How does tobacco smoke influence the morphometry of the fetus and the umbilical cord?—Research on pregnant women with intrauterine growth restriction exposed to tobacco smoke

Proper structure of the umbilical cord is important for the fetal development. We evaluated effects of toxic factors from tobacco smoke on fetal and umbilical cord morphometry. 109 women in weeks 29–40 of pregnancy (31 smokers with intrauterine growth restriction (IUGR); 28 non-smoking women with IUGR; 50 healthy pregnancies) were included. In smokers with IUGR, cotinine, cadmium and lead concentrations were significantly higher than in controls (mean 55.23 ng/l; 1.52 ng/ml; 14.85 ng/ml vs 1.07; 0.34; 9.42) and inverse correlation between lead concentration and uncoiled umbilical cord was significant (r = −0.80). In smokers with IUGR, area of Wharton’s jelly was increased compared to nonsmokers and controls. Inverse correlations occurred between cotinine and cadmium concentration and fetal percentile in smokers (r = −0.87; r = −0.87) and non-smokers (r = −0.47; r = −0.78) with IUGR. Exposure to tobacco smoke measured by cotinine, cadmium and lead concentration has an impact on fetal growth and umbilical cord morphometry and correlates with intensity of IUGR.     

Hysteroscopic observations in 348 consecutive cases of female genital tuberculosis: A prospective study

Study objectiveTo evaluate the hysteroscopic findings in female genital tuberculosis.DesignIt was a prospective study of hysteroscopic findings performed on 348 cases of female genital tuberculosis (FGTB).SettingIt was a prospective cross-sectional study in a tertiary referral centre.PatientsA total of 348 patients with infertility with FGTB on various tests.InterventionA total of 348 patients of infertility found to have FGTB on various investigations were enrolled in the study. A detailed history was taken. Clinical examination, endometrial sampling and diagnostic laparoscopy were performed was also performed in selected cases. All patients underwent hysteroscopy as part of evaluation for infertility and tuberculosis (TB) findings.Measurements and main resultsThe mean age, parity, body mass index and duration of infertility was 28.2 years, 0.31,23.1kg/m² and 3.44 years respectively. Infertility was primary in 81.03% and secondary in 18.96% cases. Diagnosis of FGTB was made by endometrial aspirate findings of positive AFB on microscopy (4.02%), positive culture (4.88%), positive PCR (83.90%), epithelioid granuloma (14.65%), positive AFB on microscopy or culture of peritoneal cytology (1.14%) or epithelioid granuloma on peritoneal biopsy (1.72%), definitive findings of TB on laparoscopy (41.95%) or probable findings of TB on laparoscopy (58.05%). Various hysteroscopic findings observed were normal findings (28.16%), pale endometrial cavity (54.31%), features of active TB (7.47%), features of chronic TB (19.54%), features of TB sequelae like obstructed ostia (both ostia in 13.79%, one ostia 14.94%, periostial fibrosis; (bilateral 4.59%, unilateral 5.17%), endometrial glands atrophy (12.35%), small shrunken cavity (6.32%), distorted cavity (5.17%), various grades of intrauterine adhesions (29.88%). Hysteroscopy in FGTB was associated with increased difficulties and complications like failed procedures, difficult visualisation, false passage and uterine perforation.ConclusionHysteroscopy is useful modality to detect endometrial TB but is associated with increased difficulty and complications.     

Delphi法确立宫内节育器综合评价指标体系

目的:采用德尔菲(Delphi)法对通过数理方法初步建立的IUD综合评价指标体系进行调整确立。方法:在数理方法初步建立的IUD综合评价指标体系基础上,按照Delphi法原理,选择副高级以上职称、对生殖健康领域研究感兴趣且在各自领域具有权威性的计划生育、妇产科和公共卫生学专家进行两轮咨询评分,总结归纳反馈意见,计算相关参数,调整确立IUD的综合评价体系,采用直接评分法和Satty's赋权法确定各指标权重。结果:调整确立了由3个一级指标、6个二级指标和20个三级指标及其权重构成的IUD综合评价体系。调整后的IUD综合评价体系与调整前相比,在指标数目上没有增减,但在二级指标项、三级指标项及其维度的划分、各指标权重方面均有较明显的变化。结论:Delphi法的结果及建立的IUD综合评价体系具有科学性、合理性和可靠性,可以应用其对IUD进行综合评价。     

