氧化应激是什么 人体内存在许多"小天平",维护着机体的正常功能.氧化系统与抗氧化系统就是其中的一对.与氧化系统相关的自由基,包括因易得失电子而具有高度活性的活性氧族,如超氧阴离子(02-)、羟自由基(OH-)和过氧化氢(H202)等,以及一氧化氮(NO)、二氧化氮(NO2)等活性氮.以限制自由基产生并使其灭活的抗氧化系统分为两类:①酶抗氧化系统,如超氧化物歧化酶、过氧化氢酶和谷胱甘肽过氧化物酶等;②非酶类抗氧化系统,包括维生素C、E,谷胱甘肽,微量元素锌、硒等.

Objective To investigate the relationship between serum anti-Mullerian hormone（AMH） and pregnancy outcome in frozen-thawed embryo transfer patients with age≥40 years old.Methods The retrospective analysis was performed on the relevant process data of the elder infertile patients（≥40 years old） undergoing the first freeze-thawed embryo transfer in this center from June 2016 to October 2017. The subjects were divided into the group A（AMH＜1.1 ng/mL,n=37） and group B（AMH≥1.1 ng/mL,n=63） according to the basic AMH level; these subjects were divided into the pregnancy group（n=14） and non-pregnancy group（n=86）according to the pregnancy outcomes. The relationship between serum AMH and pregnancy outcome of frozen-thawed embryo transfer was compared and analyzed.Results The ages of the group A and B were（43.86±3.19） years old and（42.03±2.17） years old. The age in the group A was elder than that in the group B（P＜0.05）. The ages of pregnancy group and non-pregnant group were（41.93±2.34） years old and（42.94±2.81） years old, the pregnant group was younger than the non-pregnant group（P＜0.05）;the serum AMH values of the pregnant and non-pregnant groups were（3.26±2.90） ng/mL and（2.01±1.77） ng/mL respectively, and the pregnancy group was significantly higher than the non-pregnant group（P＜0.05）. The logistic regression univariate analysis of pregnancy outcomes found that the age（OR=0.693,95% CI:0.493～0.974,P＜0.05） and AMH level（OR=1.417,95% CI: 1.089～1.843,P＜0.05） had the significant effects on clinical pregnancy; in the multivariate analysis, the age and AMH level was still found having significant effect on clinical pregnancy（OR=0.636,95% CI:0.414～0.9783,P＜0.05）,（OR=1.493,95% CI:1.052～2.118,P＜0.05）. Conclusion The younger the age, the higher the basal serum AMH level the higher the pregnancy rate of frozen-thawed embryo transfer in elder patients.

During the professional study period, the professional postgraduates of reproductive endocrinology and their tutors formed an exploratory learning community. Guided by the principle of natural ecology, the tutor group taught the postgraduates interdisciplinary knowledge according to the professional characteristics during their rotation, focusing on academic issues, explaining medical classics, integrating medical theories and confirming clinical practice from the three dimensions of literature, medical science and clinical practice, and the innovative practice of medical literature integration is carried out in classroom teaching. The subtasks are extended from the opening report of postgraduates, giving full play to the flexibility of the tutor responsibility system, and absorbing postgraduates to participate in different types of sub projects and training processes. Then, taking the subtask as the carrier, the training content and practice mode of postgraduates are innovated, and various forms of academic achievements are produced step by step, continuously stimulate postgraduates’ interest in scientific research and enhance postgraduates sense of academic achievement and honor, and gradually guide postgraduates academic innovation ability and scientific research thinking, so as to achieve synchronous improvement in the three aspects of tutors’ teaching practice experience-postgraduates’ research and innovation level-talent training quality connotation.

目的 探讨辅助生殖技术(ART)助孕受孕双胎与自然受孕双胎的产前超声筛查结果及胎儿的健康状况的差异.方法 收集应用ART怀孕双胎60例(试管组)及同期自然受孕双胎80例(对照组)临床资料,比较2组孕妇一般资料、妊娠期并发症、围生期疾病、出生缺陷发生情况等.结果 试管组平均羊水量及妊娠期高血压发病率显著高于对照组,差异具有统计学意义(P＜0.05);2组孕妇的脐带绕颈、胎膜早破、前置胎盘、贫血和产后出血发生率等方面差异无统计学意义(P＞0.05);2组新生儿在身长、体重、头围、先天畸形、高胆红素血症和新生儿窒息方面差异无统计学意义(P＞0.05).结论 ART助孕受孕双胎的孕妇妊娠期高血压发病率和平均羊水量增加.

