超声测量羊水指数和宫颈管长度预测未足月胎膜早破患者分娩潜伏期的价值

目的:探讨超声测量羊水指数(AFI)和宫颈管长度(CL)预测未足月胎膜早破(PPROM)患者分娩潜伏期的价值。方法:选择2009年10月至2014年10月我院收治的198例PPROM患者,入院后6h内超声检查测量AFI和CL。根据分娩潜伏期分为7日内分娩组和7日后分娩组,比较两组的病史、临床特点及超声指标,评估CL及AFI预测PPROM患者7日内分娩的特异性及敏感性。结果:(1)7日内分娩组患者破膜时伴阴道流血率、破膜时伴有宫缩率和新生儿转NICU率均高于7日后分娩组,差异有统计学意义(P0.05);(2)7日内分娩组患者的AFI、CL和分娩潜伏期均小于7日后分娩组患者,差异有统计学意义(P0.05);(3)CL≤2cm联合AFI≤5cm预测PPROM患者7日内分娩具有较高的敏感性及特异性(灵敏度82%,特异度51%);(4)以破膜后7日内是否分娩为应变量,经二分类logistic回归分析显示,破膜时伴阴道流血、破膜时伴有宫缩、CL≤2cm、AFI≤5cm是PPROM后7日内分娩的有效自变量(P0.05)。结论:超声测量AFI和CL对预测PPROM患者7日内是否分娩有一定价值,TVCL≤2cm联合AFI≤5cm能提高预测PPROM患者7日内分娩的敏感性及特异性。     

Screening performance of different methods defining fetal nasal bone hypoplasia as a single and combined marker for the detection of trisomy 21 in the second trimester

Objective: To evaluate different methods of defining fetal nasal bone hypoplasia in the second trimester for the detection of trisomy 21.

Methods: Prospective study in Greek women undergoing anomaly scan between 18?+?0 and 23?+?6 weeks. The following methods of defining nasal bone hypoplasia were evaluated, either as a single marker or in combination with others: (1) BPD to nasal bone length (NBL) ratio; (2) multiples of the median (MoM) of NBL, according to normal curves from a Greek population; (3–4) NBL?<?2.5 percentile according to normal curves (3) commonly used internationally curves and (4) curves from a Greek population.

Results: In total, 1301 singleton fetuses were evaluated???10 with trisomy 21. The best detection rate of trisomy 21 was achieved when the applied method was nasal bone percentiles adjusted to maternal ethnicity, in combination with other markers (<2.5 percentile according to normal curves from a Greek population; p?<?0.001; sensitivity 50%; specificity 94.8%; false-positive rate 5.2%; positive likelihood ratio 9.6).

Conclusion: Screening performance of fetal nasal bone hypoplasia in detecting trisomy 21 varies according to the method applied. The best screening performance is achieved by using percentiles adjusted to maternal ethnicity in combination with other markers of aneuploidy.     

Cervical length,risk factors,and delivery outcomes among women with spontaneous preterm birth

Objectives: To evaluate differences in risk factors and delivery outcomes among women with spontaneous preterm birth (sPTB) with short (≤25?mm) versus normal (>25?mm) cervical length (CL).

Methods: Secondary analysis of a prospective cohort study of singleton gestations between 18 0/7 and 23 6/7 weeks, without prior sPTB, undergoing universal transvaginal CL screening between 1 January 2012 and 31 December 2013. Only women with sPTB (<37 0/7 weeks) were included. Demographic characteristics, risk factors for sPTB, delivery outcomes and presentation of PTB were collected. The primary outcome was mean number of risk factors.

Results: The cohort included 2071 women, of which 145 (7%) had PTB and 84 (4%) had sPTB. Sixty-nine (82%) women with sPTB had a CL >25?mm and 15 (18%) had a CL≤25?mm. Women with a short CL did not differ from women with normal CL with respect to demographic variables or mean number of risk factors (4.20?±?2.11 versus 3.52?±?1.97, p?=?0.23), but they did deliver at a significantly earlier gestational age (25.0?±?1.1 versus 34.6?±?3.1 weeks, p?<?0.01). The distribution of the presentation of sPTB was different in women with a short versus normal CL (p?<?0.01).

