孕妇体重与妊娠期糖代谢异常及巨大儿的相关性的研究

【目的】研究分析北京昌平地区孕妇体重与妊娠期糖代谢异常及巨大儿发生的相关性。【方法】对本院3795名孕妇孕期24～32周常规行50g葡萄糖负荷试验（50gGCT）,对GCT异常的患者,进一步行口服葡萄糖耐量试验（OGTT）。计算孕妇孕前体重指数（BMI）,入院后详细测量分娩前体重,计算BMI,整个孕期BMI增加值,并分析不同体重血糖代谢异常及巨大儿体重情况。【结果】孕前BMI≥24kg／m^2孕妇孕期患妊娠期糖代谢异常几率高于BMI〈24kg／m^2孕妇,发生巨大儿几率两者相比较差异无显著性;孕期BMI增幅〉6孕妇发生巨大儿几率高于BMI增幅〈6孕妇;巨大儿发生率为8．91％。其中糖代谢异常中巨大儿的发生率为20．69％。【结论】孕前BMI在评价妊娠期糖代谢异常方面优于孕期BMI增加值,孕期BMI增加值在评价巨大儿方面优于孕前BMI。妊娠期糖代谢异常者巨大儿的发生率明显增加。     

非妊娠期糖尿病孕妇不同孕期增重对新生儿体质量的影响

目的探讨不同孕期增重对非妊娠期糖尿病(GDM)孕妇分娩巨大儿的影响。方法选取2016年在北京大学第三医院分娩巨大儿的非GDM孕妇作为病例组,并按照1∶1匹配对照组,分析两组孕产妇的不同孕期增重情况。结果两组各纳入95名产妇,巨大儿组产妇的孕前BMI、孕期总增重、孕中期增重、巨大儿分娩史、男性新生儿、剖宫产率、产后出血率均高于对照组(P0. 05)。ROC显示孕中期增重的最佳拐点为8. 75 kg。Logistic回归分析显示孕前超重、孕期增重、孕中期增重、男性新生儿与巨大儿呈正相关,其中,孕中期增重超过8. 75 kg会增加巨大儿的发生(OR=2. 802,95%CI=1. 148～6. 836)。结论对于非GDM孕妇应重视全孕期的体质量管理,尤其是孕中期体质量。对于孕前超重、有巨大儿分娩史的孕妇更应加强全程体质量管理。     

孕前体质量指数及孕期增重对妊娠结局的影响

目的探讨孕妇孕前体质量指数(BMI)、孕期增重对孕妇妊娠结局的影响。方法选取本院1427例孕妇的临床资料进行回顾性分析。根据孕前BMI情况,将孕妇分为消瘦组(BMI<18.5 kg/m 2)、正常组(BMI 18.5 kg/m 2~<25.0 kg/m 2)、超重、肥胖组(BMI≥25.0 kg/m 2)。根据2009年美国医学研究院推荐的孕期增重标准将孕妇分为增重不足组、增重正常组、增重过多组。比较不同组别的妊娠结局,并观察调整孕期增重范围后对不良妊娠结局的影响。结果超重、肥胖组妊娠期高血压疾病、妊娠期糖尿病、产后出血、巨大儿、低出生体质量儿、早产及剖宫产不良妊娠结局的发生率较高,其中3组妊娠期高血压疾病、妊娠期糖尿病、产后出血及剖宫产不良妊娠结局的发生率比较,差异有统计学意义(P<0.05);增重过多组妊娠期高血压疾病、产后出血、巨大儿及剖宫产不良妊娠结局发生率较高,其中3组妊娠期高血压疾病、产后出血及巨大儿不良妊娠结局发生率比较,差异有统计学意义(P<0.05)。孕前超重、肥胖预测早产的受试者工作曲线(ROC)下面积为0.712,预测效果尚可,差异有统计学意义(P<0.05);孕期增重过度预测巨大儿的ROC曲线下面积为0.684,预测效果尚可,差异有统计学意义(P<0.05)。BMI正常范围孕期增重值调整为10.5~15.0 kg时,增重正常组妊娠期糖尿病、贫血、产后出血和巨大儿不良妊娠结局发生率明显下降。结论孕前BMI超重和孕期体质量增长异常均会增高不良妊娠结局风险,孕前BMI及孕期增重可预测孕妇不良妊娠结局。     

