浙江省嘉兴地区初孕妇女自然流产状况研究

Objective To study the current status of spontaneous abortion of primigravid women in Jiaxing areas of Zhejiang province of China. Methods We analyzed the data from both perinatal healthcare surveillance program and spontaneous abortion, collected in Jiaxing areas by the Institute of Reproductive and Child Health, Peking University. The study population consisted of 14 769 primigravid women (excluding induced abortion, ectopic pregnancy and molar pregnancy as outcomes) attempting to become pregnant who registered between 1993 and 1995. Results 1454 spontaneous abortion cases were identified, with the spontaneous abortion rate as 9.8% (95% CI:9.3%-10.3%). The mean gestational weeks at pregnancy diagnosis were 7.6±2.1 weeks, the mean gestational weeks at miscarriage were (10.1±3.1) weeks and the incidence of first-trimester (≤12 weeks) spontaneous abortion was 7.3%(95%CI: 6.8%-7.7%), accounting for 73.7% of all the spontaneous abortion cases. A peak for risk of miscarriage was around 8-13 weeks, accounting for 37.7% of all spontaneous abortion. The observed multiple Cox regression model showed that increased spontaneous abortion rates were observed in women with age at pregnancy ≥30, being peasants and with higher education level. Conclusion The spontaneous abortion rate of primigravid women in Jiaxing areas was higher than in other areas of China. The maximum occurrence of spontaneous abortions was during period of 8-13 gestation weeks.     

多囊卵巢综合征患者自然流产后避孕时间与妊娠结局的关系

目的 探讨多囊卵巢综合征(PCOS)患者自然流产后是否避孕与妊娠率、妊娠结局的关系.方法 将141例发生自然流产的PCOS患者按自然流产后是否避孕分为两组:不避孕组67例,避孕组74例.比较两组取消周期率、单个优势卵泡生长率、妊娠率、自然流产率.结果 不避孕组取消周期率为1.49%(1/67),单个优势卵泡生长率为58.21%(39/67),妊娠率为39.39%(26/66);避孕组分别为13.51%(10/74)、20.27%(15/74)、18.75%(12/64),两组比较差异均有统计学意义(P＜0.01).不避孕组自然流产率为7.69%(2/26),均于孕7周时发生自然流产;避孕组自然流产率为33.33%(4/12),孕6周1例,孕8周2例,孕9周1例,两组比较差异有统计学意义(P＜0.05).结论 PCOS患者自然流产后不避孕即期待妊娠,部分患者可自发排卵,自然流产当个周期第28天无优势卵泡生长再促排卵者较避孕3个月再促排卵者取消周期率低,安全性高,妊娠率高,孕早期自然流产率低.

Abstract：

Objective To determine the relationship between contraceptive or not after spontaneous abortion and the outcome of pregnancy in patients with polycystic ovary syndrome (PCOS). Methods One hundred and forty-one cases of women with PCOS who post-abortion were divided into two groups by random digits table,67 cases in non-contraception group and 74 cases in contraception group. The cycle cancelled rate, single dominant follicle development rate,pregnancy rate, spontaneous abortion rate were compared between two groups. Results The cycle cancelled rate was 1.49% (1/67),single dominant follicle development rate was 58.21% (39/67),pregnancy rate was 39.39% (26/66) in non-contraception group;13.51% ( 10/74 ), 20.27% ( 15/74 ), 18.75 % ( 12/64 ) in contraception group. There were significant difference between two groups (P ＜0.01). The spontaneous abortion rate was 7.69%(2/26)at pregnant 7 weeks in non-contraception group.The spontaneous abortion rate was 33.33%(4/12 ) in contraception group, 1 case in pregnant 6 weeks, 2 cases in pregnant 8 weeks, 1 case in pregnant 9 weeks. There was significant difference between two groups (P ＜ 0.05 ). Conclusion Patients with PCOS who are not contraceptive after abortion can obtain better outcome pregnancy with the low cycle cancelled rate, high safety and pregnancy rate, low spontaneous abortion rate.     

