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Objective:To investigate whether the bladder neck descent and the area of levator ani hiatus obtained on the maximum Valsalva were consistent at the lithotomy position and separating-legs-holding-knees position.Methods:Forty four subjects who underwent perineal pelvic floor four-dimensional ultrasound at 6-8 weeks postpartum in Third Hospital of Longgang Shenzhen from November 2019 to January 2020 were enrolled in this study. All subjects were able to effectively complete the maximum Valsalva maneuver both at the lithotomy position and the separating-legs-holding-knees position. The bladder neck descent and hiatus area of the levator Ani on the maximum Valsalva at these two positions were measured and compared.Results:The bladder neck descent at the separating-legs-holding-knees position was higher than that at the lithotomy position [(41.06±8.25)mm vs (39.96±8.10)mm; t=-2.965, P=0.005], and the hiatus area of levator Ani at the separating-legs-holding-knees position was larger than that at the lithotomy position[(27.55±4.90)cm 2 vs (26.32±4.76)cm 2; t=-3.820, P<0.001]. Conclusions:The bladder neck descent and the area of levator Ani hiatus on the maximum Valsalva at separating-legs- holding-knees position are larger than those on the maximum Valsalva at the lithotomy position.
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OBJECTIVE@#To determine the efficacy of second generation endometrial ablation (NovaSure) combined with levonorgestrel-releasing intrauterine system (Mirena) in the treatment of adenomyosis.@*METHODS@#Clinical data of patients with adenomyosis admitted in Women's Hospital, Zhejiang University School of Medicine from January 2015 to December 2018 were retrospectively analyzed. Among 66 patients, 44 received Mirena placement only (control group) and 22 received Mirena placement and NovaSure treatment (study group). The menstruation blood loss, dysmenorrhea score, uterine size, expulsion rate of Mirena and the patients' satisfaction rate were assessed in two groups.@*RESULTS@#There was a significant reduction in menstruation blood loss (0.05).@*CONCLUSIONS@#NovaSure can improve the efficacy of Mirena in treatment of adenomyosis.
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Femenino , Humanos , Adenomiosis , Terapéutica , Dismenorrea , Técnicas de Ablación Endometrial , Levonorgestrel , Tamaño de los Órganos , Estudios Retrospectivos , ÚteroRESUMEN
Objective To determine the levels of coagulation and inflammatory factors in women with moderate and severe ovarian endometriosis so as to investigate the possible role of coagulation and inflammatory factors in the pathogenesis, diagnosis and treatment of this disease. Methods From June 2015 and June 2017,clinical data of 366 patients with pathologically diagnosed moderate and severe ovarian endometriosis (case group) and 244 patients with pathologically diagnosed benign ovarian cysts (control group)in Women′s Hospital of Zhejiang University School of Medicine were retrospectively analyzed.The levels of coagulation indicators, inflammatory factors and serum tumor markers were measured. Then, the values of these indicators in diagnosis of endometriosis were analyzed. Results(1)The levels of plasma prothrombin time(PT)and thrombin time(TT)in patients with ovarian endometriosis [median: 12.8 s (range:12.4-13.2 s)and 15.5 s(range:15.1-15.9 s),respectively]were significantly shorter than those with benign ovarian cysts[median:13.0 s(range:12.5-13.4 s)and 15.7 s(range:15.3-16.1 s),respectively;all P<0.01].The levels of plasma fibrinogen(FIB)and D-dimer[D-D;median:3.1 g/L(range:2.8-3.5 g/L)and 0.9 mg/L(range:0.6-2.1 mg/L),respectively]in patients with ovarian endometriosis were significantly higher than those with benign ovarian cysts[median:2.8 g/L(range:2.6-3.2 g/L)and 0.6 mg/L(range:0.4-1.2 mg/L), respectively; P=0.000]. Moreover, neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio [PLR; median: 2.3 (range: 1.8-3.1) and 144 (range: 113-179), respectively] in patients with ovarian endometriosis were significantly higher than those with benign ovarian cysts [median: 2.1 (range: 1.6-2.8) and 128 (range: 104-165), respectively; P<0.01]. Furthermore, in patients with ovarian endometriosis, the levels of PT were significantly shorter in stage Ⅳ endometriosis than that in stage Ⅲ endometriosis (P<0.05).The levels of FIB and PLR in patients with stageⅣendometriosis were significantly higher than those in patients with stage Ⅲ endometriosis(P<0.01).(2)The cut-off value of CA125was 27.2 kU/L with a sensitivity of 83.6%,the cut-off value of FIB was 3.1 g/L with a sensitivity of 53.2%,while the sensitivity of combination index(FIB×CA125)was 84.9%.Conclusion The abnormality of coagulation and inflammatory factors may be involved in the pathogenesis of moderate and severe ovarian endometriosis,and the detection of coagulation and inflammatory factors may be have important clinical significance for the diagnosis and treatment of moderate and severe ovarian endometriosis.
