宫内节育器、皮下避孕埋植剂及输卵管避孕材料特点及避孕效果分析

背景：使用安全、效率可靠、持久、无不良反应的避孕材料对生殖健康有重要意义。 目的：概述宫内节育器的进展其使用效果,分析皮下避孕埋植剂的优点、不良反应,以及输卵管避孕材料性质特点。 方法：分别以“宫内节育器,皮下避孕埋植剂,输卵管避孕,材料,避孕”为检索词,检索重庆维普(VIP)全文数据库1992-01/2011-01有关文章。根据纳入排除标准最终选入26篇进入结果分析。 结果与结论：自宫内节育器问世以来,在结构、性能、材料等方面均有不少改进和发展,是中国人使用的最多的一种避孕方法。皮下避孕埋植剂具有恒释性和缓释性、生物活性高、使用方便等优点。输卵管避孕栓具有定位准确、微小、无创、安全、可靠、可复的优点。但每种方法也都因存在或多或少的不良反应或并发症而不被接受。文章从上述3种节育方法的进展、使用效果、不良反应及材料性质特点进行了相关探讨。 关键词：宫内节育器;皮下避孕埋植剂;输卵管避孕;材料;节育,避孕 doi:10.3969/j.issn.1673-8225.2012.12.037     

形状记忆输卵管避孕材料与其他输卵管避孕材料的特点分析

背景：输卵管绝育器对女性生殖功能及内分泌平衡干扰少,方法简单有效。 目的：阐述形状记忆输卵管避孕材料与其他输卵管避孕材料的优点及不良反应。 方法：应用计算机检索1996至2013年万方医学网、中国知网、PubMed数据库有关形状记忆输卵管避孕材料与其他输卵管避孕材料的文章。 结果与结论：目前应用的输卵管避孕材料主要有记忆金属生物材料、非降解高分子生物材料及可降解高分子生物材料。形状记忆输卵管避孕器植入后,对输卵管上皮具有短期炎性刺激作用,但其对上皮输卵管黏膜层的影响是暂时的,随着植入时间延长,输卵管上皮炎性反应逐渐减退,其管壁的绒毛逐渐修复,表明输卵管再通具有可复性的组织基础。聚乙烯材料具有高抗冲性、耐磨性、优良的对化学药品稳定性、吸水性、电绝缘性、生物惰性等,现在几乎是所有宫内节育器的支架材料。硅橡胶耐热、耐寒、无毒、耐生物老化,具有化学稳定性、生理惰性、物理机械性能,植入人体组织后不会引起异物反应。聚乳酸具有较好的化学惰性、易加工性和的生物相容性,植入体内5 年后仍可能存在。     

输卵管避孕及皮下埋植缓释避孕药物的应用

目的:探讨新型可复性输卵管节育器的避孕效果以及皮下埋植缓控释避孕药引起的不良反应发生情况。方法:由第一作者应用计算机检索万方数据库(http://med.wanfangdata.com/)中与输卵管避孕和皮下埋植缓控释避孕药有关的文献,检索时限1998-01/2010-04。检索词:输卵管节育器;皮下埋植;缓控释避孕药。共入选23篇文献进一步分析。结果:镍钛合金材料、聚乙烯等高分子材料的输卵管节育器是安全的,有较好的组织相容性,且具有放置顺利、定位良好、取出自如等优点。皮下埋植避孕是一种高效、长效、安全、简便、可逆性高的深为育龄妇女欢迎的避孕方法,取出时断裂少,值得推广使用,但使用中出现的不良反应值得深入研究。结论:随着新材料技术的不断发展,希望研制出性能优良、不良反应少的避孕系统,使其更好地应用于临床。     

