血浆护骨素及有关因子水平在两组妊娠妇女间的比较

 摘要：目的 研究妊娠期糖尿病（GDM）和正常糖耐量(NGT)妊娠妇女在孕中晚期血浆护骨素及有关因子水平的比较。方法 收集NGT和GDM妊娠妇女各65例,于孕24-28周取静脉血5mL,置EDTA抗凝管中,3000r/min离心5min后留血浆,-20℃低温保存。用酶联免疫吸附测定法（ELISA）测定血浆护骨素(OPG)水平,同时测定空腹血糖(FPG),空腹胰岛素（FINS）,糖化血红蛋白（HbA1c）,血脂水平,超敏C反应蛋白（hs-CRP）,血细胞计数,计算胰岛细胞功能（HOMA-B）和胰岛素抵抗（HOMA-IR）的评估指数。结果 血浆OPG水平在NGT和GDM组中无明显差异,在NGT组中,OPG与FINS (r=0.335;P=0.012)、HOMA-IR (r=0.363;P=0.006)、血小板计数(r=0.333;P=0.009)和载脂蛋白B(r=-0.254;P=0.043)水平相关,在GDM组,未发现上述指标与OPG水平相关。结论 在糖耐量正常孕妇中OPG可能参与了妊娠期的胰岛素抵抗和炎症反应,而其在妊娠期糖尿病组中的作用不明显,可能原因是OPG为影响胰岛素抵抗和炎症反应的较弱因素,在妊娠期糖尿病时,影响力更强的因素掩盖了其作用。     

开闭口式硅橡胶取模对三类牙槽嵴全口义齿修复边缘适合性的对比研究

目的研究三类牙槽嵴患者制取开闭口式硅橡胶印模后全口义齿修复的边缘适合性。方法选取2016-01～2018-01在修复科就诊的全口牙列缺失患者,按照Atwood分级法,二级牙槽嵴18例,三级牙槽嵴20例,四级牙槽嵴12例。将这三类牙槽嵴又各自等分为观察组和对照组,每组25例。观察组采用闭口式硅橡胶印模行全口义齿修复。对照组采用开口式硅橡胶印模行全口义齿修复。修复后1个月内,统计患者因边缘不合适来诊的次数、调磨的区数及各区调磨过的次数。结果全口义齿修复1个月内,三类牙槽嵴中观察组调磨的次数均显著少于对照组(P 0. 05),尤其是四级牙槽嵴(P 0. 01)。观察组三级和四级牙槽嵴调磨的区数显著少于对照组(P 0. 05)。观察组二级牙槽嵴调磨的区数与对照组比较差异无统计学意义(P0. 05)。其中下颌磨牙区边缘调磨的次数为最多,其次为上颌磨牙区。结论闭口式硅橡胶取模制作的全口义齿边缘适合性要明显高于开口式硅橡胶取模,而且在牙槽嵴条件越差的时候效果越明显。     

Vertebral plate regeneration induced by radiation-sterilized allogeneic bone sheets in sheep

Objective： To evaluate the effects and mechanism of radiation-sterilized allogeneic bone sheets in inducing vertebral plate regeneration after laminectomy in sheep. Methods ： Twelve adult male sheep （ aged 1.5 years and weighing 27 kg on average ） provided by China Institute for Radiation Protection underwent L3-4 and L4-5 laminectomy. Then they were randomly divided into two groups： Group A （n =6） and Group B （n =6）. The operated sites of L4-5 in Group A and L3-4 in Group B were covered by ＂ H-shaped＂ freeze-drying and radiationsterilized allogeneic bone sheets （ the experimental segments）, while the operated sites of L3-4 in Group A and L4-5 in Group B were uncovered as the self controls （ the control segments ）. The regeneration process of the vertebral plate and the adhesion degree of the dura were observed at 4,8,12,16,20 and 24 weeks after operation. X- ray and CT scan were performed in both segments of 1.34 and L4-5 at 4 and 24 weeks after operation. Results： In the experimental segments, the bone sheets were located in the anatomical site of vertebral plate, and no lumbar spinal stenosis or compression of the dura was observed. The bone sheets were absorbed gradually and fused well with the regenerated vertebral plate. While in the control segments, the regeneration of vertebral plate was not completed yet, the scar was inserted into the spinal canal, compressing the dura and the spinal cord, and the epidural area almost disappeared. Compared with the control segments, the dura adhesion degree in the experimental regenerated segments was much milder （ P 〈 0. 01 ）, the internal volume of the vertebral canal had no obvious change and the shape of the dura sack remained well without obvious compression. Conclusions： Freeze-drying and radiation-sterlilized allogeneic bone sheets are ideal materials for extradural laminoplasty due to their good biocompatibility, biomechanical characteristics and osteogenic ability. They can effectively reduce formation of post-laminectomy scars, prevent recurrence of post-lamlnectomy spinal stenosis, and induce regeneration of vertebral plates.     

