PERINATAL FETAL WELL-BEING MONITORING: A COMPARISON BETWEEN RANDOMIZED URINARY ESTRIOL/CREATININE AND SERUM FREE ESTRIOL DETERMINATION

Randomized urinary and blood samples were obtained from three hundred and ninety-two cases of late pregnancies simultaneously for comparison of the validity in perinatal fetal monitoring. The results of randomized urinary estriol/creatinine （RUE3/C） and serum free estriol （SFE3） tests revealed that Ⅰ. The coefficient of correlation between RUE3/C and SFE3 level were close in either normal or high-risk pregnancies （y=0.1477X+14.2368, r=0.4586, n=170; y=0.1724X+8.6698, r=0.5868, n=222, respectively, P【0.001）; 2.92%cases of the false positive rate of RUE3/C were corrected by SFE3 test. In cases of pregnancy-induced hypertension （PIH） the false positive rate of RUE3/C were highest in comparison with those in cuses of other high-risk pregnancies （53.6%）; 3. The correct rate of SFE3 test in prenatal predication of fetal well-being was significantly higher （95.6%） than that of RUE3/C （87.3%） （X2=17.77, P【0.001）. This paper suggests that RUE3/C can be used as a first line test for perinatal monitoring. When RUE3/C value is lower than normal, SFE3 test should be added to ensure the reliability of perinatal diagnosis, especially in PIH cases. Obviously, to use these two tests for perinatal fetal monitoring simultaneously is better than to use any one test alone.

Voltammetric sensor based on cobalt-poly(methionine)-modified glassy carbon electrode for determination of estriol hormone in pharmaceuticals and urine

A voltammetric sensor based on the electropolymerization of cobalt-poly(methionine)(Co-poly(Met)) on a glassy carbon electrode (GCE) was developed and applied for the determination of estriol by differential pulse voltammetry (DPV) for the first time. The electrochemical properties of the Co-poly(Met)/GCE were analysed by cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS). Scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS) were used to characterize the polymers on the GCE surface. The deposition of the Co-poly(Met) film on the GCE surface enhanced the sensor electronic transfer. CV studies revealed that estriol exhibits an irreversible oxidation peak at t0.58 V for the Co-poly(Met)/GCE (vs. Ag/AgCl reference electrode) in 0.10 mol/L Britton-Robinson buffer solution (pH=7.0). Different voltammetric scan rates (10-200 mV/s) suggested that the estriol oxidation on the Co-poly(Met)/GCE surface is controlled by adsorption and diffusion processes. Based on the optimized DPV conditions, the linear responses for estriol quantification were from 0.596 μmol/L to 4.76 μmol/L (R2 =0.996) and from 5.66 μmol/L to 9.90 μmol/L (R2 =0.994) with a limit of detection (LOD) of 0.0340 μmol/L and a limit of quantification (LOQ) of 0.113 μmol/L. The DPV-Co-poly(Met)/GCE method provided good intra-day and inter-day repeatability with RSD values lower than 5%. Also, no interference of real sample matrices was observed on the estriol voltammetric response, making the DPV-Copoly( Met)/GCE highly selective for estriol. The accuracy test showed that the estriol recovery was in the ranges 96.7%-103% and 98.7%-102% for pharmaceutical tablets and human urine, respectively. The estriol quantification in pharmaceutical tablets performed by the Co-poly(Met)/GCE-assisted DPV method was comparable to the official analytical protocols.

A NEW TEST IN ANTENATAL MONITORING-THE EVALUATION OF SALIVARY UNCONJUGATED ESTRIOL MEASUREMENT

A new unconjugated saliva estriol （SE3） determination by radioimmunoassay（3H-E3） was used to monitor 497 fetuses of late pregnancies, including 280 high-risk and217 normal pregnant women. The normal pregnant SE3 values had been established by themeasurement of 1378 cases from 20 to 41 weeks of gestation. The results of SE3 assaysrevealed that 1. In prenatal prediction of fetal well-being, the total false negative andfalse positive rates were 2.0% and 0.6%, respectively, the correct rate which was similarto that of serum free E3 （SFE3） values was 97.4%, and was significantly higher thanthat of overnight 12-hour urine E3/C analyses as formerly reported. 2. There were 8 fetaldeathe in 11 cases with low SE3 levels. No perinatal death occurred in the 486 cases withnormal SE3 values, except one fetus who died of nuchal cord strangulation. It is highlyimportant that the saliva specimen be correctly collected and the technique ofmeasurement of SE3 be carefully carried out. Our observations suggest that the clinicaluse of SE3 assays are scientific, reliable, and it is more practicable than that of SFE3 as-says. The determination of SFE3 can be replaced by SE3 test for assessing fetal-placentalwell-being.

