目的 探究妊娠期亚临床甲状腺功能减退(妊娠期亚甲减)孕妇叶酸(FA)利用能力与血清同型半胱氨酸(Hcy)、维生素B12的相关性.方法 选取100例妊娠期亚甲减孕妇为研究组;另选同期100例甲状腺功能正常孕妇为对照组.检测两组孕妇FA、Hcy、维生素B12以及甲状腺功能,并分析其相关性.结果 两组FA利用能力比较,差异具有统计学意义(P＜0.05).研究组血清Hcy水平高于对照组,维生素B12水平低于对照组,差异具有统计学意义(P＜0.05).两组游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)水平比较,差异无统计学意义(P＞0.05),研究组促甲状腺激素(TSH)水平高于对照组,差异具有统计学意义(P＜0.05).FA利用能力与Hcy呈负相关(r=-0.454),与维生素B12呈正相关(r=0.219);Hcy与维生素B12、FT3、FT4呈负相关(r=-0.126、-0.296、-0.286),TSH呈正相关(r=0.352);维生素B12与TSH呈负相关(r=-0.095),与FT3、FT4呈正相关(r=0.062、0.075).结论 妊娠期亚甲减与FA、Hcy、维生素B12具有一定相关性,孕妇应及时补充FA、维生素B12,并关注FA、Hcy、维生素B12水平变化.

随着我国高等教育的发展和双一流战略的推进,越来越多的留学生选择来华留学.为提高医学留学生临床实践技能水平,文章研究了以岗位胜任力为导向的医学留学生临床技能教学模式.通过文献法、调研法、总结归纳法等研究方法 对现有留学生技能教学方法 的局限性进行深入分析,提出"以岗位胜任力为导向的医学留学生临床技能教学模式"路径构建的总体实施方案.这种教学模式对医学留学生临床技能培养有重大影响,也为留学生教学模式改革提供了新的思路.

BACKGROUND Uterine rupture is a serious obstetric emergency, a severe event, and a serious threat to maternal and fetal life. It is a rare and not well characterized by the fact that multiple operations of uterine cavities contribute to uterine rupture during pregnancy. Atypical uterine rupture is easily misdiagnosed as other obstetric or surgical diseases. In current guidelines, abdominocentesis is a contraindication for late pregnancy. Therefore, the cases presented in this report provide new ideas for clinical diagnosis and treatment of uterine rupture. CASE SUMMARY Case 1, a 34-year-old woman (gravida 5, para 2), 32 wk and 4 d of gestation, presented with acute upper abdominal pain for 8 h with nausea and vomiting. Computed tomography (CT) revealed pelvic and abdominal effusion. We extracted 3 mL unclotted blood from her abdominal cavity. An emergency caesarean section was performed. A uterine rupture was found, and the fimbrial portion of the left fallopian tube was completely adhered to the rupture. The prognosis of both the mother and the infant was good. Case 2, a 39-year-old woman (gravida 10, para 1) at 34 wk and 3 d of gestation complained of persistent lower abdominal pain for half a day. Her vital signs were normal. CT revealed a high probability of pelvic and abdominal hemoperitoneum. We extracted 4 mL dark red blood without coagulation. An emergency laparotomy was performed. Uterine rupture was identified during the operation. Postoperative course in both the mother and infant was uneventful. CONCLUSION For pregnant women in the second or the third trimester with persistent abdominal pain, abdominal effusion, fetal distress and even fetal death, the possibility of uterine rupture should be highly suspected. CT can identify acute abdominal surgical or gynecological and obstetric diseases. Abdominocentesis is helpful for diagnosing and clarifying the nature of effusion, but its clinical value need to be confirmed by further clinical studies.