目的 本研究以ICSI后未成熟卵母细胞为研究对象,分析比较卵母细胞不同发育阶段冷冻对其后续效果的影响,评估ICSI后未成熟卵母细胞的利用价值。方法 未成熟卵母细胞直接成熟培养(新鲜组)与玻璃化冷冻后成熟培养(冷冻组)的成熟率,并利用孤雌激活的方法比较卵母细胞的发育潜力。结果 发现新鲜组与冷冻组体外培养卵母细胞成熟率、受精率、卵裂率、优质胚胎率和囊胚率均无差异(P>0.05)。但两组的GV期卵母细胞成熟率低于MI期(P<0.05),且冷冻组的GV期卵母细胞受精率低于MI期(P<0.05)。不过裸卵体外成熟培养效果欠佳,特别是对GV期卵母细胞,体外成熟培养后的卵母细胞发育潜力低下,无囊胚形成。结论 ICSI后未成熟卵母细胞的冷冻对卵母细胞的发育潜力没有明显影响,但体外成熟培养的卵母细胞发育潜力低下,有待进一步提高体外成熟培养技术。

Objective In this study, the immature oocytes after ICSI were used to analyze the effects of freezing on the subsequent development of oocytes at different developmental stages, and to evaluate the utilization value of immature oocytes after ICSI(intracytoplasmic sperm injection). Methods The immature oocytes was directly cultured (fresh group) and matured after vitrification (frozen group), and the development potential of the oocytes was compared by parthenogenetic activation. Results There was no significant difference in the oocyte maturation rate, fertilization rate, embryo cleavage rate, high quality embryo rate and blastocyst rate between the fresh and frozen groups (P>0.05). However, the maturation rate of GV oocytes in the two groups was lower than MI oocytes (P<0.05), and the fertilization rate of GV oocytes in the frozen group was lower than MI oocytes (P<0.05). However, the in vitro maturation of naked oocytes was not effective, especially for GV oocytes, the oocyte development potential after in vitro maturation was low, there was no blastocyst formation. Conclusion The freezing of immature oocytes after ICSI has no significant effect on the development potential, but the development potential of naked oocytes matured in vitro was low, and the in vitro maturation culture technology of naked oocyte needs to be further improved.

目的 探讨脑动静脉畸形(AVM)破裂出血发生的危险因素。方法 回顾性研究2014年—2018年我院收治的AVM病例42例,根据有无破裂出血,分为出血组和非出血组,对AVM破裂出血发生的相关因素进行统计学分析。结果 通过相关性及逐步回归分析,表明AVM破裂出血的独立危险因素为: 深部静脉引流和低龄患者。结论 对于引流静脉为深部静脉引流类型和低龄的AVM患者,应积极尽早治疗。

Objective To analyze the risk factors related to cerebral arteriovenous malformation(AVM)with hemorrhage. Methods The clinical data of 42 patients with AVM between 2014 and 2018 were respectively studied. According to the presence of rupture, the cases were divided into bleeding group and non-bleeding group. The factors associated with the occurence of AVM rupture were statistically analyzed. Results The correlation and logistic regression analysis suggested that the deep venous drainage and young patients were the independent risk factors for AVM rupture. Conclusion The young patients and the patients with deep venous drainage should be operated as soon as possible to avoid hemorrhage.

目的 研究罗哌卡因阻滞用于胸腹腔镜联合食管癌根治术后镇痛的临床效果。方法 胸腹腔镜联合食管癌根治术患者60例,分为: 观察组(n=30),缝合切口时用0.25%盐酸罗哌卡因10 mL于切口局部浸润;对照组(n=30) 不做局部浸润麻醉处理;记录二组术后2 h、6 h、12 h、24 h、48 h的疼痛视觉模拟评分(VAS)及血浆皮质醇浓度。结果 观察组术后2 h、6 h、12 h VAS评分优于对照组,术后12 h观察组血浆皮质醇浓度低于对照组。结论 罗哌卡因术终阻滞术后12 h内镇痛效果明显。

Objective To evaluate the efficiency of postoperative analgesia with ropivacaine block after thoracoscopic-lapacoscopic esophagectomy (TLE). Methods Totally 60 patients with esophageal cancer underwent TLE were divided into two groups: observation group(n=30)with 0.25% ropivacaine hydrochloride solution 10 mL injection around incision before end of the operation; control group(n=30)without the treatment. The VAS and the plasma Cortisol concentration at 2 h、6 h、12 h、24 h、48 h after surgery were recorded. Results The VAS at 2 h、6 h、12 h after surgery in observation group was higher than that of the control group,but not at 24 h、48 h after surgery. The plasma Cortisol concentration in the observation group was higher than that of in the control at 12 hours postoperatively. Conclusion Ropivacaine block of incision is helpful to have analgesic effect within 12 hours after TLE.

