精索静脉曲张伴男性不育临床决策研究进展

精索静脉曲张（varicocele，VC）是一种生理性异常，约2％～22％的成人男性存在VC。VC常见于不育男性，可导致约25％的不育症患者精液异常。在所有病因明确的不育症中，VC是最常见的原因之一。尽管人们认为VC与精液质量下降及不育密切相关，但目前为止VC导致不育的具体机制尚未明确。     

皮肤鳞状细胞癌的研究进展

皮肤鳞状细胞癌是黑素瘤之外导致皮肤肿瘤患者死亡的首要病因。皮肤鳞状细胞癌的发病机制至今尚不明确,限制了相关分子靶向治疗的发展。目前,临床上对该病的治疗仍以手术治疗为主,辅以放射治疗等其他手段。本文结合文献对其相关研究进展进行综述。     

实验性精索静脉曲张大鼠生精细胞凋亡的周期时相性研究

精索静脉曲张(varicocele,VC)为泌尿外科常见疾病,其中约21%～41%系因不育而就诊,但截至目前精索静脉曲张导致不育的机制仍不十分清楚[1].由于生精细胞凋亡与不育关系密切,本研究应用流式细胞术(flow cytometry,FCM),分析实验性精索静脉曲张大鼠睾丸生精细胞凋亡的周期时相性,从细胞分子生物学角度探讨精索静脉曲张所致不育的病理机制.     

精索静脉曲张致男性不育的机制研究

精索静脉曲张(varcocele,VC)是男性常见的泌尿生殖系统疾病,多见于青壮年,发病率为10%～15%,一般以左侧为主.1880年英国外科医生Barfield首先提出VC可导致男性不育.研究表明[1],VC在男性不育症中占19%～41%.尽管VC可以引起不育是人所共知的,但迄今为止其导致男性不育的确切机制仍不十分清楚.近年来各国学者对此进行了大量研究,现对其主要的可能机制综述如下.     

原发性腹膜后脂肪肉瘤的发病机制及综合治疗

目的了解原发性腹膜后脂肪肉瘤(PRLPS)的发病机制及综合治疗的研究进展,以期为临床医生诊疗提供依据。方法复习近年来关于PRLPS的病理分型、发病机制以及包括手术、放疗、化疗及分子靶向治疗在内的综合治疗研究进展的相关文献并加以综述。结果 PRLPS病理分型分为高分化、去分化、黏液样或圆细胞型、多形型及混合型5种。分子学发病机制主要是基因表达的变化,如MDM2与相关基因的协同作用、c-myc基因表达异常、Prune-nm23-H1机制、miRNA异常表达及FUS-CHOP融合基因的异常蛋白质产物调节肿瘤的生长。PRLRS的治疗包括肿瘤根治切除术、扩大切除术、姑息性切除术,辅之以放化疗以及分子靶向治疗。结论 PRLPS是一种复发率极高、较罕见的恶性肿瘤,但早期诊疗比较困难。随着对PRLPS分子机制的进一步研究,其治疗方式已转变为以手术切除治疗为主、辅以放化疗及分子靶向治疗的综合治疗方式。     

精索静脉曲张致男性不育的研究进展

精索静脉曲张（VC）是青年男性泌尿科常见病，是导致男性不育的重要原因，目前对精索静脉曲张致男性不育的机制已进行了不少研究，但仍未完全阐明，VC可能通过睾丸微循环、血管活性物质、氧自由基、一氧化氮、缺氧、免疫及凋亡等多种途径共同作用致男性不育。近年来，细胞分子和遗传学方面的异常成为VC研究的热点，如细胞凋亡、氧化应激和NO等。现结合近几年的研究，就VC致男性不育的发病机制作一综述。     

胆囊癌发病机制及治疗的研究进展

胆囊癌是胆道系统中较为罕见的恶性肿瘤,其预后不佳主要归因于早期症状不明显导致的确诊较晚和缺乏有效的治疗方案。研究表明,胆囊结石引发的慢性炎症是主要致病因素。尽管手术治疗可能治愈早期胆囊癌,但多数患者发现时已错过最佳手术时机。化疗和靶向治疗虽然提供了新方向,但总体生存率提升有限。因此,深入理解胆囊癌的发病机制,特别是与关键基因、分子通路的关联,对开发新的治疗策略至关重要。本文综述了胆囊癌的流行病学、发病机制、治疗现状及研究进展,旨在为其基础研究和临床治疗提供新思路。     

