中医治疗男性不育辨证分型概要

夫妇婚后同居一年以上,未用任何避孕措施,由于男子方面的原因造成女方不孕者,称为男性不育症。男性不育症是由多种疾病引起的一种后果,病因非常复杂。现代医学目前在治疗方面仍缺乏有效的药物。男性不育属中医“无子”、“无嗣”、“绝育”、“不男”等范畴。中医认为,“肾藏精”,故治疗男性不育症患者多向补肾益精集中。但随着时代的变迁,     

妇女年龄、不育年限、受孕史与供精人工授精成功的关系

目的:探讨不孕妇女的年龄、不育年限、受孕史与供精人工授精成功的关系.方法:回顾性分析656对夫妇1 227周期供精人工授精的临床资料.结果:年龄35岁以上,妊娠率下降,流产率升高,尤其是>40岁组,差异有统计学意义(P<0.05).不育年限大于10年妊娠率下降,差异有统计学意义(P<0.05).女方有受孕史组妊娠率、流产率与无受孕史组比较,差异无统计学意义(P>0.05).结论:妇女的年龄、不育年限是影响供精人工授精成功的重要因素,女方受孕史对供精人工授精成功影响不大.     

中医药同步调理精卵功能治疗不孕不育的疗效分析

目的 为观察中医药同步调理精卵功能治疗不孕不育症的临床效果.方法 对同时具备男方精液质量异常及女方排卵功能障碍,且除外因遗传、解剖、输精管及输卵管梗阻等因素所致不孕不育症夫妻44对,采用夫妻双方同步治疗,分别给予生精及促排卵助孕疗法.结果 男方精液正常者占86.3%,女方排卵功能正常者占80.6%,6个月受孕率38.6%.结论 中医药同步治疗男女不孕不育症可使女方受孕机会增大,是一种相对快捷有效的治疗方法.     

梨形头畸形精子致病机制及相关研究进展

夫妻双方在无避孕措施性行为的情况下,两年未受孕可诊断为不育症[1 ].不育症在育龄期夫妻中发病率约15％,不育原因中约20％ 为男方因素、34％ 为女方因素、38％ 为双方混合因素、8％ 为先天性原发因素[2-3 ].男性不育病因复杂,研究[4-5 ]表明,畸形精子是造成男性不育的原因之一.精子形态学分析是一项评价男性生育力的常规项目之一,有研究[6-7 ]显示,精子形态学分析可预测自然受孕[8-9 ]、宫腔内人工授精、体外受精[10-11]的结局.     

“脚气”“脚癣”要分清

德国先灵制药公司正在研制一种男性避孕药，预料将在四至五年内面世。这种男性避孕药会向男性脑部发出“信号”，通知脑部制止精子的产生及成熟过程，服用者的精液就不会有精子，或精子不够成熟，不能令女方受孕。     

四逆散加味治疗“输卵管不通”验案三则

凡在生育年龄之内,婚后同居2～3年以上仍不能受孕者;或女方曾经生育或流产而又2～3年以上未能怀孕者,统谓之不孕证。前者为原发性不孕证,后者为继发性不孕证。不孕证应从男女双方寻找原因,就女方而言,造成不孕证的原因虽有多端,然以输卵管炎症引起的粘连、阻塞,导致“输卵管不通”为其重要原因,治疗亦较困难。近一年来,笔者采用辨证为主、证病结合的方法,门诊治疗三例输卵管不通     

小滴法精子冷冻在流程化治疗无精子症中的应用体会

目的 探讨小滴法精子冷冻在流程化治疗无精子症的临床效果及相关治疗措施.方法 方便选取该院2009年1月—2014年12月接受小滴法精子冷冻技术不育男性180例开展回顾性分析,按WH05人类精液检查与处理实验手册要术进行精液检查后,梗阻性无精子症患者120例,非梗阻性无精子症患者60例;另选取40例取精困难不育男性正常精液按此方法冷冻(对照组),统计、分析精液常规正常的40例取精困难不育患者、120例梗阻性无精子症患者、60例非梗阻性无精子症患者精子复苏率、妊娠率.结果 对照组中40例取精困难不育患者中解冻40例,精子的复苏率均大于60%,其中18例获得女方妊娠(18/40)妊娠率45%;梗阻性无精子症120例中解冻30例,获得女方妊娠12例(12/30)妊娠率40%;非梗阻性无精子症60例解冻25例获得女方妊娠10例(10/25)妊娠率40%.结论 小滴法精子冷冻在流程化治疗无精子症中的应用效果较好,同时由于每次冻存的最小冷冻液体剂量仅为20μL,载体为目前成熟的商品化载体,技术操作简单、价格相对低廉,具有临床推广应用价值.     

明确诊断 治疗男性不育症

正常的育龄夫妇生活在一起，有正常的性生活，又没有采取避孕措施，一般在结婚后半年内即可怀孕。如果婚后2年女方还不能受孕，或者能受孕，但胚胎不能生长，中途夭折、流产，即称为不孕。不孕可以由女方引起．也可以由男方引起，或者是双方均有问题。男性原因所致的不孕约占全部不育曲一半，如果男方于婚后从未生育过，称为原发性男性不育；如果婚后曾有生育史。而后来未再生育．则称之为继发性     

影响宫腔内人工授精成功率因素的临床研究

目的探讨影响宫腔内人工授精(IUI)成功率因素.方法对183例不育夫妇采用多管上游法体外筛选优质精子,用于配偶间人工授精.结果IUI共妊娠42例,妊娠率22.95%,授精226个周期,周期妊娠率18.58%.结论研究发现IUI成功率与精子处理方式、精子膜完整性、女方年龄及不育年限有关,在连续治疗3个周期未受孕者应改变治疗方案.     

浅谈五子衍宗丸治疗男子不育症

处于生育年龄的夫妇，结婚同居2a以上，未采取任何避孕措施，女方身体健康，生育机能正常，因男方生育机能障碍，致使女方不能受孕者，称为男子不育症。据目前统计，此症占所有不孕症的40％左右。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.