早期妊娠稽留流产患者术后转归的临床观察

目的：　观察一系列保护女性生育能力的干预措施应用在早期妊娠稽留流产患者手术治疗后的效果及在此类人群中获益情况。方法：　对293例早期妊娠稽留流产的手术治疗患者给予围手术期规范处理及全程贯彻流产后关爱（post-abortion care,PAC）服务,观察术中出血、子宫穿孔等并发症发生情况,随访其术后恢复、再生育及意外妊娠情况。结果：　通过规范围手术期操作,手术治疗术中并发症发生率极低,临床效果肯定,术后有生育意愿者术后6个月内再次妊娠占比为20.22%,1年内再次妊娠占比为46.45%。通过围手术期优质PAC服务,术后患者避孕意识明显提高,1年内无生育计划者意外妊娠率为1.82%。结论：　围手术期规范手术操作、提供优质PAC服务,降低了术中并发症的发生率,提高了早期妊娠稽留流产患者再次妊娠率,减少了意外妊娠,保护了女性生育能力。     

基于“主客浑受”学说探析胰腺癌之发生发展及转移

胰腺癌素被冠有“癌王”之称,其起病隐匿,发病率及病死率在国内外均具有上升趋势。癌浊之毒损及胰腑,总以湿热、血瘀二者胶结,相因为患,脾气亏虚,气机壅遏,阴阳气不相顺接为要。“主客浑受”学说由清代温病学家薛生白提出,主要描述为湿热交作,瘀热互结,脉络受损,阴血耗伤之象,以通络祛瘀,清热化湿为治疗总则,辅以行气散结,益气扶正,培补营血。笔者通过临床观察及复习文献资料发现,“主客浑受”所阐释的病理状态与胰腺癌的发展、转移具有高度相似之处,文章试通过“主客浑受”学说浅析胰腺癌发展转移规律及治则治法。     

机器人辅助腹腔镜与传统腹腔镜关于全子宫切除术在不同体质指数患者中的对比研究

目的 比较机器人辅助腹腔镜与传统腹腔镜关于全子宫切除术在不同体质指数患者中的安全性及可行性。方法 回顾性收集2016年2月至2021年4月于重庆医科大学附属第一医院接受了机器人辅助腹腔镜全子宫切除术（n=416）和传统腹腔镜全子宫切除术（n=725）患者的病例资料。按照不同等级体质指数（body mass index,BMI）对患者进行分层（非超重、超重和肥胖）,比较2组中各BMI亚组间患者的围术期情况、术中及术后并发症。结果 机器人组中超重亚组的手术时间短于传统腹腔镜组［（125.37±50.92） min vs. （135.68±44.55） min］,机器人组中3个BMI亚组的术中出血量均少于传统腹腔镜组［（60.46±45.20） mL vs. （92.88±105.13） mL、（72.01±62.03） mL vs. （115.02±123.38） mL及（65.59±37.92） mL vs. （125.16±96.07） mL］,机器人组中超重亚组和肥胖亚组的首次排气时间均短于传统腹腔镜组［（2.04±0.83） d vs. （2.19±0.63） d和（1.97±0.54） d vs. （2.19±0.54） d］,差异均有统计学意义（P<0.05）。机器人组中各BMI亚组术中及术后总体并发症发生率仍低于腹腔镜组,但差异无统计学意义（P>0.05）。结论 超重和肥胖患者的全子宫切除术,机器人辅助腹腔镜相较于传统腹腔镜在围术期降低并发症等方面有一定优势。     

The Antarctic ozone hole and the pattern effect on climate sensitivity

Since about 1980, the tropical Pacific has been anomalously cold, while the broader tropics have warmed. This has caused anomalous weather in midlatitudes as well as a reduction in the apparent sensitivity of the climate associated with enhanced low-cloud abundance over the cooler waters of the eastern tropical Pacific. Recent modeling work has shown that cooler temperatures over the Southern Ocean around Antarctica can lead to cooler temperatures over the eastern tropical Pacific. Here we suggest that surface wind anomalies associated with the Antarctic ozone hole can cause cooler temperatures over the Southern Ocean that extend into the tropics. We use the short-term variability of the Southern Annular Mode of zonal wind variability to show an association between surface zonal wind variations over the Southern Ocean, cooling over the Southern Ocean, and cooling in the eastern tropical Pacific. This suggests that the cooling of the eastern tropical Pacific may be associated with the onset of the Antarctic ozone hole.

