Semen analysis in laboratory practice: an overview of routine tests

Semen analysis is a basic step in the investigation of several disturbances affecting the male genital tract. Analysis of seminal parameters provides important clinical information on the spermatogenesis and functional competence of spermatozoa, as well as on the secretory pattern of the accessory genital glands. Semen analysis is particularly useful in the evaluation of couples requiring fertility investigation (to detect genital infections and pathologies) and in verifying the influence of environmental factors, drugs, lifestyle, chemical products, and professional activities on several diseases affecting male reproductive health. Measure of semen quality is of substantial interest for diagnoses in clinical urology, andrology, and gynecology. Currently, basic requirements for semen analysis are standardized by World Health Organization (WHO) guidelines that describe several procedures for an objective evaluation of the semen quality with diagnostic purposes. These guidelines include: parameters for the physical and biochemical evaluation of semen; parameters for the analysis of sperm characteristics; and other seminal parameters that can be easily adopted in any laboratory. This report summarizes current concepts on semen analysis and the significance of the seminal parameters for reaching a diagnosis based on the procedures recommended by WHO guidelines.     

乌司他丁干预重症有机磷农药中毒的临床研究

目的 评价乌司他丁干预在防治急性有机磷农药中毒（AOPP）引发的多器官功能障碍综合征（MODS）及降低其病死率方面的作用。方法 45例重症AOPP患者随机分为鸟司他丁干预组（n=23）和非乌司他丁干预组（n=22），观察两组治疗前后全血胆碱酯酶和肌酸激酶同工酶、动脉血气及血流动力学的变化，比较两组患者肺及肺外器官功能改善率、并发症发生率、ICU病死率度其死亡的原因等。结果 两组患者的年龄、全血胆碱酯酶和APACHEⅡ评分比较，差异无统计学意义（P〉0．05）。乌司他丁干预组对重症AOPP患者的全血胆碱酯酶、肌酸激酶同工酶、动脉血气及血流动力学的影响均优于对照组，肺及肺外器官功能改善率明显优于对照组，机械通气相关肺炎（VAP）、心肌缺血和心律失常的发生率也均明显下降；乌司他丁干预组因多器官功能衰竭（MOF）的ICU病死率为4．35％，明显优于对照组（27．27％，P〈0．05），使重症AOPP患者ICU救治的痊愈率从72．73％提高到95．65％（P〈0．05）。结论 乌司他丁干预能改善重症AOPP患者全血胆碱酯酶、肌酸激酶同工酶、动脉血气及血流动力学，降低VAP、心肌缺血和心律失常的发生率，在防治AOPP引发的MODS及降低其病死率方面有很好的临床效果。     

Neuromuscular adaptations in older males and females with knee osteoarthritis during weight-bearing force control

Background

Females exhibit significantly greater incidence, prevalence, and severity of osteoarthritis (OA) compared to males. Despite known biological, morphological, and functional differences between males and females, there has been little sex-related investigation into sex-specific biomechanical and neuromuscular responses to OA.

Paroxysmal Severe Mitral Regurgitation

ObjectiveTo investigate the clinical presentation, pathophysiology, and treatment for "paroxysmal severe mitral regurgitation" (MR), which is an underappreciated cause of heart failure with preserved left ventricular ejection fraction.MethodsWe retrospectively reviewed cases of transient severe MR that were evaluated at Mayo Clinic in Rochester, Minnesota, between January 1, 2006, and December 31, 2019. Paroxysmal severe MR was defined as the appearance of transient severe MR in patients with mild MR at rest, normal left ventricle (LV) size, left ventricular ejection fraction greater than 40%, and absence of obstructive coronary artery disease.ResultsWe identified 6 patients (5 women) with a median age of 68 years. There were 3 distinct mechanisms of paroxysmal severe MR, which we labeled types 1, 2, and 3. Type 1 MR was caused by LV dyssynchrony from a rate-dependent left bundle branch block, which led to apical leaflet tenting and incomplete coaptation. Type 2 MR occurred from mitral annular dilatation during maneuvers that increased left-sided volume. Type 3 MR was caused by coronary artery vasospasm with apical leaflet tenting. Treatments varied depending on the underlying cause and included cardiac resynchronization therapy for type 1, surgical valve replacement for type 2, and medical therapy for type 3.ConclusionParoxysmal severe MR is a rare cause of heart failure in patients with preserved LV function. We have identified 3 distinct mechanisms that can lead to this dynamic process, with treatments varying based on the underlying cause.     

