妊娠糖尿病孕妇分娩新生儿血糖监测结果分析

目的：了解妊娠糖尿病（GDM ）孕妇所分娩新生儿出生后的血糖水平及低血糖发生情况。方法监测50例GDM 孕妇所分娩新生儿在出生后1、4、8、12 h的血糖水平。结果新生儿出生后1、4、8、12 h低血糖发生率分别为22％、6％、2％、0％,出生后1 h低血糖发生率最高（P＜0．05）;顺产及剖宫产新生儿低血糖发生率分别为13％、44％,剖宫产新生儿低血糖发生率较高（P＜0．05）;巨大儿与正常出生体质量新生儿低血糖发生率分别为47％、23％,二者比较差异无统计学意义（P＞0．05）。结论GDM孕妇所分娩新生儿在出生后早期易发生低血糖,有必要进行血糖水平监测。     

妊娠合并糖尿病孕妇分娩的足月新生儿血糖监测及喂养时间模式的探讨

目的探讨妊娠合并糖尿病孕妇分娩的足月新生儿血糖监测及喂养时间模式。方法采用随机数字表法,将本院84例妊娠合并糖尿病孕妇分娩的足月新生儿随机分为观察组和对照组各42例,两组新生儿基线血糖及孕妇待产期空腹和餐后2 h血糖等一般资料比较差异无统计学意义,两组新生儿具有可比性。观察组出生后12 h内每次喂奶前监测指尖血糖,12~24 h每2次喂奶前监测指尖血糖;对照组定时监测血糖,生后12 h内每2 h监测血糖1次,生后12~24 h内每4 h监测血糖1次,比较两组发现新生儿低血糖的效率。结果观察组26例新生儿出现低血糖,对照组17例新生儿出现低血糖,观察组共监测血糖494次,测得低血糖95次,对照组共监测血糖420次,测得低血糖58次,两组比较差异均有统计学意义(P0.05),观察组较对照组发现低血糖的效率高。观察组低血糖较对照组更多出现在0~12 h内,但差异无统计学意义(P0.05)。结论相比定时监测血糖,奶前监测血糖有助于妊娠合并糖尿病孕妇分娩的足月新生儿低血糖的发现,可降低新生儿低血糖相关并发症的发生率。     

新生儿早期血糖监测及其与母亲妊娠期糖代谢异常的关系

[目的]探讨妊娠期糖代谢异常母亲分娩的新生儿出生后24 h血糖变化规律.[方法]选择住院孕妇分娩的新生儿143例.其中糖代谢正常孕妇分娩的新生儿50例列为对照组;妊娠期糖尿病(GDM)孕妇分娩的新生儿50例列为GDM组;妊娠期糖耐量减低(GIGT)孕妇分娩的新生儿43例列为GIGT组.分别在出生时及出生后1 h、2 h、6 h、12 h、24 h进行血糖监测.[结果]GDM组、GIGT组新生儿的低血糖发生率明显高于对照组,并且均在出生后1 h血糖值最低,而后血糖逐渐升高,至24 h后血糖值与对照组差异无统计学意义.GDM组及GIGT组间血糖紊乱发生率相比差异无统计学意义.[结论]孕妇妊娠期糖代谢异常能增加新生儿血糖紊乱率,应重视早期新生儿血糖监测.     

