来曲唑对多囊卵巢综合征患者性激素结合球蛋白水平及糖脂代谢指标的影响

目的探究来曲唑(LE)对多囊卵巢综合征(PCOS)患者性激素结合球蛋白(SHBG)水平及糖脂代谢指标的影响。方法选取2016年6月至2019年6月本院诊治的80例PCOS患者为研究对象。根据非随机临床同期对照研究及患者自愿原则分为观察组、对照组,每组40例,对照组患者口服枸橼酸氯米芬片(初始剂量50 mg/d,无排卵反应后增至100mg/d)治疗,观察组给予LE(月经第5天口服LE,5 mg/d)治疗,两组均持续给药5 d,比较治疗前、疗程结束后两组糖脂代谢指标[总胆固醇(TC)、低密度脂蛋白(LDLC)、三酰甘油(TG)及空腹胰岛素(INS)、胰岛素抵抗指数(HOMA-IR)]、SHBG水平、性激素[卵泡生成素(FSH)、黄体生成素(LH)、雌二醇(E2)、睾酮(T)]水平、排卵、妊娠情况及药物安全性。结果与同组治疗前比较,疗程结束后两组TC、LDLC、TG、INS、HOMA-IR明显降低(P<0.05),且观察组INS、HOMA-IR明显低于对照组(P<0.05),与同组治疗前比较,疗程结束后两组SHBG、FSH明显升高、LH、E2、T明显降低,且观察组SHBG、FSH相较于对照组显著升高、LH、E2、T显著降低(P<0.05),观察组周期排卵率、临床妊娠率明显高于对照组(χ^2=4.228、4.073,P<0.05),观察组不良反应总发生率与对照组比较差异无统计学意义(P>0.05)。结论LE治疗PCOS患者的促排卵效果显著,可明显降低SHBG水平、调节性激素水平并提高临床妊娠率,而促排卵治疗前需指导应用抗雄激素药物、胰岛素增敏剂以有效调节患者的糖脂代谢指标。     

Split liver transplantation is utilized infrequently and concentrated at few transplant centers in the United States

Split liver transplantation (SLT) is 1 strategy for maximizing the number of deceased donor liver transplants. Recent reports suggest that utilization of SLT in the United States remains low. We examined deceased donor offers that were ultimately split between 2010 and 2014. SLTs were categorized as “primary” and “secondary” transplants. We analyzed allocation patterns and used logistic regression to evaluate factors associated with secondary split discard. Four hundred eighteen livers were split: 54% from adult, 46% from pediatric donors. Of the 227 adult donor livers split, 61% met United Network for Organ Sharing “optimal” split criteria. A total of 770 recipients (418 primary and 352 secondary) were transplanted, indicating 16% discard. Ninety‐two percent of the 418 primary recipients were children, and 47% were accepted on the first offer. Eighty‐seven percent of the 352 secondary recipients were adults, and 7% were accepted on the first offer. Of the 352 pairs, 99% were transplanted in the same region, 36% at the same center. In logistic regression, shorter donor height was associated with secondary discard (odds ratio 0.97 per cm, 95% CI 0.94‐1.00, P = .02). SLT volume by center was not predictive of secondary discard. Current policy proposals that incentivize SLT in the United States could increase the number of transplants to children and adults.     

The capability of detecting small vessels beyond the conventional MRI sensitivity using iron‐based contrast agent enhanced susceptibility weighted imaging

