白细胞精子症与宫腔内人工授精周期临床妊娠率的关系

目的:探讨白细胞精子症对行宫腔内人工授精(intrauterine insemination,IUI)后周期临床妊娠率的影响。方法:分析在本中心行IUI男性患者的精液检查结果,根据WHO推荐方法对185例男性患者的精液质量进行分析,采用联苯胺染色法检测精液白细胞浓度,并将患者分为白细胞精子症不育患者组(白细胞浓度1×10~6/m L,n=33)和精液白细胞正常不育患者组(白细胞浓度≤1×10~6/m L,n=152)。比较两组间的精液量、精子浓度、精子正常形态率、处理前后前向运动精子总数、精子DNA碎片指数、周期临床妊娠率等方面的差异。结果:白细胞精子症不育组行IUI共47个周期,白细胞正常不育组行IUI共279个周期。两组间精液量、精子浓度、处理前后前向运动精子总数无显著性差异(P0.05)。在精子正常形态率方面,白细胞精子症患者不育组低于白细胞正常不育患者组,有统计学意义(P0.05)。精子DNA碎片指数方面,白细胞精子症患者不育组临床妊娠率高于白细胞正常不育患者组,有统计学意义(P0.05)。但是,在临床妊娠率数据中,我们发现白细胞精子症患者不育组与白细胞正常不育患者组无显著差异(P0.05)。结论:虽然白细胞精子症会影响精子的正常形态、精子存活率以及DNA碎片指数,但是白细胞精子症不影响IUI临床妊娠率。     

不同来源精子行卵胞浆内单精子注射临床结局分析

目的:比较不同来源精子行卵胞浆内单精子注射的临床结局。方法:回顾性的分析2008年1月～2011年12月在我中心行ICSI助孕的患者,选取不孕原因为单纯性严重少、弱、畸精症和无精症的,且年龄在35岁或35岁以下的153例患者入组本研究,共完成165个取卵周期,146个移植周期。按精子来源分为两组:射出精子组(严重少、弱、畸精症组)和睾丸精子组,比较两组间的女方平均年龄、不孕年限、基础FSH值、Gn支数、Gn天数、HCG日E2值、内膜厚度、MII卵数、受精、卵裂、可移植胚胎、优质胚胎、临床妊娠及流产情况。结果:两组间的女方平均年龄、不孕年限、基础FSH值、Gn支数、Gn天数、HCG日E2值、子宫内膜厚度、MII卵数、2PN卵裂率、可移植胚胎率、优质胚胎率、流产率、多胎率无统计学差异;睾丸精子组的受精率、2PN受精率较射出精子组高(72.3%vs 82.0%,P<0.01;67.9%vs72.9%,P<0.05),差异均有统计学意义;虽然睾丸精子组的临床妊娠率、种植率(60.7%、42.0%)高于射出精子组(50.0%、35.6%),但是两组间的差异无统计学意义(P>0.05)。结论:睾丸精子行ICSI助孕可以得到较好的临床结局,不比严重少、弱、畸精子症患者精液中的精子差。     

少精子症患者Y染色体微缺失与否与单精子卵细胞胞浆内注射的相关性

目的:观察探讨Y染色体微缺失少精子症患者对单精子卵细胞胞浆内注射治疗结果的影响。方法:选取我院2013年1月至2016年4月接受卵细胞胞浆内单精子注射辅助治疗的23例确诊为Y染色体微缺失特发性少精症不育患者,及同期在我院接受单精子卵细胞胞浆内注射辅助治疗的无Y染色体微缺失的100例少精子不育患者,分为缺失组及无缺失组。比较接受辅助治疗的两组不育患者在男方精液参数、女方年龄、获卵数、受精率、卵裂率,早晚期流产率等指标数值上差异,分析少精子症不育患者Y染色体微缺失对单精子卵细胞胞浆内注射辅助治疗结果的相关性。结果:缺失组患者在女性年龄,不育年限、获卵数上与无缺失组无统计学差异(P0.05)。缺失组患者在正常形态精子数量,精子浓度,子宫内膜厚度上与无缺失组具有统计学差异(P0.05)。缺失组患者在卵裂率,可移植胚胎率上与无缺失组无统计学差异(P0.05)。缺失组患者在受精率,优质胚胎率均低于无缺失组,且早期流产率,晚期流产率显著高于无缺失组(P0.05)。结论:Y染色体微缺失的少精子症不育患者在单精子卵细胞胞浆内注射治疗结局中,受精率、胚胎质量明显降低,流产率略微提高,故Y染色体微缺失会影响单精子卵细胞胞浆内注射治疗结果。男性患者面临不育问题时选择胚胎植入治疗时是否选择遗传学诊断,应在遗传咨询后尊重患者意愿。     

