男性不育患者精子DNA完整性与精浆氧化应激水平的关系及其对体外受精的影响

目的:探讨男性不育患者精子DNA完整性与精液常规参数、精浆氧化应激水平的关系,以及对体外受精(IVF)结局的影响。方法:采用精子染色质扩散法(SCD)检测433个IVF周期中精子DNA损伤性,根据精子DNA碎片指数(DFI)的不同,分为低DFI组(DFI30%)、高DFI组(DFI≥30%),比较2组精子浓度、前向运动精子百分率、快速前向运动精子百分率、精浆丙二醛(MDA)、总抗氧化能力(TAC)水平及受精率、卵裂率、优胚率的差异。结果:高DFI组与低DFI组比较,前向运动精子百分率及快速前向运动精子百分率显著降低[(29.2±16.8)%vs(48.6±16.7)%、(9.4±6.6)%vs(19.0±9.1)%,P0.01],高DFI组精子浓度与低DFI组相比差异无显著性[(52.3±32.4)×106/ml vs(51.4±30.9)×106/ml,P0.05];高DFI组精浆中的MDA含量明显高于低DFI组[(2.28±0.26)nmol/L vs(0.95±0.18)nmol/L,P0.01],高DFI组精浆中的TAC含量明显低于低DFI组[(10.2±3.5)U/L vs(33.2±7.9)U/L,P0.01];高DFI组IVF受精率明显低于低DFI组[(58.9±30.0)%vs(77.2±25.0)%,P0.01],两组间卵裂率[(70.7±35.6)%vs(80.4±15.6]、优胚率[(40.4±31.3)%vs(41.7±29.4)]比较差异均无显著性(P均0.05)。结论:精子DNA损伤与氧化应激有关,同时精子DNA损伤可降低IVF受精率,影响IVF结局。     

血红素加氧酶2和CO在去势大鼠阴茎海绵体中的表达

目的:检测去势大鼠阴茎海绵体中血红素加氧酶2(HO-2)/CO的表达,初步探讨勃起功能障碍(ED)的发病机制。方法:雄性SD大鼠72只均分为对照组、假手术组、去势组和去势锌原卟啉(Zn PP,HO阻断剂)组,检测基础条件和阿扑吗啡(APO)刺激后的海绵体内压(ICP)和勃起率;激光共聚焦显微镜检测大鼠勃起不同时期阴茎海绵体组织中HO-2蛋白的表达,分光光度计测定CO在大鼠勃起不同时期的含量。结果:基础条件和APO刺激后ICP和勃起率,去势组[(11.68±0.69)mm Hg,(54.81±3.86)mm Hg,33.3%]和去势Zn PP组[(11.20±0.71)mm Hg,(41.17±5.41)mm Hg,22.2%],与对照组[(22.83±2.66)mm Hg,(66.92±7.77)mm Hg,100%]和假手术组[(23.35±2.22)mm Hg,(70.43±7.22)mm Hg,100%]比较显著下降(P均0.01),且APO刺激后去势Zn PP组ICP较去势组明显降低(P0.01)。APO刺激后,勃起前和勃起中阴茎海绵体HO-2蛋白表达,去势组(445.4±23.7,847.4±35.0)和去势Zn PP组(390.1±29.7,526.0±52.5)较对照组(512.7±57.4,1 145.2±89.8)和假手术组(583.7±8.0,1 016.3±79.8)显著下降(P0.05或P0.01),且勃起中去势Zn PP组HO-2蛋白表达较去势组明显降低(P0.01);勃起后各组之间的HO-2蛋白表达变化差异无显著性。勃起前、中和后阴茎海绵体CO含量,去势组[(20.59±1.01)×10-7nmol/L,(32.53±1.26)×10-7nmol/L,(18.71±1.22)×10-7nmol/L]和去势Zn PP组[(12.52±1.05)×10-7nmol/L,(21.90±1.02)×10-7nmol/L,(16.56±0.55)×10-7nmol/L]较对照组[(26.76±1.41)×10-7nmol/L,(48.25±1.01)×10-7nmol/L,(27.10±1.58)×10-7nmol/L]和假手术组[(25.41±2.09)×10-7nmol/L,(47.90±1.22)×10-7nmol/L,(25.67±1.20)×10-7nmol/L]显著下降(P0.05或P0.01),且勃起中去势Zn PP组CO含量较去势组明显下降(P0.01)。结论:HO-2和CO表达下降与去势大鼠ED的发生有关。     

