Diagnosis and management of Candida of the nipple and breast

Diagnosis and treatment of ductal and/or nipple candidiasis in breastfeeding women is complicated by the variety of symptoms women experience. The differential diagnosis includes candidiasis of the nipple, candidiasis of the breast, bacterial infection of either nipple or breast, and other less common problems such as Raynaud's syndrome. Diagnosis and treatment are based on history, physical examination, and presenting symptomatology because cultures of breast milk are often inconclusive. Differential diagnoses and treatment options are reviewed.     

Comparison of indications of pregnancy termination and prognosis of mothers and neonates in early- and late-onset preeclampsia

Objective: To compare the indications of pregnancy termination and prognosis between early-onset preeclampsia (EOP) and late-onset preeclampsia (LOP). Methods: In total, 100 patients diagnosed early-onset preeclampsia in our hospital from January 1, 2012, to June 30, 2014, were recruited for this retrospective cohort study. At the same time, we randomly chose another 100 late-onset preeclampsia as the contrast group. Criterion distinguishing early versus late was set at week 34 of gestation. Indications for pregnancy termination and prognosis of mothers and neonates were compared between the groups. Results: Significant differences were observed between the groups regarding indications for terminating pregnancy. The EOP indications to terminate the pregnancy were mainly fetal-related, while LOP were mainly maternal-related. Postpartum neonatal morbidity and mortality were significantly higher, mean gestational age onset and delivery were significantly earlier, latent period for delivery and postpartum hospitalization time were significantly longer, admission 24 h proteinuria was significantly higher in EOP than in LOP group (P < 0.05). Conclusion: EOP is a distinct and more severe clinical entity with earlier gestational age onset and delivery. EOP might be a fetal-related disease complicated by severe placental and perinatal injuries; LOP might be a maternal-related derived disease condition.     

Pharmacokinetics and endometrial and tubal tissue penetration of cefalotin and cefazolin

The pharmacokinetics and concentrations of the two antibiotics cefazolin and cefalotin were studied during gynecologic operations in endometrial and tubal tissue. The patients received 0.05 g/kg of the antibiotics by intravenous injection. Under the given conditions, pharmacokinetic calculation of the plasma elimination gave half-lives of 24.8 min for cefalotin and of 63 min for cefazolin. Fitting of the tissue levels to the Bateman function showed that the two antibiotics diffuse rapidly into both tubal and endometrial tissue and attain peak concentration levels between 10 and 25 min. In both tissues the concentrations of cefazolin were higher than those of cefalotin. Higher tissue concentrations of cefazolin could also be demonstrated in experiments of longer duration.     

Vitamin and homocysteine status of mothers and infants and the risk of nonsyndromic orofacial clefts

OBJECTIVE: This study was undertaken to investigate the involvement of maternal and infant B vitamins and homocysteine as risk factors for orofacial clefting. STUDY DESIGN: Venous blood samples were taken from 96 infants with nonsyndromic orofacial clefts and 88 infants without a congenital malformation and from their mothers at approximately 14 months after the index pregnancy. Red blood cell and serum folate, serum vitamin B(12), whole blood vitamin B(6) as pyridoxal-5'-phosphate (PLP), and plasma homocysteine concentrations were measured. RESULTS: A vitamin B(12) concentration of 185 pmol/L or less and a PLP concentration of 44 nmol/L or less in mothers increased the risk of having a child with an orofacial cleft (odds ratio [OR]=3.1; 95% CI: 1.3-7.4, OR=2.9; 95% CI: 1.2-7.1, respectively). Infants with orofacial clefts had a 15% lower serum folate concentration compared with controls (P=.06). CONCLUSION: A low vitamin B(12) and PLP concentration in mothers increased the risk of orofacial clefts in the offspring. A possible role of the infant's folate status is suggested.     

关于妇产科综合征的理解和应用

综合征(syndrome)来源于希腊语syn("一起"、"共同"之意)和drómos(事件),并起意为"同时发生或同时发生的事件"(concurrence).其实,这也是医学词汇里最古老的名词之一,可以追溯到希腊的波克拉底和盖伦时代,就已被用于描述同时发生的一组症状[1].     

