Objective To study the efficacy of the preterm oral feeding assessment scale (POFAS) in evaluating oral feeding capacity in preterm infants of different gestational age.Method Revised POFAS including the preterm oral feeding readiness assessment scale and sucking ability scale was used to dynamically evaluate the oral feeding capacity of the stable preterm infants with corrected gestational age (CGA) ≥32+4 weeks.The ratio of actual oral intake volume to planned feeding volume (A/P) was measured,and the correlation of the POFAS score and A/P ratio was studied using Pearson correlation analysis.The risk factors of the A/P ratio was studied using Logistic regression analysis.The receiveroperating characteristic (ROC) curve was drawn to explore the predictive value of POFAS score for A/P ratio reaching 50％.Result A total of 44 infants (59.1％ male) with 158 times of evaluation were enrolled in the study.The gestational age was (30.9±2.1) weeks,and the birth weight was (1 543±478)g.The enteral feeding was started at (31.1 ± 2.0)weeks of CGA,the oral feeding at (33.7 ± 1.4) weeks,and complete oral feeding at (34.9± 1.3) weeks.When reaching the same CGA,infants born at earlier gestational age had a smaller A/P ratio.Pearson correlation analysis showed that with CGA＞33 weeks,all the indicators can predict the feeding conditions of the infants,the POFAS score was positively correlated with the A/P ratio (P＜0.05).The ROC for the POFAS score to predict a 50％ A/P ratio was 0.951 (P＜0.05),and the cut-off value was 6.5 (sensitivity 93.8％,specificity 83.3％).The POFAS score and sucking ability score were the risk factors of a 50％ A/P ratio in preterm infants with 34 weeks CGA.Conclusion Revised POFAS can be effectively used to assess preterm infants' oral feeding ability,promote oral feeding and early discharge from the hospital.

Objective To evaluate the effectiveness of colposcopy beginner and to define the learning curve of colposcopy examiner.Methods A retrospective study was performed.Totally 200 colposcopy cases at the outpatient clinic of Peking University First Hospital from March 2015 to October 2015 were included in this study.Patients were divided into two groups:the first 100 cases and the later 100 cases.The clinical characteristics,including age,indication of coloposcopy,examining time,rate of biopsy,the detection rate of cervical intraepithelial neoplasia (CIN) and the coincidence rate of eolposcopy with pathology,were compared.Results No significant difference was observed in the medium age and indication of colposcopy (P＞0.05).The medium examining time of first 100 cases was longer than that of the later 100 cases [(14.87±3.83) min vs.(12.05±3.57) min] (P＜0.05);Among the first 100 patients,33 turned out to be LSIL or worse,followed by 27 with LSIL or worse in the other 100 patients,no significant difference between the two groups was observed (33 vs.27 cases)(P＞0.05).No significant difference was observed in the coincidence rate with pathology (61.2％ vs.58.4％) (P＞0.05).Of the first 100 cases,four patients returned to out-patient clinic for the following reasons:fever,vaginal bleeding,and having difficulty removing the vaginal gauze.Conclusion The examining effectiveness increases with the cases accumulation for the colplscopy examining-beginner.The detection rate of CIN I or worse cases and coincidence rate with pathology are stable.

目的 通过对细胞学未见异常的性交后出血(PCB)患者临床资料分析,探讨PCB的临床管理路径.方法 回顾性总结2013年11月至2016年5月就诊于北京大学第一医院妇产科门诊149例细胞学未见异常因PCB转诊阴道镜患者的人乳头瘤病毒(HPV)检测、阴道镜以及病理结果,分析PCB患者中子宫颈高级别病变以及浸润癌的风险,探讨PCB患者的管理.结果 149例细胞学未见异常因PCB转诊阴道镜的患者,年龄21 ～ 82岁,平均年龄42.91 ±10.83岁.阴道镜下活检病理共检出子宫颈上皮内瘤变2 (CIN2)4例,子宫颈浸润癌2例,CIN2+检出率为4.0％ (6/149).其中128例(85.9％,128/149)同时进行了HPV-DNA检测,123例检测阴性,占96.1％ (123/128);5例检测阳性,占3.9％ (5/128);在123例HPV阴性者中,共检出CIN21例(1/123,0.8％),子宫颈癌1例(1/123,0.8％),CIN2+检出率为1.6％ (2/128),在5例HPV阳性者中无CIN2+检出,在21例未行HPV检测者中共检出CIN2 3例(3/21,14.3％),子宫颈癌1例(1/21,4.8％),CIN2+检出率为19.0％ (4/21);未行HPV检测与行HPV检测的病例相比较,CIN2+的检出有统计学差异(x2=14.271,P=0.004),OR=14.824(95％ CI:2.522 ～ 87.141).结论 在细胞学未见异常的PCB中存在有较低的CIN2+风险,应重视排查,细胞学联合HPV检测均阴性可能减低PCB患者的CIN2+风险.