目的 评价Turbohawk定向斑块切除系统联合药物涂层球囊在下肢动脉硬化闭塞症中临床应用价值。方法 对于术前超声以及下肢动脉CTA检查诊断为下肢动脉硬化闭塞症的8例患者,行Turbohawk斑块旋切以及药物涂层球囊治疗,术后行常规抗凝治疗,定期行彩超复查。结果 8例患者下肢动脉均全部再通成功,技术成功率为100%,术后缺血症状明显改善,术后平均踝肱指数为0.78±0.06,高于术前的0.31±0.12(P<0.05)。住院期间无并发症发生,随访3～18个月,患者保肢均获得成功。结论 Turbohawk定向机械旋切系统联合药物涂层球囊治疗下肢动脉硬化闭塞症,具有创伤小、疗效好以及安全性高等优点,值得临床推广使用。

Objective To evaluate clinical application of using Turbohawk atherectomy device in combination with drug-coated balloon in treatment of atreriosclerosis obliterans in lower extremity. Methods Turbohawk atherectomy device and DCB was performed in 8 patiments with atreriosclerosis obliterans in lower extremity. All patients were diagnosed by ultrasound and CTA. Routine anticoagulation drugs were used after the operation. Follow-up was carried out with color Doppler ultrasound. Results Revascularization was gained in 8 patients. The technically successful rate was 100% and ischemic symptoms relieved significantly immediately after the operation. The post-operative ankle brachinal index(ABI) was 0.78±0.06,which was higher than that of before operation(0.31±0.12). No obvious complications occurred after operation. The follow-up range was 3~18 months and limbs were salvaged successfully. Conclusion With minimal invasive, safe and few complications, Turbohawk atherectomy device in combination with drug-coated balloon is proved to be a very effective treatment atreriosclerosis obliterans in lower extremity and it is worth to popularize.

目的 应用FRAX^®工具评估广州社区中老年人发生骨质疏松性骨折的风险。方法 回顾性研究1 140例广州社区中老年人的临床资料,应用FRAX^®工具计算未来10年发生主要骨质疏松性骨折及髋部骨折的风险,分析不同危险因素与骨折风险的关系。结果 广州社区中老年人群10年内发生主要骨质疏松性骨折概率为(4.2±3.6)%,髋部骨折概率为(1.3±2.4)%。主要骨质疏松性骨折风险及髋部骨折风险、OSTA值均随着年龄增长而增加。多因素回归分析结果显示: 年龄、性别、既往骨折、继发性骨质疏松、股骨颈T值、跌倒对主要部位骨折及髋部骨折风险具有独立性预测意义。结论 FRAX^®工具可用于评估广州社区中老年人骨质疏松性骨折风险,建议在社区中老年人健康体检时应用FRAX^®工具进行骨折风险评估。

Objective To predict the osteoporotic fracture risk in senile people in Guangzhou communities by FRAX,the fracture risk assessment tool published by WHO. Methods Clinical data of 1140 cases were collected for the retrospective analysis. The FRAX tool was uesed to calculate the 10-year probability of a major osteoporotic and hip fracture.The relationship between different risk factors and the fracture risk predicted by FRAX was analyzed. Results The 10-year probability of major osteoporotic fractures was (4.2±3.6)%, and the 10-year probability of hip fractures was (1.3±2.4)%.The 10-year probability of the major osteoporotic and hip fracture increased with age.Multivariate regression analysis showed that age,gender,previous fracture,secondary osteoporosis,T-score of femoral neck BMD and fall were independent predictors of the 10-year probability of major osteoporotic fracture and hip fracture. Conclusion The FRAX tool may be effectively applied to assess the fracture risk of senile population in Guangzhou communities.We recommedated that FRAX-tool should be included in routine health check-up.

目的 探讨红细胞分布宽度(RDW)与稳定性冠心病的冠脉病变严重程度的关系,评价RDW对稳定性冠心病的预测价值。方法 收集我院2016年11月—2018年11月期间因胸痛住院的患者330例,根据冠脉造影确诊稳定性冠心病组200例,除外冠心病130例为对照组。比较2组RDW水平的差异,分析RDW与冠脉病变严重程度(Gensini评分)的相关性及稳定性冠心病的独立危险因素。结果 稳定性冠心病组RDW水平高于对照组(P<0.05),稳定性冠心病组RDW与 Gensini评分之间存在正相关(r=0.217,P=0.002);多因素logistic回归分析显示RDW(OR=2.950,95%CI: 1.986~4.381,P<0.001)是稳定性冠心病的独立危险因子。结论 RDW与稳定性冠心病的冠脉病变严重程度呈正相关,RDW是稳定性冠心病的独立危险因素,为稳定性冠心病的诊断提供一定预测价值。

