先天性阴道斜隔综合征临床特征及影像学诊断价值的初步研究

目的探讨先天性阴道斜隔综合征（OVSS）临床特征及影像学诊断价值。 方法回顾性分析2017年1月至2022年4月在北京协和医院手术的102例OVSS患者的临床及影像资料,以手术及病理结果为诊断标准,总结分析不同类型OVSS的临床特征及超声和MRI诊断结果。 结果102例OVSS患者中,Ⅰ型30例,Ⅱ型43例,Ⅲ型15例,Ⅳ型14例。Ⅰ型的发病年龄及初潮至发病时间间隔均显著小于其他3种类型（P均＜0.05）。痛经及腹痛在Ⅰ型（83.33%）及Ⅳ型（100.00%）的发生率明显高于Ⅱ型（44.19%）及Ⅲ型（40.00%）,差异均有统计学意义（P均＜0.05）。月经淋漓不尽在Ⅲ型（46.67%）的发生率明显高于Ⅰ型（10.00%）及Ⅳ型（0）,差异均有统计学意义（P均＜0.05）。阴道脓性分泌物在Ⅱ型（25.58%）的发生率明显高于Ⅰ型（0）,差异有统计学意义（P＜0.05）。右侧阴道斜隔56例（56/102,54.90%）,均合并右肾缺如（54.90%）;左侧阴道斜隔46例（46/102,45.1%）,伴有左肾缺如43例（42.16%）,左肾发育不良1例（0.98%）。102例患者均进行了超声检查,超声正确诊断双子宫双宫颈92例,正确诊断完全型纵隔子宫7例,超声诊断与手术符合率为97.06%（99/102）。82例进行了MRI检查,MRI正确诊断双子宫72例,正确诊断完全型纵隔子宫5例,MRI诊断与手术符合率为93.90%（77/82）。所有102例均进行了阴道斜隔切除术治疗,其中55.88%（57/102）进行了腹腔镜探查联合阴道斜隔切除术,19.61%（20/102）切除患侧子宫。Ⅳ型卵巢子宫内膜异位囊肿的发生率显著高于Ⅰ型及Ⅱ型（P均＜0.05）。Ⅳ型采用的腹腔镜探查联合阴道斜隔切除术及患侧子宫切除术明显多于其他3型（P均＜0.05）。 结论不同分型的OVSS临床特征有所不同,超声与MRI均可较好地早期诊断OVSS及其并发症,为手术方案的选择提供重要信息。     

Comparative immunocytochemical localization of enkephalin and somatostatin in the median eminence, hypothalamus and adjacent areas of the guinea-pig brain

Because of the presence of an enkephalin-related substance in the somatostatin terminals of the median eminence, an investigation was carried out on the staining for enkephalin of the somatostatin-containing perikarya localized in the hypothalamic periventricular nucleus. Only an occasional and weak enkephalin immunoreactivity was detected in these perikarya, making the common synthesis of the two peptides unlikely. Moreover, our results demonstrate an enkephalin staining in other fibers of the median eminence clearly distinct from the somatostatin ones. Enkephalin was demonstrated in perikarya distributed in the septum, preoptic area, dorsal and ventromedial hypothalamus, all regions known to possibly project into the median eminence. In none of these sites was enkephalin found in association with somatostatin. The present morphological results support the hypothesis that enkephalins may exert their GH-releasing effect at the hypothalamic level and suggest that enkephalins might directly modulate the somatostatin release into the blood of the portal plexus.     

Somatostatin connections between the hypothalamus and the limbic system of the rat brain

Somatostatin (SRIF) content of several brain structures was evaluated by radioimmunoassay in rats bearing various types of hypothalamic transections, as well as lesions of the amygdala. Analysis of the regional changes in SRIF concentrations after surgery suggest the following conclusions: (1) hypothalamic somatostatinergic neurons project to the limbic system, with the exception of the amygdaloid nuclei; (2) the olfactory tubercle, the lateral septal nucleus, the habenula and probably the hippocampus receive somatostatin projections from periventricular SRIF-containing cells; (3) somatostatin-containing fibers take a lateral course after leaving periventricular cells and join the medial forebrain bundle; (4) somatostatin innervation of the amygdala seems to be intrinsic.     

