右美托咪定对腹腔镜下子宫恶性肿瘤手术患者炎症因子及认知功能的影响

目的:探讨右美托咪定对腹腔镜下子宫恶性肿瘤手术患者炎症因子以及认知功能的影响,为右美托咪定在腹腔镜下子宫恶性肿瘤手术的临床应用提供参考。方法:选择武汉科技大学附属普仁医院2015年7月至2017年6月收治的100例行腹腔镜下子宫恶性肿瘤手术患者作为研究对象,根据不同麻醉方式分为观察组和对照组两组,各50例,其中观察组患者在给予麻醉诱导前30 min,负荷剂量1.0μg/kg的右美托咪定静脉输注10 min,之后给予患者0.5μg/kg的右美托咪定持续性静脉输注至手术结束前30 min为止,对照组患者按照上述给药方法静脉输注同等容量的生理盐水。然后分别于麻醉诱导前(T0)、手术结束时(T1)、手术结束后4 h(T2)以及手术结束后1天(T3)取患者的外周静脉血,测定比较两组患者各相应时间点的血清C反应蛋白(CRP)、肿瘤坏死因子(TNF-α)、白细胞介素(IL-6)等炎症因子水平,外周血皮质醇(cor)、肾上腺素(E)、去甲肾上腺素(NE)等应激水平,MMSE评分、TMT完成时间等认知功能;并分析两组患者术后的不良反应发生情况。结果:两组患者T0时间的血清IL-6、TNF-α、CRP、cor、E、NE水平以及TMT、MMSE认知功能评分差异不具有统计学意义(P0.05),具有可比性;而观察组患者T1、T2、T3各相应时间点的血清IL-6、TNF-α、CRP、cor、E以及NE水平明显低于对照组(P0.05);观察组患者T2、T3各相应时间点的MMSE评分明显高于对照组,TMT评分值明显低于对照组(P0.05);且术后观察组患者的不良反应发生率明显低于对照组(P0.05)。结论:右美托咪定可以明显降低腹腔镜下子宫恶性肿瘤手术患者血清应激反应以及炎症因子水平,改善术后认知功能,减少术后不良反应的发生,效果显著,值得临床推广使用。     

qSOFA评分、血乳酸及红细胞分布宽度与急性上消化道出血病情严重程度的关系及其预测患者预后的效能分析

摘要 目的：探讨快速序贯器官功能衰竭评估（qSOFA）评分、血乳酸（Lac）及红细胞分布宽度（RDW）与急性上消化道出血（AUGIB）病情严重程度的关系及其预测患者预后的效能。方法：选取2017年6月～2022年6月我院收治的230例AUGIB患者为研究对象,根据病情严重程度分为低危组44例、中危组140例、高危组36例、极高危组10例,且根据其入院28 d内生存情况分为死亡组（n=31）和存活组（n=199）。收集AUGIB患者临床资料,检测血Lac、RDW水平并计算qSOFA评分。采用多因素Logistic回归分析AUGIB患者预后不良的影响因素,受试者工作特征（ROC）曲线分析qSOFA评分和血Lac、RDW对AUGIB患者预后不良的预测价值。结果：低危组、中危组、高危组、极高危组qSOFA评分和血Lac、RDW水平依次升高（P＜0.05）。230例AUGIB患者入院28 d内死亡率为13.48％（31/230）。多因素Logistic回归分析显示,年龄增加、GBS评分≥6分及休克指数、qSOFA评分、血尿素氮、血Lac、RDW水平升高为AUGIB患者预后不良的独立危险因素（P＜0.05）。ROC曲线分析显示,qSOFA评分、血Lac及RDW联合预测AUGIB患者预后不良的曲线下面积大于qSOFA评分、血Lac及RDW单独预测。结论：AUGIB患者qSOFA评分、血Lac及RDW水平升高与病情加重和预后不良密切相关,qSOFA评分、血Lac及RDW联合预测AUGIB患者预后不良的效能较高。     

B 超引导下子宫内膜消融术治疗更年期功血51 例临床分析

目的:探讨在B超引导下子宫内膜消融术治疗更年期功血的效果。方法:扩张宫颈至6.5号,吸宫,在B超监视下由子宫右前壁始向外刮凝,依次顺时针方向刮凝宫腔2周。结果:治愈31例(60.8%),有效19例(37.3%),好转1例(1.9%),无效0例。结论:电凝刀子宫内膜消融术与其他更年期功血治疗方法相比,消融的范围及深度由B超监视,安全性高,创伤小,不开刀,恢复快,并且治愈率高,更容易在临床上推广。     

