研究中国人术中喉返神经监测肌电信号的正常值范围

目的:应用术中神经监测技术(intraoperative neuromonitoring IONM),探讨国人喉返神经肌电信号的正常值范围。方法:烟台毓璜顶医院甲状腺外科自2009年11月到2012年1月对300例甲状腺开放手术行术中喉返神经实时监测,术中一根回路电极斜行刺入同侧切口外缘直径约2 cm范围皮肤,两根记录电极斜行刺入环甲肌,手持刺激探针垂直刺激神经,发出"嘟嘟嘟"提示音,同时监测仪显示器显示肌电波形,并记录潜伏期及波幅值。结果:285例(386条)清晰显示肌电波形;15例未引出肌电波形,其中10例因机器故障和麻醉因素造成假阴性,5例因肿瘤浸润环甲肌,无法插入记录电极造成。无永久性喉返神经损伤,暂时性神经损伤2例,术后1月内恢复。V1 95%可信区间482.66～574.28μV,R1 95%可信区间521.85～615.05μV,V2 95%可信区间440.92～531.84μV,R2 95%可信区间489.25～582.05μV,T可信区间19.88～20.12ms。结论:明确喉返神经肌电信号正常值范围,为识别、确认喉返神经及通过肌电信号判断神经功能完整性提供依据,降低喉返神经损伤率,利于判断喉返神经非离端性损伤,并寻找损伤原因。     

Robust covariate-adjusted log-rank statistics and corresponding sample size formula for recurrent events data

Summary .   Recurrent events data are frequently encountered in clinical trials. This article develops robust covariate-adjusted log-rank statistics applied to recurrent events data with arbitrary numbers of events under independent censoring and the corresponding sample size formula. The proposed log-rank tests are robust with respect to different data-generating processes and are adjusted for predictive covariates. It reduces to the Kong and Slud (1997, Biometrika 84, 847–862) setting in the case of a single event. The sample size formula is derived based on the asymptotic normality of the covariate-adjusted log-rank statistics under certain local alternatives and a working model for baseline covariates in the recurrent event data context. When the effect size is small and the baseline covariates do not contain significant information about event times, it reduces to the same form as that of Schoenfeld (1983, Biometrics 39, 499–503) for cases of a single event or independent event times within a subject. We carry out simulations to study the control of type I error and the comparison of powers between several methods in finite samples. The proposed sample size formula is illustrated using data from an rhDNase study.     

Invasive advance of an advantageous mutation: nucleation theory

For sedentary organisms with localized reproduction, spatially clustered growth drives the invasive advance of a favorable mutation. We model competition between two alleles where recurrent mutation introduces a genotype with a rate of local propagation exceeding the resident's rate. We capture ecologically important properties of the rare invader's stochastic dynamics by assuming discrete individuals and local neighborhood interactions. To understand how individual-level processes may govern population patterns, we invoke the physical theory for nucleation of spatial systems. Nucleation theory discriminates between single-cluster and multi-cluster dynamics. A sufficiently low mutation rate, or a sufficiently small environment, generates single-cluster dynamics, an inherently stochastic process; a favorable mutation advances only if the invader cluster reaches a critical radius. For this mode of invasion, we identify the probability distribution of waiting times until the favored allele advances to competitive dominance, and we ask how the critical cluster size varies as propagation or mortality rates vary. Increasing the mutation rate or system size generates multi-cluster invasion, where spatial averaging produces nearly deterministic global dynamics. For this process, an analytical approximation from nucleation theory, called Avrami's Law, describes the time-dependent behavior of the genotype densities with remarkable accuracy.     

A frailty mixture cure model with application to hospital admission data [corrected

Mixture cure models have been utilized to analyze survival data with possible cure. This paper considers the inclusion of frailty into the mixture cure model to model recurrent event data with a cure fraction. An attractive feature of the proposed model is the allowance for heterogeneity in risk among those individuals experiencing the event of interest in addition to the incorporation of a cured component. Maximum likelihood estimates can be obtained using the Expectation Maximization algorithm and standard errors are calculated from the Bootstrap method. The model is applied to hospital readmission data among colorectal cancer patients.     

