• 【使用未修剪的股骨钉预防性合成骨转移性股骨时的脂肪栓塞和死亡。】 复制标题 收藏 收藏
    DOI:10.1097/00005131-199704000-00018 复制DOI
    作者列表:Peter RE,Schopfer A,Le Coultre B,Hoffmeyer P
    BACKGROUND & AIMS: :We report a case of cardiovascular collapse and death occurring intraoperatively during the prophylactic nailing of a metastatic femur using an unreamed femoral nail. The cause of death, as documented by the autopsy, was a massive fat embolism. The risk of fat embolism while performing intramedullary nailing is well known and has been linked to the process of medullary reaming. Unreamed femoral interlocking nails recently have become available. Although recent reports in the literature have concluded that the risk of fat embolism appears less likely while using unreamed implants, the surgeon should carefully consider the indications for any type of intramedullary fixation, particularly when dealing with unbroken femurs exhibiting impending pathologic fracture, or when preexisting pulmonary disease such as metastasis is present.
    背景与目标: :我们报告了一例在使用未加注股骨钉的预防性转移股骨钉内术中发生心血管衰竭和死亡的情况。尸检表明,死因是大量脂肪栓塞。进行髓内钉手术时发生脂肪栓塞的风险是众所周知的,并且与髓核扩孔过程有关。最近,无钉股骨互锁钉已经上市。尽管最近的文献报道得出结论,使用未植入的植入物时出现脂肪栓塞的可能性较小,但外科医生应仔细考虑任何类型的髓内固定的适应症,尤其是在处理表现出即将发生病理性骨折的股骨或已有的股骨时存在肺部疾病如转移。
  • 【胎儿小脑发育的磁共振成像。】 复制标题 收藏 收藏
    DOI:10.1080/14734220600589210 复制DOI
    作者列表:Triulzi F,Parazzini C,Righini A
    BACKGROUND & AIMS: :In the last few years fetal magnetic resonance imaging (MRI) has been proposed as a second level technique in the evaluation of fetal brain anomalies. It has been demonstrated that MRI is highly accurate in illustrating the morphologic changes of developing brain and fetal brain abnormalities being a useful procedure when ultrasonography is inconclusive or doubtful. Starting from the 19-20 weeks gestational age (GA), MRI can reliably depict fetal brain anatomy and locating pathology, offering a robust and reliable tool in the assessment of fetal CNS diseases. In this review both in vivo MRI quantitative and qualitative data about fetal cerebellar development are presented and compared with ultrasonography data. Fetal cerebellar development is gradual, steady, and largely comparable to the development of the supratentorial brain. Archicerebellar (flocculo-nodular lobe) and paleocerebellar (vermis) structures develop first, whereas neocerebellum (cerebellar hemispheres) develop slowly and largely after birth.
    背景与目标: :在最近几年中,胎儿磁共振成像(MRI)已被提出作为评估胎儿脑异常的第二级技术。已经证明,当超声检查不确定或值得怀疑时,MRI可以高度准确地说明发育中的大脑和胎儿脑部异常的形态变化,这是一种有用的方法。从19-20周胎龄(GA)开始,MRI可以可靠地描绘胎儿的大脑解剖结构和定位病理,从而为评估胎儿CNS疾病提供了强大而可靠的工具。在这篇综述中,提出了关于胎儿小脑发育的体内MRI定量和定性数据,并将其与超声检查数据进行了比较。胎儿小脑发育是渐进的,稳定的,并且在很大程度上可与上脑上脑的发育相媲美。先生小脑(结节状结节状)和小脑((状)结构,而新小脑(小脑半球)出生后缓慢且大部分发育。
  • 【缺乏5α-还原酶1型的小鼠中的胎儿死亡是由雌激素过多引起的。】 复制标题 收藏 收藏
    DOI:10.1210/mend.11.7.9933 复制DOI
    作者列表:Mahendroo MS,Cala KM,Landrum DP,Russell DW
    BACKGROUND & AIMS: :Female mice deficient in steroid 5alpha-reductase type 1 have a decreased litter size. The average litter in homozygous deficient females is 2.7 pups vs. 8.0 pups in wild type controls. Oogenesis, fertilization, implantation, and placental morphology appear normal in the mutant animals. Fetal loss occurs between gestation days 10.75 and 11.0 commensurate with a midpregnancy surge in placental androgen production and an induction of 5alpha-reductase type 1 expression in the decidua of wild type mice. Plasma levels of androstenedione and testosterone are 2- to 3-fold higher on gestation day 9, and estradiol levels are chronically elevated by 2- to 3-fold throughout early and midgestation in the knockout mice. Administration of an estrogen receptor antagonist or inhibitors of aromatase reverse the high rate of fetal death in the mutant mice, and estradiol treatment of wild type pregnant mice causes fetal wastage. The results suggest that in the deficient mice, a failure to 5alpha-reduce androgens leads to their conversion to estrogens, which in turn causes fetal death in midgestation. These findings indicate that the 5alpha-reduction of androgens in female animals plays a crucial role in guarding against estrogen toxicity during pregnancy.
    背景与目标: :缺乏1型甾体5α-还原酶的雌性小鼠的窝产仔数减少。纯合缺陷型雌性的平均产仔数为2.7头,而野生型对照为8.0头。在突变动物中,卵子发生,受精,着床和胎盘形态正常。胎儿丢失发生在妊娠10.75至11.0天之间,与胎盘雄激素产生的中期妊娠激增和野生型小鼠蜕膜中5α-还原酶1型表达的诱导相称。在敲除第9天,雄烯二酮和睾丸激素的血浆水平要高2至3倍,而雌二醇水平在整个妊娠早期和中期都长期升高2至3倍。在突变小鼠中施用雌激素受体拮抗剂或芳香酶抑制剂可逆转高死亡率的胎儿死亡,而雌二醇治疗野生型妊娠小鼠会造成胎儿浪费。结果表明,在有缺陷的小鼠中,未能通过5α-还原雄激素导致其转化为雌激素,进而导致妊娠中期胎儿死亡。这些发现表明,雌性动物体内雄激素的5α-还原在预防妊娠期雌激素毒性中起着至关重要的作用。
  • 【线粒体相关的己糖激酶在本氏烟草中对程序性细胞死亡的控制中发挥作用。】 复制标题 收藏 收藏
    DOI:10.1105/tpc.106.041509 复制DOI
    作者列表:Kim M,Lim JH,Ahn CS,Park K,Kim GT,Kim WT,Pai HS
