子宫肌瘤剔除术对不孕女性妊娠的影响及影响术后妊娠的相关因素分析

目的:研究分析合并子宫肌瘤的不孕妇女行子宫肌瘤剔除术后的妊娠情况以及影响术后妊娠的原因。方法:随机选取宝鸡市中心医院2012年5月至2015年6月收治的子宫肌瘤剔除术患者150例,回顾分析所有受试者的一般资料、肌瘤特征以及术后随访情况。结果:根据随访1年～2年结果显示,患者的术后总妊娠率52. 0%(78/150),胎儿存活率69. 2%(54/78);根据Cox回归分析显示,术后妊娠的危险因子是年龄[RR=0. 99,95%CI(0. 98,1. 31),P <0. 05],与不孕种类、不孕时间、孕产史以及肌瘤的数量、大小、质地、种类都无关。结论:不孕兼有子宫肌瘤妇女行子宫肌瘤剔除术后可提高患者的妊娠率和胎儿存活率,年龄是术后妊娠的危险因子,这与妊娠率为负相关关系,因此患者可根据实际的年龄而决定是否行子宫肌瘤剔除术。     

妊娠合并子宫肌瘤142例病例分析

目的:探究与分析妊娠合并子宫肌瘤的临床特点。方法:选取我院自2014年11月至2015年7月收治的142例妊娠合并子宫肌瘤孕产妇作为观察组,另选择同时期收治的140例妊娠无合并子宫肌瘤的孕产妇作为对照组,对比两组孕产妇孕期合并症、分娩期并发症发生率、分娩方式、术中处理及子宫肌瘤在妊娠期的变化。结果:观察组与对照组先兆流产、先兆早产、胎位异常、前置胎盘、妊高征、胎膜早破、胎儿生长受限、妊娠糖尿病发生率相比均无明显差异(P>0.05)。观察组与对照组脐带缠绕、胎儿窘迫、产后出血、胎盘早剥、新生儿窒息、低出生体重儿发生率相比均无明显差异(P>0.05)。观察组较对照组相比阴道分娩率降低,剖宫产率提高,具有统计学意义(P<0.05)。观察组术中同时行子宫肌瘤剔除术73例,占51.41%。孕晚期肌瘤直径较早期相比无增大或减小所占比例最高,占49.30%,明显高于其他情况,具有统计学意义(P<0.05)。剔除肌瘤后病理类型表现为肌瘤未伴变性比例最高,占47.95%,明显高于其他类型,具有统计学意义(P<0.05)。结论:妊娠合并子宫肌瘤不会增加孕产妇孕期及分娩期并发症发生率,同时不会增加肌瘤变性比例,且子宫肌瘤大小并非随着孕期延长而增大,但增加了剖宫产率,因此也应引起临床医师的重视。     

子宫内膜息肉不孕患者行宫腔镜治疗后自然妊娠相关因素研究

目的:探讨子宫内膜息肉不孕患者行宫腔镜治疗后的自然妊娠状况。方法:回顾性分析宫腔镜手术治疗的76例子宫内膜息肉合并不孕症患者的临床资料,并随访其自然妊娠状况。结果:76例患者中术后18个月内自然妊娠51例,自然妊娠率为67.11%,其中术后6个月内自然妊娠率为84.31%;术后妊娠组年龄明显低于未妊娠组,差异有统计学意义(P0.05),而两组在不孕年限、子宫内膜息肉类型比较均无统计学意义(P0.05)。结论对于无其他原因引起不孕的子宫内膜息肉患者来说,宫腔镜治疗可以明显提高患者术后自然妊娠率,年龄越小则术后自然妊娠的成功率越高,且术后6个月是妊娠的最佳时间。     

不同途径下子宫肌瘤剔除术对妊娠的影响研究

目的:探讨经腹子宫肌瘤剔除术(TAM)和腹腔镜子宫肌瘤剔除术(LM)对子宫肌瘤患者术后妊娠的影响。方法:对符合研究标准的子宫肌瘤患者进行回顾性分析,其中采用TAM手术的患者为74例为TAM组,LM手术的患者有63例为LM组,比较两组患者术后避孕时间、备孕时间、妊娠结局。结果:TAM组患者避孕时间及备孕时间均长于LM组患者,差异有显著统计学意义(P0.05);两组子宫肌瘤术后患者的妊娠、流产、子宫破裂、成功分娩情况比较,差异均无统计学意义(P0.05)。结论:与TAM比较,LM可以缩短患者避孕和备孕时间,而对妊娠结局并无影响,临床工作中,可以根据患者的实际情况选择合适的手术方式,达到人性化、个性化治疗模式。     

