雄性F344大鼠自发性Leydig 细胞瘤的比较医学研究

目的初步探讨雄性F344大鼠自发性Leydig细胞瘤与血清性激素含量及Leydig细胞AR、LH、ER表达之间的关系。方法26月龄雄性F344大鼠5只(L组),4、7、10、13月龄雄性F344、SD、Wistar大鼠各10只(分别记为A1、A2、A3、A4组,B1、B2、B3、B4组,C1、C2、C3、C4组)。各组睾丸组织切片HE染色,L组睾丸组织电镜观察,各组(除L组外)睾丸组织切片Leydig细胞雄激素受体、黄体生成素、雌激素受体免疫组化染色,放射免疫测定各组血清睾酮、黄体生成素、雌二醇、催乳素、卵泡刺激素、孕酮含量。结果1.A3组部分Leydig细胞轻度增生;A4组部分Leydig细胞中度增生,形成增生灶;L组5只大鼠双侧睾丸均发生Leydig细胞瘤。2.A4组Leydig细胞AR表达强于C3组、B4组和C4组(P<0.05)。A3组和A4组Leydig细胞LH表达均强于B3组、B4组、C4组(P<0.05)。A4组Leydig细胞ER表达弱于B1组、B4组、C4组(P<0.05)。3.血清睾酮含量A3组和A4组均显著高于B3、B4、C3、C4组(P<0.01);而L组极低,除了与C4组无统计学差异外,显著低于其它组(P<0.05或P<0.01)。血清LH含量A4组、L组与B4组、C4组之间无统计学差异(P≥0.05)。血清E2含量L组除了与B1、B2组无差异(P≥0.05)外,明显高于其它组(P<0.05或P<0.01)。血清PRL含量L组明显高于A4组(P<0.05),且此二组均显著高于其它组(P<0.05或P<0.01)。血清FSH含量三种品系大鼠相同月龄组之间无统计学差异(P≥0.05),A4组、B4组、C4组、L组基本相同。血清孕酮含量L组成倍高于其它组(P<0.01)。结论雄性F344大鼠Leydig细胞瘤绝大多数为良性,其应该是由Leydig细胞增生并形成增生灶到瘤变逐渐演变而成的。Leydig细胞LH、AR表达较强与大龄雄性F344大鼠Leydig细胞增生并形成增生灶有关。26月龄雄性F344大鼠Leydig细胞瘤可能与其血清T含量极低、血清E2和孕酮含量相对较高有关,而与其血清LH和FSH含量变化关系不紧密;血清PRL含量相对较高应该与其Leydig细胞增生和肿瘤发生过程有关。     

精子DNA碎片对IVF-ET结局的影响

目的:探讨精子DNA碎片化率(DFI)对体外受精结局的影响。方法:采用改良精子染色质扩散实验(SCD)对139例接受体外受精(IVF)的男方进行精子DFI检测,并根据精子DFI值将上述IVF患者分为:A组(DFI<17.6%)、B组(17.6%≤DFI≤30%)、C组(DFI>30%),根据单因素方差分析统计方法分析各组IVF受精率、卵裂率、优质胚胎率和妊娠结局的差异。结果:与A组比较,B组和C组正常形态精子率、精子前向活动力([a+b)%]、卵裂率、优质胚胎率均降低(P>0.05 vs B组,P<0.05 vs C组);与B组比较,C组正常形态精子率、精子前向活动力([a+b)%]、卵裂率、优质胚胎率均降低(P<0.05);与A组比较,B组和C组受精率均降低(P<0.05 vs B组,P<0.05 vs C组);与B组比较,C组受精率降低(P<0.05);A、B、C 3组间生化妊娠率、临床妊娠率差异无统计学意义(P>0.05)。结论:精子DNA碎片率升高不仅会导致精子前向活动力下降,还可导致IVF受精率、卵裂率、优质胚胎率下降,但对临床妊娠结局无明显影响。     

