妊娠期糖尿病患者产后糖代谢异常转归影响因素分析

目的探讨妊娠期糖尿病(GDM)患者产后糖代谢异常(AGM)转归及其影响因素。方法选择2019年1月至12月,于四川大学华西第二医院孕期被诊断为GDM,并于产后4~12周进行75 g口服葡萄糖耐量试验(OGTT)筛查的1175例单胎妊娠产妇为研究对象。根据其产后糖代谢是否正常,将其分为研究组(n=361,产后AGM者)与对照组(n=814,产后糖代谢正常者)。采用回顾性分析方法,收集受试者一般临床资料及孕期与产后4~12周75 g OGTT结果等,并采用成组t检验或χ^(2)检验进行统计学分析。对GDM患者产后AGM转归相关影响因素进行单因素分析与多因素非条件logistic回归分析,探讨其AGM转归的独立影响因素。本研究遵循的程序符合病例收集医院伦理委员会制定的伦理学标准,得到该伦理委员会批准[审批文号:医学科研2021伦审批第(181)号]。结果①24~28孕周时,1175例GDM患者75 g OGTT结果提示,空腹血糖(FPG)及OGTT 1、2 h血糖指标中,1、2、3项升高者分别为639例(54.4%)、373例(31.7%)与163例(13.9%)。②产后4~12周时,1175例GDM患者75 g OGTT结果提示,产后糖代谢正常者为814例(69.3%),AGM为361例(30.7%),包括空腹血糖受损(IFG)为19例(1.6%),糖耐量受损(IGT)为294例(25.0%),IFG+IGT为23例(2.0%),疑似2型糖尿病(T2DM)患者为25例(2.1%)。③产后AGM转归影响因素的单因素分析结果显示,研究组GDM患者年龄、糖尿病家族史发生率,24~28孕周OGTT 1、2 h血糖值,以及2项血糖指标(OGTT 1、2 h血糖)均升高与3项血糖指标(FPG及OGTT1、2 h血糖)均升高者所占比例,均显著高于对照组,而研究组仅1项血糖指标(FPG或OGTT 1 h血糖)升高者所占比例,则显著低于对照组,2组比较,差异均有统计学意义(P<0.05)。④多因素非条件logistic回归分析结果:模型1将受试者年龄、糖尿病家族史及24~28孕周OGTT 1、2 h血糖值进行多因素logistic回归分析结果显示,糖尿病家族史及24~28孕周OGTT 1、2 h血糖值,均为GDM患者产后AGM转归的独立危险因素(OR=1.693、1.205、1.355,95%CI:1.208~2.373、1.088~1.335、1.204~1.524,P=0.002、<0.001、<0.001)。模型2将受试者年龄、糖尿病家族史、24~28孕周OGTT血糖指标升高项目进行多因素logistic回归分析结果显示,糖尿病家族史及24~28孕周OGTT 2项血糖指标(OGTT 1、2 h血糖)升高与3项血糖指标均升高,均为GDM患者产后AGM转归独立危险因素(OR=1.668、1.421、1.747,95%CI:1.192~2.333、1.035~1.952、1.195~2.553,P=0.003、0.030、0.004);24~28孕周仅FPG或OGTT 1 h血糖升高为其独立保护因素(OR=0.401、0.646,95%CI:0.240~0.670、0.418~0.997,P<0.001、=0.048)。结论对于GDM患者产后AGM转归,临床应关注其年龄、糖尿病家族史、孕期OGTT结果等指标。对GDM高危人群进行上述指标持续监测与规范干预,是健全GDM孕前-孕期-产后全程管理的重要环节。     

