中孕期胎儿染色体异常高危孕妇羊水细胞胎儿染色体核型及介入性产前诊断指征的大样本分析

目的探讨中孕期胎儿染色体异常(FCA)高危孕妇羊水细胞胎儿染色体核型(FK)及其介入性产前诊断(IPD)指征。方法选择2014—2018年,在四川大学华西第二医院产前诊断中心进行羊膜腔穿刺术羊水细胞FK检测的63581例FCA高危孕妇(孕龄为19~27+6孕周)为研究对象。回顾性分析孕妇不同IPD指征及其胎儿染色体核型异常(FKA)检测结果。本研究遵循的程序符合四川大学华西第二医院伦理委员会所制定的伦理学标准,并通过该伦理委员会批准[审批文号:医学科研2019伦审批第(077)号]。结果①本组63581例中孕期孕妇的FKA检出率为3.13%(1989/63581)。这63581例孕妇的IPD指征分别为高龄(预产期年龄≥35岁)(25648例)、血清学筛查高风险(29009例)、无创产前筛查(NIPT)高风险(333例)、夫妇一方为染色体异常携带者(603例)、超声筛查发现胎儿结构异常及超声软指标异常(2647例)、异常儿生育史(1546例)、于外院进行羊水细胞FK分析结果异常者(7例)、孕妇智力低下及合并智力低下家族史(149例)、孕妇早孕期有害物质接触史(1400例)、其他(2239例),FKA检出率分别为3.26%(836/25648)、2.04%(593/29009)、65.17%(217/333)、34.33%(207/603)、3.51%(93/2647)、1.68%(26/1546)、85.71%(6/7)、4.03%(6/149)、0.14%(2/1400)、0.13%(3/2239)。②351例孕妇的IPD指征为超声筛查发现胎儿结构异常中,IPD指征为胎儿淋巴水囊瘤、皮肤水肿的FKA检出率最高,为26.09%(6/23)。2296例孕妇的IPD指征为胎儿超声软指标异常中,IPD指征为胎儿颈项透明层(NT)值≥2.5 mm的FKA检出率最高,为7.74%(66/853)。结论孕妇高龄、血清学筛查高风险、NIPT高风险、夫妇一方为染色体异常携带者、超声筛查发现胎儿结构异常及超声软指标异常等,均为中孕期孕妇FCA的IPD指征,孕妇IPD指征类型不同,FCA风险不同。羊膜腔穿刺术羊水细胞FK检测,可预测有IPD指征孕妇的妊娠结局,为降低FKA出生率提供参考。     

金华市农村创建社区卫生服务示范区初探

以创建示范区为目标,在农村开展社区卫生服务是新时期农村卫生工作的重要内容,是加快乡镇卫生院建设发展的必由之路。文章对农村创建社区卫生服务示范区工作进行了论述,分析存在问题,提出建议措施。     

居家养老环境风险评估体系的构建

目的 构建居家养老环境风险评估指标体系,为开展老年人居家环境风险评估提供测评工具.方法 采用文献研究法、焦点小组讨论法、德尔菲专家咨询法筛选评估指标,运用层次分析法确定指标权重,建立老年人居家养老环境风险评估体系.结果 2轮专家咨询问卷有效回收率分别为92.31％、86.11％,权威系数分别为0.878、0.892;Ⅰ级指标协调系数分别为0.276、0.291;最终构建的居家养老环境风险评估指标体系包括Ⅰ级指标9个和Ⅱ级指标43个,并确定各级指标权重.结论 居家养老环境风险评估体系被专家认可,评估指标体系的内容全面、权重合理,但需进一步在社区开展实证研究.     

Risk factors to discriminate neoplastic polypoid lesions of gallbladder: A large-scale case-series study

BackgroundPolypoid lesion of gallbladder (PLG) size larger than 10 mm is considered to be one of the surgical indications, but the final pathological results are mostly non-neoplastic polyps. The aim of the study was to define the risk factors to discriminate neoplastic PLG and create more precise criteria for surgical indications.MethodsA large scale, case-series study based on 2704 patients who underwent cholecystectomy for PLG was designed. Logistic regression analysis and receiver operating characteristic curve (ROC) was adopted to identify risk factors and the optimal size criteria for predicting neoplastic PLG.ResultsPatients in the neoplastic group were significantly older than those in the non-neoplastic group and the average PLG size is much larger in the neoplastic group (18.5 ± 4.7 mm vs 12.6 ± 3.6 mm). Neoplastic PLGs are prone to be single and non-neoplastic polyps are usually multiple. On Multivariate logistic regression analysis, PLG size larger than 15 mm and age older than 43 years were found to be the independent risk factors to discriminate neoplastic PLG （Odds ratio 3.546 and 2.77 respectively）. The ROC curve showed that 12 mm might be the more reasonable PLG size threshold for the surgical suggestion.ConclusionsConsidering its moderate diagnostic accuracy, the size of gallbladder polyp larger than 10 mm is insufficient to indicate surgical therapy for PLG and 12 mm should be the more optimal polyp's size threshold. Patients older than 43 years have a higher risk of having neoplastic polyps.     

