FSH预测非梗阻性无精子患者精子发生类型的探讨

目的　探讨不同精子发生类型的非梗阻性无精子症患者的FSH水平差异是否有显著性 ,从而评价FSH水平用于单精子卵泡浆内注射时评估精子发生及成熟情况价值。方法　选择 1 60例非梗阻性无精子症患者 ,测定其性激素水平 ,按睾丸活检分为三组 :唯支持细胞、生精成熟停滞、有精子发生但生精功能低下 ,比较三组FSH水平。结果　三组间唯支持细胞与生精成熟停滞、生精功能低下的FSH差异有显著性意义 (P <0 .0 1 ) ,生精成熟停滞与生精功能低下的FSH差异无显著性意义。结论　FSH可为非梗阻性无精子患者行单精子卵泡浆内注射前预测精子发生类型提供参考。     

无精症睾丸病理与血清FSH水平的关系及对不育诊治的意义

目的:探讨无精症患者睾丸活检与血清FSH水平关系,及其在无精症诊断、治疗中的意义.方法:用放免法测定67例无精症患者血清FSH水平,并取睾丸活检,对其进行病理学分类.比较不同病理学类型的无精症患者血清FSH水平.结果:唯支持细胞综合征患者血清FSH水平显著高于正常组、生精功能低下组及生精阻滞组.而生精功能低下、生精阻滞组血清FSH水平与正常组间无差异.结论:无精症患者血清FSH水平对于诊断难支持细胞综合征具有一定价值.对于其他类型的生精功能受损,测定血清FSH水平预测作用.睾丸活检对无精症的诊治具有重要的指导意义.     

严重少精子和无精子的不育患者Y染色体微缺失的检测

目的 探讨男性不育患者Y染色体微缺失检测的临床意义.方法应用两个多重聚合酶链反应技术对南京医科大学第一附属医院2003年7月-2005年3月收治的143例严重少精子和无精子的不育患者（严重少精子症80例、无精子症63例）进行Y染色体微缺失检测.结果在143例患者中,我们发现21例（21/143,14.7%）微缺失,其中特发性不育患者12例（严重少精子症3例、无精子症9例）,非特发性不育患者9例（严重少精子症3例、无精子症6例）.21例微缺失患者中,1例位于AZFa区,2例位于AZFb＋AZFc区,2例位于AZFb区,16例位于AZFc区.21例微缺失患者中,4例睾丸病理显示为成熟阻滞,6例为严重精子发生低下,11例为唯支持细胞综合征.在特发性和非特发性患者中AZF微缺失发生的位置和范围差异无统计学意义.结论建议对特发性不育和非特发性不育患者,特别是那些寻求卵胞内精子注射治疗的患者,都应进行Y染色体微缺失的检测.     

Long term effects of cyclophosphamide on testicular function

Thirty men treated in childhood with cyclophosphamide for a mean of 280 days were assessed at a mean of 12.8 years after treatment for hormone concentrations and spermatogenesis. Four were azoospermic, nine oligospermic, and 17 normospermic. There was a significant inverse correlation of sperm density with cyclophosphamide dosage and duration of treatment. After a further mean follow up of 7.2 years three patients who were previously oligospermic and one who was azoospermic had normal sperm counts. All patients had normal sexual characteristics and libido. Serum androgen and prolactin concentrations did not differ significantly between patients and controls. Raised basal and stimulated follicle stimulating hormone concentrations were in keeping with impaired spermatogenesis. All patients had significantly raised luteinising hormone responses on stimulation with luteinising hormone releasing hormone. The results suggest compensated Leydig cell failure, and patients with this condition require long term evaluation of testicular function. Potential recovery of spermatogenesis with time requires appropriate counselling and contraceptive advice.     

