TCu380A、TCu220C和MLCu375宫内节育器系统评估

目的 :评价TCu380A、TCu2 2 0C、MLCu375三种宫内节育器的有效性、副反应和可接受性。方法 :见中国计划生育学杂志“我国常用口服避孕药和宫内节育器系统评估的方法概述”(2 0 0 5年 1期 17页 )。结果 :TCu380AIUD妊娠率及脱落率均低于MLCu375IUD ,副作用发生率高于MLCu375IUD ,续用率等同或高于MLCu375IUD ,临床综合效能与MLCu375IUD相近 ;TCu380AIUD妊娠率低于TCu2 2 0CIUD ,脱落率及安全性与TCu2 2 0CIUD相似 ,放置满 5年后续用率高于TCu2 2 0CIUD ;MLCu375IUD妊娠率略低于TCu2 2 0CIUD ,脱落率低于或等同于TCu2 2 0CIUD ,二者的副反应发生率相似 ,临床综合效能优于TCu2 2 0CIUD。建议 :可以继续使用TCu380AIUD、MLCu375IUD和TCu2 2 0CIUD ,并且加大TCu380AIUD和MLCu375IUD的使用份额。在总体上应优先考虑提供铜表面积≥ 30 0mm2 的宫内节育器     

Trends in adolescent development in the People's Republic of China

Interest in adolescence and adolescent medicine has dramatically increased among medical professionals in the past few years in the People's Republic of China. This article will focus on changing medical practices towards adolescents in the People's Republic since 1949. It is not all meant to be exhaustive, but rather to indicate the range of medical work extent on adolescent medicine. The ‘tasks’ of adolescence, as presently understood in the West, such as individuation, separation from family, and sexual identity will be examined in a Chinese context. Changing patterns in birth control, vocational choice, and youth group organizations will then be covered. Finally, attention will be drawn to recent Chinese research on adolescence which has appeared in English language journals.Research for this article comes from a lecture and research period spent in the People's Republic from January to March 1981. Follow-up correspondence and research exchange has continued to this writing. Approximately 25 cities were visited with lectures and professional exchange occuring in six: Beijing, Shanghai, Kaifent, Chengdu, Wuhan and Changsha. Though the cultural context is different, it became clear that there are many similarities between the adolescent process in the United States and the People's Republic of China.     

对4种宫内节育器的临床效果比较

目的 观察放置吉妮致美(GeneFiexIN)、TCu220C、宫铜300、元宫药铜220,4种宫内节育器的避孕效果.方法 对836例受术的育龄妇女随机放置吉妮致美、TCu220C、宫铜300、元宫药铜220宫内节育器,规范的术后随访1年,比较使用效果.结果 4种宫内节育器放置对象的一般情况比较无统计学差异;放置吉...     

Long-term reversible contraception: Twelve years of experience with the TCu380A and TCu220C

Few data on the long-term efficacy of intrauterine devies (IUD) are available, and this article reports on the final 12-year experience with the TCu220C and TCu380A devices from two randomized, multicenter trials conducted in 24 centers. A total of 3,277 and 1,396 women, respectively, were recruited for use of each device between 1981 and 1986 and followed at 3, 6, and 12 months after insertion and yearly thereafter. At the end of 12 years, a total of 17,098 women-years of experience had been accumulated for the TCu220C and 7,159 women-years for the TCu380A. The cumulative 12-year intrauterine pregnancy rates were 7.0 (standard error [SE] 0.6) per 100 women for the TCu220C and 1.9 (SE 0.5) for the TCu380A (p < 0.001). Pregnancy rates were highest in the first years after insertion; the TCu220C had a consistently higher annual pregnancy rate than did the TCu380A at all intervals since insertion. No pregnancies were reported with the TCu380A after 8 years of use. Total medical removals were approximately 6% in the first year and dropped to approximately 4% per year for each device for up to 12 years of use (cumulative 12 year rates were 37.3 [SE 1.3] and 40.2 [SE 2.1] per 100 women for the TCu220C and TCu380A devices, respectively). The overall continuation rate at all intervals since insertion was higher with the TCu220C device, mainly due to higher removal rates for nonmedical reasons with the TCu380A. The cumulative ectopic pregnancy rates were 0.7 and 0.4 for the TCu220C and TCu380A, respectively. Pregnancy rates were higher in the Chinese compared with the non-Chinese centers for both devices, though the greater efficacy of the TCu380A was apparent in both groups of centers. The total medical and nonmedical removal rates were lower in the Chinese compared with the non-Chinese centers, and did not show any substantial differences between the devices. We conclude that both devices are safe and effective for at least 12 years of use and the low pregnancy rate with the TCu380A is comparable with that reported in the United States among women who had undergone tubal sterilization. The very high efficacy of the TCu380A makes it the IUD of choice, and it can be considered as a potentially reversible, nonsurgical alternative to sterilization for women requiring very long-term pregnancy protection.     

