Objective To explore the application value of self-made visual teaching aids in gynecological and obstetrical nursing education. Methods A total of 240 nursing students in grade 2009 from Fujian Medical University and Fujian Health College were selected by cluster sampling and divided by simple randomization into 2 groups (the trial group and the control group). Besides the multimedia combined with traditional teaching adopted in both groups, the visual teaching aids for fetal intrauterine condition was also adopted in the trial group rather than the control group. Questionnaire survey and focus group interview were adopted to appraise the satisfactory degree of all nursing students and the teaching effects evaluation of students in the trial group. Results There were no significant differences between the two groups in education background, and intelligibility evaluation of theoretical study on both the fetal intrauterine condition and the complications in pregnancy and delivery periods (Pgt;0.05), while the difference was statistically significant in the satisfactory degree between different teaching methods (Plt;0.05). 85.0% of nursing students in the trial group thought that visual model could help them to better understand the complications in pregnancy and delivery periods, and the intrauterine condition, 99.17% of students thought that the teaching effect of visual model was better than traditional teaching, and 95.83% of students considered that visual model was favorable for course study. Conclusion The application of self-made visual teaching aids for fetal intrauterine condition makes gynecological and obstetrical nursing education more visual, facilitates students to better understand fetal intrauterine situation and part of the mechanism of pregnancy complications, arouses students’ learning interests, and lays a theory and practice foundation for follow-up internship, so as to enhance the quality of nursing teaching.
【摘要】 目的 探讨MRI动态增强扫描在子宫内膜癌手术前诊断中的价值。 方法 回顾分析2008年2月-2010年3月38例经手术病理证实为子宫内膜癌患者的动态增强MRI检查资料，判断内膜癌子宫肌层和宫颈浸润情况，与病理结果对照，计算T2WI及动态增强序列诊断肌层及宫颈浸润的敏感度、特异度、准确度等，分析两种序列诊断准确度有无差异；计算内膜癌组织与子宫肌层在动态增强各期的对比信噪比，并分析其在各期间有无差异。 结果 动态增强序列诊断内膜癌肌层和宫颈受侵的敏感度、特异度、阳性预测值、阴性预测值分别为96.8%、85.7%、96.8%、85.7%和85.7%、91.7%、85.7%、91.7%；动态增强序列诊断内膜癌深肌层浸润的准确度为94.7%，显著高于T2WI诊断深肌层浸润的准确度78.9%（Plt;0.05）；平衡期内膜癌组织与子宫肌层的对比信噪比显著高于动脉期和静脉期（Plt;0.01）。 结论 MRI动态增强扫描能够在手术前准确的判断内膜癌肌层及宫颈浸润，有助于子宫内膜癌治疗方式的选择。【Abstract】 Objective To investigate the role of dynamic-enhanced MRI in the diagnosis of endometrial carcinoma. Methods Thirty-eight patients with endometrial carcinoma confirmed by surgicopathology undergone dynamic-enhanced MRI scans were analyzed retrospectively. The invasion in myometrium and uterine cervix were analyzed. The tumor and myometrium contrast-to-noise ratios during different phases of dynamic imaging were calculated. MR imaging findings were compared with pathologic findings. Sensitivity, specificity, diagnostic accuracy, positive and negative predictive values of MR imaging in depicting myometrial and cervical infiltration were calculated. Results Respective sensitivity, specificity, and positive and negative predictive values in assessing myometrial infiltration were 968%,85.7%,96.8%,85.7%;those for cervical infiltration were 85.7%,91.7%,85.7%,91.7%,respectively. The diagnostic accuracy (94.7%) of dynamic imaging in depicting deep myometrial infiltration were significantly higher than that of T2WI (78.9%) (Plt;0.05).There was a significant improvement in tumor and myometrium contrast-to-noise ratios during the equilibrium phase compared with the arterial and venous phases (Plt;0.01). Conclusion Dynamic-enhanced MRI is highly accurate in preoperative diagnosis of endometrial carcinoma, which will benefit for the treat of endometrial carcinoma.
