腹腔镜手术联合孕三烯酮治疗卵巢子宫内膜异位囊肿65例疗效观察

目的探讨腹腔镜手术联合孕三烯酮治疗卵巢子宫内膜异位囊肿的效果.方法选取2004年1月至2008年1月哈尔滨二四二医院腹腔镜手术联合孕三烯酮治疗卵巢子宫内膜异位囊肿65例患者为联合治疗组(A组),随机选取45例单纯行腹腔镜手术患者为对照组(B组),所有病例随访3-12个月,并对症状缓解情况、术后复发率及妊娠率进行比较分析.结果所有手术均获成功.联合治疗组复发率为14.3%,受孕率为27.3%;单纯腹腔镜组复发率为35%,受孕率为11.1%:差异有统计学意义(P<0.05).结论腹腔镜手术术后联合孕三烯酮治疗可以降低复发率、提高受孕率,从而获得满意治疗效果.     

腹腔镜联合罗氏内异方治疗中、重度子宫内膜异位症 相关不孕的疗效观察

目的 探讨腹腔镜联合罗氏内异方在治疗中、重度子宫内膜异位症中的价值。方法 收集2015年1月~2016年5月我院收治的中、重度子宫内膜异位症患者34例,根据腹腔镜手术后接受的不同治疗,将患者分为LSF组与GnRH-a组,每组17例。两组患者均在行腹腔镜保守性手术后接受治疗,LSF组给予口服罗氏内异方治疗,GnRH-a组给予皮下注射诺雷得治疗,观察两组患者临床疗效、不孕症疗效、妊娠时段、妊娠情况、不良反应发生率等指标。结果 LSF组有效率为76.47%,GnRH-a组有效率为82.35%,两组相比差异无统计学意义（P＞0.05）。LSF组患者中未见明显不良反应,GnRH-a组的不良反应发生率为23.52%,两组比较差异有统计学意义（P＜0.05）。治疗后的3个月内,LST组复发率为17.65%,GnRH-a组复发率为5.88%,差异有统计学意义（P＜0.05）。与未妊娠组相比,妊娠组患者LF、EFI评分均较高,r-AFS较低,差异有统计学意义（P＜0.05）。且r-AFS、LF、EFI两两之间呈显著的正相关关系（均r＞0.3,P＜0.05）。结论 罗氏内异方与GnRH-a在短期疗效、提高妊娠率、改善症状方面效果相当,但罗氏内异方在缩短术后妊娠时间,减少不良反应发生率方面优于GnRH-a。     

腹腔镜手术后 GnRH-a 对卵巢子宫内膜异位症合并不孕患者 CA19-9、CA125、HE4 水平及妊娠结局的影响

目的:研究促性腺激素释放激素激动剂(Gonadotropin-releasing hormone agonist,GnRH-a)在腹腔镜手术后对卵巢子宫内膜异位症合并不孕患者糖链抗原19-9(Sugar chain antigen19-9,CA19-9)、糖链抗原125(Sugar chain antigen125,CA125)、卵巢癌生物标记物4(Ovarian cancer biomarkers 4,HE4)水平及妊娠结局的影响.方法:选取2016年1月至2018年12月我院妇科收治的80例卵巢子宫内膜异位症合并不孕患者,根据治疗方法的不同分为对照组和观察组,各40例,对照组采用腹腔镜手术治疗,观察组在腹腔镜术后4 d给予GnRH-a进行治疗,连续治疗3个疗程.对两组临床有效率,治疗前后的CA125、CA199、HE4水平以及术后1年妊娠率及复发率进行对比分析.结果:观察组患者临床有效率明显高于对照组(P<0.05);与治疗前相比,各治疗组的血清CA125、CA19-9、HE4水平均明显降低,其中观察组降低更多;随访1年,与对照组相比,观察组的妊娠率、生育率均升高,流产率、复发率均降低(P<0.05).结论:腹腔镜手术后GnRH-a治疗可有效改善子宫内膜异位症合并不孕症患者的临床症状,降低CA125、CA19-9、HE4水平.在患者结束治疗后1年内,可有效的提高患者的受孕率、降低流产率及复发率.     

促性腺激素释放激素激动剂联合腹腔镜手术治疗EMT疗效及对TRPV1、NGF、 BK/BKB1R、PGF2α水平的影响

目的 观察促性腺激素释放激素激动剂(GnRH-a)联合腹腔镜手术治疗子宫内膜异位症(EMT)疗效及对TRPV1、NGF、BK/BKB1R、PGF2α水平的影响.方法 120例EMT患者随机分为对照组和观察组,每组60例.两组均行腹腔镜保守性手术,对照组术后不给予GnRH-a治疗,观察组术后给予GnRH-a治疗.分别于治疗前后检测血清NGF、BK、PGF2α表达水平,并以视觉模拟评分法(VAS)评价痛经、盆腔痛、性交痛严重程度;比较两组缓解率、复发率.结果 治疗后,观察组较对照组血清NGF、BK、PGF2α水平均明显降低(P＜0.05);治疗后,观察组较对照组痛经、盆腔痛、性交痛VAS评分明显降低(P＜0.05);观察组较对照组术后完全缓解率均明显升高,复发率明显降低,差异有统计学意义(P＜0.05).结论 GnRH-a联合腹腔镜治疗EMT,可能通过降低NGF、BK 、PGF2α表达水平而明显缓解患者疼痛症状,并可有效提高术后缓解率,降低复发率.     