Novel mechanism of miRNA‐365‐regulated trophoblast apoptosis in recurrent miscarriage

Clinical pregnancies increasingly end in recurrent miscarriage (RM) during the first trimester, with genetic factors shouldering the main responsibility. MicroRNAs (miRNAs) regulate gene expression in a wide array of important biological processes. We examined the potential role of dysregulated miRNAs in RM pathogenesis and trophoblast development as an approach to elucidate the molecular mechanism behind RM. miRNA profiles from clinical specimens of RM and induced abortion (IA) were compared, and several miRNAs were found to be aberrantly expressed in RM samples. Among the miRNAs, miR‐365 was significantly differentially expressed in RM decidual tissues. Furthermore, our results demonstrate that miR‐365 functions as an upstream regulator of MDM2/p53 expression, cell cycle progression and apoptosis in trophoblasts. Bioinformatic prediction and experimental validation assays identified SGK1 as a direct target of miR‐365; consistently, its protein levels were low in decidual tissues. Additionally, functional studies revealed that SGK1 silencing elicits cell cycle arrest and apoptosis in trophoblasts and that SGK1 overexpression attenuates the effects of miR‐365 on apoptosis and MDM2/p53 expression. Collectively, our data provide evidence that the up‐regulation of miR‐365 may contribute to RM by decreasing SGK1 expression, which suggests its potential utility as a prognostic biomarker and therapeutic target for RM.     

口服四种维生素联合FE复合酶含漱治疗复发性口腔溃疡的疗效及对血清炎性因子水平的影响

目的:探讨口服四种维生素[维生素E(Vit E)+叶酸(FA)+维生素B2(Vit B2)+维生素B12(Vit B12)]联合FE复合酶含漱治疗复发性口腔溃疡(ROU)的临床效果及对患者血清炎性因子水平的影响。方法:选取我院2014年1月~2016年2月收治的126例ROU患者,采用随机数字表法均分为两组。对照组予以FE复合酶治疗,观察组在此基础上口服四种维生素(Vit E+FA+Vit B2+Vit B12)治疗。记录比较两组的局部疗效、远期疗效,治疗前后血清炎性因子水平以及不良反应的发生情况。结果:与对照组相比,观察组治疗30d后疼痛指数显著降低(P0.01),平均溃疡期显著缩短(P0.01)。治疗后6个月,观察组总有效率为95.2%,较对照组明显上升(81.0%,P0.05)。与治疗前对比,两组治疗30 d后血清TNF-α、IL-17水平均显著降低(P0.01),IL-2水平均显著升高(P0.01);且观察组以上各炎性因子的改善效果均更为显著(P0.01)。两组不良反应率对比差异无统计学意义(P0.05)。结论:口服四种维生素联合FE复合酶含漱治疗复发性口腔溃疡更能有效促进溃疡创面愈合,减轻疼痛,调节机体促/抗炎因子平衡,提高远期治疗效果,且安全性高。     

改良微血管减压术治疗复发性三叉神经痛的疗效及安全性分析

目的:探讨改良微血管减压术(MVD)治疗复发性三叉神经痛的疗效及安全性。方法:回顾性分析2010年至2015年收治的50例复发性三叉神经痛患者,2012年前采取常规MVD手术方法(MVD组,n=22),2012年后采取改良MVD的手术方法(改良MVD组,n=28)。MVD组采用传统MVD对三叉神经根进行全程减压,即沿首次切口入路,依次切开皮下、肌筋膜,充分分离骨窗边缘的瘢痕组织,适当扩大骨窗直至硬脑膜充分暴露。切开硬膜,锐性分离蛛网膜后探查Meckel腔至神经出脑区(REZ),仔细探查三叉神经全段,分离压迫神经的责任血管以及首次手术置入的Teflon垫棉,对三叉神经进行全程减压。改良MVD组在此基础上,探查三叉神经颅内段及其周围结构,解剖三叉神经脑干延伸段,垫开小脑上动脉对三叉神经脑干延伸段的压迫。比较两组术后缓解率、并发症、复发情况。结果:改良MVD组术后缓解率为100.0%,显著高于MVD组72.7%(P0.05);两组术后并发症的发生率比较差异无统计学意义(P0.05);改良MVD组术后1年复发率为0%,显著低于MVD组22.7%(P0.05)。结论:MVD术中三叉神经根全程减压联合脑干延伸段减压治疗复发性三叉神经痛患者可有效缓解疼痛,降低术后复发风险,且不增加术后并发症。     

Esterase isozyme polymorphism, specific and nonspecific esterase, syngenic lines development and natural occurrence of a thermostable esterase in the tropical silkworm Bombyx mori L.

