孕酮阴道环体外释放度的研究

目的:测定并比较自制孕酮阴道环和进口孕酮阴道环的体外释放度。方法:采用HPLC分析法进行体外释放实验,十八烷基键合硅胶为填充剂,以甲醇:水(63∶37)为流动相,流速为1.0ml/min,检测波长254nm。结果:自制孕酮阴道环的d7释药量和90d的平均释药量分别为10.5mg/d、9.0mg/d,进口孕酮阴道环的d7释药量和90d的平均释药量分别为10.4mg/d、9.2mg/d。结论:自制孕酮阴道环和进口孕酮阴道环体外释药量基本一致。     

甲地孕酮阴道避孕药环体外释放量测试研究

本文研究了甲地孕酮避孕药环体外释放,以带磨口的广口瓶作释放池,内放一定体积的1:750氯化[烃基二甲基代苯甲]铵水溶液作为释放介质。甲地孕酮硅橡胶环浸在介质中,在37℃恒温条件下,以一定的频率和振幅振荡,每隔24小时调换介质溶液。用紫外分光光度法,在波长290nm 处测定释放液中甲地孕酮的含量。实验结果表明,甲地孕酮经最初七天的快速释放后,达到稳态释放。     

国产天然孕酮阴道环的抗生育作用药效学和动物体内血药浓度变化研究

目的:研究和观察天然孕酮阴道环的长效避孕效果,及其在山羊体内的血药浓度和持续释放时间。方法:①将24只具有生育能力的新西兰雌兔随机分为4组,分别阴道置入空白环、天然孕酮阴道环低剂量(210 mg/环)、中剂量(420 mg/环)和高剂量(840 mg/环)。手术15 d后进行交配,观察天然孕酮阴道环对家兔的长效避孕效果。②将12只去卵巢山羊随机分为2组,分别给予国产和智利产天然孕酮阴道环,并于置入阴道环前、后不同时间点颈静脉采血,用磁性分离酶联免疫法测定血清中天然孕酮的浓度。结果:①阴道环对动物的一般状况均无明显影响,高剂量组和中剂量组避孕效果较好,能维持3个月,而低剂量组避孕效果较差。②国产和智利产阴道环血药浓度除20 d、27 d、90 d外无显著性差异(P>0.05)。结论:天然孕酮阴道环高、中剂量组均有长效避孕作用;与智利孕酮阴道环相比,国产天然孕酮阴道环放置在山羊阴道后的血药浓度变化无明显差异,其维持释放剂量和时间相当。     

甲地孕酮硅橡胶阴道环突破性出血机制的初步探讨

本文测定了16例放置甲地孕酮硅橡胶阴道环妇女外周血及子宫内膜组织中的雌二醇(E_2)和孕酮(P)含量,正常对照组8例。结果表明各组间外周血E_2、P 水平无显著差异;使用甲硅环发生突破性出血(BTB)者内膜组织中E_2含量显著低于正常对照组及放环未出血组(P<0.05);各组内膜组织中的P 含量无显著差异。研究结果提示使用甲硅环是否发生BTB与外周血中E_2、P 水平无关;而子宫内膜组织中E_2含量低可能是BTB 发生的主要原因。     

黄体酮阴道环在家兔的药代动力学研究

目的:提供研制可供哺乳期妇女避孕的黄体酮阴道环的药理学依据。方法:将18只去卵巢后2周的新西兰雌兔随机分为3组:阴道环低剂量组(175mg,A组)、高剂量组(350mg,B组)及肌注组(C组),分别在放置阴道环及肌注黄体酮前后不同时点取静脉血,用磁性分离酶联免疫法测定兔血清中黄体酮的浓度,用PK-Graph程序计算药代动力学参数。结果:黄体酮阴道环和黄体酮注射剂在兔体内的药代动力学符合二室开放模型。主要药代动力学参数分别是A组:Tmax:2.23±1.3h,Cmax:47.64±23.58ng/ml,T1/2:818.08±511.77h,AUC:16115.11±8398.88ng·ml·h-1;B组:Tmax:2.03±1.33h,Cmax:74.04±24.57ng/ml,T1/2:730.31±306.49h,AUC:28751.95±7151.95ml·h-1;C组:Tmax:1.54±0.77h,Cmax:138.88±60.96ng/ml,T1/2:2.55±0.89h。其中A组的AUC(56d)明显低于B组,二者有显著性差异(P<0.05);A组和B组的Cmax均低于C组,差异显著(P<0.05);A组和B组的T1/2均明显高于C组(P<0.01),但A、B组间无差异。结论:与传统的黄体酮注射剂相比,黄体酮阴道环的药代动力学参数呈现明显的长效缓释特征。应可成为安全长效且使用方便的哺乳期避孕药具。     

