大鼠输精管结扎对生精细胞凋亡的影响(摘要)

大鼠输精管结扎对生精细胞凋亡的影响（摘要）沈凯唐孝达杨宇如黄明孔李虹本研究采用大鼠作为研究对象，对输精管结扎后生精细胞的凋亡状况进行了初步检测，为从理论上对输精管结扎法进行深入评价打下基础。材料与方法健康雄性大白鼠（Ｗｉｓｔａｒ，封闭群）９０只，体重...     

输精管复通后大鼠睾丸生精细胞凋亡状况的研究

目的 研究输精管阻断所生精细胞凋亡状况在输精管复通后的变化。方法 以雄性ＳＤ大鼠为研究对象，建立输精管阻断及阻断后复通模型，采用ＮＤＡ缺口原位标记凋亡细胞方法，观察大鼠生精细胞在输精管复通后４、８、１２及１６周的凋亡状况。结果 生精细胞凋亡逐渐减轻，至复通后８周开始显著少于阻断组（Ｐ〈０．０５），但８周和１２周仍显著多于阻断前水平（Ｐ〈０．０５），至１６周凋亡细胞数接近阻断前水平（Ｐ〉０．０５）。     

人输精管结扎后睪丸病理学变化

输精管结扎术系目前世界上男性最常用的避孕措施之一。随着输精管复通技术的进展及再婚率增高,每年要求做输精管复通的人越来越多。输精管复通术后生育调查表明其生育力低下,怀孕率为40-70％不等,其原因目前认为与精子抗体产生、神经损伤及附睾功能受损有关,但动物实验显示输精管结扎术后也会产生各种睾丸损害。有关人类输精管结扎对睾丸组织的长期影响报道甚少,本文就有关这方面的研究作一简单复习。一、输精管结扎后睾丸病理改变(一)曲细精管和Sertoli细胞:在人类已经观察到输精管结扎后睾丸曲细精管具有明显改变,其特征如下:1.生精细胞排列紊乱,精子生成停滞:Fletcher(1974)等对13例输精管结扎男性     

生精细胞凋亡与激素调控

生精过程中细胞凋亡既可维持正常精子数量又是导致少精无精症的重要机制之一 ,目前越来越多的研究表明 ,激素对生精细胞凋亡的调控有着重要作用。本文就T、FSH、LH、E2、PRL等激素对生精细胞凋亡的影响及机制作一综述。     

雄激素与精子发生的关系

雄激素被认为在精子发生中具有重要作用.近年的动物实验以及临床研究提示,雄激素可以导致严重少精子或者无精子症,内源性睾酮可以引起生精细胞凋亡,与生精细胞阻滞高度相关.本文对近年的材料进行分析后,认为雄激素与精子发生的关系在于,雄激素可以引起生精细胞凋亡,造成细胞重排,对精子发生起到调节作用.     

FAS/FASL系统介导的生精细胞凋亡在男性生殖中的作用

生精细胞凋亡是机体清除过量及缺陷生精细胞的正常生理机制,其病理状态下的过度凋亡会导致少、弱精子症发生.FAS/FASL系统是介导哺乳动物睾丸生精细胞凋亡的主要途径.FASL特异性的与生精细胞膜上的FAS结合后,通过胞内肽段的死亡结构域激活相关的半胱天冬氨酸酶级联反应,诱导其凋亡.FAS/FASL系统在调节生精细胞凋亡中发挥重要作用,FAS与FASL的结合可触发细胞凋亡,是人体生长发育过程中正常的生理现象,但其过度表达会对精子数量质量产生不利影响.本文综述FAS/FASL系统在生精细胞凋亡中的作用,并讨论与之相关的特发性少、弱精子症所致男性不育.     

