饮食中维生素C、E摄取与妊娠期高血压进展的关系

Objectives: To explore the relationship, if any, between dietary intake of the antioxidant vitamins C and E, and the development of pre- eclampsia and gestational hypertension. Study design: A prospective cohort study of pregnant women attending the antenatal clinic of the Women’ s and Children’ s Hospital in Adelaide, Australia, was carried out between April and July 2001. Women completed a semi- quantitative 116- item food frequency questionnaire (FFQ). Women’ s medical records were viewed after birth to collect data on pregnancy outcomes. Relationships were explored through cross- tabulations, chi- square analysis, and adjustments were made for potential confounders using binary logistic regression. Results: A total of 299 women completed the FFQ. Median intake of vitamin C was 188 mg and for vitamin E was 6.74 mg. There was no relationship between the intake of vitamin C and hypertensive disorders of pregnancy. For vitamin E, being in the lowest quartile of intake, was associated with an increased risk of hypertensive disorders (RR 1.75, 95% CI 1.11- 2.75, P = 0.02). This relationship was confirmed after adjusting for the confounding factors of maternal age and parity. Conclusions: Little support was found for a relationship between dietary intake of vitamin C and the development of hypertensive disorders of pregnancy. Low vitamin E intake was associated with a significant increase in the risk of hypertensive disorders of pregnancy, even after adjustments were made for confounding factors. Further research is required to investigate whether supplementation above dietary intake of antioxidant vitamins influences the risk of hypertensive disorders of pregnancy.

多囊卵巢综合征孕妇二甲双胍可通过胎盘屏障

Metformin passes the placenta. Fetal serum levels are comparable with maternal values.

早产双胎中头颅扫描异常与绒毛膜、出生体重不协调的关系

Objective: The purpose of this study was to determine the incidence of ultrasonographically detected cerebral white matter lesions (WMLs) in preterm twins at birth in relation to chorionicity, discordant weight and twin- twin transfusion syndrome (TTTS). Methods: In this retrospective study, perinatal, neonatal, and cranial scan data of 85 monochorionic (MC) and 94 dichorionic (DC) twin pregnancies (341 infants) delivered between 24 and 34 weeks of gestation were collected. Data were analysed according to chorionicity, discordant birth weight (>20% ), single intrauterine death and TTTS. Results: The cerebral WML was seen in 14% of preterm twins. Monochorionic infants had higher risks of WML than DC twin (odds ratio 7.1; 95% CI 3.28- 15.8). In MC group, discordant weight (37% )- , TTTS (38% ), single intrauterine death (67% ) had higher incidence of cerebral WML than concordant weight infants (7% ). Similarly, incidence of WML was higher in DC discordant compared with concordant weight infants (13% versus 2% ; P <.0.05). Conclusion: Monochorionic infants had a seven- fold higher incidence of cerebral WML than DC infants. Discordant birth weight, TTTS and survivor of co- twin demise are an independent risk of cerebral white matter lesion.

儿童和青少年时期Ⅰ期子宫颈葡萄状肉瘤的治疗

横纹肌肉瘤是儿童期最常见的软组织肉瘤。在婴儿期,葡萄状变异体从阴道或者膀胱处开始生长,但很少是从子宫颈处生长。治疗方法有从肿瘤的局部切除到根治性子宫切除并辅以药物治疗或者放射治疗。在子宫颈轻微浸润的病例中,微创的局部切除并辅以化疗的存活率相当高,而且不影响到膀胱、直肠、阴道和卵巢的功能。在这里,笔者将介绍30年以来的文献和1例5岁患有葡萄状子宫颈肉瘤女孩的病例报道。结论:根据文献以及笔者的观察,推荐对未成年人应该选择外科手术并辅以化疗的治疗方法来治疗Ⅰ期子宫颈横纹肌肉瘤。

