOT value of TAT of semen samples. RESULTS: The OOT rate of TAT of semen samples before seminal examination was significantly lower in the third and fourth than in the first and second quarters of 2018 (0.83% and 0.78% vs 3.43% and 2.07%, P < 0.01), and so was the total OOT rate of TAT (6.36% and 0.87% vs 7.00% and 7.15%, P < 0.01). The median of TAT of semen samples before computer assisted semen analysis was decreased from 22 min in the first to 17 min in the fourth quarter, and the 90th percentile from 54 min to 40 min. The median of total TAT in biochemical analysis was reduced from 387 min in the first to 315 min in the fourth quarter, and the 90th percentile from 1415 min to 1179 min. CONCLUSIONS: The application of PDCA circulation can significantly shorten the turnaround time of semen samples and improve the efficiency of diagnosis and treatment and quality control in the andrology laboratory.

Diagnostic Improvements of Deep Learning-Based Image Reconstruction for Assessing Calcification-Related Obstructive Coronary Artery Disease.

Objectives: The objective of this study was to explore the diagnostic value of deep learning-based image reconstruction (DLR) and hybrid iterative reconstruction (HIR) for calcification-related obstructive coronary artery disease (CAD) evaluation by using coronary CT angiography (CCTA) images and subtraction CCTA images. Methods: Forty-two consecutive patients with known or suspected coronary artery disease who underwent coronary CTA on a 320-row CT scanner and subsequent invasive coronary angiography (ICA), which was used as the reference standard, were enrolled. The DLR and HIR images were reconstructed as CTADLR and CTAHIR, and, based on which, the corresponding subtraction CCTA images were established as CTAsDLR and CTAsHIR, respectively. Qualitative images quality comparison was performed by using a Likert 4 stage score, and quantitative images quality parameters, including image noise, signal-to-noise ratio, and contrast-to-noise ratio were calculated. Diagnostic performance on the lesion level was assessed and compared among the four CCTA approaches (CTADLR, CTAHIR, CTAsDLR, and CTAsHIR). Results: There were 166 lesions of 86 vessels in 42 patients (32 men and 10 women; 62.9 ± 9.3 years) finally enrolled for analysis. The qualitative and quantitative image qualities of CTAsDLR and CTADLR were superior to those of CTAsHIR and CTAHIR, respectively. The diagnostic accuracies of CTAsDLR, CTADLR, CTAsHIR, and CTAHIR to identify calcification-related obstructive diameter stenosis were 83.73%, 69.28%, 75.30%, and 65.66%, respectively. The false-positive rates of CTAsDLR, CTADLR, CTAsHIR, and CTAHIR for luminal diameter stenosis ≥50% were 15%, 31%, 24%, and 34%, respectively. The sensitivity and the specificity to identify ≥50% luminal diameter stenosis was 90.91% and 83.23% for CTAsDLR. Conclusion: Our study showed that deep learning-based image reconstruction could improve the image quality of CCTA images and diagnostic performance for calcification-related obstructive CAD, especially when combined with subtraction technique.

A new TEX11 mutation causes azoospermia and testicular meiotic arrest.

There are many unknown genetic factors that lead to infertility in nonobstructive azoospermia men. Here, we performed whole-exome sequencing in blood samples obtained from 40 azoospermia patients with meiotic arrest and found a novel c.151_154del (p.D51fs) frame-shift mutation in exon 3 of the testis expressed 11 (TEX11) gene in one patient. Sanger sequencing analysis of the patient and 288 fertile men was performed to validate the mutation. Immunohistochemical analysis showed TEX11 expression in late-pachytene spermatocytes and in round spermatids in fertile human testes. In contrast, testes of the patient with TEX11 mutation underwent meiotic arrest and lacked TEX11 expression. Western blotting of human embryonic kidney (HEK293) cells transfected with a vector for the p.D51fs TEX11 variant detected no TEX11 expression. In conclusion, we identified a novel frame-shift mutation in the TEX11 gene in an azoospermia patient, emphasizing that this gene should be included in genetic screening panels for the clinical evaluation of azoospermia patients.

