精浆蛋白酶的筛查试验在无症状性生殖道炎症诊断中意义

目的研究男性不育患者精浆中弹性蛋白酶的含量变化和临床意义，探讨其在诊断无症状性生殖道炎症中的作用。方法收集140例不育症门诊患者的精浆标本（实验组），其中80例按WHO标准诊断为弱精子症，60例为精液常规正常的不育症男性。所有患者都没有生殖道感染的症状，3个月前无抗菌治疗史。所有患者都是自愿参加本研究的。采用ELISA双抗体夹心酶联免疫吸附法检测患者精浆弹性蛋白酶水平，20例生育男性作对照。结果（1）140例不育男性患者精浆中的弹性蛋白酶明显高于生育男性（P〈0．01）；（2）弹性蛋白酶浓度与患者年龄（r=0．255，P〈0．01）及精液中白细胞数（r=0．569，P〈0．01）有正相关关系；（3）弹性蛋白酶浓度与精液量（r=-0．537，P〈0．01）呈负相关关系。结论精浆中弹性蛋白酶检测对诊断无症状性生殖道炎症是一种可靠的筛查试验。     

白细胞精子症患者精液中一氧化氮和UA含量的关系分析

目的探讨白细胞精子症不育者精液中白细胞(WBC)密度、一氧化氮(NO)和尿酸(UA)之间的关系。方法依据WHO诊断标准,选择白细胞精子症不育者40例,非白细胞精子症不育者35例,生育者30例,采用过氧化物酶染色法进行精液WBC密度计数；采用镀铜镉还原荧光法检测NO代谢产物硝酸盐(NO_3)；UA含量测定采用尿酸酶。过氧化物酶偶联法。结果白细胞精子症组精液NO含量为(106．95±4．13)μmol/L、WBC为(1．985±0．696)×10~9/L,而UA含量(166．9±68．1)μmol/L,生育组NO含量(41．31±3．67)μmol/L、WBC为(0．038±0．024)×10~9/L和UA含量为(398．6±52．3)μmol/L。NO和WBC显著高于对照组,UA显著低于对照组(P＜0．01),UA与NO及WBC均呈显著性负相关(r=-0．795,P＜0．01：r=-0．857,P＜0．01)。结论白细胞精子症患者精液NO产生增多致UA含量下降,使精子中毒受损。提示临床在治疗时应加用抗氧化药物,可提高疗效。     

男性不育精液中NO与UA含量的关系

目的探讨人精液中一氧化氮(NO)与尿酸(UA)含量的关系,及对精子质量的影响。方法参照WHO标准方法,进行精液常规分析,按精子密度、活动率不同分为(正常、＜20、20～40、＞40) 4个组。采用镀酮镉还原荧光法检测NO代谢产物硝酸盐(NO_3~-)。采用尿酶一过氧化物酶偶联法检测精液尿酸含量。结果70例不育组精液中尿酸含量和NO含量为(236．4±47．8)μmol/L、(78．7±1．6)μmol/L与正常生育组(398．6±52．3)μmol/L、(41．8±1．6)μmol/L呈显著性差异(P＜0．01)。将尿酸含量与NO含量进行相关性分析,两者呈显著性负相关(r=-0．96,P＜0．05)。不育各精子密度和活动率组精液尿酸含量随精子密度及活动率增加而上升,NO含量随之下降(P＜0．01)。结论精液尿酸含量测定可作为评价精子受活性氧损害的重要指标,证明尿酸对活性氧尤其在医学领域极为重视的NO损害精子具有保护性作用。     

复发性流产与精子畸形率的相关性

目的探讨复发性流产与丈夫精子畸形率的相关性。方法按纳入标准将研究对象分成复发性流产患者丈夫组（流产组）（n=37）、孕前常规检查组（孕检组）（n=48）和正常生育男性组（生育组）（n=26）,采用改良巴氏染色法,按照严格Kruger标准检测对象精子畸形率,以及精液进行常规分析。结果三组年龄、禁欲时间、精液量、精子密度、精子活力以及颈部和中段畸形率、尾部畸形率等无统计学差异（P〉0．05）;三组间精子头部畸形率和总畸形率有显著性差异（P〈0．05）。三组问进一步两两比较,流产组与孕检组及生育组精子头部畸形率均有非常显著性差异（P〈0．01）,孕检组与生育组精子头部畸形率无显著性差异（P〉0．05）;流产组精子总畸形率与孕检组有显著性差异（P〈0．05）,与生育组有非常显著性差异（P〈0．01）,两孕检组与生育组无显著性差异（P〉0．05）。结论丈夫精子畸形率高与妻子复发性流产存在相关性,精子畸形率高与复发性流产的之间相关机理尚需进一步研究。     

