2016年 · 第96卷第36期

The seminal tract refers to the pipeline system in the male reproductive system that transports sperm. Sperm is produced by the seminiferous tubules of the testis and then excreted through the epididymis, vas deferens, seminal vesicles, ejaculatory ducts and urethra. The distal region of the seminal tract includes structures such as the ampulla of the vas deferens, the seminal vesicle, the ejaculatory duct, the prostatic vesicle, and the prostate. Structural abnormalities in this area can affect the normal discharge of sperm, thus leading to ejaculatory duct obstruction (EDO), which is one of the common causes of male infertility. EDO accounts for 1% to 5% of male infertility patients^[1]。 Common lesions in this area include local inflammation and infection, EDO due to cysts and stones, new organisms or tumors, vascular abnormalities, trauma or iatrogenic injuries, etc. The clinical manifestations of this type of patients are hematospermia, azoospermia, oligoasthenozoospermia, dull perineal pain and ejaculation pain. In the past ten years, with the continuous development of various endoscopic techniques, the use of seminal vesiculoscopy to diagnose and treat common lesions in the distal region of the seminal tract has become a vigorous new technology in the field of andrology today.

With the rapid development of point-of-care testing (POCT) industry and the continuous advent of new testing equipment, POCT has been widely used in the medical field, which plays an important role in rapid and convenient disease diagnosis and treatment monitoring. However, in clinical practice, the operation process and quality management specification of POCT are not perfect, and the resulting inaccurate test results may affect clinical decision-making and treatment effect. In order to standardize the testing process and improve the testing quality, the Laboratory Medicine Branch of Chinese Medical Association and the Clinical Laboratory Center of National Health and Family Planning Commission organized experts in relevant fields across the country to jointly formulate the "Chinese Expert Consensus on Clinical Operation and Quality Management Standards of Portable Blood Glucose Meters".

mitral stenosis is a disabling or even fatal disease. If not treated in time, progressive aggravation of mitral stenosis can lead to severe symptoms and complications (such as pulmonary edema, systemic embolism, pulmonary hypertension). The formation of mitral stenosis after acute rheumatic fever is estimated to take at least 2 years, usually more than 5 years. The asymptomatic period of most patients is more than 10 years^[1]。 According to a 20-year follow-up of 1 000 children with acute rheumatic fever in North America, clinical manifestations of valvular heart disease occur in 65% of patients after recovery from the initial rheumatic fever, and the incidence of simple mitral stenosis reaches 12% in these patients^[2]。 In China, according to the 2014 China Cardiovascular Disease Report, the number of patients with rheumatic heart disease has reached 2.5 million^[3]。 China has a vast territory and a large population. At present, there are still a large number of patients with rheumatic heart disease. The prevalence rate of rheumatic valvular heart disease in China is 1.8‰, and the prevalence rate in rural areas is higher than that in urban areas; This disease is more common in young adults, and the incidence rate of women is higher than that of men, with a male-female ratio of about 2:3^[4]。 Congenital malformations or connective tissue diseases such as systemic lupus erythematosus endocarditis are rare causes of mitral stenosis. The early manifestations of mitral stenosis are edema and exudation at the edge of the valve junction, followed by fibrin deposition to thicken the valve edge, and the valve junction gradually adheres and fuses, and then the mitral valve opening becomes smaller to form mitral stenosis. Fibrous lesions can also involve the subvalvular chordae tendineae and papillary muscles, making them shorten and adhere, which are also important factors leading to mitral stenosis^[5]。

Male, 62 years old, was admitted to hospital in March 2015 mainly due to "left scrotal swelling and pain for 8 years, aggravated for 1 month". A family genetic history is denied. Physical examination on admission: spherical mass in the left scrotum, about 15 cm in diameter, smooth surface, cystic sensation, high tension, untouched testis and epididymis, positive light transmission test, did not disappear after lying down, no change in the size of the squeezed cyst, and no abnormalities in the contralateral scrotum and testes. After admission, routine laboratory tests, chest X-ray films and electrocardiogram showed no abnormalities. Admission diagnosis: hydrocele of the left testis.

The patient was a 31-year-old male who went to the doctor because he had "no birth for 2 years without contraception". Both husband and wife were primary infertility, Han nationality. The history of repeated respiratory tract infection and sinusitis was denied, and there was no visceral inversion. No obvious abnormalities were found in physical examination and ultrasound of the reproductive system. The peripheral blood karyotype is 46, XY. Serum follicle stimulating hormone (FSH) was 3.87 U/L, luteinizing hormone (LH) was 2.95 U/L, estradiol was 119.97 pmol/L, testosterone was 7.25 nmol/L, and prolactin was 131.44 mU/L. Multiple semen examinations revealed that the semen volume was 1.6~2.6 ml, the pH value was 7.4, and the sperm concentration was 17.7~22.2×10⁹/L, the rate of forward motility sperm was 0-3.1%, the rate of sperm motility was 1.8%-5.2%, and the seminal plasma anti-sperm antibody was negative. According to the criteria of multiple morphological abnormalities of the sperm flagella (MMAF)^[1]Sperm morphology was observed under light microscope after modified Pap staining, and 97.0% of MMAF phenotype sperm were observed, and 20.5%, 46.0%, 13.5%, 2.5% and 14.5% of flagella were missing, short, curly, curved and irregular, respectively. Scanning electron microscopy showed that the malformation of sperm flagellum in the patient was consistent with the diagnosis of MMAF (Figure 1)； Transmission electron microscopy showed that the assembly of sperm flagella was abnormal, the fibrous sheath was thickened, the central microtubule was missing, and the dynamic arm existed.

