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Chinese Medical Journal 2024年第12期137卷 1477-1479页

作者： Jianbin Guo Xiaochen Song Shuo Liang Yuan Wang Yang Ye Qianqian Gao Juan Chen lan zhu Department of Obstetrics and Gynecology Peking Union Medical College HospitalChinese Academy of Medical Sciences&Peking Union Medical CollegeNational Clinical Research Center for Obstetric&Gynecologic DiseasesBeijing 100730China

To the Editor:Pelvic organ prolapse(POP)is a common pelvic floor disorder in older women and is responsible for a significant decrease in health-related quality of *** the increased longevity of women,POP is becoming a major health concern.[1]Laparoscopic sacrocolpopexy(LSC)is a common mesh-based surgical approach for severe prolapse,and a high cure rate and few complications have been reported.[2]To our knowledge,the long-term durability,complications,and pelvic floor symptoms after LSC have not been fully evaluated in detail.A few studies assessed the 5-year outcome after LSC,but these reports were limited by their retrospective design,uneven follow-up time,or inconsistent outcome assessment.

关键词： prolapse pelvic Laparoscopic

Histological Features of Uterine Myometrial Dysfunction:Possible Involvement of Localized Inflammation

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Current Medical Science 2024年第3期44卷 633-641页

作者： Sheng-lan zhu Hui-ting ZHANG Yuan-yuan DU Yi JIANG Shao-shuai WANG Wen-cheng DING Ling FENG National Clinical Research Center for Obstetrics and Gynecology Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430030China Department of Obstetrics and Gynecology Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430030China

Objective The latest perspective suggests that elevated levels of inflammation and cytokines are implicated in atonic postpartum ***(LPS)has been widely used to induce inflammation in animal ***,this study aimed to induce uterine inflammation using LPS to investigate whether local inflammation triggers dysfunction and atrophy in the myometrium,as well as the potential underlying molecular mechanisms *** In vivo,an animal model was established by intraperitoneal injection of 300μg/kg LPS in rats on gestational day ***-eosin(H&E)staining and Masson staining were employed to determine morphological changes in the rat uterine smooth ***-linked immunosorbent assay(ELISA)was used to detect inflammatory ***,tissue fluorescence,and Western blotting were conducted to assess the expression levels of the uterine contraction-related proteins Toll-like receptor 4(TLR4)and the nuclear factor kappa-B(NF-κB)signaling *** vitro,human uterine smooth muscle cells(HUtSMCs)were exposed to 2μg/mL LPS to further elucidate the involvement of the TLR4/NF-κB signaling pathway in LPS-mediated *** In this study,LPS induced uterine myometrial dysfunction in rats,leading to a disorganized arrangement,a significant increase in collagen fiber deposition,and widespread infiltration of inflammatory *** both in vivo animal models and in vitro HUtSMCs,LPS elevated IL-6,IL-1β,and TNF-αlevels while concurrently suppressing the expression of connexin 43(Cx43)and oxytocin receptor(OXTR).Mechanistically,the LPS-treated group exhibited TLR4 activation,and the phosphorylation levels of p65 and IκBαwere notably *** LPS triggered the TLR4/NF-κB signaling pathway,inducing an inflammatory response in the myometrium and leading to uterine myometrial dysfunction and uterine atony.

关键词： lipopolysaccharide inflammatory response TLR4 NF-κB myometrium

Percutaneous transhepatic cholangioscopy-assisted biliary polypectomy for local palliative treatment of intraductal papillary neoplasm of the bile duct

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World Journal of Gastrointestinal Oncology 2024年第5期16卷 1821-1832页

作者： Xu Ren Yong-Ping Qu Chun-lan zhu Xiao-Hong Xu Hong Jiang Yi-Xia Lu Hong-Peng Xue Digestive Disease Hospital of Heilongjiang Provincial Hospital Heilongjiang Provincial Clinical Medical Research Center for Minimally Invasive Diagnosis and Treatment of Pancreaticobiliary DiseasesHarbin 150001Heilongjiang ProvinceChina Digestive Endoscopy Center of Heilongjiang Provincial Hospital Heilongjiang Provincial Clinical Medical Research Center for Minimally Invasive Diagnosis and Treatment of Pancreaticobiliary DiseasesHarbin 150001Heilongjiang ProvinceChina Second Department of Gastroenterology Digestive Disease Hospital of Heilongjiang Provincial Hospitaland Heilongjiang Provincial Clinical Medical Research Center for Minimally Invasive Diagnosis and Treatment of Pancreaticobiliary DiseasesHarbin 150001Heilongjiang ProvinceChina Department of Pathology Heilongjiang Provincial HospitalHarbin 150001Heilongjiang ProvinceChina

BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB)is a premalignant biliarytype epithelial neoplasm with intraductal papillary or villous *** reported local palliative therapeutic modalities,including endoscopic nasobiliary drainage,stenting and biliary curettage,endoscopic biliary polypectomy,percutaneous biliary drainage,laser ablation,argon plasma coagulation,photodynamic therapy,and radiofrequency ablation to relieve mechanical obstruction are limited with weaknesses and *** have applied percutaneous transhepatic cholangioscopy(PTCS)-assisted biliary polypectomy(PTCS-BP)technique for the management of IPNB including mucin-hypersecreting cast-like and polypoid type tumors since *** To assess the technical feasibility,efficacy,and safety of PTCS-BP for local palliative treatment of *** Patients with mucin-hypersecreting cast-like or polypoid type IPNB and receiving PTCS-BP between September 2010 and December 2019 were ***-BP was performed by using a half-moon type snare with a soft stainless-steel wire,and the tumor was snared and resected with *** primary outcome was its feasibility,indicated by technical *** secondary outcomes were efficacy,including therapeutic success,curative resection,and clinical success,and *** Five patients(four with mucin-hypersecreting cast-like type and one with polypoid type IPNB)were ***-and high-grade intraepithelial neoplasia(HGIN)and recurrent IPNB with invasive carcinoma were observed in one,two,and two patients,*** cholangitis and/or obstructive jaundice were presented in all four patients with mucin-hypersecreting cast-like type *** five patients achieved technical success of *** patients(three with mucin-hypersecreting cast-like type and one with polypoid type IPNB)obtained therapeutic success;one with mucin-hypersecreting cast-like type tumors in the intrahepatic small bile duct and HGIN h

关键词： Intraductal papillary neoplasm of the bile duct Percutaneous transhepatic cholangioscopy Biliary polypectomy Feasibility Efficacy

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女性生殖道畸形的诊治和生育新观念

中华妇产科杂志 2024年第5期59卷 343-345页

作者：朱兰陈娜中国医学科学院北京协和医院妇产科、国家妇产疾病临床医学研究中心、疑难重症及罕见病全国重点实验室北京100730

本文简要介绍两类罕少见的女性生殖道畸形疾病近年来的诊治和生育进展。强调对不合并功能性子宫内膜的Mayer-Rokitansky-Küster-Hauser综合征(MRKH综合征)患者,非手术治疗(顶压法)为一线治疗,国内医师应更新治疗观念;少数合并功能性子... 详细信息

本文简要介绍两类罕少见的女性生殖道畸形疾病近年来的诊治和生育进展。强调对不合并功能性子宫内膜的Mayer-Rokitansky-Küster-Hauser综合征(MRKH综合征)患者,非手术治疗(顶压法)为一线治疗,国内医师应更新治疗观念;少数合并功能性子宫内膜的MRKH综合征患者,明确诊断后应及时行腹腔镜双侧始基子宫切除术,是否同时行阴道重建术需与患方充分沟通后决策。目前,代孕和子宫移植技术均可实现MRKH综合征患者的生育需求,在法律允许的前提下,代孕对患者的创伤和经济成本等方面优于子宫移植。目前,先天性子宫颈发育异常患者保留生育功能的子宫颈管通道重建术式有贯通术和吻合术两类。对于有足够子宫颈组织的患者,可考虑行贯通术。吻合或贯通术后保持生殖道的通畅性是治疗成功的关键。保留生育功能的重建手术后患者可获得生育的希望,但总体妊娠率仍较低,需妇科、产科和生殖医学专家全程通力合作以改善该类患者的生育结局。

关键词：保留生育功能 MRKH综合征子宫颈管代孕子宫移植通畅性生育结局顶压法

中国人工智能发展的空间极化与国际追赶——基于技术-产业双重视角

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农村金融研究 2024年第3期 67-80页

作者：朱兰中国社会科学院数量经济与技术经济研究所中国社会科学院经济大数据与政策评估实验室中国社会科学院大学应用经济学院

人工智能是引领未来技术和产业变革、构筑国家竞争优势的重要领域。在技术-产业框架内讨论人工智能内涵,选取人工智能专利指标、人工智能企业数目、全球人工智能发展指数衡量人工智能技术和产业发展,分析新发展格局下中国人工智能国际... 详细信息