腹腔镜手术联合GnRH-a治疗子宫腺肌病的妊娠结局

目的探讨腹腔镜手术联合促性腺激素释放激素(GnRH-a)治疗子宫腺肌病患者妊娠率。方法选择2015年3月至2016年3月深圳市南山区人民医院妇科收治有生育要求的子宫腺肌病合并不孕患者60例,年龄25～44岁,平均年龄36.22岁。按照治疗方案的差异,分别为单纯腹腔镜手术组、单纯GnRH-a治疗组、腹腔镜手术联合GnRH-a治疗组,每组20例,观察并比较3组患者痛经、月经改善情况,血清CA125、生殖激素[促卵泡成熟激素(FSH)、黄体生成激素(LH)、雌二醇(E2)]水平及妊娠情况。结果腹腔镜手术联合GnRH-a治疗组患者痛经改善总有效率可达100.0%,其中完全缓解患者比例较单纯腹腔镜手术组及单纯Gn RH-a治疗组显著升高,差异有统计学意义(P 0.05);腹腔镜手术联合Gn RH-a治疗组仅2例患者出现复发,较单纯腹腔镜手术组及单纯GnRH-a治疗组显著降低,差异有统计学意义(P 0.05);腹腔镜手术联合GnRH-a治疗组月经改善的总有效率可达100.0%,较单纯腹腔镜手术组显著升高(P 0.05);与单纯腹腔镜手术组比较,腹腔镜手术联合GnRH-a治疗组CA125、FSH、LH、E2水平均显著降低(P 0.05);与单纯GnRH-a治疗组比较,腹腔镜手术联合GnRH-a治疗组FSH、LH、E2水平均显著降低;治疗后对3组患者随访2年,腹腔镜手术联合Gn RH-a治疗组2年妊娠率可达75.0%,较单纯腹腔镜手术组及单纯GnRH-a治疗组均显著升高,差异有统计学意义(P 0.05);腹腔镜手术联合GnRH-a治疗组妊娠15例,其中自然妊娠13例,体外受精-胚胎移植助孕后妊娠2例;10例成功分娩,包括剖宫产8例,自然分娩2例。单纯腹腔镜手术组妊娠7例,自然妊娠4例,体外受精-胚胎移植助孕后妊娠3例;4例成功分娩,分娩方式均为剖宫产。单纯GnRH-a治疗组妊娠9例,自然妊娠6例,体外受精-胚胎移植助孕后妊娠3例;5例成功分娩,3例剖宫产,2例自然分娩。3组早产儿均无产科并发症,足月儿均为健康儿。结论腹腔镜手术联合Gn RH-a治疗子宫腺肌病,可有效缓解患者痛经及月经异常,改善其内分泌,从而提高患者的妊娠率。     

手术结合米非司酮治疗子宫内膜异位症的效果观察

目的：探究手术联合米非司酮应用于子宫内膜异位症(EM)治疗中的临床疗效,为后期临床治疗提供参考。方法选取我院2011年6月~2012年8月门诊收入的EM伴不孕的80例患者作为研究对象,根据术后是否服用米非司酮分为研究组与对照组,每组各40例。研究组患者术后均给予米非司酮辅助治疗,对照组患者仅行腹腔镜手术治疗。观察两组患者经治疗后的一般情况。结果两组患者经治疗在显效、临床总有效率及r-AFS中Ⅲ、Ⅳ期的妊娠率比较,差异具有统计学意义(P<0.05)。结论米非司酮辅助手术治疗EM的临床效果显著,可提高患者妊娠率,患者易于接受,可在后期临床中进一步推广及应用。     

孕三烯酮、米非司酮联合腹腔镜治疗卵巢子宫内膜异位囊肿

目的 观察孕三烯酮、米非司酮联合腹腔镜对卵巢子宫内膜异位囊肿的疗效.方法 选择卵巢子宫内膜异位囊肿拟手术病例90例,随机分为对照组、孕三烯酮组和米非司酮组.对照组采用单纯腹腔镜卵巢子宫内膜异位囊肿剔除术;孕三烯酮组在对照组基础上加孕三烯酮口服;米非司酮组在对照组基础上加服米非司酮,随访2a.比较3组疗效和妊娠率.结果 米非司酮组的疗效和妊娠率明显优于孕三烯酮组,孕三烯酮组的疗效和妊娠率优于对照组(P＜0.05).结论 腹腔镜术后联合米非司酮对卵巢子宫内膜异位囊肿的疗效显著,能提高患者妊娠率.     

