女性生育力保存技术的研究进展

近年女性生育力保存的问题引起人们的密切关注,其适用人群包括卵巢功能不全患者、肿瘤患者、自身免疫性疾病患者、欲将生育年龄延后的人群等。由于放化疗药物的使用造成女性生育力下降,严重影响了患者的生活质量,因此年轻的肿瘤患者可能成为生育力保存的主要目标人群。生育力保存的方式包括3种:胚胎冷冻、卵母细胞冷冻及卵巢组织冷冻。胚胎冷冻技术已经成功应用于临床,卵母细胞冷冻技术亦日趋成熟,但卵巢组织冷冻技术尚处于研究初始阶段,应用前景广泛。3种生育力保存方式均可采用慢速冷冻方法和玻璃化冷冻方法进行冷冻保存,2种方法各有优缺点。综述近年来对生育力保存的范围、方法及今后需要解决的问题,为进一步研究提供思路。     

女性癌症患者生育力保存技术

随着近年癌症患者生存率的不断提高以及相关辅助生殖技术的发展,针对女性癌症患者的生育力保存也成为了现阶段的研究热点。本文对近10年的文献研究中报道的女性生育力保存技术进行综述。包括卵巢组织冷冻与移植、卵巢组织体外激活技术、卵巢抑制、卵巢移位术、人工卵巢、未成熟卵母细胞冷冻和胚胎冷冻技术等生育力保存技术的有效性和安全性,并讨论比较了每种方法的优、缺点。以期将来能为女性癌症患者选择合适的生育力保存技术提供支持。     

女性肿瘤患者生育力保存的研究现状

近年来年轻的女性肿瘤患者逐年增加。抗肿瘤治疗虽然能提高患者的生存率,但大量放化疗严重损害女性生育能力,因此育龄期女性肿瘤患者有生育力保存的需要。目前,已有乳腺癌、血液系统肿瘤患者成功保存生育力的先例。依据患者所患肿瘤类型及具体情况的不同,可选择采用胚胎冷冻、卵母细胞冷冻和卵巢组织冷冻3种方式来保存女性生育力,并制定出个性化的生育力保存方案。3种冷冻方式各有优缺点。胚胎冷冻和卵母细胞冷冻方式虽技术成熟但需要在肿瘤治疗前等待一定的时间。卵巢组织冷冻后可快速进行抗肿瘤治疗,但技术尚不成熟。生育力保存方案成功与否受多种因素影响,包括患者的年龄、所患肿瘤的类型及治疗方案等。就近年女性肿瘤患者生育力保存的研究进行概述。     

人卵巢组织玻璃化冷冻及移植的影响因素分析

<正>近年来,恶性肿瘤治疗技术的进步改善了患者的远期预后,但放化疗对卵巢功能的损伤已成为新的焦点问题,越来越多的育龄期女性患者开始重视治疗后的生育力保存。女性生育力保存包括胚胎冷冻、卵母细胞冷冻及卵巢组织冷冻,其中,胚胎及卵母细胞冻存技术已近成熟,但不适用于儿童、未婚女性及迫切需要治疗的肿瘤患者。卵巢组织冷冻保存是继胚胎和卵母细胞冷冻技术之后的另一重大突破,     

女性恶性肿瘤患者的生育力保护策略

随着抗肿瘤治疗的发展,癌症患者的生存率大大提高,生育力的保护越来越受到医生和患者的重视。目前,对于女性恶性肿瘤患者,有效的生育力保存方法包括卵子冷冻、胚胎冷冻、卵巢移位术、卵巢组织冷冻与移植和子宫固定术。现就女性恶性肿瘤的生育力保护进行论述。     