70例无精子症生精细胞检出与病因分析

目的:根据精液中生精细胞的有无、形态和比例,进行精象分析,作为评价睾丸功能和鉴别阻塞性和非阻塞性无精子症的有效方法.方法:用精液涂片,瑞-吉氏染色,油镜下分类和分型,并以睾丸活检病理所见对照.结果:697例不育者中发现70例无精子,检出率为10.04%,有生精细胞者42例(60%),95.2%有精母细胞和精子细胞;无生精细胞者28例(40%),两者的睾丸大小显著不同.病因以服用过棉籽油占30.00%;原因不明占22.86%;腮腺炎史占12.86%;输精管因素占10.00%.精液细胞学检查与睾丸活检病理诊断基本一致.结论:精液细胞学检查是一种无创伤性、无后遗症、无痛苦和操作简便,适用于基层判断睾丸功能和区别病因的有效的方法,值得推广.     

成年男性睾丸微石症的生精功能分析

目的探究睾丸微石症(testicular microlithiasis,TM)对成年男性精子质量的影响。方法回顾性分析2013年1月至2017年6月于淄博市中心医院门诊健康体检时发现的90例睾丸微石症患者为研究对象,按照超声检查的结果将其分为经典型睾丸微石症组(classic testicular microlithiasis,CTM组)50例和限制型睾丸微石症组(limited testicular microlithiasis,LTM组)40例;同时,随机选取同期常规健康查体的50例非睾丸微石症成年男性作为对照组。采集三组成员的精液,观察其精液质量的差异。结果三组成员睾丸阻力指数差异无统计学意义(P>0.05)。CTM组、LTM组和对照组睾丸动脉收缩峰值血流速度(peak of systolic velocity,PSV)差异具有统计学意义(P<0.05)。三组成员精子体积和畸形率差异无统计学意义(P>0.05)。与对照组成员比较,CTM组与LTM组成员精子质量总体下降。此外,CTM组与LTM组成员在精子密度、精子活力、PR、NP、IM等方面差异均具有统计学意义(均P<0.05)。结论睾丸微石症可以影响成年男性精子质量,CTM组精子质量明显低于LTM组。     

睾丸微石症与成年男性精子质量的相关性研究

目的:研究睾丸微石症与成年男性精子质量的相关性,以期为临床提供一定的参考数据。方法:回顾性分析2011年1月至2014年1月间入院诊治的睾丸微石症患者50例(TM组),将其分为限制型睾丸微石症(LTM组,25例)和经典型睾丸微石症(CTM组,25例),同时选取同期入院体检的正常男子50例作为对照组。采集三组男性的精液,观察其精液质量的差异。结果:三组男性双侧睾丸在阻力指数的比较中无显著差异;CTM组PSV右侧为(6.17±0.44)cm/s、左侧为(6.25±1.20)cm/s,与LTM组及对照组相比,差异显著(P0.05)。三组男性精液量与畸形精子百分率无显著差异,但与对照组相比,TM组整体精子质量下降;但CTM组精子计数仅为(12.80±1.77)×106/m L、精子活力(11.68±3.69)%,与LTM组及对照组相比,差异显著(P0.05)。结论:睾丸微石症患者精子质量较之正常成年男性的低,并且经典型睾丸微石症患者精子质量下降严重。     

