Seminal plasma alpha-glucosidase activity and male infertility

Measurement of alpha-glucosidase (alpha-GLUC) activity by means of a simple colorimetric test using a commercial kit (EpiScreen; FertiPro, Lotenhulle, Belgium) yielded results that were strongly correlated with the values obtained for the neutral iso-enzyme measured by a fluorimetric reference method (r=0.85, P=0.003, n=13). The former method was characterized by a low intra- and inter-coefficient of variation (6.6 and 4.3% respectively). Vasectomized men with azoospermia (n=27) had a significantly lower alpha-GLUC activity in semen than vasectomized men with residual spermatozoa present (n=11, P < 0.01) and men with azoospermia of primary testicular origin (n=33, P < 0.01). Receiver operating curve (ROC) analysis showed alpha-GLUC measurement to be reasonably accurate in differentiation between cases with obstructive versus testicular azoospermia at criterion value 13.5 U/l (sensitivity=82%, specificity= 70%). In cases with spermatozoa present, alpha-GLUC activity and output per ejaculate were positively correlated with sperm concentration (r=0.53 and 0.38, n=472), linear velocity (r=0.35 and 0.30, n=224), curvilinear velocity (r=0.32 and r=0.29, n=224), semen adenosine triphosphate (r=0.35 and 0.26, n=64), the concentration of 5alpha-dihydrotestosterone (r=0.31 and 0.29, n=74), and gamma-glutamyltransferase activity (r=0.62 and 0.32, n=275) in seminal plasma. The activity of alpha-GLUC was inversely correlated with ROS generation after 12-myristate, 13-acetate phorbol ester stimulation (r=-0.27, n=104), and both alpha-GLUC activity and total output were inversely correlated with the concentration of peroxidase- positive white blood cells among samples with > or =1x10(6)/ml of these cells (r=-0.30 and -0.19, n=165). It is concluded that simple photometric measurement of alpha-GLUC activity in seminal plasma reflects the functional state of the epididymis and may be helpful for the differential diagnosis of certain cases with azoospermia.      

Lack of correlation between maximum early follicular phase serum follicle stimulating hormone concentrations and menstrual cycle characteristics in women under the age of 35 years

The gradual increase in follicle stimulating hormone (FSH) concentrations in women approaching menopause results from the depletion of the ovarian follicular pool, a process referred to as 'ovarian ageing'. This study investigates whether variable endogenous FSH concentrations, as have been observed in normo-ovulatory young women, are related to menstrual cycle characteristics, including predictors of ovarian ageing. Serum concentrations of immunoreactive FSH, oestradiol, and inhibin-A and inhibin-B were measured, and follicular growth was assessed by transvaginal ultrasound throughout the follicular phase in 39 healthy volunteers (20-35 years) with regular menstrual cycles. Median serum FSH concentration on cycle day 3 was 5.1 IU/l (range 3.6-11.2), and median maximum follicular phase FSH was 6.2 IU/l (range 4.3-11.2), observed on cycle day 6 (range 2-15). Maximum FSH concentrations were not correlated with age or cycle length, nor with maximum inhibin-B. The number of small (<10 mm) antral follicles on cycle day 3 was 11 (range 4-21) and was not correlated with age, nor with maximum FSH. Inhibin-A remained low until a significant rise on cycle day 9 (range 3-12), which was significantly correlated with the late follicular rise in oestradiol (r = 0.56, P = 0.01). These observations indicate a lack of correlation between maximum follicular phase serum FSH concentrations and parameters of ovarian ageing in women under the age of 35 years. In addition, FSH concentrations assessed on cycle day 3 represent an underestimation of maximum early follicular phase FSH. Distinct individual differences in intra-ovarian modification of FSH action, resulting in differences in the FSH threshold for stimulation of ovarian function, may be operative.      

Zweipunktediskrimination bei Phantomschmerzen

There is evidence that phantom pain is associated with a disrupted organization of the sensory cortex and that this organization can be normalized by training with two-point discrimination (TPD). In this case study a reduction in all three phantom modalities (i.e. phantom pain, phantom feeling and painful phantom sensation) and a reduction in pain level from m=?4.13/10 visual analogue scale (VAS) to m=?0.67/10 (VAS) could be observed in a patient with an upper limb amputation during a test period of 28 days with TPD. The quality of life and performance increased significantly. This can be a promising indication for a better social and work reintegration.     

Hereditary leiomyomatosis and renal cell cancer in families referred for fumarate hydratase germline mutation analysis

Smit DL, Mensenkamp AR, Badeloe S, Breuning MH, Simon MEH, van Spaendonck KY, Aalfs CM, Post JG, Shanley S, Krapels IPC, Hoefsloot LH, van Moorselaar RJA, Starink TM, Bayley J‐P, Frank J, van Steensel MAM, Menko FH. Hereditary leiomyomatosis and renal cell cancer in families referred for fumarate hydratase germline mutation analysis. Heterozygous fumarate hydratase (FH) germline mutations cause hereditary leiomyomatosis and renal cell cancer (HLRCC), an autosomal dominant syndrome characterized by multiple cutaneous piloleiomyomas, uterine leiomyomas and papillary type 2 renal cancer. The main objective of our study was to evaluate clinical and genetic data from families suspected of HLRCC on a nationwide level. All families referred for FH mutation analysis in the Netherlands were assessed. We performed FH sequence analysis and multiplex ligation‐dependent probe amplification. Families with similar FH mutations were examined for haplotype sharing. In 14 out of 33 families, we identified 11 different pathogenic FH germline mutations, including 4 novel mutations and 1 whole‐gene deletion. Clinical data were available for 35 FH mutation carriers. Cutaneous leiomyomas were present in all FH mutation carriers older than 40 years of age. Eleven out of 21 female FH mutation carriers underwent surgical treatment for symptomatic uterine leiomyomas at an average of 35 years. Two FH mutation carriers had papillary type 2 renal cancer and Wilms' tumour, respectively. We evaluated the relevance of our findings for clinical practice and have proposed clinical diagnostic criteria, indications for FH mutation analysis and recommendations for management.     