目前不孕症的发病率已上升至15％～20％.女方因素包括排卵功能障碍、输卵管异常、子宫内膜异位症、子宫畸形、免疫因素等;男方因素主要是精子生成及成熟障碍、运输受阻、精子活力和形态及性功能异常.还有不明原因不孕,是常规的不孕症相关检查未发现的生殖功能缺陷,据统计约占不孕夫妇的15％～30％.研究结果表明,肥胖也是影响不孕的重要因素,生育期妇女的肥胖现象越来越普遍,肥胖人群的不孕风险比正常人增高5～10 倍.

何为精子活力 精液常规是评估男性生育力的一项最基本的检查,其中精子活力是至关重要的一个指标,分为前向运动、非前向运动和不活动精子. 在精子与卵子浪漫邂逅的约会角逐中,前向运动精子是勇敢"追爱"的主力军,它们就像生机勃勃的青春期男孩儿,勇往直前,"追求真爱".因此,前向运动精子百分率是评价男性生育力强弱的最主要指标.当前向运动精子＜32％时,受孕概率则不同程度地降低.有研究证实,弱精子症患者的不育风险较精液参数正常者增加2～3倍,是导致男性不育最常见的原因之一.

目的 探讨抗苗勒管激素(AMH)水平与非优质囊胚移植临床结局的关系.方法 回顾性分析冷冻胚胎冻融周期移植的240例患者,其中非优质单囊胚移植组129例,非优质双囊胚移植组111例,根据AMH水平分组,AMH＜1.5 ng/ml为A组,AMH 1.5～4.5 ng/ml为B组,AMH＞4.5 ng/ml为C组.分析3组AMH水平与非优质单囊胚移植、非优质双囊胚移植妊娠结局的相关性.结果 在非优质单囊胚移植方案中,3组患者的临床妊娠率分别为30.30％、40.00％、52.17％,虽临床妊娠率随着AMH的升高有上升趋势,但差异无统计学意义(P＞0.05);流产率分别30.00％、15.00％、25.00％,差异无统计学意义(P＞0.05).在非优质双囊胚移植方案中,3组患者的临床妊娠率分别为58.33％、50.00％、58.82％,流产率分别42.86％、37.50％、20.00％,妊娠率和流产率比较,差异均无统计学意义(均P＞0.05),各组多胎率明显升高.双囊胚移植的临床妊娠率与单囊胚移植比较,差异有统计学意义(P＜0.05),两组流产率比较,差异无统计学意义(P＞0.05).结论 血清AMH水平在非优质囊胚移植中对妊娠结局的影响不大,AMH水平的高低并不能预估非优质囊胚移植的潜力,但非优质囊胚仍存在较大的移植价值.

目前,医学研究生培养的内容以项目实验研究或基地的规范化培训为主,但明显忽视了医学人文素质内涵的培养.文章在现有研究生教育的基础上,增加导师人文素质修养的沉淀,拓展研究生人文素质教育的方法与途径,指导学生在专业理论知识的实践载体中全程化提升自身素质.导师与学生在教学—科研—学习的互动过程中,同步完成知识的传授—创新—传承,培养了研究生的人文素质和科研创新思维.

