妇科针对性护理对保守治疗、开腹手术治疗、腹腔镜微创手术治疗宫外孕患者机体恢复的影响

目的:目前宫外孕的发病率日趋增多,发病年龄也趋向年轻化,为减轻患者痛苦,促进其早日康复,本文旨在回顾性分析妇科护理工作在三种方式治疗宫外孕治疗中的作用.方法:选取2010年10月至2011年9月间,于我院妇科进行宫外孕手术的患者172例,针对172例患者所采取的保守治疗、开腹手术治疗、腹腔镜微创手术三种不同治疗方法,根据不同情况,实施多种妇科针对性护理措施,并对结果进行回顾性分析和总结.结果:172例宫外孕患者经腹腔镜微创手术治疗治愈126例,经过针对性妇科护理,平均住院6.56天;开腹手术治愈26例,经过针对性妇科护理,平均住院9.85天;保守治疗20例,保守治疗失败转为手术治疗3例,平均住院17.87天.经过对所有患者采取有效的针对性精心护理,护理效果较为满意,预后情况良好.结论:腹腔镜微创手术治疗因其创伤小、恢复快,且兼具明确诊断和治疗的作用,是目前临床治疗宫外孕的主要方法;对选择不同治疗方式的患者采取有效的针对性护理,可以提高护理质量和治疗效果,减轻患者痛苦、减少并发症的发生,确保患者早日康复出院.     

双歧杆菌三联活菌胶囊联合营养支持治疗重症急性胰腺炎的临床研究

目的:探讨双歧杆菌三联活菌胶囊联合营养支持治疗重症急性胰腺炎的临床疗效。方法:选择2014年1月至2015年6月我院收治的90例重症急性胰腺炎患者作为研究对象,按照随机数字表法分为治疗组和对照组,每组45例患者。对照组在常规治疗基础上采用营养支持治疗,治疗组在对照组的基础上采用双歧杆菌三联活菌胶囊治疗。分别于治疗前后取患者静脉血进行C反应蛋白、白细胞介素-8、肿瘤坏死因子、白细胞计数、淀粉酶、脂肪酶、乳酸脱氢酶的检测,并对治疗效果和胃肠功能进行评分。结果:治疗组的总有效率95.56%显著高于对照组的80.00%,差异有统计学意义(P0.05)。治疗14 d后,两组患者的C反应蛋白、白细胞介素-8、肿瘤坏死因子、白细胞计数、淀粉酶、脂肪酶、乳酸脱氢酶水平均降低,且治疗组的下降幅度显著大于对照组,差异均有统计学意义(P0.05)。治疗后两组患者的胃肠功能评分均低于治疗前,且治疗组胃肠功能评分明显优于对照组,差异有统计学意义(P0.05)。结论:双歧杆菌三联活菌胶囊联合营养支持治疗重症急性胰腺炎可降低患者的血液指标,增强肠道功能,具有较好的临床疗效,临床可推广应用。     

Major correlates of male height: A study of 105 countries

The purpose of this study is to explore the main correlates of male height in 105 countries in Europe & overseas, Asia, North Africa and Oceania. Actual data on male height are compared with the average consumption of 28 protein sources (FAOSTAT, 1993–2009) and seven socioeconomic indicators (according to the World Bank, the CIA World Factbook and the United Nations). This comparison identified three fundamental types of diets based on rice, wheat and milk, respectively. The consumption of rice dominates in tropical Asia, where it is accompanied by very low total protein and energy intake, and one of the shortest statures in the world (∼162–168 cm). Wheat prevails in Muslim countries in North Africa and the Near East, which is where we also observe the highest plant protein consumption in the world and moderately tall statures that do not exceed 174 cm. In taller nations, the intake of protein and energy no longer fundamentally rises, but the consumption of plant proteins markedly decreases at the expense of animal proteins, especially those from dairy. Their highest consumption rates can be found in Northern and Central Europe, with the global peak of male height in the Netherlands (184 cm). In general, when only the complete data from 72 countries were considered, the consumption of protein from the five most correlated foods (r = 0.85) and the human development index (r = 0.84) are most strongly associated with tall statures. A notable finding is the low consumption of the most correlated proteins in Muslim oil superpowers and highly developed countries of East Asia, which could explain their lagging behind Europe in terms of physical stature.     

