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Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences最新文献

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[Research progress of probiotics regulating intestinal micro-ecological environment in obese patients after bariatric surgery]. 益生菌调节减肥术后肥胖患者肠道微生态环境的研究进展。
Q2 Medicine Pub Date : 2024-10-25 DOI: 10.3724/zdxbyxb-2024-0060
Xiaoxiao Zhang, Mizhi Wu, Jianan Wang, Jionghuang Chen, Weihua Yu, Hongying Pan

Bariatric surgery may cause intestinal microecological environment imbalance due to changes in gastrointestinal anatomy. Some patients may have compli-cations, even regain weight. Probiotics can act on intestinal mucosa, epithelium and gut-associated lymphoid tissue to improve the intestinal microecological environment of obese patients after bariatric surgery. Probiotics can promote the production of short-chain fatty acids, stimulate intestinal cells to release glucagon-like peptide-1, peptide tyrosine-tyrosine, insulin and other endocrine hormones, affect the function of the central nervous system through the gut-brain axis, make patients after bariatric surgery feel full, and reduce blood sugar at the same time. Probiotics can produce lactic acid, acetic acid and lactase, to inhibit the growth of harmful bacteria and to improve gastrointestinal symptoms of patients after bariatric surgery. Probiotics can activate the AMP-activated protein kinase signaling pathway, improve lipid metabolism, and promote the recovery of symptom indicators of nonalcoholic fatty liver disease after bariatric surgery. Probiotics can regulate the release of neurotransmitters or metabolites by the microbiota through the gut-brain axis to affect brain activity and behavior, thus helping patients improve negative emotions after bariatric surgery. This article describes the intestinal microecological environment of obese patients and mechanism of the change after bariatric surgery and summarizes the effects and possible mechanisms of probiotics in improving the intestinal microecological environment of obese patients after bariatric surgery, to provide references for promoting the clinical application of probiotics.

由于胃肠道解剖结构的改变,减肥手术可能会导致肠道微生态环境失衡。一些患者可能会出现并发症,甚至体重反弹。益生菌可作用于肠粘膜、上皮细胞和肠道相关淋巴组织,改善肥胖患者减肥手术后的肠道微生态环境。益生菌可以促进肠道抗菌物质的产生,与受体特异性结合,降低肠道 pH 值,减少炎症因子,从而帮助减肥术后患者减轻体重,降低血糖水平。益生菌能产生乳酸、醋酸、乳糖酶等,抑制有害菌的生长,改善减肥术后患者的胃肠道症状。益生菌能激活 AMP 激活蛋白激酶信号通路,改善脂质代谢,促进减肥术后非酒精性脂肪肝症状指标的恢复。益生菌可通过肠脑轴调节微生物群释放神经递质或代谢产物,影响大脑活动和行为,从而帮助患者改善减肥术后的不良情绪。本文阐述了肥胖患者的肠道微生态环境及减肥术后的变化机制,总结了益生菌改善肥胖患者减肥术后肠道微生态环境的作用及可能机制,以期为促进益生菌的临床应用提供参考。
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引用次数: 0
[Research progress and clinical application of veneer materials for implant-fixed restoration in edentulous jaws]. 无牙颌种植固定修复用贴面材料的研究进展及其临床应用。
Q2 Medicine Pub Date : 2024-10-25 DOI: 10.3724/zdxbyxb-2024-0137
Yan Chen, Xinhua Gu

Commonly used materials for fixed restorations in edentulous jaws include acrylic resins, polymerized ceramics, ceramics and zirconia, which have distinct physicochemical properties and clinical application features. The selection of these materials in clinical practice is related to the prosthodontic space, oral soft and hard tissue conditions, occlusal force, lifestyle habits, oral parafunctions, opposing dentition materials, and expectations of patients. Common mechanical complications associated with fixed restorations in edentulous jaws are cracking/chipping and abrasion of the facing materials, which can be avoided through occlusal adjustment, restoration design and processing, and the selection of appropriate restorative materials. This article reviews the characteristics, selection, and design considerations of commonly used materials for fixed restorations in edentulous jaws, as well as the causes and management of common clinical complications related to restorative materials, aiming to provide references for the selection of appropriate materials in fixed restorations for edentulous jaws in clinical practice.

