多普勒超声对双胎输血综合征外周血流变化的研究

双胎输血综合征（ＴＴＴＳ）近年来已越来越引起妇产科临床的关注。本文应用多普勒超声对１１例ＴＴＴＳ胎儿的外周血流进行评价，以探讨两胎儿间不同的血流动力学形式及对妊娠后期危险性预测，结果：１、供、受血儿脐动脉搏动指数（ＰＩ）值明显高于正常组（Ｐ＜０．０１）；２、外周动脉－降主动脉（ＤＡＯ）及大脑中动脉（ＭＣＡ）ＰＩ值和峰值（Ｖｍ）降低（Ｐ＜０．０１）；３、妊娠晚期受血儿充血性心衰加重时脐静脉出现搏动性血流及心内房室瓣返流，结论：外周血流多普勒频谱改变为ＴＴＴＳ的诊断和治疗提供了准确的资料，ＴＴＴＳ胎儿的多普勒超声监测有助于降低围产期死亡率     

Extracellular vesicles derived from injured vascular tissue promote the formation of tertiary lymphoid structures in vascular allografts

Tertiary lymphoid structures (TLS) accumulate at sites of chronic injury where they function as an ectopic germinal center, fostering local autoimmune responses. Vascular injury leads to the release of endothelial‐derived apoptotic exosome‐like vesicles (ApoExo) that contribute to rejection in transplanted organs. The purpose of the study was to evaluate the impact of ApoExo on TLS formation in a model of vascular allograft rejection. Mice transplanted with an allogeneic aortic transplant were injected with ApoExo. The formation of TLS was significantly increased by ApoExo injection along with vascular remodeling and increased levels of antinuclear antibodies and anti‐perlecan/LG3 autoantibodies. ApoExo also enhanced allograft infiltration by γδT17 cells. Recipients deficient in γδT cells showed reduced TLS formation and lower autoantibodies levels following ApoExo injection. ApoExo are characterized by proteasome activity, which can be blocked by bortezomib. Bortezomib treated ApoExo reduced the recruitment of γδT17 cells to the allograft, lowered TLS formation, and reduced autoantibody production. This study identifies vascular injury‐derived extracellular vesicles (ApoExo), as initiators of TLS formation and demonstrates the pivotal role of γδT17 in coordinating TLS formation and autoantibody production. Finally, our results suggest proteasome inhibition with bortezomib as a potential option for controlling TLS formation in rejected allografts.     

Vascular examination predicts functional outcomes in supracondylar humerus fractures: a prospective study

PurposeThis article prospectively examines the functional outcome measures following management of vascular insult secondary to paediatric supracondylar humerus fractures (SCHFX) using validated outcome measures.MethodsThe three-year, prospective, IRB-approved study consecutively enrolled operative SCHFX patients. Clinical data included presence and symmetry of the radial pulse in injured and uninjured extremities, Doppler examination of non-palpable (NP) pulses and perfusion status of the hand. Pediatric Outcomes Data Collection Instruments (PODCI) and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) Measures were used to assess functional outcome at final follow-up. Multiple regression analysis was used to determine the relationship between the presence of a vascular abnormality and functional outcome while controlling for other injury parameters.ResultsA total of 146/752 enrolled patients (mean age 6.8 years; range 2 years to 13 years) completed functional outcome measures at final follow-up. Of these, 20 (14%) patients had abnormal vascular exams at presentation: nine (6%) with palpable asymmetric pulse and 11 (7.5%) with NP pulse. Of those with NP pulses, nine/11 (6%) were Dopplerable and two (1.5%) lacked identifiable Doppler signal. Patients with a symmetric, palpable pulse demonstrated better PODCI pain and comfort scores (95.2 versus 85.2) (p < 0.0001), and QuickDASH scores (10.9 versus 21.6) (p < 0.007) compared to those with any abnormal vascular examination. Patients with palpable pulses, regardless of symmetry, demonstrated significantly higher PODCI pain and comfort scores (94.6 versus 84.7) (p < 0.003) than NP pulses.ConclusionsIn children with operative SCHFX, an abnormal vascular examination at presentation is predictive of poorer outcomes in pain and upper extremity function. A palpable pulse, versus NP, is predictive of better pain and comfort at final follow-up.Level of evidenceII     

Plasminogen activator inhibitor‐1: a potential etiological role in livedoid vasculopathy

Livedoid vasculopathy (LV) is a chronic, recurrent skin disorder with unknown aetiology and pathogenesis that seriously affects the quality of life of people who suffer from it. Plasminogen activator inhibitor (PAI)‐1 is a primary inhibitory component of the endogenous fibrinolytic system in blood coagulation. PAI‐1 also plays a role in many other physiological processes and activities, including thrombosis, fibrosis, wound healing, angiogenesis, inflammation, cell migration, and adhesion. Enhanced expression and genotype polymorphism of PAI‐1 have been observed in LV patients. In this review, we summarise the known functions of PAI‐1 with emphasis on the roles that PAI‐1 probably plays in the pathogenesis of LV, thereby illustrating that PAI‐1 represents a potential LV biomarker and therapeutic target for treating LV.     

透明质酸注射填充的不良反应及处理

作为最常用的注射用软组织填充剂,透明质酸可通过代替丢失的组织体积并填充、撑平粗糙的皱纹,以帮助恢复年轻的外貌。但在大量的临床实践中,难免会遇到注射相关的不良反应,甚至是血管栓塞等严重并发症。掌握透明质酸注射填充的不良反应及处理方法,在临床操作中具有重要的意义,本文将常见的不良反应及处理方法逐一进行总结,包括注射反应、丁达尔现象、结节和隆起、充填物迁移、感染、过敏反应、炎性肉芽肿和血管栓塞,并重点阐述了透明质酸酶在多种不良反应中的应用和血管栓塞的防治方法。