不同染色方法对精子形态学分析结果的影响

目的 探讨不同染色方法 对精子形态学分析结果 的影响.方法 选取20例人精液样本,每例样本制作2张涂片,分别采用改良巴氏染色方法 和Diff-Quik快速染色法进行染色,每例样本剩余精液经生理盐水洗涤后再制作2张涂片,也分别用上述两种染色方法 进行染色.染色后的所有涂片在精子形态自动分析软件上进行分析.结果 未经洗涤的精液涂片经改良巴氏染色和Diff-Quik快速染色正常形态精子百分率分别为7%(95%CI,5%～9%)、9%(95%CI,6%～12%),两者差异无统计学意义.洗涤后改良巴氏法和Diff-Quik法评估的精子正常形态百分率有明显提高,并且Diff-Quik法评估的精子正常形态百分率(15%,95%CI12%～18%)显著高于改良巴氏法(10%,95%CI 9%～11%).结论 未经洗涤的精子涂片两种评估正常形态精子百分率差异无统计学意义;精子洗涤后涂片染色对计算机精子形态学自动分析结果 有显著影响,且Diff-Quik法提高效果更明显.     

Functional pectoralis minor muscle flap transplantation for reconstruction of thumb opposition: an anatomic study and clinical applications

In this report, we present the results of an anatomic study on the dimensions of the pectoralis minor muscle and its neurovascular supply in 10 adult human cadavers, in attempt to evaluate the feasibility of microsurgical transplantation of a part of the muscle for thumb opposition reconstruction. A series of five patients consequently underwent thenar reconstruction with the pectoralis minor muscle flap from December 2004 to October 2006. The transferred muscle was reinnervated with the third lumbrical branch of the ulnar nerve. Follow-up assessment showed that the patients recovered functional opposition of carpometacarpal joint with 24 degrees of pronation, and a muscle power with M4 to M5. All patients were satisfied with the appearance of reconstructed thenar eminence. We recommend this new technique for thenar and opposition reconstruction in patients who have severe loss of thenar muscles, injury to the median nerve, and wish to improve the appearance of thenar eminence.     

经椎板间隙术式摘除髓核65例报告

目的　探讨经椎板解剖间隙摘除L4 ,5、L5S1间盘髓核的可行性 ,以达到术后最大限度地保留腰椎后部结构 ,预防术后腰不稳和疤痕粘连、压迫的目的。方法　随机对 6 5例L4 ,5、L5S1单纯椎间盘突出的病人 ,经椎板解剖间隙行髓核摘除术。结果　术中摘除髓核 4～ 10 g ,平均 4 8g ,手术用时 1 5h以内 ,经 3～ 2 4个月的随访 ,优 6 0例 ,良 4例 ,可 1例 ,优良率98 46 %。结论　对单纯L4 ,5、L5S1椎间盘突出 ,经椎板解剖间隙能彻底地摘除髓核 ,椎板间隙作为一自然的间隙 ,能预防术后后方的疤痕粘连和压迫     

体外短波热疗联合前列腺灸及哈乐治疗非细菌性前列腺炎和前列腺痛疗效观察

目的 探讨慢性非细菌性前列腺炎（CNP）和前列腺痛（PD）的治疗方法。方法 应用体外短波热疗联合前列腺灸及α1A-肾上腺素能受体阻滞剂哈乐治疗CNP和PD患者26例，疗程8周。观察治疗前后前列腺炎症状评分（CPSI）与最大尿流率（MFR）变化。结果 有效率为80．8％。治疗前后CPSI和MFR均有显著改善（P〈0．05）。结论 体外短波热疗联合前列腺灸及哈乐治疗CNP和PD安全有效。     

Effects of WNK3 kinase on regulation of large-conductance calcium-activated potassium channels and its mechanisms

Objective To investigate the effects of WNK3 kinase on the regulation of large-conductance calcium-activated potassium channels (Maxi K channels) on African green monkey kidney fibroblast-like cells (Cos-7 cells) and its mechanisms. Methods (1) Cos-7 cells were transfected with 0, 0.6, 1.2, 1.8 μg WNK3 plasmid+0.5 μg Maxi K plasmid. The total protein expression of Maxi K channel and the phosphorylation of mitogen-activated protein kinase (MAPK) extracellular regulated kinase-1 and-2 (ERK1/2) were detected by Western blotting. (2) Cos-7 cells were divided into the control group (2.5 μg Maxi K plasmid) and the experimental group (2.5 μg WNK3 plasmid+2.5 μg Maxi K plasmid). Cell surface biotinylation was used to investigate the cell surface protein expression of Maxi K channel in Cos-7 cells. Immunoprecipitation and Western blotting were used to detect the ubiquitination of Maxi K channel protein. (3) WNK3 kinase was knocked down by WNK3 siRNA. The lysosomal degradation pathway was blocked by the proton pump inhibitor (Baf-A1). Cos-7 cells were divided into Maxi K+negative control siRNA group, Maxi K+WNK3 siRNA group and Maxi K+WNK3 siRNA+Baf-A1 group. The protein expression of Maxi K channel protein was detected by Western blotting. Results (1) Compared with those in 0 μg WNK3 plasmid groups, in 0.6, 1.2, 1.8 μg WNK3 plasmid groups the total protein expression of the Maxi K channel increased and the phosphorylation level of MAPK ERK1/2 reduced on a dose-dependent manner (all P＜0.01). (2) Compared with those in the control group, the total protein expression and cell surface membrane protein expression of the Maxi K channel increased in the experimental group (P＜0.01), while the ubiquitination of the Maxi K channel protein reduced (P＜0.01). (3) Compared with the Maxi K+negative control siRNA group, the expression of Maxi K protein reduced in the Maxi K+WNK3 siRNA group (P＜0.01), but did not change in the Maxi K+WNK3 siRNA+Baf-A1 group (P＞0.05). The expression of Maxi K protein in Maxi K+WNK3 siRNA+Baf-A1 group was higher than that in Maxi K+WNK3 siRNA group (P＜0.01). Conclusions WNK3 kinase inhibits the lysosomal degradation pathway of Maxi K channel protein by reducing the ubiquitination of Maxi K channel, and promotes the expression of Maxi K channel protein in cells and on cell membrane. These effects may be achieved by suppressing MAPK ERK1/2 signal transduction pathway.     

