Turner Syndrome and Fertility

Turner syndrome (TS) is tightly associated with hypergonadotropic hypogonadism and ovarian dysgenesis, typically resulting in infertility in the great majority of patients. Therefore females with TS are usually treated with female sex steroids from 11–12 years of age until the normal age of natural menopause of around 53–54 years of age. Infertility is rated among females with TS as a distressing concern and a detractor from a good quality of life. Options for motherhood for females with TS has expanded during recent years. Originally, only adoption was an option, unless of course for the small minority of TS females that still has ovarian function and are capable of achieving pregnancy through normal means. Oocyte donation has become the mainstream option in many countries and seems to work well, especially if patients have been treated with optimal estrogen and gestagen for a prolonged time before the intervention. It comes with an increased risk of cardiovascular complications and TS oocyte donation pregnancies are viewed as high risk pregnancies necessitating increased vigilance. Oocyte cryopreservation of own oocytes is also becoming an option in a select group of TS and has special challenges. Ovarian tissue cryopreservation is a promising new techniques that has been applied successfully in children with cancer. Currently, several trials are running around the world evaluating this techniques in TS. The genetics and genomics behind the ovarian dysgenesis seen in TS is not understood, but new studies have elucidated global changes in DNA methylation and RNA expression in blood from persons with TS and it is likely that similar changes are present in the ovaries. We still, however, need more thorough research to fully uncover the genetic background of ovarian failure in TS. Gene expression studies and methylation analysis from ovarian TS tissues still needs to be performed.     

卵巢癌患者的护理体会

目的设计一系列合理的适合卵巢癌患者治疗前后的护理干预措施,探讨对卵巢癌患者的生活质量以及心理状态的影响。方法利用便利抽样法抽取2012年5月-2014年3月我院收治的45例卵巢癌患者作为研究对象。对其进行护理干预包括早期干预护理,常规护理,心理护理,用药安全护理,宣传教育护理,院外护理。利用世界卫生组织制订的患者生存质量测定方法中文版简表、SAS焦虑量表对患者的生活质量以及心理状态进行调查分析。结果护理干预后,患者的生存质量各项指标显著高于干预前(P<0.05);患者焦虑评分显著低于干预前(t=7.15,P<0.05)。结论以安全护理、心理护理为核心的院内、院外护理模式对于卵巢癌患者的治疗后康复情况有显著的正面效果,有利于卵巢癌患者生存质量提高,有助于患者在治疗后心理状态快速调整。     

一例卵巢过度刺激综合征并发脑梗死的护理

<正>卵巢过度刺激综合征(OHSS)为辅助生育技术治疗的主要并发症之一,是促排卵及诱导排卵过程中产生的医源性疾病[1]。近年来,随着辅助生殖技术的广泛开展,OHSS的发病率有逐年上升的趋势,1996年文献报道发生率为1%~14%[2],2004年报道发生率为20%~23%[3]。我科于2014年5月12日收治1例促排卵治疗后并发OHSS和脑梗死患者,经过积极的治疗和精心的护理,患者病情稳定,     

大剂量辛伐他汀强化治疗对缺血性脑血管患者脑血管储备能力的影响

目的探讨大剂量辛伐他汀强化治疗对缺血性脑血管患者脑血管储备能力的影响及安全性。方法将108例缺血性脑血管病患者随机分成观察组与对照组各54例,2组均在常规治疗的基础上口服辛伐他汀,观察组40mg/次,对照组20mg/d,2组均1次/d,疗程均为6个月。比较2组患者临床疗效、脑血管储备功能(CVR)及屏气指数(BHI)、药物不良反应、复发率及病死率。结果观察组CVR(35.19±5.24)、BHI(1.54±0.33)明显高于对照组;不良反应发生率为(31.48%)、复发率、病死率(5.77%、3.85%)明显低于对照组(P0.05、0.01)。结论大剂量辛伐他汀强化治疗能有效改善脑血管储备能力,降低复发率及病死率,但需严密监测药物不良反应。     

Assessment of the specificity of a new folate-targeted photosensitizer for peritoneal metastasis of epithelial ovarian cancer to enable intraperitoneal photodynamic therapy. A preclinical study

