Health service needs of women with reproductive tract infections in selected areas of China

Objective To provide insight into the psychosocial factors underlying the utilisation of health services by women with reproductive tract infection (RTI) symptoms.Methods A cross- sectional study, adopting Aday and Andersen’s Social Behaviour Model, was conducted between 1998 and 1999 in Chinese Hebei province and Beijing. A total of 864 eligible married women (age 21 to 60 years) were face to face interviewed. Results The percentage of self- reported symptoms of RTIs in urban and rural women was 35. 6 and 46. 8, respectively; the proportion of women with RTIs who utilised health services was 27. 5% and 26. 7%, respectively. Compared to urban women, rural women had less knowledge on RTIs and more traditional beliefs, and were more satisfied with local health services. The results of logistic regression analysis showed that the common factor influencing health service utilisation in women with RTIs was current experience of RTIs. Knowledge about self- medication, perceived social stigma attached to RTIs, prior experience of RTIs, family income and perceived severity of RTIs were also predictors of utilisation of health services in rural women with RTIs. Satisfaction with health providers, information received from health providers, prior experience of RTIs, occupation and medical care coverage were predictors of utilisation of health services in urban women with RTIs. Conclusion The prevalence of RTIs is high, but the rate of seeking health services is low. There is a great need for emphasizing culturally acceptable reproductive health education in different places to improve women’s ability for self- care. Regular medical check- ups for women are also important. It is necessary to improve the quality of health service, complete the reform of health insurance and alleviate women’s social stigma related to RTIs, giving women social and moral support.     

THE RELATION OF PARATHYROID FUNCTION TO PREGNANCY-INDUCED HYPERTENTION

Parathyrin (PTH) and calcitonin were measured with radioimmunoassay in 39 cases of pregnancy-induced hypertension (PIH) in late pregnancy, 76 cases in normal early pregnancy and 278 cases in late pregnancy without PIH. Markedly increased PTH was noted in the women in late pregnancy, indicating the state of secondary hyperparathyroidism. PTH values in the women in late pregnancy with PIH were higher than those in the normal early pregnancy group, but Iower than those in the women in late pregnancy without PIH. The difference between PTH values in the PIH group and late pregnancy without PIH group was of statistical significance (P<0.05), while no significant difference was seen between calcitonin values of the two groups (P>0.05). The results suggest that the pathogenesis of PIH may be related to the function of parathyroid.     

Socioeconomic Distribution of Health and Health Care Utilization in a New Town in Hong Kong, China

Objectives To assess the association of socioeconomic indicators with various chronic and acute illnesses and the utilization of public health care in a new town in Hong Kong, China.Methods Illness experience and socioeconomic and demographic data of 7570 residents from 2022 randomly selected households were collected through telephone interviews. The relationships between indicators and illnesses/choice of health care were explored using stepwise logistic regressions after adjusting for sex and age. Results Significant positive associations were noted between low household income and diabetes meUitus, any chronic illnesses among adults and flu among younger subjects; low educational level and accident-related illness among adults; being born in Chinese mainland and flu, any acute illness in adults. For the utilization of public health care, low household income was the most consistent risk factor. Conclusion This study did not demonstrate a unidirectional socioeconomic gradient in health but supported the hypothesis that socioeconomic deprivation was associated with the utilization of public health care.     

The relation of parathyroid function to pregnancy-induced hypertension.

Parathyrin (PTH) and calcitonin were measured with radioimmunoassay in 39 cases of pregnancy-induced hypertension (PIH) in late pregnancy, 76 cases in normal early pregnancy and 278 cases in late pregnancy without PIH. Markedly increased PTH was noted in the women in late pregnancy, indicating the state of secondary hyperparathyroidism. PTH values in the women in late pregnancy with PIH were higher than those in the normal early pregnancy group, but lower than those in the women in late pregnancy without PIH. The difference between PTH values in the PIH group and late pregnancy without PIH group was of statistical significance (P < 0.05), while no significant difference was seen between calcitonin values of the two groups (P > 0.05). The results suggest that the pathogenesis of PIH may be related to the function of parathyroid.

