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产后压力性尿失禁的非手术治疗研究进展
压力性尿失禁(stress urinary incontinence,SUI)是女性尿失禁的主要类型[1].国际尿控协会对SUI的定义为:在咳嗽、喷嚏等腹压增加时,出现不自主的尿液自尿道外口漏出.产后SUI是指继发于妊娠、分娩之后出现的压力性尿失禁症状.
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创伤后头痛:神经康复观点(Ⅱ)
POST-TRAUAMTIC HEADACHE VARIANTS Musculoskeletal Headache Musculoskeletal headache is classically characterized as a cap-like discomfort, but varies with the offending musculature.The sternocleidomastoid is notorious for referring pain retro or periorbitally.The pain may be constant or intermittent,relieved by application of heat,cold,massage and many over the counter medications including NSAIDs.There may be autonomic components to specific muscles.TMJ or craniomandibular syndrome may be considered a variant of musculoskeletal or tension headache and is almost always seen in conjunction with direct trauma to the craniomandibular complex when traumatic in origin.This type of headache is also frequently overlooked as a primary or contributory cause for PTHA.In TMJ,clicking,popping or malocclusion of the jaw may be noticed.Other etiologies of TMJD must be assessed for that may have little or nothing to do with the traumatic injury in question,whether in relation to stress or tension,dental malocclusion,and/or prior psychosexual abuse.
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氧化应激与子宫内膜异位症伴不孕的临床研究进展
子宫内膜异位症(endometriosis,EM)是育龄妇女常见的良性疾病,以子宫内膜腺体和间质在宫腔外生长为特点,其发病机制尚未完全清楚.Pnnz等[1-2]均报道活性氧及自由基促进子宫内膜细胞在腹腔中的生长和黏附,从而导致EM及不孕的发生.Sharma等[3]提出,氧化应激(oxidative stress,OS)在EM及妇产科其他疾病如不孕症和妊娠相关疾病(主要是先兆子痫、子痫前期、妊娠期糖尿病及习惯性流产等)的发病机制中可能起重要作用.
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干细胞治疗压力性尿失禁的进展
压力性尿失禁(stress urinary incontinence,SUI)是指在逼尿肌没有收缩的情况下,由于腹内压的骤然增加而引起的不自主排尿的现象.目前SUI 的治疗方法有很多,本文回顾了SUI 的治疗历程,重点对干细胞治疗SUI 的进展进行综述.
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压力性尿失禁诊疗135例临床分析
Objective The purpose of this study is to evaluate and compare the two different treatments by researching 135 cases with stress urinary incontinence .Methods From June 2006 to June 2010,135 patients with stress urinary incontinence were treated in Department of Gynecology and Obstetrics of Peking University Shenzhen Hospital.91 cases of them were treated with low frequency electric stimulation and biofeedback therapy (Group A),and the other 44 cases were treated by improved transobturaor tension -free vaginal tape(TVT-O) and TVT-O (Group B).Then,we compared these two groups by whole recovery rate ,recovery rate of patients with urge incontinence , charge of treatment and complication , respectively.Results Group B's recovery rate for stress urinary incontinence was 100%.Ⅰ degree stress urinary inconti-nence in Group A's recovery rate was higher;Ⅱ degree patients'recovery rate for stress urinary incontinence was lower;Ⅲ degree patients'recovery rate was 0%.Only 1 case showed abnormal urine stream;2 cases showed urinary retention,but the symptoms disappeared after the treatment .No significant complication in Group A.There were huge differences of the expense between the two groups .The effect in Group A for pa-tients with urge incontinence was good,but there was no effect shown in Group B.Conclusions The two treatments are safe and effective for stress urinary incontinence ,but there are existed prominent differences of the therapeutic efficacy between the two groups .
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AIM To investigate the effects of collagen solution on the prevention of acute gastric mucosal injury inrestricted rats inflicted by cooling in low temperature (4℃),METHODS Thirty healthy Wistar rats were randomly divided into normal (N, n = 10),injury (I, n = 10)and prevention (P, n = 10) groups. The rats were fasted for 48 h but free access to water without restrictionand cooling in normal group, fasted for 48 h but free access to water with restriction of rats onto the fixationframe for cooling in 4℃ for 4 h, so to cause stress injury of gastric mucosal membrane in I group and fed with3 mL of collagen solution 30min before injury in P group in addition to the procedures in I grobp. Gastricmucosal potential difference, blood flow volume, content of nitrite (NO2-) and hydrogen ion concentration(H+ ) in gastric juice were determined under aneasthesia at 48 h after fast in N group and at 4 h after injuryin I and P groups to evaluate the degree of injury (injury index).RESULTS Gastric mucosal potential difference was 22.10±5.27 in N group and 11.46±5.25 in I groupwith obvious difference (P<0.01), but 16.98±4.84 in P group which was remarkably improved whencompared to that in I group. Gastric mucosal blood flow volume was 23.65±10.65 in I group and 57.20±11.75 in N group with evident difference (P<0.01), but 37.49±5.87 in P group with sound effects incontrast to that in I group (P<0.01). Gastric injury index was 18.40±8.35 in I group and 7.9±2.13 in Pgroup with significant difference (P<0.01). Hydrogenion concentration in gastric juice was 118.0±41.2mmol/L in N group, 186.9±74.7 mmol/L in I group and 96.4±57.2 mmol/L in P group with prominentdifference (P< 0.01 ) between those in I and P group. Gastric mucosal nitrite concentration was 1.15±0.46in N group, 0.69±0.15 in I group and 1.04±0.44 in P group with obvious differences between N and Igroups (P<0.01) and between I and P group (P<0.01).CONCLUSION Ischemic and hypoxic injury of gastric mucosal due to low blood perfusion during restrictionand cooling injury at 4℃ was supposed to be an important factor in inducing gastric mucosal stress injury. Butcollagen solution could maintain the integrity of gastric mucosal barrier, buffer gastric acid, promotethrombocytic agglutination and ameliorate direct injury to gastric mucosa caused by various factors.