GyneFix330和TCu220C、TCu380A宫内节育器比较的系统评估

目的:评价GyneFix330与TCu220C、TCu380A宫内节育器(IUD)的有效性、副反应和续用情况。方法:电子和手工检索1990年1月~2009年11月中英文发表的相关文献,按循证医学方法对纳入文献进行分析评价。结果:纳入26篇正式发表的随机对照临床试验文献。与TCu220C IUD相比,GyneFix330IUD的12个月和24个月带器妊娠率和脱落率较低;6个月、12个月和24个月的经期延长、经量增多、腰腹痛和不规则出血发生率较低;12个月因症取出率较低,续用率则较高。GyneFix330和TCu380A IUD12个月、24个月、36个月和9年的带器妊娠率均低于2.50/100妇女。两组6个月、12个月、24个月和36个月的月经量增多、白带增多和不规则出血发生率互有优劣。与TCu380A IUD相比,Gyne-Fix330IUD12个月和24个月的因症取出率接近,续用率略高。结论:GyneFix330IUD临床应用效果优于TCu220C IUD,与TCu380A IUD相差不大,仍需长期大样本临床观察予以确证。     

A comparative clinical trial of the TCu 380A, Lippes Loop D and Multiload Cu 375 IUDs in Indonesia

The Copper T 380A (TCu 380A), Lippes Loop D (LLD) and the Multiload Cu 375 (MLCu 375) IUDs were evaluated for safety and efficacy in a multicenter randomized clinical trial in Indonesia. A total of 2992 women were enrolled into the study and data for 2845 women were analyzed (147 cases did not meet protocol criteria). Although study IUDs were randomly assigned, LLD users in this study were older and of higher parity than TCu 380A and MLCu 375 users. The 24-month gross cumulative life-table pregnancy rates for TCu 380A, LLD and MLCu 375 users were 1.2, 2.2 and 2.7, respectively. The 24-month expulsion rates for TCu 380A, LLD and MLCu 375 users were 6.7, 7.5 and 5.3, respectively. Overall, 24-month continuation rates were 85.5%, 85.0% and 85.4% for the respective device groups. Differences in both gross and age- and parity-adjusted life-tables rates for the major outcome variables were not statistically significant at 24 months postinsertion. The study suggests that the TCu 380A, LLD and MLCu 375 IUDs seem to be safe and effective contraceptive options for Indonesian women.     

宫内节育器不同铜表面积对月经血量的影响

对健康妇女随机放置TCu380A和TCu220C IUD后的月经血量变化进行观察,放器前TCu380A和TCu220C组平均月经血量(MBL)为45.3±13.4ml和42.6±11.5ml,放器后1、3、6、12周期平均MBL分别为72.4±41.6ml和73.2+38.3ml;77.0±42.9ml和82.9±46.9ml;73.2±31.2ml和74.5±30.5ml及64.5±18.9ml和68.2±14.4ml;放置两种IUD后MBL较放器前明显增多(P<0.001),但两种IUD间比较,放器后各周期平均MBL无显著差别(P>0.05),提示在一定范围内增加铜的表面积对放器后MBL的增加程度并无显著影响。     

A randomized comparative trial of the MLCu375, TCu220C,Steel Ring and Uterine Cavity-Shaped IUDs

The Stainless Steel Ring, Uterine Cavity-Shaped Device, TCu220C and MLCu375 IUDs were evaluated in a randomized trial of 1536 women in Guangdong Province, China. The first-year continuation and expulsion rates were significantly lower (p<0.05) for the latter 3 IUDs than for the Stainless Steel Ring. The first year pregnancy rates for the MLCu375 (o.76 per 100 women) and TCu220C (1.2 per 100 women) were significantly lower (p<0.05) than those of the other two devices (6.1 and 4.1 per 100 women). The results of the study show that the MLCu375 and TCu220 are the most suitable IUDs for women in Guangdong Province.