精子形态变化与生殖内分泌激素及精液参数的相关性研究

目的 通过对男性精液参数、精子正常形态率及生殖内分泌激素的测定,探讨精子形态变化与生殖内分泌激素和精液参数的关系.方法 将83例已婚男性以精子正常形态率15%为分组标准分为A、B两组,A组44例,精子正常形态率均>15%,B组39例,精子正常形态率均<15%.然后对两组志愿者行精液常规检查、生殖内分泌激素测定和精子形态学分析,计算生育力指数(FI),并作检测指标对比分析.结果 A组精子正常形态率、a级精子、精子活动力、精子活动率及FI均明显高于B组(P<0.05或0.01),而卵泡刺激素(FSH)水平则明显低于B组(P<0.05).其他指标并无明显差异(均P>0.05).所有研究对象中,已育者除精子密度明显高于未育者(P<0.05)、雄激素水平明显低于未育者(P<0.05)外,其他各检测指标均无明显差异(均P>0.05).A组已育者和未育者的a级精子、精子活动力、活动率均高于B组朱育者(P<0.05或0.01),而且FI也明显高于B组已育者和未育者(均P<0.01);A组已育者FSH水平明显低于A组未育者和B组已育者(均P<0.05).此外,相关性分析结果显示,精子活动力与精子密度、精子正常形态率呈正相关(P<0.05或0.01),与黄体生成素水平呈负相关(P<0.05);泌乳素水平与精子密度、睾丸酮水平呈正相关(均P<0.05);FSH水平与Fl呈负相关(P<0.05).结论 精子形态变化与精子运动能力的改变关系密切,并可能与FSH水平有关,FSH水平与精子正常形态率的高低有关,并且与Fl呈负相关,进一步研究其相关关系对于了解精子形态变化对男性生育能力的影响具有重要意义.     

后肢接振对雄性兔精子质量的影响

目的探讨振动对雄性新西兰兔精子质量的影响。方法将新西兰兔随机分为A组（接振强度为3．02m／s^2）、B组（接振强度为6．13m／s^2）、C组（接振强度为12．26m／s^2）和1个对照组,分别于不同接振强度测定精浆中精子的密度、活动力、活动率、畸形率。通过去透明带仓鼠卵-精子穿透试验和精子低渗膨胀试验评价精子的受精能力。结果与对照组相比较,A、B、C3个试验组精浆中精子的活动力、活动率、卵子受精率及低渗肿胀率呈显著降低,有统计学差异,精子的畸形率明显升高,有统计学差异,精子的密度无显著性差异。结论后肢接振可降低精子的活动力、活动率及卵子受精率及低渗肿胀率,增加精子的畸形率,从而影响生殖功能。     

男性年龄对精子质量和体外授精-胚胎移植治疗结局的影响

目的 探讨男性年龄对精子质量以及体外授精-胚胎移植(IVF-ET)治疗结局的影响.方法 回顾性分析该中心2010年5月至2015年12月接受IVF-ET治疗的633对夫妇的资料,按男方年龄分组:A组年龄小于30岁(187例)、B组30～34岁(248例)、C组35～39岁(156例)、D组大于或等于40岁(42例),观察男方年龄对平均精子密度、存活率、前向运动精子率、正常形态率、受精率、胚胎利用率、优质胚胎率、临床妊娠率、流产率和活产率的影响.结果 A、B、C3组间的平均精子密度无显著差异,但B组和C组均明显高于D组(P＜0.01);A、B两组平均精子活率之间无差异,但均显著高于C、D两组(P＜0.01);A组精子前向运动率高于C组(P＜0.05),A组和B组显著高于D组(P＜0.01),B组平均正常形态率与D组比较差异有统计学意义(P＜0.05).受精率、胚胎利用率、优质胚胎率、临床妊娠率、流产率和活产率4组间相比差异均无统计学意义(P＞0.05).结论 男性年龄对精子质量有负面影响,但与受精率、胚胎利用率、优质胚胎率、临床妊娠率、流产率和活产率无明显相关性.     

慢性饮酒对雄性大鼠精子顶体完整率及精子动态参数的影响

目的探讨不同剂量乙醇对大鼠精子顶体完整率及精子动态参数的影响。方法 40只健康雄性成年Sprague-Dawley大鼠随机分为4组,每组10只。对照组大鼠给予蒸馏水灌胃,乙醇低、中、高剂量组分别给予无水乙醇0.5、2.5、5.0 g·kg-1·d-1灌胃,连续20周。比较各组大鼠精子顶体完整率及精子密度、平均速率、直线运动速率、曲线运动速率、精子头侧摆幅度、鞭打频率、前向性、直线性的变化。结果乙醇低、中、高剂量组大鼠精子顶体完整率均明显低于对照组,差异有统计学意义(P<0.01);与低剂量组比较,中、高剂量组精子顶体完整率均明显降低,差异有统计学意义(P<0.01)。与对照组比较,乙醇低、中、高剂量组大鼠的精子动态参数均明显下降(P<0.05或P<0.01);与低剂量组比较,中、高剂量组大鼠精子动态参数均明显下降(P<0.01)。结论慢性饮酒可导致大鼠精子顶体完整率与精子动态参数出现不同程度异常。     

