80例男性不育症病因学新探

采用多聚酶链反应（RCR）技术．对80例男性不育症者进行生殖道解脲支原体（Uu）及沙眼衣原体（CT）检测，结果Uu－DNA阳性25例，CT－DNA阳性13例，3例Uu－DNA、CT－DNA均为阳性，经此病因学调查发现NGU（非淋菌尿道炎）与男性不育有密切关系。在治疗过程中首先治愈UU和CT感染后，再给予中医分型辨证施治,疗效明显提高。     

Lymphoid hyperplasia and eosinophilic pneumonia as histologic manifestations of amiodarone-induced lung toxicity

Amiodarone use is often limited by pulmonary toxicity. Amiodarone lung disease (ALD) classically manifests as organizing pneumonia with intra-alveolar foamy macrophages, but other patterns may also occur. Here we report 2 previously unreported patterns of ALD: lymphoid hyperplasia (LH) and eosinophilic pneumonia (EP). We identified patients with LH or EP as a prominent feature among 75 cases of probable ALD from the authors' teaching files collected from 1997 to 2010. Clinical history and lung wedge biopsies were reviewed. Twelve patients (7 men) met inclusion criteria (median age, 71 y). The exact amiodarone dose was known in all cases (median, 200 mg/d). Treatment duration was known in 10 cases and ranged from 1 to 12 years. Thoracic imaging showed diffuse infiltrates causing concern for a diagnosis of ALD. Histologic review revealed intra-alveolar foamy macrophages in all cases. Eight cases prominently displayed patterns of LH, including diffuse LH (7), follicular bronchiolitis (5), lymphoid interstitial pneumonia (2), and lymphocytic perivascular cuffing (2). Two showed features of acute EP, including diffuse alveolar damage with abundant eosinophils. Two showed features of chronic EP, including interstitial pneumonia with abundant eosinophils, patchy organization, and fibrinous exudates with macrophages and eosinophils. One chronic EP case also showed focal LH. Additional features included intra-alveolar giant cells (6), pleuritis (3), small poorly formed granulomas (3), and thrombi (2). LH and EP are previously unrecognized histopathologic manifestations of ALD, and amiodarone exposure should be included in their differential diagnosis.     

Transalveolar fluid absorption ability in rat lungs preserved with Euro-Collins solution and EP4 solution

BACKGROUND: Pulmonary reimplantation response, presenting lung edema, is a major obstacle of lung transplantation. Transalveolar fluid absorption mechanism, regulated by active transalveolar Na+ transport via Na+ channel and Na+-K+-ATPase, is considered to be essential for resolution of lung edema. We investigated the effect of lung preservation on this fluid transport mechanism. METHODS: The rat lungs were flushed and preserved with either EP4 solution (EP4) or Euro-Collins solution (EC). First, we determined the basal transalveolar fluid movement by calculating alveolar fluid clearance (AFC) after pulmonary flushing, 24- and 72-hr preservation. Then, we assessed the effects of Na+ channel blocker, amiloride, and Na+-K+-ATPase inhibitor, ouabain, on AFC after 24-hr preservation. We further measured lung ATP content and Na+-K+-ATPase activity after 24-hr preservation to evaluate cellular metabolism and enzymatic activity during preservation. RESULTS: We found that the lungs preserved with EC showed significantly lower AFC and less inhibitory effects of both blockers than with EP4 after 24-hr preservation. Na+-K+-ATPase activity was significantly lower with EC than with EP4, even though lung ATP content was not affected by preservation solution. CONCLUSIONS: EP4 preservation provides a better environment for maintaining transalveolar fluid absorption mechanism than EC preservation. Therefore, lung preservation with EP4 may ensure more reliable ability in resolving pulmonary edema.     

