Objective To explore the effects of spleen invigorating and kidney tonifying combined with lymphocyte immunotherapy on unexplained recurrent spontaneous abortion（URSA）.Methods Data of 198 URSA patients were collected. They were randomly divided into the lymphocyte immunotherapy group（66 cases）, the spleen invigorating and kidney tonifying group（66 cases）, and the combined treatment group（66 cases） for the analysis of the pregnancy outcomes.Results The rate of positive blocking antibody, success fetal protection and the level of E2, β-HCG and IL-10 after the treatment in the combined treatment group were higher than those in the lymphocyte immunotherapy group and the spleen invigorating and kidney tonifying group（P＜0.01）. The pregnancy rate in the combined treatment group was higher than that in the lymphocyte immunotherapy group（P＜0.01）. The TCM syndrome score and the level of IL-2 after the treatment in the combined treatment group were lower than those in the lymphocyte immunotherapy group and the spleen invigorating and kidney tonifying group（P＜0.01）. After the treatment, the TCM syndrome score of spleen invigorating and kidney tonifying group was lower than that of the lymphocyte immunotherapy group（P＜0.01）. After the treatment, the TCM syndrome score and the level of IL-2 in serum of the three groups were lower than those before the treatment and the level of IL-10 in serum was higher than that before the treatment（P＜0.01）.Conclusion Spleen invigorating and kidney tonifying combined with lymphocyte immunotherapy on URSA can significantly improve pregnancy outcome and has good therapeutic potential. Compared with lymphocyte immunotherapy URSA, invigorating spleen and kidney tonifying can improve TCM syndromes, and other pregnancy outcomes are similar, with no significant differences.

目的 探索临床专病实境教学方法运用于产科实习带教工作中的作用.方法 选择2019年1月-2019年9月、2020年1月-2020年9月在山东省滨州医学院附属医院实习的学生作为研究对象分为参照组、实验组,各30名.参照组给予产科常规教学方法,实验组给予产科临床专病实境教学方法.对比2组教学效果.结果 实验组理论基础知识内容、实践操作方面技术水平考查分数值均高于参照组(P＜0.05);实验组对实习带教认可情况具体调查结果均优于参照组(P＜0.05).结论 在产科实习带教工作中选用临床专病实境教学方法展示出较优的效果.

Objective To explore the expression of CIP2 A in endometrioid adenocarcinoma, and to analyze its clinicopathological significance and prognostic value.Methods Immunohistochemistry and real-time polymerase chain reaction（RT-PCR） were used to detect the protein and mRNA expression of CIP2 A in endometrioid adenocarcinoma. The correlation between the expression of CIP2 A and the clinicopathological features and prognosis was analyzed.Results The expression of CIP2 A significantly increased in endometrioid adenocarcinoma, and its expression was correlated with tumor histological grade, FIGO stage and Ki-67 proliferation index. Survival analysis showed that overexpression of CIP2 A was significantly associated with reduced overall survival rate of patients with endometrial carcinoma.Conclusion CIP2 A is overexpressed in endometrioid adenocarcinoma and plays an important role in carcinogenesis and malignant progression, and the high expression of CIP2 A is associated with poor prognosis of patients, which has certain reference value in prognosis judgment.

目的:调查滨州市孕晚期妇女血清铁蛋白(SF)水平,探讨铁缺乏与母婴结局的关联.方法:收集2020年7月至2021年6月于滨州医学院附属医院产科家庭化病房收治的667例分娩病例.根据SF水平分为3组,ID组(SF<20μg/L)360例,临界ID组(20μg/L≤SF<30μg/L)175例,非ID组(SF≥30μg/L)132例,分析比较3组研究对象的母婴结局.结果:孕晚期妇女的铁缺乏检出率为53.97％(360/667).3组的母婴结局差异有统计学意义(P<0.05).ID组的产前Hb水平、Hb正常比例、新生儿出生体质量低于临界ID组及非ID组(P<0.01),ID组的分娩前后Hb差值、总产程、产后出血量、住院时间、剖宫产、早产、羊水过少、胎儿宫内窘迫发生率均高于临界ID组及非ID组(P<0.05),ID组的妊娠期高血压疾病、胎膜早破、产褥感染、新生儿听力异常、NICU入院率高于非ID组(P<0.017).临界ID组的产前Hb水平、Hb正常比例低于非ID组(P<0.01),其分娩前后Hb差值、总产程、产后出血量高于非ID组(P<0.05).结论:孕晚期铁缺乏可导致不良母婴结局,产检时应重视铁蛋白的检测,正确指导孕妇及时补铁,预防ID甚至IDA,改善母婴结局.