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Resumen Se realizó un estudio aleatorizado de 1536 mujeres de la provincia de Guangdong, China, a fin de evaluar el anillo anticonceptivo de acero inoxidable, un dispositivo que tiene la forma de la cavidad uterina y los dispositivos intrauterinos TCu220C y MLCu375. Los porcentajes de continuación relativos al primer año y los porcentajes de expulsión fueron significativamente inferiores (p<0,05) para los tres últimos que para el anillo de acero inoxidable. Los porcentajes de embarazo durante el primer año en el caso del MLCu375 (0,76 por cada 100 mujeres) y TCu220C (1,2 por cada 100 mujeres) fueron significativamente inferiores (p<0,05) que para los dos otros dispositivos (6,1 y 4,1 por cada 100 mujeres). Los resultados de este estudio demuestran que los DIU MLCu375 y TCu220C son los más adecuados para las mujeres de la provincia de Guangdong.

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Resumé Une étude randomisée portant sur 1536 femmes a été effectuée dans la province de Guangdong (China) pour évaluer l'anneau contraceptif en acier inoxydable, un dispositif épousant la forme de la cavité utérine, ainsi que les dispositifs TCu220C et MLCu375. Les pourcentages de continuation pour la première année et les taux d'expulsion ont été significativement moins élevés (p<0,05) pour les 3 derniers que ceux pour l'anneau en acier inoxydable. Les taux de grossesse pendant la première année dans le cas du MLCu375 (0,76 par 100 femmes) et du TCu220C (1,2 par 100 femmes) ont été significativement plus faibles (p<0,05) que pour les deux autres dispositifs (6,1 et 4,1 par 100 femmes). Les résultats de cette étude montrent que les DIU MLCu375 et TCu220C sont les dispositifs qui conviennent le mieux aux femmes de la province de Guangdong.

     

Menstrual blood loss, haemoglobin and ferritin concentration of Beijing women wearing steel ring, VCu 200, and TCu 220c IUDs

Menstrual blood loss (MBL), serum ferritin and whole blood cyanmethemoglobin were measured at pre- and 1, 3, 6, 12, 18 and 24th postinsertion cycles in 60 women wearing the steel Ring, the Copper V (VCu 200) or the Copper T (TCu 220c). The MBL, incidence of menorrhagia and iron deficiency anemia were lower among users of the Steel Ring than among users of the Copper V and T. Anemia occurred later and the duration of menstruation was shorter with the Steel Ring than with the Copper T. There were no statistically significant differences between the Copper V and T.     

A randomized comparative clinical evaluation of the Steel Ring, the VCu200 and the TCu220c IUDs

A randomized comparative clinical study of the Steel Ring, VCu200 and TCu220c IUDs was carried out in Beijing. Six-hundred subjects were recruited and each group of 200 was inserted with one of the three devices. The TCu220c and the VCu200 had statistically significantly lower pregnancy and expulsion rates at one and two years of use than the Steel Ring. However, the Steel Ring consistently had the lowest rate of removal for pain and/or bleeding. At two years, the early differences of use-related discontinuation and continuation between the higher rates of the Steel Ring and the lower rates of the VCu200 and TCu220c were significantly reduced. There were no statistically significant differences of net event rates between VCu200 and TCu220c.     

Performance of the frameless GyneFix and the TCu380A IUDs in a 3-year multicenter, randomized, comparative trial in parous women

