基于人流后关爱流程的动机性访谈临床应用效果观察

目的:探讨基于人流后关爱流程的动机性访谈在人工流产中的临床应用效果。方法:选取2017年6月至2017年8月在深圳市南山区妇幼保健院行人工流产的500例患者,随机分为两组,对照组250例行流产后关爱(PAC)标准流程,观察组250例在PAC基础上采取动机性访谈。对比两组患者术后1、3、6、12个月的高效避孕措施的使用率、术后12个月的重复流产率、手术前后的负性情绪。结果:观察组术后1、3、6、12个月的高效避孕措施使用率均高于对照组(P<0.01),观察组术后12个月的重复流产率低于对照组(P<0.01),术后两组孕妇的负性情绪(焦虑抑郁评分)均下降,且观察组明显低于对照组,差异具有统计学意义(P<0.01)。结论:基于人流后关爱流程的动机性访谈可以缓解孕妇的负性情绪,促进其选择高效避孕措施,降低重复流产的发生。     

血型抗原Lewis A和Lewis X在膀胱移行细胞癌中的表达及其诊断价值

目的探讨血型抗原Lewis A和Lewis X在膀胱移行细胞癌中的表达及其诊断应用价值。方法病理标本取1981-2001年间复旦大学附属金山医院病理科的膀胱移行细胞癌标本,具有完整临床病理资料共83例及非肿瘤移行上皮标本68例。试剂选用Lewis A、Lewis X单克隆抗体,应用免疫组化Envision二步法进行染色。并收集10例膀胱移行细胞癌及10例正常人的尿脱落细胞标本进行Lewis X免疫染色。结果Lewis A和Lewis X在膀胱移行细胞癌中的表达阳性率分别为81.9%（68/83）和83.1%（69/83）,非肿瘤黏膜中的阳性表达率分别为52.9%（36/68）和11.8%（8/68）。Lewis A和Lewis X的表达强度与膀胱移行细胞癌的病理分级和临床分期无关（P〉0.05）,但膀胱移行细胞癌的Lewis A和Lewis X表达强度显著高于非肿瘤黏膜（P〈0.05）。20例尿脱落细胞标本中,8例膀胱移行细胞癌Lewis X表达阳性,10例正常对照全部阴性。结论Lewis X免疫标记应用到膀胱移行细胞癌的尿脱落细胞学诊断上,为膀胱移行细胞癌早期诊断及随访提供一种可能的方法。Lewis A抗原对膀胱移行细胞癌诊断价值低于Lewis X。     

AMH and AMHR2 genetic variants in Chinese women with primary ovarian insufficiency and normal age at natural menopause

The aim of this study was to investigate the role of the anti-Müllerian hormone (AMH) signalling pathway in the pathophysiology of idiopathic primary ovarian insufficiency (POI) and age at natural menopause (ANM) using a genetic approach. DNA sequencing was used to detect the genotype distribution and allele frequency of the genes AMH and AMH receptor II (AMHR2) in 120 cases of idiopathic POI and 120 normal-ANM women. Fourteen sequence variants of AMHR2, including 10 novel variants, were identified. Two novel exonic missense variants were p.I209N and p.L354F. The missense variant p.I209N, which is conserved in different species, was predicted to have functional and structural impacts on the AMHR2 protein. The clinical significance of one additional variant (p.L354F) remains arguable pending functional studies. The genotype frequencies of AMH and AMHR2 were similar in distribution for POI patients and normal-ANM women. These findings suggest that POI patients and normal-ANM women in China share AMH and AMHR2 genetic variants. The AMH signalling pathway associated with ANM also may contribute to POI.     

一种新的β地中海贫血基因突变类型的分子诊断和产前基因诊断

目的 对产前地中海贫血筛查确诊为β地中海贫血的一对夫妇进行β珠蛋白基因突变分析,并对胎儿进行产前基因诊断.方法 根据血常规和血红蛋白分析进行地中海贫血的筛查,对筛查诊断为β地中海贫血患者采用聚合酶链反应/寡核苷酸探针反向斑点杂交法检测中国人常见的17个β珠蛋白基因突变类型.对于未发现常见突变者采用β珠蛋白基因DNA测序和变性高效液相色谱分析.结果 丈夫为CD41/42(-TCTT)突变杂合子,妻子携带一种迄今在中国人中未见报道的β地中海贫血基因突变IVS-Ⅰ-110(G→A),产前诊断胎儿为IVS-Ⅰ-110(G→A)和CD41/42(-TCTT)突变双重杂合子,并进行引产.结论 β地中海贫血IVS-Ⅰ-110(G→A)突变的发现,丰富了中国人β地中海贫血基因突变种类,对遗传咨询和地中海贫血产前基因诊断具有重要意义.

