2001-2010年广西壮族自治区围生儿出生缺陷分析

目的 分析广西壮族自治区2001-2010年围生儿出生缺陷特征及变化趋势.方法 按照国家出生缺陷监测方案,对2001-2010年广西壮族自治区围生儿出生缺陷监测医院的围生儿进行出生缺陷监测,统计分析出生缺陷的发生率、类别和相关因素.结果 10年共监测围生儿540 449例,其中出生缺陷儿10 897例,发生率为201.63/万.出生缺陷主要为胎儿水肿综合征、多指(趾)、先天性心脏病、总唇裂、外耳其他畸形等;出生缺陷发生率男性高于女性;城镇高于乡村,其差异均有统计学意义(x2=43.71、4.04,均P＜0.05).35～岁产妇组中围生儿出生缺陷发生率最高,且高于＜20岁组、20～岁组、25～岁组、30～岁组,其差 异均有统计学意义(x2 =9.17、41.33、58.77、29.10,均P＜0.05).2001-2005年围生儿出生缺陷发生率呈上升趋势,2005-2010年呈下降趋势.结论 加强三级预防措施、提高产前诊断技术水平是降低围生儿出生缺陷发生率的有效手段.     

Elevated incidence of hypospadias in two sicilian towns where exposure to industrial and agricultural pollutants is high

We found significant elevated incidence of hypospadias in two towns in Southeastern Sicily selected on the basis of the presence of intense industrial (Augusta) and agricultural (Vittoria) activities. Cases and controls were chosen in records collected from a surveillance system on abnormal live births in the same area and in a large city (Catania) located in an area at low risk of exposure to environmental pollutants. From 1991 to 1998, 16 cases of isolated hypospadias were recorded among male live births in Augusta (12.1 per 1000 male live births) and 24 cases in Vittoria (7.4 per 1000 male live births) with an incidence significantly higher than that expected (3.2 per 1000 in Southeastern Sicily). Relative risks in Augusta and Vittoria were 3.8 (95% confidence interval: 2.16-6.14) and 2.3 (95% confidence interval: 1.48-3.43; P=0.00003 and 0.04, respectively). In Augusta, the incidence of hypospadias was higher than in Vittoria. Significant log odds ratios were found for occupational exposure in fathers both in Augusta and Vittoria (P=0.0478 and 0.026, respectively). However, daily contact with pollutants in Augusta may not be sufficient by itself to determine hypospadias and other factors might be involved. Similar factors may act also in Vittoria. Thus, contact with large amounts of pesticides is, by itself, a risk factor for hypospadias, though genetic and other environmental factors might be involved.     

大气污染暴露与某市6家哨点医院围生儿出生缺陷的流行病学研究

目的：探讨和分析某市大气污染对新生儿出生缺陷的影响。方法收集某市6家哨点医院2012—2013年期间分娩的孕满18周到出生后7 d 内的所有围产儿资料,包括分娩日期、孕产妇孕周以及孕天数和围生儿的性别等资料。同时收集该市2011—2013年的大气污染物日监测资料,包括二氧化硫、二氧化氮、可吸入污染和污染指数等。采用 SPSS16．0软件进行一般性描述、卡方检验、方差分析、Spearman 秩相关等统计分析。结果2年出生缺陷总发生率为11．63‰;2012年的出生缺陷发生率为10．49‰,2013年为12．76‰,但2年之间差异无统计学意义（P ＞0．05）;不同性别出生缺陷患儿的发生率差异有统计学意义（P ＜0．05）,男婴出生缺陷发生率高于女婴。出生缺陷发生率与大气污染物的 Spearman 秩相关分析结果显示：在孕前1月组和孕前2月组,出生缺陷发生率与可吸入颗粒物（PM10）和污染指数呈正相关。结论该次调查的该市妊娠期妇女在妊娠前期2个月内,大气 PM10暴露浓度和污染指数暴露水平与出生缺陷的发生存在统计学关联。     

The challenges of ambiguous genitalia.

