择期剖宫产及阴式分娩对新生儿Apgar评分、NBNA评分及免疫指标的影响研究

目的 研究择期剖宫产及阴式分娩对新生儿Apgar评分、NBNA(新生儿神经行为测定)评分及免疫指标的影响.方法 选取我院产科出生的新生儿170例作为研究对象.按照分娩方式进行分组,其中择期剖宫产方式分娩新生儿归为观察组,阴式分娩新生儿归为对照组.对比两组新生儿出生后各时间点Apgar评分、出生后2天NBNA评分以及各免疫指标情况.结果 两组新生儿出生后1 min及5 min Apgar评分,组内及组间对比,差异均无统计学意义(P＞0.05).两组新生儿出生后2d NBNA评分基础分及加分、向声源转头次数、手持握次数以及自动踏步步数对比,差异均无统计学意义(P＞ 0.05).观察组新生儿IgM、IgG及IgA水平均显著低于对照组,差异有统计学意义(P＜0.05).结论 择期剖宫产及阴式分娩对于新生儿Apgar评分以及NBNA评分等影响均无显著差异,而择期剖宫产对新生儿免疫能力有降低作用,提升其患病危险.     

Vaginal and anal human papillomavirus infection and seropositivity among female sex workers in Amsterdam,the Netherlands: Prevalence,concordance and risk factors

Background

We studied prevalence, risk factors and concordance of vaginal and anal HPV infection and L1 seropositivity among female sex workers (FSW) in Amsterdam.

The mammary gland is a sensitive pubertal target in CD-1 and C57Bl/6 mice following perinatal perfluorooctanoic acid (PFOA) exposure

Perfluorooctanoic acid (PFOA) is a developmental toxicant in mice, with varied strain outcomes depending on dose and period of exposure. The impact of PFOA on female mouse pubertal development at low doses (≤1 mg/kg) has yet to be determined. Therefore, female offspring from CD-1 and C57Bl/6 dams exposed to PFOA, creating serum concentrations similar to humans, were examined for pubertal onset, including mammary gland development. Pups demonstrated a shorter PFOA elimination half-life than that reported for adult mice. Prenatal exposure to PFOA caused significant mammary developmental delays in female offspring in both strains. Delays started during puberty and persisted into young adulthood; severity was dose-dependent. Also an evaluation of female serum hormone levels and pubertal timing onset revealed no effects of PFOA compared to controls in either strain. These data suggest that the mammary gland is more sensitive to early low level PFOA exposures compared to other pubertal endpoints, regardless of strain.     

初产妇经阴道分娩所致耻骨和耻尾肌损伤的MRI研究

目的 探讨经阴道分娩所致耻骨损伤与耻尾肌损伤的发生差异以及2种损伤严重程度的相关性。 方法 回顾性分析88例初产妇经阴道分娩后的盆腔MRI影像。根据MR影像上有无耻骨损伤,将产妇分为耻骨损伤组（51例）和无耻骨损伤组（37例）。由2名高年资放射科诊断医师在MRI影像上判断和评估耻骨及耻尾肌损伤情况,包括耻骨的骨髓水肿、骨折,以及耻尾肌水肿、撕裂和断裂,并对损伤程度进行评分。采用独立样本t检验、Mann-Whitney U检验、卡方检验及Fisher精确概率检验比较有无耻骨损伤的2组临床资料和影像表现,不同耻骨损伤程度间的耻尾肌损伤发生率比较采用Fisher精确概率检验。采用Kendall`s tau-b相关分析耻骨损伤程度与耻尾肌损伤程度的相关性。 结果 耻骨损伤组骨盆痛、压力性尿失禁及耻尾肌损伤发生率均高于无耻骨损伤组（均P<0.05）。耻骨损伤程度不同,其耻尾肌损伤发生率不同（P<0.05）,耻骨骨折,重度、中度及轻度骨髓水肿产妇的耻尾肌损伤发生率依次减低。耻骨损伤程度与耻尾肌损伤程度呈正性线性相关（r=0.297,P=0.036）。 结论 经阴道分娩的初产妇如有耻骨损伤则往往伴发耻尾肌损伤,并且耻骨损伤越严重,耻尾肌损伤发生率越高、程度越重。     