     

Study of Coping-competence among Unmarried Pregnant Young Women in Three Big Cites in China

Objective To identify the coping-competence among unmarried pregnant young women. Methods A cross-sectional study was conducted in the setting of clinics-based. A total of 1 391 unmarried young women were recruited as the sample in Youth Clinics of 3 maternal care hospitals in Beijing, Jinan, and Guangzhou respectively in China. ＂Behavioral Attributes of Psychosocial Competence Scale-Condensed Form＂ was administered to identify the coping-competence of these women. All these women were aged 10-24 years old and were divided into three groups based on whether or not they had sex and pregnancy. The three groups were named as follows： pregnancy group with young women having had both sex and pregnancy, sex group with young women having had only sex but not pregnancy, and non-sex group with young women having no sex experience. Results Among the adolescents aged 10-19 years old, the coping-competence was different among the three groups （P=O.050）. Compared with the pregnancy group, the non-sex group were more inclined to active coping （P=0.026）. Among all the pregnant women aged 10-24 years old, the coping-competence was various by region （P〈0.001）： the women in Jinan were more inclined to active coping than the women in another two cites （P=0.009, P〈0.001）, and there was no difference between the women from Beijing and Guangzhou （P=0.324）. Conclusion This is the first study of coping among unmarried pregnant young women in China. The results supported the point of view that the pregnant adolescents were more inclined to passive coping, and the coping had regional differences.     

A follow-up study of women with a history of severe preeclampsia: relationship between metabolic syndrome and preeclampsia

Background  Women with a history of preeclampsia have twice the risk of cardiovascular diseases, and there is a graded relationship between the severity of preeclampsia and the risk of cardiac disease. Moreover, metabolic scores are associated with developing preeclampsia. However, since there are no diagnostic criteria for metabolic syndrome during pregnancy and pregnant women undergo metabolic changes, it is difficult to elucidate the relationship between preeclampsia and metabolic syndrome. We carried out a cross-sectional study to investigate the relationship between metabolic syndrome and preeclampsia among women with a history of severe preeclampsia shortly after an indexed pregnancy.

Methods  We recruited 62 women with a history of severe preeclampsia 1 to 3 years after an indexed pregnancy. Blood pressure and body compositional indices were recorded. Fasting blood samples were tested for glucose, total cholesterol, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, triglycerides, and insulin. A questionnaire was used to collect demographic data including pre-pregnancy weight and family history of diseases associated with cardiovascular diseases. Criteria for metabolic syndrome were defined by the National Cholesterol Education Program, Adult Treatment Panel III 2001 (NCEP III) and International Diabetes Federation 2005 (IDF). Data were analyzed by the α² test and multivariate Logistic regression.

Results  According to NCEP III and IDF standards, 17 (27%) and 24 (39%) women, respectively, were identified as having metabolic syndrome. Being overweight pre-pregnancy and currently overweight were risk factors, and currently overweight was an independent risk factor. A combination of blood pressure and waist circumference was predictive of metabolic syndrome with a sensitivity of 91.67% and specificity of 94.74%.

Conclusions  An unfavorable metabolic constitution in women may lead to metabolic syndrome, preeclampsia, and long-term cardiovascular disease. In women with severe preeclampsia, therapeutic interventions should include weight-control shortly after pregnancy, especially among women who were previously overweight.

