城市网红地标建筑设计现象刍议——以重庆市杨家坪“九龙门”轻轨站地标设计为例

随着城市化的进程不断加快,现代城市公共空间类型不断拓展,地标建筑作为城市形象的重要展示部分,在城市发展中占有重要的战略地位。文章对城市网红地标建筑进行研究与分析,探讨信息化时代城市地标建筑设计的要素与不足之处,以解决城市地标建筑设计未来发展中面临的问题。

中国寻求流产的未婚年轻妇女的性虐待和生殖健康

To investigate sexual violence and its impact on reproductive health in unmarried young women seeking abortion in China. Methods: A total of 2002 participants were surveyed by questionnaire, gynecologic examination,and laboratory tests for sexually transmitted disease (STD). Results: Overall, 14% of participants had experienced sexual violence and 43.4% were diagnosed with STD. Among victims of sexual abuse, 8.6% had their first sexual encounter when they were younger than 18 years; 42.7% had had 2 or more sexual partners; and 21.6% never used contraception. Multivariate analysis revealed that sexual abuse, multiple sexual partners, sexual activity before the age of 18 years, and not using contraception were important indicators of the presence of STD. Conclusion: The prevalence of sexual abuse is high in China; and among unmarried young women seeking abortion, those who experience sexual abuse are at significantly increased risk for STD.

定期锻炼,调整绝经期不适

有3／4的女性在绝经后会有潮热，有10％的女性在10年或者15年之后，仍会出现潮热。除了激素替代疗法，运动也是一种方法。潮热往往会干扰睡眠，而运动则利于睡眠，从而减轻疲劳。在这一时期，运动具有能减轻压力、改善情绪的潜在功能。

关于母亲孕期维生素D状况与儿童9岁时骨量关系的纵向研究

Background: Vitamin D insufficiency is common in women of childbearing age and increasing evidence suggests that the risk of osteoporotic fracture in adulthood could be determined partly by environmental factors during intrauterine and early postnatal life. We investigated the effect of maternal vitamin D status during pregnancy on childhood skeletal growth. Methods: In a longitudinal study, we studied 198 children born in 1991-92 in a hospital in Southampton, UK; the body build, nutrition, and vitamin D status of their mothers had been characterised during pregnancy. The children were followed up at age 9 years to relate these maternal characteristics to their body size and bone mass. Findings: 49 (31%) mothers had insufficient and 28 (18%) had deficient circulating concentrations of 25(OH)-vitamin D during late pregnancy. Reduced concentration of 25(OH)-vitamin D in mothers during late pregnancy was associated with reduced whole-body (r = 0.21, p = 0.0088) and lumbar-spine (r = 0.17, p = 0.03) bone-mineral content in children at age 9 years. Both the estimated exposure to ultraviolet B radiation during late pregnancy and the maternal use of vitamin D supplements predicted maternal 25(OH)-vitamin D concentration (p < 0.0001 and p = 0.0110, respectively) and childhood bone mass (p = 0.0267). Reduced concentration of umbilical-venous calcium also predicted reduced childhood bone mass (p = 0.0286). Interpretation: Maternal vitamin D insufficiency is common during pregnancy and is associated with reduced bone-mineral accrual in the offspring during childhood; this association is mediated partly through the concentration of umbilical venous calcium. Vitamin D supplementation of pregnant women, especially during winter months, could lead to longlasting reductions in the risk of osteoporotic fracture in their offspring.