Effectiveness of automated machine learning models in predicting the risk of preeclampsia in the first trimesterCSCD

Objective To explore the application value of automated machine learning (autoML) model in predicting the risk of preeclampsia in the first trimester. Methods From January 2017 to October 2020, 2 180 singleton pregnant women who were registered in Jinan Second Maternal and Child Health Hospital and underwent pregnancy examination at 12 weeks of gestation were selected. The pregnant women were divided into preeclampsia group (103 cases) and control group (2 077 cases) according to the occurrence of preeclampsia. The differences in clinical data and hematological indexes in the two groups were compared, and the correlation between each index and the risk of preeclampsia was analyzed too. All the pregnant women were randomly divided into training set and test set according to the ratio of 7∶3, and the autogluon autoML algorithm was used to build a variety of machine learning models, and training and cross‑validation were performed in the training set to compare the accuracy of the different models. The importance of each index in the autoML model was analyzed, and the autoML model and the logistic regression model were used to predict the risk of preeclampsia in pregnant women in the test set respectively, and the receiver operating characteristic (ROC) curve was used to evaluate the prediction performance of the autoML and the logistic regression model. Results The age, pre‑pregnancy body mass index, body mass index at 12 weeks of gestation, waist circumference at 12 weeks of gestation, proportion of drinking history, high‑sensitivity C‑reactive protein (hs‑CRP), triglyceride, low‑density lipoprotein cholesterol (LDL‑C), aspartate aminotransferase (AST), platelet distribution width (PDW), mean platelet volume, thyroid stimulating hormone (TSH) and β‑human chorionic gonadotropin were all significantly higher than those in the control group (all P<0.05), and the free tri‑iodothyronine (free T3), free thyroxine (free T4), placental growth factor (PIGF), soluble fms‑like tyrosine kinase‑1 (sFlt‑1) and pregnancy‑associated plasma protein‑A (PAPP‑A) were all significantly lower than those in the control group (all P<0.05). Correlation analysis showed that the correlation between pre‑pregnancy body mass index, body mass index at 12 weeks gestation, waist circumference at 12 weeks gestation, hs‑CRP, triacylglycerol, AST, TSH, free T3, free T4, β‑HCG, PIGF, sFlt‑1, PAPP‑A and preeclampsia risk were obviously higher; but the correlation between each index were lower. A total of 18 models in 8 categories were constructed with the autoML model algorithm, and the neural network _L2 based on FastAI had the highest accuracy in the training set (0.963) and the validation set (0.971). The TSH, LDL‑C, PDW, waist circumference at 12 weeks of gestation, sFlt‑1, AST were more important in the model, while the free T4, total cholesterol, pregnancy times, drinking history, parity and family history of hypertension were less important indicators. The area under the ROC curve of the autoML model for predicting the risk of preeclampsia in the first trimester was significantly higher than that of the logistic regression model (0.984 vs 0.765, P= 0.002), while there was no statistical difference in the prediction accuracy of the two prediction models in the training set (P>0.05). The prediction accuracy and sensitivity of the autoML model in the test set were both significantly higher than those of the logistic regression model (99.54% vs 98.32%, 93.75% vs 75.00%, both P<0.05). Conclusions Factors such as TSH, LDL‑C, PDW, waist circumference, sFlt‑1 and AST in the first trimester of pregnancy have a certain correlation with the risk of preeclampsia. The autoML model based on the indicators of the first trimester has a high predictive value for the risk of preeclampsia. © 2021 Journal of Clinical Otorhinolaryngology Head and Neck Surgery. All rights reserved.     

