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期刊攒述-2012年6月
时间:2012.09.28
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产科与生殖



一项随机对照队列研究显示,妊娠34周后提前剖宫产对于子痫患者并不能提供更好围产期结局[1]。


ACOG对器械技术的评估:超声子宫造影[2]。


ACOG委员会意见:领养[3];疾病风险的个体化基因检测[4]。以及实践指南:早产的管理[5]。


综述:未知的恐惧——孕期暴露于电离辐射[6]。


综述:模拟病例作为产科综合患者安全程序的一部分[7]。


临床观点:产后高血压-先兆子痫的病因学和管理[8]。


一项前瞻性队列研究利用多元回归模型分析预测早产的高危因素[9],这些因素包括初始的宫颈扩张程度,产前随诊的有无,烟草的使用等等。结果发现它们有很好的阴性预测值。


对于绝大部分(99%)阴道分娩后绒毛膜羊膜炎,抗生素短期使用就已足够;剖宫产后的情况需要适当延长使用[10]。


回顾性队列研究:足月分娩的情况中,阴道检查的数目并不增加母亲发热的风险[11]。


一项大规模队列研究发现,93%总体体重增加超过标准的情况发生其早孕期就有体重过多增加,对于低危的初产妇,早期过多体重增加和GDM的发生以及胎儿体重的过多增加有关[12]。


队列研究发现,在产科门诊中开展精神心理筛查可以显著改善妊娠结局[13]。


人群基础的前瞻性队列研究发现,妊娠前半期母亲血液中的一些血管形成和纤溶因子(可溶性fms样激酶1,胎盘生长因子,PAI-2)的浓度与子宫胎盘血管阻力、胎盘重量和出生体重有关[14]。另外,孕早期胎盘生长因子和PAI-2与不良妊娠结局风险的增加也有关。


为期4年的回顾性研究:孕中期硫酸镁对胎心模式的影响[15]。妊娠结局不受影响。


回顾性队列研究:自然分娩和引产的产程进展比较[16]。引产的潜伏期显著长于自然产程进展的情况,但是活跃期没有差别。对于引产患者,潜伏期延长的诊断需要慎重。


回顾性队列研究:围产期因为治疗困难的宫缩乏力而行急诊全子宫切除的患者其急性临床炎症和病理表现更为多见[17]。


不同孕周胎盘重量和不良妊娠结局——大规模队列研究:胎盘重量是不良围产期结局的独立因素[18]。


随机对照研究:剖宫产术中行腹腔内冲洗增加术中恶心,且不能降低术后感染率[19]。


γ-干扰素释放分析检测可在孕期各个阶段诊断潜伏的结核感染[20]。


加拿大一项回顾性人群基础的队列研究发现,出院时足月新生儿完全母乳喂养的情况不足三分之二[21]。


低危风险的初产妇孕早期先兆子痫的预测——多中心观察性研究:结果没有发现可靠的指标以建立预测模式[22]。


母亲色氨酸和犬尿氨酸途径代谢物和先兆子痫的风险——大规模队列研究:肥胖女性在孕早期血清犬尿氨酸浓度的增加与先兆子痫的增加明显有关[23]。


一项胎盘病变和母胎临床情况与妊娠结局的研究发现大部分胎盘病变的预测价值仍不确定[24]。


病例报道:首次以开放的实时MRI观察分娩的过程[25]。这个也能想出来!


膀胱外翻是一种罕见的泌尿生殖道畸形,一项观察性横断面研究显示:膀胱外翻的女性生育力受损,妊娠对于母亲和宝宝都是危险的,应该在三级医院行剖宫产[26]。


病例报道:双胎之一纸样儿[27]。


多中心的对照研究:应用护士电话管理程序对GDM患者进行指导,可以降低巨大儿的风险,增加产后血糖监测的频率[28]。


产科学基础研究:产前限制蛋白质摄入的孕鼠后代血管紧张素受体以及血管舒缩反应的变化,可能和高血压发生有关[29]。


一项在极早产儿出生2年后神经发育的研究显示,胎盘病理对于这些及早产儿的神经发育有不同程度的影响,应该在评估其神经发育结局时予以重视[30]。


爱尔兰的一项调查显示,由于2000年发表的一篇队列研究发现臀位剖宫产要比阴道分娩安全,文章发表后8年臀位分娩的比例较发表前8年显著下降[31]。


一项根据208,695份电子病历数据进行的美国2002-2008年间引产情况的调查[32]。


综述:子宫移植——动物模型和在人类中的可能性[33]。


观点:极端不育[34]。


宫颈癌进行盆腔放疗的患者其卵巢移位的位置与卵巢功能的关系:文章建议将卵巢移至髂嵴以上1.5 cm的位置以避免卵巢衰竭[35]。


18例冷冻/解冻卵巢皮质移植女性卵巢储备功能的评估及辅助生育的结局:这些女性进行辅助生育的结局相对较差,可能反应了滤泡选择功能的下降[36]。


综述:卵巢组织和滤泡移植作为保留生育功能的一种方案[37]。


综述:人类多能干细胞从生殖细胞系发育到不育的疾病模型[38]。


新概念:体外受精实验室机械化的全部实现——向机器人辅助生育发展?[39]


温的和冷的介质用于子宫输卵管造影的前瞻性对照研究:温的介质可以减少HSG的疼痛,以及卵管痉挛的发生率[40]。


回顾性研究发现,通过IVF妊娠的内异症患者其产科并发症的风险并没有显著增加[41]。


一项在狒狒身上进行自体同源子宫移植的不同术式的长期随访[42]。哈,很精细的手术啊。


从广泛子宫切除得到的经验表明,如果术中仔细分解子宫动静脉,并尽量切除足够长的子宫血管,并不影响患者的术后恢复[43]。这样的手术也可为未来的子宫移植创造条件。


961例以宽松四象限缝合(0,3,6,9四点各简单缝合一针)以行输卵管再通术的长期随访:总体妊娠率高达85.1%,2.5%为异位妊娠[44]。壶腹部和间质部的再通部位最易发生异位妊娠。


