The predictive nature of uterocervical angles in the termination of second trimester pregnancy

Aim: To establish how useful and the predictive capacity of uterocervical angles (UCA) in the termination of second trimester pregnancies.

Material and methods: This prospective cohort study was conducted at a tertiary center with a total of 120 singleton pregnancies delivered between 14 and 24 gestational weeks. Before the beginning of misoprostol induction, patients were screened for both cervical length (CL) and uterocervical angles (UCA). The UCA is defined as an angle constructed by the measurement of the cervical canal and lower uterine segment. The study population was subdivided into four groups; successful and failed terminations at the end of 24?hours of induction and successful and failed terminations at the end of 48?hours of induction. We decided to further evaluate our study population based on their UCAs, and placed them into four categories; UCA ≥95°, UCA <95°, UCA ≥105°, and UCA <105°.

Results: In the 24-hour time frame group, the mean UCA was 105.50?±?15.38 degrees in the successful termination group and was 100.22?±?11.12 degrees in the failed group (p?=?.001). In the 48-hour time frame group, the mean UCA was 104.19?±?13.51° in the successful termination group and was 93.52?±?7.84° in the failed group (p?=?.007). The mean hour of induction was shortest in the UCA ≥105° group.

Conclusions: Regardless of the time frames, patients who had successful terminations had a broader angle, less amount of misoprostol use and shorter duration of induction as compared to the failed termination groups. What do the results of this study add? The uterocervical angle has never been measured in second trimester pregnancies to predict the timing of termination. Our study demonstrated the useful application of this ultrasonographic finding in the prediction of successful second trimester terminations.

Trial registration: ClinicalTrials.gov identifier: NCT03220607.     

EGFR-TKI治疗EGFR敏感突变的晚期NSCLC一线与二线疗效对比的研究进展

本文对近年来关于表皮生长因子络氨酸激酶抑制剂(EGFR-TKI)的多项研究进行分析：EGFR-TKI与传统化疗相比,无论一线还是二线治疗表皮生长因子(EGFR)突变的非小细胞肺癌(non-small cell lung cancer,NSCLC)患者均能够提高客观缓解率(objective response rate,ORR),延长无进展生存期(progression free survival,PFS),改善生活质量;应尽早明确患者基因突变状态,二线治疗进行基因检测也是十分必要的;对于EGFR敏感突变的患者,有研究显示EGFR-TKI一线治疗与二线治疗相比,能提高有效率及疾病控制率,但并未见PFS及总生存期(overall survival,OS)的延长。     

In utero exposure to second‐hand smoke activates pro‐asthmatic and oncogenic miRNAs in adult asthmatic mice

Exposures to environmental pollutants contribute to dysregulated microRNA (miRNA) expression profiles, which have been implicated in various diseases. Previously, we reported aggravated asthmatic responses in ovalbumin (OVA)‐challenged adult mice that had been exposed in utero to second‐hand smoke (SHS). Whether in utero SHS exposure dysregulates miRNA expression patterns in the adult asthma model has not been investigated. Pregnant BALB/c mice were exposed (days 6–19 of pregnancy) to SHS (10 mg/m³) or HEPA‐filtered air. All offspring were sensitized and challenged with OVA (19–23 weeks) before sacrifice. RNA samples extracted from lung homogenates, were subjected to RNA sequencing (RNA‐seq). RNA‐seq identified nine miRNAs that were most significantly up‐regulated by in utero SHS exposure. Among these nine, miR‐155‐5p, miR‐21‐3p, and miR‐18a‐5p were also highly correlated with pro‐asthmatic Th2 cytokine levels in bronchoalveolar lavage fluid. Further analysis indicated that these up‐regulated miRNAs shared common chromosome locations, particularly Chr 11C, with pro‐asthmatic genes. These three miRNAs have also been characterized as oncogenic miRNAs (oncomirs). We cross‐referenced miRNA‐mRNA expression profiles and identified 16 tumor suppressor genes that were down‐regulated in the in utero‐exposed offspring and that are predicted targets of the up‐regulated oncomirs. In conclusion, in utero SHS exposure activates pro‐asthmatic genes and miRNAs, which colocalize at specific chromosome locations, in OVA‐challenged adult mice. The oncogenic characteristics of the miRNAs and putative miRNA‐mRNA regulatory networks suggest that the synergistic effect of in utero SHS exposure and certain adult irritants may promote an oncogenic milieu in mouse lungs via inhibition of miRNA‐regulated tumor suppressor genes. Environ. Mol. Mutagen. 57:190–199, 2016. © 2016 Wiley Periodicals, Inc.     

