Static and dynamic postural control of postpartum women of different delivery methods

ObjectiveThe aim of this study was to determine whether there is a difference in postural control between nulligravida women and women who have given birth by vaginal or cesarean section.MethodsWomen who had only vaginal delivery in the previous 1–3 years were included in the vaginal delivery group (n = 27), those who had only cesarean delivery in the previous 1–3 years were included in the cesarean section group (n = 28), and those who had never given birth were included in the control group (n = 32). Evaluations were administered 6–8 days after the ovulation phase. Postural control of the participants was evaluated with the computerized dynamic posturography device.ResultsA total of 87 women with a mean age of 29.4 ± 4 years and a mean body mass index of 24.1 ± 3.1 kg/m² were included in the study. Antero-posterior somatosensory organization test values of the vaginal delivery group were lower than the control group (p = 0.0016). The cesarean delivery group had statistically lower antero-posterior somatosensory (p < 0.001 and p = 0.0013) and medio-lateral somatosensory (p = 0.002 and p = 0.017, respectively) test scores compared to the control group and the vaginal delivery group.ConclusionsIt was observed that women who birthed with vaginal or cesarean delivery had impaired somatosensory postural control. There is definitely a need for further studies with a long-term follow-up examining the effects of postural control during pregnancy and the postpartum period.     

Impact of Planned Delivery on the Perinatal Outcome of Term Fetuses with Isolated Heart Defects

ObjectivePregnancies complicated by fetal heart defects often undergo a planned delivery prior to term by either induction of labour or cesarean delivery to ensure optimal availability of neonatal care. We aimed to assess whether such planned deliveries achieve their goal of better perinatal care.MethodsWe conducted a retrospective case-control study of pregnancies complicated by isolated fetal cardiac defects, without other fetal comorbidities, managed at a single fetal medicine unit over a 10-year period. Only pregnancies delivered past 37 weeks gestation were included. Patients undergoing elective delivery for care planning reasons only were compared with patients in whom planned delivery was clinically indicated and patients who laboured spontaneously. Obstetric and perinatal outcomes were recorded.ResultsOf the 180 pregnancies included in the study, 59 (32.8%) were in the elective group, 49 (27.2%), in the indicated group, and 72 (40%), in the spontaneous group. Mean gestational age at delivery was 39.0 ± 1.1 weeks overall and did not differ between the groups. For the elective group, only 35.6% of deliveries occurred during office hours, which was similar to the 2 other groups. The rate of adverse obstetric or postnatal outcomes was not statistically significantly different between groups.ConclusionTimed delivery at term does not seem to be associated with an increased risk of poor perinatal outcomes. It may improve perinatal care by providing proximity to a neonatal intensive care unit and convenience for patients and providers.     

阴道顺产与剖宫产对初产妇产后早期盆底功能的影响比较

目的研究阴道顺产与剖宫产对初产妇产后早期盆底功能的影响。方法选择2020年1月至12月在阳春市人民医院产科中心分娩的120例初产妇展开研究,按照分娩方式的不同分为对照组与观察组,每组各60例。对照组为阴道顺产,观察组采用剖宫产,两组均在产后第6周进行早期盆底功能检查,并进行盆底康复治疗,比较两组的治疗效果。结果观察组的尿失禁、阴道脱垂、子宫脱垂发生率低于对照组,差异有统计学意义(P<0.05);观察组治疗后的盆底肌力分级情况优于对照组,差异有统计学意义(P<0.05);观察组治疗后的膀胱颈与耻骨联合下缘水平线间的垂直距离(BSD)高于对照组,膀胱尿道后角(RA)、膀胱颈移动度(BND)低于对照组,差异均有统计学意义(P<0.05)。结论阴道顺产对于盆底功能及盆腔结构的不良影响大于剖宫产,盆底功能障碍性疾病发生率更高,而康复治疗可有效改善阴道顺产、剖宫产初产妇的盆底功能,剖宫产初产妇的盆底功能恢复更好。     

