术前MRI测量腘绳肌腱横截面积与前交叉韧带重建中移植物的相关性研究

目的:探讨测量MRI腘绳肌腱横截面积在行前交叉韧带重建术前与前交叉韧带重建中移植物的相关性。方法:收集2021年11月至2022年3月在骨关节科拟行前交叉韧带重建术的50例患者的MRI资料,男32例,女18例,年龄19～48(31.1±8.7)岁。术前对半腱肌和股薄肌腱进行MRI测量并记录,然后在关节镜下行前交叉韧带重建术,术中取股薄肌腱与半腱肌腱来制备最终所需移植的肌腱,并且在术中测量已制备好的最终移植物的直径。最后使用统计学软件分析得到数据。结果:MRI测量半腱肌肌腱横截面积、股薄肌肌腱横截面积、半腱肌肌腱与股薄肌肌腱横截面积之和与前交叉韧带术中所需移植物的直径大小呈显著正相关,r值分别为0.858、0.728、0.842(P<0.001),半腱肌肌腱与股薄肌肌腱横截面积之和的曲线下面积(area uder curve,AUC)、灵敏度、和特异性分别为0.925、90.48%、85.71%。结论:在进行前交叉韧带重建术的患者中,术前MRI测量与术中腘绳肌移植直径大小有具有较强的统计学相关性,半腱肌肌腱与股薄肌肌腱横截面积之和对于前交叉韧带重建术中移植物的直径大小有较高的预测价...     

FMR1基因突变与女性生殖能力和妊娠结局

近年来原发性卵巢功能不全（primary ovarian insufficiency,POI）、不明原因的早期自然流产、复发性流产、胚胎停育等生育能力低下和反复生育失败的疾病越来越多,女性生殖健康也日益受到关注。脆性X智力低下1（fragile X mental retardation 1,FMR1）基因参与胚胎发育的基因调控过程,该基因的突变可引起多种女性生殖健康疾病,且与绝经年龄相关。因此FMR1基因的筛查对协助诊疗女性生殖健康疾病有重要的临床价值,也为疾病的早期预防、诊断和治疗提供了新思路。     

长链的非编码RNA生长停滞特异性转录本5在骨关节炎中的研究进展

骨关节炎（OA）是一种以软骨退变、骨重建为主要病理特点的慢性关节疾病。目前没有可治愈该疾病的药物及手段,治疗策略有限的根本原因是对其潜在发病机制的认识不足。长链的非编码RNA(LncRNAs)被认为是许多疾病中的一类新的调控因子,是目前研究OA发病机制的一个重要切入点。LncRNA生长停滞特异性转录本5(Cas5)参与调控细胞的增殖、分化及凋亡,是一种在软骨细胞中特异性高表达的LncRNA。然而,由于LncRNA Cas5作用机制复杂,其与OA相关具体分子机制目前仍不明确。该文针对LncRNA Cas5在OA中的软骨细胞凋亡、软骨基质代谢成骨分化及治疗方面的作用进行综述。     

十二指肠乳头括约肌切开后球囊扩张术和乳头括约肌切开术治疗巨大胆总管结石效果比较的Meta分析

目的评价两种手术方式十二指肠乳头括约肌切开术(EST)和十二指肠乳头括约肌切开后球囊扩张术(ESBD)处理巨大胆总管结石的疗效差异。方法计算机检索至2019年7月8日的Pubmed、Cochrane Central、Embase等外文数据库及中国知网、万方等中文数据库中的文献,同时检索相关会议论文等,纳入ESBD vs EST治疗巨大胆总管结石的随机对照试验(RCT),提取相关数据,采用RevMan5.3软件进行分析。结果共纳入13项RCT,共计1926例患者,其中ESBD组973例,EST组953例。Meta分析结果显示:ESBD组和EST组结石清除率[比值比(OR)=1.53,95%可信区间(95%CI):1.03~2.29,P=0.04]、一次清除率(OR=1.77,95%CI:1.06~2.93,P=0.03)、机械碎石率(OR=0.40,95%CI:0.25~0.63,P<0.0001)、出血率(OR=0.23,95%CI:0.11~0.50,P<0.001)、胆管炎发生率(OR=0.31,95%CI:0.12~0.78,P=0.01)、早期并发症(OR=0.59,95%CI:0.42~0.84,P=0.003)、手术时间(MD=-8.89,95%CI:-17.56^-0.22,P=0.04)比较,差异均有统计学意义;但在穿孔(OR=0.27,95%CI:0.05~1.30,P=0.10)、内镜后胰腺炎(OR=1.03,95%CI:0.66~1.61,P=0.91)方面二者结果相似。结论在内镜下处理巨大胆总管结石中,ESBD在结石清除率、机械碎石率、出血率、胆管炎发生率、手术时间方面比EST更有优势。     