苯扎溴铵的体外杀精效果及对阴道粘膜刺激性研究

目的 :研究苯扎溴铵的体外杀精效果及其对大鼠阴道粘膜的刺激性 ,以初步评价该药作为外用避孕药应用的可能性。方法 :将药物溶液与新鲜精液直接混合后镜检 ;用导管将药物凝胶涂布于大鼠阴道内 ,每天一次 ,一周后解剖做病理切片观察并评分。结果 :苯扎溴铵的最低杀精浓度为 0 .2 7mg/m L,略高于壬苯醇醚 - 9(0 .2 0 mg/m L ) ;苯扎溴铵凝胶对大鼠阴道粘膜刺激性评分值为 7.6 7±0 .82 ,在可接受的范围内 ,与壬苯醇醚 - 9组 (7.3 3± 0 .82 )相比无统计学差异。结论 :苯扎溴铵具有体外杀精作用 ,但同时也有轻度、可接受的阴道刺激性 ,作为外用避孕药是可行的     

腹腔镜和经阴道子宫颈环扎术治疗子宫颈机能不全患者的疗效分析

目的:探讨腹腔镜和经阴道子宫颈环扎术治疗子宫颈机能不全患者的疗效及安全性.方法:回顾性分析2016年6月至2020年6月因子宫颈机能不全在南京医科大学附属无锡妇幼保健院行子宫颈环扎术的患者资料,共计150例,孕前行腹腔镜子宫颈环扎者61例(A组),其中既往经阴道环扎失败35例;孕期行腹腔镜子宫颈环扎者49例(B组),其...     

阴道菌群中粪肠球菌对阴道加德纳菌、阴道阿托波菌和两种菌混合生长的生物膜影响的体外研究

目的:研究阴道菌群中粪肠球菌上清液对阴道加德纳菌、阴道阿托波菌和两种菌混合生长的生物膜形成的影响。方法:选取初次诊断为BV患者阴道分泌物中分离纯化鉴定的阴道加德纳菌和阴道阿托波菌,观察加德纳菌单独培养及加德纳菌与阿托波菌共培养24、48、72h的生长情况,通过检测OD值观察生物膜形成情况。通过检测OD值观察加德纳菌单独培养及其与阿托波菌共培养时加入含粪肠球菌代谢产物的上清液24、48、72h的生物膜形成情况。结果:加德纳菌生物膜形成较好,阿托波菌几乎无生物膜形成。总菌量相等的加德纳菌单独培养与加德纳菌和阿托波菌共培养时的OD值无显著差异(P=0.259,P>0.05)。加德纳菌及其与阿托波菌共培养时加含粪肠球菌代谢产物的上清液较不加上清液时OD值显著降低(P<0.05)。结论:加德纳菌和阿托波菌有相互促进生物膜形成作用。加入含粪肠球菌代谢产物的上清液对加德纳菌和加德纳菌与阿托波菌共培养形成的生物膜有显著抑制作用。     

哺乳期妇女放置缓释黄体酮阴道环和铜T380A宫内节育器避孕效果及其安全性研究

本文对产后４２～６０天的哺乳妇女放置每天释放１０ｍｇ天然黄体酮的阴道环（１６０例）与铜Ｔ３８０Ａ宫内节育器（１００例）进行避孕效果及其安全性比较研究。结果表明：通过宣教，产后４２～６０天落实节育方法是可行的，放置铜Ｔ３８０Ａ宫内节育器在哺乳期无妊娠发生，哺乳期避孕对母儿健康无不良影响。围产保健和计划生育并行对提高母乳喂养率，落实计划生育方法，降低人工流产率，保障母儿健康收效显著，值得推广。     

体外诱导耐环吡酮胺白假丝酵母菌的实验研究

目的拟建立白假丝酵母菌对环吡酮胺的耐药模型。方法采用浓度梯度递增的环吡酮胺体外诱导妇产科门诊外因阴道假丝酵母菌病患者阴道分泌物分离的白假丝酵母菌,参照美国临床实验室标准化协会(CLSI)推荐的M27-A3方案的微量液基稀释法方法对试验中0.03、0.06、0.125、0.25、0.5、1、2、4和8μg/ml各不同药物诱导浓度下的菌株进行药物敏感性检测。结果用环吡酮胺诱导白假丝酵母菌20代,菌株对环吡酮胺的最低抑菌浓度(minimal inhibitory concentration,MIC)≤0.5μg/ml。结论采用环吡酮胺浓度梯度递增方法,在20代诱导中不能使白色假丝酵母菌株对其产生耐药。     

