宫颈扩张棒与卡前列甲酯栓在宫颈手术史绝经后妇女取环中的临床效果观察

目的评价宫颈扩张棒与卡前列甲酯栓在宫颈手术史绝经后妇女取环中的安全性和有效性。方法选择2019年10月至2020年10月我院计划生育门诊行择期B超引导下取环术的绝经后女性共124例,均有宫颈手术史,采用随机生成数字法将其分为扩张棒组和卡前列甲酯栓组各62例。比较两组宫颈软化度、一次性取环成功率、术中和术后出血率和出血量、平均手术时间、术后30 min疼痛视觉模拟量表(VAS)评分以及宫颈损伤发生率。结果卡前列甲酯栓组宫颈软化优良率高于扩张棒组,出血率、出血量和VAS评分低于扩张棒组(P0.05),两组取环成功率和手术时间比较差异无统计学意义(P0.05)。两组宫颈损伤发生率均较低,均未出现严重不良反应。结论宫颈扩张棒与卡前列甲酯栓在宫颈手术史绝经后妇女取环中均有广泛应用,卡前列甲酯栓在提高宫颈软化度、降低出血风险和术后疼痛体验方面表现更优越,宫颈损伤发生率较低,安全性较好。     

不同减痛方法用于绝经后妇女取出宫内节育器的临床观察

[目的]观察炔雌醇联合宫术宁胶棒在绝经后妇女取出宫内节育器（IUD）时的应用效果.[方法]选取因绝经要求取出节育器的妇女126例根据不同的减痛方法分为三组：A组术前在宫颈管放置宫术宁胶棒5～10min;B组术前1周口服炔雌醇0.35 mg/d;C组采用炔雌醇联合宫术宁胶棒.比较三组的宫颈软化情况、术中疼痛程度及取器成功率.[结果]C组的宫颈软化程度最佳,显著优于A、B两组（P＜0.01）,但A组与B组比较无统计学差异（P＞0.05）;A手术时间为（5.23±1.27） min,明显长于B、C（2.64±0.93、2.13±0.76）min（P＜0.05）;三组的疼痛程度由大到小为A组,B组,C组;C组顺利取出IUD百分率最高,显著高于A、B组（P＜0.05）.[结论]炔雌醇联合宫术宁胶棒应用于绝经后妇女取出IUD,软化宫颈,提高取出IUD的成功率,减轻患者痛苦.     

尼尔雌醇、卡孕栓与利多卡因用于绝经后取环的临床比较

目的探讨尼尔雌醇、卡孕栓与利多卡因用于绝经后取环的临床比较。方法对270例绝经后取环的妇女进行回顾性分析，随机分3组，A组取环前1周顿服尼尔雌醇6mg；B组取环前2h卡孕栓1枚（PG051mg）置阴道后穹窿；C组常规消毒后，在宫颈旁行利多卡因阻滞麻醉，3min后行取环术。结果A、B两组疗效优于C组。结论口服尼尔雌醇、阴道后穹窿置卡孕栓用于绝经后妇女取环扩宫及软化宫颈效果好、手术时间短、成功率高。     

戊酸雌二醇片联合宫颈注射利多卡因用于绝经后妇女取环的临床效果评价

目的：探讨戊酸雌二醇片（补佳乐）联合宫颈注射利多卡因用于绝经后妇女取环的临床效果。方法：将2012年01月～2014年0s月在江阴市人民医院妇科计划生育门诊就诊的300例绝经后妇女随机分为3组,每组各100例,A组：采用口服补佳乐2mg／d,连续口服7d后取环;B组：采用绝经后妇女术前宫颈注射2％利多卡因后取环;C组：采用口服补佳乐2mg／d,连续口服7d,联合术前宫颈注射2％30多卡因后取环。比较3组的宫颈软化程度、手术疼痛度、手术时间、术中出血量、取环效果。结果：c组宫颈软化程度优于另两组,手术时间短于另两组,疼痛程度低于另两组,术中出血量少于另两组,无取环困难及取环失败,差异比较均具有统计学差异（P〈0．05）,并且,无严重并发症发生。结论：补佳乐联合宫颈注射利多卡因有利于绝经后妇女宫颈软化,减轻绝经后妇女的疼痛,值得临床推广应用。     