    BACKGROUND & AIMS: :Recent findings suggest a pivotal role for mitochondria-associated hexokinase in the regulation of apoptosis in animal cells. In this study, virus-induced gene silencing (VIGS) of a hexokinase-encoding Hxk1 caused necrotic lesions on leaves, abnormal leaf morphology, and retarded plant growth in Nicotiana benthamiana. Hxk1 was associated with the mitochondria, and this association required the N-terminal membrane anchor. VIGS of Hxk1 reduced the cellular glucose-phosphorylating activity to approximately 31% of control levels without changing the fructose-phosphorylating activity and did not alter hexose phosphate content severely. The affected cells showed programmed cell death (PCD) morphological markers, including nuclear condensation and DNA fragmentation. Similar to animal cell apoptosis, cytochrome c was released into the cytosol and caspase-9- and caspase-3-like proteolytic activities were strongly induced. Furthermore, based on flow cytometry, Arabidopsis thaliana plants overexpressing Arabidopsis HXK1 and HXK2, both of which are predominantly associated with mitochondria, exhibited enhanced resistance to H(2)O(2)- and alpha-picolinic acid-induced PCD. Finally, the addition of recombinant Hxk1 to mitochondria-enriched fractions prevented H(2)O(2)/clotrimazole-induced cytochrome c release and loss of mitochondrial membrane potential. Together, these results show that hexokinase critically regulates the execution of PCD in plant cells, suggesting a link between glucose metabolism and apoptosis.
    背景与目标: :最近的发现表明线粒体相关的己糖激酶在调节动物细胞凋亡中起着关键作用。在这项研究中,编码己糖激酶的Hxk1的病毒诱导的基因沉默(VIGS)导致了本特烟草的叶片坏死性病变,异常的叶片形态并延缓了植物的生长。 Hxk1与线粒体相关联,这种关联需要N端膜锚。 Hxk1的VIGS可以将细胞的葡萄糖磷酸化活性降低至对照水平的约31%,而不会改变果糖磷酸化活性,并且不会严重改变磷酸己糖的含量。受影响的细胞显示出程序性细胞死亡(PCD)形态标志物,包括核浓缩和DNA片段化。与动物细胞凋亡相似,细胞色素c被释放到细胞质中,并强烈诱导了caspase-9-和caspase-3-like蛋白水解活性。此外,基于流式细胞仪,拟南芥植物过表达拟南芥HXK1和HXK2,这两个主要与线粒体相关联,表现出增强的抗H(2)O(2)-和α-吡啶甲酸诱导的PCD。最后,向线粒体富集的部分中添加重组Hxk1可以防止H(2)O(2)/克霉唑诱导的细胞色素c释放和线粒体膜电位的损失。总之,这些结果表明,己糖激酶严格调节植物细胞中PCD的执行,表明葡萄糖代谢与细胞凋亡之间存在联系。
  • 【阴离子通道阻滞剂4,4'-dinitrostilbene-2,2'-二磺酸可在体内抑制海马体内糖酵解过程中防止神经元死亡和兴奋性氨基酸释放。】 复制标题 收藏 收藏
    DOI:10.1016/j.neuroscience.2006.07.004 复制DOI
    作者列表:Camacho A,Montiel T,Massieu L
    BACKGROUND & AIMS: :Neuronal death associated with cerebral ischemia and hypoglycemia is related to increased release of excitatory amino acids (EAA) and energy failure. The intrahippocampal administration of the glycolysis inhibitor, iodoacetate (IOA), induces the accumulation of EAA and neuronal death. We have investigated by microdialysis the role of exocytosis, glutamate transporters and volume-sensitive organic anion channel (VSOAC) on IOA-induced EAA release. Results show that the early component of EAA release is inhibited by riluzole, a voltage-dependent sodium channel blocker, and by the VSOAC blocker, tamoxifen, while the early and late components are blocked by the glutamate transport inhibitors, L-trans-pyrrolidine 2,4-dicarboxylate (PDC) and DL-threo-beta-benzyloxyaspartate (DL-TBOA); and by the VSOAC blocker 4,4'-dinitrostilbene-2,2'-disulfonic acid (DNDS). Riluzole, DL-TBOA and tamoxifen did not prevent IOA-induced neuronal death, while PDC and DNDS did. The VSOAC blockers 5-nitro-2-(3-phenylpropyl-amino) benzoic acid (NPPB) and phloretin had no effect either on EAA efflux or neuronal damage. Results suggest that acute inhibition of glycolytic metabolism promotes the accumulation of EAA by exocytosis, impairment or reverse action of glutamate transporters and activation of a DNDS-sensitive mechanism. The latest is substantially involved in the triggering of neuronal death. To our knowledge, this is the first study to show protection of neuronal death by DNDS in an in vivo model of neuronal damage, associated with deficient energy metabolism and EAA release, two conditions involved in some pathological states such as ischemia and hypoglycemia.
    背景与目标: :与脑缺血和低血糖有关的神经元死亡与兴奋性氨基酸(EAA)释放增加和能量衰竭有关。海马内糖酵解抑制剂碘乙酸盐(IOA)的给药可诱导EAA积累和神经元死亡。我们已经通过微透析研究了胞吐作用,谷氨酸转运蛋白和体积敏感性有机阴离子通道(VSOAC)对IOA诱导的EAA释放的作用。结果表明,EAA释放的早期组分被电压依赖性钠通道阻滞剂利鲁唑和VSOAC阻断剂他莫昔芬抑制,而谷氨酸转运抑制剂L-反式吡咯烷2则阻断了早期和晚期组分。 ,4-二羧酸盐(PDC)和DL-苏-β-苄氧基天冬氨酸(DL-TBOA);通过VSOAC阻滞剂4,4'-二硝基二苯乙烯-2,2'-二磺酸(DNDS)。利鲁唑,DL-TBOA和他莫昔芬不能预防IOA诱导的神经元死亡,而PDC和DNDS可以预防。 VSOAC阻滞剂5-硝基-2-(3-苯基丙基-氨基)苯甲酸(NPPB)和荧光素对EAA流出或神经元损伤均无影响。结果表明,糖酵解代谢的急性抑制可通过胞吐作用,谷氨酸转运蛋白的损伤或逆作用以及DNDS敏感机制的激活来促进EAA的积累。最新消息实质上涉及神经元死亡的触发。据我们所知,这是第一个在体内神经元损伤模型中由DNDS保护神经元死亡的研究,该模型与能量代谢不足和EAA释放有关,这是某些病理状态(例如局部缺血和低血糖)的两个条件。
  • 【胎儿左,右肺动脉的多普勒检查与胎儿位置和胎龄的关系:方法学研究]】 复制标题 收藏 收藏
    DOI:10.1055/s-2007-1000509 复制DOI
    作者列表:Taddei F,Chaoui R,Lenz F,Bast C,Kalache K,Heling KS,Bollmann R
    BACKGROUND & AIMS: UNLABELLED:A Methodical Study:

    AIM OF THE STUDY:To analyse the feasibility of colour and spectral Doppler assessment of blood flow in the fetal right (RPA) and left (LPA) main pulmonary arteries in relation to fetal position and to gestational age.

    STUDY DESIGN:The fetal position was a priori divided into 3 types, depending on whether the fetal heart was visualised apically (Type 1), from the right side (Type 2) or from the left side (Type 3). Three groups A (19-25 weeks gestation), B (26-32) and C (33-39) including 33 consecutive pregnancies each, were examined to document the fetal position as well as the rate of the successful Doppler examinations of the RPA and/or LPA.

    RESULTS:The fetal position Type 2 was most common throughout gestation (in group A = 42%, B = 36%, C = 51%) followed by the type 3 and then type 1. The rate of successful Doppler records from the RPA and LPA depended on the fetal position: In Type 2 RPA in 98%; in Type 3, LPA in 100%; but the apical approach was not effective (< 40%). Depending on gestational age, the success rates for a Doppler examination of at least one vessel were high (> 85%), whereas successful examination of both vessels was unlikely (12%).

    CONCLUSIONS:In the second half of pregnancy, independent of fetal position, Doppler examination of at least one pulmonary artery is successful in most cases, whereas the assessment of both vessels is rather difficult.

    背景与目标: UNLABELLED :一项系统研究:

    研究目标:分析彩色和光谱多普勒评估胎儿血流(RPA)的可行性)和左(LPA)主要肺动脉与胎儿位置和胎龄有关。

    研究设计:胎儿位置是先验的,分为3种类型,具体取决于是否从右侧(2型)或左侧(3型)顶端可见胎儿心脏(类型1)。对三组A(妊娠19-25周),B(26-32)和C(33-39)组进行了检查,每个组连续33次怀孕,以记录胎儿的位置以及RPA的多普勒检查成功率和/或LPA。

    结果:在整个妊娠期间,胎儿位置2型最为常见(A组为42%,B = 36%,C = 51%),其次是分别是3型和1型。RPA和LPA的多普勒记录成功率取决于胎儿的位置:在2型RPA中为98%。在类型3中,LPA为100%;但根尖手术方法无效(<40%)。根据胎龄,至少对一根血管进行多普勒检查的成功率较高(> 85%),而对两根血管进行多普勒检查的成功率均不高(12%)。

    结论 strong>:在怀孕的后半段,不管胎儿的身高如何,大多数情况下多普勒检查至少一条肺动脉是成功的,而两条血管的评估却相当困难。

  • 【胎儿纤连蛋白作为高危患者样品中早产的标志物】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Surbek D,Bösiger H,Pavic N,Huber P,Almendral AC,Holzgreve W
    BACKGROUND & AIMS: The accuracy of cervicovaginal fetal fibronectin as a predictor of preterm birth was studied in patients with increased risk for preterm delivery (according to the Creasy-score). In a prospective blind observational study the smear from the posterior fornix vaginae of 56 pregnant patients without PROM was examined using a quantitative immunoassay for the detection of fetal fibronectin. The patients who tested positively for fetal fibronectin had significantly more preterm deliveries than those with a negative result (CHI square-test, p < 0.01, RR 5.1). Overall, sensitivity, specificity, positive and negative predictive values were 56%, 87%, 45% and 91%, respectively. In patients with preterm labor these values were 75%, 87%, 60%, and 93%, respectively. No patient with a negative result delivered preterm during the following two weeks. It is concluded that performing the fetal fibronectin test in patients with preterm labor is useful for the prediction of preterm birth. Routine testing in patients at increased risk (asymptomatic patients) is not recommended for lack of effectiveness.

