Expression of the Cell Cycle Inhibitor p27KIP1 Is a New Prognostic Marker Associated with Survival in Epithelial Ovarian Tumors

This case-control study was designed to identify factors associated with long-term survival. We examined two groups of patients with epithelial ovarian cancer, one group of long-term survivors (>5 years) and one group of short-term survivors (<2 years), for levels of expression of p53 and p27^KIP1 proteins (as both proteins have been shown to be independent prognostic markers in tumors other than ovary) and the relationship with patient survival. Our findings show that p27^KIP1 expression, in contrast to p53 expression, is positively associated with long-term survival in univariate analysis (P = 0.001), in analyses stratified by residual disease (P = 0.02) or performance status (P = 0.02), the two strongest prognostic factors for ovarian cancer, as well as multivariate analysis (P = 0.002) adjusting simultaneously for age, tumor stage, residual disease, performance status, and grade of differentiation. Therefore, immunostaining for levels of p27^KIP1 expression may have potential as a new prognostic factor in the management of ovarian cancer.     

卵巢早衰

目的：探讨卵巢早衰（Premature ovarian failure,POF）的病因及诊断和治疗的方法。方法：查阅文献,进行综述。结果：转发性POF占81％,其他类型POF可能病因为遗传因素、免疫因素、促性腺激素及其受体异常、代谢异常等。POF的诊断根据临床表现及实验室检查确定。待确诊后给予相应治疗。结论：应该规范的诊断并进行个体化治疗。     

Factors associated with delivery complications in rural Bangladesh

Objectives There are only a few studies on maternal morbidity, delivery complications and maternal mortality in Bangladesh. This study analyzes data from a follow-up study conducted by the Bangladesh Institute of Research for Health and Technologies (BIRPERHT) on maternal morbidity in rural Bangladesh in 1993. Methods A total of 1020 pregnant women were interviewed in the follow-up component of the study. The survey collected information on socioeconomic and demographic characteristics, pregnancy-related care and practice, morbidity during the period of follow-up as well as in the past, information concerning complications at the time of delivery and during the postpartum period. For the purpose of this study, we selected 993 pregnant women with at least one antenatal follow-up. Both bivariate and multivariate analyses were conducted to identify the potential risk factors for complication during delivery and duration of labor. Results and conclusions It appears that complications during the antenatal period can result in various complications at the time of delivery. Some of the important findings are: hemorrhage during the antenatal period increases the risk of excessive hemorrhage during delivery, the risk of obstructed labor increases significantly if abdominal pain is observed during the antenatal period, prolonged labor appears to be significantly higher for the first pregnancy, and pregnancies suffering from abdominal pain during pregnancy tend to have a higher risk of prolonged labor during delivery. The duration of labor appears to be negatively associated with the number of previous pregnancies, being longest for the first pregnancies. The duration of labor pain is significantly higher for the respondents who reported the index pregnancy as undesired, and, similarly, the respondents who were reported to be involved with gainful employment would have a shorter duration of labor pain than those having no involvement with gainful employment.     

经尿道前列腺电气化术结合电切术治疗前列腺增生83例分析

目的：探讨经尿道前列腺电气化术结合电切术治疗前列腺增生（BPH）并提高其安全性及有效性。方法：使用德国WOLF F24连续冲洗气化电切镜对83例BPH患者进行了经尿道前列腺电气化术加电切术治疗。结果：平均手术时间69min,无尿失禁和死亡病例,术后随访3～36个月,国际前列腺症状评分平均9.4分,残余尿量平均为21.7ml。结论：先用铲状气化切割圈切除增生的大部分前列腺组织,并进行快速、有效的止血,再用电切环修切,可快速切除增生的前列腺组织,安全有效,并发症少,值得广泛推广。     

颅外段椎动脉先天发育异常的超声诊断价值

目的探讨彩色多普勒超声对颅外段椎动脉发育异常的诊断价值及其临床意义。方法对2012年1月至2013年3月来我院疑诊为椎动脉型颈椎病患者进行颅外段椎动脉超声检查,观测椎动脉管腔结构、血管走行、血流信号等变化。其中152例颅外段椎动脉发育异常患者同时进行磁共振血管成像（MRA）或血管造影检查。结果发现236例患者椎动脉发育异常,其中椎动脉发育不良者为114例,椎动脉走行变异者为75例,椎动脉发育不良合并椎动脉走行变异者为47例。其中152例患者同时进行磁共振血管成像（MRA）或血管造影检查,其多普勒超声与MRA或血管造影的诊断结果完全符合。结论彩色多普勒超声能准确、快捷的诊断颅外段椎动脉发育异常,且无创、检查费用较低,具有很高的临床应用价值。     

Peripheral factors in the management of congestive heart failure

Summary Maladaptive changes in the periphery largely account for the symptomatology of patients with congestive heart failure (CHF). A decline in the systolic function of the left ventricle precipitates activation of neural and humoral systems to provide circulatory support. These include sympathetic release of norepinephrine, increases in angiotensin II, elevated levels of circulating arginine vasopressin, and impairment of the counterregulatory function of atrial natriuretic peptide. The resultant circulatory changes are ultimately responsible for the declining function of the peripheral vasculature and skeletal muscles of patients with CHF. In the peripheral vasculature, impaired vasodilatory capacity results from excess vessel wall stiffness, endothelial dysfunction, and structural abnormalities. The skeletal muscles develop poor aerobic capacity as a result of a change in predominant fiber type and excess reliance on glycolytic metabolic pathways. Physical deconditioning induced by symptoms tends to further promote these peripheral changes. Therapeutic interventions with symptomatic and prognostic benefits have essentially been targeted at the periphery. Angiotensin converting enzyme inhibitors may act by normalizing electrolyte and water balance, improving vascular endothelial function, and reversing structural changes in peripheral vessels. Exercise training appears to exert its benefit at the level of the vascular endothelium. Advances in the therapy of CHF depend on a greater understanding of changes in the periphery.     

Diabetic neuropathy: electrophysiologic abnormalities of distal lower extremity sensory nerves

Electrophysiologic parameters of the medial dorsal cutaneous (MDC) and the sural nerves were analyzed in 119 diabetic patients with clinical signs and symptoms of neuropathy. Fifty-five patients were insulin dependent (ID), mean age 47.4, and 64 were non-insulin dependent (NID), mean age 55.2. Using age-adjusted criteria for the sensory nerve action potential (SNAP) amplitude and for conduction velocity (CV), the relative sensitivity of each parameter and the extent of concordance between them within each diabetic group were investigated. In mild neuropathy it was found that: 1) 43% (ID group) and 39% (NID group) had abnormalities of both parameters in both nerves; 2) 10% of MDC nerves and 12% of sural nerves were normal; 3) only 48% of the nerves studied had abnormalities of both parameters; 4) single parameter abnormalities were found with equal frequency. It is concluded that: 1) there is a high degree of concordance between corresponding parameters of the two nerves within each diabetic group; similar abnormalities occur within each group but are manifested at an earlier age in the ID group. 2) In mild diabetic neuropathy, (A) greater than 10% of sensory nerves studied may be normal; (B) less than 50% of nerves studied will have abnormalities of both parameters; (C) since single parameter abnormalities occur with almost equal frequency, both parameters should be taken into account for correct interpretation; (D) the evaluation of both parameters in two lower extremity sensory nerves increases diagnostic sensitivity.