卡孕栓联合戊酸雌二醇在绝经后取环女性中的应用观察

目的：探讨卡孕栓联合戊酸雌二醇对绝经后取环女性宫颈软化度及一次性取环成功率的影响。方法：选取2019年10月至2022年10月在江西省九江市濂溪区妇幼保健计划生育服务中心接受取环手术的绝经后女性患者80例,按照随机数字表法分为对照组与观察组,每组40例。对照组采取常规取环手术,观察组在对照组基础上于取环术前采用卡孕栓+戊酸雌二醇口服治疗。比较两组宫颈软化度及一次性取环成功率、手术相关指标、疼痛程度、血清促卵泡生成素（FSH）、促黄体生成素（LH）水平及不良反应。结果：观察组宫颈总软化率高于对照组（P<0.05）;观察组一次性取环成功率高于对照组（P<0.05）;观察组手术时间短于对照组,手术出血量少于对照组,视觉模拟评分表（VAS）评分低于对照组（P<0.05）;观察组术后FSH、LH水平低于对照组（P<0.05）;两组不良反应总发生率比较,差异无统计学意义（P>0.05）。结论：卡孕栓联合戊酸雌二醇在绝经后取环女性患者治疗中可获得较好的效果,有效改善患者宫颈软化程度,提高一次性取环成功率,缩短手术时间,减少术中出血量,缓解手术疼痛感,调节激素水平,临床应...     

尼尔雌醇与复方米非司酮用于绝经后妇女取环的临床比较

目的探讨尼尔雌醇与复方米非司酮用于绝经后取环的临床比较。方法对150例绝经后取环的妇女进行回顾性分析，随机分为3组，A组取环前1周顿服尼尔雌醇6mg；B组取环前2d每天服复方米非司酮1片，服药前后空腹2h，共2d；C组取环前不服任何药物。结果A、B两组疗效优于C组，但A组和B组疗效比较差异无显著性。结论口服尼尔雌醇、复方米非司酮用于绝经后妇女取环扩宫及软化宫颈效果好，手术成功率高。     

米索前列醇在绝经后妇女取环术中的应用效果

目的：探讨米索前列醇在绝经后妇女取环术中的应用效果。方法将177例因绝经后要求取环患者按随机数字表法分为2组：A组89例、B组88例,2组均按常规取环术去除宫内节育器,A组术前1 h口服米索前列醇400 mg, B组术前未用任何药物。比较2组患者宫颈软化程度、取环时间、出血量及一次取出成功率。结果 A组宫颈软化显效率显著高于B 组（76.4%比18.2%,P〈0.01）;与B 组比较,A 组取环时间显著缩短（P〈0.01）,出血量显著减少（P〈0.01）,一次取出成功率显著升高（P〈0.01）。结论术前口服米索前列醇再进行取环手术可有效地扩张宫颈,减轻取环痛苦,减少出血量,提高手术成功率,是一种比较理想、经济、安全、有效及患者容易接受的方法。     

卡孕栓在绝经后取环中的运用疗效观察

目的研究舌下含服卡孕栓在绝经后妇女取环中的作用。方法将绝经后拟取环妇女随机分为两组,A组为直接取环组,B组为舌下含服卡孕栓组。结果 B组宫颈软化率、取环成功率高于A组（P〈0.005、P〈0.005）,B组手术时间、综合反应程度低于A组（P〈0.005、P〈0.001）。结论舌下含服卡孕栓有利于绝经后妇女节育环的取出。     