    背景与目标: 宫颈阴道胎儿纤连蛋白作为早产预测指标的准确性已在早产风险增加的患者中进行了研究(根据Creasy评分)。在一项前瞻性盲观察研究中,使用定量免疫测定法检测了56例无PROM的孕妇的后穹vagina阴道涂片,以检测胎儿的纤连蛋白。胎儿纤连蛋白检测阳性的患者比阴性检测的早产明显多(CHI square-test,p <0.01,RR 5.1)。总体而言,敏感性,特异性,阳性和阴性预测值分别为56%,87%,45%和91%。在有早产的患者中,这些值分别为75%,87%,60%和93%。在接下来的两周内,没有阴性结果的患者早产。结论是在早产患者中进行胎儿纤连蛋白测试有助于预测早产。不建议对风险较高的患者(无症状的患者)进行常规检查,因为其缺乏有效性。

  • 【由于Fournier的坏疽突然猝死。】 复制标题 收藏 收藏
    DOI:10.1007/s004140050042 复制DOI
    作者列表:Bunai Y,Nagai A,Nakamura I,Ohya
    BACKGROUND & AIMS: A 43-year-old Japanese male vagrant collapsed suddenly in a police station. The man was resuscitated in hospital but died about 13 h later. An autopsy revealed necrotizing fasciitis in the genitalia and lower abdominal wall. The man was considered to have died from endotoxic shock following on Fournier's gangrene.

    背景与目标: 一名43岁的日本男性无业游民突然在派出所倒塌。该名男子在医院复苏,但于约13小时后死亡。尸检显示,生殖器和下腹壁有坏死性筋膜炎。该男子被认为死于傅里叶坏疽后的内毒素性休克。

  • 【胎sa尾畸胎瘤自发性破裂。】 复制标题 收藏 收藏
    DOI:10.1159/000093884 复制DOI
    作者列表:Sy ED,Lee H,Ball R,Farrell J,Poder L,Nobuhara KK,Farmer DL,Harrison MR
    BACKGROUND & AIMS: :With recent advances in technology, fetal sacrococcygeal teratoma is being diagnosed increasingly during the early prenatal period by ultrasound examination. In addition, early detection of tumor related complications such as polyhydramnios, congestive heart failure, hydrops, hemorrhage, urinary tract or bowel obstruction can be followed closely in utero. Active prenatal management can improve fetal perinatal outcome by allowing planned delivery for neonatal surgery [Chisholm, C.A. et al.: Am J Perinatol 1999;16:47-50] or in some cases, fetal intervention. Additionally, families can be counseled appropriately regarding the range of outcomes. We report a case of fetal sacrococcygeal teratoma Type I diagnosed at 20 weeks with a prominent vessel supplying the tumor mass. At 23 weeks, there was a sudden appearance of an additional lobular mass, consistent with intrauterine spontaneous ruptured of a sacrococcygeal teratoma mass.
    背景与目标: :随着技术的最新发展,在产前早期,通过超声检查越来越多地诊断出胎儿sa球畸胎瘤。此外,可以在子宫内密切追踪早期发现的与肿瘤相关的并发症,如羊水过多,充血性心力衰竭,积水,出血,尿路或肠梗阻。积极的产前管理可以通过允许新生儿手术的计划分娩来改善胎儿的围产期结局[Chisholm,C.A.等人:Am J Perinatol 1999; 16:47-50],或在某些情况下,进行胎儿干预。此外,可以就结果的范围向家庭提供适当的咨询。我们报告一例胎儿sa球菌畸胎瘤I型在20周时被诊断出有明显的血管供应肿瘤块。在第23周,突然出现额外的小叶肿块,这与sa球尾畸胎瘤肿块的子宫内自发破裂相一致。
  • 【早孕期分离出胎儿的颈部通透性:意义和预后。】 复制标题 收藏 收藏
    DOI:10.7863/jum.1997.16.2.101 复制DOI
    作者列表:Reynders CS,Pauker SP,Benacerraf BR
    BACKGROUND & AIMS: In this study, we determined the outcome in cases of isolated nuchal lucency seen sonographically in the first trimester in fetuses without karyotypic abnormalities. We reviewed all cases of isolated localized fetal nuchal lucency (3 mm or greater) in 9 to 14 week fetuses over a 4 year period. Fetuses with additional sonographic abnormalities were excluded. The width of the nuchal lucency at initial sonogram as well as findings on subsequent scans were tabulated. Karyotypic, pathologic, and clinical follow-up data were obtained. Of 44 fetuses with an isolated, localized first trimester nuchal lucency, one was lost to follow-up and two were excluded owing to pregnancy termination without karyotype or pathologic analysis, thus resulting in 41 fetuses in our study group. Five fetuses (12%) had abnormal karyotypes. Twenty-seven of the remaining 36 fetuses had normal karyotypes, eight others showed no evidence of aneuploidy at birth, and one patient underwent spontaneous abortion prior to a karyotypic analysis. Among the 36 fetuses without evidence of aneuploidy, six had a poor outcometwo were spontaneous abortions, one was a therapeutic abortion of a fetus with hydrops and a pericardial effusion seen on fetopsy; one fetus died at birth of pulmonary hypoplasia associated with autosomal recessive polycystic kidney disease, and one fetus each had Noonan syndrome, and Joubert syndrome. In addition, three patients delivered their infants prematurely. Overall, 32 of 41 fetuses survived, and two (6%) were abnormal. Excluding premature infants, 27 were normally grown, term survivors. We conclude that other than having an increased risk for aneuploidy, fetuses with isolated nuchal lucency are also at risk for spontaneous miscarriage, premature delivery, and congenital anomalies unassociated with an abnormal karyotype.

