电子胎心监护Ⅱ类图形反复性变异减速产妇分娩终止时限对新生儿结局的影响

目的探讨电子胎心监护(EFM)Ⅱ类图形反复性变异减速(VD)产妇的分娩终止时限对新生儿结局的影响。 方法选择2015年1月1日至2018年12月31日在北京市通州区妇幼保健院住院分娩，并且胎儿心率出现EFM Ⅱ类图形反复性VD的829例产妇为研究对象。其中，胎儿心率发生轻、中、重度反复性VD的产妇分别为392、246及191例。按照分娩终止时限不同，将其分为3组，A组(n＝380，分娩终止时限≤30 min)，B组(n＝251，分娩终止时限为30～60 min)和C组(n＝198，分娩终止时限≥60 min)。392例轻度反复性VD产妇中，分娩终止时限≤30 min、30～60 min和≥60 min者分别为98、163、131例；246例中度VD产妇中，分娩终止时限≤30 min、30～60 min和≥60 min者分别为152、62和32例；191例重度VD产妇中，分娩终止时限≤30 min、30～60 min和≥60 min者分别为96、62和33例。采用χ²检验，对3组不同分娩终止时限产妇的新生儿不良结局进行统计学分析，进一步对轻、中、重度反复性VD产妇不同分娩终止时限所致新生儿不良结局发生率分别进行统计学比较。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。 结果①829例EFM Ⅱ类图形反复性VD产妇的年龄为(29.3±3.7)岁，人体质量指数(BMI)为(22.6±3.5) kg/m²；存在脐带异常为578例(69.7%)。②A、B、C组新生儿不良结局发生率分别为2.6%(10/380)、8.8%(22/251)和20.2%(40/198)，3者比较，差异有统计学意义(χ²＝50.675，P<0.001)。③392例轻度反复性VD产妇中，分娩终止时限≤30 min、30～60 min和≥60 min者分娩新生儿不良结局发生率分别为1.0%(1/98)、0.6%(1/162)和1.5%(2/129)，3者比较，差异无统计学意义(χ²＝0.600，P＝0.741)。④246例中度反复性VD产妇中，分娩终止时限≤30 min、30～60 min和≥60 min者分娩新生儿不良结局发生率分别为2.0%(3/152)、9.7%(6/56)和50.0%(16/32), 3者比较，差异有统计学意义(χ²＝66.805，P<0.001)。⑤191例重度反复性VD产妇中，分娩终止时限≤30 min、30～60 min和≥60 min者分娩新生儿不良结局发生率分别为6.2%(6/96)、24.2%(15/62)和66.7%(22/33)，3者比较，差异有统计学意义(χ²＝51.535，P<0.001)。 结论EFM Ⅱ类图形中反复性VD产妇，随着分娩终止时限延长，可增加新生儿不良结局发生率。EFM Ⅱ类图形为中至重度反复性VD产妇，应分别在60 min和30 min内及时娩出新生儿。     

瑞芬太尼在镇痛分娩中的运用研究

目的：研究探讨瑞芬太尼在镇痛分娩中运用的有效性、安全性。方法：选择单胎、头位、自然分娩、无病理性妊娠因素孕妇102例，随机分为两组：瑞芬太尼组（A组）50例，导乐法组（B组）52例。A组在孕妇进入活跃期后，缓慢静注瑞芬太尼0．5μg/kg ，后持续微量注射泵注入0．04μg/（kg · min），孕妇述疼痛加剧时，单次静脉追加0．5μg/kg。B组采用常规非药物镇痛-导乐法分娩。记录宫缩疼痛视觉模拟评分（VAS）、呼吸循环指标、胎心监测情况、新生儿Apgar评分、催产素应用及器械助产情况等指标。结果：A组镇痛后VAS评分各时段均低于B组（P＜0．05），其他呼吸循环、胎心监测、Apgar评分等指标两组无显著差异（P＞0．05）。结论：瑞芬太尼静注0．5μg/kg复合泵注背景剂量0．04μg/（kg · min）用于分娩镇痛安全有效。     

Effects of exercise on sleep among young women with Generalized Anxiety Disorder

Statement of the problemGeneralized Anxiety Disorder (GAD) and disturbed sleep are prevalent, debilitating, and frequently comorbid problems for which successful treatment remains limited. Exercise can promote sleep but whether it does among GAD patients is unknown.MethodsThirty sedentary women (18−37 y) with a primary DSM-IV diagnosis of GAD were randomized to six weeks of resistance (RET) or aerobic exercise training (AET), or waitlist (WL). RET and AET involved twice-weekly sessions of either lower-body weightlifting or leg cycling matched on multiple features of exercise. Outcomes included total sleep time (TST), lights out time, awakening out of bed time, time in bed (TIB), sleep onset latency (SOL), wakefulness after sleep onset, and sleep efficiency. Hedges' d effect sizes and 95% confidence intervals were calculated for each exercise condition compared to WL. Regression examined baseline associations between anxiety and sleep and associated change.ResultsTwenty-two of 26 participants reported poor baseline sleep (Pittsburgh Sleep Quality Index > 5). RET significantly decreased weekend TIB (d = −1.79; [−2.89,−0.70]) and SOL (d = −1.30; [−2.32,−0.28]), and significantly increased weekend sleep efficiency (d = 1.30; [0.29,2.32]). AET significantly reduced weekend TIB (d = −1.13; [−2.16,−0.11]) and SOL (d = −1.08; [−2.09,−0.06]). Reduced GAD clinical severity rating was significantly associated with improved weekend sleep efficiency among RET (t₆ = −3.48, p ≤ 0.013).ConclusionsShort-term exercise training improves sleep outcomes among GAD patients, especially for RET and weekend sleep. Findings suggest improved sleep may be associated with reduced clinical severity among GAD patients.     

