通过阐述温州市中心血站核酸集中化检测实验室(以下简称实验室)的项目建设情况及建设过程中的心得体会,为采供血机构实验室的新建和改建提供参考.对项目概况、功能定位、总体原则进行介绍,重点对建设方案中平面设计、空调、通风和净化、电力、照明、给排水与信息系统、消防、安全防护等子系统进行论述,同时对建设成符合规范要求的核酸实验室过程中获得的心得体会加以总结和剖析.实验室建设前期注重调研沟通、合理规划平面布置和工作流程设计,建设实施过程监督方案中实验室分区、空气流向、工作流向等方面的细节落实,最终建设成布局合理、分区明确、流向清晰、安全高效、方便工作的核酸集中化检测实验室.实验室建设只有在项目决策、前期调研、工程设计、建设施工各阶段实行统筹规划,系统科学地控制和管理,不断地探索和完善,才能获得圆满成功.

妊娠期肝内胆汁淤积症(ICP)是妊娠特有的并发症,好发于妊娠中晚期,以皮肤瘙痒、血清胆汁酸升高(＞ 10μmol/L)为主要症状Ⅲ.流行病学研究指出,我国是ICP高发国家,其发病率高达2.3％～6％,尤其有ICP史孕妇再次妊娠时,ICP复发率可高达40％～60％[2].ICP产妇分娩后各项指标可短期内迅速恢复正常,预后良好.

目的 探讨会阴侧切对初产妇产后早期盆底康复及盆底功能障碍发生率的影响.方法 选取2018年1月至2019年11月浙江大学医学院附属妇产科医院宁海分院接收的自然分娩的初产妇90例,按照分娩中是否行会阴侧切分为两组,对照组(未行会阴侧切)45例,研究组(行会阴侧切)45例.观察两组盆底功能障碍发生率、肌纤维肌力指标、相关各项指标,Ⅰ类肌纤维疲劳度、Ⅱ类肌纤维疲劳度及阴道动态压力.结果 与对照组比较,产后研究组盆底功能障碍发生率高(P<0.05);治疗后两组肌纤维肌力均有所改善(P<0.05),但与对照组比较,研究组改善程度低(P<0.05);治疗后与对照组比较,研究组Ⅰ类、Ⅱ类肌纤维疲劳度高,阴道动态压力低(P<0.05).结论 在初产妇分娩中行会阴侧切会在一定程度上增加盆底功能障碍的发生率,且会影响早期盆底康复的效果,因此在后期临床中应当降低会阴侧切率,必要侧切后及时进行盆底康复的干预治疗.

目的 探讨盆底肌电生物反馈疗法对初产妇产后性功能及盆底功能的影响.方法 选取2019年1月至2020年10月我院收治的180例初产妇为研究对象,按照随机数字法分为两组.对照组应用盆底康复锻炼治疗,研究组应用盆底肌电生物反馈治疗.比较两组患者的FSFI评分、盆底功能及并发症情况.结果 研究组性欲(7.7±0.9)分,阴道润滑度(15.6±1.7)分、性唤起(14.5±1.7)分、性生活满意度(10.4±1.1)分、性高潮(8.2±1.1)分、性交痛(10.2±1.4)分,高于对照组性欲(6.3±1.1)分,阴道润滑度(14.1±2.0)分、性唤起(12.3±1.7)分、性生活满意度(8.2±1.2)分、性高潮(6.2±1.2)分、性交痛(8.3±1.1)分,差异有统计学意义(P<0.05);研究组Ⅰ类肌纤维持续收缩压(41.5±5.3)mmHg、Ⅱ类肌纤维持续收缩压(46.7±4.7)mmHg、盆底静息压(5.5±0.8)mmHg、盆底收缩压(48.7±4.7)mmHg,高于对照组Ⅰ类肌纤维持续收缩压(35.1±4.8)mmHg、Ⅱ类肌纤维持续收缩压(38.8±4.6)mmHg、盆底静息压(4.8±0.7)mmHg、盆底收缩压(39.4±4.4)mmHg,差异有统计学意义(P<0.05);研究组并发症(3.3％)低于对照组(13.3％),差异有统计学意义(P<0.05).结论 初产妇应用盆底肌电生物反馈治疗效果显著,可有效改善其产后性功能和盆底功能指标,减少并发症的发生.

