The relation of parathyroid function to pregnancy-induced hypertension.

Parathyrin (PTH) and calcitonin were measured with radioimmunoassay in 39 cases of pregnancy-induced hypertension (PIH) in late pregnancy, 76 cases in normal early pregnancy and 278 cases in late pregnancy without PIH. Markedly increased PTH was noted in the women in late pregnancy, indicating the state of secondary hyperparathyroidism. PTH values in the women in late pregnancy with PIH were higher than those in the normal early pregnancy group, but lower than those in the women in late pregnancy without PIH. The difference between PTH values in the PIH group and late pregnancy without PIH group was of statistical significance (P < 0.05), while no significant difference was seen between calcitonin values of the two groups (P > 0.05). The results suggest that the pathogenesis of PIH may be related to the function of parathyroid.

     

Significance of changes in serum superoxide dismutase level in hypertensive syndrome of pregnancy.

The concentration of human serum superoxide dismutase-1 (hSOD-1) containing copper and zinc ions were measured by radioimmunoassay healthy nonpregnant women, 15 normal pregnant women, 15 patients with mild to moderate hypertension (MMHSP) and 15 with severe hypertensive syndrome of pregnancy (SHSP). The mean serum hSOD-1 concentration in nonpregnant women was 148.84 +/- 60.53 (x +/- s) micrograms/L; while in the other 3 groups it was 394.19 +/- 122.21 micrograms/L, 377.12 +/- 173.45 micrograms/L and 581.15 +/- 118.50 micrograms/L. The results suggest that harmful free radicals increase gradually and a strong body defence system against oxidation damage of tissue cells is produced in the course of normal pregnancy and MMHSP. With cardionatrin treatment serum hSOD-1 concentrations of patients ameliorated returned to the level of normal pregnancy. The results indicate that there is a positive correlation between cardionatrin and hSOD-1 levels (r = 0.569, P less than 0.05), and a physiological regulation of the defence system exists, which may be related to the white blood cells. Hence, hSOD-1 probably plays a significant role in defence during normal pregnancy and hypertensive syndrome of pregnancy (HSP).

     

Study of Coping-competence among Unmarried Pregnant Young Women in Three Big Cites in China

Objective To identify the coping-competence among unmarried pregnant young women. Methods A cross-sectional study was conducted in the setting of clinics-based. A total of 1 391 unmarried young women were recruited as the sample in Youth Clinics of 3 maternal care hospitals in Beijing, Jinan, and Guangzhou respectively in China. ＂Behavioral Attributes of Psychosocial Competence Scale-Condensed Form＂ was administered to identify the coping-competence of these women. All these women were aged 10-24 years old and were divided into three groups based on whether or not they had sex and pregnancy. The three groups were named as follows： pregnancy group with young women having had both sex and pregnancy, sex group with young women having had only sex but not pregnancy, and non-sex group with young women having no sex experience. Results Among the adolescents aged 10-19 years old, the coping-competence was different among the three groups （P=O.050）. Compared with the pregnancy group, the non-sex group were more inclined to active coping （P=0.026）. Among all the pregnant women aged 10-24 years old, the coping-competence was various by region （P〈0.001）： the women in Jinan were more inclined to active coping than the women in another two cites （P=0.009, P〈0.001）, and there was no difference between the women from Beijing and Guangzhou （P=0.324）. Conclusion This is the first study of coping among unmarried pregnant young women in China. The results supported the point of view that the pregnant adolescents were more inclined to passive coping, and the coping had regional differences.     

Domestic abuse on women in China before, during, and after pregnancy

Background Some researchers found that partner-perpetrated physical violence increased in frequency and severity during the postpartum period compared with the antenatal period, however, limited data exists describing abuse of women in China. The purpose of this study was to examine patterns of abuse in China before, during, and after pregnancy, and explore possible factors related to abuse. Methods A community-based face-to-face survey of a representative group of women who had a child aged 6 to 18 months in 32 communities of Tianjin, Liaoning, Henan, and Shaanxi provinces was carried out between November 1,2001 and February 28, 2002. Results The prevalence of domestic abuse (emotional, sexual, or physical) occurring in any period (before, during, or after pregnancy) was 12.6%. The prevalence of abuse during the approximate 9 months of pregnancy (4.3%) was relatively lower compared with the prevalence of abuse during the 12 months before pregnancy (9. 1%) and after delivery (8.3%) during the mean 11-month postpartum period studied. Abuse before pregnancy was a strong risk factor for abuse during pregnancy and abuse after pregnancy, and abuse during any previous period was a strong risk factor for subsequent abuse. Many women who suffered abuse of any kind generally experienced multiple acts over time and most acts were not severe. The results of logistic regression analysis showed that the factors associated with abuse during pregnancy included women previously witnessing domestic violence, a poor relationship with the panner, socioeconomic level, alcohol consumption, and smoking. Conclusions It is necessary to do in-depth training and to raise awareness of panner abuse among all health professionals. Routine screening of abuse in maternity clinics is advocated to decrease the adverse impact of abuse on women and fetuses.     

