Surgical management of penetrating pelvic trauma: a case report and literature review.

High-velocity penetrating pelvic injury is one of the most difficult challenges to trauma surgeons. The injury sites frequently include soft tissue, pelvis, genitourinary tract, vascular structures and intraabdominal viscera. We present an unusual case of a male patient suffering a collision at night with a deformed steel bar penetrating into his right groin. Careful planning of the surgical approach is important before extracting the foreign body. The possibility of multiorgan damage to intrapelvic structures such as colon, urinary bladder, vessels and nerves, frequently necessitates a multidisciplinary involvement and systematic approach. Besides, limited incision as well as modification should be considered, and debridement and perioperative antibiotics can be used to reduce the risk of serious wound infection.

Management of hemodynamically unstable pelvic fracture in pregnancy: a case report and review of literature.

We present an unusual case of an unstable pelvic fracture during pregnancy period, who suffered fetal death and splenic rupture simultaneously which developed massive delayed hemorrhage in abdomen. When considering potential causes of fetal death, direct trauma to the uterus, placenta, or fetus was not associated with a higher fetal mortality rate, compared with maternal hemorrhage. A cesarean section and splenectomy could rescue the maternal life from the hemorrhage situation. Successful treatment of these rare cases is possible with careful pre-, peri-, and post-operative evaluation of the mother and fetus by a multidisciplinary team.

[Use of L-carnitine before percutaneous epididymal sperm aspiration-intracytoplasmic sperm injection for obstructive azoospermia].

OBJECTIVE: To explore the use of L-carnitine before percutaneous epididymal sperm aspiration-intracytoplasmic sperm injection (PESA-ICSI) in the treatment of obstructive azoospermia. METHODS: Seventy-nine cases of obstructive azoospermia treated in our center from Sep 2008 to Aug 2009 were divided into an L-carnitine (n = 43) and a control group (n = 36), the former given oral L-carnitine at 1 g bid for 3 months before PESA-ICSI, while the latter left untreated. Comparisons were made between the two groups in the number of retrieved oocytes and fertilized oocytes as well as the number and rate of good embryos. RESULTS: There were no significant differences between the two groups in the number of retrieved oocytes and fertilized oocytes. But the number and rate of good embryos were significantly higher in the L-carnitine than in the control group (P < 0.05). CONCLUSION: Three-month oral medication of L-carnitine before PESA-ICSI can raise the number and rate of good embryos in obstructive azoospermia patients and therefore benefit the therapeutic outcome.

[Effects of different proportions of cryoprotectant to seminal plasma on the motility of post-thaw human sperm].

OBJECTIVE: To investigate the effects of different proportions of cryoprotectant to seminal plasma on the motility of post-thaw human sperm. METHODS: Different proportions of cryoprotectant to seminal plasma (1:1 and 1:3) were used for freezing sperm, and the forward movement and total motility rates of the frozen-thawed sperm were compared. RESULTS: The forward movement and total motility rates were (58.60 +/- 5.57)% and (66.17 +/- 5.24)% before cryopreservation. The 1:1 proportion achieved post-thaw forward movement and total motility rates of (40.53 +/- 8.97)% and (51.23 +/- 9. 30)%, while the 1:3 (44.7 +/- 8.67)% and (51.50 +/- 7.40)%, respectively. Significantly decreased sperm motility was observed after cryopreservation (P < 0.05). Statistically significant differences were found in the forward movement but not in the total motility of the frozen-thawed sperm between the two proportions. CONCLUSION: Cryopreservation causes obvious damage to human sperm. Higher proportion of cryoprotectant to seminal plasma (1:3) can improve the forward movement of post-thaw sperm as compared with the lower one (1:1).

Total concentrations and speciation of heavy metals in municipal sludge from Changsha, Zhuzhou and Xiangtan in middle-south region of China.

