42例节育器异位诊疗分析

目的：探讨宫内节育器异位的原因、诊断方法,分析IUD异位的危险因素、处理方法。方法回顾性分析42例节育器异位的临床资料。结果爱母环占61.90%（26/42）,O形环占28.57%（12/42）,T环形占4.76%（21/42）,吉妮环占4.76%（2/42）;爱母环发生异位的机率明显高于其它类型节育器;位于子宫肌层内30例,穿破浆膜层4例;子宫外异位：位于盆腔内6例,阔韧带后叶3例;爱母环的一条金属臂穿入乙状结肠1例,穿入宫旁1例,1例位于右上腹大网膜内,1例位于肠管表面。取器方式利用宫腔镜、腹腔镜、宫腹腔镜联合、膀胱镜及开腹等方式,均成功。有随访记录的14例占33.4%,其中,术后1＋月随访3例占7.1%,1年内随访者有12例占21.4%,3年内随访者2例占4.8%,无随访者28例占66.7%。节育环异位穿孔率无随访者高于有随访记录者。在节育器异位患者中,上环后有再次妊娠15例占35.7%。结论选择合适的节育器,适宜的安环时间可减少节育器异位的发生。充分术前评估,选择适宜的手术方式、及时、合理转换术式是取环成功的关键。     

三维超声造影在诊断宫腔粘连中的应用价值

目的探讨三维超声造影(3D-CEUS)在诊断宫腔粘中的应用价值。方法对71例经阴道三维超声(3DTVS)检查提示怀疑宫腔粘连的患者行宫腔镜检查,以宫腔镜检查为金标准,比较两者诊断宫腔粘连的准确率;在月经20~23d对3D-TVS诊断疑似宫腔粘连的患者行声诺维(sonovue)3D-CEUS检查,获得内膜厚度、容积(V)、回声强度(MG)、血管指数(VI)、血流指数(FI)、血管血流综合指数(VFI)等相关指标;对经sonovue 3D-CEUS疑似宫腔粘连的的患者,于月经第3~7天行宫腔镜检查,回顾性分析不同程度宫腔粘连的患者与3D-CEUS获得的V、MG、VI、FI、VFI值的关系。结果 3DTVS与宫腔镜比较,3D-TVS诊断宫腔粘连的符合率是90.14%;宫腔镜检查轻、中、重度3组,各组间子宫内膜厚度和容积比较均有显著性差异(P0.05);轻度和重度组子宫内膜MG分别(39.75±7.46)、(45.64±6.10),其差异具有统计学意义(P0.05);轻度和重度组组间子宫内膜VI、FI、VFI相比较,差异均具有统计学意义(P0.05),而中度组与其它两组比较均无显著性差异(P0.05)。经静脉推注30mg sonovue造影剂后,3D-CEUS检查结果显示:3组内膜血流VI值分别较造影前显著增加(P0.001),轻度和重度、中度和重度组的内膜VI、FI、VFI相比较,差异均具有统计学意义(P0.05)。结论 3DCEUS检查不仅可以较准确的诊断宫腔粘连,而且通过计算机辅助分析技术对宫腔粘连患者子宫内膜V、MG、VI、FI、VFI进行定量测量,对宫腔粘连的程度有更客观的评价。     

Factors associated with growth patterns from birth to 18 months in a Beninese cohort of children

The aim of this study was to analyze factors influencing the growth pattern of children from birth to 18 months. A longitudinal prospective study was conducted in three maternity wards in Southern Benin. Inclusion took place between June 2007 and July 2008; children were followed-up until 18 months of age. Height-for-age and weight-for-height Z-scores were computed using the newborn's anthropometric measurements taken at delivery, every month up to 6 months and then quarterly. Infant and young child feeding (IYCF) practices and malarial morbidity were recorded. Gestational age was estimated using the Ballard method; William's sex-specific reference curve of birth weight-for-gestational-age was used to determine intrauterine growth retardation (IUGR). Analyses were performed on 520 children using a linear mixed model. Low birth weight (coef = −0.43; p = 0.002), IUGR (coef = −0.49; p < 0.001), maternal short stature (coef = −0.25; p = 0.001) and maternal low weight status (coef = −0.19; p = 0.006) were significantly associated with growth impairment. Only LBW (coef = −0.28; p = 0.05) and maternal low weight status (coef = −0.23; p = 0.004) were associated with wasting. A good IYCF score was positively associated with weight gain (coef = 0.14; p < 0.001) whereas we found a paradoxical association with length (coef = −0.18; p < 0.001). Malaria morbidity was not associated with growth. LBW, IUGR and maternal low weight status and height were important determinants of children's growth. These results reinforce and justify continuing public health initiatives to fight IUGR and LBW and break the intergenerational cycle of malnutrition.     