THE RELATION OF PARATHYROID FUNCTION TO PREGNANCY-INDUCED HYPERTENTION

Parathyrin (PTH) and calcitonin were measured with radioimmunoassay in 39 cases of pregnancy-induced hypertension (PIH) in late pregnancy, 76 cases in normal early pregnancy and 278 cases in late pregnancy without PIH. Markedly increased PTH was noted in the women in late pregnancy, indicating the state of secondary hyperparathyroidism. PTH values in the women in late pregnancy with PIH were higher than those in the normal early pregnancy group, but Iower than those in the women in late pregnancy without PIH. The difference between PTH values in the PIH group and late pregnancy without PIH group was of statistical significance (P<0.05), while no significant difference was seen between calcitonin values of the two groups (P>0.05). The results suggest that the pathogenesis of PIH may be related to the function of parathyroid.     

Contraceptive use behavior among never married young women who are seeking pre gnancy termination in Beijing

Objective To identify contraceptive use behavior and its determinants among never married young women with an unwanted pregnancy and seeking pregnancy termination in Beijing.Methods A cross-sectional study, adopting the Lawrence’ PRECEDE-PROCEED model was conducted in 1999 in Beijing, China. A total of 306 unmarried young women, aged 18 to 24 years and requesting pregnancy termination, were face to face interviewed.Results Only 13% of the young women insisted on contraceptive use, and almost an equal proportion occasionally or never used contraceptives (26% and 27%, respectively). Among 224 women who had contraceptive use during the past 12 months, the methods used most often were condom (49%), withdrawal (28%) and the rhythm method (16%). One of the most important reasons cited by 73 percent of women who had never used contraceptives was that they did not realize the risk of getting pregnant. The results of logistic regression analysis revealed that knowledge on contraception, boyfriend’s approval of contraceptive use, perceived risk of getting pregnant, perceived availability of contraceptive services and discussion of contraception with boyfriend were important indicators of a young woman’s contraceptive use behavior.Conclusion These results indicate an urgent need to develop sex education on conception and contraception among young women and men. It is equally important to enhance young women’s perception about the risk of unwanted pregnancy and the complications of induced abortion. Promoting men’s cooperation and participation in contraceptive use as well as strengthening communication on contraception between young women and their partners is essential.     

Use of Emergency Contraception could Halve Induced Abortion Rate in Shanghai, China

Objective To investigate and estimate the proportion of the induced abortion that could have been prevented by using emergency contraception in Shanghai.Method Structured interviews were conducted in 606 women (413 married and 193 unmarried) aged 18-49 years, who were attending three health care centers in Shanghai for termination of first trimester pregnancy.Results A total of 98.2% of the pregnancies were unwanted, and 63.7% of the women.recognized that they were at risk of pregnancy soon after the intercourse. It is estimated that 52.2% of the induced abortion could have been prevented if the women had used levonorgestrel-only emergency contrdcception. Only 28.5% of the respondents were aware of emergency contraception. The most important sources of information about emergency contraception identified by respondents were books/newspapers/periodicals (38.2%), and relatives/friends (30.6%). Family planning health education on emergency contraception was noted by 28.9% of married women but only by 5.8% of unmarried women. A portion of 85.5% of all respondents reported they would be willing to use emergency contraception when needed. Those more willing to use emergency contraception included younger, better educated, and unmarried women experiencing their first pregnancy. Women preferred drugstores (60.1%) than hospitals (30.29%)for obtaining emergency contraception.Conclusion Women‘s needs for emergency contraception were enormous. Promotion of emergency contraception by providing information and improving service could have a substantial impact on reducing the rate of induced abortion in Shanghai.     

