子宫内膜异位症病灶分泌的细胞因子与腹腔液微环境关系的研究

目的探讨子宫内膜异位症(内异症)病灶分泌的细胞因子与腹腔液之间的关系及其对生殖的影响.方法对因内异症进行手术治疗或不孕症行腹腔镜检查的妇女43例,其中内异症24例(内异症组)及正常盆腔19例(对照组),采用单核细胞趋化实验分析、斑点杂交分析、酶链免疫吸附测定及胞浆游离钙浓度([Ca2+]i)测定等方法,测定两组患者的腹腔液、腹腔巨噬细胞及异位内膜细胞的特性,并比较两组腹腔液及异位内膜细胞对精子活动力及鼠胚胎卵裂率的影响.结果内异症组及对照组患者腹腔液趋化单核细胞移动的距离分别为(87.2±9.4) μm、(51.9±3.7) μm,两组比较,差异有极显著性(P<0.01);腹腔巨噬细胞数分别为(1.47±0.87)×106/ml、(0.67±0.73)×106/ml(P<0.01);异位内膜细胞可表达低水平的单核细胞趋化蛋白(MCP)-1[吸光度(A)值为18.34±3.95],经白细胞介素(IL)-1β及肿瘤坏死因子(TNF)-α刺激后,其分泌MCP-1mRNA A值分别为56.84±3.21、41.58±2.48,刺激前后比较,差异有极显著性(P<0.01);内异症组腹腔液及异位内膜细胞明显抑制精子的活动力和鼠胚的发育.结论异位症病灶与腹腔液微环境相互影响,腹腔巨噬细胞和异位症病灶合成及分泌某些细胞因子的能力增强,同时可干扰生殖过程的某些环节.     

导乐分娩对母婴的影响

目的:导乐陪伴分娩是一种新型的分娩方式,这种分娩方式正受到越来越多的关注和应用。她主要用来观察导乐陪伴分娩这种分娩方式对产妇产程、产后出血和新生儿的影响,以提供导乐陪伴分娩作为新型分娩方式的依据,并介绍我院在实施导乐陪伴分娩中的一些经验和措施。方法:选择无产可合并症和并发症的足月出产产妇,将产妇分为实验组和对照组,实验组即导乐陪伴组188,对照组190,观察两组产妇产程及产后出血情况并进行比较。结果:两组产妇在年龄、孕周、新生儿性别与体重方面均无显著差异(P>0.05),而总产程及产后出血,新生儿Ap-gar评分结果比较,两组均有显著性差异(P<0.05)。结论:本研究显示导乐陪伴分娩可缩短产程,减少产后出血减少新生儿窒息的发生。这些结果为导乐陪伴分娩作为新型分娩方式提供了依据。     

会阴正中切口左侧切口缝合术临床效果分析

探讨会阴正中切口缝合术与会阴左侧切口缝合术的临床应用效果,根据产妇会阴体的条件,有无产科合并症胎儿的大小等情况,选择最佳的会阴切口方式,以减轻产妇的疼痛,减少切口出血量,分析比较两种切口方式术后并发症和后遗症的发生率。     

Endometriosis and the role of the integrins in the pathogenesis of the endometriosis

The endometriosis is gynecological disease what is characterized with the presence of endometrial lesions are composed of endometrial epithelial and stromal cells outside of the uterus. There are many theories for the development of the disease endometriosis. The most widely accepted theory is the theory what is postulated the endometriosis is a result of retrograde menstruation. The essential stage in the process of development of endometrial lesions is the process of adhesion of endometrial cells on the peritoneal surface and on the organs, are situated in the peritoneal cavity. The adhesion molecules (integrins) have the most essential role in this first stage. The integrins are cell surface receptors with glycoprotein structure. They have part in process of adhesion of the endometrial cells to the proteins from EC matrix outside the uterus. The integrins have part like signal molecules in the processes of proliferation and invasion of endometrial implants. They are very essential molecules what influence the viability of endometrial implants as well as the angiogenesis in the new forming endometrial implants. Improvement of the studies, related to the roles of the integrins in the pathogenesis of endometriosis would be give new possibilities to search more effective methods for therapy of the endometriosis.     