[Pre-implantation genetic screening in intracytoplasmic sperm injection for infertile patients with high sperm DNA fragmentation index].

OBJECTIVE: To investigate the application value of pre-implantation genetic screening (PGS) in intracytoplasmic sperm injection (ICSI) and embryo transfer (ET) for infertile patients with high sperm DNA fragmentation index (DFI). METHODS: We selected 90 infertile patients undergoing ICSI-ET in our center from April 2015 to October 2016, 60 with sperm DFI =≥15% and 30 with sperm DFI <15%. Of the 60 cases with sperm DFI =≥15%, 30 received PGS-ICSI (high DFI-PGS group) while the other 30 did not receive PGS (high DFI-ICSI group). The 30 cases with sperm DFI <15% were included in the low DFI-ICSI group. We made comparisons between the high and low DFI-ICSI groups in the rates of normal fertilization, good-quality embryos, blastocyst formation and embryo implantation as well as between the high DFI-PGS and high DFI-ICSI groups in the ages of the males and females, the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH) and testosterone (T) in the males, sperm concentration, the percentages of progressively motile sperm (PMS) and morphologically normal sperm (MNS), sperm DFI, and the rates of sperm nucleoprotein immaturity, normal fertilization, good-quality embryos, blastocyst formation and embryo implantation. RESULTS: Statistically significant differences were found between the high and low DFI-ICSI groups in the rate of embryo implantation (31.25 vs 52.50%, P <0.01) but not in the rates of normal fertilization (ï¼»65.38 ± 24.62ï¼½ vs ï¼»73.00 ± 17.00ï¼½%, P >0.05), good-quality embryos (ï¼»62.41 ± 25.97ï¼½ vs ï¼»73.00 ± 22.10ï¼½%, P >0.05), or blastocyst formation (ï¼»62.55 ± 25.21ï¼½ vs ï¼»64.30 ± 18.60ï¼½%, P >0.05). The rate of embryo implantation was markedly higher in the high DFI-PGS than in the high DFI-ICSI group (60.97% vs 31.25%, P <0.01), but there were no statistically significant differences between the two groups in the ages of the males and females, the levels of FSH, LH and T in the males, sperm concentration, the percentages of PMS and MNS, sperm DFI, sperm nucleoprotein immaturity, or the rates of normal fertilization (ï¼»69.76 ± 15.82ï¼½ vs ï¼»65.38 ± 24.62ï¼½%, P >0.05), good-quality embryos (ï¼»64.42 ± 30.75ï¼½ vs ï¼»62.41 ± 25.97ï¼½%, P >0.05) and blastocyst formation (ï¼»67.53 ± 19.24ï¼½ vs ï¼»62.55 ± 25.21ï¼½%, P >0.05). CONCLUSIONS: For the infertile patients with sperm DFI =≥15%, PGS-ICSI, rather than ICSI alone, can significantly increase the rate of embryo implantation.

Conjugated Microporous Polymers with Dense Sulfonic Acid Groups as Efficient Proton Conductors.

Proton-exchange membrane fuel cells, emerging as green and sustainable energy sources, have attracted extensive attention in recent decades. Porous organic polymers, which feature in high surface area values, tunable pore sizes, excellent thermal and chemical stabilities, and the flexibility to incorporate specific functional groups, have recently displayed their striking images as potential electrolytes for fuel cells. In this work, BO-CMP-1 and BO-CMP-2 that possess rich π-structure and permanent porosity and have high thermal and chemical stability were synthesized through Suzuki-Miyaura coupling reaction. Owing to their rigid structures and abundant electrophilic substitution positions, these two novel porous polymers were covalently decorated with dense sulfonic acid groups by postsulfonation, as denoted by SBO-CMP-1 and SBO-CMP-2. The proton conductivity of SBO-CMPs is systematically studied to evaluate their performance as proton-conductive materials. It was found that their performance is highly humidity- and temperature-dependent and they show relatively high proton conductivity. For SBO-CMP-1 and SBO-CMP-2, their proton conductivities are 1.29 × 10-2 and 5.21 × 10-3 S cm-1, respectively, at 70 °C and 100% relative humidity. Low activation energy values of 0.32 eV for SBO-CMP-1 and 0.40 eV for SBO-CMP-2 suggest the Grotthuss mechanism for proton conduction.

