Clinical features and microsurgical reconstruction of congenital unilateral absence of the vas deferens with obstructive azoospermia: a tertiary care center experience / 亚洲男科学杂志(英文版)

Patients with congenital unilateral absence of the vas deferens (CUAVD) manifest diverse symptoms from normospermia to azoospermia. Treatment for CUAVD patients with obstructive azoospermia (OA) is complicated, and there is a lack of relevant reports. In this study, we describe the clinical features and evaluate the treatments and outcomes of CUAVD patients with OA. From December 2015 to December 2020, 33 patients were diagnosed as CUAVD with OA in Shanghai General Hospital (Shanghai, China). Patient information, ultrasound findings, semen analysis, hormone profiles, and treatment information were collected, and the clinical outcomes were evaluated. Of 33 patients, 29 patients were retrospectively analyzed. Vasoepididymostomy (VE) or cross VE was performed in 12 patients, the patency rate was 41.7% (5/12), and natural pregnancy was achieved in one of the patients. The other 17 patients underwent testicular sperm extraction as the distal vas deferens (contralateral side) was obstructed. These findings showed that VE or cross VE remains an alternative treatment for CUAVD patients with OA, even with a relatively low rate of patency and natural pregnancy.

Chronergy of hypoxia on endoplasmic reticulum stress in neonate rat myocardial cells / 解放军医学杂志

Objective To investigate the expression of endoplasmic reticulum stress protein induced by hypoxia in different hypoxic phase, and study the significance of endoplasmic reticulum stress on the apoptosis of rats' myocardial cells in vitro. Methods The cultured myocardial cells of neonate rats were divided randomly into 0-hour group (control group) and hypoxia for 6-hour, 12-hour, 18-hour, 24-hour and 30-hour groups. Animals in hypoxia groups were treated with mixed gas of 95% N2 and 5% CO2 for different periods, and those in control group were without hypoxic treatment. Expressions of GRP78, CHOP and Caspase-12 protein were examined by Western blotting, and the apoptosis of myocardial cells was detected by flow cytometry. Results Basic expression of GRP78 was observed in control group. Up-regulation of GRP78 expression was induced by hypoxia for 6 hours. Significant increase of GRP78 expression appeared at 12-hour, and peaked at 18-hour, after hypoxia (P<0.05). Decrease of GRP78 expression was observed at 24-hour and 30-hour after hypoxia. Up-regulation of CHOP and Caspase-12 expression was detected at 12-hour after hypoxia exposure and maintained during 30-hour hypoxia exposure. Typical manifestation of myocardial cells apoptosis appeared at 12-hour after hypoxia. Compared with the control group, the apoptosis rate increased significantly at 18-hour, 24-hour and 30-hour after exposure to hypoxia (P<0.01). Conclusion Endoplasmic reticulum stress in myocardial cells play different roles in different hypoxic phase.

Chronergy of hypoxia on endoplasmic reticulum stress in neonate rat myocardial cells / 解放军医学杂志

Objective To investigate the expression of endoplasmic reticulum stress protein induced by hypoxia in different hypoxic phase, and study the significance of endoplasmic reticulum stress on the apoptosis of rats' myocardial cells in vitro. Methods The cultured myocardial cells of neonate rats were divided randomly into 0-hour group (control group) and hypoxia for 6-hour, 12-hour, 18-hour, 24-hour and 30-hour groups. Animals in hypoxia groups were treated with mixed gas of 95% N2 and 5% CO2 for different periods, and those in control group were without hypoxic treatment. Expressions of GRP78, CHOP and Caspase-12 protein were examined by Western blotting, and the apoptosis of myocardial cells was detected by flow cytometry. Results Basic expression of GRP78 was observed in control group. Up-regulation of GRP78 expression was induced by hypoxia for 6 hours. Significant increase of GRP78 expression appeared at 12-hour, and peaked at 18-hour, after hypoxia (P<0.05). Decrease of GRP78 expression was observed at 24-hour and 30-hour after hypoxia. Up-regulation of CHOP and Caspase-12 expression was detected at 12-hour after hypoxia exposure and maintained during 30-hour hypoxia exposure. Typical manifestation of myocardial cells apoptosis appeared at 12-hour after hypoxia. Compared with the control group, the apoptosis rate increased significantly at 18-hour, 24-hour and 30-hour after exposure to hypoxia (P<0.01). Conclusion Endoplasmic reticulum stress in myocardial cells play different roles in different hypoxic phase.

