Exosomes play an important role during human immunodeficiency virus (HIV) acute infection. Yet, information regarding its cargo and its association with HIV rapid progressors (RPs) and typical progressors (TPs) remain largely unknown. In this study, exosomal miRNAs sequencing and mass cytometry were used to identify differential exosomal miRNAs and membrane proteins that participate in the pathogenesis of TPs and RPs. We discovered that miR-144-5p, miR-1180-3p, miR-451a, miR-362-5p, and miR-625-5p are associated with the TPs and miR-362-5p with the RPs. Decreased autophagy, amino acid metabolism, immune response, and IL-6 are closely related to RPs. In addition, SP1 was selected as the most significant transcription factor (TF) associated with disease progression. CD49D, CD5, CCR5, CD40, CD14, and CD86 were selected as the differential exosomal membrane proteins between TPs and RPs. This study provides valuable information for clarifying the mechanism in people with acute HIV infection.

目的 探讨改良Hayman缝合术与B-Lynch缝合术对剖宫产术中及产后出血的治疗效果.方法 选取2010年1月～2019年6月在我院妇产科进行剖宫产术中出现产后出血行子宫压迫缝合术的产妇81例作为研究对象.根据手术方式不同分为改良Hayman缝合术35例(Hayman组)和B-Lynch缝合术46例(B-Lynch组),观察两组治疗效果.结果 Hayman组的手术时间、术中出血量、术后24 h出血量、输血率、术前术后血色素下降程度、产褥病率均小于B-Lynch组,差异有统计学意义(P<0.05);两组有效率、术后ICU入住率、术后住院时间、血性恶露持续时间、晚期产后出血发生率、月经复潮时间比较差异无统计学意义(P>0.05).结论 改良Hayman缝合术相较于B-Lynch缝合术,治疗剖宫产术中及产后出血更为简便快速,可明显缩短手术时间,减少出血量、输血率及产褥病率.

目的 探讨不同宫颈锥切术治疗宫颈高级别鳞状上皮内病变的临床效果.方法 选取应急总医院2016年1月至2019年1月收治的240例宫颈高级别鳞状上皮内病变患者作为研究对象,根据患者就诊号的尾数,采用简单随机分组的方法分为A、B、C三组,每组80例患者.A组患者采取宫颈环形电切除术,B组患者采取传统宫颈冷刀锥切术,C组患者采取改良宫颈冷刀锥切术.对三组患者的手术时间、术中出血量、住院时间、手术费用、术后并发症、切缘阳性率、病灶残留及复发率、高危型人乳头瘤病毒感染率等进行比较.结果 A组患者的手术时间、术中出血量、手术费用、住院时间均少于B组(P<0.05);A组患者病灶残留、复发、高危型人乳头瘤病毒感染率高于B、C两组(P<0.05);三组在切缘阳性率差异无显著性(P>0.05);C组患者术中出血量、住院时间与A组比较差异无显著性(P>0.05);B组患者术后并发症多于A、C两组(P<0.05).结论 宫颈环形电切除术与传统宫颈冷刀锥切术各有利弊,而改良宫颈冷刀锥切术既保留了传统冷刀锥切术优势,又减少了术中出血、术后并发症.临床可根据患者年龄、生育状况等做出选择.

目的:探究妊娠期糖尿病(GDM)的危险因素及膳食营养干预效果.方法:选取246例孕妇作为研究对象,其中124例非GDM孕妇作为非GDM组,122例GDM孕妇作为GDM组,比较2组患者年龄、文化程度、产次、糖尿病家族史、孕前BMI、体育锻炼、收入水平及孕早期血红蛋白等资料,对有差异的指标采用Logistic回归分析GDM发生的危险因素;再将GDM孕妇均分为观察组与对照组,对照组根据宣教内容自主择食,观察组给予膳食营养干预,比较2组母婴结局(剖宫产、早产、羊水过多、巨大儿、胎儿窘迫及产褥感染).结果:GDM发病与孕妇孕前BMI、年龄、孕早期血红蛋白、体育锻炼及糖尿病家族史有关,差异有统计学意义(P<0.05),而与文化程度、产次及收入水平无关,差异无统计学意义(P>0.05);Logistic回归分析结果显示,孕妇年龄、糖尿病家族史、孕前BMI及孕早期血红蛋白水平是GDM发病的危险因素(P<0.05),而体育锻炼则是GDM发病的保护因素(P<0.05);膳食营养干预后,观察组巨大儿、早产及胎儿窘迫发生率低于对照组,差异有统计学意义(P<0.05),2组孕妇羊水过多、剖宫产率及产褥感染发生率比较,差异无统计学意义(P>0.05).结论:孕妇孕前BMI、年龄、孕早期血红蛋白及糖尿病家族史是GDM发病的危险因素,体育锻炼是GDM的保护因素,对GDM孕妇进行膳食营养干预可一定程度改善母婴结局.