Objective To investigate the relationship between the distribution width of red blood cells (RDW) and the severity of coronary artery disease in stable coronary artery disease(SCAD), and to evaluate the predictive value of RDW for SCAD. Methods Patients who were hospitalized for chest pain from November 2016 to November 2018 were enrolled (n=330). According to coronary angiography,200 patients were divided into SCAD group (n=200),except for the SCAD group, the remaining 130 cases were the control group(n=130). The differences of RDW levels between the two groups were compared, and the correlation between RDW and severity of coronary artery disease (Gensini score) and independent risk factors for SCAD were analyzed. Results The RDW level in the SCAD group was higher than that in the control group (P<0.05). There was a positive correlation between the RDW and Gensini scores in the SCAD group (r=0.217,P=0.002). Multivariate logistic regression analysis showed RDW (OR=2.950, 95% CI: 1.986~4.381, P<0.001) is an independent risk factor for SCAD. Conclusion RDW is positively correlated with the severity of coronary artery disease in SCAD. RDW is independent risk factor of SCAD and provides predictive value for the diagnosis of SCAD.

目的 探讨钙调磷酸酶结合蛋白1(calcineurin binding protein 1, Cabin1)在肾小管上皮细胞(renal tubular epithelial cells,RTECs)线粒体损伤中的作用机制。方法 采用siRNA干预体外培养RTECs,敲低Cabin1的表达,继而以电镜观察其对RTECs线粒体形态的影响。结果 在对照组和阴性对照组中Cabin1蛋白在RTECs中有高表达,采用siRNA干预RTECs后,Cabin1蛋白的表达量较对照组和阴性对照组降低50%以上(P＜0.05)。对照组与阴性对照组中,线粒体形态规则,呈圆形或椭圆形,线粒体膜完整,线粒体嵴清晰可见。敲低组中,线粒体肿胀,呈长条形或不规则形,线粒体膜、线粒体嵴结构模糊甚至消失。结论 敲低Cabin1引起RTECs的线粒体形态学异常,提示Cabin1是维持RTECs线粒体正常功能的重要分子。

Objective To investigate the role of calcineurin binding protein 1 (Cabin1) in renal tubular epithelial cells (RTECs) mitochondrial dysfunction. Methods Knocked down Cabin1 in RTECs with siRNA, Western bolt was applied to detect the level of Cabin1 protein. The morphology of mitochondria in RTECs were observed under microscopy. Results In control and negative control groups, Cabin1 protein was obviously expressed in RTECs. After knocked down by siRNA, Cabin1 protein expression was decreased (P＜0.05). In Cabin1 knocked down group, mitochondria changed from large and ellipsoid shape to the small, long and irregulars. Morover, mitochondria were swollen and cristae were remarkably dissolved. Conclusion Knocked down Cabin1 induced RTECs mitochondrial dysfunction, which indicates Cabin1 is a crucial factor regulating mitochondrial function.

目的 探讨血必净注射液对SAP大鼠TLR4信号通路介导肠黏膜屏障功能障碍的影响。方法 24只SD大鼠随机分成空白组(n=8)、对照组(n=8)和治疗组(n=8)。对照组和治疗组用4.5%牛磺胆酸钠溶液胆胰管逆行注射制备SAP模型,空白组采用等量生理盐水逆行注射。治疗组在造模3 h后经鼠尾静脉注射血必净注射液(3 mL/kg)。三组大鼠造模后观察24 h,然后处死取胰腺和小肠组织送病理检查,采用荧光RT-PCR技术检测TLR4和NF-κB表达水平,采用ELSIA法检测血清TNF-α、IL-6、淀粉酶(AMS)及二胺氧化酶(DAO)水平,比较三组大鼠各项指标。结果 对照组和治疗组小肠组织TLR4和NF-κB表达以及血清TNF-α、IL-6、AMS及DAO水平均高于空白组(P>0.05),治疗组小肠组织TLR4和NF-κB表达以及血清TNF-α、IL-6、AMS及DAO水平低于对照组(P＜0.05)。结论 血必净注射液通过干预SAP大鼠TLR4信号通路,降低小肠组织TLR4和NF-κB的表达,减轻小肠组织的炎症反应,对肠黏膜屏障具有一定的保护作用。

