Sonographic and Doppler imaging in the diagnosis and treatment of gestational trophoblastic disease: a 12-year experience.

OBJECTIVE: To evaluate the clinical utility of sonography with Doppler examination in the diagnosis and treatment of gestational trophoblastic disease (GTD). METHODS: A retrospective analysis of 355 cases of GTD seen over a 12-year period in 2 large university referral hospitals in China was performed. Clinical appearances, sonographic findings, Doppler waveforms, and patient outcomes were reviewed. Sonographic and Doppler examinations were performed to diagnose the presence of molar tissue, detect invasive disease, assess disease recurrence, and monitor the efficacy of chemotherapy. Doppler waveforms of 13 patients with normal early pregnancies were also examined for comparison. RESULTS: Of the 355 patients with GTD, 106 had a classic hydatidiform mole (CHM), 33 had a partial hydatidiform mole (PHM), 184 had an invasive hydatidiform mole (IHM), and 32 had choriocarcinoma. Sonography showed abnormal molar tissue confined to the endometrial cavity in all cases of CHM. In cases of IHM and choriocarcinoma, soft tissue invasion and cystic vascular spaces within the myometrium were shown. Cases of PHM had a thickened, hydropic placenta with a concomitant fetus. Doppler waveforms showed resistive indices of 0.55 (SD, 0.06) for CHM, 0.56 (SD, 0.04) for PHM, 0.28 (SD, 0.06) for IHM, 0.25 (SD, 0.05) for choriocarcinoma, and 0.66 (SD, 0.04) for normal pregnancies. The abnormal sonographic and Doppler findings in invasive disease resolved when chemotherapy was successful. CONCLUSIONS: Sonography and Doppler imaging were helpful in diagnosing GTD, in determining whether invasive disease was present, in detecting recurrence of disease, and in following the effectiveness of chemotherapy.     

踏车运动对恢复期脑卒中患者ADL的影响

目的：探讨踏车运动对恢复期脑卒中患者日常生活活动能力（ADL）的影响。方法：61例有一定行走能力的恢复期脑卒中患者随机分为观察组31例和对照组30例,均采用常规康复训练方法配合治疗,观察组并增加踏车运动,每天1次,30min。结果：经过8周的训练后,与治疗前比较,2组患者的ADL明显提高（P〈0.05）,观察组提高的程度优于对照组（P〈0.05）。结论：踏车运动对提高恢复期脑卒中患者的ADL有积极作用。     

转化生长因子β1诱导骨髓间充质干细胞体外构建纤维蛋白胶软骨模块

目的:观察体外构建骨髓间充质干细胞、改良纤维蛋白胶及生长因子的组织工程软骨模块的可行性。方法:实验于2004-07/12在南方医科大学附属珠江医院中心实验室进行。选取新西兰兔10只,密度梯度法分离培养兔骨髓间充质干细胞,在培养系统中加入生长因子(含10μg/L转化生长因子β1,100mol/L地塞米松,50mg/L维生素C,以及1%ITS-A。培养第2,4,6,8天采用四甲基偶氮噻唑法在酶标仪上检测吸光度值表示细胞增殖。于培养7,14d行细胞爬片甲苯胺蓝染色及Ⅱ胶原免疫组化。诱导后骨髓间充质干细胞种植于改良纤维蛋白胶支架上,加入生长因子诱导培养,于培养7,14,21d行形态组织学及透射电镜检查。结果:实验兔10只均进入实验结果分析。①四甲基偶氮噻唑法测定培养第6和8天后,实验组骨髓间充质干细胞增殖的吸收度值高于对照组(实验组:0.4554±0.0206,0.5348±0.0169;对照组:0.4270±0.0255,0.5057±0.0368,P<0.05)。②细胞爬片甲苯胺蓝染色细胞周围有蓝色基质。Ⅱ型胶原免疫组化染色阳性。③诱导后骨髓间充质干细胞在改良纤维蛋白胶支架中培养,Masson染色可见胞浆及细胞周围有胶原的形成;Ⅱ型胶原免疫组化染色阳性。透射电镜可见细胞代谢旺盛。结论:骨髓间充质干细胞、改良纤维蛋白胶及生长因子的组织工程模块体外培养系统中,改良纤维蛋白胶支架相容性好,转化生长因子β等生长因子促进骨髓间充质干细胞在改良纤维蛋白胶支架增殖,诱导分化成软骨细胞表型。     

引入围手术期康复理念,提高骨关节创伤的疗效

随着骨科临床治疗手段发展的复杂性和多样化,骨科领域对于围手术期系统康复的要求更高,需要从事骨科康复的专业人员引入围手术期康复理念,提高骨关节创伤的疗效,以适应临床日新月异发展的需要。     

Relationship between effort–reward imbalance and hair cortisol concentration in female kindergarten teachers

Objective

The present study aims to investigate the relationship between effort–reward imbalance and hair cortisol concentration among teachers to examine whether hair cortisol can be a biomarker of chronic work stress.

Methods

Hair samples were collected from 39 female teachers from three kindergartens. Cortisol was extracted from the hair samples with methanol, and cortisol concentrations were measured with high performance liquid chromatography–tandem mass spectrometry. Work stress was measured using the effort–reward imbalance scale.

Results

The ratio of effort to reward showed significantly positive association with hair cortisol concentration.

Conclusion

The cortisol concentration in the system increases with the effort–reward imbalance. Measurement of hair cortisol can become a useful biomarker of chronic work stress.     

