腹腔镜术联合达菲林治疗中重度子宫内膜异位症临床效果观察

目的 探讨腹腔镜术联合达菲林治疗子宫内膜异位症的临床疗效,为子宫内膜异位症的治疗提供理论依据. 方法 60例子宫内膜异位症患者随机分为治疗组和对照组各30例,其中治疗组采用腹腔镜手术联合达菲林治疗,对照组采用腹腔镜手术联合孕三烯酮治疗,比较两组疗效及不良反应. 结果 达菲林组显效率高于孕三烯酮组,复发率低于孕三烯酮组,差异均有统计学意义（P＜0.05）,而两组不良反应差异均无统计学意义（P＞0.05）. 结论 腹腔镜术后联合达菲林治疗子宫内膜异位症治疗效果安全有效.     

腹腔镜联合米非司酮治疗子宫内膜异位症的疗效及对MMP-9、TIMP-1的影响

目的:了解腹腔镜联合米非司酮治疗子宫内膜异位症的疗效及对MMP-9、TIMP-1的影响,为临床治疗子宫内膜异位症提供参考依据。方法:207例子宫内膜异位症患者被采随机分为观察组112例和对照组95例。对照组仅采用腹腔镜手术治疗;观察组采用腹腔镜联合米非司酮片治疗。评价两组的疗效,观察两组的MMP-9、TIMP-1水平和药物不良反应发生情况。结果:两组治疗后的MMP-9、TIMP-1水平和MMP-9/TIMP-1比值均显著低于治疗前(t=5.694、3.741、4.023、3.816、3.550、3.019,P均<0.05)。观察组治疗后的MMP-9、TIMP-1水平和MMP-9/TIMP-1比值均显著低于对照组治疗后(t=4.263、2.945、3.751,P均<0.05)。观察组的显效率为41.1%,总有效率为92.9%,均高于观察组,两组比较,差异有统计学意义(χ2=8.512、4.028,P>0.05)。观察组药物不良反应发生率为10.7%(12/112)。结论:腹腔镜联合米非司酮治疗子宫内膜异位症可改善MMP-9/TIMP-1平衡,具有更高的有效性和安全性。     

子宫内膜异位症患者在位内膜的MMP-9和VEGF的表达

目的分析子宫内膜异位症患者在位内膜的基质金属蛋白酶9(MMP-9)与血管内皮生长因子(VEGF)的表达情况。方法选取我院接诊的70例子宫内膜异位症患者作为A组,另选我院既往接受治疗后未复发的50例子宫内膜异位症患者作为B组,同时选取同期于我院接受健康体检的50例健康人群作为对照组。检测三组的在位内膜的MMP-9、VEGF表达水平,并进行比较分析。结果 A组患者在位内膜的MMP-9、VEGF表达率显著高于B组与对照组(P<0.05);A组和B组患者在位内膜的MMP-9、VEGF表达均呈正相关关系(P<0.05)。结论子宫内膜异位症患者在位内膜的MMP-9、VEGF表达存在异常,经有效治疗后可恢复正常,且能延缓复发。     

注射用醋酸亮丙瑞林微球对子宫内膜异位症腹腔镜术后患者的临床价值

目的探讨注射用醋酸亮丙瑞林微球对子宫内膜异位症腹腔镜术后患者血清血管内皮生长因子(VEGF)、基质金属蛋白酶-2 (MMP-2)、MMP-9表达及性激素变化影响。方法选择该院于2017年4月-2019年4月期间收治的子宫内膜异位症合并不孕症患者86例,依据随机数字表法随机分为观察组43例与对照组43例。对照组患者采用腹腔镜手术治疗,观察组在对照组基础上于术后月经来潮第2 d皮下注射醋酸亮丙瑞林微球,每4周1次,共6次。两组疗程均为24周。比较两组治疗疗效,治疗前后盆腔包块大小和EHP-5评分、VEGF、MMP-2、MMP-9及性激素水平变化。结果观察组总有效率高于对照组(P0.05)。两组治疗后盆腔包块大小和EHP-5评分较治疗前降低(P0.05);观察组治疗后盆腔包块大小和EHP-5评分低于对照组(P0.05)。两组治疗后血清VEGF、MMP-2及MMP-9水平较治疗前降低(P0.05);观察组治疗后血清VEGF、MMP-2及MMP-9水平低于对照组(P0.05)。两组治疗后血清卵泡刺激素(FSH)、促黄体生成素(LH)及雌二醇(E2)水平较治疗前降低(P0.05);观察组治疗后血清FSH、LH及E2水平低于对照组(P0.05)。结论注射用醋酸亮丙瑞林微球对子宫内膜异位症腹腔镜术后患者疗效良好,可降低血清VEGF、MMP-2、MMP-9水平及改善性激素水平。     

