尼尔雌醇对绝经后妇女骨质疏松症的影响

目的 观察应用尼尔雌醇防治绝经后妇女骨质疏松的效果。方法 对照观察用药前后血清碱性磷酸酶（ALP）、空腹尿钙／肌酐比值（Ca/Cr)和羟脯氨酸／肌酐比值（Hyp/Cr)、骨密度（BMD）及性激素（E2，FSH）及子宫内膜方面的变化。结果 用药后血清ALP、尿Ca/Cr、尿Hyp/Cr较用药前有所下降（P＜0．001），骨密度有所上升，血清雌激素（E2）上升明显（P＜0．01），子宫内膜无明显变化。结论 此法有抵制骨吸收、延缓或阻断绝经后骨质丢失的作用。     

绝经前后妇女子宫内膜癌临床病理分析

【目的】分析未绝经和绝经后妇女子宫内膜癌的临床病理特征。【方法】采用回顾性分析法,将53例内膜癌患者根据绝经与否分为未绝经组34例,绝经组19例,分析比较两组的发病因素、病程、临床表现、病理组织类型及雌、孕激素受体的表达。【结果】未绝经组与绝经组均以不规则阴道流血为主要表现,分别为88．2％、79．0％;未绝经组确诊时间（610．9±145．5）d,显著长于绝经组的（104．1±27．1）d（P〈0．05）;未绝经组子宫内膜样癌占97．1％,显著高于绝经组的78．8％,而非子宫内膜样癌占2．9％,低于绝经组的21．1％（P〈0．05）;两组在肿瘤病理组织学分级均差异无显著性（P〉0．05）;在临床分期间未绝经组Ⅱ期占5．9％,明显低于绝经组的42．1％,而Ⅲ期患者占32．4％,显著高于绝经组的5．3％（P〈0．05）;雌、孕激素受体表达在两组间差异无显著性（P〉0．05）;雌、孕激素受体阳性表达率I期高于Ⅱ～Ⅲ期（P〈0．05）;雌、孕激素受体表达呈正相关关系,雌、孕激素受体与临床分期分别呈负相关关系（P〈0．05）。【结论】子宫内膜癌绝经前、后妇女均以不规则阴道流血为主要的临床表现;I型内膜癌占绝经前、后妇女的绝大多数;雌、孕激素受体可作为内膜癌预后的监测指标;重视绝经前妇女不规则阴道流血是其早期诊断的关键。     

性激素对绝经后妇女脑梗死的影响

目的：观察绝经后妇女脑梗死患者性激素及血脂水平,以探讨性激素与脑梗死的关系。方法：应用放射免疫法测定63例绝经后妇女急性脑梗死患者和51例年龄等方面匹配的健康对照者血清雌二醇（E2）、睾酮（T）的水平。用全自动化分析仪测定血脂成份。结果：绝经后妇女脑硬死患者血清E2水平和E2／T显著降低（P＜0．05）;脑梗死组血清总胆固醇（TC）、甘油三脂（TG）、低密度脂蛋白胆固醇（LDL－C）均明显高于对照组（P＜0．05或P＜0．01）,血清高密度脂蛋白胆固醇（HDL－C）明显低于对照组（P＜0．05）。结论：绝经后妇女雌激素不足,很可能是女性脑梗死发生的危险因素之一。     

围绝经期妇女异常子宫出血562例病因分析

目的：探讨围绝经期异常子宫出血的发病原因。方法：总结562例患者的临床资料和病理结果,观察围绝经期异常子宫出血的发病原因,比较不同年龄患者子宫内膜癌及其子宫内膜癌前病变发生情况以及不同病理类型患者的临床相关因素。结果：562例患者中,检出子宫内膜病变430例（76．5％）,其中单纯性增生221例,复杂性增生6例,不典型性增生4例,增殖型子宫内膜104例,萎缩型子宫内膜70例,子宫内膜息肉12例,子宫内膜腺癌13例。50～59岁患者的子宫内膜癌及癌前病变检出率明显高于40～49岁患者（P〈0．01）。子宫内膜癌、子宫内膜不典型增生及其他患者的平均年龄分别为51、46、45岁,平均出血时间分别为207、246、96d。有高危因素的围绝经期异常子宫出血患者发生子宫内膜癌的危险性明显高于无高危因素的患者（P〈0．01）。结论：子宫内膜异常增生和子宫内膜癌可能是围绝经期妇女异常子宫出血的重要原因,绝经延迟患者发生子宫内膜癌的危险性增加。     