Quality of Life before and after the Use of Vaginal Estriol in Postmenopausal Women with Lower Urinary Tract Symptoms

Background: Nowadays, a substantial number of women spend more than one-third of their lives in the postmenopausal period. It is characterized by a marked decrease in the production of estrogen, which leads to urogenital atrophy. The symptoms stemming from vulvovaginal atrophy and the lower urinary tract are currently referred to as the Genitourinary Syndrome of Menopause (GSM), which can have a negative impact on the quality of life (QoL). Estrogen replacement is the ideal treatment for GSM, and vaginal administration is the most recommended. Objective: To assess the impact of the use of topical vaginal estriol on the quality of life (QoL) of postmenopausal women with lower urinary tract symptoms (LUTS). Methods: This is an interventional, prospective study, performed in 49 women at the Antonio Pedro Hospital, at the Universidade Federal Fluminense, in Niterói, Brazil, from August 2014 to April 2015. It included postmenopausal women with lower urinary tract symptoms who were not using any estrogen hormone therapy, and it excluded those with contraindications for the use of estriol. A specific questionnaire on QoL and urinary tract symptoms, the King’s Health Questionnaire (KHQ), which identifies LUTS and assesses to what extent those symptoms interfere with QoL, has been used as a research tool. Results: The average age was 62.24 years. Urinary urgency and urge incontinence were reported by 91.8% of women. The average scores of the domains of the KHQ decreased in the domains General Health Perception (before: 46.42 ± 21.65;after: 40.81 ± 22.64), Incontinence Impact (before: 74.82 ± 27.66;after: 41.49 ± 30.83), Role Limitations (before: 43.20 ± 32.80;after: 21.09 ± 24.71), Physical Limitations (before: 38.09 ± 32.09;after: 14.62 ± 24.20), Social Limitations (before: 30.38 ± 28.75;after: 12.62 ± 19.85), Emotions (before: 43.31 ± 32.96;after: 20.18 ± 26.41), Sleep/Energy (before: 41.48 ± 37.74;after: 15.98 ± 23.31) and Severity Measures (before: 48.02 ± 24.68;after: 22.31 ± 20.25). All the differences were statistically significant (p-value ≤ 0.05). Conclusion: In the group of postmenopausal women with lower urinary tract symptoms included in the study, the use of topical vaginal estriol led to a decrease in the frequency of each symptom and the average scores in all domains of the KHQ, suggesting a positive effect on women’s QoL.

超声“四切面”法联合妊娠中期产妇血清Freeβ-hCG和uE3筛查胎儿严重先天性心脏病的研究

目的:探究超声“四切面”法联合妊娠中期孕妇血清游离人绒毛膜促性腺激素(Freeβ-hCG)和雌三醇(uE3)筛查胎儿严重先天性心脏病(CHD)的临床应用价值。方法:选择2020年1月到2021年6月我院行妊娠中期CHD筛查的孕妇97例,检测孕妇血清Freeβ-hCG和uE3水平,采用超声“四切面”法筛查CHD,分析超声“四切面”法联合血清Freeβ-hCG和uE3水平对CHD的诊断价值。结果:97例孕妇随访确诊为严重CHD 9例(9/97,9.28%);超声“四切面”法检查提示高危胎儿25例,其中4例确诊为严重CHD(4/25,16.00%);孕妇血清学检测提示高危胎儿36例,其中6例最终确诊为严重CHD(6/36,16.67%);超声“四切面”法联合孕妇血清学检测提示高危胎儿9例,其中5例确诊为严重CHD(5/9,55.56%)。超声“四切面”法筛查严重CHD的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为16.00%、93.51%、74.51%、44.44%和77.22%。孕妇血清Freeβ-hCG和uE3水平筛查严重CHD的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为55.56%、95.31%、92.08%、66.67%和64.00%,二者联合筛查严重CHD的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为55.56%、95.65%、92.08%、55.56%和91.09%。二者联合检测的诊断情况高于单一检测方法(P<0.05)。结论:超声“四切面”法对妊娠中期孕妇筛查严重CHD具有较高的诊断价值,联合孕妇血清Freeβ-hCG和uE3水平能进一步提高诊断准确度,具有较好的临床应用价值。

