应用聚类分析和因子分析对重庆市区县级妇幼保健机构卫生资源投入指标的综合评价

目的对重庆市区县级妇幼保健机构卫生资源投入指标进行综合分析和评价,提取准确、关键的重要指标,为研究者和决策者提供妇幼卫生资源合理配置的科学参考依据。方法选取重庆市39个区县级妇幼保健机构2010-2012年度妇幼保健机构监测报表和数据,应用文献资料分析优选法、变异系数法、聚类分析法和因子分析法等,对数据和指标进行综合分析、筛选和评价。结果应用变异系数法选中8项指标,应用指标聚类法选中5项指标,因子分析法选中3项指标。结合3种方法 ,最终选取至少有两种方法都选中的指标,包括有职工总数、业务用房面积、实际开放总床位日数、固定资产、医疗支出5项指标。结论应用聚类分析法和因子分析法选取的5项关键指标,对指导相关部门进行卫生资源的配置和改善运营状况起到一定的参考作用。研究中可以应用多种方法对海量数据进行综合分析和评价,选取关键指标,为妇幼卫生研究者和行政管理者推动妇幼保健机构的发展提供参考依据。     

Association between serum levels of organochlorine pesticides and sex hormones in adults living in a heavily contaminated area in Brazil

BackgroundSeveral studies have investigated the effects of organochlorine (OC) pesticides on adverse reproductive outcomes. However, few previous studies explored their effects on sex hormones.ObjectiveTo examine the association between serum concentrations of OC pesticides and levels of sex hormones in adult population in a rural area in Brazil heavily contaminated with these pesticides.MethodsA cross-sectional study with 304 men and 300 women was undertaken. Wet weight serum concentrations of 19 OC pesticides (dichloro-diphenyl-trichloroethane [DDT] and hexachlorocyclohexane [HCH], among others) were determined in all participants. Testosterone levels were obtained for men and estradiol, progesterone, prolactin, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) for women. Associations between OC pesticides and sex hormones were evaluated using linear regression models.ResultsPrevalence of women with non-physiological hyperprolactinemia was 4%. After adjusting for serum lipids and confounders, heptachlor and o,p′-DDT concentrations in men were associated with lower testosterone levels, while peri- and postmenopausal women (N = 77) showed inverse associations between LH and hexachlorobenzene (HCB), p,p′-DDT, p,p′-DDD (dichloro-diphenyl-dichloroethane), endosulfan 1 and 2, aldrin and mirex, as well as between FSH and p,p′-DDD, endosulfan 1 and aldrin. Premenopausal women (N = 210) did not show statistically significant associations between OC pesticides and sex hormones.ConclusionsInverse associations between OC pesticide concentrations and testosterone in men and LH and FSH in peri-/postmenopausal women, together with the high proportion of women with elevated prolactin, suggest that these OC compounds may have triggered anti-androgenic effects in men and estrogenic effects in women in this population.     

一种新型分级法在药品周转和供应管理中的应用

目的：探究一种能够对药品供应和药品周转有效管理的方法。方法：整理2018年1月-6月的药品储备分析报告,每月制定市场供应紧缺的药品目录,按照供应情况分为A、B、C类短缺药品。每月评价短缺药品流通情况,待药品供应恢复稳定,则调整其短缺级别。结果：2018年1月-6月,短缺药品A类为28个,B类为16个,C类为8个。连续6个月评价短缺药品供应状态,当其恢复稳定供应后,则从短缺药品目录中删除。结论：对短缺药品实行动态分级管理,有望为药品周转和药品供应的精细化管理提出一种行之有效的办法。     

醋酸泼尼松对浆细胞性乳腺炎患者血清中Treg/Th17比值及炎症因子的影响

目的探讨醋酸泼尼松对浆细胞性乳腺炎患者血清中调节性T细胞(Treg)/辅助性T细胞17(Th17)比值及炎症因子的影响。方法选取2017年10月至2019年10月重庆市妇幼保健院收治的浆细胞性乳腺炎患者80例,并将其随机分为观察组和对照组,每组40例。对照组患者给予哌拉西林舒巴坦钠治疗,观察组患者则给予醋酸泼尼松治疗。评价醋酸泼尼松对浆细胞性乳腺炎患者血清中Treg/Th17比值及炎症因子的影响。结果治疗后,两组患者Treg细胞比例、Th17细胞比例、Treg/Th17比值及炎症因子(CRP、IL-6和TNF-α)水平均较治疗前降低(P<0.05);观察组Treg细胞比例明显低于对照组,Th17细胞比例及Treg/Th17比值明显高于对照组(P<0.05),炎症因子水平明显低于对照组(P<0.05)。结论醋酸泼尼松对浆细胞性乳腺炎患者的治疗疗效显著,可明显对抗炎性反应、调节免疫细胞的功能。     

Trophectoderm biopsy protocols may impact the rate of mosaic blastocysts in cycles with pre-implantation genetic testing for aneuploidy

PurposeThis study aimed to analyze the impact of different biopsy protocols on the rate of mosaic blastocysts.MethodsThis is a retrospective cohort study which included 115 cycles with pre-implantation genetic testing for aneuploidy (PGT-A). Two groups were allocated based on the biopsy protocols: method 1 group, the zona pellucida (ZP) was drilled on day 3 embryos followed by trophectoderm (TE) biopsy; and method 2 group, the ZP was opened on day 5 or 6 blastocysts followed by TE biopsy. All biopsy samples were assessed using next-generation sequencing (NGS) at a single reference laboratory. The euploid, aneuploid, and mosaic blastocyst rates and clinical outcomes were compared.ResultsThe mosaicism rate in the method 1 group was 19.58%, significantly higher than the method 2 group (8.12%; P < 0.05). No statistically significant difference was observed in euploid, aneuploid blastocyst rates, and clinical pregnancy rates between the two groups. Logistic regression analysis indicated that the biopsy protocols were independently associated with the mosaicism rates among all the variables.ConclusionsThe present study showed that different biopsy protocols may have an impact on the mosaic blastocyst rate. ZP opening on day 3 combined with TE biopsy might increase the incidence of mosaic blastocysts.     