纳米铜/低密度聚乙烯复合材料宫内节育器对置器后子宫出血及疼痛的影响

背景：裸铜结构宫内节育器在铜离子释放过程中含有大量氧化物,容易导致女性出现出血和疼痛等。而纳米铜/低密度聚乙烯复合材料宫内节育器则可以很好地解决以上弊端,有利于维持育龄妇女的生殖健康。 目的：分析纳米铜/低密度聚乙烯复合材料宫内节育器对置器后子宫出血、疼痛的影响。 方法：将98例自愿要求放置宫内节育器的女性随机均分为两组,观察组放置纳米铜/低密度聚乙烯宫内节育器,对照组放置铜T型220C宫内节育器。放置结束后随访12个月,观察两组不良事件发生情况,包括子宫出血和疼痛等。 结果与结论：置器后随访12个月,观察组有1例出现子宫出血,2例患者出现疼痛现象,不良事件发生率为6%;对照组有5例出现子宫出血,8例出现疼痛,不良事件发生率为27%;两组不良事件发生率比较差异有显著性意义(P < 0.05)。表明纳米铜/低密度聚乙烯复合材料宫内节育器可有效减少置器后子宫出血和疼痛的出现。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

不同类型脑血管支架材料的特点及临床应用

背景：随着基础研究、临床应用,以及血管支架材料的不断发展,血管内支架置入治疗已被广泛应用于脑血管疾病治疗中。 目的：综述这几种支架材料的特点及临床应用情况。 方法：应用计算机检索CNKI数据库、万方数据库、PubMed数据库从建库到2014年3月的相关文献,中文检索关键词为“脑血管病,支架,生物相容性”,英文检索关键词为“cerebrovascular disease,stents,biocompatibility”。 结果与结论：按释放方式可将脑血管支架分为球囊扩张式支架与自膨式支架。最初应用的支架材料主要为裸金属材料,由记忆合金、医用不锈钢、钽、钴、镍钛合金等制成。由于金属支架置入后会释放金属离子,易致血栓形成,再狭窄率高,后来对其表面进行改性,出现了涂层支架与覆膜支架。支架置入治疗的围手术期并发症主要有过度灌注综合征、急性血栓形成、血管破裂和远端血管栓塞、血管痉挛和穿刺相关并发症,远期并发症主要是支架置入后再狭窄问题。相信随着科技的进步,支架材料和制作工艺的不断改进,血管支架置入治疗将更加安全有效。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程全文链接：     

组织工程支架在神经修复中的应用

背景：组织工程支架能够营造适当的神经再生微环境,富集神经再生所需的营养因子,促进轴突生长。 目的：综述近年来组织工程材料在神经损伤修复方面的科研进展。 方法：应用计算机检索PubMed数据库2009至2014年关于组织工程材料修复神经损伤的文章,检索词为“nerve regeneration, prostheses and implants”,并限定为“Full text”。同时利用计算机检索中国知网数据库2004至2014年相关方面的文章,检索词为“神经修复,材料”。 结果与结论：目前用于神经损伤的支架材料主要有天然材料、天然衍生材料、合成材料与复合材料,不同种材料具备各自的优点与缺点。通过化学交联剂或化学修饰,将天然衍生聚合物与其他天然或合成材料复合,可提高其理化和生物学特性,即复合材料神经支架取得的神经再生效果比单一材料效果好,因此当前的研究热点是复合材料。在临床研究方面,胶原蛋白基的神经修复支架材料已开始进入临床研究阶段。 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

Norplant皮下埋植避孕药对妇女rRNA活性基因影响的自身对比观察

本文应用银染技术对接受Norplant皮下埋植避孕剂妇女的外周血淋巴细胞染色体核仁组织者区的rRNA分别进行用药前、后的自身对照研究。以端着丝粒染色体核仁组织者区银染粒（Ag－NOR）和核仁组织区银染联合数（Ag－AA）的观察，间接了解核糖体活性基因变化情况。观察用药前与用药后30天、180天、365天、730天、1090天的5组自身对比。结果表明：接受Norplant皮下埋植剂避孕妇女用药前、后的rRNA活性基因无显著性变化。     

接受Norplant皮下埋植避孕剂的妇女姊妹染色单体互换（SCE）的研究

本研究对接受Ｎｏｒｐｌａｎｔ皮下埋植避孕剂妇女埋药前与埋药后３０天、１８０天、３６５天、７３０天、１０９０天、１４５５天进行了外周血淋巴细胞染色体姊妹染色单体互换（ＳＣＥ）频率分别作自身对比研究。结果表明，各组埋药前后的ＳＣＥ频率无显著性差异。可认为Ｎｏｒｐｌａｎｔ皮下埋植避孕剂在其有效剂量之内，不引起ＤＮＡ损伤的遗传效应。     