Since about 1979, the tropical eastern Pacific Ocean has cooled, while the western tropical Pacific Ocean has warmed. This pattern of sea surface temperature (SST) change has been identified with a reduction in absorbed solar radiation that has slowed the response of global surface temperature to increasing greenhouse gases (1–3). The primary mechanism that relates this SST change pattern to a reduction in apparent climate sensitivity is the development of enhanced boundary layer clouds over the cooler SST region, which reflect more solar radiation and thereby cool the planet. It is important to understand whether this pattern effect is natural variability or part of the forced response to climate change, as this may determine how long the pattern effect will persist and thereby slow the effect of greenhouse gases on global warming. In addition, the pattern of SST trend since 1979 resembles a La Niña event, which has known impacts on seasonal climate around the world, including increasing the probability of drought in the western United States (4). Here we review some recent research on the connection between changes in the Southern Ocean (SO) and changes in the tropical Pacific Ocean. Arguing from connections established in the published literature, we outline a mechanism to connect the reduction in stratospheric ozone in the Antarctic region to cooling of the tropical eastern Pacific. In this mechanism, a surface wind shift in high latitudes associated with the Antarctic ozone hole (5) triggers a cooling of the SO, which, through feedback processes involving atmospheric circulation, low-cloud feedbacks, and ocean current changes, leads to a cooling in the eastern tropical Pacific Ocean. We show, in observations, a connection between stronger winds over the SO, reduced SST there, and associated cooler ocean temperatures in the tropical eastern Pacific Ocean. If this mechanism is what has produced the SST trends since 1980, then we may expect the eastern tropical Pacific to remain relatively cool as the rest of the tropical oceans warm. This would have important consequences for apparent climate sensitivity and for the structure of climate change in the Pacific and for North and South America.     

APE/Ref-1对细胞因子的调节及与肿瘤的关系

无嘌呤无嘧啶核酸内切酶(apurinic/apyrim idinicendonuclase,APE)又名氧化还原因子1(redox factor1,Ref1),是一种多功能蛋白,除了修复AP位点外,还保持很多转录因子包括AP1、NFκB、CREB、ATF、myb、Pax、HIF1α、HLF、Egr1、NF Y、p53和PEBP2等活性还原状态,对维持DNA的稳定和调节细胞因子的表达具有重要作用。APE/Ref1基因定位于人染色体14q11.212,在体内是一种广泛表达的基因,有胞质表达、胞核表达及胞质和胞核同时表达三种表达模式,与细胞的分化成熟过程有关。APE/Ref1蛋白的不正常表达、分布及功能改变与细胞凋亡、肿瘤发生、神经系统退行性疾病和老年化等病理过程密切相关。对APE1/Ref1功能的深入研究对提高肿瘤相关性疾病的诊治水平必有重大意义。     

Comparison of glucose time in range and area under curve in range in relation to risk of diabetic retinopathy in type 2 diabetes patients

Aims/introductionWe proposed a novel continuous glucose monitoring (CGM)‐based metric, area under the curve in range (AucIR), for integrating both the amplitude and duration of dysglycemia, and further compared AucIR with the emerging key CGM‐derived metric, time in range (TIR).Materials and methodsA total of 2,030 adult patients with type 2 diabetes were enrolled during May 2020 to October 2021. AucIR and TIR were measured with 7‐day CGM data. Logistic regression analysis and the C‐statistic was carried out to assess the association of AucIR and TIR with diabetic retinopathy (DR).ResultsBoth AucIR (r = −0.89) and TIR (r = −0.95) were strongly correlated with mean glucose levels. Compared with TIR, AucIR showed a tighter relationship with parameters of glycemic variability, including the coefficient of variation (r = −0.56), standard deviation (r = −0.89) and mean amplitude of glycemic excursions (r = −0.70). For each absolute 10% decrease in AucIR, the risk of DR was increased by 7% (95% confidence interval 1.02–1.13) after adjustment for confounders. With respect to TIR, each absolute 10% decrease was associated with an 8% (95% confidence interval 1.03–1.14) increased risk of DR. The model discrimination for DR, as measured by C‐statistic, did not differ significantly between the two metrics (P > 0.05).ConclusionsAucIR did not provide added benefit over TIR in the assessment of DR risk among patients with type 2 diabetes. The potential value of AucIR needs to be explored in future studies.     

