2014-2018年某院剖宫产率及剖宫产指征的变化情况分析

目的分析我院2014-2018年剖宫产率及剖宫产指征的变化,探讨降低剖宫产率的策略和措施。方法回顾性分析2014年1月至2018年12月于我院行剖宫产分娩的42385例产妇的临床资料,分析其剖宫产率及主要剖宫产指征。结果2016年的剖宫产率均低于2014年、2015年、2017年、2018年,差异具有统计学意义(P<0.05)。瘢痕子宫在二胎政策开放后所占比例明显增加;羊水过少及相对头盆不称所占比例呈现逐年下降的趋势。2014-2018年,母体因素所占比例均最高,胎儿因素及头盆因素所占比例逐年下降。另外,社会因素在二胎生育政策开放后仍呈上升趋势。结论2016年剖宫产率明显下降,瘢痕子宫在二胎政策开放后所占比例明显增加。临床需提高剖宫产术后再次妊娠阴道试产的比例、提高助产技术水平、发挥营养门诊及助产士门诊的作用、提高产科医生对胎心监护的正确解读以降低剖宫产率。     

胎儿超声NT联合血清PIGF、ADAM12、uE3检测在唐氏综合征的早期预测中的价值分析

目的探讨胎儿超声颈项透明层厚度(NT)联合血清胎盘生长因子(PIGF)、解整合素-金属蛋白酶12(ADAM12)、游离雌三醇(uE3)检测对唐氏综合征(DS)的早期预测价值。方法回顾性分析2017年2月至2018年2月间于空军军医大学第一附属医院行产检的500例孕妇资料,使用超声检测胎儿NT,并检测孕妇血清中PIGF、ADAM12、uE3水平,以羊膜穿刺检测胎儿染色体情况为金标准,分析超声检测胎儿NT联合血清PIGF、ADAM12、uE3预测DS的价值。观察不同风险程度孕妇的异常妊娠结局率。结果单纯超声检测确诊11例DS胎儿,阳性率为2.20%(11/500),单纯血清检测确诊12例DS胎儿,阳性率为2.40%(12/500),联合检测确诊13例DS胎儿,阳性率为2.60%(13/500);单纯超声检测诊断DS的灵敏度、特异度分别为67.67%、94.77%,单纯血清检测诊断DS的灵敏度、特异度分别为73.31%、95.38%,联合检测诊断DS的灵敏度、特异度分别为92.86%、96.79%;受试者工作特征(ROC)曲线结果显示,单纯超声、血清检测的曲线下面积分别为0.630、0.660,对DS的预测价值不高;联合检测的曲线下面积为0.720,对DS具有一定的预测价值。联合筛查出的结果中,高风险孕妇的异常妊娠结局率(15.38%)明显高于低风险孕妇(1.44%),差异有统计学意义(P<0.05)。结论胎儿超声NT联合血清PIGF、ADAM12、uE3检测的DS早期预测价值高于单项筛查,值得临床推广。     

The role of cathepsin K in oral and maxillofacial disorders

Cathepsin K (CTSK) was thought to be a collagenase, specifically expressed by osteoclasts, and played an important role in bone resorption. However, more and more research found that CTSK was expressed in more extensive cells, tissues, and organs. It may not only participate in regulating human physiological activity, but also be closely related to a variety of disease. In this review, we highlight the relationship between CTSK and oral and maxillofacial disorders on the following three aspects: oral and maxillofacial abnormities in patients with pycnodysostosis caused by CTSK mutations, oral and maxillofacial abnormities in Ctsk^?/? mice, and the role of CTSK in oral and maxillofacial diseases, including periodontitis, peri‐implantitis, tooth movement, oral and maxillofacial tumor, root resorption, and periapical disease.     

加速康复外科护理在腹腔镜下子宫肌瘤切除术中的应用效果

目的 探讨加速康复外科的手术室护理在腹腔镜下子宫肌瘤切除术中的应用效果.方法 选取2018年8月至2020年8月间西北妇女儿童医院收治的100例腹腔镜下子宫肌瘤切除术患者,随机分为观察组和对照组,每组50例.对照组患者采用传统康复护理措施,观察组患者在围术期采用加速康复外科手术室护理措施,比较两组患者的护理满意度、并发...     

2017—2019年妇产科重症监护病房院内感染的特征分析

目的 分析2017—2019年妇产科重症监护病房(MICU)院内感染的特征,为产科管理服务新模式下院内感染的预防及控制工作提供参考.方法 选取2017年1月1日至2019年12月31日西北妇女儿童医院MICU院内感染患者作为研究对象,对其特征进行分析.结果 4681例患者中,发生院内感染61例,其中3例发生2次院内感染...     

Prognostic factors of childhood acute lymphoblastic leukemia with TCF3::PBX1 in CCCG-ALL-2015: A multicenter study

Background

Contemporary risk-directed treatment has improved the outcome of patients with acute lymphoblastic leukemia (ALL) and TCF3::PBX1 fusion. In this study, the authors seek to identify prognostic factors that can be used to further improve outcome.

Methods

The authors studied 384 patients with this genotype treated on Chinese Children's Cancer Group ALL-2015 protocol between January 1, 2015 and December 31, 2019. All patients provisionally received intensified chemotherapy in the intermediate-risk arm without prophylactic cranial irradiation; those with high minimal residual disease (MRD) ≥1% at day 46 (end) of remission induction were candidates for hematopoietic cell transplantation.