林奇综合征患者行预防性妇科手术以降低妇科肿瘤风险的研究

Women with the Lynch syndrome (hereditary nonpolyposis colorectal cancer) have a 40 to 60 percent lifetime risk of endometrial cancer and a 10 to 12 percent lifetime risk of ovarian cancer. The benefit of prophylactic gynecologic surgery for women with this syndrome has been uncertain. We designed this study to determine the reduction in the risk of gynecologic cancers associated with prophylactic hysterectomy and bilateral salpingo oophorectomy in women with the Lynch syndrome. METHODS: Three hundred fifteen women with documented germ line mutations associated with the Lynch syndrome were identified. Women who had undergone prophylactic hysterectomy (61 women)- and women who had undergone prophylactic bilateral salpingo oophorectomy (47 women) were matched with mutation positive women who had not undergone the procedure in question (210 women for the analysis of endometrial cancer and 223 for the analysis of ovarian cancer). Women who had undergone prophylactic surgery and their matched controls were followed from the date of the surgery until the occurrence of cancer or until the data were censored at the time of the last follow up visit. RESULTS: There were no occurrences of endometrial, ovarian, or primary peritoneal cancer among the women who had undergone prophylactic surgery. Endometrial cancer was diagnosed in 69 women in the control group (33 percent), for an incidence density of 0.045 per woman year, yielding a prevented fraction (the proportion of potential new cancers prevented) of 100 percent (95 percent confidence interval, 90 to 100 percent). Ovarian cancer was diagnosed in 12 women in the control group (5 percent), for an incidence density of 0.005 per woman year, yielding a prevented fraction of 100 percent (95 percent confidence interval,- 62 to 100 percent). CONCLUSIONS: These findings suggest that prophylactic hysterectomy with bilateral salpingo oophorectomy is an effective strategy for preventing endometrial and ovarian cancer in women with the Lynch syndrome.

母体特征联合宫颈长度在预测双胎妊娠自发早产中的作用

Objective: The purpose of this study was to examine the value of combining maternal characteristics and measurement of cervical length at 22 to 24 weeks in the prediction of spontaneous early preterm delivery. Study design: Cervical length was measured by transvaginal sonography at 22 to 24 weeks in 1163 twin pregnancies attending for routine antenatal care. Logistic regression analysis was used to examine the effect of maternal demographic characteristics and cervical length on the risk of spontaneous early preterm delivery. Results: The rate of spontaneous delivery before 32 weeks was 6.5% . The rate of early delivery was inversely related to cervical length,and for a false-positive rate of 10% , the detection rate of early delivery was 65.3% . The respective detection rate for maternal characteristics and obstetric history was 26.4% . Logistic regression analysis demonstrated that the only significant independent predictor of spontaneous early delivery was cervical length. Conclusion: In twins, the prediction of spontaneous early preterm delivery by measurement of cervical length at 22 to 24 weeks is not improved by maternal characteristics.

经阴道局部注射高渗葡萄糖液治疗异位妊娠

BACKGROUND: We report the technique and long-term outcome after a conservative approach for the treatment of heterotopic pregnancy. CASE: Two women aged 31 and 30 years presented with heterotopic pregnancies after controlled ovarian hyperstimulation intrauterine insemination. Transvaginal ultrasound-guided needle aspiration of the ectopic gestational sac and instillation of hyperosmolar glucose were performed. The ectopic pregnancies resolved without further intervention in both cases. The intrauterine pregnancies resulted in live births by cesarean delivery. Bilateral tubal patency was subsequently confirmed in both patients. CONCLUSION: Local injection of 50%glucose after aspiration of the tubal gestational sac fluid under transvaginal ultrasonographic guidance proved effective in resolving the ectopic pregnancy without adversely affecting the concurrent intrauterine pregnancy. This is a simple and inexpensive treatment modality.

子宫骶骨韧带阴道穹隆悬吊术:5年结局

OBJECTIVE: To evaluate the five-year anatomic and functional outcomes of the high uterosacral vaginal vault suspension. METHODS: One hundred ten patients with advanced symptomatic uterovaginal or posthysterectomy prolapse treated between January 1997 and January 2000 were identified and 72 (65% ) consented to participate in this study. Anatomic outcomes were obtained by Pelvic Organ Prolapse Quantification. Functional results were obtained subjectively and with quality of life questionnaires, including the short-form Incontinence Impact Questionnaire (IIQ) and Urogenital Distress Inventory (UDI), and Female Sexual Function Index. RESULTS: The mean follow-up period was 5.1 years (range 3.5- 7.5 years). Vaginal hysterectomy (37.5% ), anterior colporrhaphy (58.3% ), posterior colporrhaphy (87.5% ), and suburethral slings (31.9% ) were performed as indicated. Surgical failure (symptomatic recurrent prolapse of stage 2 or greater in one or more segments) was 11 of 72 (15.3% ). Two patients (2.8% ) had recurrence of apical prolapse of stage 2 or greater. For those sexually active preoperatively and postoperatively (n=34), mean postoperative Female Sexual Function Index scores for arousal, lubrication, orgasm, satisfaction, and pain were normal, whereas the desire score was abnormal (mean= 3.2). However, 94% (n=29) were currently satisfied with their sexual activity. Postoperative IIQ/UDI scores were significantly improved in all three domains (irritative, P= .01; obstructive, P < .001; stress, P=.03) and overall (IIQ- 7, P < .001; UDI, P < .001) compared with preoperatively. Bowel dysfunction occurred 33.3% preoperatively compared with 27.8% postoperatively (P=.24). CONCLUSION: Uterosacral ligament vaginal vault fixation seems to be a durable procedure for vaginal repair of enterocele and vaginal vault prolapse. Lower urinary tract, bowel, and sexual function may be maintained or improved.

