Uterine leiomyomas reduce the efficacy of assisted reproduction cycles: results of a matched follow-up study

A matched follow-up study design was used to test the hypothesis that pregnancy rates following assisted reproduction procedures do not differ between women with or without intramural or sub-serosal uterine leiomyomas. Women undergoing their first in-vitro fertilization (IVF)- embryo transfer or zygote intra-Fallopian transfer (ZIFT) cycle between January 1993 and June 1995 were included. Cases (women with leiomyomas) were matched 1:1 with the next consecutive control (women without leiomyomas) according to age, number of embryos transferred, embryo grade, and the route of embryo transfer (uterine or Fallopian). Assisted reproduction cycles were performed in an identical manner, independent of the presence or absence of uterine leiomyomas. The main outcomes measured were clinical pregnancy and delivery rates. A total of 182 cycles was evaluated. Of the 91 assisted reproduction cycles performed in the leiomyoma group, there were 34 clinical pregnancies (37%) and 30 deliveries (33%). Of the 91 assisted reproduction cycles in the control group, there were 48 clinical pregnancies (53%) and 44 deliveries (48%). The Mantel-Haenszel estimate of relative risk indicated that the presence of a uterine leiomyoma significantly reduced the chance for a clinical pregnancy or delivery. These findings suggest that leiomyomas are associated with a reduction in the efficacy of assisted reproduction cycles.      

Percutaneous endopyelotomy

Percutaneous endopyelotomy, introduced over 15 years ago, is a well-established alternative to open operative pyeloplasty for management of ureteropelvic junction (UPJ) obstruction. Although several variations of the technique have been described, the goal in all cases is to develop a full thickness incision though the obstructing proximal uretra that extends out to the peripyeloureteral fat and heals over an internal stent. Though a percutaneous endopyelotomy can be considered for almost any patient with primary or secondary UPJ obstruction, it is particularly valuable in the setting of upper tract stones that can then be managed simultaneously. This article reviews the indications, techniques, and outcomes of percutaneous endopyelotomy.     

血浆置换并甲基强的松龙和环磷酰胺治疗重症系统性红斑狼疮40例

1 临床资料分析我院2000/2004年收治的重症系统性红斑狼疮(SLE)患者40(男12,女28)例,年龄20～46(28.6±2.45)岁,病程1/4～9(平均5.6)a,均累及内脏,符合美国风湿病协会(ARA)1982年修定的SLE分类标准及重症狼疮诊断标准.     

The woes of waiting wives : Psychosocial battle at homefront

Few studies on stress have been carried out in soldiers and other paramilitary forces deployed in operational situations because of the security concerns, practical difficulties of conducting combat psychiatric studies and various other reasons. Studies on their families, who safeguard the family interests, during the period of absence of soldiers, have been even fewer. Significant contributions of researchers in this field were reviewed and suitably interpreted. Analysis revealed various types of stress and the multiple coping methods being practiced. It also highlighted various preventive and remedial measures being undertaken by waiting wives and their children. There is a need to understand and address the psychosocial issues of these families.     

应用通气阈控制男性肥胖型高血压患者的运动强度

目的:利用通气阈,观察男性肥胖高血压患者的适宜运动强度。方法:2004年从江西高校选取41例男性肥胖高血压者为观察对象。他们除了发现血压高、体质量指数超标外,无其他慢性病,平时不参加体育锻炼,受试者均知情同意。①运动处方的制定:以通气阈作为运动强度(相当于60%最大心率),让受试者进行为期1年的快走锻炼,运动时间为60min/次,隔日1次。每周三四次。②分别在实施运动处方前后按常规方法,各测定1次安静状态下的收缩压、舒张压、平均动脉压、心率和体成分、体质量、体质量指数、腰围、臀围、体脂、皮下脂肪面积、内脏脂肪面积。③要求受试者进行有氧运动,在达到通气阈时,记录下吸氧量、功率、心率、心率差、最高心率百分比、心率贮备百分比、主观运动强度、收缩压、平均动脉压、舒张压。结果:41例受试者全部进入结果分析。①实施运动处方前、后安静状态时各指标变化:体质量[(83.5±11.4),(78.1±7.4)kg]、体质量指数[(28.9±3.5),(27.2±2.3)kg/m2]、腰围[(95.4±8.3),(89.3±5.7)cm]、臀围[(100.6±5.9),(98.3±4.3)cm]、腰臀围比(0.95±0.05,0.91±0.04)、体脂百分比[(29.8±4.5)%,(26.6±4.3)%]、皮下脂肪面积[(147.8±35.1),(123.4±43.4)cm2];内脏脂肪面积[(109.8±57.2),(82.7±42.6)cm2]、内脏脂肪面积/皮下脂肪面积(0.80±0.51,0.72±0.39)、收缩压[(153.3±11.9),(127.0±12.1)mmHg]、舒张压[(97.0±12.6),(80.1±7.7)mmHg]和平均动脉压[(115.8±10.4),(95.7±8.7)mmHg]都有显著性改善(t=4.956～6.772,P<0.05或0.01)。②实施运动处方前、后,在通气阈时各指标变化:吸氧量[(13.5±2.1),(16.3±2.4)mL/(kg·min)]、功率[(75.1±16.5),(102.4±17.0)W],收缩压[(172.9±22.3),(149.3±15.9)mmHg]、舒张压[(100.1±16.4),(86.8±6.6)mmHg]及平均动脉压[(124.4±17.0),(107.7±7.0)mmHg]都有显著性改善(t=4.112～5.223,P<0.05);心率、心率差、最高心率百分比、心率贮备百分比以及主观强度感觉也都有改善。结论:对于男性肥胖高血压患者,可以采用通气阈确定其适宜运动强度,即运动强度是60%最高心率、30%心率贮备和主观运动强度12。     

