昆山郑氏妇科二十九代世医考

江苏昆山郑氏妇科世医、代代相传二十九世,历经宋,元、明、清、民国、迄今已有近８００年历史,堪与江南何氏二十九代世医媲美,成为中外医学史上罕见的奇迹。整理其家谱、墓志,方志,文稿,医著等传世文献资料,地郑氏二十九代妇科的世系,医家传略,医术,著述等进行了较详细的考证和整理,并编绘了世系图。     

母血、羊水中IGF水平与胎儿宫内生长受限关系的研究

目的 探讨胰岛素样生长因子-Ⅰ(IGF-1)和IGF-Ⅱ与胎儿生长发育的关系。方法 抽取15例分娩IUGR胎儿(IUGR组)及20例分娩正常Jk(对照组)产妇肘静脉血、新生儿脐静血及羊水。采用放射免疫法及免疫放射法分别测定其IGF-Ⅰ、IGF-Ⅱ水平。结果 IUGR组产妇血清IGF-Ⅰ水平低于对照组，IGF-Ⅱ水平无显著差异；IUGR组脐血及羊水中IGF-Ⅰ、IGF-Ⅱ水平较对照组显著降低。结论 检测母血及羊水中IGF-Ⅰ、IGF-Ⅱ水平可监测胎儿生长发育，早期诊断IUGR。     

腹腔镜妇科手术200例临床分析

目的探讨腹腔镜在妇科手术中的应用价值。方法回顾我院200名患者接受腹腔镜手术治疗,例如子宫肌瘤、子宫腺肌病、异位妊娠、盆腔粘连、卵巢囊肿、继发不孕的情况。结果194例患者手术均顺利完成,占97%;中转开腹4例,占2%;并发症2例,占1%。结论腹腔镜手术是一种更具人性化的手术方式,它具有创伤小、痛苦少、恢复快的优点。但必须提高医生的内镜手术技能和技巧,严格掌握手术适应证和禁忌证,减少并发症的发生。     

Impact of gynecologic hospitalist on patient waiting time at the emergency department in Korea: A retrospective pre-post cohort study

ObjectiveThis study aimed to identify the impact of care and change in the consultation process given by a gynecologic hospitalist on patient waiting time in the emergency department (ED).Materials and methodsThis is a pre-post study that compared patients’ length of stay at the ED ten months before and after intervention by the gynecologic hospitalist in 2018. The consultation process changed from ED staff contacting the gynecologic resident (pre-intervention group) to directly contacting the gynecologic hospitalist (post-intervention group). Times elapsed from gynecologic consultation to final disposition, from gynecologic consultation to discharge, and from arrival at ED to discharge were compared between the two groups.ResultsAmong 945 referrals at the ED during the study period, the number of daytime weekday gynecologic consultations were 68 and 187 cases in the pre-intervention and post-intervention groups, respectively. The time elapsed from gynecologic consultation to the final disposition, the time elapsed from gynecologic consultation to discharge and the time elapsed from arrival at ED to discharge were shorter in the post-intervention group than in the pre-intervention group (median values, 98 vs. 167.5 min, 205 vs. 311.5 min, and 419 vs. 497 min; P < 0.05), and extended length of stay more than 12 h at the ED was less common in the post-intervention group than in the pre-intervention group (9.6 vs. 19.1%; P < 0.01).ConclusionThe waiting time of gynecologic patients upon admission and prolonged length of stay at ED significantly decreased after the establishment of the gynecologic hospitalist system.     

Evaluation of the incorporation of an IOTA-ADNEX model in the discrimination of adnexal masses in our third-level hospital centre,taking into account the menopausal status of patients. Five years of experience

ObjectiveThe objectives were to estimate the performance of the IOTA-ADNEX model test after its incorporation into the ultrasound tests of our third-grade hospital gynecology service, as well as to assess whether its capacity of accuracy is modified when taking into account the patient's menopausal status.MethodsA cross-sectional study was conducted to clinically evaluate the diagnostic performance of the IOTA-ADNEX model test, which was performed between January 2016 and December 2021. The study included 573 women with an adnexal injury who underwent surgical excision within 180 days after ultrasound diagnosis and histological confirmation (gold standard). After the ultrasound exam, the injuries were classified using the ADNEX model. The study estimated the area under the receiver-operating-characteristics curve (AUC) of the ADNEX model for classifying between benign and malignant adnexal masses and compared the performance by menopausal state. Sensitivity and specificity were determined for different cut-off points.ResultsOut of the 573 women, 183 (31.9%) had a malignant tumor. The AUC of the ADNEX model for differentiating between benign and malignant adnexal masses at the time of ultrasound examination was 0.92 and the best malignancy threshold, detected by Youden index, was 22.5%. At this cut-off, the sensitivity of the ADNEX model was 91.8% and the specificity was 76.4%. However, it varies according to menopausal status: in the group of pre-menopausal patient, sensitivity was 86.1% (95% CI, 85.4%–86.8%) and specificity was 81.3% (95% CI, 85.4%–86.8%). In the postmenopausal group, sensitivity was 96.1% (95% CI, 95.6%–96.7%) and specificity was 68.5% (95% CI, 68.1%–68.8%).ConclusionsThe IOTA-ADNEX model is a reliable diagnostic tool to discard ovarian cancer. However, the accuracy of the test, at the same cut-off point, varies according to the menopausal state of the patient so it may be important to take it into account when taking decisions in clinical practice.     

Paclitaxel-related dermatological problems: Not only alopecia occurs

ObjectiveDermatological problems after chemotherapy are often neglected with gynecological oncologists. Since paclitaxel is one of most popular agents for gynecology organ-related cancers, dermatologic change after paclitaxel treatment is seldom reported before.Case reportTwo patients with gynecological organ malignancy who underwent the postoperative dose-dense weekly schedule of paclitaxel 80 mg/m² plus carboplatin (area of curve 5) every three weeks had repeat dermatological problems (skull, facial and upper trunk areas) during the treatment. They included dermatitis, eczema, and folliculitis. Topical use of anti-fungal cream and oral anti-histamine agents stopped the disease progression and all had completed their chemotherapy without interruption.ConclusionClinicians should be aware of paclitaxel-induced skin toxicities, especially on the skull, face and upper trunk areas to minimize the occurrence of severe morbidity and to provide the better quality of life when cure is our primary priority in the management of gynecological organs-related malignancies.     

CircRNA在妇科肿瘤中的研究进展

CircRNA是非编码RNA中最为稳定的RNA分子,其稳定存在于各种生物体中并参与生物体的代谢功能调节。近年来,大量研究从基因组学及信号通路方向深入研究,发现CircRNA可与miRNA通过复杂调控参与机体各种疾病的发生及发展,其中CircRNA在肿瘤细胞的增殖、凋亡及转移中的作用备受瞩目。妇科肿瘤是妇科疾病中危害最大的疾病。本文主要从CircRNA的特征功能认知、在肿瘤发生及发展中途径、以及其在妇科肿瘤中的致病机理和未来诊断方向上,综合国内外相关研究进展进行整理,总结CircRNA在妇科肿瘤中的临床应用。