The patient, a 26-year-old male, was seen in July 2015 because of "no contraception after marriage and infertility in regular sexual life for 2 years". The patient reported that his sexual desire was normal on weekdays, and his sexual life could be completed normally, about twice a week. After asking about the medical history, the patient recalled that when he was about 7 years old, his height was significantly taller than his peers and pubic hair began to appear. Considering that he had precocious puberty at that time, he had been evaluated in the local hospital and failed to make a clear diagnosis. The parents were normal and had no relevant medical history. Physical examination: Height 148 cm, weight 45 kg, body mass index 20.5 kg/m²Blood pressure is normal. The secondary sexual characteristics developed normally, and the bilateral testicles were palpated small, with a volume of about 7 ml, and no nodules were palpated. Laboratory tests: Sex hormones: prolactin 351.89 U/L (reference value 48~375 U/L), luteinizing hormone (LH)<0.07 U/L (reference 1.5-9.3 U/L), follicle stimulating hormone (FSH) 0.57 U/L (reference 1.4-18.1 U/L), estradiol 143.05 pmol/L (reference<146.1 pmol/L), testosterone 26.67 nmol/L (reference value 8.4-28.7 nmol/L), progesterone 47.49 nmol/L (reference value 0.89-3.88 nmol/L); Cortisol (8 am): 119.38 nmol/L (reference value 118.6-618.0 nmol/L); Adrenocorticotropic hormone (ACTH) 105 pmol/L (reference<10.2 pmol/L); Aldosterone: 696.75 ng/L (reference value 10-160 ng/L). Patient urinary 17 hydroxycorticosteroid, 17 ketosteroid, dehydroepiandrosterone sulfate (DHEA-SO₄), androstenedione and blood electrolytes were all within the normal range. The results of routine semen examination showed that no sperm was found after two centrifugations, the volume of semen was 0.2 ml, and the pH value was 7.5. Karyotype analysis showed 46, XY, male karyotype. Y chromosome microdeletion analysis: gr/gr large fragment deletion occurred in the AZFc region. CT scan of middle abdomen + enhancement showed diffuse hyperplasia of bilateral adrenal glands, and hypoechoic nodules about 12 mm ×8 mm in size were seen in the medial branch of right adrenal gland, which was considered to be a high possibility of adenoma (Figure 1)。 The ultrasound findings of bilateral testis and epididymis showed no abnormalities. Peripheral blood was sent to Shenzhen Huada Clinical Laboratory Center to detect the pathogenic genes, and the test results showed that there was a known pathogenic mutation c.518T>A (p.Ile173Asn, Hom) in CYP21A2 gene (Figure 2), and the pathogenicity of this site has been reported.

In recent years, endoscopic submucosal dissection (ESD) has been widely used in gastric mucosal lesions such as precancerous lesions and early cancer, and has gradually become the standard method of minimally invasive surgery due to its advantages of large resection range, complete pathological specimens and low local recurrence rate. However, the wounds of ESD surgery are large, reaching the submucosa and even the muscle propria, and the probability of complications such as bleeding and perforation is relatively increased. The role of acid suppression therapy in the prevention and treatment of gastric hemorrhage caused by ESD is unquestionable, among which the efficacy of proton pump inhibitor (PPI) has also been confirmed and recognized by a large number of clinical studies. This article will explore this further in depth.

Testosterone is a steroid hormone with a relative molecular mass of 288. It is synthesized and secreted by testicular interstitial cells. A small part of androgens in the body come from the adrenal gland. Testosterone is the most secreted androgen in male body and has the most important physiological role. It runs through all male physiological activities from embryonic development to aging, and has a significant impact on male quality of life^[1]。 Therefore, a comprehensive understanding of testosterone biosynthesis and regulation pathways is of great significance for the treatment of male androgen deficiency. 95% of testosterone is synthesized and secreted by testicular interstitial cells, and testosterone is mainly regulated by the classical hypothalamic-pituitary-gonadal axis pathway. The hypothalamus secretes gonadotropin-releasing hormone, which is divided into follicle-stimulating hormone-releasing hormone and luteinizing hormone-releasing hormone, which act on the pituitary gland to secrete gonadotropin, which is divided into follicle-stimulating hormone and luteinizing hormone (LH). The latter acts on the LH receptor on the membrane of testicular interstitial cells, making testicular interstitial cells secrete testosterone. At the same time, testosterone has negative feedback regulatory effects on hypothalamus and pituitary gland^[2]。 In recent years, more and more scientists have been studying how LH affects the secretion and regulation of testicular mesenchymal cells. Therefore, this paper reviews the new targets of androgen regulation.

Medical terms are not standardized and united, which is directly related to the accurate expression, collection, use, transmission and medical insurance of medical science and technology. Standardized and unified medical science and technology terms are the basis of information exchange such as medical science and technology journals. Therefore, the author sorts out the irregularities and wrong use of medical terms in daily work and journals, hoping to attract widespread attention of readers.