Urethral Diverticula in Pregnancy

Summary: In 4 cases, the clinical presentation of urethral diverticulum (UD) during pregnancy was a paraurethral mass (3), urinary incontinence (2), irritative symptoms (2), urinary tract infection (1), urethral pain and discharge (1) and voiding difficulty (1). The diagnosis of UD during pregnancy was made by trans vaginal ultrasonography (2), cystoscopy (1), and after pregnancy by a voiding cystourethrogram (1). Management during pregnancy involved antibiotics (2), diverticulum aspiration (2) and incision and drainage (1). Delivery was by the vaginal route in 2 women with diverticular aspiration being performed during the second stage to aid delivery in 1 woman. Caesarean section was performed in the other 2 women for reasons unrelated to the presence of the UD. Three women had diverticulectomy performed following pregnancy for persisting symptoms. Although uncommon, it is important to diagnose urethral diverticula given the associated morbidity and the potential for causing complications during pregnancy.     

掌侧锁定接骨板与普通接骨板治疗桡骨远端骨折疗效的比较

目的 比较掌侧锁定接骨板与普通接骨板治疗桡骨远端骨折的长期疗效.方法 对2005年9月-2007年11月间,采用切开复位掌侧锁定接骨板或普通接骨板内固定的45例随访资料完整的患者,进行两种疗法的比较.其中23例行锁定接骨板内固定,22例行普通接骨板内固定.按照AO分型:A型11例,B型11例,C型23例.随访内容包括:腕关节活动度(屈曲、背伸、尺偏、桡偏),前臂旋前、旋后活动范围,影像学资料(尺偏角、掌倾角、桡骨高度),应用DASH上肢功能评定标准和Gartland/Wertey腕关节评分法进行评分.结果 术后随访时间平均为18.8个月(12～36个月).腕关节活动度中,锁定板组背伸及两组的桡偏范围低于Gartland/Werley腕关节评分的基本范围.两组DASH值、腕关节活动度及前臂旋转范围,握力、捏力的恢复差异无统计学意义.Gartland/Werley腕关节评分普通接骨板治疗组优于锁定接骨板治疗组,差异有统计学意义.掌倾角均值两组都低于正常范围,尺偏角与桡骨高度均值在正常范围内,两组间差异无统计学意义.结论 掌侧锁定接骨板与普通接骨板在桡骨远端骨折治疗中具有相同疗效.     

蝶腭动脉电凝术治疗顽固性鼻出血

目的探讨鼻内镜下蝶腭动脉电凝术在临床治疗顽固性鼻出血中的可行性。方法本研究对2009年9月-2012年10月期间收住院的经常规治疗无效的6例鼻出血患者,于全身麻醉后在鼻内镜下根据解剖标志寻找蝶腭动脉,应用双极电凝烧灼,局部黏膜复位后可吸收性小块明胶海绵或止血纱布压迫。结果6例患者均完全止血,术后随访1～3个月,患者均无再次出血,未诉有特殊不适,复查未见鼻腔粘连,蝶腭动脉区黏膜愈合好。结论鼻内镜下蝶腭动脉电凝术治疗顽固性鼻出血疗效确切,是有效治疗顽固性鼻出血方法之一,也符合现代外科微创原则。     

掌侧锁定接骨板与普通接骨板治疗桡骨远端骨折疗效的比较

目的 比较掌侧锁定接骨板与普通接骨板治疗桡骨远端骨折的长期疗效.方法 对2005年9月-2007年11月间,采用切开复位掌侧锁定接骨板或普通接骨板内固定的45例随访资料完整的患者,进行两种疗法的比较.其中23例行锁定接骨板内固定,22例行普通接骨板内固定.按照AO分型:A型11例,B型11例,C型23例.随访内容包括:腕关节活动度(屈曲、背伸、尺偏、桡偏),前臂旋前、旋后活动范围,影像学资料(尺偏角、掌倾角、桡骨高度),应用DASH上肢功能评定标准和Gartland/Wertey腕关节评分法进行评分.结果 术后随访时间平均为18.8个月(12～36个月).腕关节活动度中,锁定板组背伸及两组的桡偏范围低于Gartland/Werley腕关节评分的基本范围.两组DASH值、腕关节活动度及前臂旋转范围,握力、捏力的恢复差异无统计学意义.Gartland/Werley腕关节评分普通接骨板治疗组优于锁定接骨板治疗组,差异有统计学意义.掌倾角均值两组都低于正常范围,尺偏角与桡骨高度均值在正常范围内,两组间差异无统计学意义.结论 掌侧锁定接骨板与普通接骨板在桡骨远端骨折治疗中具有相同疗效.     