Retrospective Review of Reproductive Outcomes Comparing Vaginal Progesterone to Intramuscular Progesterone as Luteal Support in Frozen Embryo Transfer Cycles

ObjectiveRecent literature suggests that progesterone in oil (PIO) is superior to vaginal progesterone (VP; Prometrium) for endometrial preparation in frozen embryo transfer cycles (FET), improving the live birth rate and reducing the rate of miscarriage. PIO has disadvantages including cost, pain, and stress of administration. The objective of this study was to evaluate whether VP is non-inferior to PIO for medicated FET cycles.MethodsWe conducted a retrospective analysis comparing pregnancy, miscarriage, and live birth rates for PIO versus VP for medicated FET cycles, from 2017 to 2020 at a single fertility clinic. A total of 745 participants were included in the study; 438 received VP, and 307 received PIO. Univariate and multivariate binary and ordinal logistic regression analyses were performed to compare the rates of pregnancy, miscarriage, and live birth between VP and PIO.ResultsOur data demonstrated no difference between PIO and VP with respect to the rates of pregnancy (51% vs. 53%), miscarriage (20% vs. 18%), or live birth (31% vs. 34%) (all P > 0.05). For participants taking PIO, the odds of pregnancy were 0.93 [95% CI (0.70, 1.25), P = 0.65] that of participants on VP.ConclusionIn our single-centre experience, VP was non-inferior to PIO for endometrial preparation in FET cycles.     

Progesterone levels on the hCG day and outcomes in vitro fertilization in women with polycystic ovary syndrome

Background

The purpose of this study was to determine the incidence of premature luteinization in patients with polycystic ovary syndrome and compared the main determinants of success in in-vitro fertilization in PCOS patients with and without premature luteinization.

Methods

Retrospective analysis of 180 PCOS women of Chinese Han origin with infertility who underwent controlled ovarian hyperstimulation (COH) with an exogenous gonadotropin/GnRH antagonist protocol. Hormone levels on the hCG day and IVF outcomes were assessed.

Results

The incidence of premature luteinization was 23.3 %. Compared with PCOS patients without premature luteinization, PCOS patients with premature luteinization(PL) had a higher number of oocytes retrieved (18.20 ± 6.6 vs 15.08 ± 7.3, p = 0.037) and a higher fertilization rate (72.9 ± 1.9 vs63.1 ± 2.3, p = 0.033), but clinical pregnancy rates were no statistical significance (53.3 vs 56.0, p = 0.836). Though the implantation rate was higher in no premature luteinization patients, but the difference was not statistically significant (37.7 vs 30.3, p = 0.115).

Conclusion

The PCOS patients with premature luteinization had a higher fertilization rate and high number of oocytes retrieved, and the similar implantation rate and clinical PRs as PCOS patients without premature luteinization.     

活性元宫型药铜365宫内节育器体外释放吲哚美辛的研究

目的:建立国产活性元宫型药铜365宫内节育器中吲哚美辛体外释放度测定方法。方法:以模拟宫腔液为释放介质,控制温度(37.0±0.1℃),匀速磁力搅拌,控制速度为70r/min,采用紫外分光光度法测定药物含量及释放量。结果:吲哚美辛的吸收度与浓度呈良好的线性关系,吲哚美辛的释放于d3达到平衡。结论:建立的吲哚美辛释放度测定方法简便、准确,可用于质量控制。     

取卵日血清孕酮水平与ICSI周期可用胚胎数及妊娠结局的关系

目的:探讨ICSI周期取卵日血清孕酮水平与可用胚胎数及妊娠结局的关系。方法:对289例超促排卵后经ICSI助孕的患者资料进行回顾性分析。结果:在预测取卵后d3可用胚胎数方面,取卵日血清孕酮水平与注射hCG日E2水平的相对风险度分别为1.83和1.39。使用受试者工作曲线,界定出预测取卵后d3可用胚胎数目<4的取卵日孕酮浓度是11.7ng/ml。取卵日孕酮水平较高的患者获得了更多的可用胚胎且差异显著,但妊娠结局并无差异。结论:取卵日血清孕酮水平与可用胚胎数目相关,但不影响新鲜ICSI周期妊娠结局。     