IntroductionTo explore the mechanism and clinical effect of acupoint selection and acupuncture therapy on premature ovarian failure.Material and methodsA total of 100 cases of POF were collected and divided into POF group and POF+acupoint selection and acupuncture therapy (POF+ACU) group. Cerebrospinal fluid samples from patients in each group were extracted by lumbar puncture, and exosomes were isolated and purified. The expression level of exosome protein NELL2 was analyzed by western blot, and the morphology of exosomes was observed by transmission electron microscopy (TEM). The changes of sex hormone levels were detected by TOSOH AIA 1800 automatic chemiluminescence analyzer. Follicular development and ovulation were monitored by B-ultrasound.ResultsThe expression of protein CD9, CD81 and NELL2 in POF+ACU group all increased compared with POF group. TEM images showed that the exosomes were oval or round membranous vesicles. After 3 months of continuous acupoint selection and acupuncture therapy, it was found that the level of testosterone (T) and estradiol (E2) in the POF+ACU group were significantly increased, while the follicular stimulating hormone (FSH) and luteinizing hormone (LH) were significantly decreased, showing a significant difference compared with the POF group. B-ultrasound observation of the endometrial thickness and the maximum follicle diameter showed that the values of POF+ACU group increased, showing no statistical difference compared with the NC group. Ovulation occurred in 20% of the 50 patients in the POF group and 70% in the POF+ACU treatment group.ConclusionsAcupoint selection and acupuncture therapy can treat POF by promoting the secretion of exosome protein NELL2

OBJECTIVE:To investigate the protective effect of Lycium barbarum polysaccharide (LBP) against testicular spermatogenic injury in mice with oxidative stress (OS) and its mechanism.METHODS:A unique OS model was made in 1.5-month-old mice with mitochondrial inner membrane-like peptide-2 mutation (Immp2l－/－), which were fed with water (the negative control group) or LBP in water at the concentration of 20 mg/kg (the LBP intervention group), and wild-type Immp2l＋/＋ mice used as normal controls and fed with water only. Then all the mice were sacrificed at 13 months old and the testis tissue harvested for observation of pathological changes by HE staining, measurement of routine semen parameters, and detection of the apoptosis of spermatogenic cells by TUNEL and the expression levels of glutathione peroxidase 4 (GPX4) and apoptosis-inducing factor (AIF) by immunohistochemistry and Western blot.RESULTS:Thinned testicular cortex was observed in the negative controls, with evident vacuolar degeneration and reduced numbers of germ cells and elongated spermatids in the lumen of the seminiferous tubules, but all these pathological changes were improved and the germ cells at different levels orderly arranged in the LBP intervention group. Compared with the normal controls, the mice in the negative control group showed dramatically reduced sperm count (［72.89 ± 8.28］ vs ［20.78 ± 1.45］ ×106, P<0.01) and the percentages of progressively motile sperm (PMS) (［58.62 ± 6.15］% vs ［18.37 ± 2.67］%, P<0.01) and morphologically normal sperm (MNS) (［65.81 ± 7.69］% vs ［20.33 ± 3.17］%, P<0.01) and increased apoptosis of spermatogenic cells (［1.45 ± 0.43］% vs ［7.14 ± 0.78］%, P<0.01). LBP intervention, however, significantly increased the sperm count (［45.25 ± 3.39］ ×106, P<0.05), PMS (［36.34 ± 4.56］%, P<0.05) and MNS (［38.72 ± 3.63］%, P<0.05) and decreased the apoptosis of spermatogenic cells (［2.28 ± 0.07］%, P<0.01). The mice in the LBP intervention group, in comparison with the negative controls, exhibited remarkably up-regulated expression of GPX4 (2.75 ± 0.48 vs 1.43 ± 0.17, P<0.05) and down-regulated expression of AIF (2.43 ± 0.15 vs 1.35 ± 0.51, P<0.05).CONCLUSIONS:Lycium barbarum polysaccharide at 20 mg/kg can reduce testicular spermatogenic injury in Immp2l－/－ mice with oxidative stress through GPX4 and AIF pathways.

目的 探讨不同卵巢储备功能人群中MEX3 RNA结合蛋白家族C(MEX3C)在颗粒细胞中的表达差异,并分析与卵巢功能的相关性.方法 选取因输卵管因素行体外受精-胚胎移植(IVF-ET)治疗的不孕妇女55例,分为卵巢储备正常组(A组)20例,卵巢储备升高组(B组)20例,卵巢储备降低组(C组)15例.收集各组患者颗粒细胞,采用Western blot检测各组颗粒细胞中MEX3C表达水平.结果 卵巢储备降低组MEX3C表达水平显著低于卵巢储备正常组(P ＜0.05);卵巢储备升高组MEX3C表达水平显著高于卵巢储备正常组(P ＜ 0.05).结论 不同卵巢储备功能患者卵巢颗粒细胞MEX3C表达水平存在差异,可为评估卵巢储备功能、促进卵泡发育提供理论依据.