目的 了解妇产科医护人员对盆底知信行现状及影响因素,促进妇产科医护人员掌握盆底肌肉锻炼知识,使患者正确掌握此项锻炼,提高女性生活质量.方法 采用医护人员对盆底相关知信行及应用调查表,对该院143名妇产科医护进行问卷调查.结果 未婚、文化程度低、初级职称的妇产科医护人员对盆底肌肉锻炼知识的知晓率低,特别是"盆底肌肉锻炼的具体运动方案"知晓率仅为33.33％,"盆底肌肉锻炼的概念"仅43.59％,"盆底肌肉锻炼的作用"为48.72％.结论 不同文化程度、学历及职称对盆底知识的知晓及应用不同,妇产科医护人员应加强盆底肌相关知识的学习.

Objective. Cervical HR-HPV persistence is the main risk factor for cervical cancer. We aimed to investigate the association of age and viral factors with HR-HPV persistence. Methods. From 2010 to 2017, 343,128 women underwent 390,411 tests performed by the Cervista HR-HPV assay (Data C3) and 157,123 women underwent 206,505 tests performed by the GenoArray HR-HPV assay (Data G14) in nine medical centers located in central and eastern China. We combined the test results and identified 9234 HPV-specific baseline-negative records for time-to-event analyses. The study endpoint event was defined as clearance of type/group-specific HPV. Therefore, hazard ratio (HR) < 1 indicated a higher risk of HPV persistence, which is contrary to the common meaning of HR. Results. The median persistence time was 375 and 541.5 days for Data C3 and Data G14, respectively. For every 5-year increase in age, a 15% (95% confidence interval [CI], 11%-19%) decrease in the clearance rate was observed only after 400 days of infection. For each additional co-infected HPV, the HR was 1.80 (95% CI, 1.63-1.97) on infection initiation but decreased by 22% (95% CI, 18%-26%) every 100 days. The HR of infection recurrence was 0.48 (95% CI, 0.32-0.72). The findings were consistent across different populations and test methods and were robust in sensitivity analysis. Conclusions. We found a time -dependent association of age and viral factors with HPV clearance. Older age reduced HPV clearance only after 400 days of infection. Co-infection promoted HPV clearance in the beginning, but the effect attenuated and reversed as infection persisted. Recurrent same-type infection cleared slower than the previous one. (C) 2019 Elsevier Inc. All rights reserved.

Objective To investigate the effects of maternal blood lipid profile over delivery of macrosomia and large-for-gestational-age. Methods The data of 4859 pregnant women who delivered their babies in Ninghai County Maternal and Child Health Hospital form Jan 1,2016 to Dec 31,2016 were analyzed retrospectively. There were 209 cases of macrosomia,1460 cases of LGA and 45 cases of small for gestational age infants. The age of pregnant,BMI and laboratory test results before pregnant,sex and birth weight of infants were analyzed and compared by macrosomia and LGA,respectively. Lipid profile indexes were categorized according to their quartiles,and the odds ratios(ORs)and 95% confidence interval(95% CI)were evaluated by conditional logistic regression analyses,and the age of pregnant,BMI,diagnosed diabetes and sex of infants were adjusted as confounders. Results The age of pregnant,BMI,diagnosed diabetes and sex of infants had significant relationship with delivery of macrosomia, the age of pregnant,BMI,diagnosed diabetes,parity and sex of infants had significant relationship with delivery of LGA. There were significant dose-response relation between triglyceride level and macrosomia and LGA,and the relationship was still significant between triglyceride level and macrosomia after confounders were adjusted. Conclusion The triglyceride level before delivery was an independent risk fact for macrosomia and LGA.

Objectives: Understanding the prevalence and characteristics of high-risk human papillomavirus (hrHPV) with the large-scale multicenter data based on a US FDA-approved testing method is important to guide ongoing vaccination programs in China. Methods: We conducted a retrospective observational study based on data from 11 large hospitals in central and eastern China. From October 1st, 2012 to December 31st, 2016, a total of 480,034 cervical specimens were collected, and 414,540 eligible participants (14-80 years, mean age 39.9 years) were included and tested using Cervista High-Risk HPV Assay (Hologic Inc., Bedford, Mass, USA). Results: The overall hrHPV prevalence in this study was 17.8% (73,713/414,540), with Wuhan slightly higher than Zhejiang (18.6% vs. 17.6%, P < 0.001). The prevalence showed a declining trend from 2012 to 2016. The most common hrHPV group was A9 (61.7%), followed by A5/A6 (29.4%) and A7 (25.6%). A U-shaped curve was observed for age-specific hrHPV prevalence: ≤19 years and ≥50 years were higher than other age groups. Conclusion: In pre-vaccination period, A9 was the most dominant hrHPV group, and infections were most likely to occur at younger and older ages. The prevalence of hrHPV varied by cities and age groups, suggesting vaccination programs should be propagated in a population-specific approach.