氯化钾治疗输卵管妊娠的手术风险

BACKGROUND: Spontaneous heterotopic pregnancies are rare, but with assisted reproductive techniques the incidence may approach 1∶100. With the widespread use of transvaginal ultrasonography, physicians have attempted treatment of heterotopic pregnancies with minimally invasive procedures such as transvaginal guided potassium chloride(KCl) injection. However, there are few data on the success of this treatment. CASE: A 30-year-old primigravida presented with a desired pregnancy and was found to have a tubal pregnancy in addition to an intrauterine pregnancy. Ultrasound-guided KCl injection into the heterotopic pregnancy was complicated by abdominal pain, surgical abdomen, and hemoperitoneum requiring salpingectomy. CONCLUSION: A review of the literature revealed that 55%of tubal heterotopic pregnancies treated by KCl injection required subsequent salpingectomy. This raises concerns about the advisability of this treatment.

重症监护病房产科患者生理改变、年龄及健康(APACHE Ⅲ)评分的应用

Objective: Amean Acute Physiology,Age, and Chronic Health Evaluation (APACHE III) score of > 50 is associated with increased intensive care unit mortality rate in nonpregnant cardiac and trauma patients. The objective was to determine the usefulness of the APACHE III score in maternal admissions to an intensive care unit in a tertiary care center in an urban multicul turalcity. Study design: This was a retrospective review of all maternal admissions ( > 20 weeks of gestation or after delivery)- to an intensive care unit between January 2002 and May 2004. Demographics, obstetric and medical history, and 20 physiologic variables that comprise the APACHE III were recorded.The minimum APACHE III score (lowest risk of death) is 0;maximum is 299. The association between APACHE III scoreand maternal death was assessed with Mann Whitney U test.Significance was assumed at a probability value of < .05. Results:Fifty-eight subjects met the study criteria. Thirty percent of these women were admitted antepartum (27 ± 1.0 weeks of gestation); 31% of the women were admitted on the day of delivery; and 29% of the women were admitted after delivery.Mean maternal age was 27 ± 6.7 years. Acute conditions that resulted in transfer to the intensive care unit included preeclampsia(24% ), cardiorespiratory disease (21% ), hemorrhage(16% ), infection (12% ), trauma (7% ), and thromboembolism(3% ). Fifty-five percent of the women had no previous underlying obstetric complications, and 98% of the women had no underlying chronic health condition. Fifty-eight percent of the women received care in a medical intensive care unit; 28% of the women received care in a surgical intensive care unit; 10% of the women received care in a cardiac intensive care unit, and 3% of the women received care in a neurologic intensive care unit. The mean intensive care unit stay was 3.7 ± 4.6 days, and the mean hospital stay was 9.0 ± 7 days. Three patients died; the rest of the patients went home in good condition. The median APACHE III score was 34 (range, 14- 102) and was not correlated with maternal death. Conclusion: The APACHE III is not associated with risk of intensive care unit- related maternal death.

