2014-2018年某院剖宫产率及剖宫产指征的变化情况分析

目的分析我院2014-2018年剖宫产率及剖宫产指征的变化,探讨降低剖宫产率的策略和措施。方法回顾性分析2014年1月至2018年12月于我院行剖宫产分娩的42385例产妇的临床资料,分析其剖宫产率及主要剖宫产指征。结果2016年的剖宫产率均低于2014年、2015年、2017年、2018年,差异具有统计学意义(P<0.05)。瘢痕子宫在二胎政策开放后所占比例明显增加;羊水过少及相对头盆不称所占比例呈现逐年下降的趋势。2014-2018年,母体因素所占比例均最高,胎儿因素及头盆因素所占比例逐年下降。另外,社会因素在二胎生育政策开放后仍呈上升趋势。结论2016年剖宫产率明显下降,瘢痕子宫在二胎政策开放后所占比例明显增加。临床需提高剖宫产术后再次妊娠阴道试产的比例、提高助产技术水平、发挥营养门诊及助产士门诊的作用、提高产科医生对胎心监护的正确解读以降低剖宫产率。     

The role of cathepsin K in oral and maxillofacial disorders

Cathepsin K (CTSK) was thought to be a collagenase, specifically expressed by osteoclasts, and played an important role in bone resorption. However, more and more research found that CTSK was expressed in more extensive cells, tissues, and organs. It may not only participate in regulating human physiological activity, but also be closely related to a variety of disease. In this review, we highlight the relationship between CTSK and oral and maxillofacial disorders on the following three aspects: oral and maxillofacial abnormities in patients with pycnodysostosis caused by CTSK mutations, oral and maxillofacial abnormities in Ctsk^?/? mice, and the role of CTSK in oral and maxillofacial diseases, including periodontitis, peri‐implantitis, tooth movement, oral and maxillofacial tumor, root resorption, and periapical disease.     

加速康复外科护理在腹腔镜下子宫肌瘤切除术中的应用效果

目的 探讨加速康复外科的手术室护理在腹腔镜下子宫肌瘤切除术中的应用效果.方法 选取2018年8月至2020年8月间西北妇女儿童医院收治的100例腹腔镜下子宫肌瘤切除术患者,随机分为观察组和对照组,每组50例.对照组患者采用传统康复护理措施,观察组患者在围术期采用加速康复外科手术室护理措施,比较两组患者的护理满意度、并发...     

胎儿超声NT联合血清PIGF、ADAM12、uE3检测在唐氏综合征的早期预测中的价值分析

目的探讨胎儿超声颈项透明层厚度(NT)联合血清胎盘生长因子(PIGF)、解整合素-金属蛋白酶12(ADAM12)、游离雌三醇(uE3)检测对唐氏综合征(DS)的早期预测价值。方法回顾性分析2017年2月至2018年2月间于空军军医大学第一附属医院行产检的500例孕妇资料,使用超声检测胎儿NT,并检测孕妇血清中PIGF、ADAM12、uE3水平,以羊膜穿刺检测胎儿染色体情况为金标准,分析超声检测胎儿NT联合血清PIGF、ADAM12、uE3预测DS的价值。观察不同风险程度孕妇的异常妊娠结局率。结果单纯超声检测确诊11例DS胎儿,阳性率为2.20%(11/500),单纯血清检测确诊12例DS胎儿,阳性率为2.40%(12/500),联合检测确诊13例DS胎儿,阳性率为2.60%(13/500);单纯超声检测诊断DS的灵敏度、特异度分别为67.67%、94.77%,单纯血清检测诊断DS的灵敏度、特异度分别为73.31%、95.38%,联合检测诊断DS的灵敏度、特异度分别为92.86%、96.79%;受试者工作特征(ROC)曲线结果显示,单纯超声、血清检测的曲线下面积分别为0.630、0.660,对DS的预测价值不高;联合检测的曲线下面积为0.720,对DS具有一定的预测价值。联合筛查出的结果中,高风险孕妇的异常妊娠结局率(15.38%)明显高于低风险孕妇(1.44%),差异有统计学意义(P<0.05)。结论胎儿超声NT联合血清PIGF、ADAM12、uE3检测的DS早期预测价值高于单项筛查,值得临床推广。     

2017—2019年妇产科重症监护病房院内感染的特征分析

目的 分析2017—2019年妇产科重症监护病房(MICU)院内感染的特征,为产科管理服务新模式下院内感染的预防及控制工作提供参考.方法 选取2017年1月1日至2019年12月31日西北妇女儿童医院MICU院内感染患者作为研究对象,对其特征进行分析.结果 4681例患者中,发生院内感染61例,其中3例发生2次院内感染...     

