1 病例资料 患者,女,29岁,因"停经9月余,阴道流液5 h"以"胎膜早破;孕39周+6天,孕2产0,左枕前"收住.患者既往对青霉素和头孢类药物过敏,于2013年人工流产1次.患者平素月经规律,末次月经2017年7月1日.孕早期早孕反应不明显,孕2月余因"宫腔积液"口服烯丙雌醇保胎治疗1周.孕5月自觉胎动至今.入院前5h无明显诱因出现阴道流液,偶感腹痛,遂入院.

目的:探讨早期宫颈癌患者术前血浆人附睾蛋白4(human epididymis protein 4,HE4)水平对复发的影响.方法:以186例早期宫颈癌患者为研究对象,根据术前血浆HE4水平分为低HE4组(＜327.6 pmol/L)93例和高HE4组(≥327.6 pmol/L)93例.应用Kaplan-Meier法估算生存率,应用Log-rank检验比较低HE4组和高HE4组的生存曲线.采用Cox比例风险回归分析宫颈癌复发的危险因素.结果:绝经、肌层浸润深度≥1/2、淋巴结转移、肿瘤直径≥4 cm、Ⅱa期均为影响HF4水平的独立因素.低HE4组有10例复发,复发时间中位数为41.5(25.0～62.0)个月,高HE4组有20例复发,复发时间中位数为25(5～50)个月.与低HE4组相比,高HE4组无复发生存率显著下降.多因素分析结果显示术后辅助治疗是早期宫颈癌术后复发的独立保护因素,而Ⅱa期、淋巴结转移及术前血浆HE4水平≥327.6 pmol/L为影响早期宫颈癌术后复发的独立危险因素.结论:术前血浆HE4水平升高是早期宫颈癌患者术后复发的危险因素,对宫颈癌患者预后判断具有潜在应用价值.

目的 探讨拉贝洛尔联合甲基多巴治疗妊娠期高血压疾病的疗效,及其对患者血流动力学指标和母婴妊娠结局的影响.方法 选取2016年8月-2017年10月本院接诊的妊娠期高血压疾病患者100例作为研究对象,依据随机数字表法平均分为对照组和观察组,对照组患者给予静脉滴注硫酸镁治疗,观察组在对照组治疗基础上给予拉贝洛尔联合甲基多巴治疗.比较两组治疗后有效率、血流动力学指标水平及不良妊娠率.结果 观察组治疗后总有效率为92.00％,显著高于对照组的82.00％,差异有统计学意义(x2=4.421,P=0.036);观察组治疗后中心静脉压(MAP)、外周阻力水平均显著低于对照组,心脏指数显著高于对照组,差异有统计学意义(P<0.05);观察组不良妊娠率为12.00％,显著低于对照组的28.00％,差异有统计学意义(x2=8.000,P=0.005).结论 拉贝洛尔联合甲基多巴可有效提高妊娠期高血压疾病的治疗有效率,改善患者血流动力学指标水平,减少不良妊娠结局的发生.

目的 观察华蟾素对人神经母细胞瘤SH-SY5Y细胞凋亡的影响,并探讨其作用机制.方法 采用巯基罗丹明B(SRB)法检测华蟾素对SH-SY5Y细胞的抑制率,流式细胞术检测细胞凋亡率,荧光探针二乙酸二氯荧光素盐(DCFH-DA)法检测细胞内活性氧(reactive oxygen species,ROS)水平;罗丹明123(Rhodamine 123)染色法检测细胞线粒体膜电位;Western blot检测胞质细胞色素C(Cyt-C)的表达;ELISA检测Caspase-3和Caspase-9酶活性.结果 华蟾素对SH-SY5Y细胞增殖具有明显抑制作用,且表现出剂量和时间依赖性.流式细胞术检测对照组及各浓度组凋亡率分别为(3.12±0.91)％、(17.65±4.28)％、(29.14±6.72)％、(50.01±9.26)％,与对照组比较,华蟾素组的凋亡率均显著性增高(P＜0.01);华蟾素能够呈浓度依赖的增加细胞内ROS水平(P＜0.01),降低线粒体膜电位(P＜0.01),增加胞质中Cyt-C的表达(P＜0.01),同时增加Caspase-3和Caspase-9酶活性.结论 华蟾素能够通过诱导SH-SY5Y细胞产生凋亡而发挥增殖抑制作用,其作用机制可能与激发线粒体凋亡途径有关.

