超低温冻存对人羊水间充质干细胞生物学特性的影响

目的 观察超低温冻存对人羊水间充质干细胞(AF-MSC)生物学特性的影响.方法 通过羊膜腔穿刺取得人孕16～23周羊水.分离培养出人AF-MSC.将第4代人AF-MSC经短期超低温冻存、复苏后,通过细胞活性率测定、形态学比较、细胞增殖功能测定、细胞周期分析及细胞表面抗原检测,观察超低温冻存对人AF-MSC生物学特性的影响.结果 第4代人AF-MSC冻存、复苏前后的两组细胞无论在细胞活性率、细胞形态、细胞增殖能力、细胞周期、细胞表面抗原的表达等方面均无显著性差异(P＞0.05).结论 短期的超低温冻存对人AF-MSC的生物活性无明显影响.     

激动剂方案中添加重组LH对体外受精-胚胎移植妊娠结局影响的Meta分析

目的:评价激动剂方案中添加重组LH(rLH)的必要性。方法:计算机检索PubMed、Ovid、EMbase、Medline、Cochrane图书馆等中、外生物医学数据库。收集有关激动剂方案中是否添加rLH的随机对照试验。按Cochrane系统评价方法,评价所纳入研究的文献质量,并提取有效数据后采用RevMan5.1软件进行Meta分析。结果:纳入7个随机对照试验(RCT),共计1 741例患者,其中FSH+rLH组897例,FSH组844例。Meta分析结果显示:与FSH组比较,添加rLH对临床妊娠率(RR=0.99,95%CI=0.87~1.13,P=0.86)、活产率(RR=0.94,95%CI=0.76~1.16,P=0.57)、种植率(RR=1.00,95%CI=0.86~1.17,P=0.99)及流产率(RR=0.79,95%CI=0.52~1.22,P=0.29)无影响。但对于高龄患者,添加rLH降低了获卵数(WMD=-1.56,95%CI=-1.81~-1.32,P0.001)及MⅡ卵数(WMD=-1.40,95%CI=-1.79~-1.01,P0.001)。结论:与单独应用FSH相比,添加rLH对临床妊娠率、活产率、种植率及流产率无影响,但会减少高龄患者获卵数及MⅡ卵数。     

妇科腹腔镜手术中转开腹53例多因素分析

目的 探讨妇科腹腔镜手术中转开腹的影响因素。方法 回顾性分析我院2009年9月至2013年9月2890例妇科腹腔镜手术中53例中转开腹的临床资料,并采用多元logistic回归分析妇科腹腔镜手术中转开腹的原因。结果  中转开腹53例,中转开腹率1.83%,中转开腹的原因：未预计的特殊部位子宫肌瘤13例(24.53％),严重盆腹腔粘连19例(35.85％), 止血困难4例(7.55％)。卵巢恶性肿瘤（包括盆腔巨大肿块）14例(26.42％),手术损伤（血管或输尿管）3例(5.66％)。腹腔镜中转开腹的影响因素为腹部手术史（OR 3.076,95％CI 2.457～3.276）、盆腔粘连程度（OR 3.909,95％CI 2.858～4.226）、术中出血（OR 3.491,95％CI 2.778～3.576）、疾病类型（OR 1.869,95％CI 1.243～2.263）和手术方式（OR 1.906,95％CI 1.321～2.211）,患者年龄与中转开腹无关。结论  手术医师腹腔镜手术操作能力,手术前加强病情的评估能够减少术中转开腹率,而及时中转开腹恰恰能够减少手术并发症的发生。      

Improving the outcomes in oncological colorectal surgery

During the last several decades, colorectal cancer surgery has experienced some major perioperative improvements. Preoperative risk-assessment of nutrition, frailty, and sarcopenia followed by interventions for patient optimization or an adapted surgical strategy, contributed to improved postoperative outcomes. Enhanced recovery programs or fast-track surgery also resulted in reduced length of hospital stay and overall complications without affecting patient safety. After an initially indecisive start due to uncertainty about oncological safety, the most significant improvement in intraoperative care was the introduction of laparoscopy. Laparoscopic surgery for colon and rectal cancer is associated with better short-term outcomes, whereas long-term outcomes regarding survival and recurrence rates are comparable. Nevertheless, long-term results in rectal surgery remain to be seen. Early recognition of anastomotic leakage remains a challenge, though multiple improvements have allowed better management of this complication.     

高原地区某铬盐厂职业性铬鼻病20例临床报告

目的 总结职业性铬鼻病(鼻中隔穿孔)的临床表现及诊断经验.方法 收集该厂铬酸盐生产车间铬及其化合物的监测数据和病例的既往史、职业史以及临床表现.结果 采用按岗位/工种个体采样,16例病例岗位/工种所测铬及其化合物浓度超标0.10～2.38倍.既往诊断3例和新发病17例鼻中隔穿孔0.1～0.6 cm.结论 低浓度铬及其化合物接触仍可导致职业性铬鼻病.企业除在进一步改进生产工艺,加大通风、降尘、排毒设施的投入外,还应加强个人防护知识的宣传、教育力度,改变不良卫生习惯.     