Imaging brain microvasculature is important in cerebrovascular diseases. However, there is still a lack of non‐invasive, non‐radiation, and whole‐body imaging techniques to investigate them. The aim of this study is to develop an ultra‐small superparamagnetic iron oxide (USPIO) enhanced susceptibility weighted imaging (SWI) method for imaging micro‐vasculature in both animal (~10 μm in rat) and human brain. We hypothesized that the USPIO‐SWI technique could improve the detection sensitivity of the diameter of small subpixel vessels 10‐fold compared with conventional MRI methods. Computer simulations were first performed with a double‐cylinder digital model to investigate the theoretical basis for this hypothesis. The theoretical results were verified using in vitro phantom studies and in vivo rat MRI studies (n = 6) with corresponding ex vivo histological examinations. Additionally, in vivo human studies (n = 3) were carried out to demonstrate the translational power of the USPIO‐SWI method. By directly comparing the small vessel diameters of an in vivo rat using USPIO‐SWI with the small vessel diameters of the corresponding histological slide using laser scanning confocal microscopy, 13.3‐fold and 19.9‐fold increases in SWI apparent diameter were obtained with 5.6 mg Fe/kg and 16.8 mg Fe/kg ferumoxytol, respectively. The USPIO‐SWI method exhibited its excellent ability to detect small vessels down to about 10 μm diameter in rat brain. The in vivo human study unveiled hidden arterioles and venules and demonstrated its potential in clinical practice. Theoretical modeling simulations and in vitro phantom studies also confirmed a more than 10‐fold increase in the USPIO‐SWI apparent diameter compared with the actual small vessel diameter size. It is feasible to use SWI blooming effects induced by USPIO to detect small vessels (down to 10 μm in diameter for rat brain), well beyond the spatial resolution limit of conventional MRI methods. The USPIO‐SWI method demonstrates higher potential in cerebrovascular disease investigations.     

Reconstruction for axillary hidradenitis suppurativa using one‐stage local tissue rearrangement: A retrospective analysis of 53 cases

Wide local excision offers a potential cure for severe axillary hidradenitis suppurativa. However, the gold standard for reconstruction has yet to be defined. Here, we describe our rotation advancement flap technique, which allows for one‐stage closure of large axillary defects, with minimal functional morbidity to the axilla. We performed a retrospective review of all patients who underwent one‐stage surgical management for axillary hidradenitis suppurativa at a single‐centre tertiary care hospital from 2009 to 2018. We identified 34 patients, with a total of 53 operative sites. The majority were female (85%) with a mean age of 31 years and body mass index 35 kg/m². The median defect size was 84 cm² and the majority were treated using the rotation advancement flap technique (86%). A quarter of operative sites experienced minor complications with only one requiring re‐operation. At a median follow‐up of 32 months, two (4%) sites showed decreased range of motion. However, all patients had achieved remission without any further recurrence of disease. We describe a one‐stage rotation advancement flap technique for management of moderate to severe hidradenitis suppurativa that achieves a high local cure rate, minimal functional morbidity, and acceptable wound complication rates.     

CT测量成人寰枢椎后方部分结构数据设计寰枢椎板间融合器

文题释义： 寰枢椎脱位：可分为可复性、难复性和不可复性脱位3种类型，其可导致C_1/2水平脊髓压迫而造成神经功能障碍症状，临床上多需要进行手术治疗，后路钉棒固定融合术是最常用的手术方式。 寰枢椎板间融合器：与寰枢椎侧块关节融合器不同，其直接固定在寰椎后弓与枢椎椎板骨面上，是一种新型融合器，此融合器可配合广泛使用的后路钉棒内固定手术，置入简便，增加植骨与寰椎后弓及枢椎椎板骨面的接触应力，促进骨性融合。 背景：寰枢椎融合器一直以侧块关节融合器为研究热点，但其置入操作风险过大，目前临床上一直缺乏可广泛应用的寰枢椎融合器。 目的：探究成人后路寰枢椎板间融合器的CT影像解剖学可行性并给出初步设计。 方法：对100例成人(男50例，女50例)寰枢椎CT三维成像进行测量，测量指标包括寰椎单侧后弓长度、寰椎后弓厚度、枢椎单侧椎板长度、枢椎椎板厚度、寰椎后弓上缘至枢椎椎板下缘距离，分析寰枢椎后方部分结构的CT测量数据并设计寰枢椎板间融合器。 结果与结论：①男、女性的寰椎单侧后弓长度分别为(23.41±1.48) mm和(22.23±1.25) mm，寰椎后弓厚度分别为(6.00±0.96) mm和(5.28±0.78) mm，枢椎单侧椎板长度分别为(18.54±2.23 )mm和(17.31±0.91) mm，枢椎椎板厚度分别为(5.12±1.31) mm和(4.98±1.26) mm，寰椎后弓上缘至枢椎椎板下缘距离分别为(32.63±2.76) mm和(31.39±4.04) mm；②不同性别的双侧测量数据差异无显著性意义(P > 0.05)；男性的寰椎单侧后弓长度、寰椎后弓厚度、枢椎单侧椎板长度大于女性，差异有显著性意义(P < 0.05)；男性与女性的枢椎椎板厚度、椎后弓上缘至枢椎椎板下缘距离差异无显著性意义(P > 0.05)；③寰枢椎后方部分结构的CT测量结果提示寰枢椎板间融合器是可行的；④寰枢椎板间融合器初步设计成功，并获得国家专利；⑤提示寰枢椎板间融合器具有应用可行性，可用于寰枢椎后路钉棒固定融合过程中，提升寰枢椎间的植骨融合率。 ORCID: 0000-0002-2101-1900(邹小宝)中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程     

