双胎妊娠44例临床分析

本文对我院1990～1995年间44例双胎妊娠的分娩方式进行了分析。指出双胎妊娠由于胎位异常、产力异常及妊娠并发症多等因素,难产及手术产率均较单胎明显增高。在25例经阴道分娩的双胎中,阴道手术产率为64％,本组双胎剖宫产率为43.22％。本文认为双胎妊娠的分娩方式应掌握以下原则:当第一胎儿为臀泣、第二胎位为头位,尤其是胎儿较大、羊水较少时,应考虑剖宫产。而单纯的第二胎儿臀位可以经阴道分娩,不必常规剖宫产。     

Course and outcome of Staphylococcus aureus bacteraemia: a retrospective analysis of 308 episodes in a Swiss tertiary-care centre

Staphylococcus aureus bacteraemia (SAB) is associated with substantial morbidity and mortality worldwide. The charts of adult patients with SAB who were hospitalised in a Swiss tertiary-care centre between 1998 and 2002 were studied retrospectively. In total, 308 episodes of SAB were included: 2% were caused by methicillin-resistant strains; 49% were community-acquired; and 51% were nosocomial. Bacteraemia without focus was the most common type of community-acquired SAB (52%), whereas intravenous catheter-related infection predominated (61%) among nosocomial episodes of SAB. An infectious diseases (ID) specialist was consulted in 82% of all cases; 83% received appropriate antibiotic treatment within 24 h of obtaining blood cultures. Overall hospital-associated mortality was 20%. Community-acquired SAB was associated independently with a higher mortality rate than nosocomial SAB (26% vs. 13%; p 0.009). Independent risk-factors for a fatal outcome were age (p < 0.001), immunosuppression (p 0.007), alcoholism (p < 0.001), haemodialysis (p 0.03), acute renal failure (p < 0.001) and septic shock (p < 0.001). Consultation with an ID specialist was associated with a better outcome in univariate analysis (p < 0.001). Compared with a previous retrospective analysis performed at the same institution between 1980 and 1986, there was a 140% increase in community-acquired SAB, a 60% increase in catheter-related SAB, and a 14% reduction in mortality. In conclusion, mortality in patients with SAB remained high, despite effective antibiotic therapy. Patients with community-acquired SAB were twice as likely to die as patients with nosocomial SAB. Consultation with an ID specialist may reduce mortality in patients with SAB.     

Long-term follow-up of patients with tuberculosis as a complication of tumour necrosis factor (TNF)-α antagonist therapy: safe re-initiation of TNF-α blockers after appropriate anti-tuberculous treatment

This study investigated the long-term outcome of patients with tuberculosis (TB) as a complication of tumour necrosis factor (TNF)-α blocker therapy. All TB cases ( n  =   21) complicating TNF-α blocker therapy from French university hospitals were collated between January 2000 and September 2002. Outcome was assessed via a postal questionnaire during September 2005. The mortality rate after 4 years was 4.8%, and one patient had relapsed and six (29%) patients had recommenced TNF-α antagonist treatment, after appropriate anti-TB therapy, without reactivation. These data support the concept that TNF-α antagonists can be restarted in TB patients provided that adequate anti-TB treatment has been completed.     

Temperament as a potential predictor of mortality: Evidence from a 41-year prospective study

Psychological factors were hypothesized to influence mortality, in particular, early versus later mortality. To explore the relationship between temperament, a psychological factor, and mortality in a prospective study of 1337 medical students, we constructed a measure portraying three temperament types, using latent class analysis. Death occurred in 113 subjects over 25–41 years of follow-up. In univariate survival analysis, subjects tending to direct tension inward when under stress (Tension-In) had a higher risk of mortality than Tension-Out or Stable types. These associations persisted after adjustment for age, smoking, cholesterol level, and Quetelet Index. The relative risk (RR) of mortality for Tension-In was 1.56 (95% confidence interval, 1.00–2.44) compared with the Stable group. The risk was due entirely to the excess risk in persons under 55 years of age (RR, 2.59; 95% confidence interval, 1.46–4.62); the corresponding risk of death in older persons was 0.66 (0.30–1.48). Thus temperament is a significant risk factor for mortality, in particular, premature death.     