Diagnostic value of vascular endothelial growth factor combined with β-human chorionic gonadotropin for suspected ectopic pregnancy

Objective To explore the diagnostic values of vascular endothelial growth factor (VEGF) and p -human chorionic gonadotropin( β -hCG) for early ectopic pregnancy. Methods The serum levels of VEGF and β-hCG were measured in 109 patients with suspected ectopic pregnancy by ELISA and RIA respectively, receiver operating characteristic (ROC) curvers were established, the diagnostic values of VEGF and β -hCG for ectopic pregnancy were analyzed. Results One hundred and nine patients with suspected ectopic pregnancy were diagnosed in the end: 62 cases with ectopic pregnancy and 47 cases with intrauterine pregnancy. The levels of VEGF in ectopic pregnancy were significantly higher than those in intrauterine pregnancy (P ＜ 0.05), but the levels of β -hCG were significantly lower than those in intrauterine pregnancy (P ＜ 0.05). The areas under ROC curves of VEGF were 0.87, the areas under ROC curves of β -hCG were 0.71. In VEGF ＞ 140 ng/L for diagnosis of ectopic pregnancy, the sensitivity and specificity were 75.8% (47/62) and 80.9% (38/47) respectively. In β-hCG ＜ 1200 U/L for diagnosis of ectopic pregnancy, the sensitivity and specificity were 64.5%(40/62) and 61.7%(29/47) respectively. The sensitivity and specificity of combined detection of VEGF and β -hCG were 80.6%(50/62) and 57.4%( 27/47) respectively. Conclusions The diagnostic values of VEGF are better than those of β -hCG. The combined detection of VEGF and β -hCG can increase the rate of early diagnosis and shorten observation time.     

11例甲型H1N1流感孕产妇的临床分析

Objective To study the clinical characteristics and therapeutic effect of pregnant women infected with severe influenza A(H1N1), to survey the disease effects for the newborns. Methods The clinical data of 11 pregnant women infected with influenza A(H1N1 ) in our hospital from November to December 2009 were analyzed retrospectively. Results All the cases were in serious conditions, and 3 cases were in critical. All the patients were with symptoms of fever and cough, the temperature were in 38.7-39.6 ℃, and duration were 3-14 days. There were 9 cases with low lymphocytes, and 9 cases with high WBC. CRP were elevated in all the cases ( 12-129 mg/L), 9 cases were with hypochromia (22.4-30.2 mg/L). X ray showed increases of pulmonary hilar density for all the cases. By comprehensive treatment, 10 patients were cured and one showed marked progress. 9 cases continued pregnacy. One infant with septicemia was cured, other newborns and fetus were in good condition. Conclusions Pregnant women infected with influenza A (H1N1) are likely to develop severe condition. It is important to use antiviral treatment promptly,supplementary comprehensive treatment. Continuing pregnancy is safe, but the outcome to newborn needs further study.     

Clinical study of the efficacy of interferon-α therapy for HBeAg-negative chronic hepatitis B patients

Objective To investigate the effect of IFN-α therapy for HBeAg-negative ehronie hepatitis B(CHB). Methods 50 cases of HBeAg-negative CHB patients were selected as treated group, while 52 cases of HBeAg-positive CHB as control group. Both groups received injection of IFN-α at dose of 6 MU every other day for 48 weeks. Levels of alanine aminotransferase, viral markers levels of HBeAg, HBV DNA and the four serum fibrosis markers were analysed before and after treatment and 24 weeks after the course. Results There were 36 cases in treated group and 26 cases in control group who had got obvious therapeutic effects at the end of 24 weeks after treatment. And the rates of efficacy were 72% and 50% separately. The rate of treated group was higher than that of control group(X2 = 5.43, P <0.05). The four serum fibrosis markers of the both groups were clearly dropped after treatment (t = 2.365, P < 0.05). Conclusions The theraputie effects of IFN-α at dose of 6 MU for HBeAg-negative CHB is prior to HBeAg-positive CHB. And IFN-α also have an evident funtion on preventing or delaying hepatic fibrosis in patients with CHB.     