Potassium Currents in Freshly Dissociated Uterine Myocytes from Nonpregnant and Late-Pregnant Rats

In freshly dissociated uterine myocytes, the outward current is carried by K⁺ through channels highly selective for K⁺. Typically, nonpregnant myocytes have rather noisy K⁺ currents; half of them also have a fast-inactivating transient outward current (I_TO). In contrast, the current records are not noisy in late pregnant myocytes, and I_TO densities are low. The whole-cell I_K of nonpregnant myocytes respond strongly to changes in [Ca²⁺]_o or changes in [Ca²⁺]_i caused by photolysis of caged Ca²⁺ compounds, nitr 5 or DM-nitrophene, but that of late-pregnant myocytes respond weakly or not at all. The Ca²⁺ insensitivity of the latter is present before any exposure to dissociating enzymes. By holding at −80, −40, or 0 mV and digital subtractions, the whole-cell I_K of each type of myocyte can be separated into one noninactivating and two inactivating components with half-inactivation at approximately −61 and −22 mV. The noninactivating components, which consist mainly of iberiotoxin-susceptible large-conductance Ca²⁺-activated K⁺ currents, are half-activated at 39 mV in nonpregnant myocytes, but at 63 mV in late-pregnant myocytes. In detached membrane patches from the latter, identified 139 pS, Ca²⁺-sensitive K⁺ channels also have a half-open probability at 68 mV, and are less sensitive to Ca²⁺ than similar channels in taenia coli myocytes. Ca²⁺-activated K⁺ currents, susceptible to tetraethylammonium, charybdotoxin, and iberiotoxin contribute 30–35% of the total I_K in nonpregnant myocytes, but <20% in late-pregnant myocytes. Dendrotoxin-susceptible, small-conductance delayed rectifier currents are not seen in nonpregnant myocytes, but contribute ∼20% of total I_K in late-pregnant myocytes. Thus, in late-pregnancy, myometrial excitability is increased by changes in K⁺ currents that include a suppression of the I_TO, a redistribution of I_K expression from large-conductance Ca²⁺-activated channels to smaller-conductance delayed rectifier channels, a lowered Ca²⁺ sensitivity, and a positive shift of the activation of some large-conductance Ca²⁺-activated channels.     

宫腔镜下冷刀分离术与电切术治疗宫腔粘连的疗效及对宫腔形态恢复和血清白细胞介素的影响

摘要 目的：对比宫腔镜下冷刀分离术与电切术治疗宫腔粘连（IUA）的疗效及对宫腔形态恢复和血清白细胞介素的影响。方法：回顾性分析2019年4月~2021年2月期间来我院接受治疗的83例IUA患者的临床资料。根据手术方式的不同将患者分为A组（宫腔镜下电切术,40例）和B组（宫腔镜下冷刀分离术,43例）,对比两组手术时间及住院时间、宫腔形态恢复情况和血清白细胞介素变化,观察两组术后并发症发生率、月经改善率和宫腔再粘连发生率。结果：B组手术时间、住院时间短于A组（P<0.05）。B组总有效率、内膜创面上皮化愈合满意率均高于A组（P<0.05）。两组血清白细胞介素-6（IL-6）、白细胞介素-8（IL-8）水平升高,但B组低于A组（P<0.05）。两组血清白细胞介素-4（IL-4）、白细胞介素-10（IL-10）降低,但B组高于A组（P<0.05）。两组术后并发症发生率组间对比无统计学差异（P>0.05）。B组月经改善率高于A组,宫腔再粘连发生率低于A组（P<0.05）。结论：与宫腔镜下电切术治疗IUA相比,宫腔镜下冷刀分离术治疗IUA手术时间、住院时间更短,宫腔形态恢复和月经改善情况更好,机体炎性反应更轻微,同时宫腔再粘连发生率更低,疗效更优。     