卵巢冷冻移植的发展历程及研究现状

女性生育力保存的方式包括胚胎冷冻、卵子冷冻及卵巢冷冻移植。胚胎冷冻技术相当成熟,玻璃化冷冻胚胎存活率已达90%以上,卵子冷冻也取得了一定进展,相较于前两种保存生育力的方法,卵巢冷冻移植不仅能够保存生殖功能,也有望保存内分泌功能。目前人类卵巢移植主要包括新鲜或冷冻卵巢组织的原位或异位移植。卵巢移植的影响因素包括冷冻保存过程、移植部位及移植前预处理等。随着器官冷冻技术及显微外科技术的完善,整体卵巢冷冻移植逐渐成为卵巢保存的发展方向。但整体卵巢移植尚处于动物实验阶段,人整体卵巢冷冻保存处于探索阶段,尚无统一的冷冻及解冻程序。综述了卵巢冷冻保存及移植的发展历程及研究现状。     

生育力保存中玻璃化冷冻载杆的研究趋势及监管挑战

阐述了生育力保存过程中关键医疗器械玻璃化冷冻载杆的演化历程，分析了现有的“开放式冷冻、开放式保存”“开放式冷冻、封闭式保存”及“封闭式冷冻、封闭式保存”3种玻璃化冷冻载杆的优势与弊端，提出了玻璃化冷冻载杆的改良趋势并提供了研究思路，立足监管挑战剖析了玻璃化冷冻载杆监管关注点，为提升生育力保存的有效利用率及国产辅助生殖医疗器械的发展提供了助力。     

生育力保存专栏导读

当前全球生育率下降的问题备受关注。特别在过去的20年中, 人们逐渐认识到肿瘤及其他严重疾病的治疗对生育力丧失有着重要影响, 而年轻肿瘤患者治疗后长期生存, 使得生育力保存的需求日益增加。同时卵母细胞冷冻、卵巢组织冷冻保存及自体移植等技术日臻完善, 生育力保存领域已取得了巨大的进步。国际生育力保存学会(International Society for Fertility Preservation, ISFP)、欧洲人类生殖和胚胎学学会(the European Society of Human Reproduction and Embryology, ESHRE)以及美国临床肿瘤学会(American Society of Clinical Oncology, ASCO)等相继颁布了有关女性生育力保存的建议和指南。近年来我国也相继发表了生育力保存领域的专家共识, 但生育力保存仍是一项长期而具有挑战性的工作。     

中国首次青春期前男孩睾丸组织冷冻保存3例报道并文献复习

目的探讨重度β地中海贫血(β-thalassemia, β-TM)青春期前男孩在性腺毒性治疗前进行生育力保存的方法。方法报道3例重度β-TM男孩行造血干细胞移植(hematopoietic stem cell transplantation, HSCT)前, 采用慢速程序化冷冻方法行睾丸组织冷冻保存, 并结合文献对青春期前男孩进行生育力保存的必要性和地中海贫血男孩生育力监测、睾丸冷冻方法学及其相关流程进行阐述。结果采用慢速程序化冷冻方法分别成功为3例男孩冷冻31块、31块、20块睾丸组织, 冷冻过程顺利。结论对拟行HSCT的重度β-TM男孩, 青春期前睾丸组织冷冻可以保存其生育力, 为其成年后孕育后代留下希望。     

卵巢皮质玻璃化冷冻保存及移植的损伤因素

卵巢组织冻存和移植在技术上可行,有效性也随着技术发展而提高,可用于女性生育力保存,尤其是青春期前放化疗的患癌女性的生育能力保存。玻璃化冷冻被认为是目前最有潜力的卵巢组织冻存方法之一,但其安全性和有效性尚需进一步验证。冷冻损伤及移植缺血再灌注损伤是卵巢冻存和移植中需要克服的难题,如何尽可能有效地保存卵泡是难点及重点。从冷冻保护剂、卵巢组织大小、冷冻载体、抗氧化剂、促进新血管形成和激素6个方面对目前已有的玻璃化冷冻及移植条件、效果等进行了阐述,有益于女性生育力保存的项目推进。     

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.     

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.     

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.     

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.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

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.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.