围产期心肌病(PPCM)是一种罕见的特发性扩张型心肌病(IDCM),通常在妊娠晚期或产后早期时出现心脏扩大、心力衰竭等症状.近年来发病率不断升高,在不同国家和种族群体中的患病率不同,是造成孕产妇死亡的主要原因之一.PPCM的病因尚不清楚,子痫前期、高龄妊娠及多胎妊娠等均为其高危因素.研究显示,妊娠期或产后血管生成紊乱、炎症反应、自身免疫反应及氧化应激等因素诱发潜在的遗传易感性致其发病.本文综述了PPCM发病机制的最新研究进展,通过对病因、发病机制的研究以期为PPCM的防治提供理论参考,以更好地改善患者的预后.

完全性前置胎盘是指胎盘组织完全覆盖在宫颈内口,可导致产后出血甚至危及孕产妇生命安全,是一种严重的妊娠并发症.胎盘血窦是指胎盘内被正常回声的胎盘组织所包围的单个或多个形状不规则的回声(可为无回声、低回声或混合回声),为均匀的、无绒毛的空间,但其发病机制以及可导致的不良妊娠结局尚存在争议.本文报道1例完全性前置胎盘伴胎盘巨大血窦疾病,以期可以重视孕期随访,警惕不良妊娠结局的发生,更好地改善母婴结局.

黑斑息肉综合征(Peutz-Jeghers syndrome,PJS)又称家族性黏膜皮肤色素沉着胃肠道息肉病,是一种常染色体显性遗传病,以皮肤黏膜色素沉着、胃肠道多发息肉为主要特点,患病率为1/200000～1/8000,男女均可发病,可发生在任何年龄 [1].现将我院接诊的1例妊娠合并PJS报道如下.

妊娠期高血压疾病是孕产妇和围产儿死亡的主要原因,肾损伤是胎儿不良预后的独立预测因子,研究显示有些标志物可以早期发现肾损伤,早发现、早干预对改善不良妊娠结局有重大意义.文章就急性肾损伤标志物在妊高症肾损伤的早期诊断最新研究进展作一综述.

Preeclampsia is the main cause of poor maternal-fetal outcomes. A series of cell and animal experiments, and a small number of clinical studies have shown that pravastatin can prevent and treat preeclampsia by regulating angiogenesis, increasing the expression of heme oxygenase, and stimulating the production of nitric oxide without any reported adverse effects during pregnancy. We review the latest progress on the mechanism, effect, and safety of pravastatin in the prevention and treatment of preeclampsia.

目的 探究以临床岗位胜任力为导向的妇产科情景模拟教学模式及评价体系的构建.方法 选取2017年7月—2019年6月来医院妇产科实习的临床实习生120名,将接受传统教学模式的2014级妇产科实习生60例设为对照组,接受以临床岗位胜任力为导向的妇产科情景模拟教学模式的2015级妇产科实习生60例设为研究组.教学结束后,进行技能和理论考核,分析其教学效果,并进行评价体系的构建.结果 研究组理论考核成绩和技能考核成绩显著高于对照组,差异具有统计学意义(P<0.05);研究组学生实习后临床岗位胜任力理论应用、实践技能、沟通能力、团队协作能力等各项得分及总分均明显高于实习前,差异具有统计学意义(P<0.05);构建了以带教效果、实习生知识应用、带教意见反馈等为主的教学质量评价体系.结论 以临床岗位胜任能力为导向的妇产科情景模拟教学模式在妇产科带教中可提高实习生的理论和技能成绩,具有良好的教学效果.

患者女,23岁,因"停经9月余,下腹痛6h"于2009年8月16日23时入院.既往月经规律,末次月经2008年11月17日.妊娠33周时彩色多普勒超声(简称彩超)首次提示羊水过多(未提供报告单).入院前2天产科彩超示:胎儿双顶径9.1 cm,股骨长6.7 cm,胎盘回声Ⅱ+度,羊水池最大前后径9.2 cm,羊水指数21.3 cm.入院体检:体温37.3℃,脉搏90次/min,呼吸24次/min,血压125/85 mm Hg(1 mm Hg=0.133 kPa).神志清,无明显痛苦貌,步入病房,自主体位,查体合作.腹部有明显波动感,移动性浊音阳性,子宫底部压痛,子宫下段无明显压痛,全腹反跳痛阳性,宫高33 cm,腹围104 cm.四步触诊时患者腹部疼痛程度强于宫缩时,无外界刺激及宫缩间歇期产妇表情自然,宫缩时其痛苦程度轻于同期其他产妇.阴道检查:宫颈口开大3 cm、先露平坐骨棘、左枕前位、胎膜未破、紧贴胎儿头皮、未触及前羊水囊.