目的 分析辅助生殖技术体外受精-胚胎移植(IVF-ET)冻融胚胎移植周期中移植非优质囊胚的移植价值,探讨辅助生殖技术IVF-ET治疗周期中非优质囊胚的移植价值.方法 回顾性分析冷冻胚胎冻融周期移植的289例患者,其中进行优质单囊胚移植组101例,非优质双囊胚移植组121例,非优质单囊胚移植组67例,对临床妊娠相关数据进行分析.结果 3组患者的女方年龄、不孕年限、BMI、内膜准备方案等差异无统计学意义(P＞0.05);优质囊胚与非优质囊胚行单囊胚移植2组患者临床妊娠率比较差异具有统计学意义(P＜0.05),2组多胎率、流产率之间差异无统计学意义(P＞0.05);进行非优质双囊胚移植的临床妊娠率和多胎率显著高于进行非优质单囊胚移植组(P＜0.05),2组种植率、流产率之间差异无统计学意义(P＞0.05).结论 在冻融周期中对于无优质胚胎的患者,移植两个非优质囊胚可获得较高的临床妊娠率,但也会增加多胎妊娠发生的几率.临床上可根据患者具体情况,制定个体化的移植策略,增加临床妊娠率,减少并发症的发生及提高胚胎利用率.

Reactions of Cu(II) or Co(II) salts and 2-(4-carboxyphenoxy)terephthalic acid (H(3)cpota) with N-heterocyclic donors (1,10-phenanthroline (phen) or 4,4 '-bipyridine (4,4 '-bpy)) formed two multidimensional CPs, [Cu(mu(3)-Hcpota)(phen)](n)center dot nH(2)O (1) and [Co-2(mu(4)-cpota)(mu(2)-4,4 '-bpy)(mu(3)-OH)](n)center dot nH(2)O (2). The apoptosis percentage of ovarian cells after cyclophosphamide (CTX) exposure and treatment with 1 and 2 was evaluated by Annexin V-FITC detection kit. In addition, the secretion of vascular endothelial growth factor was measured with ELISA (enzyme linked immunosorbent assay detection kit).

今晚你"泄"了吗 同房时你的性交时间是否不足1 分钟便射精了呢?如果是,你可能是早泄者.有多少男人的"性福"和后代被''泄''没了 性福,似乎勃起可及,唾手可得,可一"泄",就会遥不可望,欲得还休.有研究显示,全球有1/3 以上的成年男性存在早泄.古书亦有记载:"男子有精滑之极,一到妇女之门,即便泄精,欲勉强图欢不得,且泄精甚薄".

目前,全球人口老龄化的形势越来越严峻."全面二胎"政策开放之后,我国的低出生率现状并未得到明显改善.除社会因素以外,不孕症发病率的持续增高也是重要原因之一,世界范围内不孕症已占育龄期妇女的10％～15％[1].不孕症在祖国医学属"全不产"、"无子"、"断续"等范畴,中医疗法是中华民族的瑰宝,具有六千年发展历程,在不孕不育症治疗中享有其独特的优势.目前,中医疗法在治疗不孕症方面受到全世界的关注,它通过多角度、多途径、多位点的精细和整体调理,达到预防和治疗助孕的双重目的,同时提高患者的整体幸福感[2],尤其对于有自然方式生育自己后代愿望的不孕夫妇更为如此,因此其临床应用前景具有重大而深远的现实意义.

冲''凉''男孩——精子''泳''动员."泳"动员的住房 精子诞生于左右侧对称,重量约10 克,容积为 15～25 毫升的睾丸.睾丸表面覆以浆膜,深部为致密结缔组织构成''瑰丽的冰封雪山''的白膜,白膜在睾丸后缘增厚形成睾丸纵隔,纵隔深入睾丸实质,将其分割成约250 个锥形小叶,尤如高山牧场、湖泊森林,每个小叶内有1～4 条弯曲细长的生精小管,仿佛是汇入大海的众多小小支流,汇聚众多奔腾不息的江河源流.这里有精子生长所需的山湖水域环境以及精子成长需要的营养,而精子则由这里的生精细胞发育而来.生精小管中微观的生态平衡是精子生生不息的辽阔草原.由于睾丸是唯一游离于体腔外的器官组织,会阴部有利于防护和散热,也正是它特殊的生理''建筑''场地,确保精子的童年必须在低于体温2～3℃的''三江源''头环境中居住.

