手术结合聚精汤治疗精索静脉曲张不育合并精浆中性α-糖苷酶异常60例临床观察

目的:观察手术结合中药治疗精索静脉曲张合并精浆中性α-糖苷酶异常的不育症患者的临床疗效。方法:将60例符合纳入标准的精索静脉曲张并伴精浆中性α-糖苷酶异常的不育患者随机分为手术组(对照组A,n=20)、聚精汤组(对照组B,n=20)、手术与聚精汤结合组(治疗组,n=20)。手术均采用改良Palomo术,中药均以聚精汤(徐福松方)口服,一日一剂,分2次服用。三组患者共治疗12周,治疗结束后随访48周,观察其精液体积、精液p H值、精子总数、精子浓度、精子前向活动率(PR)、总活动率(PR+NP)、精浆中性α-糖苷酶活性及配偶怀孕情况等。结果:三组在治疗后组间对照比较,组间患者的精子浓度、精子前向活动率(PR)、总活动率(PR+NP)、精浆中性α-糖苷酶活性(一次射精)均有显著性的差异(P0.05),并且都以手术与聚精汤结合组为优。而精液体积、精液p H值无显著性差异(P0.05)。三组治疗后的精子浓度、精子前向活动率(PR)、总活动率(PR+NP)、精浆中性α-糖苷酶活性(一次射精)与治疗前相比均有明显提高,有显著性差异(P0.05)。精液量、精液p H值与治疗前相比无显著性差异(P0.05)。60例患者随访48周,其配偶怀孕共21人(总怀孕率35%),其中手术组6人(怀孕率30%);聚精汤组2人(怀孕率10%);手术与聚精汤结合组13人(怀孕率65%);三组间比较有显著性差异(P0.01),手术与聚精汤结合组优于聚精汤组或手术组。三组的总体疗效差异性显著(P0.01或P0.05),手术与聚精汤结合组的疗效最优。结论:手术结合聚精汤能够提高精索静脉曲张不育合并精浆中性α-糖苷酶异常患者的精液质量和精浆中性α-糖苷酶活性,改善睾丸附睾功能提高精子活力,同时也能提高配偶怀孕率;效果优于单纯手术或单纯中药治疗。     

抗乙肝病毒药物对慢性乙肝育龄患者精子质量的影响

比较研究抗乙肝病毒药物干扰素、拉米夫定和阿德福韦酯对育龄慢性乙肝男性患者精子质量的影响.将90名20~45岁男性育龄慢性乙肝患者,随机分为干扰素治疗组、拉米夫定治疗组和阿德福韦酯治疗组.分别检测各药物组患者治疗前、治疗中和治疗后的血清HBsAg阴转率、HBeAg阴转率、抗-HBe阴转率、乙肝病毒-DNA(HBV-DNA)和谷丙转氨酶(ALT)以及精子的密度和活力.结果发现,干扰素、拉夫米定、阿德福韦酯治疗慢性乙肝的疗效显著,但治疗期间和停药3个月后,各组患者的精子密度和活力水平均显著下降(P0.05;P0.01),停药6个月后恢复至治疗前的水平.结果提示,干扰素、拉夫米定、阿德福韦酯均明显降低男性患者精子密度和活力的水平,影响到患者的生育力;停药后,该副作用有所缓解.     

