术者手体积与剖宫产术中子宫切口撕裂的相关性

目的探讨医师手体积与剖宫产术中子宫切口撕裂的相关性。方法选择2006年3月至2012年5月行剖宫产术的产妇5386例,2011年6月以后胎头娩出困难者采用大S拉钩辅助胎头娩出。分四组统计,徒手胎头娩出术者手体积300 ml为A组,300 ml为B组,S拉钩辅助胎头娩出后术者手体积300 ml为C组,300 ml为D组。记录手术医师姓名及手体积、胎儿体质量、胎先露、胎头嵌入产道程度、子宫切口是否撕裂及撕裂程度、术后产妇疼痛程度。结果 5386例剖宫产手术中子宫切口撕裂538例,其中A组127例、B组246例、C组81例、D组84例,子宫切口撕裂与手术医师手体积、胎儿体质量、胎先露、胎头嵌入产道程度呈正相关(P0.05)。结论术者手体积对子宫切口撕裂有直接诱发作用,采用大S拉钩辅助胎头娩出能有效避免子宫切口撕裂,降低并发症发生率。     

子宫下段环扎术治疗凶险性前置胎盘剖宫产术后出血的效果

目的：探讨子宫下段环扎术治疗凶险性前置胎盘剖宫产术后出血的临床效果。方法选择我院2011年1月~2014年1月收治的54例凶险性前置胎盘剖宫产后出血患者,患者分为观察组和对照组各27例。观察组采用子宫下段剖宫产术止血,对照组采用宫腔纱布填塞止血。比较两组治疗效果。结果干预前观察组和对照组出血量、缩宫素用量差异均无统计学意义（P>0.05）。观察组卡前列素氨丁三醇注射液的用量、干预时出血量、干预后出血量、术中总出血量、干预时间、总输血量均低于对照组,差异均有统计学意义（P<0.05）。观察组的止血成功率为96.30%,对照组为92.59%,差异无统计学意义（P>0.05）。两组均未发生子宫坏死、感染、宫腔积血等并发症。结论子宫下段环扎术治疗凶险性前置胎盘剖宫产术后出血,止血迅速,出血量少,可减少产后出血发生率,值得临床推广。     

不同采集地土茯苓中(切面红色、白色)总糖及多糖含量分析与体外抗氧化作用

目的:分析测定26个不同采集地土茯苓中(切面红色、白色)总多糖及多糖的含量并探讨其体外抗氧化活性。方法:采用蒽酮-硫酸比色法,比较分析不同产地及不同切面颜色土茯苓中总糖及多糖含量;同时,以抗坏血酸为阳性对照,通过DPPH自由基(1,1-二苯基-2-苦肼基自由基)清除法来评价该药材中总糖与多糖的抗氧化能力。结果:切面红色土茯苓中总糖的质量分数为1.897 3%~11.680 9%,多糖为0.048 0%~1.863 4%;切面白色土茯苓中总糖的质量分数为7.957 5%~81.681 0%,多糖为0.413 2%~7.963 9%,两者含量差异较大;抗氧化结果表明,总糖及多糖均有清除自由基活性,其IC50依次为抗坏血酸(0.033 4 g·L-1)切面红色多糖(0.176 7 g·L-1)切面白色多糖(0.294 9 g·L-1)切面红色总糖(0.354 8 g·L-1)切面白色总糖(0.769 5 g·L-1)。结论:不同切面颜色及不同产地土茯苓药材中总糖及多糖的含量存在显著性差异,其多糖的含量高低与抗氧化作用的强弱不呈正相关。     

