Delivery of normal twins following the intracytoplasmic injection of spermatozoa from a patient with 47,XXY Klinefelter's syndrome

Klinefelter's syndrome is a disorder of gonadal development and typically reveals a 47,XXY karyotype although mosaic forms also occur. Azoospermia is a common feature, but severe oligozoospermia and fertility have been reported. In this study, we have used intracytoplasmic sperm injection (ICSI) to achieve a live twin birth using spermatozoa from a 47,XXY man who has occasional spermatozoa present in the ejaculate. Spermatozoa were obtained from multiple ejaculates and frozen prior to commencing IVF treatment. Nine good quality embryos developed from the injection of 13 oocytes. All nine embryos were frozen. The initial transfer of two frozen-thawed embryos was unsuccessful. In the following cycle, the transfer of two additional frozen-thawed embryos resulted in the delivery of normal, healthy male and female twins. Five embryos remain frozen. It has generally been thought that the germ cells of 47,XXY men are unable to proceed through meiosis. Any spermatozoa produced have been assumed to come from a normal germ cell and therefore likely to have a normal karyotype. However, recent evidence suggests that meiosis of 47,XXY germ cells may be possible. Whether spermatozoa in these men arise from meiosis of 47,XXY germ cells, or from germ cells which have attained a normal karyotype by loss of an X chromosome, is unclear. Any risks in using spermatozoa from these patients have not yet been established. Patients need to be advised accordingly, and preimplantation or prenatal diagnosis should be considered. A cautious approach to the treatment of these patients is therefore warranted.      

Pressure ulcers in trauma patients with suspected spine injury: a prospective cohort study with emphasis on device‐related pressure ulcers

Of all patients in a hospital environment, trauma patients may be particularly at risk for developing (device‐related) pressure ulcers (PUs), because of their traumatic injuries, immobility, and exposure to immobilizing and medical devices. Studies on device‐related PUs are scarce. With this study, the incidence and characteristics of PUs and the proportion of PUs that are related to devices in adult trauma patients with suspected spinal injury were described. From January–December 2013, 254 trauma patients were visited every 2 days for skin assessment. The overall incidence of PUs was 28·3% (n = 72/254 patients). The incidence of device‐related PUs was 20·1% (n = 51), and 13% (n = 33) developed solely device‐related PUs. We observed 145 PUs in total of which 60·7% were related to devices (88/145). Device‐related PUs were detected 16 different locations on the front and back of the body. These results show that the incidence of PUs and the proportion of device‐related PUs is very high in trauma patients.     

血清骨唾液酸蛋白的生物变异性研究

目的　骨唾液酸蛋白（Ｂｏｎｅ ｓｉａｌｏｐｒｏｔｅｉｎ,简称ＢＳＰ）是由成骨细胞分泌的一种非胶原蛋白质,反映骨转换和骨形成的指标。最近研究认为：血清ＢＳＰ浓度可反映破骨细胞活性和骨吸收过程,也可能是一个骨吸收指标。本实验测定了血清ＢＳＰ在人体内的生物变异性。方法　采用ＲＩＡ 法测定了２９０例不同性别和年龄的正常人血清ＢＳＰ的正常值,血清ＢＳＰ的天－天变异性及２４ ｈ 生物周期。　结果　在儿童组血清ＢＳＰ正常水平明显高于成人组,其最高值在新生儿期和青春期。绝经后妇女其血清浓度比绝经前妇女水平明显升高（Ｐ＜ ０．０５）。血清ＢＳＰ在每天同一时间的波动范围在 ７．３％ 至１７．７％ （平均１１．７％ ）。２４ ｈ 内有一个明显的生物周期性变化,表现为峰值在凌晨４～８ 时,然后逐渐下降直到午后１４时为最低。其生物周期的最大波幅为±２０％ ,（平均血浓度为１０．５ ｎｇ／ｍ ｌ）。结论　血清ＢＳＰ反映了骨转换的生理变化与年龄有明显相关性,其血清水平２４ ｈ 内有一个明显的生物周期,而天与天之间变异性较小。     

Predictors of clinical events or restenosis during follow-up after percutaneous mitral balloon valvotomy.

AIMS: The purpose of this study is to define predictors of events or restenosis during follow-up after percutaneous mitral balloon valvotomy. METHODS AND RESULTS: Percutaneous mitral balloon valvotomy was attempted in 137 patients with severe mitral valve stenosis. In 127 patients follow-up was complete with a mean of 4.2 +/- 2.6 years. Events during follow-up were defined as death, mitral valve surgery or repeat percutaneous mitral balloon valvotomy. Restenosis was defined as a decrease in mitral valve area from > or = 1.5 cm2 following percutaneous mitral balloon valvotomy to < 1.5 cm2. There was 80 +/- 4% event-free survival 4 years after percutaneous mitral balloon valvotomy. Multivariate analysis showed chronic atrial fibrillation at baseline (P = 0.039, relative risk (RR) = 2.5) and a high residual maximal gradient after percutaneous mitral balloon valvotomy (P = 0.004, RR = 2.0 per 5 mmHg) to be independent predictors of an event during follow-up. The restenosis rate was 28.3% after 4 years. Chronic atrial fibrillation at baseline (P = 0.0338, RR = 2.2), a small mitral valve area after percutaneous mitral balloon valvotomy (P = 0.0003, RR = 0.8/0.1 cm2) and a high residual maximal transmitral gradient (P = 0.0252, RR = 1.6/5 mmHg) were all independent predictors of restenosis. CONCLUSION: Patients with chronic atrial fibrillation and a high maximal transmitral gradient after percutaneous mitral balloon valvotomy have a higher risk for events during follow-up. Restenosis is related to the presence of chronic atrial fibrillation at baseline and a suboptimal percutaneous mitral balloon valvotomy result.     