肿瘤坏死因子相关凋亡诱导配体(tumor necrosis factor-related apoptosis inducing ligand,TRAIL)具有选择性杀伤肿瘤细胞而对多数正常细胞无明显毒性,可通过TRAIL细胞外及细胞内凋亡通路发挥诱导肿瘤细胞凋亡作用,而正常细胞则通过核转录因子介导、"诱骗"受体及反义寡核苷酸来调节逃逸TRAIL诱导的凋亡。TRAIL在基因治疗、抗死亡受体的单克隆抗体、化疗、放疗药物联合应用中可明显提高肿瘤治疗的敏感性。本文就TRAIL抗肿瘤作用研究进展作一综述。

OBJECTIVE:To explore the morbidity and relevant factors of endometrial cancer,and to provide evidence for clinic prevention and treatment.METHODS:The data of 289endometrial carcinomas pathologically diagnosed in six hospitals in northern Shandong area between 05-01-2006and 10-01-2011and a control group of 174healthy people were analyzed uniformly with a case control-study based on a epidemiological survey.We analyzed the data using single factor analysis and multivariate regression analysis with OR and 95%confidence interval as evaluation index to learn the risk factors associated with endometrial cancer.RESULTS:The number of endometrial cancer in northern Shandong area was 289.The number of endometrioid cancer was 259(90%),and the number of non-endometrioid cancer was 30(10%).The number of patients with stageⅠ was 219(76%),the number of patients with stageⅡ was 29(10%),the number of patients with stageⅢandⅣ was 41(14%).The age of the patients ranged from 25to 78with the mean of 55.41,and the peak onset age was 58to 61.The number of postmenopausal women accounted for 62%.The single factor analysis showed that hypertension(OR =3.67,χ2=33.70,P=0.00),diabetes mellitus(OR=1.92,χ2=4.13,P=0.04),obesity(OR=4.63,χ2=50.62,P=0.00),taking jasmine tea(OR=2.63,2=19.84,P=0.00),heavy physical labour(OR=1.82,χ2=9.28,P=0.00),irregular menstruation(OR=12.68,χ2=107.20,P=0.00),taking Chinese herbal medicine(OR=15.21,χ2=68.82,P=0.00),age of menopause(OR=1.10,χ2=11.56,P=0.00),nullipara(OR=19.07,χ2=15.84,P=0.00),family history of cancer(OR=2.91,χ2=12.22,P=0.00)could increase the risk of endometrial cancer;and the using of intra-uterine device could reduce the risk of endometrial cancer(OR=0.29,χ2=37.21,P=0.00).Multiple factors regression analysis showed that the OR(95%CI)of hypertension,obesity,irregular menstruation,taking Chinese herbal medicine for irregular menstruation,age of menopause,family history of cancer were 3.69(1.89-7.22),3.06(1.62-5.75),4.53(2.13-9.60),9.31(2.91-29.76),1.13(1.06-1.20),5.20(2.13-12.73)respectively.The OR(95%CI)of intra-uterine device was 0.84(0.79-0.88)and intra-uterine device was the protective factor of endometrial cancer.CONCLUSION:Factors such as hypertension,obesity,age of menopause may be the influence factors on endomtial cancer and early preventive procedures should be taken.