Elliptical localization with pulsed second‐order fields (ECLIPSE) for robust lipid suppression in proton MRSI

Proton MRSI has great clinical potential for metabolic mapping of the healthy and pathological human brain. Unfortunately, the promise has not yet been fully achieved due to numerous technical challenges related to insufficient spectral quality caused by magnetic field inhomogeneity, insufficient RF transmit power and incomplete lipid suppression. Here a robust, novel method for lipid suppression in ¹H MRSI is presented. The method is based on 2D spatial localization of an elliptical region of interest using pulsed second‐order spherical harmonic (SH) magnetic fields. A dedicated, high‐amplitude second‐order SH gradient setup was designed and constructed, containing coils to generate Z2, X2Y2 and XY magnetic fields. Simulations and phantom MRI results are used to demonstrate the principles of the method and illustrate the manifestation of chemical shift displacement. ¹H MRSI on human brain in vivo demonstrates high quality, robust suppression of extracranial lipids. The method allows a wide range of inner or outer volume selection or suppression and should find application in MRSI, reduced‐field‐of‐view MRI and single‐volume MRS.     

Development and maturation of the fibrous components of the arterial roots in the mouse heart

The arterial roots are important transitional regions of the heart, connecting the intrapericardial components of the aortic and pulmonary trunks with their ventricular outlets. They house the arterial (semilunar) valves and, in the case of the aorta, are the points of coronary arterial attachment. Moreover, because of the semilunar attachments of the valve leaflets, the arterial roots span the anatomic ventriculo‐arterial junction. By virtue of this arrangement, the interleaflet triangles, despite being fibrous, are found on the ventricular aspect of the root and located within the left ventricular cavity. Malformations and diseases of the aortic root are common and serious. Despite the mouse being the animal model of choice for studying cardiac development, few studies have examined the structure of their arterial roots. As a consequence, our understanding of their formation and maturation is incomplete. We set out to clarify the anatomical and histological features of the mouse arterial roots, particularly focusing on their walls and the points of attachment of the valve leaflets. We then sought to determine the embryonic lineage relationships between these tissues, as a forerunner to understanding how they form and mature over time. Using histological stains and immunohistochemistry, we show that the walls of the mouse arterial roots show a gradual transition, with smooth muscle cells (SMC) forming the bulk of wall at the most distal points of attachments of the valve leaflets, while being entirely fibrous at their base. Although the interleaflet triangles lie within the ventricular chambers, we show that they are histologically indistinguishable from the arterial sinus walls until the end of gestation. Differences become apparent after birth, and are only completed by postnatal day 21. Using Cre‐lox‐based lineage tracing technology to label progenitor populations, we show that the SMC and fibrous tissue within the walls of the mature arterial roots share a common origin from the second heart field (SHF) and exclude trans‐differentiation of myocardium as a source for the interleaflet triangle fibrous tissues. Moreover, we show that the attachment points of the leaflets to the walls, like the leaflets themselves, are derived from the outflow cushions, having contributions from both SHF‐derived endothelial cells and neural crest cells. Our data thus show that the arterial roots in the mouse heart are similar to the features described in the human heart. They provide a framework for understanding complex lesions and diseases affecting the aortic root.     