孕妇及新生儿潜在影响新生儿第1个24 h血糖水平相关因素

[目的]分析孕妇及新生儿潜在影响新生儿第1个24 h血糖水平相关因素。[方法]回顾性分析2016年3月—2017年3月在本院接受分娩孕妇1 863例及其所娩出的新生儿,分析孕妇不同分娩方式对新生儿娩出后微量血糖的影响,脐血血糖含量和新生儿微量血糖含量相关性及孕妇和新生儿因素对新生儿娩出微量血糖的影响。[结果]急症性剖宫产、选择性剖宫产与经阴分娩娩出新生儿在0.5 h、2 h及6 h其血糖含量比较差异有统计学意义(P0.05),娩出12 h及24 h其血糖含量比较差异无统计学意义(P0.05);在娩出新生儿时收集其脐血,检测得出脐血血糖是(4.42±0.68)mmol/L,和新生儿微量血糖行相关性分析,新生儿在娩出0.5 h、2 h其血糖和出生以后脐血血糖含量呈正相关(r值分别为0.638、0.463,P0.05);新生儿娩出2 h内低血糖发生率在孕妇年龄、体重增加量及分娩即刻血糖含量比较差异有统计学意义(P0.05);新生儿娩出2 h内低血糖发生率在其出生体重和脐带、羊水状况方面比较差异有统计学意义(P0.05)。[结论]对新生儿出生后6 h内血糖含量及时监测,可及时发现低血糖状况,便于前期进行干预,预防脑损伤等情况发生。     

新生儿早期血糖监测及其与母亲妊娠期糖代谢异常的关系

[目的]探讨妊娠期糖代谢异常母亲分娩的新生儿出生后24h血糖变化规律。[方法]选择住院孕妇分娩的新生儿143例。其中糖代谢正常孕妇分娩的新生儿50例列为对照组;妊娠期糖尿病（GDM）孕妇分娩的新生儿50例列为GDM组;妊娠期糖耐量减低（GIGT）孕妇分娩的新生儿43例列为GIGT组。分别在出生时及出生后1h、2h、6h、12h、24h进行血糖监测。[结果]GDM组、GIGT组新生儿的低血糖发生率明显高于对照组,并且均在出生后1h血糖值最低,而后血糖逐渐升高,至24h后血糖值与对照组差异无统计学意义。GDM组及GIGT组间血糖紊乱发生率相比差异无统计学意义。[结论]孕妇妊娠期糖代谢异常能增加新生儿血糖紊乱率,应重视早期新生儿血糖监测。     

妊娠期糖尿病产妇分娩镇痛过程血糖水平的健康干预

目的探讨健康干预对分娩镇痛产妇及新生儿血糖水平的影响。方法选择妊娠期糖尿病的孕妇120例随机分为观察组和对照组,每组60例。对照组常规开展糖尿病专科门诊护理项目,观察组在专科门诊护理基础上进一步进行糖尿病专科指导。记录分娩镇痛前产妇孕周、体质量指数、新生儿体质量、脐静脉血糖水平以及产妇实施分娩镇痛前(T_1),分娩镇痛后30 min(T_2)、60 min(T_3),宫口开至10 cm(T_4),胎儿娩出后2 h(T_5)时点末梢血糖水平。结果 2组产妇分娩时孕周和体质量指数比较,差异无统计学意义(P 0.05),新生儿出生后体质量和脐静脉血糖水平比较,差异有统计学意义(P 0.05)。2组T_1、T_2时点血糖水平比较,差异无统计学意义(P 0.05),T_3、T_4和T_5时点血糖水平比较,差异有统计学意义(P 0.05)。结论通过糖尿病专科护理门诊的健康干预,分娩镇痛产妇分娩过程及新生儿的血糖水平更加稳定。     

妊娠期糖耐量异常对新生儿血糖水平影响的前瞻性对照研究

目的通过对妊娠期糖耐量异常和妊娠期血糖正常产妇所分娩的新生儿出生后24 h内5个时点血糖水平的动态监测对比,分析妊娠期糖尿病对新生儿血糖水平的影响。进一步完善妊娠期糖尿病的系统管理方法,避免新生儿低血糖的发生。方法选择我院产科2003年6月~2004年6月住院孕妇所分娩的新生儿,妊娠糖尿病孕妇所分娩的新生儿66例,其中妊娠期糖尿病(GDM)47例,妊娠期糖耐量异常(GIGT)的19例与同期正常孕妇所分娩的新生儿66例比较。结果两组新生儿血糖值24 h内5个时点的比较,差异无统计学意义。新生儿体重比较差异无显著性意义。结论观察分析新生儿低血糖的发生率并能及时治疗,纠正低血糖,减少合并症的发生,反映了系统管理妊娠期糖尿病及糖耐量受损的治疗效果,对临床治疗和护理有指导意义。     