不同生育状态的子宫内膜异位症患者内膜异位不同分期与不同部位的症状分类

Objective: To evaluate endometriosis patients’ symptoms and relate them to different stages and locations of endometriosis and also to fertility/ infertility of the patients. Study design: Sixty- eight patients diagnosed with endometriosis constituted the population investigated in this cross- sectional observational study, 55 and 13 of whom were diagnosed from the visual findings recorded during laparoscopy and laparotomy, respectively. All cases were categorised as early- (stages I and II) or late (stages III and IV)- stage endometriosis and as fertile or infertile endometriosis. The extent of endometriosis was further divided into peritoneal, ovarian, and ovarian and peritoneal. Symptoms of dysmenorrhoea, deep dyspareunia, dyschesia and dysuria and also depressive mood state were analysed and compared among those different groups. Results: Cyclic chronic pelvic pain was more relevant in late- stage endometriosis (P = 0.04). Deep dyspareunia, painful defecation, dysuria, infertility, and depressive state did not differ with stages of endometriosis or fertility status. Admission for pelvic pain of any duration was more prevalent among fertile patients with endometriosis (P = 0.008). Chronic noncyclic pelvic pain was more frequently observed in patients with fertile than in those with infertile endometriosis (P = 0.01). More cases in the fertile group experienced noncyclic pelvic pain (P = 0.04). More patients admitted with cyclic pelvic pain had ovarian or ovarian and peritoneal endometriosis than peritoneal endometriosis only (P = 0.03). Infertility was more prevalent among peritoneal endometriosis cases than among those with ovarian or peritoneal and ovarian involvement (P= 0.008). Conclusion: Symptoms of endometriosis may predict the stage and localisation of the disease to some extent.

腹部触诊筛查胎儿宫内发育迟缓在低危人群中的有效性:一项观察性研究

Objective: To evaluate the performance of abdominal palpation as a screening test for intrauterine growth retardation (IUGR) in a low risk population, under standard practice conditions. Study design: Population based observational study of 6318 consecutive low risk singleton pregnancies. The Dutch obstetric system distinguishes low from high risk pregnancies. In the low risk group abdominal palpation as a screening test is performed by midwives. If a complication, like IUGR, during prenatal care is assessed, the women is referred to a consulted obstetrician. Ultrasound is performed by the consulted obstetrician. In case of sustained suspicion the women is selected as high risk. Outcome parameters: severe small for gestational age (SGA) birthweight below 2.3rd centile, all SGA birthweight below 10th centile, operative delivery, neonatal morbidity and perinatal mortality. Screening value of abdominal palpation, abdominal palpation combined with ultrasound, and the performance of high risk selection was assessed by conventional performance measures. Results: Abdominal palpation as a screening test for IUGR is of limited value: the observed sensitivities were 28%for severe SGA and 21%for SGA p≤10, respectively. After ultrasound in case of sustained suspicion, the sensitivity in detection of severe SGA was 25%and positive predictive value (PPV) 16%. In detection of SGA p≤10 sensitivity was 15%and PPV 55%, which means 45%were false positives. The sensitivity of the Dutch obstetric system in selection of high risk pregnancies in detection of severe SGA was 53%, in detection of SGA p≤10 was 37%. Perinatal mortality was 0.9%(57/6318) and 32%of these cases were SGA. Six cases of fetal death were unrecognised during prenatal care (0.09%) and seem preventable. The prevalence of a 5 min Apgar Score≤7 was significantly higher in the SGA infants if SGA was defined as p≤10. Conclusions: The diagnostic performance of abdominal palpation as a screening test for IUGR detection in a low risk population is disappointing. However, various stratagems such as routine ultrasound do not improve detection rate or perinatal morbidity and mortality.

人胎盘犬尿氨酸途径酶mRNA和代谢物的鉴定:经由炎性刺激和临床感染上调

The purpose of this study was to determine whether placentalderived kynurenines (neuroactive metabolites that are derived from tryptophan) contributes to infection- mediated fetal cerebral injury. Placentae and cord blood were obtained from term deliveries (n = 16) and preterm deliveries with or without intrauterine bacterial infection (n = 8 per group). We investigated whether the placenta expressed messenger RNAs of kynurenine metabolite- forming enzymes, the effects of infection in vivo on the expression of these enzymes by the placenta, the in vitro effects of bacterial endotoxin lipopolysaccharide on expression and kynurenine metabolite output by the placenta, and the kynurenine metabolite levels in umbilical cord blood. Placentae expressed messenger RNA of tryptophan- degrading enzymes and synthesized several compounds. The expression of several enzymes increased significantly in placentae that were exposed to infection and/or lipopolysaccharide. Lipopolysaccharide also induced significant increases in placental kynurenine and quinolinic acid output. Kynurenine and quinolinic acid in cord blood of fetuses who were exposed to infection were elevated significantly. Inflammatory mediated release of kynurenines from placentae exposes the fetus to significant amounts of potentially neurotoxic substances.

