妊娠期糖尿病患者产后糖代谢异常转归影响因素分析

目的探讨妊娠期糖尿病(GDM)患者产后糖代谢异常(AGM)转归及其影响因素。方法选择2019年1月至12月,于四川大学华西第二医院孕期被诊断为GDM,并于产后4~12周进行75 g口服葡萄糖耐量试验(OGTT)筛查的1175例单胎妊娠产妇为研究对象。根据其产后糖代谢是否正常,将其分为研究组(n=361,产后AGM者)与对照组(n=814,产后糖代谢正常者)。采用回顾性分析方法,收集受试者一般临床资料及孕期与产后4~12周75 g OGTT结果等,并采用成组t检验或χ^(2)检验进行统计学分析。对GDM患者产后AGM转归相关影响因素进行单因素分析与多因素非条件logistic回归分析,探讨其AGM转归的独立影响因素。本研究遵循的程序符合病例收集医院伦理委员会制定的伦理学标准,得到该伦理委员会批准[审批文号:医学科研2021伦审批第(181)号]。结果①24~28孕周时,1175例GDM患者75 g OGTT结果提示,空腹血糖(FPG)及OGTT 1、2 h血糖指标中,1、2、3项升高者分别为639例(54.4%)、373例(31.7%)与163例(13.9%)。②产后4~12周时,1175例GDM患者75 g OGTT结果提示,产后糖代谢正常者为814例(69.3%),AGM为361例(30.7%),包括空腹血糖受损(IFG)为19例(1.6%),糖耐量受损(IGT)为294例(25.0%),IFG+IGT为23例(2.0%),疑似2型糖尿病(T2DM)患者为25例(2.1%)。③产后AGM转归影响因素的单因素分析结果显示,研究组GDM患者年龄、糖尿病家族史发生率,24~28孕周OGTT 1、2 h血糖值,以及2项血糖指标(OGTT 1、2 h血糖)均升高与3项血糖指标(FPG及OGTT1、2 h血糖)均升高者所占比例,均显著高于对照组,而研究组仅1项血糖指标(FPG或OGTT 1 h血糖)升高者所占比例,则显著低于对照组,2组比较,差异均有统计学意义(P<0.05)。④多因素非条件logistic回归分析结果:模型1将受试者年龄、糖尿病家族史及24~28孕周OGTT 1、2 h血糖值进行多因素logistic回归分析结果显示,糖尿病家族史及24~28孕周OGTT 1、2 h血糖值,均为GDM患者产后AGM转归的独立危险因素(OR=1.693、1.205、1.355,95%CI:1.208~2.373、1.088~1.335、1.204~1.524,P=0.002、<0.001、<0.001)。模型2将受试者年龄、糖尿病家族史、24~28孕周OGTT血糖指标升高项目进行多因素logistic回归分析结果显示,糖尿病家族史及24~28孕周OGTT 2项血糖指标(OGTT 1、2 h血糖)升高与3项血糖指标均升高,均为GDM患者产后AGM转归独立危险因素(OR=1.668、1.421、1.747,95%CI:1.192~2.333、1.035~1.952、1.195~2.553,P=0.003、0.030、0.004);24~28孕周仅FPG或OGTT 1 h血糖升高为其独立保护因素(OR=0.401、0.646,95%CI:0.240~0.670、0.418~0.997,P<0.001、=0.048)。结论对于GDM患者产后AGM转归,临床应关注其年龄、糖尿病家族史、孕期OGTT结果等指标。对GDM高危人群进行上述指标持续监测与规范干预,是健全GDM孕前-孕期-产后全程管理的重要环节。     

澳大利亚护理硕士专业学位人才培养现状及启示

通过比较我国与澳大利亚护理硕士专业学位研究生人才培养项目在办学规模、师资情况、教育模式、课程设置、临床实践与评估、毕业要求方面的现状,提出了立足我国实际的教学改革建议,为完善具有中国特色的护理硕士专业学位研究生教育培养体系,培养健康中国建设所需要的高级护理人才提供参考。     

下肢肌周细胞瘤一例

患者,女,33岁。因右小腿皮肤丘疹30余年,伴红肿疼痛3个月。予以手术切除,术后病理示：瘤细胞以多层同心圆型围绕薄壁血管周围生长,部分可见血管管腔闭塞。免疫组化示：ERG(血管+),CD34(血管+),CD31(血管+),SMA(+),Desmin(-),H-caldesmon(+)。结合形态学及免疫组化考虑肌周细胞瘤。予以手术扩大切除后植皮。     