精浆中性α-葡糖苷酶含量测定对精索静脉曲张思者术后疗效的评价

精索静脉曲张（varicocele,VC）是男科常见的疾病之一,也是男性不育的的主要病因[1],该病多见于青壮年,并且有很高的发病率,在其导致不育的患者中多为少弱精子症,严重者甚至为无精子症旧引。精液生化检测是临床实验室精液常规的检测手段之一,特别是精浆中性α-葡糖苷酶,与精子浓度、前向活力和精子受精能力呈正相关,通过对精浆中性α-葡糖苷酶检测,可间接反映男性不育症的原因,为男性不育患者提供简便实用的诊断方法,也是检验不育症治疗效果的手段之一[6]。精浆中性α-葡糖苷酶检测用于VC手术效果的评估鲜有报道,本文回顾性分析我院收住的108例VC不育症的临床资料,分析精浆中性α-葡糖苷酶水平在VC手术前后的变化,探讨精浆中性α-葡糖苷酶与VC不育症之间有无相关关系,评判精浆中性仅．葡糖苷酶在手术治疗VC术后疗效观察中的临床应用价值。     

足细胞生物学与肾小球损害的研究进展

自肾小球足细胞表达的蛋白分子开始被认识之后 ,足细胞损伤作为导致蛋白尿和肾小球硬化的致病机制日益受到重视 ,本文就对足细胞近几年的研究进展作一概述。     

雌二醇与皮瓣缺血再灌注损伤

皮瓣缺血再灌注损伤是组织缺血后血流恢复所造成的组织继发性损伤,常导致皮瓣部分或全部坏死,严重影响手术疗效。近年研究发现,皮瓣缺血再灌注损伤发病机制非常复杂,涉及多种细胞分子的病理性损伤变化。雌二醇是重要的甾体类激素,能有效增加皮瓣组织内微循环灌注,抑制氧自由基对组织的氧化损害,减轻中性粒细胞介导的炎性损伤,促进皮瓣成活。该文就皮瓣缺血再灌注损伤机制及雌二醇对其治疗作用研究进展作一综述。     

如何成为合格的泌尿男科显微外科医生:美国康奈尔大学威尔医学院的学习经历

泌尿男科显微外科是泌尿外科中发展最快的的亚专业。随着男科患者数量增多,新型医疗技术的发展,最近20年男性显微外科的飞速发展,使众多男性不育患者得到有效治疗。男科的发展备受关注,对男科医师的需求越来越急迫。国内泌尿男科显微外科虽然取得一定的成绩,但有别于普通泌尿外科的培养学习曲线,如何成为合格的、规范的专业男科显微外科医师不是简单的事情,目前国内没有现成的培养模式可循。美国康奈尔大学男性生殖医学和显微外科中心建立并规范专科泌尿/男科医生培训项目,男性不育显微外科是对体力、脑力和技术的挑战,首先必须在显微外科实验室进行正规培训,为今后临床工作奠定坚实基础。通过作者在康奈尔大学显微男科培训中心的学习经历,将实验室各项系统的、专业的显微外科培训中细节和基本原则,从专业定位、知识储备、技能训练、临床积累等方面进行阐述,希望为国内培养合格的男科显微外科医师提供正确的思路和方法。     

Etiologies of sperm DNA damage and its impact on male infertility

Male factor is responsible for up to 50% of infertility cases in the world. Semen analysis is considered the cornerstone of laboratory evaluation of male infertility, but it has its own drawbacks and fails to predict the male fertility potential with high sensitivity and specificity. Different etiologies have been linked with male infertility, of which sperm DNA damage has gained significant attention with extensive research on sperm function tests. The associations between sperm DNA damage and a variety of disorders such as varicocele, obesity, cancer, radiation and lifestyle factors are explored in this review. Furthermore, we discuss the mechanisms of DNA damage as well as its impact in different scenarios of male infertility, associated with spontaneous and assisted reproduction. Finally, we review the clinical applicability of sperm DNA fragmentation testing in the management of male infertility.     

Evidenzbasierte medikamentöse Therapieansätze der Infertilität

Evidence-based drug therapy for male infertility is often difficult because 30% of all cases of male infertility are classified as idiopathic, and another 30% need surgical treatment. Without knowledge of the underlying pathology, there is no foundation for a specific and causal treatment. Most of the currently used drug therapies are empirical at best; moreover, many of the studies on drug treatment for male infertility do not fulfill the required standards of evidence-based medicine (randomized, prospective, placebo-controlled), and the statistical endpoints used (sperm quality, pregnancy rate, baby take-home rate) are not uniform. This article, which is based on a literature survey and the current guidelines concerning drug therapy for male infertility, covers the most common treatment options. Regarding the currently insufficient scientific data for drug therapy and dietary supplements on male infertility, there is a demand for critical indications that take into consideration the possible side effects and the treatment costs. In the case of insufficient drug therapy for male infertility, reproductive medicine seems to be promising.     