Myelin protein zero and its antibody in serum as biomarkers of n-hexane-induced peripheral neuropathy and neurotoxicity effects

Background Chronic exposure to n-hexane can lead to peripheral neuropathy that no effective treatment regimen could be applied presently. This study investigated whether myelin protein zero （P0） protein and its antibody could be used to distinguish n-hexane intoxication and protect workers from peripheral neuropathy. Methods We compared P0 protein and its antibody among three levels of n-hexane-exposed groups, which included 18 patients with n-hexane-induced peripheral neuropathy as case group, 120 n-hexane-exposed workers as n-hexane- exposed control group, and 147 non-hexane-exposed participants used as control group. ELISA method was applied to detect P0 protein and its antibody. Results P0 protein in serum was significantly higher in the case group and n-hexane-exposed control group in comparison with the control group （P〈0.01）. Compared with the n-hexane-exposed control group, the case group also had significant increase of P0 protein （P〈0.01）. After 6 months therapy, P0 protein was observed to decrease significantly in the case group （P〈0.01）. The P0 antibody in serum was significantly higher in the n-hexane-exposed control group than in the control group （P〈0.01）, but not significantly different between cases and controls. Conclusions P0 antibodies in serum may be a short-term effect biomarker for n-hexane exposure. P0 protein in serum may be an early effective biomarker for peripheral nerve neuropathy and its biological limit value needs investigation in the future study.     

睾丸穿刺活检对特发性非梗阻性无精子症患者显微取精成功率的影响

目的：探讨特发性非梗阻性无精子症患者中,睾丸穿刺活检对显微取精成功率的预测作用。方法：回顾性分析了从2014年1月至2017年8月在北京大学第三医院生殖医学中心接受显微取精术的特发性非梗阻性无精子症患者的临床资料,并对是否行诊断性穿刺活检、以及不同穿刺活检结果患者的精子获得率进行分析,探讨睾丸穿刺活检结果对显微取精成功率的预测作用。结果：共237例接受显微取精术的特发性非梗阻性无精子症患者入选研究,总体的精子获得率为25.7%。未行诊断性睾丸穿刺活检的103例患者与行诊断性睾丸穿刺活检的134例患者精子获得率分别为26.2%和25.4%,两组间比较差异没有统计学意义（P>0.05）;两组睾丸体积和血清卵泡刺激素水平分别为（4.3±1.4） mL vs. （8.5±2.4） mL和（36.1±5.2） IU/L vs. （26.1±3.5） IU/L,组间比较差异具有统计学意义（P<0.05）。在睾丸穿刺活检的患者中,术中镜检及术后病理均偶见少量精子患者的精子获得率为100.0%（7/7）, 术中镜检或术后病理可见精子的患者,精子获得率为47.2%（17/36）, 术中镜检及术后病理均未见精子的患者,精子获得率为11.0%（10/91）, 3组间比较差异具有统计学意义（P<0.05）。结论：睾丸体积较小的特发性非梗阻性无精子症患者仍有一定机会通过显微取精术发现精子;睾丸穿刺活检结果（包括术中镜检及术后病理能否发现精子）对后期进行显微镜下睾丸切开取精有一定的预测作用,其中术中镜检及术后病理均未见精子的患者,显微取精术找到精子的概率较低。     

Changes of atrial natriuretic peptide and antidiuretic hormone in children with postural tachycardia syndrome and orthostatic hypertension: a case control study

Background The abnormal blood volume regulation is one of the most important pathogenesis in postural tachycardia syndrome in children.This study was designed to investigate the plasma atrial natriuretic peptide and antidiuretic hormone levels in postural tachycardia syndrome children,and their associations with the changes in heart rate and blood pressure in head-up test.Methods Twenty-one postural tachycardia syndrome patients （（12±2） years） and 26 healthy children （（12±1） years） were included.According to blood pressure changes in head-up test,the postural tachycardia syndrome patients were divided into two subgroups：postural tachycardia syndrome with orthostatic hypertension and postural tachycardia syndrome without orthostatic hypertension.The plasma atrial natriuretic peptide and antidiuretic hormone levels were measured using enzyme-linked immunosorbent assay.Results The plasma atrial natriuretic peptide level in postural tachycardia syndrome patients was higher than the control （P=0.004）,whereas the difference in plasma antidiuretic hormone level between postural tachycardia syndrome and controls was not significant （P=0.222）.The plasma antidiuretic hormone level of patients suffering from postural tachycardia syndrome with orthostatic hypertension was much higher than that of children having postural tachycardia syndrome without orthostatic hypertension （P ＜0.05）.In postural tachycardia syndrome patients,the updght max heart rate was positively correlated with the plasma atrial natriuretic peptide level （r=0.490,P＜0.05） and the upright systolic blood pressure was positively correlated with the plasma antidiuretic hormone levels （r=0.472,P ＜0.05）.Conclusions There was a disturbance of plasma atrial natriuretic peptide and antidiuretic hormone in postural tachycardia syndrome children.     