The presence of heavy metals in municipal sludge restricts its use for agricultural purposes. In this paper, the bioavailability and eco-toxicity of heavy metals in municipal sludge was evaluated, taking into consideration both the speciation of metals and the local environmental characteristics. The dewatered municipal sludge samples were collected from five sewage plants in Changsha, Zhuzhou and Xiangtan respectively, which are representative cities with characteristics of the middle-south region of China. Some agricultural significant parameters and total metal concentrations in the sludge were determined and the metal speciation was studied by using BCR sequential extraction procedure. It was found experimentally that in general the municipal sludge collected from the five sewage plants was rich in organics, N and P. Except that the sludge from Xia Wan Sewage Treatment Plant showed higher concentrations of heavy metals, the sludge from other plants all showed a low total content of heavy metals with only Cd slightly exceeding the permitted values of the national application standard of acid soil in China (GB18918-2002). The sequential extraction results showed that Cu and Zn were principally distributed in the oxidizable fraction, which meant a high potential toxicity, but the bioavailability of Zn might be overestimated to the soil of Hunan. Pb was mainly in the residual fraction. The distribution of Cd showed no obvious characteristics.

[Effects of two different cryoprotectants on the motility of post-thaw human sperm].

OBJECTIVE: To compare the effects of the cryoprotectant containing glucose and that containing sucrose on the motility of post-thaw human sperm. METHODS: The cryoprotectant containing glucose and that containing sucrose were applied to 50 semen samples and the motility of the post-thaw human sperm was compared before and after cryopreservation and between the study groups. RESULTS: The forward motility and total motility of the sperm were (58.4 +/- 5.7)% and (63.4 +/- 6.1)% before cryopreservation, (43.8 +/- 7.6)% and (48.4 +/- 7.6)% after thawing with the cryoprotectant containing glucose, and(42.6 +/- 8.9)% and (48.0 +/- 8.5)% after thawing with the cryoprotectant containing sucrose. Decreased sperm motility was observed after cryopreservation, with statistic significance (P < 0.01). There was no significant difference in the forward and total motility of the post-thaw sperm between the two cryoprotectants. CONCLUSION: Cryopreservation inflicts obvious damage on sperm. Sucrose is a feasible sperm cryoprotectant.

[Spindle and chromosome configuration of human in vitro matured oocytes after slow freezing-fast thawing].

OBJECTIVE: To evaluate the development of immature oocytes after freezing-thawing by conventional cryopreservation method for mature oocytes. METHODS: Immature oocytes were collected from stimulated ovaries of intracytoplasmic sperm injection (ICSI) cycles. Immature oocytes were in vitro matured directly or after slow freezing-fast thawing and immunostained for tubulin and chromatin and at last visualized by confocal microscopy. RESULTS: No statistical difference was found in maturity rate between freezing groups and the controls. There was a statistically significant increase in abnormalities of chromosome (23.7% vs. 50%) and spindle (28.9% vs. 53.9%) in the GV freezing group compared with the GV control (P < 0.05). MI groups gave the same results. But we did not find any statistical difference between GV frozen group and MI frozen group. CONCLUSIONS: Cryopreservation decreases the ability of immature oocytes to form normal meiosis spindle and induce abnormal division of chromosomes. This suggests that the routine slow freezing-fast thawing procedure for mature oocyte couldn't preserve the ability well to form normal meiosis spindle during in vitro maturation.

[Successful clinical pregnancy of cryopreserved human oocytes after vitrification].

OBJECTIVE: To assess the feasibility and clinical value of cryopreservation of human oocytes. METHODS: Human oocytes were collected during stimulated cycle and then vitrificated with cryoloop. Surviving oocytes were thawed and then inseminated by intracytoplasmic sperm injection (ICSI). The fertilized oocytes were further cultured in vitro for 48 - 72 hours. High-quality embryos were transferred to the patients of infertility with informed consent. RESULTS: A total of 235 oocytes were vitrificated and thawed. The survival and fertilization rates of the oocytes were 71.9% and 72.5% respectively. Forty-one embryos were transferred to 11 patients. Two of the 11 patients achieved pregnancy, one of which gave birth of 2 healthy female twin babies and the other was at the 16 th week of pregnancy. The mother and babies were all healthy. CONCLUSION: Human oocyte vitrification is safe and feasible.

[Oocyte activation with calcium ionophore A23187 and puromycin on human oocytes that fail to fertilize after intracytoplasmic sperm injection].