高强度聚焦超声对子宫肌瘤患者术后血清白介素-10、肿瘤坏死因子-α、C反应蛋白水平及妊娠结局的影响

目的探讨高强度聚焦超声(HIFU)对子宫肌瘤患者术后血清白介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)水平及妊娠结局的影响。方法选取2016年5月至2018年6月诸暨市第二人民医院诊治的93例子宫肌瘤患者作为研究对象。依据治疗方案不同分为HIFU组(n=46)和腹腔镜组(n=47)。HIFU组采取HIFU子宫肌瘤消融术,腹腔镜组采取腹腔镜下子宫肌瘤剔除术。对比两组手术情况,术前、术后当日IL-10、TNF-α、CRP水平,术前、术后3个月子宫内膜容受性指标情况,以及两组肌瘤复发率、妊娠率、妊娠结局。结果 HIFU组手术时间、住院时间、术后恢复正常生活时间短于腹腔镜组,术中出血量少于腹腔镜组(P0.05);两组术后当天血清IL-10、TNF-α、CRP水平较术前增高,但HIFU组低于腹腔镜组(P0.05);两组术后3个月子宫内膜容积与厚度均较术前提高,且HIFU组高于腹腔镜组(P0.05);HIFU组术后18个月妊娠率高于腹腔镜组,剖宫产率低于腹腔镜组(P0.05)。结论 HIFU治疗子宫肌瘤可降低手术创伤与血清炎症反应水平,促进术后恢复,改善妊娠结局。     

卵巢子宫内膜异位囊肿患者临床妊娠结局分析

目的:探讨卵巢子宫内膜异位囊肿不孕患者体外受精与胚胎移植前行非手术治疗后影响妊娠结局的相关因素。方法:对51例卵巢子宫内膜异位囊肿不孕患者临床资料进行分析,IVF-ET前行阴道超声介入穿刺治疗。结果:行IVF-ET治疗后妊娠28例,未妊娠23例,妊娠率为54.9%(28/51)。妊娠组与失败组相比,妊娠组血清CA125水平小于失败组,有显著性差异。结论:卵巢子宫内膜异位囊肿不孕患者,阴道超声介入穿刺治疗后妊娠率与血清CA125有密切关系。     

子宫肌瘤对女性生育能力的临床影响分析

目的:探讨子宫肌瘤对女性生育能力的临床影响分析。方法:回顾性分析2011年11月至2013年11月期间来我院就诊的子宫肌瘤且有生育要求的患者18例(观察组)以及同样来院就诊有生育要求的正常患者18例(对照组)的临床资料。分析对比两组患者的临床妊娠率、着床率、继续妊娠/活产率以及自然流产率。结果:经分析对比后发现,观察组患者的临床妊娠率和继续妊娠/活产率均显著性低于对照组患者(P0.05);结论:子宫肌瘤对女性的生育能力有着潜在的不良影响。若子宫肌瘤患者有生育要求,则需要经过仔细的评估后进行安全可靠的治疗。     

子宫动脉阻断对腹腔镜下行子宫肌瘤剔除术的临床意义探讨

目的:探讨腹腔镜下子宫动脉阻断后行子宫肌瘤剔除术对子宫肌瘤患者的临床应用价值及其影响。方法:回顾分析2011年1月至2013年1月我院收治的288例子宫肌瘤患者的临床资料,根据手术方式分为观察组和对照组,其中观察组在腹腔镜下子宫动脉阻断后行子宫肌瘤剔除术,对照组仅行腹腔镜下子宫肌瘤剔除术。对比两组在术前肌瘤最大径≤9cm、>9cm以及总体分析时术中情况、术后卵巢功能恢复、预后、妊娠等方面的差异。结果:观察组手术时间、术中出血量及住院时间均少于对照组,而术前肌瘤最大径≤9cm患者手术中,对照组手术时间少于观察组(P<0.05);观察组FSH、LH及E2均低于对照组(P<0.05);与对照组相比,观察组月经异常症状缓解明显、肌瘤复发率降低、发生闭经较少及子宫体积缩小明显(P<0.05),而术前肌瘤最大径≤9cm患者手术中,两组术后2个月月经异常症状缓解无统计学差异(P>0.05);随访2年,两组妊娠情况比较无统计学差异(P>0.05)。结论:腹腔镜下子宫动脉阻断后行子宫肌瘤剔除术能有效减少术中出血、减小手术创伤、降低子宫肌瘤复发率,对内分泌及妊娠无明显影响,值得临床推广。     

高强度聚焦超声对子宫肌瘤治疗效果的相关因素研究

目的探究高强度聚焦超声对子宫肌瘤疗效的相关因素。方法选取2015年3月至2018年3月北部战区总医院治疗的388例子宫肌瘤患者作为研究对象。按照子宫肌瘤消融率将患者分为低消融率组(直径减少率50%,77例)、中消融率组(直径减少率为50%～75%,132例)和高消融率组(直径减少率75%,179例)。随访6个月,比较三组子宫肌瘤的直径、位置、MRI信号强弱,对有统计学意义的指标行多因素Logisitic回归分析,探究高强度聚焦超声治疗子宫肌瘤疗效影响因素。结果低消融率组子宫肌瘤直径以30mm为主,肌瘤位置以后壁、侧壁和宫底为主;中消融率组子宫肌瘤直径以30～50mm为主,位置以前壁为主;高消融率组子宫肌瘤直径以50mm为主,肌瘤位置以前壁为主;三组差异具有统计学意义(P0.05);三组中T_1WI增强强度和T_2WI信号强度处于高等的比例呈现出低消融率组中消融率组高消融率组,三组分布比较,差异具有统计学意义(P0.05);多因素Logisitic回归分析显示,子宫肌瘤直径50mm、位置为前壁、T_1WI增强强度低、T_2WI信号强度低是子宫肌瘤女性高强度聚焦超声疗效高的影响因素。结论子宫肌瘤女性高强度聚焦超声疗效与子宫肌瘤直径、位置、T_1WI增强程度和T_2WI信号强度有关,临床上应该加以重视。     