324例肠神经元发育异常患儿病理特点与术后并发症关系分析

目的 探讨肠神经元发育异常的病理特点及其与术后并发症之间的关系。方法 总结324例肠神经元发育异常患儿的术后病理检查的特点,并对照相应的治疗效果和术后并发症,进行统计分析。结果 324例患儿中,先天性巨结肠（Hirschsprung＇s disease,HD）210例,肠神经元发育不良（intestinal neuronal dysplasia,IND）38例,HD伴IND45例,神经节细胞减少症8例,HD伴神经细胞节减少22例,神经节细胞未成熟症1例。不同病理类型在扩张段神经元正常的比例分别为HD88,1％,HD伴IND24,4％,IND18,4％,神经节细胞减少症4／8,HD伴神经细胞节减少27．7％,神经节细胞未成熟症0／1。全组有46例患儿术后出现反复小肠结肠炎（EC）。HD、HD伴IND、IND患儿的术后反复EC发生率分别为6,7％、35,6％、28．9％;切缘正常组与切缘IND组术后反复EC发生率分别为8,7％、38．2％;经肛门手术和经腹手术术后EC的发生率分别为18．0％和8．3％。术后仍有反复腹胀、便秘或严重的EC行再次手术9例,其中4例为HD伴IND,1例为IND,3例HD,1例HD伴神经细胞节减少。结论 肠神经元发育异常的神经元分布与大体病理改变有不平衡性,巨结肠同源病较HD神经元分布更不典型;单纯HD的治疗效果较好,术后小肠结肠炎发生率低;切缘仍有IND病变以及经肛门手术是术后反复EC的危险因素;术中冰冻切片对判断切缘神经元有重要意义;IND的切除范围仍有不确定性。     

Bone biomechanical properties in prostaglandin EP1 and EP2 knockout mice

Prostaglandins play an important role in regulating the bone adaptation response to mechanical stimuli. Prostaglandin E2 (PGE2) is an effective modulator of bone metabolism. Administration of PGE2 to rodents results in increased cancellous and cortical bone mass translating into enhanced mechanical strength. The PGE2 influence on bone is mediated through four well-characterized receptors (EP1, EP2, EP3, and EP4). Although the PGE2 pathways and mechanisms of action on cells involved in bone adaptation are still under investigation, it is now known that each receptor plays a unique role in regulating PGE2-related bone cell function. The EP1 subtype is coupled with Ca2+ mobilization. The EP2 subtype stimulates cyclic adenosine monophosphate (cAMP) formation. cAMP in turn is responsible for the early cellular signal that stimulates bone formation. This study compared physical and biomechanical properties of bone in EP1 and EP2 knockout mice to their corresponding wild-type controls. Ash weight was measured in the ulnae, and femurs and vertebral bodies were tested in three-point bending and compression, respectively. The results suggest: (a) EP1 receptors have a minimal influence on skeletal strength or size in mice; and (b) EP2 receptors have a major influence on the biomechanical properties of bone in mice. The absence of EP2 receptors resulted in weak bone biomechanical strength properties in the EP2 knockout model as compared with the corresponding wild-type control mice.     

The effect of deletion of cyclooxygenase-2, prostaglandin receptor EP2, or EP4 in bone marrow cells on osteoclasts induced by mouse mammary cancer cell lines

The inducible prostaglandin (PG) synthesis enzyme, cyclooxygenase-2 (COX-2), is involved in osteoclast (OC) formation in cocultures of mouse mammary cancer cell lines (MMT060562 or BALB/c-MC) and bone marrow cells through production of PGE(2). There are four PGE(2) receptors but only the EP2 and EP4 receptors are reported to be important for OC formation. We have investigated the role of COX-2, EP2 receptor, and EP4 receptor in marrow cells for osteoclastogenesis in cocultures of cancer cells and bone marrow cells. We cocultured cancer cell lines with bone marrow cells from COX-2 knockout (-/-), EP2 -/- or EP4 -/- mice compared to wild-type mice. In addition, an EP4 receptor antagonist (EP4 RA) was added in some cocultures. Disruption of COX-2 gene in bone marrow cells had no effect on PGE(2) production and OC formation in cocultures with MMT060562, while it abrogated PGE(2) production and OC formation in cocultures with BALB/c-MC. Disruption of the EP2 gene in bone marrow cells had no effect on OC formation in the cocultures, while disruption of the EP4 gene in bone marrow cells abrogated OC formation in the cocultures. Furthermore, EP4 RA suppressed OC formation and prevented the increase in receptor activator of nuclear factor kappaB ligand (RANKL) mRNA levels in the cocultures. We conclude that COX-2 in cancer cells is responsible for PGE(2) and OC production in cocultures with MMT060562, while COX-2 in bone marrow cells, not cancer cells, is responsible for PGE(2) and OC production in cocultures with BALB/c-MC, and EP4 receptors are essential for OC formation in both cocultures.     