In this paper, we assessed 71 patients between January 1985 and December 1990. Patients with ambiguous genitalia who were seen in the out-patient clinics of both the Paediatric and Urology Departments in the Harare Group of Hospitals. The majority of patients were seen by both the paediatricians and the urologists as children with anomalous genitalia, and a good number were referred to the Urological out-patients as cases of severe perineal, penoscrotal hypospadias, or cryptorchidism. Generally, there were three categories of patients who were seen. The first group were patients referred with severe hypospadias, perineal or penoscrotal and who only, after chromosomal studies, were then categorised into the ambiguous genitalia group. These patients were sent for chromosomal studies because of the concomitant cryptorchidism or, as they were suspected of having ambiguous genitalia because of the well developed labial folds without palpable testes. The second group of patients were patients seen at birth with incongruities which typify ambiguous genitalia. The third group was those who attended the urology clinics with a wish of having surgery performed to render their "phallic organ" long or good enough to help achieve rigidity for sexual intercourse. In the 71 patients seen, the classification had been made and surgery performed on a great majority of them at an early stage, to avoid later catastrophes and the possibility of the development of gonadoblastoma.     

Per- and polyfluoroalkyl substances and male reproductive health: a systematic review of the epidemiological evidence

ABSTRACT

Exposure to environmental pollutants may produce impairment of male reproductive health. The epidemiological literature evaluating potential consequences of human exposure to per- and polyfluoroalkyl substances (PFAS) has grown in recent years with concerns for both pre- and postnatal influences. The aim of this systematic review was to assess available evidence on associations between PFAS exposures in different stages of life and semen quality, reproductive hormones, cryptorchidism, hypospadias, and testicular cancer. A systematic search of literature published prior to March 9th, 2020, was performed in the databases PubMed and Embase®. Predefined criteria for eligibility were applied by two authors screening study records independently. Among the 242 study records retrieved in the literature search, 26 studies were eligible for qualitative assessment. While several investigations suggested weak associations for single compounds and specific outcomes, a lack of consistency across studies limited conclusions of overall evidence. The current gap in knowledge is particularly obvious regarding exposures prior to adulthood, exposure to combinations of both PFAS and other types of environmental chemicals, and outcomes such as cryptorchidism, hypospadias, and testicular cancer. Continued efforts to clarify associations between PFAS exposure and male reproductive health through high-quality epidemiological studies are needed.     

隐睾患者采取经阴囊联合经脐腹腔镜隐睾无瘢痕下降固定术的治疗效果探讨

目的 探讨隐睾患者采取经阴囊联合经脐腹腔镜隐睾无瘢痕下降固定术的治疗效果.方法 选取2014年2月至2015年2月我院收治的62例隐睾患者作为研究对象,采取随机数字表法,有31例患者采取开放手术治疗(对照组),有31例患者采取经阴囊联合经脐腹腔镜隐睾无瘢痕下降固定术治疗(观察组),对两组患者的临床效果进行统计对比.结果 观察组有效率为96.77％,略高于对照组的90.32％,组间比较差异无统计学意义(P＞0.05);观察组术中出血量较对照组低,手术时间、住院时间较对照组短,组间比较差异有统计学意义(P＜0.05),观察组术后并发症发生率为0％,低于对照组的6.45％,组间比较差异有统计学意义(P＜0.05).结论 对隐睾患者的治疗,采取经阴囊联合经脐腹腔镜隐睾无瘢痕下降固定术可取得较好效果,可促进患者康复,值得临床推广应用.     