经肛肠减压后3D腹腔镜根治术治疗梗阻性结肠癌的临床观察

目的探讨经肛肠减压后3D腹腔镜根治术治疗梗阻性结肠癌的临床疗效。 方法回顾性分析2015年6月至2018年6月收治的54例梗阻性结肠癌患者的临床资料,所有患者术前均经肛肠减压,根据手术方式分为3D组(25例)和开腹组(29例),所有数据均应用SPSS22.0软件进行统计学分析,围术期相关指标等计量资料以( ±s)表示,采用独立样本t检验;术后并发症发生率组间比较采用χ²检验,P<0.05为差异有统计学意义。 结果两组患者术前减压管放置时间、手术时间和淋巴结清扫数目比较,差异均无统计学意义(P>0.05);3D组术中出血量、首次通气时间以及平均住院时间均明显少于开腹组,但平均住院费用高于开腹组;两组患者术后并发症发生率比较,差异无统计学意义(P>0.05)。 结论经肛肠减压后实施3D腹腔镜根治术治疗梗阻性结肠癌是安全、有效的,术中出血量少、术后恢复快,值得在临床广泛推广应用。     

试论岳甫嘉医案中不育的诊治思维

岳甫嘉诊病重视脉症合参,尤以诊脉见长;处方多用中和之剂,收固真阴,反对过用热药,耗散精血。诊治思维贯穿其著作《妙一斋医学正印种子编》上卷所载验案。此卷专门论述男性不育的诊治,虽仅载验案八则,但八者皆奇,诊治结合,涵盖多法,可归纳为“先清热毒,再施温补”“药用滑涩,当辨标本”“先治脾,后治肾”“脾肾同治”“先祛痰火,再滋肾阴”及“交通心肾”6类,诸法之中的诊治思维,蕴含奥妙,颇具特色,特作探析。     

再次或多次手术治疗复发性腹膜后 脂肪肉瘤的临床意义

目的 探讨再次手术或多次手术治疗复发性腹膜后脂肪肉瘤的治疗策略和临床意义。方法 回 顾性分析2013 年1 月—2017 年8 月北京大学第一医院普通外科收治的16 例腹膜后脂肪肉瘤术后复发患者（复 发组）行再次或多次手术的临床资料,随访时间12 ～ 62 个月,平均30 个月;观察其术后效果。结果 16 例 腹膜后肿瘤术后复发患者共行手术30 例次,手术时间60 ～ 840 min,平均360 min ;中位手术时间270 min, 术中出血50 ～ 33 100 ml,平均3 755 ml ;中位出血量800 ml。其中,28 例次手术为联合脏器切除。原发性腹 膜后脂肪肉瘤行手术治疗患者（原发组）与复发组在肿瘤最大径、是否多灶等指标比较,差异无统计学意义 （P >0.05）,而手术时间、出血量及是否联合脏器切除比较,差异有统计学意义（P <0.05）。随访期间无瘤存 活率为25%（4/16）,带瘤生存8 例,死亡4 例。结论 对于复发性腹膜后脂肪肉瘤患者,经多学科评估和完 善的术前准备,可行再次或多次手术治疗。     

纯音听阈正常糖尿病前期患者畸变产物耳声发射的变化特点

目的 观察纯音听阈正常的糖尿病前期（pre-diabetic）患者畸变产物耳声发射（distortion product otoacoustic emission,DPOAE）情况,探讨其变化特点。方法 根据口服葡萄糖耐量试验（oral glucose tolerance test,OGTT）和纯音测听结果连续入组年龄<60岁的纯音听阈正常的糖尿病前期患者30例,其中,男性13例,女性17例,平均年龄（49.80±8.23）岁,对照组为同期年龄、性别构成接近、血糖结果正常的健康体检人群30例,其中,男性9例,女性21例,平均年龄（46.55±5.09）岁。所有受试者进行内分泌相关检查（包括空腹血糖、2 h血糖、糖化血红蛋白、血脂、尿白蛋白/肌酐等）及畸变产物耳声发射检查,比较两组受试者各频率畸变产物耳声发射反应幅值及异常检出率。结果 糖尿病前期组左、右耳DPOAE反应幅值均低于对照组,其中左耳在0.7、1、1.5、2、3、4 kHz差异有统计学意义（P<0.05）,右耳在1.5、2、3、4、6 kHz差异有统计学意义（P<0.05）。在异常检出率方面,糖尿病前期组各频率均高于对照组,在3 kHz差异有统计学意义（P=0.037）。结论 糖尿病前期在纯音测听正常时就已出现耳蜗外毛细胞功能受损,以右耳受损更为显著,存在右耳优势减弱,畸变产物耳声发射较纯音测听敏感性更高。