分娩方式与阴道松弛综合征

研究表明分娩方式与盆底功能障碍有关,如盆腔脏器脱垂(pelvic organ prolapse,POP)、压力性尿失禁及肛门失禁等,但就分娩方式对阴道松弛综合征( vaginal relaxation syndrom,VRS)影响的报道却相对较少.近年来有研究认为经阴道自然分娩可增加产后患VRS的风险,临床剖宫产率也因...     

阴道松弛综合征与盆底功能障碍性疾病相关思考

阴道松弛综合征( vaginal relaxation/laxity syndrome, VRS/VLS )或称阴道松弛(症) ( vaginal laxity,VL)属于女性盆底医学( female pelvic floor medicine,FPFM)的范畴,与正常盆底支持结构健康与否密切相关.盆底支持结构松弛(r...     

从生殖内分泌角度探讨阴道松弛综合征的诊疗

阴道松弛综合征( vaginal relaxation syndrome,VRS)在盆底功能障碍性疾病中发生率较高,并在早期最先出现,目前临床对于该症状尚无标准化定义.由于阴道周围结缔组织及盆底肌改变而表现为阴道口和(或)阴道腔和四壁松弛,可显著影响女性的性生活满意程度[1] ,因而成为新时代女性生殖健康的热点.VRS...     

阴道松弛矫正术

女性因生育、长期性生活及外伤（产伤及手术）等均会造成阴道肌力减弱、韧带松弛、粘膜皱襞减少，使阴道过于松弛。在性交和运动时，阴道的握持力减弱，空气出入阴道会发出异常声响，导致性快感降低，严重影响性生活的和谐。手术一般在局麻下进行。对于阴道口有产伤疤痕或阴道特别松弛的女性，可直接去除阴道后壁的部分粘膜，缩紧环绕阴道的肌肉达到紧缩目的。而年轻或阴道口完整的妇女，可采用不损伤阴道粘膜的紧缩术，不去除阴道粘膜，直接缩紧阴道的肌肉。     

从应用解剖学谈阴道紧致手术的操作要点

阴道松弛综合征( vaginal laxity syndrome, VLS 或vaginal relaxation syndrome, VRS)是由于阴道壁或盆腔的支持组织薄弱、损伤、退化继而导致阴道壁顺应性降低、收缩力下降、阴道神经敏感度下降、阴道口变宽,常导致性生活质量下降、压力性尿失禁及女性生殖道炎症等一系列并发...     

阴道松弛的克敌：阴道紧缩术

自然分娩中，作为生育的代价，阴道松弛几乎不可避免。阴道是性生活的器官，同时又是胎儿娩出的通道，在相对庞大的胎儿分娩后，阴道很难恢复到产前的口径。在性活动过程中，阴道口径的增大，势必减少与阴茎间的相互刺激，对于男女双方的性快感均会有重要的影响。     

阴道缩窄术及药物治疗妇女阴道松弛症的临床观察

近年来 ,随着人民生活水平提高 ,追求高质量的生活 ,有关提高性生活质量的问题 ,已经受大家的关注。我院妇科自 1995年 2月至 2 0 0 0年 3月 ,对因足月妊娠阴道分娩致会阴裂、多产至阴道前、后壁膨出、或仅因年龄增长、长期性生活而阴道弹性下降等而感阴宽—“阴道松弛”而致性生活不满意为主诉而就诊的 10 3例患者 (以下统称阴道松弛症 )。进行了不同方法的治疗 ,其中以用“阴道缩窄术”联合药物治疗者 ,效果较满意 ,现介绍如下。1　临床资料1·1　对象　因阴道松弛致性生活不满意为主诉而来我院妇科就诊的 10 3例妇女 ,平均年龄 36 4 1岁 …     

阴道松弛，练练PC肌

在本刊2010年第10期《阴道“放屁”真羞人》一文中，我们提到，产后锻炼盆底PC肌（耻骨尾骨肌）对减少“阴吹”是很重要的。有读者来信问道：该怎么进行PC肌锻炼呢？     