人工智能是引领未来技术和产业变革、构筑国家竞争优势的重要领域。在技术-产业框架内讨论人工智能内涵,选取人工智能专利指标、人工智能企业数目、全球人工智能发展指数衡量人工智能技术和产业发展,分析新发展格局下中国人工智能国际国内发展现状与特征。国内跨区域比较发现,人工智能技术和产业分布高度不均衡,具有“东强西弱、南多北少、高度集中、梯度分布”特征,且技术集中度高于企业集中度,存在空间极化现象。跨国比较发现,中国人工智能技术和产业发展整体处于领先地位,专利数量和海外布局不弱于美国,但是专利质量、顶尖企业和人才落后于美国,存在“木桶效应”,尤其是AI人才。在新发展格局下推动人工智能发展,有必要统筹国内与国际,既要平衡区域人工智能发展水平,多措并举缩小区域“数字鸿沟”,也要立足和巩固比较优势,补足人才短板,融入人工智能全球创新网络。

关键词：人工智能指标测度特征分析空间极化国际追赶

Efficacy and safety of transvaginal mesh repair in a cohort with a minimum of 10-year follow-up

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Science China(Life Sciences) 2024年第5期67卷 1061-1068页

作者： Zhibo Zhang Jianbin Guo Weijie Tian Ye Zhang Yuelun Zhang Tianshu Sun Jiali Duan Xinmiao Bao Yuan Wang Yang Ye Qianqian Gao Honghui Shi Abraham Nick Morse Juan Chen lan zhu Departmentof Obstetrics and Gynecology Peking Union MedicalCollege HospitalChinese Academyof Medical Sciences&Peking Union MedicalCollegeNational Clinical Research Center for Obstetricand Gynecologic DiseasesBeijing 100730China Department of Gynecology Guizhou Provincial People’s HospitalMedical College of Guizhou UniversityGuiyang 550002China Department of Obstetrics and Gynecology The First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450000China Medical Research Center Peking Union Medical College HospitalChinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing 100730China Medical Doctor Program Chinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing 100730China Department of Pathology Peking Union Medical College HospitalBeijing 100730China Tufts University School of Medicine Boston MA 02111USA

Although transvaginal mesh(TVM)repair is no longer used in some countries,long-term outcomes after TVM surgery are of great importance ***,reports with follow-up>10 years are ***,this study aimed to report outcomes in a prospective cohort with at least 10 years of *** with stageⅢ–Ⅳsymptomatic prolapse were approached consecutively from 2008 to 2013 at one tertiary *** main outcome measure was symptomatic *** outcomes included anatomic failure,recurrence,patient satisfaction,complications,and *** Kaplan-Meier curve was used to estimate the cumulative failure *** the 121 patients enrolled in the study,103(85.1%)completed a median follow-up of 11 *** estimated probability rates of symptomatic and anatomic failure were 17.6%and 8.8%in 11 years,*** estimated incidence of symptomatic failure increased by 8.2%between 5 and 11 years;however,the corresponding rate for anatomic failure was 3.7%.The most common complication was vaginal mesh exposure,and its estimated probability increased from 19.3%to 28.4%from 5 to 11 years,*** trimming resolved 80.0%of vaginal *** patients did not report decreased overall *** with vaginal mesh exposure requiring>3 office procedures or mesh removal in the operating room(5.8%by 11 years)had lower satisfaction rates(P<0.01)and were defined as having severe mesh *** rates of postoperative pain,reoperation,and Patient Global Impression of Improvement≥2 were 2.5%,3.3%,and 94.2%,*** results of this study implied that TVM treatment gradually increased the symptomatic failure rate but provided durable anatomical support of the vaginal *** mesh exposure was common in women who were largely not sexually active;however,80%of the cases could be managed in the outpatient clinic,which did not affect patient satisfaction.

关键词： complication efficacy long-term follow-up pelvic organ prolapse safety transvaginal mesh

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骶骨固定术后盆腔器官脱垂的复发与网片暴露

中国实用妇科与产科杂志 2024年第3期40卷 287-292页

作者：周莹俞茜蓝朱兰中国医学科学院北京协和医学院、北京协和医院妇产科、国家妇产疾病临床医学研究中心北京100730 中国医学科学院北京协和医学院北京100730

骶骨固定术是当前公认的治疗顶端脱垂(Ⅰ水平缺陷)的“金标准”术式,术中利用网片将脱垂的阴道顶端或子宫颈悬吊固定于骶骨前纵韧带上,解剖学矫正成功率高。但网片相关并发症以及术后复发问题一直是该术式业内关注的话题。文章就骶骨固... 详细信息

