男性不育患者精液分析和精子形态学分析

目的：回顾性分析助孕门诊男性不育患者精液分析与精子形态学检测，为防止临床对女方过度治疗提供依据。方法：选择2007年10月1日～2008年2月29日在本院助孕门诊就诊的不孕夫妇，男方至少行精液分析2次，在第一次精液分析即进行精子形态学分析。精液分析采用清华同方精液分析系统，精子形态学分析采用改良巴氏法染色，应用Microsoft Excel进行分析。结果：进行精液分析共1206人次，进行精子形态学分析共517人次。精子密度0-180^★10^9／L，平均55．3±32．2^★10^9／L，75．1％的病例精液密度为20-100^★10^9／L，仅13．3％为少精症，无精症占1．5％；a级精子为14．0％±9．9％，b级精子为10．6％±7．8％，a级＋b级〉50％者仅占0．6％，超过半数的为30％-50％（51．1％），精子形态学分析，仅有20．5％病例是正常的（〉14％）。结论：除无精症显然与不育相关外，精液密度可能不是评估男性不育的一个很好的指标，精子活动力低下或精子畸形率过高更能预示不孕因素，精液分析和精子形态学分析可以作为助孕门诊男性不育的首要筛查手段，防止对女方的过度治疗。     

Effect of Sample Collection Site on Semen Parameters of Healthy Young Volunteers

The effect of sample collection site on semen parameters in ten men aged between 22 and 24 years was investigated. Sperm was collected at two sites: in a university hospital restroom for general use and in a one-person hospital room. Samples were collected from the same individual twice, with an interval of two weeks between collections. Semen parameters for the two sites were compared. Samples were collected after a minimum of three days and not longer than seven days of sexual abstinence. Sperm concentration did not differ significantly between the university hospital restroom location (86.8 ± 25.4 × 10⁶/ml; mean ± standard deviation) and the private hospital room (97.1 ± 72.0 × 10⁶/ml). There was no difference in the total motile sperm count or daily sperm production between the collection sites. These results suggest that the collection site has little effect on semen parameters.     

计算机辅助精液质量分析系统参数调校方法

目的：调校精子质量分析系统的体积参数和速度参数。方法：按WHO规定的标准和方法自制精液分析的标准品，分别进行人3-．分析、CASA分析精子的浓度和活力，以人工分析结果来调校精子质量分析系统的体积、速度参数。结果：自制标准品的人工分析精子浓度（×106／mL）、总活力（％）、前向运动精子（％）分别为47．6±3．3、56．6±4．9、36．4±3．8：精子质量分析系统调校前、后的精子浓度（×106／mL）、总活力（％）、前向运动精子（％）分31]为74．8±7．5、53．3±3．6、31．9±2．8和51．3±5．1、55．1±4．5、37．5±3．4。精子质量分析系统体积参数调校前计算出的精子浓度与人工分析结果间存在显著性差异（P〈0．01）。结论：虽然精子质量分析系统经过厂家的定标，但在临床使用前仍有必要进行体积和速度参数设置。     

吡虫灵农药职业暴露对男工精液质量的影响

[目的]探讨吡虫灵农药生产职业暴露对男工精液质量的影响。[方法]分别选择某农药厂吡虫灵生产男工22名为暴露组、厂行政办公区男性工作人员46名为内对照组，另选择某疾控中心男性工作人员22名为外对照组。对各组所处环境空气中吡虫灵及其相关化学物如四氯化碳及氯气进行连续3d的监测，同时选择暴露区及外对照区各3人进行连续3d的个体采样和皮肤污染量测定，评价暴露水平；按统一的实施标准收集一次性精液，用UCDavis推荐的方法对精液质量进行评价，用WHO推荐的标准对精子的形态学进行评价，同时应用计算机辅助精子分析系统（CASA）对精子的运动能力进行分析。[结果]暴露组空气中吡虫灵、四氯化碳浓度明显高于内、外对照组（P〈0．01），而氯气差异无显著性（P〉0．05），同时个体采样及皮肤污染量结果均显示暴露组吡虫灵浓度显著高于外对照组（P〈0．01）；暴露组精子直线性（LIN）、精子前向性（STR）均显著低于外对照组（P〈0．05），精液量异常率显著高于外对照组（P〈0．01）；内对照组精子活动度显著低于外对照组（P〈0．05），精液量及精子活动度异常率显著高于外对照组（P〈0．05）。[结论]吡虫灵农药生产职业暴露对男工精液质量有一定影响。     

Urinary Concentrations of Parabens and Serum Hormone Levels,Semen Quality Parameters,and Sperm DNA Damage

Background

Parabens are commonly used as antimicrobial preservatives in cosmetics, pharmaceuticals, and food and beverage processing. Widespread human exposure to parabens has been recently documented, and some parabens have demonstrated adverse effects on male reproduction in animal studies. However, human epidemiologic studies are lacking.

