Barriers and outcomes associated with unfulfilled requests for permanent contraception following vaginal delivery

Objectives

To identify barriers to postpartum permanent contraception procedures after vaginal delivery and to explore contraceptive and reproductive outcomes of women who experience unfulfilled requests.

Ethanol upregulates the P2X7 purinergic receptor in human macrophages

Alcohol consumption is considered to be the third leading cause of death in the United States. In addition to its direct toxicity, ethanol has two contrasting effects on the immune system: the nucleotide oligomerization domain‐like receptor pyrin domain‐containing‐3 (NLRP3) inflammasome is inhibited by acute ethanol exposure but activated by chronic ethanol exposure. Purinergic receptors (especially the P2X7 receptor) are able to activate the NLRP3 inflammasome and are involved in many ethanol‐related diseases (such as gout, pulmonary fibrosis, alcoholic steatohepatitis, and certain cancers). We hypothesized that ethanol regulates purinergic receptors and thus modulates the NLRP3 inflammasome's activity. In experiments with monocyte‐derived macrophages, we found that interleukin (IL)‐1β secretion was inhibited after 7 h of exposure (but not 48 h of exposure) to ethanol. The disappearance of ethanol's inhibitory effect on IL‐1β secretion after 48 h was not mediated by the upregulated production of IL‐1β, IL‐1α, IL‐6 or the inflammasome components NLRP3, apoptosis‐associated speck‐like protein containing a caspase recruitment domain, and caspase 1. P2X7R expression was upregulated by ethanol, whereas expression of the P2X4 and P2X1 receptors was not. Taken as a whole, our results suggest that ethanol induces NLRP3 inflammasome activation by upregulating the P2X7 receptor. This observation might have revealed a new mechanism for inflammation in ethanol‐related diseases.     

Logistical and Economic Advantages of Sterile-Packed,Single-Use Instruments for Total Knee Arthroplasty

BackgroundTotal knee arthroplasty (TKA) is well established as a clinically successful and cost-effective procedure. The transition of the US healthcare system from a fee-for-service model to a value-based care model requires careful examination of patient care to ensure both quality and efficiency. Sterile-packed, single-use instruments have been introduced as a tool to help streamline the operating room (OR) logistics while reducing sterilization requirements. The aim of this study was to examine the potential logistic and economic benefits of single-use instruments compared to traditional, reusable instruments for TKA.MethodsFour variables related to TKA costs and logistics were modeled in this study: OR turnover time tray sterilization, tray management time, and 90-day infection rates. Model input data for traditional instruments and single-use instruments were based on peer-reviewed literature. A total of 200 sites and 500 cases per site were simulated using the Monte-Carlo-Technique.ResultsThe median total cost savings with single-use instruments was $994 per case. The largest driver for cost savings was tray sterilization. Sites with higher staff wages and sterilization costs had a larger probability of realizing greater cost savings with adoption of single-use instruments. In cases using single-use instruments, up to 51% of operating days could have accommodated an additional procedure due to the time savings in OR turnover.ConclusionThis cost modeling study observed significant potential for logistical and economic improvements in TKA with single-use vs reusable instruments. Although few studies have been conducted to measure the impact of single-use instruments in practice, the results of these simulations motivate further investigation.     

超声引导下聚桂醇与无水乙醇硬化治疗单纯性肝囊肿的疗效分析与对比研究

目的对比分析超声引导下经皮穿刺聚桂醇与无水乙醇注射硬化术治疗单纯性肝囊肿的临床疗效,不良反应发生率及术后肝功能、血常规等变化,以评价两种硬化剂治疗单纯性肝囊肿的优劣。方法收集2013年3月-2015年3月上海市浦东新区公利医院消化内科肝囊肿患者62例,随机分为观察组(聚桂醇组)与对照组(无水乙醇组),分别行超声引导下两种硬化剂治疗,比较两组患者术中、术后的不良反应发生率、治愈率及治疗前、后TBil、ALT、AST、胆碱酯酶、ALP的变化和术后24 h血常规等变化。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果观察组患者不良反应发生率及血乙醇浓度明显低于对照组(P值均0.05)。观察组与对照组患者的治愈率(术后1个月与术后6个月)、术后24 h血常规变化差异无统计学意义(P值均0.05)。单发肝囊肿观察组术后1周与对照组术后1周进行比较ALT、AST差异均有统计学意义(t值分别为-3.680、-5.571,P值分别为0.001、0.001)。多发肝囊肿观察组术后1周与对照组术后1周进行比较ALT、AST差异均有统计学意义(t值分别为-2.156、-4.626,P值分别为0.040、0.001)。结论超声引导下聚桂醇及无水乙醇硬化术治疗单纯性肝囊肿均安全、有效、损伤小、临床治愈率较高,但聚桂醇引起的不良反应明显少于无水乙醇,对肝功能的不良影响也明显较无水乙醇为轻。对于多发性肝囊肿及肝功能储备不佳患者,聚桂醇优势明显,应为首选治疗用硬化剂。     

急性乙醇中毒对大鼠创伤性脑损伤后GFAP、AQP4表达的影响

目的探讨急性乙醇中毒对大鼠创伤性脑损伤(TBI)后血清及脑组织神经胶质纤维酸性蛋白(GFAP)、水通道蛋白4(AQP4)表达的影响,并分析其分子生物学机制。方法将45只大鼠按体质量随机分为3组,实验1组、2组及对照组,每组15只大鼠。实验1组、2组大鼠分别给予浓度为30%、60%的乙醇(蒸馏水稀释)1 ml/100 g灌胃,对照组大鼠给予相同剂量的蒸馏水灌胃。在灌胃后1 h后对各组大鼠采用改进的Feeney's自由落体硬膜外撞击方法行创伤性脑损伤模型的制作。于大鼠TBI后1 h、6 h、24 h,分别从各组随机抽取5只大鼠抽血,高速离心后测定血清中AQP4、GFAP的含量。各组大鼠抽血后断头处死,迅速完整取出大脑,进行脑组织中AQP4、GFAP的含量测定。结果(1)与对照组比较,实验1组、2组大鼠血清及脑组织中GFAP和AQP4的表达均有显著增加(均P0.05)。(2)实验2组比1组大鼠血清及脑组织中GFAP和AQP4的表达增加更明显(均P0.05)。(3)随着伤后时间延长,3组大鼠血清及脑组织中GFAP和AQP4的表达越明显。结论急性乙醇中毒可加重大鼠TBI的程度,且血液中乙醇浓度越高,伤后时间越长,TBI的程度越严重。