子宫动脉栓塞治疗异位妊娠

目的观察子宫动脉栓塞（UAE）在治疗异位妊娠（EP）中的应用价值。方法收集33例接受UAE治疗（其中13例伴阴道出血）、并于栓塞后1周内接受清宫术或取胚术终止妊娠的EP患者,回顾性分析其DSA表现及疗效。结果33例DSA均表现为病灶局部血供丰富,24例为双侧均等供血（24／33,72．73％）,9例为单侧优势供血（9／33,27．27％）。对所有患者均成功完成双侧UAE33例中,治疗有效32例,无效1例,有效率96．97％（32／33）。结论UAE有利于提高保守治疗EP的成功率。     

231例淋病患者临床特征及应用头孢曲松钠疗效

目的探讨淋病患者的临床特征以及应用头孢曲松钠的疗效。 方法收集2013年5月至2019年12月就诊于首都医科大学附属北京地坛医院皮肤性病科经临床和实验室确诊为淋病且给予头孢曲松钠治疗的患者，筛选出有随访结果的231例患者，对其临床特征、合并感染及治疗随访结果进行分析。 结果231例淋病患者中男性196例（84.8%）、女性35例（15.2%），年龄为[30（26，35）]岁。224例（97%）患者有尿道炎等临床症状。43例（18.6%）患者合并沙眼衣原体感染，50例（21.6%）患者合并解脲脲原体感染，其中15例（6.5%）患者同时合并沙眼衣原体和解脲脲原体感染。女性患者合并沙眼衣原体[31.4%（11/35）]或者解脲脲原体[77.1%（27/35）]的感染率均高于男性[沙眼衣原体：16.3%（32/196）、解脲脲原体：11.7%（23/196））]，差异均具有统计学意义（合并沙眼衣原体：χ² = 4.471、P = 0.034；合并解脲脲原体：χ² = 74.912、P < 0.001）。入组患者经高剂量（≥ 1 g）头孢曲松钠治疗后淋球菌均为阴性，但10例（4.3%）患者随访复查发现淋球菌再感染。 结论淋病患者常合并沙眼衣原体等其他性病病原体感染，本研究尚未发现高剂量（≥ 1 g）头孢曲松钠治疗失败病例，但淋病患者治愈后可发生再感染，故淋病患者治疗后应多次随访复查，及早发现治疗失败或再感染。     

PGE2 Signaling Through the EP4 Receptor on Fibroblasts Upregulates RANKL and Stimulates Osteolysis

Periprosthetic osteolysis is the most common cause of aseptic loosening in total joint arthroplasty. The role of inflammatory mediators such as prostaglandin E2 (PGE2) and osteoclast promoting factors including RANKL in the pathogenesis of osteolysis has been well characterized. However, the PGE2 receptor (EP1, EP2, or EP4), and cell type in which it is expressed, which is responsible for PGE2 induction of RANKL during wear debris–induced osteolysis, has yet to be elucidated. To address this, we used mice genetically deficient in these EP receptors to assess PGE2 and wear debris responses in vitro and in vivo. Wear debris–induced osteolysis and RANKL expression were observed at similar levels in WT, EP1^?/?, and EP2^?/? mice, indicating that these receptors do not mediate PGE2 signals in this process. A conditional knockout approach was used to eliminate EP4 expression in FSP1⁺ fibroblasts that are the predominant source of RANKL. In the absence of EP4, fibroblasts do not express RANKL after stimulation with particles or PGE2, nor do they exhibit high levels of osteoclasts and osteolysis. These results show that periprosthetic fibroblasts are important mediators of osteolysis through the expression of RANKL, which is induced after PGE2 signaling through the EP4 receptor.     