Plasma motilin concentration in the second and third trimesters of pregnancy and postpartum

Plasma motilin concentrations were measured in 135 women during the second andthird trimesters of pregnancy and 3～5 d after delivery and the results were compared withthose of 20 healthy nonpregnant women.The mean plasma motilin concentration (323.96±125.10 ng/L) in women during the second trimester of pregnancy was lower than in healthynonpregnant women (366.12±96.23 ng/L) (P<0.05),but that was significantly higher thanin women during the third trimester of pregnancy (121.04±27.00 ng/L) (P<0.01);theplasma motilin concentration in women during 3～5d after delivery (443.05±140.79 ng/L)was significantly higher than that in pregnant women (P<0.01).The results showed thatpregnancy appears to have a profound inhibitory effect on plasma motilin,and this may partlybe responsible for the gastrointestinal hypomotility associated with pregnancy.     

Association between change of health care providers and pregnancy exposure to FDA category C, D and X drugs

Background Changing health care providers frequently breaks the continuity of care,which is associated with many health care problems.The purpose of this study was to examine the association between a change of health care providers and pregnancy exposure to FDA category C,D and X drugs.Methods A 50% random sample of women who gave a birth in Saskatchewan between January 1,1997 and December 31,2000 were chosen for this study.The association between the number of changes in health care providers and with pregnancy exposure to category C,D,and X drugs for those women with and without chronic diseases were evaluated using multiple logistical regression,with adjusted odds ratios （ORs） and its 95% confidence intervals （C/s） as the association measures.Results A total of 18 568 women were included in this study.Rates of FDA C,D,and X drug uses were 14.35%,17.07%,21.72%,and 31.14%,in women with no change of provider,1-2 changes,3-5 changes,and more than 5 changes of health care providers.An association between the number of changes of health care providers and pregnancy exposure to FDA C,D,and X drugs existed in women without chronic diseases but not in women with chronic disease.Conclusion Change of health care providers is associated with pregnancy exposure to FDA category C,D and X drugs in women without chronic diseases.     

原发性肝癌自发性破裂出血的治疗方法选择

目的总结原发性肝癌自发性破裂出血的治疗方法选择及疗效。方法回顾性分析2005年1月~2008年12月收治的32例非保守治疗的原发性肝癌自发性破裂出血患者的临床资料。结果开腹手术组19例,2例死于术后并发症;介入治疗组13例,无围手术期死亡。一期及二期根治性手术15例中生存2年内者7例,超过2年者6例,失访2例：姑息止血治疗组13例生存期均为2年内。结论①介入治疗止血满意,并为后续的根治性手术创造条件;②急诊手术具有一定的盲目性,围手术期并发症多,死亡率高;③术后生存期以根治性手术切除为佳。     

晚期肝细胞癌免疫治疗的相关不良反应

目的 探讨晚期肝细胞癌患者采用免疫检查点抑制剂治疗时出现免疫相关不良反应的概率及应对以及对疗效的影响。方法 回顾性分析收治的、接受以PD-1/PD-L1抗体或联合CTLA-4为基础治疗的晚期肝细胞癌患者的临床特点、不良反应发生率，及应对措施，并通过电话、微信等方式进行随访。结果 63例患者中，男54例，女9例；中位年龄54(33～82)岁。单用PD-1/PD-L1抗体者13例，联合仑伐替尼者14例，联合阿帕替尼者23例，联合贝伐单抗者9例，联合卡培他滨者4例；其中一线接受以PD-1抗体为基础治疗者40例，二线者为14例，三线及以后9例。63例患者中23例患者乙肝病史>20年，11例患者乙肝病史10～20年，乙肝病史10年以下者26例；另有2例为丙型肝炎患者，1例无病毒性肝炎病史。63例患者中完全缓解3例，部分缓解14例，疾病稳定31例，疾病进展15例，客观有效率为26.9%,疾病控制率为76.2%。治疗过程中不良反应整体发生率为77.8%(49/63),其中3～4级不良反应发生率为15.8%(10/63),免疫相关不良反应发生率为53.9%(34/63),其中3～4级免疫相关不良...     