睾丸支持细胞和间质细胞在生精细胞凋亡中的作用

睾丸精子发生过程中存在生精细胞凋亡，支持细胞和间质细胞作为非生殖细胞对生精细胞凋亡具有重要作用，本文对这方面的研究作一综述。     

睾丸支持细胞和间质细胞在生精细胞凋亡中的作用

睾丸精子发生过程中存在生精细胞凋亡，支持细胞和间质细胞作为非生殖细胞对生精细胞凋亡具有重要作用。本文对这方面的研究作一综述。     

生精细胞凋亡与激素调控

生清过程中细胞凋亡既可维持正常精子数量又是导致少精无精症的重要机制之一，目前越来越多的研究表明，激素对生精细胞凋亡的调控有着重要作用。本文就T、FSH、LH、E2、PRL等激素对生精细胞凋亡的影响及机制作一综述。     

生精细胞凋亡的基因调控

睾丸生精细胞凋亡是维持精子发生动态平衡,限制生精上皮生精细胞数量的一个重要生理机制,受多种因素调控。本文就基因等对精子发生过程中生精细胞凋亡调控的研究近况进行综述。     

Endogenous nitric oxide in the airways of different animal species

Background: High amounts of endogenous nitric oxide (NO) have been demonstrated in the human upper airway, but the role of nasal NO is still unclear. The present study aims to describe nasal NO excretion in different animal species with special living conditions or anatomy.
Methods: Domestic animals (horse, cow, pig, sheep, dog, cat) and zoo-animals (Rhesus monkey, chimpanzee, gorilla, elephant, fur seal, alpaca, yak, dolphin, camel, capybara, bear, tiger, wolf, giraffe, alligator, Harris' hawk, kangaroo) were studied awake, resting or anaesthetised. NO concentrations were measured by chemiluminescence using different analysers and techniques, including measurements on mixed exhaled air, during continuous or intermittent gas sampling, and on single breaths.
Results: Rhesus monkeys (number of individuals N=5) and pigs (N=2) were compared and displayed quite different excretion patterns. Allowing NO to accumulate in the nose during timed occlusions yielded peak concentrations in monkeys of 0.46-CO.07 parts per million (ppm, meanzSEM), 0.590.08 ppm, 0.700.08 ppm and 1.020.05 pprn NO after 15, 30, 60 and 120 s of occlusion. In pigs, 0.012–0.021 ppm NO were recorded, independent of occlusion time. The chimpanzee was similar to the Rhesus monkey and the highest NO value, 2.9 ppm, was recorded after 4–5 min of occlusion. In single breaths from 3 elephants 0.031–0.082 ppm, from 1 gorilla 0.029 ppm, and from 1 chimpanzee 0.0690.003 pprn NO (8 observations) were recorded.
Conclusions: We found considerable species difference in nasal NO excretion with pronounced amounts only in primates and elephants. The physiological implications of these findings remain to be defined.     

Neurological consequences after long-term sedation in the ICU

Experiments performed in mammals, including non-human primates, have demonstrated an increase in neuronal death rates normally seen in normal brain development. Such an increase is encountered in diseases but also after exposure of the brain to various class of anaesthetics. In living animals, it can (but not always) result in persistent cognitive impairment. Most of the experiments have been conducted in animals which were never exposed to any pain, which questions their relevancy. On the clinical side, all data comes from retrospective studies. Given the multiple bias, they cannot definitely state that a protocol, if toxic, is more or less when compared to another. Until now, prospective follow-up of children exposed to anaesthetics in utero or during the first months of life do not suggest a major deleterious effect. Yet, a minor one, if existing, would be hard to detect among polluting variables (e.g. pathology requiring anaesthesia, long hospitalization after birth, preterm birth, environmental stress...). For sure, when surgery is mandatory during pregnancy, it is generally for maternal indication and should not be a motif strong enough for foetal extraction, especially in terms where the baby has few chances to survive. Second, it is known for years than anaesthesia before 1 year of age is much riskier than after 1 year, whatever the theorical neurotoxicity is. Third, this enforces the need to develop tools enhancing the precision of anaesthesia as much as possible. Meanwhile, when an infant has undergone numerous general anaesthesias, we strongly recommend a long-time neurological follow-up.     