TORCH联合血清β-hCG、AFP、uE3检测诊断超声软指标异常胎儿价值

目的:探究TORCH联合血清人绒膜促性腺激素(β-hCG)、甲胎蛋白(AFP)和游离雌三醇(uE3)检测对超声软指标异常胎儿产前诊断价值。方法:选取2021年7月-2023年12月于本院产前检查胎儿超声软指标异常的孕妇324例(300例单项软指标异常、24例≥2项软指标异常)纳入异常组,产前检查健康产妇300例纳入对照组。均行TORCH血清学检测,测定血清AFP、freeβ-hCG及uE3水平。对比两组血清TORCH、β-hCG、AFP和uE3检测结果;对比不同软指标异常组血清TORCH、β-hCG、AFP和uE3检测结果;ROC分析TORCH联合血清β-hCG、AFP和uE3对超声软指标异常胎儿产前诊断价值。结果:与对照组相比,异常组血清TORCH阳性率、β-hCG、AFP水平更高,血清uE3水平更低(均P<0.05);与单项软指标异常组相比,多项软指标异常组血清TORCH阳性率、β-hCG、AFP更高,血清uE3水平更低(均P<0.05);ROC工作曲线结果显示,血清TORCH、β-hCG、AFP和uE3联合检测诊断超声软指标异常孕妇的AUC分别为0.927,显著高于指标单独检测,且敏感度和特异度均较高,分别为90.00%和92.59%。结论:对产前检查孕妇行血清TORCH联合β-hCG、AFP和uE3检测,有助于提升超声软指标异常胎儿的产前诊断率,可为临床提供一种准确有效的诊断方法。

高危妊娠孕妇血清游离雌三醇联合胎儿大脑中动脉血流参数对母婴不良结局的预测价值

【目的】探讨高危妊娠孕妇血清游离雌三醇(uE3)联合胎儿大脑中动脉血流参数对母婴不良结局的预测价值。【方法】选取2019年2月至2021年2月在本院定期产检的95例高危妊娠孕妇(观察组),根据孕妇妊娠结局分为不良组和良好组;另选取同期在本院定期产检的88例健康孕妇作为对照组。比较各组孕妇临床资料、血清游离雌三醇(uE3)水平及胎儿大脑中动脉血流参数[大脑中动脉搏动指数(PI)、阻力指数(RI)、收缩期末峰值/舒张期末峰值(S/D)];采用Logistic回归分析高危妊娠孕妇发生不良妊娠结局的危险因素;采用受试者工作特征(ROC)曲线分析胎儿大脑中动脉血流参数和孕妇血清uE3水平对高危妊娠孕妇发生不良妊娠结局的预测价值。【结果】观察组孕妇血清uE3水平及胎儿大脑中动脉PI、RI、S/D均低于对照组(P<0.05)。高危妊娠孕妇不良妊娠结局发生率为35.79%。不良组孕妇血清uE3水平和胎儿大脑中动脉PI、RI、S/D均低于良好组(P<0.05);不良组孕妇流产史、胎盘前置构成比与良好组比较,差异均有统计学意义(P<0.05)。Logistic多因素回归分析结果显示:胎儿PI、RI、S/D低及孕妇血清uE3水平低、胎盘前置均是高危妊娠孕妇发生不良妊娠结局的独立危险因素(P<0.05);ROC曲线分析结果显示,胎儿大脑中动脉PI、RI、S/D和孕妇血清uE3水平预测高危妊娠孕妇发生不良妊娠结局的最佳截断点分别为0.92、0.42、3.20、0.66 ng/mL,曲线下面积(AUC)分别为0.797、0.756、0.708、0.766,联合预测的特异度和AUC分别为98.33%和0.838。【结论】不良妊娠结局孕妇胎儿大脑中动脉PI、RI、S/D及孕妇血清uE3水平降低,监测高危妊娠孕妇胎儿大脑中动脉PI、RI、S/D和孕妇血清uE3水平对不良妊娠结局具有一定的预测价值。