Morbidity in a Danish national cohort of 472 IVF/ICSI twins, 1132 non-IVF/ICSI twins and 634 IVF/ICSI singletons: health-related and social implications for the children and their families

BACKGROUND: There is a lack of knowledge on child health as well as family well-being in IVF/ICSI twins. METHODS: These data originated from questionnaires completed by mothers taking part in a national cohort study of twin and singleton births occurring in Denmark in 1997. The overall response rate was 83%. The three cohorts consisted of all IVF/ICSI twin children (n = 472), all IVF/ICSI singletons (n = 634) and all non-IVF/ICSI twin children (n = 1132) born in Denmark in 1997. RESULTS: No major differences in physical health were observed between IVF/ICSI twins and non-IVF/ICSI twins. Compared with IVF/ICSI singletons, more IVF/ICSI twins were admitted to a neonatal intensive care unit (NICU) (P < 0.01) and more had surgical interventions (P = 0.03) and special needs (P = 0.02), moreover they had poorer speech development (P < 0.01). Correspondingly, IVF/ICSI twin mothers rated their infant's general health poorer than IVF/ICSI singleton mothers did. All discrepancies between IVF/ICSI twins and singletons disappeared after stratification for birthweight except for NICU admissions and speech development. Multiple logistic regression analyses showed that both IVF/ICSI and non-IVF/ICSI twin parents experienced more marital stress [odds ratio (OR) 2.9, 95% CI 2.2-3.8] and that twins had more impact on the mother's life (OR 1.7, 95% CI 1.2-2.4) compared with singletons. Nevertheless, the only predictor of low divorce/separation risk was IVF/ICSI treatment. CONCLUSION: Our study indicates that physical health of IVF/ICSI twins is comparable with that of non-IVF/ICSI twins. However, physical health of IVF/ICSI twins is poorer and the implications for the families stronger compared with IVF/ICSI singletons.     

Long-term mortality study of oil refinery workers: V. Comparison of workers hired before, during, and after World War II (1940-1945) with a discussion of the impact of study designs on cohort results

The mortality experience of a large refinery cohort (1937-1978) was examined by dividing it into three subcohorts according to hire dates: those hired before 1940, those hired during the period 1940-1945, and those hired after 1945. These three periods are approximately equivalent to before, during, and after World War II and span a total hiring period of more than 75 years. The results showed that a substantial portion of the cohort (3,330 or 27%) had been recruited during 1940-1945, and they contributed 980 or 28% of the total deaths. However, their mortality experience was quite different from the rest. A series of significant increases were seen among the external causes for accidents, suicide, and homicide. In terms of overall mortality and in contrast to the rest of the cohort, no "healthy worker effect" was seen (SMR = 1.00). They also showed increases in several types of cancer including cancers of the pancreas and prostate and leukemia. These unusual experiences cannot be explained either on the basis of their war-related deaths or on their period of employment (one-half were terminated within 1 year from date of hire), and data is insufficient to separate the role of hiring practices or their socioeconomic status. However, their life-styles were probably quite different judged from the fact that alcoholism-related deaths were increased as much as fivefold. Almost two-thirds of the total deaths occurred among 4,080 workers in the before 1940 subcohort. Further, the 5,117 workers of the after-1945 subcohort contributed only 5% of the total deaths. Thus, the results of the original refinery cohort (1937-1978) primarily reflect the experience of those employees hired before 1940. Given the same cohort method (historical prospective), cohort results vary widely according to different study designs, and this has implications for "generalizable" risk assessment or risk projections. A prospective study of new hires with 30 years of follow-up is rather inefficient because it would yield only a small number of deaths, with a strong healthy worker effect. The same is true for studies based on active workers with a short period of follow-up. Studies based on time of hire, however, provide a means for controlling time-related occupational exposures.     

2011—2020年郑州市二七区居民恶性肿瘤死亡趋势及减寿分析

目的了解郑州市二七区居民2011—2020年恶性肿瘤死亡流行趋势及对居民寿命的影响情况,为制定恶性肿瘤防治对策提供科学依据。方法对2011—2020年郑州市二七区居民恶性肿瘤死亡资料进行分析,计算恶性肿瘤死亡率、潜在减寿年数(potential years of life lost,PYLL)、标化潜在减寿年数(standardized potential years of life lost,SPYLL)、标化潜在减寿率(standardized potential years of life lost rate,SPYLLR)和人均减寿年数(average years of life lost,AYLL)等指标,采用年度变化百分比(annual percent change,APC)分析率的时间变化趋势。结果2011—2020年郑州市二七区居民恶性肿瘤年均死亡率为114.68/10万,标化死亡率为103.52/10万,男性年均死亡率(146.09/10万)高于女性(84.56/10万)。恶性肿瘤前5位死因依次为肺癌、肝癌、胃癌、结直肠癌和食管癌,共占恶性肿瘤死亡构成的65.36%。2011—2020年该区居民恶性肿瘤死亡率呈上升趋势(APC=3.70%,P<0.001)。0~44岁年龄组恶性肿瘤死亡率处于较低水平,45岁后随年龄增长逐渐升高,75岁以后迅速升高。恶性肿瘤总PYLL为39067人年,SPYLLR为6.73‰,AYLL为12.59年。结论肺癌、肝癌、胃癌、结直肠癌和食管癌是二七区恶性肿瘤预防控制的重点工作,同时宫颈癌和乳腺癌对女性健康的影响不可忽视,应针对主要恶性肿瘤和重点人群开展综合防控措施,以降低恶性肿瘤的死亡率。     