藏药鲁堆多吉水提物对雄性幼年大鼠生殖系统的影响

目的:研究藏药鲁堆多吉对雄性幼年大鼠生殖系统的影响。方法:将32只SD雄性幼年大鼠分为对照组、鲁堆多吉水提物低、中、高剂量组,灌胃2周后处死,用放射免疫法检测大鼠血清中睾酮(T)的含量,用ELISA试剂盒测量大鼠血清中LH和FSH的含量,称量大鼠的睾丸重量,计算体重增加量、睾丸脏器系数和精子浓度。将高剂量组大鼠血清在57℃水浴锅中灭活后,按0(对照组)、10%、15%、20%的体积分数加到培养的大鼠睾丸间质细胞中,分别用台盼蓝染色法和MTT检测细胞活率和活力,用放免法检测睾丸间质细胞培养液中T的含量,用大鼠环磷酸腺苷(cAMP)ELISA试剂盒检测睾丸间质细胞内cAMP的变化。结果:与对照组相比,低、中、高剂量的鲁堆多吉水提物能使幼年雄性大鼠的血清T水平[(1.22±0.32)、(1.06±0.29)、(0.57±0.18)nmol/L vs(3.09±0.42)nmol/L,P0.01]、睾丸重量[(0.96±0.09)、(0.92±0.11)、(0.91±0.08)g vs(1.40±0.16)g,P0.01]和精子浓度[(0.19±0.07)、(0.17±0.08)、(0.16±0.07)×106/ml vs(1.03±0.16)×106/ml,P0.01]显著降低,并且呈剂量依赖性。与对照组相比,中、高剂量给药组血清中的LH[(14.69±0.12)、(14.93±0.28)ng/L vs(13.62±0.89)ng/L,P0.01]、FSH[(4.77±0.23)、(4.89±0.38)IU/L vs(4.32±0.18)IU/L,P0.05]显著上升;睾丸脏器系数[(51.39±3.09)、(52.28±4.86)、(54.13±6.06)mg/10 g vs(42.22±3.02)mg/10 g,P0.01]显著提高。与对照组相比,鲁堆多吉水提物含药血清能显著抑制睾丸间质细胞内cAMP水平[(4.39±0.06)、(4.28±0.07)、(4.11±0.10)nmol/L vs(5.51±0.12)nmol/L,P0.01]和T的合成[(1.42±0.15)、(1.12±0.18)、(0.88±0.21)nmol/L vs(1.85±0.18)nmol/L,P0.01]。结论:鲁堆多吉水提物可能通过PKA途径抑制大鼠睾丸间质细胞中T的合成,从而抑制睾丸发育和精子生成,影响雄性幼鼠生殖系统的发育。     

肥胖对雄性大鼠生殖功能影响的机制研究

目的研究肥胖对雄性大鼠生殖功能的影响,初步探讨其氧化损伤的相关机制。方法 6周龄SD雄性大鼠随机分成对照组(普通饮食,15只)和肥胖组(高脂饮食,30只)。喂养16周后,处死,测定体重、脏器系数、代谢参数和生殖内分泌激素(GnRH、FSH、LH、TT、E_2)和SHBG,检测睾丸生精细胞凋亡、氧化应激和附睾精子参数,比较两组各指标差异。结果与对照组大鼠相比,肥胖组大鼠体重和Lee指数明显增加,血清瘦素(Lep)[(3.17±0.23)ng/ml vs.(2.33±0.21)ng/ml]、胰岛素(INS)[(28.99±2.43)μU/ml vs.(20.62±1.72)μU/ml]和甘油三酯(TG)[(0.55±0.03)mmol/L vs.(0.36±0.04)mmol/L]显著升高,血清GnRH[(36.46±1.95)pg/ml vs.(45.51±2.75)pg/ml]、LH[(3.06±0.37)U/L vs.(4.67±0.70)U/L]、总睾酮(TT)[(0.81±0.13)ng/ml vs.(1.98±0.32)ng/ml]、SHBG[(55.31±3.80)nmol/L vs.(71.69±4.65)nmol/L]显著降低,差异均有统计学意义(P0.05);TUNEL结果显示,肥胖组大鼠睾丸生精细胞凋亡指数显著高于对照组[(4.26±0.35)%vs.(3.09±0.28)%,P0.05];氧化应激结果表明,肥胖组大鼠的MDA上升、SOD降低,差异有统计学意义(P0.05);附睾精子分析发现,与对照组相比,肥胖组大鼠的精子活力显著下降[(14.36±7.67)%vs.(36.40±9.17)%,P0.01],而精子浓度无显著性差异(P0.05)。结论高脂饮食诱导雄性大鼠的肥胖,代谢和生殖内分泌紊乱,氧化损伤增加,导致生精细胞凋亡增加,并最终使精子活力下降。     