男性不育病人精液中磷脂酶A2的测定及其临床意义

目的 :探讨人精液中磷脂酶A2 (PLA2 )含量测定在男性不育症中的临床意义。　方法 :以自制的 2株PLA2单克隆抗体建立酶联免疫吸附试验 (ELISA)、免疫细胞化学法 (ICC)和流式细胞术 (FCM)等 3种方法 ,分别检测男性不育病人精浆及精子头部PLA2的含量 ,并与生育组进行比较。精液常规分析采用计算机辅助精液分析系统 (CASA)进行。　结果 :男性不育病人精浆中PLA2含量分别为 :无精子症组 (31.13± 14 .4 9)ng ml,少精子症组 (17.71±12 .4 5 )ng ml,精子数目正常组 (16 .4 6± 11.31)ng ml;与生育组 [(8.0 9± 3.15 )ng ml]相比差异均有极显著性 (P <0 .0 1) ;精浆中PLA2含量与精子密度呈显著负相关 (r=- 0 .6 0 2 ,P <0 .0 5 ) ,而与精子活动力及活率无显著相关性 (r=0 .2 6 6和r=- 0 .2 0 0 ,P均 >0 .0 5 ) ;ICC和FCM试验均提示 ,生育组精子头部PLA2含量显著高于各不育组病人 ,且FCM试验显示差异有极显著性 (P <0 .0 1)。　结论 :精浆中PLA2与男性生育密切相关 ,精子头部PLA2含量缺乏可能是引起男性不育的病因之一。精液中PLA2含量测定方法的建立可为探讨男性不育的发病机制提供有力的依据。     

不育症患者精浆IL-1β、IL-4、IL-10含量测定及临床意义

目的 :观察男性不育症患者精浆中白细胞介素 1β(IL 1β)、白细胞介素 4 (IL 4 )、白细胞介素 10 (IL 10 )含量 ,及其与精子的各项功能指标之间的相互关系。　方法 :应用放射免疫分析 (RIA)技术 ,对 12 6例男性不育症和 2 0例正常生育者精浆中IL 1β、IL 4、IL 10含量进行检测。根据精子密度将不育症患者分为A组 (精子密度≥ 2 0× 10 6/ml)、B组 (精子密度 <2 0× 10 6/ml)和C组 (无精子症者 ) 3组 ;根据精子活动力、活动率将A组分别分为精子活动力正常组和不良组 ,精子活动率正常组和下降组 ;根据不育症患者血清抗精子抗体 (AsAb)检测结果、精液中WBC多少分为AsAb阳性组和阴性组 ,WBC精液组和非WBC精液组。根据生育组检测结果 ,将不育A组和B组分为精子穿透力正常组和下降组 ,精子顶体完整率正常组和下降组 ,精子尾部肿胀率正常组和下降组。　结果 :不育症组精浆IL 1β含量显著高于生育组 (P <0 .0 1) ,IL 4、IL 10含量显著低于生育组 (P <0 .0 1)。不育症组精浆中IL 1β、IL 4、IL 10含量在WBC精液组与非WBC精液组、血清AsAb阳性组与阴性组之间差异均有显著性 (P <0 .0 5或P <0 .0 1) ;IL 4含量在不育症组精子活动力、活动率、精子穿透力、顶体完整率、尾部肿胀率正常与减少之间差异均有显著性 (P <0     

人精子运动功能与腹腔液中干扰素-γ含量的关系

目的 观察子宫内膜异位症（EMs）患者腹腔液干扰素（IFN）-γ体外对精子运动功能的影响。方法 用双抗体夹心法，检测30例EMs不孕妇女，30例其他病因所致不孕妇女和20例生育力正常妇女腹腔液中IFN-γ含量，用精液自动分析系统检测与腹腔液共同孵育后的正常精液中精子活动力参数，荧光显微镜观察顶体反应发生率。结果 EMs组腹腔液IFN-γ含量（250．3±102．6）ng／L高于其他2组（P〈0．01）；EMs组腹腔液与正常精液共同孵育后，精子活动力显著降低（P〈0．01），并与IFN-γ含量呈负相关（r=-0．958，P〈0．01）。精子与EMs组腹腔液孵育16h后顶体反应发生率低于正常对照组（P〈0．01）。结论 EMs患者腹腔液IFN-γ对精子活动的抑制可能是导致不孕因素。     

