目的:探究FMR1基因CGG重复次数与孕产妇不良孕产史关系,比较不良孕产史孕妇与正常孕妇FMR1基因(CGG)n重复数分布差异性.方法:收集2018年8月-2020年10月就诊于本院有不良孕产史的108例孕妇作为不良孕史组,无不良孕产史孕妇217例为对照组.收集两组孕妇外周静脉血全血磁珠DNA提取法提取基因组DNA,利用脆性X-FMR1基因AmplideX检测技术进行CGG重复序列数检测,比较分析CGG重复序列.结果:两组FMR1基因检测未检出全突变病例,CGG重复次数的变异范围为n=24～58,其中FMR1基因CGG重复等位基因杂合子数225例,占总数69.2％,最常见杂合子为30/29,占总等位基因中的11.4％;最大频率等位基因(CGG)n=30(30.1％),其次为37、31、29、36.正常范围(n=6～34)、正常范围高线(n=35～44次),两组(CGG)n重复数占比无差异(P＞0.05);对照组FMR1基因灰区携带率为0.43％(1例),不良孕史组前突变携带率为0.93％(1例),两组存在差异(P＜0.05).结论:FMR1基因CGG重复序列前突变与孕妇不良孕产史可能存在相关性.

目的 了解剖宫产后再次妊娠孕妇经阴道分娩的意愿,为临床工作提供方向.方法 采用自行设计的调查表对168名剖宫产后再次妊娠孕妇经阴道分娩的意愿进行调查.结果 56.54％的剖宫产后再次妊娠孕妇非常不愿意经阴道分娩,不愿意的首要原因是担心试产失败.结论 剖宫产后再次妊娠孕妇不愿意经阴道分娩,对阴道分娩了解不足,提示医护人员要积极开展产前宣教和孕期体质指数控制,以利于经阴道分娩.

Objective To investigate the clinical efficacy and adverse reactions of microneedle importing tranexamic acid into skin combined with Q Switch 1064nm laser to treat chloasma. Methods 94 patients with chloasma were randomly selected from department of dermatology in our hospital during April 2014 to April 2015, and these patients were divided into two groups: the control group was treated by only Q switch 1064nm laser, a total of 62 patients; the observation group were treated by combined method including microneedle importing tranexamic acid into skin for 4 times, and then used Q switch 1064nm laser treatment for 6 times,a total of 32 patients. The average area of melasma and severity index scores were calculated respectively before and after treatment. The adverse effects and patient satisfaction survey were recorded at the same time. Results The score of MASI in the observation group decreased from 13.58±3.39 to 8.79±1.69, and the effective rate was 96.88％,compared with the MASI score in the control group decreased from 13.89±3.23 to 10.74±1.92 and the effective rate was 81.25％, the observation group was significantly better than the control group. The adverse reactions in the observation group were significantly less than the control group, and the patient's satisfaction was higher in the observation group than in the control group. Conclusion Microneedle importing tranexamic acid into skin combined with Q Switch 1064nm is effective in the treatment of chloasma, and it has the value of popularization in clinic.

目的:观察755nm皮秒激光联合口服氨甲环酸治疗黄褐斑的临床疗效.方法:选择笔者科室2016年4月-2017年10月门诊收治的26例黄褐斑患者,采用755nm皮秒激光联合口服氨甲环酸治疗.皮秒激光治疗6次,每2次间隔4周.氨甲环酸口服方法为0.5g/次,2次/d,共5个月.分别于开始治疗后不同时间点观察其疗效及不良反应,并由患者自行进行满意度评价.结果:治疗开始后3个月、治疗结束以及治疗结束后3个月,平均MASI评分较治疗开始前均有明显下降,治疗结束后以及结束后3个月效果均优于治疗前,治疗结束时效果轻度优于治疗结束后3个月.所有患者均无明显不良反应发生.结论:755nm皮秒激光联合口服氨甲环酸治疗黄褐斑安全、有效、复发率较低,值得临床推广应用.