男性精子DNA碎片指数与精液常规参数的相关性研究

目的考察精子DNA碎片指数(DFI)与精液常规参数的相关性,评价其在男性精子质量评估中的临床意义。方法选取2020年1月至9月南京大学医学院附属鼓楼医院生殖医学中心和男科门诊治的4 943例男性患者作为研究对象。共收集4 943例男性精液标本,采用精子染色质结构分析法(SCSA)进行精子DFI和高DNA着色性(HDS)检测。根据DFI值将样品分为DFI≤15%组、15%DFI30%组和DFI≥30%组;根据HDS值将样品分为HDS≤15%组和HDS15%组,分别分析DFI、HDS与精液参数的关系。根据精液参数的参考值将其分为正常组和精液异常性疾病组。异常组再根据精子浓度、前向运动精子百分率(PR)、正常形态精子百分率分为少精子症组、弱精子症组、畸形精子症组、少弱精子症组、少畸精子症组、弱畸精子症组和少弱畸精子症组,比较精液异常性疾病组与正常组精子DFI、HDS的差异。结果 DFI≤15%组、15%DFI30%组和DFI≥30%组的年龄、精子浓度、PR、正常形态精子百分率、畸形精子指数(TZI)、HDS组间比较,差异具有极显著性统计学意义(P0.01);DFI≤15%组的精液体积与15%DFI30%组和DFI≥30%组比较,差异具有极显著性统计学意义(P0.01);HDS≤15%组和HDS15%组的精子浓度、PR、正常形态精子百分率、TZI、DFI比较,差异具有极显著性统计学意义(P0.01)。DFI、HDS均与精子浓度、PR和精子正常形态率负相关,且DFI与年龄、精液体积、TZI和HDS呈正相关,HDS只与TZI呈正相关。弱精子症组、畸形精子症组、少弱精子症组、弱畸精子症组和少弱畸精子症组的DFI、HDS与正常组比较,差异具有统计学意义(P≤0.05)。结论精子DFI与精液常规参数有显著相关性且其在不同精液异常性疾病中有显著性差异,精子DFI对临床评估男性精子质量有重要意义。     

多种无创性检测方法评价无精子症患者生精功能的临床研究

目的探讨多种无创性检测方法在无精子症患者生精功能中的应用效果。方法选择2015年6月至2017年7月自愿到南宁市第二人民医院生殖中心接受治疗的无精子症患者235例,入院后患者均行经皮附睾睾丸穿刺术及睾丸活检术,根据睾丸内有无精子分为少精组(n=128)和无精组(n=107)。采用Prader椭圆型睾丸测量模型完成患者睾丸体积测量;采用电化学发光法测定各组血清促卵泡激素(FSH)水平;采用酶联免疫吸附试验方法测定各组抑制素B(InhB)水平;采用多重PCR技术测定各组Y染色体无精子基因(AZF)基因微缺失情况。结果少精组睾丸大小 5mL、5 ml～8ml、8 ml～12ml人数,均少于无精组,差异具有统计学意义(P 0. 05);少精组睾丸大小≥12ml例数,多于无精组,差异具有统计学意义(P 0. 05);少精组正常值下限例数,高于无精组,差异具有统计学意义(P 0. 05);少精组≥正常值上限≤正常值2倍、≥正常值2倍例数,均低于无精组,差异具有统计学意义(P 0. 05);少精组A区缺失、B区缺失、C区缺失及联合缺失率,均低于无精组,差异具有统计学意义(P 0. 05);少精组无缺失率,高于少精组,差异具有统计学意义(P 0. 05);少精组InhB≥正常值下限例数,多于无精组,差异具有统计学意义(P 0. 05);少精组InhB≥正常值下限1/2 正常值下限、正常值下限1/2例数,少于无精组,差异具有统计学意义(P 0. 05);相关性分析显示:无精子症患者生精功能与睾丸体积、InhB呈正相关性,差异具有统计学意义(P 0. 05);无精子症患者生精功能与FSH及AZF基因缺失呈负相关性。结论将多种无创性检测方法用于无精子症患者生精功能患者中能发挥不同检测方法优势,能评估患者睾丸生精功能,值得推广应用。     

不同类型精子缺陷与印记基因H19甲基化水平关联性研究

目的:探讨不同类型精子缺陷与印记基因H19印记控制区域甲基化水平的相关性。方法:以2014年4月至2014年9月间入院诊治的男性不育患者为研究对象,排除患有精索静脉曲张、隐睾症、核型异常和Y染色体微缺失的病例,依据临床精液常规检查结果,分别筛选出特发性少精子症患者(浓度20×10~6/m L,其余指标均正常)、特发性弱精子症患者(前向运动精子百分率50%,其余指标均正常)、特发性畸形精子症患者(正常精子形态比率15%,其余指标均正常)各25例;25例正常精液样本作为对照组。采用焦磷酸测序法定量分析各组精子DNA中H19基因印记控制区域的甲基化水平。结果:少精子症组[(75.04±15.35)%]和弱精子症组[(79.48±11.64)%]印记基因H19甲基化水平显著低于正常对照组[(89.10±11.23)%],差异均有统计学意义(P=0.006,P=0.024);畸形精子症组[(87.82±12.10)%]与正常对照组H19基因甲基化水平的差异无统计学意义(P=0.758)。结论:印记基因H19印记控制区域的DNA甲基化程度的降低与少精子症和弱精子症有关联,可能与畸形精子症无关。     