前部增生性玻璃体视网膜病变引起慢性低眼压房水生成率的测定

目的：探讨前部增生性玻璃体视网膜病变（anterior prolieferative vitreoretinopathy,aPVR)低眼压状态下房水生成率变化,从房水动力学的角度揭示aPVR引起慢性低眼压的发病机制。方法：利用培养的同种兔皮肤成纤维细胞制作aPVR引起慢性低眼的动物模型。于术前及术后不同时间点分别观测眼压、术后14d,28d,56d分别以高效液相色谱仪测量房水荧光素清除率,进一步计算房水生成率。结果：术后2周、4周、8周实验组平均眼压、房水生成率明显低于对照组（P＜0．05或P＜0．01）。结论：在aPVR病理状态下,低眼压的形成与房水生成率下降有关。     

雷公藤多甙片加益肾活血法治疗IgM相关性肾小球疾病

目的探讨IgM相关性肾小球疾病的治疗。方法53例患者分为雷公藤多甙片组(A组)和雷公藤多甙片＋中药益肾活血(B组)治疗,疗程2个月。结果两组治疗前后尿蛋白均下降（P＜0．05）,组间比较则B组降低更明显(P＜0．05)。尿红细胞均有减少,A组P＞0．05,B组P＜0．05;组间比较P＜0．05。结论雷公藤多甙片＋中药益肾活血法治疗IgM相关性肾小球疾病较单用雷公藤多甙片疗效显著提高。认为辨病辨证相结合组方用药,能够提高疗效。     

氧化氮-环磷酸鸟苷通路在支气管哮喘发病机制中的作用

目的 :探讨一氧化氮 -环磷酸鸟苷 (NO- c GMP)通路在支气管哮喘发病机制中的作用。方法 :给 10名健康人、13例缓解期哮喘病人及 2 9例发作期哮喘患者诱导痰液 ,检测诱导痰液中 NO2 - /NO3- 及 c GMP的水平。并对其中 11例哮喘发作期患者应用强的松 (30 mg/d) ,治疗 1周的前后进行自身对照研究。结果 :哮喘发作期患者 NO2 - /NO3-水平显著高于健康对照者 [(4 0 6 .34± 5 12 .18) μmol/L,(71.80± 10 0 .98) μmol/L,P<0 .0 1],应用激素后患者在症状、体征好转的同时 ,NO2 - /NO3-和 c GMP的水平均有明显下降 ,稳定期哮喘患者的 NO2 - /NO3-水平同正常人相比差异无显著性。结论 :NO- c GMP通路可能在哮喘的发病中起重要作用 ,诱导痰 NO2 - /NO3- 的测定是无创伤性检测哮喘气道炎症的一项简便易行的实用方法。     

前列腺增生症伴有神经源性排尿功能障碍的处理

目的：提高对前列腺增生症伴有神经源性排尿功能障碍的认知和处理水平。方法：回顾分析14例前列腺增生症伴有神经源性排尿功能障碍患者的临床资料、尿动力学检查、诊断、处理及预后情况。结果：14例中行前列腺电气化9例,趾骨上经膀胱前列腺摘除术1例,膀胱永久造瘘2例,药物保守治疗2例。电气化患者1例出现永久性尿失禁,1例术后1年又出现增生,经再次气化治疗后痊愈,其余患者排尿均明显改善,残余尿减少或消失。结论：前列腺增生症伴有原性尿功能障碍并不少见,通过细致的检验和尿动力学检查,明确神经性排尿功能障碍的严重程度,选择恰当的治疗方案能够改善排尿症状,减少永久膀胱造瘘,最大限度地提高病人的生活质量。     

上田法对脑瘫儿运动功能改善的疗效评价

目的　为了研究上田法与Vojta等法对脑瘫儿运动功能改善情况。方法　将 5 8例脑瘫儿 (包括 3岁以上及重症脑瘫儿 )分为年龄相同的两组 ,分别采用上田法与Vojta等法治疗 ,疗程≥ 1个月。 结果　上田组的坐位功能改善较Vojta组明显 (P <0 0 1)。在上田组中 ,3岁以上脑瘫儿治疗前、后总分平均为 (5 7 0 4± 31 92 )分和 (78 5 2± 2 0 83)分 ,重症脑瘫儿治疗前、后总分平均为 (10 5 4± 9 6 1)分和 (31 5 2± 15 0 3)分。而Vojta组中 ,3岁以上脑瘫儿治疗前、后总分平均为 (73 33± 31 86 )分和 (80 37± 2 4 76 )分 ,重症脑瘫儿治疗前、后总分平均为 (2 3 5 5± 2 1 98)分和 (2 9 33± 2 5 2 1)分。结论　上田法对脑瘫儿坐位功能改善优于Vojta等法 ,尤其对 3岁以上脑瘫儿及重症脑瘫儿效果更佳     