口腔正畸患者恒牙先天缺失的调查

目的:探讨恒牙先天缺失在口腔正畸患者中的发生率、发生程度及牙齿缺失分布情况。方法:选取我院2012年4月-2014年9月收治的口腔正畸患者648例,对其全颌曲面断层片情况进行观察,并详细统计患性别、缺失牙数及分布情况。结果:648例口腔正畸患者中,恒压先天缺失例数为59例,发生率为9.10%,其中男性例数为19例,女性例数为40例,发生率分别为9.05%、9.13%,对比无显著差异(P0.05);59例恒牙先天缺损患者缺牙总数为96颗,缺失牙数为2颗及以下患者总例数为51例(86.44%),缺失牙数2颗的患者例数为8例(13.56%),对比差异显著(P0.05);上颌、下颌缺牙数分别占缺牙总数的31.25%、68.75%,对比具有显著差异(P0.05),左侧、右侧缺牙数分别占缺牙总数的48.96、51.04%%,对比无明显差异(P0.05)。结论:口腔正畸患者恒压先天缺失在男女中的发生率无明显差异,大多数患者缺失牙数为1-2颗,且多数缺失发生于下颌,下颌侧切牙及下颌第二前磨牙为主要缺失牙位。     

西藏高原地区146例成人肺结核应用Xpert MTB/RIF联合T-SPOT.TB在诊断中的价值

目的总结分析肺结核疾病应用Xpert MTB/RIF技术联合T-SPOT.TB技术在诊断肺结核疾病中的临床价值。方法回顾性选择2018年1月至2018年12月在西藏自治区人民医院住院期间同时行Xpert MTB/RIF技术、T-SPOT.TB技术患者的临床资料,146例患者的临床表现、影像学资料等均符合《临床诊疗指南:结核病分册》标准的患者为此次研究对象。回顾性分析146例肺结核病患者的相关数据,总结其Xpert MTB/RIF技术联合TSPOT.TB技术在诊断中的价值。结果 146例肺结核病患者中,应用Xpert MTB/RIF技术组阳性例数为61例,其阳性预测值为42%,其阴性预测值为58%;应用T-SPOT.TB技术组阳性例数为92例,阳性预测值为63%,其阴性预测值为37%;应用Xpert MTB/RIF技术联合T-SPOT.TB技术组阳性例数为125例,阳性预测值为86%,其阴性预测值为14%,组间差异具有统计学意义(P0.05)。结论肺结核病患者应用T-SPOT.TB技术组阳性预测值(63%)明显高于应用Xpert MTB/RIF技术组阳性预测值(42%),而单独应用Xpert MTB/RIF技术或者单独应用TSPOT.TB技术组其阳性预测值明显低于Xpert MTB/RIF联合T-SPOT.TB技术组的阳性预测值,所以同时应用Xpert MTB/RIF检测技术及T-SPOT.TB检测技术可以弥补单项检测技术阳性预测值较低的现象,其在诊治肺结核病中具有较高的参考价值。     

我们从哪里来?

35岁的安迪·卡尔文是美国华盛顿特区一名IT界从业人员.2006年,他利用DNA检测技术把家族起源追溯到了乌克兰,但在那里却卡住了.有一天,他读到Y染色体可以从父亲完整地遗传给儿子,研究人员利用Y染色体成功在找到了一个原始部落的始祖.……     

不同剂量孕激素治疗无排卵型月经失调的效果对比分析

目的:研究分析在无排卵型月经失调患者采用不同剂量的孕激素进行治疗后的效果。方法:选取在本院接受治疗的无排卵型月经失调患者,选取时间段为2016年4月至2017年12月,病例数为90例。通过随机数字表格法分组,平均分成对照组和观察组各45例。观察组中患者接受100mg/d的剂量治疗,对照组中患者接受200mg/d的计量治疗。分析两组患者的治疗效果以及不良反应情况。结果:观察组中患者的总疗效率为97.78%,对照组中患者的总疗效率为95.56%,组间差异不具有统计学意义(P0.05)。观察组中患者的不良反应率为22.22%,对照组中患者的不良反应率为6.67%,组间差异具有统计学意义(P0. 05)。结论:临床上针对无排卵型月经失调患者采用100mg/d的较低剂量孕激素治疗效果良好,与200mg/d剂量相比不良反应率更低。     