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AIM To determine the effect of glutathione (GSH) on stress gastric mucosal lesion.METHODS The stress gastric mucosal lesion as produced by restraint water-immersion in rats and gastricmucosal lesion, gastric mucosal GSH content, gastric acid secretion and gastric barrier mucus secretion wereexamined. We also observed the effect of GSH on gastric mucosal lesion and the effect of N-ethylmaleimine(NEM) and indomethacin on GSH protection. Comparisons between two groups were made using the Students t test.RESULTS GSH (100 and 200 mg/kg) intraperitoneally protected against stress gastric mucosal lesion(P<0.001 and P<0.001). Restraint water-immersion stress significantly reduced gastric mucosal GSHcontent (P < 0.001), but pretreatment with GSH (100 mg/kg) had no effect on gastric mucosal GSH content(P>0.05). The preinjection of NEM (10 mg/kg, sc.), a sulfhydryl-blocking reagent, or indomethacin(5 mg/kg, im.), a cyclooxygenase inhibitor, had no effect on protection of GSH (P>0.05). GSH(100mg/kg) significantly increased secretion of gastric barrier mucus (P<0.05), but had no effect onsecretion of gastric acid in restraint water-immersed rats (P >0.05).CONCLUSION GSH can inhibit the formation of gastric mucosal lesions induced by restraint water-immersion. The protective effect of GSH was due, in part, to promoting the secretion of gastric barriermucus, but not to suppress the gastric acid secretion. The protection effect of GSH has no relation withgastric mucosal GSH and PGs.
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心脏磁共振显像技术在冠心病诊断中的应用
目前,冠心病诊断的金标准仍然是冠状动脉造影(coronary angiography,CAG),但冈其有创性以及含碘造影剂可能带来的过敏反应和肾脏损害,对低度、中度可疑冠心病的患者,临床医生仍首选无创检查,如运动负荷心电图(exercise tolerance test,ETT)、运动和(或)药物负荷超声心动图(stress echocardiography)、心肌核素显像包括单光子发射计算机断层成像术(single photon emission eomputedtomography,SPECT)或正电子发射型计算机断层显像(positron emission tomography,PET)及多排CT(multi-detector CT,MDCT)冠状动脉成像.
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心肌声学造影与心肌造影负荷超声心动图在冠心病的研究进展
心肌声学造影(myocardial contrast echocardiography,MCE) 是诊断微循环水平心肌灌注的新技术,利用声学微气泡作为造影剂经冠状动脉或周围静脉注入,应用超声技术接收声学微气泡的背向散射信号而实现心肌灌注显像.
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应激性心肌病与围麻醉期管理
应激性心肌病(stress cardiomyopathy,SCM)是一种临床症候群,表现为在没有冠状动脉粥样硬化性心脏病存在的情况下,急骤发生而又能很快恢复的左心室收缩功能障碍,多由应激性刺激诱发,常见于绝经后中老年妇女.本病由日本学者Sato等[1]于1990年首次报道,此后开始见于全世界范围,并出现于多种临床情况下.2006年,北美麻醉学杂志报道了首例围麻醉期应激性心肌病病例[2],到目前为止,国外杂志已发表了多篇与手术操作有关的应激性心肌病病例报告.近年来,国内虽然也出现关于该病的个案报告[3,4],但尚未有与此综合征有关的围麻醉期诊断和处理的文献.本文拟综述应激性心肌病治疗进展以及围麻醉期管理要点.
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女性压力性尿失禁手术治疗的新进展
压力性尿失禁(stress urinary incontinence,SUI)是指在腹压增加时(如咳嗽、喷嚏、大笑、提重物或体位改变等)引起的不自主尿液漏出.国际尿控协会(international continence society,ICS)将其定义为:构成社会和卫生问题,且客观上能被证实的不自主的尿液流出.