产前血清uE3、游离β-hCG、AFP水平与孕妇不良妊娠结局的相关性分析

目的 分析产前血清游离雌三醇(uE3)、游离人绒毛膜促性腺激素(β-hCG)、甲胎蛋白(AFP)水平与孕妇不良妊娠结局的相关性。方法 选择2022年1月至2023年1月本院200名孕妇,检测产前血清uE3、游离β-hCG、AFP水平,对患者进行随访,统计妊娠结局并据此分为两组,比较高风险妊娠结局组和低风险妊娠结局组孕妇的资料,分析产前血清uE3、游离β-hCG、AFP水平与孕妇高风险妊娠结局的相关性以及对高风险妊娠结局的评估价值。结果 高风险妊娠结局组uE3、AFP水平低于低风险妊娠结局组,游离β-hCG高于低风险妊娠结局组(均P <0.05);经Logistic回归分析结果显示,产前血清uE3、游离β-hCG、AFP水平与孕妇高风险妊娠结局发生有关(P <0.05);绘制ROC曲线图,结果显示,产前血清uE3、游离β-hCG、AFP水平评估孕妇高风险妊娠结局的AUC分别为0.729、0.753、0.765。结论 产前血清uE3、AFP低水平及游离β-hCG高水平与孕妇高风险妊娠结局有关,可作为预测因子预测不良妊娠结局的风险。

Modeling the aqueous reaction kinetics of estriol with ferrate

In this study the aqueous oxidation kinetics of estriol(E3)by potassium ferrate(K_(2)FeO_(4)),a chemical for its strong oxidizing power and for producing a coagulant from its reduced state(i.e.Fe(III)),was evaluated in the range of pH 8–12 with different molar ratios of the reactants.As the degree of Fe(VI)protonation varies with the solution pH,it was found that afirst order model was not suitable to describe the oxidation reaction.This paper describes a theoretical representation that closely models the reaction kinetics of E3 and ferrate.From this modeling,the reaction rates of HFeO_(4)^(-) and FeO_(4)^(2-) with E3 have been determined.The results show that the reactivity of HFeO–with dissociated and undissociated E3 is greater than that4 of FeO_(4)^(2-),and that E3 is more reactive in its dissociated state.

An UPLC-MS/MS method to monitor Estriol injection and comparison of pharmacokinetic characteristics after irradiation

Objective:To develop an UPLC-MS/MS method for the accurate quantification of Estriol(E3),a new radioprotective agent,and observe the variation in pharmacokinetic characteristics of E3 after irradiation.As a hormone drug,the gender differences of E3 metabolism were also concerned here.Methods:Various chromatographic and mass spectrometric conditions of E3 were optimized.The specificity,linearity,precision and accuracy of UPLC-MS/MS method were validated.Twenty SD rats,half male and half female,were administered with intramuscular(im)injection of 2.7 mg/kg E3,and then divided randomly into two groups,sham-irradiated group(Con)and irradiated group(IR).IR group was irradiated to 7 Gy ofγ-rays.Blood samples were collected at different times post-irradiation and E3 concentrations were detected.The changes of concentration-time variation and pharmacokinetic parameters for E3 after irradiation were investigated,together with metabolic differences between male and female rats.Results:The range of the calibration curve of UPLC-MS/MS for E3 was 1.00–200.0 ng/mL.Con group reached maximum concentration(Cmax)(77.57±18.71)ng/mL at(0.68±0.29)h(Tmax)after im injection.The drug concentration-time profiles and pharmacokinetic parameters of E3 were consistent before and after irradiation.The areas under time curve(AUC0-t)of E3 were(353±74)h⋅ng/mL for Con group,and(299±74)h⋅ng/mL for IR group(P>0.05).There were also no statistical differences in pharmacokinetic parameters between female and male rats.The elimination half-lifes(T1/2)of males and females were(3.02±0.68)h and(3.01±0.42)h in Con group,and(3.64±0.51)h and(3.38±0.60)h in IR group,respectively(P>0.05).Conclusion:A rapid and sensitive UPLC-MS/MS method for determination of E3 was established.The pharmacokinetic characteristics of E3 in rat were not affected by 7 Gy irradiation and gender differences.This study provided a theoretical basis for the development and application of new radiation injury treatment drug。

