不同来源精子行ICSI妊娠结局分析

目的：比较经皮附睾或睾丸穿刺抽吸术和手淫取精两种方法获得的精子行卵胞浆内单精子注射（ICSI）治疗妊娠结局。方法：回顾性分析进行ICSI治疗的30例36个周期的临床资料,对其中11例15个周期梗阻性无精子症患者行经皮附睾穿刺抽吸术（PESA）或睾丸穿刺抽吸术（TESA）为A组;19例21个周期严重少、弱、畸精子或受精障碍患者采用手淫获得精子为B组,比较两组的受精率、卵裂率、优质胚胎率、种植率和临床妊娠率。结果：两组的受精率、卵裂率、优质胚胎率、种植率和临床妊娠率分别为81.6%vs79.0%、87.9%vs96.9%、57.8%vs39.0%、15.2vs19.2%和26.7%vs33.3%,经统计学分析,两组间以上指标均无显著性（P〉0.05）。结论：两组取得相似的临床结局,经皮附睾穿刺获得的精子不影响ICSI的成功率。     

利用附睾或睾丸精子行卵胞浆内单精子注射治疗阻塞性无精子症

目的回顾性分析38例阻塞性无精子症(OA)患者利用附睾或睾丸精子行卵胞浆内单精子注射(ICSI)的治疗结局。方法OA患者通过经皮附睾精子抽吸术(PESA)或睾丸切开取精术(TESE)获得精子行ICSI,评估受精率及临床妊娠率,以精液精子行ICSI组为对照。结果OA组38例共41个治疗周期,受精率和临床妊娠率分别为73.3%和53.6%,精液精子组31例33个治疗周期受精率和临床妊娠率分别为75.1%和48.4%,两组间比较,受精率和临床妊娠率差异无统计学意义(P>0.05)。OA组共妊娠22例,已分娩13例,流产6例,继续妊娠3例;精液精子组共妊娠16例,已分娩10例,流产1例,继续妊娠5例。结论采用附睾/睾丸精子行ICSI是治疗男性阻塞性无精子症的有效方法。     

利用附睾或睾丸精子行卵胞浆内单精子注射治疗阻塞性无精子症

目的 回顾性分析38例阻塞性无精子症（OA）患者利用附睾或睾丸精子行卵胞浆内单精子注射（ICSI）的治疗结局。方法OA患者通过经皮附睾精子抽吸术（PESA）或睾丸切开取精术（TESE）获得精子行ICSI，评估受精率及临床妊娠率，以精液精子行ICSI组为对照。结果OA组38例共41个治疗周期，受精率和临床妊娠率分别为73．3％和53．6％，精液精子组31例33个治疗周期受精率和临床妊娠率分别为75．1％和48．4％，两组间比较，受精率和临床妊娠率差异无统计学意义（P〉0．05）。OA组共妊娠22例，已分娩13例，流产6例，继续妊娠3例；精液精子组共妊娠16例，已分娩10例，流产1例，继续妊娠5例。结论采用附睾／睾丸精子行ICSI是治疗男性阻塞性无精子症的有效方法。     

梗阻性无精子症患者应用附睾、睾丸精子助孕的结局比较

目的比较梗阻性无精子症患者应用附睾、睾丸精子助孕的结局差异。方法梗阻性无精子症患者54例,其中经皮附睾穿刺抽吸术取精者29例(PESA),睾丸精子抽提术取精者25例(TESE)。辅助生殖采用卵胞浆内单精子注射技术(ICSI),对其正常受精率、胚胎种植率、人绒毛膜促性腺激素(HCG)阳性率及临床妊娠率进行比较。结果不同取精组的正常受精率无统计学差异(P>0.05),而PESA组的胚胎种植率、HCG阳性率及临床妊娠率均高于TESE组(P<0.05)。结论梗阻性无精子症患者附睾、睾丸穿刺取精简单易行,创伤小,并发症少,获精率高,ICSI妊娠结局满意;附睾取精避免了睾丸损伤,且助孕结局可能优于睾丸取精。     

两种取精方式行ICSI治疗结局的比较

目的:回顾性分析经皮附睾精子抽吸术(PESA)获得的精子和射出的精子行卵浆内单精子注射(ICSI)治疗后的结局。方法:37例因梗阻性无精症或严重少弱畸精症首次要求作ICSI的夫妇,分为附睾穿刺组(9例)和射精组(28例),观察ICSI后两组受精率、优质胚胎率、妊娠率。结果:附睾穿刺组、射精组两组受精率、优质胚胎率、临床妊娠率无显著性差异。结论:经附睾取精和射精获得的精子行ICSI,其治疗结局是相似的。     

三种不同来源精子行卵胞浆内单精子注射临床结局的比较

目的：比较三种方法获得的精子行卵胞浆内单精子注射的临床结局。方法：回顾性分析笔者所在医院2011年1月-2012年12月374个卵胞浆内单精子显微注射（ICSI）治疗周期的妊娠结局,依据精子来源不同分为三组：射出精液组（A组）,经皮附睾穿刺和经皮睾丸穿刺取精子组（B组）,供精组（C组）,比较三组的受精率、卵裂率、优质胚胎率和临床妊娠率。结果：A组的优胚率高于C组（P〈0.017）,三组患者的受精率、卵裂率、临床妊娠率比较差异无统计学意义（P〉0.05）。结论：精液、附睾或睾丸精子、供精行ICSI助孕的结局相近。精子的成熟度、精子的冷冻可能并不影响最终的妊娠率。     