2015—2020年徐州市铜山区儿童青少年伤害死亡流行特征分析

目的 掌握2015—2020年徐州市铜山区5～18岁儿童青少年伤害死亡流行特征,为政府部门出台相关政策提供科学依据。方法 搜集徐州市铜山区2015—2020年儿童青少年伤害死亡资料进行描述性统计分析,计算伤害的死亡率和构成比,比较采用χ2检验。结果 伤害是铜山区儿童青少年的首位死亡原因,死亡率为8.01/10万,占儿童青少年总死亡的54.05%。随着年龄增加,主要伤害的死亡率从5～9岁年龄组的5.30/10万增加到15～18岁年龄组的12.47/10万(χ2趋势=14.383,P<0.001)。道路交通事故、溺水、意外跌落和自杀的死亡率分别为3.01/10万、2.81/10万、0.67/10万、0.33/10万,居铜山区儿童青少年伤害死亡的前4位。结论 道路交通事故、溺水、意外跌落、自杀是铜山区儿童青少年伤害死亡的主要原因,应采取针对性措施,预防控制儿童青少年伤害的发生。     

吉林省2014-2019年孕产妇死亡分析

目的探讨孕产妇死亡的相关因素,为卫生行政部门制定相关政策提供依据,进一步降低孕产妇死亡率。方法收集2014-2019年发生在吉林省的孕产妇死亡共计167例,将基本情况、死因诊断、省级评审结果等逐一进行统计分析。结果 6年间,孕产妇死亡率总体呈下降趋势(P<0.05),近三年孕产妇死亡年龄较前升高(P<0.05),死亡的孕产妇分娩方式以剖宫产为主,死于直接产科死因的孕产妇占到总死亡数的44.71%,死于直接产科死因的又以产科出血占到死因第一位,可避免死亡占总死亡数的50.3%。结论 "二孩"政策的实施,人口流出,高危孕产妇比例增加,活产数的下降,都对降低孕产妇死亡率提出了严峻考验。必须将孕产妇的管理关口前移,多措并举才能进一步降低孕产妇死亡率,确保母婴安全。     

Association between Vitamin D and Heart Failure Mortality in 10,974 Hospitalized Individuals

A broad range of chronic conditions, including heart failure (HF), have been associated with vitamin D deficiency. Existing clinical trials involving vitamin D supplementation in chronic HF patients have been inconclusive. We sought to evaluate the outcomes of patients with vitamin D supplementation, compared with a matched cohort using real-world big data of HF hospitalization. This study was based on the Diagnosis Procedure Combination database in the Japanese Registry of All Cardiac and Vascular Datasets (JROAD-DPC). After exclusion criteria, we identified 93,692 patients who were first hospitalized with HF between April 2012 and March 2017 (mean age was 79 ± 12 years, and 52.2% were male). Propensity score (PS) was estimated with logistic regression model, with vitamin D supplementation as the dependent variable and clinically relevant covariates. On PS-matched analysis with 10,974 patients, patients with vitamin D supplementation had lower total in-hospital mortality (6.5 vs. 9.4%, odds ratio: 0.67, p < 0.001) and in-hospital mortality within 7 days and 30 days (0.9 vs. 2.5%, OR, 0.34, and 3.8 vs. 6.5%, OR: 0.56, both p < 0.001). In the sub-group analysis, mortalities in patients with age < 75, diabetes, dyslipidemia, atrial arrhythmia, cancer, renin-angiotensin system blocker, and β-blocker were not affected by vitamin D supplementation. Patients with vitamin D supplementation had a lower in-hospital mortality for HF than patients without vitamin D supplementation in the propensity matched cohort. The identification of specific clinical characteristics in patients benefitting from vitamin D may be useful for determining targets of future randomized control trials.