胎儿镜激光凝固治疗双胎输血综合征的阶段相关性结局

OBJECTIVE: To assess perinatal outcome in monochorionic twin pregnancies according to different stages of severe mid-trimester twin-twin transfusion syndrome managed by fetoscopic laser coagulation of the placental vascular anastomoses. METHODS: In a prospective study fetoscopic laser therapy was performed in 200 consecutive pregnancieswith severe mid-trimester twin-twin transfusion syndrome at a median gestational age of 20.7 weeks (range 15.9- 25.3 weeks). Outcome data were analyzed for the whole group and separately for each stage according to the Quintero staging system. RESULTS: The overall survival rate was 71.5% (286/400), with survival of both twins in 59.5% (119/200) and survival of at least one of the twins in 83.5% (167/200). The median gestational age at delivery of liveborn neonates was 34.3 weeks (range 23.1- 40.4 weeks). There was a significant trend toward reduced survival rates with increasing stage (P=.038). The percentage of pregnancies with survival of both fetuses was 75.9% (22/29) for stage I, 60.5% (49/81) for stage II, 53.8% (43/80) for stage III, and 50% (5/10) for stage IV. At least one of the twins survived in 93.1% (27/29) at stage I, 82.7% (67/81) at stage II, 82.5% (66/80) at stage III, and 70% (7/10) at stage IV. The overall survival rate for donor fetuses was 70.5% (141/200) and for recipient fetuses, 72.5% (145/200). CONCLUSION: These data show that laser therapy is an effective therapeutic option for all stages of severe twin-twin transfusion syndrome and provide information to counsel patients according to the stage of the syndrome.

绝经后早期乳腺癌患者应用来曲唑和他莫昔芬的疗效比较

The aromatase inhibitor letrozole is a more effective treatment for metastatic breast cancer and more effective in the neoadjuvant setting than tamoxifen. We compared letrozole with tamoxifen as adjuvant treatment for steroid hormone receptor positive breast cancer in postmenopausal women. METHODS: The Breast International Group (BIG) 1- 98 study is a randomized, phase 3, double blind trial that compared five years of treatment with various adjuvant endocrine therapy regimens in postmenopausal women with hormone receptor positive breast cancer: letrozole, letrozole followed by tamoxifen, tamoxifen, and tamoxifen followed by letrozole. This analysis compares the two groups assigned to receive letrozole initially with the two groups assigned to receive tamoxifen initially; events and follow up in the sequential treatment groups were included up to the time that treatments were switched. RESULTS: A total of 8010 women with data that could be assessed were enrolled, 4003 in the letrozole group and 4007 in the tamoxifen group. After a median follow up of 25.8 months, 351 events had occurred in the letrozole group and 428 events in the tamoxifen group, with five year disease free survival estimates of 84.0 percent and 81.4 percent, respectively. As compared with tamoxifen, letrozole significantly reduced the risk of an event ending a period of disease free survival (hazard ratio, 0.81; 95 percent confidence interval, 0.70 to 0.93; P = 0.003), especially the risk of distant recurrence (hazard ratio, 0.73; 95 percent confidence interval, 0.60 to 0.88; P = 0.001). Thromboembolism, endometrial cancer, and vaginal bleeding were more common in the tamoxifen group. Women given letrozole had a higher incidence of skeletal and cardiac events and of hypercholesterolemia. CONCLUSIONS: In postmenopausal women with endocrine responsive breast cancer, adjuvant treatment with letrozole, as compared with tamoxifen, reduced the risk of recurrent diseas, especially at distant sites.

羊水粪染与孕周及新生儿酸碱平衡状态

OBJECTIVE: To estimate whether the acid-base status of neonates born to women with meconium-stained amniotic fluid varies across gestation. METHODS: We carried out a retrospective cohort study of all pregnancies that were complicated by meconium-stained amniotic fluid in 2004. Cases were identified from a perinatal pathology database that contained data on all pregnancies complicated by meconium- stained amniotic fluid. Data abstracted from the charts included gestational age at delivery, umbilical arterial pH, birth weight, and the presence or absence of labor. Cases were stratified according to gestational age at delivery. The distribution of meconium-stained amniotic fluid across gestation was computed. The mean umbilical arterial pH values (with 95% confidence intervals) across gestation were assessed by analysis of variance. RESULTS: The mean umbilical arterial pH in women with meconium-stained amniotic fluid did not differ across gestation. The overall incidence of meconium-stained amniotic fluid was 12.0% (766 of 6,403 deliveries). The rates of meconium-stained amniotic fluid increased from 1.2% at 32 weeks to 100% at 42 weeks. CONCLUSION: The rising incidence of meconium-stained amniotic fluid with gestational age is consistent with the hypothesis that fetal maturation is a major etiologic factor in meconium passage. Also, the lack of variation of mean umbilical arterial pH across gestation suggests that fetal acidemia is not increased when meconium passage occurs earlier in pregnancy rather than at later gestational ages.

