正常男子和弱精子症者精子中3β-羟基甾体脱氢酶的研究

目的：测定精子中3β-羟基甾体脱氢酶（HSD）。方法：采用酶组织化学方法对27例精子活率正常和20例精子活率低下的男子精子进行了研究。结果：3β-HSD主要分布在精子颈部，其着色面积不等，精子活率正常组3β-HSD着色面积为616．48±108．48μm2／100个精子，精子活率低下组为354．37±50．58μm2／100个精子，两组差异极显著（P＜0．001）。结论：3β-HSD可能通过某种途径间接参与精子的运动。     

精子尾部卷曲试验及影响因素的探讨

本文介绍了精子尾部卷曲试验及影响因素（时间、温度、ｐＨ）。３０例正常生育男性和４３例不育男性的精液分析表明，精子尾部卷曲率与精子活率具有高度的相关性（ｒ＝０．９６２５），与精子密度无相关性（ｒ＝０．１６２）；男性生育组与不育组之间的精子尾部卷曲率具有显著性差异（ｘ±ｓ，百分率分别为７５．２１±２０．０１和５９．４３±２０．５４，Ｐ＜０．０５）。     

弱精症男子与正常人精浆和精子膜尿激酶酶活性的研究

应用琼酯糖－纤维蛋白－平板法和抗人尿激酶多克隆抗体的免疫阻断法，分别测定了２０名正常生育力男子和２２例精子活力低下（弱精症）的男性不育症患者精浆中及精子膜尿激酶型纤溶酶原激活因子（ｕＰＡ）的酶活性。结果：弱精症组精浆ｕＰＡ活性为２１３４±１５８１ＩＵ／Ｌ，正常生育组精浆ｕＰＡ活性为３３６５±１８５９．５ＩＵ／Ｌ，两组间差异有显著性意义（Ｐ＜０．０５）。弱精症组精子膜ｕＰＡ活性为５．１３±３．８２ｍＵ／１０６ｃｅｌｓ，正常生育组精子膜ｕＰＡ活性为１０．１７±６．１８ｍＵ／１０６ｃｅｌｓ，两组间差异有极显著性意义（Ｐ＜０．００５）。精子膜ｕＰＡ活性值与精子活率、活力亦呈线性相关。提示精子膜ｕＰＡ酶活性与精子活力及生育力可能有一定关系。     

UU感染对精子运动轨迹影响的实验研究

目的：探究解脲支原体（ＵＵ）感染对精子运动轨迹的影响,阐明ＵＵ感染引起男性不育症的发病机制。方法：正常精液一式２份,１份用ＵＵⅣ型人工感染正常精子,１份作对照,于感染后４、８、１６和２４ｈ分别进行精子运动轨迹分析。结果：正常精子受ＵＵ感染８ｈ精子运动速度明显低于对照组（３２．１８±０．８２μｍ／ｓｖｓ２１．０２±０．６２μｍ／ｓ,Ｐ＜０．０１）;感染１６ｈ精子运动方式为原地转圈和锯齿形运动;感染２４ｈ精子运动速度＜１０μｍ／ｓ,有活力精子几乎全是原地转圈运动。结论：解脲支原体Ⅳ型对精子运动速度和运动方式有明显影响,可能是ＵＵ引起男性不育的原因之一。     

精子运动轨迹图像分析影响因素的探讨

报告了正常生育男性春夏秋冬的精子运动平均速度的正常值范围分别为２４．６±２．１，３０．９±３．０，３１．２±２．７和２３．５±２．２μｍ／ｓ。探讨了季节（温度）、生育年龄、禁欲时间等因素对精子运动轨迹图像分析的影响。结果表明，冬春与夏秋季节对精子运动轨迹有明显的影响（Ｐ＜０．０１）；春季与冬季，夏季与秋季精子运动速度无显著差异；生育年龄和禁欲时间对精子运动轨迹无影响。实验表明，男性在生育力旺盛期间（２１～４８岁），睾丸的功能是相对稳定的，人类的生殖也无季节性变化。     

精子运动轨迹图像分析影响因素的探讨

本文报告了正常生育男性春夏秋冬的精子运动平均速度的正常值范围分别为２４．６±２．１，３０．９±３．０，３１．２±２．７，和２３．５±２．２μｍ／ｓ。探讨了季节（温度）、生育年龄、禁欲时间等因素对精子运动轨迹图像分析的影响。结果表明，冬春与夏秋季节对精子运动轨迹有明显的影响（Ｐ＜０．０１）；春季与冬季，夏季与秋季精子运动速度无显著差异；生育年龄和禁欲时间对精子运动轨迹无影响。实验表明男性在生育力旺盛期间（２１～４８岁），睾丸的功能是相对稳定的，人类的生殖也无季节性变化。     