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Objective To investigate the safety and efficacy of hysterosopic management of typeⅡcesarean scar pregnancy (CSP) and the value of prophylactic uterine artery embolization (UAE). Methods Totally 104 patients with typeⅡCSP treated with hysteroscopic surgery at the Women′s Hospital,School of Medicine, Zhejiang University, during Jan. 2009 to Jun. 2016 were analyzed retrospectively, 67 patients combined with UAE (UAE group) and 37 patients without combined with UAE (non-UAE group). Laparoscopy or sonography guidance was conducted simultaneously.The following clinical parameters were compared, including: primary cure rate, uterine packing rate, uterine perforation rate, hemoglobin level change,the time for the mass absorption and the return of β-hCG to normal,complications,hospital days and hospital stay cost.Results Median gestational age,size of mass,thickness of the anterior myometrium and β-hCG level in UAE group versus non-UAE group were 47 versus 47 days,30 versus 30 mm,2 versus 2 mm, 36 524 versus 32 226 U/L(all P>0.05).Out of 104,100 patients were managed successfully with hysteroscopic surgery, and 4 patients transformed to laparoscopic or laparotomy surgery. Hysteroscopic surgery was effective in 63 out of 67 patients(94%)in UAE group and 34 out of 37 patients(92%)in non-UAE group(P>0.05). There was no significant differences regarding uterine perforation rate, uterine packing rate, hemoglobin change and recovery time between UAE group and non-UAE group (all P>0.05). The median hospital day was 7 days in UAE group versus 5 days in non-UAE group(P<0.01).The median hospital stay cost was 13 654 yuan in UAE group versus 9 108 yuan in non-UAE group (P<0.01). Serious complication occurred in 4 patients (6%, 4/67) in UAE group and 2 patients (5%, 2/67) in non-UAE group (P=0.906). Conclusions Hysteroscopic surgery is effective and safe for patients with typeⅡCSP in the first trimester with size≤30 mm in diameter and gestation age<7 weeks.The value of prophylactic UAE is uncertain.
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Objective To discuss task-based learning and team-based learning methods and lecture-based learning method in the class of ethnic medicine.Method 50 students in clinic medicine (general practice) of grade 2012 were selected as D-TBL group and 54 students in clinic medicine of grade 2013 were selected as LBL group.Both groups have teaching content,textbook,teachers,class hours in common.Effect of teaching was valued by tests,evaluation in students,questionnaires.SPSS was used to analyze scores of tests.T test was used.Results The correct answer rate?of subject items in D-TBL group was higher than that of LBL group and the difference had statistical significance [(94.56 ± 4.95)％ vs.(29.26 ± 12.15)％,t=36.382,P=0.000).There was no significant difference between the correct answer rate of personal test in D-TBL group and objective item in the LBL group[(75.20 ± 11.82)％ vs.(68.61 ± 14.65)％,t=2.512,P=0.374].There was no statistically significant difference between the correct answer rate of group test in D-TBL group and objective item in the LBL group[(84.25 ± 13.08)％ vs.(68.61 ± 14.65)％,t=5.727,P=0.961].In Score table for members in every division,41(85.42％) students got straight A,7(14.58％) students got B and nobody got C.Feedback questionnaire showed 40(83.33％) students like D-TBL while 26(50.00％) students like LBL.Conclusion Most of students in D-TBL group like D-TBL.D-TBL and LBL cannot take the place of each other.In the future teaching,both methods should be used in different teaching periods according to their merits.
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BACKGROUND:To repair and reconstruct the joint capsule and surrounding ligaments is one of effective methods against displacement and dislocation after total hip arthroplasty. In recent years, anterolateral total hip arthroplasty has been widely used, but little is reported on the anatomic features of the anterolateral hip joint capsule and iliofemoral ligament. OBJECTIVE:To investigate the anatomic features of the anterolateral hip joint capsule and iliofemoral ligaments, thereby providing anatomic evidence for selecting and optimizing the approach for total hip arthroplasty and for clinical practice. METHODS:Thirty adult cadaver hips fixed with formalin were used for this study. The anterolateral hip joint capsule and the iliofemoral ligaments were dissected and anterolateral hip joint capsules were divided into three sections and nine parts. The average thickness of each part and the average height and width of each section were measured. The anterolateral hip joint capsule was observed by its beginning and ending, course, branch and histological features. RESULTS AND CONCLUSION:The anterolateral hip joint capsule was tightly connected with the iliofemoral ligaments to form a complex. The thickness of the capsule was varied. The thinnest parts of the complex were BI and BII. In addition, the average height and width of each section were different. The joint capsule originating from the anterior inferior iliac spine and acetabulum was divided into three branches and fixed on the intertrochanteric line. Understanding of the anterolateral hip joint capsule and iliofemoral ligaments may make for the approach selection, design and optimization of total hip arthroplasty.