宫颈活检的数目和阴道镜检查的敏感性

OBJECTIVE: To examine the influence that type of medical training and number of biopsies have on sensitivity of colposcopically guided biopsies. METHODS: Among 408 women with an adequate enrollment colposcopy and a diagnosis of cervical intraepithelial neoplasia (CIN) 3 or cancer (CIN 3+ ) over 2 years in the Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesions (ASCUS-LSIL) Triage Study, we evaluated factors influencing the sensitivity of the enrollment colposcopic procedure. We used contingency table analysis to examine confounding variables and χ 2 tests to ascertain statistical significance. RESULTS: Overall, 69.9% of women with a cumulative diagnosis of CIN 3+ had a “ true-positive” enrollment colposcopically guided biopsy result of CIN 2 or worse (CIN 2+ ), the threshold that would trigger excisional therapy. The sensitivity of the procedure did not vary significantly by type of colposcopist. However, the sensitivity was significantly greater when the colposcopists took two or more biopsies instead of one (P < .01), a pattern observed across all types of colposcopists. Independent of the severity of the colposcopic impression, the frequency with which colposcopists took two or more biopsies instead of one varied (in descending order) from nurse practitioners to general gynecologists to gynecologic oncology fellows to gynecologic oncologists (P < .01). CONCLUSION: Colposcopy with guided biopsy or biopsies detects approximately two thirds of CIN 3+ . Although the sensitivity of the procedure does not differ significantly by type of medical training, it is greater when two or more biopsies are taken.

与动产前行剖宫产相关的母体发病率同足月引产母体发病率的比较

OBJECTIVE: To estimate the maternal morbidity associated with cesarean deliveries performed at term without labor compared with morbidity associated with induction of labor at term. METHODS: A 15- year population-based cohort study (1988- 2002) using the Nova Scotia Atlee Perinatal Database compared maternal outcomes in nulliparous women delivering by cesarean delivery without labor and nulliparous women at term undergoing induction of labor for planned vaginal delivery with singleton, cephalic presentation. RESULTS: A total of 5,779 pregnancies satisfied inclusion and exclusion criteria, 879 of which were cesarean deliverieswithout labor. There were no maternal deaths. There was no difference in wound infection, puerperal febrile morbidity, blood transfusion or intraoperative trauma. After controlling for potential confounders, women undergoing cesarean delivery without labor were less likely to have complications of early postpartum hemorrhage (relative risk 0.61, 95% confidence interval 0.42- 0.88, number needed to treat 32) and composite maternal morbidity (relative risk 0.71, 95% confidence interval 0.52- 0.95, number needed to treat 34) compared with women undergoing induction of labor. Subgroup analyses of maternal outcomes after induction of labor in women by method of delivery were also performed and demonstrated additional risks of traumatic morbidity after induction of labor. The highest morbidity was found in the assisted vaginal delivery and cesarean delivery in labor groups. CONCLUSION: Early postpartum hemorrhage and composite maternal morbidity were decreased in cesarean delivery without labor compared with induction of labor. Hemorrhagic and traumatic morbidities with labor induction are increased after assisted vaginal delivery and cesarean delivery in labor compared with cesarean delivery without labor.

会阴切开术是经阴道分娩时重度会阴裂伤的危险因素还是保护因素(德国)

