运动对多囊卵巢综合征大鼠血清激素和卵巢形态学的影响

目的：探讨运动对多囊卵巢综合征（PCOS）大鼠胰岛素、性激素和卵巢形态学的影响。方法：17只21日龄Wistar大鼠随机分为PCOS运动组（n=6）、PCOS非运动组（n=6）和非PCOS对照组（n=5）。注射丙酸睾酮诱导PCOS模型，对照组注射相应容积茶油。运动程序为每天游泳2h，连续15d。实验结束后取血测定葡萄糖、胰岛素、雌二醇、黄体酮和睾酮浓度；卵巢病理切片运用图像分析软件Image—Pro Plus6．0进行形态学分析。结果：PCOS运动组胰岛素、雌二醇和睾酮水平均显著低于非运动组（P〈0．05），空腹血糖与空腹胰岛素（FBG／FINS）比值显著高于非运动组（P〈0.05）．接近于对照组水平。血糖和血清黄体酮水平三组间差异没有显著性。卵巢病理显示，PCOS运动组窦前卵泡数和闭锁卵泡显著减少（P〈0．05），而窦状卵泡和黄体数目则显著升高（P〈0．05），均接近于对照组水平。结论：短期运动能改善PCOS大鼠胰岛素敏感性．降低血清雄激素和雌激素水平，恢复正常卵巢形态，提示运动是PCOS的基础治疗方法。     

多囊卵巢综合征患者血清瘦素水平与性激素间的相关性研究

目的探讨多囊卵巢综合征(PCOS)患者血清瘦素(leptin)水平与性激素的相关性。方法选择初诊的PCOS患者34例作为研究对象,选择年龄及体重指数(BMI)相匹配的健康女性作为对照组进行血清瘦素、空腹血糖(FBG)、空腹胰岛素(FIn)、尿促卵泡素(FSH)、黄体生成素(LH)、孕激素(P)/雌激素(E)及睾酮(T)测定,并对它们间的相关性进行分析。结果 PCOS患者血清瘦素、LH、LH/FSH、T、BMI、FBG、胰岛素抵抗指数(HOMA-IR)水平均显著高于对照组,而FSH水平显著降低。血清瘦素水平与BMI、FBG、FIn及HOMA-IR存在相关性,进一步多元回归分析提示,血清瘦素与BMI独立相关。结论 PCOS患者血清瘦素水平变化与肥胖、糖代谢紊乱及性激素代谢异常有一定关系。     

人参总皂苷对多囊卵巢综合征模型大鼠激素水平及NGF表达的影响

目的 研究人参总皂苷(GTS)对多囊卵巢综合征(PCOS)模型大鼠的治疗作用。方法 选取SPF级雌性SD大鼠,通过肌内注射4 mg脱氢表雄酮(DHEA)诱导PCOS模型,然后随机分为空白组(正常SD大鼠+腹腔注射等量等时长0. 9%氯化钠溶液)、模型模型对照组(PCOS模型大鼠+腹腔注射等量等时长0. 9%氯化钠溶液)和GTS干预组(PCOS模型大鼠+建模次日每隔1天腹腔注射GTS 50 mg/kg,连续28 d)。实验结束观察大鼠卵巢形态,并测定其血清中激素水平及卵巢、垂体和海马体中神经生长因子(NGF)水平。结果 与空白组比较,模型对照组大鼠的卵巢呈多囊样改变,体重和卵巢质量均显著增大,游离睾酮(FT)、黄体生成素(LH)/促卵泡激素(FSH)水平及卵巢、海马体和垂体中NGF的表达均显著升高,差异有统计学意义(P 0. 05);而与模型对照组相比,GTS组体重和卵巢质量均显著降低,FT、LH/FSH水平及卵巢中NGF中的表达均显著降低,差异有统计学意义(P 0. 05)。结论 GTS对PCOS模型大鼠有潜在的治疗作用。     