Results

The overall 5-year event-free survival was 84.4% (95% confidence interval [CI], 80.6–88.3) and 5-year overall survival 88.9% (95% CI, 85.5–92.4). Independent factors associated with lower 5-year event-free survival were male sex (80.4%, [95% CI, 74.8–86.4] vs. 88.9%, [95% CI, 84.1–93.9] in female, p = .03) and positive day 46 MRD (≥0.01%) (62.1%, [95% CI, 44.2–87.4] vs. 87.1%, [95% CI, 83.4–90.9] in patients with negative MRD, p < .001). The presence of testicular leukemia at diagnosis (n = 10) was associated with particularly dismal 5-year event-free survival (33.3% [95% CI, 11.6–96.1] vs. 83.0% [95% CI, 77.5–88.9] in the other 192 male patients, p < .001) and was an independent risk factor (hazard ratio [HR], 5.7; [95% CI, 2.2–14.5], p < .001).

Conclusions

These data suggest that the presence of positive MRD after intensive remission induction and testicular leukemia at diagnosis are indicators for new molecular therapeutics or immunotherapy in patients with TCF3::PBX1 ALL.     

Effects of three pro-nuclei (3PN) proportion incidence on clinical outcomes of patients with lower retrieved oocytes in the fresh cleavage-stage embryo transfer (ET) cycles

Purpose: To analyze the three pro-nuclei (3PN) incidence on clinical outcomes of patients with lower retrieved oocytes in the fresh cleavage-stage embryo transfer (ET) cycles.

Methods: This study included 1200 fresh cleavage-stage ET cycles from January 2013 to June 2015. The patients were divided into 3PN?=?0% (773 cycles) and 3PN?>?0% (427 cycles) group. Main outcomes compared were fertilization, cleavage, normal fertilization, good quality embryo, implantation, clinical pregnancy, and early abortion rate.

Results: We observed that there was no significant difference in female's age, the number of retrieved oocytes, the number of transferred embryos, the number of good quality embryos, endometrial thickness, infertile time, basal serum follicle-stimulating hormone, and E2 value between two groups (p?>?0.05). The fertilization (89.43 versus 83.90%, p?<?0.001) and cleavage (98.34 versus 97.19%, p?=?0.048) rates were significantly higher in 3PN?>?0% than 3PN?=?0% group. However, the normal fertilization (70.05 versus 50.67%, p?<?0.001), good quality embryos (37.11 versus 26.47%, p?<?0.001), and clinical pregnancy (49.81 versus 43.79%, p?=?0.046) rates were significantly higher in 3PN?=?0% than 3PN?>?0% group. The implantation (35.88 versus 33.78%, p?=?0.333) and early abortion (8.83 versus 10.70%, p?=?0.474) rates were not significantly different between two groups.

Conclusion: 3PN incidence might make a negative effect on clinical outcomes for patients with lower retrieved oocytes in the fresh cleavage-stage ET cycles.     

产前超声与MRI对胎儿先天性肺囊腺瘤样畸形分型的鉴别诊断

目的分析产前超声与MRI对胎儿先天性肺囊腺瘤样畸形分型的鉴别诊断。方法选取2018年1月至2019年8月本院收治并已被确诊为先天性肺囊腺瘤样畸形的36例胎儿作为研究对象,采用奇偶分组法将其分成参照组(18例)和研究组(18例)。参照组行产前MRI诊断,研究组行产前超声诊断。比较两种诊断方式的准确率、漏诊率、误诊率、囊肿体积大小以及异常和病灶位置的检出情况。结果研究组胎儿接受产前超声诊断的准确率为94.44%,高于参照组胎儿接受MRI诊断的83.33%,但两组数据比较,差异无统计学意义(P>0.05);参照组胎儿的误诊率为5.56%,高于研究组的0.00%,但两组数据比较,差异无统计学意义(P>0.05)。两组胎儿囊肿体积平均值比较,差异无统计学意义(P>0.05)。MRI检查中,胎儿异常发生率为33.33%(6/18),双侧病灶1例、单侧病灶17例;产前超声检查中,胎儿异常发生率为22.22%(4/18),双侧病灶2例、单侧病灶16例,两组胎儿异常发生率比较,差异无统计学意义(P>0.05)。结论产前超声与产前MRI均可对胎儿先天性肺囊腺瘤样畸形作出准确的观察及诊断,对疾病的分型和预后具有十分重要的作用,其中产前超声检查具有操作简便、价格实惠的特点,值得临床推广。     

超声特征联合免疫组化对不同组织学分级的乳腺浸润性导管癌的诊断价值

目的:评估乳腺浸润性导管癌（invasive ductal cancer,IDC）的超声特征及免疫组化生物分子的表达在不同组织学分级中的鉴别诊断价值。方法:回顾性分析2017年05月至2019年05月经三家医院收集的390例IDC患者,均接受超声检查及免疫组化检查,并且均经穿刺或手术病理结果证实;分析超声特征及免疫组化生物分子在不同组织学分级IDC之间的差异。结果:不同组织学分级的IDC中,肿瘤方位、回声、微钙化、血流分级表现具有显著统计学差异;ER、HER-2、Ki-67、AR、p53表达水平具有显著统计学差异;根据主成分分析计算得出的综合评分绘制受试者工作特征曲线（receiver operating characteristic curve,ROC）,得出IDC I级与Ⅱ、Ⅲ级的AUC、灵敏度、特异度分别是0.611、0.818、0.409,Ⅰ、Ⅱ级与Ⅲ级的AUC、灵敏度、特异度分别是0.596、0.558、0.675。结论:超声特征结合免疫组化生物分子一定程度上可以预测IDC的组织学分级,为临床医师在决策患者的治疗方案中提供一定的指导。