无牙颌固定修复常用的材料包括丙烯酸树脂、聚合陶瓷、陶瓷和氧化锆等,这些材料具有不同的理化性质和临床应用特点。在临床实践中,这些材料的选择与修复空间、口腔软硬组织条件、咬合力、生活习惯、口腔副功能、对 咬合材料以及患者的期望值有关。无牙颌固定修复体常见的机械并发症是裂纹/崩裂和面材磨损,这些可以通过咬合调整、修复体设计和加工以及选择合适的修复材料来避免。本文综述了无牙颌固定修复常用材料的特点、选择和设计注意事项,以及与修复材料相关的常见临床并发症的原因和处理方法,旨在为临床实践中选择合适的无牙颌固定修复材料提供参考。
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引用次数: 0
[Pathogenesis and potential diagnostic biomarkers of atrial fibrillation in Chinese population: a study based on bioinfor-matics]. 中国人群心房颤动的发病机制和潜在诊断生物标志物:一项基于生物信息学的研究。
Q2 Medicine Pub Date : 2024-10-25 DOI: 10.3724/zdxbyxb-2024-0027
Xize Wu, Yue Li, Jiaxiang Pan, Jian Kang, Xue Pan, Chentian Xue, Lihong Gong
<p><strong>Objectives: </strong>To explore the pathogenesis and potential biomarkers of atrial fibrillation based on bioinformatics.</p><p><strong>Methods: </strong>Differentially expressed genes and module genes related to atrial fibrillation were obtained from GSE41177 and GSE79768 datasets (Chinese-origin tissue samples) through differential expression analysis and weighted gene co-expression network analysis. Candidate hub genes were obtained by taking intersections, and hub genes were obtained after gender stratification. Subsequently, functional enrichment analysis and immune infiltration analysis were performed. Four machine learning models were constructed based on the hub genes, and the optimal model was selected to construct a prediction nomogram. The prediction ability of the nomogram was verified using calibration curves and decision curves. Finally, potential therapeutic drugs for atrial fibrillation were screened from the DGIdb database.</p><p><strong>Results: </strong>A total of 67 differentially expressed genes and 65 module genes related to atrial fibrillation were identified. Functional enrichment analysis indicated that the pathogenesis of atrial fibrillation was closely related to inflammatory response, immune response, and immune and infectious diseases. Four common hub genes (<i>TYROBP</i>, <i>FCER1G</i>, <i>EVI2B</i> and <i>SOD2</i>), and two genes specifically expressed in male (<i>PILRA</i> and <i>SLC35G3</i>) and female (<i>HLA</i>-<i>DRA</i> and <i>GATP</i>) patients with atrial fibrillation were obtained after gender-segregated screening. The extreme gradient boosting model had satisfactory diagnostic efficiency, and the nomogram constructed based on the hub genes, male significant variables (<i>PILRA</i>, <i>SLC35G3</i> and <i>SOD2</i>), and female significant variables (<i>FCER1G</i>, <i>SOD2</i> and <i>TYROBP</i>) had satisfactory predictive ability. Immune infiltration analysis demonstrated a disturbed immune infiltration microenvironment in atrial fibrillation with a higher abundance of plasma cells, neutrophils, and γδT cells, with a higher abundance of neutrophils in males and resting mast cells in females. Two potential drugs for the treatment of atrial fibrillation, valproic acid and methotrexate, were obtained by database and literature screening.</p><p><strong>Conclusions: </strong>The pathogenesis of atrial fibrillation is closely related to inflammation and immune response, and the microenvironment of immune cell infiltration of cardiomyocytes in the atrial tissue of patients with atrial fibrillation is disordered. <i>TYROBP</i>, <i>FCER1G</i>, <i>EVI2B</i> and <i>SOD2</i> serve as potential diagnostic biomarkers of atrial fibrillation; <i>PILRA</i> and <i>SLC35G3</i> serve as potential specific diagnostic biomarkers of atrial fibrillation in the male population, which can effectively predict the risk of atrial fibrillation development and are also potential targets for the treatment of atrial fibrillation
目的:基于生物信息学探索心房颤动的发病机制和潜在生物标志物:基于生物信息学探索心房颤动的发病机制和潜在生物标志物:通过差异表达分析和加权基因共表达网络分析,从GSE41177和GSE79768数据库(使用中国原产组织样本的平台)中获得与心房颤动相关的差异表达基因和模块基因,通过交叉获得候选中枢基因,并在性别分层后获得中枢基因。随后,进行了功能富集分析和免疫浸润分析。根据中枢基因构建了四个机器学习模型,并选择最优模型构建了预测提名图,利用校准曲线和决策曲线验证了提名图的预测能力。最后,在DGIdb数据库中筛选了潜在的心房颤动治疗药物:功能富集分析表明,心房颤动的发病机制与炎症反应、免疫反应以及免疫和感染性疾病密切相关。经过性别分类筛选,得到了四个具有泛化作用的中枢基因(TYROBP、FCER1G、EVI2B和SOD2)和两个在男性(PILRA和SLC35G3)和女性(HLA-DRA和GATP)心房颤动患者中特异表达的基因。极梯度增强模型具有令人满意的诊断效果,基于枢纽基因、男性重要变量(PILRA、SLC35G3 和 SOD2)和女性重要变量(FCER1G、SOD2 和 TYROBP)构建的提名图具有令人满意的预测能力。免疫浸润分析表明,心房颤动患者的免疫浸润微环境紊乱,浆细胞、中性粒细胞和γδT细胞的丰度较高,男性中性粒细胞和女性静止肥大细胞的丰度较高。通过数据库和文献筛选,获得了两种治疗心房颤动的潜在药物,即丙戊酸和甲氨蝶呤:结论:心房颤动的发病机制与炎症和免疫反应密切相关,心房颤动患者心房组织中免疫细胞浸润心肌细胞的微环境紊乱。TYROBP、FCER1G、EVI2B和SOD2是潜在的心房颤动诊断生物标志物;PILRA和SLC35G3是潜在的男性心房颤动特异性诊断生物标志物,可有效预测心房颤动的发病风险,也是治疗心房颤动的潜在靶点。
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引用次数: 0
[Anatomy and function of the canalis sinuosus and its injury prevention and treatment strategies in implant surgery]. 鼻窦的解剖和功能及其在植入手术中的损伤预防和治疗策略。
Q2 Medicine Pub Date : 2024-10-25 DOI: 10.3724/zdxbyxb-2023-0502
Zheyuan Sun, Yiting Lou, Zhichao Liu, Baixiang Wang, Mengfei Yu, Huiming Wang