Progression of atherosclerosis after venous coronary artery bypass graft surgery: A 15-year follow-up study

We investigated the influence of progression of atherosclerosis on clinical outcome in a cohort of 428 consecutive patients with isolated venous coronary artery bypass graft surgery followed prospectively for 15 years. In 189 patients 307 repeat coronary angiograms were performed because of recurrent signs of ischemia. Progression in the native coronary circulation only was found in 38 angiograms (12%), in both the native circulation and in venous grafts in 66 angiograms (21%), in venous grafts only in 135 angiograms (44%), and no progression was found in 68 angiograms (22%). In all the angiographies with a proven progression in the native coronary arteries, 40% was found to be distal to a vein graft insertion. In multivariate analysis the number of distal anastomoses predicts progression in both the native circulation and in venous grafts. Thus, progression is determined by the extensiveness of coronary artery disease at operation. Also, the interval between operation and repeat angiography predicts progression in the native circulation. We conclude that clinical outcome is also determined by progression in the native coronary circulation. Secondary prevention may, therefore, benefit not only the long-term result in patients with venous bypass grafts but probably also in patients with any type of coronary bypass surgery. Cathet. Cardiovasc. Diagn. 41:141–150, 1997. © 1997 Wiley-Liss, Inc.     

Acute occlusion of the left main coronary artery following intracoronary ultrasound examination

Intracoronary ultrasound (ICUS) is generally considered as safe procedure, with a low complication rate. We describe a nearly fatal complication of a diagnostic ICUS study that was treated succesfully with stent implantation in the left main coronary artery and discuss the indications and remaining risks of this procedure. Cathet. Cardiovasc. Intervent. 47:181–184, 1999. © 1999 Wiley-Liss, Inc.     

Stimulation of osteogenic differentiation in human osteoprogenitor cells by pulsed electromagnetic fields: an in vitro study

Background  

Although pulsed electromagnetic field (PEMF) stimulation may be clinically beneficial during fracture healing and for a wide range of bone disorders, there is still debate on its working mechanism. Mesenchymal stem cells are likely mediators facilitating the observed clinical effects of PEMF. Here, we performed in vitro experiments to investigate the effect of PEMF stimulation on human bone marrow-derived stromal cell (BMSC) metabolism and, specifically, whether PEMF can stimulate their osteogenic differentiation.     

精液分析现状：对《亚洲男性学杂志》出版的陆金春等所著的“中国118 家实验室精液分析状况的调查”一文的评论

陆金春等[1]所著的"中国118家实验室精液分析状况的调查"一文主要回顾了当前在中国采用的精液分析方法.     

Routine defunctioning stoma after chemoradiation and total mesorectal excision:A single-surgeon experience

AIM:To investigate the 10-year results of treating low rectal cancer by a single surgeon in one institution.METHODS:From Oct 1998 to Feb 2009,we prospectively followed a total of 62 patients with cT2-4 low rectal cancer with lower tumor margins measuring at 3 to 6 cm above the anal verge.All patients received neoadjuvant chemoradiation(CRT) for 6 wk.Among them,85% of the patients received 225 mg/m2/d 5-fluorouracil using a portable infusion pump.The whole pelvis received a total dose of 45 Gy of irradiation in 25 fractions over 5 wk.The interval from CRT completion to surgical intervention was planned to be approximately 6-8 wk.Total mesorectal excision(TME) and routine defunctioning stoma construction were performed by one surgeon.The distal resection margin,circumferential resection margin,tumor regression grade(TRG) and other parameters were recorded.We used TRG to evaluate the tumor response after neoadjuvant CRT.We evaluated anal function outcomes using the Memorial Sloan-Kettering Cancer Center anal function scores after closure of the defunctioning stoma.RESULTS:The median distance from the lower margin of rectal cancer to the anal verge was 5 cm:6 cm in 9 patients,5 cm in 32 patients,4 cm in 10 patients,and 3 cm in 11 patients.Before receiving neoadjuvant CRT,45 patients(72.6%) had a cT3-4 tumor,and 21(33.9%) patients had a cN1-2 lymph node status.After CRT,30 patients(48.4%) had a greater than 50% clinical reduction in tumor size.The final pathology reports revealed that 33 patients(53.2%) had a ypT3-4 tumor and 12(19.4%) patients had ypN1-2 lymph node involvement.All patients completed the entire course of neoadjuvant CRT.Most patients developed only Grade 1-2 toxicities during CRT.Thirteen patients(21%) achieved a pathologic complete response.Few post-operative complications occurred.Nearly 90% of the defunctioning stomas were closed within 6 mo.The local recurrence rate was 3.2%.Pathologic lymph node involvement was the only prognostic factor predicting disease recurrence(36.5% vs 76.5%,P = 0.006).Ne