不同睾丸活检术对睾丸功能及抗精子抗体的影响

目的:研究不同睾丸活检术对无精子症患者血清抑制素B(INHB)、血清抗精子抗体(As Ab)、卵泡刺激素(FSH)、睾酮(T)的影响。方法:选取无精子症患者210例,根据不同的睾丸活检手术方式,分为睾丸切开活检取精术(TESE)组50例、睾丸穿刺抽吸取精术(TESA)组56例、睾丸细针穿刺抽吸取精术(TEFNA)组64例、显微睾丸切开取精术(micro-TESE)组40例,分别检测睾丸活检术前及术后1、3个月患者血清INHB、FSH、T水平和As Ab阳性率。结果:4组患者术后1、3个月FSH与术前比较均无显著性差异[TESE:(8.76±3.07)IU/L、(7.24±3.32)IU/L vs(8.51±4.34)IU/L;TESA:(7.90±4.57)IU/L、(8.04±3.65)IU/L vs(7.70±2.72)IU/L;TEFNA:(6.08±2.70)IU/L、(6.10±3.32)IU/L vs(6.04±3.17)IU/L;micro-TESE:(6.89±1.78)IU/L、(6.75±2.57)IU/L vs(6.59±2.74)IU/L,P均>0.05]。TESE组和micro-TESE组术后1个月As Ab Ig M阳性率(14.00%和15.00%)较术前(0.00和2.50%)明显升高(P<0.05)。TESE组和micro-TESE组患者术后1个月T水平[(9.25±5.76)nmol/L和(8.23±4.12)nmol/L]较术前[(16.52±6.25)nmol/L和(14.16±5.45)nmol/L]明显下降(P均<0.05)。TESE、TESA、TEFNA、micro-TESE4组患者术后1、3个月血清INHB较术前均明显下降[TESE:(42.63±15.34)pg/ml、(44.05±18.47)pg/ml vs(70.56±23.17)pg/ml;TESA:(40.55±20.51)pg/ml、(42.11±19.34)pg/ml vs(68.71±14.74)pg/ml;TEFNA:(46.31±19.28)pg/ml、(48.32±20.54)pg/ml vs(76.81±27.04)pg/ml;micro-TESE:(45.27±18.83)pg/ml、(47.64±28.34)pg/ml vs(74.74±28.35)pg/ml,P均<0.05],但不同方法组组间无统计学差异(P>0.05)。结论:不同睾丸活检术对无精子症患者睾丸功能及As Ab有影响,且存在一定差异。     

麒麟丸对少弱精子症模型雄性大鼠生殖功能的保护作用研究

目的:研究麒麟丸对雷公藤多苷所致少弱精子症模型雄性大鼠的生殖功能保护作用。方法:取28只雄性SD大鼠,随机分成正常对照组、模型组、麒麟丸低、高剂量组,除正常对照组外,其他各组灌服雷公藤多苷40 mg/(kg·d),同时麒麟丸给药组同日给予不同剂量麒麟丸保护,低剂量组给予麒麟丸1.62 g/(kg·d),高剂量组给予麒麟丸3.24 g/(kg·d)。连续给药30 d后,处死大鼠,称重大鼠睾丸,计算睾丸脏器指数,检测附睾精子浓度、活动率,检测生殖激素水平,评估抗氧化指标,HE切片观察大鼠睾丸组织形态学改变。结果:实验结束后,麒麟丸低、高剂量组精子浓度分别为(14.57±3.95)×10~6/ml、(39.71±11.31)×10~6/ml,精子活力为(3.71±1.11)%、(4.29±1.80)%皆较模型组(4.71±1.25)×10~6/ml、(0.57±0.53)%有明显提高(P0.05);与模型组FSH(1.71±0.52)mIU/ml比较,麒麟丸低、高剂量组FSH下降,分别为(1.49±0.62)mIU/ml、(1.12±0.83)mIU/ml;fT水平较模型组升高(27.27±3.63)nmol/L、(32.80±2.51)nmol/L vs(22.81±2.75)nmol/L,SHBG水平升高(94.83±11.17)nmol/L、(88.05±9.21)nmol/L vs(56.74±8.29)nmol/L,差异皆有显著性(P0.05),但T水平无明显变化(P0.05)。与模型组比较,麒麟丸低、高剂量组SOD水平升高(277.14±15.84)U/ml、(299.60±20.83)U/ml vs(250.04±31.06)U/ml;ROS水平下降(397.61±62.71)IU/ml、(376.84±67.14)IU/ml vs(552.20±58.07)IU/ml(P0.05)。与模型组比较,低、高剂量组HE染色显示麒麟丸能增加少弱精子症大鼠睾丸生精小管内各级生精细胞层次和数量。结论:麒麟丸能明显提高少弱精子症大鼠精子质量,改善生殖激素水平,减轻氧化应激损伤,改善大鼠睾丸组织形态,对生殖系统有较好的保护作用。     