永川区1872例健康妇女子宫内膜经阴道超声检查结果分析

目的了解正常妇女子宫内膜回声及厚度情况，为建立中国妇女正常子宫内膜标准提供依据。方法对重庆市永川区1872例已婚健康妇女进行经阴道超声检查，观察内膜声像图并测定其内膜厚度，而后进行统计分析。结果绝经前不同年龄段的妇女从增生期、排卵期到分泌期其子宫内膜逐渐增厚，回声逐渐增强；在不同月经周期，其子宫内膜厚度差异有统计学意义（P〈0．05），但在同一月经周期不同年龄段妇女子宫内膜厚度差异无统计学意义；绝经前和绝经后妇女子宫内膜厚度差异有统计学意义。结论通过经阴道超声普查，建立大样本的数据库，将有助于建立中国妇女正常子宫内膜的标准，为鉴别异常子宫内膜提供依据。     

子宫内膜样腺癌组织PELP1／MNAR表达及其与雌激素受体相关性

目的探讨脯氨酸-谷氨酸-亮氨酸富集蛋白1／雌激素受体非基因组活性辅助调节因子（PELP1／MNAR）和雌激素受体（ER）在子宫内膜样腺癌组织中的表达及意义。方法采用免疫组化PV二步染色法,对40例正常子宫内膜组织、60例子宫内膜增生过长组织和60例子宫内膜样腺癌组织中PELP1／MNAR、ER进行测定。结果子宫内膜样腺癌及不典型增生组织腺上皮细胞核中PELP1／MNAR阳性表达率高于正常子宫内膜及单纯性、复杂性增生组织（x^2=6．25～16．90,P〈0．05）;子宫内膜样腺癌绝经后组织间质中PELP1／MNAR阳性表达率低于未绝经组织（x^2=7．17,P〈0．05）;子宫内膜样腺癌及增生期内膜腺上皮细胞核中ER阳性表达率高于分泌期及增生过长组织（x^2=5．208～12．907,P％0．05）。子宫内膜样腺癌组织中ER与PELP1／MNAR的阳性表达率呈正相关（x^2=0．315,P〈0．01）。结论PELPl／MNAR在子宫内膜各个时期的表达异常可能与子宫内膜样腺癌的发生发展有关。     

经阴道超声对绝经后子宫内膜息肉的诊断价值

子宫内膜息肉（endometrial polyps，EP）是妇科常见内膜良性病变，多以不规则流血，不孕或无症状体检时发现。绝经前子宫内膜息肉由于诊断性刮宫，超声检查和官腔镜检查及时、准确，多可及时治疗，愈后效果好。而绝经后子宫内膜息肉患者往往症状不明显，没有得到足够的重视。其实，年轻妇女宫内膜息肉癌变率为0．5％-4．8％，而更年期和绝经后子宫内膜息肉患者癌变率可达10％-15％，因此明确诊断出绝经后的子宫内膜息肉，意义重大。     

超声检查对绝经后子宫内膜病变诊治价值分析

子宫内膜病变主要包括子宫内膜息肉、子宫内膜增生、子宫内膜癌、粘膜下肌瘤等,是妇科常见疾病,综合分析绝经后子宫出血、阴道排液、腹痛及彩色多普勒提示宫腔异常,使绝经后子宫内膜病变诊断水平明显提高。本文回顾性分析126例绝经后子宫内膜病变的临床特点及超声检查,     

