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儿童睾丸混合性生殖细胞肿瘤两例

Construction Workers Among Migrants- A Vulnerable Population for Accessing Reproductive Health ServicesQualitative Situation Analysis in Chengdu Construction Sites for Project YOLAMI

目的：调查了解成都市建筑工地工作的流动人口工人的生殖健康现状，为项目的干预打下基础。方法：采用定量调查和定性研究相结合的方法获取相关数据和信息。结果和结论：流动人口中的建筑工人的确是一个获取生殖健康知识和服务方面十分脆弱的人群：1)流动人群中的建筑工人们的健康状况不容乐观。他们大都看似健康，但健康知识贫乏、不重视自身生殖健康、寻求健康服务的行为单一且不安全；2)建筑公司和工地基本不允许女工在工期怀孕；除特殊工种外，工人没有体检；一般只给工人买工伤险，但没有医疗保险；3)流动人群中的建筑工人们对性与生殖健康方面的需求是迫切的。但他们求医难，寻求性与生殖健康服务更难。

Research on the Diagnostic Value of Ultrasonography in Examining Oblique Vaginal Septum Syndrome

【摘要】　目的　探讨超声检查对阴道斜隔综合征的诊断价值，分析超声图像特点，提高诊断率，为临床选用最佳的手术方式提供依据。　方法　回顾性分析2008年1月-2010年6月经手术确诊为阴道斜隔综合征的15例患者的临床资料及超声检查结果，总结阴道斜隔综合征的声像图特点。　结果　15例经临床确诊为阴道斜隔综合征的患者，超声诊断14例，均表现为双子宫、双宫颈、阴道或宫颈积液/血，9例左肾缺如，5例右肾缺如。误诊1例，为单子宫伴一侧附件巨大囊肿。　结论　超声具有诊断准确、简便、无创、重复性好、价格实惠等优点，对于临床诊断生殖系统畸形具有十分重要的意义，应列为首选检查方式。【Abstract】　Objective　To investigate the diagnostic value of ultrasonography in examining oblique vaginal septum syndrome, analyze the characteristics of ultrasound image to improve the ultrasound diagnosis rate, in order to provide guidance for clinical surgeries.　Methods　We retrospectively analyzed the clinical data and ultrasound examination results of 15 patients diagnosed to have oblique vaginal septum syndrome in our hospital, and summarized their ultrasonographic characteristics.　Results　Among the 15 patients, 14 were diagnosed to have the disease by ultrasound examination. The ultrasound image showed a double uterus, double cervix, and vaginal or cervical fluid or blood for all the patients among whom 9 had absent left kidney, and 5 had absent right kidney. One patient was misdiagnosed to have single uterus with giant cysts on one side.　Conclusions　Ultrasound diagnosis is simple, noninvasive, reproducible, affordable and accurate in diagnosing. It is very useful in clinical diagnosis of reproductive system abnormalities and should be listed as the preferred way of examinations.

Clinical Characteristics of Primary Intracranial Germinoma

【摘要】 目的 探讨颅内原发生殖细胞瘤的临床特征。方法 收集华西医院脑外科2000年1月—2009年3月119例颅内原发生殖细胞瘤的临床资料进行回顾性分析。结果 发病率约占同期颅内肿瘤的 1.1%。男〖DK〗∶女=1.64〖DK〗∶1,平均发病年龄15.4岁。临床表现主要为颅内高压症状及视力视野改变,分别为61、56例；肿瘤主要来源于松果体区及鞍区；64例患者行放疗或放疗加化疗,随访45例。55例患者行手术治疗(其中术后行单纯放疗19例,放疗加化疗5例),随访36例。随访时间3~94个月,平均29.7个月。行放疗和放化疗的患者3、5年生存率明显高于单纯行手术治疗的患者。结论 颅内原发生殖细胞瘤多见于儿童及青少年,男性多见,肿瘤大多位于松果体区及鞍区。临床表现位于松果体区者主要为颅内高压症状等,位于鞍区者主要为视力视野改变、尿崩等。放疗联合化疗是主要治疗手段。

Effects of assisted reproductive technology in single pregnancy on the incidence of gestational diabetes: a systematic review and meta-analysis

ObjectiveTo systematically review the effects of assisted reproductive technology in single pregnancy on the incidence of gestational diabetes.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect cohort studies on the correlation between assisted reproductive technology (ART) and gestational diabetes mellitus (GDM) incidence in single pregnancy from inception to June 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed by using RevMan 5.3 software.ResultsA total of 16 cohort studies involving 2 017 573 cases of single pregnancy were included. The results of meta-analysis showed that compared with the natural pregnancy group, the incidence of GDM was higher in the ART group (RR=1.54, 95%CI 1.30 to 1.83, P<0.000 01). In East Asia and Non-East Asia, the incidence of GDM in the ART group was higher than that in the natural pregnancy group (East Asia: RR=1.55, 95%CI 1.26 to 1.92, P<0.000 01; Non-East Asia: RR=1.49, 95%CI 1.18 to 1.89. P<0.000 1).ConclusionsCurrent evidence shows that the incidence of GDM may increase in single pregnancy with ART compared with natural pregnancy. Due to limited quantity and quality of the included studies, more high quality studies are required to verify above conclusions.