<正>目标管理(Management by Objective,MBO)亦称"成果管理",俗称责任制,是以目标为导向,以人为中心,以成果为标准,而使组织和个人取得最佳业绩的现代管理方法。该方法是在企业个体职工的积极参与下,自上而下地确定工作目标,并在工作中实

通过消减杂交法从人黑色素瘤细胞中分离出来的黑色素瘤分化相关基因(melonoma differentiation associated gene 7,MDA-7),因其分子生物学特性与IL-10相似,故将其归入IL-10家族,并重新命名为IL-24。IL-24能选择性地促进肿瘤细胞凋亡、抑制肿瘤新生血管形成、增强放疗敏感性和免疫调节作用,而对正常细胞和组织无毒副作用。作为一种具有多种抗肿瘤功能的细胞因子,IL-24将成为肿瘤基因治疗的新武器。全文主要对IL-24抗肿瘤作用机制及在肿瘤治疗中的作用作一综述。

<正>1临床资料患者77岁,因"全子宫切除术后23年,发现阴道内肿物脱出10年"入院,患者于26年前绝经,于23年前因多发性子宫肌瘤于当地医院行全子宫切除术,术后无阴道异常排液及出血,病人于10余年前无明显诱因出现阴道脱出肿物,平卧后不能还纳,无尿急、尿频及尿痛,咳嗽时偶有尿液溢出,近2个

Objective:To explore the correlation between serum antisperm antibody expression and heat shock protein(HSP) expression in endometrium of patients with infertility. Methods:55 endometrium samples from 55 patients with primary infertility underwent conventional pathological section in order to determine the histological types,ELISA was used to detect serum antisperm antibody,immunohistochemical SP method was used to label the expression of HSP70 in endometrium samples. Results:Among 55 patients with primary infertility,36 patients were found with positive HSP70,accounting for 65.5%,compared with histological types of endometrium,there was significant difference(P<0.05);there was significant difference between the patients with positive serum antisperm antibody and the patients with negative serum antisperm antibody(P<0.01). Conclusion:The high expression of HSP70 in endometrium of patients with primary infertility may be a kind of autoimmune reactions;HSP inhibitor can suppress its synthesis,then inhibit the expression of HSP gene,which provides a new method for the treatment of primary infertility.

Objective:To study the expression of STAT3,DC,CD4+,CD8+ in ovarian epithelial carcinoma and explore the relationship between them and the clinical significance,to discuss a mechanism of the tumor escaping immunity surveillance in the ovary occurrence process.Methods:Tissue samples from 42 women with primary ovarian epithelial carcinoma(OVCA),25 with benign ovarian tumor(OVBT) and 13 with normal ovarian tissue(NOV) were collected.SABC immunohistochemical staining was used to determine the expression of STAT3 and DC,CD4+,CD8+,also carry on half fixed amount and relativity analysis.Results:(1)Semi-quantitative scoring showed that STAT3 expression in OVCA was significantly higher than that in OVBT and NOV(P<0.005).In OVCA,tumor tissue expressed STAT3 at significantly higher levels in Ⅲ～Ⅳ than Ⅰ～Ⅱ by the FIGO staging(P<0.05).(2)DC,CD4+ was lower expressed significantly in OVCA than that in OVBT and NOV(P<0.005).Tumor tissue expressed DC,CD4+ at significantly lower levels in Ⅲ～Ⅳ than Ⅰ～Ⅱ by the FIGO staging(P<0.05).(3)CD8+was also lower expressed significantly in OVCA than that in OVBT and NOV(P<0.005).The Ⅲ～Ⅳ and Ⅰ～Ⅱ comparison by the FIGO staging,the low expression rate increased,but had no significant differences(P>0.05).(4)The level of STAT3 expression was negatively related with level of DC,CD4+ and CD8+(P<0.05).Conclusion:The expressions of STAT3 and DC,CD4+,CD8+may play an important role in the development of ovarian tumors.The ovarian epithelial carcinomas with STAT3 higher expression and those with DC,CD4+,CD8+ lower expression might have worse prognosis.STAT3 inhibited the function of DC,CD4+,CD8+T cell,which might be one of the mechanisms of tumor evasion of immune surveillance.

基质金属蛋白酶(MMPs)是一组锌和钙依赖的特殊蛋白水解酶,它能特异性降解细胞外基质(ECM),在控制ECM的转归方面起到至关重要的重用[1].心血管疾病是西方社会人口的主要死亡原因,而ECM的降解在心血管病理过程中,例如动脉血管重塑、斑块破裂、经皮腔内血管成形术(PTA)、支架置入术后再狭窄(RS)、动脉瘤形成以及心衰中都发挥重要作用.MMPs抑制剂同样在心血管疾病中发挥潜在作用,它很可能减少心血管疾病的死亡率.

