Intrapartum fetal surveillance: a physiological approach

Continuous utero-placental circulation, and patent umbilical blood vessels ensure an uninterrupted transfer of oxygen and nutrients to the fetus as well as clearance of metabolic waste products. The onset of labour characterized by progressive and strong uterine contractions poses a threat to fetal oxygenation as a result of collapsing the spiral arterioles traversing the myometrium to supply the placental bed, and repetitive compression of the blood vessels within the umbilical cord. Human fetuses are equipped with compensatory mechanisms to cope with transient interruptions of blood supply during labour. The ability to compensate may be blunted in cases of poor fetal reserves, increased metabolic demand (macrosomia or maternal fever), and due to non-hypoxic pathways (e.g. chorioamniontis or fetal hypovolumia-hypotension syndrome). Intrapartum fetal surveillance involves prompt recognition of the features that signal the onset of fetal decompensation on the cardiotocograph (CTG) to ensure a timely intervention to avoid hypoxic-ischaemic encephalopathy (HIE) or perinatal deaths. This article summarises a ‘physiological approach’ to the interpretation of the CTG which, in places, conflicts with other current UK guidance.     

Delineating the geographic context of physical activities: A systematic search and scoping review of the methodological approaches used in social ecological research over two decades

BackgroundThe social ecological approach suggests that the spatial context among other factors influence physical activity behavior. Ample research documents physical environmental effects on physical activity. Yet, to date inconsistent associations remain, which might be explained by conceptual and methodological challenges in measuring the spatial dimensions of health behavior. We review methods applied to measure the spatial contexts in the social ecological physical activity literature.MethodsOnline databases and selected reviews were used to identify papers published between 1990 and 2020. A total of 2167 records were retrieved, from which 412 studies that used physical activity as a primary outcome variable, included measures of the physical environment and applied the main principles of the social ecological approach, were included.ResultsSubjective approaches were the dominant method to capture the spatial context of physical activities. These approaches were applied in 67% (n=279) of the studies. From the objective approaches an administrative unit was most prevalent and was applied in 29% (n=118) of the studies. The most comprehensive objective spatial methods that capture the true environmental exposure, were used only in 2% (n=10) of the studies.ConclusionsCurrent social ecological physical activity research applies simple conceptualizations and methods of the spatial context. While conceptual and methodological concerns have been repeatedly expressed, no substantive progress has been made in the use of spatial approaches. To further our understanding on place effects on health, future studies should carefully consider the choice of spatial approaches, and their effect on study results.     

不同手术方法治疗儿童基本型外斜视对术后侧转非共同性的影响

目的：研究不同手术方法治疗儿童基本型外斜视与术后侧转非共同性发生及矫正效果相关性。

方法：回顾性研究。选取2018-06/2020-12于我院眼科接受治疗的180例基本型外斜视患儿临床资料。根据手术方式分为单眼一退一截术组(R&R组)104例和双眼外直肌后徙术组(BLR-rec组)76例。比较两组患者一般资料、手术矫正效果，以及随访期间手术斜视度数、侧转非共同性发生情况。

结果：两组患者术后3d，1、6mo视近、视远斜视度比较均无差异(均P>0.05)。R&R组术后不同时间点正位率高于BLR-rec组(P<0.05)。R&R组较BLR-rec组发生侧转非共同性的风险更低(OR=0.524， Wald χ²=4.260， P=0.039)。两组患者术后6mo主要表现在水平直肌手术眼外展方向注视，但两组患儿视远和视近侧转非共同性发生率均无差异(均P>0.05)。

结论：R&R对于儿童基本型外斜视的矫正效果优于BLR-rec术式，可降低侧转非共同性发生情况。     

长臂单轴椎弓根螺钉在单纯性胸腰椎压缩性骨折复位固定中的应用及对肌肉损伤的影响

目的分析长臂单轴椎弓根螺钉经 Wiltse入路在单纯性胸腰椎压缩性骨折中的应用效果及对肌肉损伤的影响。方法选取自 2018年 1月至 2020年 8月周口市中心医院收治的单纯性胸腰椎压缩性骨折病人 87例，根据复位固定术式不同，分为观察组 38例、对照组 49例，其中观察组采取长臂单轴椎弓根螺钉经 Wiltse入路，对照组采取 AF系统经传统后正中入路。记录两组病人围术期指标、手术前后血清肌肉损伤指标［肌酸激酶( CK)、肌红蛋白( Mb)］变化；采用疼痛视觉模拟评分( VAS)评价病人不同时间节点疼痛水平；经胸腰椎正侧位片检查获取伤椎原始高度( H0)、术前及术后 1周伤椎椎体前缘高度( H1H2)，计算术前、术后 1周伤椎相对高度( H1/H0、H2/H0)及伤椎复位率，并测量矢状位 Cobb角变化；随访 3个月，采用 Oswestry功能障、碍指数( ODI)评价功能障碍情况，并统计手术相关并发症。结果观察组手术时长、术中失血量、术后引流量及首次下床活动时间均明显短于或低于对照组( P<0.05)。术后 3d，两组血清 CK、Mb水平均较术前升高( P<0.05)，且观察组血清 CK、Mb水平     

Pentobarbital overdose: A case of contract killing

Suicides by pentobarbital overdose have increased since about 2012, which appear to be influenced by technical information on active euthanasia that has spread over the Internet. We encountered a pentobarbital poisoning case of a patient with amyotrophic lateral sclerosis. A caregiver found the patient unconscious immediately after two visitors left the room. The patient was immediately transferred to the emergency hospital but eventually declared dead. A fatal concentration of pentobarbital was detected in peripheral blood samples collected in the emergency hospital and during autopsy (53.8 μg/mL and 29.4 μg/mL, respectively). Because the ratios of pentobarbital concentrations between the gastric contents and peripheral blood were 35 and 29 in the hospital and autopsy samples, respectively, it is likely that pentobarbital was administered via the gastrostomy tube. The patient had contacted the visitors through social media. Although the patient had requested the doctor perform active euthanasia and expressed a desire to end their life on social media, nobody had noticed the plan to commit suicide.