供精人工授精中卵泡直径对妊娠率的影响

目的研究卵泡直径对供精人工授精(AID)妊娠率的影响。方法收集2016年1月至2018年12月在我生殖中心行AID助孕治疗的1073例不孕夫妇共2333个治疗周期的数据,根据术前卵泡直径将患者分为A组(<17 mm)、B组(17~<19 mm)、C组(19~<21 mm)、D组(≥21 mm),分析四组的妊娠情况。结果临床妊娠共636例,其中双胎共8例(1.26%),流产46例(7.23%),宫外孕10例(1.57%)。A、B、C、D组的临床周期妊娠率分别为27.48%、28.20%、26.98%、21.26%,B组高于其他三组。Logistic回归分析结果显示,女方年龄、卵泡直径对临床妊娠结果有一定的影响(P<0.05)。结论通过对不同卵泡直径AID妊娠结局的分析,发现卵泡直径15~17 mm者不宜放弃人工授精手术,但对于卵泡发育不良未妊娠者,再次AID可采用促排卵方案,以改善卵子质量,提高临床妊娠率。     

乳腺梭形细胞癌1例报道并文献复习

乳腺梭形细胞癌是乳腺化生性癌的一个亚型,在临床中较为罕见,常常与乳腺良性肿瘤难以鉴别,因此了解乳腺梭形细胞癌的临床及影像学特征,有助于该病患者的早期诊断和及时、有效治疗。本文通过报道1例乳腺梭形细胞癌病例,探讨该病的临床及影像学特征,并进行相关文献复习,总结临床经验,旨在增强临床医师对乳腺梭形细胞癌的认识。     

Prognostic factors of childhood acute lymphoblastic leukemia with TCF3::PBX1 in CCCG-ALL-2015: A multicenter study

Background

Contemporary risk-directed treatment has improved the outcome of patients with acute lymphoblastic leukemia (ALL) and TCF3::PBX1 fusion. In this study, the authors seek to identify prognostic factors that can be used to further improve outcome.

Methods

The authors studied 384 patients with this genotype treated on Chinese Children's Cancer Group ALL-2015 protocol between January 1, 2015 and December 31, 2019. All patients provisionally received intensified chemotherapy in the intermediate-risk arm without prophylactic cranial irradiation; those with high minimal residual disease (MRD) ≥1% at day 46 (end) of remission induction were candidates for hematopoietic cell transplantation.

Results

The overall 5-year event-free survival was 84.4% (95% confidence interval [CI], 80.6–88.3) and 5-year overall survival 88.9% (95% CI, 85.5–92.4). Independent factors associated with lower 5-year event-free survival were male sex (80.4%, [95% CI, 74.8–86.4] vs. 88.9%, [95% CI, 84.1–93.9] in female, p = .03) and positive day 46 MRD (≥0.01%) (62.1%, [95% CI, 44.2–87.4] vs. 87.1%, [95% CI, 83.4–90.9] in patients with negative MRD, p < .001). The presence of testicular leukemia at diagnosis (n = 10) was associated with particularly dismal 5-year event-free survival (33.3% [95% CI, 11.6–96.1] vs. 83.0% [95% CI, 77.5–88.9] in the other 192 male patients, p < .001) and was an independent risk factor (hazard ratio [HR], 5.7; [95% CI, 2.2–14.5], p < .001).

Conclusions

These data suggest that the presence of positive MRD after intensive remission induction and testicular leukemia at diagnosis are indicators for new molecular therapeutics or immunotherapy in patients with TCF3::PBX1 ALL.     

Effects of three pro-nuclei (3PN) proportion incidence on clinical outcomes of patients with lower retrieved oocytes in the fresh cleavage-stage embryo transfer (ET) cycles

Purpose: To analyze the three pro-nuclei (3PN) incidence on clinical outcomes of patients with lower retrieved oocytes in the fresh cleavage-stage embryo transfer (ET) cycles.

Methods: This study included 1200 fresh cleavage-stage ET cycles from January 2013 to June 2015. The patients were divided into 3PN?=?0% (773 cycles) and 3PN?>?0% (427 cycles) group. Main outcomes compared were fertilization, cleavage, normal fertilization, good quality embryo, implantation, clinical pregnancy, and early abortion rate.

Results: We observed that there was no significant difference in female's age, the number of retrieved oocytes, the number of transferred embryos, the number of good quality embryos, endometrial thickness, infertile time, basal serum follicle-stimulating hormone, and E2 value between two groups (p?>?0.05). The fertilization (89.43 versus 83.90%, p?<?0.001) and cleavage (98.34 versus 97.19%, p?=?0.048) rates were significantly higher in 3PN?>?0% than 3PN?=?0% group. However, the normal fertilization (70.05 versus 50.67%, p?<?0.001), good quality embryos (37.11 versus 26.47%, p?<?0.001), and clinical pregnancy (49.81 versus 43.79%, p?=?0.046) rates were significantly higher in 3PN?=?0% than 3PN?>?0% group. The implantation (35.88 versus 33.78%, p?=?0.333) and early abortion (8.83 versus 10.70%, p?=?0.474) rates were not significantly different between two groups.

Conclusion: 3PN incidence might make a negative effect on clinical outcomes for patients with lower retrieved oocytes in the fresh cleavage-stage ET cycles.