目的 探讨选择性输卵管插管疏通术(selective hydrotubation,SHT)的临床疗效及其影响因素.方法 收集2015年6月至2019年6月行选择性输卵管插管疏通术治疗的58例诊断为输卵管近端阻塞患者的临床资料,包括不孕时间(＜3年或≥3年)、不孕类型(原发或继发)、是否有支原体感染、输卵管阻塞数量和程度、是否患有其他妇科合并症以及手术方式,分析术后的临床疗效并对其影响因素进行单因素和多因素分析.结果 选择性输卵管插管疏通术疏通成功率97％,总妊娠率41.4％.已孕组24例,未孕组34例,单因素分析表明输卵管近端完全性阻塞的患者术后妊娠率高于不完全阻塞者(x2 =7.643,P=0.006),原发性不孕患者术后妊娠率高于继发性不孕者(x2=5.170,P=0.023),而患者年龄、手术方式、生殖道感染、输卵管阻塞个数以及是否有其他妇科合并症不影响术后妊娠率(P＞0.05).与单因素分析相同,多因素分析表明输卵管近端完全性阻塞的患者术后妊娠率高于不完全阻塞者(OR=3.671,P=0.035),但不孕类型不影响术后妊娠率(P=0.395).结论 选择性输卵管插管疏通治疗是治疗输卵管近端梗阻的有效方法,输卵管完全梗阻的病人术后更容易受孕.

系统性红斑狼疮(SLE)患者常伴有消化系统受累表现，但以消化系统症状首发的病例相对少见，因症状无特异性，易被误诊、误治。该例SLE患者以急性腹膜炎为首发表现，经多学科协作会诊，最终确诊。现分享诊治思路，为临床类似病例提供参考和借鉴。

1 临床资料 病例1 ,女,35岁,2017年7月14日以"发现右侧会阴部肿物渐增大7年"为主诉于大连医科大学附属第二医院普外科入院.患者于7年前右侧会阴部触及一肿物,大小约2 cm×2 cm×2 cm ,质软,无触痛,立位明显,平卧难触及,7年来肿物逐渐增大近1倍,就诊于我院普外科,查体:右侧大阴唇处可触及一肿物,大小约4 cm×3 cm×3 cm ,质软,边界清,无触痛.盆腔增强CT:盆腔右侧及右侧会阴区可见一形态不规则低密度影,密度欠均匀,较大层面范围约 74 mm × 57 mm ,CT值约为22 HU ,增强扫描其内可见少许轻度强化.盆腔M RI增强扫描:盆腔右侧及右侧会阴部见一不规则肿块影,最大截面积约12 cm × 5 cm ,病灶与盆部结构欠清晰,与子宫及直肠界限尚清晰,诊断为盆腔右侧及右侧会阴部肿块,考虑侵袭性血管黏液瘤(AAM )可能(图1A ).

目的 探讨3.0 T MRI在直肠癌术前分期和评估中的应用价值.方法 收集经肠镜及病理确诊的76例直肠癌患者资料,通过术前MRI影像判断T分期、N分期并测量肿瘤下缘至肛缘距离,将MRI分期和评估结果与术后病理进行对照分析.结果 MRI诊断T1期9例,T2期19例,T3期32例,T4a期14例,T4b期2例.病理诊断T1期9例,T2期22例,T3期28例,T4a期15例,T4b期2例.MRI T1、T2、T3、T4a、T4b期诊断敏感度和特异度分别为67％和100％、68.2％和92.6％、89.3％和85.4％、80.0％和96.7％、100％和100％,两者一致性较好(Kappa =0.708,P＜0.05).MRI诊断肠旁淋巴结转移36例,术后病理诊断肠旁淋巴结转移33例,MRI诊断肠旁淋巴结转移敏感度、特异度分别为85.2％和83.3％(Kappa=0.701,P＜0.05).76例患者中有12例患者行Miles术,术前均通过MRI曲线测量技术测量肿瘤下缘至肛缘距离,与术后病理标本数据进行对比,差值≤7 mm,差异无统计学意义(t=0.480,P＞0.05).结论 3.0 T MRI可准确地对直肠癌患者进行术前分期和评估,为临床诊疗提供帮助.

To study multi-slice CT angiography(MSCTA) features of Takayasu arteritis(TA) and to explore the clinical values.The MSCT images of TA were retrospectively analyzed.MSCT examination methods and findings were analyzed and discussed.Multi-slice CT angiography clearly depicted lumenal stenosis and expanding and the wall thickness of the arteries.It is useful for early diagnosis of MSCTA because it allows evaluation of both the wall thickness and the lumenal stenosis,which is especially important for prognosis and the choice of therapy.

Objective The expression of gonadotropin-releasing hormone(GnRH) and its receptor has been demonstrated in peripheral tissues as well CNS.Although antineoplastic activity of GnRH antagonist has been demonstrated,the mechanism of action of these peptide analogs remains incompleted understand.The objectives of this study were to investigate direct antiproliferative effect of GnRH antagonist Cetrorelix on HEC-1A human endometrial cancer cell line and elucidate its underlying mechanism.Methods RT-PCR was performed to detect mRNA expression for GnRH and its receptor in HEC-1A cells.The proliferation of HEC-1A cells was examined by measuring incorporation of 5-Bromo-2′-deoxyuridine (BrdU) into DNA.Signal transduction-related mitogen activated-protein kinase (MAPK) protein levels were evaluated by Western Blot.Results HEC-1A cells expressed mRNA for GnRH and GnRH receptor.Cetrorelix,at 10～(-5) mol/L,exerted an antiproliferative action on HEC-1A cells.Cetrorelix,at concentrations between 10～(-6) and 10～(-5) mol/L(24 h),extracellular signal-regulated kinase 1/2 (ERK1/2) protein level exerted a dose-dependent increased on HEC-1A cells and at the concentration of 10-5 mol/L ERK1/2 protein level exerted the largest increased after 24 h treatment and canceled by U0126,an inhibitor of mitogen-activated protein/MEK kinase (MAPK/MEK).While the protein levels of activated c-JUN N-terminal kinase (JNK) and p38 kinase were not to change significantly.Conclusions These results demonstrate that the successive activation of ERK1/2 might play an important role in the antiproliferation effects of Cetrorelix on HEC-1A cell lines.

To determine how estrogens are involved in the growth of endometrial cancers we investigated the status of ERα and its cofactors p72,AIB1 and erbB-2 in endometrial cancers with varying degrees of differentiation by real-time RT-PCR,and their in vivo cellular effects on the transactivation function of ERα were examined by a transient expression assay.Results showed that the mRNA levels of p72,AIB1 and ERα decreased and those of erbB-2 increased with the loss of histological differentiation.Transient expression of p72,AIB1 and erbB-2 in human embryonic kidney 293T cells led to a synergistic promotion of the transactivation function of ERα in the presence of 17α-estradiol or 4-hydroxytamoxifen,an ERα AF-1 agonist/AF-2 antagonist,as a ligand.In conclusion,estrogen action through ERα AF-1 might be exerted by the increased expression of the coactivators,p72 and AIB1,together with cross talk between erbB-2 and p72 to accelerate the transactivation of ERα AF-1 in endometrial cancer.