Abstract Introduction: Synchronous occurrence of benign cystic mesothelioma and adenomatoid tumor of uterus (UAT) are very rare and few cases have been published in the English literature. They are easily misdiagnosed as malignant by clinicians, due to the lack of reports. Patient concerns: A case of benign mesothelial combined with uterus adenomatoid tumor (UAT) in a 48-year-old Chinese woman was reported. Our patient presented with abdominal pain and surgery showed a large subserous mass (12.0 × 11.4 × 9.8 cm) combined with a small intramural solid nodule (2.0 × 1.0 × 1.0 cm), and multiple minute neoplastic growth on the ovary. Diagnosis: Due to the patient's symptoms, pathological findings, she was diagnosed with synchronous occurrence of benign mesothelioma and UAT. Interventions: We treated her with a total hysterectomy and bilateral adnexectomy. Outcomes: The patient is now in stable condition, without any signs of recurrence during 1 year of follow-up. Lessons: Most mesotheliomas are malignant, synchronous occurrence of benign mesothelioma and UAT are extremely rare. And they are often misdiagnosed as malignancy by clinicians. Our case report can improve the awareness of the disease and avoid excessive treatment.

性交后出血多见于粗暴或不文明性交引起的生殖器损伤,较常见的为外阴或阴道壁撕裂伤.性交后导致的腹腔内出血发生率较低,容易被误诊.现将本院收治的1例性交损伤子宫阔韧带致腹腔内出血病例报告如下.

Introduction: Synchronous occurrence of benign cystic mesothelioma and adenomatoid tumor of uterus (UAT) are very rare and few cases have been published in the English literature. They are easily misdiagnosed as malignant by clinicians, due to the lack of reports.Patient concerns: A case of benign mesothelial combined with uterus adenomatoid tumor (UAT) in a 48-year-old Chinese woman was reported. Our patient presented with abdominal pain and surgery showed a large subserous mass (12.0 x 11.4 x 9.8 cm) combined with a small intramural solid nodule (2.0 x 1.0 x 1.0 cm), and multiple minute neoplastic growth on the ovary.Diagnosis: Due to the patient's symptoms, pathological findings, she was diagnosed with synchronous occurrence of benign mesothelioma and UAT.Interventions: We treated her with a total hysterectomy and bilateral adnexectomy.Outcomes: The patient is now in stable condition, without any signs of recurrence during 1 year of follow-up.Lessons: Most mesotheliomas are malignant, synchronous occurrence of benign mesothelioma and UAT are extremely rare. And they are often misdiagnosed as malignancy by clinicians. Our case report can improve the awareness of the disease and avoid excessive treatment.

文章回顾1352例接受胎儿颈项透明层厚度(Fetal neck transparent layer thickness ultrasound,NT)超声检测和孕中期四维彩超诊断的妊娠期妇女临床资料,分析超声检测联合孕中期四维彩超诊断胎儿畸形的应用价值.NT超声联合孕中期四维彩超诊断能早期诊断胎儿染色体异常、结构异常等,是提高产前筛查检出率的关键,对预测不良妊娠结局有较高的临床价值.

Rationale: Acinic cell carcinoma (AcCC) of the breast is a rare histological type of malignant epithelial neoplasm exhibiting acinic cell differentiation. Patient concerns: A 52-year-old woman presented to the hospital with a palpable mass over the upper outer quadrant of the right breast. Diagnoses: Physical examination revealed an irregular mass in the lateral upper quadrant of the left breast, approximately 1.5 cm in diameter. Histologically, the tumor cells were round to oval, had displaced nuclei with striking single nucleoli and basophilic cytoplasm, and contained large coarse cytoplasmic granules. They showed an infiltrating growth pattern with a combination of cystic and cribriform feature. We diagnosed the tumor as AcCC of the breast. Interventions: The patient was given a simple mastectomy and sentinel lymph node biopsy. After the surgery, AcCC of the breast was confirmed histologically. Outcomes: The patient was symptom free 3 months after surgery. Lessons: AcCC of the breast is a very rare tumor, and its prognosis appears to be good. Thus, treatment followed the guidelines for invasive breast carcinoma and no further therapy was suggested by oncologists based on the tumor biology.

