缩宫素联合B-Lynch缝扎术治疗产后出血的临床疗效分析

目的:观察缩宫素联合B-Lynch缝扎术治疗产后出血的临床效果和安全性。方法:将2011年7月至2012年9月在我院接受治疗的120例患者随机分成两组,对照组接受传统综合治疗,治疗组接受缩宫素联合B-Lynch缝扎术治疗,比较两组术中、术后12h以及术后24h出血量、输血人数、住院天数,子宫切除人数;比较两组术后并发症,同时观察两组患者术后血清性激素水平,了解不同术式对卵巢功能的影响。结果:治疗组术中、术后12h以及术后24h出血量均少于对照组,差异有显著性(p0.05);治疗组和对照组输血人数、住院天数,子宫切除人数相比,无统计学差异(P0.05);治疗组受试者严重贫血、术后发热、产后出血的人数少于对照组,差异有统计学意义(P0.05);两组刀口愈合不良人数差异无显著性(P0.05);两组患者术后血清性激素水平相比较无统计学差异(P0.05)。结论:缩宫素联合B-Lynch缝扎术治疗产后出血安全可靠,疗效确切。     

Early onset of craniosynostosis in an Apert mouse model reveals critical features of this pathology

Activating mutations of FGFRs1-3 cause craniosynostosis (CS), the premature fusion of cranial bones, in man and mouse. The mechanisms by which such mutations lead to CS have been variously ascribed to increased osteoblast proliferation, differentiation, and apoptosis, but it is not always clear how these disturbances relate to the process of suture fusion. We have reassessed coronal suture fusion in an Apert Fgfr2 (S252W) mouse model. We find that the critical event of CS is the early loss of basal sutural mesenchyme as the osteogenic fronts, expressing activated Fgfr2, unite to form a contiguous skeletogenic membrane. A mild increase in osteoprogenitor proliferation precedes but does not accompany this event, and apoptosis is insignificant. On the other hand, the more apical coronal suture initially forms appropriately but then undergoes fusion, albeit at a slower rate, accompanied by a significant decrease in osteoprogenitor proliferation, and increased osteoblast maturation. Apoptosis now accompanies fusion, but is restricted to bone fronts in contact with one another. We correlated these in vivo observations with the intrinsic effects of the activated Fgfr2 S252W mutation in primary osteoblasts in culture, which show an increased capacity for both proliferation and differentiation. Our studies suggest that the major determinant of Fgfr2-induced craniosynostosis is the failure to respond to signals that would halt the recruitment or the advancement of osteoprogenitor cells at the sites where sutures should normally form.     

Jagged1 functions downstream of Twist1 in the specification of the coronal suture and the formation of a boundary between osteogenic and non-osteogenic cells

The Notch pathway is crucial for a wide variety of developmental processes including the formation of tissue boundaries. That it may function in calvarial suture development and figure in the pathophysiology of craniosynostosis was suggested by the demonstration that heterozygous loss of function of JAGGED1 in humans can cause Alagille syndrome, which has craniosynostosis as a feature. We used conditional gene targeting to examine the role of Jagged1 in the development of the skull vault. We demonstrate that Jagged1 is expressed in a layer of mesoderm-derived sutural cells that lie along the osteogenic-non-osteogenic boundary. We show that inactivation of Jagged1 in the mesodermal compartment of the coronal suture, but not in the neural crest compartment, results in craniosynostosis. Mesodermal inactivation of Jagged1 also results in changes in the identity of sutural cells prior to overt osteogenic differentiation, as well as defects in the boundary between osteogenic and non-osteogenic compartments at the coronal suture. These changes, surprisingly, are associated with increased expression of Notch2 and the Notch effector, Hes1, in the sutural mesenchyme. They are also associated with an increase in nuclear β-catenin. In Twist1 mutants, Jagged1 expression in the suture is reduced substantially, suggesting an epistatic relationship between Twist1 and Jagged1. Consistent with such a relationship, Twist1-Jagged1 double heterozygotes exhibit a substantial increase in the severity of craniosynostosis over individual heterozygotes. Our results thus suggest that Jagged1 is an effector of Twist1 in coronal suture development.     

Reproductive isolation between phylogeographic lineages scales with divergence

Phylogeographic studies frequently reveal multiple morphologically cryptic lineages within species. What is not yet clear is whether such lineages represent nascent species or evolutionary ephemera. To address this question, we compare five contact zones, each of which occurs between ecomorphologically cryptic lineages of skinks from the rainforests of the Australian Wet Tropics. Although the contacts probably formed concurrently in response to Holocene expansion from glacial refugia, we estimate that the divergence times (τ) of the lineage pairs range from 3.1 to 11.5 Ma. Multi-locus analyses of the contact zones yielded estimates of reproductive isolation that are tightly correlated with divergence time and, for lineages with older divergence times (τ > 5 Myr), substantial. These results show that phylogeographic splits of increasing depth represent stages along the speciation continuum, even in the absence of overt change in ecologically relevant morphology.     

