早孕期监测子宫动脉多普勒参数在预测低危人群不良妊娠结局的价值

目的 建立妊娠11~13+6周子宫动脉多普勒参数在低危人群中的正常参考值，同时评估其对不良妊娠结局的预测价值。方法 收集2019年6月至2021年6月于我院行产前超声检查的妊娠11~13+6周孕妇，根据妊娠结局分组。收集两侧子宫动脉多普勒指标，包括搏动指数（PI）、阻力指数（RI）、舒张早期是否有切迹，以及孕妇基本临床资料和胎儿出生信息，将以上相关参数进行统计学分析。结果 最终纳入800例孕妇，包括正常妊娠结局组740例和不良妊娠结局组60例。两组孕妇体质量指数（BMI）、分娩孕周和胎儿出生体质量比较，差异均有统计学意义（均P＜0.05）。随着孕周的增加，子宫动脉两侧平均搏动指数（mPI）、平均阻力指数（mRI）和两侧舒张早期切迹检出率均呈逐渐下降的趋势。ROC曲线分析显示，mPI、mRI及两侧舒张早期切迹预测妊娠结局的曲线下面积（AUC）分别为0.542、0.574、0.521，三者联合预测妊娠结局的AUC为0.648；孕妇BMI、年龄mPI、mRI及两侧舒张早期切迹预测妊娠结局的AUC为0.751。结论 建立了低危人群在妊娠11~13+6周子宫动脉多普勒参数的正常参考值范围。在妊娠11~13+6周单纯应用子宫动脉多普勒参数预测妊娠结局的价值有限，将子宫动脉参数与临床相关指标结合可提高对不良妊娠结局的预测价值。     

An update in pathologic diagnosis of uterine mesenchymal tumours

Recent discovery of new disease-defining molecular alterations and development of novel targeted therapies has dramatically changed the classification and management of uterine mesenchymal neoplasms. This review discusses diagnostic updates in endometrial stromal sarcoma, PEComa, uterine tumor resembling ovarian sex cord tumor (UTROSCT), inflammatory myofibroblastic tumor, NTRK fusion uterine sarcoma, COL1A1-PDGFB fusion sarcoma, and SMARC-deficient uterine sarcoma. Key clinical, morphologic, immunophenotypic, and molecular features are reviewed, with emphasis on common differential diagnoses and pitfalls, and their impact on prognosis or management. Where applicable, the role of novel targeted therapies is discussed. A stepwise approach to uterine mesenchymal neoplasms can achieve a proper diagnosis and guide appropriate clinical management in most cases. Nonetheless, given the rarity of these tumors, their overlapping pathologic features, and rapid evolution in their classification and management, we advocate a low threshold for diagnostic consultation.     

子宫内膜功能亢进性疾病的“异病同治”诊治研究思路＊

笔者根据现代临床子宫内膜的病理演变过程结合中医“异病同治”理念，提出“子宫内膜功能亢进性疾病”概念，涵盖5种常见的子宫内膜疾病：无排卵性异常子宫出血（Abnormal Uterine Bleeding Ovulatory dysfunction，AUB-O），子宫内膜息肉（Endometrial Polyp，EP），子宫内膜异位症（Endometriosis，EMs），子宫腺肌病（Adenomyosis，AM），子宫内膜癌（Endometrial Carcinoma，EC）。基于文献的汇总，分析得到此类疾病的子宫内膜病理演变与中医病因病机的关联性，为寻找关键通路、创新性治疗此类疾病提供了重要的参考方向，对深化中医妇科学常见疾病的共性病因病机提供了理论依据和探索思路。     