1 病例 患者,女,34岁,2013年11月因“体检发现宫颈病变1个月”入院.生育史:1-0-0-1,足月顺产1女,16岁体健.既往史及家族史无殊.入院妇科检查:子宫颈重度糜烂,质地偏硬,无接触性出血.入院前辅助检查:2013年10月浙江省宁海县妇幼保健院新柏氏液基细胞学技术(TCT)提示高度鳞状上皮病变;阴道镜检查活检病理报告:(宫颈活检及颈管刮出物)颈子宫颈鳞状上皮内瘤变Ⅲ级(CINⅢ),累及腺体;外院人乳头瘤病毒(HPV)检测:HPV 16型阳性;入院后辅助检查:鳞状上皮细胞抗原(SCCA):0.64 ng/ml;妇科B超:子宫后壁低回声20 mm×21 mm× 14mm,双卵巢未见明显异常.

Fibroblastic reticular cells (FBRCs) are basic mesenchymal cells that belong to the dendritic cell family. Primary extranodal FBRC tumor (FRCT) cases are rare, with only 19 cases reported in the literature thus far. However, none of these cases originated in the breast tissue. To the best of our knowledge, the present study reported the first FRCT case of the breast in a 57-year-old woman. The patient complained of a painless mass that was located in the right breast and was ~3.5×2.5 cm in size. The patient underwent modified radical mastectomy subsequent to the diagnosis of FRCT after analysis of the lumpectomy specimen. Pathological examination revealed that the tumor was mainly composed of oval and spindle cells, and was infiltrated with lymphocytes and plasma cells. The tumor cells were immunoreactive for vimentin and negative for CD21, CD35 and S-100 protein. Six axillary lymph nodes were found to have been involved. Following surgery, the patient received four cycles of mesna, doxorubicin, ifosfamide and dacarbazine regimen chemotherapy (70 mg adriamycin day 1; 2.0 g ifosfamided days 1-3; 0.4 g dacarbazine day 1-3), which cycled every 21 days. The patient was uneventfully followed-up for 20 months following chemotherapy. In conclusion, the present study reported what appeared to be the first case of primary breast FRCT. The diagnosis, treatment and prognosis details presented in this study will help improve the diagnosis of the disease.

目的:总结胎盘早剥的临床特点,探讨早期诊断。方法:对近4年在我院发生的32例胎盘早剥病例进行回顾性分析。结果:胎盘早剥的发生率为0.62%,15例有发病诱因,17例无明显诱因,B超检查29例,10例提示异常,胎心监护30例,有23例提示异常,7例分娩前提示正常,2例产后检查胎盘才确诊。结论:加强孕期保健,及早发现胎盘早剥高危因素,及时处理并发症和合并症,根据病史、临床症状和体征,结合B超和胎心监护,进行综合分析判断是提高胎盘早剥诊断的有效手段。

目的探讨卵巢癌手术前后体内甲状腺激素水平变化及意义。方法分别检测60例接受手术治疗的卵巢癌患者手术前、手术后第1天、第7天及第14天血清促甲状腺素(TSH)、游离三碘甲状原氨酸(FT3)及游离四碘甲状原氨酸(FT4)表达水平,术前甲状腺激素水平同健康志愿者比较,术前及手术后第1天,第7天及第14天的甲状腺激素水平进行比较。结果术前卵巢癌患者同健康志愿者之间TSH、FT3、FT4水平差异无显著性。手术后第1天,患者体内FT3、FT4水平下降,TSH水平无明显变化;术后第7天FT3、FT4水平下降,TSH水平下降;术后第14天,FT3、FT4水平回升,TSH水平回升。结论卵巢癌手术治疗后,体内甲状腺激素表达水平发生变化;在术后早期,甲状腺自身调控系统功能失常,可能与雌激素水平变化有关。

目的:探讨选择性子宫动脉化疗药物灌注和静脉给药保守治疗输卵管妊娠两种方法成功率及治疗后患者输卵管再通率的比较。方法:选择具有保守治疗条件的患者78例,随机分为两组,回顾性分析选择性子宫动脉化疗药物灌注和静脉给药保守治疗,比较他们的成功率,并随访1年,比较它们的输卵管再通率。结果:78例保守治疗对象中38例研究组中给药后7天β-HCG下降率为76.15%,对照组40例中给药7天β-HCG下降率为42.5%,两组相比P<0.05,差异具有显著性;两组β-HCG恢复正常的时间相比,差异有显著性。结论;选择性子宫动脉化疗药物灌注及栓塞治疗妊娠具有疗效高、微创等特点,值得临床推广。

<正>腹腔镜技术由于创伤小,能在直视的条件下手术,具有很高的确诊率,同时还能对疾病进行治疗,目前已得到广泛的应用。随着腹腔镜操作技巧的不断成熟,其适应证和手术范围也在不断扩大,使得急腹症腹腔镜手术也逐渐得以开展,不但可以对一些不明原因的疾病进行早期诊断,减少误诊率,而且还可同时用腹腔镜进行治疗,提高了临床治疗