Testosterone and cortisol concentrations vary with reproductive status in wild female red deer

Although hormones are key regulators of many fitness and life history traits, the causes of individual level variation in hormones, particularly in wild systems, remain understudied. Whilst we know that androgen and glucocorticoid levels vary within and among individuals in mammalian populations, how this relates to key reproductive processes such as gestation and lactation, and their effects on a female''s measurable hormone levels are poorly understood in wild systems. Using fecal samples collected from females in a wild red deer population between 2001 and 2013, we explore how fecal androgen (FAM) and cortisol (FCM) metabolite concentrations change with age and season, and how individual differences relate to variation in reproductive state. Both FAM and FCM levels increase toward parturition, although this only affects FCM levels in older females. FCM levels are also higher when females suckle a male rather than a female calf, possibly due to the higher energetic costs of raising a son. This illustrates the importance of accounting for a female''s life history and current reproductive status, as well as temporal variation, when examining individual differences in hormone levels. We discuss these findings in relation to other studies of mammalian systems and in particular to the relatively scarce information on variation in natural levels of hormones in wild populations.     

血清妊娠相关血浆蛋白A在诊断异常妊娠中的临床意义

目的:探讨血清妊娠相关血浆蛋白A(PAPP-A)在诊断异常妊娠中的临床意义,分析其与异常妊振的关系。方法:选取299例5~13周的正常早孕妇为正常早孕组,同期选取稽留流产86例,先兆流产54例,异位妊娠76例为异常妊娠组,用酶联免疫吸附试验(ELASA)测定两组受试者的血清PAPP-A水平,分析两组受试者各个孕周内的血清PAPP-A水平的差异。结果:稽留流产孕妇在各个孕周内(9~13周)的血清PAPP-A水平显著低于同孕周内正常早孕孕妇(t值分别为9.500,8.113,3.511,9.538,8.504,P值均0.05);稽留流产孕妇总的平均血清PAPP-A水平亦低于常早孕孕妇(t=3.651,P值均0.05);异位妊娠孕妇在各个孕周内(9~13周)的血清PAPP-A水平显著低于同孕周内正常早孕孕妇(t值分别为7.976,9.030,9.941,11.625,14.079,12.569,P值均0.05),异位妊娠孕妇总的平均血清PAPP-A水平亦低于常早孕孕妇(t=28.168,P值均0.05);先兆流产孕妇(除孕8周)与正常早孕妊娠血清PAPP-A水平比较无显著统计学意义。结论:血清PAPP-A水平在异常妊娠如异位妊娠、稽留流产中显著降低,可作为诊断异位妊娠、稽留流产及先兆流产辅助诊断的生物学指标。     

An Evaluation of the Impact of PD‐1 Pathway Blockade on Reproductive Safety of Therapeutic PD‐1 Inhibitors

This report discusses the principles of reproductive toxicity risk assessment for biopharmaceuticals blocking the PD‐1/programmed cell death ligand 1 (PD‐L1) pathway, which have been developed for the treatment of patients with advanced malignancies. The PD‐1/PD‐L1 pathway is a T‐cell co‐inhibitory pathway that normally maintains immune tolerance to self. Its role in pregnancy is to maintain immune tolerance to the fetal allograft. In cancer patients, this signaling pathway is hijacked by some neoplasms to avoid immune destruction. PD‐1/PD‐L1‐blocking agents enhance functional activity of the target lymphocytes to eventually cause immune rejection of the tumor. A therapeutic blockade of PD‐1/PD‐L1 pathway that occurs at full target engagement provides a unique challenge to address the risk to pregnancy because disruption of the same pathway may also reduce or abrogate maternal immune tolerance to the fetal alloantigens inherited through the father. Typically, nonclinical reproductive and developmental toxicity (DART) studies in animals (rats and rabbits) with clinical drug candidates are conducted to identify potential risk in humans and to determine exposure margin for the effects on reproduction as part of the risk assessment. However, for biopharmaceuticals for which the desired mechanism of action cannot be separated from potential deleterious effects to the fetus and when the only relevant toxicology species is nonhuman primate (NHP), the risk to reproduction can be predicted by a mechanism‐based assessment using data generated from murine surrogate models as supportive information without conducting DART in NHPs. Such an approach has been used in the evaluation of pregnancy risk of anti‐PD‐1 agent, pembrolizumab, and has been demonstrated as an important alternative to performing DART studies in NHPs