复方莪术油栓联合克霉唑阴道片治疗老年性阴道炎的临床研究

目的研究复方莪术油栓联合克霉唑阴道片治疗老年性阴道炎的临床疗效。方法选取2018年6月—2019年6月在平顶山市第二人民医院治疗的120例老年性阴道炎患者为研究对象,将所有患者随机分为对照组和治疗组,每组各60例。对照组给予克霉唑阴道片,1片/次,1次/d;治疗组在对照组治疗的基础上给予复方莪术油栓,1枚/次,1次/d。两组患者持续治疗10 d。观察两组患者临床疗效,比较两组临床症状缓解时间、阴道p H值、病原菌检出率、生活质量综合评定问卷(GQOLI-74)量表评分、阴道灌洗液炎性因子水平。结果治疗后,治疗组总有效率为95.00%,显著高于对照组的83.33%(P0.05)。治疗后,治疗组白带减少时间、外阴瘙痒、外阴阴道疼痛、黏膜充血消失时间明显短于对照组(P0.05)。治疗后,两组患者阴道酸碱度(p H)值、病原菌检出率均显著降低,GQOLI-74量表评分显著升高(P0.05);且治疗组指标改善较多(P0.05)。治疗后,两组患者阴道灌洗液白细胞介素-8(IL-8)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平显著降低(P0.05);并且治疗组阴道灌洗液中细胞因子水平降低较多(P0.05)。结论复方莪术油栓联合克霉唑阴道片治疗老年性阴道炎具有较好的临床疗效,可缓解临床症状,提高患者生活质量,降低患者阴道灌洗液中细胞因子水平。     

剖宫产术后再次妊娠分娩方式的临床分析

目的探讨剖宫产术后再次妊娠的分娩方式。方法124例剖宫产术后再次妊娠分娩产妇,根据产妇分娩结局不同分为观察组(52例)和对照组(72例)。观察组产妇实施阴道分娩,对照组产妇实施剖宫产术分娩。比较两组产妇产后出血量、住院时间、产后感染情况、并发症发生情况、新生儿体重、Apgar评分情况及满意率。结果观察组产妇产后出血量、住院时间分别为(166.3±62.1)ml、(3.5±0.4)d,对照组产妇产后出血量、住院时间分别为(275.6±51.8)ml、(7.0±0.8)d,观察组产妇产后出血量明显少于对照组,住院时间明显短于对照组,差异均有统计学意义(P<0.05)。对照组产妇产后感染率、并发症发生率分别为12.5%、13.9%,观察组产妇产后感染率、并发症发生率分别为1.9%、1.9%,观察组产妇产后感染率、并发症发生率明显低于对照组,差异均有统计学意义(P<0.05)。观察组新生儿体重为(3512±354)g,Apgar评分<7分1例(1.9%);对照组新生儿体重为(3501±341)g,Apgar评分<7分1例(1.4%)。两组新生儿体重及Apgar评分情况比较,差异均无统计学意义(P>0.05)。观察组产妇满意率为94.2%(49/52),对照组产妇满意率为91.7%(66/72),两组产妇满意率比较,差异无统计学意义(P>0.05)。结论针对剖宫产术后再次妊娠分娩方式的选择,若符合指征可实施阴道分娩,其能够更好地保障分娩安全性,但具体需要根据产妇实际情况进行确定。     

Emerging therapies for postmenopausal vaginal atrophy

Symptoms related to vaginal atrophy are a significant problem for postmenopausal women and estrogen has been the gold standard for its treatment. A number of recent reviews of vaginal estrogen products are available. This review will, therefore, focus on other products and potential products for this indication, including the tissue selective estrogen complex and selective estrogen receptor modulators. Additionally, lesser-studied approaches will be discussed.     