两种药物联合用于人工流产50例临床分析

目的观察复方萘普生栓联合米索前列醇片用于人工流产的临床观察。方法人工流产患者150例,随机分为3组：A组50例,术前3～4h口服米索前列醇片200μg,术前30min肛门放置复方萘普生栓1枚。B组50例术前3～4h口服米索前列醇片200μg。C组不用任何药物。对3组镇痛效果、宫颈软化情况、人工流产综合征发生率及手术时间进行比较。结果镇痛效果、人工流产综合征发生率3组差异有统计学意义（P〈0．05）,尤其以A纽镇痛效果最佳。A、B、C组宫颈软化、手术时间A、B组间差并无统计学意义（P〉0．05）,C组明显低于前两组（P〈0．05）。结论复方萘普生栓联合米索前列醇片用于人工流产达到较好的镇痛效果及宫颈软化作用,且减少了人工流产综合征的发生。     

复方吲哚美辛栓在人工流产术中镇痛效果的临床研究

目的：探讨复方吲哚美辛栓在人工流产术中的镇痛和扩宫效果：方法：通过对120例早孕妇女,进行复方吲哚美辛栓直肠给药、利多卡因宫颈注射、异丙酚静脉注射、生理盐水宫颈注射4种人工流产术中用药,比较观察疼痛、宫口松弛度、出血量及人工流产综合征（RAAS）的发生率,并分别记录术前及术后2min、5min、10min血压、脉搏、呼吸等生命体征。结果：利多卡因宫颈注射有扩张宫颈作用而不减轻吸管负压对宫壁肌的刺激痛：异丙酚镇痛效果好,但无明显扩张宫颈作用且术中出血最多;复方吲哚美辛栓不仅能了扩张宫颈还有良好的镇痛作用。结论：复方吲哚美辛栓直肠给药是一种值得推广应用的人流术的镇痛方法。     

现代残疾康复理念、政策与社区康复体系研究

本研究分析了当代残疾康复的理念和理论架构,构建了以国际公约、决议和政策、国内法律和政策以及操作性工具3个层次的康复理论体系;运用包容性发展,分析探讨了当代社区康复的体系和特点;就发展康复事业、为残疾人提供全面系统的康复服务提出相关的政策建议。     

国内外唇腭裂专科护理发展现状的文献研究及分析

目的了解和分析国内唇腭裂专科护理工作发展的现状。方法检索并分析万方医学网、中国知网、Springer Link及PubMed英文数据库近6年有关唇腭裂手术的围术期护理、患儿的喂养、手术安全管理、围术期疼痛研究以及心理护理的相关文献。结果共检索出国内文献89篇(核心期刊20篇)、国外文献22篇,其中围术期护理38篇、患儿的喂养16篇、手术安全管理10篇、围术期疼痛研究10篇、心理护理15篇。结论与国外文献相比,国内论文总结和回顾性居多,应增加研究探讨性论文,从而促进唇腭裂临床护理工作专科化的发展。     

城乡学童个性行为特征调查

目的探讨农村与城市儿童的个性行为特征。方法将97名农村学龄儿童设为农村组,97名城市学龄儿童设为城市组,采用艾森克个性问卷一儿童版和Achenbach’s 行为量表一儿童版进行评定分析。结果两组学龄儿童艾森克个性问卷各维度评分均无显著性差异（P均〉0．05）,且与全国常模相一致（P均〉0．05）;农村组男学童Achenbach’s行为量表违纪行为、攻击行为及外向型因子分均显著高于城市组,女学童退缩、社交问题因子分均显著高于城市组（P〈0．05或0．01）,其他因子分均无显著性差异（P均〉0．05）。结论农村与城市儿童个性无显著差异,而农村儿童存在较多的行为问题,可能与其所受教养和生活方式有关。     

