Estimating time to full uterine cervical dilation using genetic algorithm

The objectives of this study were to provide new parameters to better understand labor curves, and to provide a model to predict the time to full cervical dilation (CD). We studied labor curves using the retrospective records of 594 nulliparas, including at term, spontaneous labor onset, and singleton vertex deliveries of normal birth weight infants. We redefined the parameters of Friedman's labor curve, and applied a three-parameter model to the labor curve with a logistic model using the genetic algorithm and the Newton-Raphson method to predict the time necessary to reach full CD. The genetic algorithm is more effective than the Newton-Raphson method for modeling labor progress, as demonstrated by its higher accuracy in predicting the time to reach full CD. In addition, we predicted the time (11.4 hours) to reach full CD using the logistic labor curve using the mean parameters (the power of CD = 0.97 cm/hours, a midpoint of the active phase = 7.60 hours, and the initial CD = 2.11 cm). Our new parameters and model can predict the time to reach full CD, which can aid in the forecasting of prolonged labor and the timing of interventions, with the end goal being normal vaginal birth.     

儿童颅脑损伤的临床特点及手术策略（附257例分析）

目的分析总结儿童颅脑损伤的临床特点及手术方法。方法回顾性分析我院2003年1月～2010年12月收治的257例颅脑损伤患儿的临床资料,平均年龄6.3（1～14）岁,其中小于3岁者52例,3～6岁者98例,7～14岁者107例;闭合性颅脑损伤217例,开放性颅脑损伤40例。按GCS评分：13～15分92例,9～12分62例,6～8分87例,3～5分16例。其中,轻型颅脑损伤90例,中型颅脑损伤57例,重型颅脑损伤89例,特重型颅脑损伤21例。手术治疗97例,包括颅内血肿清除＋保留颅骨62例（其中环钻开颅14例）、颅内血肿清除＋去骨瓣减压术11例、颅内血肿清除＋凹陷骨折复位术18例、开放性颅脑损伤清创术或颅内异物摘除术等6例。21例患儿施行气管切开术。非手术治疗160例。结果术后按照GOS评估预后：恢复良好212例（82.5%）;中残18例（7.0%）;重残8例（3.1%）;植物生存2例（0.8%）,死亡17例（6.6%）。本组住院时间平均29（11～195）d。95例患儿获随访,随访时间6个月～2年。出现癫痫症状26例,硬膜下积液20例,交通性脑积水11例。结论儿童因解剖、生理、病理生理等与成人有所不同,容易导致颅脑损伤后原发损伤重、临床症状重、病情变化快;强调对每个患儿行个体及规范化治疗,积极预防术后并发症及癫痫的发生,及时、恰当的综合治疗,可降低病死率及致残率,且小儿神经系统修复能力强,与成人相比多预后良好。     

Thrombomodulin Functional Domains Support Osteoblast Differentiation and Bone Healing in Diabetes in Mice

Thrombomodulin (TM) is a transmembrane glycoprotein that contains five functional domains. Soluble TM (sTM), comprising extracellular domains TMD1 (lectin-like), TMD2 (epidermal growth factor [EGF]-like repeat containing), and TMD3 (serine-threonine rich), can be shed from cells by the intramembrane protease rhomboid-like-2 (RHBDL2). TM is expressed by osteoblasts, yet its role there has not been determined. Herein we aimed to investigate the properties of TM and its domains in osteoblast function and bone repair following injury in diabetes. In response to a scratch injury of cultured osteoblast-like MG63 cells, expression of TM and RHBDL2 was enhanced, with increased release of sTM. Conditioned media from the injured cells promoted osteoblast migration, an effect that was lacking with conditioned media from MG63 cells in which TM was silenced by shRNA. Exogenous recombinant TMD1 had no effect on osteoblast activities or on bone repair in vivo. However, TM domains 2 and 3 (TMD2/3), induced MG63 cell migration, proliferation and mineralization in vitro, and when locally administered in mice, improved in vivo healing of injured calvarium. This beneficial effect of TMD2/3, mediated via fibroblast growth factor receptor (FGFR)/ERK signaling pathways, was also observed in vitro under high glucose conditions where endogenous TM expression was reduced, and in vivo in diabetic mice following tibia fracture or calvarium injury, where the osteoblastic response and healing were otherwise dampened. Taken together, osteoblast TM participates in bone healing, and recombinant TMD2/3 holds promise as a novel therapy for diabetic bone defect healing. © 2020 American Society for Bone and Mineral Research.     

