前列腺动脉的解剖及临床意义

前列腺动脉的起源和走行具有较高的变异性;传统解剖学中的前列腺动脉描述与活体影像解剖的表现有部分差异;正确辨认前列腺动脉及其与周围血管的吻合是血管内介入诊疗前列腺疾病的首要和关键.     

IN VIVO EFFECT OF HEPARIN PRETREATMENT OF SMALL-CALIBER DECELLULARIZED XENOGRAFT

Objective To develop a new vascular xenograft and to compare the in vivo behavior of thrombogenicity and intimal hyperplasia in the heparin-treated and the non-heparin-treated decellularized xenografts. Methods Canine common carotid arteries were decellularized by enzymatic and detergent extraction procedures. Then a part of decellularized vascular grafts were covalently linked with heparin. Xenagrafts with （ n = 24） and without （n = 24） heparin treatment were implanted in rabbits＇ left and right carotid artery respectively as bypass grafts. Graft patency were checked by Duplex ultrasonography at 3 and 6 months after implantation. Twelve rabbits were euthanized randomly at 3 and 6 months respectively and bilateral grafts were explanted. Histological examination and immunohistochemical staining were performed to observe the vascular remodeling. The efficiency of heparin release was demonstrated with toluidine blue staining. HE staining and micrograph analysis system were used for valuating the intima hyperplasia （1H） of bilateral grafts. Results During implantation, thrombosis rate was 4% in the heparin-treated xenografts and 25% in the non-heparin-treated xenografls after 3 weeks （ P 〈0. 05）. After 6 months, it was 8% versus 58% respectively （ P 〈 0. 01 ）. Both xenografls of two groups harvested at the end of 3 or 6 months showed a satisfactory cellular reconstruction of either smooth muscle cells or endothelial cells. Intimal hyperplasia in the heparin-treated vascular was less than in the non-heparin treated xenografls. In addition, intimal hyperplasia was liable to appear close to the proximal and distal anastomotic stoma. Toluidine blue staining demonstrated that heparin was slowly released during 6 months. Conclusion This study provides a new strategy to develop a small-caliber vascular xenograft through enzymatic-detergent extraction and heparin treatment. Heparin treatment of the decellularized xenografi is helpful for improving bypass graft patency and reducing intimal hyperplasia. If there was no thrombus, bilateral bypass grafts will undergo a vessel remodeling procedure. Canine common carotid artery treated by detergent and enzymatic extraction and heparin treatment may be used as a new small-caliber vascular xenografi.     

子宫内膜增生症及早期子宫内膜癌保留生育功能后冻胚移植妊娠结局

目的 探讨子宫内膜复杂性增生/不典型增生/早期子宫内膜癌保留生育力治疗后冻胚移植子宫内膜准备方案对妊娠结局的影响。方法 回顾性分析2015年1月至2020年12月于山东大学附属生殖医院门诊经体外受精或卵细胞质内单精子注射行冻胚移植的经保留生育功能治疗后逆转的子宫内膜复杂性增生/不典型增生/早期子宫内膜癌患者的临床资料,纳入了112例患者的179个冻胚移植周期,按冻胚移植子宫内膜准备方案分为4组：自然周期组(n=29)、促排卵周期组(n=38)、直接替代周期组(n=89)、降调+替代周期组(n=23)。比较分析各组的临床特征和妊娠结局,采用二分类Logistic回归分析影响患者活产率的因素。结果 在179个周期中,促排卵周期组与自然周期组、直接替代周期组和降调+替代周期组比较,其妊娠周期活产率(34.2%、31.0%、31.5%、30.4%)、活产率(46.7%、31.8%、34.8%、22.2%)、妊娠周期临床妊娠率(52.6%、37.9%、49.4%、43.5%)、妊娠周期生化妊娠率(65.8%、44.8%、64.0%、47.8%)更高,自然周期组妊娠周期流产率低于其他3组(18.2...     

Reactivation of codogenic endogenous retroviral (ERV) envelope genes in human endometrial carcinoma and prestages: Emergence of new molecular targets

Endometrial carcinoma (EnCa) is the most common invasive gynaecologic carcinoma. Over 85% of EnCa are classified as endometrioid, expressing steroid hormone receptors and mostly involving pathological prestages. Human endogenous retroviruses (ERV) are chromosomally integrated genes, account for about 8% of the human genome and are implicated in the etiology of carcinomas. The majority of ERV envelope (env) coding genes are either not present or not consistently represented between common gene expression microarrays. The aim of this study was to analyse the absolute gene expression of all known 21 ERV env genes including 19 codogenic and two env genes with premature stop codons in EnCa, endometrium as well as in hyperplasia and polyps. For EnCa seven env genes had high expression with >200 mol/ng cDNA (e.g. envH1-3, Syncytin-1, envT), two middle >50 mol/ng cDNA (envFc2, erv-3) and 12 low <50 mol/ng cDNA (e.g. Syncytin-2, envV2). Regarding tumor parameters, Syncytin-1 and Syncytin-2 were significantly over-expressed in advanced stage pT2 compared to pT1b. In less differentiated EnCa Syncytin-1, erv-3, envT and envFc2 were significantly over-expressed. Syncytin-1, Syncytin-2 and erv-3 were specific to glandular epithelial cells of polyps, hyperplasia and EnCa using immunohistochemistry. An analysis of 10 patient-matched EnCa with endometrium revealed that the ERV-W 5'' long terminal repeat regulating Syncytin-1 was hypomethylated, including the ERE and CRE overlapping MeCP2 sites. Functional analyses showed that 10 env genes were regulated by methylation in EnCa using the RL95-2 cell line. In conclusion, over-expressed env genes could serve as indicators for pathological pre-stages and EnCa.     