Irisin与糖脂代谢性疾病的研究进展

Irisin是一种新发现的肌肉因子,其前体物质为Ⅲ型纤连蛋白结构域5(FNDC5)。运动使骨骼肌中的过氧化物酶体增殖活化受体γ(PPARγ)辅助激活因子1α(PCG-1α)的表达增加,PCG-1α能诱导FNDC5表达,FNDC5断裂后可形成分泌性的肌肉因子Irisin,从而诱导白色脂肪棕色化,导致能量消耗增多,体质量减轻,改善糖耐量和胰岛素抵抗,调节糖脂代谢和能量代谢。因此,Irisin有望成为治疗糖脂代谢性疾病的新靶点。本文对Irisin与糖脂代谢性疾病的相关性研究进行综述。     

Accuracy and correlates of maternal recall of birthweight and gestational age

Objective  To determine the accuracy of maternal recall of children birthweight (BW) and gestational age (GA), using the Danish Medical Birth Register (DBR) as reference and to examine the reliability of recalled BW and its potential correlates.
Design  Comparison of data from the DBR and the European Youth Heart Study (EYHS).
Setting  Schools in Odense, Denmark.
Population  A total of 1271 and 678 mothers of school children participated with information in the accuracy studies of BW and GA, respectively. The reliability sample of BW was composed of 359 women.
Method  The agreement between the two sources was evaluated by mean differences (MD), intraclass correlation coefficient (ICC) and Bland–Altman's plots. The misclassification of the various BW and GA categories were also estimated.
Main outcome measures  Differences between recalled and registered BW and GA.
Results  There was high agreement between recalled and registered BW (MD =−0.2 g; ICC = 0.94) and GA (MD = 0.3 weeks; ICC = 0.76). Only 1.6% of BW would have been misclassified into low, normal or high BW and 16.5% of GA would have been misclassified into preterm, term or post-term based on maternal recall. The logistic regression revealed that the most important variables in the discordance between recalled and registered BW were ethnicity and parity. Maternal recall of BW was highly reliable (MD =−5.5 g; ICC = 0.93), and reliability remained high across subgroups.
Conclusion  Maternal recall of BW and GA seems to be sufficiently accurate for clinical and epidemiological use.     

PRL-3和MMP-9与子宫内膜异位症侵袭、种植关系的研究

目的:观察促肝细胞再生磷酸酶3(PRL-3)和基质金属蛋白酶9(MMP-9)在子宫内膜异位症(EMs)的表达,探讨它与子宫内膜异位症侵袭、种植的关系。方法:用SABC免疫组织化学法检测PRL-3和MMP-9在31例EMs的异位内膜及在位内膜组织、27例正常子宫内膜组织的表达。结果:PRL-3与MMP-9表达的强弱顺序均为:EMs组异位内膜>EMs组在位内膜>对照组子宫内膜,组间差异有统计学意义(P<0.05);Ⅰ~Ⅱ期的异位内膜PRL-3及MMP-9表达强度均高于Ⅲ~Ⅳ期(P<0.05),但在位内膜二者表达强度在不同临床分期中无统计学差异(P>0.05)。EMs组异位内膜的PRL-3与MMP-9表达呈正相关(P<0.05),在位内膜的PRL-3与MMP-9表达则无明显相关性(P>0.05)。结论:PRL-3和MMP-9可能与EMs的侵袭、种植密切相关。     

新生儿围产期肝脾出血的临床特点和预后分析

目的 总结新生儿围产期肝脾出血的临床特点、诊治方法 和预后.方法 回顾分析1992年6月1日至2009年6月1日南京医科大学附属南京儿童医院新生儿内、外科收治的围产期肝脾出血新生儿的临床资料,分析病因、临床表现、治疗及预后情况.结果 围产期肝脾出血新生儿共23例,其中巨大儿12例,早产儿6例.主要原因是异常分娩史(剖宫产、胎儿窘迫、产程延长、胎头吸引、急产等)和产伤,分别占65.2%(15/23)和47.8%(11/23).肝出血14例,脾出血6例,肝脾同时出血3例.早期主要临床表现包括反应差、嗜睡、拒乳者21例(91.3%),早期出现黄疸者18例(78.3%),苍白、贫血貌者17例(73.9%),腹胀者15例(65.2%),其他临床表现包括易激惹、呼吸困难、腹壁发紫、阴囊血肿等.保守治疗15例;手术治疗8例,其中死亡3例,病死率13.0%.结论 新生儿围产期肝脾出血与巨大儿、早产儿及异常分娩史有关,以产伤为主要原因,临床表现与出血量有关,早期表现具有非特异性,超声是最好的诊断手段.血流动力学稳定的患儿保守治疗成功率高,出血不止者应尽早手术.