Conclusions: Among women with sPTB, women with a short CL had similar number of risk factors, but were more likely to deliver at a significantly earlier gestational age. A short CL identifies women at risk for very early sPTB.     

The use of sonographic cervical length assessment for the prediction of time from induction to delivery

Objective: The objective of this study is to investigate the role of trans-vaginal cervical length measurement in the prediction of the interval to successful vaginal delivery after induction of labor with balloon catheter.

Methods: In this prospective study of cervical length measurement before induction of labor, singleton pregnancies that underwent induction of labor between 37 and 42 weeks of gestation were included. The data collected included trans-vaginal sonographic cervical measurements followed by digital cervical assessment. Bishop score was used to quantify digital assessment (before induction of labor).

Results: During the study period, 71 patients were included in the study. A statistically significant linear correlation was found between sonographic cervical length prior to induction of labor and the time of delivery (Pearson correlation 0.335; p values 0.005). Of the 57 vaginal deliveries, 27 patients had a cervical length of less than 28?mm. Patients with a cervical length of less than 28?mm had a significantly shorter time to delivery compared to patients with more than 28?mm length (20.4 versus 28.7, respectively; p value?=?0.019). Cervical length of 28?mm remained significantly correlated even after performing several logistic regression models in order to control for confounders such as parity and age. In addition, a correlation was found between Bishop scores of above 7 to the time to delivery.

Conclusions: Cervical length is correlated linearly to the time interval between induction of labor and delivery. A cervical length of less than 28?mm was found to be statistically significant in predicting a shorter time to delivery.     

Reinforcing cerclage for a short cervix at follow-up after the primary cerclage procedure

Objective: To determine whether a reinforcing cerclage (RC) for a short cervix measured after the primary cerclage procedure prolonged pregnancy.

Methods: We conducted a retrospective cohort study of 157 women with singleton gestations who underwent cerclage for standard indications. Women were grouped according to cervical length (CL) at the time of follow-up 1–2 weeks after the initial cerclage placement: ≥25?mm (106 women) and <25?mm with (20 women) or without RC (31 women). Gestational age (GA) at delivery was compared by ANOVA. Survival risk analysis was applied to model GA at delivery adjusted for indication and CL before and after the first cerclage.

Results: Women with CL?≥25mm delivered later than women with CL?<?25mm after the first cerclage (p?<?0.01). RC did not delay delivery for women with CL?<?25?mm (p?=?0.17) after the primary procedure. Indication for the primary cerclage (p?<?0.01) and CL (p?<?0.01) after the primary cerclage were the best predictors for GA at delivery.

Conclusion: Placement of RC for short cervix did not prolong duration of pregnancy, GA at delivery or modify the probability of preterm birth.     

Comparison of cord blood vitamin D levels in newborns of vitamin D supplemented and unsupplemented pregnant women: a prospective,comparative study

Objective: To screen pregnant women for deficiency of 25-hydroxyvitamin D (25(OH)D) and supplement selected vitamin D deficient pregnant women with vitamin D and to compare 25(OH)D levels in cord blood between them.

Method: Sixty pregnant women were selected as cases (vitamin D levels <30?ng/ml) and 60 unscreened pregnant women were taken as controls. Cases were supplemented with available 60?000?IU vitamin D every two weeks for eight doses or till delivery, whichever was earlier. In both the cases and controls, cord blood was collected at the time of delivery and tested for 25(OH)D levels using Biomerieux miniVIDAS.

Result: Maximum (66.7%) pregnant women who received vitamin D supplementation had cord blood vitamin D level >30?ng/ml, while only 3.3% unsupplemented pregnant women had cord blood vitamin D level >30?ng/ml. The median cord blood vitamin D level was 36.5?ng/ml in vitamin D supplemented and 11.35?ng/ml in unsupplemented women. The mean birth weight and mean crown heel length were 3.1?±?0.485?kg versus 2.8?±?0.705?kg and 49.35?±?1.36?cm versus 48.67?±?2.12?cm, respectively.

Conclusion: Vitamin D supplemented women had sufficient levels of 25(OH)D in cord blood at birth in maximum cases and neonates had higher birth weights and increased crown heel length.     