超声引导下腹横肌平面阻滞在剖宫产术后镇痛中的应用

目的 研究超声引导下腹横肌平面(transverses abdominis plane,TAP)阻滞在剖宫产术后镇痛中的应用.方法 择期行剖宫产术的产妇60例,ASA Ⅰ ～Ⅱ级,随机分为TAP组(T组,n=30)和对照组(C组,n=30).术前所有产妇均行腰-硬联合麻醉(L2～3间隙蛛网膜下腔,0.5布比卡因等比重液7.5 mg);术毕两组产妇均连接自控硬膜外镇痛(PCEA),镇痛泵配置相同;术毕T组产妇行双侧TAP阻滞(0.4％罗哌卡因).于术后4、6、8、24、28及48 h采用VAS评分法进行镇痛评分,观察恶心呕吐、瘙痒及呼吸抑制的情况,记录各时点产妇按压镇痛泵的累计有效次数、累计总次数、术后48 h内按压总次数与按压有效次数;术后镇痛用药量和满意度评分.记录TAP操作相关并发症,包括感染、血肿形成、神经损伤、局麻药的毒性反应、穿入腹腔、穿伤肠管、穿伤肝脏等.结果 T组术后4、6h静息状态VAS评分低于C组(P＜0.05),两组术后8、24、28、48 h静息状态VAS评分比较差异均无统计学意义(P＞0.05);T组术后4h活动状态VAS评分低于C组(P＜0.05),其他各时点两组VAS评分差异均无统计学意义(P＞0.05).T组术后6h的硬膜外镇痛用药量低于C组(P＜0.05),其他各时点两组比较差异无统计学意义(P＞0.05),但T组各时点用药量均少于C组.两组在各时点按压镇痛泵的累计有效次数、累计总次数及术后48 h内按压总次数与按压有效次数比值的差异均无统计学意义(P＞0.05).两组术后均无恶心呕吐、瘙痒、呼吸抑制、镇静过度等不良反应发生.T组无TAP操作相关并发症的发生.结论 TAP阻滞在剖宫产术后具有明显的辅助镇痛作用.     

羊膜腔灌注对足月孤立羊水过少产妇分娩结局的影响

 目的 探究羊膜腔灌注对足月孤立羊水过少产妇分娩结局的影响。方法 本研究为回顾性研究,选择2017-01至2019-01北京妇产医院产科93例足月孤立羊水过少经腹羊膜腔灌注后引产患者作为灌注组,取同期135例足月孤立羊水过少产妇未接受羊膜腔灌注而直接引产为对照组,比较两组分娩结局。结果 灌注组与对照组一般情况如年龄、孕次、产次、分娩孕周及羊水指数等方面比较,差异无统计学意义(均P>0.05)。灌注组中14例中转剖宫产手术, 剖宫产率15.0%;对照组中40例中转剖宫产,剖宫产率29.6%,灌注组剖宫产率低于对照组,差异有统计学意义(P<0.01)。灌注组与对照组比较,产后出血量[(352.58±163.05)ml vs. (353.78±99.09)ml]、胎儿窘迫发生率(25.8% vs. 34.1%)、羊水Ⅲ度粪染发生率(19.4% vs. 24.4%)、新生儿窒息率(1.1% vs. 4.4%)均无统计学差异。结论 羊膜腔灌注可降低足月羊水过少产妇剖宫产率,不增加并发症发生率,提高产科质量。     

不同手术方式治疗剖宫产子宫瘢痕憩室的临床分析

目的：探讨不同手术方式在剖宫产子宫瘢痕憩室（PCSD）的应用疗效及适应证。方法回顾性分析手术治疗的37例剖宫产子宫瘢痕憩室患者：A组为15例行经腹联合宫腔镜下子宫瘢痕憩室切除+子宫修补术患者;B组为12例行宫腹腔镜联合下子宫瘢痕憩室切除+子宫修补术患者;C为10例行经阴道子宫瘢痕憩室切除+子宫修补术患者。比较三组术中出血量、手术时间、术后住院日、住院费用;术后6月随访月经恢复情况、B超复查子宫瘢痕憩室及进行生存质量评估复测。结果三组患者术中出血量、手术时间、术后住院日、住院费用比较,差异均有统计学意义（F分别=19.39、108.09、44.54、177.15,P均＜0.05）。与A组、B组比较,C组术中出血最少,手术时间最短,术后住院时间最长,住院费用最少,差异均有统计学意义（t分别=-5.92、-5.26、-7.75、-15.35、-5.43、-15.67、8.91、7.29, P均＜0.05）。三组患者术后月经期均较术前缩短,生存质量评分均较术前提高,差异均有统计学意义（t分别=11.09、8.50、6.08;-10.34、-7.95、-5.02,P均＜0.05）。术后随访发现A、B组有效率100％,C组有效率90.00％。结论三种手术治疗均能改善患者临床症状,改善生存质量。经腹联合宫腔镜手术适用于盆腔粘连严重患者,宫腹腔镜手术适用于盆腔粘连轻微患者,阴式手术适用于憩室位置较低,位于宫颈管或者有生育要求的患者。     

