子宫内膜异位症不孕并发内膜息肉的病理特征及手术后复发分析

目的:分析子宫内膜异位症(EM)不孕患者发生内膜息肉情况及病理特征。方法:收集本院2016年1月-2017年1月收治的不孕患者,EM 67例为观察组,非EM 82例为对照组,比较两组内膜息肉发生率,观察组r-AFS不同分期内膜息肉发生率、治疗后临床妊娠率,分析发生内膜息肉的病理特征。结果:观察组内膜息肉发生率(31.3%)及息肉复发率(11.9%)高于对照组(12.2%、2.4%)(P<0.05);观察组EMⅠ期患者内膜息肉发生率17.7%、无复发,Ⅱ期内膜息肉发生率32.0%、复发率8.0%,Ⅲ期内膜息肉发生率40.0%、复发率20.0%,Ⅳ期内膜息肉发生率40.0%、复发率30.0%,各期发生率及复发率比较无差异(P>0.05);卵巢型内膜息肉发生率25.0%、复发率10.0%,腹膜型内膜息肉发生率29.0%、复发率9.7%,DIE型内膜息肉发生率43.8%、复发率18.8%,EM不同病理类型内膜息肉发生率及复发率无差异(P>0.05)。结论:EM不孕患者发生内膜息肉几率较大,及时手术切除息肉可提高妊娠率,临床应及早诊断和治疗。     

青壮年股骨颈骨折患者行闭合复位内固定手术后发生股骨头无菌性缺血坏死影响因素分析

目的探讨青壮年股骨颈骨折患者经闭合复位内固定手术治疗后发生股骨头无菌性缺血坏死的影响因素。方法回顾性分析自2015年1月至2020年1月北部战区总医院骨科收治的经闭合复位内固定手术治疗的62例青壮年股骨颈骨折患者临床资料,包括年龄、性别、体质量指数、骨折侧、Garden分型、损伤至手术前时间、术前是否牵引、内固定是否取出、股骨头后倾角度、是否有股骨颈皮质粉碎、术后负重活动时间、复位质量等,并分析上述指标对术后发生股骨头无菌性缺血坏死的影响。结果青壮年患者发生术后股骨头无菌性缺血坏死与Garden分型、内固定是否取出、股骨头后倾角度、股骨颈皮质粉碎情况、复位质量相关(P<0.05)。多因素Logistic分析显示,内固定是否取出、复位质量、股骨头后倾角度与术后发生股骨头无菌性缺血坏死关系密切(P<0.05)。结论青壮年股骨颈骨折闭合复位内固定术后发生股骨头坏死的影响因素较多,其中,内固定是否取出、复位质量、股骨头后倾角度与术后发生股骨头坏死密切关系。     

冠心病患者发生二尖瓣脱垂样改变超声心动图特点分析

目的 探讨冠心病患者发生二尖瓣脱垂样改变的超声心动图特点,并分析其对治疗策略的影响.方法 选取北部战区总医院收治的同时行冠状动脉旁路移植与二尖瓣手术的171例患者为研究对象.根据冠状动脉病变严重程度将其分为A组(病变支数≥3支,n=98)与B组(病变支数1～2支,n=73).另选取我院同期收治的二尖瓣脱垂无冠心病行二尖...     

核因子E2相关因子2/血红素加氧酶1信号通路介导的氧化应激反应对早期小鼠视网膜爆震伤的影响及其作用机制

目的　探讨核因子E2相关因子2(Nrf2)/血红素加氧酶1(HO-1)信号通路介导的氧化应激反应对早期小鼠视网膜爆震伤的影响及其作用机制。方法　取雄性C57BL/6小鼠60只随机分为对照组和模型组,对照组小鼠常规饲养,模型组小鼠接受爆震冲击处理。去除建模过程中5只死亡小鼠,最终纳入对照组16只小鼠、6 h模型组19只小鼠、48 h模型组20只小鼠。分别于建模后6 h、48 h腹腔注射200 g·L^-1戊巴比妥钠过量麻醉处死小鼠,解剖取材。对各组小鼠视网膜组织进行HE染色,计数视网膜神经节细胞（RGC）并测量视网膜神经纤维层（RNFL）厚度。免疫组织化学染色检测各组小鼠视网膜组织Nrf2蛋白、HO-1蛋白、超氧化物歧化酶2(SOD2)蛋白表达情况。Western blot检测各组小鼠视网膜组织Nrf2蛋白、HO-1蛋白、SOD2蛋白、诱导型一氧化氮合酶(iNOS)蛋白、黑色素瘤分化相关基因5（MDA5）蛋白的相对表达量。结果　与对照组相比,6 h模型组小鼠视网膜组织结构疏松,细胞排列紊乱,神经节细胞层、内核层及外核层出现核浓缩和空泡现象;RGC数减少(P<0.05),RNFL厚度增加(P<0.05);48 h模型组小鼠视网膜组织细胞排列更为杂乱疏松,RGC数明显减少(P<0.05),RNFL进一步增厚(P<0.05),并伴有新生血管生成。与对照组［(7.85±1.16)%］相比,6 h模型组小鼠视网膜组织Nrf2蛋白阳性细胞表达率升高至(16.78±1.38)%;48 h模型组进一步升高至(20.01±1.48)%,差异均有统计学意义(均为P<0.05)。与对照组［(4.67±0.98)%、(4.15±1.11)%］相比,6 h模型组小鼠视网膜组织HO-1蛋白、SOD2蛋白阳性细胞表达率分别升高至(7.95±1.27)%和(6.14±0.90)%;48 h模型组继续升高,分别为(12.34±1.48)%、(10.25±1.46)%,差异均有统计学意义(均为P<0.05)。与对照组相比,6 h模型组小鼠视网膜组织Nrf2蛋白、HO-1蛋白、SOD2蛋白、iNOS蛋白、MDA5蛋白相对表达量均升高,差异均有统计学意义(均为P<0.05);48 h模型组进一步升高,差异均有统计学意义(均为P<0.05)。结论　Nrf2/HO-1信号通路介导的氧化应激反应参与早期视网膜爆震伤的发生,其作用机制与上调SOD2蛋白、MDA5蛋白、iNOS蛋白表达有关。     