A comparative study of multimodality evoked potentials and computed tomography in head injuries]

Multimodality evoked potentials (EPs) or three types of EPs--auditory brainstem response (ABR), somatosensory evoked potential (SEP), and visual evoked potential (VEP)--were recorded in 51 cases of traumatic intracranial hemorrhage within 3 days after injury. In order to assess these EPs, five EP grades were constructed, from normal, Grade I, to highly abnormal, Grade V. Furthermore, an EP pattern classification was devised to integrate the respective EP grades. Namely, PA, consisting of all three EPs within Grades I-III; PB, composed of one type of EP or both ABR and VEP at Grades IV and V; PC, consisting of both SEP and VEP at Grades IV and V; PD, comprising both ABR and SEP at Grades IV and V; and PE, covering all three EPs at Grades IV and V. PA signifies "no severe damage," PB, "localized damage," PC, "severe cerebral damage," PD, "severe brainstem damage," and PE, "severe diffuse damage." The results when compared with computed tomography (CT) findings were as follows: 1) The size of hematoma correlated with the SEP grade in 16 cases of acute epidural hematoma; a hematoma diameter of 17.5 mm was the threshold value at which SEP abnormalities developed. Eleven patients who underwent surgical removal of the hematoma showed "no severe damage," and the outcome was good. 2) In 13 cases of acute subdural hematoma, six cases revealed "severe cerebral damage" or "severe diffuse damage." In such cases, the degree of damage was not related to the hematoma size, and the outcome was very poor. 3) In 13 cases of a solitary contusional hemorrhage, only one case revealed "severe diffuse damage" and subsequently died.(ABSTRACT TRUNCATED AT 250 WORDS)     

北京地区宫外孕与节育方法使用关系的流行病学调查

应用流行病学监测调查方法,在获取北京地区育龄妇女官外孕发病率的基础上,对该人群中的2076298名已婚育龄妇女宫外孕与节育方法使用之间的关系进行归因分析。结果显示:宫外孕与节育方法使用之间有相关关系。女性绝育术、宫内节育器、避孕药及外用药具避孕(避孕套、膏、膜)均有不同程度的降低官外孕发病率的作用。自然避孕方法(安全期、体外排精)则具有增加宫外孕发病率的趋势。本研究数据对正确评估节育方法使用的安全性及促进其安全使用均具有重要意义。     

The importance and frequency of mixed infections with Chlamydia trachomatis and mycoplasmas in acute gonococcal urethritis

Chlamydia trachomatis, Ureaplasma urealyticum and Mycoplasma hominis are frequently involved in gonococcal urethritis. We investigated 143 male White and Black patients with gonococcal urethritis (average age 22,5 years). Of these 29% had coexisting Chlam. trachomatis infection, 34% U. urealyticum infection and 13% Mycoplasma hominis infection. Conventional penicillin therapy did not affect Chlam. trachomatis, U. urealyticum or Mycoplasma hominis, which persisted in the lower urogenital tract, causing a so-called 'post-gonococcal urethritis.' Additional therapy with tetracycline or erythromycin was successful in most cases.     

Endoscopic Parathyroid Surgery: Results of 365 Consecutive Procedures

In recent years, several series have documented the feasibility of endoscopic approaches for parathyroid diseases. We performed a retrospective study to evaluate the results of endoscopic parathyroidectomy (EP) in the management of our patients with primary hyperparathyroidism (PHPT). During a 5.5 year period (1998–2003), we operated on 644 patients with PHPT. EP was proposed for patients with sporadic PHPT, without associated goiter, and without previous neck surgery in whom a single adenoma was localized by means of sonography and sestamibi scanning. EP was performed by the lateral approach with insufflation for patients with an adenoma located deep in the neck and by a gasless midline approach for patients whose adenoma was located anteriorly. A quick parathyroid (QPTH) assay was used during the surgical procedures. Among 644 patients with PHPT, 279 (43.3%) were not eligible for EP for the following reasons: associated nodular goiter (116 cases), previous neck surgery (52 cases), suspicion of multiglandular disease (31 cases), lack of preoperative localization (61 cases), and miscellaneous causes (19 cases). EP was performed in 365 patients with sporadic PHPT: 339 lateral access, 25 midline access, and one thoracoscopy. The median operating time was 49 minutes (16–130 minutes). Conversion to conventional parathyroidectomy was required in 49 patients (13.4%) for these reasons: missed adenomas (14 cases), difficulty with the dissection (8 cases), multiglandular disease correctly predicted by QPTH (11 cases), false-negative QPTH assay results (4 cases), false-positive sestamibi scan results (11 cases), and 1 false-positive sonography result. One patient presented with definitive recurrent nerve palsy. Three patients remained hypercalcemic, and one other patient had recurrent hypercalcemia. In conclusion, EP can be proposed for more than half of the patients with PHPT. Immediate results of EP are similar to those obtained with conventional parathyroidectomy, but no conclusions can be drawn in terms of the influence of EP on the outcome of the patients operated on for PHPT.This article was presented at the International Association of Endocrine Surgeons meeting, Uppsala, Sweden, June 14–17, 2004.     