     

An Impact of Suspected Peritubal Adhesions by Hysterosal- pingography on Outcomes of Intrauterine Insemination

Objective To assess the fertility prospect of women with suspected peritubal adhesions diagnosed by hysterosalpingography （HSG） treated with intrauterine insemination （IUI）. Methods The study group consisted of 93 patients diagnosed as bilateral suspected peritubal adhesions by HSG, and 175 patients with no tubal pathology were classified as control group. A total of 496 cycles of lUI were finished in 268 infertile women. Results There were no differences in basic clinical parameters between the two groups. Cumulative pregnancy rates after two cycles of lUI were 19.4%for the study group, and 34.3%for the control. Cumulative pregnancy rate in the women with abnormal contrast media loculation was significantly lower than that in women of the control （7.4% vs 34.3%, P=0.037）. The cumulative pregnancy rates were similar between the women with abnormal tubal contour and the normal ones （36. 7% vs 34.3%, P=0.800）. Conclusion Suspected peritubal adhesions in HSG were worthy more attention, since the outcome of lUI in women with loculation of contrast material, combined with or without abnormal tubal contour resulted in a significantly lower pregnancy rate than the normal ones. IUI should be delayed before tubal patency was confirmed during these patients.     

A Multicentre Comparative Clinical Study of Three Types of IUD（Eight：Year Follow up）

The Stainless steel ring(SSR), VCu200 and TCu220C were in randomized comparison for eight years in a cohort of 4,490 subjects covering 16 centres in 9 provinces and municipalities. The follow-up rate at the end of the eithth year was 90.33%. The cumulative continuation rates were 47.06 per 100 women at the end of the eighth year for SSR,54.05 for VCu200 and 61.14 for TCu220C. The cumulative pregnancy rates for VCu200 and TCu220C were 10.35 and 8.94 per 100 women respectively, significantly lower than 24.14 for SSR. There were significant differences in eight-year expulsion rates among SSR(21.69%), VCu200(13.05%) and TCu220C(7.48%). The removal for bleeding and/or pain was the lowest in SSR; and no significant differences were found between VCu200 and TCu200C. but the rate ws getting higher in VCu200 at the end of the eighth year than in TCu220C. The discontinued use of lUD for desire to become pregnant in rural area was extremely higher than in urban area. The risk of pregnancy and expulsion was in association with the types of lUD in this study, age at insertion, previous use of IUD and pregnancy frequency prior to insertion. The risk of pregnancy and expulsion for VCu200 and TCu220C was significantly lower than that for SSR. Failure risks were associated with age at insertion, the types of IUD in this study and pregnancy frequency prior to insertion, and failure risk in SSR was still higher than in VCu200 and TCu220C at the end of the eighth year. The study revealed that TCu220C was of good long-term safe ty, efficacy, and acceptability.     

Association between maternal psychological status and fetal hemodynamic circulation in late pregnancy

Background The prevalence reported of maternal depression from the first to the third trimester was 7.4％,12.8％,12.0％ respectively,which implies that around one-tenth of pregnant women suffer from psychological disorder during the whole pregnancy.It is assumed that during pregnancy the maternal-fetal circulation unit is also affected by maternal psychological status.The aim of this study is to explore the association between maternal psychological status and fetal dynamic blood flow circulation during pregnancy.Methods We recruited 102 singleton low risk pregnant women between 30 to 33 gestational weeks.The Symptom Checklist-90 （SCL-90） was used to assess maternal psychological status.Ultrasound Doppler was used to measure blood flow changes in maternal-fetal circulation.Pulsatility index （PI） value was measured in umbilical artery （UA）,fetal middle cerebral artery （MCA） and maternal uterine arteries （UTA）.Peak systolic velocity （PSV） was measured in MCA and velocity was measured in umbilical vein （UV）.Statistical analysis was performed with standard nonparametric MannWhitney U tests.Two-tailed P values ＜0.05 were considered statistical significance.Results Of the 102 pregnant women,12 patients show high levels of poor mental health.Women with poor mental health have higher umbilical artery PI values than good mental health patients （P=0.020）.A higher MCA PI value is found in poor mental health patients but this does not reach statistical significance （P=0.053）.Women with hostility show lower placental scores （P=0.030）.Women with somatization demonstrate higher values in UA PI,MCA PI and MCA PSV （P=0.049,0.030 and 0.035 respectively）.A higher MCA PSV value is also found in phobic anxiety patients （P=0.046）.Conclusions Poor mental health during pregnancy is found to have an adverse effect on maternal-fetal circulation.Umbilical artery and fetal cerebral circulation are more sensitive and affected by maternal psychological disorder.     