妊娠期孕妇血糖水平对分娩方式及新生儿体质量的影响

目的探讨妊娠期孕妇血糖水平对分娩方式及新生儿体质量的影响。方法选择2014年9月至2015年9月于本院接受产前检查及分娩的妊娠期期糖尿病孕妇80例(糖尿病组),同期于本院分娩的血糖水平正常孕妇(80例)纳入对照组,比较孕妇血糖指标、新生儿体质量及即刻血糖浓度、分娩方式、巨大儿发生率,分析新生儿体质量和孕妇血糖水平的相关性。结果糖尿病组孕妇空腹血糖(FBG)水平,新生儿体质量及即刻血糖浓度高于对照组,顺产率低于对照组,产钳助产率、剖宫产率、巨大儿发生率高于对照组(P0.05)。新生儿体质量与妊娠期糖尿病孕妇FBG水平呈正相关(P0.05)。结论妊娠期糖尿病分娩巨大儿的发生率较高,剖宫产率高,应严格控制此类产妇血糖水平,以降低不良妊娠结局及巨大儿的发生率。     

糖尿病母亲分娩的足月新生儿血糖监测及喂养时间模式的探讨

目的探讨糖尿病母亲分娩的足月新生儿喂养时间及血糖监测关系的模式。方法将2012年7月至2014年2月的168例由妊娠合并糖尿病的孕妇分娩的足月新生儿分为实验组和对照组,各84例,实验组出生后12 h内每次喂奶前监测指尖血糖,12~24 h每两次喂奶前监测指尖血糖;对照组出生后12 h内监测血糖每2 h一次,12~24 h监测血糖每4 h一次,比较两组发现新生儿低血糖的概率。结果实验组共发现低血糖190次,低血糖新生儿50例;对照组发现低血糖116次,低血糖新生儿34例,实验组较对照组发现低血糖的概率高。结论相比定时监测血糖,喂奶前监测血糖有助于糖尿病母亲分娩的新生儿低血糖的发现,可降低新生儿低血糖相关并发症的发生率。     

孕期血糖逆向增高对妊娠结局的影响

目的探讨孕期血糖逆向增高对妊娠结局的影响。方法选取我院2017年11月～2018年11月期间诊治的定期产检和分娩孕妇106例作为观察组,均在孕24～28周实行葡萄糖耐量试验筛查,根据筛查结果分组:31例孕期血糖检查提示逆向增高孕妇为逆向增长组,32例妊娠期糖尿病孕妇为妊娠期糖尿病组,43例血糖正常孕妇为正常组,对三组孕妇妊娠结局进行统计学分析。结果妊娠期糖尿病组剖宫产率与逆向增高组比较,差异无统计学意义(P0.05),而正常组的剖宫产率明显低于妊娠期糖尿病组、逆向增高组,差异有统计学意义(P0.05);三组受试者的羊水异常、妊娠期高血压综合征、胎膜早破、早产、产后出血发生率比较差异均无统计学意义(P0.05);逆向增高组新生儿发生胎儿宫内窘迫、巨大儿、胎死宫内、低体重儿、新生儿窒息等不良结局的概率最高,但与妊娠期糖尿病组比较差异无统计学意义(P0.05),明显高于正常组,差异有统计学意义(P0.05)。结论孕期血糖逆向增高者存在血糖代谢延迟现象,对妊娠结局的影响不大,但可影响新生儿远期预后,应加强对孕期血糖逆向增高孕妇的孕期管理,以改善新生儿预后。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."