腹腔镜联合药物治疗子宫内膜异位症合并不孕的临床分析

目的探讨腹腔镜联合药物治疗子宫内膜异位症（endometriosis,EM）合并不孕的临床价值。方法选择2003年1月至2007年1月本院收治的Ⅰ～Ⅳ期子宫内膜异位症合并不孕患者341例为研究对象。对其在腹腔镜下子宫内膜异位症类型分别行粘连松解术、异位病灶电凝术、卵巢子宫内膜异位囊肿切除术、输卵管造13及通液术后,将各期患者随机分为A,B组和对照组。A组（n=93）口服孕三烯酮（内美通,2．5mg／粒,每周2次,每次1粒）,疗程为6个月。B组（n=114）肌内注射醋酸曲普瑞林（达菲林,规格：3．75mg／支,每4周1次,每次1支）,疗程3个月,对照组（n=134）未用药。治疗后,随访1年,比较三组的妊娠结局。结果对于Ⅰ,Ⅱ期子宫内膜异位症合并不孕患者,A,B组平均受孕率为39．2％,对照组受孕率为30．1％,A,B组与对照组比较,差异无显著意义（P〉0．05）。对于Ⅲ,Ⅳ期子宫内膜异位症合并不孕患者,A,B组平均受孕率为37．5％,对照组受孕率为23．0％,A,B组与对照组比较,差异无显著意义（P〉0．05）;且B组受孕率（45．6％）高于A组（28．3％）,两组比较,差异有显著意义（P〈0．05）。结论腹腔镜手术治疗,可提高子宫内膜异位症合并不孕患者的妊娠率,对于Ⅲ期、Ⅳ期的子宫内膜异位症合并不孕患者,腹腔镜术后联合药物治疗对提高妊娠率有重要作用。促性腺激素释放激素激动剂是腹腔镜术后联合药物治疗的最好选择。     

腹腔镜术联合达菲林治疗子宫内膜异位症的临床疗效及对患者血清IL-6、Syndecan-1表达的影响

目的探讨达菲林辅助腹腔镜术对子宫内膜异位症(EMT)的临床治疗效果及对患者血清白介素-6(IL-6)、可溶性多配体蛋白聚糖-1(Syndecan-1)表达的影响。方法选取2013年3月-2016年5月在该院妇产科进行腹腔镜治疗的132例EMT患者作为研究对象,按照随机数字表法分为对照组(采用腹腔镜术)和观察组(采用腹腔镜术联合达菲林),每组各66例。比较两组治疗效果、复发率及两组患者治疗前后盆腔包块体积、生存质量评分、痛经及盆腔痛评分以及促黄体生成素、雌二醇、卵泡刺激素、IL-6、Syndecan-1表达水平和不良反应发生率。结果治疗总有效率、复发率两组比较差异具有统计学意义(U=32.133,P=0.012;χ2=9.570,P=0.002);且治疗后,盆腔包块体积、生存质量评分、痛经评分、盆腔痛评分、促黄体生成素、雌二醇、卵泡刺激素、IL-6、Syndecan-1表达水平两组比较差异均具有统计学意义(均P0.05);观察组体重增加、胃肠道反应、潮热、围经期症状不良反应率高于对照组(P0.05),而痤疮、肝功能异常发生率两组比较差异无统计学意义(P0.05)。结论达菲林辅助腹腔镜术有助于降低患者血清IL-6及Syndecan-1表达水平,并提高子宫内膜异位症临床治疗效果,降低复发率。     