速度向量成像分层应变技术评价血液透析对尿毒症患者左心室心肌即时纵向应变的影响

目的 观察速度向量成像（VVI）分层应变技术评价尿毒症血液透析患者左心室心肌即时纵向应变功能变化的价值。方法 对35例接受高通量血液透析的尿毒症患者分别于透析前和透析后2 h行二维超声心动图检查。常规测量并采集图像后,应用VVI软件分析二维动态图像,获得左心室17个节段3层心肌收缩期纵向峰值应变（LPS）。结果 透析后左心房收缩期前后径、左心室舒张末期和收缩末期内径、左心室舒张末期和收缩末期容积、每搏输出量均较透析前减小（P均<0.05）,左心室射血分数差异无统计学意义（P=0.183）。与透析前比较,透析后2 h左心室整体全层、内层,基底段全层、内层、中层、外层,中间段全层、内层心肌收缩期LPS均较透析前减低（P均<0.05）;左心室整体外层、中层,中间段外层、中层,心尖段全层、内层、中层、外层心肌LPS差异均无统计学意义（P均>0.05）。结论 VVI分层应变技术可敏感、准确地评价血液透析对尿毒症患者即时左心室心肌整体及局部收缩功能的影响。     

经侧前方肋间隙胸膜外入路切除胸椎椎体后缘骨内软骨结节的胸椎管减压

【摘要】 目的：探讨侧前方经肋间隙胸膜外入路手术切除胸椎椎体后缘骨内软骨结节治疗胸椎管狭窄症的方法和疗效。方法：2002年4月~2012年9月,对18例明确诊断为胸椎椎体后缘骨内软骨结节所致椎管狭窄症患者采用经侧前方肋间隙胸膜外入路减压内固定融合术治疗,男12例,女6例;年龄33~61岁,平均46岁。影像学证实均为单一节段椎体后缘骨内软骨结节,且不合并胸椎黄韧带骨化及后纵韧带骨化。病变节段：T7/8 2例,T8/9 4例,T9/10 5例,T10/11 7例。术前神经功能Frankel分级：C级6例,D级12例;JOA评分6.6±1.3分。观察术后疗效和并发症发生情况。结果：18例患者均顺利完成手术,平均用时3.5h,平均出血量420ml（350~620ml）,术后无气胸、胸腔积液等并发症发生;1例术后1周发生肺炎,5例术后第2天复查胸片时发现邻近肋骨骨折,均经保守治疗后痊愈。所有患者均获得随访,随访时间2~12年,平均6年。疗效参照Epstein标准评价,优15例,良2例,差1例,优良率94%（17/18）。术前Frankel分级为C级的患者1例无明显改善,1例改善至D级,4例改善为E级;12例D级患者均改善为E级。JOA评分改善到9.4±1.6分,与术前比较有显著性差异（P<0.05）。术后1年复查CT见椎间植骨区表面有连续性骨小梁通过,末次随访时影像学检查未发现内固定断裂、松动和植骨不融合现象。结论：对于胸椎椎体后缘骨内软骨结节所致胸椎管狭窄症患者,采用经侧前方肋间隙胸膜外入路胸椎椎体后缘骨内软骨结节切除减压可取得较好的临床疗效,是一种安全有效的手术方式。     

双氢睾酮对大鼠原代卵泡颗粒细胞抗苗勒管激素表达的影响

目的 探讨双氢睾酮（DHT）对大鼠原代卵泡颗粒细胞抗苗勒管激素（AMH）表达的影响。方法 从95只21 d SD雌性大鼠中提取颗粒细胞原代培养48 h后,先用HE染色检测细胞形态,卵泡刺激素受体（FSHR）细胞免疫荧光检测细胞纯度;然后根据干预方法和实验的不同,随机将细胞分为对照组（无药物干预）、10^-8mol/L DHT组、10^-5mol/L DHT组,2×10^-5mol/ L蛋白激酶B(Akt)抑制剂（MK-2206 2Hcl）组和10^-8mol/L DHT+2×10^-5mol/L MK-2206 2Hcl组,分别使用相应浓度的试剂干预细胞3 h。干预完成后,细胞免疫荧光染色观察AMH表达的部位和变化;Western blotting测定不同组的AMH、Akt、p-Akt蛋白表达量。结果 大鼠原代卵泡颗粒细胞的纯度为93.33%±3.09%,AMH表达在大鼠原代卵泡颗粒细胞膜和细胞质中;与对照组相比,10-8 mol/L DHT和10-5 mol/L DHT均可使颗粒细胞AMH表达增加（P<0.05）,但这两个浓度的DHT对颗粒细胞AMH的表达影响差异无显著性（P>0.05）;与对照组相比,10^-8 mol/L DHT可以使p-Akt、AMH表达升高,2×10^-5 MK-2206 2Hcl使AMH表达降低（P<0.05）;与2×10^-5MK-2206 2Hcl相比,10^-8mol/L DHT+2×10^-5 MK-2206 2Hcl处理组AMH表达升高（P<0.05）。结论 DHT可以上调大鼠原代卵泡颗粒细胞AMH的表达,这种作用可能与Akt信号通路有关。