This study was conducted to evaluate a new and improved inserter (GyneFix) for the anchoring of the Frameless IUD in the uterine cavity. Previous studies conducted with a prototype inserter (Flexigard) did not show fully the advantages of the new anchoring concept because of the shortcomings of the Flexigard inserter and the complexity of the insertion technique. The GyneFix IUD was compared with the TCu380A IUD in six centers in China in approximately 300 women in each group. Only parous women were included in the study. The data from this 3-year, ongoing study demonstrate that the shortcomings of the inserter have been corrected, resulting in better performance and a much reduced rate of failed insertion/expulsion of the frameless and anchored device. The cumulative expulsion rate with the GyneFix IUD was 3.0 at 3 years (annual rates 2.67, 0.33, and 0.0, respectively) compared with a cumulative expulsion rate of 7.38 at 3 years with TCu380A (annual rates 4.63, 1.76, and 1.04, respectively). This difference is statistically significant. The majority of the expulsions with the anchored IUD occurred early in the study, indicating improper anchoring technique. The study also shows that both devices are highly efficacious. No pregnancies occurred with the GyneFix IUD (cumulative pregnancy rate 0.0 at 3 years) versus one pregnancy with TCu380A (cumulative pregnancy rate 0.34 at 3 years). The total use-related discontinuation rate at 3 years was significantly lower with the GyneFix IUD (8.34) than with the TCu380A IUD (14.13) and results in a higher rate of continuation with the GyneFix IUD compared to the TCu380A IUD (90.73 vs 85.25). Neither perforations nor pelvic inflammatory disease cases were encountered with either device in this study, demonstrating the safety of the anchoring system.     

三种国产宫内节育器临床多中心比较性研究——八年随访总结

全国9省市16个单位,对不锈钢金属单环(金单)、VCu200及TCu220C三种宫内节育器(IUD)进行随机临床多中心比较性研究。自1983年7月1日至1984年3月31日共接受对象4490例。八年末随访率为90.33％。三种IUD间每百妇女累积续用率的差别后期有随使用时间的增长而缩小的趋势,但96个月时仍以金单为最低,47.08％,VCu200和TCu220C各为54.05％和61.14％。VCu20O和TCu220C的妊娠率分别为10.35％和8.94％,它们间差异较前期增大,并显著地低于金单的24.14％。96个月时,金单、VCu200和TCu220C的脱落率分别为21.69％、13.05％和7.48％,三者间呈显著性差异。因出血和/或疼痛取器,八年中金单最低,前期VCu200略低于TCu220C,96个月时仍以金单为最低,VCu200略高于TCu220C,但二种带铜IUD间无差别。三种IUD使用情况城市与农村比较,城市的累积续用率均高于农村;妊娠、脱落和个人原因停用农村均高于城市。用COX比例风险模型和似然比检验分析,发现妊娠和脱落均受年龄、过去使用IUD、本次IUD类型和孕次的影响,显示了两种带铜IUD的妊娠和脱落风险远小于金单;出血和/或疼痛受孕次和本次IUD类型的影响,金单的出血和/或疼痛风险小于两种带铜IUD,总的失败风险受年龄、本次IUD类型、过去使用IUD和孕次的影响,显示了直至使用八年金单的失败风?     

Genetic testing,governance, and the family in the People’s Republic of China

In western countries the rise of genetic testing has been accompanied by ethical arrangements like autonomy and informed consent that help to dissociate genetics from eugenic policies. However, critics have argued that this trend to increase individual choice should be considered as a neoliberal governance strategy to promote bio-citizenship. These western concepts are often used to discuss genetic testing in the Peoples Republic of China as well. China’s population policy has a reputation for condoning eugenic practices and for ruthless one-child and family planning policies, but there have been many reforms recently, which, together with the revival and development of traditional religions and beliefs, have complicated the discussion about the meaning of the Chinese family. In this context, the introduction of genetic testing in China has been linked to state eugenics as well as post-reform neo-liberalist governance. Based on fieldwork and various archival and literature studies it explores genetic testing in five different Chinese contexts. The analysis makes clear that, although population planning in China proceeds from the idea that the planning of family health leads to a healthier population, traditional beliefs, individual initiative, group pressure, commercial organisations and state policies make for an amalgam of genetic testing practices that cannot be understood in terms of eugenics or liberal governance.     

