择期剖宫产术中胎头高浮娩头方法探讨

目的:探讨胎头高浮产妇择期子宫下段剖宫产取头困难方法。方法:术中用腰-硬外麻联合麻醉,改进子宫切口、加强术者与助手配合等方法娩头的80例为研究组;常规子宫下段剖宫产娩头的73例为对照组,对比两组的取头时间、产妇和新生儿并发症发生率。结果:对照组发生取头困难9例,占12.53%;研究组2例,占2.50%,差异有显著性(P<0.05)。平均取头时间研究组55 s,对照组105 s;研究组产妇并发症发生率明显低于对照组,差异有显著性(P<0.05);研究组新生儿窒息发生率也低于对照组,差异有显著性(P<0.05)。结论:改进后的娩头法较常规娩头法能迅速而顺利取出胎头,安全性较高,母儿并发症较少,是胎头高浮子宫下段剖宫产取头的一种有效方法。     

新化合物PPVP在大鼠动脉粥样硬化模型上抗动脉粥样硬化分子机制的研究

目的　研究新化合物PPVP抗动脉粥样硬化作用的分子机制。方法　在高血脂诱发大鼠早期动脉粥样硬化模型上 ,观察PPVP给药组动物血液及血管组织中重要的动脉粥样硬化相关因子表达的情况。结果　PPVP对血脂 ,ET 1和PGI2 水平无明显影响 ,但明显增加血清中NO含量 ,降低血清TXA2 含量 ,抑制趋化因子IL 8的过度表达。结论　PPVP的上述作用特点可能与其抗动脉粥样硬化作用相关     

心内膜垫缺损超声心动图与X线检查的对照分析

本文报道了２５例心内膜垫缺损的Ｘ线、心血管造影及超声心动图的对照分析，总结了３种方法各自的优缺点，并与手术结果进行了对照。     

孕产妇脑静脉窦及静脉血栓形成的早期诊断及误诊分析

脑静脉窦及静脉血栓形成(cerebral venous and sinus thrombosis,CVST)是缺血性脑血管病的特殊类型,好发于妊娠期和产褥期的孕产妇。发病率低,起病隐匿,临床表现错综复杂,易于误诊、漏诊,死亡率、致残率高,但早期诊断和干预则预后良好。本文重点就孕产妇CVST的早期诊断及误诊相关研究做一综述,以促进临床医师及早识别危险预警,避免误诊,早期诊断,及时干预。     

A novel rabbit disc degeneration model induced by fibronectin fragment

ObjectiveTo establish a novel and useful rabbit model of lumbar disc degeneration using microinjection of a fibronectin fragment.MethodsThirty-two rabbits underwent injection of N-terminal 30 kDa fibronectin fragment (Fn-f) (Group A, n = 12; Group B, n = 4) or phosphate buffered saline (PBS) (Group C, n = 12; Group D, n = 4) into the lumbar discs using a 32-gauge microsyringe. Two rabbits (Group E) with no treatment were sacrificed to examine the proteoglycan synthesis of neucleus pulposus (NP) using ³⁵S-sulfate incorporation assay. At the 4-, 8-, 12-, and 16-week time points, the discs were examined histologically, radiographically and with proteoglycan synthesis.Results(1) Histology demonstrated a progressive loss of cell numbers in NP and architecture disorganization in NP and annulus fibrosus (AF) over the study period. (2) Radiology: comparing with the PBS-injected discs, the Fn-f-injected discs exhibited no significant differences in disc heights at the 4-week time point, but significant decreases in disc heights at the 8-, 12-, and 16-week time points (P < 0.01). Apparent anterior osteophytes formed at the 12-week time point and enlarged remarkably by the 16-week time point in the Fn-f-injected spines. (3) Protoglycan synthesis in the Fn-f-injected discs decreased progressively (P < 0.01). At each time point, the Fn-f-injected discs showed significantly decreased proteoglycan synthesis compared with controls (P < 0.05 or P < 0.01).ConclusionsFn-f induced a progressively degenerative process in rabbit discs, which was consistent with the spontaneous degeneration in human. Fn-f induced degeneration seemed to be a novel and useful model for the study of disc degeneration at the molecular level.     

Ocular bacterial infections at a tertiary eye center in China: a 5-year review of pathogen distribution and antibiotic sensitivity

