截止至2002年5月,现有早产治疗的临床证据如下: (1) 高危早产:在一些国家实施的RCT发现,在降低早产危险方面,加强产前保健与普通产前保健没有明显差异.包括5个RCT的1个系统评价发现,对有宫颈改变的妇女行宫颈环扎术有不同的结果,没有明确的结论.1个大样本的RCT发现,孕9～29周宫颈功能可能不全的妇女进行预防性宫颈环扎手术与不环扎相比,能明显降低早产(＜33孕周),但也会明显增加产褥感染的危险.另外4篇较小样本的RCT发现,孕10～30周、具各种早产高危因素的妇女,进行预防性宫颈环扎手术与不环扎相比,并不能降低早产(＜34孕周).1篇系统评价的2个RCT报告,对有宫颈改变的妇女进行环扎术有不同的结果,其中1个RCT发现其并不能明显降低早产(＜34孕周),而另外1个较小样本的RCT却发现宫颈环扎手术加卧床休息与单纯卧床休息比较,能明显降低34周前的早产.没有1个RCT证实行环扎术加卧床休息与单纯卧床休息相比,能降低围生儿死亡率. (2) 胎膜早破:1个系统评价发现,对胎膜早破的妇女,抗生素较安慰剂能明显延长孕周、降低新生儿发病率的危险,如新生儿感染、出生后氧疗、脑部超声异常等.阿莫西林加克拉维酸治疗与新生儿坏死性小肠结肠炎的发生率明显增加有关.一个基于1个RCT的系统评价发现,没有充足的证据证实羊膜腔灌注与不灌注比较能改善胎膜早破后的新生儿结局. (3) 先兆早产的治疗:①β-肾上腺素兴奋剂:1个系统评价发现,β-肾上腺素兴奋剂与安慰剂或不治疗相比,并不能明显降低围生儿死亡率、呼吸窘迫综合征及低体重儿(＜2 500 g)发生率,且与与安慰剂或不治疗相比,β-肾上腺素兴奋剂增加孕母副反应,如胸痛、心悸、呼吸困难、震颤、恶心、呕吐、头痛、高血糖、低钾血症.②钙离子通道拮抗剂: 没有关于钙离子通道拮抗剂与安慰剂比较的系统评价或RCT.1个系统评价发现,钙离子通道抑制剂与其它保胎药(主要是β-肾上腺受体兴奋剂)比较,能显著降低48 h内的早产分娩,减少因孕母副反应退出治疗和新生儿发病率.③硫酸镁:1个系统评价发现,硫酸镁与安慰剂比较,并不能明显降低孕36周前的早产率、围生儿死亡率、呼吸窘迫综合征的发生率.另一个系统评价发现,硫酸镁和其他宫缩抑制剂(β-肾上腺素兴奋剂、钙离子通道拮抗剂、前列腺素合成抑制剂、硝化甘油、酒精和葡萄糖注射剂)比较,并不能明显降低48 h内早产率(尽管结果没有差异).④垂体受体拮抗剂(阿托西班):1个系统评价纳入 2个RCT,对阿托西班和安慰剂治疗早产进行比较有不同的结果.较大样本的RCT发现,阿托西班较安慰剂能延长孕周,但阿托西班增加了孕28周以下的胎儿死亡率.另一个RCT发现,阿托西班增加了48 h内的早产.⑤前列腺素抑制剂(消炎痛):1个系统评价发现,消炎痛与安慰剂比较,能明显降低孕37周前的48 h和7天的早产率的证据有限.然而,同时发现消炎痛与安慰剂或不治疗相比,并不能明显降低围生儿死亡率、新生儿呼吸窘迫综合征、肺支气管发育不良、坏死性小肠结肠炎、新生儿败血症或低体重儿.但这个系统评价样本太小,尚不能发现有临床意义的差异. (4) 择期或非择期剖宫产对早产妇女治疗效果:1个系统评价结果发现,择期剖宫产较非择期剖宫产会增加孕母的发病率,却不能降低新生儿的发病率和死亡率.但尚不能证明此效果是否对新生儿有临床意义. (5) 改善早产妊娠结局的干预措施:①对早产者采用皮质类固醇:1个系统评价认为,对可能发生早产的妇女使用皮质激素较安慰剂或不处理能明显降低早产儿出生后呼吸窘迫综合征、新生儿死亡率和颅内出血的发生.②促甲状腺激素释放激素在早产中的运用:1个系统评价发现,在早产的高危妇女中,促甲状腺激素释放激素和类固醇激素联合应用与单用皮质类固醇激素比较,对新生儿结局的影响无明显差异,但会明显增加孕母和胎儿的不良反应.③抗生素:1个系统评价发现,抗生素与安慰剂比较,不能延长孕周、降低新生儿死亡率,但可降低孕母感染率.
