Is Mode of Delivery Associated With Sexual Response? A Pilot Study of Genital and Subjective Sexual Arousal in Primiparous Women With Vaginal or Cesarean Section Births

IntroductionAlthough postpartum sexual concerns are common, limited data exist on postpartum sexual response. Furthermore, the physiological process of vaginal birth may negatively impact genital response compared with unlabored cesarean section (C-section), but this hypothesis has yet to be tested.AimTo (i) compare genital and subjective sexual response and sexual concordance by mode of delivery with inclusion of a control group, (ii) compare groups on self-reported sexual function over the past month, (iii) examine the relationship between laboratory measurement of sexual response and self-reported sexual function, and (iv) investigate association between obstetrical factors and breastfeeding and between sexual response and self-reported sexual function.Methods3 groups of cisgender women were recruited from the community: primiparous women who delivered via vaginal birth within the past 2 years (VB group; n = 16), primiparous women who delivered via unlabored C-section within the past 2 years (CS group, n = 15), and age-matched nulliparous women (NP group, n = 18). Laser Doppler imaging was used to assess genital response while participants watched a neutral and erotic film.Main Outcome MeasuresThe main outcome measures were change in flux units from neural to erotic video as a measure of genital response, subjective sexual arousal rated continuously throughout films, perceived genital response rated after films, and Female Sexual Function Index (FSFI).ResultsWomen in the VB group had significantly lower change in flux units than women in the CS (P = .005, d = 1.39) and NP (P < .001, d = 1.80) groups. Groups did not differ on their subjective indices of sexual response or in sexual concordance. Women in both postpartum groups reported lower FSFI scores than women in the NP group. No relationship was determined between FSFI scores and sexual response in the laboratory. Results suggested that genital trauma and breastfeeding may negatively impact FSFI scores, but they were not related to genital response or subjective sexual arousal as measured in the laboratory.Clinical ImplicationsResults underscore the importance of balancing objective and subjective indices of sexual response and function, especially considering the biopsychosocial nature of postpartum sexuality.Strengths & LimitationsThe present study is the first to apply modern sexual psychophysiological methodology to the study of postpartum sexuality. Cross-sectional methodology limits the ability to make causal inferences, and the strict inclusion criteria limits generalizability.ConclusionPhysiological changes as a result of labor and delivery may have a detrimental impact on genital response; however, these physiological differences may not impact women's subjective experience of postpartum sexuality.Cappell J, Bouchard KN, Chamberlain SM, et al. Is Mode of Delivery Associated With Sexual Response? A Pilot Study of Genital and Subjective Sexual Arousal in Primiparous Women With Vaginal or Cesarean Section Births. J Sex Med 2020; 17:257–272.     

Fulfilment of expectations on birth and the postpartum period – A Swedish cohort study

BackgroundThe fulfilment of birth expectations is important to women and strongly related to birth satisfaction.ObjectiveThe aim of this study was to investigate women’s expectations and experiences of birth and the postnatal period and associated factors. An additional aim was to explore if women's expectations were fulfilled.MethodsA longitudinal cohort study of 280 women where 226 were followed up two months after birth. Data were collected using questionnaires. Odds ratios with a 95% confidence interval were calculated between the explanatory background variables and expectations/experiences.ResultsThe majority (79%) rated continuity as important, but few (32%) actually had a known midwife assisting during birth. Positive birth expectations were found in 37% and a positive birth experience in 66%. Many women (56%) preferred a short postnatal stay, and 63% went home within 24 h. Thirty-six percent preferred postnatal home visits, but only eight women (3.5%) received this. Breastfeeding expectations were high with 86% rating it as important but after birth 63% reported exclusively breastfeeding. Only a few background factors were associated with women’s expectations and experiences. Most likely to be fulfilled were women’s expectations for a vaginal birth (83%), a positive birth experience (71%) and short length of postnatal stay (67%). Postnatal home visits (96%) and continuity of care (73%) were not fulfilled.ConclusionsPregnant women’s expectations about continuity are fulfilled only to a minor degree. The fulfilment of postnatal expectations varied and the preference for a short postnatal stay was fulfilled whereas home visits were not.     

术中按需喷洒与术前口服二甲硅油 在肠镜检查中的作用研究

〔摘 要〕 目的：探讨术中按需喷洒与术前口服二甲硅油在肠镜检查中的应用效果。 方法：选取 2020 年 1 月至 2021 年 6 月于萍乡市人民医院行肠镜检查的无明显症状患者 90 例，按随机数字表法分为两组，对照组和观察组各 45 例。两组均 使用聚乙二醇电解质散清洁肠道，对照组术前口服二甲硅油，观察组术中按需喷洒二甲硅油。比较两组患者肠道清洁分级、 气泡分级、二甲硅油用量、肠镜检查操作时间、结肠息肉检出率及患者满意度。 结果： 两组患者肠道清洁分级相比，差异无 统计学意义（P ＞ 0.05）。观察组患者气泡分级 1 级率为 80.00 %，高于对照组的 62.22 %，差异具有统计学意义（P ＜ 0.05）。 观察组患者二甲硅油用量为（14.58 ± 2.01）mL，少于对照组的（22.35 ± 2.65）mL，进、退镜时间分别为（8.89 ± 1.14）min、 （8.33 ± 1.08）min，短于对照组的（9.76 ± 1.27）min、（10.27 ± 2.04）min，差异有统计学意义（P ＜ 0.05）。观察组患者 结肠息肉检出率、患者满意度为 17.78 %、97.78 %，高于对照组的 4.44 %、82.22 %，差异具有统计学意义（P ＜ 0.05）。 结论：术中按需喷洒二甲硅油在肠镜检查中效果更佳，可减少二甲硅油用量，提高视野清晰度，缩短肠镜检查操作时间， 并利于结肠息肉的检出，提高患者满意度。     