OBJECTIVE: To investigate the effect of assisted oocyte activation with calcium ionophore A23187 and puromycin on human oocytes that fail to fertilize after intracytoplasmic sperm injection (ICSI). METHODS: All 113 discarded oocytes that showed no evidence of fertilization at 16 - 18 hours after in vitro maturation (IVM)-ICSI cycles and conventional ICSI were assigned to four groups according to the time after ICSI: IVM-ICSI 22-hour group (n = 33), IVM-ICSI 44-hour group (n = 18), ICSI 44-hour group (n = 37) and ICSI 68-hour group (n = 25). All unfertilized oocytes were exposed to calcium ionophore A23187 (5 micromol/L) for 5 minutes and subsequently incubated with puromycin (10 microg/ml) for 4 hours. After incubation, the oocytes were cultured in vitro for 3 - 5 days. The activation rate, proportion of oocytes that showed pronucleus formation and cleavage rate were calculated after activation. Sex chromosomal analysis was performed by dual color fluorescence in situ hybridization (FISH) on the embryos that displayed two pronuclei and a second polar body. RESULTS: The combination of calcium ionophore A23187 with puromycin could activate the unfertilized oocytes 22 - 68 hours after ICSI. Best results were achieved in IVM-ICSI 22-hour group, which elicited 88% (29/33) of activation rate, 62% (18/29) of cleavage rate and 28% (5/18) of 4-cell embryos. One embryo in this group developed to the morular stage. The activation rate and developmental potential of the activated embryos in IVM-ICSI 44-hour group, ICSI 44-hour group and ICSI 68-hour group decreased. FISH analysis showed 4 embryos with XX and 9 embryos with XY in 16 embryos. CONCLUSIONS: The combination of calcium ionophore A23187 with puromycin could effectively activate unfertilized oocytes 22 - 68 hours after ICSI. The cultured time of unfertilized oocytes after ICSI affects activation efficiency and developmental potential of the activated embryos. The activated zygotes that display two pronuclei and a second polar body can develop normally.

[Comparison of the outcome of intracytoplasmic single sperm injection between two motile sperm separation methods].

OBJECTIVE: To evaluate the efficiency of density gradient and improved swim-up methods for motile sperm isolation from fresh semen samples in intracytoplasmic sperm injection and embryo transfer (ICSI-ET) program, thus guiding the clinical application. METHODS: The fertilization rate, cleavage rate, high-quality embryo rate, clinical pregnancy rate, sperm abnormal rate and recovery rate of 42 cycles were studied prospectively. The cycles were divided into two groups with respect to the motile sperm isolation methods. RESULTS: No obvious difference was found in the fertilization rate, cleavage rate, high-quality embryo rate and clinical pregnancy rate between the two methods. The abnormal sperm rate induced by the improved swim-up method was significantly higher than that of the density gradient method (P < 0.01). For severe oligozoospermia, the recovery rate of motile sperm with density gradient was higher than that of improved swim-up (P < 0.01). CONCLUSION: In the ICSI-ET, there is no obvious difference in clinical pregnancy outcome between the two methods. The method of improved swim-up can be used for all patients but those with severe oligozoospermia.

[In vitro maturation and fertilization of oocytes from unstimulated cycles in women with infertility due to polycystic ovary syndrome].

OBJECTIVE: To investigate the effect of in vitro maturation (IVM) and fertilization of oocytes from unstimulated cycles in women with infertility due to polycystic ovary syndrome (PCOS). METHODS: Seventy women with PCOS, who came to our clinic during March to were involved in this trial. June 2003. Every cycle was given human chorionic gonadotropin 10,000 IU 36 h before oocyte retrieval. Immature oocytes were matured in vitro and fertilized, and the resulting embryos were replaced back to the uterus. RESULTS: A total of 94 IVM cycles were performed and 1283 oocytes were obtained. The overall maturation, fertilization and cleavage rates were 65.3%, 66.0% and 48.0% respectively. Maturation, fertilization, cleavage and high quality embryo rates had no difference between metaphase I stage oocytes (69.7%, 71.7%, 52.2% and 26.1% respectively) and germinal vesical (GV) stage oocytes (67.7%, 66.4%, 47.6% and 24.1% respectively), but the rates in those oocytes which could not be classified (44.8%, 53.8%, 46.2% and 16.9% respectively) were much lower than the former two groups. After embryo transfer, 18 pregnancies were reported (24%). CONCLUSION: IVM/IVF-ET in unstimulated cycles is a feasible treatment for women with PCOS.