Spermatogenic failure is a severe disease in male infertility, with high clinical incidence, and seriously affects the reproductive health and population security. However, due to its significant clinical heterogeneity and genetic heterogeneity, there is still no unified and standardized clinical treatment strategy currently. Our team has innovatively classified spermatogenic failure into 3 subtypes: "focal type", "arrested type" and "exhausted type". The "arrested type" spermatogenic failure is mainly caused by genetic factors such as chromosomal abnormalities, copy number variations, and single nucleotide mutations. In this paper, we review the phenotype and genetic etiology of "arrested type" spermatogenic failure, then screen the type of patients with the aid of whole-exome sequencing and other technologies, and provide frontier treatment options such as endocrine neoadjuvant therapy and targeted therapy for endocrine neoadjuvant therapy. What's more, we discuss the establishment of a multifaceted and precise diagnosis and treatment system combined with artificial intelligence.

Objective To investigate the occurrence and outcomes of immune-related adverse events (irAEs) in the clinical application of programmed cell death protein 1 (PD-1) inhibitors. Methods A retrospective cohort studies was performed on 456 patients with malignant tumors treated with PD-1 inhibitors from March 2020 to November 2022, and the types, grades and prognosis of adverse skin reactions were observed. Results In the cohort, 101 patients experienced irAEs. There were 71 (70.29%) patients having reactive cutaneous capillary endothelial proliferation (RCCEP), including 15 cases of grade 2 and 56 cases of grade 1, most of whom did not receive special treatment and a small number of whom had hemangioma regression after apatinib treatment; 22 (21.7%) patients developing itchy skin, including 4 cases of grade 2 and 18 cases of grade 1, with the symptoms disappearing within 1 week after topical glucocorticoid and oral antihistamine treatment; 15 (14.8%) patients experiencing maculopapular rash, including 9 cases of grade 1 and 6 cases of grade 2 of skin adverse reactions, which were greatly improved after symptomatic treatment with emollients, topical glucocorticoids and oral antihistamines; 4 (3.9%) cases of vitiligo-like depigmentation, including 1 case of grade 2 and 3 cases of grade 1, all of which did not receive special treatment; 1 case of toxic epidermal necrolysis (TEN), and the skin lesions were improved after ICU supportive therapy and hormonal antibiotic administration; and 1 case of psoriasis at grade 3 skin reaction, and the lesions were improved after intravenous glucocorticoid drugs. Conclusion Among the irAEs events after PD-1 inhibitor treatment, the adverse skin reactions are mainly grade 1~3, and grade 4 or above are rare. After symptomatic treatment of irAEs, most symptoms can be relieved. Early identification and full management of skin adverse events can prevent the deterioration of lesions, and irAEs are generally safe and controllable.

Objective To investigate the diagnostic value of fecal calprotein (FCP) combined with C-reactive protein (CRP) in severe Clostridium difficile infection (CDI) in order to provide a reference for improving the diagnostic strategy of severe CDI. Methods A case-control trial was conducted on 73 patients diagnosed with CDI and treated in our hospital from January 2020 to December 2022. They were divided into mild-moderate CDI group and severe CDI group. Demographic information and severity-related factors were selected as variables, univariate and multivariate logistic regression analyses were employed to analyze the risk factors for severe CDI, and receiver operating characteristic (ROC) curve was plotted to determine diagnostic values of CRP and FCP. Results Comparison of clinical data between the 2 groups showed that more patients having fever (P=0.028), higher serum CRP (P < 0.001) and FCP levels (P < 0.001) were observed in the severe CDI group. Multifactorial analysis indicated that both serum CRP level (P=0.005, OR=1.028, 95%CI: 1.008-1.049) and FCP level (P < 0.001, OR=1.023, 95%CI: 1.010-1.036) were independent risk factors for severe CDI. ROC curve analysis revealed that both serum CRP level (AUC: 0.753, 95%CI: 0.626-0.880) and FCP level (AUC: 0.794, 95%CI: 0.671-0.917) had a moderate predictive value for severe CDI, and their combination had a high predictive value for severe CDI (AUC: 0.923, 95%CI: 0.865-0.982). Conclusion FCP is an independent risk factor for severe CDI, and FCP combined with CRP shows more accurate diagnosis for severity of CDI, which provides a basis for choosing an appropriate antibiotic regimen.

Male reproductive damage is a major health challenge China and the world are facing. Environmental factors are one of the most important causes of male reproductive damage. Identifying these environmental factors, elucidating their damage mechanisms and developing targeted prevention and control strategies are of great significances in maintenance of male reproductive health and improvement of national population security. In this article, we summarize the recent progress on male reproductive damage caused by environmental factors. In male-reproductive toxicity, physical, chemical and biological factors, including electromagnetic radiation, emerging environmental contaminants and corona virus disease 2019 (COVID-19) etc., have been recently recognized. On the other hand, ferroptosis, circadian rhythm & circadian clock, epigenetics & chromatin characteristics, as well as microbiota have been noticed to play important roles in the mechanism of the damage caused by environmental factors. In the future, we should focus on the new challenges of environmental changes, make full use of the advances in basic research and interdisciplinary integration, profoundly explore the key issues such as combinative exposure, and promote the transformation of research results into health prevention and control practices by combining population and laboratory research.