Purpose: Is an episiotomy a protective or a risk factor for severe perineal lacerations; which other obstetric influencing factors exist? Patients and Methods: Retrospective analysis of the perinatal data from Berlin from 1993 to 1999. Study inclusion criteria: vaginal delivery in singleton pregnancies. Setting up of two study subgroups: vaginal delivery of singletons, cephalic presentation >34/0 gestational weeks, birth weight 2500 to 4000 g. Separate analysis of the primi- (subgroup 1) and multiparae (subgroup 2). Multivariate analysis with stepwise logistic regression. Identification of factors which correlate with severe perineal lacerations. Results: 74.7% of all vaginal deliveries of singletons (n = 128 745) fulfilled the inclusion criteria. In spontaneous deliveries, the frequency of episiotomy was 60.8% , in vacuum extraction and forceps delivery 95.3 and 98.6% respectively. Severe perineal lacerations were significantly more frequent in vaginal- operative deliveries than in spontaneous vaginal delivery. If no episiotomy was incised, perineal lacerations stage 3/4 were less frequent in spontaneous and vacuum extraction deliveries. Following regression analysis, severe perineal- lacerations were less frequent in primipara if the active period of labour is ≤ 10 minutes, if no episiotomy is incised, in vacuum than in forceps extraction, if fetal head circumference is < 36 cm, and if no further traumas of the birth canal occur. Results were similar for multiparae: severe perineal lacerations were less frequent if the active period of labour is < 10 minutes, if no episiotomy is incised, and if no vaginal operative delivery occurs. Conclusions: Episiotomies seem to carry one of the highest risks for a severe perineal laceration among the avoidable risk factors. Therefore, use of an episiotomy must be restricted to well- justified cases. When considering perineal protection, vacuum extraction should be preferred to forceps extraction.

体外模式人工氧合法治疗产后出血引起的循环骤停

BACKGROUND: Cardiac arrest after postpartum hemorrhage may not respond to advanced life support. Various resuscitation methods have been proposed, including sternotomy and direct cardiac massage. Extracorporeal membrane oxygenation (ECMO) might be an alternative. CASE:We report the case of a woman who suffered atonic uterine hemorrhage perioperatively after cesarean delivery of twins. During initial conservative treatment using pros taglandin analog(sulprostone), cardiac decompensation developed andwas followed by cardiopulmonary arrest. Circulatory failure remained unresponsive after 2 hours of resuscitation, when ECMO was initiated. The ensuing recoverywas favorable. CONCLUSION: Aggressive mechanical circulatory support, such as ECMO, should be considered in a case of potentially reversible cardiocirculatory failure in a young obstetric patient.

下生殖道感染孕妇宫颈黏液中的宫颈炎症细胞因子及其他炎症标志物

To evaluate concentrations of interleukin (IL)- 6, IL- 8, lactoferrin (LF), and alpha defencine (α - DF) in the cervical mucus of pregnant women and analyze their relation to cervicitis and bacterial vaginosis (BV). Methods: Cervical mucus samples were obtained from August 2003 through May 2004 from 157 women who were between the 6th and 36th week of an uncomplicated singleton pregnancy. All women were delivered at term, 69 without BV or cervicitis, 9 with BV, and 79 with cervicitis. Results: Interleukin 8, LF, and μ - DF concentrations were higher in women with cervicitis (0.81 ± 0.36 pg/mL, 14.8 ± 12.3 μ g/mL, and 0.60 ± 0.49 μ g/mL) than in women without BV or cervicitis (0.35 ± 0.34 pg/mL, 8.0 ± 11.0 μ g/mL, and 0.15 ± 0.12 μ g/mL). Interleukin 6 concentration was higher in women with BV (0.26 ± 0.32 pg/mL) than in women without BV or cervicitis (0.09 ± 0.15 pg/mL) or in women with cervicitis (0.12 ± 0.18 pg/mL). Conclusions: Higher levels of inflammatory cytokines in the cervical mucus of pregnant women may lead to early detection of lower genital tract infection.