Saliva flow rates and clinical characteristics of patients with burning mouth syndrome: A case–control study

Burning mouth syndrome (BMS) is a chronic pain condition that most commonly affects postmenopausal women older than 50 years of age. Xerostomia is a common complaint among BMS patients. However, previous studies showed inconsistent findings regarding saliva flow rate reduction. This study examined saliva flow rates, degree of mucosal hydration, xerostomia, and clinical characteristics in BMS patients compared with healthy controls. Unstimulated whole saliva (USWS) was collected through passive drooling; residual mucosal saliva (RMS) was collected using filter paper strips. Stimulated whole saliva (SWS) was collected while chewing on gum base. Oral exam and self-report data were collected. A total of 50 women (22 BMS cases and 28 healthy controls) aged 50 years or older were included in the analysis of this study. Mean age was 62 years for cases and 56 years for controls (P = 0.05). Compared with controls, cases had significantly lower USWS flow rates (P < 0.001) and had a higher prevalence of xerostomia (P = 0.001), gastrointestinal disease (P < 0.001), and vaginal dryness (P = 0.01). These data show that oral and vaginal dryness are common among BMS patients. Further studies are needed to investigate potential pathophysiological mechanisms related to the quality of saliva and mucosal barrier status among these patients.     

基于盆底肌加强的阴道紧缩术

目的探讨通过加强盆底相关肌群在提升阴道紧缩术临床效果中的作用及其关键操作。方法:从作者手术项目组2018年1月至2019年12月期间实施的盆底肌加强型阴道紧缩术案例中,随机选择50例作为观察对象。均采用阴道粘膜和会阴皮肤菱形切口,行粘膜下潜行分离,依次暴露会阴浅横肌、球海绵体肌和双侧肛提肌;首先拉拢缝合固定肛提肌;然后重叠缝合球海绵体肌和会阴浅横肌;最后常规关闭切口。统计手术时间,观察阴道收紧、会阴体高度、盆底肌评估得分及并发症等情况,随访求美者手术满意度。结果:50例阴道紧缩术平均手术时间1.5h;阴道腔中下段均明显缩窄,即刻有效率100%;会阴体高度平均抬高1.9cm。术后2月恢复良好,盆底肌评估得分平均增加33分。术后1例出现缝合口渗血,2例短暂排尿困难,无直肠损伤、血肿、感染等。45例得到完整随访,术后3月、6月、1年求美者性生活平均满意度分别为73%、90%、95%。结论:在阴道紧缩术中重点加强肛提肌、球海绵体肌和会阴浅横肌等盆底肌群,可有效收紧阴道,抬高会阴体,有利于改善阴道握持力,提高性生活满意度,值得临床推广应用。     

经阴道彩超联合宫腔镜诊断子宫内膜病变的价值研究

目的:对子宫内膜病变患者联合应用TVS+HS诊断,并分析其应用价值。方法:选取2018年12月—2020年11月我院治疗的82例疑似子宫内膜病变患者,所有患者均于月经结束后3~7 d安排TVS、HS检查,以病理检查为依据,判断TVS、HS单独检查及联合检查的诊断价值。结果:TVS单独诊断的敏感度为70.83%,特异度为70%,准确度为70.73%;HS单独诊断分别为80.56%、80.00%、80.49%,TVS+HS诊断分别为95.83%、90.00%、95.12%。TVS+HS诊断的敏感度、特异度明显高于TVS、HS单独诊断(P<0.05);TVS+HS对EH、EP、子宫内膜炎的诊断准确率明显高于TVS、HS单独诊断(P<0.05)。结论:TVS+HS联合诊断对子宫内膜病变的诊断价值明显高于两者单独诊断,尤其是在EH、EP、子宫内膜炎诊断鉴别方面,其准确率更高,值得推广。