妊娠分娩对盆底结构与功能的影响

盆底功能障碍性疾病(PFD)是由于盆底支持结构异常所致,其发生与妊娠和分娩密切相关。该文就妊娠分娩对盆底支持结构的损伤进行综述,以期为进一步探讨妊娠分娩相关PFD的预防诊治提供依据。     

Minimally invasive surgery for young female patients with mild-to-moderate juvenile hallux valgus deformity

BackgroundWe aimed to compare the clinical and radiographic outcomes of minimally invasive surgery (MIS) and distal chevron metatarsal osteotomy (DCMO) for young female patients with mild-to-moderate juvenile hallux valgus deformity.MethodsWe retrospectively reviewed the radiographs and clinical findings of young female patients with mild-to-moderate juvenile hallux valgus who underwent MIS (25 feet) or DCMO (30 feet). In 12 of 25 MIS feet, 2.0-mm bio-absorbable pins were used as an additional fixation device crossing the osteotomy site, and 1.4-mm Kirschner wires were used in the remaining 13 feet.ResultsRadiographic and clinical parameters preoperatively and at the final follow-up were not significantly different between the 2 groups. There were no significant differences in the increments of hallux valgus angle (HVA), distal metatarsal articular angle, medial sesamoid position, first metatarsal length, metatarsal length index, or relative second metatarsal length. Two MIS subgroups according to the additional fixation device showed no significant differences in HVA, the first to second intermetatarsal angle lateral translation ratio, or plantar offset at the final follow-up.ConclusionsMIS for young female patients with mild-to-moderate juvenile hallux valgus deformity had similar radiographic and clinical outcomes compared to DCMO. Regarding additional fixation crossing the osteotomy site, both temporary Kirschner wires and absorbable pins showed no radiographic differences in terms of correction maintenance.Level of evidence: 3.     

下肢外骨骼康复机器人在膝关节活动受限康复治疗中的应用

背景:下肢外骨骼康复机器人以持续主被动活动联合为理论基础,通过模拟人体运动,刺激机体的自然复原力,发挥组织代偿作用。目的:动态观察并了解下肢外骨骼康复机器人在膝关节活动受限患者功能锻炼中的康复作用。方法:将20例术后早期膝关节活动受限患者随机等分为实验组与对照组,实验组采用下肢外骨骼康复机器人行肢体功能锻炼,对照组采用被动训练装置CPM机行功能锻炼,治疗间隙2组均采用心理疏导、低频脉冲电疗和红外线等物理治疗。结果与结论:治疗2个月后,实验组与对照组患者膝关节后屈、前伸活动度均较治疗前明显改善(P<0.01),同时实验组股四头肌肌力较治疗前明显改善(P<0.01)。2个月后的后续治疗,实验组患者膝关节后屈、前伸活动度有了进一步的改善(P<0.05),对照组上述指标无明显改善。说明早期采用下肢外骨骼康复机器人或CPM机配合心理疏导、低频脉冲电疗和红外线等治疗均能明显提高膝关节活动受限患者膝关节活动度,同时下肢外骨骼康复机器人具有恢复患者股四头肌肌力的作用。     