富马酸二甲酯对小鼠肾缺血再灌注损伤的保护作用及其机制

目的探讨富马酸二甲酯(DMF)在小鼠肾脏缺血再灌注损伤中的保护作用及可能的机制。方法将小鼠随机分成3组(n=8):假手术组(S组)、缺血再灌注组(IR组)和DMF预处理组(DMF组)。IR组及DMF组制备肾脏IR模型,再灌注24h后收集血清及肾组织,测定血清肌酐(SCr)及尿素氮(BUN)值;评定肾脏组织形态学改变;检测肾脏组织中丙二醛(MDA)含量及超氧化物歧化酶(SOD)活力;Western-blot检测各组肾组织内核因子E2相关因子2(Nrf2)及血红素氧化酶-1(HO-1)蛋白含量。结果IR组SCr及BUN显著高于S组[(143.17±14.18)μmol/L,(26.52±3.56)mmol/L vs.(24.50±5.54)μmol/L,(8.25±2.14)mmol/L,P0.01];DMF组SCr及BUN均低于IR组[(81.83±9.39)μmol/L,(18.62±2.75)mmol/L vs.(143.17±14.18)μmol/L,(26.52±3.56)mmol/L](P0.01);和IR组比较,DMF组的组织形态学损伤较轻(P0.01);DMF组过氧化损伤指标MDA水平低于IR组[(3.55±0.48)μmol/g vs.(5.48±0.70)μmol/g](P0.01),而抗氧化酶SOD水平高于IR组[(35.02±4.13)kU/g vs.(23.80±4.36)kU/g](P0.01)。Western-blot及免疫组化结果显示DMF组Nrf2和HO-1蛋白表达水平高于IR组(P0.05)。结论 DMF对小鼠肾缺血再灌注损伤具有保护作用,其机制可能与激活Nrf2/HO-1通路进而提高肾脏抗氧化应激能力有关。     