子宫良性病变保留附件新型手术效果

目的探讨未绝经妇女子宫良性病变保留附件新型手术的效果。方法将82例良性子宫病变病人随机分为2组，对照组（46例）行筋膜内全子宫切除术．研究组（36例）行保留附件的新型手术，比较两组术中出血量、手术时间、术后病率。两组分别于术前、术后1个月、6个月、1年、2年测定血清性激素水平，比较两组术前、术后卵泡刺激素（FSH）、黄体生成素（LH）、雄激素（T）、泌乳素（PRL）、雌激素（E2）、孕激素（P）的变化。结果两组手术时间及术后各项指标比较差异无统计学意义（P〉0．05），对照组术后1、2年E。水平与术前比较差异有显著性（F=9．635．P〈0．05）。研究组术前、术后FSH、LH、T、PRL、E2、P等6种激素比较，差异无显著意义（P〉0．05）。结论保留附件的新型手术方式是45岁以下未绝经妇女子宫良性病变安全、可靠、损伤小、对内分泌影响最小的手术方式。     

阴道超声和宫腔镜检查在绝经后子宫内膜病变中诊断价值

目的：探讨阴道超声和宫腔镜检查诊断绝经后子宫内膜病变的临床价值。方法：160例绝经后子宫内膜病变患者行阴道超声及宫腔镜检查;以病理结果为标准,评价阴道超声和宫腔镜检查对诊断子宫内膜病变的敏感性、特异性、阳性预测值及阴性预测值。结果：经阴道超声检查48例正常,其中40例病理证实子宫内膜无异常;112例诊断为宫腔病变,其中96例经病理证实。宫腔镜检查52例正常,其中1例病理证实为子宫内膜单纯型增生;108例诊断为宫腔病变,其中103例经病理证实。宫腔镜检查宫腔内病变、子宫内膜癌和癌前病变的特异性、阳性预测值均高于经阴道超声检查(P＜0.05).结论：经阴道超声检查是一种筛查子宫内膜病变较好的方法;阴道超声联合宫腔镜检查对诊断绝经后子宫内膜病变有重要价值。     

现代残疾康复理念、政策与社区康复体系研究

本研究分析了当代残疾康复的理念和理论架构,构建了以国际公约、决议和政策、国内法律和政策以及操作性工具3个层次的康复理论体系;运用包容性发展,分析探讨了当代社区康复的体系和特点;就发展康复事业、为残疾人提供全面系统的康复服务提出相关的政策建议。     

Comparison of short-term and long-term protocols for stabilization and preservation of RNA and DNA of Leishmania, Trypanosoma, and Plasmodium

Molecular tools continue to be important in the prevention and control of parasitic diseases. However, using these techniques directly in the field remains a major challenge. Therefore, the preservation of clinical samples collected from endemic field areas for later analysis remains an important preanalytical process. This study aimed at identifying a suitable protocol for stabilization and preservation of RNA and DNA in bioclinical specimens for Trypanosoma, Leishmania, and Plasmodium research. Both spiked and unspiked blood samples were preserved in 7 protocols (different media; storage temperatures). Samples were evaluated for possible degradation of DNA and RNA along the storage duration up to the 10th week. Nucleic acid targets were assessed as follows: (i) Trypanosoma and Plasmodium RNA analysis was done using real-time nucleic acid sequence-based amplification (RT-NASBA) for 18S rRNA and for stage-specific Pfs25 mRNA, respectively; (ii) Trypanosoma DNA assessment analysis was conducted by using a conventional PCR for 18S rDNA; (iii) Leishmania RNA analysis was performed with a quantitative NASBA for 18S rRNA and Leishmania DNA assessment with an RT-PCR for 18S rDNA. Findings suggested that a newly developed L3™ buffer proved to be reliable and suitable for both short- and long-term preservation of parasite nucleic acid material. This buffer is envisaged to be suitable for utilization in field situations where resources are limited.     

Rates and risks of transmission of smallpox and mechanisms of prevention

In 1980, the World Health Organization declared smallpox eradicated from the world; the last known natural case had occurred in Somalia in 1977, and the United States had stopped routinely vaccinating its citizens in 1972. However, with increasing concerns regarding domestic and international terrorism, smallpox has resurfaced as a potential threat to global health. We review the direct and indirect modes of smallpox transmission and how patterns of transmission vary substantially, depending on the severity of circulating disease, vaccination status, environmental and socioeconomic factors, and the setting of an outbreak. We examine mechanisms for controlling outbreaks of disease and preventing further transmission in the event of an outbreak, with an emphasis on smallpox vaccination.     