卵巢子宫内膜异位囊肿超声分型及其临床价值

目的 分型认识卵巢子宫内膜异位囊肿的复杂声像图,以求提高超声对本病的诊断符合率。方法 回顾性分析131例卵巢子宫内膜异位囊肿患者共139个肿块的声像图特点,分型观察,计算各型诊断符合率。结果依据肿块声像特点共分7种类型。囊内均匀光点型的符合率最高（88．3％）,单纯囊肿型符合率最低（12．0％）。易误诊为单纯囊肿、囊腺瘤、炎性包块、畸胎瘤、子宫肌瘤、卵巢癌等。结论 分型可使子宫内膜异位囊肿复杂的声像简单化,鉴别重点更明确,有助于提高对本病的认识。     

HPLC测定桂枝、茯苓药对提取物中6个成分含量

目的:建立高效液相色谱法测定桂枝、茯苓药对提取物中原儿茶酸、香豆素、桂皮醇、肉桂酸、桂皮醛、茯苓酸6个成分的含量。方法:采用Diamonsil C18色谱柱(200 mm×4.6 mm,5μm),流动相乙腈-0.05%磷酸水,梯度洗脱,流速1.0 m L·min-1,检测波长254 nm,柱温25℃,对药对桂枝中5个成分同时测定;以乙腈-0.05%磷酸水(75∶25)为流动相,流速1.0 m L·min-1,检测波长210 nm,柱温25℃,对药对茯苓中茯苓酸的含量测定。结果:原儿茶酸、香豆素、桂皮醇、肉桂酸、桂皮醛和茯苓酸分别在0.00818~0.0818μg(r=0.9995),0.03866~0.3866μg(r=0.9999),0.03138~0.3138μg(r=0.9998),0.03512~0.3512μg(r=0.9998),0.3522~3.522μg(r=0.9998),0.03920~0.3920μg(r=0.9998)范围内有良好的线性关系。原儿茶酸、香豆素、桂皮醇、肉桂酸、桂皮醛和茯苓酸的加样回收率(n=6)分别为99.2%,98.9%,100.0%,98.4%,99.2%,98.9%,RSD均<3%。结论:该方法简便、准确,可测定桂枝、茯苓药对提取物中6个成分的含量,为其质量控制提供参考。     

基于治未病论治桥本病亚临床期的理论与实践

从治未病理论出发探讨"阴阳失衡"和"正虚外侵"与桥本甲状腺炎亚临床期的关系.该病亚临床期多以肝郁脾虚或兼肾虚为其病机关键,临床常伴有颈部不适感、周身乏力、情绪不宁或兼有腰膝酸软等症状.围绕既病防变的治疗理念,中医针对桥本病亚临床期进行药物干预具有独特的治疗优势.根据患者亚临床期的症状及病情转归,予疏肝健脾、补肾软坚功效...     

紫金化毒栓制备工艺研究

目的：优选最佳紫金化毒栓制剂工艺。方法：以外观性状、融变时限、指标成分溶出度为考察指标,优选基质,确定栓剂的载药量、附加剂种类和用量、基质熔融温度、注模及固化温度等工艺条件及参数。结果：栓剂中药物占比37%,辅料为吐温80 1.0%、单硬脂酸甘油酯5.0%、硬脂酸3.0%、半合成脂肪酸甘油酯（36）54.0%。栓剂基质在65℃熔融完全后,加入膏粉,搅拌均匀;待降温至约50℃时,将挥发油用吐温80溶解,加入到药液中,搅拌均匀;待降温至约40℃时,灌注于栓模内,5℃固化10min,脱模,即得。结论：通过对制剂处方及工艺条件的研究,确定了最佳工艺,并进行了3批中试工艺验证,表明紫金化毒栓制剂工艺合理可行,可用于工业化生产。     

Prevention of Gestational Diabetes Mellitus and Gestational Weight Gain Restriction in Overweight/Obese Pregnant Women: A Systematic Review and Network Meta-Analysis

