两种阴道缩窄术矫正阴道松弛症的疗效分析

目的探讨改良阴道后壁修补术和阴道后壁环肌紧缩术的手术要点和效果,评价两种手术的优点及适应证。方法将42例不同程度阴道松弛的患者分为两组,其中24例行改良阴道后壁修补术,18例行阴道后壁环肌紧缩术,分析观察两组患者手术时间、术中出血量、术后伤口愈合情况,1年后评价两组患者的性生活满意度及阴道的松紧度。结果两种手术方法的手术时间、术中出血量及术后伤口愈合情况无明显差异,但1年后的远期效果包括性生活满意度和阴道的松紧度有明显差异。结论矫正阴道松弛症的目的不仅要达到解剖的恢复,更重要的是恢复功能。要根据患者的实际情况选择最佳的手术方法(A组优于B组)。     

Severe constrictive pericarditis as an unsuspected cause of death in a patient with idiopathic hypereosinophilic syndrome and restrictive cardiomyopathy

A 43-year-old man with idiopathic hypereosinophilic syndrome survived a relatively long term (6 1/2 years) before he succumbed to intractable heart failure. Six months before death, his chronic heart failure from restrictive cardiomyopathy was well compensated. Autopsy demonstrated severe constrictive pericarditis which was not suspected antemortem. Constrictive pericarditis as a late complication of idiopathic hypereosinophilic syndrome is discussed.     

Wnt3a信号通路通过JMJD6的表观遗传修饰参与神经病理性疼痛

目的：探讨Wnt3a通过Jumonji C结构域6( Jumonji C domain 6,JMJD6)的表观遗传修饰在神经病理性疼痛 中发挥作用的机制。方法：将SD大鼠分为4组：Sham组,慢性缩窄性损伤(chronic constriction injury,CCI)组,CCI+阴性慢病毒表达载体(LV-NC)组;CCI+慢病毒过表达载体(LV-JMJD6)组。构建SD大鼠坐骨神经CCI模型和JMJD6慢病毒 表达载体。CCI术后第3天通过鞘内导管给药,按照分组分别给予生理盐水和含慢病毒的试剂(病毒滴度1×108 TU/mL) 各20 μL。监测大鼠的机械缩足阈值(paw withdrawal mechanical threshold,PWMT)和热缩足潜伏期(paw withdrawal thermal latency,PWTL),并运用蛋白质印迹法检测脊髓水平Wnt3a及NR2B蛋白的表达变化,免疫共沉淀检测JMJD6与Wnt3a之间是否存在直接相互作用。结果：与Sham组相比,CCI术后各组大鼠的PWMT明显降低和PWTL明显缩短(P<0.05)。与CCI组和CCI+LV-NC组相比,CCI+LV-JMJD6组的PWMT在术后第10和14天明显升高,PWTL在术后第14 天明显延长(P<0.05)。CCI术后第14天,CCI组及CCI+LV-NC组Wnt3a和NR2B蛋白表达水平较Sham组明显升高,鞘内注 射慢病毒载体后, CCI+LV-JMJD6组的Wnt3a和NR2B蛋白表达水平较CCI+LV-NC组降低(P<0.05)。免疫共沉淀结果显示Wnt3a与JMJD6之间无直接相互作用。结论：Wnt3a参与调节神经病理性疼痛,其作用可能与JMJD6的表观遗传修饰相关,两者可能通过间接相互作用进行调节。     

Two‐dimensional speckle tracking cardiac mechanics and constrictive pericarditis: systematic review

Transthoracic echocardiography has a pivotal role in the diagnosis of constrictive pericarditis (CP). In addition to the classic M‐mode, two‐dimensional and Doppler indices, newer methodologies designed to evaluate myocardial mechanics, such as two‐dimensional speckle tracking echocardiography (2DSTE), provide additional diagnostic and clinical information in the context of CP. Research has demonstrated that cardiac mechanics can improve echocardiographic diagnostic accuracy of CP and aid in differentiating between constrictive and restrictive ventricular physiology. 2DSTE can also be used to assess the success of pericardiectomy and its impact on atrial and ventricular mechanics. In the course of this review, we describe cardiac mechanics in patients with CP and summarize the influence of pericardiectomy on atrial and ventricular mechanics assessed using 2DSTE.     

Effusive-Constrictive Pericarditis After Pericardiocentesis: Incidence,Associated Findings,and Natural History

Objectives

This study sought to investigate the incidence, associated findings, and natural history of effusive-constrictive pericarditis (ECP) after pericardiocentesis.

Hemodynamics of constrictive pericarditis and restrictive cardiomyopathy

Constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM) are indolent disabling diseases of diastolic function. The two conditions share common pathophysiologic features, resulting in similar and overlapping clinical presentations, echocardiographic findings, and hemodynamic characteristics. However, their clinical course differs, as CP is surgically curable whereas RCM is a chronic condition managed medically. Separating these two entities is based on delineation of anatomic and physiologic derangements employing multimodality hemodynamic interrogation by advanced imaging techniques (Echo–Doppler, CT, and especially MRI) combined with sophisticated invasive hemodynamics.     

结核所致缩窄性心包炎的临床病理分析

目的 总结结核所致缩窄性心包炎的临床特点与病理改变.方法 对北京协和医院2000至2007年诊断的150例缩窄性心包炎病例的临床表现与病理特征进行回顾性分析.结果 在150例患者中,61例(40.7%)无心包积液史.超声心动图诊断心包缩窄149例,与手术诊断的一致率为98.7%(107/109).118例(78.7%)诊断为结核性,24例(16.0%)为肿瘤转移或浸润、放射性损伤、心脏手术后等其他原因,8例(5.3%)原因不明.经病理或病原学检查确诊为结核性心包炎者占16.7%(25/150);有心包外活动性结核病理证据者占5.3%(8/150);有典型的结核病临床表现或因抗结核治疗有效诊断者占44.0%(66/150);临床怀疑结核者占12.7%(19/150).108例患者接受心包剥脱术,1例行心包活检和心包切开引流术.死亡13例(8.7%),4例为结核.结论 结核仍然是缩窄性心包炎的最常见病因.心包结核多为全身结核病的一部分,但心包病理和病原学检查阳性率低.超声心动图对诊断缩窄性心包炎具有较高的实用价值.