我院文职护士管理和培训的实践与体会

目的构建文职护士培训、使用及管理的科学方法。方法通过规范管理、科学施训、作为骨干大胆任用等多种管理方式,使文职护士得到充分的发展。结果文职护士群体成长为医院优秀骨干,首批满3年的文职护士顺利通过续聘考核。结论科学的管理培训是文职护士成长的重要基石,对医院护理管理有着重要作用。     

Comparison of short-term and long-term protocols for stabilization and preservation of RNA and DNA of Leishmania, Trypanosoma, and Plasmodium

Molecular tools continue to be important in the prevention and control of parasitic diseases. However, using these techniques directly in the field remains a major challenge. Therefore, the preservation of clinical samples collected from endemic field areas for later analysis remains an important preanalytical process. This study aimed at identifying a suitable protocol for stabilization and preservation of RNA and DNA in bioclinical specimens for Trypanosoma, Leishmania, and Plasmodium research. Both spiked and unspiked blood samples were preserved in 7 protocols (different media; storage temperatures). Samples were evaluated for possible degradation of DNA and RNA along the storage duration up to the 10th week. Nucleic acid targets were assessed as follows: (i) Trypanosoma and Plasmodium RNA analysis was done using real-time nucleic acid sequence-based amplification (RT-NASBA) for 18S rRNA and for stage-specific Pfs25 mRNA, respectively; (ii) Trypanosoma DNA assessment analysis was conducted by using a conventional PCR for 18S rDNA; (iii) Leishmania RNA analysis was performed with a quantitative NASBA for 18S rRNA and Leishmania DNA assessment with an RT-PCR for 18S rDNA. Findings suggested that a newly developed L3™ buffer proved to be reliable and suitable for both short- and long-term preservation of parasite nucleic acid material. This buffer is envisaged to be suitable for utilization in field situations where resources are limited.     

History of violence and subjective health of mother and child

Objective: To study the self-reported prevalence of experienced violence among a cohort of women about two years after giving birth, their health during pregnancy, pregnancy outcomes and their experience of their child’s health.

Setting and subjects: In 2011, a total of 657 women participated in phase III of the Childbirth and Health Cohort Study in Icelandic Primary Health Care, 18 to 24 months after delivery. The women had previously participated in phase I around pregnancy week 16 and phase II 5–6 months after delivery. Data were collected by postal questionnaires.

Main outcome measures: Women’s reported history of experienced violence, sociodemographic and obstetric background, self-perceived health, the use of medications and their child’s perceived health.

Results: In phase III, 16% of women reported experiencing violence. These women felt less support from their current partner (p?p?p?p?p?p?=?0.008).

Conclusions: Our study confirms that a history of violence is common among women. A history of violence is associated with various maternal health problems during and after pregnancy, a higher rate of caesarean sections and maternal reports of health problems in their child 18–24 months after birth.

• KEY POINTS

• Violence is a major concern worldwide. Understanding the impact of violence on human health and developing effective preventive measures are important elements of any public health agenda.

• ??The reported prevalence of experiencing violence was 16% among women attending antenatal care in the primary health care setting in Iceland.

• ??Women with a history of violence reported worse health in general during pregnancy and delivered more often by caesarean section, compared to women with no such history.

• ??Mothers with a history of violence also evaluated the general health of their child as worse than women with no such history.

• ??The findings of this study support the importance of recognizing and addressing experienced violence among women in primary care.

     

Rates and risks of transmission of smallpox and mechanisms of prevention

In 1980, the World Health Organization declared smallpox eradicated from the world; the last known natural case had occurred in Somalia in 1977, and the United States had stopped routinely vaccinating its citizens in 1972. However, with increasing concerns regarding domestic and international terrorism, smallpox has resurfaced as a potential threat to global health. We review the direct and indirect modes of smallpox transmission and how patterns of transmission vary substantially, depending on the severity of circulating disease, vaccination status, environmental and socioeconomic factors, and the setting of an outbreak. We examine mechanisms for controlling outbreaks of disease and preventing further transmission in the event of an outbreak, with an emphasis on smallpox vaccination.     