叶下珠有效部位对血栓形成的影响及其作用机制初探

采用Born方法和改良的Hamburger方法分别测定叶下珠 (Phyllanthusurinaria)含corilagin的有效部位 (代号PUW )在体内外对血小板聚集功能和对血小板与中性粒细胞之间粘附反应的影响 ;应用Myers方法评价PUW灌胃对小鼠尾静脉注射花生四烯酸 (AA)引起猝死的保护作用 ;运用改良的Charl ton方法及陈长勋等方法分别观察PUW灌胃对电刺激大鼠颈动脉血栓形成和下腔静脉血栓形成的影响 ;采用Tomihisa方法 ,观察PUW对大鼠尾尖出血时间的影响。结果显示 ,PUW在体内外对ADP、AA或血小板活化因子 (PAF)诱导的血小板聚集均无明显抑制作用 ;PUW呈浓度依赖性明显阻抑AA激活的血小板与中性粒细胞之间的粘附反应 ,其半数抑制浓度 (IC50 )为 39 7mg/kg。PUW (10、2 0和 4 0mg/kg)灌胃呈剂量依赖性显著减少AA致小鼠死亡的数量 ,明显延长电刺激大鼠颈动脉血栓形成时间 ,减轻大鼠下腔静脉血栓的干、湿重。 2 0mg/kg的PUW对出血时间无明显影响 ,4 0mg/kg的PUW虽延长出血时间 ,但与阿司匹林 (2 0mg/kg)比较 ,出血时间明显缩短 (P <0 0 5 )。本实验结果提示 ,PUW灌胃在多种体内血栓模型中均具有明显的抗血栓形成作用 ,其机制可能与阻抑血小板和中性粒细胞之间的的粘附作用密切相关。     

宫腔镜联合B超诊断异常子宫出血124例临床分析

目的：探讨宫腔镜联合B超在诊治异常子宫出血的临床价值。方法：对124例异常子宫出血的病例进行回顾性分析,所有患者作B超及宫腔镜检查,宫腔内切除物或刮出物均送病理检查。结果：124例患者经病理检查确诊为子宫内膜息肉84例（67．7％）,合并宫颈息肉10例;子宫内膜增生症16例（12．9％）,其中单纯性增生12例,复杂性增生4例;子宫内膜不典型增生1例（0．8％）;子宫粘膜下肌瘤12例（9．7％）;子宫内膜样腺癌6例（4．8％）;子宫内膜炎3例（2．4％）;胚物残留2例（1．6％）。结论：宫腔镜联合B超检查是诊断异常子宫出血最好的方法.     

Eradication of Helicobacter pylori for the prevention of peptic ulcer rebleeding

AIM: To evaluate the effect of Helicobacter pylori eradication on ulcer bleeding recurrence in a prospective, long-term study including more than 400 patients. METHODS: Patients with peptic ulcer bleeding were prospectively included. H. pylori infection was confirmed by rapid urease test, histology or (13)C-urea breath test. Several eradication regimens were used. Ranitidine 150 mg was administered daily until eradication was confirmed by breath test 8 weeks after completing eradication therapy. Patients with therapy failure received a second or third course of therapy. Patients with eradication success did not receive maintenance anti-ulcer therapy, and were controlled yearly with a repeated breath test. RESULTS: Four hundred and twenty-two patients were followed up for at least 12 months, with a total of 906 patient-years of follow up. Mean age was 59 years, and 35% were previous nonsteroidal anti-inflammatory drug (NSAID) users. Sixty-nine percent had duodenal, 24% gastric, and 7% pyloric ulcer. Recurrence of bleeding was demonstrated in two patients at 1 year (incidence: 0.22% per patient-year of follow up), which occurred after NSAID use in both cases. CONCLUSION: Peptic ulcer rebleeding does not occur in patients with complicated ulcers after H. pylori eradication. Maintenance anti-ulcer (antisecretory) therapy is not necessary if eradication is achieved.     

The embryo culture media in the era of epigenetics: is it time to go back to nature?

This review is intended to draw attention to the importance of the culture media composition on the health of the embryos, fetuses, newborns, and adults derived from assisted reproductive technologies (ART). Although current research and industry trends are to use chemically defined media because of their suitability for manufacturing, commercialization, and regulatory purposes, compelling evidence indicates that those media fail to adequately account for the biological demands of early embryogenesis. Here, we list the main undesirable consequences of the ART described in the literature and results we and others have obtained over the past decade exploring an alternative and more natural way to support embryo growth in vitro: inclusion of endogenous reproductive fluids as additives in the ART culture media for pigs, cows, and humans. This review systematically assesses the pros and cons of using reproductive fluid additives, as well as the requirements to implement this approach in the future.