糖尿病合并妊娠和妊娠期糖尿病母儿并发症的诊断分析

目的探讨分析糖尿病合并妊娠和妊娠期糖尿病母儿并发症的诊断。方法选取2013年6月—2014年6月该院收治的GDM患者12例与同期糖尿病合并妊娠期患者12例,分别作A、B组,A组患者视病情采取饮食控制与必要胰岛素治疗,B组患者全部饮食控制与胰岛素治疗,对比两组患者的母儿并发症与妊娠结局。结果 GDM患者的妊娠结局明显好于糖尿病合并妊娠患者,母儿的并发症明显较少,组间差异有统计学意义(P0.05)。结论对糖尿病合并妊娠患者与妊娠期糖尿病患者进行有效的血糖控制,能够有效降低并发症的发生,提高妊娠结局。     

系统性红斑狼疮合并妊娠71例的前瞻性研究和长期随访

目的：了解系统性红斑狼疮（SLE）患者妊娠的母婴风险因素。方法：前瞻性地观察1988－1999年间仁济医院SLE患者妊娠结果，将患者分为病控制1年经以上妊娠组（A组），妊娠前1年内有病情活动组（B组）和妊娠期首发病例组（C组），分别观察妊娠期及产后0．5年内母婴情况并长期随访。结果：71例患者中A组患者49例，B组患者13例，C组患者9例，1例患者因严重狼疮活动而终止妊娠，另1例患者产下双胎，出生活婴71名，无新生儿狼疮，无母婴死亡，妊娠期SLE活动比例A组9例（18．4％）显著低于B组10例（76．9％）和C组9例（100％（P＜0．01），A组妊娠期新发肾炎显著少于B、C组（P＜0．05），产后0．5年肾炎活动显著少于B组（P＜0．05），A组出生早产儿和低体重儿显著少于B组（P＜0．05），A组患者中既往有无SLE内脏累及者之间比较，妊娠期SLE活动和胎儿异常的比例差异均无显著性（P＞0．05），结论：SLE患者病情控制1年以上妊娠，母婴安全度显著增高，既往有内脏累及不构成特别的风险，妊娠前1年内有SLE活动者母婴风险显著增大。     

妊娠期糖尿病对妊娠结局的影响

目的 探讨妊娠期糖尿病对妊娠结局的影响.方法 选取该院2013年5月-2013年12月期间确诊为妊娠期糖尿病的孕产妇38例为实验组,对妊娠期糖尿病(GDM)孕产妇临床资料进行回顾性分析.确诊为糖尿病的孕产妇38为实验组(A);随机选择与A组分娩时间最接近的正常孕产妇40例作为对照组(B).对A组与B组的妊娠结局进行比较,新生儿患病率以及终止妊娠方式比较.结果 新生儿患病率实验组高于对照组,差异有统计学意义(P＜0.05);剖宫产率实验组高于对照组,差异有统计学意义(P＜0.05).结论 妊娠期糖尿病对妊娠结局有重要影响,对妊娠期糖尿病应早筛查、早诊断、早治疗,以降低母婴并发症.     

规范筛查与治疗妊娠期糖尿病对妊娠结局的影响

目的 观察规范筛查与治疗妊娠期糖尿病对妊娠结局的影响.方法 随机选取该院2011年1月-2013年1月期间收治的产检时确诊为妊娠期糖尿病的患者30例,设为A组;随机选取同时期分娩前(后)确诊为妊娠期糖尿病的患者30例,设为B组.对两组患者妊娠结局进行对比.结果 A组患者在妊高征、羊水过多、新生儿呼吸窘迫、巨大儿、新生儿呼吸窘迫、新生儿血糖低等方面均明显优于B组患者,差异显著具有统计学意义(P＜0.05).结论 规范筛查与治疗,可明显改善妊娠期糖尿病患者的妊娠结局,降低孕妇及胎儿风险.     

