回顾性分析190例产后妇女尿失禁发病情况及影响因素

目的探讨产后妇女尿失禁发病及影响因素,为产后尿失禁的防治提供参考依据。方法收集某院190例妇女产后复查的病案资料,结合其产后6-8周临床表现,按照是否出现产后尿失禁分为两组,进一步分析产后尿失禁发病情况及影响因素。结果 190例妇女中产后尿失禁发生率为12.11%,孕期尿失禁的发生率为16.84%,产时年龄、孕周、产次、孕次、分娩方式、新生儿出生体重以及孕期尿失禁,是产后尿失禁发生的影响因素(P<0.05)。结论高龄生产、孕周长、产次孕次增加、经阴道分娩、出生体重偏大以及孕期尿失禁,可增加产后尿失禁的发生风险,临床工作中应结合个体所存在的危险因素,有针对性地开展产后尿失禁的防治工作,改善女性盆底健康。     

高龄阴道分娩产妇产后发生盆底功能障碍的危险因素分析

目的 分析经阴道分娩高龄产妇产后发生盆底功能障碍(PFD)的相关危险因素,为减少高龄产妇产后盆底功能障碍的发生提供参考依据.方法 回顾性分析2017年3月至2018年3月在本院行阴道分娩的80例高龄产妇的临床资料,根据产后是否发生PFD分为发生组(n=35)和非发生组(n=45),通过多因素Logistic回归分析法分析高龄阴道分娩产妇产后发生PFD的独立危险因素.结果 单因素分析结果显示,产妇年龄、孕期增加体质量、妊娠期有无尿失禁、第二产程时长与经阴道分娩产妇产后PFD的发生密切相关(P<0.05);多因素Lo-gistic回归分析结果显示,产妇年龄、孕期增加体质量、孕期有尿失禁、第二产程时长是经阴道分娩产妇产后PFD发生的独立危险因素(P<0.05).结论 高龄阴道分娩产妇产后PFD的发生率较高,年龄≥40岁、孕期增加体质量>12.5 kg、妊娠期尿失禁、第二产程时长延长的产妇产后更易发生PFD,控制孕期体质量,指导产妇进行盆底功能锻炼,可减少高龄阴道分娩产妇产后PFD.     

产科因素对压力性尿失禁的发生及盆底肌力的影响

目的：探讨不同产科因素对压力性尿失禁的发生和盆底肌力的影响。方法采用国际尿控协会推荐的国际尿失禁标准问卷,对701例在新疆医科大学第一附属医院产科分娩并进行产后复查的初产妇进行问卷调查,按分娩方式分为阴道妥娩组（161例）和选择性剖宫产组（540例）,了解其孕期及产后6 w 尿失禁的发生情况,并测定盆底肌肉收缩及舒张功能,分析与尿失禁发生及影响盆底肌力有关的产科因素。结果701例产妇中有42例（5．99％）在产后6 w 左右出现了尿失禁症状;产后尿失禁的发生与分娩方式、新生儿体质量、孕前体质量、体质指数相关（P ＜0．05）;阴道分娩组、选择性剖宫产组的尿失禁发生率分别为11．18％（18/161）、4．44％（24/540）,两组差异有统计学意义（P ＜0．05）;阴道分娩组中与产后尿失禁发生有关的因素有新生儿体质量、孕前体质量和体质指数（P ＜0．05）,而与孕周、年龄、第二产程时间均无明显相关性。阴道分娩组的产后盆底肌力检测数值低于选择性剖宫产组,差异有统计学意义（P ＜0．05）。结论阴道分娩、新生儿体质量、孕前体质量、体质指数增加与产后压力性尿失禁的发生有关;阴道分娩、选择性剖宫产2种分娩方式均影响产后盆底肌力,阴道分娩可以明显降低产后盆底肌力。     

阴道顺产后压力性尿失禁发生的相关危险因素分析

目的探索分析阴道顺产后压力性尿失禁发生的相关危险因素。方法选择2014年1月至2015年6月期间在我院接受阴道顺产的产妇共100例,对产后压力性尿失禁的因素进行回归分析,筛选其影响因素。结果 2014年1月到2015年6月期间在我院接受阴道顺产的100例产妇中,出现产后压力性尿失禁者12例,发生率为12%;影响产后压力性尿失禁的相关因素中,产妇年龄、分娩孕周、新生儿体重以及孕前是否存在尿失禁等因素,对比差异不具有统计学意义,产妇孕期是否存在尿失禁对比差异明显,具有统计学意义。结论阴道顺产分娩后压力性尿失禁发生率较高,孕期尿失禁是主要的影响因素,可采取积极有效的措施,避免顺产产后压力性尿失禁的发生。     