胃癌中P16与MDM2的免疫组化研究

目的 :检测胃肿瘤及正常胃组织中P16与MDM2的表达 ,探讨其在肿瘤凋亡中的相互关系。方法 :采用免疫组织化学方法 (SABC法 )。结果 :胃癌中P16阳性率为 69% ,MDM2阳性率为 75 % ,它们与正常胃组织及良性胃肿瘤相比差异均有显著性 (P <0 .0 5 )。结论 :在胃癌的细胞凋亡中 ,P16与MDM2均发挥了其各自对细胞凋亡的作用 ,为临床胃癌的组织学检测提供了理论依据 ,同时也支持胃癌的发生是多基因协同作用的过程     

Anticoagulation therapy for pulmonary embolism involving a myxoma mimicking,giant type C thrombus: A case report

Right heart thrombus (RHTh) with concurrent acute pulmonary embolism (PE) is rare and can seriously destabilize hemodynamics, leading to an emergency situation with high mortality. Diagnosis and treatment of RHTh with acute PE are not yet standardized. There are few reports of acute PE concurrent with RHTh and even less is known about patients with a right heart mural thrombus. For physicians, the diagnostic choice and treatment of these patients are particularly difficult due to the lack of knowledge. Here, we report a rare case of partial mural RHTh (type C RHTh) with acute PE. The mural mass in the right heart was initially diagnosed as atrial myxoma according to transthoracic echocardiography (TTE), and both pulmonary embolus and the mural mass were completely absorbed after administering Rivaroxiban. This case suggests that TTE alone is insufficient to identify and diagnoses a right heart mural mass such as this. However, novel oral anticoagulants may be effective at alleviating PE with type C RHTh.     

Clinicopathological characteristics,prognosis, and chemosensitivity in patients with metastatic upper tract urothelial carcinoma

PurposeTo investigate the clinical characteristics, chemosensitivity, and outcome of metastatic upper tract urothelial carcinoma (UTUC).Patients and MethodsRecords of patients with metastatic UTUC since January 2005 were retrieved from a database that included clinical and survival data. Statistical analyses including survival and multivariate analyses of factors were respectively performed by the Kaplan-Meier method and Cox proportional hazard model.ResultsA total of 250 consecutive UTUC cases were evaluated. There were 56 patients (22.4%) with initially diagnosed stage IV disease. The most common metastatic sites were lung (39.6%), distant lymph nodes (39.2%), bone (19.6%), liver (18.0%), and adrenal gland (7.2%), respectively, and the local recurrence rate was 10.4%. Two hundred thirteen patients received first-line chemotherapy. The overall response rate was only 28.7% and the median progression-free survival time was only 5.0 months. The overall survival time of the cohort was 18.0 months. Multivariate analyses showed that initially diagnosed stage IV disease, number of metastatic organs ≥3, no response to chemotherapy and cycles of chemotherapy ≤2 were adverse prognosticators for overall survival.ConclusionUTUC presented to be more prone to metastasize than locally recur and thought to have low chemosensitivity. Stage IV disease at initial diagnosis, number of metastatic organs, response and cycles of chemotherapy were independent prognosticators for metastatic UTUC.     

Changing Levels of Social Engagement with Gay Men Is Associated with HIV Related Outcomes and Behaviors: Trends in Australian Behavioral Surveillance 1998–2020

Archives of Sexual Behavior - Changes to how gay, bisexual, and other men who have sex with men (GBM) connect with each other and with their communities have implications for HIV prevention. Social...