HBV宫内感染儿童接种乙型肝炎疫苗免疫失败与IL-2及其受体的关系

目的从ＩＬ－２及其受体角度探讨宫内感染ＨＢＶ导致乙型肝炎（乙肝）疫苗免疫失败的机制。方法采用体外细胞培养、流式细胞仪和酶联免疫检测技术对２２例ＨＢＶ宫内感染儿童和１５例正常儿童的外周血单个核淋巴细胞（ＰＢＭＣ）在非特异性刺激（ＰＨＡ）和特异性刺激（ＨＢｓＡｇ）下的膜ＩＬ－２受体表达水平和ＩＬ－２含量进行了测定。结果在ＨＢｓＡｇ刺激情况下，ＨＢＶ宫内感染儿童接种乙肝疫苗无反应组ＰＢＭＣ的ＩＬ－２膜受体表达水平低于有反应组和正常儿童组。在ＰＨＡ或ＨＢｓＡｇ刺激情况下，ＨＢＶ宫内感染儿童接种乙肝疫苗无反应组ＰＢＭＣ细胞培养上清的ＩＬ－２水平低于有反应组和正常儿童组。结论ＩＬ－２分泌能力低下，以及ＩＬ－２膜受体表达不足可能是宫内感染ＨＢＶ导致乙肝疫苗免疫失败的机制之一。     

Effect of early nutrition on intestine development of intrauterine growth retardation in rats and its correlation to leptin

AIM: To investigate the intestine and body development of intrauterine growth retardation (IUGR) rats under early different protein diet and to analyze the correlation between leptin and intestine and body development. METHODS: An IUGR rat model was established by food restriction of pregnant female rats. Fifty-six neonatal IUGR rats and 24 neonatal normal rats were randomly divided into normal control group (C group), IUGR model group (SC group), low protein diet IUGR group (SL group), and high protein diet IUGR group (SH group). Eight rats were killed per group at wk 0, 4, and 12. Serum leptin, body weight (BW), body length (BL), intestinal weight (IW), intestinal length (IL), and intestinal disaccharidase (including lactase, maltase, and saccharase) were detected. RESULTS: BW (4.50±0.41 g), BL (5.96±0.40 cm), IW (0.05±0.01 g), and IL (15.9±2.8 cm) in neonatal IUGR rats were much lower than those in C group (6.01±0.55 g, 6.26±0.44 cm, 0.10±0.02 g, 21.8±2.7 cm, P<0.05), while intestinal lactase and maltase activities were higher than those in C group. SH group showed the fastest catch up growth and their BW, BL, IW, and IL reached the C group level at wk 4. SC group showed relatively slower catch up growth than SH group, and their BW, BL, IW did not reach the C group level at wk 4. SL group did not show intestine and body catch up growth. Intestinal maltase [344±33 μmol/(min·g)] and saccharase activities [138±32 μmol/(min·g)] in SL group were both markedly lower than those in C group [751±102, 258±27 μmol/(min·g), P<0.05]. There were no significant differences in lactase activities at wk 4 and disaccharidase activities at wk 12 among all groups (P>0.05). The leptin level in SL. group (0.58±0.12 ng/mL) was the highest in all groups, and much lower in SH group (0.21±0.03 ng/mL) than that in any other IUGR groups at wk 4 (P<0.05). Leptin was negatively related to BW (r=-0.556, P= 0.001), IW (r=-0.692, P=0.001) and IL (r=-0.738, P= 0.000) at wk 4, while no correlation was found at wk 12. CONCLUSION: High protein diet is a reasonable early nutritional mode to IUGR rats in promoting intestine and body catch up growth.     

肿瘤坏死因子-α基因多态性与乙型肝炎病毒宫内感染易感性的关系

目的 探讨肿瘤坏死因子-α(TNF-α)基因-238位点G／A单核苷酸多态性与乙型肝炎病毒(HBV)宫内感染易感性的关系。方法 应用实时荧光定量聚合酶链反应技术检测HBV标志物阳性母亲所生45例HBV宫内感染儿童(Ⅰ组)、85例宫内未感染儿童(Ⅱ组)和126例对照组儿童TNF-α基因-238位点G／A单核苷酸多态性。结果 HBV宫内感染组TNF-α基因-238位点A等位基因频率显著高于HBV宫内未感染组(X^2=6．797，P=0．009)和对照组(X^2=9．513，P=0．002)，HBV宫内未感染组和对照组之间差异无显著性(X^2=0．047，P=0．828)。结论 TNF-α基因启动子区-238位点A等位基因与HBV宫内感染易感性相关，可作为检测其遗传易感性的标志之一。     