Pesticide exposures and developmental outcomes: the epidemiological evidence

Since the advent of DDT as an insecticide in the late 1930s, billions of kilograms of pesticide active ingredient have been sold in North America and around the world. In recent years, there has been a heightened public awareness of pesticides and child health and a number of epidemiologic studies linked pre- and postnatal exposures to pesticides to a number of adverse developmental outcomes, including fetal death, intrauterine growth restriction, preterm birth, and birth defects. Given this, it was felt prudent to critically appraise the evidence for periconceptual pesticide exposures and developmental outcomes. The epidemiological evidence for specific pesticide classes, families, and active ingredients were examined and summarized and recommendations were made for how to improve future studies in order to address the current pitfalls and gaps in the studies in this area. Many of the studies suffered from poor exposure estimation, relying on job title only and/or the exposure category "any pesticide" as a measure of exposure, and there was limited or inadequate evidence to support causality for all associations examined.     

新生儿出生缺陷对产妇负性心理的影响研究

目的 观察新生儿出生缺陷导致产妇产后的负性心理,并为临床产妇的心理护理提供方案依据.方法 将本院28例先天性缺陷新生儿的产妇作为实验组,另选1473例正常新生儿的产妇作为对照组.心理行为调查以爱丁堡产后抑郁量表(EPDS)作为判断标准.通过两组产妇的抑郁症发生率的比较分析,研究新生儿出生缺陷对产妇心理的影响.结果 实验组产后抑郁率为57.14％,严重的产后抑郁率为21.43％;对照组产后抑郁率为19.96％,严重的产后抑郁率为5.57％;两组比较差异有统计学意义(P＜0.05).结论 产妇在新生儿出现先天性缺陷的情况下易产生负性心理,产妇的产后抑郁率明显提高,对产妇和家庭造成不良影响.     

5281例围产儿出生缺陷监测结果分析

目的降低出生缺陷率,提高人口素质。方法对2008年10月1日至2010年9月30日于本院分娩的5281例围产儿出生缺陷情况及其相关危险因素进行统计、分析,为开展出生缺陷的预防和干预提供依据。结果3年来同产儿出生缺陷率平均为16．10％。,呈逐年上升趋势。先天性心脏病以及四肢骨骼肌肉系统缺陷为最常见的出生缺陷,分列l、2位。孕母年龄对围产儿出生缺陷有重要影响,〉35岁组出生缺陷率明显高于其他各年龄组。出生缺陷的性别、产母居住地城乡差异均无统计学意义（P〉0．05）。结论加强孕前、孕早期预防以及产前诊断,可减少出生缺陷的发生;需进一步加强胎儿心血管系统、四肢等超声产前检查;高龄孕妇孕中期应常规行产前诊断。     

Pesticide application to agricultural fields: effects on the reproduction and avoidance behaviour of Folsomia candida and Eisenia andrei

The objective of this work was to assess the impact of pesticide application to non-target soil organisms simulating what happens following pesticide application in agricultural fields and thus obtaining higher realism on results obtained. For that purpose, three commercial formulations containing the insecticides chlorpyrifos and endosulfan and the herbicide glyphosate were applied to a Mediterranean agricultural field. The soil was collected after spraying and dilution series were prepared with untreated soil to determine the impact of the pesticides on the avoidance behaviour and reproduction of the earthworm Eisenia andrei and the collembolan Folsomia candida. A significant avoidance was observed at the recommended field dose in case of endosulfan by earthworms (60?%) and in case of chlorpyrifos by collembolans (64?%). In addition, both insecticides affected the number of juveniles produced by the earthworms (EC₅₀ were below the recommended field dose). Glyphosate did not seem to affect either earthworms or collembolans in the recommended field dose. Folsomia candida was more sensitive to pesticide application than Eisenia andrei, what was corroborated by the EC₅₀ and LC₅₀ values. In conclusion, insecticides may affect the structure of the soil community by reducing the survival of collembolans and the reproductive capacity of collembolans and earthworms.     

