Magnetic resonance imaging in assessment of stress urinary incontinence in women: Parameters differentiating urethral hypermobility and intrinsic sphincter deficiency

AIM: To define the magnetic resonance imaging (MRI) parameters differentiating urethral hypermobility (UH) and intrinsic sphincter deficiency (ISD) in women with stress urinary incontinence (SUI).METHODS: The static and dynamic MR images of 21 patients with SUI were correlated to urodynamic (UD) findings and compared to those of 10 continent controls. For the assessment of the urethra and integrity of the urethral support structures, we applied the high-resolution endocavitary MRI, such as intraurethral MRI, endovaginal or endorectal MRI. For the functional imaging of the urethral support, we performed dynamic MRI with the pelvic phased array coil. We assessed the following MRI parameters in both the patient and the volunteer groups: (1) urethral angle; (2) bladder neck descent; (3) status of the periurethral ligaments, (4) vaginal shape; (5) urethral sphincter integrity, length and muscle thickness at mid urethra; (6) bladder neck funneling; (7) status of the puborectalis muscle; (8) pubo-vaginal distance. UDs parameters were assessed in the patient study group as follows: (1) urethral mobility angle on Q-tip test; (2) Valsalva leak point pressure (VLPP) measured at 250 cc bladder volume; and (3) maximum urethral closure pressure (MUCP). The UH type of SUI was defined with the Q-tip test angle over 30 degrees, and VLPP pressure over 60 cm H₂O. The ISD incontinence was defined with MUCP pressure below 20 cm H₂O, and VLPP pressure less or equal to 60 cm H₂O. We considered the associations between the MRI and clinical data and UDs using a variety of statistical tools to include linear regression, multivariate logistic regression and receiver operating characteristic (ROC) analysis. All statistical analyses were performed using STATA version 9.0 (StataCorp LP, College Station, TX).RESULTS: In the incontinent group, 52% have history of vaginal delivery trauma as compared to none in control group (P < 0.001). There was no difference between the continent volunteers and incontinent patients in body habitus as assessed by the body mass index. Pubovaginal distance and periurethral ligament disruption are significantly associated with incontinence; periurethral ligament symmetricity reduces the odds of incontinence by 87%. Bladder neck funneling and length of the suprapubic urethral sphincter are significantly associated with the type of incontinence on UDs; funneling reduced the odds of pure UH by almost 95%; increasing suprapubic urethral sphincter length at rest is highly associated with UH. Both MRI variables result in a predictive model for UDs diagnosis (area under the ROC = 0.944).CONCLUSION: MRI may play an important role in assessing the contribution of hypermobility and sphincteric dysfunction to the SUI in women when considering treatment options.     

Intimate partner violence against women in Spain: A medico-legal and criminological study

Intimate partner violence (IPV) is a significant worldwide problem whose magnitude and risk factors vary across different settings and cultures. Nowadays, it is a priority to improve the knowledge on this issue in order to formulate better evidence-based policy responses. This study aims to contribute to a better understanding of non-fatal IPV against women in Spain. A retrospective analysis of IPV cases with a final judicial decision was carried out. The period under study extended from January 2005 to December 2012, with a total of 582 files included in the investigation. Most IPV victims were young adult women of Spanish origin, either married or single, with children, unemployed and with a low family income level. The majority of alleged perpetrators were young adults, employed, with a middle-low income level, a history of alcohol consumption/abuse, but no criminal records. Most victims had previous history of IPV, were engaged in a long-term relationship with their abuser and lived with him at the time of assault. The combination of psychological and physical abuse was the most frequent form of violence. The most common mechanisms of assault consisted in minor acts of physical violence, which resulted in mild injuries, most of them in the upper limbs and face. Nearly half of women sought medical care, but physician's injury report was only made in about a quarter of these cases, even though it is mandatory for health professionals. The majority of criminal proceedings were initiated by the victim's report and ended in conviction, most of them being considered occasional mistreatment. This study confirms the heterogeneity of the phenomenon of intimate partner violence. The importance of adopting standard IPV concepts and promoting the recognition and assessment of this form of violence amongst health care professionals, criminal investigators and forensic personnel is emphasized.     