国内外唇腭裂专科护理发展现状的文献研究及分析

目的了解和分析国内唇腭裂专科护理工作发展的现状。方法检索并分析万方医学网、中国知网、Springer Link及PubMed英文数据库近6年有关唇腭裂手术的围术期护理、患儿的喂养、手术安全管理、围术期疼痛研究以及心理护理的相关文献。结果共检索出国内文献89篇(核心期刊20篇)、国外文献22篇,其中围术期护理38篇、患儿的喂养16篇、手术安全管理10篇、围术期疼痛研究10篇、心理护理15篇。结论与国外文献相比,国内论文总结和回顾性居多,应增加研究探讨性论文,从而促进唇腭裂临床护理工作专科化的发展。     

城乡学童个性行为特征调查

目的探讨农村与城市儿童的个性行为特征。方法将97名农村学龄儿童设为农村组,97名城市学龄儿童设为城市组,采用艾森克个性问卷一儿童版和Achenbach’s 行为量表一儿童版进行评定分析。结果两组学龄儿童艾森克个性问卷各维度评分均无显著性差异（P均〉0．05）,且与全国常模相一致（P均〉0．05）;农村组男学童Achenbach’s行为量表违纪行为、攻击行为及外向型因子分均显著高于城市组,女学童退缩、社交问题因子分均显著高于城市组（P〈0．05或0．01）,其他因子分均无显著性差异（P均〉0．05）。结论农村与城市儿童个性无显著差异,而农村儿童存在较多的行为问题,可能与其所受教养和生活方式有关。     

糖尿病视网膜病变筛查与防治中存在的问题及对策

目的探讨糖尿病视网膜病变(diabetic retinopathy,DR)患者筛查和防治中存在的问题及对策。方法以76例糖尿病DR患者为对象,调查未能早期接受眼科诊治的原因。结果存在问题主要是患者对DR防治知识不了解、血糖控制不理想、内科医生未建议进行专科检查等。结论眼科医护人员应密切与糖尿病专科的联系,尽早对DM患者进行DR健康教育,并开展社区DR防治工作。     

罕见和未知基因型珠蛋白生成障碍性贫血的分析与鉴定

目的对珠蛋白生成障碍性贫血(简称地贫)血液学表型阳性但未检出常见地贫基因型的疑似个体做进一步分子水平检测,以明确诊断。方法收集2015年5月至2018年8月在清远市妇幼保健院就诊的地贫血液学表型阳性但常见地贫基因型检测为阴性的标本96例(包括疑似α-地贫88例和β-地贫8例),分别采用单管多重PCR、DNA测序法、荧光定量PCR和芯片捕获测序法检测罕见和未知缺失型地贫基因。结果从上述疑似α-地贫标本中共检出罕见α-地贫基因型17例,其中泰国缺失型(--^THAI/αα)5例,菲律宾缺失型(--^FIL/αα)2例,α^ΔCD303例,α珠蛋白基因拷贝数增加(ααα^anti3.7或ααα^anti4.2)5例,并且发现2例新的α-地贫突变,即α^ΔCD272-279delAGCTTCGG和CD167-169insT。在8例β-地贫特征个体中检出罕见β-地贫基因型Poly A(A>G)2例,-90(C>T)3例,CD37(TGG>TAG)1例,IVS-I-2(T>A)1例,另外还鉴定出1例新的缺失型β-地贫基因(缺失位置为ch11:5,246,000-5,250,500,缺失长度为4kb左右)。结论对未检出常见地贫突变但血液学表型阳性个体进行深度分析,既可提高地贫基因的检出率,有利于遗传咨询和产前诊断,又可能发现新的地贫突变,丰富了中国人群的地贫基因突变谱。     

Prevalence and severity of nausea and vomiting of pregnancy and effect of vitamin supplementation.