通用设计原则与产品研发策略

本文介绍了通用设计的概念和设计原则,并阐述了根据此原则实施通用设计的产品研发策略。通用设计惠及的不仅是残疾人,也惠及了包括普通公众在内的广泛人群,以及企业。应将通用设计的原理应融入政府相关政策和未来发展的规划中,为残疾人以及更多人群提供合理便利的通用设计产品。     

Prevalence and severity of nausea and vomiting of pregnancy and effect of vitamin supplementation.

OBJECTIVE: Although nausea and vomiting of pregnancy is the most common medical condition during pregnancy, there are many unanswered questions regarding its cause, epidemiologic features and optimal management. The objectives of this study were to ascertain the prevalence of nausea and vomiting in a sample of Canadian women, to characterize the distribution of their severity and to investigate the role of vitamin B6 deficiency in their etiology. DESIGN: Prospective study. SETTING: Antenatal counselling service for pregnant women. PATIENTS: Three cohorts of women: a prospective, population-based cohort of 193 women, to estimate the rate and severity of nausea and vomiting (cohort A); a cohort of 555 women who sought advice for nausea with or without vomiting, to study the correlation between the maximal daily number of episodes of vomiting and maximal weight loss (cohort B); and a prospective cohort of 301 women who reported vomiting, to correlate vitamin supplementation with vomiting (cohort C). INTERVENTIONS: All 3 cohorts were interviewed during the counselling session, and cohort B was followed up prospectively. OUTCOME MEASURES: Frequency of nausea and vomiting, weight loss, maximal number of daily episodes of vomiting, rate of multivitamin supplementation. RESULTS: Overall, 67% of the women in cohort A reported experiencing nausea or vomiting, or both; 22% reported vomiting, and 9% experienced weight loss. In cohort B there was a significant correlation between the maximal number of daily episodes of vomiting and maximal weight loss, although there was wide variation (r2 = 0.25, p < 0.001). There was a highly significant correlation between the number of daily vomiting episodes and mean weight loss (r2 = 0.99). In cohort C, vomiting was significantly associated with lack of supplementation with multivitamins before 6 weeks' gestation (p = 0.002). CONCLUSIONS: The relation between number of daily vomiting episodes and mean weight loss may serve as a clinical tool to assess the severity of nausea and vomiting in pregnancy and the success of anti-emetics and rehydration regimens. Further study is needed to elucidate the biologic basis of the observed association between vomiting and lack of multivitamin supplementation in early pregnancy.     

胃癌DNA含量与E-cad、EGFR表达的关系及其意义

目的　探讨胃癌组织DNA含量与E cad、EGFR表达的关系 ,评价其在浸润、转移潜能及预后判断中的作用。方法　应用图像分析仪及SP免疫组化法检测 30例正常胃黏膜上皮、30例不典型增生和 5 0例胃癌组织DNA含量与E cad、EGFR蛋白表达情况。结果　①正常胃黏膜上皮、Ⅰ、Ⅱ、Ⅲ级不典型增生及胃癌组的DI、PI、S %、>5c %逐渐增高 ,与胃癌分期、淋巴结转移显著相关 (P <0 0 1)。②E cad在正常胃黏膜上皮阳性表达率 10 0 % ,EGFR呈阴性表达 ;Ⅰ、Ⅱ、Ⅲ级不典型增生及胃癌E cad阳性表达率逐渐降低 ,EGFR的阳性表达率逐渐升高 ,且差异显著 (P <0 0 5 ) ;E cad表达减弱、EGFR表达升高与胃癌分化差、淋巴结转移显著相关 (P <0 0 1)。③E cad表达阴性的胃癌DNA指数及EGFR表达水平显著高于E cad阳性 (P <0 0 1)。结论　检测DNA含量及E cad、EGFR蛋白表达有助于胃癌的早期诊断及转移潜能和预后的判断。