OBJECTIVE: To evaluate the therapeutic effect of amniotic membrane transplantation(AMT) for ocular burn. METHODS: Twenty patients with ocular burn(28 eyes) were treated with amniotic membrane transplantation. Of them, there were 6 cases of severe alkali burn(10 eyes), 8 cases of severe acid burn(10 eyes), and 6 cases of thermal burn(8 eyes). RESULTS: In 28 eyes, ocular inflammation was controlled after 3-7 days of surgery; no continued dissolution, perforation and iris atrophy were found. There were corneal transparency in 16 eyes, keratoleukoma in 4 eyes, and total corneal opacity in 8 eyes. All eyeballs were saved and had stable ocular surface. There was no allograft immune rejection and secondary infection. CONCLUSION: Amnitic membrane transplantation can relieve the inflammatory reaction, reduce the growth of blood vessel and restrain the proliferation of fibrous tissue. It is an effect surgical method for ocular burn in reconstruction of ocular surface and salvage of eyeball.
ObjectiveTo evaluate the safety and efficacy of amniotic membrane patching in the treatment of recurrent macular hole associated with retinal detachment of high myopia (MHRD). MethodsA prospective study. From March 2018 to January 2020, 11 patients (11 eyes) of recurrent macular hole associated with MHRD at the First Affiliated Hospital of Zhengzhou University were enrolled. Among them, there were 3 males (3 eyes), and 8 females (8 eyes). The average age was 63.64±5.82. The axis length (AL) was 29.10±0.59 mm, and the logarithm of the minimum angle of resolution best corrected visual acuity (logMAR BCVA) was 2.23±0.57. Patients previously received pars plana vitrectomy (PPV) combined with internal limiting membrane stripping surgery, which was more than 1 time. All eyes underwent standard pars plana three-channel 23G PPV combined with amniotic membrane covering and silicone oil filling. The silicone oil was removed 6 months after surgery. Follow-up time was up to 3 months after silicone oil removal surgery. 1, 3, and 6 months after the operation, the same equipment and methods were used to conduct relevant examinations before the operation to observe the closure of the macular hole, retinal reattachment and changes in logMAR BCVA. The logMAR BCVA before and after surgery was compared by paired t test. ResultsAt 1, 3, and 6 months after the operation, the retinas of all eyes were anatomically repositioned, the macular holes were well closed, and the amniotic membrane was attached to the retina. At 3 months after the silicone oil removal operation, there was no recurrence of macular hole in all eyes; logMAR BCVA was 1.35±0.32. No serious complications occurred during and after surgery in all eyes. ConclusionAmniotic membrane patching is a safe and effective method for recurrent macular hole associated with MHRD.