第2骶椎骶髂螺钉最佳进钉通道的分析

目的　利用数字化仿真技术确定并测量第二骶椎骶髂螺钉最佳进钉通道参数。 方法　将2011年4月至2011年7月入院的8例无骨盆病变患者（男性4例,女性4例,年龄25~53岁）的CT数据集导入Mimics10.01进行三维重建,利用数字化仿真技术生成骶椎阴模,利用透视骶椎阴模确定S2骶髂螺钉最佳进钉通道,利用空间解析几何测量相关参数。 结果　8例共16侧资料的S2骶髂螺钉最佳进钉通道均能以此方法确定。最佳进钉通道参数：最大半径男性为（6.38±0.54）mm,女性为（4.9±0.74）mm;深度男性为（68.93±3.49）mm,女性为（58.43±8.16）mm;与矢状面夹角男性为（73.48±8.57）°,女性为（79.93±　5.29）°;与横截面夹角男性为（14.07±6.22）°,女性为（6.95±4.81）°;与冠状面夹角男性为（7.12±7.11）°,女性为（5.87±5.01）°。最佳进钉点及最佳进钉终点的确定方法为：在骨盆出口位X线透视图像上,作一边长分别水平及垂直并恰好包围骨盆的矩形,以左下角顶点为原点,左上角顶点为（0,1）,右下角顶点为（1,0）建立二维直角坐标系,进钉点坐标男性为（0.5±0.26,0.52±0.04）,女性为（0.49±0.24,0.47±0.10）;进钉终点坐标男性为（0.5±0.01,0.59±0.07）,女性为（0.5±0.02,0.49±0.14）。在骨盆入口位X线透视图像上,用相同的方法作一矩形并定义坐标系,进钉点坐标男性为（0.5±0.26,0.52±0.04）,女性为（0.49±0.24,0.47±0.10）,进钉终点坐标男性为（0.5±0.01,0.78±0.01）,女性为（0.5±0.02,0.81±0.03）。S2骶髂螺钉最佳进钉通道参数男女对比“最大半径”、“深度”、“与横截面夹角”、“进钉点前后相对位置”有统计学差异（P<0.05）,余无统计学差异。 结论　数字化仿真技术能精确确定S2骶髂螺钉最佳进钉通道参数。     

兰州地区孕中期产前筛查血清指标MoM值分析

目的分析兰州地区孕中期唐氏综合征（Down syndrome,Ds）筛查人群中位数分布并探讨其临床应用价值。方法采用时间分辨荧光分析法检测7172例妊娠14—20“周妊娠女性血清甲胎蛋白（alpha fetoprotein,AFP）和游离绒毛促性腺激素（free—beta human chorionic gonadotropin,Freeβ—HCG）的浓度。利用DS筛查风险评估软件（LifeCycle3．0,LC3．0）的MediansTool统计不同孕用AFP和Freeβ-HCG的人群中位数、体质量,对LC3．0的中位数方程、体质量校正方程系数进行修正。结果各孕周血清AFP中位数平均水平均比软件内嵌值低,而Freeβ-HCG中位数水平在孕17周前中位数高于软件内嵌值而孕17周后中位数则低于软件内嵌值。各体重血清AFP与软件内嵌值几乎吻合,而Freeβ-HCG中位数平均水平比软件内嵌值低。结论不同地区血清中位数的筛查切割值制定标准可能存在差异,有必要进一步建立本地区孕中期产前筛查人群中位数系统。     

以第1跖背动脉为蒂的足背皮瓣血供范围的解剖学研究

目的　通过墨汁灌注及血管铸形标本的制作,从解剖学探讨以第1跖背动脉为蒂的足背皮瓣的血供范围,为临床以第1跖背动脉为蒂的带足背皮瓣的第2足趾移植提供理论依据。 方法　将10侧新鲜截肢单足标本解剖分离后,从第1跖背动脉灌注墨汁,观测其染色范围。然后在显微镜下将皮瓣从深筋膜下掀起,观察细小皮支的染色范围。另取3侧标本,制作血管铸型标本。对测量结果进行统计学处理。 结果　(1)墨汁灌注染色：10侧标本染色范围为：内侧界达趾胫侧,外侧界达第3趾蹼间隙,远侧界达趾端,近侧界达跖跗关节。 (2)铸型标本观察：第1、2趾近端动脉分支分布密集,并可见第1、2、3跖背动脉之间的交通支。 结论　(1)以第1跖背动脉为蒂的足背皮瓣胫侧血供丰富,腓侧血供范围可达第3趾蹼腓侧。(2)在临床上设计带菱形或舵样足背皮瓣时,腓侧皮瓣不宜设计过大。     