目的 评判多元化教育教学模式实施在高危产科对应临床带教工作中的教育意义.方法 报告中将各自选择2018年3月—2019年4月、2019年5月—2020年6月于医院高危产科实习的20名实习学生归入参照组、试验组统计内容,各自选用单纯一种教育教学模式、多元化教育教学模式,探析对应指标.结果 试验组专科理论基本知识掌握程度调查值、病史收集能力掌握程度调查值、专业操作能力掌握程度调查值、对于教学老师带教方式满意人数、对于教学老师带教效果满意人数比对参照组评估结果提升(P<0.05).结论 于高危产科对应临床带教工作中选取多元化教育教学模式存在较好教育效果.

目的 探究对妇产科规培医师实行临床思维能力培养过程中采取案例教学方法 的使用效果.方法 对2017年6月-2019年7月滨州医学院附属医院68名妇产科规培医师实施指标研究,依据抽签方式分组,每组34名.实验组选择案例教学方法 ,对照组选择传统授课教学方法 ,记录规培医师理论知识考核分数数值、操作技能考核分数数值、教学质量评估情况、教学效果满意情况.结果 实验组理论知识考核分数数值、操作技能考核分数数值、教学质量评估情况、教学效果满意情况优于对照组(P<0.05).结论 在妇产科规培医师实施临床思维能力培养过程中运用案例教学方法 显示较好教学效果.

目的 评价在急诊科轮转规培生气管插管教学过程中选用可视喉镜和PBL教学方式相结合的教学效果.方法 对2017年5月—2019年6月医院急诊科轮转的62名规培生实施指标分析,分组方式依据信封法,各组入组31名,实验组运用可视喉镜和PBL教学方式,参比组运用普通喉镜和常规讲授教学方式,评定气管插管理论及操作技术评分数值、教学效果评估情况、教学质量满意情况.结果 实验组气管插管理论知识及操作技术评分数值、教学效果评估情况、教学质量满意率大于参比组(P<0.05).结论 在急诊科轮转规培生气管插管教学过程中采取可视喉镜相结合PBL教学方式显示较好教学效果.

染色体微阵列分析(chromosomal microarray a-nalysis,CMA)技术是一项新型的染色体分析技术,能够检测出大于100 Kb 的拷贝数变异(copy num-ber variation,CNV)微缺失/微重复,故而被称为分子核型[1].相比传统核型分析,CMA具有更好的分辨率、更高的自动化程度和更快的检测周期,弥补了染色体核型分析的不足,近年来越来越广泛地应用于产前诊断领域[1].该项技术已被推荐为一线产前诊断技术应用于存在超声结构异常的胎儿中[2-3].2016年,美国妇产科医师学会(ACOG )与母胎医学会(SMFM)联合发表指南指出在胎儿超声及染色体核型分析正常的群体中,CMA可以检出约1 .7％患者具有致病性或可致病性拷贝数变异,因此CMA可应用于所有接受有创产前诊断的孕妇[4].本研究对112例中孕期血清学筛查高风险孕妇的羊水标本进行染色体核型分析与染色体微阵列分析,探讨染色体微阵列分析技术在血清学筛查高风险孕妇中的应用价值.

