新生儿窒息513例临床分析

目的 探讨新生儿窒息的相关因素及预防措施。方法 对1995年1月～2004年12月哈尔滨二四二医院住院分娩发生的新生儿窒息513例临床资料进行分析。结果 新生儿窒息与胎儿窘迫高度相关。脐带因素、产程异常、胎盘功能不全是新生儿窒息的主要产科原因。结论 新生儿窒息是胎儿窘迫产程中缺氧在出生后的表现和继续。应以预防为主：要重视产前检查，对高危妊娠进行系统管理，指导胎动计数，加强产程监护，综合判断后选择最佳分娩方式。一旦发生，及时进行复苏术。     

1444例女性伤害病人住院时间的影响因素分析

目的探讨伤害病人住院时间的影响因素,为减轻伤害患者的住院负担提供信息支持.方法抽取武汉市某医院1996-2000年伤害住院病案资料中15～59岁女性伤害住院病例,联合应用因子分析和Cox回归分析探讨住院时间的影响因素.结果筛选出的因素有手术与麻醉(P=0.0001, RR:0.561, 95%CI:0.521～0.604)、伤害类型(P=0.0001,RR:1.098, 95%CI:1.055～1.144)、抢救次数(P=0.0001, RR:1.315,95%CI:1.247～1.387)和转归结局(P=0.0001, RR:4.048,95%CI:3.690～4.442).除骨折和颅脑伤外的其他伤害、抢救次数少和转归好为缩短住院时间的有利因素.实施手术、手术次数对伤害病例住院时间产生影响,即手术次数越多住院时间越长.采取全麻的病人比其他麻醉方法住院时间长.结论伤害临床研究的重点应是"第一时间紧急救护".病人入院后,及时确诊、正确的治疗,是保证病人治愈并缩短住院日的关键.     

石家庄市学龄儿童超重、肥胖与血压、血脂和血糖的关系

目的探讨城市学龄儿童超重、肥胖与血压、血脂和血糖等心血管疾病危险因素的聚集性。方法采用多阶段分层抽样，测定石家庄市区913名7～13岁儿童的身高、体重、收缩压（SBP）、舒张压（DBP）、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）和空腹血糖水平。结果儿童超重和肥胖总检出率为29．24％（男34．98％，女24．23％）。与正常儿童相比，超重和肥胖儿童的SBP、DBP、TC和TG水平明显升高，HDL-C明显降低。超重和肥胖儿童的高血压、高TG、高TC、高血糖和低HDL-C检出率也明显高于正常儿童。校正年龄和性别后，超重和肥胖儿童的SBP、DBP、TC、TG、血糖升高和HDL-C降低的危险性分别为正常儿童的6．77、3．22、2．55、6．42、3．85和2．94倍（95％CI分别是4．15～11．04、1．38～7．49、1．59～4．11、3．46～11．92、1．69～8．78和1．83～4．73）；超重与肥胖儿童有任意1、2、3个所选心血管疾病危险因素的危险性分别是正常儿童的2．74、13．15和15．33倍（95％CI分别是1．92～3．92、6．69～25．87和4．17～56．39）。结论儿童期超重与肥胖增加儿童心血管疾病危险因素的聚集性以及儿童获得多个心血管疾病的危险性。控制儿童超重和肥胖有助于心血管疾病的早期预防。     