循环中的血管生成因子与胎盘早剥

OBJECTIVE: Abnormalities in circulating angiogenic factors have been reported in diseases of abnormal placentation, such as preeclampsia and intrauterine growth restriction. Our objective was to determine whether circulating angiogenic factors are altered in another placental vascular disease, abruptio placentae. METHODS: In a nested case-control study of nulliparous pregnancies, we examined levels of placental growth factor (PlGF) and soluble fms-like tyrosine kinase 1 (sFlt-1) in serum collected prospectively from 31 women who later developed placental abruption and from 31 normal control subjects. All serum specimens were collected before the onset of hypertension or abruption and before labor or delivery. Serum angiogenic factors were compared within 3 gestational age windows: early (20 weeks or less), middle (21- 32 weeks), and late (33 weeks or more) pregnancy. RESULTS: During early pregnancy women who developed placental abruption had lower PlGF and higher sFlt- 1 concentrations and higher sFlt- 1/PlGF ratios than women with normal pregnancies. In mid- pregnancy these differences became greater, reaching statistical significance for PlGF concentration (431 versus 654 pg/mL, P < .01) and the sFlt- 1/PlGF ratio (25.3 versus 2.5, P < .01) . When the women with placental abruption were subdivided into those who did (n=10) and those who did not (n=21) develop preeclampsia or gestational hypertension, significant alterations in angiogenic factors were noted only in women who later developed hypertension in pregnancy. Among these women, PlGF concentrations were decreased in mid-pregnancy (160 versus 723 pg/mL, P < .001), and the mid-pregnancy sFlt- 1/PlGF ratio was increased (70.1 versus 2.3, P=.001). CONCLUSION: Serum levels of the proangiogenic factor PlGF were decreased, and those of the antiangiogenic ratio sFlt- 1/PlGF were increased in nulliparous women who subsequently devel-oped hypertension and placental abruption.

重度盆腔脏器脱垂治疗的妇女体型及生活质量

Objective: Women who seek treatment for pelvic organ prolapse strive for an improvement in quality of life. Body image has been shown to be an important component of differences in quality of life. To date, there are no data on body image in patients with advanced pelvic organ prolapse. Our objective was to compare body image and quality of life in women with advanced pelvic organ prolapse with normal controls. Studydesign: We used a case-control study design. Cases were defined as subjects who presented to a tertiary urogynecology clinic with advanced pelvic organ prolapse (stage 3 or 4). Controls were defined as subjects who presented to a tertiary care gynecology or women s health clinic for an annual visit with normal pelvic floor support (stage 0 or 1) and without urinary incontinence. All patients completed a valid and reliable bodyimage scale and a generalized (Short Form Health Survey) and condition-specific (Pelvic Floor Distress Inventory- 20) quality- of- life scale. Linear and logistic regression analyses were performed to adjust for possible confounding variables. Results:Forty-seven case and 51 control subjects were enrolled.After controlling for age, race, parity, previous hysterectomy,and medical comorbidities, subjects with advanced pelvic organ prolapse were more likely to feel self-conscious (adjusted oddsratio 4.7; 95% confidence interval 1.4 to 18, P = .02), less likely to feel physically attractive (adjusted odds ratio 11; 95% confidence interval 2.9 to 51, P < .001), less likely to feel feminine(adjusted odds ratio 4.0; 95% confidence interval 1.2 to 15, P = .03), and less likely to feel sexually attractive (adjusted odds ratio 4.6; 95% confidence interval 1.4 to 17, P = .02) than normal controls. The groups were similar in their feeling of dissatisfaction with appearance when dressed, difficulty looking at themselves naked, avoiding people because of appearance, and overall dissatisfaction with their body. Subjects with advanced pelvic organ prolapse suffered significantly lower quality of life on the physical scale of the SF- 12 (mean 42; 95% confidence interval 39 to 45 versus mean 50; 95% confidence interval 47 to 53, P < .009). However, no differences between groups were noted on the mental scale of the SF- 12 (mean 51; 95% confidence interval 50 to 54 versus mean 50; 95% confidence interva l47 to 52, P = .56). Additionally, subjects with advanced pelvic organ prolapse scored significantly worse on the prolapse, urinary,and colorectal scales and overall summary score of Pelvic Floor Distress Inventory- 20 than normal controls (mean summary score 104; 95% confidence interval 90 to 118 versus mean 29; 95% confidence interval 16 to 43, P < .0001), indicating a decrease in condition-specific quality of life. Worsening body image correlated with lower quality of life on both the physical and mental scales of the SF- 12 as well as the prolapse, urinary,and colorectal scales and overall summary score of Pelvic Floor Distress Inventory- 20 in subjects with advanced pelvic organ prolapse. Conclusion: Women seeking treatment for advanced pelvic organ prolapse have decreased body image and overall quality of life. Body image may be a key determinant for quality of life in patients with advanced prolapse and may be an important outcome measure for treatment evaluation in clinical trials.