[Routine semen parameters and sperm morphological index of infertile males with partial globozoospermia].

OBJECTIVE: To investigate the routine semen parameters and sperm morphological indexes of the patients with partial globozoospermia (PGZ). METHODS: We included in this study 100 infertile males with PGZ and another 180 non-PGZ infertile men as controls. According to the proportion of round-headed sperm (RHS) in the semen, we classified the PGZ males into five subgroups: 25%－40%, 41%－55%, 56%－70%, 71%－85%, and 86%－99% RHS. We obtained sperm concentration, total sperm motility, the percentage of progressively motile sperm, teratozoospermia index (TZI), and sperm deformity index (SDI) from the subjects and compared them among different groups. RESULTS: Statistically significant differences were found between the PGZ patients and non-PGZ controls in total sperm motility (ï¼»35.76±24.88ï¼½% vs ï¼»62.03±10.20ï¼½%, P<0.01), the percentage of progressively motile sperm (ï¼»26.11±20.39ï¼½% vs ï¼»45.62±6.87ï¼½%, P<0.01), the percentage of morphologically normal sperm (ï¼»1.45±1.45ï¼½% vs ï¼»5.98±2.21ï¼½%, P<0.01), and SDI (1.33±0.11 vs 1.27±0.57, P<0.01), but not in age (ï¼»29.82±4.90ï¼½ vs ï¼»30.33±3.59 ï¼½ yr, P>0.05), sperm concentration (ï¼»46.01±40.38ï¼½ vs ï¼»54.00±25.15ï¼½ ×106/ml, P>0.05), or TZI (1.35±0.11 vs 1.34±0.54, P>0.05). There were also significant differences among the five PGZ subgroups in total sperm motility, progressive sperm motility, normal sperm morphology, TZI, and SDI (P<0.01), but not in age or sperm concentration (P>0.05). Morphologically, the sperm head changed from heterogeneous to homogeneous with the increased proportion of round-headed sperm. CONCLUSIONS: Different proportions of round-headed sperm are closely related to routine semen parameters and sperm morphological index in PGZ patients, which can help clinicians choose the proper assisted reproductive technology and predict the rate of fertilization for infertile males.

Byproduct-catalyzed four-component reactions of aldehydes with hexamethyldisilazane, chloroformates, and nucleophiles in acetonitrile leading to protected primary amines, beta-amino esters, and beta-amino ketones.

Multicomponent reactions are a very powerful tool for the construction of complex organic molecules by using readily available starting materials. While most of the multicomponent reactions discovered so far consist of three components, the reactions with four or more components remain sparse. We have successfully developed several four-component reactions using a catalytic amount of water as a hydrolyzing agent to decompose byproduct chlorotrimethylsilane (TMSCl) to yield secondary byproduct HCl that serves as a catalyst. In the presence of 40 mol % of water, the four-component reaction of aldehydes with hexamethyldisilazane (HMDS), chloroformates, and silylated nucleophiles proceeds smoothly at room temperature to give a range of protected primary amines in moderate to excellent yields. Importantly, a wide variety of protic carbon nucleophiles, such as beta-keto esters, beta-diketones, and ketones, have further been explored as suitable substrates for the synthesis of protected beta-amino esters and beta-amino ketones that are useful building blocks for various pharmaceuticals and natural products. These four-component reactions proceed through a pathway of tandem nitrogen protection/imine formation/imine addition, and the decomposition of byproduct TMSCl, generated in the first step of nitrogen protection, with water results in the formation of secondary byproduct HCl, a strong Brønsted acid that catalyzes the following imine formation/imine addition. Taking advantage of the fact that alcohols or phenols are also able to decompose byproduct TMSCl to yield secondary byproduct HCl, no catalyst is needed at all for the four-component reactions with aldehydes bearing hydroxy groups.