Distinct properties and metabolic mechanisms of postresuscitation myocardial injuries in ventricular fibrillation cardiac arrest versus asphyxiation cardiac arrest in a porcine model

Background The two most prevalent causes of sudden cardiac death are ventricular fibrillation cardiac arrest （VFCA） and asphyxiation cardiac arrest （ACA）. Profound postresuscitation myocardial dysfunction has been demonstrated in both VFCA and ACA animal models. Our study aimed to characterize the two porcine models of cardiac arrest and postresuscitation myocardial metabolism dysfunction. Methods Thirty-two pigs were randomized into two groups. The VFCA group （n=16） were subject to programmed electrical stimulation and the ACA group （n=16） underwent endotracheal tube clamping to induce cardiac arrest （CA）. Once induced, CA remained untreated for a period of 8 minutes. Two minutes following initiation of cardiopulmonary resuscitation （CPR）, defibrillation was attempted until return of spontaneous circulation （ROSC） was achieved or animals died. To assess myocardial metabolism, 18F-FluoroDeoxyGlucose Positron Emission Tomography was performed at baseline and 4 hours after ROSC. Results ROSC was 100% successful in VFCA and 50% successful in ACA. VFCA had better mean arterial pressure and cardiac output after ROSC than ACA. Arterial blood gas analysis indicated more detrimental metabolic disturbances in ACA compared with VFCA after ROSC （ROSC 0.5 hours, pH： 7.01±0.06 vs. 7.21±0.03, P〈0.01; HCO3： （15.83±2.31 vs. 20.11±1.83） mmol/L, P〈0.01; lactate： （16.22±1.76 vs. 5.84±1.44） mmol/L, P〈0.01）. Myocardial metabolism imaging using Positron Emission Tomography demonstrated that myocardial injuries after ACA were more severe and widespread than after VFCA at 4 hours after ROSC （the maximum standardized uptake value of the whole left ventricular： 1.00±0.17 vs. 1.93±0.27, P〈0.01）. Lower contents of myocardial energy metabolism enzymes （Na＊-K＊-ATPase enzyme activity, Ca2＊- ATPase enzyme activity, superoxide dismutase and phosphodiesterase） were found in ACA relative to VFCA. Conclusions Compared with VFCA, ACA causes more severe myocardium injury an     

CEP55可能是治疗成熟阻滞型非梗阻无精子症的分子靶标

目的应用siRNA技术沉默CEP55基因表达对小鼠精原细胞增殖的影响。方法选取2017年1月1日~12月31日在南方 医科大学南方医院妇产科生殖中心就诊的无精子症男性不育症患者,根据其睾丸病理切片诊断分为成熟阻滞组和生精正常组 各3 名。应用核素标记相对和绝对定量（iTRAQ）技术,发现两组患者的睾丸组织表达差异蛋白质CEP55 蛋白。设计并合成 CEP55 基因特异性的siRNA 序列,转染小鼠精原细胞,分为空白对照组、阴性对照组及siRNA 转染组,应用Western blot 和 qPCR检测在siRNA 对CEP55的影响,CCK8实验观察siRNA抑制CEP55后对小鼠精原细胞增殖的影响。结果通过iTRAQ 核素标记结合LC/MS/MS分析,共鉴定出差异蛋白共两百多个,CEP55在基因表达水平差异最显著。Western blot结果显示, siRNA转染组CEP55蛋白的相对表达水平明显低于空白对照组和阴性对照组（P<0.05）。qPCR结果显示,siRNA转染组CEP55 的mRNA表达量低于空白对照组和阴性对照组（P<0.05）。CCK8实验发现siRNA干扰CEP55表达后,小鼠精原细胞生长明显 受到抑制（P<0.05）。结论CEP55可能在精子发生过程中起到关键作用,CEP55可能成为治疗成熟阻滞型非梗阻无精子症的分 子靶标。     