Clinical study of the efficacy of interferon-α therapy for HBeAg-negative chronic hepatitis B patients

Objective To investigate the effect of IFN-α therapy for HBeAg-negative ehronie hepatitis B(CHB). Methods 50 cases of HBeAg-negative CHB patients were selected as treated group, while 52 cases of HBeAg-positive CHB as control group. Both groups received injection of IFN-α at dose of 6 MU every other day for 48 weeks. Levels of alanine aminotransferase, viral markers levels of HBeAg, HBV DNA and the four serum fibrosis markers were analysed before and after treatment and 24 weeks after the course. Results There were 36 cases in treated group and 26 cases in control group who had got obvious therapeutic effects at the end of 24 weeks after treatment. And the rates of efficacy were 72% and 50% separately. The rate of treated group was higher than that of control group(X2 = 5.43, P <0.05). The four serum fibrosis markers of the both groups were clearly dropped after treatment (t = 2.365, P < 0.05). Conclusions The theraputie effects of IFN-α at dose of 6 MU for HBeAg-negative CHB is prior to HBeAg-positive CHB. And IFN-α also have an evident funtion on preventing or delaying hepatic fibrosis in patients with CHB.     

Clinical study of the efficacy of interferon-α therapy for HBeAg-negative chronic hepatitis B patients

Objective To investigate the effect of IFN-α therapy for HBeAg-negative ehronie hepatitis B(CHB). Methods 50 cases of HBeAg-negative CHB patients were selected as treated group, while 52 cases of HBeAg-positive CHB as control group. Both groups received injection of IFN-α at dose of 6 MU every other day for 48 weeks. Levels of alanine aminotransferase, viral markers levels of HBeAg, HBV DNA and the four serum fibrosis markers were analysed before and after treatment and 24 weeks after the course. Results There were 36 cases in treated group and 26 cases in control group who had got obvious therapeutic effects at the end of 24 weeks after treatment. And the rates of efficacy were 72% and 50% separately. The rate of treated group was higher than that of control group(X2 = 5.43, P <0.05). The four serum fibrosis markers of the both groups were clearly dropped after treatment (t = 2.365, P < 0.05). Conclusions The theraputie effects of IFN-α at dose of 6 MU for HBeAg-negative CHB is prior to HBeAg-positive CHB. And IFN-α also have an evident funtion on preventing or delaying hepatic fibrosis in patients with CHB.     

Clinical study of the efficacy of interferon-α therapy for HBeAg-negative chronic hepatitis B patients

Objective To investigate the effect of IFN-α therapy for HBeAg-negative ehronie hepatitis B(CHB). Methods 50 cases of HBeAg-negative CHB patients were selected as treated group, while 52 cases of HBeAg-positive CHB as control group. Both groups received injection of IFN-α at dose of 6 MU every other day for 48 weeks. Levels of alanine aminotransferase, viral markers levels of HBeAg, HBV DNA and the four serum fibrosis markers were analysed before and after treatment and 24 weeks after the course. Results There were 36 cases in treated group and 26 cases in control group who had got obvious therapeutic effects at the end of 24 weeks after treatment. And the rates of efficacy were 72% and 50% separately. The rate of treated group was higher than that of control group(X2 = 5.43, P <0.05). The four serum fibrosis markers of the both groups were clearly dropped after treatment (t = 2.365, P < 0.05). Conclusions The theraputie effects of IFN-α at dose of 6 MU for HBeAg-negative CHB is prior to HBeAg-positive CHB. And IFN-α also have an evident funtion on preventing or delaying hepatic fibrosis in patients with CHB.     

Clinical study of the efficacy of interferon-α therapy for HBeAg-negative chronic hepatitis B patients

Objective To investigate the effect of IFN-α therapy for HBeAg-negative ehronie hepatitis B(CHB). Methods 50 cases of HBeAg-negative CHB patients were selected as treated group, while 52 cases of HBeAg-positive CHB as control group. Both groups received injection of IFN-α at dose of 6 MU every other day for 48 weeks. Levels of alanine aminotransferase, viral markers levels of HBeAg, HBV DNA and the four serum fibrosis markers were analysed before and after treatment and 24 weeks after the course. Results There were 36 cases in treated group and 26 cases in control group who had got obvious therapeutic effects at the end of 24 weeks after treatment. And the rates of efficacy were 72% and 50% separately. The rate of treated group was higher than that of control group(X2 = 5.43, P <0.05). The four serum fibrosis markers of the both groups were clearly dropped after treatment (t = 2.365, P < 0.05). Conclusions The theraputie effects of IFN-α at dose of 6 MU for HBeAg-negative CHB is prior to HBeAg-positive CHB. And IFN-α also have an evident funtion on preventing or delaying hepatic fibrosis in patients with CHB.     