分娩过程中羊水粪染与脐带血8-异前列腺素F2α浓度升高相关

The purpose of this study was to compare the umbilical arterial 8- iso- prostaglandin F2α ,.concentrations between pregnancies that were complicated by moderate or thick meconium- stained liquor and those with clear liquor. Umbilical cord arterial blood samples were collected from 247 singleton pregnancies with either moderate or thick meconium- stained liquor at any stage of labor or clear liquor at all stages of labor for the determination of the total 8- iso- prostaglandins F2α concentration. The median total 8- iso- prostaglandins F2α concentration of the meco- niumstained liquor group was significantly higher than that of the control group (719.2 vs 115.8 pg/mL). Among the meconiumstained liquor group, those who had a change from "clear liquor" at early labor to "moderate/ thick meconium- stained liquor" at late first stage or at delivery (late meconium- stained liquor group) had higher 8- iso- prostaglandins F2α concentration, compared with those who had moderate/ thick meconiumstained liquor since early labor (early meconium- stained liquor group; 959.8 vs 499.9 pg/mL). With the use of multiple regression analysis, meconium- stained liquor, duration of second stage of labor, and abnormal fetal heart tracings were independent determinants of cord blood 8- iso- prostaglandins F2α concentration. Moderate or thick meconium- stained liquor is an independent factor for increased oxidative stress in pregnancy.

ATP细胞活力试验在测量宫颈癌固有放射敏感性中的应用前景

Background. Intrinsic radiosensitivity using the clonogenic assay and the cell surviving fraction at 2 Gy (SF2) has been shown to be an independent prognostic factor for patient response to radiotherapy in carcinoma of the cervix. The clonogenic assay has significant shortcomings, making it unsuitable for routine clinical use. The ATP cell viability assay (ATP- CVA) has been shown to have a high tumor evaluability rate, technical simplicity, and reproducibility in chemosensitivity testing. Aims. This study compares the ATP- CVA with the clonogenic assay in the in vitro radiosensitivity testing of cervical cancer cell lines. Correlation of in vitro radiosensitivity and in vivo patient response was also determined. Methods. Five cervical carcinoma cell lines (SiHa, HeLa, Caski, C- 33A, and C4- 1) were tested using the ATP- CVA and the clonogenic assay. Survival curves were plotted and the mean SF2 values obtained by the two different assay methods were compared using ANOVA to see if there were significant differences. Mean SF2 values obtained from 27 cervical cancers were compared with clinical outcomes. Results. The SF2 values for the cell lines ranged from 0.28 to 0.67 when tested using the ATP- CVA. Using the clonogenic assay, the SF2 values ranged from 0.27 to 0.70. ANOVA with Bonferroni pairwise multiple comparison showed no significant difference between the mean SF2 values for the individual cell lines between the two assay methods. Twenty- three cervical cancer samples (85% ) were evaluable for SF2 using ATP- CVA. The mean SF2 values of patients who had locoregional failure were significantly higher than those who achieved local control (P < 0.01). Conclusions. Testing intrinsic radiosensitivity using the surviving fraction at 2 Gy (SF2) is comparable using the two assay methods of ATP- CVA and clonogenic assay. The ATP- CVA should be further investigated in the testing of intrinsic radiosensitivity in patients with cervical cancer.