Kinetics of serum HBsAg in Chinese patients with chronic HBV infection with long-term adefovir dipivoxil treatment

Background Knowledge on Hepatitis B surface antigen （HBsAg） kinetics in chronic hepatitis B （CHB） patients with longterm adefovir dipivoxil （ADV） treatment is limited.The aims of this study were to investigate HBsAg kinetics in patients with chronic hepatitis B virus （HBV） infection treated with long-term ADV and to evaluate different characteristics between patients with and without HBsAg loss.Methods We retrospectively evaluated HBsAg kinetics in 24 Chinese patients with chronic HBV infection who achieved continuous virologic suppression during ADV therapy.HBV genotype was determined at baseline.Liver biochemistry,hepatitis B e antigen status,serum HBV DNA,and HBsAg levels were measured at baseline,6 months,and once every year thereafter.Results Of these 24 patients,3,1,and 20 patients were followed up for 3,5,and 6 years,respectively.Baseline serum HBsAg level had a moderate correlation with baseline HBV DNA level （r=0.52,P=0.01）.The median rate of HBsAg reduction during the therapy period was 0.08 Ig IU·ml-1·y-1.Baseline serum HBsAg level was significantly higher than other time points （P ranges from 0.046 to 0.002）.The HBsAg reduction rate during the first year was similar to that in other years （P〉0.05）.The HBsAg reduction rate during the first year in patients with eventual HBsAg loss was significantly faster than that in patients without HBsAg loss （P=0.005）.Conclusions Serum HBsAg levels in Chinese CHB patients receiving long-term ADV demonstrated a gradual reduction.Patients with eventual HBsAg loss had a significantly faster HBsAg reduction rate during the first year than those without HBsAg loss.     

FSH和睾丸体积对373例无精子症患者病因诊断的临床研究

目的 探讨血清卵泡刺激素(FSH)水平和睾丸体积在无精子症患者病因学诊断中的临床价值.方法 回顾性分析373例无精子症患者的临床资料,根据其FSH检测水平将患者分为A、B、C3组,A组FSH正常、B组FSH轻度升高、C组FSH重度升高.分别统计分析各组患者睾丸体积和取精成功率.结果 A、B、C3组患者睾丸取精成功率分别为70.81％、22.22％、0;3组患者的平均睾丸体积分别为(11.39±5.06)、(8.79±4.18)、(6.96±4.12)mL,组间比较差异均有统计学意义(P＜0.05).结论 对无精子症患者,FSH水平和睾丸体积有助于综合判断睾丸的生精功能状态,并可对无精子症类型进行鉴别.     

Intraoperative cardiac arrest during anesthesia: a retrospective study of 218 274 anesthetics undergoing non-cardiac surgery

Background  Patient safety has been gained much more attention in recent years. The authors reviewed patients who had cardiac arrest in the operating rooms undergoing noncardiac surgery between January 1989 and December 2001 at the University of Pittsburgh Medical Center, USA. The main objectives of the study were to determine the incidence of intraoperative cardiac arrest, to identify possible causes of cardiac arrest and to explore amenable modifications.

Methods  With approval by the University of Pittsburgh Institutional Review Board, patients experienced cardiac arrest during surgery were retrieved from medical records, surgical operation and anesthesia records and pathological reports by searching the Medical Archival Retrieval System (MARS), a hospital electronic searching system. Cases of cardiac arrest were collected over a period of thirteen years from the Pre byteria University Hospital (PUH), USA.

Results  We found 23 cases of intraoperative cardiac arrests occurred in 218 274 anesthesia cases (1.1 per 10 000). Fourteen patients (60.8%) died in the operating room, leading to a mortality rate from all causes of 0.64 per 10 000 anesthetics. Immediate overall survival rate after arrest was 39% (9/23). Half of the patients (12/23) were emergency cases with 41% survival rate (5/12). One fourth of the arrests were trauma patients (6/23). Most arrest patients (87%, 20/23) were American Society of Anesthesiologists Physical Status (ASA PS) IV and V, while only three patients were ASA PS-I, II and III, respectively. One case was attributable to an anesthesia-related cardiac arrest and recovered after successful resuscitation.