CD44v6 mRNA及其蛋白表达与胃癌预后的关系

目的：探讨CD44v6 mRNA及其蛋白表达与胃癌预后的关系。方法：应用催化信号放大系统原位杂交和免疫组织化学技术，对17例早期胃癌、21例中期胃癌和57例晚期胃癌组织进行CD44v6 mRNA及其蛋白检测。结果：在胃癌中，CD44v6 mRNA及其蛋白的表达阳性率分别为85．3％和82．1％。CD44v6 mRNA及其蛋白表达阳性率在晚期胃癌明显高于早、中期胃癌（P＜0．05）。CD44v6 mRNA表达及其蛋白表达均与胃癌浆膜浸润、淋巴结转移和患者预后呈正相关（P＜0．05）。结论：CD44v6 mRNA及其蛋白表达可反映胃癌分化不良或晚期阶段，可作为预测预后的客观指标。     

Non-simulator-based techniques in teaching direct ophthalmoscopy for medical students: a systematic review

Non-simulator-based examination methods of the fundal examination have shown to be cost-effective.We reviewed different non-simulator-based direct fundoscopy examination methods used in undergraduate curricula and their outcomes.PubMed(MEDLINE) and Cochrane Database of Systematic Reviews were searched using standard Medical Subject Heading(MeSH) terms ophthalmoscopy,medical education,undergraduate medical education,medical student,educational assessment and learning.The search included publications until 28^thFebruary 2019.We obtained 34 articles after screening abstracts;of them,12 articles were included in the qualitative synthesis.The studies were comprised of diverse teaching methods which included fundal photograph matching with corresponding eye,continuous education using community-based eye clinics,formal instructions and demonstrations prior to skills training,ophthalmoscopy skills practice using eye pathologies,teaching versus conventional ophthalmoscopy and group-based teaching.We concluded that non-simulator-based techniques such as use of fundal photograph matching of an eye of a volunteer,introduction to eye pathologies,smaller student groups and formal instructions with video demonstrations prior to skills training were highly effective in teaching direct ophthalmoscopy for undergraduate medical students.     

Frequency of specific CD8+ T cells for a promiscuous epitope derived from Trypanosoma cruzi KMP‐11 protein in chagasic patients

The K1 peptide is a CD8 ⁺ T cell HLA‐A*0201‐restricted epitope derived from the Trypanosoma cruzi KMP‐11 protein. We have previously shown that this peptide induces IFN‐γ secretion by CD8⁺T cells. The aim of this study was to characterize the frequency of K1‐specific CD8⁺T cells in chagasic patients. Nineteen HLA‐A2⁺individuals were selected from 50 T. cruzi infected patients using flow cytometry and SSP‐PCR assays. Twelve HLA‐A*0201⁺noninfected donors were included as controls. Peripheral blood mononuclear cells were stained with HLA‐A2‐K1 tetramer, showing that 15 of 19 infected patients have K1‐specific CD8⁺T cells (0·09–0·34% frequency) without differences in disease stages or severity. Of note, five of these responders were A*0205, A*0222, A*0226, A*0259 and A*0287 after molecular typing. Thus, a phenotypic and functional comparison of K1‐specific CD8⁺T cells from non‐HLA‐A*0201 and HLA‐A*0201⁺infected patients was performed. The results showed that both non‐HLA‐A*0201 and HLA‐A*0201⁺individuals have a predominant effector memory CD8⁺T cell phenotype (CCR7?, CD62L?). Moreover, CD8⁺T cells from non‐HLA‐A*0201 and HLA‐A*0201⁺individuals expressed IL‐2, IFN‐γ and perforin without any differences. These findings support that K1 peptide is a promiscuous epitope presented by HLA‐A2 supertype molecules and is highly recognized by chagasic patients.     

体外诱导骨髓间充质干细胞向肾小管上皮样细胞分化

目的 观察不同条件下骨髓间充质干细胞（MSC）体外诱导分化为肾小管上皮样细胞的差异。 方法 抽取SD大鼠的骨髓,经密度梯度离心分离,联合贴壁筛选法获取纯化的MSC。以流式细胞仪鉴定间充质干细胞表面标志。取扩增3代的MSC分组培养：（1）对照组：用含胎牛血清培养基;（2）全反式维甲酸（ATRA）组：胎牛血清+缺血再灌注肾脏匀浆上清+ATRA;（3）联合诱导组：胎牛血清+缺血再灌注肾脏匀浆上清+ATRA+表皮生长因子（EGF）+骨形成蛋白（BMP-7）。诱导7 d后,倒置显微镜下观察细胞形态变化;化学染色检测细胞碱性磷酸酶表达;免疫细胞化学法检测细胞角蛋白18（cytokeratin-18）、E钙黏蛋白(E-cadherin)的表达。 结果 流式细胞仪显示,体外分离培养的第3代MSC,CD44阳性细胞表达率为97.8%±0.9%;CD90阳性细胞表达率为96.8%±1.4%;CD29阳性细胞表达率为97.6%±2.4%;而CD11b/c阳性细胞表达率为13.2%±0.6%; CD34阳性细胞表达率为1.2%±0.5%。诱导7 d后,与对照组长梭形细胞相比,ATRA组部分细胞为圆形、短梭形单层排列;联合诱导组的大部分细胞为圆形、短梭形,细胞密集处呈鹅卵石样排列。碱性磷酸酶染色显示,对照组细胞为阴性;ATRA组部分细胞阳性;联合诱导组阳性细胞数明显增多。免疫细胞化学显示,ATRA组和联合诱导组细胞cytokeratin-18阳性表达率分别为29.47%±1.08%和47.52%±2.13%,显著高于对照组（P ＜ 0.05）;E-cadherin阳性表达率分别为14.88%±2.46%和36.15%±1.13%,也显著高于对照组（P ＜ 0.05）。 结论 在体外模拟的急性肾衰竭微环境中加入ATRA可诱导MSC部分分化为肾小管上皮样细胞。联合EGF、BMP-7共同诱导能进一步促进MSC向肾小管上皮样细胞分化。