口语化疾病名称向国际规范疾病术语集的映射研究

目的：研究患者口语化疾病名称到术语疾病名称的映射，解决在线口语化疾病名称难以有效利用的问题。方法：抓取“微医网”上患者口语中的疾病名，将PubMed摘要、百度搜索页摘要与百科内容作为语料，训练词向量，用余弦距离计算相似度，由2名具有临床知识和从业经验的编码人员对结果的准确性进行检验。结果：将最相似词条的参数TopN设置为>= 30的时候效果比较好，映射到大类和细类的准确性分别稳定在60%和70%左右。结论：利用词向量将口语化疾病名称映射到国际疾病术语集，具有较强的通用性和可行性，对于在线问诊、智能分诊甚至自动化编码具有明显的参考借鉴价值。     

Aminotransferases During Treatment Predict Long-Term Survival in Patients With Autoimmune Hepatitis Type 1: A Landmark Analysis

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Automated brain MRI metrics in the EPIRMEX cohort of preterm newborns: Correlation with the neurodevelopmental outcome at 2 years

PurposeThe purpose of this study was to identify in the EPIRMEX cohort the correlations between MRI brain metrics, including diffuse excessive high signal intensities (DEHSI) obtained with an automated quantitative method and neurodevelopmental outcomes at 2 years.Materials and methodsA total of 390 very preterm infants (gestational age at birth ≤ 32 weeks) who underwent brain MRI at term equivalent age at 1.5T (n = 338) or 3T (n = 52) were prospectively included. Using a validated algorithm, automated metrics of the main brain surfaces (cortical and deep gray matter, white matter, cerebrospinal fluid) and DEHSI with three thresholds were obtained. Linear adjust regressions were performed to assess the correlation between brain metrics with the ages and stages questionnaire (ASQ) score at 2 years.ResultsBasal ganglia and thalami, cortex and white matter surfaces positively and significantly correlated with the global ASQ score. For all ASQ sub-domains, basal ganglia and thalami surfaces significantly correlated with the scores. DEHSI was present in 289 premature newborns (74%) without any correlation with the ASQ score. Metrics of DEHSI were greater at 3T than at 1.5T.ConclusionBrain MRI metrics obtained in our multicentric cohort correlate with the neurodevelopmental outcome at 2 years of age. The quantitative detection of DEHSI is not predictive of adverse outcomes. Our automated algorithm might easily provide useful predictive information in daily practice.     

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.     

单中心汉族足月新生儿18个体表信息横断面研究

目的在单中心汉族人口中建立正常足月新生儿18个体表信息的参考范围值。方法依据《人体测量手册》上提供的方法,选取复旦大学附属妇产科医院37～40周生后2 h内的595名健康足月、汉族和单胎新生儿,行身长、体重、头围、乳距、胸围、内眦间距、外眦间距、睑裂长、耳长、耳宽、鼻长、鼻宽、鼻高、口宽、人中线长、手长、手中指长和足长信息的直接测量,每个体表信息连续重复测量3次,取3次测量的平均值行统计学分析。应用LMS软件 （light version）来构建分性别按照孕周的各测量的光滑的百分位数曲线。 结果2011年8月至2012年9月间符合本文纳入和排除标准的新生儿595例进入分析,男性305例,女性290例,其中37周83例（男40例,女43例）,38周218例（男118例,女100例）,39周185例（男91例,女94例）,40周109例（男54例,女55例）。构建18个体表信息第3~97百分位数。37周新生儿中5/18个（27.8%）体表信息值男性>女性,P均＜0.05,分别为耳长、耳宽、鼻宽、鼻长和足长;38周新生儿中11/18个（61.1%）体表信息值男性>女性,P均＜0.05,分别为身长、体重、耳长、耳宽、鼻高、鼻宽、鼻长、口宽、手长、中指长和足长;39周新生儿中14/18个（77.8%）体表信息值男性>女性,P均＜0.05,分别为身长、体重、头围、胸围、内眦间距、外眦间距、睑裂长、耳长、耳宽、鼻宽、鼻长、人中线长、手长和足长;40周新生儿中11/18个（61.1%）体表信息值男性>女性,P均＜0.05,分别为身长、体重、头围、胸围、内眦间距、外眦间距、耳长、耳宽、鼻宽、足长和乳距,其余体表信息值性别差异均无统计学意义,P均＞0.05。 结论建立了单中心汉族足月新生儿18个体表信息的参考范围值和百分位数。男女新生儿5～14个体表信息值有差异,男性体表信息值>女性。     

