An epidemiologic study of risk factors associated with pregnancy following female sterilization

Data on 14,700 female sterilization patients were collected by the International Fertility Research Program (IFRP) from 1972 to 1978 and analyzed to determine risk factors associated with the incidence of pregnancy following sterilization. With a case-control approach, it was found that younger patients (less than or equal to 34 years old) and those who did not lactate after sterilization had a higher risk of becoming pregnant. Patients who were sterilized in the early phases of a service program had a higher risk of pregnancy than those sterilized later. In the laparoscopic series, the relative risk of pregnancy was four times greater in patients who had the prototype spring clip than in patients who had the Falope ring. The relative risk increased to 7.0 when patients who had the prototype spring clip were compared to those who had the Falope ring, electrocoagulation, or the Rocket clip. Patients sterilized by electrocoagulation had a low pregnancy risk, but the risk of an ectopic pregnancy was significantly higher than for those sterilized with mechanical devices. In the culdoscopic series, the tantalum clip had an unacceptable pregnancy risk.     

Incidence of pain among women undergoing laparoscopic sterilization by electrocoagulation, the spring-loaded clip, and the tubal ring.

Data analyzed from five comparative studies show a relationship between the technique of tubal occlusion and pain experienced by patients both at the time of the procedure and during the recovery period. During the procedure, the spring-loaded clip is the technique least likely and the tubal ring the technique most likely to be associated with pain. During the recovery period, both the spring-loaded clip and the tubal ring are associated with higher rates of abdominal or pelvic pain than is electrocoagulation. Differences in pain that occurred during the recovery period did not persist to the early follow-up visit.     

Hydroxyurea inhibition of cellular and developmental activities in the decidualized and pregnant uteri of rats

The cytotoxicity of hydroxyurea (HU), currently used to combat various cancers, sickle cell anemia and human immunodeficiency infection, was assessed by exposing decidualized and pregnant uteri of Sprague-Dawley rats to this drug. Consecutive daily doses of HU (500 mg/kg(-1)) for 4 days were injected subcutaneously during decidualization when proliferation of the deciduoma was biochemically analyzed on pseudopregnancy day 9, or injected intraperitoneally during pregnancy when uterine developmental processes were evaluated on gestation day 16. Hydroxyurea displayed prominent antiproliferative effects on decidual growth. These actions were comparable to significantly impaired (P<0.001) developmental responses (increases in post-implantation losses, in resorbed fetuses and in reduced fetal and placental weights) during pregnancy. The cellular components inhibited by HU were DNA, protein, nitric oxide synthase, a matrix metalloproteinase and decidual prolactin-related protein mRNA (P<0.05). Steroid-related endocrine events (serum progesterone concentrations, estrogen receptor and mRNA levels) were unaffected by HU, implying direct cellular action by the drug. Interestingly, endometrial alkaline phosphatase bioactivity was enhanced by HU (P<0.05). Subsequently, the reproductive toxicity of HU was apparently related to mitogenic and differentiation-induced endometrial cellular activities.     

先天性巨结肠31例的诊治体会

目的探讨新生儿先天性巨结肠的诊断、合理的治疗方案,以提高治愈率。方法对３１例先天性巨结肠的患儿进行回顾性分析,本组有近半数在新生期误诊为胎粪堵塞综合征或其它疾病。结果１３例采用保守治疗,仅暂时缓解症状;５例行Ｓｗｅｎｓｏｎ术,２例复发,１例并发肠扭转,１例吻合口出血并发小肠结肠炎;３例行Ｒｅｈｂｅｉｎ术,１例复发,１例并发小肠结肠炎;１２例行Ｄｕｈａｍｅｌ术,仅１例出现不全性肠梗阻,余随访１～２年。结论传统的保守治疗仅作为术前准备阶段或暂时缓解症状,Ｄｕｈａｍｅｌ术与其它术式比较创伤小,操作简便,并发症少。     

酒精和激素性股骨头缺血性坏死发病机制的实验研究

目的研究酒精和激素性股骨头缺血坏死的发病机制。方法选用健康成熟的中国白兔６０只,体重２．５±０．５ｋｇ,雌雄不限,随机分成两组。Ａ组３０只为酒精组,Ｂ组３０只为激素组。分别于实验前和实验后２、４、６、８周测血脂、前列腺素Ｅ２和血栓烷素Ｂ２。并于第４、８、１０周分批处死,取肝脏和股骨头作常规病理组织学和超微结构观察。结果两组血脂水平明显升高,差异无显著性意义;从实验第４周开始两组前列腺素Ｅ２较处理前明显增高（Ｐ＜０．０１）;而实验第４周和第８周前列腺素Ｅ２的含量Ａ组较Ｂ组明显增高（Ｐ＜０．０１）。两组动物都出现股骨头骨细胞坏死,同时有大量骨细胞发生脂肪变性及坏死。电镜下两实验组可见股骨头部骨细胞内出现异常增多的脂滴,核变性深染,细胞器消失。但Ａ组动物骨细胞坏死程度比Ｂ组动物严重,表现为损伤作用强烈,经过急剧,呈急性坏死表现。而Ｂ组动物骨细胞坏死呈慢性进行性坏死表现。结论激素所致的股骨头缺血坏死是多种因素引起股骨头血液循环障碍,导致骨坏死;而酗酒使血中游离脂肪酸升高,前列腺素增多,易发生血管炎而栓塞,以致骨缺血坏死     