干扰素泡腾片、雌三醇乳膏联合乳杆菌活菌治疗绝经后宫颈高危人乳头瘤病毒感染的临床研究

目的探讨干扰素泡腾片、雌三醇乳膏联合乳杆菌活菌治疗绝经后宫颈高危型人乳头瘤病毒(HR-HPV)感染的临床疗效与安全性。方法选取2021年6月至2022年6月三所医院收治的绝经后宫颈HR-HPV感染患者240例,按随机数字表法分为对照组和研究组各120例。对照组采用干扰素泡腾片与雌三醇乳膏联合治疗,研究组在此基础上加用乳杆菌活菌,两组总疗程均为6个月。比较两组临床疗效,治疗前后的阴道微生态指标、子宫内膜厚度及治疗期间不良反应发生情况。结果研究组治愈率及总有效率明显高于对照组(P<0.05),两组治疗后阴道微生态指标正常比例较治疗前增加(P<0.05),且研究组正常比例高于对照组(P<0.05);两组治疗前后子宫内膜厚度及不良反应发生率比较,差异无统计学意义(P>0.05)。结论干扰素泡腾片、雌三醇乳膏联合乳杆菌活菌治疗绝经后宫颈HR-HPV感染疗效确切,能有效提高HR-HPV清除率,也能显著改善患者绝经后阴道微生态状况,安全性良好。

孕期血清游离雌三醇、胎盘泌乳素及胰岛素样生长因子-1对胎儿生长受限的预测价值

目的:分析孕期血清游离雌三醇(uE3)、胎盘泌乳素(PL)及胰岛素样生长因子-1(IGF-1)对胎儿生长受限(FGR)的预测价值。方法:采用回顾性分析法,对2020年1月至2022年6月在某院系统产检,并住院分娩的孕妇共220例展开研究,其中正常妊娠组110例,FGR组110例。对两组孕妇的一般资料进行比较,并对两组孕妇不同时刻的血清uE3、PL、IGF-1水平进行比较。结果:与正常妊娠组相比,FGR组的年龄、孕前BMI、既往孕次、既往产次、既往剖宫产次、既往流产次无明显差异(P>0.05),FGR组的分娩孕周缩短,差异有统计学意义(P<0.05)。两组孕妇的血清uE3、PL、IGF-1水平均随孕周的增加而升高,且与正常妊娠组相比,FGR组孕妇孕20、24、28、32、36、37周的血清uE3、PL、IGF-1水平均降低,差异有统计学意义(P<0.05)。结论:孕中期、孕晚期的FGR孕妇血清uE3、PL、IGF-1水平均低于同妊娠阶段的正常妊娠妇女,对FGR具有一定的预测价值。