Sequence variants in the HLX gene at chromosome 1q41-1q42 in patients with diaphragmatic hernia

Congenital diaphragmatic hernia (CDH) is a common birth defect for which few causative genes have been identified. Several candidate regions containing genes necessary for normal diaphragm development have been identified, including a 4–5 Mb deleted region at chromosome 1q41-1q42 from which the causative gene(s) has/have not been cloned. We selected the HLX gene from this interval as a candidate gene for CDH, as the Hlx homozygous null mouse has been reported to have diaphragmatic defects and the gene was described as being expressed in the murine diaphragm. We re-sequenced HLX in 119 CDH patients and identified four novel single nucleotide substitutions that predict amino acid changes: p.S12F, p.S18L, p.D173Y and p.A235V. These sequence alterations were all present in patients with isolated CDH, although patients with both isolated CHD and CDH with additional anomalies were studied. The single-nucleotide substitutions were absent in more than 186 control chromosomes. In-situ hybridization studies confirmed expression of Hlx in the developing murine diaphragm at the site of the junction of the diaphragm and the liver. Although functional studies to determine if these novel sequence variants altered the inductive activity of Hlx on the α-smooth muscle actin and SM22α promoters showed no significant differences between the variants and wild-type Hlx , sequence variants in HLX may still be relevant in the pathogenesis of CDH in combination with additional genetic and environmental factors.     

米非司酮对人绒毛和蜕膜内纤维粘连蛋白表达的影响

目的 观察米非司酮终止早孕后,绒毛和蜕膜内纤维粘连蛋白(FN)的表达情况.方法 宫内早孕要求终止妊娠且孕龄<49 d的妇女,分为药物完全流产组(n=15)、药物不全流产组(n=15)和对照组(手术流产组,n=15).两药物流产组取服药(米非司酮配伍米索前列醇)第3天排出的绒毛和蜕膜组织,对照组取负压吸引出的绒毛和蜕膜组织.采用免疫组化法测定绒毛和蜕膜组织中FN的表达.结果 对照组绒毛和蜕膜FN的阳性表达率明显高于两药物流产组(P<0.017);其中,不完全流产组绒毛和蜕膜组织中FN的阳性表达率高于完全流产组(P<0.017).结论 米非司酮可通过降低早孕妇女绒毛和蜕膜中FN的表达,改变胚胎宫内发育的内环境,在细胞外基质水平发挥抗早孕的作用.     

MSCs成骨分化中BMP2对成骨转录因子SATB2表达的调控作用

目的探索间充质干细胞（MSCs）成骨分化中骨形态发生蛋白2（BMP2）对成骨转录因子SATB2表达的调控作用。方法体外培养小鼠间充质细胞系C2C12,腺病毒介导的BMP2（Adv-BMP2）诱导其向成骨细胞分化,建立并验证C2C12细胞成骨分化细胞模型。Real-Time PCR和Western blotting分别检测C2C12细胞成骨分化过程中经不同浓度Adv-BMP2处理不同时间时SATB2 mRNA和SATB2蛋白表达;以经相应浓度Adv-β-Gal处理细胞作对照。结果经150 pfu/cell Adv-BMP2处理C2C12细胞5 d后,成骨细胞标志基因Ⅰ型胶原、骨唾液酸蛋白和骨钙素表达以及碱性磷酸酶活性均显著增加,MSCs成骨分化模型构建成功。150 pfu/cell Adv-BMP2诱导C2C12细胞成骨分化过程中,SATB2 mRNA和SATB蛋白表达随分化进程而增加;Adv-BMP2浓度为0～225 pfu/cell时,SATB2表达随Adv-BMP2浓度升高而增加。结论 BMP2可调控SATB2的表达,从而影响MSCs成骨分化。     

Coronary Left Main and Non‐Left Main Bifurcation Angles: How are the Angles Modified by Different Bifurcation Stenting Techniques?

Background: Investigation of the correlation between bifurcation angles and outcomes is limited with discordant results. The aim of this study is to investigate left main (LM) and non‐left main (N‐LM) bifurcation angles and their modification after percutaneous coronary intervention (PCI). Measurement of all three angles adds to our understanding of bifurcation anatomy and the resultant effect of different stenting techniques. Methods and Results: All three bifurcation angles were described according to the European Bifurcation Club definition: the A (proximal bifurcation angle), the B (distal bifurcation angle) and the C (main branch angle). Measurements were performed in 75 LM and 140 N‐LM bifurcations. In LM bifurcations baseline mean values of C, A, and B were 151°± 28°, 131°± 32°, and 78 ± 28°, respectively. In bifurcations with 2 stents the B significantly decreased by a mean of 10° (P = 0.003) and A increased by 10° (P = 0.006). Crush stenting significantly decreased B (A – 14°; P = 0.020) and increased A (A + 21°; P = 0.005), particularly non‐true bifurcations. In N‐LM bifurcations mean values for C, A, and B were 156°± 19°, 144°± 22°, and 60°± 20°, respectively. Similar to LM bifurcations, the B became narrower mainly at the expense of the A, which became wider. In both types of bifurcations the greatest variation in A and B was found following 2‐stent techniques performed in T‐shaped (≥70°) bifurcations. Conclusions: In both LM and N‐LM bifurcations we found a significant difference in A and B pre‐ and post‐PCI. This difference was driven by the 2‐stent technique and was most evident with a baseline bifurcation angle ≥70°. The Crush technique caused the largest angle variation post‐procedure, particularly in non‐true LM bifurcations. (J Interven Cardiol 2010;23:382–393)