Micro (mi)RNAs are crucial participants in the progression of cervical cancer (CC). Growing evidence indicates that miRNA (miR)-34c-5p is a pivotal tumor suppressor in numerous types of cancer and its functions in CC require further investigating. The present study demonstrated that there was a decreased level of miR-34c-5p in CC-associated cell lines compared with healthy control samples. It also demonstrated that miR-34c-5p targeted Notch1 and suppressed CC progression. Dual-Luciferase reporter assays verified the targeted relationship of miR-34c-5p and Notch1. The expression of Notch1 in HeLa cells was markedly reduced following miR-34c-5p overexpression and the proliferation, migration and invasion of HeLa cells were reduced although apoptosis was accelerated. However, overexpression of miR-34c-5p was reversed following the addition of Notch1, which supported the finding of the targeted relationship between miR-34c-5p and Notch1. Flow cytometry demonstrated that miR-34c-5p inhibited the proliferation of HeLa cells while accelerating apoptosis. The present study concluded that miR-34c-5p was a tumor suppressor in CC and may be a novel measure for the future treatment of CC.

目的 提高某综合医院住院病案首页填写质量.方法 采用按比例分层随机抽样原则,从2018年9月1日-2018年10月31日期间2004份住院病案中抽取360份作为改善前的对照组,从2019年1月1日-2019年2月28日期间1754份住院病案中抽取315份作为改善后的观察组.利用品管圈质量管理工具,分四个阶段共10个步骤开展品管圈改善活动,用卡方检验分析改善前后住院病案首页填写的正确率.结果 住院病案首页总体填写正确率由改善前的66.67％提高到改善后的73.97％,经卡方检验差异有统计学意义(P<0.05).改善后的住院病案首页正确率提升7.30％,达到预先设定的提升6.00％的目标,目标达成率为121.67％,住院病案首页填写质量进步率为10.95％.结论 品管圈是一种成本低、见效快的质量推进活动,可显著改善住院病案首页填写质量,从而提升基于DRG的医院绩效评价结果.

Objective: To investigate the effect of the erythropoietin-activating EPO-EPOR signalling pathway on improving cardiac function in diabetic rats. Methods: The rats were randomly divided into the normal control group, the diabetes group and the diabetes + EPO intervention group, with 10 rats in each group. The diabetic rats model was established. The rats in the diabetes + EPO intervention group were given a subcutaneous injection of 1000IU/kg EPO and the normal control group and the diabetes group were given subcutaneous injections of normal saline of equal volume once a week for 12 consecutive weeks. Echocardiography was used to determine the heart to body weight ratio, left ventricular end-diastolic diameter (LVDd), ejection fraction (EF) and left ventricular end-systolic diameter (LVDs) in rats. The levels of blood lipids (glycerin trilaurate [TG]), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), blood glucose content and blood routine red blood cell (RBC) were measured by the Hitachi automatic biochemical analyser, the GOD-PAP method and the blood routine detector JHF7-3000, respectively. The expression of the glucose-regulated protein 78 (GRP78), the sarcoplasmic reticulum Ca2+-ATP enzyme (SERCA2a) and the EPOR mRNA in the left ventricular myocardium of the rats was detected by an RT-PCR assay. The expression levels of GRP78, SERCA2a and EPOR proteins were detected by a western blot assay and the immunohistochemistry method. Results: The EF and LVDD values of rats in the diabetes group were significantly lower than those of the normal control group (P<0.01), and the heart to body weight ratio was markedly higher than that of the normal control group (P<0.01). There was no statistically significant difference in LVDS between the diabetes group and the normal control group (P>0.05). The EF value of rats in the diabetes + EPO intervention group was significantly higher than that in the diabetes group, and the LVDS and LVDD values and heart to body weight ratio were remarkably lower than those in the diabetes group (P<0.01). The body weight and HDL-C levels of the rats in the diabetes group were significantly lower than those in the control group, while the levels of blood glucose, TG, TC and LDL-C were remarkably higher than those in the control group (P<0.01). There was no statistically significant difference in the RBC level between the diabetes group and the control group (P>0.05). Moreover, the weight of rats in the diabetes + EPO intervention group was significantly higher than that in the diabetes group, and there was no statistically significant difference in blood lipid, blood glucose and RBC levels compared with the diabetes group (P>0.05). The expression of GRP78 mRNA in the diabetes group was markedly higher than that in the control group (P<0.01), and the expression of the SERCA2a, EPOR mRNA in the diabetes group was significantly lower than that in the control group (P<0.01). Besides, the expression of the GRP78 mRNA in the diabetes + EPO group was significantly lower than that in the diabetes group (P<0.01), and the expression of the SERCA2a, EPOR mRNA in the diabetes group was obviously higher than that in the diabetes group (P<0.01). The expression of the GRP78 protein in the diabetes group was significantly higher than that in the control group (P<0.01), and the expression of the SERCA2a, EPOR protein in the diabetes group was remarkably lower than that in the control group (P<0.01). Moreover, the expression of the GRP78 protein in the diabetes + EPO group was significantly lower than that in the diabetes group (P<0.01), and the expression of the SERCA2a, EPO protein in the diabetes group was significantly higher than that in the diabetes group (P<0.01). Conclusion: EPO can effectively improve cardiac function in rats, which may be due to the activation of the EPO-EPOR signalling pathway by reducing the stress response of the myocardial endoplasmic reticulum, thus leading to the increased expression of the SERCA2a and EPOR protein and playing a protective role in the heart.