子宫内膜异位症保守手术后延续用药的临床观察

目的:探讨子宫内膜异位症保守手术后延续用药时间对预后的影响。方法:自2003年1月～2004年12月在天津市中心妇产科医院行开腹子宫内膜异位症保守手术的患者65例,均为中重度子宫内膜异位症。其中A组43例术后应用达菲林3个月,B组22例术后应用达菲林6个月,观察两组患者的妊娠率及复发情况。结果:A组43例,妊娠29例,复发6例。B组22例,妊娠13例,复发3例,两组比较差异无统计学意义(P>0.05)。结论:子宫内膜异位症保守手术后延续达菲林治疗以3个月较为适宜。延续治疗6个月并不能提高术后的妊娠率,也没有降低术后的复发率。     

腹腔镜手术联合戈舍瑞林治疗子宫内膜异位症合并不孕症的疗效及对血清MMP-9、TIMP-1水平的影响

目的探讨腹腔镜手术联合戈舍瑞林治疗子宫内膜异位症合并不孕症的疗效及对患者血清基质金属蛋白酶-9(MMP)-9、基质金属蛋白酶抑制剂-1(TIMP)-1水平的影响。方法选取2014年5月-2015年12月绵阳市盐亭县人民医院收治的128例子宫内膜异位症合并不孕症患者作为研究对象,采取随机数字表将其分成观察组和对照组,每组64例患者。两组患者均给予腹腔镜保守手术治疗,观察组于术后给予戈舍瑞林治疗,对照组不用药,仅随访观察。比较两组疗效,治疗前后血清MMP-9、TIMP-1水平,术后6个月、1年妊娠率及术后1年复发率。结果观察组总有效率为96.88%,显著高于对照组(87.50%),差异有统计学意义(P0.05)。与术前相比,两组患者术后3个月血清MMP-9水平、MMP-9/TIMP-1比例均明显下降(P0.05),但观察组下降更明显(P0.05)。与对照组相比,观察组患者术后6个月、1年妊娠率均明显上升,术后1年复发率明显下降,差异均有统计学意义(均P0.05)。观察组患者于停药后1~3个月月经复潮。对照组患者于术后16~40 d月经复潮。观察组与对照组不良反应发生率分别为18.75%(12例)和14.06%(9例),两组比较差异无统计学意义(P0.05)。结论腹腔镜手术联合戈舍瑞林治疗子宫内膜异位症合并不孕症可有效调节患者MMP-9/TIMP-1平衡,提高近期疗效,减少复发,同时增加远期妊娠率,具有较高的临床应用价值。     

促性腺激素释放激素激动剂联合腹腔镜手术治疗子宫内膜异位症合并不孕症的效果

目的探究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合并不孕症的效果,为子宫内膜异位症的治疗提供理论依据。方法选取2015年1月-2016年11月在该院进行治疗的子宫内膜异位症合并不孕症患者72例为研究对象,根据患者的意愿并参照随机数表法分为对照组和观察组,每组各36例。对照组采用腹腔镜手术进行治疗,观察组采用GnRH-a联合腹腔镜手术治疗。对两组治疗效果,血清中糖类抗原125(CA125)、糖类抗原199(CA199)、胎盘蛋白14(PP14)、卵巢癌生物标记物4(HE4)水平,血清中性激素相关指标、疾病复发相关指标,6个月及1年内的妊娠率及治疗满意度进行对比分析。结果观察组治疗总有效率显著高于对照组(P0.05)。治疗前,两组患者CA125、CA199、PP14、HE4水平比较,差异无统计学意义(P0.05);治疗后,两组患者CA125、CA199、PP14、HE4水平较治疗前显著降低(P0.05),且观察组血清CA125、CA199、PP14、HE4水平显著低于对照组(P0.05)。治疗前后,观察组患者卵泡刺激素(FSH)、FSH/黄体生成素(FSH/LH)、雌二醇(E——2)水平无显著变化(P0.05);而对照组则波动较大(P0.05)。治疗前,两组患者血清基质金属蛋白酶-9(MMP-9)、组织金属蛋白酶抑制物-1(TIMP-1)及血管内皮生长因子(VEGF)水平比较,差异无统计学意义(P0.05);治疗后,观察组MMP-9、TIMP-1和VEGF水平显著低于对照组(P0.05)。观察组总复发率显著低于对照组(P0.05)。观察组治疗满意度度显著高于对照组(P0.05)。结论 GnRH-a联合腹腔镜手术治疗子宫内膜异位症合并不孕症临床效果较好,可以显著降低血清中疾病及复发相关因子水平、维持患者体内激素水平的稳定、降低复发率,且具有较好的治疗满意度,值得在临床上广泛推广。     