The effectiveness of non-surgical interventions in the treatment of Charcot foot

Background Charcot neuropathic osteoarthropathy is commonly known as 'Charcot foot'. It is a serious foot complication of diabetes mellitus that can frequently lead to foot ulceration, gangrene, hospital admission and foot amputation. A multidisciplinary approach to the management of Charcot foot is taken involving medical and allied health professionals. The management approach may also differ between different countries. To date, there is no systematic review of the literature undertaken to identify the clinical effectiveness of non-operative interventions in the treatment of acute Charcot foot. Objective The objective of this review was to identify the effectiveness of non-surgical interventions with reducing lesions, ulceration, the rate of surgical intervention, reducing hospital admissions and improve the quality of life of subjects with Charcot foot. Search strategy A comprehensive search strategy was undertaken on databases available from University of South Australia from their inception to November 2006. Selection criteria Randomised controlled trials or clinical controlled trials were primarily sought. Critical appraisal of study quality and data extraction was undertaken using Joanna Briggs Institute instruments. Review Manager software was used to calculate comparative statistics. Results This review identified 11 trials and five trials were included in the review. Three trials involved the use of bisphosphonate, a pharmacological agent. Two experimental treatments were also included, evaluating palliative radiology and magnetic fields. No trials were found using immobilisation and off-loading interventions for acute Charcot foot. The overall methodological quality score of the five studies was moderate. Owing to heterogeneous data, meta-analysis could not be performed. The trials did not report on reducing lesions, ulceration, rate of surgical intervention, hospital admissions and the quality of life of subjects with Charcot foot. The trials evaluating bisphosphonates reported greater reduction in foot temperature and disease activity for intervention subjects compared with controls. Another outcome of this review indicated additional beneficial effects of bisphosphonates in reducing pain and discomfort. The trial evaluating palliative radiotherapy found no difference between groups on any outcome. A significant reduction in the amount of deformity and reduced healing time to consolidation was found after treatment in the group receiving magnetic therapy treatment. Discussion There is a lack of clinical trials evaluating the effectiveness of non-operative interventions for the management of Charcot foot (immobilisation, removable cast walkers, advice/dispensing of footwear and prescribing of orthotics). Bisphosphonates may be useful adjuncts to standard management of Charcot foot by improved healing demonstrated by a reduction in disease activity indicated by skin temperature and bone destruction. Magnetic therapy may reduce deformity, joint destruction and improve mobility. Conclusion There is a lack of evidence supporting the use of pharmacological or non-surgical interventions with reducing lesions, ulceration, rate of surgical intervention, hospital admissions and improving the quality of life of subjects with Charcot foot. Bisphosphonates may improve the healing of Charcot foot by reducing skin temperature and disease activity of Charcot foot, when applied in addition to standard interventions to control the position and shape of the foot.     

Evaluation of interventions

The first modern randomized controlled trial was published in 1948, and featured randomly allocated treatment groups, blinded outcome assessment, and a sufficient number of patients. Randomized controlled trials are now accepted as the best possible way to assess the effects of clinical interventions, but good trials sometimes disagree. Although the elements of a credible trial have been defined, the relative importance of these elements to results is not known. Information from clinical trials may be difficult to use in the care of patients if trial outcomes are not patient centered or the conditions of the trial are very different from the situation in clinical practice. Observational studies are often, but not always, an adequate substitute from randomized trials. Systematic reviews with meta-analyses may reveal patterns of results when individual trials do not, and so complement the information content of large trials. When trials disagree, resolution may be found not by from more trials but also from critical appraisal of individual trials, weighing the totality of the evidence, and Bayesian reasoning.     

