Intracytoplasmic sperm injection in obstructive and non-obstructive azoospermia

We compared the results of intracytoplasmic sperm injection (ICSI) in: (i) obstructive versus non-obstructive azoospermia, (ii) obstructive azoospermia using epididymal versus testicular spermatozoa and (iii) acquired versus congenital obstructive azoospermia due to congenital absence of the vas deferens (CAVD). A retrospective analysis was done of 241 consecutive ICSI cycles done in 103 patients with non- obstructive azoospermia and 119 patients with obstructive azoospermia. In the obstructive group, 135 ICSI cycles were performed. Epididymal spermatozoa were used in 44 cycles and testicular spermatozoa in 91 cycles. In the non-obstructive group, 106 cycles were performed. The fertilization and pregnancy per cycle rates were 59.5 and 27.3% respectively using epididymal spermatozoa, 54.4 and 31.9% respectively using testicular spermatozoa in obstructive cases, and 39 and 11.3% respectively in non-obstructive cases. The fertilization and pregnancy per cycle rates were 56.6 and 37% respectively in acquired obstructive cases, and 55.2 and 20.4% respectively in CAVD. In conclusion, ICSI using spermatozoa from patients with acquired obstructive azoospermia resulted in significantly higher fertilization and pregnancy rates as compared to CAVD and non-obstructive cases.      

Prevalence and association analysis of obstructive sleep apnea with gender and age differences – Results of SHIP‐Trend

Identification of obstructive sleep apnea and risk factors is important for reduction in symptoms and cardiovascular risk, and for improvement of quality of life. The population‐based Study of Health in Pomerania investigated risk factors and clinical diseases in a general population of northeast Germany. Additional polysomnography was applied to measure sleep and respiration with the objective of assessing prevalence and risk factors of obstructive sleep apnea in a German cohort. One‐thousand, two‐hundred and eight people between 20 and 81 years old (54% men, median age 54 years) underwent overnight polysomnography. The estimated obstructive sleep apnea prevalence was 46% (59% men, 33% women) for an apnea–hypopnea index ≥5%, and 21% (30% men, 13% women) for an apnea–hypopnea index ≥ 15. The estimated obstructive sleep apnea syndrome prevalence (apnea–hypopnea index ≥5; Epworth Sleepiness Scale >10) was 6%. The prevalence of obstructive sleep apnea continuously increased with age for men and women with, however, later onset for women. Gender, age, body mass index, waist‐to‐hip ratio, snoring, alcohol consumption (for women only) and self‐reported cardiovascular diseases were significantly positively associated with obstructive sleep apnea, whereas daytime sleepiness was not. Diabetes, hypertension and metabolic syndrome were positively associated with severe obstructive sleep apnea. The associations became non‐significant after adjustment for body mass. Women exhibited stronger associations than men. The prevalence of obstructive sleep apnea was high, with almost half the population presenting some kind of obstructive sleep apnea. The continuous increase of obstructive sleep apnea with age challenges the current theory that mortality due to obstructive sleep apnea and cardiovascular co‐morbidities affect obstructive sleep apnea prevalence at an advanced age. Also, gender differences regarding obstructive sleep apnea and associations are significant for recognizing obstructive sleep apnea mechanisms and therapy responsiveness.     

Reduced evoked motor and sensory potential amplitudes in obstructive sleep apnea patients

It is unknown to what extent chronic intermittent hypoxaemia in obstructive sleep apnea causes damage to the motor and sensory peripheral nerves. It was hypothesized that patients with obstructive sleep apnea would have bilaterally significantly impaired amplitudes of both motor and sensory peripheral nerve‐evoked potentials of both lower and upper limbs. An observational study was conducted on 43 patients with obstructive sleep apnea confirmed by the whole‐night polysomnography, and 40 controls to assess the relationship between obstructive sleep apnea and peripheral neuropathy. All obstructive sleep apnea subjects underwent standardized electroneurographic testing, with full assessment of amplitudes of evoked compound muscle action potentials, sensory neural action potentials, motor and sensory nerve conduction velocities, and distal motor and sensory latencies of the median, ulnar, peroneal and sural nerves, bilaterally. All nerve measurements were compared with reference values, as well as between the untreated patients with obstructive sleep apnea and control subjects. Averaged compound muscle action potential and sensory nerve action potential amplitudes were significantly reduced in the nerves of both upper and lower limbs in patients with obstructive sleep apnea compared with controls (P < 0.001). These results confirmed that patients with obstructive sleep apnea had significantly lower amplitudes of evoked action potentials of both motor and sensory peripheral nerves. Clinical/subclinical axonal damage exists in patients with obstructive sleep apnea to a greater extent than previously thought.     