Objective To explore the effects evaluation of extended care after “one-day care” for delivery women with gestational diabetes mellitus ( GDM ) . Methods From May to September 2013 in Department of Gynaecology and Obstetrics Peking University First Hospital, a total of 354 GDM pregnant women participated “one-day care” and then they were divided into experimental group (171 cases) and control group (183 cases) according to whether attended the extended care. Using repeated variance analysis measurement, the fasting blood glucose and postprandial 2h blood glucose values were compared whether the values had statistical significance between two groups at different visit time. Results The uterine-incision rates were 48. 55%(83/171) and 49. 7%(91/183) in the experimental group and control group respectively, and the incidence of giant babies were 9. 4%(16/171) and 12. 0%(22/183) respectively in the experimental group and control group (P>0. 05). The time point of before visit, during visit and last visit in the experimental group, the fasting blood glucose and postprandial 2 h blood glucose were lower than that of the control group (P<0. 05). Conclusions “One-day care” for GDM can reduce the blood glucose level of GDM delivery women, but it has not significant effects on the control of gestation′s body weight and to decline the uterine-incision rate and incidence of giant babies.

Objective To determine effects on mothers of gestational diabetes on their future anthropometry and metabolic risks.Methods We conducted a follow-up study of 222 women who delivered in the Department of Obstetrics and Gynecology of First Hospital of Peking University from June 2006 to Dec 2007.The selected cases consisted of 124 women with gestational diabetes mellitus (GDM) and 98 women with normal glucose metabolism( control group).The follow-up study was performed from Nov 2010 to Feb 2011,anthropometry indexes include height,weight,waist circumference,hip circumference, systolic pressure,diastolic pressure and body fat.Laboratory tests include fasting blood glucose,triglyceride,total cholesterol,high density lipoproteins,low density lipoproteins,insulin and C-peptide. Results (1)Compared with control mothers,GDM mothers had higher body weight ( ( 61 ± 10) vs ( 59 ± 9 ) kg,t =2.023,P ＜ 0.05 ),waist circumference (WC) ( (78 ± 9 ) vs (76 ± 8 ) cm,t =2.229,P ＜ 0.05 ) and body fat ( 34.3 ％ vs 31.4％,t =3.102,P ＜ 0.05 ).Serum fasting glucose ( ( 5.3 ± 0.8 ) vs (4.9 ± 0.3 ) mmol/L,t =5.369,P ＜ 0.001 ),triglyceride ( ( 1.1 ± 0.6) vs ( 0.9 ± 0.4 ) mmol/L,t =2.346,P ＜ 0.05 ) and HOMAIS(0.077 ± 0.029 vs 0.086 ± 0.029,t =- 2.221,P ＜ 0.05 ) level had significant differences between two groups. (2) GDM mothers had higher proportion on WC ≥ 80 cm (37.1％ vs 24.5％,x2 =4.03,P ＜0.05),Fasting glucose ≥6.1 mmol/L(7.4％ vs 1.0％,x2 =5.05,P ＜0.05),DBP≥85 mm Hg ( 1 mm Hg =0.133 kPa,16.9％ vs 6.1％,x2 =5.991,P ＜ 0.05 ) and metabolic syndrome ( 13.2％ vs 5.2％,x2 =4.026,P ＜ 0.05 ) than control mothers. Conclusions GDM pregnancies led to increased conversion to glucose intolerance in mothers,GDM mothers have increased risk of central adiposity,lower insulin sensitivity,impaired glucose intolerance,Hyperlipidemia and metabolic syndrome at 3 -4 years after delivery than control mothers.