Electrical resonance with voltage-gated ion channels: perspectives from biophysical mechanisms and neural electrophysiology

Electrical resonance, providing selective signal amplification at preferred frequencies, is a unique phenomenon of excitable membranes, which has been observed in the nervous system at the cellular, circuit and system levels. The mechanisms underlying electrical resonance have not been fully elucidated. Prevailing hypotheses attribute the resonance to voltage-gated ion channels on the membrane of single neurons. In this review, we follow this line of thinking to summarize and analyze the biophysical/molecular mechanisms, and also the physiological relevance of channel-mediated electrical resonance.     

调整Kappa角及光学切削直径对准分子激光原位角膜磨镶术后的影响

目的　评价调整光学切削直径及Kappa角后对准分子激光原位角膜磨镶术（laser in situ keratomileusis，LASIK）后效果的影响。方法　选取2017年1月至12月在我院行LASIK手术的高度近视患者313例（626眼），根据切削直径分成两组，试验组157例314眼，切削直径设定为6.0 mm，对照组156例312眼，切削直径设定为6.5 mm。试验组患者激光切削前修正Kappa角，对照组不做修正。患者术前进行裸眼视力、主视眼确定、验光、眼压、暗室下瞳孔直径、泪液分泌试验、裂隙灯、散瞳验光、眼底检查、pentacam测量角膜厚度、角膜地形图测量角膜前后表面及Kappa角等检查。术后1 d、1周、1个月随访，并检查裸眼视力、角膜厚度、波前像差及夜间视力、光晕、眩光等情况。比较两组患者角膜厚度变化、手术所用时间以及两组患者术后的高阶像差的差异。结果　试验组与对照组患者年龄分别为18～44（24.19±5.33）岁、18～42（25.08±4.91）岁，屈光度分别为（-7.47±1.04）D、（-7.61±1.12）D。两组年龄、屈光度比较差异均无统计学意义（均为P>0.05）。试验组与对照组患者术前Kappa角分别为，X轴:（210±40）μm、（200±30）μm，Y轴:（190±30）μm、（220±40）μm，差异无统计学意义（P=0.210）。两组手术前后的角膜厚度及术后角膜基质床的厚度差异均无统计学意义（均为P>0.05）。试验组与对照组的手术时间分别为（15.56±1.89）s和（20.83±3.03）s，差异有统计学意义（P=0.000）。试验组的总高阶像差和垂直慧差的变化均明显低于对照组（均为 P<0.01），但两组间的水平慧差差异无统计学意义（P>0.05），对照组的球差低于试验组（P<0.01）。结论　LASIK手术中科学合理地调整Kappa角可有助于提高患者术后的视觉质量。