Clinicopathologic Features and Survival Outcomes for Primary Renal Neuroendocrine Neoplasms

PurposePrimary renal neuroendocrine neoplasms (NENs) are exceedingly rare. We used the Surveillance, Epidemiology, and End Results (SEER) data to summarize clinicopathologic characteristics, treatment outcomes, and prognostic factors of primary renal NENs.MethodsData were identified from the SEER database. Clinicopathologic characteristics were compared by the Pearson chi-square or correction test, in which continuous variables were analyzed by t test. Kaplan-Meier analyses and log-rank tests were used to compare the differences in overall survival (OS). Univariable and multivariable regression model analyses of OS were conducted using the Cox proportional hazard model. Also, we used directed acyclic graphs to guide the multivariable regression model and to try to determine the impact of each of surgery, chemotherapy, and radiotherapy on OS.ResultsA total of 132 patients were enrolled. There were significant differences in age, grade, tumor size, SEER stage, surgery, and chemotherapy between patients with carcinoid tumors and those with neuroendocrine carcinomas. Patients with disease with carcinoid tumors, younger age, smaller tumor size, and lower SEER exhibited better survival outcomes. Univariable and multivariable regression models analyses indicated that age, sex, tumor size, and SEER stage were independent prognostic factors for OS. Directed acyclic graphs guided the respective inclusion of variables in the multivariable regression model to assess the causal effect of surgery, chemotherapy, and radiotherapy on OS. The results showed that surgery, chemotherapy, and radiotherapy did not improve OS.ConclusionPrimary renal NENs are exceedingly rare and exhibit different biological behavior. Older age, male sex, larger tumor size, and tumors not confined to the renal parenchyma may indicate poor prognosis. Resection of all visible disease remains the reference-standard treatment of choice. Longer-term studies with a larger patient cohort are needed to determine systemic therapeutic options.     

腹腔镜下燕尾服式骶骨固定术4例报道

目的 ：探讨燕尾服式骶骨固定术式治疗中盆腔和（或）合并后盆腔缺陷的可行性及临床疗效。方法 ：回顾性分析2019年重庆市妇幼保健院采用燕尾服式骶骨固定术治疗中盆腔和（或）合并后盆腔缺陷的4例患者临床资料,本研究使用自裁的网片和自行设计的穿刺锥完成手术。结果：4例患者均诊断为中盆腔合并后盆腔缺陷,其中3例为子宫脱垂伴阴道后壁膨出,1例为穹窿脱垂伴肠疝患者;4例患者均接受燕尾服式骶骨固定术并成功完成手术,无辅助阴式修补和中转开腹病例,术中无肠管等器官损伤的并发症发生。手术平均时间166 min,术中平均出血量为68 mL。所有患者在术后5～6 d均顺利出院,随访中超声提示盆腔脏器位置正常,网片覆盖平整,直肠阴道检查网片平铺无张力,且阴道后壁柔软无膨出。结论：燕尾服式骶骨固定术可以在修复和加强Ⅰ水平缺陷的同时修复加强Ⅱ、Ⅲ水平缺陷,是治疗中盆腔缺陷、中盆腔合并后盆腔的有效方法,也适用于后盆腔缺陷疾病的诊治。     

超声检查早期诊断体外受精-胚胎移植术后复合妊娠

目的探讨超声检查早期诊断体外受精-胚胎移植术(IVF-ET)后复合妊娠(HP)的价值。方法回顾性分析81例IVF-ET后临床确诊为复合妊娠患者的超声和手术情况,并随访宫内妊娠结局。结果超声诊断HP的时间为IVFET后20~49天,平均(29.08±5.74)天。81例中,术前超声诊断为宫内合并输卵管妊娠70例,宫内合并宫角妊娠8例,宫内合并宫颈妊娠、宫内合并肌壁间妊娠、单侧输卵管妊娠各1例;术前超声误诊3例,漏诊1例;超声诊断符合率为95.06%(77/81)。对77例宫内妊娠情况进行随访,其中60例已分娩或继续妊娠,6例术后宫内胚胎停育而接受清宫术,1例因21-三体高风险而接受引产,10例失访。结论超声检查可早期诊断IVF-ET后HP,指导临床及时治疗。     

宫内早孕合并宫角妊娠腹腔镜手术后宫角妊娠物残留一例

宫内外同时妊娠（heterotopic pregnancy,HP） 是指宫腔内妊娠和异位妊娠同时存在的一种病理妊娠。其中,宫内合并宫角妊娠（cornual heterotopic pregnancy,CHP）是一种对母胎危害极大的罕见类型之一。CHP的治疗包括期待治疗、减胎术及手术治疗,目前尚未完全统一。2018年5月收治1例行体外受精-胚胎移植术（IVF-ET）后27 d经三维超声诊断为CHP的患者。于ET术后37 d通过腹腔镜手术清除宫角妊娠物,但术后多次超声提示宫角妊娠物残留。经整个孕期的严密随访,最终获得宫内妊娠活产及良好的母体结局。该病例提示CHP患者选择治疗方案前应权衡不同治疗手段的利弊,孕期做到严密随访,以获得良好的母胎结局。