Objective:To investigate the feasibility and characteristics of ultrasound imaging in diagnosing fractures in neonates.Methods:Thirty neonates with bone fracture in Beijing Chaoyang District Maternal and Child Healthcare Hospital during January 2018 to June 2019 were retrospectively recruited. The causes and ultrasound imaging features of these cases were analyzed. The ultrasound findings were compared with the results of X-ray examination.Results:Among the 30 cases, 29 (96.7%) were diagnosed as fracture due to birth trauma, including 28 (93.3%) of clavicle fracture and one (3.3%) of humerus fracture, and one (3.3%) with rib fracture probably caused by metabolic osteopathy. The ultrasound imaging characteristics included interruption of bone continuity, dislocation and/or angulation of fracture ends, and callus formation during recovery. All of the 30 cases were diagnosed by ultrasound. However, X-ray examination failed in the diagnosis of one clavicle fracture.Conclusions:Ultrasound is an accurate and reliable method for the diagnosis of neonatal fracture. The main characteristics of ultrasound imaging include interruption of bone continuity, dislocation and/or angulation of fracture ends and callus formation.

Myocardial ischemia-reperfusion (I/R) injury is the oxidative stress and inflammatory response that occurs when a tissue is reperfused following a prolonged period of ischemic injury. Growing evidence has demonstrated that microRNAs (miRs) are essential in the development of myocardial I/R injury. Salidroside, a phenylpropanoid glycoside isolated from a traditional Chinese medicinal plant, Rhodiola rosea, possesses multiple pharmacological functions and protects against myocardial I/R injury in vitro and in vivo. However, the role of miRs in the cardioprotective effects of salidroside against myocardial I/R injury has not been studied, to the best of our knowledge. In the present study, the role of miR21 in the underlying mechanism of salidroside-induced protection against oxidative stress and inflammatory injuries in hypoxia/reoxygenation (H/R)-treated H9c2 cardiomyocytes was determined. The cell viability was assessed with an MTT assay. Lactate dehydrogenase (LDH) release, caspase-3 activity, malondialdehyde (MDA) level, superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities were determined by commercial kits. Cell apoptosis was measured by flow cytometry. Intracellular reactive oxygen species (ROS) generation was monitored by DCFH-DA. The miR-21 level was quantified by reverse transcription-quantitative (RT-q)PCR. The interleukin (IL)-6, IL-1β and tumor necrosis factor (TNF)-α levels were measured by RT-qPCR and ELISA. The results showed that salidroside pretreatment significantly increased cell viability and decreased the release of LDH, accompanied by an increase in miR-21 expression in H/R-treated H9c2 cells and a miR-21 inhibitor reversed these effects. In addition, the miR-21 inhibitor also abrogated the inhibition of salidroside on H/R-induced increases in apoptosis and caspase-3 activity in H9c2 cells. Salidroside mitigated H/R-induced oxidative stress as illustrated by the downregulation of ROS generation and MDA level and increased the activities of the antioxidant enzymes, SOD and GSH-Px, all of which were abrogated in cells transfected with the miR-21 inhibitor. Salidroside induced a decrease in the expression and levels of the pro-inflammatory cytokines, IL-6, IL-1β and TNF-α, which were prevented by the miR-21 inhibitor. Together, these results provide evidence of the beneficial effects of salidroside against myocardial I/R injury by reducing myocardial oxidative stress and inflammation which are enhanced by increasing miR-21 expression.