目的 研究宫颈环形电切除术(LEEP)术后保妇康栓促进创面愈合的临床疗效.方法 选择2009年9月至2014年6月北京大学第一医院收治的564例经宫颈液基细胞学检查(TCT)和人乳头瘤病毒(HPV)检测后需要转诊阴道镜,经组织病理学确诊为宫颈高级别病变并行LEEP治疗的患者,术后随机分为联用保妇康栓组458例(观察组)和未使用保妇康栓组106例(对照组),对比LEEP术后观察组与对照组创面愈合情况.结果 LEEP术后1个月保妇康栓组患者创面愈合率(84.06％)较对照组(25.47％)差异有统计学意义(P＜0.01);LEEP术后高危型HPV转阴率为81.64％.结论 LEEP治疗宫颈高级别病变,术后联合应用保妇康栓,可显著加快创面愈合.

目的 探讨重组人干扰素α-2b凝胶(尤靖安(R))治疗宫颈高危型人乳头瘤病毒(HPV)感染的有效性和安全性.方法 收集2011年7月至2012年7月北京大学第一医院等14家医院323例高危型HPV(hr-HPV)阳性患者随机分配到尤靖安组和空白组,其中尤靖安组233例,尤靖安阴道用药,1次1支,隔日用药1次,连续用药3个疗程(连续使用10次为1疗程);空白组90例不使用药物,仅做观察.结果 在第6个月复查宫颈hr-HPV DNA.主要疗效:全分析(FAS)集,2组之间转阴率和总有效率均无统计学意义(P＞0.05);符合方案(PPS)集,尤靖安组转阴率71.92％(146/203)高于空白组转阴率59.76％ (49/82),且差异有统计学意义(P=0.0459).次要疗效:(1)单型感染(仅一种类型的病毒感染),FAS集,尤靖安组的转阴率69.18％(110/159)高于空白组转阴率52.63％(30/57),且差异有统计学意义(P=0.0251);PPS集,尤靖安组转阴率和总有效率均高于空白组,且差异有统计学意义(P=0.0053,P=-0.0310).(2)复合型感染(仅两种类型的病毒感染)和多型感染(3种类型或以上的病毒感染),FAS集与PPS集,2组间疗效的差异无统计学意义(P＞0.05).尤靖安组不良事件发生率为1.3％(3/227),对照组无不良事件发生,2组间差异无统计学意义(P＞0.05).结论 尤靖安外用治疗宫颈hr-HPV感染,可能有效,目前观察未发现严重不良反应.

流行病学研究显示,人乳头瘤病毒（HPV）感染是宫颈癌及宫颈上皮内瘤变的主要病因。HPV的检出常常给当事人造成一系列严峻的心理压力,更由于病毒本身的传染性,给病人的性生活、生育、家庭关系、社会关系等带来许多道德和伦理上的冲击[1]。社会因素及病人的心理因素在宫颈病变的发生、发展、治疗和康复的过程中起着重要作用。本研究对HPV感染病人可

Objective To investigate the value of TCT and HPV detect in CIN patients. Method 135 patients diagnosed as CIN by pathologic method were involved. Their clinical and pathological data were reviewed and were given a 3-times follow-up in 2007,2008 and 2009. The follow-up studies include TCT and HPV detect. Results (1) in 73 HR-HPV positive patients, 15 of them were diagnosed as ASCUS, 3 were ASCUS-H ,28 were LSIL and 27 were HSIL by ThinPrep Cytology Test(TCT). In those 73 patients, 17 of them were CIN Ⅰ,24 were CIN Ⅱ,30 were CIN Ⅲ and 2 were possibly-invasive cervical cancer. (2) in the 3-times follow-up, non of the patients recurred. Conclusion TCT and HPV detect are effective in diagnose and follow-up of CIN patient.

阐述阴道镜下宫颈活检术诊断宫颈上皮肉瘤样变(CIN)的方法、效果和护理,通过对458例进行阴道镜检查病人的护理,观察可见在阴道镜检查及在宫颈取活检术过程中,护士应该熟练掌握宫颈病变的3个阶梯诊断标准知识及手术操作步骤、以及检查中的术前、术中的心理护理及术后的健康指导,减轻病人不必要的恐惧,方能保证阴道镜下取活检术的顺利完成。

<正>新生儿持续肺动脉高压(persistent pulmonary hypeaension of the newborn,PPHN)于1969年被首次认识,当时因考虑其血流动力学改变类似于胎儿循环,故称为持续胎儿循环(persistent fetal circulation, PFC),但由于主要病因是生后肺动脉压力的持续增高,故现在多将其称为新生儿持续肺动脉高压,即 PPHN。该病是指新生儿出生后由于一种或多种病因导致肺血管阻力持续性增高,胎儿型循环向正常“成人型”循环过渡受到阻碍,当肺循环压力超过体循环压力时,心房及(或)动脉导管水平出现血液的右向左分流,临床上以严重的低氧血症为主要表现。本病是新生儿期发病和死亡的主要原因之一,多见于足月儿或过期产儿。

缺氧性肺动脉高压肺血管结构重建的发生机理十分复杂.本文对肺血管结构重建的主要部位肺腺泡内动脉(肌型动脉MA、部分肌型动脉PMA及非肌型动NMA)进行超微结构观察.