GnRH-a联合腹腔镜手术对子宫内膜异位症患者临床症状及妊娠率的影响

目的探讨GnRH-a联合腹腔镜手术对子宫内膜异位症患者临床症状及妊娠率的影响。方法 70例子宫内膜异位症患者随机均分为两组,对照组采用腹腔镜手术治疗,研究组采用GnRH-a联合腹腔镜手术治疗。比较两组的治疗效果、临床症状及妊娠率。结果研究组的治疗总有效率、术后2年内妊娠率均显著高于对照组(P <0.05)。治疗后,研究组的临床症状总分显著低于对照组(P <0.05)。结论 GnRH-a联合腹腔镜手术治疗子宫内膜异位症的疗效显著,可改善患者的临床症状,提高妊娠率。     

Living with opioids: A qualitative study with patients with chronic low back pain

BackgroundOpioids are one of the most prescribed treatments for chronic pain (CP). However, their long‐term use (>3 months) has been surrounded by controversy, due to loss of beneficial effects.ObjectiveTo explore the experiences of people with chronic non‐malignant low back pain in Spain undergoing long‐term treatment with opioids.DesignQualitative study.Setting and participantsWe conducted 15 semi‐structured interviews at the Pain Clinic with persons taking opioid treatment.MethodsThe interviews were analysed by qualitative content analysis as described by Graneheim and Lundman, and developed categories and themes discussed in light of a biomedicalization framework.Main resultsWe developed one overarching theme—Living with opioids: dependence and autonomy while seeking relief—and three categories: The long pathway to opioids due to the invisibility of pain; Opioids: from blind date to a long‐term relationship; and What opioids cannot fix.DiscussionThe long and difficult road to find effective treatments was a fundamental part of coping with pain, involving long‐term relationships with the health system. This study reflects the benefits, and drawbacks of opioids, along with struggles to maintain autonomy and make decisions while undergoing long‐term treatment with opioids. The paper also highlights the consequences of pain in the economy, family and social life of patients.ConclusionsPatients'' experiences should be considered to a greater extent by health‐care professionals when giving information about opioids and setting treatment goals. Greater consideration of the social determinants of health that affect CP experiences might lead to more effective solutions to CP.     

Incorporating Cognitive-Behavioral Therapy with Occupational Therapy: A Comparative Study with Patients with Low Back Pain

This paper reports on the implementation of a psychoeducational program utilizing cognitive-behavioral principles. The efficacy of this psychoeducational treatment program in modifying dysfunctional attitudes in patients with chronic low back pain was examined using a two-group pretest posttest design with a follow-up at 3 months. Thirty patients (average age = 44,37, SD = 13.71) participated in the study, with 15 in the psychoeducational treatment group and 15 in the placebo control group. These two conditions were added on to an existing eclectic inpatient pain management program. After assessment on the IPAM (The Integrated Psychosocial Assessment Model), scores were reduced to multivariate composite scores on the factors of illness behavior, depressed and negative cognitions, and acute pain strategies. Results of a group × time repeated measures analysis of variance for the three pain factors revealed a significant main effect for group(F(23,1) = 5.00, p > .04), tempered by a significant interaction between group and time on the depressed and negative pain factor(F(23,1) = 4.77, p > .04). Patients in the treatment group improved significantly over time and significantly more than the placebo control group patients at posttreatment. Results provide support for the program in increasing patients' feelings of control over their pain and the use of positive coping strategies, while reducing perceived helplessness, depression, disability, and pain intensity.     