The renin-angiotensin system (RAS) serves an essential role in hypertension. MicroRNAs (miRs) have been reported to be important regulators in angiotensin (Ang) II-dependent hypertension. We aimed to explore the roles of Ang II and miR-133a in the mechanism underlying hypertension. Human umbilical vein endothelial cells (HUVECs) were identified by immunofluorescence staining. Cell viability and miR-133a expression under the inhibition of Ang II of various concentrations were determined by an MTT assay and reverse transcription-quantitative polymerase chain reaction (RT-qPCR), respectively. The effects of HUVECs transfected with miR-133a mimic or inhibitor on Ang II-induced apoptosis were measured using flow cytometry. The potential targeting of miR-133a to the 3' untranslated region of (pro) renin receptor (PRR) was assessed using TargetScan and a dual-luciferase assay. The effects of PRR interference using small interfering (si)RNA on PRR expression and the rate of apoptosis were determined by RT-qPCR, western blotting and flow cytometry, respectively. Ang II at a concentration of 10(-5) M significantly inhibited the cell viability (P<0.05) and miR-133a expression (P<0.01); Downregulation of miR-133a suppressed cell viability. HUVECs transfected with miR-133a mimic reduced the rate of Ang II-induced apoptosis from 21.99 to 12.38%, but miR-133a inhibitor promoted Ang II-induced apoptosis (apoptosis rate, 28.9%). PRR was predicted to be a target gene of miR-133a. Transfection with siPRR decreased the apoptotic rate in Ang II + negative control and Ang II + miR-133a inhibitor group to 11.39 and 12.94%, respectively. Our findings also suggested that Ang II promoted PRR expression to enhance the apoptotic rate of HUVECs via the suppression of miR-133a. Furthermore, siPRR efficiently decreased the Ang II-induced apoptosis.

To investigate the clinical effects of leuprolide acetate microspheres combined with levonorgestrel intrauterine delivery system in the treatment of adenomyosis (AM S ).[M ethods]Seventy‐two patients with AM S in our hospital from December 2014 to December 2017 were selected and divided into obser‐vation group and control group according to random number table method ,36 cases in each group .T he control group was treated with levonorgestrel intrauterine release system ,w hile the observation group was treated with leuprorelin acetate microspheres for injection on the basis of the control group .T he curative effect ,uter‐ine volume change ,menstrual volume change ,dysmenorrhea improvement ,serum carcinoembryonic antigen (CA125) ,quality of life score and incidence of adverse reactions were compared between the two groups before and after treatment .[Results]T he total effective rate of the observation group was 94 .44%,which was signifi‐cantly higher than 77 .78% of the control group ( P ＜0 .05).After 6 months of treatment ,the uterine volume of the observation group was significantly smaller than that of the control group ,the dysmenorrhea and men‐strual volume score and serum CA 125 level were significantly lower than those of the control group ( P ＜0 . 05) ,and the quality of life score of the observation group was significantly higher than that of the control group ( P ＜0 .05).T he incidence of adverse reactions in the observation group was 25 .00%,and there was no significant difference between the observation group and the control group (19 .44%) ( P ＞0 .05).[Conclusion]Levonorgestrel intrauterine release system combined with leuprorelin acetate microspheres for injection in the treatment of AM S patients has a significant effect ,can significantly improve the clinical symptoms and quality of life of patients ,effectively reduce the level of serum CA 125 ,and has high safety ,w hich is worthy of clinical application .

