Clinical efficacy of treatments against non-obstructive azoospermia (NOA), which affects 1% of men, are currently limited by the incomplete understanding of NOA pathogenesis and normal spermatogenic microenvironment. Here, we profile >80,000 human testicular single-cell transcriptomes from 10 healthy donors spanning the range from infant to adult and 7 NOA patients. We show that Sertoli cells, which form the scaffold in the testicular microenvironment, are severely damaged in NOA patients and identify the roadmap of Sertoli cell maturation. Notably, Sertoli cells of patients with congenital causes (Klinefelter syndrome and Y chromosome microdeletions) are mature, but exhibit abnormal immune responses, while the cells in idiopathic NOA (iNOA) are physiologically immature. Furthermore, we find that inhibition of Wnt signaling promotes the maturation of Sertoli cells from iNOA patients, allowing these cells to regain their ability to support germ cell survival. We provide a novel perspective on the development of diagnostic methods and therapeutic targets for NOA.

Objective. To explore the status of electroacupuncture (EA) among other treatments for peripheral facial paralysis (PFP). Methods. Randomized controlled trials comparing EA with other treatments that met the eligibility criteria published in databases were included. The differences were observed and quantified through the risk ratio (RR) for dichotomous outcomes and the standardized mean difference (SMD) for continuous outcomes. Then, their 95% confidence intervals (CI) were recorded. Results. Twenty-three studies involving 1985 participants were included. META-analysis results showed that EA was better than manual acupuncture for PFP (RR: 1.16, 95% CI 1.11 to 1.22, for responding rate; SMD: 2.26, 95% CI 0.15 to 4.37, for facial nerve function) and current promoted recovery (RR: 1.21, 95% CI 1.15 to 1.27, for responding rate; SMD: 2.87, 95% CI 1.16 to 4.58, for facial nerve function). When combined with other treatments, EA improved their effectiveness (RR: 1.19, 95% CI 1.12 to 1.28, responding rate; SMD: 1.85, 95% CI 0.67 to 3.03, facial nerve function). Conclusion. Patients with PFP received EA (used separately or combined with other treatments) resulting in a better prognosis. However, the quality of evidence was very low-to-moderate. Considering the poor quality of evidence, we are not very confident in the results. We look forward to more research and update results in the future and improve the evidence quality.

Background: To evaluate the clinical outcomes and the duration required for the sperm to return to the ejaculate after a modified single-armed 2-suture longitudinal intussusception vasoepididymostomy (SA-LIVE). Methods: From March 2015 to December 2018, 134 patients with epididymal obstruction azoospermia underwent the modified single-armed vasoepididymostomy at Shanghai General Hospital. The outcomes and clinical findings were documented and evaluated. The mean follow-up period was 17 (range: 3-36) months. Results: Patency was assessed by the return of sperm in the ejaculate. The overall patency rate was 55.2%, and the patency rates were 58.9, 40.7, 36.4, and 58.9% for bilateral surgery, unilateral surgery, proximal anastomosis, and distal anastomosis, respectively. The average time to achieve patency was 4.11 ± 2.74 months. In the first 6 months, 87.8% (65/74) patency patients reported sperm in the ejaculate. The overall pregnancy rate was 40.9% (29/66) at the follow-up of 3-36 months, and the natural pregnancy rate was 30.3% (20/66). The natural pregnancy rate was 32.1% post-bilateral surgery and 33.3% for the site of distal anastomosis; surprisingly, it was 0% for the site of proximal anastomosis. Conclusion: Modified SA-LIVE is safe and may achieve favorable patency and pregnancy rates. When double-armed sutures are not accessible, single-armed may be preferable. The expected patency time was within 1 year. Moreover, because of the low natural pregnancy rate for proximal anastomosis, sperm banking is preferred to SA-LIVE.