    背景与目标: 在这项研究中,我们确定了在没有核型异常的胎儿中,在头三个月的超声检查中发现的孤立的颈部通透性的情况下的结果。我们回顾了在4年期间9至14周胎儿中所有孤立的局部胎颈透明性(3 mm或更大)的病例。具有其他超声异常的胎儿被排除在外。将初始超声检查时的颈部通透性宽度以及随后的扫描结果列表化。获得了核型,病理和临床随访数据。在分离出的局部早孕颈部通透性的44例胎儿中,有1例失去了随访,而2例由于终止妊娠而没有进行核型或病理分析而被排除在外,因此,我们的研究组中有41例胎儿。 5名胎儿(占12%)的核型异常。其余36例胎儿中有27例具有正常的核型,另外8例在出生时未显示非整倍性,并且有一名患者在进行核型分析之前进行了自然流产。在没有非整倍性证据的36例胎儿中,有6例结局不良,其中2例是自然流产,一种是治疗性流产,胎儿因积水和心包积液见于女性。一名胎儿死于与常染色体隐性隐性多囊肾疾病相关的肺发育不全,另一名胎儿分别患有Noonan综合征和Joubert综合征。此外,三名患者提前分娩了婴儿。总体而言,41例胎儿中有32例存活,其中2例(6%)异常。除早产婴儿外,正常生长的足月存活者为27名。我们得出的结论是,除了具有非整倍性的风险增加外,具有孤立的颈部透明性的胎儿也有自发流产,早产和与异常核型无关的先天性异常的风险。

  • 【产中胎儿窒息:定义,诊断和分类。】 复制标题 收藏 收藏
    DOI:10.1016/s0002-9378(97)70385-5 复制DOI
    作者列表:Low JA
    BACKGROUND & AIMS: Evidence of a significant metabolic acidosis, an umbilical artery base deficit > 12 mmol/L, confirms that an asphyxial exposure has occurred. This is observed at delivery in approximately 2% of all pregnancies. Classification of the severity of the asphyxial exposure is difficult because the duration and nature of the exposure and the characteristics of the fetal cardiovascular response to the asphyxia in the affected fetus is usually not known. A classification is proposed in which the exposure to asphyxia is confirmed by a blood gas and acid-base assessment with evidence of a significant metabolic acidosis and the severity is defined by newborn encephalopathy and other organ system complications. Outstanding issues that may enhance this classification are identified.

    背景与目标: 明显的代谢性酸中毒,脐动脉基础缺损> 12 mmol / L的证据证实发生了窒息。大约有2%的孕妇在分娩时观察到这种情况。窒息暴露严重程度的分类很困难,因为通常不知道暴露的持续时间和性质以及胎儿对窒息对窒息的心血管反应特征。提出了一种分类,其中通过血气和酸碱评估证实窒息暴露,并伴有明显的代谢性酸中毒,严重程度则由新生儿脑病和其他器官系统并发症定义。确定了可能会增强此分类的突出问题。