ObjectiveTo systematically review the effectiveness and safety of laparoscopy with postoperative gonadotropin releasing hormone agonist (GnRH-a) versus laparoscopy alone for endometriosis. MethodsRandomized controlled trials (RCTs) on laparoscopy with postopertative GnRH-a versus laparoscopy alone in treatment of endometriosis were retrieved in the following databases:the Cochrane Library (Issue 3, 2013), PubMed, EMbase, WanFang Data, CNKI, and CBM from inception to February, 2013. According to the inclusion and exclusion criteria, the literature were screened, the data was extracted and the methodological quality of the included studies was also assessed by two reviewers independently. Then, meta-analysis was performed using RevMan 5.1.7 software. ResultsA total of 15 RCTs involving 1 761 patients were included. There were statistically significant differences between the laparoscopy with postoperative GnRH-a group and the laparoscopy alone group in the following 4 aspects:the symptom relief rate (RR=1.24, 95%CI 1.16 to 1.33, P < 0.000 01), the recurrence of lesion (RR=0.35, 95%CI 0.24 to 0.51, P < 0.000 01), the recurrence of pain (RR=0.70, 95%CI 0.53 to 0.92, P=0.01), and the pregnancy rate (RR=1.43, 95%CI 1.25 to 1.65, P < 0.000 01). ConclusionLaparoscopy postoperative GnRH-a for endometriosis can enhance the symptom relief rate, reduce the recurrence of lesion and the recurrence of pain, and increase the pregnancy rate. But because of the limitation of the quality of the included studies and publication bias, the above conclusion should be verified by conducting more high quality RCTs.
Pulmonary endometriosis (PEM) is a rare disease with diverse clinical manifestations, most commonly presenting as hemoptysis, while patients presenting solely with pulmonary nodules are less common. Here, we report three female patients (aged 32, 19, and 46 years, respectively). One patient sought medical attention due to hemoptysis during menstruation, while the other two had no obvious symptoms and were found to have pulmonary nodules during routine physical examinations. Two patients had a history of cesarean section, and one had a history of miscarriage. Pathologically, one patient of PEM showed extensive hemorrhage in the alveolar spaces, with fragmented endometrial glandular epithelium observed within the hemorrhagic foci. The other two patients exhibited proliferative endometrial glands and stroma, surrounded by old hemorrhage. Immunohistochemistry revealed that the endometrial glands and stroma in all three patients were positive for estrogen receptor, progesterone receptor, and vimentin, with CD10 positivity in the endometrial stroma. All three patients were definitively diagnosed as PEM by pathology and underwent thoracoscopic pulmonary wedge resection. Follow-up periods were 18, 31, and 49 months, respectively, with no recurrence observed in any of the patients.
Objective To investigate the endometrial thickness and echo patterns of healthy women, so as to provide a basis for the formulation of a standard to define normal endometrium in Chinese women. Method A total of 1872 married healthy women in Yongchuan District received transvaginal ultrasound examination. The endometrial sonograph was observed and endometrial thickness was measured for statistical analyses. Results In pre-menopausal women of different age groups, the endometrial thickness was increased and the endometrial echo was enhanced from the proliferative phase, ovulatory phase and secretory phase. The endometrial thickness varied significantly among different menstrual cycles, while no significant difference was observed in the endometrial thickness of a same menstrual cycle among women of different age groups. Pre-menopausal women had significantly different endometrial thickness when compared with post-menopausal women. Conclusion Through a general survey of women by transvaginal ultrasound, a large sample database can be established, which may contribute to the formulation of a standard to define normal endometrium in Chinese women and to help identify abnormal endometrium.