妊娠期糖尿病妇女膳食状况与巨大儿的相关影响因素研究

目的探讨妊娠期糖尿病妇女膳食状况与发生巨大儿的相关影响因素。方法选取2012年1月至2015年6月在该院产前门诊接受治疗的妊娠期糖尿病妇女60例作为研究对象,根据分娩的新生儿体质量分为巨大儿组和正常体质量儿组,统计分析一般资料和膳食状况,探讨膳食状况中影响妊娠期糖尿病妇女发生巨大儿的相关影响因素。结果本研究纳入的60例妊娠期糖尿病妇女中共发生8例巨大儿,单因素分析结果显示,影响妊娠期糖尿病妇女发生巨大儿的因素包括身高、孕前体质量、孕前体质量指数(BMI)值、分娩前体质量、孕期增重、水果、蔬菜、油类;多因素Logistic回归分析结果显示,孕前体质量、孕期增重过多、油类的摄入量过多均为妊娠期糖尿病妇女发生巨大儿的危险因素。结论对妊娠期糖尿病妇女合理膳食干预和增加运动量可减少巨大儿的发生。     

产前体重与产科并发症的关系

目的：探讨产前体重与产科并发症的关系。方法：对747例孕足月、单活胎初产妇行前瞻性调查研究,根据产前体重指数（BMI）的不同分为三组：A组（BMI〈26 kg/m2）,B组（26 kg/m2≤BMI〈28 kg/m2）,C组（28 kg/m2≤BMI〈30 kg/m2）,D组（BMI≥30 kg/m2）,比较各组间产科并发症发生情况。结果：随产前体重增加,妊娠期高血压疾病、巨大儿、产程阻滞、难产剖宫产呈增高趋势（P〈0.001,P〈0.05）,产前BMI≥28 kg/m2是巨大儿的危险因素;产前BMI≥30 kg/m2是妊娠期高血压疾病、产程阻滞、难产剖宫产危险因素;产前体重对妊娠期糖尿病、产后出血及胎儿窘迫、新生儿窒息、新生儿病理性黄疸发生的影响,无统计学意义（P〉0.05）;产前BMI与孕前BMI及孕期增重呈正相关（P〈0.001）。结论：对孕前体重及孕期增重适当控制,有利于降低产前体重,减少产科并发症及不良妊娠结局的发生。建议最佳产前BMI〈28 kg/m2,最高不应≥30 kg/m2。     

本土化孕期适宜增重指导对降低巨大儿风险的对照研究

目的用基于孕前体质指数(BMI)的孕期增重指导作为干预手段,探讨孕前BMI与孕期增重对胎儿出生体重的影响。方法采用前瞻性开放性对照研究,将上海市闵行区两家医院产检孕妇9 018例非随机地分为干预组(4899例)和对照组(4 119例)。干预组给与研究对象孕期增重适宜范围的指导;对照组按原来标准产前检查进行,不开展任何关于孕期增重方面的指导。比较两组婴儿出生体重、巨大儿发生率,多因素Logistic回归法分析巨大儿发生率的影响因素。结果多因素Logistic分析结果显示,偏瘦组(BMI18.5 kg/m2)和超重组(BMI≥24 kg/m~2)的巨大儿发生率分别是正常体重组(BMI 18.5~23.9 kg/m~2)的0.711、1.555倍。母亲的怀孕年龄每增加一岁,其分娩巨大儿的危险增加3.7%。经产妇分娩巨大儿的风险会降低17.1%;孕周每增加一周,巨大儿发生率增加9.1%。孕期增重指导的干预手段可明显降低巨大儿发生率,干预组巨大儿的危险度是对照组0.836倍(95%CI:0.67~0.99)。结论巨大儿与孕妇年龄、孕前BMI、孕期增重、孕周及产次有关。基于孕前BMI的孕期增重指导可降低巨大儿发生率。     