等离子体处理胶原锚定PLGA/脱细胞骨基质骨软骨双层支架材料的制备和评估

目的:分别以胶原锚定方法修饰的聚乳酸-聚羟基乙酸共聚物(PLGA)为组织工程软骨支架材料,以脱细胞骨基质为组织工程骨支架材料,将二者结合制备出结合良好的组织工程骨软骨双层支架,并观察结构特征,以评估其作为组织工程化骨软骨复合体支架材料的可行性。方法:实验于2006-02/2007-02在解放军总医院骨科研究所完成。①支架的制备:以犬新鲜松质骨为原料,制备脱细胞骨基质作为骨支架材料;将脱细胞骨基质浸于盛有PLGA溶液的模具中,采用固-液相分离法结合致孔剂溶出法制备出多孔的PLGA/脱细胞骨基质双层支架,然后对PLGA支架部分进行等离子体处理和Ⅰ型胶原锚定修饰。得到的新型组织工程骨软骨双层支架的上层为多孔PLGA,下层为脱细胞骨基质。②支架的特征观察:对支架行扫描电镜检测,并采用乙醇置换法测定PLGA层孔隙率,采用北京亚林公司提供的扫描电镜图像分析系统测定PLGA层支架的平均孔径。结果:扫描电镜显示双层支架的PLGA部分具有良好的孔隙贯通结构,孔径为(211±33)μm,孔隙率为(95.0±1.5)%;脱细胞骨基质骨支架部分具有天然骨的孔径和空隙率;PLGA材料渗入骨支架部分,双层支架结合良好。结论:等离子体处理后胶原锚定修饰的PLGA/脱细胞骨基质双层支架具有良好的结构和孔隙率,结合良好,可作为支架载体应用于组织工程骨软骨复合体的构建。     

重组内皮抑制素抑制大鼠角膜移植术后的新生血管

目的:内皮抑制素是一种内源性血管内皮细胞的强效抑制剂,实验拟验证局部应用重组内皮抑制素滴眼液对大鼠角膜移植术后新生血管的抑制作用.方法:实验于2005-09/2006-03在重庆医科大学附属第一医院实验动物中心完成.①选用清洁级成年雌性SD大鼠(受体)60只,Wistar大鼠(供体)30只,建立大鼠同种异体穿透性角膜移植模型,供体提供双眼角膜,受体均选择右眼手术.移植术后按随机数字表法分成内皮抑制素组和对照组,分别用50mg/L的内皮抑制素眼液及赋形剂滴眼.②于术后1周、2周、3周、1个月及2个月5个时间点,麻醉后每组随机处死6只大鼠.观察角膜新生血管生长状况;比较各组角膜植片透明度、水肿、新生血管程度及移植排斥反应指数;检测角膜植片上内皮抑制素及血管内皮生长因子的表达情况.结果:60只受体大鼠全部进入结果分析.①内皮抑制素组大鼠角膜新生血管面积显著低于对照组(P＜0.05～0.01).②内皮抑制素组大鼠的排斥反应指数在术后1周、2周、3周、1个月及2个月均低于对照组(P＜0.05～0.01).③与对照组相比,内皮抑制素组角膜植片组织中内皮抑制素的表达明显增强(P＜0.05～0.01),血管内皮生长因子的表达明显降低(P＜0.05～0.01).结论:内皮抑制素滴眼液可以有效抑制大鼠角膜移植术后角膜新生血管的形成,下调角膜植片中血管内皮生长因子的表达,从而降低角膜移植术后免疫排斥反应的发生,为临床防治角膜移植术后新生血管提供了新的思路.     