现状与未来：论我国综合性大学医学教育

在不同历史阶段,我国综合性大学医学教育经历了不同的发展模式。文章简要回顾了我国综合性大学医学教育的基本办学现状;结合我国高等教育事业的总体改革与发展思路,厘清综合性大学医学教育的办学定位和人才培养模式;重点分析和论述了综合性大学医学教育的人才培养目标以及基于此目标的预期教学效果。     

The clinical profile of musculoskeletal injuries in children attending a major hospital in Delhi,India

Background

Children are vulnerable to musculoskeletal injuries both at home and on the street for various reasons. Morbidity and disabilities resulting from these, mostly preventable, injuries, make them a burden to their families and society. The role of various factors associated with injuries is often not documented.

Methods

This prospective study, done on 100 children aged up to 12 years with musculoskeletal trauma, analysed in details, the various modes of injuries.

Results

One in every five patient was a child below 12 years of age. Boys were injured more than girls. Injuries, especially fractures, were most common in the extremities, the upper limb more commonly injured than the lower limb. Most of the injuries occurred at home. The most common mode of injuries was falls that happened while playing both within and outside the home, followed by road traffic accidents. Most injuries occurred during daytime.

Conclusions

Injuries in children were found to be preventable. Small interventions while constructing homes can contribute tremendously to injury prevention and control in children. Parental awareness about the various modes of injury, role of supervised playing and their responsibility towards injury prevention can play a key role in reducing the morbidity associated with childhood fractures.     

新型冠状病毒疫情在线防控的“华西项目化工作模式”探索与实践

目的探索"华西项目化工作模式"在新型冠状病毒(2019-nCoV)疫情在线防控工作中的应用价值。方法基于四川大学华西医院丰富的抗震救灾和项目管理经验,依托PDCA循环持续优化"华西项目化工作模式"。结果"华西项目化工作模式"可运用于新型冠状病毒(2019-nCoV)突发公共卫生事件,已建立快速反应工作闭环,整个项目组运行良好、系统运维稳定。结论"华西项目化工作模式"为疫情在线防控工作提供了工作路径,采用互联网+方式远程协作办公方式,有效促进疫情应急管理科学化,在疫情在线干预防控工作中起到了积极作用。     

基于光学表面成像与锥形束CT结合的综合引导模式在头颈部肿瘤精确放疗中的研究

目的 探讨光学表面成像（OSI）Catalyst^TM系统与锥形束CT（CBCT）相结合用于引导头颈部肿瘤精确放疗的临床价值。方法 82名患者均来自四川大学华西医院2015年2月至2018年1月收治的需要进行头颈部肿瘤放射治疗的患者,其中45名患者使用OSI-CBCT综合引导放射治疗,37名患者CBCT独立引导治疗。每组患者在治疗疗程中均获得208次有效分次治疗;对综合引导治疗组与独立引导治疗组CBCT所得到的摆位误差数据进行统计学分析。结果 独立引导组CBCT扫描得出的分次间摆位误差平移方向x、y、z和旋转方向rx、ry、rz的结果（均值±标准差）分别为（0.19±1.01）mm、（0.29±1.36）mm、（-0.05±1.23）mm,（-0.05±0.65）°、（0.18±0.83）°、（-0.12±0.59）°;综合引导组OSI-CBCT得出的分次间摆位误差的结果分别为（0±1） mm、（0.01±0.98） mm、（-0.4±1.08） mm,（-0.03±0.72）°、（-0.19±0.82）°、（-0.37±0.85）°。两系统的相关性系数分别为：0.17、0.07、0.03、0.1、-0.06、0.01。两系统进行配对样本t检验,结果分别为（0.19±1.3） mm,P<0.05;（0.28±1.62） mm, P<0.05;（0.35±1.62） mm, P<0.05;（-0.03±0.92）°, P>0.05;（0.37±1.2）°, P<0.05、（0.25±1.03）°, P<0.05。结论 OSI-CBCT系统综合引导模式在保证放疗精确性的同时可以减少CBCT扫描次数,能有效降低CBCT带来的额外辐射量,在头颈部肿瘤放疗中优于传统的单一的CBCT引导模式。     

低置胎盘的分娩方式探讨

目的:探讨低置胎盘的合理分娩方式。方法:选取2012年1月1日至2014年4月30日在我院分娩的单胎头位低置胎盘产妇650例。按是否试产将患者分为试产组和选择性剖宫产组;按分娩前最后一次超声胎盘下缘距离宫颈内口的距离将患者分为低置胎盘1组(下缘距内口≥0mm但20mm)、低置胎盘2组(下缘距内口≥20mm但40mm)和低置胎盘3组(下缘距内口≥40mm但70mm)。分析患者的阴道试产成功率、试产失败原因、产后出血量及分娩期并发症。结果:(1)试产组的试产总成功率为82.64%,低置胎盘1、2、3组的阴道试产成功率分别为62.5%、82.61%和84.65%,其中因产前出血而改行剖宫产的风险分别为31.25%、8.7%和1.49%;(2)低置胎盘1组患者中阴道试产和选择性剖宫产的产后出血量无显著差异[(590.94±382.79)ml vs(465.68±367.83)ml];低置胎盘2组和3组中阴道试产的产后出血量明显少于剖宫产组[(267.17±104.47)ml vs(388.10±205.61)ml,P0.0001]及[(293.00±263.731)ml vs(348.59±98.68)ml,P0.0001]。结论:胎盘下缘距宫颈内口≥20mm不应作为孕妇选择性剖宫产的手术指征。