Hypercoagulability in patients with obstructive sleep apnea

BACKGROUND: Obstructive sleep apnea (OSA) has been linked to cardiovascular complications such as stroke and myocardial infarction. Previous studies demonstrate that OSA patients show elevated fibrinogen levels and increased platelet aggregation that are reversed with 1 night of nasal continuous positive airway pressure treatment (NCPAP). Questioning overall coagulability in OSA, we examined whole blood coagulability in 11 chronically NCPAP treated OSA subjects, 22 previously untreated OSA subjects, and in 16 of these after 1 night of NCPAP treatment. PATIENTS AND METHODS: During full polysomnography, subjects from each group had blood drawn prior to bedtime (21:00 h) and upon waking in the morning (07:00 h). RESULTS: Untreated OSA patients had faster P.M. clotting times than chronically treated OSA patients (3.33+/-0.31 versus 6.12+/- 0.66 min, P<0.05 by ANOVA). A.M. values showed similar results (4.31+/- 0.34 min versus 7.08+/-0.52 min, P<0.05 by ANOVA) for the respective groups. One overnight treatment with nasal CPAP did not produce a significant change in A.M. whole blood coagulability (4.35 +/-0.43 to 5.31+/-0.53 min; n=16; P=0.1) in 16 treated subjects. CONCLUSIONS: These data indicate a relationship between obstructive sleep apnea and blood hypercoagulability status that appears to be reversed by chronic NCPAP treatment. These data suggest that NCPAP might protect against the development of cardiovascular complications in OSA patients.     

Effect of treatment on serum glial cell line-derived neurotrophic factor in depressed patients

Post-mortem studies have demonstrated a decreased number of glia, reduced glial density, and a decreased glia/neuron ratio in different brain areas of patients diagnosed with a major depressive disorder (MDD). Researchers have therefore suggested that neurotrophic growth factor systems might be involved in the aetiology of MDD. This study aimed to test whether glial cell line-derived neurotrophic factor (GDNF), a member of the transforming growth factor beta family, in serum was associated with MDD. Serum concentrations were measured in MDD patients before treatment (n=76), after 8 weeks of antidepressant treatment (n=39), and in control subjects (n=50) using a sandwich ELISA method. Serum GDNF was significantly lower in MDD patients before treatment than in control subjects (P<0.001). From baseline to remission after 8 weeks of treatment, the increase in serum GDNF was statistically significant (P<0.001). The present study suggests that lower serum GDNF might be involved in the pathophysiology of MDD and antidepressant treatment increases the GDNF in MDD.     

Asymptomatic Lacrimal Flow Abnormalities in Patients with Septal Deviations and Turbinate Hypertrophy

Background: This study aimed to investigate the lacrimal flow in patients affected by septal deviations and turbinate hypertrophy and to evaluate changes after rhinoseptoplasty with dacryocystography (DCT) and computed tomographic dacryocystography (CT-DCT). Methods: The study prospectively recruited patients having septal deviations with or without turbinate hypertrophy who underwent surgical evaluation for correction of their respiratory symptoms and were not referred for epiphora. Patients were excluded if they had undergone surgery for cranial vault defects or had experienced septal deviations after traumatic accidents. All patients were studied with DCT and CT-DCT preoperatively and postoperatively. Results: A total of 24 patients (10 men and 14 women) were recruited for the study. Of these patients, 11 (45.8%) had a reduced flow of the medium contrast due to a partial obstruction at the level of the internal ostium. All 11 patients had septal deviations and turbinate hypertrophy, whereas 8 patients had a unilateral obstruction (72.7%), and 3 patients had a bilateral obstruction (27.3%). All flows were corrected after surgery. Conclusions: The safe and well-tolerated radiologic techniques performed in this study provided detailed imaging of the lacrimal outflow system. A high incidence of partial obstruction to the internal ostium was found in patients with septal deviations, turbinate hypertrophy, and no lacrimal symptoms, suggesting a frequent presymptomatic condition.     