OBJECTIVE: Although nausea and vomiting of pregnancy is the most common medical condition during pregnancy, there are many unanswered questions regarding its cause, epidemiologic features and optimal management. The objectives of this study were to ascertain the prevalence of nausea and vomiting in a sample of Canadian women, to characterize the distribution of their severity and to investigate the role of vitamin B6 deficiency in their etiology. DESIGN: Prospective study. SETTING: Antenatal counselling service for pregnant women. PATIENTS: Three cohorts of women: a prospective, population-based cohort of 193 women, to estimate the rate and severity of nausea and vomiting (cohort A); a cohort of 555 women who sought advice for nausea with or without vomiting, to study the correlation between the maximal daily number of episodes of vomiting and maximal weight loss (cohort B); and a prospective cohort of 301 women who reported vomiting, to correlate vitamin supplementation with vomiting (cohort C). INTERVENTIONS: All 3 cohorts were interviewed during the counselling session, and cohort B was followed up prospectively. OUTCOME MEASURES: Frequency of nausea and vomiting, weight loss, maximal number of daily episodes of vomiting, rate of multivitamin supplementation. RESULTS: Overall, 67% of the women in cohort A reported experiencing nausea or vomiting, or both; 22% reported vomiting, and 9% experienced weight loss. In cohort B there was a significant correlation between the maximal number of daily episodes of vomiting and maximal weight loss, although there was wide variation (r2 = 0.25, p < 0.001). There was a highly significant correlation between the number of daily vomiting episodes and mean weight loss (r2 = 0.99). In cohort C, vomiting was significantly associated with lack of supplementation with multivitamins before 6 weeks' gestation (p = 0.002). CONCLUSIONS: The relation between number of daily vomiting episodes and mean weight loss may serve as a clinical tool to assess the severity of nausea and vomiting in pregnancy and the success of anti-emetics and rehydration regimens. Further study is needed to elucidate the biologic basis of the observed association between vomiting and lack of multivitamin supplementation in early pregnancy.     

头面部血管肉瘤3例报告并文献复习

目的:总结我们对头面部血管肉瘤手术联合放射治疗方法的经验认识。方法:报道3例头面部血管肉瘤病例,并复习相关文献。结果和结论:头面部血管肉瘤是一种少见的、多中心的血管肿瘤,预后差。头面部血管肉瘤的手术治疗常常需要切除较广的范围。放射治疗对头面部血管肉瘤是一种合理治疗,既能使受侵犯的真皮组织和周围皮肤得到进一步治疗,又能保护其下的正常组织。     

History of violence and subjective health of mother and child

Objective: To study the self-reported prevalence of experienced violence among a cohort of women about two years after giving birth, their health during pregnancy, pregnancy outcomes and their experience of their child’s health.

Setting and subjects: In 2011, a total of 657 women participated in phase III of the Childbirth and Health Cohort Study in Icelandic Primary Health Care, 18 to 24 months after delivery. The women had previously participated in phase I around pregnancy week 16 and phase II 5–6 months after delivery. Data were collected by postal questionnaires.

Main outcome measures: Women’s reported history of experienced violence, sociodemographic and obstetric background, self-perceived health, the use of medications and their child’s perceived health.

Results: In phase III, 16% of women reported experiencing violence. These women felt less support from their current partner (p?p?p?p?p?p?=?0.008).

Conclusions: Our study confirms that a history of violence is common among women. A history of violence is associated with various maternal health problems during and after pregnancy, a higher rate of caesarean sections and maternal reports of health problems in their child 18–24 months after birth.

• KEY POINTS

• Violence is a major concern worldwide. Understanding the impact of violence on human health and developing effective preventive measures are important elements of any public health agenda.

• ??The reported prevalence of experiencing violence was 16% among women attending antenatal care in the primary health care setting in Iceland.

• ??Women with a history of violence reported worse health in general during pregnancy and delivered more often by caesarean section, compared to women with no such history.

• ??Mothers with a history of violence also evaluated the general health of their child as worse than women with no such history.

• ??The findings of this study support the importance of recognizing and addressing experienced violence among women in primary care.