2015年 · 第95卷第36期

Male infertility, that is, the couple has normal sex for more than 1 year without using any contraceptive measures, and the woman is infertile due to the male factor. Under the interactive influence of global environmental degradation, bad lifestyle and genetic factors, the incidence of male infertility is increasing day by day. Because male infertility is caused by many factors, its etiology and pathogenesis need to be elucidated. However, at present, the diagnosis and treatment of male infertility in China is full of chaos, doctors lack standardized training, and some hospitals are out of standard diagnosis and treatment. China issued guidelines for the diagnosis and treatment of male infertility in 2013^[1]This guide explains the etiology, physical examination, auxiliary examination, treatment methods and other aspects of male infertility in detail, and summarizes a series of diagnosis and treatment strategy flow charts, which is of great significance for the standardized diagnosis and treatment of male infertility. However, with the in-depth research on the etiology and mechanism of male infertility and the development of related diagnosis and treatment methods, this guide begins to show certain limitations and cannot meet the needs of medical treatment. Therefore, we need to introduce the "three-point method" of etiology to further improve the diagnosis and treatment process of male infertility.

Varicocele is one of the common diseases in urology and causes male infertility, with an incidence of about 15% in the general population. Previous treatments mostly focused on scrotal symptoms and male infertility. With the research on varicocele and the improvement of surgical techniques in recent years, new understanding of varicocele has been gained.

Y chromosome microdeletion is an important cause of severe oligozoospermia or azoospermia, and it is the second leading genetic factor leading to male infertility, and its incidence is second only to Klinefelter syndrome (Klinefelter syndrome). Since 1999, the European Association of Andrology and the European Quality Control Network of Molecular Genetic Experiments (EAA/EMQN) have published a guide for molecular diagnosis of Y chromosome microdeletions in order to improve the diagnostic quality, and provided an objective method for evaluating the experimental quality. The latest version of the laboratory guidelines was revised by EAA/EMQN in September 2013 based on 12 years of clinical accumulation and expert consensus, based on the 1999 and 2004 editions. The new guidelines focus on clarifying that the Y chromosome microdeletion regions found in oligozoospermia or azoospermia men, mainly azoospermia factor (AZF) regions, only contain AZFa, AZFb, AZFbc, AZFc and AZFabc regions, and independent AZFd regions do not exist; gr/gr deletion in AZFc region is a risk factor affecting spermatogenesis, but its clinical significance is still controversial, and it is not used as a routine examination index; The increase of detection sites does not improve the detection sensitivity, but may complicate the results; Two-tube multiplex PCR-based detection methods are still suitable for entire AZF deletion detection. The implementation of the EAA/EMQN 12-year International Quality Assessment Program (EQA Program) shows that participating laboratories can effectively reduce the diagnostic error rate by standardizing experimental operations and improving the quality of reports. The frequency of Y chromosome microdeletion in Chinese infertile men is 11.5%, which is at a high level. We recommend that AZF detection be used as a routine detection item for male severe oligozoospermia or azoospermia, and call on domestic AZF detection laboratories to join the EQA program to improve the operating specifications of Y chromosome microdeletion detection in China.

A 14-year-old female was admitted to the hospital on July 11, 2014 for 9 years of pulmonary hypertension, shortness of breath, dizziness and hoarseness after activity. In 2005, the patient underwent echocardiographic examination due to recurrent pneumonia and bronchitis: left atrial diameter (LAD) 28 mm, left ventricular end-diastolic diameter (LVDD) 42 mm, right ventricular end-diastolic diameter (RVDD) 16 mm, estimated pulmonary systolic pressure 58 mmHg (1 mmHg =0.133 kPa), left atrial and right ventricular enlargement, pulmonary hypertension, in order to further examine the etiology of pulmonary hypertension and carry out corresponding treatment. In 2010, the echocardiographic results were as follows: LAD 35 mm, LVDD 48 mm, RVDD 23 mm, ejection fraction (EF) 58%, estimated pulmonary artery systolic pressure 87 mmHg, left atrium and right ventricle enlargement, pulmonary artery pressure increased progressively, but the patient did not have obvious exertion shortness of breath, and physical activity was not restricted. In 2011, I had abdominal pain after activity. Abdominal ultrasound found multiple mesenteric lymph node adhesions, with a maximum of 26 mm ×7 mm. The abdominal pain was relieved after anti-inflammatory treatment. In 2012, I went to a local hospital for pulmonary hypertension. After examination (details unknown), I was diagnosed with idiopathic pulmonary hypertension. At that time, the echocardiogram showed: LAD 37 mm, LVDD 45 mm, RVDD 39 mm, EF 60%, and the estimated pulmonary systolic pressure was 84 mmHg. Sildenafil 25 mg was given orally twice a day, and then stopped taking the drug spontaneously due to dizziness, shortness of breath and fatigue. Six months before admission to our hospital, the patient had chest tightness, shortness of breath, dizziness, hoarseness, mild abdominal pain after activity, colic, without diarrhea, fever, nausea, vomiting and other symptoms. Since the onset of the disease, the patient has normal urine and stool, no obvious change in body weight, no history of hemoptysis and hematemesis, denial of family history and genetic history, denial of drug and food allergy.