The canalis sinuosus, a canal containing the anterior superior alveolar nerve bundle, originates from the infraorbital canal and extends along the maxillary sinus and nasal cavity edges to the anterior maxilla. It was once regarded as an anatomical variation. However, with the widespread application of cone beam computed tomography (CBCT), the detection rate of canalis sinuosus in the population has increased. The canalis sinuosus exhibits diverse courses, branching into multiple accessory canals and terminating at the nasal floor or the anterior tooth region, with the majority traversing the palatal side of the central incisor. The anterior superior alveolar nerve bundle within the canalis sinuosus not only innervates and nourishes the maxillary anterior teeth and the corresponding soft tissues, and the maxillary sinus mucosa, but also relates to the nasal septum, lateral nasal wall, and parts of the palatal mucosa. To minimize surgical complications, strategies for preventing and treating canalis sinuosus injuries need to be investigated. Preoperatively, CBCT is used to identify the canalis sinuosus and to virtually design implant placement at a distance of more than 2 mm from the canalis sinuosus. Intraoperatively, assessing bleeding and patient comfort, complemented by precision surgical techniques such as the use of implant surgical guide plates. Postoperatively, CBCT is used to examine the relationship between the implant and the canalis sinuosus, and treatment of canalis sinuosus injuries can be tailored based on the patient's symptoms. This review summarizes the detection of canalis sinuosus in the population, its anatomical characteristics, and the physiological functions in the anterior maxilla, and discusses strategies for avoiding canalis sinuosus injuries during implant surgery, thereby enhancing clinical awareness and providing references for clinical decision-making.

