BACKGROUND:Neurological complications significantly contributed to mortality in patients with acute respiratory distress syndrome (ARDS) supported by venovenous extracorporeal membrane oxygenation (VV ECMO). Early fluctuations in arterial partial pressure of carbon dioxide (PaCO2) during ECMO initiation may have affected cerebral perfusion and increased the risk of brain injury. This study investigated the association between early changes in PaCO2 and pH levels and subsequent neurological outcomes in patients with ARDS receiving VV ECMO. METHODS:We conducted a retrospective cohort study using data from adult ARDS patients who underwent VV ECMO between January 2018 and December 2022, sourced from the Chinese Society of Extracorporeal Life Support (CSECLS) Registry. Patients were stratified into clusters based on absolute changes in PaCO2 and pH using K-means clustering. Logistic regression models and restricted cubic splines were used to evaluate the associations between these clusters and the occurrence of neurological complications, adjusting for potential confounders. RESULTS:Among 983 patients included, the incidence of neurological complications was 2.95%. Cluster 1, characterized by significant reductions in PaCO2 (median: -50 mmHg, relative reduction: -58%), exhibited the highest rate of neurological complications (11.94%). Cluster 3, with substantial increases in pH and minimal reductions in PaCO2, showed a relatively lower rate of neurological complications (3.96%), suggesting that PaCO2 fluctuations, rather than pH changes, were primarily associated with neurological complications. CONCLUSIONS:Excessive reductions in PaCO2 during the early initiation of VV ECMO, rather than pH elevation, were associated with an increased risk of neurological complications in ARDS patients. Close monitoring and management of PaCO2 during ECMO initiation may mitigate this risk.

Mechanical ventilation may cause pulmonary hypertension in patients with acute lung injury (ALI), but the underlying mechanism remains elucidated.ALI was induced in rabbits by a two-hit injury, i.e., hydrochloric acid aspiration followed by mechanical ventilation for 1 h. Rabbits were then ventilated with driving pressure of 10, 15, 20, or 25 cmH2O for 7 h. Clinicopathological parameters were measured at baseline and different timepoints of ventilation. RNA sequencing was conducted to identify the differentially expressed genes in high driving pressure ventilated lung tissue.The two-hit injury induced ALI in rabbits was evidenced by dramatically decreased PaO2/FiO2 in the ALI group compared with that in the control group (144.5 ± 23.8 mmHg vs. 391.6 ± 26.6 mmHg, P < 0.001). High driving pressure ventilation (20 and 25 cmH2O) significantly elevated the parameters of acute pulmonary hypertension at different timepoints compared with low driving pressure (10 and 15 cmH2O), along with significant increases in lung wet/dry ratios, total protein contents in bronchoalveolar lavage fluid, and lung injury scores. The high driving pressure groups showed more pronounced histopathological abnormalities in the lung compared with the low driving pressure groups, accompanied by significant increases in the cross-sectional areas of myocytes, right ventricular weight/body weight value, and Fulton's index. Furthermore, the expression of the genes related to ferroptosis induction was generally upregulated in high driving pressure groups compared with those in low driving pressure groups.A rabbit model of ventilation-induced pulmonary hypertension in ALI was successfully established. Our results open a new research direction investigating the exact role of ferroptosis in ventilation-induced pulmonary hypertension in ALI.

Background: Venovenous extracorporeal membrane oxygenation (VV-ECMO) has been demonstrated to be effective in treating patients with virus-induced acute respiratory distress syndrome (ARDS). However, whether the management of ECMO is different in treating H1N1 influenza and coronavirus disease 2019 (COVID-19)-associated ARDS patients remains unknown. Methods: This is a retrospective cohort study. We included 12 VV-ECMO-supported COVID-19 patients admitted to The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Eighth People's Hospital, and Wuhan Union Hospital West Campus between January 23 and March 31, 2020. We retrospectively included VV-ECMO-supported patients with COVID-19 and H1N1 influenza-associated ARDS. Clinical characteristics, respiratory mechanics including plateau pressure, driving pressure, mechanical power, ventilatory ratio (VR) and lung compliance, and outcomes were compared. Results: Data from 25 patients with COVID-19 (n=12) and H1N1 (n=13) associated ARDS who had received ECMO support were analyzed. COVID-19 patients were older than H1N1 influenza patients (P=0.004). The partial pressure of arterial carbon dioxide (PaCO2) and VR before ECMO initiation were significantly higher in COVID-19 patients than in H1N1 influenza patients (P <0.001 and P=0.004, respectively). COVID-19 patients showed increased plateau and driving pressure compared with H1N1 subjects (P=0.013 and P=0.018, respectively). Patients with COVID-19 remained longer on ECMO support than did H1N1 influenza patients (P=0.015). COVID-19 patients who required ECMO support also had fewer intensive care unit and ventilator-free days than H1N1. Conclusions: Compared with H1N1 influenza patients, COVID-19 patients were older and presented with increased PaCO2 and VR values before ECMO initiation. The differences between ARDS patients with COVID-19 and influenza on VV-ECMO detailed herein could be helpful for obtaining a better understanding of COVID-19 and for better clinical management.