In recent years, the skin and soft tissue infections caused by non-tuberculous mycobacteria (NTM) have a gradual increase trend, among which fast-growing mycobacteria (RGM) are the most reported^[1]。 However, the diagnosis of RGM remains a clinical dilemma. According to the data released by the International Society of Aesthetic Surgeons, in 2013, the number of liposuction and fat transplantation surgeries reached 1.614 million and 1.054 million respectively, ranking the top 5 in the world in terms of plastic and cosmetic surgery cases^[2]。 In such a huge volume of surgery, there are many cases of postoperative RGM infection. The research on RGM infection and liposuction and fat transplantation is summarized as follows.

Dopamine is an important catecholamine neurotransmitter. It acts on the central nervous system through dopamine receptor (DRs), and plays an important role in regulating cognition, emotion and limb movement. At the same time, as a neuroendocrine hormone, it can also act on peripheral tissues, mainly regulating peripheral vascular tone and cardiorenal function. In recent years, studies have found that DRs polymorphism is related to the risk of tumorigenesis, and a variety of tumor cells, tumor vascular endothelium and immune cells can express DRs. In this paper, the research progress of peripheral dopamine and tumor is described as follows.

Breast cancer is the most common malignant tumor in women in developed and developing countries^[1]。 Angiogenesis plays an important role in the occurrence, development, invasion and metastasis of breast cancer, and is also an independent prognostic factor of breast cancer^[2]。 The formation of tumor neovascularization is a complex process with multiple factors and steps, which is regulated by the balance between positive and negative regulators of angiogenesis. This paper mainly summarizes the characteristics of angiogenesis of breast cancer, the influence of pro-angiogenic factors and anti-angiogenic factors on the occurrence and development of breast cancer, and the current status of anti-angiogenic therapy for breast cancer.

spermatogonial stem cell (SSC) is the basis of spermatogenesis. It forms mature sperm through three stages: proliferation and differentiation of SSC, meiosis of spermatocytes and spermatogenesis. It is the only adult stem cell in which men can transmit their genetic material to their offspring^[1]。 human spermatogonial stem cells (HSSCs) are located at the basement membrane of seminiferous tubules and are developed and differentiated from primordial germ cells (PGCs). Human spermatogenesis begins around puberty. One hSSC produces about 128 spermatozoa after 8-9 mitosis and 2 meiosis, and each complete spermatogenic cycle lasts for about 70 days. On the one hand, hSSC maintains the relative stability of its number through self-renewal, on the other hand, it can proliferate and differentiate into spermatogenic cells at all levels and finally form sperm. Under normal circumstances, hSSC achieves the relative balance between the two through complex and fine regulation. In addition, recent studies suggest that hSSC can undergo transdifferentiation and gain pluripotency under in vitro culture conditions, which shows its broad application prospect in the field of regenerative medicine^[2]。 Therefore, the study of the characteristic phenotype, isolation and enrichment of hSSC, and in vitro culture (including long-term culture and induction of differentiation) will help us to better understand the biological characteristics of hSSC, reveal the fertility process of male, and lay the foundation for its application in the fields of reproductive and regenerative medicine.

In recent years, the detection of sperm DNA damage has been more and more widely used in clinical practice, and there are many related literature reports. However, at present, the detection methods of sperm DNA damage in clinical practice and related literature are different, and the normal threshold is also very different, which brings a lot of confusion to clinicians and some related scientific researchers. Therefore, this paper reviews the clinical application value and current problems of sperm DNA damage detection, so that readers can correctly view the clinical application of sperm DNA damage detection.