鼻窦管(canalis sinuosus)是一条包含前上齿槽神经束的管道,它起源于眶下管,沿着上颌窦和鼻腔边缘延伸至上颌骨前部。它曾一度被认为是一种解剖变异。然而,随着锥形束计算机断层扫描(CBCT)的广泛应用,人群中鼻窦坎的检出率有所上升。鼻窦窦管的走向多种多样,分支成多个附属管,终止于鼻底或前牙区,其中大部分穿过中切牙的腭侧。上颌窦内的前上齿槽神经束不仅支配和营养上颌前牙及其相应的软组织和上颌窦粘膜,还与鼻中隔、鼻侧壁和部分腭粘膜有关。为了最大限度地减少手术并发症,种植医生需要研究预防和治疗上颌窦损伤的策略。术前,种植医生应使用 CBCT 识别鼻窦,并在距离鼻窦超过 2 毫米的地方设计种植体的植入位置。术中,种植医生应评估出血情况和患者舒适度,并辅以精确的手术技术,如使用种植手术导板。术后可以使用 CBCT 检查种植体与蝶窦之间的关系,并根据患者的症状对蝶窦损伤进行针对性治疗。本综述总结了上颌窦在人群中的检出情况、解剖特点及其在上颌骨前部的生理功能,并探讨了在种植手术中有效避免上颌窦损伤的策略,从而提高种植医生的认识,为临床决策提供参考。
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引用次数: 0
[Research progress on iron metabolism in the occurrence and development of periodontitis]. 关于铁代谢在牙周炎发生和发展中的作用的研究进展。
Q2 Medicine Pub Date : 2024-10-25 DOI: 10.3724/zdxbyxb-2024-0037
Yuting Yang, Yingming Wei, Lili Chen

Iron metabolism refers to the process of absorption, transport, excretion and storage of iron in organisms, including the biological activities of iron ions and iron-binding proteins in cells. Clinical research and animal experiments have shown that iron metabolism is associated with the progress of periodontitis. Iron metabolism not only enhances the proliferation and toxicity of periodontal pathogens, but also activate host immune-inflammatory response mediated by macrophages, neutrophils and lymphocytes. In addition, iron metabolism is also involved in regulating cellular death sensitivity of gingival fibroblasts and osteoblasts and promoting the differentiation of osteoclasts, which plays a regulatory role in the regeneration and repair of periodontal tissue. This article reviews the research progress on the pathogenesis of periodontitis from the perspective of iron metabolism, aiming to provide new ideas for the treatment of periodontitis.

铁代谢是指铁在生物体内的吸收、运输、排泄和储存过程,包括细胞内铁离子和铁结合蛋白的生物活性。临床研究和动物实验表明,铁代谢与牙周炎的进展有关。铁代谢不仅能增强牙周病原体的增殖和毒性,还能激活由巨噬细胞、中性粒细胞和淋巴细胞介导的宿主免疫炎症反应。此外,铁代谢还参与调控牙龈成纤维细胞和成骨细胞的细胞死亡敏感性,促进破骨细胞的分化,在牙周组织的再生和修复中发挥调控作用。本文从铁代谢的角度综述了牙周炎发病机制的研究进展,旨在为牙周炎的治疗提供新思路。
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引用次数: 0
[Advances on physiology and pathology of subpopulations of macrophages in the lung tissue]. 肺组织中巨噬细胞亚群的生理和病理研究进展。
Q2 Medicine Pub Date : 2024-10-25 DOI: 10.3724/zdxbyxb-2024-0129
Xiaohui Zhong, Chengjie Lyu, Dengming Lai, Qiang Shu

Macrophages are vital in maintaining tissue homeostasis in the lungs by modulating and regulating immune responses. Based on different origins and anatomical locations, macrophages in the lungs are categorized into alveolar macrophages, interstitial macrophages, perivascular macrophages, and inflammatory macrophages. Alveolar macrophages are located in the alveolar spaces and are primarily responsible for maintaining alveolar surfactant homeostasis, defending against pathogens and regulating immune responses. Interstitial macrophages can maintain homeostasis, regulate immunity and anti-inflammation in the lung tissue. Perivascular macrophages play a crucial role in inhibiting lung inflammation, improving pulmonary fibrosis, and regulating lung tumor progression due to antigen-presenting and immunomodulatory effects. Inflammatory macrophages, which are differentiated from monocytes during inflammation, regulate the inflammatory process. This article reviews the origins of various subpopulations of macro-phages in the lung tissue and their physiological and pathological functions as well as discusses the underlying mechanisms and potential therapeutic targets.