Sexual Intercourse for Induction of Spontaneous Onset of Labor: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

IntroductionSexual intercourse during pregnancy is commonly believed to trigger the onset of contractions and, therefore, labor. However, in low-risk pregnancies, there is neither association with preterm birth, premature rupture of membranes, or low birth weight, nor with spontaneous onset of labor at term.AimTo evaluate the effectiveness of sexual intercourse for spontaneous onset of labor at term in singleton pregnancies.MethodsThe systematic search was conducted using electronic databases from inception of each database to June 2019. Review of articles also included the abstracts of all references retrieved from the search. Inclusion criteria were randomized controlled trials comparing sexual intercourse in singleton low-risk pregnancies at term with controls (either reduced number of coitus or no coitus) for spontaneous onset of labor. Estimates were pooled using random-effects meta-analysis.Main Outcome MeasuresThe primary outcome was the incidence of spontaneous onset of labor. The summary measures were reported as summary relative risk with 95% CI using the random-effects model of DerSimonian and Laird.ResultsData extracted from 3 trials, including 1,483 women with singleton pregnancy at term and cephalic presentation, were analyzed. Women who were randomized in the sexual intercourse group had similar incidence of spontaneous onset of labor compared with control subjects (0.82% vs 0.80%; relative risk 1.02, 95% CI 0.98–1.07).Clinical ImplicationSexual intercourse should not be restricted in low-risk term pregnancies. Further studies are needed to properly evaluate the impact of orgasm, penetration, condom use, frequency of intercourse and other factors on induction of labor at term.Strength & limitationsOur study has several strengths. The three included trials had low risk of allocation bias; intention-to-treat analysis was used; this is the first meta-analysis on this issue so far. Limitations mainly depend on the design of the included studies. Firstly, compliance to the protocol relied on self-reporting by patients; in addition, not all the features of sexual intercourse could be adequately assessed (orgasm, nipple stimulation, sexual positions, etc.).ConclusionIn women with singleton, cephalic, low-risk pregnancies, sexual intercourse at term does not significantly increase the incidence of spontaneous onset of labor.Carbone L, De Vivo V, Saccone G, et al. Sexual Intercourse for Induction of Spontaneous Onset of Labor: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Sex Med 2019;16:1787–1795.     

Demographic and clinical characteristics of familial and sporadic multiple sclerosis: A single center exploratory study from Abu Dhabi

Demographic and clinical characteristics of Familial Multiple Sclerosis (FMS) have not been fully investigated yet in Abu Dhabi. The aim of this single center exploratory study was to investigate demographic and clinical characteristics of FMS compared to sporadic MS (SMS) in Abu Dhabi.A chart review single center study was conducted in 98 patients with MS. Group comparisons were performed using Mann-Whitney and Chi-Square tests as appropriate. A p < 0.05 was considered statistically significant. 24.5% were patients with FMS and 83% were Emirates. No significant differences in demographic and clinical characteristics were found between patients with FMS and SMS in overall all MS patients and in the Emirati group analyzed alone.Patients with FMS did not differ in demographic and clinical characteristics compared to patients with SMS. Further prospective studies are needed to elucidate environmental and genetic risk factors contributing to FMS in the Emirati population.     

Heat and cold therapy reduce pain in patients with delayed onset muscle soreness: A systematic review and meta-analysis of 32 randomized controlled trials

ObjectiveThe aim of this review and meta-analysis was to evaluate the effect of heat and cold therapy on the treatment of delayed onset muscle soreness (DOMS).MethodsWe followed our protocol that was registered in PROSPERO with ID CRD42020170632. A systematic review and meta-analysis of randomized controlled trials (RCT) was conducted. Nine databases were searched up to December 2020. Data was extracted from the retained studies and underwent methodological quality assessment and meta-analysis.ResultsA total of 32 RCTs involving 1098 patients were included. Meta-analysis showed that, the application of cold therapy within 1 h after exercise could reduce the pain of DOMS patients within 24 h (≤24 h) after exercise (SMD -0.57,95%CI -0.89 to −0.25, P = 0.0005) and had no obvious effect within more than 24 h (>24 h) (P = 0.05). In cold therapies, cold water immersion (SMD -0.48, 95%CI -0.84 to −0.13, P = 0.008) and other cold therapies (SMD -0.68, 95%CI -1.28 to −0.08, P = 0.03) had the significant effects within 24 h. Heat treatment could reduce the pain of patients. It had obvious effects on the pain within 24 h (SMD -1.17, 95%CI -2.62 to −0.09, P = 0.03) and over 24 h (SMD -0.82, 95%CI -1.38 to −0.26, P = 0.004). Hot pack effect was the most obvious, which reduced the pain within 24 h (SMD -2.31, 95%CI -4.33 to −0.29, P = 0.03) and over 24 h (SMD -1.78, 95%CI -2.97 to −0.59, P = 0.003). Other thermal therapies were not statistically significant (P > 0.05). Both cold and heat showed effect in reducing pain of patients, however there was no significant difference between cold and heat group (P = 0.16).ConclusionsThe current evidence indicated that the application of cold and heat therapy within 1 h after exercise could effectively reduce the pain degree of DOMS patients for 24 h cold water immersion and hot pack therapy, which had the best effect, could promote the recovery of DOMS patients. But more high-quality studies are needed to confirm whether cold or heat therapy work better.