目的探讨内源性血红素氧合酶/一氧化碳(HO/CO)系统在低氧性肺动脉高压大鼠体内的变化.方法采用常压低氧大鼠肺动脉高压模型,观察低氧大鼠肺动脉平均压(mPAP)和肺组织匀浆碳氧血红蛋白(HbCO)含量,用核酸原位杂交和免疫组织化学的方法检测低氧大鼠肺动脉血红素氧合酶-1(HO-1)mRNA和HO-1蛋白的表达.结果低氧组大鼠mPAP为(22.00±2.31)kPa,较对照组[(16.57±2.51)kPa]增高32.77%(t=3.90,P＜0.01);低氧大鼠在mPAP升高的同时,伴有肺动脉HO-1 mRNA和HO-1蛋白表达积分值增加,分别较对照组增加82%和260%(t=3.79、5.79,P均＜0.01);低氧组大鼠肺组织匀浆CO含量(16.74±0.92)nmol/μg,较对照组(14.05±1.49)nmol/μg增高19.14%(t=5.85,P＜0.01).结论低氧促使HO/CO系统上调,HO/CO参与了低氧性肺动脉高压的发病机制.

Objective: To observe ultrastructural changes of intra-acinar pulmonary arteries and study the pathogenesis of experimental hypoxic pulmonary hypertension.Methods: Wistar rats were randomly divided into control groups(n=9)and pulmonary hypertension groups(n=9).Mean Pulmonary artery Pressure(mPAP)of each rat was evaluated using a right cardiac Catheterization procedure.Ultrastructure of intra-acinar pulmonary arteries was observed by transmission electron microscope.Results: The mPAP was significantly higher in rats of pulmonary proliferation and degeneration hypertension group than that of control group(P0.01).Ultrastructrural observation showed the proliferation and degeneration of endothelial cells in intra-acinar pulmonary arteries on pulmonary hypertension group.The internal elastic laminar was irregular.The proliferation of medial smooth muscle cells of arteries was showed at the level of respiratory bronchioles.The muscularized arteries were observed at the level of both respiratory bronchioles and alveoli.The hyperplasia of intermediate cells and pericytes was present.The collagens increased.Conclusions: The proliferation of smooth muscle cells and arterialization of intra-acinar pulmonary arteries are characteristic ultrastructural changes of hypoxic pulmonary hypertension.The results indicate that pulmonary vascular structural remodeling is the important pathologic basis of hypoxic pulmonary hypertension.

弥散性血管内凝血(Disseminated intravascular coagulation,DIC)是由多种致病因素引起的凝血机能障碍的病理过程,是危重新生儿较常见的并发症,也是新生儿死亡的重要原因.肝素是治疗DIC的重要药物,为了探讨肝素在新生儿DIC治疗中的合理应用,以进一步提高新生儿DIC抢救的成功率,2001年10月～2003年2月我们应用微剂量肝素皮下注射治疗20例新生儿DIC,并对此进行了系统的观察和总结.

目的:肺动脉高压的形成机制至今还不清楚.近年来我们围绕气体信号一氧化氮及一氧化碳调节网络在肺动脉高压形成机制中的作用开展了系列研究.方法:低氧性肺动脉高压及高肺血流性肺动脉高压动物模型的建立,血流动力学测定,血管环舒张反应研究,肺动脉超微及显微结构研究,分子生物学,免疫细胞化学,免疫组织化学,流式细胞术,生物化学,肺动脉平滑肌细胞及内皮细胞培养等.结果:一氧化氮、一氧化碳及其调节网络在肺血管结构重建、肺动脉高压形成中发挥重要作用.二者参与对肺动脉平滑肌细胞增殖的抑制作用及凋亡的促进作用,证明二者对肺动脉高压时胶原堆积具有抑制作用.研究同时发现,二者对平滑肌细胞增殖促进因子的抑制作用以及对平滑肌细胞增殖抑制因子的促进作用参与其对肺血管结构重建、肺动脉高压形成的调节.结论:一氧化氮、一氧化碳及其调节网络在肺动脉高压的形成中发挥重要作用.