巨噬细胞通过调节和控制免疫反应来维持肺部组织的平衡。根据来源和解剖位置的不同,肺中的巨噬细胞可分为肺泡巨噬细胞、间质巨噬细胞、血管周围巨噬细胞和炎症巨噬细胞。肺泡巨噬细胞位于肺泡间隙,主要负责维持肺泡表面活性物质的平衡、抵御病原体和调节免疫反应。间质巨噬细胞的功能是维持肺组织内的平衡、调节免疫和抗炎。血管周围巨噬细胞具有抗原递呈和免疫调节作用,在抑制肺部炎症、改善肺纤维化和调节肺部肿瘤进展方面发挥着重要作用。炎性巨噬细胞是在炎症过程中从单核细胞分化而来,可调节炎症过程。本文回顾了肺组织中各种亚群巨噬细胞的起源及其生理和病理功能,探讨了其潜在机制和治疗靶点。
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引用次数: 0
[Construction of HEK293T cell line stably expressing TRPM2 channel based on PiggyBac transposition system and its application in drug screening for cerebral ischemia and other diseases]. 基于 PiggyBac 转座系统构建稳定表达 TRPM2 通道的 HEK293T 细胞系及其在脑缺血和其他疾病药物筛选中的应用。
Q2 Medicine Pub Date : 2024-10-25 DOI: 10.3724/zdxbyxb-2024-0257
Kaiyue Ying, Ning Hua, Yanping Luo, Xingyu Liu, Min Liu, Wei Yang

Objectives: To establish a cell line stably expressing the transient receptor potential melastatin 2 (TRPM2) channel for screening TRPM2 inhibitors based on PiggyBac transposition system.

Methods: A plasmid PiggyBac-human TRPM2 (pPB-hTRPM2) eukaryotic expression vector was constructed using PiggyBac transposition system. The plasmid and a helper plasmid were co-transfected into HEK293T cells to express TRPM2, which was identified by fluorescence and patch-clamp assays. The high throughput screening performance was assessed with the Z ´ factor. Calcium imaging and patch clamp techniques were employed to assess the initial activity of eleven compound molecules, confirming the inhibitory effects of the primary molecules on TRPM2. The protective effect of the screened compounds on damaged cells was validated using the oxygen-glucose deprivation/reperfusion (OGD/R) injury model and CCK-8 kit. The level of cellular reactive oxygen species (ROS) was detected by flow cytometry. The neuroprotective effects of the compounds were evaluated using a transient middle cerebral artery occlusion (tMCAO) mouse model.

Results: The HEK293T cells transfected with pPB-hTRPM2-EGFP showed high TRPM2 expression. Puromycin-resistant cells, selected through screening, exhibited robust fluorescence. Whole-cell patch results revealed that induced cells displayed classical TRPM2 current characteristics comparable to the control group, showing no significant differences (P>0.05). With a Z ´ factor of 0.5416 in calcium imaging, the model demonstrated suitability for high-throughput screening of TRPM2 inhibitors. Calcium imaging and electrophysiological experiments indicated that compound 6 significantly inhibited the TRPM2 channel. Further experiments showed that 1.0 μmol/L of compound 6 enhanced cell viability (P<0.05) and reduced the level of ROS (P<0.05) of SH-SY5Y under OGD/R injury. 0.3 and 1.0 mg/kg of compound 6 reduced the cerebral infarction volume in tMCAO mice (both P<0.05).

Conclusions: A stable TRPM2 gene expressing cell line has been successfully established using PiggyBac gene editing in this study. TRPM2 channel inhibitors were screened through calcium imaging and patch clamp techniques, and an inhibitor compound 6 was identified. This compound can alleviate cell damage after OGD/R by reducing cellular ROS levels and has a protective effect against cerebral ischemia-reperfusion injury in mice.