谷胱甘肽S-转移酶基因多态性与男性不育

男性不育的发生是遗传因素与环境因素相互作用的过程,机体对内外源性化学物质的代谢和解毒能力影响个体对男性不育的易感性。谷胱甘肽S-转移酶(GSTs)属于机体Ⅱ相解毒酶系统,其参与细胞对外源性化学物质和人工合成有机物质解毒的各个生理阶段。研究发现,GSTs基因多态性与男性不育有一定的相关性。在同一地区人群中,GSTs基因多态性对男性不育的易感性具有相似性,也存在不一致性;在不同地区人群中,GSTs基因多态性对男性不育的易感性不一致,也存在相似性。因此,GSTs基因多态性对男性不育患者的易感性在不同人群中存在差异。     

Prevalence of human papilloma virus in men attending the infertility clinic

Summary. Subclinical human papilloma virus is a potential carcinogen in the male and female genital tract. The sexually active male infertility population represents a high risk group for harbouring this disease. To determine the prevalence of subclinical human papillomavirus in this group, penoscopy was done on 96 male patients visiting the infertility clinic. The feasibility of routine penoscopy as part of the infertility work-up was also investigated. Of the 96 patients 20 had acetowhite lesions on their penes with penoscopy. Thirteen patients (13.5%), 12 proven by biopsy of the aceto-white lesions, and one proven by fluid in situ hybridization on superficial epithelial cells of the distal urethra, were positive for human papillomavirus. Two of the 12 biopsy-positive cases were also proven positive by fluid in situ hybridization. It was concluded that human papillomavirus had a high prevalence amongst asymptomatic male patients attending the infertility clinic and that penoscopy should be included as routine investigation in the work-up of the male infertility patient.—     

Sexually transmitted diseases and their relation to male infertility.

Controversy surrounds the role of sexually transmitted diseases in male infertility. Because our understanding of male infertility is limited, and because diagnostic tests such as semen analysis including culture and leukocyte count are variable, definitive conclusions on STDs and their effect on infertility cannot be substantiated. Prospective investigations of infertile couples using appropriate control groups, sophisticated semen collection protocols, proper microbiologic techniques, and standardization of seminal fluid analysis are required to understand the role of STDs in male infertility. Regardless of the ongoing research to delineate the role of STDs in male infertility, advocating primary prevention by increasing public awareness of the negative effects of STDs and the use of contraceptive methods to prevent the spread of STDs is mandatory for the health care professional.     

中国男性不育显微外科15年发展历程及展望

男性不育症是泌尿男科常见而复杂的疾病,长期以来缺少有效的外科治疗方法。随着男性不育显微外科和辅助生殖技术的出现,男性不育症的治疗得到飞速发展。美国康奈尔大学医学院(Weill Cornell Medical College of Cornell University)引领了男性不育显微外科发展的方向和进程。男性不育显微外科从系统地引入中国到今天被大家普遍接受,经历了漫长的过程。男性不育显微外科在中国近15年经历了引入、兴起和繁荣3个阶段,目前中国多家医院相继开展男科显微外科手术,初步建立了男性不育显微外科治疗体系。然而,在中国,男性不育显微外科医生仍然缺乏严格规范的显微外科技术培训,缺乏统一的男性不育评估标准和手术效果的评估,缺乏详细的患者术后随访数据。本综述回顾了男性不育显微外科在中国的发展历程,肯定了男性不育显微外科在中国的发展,也指出了不足,建议今后在显微外科医生的正规培训、建立标准化的男性不育显微手术前后评估和随访流程、在国内开展大规模男性不育显微手术协作临床科学研究等方面加强工作,促进男性不育显微外科在中国发展。     

男性不育的遗传学改变及可能对策

染色体畸变和基因突变在男性不育中起着重要作用。了解其原因对于预防和治疗男性不育有积极的作用 ,为此本文对男性不育已知的遗传学原因、与生育相关的候选基因、检测方法及防治等有关问题进行了综述。     

Endocrine manipulation in male infertility

Endocrine therapy for male infertility is broadly categorized as specific or nonspecific therapy. Although uncommon, primary endocrine diagnoses in infertile men are amenable to targeted therapy. The efficacy of empiric endocrine therapy for idiopathic male infertility, however, has not been demonstrated conclusively by clinical trials. With better understanding of the underlying pathophysiology of idiopathic male infertility, careful evaluation of endocrine therapy in well-selected treatment groups and well-designed randomized, controlled trials is warranted. Although empiric endocrine therapy for idiopathic male infertility has been largely replaced by assisted reproductive techniques, both treatment modalities could play a role, perhaps as combination therapy.     

The role of infections and leukocytes in male infertility

Declining birth rates are one of the problems facing society today. Male counterparts are responsible for about half of the infertility cases, and genitourinary tract infections may play a contributing role in approximately 15% of male infertility cases. Leukocytospermia is an established indicator of infection in the male urogenital tract, although other microorganisms such as bacteria and virus may also be contributors to the etiology of male infertility. The pathophysiology of these infectious agents may be initiated by a local inflammatory reaction resulting in an increase in reactive oxygen species (ROS). This results in testicular injury, thereby affecting sperm morphology, sperm motility, sperm viability and elevation of the seminal leukocyte as a result of the genital tract infection. The infectious and inflammatory changes can result in male infertility. It is proposed that high concentrations of seminal leukocyte and infectious agents may affect sperm function resulting in clumping of motile spermatozoa, decreasing acrosomal functionality and also causing alterations in sperm morphology. However, the literature has poorly clarified the role of infection in male infertility, provoking further debate and research on this topic.