高强度聚焦超声联合甲氨蝶呤在瘢痕子宫妊娠行宫腔镜微创清宫术中的应用效果分析

目的 探究采用高强度聚焦超声(HIFU)联合甲氨蝶呤(MTX)在瘢痕子宫妊娠行宫腔镜微创清宫术中的应用效果。方法 选择2018年5月—2019年5月在本院接受宫腔镜治疗的108例瘢痕子宫妊娠患者,依据随机数字表法分为研究组与对照组,每组各54例。对照组使用HIFU预处理,研究组则使用HIFU联合MTX的方式预处理,处理后两组均行宫腔镜辅助微创清宫术。通过随访分析比较两组的治疗效果及妊娠结局。结果 研究组术后7 d血清β-HCG水平为(28 598.38±2 176.52)U/L,低于对照组的(32 423.13±2 734.65)U/L,差异有统计学意义(t=8.042,P<0.001);研究组血清β-HCG转阴时间、月经恢复时间、住院时间分别为(21.33±3.78)d、(28.21±3.83)d、(6.53±2.12)d,分别短于对照组的(26.72±4.83)d、(33.82±4.91)d、(9.53±2.67)d,差异具有统计学意义(t=6.458、6.620、6.466,P均<0.001)。两组均随访≥24个月,宫内妊娠、未孕、流产、再次瘢痕子宫妊娠、异位妊娠比较,差异无统计学意义(χ2=1.895,P>0.05);宫内妊娠中足月分娩与早产比较,差异无统计学意义(χ2=0.131,P>0.05),研究组并发症发生率为22.58%,低于对照组的37.50%,差异有统计学意义(χ2=5.296,P=0.021)。结论 在宫腔镜辅助微创清宫术治疗瘢痕子宫妊娠前使用HIFU联合MTX预处理的效果优于单一使用HIFU预处理,可明显缩短患者血清β-HCG转阴时间、月经恢复时间与住院时间,但对女性的妊娠结局无影响,妇产科临床治疗前可结合患者需求择取最合适的预处理方案。     

Non‐Invasive Ultrasound Quantification of Scar Tissue Volume Identifies Early Functional Changes During Tendon Healing

Tendon injuries are very common and disrupt the transmission of forces from muscle to bone, leading to impaired function and quality of life. Successful restoration of tendon function after injury is a challenging clinical problem due to the pathological, scar‐mediated manner in which the tendons heal. Currently, there are no standard treatments to modulate scar tissue formation and improve tendon healing. A major limitation to the identification of therapeutic candidates has been the reliance on terminal endpoint metrics of healing in pre‐clinical studies, which require a large number of animals and result in destruction of the tissue. To address this limitation, we have identified quantification of scar tissue volume (STV) from ultrasound (US) imaging as a longitudinal, non‐invasive metric of tendon healing. STV was strongly correlated with established endpoint metrics of gliding function including gliding resistance and metatarsophalangeal (MTP) flexion angle. However, no associations were observed between STV and structural or material properties. To define the sensitivity of STV to identify differences between functionally discrete tendon healing phenotypes, we utilized S100a4 haploinsufficient mice (S100a4^GFP/+), which heal with improved gliding function relative to wild‐type (WT) littermates. A significant decrease in STV was observed in S100a4^GFP/+ repairs, relative to WT at day 14. Taken together, these data suggest US quantification of STV as a means to facilitate the rapid screening of biological and pharmacological interventions to improve tendon healing, and identify promising therapeutic targets, in an efficient, cost‐effective manner. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2476–2485, 2019     

产前乳房按摩点穴对缩短产程和早泌乳的影响

目的探讨产前乳房按摩点穴对缩短产程和产后泌乳的影响。方法选择符合阴道试产的经产妇100例,按时间先后顺序分为观察组和对照组各50例。对照组采用常规护理方法,观察组由助产师进行产前乳房按摩点穴,每日2次,每次30 min。比较两组宫缩情况、产程时间、乳汁分泌始动时间。结果入院3 d内两组孕妇规律宫缩及分娩率、产妇泌乳始动分布比较,差异有统计学意义(均P0.01);观察组第二、三产程时间及总产程时间显著短于对照组(均P0.01)。结论产前乳房按摩点穴有利于诱发宫缩,缩短产程,促进产妇产后泌乳。