138例早产孕妇的孕期体质量指数分布情况及关系研究

正孕妇孕期适宜增重可减少巨大儿、低体质量初生儿、妊娠期糖尿病、早产等的发生[1-2]。多项研究[3-4]报道,孕妇体质量与妊娠期并发症及妊娠结局密切相关。研究[5]指出,孕妇孕前体质量指数(BMI)过高或过低可能对产妇及胎儿造成近期或终身的影响。本研究回归性分析138例早产孕妇孕前BMI及孕期增重情况,分析其与早产的关系,现报告如下。     

138例孕妇早产高危因素及母婴结局

【目的】探讨早产的常见危险因素与母婴结局的关系。【方法】回顾性分析138例早产的临床资料,与同期足月分娩的138例相比较,分析引起早产的危险因素,并对不同孕周组的母婴结局进行比较。【结果】胎膜早破、未作产前检查和妊娠期高血压疾病是造成早产的高危因素,与足月组比较差异均有统计学意义（ P ＜0．05）。不同孕周早产组在低体质量儿、新生儿呼吸窘迫综合征、Apgar评分＜7分的比率及新生儿病死率方面比较差异具有显著性（P＜0．05）;而对母亲的影响差异不显著（P＞0．05）。【结论】早产的发生与多种因素相关,胎龄越小、体质量越轻,其病死率和并发症越高;加强孕期保健,重视产前检查对新生儿结局意义重大。     

孕前体重指数和孕期体重控制对妊娠结局的影响

目的探讨孕前体重指数(BMI)和孕期体重控制对妊娠结局的影响。方法选择2015年1月~2017年10月我院产前检查以及住院分娩的3000例健康孕妇为研究对象,依据BMI不同将其分为孕前低体重组(A组)、孕前正常体重组(B组)和孕前体重超重组(C组)。依孕期BMI增长情况分为BMI增长不足组(A1组)、BMI增长适宜组(B1组)和BMI增长过多组(C1组)。比较三组妊娠糖尿病、新生儿窒息、妊娠高血压疾病、剖宫产、巨大儿、低出生体重儿及早产儿情况。结果 C组妊娠高血压疾病、剖宫产、妊娠糖尿病、巨大儿发生率显著高于A组、B组(P0.05);A组新生儿窒息、早产及低出生体重儿发生率高于C组、B组(P0.05);C1组剖宫产、妊娠高血压疾病、妊娠糖尿病、巨大儿发生率高于A1、B1组(P0.05)。A1组新生儿窒息、早产及低出生体重儿发生率明显高于B1组、C1组(P0.05)。结论孕前BMI及孕期体重的控制对妊娠结局有不同的影响,控制孕期体重在适宜范围内,能够有效减少并发症的发生,改善妊娠结局。     

孕妇肥胖与分娩方式及新生儿低血糖、体质量的关系

目的 探讨孕妇肥胖与分娩方式、新生儿低血糖及新生儿体质量的关系.方法 选取2017年11月至2019年11月于该院分娩的212例孕妇及其新生儿作为研究对象,收集孕妇产检资料、新生儿出生资料,新生儿于出生后30 min内采集足跟末梢血检测血糖.根据孕妇孕前体质量指数(BMI)分为消瘦组、正常组和超体质量/肥胖组,根据孕期增重分为增重不足组、增重适宜组和增重过多组,对不同孕前BMI分组及孕期增重分组的分娩方式、新生儿低血糖发生率及新生儿体质量进行比较分析.结果 212例孕妇孕前BMI平均(20.86±2.91)kg/m2,超体质量/肥胖组孕期增重显著低于消瘦组和正常组,差异有统计学意义(P<0.05).消瘦组、正常组、超体质量/肥胖组分娩方式占比比较,差异有统计学意义(P<0.05);消瘦组、正常组、超体质量/肥胖组新生儿低血糖发生率、新生儿体质量比较,差异均有统计学意义(P<0.05);增重不足组、增重适宜组、增重过多组新生儿体质量比较,差异有统计学意义(P<0.05).结论 孕前超体质量/肥胖会增加新生儿体质量、剖宫产占比及新生儿低血糖发生率,孕期增重过度会明显增加新生儿体质量,但未显著增加剖宫产占比及新生儿低血糖发生率.     

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.     

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.     

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.     

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.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.