不同产科因素对产后尿失禁的影响

目的探讨妊娠和分娩方式以及与分娩有关的不同产科因素对产后尿失禁发生率的影响.方法采用国际尿失禁咨询委员会尿失禁问卷表,对产后6～8周复查的初产妇400例进行问卷调查,询问产妇孕前、妊娠期及产后42天尿失禁的发病情况和产后下尿路症状.分析不同分娩方式与产后尿失禁的关系,探讨与尿失禁发生率有关的产科因素.结果①368例产妇中有51人(13.86%)在产后42天内至少一次出现尿失禁症状;②剖宫产、阴道顺产、产钳助产的尿失禁发生率分别为4.22%(7/166)、19.34%(35/181)、42.86%(9/21),产钳助产分别与其它两组之间有极显著性差异(P＜0.01),阴道顺产组的产后尿失禁发生率也明显高于剖宫产组(P＜0.05);③阴道分娩组中与产后尿失禁有明显关系的因素有孕期发生尿失禁、孕前体重指数、产钳助产和产后尿急尿频等症状,而与硬膜外镇痛、第一产程时间、第二产程时间、会阴裂伤、会阴侧切术、新生儿体重、产后哺乳均无明显相关性;④剖宫产中影响产后尿失禁的因素只有孕前尿失禁的发生,而与是否临产后剖宫产和新生儿体重无明显相关性.结论①剖宫产与产钳助产和阴道顺产相比具有明显的保护作用,可以显著降低产后42天内尿失禁的发生率;②产钳助产、孕期发生尿失禁、孕前高体重指数和产后出现下尿路症状可增加自娩后尿失禁发生的机率;③产后尿失禁以轻度为主,加强孕期和产后盆底肌肉训练可以预防和治疗产后尿失禁.     

阴道分娩和剖宫产对产后压力性尿失禁的影响

目的 研究阴道分娩和剖宫产对产后压力性尿失禁的影响.方法 选择2007年9月至2008年3月在我院妇产科分娩的289例产妇,通过对产妇的年龄、孕期、产后压力性尿失禁的发生、分娩方式等进行同卷调查,其中阴道分娩142例,剖宫产147例.结果 阴道分娩组发生产后压力性尿失禁发生率为22.5%,明显高于剖宫产组的10.2%,差异有统计学意义(P<0.05).结论 不同的分娩方式对产后压力性尿失禁有一定的影响,而剖宫产产后压力性尿失禁的发生率比阴道分娩发生率低.     

分娩方式对产后压力性尿失禁的影响因素

目的探讨不同的分娩方式对产后压力性尿失禁(SUI)的影响因素。方法抽取2871例分娩产妇,采用电话或信访形式调查,共回收问卷2 784份,将其分为阴道分娩组(1 931例)和剖宫产组(853例),对两组产妇的年龄、孕期、分娩方式、新生儿体重、产后SUI的发生等进行回顾性分析。结果阴道分娩组产后SUI的发生率(39.41%)明显高于剖宫产组(31.42%)。此外,孕期尿失禁、新生儿出生体重过大、第二产程过长、产钳分娩、会阴裂伤也是产后SUI的诱因。结论与阴道分娩相比,剖宫产可以降低产后SUI的发生率。     

分娩方式、胶原代谢在产后压力性尿失禁发生中的作用

目的探讨不同的分娩方式和胶原蛋白特异性代谢产物吡啶酚与产后压力性尿失禁的相关性。方法选取2011年1月-2012年1月在广州市红十字会医院行产前检查、分娩并分娩后复查的产妇82例作为研究对象,根据不同的分娩方式分为阴道分娩组42例,选择性剖宫产组40例,比较两组产妇产后压力性尿失禁发生情况,并分析其相关因素,使用酶联免疫吸附试验法（ELISA）测定尿吡啶酚的浓度。结果①产后6～8周压力性尿失禁的总发生率为15.9%（13/82）,其中阴道分娩组为26.2%（11/42）,选择性剖宫产组为5.0%（2/40）,阴道分娩组产后6～8周压力性尿失禁发生率高于选择性剖宫产组,差异有统计学意义（P〈0.05）。②孕期发生尿失禁、分娩方式及新生儿体重是产后发生压力性尿失禁的主要影响因素（P〈0.05）。③产后6～8周尿吡啶酚/肌酐值：阴道分娩组为（24.61±2.27）nmol/mmol,选择性剖宫产组为（22.11±3.55）nmol/mmol,阴道分娩组高于选择性剖宫产组,差异有统计学意义（P〈0.05）。结论经阴道分娩的产妇产后压力性尿失禁的发生率及尿吡啶酚的浓度较选择性剖宫产产妇高。     

产后尿失禁妇女的时间分布及针对性治疗策略

目的：探讨产后发生尿失禁的时间分布,以及不同分娩方式等产科因素对产后尿失禁的影响,为针对性治疗提供策略。方法选取2011年1月-2014年7月在该院分娩所有的产妇2432例,采用国际尿失禁咨询委员会尿失禁问卷表(ICI-Q-SF)对产妇进行问卷调查。结果该次调查2432例孕产妇,回收有效问卷2342份(96.30%),其中发生尿失禁者65例,发生率为2.78%;多胎产妇、阴道产产妇、经产产妇尿失禁发生率分别为30.00%、5.04%和5.76%,高于单胎产妇、剖宫产产妇和初产妇,差异有统计学意义(P<0.05)。结论尿失禁主要发生在产后8周以上,其中胎数、分娩方式和产次是产后尿失禁的独立危险因素,做好产前预防,加强盆底肌肉训练避免尿失禁风险。     

不同分娩方式对产后早期压力性尿失禁的影响

目的探讨不同分娩方式对产后早期压力性尿失禁的影响。方法抽取产科分娩的产妇228例,根据不同分娩方式分为选择性剖宫产组（CS,110例）和阴道分娩组（VD,118例）。于产后6-8周进行问卷调查（ICI-Q改良问卷）、超声检测残余尿,比较两组产妇压力性尿失禁的发病率。结果阴道分娩组发生产后尿失禁23例,发生率为11.01%（23/118）;剖宫产组产后压力性尿失禁5例,发生率为4.55%（5/110）,阴道分娩组产后压力性尿失禁发病率明显高于剖宫产组,差异有统计学意义（P〈0.05）。结论选择性剖宫产对于降低产后压力性尿失禁发生率起到一定作用。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.