Objectives: To evaluate the relation between metagenomic next-generation sequencing (mNGS) and the prognosis of patients with infectious diseases undergoing mechanical ventilation in the intensive care unit (ICU).Methods: This is a single-center observational study, comparing nonrandomly assigned diagnostic ap-proaches. We analyzed the medical records of 228 patients with suspected infectious diseases undergoing mechanical ventilation in the ICU from March 2018 to May 2020. The concordance of pathogen results was also assessed for the results of mNGS, culture, and polymerase chain reaction assays.Results: The 28-day mortality of the patients in the mNGS group was lower after the baseline difference correction (19.23% (20/104) vs 29.03% (36/124) , P = 0.039). Subgroup analysis showed that mNGS assay was associated with improved 28-day mortality of patients who are not immunosuppressed (14.06% vs 29.82%, P = 0.018). Not performing mNGS assay, higher acute physiology and chronic health evaluation II score, and hypertension are independent risk factors for 28-day mortality. The mNGS assay presented an advantage in pathogen positivity (69.8% double-positive and 25.0% mNGS-positive only), and the concor-dance between these two assays was 79.0%.Conclusion: mNGS survey may be associated with a better prognosis by reducing 28-day mortality of patients with infectious diseases on mechanical ventilation in the ICU. This technique presented an ad-vantage in pathogen positivity over traditional methods.(c) 2022 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )

Background. Since 2020 COVID-19 pandemic became an emergent public sanitary incident. The epidemiology data and the impact on prognosis of secondary infection in severe and critical COVID-19 patients in China remained largely unclear. Methods. We retrospectively reviewed medical records of all adult patients with laboratory-confirmed COVID-19 who were admitted to ICUs from January 18 th 2020 to April 26 th 2020 at two hospitals in Wuhan, China and one hospital in Guangzhou, China. We measured the frequency of bacteria and fungi cultured from respiratory tract, blood and other body fluid specimens. The risk factors for and impact of secondary infection on clinical outcomes were also assessed. Results. Secondary infections were very common (86.6%) when patients were admitted to ICU for >72 hours. The majority of infections were respiratory, with the most common organisms being Klebsiella pneumoniae (24.5%), Acinetobacter baumannii (21.8%), Stenotrophomonas maltophilia (9.9%), Candida albicans (6.8%), and Pseudomonas spp. (4.8%). Furthermore, the proportions of multidrug resistant (MDR) bacteria and carbapenem resistant Enterobacteriaceae (CRE) were high. We also found that age ≥60 years and mechanical ventilation ≥13days independently increased the likelihood of secondary infection. Finally, patients with positive cultures had reduced ventilator free days in 28 days and patients with CRE and/or MDR bacteria positivity showed lower 28 day survival rate. Conclusions. In a retrospective cohort of severe and critical COVID-19 patients admitted to ICUs in China, the prevalence of secondary infection was high, especially with CRE and MDR bacteria, resulting in poor clinical outcomes.