VEGF对缺血/再灌注损伤胰腺细胞凋亡的影响

目的 研究血管内皮生长因子(VEGF)对缺血/再灌注损伤胰腺组织细胞凋亡的影响.方法 将雄性sD大鼠30只随机分为3组(n=10),A组为假手术组,B组为缺血/再灌注损伤组,C组为缺血/再灌注损伤+VEGF反义寡核苷酸组.通过血管夹阻断大鼠腹腔干及肠系膜上动脉30 min,然后去除血管夹再灌注6 h,建立大鼠胰腺缺血/再灌注损伤模型.对各组胰腺组织进行VEGF免疫组化染色及TUNEL法细胞凋亡检测.结果 缺血/再灌注损伤后胰腺组织出现细胞凋亡,同时VEGF蛋白表达上调.缺血/再灌注损伤+VEGF反义寡核苷酸组的胰腺组织VEGF蛋白表达较缺血/再灌注损伤组显著减少(P<0.05),前者细胞凋亡指数较后者明显升高(P<0.05).结论 VEGF能抑制缺血/再灌注损伤胰腺细胞凋亡,可能对胰腺缺血再灌注损伤具有保护作用.     

早产流行趋势及影响因素研究进展

早产是围产保健工作面临的一项严重临床问题,根据世界卫生组织的定义,早产是指从孕妇末次月经周期首日算起,孕龄《37周或259天的分娩.     

The refinement of uncertainty/safety factors in risk assessment by the incorporation of data on toxicokinetic variability in humans.

The derivation of safe levels of exposure in humans for compounds that are assumed to cause threshold toxicity has relied on the application of a 100-fold uncertainty factor to a measure for the threshold, such as the no observed adverse effect level (NOAEL) or the benchmark dose (BMD). This 100-fold safety factor consists of the product of two 10-fold factors allowing for human variability and interspecies differences. The International Programme on Chemical Safety has suggested the subdivision of these 10-fold factors to allow for variability in toxicokinetics and toxicodynamics. This subdivision allows the replacement of the default uncertainty factors with a chemical-specific adjustment factor (CSAF) when suitable data are available. This short review describes potential options to refine safety factors used in risk assessment, with particular emphasis on pathway-related uncertainty factors associated with variability in kinetics. These pathway-related factors were derived from a database that quantified interspecies differences and human variability in phase I metabolism, phase II metabolism, and renal excretion. This approach allows metabolism and pharmacokinetic data in healthy adults and subgroups of the population to be incorporated in the risk-assessment process and constitutes an intermediate approach between simple default factors and chemical-specific adjustment factors.     

Evaluation of three risk scores to predict postoperative nausea and vomiting

BACKGROUND: So far there are three different scores to predict postoperative vomiting (PV: Apfel et al., 1998) or postoperative nausea and vomiting (PONV: Koivuranta et al., 1997; Palazzo and Evans, 1993). All three scores used logistic regression analysis to identify and create weights for the risk factors for PV or PONV. In short, these were sex, age, history of previous PONV, motion sickness, duration of anaesthesia, and use of postoperative opioids. However, an external evaluation and a comparison of these scores has not been performed so far. METHODS: Patients undergoing a variety of surgical procedures under general anaesthesia were studied prospectively. Preoperatively, they completed a questionnaire concerning potential risk factors for the occurrence of PV or PONV implemented in the three risk scores. Balanced anaesthesia (induction agent, nondepolarising neuromuscular blocker, opioid, and inhalation agent in nitrous oxide/oxygen) was performed. No intravenous anaesthesia or any antiemetic prophylaxis was applied. Postoperatively, the patients were observed in the recovery room for the occurrence of PV and PONV and were visited twice on the ward within the 24-h observation period. Both the patients and the nursing staff were asked whether PV or PONV was present. The severity of PONV was categorised using a standardised scoring algorithm. A total of 1,444 patients was finally included into the analysis. Using information of the predicted risk for the individual patients and the actual occurrence of PV or PONV, Receiver Operator Characteristics (ROC-curves) were drawn. The area under each ROC-curve was calculated as a means of the predictive properties of each score and was compared for statistical differences. RESULTS: For prediction of PONV (any severity) the AUC-values (AUC=area under the curve) and the corresponding 95%-confidence intervals were: Apfel: 0.70 (0.67-0.72); Koivuranta: 0.71 (0.69-0.73); Palazzo: 0.68 (0.65-0.70). For prediction of PV: Apfel: 0.73 (0.71-0.75); Koivuranta: 0.73 (0.70-0.75); Palazzo: 0.68 (0.65-0.70). Thus, all three scores appeared to have a moderate accuracy as measured by the AUC. The score of Koivuranta predicts PONV (P=0.007) and also PV (P=0.002) significantly better than Palazzo's score. Furthermore, for predicting of PV the score of Apfel was also superior to Palazzo's score (P=0.005). All three scores predict PV with the same accuracy as PONV. CONCLUSION: The occurrence of PV and PONV in patients undergoing surgery under balanced anaesthesia can be predicted with moderate but acceptable accuracy using one of the available risk scores, regardless of local surgical or anaesthesiological circumstances. For clinical practice, we recommend the score published by Koivuranta, since its calculation is very simple.     