弱精症男子与正常人精子膜尿激酶型纤溶酶原激活因子含量的研究

按ＷＨＯ精液参数标准，分别选择精子活力低下的男性不育症患者和正常生育力男子精液标本各２０例，将洗涤后的精子用含１％ＴｒｉｔｏｎＸ－１００的０．１ＭＴｒｉｓ－ＨＣｌ缓冲液处理，提取精子膜结合尿激酶型纤溶酶原激活因子（ｕＰＡ），然后采用抗人尿激酶多克隆抗体，进行各样品ｕＰＡ含量的测定（夹心法ＥＬＩＳＡ）。结果显示：弱精症男子精子膜结合ｕＰＡ（２３．１０±７．３５ｍｕ／１０６ｃｅｌｓ）显著性低于正常人精子膜ｕＰＡ（２９．８９±９．４８ｍｕ／１０６ｃｅｌｓ），Ｐ＜０．０２５。且精子膜ｕＰＡ含量与精子活率呈直线正相关（ｒ＝０．６４，Ｐ＜０．０００１），与精子活力（直线前向运动精子百分率）亦呈线性相关（ｒ＝０．４８，Ｐ＜０．００５）。说明精子膜结合ｕＰＡ可能与精子活力及生育力之间有一定关联。     

Makler精子计算盘的应用及其临床意义

作者应用Ｍａｋｌｅｒ精子计算盘对精液有关参数进行了实验研究与临床应用。报道了１００例正常生育男性的精子密度与活动率分别为（６６．３５±２０．０９）×１０￣９／Ｌ和５８．６４±１８．３２％。３０例自愿者正常精液春、夏、秋、冬四季精子运动的平均速度依次为２４．６、３０．９、３１．２和２３．５μｍ／ｓ。指出了禁欲时间和不同生育年龄对精子运动速度与运动方式没有影响。同时还报道了解脲支原体感染不仅可降低精子的运动速度，而且还改变其运动方式。作者认为Ｍａｋｌｅｒ精子计算盘是有应用价值的精液分析工具，值得推广使用。     

精浆酸性磷酸酶活性与抗精子抗体

目的：探讨男性不育症精浆酸性磷酸酶（ＡＣＰ）与精子密度、精子成活率、血清和精浆抗精子抗体（ＡｓＡｂ）之间的关系。方法：检测不育男性精子密度、精子活率、血清和精浆ＡｓＡｂ及精浆ＡＣＰ活性。结果：精子成活率＞５０％、３０％～５０％、＜３０％组的精浆ＡＣＰ活性逐渐降低,分别为（１６２．１２±８５．７７）Ｕ／ｍｌ、（１２３．０１±５２．５５）Ｕ／ｍｌ和（１１１．２１±５４．４２）Ｕ／ｍｌ;与成活率＞５０％的精浆ＡＣＰ相比,活率在３０％～５０％和＜３０％组的ＡＣＰ活性降低,具有显著性差异（ＳＮＫ检验,Ｐ＜０．０１）;精子密度＞２０×１０９／Ｌ、（１０～１９）×１０９／Ｌ和＜１０×１０９／Ｌ组的精浆ＡＣＰ活性依次下降,分别为（１６５．９９±８８．６７）Ｕ／ｍｌ、（１３９．１９±７０．７８）Ｕ／ｍｌ和（１１５．２１±６０．５１）Ｕ／ｍｌ;与密度＞２０×１０９／Ｌ组的ＡＣＰ活性相比,密度在（１０～１９）×１０９／Ｌ和＜１０×１０９／Ｌ的精浆ＡＣＰ活性降低,具有显著性差异（ＳＮＫ检验,Ｐ＜０．０１）;血清、精浆ＡｓＡｂ阳性病人的ＡＣＰ活性明显低于二者均阴性的病人,且ＡＣＰ降低具有显著性差异（ＳＮＫ检验,Ｐ＜０．０１）。结论：?     

Makler精子计算盘的应用及其临床意义

应用Ｍａｋｌｅｒ清子计算盘对精液有关参数进行了实验研究与临床应用。１００例正常生育男性精子密度与活动率分别为６６．３５±２０．０９×１０９和５８．６４±１８．３２％。正常生育男性精液春夏秋冬四季精子运动平均速度依次为２４．６，３０．９，３１．２和２３．５μｍ／ｓ。禁欲时间和不同生育年龄对精子运动速度与运动方式没有影响。同时报道了解脲支原体感染不仅降低精子运动速度，而且改变其运动方式。作者认为Ｍａｋｌｅｒ精子计算盘是精液分析有广泛应用价值的检测工具，值得在我国推广使用。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.