对医院护理管理队伍建设的几点思考

文章分析了当前医院护理管理队伍存在的主要问题：知识结构不合理；专业思想不纯正；接受继续教育不足：工作效能低下。提出了建设高素质护理管理人才队伍的思路：严格标准，搞好选才；加强思想教育和引导；加大培养力度；建立科学考评和激励机制；完善人才合理流动措施；合理编制，突出效率。     

医学科技成果信息资源网络开放利用的原则探析

医学科技成果信息资源网络开放利用，为资源的开放共享创造了良好条件，它使医学科技信息得到了高效传播和最大利用。网络开放利用医学科技成果信息资源，利用的主体和核心是其信息内容。信息内容是网络用户从中提取知识和所需资料的主要来源，同时也是信息破坏者发动攻击的主要目标之一，因而，信息内容的安全是信息安全的基本问题，主要包括信息内容的规范性、完整性与真实性、知识产权保护与利用的合理性等。要做好这些工作，应该遵循相应的原则和要求。     

Correlates of stages of change of smoking among inhabitants of deprived neighbourhoods

BACKGROUND: This study examines the prevalence and correlates of stages of change of smoking, in terms of psychosocial, structural and sociodemographic factors, among inhabitants of deprived neighbourhoods. METHODS: Cross-sectional data were obtained from a survey on health related behaviour. Subjects were 2009 current and former smokers, aged 20-46, living in deprived neighbourhoods in Rotterdam, the second largest city in the Netherlands. Three groups of smokers were formed according to the stages of change-definitions of the Transtheoretical Model: smokers not planning to quit (precontemplators), smokers planning to quit (contemplators/preparators) and former smokers (actors/maintainers). Smokers planning to quit and smokers not planning to quit were compared regarding psychosocial factors (attitude, social norm, self-efficacy), structural factors (neighbourhood problems, material deprivation, financial problems, employment status) and sociodemographic factors (age, gender, marital status, cultural background, educational level). Former smokers were compared with smokers planning to quit regarding structural and sociodemographic factors. Logistic regression was used to assess correlates of stages of change. RESULTS: Smokers planning to quit (prevalence = 19%) reported a more positive attitude, stronger social norms and higher self-efficacy expectations in quitting smoking than smokers not planning to quit (prevalence = 57%). Smokers planning to quit less often were Dutch-born, more often had attended higher vocational schooling or university and more often reported experiencing two or more neighbourhood problems compared to smokers not planning to quit. Former smokers (prevalence = 24%) were older, more often Dutch-born, married, employed and higher educated, compared to smokers planning to quit. Furthermore, former smokers less often reported material deprivation and financial problems than smokers planning to quit. CONCLUSION: Among people living in deprived neighbourhoods, different factors correlate with different stages of change of smoking. Implications for health promotion are discussed.     

转基因食品产业化的风险防范及制度构建

风险防范机制的缺失是阻碍转基因食品产业发展的因素之一。基于转基因食品产业对人类健康、物种进化和生态环境的负面影响，及时有效地构建风险防范机制十分必要。我国既有的转基因食品产业风险防范机制存在诸多缺陷：未形成转基因食品全程跟踪制度及安全事故应急处理制度，在安全性评价制度及法律责任体系等方面也有待进一步完善。     

中医药干预治疗不同程度产后抑郁临床研究

目的 观察中药干预不同程度产后抑郁症患者的临床疗效.方法 选择90例产后抑郁症患者,随机平均分为干预组和对照组,每组中又平均各自分为轻度、中度、重度3组.干预组在基础治疗上加中药干预治疗,对照组只进行基础治疗.结果 两组轻度产后抑郁症患者均100％痊愈;中度产后抑郁症患者,痊愈率和有效率差异无统计学意义(P＞0.05);重度产后抑郁症患者中,干预组的痊愈率和有效率均显著高于对照组(P＜0.05).结论 中药干预重度产后抑郁症患者具有一定的疗效.