孕妇HBV感染对胎儿生长发育的影响

目的：研究孕妇HBV感染对胎儿生长发育的影响。方法分别选取我院HBsAg阳性（阳性组）与健康产妇（阴性组）,对其胎儿出生时的体重、身长、FGR发生率以及胎盘的体积进行研究,采用t检验和x2检验统计分析各组之间的差异性,P＜0.05差异具有统计学意义。结果 HBsAb阳性组新生儿的体重、身长、胎盘体积小于阴性组,FGR发生率明显高于阴性组, HBeAg阳性组胎盘体积小于阴性组,差异具有统计学意义（P＜0.05）。结论孕妇HBV感染会影响胎儿的生长发育,导致新生儿出生体重偏低,孕妇胎盘体积有所缩小,另外新生儿HBsAb可对胎盘进行保护。     

新余市围产儿出生缺陷相关因素及产前诊断分析

目的 了解新余市出生缺陷的可疑因素及产前诊断现状,提出干预措施和提高产前诊断率的对策.方法 回顾性统计新余市2001～2011年出生缺陷情况,分析出生缺陷率、出生缺陷发生顺住与构成比及产前诊断情况.结果 72514例围产儿中,出生缺陷儿481例,出生缺陷发生率 66.33/万;随孕母年龄增加,围产儿的出生缺陷发生率升高(χ2=45.63,P<0.05),35岁以上缺陷发生率明显增高(P<0.05);孕母文化程度越低,出生缺陷的发生机会越大(RR=4.59);出生缺陷围产儿死亡高于非出生缺陷围产儿(RR=16.21);产前诊断的出生缺陷儿有151例(31.39%).结论 新余市出生缺陷发生率偏高,产前诊断率偏低,提高产前诊断水平已是势在必行.     

104例急性农药中毒护理经验分析

目的 探讨不同护理干预方式对急性农药中毒患者预后的影响.方法 采用回顾性分析方法,收集104例在我院明确诊断为急性农药中毒并住院治疗的患者,对其一般资料、护理干预方式以及住院状况等进行比较.结果 (1)急性农药中毒患者每年病例数呈逐渐减少趋势,男女之间比例接近,发病患者以中年人群为主.入院时三个时间段患者的生命体征组间无统计学差异.(2)患者的每日平均病情观察时间、每日平均基础护理次数以及每日平均心理护理次数均呈现逐渐升高趋势,差异有统计学意义(P＜0.05).(3)患者住院天数、住院总费用以及死亡率均呈现逐渐下降趋势,差异有统计学意义(P＜0.05).结论 对于急性农药中毒的患者,制定专科护理、延长病情观察时间、增加基础护理和心理护理次数,有利于提高临床治疗效果,减少患者经济费用支出.     

Pre- and post-conception pesticide exposure and the risk of birth defects in an Ontario farm population

The use of pesticides has enhanced the health and economies of nations around the world by improving crop production. However, pesticides may pose health risks, particularly to the fetus and young children. In a secondary analysis of the Ontario Farm Family Health Study, we explored the relationship between birth defects and parental pesticide exposure during the 3 months prior to conception and the first trimester of pregnancy. A total of 3412 pregnancies were included in the study. Logistic regression fit by maximum likelihood was used in the analysis. The results showed that pre-conception exposure to both cyanazine (odds ratio=4.99, 95% confidence interval: 1.63-15.27) and dicamba (OR=2.42, 95% CI: 1.06-5.53) were associated with increased risk of birth defects in male offspring. Nevertheless, given the self-reported nature of the exposure and outcomes in this study, the present findings should be considered primarily as hypothesis generating, requiring verification in subsequent investigations.     