第二产程分阶段自由体位在产妇分娩中的应用效果

目的探究第二产程分阶段自由体位在产妇分娩中的应用效果。方法选择于我院分娩的88例产妇作为研究对象,采用数字随机表法将其分为对照组和观察组,各44例。对照组第二产程取常规仰卧位或半卧截石位,观察组第二产程选择分阶段自由体位。比较两组的分娩方式、第二产程时间、自主用力时间、产后出血量、生殖道损伤及新生儿窒息发生情况。结果观察组的自然分娩率高于对照组,第二产程时间和自主用力时间短于对照组,产后出血量少于对照组,会阴侧切、宫颈裂伤、会阴裂伤发生率低于对照组(P<0.05)。两组的新生儿窒息发生率无显著差异(P>0.05)。结论在第二产程实施分阶段自由体位分娩可提高产妇的阴道分娩率,缩短产程时间,降低生殖道损伤的发生风险,值得推广。     

血清CA125水平检测在妇科疾病中的临床应用

[目的] 探讨血清CA125水平在某些妇科疾病中的升高情况及临床应用价值.[方法] 采用电化学免疫发光法检测196例妇科疾病患者与100名正常人血清CA125水平.[结果] 血清CA125水平在卵巢癌、卵巢良性肿瘤、子宫肌瘤、子宫腺肌症、盆腔炎有增高,平均值分别为402.65、146.40、57.62、107.50、56.14 kU/L,妇科疾病各组阳性检出率分别为81.03%、19.73%、40.0%、72.73%、35.0%,其中卵巢癌患者血清CA125水平与卵巢良性肿瘤相比,差异具有高度显著性（P〈0.01）;子宫肌瘤与子宫腺肌症血清CA125水平差异具有显著性（P〈0.05）.如以CA125〈35 kU/L和CA125〈65kU/L为临界值诊断卵巢癌,其特异性分别为80.2%、92.1%,两者具有统计学差异（P〈0.05）.[结论] 血清CA125水平增高可见于卵巢癌及一些妇科良性疾病;以CA125〈65 kU/L为临界值可显著提高卵巢癌诊断特异性;依据血清CA125水平有利于术前鉴别子宫肌瘤与子宫腺肌症.     

Urinary androgens and cortisol metabolites in field-sampled bonobos (Pan paniscus)

Urinary metabolites of androgens and cortisol were measured in free-living male and female bonobos. Sex differences and correlations between adrenal and gonadal steroid excretion were investigated. The immunoreactive concentrations of androgens were measured with two different androgen assays. One assay used a testosterone (T) antibody raised with a 17beta-hydroxy group, and the other employed an antibody raised against a reduced form, 5alpha-androstane-17alpha-ol-3-one-CM (17alpha) with cross reactivity for epitestosterone and 5alpha-androstanedione. Both assays have been used in bonobo and chimpanzee studies where non-invasive techniques were employed. The levels of 17alpha-androgen metabolites were 1.7- and 3-fold higher than those of T-metabolites in males and females. The two androgen assay results correlated in males but not females. There was a sex difference in the T-metabolites measured. Male levels were significantly higher. Levels of 17alpha in the two sexes were similar. Cortisol metabolite levels (CORT) were similar between the sexes. The T-metabolites were significantly correlated with CORT in males but not in females. In females, the 17alpha-androgen metabolites correlated with CORT. This suggests that either androgen secretion or metabolism differs between the sexes. A parsimonious interpretation of the androgen assay cortisol/androgen correlation differences would be that larger components of dehydroepiandrosterone (DHEA), androstenedione or epitestosterone from the adrenal androgens were being excreted and measured in the females. The CORT/T metabolite interactions in males may reflect male-specific social or metabolic endocrine conditions.     

Pregnant women's experiences of male partner involvement in the context of prevention of mother-to-child transmission in Khayelitsha,South Africa

Male partner involvement (MPI) has been identified as a priority intervention in programmes for the prevention of mother-to-child transmission (PMTCT) of HIV, but rates of MPI remain low worldwide. This study used a quantitative survey (n = 170) and two focus group discussions (FGDs) with 16 HIV-positive pregnant women attending a public sector antenatal care service in Khayelitsha, South Africa, to examine the determinants of high levels of involvement and generate a broader understanding of women's experiences of MPI during pregnancy. Among survey participants, 74% had disclosed their status to their partner, and most reported high levels of communication around HIV testing and preventing partner transmission, as well as high levels of MPI. High MPI was significantly more likely among women who were cohabiting with their partner; who had reportedly disclosed their HIV status to their partner; and who reported higher levels of HIV-related communication with their partner. FGD participants discussed a range of ways in which partners can be supportive during pregnancy, not limited to male attendance of antenatal care. MPI appears to be a feasible intervention in this context, and MPI interventions should aim to encourage male partner attendance of antenatal care as well as greater involvement in pregnancy more generally. Interventions that target communication are needed to facilitate HIV-related communication and disclosure within couples. MPI should remain a priority intervention in PMTCT programmes, and increased efforts should be made to promote MPI in PMTCT.