Indian hedgehog positively regulates calvarial ossification and modulates bone morphogenetic protein signaling

Much is known regarding the role of Indian hedgehog (Ihh) in endochondral ossification, where Ihh regulates multiple steps of chondrocyte differentiation. The Ihh-/- phenotype is most notable for severely foreshortened limbs and a complete absence of mature osteoblasts. A far less explored phenotype in the Ihh-/- mutant is found in the calvaria, where bones form predominately through intramembranous ossification. We investigated the role of Ihh in calvarial bone ossification, finding that proliferation was largely unaffected. Instead, our results indicate that Ihh is a pro-osteogenic factor that positively regulates intramembranous ossification. We confirmed through histologic and quantitative gene analysis that loss of Ihh results in reduction of cranial bone size and all markers of osteodifferentiation. Moreover, in vitro studies suggest that Ihh loss reduces Bmp expression within the calvaria, an observation that may underlie the Ihh-/- calvarial phenotype. In conjunction with the newly recognized roles of Hedgehog deregulation in craniosynostosis, our study defines Ihh as an important positive regulator of cranial bone ossification.     

空心钉配合缝线张力带技术治疗移位的肱骨大结节骨折

目的:探讨使用空心钉配合缝线张力带技术治疗移位的肱骨大结节骨折的效果。方法:2008年3月-2010年3月,收治12例肱骨大结节骨折病人,男10例,女2例,年龄21-71岁,平均年龄46.3岁。其中8例摔伤,2例车祸外伤,2例运动中损伤并伴有盂肱关节脱位。受伤至手术时间5小时-1周。X线显示大结节骨折移位大于5mm。大结节骨折块采用空心钉配合5-Ethibond缝线构成的张力带技术进行固定。结果:患者伤口均一期愈合无感染等并发症发生,所有患者均获随访,随访时间9-33个月,平均14个月。X线显示术后2-4个月骨折愈合,平均2.5个月。美国加州大学洛杉矶分校评分标准评分为(33.65±3.83)分;优9例,良2例,可1例,优良率91.7%。结论:采用切开复位空心钉配合缝线张力带技术治疗肱骨大结节骨折疗效满意,功能恢复良好,疼痛缓解明显。     

Pleistocene and ecological effects on continental-scale genetic differentiation in the bobcat (Lynx rufus)

The potential for widespread, mobile species to exhibit genetic structure without clear geographic barriers is a topic of growing interest. Yet the patterns and mechanisms of structure--particularly over broad spatial scales--remain largely unexplored for these species. Bobcats occur across North America and possess many characteristics expected to promote gene flow. To test whether historical, topographic or ecological factors have influenced genetic differentiation in this species, we analysed 1 kb mtDNA sequence and 15 microsatellite loci from over 1700 samples collected across its range. The primary signature in both marker types involved a longitudinal cline with a sharp transition, or suture zone, occurring along the Great Plains. Thus, the data distinguished bobcats in the eastern USA from those in the western half, with no obvious physical barrier to gene flow. Demographic analyses supported a scenario of expansion from separate Pleistocene refugia, with the Great Plains representing a zone of secondary contact. Substructure within the two main lineages likely reflected founder effects, ecological factors, anthropogenic/topographic effects or a combination of these forces. Two prominent topographic features, the Mississippi River and Rocky Mountains, were not supported as significant genetic barriers. Ecological regions and environmental correlates explained a small but significant proportion of genetic variation. Overall, results implicate historical processes as the primary cause of broad-scale genetic differentiation, but contemporary forces seem to also play a role in promoting and maintaining structure. Despite the bobcat's mobility and broad niche, large-scale landscape changes have contributed to significant and complex patterns of genetic structure.     

Phylogeography of the Eurasian green woodpecker (Picus viridis)