ObjectiveTo systematically review the effectiveness of breastfeeding duration and intensity in reducing the risk of overweight or obesity among offspring exposed to intrauterine hyperglycemia. MethodsThe PubMed, EMbase, Web of Science, CBM, WanFang Data, CNKI and VIP databases were electronically searched to collect observational studies on the associations of breastfeeding with the risk of overweight or obesity among offspring exposed to intrauterine hyperglycemia from inception to September 25th, 2021. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Stata 16.0 software was used for the meta-analysis. ResultsA total of 12 657 participants from 13 observational studies were included. The results of meta-analysis showed that breastfeeding could reduce the risk of overweight or obesity among offspring exposed to intrauterine hyperglycemia (OR=0.67, 95%CI 0.53 to 0.84, P=0.001). Subgroup analysis revealed a protective effect of breastfeeding for both 1-6 months (OR=0.53, 95%CI 0.37 to 0.75, P<0.001) and ≥6 months (OR=0.56, 95%CI 0.46 to 0.69, P<0.001); however, breastfeeding shorter than one month was suggested to increase the risk of overweight or obesity (OR=2.15, 95%CI 1.41 to 3.27, P<0.001). ConclusionAvailable evidence suggests that breastfeeding for more than one month is effective in reducing the risk of overweight or obesity in offspring exposed to intrauterine hyperglycemia, and women with hyperglycemia should be encouraged to breastfeed their offspring for at least 1 month to achieve the effect. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
目的:分析腹腔镜手术联合药物治疗子宫内膜异位症的疗效。方法:回顾性分析2002年至2005年四川大学华西第二医院收治的830例子宫内膜异位症患者腹腔镜手术治疗后的随访资料。比较手术后加用丹那唑、孕三烯酮(内美通)、诺雷得以及中药治疗3个月后的轻、重度子宫内膜异位症的复发率、合并不孕患者的受孕率。结果:术后两年,各药物组在各类中受孕率及在轻度中复发率无明显差异,在重度中,中药组复发率显著高于其他各药物组。结论:子宫内膜异位症腹腔镜手术后联合用药可降低复发率,提高受孕率。中药组的复发率在重度子宫内膜异位症中要高于其他组。各药物组在受孕率上无显著差异。
ObjectiveTo systematically review the efficacy of 10 commonly used intrauterine devices (IUD) by network meta-analysis.MethodsPubMed, The Cochrane Library, EMbase, Web of Science, POPLINE, CNKI, WanFang Data, SinoMed, CMCI, ChiCTR databases and websites were electronically searched to collect randomized clinical trials (RCTs) on efficacy of 10 IUDs from inception to December 31st, 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, network meta-analysis was performed by using WinBUGS 1.4.3 software and Stata 13.0 software.ResultsA total of 67 RCTs involving 59 991 IUD users were included. The results of network meta-analysis indicated that after 1 year of use, GyneFix had a lower pregnancy rate than those of TCu220C, TCu380A, YCu300, OCu165 and MLCu375, and its effectiveness ranked second out of ten IUDs (SUCRA=77.1%). YCu200 had a lower pregnancy rate than that of TCu220C, which ranked third (SUCRA=71.5%). After 2 years of use, GyneFix had a lower pregnancy rate than those of TCu220C, TCu380A and OCu165, which had the highest probability to be the most effective intervention (SUCRA=92.1%). YCu200 had a lower pregnancy rate than those of TCu220C, TCu380A, YCu300, OCu165, GCu200, GammaCu and MLCu375, and its effectiveness ranked second (SUCRA=81.2%).ConclusionsCurrent evidence shows that the risk of pregnancy of GyneFix and YCu200 are lower at 1 and 2 years of use, which suggests they possess superior short-term effectiveness. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To evaluate the feasibil ity of intrauterine abdominal wall defect repair of fetal lamb at late pregnancy. Methods Eight healthy pregnant ewes at 110-115 days of gestation (weighing 14-22 kg) were randomly divided into 2 groups. In group A (n=3), the abdominal wall defect of 5 cm × 1 cm was made in the fetal lambs, then was closed by strengthening suture; in group B (n=5), the abdominal wall defect of 5 cm × 2 cm was made in the fetal lambs, then was repairedby 2 layers of biological patches. After the lambs del ivered naturally, the lambs and their wounds were observed; at 10th day after birth, the scars were harvested for biomechanical and histological observations. Results One ewe of group A and 2 ewes of group B aborted, while the others were successfully del ivered. In group A, the abdominal incisions of 2 lambs healed well with a l ine-l ike scar and mild intra-abdominal adhesion, and the scar thickness was 4-5 mm. In group B, the abdominal incisions of 3 lambs did not heal completely with minor intra-abdominal adhesions, and the scar thickness was 3-4 mm. The wound breaking strength was 16, 20 N in group A and 10, 14, and 18 N in group B, respectively. A sl ight scar was seen in group A; skin ulcer and underlying fibrous connective tissue with inflammatory cell infiltration were seen in group B. Conclusion It was feasible to repair the abdominal wall defect of fetal lamb at late pregnancy in uterine. Small abdominal wall defect can be sutured directly; biological patch can be used to repair larger abdominal wall defect.