目的 探討不同劑量和不同療程米非司酮對大鼠子宮異位內膜基質金屬蛋白酶-9（MMP-9）及其組織特異性抑制物-1（TIMP-1）表達的影響。 方法 65只子宮內膜異位癥大鼠隨機分為低劑量組、高劑量組、對照組。各個劑量組分別灌胃20、30、40 d后取異位子宮內膜組織用免疫組織化學法檢測MMP-9及TIMP-1的表達，并計算MMP-9/TIMP-1比值。 結果 低劑量組和高劑量組均能使異位內膜MMP-9表達下降（P＜0.05）,TIMP-1表達升高（P＜0.05）,高劑量組的作用更加明顯，與低劑量組差異有統計學意義（P＜0.05）；用藥30 d低劑量組TIMP-1表達最高，與用藥20 d和40 d相比差異有統計學意義（P＜0.05）,同樣高劑量組用藥30d TIMP-1的表達也最高，與用藥20 d和用藥40 d比較差異有統計學意義（P＜0.05）。與用藥20、40 d比較差異有統計學意義（P＜0.05）。 結論 米非司酮能夠降低大鼠異位子宮內膜的侵襲能力，高劑量米非司酮抑制效果更明顯；用藥30 d米非司酮對大鼠異位內膜的侵襲能力抑制最強，延長用藥時間不能使異位內膜侵襲能力繼續下降。
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.
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.