<正>例1,患者女,41岁,G5P1,因"孕23+1周,间断下腹发紧1d,阴道少量出血2h"于2011年5月25日入院。入院前1d劳累后感间断下腹发紧,入院前2h出现阴道少量出血,色鲜红。查体:宫底脐上一指,偶及宫缩,强度弱,胎心140次/min。妇科检查:外阴已婚经产型,消毒外阴后窥器小心窥开阴道,阴道内少许新鲜血迹,无血块。宫颈光,宫颈管未消,宫口未开,宫颈口无活动性出血,无组织物阻塞。入院诊断:G5P1,孕23+1周先兆晚

<正>随着社会的进步和医疗法制建设的逐步完善,人们的法制观念和维权意识逐渐增强,医疗纠纷呈上升趋势。据统计,从2000年起,我国医疗纠纷每年以l1%的递增速度上升,产科风险排在第一位,要求经济赔偿和追究法律责任的案件逐年增多[1],更有人形容产科的职业风险犹如在高空踩钢丝[2]。1产科医疗纠纷的原因1.1产科的特殊性产科患者大多为年轻育龄女性,孕前一

<正>慢性宫颈炎是妇科门诊常见病,常合并人乳头状瘤病毒(human papilloma-virus,HPV)感染,其感染率约为37%～60%[1]。HPV是宫颈癌的病因已经在分子及基因水平得以证实,在99%的宫颈癌中可以检测出HPV感染,尤其是高危型HPV(16/18型)感染可见于70%以上的宫颈癌患者。30岁以

<正>外伤后外阴皮肤缺损及瘢痕形成临床并不多见,往往导致局部解剖外观改变及功能变化。如何修复局部外观、促进创面愈合,从而恢复功能,有效改善患者生活质量是至关重要的。髂腹股沟皮瓣修复皮肤缺损目前在外科手术中应用较多,大多应用于手部、足部、四肢等部位皮肤软组织缺损的修复。我院收治外伤后外阴瘢痕1例,进行外阴瘢痕切除,应用左髂腹股沟皮瓣修复,取得良好疗效。现报道如下:

<正>1病历报告患者,33岁,孕3产0,因"停经43d,下腹痛1d,伴阴道少量出血"于2010年8月20日入院。停经后无明显早孕反应。右下腹疼痛1d,呈持续性,程度中等,伴少量阴道出血,暗红,未见组织物排出,无头晕、

<正>妊娠糖尿病(gestational diabetes mellitus,GDM)是指妊娠后首次发现或发病的糖尿病。GDM的发生率为1%～5%,其发生率因种族和地区差异较大,近年来发病率有增高趋势。GDM临床经过复杂,对母儿均有较大危害,如:羊水过多、

<正>脐带是连接胎儿与胎盘的条索状结构,是胎儿营养物质来源和代谢产物排出的主要通道。正常脐带中有两条动脉和一条静脉,脐带中仅有一条脐动脉者称为单脐动脉(Single umbilical artery,SUA)[1],属于脐带发育和结构异常。分析我院

剖宫产术是解决难产的一种手术分娩方法,由于社会因素等原因,近年来国内剖宫产率居高不下.随着人们生活水平提高和审美情趣的增强,尤其剖宫产手术针对的患者绝大多数是年轻妇女,对美的要求更甚于男性或其他年龄段女性患者,因此对剖宫产术后皮肤切口愈合的美观更为重视.如果患者无既往手术史,目前剖宫产手术多采用腹壁横切口,而切口缝合的方法和采用的材料不尽相同,各有优缺点[1] .

Objective:To evaluate efficacy and feasibility of laparoscopy for ectopic pregnancy with hemorrhagic shock. Method:75 cases of ectopic pregnancy with hemorrhagic shock treated with laparoscope and laparotomy from Jan.2002 to Jun.2009 in our hospital were retrospectively analyzed.32 cases were in the laparoscopic group(observation group) and 43 cases in laparotomy group(control group).Parameters including operating time,the hemorrhage volume,the time staying in hospital after operation and the mean recovery time of bowel function were collected for comparison. Result:All patients operated successfully in observation group,and no complications occurred.In the observation group,the operating time was(25.40±9.10) min,the blood amount loss was(56.88±59.75) mL during operation,the mean recovery time of bowel function was(36.0±11.41) h,the time staying on bed after the operation was(20.50±5.50) h,the time staying in hospital after operation(4.31±0.47) d.In the control group,the operating time was(64.80±22.90) min,the blood amount loss was(135.35±66.85) mL during operation,the mean recovery time of bowel function was(47.07±15.50) h,the time staying on bed after the operation was(46.65±11.64) h,the time staying in hospital after operation was(7.02±0.15) d.These's obvious statistical difference between two groups(P 0.001). Conclusion:Laparoscopy is safe and feasible for ectopic pregnancy with hemorrhagic shock,with skilled laparoscopic operation technique,prompt and effective anti-shock treatment,ideal anesthesia and monitor.It deserves to promote in clinical.