  • 【非小细胞肺癌中的自噬和Bcl-2 / BNIP3死亡调控途径。】 复制标题 收藏 收藏
    DOI:10.1111/apm.12026 复制DOI
    作者列表:Karpathiou G,Sivridis E,Koukourakis M,Mikroulis D,Bouros D,Froudarakis M,Bougioukas G,Maltezos E,Giatromanolaki A
    BACKGROUND & AIMS: :We recently showed that non-small cell lung carcinomas (NSCLCs) are of dismal prognosis when encompassing accelerated autophagic activity. The regulation of this abnormally functioning degradation system and its association with hypoxia and apoptosis in lung carcinoma patients is unexplored. In this study we used 115 NSCLC tissues to examine the immunohistochemical expression of four distinct molecules - the major regulator of autophagy Beclin 1, the anti-apoptotic and anti-autophagic protein Bcl-2, the pro-apoptotic and pro-autophagic protein BNIP3, and a marker of hypoxia and glucolysis, the glucose transporter Glut 1. Most cases showed reduced reactivity for Beclin 1 (62%) and Bcl-2 (82%) proteins, almost half of our sample revealed strong BNIP3 expression (57%), whereas most of the carcinomas strongly expressed Glut 1 antigen (71%). Beclin 1 expression showed no association with survival. Bcl-2 positivity was a marker of good prognosis (p = 0.04), whereas BNIP3 (p = 0.0004) and Glut 1 (p = 0.03) expression correlated with poor outcome in Stage I disease. Autophagic status was negatively associated with Bcl-2 (p = 0.0006), but positively with Glut 1 expression (p = 0.001). In conclusion, the accelerated autophagic status in NSCLC is unrelated to Beclin 1 and BNIP3 expression, but does show significant association with Bcl-2 reactivity. Furthermore, we showed important correlations between glucolysis and autophagy, guiding new pathways in future lung carcinoma research.
    背景与目标: :我们最近发现,非小细胞肺癌(NSCLC)包含加速自噬活性时预后不良。肺癌患者中这种功能异常的降解系统的调控及其与缺氧和细胞凋亡的关系尚待探索。在这项研究中,我们使用115个NSCLC组织检查了四个不同分子的免疫组织化学表达-自噬Beclin 1的主要调节剂,抗凋亡和抗自噬蛋白Bcl-2,促凋亡和自噬蛋白BNIP3,葡萄糖转运蛋白Glut 1是缺氧和糖酵解的标志。大多数病例显示Beclin 1(62%)和Bcl-2(82%)蛋白的反应性降低,几乎一半的样本显示BNIP3表达强(57%),而大多数癌症强烈表达Glut 1抗原(71%)。 Beclin 1的表达与存活率无关。 Bcl-2阳性是预后良好的标志(p = 0.04),而BNIP3(p = 0.0004)和Glut 1(p = 0.03)的表达与I期疾病的不良预后相关。自噬状态与Bcl-2呈负相关(p = 0.0006),但与Glut 1表达呈正相关(p = 0.001)。总之,NSCLC中自噬状态的加速与Beclin 1和BNIP3的表达无关,但确实与Bcl-2的反应性显着相关。此外,我们显示了糖酵解与自噬之间的重要关联,为未来肺癌研究的新途径提供了指导。
  • 【单绒毛膜和绒毛膜对双胎妊娠的早期胎儿丢失:西南泰晤士河产科研究合作组织(STORK)多胎队列的分析。】 复制标题 收藏 收藏
    DOI:10.1002/uog.12363 复制DOI
    作者列表:D'Antonio F,Khalil A,Dias T,Thilaganathan B,Southwest Thames Obstetric Research Collaborative (STORK).
    BACKGROUND & AIMS: OBJECTIVES:Monochorionic (MC) twins are at increased risk of early fetal loss secondary to vascular complications such as twin-twin transfusion syndrome (TTTS). This study compared the early perinatal loss rates between MC and dichorionic (DC) twins in an era of invasive treatment for TTTS. METHODS:This was a retrospective study of all twin pregnancies of known chorionicity from a large regional cohort of nine hospitals over a 10-year period. Ultrasound data were matched to hospital delivery records and to a mandatory national register of pregnancy losses. Prospective risk of pregnancy loss from 14 to 24 weeks' gestation was calculated and the survival trend of MC and DC twins was analyzed using Kaplan-Meier survival analysis. RESULTS:The analysis included 3117 twin pregnancies (605 MC and 2512 DC). The total risk of early pregnancy loss (miscarriage and neonatal death) before 24 weeks was significantly higher in MC twins (60.3 per 1000 fetuses) than in DC twins (6.6 per 1000 fetuses), with a relative risk of 9.18 (95% CI, 6.0-13.9). Survival analysis showed a significant difference in overall and early mortality between MC and DC twins (log-rank test, P < 0.0001), while no difference was noted after 24 weeks' gestation (log-rank test, P = 0.08). CONCLUSIONS:Early pregnancy loss is significantly more common in MC than in DC twins, but no difference in the prospective risk of mortality between MC and DC twins is evident after 24 weeks' gestation. The observed early mortality rate has almost halved in comparison with previous studies in the published literature. Early detection and prompt treatment of complications in MC twins are likely to have contributed to this improvement in outcome.
    背景与目标: 目的:双卵母细胞(MC)双胞胎因血管并发症(如双胞胎双输血综合征)而继发早期胎儿丢失的风险增加。这项研究比较了在TTTS侵入治疗时代MC和二甲胎(DC)双胞胎之间的早期围产期丢失率。
    方法:这是一项回顾性研究,研究对象是一个大型的区域性队列,其中包括9家医院,历时10年,对所有已知绒毛膜性的双胎妊娠进行了研究。超声波数据与医院的分娩记录以及国家强制性的妊娠损失登记表相匹配。计算了妊娠14至24周的预期流产风险,并使用Kaplan-Meier生存分析法分析了MC和DC双胞胎的生存趋势。
    结果:该分析包括3117例双胎妊娠(605 MC和2512 DC)。 MC双胞胎(每1000胎儿中60.3)比DC双胞胎(每1000胎儿6.6)在24周前丧失早孕(流产和新生儿死亡)的总风险显着更高,相对风险为9.18(95%CI, 6.0-13.9)。生存分析显示,MC和DC双胞胎的总体死亡率和早期死亡率有显着差异(对数秩检验,P <0.0001),而在妊娠24周后未发现差异(对数秩检验,P = 0.08)。