The severity and duration of postoperative pain and analgesia requirements in children after tonsillectomy, orchidopexy, or inguinal hernia repair

Objectives: To provide parents of children with accurate information regarding postoperative pain, its management, and functioning following common surgical procedures. Background: The increasing prevalence of pediatric day‐case procedures demands a more thorough understanding of the recovery profiles associated with these operations. Aim: To document postdischarge pain profiles, analgesia requirements, and functional limitation in children following tonsillectomy, orchidopexy, or inguinal hernia repair (IHR). Methods: Following hospital discharge, parents were asked to record their children’s pain levels, analgesia consumption, and degree of functional limitation each day until complete recovery. Pain and functional limitation were measured using the Parents’ Postoperative Pain Measurement (PPPM) scale and Functional Activity Score, respectively. Significant pain was defined as PPPM ≥ 6. Results: One hundred and five patients (50, tonsillectomy; 24, orchidopexy; and 31, IHR) were recruited. Median PPPM was always <6 after IHR, ≥6 only on day 1 after orchidopexy and persisted through to day 8 after tonsillectomy. Mild or severe functional limitation was observed after all surgeries and persisted for 4, 5, and 4 days after median PPPM < 6 after IHR, orchidopexy, and tonsillectomy, respectively. Combination analgesia was commonly administered after orchidopexy and tonsillectomy but less so after IHR. The general practitioner consultation rate following tonsillectomy was 54%. Conclusions: After tonsillectomy, children experience significant pain and severe functional limitation for 7 days after surgery. For many children, pain and functional limitation persists throughout the second postoperative week. In children undergoing orchidopexy, paracetamol and ibuprofen provide adequate analgesia. Pain begins to subside after the first postoperative day, and normal activity resumes after 7 days. After IHR, children experience mild pain that can be treated with paracetamol and return to normal functioning after 4 days.     

Répercussions psychocomportementales en périopératoire chez l’enfant

The relevant literature since the 1940s has been collected from the Medline database, using the keywords: child, operation, anxiety, distress, postoperative complications, preparation, premedication, parental presence, prevention. Preoperative anxiety, emergence delirium, and postoperative behavior changes are all manifestations of psychological distress in children undergoing surgery. Preoperative anxiety is most prominent during anaesthesia induction. Emergence delirium is frequent and somewhat independent of pain levels. Postoperative behavior changes most often include separation anxiety, tantrums, fear of strangers, eating problems, nightmares, night terrors and bedwetting. These difficulties tend to resolve themselves with time but can last up to one year in some children. The major risk factors for postoperative behavior problems are young age, prior negative experience with hospitals or medical care, certain kinds of hospitalization, postoperative pain, parental anxiety, and certain personality traits of the child. Currently, tools exist for quantifying anxiety (m-YPAS) and postoperative behavior (PHBQ). It is possible to identify those children who are at risk for postoperative complications during the preanaesthesia consultation by paying close attention to children under six years with higher levels of emotionality and impulsivity and poorer socialization skills with anxious parents. Suggested strategies for reducing child distress include preoperative preparation, premedication, parental presence during anaesthesia induction, and interventions affecting the child's environment, such as hypnosis. There are numerous ways to provide preoperative preparation (information, modeling, role playing, encouraging effective coping) and their effectiveness is proven in the preoperative setting but not during anaesthesia induction or in the operating room. Midazolam has been shown to be an effective preoperative sedative for reducing anxiety. Parental presence during induction has been shown to effectively reduce preoperative anxiety in children in certain contexts (when the parent is calm and the child is anxious). It is worthwhile if it is integrated into a family-centered anxiety management program and remains one of several options offered to families. Overall, taking into account the child's psychological needs should be considered an essential part of paediatric anaesthesia. Tools and techniques are available for assessing and managing the perioperative distress experienced by children.     