薄瓣LASIK术后中央角膜厚度的变化分析

目的:探讨薄瓣LASIK术后6mo内中央角膜厚度(central corneal thickness,CCT)及屈光度的变化规律.方法:使用非接触式角膜内皮细胞计追踪观察158例302眼近视眼行LASIK手术患者术前及术后1d;1wk;1,3,6mo时CCT的变化,同时记录患者的年龄,预计激光角膜切削值、术中手术光区的大小,术后预计屈光度以及实际屈光度的改变等.结果:术前平均CCT为531.6±24.3μm.术后第1d平均CCT迅速下降,术后1wk平均CCT继续下降,1mo后角膜厚度开始增厚.术前和术后第1d CCT差值与预计激光角膜切削值呈强相关性(r＝0.916,P<0.01).术后6mo和术后1d时CCT的差值,即6mo内CCT的增厚值与患者年龄、术眼屈光度和术中手术光区均呈显著负相关性(r＝ -0.180,P＝0.026;r＝-0.187,P<0.01;r＝-0.171,P＝0 137).术后6mo时,实测平均等效球镜与术前预期值接近(术前等效球镜预期值平均为0.34±0.30D).所有病例随访6mo,无1例发生屈光回退,6mo时裸眼视力均≥0.8,平均视力为1.3±0.2.结论:薄瓣LASIK术后CCT和屈光状态的稳定大约需要6mo时间.术后6mo内CCT增厚值与术前患者年龄、屈光度及术中手术光区大小均呈显著负相关性.术后6mo时实测平均等效球镜值与术前预期值接近.薄瓣LASIK手术治疗近视眼具有良好的预测性和稳定性.     

雌激素受体β和HER2共表达对乳腺癌预后的影响

目的分析雌激素受体（ER-β）和人体表皮生长因子受体（HER2）共表达对乳腺癌的预后价值。方法收集308例原发性乳腺癌患者信息，采用免疫组化方法检测ER-β和HER2状态，评价其预后价值。结果免疫组化结果显示．ER-β阳性123例（40％），58例HER2阳性，44例ER-B及HER2共表达，呈显著相关性（P=0．018）。ER-β阳性与细胞低分化（P=0．01）、绝经低于45岁（P=0．031）、无远处复发时间（DDFS）相关，与总生存时间（OS）无关。HER2阳性与细胞低分化（P=0．001）、肿瘤大于3cm显著相关（P=0．011）。ER-13与HER2共表达与患者0S更短相关（P〈0．01）。结论ER-13．HER2阳性均可能促进乳腺癌转移，ER-β与HER-2患者其OS更短。     

Serum growth differentiation factor 11 is closely related to metabolic syndrome in a Chinese cohort

Aims/IntroductionDespite increasing interest in growth differentiation factor 11 (GDF11) based on its involvement in age‐related disorders, clinical implications – especially for metabolic diseases – remain unclear. Therefore, we assessed the association between serum GDF11 levels and metabolic disturbance in the Chinese population.Materials and MethodsA total of 381 individuals from the Shanghai Nicheng Cohort Study were included. In addition to anthropometry, laboratory and ultrasonography measurements, serum concentrations of GDF11 were measured by enzyme‐linked immunosorbent assay.ResultsCirculating GDF11 concentrations were unchanged with age (r = –0.064, P = 0.210), but showed an inverse relationship to body mass index, waist circumference and fat‐free mass index (all P < 0.05). Correlation analysis showed decreased GDF11 concentrations accompanied by elevated diastolic blood pressure, fasting and 2‐h plasma glucose, triglycerides, and low‐density lipoprotein cholesterol after adjusting for sex, age and body mass index, whereas variations in aspartate aminotransferase and free thyroxine were consistent with GDF11 (all P < 0.05). Furthermore, people, especially men, with abnormal glycometabolism, body mass index and/or fat accumulation in the liver had lower serum levels of GDF11 (P < 0.05); an increase in metabolic syndrome morbidity along with the circulatory decline of GDF11 was found when stratified by GDF11‐level quartiles (P‐trend <0.001). Logistic regression showed that serum GDF11 levels were independently correlated with the presence of metabolic syndrome (odds ratio 0.665, 95% confidence interval 0.510–0.867, P = 0.003).ConclusionsWe confirmed GDF11 as an endocrine factor playing a significant role in multiple metabolic processes and an indicator of metabolic syndrome in the Chinese population, particularly in males.     

���Ӫ����ص��ܺ���ѡ�񼰲���֢����

临床上行营养支持治疗的病人往往病情复杂,需要根据病人的代谢特点选择合适途径,给予合理、有效的营养支持。各种外科营养导管的快速发展使临床医师面对多种选择,如何作出合理选择并有效防止相关并发症的发生是取得良好疗效的基础。