Objective

We investigated relationships between urinary concentrations of parabens and markers of male reproductive health in an ongoing reproductive epidemiology study.

Methods

Urine samples collected from male partners attending an infertility clinic were analyzed for methyl paraben (MP), propyl paraben (PP), butyl paraben (BP), and bisphenol A (BPA). Associations with serum hormone levels (n = 167), semen quality parameters (n = 190), and sperm DNA damage measures (n = 132) were assessed using multivariable linear regression.

Results

Detection rates in urine were 100% for MP, 92% for PP, and 32% for BP. We observed no statistically significant associations between MP or PP and the outcome measures. Categories of urinary BP concentration were not associated with hormone levels or conventional semen quality parameters, but they were positively associated with sperm DNA damage (p for trend = 0.03). When urinary BPA quartiles were added to the model, BP and BPA were both positively associated with sperm DNA damage (p for trend = 0.03). Assessment of paraben concentrations measured on repeated urine samples from a subset of the men (n = 78) revealed substantial temporal variability.

Conclusions

We found no evidence for a relationship between urinary parabens and hormone levels or semen quality, although intraindividual variability in exposure and a modest sample size could have limited our ability to detect subtle relationships. Our observation of a relationship between BP and sperm DNA damage warrants further investigation.     

Evaluation of the Sperm Motility Analyzer System (SMAS) for the Assessment of Sperm Quality in Infertile Men

Eighty-one fresh semen samples were analyzed to compare the sperm parameters obtained using the new Sperm Motility Analysis System (SMAS; version 1.0, Kaga Electronics, Tokyo, Japan) with the CellSoft^TM Series 3000 (CRYO Resources, New York, USA) computer-assisted semen analysis (CASA) system and conventional manual semen analysis, based on WHO guidelines.. Significant correlations of sperm concentration (p<0.0001) and sperm motility (p<0.0001) were observed between SMAS and manual semen analysis estimates. There were also significant correlations of sperm concentration (p=0.0003) and sperm motility (p<0.0001) between SMAS and CellSoft estimates. Significant correlations for motility-related parameters were demonstrated in sperm velocity (p<0.0001), and linearity (linear velocity (VSL) divided by curvilinear velocity (VCL)×100) (p<0.0001), amplitude of lateral head displacement (ALH) (p<0.0001), and beat/cross frequency (BCF) (p=0.0127), between SMAS and CellSoft estimates. In this study, we showed the usefulness of the new SMAS, which has high reliability in estimating sperm concentration, sperm motility, velocity and linearity compared with CellSoft. SMAS can be a promising alternative, providing cost-effective semen analysis with the utility of the CASA system.     

Combination of Hypoosmotic Swelling/Eosin Y Test for Sperm Membrane Integrity Evaluation: Correlations with Other Sperm Parameters to Predict ICSI Cycles

The objective of our study was to evaluate the accuracy of the combination of hypoosmotic swelling (HOS) and eosin Y (Ey) exclusion tests to predict the ICSI cycles' outcome and its correlations with other sperm parameters.

The functional and structural integrity of sperm membrane was evaluated with the combined HOS/Ey test in 95 ICSI cycles and the results were correlated with other sperm parameters, including concentration, motility, strict morphology, and total motile sperm count. The combined HOS/Ey test was evaluated for the prediction of the ICSI cycles' outcome parameters including fertilization, cleavage, and pregnancy rates. The HOS/Ey test presented significant relationships with concentration, motility, and strict morphology (p < 0,0001) but it couldn't predict the fertilization, cleavage, and pregnancy outcomes of ICSI cycles. The combined HOS/Ey test has strong correlations with motility and strict morphology parameters of sperm samples but is not sufficiently sensitive to estimate the outcome of ICSI cycles.     