Ｂ超引导下经皮胆囊穿刺置管引流术治疗妊娠中晚期急性结石性胆囊炎

目的:探讨超声引导下经皮胆囊穿刺引流术(PPDG)治疗妊娠中晚期急性结石性胆囊炎的疗效。方法:回顾性分析2010年9月—2015年10月47例妊娠中晚期急性结石性胆囊炎患者行超声引导下PPDG的临床资料。结果:47例患者均成功实施PPDG,治疗后腹痛、发热等症状迅速缓解,无出血、胆瘘等并发症,实验室指标包括白细胞计数、转氨酶、总胆红素、降钙素原均较治疗前明显改善(均P0.05)。除1例患者置管后7 d导管脱落,其余患者均常规拔管或带管分娩后择期行胆囊切除术时拔管。47例患者28例自然分娩,19例剖宫产,新生儿均正常。结论:超声引导下PPDG是治疗妊娠中晚期急性结石胆囊炎有效、安全和简便的方法,推荐临床应用。     

Vitamin D, parathyroid hormone levels and bone mineral density in community-dwelling older women: The Rancho Bernardo Study

Vitamin D (25(OH)D) increases the efficiency of intestinal calcium absorption. Low levels of serum calcium stimulate the secretion of parathyroid hormone (PTH), which maintains serum calcium levels at the expense of increased bone turnover, bone loss and increased risk of fractures. We studied the association between 25(OH)D and PTH levels, and their associations with bone mineral density (BMD), bone loss, and prevalence of hip fractures in 615 community-dwelling postmenopausal aged 50–97 years. Mean level of 25(OH)D and PTH were 102.0 nmol/l±35.0 nmol/l and 49.4 ng/l±23.2 nmol/l, respectively; 49% of women were current hormone therapy users. The overall prevalence of vitamin D insufficiency (25(OH)D<50 nmol/l) was 2%, and prevalence of high PTH levels (>65 ng/l) was 17.4%. In multiple linear regression analyses hip BMD was negatively and independently associated with PTH levels ( p =0.04), and positively and independently associated with 25(OH)D levels ( p =0.03). There were only 23 women (3.7%) who experienced a hip fracture. In age-adjusted analyses there were no significant differences of 25(OH)D and PTH levels by hip fracture status. Across the entire range of values, the overall correlation between 25(OH)D and PTH was moderate ( r =–0.20). However, after the threshold vitamin D level of 120 nmol/l, all PTH values were below 65 ng/l. Further studies are necessary to identify the optimal vitamin D levels necessary to prevent secondary hyperparathyroidism.     

绝经后期妇女生活质量和保健现状调查

目的探讨绝经对妇女生活质量的影响,为中老年妇女保健工作提供依据。方法随机选择城乡已绝经妇女1,860名为研究对象,对其生活质量、保健状况进行横断面调查,资料由Epilnfo5．0和SPSS10．0统计软件包处理。结果被调查妇女的平均绝经年龄（48．3±3．8）（35～55）岁,平均绝经年限是（6．5±2．8）（1～10）年。有65．9％的妇女出现绝经后期综合征,改良Kupperman评分13项中以躯体症状（68．5％）、性生活不适（46．2％）、泌尿系症状（31．6％）为主,症状程度与绝经年限有关。采用激素替代疗法、钙剂的妇女仅占15．6％,且用药不规范,时间较短。结论绝经对妇女生活质量有很大影响,绝经后期保健应引起高度重视。     

绝经后女性的体成分与年龄和绝经的关系及其对不同部位骨密度的影响

目的 调查绝经后女性的体成分与年龄、绝经年龄、绝经年限和腰椎、髋部BMD之间的关系.方法 用双能X线骨密度仪测量919例绝经后女性的体成分、正位腰椎和髋部BMD.结果 下身脂肪量、全身脂肪量和全身瘦组织量与年龄、绝经年龄和绝经年限都相关(P＜0.05～0.01),但只有绝经年限进入体成分的多元逐步回归方程,采用复合或三次回归模型拟合优度最佳.体成分随绝经年限的延长有下降趋势.绝经10年以上女性的下身脂肪量和全身瘦组织量显著减少,分别较绝经年限5年以内女性下降8.6%和3.1%.所有部位的体成分与所测区域的BMD 均呈正相关(P＜0.05～0.01),控制体重变量后,仅有全身脂肪量与腰椎BMD 呈正相关(P＜0.05),而全身瘦组织量与髋部BMD 呈正相关(P＜0.05).多元逐步回归分析发现体成分是影响腰椎和髋部BMD的一个重要因素,但对腰椎BMD影响最大的是全身脂肪量,而对髋部BMD影响最大的是全身瘦组织量.BMD 越低者,全身脂肪量和全身瘦组织量也越低,组间比较有显著性差异.结论 绝经后女性的体成分与年龄、绝经年龄、绝经年限和腰椎、髋部BMD相关,其中,绝经年限对体成分的影响最大,体成分组分对BMD的影响存在部位差异.     