Correlation Questions Clinical Discussion of Uterine Artery Embolization in Induced Abortion Patients with Management of Cesarean Scar Pregnancy

Objective To analyze retrospectively the utility of uterine arterial embolization （UAE） for cesarean scar pregnancy （CSP）.Methods Fifty-one women with CSP were pretreated with UAE before dilatation ＆ curettage （D＆C）. Indexes such as blood loss volume, operation-associated complications, serum hCG level ultrasound imaging and hospitalization cost were analyzed.Results Thirty-eight women accepted D＆C following UAE （group A）, 10 patients had medicine （3 took trichosanthin injection, 7 took MTX injection） before UAE and D＆C （group B）. Uterine packing following emergency UAE were performed in another 3 women due to severe hemorrhage during direct curettage without pretreatment （group C）. There were no statistically significant differences between group A and group B about the serum fl-hCG level resolution time and the blood loss in the opertation. Patients had shorter duration of hospital stay （P〈0.01） and cheaper cost of hospitalization （P〈0.05） of group A than group B.Conclusion Pretreatment with UAE before curettage is safe and effective in terminating CSP, reducing hospitalization cost. UAE followed by curettage is recommended to medical facilities where UAE is available.     

Misdiagnosis and Delayed Diagnosis for Ectopic and Heterotopic Pregnancies after In Vitro Fertilization and Embryo Transfer简

This study examined the misdiagnosis and delayed diagnosis factors for ectopic pregnancy（EP） and heterotopic pregnancy（HP） after in vitro fertilization and embryo transfer（IVF-ET） in an attempt to reduce the diagnostic error. Clinical data of patients who underwent IVF-ET treatment and had clinical pregnancy from 12463 cycles were retrospectively analyzed. Their findings of serum β-hCG test and transvaginal ultrasonography were also obtained during follow-up. These patients were divided into two groups according to the diagnosis accuracy of EP/HP： early diagnosis and misdiagnosis/delayed diagnosis. The results showed that the incidence of EP and HP was 3.8%（125/3286） and 0.8%（27/3286） respectively for IVF/ICSI-ET cycle, and 3.8%（55/1431） and 0.7%（10/1431） respectively for frozen-thawed embryo transfer（FET） cycle. Ruptured EP occurred in 28 patients due to initial misdiagnosis or delayed diagnosis. Related factors fell in 3 categories：（1） clinician factors： misunderstanding of patients＇ medical history, insufficient training in ultrasonography and unawareness of EP and HP;（2） patient factors： noncompliance with medical orders and lack of communication with clinicians;（3） complicated conditions of EP： atypical symptoms, delayed elevation of serum β-hCG level, early rupture of cornual EP, asymptomatic in early gestation and pregnancy of unknown location. All the factors were interwoven, contributing to the occurrence of EP and HP. It was concluded that complicated conditions are more likely to affect the diagnosis accuracy of EP/HP after IVF-ET. Transvaginal ultrasonography should be performed at 5 weeks of gestation. Intensive follow-up including repeated ultrasonography and serial serum β-hCG tests should be performed in patients with a suspicious diagnosis at admission.     