Conclusions  Most intraoperative cardiac arrests were not due to anesthesia-related causes. Anesthesia-related cardiac arrests might have a higher survival rate when compared to other possible causes of cardiac arrest in the operating room.

     

Influence of tube voltage on digitized image qualityof patients exposed to occupational dust: phantoms and clinical studies

Background High-voltage analog X-ray examination is a main tool for pneumoconiosis,which is challenged by digital radiography （DR）.The tube voltage of DR chest films required for diagnosis and staging of pneumoconiosis is concerned technically.We investigated the influence of the tube voltage on chest X-ray DR image quality of patients exposed to occupational dust.Methods DR images of the CDRAD2.0model,an anatomical chest phantom,and 136 exposed workers were analyzed at different tube voltages by threereaders.Image quality factors （IQF） were calculated and compared using the CDRAD2.0 model.DR images of ten anatomic positions were scored against those of the high-kilovolt chest films in anatomical phantom and clinical cases,and differences in scores were analyzed.Results In the CDRAD2.0 model,all three readers had a minimal IQF at 120 kV （mean：22.25 kV）.The differences in the mean IQF of DR images at different tube voltages was significant （F=13.78,P〈0.001）.The IQF of DR imaging at 120 kV was similar to high kilovolt analog imaging （t=-0.58,P〉0.05）.In the anatomic phantom and clinical cases,the DR images at 120 kV were closest in anatomical detail to the high W analog images,and the means were similar （P〉0.05）.Conclusions Among different tube voltages,DR image quality is closest to the high kilovolt analog images at 120 kV in patients exposed to occupational dust.     

PIAS2蛋白在不同病理分型的无精子症患者睾丸组织中的表达

目的:探讨PIAS2在不同生精功能状态的人睾丸组织中的表达情况。方法:对80例无精子症患者进行睾丸组织病理检查诊断,根据病理形态的不同分为：生精功能正常或基本正常(n=40)、精子发生低下(n=20)、唯支持细胞综合征(n=20)等。选择上述各型结构完整的睾丸组织,分别应用免疫组化法(SP)对PIAS2在不同生精功能状态的睾丸组织进行研究。结果:PIAS2在各级生精细胞多为强阳性表达,呈深棕黄色;PIAS2在间质细胞及支持细胞表达弱阳性表达或不表达。结论:PIAS2染色强弱与睾丸生精功能的强弱有一定关系,是一个潜在的判断睾丸生精功能的指标。     

Effect of catheter radiofrequency ablation on C-reactive protein, brain natriuretic peptide and echocardiograph in patients with persistent and permanent atrial fibrillation

Background Radiofrequency catheter ablation （RFCA） for atrial fibrillation （AF） has developed rapidly,and is a commonly performed ablation in many major hospitals throughout the world,due to its satisfactory results.The aim of this study was to detect the effect of RFCA on C-reactive protein （CRP）,brain natriuretic peptide （BNP）,and echocardiograph in patients with persistent and permanent AF.Methods A total of 120 patients （71 males,mean age （50.8＆#177;12.0） years） with persistent and permanent AF undergoing RFCA under guidance of the Carto merge technique were studied.Left atrial diameter （LAD）,right atrial diameter （RAD）,left ventricular ejection fraction （LVEF）,CRP,and BNP were observed 3,6 and 12 months after RFCA and compared with results before RFCA.The recurrence of atrial arrhythmias was observed 3 and 12 months after the procedure.Results Compared with that before RFCA,LAD and RAD decreased and LVEF increased significantly after RFCA.Meanwhile,the levels of CRP and BNP were reduced significantly at 3,6,and 12 months after RFCA （P〈0.05）.In the non-recurrent patients,LVEF was increased significantly compared with the recurrent patients at 3,6,and 12 months after RFCA （P〈0.05）.CRP and BNP levels were decreased significantly in the non-recurrent patients compared with the recurrent patients at 3,6,and 12 months after RFCA （P〈0.05）.After one or two applications of RFCA,during a follow-up of 12 months,12 patients （10.0%） had AF,10 patients （8.3%） had atrial flutter,and 5 patients had atrial tachycardia （4.2%）.Conclusions Conversion of AF to sinus rhythm by RFCA,has been shown to reduce LA size and improve LVEF.It can also significantly decrease the levels of CRP and BNP in patients with persistent and permanent AF and reduce the risk of inflammation and developing heart failure.     