Heart rate variability changes in patients with obstructive sleep apnea: A systematic review and meta-analysis

Obstructive sleep apnea is a common sleep breathing disorder related to autonomic nervous function disturbances. Heart rate variability is an important non-invasive indicator of autonomic nervous system function. The PubMed, Embase, Medline and Web of Science databases were systematically searched for English literature comparing patients with obstructive sleep apnea with controls up to May 2021. Heart rate variability outcomes, including integrated indices (parasympathetic function and total variability), time domain indices (the standard deviation of NN intervals and the root mean square of the successive differences between normal heartbeats) and frequency domain indices (high-frequency, low-frequency, very-low-frequency and the ratio of low-frequency to high-frequency) were derived from the studies. Twenty-two studies that included 2565 patients with obstructive sleep apnea and 1089 healthy controls were included. Compared with controls, patients with obstructive sleep apnea exhibited significantly reduced parasympathetic function. For the obstructive sleep apnea severity subgroup meta-analysis, patients with severe obstructive sleep apnea had significantly lower parasympathetic function, high-frequency, root mean square of the successive differences between normal heartbeats and standard deviation of NN intervals, and higher low-frequency and ratios of low-frequency to high-frequency. However, only the ratio of low-frequency to high-frequency was significantly higher in patients with moderate obstructive sleep apnea than in controls. Finally, for the collection time analysis, patients with obstructive sleep apnea had significantly higher low-frequency and ratio of low-frequency to high-frequency at night, significantly lower parasympathetic function, high-frequency, root mean square of the successive differences between normal heartbeats and standard deviation of NN intervals, and a higher ratio of low-frequency to high-frequency during the day than controls. Autonomic function impairment was more serious in patients with severe obstructive sleep apnea. During sleep, low-frequency can well reflect the impairment of autonomic function in obstructive sleep apnea, and the ratio of low-frequency to high-frequency may play an important role in obstructive sleep apnea diagnosis.     

基于Amira的OSAS动物模型阻塞形态可视化研究

上气道组织结构异常诱发的气道狭窄,是OSAS病人发生阻塞件呼吸暂停的病理学基础.通过动物实验.建立猪的OSAS模型.结合数字图像处理技术以及三维重建方法.从形态学上观测OSAS动物模型上气道阻塞部位及其形态.结果发现,模型猪在出现常见的OSAS表现30天之后.在其上气道鼻腔部位观测到明显的阻塞形态.表明建立的OSAS动物模型不仪可行,而且有效,能为OSAS力学仿真模型的建立以及OSAS疾病的临床诊治提供可靠基础.     

Immediate and late bronchial obstructive reactions to inhalation of house dust and protective effects of disodium cromoglycate and prednisolone

The immediate and late obstructive reactions after house dust inhalation were studied in 10 patients with reversible obstructive lung disease. The immediate obstructive reactions were of the conventional type. The late obstructive reactions occurred 4 to 8 hours after the allergen challenge and in this respect followed the time table of the Arthus reaction but were otherwise clearly distinct from the conventional Arthus reaction: marked bronchial obstruction, no crepitations, no fever, and no leukocytosis. Disodium cromoglycate showed an evident protective effect on the immediate reactions in contrast to prednisolone, which produced no protection in this type of reaction. There was a marked inhibitory effect on the late obstructive reaction with prednisolone and with disodium cromoglycate.     

Night‐to‐night variability of obstructive sleep apnea

One night of a sleep study is the standard for diagnosis and exclusion of obstructive sleep apnea. Single testing requires high sensitivity of the test method and a stable disease of interest to warrant a low rate of false‐negative tests. Obstructive sleep apnea is diagnosed and graded by conventional thresholds of apneas and hypopneas per hour of sleep, and treatment is usually initiated in the presence of symptoms. The aim of this study was to assess night‐to‐night variability of obstructive sleep apnea to reassess the current practice. Seventy‐seven patients previously diagnosed with obstructive sleep apnea, randomised to continuous positive airway pressure withdrawal within four trials, performed nightly pulse‐oximetry over 2 weeks while off continuous positive airway pressure. The main outcome of interest was the coefficient of variation of the oxygen desaturation index marking night‐to‐night variability in obstructive sleep apnea. Obstructive sleep apnea was categorised according to conventional thresholds using oxygen desaturation index (no obstructive sleep apnea: <5 per h; mild: 5–15 per h; moderate: 15–30 per h; and severe: >30 per h). High night‐to‐night variability of obstructive sleep apnea was evidenced by a coefficient of variation of oxygen desaturation index of 31.1% (SD 16.5). Differences in oxygen desaturation index of >10 per h between nights were found in 84.4% and shifts in obstructive sleep apnea severity category in 77.9% of patients. The probability of missing moderate obstructive sleep apnea was up to 60%. Variability was higher in less severe obstructive sleep apnea. Obstructive sleep apnea shows a considerable night‐to‐night variability. Single‐night diagnostic sleep studies are prone to miscategorise obstructive sleep apnea if arbitrary thresholds are used. Thus, treatment decisions should be based less on the conventional derivatives from sleep studies, especially in patients with less severe obstructive sleep apnea. Clinical trial registration: www.controlled-trials.com (ISRCTN 93153804, ISRCTN 73047833) and www.clinicaltrials.gov (NCT01332175 & NCT02050425).     

