妊高征患者胎盘组织中FasL的表达及其意义

目的　探讨FasL在妊高征患者胎盘组织中的表达是否异常 ,进一步从免疫学角度分析妊高征的发病机制。方法　 2 0 0 1年 11月至 2 0 0 2年 7月 ,采用免疫组织化学SP法检测 2 0例正常孕妇 (对照组 ) ,6 5例妊高征患者 (妊高征组 ,其中轻度 2 2例、中度 2 0例、重度 2 3例 )胎盘组织中FasL表达强度。结果　FasL主要表达于胎盘绒毛滋养细胞 ,妊高征组胎盘绒毛滋养细胞及蜕膜组织细胞FasL表达强度明显低于对照组 (P <0 0 1,P <0 0 5 )。结论　妊高征患者胎盘组织FasL表达减少 ,母胎免疫耐受机制遭到破坏 ,引发胎盘绒毛发育不全、功能下降等一系列免疫病理改变 ,最终可能导致妊高征及其并发症的发生。     

妊娠期糖尿病母儿血清瘦素水平及胎盘瘦素的表达

目的　探讨妊娠期糖尿病 (gestationaldiabetesmellitus ,GDM)母儿血清瘦素水平及胎盘瘦素表达的变化。　方法　采用放射免疫法 (RIA)检测 2 4例GDM母儿和 2 6例正常母儿血清胰岛素和瘦素水平 ,采用逆转录 聚合酶链反应 (RT PCR)技术检测胎盘瘦素mRNA的表达水平。　结果　 (1)GDM组孕妇血清瘦素和胰岛素水平分别为 (18.6 2± 7.86 ) μg/L和 (13.4 7± 5 .11)mIU/L ,对照组分别为 (14 .2 1± 7.5 9) μg/L和 (8.98± 4 .2 3)mIU/L ,两组比较差异有显著性 (P <0 .0 5 )。 (2 )GDM组脐血瘦素和胰岛素水平分别为 (17.93± 6 .14 ) μg/L和 (19.2 6± 6 .73)mIU/L ,对照组分别为 (7.2 7± 4 .32 ) μg/L和 (9.6 7± 4 .89)mIU/L ,两组比较差异有显著性 (P <0 .0 1)。 (3)两组孕妇血清瘦素与胰岛素水平之间无相关关系 (r =0 .2 2 ,P >0 .0 5 ) ,而脐血血清瘦素与胰岛素水平之间呈正相关关系(r =0 .5 3,P <0 .0 1)。 (4 )GDM组胎盘瘦素mRNA表达水平为 (1.92± 0 .0 5 ) ,对照组为 (0 .97± 0 .0 2 ) ,两组比较差异有显著性 (P <0 .0 1)。　结论　胰岛素及瘦素抵抗可能是妊娠期糖尿病的发病原因之一 ,胰岛素对调节胎盘瘦素的表达起重要作用。     

孕妇静脉血及其新生儿脐血硒水平及谷胱甘肽过氧化物酶活性与妊娠肝内胆汁淤积症的关系

目的　探讨孕妇静脉血及其新生儿脐血硒水平及谷胱甘肽过氧化物酶 (GSH Px)活性与妊娠肝内胆汁淤积症 (ICP)的关系。方法　采用催化极谱法及 5 ,5 ' 二硫代双 (二硝基苯甲酸 )直接法检测健康未孕妇女 30例 (健康未孕组 )血硒水平及GSH Px活性 ;检测ICP孕妇 (ICP组 )和正常妊娠妇女 (正常妊娠组 )各 30例孕晚期及产后母血、脐血硒水平及母血、脐血GSH Px活性。结果　 (1)ICP组产前、后母血硒水平分别为 (0 .0 389± 0 .0 0 90 )mg/L和 (0 .0 46 3± 0 .0 0 92 )mg/L ,GSH Px活性分别为 (5 9.31± 11.42 )活力单位 (U)和 (6 8.12± 11.46 )U ,正常妊娠组产前、后母血硒水平分别为 (0 .0 477± 0 .0 0 94)mg/L和 (0 .0 5 10± 0 .0 0 93)mg/L ,GSH Px活性分别为 (6 8.48± 10 .47)U和 (72 .6 7±9.83)U ,两组比较 ,差异均有显著性 (P <0 .0 0 5 )。 (2 )ICP组脐血硒水平为 (0 .0 387± 0 .0 0 93)mg/L ,GSH Px活性为 (5 7.6 6± 12 .2 5 )U ,正常妊娠组脐血硒水平为 (0 .0 46 1± 0 .0 0 89)mg/L ,GSH Px活性为(6 7.46± 11.93)U ,两组比较 ,差异均有极显著性 (P <0 .0 0 5 )。 (3)血硒水平与GSH Px活性呈正相关(P <0 .0 0 1)。结论　ICP患者血硒水平降低 ,导致GSH Px活性下降 ,自由基形成 ,破坏了肝细胞膜     

