扬州市农村地区妇女生殖道感染现状分析

目的：了解3年来扬州市农村地区已婚妇女生殖道感染状况。方法：对扬州市农村地区已婚妇女64 561人常规行B超、妇科、实验室及乳腺检查，结果使用统一的调查问卷和妇科检查表填写。结果：生殖道感染居妇科疾病首位，其次是子宫肌瘤。结论：连续的妇女病普查可以有效提高生殖道感染的检出率及妇科肿瘤的早期发现率。     

已婚妇女36683例妇女病普查结果分析

目的了解不同职业对已婚妇女生殖道感染疾病的影响情况,为已婚妇女病的防治措施提供依据。方法由区计划生育委员会制定对辖区已婚妇女进行妇科病普查普治方案,对普查结果进行分析。结果3年来受检人数共36683例,患病人数9954例,总患病率为27.14%,乳腺增生患病率最高,宫颈糜烂患病率次之。结论应积极探索综合性社会卫生保健措施和干预办法,调动政府、各部门、社区及个人各个层面的积极性,努力提高妇女健康水平。     

1396例妇女健康体检结果分析

目的分析在我院体检中心体检的1396名已婚妇女健康体检结果,了解受检女性生殖道感染的现状,探讨有效的干预办法。方法2012-03—2013—02我院体检中心体检的已婚妇女,进行妇科检查,彩超,阴道分泌物常规检查,对有临床症状或可疑病例进一步行电子阴道镜及宫颈脱落细胞学检查。同时对患有生殖道感染的妇女进行指导治疗,定期随访,建立健康体检档案。结果接受体检已婚妇女1396人,平均年龄38岁,其中慢性宫颈炎占41.97％,细菌性阴道炎占41.62％,慢性盆腔炎占12．11％,滴虫性阴道炎占1.36％,外阴阴道假丝酵母茵占1．86％。结论加强妇女卫生健康保健的宣传,提高妇女自我保健意识及对生殖系统疾病的认知,重视妇科体检,积极开展妇科普查及宫颈癌筛查,做到早发现、早诊断、早治疗,改善女性生殖道感染的现状,降低生殖道感染的患病率。     

龙川县20 435名农村已婚妇女生殖健康的调查

目的了解农村已婚妇女生殖健康状况,以便开展妇女生殖疾病的防治工作.方法分期分批对农村已婚妇女进行生殖疾病普查.结果龙川县农村已婚妇女生殖疾病的患病率41.88%,其中以生殖道感染为主,不同年龄患病率不同.结论农村妇女生殖健康意识薄弱,有病也羞于启齿,加之经济欠缺,治疗不及时,致妇女生殖疾病发病率高.     

大丰市城区已婚育龄妇女生殖健康普查结果分析及对策

目的 了解本市已婚育龄妇女的生殖健康状况,提高育龄妇女的健康水平和自我保健意识.方法 2004年9月至2006年9月,每年一次对本市城区企事业单位已婚育龄妇女作生殖健康普查,同时给予对症治疗、护理及发放宣传资料,开展生殖健康的宣传教育.结果 参加普查人数逐年增加,通过综合干预后育龄妇女的生殖道感染阳性率逐年降低.结论 定期对育龄妇女进行疾病的普查、普治及生殖健康教育,可提高妇女的生殖健康状况及自我保健意识.     

农村妇女生殖道疾病普查结果分析

目的：掌握农村妇女生殖健康状况和要求,为开展生殖健康优质服务提供依据。方法：采用妇科检查、阴道涂片检查、B超,询问病史并建立档案,对农村1 680位已婚妇女进行了妇女病普查。结果：生殖道感染1 013例（78.2%）,其中宫颈炎668例（65.9%）,阴道炎215例（21.2%）。结论：生殖道感染目前仍然是影响妇女健康的主要疾病,农村妇女知识缺乏,应加强生殖健康知识宣传教育,做到早发现、早诊断、早治疗的原则,提高其自我保健意识,促进生殖健康。     

社区已婚妇女妇科病调查分析

目的通过对社区已婚妇女妇科病普查,了解妇女人群的健康水平,找出影响妇女健康的重要疾病,及时给予治疗以保障女性健康,并制定出防治措施和相应的对策,切实提高广大妇女的健康水平。掌握妇女病的流行病学特点和发病趋势,进一步做好妇女病的普查及保健工作,为妇女常见病防治提供可靠依据。方法对鹰潭市东湖社区2009、2010年已婚妇女妇科病（包括流动人口）进行普查,检查项目包括妇科检查、白带常规化验、宫颈刮片、乳腺红外线扫描、盆腔B超等。结果 2009年共普查5 456例次,生殖系炎症4 108例次,占75.3%,其中宫颈炎2 494例,占60.7%;2010年共普查5 145例次,生殖系炎症2 176例次,占42.3%,其中宫颈炎1 158例次,占53.2%。2010年妇女生殖系炎症发生率显著低于2009年（P〈0.05）。结论生殖系炎症发病率高,其中以宫颈炎为主,外阴阴道炎及盆腔炎次之。生殖道感染是影响妇女健康的主要原因,加强宣传教育,提高认识,定期组织社区妇女进行妇科病普查是降低发病率,提高治疗率的重要措施,对于提高妇女生殖健康十分重要。     

湘西少数民族地区育龄妇女生殖道感染状况的分析

目的通过调查湘西民族地区育龄妇女生殖道感染状况,找出患病规律,制订出护理健康教育指导体系,降低生殖道感染率,提高该地区育龄妇女生殖健康水平,并为当地卫生行政部门决策提出建议。方法用统一制定的妇科病普查表,对10672位已婚妇女逐个询问病史,并进行阴道显微镜、阴道分泌物等常规检查,对结果进行分析。结果2000-2005年资料完整者10672人次,宫颈炎6333人次,患病率为59.34%;阴道炎4847人,患病率为45.42%。结论目前湘西民族地区育龄妇女的生殖道感染率高,应引起当地妇幼保健工作者和社区护士的高度重视,制订相应的健康教育对策。     

62238例农村已婚育龄妇女生殖道感染状况分析

生殖道疾病是困扰育龄妇女健康的多发病，常见病，也是妇科各种病变的主要诱因。随着现代生活质量的提高，妇女生殖道感染已愈来愈受到社会的关注。生殖道感染不但直接危害妇女的身心健康和生活质量，而且也影响着出生人口素质。为了了解临沭县农村已婚育龄妇女生殖道感染状况，笔者利用对全县62238例农村已婚育龄妇女生殖道健康查体的时机，对感染状况进行了总结分析，现报告如下：     

湘西少数民族地区育龄妇女生殖道感染状况的分析

目的通过调查湘西民族地区育龄妇女生殖道感染状况,找出患病规律,制订出护理健康教育指导体系,降低生殖道感染率,提高该地区育龄妇女生殖健康水平,并为当地卫生行政部门决策提出建议。方法用统一制定的妇科病普查表,对10672位已婚妇女逐个询问病史,并进行阴道显微镜、阴道分泌物等常规检查,对结果进行分析。结果2000-2005年资料完整者10672人次,宫颈炎6333人次,患病率为59.34%;阴道炎4847人,患病率为45.42%。结论目前湘西民族地区育龄妇女的生殖道感染率高,应引起当地妇幼保健工作者和社区护士的高度重视,制订相应的健康教育对策。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.