PPAR-γ在多囊卵巢综合征大鼠卵巢组织中的表达及意义

目的:探讨过氧化物酶增殖物激活受体-γ(PPAR-γ)在多囊卵巢综合征(PCOS)大鼠卵巢的表达与其性激素变化及胰岛素抵抗(IR)的关系。方法:应用脱氢表雄酮(DHEA)皮下注射23日龄SD雌性大鼠20d,观察卵巢巢重量及光镜(HE染色)形态学改变,应用ELISA(酶联免疫法)测定T、E2、LH、FSH及血清胰岛素、糖耐量试验,应用荧光定时定量聚合酶链反应(real-timePCR)检测PPAR-γmRNA的表达。结果:实验组卵巢重量显著高于对照组(P<0.05),实验组卵巢呈多囊样改变而黄体形体比例减少;实验组血清T、E2、FSH、空腹血糖水平显著高于对照组(P<0.05),空腹胰岛素及胰岛素抵抗指数(HOMA-IR)显著高于对照(P<0.05);在PCOS大鼠卵巢中PPAR-γ相对含量显著高于对照组(P<0.05)。结论:DHEA诱导的PCOS大鼠动物模型与PCOS患者相似,PPAR-γ在PCOS大鼠卵巢发育中起部分调节作用,并与PCOS的IR密切相关。     

LncRNA TMPO-AS1通过PI3K/Akt信号通路对多囊卵巢综合征大鼠性激素和卵巢功能的影响

目的 探究LncRNA TMPO-AS1对多囊卵巢综合征(PCOS)大鼠的影响以及其对磷脂酰肌醇-3-激酶(PI3K)/蛋白激酶B(Akt)通路相关分子的调控作用。方法 选取36只SPF级SD雌性大鼠,按照随机数字表法分为模型组(A组)、空白质粒组(B组)、TMPO-AS1过表达质粒组(C组)共3组,每组12只大鼠。采用来曲唑注射法制备大鼠PCOS模型,于造模第1天起,B、C组大鼠尾静脉注射空白质粒及TMPO-AS1过表达质粒,A组注射等量0.9%氯化钠溶液,连续注射21 d。比较各组大鼠的性激素[促黄体生成素(LH)、睾酮、卵泡刺激素(FSH)]水平、卵巢功能(卵巢重量/体重比例、成熟卵泡数量、黄体数量)、卵巢组织的PI3K、Akt mRNA和蛋白表达量以及子宫容受性[白血病抑制因子(LIF)蛋白和整合素β3(ITG β3)]、代谢功能[空腹血糖(FBG)、空腹胰岛素(FINS)、HOMA-IR]水平。结果 C组大鼠的性激素LH、睾酮水平、卵巢重量/体重比例、成熟卵泡数量、FBG、FINS、HOMA-IR水平均高于A、B组,FSH水平、黄体数量均低于A、B组,同时C组大鼠的PI3K、...     

雷帕霉素对脱氢表雄酮诱导PCOS大鼠卵巢组织的影响及作用机制探讨

目的 探讨雷帕霉素对脱氢表雄酮（DHEA）诱导的多囊卵巢综合征（PCOS）大鼠卵巢组织的影响及作用机制。方法 55只SD雌性大鼠适应性喂养1周后随机分为空白组（13只）、对照组（13只）及PCOS组（29只），其中PCOS组大鼠皮下注射DHEA诱导建立PCOS大鼠模型，对照组大鼠给予皮下注射大豆油，空白组全程不做任何处理。造模成功后分为空白组、对照组（腹腔注射等体积生理盐水），将PCOS大鼠分为模型对照组（腹腔注射等体积生理盐水）、低剂量组（腹腔注射雷帕霉素1 mg/kg）及高剂量组（腹腔注射雷帕霉素10 mg/kg），每组各8只大鼠，共干预28 d，给药结束后检测各组大鼠血糖、性激素水平，并进行HE、Masson、免疫组织化学染色，检测并比较组间mTOR、p-mTOR及p-P70S6蛋白表达，TUNEL法检测卵巢组织凋亡情况。结果 PCOS大鼠动情周期出现紊乱，卵巢组织中卵泡呈现多囊样变化，PCOS大鼠体重、卵巢质量、体积、相对质量、性激素水平、纤维化阳性范围均高于对照组（P均<0.05），而低剂量组和高剂量组大鼠的上述指标均低于模型对照组（P均<0.05），且卵巢组织多...     

