Drug treatment of male fertility disorders

Drug treatment remains an active domain in the therapy of male fertility disorders. Although there are only a fewconditions that allow causal treatment, rational approaches are possible in many cases. Best results are obtained in casesrequiring an anti-inflammatory treatment and in patients with an impaired sperm transport. High-dosage administrationof FSH is a promising new development, aimed particularly at improving the disturbed sperm structures. A careful di-agnostic work-up with elucidation of the underlying disease is essential to achieve a successful therapy.

Evidence-Based Therapy May Improve Outcome in Glomerulonephritis—A Prospective Field Survey

Introduction and aims: Although glomerulonephritis is rare in the general population it is the second most important cause for end-stage renal failure. The therapy of glomerulonephritis is guided by a limited number of individual clinical trials and treatment recommendations are based on meta-analysis and Cochrane Systematic Reviews. The impact of such therapy standards on the prognosis of glomerulonephritis is not known. Methods: Between October 2002 and December 2008 patients with abnormal urine findings and/or decreasing renal function of unknown cause were referred for renal biopsy. In a collaboration of out-patient nephrologists with a major teaching hospital, all patients received treatment recommendations according to evidence-based therapy guidelines based on Cochrane Systematic Reviews. Patient charts were systematically reviewed and patients were re-examined for follow-up until November 2009. Cox Regression analysis was performed to identify independent prognostic factors. Results: Two hundred patients with primary or secondary glomerulonephritis were identified. Complete follow-up data were available from 196 patients with 324 therapeutic interventions. The mean follow-up was 2.8 ± 2.0 years. Among all patients, 37% remained unchanged ill, 13% died, 17% had progressing renal disease, while 19% had a complete and 14% a partial remission. Proteinuria declined in primary glomerulonephritis (5.0 ± 5.4 g/d to 2.1 ± 3.4 g/d, p Conclusions: In a multivariate model of standardised glomerulonephritis therapy the presence of tubulointerstitial fibrosis was associated with death or progresssive renal disease, while prednisolone-based therapy regimens and intensified nephrological follow-up resulted in a significant delay of endstage-renal failure. This result should direct future health care policies because glomerulonephritis accounts for nearly 20% of the dialysis population.

Diagnosis and treatment of emergency surgeries in otorhinolaryngology, head and neck surgery during the covid-19 outbreak: A single center experience

The 2019 Novel Coronavirus(2019-nCoV,SARS-CoV-2)infection has already been assigned as a Class B infectious disease requiring Class A management strategy according to“the Law on the Prevention and Control of Infectious Diseases of the People’s Republic of China”and become a global pandemic.The incidence of emergencies in otorhinolaryngology,head and neck surgery such as foreign bodies in the esophagus and the respiratory tract,epistaxis,laryngeal obstruction with dyspnea,and head and neck trauma are relatively high.Emergency surgeries are required as some of these diseases progress rapidly and probably be life-threatening.In this article,we drafted the recommendations for diagnosis and treatment of emergency surgeries in otorhinolaryngology,head and neck surgery in the epidemic area of novel coronavirus pneumonia based on“Novel Coronavirus Pneumonia Diagnosis and Treatment Plan(Provisional;7th Edition Revisions)”and WHO guidelines,combined with the experience of emergency surgeries in the Department of Otorhinolaryngology,Wuhan Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,which is at the center outbreak area of the SARS-CoV-2 pneumonia(COVID-19)in China,to improve the success rate of treatment for otorhinolaryngology,head and neck surgery emergency surgeries and to reduce the SARS-CoV-2 infection rate in the perioperative period.

A self-supervised method for treatment recommendation in sepsis

Sepsis treatment is a highly challenging effort to reduce mortality in hospital intensive care units since the treatment response may vary for each patient.Tailored treatment recommendations are desired to assist doctors in making decisions efficiently and accurately.In this work,we apply a self-supervised method based on reinforcement learning(RL)for treatment recommendation on individuals.An uncertainty evaluation method is proposed to separate patient samples into two domains according to their responses to treatments and the state value of the chosen policy.Examples of two domains are then reconstructed with an auxiliary transfer learning task.A distillation method of privilege learning is tied to a variational auto-encoder framework for the transfer learning task between the low-and high-quality domains.Combined with the self-supervised way for better state and action representations,we propose a deep RL method called high-risk uncertainty(HRU)control to provide flexibility on the trade-off between the effectiveness and accuracy of ambiguous samples and to reduce the expected mortality.Experiments on the large-scale publicly available real-world dataset MIMIC-Ⅲdemonstrate that our model reduces the estimated mortality rate by up to 2.3%in total,and that the estimated mortality rate in the majority of cases is reduced to 9.5%.