不育病人精浆胆固醇酯转运蛋白的检测

目的 :检测不育病人精浆胆固醇酯转运蛋白 (cholesterolestertransferprotein ,CETP)的含量 ,并探讨其与不育的关系。　方法 :随机选择 163例不育病人及 15例生育男性 ,行精液常规分析及精浆CETP浓度测定 ,其中5 5例不育病人同时测定了血清CETP含量。　结果 :不育病人及生育男性精浆CETP含量分别为 ( 2 .2 1± 1.2 3 )μg/L和 ( 1.40± 0 .45 ) μg/L ,两组间差异无显著性 (P >0 .0 5 ) ;在不育病人中 ,无精子症组 (n =2 9)、少弱精子症组(n =5 8)、少精子症组 (n =15 )、弱精子症组 (n =44 )及正常精子症组 (n =17)间CETP含量差异也无显著性 (P >0 .0 5 )。精浆平均CETP含量仅占血清的 1/ 10 0 0 ,不育病人精浆及其血清CETP含量间并无相关性 (r =0 .0 0 9,P>0 .0 5 )。　结论 :精浆CETP含量极低 ,与精子密度、活率的改变无关 ,可能保证了精子在未进入女性生殖道前膜结构与功能的完整性     

精子顶体素ELISA检测法的建立与临床应用

从人精子中提取顶体素，制备兔抗人精子顶体素抗体，建立定量检测顶体素的ELISA方法。本法线性范围为（0．35～3．0）×10－3g／L，批内、批间cV分别为7．8％～9．6％和8．4％～10．8％。临床检测结果表明，在精子密度为50×109／L，生育组（n=15）顶体素含量（X±S）为（1．04±0．10）×10－3g／L；不育组（n=30）顶体素含量为（0．81±0．18）×10－3g／L，两组之间差异显著（P＜0．01），顶体素含量与精子密度、精子顶体完整率之间呈正相关（r=0．987、r=0．821），提示精子顶体素含量的降低是引起男性不育的原因之一。     

精液粘度增高与不育的关系

目的 :探讨精液粘度增高对生育的影响。方法 :检测 15 9例不育症患者的精液 ,观察精液粘度与其他参数之间的关系及影响粘度的因素。结果 :精液粘度增高与吸烟程度有关 ,精液粘度增高组与正常组比较 ,精液液化时间和精子密度均有极显著性差异 (P<0 .0 1) ,精子活动率、活动度异常率及穿透力异常率均有显著性差异 (P<0 .0 5 )。结论 :戒烟和治疗前列腺炎可降低不育患者精液粘度 ,从而有利于不育症的治疗     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

肝内胆管囊腺瘤和囊腺癌的CT、MRI及病理表现

目的探讨肝内胆管囊腺瘤和囊腺癌的CT、MRI和病理特点。方法回顾性分析经手术病理证实的6例肝内胆管囊腺瘤和2例肝内胆管囊腺癌的影像及临床病理资料，将病变的影像表现与其病理大体形态及组织学表现作对照分析。结果6例肝内胆管囊腺瘤，女4例、男2例；2例肝内胆管囊腺癌均为女性病人；8例病人平均年龄55岁。所有病灶均表现为多房囊性肿块，肿瘤囊腔各分房内常为多种液体成分，在CT上可表现为不同密度、在MRI上可表现为不同信号强度。囊内出现多发大小不等的壁结节在胆管囊腺癌内更常见，囊内有分隔但无壁结节只见于胆管囊腺瘤。在7例CT扫描中，4例胆管囊腺瘤和1例胆管囊腺癌可见囊壁或分隔上钙化，囊壁、囊内分隔及囊内结节均为轻、中度延迟增强。肿瘤中出现卵巢样间质见于3例胆管囊腺瘤和1例胆管囊腺癌，且均为女性病人。结论肝内胆管囊腺瘤和囊腺癌是肝脏不常见的囊性肿瘤，影像上多房、囊内有分隔且各分房囊内密度或信号不一致，高度提示肝内胆管囊腺瘤或囊腺癌的诊断，如囊内伴有多发大小不等的结节，则进一步提示囊腺癌的可能。但影像学表现不能区分肿瘤中有无卵巢样间质。     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.