ISOLATED WELL-FORMED INTESTINAL TISSUE IN THE UMBILICAL CORD: A Variant of Cyst of Omphalomesenteric Duct

An extremely rare abnormality, a variant of omphalomesenteric duct, was observed in the umbilical cord 1 cm from the entry point into the abdominal wall, which itself was as an isolated mass of well-formed intestinal tissue free of structural defects. This intestinal tissue seems to be the remnant of an intestinal loop from caudal limb of midgut following physiological herniation during the third month of gestation.     

Methotrexate and misoprostol used alone or in combination for early abortion

The purpose of this study was to compare the outcome and side effects of using the drugs methotrexate and misoprostol, alone or in combination, to induce abortion. A total of 108 subjects who had requested elective termination of pregnancy and medical abortion at 9 weeks gestation or less were randomized into three groups. The first group received 50 mg/m² intramuscular (IM) methotrexate on day 1 and, if the hCG level had risen by >50% of the initial level on day 4, a second dose was given. They were then followed-up at weekly intervals up to day 21. Group 2 received 800 μg vaginal misoprostol on day 1 and, if ultrasound showed a gestational sac on day 4, they received a repeat dose and were re-examined on day 7. Group 3 received 50 mg/m² methotrexate intramuscularly followed 3 days later by 800 μg vaginal misoprostol and were re-examined on day 7. Complete abortion occurred in 25 (69%) of the 36 subjects in group 1, 21 (58%) of the 36 subjects in group 2, and 32 (89%) of the 36 subjects in group 3. The complete abortion rate in group 3 was significantly higher than that of both group 1 and group 2 (p <0.05). The incomplete abortion rate was significantly higher in group 2 as compared with both of the other groups (p <0.05). There were significant differences between the mean gestational age of the successful abortions and the failures in group 1 (no abortion occurred at more than 49 days gestation), but not in groups 2 or 3. Vaginal bleeding in subjects who successfully aborted began within 16 ± 4 days in group 1 after the first dose, and within 24 h in 18 (86%) of the 21 subjects in group 2 and 27 (84%) of the 32 subjects in group 3 after the misoprostol dose. The drugs caused no serious or prolonged side effects. The combination of methotrexate and misoprostol is a more effective abortifacient regimen than when either drug is used alone.     

子宫内膜异位症患者血清中可溶性细胞间粘附分子-1可溶性白介素Ⅱ受体23例测定及其意义

目的　测定子宫内膜异位症患者血清中可溶性细胞间粘附分子 - 1(sICAM - 1)、可溶性白细胞介素Ⅱ受体 (sIL - 2R)的水平 ,并探讨其临床意义。方法　应用酶联免疫吸附试验双抗体夹心法 (ELISA)对 2 3例子宫内膜异位症患者及 17例正常妇女血清sICAM - 1、sIL - 2R水平进行测定。结果　术前子宫内膜异位症患者血清中sICAM - 1、sIL - 2R水平明显高于正常对照组 (P <0 0 1)。轻度组与重度组之间无显著性差异 (P >0 0 5 )。血清中sICAM - 1对子宫内膜异位症的敏感性与特异性分别为 6 9 5 7%与 76 4 7%。血清sIL - 2R对子宫内膜异位症的敏感性与特异性分别为 6 5 2 2 %与 70 5 9%。血清中sICAM - 2R、sIL - 2R联合检测子宫内膜异位症的敏感性与特异性分别为 5 2 17%和 82 35 %。结论　血清中sICAM - 1、sIL - 2R可能与子宫内膜异位症的发生相关 ;检测血清中sICAM - 1与sIL - 2R有助于子宫内膜异位症的诊断和治疗     