晚孕期多血管血流参数联合胎盘功能评估胎儿生长受限的价值

目的探讨晚孕期多普勒超声技术测定多血管血流参数联合胎盘功能标评估胎儿生长受限(FGR)的价值。方法选择FGR孕妇42例作为FGR组,年龄23~35岁,平均年龄28.8岁(标准差3.35岁);孕周28~37+4周,平均孕周32+6.5周(标准差2+4.5周);孕前身体质量指数(BMI)18.6~23.8 kg/m^(2),平均BMI 21.5 kg/m^(2)(标准差1.43 kg/m^(2))。产前检查正常孕妇61例作为对照组,年龄23~36岁,平均年龄29.3岁(标准差3.49岁);孕周28^(+2)~38周,平均孕周31^(+4.5)周(标准差3^(+2.7)周);孕前BMI 18.2~23.6 kg/m^(2),平均BMI 21.4 kg/m^(2)(标准差1.39 kg/m^(2))。通过多普勒超声检测各组多血管参数,包括脐动脉(UA)、大脑中动脉(MCA)、子宫动脉(UtA)的搏动指数(PI)、阻力指数(RI)及收缩期最大血流速度与舒张末期血流速度之比(S/D),计算脑-胎盘比(CPR)。定量检测母体血清雌三醇(E3)、胎盘泌乳素(HPL),评估胎盘功能,分析多血管血流参数及母体血指标与FGR的相关性,采用受试者工作特性(ROC)曲线评价不同指标对FGR的诊断预测价值。结果FGR组不良妊娠结局的发生率显著高于对照组(61.9%vs 11.5%。P<0.001)。FGR组UA-PI高于对照组(1.06±0.33 vs 0.94±0.19。P<0.05),而两组UA-S/D及RI比较,差异无统计学意义(P>0.05);FGR组MCA各参数[(PI:1.53±0.33 vs 1.75±0.32;S/D:4.26(3.43~5.24)vs 5.12(4.25~6.72);RI:0.76±0.07 vs 0.81±0.06]、CPR(1.59±0.59 vs 1.91±0.44)及母体血清E3[7.79(4.91~11.30)ng/mL vs 12.00(10.20~13.95)ng/mL]和HPL[(9.00±2.80)mg/L vs(11.91±2.27)mg/L]水平低于对照组,FGR组UtA各参数高于对照组[PI:0.75(0.66~1.07)vs 0.56(0.50~0.67);S/D:2.11(1.80~2.78)vs 1.86(1.70~2.19);RI:0.55±0.12 vs 0.47±0.08。均P<0.05]。多普勒超声检测单一血管参数预测FGR的诊断效能普遍较低(AUC<0.7),多普勒超声检测多血管参数联合母体血指标评估FRG(AUC=0.883),可显著提高诊断效能。结论单一血管的多普勒血流参数预测FGR的准确性较低,联合多血管血流参数与胎盘功能综合评估,可提高预测FGR的准确度,避免不良妊娠结局的发生。

母体血清微RNA-146a-5p联合三联法检测在孕中期唐氏综合征筛查中的意义

目的 探讨母体血清微RNA-146a-5p(miR-146a-5p)联合三联法检测在孕中期唐氏综合征筛查中的意义。方法 选取2017年1月至2020年8月于黄冈市中心医院孕中期行唐氏综合征筛查结果为阳性的孕妇65例(病例组),同期选择本院健康的妊娠孕妇65例(对照组)。使用化学发光免疫分析仪检测孕妇血清甲胎蛋白(AFP),人绒毛膜促性腺激素(β-hCG)以及游离雌三醇(uE3)指标。实时荧光定量PCR法检测血清中miR-146a-5p的水平。采用受试者操作特征(ROC)曲线分析母体血清miR-146a-5p联合三联法对孕中期唐氏综合征的预测价值。采用Pearson法分析miR-146a-5p相对表达水平与血清AFP、uE3、β-hCG中位数的倍数(MOM)值的相关性。结果 与对照组(1.89±0.32)U/mL、(1.63±0.36)μg/L、1.03±0.24、(2.41±0.28)μg/L相比,病例组孕妇血清AFP MOM值(2.84±0.27)U/mL、β-hCG MOM值(2.84±0.25)μg/L及血清miR-146a-5p相对表达水平3.07±0.95较高(P<0.05),uE3 MOM值(1.71±0.19)μg/L较低(P<0.05)。Pearson法分析显示,miR-146a-5p与AFP、β-hCG呈正相关(P<0.05),与uE3呈负相关(P<0.05)。ROC曲线结果显示,AFP+uE3+β-hCG预测孕中期唐氏综合征的曲线下面积(AUC)为0.85,灵敏度分别为83.10%,特异度分别为75.40%;miR-146a-5p预测孕中期唐氏综合征的AUC为0.86,灵敏度为81.50%,特异度为87.70%;miR-146a-5p+AFP+uE3+β-hCG预测子孕中期唐氏综合征的AUC为0.91,灵敏度为86.20%,特异度为80.00%,miR-146a-5p联合三联法检测对孕中期唐氏综合征筛查价值高于三联法检测(P<0.05)。结论 母体血清miR-146a-5p联合三联法对孕中期唐氏综合征的预测效能具有较高的临床价值,可为孕中期唐氏综合征筛查提供一种新途径。