用小鼠精子畸形试验评价正海生物膜遗传毒性的研究

目的用小鼠精子畸形试验评价正海生物膜引起遗传毒性的可能性。方法参照中华人民共和国国家标准《小鼠精子畸形试验》(GB15193.7-94)的方法及指导原则进行试验。结果正海生物膜三种浓度浸提液与阴性对照组相比小鼠精子畸形率无显著性差异(P>0.05)。结论正海生物膜用小鼠精子畸形试验评价不会引起遗传毒性。     

健康教育对水中分娩产妇影响的研究

[目的]了解健康宣教对产妇水中分娩的影响。[方法]选择2006年10月-2008年4月符合水中分娩条件的46例产妇为实验组,对符合水中分娩的产妇及家属进行水中分娩健康教育,以同期进行传统分娩的产妇61例为对照组。对两组产妇产后的疼痛强度、隐私满意度、体位舒适度及两组活跃期及第二产程时间进行比较。[结果]两组产妇疼痛强度及体位舒适度经比较差异有统计学意义,隐私满意度差异无统计学意义。[结论]在符合水中分娩条件下,通过健康宣教可促进水中分娩顺利进行。     

In Situ Nano-Indentation of a Gold Sub-Micrometric Particle Imaged by Multi-Wavelength Bragg Coherent X-ray Diffraction

The microstructure of a sub-micrometric gold crystal during nanoindentation is visualized by in situ multi-wavelength Bragg coherent X-ray diffraction imaging. The gold crystal is indented using a custom-built atomic force microscope. A band of deformation attributed to a shear band oriented along the (221) lattice plane is nucleated at the lower left corner of the crystal and propagates towards the crystal center with increasing applied mechanical load. After complete unloading, an almost strain-free and defect-free crystal is left behind, demonstrating a pseudo-elastic behavior that can only be studied by in situ imaging while it is invisible to ex situ examinations. The recovery is probably associated with reversible dislocations nucleation/annihilation at the side surface of the particle and at the particle-substrate interface, a behavior that has been predicted by atomistic simulations. The full recovery of the particle upon unloading sheds new light on extraordinary mechanical properties of metal nanoparticles obtained by solid-state dewetting.     

Biodegradable Polymer Nanosheets Incorporated with Zn-Containing Nanoparticles for Biomedical Applications

So far, poly(L-lactic acid), PLLA nanosheets proved to be promising for wound healing. Such biodegradable materials are easy to prepare, bio-friendly, cost-effective, simple to apply and were shown to protect burn wounds and facilitate their healing. At the same time, certain metal ions are known to be essential for wound healing, which is why this study was motivated by the idea of incorporating PLLA nanosheets with Zn²⁺ ion containing nanoparticles. Upon being applied on wound, such polymer nanosheets should release Zn²⁺ ions, which is expected to improve wound healing. The work thus focused on preparing PLLA nanosheets embedded with several kinds of Zn-containing nanoparticles, their characterization and ion-release behavior. ZnCl₂ and ZnO nanoparticles were chosen because of their different solubility in water, with the intention to see the dynamics of their Zn²⁺ ion release in liquid medium with pH around 7.4. Interestingly, the prepared PLLA nanosheets demonstrated quit similar ion release rates, reaching the maximum concentration after about 10 h. This finding implies that such polymer materials can be promising as they are expected to release ions within several hours after their application on skin.