精子DNA碎片率与AIH或IVF-ET临床妊娠率的相关性

目的:探讨精子DNA碎片率与因常见男性因素为主行夫精人工授精术(AIH)或体外受精-胚胎移植术(IVF-ET)治疗夫妇临床妊娠率的相关性。方法:筛选因常见男性因素为主行AIH的患者64例及IVF-ET的患者46例,其中女方的促排方案相同,男女年龄均在40岁以下,平均年龄(31±9)岁,基本排除女方常见不孕因素。根据术中精子DNA碎片率的高低,分为五组:组1:术前3个月内精子DNA碎片检查结果正常组,24例(AIH,16例);组2:术前精子DNA碎片检查结果异常,经治疗后好转组,44例(AIH,30例);组3:术前精子DNA碎片检查结果异常,经治疗后未见明显好转或拒绝治疗组,22例(AIH,10例);组4:术前未做精子DNA碎片率检查,术中留取精液检测结果异常组,10例(AIH,4例);组5:术前未做精子DNA碎片率检查,术中留取精液检测结果正常组,10例(AIH,4例);分别统计各组AIH及IVF-ET的临床妊娠率,计算两者均值,并比较各组差异。结果:组1、组2、组3、组4、组5妊娠率分别为37.5%、31.8%、31.8%、20.0%、45.5%。结论:精子DNA碎片率会显著影响以男性因素为主的AIH或IVF-ET的妊娠结局。     

New fillers for the new man

ABSTRACT:  Two new collagen-based lidocaine-containing dermal fillers, ArteSense™/ArteFill™ (Artes Medical, San Diego, CA) and Evolence® (Colbar LifeScience Ltd., Herzliya, Israel), have proved to be of particular interest to men, many of whom seek a long-lasting or permanent correction. ArteFill™ has been available in the United States since 2006, and it is expected that Evolence® will reach the American market in 2008. The properties of the two products will be described, and experience based on the administration of many hundreds of syringes of both products by a Canadian dermatologist will be detailed here, with tips and precautions to optimize patient outcomes.     

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA‐compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms “ablative laser” and “skin resurfacing” from March 2002 until July 2020. Studies included meta‐analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self‐resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.     

Genetic alterations in RAS‐regulated pathway in acral lentiginous melanoma

Studies integrating clinicopathological and genetic features have revealed distinct patterns of genomic aberrations in Melanoma. Distributions of BRAF or NRAS mutations and gains of several oncogenes differ among melanoma subgroups, while 9p21 deletions are found in all melanoma subtypes. In the study, status of genes involved in cell cycle progression and apoptosis was evaluated in a panel of 17 frozen primary acral melanomas. NRAS mutations were found in 17% of the tumors. In contrast, BRAF mutations were not found. Gains of AURKA gene (20q13.3) were detected in 37.5% of samples, gains of CCND1 gene (11q13) or TERT gene (5p15.33) in 31.2% and gains of NRAS gene (1p13.2) in 25%. Alterations in 9p21 were identified in 69% of tumors. Gains of 11q13 and 20q13 were mutually exclusive, and 1p13.2 gain was associated with 5p15.33. Our findings showed that alterations in RAS‐related pathways are present in 87.5% of acral lentiginous melanomas.     

Self‐resolving superficial primary cutaneous mucormycosis in a 7‐week‐old infant

A 7‐week‐old girl, born at 30 weeks' gestational age, presented to clinic for evaluation of a crop of vesicular lesions that were noted after removal of a bandage that had been in place for 4 days. A punch biopsy of the lesion revealed fungal elements that were later identified as Rhizopus spp. The lesion began to self‐resolve, and no further treatment was needed, with full resolution of the lesion by 1 month after presentation. Clinicians should be aware of the variable presentations of mucormycosis and consider fungal infection in the differential diagnosis when evaluating vulnerable patients with skin eruptions.     

Pathogenic role of IL-17 in psoriasis and psoriatic arthritis

Psoriasis is a chronic inflammatory skin disorder resulting from a complex network of cytokines and chemokines produced by various immune cell types and tissue cells. Emerging evidence suggests a central role of IL-17 and IL-23/T17 axis in the pathogenesis of psoriasis, giving a rationale for using IL-17-blocking agents as therapeutics.Three agents targeting IL-17 signaling are being studied in Phase III clinical trials: secukinumab and ixekizumab (IL-17 neutralizing agents), and brodalumab (IL-17 receptor antagonist). Preliminary results are highly promising for all anti-IL17 agents, creating fair expectations on this class of agents as the new effective therapeutic approach for the treatment of psoriasis.