人工生殖技术的发展

自爱德华兹和斯特普托创造试管婴儿技术之后,人工生殖技术在今天有了长足的发展。今天人工生殖技术已发展为典型的三种方式。一是体外授精和胚胎移植,二是卵子胞浆内羊精子注射（ICSI）,三是胚胎移植前基因诊断。过去曾把这三种技术说成是三代人工生殖技术,但这显然是不准确的。     

子宫内膜异位症相关性不孕症患者卵泡液TGF-β1的测定和临床意义

目的探讨子宫内膜异位症(内异症)相关性不孕症患者卵泡液中转化生长因子β1(TGF-β1)测定在诊治中的临床价值.方法酶联免疫吸附分析法(ELISA)测定35例内异症相关性不孕症患者、45例输卵管因素和男性因素不孕症患者,在控制性超排卵(COH)周期取卵日的卵泡液TGF-β1水平,并随访两组的妊娠结局.结果35例内异症组患者的TGF-β1水平(896.2±203.7)pg/mL,与对照组(1005.0±305.7)pg/mL相比较无统计学差异(P＞0.05).内异症组患者的妊娠率与对照组相比显著降低(22.6%versus 37.5%,P＜0.001),难免流产率有显著增高(33.3%versus 6.6%,P＜0.0001).结论COH周期排卵日卵泡液的TGF-β1测定对内异症相关性不孕症患者的IVF妊娠结局无辅助诊断价值.     

高原(拉萨)地区藏族新生儿红细胞增多症临床分析

目的了解高原(拉萨)地区藏族新生儿红细胞增多症临床特征,探讨符合高原地区藏族新生儿红细胞增多症有效的治疗方案,了解外周和静脉血常规检测指标结果.方法文章对2012年1月至2014年9月16日西藏自治区人民医院儿科新生儿重症监护室(NICU)病区收治的藏族新生儿红细胞增多症30例病例和20例平原地区新生儿红细胞增多症的临床症状、体征、治疗效果进行了回顾性分析,同时进行静脉血常规参数治疗前、治疗后对比。结果文章30例新生儿红细胞增多症临床特征:病因以异常产为主,缺氧为诱发因素;临床以发绀、呼吸急促、面色紫红、易激惹、呼吸暂停、症状重为主要特征。其次是心音低钝、原始反射弱、心电图异常6例、治疗前与治疗后各组外周和静脉血常规检测指标结果比较均0.01、治疗前与对照组除了外周血常规HCT P0.01、P值均在0.01,治疗后与对照组:各组P值0.01。结论在临床工作中注重临床特征,建议新生儿红细胞增多症患儿检测血液中可首选外周血常规检测,可指导新生儿红细胞增多症的诊治,首选生理盐水是有效的治疗方案。     

放射性核素骨显像技术与PSA联合检测在前列腺癌骨转移中的临床运用价值

目的：分析放射性核素骨显像技术与PSA联合检测在前列腺癌骨转移中的临床运用价值。方法：对淮安市肿瘤医院2019年1月至2022年1月间诊治的40例前列腺癌患者同时进行放射性核素骨显像技术及血清前列腺特异性抗原（PSA）联合检测的结果进行回顾性分析。结果：放射性核素显像技术显示骨转移38例，阳性率占95%。38例骨转移病例中，发生在中轴骨转移较多，主要部位以胸、腰椎为主，有20例，占骨转移例数的52.63%；骨盆次之，有13例，占34.21%；胸骨、四肢及四肢带骨、肋骨、颅骨转移占比较少，有5例，占13.16%，多部位骨转移灶有23例，占60.53%;PSA检测显示其浓度越高其放射性核素显示比例越高，两者呈现正相关，PSA<20μg/L患者，骨转移灶显示率较低。结论：PSA血清检测结果大于或等于20μg/L患者，应该进行放射性核素全身骨显像检查，为后续治疗方案的制定和对疾病发展趋势的研判提供有效的临床参考依据。     