Association of ureaplasma urealyticum with abnormal reactive oxygen species levels and absence of leukocytospermia

PURPOSE: Ureaplasma urealyticum is a commensal of the lower genitourinary tract of many sexually active adults. The organism is more common in partners of infertile than fertile marriages. We conducted a prospective study at our tertiary care center to confirm a possible association between U. urealyticum and abnormal sperm function parameters. MATERIALS AND METHODS: A total of 50 consecutive male patients seeking general urology consultation for lower urinary tract symptoms characteristic of chronic prostatitis were evaluated. Urine and semen localization cultures were performed with additional semen cultures for U. urealyticum, Chlamydia trachomatis and Mycoplasma hominis. Specimens from 21 healthy men were used as controls. Specimens were analyzed by a computer assisted semen analyzer, and verified manually for concentration, percent motility and morphology. Leukocytospermia was measured by the Endtz test. Semen specimens were also analyzed for reactive oxygen species (ROS), acrosome reaction and mannose binding assay. RESULTS: Of the patients 17 had positive U. urealyticum cultures and the other cultures were negative. Patients with U. urealyticum had significantly higher ROS levels (log [ROS + 1] = 2.52 +/- 0.25) than those without U. urealyticum (1.49 +/- 0.20, p = 0.002) or controls (1.31 +/- 0.19, p = 0.002). Leukocytospermia was detected in only 1 of the 17 (6%) positive specimens and 4 (12%) negative specimens. CONCLUSIONS: Seminal ROS levels are elevated among patients with U. urealyticum. ROS induces lipid peroxidation, which reduces membrane fluidity and sperm fertilization capability, and may be the mechanism by which U. urealyticum impairs sperm function. Absence of leukocytospermia does not exclude U. urealyticum.     

Late onset erythropoietic porphyria (Gunther's disease)

Congenital erythropoietic porphyria (CEP) or Gunther's disease is inherited disorder of porphyrin heme synthetic pathway that usually presents early in life. A very rare form of this disease has its onset in later years of life, called late onset erythropoietic porphyria (late onset EP). Fourteen cases of late onset EP have been reported to-date. We report another case of this rare entity in a 40 years old male with associated findings of haemolysis and thrombocytopenia.     

Protective effect of prostaglandin E2 receptors EP2 and EP4 in alloimmune response in vivo

Prostaglandin E2 (PGE2) is produced during inflammatory responses mediating a variety of both innate and adaptive immune responses through 4 distinct receptors: EP1 to EP4. The use of gene-targeted mice and selective agonists/antagonists responsible for each receptor has gradually revealed that each receptor plays a unique and important role in various disease conditions. In addition, PGE2 is known to have some immunosuppressive properties. In this study, we investigated the role of PGE2 receptors by examining the therapeutic efficacy of highly selective receptor agonists on the alloimmune response in vivo. We used a fully major histocompatibility complex (MHC)-mismatched murine cardiac transplantation model. C57BL/6 cardiac allografts were heterotopically transplanted into BALB/c recipients. We treated mice with a highly selective agonist for each EP receptor. EP2 and EP4 agonists significantly prolonged allograft survival compared with controls. In particular, the EP4 agonist was more effective than the EP2 agonist in the inhibition of acute allograft rejection. In conclusion, PGE2 receptors merit further study as novel therapeutics for clinical transplantation.     