Does follicular flushing increase oocyte number in poor responders? An update of a systematic review

Research questionDoes flushing of the follicles at ovum retrieval increase the number of retrieved oocytes in poor-response IVF patients?DesignAn update of an electronic literature search was performed to identify randomized controlled trials (RCT) investigating follicular flushing versus no flushing in women with a poor response to IVF treatment. No exclusion criteria for type of needle, stimulation or protocol were applied. A meta-analysis was conducted using the software RevMan 5.4.ResultsSix RCT were identified that had the primary objective of testing for an increase in mean number of cumulus–oocyte complexes or/and metaphase II oocytes between flushing and no flushing. A double-lumen needle was used in five trials, one study investigated a pseudo-double-lumen needle, and a conventional single-lumen needle was used in all the control groups. The main risk of bias in all the included studies is a lack of blinding of the physicians performing the puncture and incomplete data in four trials. A heterogeneity of direction and size of effect of follicular flushing on mean oocyte number retrieved was detected (I² = 80, P = 0.0001), which precludes a synthesis of the data. Two studies showed a decrease or tendency towards a decrease in oocyte numbers, one study showed similar oocyte numbers, and one study showed a strong tendency towards increased oocyte numbers with flushing. A similar picture was seen for metaphase II oocytes (I² = 73, P = 0.002).ConclusionsIt is uncertain whether follicular flushing in poor-response IVF patients affects the number of retrieved oocytes. Larger pragmatic trials are warranted to clarify the effect of flushing on oocyte numbers and clinical outcomes in poor responders and monofollicular patients.     

人成骨细胞与复合型多孔生物支架降解产物的相容性

背景：以Ⅰ型胶原蛋白改性多孔硫酸钙生物支架在体内的降解过程尚不明确,其降解产物对人成骨细胞的影响国内外也缺少相关研究。目的：观察人成骨细胞与硫酸钙/胶原膜复合型多孔生物支架降解产物的生物相容性。方法：将第2代人成骨细胞分别置于硫酸钙/胶原膜复合型多孔生物支架降解产物浸提液及含体积分数10%新生牛血清DMEM培养液中培养,培养第1,3,5,7天以MTT法检测两组细胞增殖曲线,联合会推荐法测定细胞碱性磷酸酶活性,考马氏亮蓝微板法测定总蛋白。结果与结论：在硫酸钙/胶原膜复合型多孔生物支架降解产物浸提液中培养人成骨细胞的增殖速度略高于在含体积分数10%新生牛血清DMEM培养液中培养的细胞,但差异无显著性意义（P〉0.05）。两组碱性磷酸酶活性、总蛋白合成及碱性磷酸酶/总蛋白都随时间递增而增加,两组不同时间点上述指标差异均无显著性意义（P〉0.05）。表明硫酸钙/胶原膜复合型多孔生物支架降解产物既不影响人成骨细胞的增殖生长,也不影响其正常生理功能,具有较好的生物相容性。     

A 10-year follow-up study on suicidal mortality after 1999 Taiwan earthquake

ObjectiveThe long-term impact of natural disasters on suicide in general population and survivors remains uncertain. The present report examined the direction and the length of the influence of an earthquake over suicide across age groups.MethodWe used an interrupted time-series design with non-equivalent no-treatment group to evaluate post-earthquake changes in suicide rates by the standardized mortality ratio.ResultsThe time trend changes in suicide rates before and after the earthquake were similar for males and females but different between senior and junior age groups. Gender-specific relative ratios were 0.85 (95%CI: 0.81–0.90) for males and 0.79 (95% CI: 0.72–0.86) for females. Age-gender-stratified relative ratios were 0.61 (95% CI: 0.53–0.70) and 0.69 (95% CI: 0.64–0.75) for males and females aged less than 45 years, respectively. Although the overall suicide mortality increased after the earthquake, the relative suicide risk ratio decreased 31–39% for those aged less than 45 years, which persisted for nearly 10 years after earthquake.ConclusionOur study demonstrated that a severe earthquake resulted in a significant decrease in standardized suicide mortality ratios in exposed areas for 10 years compared to unexposed area, particularly in a younger population.     