无精子症患者血清抑制素B测定的临床意义

目的:通过对无精子症患者血清抑制素B(INH-B)水平的测定来鉴别梗阻性无精子症(OA)及非梗阻性无精子症(NOA),并对NOA患者睾丸切开取精及睾丸显微取精成功率进行预判。方法:对我中心就诊的3650例无精子症患者进行血清INH-B水平测定,分为OA组及NOA组。结果:OA组患者血清INH-B水平明显高于NOA组,NOA组中睾丸切开取精及睾丸显微取精获得精子者血清INH-B水平高于未获得精子者。结论:血清INH-B在鉴别OA与NOA以及判断NOA患者睾丸切开取精及睾丸显微取精成功方面是一个较好的临床测定指标。     

Occupational allergic contact dermatitis caused by decorative plants

12 cases of occupational allergic contact dermatitis caused by decorative plants were diagnosed in a 14-year period. The patients were middle-aged, and their average exposure time was 13 years. The plant families and plants causing occupational contact dermatitis were Compositae (5 patients: chrysanthemum, elecampane, gerbera, feverfew), Alstroemeriaceae (5 patients, Alstroemeria ), Liliaceae (4 patients; tulip, hyacinth). Amaryllidaceae (2 patients: narcissus) and Caryophyllaceae (2 patients; carnation, cauzeflower). The known chemical allergens causing dermatitis were tuliposide-A and sesquiterepene lactones, such as alantolactones and parthenolide, in the Liliaceae and Compositae families. 7 of the 12 patients were able to continue their work; 5 were not because of severe relapses of skin symptoms. The plant allergen and extract series currently available are of great help in the diagnosis.     

Deutliche Einschränkung der Lebensqualität bei Patienten mit Pemphigus vulgaris: Ergebnisse der deutschen Bullous Skin Disease (BSD)‐Studiengruppe

Background: Pemphigus vulgaris is a potentially life‐threatening autoimmune disorder of the skin and mucous membranes characterized by antibodies against epidermal adhesion molecules. Clinically characteristic are painful chronic blisters or erosions of mucous membranes and skin. There are no published studies on the impact o this disease on quality of life. Patients and methods: This registration was performed within the scope of the German BSD (Bullous Skin Disease) study group, from November 1997 until January 2002. A total of 36 patients with the first diagnosis of pemphigus vulgaris were registered at the university hospitals of Dresden, Erlangen, Kiel, Mannheim, München and Würzburg. Thirty of the 36 (83 %) patients participated in the quality of life questionnaire utilizing the German version of ‘Dermatology Life Quality Index’ (DLQI) provided by A. Y. Finlay. The DLQI varies from 0 to 30 with an increased DLQI score indicating a decrease in quality of quality. Results: The overall DLQI total score of 10 ± 6,7 in the investigated pemphigus patients was significantly increased in comparison to other skin diseases. Conclusions: These results suggest that the DLQI can be a very useful additional outcome criteria for clinical studies with pemphigus vulgaris and in the treatment of these patients.     

Mutations in mevalonate pathway genes in patients with familial or sporadic porokeratosis

Porokeratosis comprises heterogeneous keratinization disorders that are characterized by one or more atrophic patches surrounded by a ridge‐like cornoid lamella. In this study, we evaluated seven families affected by porokeratosis and five sporadic patients of the disease in a Chinese population. We performed Sanger sequencing of exons and flanking intron–exon boundaries of mevalonate pathway genes (MVD, MVK, PMVK and FDPS) and of SLC17A9. In five familial and three sporadic patients, we detected six variations, including four novel mutations (MVD c.1A>G; p.Met1?, c.916G>A; p.Ala306Thr, c.1013+1G>A, and PMVK c.65A>G; p.Lys22Arg) and two recurrent mutations (MVD c.746T>C; p.Phe249Ser, and MVK c.1028T>C; p.Leu343Pro). We then applied I‐TASSER and iGEMDOCK to assess these variants for probable functional impacts. The findings of this study extend the mutation spectrum of porokeratosis and provide further evidence for the genetic basis of this disease.     