Esterase isozyme polymorphism was documented for digestive juice and haemolymph of the tropical multivoltine silkworm, Bombyx mori L., breed CB5 (GP) and its syngenic lines (CB5Lm^e-1, CB5Lm-2 and CB5Lm-5) using α- and β-naphthylacetate separately as nonspecific substrates (Ogita, Z., Kasai, T., 1965. Genetico-biochemical analysis of specific esterases in Musca domestica. Jpn. J. Genet. 40, 173–184). Polymorphism existed in the isozyme pattern of α-esterase with two or three bands in digestive juice and three to five bands in haemolymph. No polymorphism was observed in β-esterase isozyme pattern having four bands in digestive juice and two bands in haemolymph. During the course of esterase isozyme studies, the presence of some specific α-esterase bands (Est-1, 4 and 5) in haemolymph and β-esterase bands (Est-1, 2 and 3) in digestive juice were observed. But both α- and β-esterase bands Est-3 and 4 in digestive juice and Est-2 and 3 in haemolymph were found to be nonspecific. Nonspecific β-esterase band (Est-3) in haemolymph of CB5 (GP) and its syngenic lines withstood a temperature up to 80±1°C for 10 min. No thermostable band was observed in the isozyme zymogram of α-esterase in digestive juice and haemolymph or β-esterase in digestive juice. Overall, this study discusses the presence of esterase heterogeneity in the CB5 (GP) genepool, syngenic lines development, occurrence of specific α- and β-esterase bands in digestive juice and haemolymph and thermostable β-esterase band Est-3 in haemolymph in tropical silkworm Bombyx mori L.     

同型半胱氨酸、子宫动脉血流参数与反复妊娠丢失患者胰岛素抵抗和妊娠结局的关系

摘要 目的：探讨同型半胱氨酸（Hcy）、子宫动脉血流参数与反复妊娠丢失（RPL）患者胰岛素抵抗和妊娠结局的关系。方法：选择2020年6月至2022年10月昆明市妇幼保健院收治的162例RPL患者作为RPL组和同期82例规律产检的健康孕妇作为对照组。按照妊娠结局将RPL患者分为活产组（85例）和流产组（77例）。检测血清Hcy水平,胰岛素抵抗指数（HOMA-IR）,超声检查子宫动脉血流参数,包括子宫动脉收缩期峰值/舒张末期流速（S/D）、搏动指数（PI）、血流阻力指数（RI）。Pearson相关性分析Hcy、子宫动脉血流参数与HOMA-IR的相关性。采用多因素Logistic回归分析RPL 患者妊娠结局的影响因素。采用受试者工作特征（ROC）曲线分析Hcy、子宫动脉血流参数对RPL 患者妊娠结局的预测价值。结果：RPL组血清Hcy水平,S/D、PI、RI以及HOMA-IR均高于对照组（P＜0.05）。RPL组血清Hcy,S/D、PI、RI与HOMA-IR均呈正相关（P＜0.05）。流产组血清Hcy水平,S/D、PI、RI以及HOMA-IR均高于活产组（P＜0.05）,多因素Logistic回归分析显示高HOMA-IR、高Hcy、高S/D、高RI、染色体异常是RPL患者流产的危险因素（P＜0.05）。ROC曲线分析显示联合Hcy、S/D、RI预测RPL患者流产的曲线下面积（AUC）为0.849,高于单独预测。结论：RPL患者子宫动脉血流参数S/D、RI、PI和血清Hcy水平均增高,高S/D、RI和Hcy与RPL患者胰岛素抵抗以及流产风险增加有关。联合S/D、RI和Hcy可提高RPL流产风险评估效能。