目的 探讨无创正压通气(NIV)与球囊面罩(BVM)通气相比是否能够改善重症加强治疗病房(ICU)危重患者气管插管前的预氧合.方法 这是一个单中心、前瞻性随机对照研究,研究纳入2015年6月至2017年6月在广州医科大学附属第一医院、广州呼吸健康研究院ICU内需要气管插管的患者.随机将患者分为对照组和NIV组,分别使用BVM或者NIV进行预氧合.比较两组患者各项指标的差异,探讨NIV在危重症患者预氧合中的应用价值.结果 共纳入患者106例,男75例,女31例;平均年龄(65.0±12.6)岁.对照组53例,NIV组53例.对照组和NIV组气管插管的原因分别为:肺炎[40例(75.5％)比39例(73.6％)],慢性阻塞性肺疾病[12例(22.6％)比11例(20.8％)],其他[1例(1.9％)比3例(5.7％)],两组气管插管原因比较差异均无统计学意义(P＞0.05).对照组和NIV组急性生理学和慢性健康状况评分系统Ⅱ评分分别为20(17,26)比20(16,26)分,差异无统计学意义(P=0.86).对照组和NIV组预氧合前脉搏血氧饱和度(SpO2)分别为92％(85％,98％)比91％(85％,98％)(P=0.87).预氧合后,NIV 组的 SpO2显著高于对照组99％(96％,100％)比96％(90％,99％)(P=0.001).在预氧合前SpO2＜90％的亚组患者中,对照组和NIV组的SpO2分别为83％(73％,85％)和81％(75％,86％)(P=0.75);预氧合后,NIV 组的 SpO2明显高于对照组的99％(96％,100％)比94％(90％,99％)(P=0.000).预氧合前SpO2≥90％的亚组患者中,对照组和NIV组的SpO2分别为95.5％(92％,99％)比96％(94％,99％)(P=0.52);预氧合后两组 SpO2相似98％(95％,100％)比99％(96％,100％)(P=0.1).对照组和 NIV 组机械通气时间 17(10,23)d 比 19(11,26)d(P=0.86);28天生存率73.6％比71.7％(P=0.34),ICU 病死率31.3％比31.7％(P=0.66).结论 与传统的BVM比较,NIV辅助预氧合对危重患者是安全有效的,严重低氧血症的危重患者更有可能从NIV预氧合中获益.

Background The coronavirus disease 2019 (COVID-19) pandemic has spread all over the world resulting in high mortality, yet no specific antiviral treatment has been recommended. Methods A retrospective descriptive study was conducted involving 19 consecutive critically ill patients during January 27, 2020 to April 18, 2020. Ribavirin was given at 0.15g q8h orally upon ICU admission for 7 to 21 days. Here, 28-day mortality, lower respiratory tract specimens (ETA), and ribavirin side effect on the day of ICU admission (Day 1), Day 7, Day 14 and Day 21 were analyzed. Results All the nineteen critically ill COVID-19 patients (14 males and 5 females, median age 56yr) survived through to the 28th day of observations with 6 patients (31.58%) being discharged from the ICU. The SARS-CoV-2 viral positivity in sputum/ETA was 100% (19/19) on Day 1, 73.68% (14/19) on Day 7, 57.89% (11/19) on Day 14 and 36.84% (7/19) on Day 21. Ribavirin side effect was not observed in these patients. Conclusion Ribavirin is well tolerated in critically ill patients with COVID-19 and may benefit COVID-19 patients through increasing the virus clearance.

目的 总结经腹途径腹腔镜在膀胱阴道瘘修补中的可行性及疗效.方法 2012年12月至2017年12月暨南大学附属第一医院因子宫全切除(n=6,均为开放手术)或宫颈癌根治术后(n=1)致膀胱阴道瘘患者共7例,年龄42～57岁,所有瘘口均位于输尿管嵴以上,瘘口直径0.5～3.5 cm,尿瘘病史3个月～5年余,其中2例既往有1～2次经膀胱修补失败病史.采用经腹腹腔镜下膀胱阴道瘘修补术,直视下放置操作通道,其中5例瘘口较大或复发性膀胱阴道瘘采用大网膜填充膀胱与阴道之间的间隙.术后留置尿管2～3周.结果 7例患者手术均顺利完成,手术时间150～280 min,出血量50～150 ml,无输血,术后拔除尿管后尿瘘消失.随访6～54个月未出现尿瘘.结论 经腹腹腔镜修补高位膀胱阴道瘘微创、有效,尤其是复发性病例,但尚需更多临床资料论证.