The effect of adenomyosis types on clinical outcomes of IVF embryo transfer after ultra-long GnRH agonist protocol

Research questionWhat is the effect of adenomyosis types on IVF and embryo transfer (IVF-ET) after ultra-long gonadotrophin-releasing hormone (GnRH) agonist protocol?DesignPatients who underwent the first cycle of IVF-ET with ultra-long GnRH agonist protocol were included in this retrospective cohort study. They were divided into three groups: (A) 428 patients with diffuse adenomyosis; (B) 718 patients with focal adenomyosis; and (C) 519 patients with tubal infertility. Reproduction outcomes were analysed.ResultsLogistic regression analysis revealed that, compared with focal adenomyosis and tubal infertility, diffuse adenomyosis was negatively associated with clinical pregnancy and live birth (clinical pregnancy: A versus B: OR 0.708, 95% CI 0.539 to 0.931, P = 0.013; A versus C: OR 0.663, 95% CI 0.489 to 0.899, P = 0.008; live birth: A versus B: OR 0.530, 95% CI 0.385 to 0.730, P < 0.001; A versus C: OR 0.441, 95% CI 0.313 to 0.623, P < 0.001), but positively associated with miscarriage (A versus B: OR 1.727, 95% CI 1.056 to 2.825, P = 0.029; A versus C: OR 2.549, 95% CI 1.278 to 5.082, P = 0.008). Compared with patients with tubal infertility, focal adenomyosis was also a risk factor for miscarriage (B versus C: OR 1.825, 95% CI 1.112 to 2.995, P = 0.017).ConclusionsCompared with patients with focal adenomyosis or tubal infertility, the reproduction outcomes of IVF-ET in patients with diffuse adenomyosis seems to be worse.     

晚期非小细胞肺癌EGFR-TP53共突变的研究进展

随着二代基因检测（next generation sequencing, NGS）技术的快速发展及广泛应用，多种共突变基因被我们发现。许多研究表明，共突变在表皮生长因子受体（epidermal growth factor receptor, EGFR）突变型非小细胞肺癌（non-small cell lung cancer, NSCLC）中对EGFR酪氨酸激酶抑制剂（EGFR tyrosine kinase inhibitor, EGFR-TKI）的反应和耐药起着重要作用。其中，TP53作为EGFR突变型NSCLC最常见的共突变基因，已被证明是一代、二代及三代EGFR-TKIs治疗预后差的重要因素，如何为EGFR-TP53共突变的晚期NSCLC患者选择最佳的治疗策略，目前仍在探索中。本文就近年来关于晚期NSCLC患者EGFR-TP53共突变的研究进展作一综述。     

Accelerated leukocyte telomere erosion in schizophrenia: Evidence from the present study and a meta-analysis

Human telomeres consist of tandem nucleotide repeats (TTAGGG) and associated proteins, and telomere length (TL) is reduced progressively with cell division over the lifespan. Telomere erosion might be accelerated or prevented to varying degrees when exposure to serious medical illnesses. In previous studies, an association between TL decrease and schizophrenia has been extensively reported; however, the results remain largely controversial. To further investigate TL in schizophrenia patients and reconcile this controversy, we first measured leucocyte TL (LTL) in our samples (52 paranoid schizophrenia, 89 non-paranoid patients and 120 controls), and then conducted a comprehensive meta-analysis of the existing results of LTL in patients of schizophrenia compared to healthy subjects. Totally, 11 studies encompassing 1243 patients of schizophrenia and 1274 controls were included in the final meta-analysis model. In our samples, significant reduction of LTL in paranoid schizophrenia was observed compared to controls (F = 50.88, P < 0.001); whereas there was no significant difference in LTL between non-paranoid schizophrenia and controls (F = 0.842, P = 0.360). For meta-analysis, random-effects model showed significant LTL decrease in patients of schizophrenia when compared to controls (Z = 2.07, P = 0.039, SMD = −0.48, 95% CI = −0.94 to −0.03). Moreover, a marginal decrease in LTL was observed in medicated patients (Z = 1.92, P = 0.055, SMD = −0.58, 95% CI = −1.18–0.01) and those patients with poor response to antipsychotics (Z = 1.76, P = 0.078, SMD = −0.60, 95% CI = −1.27–0.07). In conclusion, we observed significant reduction of LTL in individuals with schizophrenia compared with controls. However, all the studies included in the meta-analysis were cross-sectional, and better controlled long-term studies are needed to replicate this result.