彩色多普勒超声联合孕妇血FE3预测胎儿窘迫价值

目的:讨论彩色多普勒超声及母血游离雌三醇(FE3)联合诊断胎儿窘迫的临床价值。方法:选取2020年1月-2021年1月本院收治的78例胎儿窘迫孕妇纳入观察组,正常产前检查孕妇80例纳入对照组,检测两组彩色多普勒超声指标,包括脐动脉(UA)、大脑中动脉(MCA)、肾动脉(RA)阻力指数,检测两组母血FE3水平。采用logistic回归分析影响胎儿窘迫的危险因素。绘制受试者工作特征曲线(ROC)评估上述指标诊断胎儿窘迫价值。结果:观察组多普勒超声检查指标中UA(0.78±0.20)及RA(1.70±0.41)阻力指数高于对照组(0.60±0.15、1.46±0.35),MCA阻力指数(0.53±0.12)及母血FE3(5.38±1.69 ng/ml)低于对照组(0.79±0.22、15.26±2.38 ng/ml)(均P<0.05)。经多因素分析显示,妊娠高血压疾病及剖宫产,以及UA、RA、MCA、母血FE3异常均为胎儿窘迫发生的危险因素(P<0.05);ROC曲线分析,UA、RA、MCA及母血FE3联合诊断胎儿窘迫的灵敏度、准确度、曲线下面积分别为90.3%、86.8%、0.826,诊断效能均高于单一指标,但诊断特异度(75.2%)低于单一指标诊断。结论:彩色多普勒超声指标UA、RA、MCA阻力指数及母血FE3水平异常均为胎儿窘迫发生的危险因素,联合检测诊断胎儿窘迫价值较高。

胎儿NT厚度联合uE3检测在胎儿染色体异常及异常妊娠中的诊断价值

目的分析胎儿颈项透明层厚度(nuchal translucency,NT)联合雌三醇(estriol,uE3)检测与胎儿染色体异常及异常妊娠发生情况的关系。方法选取南京医科大学附属无锡妇幼保健院2019年1月1日至2021年12月31日期间收治的孕早期孕妇作为研究对象,胎儿染色体异常或异常妊娠患者共126例作为观察组,其中胎儿染色体异常的24例孕妇为胎儿染色体异常组,对照组为正常妊娠和分娩的孕妇389例;采用彩色多普勒超声诊断仪对受试者NT进行测量,检测孕妇血中uE3水平;绘制工作者受试曲线分析各指标单独及联合应用对胎儿染色体异常及异常妊娠的诊断价值。结果对照组、观察组和胎儿染色体异常组的NT及uE3水平存在明显差异,其中对照组NT最低,uE3水平最高,差异有统计学意义(P<0.05);NT与胎儿染色体异常及异常妊娠均呈现明显正相关关系,uE3水平与胎儿染色体异常及异常妊娠呈明显负相关关系,差异有统计学意义(P<0.05);NT与uE3联合应用诊断胎儿染色体异常及异常妊娠的曲线下面积均明显高于各指标单独应用,差异有统计学意义(P<0.05)。结论胎儿NT联合uE3检测具有较高的预测胎儿染色体异常及异常妊娠发生的价值。

妊娠期糖尿病患者胎儿主动脉峡部血流参数联合血清游离雌三醇、脂联素水平预测胎儿窘迫的价值

目的探讨妊娠期糖尿病(GDM)患者胎儿主动脉峡部(AOI)血流参数联合血清游离雌三醇(FE3)、脂联素(ADP)水平预测胎儿窘迫(FD)的价值。方法选取我院300例GDM患者,根据是否发生FD分为FD组74例和非FD组226例,另选同期正常妊娠者75例为对照组,比较各组胎儿AOI血流参数[血流指数(IFI)、收缩指数(ISI)]及血清FE3、ADP水平的差异。应用Pearson相关分析法分析血清FE3、ADP水平与胎儿IFI、ISI的关系;绘制受试者工作特征(ROC)曲线分析GDM患者胎儿IFI、ISI和血清FE3、ADP水平单独及联合应用预测FD的效能。结果FD组血清FE3、ADP水平及胎儿IFI均低于非FD组和对照组,胎儿ISI高于非FD组和对照组,差异均有统计学意义(均P<0.05);非FD组血清FE3、ADP水平及胎儿IFI均低于对照组,胎儿ISI高于对照组,差异均有统计学意义(均P<0.05)。Pearson相关分析显示,GDM患者血清FE3水平与胎儿IFI呈正相关(r=0.553,P<0.01),与胎儿ISI呈负相关(r=-0.488,P<0.01);血清ADP水平与胎儿IFI呈正相关(r=0.547,P<0.01),与胎儿ISI呈负相关(r=-0.464,P<0.01)。ROC曲线分析显示,GDM患者胎儿IFI、ISI和血清FE3、ADP水平单独及联合应用预测FD的曲线下面积(AUC)分别为0.711、0.642、0.690、0.811、0.947,血清ADP水平的AUC高于血清FE3水平和胎儿ISI(Z=3.511、3.185,均P<0.05),联合应用预测的AUC高于血清FE3水平和胎儿IFI、ISI(Z=6.952、6.019、9.078,均P<0.05)。结论GDM患者胎儿AOI血流参数IFI、ISI联合血清FE3、ADP水平在预测FD中具有重要价值。