Liver transplant in patients with hepatocellular carcinoma

Liver transplant in patients with cirrhosis and hepatocellular carcinoma is indicated in the early stages of the disease, which can be achieved with early detection programs using liver ultrasound. Dynamic imaging techniques (ultrasound with contrast, magnetic resonance and tomography) are essential in the diagnosis of this tumour, being able to type the lesion clearly, and, in the majority of cases, lead to the therapy to follow. Surgery is the treatment of choice in these patients, and liver transplant, from a theoretical point of view, is the best. Currently, the size and number of nodes play an important role in the indication of a transplant. The best liver transplant results are obtained in these patients using the Milan criteria, with survivals that exceed 70% and recurrence indices of 15%, at 5 years. Nowadays we have the possibility of using neo-adjuvant treatments to transplant, such as arterial chemoembolisation, percutaneous ablation techniques, and even liver resection as a bridging technique. The survival of patients transplanted due to liver cancer is similar to that obtained for other non-tumour diseases. In Spain it is 1, 3 and 5 years and 82%, 70% and 60%, respectively. The recurrence is between 6.4% and 16%, micro- and macrovascular invasion being its highest risk variable.     

Evidenzbasiertes diagnostisches Vorgehen bei Verdacht auf stumpfes HWS-Trauma

ZusammenfassungHintergrund Ziel dieser Arbeit war einerseits die Darstellung der bisher publizierten, unterschiedlichen diagnostischen Vorgehensweisen bei Verdacht auf stumpfe HWS-Verletzung, sowie andererseits deren evidenzbasierte Berücksichtigung bei der Entwicklung einer Empfehlung zum adäquaten diagnostischen Vorgehen.Material und Methoden Mittels systematischer Literaturrecherche in Medline, Embase, National Guideline Clearinghouse, Cochrane Library sowie manueller Referenzrecherche sichteten wir relevante Veröffentlichungen zwischen 1966 und Juli 2004. Suchbegriffe waren: Cervical Spine, Cervical Vertebrae, Spinal, Spinal Cord, Injury, Trauma, Fracture, Dislocation, Imaging, Radiography, Flexion, Extension, Fluoroscopy, Computed Tomography, Computed Scanning und Magnetic Resonance Imaging. Evidenzbasiert selektierten wir die Suchergebnisse und klassifizierten sie entsprechend ihrem Evidenzgrad.Ergebnisse Aus insgesamt >10.000 Veröffentlichungen sichteten wir mit stringenten Kriterien 137 relevante Artikel. Der Evidenzgrad ist aufgrund mangelnder Datenlage insgesamt eingeschränkt. Wegen fehlender Klasse-I-Daten sind nur Stufe-II- bis -III-Empfehlungen möglich. Wir entwickelten einen Algorithmus für das diagnostische Vorgehen bei Verdacht auf HWS-Trauma. Dieser klinische Algorithmus setzt die komplexe Diagnostik potentieller HWS-Verletzungen in einen übersichtlichen, logisch aufgebauten und systematischen Prozess um.Schlussfolgerungen Der nach reproduzierbaren, evidenzbasierten Kriterien entwickelte diagnostische Algorithmus erfüllt aktuelle geforderte Standards, um die Behandlungsqualität frisch Verletzter zu maximieren. Auch durch seine nachvollziehbare Transparenz bietet er eine wesentliche Entscheidungshilfe in der Auswahl des adäquaten diagnostischen Vorgehens.     

Regional anesthesia for orthopedic procedures: What orthopedic surgeons need to know

Regional anesthesia is an integral component of successful orthopedic surgery. Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia. Patient evaluation for regional anesthesia should include neurological, pulmonary, cardiovascular, and hematological assessments. Neuraxial blocks include spinal, epidural, and combined spinal epidural. Upper extremity peripheral nerve blocks include interscalene, supraclavicular, infraclavicular, and axillary. Lower extremity peripheral nerve blocks include femoral nerve block, saphenous nerve block, sciatic nerve block, iPACK block, ankle block and lumbar plexus block. The choice of regional anesthesia is a unanimous decision made by the surgeon, the anesthesiologist, and the patient based on a risk-benefit assessment. The choice of the regional block depends on patient cooperation, patient positing, operative structures, operative manipulation, tourniquet use and the impact of post-operative motor blockade on initiation of physical therapy. Regional anesthesia is safe but has an inherent risk of failure and a relatively low incidence of complications such as local anesthetic systemic toxicity (LAST), nerve injury, falls, hematoma, infection and allergic reactions. Ultrasound should be used for regional anesthesia procedures to improve the efficacy and minimize complications. LAST treatment guidelines and rescue medications (intralipid) should be readily available during the regional anesthesia administration.     