Endobutton袢钢板与Rigidfix横穿钉股骨端固定自体腘绳肌腱重建前交叉韧带的转归

文题释义： 前交叉韧带重建：前交叉韧带是控制膝关节前向稳定的一个重要结构,包括前内侧和后外侧束。前交叉韧带对膝关节稳定提供了强有力的支持,当它出现完全断裂,膝关节会出现明显不稳定的情况。目前最常用的治疗方案为采用关节镜取腘绳肌等肌腱来重建交叉韧带,恢复膝关节的稳定性。 Rigidfix横穿钉：DePuy Mitek RIGIDFIX BIOCRYL股骨3.3 mm ST交叉钉为一种可吸收多聚乳酸和磷酸三钙植入物,用于重建前交叉韧带时,将软组织(半腱肌和股薄肌)移植物固定于股骨。 背景：固定方式的选择是影响前交叉韧带重建预后的重要因素,Endobutton袢钢板和Rigidfix横穿钉作为目前应用较为广泛的2种股骨端悬挂固定装置,它们的优点是固定强度大,肌腱与骨隧道接触面积大,有利于腱-骨愈合等。但这2种固定方法本身在临床疗效、骨隧道扩大等方面是否存在差异还有争议。 目的：探讨Endobutton袢钢板与Rigidfix横穿钉股骨端固定自体腘绳肌腱重建前交叉韧带术后的转归。 方法：回顾性分析2015年6月至2017年12月开展前交叉韧带重建并进行了第2次关节镜探查的 270例病例。所有患者对治疗方案均知情同意,且得到医院伦理委员会批准。根据股骨端固定方式将患者分成 2 组,Endobutton组150例采用Endobutton袢钢板行自体腘绳肌腱股骨端固定重建前交叉韧带;Rigidfix组120例采用Rigidfix横穿钉行自体腘绳肌腱股骨端固定重建前交叉韧带,2组胫骨端均采用Bioabsorbable Interference Screw+AO空心钉固定。采用 MRI 测量2组骨隧道扩大情况,采用Lysholm评分、国际膝关节文献委员会评分、Tenger评分表及抽屉试验、Lachman试验、轴移试验、KT-1000关节测量仪评价膝评价膝关节功能恢复情况及稳定性;术后1年二次关节镜探查时观察移植物连续性、移植物滑膜覆盖情况以及关节内是否有异常结构。 结果与结论：①所有患者均获得随访,随访时间14-44个月;②术后1年Endobutton组股骨端和胫骨端骨隧道扩大均较Rigidfix组明显(P < 0.05);③术后1年2组患者术后 Lysholm评分、Tegner评分、国际膝关节文献委员会评分均较术前改善(P < 0.05),2组间术后评分差异无显著性意义(P > 0.05);④术后1年2组膝关节活动度对比差异无显著性意义(P > 0.05);⑤二次探查前2组患者前抽屉试验、Lachman试验、轴移试验情况对比差异无显著性意义(P > 0.05);Endobutton组KT-1000侧-侧差值为(1.12±1.20) mm,Rigidfix组KT-1000侧-侧差值为(1.23±0.91)mm,2组对比差异无显著性意义(P > 0.05);⑥二次关节镜探查示Endobutton组患者移植物完全吸收1例、移植物磨损11例;Rigidfix组患者移植物完全吸收2例,移植物磨损15例,2组差异无显著性意义(P > 0.05);⑦二次探查时移植物滑膜覆盖程度Endobutton组优59例,良61例,差30例;Rigidfix组优47例,良49例,差24例,2组差异无显著性意义(P > 0.05);⑧Endobutton组术后并发症的发生率为2.6%,Rigidfix组为6.6%,2组差异无显著性意义(P > 0.05);⑨结果表明,Endobutton袢钢板与Rigidfix横穿钉股骨端固定自体腘绳肌腱重建前交叉韧带效果相当,二次探查移植物滑膜覆盖及连续性无明显差异;但与Rigidfix横穿钉系统相比,股骨端采用 Endobutton固定更易引起骨隧道扩大。 ORCID: 0000-0002-4264-8492(赵立连) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程