门静脉海绵样变性的MRI诊断

目的 分析门静脉海绵样变性的MRI特征.方法 分析20例经手术病理或DSA证实的门静脉海绵样变性患者的MRI平扫、动态增强扫描及动态增强磁共振血管成像(DCE-MRA)的影像表现.结果 20例患者中,11例为原发性肝细胞癌,3例为脾切除术后,5例为肝硬化,1例原因不明.门静脉海绵样变性在MRI平扫图象上,表现为门静脉主干或分支闭塞,周围可见由侧支静脉形成的团块状、网状异常软组织信号影,增强扫描门静脉期上述软组织影明显强化,表现为扩张迂曲的网状血管结构.增强扫描1例出现动脉期肝实质一过性灌注异常,2例见门静脉提前显影.1例可以出现肝外胆管低位梗阻.结论 MRI能很好地显示门静脉海绵样变性的特征,是有效的诊断方法.     

85例青年原发性肝癌的临床病理特征及预后因素分析

目的:探讨青年（年龄≤40岁）原发性肝癌（PHC）患者的临床病理特征、治疗及其预后影响因素。方法:回顾分析85例青年PHC患者的临床资料,描述青年PHC患者的临床病理特征和治疗情况,并分析相关预后因素。结果:85例青年PHC患者中,男69例,女16例,男女比例4.31∶1;81.2%有肝炎病史,12.9%有肝癌家族史。52例患者有明确病理结果,其中肝细胞肝癌88.5%（46/52）,胆管细胞癌7.7%（4/52）,混合细胞癌3.8%（2/52）。29例患者接受手术治疗,中位总生存时间（OS）为23个月;35例接受介入治疗,中位OS为12个月;21例接受手术联合介入治疗,中位OS为33个月。单因素分析显示,肿瘤大小、肝功能Child-Pugh分级、ECOG评分、AST、ALP、总胆红素、GGT、胆碱酯酶、AFP、CEA、腹水、门脉癌栓是影响预后的相关因素（P均＜0.05）。多因素分析显示,肿瘤大小、GGT、AFP、CEA及门脉癌栓是独立预后因素（P均＜0.05）。结论:青年PHC起病隐匿,进展快,恶性度高,行手术联合介入的综合治疗可使患者生存获益,并且肿瘤大小、GGT、AFP、CEA及门脉癌栓可作为判断青年PHC患者预后的独立因素。     

妊娠完全性子宫破裂9例临床分析

目的 探讨妊娠完全性子宫破裂的高危因素、临床特点及预后.方法 回顾性分析2014年1月至2017年4月沈阳市妇婴医院收治的9例妊娠完全性子宫破裂患者的临床资料,对患者的年龄、孕产史、孕周、既往手术史、此次妊娠距手术间隔时间、子宫破裂的位置、临床处理及母婴结局进行归纳总结.结果 9例妊娠合并完全性子宫破裂患者中,剖宫产术后瘢痕子宫前次剖宫产切口破裂3例(1例剖宫产切口妊娠并子宫破裂,2例为剖宫产术后瘢痕子宫中期引产)、腹腔镜子宫肌瘤术后瘢痕子宫2例、剖宫产合并腹腔镜输卵管手术后妊娠1例,腹腔镜输卵管手术后妊娠1例,双子宫1例,原因不明1例(有刮宫术病史).表现为持续性下腹痛7例,无典型子宫破裂的临床表现2例.9例均行子宫修补术,产后出血5例,输红细胞4例,无产妇死亡;1例胎死宫内,4例新生儿结局良好,3例为引产及剖宫产切口妊娠,1例新生儿窒息后死亡.结论 剖宫产史再次妊娠有子宫破裂的风险,应将所有曾接受子宫体部、输卵管手术的患者、子宫畸形、胎盘植入、多次孕产史的无子宫瘢痕孕妇视为发生子宫破裂的高危人群,以便早期识别和处理子宫破裂.     

Analysis of serious complications of transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma

Objective： To analyze the inductive agents, post-surgical managements and precautions of the serious complications caused by transcatheter arterial chemoembolization （TACE） for the treatment of hepatocellular carcinoma. Methods： Clinical data of 2 375 cases of TACE for 832 patients with middlestage or advanced hepatocellular carcinoma from January 1994 to December 2002 were analyzed. Results： There were 7 cases of serious complications, one of which was liver carcinoma rupture and another was acute renal failure. Totally there were 4 cases of paraplegia and one case of conduit knotted. Conclusion： Deadly complications may happen after TACE and it needs close surveillance and management in time.     