氧化型染发剂对小鼠精子畸形和骨髓细胞微核的影响

目的探讨氧化型染发剂对小鼠精子畸形和骨髓嗜多染红细胞(PCE)微核的影响。方法将40只成年健康昆明种雄性小鼠随机分为染发剂A组、染发剂B组、染发剂C组和对照组,每组10只。3个染发剂组用氧化型染发剂染毒,每隔2d经皮染毒1次,连续染毒7次,于首次染毒后35d处死小鼠,检测精子畸形率及骨髓微核率。结果各染发剂组精子畸形率均高于对照组(P<0.008);各染发剂组小鼠精子畸形率比较差别均无统计学意义(P>0.008)。染发剂A组小鼠骨髓PCE细胞微核率变化与对照组比较差别无统计学意义(P>0.008);染发剂B组和染发剂C组小鼠骨髓PCE细胞微核率均高于对照组,差别有统计学意义(P<0.008);染发剂B组和染发剂C组骨髓细胞微核率高于染发剂A组,差别有统计学意义(P<0.008);染发剂B组与染发剂C组骨髓细胞微核率比较差别无统计学意义(P>0.008)。结论氧化型染发剂可导致小鼠精子畸形和骨髓微核率的升高,对使用者的健康存在潜在危害。     

精子核成熟度在诊断男性不育中的意义

目的 探讨精子核成熟度在男性不育中的价值.方法 40例精液标本,其中生育组20例,不育组20例.应用精子质量自动检测系统(CASA)检测精子活力及密度,用苯胺蓝染色法评价精子核成熟度,人工显微镜下分析精子形态.结果 不育组苯胺蓝染色阳性率明显高于生育组.形态异常的精子组中头部、体部、尾部、混合型畸形的精子苯胺蓝染色阳性率明显高于形态正常精子,活动力差的精子标本其苯胺蓝染色阳性率明显高于活动力正常精子.结论 苯胺蓝染色法可以检测精子核成熟度,在诊断由于精子核蛋白转型障碍引起的男性不育症中有一定的临床意义.     

电针治疗对睾丸功能损害雄性大鼠精子数量和质量的影响

【目的】探讨电针治疗对睾丸功能损害雄性大鼠精子数量和质量的影响。【方法】SD雄性大鼠34只,除正常组10只外,其他大鼠采用腺嘌呤灌胃复制睾丸功能损害模型,存活大鼠随机分为电针组(N=8)和模型组(N=8);电针组针刺关元、肾俞及三阴交穴。采用计算机辅助精子质量分析(CASA)系统对大鼠精液进行分析。精子质量测定指标包括精子密度、精子活率及前向运动精子百分率。【结果】与正常组比较,模型大鼠精子密度、精子活率及前向运动精子百分率均显著降低(P<0.01);电针组与模型组比较,各指标均显著升高(P<0.05)。【结论】电针关元、肾俞及三阴交穴可以改善腺嘌呤所致睾丸功能损害大鼠的精液质量。     

精子形态联合精子核DNA在试管婴儿周期治疗中的预测价值

目的:探讨精子形态联合精子DNA碎片率(DFI)对体外受精-胚胎移植临床结局的影响。方法:选取2020年1月－2021年8月在江西省九江市妇幼保健院生殖中心实施IVF-ET治疗的231例IVF新鲜治疗周期,取卵当日对精液标本进行精子形态及DNA完整性检测。依据精子形态分为正常组164例及畸形精子组67例,纳入精子DFI后分为A组(MNS≥4%且DFI<30%)、B组(MNS≥4%且DFI≥30%)、C组(MNS<4%且DFI<30%)和D组(MNS<4%且DFI≥30%),对比各组间受精率、2PN卵裂率、优胚率、临床妊娠率、早期流产率的差异;比较DFI与男方年龄、精液参数间的相关性。结果:正常形态组总受精率、2PN受精率显著高于畸形精子组(P<0.001),2PN卵裂率、优胚率、临床妊娠率、早期流产率在不同形态组间比较,差异均无统计学意义(均P>0.05);纳入精子DFI后,C、D两组的总受精率、2PN受精率显著低于A、B两组,D组2PN卵裂率显著低于A、C两组,B组、D组优质胚胎率显著低于A组、C组,B组临床妊娠率明显低于A组(P<0.0083);DFI与年龄及其他精液参数的相关性分析中,DFI与男性年龄呈显著正相关,与前向运动精子率呈显著负相关(P=0.002,0.001)。结论:精子核DNA联合精子形态评估能为IVF-ET的治疗结局带来更为高效准确的预测价值,值得在临床上推广应用;同时在IVF-ET的治疗中,也要关切男方年龄,避免高龄带来的诸多不利影响。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.