神经细胞黏附分子L1在先天性巨结肠中的表达

目的：研究L1型神经细胞黏附分子（LICAM）基因在先天性巨结肠不同肠段的表达。方法：分别取16例先天性巨结肠惠儿狭窄段和正常段平滑肌组织，经处理后提取总RNA，应用逆转录多聚酶链反应（RT-PCR）扩增目的基因和看家基因片段，观察狭窄段和正常段的LICAM基因的表达，并与看家基因（β-aetin）在狭窄段和正常段的表迭作对比。结果：16例患者正常段LICAM和β-actin均有明显的表达，狭窄段β-actin亦有明显的表达，但LICAM均无表迭或弱表达。结论：先天性巨结肠患者狭窄段LICAM减少的原因可能是LICAM的mRNA的减少或缺如，并进一步引起病变段运动障碍和巨结肠发生。     

Technique Selection of Bricker or Wallace Ureteroileal Anastomosis in Ileal Conduit Urinary Diversion: A Strategy Based on Patient Characteristics

Objectives

This study was designed to establish an individualized selection strategy for the two most common types of ureteroenteric anastomotic techniques (Bricker and Wallace anastomosis) used in ileal conduit (IC) diversion.

Methods

Patients who underwent IC diversion after radical cystectomy for transitional cell carcinoma between January 2009 and December 2011 were prospectively collected. The choice of anastomosis type (Bricker vs. Wallace) was successively based on tumor characteristics, ureteral anomalies, and ureteral length after retrosigmoidal tunneling.

Results

Ninety-nine patients were enrolled in the final study. Fifty-three patients underwent Bricker anastomosis, and 46 underwent Wallace anastomosis. Ureteral stricture developed in 6 (6.1 %) patients and the overall stricture rate for all ureters was 3.1 % (6/196). Strictures occurred at an average of 13.3 months after surgery and were predominately located in the left ureter (66.7 %, 4/6). The difference in the ureter stricture rates between the two groups was not statistically significant: 3.8 % (4/104) and 2.2 % (2/92) for Bricker and Wallace, respectively (p = 0.686). There were no significant differences in age, sex, body mass index (BMI), prevalence of pelvic radiation therapy, length of stay, follow-up time, or time to stricture between the two techniques. Patients in whom stricture developed had a significantly higher mean BMI compared with those without stricture (25.2 vs. 23.3 kg/m², respectively; p = 0.008).

Conclusions

Our preliminary outcomes demonstrate that this selection strategy of Bricker vs. Wallace anastomosis seems to be clinically reliable, providing an acceptable low ureteral stricture rate of 3.1 %. However, the potential advantage for oncologic control of this strategy is needed to further confirm.     

A novel reference coordinate system to locate the inferomedial point of the transverse-sigmoid sinus junction

Background

A coordinate system was previously developed to identify landmarks on the skull surface to help locate the transverse-sigmoid sinus junction in order to reduce surgical morbidity in retrosigmoid craniotomy; however, in practice we found that this system has important flaws.

Objective

To develop and evaluate a novel reference coordinate system to precisely locate the inferomedial point of the transverse-sigmoid sinus junction (IMTS) and evaluate the effect of gender and skull side (left or right).

Methods

Forty-two adult skulls (84 sides) were obtained for analyses. The X-axis was defined by point A (where the upper edge of the zygomatic arch joins with the frontal process of the zygomatic bone) and point B (where the upper edge of the zygomatic arch blends posterosuperiorly into the supramastoid crest). The Y-axis was defined by the line perpendicular to the X-axis and extending across the tip of the mastoid. The x and y coordinates of IMTS (IMTS-x and IMTS-y) were measured in this coordinate system.

Results

There were 20 male skulls and 22 female skulls. The mean IMTS-x measurements were significantly higher on the right side compared with the left side in both males and females. For the left skull side, the mean IMTS-y measurements were significantly lower in females compared with males.

Conclusion

This novel reference coordinate system may be a reliable and practical method for identifying the IMTS during retrosigmoid craniotomy. There are significant differences in location of the axes with regard to gender and skull side.     

SRK-Ⅱ公式预测人工晶体屈光度数准确性分析

目的SRK-Ⅱ公式预测人工晶体度数准确性的探讨。方法158例（158只眼）老年性白内障患者行超声乳化联合IOL植入术，用SRK-Ⅱ公式预测IOL屈光度数，记录并比较术后实际屈光度数与预计屈光度数。结果SRK-Ⅱ公式平均预测误差为0．68D。当眼轴长度为L≤22mm时，0％误差值大于2D；22mm〈L≤24．5mm时，为2％；24．5mm〈L≤26mm时，为11％；26mm〈L≤28mm时，为23％；当L〉28mm时，为29％。结论SRK-Ⅱ公式预测正常眼轴和短眼轴IOL屈光度数的准确性较高，而在长眼轴中误差明显增大。     

Changes in motor function in the unaffected hand ol stroke patients should not be ignored

Motor function changes in the unaffected hand of stroke patients with hemiplegia. These changes are often ignored by clinicians owing to the extent of motor disability of the affected hand. Finger tapping frequency and Lind-mark hand function score showed that the motor function of unaffected hands in stroke patients was poorer than that of a healthy control hand. After 2 weeks of rehabilitation treatment, motor function of the unaffected hand of stroke patients was obviously improved. Therefore, attention should also be paid to motor function in the unaffected hand of stroke patients with hemiplegia during rehabilitation.