干扰素－α对离体大鼠黄体细胞孕酮生成的影响及与Ca~（2＋）的关系

本工作采用离体培养大鼠黄体细胞的方法，观察了干扰素－α（ＩＦＮ－α）对黄体细胞孕酮生成的影响。１００～２０００ｕ／ｍｌ的ＩＦＮ－α能明显地刺激黄体细胞孕酮的生成，并呈剂量依赖式关系，其作用在２ｈ后达最大。实验进一步观察到，培养液中无Ｃａ２＋、加入ＥＧＴＡ或戊脉胺（Ｖｅｒａｐａｍｉｌ）可明显地抑制ＩＦＮ－α的促孕酮生成作用；相反，Ｃａ２＋载体Ａ２３１８７、培养液中高Ｃａ２＋、高Ｋ＋可增加ＩＦＮ－α的促孕酮生成作用。本实验结果表明，ＩＦＮ－α刺激大鼠离体黄体细胞孕酮生成的作用，依赖于细胞外的ｃａ２＋。     

药铜宫形节育器体外释放药物速率的初步研究

本文用紫外分光光度法对大型和中型药铜宫形节育器在体外进行９０天内每天消炎痛的释放量及第１２０、１５０和１８０天的释放量测定。结果表明，两种型号的节育器具有相同的释放特征。在第１个月内，药物呈瀑布样释放，其累计量分别为总含量的５３．１９％和５２．０４％，以后释放量逐日减缓，至３个月后趋于稳定，释放时间可维持７～８个月。     

孕激素协同降钙素基因相关肽在妊娠高血压综合征发病中的作用

目的 探讨妊娠高血压综合征（简称妊高征）发病中降钙素基因相关肽（calcitonin gene-related peptide,CGRP）及孕激素协同CGRP所起的作用。方法 体外原代培养8例妊高征患者的脐静脉内皮细胞，特细胞融合成为单层后随机分为四组，分别加入正常孕妇血清（第1组）、妊高征患者血清（第2组）、妊高征患者血清及孕激素（第3组）、等量的1640培养液（第4组），均置于37℃、5％的CO2培养箱中培养24h，收集培养液，应用放射免疫法测定其中CGRP及内皮素（en-dothelin,ET）的含量。结果 第2组与第1组比较，CGRP明显下降，ET明显升高，ET／CGRP差异无显著性；第3组与第1组比较，CGRP无变化，ET明显升高，ET－CGRP差异无显著性；第2组与第3组比较，CGRP明显下降，ET无变化，ET／CGRP差异有显著性。结论 在妊高征的发生、发展过程中，孕激素可能与CGRP共同起到延缓作用。     

A Prospective Study to Determine the Predictive Ability of HDP-Gestosis Score for the Development of Pre-eclampsia

BackgroundHDP-gestosis score is a risk scoring system (score 1–3) for the development of pre-eclampsia. When a pregnant woman’s total score is equal to or greater than 3, she is labelled as “at risk for pre-eclampsia” and is managed accordingly.ObjectivesTo determine the sensitivity, specificity, Positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of HDP-gestosis score for predicting pre-eclampsia.MethodsThis prospective study included 473 pregnant women who presented at the department of Obstetrics and Gynaecology, from June 2020 to December 2021. After 20 weeks of pregnancy, the patients were assessed for the development of pre-eclampsia. Details of age, gravida, obstetric history, menstrual cycle regularity, polycystic ovarian disease history, duration of marriage, parity, past medical and surgical intervention, previous/present medication, and family history were taken. Gestosis score was calculated and classified into mild (score of 1), moderate (score of 2) and high risk (score of ≥ 3) for the development of Pre-eclampsia (PE). Sensitivity, Specificity, PPV, NPV and diagnostic accuracy of HDP-gestosis score for predicting the development of PE were determined.ResultsThe mean age, gestational age, and BMI of the women were 28.4 ± 6.8 years, 11.5 ± 2.04 weeks, and 24.5 ± 3.7 kg/m^2, respectively. The gestosis score was 2 in 43.13% of the participants, 1 in 42.28%, and ≥ 3 in 14.59% of the women. PE developed in 15.01% (n = 71) participants. The Sensitivity, Specificity, PPV, NPV, and Diagnostic accuracy of HDP-gestosis score for predicting PE were 83.1%, 97.51%, 85.51%, 97.03% and 95.35%, respectively.ConclusionGestosis score is a novel early marker for prediction of the development of PE allowing for a prompt management for the patients, thereby curbing the adverse consequences.