Interaction and Relationship Between Angiotensin Converting Enzyme Gene and Environmental Factors Predisposing to Essential Hypertension in Mongolian Population of China

Objective To investigate the association of specific functional gene ACE (I/D) variants of the renin-angiotensin system with essential hypertension (EH) and interaction between ACE (I/D) gene and risk factors for EH in a genetically homogenous Mongolia rural population of China. Methods Individuals (n=1099) were recruited from general population of Kezuohouqi Banner in Inner Mongolian Autonomous Region. Results The association was found between ACE genotype DD plus ID and EH, with an interaction between ACE genotype DD plus ID and cigarette smoking in an additive model. Cigarette smoking index and ACE gene showed a low exposure-gene (LEG) effect on EH, with interaction indices from 7.10 to 1.16. Interaction between ACE genotype DD plus ID and alcohol drinking on EH appeared an additive model. Alcohol drinking index and ACE gene showed a low exposure-gene (LEG) effect on EH, with interaction indices from 1.66 to 1.09. BMI and ACE gene showed a low exposure-gene (LEG) effect on EH, with interaction indices from 6.15 to 2.49.Interactions between ACE genotype and WHR on EH showed a multiplicative model. In a short, there was an interaction between ACE gene and cigarette smoking, alcohol drinking and BMI on EH,especially in a low dose-exposure effect.Cpmchusion It is important for individuals who carry ACE D allele gene to prevent FH, and furthermore, to prevent and control coronary heart disease, in a view of population-based prevention.     

建筑工地工人艾滋病防治知识影响因素的调查

目的 :研究建筑工地工人艾滋病防治知识知晓程度 ,分析其影响因素。方法 :问卷调查 ,数据采用 Foxpro软件录入 ,用 SPSS8.0 for Windows软件进行单因素分析和 L ogistic回归分析。结果 :婚姻、性别、文化程度、宣传途径是影响建筑工地工人艾滋病防治知识知晓度的主要因素。结论 :对建筑工地工人开展艾滋病防治知识宣传应采取电视、报纸等形式 ,主要针对未婚男性 ,内容通俗易懂 ,以提高他们艾滋病防治知识的知晓度     

原发性中枢神经系统淋巴瘤患者预后因素的 Weibull回归模型分析

目的:研究原发性中枢神经系统淋巴瘤患者术后的生存期,寻找影响患者生存期的主要因素.方法:通过回顾性调查收集我院1995～2002年期间接受手术治疗的22例中枢神经系统淋巴瘤患者的病例资料,用Kaplan-Meier方法估计患者的生存率曲线和平均生存期,采用Weibull回归对患者生存的影响因素进行模型拟合.结果:原发性中枢神经系统淋巴瘤患者的中位生存时间为18个月(95%CI:14～22月).Weibull回归模型分析显示:患者的年龄、肿瘤发生的部位、病程、手术后治疗方法是影响患者生存期的主要因素;患者的性别以及肿瘤的病理特点与患者的生存期没有关系.结论:Weibull回归模型对患者的生存期及其影响因素具有较好的拟合优度.