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Teachers applied task-based learning and Team-based learning methods in the course of ethnic medicine.Teaching contents were classified according to relations of different herbs and quantity of herbs in each chapter.7-9 students formed a learning group which was also called team.Learning groups prepared lessons before class,debated on different tasks such as herb identification and treatment prescription of clinical cases in class,and drew a conclusion after debates.Learning groups expounded their viewpoints and debated with other learning groups about different views.Teachers recorded and commented on viewpoints from each learning group.After class,through a questionnaire,teachers understood the students' feedback to the whole teaching process,and the effect of application of task driven and cooperative team learning got students' recognition.In the future,we will make some improvement by increasing the classroom comment,improving the preparation before class,increasing the efficiency of learning group presentation and debate time,enriching teachers' academic knowledge and improving their teaching skills.
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Objective To investigate the causes and countermeasures of medical disputes between nursing students and patients in hospitals, which will prevent the occurrence of the disputes and promote the comprehensive development of the hospitals. Methods The causes of 107 cases of medical disputes between nursing students and patients during the last three years in hospitals was analyzed. Results In recent years, there was an upward trend in medical disputes be-tween nursing students and patients, in which 57%were caused by poor communication and service attitude. And some preventive measures were put forward. Conclusion To strengthen the communication between nursing students and pa-tients, improve service awareness, better service attitude, enhance the legal safety education, regulate the profession practice and improve the comprehensive quality and nursing quality of nursing students are the key factors in reducing the nurse-patient disputes.
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Objective To investigate safety and efficacy of hysteroscopy in treatment of cesarean scar pregnancy(CSP).Methods From Aug.2003 to Dec.2011, 33 cases with CSP treated by hysteroscopy guided by transabdominal ultrasound or laparoscopy were studied retrospectively in Women's Hospital,School of Medicine, Zhejiang University.The clinical characteristics including gestational age, myometrial thickness anterior to the CSP, β-hCG level before treatment,success rate, cure rate, operative time, blood loss, time of serum β-hCG resolution and CSP mass clearance, and complication were collected and analyzed.Results Median gestational age was 54 days (range, 37 - 140 days).Median level of β-hCG before treatment was 15 000 U/L( range,3.3 - 151 747 U/L).Mean thickness of anterior myometrium was 3.3 mm.Twenty-nine cases underwent uterine artery embolism (UAE) before hysteroscopy.Pouch in the anterior uterine isthmus with gestation masses implanted were observed in 30 cases (91%, 30/33 ).CSP masses progressed toward the pouch or uterine cavity in all cases was removed by cutting wire loop electrode combined with curettage.The mean operative time was (34 ± 10) minutes.Both success rate and cure rate were 94% ( 31/33 ) .Salvage methotrexate ( MTX ) therapy was administrated in one case.Complication occurred in three cases (9%, 3/33 ).Both massive hemorrhage rate and hysterectomy rate were performed in two cases (6%, 2/33).No uterine perforation occurred.The mean time of hCG resolution was (22 ± 10)days.The mean time of CSP mass clearance was (21 ± 12) days.Four pregnancies were achieved in four cases:one term pregnancy and three abortions.No recurrent CSP occurred.Conclusion Management of CSP by hysteroscopy combined with UAE is safe and effective.
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Objective To investigate the association between distribution of protein gene product (PGP) 9.5-immunoactive nerve fibers in peritoneal endometriotic lesions and disease-associated pain symptoms.Methods Thirty two peritoneal endometriotic lesions from patients with endometriosis (16 cases with pain and 16 cases without pain) and matched with 20 peritoneal tissues from patients with uterine leiomyoma without endometriosis were stained immunohistochemically for PGPg.5-immunoactive nerve fibers.Results The positive rate and density of PGP9.5-immunoreactive nerve fibers in peritoneal endometriotic leision were 62% (10/16) and (3.8 ± 1.7)/mm~2 in endometriosis patients with pain, which were significantly higher than 19% (3/16) and (1.7 ± 0.5)/mm~2 in endometriosis patients without pain (P <0.05) and 25% (5/20) and (1.3±0.6) /mm~2 in peritoneal tissues in women without endometriosis (P <0.05).However, no differences were found between endometriosis patients without pain and women without endometriosis (P > 0.05) .Moreover, the density of PGP9.5-immunoreactive nerve fibers in peritoneal lesions in endometriosis patients with pain was positively correlated with the severity of pain (r = 0.855, P < 0.05).In addition, the density of PGP9.5-immunoreactive nerve fibers in peritoneal lesions was statistically higher in endometriosis patients with chronic pelvic pain and(or) dysmenorrhea than those in endometriosis patients with other type of pain(P < 0.05), which was not associated with active lesion, site and staging (P > 0.05).Conclusion It suggested that PGP9.5-immunoreactive nerve fibers might confer the mechanism of pelvic pain with endometriosis.