二甲双胍联合罗格列酮治疗多囊卵巢综合征40例疗效观察

【目的】探讨二甲双胍联合罗格列酮治疗多囊卵巢综合征（PCOS）临床疗效。【方法】选择PCOS患者80例，随机分为二甲双呱联合罗格列酮治疗（治疗组）和单用二甲双呱治疗（对照组）两组，每组40例。疗程均6个月。检测并比较两组患者血清性激素水平、空腹血糖及胰岛素水平，观察卵巢的变化。【结果】治疗组治疗后促黄体生成素（LH）、睾酮（T）、空腹血糖、胰岛素、稳态模型胰岛素抵抗指数（HomaIR）、卵巢体积和卵泡数与治疗前及对照组治疗后比较均有显著性差异（P〈0．05）；治疗后两组促卵泡素（FSH）水平均有升高，但与治疗前比较无显著性差异（P〉0．05）；治疗组治疗前后HomaIR及卵巢改善显著高于对照组（P〈0．05）。【结论】两种药物联合使用治疗PCOS疗效可靠，值得临床推广。     

护理干预对肥胖型多囊卵巢综合征不孕患者的影响

目的 探讨护理干预对肥胖型多囊卵巢综合征不孕患者内分泌、糖代谢和药物促排卵治疗后妊娠率的影响.方法 将32例多囊卵巢综合征排卵障碍性不孕患者随机分成对照组和护理组各16例.对照组直接进行药物促排卵治疗;护理组先行4个月系统护理干预,再加入药物促排卵治疗.观察比较对照组和护理组促排卵治疗后妊娠率的情况;比较护理组经系统护理干预前后睾酮、黄体生成素、卵泡刺激素、空腹血糖、空腹胰岛素、胰岛素抵抗指数的变化.结果 护理组妊娠率较对照组高,有显著性差异.护理干预前后护理组患者睾酮、黄体生成素、空腹胰岛素、胰岛素抵抗指数比较差异有显著性意义;空腹血糖和卵泡刺激素则差异无显著性意义.结论 系统护理干预对提高PCOS不孕患者药物促排卵治疗后的妊娠率.改善患者体内内分泌及糖代谢紊乱有积极的作用.     

多囊卵巢综合征的性激素、胰岛素抵抗与超声影像相关性分析

目的探讨多囊卵巢综合征(PCOS)患者血液中性激素及胰岛素抵抗的特征并分析与超声影像之间的相关性。方法对2010年4月至2013年12月来本院进行治疗的120例PCOS患者(PCOS组)及50例健康体检者(对照组)进行超声影像指标检查,包括卵巢间质面积(SA)、卵巢总面积(TA)并计算SA/TA比值,以及检测血液中卵泡生成激素(FSH)、黄体生成激素(LH)、LH/FSH、雌二醇(E2)、睾酮(TESTO)、催乳激素(PRL)。对PCOS组检测空腹血糖(FPG)和空腹胰岛素(FIN),计算稳态模型指数(HOMA-IR)来评估胰岛素抵抗。结果 PCOS组的LH、LH/FSH、TESTO、SA、SA/TA均明显高于对照组,PCOS组的SA、SA/TA与LH、LH/FSH、TESTO、HOMA-IR呈正相关。结论 PCOS患者性激素水平及胰岛素抵抗与超声影像指标具有相关性。     

吡格列酮和二甲双胍联合治疗肥胖型多囊卵巢综合征临床研究

目的观察吡格列酮和二甲双胍联合治疗肥胖型多囊卵巢综合征(polycystic ovary syndrome,PCOS)后,体重、胰岛素敏感性和排卵情况的变化.方法7例年龄在19～29周岁的初诊PCOS患者给予吡格列酮15mg/d和二甲双胍(格华止)1000mg/d,治疗3个月,比较治疗前后体重、简化葡萄糖耐量试验、胰岛素水平(空腹和服糖后2h)、性激素、泌乳素和卵巢超声检查、基础体温曲线、体重指数和胰岛素敏感指数的变化.结果治疗后7例患者均出现月经来潮,体重减轻,血胰岛素、睾酮、黄体生成素水平降低,卵泡刺激素升高,基础体温曲线呈双相曲线.卵巢超声检查无显著变化.结论吡格列酮和二甲双胍联合治疗肥胖型多囊卵巢综合征疗效可靠.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.