目的:探讨755nm皮秒激光治疗颧部褐青色痣的临床疗效及安全性.方法:选取2016年3月-2018年2月来笔者科室就诊的80例颧部褐青色痣患者,随机分为两组.皮秒组:40例,接受755nm皮秒激光治疗;纳秒组:40例,接受755nm纳秒激光治疗,每3个月治疗1次,观察疗效并记录不良反应,经过4次治疗后进行疗效统计学分析.结果:80例患者经过4次治疗后,均有不同程度改善,皮秒组有效率100.0%,纳秒组有效率82.5%,两组疗效比较,具有统计学差异(P<0.05).皮秒组激光治疗后未出现明显不良反应,治疗周期短,患者满意度高;纳秒组术后色斑颜色加重发生概率高达60%,治疗周期长,患者满意度不高.结论:755nm皮秒激光治疗颧部褐青色痣临床疗效确切、见效快、不良反应少且安全性较高.

Objective To explore the clinical efficacy and safety of deep blue radio frequency combined with hyaluronic acid filling in the treatment of skin type nasolabial fold. Methods 35 patients who wanted improvement of nasolabial grooves were involved in the study. All the patients received deep blue radio frequency 5 times, and experienced filling with hyaluronic acid 2 times. The nasolabial grooves were graded before, 3 months, 6 months, 12 months after treatment. The total effective rate, duration, and safety of clinical treatment were observed. Results Following up for 1-12 months after treatment, the nasolabial depression of 35 patients was improved to a certain extent. The curative effect lasted for 6-18 months without serious complications. Conclusion Radio frequency combined with hyaluronic acid filling is effective on the treatment of nasolabial fold. And the maintenance effect is relatively durable and safe.

Objective To observe the clinical efficacy and adverse effects of the 755nm picosecond laser to treat melasma. Methods Total 52 outpatients with melasma in our hospital during December 2015 to December 2016 were randomly selected for treatment with 755nm picosecond laser.These patients were treated once every 7 weeks, 3-4 times as a course. The average area of melasma and severity index scores were calculated respectively before and after treatment. The adverse effects and patient satisfaction survey were recorded at the same time. Then statistical analysis was performed. Results 52 cases of chloasma patients after 2-4 treatment, chloasma patients had different degrees of improvement, 12 cases improvement rate reached more than 60% and more than 50% of the 32 cases improved.No serious adverse reactions occurred in the patients, and the effect of improving the texture of the skin, more than 90% of patients expressed satisfaction. Conclusion The application effect of the picosecond laser treatment is better, and it has the value of popularization and popularization in clinic.

Objective:To understand the subtypes of HPV infection in different skin diseases.Methods:368 patient were included in the study from June 2014 to June 2015 and divided into four groups:242 cases with condyloma acuminatagroup,18 cases with Bowenoid papulosis,70 cases with male pearl rash and female pseudo-condyloma,38 cases without any visible lesions and acetowhite test negative.The HPV-DNA subtypes in the clinical samples were examined by reverse dot hybridization combined with PCR.All the data were statistically analyzed using SPSS11.0 software.Results:(1) The total positive rate of HPV was 72.9 ％,with the single type 57.1％ and multiple types 15.8 ％.(2) Of all the 268 cases with HPV infection,the infection rate by the high-risk type of HPV virus was 51.9 ％ and those of the low-risk and mixed types 33.2 ％,14.9 ％,respectively.(3) The infection rates in different groups are as follows,condyloma acuminatagroup 97.9 ％,bowenoid papulosis 88.9 ％,male pearl rash and female pseudo-condylomal4.3 ％,patients without any visible lesions and acetowhite test negative 13.2 ％.According to the analysis of infection HPV subtypes,HPV 6,11,16,18,31,33,35,43 and 66 subtypes,were mainly found in condyloma acuminata group and 16 subtypes in Bowenoid papulosis while male pearl rash and female pseudo-condyloma and others infected mainly by low risk types of 6,42,43,81 and 83.(4) Of the 18 high risk subtypes,the most common types found were HPV16,18,58,56,33,52,68,31,39 but HPV35,45,51,53,59,66,73 and 82 subtypes were not detected.Among the5 low-risk HPV subtypes,HPV6,11,42 and 43 were detected but no 81 subtypes.Conclusions:The study showed that HPV infection was mainly single HPV subtype,mostly high-risk type,which should be given much consideration in clinical practice.