Effect of neoadjuvant chemotherapy on expressions of estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, and Ki-67 in breast cancer

Background This study was designed in an attempt to determine the influence of neoadjuvant chemotherapy on estrogen receptor （ER）, progesterone receptor （PR）, human epidermal growth factor receptor 2 （Her-2）, and Ki-67 expressions in patients with breast cancer. Methods Pre- and post-neoadjuvant chemotherapy, paired-tumor specimens from 103 patients with breast cancer administrated with anthracycline or anthracycline combined taxane regimen were collected. Immunohistochemical staining for ER, PR, Her-2, and Ki-67 was performed by the DAKO EnVision method. Results Among the 103 cases, five patients （4.9%） had a complete response （CR）, 82 （79.6%） partial response （PR）, 15 （14.6%） stable disease （SD）, and one （0.9%） progressive disease （PD）, yielding an overall response rate （CR ＋ PR） of 84.5%. Nine patients achieved pathological CR. There was a significant decrease in the average index of Ki-67 post- neoadjuvant chemotherapy, compared with that before chemotherapy （24.1% vs. 39.7%, P 〈0.001）. After neoadjuvant chemotherapy, the changes of Ki-67 in different subtypes of breast cancer were different （P 〈0.001）, and these changes correlated with response to neoadjuvant chemotherapy （P 〈0.001）. No significant changes in immunohistochemical expression were observed for ER, PR and Her-2. Conclusions Neoadjuvant chemotherapy apparently reduced Ki-67 index in primary breast carcinomas, but profiles for ER, PR and Her-2 were not significantly different before and after neoadjuvant chemotherapy. The change of Ki- 67 correlated with molecular subtypes and response to neoadjuvant chemotherapy, suggesting that Ki-67 index was a surrogate marker to predict the treatment response of neoadjuvant chemotherapy.     

Evaluation of efficacy and safety of sunitinib regimen in 22 patients with metastatic renal cell carcinoma: at least 12-month follow-up

Background Sunitinib has been proved an effective new option for treatment of metastatic renal cell carcinoma (mRCC). Analysis of clinical data of 22 patients, who were exposed to sunitinib for at least 1 year, was conducted to evaluate the long-term efficacy and safety of sunitinib for the treatment of mRCC.

Methods A total of 54 patients with mRCC were treated with sunitinib malate, 50 mg/d orally, on a 4-weeks-on and 2-weeks-off dosing schedule in Peking University First Hospital. Treatment continued until disease progression, unacceptable adverse events (AEs), or death. Among them, 22 patients continued treatment for at least 1 year. The clinical data of these 22 patients were prospectively collected for analysis. AEs were assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events, Version 3.0. Tumor response was evaluated in accordance with the Response Evaluation Criteria in Solid Tumors.

Results Median progression-free survival was 19.5 months until last follow-up. The best efficacy results achieved were complete response, partial response, and stable disease for 2, 9, and 11 patients, respectively. Objective response rate was 50%. The most common AEs were hand-foot syndrome (95%) and hypertension (91%). Other common AEs were thyroid-stimulating hormone elevation (82%), platelet decrease (77%), and loss of appetite (77%). Only one patient withdrew from treatment for cardiac infarction. Another nine patients experienced dose modifications or short-term suspensions.

Conclusion Long-term exposure to sunitinib malate showed encouraging efficacy in the treatment of mRCC. At the same time, the tolerability was good.