卡贝缩宫素和缩宫素治疗剖宫产高危产妇的效果比较

目的:比较卡贝缩宫素和缩宫素治疗剖宫产高危产妇的效果。方法:选取122例剖宫产高危产妇为研究对象,按照随机数字表法分为观察组与对照组各61例。两组均行剖宫产手术,胎儿娩出后,对照组给予缩宫素治疗,观察组给予卡贝缩宫素治疗,比较两组术中、产后2、24 h出血量,产后加用前列素氨丁三醇率,凝血功能指标[纤维蛋白原(FIB)、D-二聚体(D-D)、凝血酶原时间(PT)、部分凝血活酶时间(APTT)]水平,心率,血压,血红蛋白水平和不良反应发生率。结果:观察组术中、产后2、24 h出血量均低于对照组,差异有统计学意义(P<0.05);观察组加用卡前列素氨丁三醇率为4.92%(3/61),明显低于对照组的16.39%(10/61),差异有统计学意义(P<0.05);术后,两组FIB、D-D水平均高于术前,且观察组高于对照组,两组PT、APTT均短于术前,且观察组短于对照组,差异有统计学意义(P<0.05);术后,两组血红蛋白水平均低于术前,但观察组高于对照组,差异有统计学意义(P<0.05);手术前后,两组心率、血压和不良反应发生率比较,差异均无统计学意义(P>0.05)。结论:卡贝缩宫素治疗剖宫产高危产妇可减少出血量和加用卡前列素氨丁三醇率,提高其术后血红蛋白水平,以及改善凝血功能指标,效果优于缩宫素。     

妊娠期体育锻炼干预对自然分娩影响的Meta分析

背景 自然分娩是人类繁衍的正常生理过程，中国剖宫产率超出了世界卫生组织（WHO）提出的警戒线2倍多，而体育锻炼作为一种非药物性的健康干预方式，应引起相关部门的重视。 目的 运用Meta分析方法检验妊娠期体育锻炼对自然分娩影响的干预效果，并提出最优的锻炼方案。 方法 检索中国知网（CNKI）、中国生物医学文献服务系统（CBM）、维普网中文数据库和PubMed、EMBase、Web of Science、Cochrane Library英文数据库中有关妊娠期体育锻炼干预影响自然分娩结果的随机对照试验（其中干预组以体育锻炼干预为唯一干预方式，对照组进行常规护理知识教育或不进行有规律的体育锻炼），同时追踪相关系统评价所引用的参考文献，检索时间为1990—2021年。提取纳入文献资料，并对纳入文献进行方法学质量评价，采用RevMan 5.2软件进行Meta分析，运用GRADE工具对结局指标进行质量评价。 结果 共纳入30篇文献。Meta分析结果显示，干预组自然分娩发生率高于对照组〔RR=1.34，95%CI（1.28，1.40），P<0.000 01〕。亚组分析结果显示，锻炼开始节点对自然分娩的干预效果从高到低依次为：>24周、13~24周、≤12周；锻炼内容对自然分娩的干预效果从高到低依次为：盆底肌训练、运动课、体操、有氧运动、分娩球、瑜伽；锻炼频率对自然分娩的干预效果从高到低依次为：≥12次/周、3~5次/周、6~8次/周、9~11次/周；中等强度的锻炼较低强度的锻炼对自然分娩具有更大的影响；锻炼时长对自然分娩的干预效果从高到低依次为：30~<50 min/次、<30 min/次、≥50 min/次；锻炼周期对自然分娩的干预效果从高到低依次为：≤8周、17~24周、9~16周、25~34周。绘制体育锻炼干预对孕妇自然分娩影响的漏斗图，结果显示，漏斗图左右两侧基本对称，发表偏倚较小。运用GRADE工具对结局指标进行质量评价，结果显示，妊娠期体育锻炼影响自然分娩的评级为中等级。 结论 孕妇在妊娠期进行一定的体育锻炼对自然分娩结果具有良好的干预效果，且从妊娠期>24周开始锻炼、≥12次/周、30~<50 min/次、持续进行≤8周的中等强度的盆底肌训练、运动课、体操、有氧运动、分娩球以及瑜伽均对孕妇自然分娩的选择具有积极的影响。     

Borderline or locally advanced pancreatic adenocarcinoma: A single center experience on the FOLFIRINOX induction regimen