Exercise-induced leg pain in athletes: diagnostic,assessment, and management strategies

The purpose of this review is to describe and critically evaluate current knowledge regarding diagnosis, assessment, and management of chronic overload leg injuries which are often non-specific and misleadingly referred to as ‘shin splints’. We aimed to review clinical entities that come under the umbrella term ‘Exercise-induced leg pain’ (EILP) based on current literature and systematically searched the literature. Specifically, systematic reviews were included. Our analyses demonstrated that current knowledge on EILP is based on a low level of evidence. EILP has to be subdivided into those with pain from bone stress injuries, pain of osteo-fascial origin, pain of muscular origin, pain due to nerve compression and pain due to a temporary vascular compromise. The history is most important. Questions include the onset of symptoms, whether worse with activity, at rest or at night? What exacerbates it and what relieves it? Is the sleep disturbed? Investigations merely confirm the clinical diagnosis and/or differential diagnosis; they should not be solely relied upon. The mainstay of diagnosing bone stress injury is MRI scan. Treatment is based on unloading strategies. A standard for confirming chronic exertional compartment syndrome (CECS) is the dynamic intra-compartmental pressure study performed with specific exercises that provoke the symptoms. Surgery provides the best outcome. Medial tibial stress syndrome (MTSS) presents a challenge in both diagnosis and treatment especially where there is a substantial overlap of symptoms with deep posterior CECS. Conservative therapy should initially aim to correct functional, gait, and biomechanical overload factors. Surgery should be considered in recalcitrant cases. MRI and MR angiography are the primary investigative tools for functional popliteal artery entrapment syndrome and when confirmed, surgery provides the most satisfactory outcome. Nerve compression is induced by various factors, e.g., localized fascial entrapment, unstable proximal tibiofibular joint (intrinsic) or secondary by external compromise of the nerve, e.g., tight hosiery (extrinsic). Conservative is the treatment of choice. The localized fasciotomy is reserved for recalcitrant cases.     

An Analysis of Morphometric Qualities of Bulbus Oculi in Cataract Patients: A Comparative Biometric Study

Cataract is considered to be the primary reason for curable blindness that is caused by progressive loss of lens transparency and affects millions of people around the world. This study aims to analyze the changes in morphometric qualities of bulbus oculi (BO) as well as its morphometric measurements such as anterior chamber depth (ACD), lens thickness (LT), vitreous length (VL), axial length (AL), etc. depending on age and gender in cataract patients through comparison with healthy eyes. 200 eyes with cataract were separately analyzed in five different categories of ages for males and females at the ages of 40–89. Biometric measurements of a total of 128 eyes (64 males and 64 females) were used as the control group. The study revealed a strong negative relation between age and ACD and a strong positive relation between age and LT in males and females for healthy eyes and eyes with cataract (P < 0.05). No significant relation was found for VL and AL in either gender (P > 0.05). A significant decrease was observed in ACD with aging while a positive correlation with age was detected in LT. We believe that the data obtained from this study will serve as a guide for BO interventions, diagnose and treatment stages and training of physician assistants. Anat Rec, 299:1308–1312, 2016. © 2016 Wiley Periodicals, Inc.     

和田羊KRT31和KRT85基因遗传多态性及其 与羊毛性状关联性分析

试验旨在研究KRT31和KRT85基因是否是影响和田羊羊毛性状的候选基因,为今后和田羊的育种工作和改善羊毛性状提供科学依据。采集400只和田羊血样,运用PCR-SSCP和DNA测序等技术对和田羊个体的KRT31和KRT85基因进行遗传多态性分析。结果表明:和田羊KRT31和KRT85基因具有多态性,且均存在两种基因型,都处于Hardy-Weinberg平衡状态(P>0.05),KRT31基因多态信息含量(PIC)为0.233,属于低度多态(PIC<0.25)。KRT85基因多态信息含量(PIC)为0.346,属于中度多态(0.250.05)。KRT85基因在外显子2的204bp处存在A到G的突变,可以记作A204G。对氨基酸序列进行比较分析,该基因上A204G处的突变并未使氨基酸的编码发生改变,此位点突变为同义突变。与羊毛性状关联分析得出,AA和AB两种基因型的羊毛长度及细度差异均不显著(P>0.05)。说明和田羊KRT31基因可以作为影响和田羊羊毛性状的候选基因。