Omniview检查诊断宫腔粘连的临床应用价值

目的探讨经阴道三维超声自由解剖成像(Omniview)检查诊断宫腔粘连的临床应用价值。方法选取本院收治的86例疑似宫腔粘连患者,全部患者均行Omniview检查与宫腔镜检查,以宫腔镜结果为金标准评价Omniview检查诊断宫腔粘连的效能。结果 Omniview检查诊断宫腔粘连的准确度为88.37%,与宫腔镜结果比较差异显著(P<0.05);Omniview检查诊断不同宫腔粘连程度的特异度、灵敏度、准确度结果如下:中央型粘连:90.00%、96.36%、94.67%,周围型粘连:95.52%、75.00%、93.33%,混合型粘连:93.65%、100.00%、94.67%,Omniview检查诊断不同程度宫腔粘连的总体符合率为94.68%,与宫腔镜结果相符(P>0.05)。结论 Omniview检查在宫腔粘连程度判断中结果可靠,能够有效检出中央型粘连、混合型粘连病例,但在周围型粘连诊断中仍存在局限性。     

Secular change in height,sitting height and leg length in rural Oaxaca,southern Mexico: 1968–2000

Objective: To evaluate secular changes in height, sitting height and estimated leg length between 1968 and 2000 in residents in a rural Zapotec-speaking community in Oaxaca, southern Mexico.

Materials and methods: Height and sitting height were measured in school children 6–13 years (1968, 1978, 2000), in adolescents 13–17 years (1978, 2002) and adults 19–29 years (1978, 2000). Leg length was estimated as height minus sitting height. The sitting height/height ratio was calculated. Subjects were grouped by sex into four age categories: 6–9, 10–13, 13–17 and 19–29 years for analysis. The Preece–Baines Model I growth curve was fitted to cross-sectional means for 1978 and 2000.

Results: There were no differences between children 6–9 and 10–13 years in 1968 and 1978 with the exception of the sitting height ratio in girls 6–9 years. Children of both sexes 6–13 years and adolescent boys 13–17 years were significantly larger in the three dimensions in 2000 compared to 1978; adolescent girls differed only in height and sitting height. Adult males in 2000 were significantly taller with longer legs than those in 1978, but the samples did not differ in sitting height and the ratio. Adult females in 1978 and 2000 did not differ significantly in the three dimensions. Rates of secular change in height and sitting height between 1978 and 2000 were reasonably similar in the three age groups of male children and adolescents, but the rate for estimated leg length was highest in 10–13-year-old boys. Secular gains were smaller in adult males, but were proportionally greater in estimated leg length. Girls 6–9 and 10–13 years experienced greater secular gains in height, sitting height and estimated leg length than adolescent and young adult females, while secular gains and rates decreased from adolescent girls to young adult women. Ages of peak velocity for height, sitting height and estimated leg length declined in boys, while only ages of peak velocity for height and estimated leg length declined in girls.

Conclusions: There are major secular increases in height, sitting height and estimated leg length of children and adolescents of both sexes since 1978. Secular gains in height are of similar magnitude in boys and girls 6–13 years, but are greater in adolescent and young adult males than females. The secular increase in height of young adults of both sexes is smaller than that among adolescents. Estimated leg length accounts for about 60% of the secular increase in height in children of both sexes. Estimated leg length and sitting height contribute equally to the secular increase in height in adolescent boys, whereas estimated leg length accounts for about 70% of the secular increase in height in young adult males. Sitting height contributes about two-thirds of the secular increase in height in adolescent and young adult females.     

Social Inequality in Birth Outcomes in Korea, 1995-2008

Social inequality in adverse birth outcomes has been demonstrated in several countries. The present study examined the separate and joint effects of parental education and work in order to investigate the causal pathways of social class effects on adverse birth outcomes in Korea. The occurrence of low birth weight, preterm births, and intrauterine growth retardation was examined among 7,766,065 births in Korea from 1995 to 2008. The effect of social inequality, as represented by parental education and work, was examined against adverse birth outcomes using multivariate logistic regression after controlling for other covariates. Parental education had the most significant and greatest effect on all three adverse outcomes, followed by parental work and employment, which had lesser effects. For adverse birth outcomes, the gap between educational levels increased steadily in Korea from 1995 to 2008. Throughout the analysis, the effect of maternal manual work on adverse birth outcomes was apparent in the study results. Given this evidence of social inequality in education and employment, social interventions should aim at more in-depth and distal determinants of health.     

几丁糖预防宫腔镜术后宫腔粘连

目的探讨几丁糖预防宫腔镜术后宫腔粘连的临床应用价值。方法将84例因早孕要求进行宫腔镜手术的患者按随机数字表法分组,即几丁糖5 ml子宫腔内局部应用组(实验组)及无任何干预措施组(对照组),观察两组术后宫腔改变情况。结果实验组宫腔粘连轻、中、重度粘连发生率均低于对照组,差异均有统计学意义(P0.05)。结论宫腔内应用几丁糖可以减少宫腔镜术后宫腔粘连的发病率,是一种操作简便、疗效满意的预防方案。