妊娠期腹腔镜与开腹手术对母胎影响的对比研究

目的对比分析妊娠期腹腔镜与开腹手术对母胎影响的情况,评估妊娠期腹腔镜的安全性。方法采用前瞻性对照研究方法,妊娠期腹腔镜手术与开腹手术病例各20例,将腹腔镜组、开腹组的麻醉时间、手术时间、出血量、术后15min的动脉血气分析及子宫动脉血流参数、术后镇痛、术后恢复情况及妊娠结局进行对比研究。结果妊娠期腹腔镜手术组麻醉时间较开腹组短[（18．91±8．76）min vs．（35．28±14．67）min;t=4．28,P〈0．05],手术时间较开腹组短[（17．85±6．32）min vs．（30．27±10．41）min;f=4．56,P〈0．05];腹腔镜组出血量较开腹组少[（15．48±10．24）ml vs．（25．48±15．56）ml;t=2．40,P〈0．05]。腹腔镜手术组拔尿管时间、术后下床时间、术后排气时间分别为f6．58±0．92）h、（6．98±1．69）h、（18．52±3．45）h,较开腹组的（24．63±3．85）h、（25．37±5．34）h、（23．67±7．81）h短（t=2．70,14．68,20．39;P〈0．05）。妊娠期腹腔镜术后疼痛较开腹手术明显轻（P〈0．05）;腹腔镜组和开腹组术后15min的动脉血气分析及子宫动脉血流参数比较差异无统计学意义（P〈0．05）。腹腔镜组、开腹组和正常妊娠组的流产率、早产率、足月分娩率、出生缺陷率、新生儿Apgar评分、足月新生儿体重比较差异无统计学意义（P〉0．05）。结论妊娠期腹腔镜手术较开腹手术对母胎的影响小,妊娠期腹腔镜手术不增加妊娠不良结局的风险。     

Mode of action: impaired fetal leydig cell function--effects on male reproductive development produced by certain phthalate esters

Certain phthalate esters (di-2-ethylhexyl; di-n-butyl and butyl benzyl) have profound effects on the developing male reproductive system when administered orally to pregnant experimental animals during a critical window of development. These esters produce a syndrome of adverse effects that are characteristic of a disturbance in androgen-mediated development and include a variety of reproductive tract malformations and effects on developmental phenotypic markers. A testicular dysgenesis syndrome has been proposed to explain the secular increases in a number of human male reproductive deficits, including decreased semen parameters, increased incidence of cryptorchidism and hypospadias (two of the most common human birth defects), and increased incidence of testicular (germ cell derived) cancer. The rodent phthalate data lend support to the hypothesis. This example illustrates a number of points in the use of the Human Relevance Framework. First, chemical agents may have more than one mode of action (MOA): for example, phthalate-induced peroxisome proliferation leading to hepatocarcinogensis, compared with the induction of developmental effects via effects on androgen signaling. Second, the case demonstrates the life-stage sensitivity of the response to these compounds. Third, because humans may be exposed to multiple phthalate esters producing adverse effects on reproductive development, these compounds may be useful in testing the utility of the Human Relevance Framework (HRF) approach for evaluating cumulative and aggregate risk.     

265例出生缺陷儿的临床分析

目的分析我院住院分娩围生儿的出生缺陷发生情况、变化趋势,为进一步预防出生缺陷的发生提供依据。方法对2006至2011年在怀柔区第一医院住院分娩的围生儿出生缺陷监测资料进行分析。结果 6年共监测围生儿12742例,发现缺陷儿265例,平均出生缺陷发生率为207.97/万,前5位分别是多指(趾)及并指(趾)36例,副耳34例,先天性心脏病33例,唇裂合并腭裂23例,色素痣13例。结论减少出生缺陷的工作重点在预防,应加强优生知识的宣传,提高产前检查质量及产前诊断技术,做好三级预防工作,以期降低围生儿出生缺陷的出生率,提高出生人口素质。     