Randomized clinical trial with intrauterine devices (levonorgestrel intrauterine device (LNG), CuT 380Ag, CuT 220C and CuT 200B). A 36-month study. Indian Council of Medical Research Task Force on IUD

A total of 1905 subjects were randomly allocated to four types of intrauterine devices (IUDs) and were observed for 45,683 woman-months of use. While no method failure was observed with levonorgestrel (LNG) IUD, 11 women became pregnant with other devices; 4 with Copper T 380Ag, 1 with Copper T 220C, and 6 while using Copper T 200B, indicating method failure rates of 1.0, 0.3 and 1.6, respectively, at 36 months of use. These rates were within acceptable range. Continuation rates were significantly lower with LNG IUD (74.5, 58.7, 38.8 at 1 year, 2 years and 3 years, respectively) as compared to other copper devices, which ranged between 82.4 to 84.4 at 1 year, 66.6 to 69.9 at 2 years and 45.4 to 50.4 at 3 years. The difference in continuation rates was mainly due to menstrual disturbances (e.g. amenorrhoea, irregular bleeding) which were higher with LNG IUD (27.9 per 100 users) as compared to the copper devices (13.4-15.4 per 100 users) at 36 months of use. The risk of expulsion ranged between 8.3 to 10.6 per 100 users and was comparable for all the devices. The observations from the present study based on 36 months of experience with different intrauterine devices do not indicate the need to replace CuT 200, the device currently in use in the National Programme.     

Randomized clinical study of the T-Cu 380A and the Lippes loop C,in Campinas,Brazil

The copper IUD model T-Cu 380A has shown the best performance when compared with other copper and inert IUDs in studies carried out in the U.S.A., but it had not been tried out in developing countries yet.T-Cu 380A and Lippes loop C were inserted at random in 328 healthy parous women, in Campinas, SP, Brasil. Forty-five percent of the T-Cu 380A insertions and 40% of the Lippes loop insertions were performed by trained midwives.No pregnancies occurred in 1419 woman-months of use of T-Cu 380A, against 5 pregnancies in 1454 woman-months of use of Lippes loop. The difference was significant at the 5% level. No other significant differences were found. The continuation rate after one year of use was 82.5 for the T-Cu 380A and 75.1 for the Lippes loop.These results suggest that the performance of the T-Cu 380A in developing countries could be similar to the one observed in the United States, provided that the users are carefully selected and that an adequate insertion technique is followed.     

Comparative epidemiological features of Japanese encephalitis in the Republic of Korea, China (Taiwan) and Japan

The epidemiology of Japanese encephalitis in the Republic of Korea from 1949 to 1966 is described and comparisons are made with the situations in Japan and China (Taiwan). Some similarities and some differences are noted. Recent epidemics in Korea coincided with those in southern Japan but the annual fluctuations were more distinct in Korea. The disease mainly affected children in Korea and, in contrast to the situation in Japan, persons in the older age-groups were rarely affected. The authors also discuss the geographical pathology of Japanese encephalitis in Korea.     

Comparative effect of dietary olive, safflower, and linseed oils on spontaneous liver tumorigenesis in C3H/He mice

In male C3H/He mice, which frequently develop spontaneous liver tumorigenesis, 5 wk of age and weighing about 20 g, the comparative effects on liver tumor incidence from the feeding of olive oil (OLI), safflower oil (SAF), and linseed oil (LIS) diets for 50 wk, the concentrations of total cholesterol (T-CHOL), triacylglycerol (TG), lipid peroxides in the plasma and liver, and the activities of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in the plasma were examined. The changes in body weight and liver weight were not different among dietary groups. The number of mice bearing liver adenoma was greater in the SAF group than in the OLI and LIS groups. Liver carcinoma was observed in the SAF group, but not in the OLI and LIS groups. The concentrations of T-CHOL in the plasma and liver were higher in the OLI group than in the other groups. TG levels in the plasma and liver were highest in the OLI group and followed in order by the SAF and LIS groups. The concentration of plasma lipid peroxide was higher in the LIS group than in the other groups. Liver lipid peroxide content was extremely high in the LIS group, medium in the SAF group, and low in the OLI group. The activity of AST was highest in the OLI group and followed in order by the SAF and LIS groups. ALT activity was higher in the OLI group than in the other groups. A positive relationship between spontaneous liver tumorigenesis and the concentrations of T-CHOL, TG, and lipid peroxide or AST and ALT activities was hardly observed. These results suggested that spontaneous tumorigenesis in the liver of male C3H/He mice bred for 50 wk was suppressed by being supplied with OLI and LIS, compared with SAF, which had no direct relation to the concentrations of T-CHOL, TG, and lipid peroxide in the plasma and liver and the activities of plasma AST and ALT.