手术治疗老年性椎管狭窄症的临床研究

目的:探讨老年性腰椎管狭窄症的临床特点及治疗效果.方法: 对2002年1月至2006年1月收治的35例腰椎管狭窄症患者进行前瞻性研究,并进行追踪随访.结果:随访1～4.0年,随访率为100%,优良率91.43%.本组术后共出现并发症7例(20.00%),其中切口感染1例,延迟愈合2例,肺部感染1例,泌尿系感染1例,消化系统功能紊乱2例,经过对症处理后均好转;无腰椎滑脱和椎管再狭窄发生.结论:在积极控制共存疾病的基础上,严格掌握手术指征,把握手术时机,手术减压治疗对老年腰椎管狭窄症神经功能的恢复具有重要作用.     

Age at sexual initiation and number of sexual partners in the female Spanish population Results from the AFRODITA survey

Objectives

The AFRODITA study was designed to describe patterns relating to the number of lifetime sexual partners (SP) and age at first sexual intercourse (AFSI) by geographic region in a representative sample of Spanish women.

Study design

A representative sample of the female Spanish population was obtained using the Access Panel Technique. Postal questionnaires were sent to 11,086 women aged 18–70 years. Data were collected on AFSI, number of sexual partners, contraceptive methods, cervical cancer screening and socio-demographic characteristics.

Results

The average AFSI was 20.9 years. AFSI below the age of 19 years was reported by 30.8% of the women. Among sexually active women, 70.6% reported being monogamous and 6.4% reported ≥5 lifetime sexual partners. Younger age at interview was strongly related to earlier AFSI and to higher number of lifetime sexual partners. Women younger than 25 were 39 times more likely to have an AFSI before age 18 than women over age 55. The percentage of women aged less than 25 reporting two or more sexual partners was four times higher than that of women 56 and older. In the multivariate analysis, having two or more sexual partners was independently associated with young age, early AFSI, having ever used oral contraceptives, living in an urban area, having had a screening Pap test in the last 3 years, having a sexually transmitted infection and nuliparity.

Conclusions

This study confirms important changes in the sexual behaviour of Spanish women. Younger cohorts show a younger age at sexual initiation and higher number of sexual partners. These are key factors that may induce changes in the human papillomavirus (HPV) prevalence and the cervical cancer incidence in Spain.     

Obstetric outcomes in nulliparous women aged 35 and over with singleton pregnancies conceived by in vitro fertilization

Objective To investigate obstetric outcomes in singleton pregnancies conceived by in vitro fertilization (IVF) to nulliparous women older than 35 compared to those of their younger counterparts. Methods Nulliparous women 35 years and older at delivery conceived by IVF (n = 89) were compared with nulliparous women 34 years and younger at delivery conceived by IVF (n = 48). Data included antenatal data, gestational age at delivery, maternal and neonatal complications and mode of delivery. Results The incidence of pregnancy-induced hypertension in the younger group was significantly higher than that in the elderly group (13 vs. 3.4%, P = 0.043). There were no measurable differences in other obstetric outcomes such as placental abnormality, premature delivery or neonatal asphyxia between the two groups. Conclusion The current results suggest that obstetric complications in pregnancies conceived IVF are attributed to mechanisms other than those depend on advanced maternal age.     

The treatment of early stage cervical cancer: an assessment of pre-operative factors

OBJECTIVE: To assess the pre-operative clinical factors of a group of early stage cervical cancer patients and correlate them to the risk for adjuvant radiotherapy using GOG 92 and 109 criteria. METHOD: A retrospective chart review of cervical cancer patients treated at the Saint Louis University Division of Gynecologic Oncology between the years 1989 and 2004 was performed. The results were compared with chi-squared testing and multivariable regression analysis. A p-value of 0.05 was considered significant. RESULTS: One hundred and thirty-one cervical cancer patients underwent exploration for radical hysterectomy during the study time period. Five patients had stage IA1 disease, 6 patients had stage IA2 disease, 98 patients had stage IB1 disease, 20 patients had stage IB2 disease and one patient had stage IIA disease. No patient with stage IA1 or IA2 disease met criteria for adjuvant radiotherapy. The patients with stage IB1 tumors who were 45 years of age or younger and had tumors up to 2 cm in diameter had a low (14%) likelihood for treatment with adjuvant radiotherapy. The patients with stage IB1 tumors who were older than 45 years of age with tumors larger than 2 cm in diameter and the patients with stage IB2 tumors both had a high likelihood for adjuvant radiotherapy (77% and 90% respectively). CONCLUSION: In our study group, the stage of cervical cancer and a combination of tumor diameter and patient age was found to stratify early stage cervical cancer patients by likelihood for adjuvant radiotherapy.     

Too old for IVF: are we discriminating against older women?