骶骨固定术是当前公认的治疗顶端脱垂(Ⅰ水平缺陷)的“金标准”术式,术中利用网片将脱垂的阴道顶端或子宫颈悬吊固定于骶骨前纵韧带上,解剖学矫正成功率高。但网片相关并发症以及术后复发问题一直是该术式业内关注的话题。文章就骶骨固定术的演变发展历史以及网片暴露与术后复发的相关因素和处理方法进行阐述及讨论。

关键词：盆腔器官脱垂骶骨固定术网片暴露复发

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盆底植入物手术并发症的诊断与防治策略

中国实用妇科与产科杂志 2024年第3期40卷 257-260页

作者：朱兰梁硕中国医学科学院北京协和医学院、北京协和医院妇产科、国家妇产疾病临床医学研究中心北京100730

盆腔器官脱垂(pelvic organ prolapse,POP)和压力性尿失禁(stress urinary incontinence,SUI)是严重影响女性生活质量的盆底功能障碍性疾病。我国流行病学资料显示,成年女性中有9.6%患有症状性POP[1],绝经后患病比例则上升到14.8%[2];SU... 详细信息

盆腔器官脱垂(pelvic organ prolapse,POP)和压力性尿失禁(stress urinary incontinence,SUI)是严重影响女性生活质量的盆底功能障碍性疾病。我国流行病学资料显示,成年女性中有9.6%患有症状性POP[1],绝经后患病比例则上升到14.8%[2];SUI的患病率高达18.9%[3]。20%的女性一生中可能需要接受手术治疗POP或SUI[4]。盆底重建手术术中使用植入物(网片/吊带)的术式主要包括治疗盆腔器官脱垂的骶骨固定术(sacrocolpopexy,SC)、经阴道植入网片手术(transvaginal mesh,TVM)和尿道中段悬吊术(midurethral sling,MUS)三大类。

关键词：盆底重建手术植入物并发症网片暴露慢性疼痛

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盆底重建手术术后网片感染的评估与处理

中国实用妇科与产科杂志 2024年第3期40卷 300-304页

作者：梁硕朱兰中国医学科学院北京协和医学院、北京协和医院妇产科、国家妇产疾病临床医学研究中心北京100730

网片感染是盆底重建手术术后较为罕见的并发症,起病隐匿,常合并网片暴露、侵蚀或器官穿孔。其发生与网片的材质、网片与机体的相互作用、阴道细菌菌落定植以及术者的操作有关。一旦出现蜂窝织炎、脓肿、窦道/瘘管形成,处理困难,需要全... 详细信息

网片感染是盆底重建手术术后较为罕见的并发症,起病隐匿,常合并网片暴露、侵蚀或器官穿孔。其发生与网片的材质、网片与机体的相互作用、阴道细菌菌落定植以及术者的操作有关。一旦出现蜂窝织炎、脓肿、窦道/瘘管形成,处理困难,需要全面评估,首选盆腔磁共振成像(MRI)检查,并进行积极的手术处理和多学科诊疗团队支持。文章介绍了盆底重建手术术后网片感染的发病率、病因、临床表现、诊断与处理方法。选择合适的网片和术式、避免术中损伤、确切止血、应用抗生素以及尽可能避免子宫切除是较为有效的预防措施。

关键词：网片盆底重建手术并发症感染

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重视植入物盆底重建手术并发症诊治的规范化

中国实用妇科与产科杂志 2024年第1期40卷 7-9页

作者：朱兰梁硕中国医学科学院北京协和医院妇产科北京100730

植入物盆底重建手术主要针对盆腔器官脱垂(pelvic organ prolapse, POP)和抗尿失禁手术。盆底重建手术使用植入物(网片/吊带)的术式主要包括针对盆腔器官脱垂的骶骨固定术(sacrocolpopexy,SC)和经阴道植入网片手术(transvaginal mesh,T... 详细信息

植入物盆底重建手术主要针对盆腔器官脱垂(pelvic organ prolapse, POP)和抗尿失禁手术。盆底重建手术使用植入物(网片/吊带)的术式主要包括针对盆腔器官脱垂的骶骨固定术(sacrocolpopexy,SC)和经阴道植入网片手术(transvaginal mesh,TVM)及抗尿失禁尿道中段悬吊带术(mid-urethral sling,MUS)三大类。《盆腔器官脱垂的中国诊治指南(2020年版)》[1]推荐的骶骨固定术的手术适应证为有症状的穹隆脱垂POP-QⅡ度以上;POP术后顶端复发的患者(有症状,且POP-Q≥Ⅱ度);初治的中盆腔缺陷为主的POP-QⅢ度以上,特别是性生活活跃的年轻患者。

关键词：盆底重建手术网片吊带并发症