独活寄生汤联合来氟米特治疗类风湿关节炎临床研究

目的:对独活寄生汤联合来氟米特片治疗类风湿关节炎的临床疗效进行观察。方法:对独活寄生汤联合来氟米特片治疗类风湿关节炎(肝肾亏虚型)的临床疗效进行回顾性分析;应用随机数字表把纳入的120例患者随机分为治疗组和对照组,两组各60例,对照组给予来氟米特片治疗;治疗组予以独活寄生汤联合来氟米特片治疗,1疗程为6个月,分别于治疗前、治疗1个月、2个月、3个月对患者进行DAS-28评分并采用HAQ健康评估问卷进行生存质量评估。结果:治疗组总有效率、显效率分别为88.33%和80%;对照组总有效率、显效率分别为73.33%和61.61%。总有效率、显效率治疗组均显著优于对照组。两组患者HAQ评分、DAS-28评分在治疗1个月均有所改善,病情得到控制;两组患者HAQ评分、DAS-28评分在2个月后仍继续减少,病情初步缓解,较本组治疗前有显著性差异(P0.05),组间相比仍无显著性差异(P0.05);两组患者在治疗结束时HAQ评分、DAS-28评分明显减少,病情完全控制,较本组治疗前及治疗1个月有显著性差异(P0.05),组间相比均有显著性差异(P0.05)。结论:独活寄生汤联合来氟米特片可有效改善肝肾亏虚型型类风湿关节炎患者的临床症状及实验室指标,且无明显不良反应,提高生存质量,取得了满意效果。     

主动脉夹层31例临床回顾性分析

目的:探讨主动脉夹层患者的临床特点及其与Stanford分型、临床症状的关系,减少误诊率。方法:回顾性分析广西中医药大学附属瑞康医院2005年1月至2015年9月间收治确诊为主动脉夹层的住院治疗患者31例的临床资料、生化指标及转归。按Stanford分型及性别分组,对每组患者进行统计分析。结果:31例患者中男性患者28例,女性3例,既往有高血压病史15例,缺血性心肌病7例,马方综合征1例。5例死亡(2例死于并发症,3例自然破裂),死亡率16.12%。3例行人工血管置换,2例行带膜支架植入成功,男性发病年龄小于女性,二者差异有统计学意义(P=0.043)。女性患病人数明显少于男性。男女组患Stanford A、B型年龄差异无统计学意义;A型住院天数短于B型,但差异无统计学意义(P=0.053);A型转归差于B型;合并高血压患者入院收缩压高于无高血压患者,舒张压二组无差别。结论:在入院治疗患者中,男性患病人数较多。Stanford A型住院天数较短,预后较B型差。     

Microscopic haematuria as an occult filarial infection in bhubaneshwar an endemic area for bancroftian filariasis

Sera samples of 7 microscopic haematuria cases collected before and after treatment with Diethylcarbamazine citrate, (DEC), 9 microfilaraemic cases and 19 endemic normal individuals were analysed for filarial antigen and IgG antibody levels. Filarial antigen was detected in 5 of the 7 microscopic haematuria cases, of which 3 turned negative for antigen after treatment with DEC. While none of the 7 haematuria cases were positive for filarial IgG antibodies, before the DEC treatment, all of them turned positive after DEC treatment. The sensitivity and specificity values(to detect mf +ve cases) were 89% and 90% respectively for the detection of filarial antigen and 78% and 95% respectively for the detection of filarial IgG antibodies.     