    结论:MC早孕的发生率明显高于DC双胞胎,但孕24周后MC和DC双胞胎之间的预期死亡风险无明显差异。与已发表文献中的先前研究相比,观察到的早期死亡率几乎降低了一半。早期发现和及时治疗MC双胞胎的并发症可能有助于改善结局。
  • 【双胎妊娠的胎儿生长和围产期死亡率-病假和住院的影响。】 复制标题 收藏 收藏
    DOI:10.1016/0020-7292(85)90054-2 复制DOI
    作者列表:Erkkola R,Ala-Mello S,Kero P,Sillanpää M
    BACKGROUND & AIMS: :Fetal growth, birth weight specific mortality rates and effect of sick leave or hospitalization on the fetal growth were investigated in a material of 476 twin pregnancies managed at University Central Hospital of Turku in years 1970-81. Birth weights of twin babies at any gestational age were slightly but not significantly higher than in earlier materials. When compared to growth curve of singleton fetuses, the growth rate of both twins is equal to singletons up to 30th week of pregnancy, being thereafter slower than in singleton pregnancies. Although duration of sick leave and hospitalization increased considerably during the study period, no change in the duration of pregnancy nor in the weight of twin babies occurred. Instead perinatal mortality decreased from 101/per thousand to 36.2/per thousand. Birth weight specific mortality rates did not differ from those in singleton fetuses.
    背景与目标: :在1970-81年间,在图尔库大学中心医院进行的476次双胎妊娠研究中,研究了胎儿的生长,特定体重的死亡率以及病假或住院对胎儿生长的影响。在任何胎龄的双胞胎婴儿的出生体重均比早期胎龄婴儿的出生体重稍高但不明显。与单胎胎儿的生长曲线相比,直到怀孕第30周,双胎的生长速度等于单胎,此后比单胎妊娠要慢。尽管在研究期间病假和住院时间显着增加,但怀孕时间或双胞胎婴儿的体重均未发生变化。相反,围产期死亡率从101 /千降低到36.2 /千。出生体重比死亡率与单胎胎儿无异。
  • 【产前超声检查与胎儿尸检结果之间的一致性:妊娠中期终止妊娠的回顾性研究。】 复制标题 收藏 收藏
    DOI:10.1055/s-0032-1325538 复制DOI
    作者列表:Lomax L,Johansson H,Valentin L,Sladkevicius P
    BACKGROUND & AIMS: OBJECTIVES:To estimate the agreement between prenatal ultrasonography observations at 16 - 21 gestational weeks and fetal autopsy findings in pregnancies terminated because of fetal anomalies. STUDY DESIGN:This 4½ year retrospective study includes consecutive fetuses that were terminated because of fetal malformation and/or chromosomal anomaly diagnosed in the second trimester. Only fetuses that had undergone fetal anatomy scanning by an obstetrician trained in fetal ultrasound before the termination and with available fetal autopsy reports were included. The cases were identified through the malformation registry database of our ultrasound unit. The sensitivity and specificity of ultrasound were calculated per organ system. When estimating the agreement between ultrasound results and autopsy findings, the cases were allocated to one of four categories according to the degree of concordance between ultrasound and autopsy findings: full agreement, near match, partial agreement and unconfirmed ultrasound findings. RESULTS:71 of 95 pregnancy terminations due to fetal malformations met the inclusion criteria and constitute our study population. The sensitivity of ultrasonography with regard to malformations in the brain and spine was 100 % (27/27) and with regard to malformations in the internal organ system (including malformations in the urogenital and gastrointestinal systems and in the abdominal wall and diaphragm) was 91 % (30/33). The corresponding figures for malformations in the cardiovascular and skeletal organ systems were 63 % (17/27) and 71 % (25/35), respectively. The specificity was lowest for malformations in the central nervous system and internal organ system (33/38, 87 % and 39/44, 89 %, respectively). There was full agreement between the ultrasound and autopsy findings in 44 % (31/71) of all cases and a near match in 46 % (33/71) of cases. In almost 10 % (7/71) of the pregnancies, the ultrasound findings were only partially confirmed or not confirmed by autopsy. In one case the discrepancy between the ultrasound and autopsy findings suggests that the pregnant woman might have decided to terminate the pregnancy on the basis of incorrect interpretation of ultrasound findings. CONCLUSION:Even though the agreement between ultrasound and autopsy findings was acceptable from a clinical point of view, agreement with regard to the detailed description of malformations was far from perfect. The detection rates were suboptimal for the cardiovascular and skeletal organ systems. :ZIEL:: Bewertung, inwieweit bei Schwangerschaftsabbrüchen aufgrund fetaler Anomalien die Befunde der pränatalen Ultraschalluntersuchung in der 16.