Abstract：

Objective To conduct molecular and prenatal diagnosis for a couple with β thalassemia.Methods Blood routine examination and hemoglobin analysis were used for screening of thalassemia. Seventeen common Chinese mutations of β thalassemia were detected for the carriers with β thalassemia using PCR/RDB. The unknown mutation of β thalassemia was identified by DNA sequencing and DHPLC analysis. Results The husband was heterozygote of CD41/42(-TCTT). The wife carried a mutation IVS- Ⅰ -110(G→A)of β thalassemia having not been reported in Chinese so far. The fetus was a double mutated heterozygote of IVS- Ⅰ -110(G→A)and CD41/42(-TCTT). The pregnancy was terminated. Conclusion Mutation IVS- Ⅰ -110(G→A)of β thalassemia in Chinese is of importance to the genetic counseling and prenatal diagnosis of thalassemia.     

新生儿经大隐静脉置入中心静脉导管的研究

[目的]探讨新生儿经大隐静脉置入中心静脉导管的安全性及有效性。[方法]对52例新生儿(观察组)经大隐静脉置入中心静脉导管,75例(对照组)经肘部静脉置入中心静脉导管。比较两组患儿一次穿刺成功及上(下)腔静脉一次到位情况、并发症发生情况、非计划性拔管情况。[结果]观察组一次到位率高于对照组(P<0.05);观察组液体外渗发生率、非计划性拔管率低于对照组(P<0.05)。[结论]经大隐静脉置入中心静脉导管安全有效,可作为新生儿经外周静脉置入中心静脉导管的备选途径。     

SLC11A1 is expressed in the human placenta across multiple gestational ages

The human placenta functions as an innate immune barrier to prevent fetal infection. However, the molecular mechanisms accounting for placental resistance to pathogens are currently poorly understood. The solute carrier family 11 member 1 (SLC11A1) is a divalent cation transporter expressed primarily by macrophages and neutrophils that is essential for controlling infections by intracellular pathogens such as Salmonella, Leishmania and Mycobacteria. This report demonstrates that SLC11A1 is expressed in the syncytiotrophoblast of the human placenta at multiple gestational ages. These results suggest that SLC11A1 may play a role in blocking productive placental infections by certain intracellular pathogens.     

腹腔镜输卵管妊娠保守手术及手术加用药物的疗效比较

目的：比较单用腹腔镜输卵管妊娠保守手术及手术加在患侧输卵管系膜内注射氨甲喋呤两者的疗效。方法：把65例腹腔镜下输卵管妊娠保守手术的患者分为两组。A组单行腹腔镜下输卵管妊娠产物清除术；B组手术同时于输卵管系膜内注射氨甲喋呤30mg。术后随访监测血β-HCG下降水平。结果：A组治愈率87．10%,B组治愈率100%(P＜0．05)；A组血β-HCG下降至正常水平时间为13．5±1．86d,B组下降至正常为9．0±1．01d(P＜0．05)。结论：腹腔镜下输卵管妊娠产物清除术并在输卵管系膜内注射氨甲喋呤30mg比单行妊娠产物清除术的疗效显著好,并降低持续性宫外孕发生率。     

足月小于胎龄儿早期生长追赶与胰岛素抵抗相关性研究

目的旨在探讨2~4岁足月小于胎龄儿出生后早期生长追赶与胰岛素抵抗的关系。方法采用1∶1配对的研究方法,分析44对足月小于胎龄(small for gestational age,SGA)儿和足月适于胎龄(appropriate for gestational age,AGA)儿的生长发育情况及稳态模型的胰岛素抵抗指数、胰岛素敏感性指数、胰岛β细胞功能指数,及生长追赶与以上指标的关系。结果 SGA儿出生时生长发育指标、0~6月龄期生长追赶指标与AGA儿差异均有统计学意义(P0.05)。2~3岁组、3~4岁组SGA儿胰岛素抵抗指标低于AGA儿,胰岛素敏感指标高于AGA儿,差异均有统计学意义(P0.05)。小于4岁组0~6月龄期身长Z积分增值与Homa-IAI呈正相关;大于4岁组7~12月龄期体重Z积分增值与Homa-IR呈正相关。结论 SGA儿早期存在明显的生长追赶现象,尚未出现胰岛素抵抗,胰岛素敏感、胰岛素抵抗的改变都是随着时间的推移而出现逐渐变化的过程。     

铸造钴铬合金烤瓷冠与铸造钛合金烤瓷冠边缘适合性的比较研究

目的：比较铸造钴铬合金烤瓷冠与铸造钛合金烤瓷冠的边缘适合性。方法：分别制作铸造钴铬合金烤瓷冠72例和铸造钛合金烤瓷冠66例,观察二者粘固1个月后及戴入3年后冠的边缘适合性、龈缘染色和牙龈指数。结果：铸造钴铬合金烤瓷冠的边缘适合性、牙龈指数略比铸造钛合金烤瓷冠好,但两者之间无差异显著性;在龈缘染色方面,铸造钴铬合金明显比铸造钛合金好。结论：与铸造钛合金烤瓷冠相比,铸造钴铬合金烤瓷冠具有更好的颈缘修复。