基于决策树模型与logistic回归模型的HBV宫内传播影响因素分析

目的:结合logistic回归与 χ 2自动交互检测法（CHAID）决策树模型探讨乙型肝炎病毒（HBV）宫内传播的影响因素及其相互关系。 方法:选取2007-2013年在太原市第三人民医院产科分娩的689对HBsAg阳性母亲及其新生儿,通过问卷调查和病历查阅获得母亲及其新生儿的一般人...     

含吲哚美辛MYCu宫内节育器多中心临床研究

目的:探讨放置MYCu宫内节育器(IUD)的临床效果。方法:在我国不同地域选择8个省的49个中心放置MYCuIUD5200例,放置后1、3、6、12个月随访。结果:放置满12个月者纳入统计分析共4998例,累积带器妊娠率0.29/百妇女年,累积脱落率0.24/百妇女年,因出血/疼痛累积终止率1.56/百妇女年,与使用IUD有关的累积终止率2.08/百妇女年;8个省因与使用IUD有关的累积终止率3.51/百妇女年～1.00/百妇女年,差异无统计学意义(P﹥0.05);放置后不良反应主要为月经异常、不规则出血、腰腹疼痛和白带增多,随放置时间延长而逐渐缓解。结论:MY-CuIUD避孕效果可靠,脱落率低,不良反应发生率低,是比较理想的IUD。     

宫腔手术后预防宫腔粘连的研究现状

宫腔粘连（intrauterine adhesion,IUA）是宫腔手术后常见并发症,是导致子宫性不孕的主要原因。对于IUA最重要的是进行预防,术后口服避孕药及宫内节育器的置入在临床上应用广泛,同时具有避孕的作用。使用球囊导尿管需住院治疗,且术后应用广谱抗生素预防上行感染。防粘连产品的应用需考虑患者经济因素。羊膜移植的有效性有待进一步研究证实。早期门诊宫腔镜检查是预防IUA的发展趋势。     

Current management of endometrial hyperplasia-a survey of United Kingdom consultant gynaecologists

Objective

To determine current practice for the management of endometrial hyperplasia.

Study design

We carried out a web-based survey of all UK consultant gynaecologists, from the Royal College of Obstetricians and Gynaecologists (RCOG) database, to evaluate the current practice and to enquire whether a trial between oral progestogens and LNG-IUS for endometrial hyperplasia is required.

Results

We sent 1090 email invitations and 411 (37.7%) responded to this survey. In total, 338 consultant gynaecologists, who manage patients with endometrial hyperplasia, responded to all items of the survey. The oral progestogens (33.2%) and the LNG-IUS (52.1%) were the most popular choices for managing complex endometrial hyperplasia. The majority of the gynaecologists would explore two conservative choices before embarking into performing a hysterectomy for this condition (130, 52.6%). However, for atypical hyperplasia, the majority of the gynaecologists would perform a hysterectomy (273, 83.2%) and would only consider LNG-IUS or oral progestogens as a second or third option. Two hundred forty-four (72.2%) responded that an RCT for oral progestogens versus LNG-IUS for the management of endometrial hyperplasia is required. There were 171 (50.6%) gynaecologists that would be willing to randomise in such an RCT.

Conclusion

Our survey shows that complex endometrial hyperplasia is managed conservatively in UK, with oral progestogens or LNG-IUS, and atypical endometrial hyperplasia is managed with hysterectomy. An RCT, between oral progestogens and LNG-IUS for endometrial hyperplasia, is required to identify the optimum therapy.     

ABH secretor genetic polymorphism: evidence of intrauterine selection

Objective

Fucosyltransferase locus 2 (FUT2) controls the presence or absence of blood group substances (A, B, H) in the saliva and other body secretions. Secretor/non-secretor phenotypes are associated with some metabolic and infectious diseases. ABO and FUT2 contribute to build up oligosaccharide structures of the cell surface that are important for blastocyst adhesion and resistance to microbial invasion. We investigated a possible selection on ABH secretor phenotypes during intrauterine life.

Study design

Three hundred and fifty-six consecutive healthy puerperae and their newborn infants from the caucasian population of Rome were studied. Informed consent for study participation was obtained from the mothers to participate and the study was approved by the Institutional Review Board. ABH secretor Se phenotype was determined on saliva by standard laboratory procedure.