Total Intravenous Anesthesia with Midazolam, Remifentanil, Propofol and Cisatracurium in Morbid Obesity

Background: According to physical impairments of massive obesity, cardiac, respiratory and gastrointestinal physiology must be considered as much as pharmacokinetic behavior. Anesthetic management of morbidly obese patients has to be carefully planned, in order to minimize the increased risks of aspirative pneumonitis, hemodynamic instability and delay in recovery.The ideal anesthesia should provide a smooth and quick induction, allowing rapid airway control, prominent hemodynamic stability, and rapid emergence from anesthesia.To approach these ideal conditions,aTotal Intravenous Anesthesia (TIVA) with midazolam, remifentanil, propofol and cisatracurium was designed and analyzed. Methods: 10 consenting morbidly obese patients scheduled for elective Laparoscopic Adjustable Gastric Banding participated in the study.TIVA with midazolam, remifentanil, propofol and cisatracurium was used in all cases.Time to loss of consciousness, tracheal intubation, perianesthetic physiological parameters and complications, incidence of awareness with recall, recovery times, postoperative analgesia and costs of drugs were evaluated. Results:The analyzed data showed adequate time and physiological conditions for induction and tracheal intubation, stable maintenance with easy handling of deepness, low incidence of perianesthetic complications, excellent recovery performance and institutional efficiency. Conclusions: TIVA with midazolam, remifentanil, propofol and cisatracurium was found to be effective, secure, predictable and economic for the anesthetic management of morbidly obese patients.     

Isobolographic analysis of epinephrine with bupivacaine, dextromethorphan, 3-methoxymorphinan, or dextrorphan on infiltrative anesthesia in rats: dose-response studies

BACKGROUND AND OBJECTIVES: The aims of this study were to establish the potencies of epinephrine, bupivacaine, dextromethorphan, 3-methoxymorphinan, and dextrorphan and evaluate interactions of epinephrine with bupivacaine, dextromethorphan, 3-methoxymorphinan, or dextrorphan as an infiltrative anesthetic. Bupivacaine, a common and long-acting local anesthetic, was used as control. METHODS: Dose-dependent responses of epinephrine, dextromethorphan, 3-methoxymorphinan, and dextrorphan on cutaneous analgesia were compared with bupivacaine in rats. The interactions of drugs were evaluated via an isobolographic analysis. RESULTS: We found that epinephrine, bupivacaine, dextromethorphan, 3-methoxymorphinan, and dextrorphan produced a dose-dependent local anesthetic effect as infiltrative cutaneous analgesia. Relative potencies were epinephrine > bupivacaine > dextromethorphan > 3-methoxymorphinan > dextrorphan (P < .01 for each comparison). Coadministration of bupivacaine with epinephrine produced a synergistic effect, and coadministration of dextromethorphan, 3-methoxymorphinan, or dextrorphan with epinephrine produced an additive effect. CONCLUSIONS: Epinephrine, dextromethorphan, 3-methoxymorphinan, and dextrorphan are known to have local anesthetic effects as infiltrative cutaneous analgesia in rats. Epinephrine increased the potency of bupivacaine, but not dextromethorphan, 3-methoxymorphinan, or dextrorphan as an infiltrative anesthetic. The cutaneous analgesic effects of adding epinephrine to dextromethorphan, 3-methoxymorphinan, or dextrorphan, are similar to combinations of 2 local anesthetics.