膝胸卧位红光照射联合肛提运动对产后痔急性发作的疗效

目的 探讨膝胸卧位红光照射联合肛提运动对产后痔急性发作的改善效果.方法 将68例经阴道分娩并发产后痔急性发作的产妇按入院时间分为对照组36例、观察组32例.两组产妇产后给予相同的产褥期知识宣教、母婴护理指导等常规护理措施,在此基础上,对照组采用屈膝侧卧位配合红光照射,观察组给予膝胸卧位红光照射联合肛提运动.观察两组产后24 h和产后5d痔疼痛程度、肛周水肿程度、治疗效果、治疗过程舒适度.结果 干预后两组疼痛评分、肛周水肿程度、治疗效果比较,差异有统计学意义(均P＜0.01);两组治疗过程舒适程度差异无统计学意义(P＞0.05).结论 产后痔急性发作的产妇应用膝胸卧位红光照射配合肛提运动能有效减轻产妇疼痛及肛周水肿程度,治疗效果较好.     

Current status and solutions for gender equity in anaesthesia research

Despite increasing numbers of women entering anaesthesia, they remain persistently under-represented within academic anaesthesia and research. Gender discordance is seen across multiple aspects of research, including authorship, editorship, peer review, grant receipt, speaking and leading. Women are also under-represented at higher faculty ranks and in department chair positions. These inequities are further magnified for women with intersectional identities, such as those who identify as Black, indigenous and women of colour. Several barriers to participation in research have been identified to date, including a disproportionate amount of family responsibilities, a disproportionate burden of clinical service, gender bias, sexual harassment and the gender pay gap. Several strategies to improve gender equity have been proposed. Increasing access to formal mentorship of women in academic medicine is frequently cited and has been used by healthcare institutions and medical societies. Senior faculty and leaders must also be conscious of including women in sponsorship and networking opportunities. Institutions should provide support for parents of all genders, including supportive parental leave policies and flexible work models. Women should also be materially supported to attend formal educational conferences targeted for women, aimed at improving networking, peer support and professional development. Finally, leaders must display a clear intolerance for sexual harassment and discrimination to drive culture change. Peers and leaders alike, of all genders, can act as upstanders and speak up on behalf of targets of discrimination, both in the moment or after the fact. Gender inequities have persisted for far too long and can no longer be ignored. Diversifying the anaesthesia research community is essential to the future of the field.     

年轻女性乳腺癌外科治疗焦点问题及对策

年轻乳腺癌病人预后较差,与侵袭性生物学特征密切相关,是临床治疗的一大难点。年轻女性乳腺癌病人的外科手术抉择需要综合权衡肿瘤生物学特征、病人的自身需求、社会家庭支持因素等各个方面。对于早期肿瘤应当积极开展保乳手术,对于临床分期较晚的肿瘤,建议参照分子分型积极开展新辅助治疗,或者实施合适的乳房重建技术。临床医师应当为病人提供更加充分的信息与高级别的循证医学证据,鼓励病人积极参与外科手术决策的制定。     

Breast cancer in young women: Imaging and clinical course

The purpose of this study was to characterize presenting imaging findings in women younger than 40 diagnosed with invasive breast cancer in the context of pathology and clinical course. Retrospective chart and imaging reviews were performed in patients under 40 diagnosed with breast cancer between July 1, 2004, and December 31, 2013. Patient demographic, imaging, pathology, and clinical data were collected. Overall and recurrence-free survival were estimated using the Kaplan-Meier method. Univariate Cox proportional hazards models were performed to identify factors associated with recurrence-free survival. Our study cohort consisted of 110 patients with invasive mammary carcinoma. One hundred one (91.8%) presented with a palpable mass. The mean size of all lesions on imaging was 3.5 cm ± 2.9 cm. Malignant calcifications were present in 54 (49.1%) cases. Imaging demonstrated multifocal or multicentric disease in 45 (40.9%) cases. Seventy four (67.3%) cancers were high grade. Luminal genomic subtypes were the most common (n = 61, 55.5%). At presentation, 4 (3.6%) patients had bilateral malignancy and 8 (7.3%) patients had distant metastatic disease. Ninety seven (88.2%) underwent neoadjuvant chemotherapy and 67 (60.9%) underwent radiation therapy. Seventy five (68.2%) of the patients underwent mastectomy. The restricted mean time to recurrence was 9.01 years (standard error 3.162 months). ER positivity was associated with compromised recurrence-free survival. The overall survival rate was 0.962 at 10 years. Young patients diagnosed with breast cancer typically present with advanced breast imaging findings and undergo aggressive treatment. Recurrence often occurs >5 years from diagnosis, and ER positive subtypes are at increased risk for recurrence.     