目的 探讨早期肠内营养治疗对重症医学科(ICU)心脏手术后患者临床疗效及治疗结局的影响.方法 选取96例心脏手术患者为研究对象,采用随机数字表法分为两组,每组48例.观察组患者于术后24 h内开始肠内营养治疗,对照组患者于术后24～72 h开始肠内营养治疗,分别记录两组患者入住ICU时及肠内营养开始后7、10、14 d后的营养状况指标如白蛋白(Alb)、前白蛋白(PAB)、血红蛋白(Hb)、转铁蛋白(TF)水平、三酰甘油(TG)水平、炎性反应指标白细胞介素-6(IL-6)、降钙素原(PCT)、B型尿钠肽(BNP)以及预后指标(病死率、ICU住院时长、住院总时长、并发症发生情况),并在治疗前后对两组患者进行APACHEⅡ、SOFA评分.结果 两组患者入ICU前营养风险评分差异无统计学意义(P>0.05);两组患者入住ICU时Alb、PAB、Hb、TF、TG、IL-6、PCT、BNP水平及APACHEⅡ、SOFA评分均差异无统计学意义(P>0.05),给予营养支持治疗7、10、14 d后,观察组患者Alb、PAB、Hb水平较对照组患者明显升高(P<0.05),IL-6、PCT、BNP水平较对照组患者明显降低(P<0.05),并且观察组APACHEⅡ、SOFA评分明显低于对照组(P<0.05),观察组患者病死率、ICU住院时长、住院总时长、并发症发生率均低于对照组(P<0.05).结论 早期肠内营养能够有效及时改善ICU心脏手术患者的营养状况,纠正患者低蛋白血症,减轻机体炎症反应,降低病死率、住院时间、并发症发生率,并改善患者预后.

目的 评估无创正压通气(NIV)在重症加强治疗病房(ICU)非计划拔管(UE)患者中的应用价值.方法 回顾性分析2014年1月至2018年12月在广州医科大学附属第一医院、广州呼吸健康研究院ICU中UE患者的临床资料、NIV的应用、重新插管率及预后情况.根据UE后NIV的应用情况将患者分为对照组和NIV组.比较两组患者各项指标的差异,评估NIV在UE患者中的应用效果.结果 本研究共纳入66例UE患者,男44例,女22例,平均年龄(64.2±16.1)岁,对照组41例(62.1％)患者UE后使用鼻导管或者面罩吸氧,另外25例(37.9％)患者使用NIV.对照组和NIV组急性生理学和慢性健康状况评分系统Ⅱ评分分别为(18.6±7.7)和(14.8±6.3)分,差异有统计学意义(P=0.043).对照组和NIV组呼吸衰竭的原因分别为:肺炎16例(39.0％)比7例(28.0％),术后呼吸衰竭7例(17.1％)比8例(32.0％),慢性阻塞性肺疾病8例(19.5％)比6例(24.0％),其他原因5例(12.2％)比4例(16.0％),心功能衰竭3例(7.3％)比0例(0％),神经系统疾病2例(4.9％)比0例(0％),两组病因比较差异均无统计学意义.UE前通气时间(12.5±19.8)d比(12.7±15.2)d(P=0.966),拔管前对照组和NIV组PaO2(114.9±37.4)比(114.4±46.3)mm Hg(P=0.964),氧合指数(267.1±82,0)比(257.4±80.0)mmHg (P=0.641),重新插管率65.9％比24.0％ (P=0.001),机械通气时间(23.9±26.0)比(21.8±26.0)d (P=0.754),ICU住院时间(34.4±36.6)比(28.5±25.8)d(P=0.48).本研究总死亡率19.7％,对照组与NIV组死亡率分别为22.0％和16.0％(P=0.555).结论 ICU中的UE患者可以考虑使用NIV来避免重新插管.

Background: Weaning from mechanical ventilation (MV) is an important and universal issue in critically ill patients, with no consensus that predicts weaning success. Twitch tracheal airway pressure (TwPtr) may be a more objective indicator of diaphragm function. The present study evaluated TwPtr relative to negative inspiratory force (NIF) or Medical Research Council (MRC) score, for predicting success of weaning from MV. Methods: From December 2015 to March 2017, 62 patients were included who received invasive MV >48 hours and then underwent a test for spontaneous breathing. The NIF and MRC score were sequentially determined. The TwPtr measurement was performed via magnetic stimulation of the neck phrenic nerve. Results: Weaning success was achieved by 54 patients (87.1%), including 30, 12, and 12 patients who experienced simple, difficult, and prolonged weaning, respectively. The areas under receiver operating characteristic curves (AUCs) for NIF, MRC score, and TwPtr were 0.778, 0.560, and 0.792. When TwPtr was combined with NIF, the sensitivity and specificity of weaning success were 96.3% and 75.0%, and AUC was 0.807. In the weaning success group, after correction for age, the AUC of TwPtr was 0.878, which differentiated the simple weaning from non-simple group. Conclusions: TwPtr was superior to either NIF or MRC score for differentiating patients in the simple weaning group from those patients who experienced difficult, prolonged, or failed weaning. TwPtr combined with NIF may be used to predict weaning success better than the MRC score alone.