AIM: To provide statistical evidence for the use of antibiotics in ophthalmology by assessing the distribution and antibiotic sensitivity of bacterial isolates from ocular specimens with suspected microbial infections. METHODS: This study applied a retrospective analysis of 3690 bacterial isolates from ocular specimens, which were obtained from the conjunctiva, cornea, aqueous humor, vitreous body, and other ocular sites of the patients at Shandong Eye Institute in northern China from January 2013 to December 2017. The parameters assessed mainly included the distribution of isolated bacteria and the results of susceptibility tests for antibiotics. In the analysis of antibiotic sensitivities, the bacteria were divided into four groups according to gram staining, and statistical methods were used to compare their antibiotic sensitivities. RESULTS: Among the 3690 isolated bacterial strains, Staphylococcus epidermidis (2007, 54.39%) accounted for the highest proportion. As for the total isolates, their sensitivity rate to gatifloxacin was up to 90.01%, with four types of gram-stained bacteria being all highly sensitive to it, but their sensitivity rate to levofloxacin was only 51.91%. The sensitivity rate of gram-negative bacilli (G-B) to levofloxacin was 83.66%, significantly higher than the other three types of gram-stained bacteria (P<0.05). Gram-positive cocci (G+C, 97.95%) and gram-positive bacilli (G+B, 97.54%) were more sensitive to vancomycin than gram-negative cocci (G-C, 70.59%) and G-B (68.57%; P<0.05). For fusidic acid, the sensitivity rates of G+C (89.83%) and G+B (73.37%) were significantly higher than that of G-B (29.83%; P<0.05). The gram-negative bacteria’s sensitivity rate to cefuroxime was as low as 59.25%, but only G-B was less sensitive to cefuroxime (57.28%), while G-C was still highly sensitive (89.29%). The sensitivity rate of gram-positive bacteria to moxifloxacin was as high as 80.28%, but only G+C was highly sensitive to moxifloxacin (81.21%), while G+B was still less sensitive (32.00%). CONCLUSION: Staphylococcus epidermidis is the predominant isolate in all ocular specimens with bacteria. Gatifloxacin is more suitable for topical prophylactic use than levofloxacin in ophthalmology when necessary. Vancomycin and fusidic acid both have better effects on gram-positive bacteria than gram-negative bacteria. More accurate antibiotic sensitivity analysis results can be obtained when a more detailed bacterial classification and more appropriate statistical methods are performed.     

人周围血单核细胞载脂蛋白E基因表达的竞争性逆转录-聚合酶链反应定量分析

为建立人周围血单核细胞载脂蛋白E基因表达检测方法,研究载脂蛋白E基因与儿童健康的关系,我们抽取26例健康儿童外周静脉血,分离血单核细胞,抽提RNA,采用逆转录-聚合酶链式反应检测载脂蛋白E基因表达,并以正常人cDNA作定量标准物,待测样品与定量标准物共扩增,计算出待测样本的个体的mRNA量.研究发现载脂蛋白E基因能在健康儿童周围血单核细胞表达,健康儿童载脂蛋白E基因表达量为0.37±0.15 mol/mol mRNA.表明采用竞争性逆转录-聚合酶链反应方法来检测人周围血单核细胞载脂蛋白E基因表达的分析方法快速、简便、灵敏、实用、可靠,且能准确定量,值得推广应用.     

Preoperative prediction of tumour deposits in rectal cancer by an artificial neural network–based US radiomics model

To develop a machine learning–based ultrasound (US) radiomics model for predicting tumour deposits (TDs) preoperatively. From December 2015 to December 2017, 127 patients with rectal cancer were prospectively enrolled and divided into training and validation sets. Endorectal ultrasound (ERUS) and shear-wave elastography (SWE) examinations were conducted for each patient. A total of 4176 US radiomics features were extracted for each patient. After the reduction and selection of US radiomics features , a predictive model using an artificial neural network (ANN) was constructed in the training set. Furthermore, two models (one incorporating clinical information and one based on MRI radiomics) were developed. These models were validated by assessing their diagnostic performance and comparing the areas under the curve (AUCs) in the validation set. The training and validation sets included 29 (33.3%) and 11 (27.5%) patients with TDs, respectively. A US radiomics ANN model was constructed. The model for predicting TDs showed an accuracy of 75.0% in the validation cohort. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and AUC were 72.7%, 75.9%, 53.3%, 88.0% and 0.743, respectively. For the model incorporating clinical information, the AUC improved to 0.795. Although the AUC of the US radiomics model was improved compared with that of the MRI radiomics model (0.916 vs. 0.872) in the 90 patients with both ultrasound and MRI data (which included both the training and validation sets), the difference was nonsignificant (p = 0.384). US radiomics may be a potential model to accurately predict TDs before therapy. • We prospectively developed an artificial neural network model for predicting tumour deposits based on US radiomics that had an accuracy of 75.0%. • The area under the curve of the US radiomics model was improved than that of the MRI radiomics model (0.916 vs. 0.872), but the difference was not significant (p = 0.384). • The US radiomics–based model may potentially predict TDs accurately before therapy, but this model needs further validation with larger samples.     

上皮性卵巢癌满意减灭术后TP、CBP方案化疗的疗效比较

背景与目的:上皮性卵巢癌的治疗以手术加化疗的综合治疗最为有效.手术强调彻底性,化疗方案目前多认为TP(paclilaxel,carboplatin/cisplatin)为优选,但仍有争论.本研究回顾性对照分析满意减灭术后,应用TP和CBP(cyclophosphamide,bleomycin,carboplatin/cisplatin)方案作为一线化疗方案的两组患者的生存情况,旨在比较TP和CBP方案作为上皮性卵巢癌满意减灭术后一线化疗方案的疗效.方法:选取满意减灭术后应用TP方案为一线化疗方案的患者60例和以CBP方案为一线方案的患者65例,分别比较其3年生存率、3年无瘤生存率、3年内复发病例的无进展生存期、3年生存分析和无瘤生存分析,以及主要的不良反应.结果:CBP、TP两组3年生存率分别为69.2%、75.3%(P=0.473);3年无瘤生存率分别为38.5%、43.3%(P=0.580);3年内复发病例的中位无进展生存期分别为12个月、13个月(P=0.672);比较两组3年生存分析和无瘤生存分析曲线,P值分别为0.285和0.517.两组间比较差异均无显著性.各项不良反应除周围神经毒性外,两组之间的差异也无显著性.结论:对满意减灭术后上皮性卵巢癌患者用TP方案化疗的效果与传统CBP方案相当.