Results

Symmetry analysis of mother infant Se phenotype revealed a deficit of mother Se+/newborn Se− with respect to expected values. The asymmetry is present only in infants carrying the A blood group antigen. The asymmetry was dependent on several maternal and neonatal parameters including maternal age, smoke, parity and gestational duration.

Conclusions

The data suggest intrauterine selection against Se− of the embryo carried by a Se+ mother. Such selection is dependent on factors influencing the maternal environment. The study could have practical importance in assessing the risk of infertility and success of artificial insemination.     

Evidence based management guidelines for the detection and treatment of congenital CMV

CMV is the most common congenital infection in newborns worldwide. Congenital CMV causes sensorineural hearing loss in a significant proportion of infected newborns, while the majority of newborns are asymptomatic. In the last three years there have been significant advances in the diagnosis and treatment of congenital CMV. We have developed practical evidence based guidelines for the management of congenital CMV.     

乙肝孕妇血清病毒标志物模式与宫内感染的关系

目的:检测乙肝感染孕妇的血清乙肝病毒标志物及所产新生儿脐血清HBV-DNA,探讨孕妇乙肝感染状况与新生儿宫内感染的关系,寻找有效阻断乙肝宫内感染的措施。方法:采用ELISA法检测302例乙肝感染孕妇血清乙肝病毒标志物,用Realtime-PCR法检测新生儿脐血清HBV-DNA。结果:"大三阳"和"小三阳"孕妇分别占64.90%和21.19%,"大三阳"组孕妇的新生儿脐血清HBV-DNA阳性率为46.88%,明显高于"小三阳"组的1.02%。孕妇血清HBeAg阳性组的新生儿脐血清HBV-DNA阳性率为46.27%,远高于阴性组的1.28%。结论:孕妇乙肝感染状况与新生儿宫内感染率密切相关,孕妇血清HBeAg可作为宫内感染发生的预测指标;HBeAg阳性妇女待HBeAg转阴后再妊娠,可大大减少宫内感染的发生。     

腹腔镜取出盆腹腔内异位节育器23例临床分析

目的:探讨宫内节育器(IUD)异位或嵌顿的原因、临床诊断及治疗。方法:回顾分析23例节育器盆腹腔内异位或嵌顿经腹腔镜取出的临床资料及诊治过程。结果:23例患者中13例通过腹腔镜手术顺利取出异位节育器,2例因节育器部分嵌顿/异位至膀胱、同时行膀胱壁切开及修补术,6例联合宫腔镜取出异位节育器,1例在宫腔镜、膀胱镜联合下取出异位节育器,1例因术中未探查到IUD而取器失败。结论:对于IUD盆腹腔内异位或嵌顿患者应准确诊断,及时取出。     

孕妇乙型肝炎病毒携带状态与阻断母婴传播的研究

目的:研究HBsAg阳性孕妇产前应用HBIG、新生儿联合应用HBIG和乙肝疫苗阻断乙肝病毒母婴传播的效果。方法:98例HBsAg阳性孕妇在孕28、32、36周时肌内注射乙型肝炎人免疫球蛋白(HBIG)200 IU,新生儿出生采股静脉血后,臀部肌内注射HBIG 200 IU,三角肌内注射重组乙型肝炎疫苗(酵母)10μg,1月龄时再次注射HBIG 200 IU,1、6月龄常规注射乙肝疫苗10μg,作为实验组;选取92例产前未使用HBIG的HBsAg阳性孕妇作为对照组,所生婴儿仅0、1、6月龄注射重组乙型肝炎疫苗(酵母)10μg。两组婴儿分别在0、1、6、12月龄时采静脉血,检测HBV标志物,随访两组婴儿至1岁。观察、比较两组婴儿的宫内感染率、慢性感染率、保护率及免疫失败率。结果:实验组和对照组宫内感染率分别为3.06%和18.48%,两组比较差异有统计学意义(P<0.01);实验组和对照组慢性感染率分别为1.02%和13.04%,两组比较差异有统计学意义(P<0.01);实验组和对照组保护率分别为95.92%和76.09%,两组比较差异有统计学意义(P<0.01);实验组和对照组免疫失败率分别为1.02%和7.61%,两组比较差异无统计学意义(P>0.01)。结论:HBsAg阳性孕妇产前应用HBIG、新生儿出生后应用HBIG和乙肝疫苗联合免疫,可有效阻断母婴垂直传播,提高婴儿的免疫成功率,明显降低慢性HBV感染率。