目的建立稳定表达 TRPM2 通道的细胞系,用于筛选基于 PiggyBac 转座系统的 TRPM2 抑制剂:方法:利用 PiggyBac 转座系统构建 pPB-hTRPM2 真核表达载体。方法:利用 PiggyBac 转座系统构建了 pPB-hTRPM2 真核表达载体,将构建的质粒和辅助质粒反转染 HEK293T 细胞以表达 TRPM2,并通过荧光和膜片钳检测鉴定了 TRPM2。用 Z ´因子对高通量筛选进行了评估。利用氧-葡萄糖剥夺再灌注(OGD/R)模型和 CCK-8 试剂盒验证了筛选出的化合物对受损细胞的保护作用。流式细胞术检测了细胞活性氧(ROS)的水平。利用瞬时大脑中动脉闭塞(tMCAO)小鼠模型评估了化合物的神经保护作用:结果:转染 pPB-hTRPM2-EGFP 的 HEK293T 细胞显示出 TRPM2 的高表达。通过筛选选出的嘌呤霉素抗性细胞表现出强大的荧光。全细胞贴片结果显示,诱导细胞显示出与对照组相当的经典 TRPM2 电流特征,无显著差异(P>0.05)。该模型在钙成像中的 Z ´系数为 0.5416(Z ´>0.5),表明它适合高通量筛选 TRPM2 抑制剂。钙成像和电生理实验表明,化合物 6 能显著抑制 TRPM2 通道。进一步的实验表明,1 μmol/L 的化合物 6 能增强细胞活力(PPP结论:本研究利用 PiggyBac 基因编辑技术成功建立了稳定表达 TRPM2 基因的细胞系。通过钙成像和膜片钳技术筛选出了TRPM2通道抑制剂,其中化合物6能通过降低细胞ROS水平减轻OGD/R后的细胞损伤,并对小鼠脑缺血再灌注损伤有保护作用。
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引用次数: 0
[Application of prophylactic flow restriction in brachiocephalic arteriovenous fistulas]. 在肱动静脉瘘中应用预防性血流限制。
Q2 Medicine Pub Date : 2024-10-25 DOI: 10.3724/zdxbyxb-2024-0092
Jue Wang, Xuan Zheng, Yajin Zhu, Guoning Zhu, Mingxi Lu
<p><strong>Objectives: </strong>To investigate the effects of prophylactic flow restriction for brachiocephalic arteriovenous fistula on postoperative high-flow-related complications and patency rate in patients undergoing hemodialysis.</p><p><strong>Methods: </strong>Clinical data of patients with end-stage renal disease who underwent brachiocephalic arteriovenous fistula surgery for hemodialysis from February 2017 to May 2022 in Department of Nephrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine were retrospectively analyzed. During surgery, a 4-5 mm vascular suture loop was placed around the vein near the anastomosis as a flow restriction device in 43 patients (flow restriction group), while 42 patients did not receive the prophylactic flow restriction ring (control group). All patients were followed up for 1 to 5 years. The incidence rates of complications related to the hemodialysis access pathway, including distal ischemia syndrome, the formation of arteriovenous fistula aneurysms, thrombus, high-flow congestive heart failure, anastomosis of the vein within 1 cm of the anastomosis and cephalic arch stenosis, were compared between the two groups. The natural blood flow rate of the arteriovenous fistula, anastomosis size, the internal diameter of the vein near the anastomosis, primary patency rate, assisted primary patency rate, and secondary patency rate of the arteriovenous fistula, were also evaluated and compared between the two groups. Logistic regression analysis was used to investigate the factors affecting arteriovenous fistula patency rates, as well as the impact of the flow-restricting ring on postoperative factors.</p><p><strong>Results: </strong>Ultrasound measurements showed that the internal diameter of the vein at the site of the flow restriction ring in the flow restriction group was (3.7±0.6) mm at three months postoperatively, which was significantly smaller than the internal diameter of the narrowest part of the vein near the anastomosis in the control group [(4.1±1.0) mm, <i>t</i>=-2.416, <i>P</i><0.01]. The postoperative anastomotic diameter and natural blood flow rate of the arteriovenous fistula in the flow restriction group were both significantly lower than those in the control group (both <i>P</i><0.05). Furthermore, the incidence rates of various complications in the flow restriction group were significantly lower than those in the control group (all <i>P</i><0.05). At 6, 12, and 24 months postoperatively, the primary patency rate and assisted primary patency rate in the flow restriction group were significantly higher than those in the control group (both <i>P</i><0.05), while there was no significant difference in secondary patency rates between the two groups (<i>P</i>>0.05). Binary logistic regression analysis indicated that age, diabetes, and natural blood flow rate of the arteriovenous fistula at 3 months postoperatively were independent risk factors for primary patency rate, while the
目的探讨肱动脉动静脉内瘘预防性限流对血液透析患者术后高流量相关并发症及通畅率的影响:回顾性分析2017年2月至2022年5月在浙江大学医学院附属邵逸夫医院肾内科接受肱脑动静脉内瘘手术进行血液透析的终末期肾病患者的临床资料。在手术过程中,43 名患者在吻合口附近的静脉周围放置了一个 4-5 毫米的血管缝合环作为限流装置(限流组),42 名患者没有接受预防性限流环(对照组)。所有患者均接受了 1 至 5 年的随访。比较了两组患者血液透析通路相关并发症的发生率,包括远端缺血综合征、动静脉瘘动脉瘤形成、高流量充血性心力衰竭和头弓狭窄。两组动静脉瘘的自然血流量、吻合口大小、吻合口附近静脉的内径、动静脉瘘的原发性通畅率、辅助性原发性通畅率和继发性通畅率也进行了评估和比较。采用逻辑回归分析法研究影响动静脉瘘通畅率的因素,以及阻流环对术后因素的影响:超声测量结果显示,限流组术后三个月限流环部位的静脉内径为(3.7±0.6)毫米,明显小于对照组吻合口附近静脉最窄处的内径(4.1±1.0毫米,t=-2.416,PPPP>0.05)。二元逻辑回归分析表明,年龄、糖尿病和术后 3 个月时动静脉瘘的自然血流量是原发性通畅率的独立危险因素,而肱动脉动静脉瘘的血流限制是原发性通畅率的独立保护因素(所有 PPConclusions:对血液透析患者进行肱动脉动静脉内瘘手术时进行预防性收缩,可以限制吻合口的大小和术后动静脉内瘘的血流量,减少头弓狭窄和高流量心衰等并发症,提高动静脉内瘘的一次通畅率,延缓动静脉内瘘的再次介入。