Clinical course and outcomes of COVID-19 patients with chronic obstructive pulmonary disease: A retrospective observational study in Wuhan,China

Information about coronavirus disease 2019 (COVID-19) patients with pre-existing chronic obstructive pulmonary disease (COPD) is still lacking. The aim of this study is to describe the clinical course and the outcome of COVID-19 patients with comorbid COPD.This retrospective study was performed at Wuhan Huoshenshan Hospital in China. Patients with a clear diagnosis of COVID-19 who had comorbid COPD (N = 78) were identified. COVID-19 patients without COPD were randomly selected and matched by age and sex to those with COPD. Clinical data were analyzed and compared between the two groups. The composite outcome was the onset of intensive care unit admission, use of mechanical ventilation, or death during hospitalization. Multivariable Cox regression analyses controlling for comorbidities were performed to explore the relationship between comorbid COPD and clinical outcome of COVID-19.Compared to age- and sex-matched COVID-19 patients without pre-existing COPD, patients with pre-existing COPD were more likely to present with dyspnea, necessitate expectorants, sedatives, and mechanical ventilation, suggesting the existence of acute exacerbations of COPD (AECOPD). Greater proportions of patients with COPD developed respiratory failure and yielded poor clinical outcomes. However, laboratory tests did not show severer infection, over-activated inflammatory responses, and multi-organ injury in patients with COPD. Kaplan–Meier analyses showed patients with COPD exhibited longer viral clearance time in the respiratory tract. Multifactor regression analysis showed COPD was independently correlated with poor clinical outcomes.COVID-19 patients with pre-existing COPD are more vulnerable to AECOPD and subsequent respiratory failure, which is the main culprit for unfavorable clinical outcomes. However, COPD pathophysiology itself is not associated with over-activated inflammation status seen in severe COVID-19.     

丹参多酚酸联合尼麦角林治疗急性脑梗死恢复期的临床研究

目的 探讨丹参多酚酸联合尼麦角林治疗急性脑梗死恢复期的临床疗效。方法 选取2019年6月—2021年12月在中国人民解放军北部战区总医院治疗的72例急性脑梗死恢复期患者,随机将患者分为对照组和治疗组,每组各36例。对照组口服尼麦角林片,20 mg/次,3次/d。在对照组的基础上,治疗组静脉滴注注射用丹参多酚酸,0.13 g/次,加于生理盐水250 mL中,1次/d。两组连续治疗14 d。观察两组患者临床疗效,比较治疗前后两组患者症状改善时间,美国国立卫生研究院卒中量表（NIHSS）评分、日常生活活动能力（BI）评分,血清因子肿瘤坏死因子-α(TNF-α)、血管间黏附分子-1(VCAM-1)、白细胞介素-6(IL-6)和单核细胞趋势蛋白-1(MCP-1)水平,及不良反应情况。结果 治疗后,治疗组临床有效率（97.22%）明显高于对照组（75.00%,P<0.05）。治疗后,治疗组症状改善时间均明显早于对照组（P<0.05）。治疗后,两组BI评分明显升高,而NIHSS评分明显下降（P<0.05）,且治疗组BI和NIHSS评分明显好于对照组（P<0.05）。治疗后,两...     