BackgroundOvarian cancer’s prognosis remains dire after primary therapy. Recurrence rate is disappointingly high as 60% of women with epithelial ovarian cancer considered in remission will develop recurrent disease within 5 years. Special attention to undetected peritoneal metastasis during surgery is necessary as they are the main predictive factors of recurrences. Folate Receptor α (FRα) shows promising prospects in targeting ovarian cancerous cells and intraperitoneal photodynamic therapy (PDT) could be a solution in addition to macroscopic cytoreductive surgery to treat peritoneal micrometastasis. The aim of this preclinical study is to assess the specificity of a folate-targeted photosensitizer for ovarian peritoneal micrometastasis.MethodsWe used the NuTu-19 epithelial ovarian cancer cell line to induce peritoneal carcinomatosis in female Fischer 344 rats. Three groups of 6 rats were studied (Control (no photosensitizer)/Non-conjugated photosensitizer (Porph)/Folate-conjugated photosensitizer (Porph-s-FA)). Four hours after the administration of the photosensitizer, animals were sacrificed and intraperitoneal organs tissues were sampled. FRα tissue expression was evaluated by immunohistochemistry. Tissue incorporation of photosensitizers was assessed by confocal microscopy and tissue quantification.ResultsFRα is overexpressed in tumor, ovary, and liver whereas, peritoneum, colon, small intestine, and kidney do not express it. Cytoplasmic red endocytosis vesicles observed by confocal microscopy are well correlated to FRα tissue expression. Photosensitizer tissue quantification shows a mean tumor-to-normal tissue ratio of 9.6.ConclusionWe demonstrated that this new generation folate-targeted photosensitizer is specific of epithelial ovarian peritoneal metastasis and may allow the development of efficient and safe intraperitoneal PDT procedure.     

正常人心电复极储备功能研究

目的研究反映心电复极指标QT间期在正常人的变化特点。方法选取住院检查活动平板运动负荷试验阴性的患者67例。其中男性34例、女性33例,测量活动平板运动试验运动前起始心率;运动中90次/分、120次/分、最快心率;运动结束后恢复期1分钟、3分钟的心率及QT间期并用Ba Zett's校正计算后计算出QTc值,并将结果进行统计学分析,探讨正常人复极储备功能。结果在正常人随着活动平板运动速度的增快,心室率增快,RR间期逐渐缩短,QT间期也随之缩短,随着运动结束后恢复期,心室率减慢,RR间期逐渐延长,QT间期也随之延长,各个运动期QTc值均值均在452ms以下。结论正常人QT间期随着心室率增加而减小,正常人复极储备功能良好。     

Web-Based Symptom Management for Women With Recurrent Ovarian Cancer: A Pilot Randomized Controlled Trial of the WRITE Symptoms Intervention

ContextLittle research has focused on symptom management among women with ovarian cancer. Written Representational Intervention To Ease Symptoms (WRITE Symptoms) is an educational intervention delivered through asynchronous web-based message boards between a study participant and a nurse.ObjectivesWe evaluated WRITE Symptoms for 1) feasibility of conducting the study via message boards, 2) system usability, 3) participant satisfaction, and 4) initial efficacy.MethodsParticipants were 65 women (mean age, 56.5; SD = 9.23) with recurrent ovarian cancer randomized using minimization with race/ethnicity (non-Hispanic white vs. minority) as the stratification factor. Measures were obtained at baseline and two and six weeks after intervention. Outcomes were feasibility of conducting the study, system usability, participant satisfaction, and efficacy (symptom severity, distress, consequences, and controllability).ResultsFifty-six (87.5%) participants were retained, and the mean usability score (range 1–7) was 6.18 (SD = 1.29). All satisfaction items were scored at 5 (of 7) or higher. There were significant between-group effects at T2 for symptom distress, with those in the WRITE Symptoms group reporting lower distress than those in the control group [t(88.4) = −2.57; P = 0.012], with a similar trend for symptom severity [t(40.4) = −1.95; P = 0.058]. Repeated measures analysis also supported a group effect, with those in the WRITE Symptoms group reporting lower symptom distress than those in the control condition [F(1, 56.7) = 4.59; P = 0.037].ConclusionParticipants found the intervention and assessment system easy to use and had high levels of satisfaction. Initial efficacy was supported by decreases in symptom severity and distress.     

卵巢动脉栓塞术的研究进展及临床意义

近年来,子宫动脉栓塞术(UAE)已成为公认的替代外科手术治疗子宫肌瘤的方法.选择性卵巢动脉栓塞术(OAE)在技术上安全有效,UAE联合OAE治疗与单纯UAE治疗比较,在绝经的发病率、绝经样症状的严重程度方面无差异.但目前还需进一步明确OAE对卵巢储备功能的血清标志物及卵巢血管的影响.本文对卵巢动脉的解剖、血管造影及栓塞技术、OAE后卵巢功能的研究进展进行综述.