–21. SSW mit dem Autopsiebefund des Feten übereinstimmen. METHODEN:Diese 4½ jährige retrospektive Studie schließt fortlaufend Feten ein, bei denen im 2. Trimenon ein Schwangerschaftsabbruch (TOP) aufgrund fetaler Fehlbildungen und/oder aufgrund von diagnostizierten Chromosomenanomalien erfolgt ist. Es wurden nur Feten einbezogen, bei denen vor dem Abbruch eine anatomische Untersuchung durch einen in der Fetalsonografie geübten Geburtshelfer durchgeführt wurde und bei denen fetale Autopsiebefunde vorlagen. Die Fälle wurden durch die Datenbank unserer Sonografieabteilung zur „Registrierung von Fehlbildungen“ ermittelt. Die Sensitivität und Spezifität der Sonografie wurde für jedes Organsystem berechnet. Zur Abschätzung der Übereinstimmung von Ultraschall- und Autopsiebefunden wurden die Fälle einer der vier Kategorien zugewiesen, je nach Grad der Übereinstimmung der Befunde: Solche mit völliger, sich fast entsprechender und nur teilweiser Übereinstimmung sowie nicht bestätigte Ultraschallbefunde. ERGEBNISSE:Die Einschlusskriterien erfüllten 71 von 95 Schwangerschaftsabbrüchen aufgrund fetaler Anomalien und bildeten somit unsere Studienpopulation. Die Sensitivität der Sonografie in Bezug auf Malformationen des Gehirns und Wirbelsäule betrug 100 % (27/27) und in Bezug auf Anomalien der inneren Organe (einschließlich der Fehlbildungen des Urogenital- und Magen-Darm-Systems, der Bauchdecke und des Diaphragmas) 91 % (31/33). Die entsprechende Rate für Anomalien des Herz-Kreislauf-Systems betrug 63 % (17/27) und für die des Skelettsystems 71 % (25/35). Die niedrigste Spezifität wurde für Malformationen des zentralen Nervensystems (33/38, 87 %) und der inneren Organe (39/44, 89 %) ermittelt. Eine völlige Übereinstimmung von Ultraschall- und Autopsiebefunden wurde in 44 % (31/71) und eine sich fast entsprechende Übereinstimmung in 46 % (33/71) aller Fälle gefunden. Bei beinahe 10 % (7/71) der Schwangerschaften konnten die Ultraschallbefunde nur teilweise beziehungsweise gar nicht durch die Autopsie bestätigt werden. In einem Fall mit diskrepanten Ultraschall- und Autopsiebefunden kann angenommen werden, dass die Schwangere die Entscheidung für einen Abbruch vermutlich aufgrund der fehlerhaften Interpretation des Ultraschallbefundes fällte. SCHLUSSFOLGERUNG:Obwohl die Übereinstimmung von Ultraschall- und Autopsiebefunden vom klinischen Standpunkt betrachtet akzeptierbar schien, war sie bezüglich der genauen Beschreibung der Fehlbildungen bei weitem nicht perfekt. Die Trefferquoten beim Herz-Kreislauf- und Skelettsystem waren suboptimal.
    背景与目标: 目的:估计在妊娠16〜-21周的产前超声检查结果与因胎儿异常而终止妊娠的胎儿尸检结果之间的一致性。
    研究设计:这项为期4½年的回顾性研究包括由于胎儿畸形和/或在妊娠中期诊断为染色体异常而终止的连续胎儿。仅包括终止前接受过胎儿超声培训的产科医生进行的胎儿解剖学扫描的胎儿,并提供胎儿尸检报告。这些病例是通过我们超声科的畸形登记数据库确定的。超声的灵敏度和特异性是根据每个器官系统计算的。在估计超声结果与尸检结果之间的一致性时,根据超声与尸检结果之间的一致性程度,将病例分为以下四类之一:完全一致,接近匹配,部分一致和未经证实的超声发现。
    结果:因胎儿畸形而终止的95例妊娠中有71例符合纳入标准,构成了我们的研究人群。超声检查对脑和脊柱畸形的敏感性为100%(27/27),对内脏器官系统的畸形(包括泌尿生殖系统和胃肠系统以及腹壁和and肌的畸形)的敏感性为91 %(30/33)。心血管和骨骼器官系统畸形的相应数字分别为63%(17/27)和71%(25/35)。中枢神经系统和内脏器官系统畸形的特异性最低(分别为33 / 38、87%和39 / 44、89%)。在所有病例中,超声检查和尸检结果完全吻合(44%)(31/71),接近匹配率在46%(33/71)中。在几乎10%(7/71)的怀孕中,超声检查结果仅部分被证实或尸检未得到证实。在一种情况下,超声检查与尸检结果之间的差异表明,孕妇可能已基于对超声检查结果的错误解释而决定终止妊娠。
    结论:即使从临床角度来看,超声检查与尸检结果之间的一致性是可以接受的,但就畸形的详细描述而言,一致性还远非完美。对于心血管和骨骼器官系统,检出率不是最理想的。
    :ZIEL :: Bewertung,来自Schwangerschaftsabbrüchen的胎儿异常胎儿在16到21日间因超自然现象丧生。 SSW mit dem Autopsiebefund des Fetenübereinstimmen。
    Methoden:Diese4½jährige具有追溯力的Studieschließtfortlaufend Feten ein,bei denen im 2。 Es wurden nur Feten einbezogen,bei denen vor dem Abbruch eine anatomische Untersuchung durch einen der FetalsonografiegeübtenGeburtshelferdurchgeführtwurde und bei denen fetale Autopsiebefunde vorlagen。 DateFällewurden durch和Datenbank取消注册„ Registrierung von Fehlbildungen“ ermittelt。器官系统的敏感度和敏感度。 ZurAbschätzungderÜbereinstimmungvon Ultraschall- and AutopsiebefundenwürdendieFälleeiner der vier Kategorien zugewiesen,je nach Grad derÜbereinstimmungder Befunde:Solche mitvölligenics undtüstenchänder
    急诊室:死于脑卒中71到95Schwangerschaftsabbrüchenaufgrund胎儿异常和二等体不育的研究人群。百事可乐和Wirbelsäule投注在100%(27/27)和内部器官异常(Einschließlichder Fehlbildungen des Urogenital- und Magen-Darm-Duch-System)中, (31/33)。赫兹-克劳斯劳夫系统异常率达到63%(17/27),而斯凯莱特系统异常率达到71%(25/35)。神经系统神经网络(33/38,87%)和内部有机体(39/44,89%)。 EinevölligeÜbereinstimmungvon Ultraschall- and Autopsiebefunden wurde患病率为44%(31/71),eine sich fast entsprechendeÜbereinstimmung患病率为46%(33/71)。贝纳赫河(Bei beinahe)10%(7/71)从施万格啤酒厂(Ultraschallbefunde nur teilweise beziehungsweise gar nicht durch)进行尸检。在《超常的世界》和《超常的世界》中,施瓦格大帝和德国的企业家之间的关系得到了解释。
    SCHLUSSFOLGERUNG:Obwohl死于Ultraschall-and Autopsiebefunden vom klinischen Standpunkt betrachtet akzeptierbar schien,战胜了beschüglichder genauen Beschreibung der Fehlbildungen bei weitem nicht。 Die Trefferquoten认为Herz-Kreislauf-和Skelettsystem警告不理想。

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