A Randomized,Double-Blind,Placebo-Controlled Trial of Oral Pregabalin for Relief of Shoulder Pain after Laparoscopic Gynecologic Surgery

Study ObjectiveTo investigate the efficacy of pregabalin for the relief of postoperative shoulder pain after laparoscopic gynecologic surgery.DesignProspective, randomized, double-blind, placebo-controlled trial (Canadian Task Force classification I).SettingTertiary referral center, university hospital.PatientsFifty-six women undergoing elective laparoscopic gynecologic surgery between June 2012 and March 2013.InterventionsWomen in the study group received 75 mg pregabalin 2 hours before surgery and then every 12 hours for 2 doses, and women in the control group received an identical capsule and the same dosage of placebo.Measurements and Main ResultsVisual analog scale (VAS) scores for shoulder pain and surgical pain at 24 and 48 hours after surgery were evaluated as primary outcome. Postoperative analgesics used and drug-related adverse events were also monitored. Patients in the pregabalin group had significantly lower postoperative VAS scores for shoulder pain at 24 hours, compared with the placebo group (median, 23.14 [range, 13.67–32.61] vs 37.22 [27.75–46.64]; p = .04), and required less analgesic (p = .01). There were no significant differences in VAS scores for surgical pain and adverse events between the 2 groups (p = .56).ConclusionsPerioperative administration of 75 mg pregabalin significantly reduced postoperative laparoscopic shoulder pain and amount of analgesic used.     

应用二分类Logistic回归筛选重度阴道炎症反应的危险因素

目的:筛选阴道微生态评价检测系统中重度阴道炎症反应的危险因素。方法:收集4019例患者的阴道微生态评价检测及诊断结果,采用二分类Logistic回归统计分析。结果:重度阴道炎症反应最重要的危险因素为需氧菌性阴道炎(B=1.055,P=0.000,OR=2.873);其次为乳酸杆菌功能(B=1.044,P=0.000,OR=2.841)、菌群多样性(B=0.871,P=0.000,OR=2.390)、滴虫阴道炎(B=0.462,P=0.000,OR=1.588)及年龄(B=0.233,P=0.014,OR=1.263)。结论:重度阴道炎症反应主要危险因素包括需氧菌性阴道炎、乳酸杆菌功能、菌群多样性、滴虫阴道炎及年龄。     

Clinical evaluation of early postpartum pain and healing outcomes after mediolateral versus lateral episiotomy

Objective

To evaluate short-term perineal pain among primiparous women after mediolateral episiotomy (MLE) and lateral episiotomy (LE).

Methods

The prospective randomized study was conducted in the Czech Republic during 2010–2012. Consecutive primiparous women who gave birth at or after 37 weeks of pregnancy and had indications for an episiotomy were enrolled and randomly assigned to undergo MLE or LE. Patients were unaware of the episiotomy type performed. The primary outcomes were pain at 24 hours, 72 hours, and 10 days post partum, measured by a visual analog scale, verbal rating scale, interference with activities of daily living, and amount of analgesic use.

Results

The analysis included 266 women who underwent MLE and 297 women who underwent LE. Complete relief of pain was observed in 6 (2.3%) of 266 women after 24 hours, 21 (8.0%) of 264 after 72 hours, and 77 (29.1%) of 265 after 10 days in the MLE group, and in 11 (3.9%) of 285, 23 (7.7%) of 297, and 78 (26.4%) of 295 in the LE group, respectively (P = 0.36). There were no significant differences in overall pain scores from any rating system or in the amount of analgesics used.

Conclusion

Incidence and extent of pain in the first 10 days after LE correspond to those after adequately performed MLE.     

Effectiveness,tolerability and acceptance of an oral estradiol/levonorgestrel formulation for the treatment of menopausal complaints: a non-interventional observational study over six cycles of 28 days

Background: Use of hormone therapy for menopausal complaints is a subject of controversy and increased uncertainty and concerns. This non-interventional study aimed to investigate a marketed oral formulation containing 1?mg estradiol and 0.04?mg levonorgestrel for continuous treatment of menopausal symptoms for approximately 6 months in women visiting gynecological practices in Germany.

Methods: Changes in the menopause rating scale (MRS) total and sub-domain scores after three and six 28-d cycles served as primary endpoint. Skin- and hair-related complaints, quality of sexual life and subjective satisfaction with the treatment were assessed. Adverse drug reactions (ADRs), adverse events (AEs) and vaginal bleeding were evaluated.

Results: MRS scores improved significantly above 5 points of clinical relevance as compared to baseline (n?=?736, p?75% of the subjects were amenorrheic throughout the study. Medication's effectiveness and tolerability was rated very good/good by >80% of the participants, who also continued treatment.

Conclusion: This estradiol/low-dose levonorgestrel formulation safely alleviates menopausal symptoms in peri- and postmenopausal women with add-on benefits regarding dermatological and sexual life complaints.     

妇科手术术前感染因素评估及围手术期预防性抗生素应用规范

手术部位感染是妇科手术患者最常见的并发症,可导致住院时间延长、住院费用增加。预防术后感染包括多方面：术前进行生殖道感染的检查并进行相应治疗;正确术前阴道准备;合理使用预防性抗生素;以及对手术室、工作人员、患者皮肤内源性细菌、病毒、真菌污染等危险因素的管理。     

针刺治疗脑卒中的卫生经济学评价研究思路与方法*

针刺作为脑卒中的一种有效治疗方法,对其进行卫生经济学评价,可以更客观、全面地体现针灸“简、便、廉、验”的特点,凸现出中医针灸治疗的优势所在。文章简介了卫生经济学评价应用于针刺治疗脑卒中研究的一些思路与方法。     

The contribution of medical burden to 22q11.2 deletion syndrome quality of life and functioning

PurposeTo date, there is no systematic method to quantify the medical burden of individuals with 22q11.2 deletion syndrome (22q11.2DS). This study aimed to design a Medical Burden Scale for 22q11.2DS to evaluate the effect of medical symptoms severity on quality of life (QoL) and functioning in individuals with this syndrome.MethodsIndividuals with 22q11.2DS (n = 76) were included in the study. A multidisciplinary group of physicians determined the severity of symptoms (on a scale of 0 to 4) of 8 major medical systems affected in 22q11.2DS, as well as the level of cognitive deficits and psychiatric morbidity. Regression models were used to evaluate the impact of medical, cognitive, and psychiatric symptoms’ severity on global assessment of functioning (GAF) and QoL.ResultsThe total Medical Burden Scale score was significantly associated with both QoL and GAF scores, beyond the effect of the psychiatric and cognitive deficits. We also found that QoL and GAF scores were associated with the severity scores of specific medical systems, particularly neurological symptoms, but also cardiovascular, ear-nose-throat, endocrinology, and orthopedics.ConclusionQuantifying the medical burden of 22q11.2DS individuals is feasible and indicates the overall and specific contribution of medical symptoms to QoL and functioning of 22q11.2DS individuals.     

子宫颈癌治疗前评估的规范化

在FIGO 2018子宫颈癌分期系统中,病理学和影像学检查可纠正临床分期,但子宫颈癌患者治疗前的临床分期及治疗方式选择仍主要是基于临床评估,规范的临床评估是规范治疗的前提和基础.文章从初治子宫颈癌患者的临床评估问题着手,结合新技术、新方法,提出子宫颈癌治疗前规范化评估的建议和策略.