患者女性,39 岁,因白带多并阴道流血 1 年余入院.患者于 1 年前无明显诱因出现白带多、色黄,黏稠,伴接触性出血.婚育史:24 岁结婚,G3P2L2A;MRI 示:子宫颈部偏后部见一菜花状肿块,最大截面积 12.4 mm ×12.1 mm,宫颈管变窄,临近宫体局部受侵(图 1).妇科检查:宫颈肥大,前后唇均见菜花样肿物,大小 3 cm ×3 cm ×2 cm,蒂部 0.5 cm.宫颈 HPV分型检查提示 HPV 16 阳性.入院行宫颈活检,病理示:送检组织呈乳头状增生,细胞有异型,考虑为绒毛腺管状癌,建议进一步检查.患者于活检后行全子宫及双侧附件切除术.

目的 观察标准化病人联合案例教学法应用于妇产科教学的效果.方法 选择2018年1—12月于滨州医学院附属医院妇产科进行住院医师规范化培训(简称规培)的83名医学生为研究对象,按照带教方法分为观察组(n=43,标准化病人联合案例教学法教学)及对照组(n=40,传统教学方式规培).比较两组教学效果及学生对教学的满意度.结果 教学结束后,观察组学生理论成绩、实习成绩及总成绩均高于对照组,学生对教学方式的满意度高于对照组,差异均有统计学意义(P<0.05).结论 标准化病人联合案例教学法应用于妇产科教学中,能够有效提高医学生的基础理论成绩、实习成绩,教学效果显著,学生对该教学方式普遍比较满意.

Background: Leiomyosarcoma that arises in the uterine cervix stump after subtotal hysterectomy is exceedingly rare. Only one case has been documented. The authors report an unusual case of leiomyosarcoma that arose in the cervix stump. Case presentation: A 46-year-old female presented with a one-month history of vaginal bleeding. Vaginal and ultrasonography examination revealed a mass in the cervix. The patient underwent radical resection of the cervix, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy. Chemotherapy and radiotherapy was given after the operation. The patient suffered from severe menopausal symptoms and received hormone replacement therapy. She eventually committed suicide. Conclusion: Given the rarity of cases of leiomyosarcoma of cervical stump, its proper treatment remains to be determined. In dealing with benign uterus diseases, we should pay adequate attention in retaining the cervix. If the cervix is retained, patients require appropriate follow-up. The authors hope that this work will benefit the fields of gynecology and oncology.

This paper mainly introduces the application of PDCA cycle in the practical teaching of cardiopulmonary resuscita-tion (CPR)training for interns.CPR practice of interns can be divided into four stadges:①find out problems and formulate solutions;②change errors and practice repeatedly;③check;④summarize and find out new problems.After PDCA cycle training,interns can complete CPR more skillfully and accurately.

It is important in evidence-based medicine (EBM)that the perfect combination of best clinical research evidence, the patient's wishes and the doctor's expertise.The core idea of EBM is to use the latest and most powerful scientific informa-tion obtained in clinical studies to treat patients.EBM provides a new mode in clinical practice teaching.The authors of this article introduce the EBM to obstetrics and gynecology clinical teaching,and get a good effect.This model has an active role in the training of medical students'clinical thinking,innovation and lifelong self-education capacity,and can improve the o-verall quality of medical students.

我国传统文化对女性的婚前贞洁过于重视，而当前社会开放的风气增加了婚前性行为的比例，因此诸多女性求助于处女膜修复手术来保证自己的婚姻幸福。以35例处女膜修复手术从医学角度来看，术前需要对患者阴道进行健康检查，确保健康适合手术，手术中注意局部麻醉和与患者进行交流，降低其紧张程度，术后指导其进行恰当的护理，避免手术失败。对处女膜修复术患者围手术期的护理需要注意保护其隐私、尊重其心理和指导其正确护理。