环状RNA在慢性阻塞性肺疾病中生物学作用的研究进展

环状RNA(circRNA)是一类新型的非编码RNA,由于其环状结构稳定存在于各种生物体中并参与代谢调节功能,环状RNA参与多种疾病的发生与发展,且与多种呼吸系统疾病密切相关。慢性阻塞性肺疾病是一种基因与环境共同作用的复杂呼吸系统疾病,有研究发现环状RNA在慢性阻塞性肺疾病发病中起重要作用,且可能成为慢性阻塞性肺疾病诊断标志物或新的治疗干预靶点。本文将环状RNA与慢性阻塞性肺疾病发生机制的关系进行综述,总结环状RNA在慢性阻塞性肺疾病中的生物学作用。     

内皮细胞在缺血性心脏病及心力衰竭中的作用

内皮细胞是上皮细胞的一种,广泛分布于心、血管和淋巴管腔面,在人体生理稳态中参与止血、血管调节、血管生成等重要过程。近年来有研究发现,内皮细胞除上述作用外,还促进了缺血性心脏病等多种疾病的病理进展,并且表现出独特的多向分化能力,其中内皮间质转分化能力与心肌纤维化及心力衰竭关系密切。本文主要探讨血管内皮细胞生理特点及在缺血性心脏病、心力衰竭治疗中的研究进展,为相关疾病治疗提供新思路。     

乳腺癌根治术中硬膜外阻滞左旋布比卡因临床应用观察

目的比较盐酸左旋布比卡因（Levobupivacaine hydrochloride）和盐酸利多卡因（Lidocainehydrochloride）作为高位硬膜外阻滞用于乳腺手术对血压（BP）、心率（HR）及血氧饱和度（SpO2）的影响。方法随机将美国麻醉医师协会（ASA）Ⅰ～Ⅱ级乳腺癌患者117例分为盐酸左旋布比卡因组57例,盐酸利多卡因组60例。2组麻醉前用药和麻醉操作相同,均硬膜外腔注入相应药物,分别于硬膜外麻醉注药前,注药后20 min、45 min记录BP、HR及SpO2各参数值。结果盐酸利多卡因组患者硬膜外注药后20 min和45 min时BP、SpO2均有不同程度的下降,HR增快,与硬膜外注药前相比,有显著性差异（P〈0.01）;盐酸左旋布比卡因组患者硬膜外注药前后HR、BP及SpO2无明显变化。结论低浓度盐酸左旋布比卡因血浆游离浓度低,用于乳腺手术高位硬膜外阻滞,具有对中枢神经系统毒性低,心脏毒性小,维持时间长和对呼吸循环影响小等优点,是较为可取的一种麻醉方法。     

The clinical evaluation and treatment of female precocious puberty

One in 180 American girls has precocious puberty. Accordingly, as a primary care physician, the obstetrician/gynecologist must be knowledgeable about the clinical evaluation and management of this disorder. Pubertal precocity has numerous causes and may be classified broadly as being central or peripheral in etiology. A meticulous history and physical examination, the judicious choice and interpretation of laboratory tests, and the selective use of radiological studies are the cornerstones of the evaluation. The initial approach should focus on identifying life-threatening tumors of the brain, adrenal gland, or ovary. The management goals include reducing the gonadotropin secretion and sex steroid effects and maximizing the eventual adult height. Because the child and her parents are frequently extremely distressed, the treating physician’s sensitivity and reassurance are paramount. The obstetrician/gynecologist, as both primary care physician and consultant, is in an ideal position to investigate, diagnose, and treat female precocious puberty.     