雌三醇关键中间体的连续化合成

氧化反应速度快、放热量大,传统釜式工艺存在传质传热效率低、安全性低、生产效率低等缺点。本文以冰醋酸、浓硫酸、双氧水、乙酸钠为起始物料,通过连续化技术在线制备过氧乙酸,接着与双酯物I进行环氧化反应制备雌三醇的关键中间体环氧物II(3,17β-二乙酰氧基-16α,17α-环氧基-雌甾-1,3,5(10)-三烯),进一步考察了物料配比、反应温度、停留时间对氧化反应的影响。实验结果显示,双酯物I、乙酸钠、双氧水、浓硫酸、冰醋酸的摩尔比约为2:2:12:1:9,过氧乙酸制备温度为60℃,环氧化反应温度为50℃,反应停留时间为75 s为最优反应条件。本工艺利用连续化技术避免了过氧乙酸储存带来的安全隐患,并且大幅缩短了反应时间,过氧化、氧化反应得到有效控制,实现了工艺的本质安全。

复方甲硝唑栓联合雌三醇软膏治疗老年细菌性阴道炎的效果及对睡眠质量的影响分析

目的:观察在对老年细菌性阴道炎患者治疗时按照复方甲硝唑栓联合雌三醇软膏进行治疗的具体效果。方法:选取2022年4月至2023年3月连江和谐医院收治的老年细菌性阴道炎患者60例作为研究对象,按照随机数字表法分为对照组和观察组,每组30例。对照组单用甲硝唑栓治疗,观察组按照复方甲硝唑栓联合雌三醇软膏进行治疗。针对2组睡眠质量、炎症反应水平等进行比较。结果:比较患者睡眠质量,治疗前无差异,治疗后观察组匹兹堡睡眠质量指数(PSQI)低于对照组,差异有统计学意义(P<0.05)。治疗前2组炎性因子水平比较差异小,观察组治疗后低于对照组,差异有统计学意义(P<0.05)。与对照组相比,观察组治疗有效率高,复发率较低,差异有统计学意义(P<0.05)。统计治疗期间不良反应发生率,观察组低于对照组,差异有统计学意义(P<0.05)。结论:在对老年细菌性阴道炎治疗过程中按照复方甲硝唑栓联合雌三醇软膏进行治疗,能够减轻阴道烧灼感,缓解瘙痒症状,提升患者恢复期间睡眠质量,降低患者炎症反应水平,提升整体治疗效果,并降低治疗期间不良反应发生率,有助于患者恢复。

MnO/C的制备及其活化过硫酸钠对水中雌三醇的去除研究

水体中雌三醇(E3)对生物体生长发育和繁殖功能具有深远的影响,而目前常用的城市污水处理手段难以高效去除E3。本文采用水热法合成碳酸锰前驱体,并将制备的碳酸锰在N2条件下600℃下煅烧得到MnO/C。通过MnO/C活化过硫酸钠(PDS)对E3的降解实验,发现反应在90min时达到平衡,此时去除效率高达100%。同时,通过XRD、SEM和FTIR等表征分析得出MnO/C是具备良好的晶型的哑铃状颗粒,且表面存在着大量的有机物。采用电子顺磁共振波谱仪测定活性自由基,发现体系中单线态氧在整个氧化过程中起到主要作用。