抗苗勒氏管激素评估卵巢储备功能的临床应用现状

卵巢储备功能指卵巢内存留卵泡的数量和质量,其能间接地反映女性的生育能力。抗苗勒氏管激素(anti-Müllerian hormone,AMH)作为卵巢特异性的生长因子,由颗粒细胞分泌,是预测卵巢储备功能的一个有效指标。血清AMH的水平可以预测卵泡池的大小、卵巢的反应性及女性的绝经年龄,同时可以评估癌症患者的卵巢储备功能。但AMH的测定值受到多种因素的影响,存在一定的局限性。     

Abutilon mosaic virus DNA B component supports mechanical virus transmission, but does not counteract begomoviral phloem limitation in transgenic plants

Different Nicotiana benthamiana lines stably transformed with Abutilon mosaic virus (AbMV) dimeric DNA B were capable of systemically spreading complete bipartite AbMV genomes, following agroinoculation of DNA A alone. Constitutively expressed viral movement protein (BC1) did not induce any persistent disease phenotype, but plants developed transient morphological abnormalities such as radially symmetric leaves after kanamycin withdrawal. Systemic AbMV infection produced symptoms and virus titers indistinguishable from those in non-transgenic plants. In systemically invaded leaves, the begomovirus remained phloem-limited, whereas the plants' susceptibility to mechanical transmission of AbMV was enhanced by a factor of three to five, as compared to non-transgenic controls. Hence, DNA B-encoded movement functions can complement local movement to the phloem after mechanical transmission, but fail to support viral invasion of non-phloem cells in systemically infected organs, indicating that the phloem restriction of AbMV does not result predominantly from a lack of transport competence in mesophyll tissues.     

On the Formation and Electropolymerization of a Star Copolymer With Peripheral Carbazoles

Utilizing a hyperbranched cored ring‐opening polymerization of caprolactone, carbazole peripheral groups are extended to afford electropolymerizable star‐like copolymers. Different arm lengths are obtained on the basis of different degrees of polymerization from the polyethyleneimine core. This is confirmed by NMR and Fourier transform IR (FTIR) spectroscopy, size‐exclusion chromatography (SEC), and quantitative spectral characterization. Atomic force microscopy (AFM) imaging shows two distinct particle aggregation characteristics, before and after functionalization with carbazole groups. Cyclic voltammetry verifies the electrochemical cross‐linking properties. The results indicate that the conformational freedom of the electroactive peripheral functional groups can be controlled. Moreover, an interesting “loop effect” together with solid‐state polymerization is observed.     

锥形束CT诊断颌面部异物1例

<正>张口受限为颌面外科的常见疾患,但颌面部异物引起张口受限多为个案报道[1-3]。准确定位异物位置及其形状大小,是外科手术取出异物,保证手术成功的关键。锥形束CT(cone beam computed tomography,CBCT)因其独特的三维成像特点,可以精确定位,更好地引导外科手术的顺利进行[4-6]。现对我院收治的1例颌面部异物引起的张口受限患者的临床资料进行报道,并结合文献回顾对CBCT在颌面异物诊断中的应用价值进行讨论。     

Assessing the 16 hour intern shift limit: Results of a multi-center,mixed-methods study of residents and faculty in general surgery

Background

The study explores how residents and faculty assess the ACGME's 16-h limit on intern shifts.

Availability and need of home adaptations for personal mobility among individuals with spinal cord injury

Objective: To identify the availability and unmet need of home adaptations (HAs) among the Swiss population with spinal cord injury (SCI).

Design: Cross-sectional study.

Setting: Swiss Spinal Cord Injury Community Survey 2012.

Participants: Individuals aged 16 or older with chronic SCI living in Switzerland.

Interventions: Not applicable.

Outcome measures: The availability of ten HAs (self-report) was analyzed by sex, age, living situation, indoor mobility, SCI severity, SCI etiology and time since SCI. The unmet need (self-report of not having a HA but needing it) of HAs was analyzed by financial hardship.