艾滋病合并卡氏肺囊虫肺炎的诊断及治疗

非洲国家艾滋病肆虐,HIV阳性者屡见不鲜。我国第八批维和医疗队在联合国驻利比里亚绥德鲁地区二级医院执行维和医疗任务期间,抢救2例艾滋病合并卡氏肺囊虫肺炎患者,报告如下。     

载脂蛋白E基因多态性与女性冠心病相关性的Meta分析

目的研究载脂蛋白E基因多态性与女性冠心病发病的关系。方法以载脂蛋白E(ApoE)、女性冠心病、基因多态性、Apolipoprotein E、women coronary heart disease、gene polymorphisms为检索词,检索万方数据库、中国知网、中国生物医学文献、SpringerLink数据库和PubMed数据库,检索时时限为建库至2018年9月30日。然后以等位基因E2、E4分别与E3相比较,基因型E2/2、E2/3、E2/4、E3/4、E4/4分别与E3/3相比较。应用统计学软件Stata14.0对所有数据进行Meta分析,计数资料采用合并比值比(OR值)和95%可信区间(95%CI)描述。异质性分析过程应用I~2完成,认为P0.1或I~250%时存在明显的异质性。发表偏倚用漏斗图进行分析。结果的可靠性通过敏感性分析评估。P0.05为差异有统计学意义。结果初步检索文献940篇,最终纳入9篇。其中中文1篇,英文8篇。所选文献均使用NOS质量评分量表进行质量评价,所选文献均大于5分,为高质量文献。所选文献Meta分析结果示基因型E2/2[OR 4.65,95%CI (1.02,21.19)]、E3/4[OR 1.68,95%CI (1.00,2.82)]、E4/4[OR 4.55,95%CI (2.16,9.60)]在病例组表达率要显著高于对照组,E2/3[OR 1.10,95%CI (0.79,1.54)]、E2/4[OR 1.03,95%CI (0.51,2.07)]与女性冠心病的发病无统计学意义。结论 E2/2、E3/4、E4/4基因携带者女性冠心病的发病风险显著增加;E2/3、E2/4携带者无明确相关性。     

Sélection de patientes et tolérance précoce de l’irradiation mammaire selon le protocole « Fast Forward » : résultats préliminaires

PurposeModerate hypofractionated radiotherapy has become routine practice for a selected population of patients treated for early-stage breast cancer. In April 2020, the Fast Forward (FF) study was published which introduced another extreme hypofractionated radiotherapy regimen in five sessions over a week. The aim of this work is to evaluate the population of first patients in whom this regimen was used in our department, as well as the results in terms of early toxicity.Material and methodsWe retrospectively analysed all the patients treated in our department according to the Fast Forward protocol after establishing an institutional consensus regarding the selection of patients with breast cancer without indication for lymph node irradiation. All patients received breast-only irradiation at a total dose of 26 Gy in five fractions according to protocol. All patients were treated by modern conformational techniques with planning large volume coverage between 95 and 100%. Acute toxicity of the treatment was assessed using the NCI CTC v4.0 scale and the general condition was assessed according to the WHO classification.ResultsBetween August 2020 and May 2021, 30 patients were included, treated on the breast alone without complement on the tumour bed or irradiation of the lymph node areas. The median age of the patients was 80 years (range: 60–85 years) with performance status 2 in 27 cases (89%). Only one patient had metastatic disease (3%), one patient presented locally advanced and 28 (94%) patients had early stage disease. Three patients (10%) were treated in dorsal decubitus according to the “field in the field” technique and 27 patients (90%) in isocentric lateral decubitus, which made it possible to avoid the organs at risk such as the heart (average dose of less than 1 Gy) and the lungs. The early toxicity observed was grade I radio dermatitis in 8 patients (27%). No grade 2 and 3 toxicity, as well as radiation-induced pain or lymphedema were observed.ConclusionsThe results of this series of patients treated with hypofractionated radiotherapy according to the Fast Forward protocol on the breast alone with adapted techniques show that the protocol is feasible, with little early toxicity but a greater follow-up is necessary to assess long-term toxicity.