基于网络药理学-分子对接探讨益气养阴通络方抗类风湿关节炎的作用机制

[目的]采用网络药理学与分子对接探究益气养阴通络方干预类风湿关节炎（RA）的作用机制。[方法]通过中药系统药理学数据库及分析平台（TCMSP）、本草组鉴（HERB）和文献查阅获得复方活性成分与靶点,采用Genecards、在线人类孟德尔遗传数据库（OMIM）等数据库获得疾病靶点,然后采用数据库计算出益气养阴通络复方成分与疾病的交集靶点。对交集靶点施行功能和通路富集分析,选取益气养阴通络方核心药物靶点与关键化合物施行分子对接。[结果]网络药理学共筛选出益气养阴通络方的83种活性成分和779个潜在靶点,RA相关靶点5 393个,交集靶点465个,其中交集核心靶点9个（分别为SRC、STAT3、MAPK3、MAPK1、HSP90AA1、PIK3R1、GRB2、AKT1、PIK3CA）。富集得出PI3K-AKT、癌症相关及神经活性配体-受体相互作用等通路,其中PI3K-AKT信号通路可能是复方干预RA的关键通路之一。对接计算表明,益气养阴通络方的11种主要活性成分与关键靶点SRC、STAT3、PIK3R1、AKT1均有较稳定的结合,其中与AKT的结合可能最大。[结论]益气养阴通络方通过多成分-...     

LY294002对过敏性鼻炎-哮喘综合征大鼠氧自由基、TRPV1神经元敏感性及TSLP表达的影响

目的 研究LY294002对过敏性鼻炎-哮喘综合征(CARAS)大鼠氧自由基、TRPV1神经元敏感性及TSLP表达的影响。方法 将40只大鼠随机分为健康组(健康大鼠常规饲养)、模型组(卵蛋白致敏和鼻部滴注攻击法建立过敏性鼻炎-哮喘综合征大鼠模型)、治疗组(模型+静脉注射LY294002 0.5 mg/kg)、对照组(模型+布地奈德气雾剂)。ELISA与免疫组织化学法检测TSLP表达,黄嘌呤氧化酶法检测SOD,TBA法检测MDA,HE染色观察大鼠肺组织病理形态学变化,免疫荧光检测TRPV1表达,免疫印迹检测NF-кB、IкB蛋白表达。结果 与健康组相比,模型组大鼠支气管及周围产生大量炎性细胞,支气管黏膜水肿、增厚,管腔狭窄,黏液分泌增多;与模型组比较,治疗组与对照组肺组织病理明显有所改善。与健康组相比,模型组TRPV1、MDA、TSLP、NF-кB升高,SOD、IкB降低(P<0.05);与模型组相比,治疗组与对照组TRPV1、MDA、TSLP、NF-кB降低,SOD、IкB升高(P<0.05);治疗组与对照组各指标相比无差异(P>0.05)。结论 通过抑制TRPV1、...     

A Novel Free-hand Technique of Pedicle Screw Placement in the Lumbar Spine: Accuracy Evaluation and Preliminary Clinical Results

Objective

Pedicle screw implantation is the most common technique to achieve stability during spinal surgeries. Current methods for locating the entry point do not have a quantified criteria and highly rely on the surgeons' experience. Therefore, we aim to propose a quantified pedicle screw placement technique in the lumbar spine and to investigate its accuracy and safety in clinical practice.

Methods

We conducted a retrospective study involving 110 patients who received spinal surgery in our hospital from August 2018 to August 2021. All patients included had herniation of a single lumbar disc and were consistently treated with posterior discectomy, inter-body fusion, and transpedicular internal fixation. For 54 patients in the observation group, the pedicle screws were placed with our technique, which is located at 4 mm below the superior edge of the transverse process in line with the lateral margin of the superior articular process. For 56 patients in the control group, pedicle screws were placed according to the traditional crista lambdoidalis method. Comparisons were made in terms of the operation time, blood loss, time for exposure, the accuracy of placement, and postoperative complications. Furthermore, we applied our method to 64 patients with indistinguishable crista lambdoidalis and evaluated the accuracy of screw placement and clinical outcomes according to the visual analogue scale (VAS) and the Japanese Orthopaedic Association (JOA) score.

Results

There was no significant difference in intraoperative bleeding, accuracy of placement, and postoperative complications between our technique and the traditional crista lambdoidalis method (P > 0.05). However, the exposure time before screw placement (12.8 ± 0.3 vs. 17.4 ± 0.3, P = 0.001) and the total surgery time (97.2 ± 1.9 vs 102.3 ± 0.9, P = 0.020) were significantly shortened with our method. Additionally, in cases with indistinguishable crista lambdoidalis, our technique showed satisfying accuracy, with 97.6% screws placed in appropriate trajectory on the first attempt and all screws eventually positioned in the safe zone according to the Gertzbein–Robbins grading. All patients experienced steady improvement after surgery.

Conclusion

Placing pedicle screws at 4 mm below the superior edge of the transverse process in line with the lateral margin of the superior articular process is a viable pedicle screw placement method. With this method, we observed a higher success rate and shorter operation time. In addition, this method can be applied in cases with indistinguishable crista lambdoidalis, and have satisfied success rate and clinical outcome.