Long‐term high‐physiological‐dose growth hormone reduces intra‐abdominal fat in HIV‐infected patients with a neutral effect on glucose metabolism

Objectives

The aim of the study was to investigate the effect of long‐term high‐physiological‐dose recombinant human growth hormone (rhGH) therapy on fat distribution and glucose metabolism in HIV‐infected patients.

Methods

Forty‐six HIV‐infected Caucasian men on highly active antiretroviral therapy (HAART), with an age range of 21–60 years and no significant comorbidity, were included in this randomized, placebo‐controlled, double‐blind, single‐centre trial. Twenty‐eight subjects were randomized to 0.7 mg/day rhGH, and 18 subjects to placebo, administered as daily subcutaneous injections between 1 and 3 pm for 40 weeks. Endpoints included changes in visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), limb fat mass, percentage of limb fat, plasma lipids, insulin resistance and glucose tolerance.

Results

VAT and trunk fat mass decreased significantly in the GH group compared with the placebo group [−19 cm² (−11%) vs. 12 cm² (6%), P=0.03, and −548 g (−9%) vs. 353 g (6%), P<0.01, respectively]. The beneficial fat redistribution in the GH group occurred without concomitant changes in subcutaneous fat at the abdomen or extremities. rhGH therapy was well tolerated. Insulin resistance, glucose tolerance, and total plasma cholesterol and triglycerides did not significantly change during intervention.

Conclusions

Daily 0.7 mg rhGH treatment for 40 weeks reduced abdominal visceral fat and trunk fat mass in HIV‐infected patients. This treatment appeared to be safe with respect to glucose tolerance and insulin sensitivity.

     

人类项韧带的精细解剖结构

目的:观察人类项韧带的精细解剖结构及形态。方法:实验于2004-09/2005-04在大连医科大学解剖教研室及大连医大生物塑化有限公司科研部完成。观察对象为4具成人尸体的颈部,均有完整的颈部(椎)全段,包括颅骨后枕外隆突。其中1具尸体进行肉眼大体解剖;3具尸体取寰椎到C7水平,制作成P45(聚酯树脂)生物塑化薄片。所有标本及材料均由大连医大生物塑化有限公司及大连医科大学解剖教研室提供。观察大体标本及P45断层塑化薄片标本,记录各种新发现。最后将两部分的观察及影像结果合并,利用断层解剖知识,标注项韧带组织名称并进行分析。结果:在颈椎的不同平面,项韧带的浅层、背侧部和腹侧部分别由斜方肌、头夹肌、小(大)菱形肌和上后锯肌的腱膜纤维组成的一个整体,且绝大部分纤维走向为横行。结论:①项韧带的结缔组织纤维不是全部纵向走行的,是以横向走行为主的肌腱腱膜组织纤维。②P45生物塑化薄片技术的应用使项韧带精细解剖结构的全貌更直观。     

静脉注射途径移植骨髓基质细胞的特点

目的:探讨在大鼠脑缺血的情况下经尾静脉注射移植骨髓基质细胞的可行性,为骨髓基质细胞脑移植治疗提供一种简捷、安全、有效的途径。方法:实验于2005-10/2006-08在北华大学医学院实验中心完成。取1～2个月龄SD大鼠双侧股骨和胫骨,体外分离培养大鼠骨髓基质细胞。取体质量为280～320g的SD大鼠25只,采用颈内动脉线栓法制作大脑中动脉梗死模型,造模成功后在25只大鼠中随机盲抓分为2组:骨髓基质细胞移植组(n=15)、对照组(n=10)。骨髓基质细胞移植组经静脉缓慢推入含Hoeschst33342标记的骨髓基质细胞细胞悬液1mL(2.0×107个细胞),对照组用同样方法经尾静脉注入等量不含骨髓基质细胞的DMEM培养液作为对照。分别于移植后1d、7d、14d时间点对两组大鼠进行神经功能损害严重程度评分及大脑组织切片观察比较。结果:25只大鼠均进入结果分析。①各代细胞90%以上表达巢蛋白阳性。②与对照组相比,骨髓基质细胞移植组大鼠运动、神经功能恢复明显[骨髓基质细胞移植组:(6.10±2.96),(3.30±1.83),(2.10±1.20)分;对照组:(7.43±1.51),(6.14±1.35),(4.43±1.40)分,P<0.05]。③骨髓基质细胞移植组大鼠脑组织结构较清晰、完整;对照组大鼠脑组织破坏溶解,组织结构松散,细胞结构不完整,胞浆疏松,染色变浅,间质水肿。结论:通过静脉注射进行骨髓基质细胞移植,方法简便、安全,对神经损伤动物组织重建及神经功能有确切的修复效果。