Influences of different time intervals between loop electrosurgical excision and abdominal hysterectomy or radical hysterectomy on postoperative complications: a retrospective analysis

Objective： To study the influences of different time intervals between loop electrosurgical excision （LEEP） and abdominal hysterectomy or radical hysterectomy on postoperative complications. Methods： Sixty-eight patients, who received subsequent abdominal hysterectomy or radical hysterectomy after LEEP due to C1N III and cervical cancer （IA1, IA2 and IB1）, were included in the present study. The hospital and clinic records of these patients were reviewed. The patients were divided into three groups according to the time intervals between LEEP and hysterectomy or radical hysterectomy： group l（within 48 h）, group 2 （between 48 h to 6 weeks）, and group 3（〉 6 weeks ）.Results： General characteristics of patients, including the mean age, delivery history, BMI, menopausal status, clinical stage and HPV infection, were comparable between patients of different groups. There were no significant differences in the mean transfusion amount, posthysterectomy hospital stay or operation time between different groups. The frequencies and spectrum of complications were not significantly affected by the time interval between LEEP and hysterectomy or radical hysterectomy. Conclusion： It is concluded that whenever the LEEP is done, the operation including hysterectomy or radical hysterectomy can be conducted at any time as it is necessary for the patients.     

The economic impact of overactive bladder syndrome in six Western countries

OBJECTIVE

To calculate up‐to‐date estimates of the economic impact of overactive bladder syndrome (OAB) with and without urgency urinary incontinence (UUI) on the health sector of six countries (Canada, Germany, Italy, Spain, Sweden and the UK), as OAB is a significant health concern for adults aged >18 years living in Western countries.

MATERIALS AND METHODS

The prevalence data derived from the EPIC study were combined with healthcare resource‐use data to derive current direct and indirect 1‐year or annual cost of illness estimates for OAB including UUI in Canada, Germany, Italy, Spain, Sweden and the UK. This model estimates the direct healthcare costs attributed to OAB, as well as the impact of work absenteeism.

RESULTS

The estimated average annual direct cost of OAB per patient ranged between €262 in Spain and €619 in Sweden. The estimated total direct cost burden for OAB per country ranges between €333 million in Sweden and €1.2 billion in Germany and the total annual direct cost burden of OAB in these six countries is estimated at €3.9 billion. In addition, nursing home costs were estimated at €4.7 billion per year and it was estimated that work absenteeism related to OAB costs €1.1 billion per year.

CONCLUSIONS

The cost of illness for OAB is a substantial economic and human burden. This study may under‐estimate the true economic burden, as not all costs for sequelae associated with OAB have been included. Cost‐effective treatments and management strategies that can reduce the burden of OAB and in particular UUI have the potential to significantly reduce this economic burden.     

腹腔镜与开腹手术治疗子宫内膜癌效果比较

目的探讨腹腔镜辅助的子宫内膜癌手术与传统开腹手术临床效果的差异。方法回顾性研究2007年1月至2010年3月在上海交通大学附属第一人民医院妇科行子宫内膜癌腹腔镜手术的51例患者临床资料,选择同期同组医生施行的子宫内膜癌传统开腹手术69例作为对照组,比较两组临床效果。结果腹腔镜组与开腹组在手术时间、术中清扫淋巴结数目上差异无统计学意义。腹腔镜组术中失血少、术后发热率低、肠道恢复快、住院时间短,与开腹组差异有统计学意义(P<0.05)。开腹组切口裂开率高于腹腔镜组,而其他并发症组间差异无统计学意义。结论腹腔镜手术是治疗早期子宫内膜癌稳妥可行的选择。     

Is preterm delivery genetically determined?

Summary. Surprisingly, the genetics of preterm delivery have received very little attention in the literature. Possible explanations are the inability to obtain accurate information on the length of gestation in family studies and the heterogeneous nature of this disorder. In contrast to the many studies which consider the relative contribution of both genetic and environmental variance to the total variance of birthweight, few studies have examined the genetic basis of the duration of gestation in man. It is argued that both genetic and epidemiological approaches are needed to separate the effects of heredity and the environment on the duration of gestation.