不同温度液体静脉输入对剖宫产术中穿刺局部疼痛的影响

目的观察不同温度的液体静脉输入对剖宫产术中穿刺局部疼痛的影响。方法按随机数字表将240例择期剖宫产产妇分为A、B、C组,每组80例。在剖宫产手术中输入不同温度的液体:A组输入38.5℃液体,B组输入37.5℃液体,C组输入未经加热液体。运用视觉模拟法观察、记录静脉输液穿刺部位疼痛情况。结果无痛率A组高于B组、B组高于C组,经比较x2=20.138,P=0.000。结论在剖宫产术中,静脉输入38.5℃加热液体,能有效缓解输液肢体局部疼痛。     

Clusters of proliferating endothelial cells and smooth muscle cells in rabbit carotid arteries

Schwarz and Benditt found clustering of replicating cells in aortic endothelium in 1976 and discussed how homeostasis of the arterial wall is maintained through this nonrandom distribution of replicating cells. However, it is still unclear how cells of vascular walls turnover. In order to address this issue, we evaluated distribution of the cells in mitotic cycle, labeled by Ki67‐immunostaining, in serial histological sections of twelve carotid arteries of six adult male Japanese rabbits. As a result, a total of 1713 Ki67‐positive endothelial cells (ECs) and 1247 Ki67‐positive smooth muscle cells (SMCs) were identified. The Ki67‐positivity rate in ECs and SMCs were about 0.048% and 0.0027%, respectively. Many of the Ki67‐positive cells clustered in two (EC, 37%; SMC, 33%), three to four (EC, 8%; SMC, 28%), and five to eight cells (EC, 5%; SMC, 10%). Clusters having more than eight cells were not found. Thus, it can be speculated that the cell division of proliferating ECs and SMCs occur four times at most. These novel findings offer great insights for better understanding of the mechanism that underlies cell number regulation of the blood vessel.     

Childhood acute lymphoblastic leukaemia and indicators of early immune stimulation: the Estelle study (SFCE)

Background:

Factors related to early stimulation of the immune system (breastfeeding, proxies for exposure to infectious agents, normal delivery, and exposure to animals in early life) have been suggested to decrease the risk of childhood acute lymphoblastic leukaemia (ALL).

Methods:

The national registry-based case–control study, ESTELLE, was carried out in France in 2010–2011. Population controls were frequency matched with cases on age and gender. The participation rates were 93% for cases and 86% for controls. Data were obtained from structured telephone questionnaires administered to mothers. Odds ratios (OR) were estimated using unconditional regression models adjusted for age, gender, and potential confounders.

Results:

In all, 617 ALL and 1225 controls aged ⩾1 year were included. Inverse associations between ALL and early common infections (OR=0.8, 95% confidence interval (CI): 0.6, 1.0), non-first born (⩾3 vs 1; OR=0.7, 95% CI: 0.5, 1.0), attendance of a day-care centre before age 1 year (OR=0.7, 95% CI: 0.5, 1.0), breastfeeding (OR=0.8, 95% CI: 0.7, 1.0), and regular contact with pets (OR=0.8, 95% CI: 0.7, 1.0) in infancy were observed.

Conclusions:

The results support the hypothesis that conditions promoting the maturation of the immune system in infancy have a protective role with respect to ALL.