Antimalarial activity of alkaloids isolated from Stephania rotunda

Stephania rotunda (Menispermaceae) is used in traditional medicine for the treatment of fever. Four major alkaloids: dehydroroemerine, tetrahydropalmatine, xylopinine, cepharanthine as well as aqueous extract (SA), dichloromethane extracts (SD1 and SD2) from this plant were tested against Plasmodium falciparum W2 in vitro. Dehydroroemerine, cepharanthine and SD1 were the most active against W2 with IC(50) of 0.36, 0.61microM and 0.7microg/mL, respectively. Their IC(50) on human monocytic THP1 cells were 10.8, 10.3microM and >250microg/mL, respectively. Cepharanthine, SD1 and SA were selected for in vivo antimalarial test against Plasmodium berghei in mice. The results of SD1 and SA at dose of 150mg/kg showed a decrease of 89 and 74% of parasitaemia by intra-peritoneal injection and 62.5 and 46.5% of parasitaemia by oral administration, respectively. The result of cepharanthine at dose of 10mg/kg showed a decrease of 47% of parasitaemia by intra-peritoneal injection and 50% of parasitaemia by oral administration. Drug interaction of chloroquine and major alkaloids indicates that cepharanthine-chloroquine and tetrahydropalmatine-xylopinine associations are synergistic. These results are in agreement with the use of this plant in the treatment of malaria. This is the first report on in vivo antimalarial investigation for Stephania rotunda.     

Relationship between frontal craniofacial morphology and horizontal balance of lip‐closing forces during lip pursing

The objectives of this study were to quantitatively evaluate the relationship between frontal craniofacial morphology and the horizontal balance of the lip‐closing forces (LCF) generated during maximum voluntary pursing‐like movements in patients with mandibular deviation. Thirty‐one subjects (median age 25·4 ± 8·9 years) without a history of orthodontic treatment were randomly selected from among the orthodontic patients who visited our hospital. Lip‐closing forces was recorded in eight directions during maximum voluntary pursing‐like lip‐closing movements. The subjects were divided into the deviation (two males and 11 females) and non‐deviation groups (four males and 14 females). There was no significant difference in the total LCF between the deviation and non‐deviation groups. In the deviation group, the mean LCF value on the deviation side of the upper lip was significantly lower than that detected on the non‐deviation side of the upper lip, while the mean LCF value for the deviation side of the lower lip was significantly higher than that for the non‐deviation side of the lower lip. In contrast, no significant difference in upper or lower lip LCF was detected between the deviation and non‐deviation sides in the non‐deviation group. The difference in the LCF generated in the lower lip between the deviation and non‐deviation sides was significantly positively correlated with mandibular menton deviation and significantly negatively correlated with the difference in maxillary height between the deviation and non‐deviation sides. These results suggest that the horizontal balance of the upper and lower lip LCF produced during pursing‐like lip‐closing movements in patients with mandibular deviation is related to frontal craniofacial morphology.     

Tolerance of low‐frequency ultrasound sonophoresis: a double‐blind randomized study on humans

Background: Sonophoresis [low‐frequency ultrasound (US)] has been used in animals and in vitro to investigate enhanced percutaneous absorption of drugs. No study focused on its clinical human tolerance has been published as yet. Methods: We aimed to assess the bioeffects of low‐frequency US in vivo on human skin in a double‐blind randomized‐controlled study. We applied pulse‐mode US at 36 kHz for 5 min in a step procedure of increasing dosage, from 1.57 to 3.50 W/cm², and placebo. The primary outcome was toxic effects of the procedure, defined as a pain score >40 on a 0–100 mm visual analogue scale or necrosis. Erythema (scored from 0 to 3 in severity) was also evaluated. The secondary outcomes were measurements of skin thickness by high‐resolution skin imaging, of skin capacitance and temperature. Results: We included 34 healthy volunteers. We found no pain score >38 and no skin necrosis with either US or placebo. Erythema was systematically observed immediately after US application, but after 1 day, we observed three cases in the knee group. The most frequent adverse effect was tinnitus. We observed no marked increase in temperature or cutaneous thickness after US or placebo. Cutaneous capacitance increased immediately after both applications. Conclusion: Such data demonstrating good tolerance of sonophoresis can be useful before the initiation of a clinical trial of the therapeutic use of low‐frequency sonophoresis in humans.