Objective To investigate the clinical therapeutic effects of two types of vaginoplasty. Methods From January 1996 to March 2005, 63 patients wih the congenital absence of the vagina were treated by two types of vaginoplasty. Of the 63 patients, 37 underwent vaginoplasty using the amnion and 26 underwent an improved laparoscopic Vecchitti operation. The durations ofthe operation and hospitalization, as well as the blood loss were compared between the two types of vaginoplasty. The vaginal moulds were improved during the operations. Results According to the follow-up for 2 months to 4 years in the 35 patients. Compared with vaginoplasty using the amnion, vaginoplasty by an improved laparoscopic Vecchitti operation had advantages of significantly shorter surgical duration, shorter hospitalization, and less blood loss (Plt;0.05). After the operations, the artificial vagina of all the 63 patients could hold a speculum and the mucosa appeared so soft and smooth with normal lubrication. The married patients were satisfied with the intercourse. However, after vaginoplasty using the amnion, an infection of the amnion occurred in 3 patients, scar contracture in 2 patients, one of whom underwent scar incision 13 months after operation with a success; but the other refuse to accept another operation. But the improved laparoscopic Vecchitti operation achieved a success in the patients without any infectionor scar contracture, according to the 2 month-2.5 years follow-up. Conclusion The improved laparoscopic Vecchitti operation is a preferred procedure of constructing a vagina for the patients suffering from the congenital absence of the vagina.
Objective To investigate the effects of human acellularamnion membrane on SD rat tendon adhesion and to obtain the experimental data for clinical application in preventing postoperative tendon adhesion. Methods The tendons of 28 adult SD rats hindlimb were cut and sutured. The tendons of left hindlimb were encapsulated by human accellular amnion membraneas the experimental group and the ones of the other side were not encapsulatedas control group. The rats were killed 1, 2, 4, 6, 8 and 12 weeks after operation. The results were evaluated grossly and histologically. Results There were no differences in healing of injury tendon and inflammatory response between the two groups. The anatomical and histological results showed the experimental group had less adhesion than the control group(Plt;0.05). Conclusion Human acellular amnion membrane can prevent adhesion of tendonwithout affecting tendon healing and is an optimal biological material to prevent tendon adhesion.
ObjectiveTo observe the survival, migration, and effect of human amniotic epithelial cells (hAECs) on hepatic fibrosis in immune rats so as to provide the experimental theory for the clinical treatment with hAECs. MethodsSixty-four 10-week-old male Sprague Dawley rats (weighing, 220-280 g) were randomly divided into 4 groups, sixteen rats in each group. Rat hepatic fibrosis model was induced in groups A, B, and C; hepatic fibrosis rats were injected with 4×106 hAECs in group A, and with normal saline in group B, and no treatment was given in group C; group D served as control group. After 2 weeks of transplantation, the expression of human Alu gene repeat sequence was detected by DNA-PCR method and human leucocyte antigen G (HLA-G) by immunohistochemical staining in heart, liver, spleen, kidney, lung, and brain in group A, and then the percentage of positive expression was compared between organs except spleen. Semi-quantitative analysis was done for liver fibrosis with HE staining according to Chevallier semi-quantitative histological liver fibrosis scoring system, and immunohistochemical staining for TGF-β1 was used to record immunohistochemical score (ISH), the concentrations of aspartate transaminase (AST), alanine aminotransferase (ALT), and albumin (ALB) were determined to analyze hepatic fibrosis. ResultsAlu gene repeat sequence and HLA-G could be detected in liver, heart, brain, lung, and kidney in group A, the percentage of positive expression in the liver was significantly higher than that in the other organs (P<0.05). The histological semi-quantitative score of group A (10.47±3.20) was significantly lower than that of groups B and C[(13.84±3.46) and (13.85±3.16)](P<0.05), but no significant difference was found between groups B and C (P>0.05). The ISH scores in groups A, B, C, and D were 3.60±1.50, 5.38±2.60, 5.50±2.40, and 1.87±1.36, respectively; groups A, B, and C were significantly higher than group D, and group A was significantly lower than groups B and C (P<0.05), but there was no significant difference between groups B and C (P>0.05). The concentrations of ALT and AST in groups A, B, and C were significantly higher than those in group D, and group A was significantly lower than groups B and C (P<0.05), but there was no significant difference between groups B and C (P>0.05). The concentration of ALB in groups A, B, and C was significantly lower than that in group D, and group A was significantly higher than groups B and C (P<0.05), but there was no significant difference between groups B and C (P>0.05). ConclusionhAECs can survive in immune rats by intrasplenic transplantation and migrate to liver, heart, brain, lung, and kidney, and the liver shows the largest migration. The transplantation of hAECs in immune rat with cirrhosis can alleviate hepatic fibrosis and improve the serum indexes of liver function.