Objective: To evaluate mechanism of inhibition of ectopic endometrial growth with endostar,then to provide a theoretical basis for the clinical treatment of patients with EMS.Methods: 35 nude mice were randomly divided into normal group and experimental group,25 mice that were subcutaneously implanted in a methods used to establish nude mouse model of endometriosis.Then the models were randomly divided into control group and endostar group.Endostar group were given the endostar by intraperitoneal injection of 2 mg·(kg·d)-1,control group given the same daily dose of PBS solution.Two weeks later,serum were collected to detect serum cytokines(VEGF,TNF-α) levels and immunohistochemical methods were taken to determine the expression of VEGF.Results: The model group had higher levels of cytokines and the expression of VEGF than treatment group(P0.05).Conclusion: Endostar significantly inhibit levels of VEGF and other cytokines,reduce the expression of VEGF in the ectopic endometrial tissue,thus inhibiting the growth of ectopic endometrial blood vessels,and ectopic lesions.Thereby endostar can achieve the purpose of EMS treatment.

目的:观察依托咪酯联合米索前列醇无痛人工流产术的临床效果及其对血浆激素的影响.方法:选择确诊宫内早孕要求人工流产的妇女150例,随机分为对照组,静脉用药组,联合用药组.比较3组患者手术当时情况、手术时间、术中出血以及人流综合征、疼痛等情况.结果:平均动脉压、心率在手术前后均有变化,而联合用药组患者很快恢复至术前水平;联合用药组手术时间较对照、静脉用药两组时间短,术中出血量少(P<0.05),人工流产综合征发生率低,宫颈松弛度优于对照和静脉用药两组,而因肌震颤及肢体活动影响手术例数低于对照组和静脉用药组;静脉用药、联合用药组VAS评分低于对照组(P<0.05);术后测定血浆β-内啡肽、促肾上腺皮质激素、皮质醇的含量低于对照组(P<0.05).结论:依托咪酯联合米索前列醇片用于人工流产术能有效松弛宫颈,减少人工流产综合征的发生率,缩短手术时间.

目的对我院应用黄体酮胶丸治疗早孕药物流产宫腔残留的效果进行探讨。方法对我院证实有宫腔残留的41例患者应用黄体酮胶丸200mg口服,每日2次,连服5d,同时辅以口服抗生素预防感染治疗。结果37例阴道出血停止,彩超亦证实宫腔无残留,4例停药7d后阴道仍淋漓出血,彩超检查宫腔仍有残留,行清宫术,刮出物病检结果3例为坏死变性蜕膜组织,1例为血块机化组织。总有效率为90.24%。结论因米非司酮配伍米索前列醇致不全流产,彩超证实有宫腔残留者应用黄体酮胶丸治疗,取得了满意的效果。

Objective To study the suitable operation range of the young patients with endometrial carcinoma.Methods Thirty-nine endometrial carcinoma patients underwent operations below 45 years of age who were retrospectively studied for their prognosis.They were divided on the operation fashion into Ⅰ group with hysterectomy and group Ⅱ with hysterectomy plus oophorectomy.Results Thirty-nine cases were followed up and 29 patients were survival for 5 years old.Surival vate was 74.35%.Conclusion It had hysterectomy for the young patients with stageⅠendometrial carcinoma whom did not spread to muscular,other had hysterectomy with oophorectomy or extensive hysterectomy.

患者女性,32岁.因"阴道不规则流血1 d,下腹坠胀0.5 d" 于2008年6月29日11∶00急诊入院.病史采集:既往体健,月经周期正常,G3P1,无特殊家族病史.停经73 d,末次月经为2008年4月17日.停经40+d后出现早孕反应(恶心、呕吐等),持续至入院前3 d消失.入院前1 d无明显诱因阴道流血(少于月经量),无腹痛、腹胀、组织排出.入院前0.5 d出现阵发性下腹坠胀、隐痛,伴阴道流血增多,当地医院疑诊为宫外孕.入院查体:BP为100 mm Hg/80 mm Hg, 心、肺正常,腹软、压痛、反跳痛,肝、脾肋下未触及,移动性浊音(-).