胶原/壳聚糖止血敷料在外科伤口中的应用

背景：壳聚糖与胶原联合可更有效地止血。 目的：评价胶原/壳聚糖止血敷料的材料学性能及应用于外科伤口的生物相容性。 方法：以“生物材料,止血敷料,纱布,胶原/壳聚糖,生物相容性”为中文关键词,以“biomaterial;hemostatic material;bioresorbable material;hemostasis effect;hemostatic mechanism”为英文关键词,采用计算机检索2000-01/2010-06与生物敷料、胶原/壳聚糖止血材料在伤口或创面止血过程中应用相关的文献。 结果与结论：壳聚糖独特的生物学特性,具有广谱抑菌、促进上皮细胞生长及止血,促进创面愈合的作用,在体内具有良好的生物降解性与组织相容性,可用于指端损伤和肉芽创面的治疗,如制成伤口敷料、可吸收缝线、止血材料、防粘连剂、药物缓释及组织工程支架,用于平战时伤口的处理。     

人工骨或自体骨移植联合椎弓根钉内固定修复脊柱结核

背景：随着内固定材料和内固定技术的发展,越来越多的国内外学者开始应用人工骨材料联合椎弓根钉内固定修复脊柱结核。目的：综述人工骨修复材料联合椎弓根内固定修复脊柱结核的特点。方法：应用计算机检索CNKI和PubMed数据库1985至2014年有关人工骨移植材料修复脊椎结核方面的文献,中文关键词为“脊椎结核、骨移植、内固定”,英文关键词为“Spinal tuberculosis,Bone graft,Fixation”。结果与结论：在骨修复材料联合椎弓根内固定修复脊柱结核中,自体骨是骨移植的金标准,无免疫排斥反应,但为了避免自体骨取骨量有限、取骨后疼痛等并发症的发生,人工骨材料得到了广泛研究。目前应用的人工骨材料主要包括钛及其合金、羟基磷灰石复合物及医用硫酸钙,具有良好的生物相容性,但均存在一定的局限性和不足。     中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

Intrauterine devices and intrauterine systems

From a public health viewpoint, the intrauterine device (IUD)is the most widely used contraceptive method in the world. Prevalencerates range among countries from 2 to 80% of contraceptive users.During 5 years of IUD use, pregnancy occurs in less than 2 per100 insertions. Bleeding and pain are the most common reasonsfor removal rates of 10% in the first year and up to 50% within5 years. The contraceptive effects of IUDs may be due to a sterileinflammatory reaction in the endometrial cavity which interfereswith sperm function, so that fertilization is less likely tooccur. IUDs also interfere with implantation but the extentto which this contributes to their contraceptive action is unknown.In nulliparous women rates of expulsion and removal for bleedingand/or pain are higher than in parous women. Effective use ofIUDs for up to 10 years has the same pregnancy rate as tubalinterruption. Thus, the IUD may be an alternative to femalesterilization, especially in younger women who are more likelyto experience regret after sterilization. The levonorgestrelintrauterine system (LNG-IUS) reduces bleeding and dysmenorrhoea,provides superior effectiveness to copper IUDs, and may be auseful treatment for endometriosis or an alternative to hysterectomyfor menorrhagia.     

Long term use of inert intrauterine contraceptive devices in 94 women in Israel.

A 22 year retrospective survey was undertaken in an Israeli family practice to determine how long inert (plastic only, unmedicated) intrauterine contraceptive devices could be safely left in place. Ninety four women were identified who had used 100 inert intrauterine contraceptive devices continuously for between five and 19 years. Fifty nine women complained of pain, increased uterine bleeding or increased vaginal discharge, but these were the reasons for removal of the device in only 32 women. There was only one case of pelvic inflammatory disease but this was treated without removal of the intrauterine contraceptive device. Of 14 women who requested to have their device removed after between five and nine years without having had any side effects, 11 women conceived within nine months. The results of the study indicate that inert intrauterine contraceptive devices can be safely left in place until the menopause. As it will take many years before the new type of copper devices can be shown to be as safe for long term use, it seems an appropriate time to reintroduce inert intrauterine contraceptive devices for women.     