一项最新的儿童肿瘤组的报告说明,父母的不育及其治疗与后代肝母细胞瘤之间的关系缺少证据[45]。


前瞻性随机对照研究:对于不育、多毛的PCOS患者,以克罗米芬、二甲双胍或二者联合治疗,都不能改变多毛状况[46]。


普通妇科


手术前沿:老年患者的妇科手术[47]。


随机双盲对照研究发现,连续或周期应用口服短效避孕药对于治疗原发痛经都是有效的,短期内连续应用效果更好,但是过了6个月后这种优势就不存在了[48]。


针对腹膜相关炎性因子的研究发现,腹腔镜手术CO2气腹压力如调整为8 mmHg要比传统的12 mmHg对于腹膜环境更为有利[49]。


芬兰一项良性疾病行全子宫切除相关血栓处理的全国性调查:随着预防性抗凝的开展(64.8%),深静脉血栓的发生率很罕见(0.1%)[50]。


北京协和医院陈娜等[51]研究:累积肛门括约肌的内异症治疗——紧邻病灶切除并行括约肌成形术是治疗成功的关键。


病例对照研究:内异症患者中腹膜VEGF-A水平的升高可能和内异症病程中粘连发生率降低有关[52]。


前瞻性研究:腹腔镜卵巢内异症囊肿剔除导致患者血清抗苗勒氏管激素(AMH)水平显著的进行性下降[53]。


一项多中心回顾性研究发现,通过IVF妊娠的内异症患者,与没有内异症的IVF患者相比,产科并发症的风险并没有显著增加[41]。


内异症基础研究:和在位内膜相比,内异症患者中Pax2基因在病灶中降调节,可能与EGFR表达降低有关[54]。


E-钙粘蛋白多型性rs4783689与日本人群的内异症有边缘性相关,提示E-钙粘蛋白可能牵涉到内异症的基因易感性[55]。


BDNFMet寡核苷酸多态性可能导致III-IV期内异症易感性的增加及内异症相关不育[56]。


病例报道:子宫阴道纵隔、处女膜闭锁及双侧阴道积脓[57]。


利用切除的全子宫构建的一种体外子宫平滑肌瘤及相应匹配子宫内膜的三维培养模型[58]:可保持原有组织的分子表型,能产生细胞外基质,并且能够和细胞外基质相互作用。


多中心随机对照双盲研究:依地普伦(escitalopram,抗抑郁药)对潮热干预的效果[59]。10-20 mg/d总计8周的治疗可改善患者的生活质量。


横断面病例对照研究:生殖支原体(Mycoplasma genitalium)是宫颈炎和PID的独立的强高危因素,但是和沙眼衣原体相比,临床表现较少[60]。


队列研究:不同避孕方法的女性对于避孕效果的知识存在较大差异[61]。


一项依托孕烯(etonogestrel)皮埋剂在产后的应用研究发现,这种避孕方式要比对照组显著降低近期内(<1年)再次妊娠的比例[62]。


专家综述:现役军人的意外妊娠和避孕[63]。


一种LEEP手术训练模式:总计2.5天,训练前后对医师的评估存在显著差异,且这种进步与既往手术技能无关[64]。


病例报道:宫外腺肌瘤MRI的间期变化[65]。


在内异症免疫活性老鼠模型中维甲酸抑制病灶发展和腹膜细胞因子分泌,并促进巨噬细胞分化[66]。


妇科肿瘤


淋巴结比例(lymph node ratio)指阳性淋巴结在全部淋巴结中所占比例。一项回顾性队列研究发现对于接受系统性淋巴切除的III期内膜癌患者,淋巴结比例是很有用的预后因素[67]。


一项对照研究发现,对于早期宫颈癌的肥胖女性,腹腔镜宫颈癌根治术在安全性上要优于开腹手术[68]。


根据2006年发表的美国阴道镜和宫颈病变联合会指南针对青少年异常巴氏涂片保守性治疗的依从性调查——回归性队列研究[69]。


年轻和青少年女性宫颈外翻(宫颈糜烂)与HPV感染的关系——前瞻性队列研究:宫颈外翻的程度与HPV感染没有明确相关[70]。


Fertility and Sterility发表了一篇53例患者的回顾性研究:宫颈癌进行盆腔放疗的患者其卵巢移位的位置与卵巢功能的关系[35]。文章建议将卵巢移至髂嵴以上1.5 cm的位置以避免卵巢衰竭。


利用倾向评分匹配对大型内膜癌数据库进行分析,发现系统性淋巴结切除对于I期内膜癌患者并不能改善生存,除了低分化的情况[71]。所谓倾向评分匹配(propensity score matching),是一种非实验方法,对于一些没有采用实验方法区分实验组和参照组的数据采用了一种近似于实验的方法,尽可能的产生出随机分组,以控制可观测变量)。


一项法国的多中心研究显示,孕期诊断的卵巢交界性肿瘤表现出很高比例的侵袭性,剖宫产时很难得到全面分期[72]。文章建议行预防性的附件切除,并考虑再分期手术。


Annals of Oncology综述:阿司匹林和癌症风险[73]。


综述和系统性分析:2008年因为感染导致癌症的全球负担[74]。


病理学研究:Lynch综合征中错配修复缺陷隐窝灶的发生率[75]。


综述:miRNA在癌症治疗中的应用[76]。


其他


过去一年中最好的有关乳腺疾病的文章——专家观点[77]。


参考文献

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