Autologous bone marrow stem cell transplantation in critical limb ischemia: a meta-analysis of randomized controlled trials / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Amputation-free survival (AFS) has been recommended as the gold standard for evaluating No-Option Critical Limb Ischemia (NO-CLI) therapy. Early-phase clinical trials suggest that autologous bone-marrow derived cells (BMCs) transplantation may have a positive effect on patients with NO-CLI, especially decreasing the incidence of amputation. However, the BMCs therapeutic efficacy remains controversial and whether BMCs therapy is suitable for all CLI patients is unclear.</p><p><b>METHODS</b>We conducted a meta-analysis using data from randomized controlled trials (RCTs) by comparing autologous BMCs therapy with controls in patients with critical limb ischemia, and the primary endpoint is the incidence of amputation. Pubmed, EBSCO and the Cochrane Central Register of Controlled Trials (to approximately July 25, 2012) were searched.</p><p><b>RESULTS</b>Seven RCTs with 373 patients were enrolled in the meta-analysis. Because serious disease was the main reason leading to amputation in one trial, six studies with 333 patients were finally included in the meta-analysis. Pooling the data of the final six studies, we found that BMCs therapy significantly decreased the incidence of amputation in patients with CLI (odds ratio (OR), 0.37; 95% confidence interval (CI), 0.22 to 0.62; P = 0.0002), and the efficacy had not significantly declined within 6 months after BMCs were transplanted; OR, 0.33; 95%CI, 0.16 to 0.70; P = 0.004 within 6 months and OR, 0.30; 95%CI, 0.11 to 0.79; P = 0.01 within 3 months. The rate of AFS after BMCs therapy was significantly increased in patients with Rutherford class 5 CLI (OR 3.28; 95%CI, 1.12 to 9.65; P = 0.03), while there was no significant improvement in patients with Rutherford class 4 (OR 0.35; 95%CI, 0.05 to 2.33; P = 0.28) compared with controls. The BMCs therapy also improved ulcer healing (OR, 5.83; 95%CI, 2.37 to 14.29; P = 0.0001).</p><p><b>CONCLUSIONS</b>Our analysis suggests that autologous BMCs therapy has a beneficial effect in decreasing the incidence of amputation and the efficacy does not decrease significantly within 6 months after BMCs transplantation. Patients with Rutherford class 5 are suitable for BMCs therapy, while the efficiency in patients with Rutherford 4 needs further evaluation.</p>

Metformin versus metformin plus rosiglitazone in women with polycystic ovary syndrome / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Hyperinsulinemia and insulin resistance are present in the majority of women with polycystic ovary syndrome (PCOS). Both metformin and rosiglitazone can improve the ovulation and endocrine disorders of the patients. How about the combination of the two? It is rarely reported. This study aimed to compare the therapeutic efficacy of metformin versus metformin plus rosiglitazone in patients with PCOS.</p><p><b>METHODS</b>Fifty-eight women with PCOS were randomly assigned to two groups. Metformin group (29) was treated with metformin mono-therapy and metformin plus rosiglitazone group (29) was treated with metformin plus rosiglitazone for 6 months. Treatment was discontinued once pregnancy was diagnosed.</p><p><b>RESULTS</b>Fasting insulin, postprandial insulin, the homeostatic model assessment of insulin resistance (HOMA-IR), luteinizing hormone (LH), triglyceride, lower density cholesterol and testosterone level decreased significantly in both groups (P < 0.05). Metformin plus rosiglitazone had a better effect than metformin mono-therapy. Body mass index decreased by 7.8% in metformin group while no significant change in metformin plus rosiglitazone group. There were eight pregnancies, six in metformin plus rosiglitazone group (one abortion) and two in metformin group. There was no congenital anomaly at birth and seven infants developed well at one year's follow-up.</p><p><b>CONCLUSIONS</b>Metformin can improve insulin resistance and imbalance of endocrine hormones. Metformin plus rosiglitazone has a more pronounced therapeutic effect and achieved more pregnancies than mono-therapy with metformin. The use of metformin and rosiglitazone before pregnancy has no obvious side effect on the development of the infants. Our study might suggest that metformin is the better choice in PCOS patients with serious obese and rosiglitazone plus metformin would be more effective in patients with severe insulin resistance or those do not respond to metformin.</p>