Contraceptive failure rates in France: results from a population-based survey

BACKGROUND: Despite the widespread use of highly effective contraceptive methods in France, one in every three pregnancies is unintended, of which 65% occur while using contraceptives. In the USA, 49% of pregnancies are unintended, half of which result from contraceptive failure. This study provides estimates of method-specific failure rates among French women. METHODS: We use data from the 2000 Cocon Study, a population-based cohort, comprising a representative sample of 1689 women aged 18-44 years who described their contraceptive history. Piecewise-constant hazards models were used to estimate method-specific contraceptive failure rates during the first 5 years of contraceptive use. A random effect was introduced to take into account the fact that some women contribute more than 1 contraceptive episode. These same models were used to assess the effects of socio-demographic characteristics on the probability of contraceptive failure among pill, intrauterine device (IUD) and condom users. RESULTS: Overall, 2.9% of women experienced a contraceptive failure in the first year of use and 8.4% in the first 5 years of use. The IUD had the lowest first year failure rate (1.1%), followed by the pill (2.4%), the condom (3.6%), fertility awareness methods (periodic abstinence or safe period by temperature) (7.7%), withdrawal (10.1%) and spermicides (21.7%). These failure rates varied little by user characteristics. CONCLUSIONS: Lower failure rates among French women compared with those reported for US women suggest differences in contraceptive practices which need to be further explored.     

Pre-clinical in vivo evaluation of orthopaedic bioabsorbable devices

The presence of bioabsorbable materials in orthopaedics has grown significantly over the past two decades with applications in fracture fixation, bone replacement, cartilage repair, meniscal repair, fixation of ligaments, and drug delivery. Numerous biocompatible, biodegradable polymers are now available for both experimental and clinical use. Not surprisingly, there have been a wealth of studies investigating the biomechanical properties, biocompatibility, degradation characteristics, osteoconductivity, potential toxicity, and histologic effects of various materials. Promising results have been reported in the areas of fracture fixation, ligament repair, and drug delivery. In this article we review the pre-clinical in vivo testing of bioabsorbable devices with particular emphasis on implants used for these applications.     

Use of drugs and intrauterine devices for birth control

The current use of oral contraceptives and intrauterine devices for population control is reviewed including the mechanism of their antifertility actions and the use-effectiveness of each method. The use-effectiveness of the IUD has been calculated as 1.5-3.0 pregnancies per 100 woman-years of exposure. The IUD has a high continuation rate (70% after 2 years) and is excellent for poorly motivated population groups. The most serious common side-effect--pelvic infection--can be controlled by more careful screening and modern antibiotic therapy. Other side-effects include irregular bleeding and uterine perforation, but not at significantly high levels. Oral contraceptives have been found to be virtually 100% effective, even in the new lower dose preparations containing around .5 mg progesterone and .05-.15 mg estrogen per tablet. New hormonal contraceptive approaches include pills which progesterone only, high postcoital estrogen administration, and long-acting injectable progestogen (Depo-Provera). All of these methods are highly effective but have some undesirable side-effects and require further study. Careful examination of the recent research reports connecting oral contraceptive use with increased risk of thromboembolism indicate that whatever the danger in oral contraceptive use, the direct physical hazards of pregnancy after contraceptive failure are much higher and more serious. Though a 100% safe contraceptive is a desirable ideal, the safety of current oral contraceptives and IUDs is higher than most other aspects of modern life.     

The combined contraceptive vaginal ring and bone mineral density in healthy pre-menopausal women

BACKGROUND: Hormonal contraceptives have been associated with various effects on the bone mineral density (BMD) of pre-menopausal women. The aim of this study was to assess the effects of a vaginal contraceptive ring on BMD in pre-menopausal women and compare them with those of non-hormonal contraceptive use. METHODS: This open-label, multicentre study used dual-energy X-ray absorptiometry to measure BMD in the lumbar spine (L(2)-L(4)) and femoral neck regions. Subjects were assigned 3:1 to receive a contraceptive ring (n = 105) or a non-hormonal contraceptive control (n = 39) and were assessed after 13 and 26 cycles of contraceptive ring treatment or 12 and 24 months of control treatment. RESULTS: No change from baseline in BMD (Z-scores) was seen in contraceptive ring users (n = 73) at either time-point. In the control group (n = 30), BMD increased slightly from baseline resulting in significant differences (P < 0.0001) between the two groups at cycle 26/month 24. These differences are not clinically relevant, although some degree of acquisition of peak bone mass might have been prevented in the contraceptive ring group. The contraceptive ring was generally well tolerated; a higher incidence of treatment-related adverse events was observed in the contraceptive ring group compared with the non-hormonal contraceptive control group. CONCLUSIONS: In healthy pre-menopausal women, 2 years of contraceptive ring use produced no changes in BMD.     