Associations of in Utero Exposure to Perfluorinated Alkyl Acids with Human Semen Quality and Reproductive Hormones in Adult Men

Background: Perfluorinated alkyl acids (PFAAs), persistent chemicals with unique water-, dirt-, and oil-repellent properties, are suspected of having endocrine-disrupting activity. The PFAA compounds perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS) are found globally in humans; because they readily cross the placental barrier, in utero exposure may be a cause for concern.Objectives: We investigated whether in utero exposure to PFOA and PFOS affects semen quality, testicular volume, and reproductive hormone levels.Methods: We recruited 169 male offspring (19–21 years of age) from a pregnancy cohort established in Aarhus, Denmark, in 1988–1989, corresponding to 37.6% of the eligible sons. Each man provided a semen sample and a blood sample. Semen samples were analyzed for sperm concentration, total sperm count, motility, and morphology, and blood samples were used to measure reproductive hormones. As a proxy for in utero exposure, PFOA and PFOS were measured in maternal blood samples from pregnancy week 30.Results: Multivariable linear regression analysis suggested that in utero exposure to PFOA was associated with lower adjusted sperm concentration (p_trend = 0.01) and total sperm count (p_trend = 0.001) and with higher adjusted levels of luteinizing hormone (p_trend = 0.03) and follicle-stimulating hormone (p_trend = 0.01). PFOS did not appear to be associated with any of the outcomes assessed, before or after adjustment.Conclusions: The results suggest that in utero exposure to PFOA may affect adult human male semen quality and reproductive hormone levels.     

《世界卫生组织人类精液分析实验室技术手册》第5版中低正常精子形态值的临床意义

第5版《世界卫生组织人类精液分析实验室技术手册》中提出4%这一非常低的正常精子形态临界值与近期发表的数值和报道中正常精子形态平均值下降趋势一致。导致正常形态精子比例下降的可能原因很多。首先是引进了评估精子形态的严格标准。其他的原因可能包括采用另外的标准定义精子形态异常,诸多负面环境因素导致的精液参数下降。虽然同原先使用的严格评估精子形态的标准一样,新引入的非常低的正常值本身并不能提供强有力的预测值来评价男性生殖潜能,但是如果将全面、严格的评价精子形态的方法与其他可行的精子形态参数一起应用,仍然可得到一个良好的预测值,已知有一些形态参数对精子异常有很强的预测与预后判断作用。此外,更好的方法学国际标准化,精子形态评估标准解释的一致性及标准的国际室间质量控制(EQC)计划对保证精子形态预测值的精确性极为重要。     

公共场所集中空调冷却水水质及其与嗜肺军团菌污染的关系

[目的]分析集中空调冷却水水质及其与嗜肺军团菌污染间的相关性,为预防和控制军团菌病提供科学依据。[方法]对深圳市南山区安装有集中空调的36家公共场所冷却水进行检测,检测指标有冷却水嗜肺军团菌微生物指标和水质理化指标。[结果]集中空调冷却水水温较一般自来水高,中位数为30．0℃;细菌总数中位数为6．8CFU／mL,浊度中位数为3．5NTU,均超过生活饮用水卫生标准。多因素logistic回归分析显示,浊度、溶解性总固形物是冷却水嗜肺军团菌阳性率的影响因素,其比值比（OR及95％CI）分别为1．300（1．011—1．672）和1．102（1．016～1．196）。[结论]冷却水浊度和溶解性总固形物可能是影响嗜肺军团菌生长繁殖的重要因素,加强冷却水水质管理对预防军团菌病有重要公共卫生学意义。     

A Comparative Evaluation of Public Health Centers with Private Health Training Centers on Primary Healthcare Parameters in India: a Study by Data Envelopment Analysis Technique

Background:

The evaluation of primary healthcare services provided by health training centers of a private medical college has not been studied in comparison with government health facilities in Indian context. Data envelopment analysis (DEA) is one such technique of operations research, which can be used on health facilities for identifying efficient operating practices and strategies for relatively efficient or inefficient health centers by calculating their efficiency scores.

Materials and Methods:

This study was carried out by DEA technique by using basic radial models (constant ratio to scale (CRS)) in linear programming via DEAOS free online Software among four decision making units (DMUs; by comparing efficiency of two private health centers of a private medical college of India with two public health centers) in district Muzaffarnagar of state Uttar Pradesh. The input and output records of all these health facilities (two from private and two from Government); for 6 months duration from 1^st Jan 2014 to 1^st July 2014 was taken for deciding their efficiency scores.

Results:

The efficiency scores of primary healthcare services in presence of doctors (100 vs 30%) and presence of health staff (100 vs 92%) were significantly better from government health facilities as compared to private health facilities (P < 0.0001).

Conclusions:

The evaluation of primary healthcare services delivery by DEA technique reveals that the government health facilities group were more efficient in delivery of primary healthcare services as compared to private training health facilities group, which can be further clarified in by more in-depth studies in future.