RATIONALE:Many factors contribute to a complicated postoperative course following difficult weaning off a ventilator after lung transplantation.PATIENT CONCERNS:A female patient underwent a successful surgery but received a size-mismatched lung graft. The graft had been pruned before transplantation. She experienced delayed ventilator weaning 3 days after lung transplantation.DIAGNOSES:A postoperative X-ray revealed a normal mediastinal structure and diaphragm position. Diaphragmatic function was assessed by diaphragm electromyography (EMGdi) via esophageal and surface electrodes. EMGdi showed decreased left compound motor action potentials (CMAPs), prolonged left phrenic nerve conduction time (PNCT), failure to induce right CMAPs and PNCT under bilateral magnetic stimulation, and right phrenic nerve injury.INTERVENTIONS:She was treated with neural nutritional support and prescribed rehabilitation measures such as strengthening limb activities on the bed.OUTCOMES:The patient finally achieved satisfactory outcomes after an early diagnosis and medical interventions.LESSONS:Lung size mismatch before transplantation and phrenic nerve injury during surgery should be avoided wherever possible.

INTRODUCTION:Prone position ventilation (PPV) has been shown to improve oxygenation and decrease pulmonary vascular resistance and mortality in patients with severe acute respiratory distress syndrome (ARDS). Whether these benefits of PPV occur similarly in acute exacerbations of interstitial lung disease (ILD) is not clear. We retrospectively explored the use of PPV in acute exacerbation with ILD versus those with severe acute respiratory distress syndrome (severe ARDS).METHODS:Retrospective study of the application of PPV in 17 patients with acute exacerbations of ILD and in 19 patients with severe ARDS. Pre- and post-PPV hemodynamic parameters, respiratory mechanics, prognostic indicators, complications and mortality rates at 28, 60 and 90 days were compared.RESULTS:There was no difference in baseline characteristics between the two groups except for higher driving pressure and more diastolic dysfunction in ILD group than severe ARDS group Compared with pre-PPV, cardiac index and driving pressure remained unchanged post-PPV in both groups. PPV increased PaO2 /FiO2 [118.7 (92.0, 147.8) pre-PPV vs 132.0 (93.5, 172.0) post-PPV; P < 0.05] and central venous oxygenation in patients with ILD. In patients with severe ARDS, PPV significantly increased PaO2 /FiO2 [109.23 (89,135) pre- PPV vs 126.13 (100.93, 170) post-PPV; P < 0.05] and intrathorax blood volume index. However, mortality rates at 28, 60 and 90 days remained high in both groups (76.4%, 88.2% and 88.2% vs 36.8%, 57.9% and 57.9% in ILD and severe ARDS, respectively; P < 0.05).CONCLUSION:Our findings suggest that PPV may improve oxygenation and partially improve hemodynamic parameters during acute exacerbations of ILD.

Acute respiratory distress syndrome (ARDS) is a clinical syndrome characterized as an increased pulmonary capillary permeability and systemic inflammation. More than 60% of ARDS patients complicated with hemodynamic disorder, which might be worsen during mechanical ventilation. It is important to assess volume status and correct hemodynamic disorder during treatment of ARDS. In addition to restrictive fluid management strategy, an individualized fluid management according to different stage and type of the disease, mechanical ventilaiton setting and synchrony, recruitment maneuver, use of sedatives and analgesics, fluid type we give to the patient, as well as avoiding acute cor pulmonale,is necessary to manage ARDS patients complicated with hemodynamic disorder. This review makes a summary of the advances in fluid management of ARDS patients. Key words: Acute respiratory distress syndrome; Fluid management; Hemodynamics; Fluid responsiveness; Acute corpulmonale

Aim:To explore the effectiveness of Interventional therapy and shengjing pill in Nutcracker syndrome with asthenospermia.Methods:Eighty patients diagnosed as nutcracker syndrome with asthe-nospermia,Therapeutic method:Interventional therapy with shengjing pill.Results:All patients is suc-cessful,70 patients’symptom of nutcracker syndrome is absent,Angle θof SMA with AO、LRVD1 、the semen quantity and the Inh B are obviously significant(P <0.01 ),after treatment Angle θ(50.1 8 ± 8.84)°、LRVD1 (4.04 ±1 .24)cm、semen density [(21 .51 ±0.1 9)×1 06 /L]and vigour(62.86 ± 5.67)、Inh B(1 39.37 ±34.94)pg/mL is better than prior treatment Angle θ(24.78 ±8.54)°、LRVD1 (2.28 ±1 .1 4)cm、semen density [(1 5.74 ±2.34)×1 06 /L]and vigour(28.95 ±3.24)、Inh B (86.41 ±20.46)pg/mL(P <0.01 ),composite group pregnancy rate(71 .43%).Conclusion:After in- terventional therapy with shengjing pill therapy in Nutcracker syndrome with asthenospermia,the semen of the patients who is diagnosed as asthenospermia is obviously significant.