目的 探讨重度子痫前期对早产儿心肌及脑损伤的影响.方法 155例重度子痫前期早产儿(重度子痫前期早产组)和无妊娠期高血压疾病及急性宫内窘迫的早产儿86例(对照组)出生后立即抽取脐血进行肌酸激酶同工酶MB(CK-MB)及烯醇化酶(NSE)测定,并行1 min Apgar评分.结果 重度子痫前期早产组和对照组脐血NSE水平分别为(84.87±68.79)μg/L和(58.52±48.46)μg/L,差异有统计学意义;两组早产儿脐血CK-MB水平比较,差异无统计学意义;对照组脐血的CK-MB水平与出生后1 min Apgar评分呈负相关,与分娩孕周及出生体重间无相关性;NSE水平与出生体重及出生后1 min Apgar评分均呈负相关,与分娩孕周间无相关性;子痫前期早产组脐血CK-MB及NSE水平与分娩孕周、出生体重及1 min Apgar评分等各变量间均无相关性.结论 重度子痫前期对早产儿的心肌损伤无明显加重,对早产儿的脑损伤加重明显;出生后1 min Apgar评分及出生体重与早产儿的心肌损伤及脑损伤有关,即出生后1 min Apgar评分越低,早产儿的心肌损伤及脑损伤越重,早产儿出生体重越低,脑损伤越重.

目的 研究情景教学和以问题为基础的教学(PBL)相结合的方法在院前急救教学中的应用效果.方法 采用随机抽样法将医学学生分成两组.对照组96名学生在教学中应用传统的教学法进行教学,试验组96名学生在教学中应用情景教学和PBL教学相结合的方法进行教学;两组的教学内容为急诊常见的心肺复苏、创伤急救与中毒.比较两组学生理论考试、技能考核成绩,调查学生对情景教学和PBL教学相结合方法的认可程度.两组间均数比较采用t检验.结果 试验组和对照组比较差异有统计学意义(P<0.01).92.71%的学生认同情景教学结合PBL的教学法.结论 情景教学和PBL相结合教学法能够提高学生的学习兴趣,增强学生自主学习能力,提高学生综合分析问题的能力,培养学生团队合作精神,锻炼学生动手实践能力.

患者女性,29岁.因“停经39+4孕周,阴道流液2h”于2012-01-18 1:00 am入本院.病史采集:G1 Po,LMP为2011-04-14,EDC为2012-01-21.2h前出现阴道流液.定期产前检查未见异常,孕龄为19孕周始自觉胎动.

Objective To observe the influence of comprehensive nursing intervention on patients with urinary bladder function after hysterectomy. Methods From July 2007 to December 2008, 70 women who accepted hysterectomy were included in the study, and randomly divided into study group(n=35, comprehensive nursing intervention) and control group(n=35, routine nursing intervention). Residual urine volume was measured, incidence rate of urinary retention and urinary tract symptoms were compared between two groups. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Binzhou Medical University Hospital.Informed consent was obtained from each patients. Results There had significant differences in incidence rate of urinary retention and urinary tract symptoms between two groups(P<0.05). Conclusions Comprehensive nursing intervention after hysterectomy can reduce the incidence rate of bladder dysfunction, promote the recovery of urinary bladder function, and improve quality of nursing intervention. Key words: hysterectomy; nursing intervention; bladder dysfunction; urinary bladder function

患者 女性,43岁.因"发现子宫肌瘤3年,月经量增多2年",于2010-11-14入本院.病史采集:3年前本院超声检查结果示子宫肌瘤,2年前出现月经量增多.G2P1,平素月经规律,有痛经史.入院查体:心、肺(一),腹软、压痛及反跳痛.妇科检查:宫颈肥大,可见数个官颈腺体囊肿(纳氏囊肿);子宫前位,大小如妊娠10孕周,形态不规则、伴压痛;双附件区未见异常.

OBJECTIVE To investigate the value of TruScreen combined electronic colposcope in screening of cervical disease.METHODS 258 patients who accepted cervical LEEP was involved in our hospital during the first half of the year in 2011.Both TruScreen and electronic colposcope were administered before cervical LEEP,and pathology examination after the operation.The histopathological examination was used as the gold standard to assess the value of the two screening methods.RESULTS The positive rate found with TruScreen was 28.68%(74 patients),while the positive rate found with electronic colposcope was 31.78%(82 patients).The consistency rate wan 81.78%(211 /258).CONCLUSION Both TruScreen and electronic colposcope are in conformity with histopathological examination.The combination of the two methods is more propitious to screen cervical cancer and precancerous lesion.