不同营养状况与慢性阻塞性肺病患者预后的相关性分析

<正>慢性阻塞性肺病(chronic obstructive pulmonary diseases,COPD)在临床呼吸科发病率与病死率排名首位,使患者的生命受到严重威胁[1]。COPD患者由于消化、呼吸功衰退,营养吸收功能减弱,同时气道阻力升高,减弱了肺部顺应性,所以伴发能量不足型营养障碍的机率较高[2-3]。出现营养不良的患者往往疾病加重,影响预后,而临床COPD患者疾病严重程度与预后又同肺功能变化密切相关[4]。本文分析了不同营养状况与COPD患者预后的相关性。     

Safety and efficacy of different anesthetic regimens for parturients with COVID-19 undergoing Cesarean delivery: a case series of 17 patients

Canadian Journal of Anesthesia/Journal canadien d'anesthésie - To assess the management and safety of epidural or general anesthesia for Cesarean delivery in parturients with coronavirus...     

Characterization of membrane occupation and recognition nexus repeat containing 3, meiosis expressed gene 1 binding partner,in mouse male germ cells

Mammalian spermatogenesis is a well-organized process of cell development and differentiation. Meiosis expressed gene 1 (MEIG1) plays an essential role in the regulation of spermiogenesis. To explore potential mechanisms of MEIG1''s action, a yeast two-hybrid screen was conducted, and several potential binding partners were identified; one of them was membrane occupation and recognition nexus repeat containing 3 (MORN3). MORN3 mRNA is only abundant in mouse testis. In the testis, Morn3 mRNA is highly expressed in the spermiogenesis stage. Specific anti-MORN3 polyclonal antibody was generated against N-terminus of the full-length MORN3 protein, and MORN3 expression and localization was examined in vitro and in vivo. In transfected Chinese hamster ovary cells, the antibody specifically crossed-reacted the full-length MORN3 protein, and immunofluorescence staining revealed that MORN3 was localized throughout the cytoplasm. Among multiple mouse tissues, about 25 kDa protein, was identified only in the testis. The protein was highly expressed after day 20 of birth. Immunofluorescence staining on mixed testicular cells isolated from adult wild-type mice demonstrated that MORN3 was expressed in the acrosome in germ cells throughout spermiogenesis. The protein was also present in the manchette of elongating spermatids. The total MORN3 expression and acrosome localization were not changed in the Meig 1-deficient mice. However, its expression in manchette was dramatically reduced in the mutant mice. Our studies suggest that MORN3 is another regulator for spermatogenesis, probably together with MEIG1.     

Quality of Regional Nodal Irradiation Plans in Breast Cancer Patients Across a Large Network—Can We Translate Results From Randomized Trials Into the Clinic?

PurposeRegional nodal irradiation (RNI) improved disease-free survival by 3% to 5% in 2 large randomized trials, but this small absolute advantage relies on accurate contouring and dose delivery. We audited our network to determine compliance on regional nodal coverage, contouring, and dosimetric parameters with respect to accepted guidelines.Methods and MaterialsIn our network, we have established a clinical pathway for patients with node-positive breast cancer that guides indications for RNI and dosimetric goals. We reviewed records of 183 patients with nodal macrometastases after upfront surgery or involved nodes of any size after neoadjuvant chemotherapy. Radiation treatment plans were examined to determine lymph node volumes treated, whether nodes were contoured, quality of nodal contours, and whether target coverage and normal organ dosimetric constraints were met when RNI was delivered.ResultsDespite the presence of macrometastases on sentinel lymph node biopsy, no lymph nodes were treated in 2.2% (4 of 183). Of 179 patients who received nodal irradiation, 18 received radiation to axillary levels 1 and 2 only, and 161 patients received RNI. Overall, regional nodes were not treated despite strong indications in 7.6% (14 of 183). Treated nodes were not contoured for 2.2% (4 of 179), and lymph node contours were unacceptable in 15.4% (27 of 175). Of patients receiving RNI, 14.9% (24 of 161) did not have adequate nodal target volume coverage, mean heart dose was >4 Gy for 3.1% (5 of 161), and lung V20 Gy was >35% for 8.7% (14 of 161).ConclusionsAdherence to indications for regional nodal treatment was high, but nodes were either not contoured or had unacceptable contour quality in 18% of plans, and coverage was inadequate in 15%. Because the small disease-free survival advantage seen in trials may be decreased with these deviations, routine clinical practice requires detailed peer review to fully translate results of clinical trials.     