2015--2019年南通市通州区适龄妇女宫颈癌及乳腺癌筛查结果分析

目的:了解南通市通州区适龄妇女宫颈癌、乳腺癌筛查情况。方法:利用2015—2019年南通市通州区每年筛查年报结果进行描述流行病学分析。结果:2015—2019年宫颈癌筛查合计阳性病例14 681例,患病率达11.61%。其中癌前病变480例,癌前病变检出率为397.68/10万,宫颈癌确诊86例,宫颈癌检出率为68.03/10万。乳腺癌筛查合计阳性病例598例,患病率达0.47%。其中乳腺癌确诊63例,乳腺癌检出率为49.71/10万。HPV16、18阳性人群癌前病变患病率及宫颈癌确诊病例患病率高于HPV其他阳性人群,HPV其他阳性人群癌前病变患病率及宫颈癌确诊病例患病率高于HPV阴性人群,差异均有统计学意义。结论:宫颈癌、乳腺癌筛查,可以达到早诊断、早发现和早治疗的目的,HPV检测结果与宫颈癌癌前病变及宫颈癌病例确诊关系密切。     

孕妇社会资本量表的修订及信效度检验

目的 旨在翻译、修订孕妇社会资本评估量表（Social Capital Assessment Tool for in Pregnancy for Maternal Health, SCAT-MH）,并检验其信效度。方法 采用两阶段便利抽样的方法,样本1（n=253）主要用于修订中文版SCAT-MH量表;样本2（n=335）主要验证该量表的信效度。结果 中文版SCAT-MH主要包含4个维度16个条目,量表总的Cronbach ɑ为0.862,各个维度的信度系数在0.701~0.901之间,分半信度系数为0.819、0.760,重测信度系数为0.854;量表各个条目与总分（r=0.484~0.776,PSymbol|@@0.01）、维度与总分均呈中高度相关（r=0.575~0.807,PSymbol|@@0.01）,具有较好的内容效度;总量表及4个维度得分与效标工具均有相关性;验证性因子结果显示模型拟合度较好。结论 修订、汉化后的中文版SCAT-MH量表具有较好的信度、效度及区分度,适用于我国孕妇社会资本的评估。     

妊娠期糖尿病与产后抑郁关系的Meta分析

目的 系统评价妊娠期糖尿病与产后抑郁的关系。方法 检索Embase、Cochrane Library、PubMed、Web of Science、PsycINFO、中国知网、万方及维普数据库中探讨糖尿病与产后抑郁关系的研究,时限均从建库至2020年7月1日。同时对最终纳入的文献进行数据提取与质量评价,并采用Stata 14.0软件进行Meta分析。结果 最终纳入13项队列研究,共计736598名患者。文献质量评价均处于中高水平。Meta分析结果显示:妊娠期糖尿病与产后抑郁呈显著相关性（OR=2.02,95%CI: 1.44～2.81,P<0.001）。亚组分析显示:不同研究地区或国家［伊朗(OR=2.04)、美国(OR=1.47)、欧洲(OR=2.60)］、糖尿病诊断依据［临床诊断(OR=2.02)、自我报告(OR=1.87)］、产后抑郁评估期［产后6周及以下(OR=2.00)、产后6周以上(OR=2.14)］、抑郁测量工具［EPDS (OR=2.05)、ICD (OR=1.57)］中妊娠期糖尿病均与产后抑郁呈显著相关性。结论 产妇妊娠期糖尿病与产后抑郁具有显著相关性,糖尿病是产后抑郁的危险因素。     

孕妇风疹病毒IgG、IgM检测及意义

目的：了解温州地区孕妇对风疹的免疫状态,探讨风疹病毒IgG、IgM检测对评估孕妇免疫状态及判断风疹宫内感染的作用。方法：用ELISA法对1471名产前检查孕妇检测风疹病毒特异性抗体IgG、IgM,电镜检查和分子生物学法检查组织中病毒颗粒和病毒核酸。结果：76.07%（1119／1471）的孕妇具有免疫力,7.41%（109／1471）有孕妇为原发感染,14.14%的孕妇为易感,2.38%（35／1471）的孕妇IgG、IgM均呈阳性,其中1例引产胎儿心肌细胞和1例死胎的心肌、肝及脑细胞中均发现病毒颗粒。结论：同时检测孕妇风疹IgG和IgM可以正确判断孕妇的免疫状态,对IgM阳性孕妇应进行连续多次检测,IgM持续呈阳性三个月以上的孕妇可大致确定为宫内感染。