Profile of intrauterine contraceptive device acceptors at the University of Uyo Teaching Hospital, Uyo, Nigeria

BACKGROUND: Use of modern contraceptive methods has been shown to reduce unwanted pregnancy, high parity and maternal mortality. Intrauterine contraceptive devices which are among the safest and most effective reversible contraceptives available, are particularly suitable for women in developing countries as they are affordable, convenient to use, do not require re -supply visits and are very cost-effective. The aim of this study is to determine the socio-demographic characteristics of intrauterine contraceptive device acceptors, the pattern of insertions and complications at the University of Uyo Teaching hospital, Uyo. METHOD: The record cards of all clients who had intrauterine contraceptive device inserted at the family planning clinic over a six-year period were reviewed. RESULTS: During the study period, there were 852 new contraceptive acceptors out of which 39.7% accepted the intrauterine contraceptive device. The modal age group of the clients was 25-29 years (32.5%). Acceptance of intrauterine contraceptive device was most common among multiparous clients (65.1%). Majority of the acceptors were married (90.0%), Christians (98.8%) and 72.8% had at least secondary school education. Clinic personnel (65.7%) and friends/relatives (21.3%) were the most common sources of information on contraception. Most (93.5%) of the clients had their intrauterine contraceptive devices inserted within 7 days of menstruation. Lower abdominal pain (5.5%) and vulval/vaginal itching (5.3%) were the most common complications. CONCLUSION: The acceptors of intrauterine contraceptive devices in our center were young, multiparous and educated women. Increasing mass media involvement in the dissemination of accurate information about intrauterine contraceptive devices to the general populace, the introduction of postpartum and post-abortal intrauterine contraceptive device insertions and the encouragement of our grandmultiparous women to accept intrauterine contraceptive device would lead to an increase in its acceptance and use.     

Discontinuous low-dose flutamide-metformin plus an oral or a transdermal contraceptive in patients with hyperinsulinaemic hyperandrogenism: normalizing effects on CRP, TNF-alpha and the neutrophil/lymphocyte ratio

BACKGROUND: Low-dose flutamide-metformin (Flu-Met) with an oral contraceptive is a therapeutic option for women with hyperinsulinaemic hyperandrogenism. We questioned (i) whether Flu-Met maintains efficacy if given discontinuously; (ii) how the efficacy of discontinuous Flu-Met plus a transdermal contraceptive compares with Flu-Met plus oral contraceptive; and (iii) whether these treatments also lower circulating C-reactive protein (CRP) and tumour necrosis factor alpha (TNF-alpha) and the high neutrophil/lymphocyte ratio. METHODS: Non-obese, young patients (n = 31) with hyperinsulinaemic hyperandrogenism were started on Flu-Met (21/28 days) and randomized to receive in addition either a drospirenone oral contraceptive or a transdermal contraceptive for 6 months. RESULTS: The effects of Flu-Met were similar whether combined with oral or transdermal contraceptive. In both groups, CRP and TNF-alpha levels fell and the high neutrophil/lymphocyte ratio normalized (P < 0.001). Lean body mass increased (P < 0.001) in both groups but, in contrast to earlier experience with continuous Flu-Met, fat mass failed to decrease in either group. CONCLUSIONS: Flu-Met seems less lipolytic, if given for only 21 days in every 28-day period. The efficacy of Flu-Met is comparable when combined with an oral contraceptive or a transdermal contraceptive. The range of Flu-Met effects may henceforth include lower levels of CRP and TNF-alpha, and a normalization of the neutrophil/lymphocyte ratio.