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引用次数: 0
Association between factors in life course and physiological disorders among the middle-aged and older population in Zhoushan city of Zhejiang province. 浙江省舟山市中老年人群生活过程中的因素与生理失调之间的关系。
Q2 Medicine Pub Date : 2024-09-06 DOI: 10.3724/zdxbyxb-2024-0168
Xingqi Cao, Cedric Zhang Bo Lua, Jia Li, Wei Shao, Chengguo Liu, Di He, Jingyun Zhang, Yongxing Lin, Yimin Zhu, Zuyun Liu
<p><strong>Objective: </strong>To analyze the associations between factors in life course and physiological dysregulation in the middle-aged and elderly population in Zhoushan city of Zhejiang province, and the mediating roles of lifestyle and mental health.</p><p><strong>Methods: </strong>A total of 1553 island residents aged ≥45 years were enrolled from the Zhejiang Metabolic Syndrome Cohort Zhoushan Liuheng Sub-cohort. The demographic information, life course information, lifestyle, and mental health information of participants were documented, and blood samples were collected. The status of aging was evaluated by physiological dysregulation calculation model developed by authors previously. The Shapley value decomposition method was used to assess the cumulative and relative contribution of multiple factors in life course to the aging. Principal component analysis and hierarchical cluster analysis were used to classify subgroups. General linear regression model was used to assess the associations between the life course subgroups and physiological dysregulation, and the key factors associated with aging were finally identified. Logistic regression model, general linear regression model, and mediation analysis model were used to assess the complex associations between life course subgroups, key factors, unhealthy lifestyle, mental health, and aging.</p><p><strong>Results: </strong>Shapley value decomposition method indicated that eight types of life course factors explained 6.63%(<i>SE</i>=0.0008) of the individual physiological dysregulation variance, with the greatest relative contribution (2.78%) from adversity experiences in adulthood. The study participants were clustered into 4 subgroups, and subgroups experiencing more adversity in adulthood and having low educational attainment or experiencing more trauma and having poorer relationships in childhood had significantly higher levels of physiological dysregulation. Life course subgroups and key factors childhood trauma and health, adversity experience in adulthood, and lower education were positively associated with unhealthy lifestyles (<i>β</i>=0.12-0.41, <i>P</i><0.05). In addition, life-course subgroups and key factor adversity experience in adulthood were positively associated with psychological problems (<i>OR</i>=2.14-4.68, <i>P</i><0.05). Unhealthy lifestyle scores showed a marginal significant association with physiological dysregulation (<i>β</i>=0.03, <i>P</i>=0.055). However, no significant association was found between psychological problems and physiological dysregulation (<i>β=</i>0.03, <i>P</i>=0.748). The results of the mediation analysis model suggested that unhealthy lifestyles partially mediated the associations between life course subgroups, adversity experience in adulthood and physiological dysregulation, with the proportions mediated ranged from 3.9%-6.8%.</p><p><strong>Conclusion: </strong>Multiple life course factors contribute about 6.63% of the variance in phy
摘要分析浙江省舟山市中老年人群生活过程因素与生理紊乱之间的关系,以及生活方式和心理健康的中介作用:方法:从浙江省代谢综合征队列舟山六横亚队列中纳入 1553 名年龄≥45 岁的海岛居民。研究人员记录了参与者的人口统计学信息、生命历程信息、生活方式和心理健康信息,并采集了血液样本。衰老状况由作者之前开发的生理紊乱计算模型进行评估。沙普利值分解法用于评估生命过程中多种因素对衰老的累积和相对贡献。主成分分析和分层聚类分析用于划分亚组。采用一般线性回归模型评估生命历程亚组与生理失调之间的关联。最终确定了与衰老相关的五个关键因素。采用逻辑回归模型、一般线性回归模型和中介分析模型来评估生命过程亚组、关键因素、不健康生活方式、心理健康和衰老之间的复杂关联:沙普利值分解法表明,8种生活过程因素解释了6.63%(SE=0.0008)的个体生理失调变异,其中成年期逆境经历的相对贡献最大(2.78%)。研究参与者被分为 4 个亚组,成年后经历逆境较多且教育程度较低的亚组,或童年时经历创伤较多且人际关系较差的亚组,其生理失调程度显著较高。生命历程亚组和关键因素(童年创伤与健康、成年后的逆境经历和教育程度较低)与不健康的生活方式呈正相关(β=0.12-0.41,POR=2.14-4.68,Pβ=0.03,P=0.055)。然而,心理问题与生理失调之间没有发现明显的关联(β=0.03,P=0.748)。中介分析模型的结果表明,不健康的生活方式部分中介了生活过程亚群、成年期逆境经历和生理失调之间的关联:结论:研究地区中老年人群生理失调的变异中约有 6% 是由多种生命历程因素造成的;具有不利生命历程经历的亚组老龄化程度更高;不健康的生活方式可能部分地调解了这种关联。
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引用次数: 0
Mature oocyte found during ovarian tissue cryopreservation in an early adolescent female. 在一名青春期少女的卵巢组织冷冻过程中发现的成熟卵母细胞。
Q2 Medicine Pub Date : 2024-08-25 DOI: 10.3724/zdxbyxb-2023-0561
Haocheng Zhang, Libing Shi, Haichao Wang, Haiyan Zhu