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腹腔镜下膀胱尿道悬吊术围手术期护理
压力性尿失禁(stress urinary incondtience,USI)是因各原因引起的盆底肌肉筋膜组织松弛,膀胱、尿道解剖改变及尿道阻力降低,而腹压突然增加时排尿失去控制,尿液不自主溢出的现象,由于分娩产伤、雌激素水平下降引起,是中老年妇女常见病[1] .腹腔镜手术治疗女性压力性尿失禁具有安全、损伤小、恢复快、临床疗效满意的特点.
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Proift全盆腔重建术在治疗盆腔脏器脱垂中的作用
盆底功能障碍性疾病(pelvic floor dysfunctional,PFD)是指各种病因导致的盆底支持薄弱,进而引起盆腔脏器移位,连锁引发其他盆腔器官的位置和功能异常的疾病,是严重影响中老妇女健康和生活质量的社会生活问题,被称为"社交癌",发病率约为30.0%~40.0%[1].PFD包括盆腔脏器脱垂(pelvicorgan prolapse,POP)、压力性尿失禁(stress uri-nary incontinence,SUI),性功能障碍(sexual dysfunction,SD)和粪失禁(fecal incontinence,FI)等几大类.
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浅谈妇科盆底修补和重建手术患者的护理
女性盆底障碍性疾病(pelvic floor dysfunction,PFD),又称为盆底缺陷(Pelvic Floor Defeets)或盆底支持组织松弛(Relaxation of Pelvic Supports),表现为子宫脱垂等盆底器官膨出(pelvic organ prolapse, POP)和压力性尿失禁(stress urinary incontinence, SUI)等疾病.随着人口的老龄化和对生活质量要求的提高,PFD的发病率逐年增高,美国1年的盆底重建手术约40万例,重建修复手术已占到普通妇科大手术的40%~60%[1].
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压力性尿失禁的保守治疗
女性压力性尿失禁(stress urinary incontinence,SUI)这一非致命性疾病,在20世纪90年代中期开始被认为是影响人类的五大疾病之一.但由于妇女们通常认为尿失禁是一种随年龄增长而出现的正常现象,普遍存在就诊后滞现象.2006年北京协和医院完成的2万人的全国尿失禁流行病学调查显示,尿失禁的总患病率为30.9%,5年就诊率仅为8%,表明我国成年女性尿失禁患者的就诊率较低,需加强临床医生对该病的重视和向民众普及相关知识.
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TVT-O治疗女性压力性尿失禁38例临床分析
女性压力性尿失禁(stress urinary incontinence,SUI)是女性常见疾病,发生率约15%~30%,严重影响患者的生活质量[1].TVT-O 是de Leval 在TVT 基础上改良的吊带手术,近年来临床上应用较广泛[2].现总结本院采用TVT-O治疗的38例SUI患者的临床资料,报道如下.
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盆底功能障碍性疾病基质金属蛋白酶及其抑制剂的研究进展
盆底功能障碍性疾病(pelvic floor dysfunction,PFD)主要表现为子宫等盆腔器官脱垂(pelvic organ prolapsed,POP)和压力性尿失禁(stress urinary incontinence,SUD) 等,多见于中老年女性,严重影响其生活质量.近年来,盆底支持结构的组织病理学改变的研究较多,其中盆底结缔组织中各种组成成分质和量的改变研究多,内容相对全面.虽然研究结果并非完全一致,但对于构成结缔组织主要成分的胶原和弹性纤维的超微结构和生化改变参与PFD的发生与发展已经达成共识.
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关于盆底功能障碍性疾病手术的几个问题
女性盆底功能障碍性疾病(pelvic floor dysfunction,PFD)是一组盆底支持缺陷、损伤及功能障碍造成的疾患,主要问题是压力性尿失禁(stress urinary incontinence,SUI)和盆腔器官脱垂(pelvic organ prolapse,POP).随着人口老龄化和生命质量的提高,各种PFD的修复重建手术蓬勃开展.
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带蒂条形阴道前壁组织交叉悬吊治疗压力性尿失禁的术式探讨
女性压力性尿失禁(stress urinary incontinence, SUI)是腹压突然增加(如咳嗽、喷嚏、大笑、提取重物或体位改变时)大于大尿道压,在无逼尿肌收缩状态下,尿液不自主排出的疾病.该病好发于盆腔器官脱垂(pelvic organ prolapse,POP)、阴道前壁松弛引起的尿道膨出、后膀胱膨出,且后两种膨出常同时存在.SUI手术治疗常采用前盆腔器官修复术+尿道中段无张力悬吊术(tension-free vaginal tape, TVT)或经闭孔阴道吊带悬吊术(tension-free vaginal tape-obturator, TVT-O),但均具有侵蚀及裸露等并发症,且治疗费用昂贵.本研究采用带蒂条形阴道前壁组织交叉悬吊治疗SUI,取得满意疗效.现将研究结果,报道如下.
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胎心电子监护国外指南解读
胎心电子监护(electronic fetal monitoring, EFM)亦称为胎心宫缩描记图(cardiotocography, CTG),包括无应激试验(non-stress test, NST)及宫缩应激试验(contraction stress test, CST).