胎膜早破孕妇阴道分泌物中白细胞介素-6与新生儿感染的关系:快速免疫色谱检验法

The purpose of this study was to evaluate the diagnostic value of an interleukin- 6 (IL- 6) bedside test of vaginal secretions for neonatal infection in cases of preterm premature rupture of membranes. This prospective clinical study included 73 patients. Interleukin- 6 protein in vaginal secretions was determined with an immunochromatographic bedside test in < 20 minutes. Elevated C- reactive protein level (>20 mg/dL; odds ratio, 5.1; 95% CI, 0.9- 28.6) and positive interleukin- 6 level (odds ratio, 4.6; 95% CI, 1.2- 18.4) were both associated with neonatal infection. After adjustment, only interleukin- 6 remained associated with neonatal infection (odds ratio, 4.5; 95% CI, 1.1- 18.5). The sensitivity of interleukin- 6 for the prediction of neonatal infection was 79% (95% CI, 65- 92); its specificity was 56% (95% CI, 42- 70); its positive predictive value was 30% (95% CI, 12- 47), and its negative predictive value was 92% (95% CI, 84- 99). Interleukin- 6 protein determination by this new immunochromatographic test is a noninvasive prenatal vaginal marker of neonatal infection.

传统体外受精和卵母细胞单精子显微注射法得到的前核期及分裂期胚胎的保存:一种灵活的冷冻保存方法

Objectives: To evaluate the hospital’s cryopreservation protocol. Study design: A retrospective cohort analysis of 30 conventional IVF and 44 ICSI cycles in an assisted conception unit at a tertiary referral hospital. All supernumerary embryos were cryopreserved at the pronuclear or blastomere stage. The survival, morphology, implantation and pregnancy rates were evaluated. The χ2 test and Fishers exact test were used to determine the statistical significance. Results: A total of 327 pronuclear and cleavage stage embryos were cryopreserved. The post thaw survival rates of 107 conventional IVF and 220 ICSI embryos were 90.6%and 69.0%, respectively. Of the thawed cleavage stage embryos from 43 IVF and 88 ICSI cycles, 90.6%and 69.3%were intact, respectively. Of the thawed pronuclear stage embryos from 64 IVF and 132 ICSI cycles, 90.6%and 68.9%were intact with cleavage rates of 57.8%and 56%, respectively. In the final 27 conventional IVF and 41 ICSI frozenthawed embryo transfer cycles, the pregnancy rates were 18.5%and 19.5%, respectively. Conclusions: The adopted cryopreservation protocol flexibly allows for the selection of cleavagestage embryos for fresh embryo transfer and the cryopreservation of all supernumerary embryos at the pronuclear or the cleavage stage in a single cycle with satisfactory pregnancy rates. Further validation of this protocol is required.

舌下含服米索前列醇与静脉注射甲基麦角新碱在积极处理第三产程中的疗效比较

Objective: To compare the efficacy and side effects of sublingual misoprostol and intravenous methylergometrine for active management of third stage of labor. Method: One hundred twenty low risk pregnant women at term with spontaneous onset of labor were included in the study. The women were randomized to receive either two tablets of misoprostol (200 μ g/tablet) sublingually or 1 ml of methylergometrine (200 μ g) intravenous injection, after the delivery of the anterior shoulder of the baby. The main outcome measures were: need for additional oxytocic drugs, blood loss ≥ 500 ml, change in hemoglobin levels and side effects. Results: Postpartum hemorrhage as defined by hemorrhage ≥ 500 ml occurred in 3.1% of the women in the sublingual misoprostol group but none of the women in the methylergometrine group (P > 0.05). There was a need for additional oxytocic drugs in 5.0% and 8.3% after methylergometrine and misoprostol, respectively (P > 0.05). The change in hemoglobin levels at 24 h postpartum were 0.8 and 0.7 mg% in methylergometrine and misoprostol group, respectively(P > 0.05). In the misoprostol group, 6.6% women developed fever ≥ 38° C and 21.6% had shivering while in methylergometrine group none experienced these side effects. However, the incidence of other side effects like nausea, vomiting, headache and giddiness were similar in both groups. Conclusion: Sublingual misoprostol appears to be as effective as intravenous methylergometrine in the prevention of postpartum hemorrhage. However, larger randomized studies are needed to advocate its routine use.