Abstract：

Objective To summarize the clinical characteristics,diagnosis and management methods and prognosis of hepatorrhagia and splenorrhagia of newborns.Methods A retrospective review of clinical data of neonates with hepatorrhagia and splenorrhagia in perinatal period was performed from June 1,1992 to June 1,2009 in Nanjing Children's Hospital.Results There were twenty-three neonates suffered from hepatorrhagia and splenorrhagia in the perinatal period.There were 12 macrosomias and 6 preterm newborns.Abnormal birth history (65.2%,15/23),including caesarean section,fetal distress,application of vacuum extractor,prolonged labour and precipitate labor,were most commom reasons of hepatorrhagia and splenorrhagia,and birth injuries [47.8% (11/23)]was subsequent.In all cases,14 cases were hepatorrhagia,six were splenorrhagia,three were hepatorrhagia and splenorrhagia simultaneously.Primary early symtoms included low response,sleepiness (91.3%,21/23);jaundice 78.3% (18/23);pallor and anemia 73.9% (17/23);abdominal distension (65.2%,15/23) and so on.Ultrasonography and computed tomography may make a definite diagnosis.Fifteen newborns underwent non-operative treatment and 8 received hemostatic laparotomy.The general mortality was 13.0%(3/23).Conclusions Hepatorrhagia and splenorrhagia of neonates in perinatal period is associated with macrosomias,abnormal birth history and preterm birth,and birth injuries were the major etiological factors.Clinical presentations are nonspecific which maybe asociated with the degree of blood loss.Abdominal ultrasonography is an optimal diagnostic method.Nonoperative management may be successful in hemodynamically stable patients,while immediate intervention,such as laparotomy,is required to control persist bleeding.     

植物雌激素与中老年女性骨质疏松症

大多数的临床试验结果提示植物雌激素可以增加中老年女性腰椎骨密度,降低骨吸收指标尿脱氧吡啶啉（urine deoxypyridinoline,DPD）水平,从而降低中老年女性骨折的风险。但是,现有的研究证据还不足以推荐植物雌激素作为治疗中老年女性骨质疏松症的标准方案,仅可作为个体化治疗的一种有益的选择。     

Evaluation of pelvic and breast examination skills of interns in obstetrics and gynecology and internal medicine

OBJECTIVE: The purpose of this study was to evaluate the pelvic and breast examination skills of a group of interns who were entering obstetrics and gynecology and internal medicine and to determine whether previous experience predicts performance. STUDY DESIGN: This was a prospective study that, with the use of an examination with a standardized format of 26 skills, assessed the performance of 10 interns who were entering internal medicine and 9 interns who were entering obstetrics and gynecology. chi(2) analysis and Fisher exact tests were used. RESULTS: There was no significant difference in overall performance on the pelvic and breast examinations between the two groups. The obstetrics and gynecology interns performed significantly better (P<.05) on the three skills that assessed professional conduct. There was considerable variability within each group. There was no correlation between previous clinical experience and performance on the skills assessment, nor was there a correlation between perceived competence and actual performance. CONCLUSIONS: Previous clinical experience does not predict performance in a standardized assessment of pelvic and breast examination skills nor does it account for the great variability in competence levels in interns who are entering obstetrics and gynecology and internal medicine.     

Physician and patient use of and attitudes toward complementary and alternative medicine in the treatment of infertility

Objective

To determine use of and attitudes toward complementary and alternative medicine (CAM) among infertility patients and subspecialty physicians.

Methods

Infertility patients were asked to complete anonymous written surveys at an academic infertility practice; members of the Society for Reproductive Endocrinology and Infertility were electronically surveyed. Both groups were assessed regarding their use of and attitudes toward CAM.

Results

The response rate was 32.1% (115/358) among patients and 22.6% (225/995) among physicians (P < 0.05). In total, 105 (91.3%; 95% confidence interval [CI], 85.8–96.2) patients used CAM, and 84 (73.0%; 95% CI, 64.9–81.1) regarded it as beneficial to their fertility treatment. However, only 30 (26.1%; 95% CI, 18.0–34.0) patients reported CAM use to physicians, with the most common reason being that they were “never asked.” Overall, 202 (89.8%; 95% CI, 85.9–93.8) physicians reported inquiring about CAM.

Conclusion

Significant discrepancies exist between subfertile patients and physicians in attitudes toward the use of CAM. The current prevalence of CAM use among infertility patients requires greater physician attention and justifies further study on the risks and benefits of integrating CAM into the biomedical treatment of infertility.     

Diagnosis and management of preeclampsia and eclampsia

Hypertensive disease occurs in approximately 12-22% of pregnancies, and it is directly responsible for 17.6% of maternal deaths in the United States (1,2). However, there is confusion about the terminology and classification of these disorders. This bulletin will provide guidelines for the diagnosis and management of hypertensive disorders unique to pregnancy (ie, preeclampsia and eclampsia), as well as the various associated complications. Chronic hypertension has been discussed elsewhere (3).     

妇产科学的解剖绘图

这也许是尚无人涉猎的主题,但却是与我们日常的医疗工作密不可分的问题.诊断与治疗离不开解剖学的观念和知识,可是我们却常常忽略表达解剖的绘图以及它的作用和技法.学习、应用解剖绘图是一种科学与艺术结合的体验和实践.