戊酸雌二醇对大鼠宫腔粘连形成的预防作用观察

目的 探讨雌二醇对大鼠宫腔粘连形成的预防作用及其机制.方法 30只雌性SD大鼠随机均分为5组,采用刮宫加感染双重损伤法制作大鼠宫腔粘连模型,实验处理因素为戊酸雌二醇灌胃.空白对照组(A)大鼠不予造模也不施加雌二醇处理;生理量雌激素组(B)造模但不给予雌二醇;低剂量雌激素组(C)、中剂量雌激素组(D)、高剂量雌激素组(E)于造模后分别给予剂量为0.206、0.514、1.028mg/(kg·d)的戊酸雌二醇灌胃.采用ELISA法测定各组大鼠戊酸雌二醇灌胃前后的血清雌二醇浓度,采用HE染色观察各组大鼠子宫内膜腺体数量,Masson染色计算子宫内膜纤维化面积,并通过免疫组化法检测子宫内膜组织中转化生长因子β(TGF-β)、基质金属蛋白酶9(MMP-9)的表达情况.结果 戊酸雌二醇灌胃后,C、D、E组血清雌二醇水平较A、B组明显增高(P＜0.05);随着灌胃戊酸雌二醇量增加,血清雌二醇水平也升高,差异有统计学意义(P＜0.05).与B组相比,C、D、E组子宫内膜腺体数目明显增多,纤维化面积比降低(P＜0.05),但D、E组间比较差异无统计学意义.与B组比较,C、D、E组子宫内膜TGF-β表达明显降低(P＜0.05),MMP-9表达明显升高(p＜0.05),但D、E组间差异无统计学意义.结论 雌二醇可减轻子宫内膜损伤后宫腔粘连的形成,在一定范围内随着雌二醇量的增加改善作用会更加明显.     

子宫内膜血流灌注在评价子宫内膜容受性中的作用

目的 探讨超声检测的子宫及内膜血流指标在评价子宫内膜容受性中的价值.资料与方法 不孕组21例,对照组18例.自然月经周期中,黄体生成素峰出现日(LH d),超声观察子宫内膜回声类型,检测双层子宫内膜厚度、子宫动脉收缩期峰值血流速度(PSV)、阻力指数(RI);能量多普勒超声检测子宫内膜血流灌注情况并分为A、B、C型;扫描电镜观察(LH+3)～(LH+9)d子宫内膜胞饮突的发育.结果 不孕组与对照组子宫内膜厚度(t=-0.768,P=0.447)、回声类型分布(Z=-0.203,P=0.839)以及子宫动脉PSV(t=-0.947,P=0.349)、RI(t=0.591,P=0.557)差异均无统计学意义;能量多普勒超声检测两组子宫内膜血流灌注分型差异有统计学意义(Z=-2.272,P=0.023);完全发育的胞饮突出现在“种植窗”期,A、B、C型内膜血流灌注组完全发育的胞饮突数量差异有统计学意义(x2=6.785,P=0.034),两者呈负相关(r=-0.672,P=0.004).结论 临近“种植窗”期,子宫内膜从血流灌注水平、超微结构的胞饮突数量上呈相关性变化,提示能量多普勒超声检测的子宫内膜血流灌注状态指标可作为胞饮突的替代性指标,用以评价子宫内膜容受性.     

子宫内膜修整术后超排卵周期着床窗期子宫内膜基因表达谱

目的运用基因芯片技术探讨子宫内膜修整术改善子宫内膜容受性的机理,试图为子宫内膜修整术合理运用于临床提供可能的理论依据。方法根据纳入标准选取3例患者做为研究对象进行自身对照研究：①在自然周期的LH＋7日行子宫内膜微活检术;②子宫内膜修整术：A组和B组分别在超促排卵周期的D5天和D10天行子宫内膜修整术,C组做为对照组不行子宫内膜修整术;③各组在超排卵周期的HCG＋5天行子宫内膜微活检术;④所获得的全部标本送至专业的基因公司做基因芯片检测,并协助分析实验数据。结果①各组在自然周期着床期基因表达谱无明显差异性表达;②子宫内膜修整术A组和B组的自然周期与超排卵周期着床期基因表达谱无差异性表达,C组自然周期与超排卵周期着床期基因表达谱有显著差异;③未行子宫内膜修整术C组与D5天和D10天行子宫内膜修整术后超排卵周期HCG＋5天的基因表达谱有差异性。结论子宫内膜修整术可能通过改变某些基因的表达如整合素α6（integrin）基因,纠正高剂量雌孕激素对子宫内膜容受性的负面影响,使发育较自然周期提前的子宫内膜形态学表达延迟,使胚胎与子宫内膜发育同步。     