控制妊娠期糖尿病孕妇血糖对减少母体及围生儿并发症和改善妊娠结局的意义

目的分析控制妊娠期糖尿病孕妇血糖对减少母体及围生儿并发症和改善妊娠结局的意义,为临床提供参考。方法选取该院收治的300例妊娠期糖尿病孕妇作为观察对象,收治时间为2012年8月—2015年8月,结合孕妇入院资料的分析结果将300例妊娠期糖尿病孕妇分成A组与B组,A组为血糖控制满意组150例,B组为血糖控制不满意组150例,再选取同期我院收治的150例正常孕妇为对照组,观察比较3组孕妇及围生儿的并发症发生率和妊娠结局。结果经比较可知,A组孕妇及围生儿的并发症发生率和对照组孕妇及围生儿的并发症发生率的比较结果差异无统计学意义(P0.05);B组孕妇及围生儿的并发症发生率显著高于对照组孕妇及围生儿的并发症发生率,比较结果差异无统计学意义,P0.05;A组和B组妊娠期糖尿病孕妇及围生儿的并发症发生率和妊娠结局的比较结果差异有统计学意义(P0.05)。结论对妊娠期糖尿病孕妇采取有效的血糖控制措施,能够有效降低孕妇以及围生儿发生并发症的机率,值得推广。     

妊娠期糖尿病孕妇孕期体重指数增长对妊娠结局的影响临床分析

目的该文将对妊娠期糖尿病孕妇孕期体重指数增长对妊娠结局的影响进行临床分析,从而有效维持妊娠期糖尿病孕妇孕妇体重,减少妊娠不良结局的发生。方法选取2017年4月—2018年4月该院接收的750例孕妇中诊断为妊娠期糖尿病的85例孕妇作为此次实验研究对象,采用回顾分析方法,对该院85例患妊娠期糖尿病的孕妇进行分组,根据孕妇24周到分娩前孕妇体重指数增长情况,将患者分为3组,对比3组患者体重指数增长对妊娠结局的影响。结果 C组患者体重指数增长(5.41±0.3)kg/m~2显著高于A组(2.46±0.3)kg/m~2与B组(3.84±0.3)kg/m~2,妊娠终止时间(37.8±1.0)周短于A组(39.5±1.0)周与B组(40.2±1.0)周;3组患者胎膜早破、羊水过多并发症发生并差异无统计学意义(P0.05);B组与C组患者子痫前期、早产、胎儿窘迫并发症发生显著高于A组;3组围产儿窒息、湿肺并发症发生情况差异无统计学意义(P0.05);低血糖、低体重儿以及巨大儿并发症B组与C组明显高于A组。结论妊娠期糖尿病孕妇体重指数增长,对妊娠结局有一定影响,提升不良妊娠结局的发生情况,临床需要对妊娠期糖尿病孕妇进行有效治疗,维持正常血糖,控制体重增长,从而确保母婴安全。     

优质护理在妊娠期糖尿病患者中的应用效果分析

目的研究分析在临床中对妊娠期糖尿病患者中行优质护理干预的效果。方法选择2018年3月—2019年1月时段到该医院治疗的88例妊娠期糖尿病患者,行随机数字表法分组,分为A组(44例)与B组(44例),A组接受常规护理干预,B组接受优质护理干预,观察统计护理干预前后血糖情况以及妊娠结局情况,并予以对比评价。结果干预前,组间对比FBG、PBG、HbAlc指标水平,差异无统计学意义(P0.05),干预后,B组血糖指标情况均显著优于A组(P0.05);B组妊娠结局情况显著优于A组(P0.05)。结论对于妊娠期糖尿病患者,在治疗过程中予以优质护理干预,能够对血糖指标水平进行有效控制,并改善妊娠结局,值得进一步推广。     

规范化治疗对妊娠期糖尿病(GDM)及新生儿的影响研究

目的研究规范化治疗对妊娠期糖尿病(GDM)及新生儿的影响。方法随机抽取该院自2015年2月—2016年2月收治的妊娠期糖尿病患者100例,分为A组(n=50)和B组(n=50)。B组患者给予常规的保守治疗,A组患者给予规范化治疗。而后对比两组的血糖、妊娠相关情况以及新生儿结局。结果 A组的血糖情况(空腹血糖、餐后2h血糖)、妊娠相关情况(孕期感染、早产、羊水过多、剖宫产、妊高症)、新生儿结局(新生儿低血糖、新生儿呼吸窘迫综合征、胎儿畸形、胎儿生长萎缩、巨大儿)明显优于B组的,差异有统计学意义(P0.05)。结论妊娠期糖尿病患者采用规范化治疗,有效的控制了患者的血糖,改善了母婴结局,值得进一步推广和使用。     