Reproductive outcomes after operative laparoscopy of patients with tubal infertility with or without hydrosalpinx

Infertility is defined as the inability for a couple to have children without any contraceptive methods within 1 year.Tubal factors are responsible for 25％ to 35％ of female reasons,and these have been proven to be a major cause of female infertility.Hydrosalpinx is a special type of tubal occlusion in which fluid accumulates inside the hymen of the tube.This adversely affects fallopian function,and hydrosalpinx fluids have a toxic effect on the quality of the embryos and endometrial receptivity.Currently,reconstructive surgery still plays a role in female infertility for tubal factors and has not been totally replaced by assisted reproductive technology in developing countries and districts.Keywords：infertility; hydrosalpinx; laparoscopy; pregnancy; ectopic pregnancy rate     

A comparison of implantation, miscarriage and pregnancy rates of single and double day 3 embryo transfer between fresh and frozen thawed transfer cycles: a retrospective study

Background Reduced endometrial receptivity in hyperstimulated cycles may lead to a lower implantation rate and a lower clinical pregnancy rate,but it is unclear if it is also associated with an increase in pregnancy loss rate.The aim of this study was to compare the implantation,miscarriage,and pregnancy rates between fresh and frozen thawed transfer of one or two day-3 embryos,with a view to understanding whether or not reduced endometrial receptivity encountered in hyperstimulated cycles is associated with an increase in miscarriage rate.Methods This study involved a consecutive series of 1 551 single day-3 embryo transfer cycles and consecutive 5 919 double day-3 embryo transfer cycles in the Assisted Reproductive Unit of the Sir Run Run Shaw Hospital,Hangzhou,China,between January 2010 and December 2012.Results The implantation and clinical pregnancy rates （single embryo 30.7％ and double embryos 33.4％ and 51.4％）using fresh cycle were both significantly lower than that of frozen-thawed cycles （single embryo 35.8％ and double embryos 38.1％ and 57.8％）.There was no difference in biochemical loss or clinical miscarriage rates between the two groups.Conclusions Impairment of endometrial receptivity associated with ovarian hyperstimulation leads to implantation failure at a very early stage,resulting in an increased number of non-pregnancy.It does not lead to increase in biochemical or clinical losses.The significantly reduced ongoing pregnancy rates in both fresh single and double embryo transfer are therefore due to failure to achieve a pregnancy,rather than pregnancy loss after conception.     

Primitive neuroectodermal tumor of the kidney with inferior vena cava tumor thrombus during pregnancy response to sorafenib

Primitive neuroectodermal tumor （PNET） most often presents as a bone or soft tissue mass in the trunk or axial skeleton in adolescents and young adults.1 It is highly aggressive and rarely arises in the kidney.2 A combined therapy, consisting of surgical resection,chemotherapy and radiotherapy, is needed to treat this tumor but long-term survival remains poor.3,4 In the current study, we describe a case of 26-year-old woman （primigravida） who presented with a PNET of the right kidney with inferior vena cava （IVC） tumor thrombus.     

Chinese herbal medicine Xinfeng Capsule in treatment of rheumatoid arthritis： study protocol of a multicenter randomized controlled trial

BACKGROUND： Rheumatoid arthritis （RA）, as a common systemic inflammatory autoimmune disease, affects approximately 1 in 100 individuals. Effective treatment for RA is not yet available because current research does not have a clear understanding of the etiology and pathogenesis of RA. Xinfeng Capsule, a patent Chinese herbal medicine, has been used in the treatment of RA in recent years. Despite its reported clinical efficacy, there are no large-sample, multicenter, randomized trials that support the use of Xinfeng Capsule for RA. Therefore, we designed a randomized, double-blind, multicenter, placebo-controlled trial to assess the efficacy and safety of Xinfeng Capsule in the treatment of RA. METHODS AND DESIGN： This is a 12-week, randomized, placebo-controlled, double-blind, multicenter trial on the treatment of RA. The participants will be randomly assigned to the experimental group and the control group at a ratio of 1：1. Participants in the experimental group will receive Xinfeng Capsule and a pharmaceutical placebo （imitation leflunomide）. The control group will receive leflunomide and an herbal placebo （imitation Xinfeng Capsule）. The American College of Rheumatology （ACR） Criteria for RA will be used to measure the efficacy of the Xinfeng Capsule. The primary outcome measure will be the percentage of study participants who achieve an ACR 20% response rate （ACR20）, which will be measured every 4 weeks after randomization. Secondary outcomes will include the ACR50 and ACR70 responses, the side effects of the medications, the Disease Activity Score 28, RA biomarkers, quality of life, and X-rays of the hands and wrists. The first four of the secondary outcomes will be measured every 4 weeks and the others will be measured at baseline and after 12 weeks of treatment. DISCUSSION： The result of this trial will help to evaluate whether Xinfeng Capsule is effective and safe in the treatment of RA. TRIAL REGISTRATION： This trial has been registered in ClinicalTrials.gov. The identifier is N CT01774877.     