经皮附睾或睾丸抽吸取精结合ICSI治疗无精子症

目的评价经皮附睾精子抽吸术（percutaneus epididymal sperm aspiration,PESA）或睾丸精子抽吸术（testicu1ar sperm aspiration,TESA）结合卵胞浆内单精子注射（intracytoplasmic sperm injection,ICSI）治疗无精子症的临床效果。方法对290例因男性梗阻性及非梗阻性无精子症（non-obstructive azoospermia,NOA）采用PESA或TESA穿刺获取精子,女方采用长方案超排卵,然后对处于细胞分裂中期的成熟卵母细胞进行单精予注射。结果梗阻性无精子症组203例,受精率77．5％,临床妊娠率46．1％;非梗阻性无精子症组87例,受精率73．O％,临床妊娠率41．4％,两组比较其受精率及临床妊娠率均无显著性差异（P〉0．05）。结论采用PESA或TESA获取精子结合ICSI是治疗梗阻性及非梗阻性无精子症等严重的男性不育症的一种有效的方法。     

下颌前移矫治器治疗阻塞性睡眠呼吸暂停对颏舌肌线粒体超微结构的影响北大核心

背景:目前阻塞性睡眠呼吸暂停的常用治疗方法为下颌前移矫治器,学者对颏舌肌功能异常可以引发阻塞性睡眠呼吸暂停发病已经达成共识,但对于引起颏舌肌损伤和功能障碍的机制以及相关治疗方法对颏舌肌的影响关注不足。目的:探讨下颌前移矫治器治疗阻塞性睡眠呼吸暂停对颏舌肌线粒体超微结构的保护作用,分析阻塞性睡眠呼吸暂停致颏舌肌结构功能紊乱是否与氧化应激有关。方法:将30只兔随机分为对照组、阻塞性睡眠呼吸暂停组和下颌前移矫治器组,后两组构建阻塞性睡眠呼吸暂停模型,下颌前移矫治器组佩戴下颌前移矫治器。建模成功后诱导3组兔仰卧位睡眠。CT扫描观察上气道结构变化,多导睡眠图监测血氧饱和度和呼吸睡眠指标变化。8周后制备颏舌肌透射电镜标本,观察其组织超微结构;用硫代巴比妥酸法测颏舌肌组织内丙二醛水平,酶联免疫吸附测定法测血浆及颏舌肌组织内8-异前列腺素水平;严格按照试剂盒说明书检测谷胱甘肽水平及过氧化氢酶、总超氧化物歧化酶、铜锌超氧化物歧化酶、锰超氧化物歧化酶和琥珀酸脱氢酶活性。结果与结论:(1)对照组线粒体形态结构正常,阻塞性睡眠呼吸暂停组严重破坏;下颌前移矫治器组较阻塞性睡眠呼吸暂停组明显减轻,接近对照组;(2)阻塞性睡眠呼吸暂停组8-异前列腺素水平明显高于对照组(P<0.05),丙二醛水平明显高于其余两组(P<0.05),总超氧化物歧化酶、铜锌超氧化物歧化酶和锰超氧化物歧化酶活性均低于其余两组(P<0.05);谷胱甘肽水平、过氧化氢酶和琥珀酸脱氢酶活性均明显低于对照组(P<0.05);(3)以上指标下颌前移矫治器组与对照组相比差异无显著性意义(P>0.05);(4)提示阻塞性睡眠呼吸暂停所致的颏舌肌线粒体结构损伤与氧化应激有关,下颌前移矫治器可预防或缓解阻塞性睡眠呼吸暂停所致颏舌肌线粒体结构的损伤。     

Obstructive sleep apnea and risk of Parkinson's disease: a population‐based cohort study

Sleep disorders could be associated with neurodegenerative diseases. This study aimed to determine the risk of Parkinson's disease in patients with obstructive sleep apnea. The incident cases of newly diagnosed obstructive sleep apnea were identified between 2000 and 2009 from the medical claims database of National Health Institute of Taiwan. The risk of Parkinson's disease onset at least 1 year after the diagnosis of obstructive sleep apnea was measured during and up to 11 years of period, compared to that of age‐ and gender‐matched controls estimated in the same period. A total of 5864 patients with newly diagnosed obstructive sleep apnea and 23 269 subjects without obstructive sleep apnea were identified for data analysis. The study reported that the incidence of Parkinson's disease in the obstructive sleep apnea cohort was approximately two times higher than that in the control cohort (2.57 versus 1.32 per 1000 person‐years), with an adjusted hazard ratio of 1.84. Furthermore, the risk of Parkinson's disease was particularly greater for the obstructive sleep apnea with insomnia subgroup (adjusted hazard ratio = 1.97, 95% confidence interval = 1.44–2.69) than for the control cohort. The sex–age‐specific analysis further discovered that the most elevated risk of Parkinson's disease onset was noted in female obstructive sleep apnea patients aged 50–69 years (adjusted hazard ratio = 2.82). This population‐based study indicated that patients with obstructive sleep apnea, especially those who suffered from insomnia, are at an increased risk of Parkinson's disease onset.