In vitro fertilization (IVF) in women of advanced age (>42 years) represents only 5%, a comparatively minute part, of the national IVF experience in the United States (US). In view of evolving population dynamics, it, however, also represents proportionally a rather quickly expanding patient need. Because of access restrictions at many IVF programs, this market does not live up to its potential. As best demonstrated by the 2004 US National Summary and Fertility Clinic Report, which for the first time reported pregnancies and births above age 45 year, IVF in women of advanced reproductive age represents a cutting edge area of interest for improving current IVF outcomes. Access to IVF should, therefore, not be withheld based on female age and/or baseline FSH levels. Instead, a definition of acceptable minimal pregnancy and life birth rates could be used to define the limits of offered access to IVF, independent of age and/or baseline FSH levels.     

1237例夫精宫腔内人工授精周期临床妊娠结局探讨

目的:探讨患者年龄,不孕年限,输卵管通畅度和注入宫腔内前向运动精子总数(NMSI)对夫精宫腔内人工授精(AIH)临床妊娠率的影响,旨在更好地指导临床工作.方法:选取835对夫妻1 237个AIH周期,按年龄分为:≤35岁、36～39岁、≥40岁组;按不孕年限分为:＜2年、2～4年及＞4年;按输卵管通畅度分为:双侧输卵管通畅、单侧输卵管通畅和双侧输卵管不全通畅组;按处理后NMSI分为＜2、2～5、5～10及＞10×106组.结果:临床妊娠175例,周期妊娠率为14.1％,夫精宫腔内人工授精临床妊娠的成功率随着患者年龄及不孕年限的增加而降低,差异具有统计学意义(P＜0.05);注入宫腔内前向运动精子总数(NMSI)小于5×106时临床妊娠率低,差异具有统计学意义(P＜0.05);双侧及单侧榆卵管通畅组妊娠率高于双侧输卵管不全通畅组.结论:年龄≥40岁,不孕年限＞4年,处理后注入宫腔内前向运动精子总数(NMSI)小于5×106或双侧输卵管不全通畅的患者,不适合继续尝试IUI治疗.     

年龄对多普勒测定左室舒张功能参数的影响

本文测定了100例不同年龄组正常人的多普勒左室舒张功能参数,对其与年龄关系进行分析研究。结果表明正常人多普勒左室舒张功能参数随年龄增长而变化,年龄是影响多普勒左室舒张功能参数的独立因素,因而在评价左室舒张功能时,对于年龄的重要影响不容忽视。     

天津市1981年～2000年结肠癌发病年龄趋势研究

目的 :研究1981年～2000年天津市结肠癌发病年龄分布及其变化趋势 ,为确定结肠癌高发人群 ,探讨结肠癌病因提供线索。方法 :利用天津市肿瘤登记处的肿瘤发病资料 ,分性别、年份计算发病中位年龄 ,并进行直线回归分析。结果 :20年结肠癌发病中位年龄为64岁 (男性 :64岁 ,女性65岁 ) ,以70岁年龄发病人数最多 ,发病年龄在54岁～72岁之间者占发病总数的50%。1981年～2000年结肠癌发病中位年龄呈上升趋势 ,20年共上升6.0岁。结论 :天津市1981年～2000年结肠癌发病年龄变化趋势表明 ,应进一步加强对高年龄组人群结肠癌的预防工作     

代谢综合征患病率随性别和年龄的变化趋势

目的探讨代谢综合征患病率随性别和年龄的变化趋势。方法对2006年1~12月和2009年1~12月笔者医院的健康体检人群进行回顾性调查。男性:2006年1619例,2009年2202例;女性:2006年418例,2009年636例。MS诊断标准采用NCEP-ATPⅢ的中国人修订标准。结果男性2009年的MS患病率(41.2%vs 36.6%,P=0.003)较2006年显著增加了4.6%;女性2009年MS患病率(33.2%vs 36.1%,P>0.05)较2006年降低了2.9%。年龄分层显示,男性在44岁以下MS患病率有下降趋势,45岁后各年龄组皆呈增加趋势,特别是45~64岁年龄段MS患病率显著增加(P<0.05);女性年龄小于64岁MS患病率呈降低趋势,65岁后呈增加趋势。2006~2009年MS各危险因子变化率比较显示,2009年男性WC、HDL-C、FPG阳性例数明显增加(P<0.05);女性TG阳性例数明显减少(P<0.05)。结论 2006~2009年北京某公司MS患病率变化趋势呈现明显的性别和年龄差异。男性45~64岁和女性65岁后人群是MS患病的重点防治人群。     

骨髓幼红细胞转铁蛋白结合铁摄入与年龄的关系

为观察骨髓幼红细胞转铁蛋白(Tf)受体(TfR)介导铁摄入途径的功能与年龄的关系,将雌性SD大鼠随机分为5、8和14个月共三个年龄组,分离骨髓单个核细胞,观察细胞膜TfR的表达和细胞Tf结合铁摄入的动力学变化。14月龄时幼红细胞表面Tf受体的表达显著低于5月龄和8月龄。受体的解离常数没有显著差异。14月龄时幼红细胞Tf的内吞平台和细胞铁聚积速度显著降低。结果表明,在到达一定年龄后骨髓幼红细胞TfR介导铁摄入的功能降低,这种变化的机制尚未清楚。