Morbilidad neonatal en los recién nacidos a término precoz

IntroductionIn the last decades has increased significantly The birth of children from 37 to 38 weeks of gestation, a period called early term, has significantly increased in the past twenty years or so, parallel to the increase in induced deliveries and the cesarean rate.Patients and methodRetrospective cohorts population study, which included those babies born between 37 and 41 weeks of gestation in the period 1992-2011 (n = 35.539). This population was divided into two cohorts, early term newborn (RNTP) of 37-38 weeks (n = 11,318), and full term newborn (RNTC), of 39-41 weeks of gestation (n = 24,221). The rates of cesarean section, neonatal unit admission, respiratory morbidity, apnea and need for assisted ventilation, hyperbilirubinemia requiring phototherapy, hypoglycemia, seizures, hypoxic-ischemia encephalopathy, need for parenteral nutrition and early sepsis were all reviewed.ResultsThere was a progressive increase in the number of caesarean sections throughout the period studied (from 30.9% to 40.3%). The cesarean section rate was higher in RNTP than in the RNTC (38.3% vs 31.3%, P<.0001). On comparing the two groups, significant differences were found in the rate of admission to neonatal unit, 9.1% vs 3.5% (P<.0001); respiratory morbidity (hyaline membrane 0.14% vs 0.007% [P<.0001], transient tachypnea 1.71% vs 0.45% [P<.0001], mechanical ventilation 0.2% vs 0.07% [P<.009], continuous positive airway pressure 0.11% vs 0.01% [P<.0001]), phototherapy 0.29% vs 0.07% (P<.0001), hypoglycemia 0.54% vs 0.11% (P<.0001), parenteral nutrition 0.16% vs 0.04% (P<.0001). There were no significant differences in the rate of early sepsis, pneumothorax, aspiration syndromes, seizures and hypoxic-ischemic encephalopathy.ConclusionsIn our environment, there is a significant number of RNTP, which have a significantly higher morbidity than newborns RNTC registered. After individualizing each case, it is essential not end a pregnancy before 39 weeks of gestation, except for maternal, placental or fetal conditions indicating that continuing the pregnancy may increase the risk for the fetus and/or the mother.     

延迟脐带结扎对新生儿近远期影响的研究进展

新生儿娩出后通过脐带结扎与母体分离,临床上比较传统的做法是生后立即结扎脐带,但是随着对脐带结扎时间的深入研究,延迟脐带结扎的优势已经引起了人们的重视.该文围绕延迟脐带结扎分别对早产儿和足月儿的近远期影响这一课题进行探讨,发现延迟脐带结扎可以促进新生儿胎盘输血,使血容量增加,从而改善了新生儿的贫血状态,促进了循环与内环境的稳定,且未发现延迟脐带结扎对新生儿有不良影响.     

Brain maturation in the first 3 months of life,measured by electroencephalogram: A comparison between preterm and term-born infants

ObjectivePreterm infants are at risk for altered brain maturation resulting in neurodevelopmental impairments. Topographical analysis of high-density electroencephalogram during sleep matches underlying brain maturation. Using such an EEG mapping approach could identify preterm infants at risk early in life.Methods20 preterm (gestational age < 32 weeks) and 20 term-born infants (gestational age > 37 weeks) were recorded by 18-channel daytime sleep-EEG at term age (GA 40 weeks for preterm and 2–3 days after birth for term infants) and 3 months (corrected age for preterm infants).ResultsPreterm infant’s power spectrum at term age is immature, leveling off with term infants at 3 months of age. Topographical distribution of maximal power density however, reveals qualitative differences between the groups until 3 months of age. Preterm infants exhibit more temporal than central activation at term age and more occipital than central activation at 3 months of age. Moreover, being less mature at term age predicts being less mature at 3 months of age.ConclusionTopographical analysis of sleep EEG reveals changes in brain maturation between term and preterm infants early in life.SignificanceIn future, automated analysis tools using topographical power distribution could help identify preterm infants at risk early in life.