Efficacy of intracytoplasmic sperm injection using intentionally cryopreserved epididymal spermatozoa

Microsurgical epididymal sperm aspiration was a great advancein the therapy of patients with non-recon-structable, obstructiveazoospermia, most notably congenital bilateral absence of thevas deferens. Using conventional in-vitro fertilization, pregnancieswere rarely achieved because the rate of oocyte fertilizationwas extremely poor. However, the use of retrieved spermatozoain conjunction with intracytoplasmic sperm injection (ICSI)has dramatically increased the likelihood of embryo formation.Typically, sperm and oocyte harvesting are performed simultaneously.We have investigated whether frozen-thawed spermatozoa workas well as fresh spermatozoa. When we had concluded from ourown population of patients (groups I and II) that they did,we adopted a policy of aspirating spermatozoa, primarily cryopreservingthem and using them for ICSI at a later date. We found the fertilizationrates of this latter cohort of patients (group III) to be excellent(37% per oocyte), and the ongoing pregnancy rate is quite satisfactory(40 % per couple, 29% per cycle). We offer this approach asan alternative to the traditional scheme because it markedlyeases the burden of partner scheduling on both the couple andthe clinicians involved. In addition, assurance of the availabilityof male partner spermatozoa can be attained prior to beginningovulation induction.     

急性ST段抬高型心肌梗死患者院内新发心房颤动的列线图预测模型构建与验证

目的 探究急性ST段抬高型心肌梗死（ST-segment elevation myocardial infarction,STEMI）患者新发心房颤动（new-onset atrial fibrillation,NOAF）的风险预测模型构建并验证,以便为尽早发现高风险人群、及时采取干预措施提供依据。方法 选取2017年1月至2021年12月在重庆市第四人民医院心血管内科住院的1 080名STEMI患者,其中院内新发房颤患者作为NOAF组（n=87）,从未发生NOAF的STEMI患者中随机抽取一部分作为对照组（n=199）,比较2组患者人口学特征及入院时临床资料,利用LASSO回归模型分析STEMI患者发生院内新发心房颤动的风险因素。对纳入的患者按7∶3的比例划分为模型组及验证组,建立个性化的院内NOAF预测模型并进行验证。结果 LASSO回归结果提示,年龄、入院心率、Killip分级≥II级、右房内径、二尖瓣中度以上反流、氨基末端脑钠肽前体（N-terminal pro-B-type natriuretic peptide,NT-proBNP）为STEMI患者发生院内NOAF的重要预测因素（P<0.05）。利用上述6个预测指标构建列线图模型。模型组曲线下面积（area under the curve,AUC）为 0.842（95%CI=0.780~0.905）,准确度为0.840（95%CI=0.782~0.888）;验证组 AUC 为 0.858（95%CI=0.774~0.943）,准确度为0.826（95%CI=0.729~0.899）。同时,校准曲线提示预测模型的校正能力良好。结论 本研究成功构建了STEMI患者院内发生NOAF风险的预测模型,经相关指标证实该预测模型具有较好的预测效率和临床适用性。利用列线图可方便直观地协助临床医护人员筛选高NOAF风险患者,制定针对性的干预措施,为早期防治和改善预后提供依据。     

Externalization and internalization of cardiac endothelin receptors during different phases of sepsis in rat.

Objective. To study the redistribution ofendothelin- 1 (ET- 1 ) receptors in two subcellular organelles, the sarcolemreal membrane and the light vesicle, of rat heart during the progression of sepsis. Methods. Sepsis was induced by cecal ligation and puncture (CLP). ET1 receptor was assayed by using[125I]-ET1 binding. Marker enzyme activities, protein yield, and dry-to-wet weight ratio of cardiac membraneswere measured. Results. Septic rat heart exhibited two distinct phases: an initial hyperdynamic phase( 9h after CLP; early stage of sepsis) followed by a hypodynamic ( 18h after CLP, late stage of sepsis) phase. [125I]-ET1 binding study showed that during early stage of sepsis, the Bmax of ET1 receptors was increased by 30% in sarcolemma but decreased by 19% in light vesicles, while during late stage of sepsis, the Bmax was decreased by 24% in sarcolem-ma but increased by 38% in light vesicles. The total binding of sarcolemma and light vesicles was increased by 25% during early stage of sepsis but decreased by 17% during late stage of sepsis. Conclusions. These data indicated that ET1 receptors in the rat heart were externalized from light vesicles to sarcolemmal membranes during early hyperdynamic phase while internalized from surface membranes to intracellu-lar compartment during late hypodynamic phase of sepsis.     