目的观察大鼠在慢性低氧环境中不同节段肺血管显微结构的变化规律,探讨其在慢性缺氧性肺动脉高压形成中的病理意义.方法将23只Wistar大鼠随机分为对照组、低氧1周组、低氧2周组.以右心导管法测定肺动脉压力;对肺组织进行弹力纤维染色,计数各型肺内动脉百分比;应用计算机图像分析系统测定分别与三级呼吸道伴行的肺动脉的相对中膜面积(RMA)、厚度(RMT)及血管壁内弹力层(IEL)厚度.结果低氧2周组大鼠肺动脉平均压明显高于对照组及低氧1周组,低氧1周组肺动脉平均压明显高于对照组;低氧2周组肌型动脉百分比(MA%)、三级动脉RMA、RMT均明显高于对照组及低氧1周组,低氧1周组MA%、肺泡水平动脉RMA、RMT明显高于对照组(P均＜0.05).与对照组相比,低氧2周组和1周组肺内动脉血管壁IEL均明显减少(P均＜0.05).多因素相关分析表明,肺动脉平均压与肺泡水平动脉RMA、RMT呈正相关;与肺泡水平肺动脉血管壁IEL厚度呈负相关(P均＜0.05).结论慢性低氧环境中大鼠肺血管结构呈现节段依赖性的重构规律,这一改变是缺氧性肺动脉高压形成的重要病理基础.

本实验旨在研究尾加压素Ⅱ(uⅡ)在慢性低氧性肺动脉高压及肺血管结构重构形成中的变化.应用免疫组化技术对慢性低氧性肺动脉高压大鼠不同节段肺内动脉uⅡ蛋白表达进行定位及半定量分析.结果显示:低氧1周和2周组大鼠肺动脉平均压(mPAP)、右心室肥厚指标R/(L+S)、肺动脉相对中膜面积(RMA)和相对中膜厚度(RMT)均明显高于对照组(P＜0.001).低氧2周组大鼠各节段肺内动脉内皮细胞中uⅡ表达较对照组分别下降27.75%、32.50%、39.63%(P均＜0.01).相关分析显示:与呼吸性细支气管伴行的肺动脉内皮细胞uⅡ表达与mPAP呈显著负相关;各节段肺动脉内皮细胞uⅡ表达分别与各级肺动脉RMA、RMT呈明显负相关(P均＜0.05).研究表明:低氧性肺动脉高压及肺血管结构重构形成过程中,肺内动脉内皮细胞uⅡ表达呈现明显下调;推测uⅡ在慢性低氧性肺动脉高压形成机制中具有重要的病理生理意义.

Objective To explore the role of endogenous carbon monoxide (CO) in regulating hypoxic pulmonary hypertension and pulmonary vascular structure. Methods Eighteen Wistar rats were randomly divided into control group, hypoxic group and hypoxic with ZnPP group. Pulmonary artery mean pressure of each rat was evaluated using right cardiac catheterization. Lung tissues were dyed with Weighert′s method. The percentage of each type of intra-acinar pulmonary arteries was measured. Relative media thickness (RMT) and relative media area(RMA) of the intrapulmonary arteries were observed. Collagen Ⅰand collagen Ⅲ expressions were detected by immunohistochemical assay. The expressions of type Ⅲ procollagen [Pro-α 1(Ⅲ) collagen] mRNA were detected by situ hybridization. Results mPAP was significantly increased in hypoxic group as compared with that of controls;and mPAP in hypoxic with ZnPP group was markedly increased compared with that of hypoxic group (P0.01).Percentage of muscularized artery,RMA and RMT of intra-pulmonary arteries were significantly increased in hypoxic group;ZnPP augmented mPAP and RMT and RMA markedly in hypoxic rats (P0.01). In hypoxic rats the expressions of collagen Ⅰ,collagen Ⅲ proteins and Pro-α 1 (Ⅲ) collagen mRNA in pulmonary arteries were increased significantly compared with rats of control group. ZnPP elevated expressions of collagen Ⅰ,collagen Ⅲ proteins and Pro-α 1 (Ⅲ) collagen mRNA obviously(P0.01). Conclusion Endogenous CO may act as a protective factor in hypoxic pulmonary hypertension and pulmonary vascular structure remodeling at least, which has partly involved in the regulation of CO in synthesis of collagen in pulmonary artery of hypoxic rats.