Objective:To analyze the application value of recombinant human epidermal growth factor (rhEGF) for the repair of facial scar.Methods:80 cases of patients with facial scar treated in our hospital from March 2013 to February 2016 were selected as the study subjects and divided into the control group and the observation group by the random number table method,with 40 cases in each group.Both groups were treated with carbon dioxide fractional laser for facial scar repair.The observation group was additionally treated by external application of rhEGF on skin surface after surgery,while the control group was treated by external application of isotonic saline on skin surface.The wound healing rate,wound healing time and pain during dressing change were compared between the two groups at different time points.The scar area after wound healing was measured,and the maturity of granulation tissues at different time points after treating wounds,the scar area after wound healing and the occurrence of adverse reactions were compared between two groups.Results:The wound healing rates in the two groups on the 7th and 14th day after surgery were significantly higher than that on the 3rd day after surgery (P＜0.05),and the healing rates in the observation group were significantly higher than those in the control group at the same time point (P＜0.05).The wound healing time of the observation group was shorter than that of the control group,and the scar area after wound healing was smaller than that of the control group (P＜0.05).The pain degree of observation group was lower than that in the control group,and the proportion of mild pain was higher than that in the control group (P＜0.05).The grades of mature granulation tissues in the observation group on the 7th and 14th day after surgery were higher than those in the control group (P＜0.05).There was no inflammation or systemic adverse reactions in the two groups.Conclusion:ReEGF can promote the wound healing of patients with facial scars,shorten the wound healing time,reduce the scar area,relieve the pain degree during dressing change,and promote granulation tissue maturation with high safety.

Objective To explore the clinical efifcacy and safety of optimal pulse technology (OPT) combined with intradermal injection of tranexamic acid on melasma. Methods Total of 74 patients with melasma were randomly divided into two groups,the OPT group and the combining group. OPT group (39 cases) only accepted the OPT treatment, the combining group (35 cases) accepted treatment with OPT and intradermal injection of ammonia tranexamic acid. After one course of treatment, clinical efifcacy and adverse reaction of both groups were observed. Results In the OPT group, the cure rate was 20.5%, the efifcient rate was 64.1%. In the combining group, the cure rate was 31.4%, the efifcient rate was 85.7%. There were signiifcantly difference between OPT group and combining group (P<0.05). Local injection of tranexamic acid had no obvious adverse reaction. Conclusion OPT with local intradermal injection of tranexamic acid are effective on the treatment of melasma without side effects.

Objective To observe therapeutic effect of fractional ultrapulsed CO2 laser on atrophic scars. Methods Sixty cases of patients with atrophic scar resulted from different causes were included in our study. Appropriate laser parameters were set according to the Fitzpatrick classification of patients’ skin, the depth and location of scars. All the patients were treated with super pulse CO2 laser for 4 times with each interval of three months. According to the doctor and patient satisfaction, the curative effect were evaluated after 2 and 4 times’ treatment respectively. Results The total effective rate was 86.7% and 100% with 2 times and 4 times laser treatments, respectively. Conclusion Ultrapulsed CO2 fractional laser is effective on the treatment of atrophic scars. The therapeutic effect was positively correlated with the times of laser treatment.

目的:调查妊娠期妇女血25(OH)D水平,为健康指导及防治维生素D缺乏病提供依据.方法:采用酶联免疫吸附测定方法检测2 517例妊娠期妇女血清25(OH)D水平.结果:2 517例标本中血25(OH)D平均水平为(41.98±15.027) nmol·L-1,随着孕龄的增大25 (OH)D水平呈下降趋势.异常例数检出率为18.4％,随着孕龄的增大25(OH)D异常检出比例呈上升趋势.结论:妊娠期妇女是维生素D缺乏的高危人群,应加强补充维生素D治疗.