Usage of Conventional PCR Technology for the Detection of HLA-B27 Allele: A Significant Molecular Marker of Ankylosing Spondylitis

Ankylosing spondylitis is a chronic inflammatory disease that has been linked to the human leukocyte antigen class I allele HLA-B27. More than 90 % of patients with ankylosing spondylitis possess the HLA-B27 allele, but only 1 % of people with HLA-B27 develop the disease. Ankylosing spondylitis predominately affects young males. The present study was planned to find out the involvement of HLA-B27 specific allele in relation to age and sex in symptomatic suspected patients of ankylosing spondylitis using conventional PCR technology. Forty symptomatic patients of ankylosing spondylitis were included in the present study. SSP–PCR technique was used to detect the HLA-B27 specific allele. This study showed (out of 40 symptomatic suspected cases of ankylosing spondylitis only 12 patients were detected positive with HLA-B27 allele, while remaining 28 were negative) that the positivity rate for ankylosing spondylitis with HLA-B27 allele is low. Furthermore, it was observed that the males above 50 years are more prone to develop AS with HLA-B27 specific allele. It could be concluded that the conventional PCR technology is a rapid, sensitive, and confirmatory method for the diagnosis of ankylosing spondylitis.     

逍遥散治疗慢性病毒性乙型肝炎(肝郁脾虚证)50例临床观察

目的:观察逍遥散治疗慢性乙型病毒性肝炎的临床疗效。方法:100例慢性乙型病毒性肝炎患者随机分为两组,观察组50例在对照组基础上口服逍遥散,150ml/次,3次/d;对照组50例口服恩替卡韦分散片,0.5mg/次,1次/d。两组患者均治疗3个疗程共12周,观察两组患者治疗前后的临床症状、体征、HBV-DNA、肝功能的变化程度。结果:观察组患者临床疗效总有效率显著高于对照组(98%vs 84%),两组间比较差异有显著性意义(P0.05)。结论:加服逍遥散治疗慢性乙型病毒性肝炎有较好的疗效,值得临床进一步研究应用。     

单克隆抗体MC3用于大肠癌和腺瘤的免疫组织化学研究及其预后意义

用单克隆抗体MC_3在福尔马林固定的48例大肠癌、31例癌变腺瘤、42例伴有不典型增生腺瘤、40例腺瘤、13例息肉以及48例正常肠粘膜组织切片上用免疫组化(PAP)法检测,结果MC_3相应抗原的表达阳性率分别为93.8％(45/48)、80.65％ (25/31)、47.62％ (20/42)、37.5％(15/40),其阳性率差异有非常显著性(P<0.001).48例正常肠粘膜均为阴性.MC_3在大肠癌组织中的反应程度与患者3年生存率有关,差异有显著意义(P<0.05).MC_3反应强度在高分化肠癌组与中～低分化肠癌组比较差异有显著意义(P<0.05).在绒毛状腺瘤、混合性腺瘤和管状腺瘤中MC_3相应抗原表达阳性率分别为71.4％(25/35)、60.0％(9/15)、41.3(26/63),差异有显著性(p<0.05).绒毛状腺瘤、混合性腺瘤和管状腺瘤其癌变率分别为45.7％(16/35)、13.3％(2/15)、20.6％(13/63),其癌变率比较差异有显著性(P<0.05).     

80例非胰岛素依赖性糖尿病患者前臂尺,桡骨骨密度分析

用单光子吸收法（ＳＰＡ）对杭州市汉族５０岁以上的８０例非胰岛素依赖性糖尿病（ＮＩＤＤＭ）患者和年龄、性别与ＮＩＤＤＭ患者相配对的４３１名正常人的前臂尺、桡骨骨密度（ＢＭＤ）进行测定，发现女性轻中型和重型组、男性重型组ＮＩＤＤＩＭ患者的尺桡骨平均ＢＭＤ显著地低于正常人（Ｐ＜０．０１）；本组ＮＩＤＤＭ患者（男女合计）的一般性骨质疏松症（ＧＯＰ）和进行性骨质疏松症（ＰＯＰ）的发病率分别为６３．７５％和８．７５％，与正常人组相比较差异非常显著（Ｐ＜０．０１）；不同病程ＮＩＤＤＭ患者组别间尺桡骨平均ＢＭＤ的差异不显著（Ｐ＞０．０５），提示ＮＩＤＤＭ的病程与ＢＭＤ的相关程度不密切。     

