Economic Evaluation of Prenatal and Postpartum Care in Women With Gestational Diabetes and Hypertensive Disorders of Pregnancy: A Systematic Review

ObjectivesThis study aimed to summarize evidence on the economic outcomes of prenatal and postpartum interventions for the management of gestational diabetes mellitus and hypertensive disorders of pregnancy (HDP), assess the quality of each study, and identify research gaps that may inform future research.MethodsElectronic databases including PubMed/MEDLINE, Embase, the Cochrane Library, and Cochrane Central Register of Controlled Trials were searched from January 1, 2000, to October 1, 2021. Selected studies were included in narrative synthesis and extracted data were presented in narrative and tabular forms. The quality of each study was assessed using the Consolidated Health Economic Evaluation Reporting Standards and Consensus on Health Economic Criteria list.ResultsAmong the 22 studies identified through the systematic review, 19 reported favorable cost-effectiveness of the intervention. For prenatal management of HDP, home blood pressure monitoring was found to be cost-effective compared with in-person visits in improving maternal and neonatal outcomes. For postpartum care, regular screening for hypertension or metabolic syndrome followed by subsequent treatment was found to be cost-effective compared with no screening in women with a history of gestational diabetes mellitus or HDP.ConclusionsExisting economic evaluation studies showed that prenatal home blood pressure monitoring and postpartum screening for hypertension or metabolic syndrome were cost-effective. Nevertheless, limitations in the approach of the current economic evaluations may dampen the quality of the evidence and warrant further investigation.     

基于自动勾画和快速蒙特卡罗计算的放射治疗全身器官剂量数据库平台的可行性研究

目的:探讨建立一种放射治疗全身器官剂量数据库平台的可行性。方法:使用基于深度学习的自动勾画软件DeepViewer?1例食管癌患者的全身CT上勾画全身器官，然后利用基于GPU加速的蒙特卡罗软件ARCHER计算相应的器官剂量分布，最后利用Lyman-Kutcher-Burman（LKB）模型评估放疗患者正常组织并发症概率（NTCP）。结果:针对该病例，成功建立基于DeepViewer?ARCHER和LKB模型的全身器官剂量数据库，发现距离靶区越近的器官剂量越大，其中心脏与靶区间距离最小，剂量为14.11 Gy，但因其模型参数特殊，通过LKB模型计算的NTCP为0.00%；左、右肺的剂量分别为3.19和1.16 Gy，但是NTCP值却很大，分别为2.13%和1.60%。对于距离靶区较远的头颈部器官（视交叉、视神经和眼）和腹部器官（直肠、膀胱和股骨头）剂量分别约为9和2 mGy，并且NTCP均近似为0.00%。结论:研究结果证明通过自动勾画软件DeepViewer?蒙特卡罗软件ARCHER和LKB模型建立全身器官剂量数据库的可行性。     

经椎旁肌间隙入路与微创经皮入路手术治疗胸腰椎骨折的效果比较

目的比较胸腰椎骨折患者接受经椎旁肌间隙入路与微创经皮入路手术治疗的效果及关节功能。方法回顾性分析2014年4月-2015年10月在该院接受内固定手术治疗的胸腰椎骨折患者,根据手术入路不同分为椎旁入路组和经皮微创组,分别接受经椎旁肌间隙入路与微创经皮入路手术治疗。比较两组患者的手术情况、围手术期血清创伤分子含量以及远期功能恢复情况和矫正畸形效果。结果椎旁入路组的手术时间明显短于经皮微创组,差异有统计学意义(P0.05);术中出血量、术后引流量、术后卧床时间、住院总时间与经皮微创组比较,差异均无统计学意义(P0.05);两组患者术后当天的血清肌酸激酶(CK)、肌红蛋白(Myo)和乳酸脱氢酶(LDH)含量比较,差异均无统计学意义(P0.05),术后3、6和12个月时的伤椎前后缘高度比、Cobb角、视觉模拟评分(VAS)比较,差异均无统计学意义(P0.05)。结论椎旁肌间隙入路与微创经皮入路手术治疗胸腰椎骨折的效果和创伤程度相当,椎旁肌间隙入路的手术操作更为简单、手术时间更短。     

Fetal Intra‐pericardial Morgagni Hernia with effusion affecting one member of a twin gestation

Congenital diaphragmatic hernia (CDH) is a rare type of developmental defect of the diaphragm, occurring in 1 per 2000 pregnancies. Morgagni hernia, in particular, which results from an anterior defect of the diaphragm, is the least common type of CDH (5%). Herniation of the liver into the pericardial space, presenting as a thoracic mass with pericardial effusion, is an extremely rare form of Morgagni hernia. Such reported cases are few and occurred only in singleton pregnancies. To the best of our knowledge, we report the first case of fetal echocardiography and fetal MRI following referral due to large pericardial effusion.     

HIV infection after prenatal screening: an open window leading to perinatal infection

Despite a dramatic decrease in vertical transmission of HIV in the developed world, maternal HIV infection acquired after negative prenatal screening still leaves a window of vulnerability. Through quality assurance programs in two Canadian Provinces, five cases where perinatal HIV transmission occurred despite negative prenatal screening were identified between 2005 and 2015. Maternal risk factors such as intravenous drug use, high–risk sexual behavior, hepatitis C virus co–infection, and belonging to high prevalence minority groups were common. Two mothers had their negative HIV test performed in the first trimester and three mothers had negative testing in the third trimester. All babies were clinically healthy at delivery with a normal weight. Three babies were tested following subsequent identification of maternal HIV infection and two babies presented with opportunistic infections leading to their diagnoses. The characteristics of these cases suggest that to achieve complete elimination of vertical HIV transmission, selective and innovative clinical management of mothers at high risk for HIV may be required.     

Ectópico abdominal complicado con hemoperitoneo

Abdominal ectopic pregnancy is an extremely rare type of extratubal ectopic (EE) pregnancy, with very few cases documented in the literature. Maternal mortality is higher than in tubal EE because of the delay in diagnosis and complications. The case is presented of a patient with an abdominal EE that was complicated by the appearance of severe haemoperitoneum in the first trimester of pregnancy. In this case, two emergency laparoscopies were needed in less than 24 hours, until the definitive diagnosis could be found. This demonstrates how difficult it can be to identify this pathology in its early stages.