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Objective To evaluate the quality of literatures and the accuracy of ultrasonography in diagnosis of deeply infiltrating endometriosis(DIE).Methods The database of Medline (1966 to 2009), the excerpta medica database (EMBASE, 1980 to 2009), Chinese biological medicine on disc (CBMdisc, 1978 to 2009), China national knowledge infrastructure (CNKI, 1979 to 2009) and VIP for Chinese technology periodical database (VIP, 1989 to 2009) Cochrane library of studies about the diagnosis of ultrasound for DIE were searched and analyzed.Quality assessment of diagnostic accuracy studies (QUADAS) items were used to evaluate the quality of literatures.The sensitivity, specificity, positive likelihood ratio(+ LR), negative likelihood ratio (-LR) ,diagnostic test odds ratio (DOR) for the pooled analysis and heterogeneity test were analyzed for transvaginal ultrasonography(TVUS), transrectal ultrasonography (TRUS) and rectal endoscopic sonography(EUS) by Meta-disc software, and drew the summary receiver operating characteristic (SROC) curves for those without heterogeneity.Results Totally 15 literatures in English were enrolled into this study.The positive rate of 10 items of QUADAS were above 60%, whereas that of the 11th item "Were the reference standard results interpreted without knowledge of the results of the index test" was 46.7% ;none of studies had mentioned the 13th item " Were uninterpretable/intermediate test results reported".All researches had no heterogeneity by explored threshold effect.The results of pooled sensitivity, specificity, + LR, - LR, DOR were 0.925,0.986, 30.036,0.107, 299.25 for TRUS, 0.799,0.944,11.972,0.187, 69.126 for transvaginal ultrasonography (TVUS), and 0.635,0.928,8.022, O.320, 39.606 for EUS, respectively.Area under the curve of EUS was 0.9479, and that of TVUS was 0.9246.Conclusions TRUS,TVUS and EUS all showed optimal value in diagnosis of DIE.The bias identified from the 15 studies might be mainly resulted from reference standard review bias.
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Objective To investigate nerve fibers distribution in endometrium of adenomyosis and their relationship with dysmenorrhea. Methods Endometrial tissue was sampled from 74 hysterectomy specimens including 32 cases with adenomyosis and 42 cases with uterine fibroids. Two-step Envision immunohistochemical staining was used to detect distribution of nerve fibers in endometrium. Highly specific polyclonal rabbit anti-protein gene product 9.5 (PGP9.5) and monoclonal mouse anti-neurofilament protein (NF) were used to demonstrate both myelinated and unmyelinated nerve fibers in endometrium in women with adenomyosis and uterine fibroids. Results The positive rate of PGP9.5 immunoreactive nerve fibers in the functional layer of endometrium of pain patients were with 64%(14/22) in adenomyosis and 67% (10/15) in uterine fibroids. And their density were 0.6(0-9.4)/mm2 and 0.6(0-6.0)/mm2 without reaching statistical difference (P> 0.05). No expression of NF could be detected in the functional layer of endometrium of adenomyosis and uterine fibroids. There were no PGP9.5 immunoreactive nerve fibers in the functional layer of endometrium in non-pain women with adenomyosis and uterine fibroids. Moreover, No NF immunoreactive nerve fibers in the functional layer of endometrium were shown in non-pain patients with adenomyosis and uterine fibroids. PGP9.5 immunoreactive nerve fibers and the nerve density in the basal layer of endometrium were 64%(14/22), 1.1(0-12.0)/mm2 in pain adenomyosis and 50%(5/10), 0.6(0-3.0)/mm2 in non-pain adenomyosis. NF immunoreactive nerve fibers and the density in the basal layer of endometrium were 23%(5/22),(0-0.6)/mm2 in pain adenomyosis and 20% (2/10),(0-1.0)/mm2 in non-pain adenomyosis. PGP9.5 immunoreactive nerve non-pain fibroids. NF immunoreactive nerve fibers and the nerve density in the basal layer of endometrium were 40%(6/15),0(0-0.4)/mm2 in pain fibroids and 15%(4/27),0(0-1.0)/mm2 in non-pain fibroids. There was no statistical different PGP9.5 and NF immunoreactive nerve fibers distribution in basal layer of endometrium between pain adenomyosis and pain fibroids or between non-pain adenomyosis and non-pain fibroids (all P>0.05). However, PGP9.5 immunoreactive nerve fibers density in basal layer of endometrium was higher in pain adenomyosis and fibroids when compared with non-pain adenomyosis and fibroids(P<0.05). Conclusions PGP9.5 immunoreactive nerve fibers might confer the occurrence of pelvic pain, however, NF immunoreactive nerve fibers may not involved in the pathogenesis of pain.