Long non-coding RNA CRNDE deteriorates intrauterine infection-induced neonatal brain injury

BackgroundThis study aimed to test the hypothesis that long non-coding RNA (lncRNA) colorectal neoplasia differentially expressed (CRNDE) could exacerbate brain injury caused by intrauterine infection in neonatal rats.MethodsIntrauterine infection was induced in pregnant rats by lipopolysaccharide (LPS). After delivery, newborn rats with brain injury caused by intrauterine infection were randomly divided into control, control shRNA, and CRNDE shRNA groups. CRNDE expression in serum and amniotic fluid of pregnant rats and neonatal brain tissues were determined by quantitative real-time PCR (qRT-PCR). Morris water maze (MWM) task was used to test the spatial learning and memory ability. Histological examination and apoptosis detection were performed by hematoxylin and eosin (H&E) and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining, respectively. Immunohistochemistry was conducted to evaluate the activation of astrocytes and microglia.ResultsLncRNA CRNDE was highly expressed in serum and amniotic fluid of maternal rats and in brain tissues of offspring rats. Furthermore, shRNA-mediated CRNDE downregulation could rescue the spatial learning and memory ability, improve brain histopathological changes and cell death, and inhibit the activation of astrocytes and microglia caused by LPS.ConclusionCRNDE silencing possessed a cerebral protective effect in neonatal rats with brain injury caused by interauterine infection.     

No intrauterine vertical transmission in pregnancy with COVID-19: A case report

The coronavirus disease 2019 (COVID-19) has been a worldwide pandemic diseases, nearly 400,000 people died at now. The data of status of pregnant women and neonates after infection of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is limited. We report a case of pregnant woman in her third trimester with critical COVID-19, and amniotic fluid, umbilical cord blood, placenta, and neonatal gastric fluid were retained during cesarean section. The SARS-COV-2 nucleic acid test results of these specimens were negative. There is no evidence of intrauterine vertical transmission during delivery in the third trimester, but the data are limited and need to be further explored.     

Birth weight charts for gestational age in 63 620 healthy infants born in Peruvian public hospitals at low and at high altitude

Aim: To construct distribution curves for birth weight, length and head circumference using a large sample of infants born at low (150 m) and high (3000–4400 m) altitude.
Methods: Cross-sectional analysis of a perinatal database. All live singleton deliveries from public hospitals during 2001–2006 (gestational age from 26 to 42 weeks) with no history of perinatal deaths or smoking and no current obstetric complications (n = 63 620) were included. Fractional polynomial regression models were used to smooth curves for each gestational age.
Results: Mean and median birth weight differences between those born at low and high altitudes reached statistical significance after 35 and 33 weeks, respectively. Values of the 10th percentile were higher at low altitude from 36 weeks, whereas values at the 90th percentile were different from 34 weeks. In the Peruvian growth curves, birth weight was greater at each gestational age than in the curves derived by Lubchenco.
Conclusion: Altitude affects growth patterns; these growth standards will provide useful references for the care of the newborn in highland populations. In addition, the data have implications for the antepartum management of pregnant patients undergoing sonographic evaluation of fetal weight in whom new definitions of what represents small or large for gestational age in utero can result in differences in time or mode of delivery.     

经阴道彩色多普勒超声对宫内残留物的诊断价值

目的 探讨经阴道彩色多普勒超声(TV-CDFI)及经腹部彩色多普勒超声(TA-CDFI)诊断宫内残留物的临床价值.方法 运用经TV-CDFI及经TA-CDFI诊断宫内残留物98例,并与清官后病理结果对照.结果 98例宫内残留物全部经清官术后病理证实.超声诊断与病理诊断的符合率TV-CDFI为97.9%,误诊2例;而TA...     

雌激素结合中药汤剂预防宫腔镜分离后宫腔粘连的疗效分析

目的：探讨雌激素结合中药汤剂预防官腔镜分离后宫腔粘连的疗效与安全性。方法：将40例宫腔镜电切术后患者随机分为治疗组和对照组，每组20例。对照组术后口服戊酸雌二醇预防官腔粘连，而治疗组在对照组基础上加用中药汤剂预防宫腔粘连。结果：治疗组与对照组的宫腔粘连发生率分别为10％（2／20）和30％（6／20），治疗组与对照组比较，官腔粘连的发生率明显减少（P〈O．05），并且治疗组术后官腔粘连的程度和范围均低于对照组；两组不良反应情况，治疗组发生不良反应1例，对照组无不良反应发生，两组比较，差异无统计学意义（P〉0．05）。结论：雌激素结合中药汤剂预防官腔镜分离后官腔粘连的疗效好，预防范围广，安全性强，值得推广应用。     

上海市宫内节育器取出术现状的调查分析

目的:调查上海市宫内节育器(IUD)取出的现状和方法,探讨手术并发症的原因及安全取出IUD的措施。方法:对上海市87所医院2001～2007年期间所有IUD取出术病例进行回顾性调查,内容包括手术方式、手术地点及是否施行静脉麻醉手术等。对严重并发症进行个案调查。结果:2001～2007年常规IUD取出术数量稳步上升,维持在每年60000～100000例。二级综合医院、三级综合医院和妇幼保健院手术分布为37.61%、16.41%和45.98%。与2001年比较,2007年宫腔镜IUD取出术住院数量上升158.47%,静脉麻醉宫腔镜IUD取出手术上升124.47%。常规IUD取出术和宫腔镜IUD取出术中,严重并发症的发生率各为2.99/10万和36.00/10万。常规IUD取出术中17例严重并发症为脏器损伤14例,感染引起再次开腹手术3例。宫腔镜IUD取出术的严重手术并发症为死亡病例4例。结论:随着近年来IUD取出术逐年上升,宫腔镜手术有助于困难IUD的取出。建立宫腔镜操作规范,包括配置、抢救设备和有资质的医护人员是非常必要的。