去势比格犬腹部脂肪与相关血清学指标及骨密度的变化关系

目的通过建立去势比格犬模型,观察绝经早期腹部脂肪变化规律,并通过对脂肪与骨代谢相关血清学指标的测量与分析,探讨脂肪及骨代谢的关键影响因素。方法选取6只成年雌性比格犬进行去势术,分别在术前、术后4个月、6个月、10个月进行腰椎定量CT(quantatitive computed tomography,QCT)腹部脂肪面积、骨密度(bone mineral density,BMD)、MRI腰椎骨髓脂肪含量及血清学指标的检测,比较不同时间各指标的变化趋势及关系。结果比格犬腹内脂肪面积(visceral fat area,VFA)、皮下脂肪面积(subcutaneous fat area,SFA)、腹部总脂肪面积(total fat area,TFA)在术后6个月、10个月均增加(P0.05),术后10个月VFA增加百分比均值为84.39%,且为三者中最大;术后比格犬BMD并未明显降低。体重、BMD、瘦素(leptin,LP)、VFA、高密度脂蛋白(high-density lipoprotein,HDL)与SFA相关。SFA、体重、低密度脂蛋白(low-density lipoprotein,LDL)、内脏脂肪素(visfatin,VFN)与BMD相关。结论去势比格犬模型可用于研究绝经后雌激素缺乏所引起的脂肪代谢变化,但短期内BMD并未明显丢失,骨、脂肪代谢之间存在交互作用。     

远程胎儿监护的临床应用

远程胎儿监护是应用互连网及计算机技术，孕妇在家中或远程监护终端将胎心监护图形传输到中央监护站，医生即可通过电脑或手机APP远程判读。对高危孕妇实行远程监护，便于及时发现胎儿宫内缺氧情况和及时处理，改善围产儿结局。     

40岁以上高龄女性体外受精-胚胎移植妊娠结局分析

目的：探讨40岁以上高龄女性体外受精-胚胎移植（IVF-ET）的妊娠结局，旨在为高龄女性提供生育咨询以及为改善高龄女性个体化辅助生殖治疗结局提供临床依据。方法：选择我院生殖中心2015年1月—2017年12月女方年龄≥40岁且使用自身卵子行体外受精的共2 467个治疗周期资料，对各项临床数据进行回顾性分析。结果：40岁及以上行辅助生殖治疗的患者，随着女性年龄增加获卵数明显减少（40～48岁女性平均获卵数分别为2.97、 2.69、2.17、2.01、1.77、1.61、1.68、1.29和1.00，44～48岁与40～43岁依次组间比较均P＜0.05），尤其是44岁以上女性胚胎发育潜能明显降低（40～48岁囊胚形成率分别为48.90%、43.72%、33.67%、34.29%、24.39%、21.14%、26.32%、16.67%和0%，44～48岁与40～43岁组间依次比较均P＜0.05）。共有518个周期行新鲜胚胎移植，结果显示，随女性年龄增加，临床妊娠率（40～48岁临床妊娠率分别为26.92%、21.15%、20.79%、10.96%、18.87%、11.11%、5.88%、0%和0%，43～48岁与40～42岁组间依次比较均P＜0.05）、种植率（40～48岁种植率分别为23.65%、19.51%、17.70%、8.54%、7.49%、10.81%、5.56%、0%和0%，43～48岁与40～42岁组间依次比较均P＜0.05）和活产率均显著降低（40～46岁活产率分别为18.46%、10.58%、9.90%、5.48%、5.66%、2.78%和5.88%，43～46岁与40～42岁组间依次比较均P＜0.05），43岁以上者结局更差。44岁以上女性自然流产率明显增高（40～45岁流产率分别为31.43%、50.00%、52.38%、50.00%、70.00%和75.00%，44～45岁与40～43岁组间依次比较均P＜0.05）。46岁女性仅1例妊娠并分娩，47岁和48岁女性均无成功妊娠。与抗苗勒管激素（AMH）＞1.0 ng/mL组相比，AMH≤1.0 ng/mL组妊娠率、种植率及活产率均显著下降（27.04% vs. 14.74%，22.99% vs. 13.50%，15.88% vs. 7.37%；均P＜0.05），流产率明显升高（41.27% vs. 50.00%，P＜0.05）。结论：≥40岁高龄女性随年龄增长生育力逐渐降低。40～43岁年龄段女性助孕仍有一定的价值，尤其是卵巢仍有一定储备者（AMH＞1.0 ng/mL），但44岁以上女性原则上不再建议ART助孕，对于46岁以上卵巢功能衰竭的女性强烈建议卵子捐赠或收养。