Objective To investigate the effect on intestinal mucosal barrier dysfunction (IBF) of Xuebijing injection mediated by Toll-like receptor 4 (TLR4) signal pathway in rats of severe acute pancreatitis (SAP). Methods 24 Sprague Dawley (SD) rats were randomly divided into Sham group (n=8), control group (n=8) and treatment group (n=8). The SAP model was established by retrograde injection of 4.5% sodium taurocholate into the biliopancreatic duct in control group and treatment group, while control group was injected with the same amount of saline. In treatment group, Xuebijing injection (3 mL/kg) was injected via tail vein after 3h of modeling. All rats were monitored and sacrificed after 24 hours of modeling. Samples of pancreas and intestine were collected for pathologic determination. A fluorescent RT-PCR was used to determine the expression of TLR4 and NF-κB of small intestine. The serum levels of TNF-α, IL-6, amylase (AMS) and diamine oxidase (DAO) were measured by using ELISA. All parameters of three groups were compared. Results The expression of TLR4 and NF-κB of small intestine in control group and treatment group were higher than it in control group (P<0.05), as well as the serum levels of TNF-α, IL-6, AMS and DAO (P<0.05). The expression of TLR4 and NF-κB of small intestine in treatment group were lower than it in control group (P<0.05), as well as the serum levels of TNF-α, IL-6, AMS and DAO (P<0.05). Conclusion Xuebijing injection may not only reduce the expression of TLR4 and NF-κB of small intestine, but also alleviate the inflammation reaction of small intestine by interfering with TLR4 signal pathway, which may have a protective effect on intestinal mucosal barrier in SAP rats.

尼可地尔是一种ATP敏感型钾离子通道开放剂,同时兼有类硝酸酯作用,具有舒张冠脉和外周血管及通过缺血预适应对心脏起保护作用等双重功效,主要用于抗心绞痛的治疗。介于尼可地尔这种特殊结构及其作用机制能否降低急性心肌梗死患者PCI术后无复流的发生率及改善临床预后,目前临床研究仍在探索中。现就尼可地尔的作用机制、模拟的药物预适应作用、及综合作用与急性心肌梗死的关系做一综述,评估尼可地尔作为辅助药物在AMI行介入治疗中的作用及临床预后,指导临床用药。

Nicorandil is an ATP-sensitive potassium (K-ATP) channel opener, meanwhile has an effect like nitrate, has dual actions including coronary and peripheral vasodilatation and cardioprotective effects through ischemic preconditioning, mainly for the treatment of anti-angina. Whether the specific structure of nicorandil and its mechanism can reduce the incidence of no-reflow in patients with acute myocardial infarction (AMI) after PCI and improve the clinical prognosis, the current clinical research is still under investigation. We will expound mechanisms of nicorandil, drug preconditioning and its comprehensive effect. The role of nicorandil in the interventional therapy of AMI was reviewed to guide clinical medication.

目的 了解长沙市雨花区环卫工人的健康状况,为有针对性地制定健康教育措施提供依据。方法 为环卫工人进行体格检查,对其体检资料进行统计分析。结果 1 672名受检环卫工人中仅有57人所检项目完全正常,异常检出率达96.60%,其中男性职工的总体检出率要高于女性职工(P<0.05);男性职工慢性咽炎、高血压、血脂异常、高尿酸血症、肾囊肿的检出率较女性职工高(P<0.05);而女性职工肾结石、甲状腺结节、痔疮的检出率要高于男性职工(P<0.05)。体检结果尚具有一定的年龄段分布规律,膝关节退变、超重和肥胖、慢性咽炎、脂肪肝、高尿酸血症、甲状腺结节等检出率差异有统计学意义(P<0.05);其中膝关节退变、高血压、前列腺增生等检出率随着年龄的增长而增加。结论 环卫工人的卫生保健意识薄弱,进一步促进改善他们的工作条件,并对其进行健康教育非常必要。

Objective To understand the health status of sanitation workers in Yuhua District of Changsha city, and to provide evidence for the establishment of health education measures. Methods The sanitation workers were examined by medical examination and their physical examination data were statistically analyzed. Results In the 1 672 subjects of sanitation workers there were only 57 people seized items completely nor -mal. Abnormal rate was 96.60%. The total examination rate of male workers was higher than that of female workers (P<0.05); morbidity of male workers in chronic pharyngitis, hypertension, dyslipidemia, hyperuricemia and renal cysts were higher than female workers (P<0.05); morbidity of the female workers in kidney stones, thyroid nodules, hemorrhoids, was higher than that of the male workers (P<0.05). The examination results had age distribution. There was statistically significant in knee joint degeneration, overweight and obesity, chronic pharyngitis, hyperuricemia, fatty liver, thyroid nodule (P<0.05); the knee joint degeneration, hyperten -sion, prostatic hyperplasia detection rate increased with age. Conclusion The sanitation workers' awareness of health care is weak. It is necessary to further improve their working conditions and to carry out health education for them.