袋鼠式护理干预对新生儿体格生长发育和神经行为发育的影响

目的 研究袋鼠式护理干预对新生儿体格生长发育和神经行为发育的影响,为临床护理提供理论参考.方法 选取2015年11月至2016年5月本院产科182例经阴道自然分娩生产的足月新生儿,随机分为对照组和研究组,其中对照组90例,研究组92例.对照组采用常规护理干预,研究组在常规护理基础上给予1h的袋鼠式护理.新生儿出生后30 d测量体格发育情况;新生儿出生后的5、15、30 d进行神经发育测评.结果 研究组新生儿在出生后30 d的体重增长(2.11 ±0.34)kg、身长增长(6.89±2.20)cm、头围增长(4.68±1.56) cm;对照组新生儿在出生后30 d的体重增长(1.29±0.27)kg、身长增长(5.35±1.67) cm、头围增长(3.21±1.79) cm;两组比较差异有统计学意义(P＜0.05);研究组新生儿在出生后3、15及30 d的一般反应、原始反射、行为能力、被动肌张力、主动肌张力的测评结果均明显高于对照组新生儿,差异有统计学意义(P＜0.05).结论 袋鼠式护理干预可显著促进新生儿体格和神经发育,对新生儿的生长发育具有重要影响,值得临床上广泛推广应用.     

抑郁情绪对慢性阻塞性肺疾病患者疾病转归和生活质量的影响

目的 调查住院慢性阻塞性肺疾病(COPD)患者抑郁症的发病率,研究其对患者健康相关生活质量的影响.方法 对65例住院COPD患者进行汉密尔顿抑郁量表(HAMD),StGeorge呼吸问卷(SGRQ),简明健康调查问卷(SF-36)调查.结果 共调查COPD患者65例.HAMD分值8～20分者10例,21～35分者5例,35分以上者2例.不合并抑郁(HAMD＜8分)与合并抑郁(HAMD≥8分)的COPD患者SGRQ总分[(38.6士19.4)分比(53.3±27.6)分]、活动受限[(39.8±18.5)分比(57.7 ±24.4)分]、疾病影响[(33.9±13.7)分比(43.5±18.9)分]差异均有统计学意义(P＜0.05),不合并抑郁的COPD患者低于合并抑郁的COPD患者.与合并抑郁的COPD患者比较,不合并抑郁的患者SF-36的8个维度分值均较高,其中生理功能[(51.1±10.8)分比(26.9±14.4)分]、生理职能[(26.6±11.7)分比(8.3±1.4)分]、社会功能[(33.3±14.5)分比(17.9±7.5)分]、情感职能[(41.7±19.2)分比(23.8±8.8)分]、精神健康[(37.4±11.4)分比(23.8±8.0)分]分值相比,差异有统计学意义.较轻的COPD患者(Ⅰ期和Ⅱ期)和较重的COPD患者(Ⅲ期和Ⅳ期)SGRQ总分[(37.8±15.7)分比(58.6±20.4)分]、活动受限[(37.8±16.4)分比(59.2±21.6)分]、疾病影响[(31.7±8.2)分比(45.6±17.8)分]相比,较轻的COPD患者均低于较重的COPD患者,差异有统计学意义(P＜0.05).较轻和较重的COPD患者SF-36表的生理机能[(57.5±29.7)分比(27.0±12.9)分]、生理职能[(33.0±13.9)分比(6.0±2.7)分]、一般健康状况[(76.6±l9.4)分比(55.1±24.8)分]、社会功能[(41.1±16.8)分比(10.3±2.8)分]和精神健康[(40.6±1.6)分比(24.6±6.6)]相比,较轻的COPD患者评分均高于较重的COPD患者,差异有统计学意义(P＜0.05).结论 抑郁症在COPD患者中有一定的发生率,且严重影响COPD患者的健康生活质量.     

13208例围产儿出生缺陷监测结果分析

目的 了解该院出生缺陷的发病特点,寻找预防出生缺陷的措施.方法 对该院1999年至2008年之间围产儿出生缺陷资料进行回顾性分析.结果 该院10年间围产儿13 208例,出生缺陷儿141例,出生缺陷的发生率10.68‰,其中前5位分别是外耳及外耳其它畸形,多指(趾),唇、腭裂,先天性脑积水,马蹄内(外)翻足.确诊方式以...