腹腔镜治疗子宫内膜异位症合并不孕症的疗效分析

目的探讨腹腔镜治疗子宫内膜异位症合并不孕症的疗效分析。方法我院收治的子宫内膜异位症合并不孕患者110例,按照手术方法的不同,分为腹腔镜组和开腹组,两组各55例,观察两组手术时间、术中出血量、住院时间和术后并发症,检测高敏C反应蛋白（hs-CRP）和前白蛋白（PA）,随访半年妊娠率、1年妊娠率和1年内膜异位症复发率。结果腹腔镜组的手术时间、术中出血量、住院时间和术后并发症分别为（55.87±22.73）min、（43.37±12.72）ml、（4.76±1.06）d和7.27%,均较开腹组短或者减少,差异有统计学意义（P〈0.01）。两组半年妊娠率、1年妊娠率和子宫内膜异位症复发率接近,差异无统计学意义（P〉0.05）。手术后,两组的hs-CRP和PA水平均较术前明显升高或者下降,但开腹组的升高或降低水平更为明显,差异有统计学意义（P〈0.01）。结论腹腔镜治疗子宫内膜异位症具有手术创伤小,术后微炎症反应轻,恢复时间短等特点,是一种具有发展前景的新技术。     

腹腔镜手术联合药物治疗卵巢子宫内膜异位症疗效分析

目的探讨腹腔镜手术联合孕三烯酮治疗卵巢子宫内膜异位症的远期疗效及安全性。方法回顾性分析我院2008年8月-2009年12月收治的经腹腔镜手术的卵巢子宫内膜异位症患者78例,将术后给予孕三烯酮治疗的39例设为治疗组,单纯开腹手术治疗组39例设为对照组。所有患者随访1年以上,评价两组临床治疗效果。结果 LO组手术情况39例EM患者均成功完成手术。无一例转开腹手术。其手术时间、出血量、平均住院时间等与AO组相比差异有显著性(P<0.05),复发率分别为17.95%和20.51%,两者相比无统计学意义(P>0.05)。结论腹腔镜术后联合孕三烯酮治疗卵巢子宫内膜异位症疗效确切,能降低复发率,提高受孕,且副反应小。     

腹腔镜联合人工授精治疗子宫内膜异位症不孕的临床观察

目的探讨子宫内膜异位症（EMs）不孕患者腹腔镜术后行夫精人工授精妊娠率的影响因素。方法回顾性分析164例腹腔镜术后的EMs不孕患者进行的318个人工授精周期的临床资料。以年龄、不孕年限、腹腔镜术后时间、用药情况、周期数、是否促排卵、r-AFS分期、IUI时机分别进行妊娠率的比较。结果 EMs不孕患者术后人工授精的周期妊娠率为13.21%。年龄≤35岁的周期妊娠率高于35岁以上者（χ2=6.687,P〈0.05）,不孕年限≤5年的妊娠率高于5年以上者（χ2=5.430,P〈0.05）,腹腔镜术后1年内行人工授精的妊娠率高于1年以上者（χ2=6.005,P〈0.05）,Ⅰ～Ⅱ期患者的妊娠率高于Ⅲ～Ⅳ期患者（χ2=8.264,P〈0.05）,加用促排卵治疗的妊娠率高于自然周期者（χ2=4.569,P〈0.05）,3周期内人工授精的妊娠率高于3周期以上者（χ2=4.031,P〈0.05）,双次IUI者妊娠率高于单次者（χ2=4.371,P〈0.05）,差异均有统计学意义。而术后是否使用GnRH-a则与妊娠率无关。结论 EMs不孕患者腹腔镜术后行人工授精治疗的最佳时间是术后1年内3周期内有较高的妊娠率,建议同时加用促排卵治疗。     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

What will studies of Fulani individuals naturally exposed to malaria teach us about protective immunity to malaria?

There are an estimated over 200 million yearly cases of malaria worldwide. Despite concerted international effort to combat the disease, it still causes approximately half a million deaths every year, the majority of which are young children with Plasmodium falciparum infection in sub-Saharan Africa. Successes are largely attributed to malaria prevention strategies, such as insecticide-treated mosquito nets and indoor spraying, as well as improved access to existing treatments. One important hurdle to new approaches for the treatment and prevention of malaria is our limited understanding of the biology of Plasmodium infection and its complex interaction with the immune system of its human host. Therefore, the elimination of malaria in Africa not only relies on existing tools to reduce malaria burden, but also requires fundamental research to develop innovative approaches. Here, we summarize our discoveries from investigations of ethnic groups of West Africa who have different susceptibility to malaria.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.