Objective:To explore the genetic basis for a pedigree affected with Charcot-Marie-Tooth (CMT) disease through high-throughput sequencing.Methods:Potential variants of the genes associated with CMT were screened by next-generation sequencing (NGS) of the members of the pedigree.Results:NGS has revealed that the two affected sisters both harbored homozygous c. 1A>G variant of the GDAP1 gene, which caused replacement of the first amino acid Methionine by Valine (p.Met1Val). Their parents were both carriers of the heterozygous c. 1A>G variant. The variant was unreported previously and has an extremely low frequency in the population. Meanwhile, one of the sisters and the mother also carried heterozygous c. 710A>T variant of the BAG3 gene. Conclusion:The homozygous c. 1A>G variant of the GDAP1 gene probably underlay the CMT in both children. Above result has enabled clinical diagnosis and genetic counseling for this pedigree.

目的 利用激光破膜软件测量中期Ⅱ卵母细胞的形态参数,探寻一种客观评价卵母细胞受精方法,从而提高卵子可利用率和优质胚胎率.方法 共78个周期接受了激光破膜仪器测量作为实验组,常规操作共80个周期作为对照组.应用激光破膜软件分别测量卵母细胞直径、透明带厚度、卵周间隙的宽度,用相同脉冲频度在透明带打孔,测量同一个卵母细胞受精前透明带、后打孔的直径,比较受精前、后卵母细胞形态学参数的变化,评估卵母细胞受精状态及胚胎发育的潜能.结果 受精后卵母细胞的透明带厚度较受精前卵母细胞变薄[(15.5±0.4)μm、(13.8 ±0.4) μm,P＜0.05)];与未受精卵母细胞相比,受精卵母细胞卵周间隙的宽度[(6.5±0.4) μm、(5.2±0.3)μm]缩小(P＜0.05),卵子受精后透明带打孔孔径变小(P＜0.05);测量组受精率和优质胚胎率高于对照组(P＜0.05),但2PN卵裂率、着床率和妊娠率差异无统计学意义(P＞0.05).结论 卵母细胞透明带厚度和硬度对预测受精具有一定的临床价值,监测卵母细胞参数并结合常规极体判断能够提高受精率和优质胚胎率.

抗苗勒管激素( AMH)是一种由窦前卵泡和窦卵泡的颗粒细胞分泌的肽类生长因子,在胚胎早期性腺器官发育过程中起着非常重要的作用.AMH的分泌在育龄期(约25岁)达到高峰,之后随着年龄的增长而逐渐降低.

Studies have indicated that high levels of ethanol exposure impaired spermatogenesis in mice. However, the effects of chronic and low-dose alcohol consumption on susceptible populations remain unclear. The previous studies have confirmed that Immp2l mutant mice (Immp2lTg(Tyr)979Ove or Immp2l-/- ) suffered from increased levels of oxidative stress(OS) and male infertility, heterozygous lmmp2l mice (Immp2l+/- ) showed no altered ROS levels under physiological condition. Lycium barbarum polysaccharide (LBP) significantly scavenge oxygen free radicals and enhance antioxidant enzyme activity. The objectives of present study were to research the effects of chronic and low-dose alcohol-induced damage on Immp2l+/- , explore the protective function of LBP and possible mechanism. The results indicated that chronic ethanol exposure leads to spermatogenic impairment and triggered a toxic effect on germ cell, 10 mg/kg LBP administration improved the quality of spermatozoon, decreased the ratio of apoptotic germ cells and the expression of Col1a1 and Col1a2, while increased the level of TNP2 and RPL31. In conclusion, the study may provide basic knowledge about LBP's important role against ethanol-induced spermiotoxicity and testicular degeneration in Immp2l+/- mice, and the mechanism may be that LBP influenced the state of the spermatogenic epithelium by decreasing the expression of Collagen level leading to alterations in protein biosynthesis during the process of spermatogenesis.