Results: Among the 482 study participants (mean age 55.2 years, standard deviation 15.0 years, 71.6% males), 85.1% had at least one HA. The most frequent HA was a wheelchair accessible shower (62.7%). Availability of HAs markedly varied with indoor mobility (e.g. 38.4% of participants using a wheelchair had a stair lift compared to 17.4% of those walking) and with SCI severity (e.g. 54.8% of those with complete paraplegia had a wheelchair accessible kitchen worktop compared to 26.0% of those with incomplete paraplegia). Unmet need was highest for adjustable kitchen worktops (78.7% of those with a need) and adjustable kitchen cabinets (75.7%) and lowest for wheelchair accessible showers (9.4%) and grab bars next to the toilet (8.5%). No significant differences in unmet need were found when stratifying for financial hardship.

Conclusion: Availability of HAs is dependent on indoor mobility and SCI severity. There is a considerable degree of unmet need for selected HAs, which couldn't be explained by financial hardship.     

Damage limitation in cosmetic dermatology

Good communication is the key to damage limitation. A complaint by a patient should be treated as a medical emergency as early effective communication will almost always neutralise patient anger. Legible and appropriate clinical notes are also important. Patients with depression and dysmorphophobia are potentially litigious, underlying the importance of patient selection.     

中药和限制门静脉血流对大鼠极限性肝叶切除早期残肝损害的影响

目的：探讨丹参针剂和限制门静脉血流对大鼠极限性肝叶切除（90％）后早期残肝损害的效应。方法：按Gaub的方法建立大鼠90％极限性肝叶切除模型，分别观察限制门静脉血流和加用丹参对大鼠手术后死亡率，残肝HE染色肝细胞中央静脉及汇管区的改变以及术后血生化的改变。结果：限制门静脉血流能减轻早期极限性肝叶切除后残肝的损害，加用丹参后能进一步减轻损害，但均不能改善实验动物的死亡率。结论：限制门静脉血流能减轻早期极限性肝叶切除后残肝的损害，加用丹参后能进一步减轻，但并不能引发残肝细胞再生的启动而延长动物的存活。     

Measurement of cerebral vascular extraction fractions in the rat using intracarotid injection techniques

A small volume (5 μl) common carotid arterial injection method is described for the quantitation of cerebral vascular extraction fractions (E_t) of diffusion limited tracer molecules in the rat. The method is a modification of a technique diffusion duced by Oldendorf and widely used for the study of blood-brain barrier phenomena. While the Oldendorf technique has proven valuable for estimating the relative permeabilities of substances, it is limited in measuring E_t under conditions of physiologically or pharmacologically altered permeability or blood flow. The method described in this paper — using a small volume (5 μl) common carotid injection, a freely diffusible reference tracer, [¹⁴C]butanol, and a 5 sec circulation time — allows for measurements of E_t that reflect changes in blood flow and small differences in permeability. The modified method is important for the study of the regulation of cerebral vascular permeability and flow in an inexpensive animal model.     

Reproducibility and validity of the Dutch translation of the de Morton Mobility Index (DEMMI) used by physiotherapists in older patients with knee or hip osteoarthritis

Jans MP, Slootweg VC, Boot CR, de Morton NA, van der Sluis G, van Meeteren NL. Reproducibility and validity of the Dutch translation of the de Morton Mobility Index (DEMMI) used by physiotherapists in older patients with knee or hip osteoarthritis.

Objective

To examine the reproducibility, construct validity, and unidimensionality of the Dutch translation of the de Morton Mobility Index (DEMMI), a performance-based measure of mobility for older patients.

Design

Cross-sectional study.

Setting

Rehabilitation center (reproducibility study) and hospital (validity study).

Participants

Patients (N=28; age >65y) after orthopedic surgery (reproducibility study) and patients (N=219; age >65y) waiting for total hip or total knee arthroplasty (validity study).

Intervention

Not applicable.

Main Outcome Measures

Not applicable.

Results

The intraclass correlation coefficient for interrater reliability was high (.85; 95% confidence interval, 71–.93), and minimal detectable change with 90% confidence was 7 on the 100-point DEMMI scale. Rasch analysis identified that the Dutch translation of the DEMMI is a unidimensional measure of mobility in this population. DEMMI scores showed high correlations with scores on other performance-based measures of mobility (Timed Up and Go test, Spearman r=−.73; Chair Rise Time, r=−.69; walking test, r=.74). A lower correlation of .44 was identified with the self-report measure Western Ontario and McMaster Universities Osteoarthritis Index.

Conclusions

The Dutch translation of the DEMMI is a reproducible and valid performance-based measure for assessing mobility in older patients with knee or hip osteoarthritis.