Objective The antioxidant enzymes,lipid peroxidation and vaginal lactobacilli in the vaginal discharge from patients with bacterial vaginosis(BV) were observed to investigate the relationship between oxidative stress and pathogenesis of bacterial vaginosis. Methods Smear of vaginal secretion was observed to detect the type of pathogenic microorganism and quantity of bacillus lacticus. The vaginal secretion was also made into stock solution for determining enzyme activity or concentration using detecting kits,including lipid peroxide malondialdehyde(MDA),hydrogen peroxide(H2O2),oxidation resistance enzyme superoxide dismutase(SOD),catalase(CAT) and Vitamin C(VC). Results Prevalence of BV in this group was 33. 5%; pH value of vaginal secretion in BV patients was significantly elevated,while the detection rate of bacillus lacticus was reduced. The enzyme detection results showed that lipid peroxide MDA and H2O2 level in BV group were elevated,while the CAT,SOD and VC level in BV group were decreased compared to the control group(P < 0. 01). All indicators recovered to normal levels after therapy. Conclusion Oxidative stress might participate and affect pathological processes of BV. Changing the oxidative stress status in vaginal environment might be a prospective therapy for BV.

Objective To assess the clinical effectiveness and safety of paclitaxel liposomes and carboplatin for ovarian cancer.Methods The databases such as The Cochrane Library,PubMed,EMBASE,CNKI and CBM were searched to collect all randomized control trials(RCTs) about the clinical effectiveness and safety of paclitaxel liposomes and carboplatin for ovarian cancer.Literatures were screened according to the inclusive and exclusive criteria,the data were extracted,the methodological quality of the included studies was assessed in line with Cochrane Handbook 5.0.1,and Meta-analysis was performed by using RevMan 5.0.24 software.Results Three RCTs involving 214 patients were included.Meta-analysis showed that compared with the paclitaxel plus carboplatin group,the paclitaxel liposomes plus carboplatin group didn't show significant differences in the total effective rate(P=0.62),while it was obviously superior in reducing the adverse events,such as muscle and joint pain(P0.000 01),peripheral neurotoxicity(P=0.04),nausea or vomiting(P=0.000 2),facial blushing(P=0.03) and rashes(P=0.003).But there were no significant differences between the two groups in trichomadesis,dyspnea,diarrhea,bellyache and blood system abnormalities.Conclusion As current clinical evidences shows,the paclitaxel liposomes and carboplatin in treating ovarian cancer is as effective as the paclitaxel and carboplatin,and it can reduce some of the adverse reactions.Therefore,the paclitaxel liposomes and carboplatin is available for ovarian cancer as a new,safe and effective treatment.Due to small scale and low quality of the included studies,this conclusion has to be further proved with more high-quality,large-scale,and double-blind RCTs.

Objective:To study the relationship of the viral load of HPV and TSLC-1 during the development of cervical squamous cancer.Methods:100 specimens of tissues which had been detected the viral load of HPV by HC-Ⅱ,including squamous carcinoma of the cervix,cervical intraepithelial neoplasia(CINs) and chronic cervicitis underwent immunehistochemistry to detect the expression of TSLC-1,and evaluated their correlations.Results:54 out of 100 samples were HPV DNA positive,the viral load of HPV were 1≤RLU/CO≤100(27/100),100-1 000(23/100),≥1 000(4/100),TSLC-1"-"(42/100),"+"(23/100),"++"(20/100) and"+++"(15/100).Statistical analysis for the association of TSLC-1 and the viral load of HPV revealed that: the expression levels of TSLC-1 and the viral load of HPV showed a significant correlation(rs=0.586,P=0.000).Conclusions:Down-regulation of TSLC-1 and the viral load of HPV showed a significant correlation during the pathogenesis of CIN and cervical squamous cell carcinoma,to detect both of them is helpful to calculated the tendency of cervical pathological changes.