盐酸二甲双胍治疗多囊卵巢综合征对排卵和子宫内膜容受性的影响

目的 分析盐酸二甲双胍治疗多囊卵巢综合征对排卵和子宫内膜容受性的影响。方法对2012年6月~2014年3月来我院就诊的49例多囊卵巢综合征患者进行回顾性分析并将其作为观察组，本组患者均伴有胰岛素抵抗；选取同期来我院就诊的49例多囊卵巢综合征患者作为对照组，本组患者均有自发排卵。观察组口服盐酸二甲双胍治疗，对照组不服用任何药物。比较两组间质、腺体整合素αv、β3的表达及PR、ER、AR表达。结果多囊卵巢综合征患者用药后总排卵率为29.23%，观察组排卵前内膜厚度与对照组比较明显较高，两组有显著性差异（P＜0.05）。观察组间质、腺体整合素αv、β3的表达与对照组比较均明显较高，PR、ER、AR的表达与对照组比较均明显较低，两组有显著性差异（P＜0.05）。结论盐酸二甲双胍治疗多囊卵巢综合征可以提高排卵率，使子宫内膜厚度增加，子宫内膜容受性也得到明显改善。     

兔子宫内膜VX2肿瘤的建立及介入治疗的研究

目的 制作兔子宫内膜VX2肿瘤模型并探讨其在介入放射学研究中的应用价值.材料与方法 新西兰大白兔30只采用宫腔内瘤块置入法建立肿瘤模型,分为实验A 组(n=10)、B 组(n=10)及C 组(n=10),经右侧颈动脉用3F导管选择插至子宫动脉内分别注入顺铂(0.5 mg/kg)、聚乙烯醇(PVA)颗粒及生理盐水(1 ml/kg),分别于种植后2周和介入治疗后1周行MRI平扫及增强扫描观察肿瘤生长及坏死情况,处死观察其肿瘤大体外观并行病理学检查.结果 30只大白兔种植2周后经过MRI检测证实子宫均有肿瘤生长,种植成瘤率100%.在行介入治疗时有2只死于出血,1只死于术后感染.MRI平扫表现为子宫腔内占位性病变,呈类圆形或分叶状等信号肿块,增强扫描呈中等或明显不均匀强化,或呈边缘强化;血管造影示动脉期子宫动脉增粗,实质期肿瘤染色明显.A组和B组肿瘤治疗前后大小之间无统计学意义(P＞0.05),C组治疗前后及C组与A、B组治疗后大小与坏死百分比之间的差异具有统计学意义(P＜0.05).兔子宫病理切片HE染色示兔子宫内膜腺体下鳞癌组织浸润.结论 兔子宫内膜VX2肿瘤模型建立容易,成功率高,适合介入治疗,是一种较好的研究兔子宫内膜肿瘤的介入治疗模型.MRI能对兔子宫内膜VX2肿瘤进行动态观察,其表现具有一定特征性.     

宫腔粘连分离术后预防再粘连方法分析

目的探讨宫腔粘连分离术后预防再粘连的方法及联合应用的临床效果。方法回顾性分析自2010年6月至2015年6月于中国医科大学附属盛京医院妇产科住院手术的201例宫腔粘连患者的临床资料。根据预防再粘连方法不同分为3组:A组患者术后宫腔留置球囊导尿管+几丁糖,B组患者宫腔单留置球囊导尿管,C组患者宫腔单留置几丁糖,每组患者各67例,术后均使用人工周期治疗促进子宫内膜生长。比较3组患者术后的月经情况、宫腔形态、妊娠情况、子宫内膜厚度等。结果在宫腔形态方面,A组患者术后的治愈率及有效率均高于B组及C组,差异均有统计学意义(P<0.05);在月经恢复方面,A组患者的临床有效率(90.3%)高于B组(72.4%)及C组(76.3%),差异均有统计学意义(P<0.05);在术后妊娠方面,3组妊娠率差异无统计学意义(P>0.05)。3组患者术后3个月、术后6个月子宫内膜厚度与本组术前比较,差异均有统计学意义(P<0.01);但3组同一时期组间比较,差异均无统计学意义(P>0.05)。结论宫腔粘连分离术后联合使用球囊导尿管及医用几丁糖预防宫腔再粘连的临床效果优于单使用球囊导尿管或医用几丁糖,值得临床推广应用。     