Background: Overweight/obesity is associated with pregnancy-related disorders, such as gestational diabetes mellitus (GDM) and excessive gestational weight gain (GWG). Although multiple interventions have been proposed to prevent GDM and restrict GWG, our knowledge of their comparative efficacy is limited. Objective: To evaluate the effectiveness and identify the optimal intervention strategy to prevent GDM and restrict GWG among overweight/obese pregnant women. Methods: Randomized controlled trials that recruited overweight/obese pregnant women at <20 gestational week were obtained. Predictive and confidence interval plot and surface under the cumulative ranking (SUCRA) were performed using Stata statistical software to determine and compare the efficacy of interventions (diet, physical activity (PA), diet + PA intervention and medication). Results: 23 studies with a total of 8877 participants were eligible for analysis. Our results indicated that although neither PA, diet + PA, diet nor medication intervention could significantly protect overweight/obese women from the development of GDM, there was a trend that PA and diet + PA intervention were preventive factors of GDM. Of these, PA intervention (SUCRA, 82.8%) ranked as the superior strategy, and diet intervention (SUCRA, 19.7%) was the least efficacious regimen. Furthermore, interventions of diet, PA and diet + PA were significantly beneficial for GWG restriction, whereas medication intervention could not restrict GWG. In detail, diet intervention (SUCRA, 19.7%) ranked as the optimal regimen, whilst PA intervention (SUCRA, 62.3%) ranked as the least efficacious regimen. Conclusion: Although none of the interventions could offer remarkable benefit for GDM prevention, interventions of diet, PA and diet + PA were significant factors to restrict GWG. In aggregate, diet + PA intervention seemed the superior choice for the prevention of both GDM and excessive GWG. Registration: PROSPERO CRD42022313542.     

宫腔镜术后放置左炔诺孕酮宫内缓释系统与口服地屈孕酮治疗子宫内膜息肉患者的效果比较

目的:比较宫腔镜术后放置左炔诺孕酮宫内缓释系统与口服地屈孕酮治疗子宫内膜息肉患者的效果。方法:回顾性分析2018年4月至2019年4月该院收治的80例子宫内膜息肉患者的临床资料,根据患者术后用药不同分为对照组和观察组各40例。两组患者均在宫腔镜下切除息肉,对照组术后口服地屈孕酮片治疗,观察组在术后放置左炔诺孕酮宫内缓释系统治疗。比较两组治疗前后子宫内膜厚度、血红蛋白水平、月经失血图(PBAC)评分、复发率及不良反应发生情况。结果:术后1周,两组子宫内膜厚度均低于术前,但组间比较,差异无统计学意义(P>0.05)。术后6个月,观察组子宫内膜厚度、PBAC评分均明显低于对照组,血红蛋白水平明显高于对照组,差异均有统计学意义(P<0.05)。术后1年,观察组复发率为2.50%(1/40),低于对照组的20.00%(8/40),差异有统计学意义(P<0.05)。观察组不良反应发生率为7.50%(3/40),低于对照组的27.50%(11/40),差异有统计学意义(P<0.05)。结论:宫腔镜术后放置左炔诺孕酮宫内缓释系统治疗子宫内膜息肉患者的效果较好,可改善患者月经情况...     

The changing risk and burden of wildfire in the United States

Recent dramatic and deadly increases in global wildfire activity have increased attention on the causes of wildfires, their consequences, and how risk from wildfire might be mitigated. Here we bring together data on the changing risk and societal burden of wildfire in the United States. We estimate that nearly 50 million homes are currently in the wildland–urban interface in the United States, a number increasing by 1 million houses every 3 y. To illustrate how changes in wildfire activity might affect air pollution and related health outcomes, and how these linkages might guide future science and policy, we develop a statistical model that relates satellite-based fire and smoke data to information from pollution monitoring stations. Using the model, we estimate that wildfires have accounted for up to 25% of PM_2.5 (particulate matter with diameter <2.5 μm) in recent years across the United States, and up to half in some Western regions, with spatial patterns in ambient smoke exposure that do not follow traditional socioeconomic pollution exposure gradients. We combine the model with stylized scenarios to show that fuel management interventions could have large health benefits and that future health impacts from climate-change–induced wildfire smoke could approach projected overall increases in temperature-related mortality from climate change—but that both estimates remain uncertain. We use model results to highlight important areas for future research and to draw lessons for policy.