Profiling nurses' job satisfaction,acculturation, work environment,stress, cultural values and coping abilities: A cluster analysis

This study aimed to determine whether definable profiles existed in a cohort of nursing staff with regard to demographic characteristics, job satisfaction, acculturation, work environment, stress, cultural values and coping abilities. A survey was conducted in one hospital in Singapore from June to July 2012, and 814 full‐time staff nurses completed a self‐report questionnaire (89% response rate). Demographic characteristics, job satisfaction, acculturation, work environment, perceived stress, cultural values, ways of coping and intention to leave current workplace were assessed as outcomes. The two‐step cluster analysis revealed three clusters. Nurses in cluster 1 (n = 222) had lower acculturation scores than nurses in cluster 3. Cluster 2 (n = 362) was a group of younger nurses who reported higher intention to leave (22.4%), stress level and job dissatisfaction than the other two clusters. Nurses in cluster 3 (n = 230) were mostly Singaporean and reported the lowest intention to leave (13.0%). Resources should be allocated to specifically address the needs of younger nurses and hopefully retain them in the profession. Management should focus their retention strategies on junior nurses and provide a work environment that helps to strengthen their intention to remain in nursing by increasing their job satisfaction.     

宫颈细胞学p16INK4a蛋白检测联合细胞学检测在宫颈癌筛查中的价值

目的:探讨宫颈细胞学p16INK4a蛋白联合细胞学检测在宫颈癌筛查中对宫颈癌前病变和宫颈癌的诊断价值.方法:选取790例20～70岁自愿行宫颈癌筛查的女性,同时行高危型人乳头瘤病毒(HR-HPV)、液基薄层细胞学检查(TCT)以及细胞学p16INK4a蛋白检测.任一检测结果阳性以及检测均阴性但有明显临床症状高度怀疑宫颈...     

循证护理模式在心血管内科老年患者中的应用

目的:探讨循证护理模式在心血管内科老年患者中的应用效果。方法:将140例心血管内科老年患者随机分为对照组和观察组各70例,对照组采用常规护理模式,观察组采用循证护理模式,比较两组护理前及护理后1周的治疗依从性、积极性、满意度及SCL-90评分。结果:观察组护理后1周治疗依从性、积极性、满意率及SCL-90评分均优于对照组(P<0.05)。结论:循证护理模式可增强心血管内科老年患者的治疗信心,提高生存质量。     

大鼠角膜中央区SP样、CGRP样免疫阳性纤维的起源

向角膜中央区注射ＨＲＰ后，用抗ＳＰ和抗ＣＧＲＰ抗体对三叉神经节、颈上神经节和迷走神经节进行免疫组织化学处理。结果证明：双重阳性细胞出现于三叉神经节的内侧区且集中分布于背内侧部．ＣＧＲＰ样双重阳性细胞主要分布在节的背内侧部的周边区；ＳＰ样双重阳性细胞散在于节的背内侧部的深部。两者均为圆形或椭圆形。在颈上神经节和迷走神经节内未见双重阳性细胞。     

促红细胞生成素上调海马pCREB表达和改善脑缺血小鼠认知功能

目的: 探讨促红细胞生成素(EPO)对小鼠脑缺血所致的认知功能障碍和海马神经元损伤的保护作用及机制。方法: C57BL/6绿色荧光蛋白转基因小鼠随机分为假手术(sham)组、脑缺血/再灌注(I/R)组和EPO治疗组;采用双侧颈总动脉阻断(2-VO)方法复制小鼠全脑缺血模型,跳台实验测试小鼠学习记忆能力,Nissl染色检测海马神经元存活情况,Western blotting检测磷酸化cAMP反应元件结合蛋白(pCREB)表达水平,激光共聚焦显微镜和Neurolucida软件分析检测海马CA1区神经元形态及树突棘的变化。结果: 脑缺血导致小鼠学习记忆能力下降,海马CA1区神经元迟发性死亡和树突棘丢失;EPO治疗能显著提高脑缺血小鼠的学习记忆能力,减少脑缺血所致的海马CA1区神经元死亡和树突棘的丢失,显著上调海马CA1区神经元pCREB蛋白的表达。结论: EPO可能通过上调pCREB的表达来保护神经元损伤、防止神经元树突棘的丢失,进而改善脑缺血小鼠的认知功能。