电话传送心电图监测与常规心电图诊断心肌缺血的应用比较

目的：探讨电话传送心电图检测（Ｔｒａｎｓｔｅｌｅｐｏｍｉｃ Ｅｌｅｃｔｒｏｃａｒｄｉｏｇｒａｐｈｉｃ Ｍｏｎｉｔｏｒｉｎｇ,ＴＴＭ）心肌缺血的诊断价值。方法：同步检测９７例心肌缺血患者的常规心电图（ＥＣＧ）、电话传送心电图（ＴＴＭ）,调整后者的监测电极与ＥＣＧ的电极部位完全相同,判断二者的Ｓ－Ｔ、Ｔ缺血变化。结果：ＥＣＧ发现９７例典型Ｓ－Ｔ、Ｔ心肌缺血患者,ＴＴＭ有９０例相同变化（敏感性９２．５％     

壮族人和汉族人高血压与心肌肥厚关系探讨

目的:通过对壮族人和汉族人原发性高血压与左室心肌肥厚关系的研究,从侧面探讨两个民族的原发性高血压的等位基因是否相同,从而指导临床的治疗用药.方法:壮族组30例,汉族组40例,两组患者均为原发性高血压病人.采用彩色多谱勒超声仪进行心脏检查,测量相关径线并进行比较.结果:两组患者的心超测值及左室心肌肥厚情况无显著性差异.结论:壮族人与汉族人原发性高血压左室心肌肥厚情况无差异,说明两者的等位基因有可能相同.     

二尖瓣脱垂与急性风湿性心脏炎的相关性研究

目的探讨二尖瓣脱垂(MVP)与急性风湿性心脏炎(ARC)的相关性。方法对108例风湿热并ARC的患者行超声心动图检查以观察MVP的发生率。结果超声心动图检查发现MVP76例,发生率为70％,其中前叶脱垂57例(53％),后叶脱垂13例(12％),前后叶均脱垂6例(6％)。与对照组比较有明显的差异(P＜0．01)。ARC所致MVP中74例(97％)并发二尖辫关闭不全(MI),且MVP与MI的严重程度密切相关(P＜0．01)。结论ARC是MVP,尤其是二尖瓣前叶脱垂的重要原因之一,而MVP是ARC所致MI的重要因素。     

妊娠期糖尿病对妊娠结局的影响

目的研究GDM对母婴的影响。方法对112例GDM孕妇和112例健康孕妇的妊娠结局进行分析。采用11配对病例—对照研究,配对的条件是孕妇年龄相近(±2),同年同月同医院分娩。结果GDM孕妇手术分娩率、早产率、妊娠高血压综合征和巨大儿发生率都较对照组高。GDM的及早诊断和及时治疗可使巨大儿发生率降低。与新生儿病率有关的因素是GDM的严重程度、血糖控制情况及巨大儿。结论早期诊断GDM及控制血糖是减少妇婴并发症的关键。     

复杂型先天性心脏病磁共振成像的诊断研究

目的对复杂型先天性心脏病(先心病)磁共振成像(MRI)与心血管造影(Angio)进行对比分析研究,评价MRI在小儿复杂型先心病的诊断价值.方法对复杂型先心病患儿42例,应用超导磁共振仪,选用心电图门控自旋回波法技术(SE),电影磁共振(cine-MRI),磁共振造影(MRA),获取T1加权像(T1WI),并进行二维彩色多谱勒超声心动图检查,其中30例做了Angio检查,25例经手术治疗.结果 MRI能准确诊断本组病例,包括大动脉转位(TGA)、主动脉缩窄(COA)、法洛四联症(TOF)、右室双出口(DORV)、永存动脉单干(TA)、肺静脉易位引流(TAPVD)及单心室(SV) 的主要解剖畸形及合并畸形.MRI亦能准确显示肺动脉及其分枝.结论 MRI在小儿复杂型先心病诊断上有重要的临床应用价值.     

氧化低密度脂蛋白、低氧和5-HT对血管平滑肌细胞5-HT2A受体及胞内游离钙的影响

目的　为探讨粥样硬化病变动脉对 5 - HT收缩反应增加的机制 ,观察与粥样硬化有关因子氧化低密度脂蛋白 (ox L DL)、低氧、5 - HT对血管平滑肌细胞 5 - HT2 A受体及其基因表达 ,以及细胞 [Ca2 ]i的效应。方法　分别将大鼠主动脉平滑肌细胞单独以 5 0 μg/ m l ox L DL 培养 8h,2 %低氧处理 2 4和 48h,10 μm ol/ L 5 - HT处理30 min,放射配基结合分析测定 5 - HT2 A受体 ;RT- PCR和 Southern杂交检测受体基因的 m RNA;激光共聚焦扫描显微镜测单个细胞 [Ca2 ]i。结果　经 ox L DL、低氧、 5 - HT处理 ,血管平滑肌细胞 5 - HT2 A受体显著上调 (P<0 .0 1) ;ox L DL及低氧处理的受体基因的 m RNA表达增加 ;ox L DL、低氧处理后 ,5 - HT刺激的血管平滑肌细胞[Ca2 ]i升高幅度显著加大 (P<0 .0 5及 P<0 .0 1)。结论　 ox L DL、低氧、5 - HT引起血管平滑肌细胞 5 - HT2 A受体上调及细胞 [Ca2 ]i增加 ,可能是粥样硬化动脉对 5 - HT收缩反应增强的部分原因。