浙江省海岛农村社区成年人代谢综合征发病率及其危险因素

目的估计浙江省海岛农村社区成年人代谢综合征发病情况, 探索该地区代谢综合征发病的相关影响因素。方法 2018年6-12月在浙江省玉环市对2012年开展的代谢综合征基线调查人群中无代谢综合征调查对象进行随访调查, 获取相关调查表信息以及实验室数据, 描述代谢综合征发病情况, 使用logistic回归探索发病危险因素及调整风险比(aRR)和95%CI。结果 3 162名随访对象中新发代谢综合征522例, 6年累积发病率为16.5%, 男女性累积发病率分别为12.3%、20.6%, 女性高于男性(P<0.001)。无业、吸烟、饮酒调查对象中代谢综合征发病率较高。女性(aRR=1.96, 95%CI:1.50～2.58)和高血压家族史(aRR=1.31, 95%CI:1.04～1.63)为代谢综合征发病独立危险因素。结论海岛农村社区成年人代谢综合征发病率相对较高, 其中女性以及有高血压家族史者发病风险更高。     

Distal rectus femoris surgery in children with cerebral palsy: results of a Delphi consensus project

PurposeThe purpose of this study was for an international panel of experts to establish consensus indications for distal rectus femoris surgery in children with cerebral palsy (CP) using a modified Delphi method.MethodsThe panel used a five-level Likert scale to record agreement or disagreement with 33 statements regarding distal rectus femoris surgery. The panel responded to statements regarding general characteristics, clinical indications, computerized gait data, intraoperative techniques and outcome measures. Consensus was defined as at least 80% of responses being in the highest or lowest two of the five Likert ratings, and general agreement as 60% to 79% falling into the highest or lowest two ratings. There was no agreement if neither threshold was reached.ResultsConsensus or general agreement was reached for 17 of 33 statements (52%). There was general consensus that distal rectus femoris surgery is better for stiff knee gait than is proximal rectus femoris release. There was no consensus about whether the results of distal rectus femoris release were comparable to those following distal rectus femoris transfer. Gross Motor Function Classification System (GMFCS) level was an important factor for the panel, with the best outcomes expected in children functioning at GMFCS levels I and II. The panel also reached consensus that they do distal rectus femoris surgery less frequently than earlier in their careers, in large part reflecting the narrowing of indications for this surgery over the last decade.ConclusionThis study can help paediatric orthopaedic surgeons optimize decision-making for, and outcomes of, distal rectus femoris surgery in children with CP.Level of evidenceV     

Community-living older people’s interpretation of the Norwegian version of older people’s quality of life (OPQOL) questionnaire

The aim of this study is to investigate how community-living older people interpret the Norwegian version of Older People's Quality of Life (OPQOL) questionnaire. The original OPQOL questionnaire was translated based on guidelines for cross-cultural translation. The Three-Step Test-Interview instrument was adopted to investigate how community-living older people interpreted the questionnaire. Data were collected from 14 participants (72–89 years). The questionnaire was filled in under observation. Semi-structured interviews were then conducted to clarify the observational data and elicit the participants’ experiences and opinions. Lastly, data were analysed using a hermeneutic interpretation approach. Our findings indicate that most of the participants managed to complete the OPQOL questionnaire without problems. The data analysis resulted in four primary themes: relevance & applicability, formulation, consistency & accuracy and subjectivity. The questionnaire covered all aspects related to the participants’ quality of life. However, statements related to religion were found to be irrelevant to their quality of life. Most of the participants thought that religion, philosophy and culture should be separate rather than included in the same statement. The participants missed the option of ‘not applicable’ when the statements were irrelevant to them. The statements are formulated in both positive and negative ways, which was sometimes confusing to them. The participants perceived phases such as “around me” “local,” and “things” as ambiguous, and thus they raised concerns about whether the OPQOL questionnaire could capture consistent data regarding their quality of life. The results of this study pinpoint the issues that community-living older people faced when interpreting and answering the Norwegian version of OPQOL questionnaire. These issues were mostly caused by sociocultural differences. Our work provides an overview of the changes that must be made in the questionnaire in order to address these sociocultural differences while using the OPQOL questionnaire in the Norwegian context.