Serum analyses compared with widal after inoculation with Typhus-Paratyphus

Zusammenfassung 20 Patienten — typische chronische Alkoholiker ohne Cirrhosis hepatis — wurden mit hitzegetöteten Typhus-Paratyphus Bacilli geimpft. Die Impfung rief keine Veränderung im Inhalt von Zucker, Transminasen (GOT, GPT) oder Rest-N des Serums hervor. Die Serumproteine, die durch Papierelektrophorese geprüft wurden, zeigten vermehrte Globuline und verminderte Albumine nach der Impfung.Alkoholiker bilden Antistoffe ebensogut wie Nicht-Alkoholiker.

---

Résumé 20 malades — des alcooliques typiquement chroniques sans cirrhosis hepatis — furent vaccinés avec des bacilli de typhusparatyphus, tués par la chaleur. La vaccination ne provoqua pas de changement du contenu de sucre, de transminases (GOT, GPT) ou de N-résidu du sérum. Les protéines de sérum, qui furent examinées par l'électrophorèse de papier montrèrent une augmentation des globulines et une décroissance des albumines après la vaccination.Les alcooliques produisent des anticorps aussi bien que les non-alcooliques.

---

---

(Clinical Laboratory Investigations of Male Chronic Alcoholics)     

Satisfaction with healthcare services among Spanish people with disabilities

BackgroundSeveral studies show the relationship between patient satisfaction and quality of health services and also between disabling conditions and healthcare access, but none sufficiently analyze the factors that contribute to satisfaction among patients with disabilities.Objective/hypothesesThe primary aim of this paper is to quantify the impact of social factors, perceived health status and access on satisfaction with healthcare services among Spanish people with disabilities.MethodsThis paper uses data from the European Health Survey 2009 to construct latent variables related to satisfaction, use and health status among Spanish patients with disabilities. Next, partial least squares path modeling is used for quantifying the effects of certain social factors, service use, and health status on patient satisfaction with received healthcare services.ResultsSatisfaction with healthcare services among people with disabilities is correlated (Nagelkerke R² of 0.175) with certain demographic factors (age, gender and town size), assistance support and patient use of these services. Education level and income were not found to have significant effects.ConclusionsPeople with disabilities generally show a high level of satisfaction with healthcare services, influenced by a positive valuation of the differentiated use given their specific care needs. Subjective aspects of care have a notable influence, linked with the perception of the person's own state of health and emotional status, on these positive valuations; patients' individual perceptions can reduce care needs and the use patients make of healthcare services and tend to increase their level of satisfaction with these services when they do seek them.     

Supplementation with Guanidinoacetic Acid in Women with Chronic Fatigue Syndrome

A variety of dietary interventions has been used in the management of chronic fatigue syndrome (CFS), yet no therapeutic modality has demonstrated conclusive positive results in terms of effectiveness. The main aim of this study was to evaluate the effects of orally administered guanidinoacetic acid (GAA) on multidimensional fatigue inventory (MFI), musculoskeletal soreness, health-related quality of life, exercise performance, screening laboratory studies, and the occurrence of adverse events in women with CFS. Twenty-one women (age 39.3 ± 8.8 years, weight 62.8 ± 8.5 kg, height 169.5 ± 5.8 cm) who fulfilled the 1994 Centers for Disease Control and Prevention criteria for CFS were randomized in a double-blind, cross-over design, from 1 September 2014 through 31 May 2015, to receive either GAA (2.4 grams per day) or placebo (cellulose) by oral administration for three months, with a two-month wash-out period. No effects of intervention were found for the primary efficacy outcome (MFI score for general fatigue), and musculoskeletal pain at rest and during activity. After three months of intervention, participants receiving GAA significantly increased muscular creatine levels compared with the placebo group (36.3% vs. 2.4%; p < 0.01). Furthermore, changes from baseline in muscular strength and aerobic power were significantly greater in the GAA group compared with placebo (p < 0.05). Results from this study indicated that supplemental GAA can positively affect creatine metabolism and work capacity in women with CFS, yet GAA had no effect on main clinical outcomes, such as general fatigue and musculoskeletal soreness.     

