目的 探讨不同剂量和不同疗程米非司酮对大鼠子宫异位内膜基质金属蛋白酶-9（MMP-9）及其组织特异性抑制物-1（TIMP-1）表达的影响。 方法 65只子宫内膜异位症大鼠随机分为低剂量组、高剂量组、对照组。各个剂量组分别灌胃20、30、40 d后取异位子宫内膜组织用免疫组织化学法检测MMP-9及TIMP-1的表达，并计算MMP-9/TIMP-1比值。 结果 低剂量组和高剂量组均能使异位内膜MMP-9表达下降（P＜0.05）,TIMP-1表达升高（P＜0.05）,高剂量组的作用更加明显，与低剂量组差异有统计学意义（P＜0.05）；用药30 d低剂量组TIMP-1表达最高，与用药20 d和40 d相比差异有统计学意义（P＜0.05）,同样高剂量组用药30d TIMP-1的表达也最高，与用药20 d和用药40 d比较差异有统计学意义（P＜0.05）。与用药20、40 d比较差异有统计学意义（P＜0.05）。 结论 米非司酮能够降低大鼠异位子宫内膜的侵袭能力，高剂量米非司酮抑制效果更明显；用药30 d米非司酮对大鼠异位内膜的侵袭能力抑制最强，延长用药时间不能使异位内膜侵袭能力继续下降。
Objective To compare the effectiveness of different puncture methods of the flexible bone cement delivery device in unilateral percutaneous curved vertebroplasty for osteoporotic vertebral upper 1/3 compression fractures. Methods A retrospective analysis was conducted on the clinical data of 67 patients with osteoporotic vertebral upper 1/3 compression fractures who were admitted and met the selection criteria between January 2023 and April 2024. The patients were divided into two groups based on the puncture method of the flexible bone cement delivery device: the oblique puncture group (n=37) and the parallel puncture group (n=30). There was no significant difference (P>0.05) between the two groups in terms of gender, age, bone mineral density (T value), distribution of fractured vertebrae, time from injury to operation, and preoperative visual analogue scale (VAS) score for pain, Oswestry disability index (ODI), anterior vertebral height of the fractured vertebra, and Cobb angle of the fractured vertebra. The following parameters were compared between the two groups: operation time, incidence of secondary puncture, incidence of bone cement leakage, volume of injected bone cement, bone cement distribution score, as well as VAS score, ODI, anterior vertebral height of the fractured vertebra, and Cobb angle of the fractured vertebra at 1 day after operation and at last follow-up. Results Two cases in the oblique puncture group and 7 cases in the parallel puncture group underwent secondary puncture during operation, and the difference in the incidence of secondary puncture was significant (P<0.05). No complications such as bone cement hypersensitivity, bone cement embolism, nerve injury, or epidural hematoma occurred in both groups. There was no significant difference in operation time, volume of injected bone cement, incidence of bone cement leakage, distribution score and rating of bone cement between the two groups (P>0.05). All patients were followed up 6-18 months (mean, 12.0 months), and there was no significant difference in the follow-up time between the two groups (P>0.05). No further fracture collapse or compression occurred in the fractured vertebra during follow-up. Both groups exhibited significant improvements in VAS score, ODI, anterior vertebral height, and Cobb angle of the fractured vertebra after operation compared to baseline (P<0.05). There were also significant differences between the two time points after operation (P<0.05). However, there was no significant difference in the above indicators between the two groups (P>0.05). Conclusion For osteoporotic vertebral upper 1/3 compression fractures treated with unilateral percutaneous curved vertebroplasty, both oblique and parallel puncture methods of the flexible bone cement delivery device can effectively relieve pain, but the former is more conducive to reducing the incidence of secondary puncture.
ObjectiveTo study intraoperative reduction strategy in treatment of femoral neck fracture using cannulated screw fixation and the relationship between excellent and good rate of reduction and postoperative effectiveness. MethodsA retrospective analysis was made on the clinical data of 174 cases of femoral neck fracture treated between August 2005 and March 2015. There were 78 males and 96 females with an average age of 53.8 years (range, 23-75 years). The injury causes were falling in 85 cases, traffic accident in 61 cases, and falling from height in 28 cases. According to Garden typing, there were 35 cases of type I, 56 cases of typeⅡ, 47 cases of typeⅢ, and 36 cases of typeⅣ. The time from injury to operation was 1-7 days (mean, 2.74 days). Based on reduction strategy, closed 3 hollow compression screws were used; evaluating standards for fracture reduction effect were also established. Harris score was used for effectiveness evaluation. ResultsAll the cases received follow-up of 12-42 months (mean, 36.5 months). Bone healing was obtained in 152 cases at 6-12 months (mean, 9 months). Non-union and internal fixation failure occurred in 9 and 3 patients respectively, who underwent hemiarthroplasty; femoral head necrosis occurred in 6 patients after removing internal fixator at 15-26 months (mean, 18.5 months) after operation, who underwent total hip arthroplasty; 4 patients with non-union received vascular pedicle iliac flap transplantation. No other serious complications were observed. At last follow-up, the excellent and good rate of reduction was 94.29% for Garden type I, 91.07% for typeⅡ, 87.23% for typeⅢ, and 75.00% for typeⅣ, with a total excellent and good rate of 87.36%; the excellent and good rate of Harris score was 97.14% for Garden type I, 78.57% for typeⅡ, 68.09% for typeⅢ, and 50.00% for typeⅣ, with a total excellent and good rate of 73.56%. ConclusionTo obtain high Harris score in fixation of femoral neck fractures by using hollow screws, surgeons not only need reasonable technology, but also follow correct and good reduction strategy and assessment, fracture complexity is inversely proportional to excellent and good rate of reduction. Higher excellent and good reduction rate of complexity fracture should be obtained as much as possible in order to achieve good prognosis.
Abnormal uterine bleeding with ovulatory dysfunction (AUB-O) is a common reproductive endocrine disease with complex and variable clinical manifestations. This disease has a long course and large individual differences. Difficulties in diagnosis and treatment and nonstandardized management are common in primary hospitals. In order to improve the diagnosis and treatment efficiency of AUB-O in primary hospitals, the gynecological endocrinologists in western China proposed this primary diagnosis and treatment norms and referral recommendations for gynecological outpatient clinics in primary hospitals, including the key points of diagnosis, hemostasis and cycle adjustment strategies, adjuvant treatment, and the principle of two-way referral. In particular, individualized treatment recommendations were proposed for young adolescents and menopausal transition patients. This recommendations are expected to serve as an important reference for AUB-O diagnosis, treatment and two-way referral of primary hospitals in western China.