辅助生殖技术后异位妊娠相关因素分析

目的探讨接受辅助生殖技术（ART）助孕后发生异位妊娠（EP）的相关因素。方法对我中心2006年11月至2010年6月接受体外受精一胚胎移植（IVF-ET）、卵胞浆内单精子注射-胚胎移植（ICSI-ET）、冻融胚胎移植（FET）治疗后发生EP的病例进行回顾性分析。结果4,219个周期获妊娠1,773例（42．02％）,EP52例,发生率2．93％（52／1,773）,其中单纯输卵管妊娠占88．46％（46／52）,宫内外同时妊娠3例,发生率5．77％（3／52）,宫颈妊娠、卵巢妊娠、宫角妊娠各1例,发生率各占1．92％（1／52）;3种ART方式发生率比较,IVF-ET显著高于ICSI—ET和FET（P~0．05）,ICSI—ET和FET无统计学差异;异位妊娠史、盆腔手术史、输卵管炎和子宫内膜异位症是发生EP的重要危险因素,胚胎移植数与EP发生无显著相关性。结论输卵管因素是ART后发生EP的主要因素。     

泌尿生殖道炎症病人支原体感染现况及耐药性分析

目的 :了解泌尿生殖道炎症病人支原体感染现况及耐药性情况。　方法 :统计 1999～ 2 0 0 3年门诊诊断为非淋菌性尿道炎 (NGU)、慢性前列腺炎及盆腔炎等泌尿生殖道疾病病人 30 5 5例 ,分析其支原体培养及药物敏感试验结果。　结果 :30 5 5例病人共检出支原体感染 992例 ( 32 .5 % ) ,5年间差异无显著性 (P <0 .0 5 )。其中单纯溶脲脲原体 (Uu)感染 70 1例 ( 70 .7% ) ,单纯人型支原体 (Mh)感染 4 4例 ( 4 .4 % ) ,Uu和Mh混合感染 2 4 7例 ( 2 4 .9% ) ,单纯Uu感染远高于混合感染和单纯Mh感染 (P <0 .0 1)。单纯Uu感染计数≥ 10 4cfu/ml占 76 .7% ,而单纯Mh感染者≥10 4cfu仅占 18.2 %。对强力霉素、原始霉素、交沙霉素和四环素敏感性较高 ,分别为 94 .3%、96 .6 %、86 .5 %和97.4 % ,对红霉素和氧氟沙星敏感性仅 5 4 .8%和 2 9.4 %。　结论 :在对病人进行支原体检测时 ,应同时进行Uu和Mh的检测 ,并做支原体药物敏感试验 ,以合理选择抗生素。     

Detection of Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum (biovar 1) and Ureaplasma urealyticum (biovar 2) in patients with non-gonococcal urethritis using polymerase chain reaction-microtiter plate hybridization

AIM: To use polymerase chain reaction (PCR)-microtiter plate hybridization assays to detect Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum (biovar 1) and Ureaplasma urealyticum (biovar 2) in first-voided urine specimens from patients with non-gonococcal urethritis (NGU). METHODS: A total of 153 male patients with NGU, who visited one of 24 clinics in Japan, were recruited for this study. All were examined using PCR-microtiter plate hybridization assays for the presence of M. genitalium, M. hominis, U. parvum (biovar 1) and U. urealyticum (biovar 2) in first-voided urine specimens. They were also examined for the presence of Chlamydia trachomatis. RESULTS: Of these 153 patients, 73 (47.7%) were positive for C. trachomatis. Overall, the prevalence was 17.0% for M. genitalium, 16.3% for U. urealyticum (biovar 2), 7.8% for U. parvum (biovar 1) and 2.6% for M. hominis. In the 80 patients with non-chlamydial NGU, the prevalence of M. genitalium, U. urealyticum (biovar 2), U. parvum (biovar 1) and M. hominis was 23.8%, 18.8%, 8.8% and 2.6%, respectively. CONCLUSIONS: This study shows the prevalence of mycoplasmas and ureaplasmas in NGU in Japan. M. genitalium and U. urealyticum (biovar 2) might be pathogens of NGU and could be associated with persistent and recurrent urethritis. When patients with NGU are treated, such pathogens should be taken into account. This PCR-microtiter plate hybridization assay provides a useful method for diagnosing NGU caused by M. genitalium and U. urealyticum (biovar 2).