Aim In this paper we investigate the evolutionary history of the Eurasian green woodpecker (Picus viridis) using molecular markers. We specifically focus on the respective roles of Pleistocene climatic oscillations and geographical barriers in shaping the current population genetics within this species. In addition, we discuss the validity of current species and subspecies limits. Location Western Palaearctic: Europe to western Russia, and Africa north of the Sahara. Methods We sequenced two mitochondrial genes and five nuclear introns for 17 Eurasian green woodpeckers. Multilocus phylogenetic analyses were conducted using maximum likelihood and Bayesian algorithms. In addition, we sequenced a fragment of the cytochrome b gene (cyt b, 427 bp) and of the Z‐linked BRM intron 15 for 113 and 85 individuals, respectively. The latter data set was analysed using population genetic methods. Results Our phylogenetic results support the monophyly of Picus viridis and suggest that this taxon comprises three allopatric/parapatric lineages distributed in North Africa, the Iberian Peninsula and Europe, respectively. The North African lineage split from the Iberian/European clade during the early Pleistocene (1.6–2.2 Ma). The divergence event between the Iberian and the European lineages occurred during the mid‐Pleistocene (0.7–1.2 Ma). Our results also support a post‐glacial range expansion of these two lineages from distinct refugia located in the Iberian Peninsula and possibly in eastern Europe or Anatolia, which led to the establishment of a secondary contact zone in southern France. Main conclusions Our results emphasize the crucial role of both Pleistocene climatic oscillations and geographical barriers (Strait of Gibraltar, Pyrenees chain) in shaping the current genetic structure of the Eurasian green woodpecker. Our molecular data, in combination with diagnosable plumage characters, suggest that the North African green woodpecker (Levaillant’s woodpecker) merits species rank as Picus vaillantii (Malherbe, 1847). The two European lineages could be distinguished by molecular and phenotypic characters over most of their respective geographical ranges, but they locally exchange genes in southern France. Consequently, we prefer to treat them as subspecies (P. viridis viridis, P. viridis sharpei) pending further studies.     

Phylogeography of the fiscal shrike (Lanius collaris): a novel pattern of genetic structure across the arid zones and savannas of Africa

Aim Savanna occupies a substantial part of Africa, being distributed around the two major tropical rain forest blocks in what is referred to as the Savanna Belt. Our current understanding of the genetic structure within species distributed across the Savanna Belt is primarily derived from mammalian taxa, studies of which have revealed a suture zone or transition between northern and east/southern Africa clades in south‐western Kenya and north‐western Tanzania. We conduct a phylogeographic study of the fiscal shrike (Lanius collaris), a polytypic species distributed across the Savanna Belt of Africa and for which morphological and vocal data are in agreement with the suture zone recovered for mammalian taxa, to test the hypothesis of a spatially congruent genetic break across several taxa, including birds. Location Africa, south of the Sahara. Methods We analysed DNA sequences recovered from four loci (one mitochondrial, two autosomal and one Z‐linked) in 66 individuals, representing all recognized subspecies, as well as putatively closely related species. We make use of a combination of tree‐building and population genetic methods to investigate the phylogeographic structure of the fiscal shrike across Africa. Results The fiscal shrike consists of two primary lineages with a strong geographic component: a northern group distributed from southern Tanzania to Senegal, and a southern group distributed from Botswana/Zambia to South Africa with isolated populations in Tanzania and northern Malawi. Unexpectedly, Souza’s shrike (L. souzae) was nested within L. collaris, as the sister group of the southern group. The positions of Mackinnon’s shrike (L. mackinnoni) and that of the São Tomé shrike (L. newtoni) were variable, being either nested within the fiscal shrike or sister to the L. collaris–L. souzae clade. Our divergence time analyses suggest that the Lanius collaris species complex started to diversify around 2.2 Ma. Main conclusions Our study reveals a distinct biogeographic pattern for a savanna distributed species in Africa, with the transition between the two primary genetic lineages occurring at a latitude of c. 15–16° S, 10° S further south than shown elsewhere for several mammalian species.     

脑血疏口服液与大骨瓣减压硬膜扩大减张缝合术治疗大面积脑梗死的疗效及对血清NSE和hs-CRP水平的影响

目的:探讨脑血疏口服液配合大骨瓣减压硬膜扩大减张缝合术对大面积脑梗死患者的临床疗效及对血清超敏C反应蛋白(hs-CRP)及神经元特异性烯醇化酶(NSE)水平的影响。方法:选取2013年1月~2015年1月我院收治的大面积脑梗死患者87例,采用随机单盲取法分为试验组44例,对照组43例。两组患者均给予标准大骨瓣减压硬膜扩张缝合术治疗,对照组术后给予常规及对症治疗,试验组在对照组基础上给予脑血舒口服液治疗。观察两组患者治疗前后hs-CRP、NSE水平变化,同时进行日常生活活动能力量表(ADL)评分、神经功能缺损量表(NIHSS)评分及生活质量指数(BI)测定,并评定和比较治疗效果。结果:治疗1疗程后,试验组总有效率为97.73%,显著高于对照组81.40%(P0.05)。两组血清hs-CRP、NSE水平ADL、NIHSS评分均显著低于治疗前(P0.05),BI指数明显高于治疗前,且试验组血清hs-CRP、NSE水平ADL、NIHSS评分明显低于对照组(P0.05),BI指数明显高于对照组(P0.05)。两组治疗期间均未见严重不良反应。结论:脑血舒口服液配合大骨瓣减压硬膜扩大减张缝合术治疗大面积脑梗死患者可有效提高临床疗效,且安全性高,可能与其降低血清NSE、hs-CRP水平有关。