【摘要】 目的 探讨各种不同体外受精（IVF）助孕方案对子宫腺肌病伴不孕症患者的疗效。 方法 对2006年1月-2009年6月进行IVF助孕治疗的子宫腺肌病伴不孕症患者63例的临床资料进行回顾性分析。根据是否应用长效促性腺激素释放激素激动剂（GnRH-a）及启动促性腺激素（Gn）时间分为超长方案、长效GnRH-a后长或短方案、常规长方案3组，对IVF助孕疗效进行分析。 结果 3种治疗方案的Gn刺激天数、Gn总量、获卵数、不良反应发生率和流产率比较无统计学意义（Pgt;0.05）；3种治疗方案的周期取消率为20.0%、7.7%、30.0%，比较有统计学意义（χ2=5.74，Plt;0.05），方案2的周期取消率低于方案1和方案3，有统计学意义（χ2=7.21，Plt;0.05）；3种治疗方案的继续妊娠率为23.0%、37.0%、15.3%，有统计学意义（χ2=11.31，Plt;0.05），方案2的继续妊娠率高于方案1和方案3，有统计学意义（χ2=8.52，Plt;0.05）。 结论 与超长方案和常规长方案相比，子宫腺肌病伴不孕症患者采用长效GnRH-a治疗后长方案或短方案行IVF助孕治疗，妊娠率升高，周期取消率降低。【Abstract】 Objective To investigate the effect of different in vitro fertilization (IVF) treatment protocols on infertile women with adenomyosis. Methods Sixty-four infertile women with adenomyosis who had IVF treatment cycles from January 2006 to June 2009 were retrospectively analyzed. According to administration of long course gonadotropin-releasing hormone agonist (GnRH-a) and the start time of gonadotropin (Gn), all participants were divided into three groups: the first group with ultra-long term protocol, the second group with long or short term protocol after administration of long course GnRH-a and the third group with routine long term protocol. Results There were no differences among the three groups with regard to days of Gn administration, amounts of Gn administration, numbers of retrieved oocytes, prevalence of poor response and miscarriage (Pgt;0.05). The cancelation rates of the three groups were 20.0%、7.7% and 30.0% respectively. There were significant differences in cancelation rates among the groups (χ2=5.74, Plt;0.05), and the cancelation rate in the second group was significantly lower than the other groups (χ2=7.21, Plt;0.05). The ongoing pregnancy rates of the groups were 23.0%、37.0% and 15.3% respectively. There were significant differences in ongoing pregnancy rates among three groups (χ2=11.31, Plt;0.05), and the ongoing pregnancy rate in the second group was significantly higher than the other groups (χ2=8.52, Plt;0.05). Conclusion Compared with the ultra-long term and routine long term protocol of IVF treatment in infertile woman with adenomyosis, the ongoing pregnancy rate might be higher and the cancelation rate might be lower in the long or short term protocol after administration of long course GnRH-a.
Objective To observe the expression of hepcidin-ferroportin (FPN) pathway in adenine-induced chronic kidney disease (CKD) rat model and to explore the mechanism of its involvement in renal fibrosis in CKD. Methods A total of 20 6-week-old male SD rats without specific pathogen were selected. The rats were divided into control group and CKD group, with 10 rats in each group, using a simple random method. Rats were sacrificed at the end of the second and sixth weeks after modeling. The levels of serum creatinine (Scr), blood urea nitrogen (BUN) and 24 h urine protein quantification were measured. The pathological changes of rats were observed. The iron content of rat kidney tissue was detected by colorimetric method, and the level of serum hepcidin-25 was detected by enzyme linked immunosorbent assay method in both groups. Immunohistochemistry and reverse transcription-polymerase chain reaction were used to detect the renal protein and mRNA expression of α-smooth muscle actin (α-SMA), collagen type Ⅰ (Col-Ⅰ), FPN1, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), nuclear factor kappa-B (NF-κB) P65. Results Compared with the control group, the levels of Scr, BUN, and 24 h urine protein quantification were higher in the CKD group at the end of the second and sixth weeks of modeling (P<0.05). The results of renal tissue staining showed that the CKD group had obvious glomerular structural disorders, tubular dilation, and interstitial collagen fiber deposition. Compared with the control group, the serum hepcidin-25 level and the iron content of kidney tissues in the CKD group were significantly higher, and correlation analysis suggested that both were positively correlated with the renal function of rats (P<0.05). Compared with the control group, the protein and mRNA expression levels of α-SMA, Col-Ⅰ, HAMP, IL-6, TNF-α, NF-κB P65 were higher (P<0.05), while FPN1 expression was lower in CKD group at the end of the second and sixth weeks of modeling (P<0.05). Correlation analysis results showed that HAMP mRNA expression was positively correlated with α-SMA, Col-Ⅰ, IL-6, TNF-α, and NF-κB p65 (P<0.001), which was negatively correlated with FPN1 mRNA expression (P<0.001). FPN1 mRNA expression was significantly negatively correlated with α-SMA, Col-Ⅰ (P<0.001). Conclusions Ferroptosis may be present in the adenine-induced rat model of CKD, and it may be involved in the process of renal fibrosis through the interaction of HAMP-FPN signaling pathway with the inflammatory response. Serum hepcidin-25 is expected to be a serological marker for the early diagnosis of CKD.
Objective To investigate the effectiveness of local skin flaps such as V-Y advancement flap (V-Y plasty) and transposition flap (Z plasty) in the adjustment of reconstructed nasal alars at second stage. Methods Between June 2012 and January 2017, 14 cases of reconstructed nasal alars by nasolabial flap or expanded forehead flap were recruited. There were 9 males and 5 females with an average age of 34.8 years (range, 18-52 years). The interval time between one- and two-stage operations was 1-12 months (mean, 3 months). The type of local skin flap was decided according to the flaws of reconstructed nasal alars. V-Y plasty was used in 5 cases, Z plasty in 2 cases, and V-Y plasty combined with Z plasty in 7 cases. Results All operations were successfully completed. The flaps in 3 cases suffered from epidermal necrosis at the far end and healed by dressing change. The other wounds healed by first intention. All 14 cases were followed up 6-40 months (mean, 12 months). The nasal alars had verisimilar shape and symmetrical appearance. The color and texture of reconstructed nasal alar were closed to peripheral tissues. Conclusion Applying local skin flaps such as V-Y plasty and Z plasty can acquire a better shape in the adjustment of reconstructed nasal alars.
Objective To investigate the current status of constipation during postoperative hospitalization and the factors associated with moderate to severe constipation at discharge in lung cancer patients. Methods Lung cancer patients who underwent surgery in 6 tertiary hospitals in Sichuan Province from November 2017 to January 2020 were enrolled. The MD Anderson Symptom Scale-Lung Cancer Module was used to collect postoperative constipation scores. Unconditional logistic stepwise regression was used to analyze the related influencing factors for moderate to severe constipation on the day of discharge. Results Finally 337 patients were collected. There were 171 males and 166 females, with an average age of 55.0±10.3 years. Constipation scores of lung cancer patients increased from postoperative day 1 to day 3, and showed a decreasing trend from day 3 to day 7. Moderate to severe constipation was present in 68 (20.2%) patients at discharge. The postoperative hospital stay (OR=0.743, P<0.001) and the dose of morphine used during postoperative hospitalization (OR=1.002, P=0.015) were influencing factors for moderate to severe constipation at discharge in lung cancer patients. ConclusionLung cancer patients have the most severe constipation on postoperative day 3. Moderate to severe constipation at discharge is associated with the postoperative hospital stay and the dose of morphine used during postoperative hospitalization.