IntroductionThis study aimed to determine the impact of FOLFIRINOX neoadjuvant therapy on patients with non-metastatic borderline/locally advanced (BL/LA) pancreatic ductal adenocarcinoma (PDAC), in current practice.Material and methodsFrom 2010 to 2017, 258 patients with BL/LA PDAC from a single high-volume institution received FOLFIRINOX neoadjuvant treatment.ResultsThe 258 patients received a median number of 6 cycles of FOLFIRINOX (range, 3–16); 98 (38%) patients underwent curative surgery, and 160 (62%) continued medical treatment. A venous resection was performed in 57 patients (58%), and an arterial resection in 12 (12%). The postoperative 30- and 90-day mortality rates were 6.1% and 8.2%, respectively. Adjuvant chemotherapy was performed in 57 patients (59%). The median overall survival (OS) in patients who did (n = 98) or did not (n = 160) undergo surgical resection were 39 months and 19 months, respectively (P < 0.001). In resected patients, the ASA 3 score (P < 0.01), venous resection (P < 0.01), hemorrhage (P < 0.01), and R1 margin status (P = 0.03) were found to negatively influence the OS. The median OS was significantly higher in patients who did not require a venous resection (not reached vs. 26.5 months, P < 0.001).ConclusionsNeoadjuvant FOLFIRINOX provided a survival benefit in BL/LA PDAC patients, particularly in those who did not ultimately require venous resection.     

欧盟和美国对药品说明书【适应症】项目的撰写要求及启示

介绍欧盟和美国有关药品说明书[适应症]项目撰写的法规和指导原则，特别是最近欧洲药品管理局（EMA）发布的"治疗适应症的用语"。从这些管理文件得到的启示是相关法规规定不宜太粗糙，应具体、精准，应包括内容和格式的规定；而且要有指导原则伴随，以保证法规落到实处。熟悉掌握药品说明书[适应症]项目的撰写要求对规范撰写其他项目有普遍指导意义，对于药品说明书的监管也有裨益。     

Cranio-caudal approach to hepatic veins in laparoscopic central bisectionectomy (with Video)

BackgroundLaparoscopic central bisectionectomy (Couinaud's segment IV, V, and VIII) needs exposure of the RHV and MHV on the surface of the remnant and the resecting side, respectively. Avoiding venous injury is mandatory and laparoscopy-specific cranio-caudal approach to hepatic veins might be helpful [1]. We present this procedure in performing laparoscopic central bisectionectomy.PatientA 45-year-old female was admitted to our hospital with a 6 cm HCC in the segment VIII and IV. Her comorbid disease was non-cirrhotic HBV hepatitis (Child-Pugh grade A) and diabetes (untreated).MethodAfter cholecystectomy, G₄ branches were dissected and cut by extra- or intra-hepatic approach. Hilar plate was dissected and the G_ant was encircled and occluded by a vascular clip. Afterwards, exposure of the MHV was started at its root on IVC [2,3] and extended in cranio-caudal direction [1]. After sufficient space was obtained around the G_ant, the G_ant and the MHV were cut. Parenchymal transection between right anterior and right posterior sections was also started form the root of the RHV to its cranio-caudal direction. Liver resection was finished with full exposure of the RHV.ResultsThe operating time was 380 minutes, and the blood loss volume was 30 ml. Postoperative CT image showed exposure of the RHV and umbilical portion of Glissonean branch, and no fluid retention.ConclusionLaparoscopy-specific cranio-caudal approach to hepatic veins may be useful to avoid split injury of venous branches [4], especially if the hepatectomy requires complete exposure of hepatic vein, such as central bisectionectomy.     

胃部超声检查对剖宫产前后胃窦部变化的评估

目的通过胃部超声检查方法观察剖宫产前后胃窦部变化的情况并比较皮肤到胃窦部中心距离及腹主动脉前壁到胃窦部中心距离的变化。方法选择拟行择期剖宫产手术的产妇47例,年龄18～35岁,麻醉方法均采用蛛网膜下腔阻滞。胃部超声检查记录产妇剖宫产前后仰卧位和右侧卧位下胃窦部横截面积(cross-sectional area, CSA)和Perlas评分,同时测量皮肤到胃窦部中心和腹主动脉前壁到胃窦部中心的距离变化情况。结果与剖宫产前比较,剖宫产后仰卧位下胃窦部CSA明显减小(P=0.001),但右侧卧位下胃窦部CSA差异无统计学意义。剖宫产前后仰卧位和右侧卧位下Perlas评分差异均无统计学意义。与剖宫产前比较,剖宫产后皮肤到胃窦部中心距离和腹主动脉前壁到胃窦部中心的距离明显缩短(P0.05)。结论剖宫产后仰卧位下胃窦部CSA减小,妊娠晚期胃窦部CSA不能用于胃内容物的定量评估,但胃内容物的定性评估不会受到影响。