Harnessing the power of the pedigree

Primary care providers are in an ideal position to practice genomic-based medicine. Family history data can be used to assess reproductive risks or determine an individual's risk for developing specific diseases. The US Department of Health and Human Services has recently launched the US Surgeon General's Family History Initiative, a national public health campaign designed to encourage Americans to learn more about their family health histories. Furthermore, several national associations now recommend that primary care providers collect family history data to identify patients at risk for these diseases. Ideally, family history data should be ascertained, documented, and analyzed in a standardized manner. Graphic representation of a family history in the form of a pedigree may be preferable to a text format, but further research will clarify this issue. Family history tools are now being developed and studied to identify which methods are most beneficial in different clinical settings.     

When the spleen meets the fetus

Patient’s first pregnancy was complicated by mild thrombocytopenia caused by a 13-cm splenic cyst, who delivered vaginally without complication. Risks and management of maternal splenic cysts in pregnancy and delivery are reviewed here.     

两种保留子宫治疗子宫脱垂的手术方式的疗效分析

目的:探讨腹腔镜下子宫腹壁悬吊术及子宫骶骨岬悬吊术治疗要求保留子宫的女性盆腔脏器脱垂患者的可行性及临床疗效。方法:回顾分析2012年6月1日至2013年6月1日郑州大学第一附属医院收治的64例要求保留子宫的子宫脱垂患者的临床资料,其中34例行腹腔镜下子宫腹壁悬吊术(研究组),30例行子宫骶骨岬悬吊术(对照组)。比较两组患者的手术时间、术中出血量、住院天数及术后并发症,术后12个月测量患者POP-Q各点值评价术前术后盆底功能改善状况,以盆底不适调查表短表20(PFDI-20)评价手术前后患者的生活质量。结果:64例患者均经腹腔镜成功完成手术,术中无膀胱、输尿管、直肠损伤。研究组的手术时间、术中出血量、住院天数均少于对照组,差异均有统计学意义(P0.05)。术后随访12个月,两组患者均无子宫脱垂复发,POP-Q各点测量值差异无统计学意义(P0.05);两组的术前与术后生活质量调查表问卷得分比较,差异有统计学意义(P0.05)。研究组和对照组分别有3例(8.8%)和2例(6.7%)发生术后并发症。结论:腹腔镜下腹壁子宫悬吊术及子宫骶骨岬悬吊术治疗子宫脱垂安全有效;腹腔镜下腹壁子宫悬吊术具有手术时间短、术中出血量少、经济安全、术后并发症少等优点,有望临床推广。     

腹腔镜能量器械的使用对卵巢功能的影响及预防

能量器械是腹腔镜手术依赖的器械,热损伤是腹腔镜手术并发症发生的主要原因。文章针对能量器械导致卵巢热损伤的特点、卵巢的损伤程度和恢复情况的影响因素以及预防加以叙述。     

论护生角色意识培养的重要性及策略

提高护理人员的综合素质及从业水平是21世纪护理教育的根本目标,而培养护生具有明确的角色定位,使他们在学校就能具备较强的角色意识,有利于他们在临床护理工作中自觉按照角色期待行事,这对于护理人员整体从业水平的提高及护理人员自身发展都大有裨益。文章通过分析护理人员的角色含义,提出了具体的角色意识的培养策略。     

Systems integration in the operating room: the challenge of the decade

In the past 50 years the equipment of operating rooms has changed enormously due to technological innovation and new surgery methods. In particular the establishment of minimally invasive therapy has led to a considerable increase in equipment and instruments that have to be used during surgery. The development of new equipment and instruments has had priority over the past 10–15 years, whereas now the manifold different equipment require systems integration and networking. Systems integration and networking of different OR (operating room) system components are very important current technological challenges in operative medicine. While certain technologies like robotic and navigation are still in the early stages, image documentation is an excellent starting point for systems integration because of the advanced development stage and the need for all operative disciplines. The Department of Obstetrics and Gynecology at the University of Tübingen in Germany (UFK) is delving into systems integration and networking in the operating room. In addition to the central control and monitoring of different systems, operating tables and lighting, the image documentation of intraoperative results is a principal topic. The UFK project is part of the Center of Competence for Minimally Invasive Medicine and Technology Tübingen-Tuttlingen (MITT), which is promoted by the German Federal Ministry of Education and Research. This article presents the importance and potential of systems integration and networking in health care, the current stage of development and future trends, considering image documentation as an example.