硫辛酸对奥硝唑所致少弱精子症大鼠精子发生的保护作用研究

目的:研究硫辛酸(LA)对奥硝唑(ORN)所致少弱精子症模型雄性大鼠生精功能的保护作用。方法:取70只雄性SD大鼠,随机分成7组,每组10只,分别为:A组(溶剂对照组):1 ml 0.5%羧甲基纤维素钠(CMC-Na)+1 ml橄榄油;B组(低剂量ORN造模组):400 mg/kg ORN+1 ml橄榄油;C组(低剂量ORN+低剂量LA治疗组):400 mg/kg ORN+50 mg/kg LA;D组(低剂量ORN+高剂量LA治疗组):400 mg/kg ORN+100 mg/kg LA;E组(高剂量ORN造模组):800 mg/kg ORN+1 ml橄榄油;F组(高剂量ORN+低剂量LA治疗组):800 mg/kg ORN+50 mg/kg LA;G组(高剂量ORN+高剂量LA治疗组):800 mg/kg ORN+100 mg/kg LA。连续给药20 d,处死大鼠,称量大鼠体重、睾丸、附睾、精囊重量,计算脏器指数,检测附睾精子计数及活力,睾丸、附睾做HE染色观察组织形态学改变。结果:与A组相比,E组大鼠体重增量、睾丸、附睾脏器指数明显减少[(117.67±11.53)g vs(88.11±12.65)g;(1.06±0.12)%vs(0.65±0.13)%;(0.21±0.03)%vs(0.17±0.01)%,P均0.01];与E组相比,F组大鼠附睾脏器指数明显增加[(0.17±0.01)%vs(0.20±0.02)%,P0.01],G组大鼠体重增量、睾丸、附睾脏器指数明显增加[(88.11±12.65)g vs(102.70±16.10)g,P0.05;(0.65±0.13)%vs(0.95±0.06)%,P0.01;(0.17±0.01)%vs(0.19±0.02)%,P0.05],精囊脏器指数各组之间并无明显差异。与A组相比,B组大鼠精子活力明显降低[(74.12±8.73)%vs(40.25±6.08)%,P0.01],E组大鼠精子计数与活力明显降低[(38.59±6.40)×105/100 mg vs(18.67±4.59)×105/100 mg;(74.12±8.73)%vs(27.58±8.43)%,P均0.01];与B组相比,C、D组大鼠精子活力明显增加[(40.25±6.08)%vs(58.13±7.62)%;(40.25±6.08)%vs(76.04±8.44)%,P均0.01];与E组相比,F、G组大鼠精子计数及活力明显增加[(18.67±4.59)×10~5/100 mg vs(25.63±9.66)×10~5/100 mg,P0.05;(18.67±4.59)×10~5/100 mg vs(29.92±4.15)×10~5/100 mg,P0.01;(27.58±8.43)%vs(36.56±11.08)%,P0.05;(27.58±8.43)%vs(45.05±9.59)%,P0.01]。A、B、C、D组大鼠睾丸、附睾组织形态学无明显改变。E组大鼠睾丸与A组相比,生精小管腔内可见坏死脱落的生精细胞,生精细胞层次不清,排列紊乱;附睾管腔中精子数目明显减少,并伴有较多非细胞成分存在。F、G组大鼠睾丸生精小管内精子数目增加,但仍可见到生精小管内有生精细胞脱落,生精细胞层次不清晰,排列紊乱,但较E组有明显改善;F、G组大鼠附睾管腔中精子数目明显减少,可见散在、脱落的生精细胞,但较E组有明显改善。结论:LA能够改善ORN对大鼠造成的生殖系统损伤,提高精子质量,对生殖系统有较好的保护作用。     

中频穴位电刺激联合他莫昔芬片治疗少弱精子症患者的临床研究

目的:探讨中频穴位电刺激联合他莫昔芬片治疗少弱精子症的临床效果及其可行性与安全性。方法:120例少弱精子症患者随机分为他莫昔芬片口服治疗组(他莫昔芬组)、中频穴位电刺激治疗组(穴位电刺激组)与联合治疗组,每组40例。连续治疗8周,记录各组治疗前后的精液体积、精子总数及浓度、总活力、前向运动(PR)精子百分率及血清生殖激素(FSH、LH、T)水平,对比分析3组患者治疗前后的精液参数及生殖激素水平。结果:所有患者均完成本研究,治疗前后3组精液体积无明显改善(P0.05)。与治疗前对比,3组均可改善生殖激素(FSH、LH、T)水平(P0.05);他莫昔芬组可以显著提高精子总数[(42.65±5.78)×10~6vs(25.16±2.05)×10~6,P0.05]及精子浓度[24.31±2.59)×10~6/ml vs(12.15±2.51)×10~6/ml,P0.05],而精子总活力及PR精子百分率无明显改善[(22.61±5.75)%vs(21.78±8.81)%;(16.76±5.86)%vs(15.87±7.81)%,P均0.05];穴位电刺激组可以增加精子总活力率[(32.43±4.97)%vs(24.81±8.27)%,P0.05]及PR精子百分率[(27.17±5.09)%vs(19.71±9.15)%,P0.05],而精子总数及精子浓度无明显改善[(25.87±4.96)×10~6vs(23.23±3.14)×10~6;(14.12±2.47)×10~6/ml vs(11.27±2.24)×10~6/ml,P均0.05];联合治疗组不仅可以提高精子总数[(51.14±3.69)×10~6vs(26.17±5.05)×10~6,P0.05]及精子浓度[(27.28±1.98)×10~6/ml vs(12.78±2.41)×10~6/ml,P0.05],而且可以显著提高精子总活力[(37.12±5.33)%vs(23.89±9.05)%,P0.05]及PR精子百分率[(31.09±7.12)%vs(17.14±8.04)%,P0.05],并且显著优于他莫昔芬组和穴位电刺激组(P0.05)。联合治疗组总有效率(97.5%)显著高于他莫昔芬组(72.5%)和穴位电刺激组(75.0%),P0.05。结论:中频穴位电刺激联合他莫昔芬片口服可以明显改善特发性少弱精子症患者的精液质量和生殖激素水平,有一定的临床推广意义。     