Thoracic Computed Tomographic Manifestations of Tuberous Sclerosis in Adults

The purpose of this article is to illustrate the various manifestations that can be encountered on thoracic computed tomography of tuberous sclerosis in adults. The pulmonary findings include lymphangioleiomyomatosis and multifocal micronodular pneumocyte hyperplasia. The extrapulmonary manifestations are divided into cardiac, vascular, mediastinal, osseous, and upper abdominal findings.     

股骨髁锁定钢板结合重建锁定钢板治疗股骨远端骨折

2007年1月～2010年6月,我科采用切开复位股骨髁锁定钢板结合重建锁定钢板内固定治疗股骨远端骨折28例,疗效满意,报道如下。1材料与方法1.1病例资料本组28例,男20例,     

肝局灶性病变CT与MRI动态增强对照研究

目的:探讨肝局灶性病变在CT和MRI动态增强中的影像差异及其原因,以提高对CT及MRI各自动态增强表现的认识。方法:搜集17例肝脏局灶性病变患者的临床资料,其中7例肝细胞肝癌,5例海绵状血管瘤,2例腺瘤,2例局灶结节性增生,1例转移瘤。全部病例均分别行CT及MRI的平扫和三期动态增强扫描;MRI采用SE序列加快速扰相梯度回波序列,将CT和MR动态增强图像进行对照观察,包括动态增强各期的强化范围、强化方式和强化幅度,强化幅度的比较用病灶密度(信号)与肝脏密度(信号)的比值进行比较。结果:肝癌、腺瘤和局灶结节性增生在CT与MRI上强化范围相似。1例肝癌动脉期强化幅度MRI大于CT,3例肝癌和2例局灶结节性增生门脉期及延迟期强化幅度MRI大于CT,2例腺瘤增强各期强化幅度MRI均大于CT,以动脉期差异最大。5例海绵状血管瘤强化范围动脉期及门脉期MRI大于CT,延迟期则相仿。1例转移瘤CT增强各期均未见明显强化,MRI门脉期及延迟期可见环状强化。结论:肝局灶性病变CT与MRI动态增强表现存在一定的差异,主要表现为部分病变增强各期强化幅度MRI大于CT,尤以动脉期差异最大;部分病变增强范围MRI大于CT。     

子宫畸形伴处女膜闭锁和一侧肾脏缺如1例

患儿女,13岁,主因“腹痛,逐渐加重5天,排尿困难1天”急诊人院.既往史及家族史无异常,月经初潮未至.查体:腹部平软,下腹部压痛,无反跳痛及腹肌紧张;外阴阴毛女性分布,未见阴道开口,相应部位处女膜闭锁并轻度膨出,黏膜颜色正常.肛门指诊:直肠前壁扪及约10 cm×8cm质中包块,压痛明显.超声;右肾体积轻度增大(图1),形态饱满,包膜光滑,皮质回声低匀,锥体较清,肾窦呈复合回声,盏盂无异常分离;左肾区未见明显肾脏回声;子宫前位,形态、大小正常,包膜光滑,肌层回声均匀,官腔线清晰、居中,内膜无增厚;阴道明显扩张,约112 mm×73 mm×78 mm,内充满浮点状弱回声液性暗区(图2).超声提示:阴道积液(考虑处女膜闭锁可能);左肾缺如;右肾代偿性增大.于局麻下行处女膜切开引流术,排出黏稠血液约80 ml.     

Sellar chordoma presenting as pseudo-macroprolactinoma with unilateral third cranial nerve palsy

We described a 61‐year‐old female with a sellar chordoma, which presented as pseudo‐macroprolactinoma with unilateral third cranial nerve palsy. Physical examination revealed that her right upper lid could not be raised by itself, right eyeball movement limited to the abduction direction, right pupil dilated to 4.5 mm with negative reaction to light, and hemianopsia in bitemporal sides. CT scanning showed a hyperdense lesion at sellar region without bone destruction. Magnetic resonance imaging (MRI) revealed the tumor was 2.3 cm×1.8 cm×2.6 cm, with iso‐intensity on T1WI, hyper‐intensity on T2WI and heterogeneous enhancement on contrast imaging. Endocrine examination showed her serum prolactin level increased to 1,031.49 mIU/ml. The tumor was sub‐totally resected via pterional craniotomy under microscope and was histologically proven to be a chordoma. Postoperatively, she recovered uneventfully but ptosis and hemianopsia remained at the 6th month.     

腔内超声对多囊卵巢综合征并发子宫内膜增生症的诊断价值

 目的 探讨腔内超声对多囊卵巢综合征(polycystic ovarian syndrome,PCOS)并发子宫内膜增生(endometrial hyperplasia,EH)的诊断价值.方法 对89例PCOS患者根据是否合并EH进行分组,包括合并EH组(n=13)和不合并EH组(n=76).超声检查内容,观察子宫内膜厚度、卵巢血流参数以及子宫动脉血流参数变化.结果 PCOS并发EH组的子宫内膜厚度明显大于对照组,差异有统计学意义(P＜0.05).子宫动脉搏动指数和阻力指数小于未并发EH组,差异有统计学意义(P＜0.05).PCOS并发EH组和未并发EH组的卵巢阻力指数(RI)差异无统计学意义(P＞0.05).结果 显示PCOS并发EH组患者的子宫内膜增厚,卵巢血流丰富,子宫动脉阻力指数明显减低.结论 腔内超声诊断对于PCOS并发EH诊断具有重要的临床意义.