先天性生殖器官异常孕妇的围生结局分析

目的探讨先天性生殖器官异常孕妇的围生结局。方法选择2009年1月至2019年12月,于四川大学华西第二医院活产分娩的99779例单胎妊娠孕妇为研究对象。根据是否合并先天性生殖器官异常,将其分为观察组(n=324,合并)及对照组(n=99455,未合并)。回顾性分析2组孕妇的临床病例资料,总结观察组不同类型先天性生殖器官异常孕妇的围生结局特点。采用χ^(2)检验及独立样本t检验,对2组孕妇妊娠期各并发症发生率、剖宫产率及新生儿出生体重等,进行统计学分析。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。结果①观察组孕妇最常见先天性生殖器官异常前3位依次为纵隔子宫、单角/残角子宫及弓形子宫,分别占35.2%(114/324)、26.2%(85/324)及13.9%(45/324)。包括既往妊娠次数在内,观察组孕妇共计妊娠571次,其中弓形子宫、纵隔子宫孕妇的自然流产率位列前2位,分别为38.5%(35/91)、28.6%(61/213);阴道畸形孕妇足月产率(70.0%),高于子宫畸形者(52.8%),并且差异有统计学意义(χ^(2)=4.432、P=0.035)。②观察组孕妇早产、胎膜早破、胎位异常、胎盘早剥、胎儿生长受限(FGR)、胎盘黏连/植入、子宫破裂及剖宫产率分别为29.6%、29.3%、36.1%、5.9%、2.5%、21.0%、3.4%、78.7%,均分别高于对照组孕妇的9.8%、22.3%、5.7%、1.2%、1.0%、11.5%、1.5%、62.0%;而羊水过少率(0.9%)及新生儿出生体重[(2913±652)g],则显著低于对照组的2.9%、(3254±445)g,并且上述差异均有统计学意义(均为P<0.05)。2组孕妇前置胎盘、妊娠期高血压疾病(HDCP)、产后出血(PPH)及子宫切除率比较,差异均无统计学意义(P>0.05)。结论先天性生殖器官异常孕妇的母、胎围生期并发症发生风险高。提高该病孕妇的孕前及早孕期诊断率,加强围生期保健及处理,可改善其围生结局。     

A Review of the Current Status of Laparoscopic and Robot-assisted Sacrocolpopexy for Pelvic Organ Prolapse

Context

Abdominal sacrocolpopexy (ASC) represents the superior treatment for apical pelvic organ prolapse (POP) but is associated with increased length of stay, analgesic requirement, and cost compared with transvaginal procedures. Laparoscopic sacrocolpopexy (LSC) and robot-assisted sacrocolpopexy (RSC) may offer shorter postoperative recovery while maintaining equivalent rates of cure.

Objective

This review evaluates the literature on LSC and RSC for clinical outcomes and complications.

Evidence acquisition

A PubMed search of the available literature from 1966 to 2013 on LSC and RSC with a follow-up of at least 12 mo was performed. A total of 256 articles were screened, 69 articles selected, and outcomes from 26 presented. A review, not meta-analysis, was conducted due to the quality of the articles.

Evidence synthesis

LSC has become a mature technique with results from 11 patient series encompassing 1221 patients with a mean follow-up of 26 mo. Mean operative time was 124 min (range: 55–185) with a 3% (range: 0–11%) conversion rate. Objective cure was achieved in 91% of patients, with similar satisfaction rates (92%). Six patient series encompassing 363 patients treated with RSC with a mean follow-up of 28 mo have been reported. Mean operative time was 202 min (range: 161–288) with a 1% (range: 0–4%) conversion rate. Objective cure rate was 94%, with a 95% subjective success rate. Overall, early outcomes and complication rates for both LSC and RSC appeared comparable with open ASC.

Conclusions

LSC and RSC provide excellent short- to medium-term reconstructive outcomes for patients with POP. RSC is more expensive than LSC. Further studies are required to better understand the clinical performance of RSC versus LSC and confirm long-term efficacy.

Patient summary

Laparoscopic and robot-assisted sacrocolpopexy represent attractive minimally invasive alternatives to abdominal sacrocolpopexy. They may offer reduced patient morbidity but are associated with higher costs.     

鲑鱼鱼白DNA对小鼠胸腺作用的差异表达基因筛选

目的　探讨鲑鱼鱼白DNA(salmonmiltDNA ,SMD)对小鼠胸腺增龄性萎缩的作用及作用机制。方法　 10月龄雌性BALB/C小鼠按体重随机分为高剂量组 (333 33mg·kg-1·d-1)、低剂量组 (16 6 6 7mg·kg-1·d-1)和对照组 (0mg·kg-1·d-1)。喂饲 5周后 ,测定胸腺脏器指数 ;组织切片后以Image ProPlus专业图像分析系统 (4 0版 )进行胸腺细胞计数和皮质厚度测量 ,所得数据经SAS统计软件分析。应用基因芯片技术在对照组和高剂量组胸腺组织中筛选差异表达的基因片段、RT PCR鉴定部分片段。结果　SMD对小鼠的体重、胸腺重量和胸腺指数均无影响 ;高剂量组小鼠的胸腺皮、髓质细胞数量与对照组经统计学分析相比均显著增多 ;低剂量组的胸腺皮、髓质细胞数量与对照组相比经统计学分析差异均不显著 ;高、低剂量组的胸腺皮质平均厚度经统计学分析均显著高于对照组 ;经基因芯片技术初筛出 112条差异表达的基因片段 ;Genebank登录号为Aw2 0 910 2、U2 3789、X80 2 32的 3条上调表达的基因片段 ,经RT PCR鉴定 ,在高剂量组确实存在上调表达。结论SMD有通过促进细胞增殖相关基因的表达并同时促进发育、分化相关基因表达而逆转胸腺增龄性萎缩的可能。     