AIM:To investigate the expression of up-regulated gene 11 ( URG11 ) in prostate cancer cell line and the effect of URG11 siNRA on the proliferation and invasion of human prostate cancer LNCaP cells.METHODS:The mRNA and protein levels of URG11 in prostate cancer cell lines and normal prostate epithelial cell line were evaluated by real-time PCR and Western blot.LNCaP cells were transfected with designed siRNA using the liposome method.The prolif-eration, apoptosis, migration and invasion abilities of the LNCaP cells were evaluated by MTS assay, flow cytometry, wound-healing assay and Transwell assay.RESULTS:The expression of URG11 at mRNA and protein levels in the DU145, PC3, LNCaP cell lines was significantly higher than that in RWPE-1 cell line.Compared with the control group, the proliferation of LNCaP cells with URG11 siRNA was stagnant in G1/S phase and induced apoptosis.The proliferation of LNCaP cells at 0 h, 24 h, 48 h and 72 h was inhibited after URG11 expression was down-regulated (P<0.05).Transwell assay showed that migration (P<0.05) and invasion (P<0.05) were also inhibited.CONCLUSION:URG11 is highly expressed in prostate cancer.Silencing of URG11 significantly inhibits the proliferation and invasion and induces apoptosis of LNCaP cells.

目的 探讨洁悠神(JUC)在腹股沟疝手术伤口的应用效果.方法 选取2012年9月～2014年7月在笔者所在科室行开放式腹股沟疝手术患者60例,采用随机数字表法将其分为观察组和对照组,每组各30例,所有患者都在术前和术后各使用一次抗生素后停用,术后第3～4d办理出院,出院后对照组每2～3d返院换药一次,观察组自行使用洁悠神喷洒伤口,通过远程监护了解患者伤口情况.比较两组术后伤口换药次数、拆线时间、愈合情况.结果 观察组伤口换药次数明显小于对照组(P＜0.01),两组患者术后伤口拆线时间、愈合情况差异无统计学意义,P均＞0.05.结论 腹股沟疝手术出院后伤口应用洁悠神能取得同常规伤口换药一样的效果,并能减少伤口换药次数,省却患者出院后返院换药的麻烦,值得临床推广应用.

Objective To explore the therapeutic effectiveness of microsurgical varicocelectomy and Qilin pill for varicocele complicated with asthenospermia,Methods Eigthy cases of varicocele with asthenospermia were randomly divided into two groups:simple surgical group (n =40),and surgical treatment and Qilin pill (combined) group (n =40).Results The microsurgical varicocelectomy was performed successfully on all patients,and the symptoms of varicocele disappeared.The semen quantity and the serum inhibin B (Inh B) were obviously improved (P ＜0.01) after operation in two groups.The semen density [(22.46 ±2.58) × 106/L] and vigour (60.43 ±3.14)％,and Inh B [(139.37 ±34.94) ng/L] were significantly increased in combined group as compared with simple surgical group [semen density (19.68 ± 2.04) × 106/L and vigour (53.42 ± 3.97) ％,Inh B (128.75 ± 6.94) ng/L,P ＜ 0.05].Pregnancy rate (77.50％) was significantly higher than in smple surgical group (55.00％,P ＜ 0.05).Conclusion Microsurgical varicocelectomy and Qilin pill therapy for varicocele could significantly improve the semen quality after operation in patients with asthenospermia.

Lipid storage myopathy is a metabolic disorder characterized by abnormal lipid accumulation in muscle fibers and progressive muscle weakness. Here, we report the case of a 17-year-old woman with progressive muscle weakness, refractory hyperlactatemia, and multiple organ insufficiency. Severe pneumonia was the initial diagnosis. After anti-infective treatment, fluid resuscitation, and mechanical ventilation, the patient's symptoms improved but hyperlactatemia and muscle weakness persisted. She was empirically treated with carnitine. Biochemical tests, electromyography, and muscle biopsy confirmed lipid storage myopathy. After 7 weeks of treatment, the patient resumed normal daily life. An empirical treatment with carnitine may be beneficial for patients before an accurate diagnosis of lipid storage myopathy is made.