RB1基因的一生殖细胞系新生突变致视网膜母细胞瘤

输卵管妊娠患者开腹行患侧输卵管切除术后生殖状况调查

目的:了解输卵管妊娠患者开腹行患侧输卵管切除术后生殖状况,以指导输卵管妊娠的临床治疗。方法:选择我院2004年至2007年因输卵管妊娠行开腹患侧输卵管切除术患者183例术后的生殖状况进行随访调查,回顾性分析其再次受孕及输卵管妊娠情况。结果: 在有生育要求的107位患者中,总的宫内妊娠率为64.5％(69/107例),8.7％复发输卵管妊娠(6/107例)。宫内受孕率以lt;30岁,术后1～2年最高,中重度贫血及盆腔中重度黏连导致宫内受孕机率下降;复发输卵管妊娠与年龄及术后时间无相关性,随贫血程度及盆腔黏连程度的加重进行性增加。结论: 开腹患侧输卵管切除术后生殖状况与年龄、术后时间、盆腔黏连程度、贫血程度密切相关。及时手术,减轻贫血程度,细致分黏,合理生殖健康指导,能有效提高宫内妊娠,降低复发输卵管妊娠。

Diagnosis and treatment of emergency complications after oocyte retrieval with assisted reproductive technology

Objective To retrospectively analyze the emergency complications of the patients after oocyte retrieval with assisted reproductive technology (ART), and analyze the corresponding strategies. Methods The clinical data of patients after oocyte retrieval with ART between January and December 2016 were retrospectively anayzed. The postoperative emergency complications were observed. Results A total of 5 013 patients were included in the study. The common emergency complications after oocyte retrieval included vaginal bleeding in 137 cases (2.73%) , ovarian hyperstimulation syndrome (OHSS) in 35 (0.69%), hematuria caused by bladder injury in 11 cases (0.21%), pelvic infection in 3 (0.06%), and vagal reflex in 2 (0.04%). OHSS was related to age, the number of basal follicles, the number of oviposaccharides and the estradiol level on the day of human chorionic gonadotropin injection, but not related to the body mass index and the number of days of gonadotropin use; which might be misdiagnosed most likely. Conclusions OHSS is one of the common and severe emergency complications after oocyte retrieval with ART, which should be concerned. Active treatment of complications is helpful to reduce the incidence of emergency complications after oocyte retrieval with ART.

干细胞治疗卵巢功能低下性不孕的研究进展和挑战

不孕不育发病率在世界范围内逐年增加，其中女性不孕患者50%～60%，其可能与生活环境及生活方式的改变有关。由于妇科恶性肿瘤发生率有逐年增加及年轻化趋势，卵巢功能缺陷或卵巢结构缺如导致生殖细胞缺陷的患者可能终身不孕，但干细胞移植治疗为这类患者带来了新的希望。干细胞是具有自我更新及多向分化潜能的未分化细胞，存在于胚胎、胎儿或成年各阶段，这些特点使其成为细胞治疗及再生医学领域的研究热点。理论上，在适宜条件下，干细胞能分化为包括雌性生殖细胞在内的三胚层不同类型细胞，进而形成机体不同组织及器官。现今，多能干细胞诱导分化为雌性生殖细胞的实验研究取得了一定的成果，因此，干细胞转分化为雌性生殖细胞从而进行细胞移植治疗及卵巢组织再生可能作为未来治疗不孕不育的新方法。此综述旨在总结干细胞向雌性生殖细胞转分化的研究进展及其应用于生殖医学所面临的挑战。

辅助生殖技术与子代神经系统疾病的相关性研究回顾

辅助生殖技术是目前治疗不孕症的主要手段之一。由于辅助生殖技术涉及对卵泡发育、精卵结合、胚胎形成、转运、种植过程的人为干预，自 1978 年首例试管婴儿诞生以来，其安全性，尤其是对子代健康的影响一直受到人们的关注。神经系统疾病是常见的出生缺陷之一。由于神经系统疾病通常影响儿童的精神、情绪、智力、运动、语言等关键能力，且神经系统的损伤往往不可修复，因此婴幼儿一旦罹患神经系统疾病对家庭和社会来说无疑是巨大的打击与负担。该文就辅助生殖技术与几种常见的子代神经系统疾病如智力低下、脑瘫、癫痫的关系进行了综述，并对辅助生殖技术对子代神经系统的安全性进行评价，从而进一步指导临床不孕症的治疗及围产期的母儿监护。