Genetic control of murine limb morphogenesis: Relationships with human syndromes and evolutionary relevance

Over the past ten years, the discovery and functional characterisation of murine Hox genes has led to a better understanding of some of the molecular mechanisms underlying limb development. It has also shed some light on the potential genetic events which have accompanied the fin-to-limb transition, an evolutionary step of critical importance which opened the way to the evolution of higher vertebrates. This convergence between developmental biology and the sciences of evolution is one of the synergistic interface that has been established recently thanks to the use of genetic engineering and transgenic animals. The increasing number of human genetic syndromes which are derived from mutations in developmental control genes remind us that many human genetic diseases are nothing else but alterations in our developmental programme. Here, we illustrate these various issues by discussing the function of Hox genes during limb development.     

某高校大学生性与生殖健康知识状况调查分析

【目的】了解高校大学生性与生殖健康知识知晓情况,探索在高校大学生中开展生殖健康教育的有效模式。【方法】采用自行设计的调查表,随机抽取某高校506名年龄为16～22岁的一至四年级学生进行问卷调查,统计分析青春期相关行为、性传播疾病、避孕、婚前性行为及妊娠等生殖健康相关知识知晓情况。【结果】发放调查问卷506份,收回有效问卷482份,平均年龄19．2＆#177;2．3岁,能正确认识“遗精”、“自慰”、“性幻想”的分别占56．4％、43．1％、64．1％;关于艾滋病的传播途径,能正确回答的仅占65．2％;关于预防性病的手段,回答正确的仅占56．9％;能完整、正确回答安全套的使用相关问题的仅占11％,来自城市和农村的学生比例分别为12．0％和10．2％,差异无统计学意义（ P ＞0．05）;对于婚前性行为态度,45．9％的学生认为不能接受,54．1％的学生认为“无所谓”或“很正常”,在城乡学生对比上,城乡学生持后者态度的比例分别为60．1％和49．6％,差异具有统计学意义（ P＜0．05）;问及“怀孕后会向谁寻求帮助”,47．5％的学生选择了“医生”,37．6％的学生选择了“朋友”,仅14．9％的学生选择“母亲”。在城乡学生对比上,50％的来自城市的学生选择向朋友求助,而59．2％的来自农村的学生选择了向医生求助,差异具有统计学意义（ P ＜0．05）。【结论】大学生性与生殖健康知识知晓率低,性观念较开放,在高校开展性与生殖健康教育迫在眉睫,兼顾城乡学生特点的同伴教育和新媒体教育模式值得推广。     

浅谈固有荧光在妇科临床的应用

目的 探讨固有荧光早期肿瘤诊断技术在妇科临床上的应用。方法 将固有荧光诊断仪的光导纤维探头对准宫颈部位，将阴道镜镜头对准宫颈，观察显示器上荧光图象加一判定。结果 共查1456例，阳性2例，占0．14％，生殖道感染等896人占61．5％。结论 固有荧光肿瘤早期诊断技术可作为妇科临床常规检查手段，特别适于生殖健康普查。     

A partial uterine perforation (type 2) by a copper-T IUD: sonographic diagnosis and management

The case reported in this paper demonstrates the difficulties in establishing the diagnosis of type 2 uterine perforation incident to the use of an IUD. A type 2 perforation is considered to have occurred when the IUD is entirely within the myometrium, no part of the IUD can be detected in the uterine cavity, and no part can be visually detected in the peritoneal cavity. The patient, a 28-year old gravida 3, para 2, had an IUD inserted 18 months prior to admittance, 7 weeks after her 2nd delivery. 1 year later she became pregnant. During a therapeutic abortion, the IUD string was removed without the device, which was considered to be outside and behind the uterus. Ultrasonography revealed that the IUD was inside the posterior uterine wall, parallel to the endometrial mucosal lining, with no connection to the uterine cavity. Other diagnostic methods used in this case included plain abdominal films, hysterography, and hysteroscopy; however, neither these methods nor uterine palpation suggested that there was an IUD in the uterus. The original diagnosis was later confirmed by intraoperative radiography, and the IUD was removed through a small incision on the posterior uterine wall. This case demonstrates the useful role of ultrasonography in the work-up of a woman with a missing IUD. It is suggested that ultrasonography be used following difficult IUD insertions or postpartum insertions, since most perforations occur in such cases. Partial and complete uterine perforation is considered more likely when the IUD is inserted during the 1st 3 months postpartum.