A 15-year-old female with Hodgkin's lymphoma underwent ovarian tissue cryopreservation for preserving fertility in Reproductive Department of Sir Run Run Shaw Hospital, Zhejiang University School of Medical after receiving one course of chemotherapy. During the ovarian tissue cryopreservation, one MⅡmature oocyte and three germinal vesicle oocytes were found. The three immature oocytes underwent in vitro maturation but failed. Ultimately, one mature oocyte and 12 ovarian cortex slices were cryopreserved using vitrification. This case indicates that for patients with established gonadal axis feedback, ovarian tissue cryopreservation may not be the only method for fertility preservation. It is advisable to consider ovarian stimulation and oocyte retrieval for oocyte cryopreservation. Alternatively, for individuals in the ovulation phase of their menstrual cycle, attempting oocyte retrieval before ovarian tissue cryopreservation to obtain mature oocytes from the natural cycle, followed by oocyte cryopreservation, may enhance the likelihood of successful fertility preservation.

一名患有霍奇金淋巴瘤的15岁女性患者在接受一个疗程的化疗后,在浙江大学医学院附属邵逸夫医院生殖科接受了卵巢组织冷冻保存以保留生育能力。在卵巢组织冷冻保存过程中,发现了一个 MⅡ 成熟卵母细胞和三个生殖囊卵母细胞。这三个未成熟卵母细胞进行了体外成熟,但失败了。最终,一个成熟卵母细胞和 12 个卵巢皮质切片被玻璃化冷冻保存。这个病例表明,对于已经出现性腺轴反馈的患者来说,卵巢组织冷冻保存可能不是保留生育能力的唯一方法。建议考虑卵巢刺激和卵母细胞提取来进行卵母细胞冷冻保存。另外,对于处于月经周期排卵期的人来说,在卵巢组织冷冻保存之前尝试取卵,从自然周期中获得成熟卵母细胞,然后进行卵母细胞冷冻保存,可能会提高成功保存生育能力的可能性。
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引用次数: 0
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Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences
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