[Translated article] Pruritus in Dermatology: Part 1—General Concepts and Pruritogens

Pruritus is the most common symptom of dermatologic and systemic diseases. The diagnosis of pruritus is clinical, although additional tests may be necessary to identify or confirm the cause. Translational medicine has led to the discovery of new mediators of itch, or pruritogens, as well as new receptors. Knowing how to properly recognize the main pathway that mediates itch in each patient is the key to successful treatment. Although the histaminergic pathway predominates in conditions like urticaria or drug-induced pruritus, it is the nonhistaminergic pathway that predominates in nearly all other skin diseases covered in this review. Part 1 of this 2-part review discusses the classification of pruritus, additional testing, the pathophysiology of itch and the pruritogens implicated (including cytokines and other molecules), and central sensitization to itch.     

Anästhesieverfahren in der Dermatologie

Zusammenfassung Die Verfahren der Lokalanästhesie sind integraler Bestandteil der operativen Dermatologie. Sie gewährleisten eine effiziente und sichere Analgesie in umschriebenen Haut- und Weichteilregionen und ermöglichen, einen sonst schmerzhaften diagnostischen oder therapeutischen Eingriff bei erhaltenem Bewusstsein zu tolerieren. Einzelne Methoden der Applikation sind "konkurrenzlos", wie die topische Applikation von EMLA^® oder die Kryoanästhesie, andere bieten alternative Optionen zur Allgemeinanästhesie. Die Tumeszenzlokalanästhesie wurde—jenseits der kosmetischen Liposuktion—zu einer effizienten Anästhesieform für größere Operationen bei Tumoren der Haut, plastische Rekonstruktionen und in der Phlebochirurgie weiterentwickelt. Die Wahl des Verfahrens im Einzelfall wird vom Alter, der Kooperationsfähigkeit und der Komorbidität des Patienten bestimmt. Für Infiltrationsanästhesien werden heute vorwiegend Lokalanästhetika vom Amidtyp eingesetzt. Fundierte Kenntnisse über die Anatomie der sensiblen Nerven sind Voraussetzung für erfolgreiche operationsfeldnahe periphere Blockaden. Wenn die Wirkungsweise der Lokalanästhetika, ihre toxischen Effekte und potenzielle Arzneimittelinteraktionen bei ihrem Metabolismus in der Praxis beachtet werden, dann ist das Risiko von Komplikationen relativ gering. Es sollte dennoch nicht unterschätzt, und adäquate Notfallmaßnahmen im Operationsteam sollten regelmäßig trainiert werden.     

Leprosy in a University Hospital in Southern Brazil

BACKGROUND

Leprosy is an infectious disease that may lead to irreversible nerve damage, compromising patient''s quality of life and leading to loss of working years.

OBJECTIVES

To evaluate the epidemiological profile of patients followed at a University Hospital.

MATERIALS AND METHODS

This is a retrospective observational study, based on a review of medical records. We studied the clinical and epidemiological features of patients with leprosy monitored at the Hospital de Clínicas of the Federal University of Paraná between January 2005 and January 2010.

RESULTS

The mean age was 47.51, while 35.94% of patients were aged 41-60. The male:female rate was 1.8:1. The most prevalent occupations were: retired, students or rural workers. Patients came mainly from Curitiba or nearby areas, but there were also patients from the countryside. The mean diagnostic delay was 24.57 months. Multibacillary forms prevailed, with the lepromatous variety being the most common, closely followed by the borderline type. Neural enlargement was found in more than 50% of the patients and 48.44% of them developed reactional states. Hemolysis was the most commonly detected drug side effect. Initial functional evaluation was possible in 70% of patients, 55% of whom had disabilities upon diagnosis. The most prevalent associated disease was hypertension.

CONCLUSIONS

This study showed an important diagnostic delay and a high rate of sequelae in this specific population. Brazil is one of the few remaining countries that has not yet eradicated leprosy and it is important to improve health policies in order to prevent sequelae and achieve eradication.