血红素氧化酶-1介导脂联素在脓毒症肺损伤中的保护作用

目的 探讨血红素氧化酶-1(heme oxygenase,HO-1)介导脂联素(adiponectin,APN)在脓毒症肺损伤中的保护作用.方法 80只雄性Wistar大鼠采用随机数字表法分为4组(每组20只):对照组(C组)、脓毒症模型组(LPS组)、脂联素预处理组(APN组)和HO-1抑制剂锌原卟啉IX(zinc protoporphyrin IX,ZnPP IX)干预组(Zn组).各组分别于腹腔注射脂多糖(lipopolysaccharide,LPS) (20 mg/kg)或0.9％氯化钠溶液后6h,采用酶联免疫吸附法检测血清中肿瘤坏死因子(tumor necrosis factor-alpha,TNF-α)和白介素(interlukin-6,IL-6)的含量.采用分光光度法测定一氧化氮(nitric oxide,NO)浓度、肺组织丙二醛(malonaldehyde,MDA)和髓过氧化物酶(myeloperoxidase,MPO)活性变化.采用实时荧光定量聚合酶链反应(real-time PCR)法检测肺组织HO-1、诱导型一氧化氮合成酶(inducible nitric oxide synthase,iNOS)mRNA的表达水平.观察5d内大鼠生存情况,并绘制生存曲线. 结果 与C组比较,LPS组、APN组和Zn组血清TNF-α [(321.3±11.2)、(132.5±10.2)、(311.7±12.4)vs (52.1±1.4)] ng/L、IL-6[(2 229.26±210.25)、(1 134.14±11.24)、(2 028.27±167.04)vs(55.38±0.23)] ng/L、NO[(103±10)、(79±8)、(97±9)vs(48±3)] μmol/L和肺组织匀浆MDA[(16.209±0.151) 、(5.943±0.310)、(13.238±0.326)vs(3.081 ±0.017)] μmol/g、MPO[(12.42±0.46)、(6.77±0.14)、(10.45±0.21)vs(2.74±0.06)] U/g水平显著升高(P＜0.05),生存率显著下降(20％ vs 100％;70％ vs 100％;30％ vs 100％,P＜0.05);与LPS组比较,APN组血清TNF-α [(132.5±10.2)vs (321.3±11.2)] ng/L、IL-6 [(1 134.14±107.13)vs(2229.26±210.25)] ng/L、NO[(79±8)vs (103±10)] μmol/L和肺组织匀浆MDA[(5.943±0.310)vs (16.209±0.151)] μmol/g、MPO [(6.77±0.14)vs (12.42±0.46)] U/g水平显著降低(P＜0.05),肺组织HO-1 mRNA[(8.73±0.24)vs(1.54±0.03)]显著升高(P＜0.05),iNOS mRNA[(1.42±0.15)vs(2.01±0.10)]显著下降(P＜0.05),生存率显著增高(70％ vs 20％,P＜0.05);与APN组比较,Zn组血清TNF-α[(311.7±12.4)vs(132.5±10.2)] ng/L、IL-6[(2 028.27±167.04)vs(1 134.14±107.13)]ng/L、NO[(97±9)vs(79±8)] μmol/L和肺组织匀浆MDA[(13.238±0.326)vs(5.943±0.310)] μmol/g、MPO[(10.45±0.21)vs(6.77±0.14)] U/g水平显著升高(P＜0.05),肺组织HO-1 mRNA[(2.66±0.14)vs (8.73±0.24)]显著下降(P＜0.05),iNOS mRNA[(2.06±0.23)vs(1.42±0.15)]显著升高(P＜0.05),生存率显著下降(30％ vs 70％,P＜0.05). 结论 HO-1可能介导了APN在脓毒症性肺损伤中的保护作用.     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.