延时摄像系统对胚胎发育及妊娠结局的影响

目的探讨延时摄像系统(TLS)对胚胎发育及妊娠结局的影响。 方法选择2016年12月至2017年12月,在江苏省苏北人民医院生殖医学中心接受体外受精/卵母细胞胞质内单精子注射-胚胎移植(IVF/ICSI-ET)的302例不孕症患者的319个周期为研究对象,将采用TLS培养胚胎的137个周期纳入TLS组,将采用传统培养箱培养胚胎的182个周期纳入对照组。其中,TLS组采用短时体外受精(IVF)的周期数为72个,采用卵母细胞胞质内单精子注射(ICSI)受精的周期数为16个,对照组分别为101个和23个。回顾性分析2组患者的一般临床资料、受精情况及妊娠结局等。采用Wilcoxon秩和检验,对2组患者窦卵泡数和获卵数等进行比较;采用χ²检验或Fisher确切概率法,对2组患者优质胚胎率、囊胚形成率、优质囊胚率、生化妊娠率及临床妊娠率等进比较。本研究获得江苏省苏北人民医院伦理委员会审核批准(审批文号：2018KY-104)。 结果①2组患者的年龄、人体质量指数(BMI)、不孕年限、既往周期数、子宫内膜厚度、促排卵方案构成比、授精方式构成比、精子浓度、精子向前运动比例、促性腺激素(Gn)用量、基础雌二醇水平和基础促黄体激素(LH)水平等一般临床资料比较,差异均无统计学意义(P>0.05)。②TLS组患者窦卵泡数与获卵数分别为12.0个(9.5～15.0个)与10.0个(6.5～14.0个),显著高于对照组的10.0个(6.0～14.0个)和7.0个(4.0～11.3个),2组分别比较,差异均有统计学意义(Z＝－3.751、－4.618,P<0.001)。③TLS组患者优质胚胎率、囊胚形成率、优质囊胚率分别为72.6%、74.7%和45.3%,分别高于对照组的67.5%、56.7%和36.8%,2组分别比较,差异均有统计学意义(χ²＝5.411、19.660、4.192,P＝0.020、<0.001、＝0.041)。④采用短时IVF时,TLS组患者优质胚胎率、囊胚形成率分别为74.5%和68.7%,分别高于对照组的69.6%和57.0%,2组比较,差异有统计学意义(χ²＝4.145、16.966,P＝0.042、<0.001)。采用ICSI受精时,TLS组患者生化妊娠率和临床妊娠率分别为87.5%和87.5%,分别高于对照组的43.5%和43.5%,2组比较,差异均有统计学意义(χ²＝7.726、7.726,P＝0.005、0.005)。 结论采用TLS培养胚胎,可提高胚胎质量,改善受精方式为ICSI患者的妊娠结局。     

精子畸形率与体外受精率关系的分析

目的 分析精子畸形率对行体外受精-胚胎移植(IVF-ET)助孕患者受精率的影响.方法 统计2007年3月-2010年9月在我院生殖中心因畸精子症首次行Half-ICSI助孕的82个周期中IVF受精率和ICSI受精率,根据受精率分为4组:50个周期畸形率≤95％(轻度畸精子症组),22个周期畸形率≥96％(重度畸精子症组),与因精液异常进行IVF助孕的28个周期(IVF组),和因严重少精症进行ICSI助孕的56个周期(ICSI组)受精率进行比较.结果 轻度畸精子症组IVF和IC-SI受精率分别为80.8％和87.3％,与单纯IVF组和ICSI组比较,差异均无统计学意义(P＞0.05),重度畸精子症组IVF受精率为29.2％,明显低于IVF组,差异有统计学意义(P＜0.05),重度畸精子症组ICSI受精率为85.1％,与ICSI组比较差异无统计学意义(P＞0.05).结论 精子畸形率≤95％,不影响IVF受精率;畸形率≥96％,IVF受精率明显降低.男方轻度畸精子症患者可行IVF受精,重度畸精子症建议行ICSI授精.     

126例梗阻性无精子症借助ICSI治疗的临床结局分析

目的 探讨梗阻性无精子症采用不同方式获取的精子对卵胞浆内单精子注射术（ICSI）治疗的妊娠结局.方法 根据获取精子的方式不同将梗阻性无精子症患者分为两组：TESA组46例、PESA组80例,两组患者均行ICSI治疗.比较两组受精率、卵裂率、优质胚胎率、种植率及临床妊娠率等.结果 TESA组与PESA组的卵裂率分别为882%和942%,优质胚胎率分别为622%和625%,两组比较差异均无统计学意义（P〉005）.两组受精率分别为721%和776%,种植率分别为233%、348%,临床妊娠率分别431%、687%,两组比较差异均有统计学意义（P〈005）.结论 PESA或TESA结合ICSI是治疗梗阻性无精子症的有效治疗方法,附睾精子优于睾丸精子,可首选抽取附睾精子.     

隐匿精子症和无精子症卵胞浆内单精子注射的临床结局比较

目的:比较隐匿精子症和无精子症卵胞浆内单精子注射(ICSI)的临床结局.方法:选择1999 ～ 2012年在唐山市妇幼保健院生殖遗传科的156例隐匿性精子症和288例无精子症患者,无精子症患者分别通过附睾或睾丸穿刺取精后进行ICSI治疗,比较受精率、卵裂率、优胚率、生化妊娠率、临床妊娠率、流产率、出生缺陷率等.结果:三组的受精率、卵裂率差异有统计学意义(P＜0.05),优胚率、生化妊娠率、临床妊娠率、流产率、出生缺陷率差异无统计学意义(P＞0.05).结论:隐匿精子症和无精子症ICSI后虽然受精率、卵裂率不同,但临床结局相同.     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.