出生体重<501g的新生儿短期生存状况

Aim: To report survival and morbidity until discharge in preterm infants< 501 g with life support started immediately after birth. Methods/study design: Cohor t study of all preterm infants with birthweights < 501 g born in three tertiary perinatal centres between 1 January 1998 and 31 December 2001 (gestational age ( GA) 25.2 [21.0～30.7] wk; birthweight 435 [290-500] g; median [range]). Results : A total of 107 infants with birthweights < 501 g were born. Twenty-nine were stillborn. A prenatal decision to initiate life support immediately after birth was reached in 9/37 (24%) infants < 24.0 wk GA and in 39/42 (93%) infants ≥24 .0 wk GA. Survival was 3/37 (8%) and 26/41 (63%) in infants < .24 wk GA and ≥ .24.0 wk GA, respectively. Twenty-nine of the 48 infants with immediate life su pport (60%) survived (95%CI: 46-75%). Forty-two of these 48 (88%) infants were small for gestational age. No infant without immediate life support survive d (0/30). Twenty-three (79%) survivors developed chronic lung disease (CLD) an d eight (28%) received photocoagulation for retinopathy of prematurity (ROP). C onclusion: In this population of extremely low birthweight infants, survival was higher than in previous studies when life support was provided immediately afte r birth. Short-term morbidity was similar to other studies. The presented data on survival support our concept to offer immediate life support after birth in p reterm infants with birthweights< 501 g. The long-term outcome of these infants needs to be assessed urgently.

宫颈癌患者染色体1杂合性缺失的临床病理学意义

We studied the loss of heterozygosity (LOH) in chromosome 1 in squamous cell carcinoma (SCC) of the uterine cervix and evaluated its clinical and pathological significance. Sixty- three highly polymorphic markers were used to study the LOH in 84 SCC. Microdissection was performed to enrich the tumor cells population before the alleotyping study. The findings were correlated with clinicopathologic findings. LOH was detected in all but one SCC. The number of loci showing LOH in each case ranged from 0 to 41. Five loci showed LOH in ≥ 30% SCC and 28 other loci had an LOH frequency between 20% and 30% . Six of the eight markers located at 1p36.21 to 1p36.33 had a frequency of LOH >20% . Shortened total survival was associated with LOH at 14 loci and shortened disease- free survival was associated with LOH at 11 loci while LOH at nine loci were associated with both. A high frequency of LOH was associated with stage as well as shortened total and disease- free survival. LOH is a common and early event in the development of cervical SCC. Tumor suppressor genes may be present at 1p36. The incidence of LOH increases as the tumor progresses but a high frequency of LOH is not an independent prognostic factor.

出生体重低于501g的婴儿的短期情况

Aim: To report survival and morbidity until discharge in preterm infants < 50 1 g with life support started immediately after birth. Methods/study design: Coh ort study of all preterm infants with birthweights < 501 g born in three tertiary perinata l centres between 1 January 1998 and 31 December 2001 (gestational age (GA) 25.2 [21.0- 30.7] wk; birthweight 435 [290- 500] g; median [range]). Results: A to tal of 107 infants with birthweights < 501 g were born. Twenty- nine were still born. A prenatal decision to initiate life support immediately after birth was r eached in 9/37 (24% ) infants < 24.0 wk GA and in 39/42 (93% ) infants ≥ 24. 0 wk GA. Survival was 3/37 (8% ) and 26/41 (63% ) in infants < 24 wk GA and ≥ 24.0 wk GA, respectively. Twenty- nine of the 48 infants with immediate life support (60% ) survived (95% CI: 46- 75% ). Forty- two of these 48 (88% ) infants were small for gestational age. No infant without immediate life suppor t survived (0/30). Twenty- three (79% ) survivors developed chronic lung disea se (CLD) and eight (28% ) received photocoagulation for retinopathy of prematur ity (ROP). Conclusion: In this population of extremely low birthweight infants, survival was higher than in previous studies when life support was provided imme diately after birth. Short- term morbidity was similar to other studies. The pr esented data on survival support our concept to offer immediate life support aft er birth in preterm infants with birthweights< 501 g. The long- term outcome of these infants needs to be assessed urgently.

阴道内微生物的独立培养分析:奇异菌与细菌性阴道病间尚未认知的相关性

Although the pathogenesis of bacterial vaginosis remains elusive, a few microorganisms, such as Gardnerella vaginalis, are considered markers on Gram stain or culture. Culture independent analysis of vaginal microflora using 16S rDNA cloning and sequencing of total bacterial communities reveals the gram positive Atopobium vaginae as a predominant species in disturbed vaginal flora.