The role of central nervous system on hypoglycemia and the feasibility of the brain theory in traditional Chinese medicine on treatment of diabetes mellitus

The central nervous system （CNS） plays a key regulatory role in glucose homeostasis. In particular, the brain is important in initiating and coordinating protective counterregulatory responses when blood glucose levels fall. This may due to the metabolic dependency of the CNS on glucose, and protection of food supply to the brain. In healthy subjects, blood glucose is normally maintained within a relatively narrow range. Hypoglycemia in diabetic patients can increase the risk of complications, such as heart disease and diabetic peripheral neuropathy. The clinical research finds that the use of traditional Chinese medicine （TCM） has a positive effect on the treatment of hypoglycemia. Here the authors reviewed the current understanding of sensing and counterregulatory responses to hypoglycemia, and discuss combining traditional Chinese and Western medicine and the theory of iatrogenic hypoglycemia in diabetes treatment. Furthermore, the authors clarify the feasibility of treating hypoglycemia on the basis of TCM theory and CNS and have an insight on its clinical practice.     

WHO西太区与世界中医药学会联合会中医名词术语国际标准比较研究:津液辨证(英文)

Intraditional Chinese medicine (TCM),the so-called津液refers to all the fluid and liquid flowingand maintaining inside the human body.In Chineselanguage,津液is a phrase composed of twoChinese characters which describes two differentkinds of fluid or liquid in the human body .According to the theory of TCM,津refers to thepart of fluid that is thin in texture and flowss moothly inside the body while液refers to thepart of fluid that is thick in texture and mainlymaintains in the joints of the body to nourish andlubr...     

Antioxidant and Antigenotoxic Activity of Bioactive Extracts from Corn Tassel简

This study is designed to evaluate antioxidant and antigenotoxic activities of corn tassel extracts（CTTs）. The major bioactive components of CTTs include flavonoid, saponin and polysaccharide. The antioxidant properties of the three bioactive components of CTTs were investigated by Ferric Reducing Antioxidant Property（FRAP） and 1, 1-diphenyl-2-picrylhydrazyl（DPPH） assays. The activities of the extracts were determined by assessing the inhibition of mutagenicity of the direct-acting mutagen fenaminosulf, sodium azide, and indirect-acting mutagen 2-aminofluorene using the Ames test（strains TA98 and TA100）. The results showed that the extraction rates of flavonoid, saponin, and polysaccharide from the dried corn tassels were 1.67%, 2.41% and 4.76% respectively. DPPH and FRAP assay strongly demonstrated that CTTs had antioxidant properties. CTTs at doses of 625, 1250 and 2500 μg per plate reduced 2-aminofluorene mutagenicity by 12.52%, 28.76% and 36.49% in Salmonella typhimurium TA98 strain assay respectively and by 10.98%, 25.27% and 37.83%, at the same doses in Salmonella typhimurium TA100 assay system, respectively. 3-[4, 5-dimethylthiazol-2-yl]-2, 5-diphenyltetrazolium bromide（MTT） assay showed that the different concentrations of CTTs inhibited the proliferation of MGC80-3 cells in a dose-dependent manner（P0.01）. It is concluded that these integrated approaches to antioxidant and antigenotoxicity assessment may be useful to study corn tassel as a natural herbal material.