椎体与髋部BMD预测骨质疏松骨折敏感性研究

目的 通过对骨折患者各部位的骨密度分析, 评价不同部位骨密度对骨折的预测作用.方法 191例患脆性骨折的女性患者来自2000～2004年青岛市区五家医院的骨科.采用双能X线骨密度测量仪同时测量191例患者的仰卧正位腰椎2至4椎体BMD(g/cm~2),左侧髋部股骨颈、大转子、和Ward's三角区BMD(g/cm~2)处骨密度,与当地同性别峰值骨量进行比较.结果 各部位骨质疏松诊断率L_2是最高的,经卡方检验,L_2预测价值大于L_3、L_4、及WARD三角区,但与NECK及GT无统计学差异.结论 在常用的骨密度测定部位中,L_2对骨质疏松骨折的预测作用最大.     

脑后部可逆性脑病综合征的MRI特征和临床价值

目的探讨脑后部可逆性脑病综合征的MRI特征和临床价值。方法回顾性分析25例脑后部可逆性脑病综合征(PRES)孕妇的MRI资料并随访观察。结果所有病例MRI均显示脑实质内多发性的斑片状T1WI低信号、T2WI及FLAIR高信号病灶,大致对称分布。病灶分布以顶枕叶白质为主,额颞叶、基底节、小脑、脑干及皮层灰质也可受累。DWI(b=1000)显示高信号病灶9例,其中ADC图呈低信号3例,提示形成脑梗死。随访发现22例病灶于治疗后短期内恢复,病灶范围大、分布广或于DWI、ADC图显示弥散受限者预后较差。结论孕妇PRES的MRI表现具有显著的特征,MRI对早期诊断、判断预后和指导治疗有重要价值。     

妊娠妇女口腔健康状况调查分析

目的：了解孕妇口腔健康情况,以便提供有针对性的口腔健康教育。方法对476例孕妇进行知识、态度、行为的口腔健康问卷调查,并检查其口腔健康情况。结果问卷调查结果显示孕妇健康知识得分（68.24±7.33）分,健康态度得分（83.45±8.15）分,健康行为得分（53.76±6.09）分。口腔体检情况：90.76%孕妇有不同程度食物软垢,47.69%出现牙结石,龋失补牙5.67%、缺牙未补24.16%,口腔卫生指数良37.39%、差17.02%,15.76%牙龈正常、84.24%的孕妇出现不同程度的牙龈炎。结论孕妇整体口腔卫生情况较差,应加强孕期口腔健康教育,提高其口腔健康水平。     

2010至2012年31省2120131名育龄妇女孕前营养指标趋势分析

目的 分析2010至2012年中国育龄妇女孕前营养状况的变化趋势.方法 研究人群为2010年1月1日至2012年12月31日参加“国家免费孕前优生健康检查项目”覆盖的31个省、市、自治区220个试点县的21～49岁育龄妇女,共2 120 131人.研究孕前营养指标主要包括体质量指数(BMI)、血红蛋白含量(HB)和空腹血糖(FBG).结果 2010至2012年总体上中国育龄妇女孕前平均HB含量持续升高,而孕前平均BM1和FBG水平呈逐年下降趋势.将3个孕前营养指标测定的结果均分为4类,各类构成人群均主要分布在25 ～34岁年龄组.孕前低BMI人群发生率逐年增加,从2010年10.4％(31 649/304307)增加到2012年14.14％(114 159/807 131);孕前超重人群及肥胖人群均在2012年发生率最低,分别为10.65％(85 984/807 131)和2.32％(18 735/807 131).孕前低血糖发生率由2010年5.45％(16 581/304307)降至2012年5.23％(42 199/807 131);孕前空腹血糖受损及糖尿病发生率逐年降低,分别从2010年3.17％ (9 652/304 307)和1.64％(4 982/304307)降至2012年2.71％(21 875/807 131)和1.05％(8 505/807 131).孕前轻度及中重度贫血的发生率在逐年下降,分别从2010年12.29％和0.95％降至2012年9.62％和0.78％;孕前高HB含量人群也呈现不断下降趋势.2010至2012年中国育龄妇女3个孕前营养指标的变化趋势在4个分类中均差异有统计学意义(P ＜0.001).结论 中国育龄妇女总体孕前营养状况良好,肥胖、贫血及糖尿病的发生率呈逐年下降趋势.