妊娠期鼻咽恶性肿瘤临床分析

目的：总结妊娠期合并鼻咽恶性肿瘤患者的临床资料，探讨妊娠期合并鼻咽恶性肿瘤的临床特点，以达到早期诊断、早期治疗的目的。方法以2007年9月至2012年7月收治的妊娠期合并鼻咽恶性肿瘤5例作为研究对象。其中鼻咽鳞状细胞癌4例，鼻咽恶性肌上皮瘤1例。回顾分析患者的临床表现、诊断结果及治疗情况，并对患者及其子代进行随访。结果5例患者均为单胎妊娠，3例（60．00％）在妊娠过程中活检确诊后终止妊娠行引产术，2例（40．00％）为妊娠中发病，分别于产后1周和产后1个月活检确诊。新生儿健康存活。鼻咽鳞状细胞癌患者均采用同期放化疗，鼻咽恶性肌上皮瘤患者采用经鼻内镜及软腭联合径路手术治疗，术后1周辅助放疗。结论妊娠期合并鼻咽恶性肿瘤较为少见，合并鼻咽恶性肌上皮瘤更为罕见。妊娠期由于检查及用药的局限性，容易出现漏诊及误诊。治疗应根据肿瘤性质、分期、患者意愿等因素综合考虑，并对患者及子代做长期随访。     

术前预置鼻胆管引流在肝门部小肝癌射频消融治疗中的作用

目的探讨术前预置鼻胆管引流在肝门部小肝癌射频消融中的作用。方法选择我院在2014年6月~2017年6月期间收治的7例肝门部小肝癌患者,所有患者均为在肝门部小肝癌中射频电极针穿刺进入肝癌时容易误损伤肝门部胆管的病例,术前预置鼻胆管,术中行鼻胆管注水可扩张胆管便于术中辨识及避免误穿刺,部分病例术中损伤胆管后,通过术后鼻胆管引流避免阻塞性黄疸或肝门部胆汁瘤的发生。结果患者治疗有效率为100%(7/7),术后1 d复查血生化、血常规、肝功能等,术后30~60 d复查肝脏CT或者MRI,其中发生预置鼻胆管后轻型胰腺炎l例,并发症发病率为14.3%,远期治疗效果良好,未见肿瘤复发。结论对于肝门部小肝癌,采用术前预置鼻胆管引流技术,可在射频消融治疗过程中明显观察到胆管走向,有效避免胆管误伤。     

腹腔镜手术治疗妊娠期妇科疾病的临床分析

目的探讨腹腔镜手术在妊娠期妇科疾病中的应用和特征研究。方法分析因妇科疾病行腹腔镜治疗的35例妊娠期妇女的临床资料,孕周在11周以内者21例,11周以上者14例,最大孕周22周。其中宫内妊娠合并宫外孕5例,均为输卵管不通而行体外受精胚胎移植术后（IVF.ET）受孕,其中输卵管妊娠破裂者6例,因B超提示附件包块而入院;妊娠合并卵巢囊肿蒂扭转9例;合并黄体破裂8例;合并卵巢巧克力囊肿破裂7例;妊娠期子宫浆膜层血管自发破裂3例。术前B超提示有附件包块23例;后穹窿穿刺或腹腔穿刺抽出不凝血8例,其中4例患者出现面色苍白、血压下降等休克表现。结果其中15例行急诊手术,14例行择期手术,手术全部采用腹腔镜,而且全部成功,无一例发生手术和麻醉并发症。24例已足月妊娠分娩,新生儿无畸形,9例仍在妊娠中晚期随诊中,1例因其它因素行人工流产术,1例术后2周因胚胎停止发育行清宫术。结论腹腔镜手术治疗妊娠期妇科疾病是安全和可行的。     

外生性肝癌的螺旋CT诊断

目的探讨螺旋CT肝脏双期扫描对外生性肝癌的诊断价值,提高对该病的诊断能力。方法回顾性分析12例经病理证实的外生性肝癌螺旋CT肝脏双期扫描的临床和影像学表现。结果12例中主诉有上腹疼痛或隐痛7例,其中6例可触及巨大包块,消瘦伴乏力3例,2例B健康体检发现;8例HbsAg（＋）,甲胎蛋白（AFP）增高9例,3例≥500ng／ml;12例外生性肝癌均与肝脏相连,呈向肝外生长的肿块,4例有明显蒂部,11例病灶内见“更低密度区”,11例增强后表现为典型“快进快出”表现,CT多平面重建（MPR）能更好地显示肿块与肝脏的关系。结论外生性肝癌有明显的CT征象特点,螺旋CT肝脏双期扫描对外生性肝癌的诊断有较高的临床价值。