[目的]探讨自我效能干预对初产妇产程及自然分娩率的影响。[方法]将200例初产妇根据随机数字表法分为观察组及对照组各100例，对照组病人实施常规性护理，观察组病人在对照组的基础上实施自我效能干预。干预前后采用焦虑自评表(SAS)、抑郁自评表(SDS)及自我效能量表对两组病人心理状况及自我效能进行评价。[结果]观察组病人护理后 SAS评分、SDS评分低于对照组护理后，而自我效能评分则高于对照组，差异有统计学意义(P<0.05)；与对照组比较，观察组剖宫产率、产后出血率、胎儿窘迫率较低，而自然分娩率、新生儿阿氏评分较高，差异有统计学意义(P<0.05)；观察组活跃期、第1产程、第2产程、总产程时间显著缩短，差异有统计学意义(P<0.05)。[结论]自我效能干预能有效改善初产妇焦虑及抑郁的情绪、可缩短初产妇产程、提高初产妇自然分娩率、降低产妇剖宫产率。

目的 探讨集体运动联合家庭跟进式干预对妊娠期糖尿病患者血糖控制效果和妊娠结局的影响.方法 将60例妊娠期糖尿病患者,按入院先后顺序分为干预组和对照组各30例.两组均给予常规护理,干预组在常规护理的基础上接受为期8周左右的集体运动联合家庭跟进式干预.结果 干预组干预后空腹血糖、餐后2h血糖与对照组比较,差异有统计学意义(均P＜0.01),干预组运动依从性好,新生儿呼吸窘迫综合征的发生率显著低于对照组(均P＜0.01).结论 集体运动联合家庭跟进式干预能有效降低孕妇血糖,减少新生儿并发症的发生,促进母婴健康.

临床资料 先症者女,26岁.双手、足背及肘关节伸侧色素沉着伴色素减退斑20余年,进行性加重来我科就诊.患者自幼双手、足背及肘关节伸侧散在针头大褐色斑点,间以色素减退斑,呈网状.随年龄增长,皮疹数量增多、面积变大.幼年时曾到医院就诊,诊断不清,未予治疗.皮疹于每年夏季或日晒后更加明显,无自觉症状.家族中多人有类似皮损(图1),否认父母近亲婚配.

Objective To explore the clinical features of ocular syphilis.Methods The clinical manifestations and the results of laboratory test of 3 patients with ocular syphilis were retrospectively analyzed.Results Three patients with ocular syphilis,1 male and 2 females,had no homosexual behaviors,but their sexual partners had extramarital affairs.All three patients presented with acute decreased vision and one had generalized skin lesions without itching.Luetic serology was positive for RPR with the titer ranged from 1∶ 32 to 1∶ 64,and TPPA positive but HIV negative.They all refused to perform lumbar puncture for the examination of the cerebrospinal fluid to determine whether they had been complicated by neurosyphilis.According to the ocular characteristics and serological test for syphilis,they were diagnosed as choroiditis.After intravenous administration of aqueous crystalline penicillin G 8 000 000 U/d for 14 d,their visual acuity was greatly improved and the titers of RPR markedly lowered.Conclusion With the increasing incidence of syphilis,the patients with acute decreased vision in single or both eyes should be given serological test for syphilis to avoid misdiagnosis.Additionally,it should be given the same therapy as neurosyphilis and longer follow-up to recognize whether they have been complicated with neurosyphilis.

<正>三叉神经支配区是老年患者带状疱疹的好发部位,部分患者在皮损愈合后发生后遗神经痛(PHN),严重影响了患者的生活质量。治疗三叉神经支配区带状疱疹应重视局部神经受累引发的神经根的炎症反应。本研究观察了阿昔洛韦联合小剂量

通过对h指数与影响因子、总被引频次作相关性分析,探讨h指数与影响因子以及总被引频次的关系。发现h指数与影响因子、总被引频次之间既有较好的相关性,也有其独有的特点。三者可以相互补充,在今后医学类期刊学术影响力的评价中发挥一定的辅助作用。

选取用于定量分析评价期刊质量的8项指标,运用综合评估法分别计算出每项指标的权重,提出可以用其中的4项指标代替8项指标来构建期刊学术质量的综合评价指标体系,并对医学期刊综合评价指数进行计算、分类及结果的合理性效验。

报道3例乳腺癌术后丹毒患者。所有病人进行了胸部手术及淋巴结清扫术,相应上肢均有高度淋巴水肿,首发症状是发热及寒战,临床表现为患肢炎症性斑块。所有患者对青霉素治疗敏感,值得注意的是所有患者均无外伤史,提示乳腺癌术后淋巴淤积在丹毒的发生中起着重要的作用。