Appropriate insulin initiation dosage for insulin-naive type 2 diabetes outpatients receiving insulin monotherapy or in combination with metformin and/or pioglitazone / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Few studies have given suggestions on appropriate initiation insulin dosage when combined with oral antidiabetic drugs (OADs). This research was to investigate appropriate initiation insulin doses for insulin-naive type 2 diabetes patients with different combinations and the relationship between insulin dosage and relevant factors.</p><p><b>METHODS</b>This was a randomized, open-label, treat to target study. The target was 20% decrease of both fasting plasma glucose (FPG) and 2 hours post-breakfast blood glucose (P2hBG). One hundred and forty-seven insulin-naive Chinese patients recruited were randomly assigned to 3 groups: group A, patients received insulin monotherapy; group B, received insulin plus metformin (0.5 g, tid) and group C, received insulin plus metformin (0.5 g, tid) and pioglitazone (15 mg, qd). Insulin doses were initiated with a dose of 0.3 U×kg(-1)×d(-1) and titrated according to FPG and P2hBG till reached the targets.</p><p><b>RESULTS</b>Both the time of getting 20% reduction of FPG and P2hBG showed significant differences among the three groups. The time was shortest in Group C. The insulin doses needed to achieve glucose reduction of 20% in three treatment groups were (0.40 ± 0.04) U×kg(-1)×d(-1) for Group A, (0.37 ± 0.04) U×kg(-1)×d(-1) for Group B, and (0.35 ± 0.03) U×kg(-1)×d(-1) for Group C, respectively. Multiple linear stepwise regression analysis showed that insulin doses correlated with body weight, FPG, diabetes duration, age and history of sulfonylurea treatment. The standardized regression coefficients were 0.871, 0.322, 0.089, 0.067 and 0.063 (with all P < 0.05).</p><p><b>CONCLUSIONS</b>To achieve blood glucose's reduction of 20% within safety context, initial insulin doses were recommended as the following: 0.40 U×kg(-1)×d(-1) for insulin mono-therapy, 0.37 U×kg(-1)×d(-1) for insulin plus metformin treatment, and 0.35 U×kg(-1)×d(-1) for insulin plus metformin and pioglitazone treatment in Chinese type 2 diabetes outpatients. Body weight is found the most closely related factor to the insulin dosage.</p>

Differentiation of bone marrow-derived mesenchymal stem cells from diabetic patients into insulin-producing cells in vitro / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Stem cells, which have the ability to differentiate into insulin-producing cells (IPCs), would provide a potentially unlimited source of islet cells for transplantation and alleviate the major limitations of availability and allogeneic rejection. Therefore, the utilization of stem cells is becoming the most promising therapy for diabetes mellitus (DM). Here, we studied the differentiation capacity of the diabetic patient's bone marrow-derived mesenchymal stem cells (MSCs) and tested the feasibility of using MSCs for beta-cell replacement.</p><p><b>METHODS</b>Bone marrow-derived MSCs were obtained from 10 DM patients (5 type 1 DM and 5 type 2 DM) and induced to IPCs under a three-stage protocol. Representative cell surface antigen expression profiles of MSCs were analysed by flow cytometric analysis. Reverse transcription-polymerase chain reaction (RT-PCR) was performed to detect multiple genes related to pancreatic beta-cell development and function. The identity of the IPCs was illustrated by the analysis of morphology, ditizone staining and immunocytochemistry. Release of insulin by these cells was confirmed by immunoradioassay.</p><p><b>RESULTS</b>Flow cytometric analysis of MSCs at passage 3 showed that these cells expressed high levels of CD29 (98.28%), CD44 (99.56%) and CD106 (98.34%). Typical islet-like cell clusters were observed at the end of the protocol (18 days). Ditizone staining and immunohistochemistry for insulin were both positive. These differentiated cells at stage 2 (10 days) expressed nestin, pancreatic duodenal homeobox-1 (PDX-1), Neurogenin3, Pax4, insulin, glucagon, but at stage 3 (18 days) we observed the high expression of PDX-1, insulin, glucagon. Insulin was secreted by these cells in response to different concentrations of glucose stimulation in a regulated manner (P<0.05).</p><p><b>CONCLUSIONS</b>Bone marrow-derived MSCs from DM patients can differentiate into functional IPCs under certain conditions in vitro. Using diabetic patient's own bone marrow-derived MSCs as a source of autologous IPCs for beta-cell replacement would be feasible.</p>

Investigation of Skeletal Age of Adolescent in Yantai Area / 中国康复理论与实践

@#ObjectiveTo assesses the skeletal development of adolescent in Yantai area, and investigates the characteristics of the tendency of their skeletal development. MethodsTotally 1180 healthy adolescents ( 574 males and 606 females ) at 10 to 20 years of age living in Yantai area were randomly selected, and their left wrist were radiated at the posterior-anterior position. The bones at wrist were scored according to the Chinese Wrist Skeletal Development Standard CHN Method. The correlation among skeletal age, chronological age and the sex were analyzed. ResultsSkeletal age positively correlated with chronological age (male: r=0.943,females: r=0.942,totally: r=0.942). ConclusionThe skeletal development of adolescent in Yantai area has the characteristic of acceleration. So it is necessary to establish a new skeletal age standard for the skeletal development of adolescent.