Waist circumference is positively correlated with markers of inflammation and negatively with adiponectin in women with metabolic syndrome

The purpose of this study was to correlate biomarkers of metabolic syndrome (MetS), with markers of inflammation and macronutrient intake in 89 women (25-72 years) with MetS. We hypothesized that waist circumference (WC) would have the stronger correlations with inflammatory parameters and would correlate with carbohydrate intake. Values for WC (108.7 ± 11.1 cm) and plasma triglycerides (202.7 ± 52.1 mg/dL) were elevated, whereas plasma glucose levels varied from 66 to 179 mg/dL, with 42% of women having insulin resistance. Plasma levels of interleukin 6 (0.2-15.9 mg/L), tumor necrosis factor α (1.47-12.3 mg/L), and high-sensitivity C-reactive protein (0.06-3.08 mg/dL) varied widely, with most women being above values considered normal. Subjects had high intake of total sugar (92.3 ± 56.4 g/d), high glycemic index (59.8 ± 6.5), and glycemic load (127.2 ± 56.1), whereas dietary fiber (17.1 ± 9.1 g/d) was below recommended intake. Waist circumference was positively correlated with insulin (r = 0.275, P < .01) and with the inflammatory markers interleukin 6 (r = 0.307, P < .01) and tumor necrosis factor α (r = 0.228, P < .05) and negatively correlated with plasma adiponectin (r = −0.309, P < .0001). In addition, WC was positively correlated with total carbohydrate, added sugar, and glycemic load (P < .05) but not with fat or protein. These results are consistent with central obesity being a key marker of the inflammatory state, and they also suggest that carbohydrates, particularly those that are digested rapidly, contribute to increased risk of central obesity and development of MetS.     

Higher persistence with valsartan compared with enalapril in daily practice

Objective

To compare persistence with valsartan and enalapril in daily practice.

Methods

The PHARMO Record Linkage System includes various data registries including drug dispensing and hospitalizations for ≥2 million subjects in the Netherlands. Patients newly treated with valsartan or enalapril in the period of 1999–2002 were selected. Persistence was calculated by summing up the number of days of continuous treatment. Patients who remained on therapy with valsartan or enalapril for 12 or 24 months were defined as persistent at 1 or 2 years, respectively.

Results

3364 patients received valsartan and 9103 patients received enalapril. About 62% of patients treated with valsartan and 55% of patients treated with enalapril remained on therapy at 12 months after the initial dispensing, while 48% of patients treated with valsartan and 43% of patients treated with enalapril were persistent at 24 months. Patients treated with valsartan were about 20% more likely to stay on treatment than patients treated with enalapril (1 year RR_adj: 1.23, 95% CI: 1.16–1.32; 2 years RR_adj: 1.16, 95% CI: 1.11–1.23).

Conclusions

Real-life persistence is higher with valsartan than with enalapril. The results of this and other studies on persistence in daily practice should be taken into account when deciding upon drug treatment for hypertension.     

肾综合征出血热患者血清炎性细胞因子与疾病进程及预后的相关性

目的 分析肾综合征出血热患者不同临床分期及不同临床分型血清中C反应蛋白、白细胞介素-1、白细胞介素-6、肿瘤坏死因子-α水平与疾病的相关性,为HFRS临床诊治提供依据.方法 以2018年6月至2020年1月在锦州医科大学附属第一医院住院的37例HFRS患者和15例健康体检者(对照组)为研究对象,用ELISA法分别检测患...     

Participant Satisfaction with a Food Benefit Program with Restrictions and Incentives

Background

Policy makers are considering changes to the Supplemental Nutrition Assistance Program (SNAP). Proposed changes include financially incentivizing the purchase of healthier foods and prohibiting the use of funds for purchasing foods high in added sugars. SNAP participant perspectives may be useful in understanding the consequences of these proposed changes.