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BACKGROUND: Skinfold thickness instrument was used to analyze the distribution and development of subcutaneous fat. This method is simple, economic, and widely used. OBJECTIVE: To investigate the body fat development and age changes in female adults from Maonan nationality in Guangxi province. DESIGN, TIME AND SETTING: The cluster sampling investigation was performed at the Department of Anatomy, Basic College, Youjiang Medical College for Nationalities from September to October 2006. PARTICIPANTS: Using random sampling method, 533 healthy adult females of Maonan nationality and aged 25-75 years were selected from Huanjiang county of Guangxi province. They all live in Huanjiang count for over 10 years and their parents were also Maonan nationality. Taking five years were served as a group, totally 10 groups. METHODS: The indexes were measured and calculated by professionals according to Handbook of Human Measure. The equipment was modified skinfold thickness instrument. The database was set up in computer. MAIN OUTCOME MEASURES: Skinfold thickness of triceps brachii, anterior superior iliac spine, inferior angle of scapula and gastrocnemius. Four indexes were compared with other groups in China. RESULTS: The torso skinfold was thicker than limb ones. Skinfold thickness decreased with age after it came to the maximum. Compared with other minornationalities, the skinfold of Maonan adult females in Huanjiang of Guangxi province was thinner than Daur and Uzbek, but thicker than Bouyei nationality. CONCLUSION: The skinfold thickness of Chinese Maonan nationality in Guangxi province has a wavy change. It is thicker than Bouyei nationality and thinner than those in Dong nationality and Daur nationality and Uzbek nationality.
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Objective To found sensitive and reliable method to identify trophoblastic tumor cells in the peripheral blood of the patients suffered from gestational trophoblastic tumor.Methods Given numbers of JAR cell from ten to million were mixed into 10ml non pregnant peripheral blood as a model. Detection of ? hCG mRNA with fluorescence quantitative reverse transcription polymerase chain reaction (FQ RT PCR) and then estimation of the numbers of tumor cell in the blood. Nine cases of peripheral blood were collected from the pretreatment patients of gestational trophoblastic tumor to assay ? hCG mRNA with FQ RT PCR, then to estimate the numbers of tumor cell in the circulation blood. Results FQ RT PCR could detect ? hCG mRNA when ≥10 2 JAR cells were mixed into 10ml non pregnant peripheral blood. Four cases of bloods had been detected ? hCG mRNA expression in 9 cases of gestational trophoblastic tumor, and the numbers of tumor cell from 10 4 to 10 7 per 10ml blood. Conclusion FQ RT PCR of which primers and probe are designed for ? hCG had been proved to be very sensitive detection means, it could be used to detect gestational trophoblastic tumor cells from patient preipheral blood; With FQ RT PCR the tumor cells had been detected in some patients of gestational trophoblastic tumor.
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Objective\ To study the influence of long-term quality of life in MHD patient after their family numbers have received home-nursing education Methods 49 cases of MHD were divided into two groups randomly: the observe groups(n=24),and the control groups(n=25).Both groups were received routing treatment with health education,while the family members of observation groups were also guided with home-nursing education.After one and five years′ treatment,the index of quality of life were compared with SF-36 respectively. Results The quality of life in observation groups was significant higher than that of control group(after one year P
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A rapid, sensitive, reliable and simple microdetermination technology for anti-cancer activity, incorporation technology of ~3H-TdR, was developed to seek the process for anti-cancer preparations of compound Chinese medicines. In such a way, more rational process could be drafted during the short time. The preparation made by this process was found to possess good curative effect, no obvious toxicity and no side-effect in the compreshensive evaluation of clinic and a total 14 biology indexes, The application of some rapid and sensitive medical-determination technology in studies of preparation process, quality standards and stability could solve some problems induced by indefinite active components, make research way broad, and raise research level.