带状疱疹后遗神经痛发病相关因素及干预方法分析

目的带状疱疹后遗神经痛(postherpetic neuralgia,PHN)是临床较为常见的慢性疼痛病理综合征,其发病机制尚未完全阐明,对临床各种治疗效果不佳。因此,探讨其好发因素及干预方法,对预防和减少PHN的发生有重要意义。方法对34例带状疱疹后遗神经痛患者及152例未发生带状疱疹后遗神经痛患者治疗康复过程进行比较分析。结果 PHN发生的相关因素可能为患者年龄较大、发病时有严重的前驱痛、治疗时间不及时、早期未合并使用小剂量激素、皮损的严重程度、疗程过短、伴有原发疾病及患者的社会心理因素等。结论高龄、急性期有严重的前驱痛、治疗过晚、疗程过短、伴有其他原发病及伴有焦虑及相关症状的患者易并发带状疱疹后遗神经痛。积极控制原发疾病,早期综合治疗,适量使用激素,适当的心理干预均可能减少PHN的发生。     

代谢综合征的饮食营养干预

代谢综合征(metabolic syndrome)是一种包括葡萄糖代谢异常、肥胖(特别是腹型肥胖)、高血压、血脂代谢紊乱等临床症候群.体力活动不足和不健康的饮食使代谢综合征患病率不断攀升[1],已成为目前国内外共同关注的热点健康问题.据报道美国代谢综合征人群患病率已达25%以上,我国几个城市的代谢综合征患病率为14%～17%,而在高血压、糖尿病和肥胖等特定人群中符合代谢综合征诊断者则高达50%～80%[2].     

沈阳市开展唐氏综合征系列产前筛查的方法及效果评价

目的:探讨在妊娠中期筛查唐氏综合征系列〔包括唐氏综合征和神经管畸形(简称唐筛)〕的方法和群体干预的效果。方法:利用妇幼三级保健网络,进行唐筛的宣传、标本的采集、转运和检测母体血清中甲胎蛋白和绒毛膜促性腺激素的浓度;对高危孕妇进行咨询,对彩超诊断胎儿畸形并同意者做染色体核型分析确诊;全部进行产后随访。结果:1998~2005年5月共筛查6.25万人,城区筛查率为70%,确诊出生缺陷245例(其中神经管缺陷畸形105例、唐氏综合征等染色体异常17例)。羊膜腔穿刺及羊水细胞培养成功率均达到100%。结论:在妇幼保健三级保健网络中开展唐氏综合征系列产前筛查是降低出生缺陷的有效措施,值得推广。     

The vaginal ring and transdermal patch: new methods of contraception

The most common method of reversible contraception used worldwide is the intrauterine device. However, in the Asia-Pacific the combined oral contraceptive pill and condoms, methods of contraception that require a high degree of day-to-day user compliance, are more popular. The combined vaginal ring and transdermal patch have been developed to overcome the need for daily compliance associated with combined pill use. They have the added advantages of non-oral delivery, thus avoiding gastro-intestinal interference with absorption, and in addition there is no hepatic first-pass effect. Both have been available internationally for some years and offer an alternative to the combined pill. This article reviews and summarises published data on these new methods.     

灵宝市餐饮业人员艾滋病干预措施评价

目的评价不同健康教育模式对宾馆,职工食堂,饭店等餐饮业单位外来务工人员艾滋病知识和态度的干预效果。方法将在灵宝市疾病预防控制中心参加健康体检的外来务工人员随机分为4组,其中3个干预组,1个空白组。结果集中宣教、集中宣教和观看VCD、观看VCD和空白对照4种方法有统计学意义(P<0.05),进行两两比较集中宣教,观看VCD和集中宣教比较无统计学意义(P>0.05),观看VCD和空白对照比较无统计学意义,其他两两比较均有统计学意义。外来务工人员对艾滋病态度4组之间有统计学意义(P<0.001),两两比较只有集中宣教,观看VCD和空白组有统计学意义(P<0.05)。结论不同干预措施有不同的干预效果,其中集中宣教和发放宣传资料,观看VCD效果最好。