子宫结合带与宫腔粘连预后的初步研究

目的 探讨宫腔粘连(IUAs)患者子宫结合带(JZ)损伤程度对术后妊娠结局的影响.方法 回顾性分析2011年7月-2014年7月于海军总医院住院行子宫MRI及超声引导下宫腔粘连松解术,术后试孕时间超过6个月,符合入组标准的92例IUAs患者的临床资料.根据MRI子宫JZ是否受损将IUAs分为A组(JZ正常组)、B组(JZ损伤组),2015年8月电话随访所有IUAs患者的妊娠情况,比较两组重度IUAs所占比例、妊娠率、活产率及妊娠丢失率之间的差异.结果 A、B组分别有51、41例IUAs,按照1995年欧洲腔镜协会宫腔粘连分类标准,A组轻、中、重度IUAs分别为20、24、7例,B组分别为10、12、19例,B组重度IUAs所占比例明显高于A组(P=0.001).所有IUAs患者中有46例妊娠,妊娠率为50％(46/92).其中4例IUAs术后妊娠2次,21例顺利分娩(其一为双胎分娩),抱婴率为42％(21/50),妊娠丢失率为38％(19/50),10例正处于妊娠期.A、B组妊娠人数(妊娠次数)分别为31例(34次)和15例(16次),妊娠率分别为60.8％和36.6％,差异有统计学意义(P=0.021);抱婴率分别为47.1％和31.3％,妊娠丢失率分别为29.4％和56.3％,差异均无统计学意义(P=0.365,P=0.117).B组中8例JZ完全不清,JZ不可辨认,宫腔镜下为V级IUA,术后无1例怀孕.结论 子宫JZ损伤越重,IUA程度可能越重,妊娠率及抱婴率下降,孕期妊娠丢失率增加..JZ损伤程度是评估IUA严重程度及术后妊娠结局的新视角,可作为一项独立指标用以评估IUA严重程度及术后生殖预后,尤其对于重度IUAs,JZ严重损伤者,术后妊娠结局极差.     

皮下移植和皮下注射构建子宫内膜异位症皮下模型的比较研究

目的 比较皮下移植和皮下注射两种方法建立裸鼠人子宫内膜异位症模型的效果及血管新生相关因子表达的差异.方法 雌性BALB/c裸鼠41只,随机分为皮下移植组(A组,n=22)和皮下注射组(B组,n＝19),分别采用皮下移植人子宫内膜块和皮下注射人子宫内膜碎屑的方式建模.每组又分为2、4周两个亚组,即A1、A2组和B1、B2组.采用SP法检测异位病灶血管内皮生长因子(VEGF)表达和微血管密度(MVD),并比较组间的异位病灶的体积和重量.结果 在相同时间点(2周或4周),两组异位病灶体积差异无统计学意义(P>0.05),A组异位病灶重量较B组明显增加(P<0.05),而两组病灶腺体和间质中VEGF表达、MVD差异无统计学意义(P>0.05).两组在2周时病灶腺体中VEGF表达及MVD均明显高于4周时(P<0.05).结论 两种方法均可成功构建裸鼠人子宫内膜异位症模型,并可观察血管新生情况,以皮下移植造模效果较好.     

整合素α6在子宫内膜异位症中的表达分析

目的分析子宫内膜异位症(EMS)患者在位和异位内膜组织中整合素α6的表达和分布,初步探讨其在子宫内膜异位症发生中的意义。方法收集EMS患者的子宫内膜(15例)、异位病灶组织(14例),并以正常子宫内膜组织(12例)作为对照组。采用RT PCR、Westernblot和免疫组织化学等方法,对整合素α6在这些组织中的分布和表达进行分析。另取21例新鲜组织(EMS患者的在位内膜9例,异位病灶组织6例,正常子宫内膜6例)进行流式细胞分析。结果对照组在位内膜和EMS患者同期在位内膜的整合素α6分子的表达无显著性差异;EMS患者异位病灶组织的整合素α6分子表达较在位内膜明显降低(P<0.01);异位组织的整合素α6分子表达较对照组明显降低(P<0.01)。结论整合素α6在异位子宫内膜组织中的表达下调可能与EMS的发生发展有关。     

脐带血干细胞移植对兔糖尿病后肢血管病变介入术后支架内再狭窄的影响

目的 观察脐带血干细胞移植对糖尿病实验兔后肢血管病变血管内介入术后支架内再狭窄的影响.方法 制备糖尿病后肢血管病变兔模型22只,随机分成A组(n=8,介入术联合脐带血干细胞移植)、B组(n=8,单纯介入术)、C组(n=6,未治疗干预)、D组(n=6,未制模,为正常对照).采用酶联免疫吸附试验分别测定血清血管内皮钙黏蛋白(VE-cadherin)和血浆脂蛋白相关磷脂酶A2(Lp-PLA2)水平,苏木精-伊红染色测定新生内膜面积及内膜面积与中膜面积比值.结果 治疗后A组VE-cadherin和Lp-PLA2水平明显低于B、C组(P均＜0.01),与D组比较差异无统计学意义(P＞0.05).A组兔股动脉有轻度内膜中断和增生,弹力膜轻度断裂;A组内膜面积、内膜面积与中膜面积比值均显著小于B、C组(P均＜0.05),与D组比较差异无统计学意义(P＞0.05).结论 脐带血干细胞移植可有效保护血管内介入术后血管内皮损伤,预防术后支架内再狭窄.     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.