Direct diagnosis ofMycobacterium tuberculosis in blood samples of HIV infected patients by polymerase chain reaction

We have developed a simple, economical and reproducible method for processing blood samples from HIV infected patients for diagnosis of tuberculosis. The procedure was validated on 55 samples selected for tuberculosis based on clinical criteria. 52 patients had radiological changes indicative of pulmonary tuberculosis of which only 28 were positive for AFB in sputum (sensitivity 54%) and 27 for tuberculin (sensitivity 52%). 26 HIV positive patients who showed positive X-ray did not react to tuberculin. The genus PCR probe missed 3 samples (sensitivity 94%) compared to X-ray.M.tuberculosis was detected in the blood of all X-ray positive cases by PCR using TB400 probe (sensitivity 100%) and another probe forM. tuberculosis, IS6110, missed 6 of them (sensitivity 88% compared to X-ray and 89% compared to TB400). It is proposed that this simple sample processing method could be used to screen all blood samples quickly for mycobacteremia using the genus PCR and only those positive for mycobacteria need to be tested forM.tuberculosis. This would save the scarce resources and time by reducing significantly the number of samples to be screened for species confirmation.     

Multiplex PCR for rapid detection of exonal deletions in patients of duchenne muscular dystrophy

Duchenne muscular dystrophy (DMD) is the most common X-linked disorder in children affecting 1 in 3500 males. Since, as of now, we have no treatment for DMD, carrier detection and prenatal diagnosis is the most important preventive strategy. Multiplex PCR helps in rapid detection of hot spot exonal deletions (positive in 65% of cases) as many exons can be identified in a single run. 10 children with characterstic clinical features of DMD and chorionic villus samples of 10 antenatal patients with positive family history were studied. We identified a deletion mutation in exon 49 of the dystrophin gene in a 4 yr old boy referred with signs and symptoms suggestive of DMD using primers for exons 45, 48, 49, 43, 44, 19, 3, 8, 13 and muscle promoter, subjected to multiplex polymerase chain reaction (PCR) and agarose/Nu-Sieve gel electrophoresis. These genetic methods aid in prenatal diagnosis of DMD as well as confirmation of diagnosis in children with signs and symptoms suggestive of the disease. Work done as WHO fellow in Deptt. of Genetics, All India Institute of Medical Sciences, New Delhi.     

Isolation, PCR based identification, and sensitivity pattern of environmental mycobacteria from leprosy and tuberculosis patients

We have isolated and identified the biotype of environmental mycobacteria from the expectorate of leprosy patients, their contacts, their drinking water supply and also from the sputa samples of tuberculosis patients. 78% of the isolates from lepromatous leprosy patients and their contacts wereMycobacterium fortuitum- chelonae complex (MFC), 9%Mycobacterium avium complex (MAC), 9%Mycobacterium scrofulaceum and 4% wereMycobacterium smegmatis. Among the isolates from tuberculosis patients 63% belonged toM. fortuitum- chelonae complex, 19% toM. avium complex, 12% toMycobacterium Kansasii and 6% toM. smegmatis. All the isolates were multi-drug resistant when tested for sensitivity total of 21 drugs. TheMycobacterium fortuitum-chelonae complex organisms from leprosy contacts were more sensitive to rifampicin than those isolated from lepromatous leprosy and tuberculosis patients. Among 23 isolates from leprosy patients one isolate was resistant to 20 drugs, one isolate to 17 drugs and another isolate was resistant to 13 drugs. Among the 18 isolates from drinking water supply six showed resistance to more than 12 drugs. Polymerase Chain Reaction (PCR) and subsequent hybridisation with specific probes confirmed all the isolated strains as nontuberculous mycobacteria (Using genus primers and probe sensitivity 100%) and none asM. tuberculosis, suggesting that PCR could be used to rapidly identify mycobacteria at the genus level and to rule out tuberculosis in leprosy patients at an early stage to decide on appropriate course of therapy.