     

Microsurgical transverse 2-suture intussusception vasoepididymostomy: effectiveness and rationality

Background 2-Suture longitudinal vasoepididymostomy shows superiority to transverse technique in an animal study; to date, this has not been consistently confirmed in human body. In the present study, we evaluated the effectiveness of 2-suture transverse intussusception vasoepididymostomy and compared the rationality between transverse and longitudinal techniques. Methods From May 2007 to December 2008, we performed 2-suture transverse vasoepididymostomy in 19 consecutive patients, as described by Marmar with modification. Between March 2009 and January 2010, the internal diameter of the vas lumen and the outer diameter of the epididymal tube were measured using microruler （21 patients and 37 sides）. Results Three patients lost to follow-up. At the first follow-up period （ranged from 10 to 24 months）, the patency rate was 56.3% （9/16） and the natural pregnancy rate was 25% （4/16）. At the second follow-up period （ranged from 46 to 63 months）, the patency rate was 68.8% （11/16）, the natural pregnancy rate was 37.5% （6/16）, respectively, and the take- home baby rate was 31.3% （5/16）. The diameter of the vas lumen and the outer diameter of the epididymal tubule were （0.512±0.046） mm and （0.572±0.051） mm （P 〈0.001）, respectively. Conclusion Transverse 2-suture intussusception vasoepididymostomy is still an effective technique in treating obstructive azoospermia.     

非梗阻性无精子症患者的精子获得及其预测指标的荟萃分析

目的 探讨非梗阻性无精子症(NOA)患者的取精技术、精子获得率及其预测指标.方法 通过Cochrane图书馆、中国学术期刊网(CNKI)、MEDLINE计算机检索系统检索1990-2008年的相关文献,摘录相关内容,进行荟萃分析.结果 共纳入25篇文献.分别比较睾丸细针穿刺抽吸活检技术(TEFNA)与睾丸活检(TESE)、TESE与显微切割睾丸取精术(mTESE)的精子获得率(23.0%vs 52.2%,35.7%vs 54.6%;RR:0.49,0.70;95%可信区间:0.41～0.60,0.50～0.98;均P<0.05),差异有统计学意义.NOA患者精子的获得与其睾丸不同的病理类型密切相关,精子发生低下、精子成熟阻滞、唯支持细胞综合征的精子获得率分别为76.7%、46.2%、32.8%(三者间比较,RR:1.65,2.40,1.50;95%可信区间:1.21～2.91,1.85～6.90,1.02～2.26;均P<0.05).漏斗图分析未能避免发表偏移.结论 在综合考虑可能影响评价结果 的前提下,mTESE是从NOA患者睾丸获取精子成功率较高的方法 ;先明确NOA患者睾丸的病理类型,预测患者行辅助生殖技术前睾丸取精的结果 ,可能是制订NOA患者治疗方案之前较好的选择.     

Idiopathic pulmonary fibrosis will increase the risk of lung cancer

Objective To review the studies investigating the increased risk of lung cancer in patients with idiopathic pulmonary fibrosis （IPF）.Data sources Data cited in this review were obtained mainly from PubMed and Medline from 1999 to 2013 and highly regarded older publications were also included.Study selection We identified,retrieved and reviewed the information on the frequency,risk factors,anatomical features,histological types,clinical manifestations,computed tomography findings and underlying mechanisms of lung cancer in IPF patients.Results The prevalence rates of lung cancer in patients with IPF （4.8％ to 48％） are much higher than patients without IPF （2.0％ to 6.4％）.The risk factors for lung cancer in IPF include smoking,male gender,and age.Lung cancers often occur in the peripheral lung zones where fibrotic changes are predominant.Adenocarcinoma and squamous cell carcinoma are the most common types of lung cancer in patients with IPF.Radiologic features of these patients include peripherally located,ill-defined mass mimicking air-space disease.The underlying mechanisms of the development of lung cancer in patients with IPF have not been fully understood,but may include the inflammatory response,epithelial injury and/or abnormalities,aberrant fibroblast proliferation,epigenetic and genetic changes,reduced cell-to-cell communication,and activation of specific signaling pathways.Conclusions These findings suggest that IPF is associated with increased lung cancer risk.It is necessary to raise the awareness of lung cancer risk in IPF patients among physicians and patients.