Tooth root dentin mineralization defects in a mouse model of hypophosphatasia

Tissue‐nonspecific alkaline phosphatase (TNAP) is expressed in mineralizing tissues and functions to reduce pyrophosphate (PP_i), a potent inhibitor of mineralization. Loss of TNAP function causes hypophosphatasia (HPP), a heritable disorder marked by increased PP_i, resulting in rickets and osteomalacia. Tooth root cementum defects are well described in both HPP patients and in Alpl^?/? mice, a model for infantile HPP. In Alpl^?/? mice, dentin mineralization is specifically delayed in the root; however, reports from human HPP patients are variable and inconsistent regarding dentin defects. In the current study, we aimed to define the molecular basis for changes in dentinogenesis observed in Alpl^?/? mice. TNAP was found to be highly expressed by mature odontoblasts, and Alpl^?/? molar and incisor roots featured defective dentin mineralization, ranging from a mild delay to severely disturbed root dentinogenesis. Lack of mantle dentin mineralization was associated with disordered and dysmorphic odontoblasts having disrupted expression of marker genes osteocalcin and dentin sialophosphoprotein. The formation of, initiation of mineralization within, and rupture of matrix vesicles in Alpl^?/? dentin matrix was not affected. Osteopontin (OPN), an inhibitor of mineralization that contributes to the skeletal pathology in Alpl^?/? mice, was present in the generally unmineralized Alpl^?/? mantle dentin at ruptured mineralizing matrix vesicles, as detected by immunohistochemistry and by immunogold labeling. However, ablating the OPN‐encoding Spp1 gene in Alpl^?/? mice was insufficient to rescue the dentin mineralization defect. Administration of bioengineered mineral‐targeting human TNAP (ENB‐0040) to Alpl^?/? mice corrected defective dentin mineralization in the molar roots. These studies reveal that TNAP participates in root dentin formation and confirm that reduction of PP_i during dentinogenesis is necessary for odontoblast differentiation, dentin matrix secretion, and mineralization. Furthermore, these results elucidate developmental mechanisms underlying dentin pathology in HPP patients, and begin to explain the reported variability in the dentin/pulp complex pathology in these patients. © 2013 American Society for Bone and Mineral Research     

Are There Racial Disparities in Trauma Care?

Background  A number of recent studies have demonstrated disparity between racial groups in both outcome and processes of trauma care. These were not controlled for the presence of shock. Methods  We used data from the National Trauma Databank (NTDB) (version 6.0) to evaluate mortality, length of hospital stay, and discharge disposition for patients who suffered gunshot wounds (GSW) or who were drivers in motor vehicle crashes (MVC). Using regression analysis to control for age, gender, first measured systolic blood pressure, geographic region, trauma center verification status, and hospital teaching status, we looked for differences in trauma care outcomes by race as represented in the NTDB. Results  We included 235,557 MVC victims and 13,378 GSW victims in our analysis. When potential confounding variables were accounted for, there were no differences in mortality based on race in either group, with the exception that Hispanic motor vehicle drivers suffered higher mortality, OR: 1.72 (95% CI: 1.36, 2.19; p < .001). Both Blacks and Hispanics had shorter lengths of stay in linear regression models (p < .001 in both cases) than whites. Blacks and Hispanics were less likely to be discharged home when compared to white patients (OR 0.83, 95% CI 0.80–0.86 for Blacks, and OR 0.53, 95% CI 0.50–0.56 for Hispanics). Shock, as reflected by first systolic blood pressure reported, and to a lesser degree, anatomic injury, as measured by Injury Severity Score (ICISS), were much more powerful predictors of outcome than race in all analyses. Conclusions  We found no mortality differences based on race for GSW. Hispanics have a higher mortality rate for MVC. For both injury types, Blacks and Hispanics had shorter hospital stays and a greater likelihood of transfer to post-acute care when compared to white patients. Hypotension on admission has a much more significant impact on outcome than race and ethnicity.     

甲基莲心碱对豚鼠心房生理特性及异丙肾上腺素和Ca~(2+)量—效反应的影响

甲基莲心碱1～100μmol/L浓度依赖性地抑制豚鼠左心房收缩性,延长功能性不应期,降低兴奋性;30μmol/L甲基莲心碱能明显提高肾上腺素诱发左心房自律性的阈浓度。对异丙肾上腺素量—效反应的影响,不同于β-受体阻滞剂普萘洛尔,表现为非竞争性拮抗作用,对Ca~(2+)量—效反应的影响,与抗钙剂维拉帕米类似,呈竞争性和非竞争性双重拮抗作用。     

中青年糖尿病患者胰岛素治疗存在的问题及护理干预

糖尿病易导致严重的急慢性并发症,已成为影响人们生活质量的一种常见疾病。胰岛素作为降糖激素,在控制糖尿病的发生、发展中有不可取代的作用。本文对中青年糖尿病患者在接受胰岛素治疗方面存在的问题及护理干预进行归纳。