Objective To observe the differentiation effect of rabbit amnion-derived stem cells (ADSC) induced into neural cells.Methods ADSC of New Zealand female rabbits were isolated and cultured. Its mRNA level of Fibronectin, Nestin and Vimentin were detected by real-time quantitative polymerase chain reaction. The selfreplication ability of ADSC was confirmed by monoclonal formation experiments. These ADSC were further induced into neural cells in vitro. Five days after induced differentiation, the expression of -tubulin and glial fibrillary acidic protein (GFAP) were detected by immunofluorescent staining. Results ADSC were separated from amnion tissue gradually after 24 hours. There were polygonal cells gathered around the amnion tissue at 72 hours, and were distributed compactly around the amnion at 120 hours. The morphology of cleavage daughter cells was basically the same as parent cells. ADSC has the ability of self-replication. The Nestin, Vimentin, Fibronectin mRNA expressions in ADSC were 15.79, 1.91, 7.65 times those in spleen cells. The differences were statistically significant(Z=-5.243, -3.972, -2.524; P＜0.05). The beta;-tubulin expression was found in cytoplasm of most cells. The GFAP expression was found in cytoplasm in some cells. Conclusions ADSC has self-replication ability. It can be induced into neurons and neuroglial cells under the right conditions.
目的 观察两种手术方式治疗翼状胬肉的临床效果。 方法 对2007年1月－2012年6月一般情况较好的73例单纯原发性双眼翼状胬肉患者进行了回顾性研究，比较同一患者双眼分别行翼状胬肉切除+生物羊膜移植（左眼）和翼状胬肉切除+自体角膜缘干细胞移植（右眼）手术后痊愈率、复发率及并发症。 结果 行翼状胬肉切除+自体角膜缘干细胞移植（右眼）的痊愈率达93.15%，复发率1.37%，并发症率5.48%，其痊愈率更高而复发率及并发症均更低。 结论 翼状胬肉切除+自体角膜缘干细胞移植用于治疗翼状胬肉比翼状胬肉切除+人工羊膜移植的疗效更好，值得临床推广。
Objective To investigate the results of human amniotic membrane(HAM) which are loaded with marrow mesenchymal stem cells(MSCs) and epidermis cells in treating fullthickness skin defect combined with radiation injury. Methods Eight minipigs were used in this study. Three round fullthickness wounds（Ф3.67cm）, which combined with radiation injury, were created on the dorsum of each side close to the vertebral column in each animal. Among 48 wounds, 24 left side wounds were treated with HAM loaded with MSCs and epidermis cells as experimental group (group A), 16 right side wounds with simple HAM (HAM group, group B) and 8 right side wounds with oil gauze as control (group C). The granulation tissue, reepithelization and wound area were observed after 1,2 and 3 weeks. Immunohistochemistry was performed using vWF as a marker for blood vessels.Image analysis was employed to test new area of wound at different interval time and healing rate of wound.Results The healing time of group A was 6 to 7 days faster than that of group C and 5 to 6 days faster than that of group B. After 15-17 days of graft, there were significant differences in new area of wound and healing rate between group A and groups B,C(Plt;001). New epidermis fully covered whole wound surface in group A, and their granulation tissue, which contained a lot of vWF, fibroblasts, capillaries and collagen, grew well. Many inflammatory cells still were seen in groups B and C, and their contents of vWF, fibroblasts, capillaries and collagen in granulation tissue were smaller than that in group A.Conclusion The graft of HAM loaded with MSCs and epidermis cells played an effective role in promoting healing of wound combined radiation injury with high quality.