规范筛查与治疗妊娠期糖尿病对妊娠结局的影响

目的观察规范筛查与治疗妊娠期糖尿病对妊娠结局的影响。方法随机选取该院2011年1月—2013年1月期间收治的产检时确诊为妊娠期糖尿病的患者30例,设为A组;随机选取同时期分娩前（后）确诊为妊娠期糖尿病的患者30例,设为B组。对两组患者妊娠结局进行对比。结果 A组患者在妊高征、羊水过多、新生儿呼吸窘迫、巨大儿、新生儿呼吸窘迫、新生儿血糖低等方面均明显优于B组患者,差异显著具有统计学意义（P〈0.05）。结论规范筛查与治疗,可明显改善妊娠期糖尿病患者的妊娠结局,降低孕妇及胎儿风险。     

胰岛素治疗对妊娠期合并糖尿病患者在改善妊娠结局中的效果分析

目的探究胰岛素在妊娠期合并糖尿病(gestational diabetes mellitus,GDM)中的治疗效果及对妊娠结局的影响。方法回顾性选取该院2017年2月—2018年4月90例妊娠期合并糖尿病患者作为观察对象,采用饮食控制疗法的45例患者列为A组,采用胰岛素泵治疗的45例患者列为B组,对比两组患者的血糖情况、妊娠结局以及新生儿Apgar评分。结果经治疗后,A组空腹血糖为(5.56±0.36)mmol/L,餐后2 h血糖为(6.7 8±0.74)mmol/L,B组空腹血糖为(4.78±0.43)mmol/L,餐后2 h血糖为(5.86±0.65)mmol/L,B组血糖情况均明显优于A组(P0.05);B组的不良妊娠发生率为4.44%,显著低于A组的17.7%(P0.005);A组新生儿的Apgar评分为(7.76±1.13)分,B组为(9.12±1.10)分,B组新生儿Apgar评分明显高于A组(P0.05)。结论对妊娠期合并糖尿病患者使用胰岛素治疗可显著改善其血糖水平、降低不良妊娠结局发生率,因此具备临床推广价值。     

Behcet's disease and pregnancy relationship study

The effects of pregnancy on the course of Behcet's disease (BD), and vice versa, are unknown and little has been reported. We have studied three groups of women: (1) group A included 61 pregnancies in 23 women with BD, 25 pregnancies took place in 10 patients already diagnosed (group 1A) and 36 pregnancies occurred in 13 patients before disease diagnosis (group 2A); (2) group B included 30 females with 83 pregnancies affected by recurrent oral ulcers (ROU); (3) group C included 20 healthy women with 61 pregnancies. We investigated the effects of BD on pregnancy and fetal outcome, and the influence of gestation on the course of BD. A questionnaire was used in which specific information about each pregnancy, labour and puerperium was collected. We looked for medical confirmation in all cases where any pathology had been identified. No significant differences were found in the incidence of pregnancy complications between groups. The incidence of perinatal death was also similar and neither congenital abnormalities nor neonatal BD were observed. Only two patients observed a flare of the disease and in two cases the diagnosis of BD was made during the pregnancy. In our series, the outcome of pregnancy was generally good in BD patients, disease manifestations were not consistently worsened and fetal outcome was excellent. The first case of Budd-Chiari syndrome during the puerperium in a BD patient is reported.      

Comparison of two different doses of iodide in the prevention of gestational goiter in marginal iodine deficiency: a longitudinal study

OBJECTIVE: A prospective randomized trial was performed to assess the usefulness of iodine supplementation in the prevention of goiter in pregnant women living in marginally iodine-deficient areas. DESIGN: Eighty-six pregnant women were recruited and randomized in two groups and treated daily for up to six months after delivery with 200 microg iodide (group A) or 50 microg iodide (group B). Sixty-seven women (32 in group A and 35 in group B) completed the study. METHODS: Thyroid volume (TV), thyroid functional parameters and urinary iodine concentration were determined in all subjects at booking, at the 18th-26th, and the 29th-33rd week of gestation, and at the 3rd and 6th month after delivery. RESULTS: A slight but not significant increase in TV during gestation was observed only in group B. After delivery a progressive decrease in TV was documented in both groups, the final TV being significantly reduced with respect to the initial volume in group A. No significant changes in serum free thyroid hormones and TSH concentrations were found during gestation in either group. Postpartum thyroiditis was observed in 5 women (2 in group A, 3 in group B). No side effects were seen. CONCLUSION: The present data indicate that in marginally iodine-deficient areas, the administration of iodide is recommended in pregnancy and lactation. In the conditions of the present trial a dose of 50 microg iodide/day is a safe and effective measure in preventing an increase in TV during pregnancy but a dose of 200 microg iodide/day appeared to be more effective without inducing side effects and without enhancing the frequency of post-partum thyroiditis.     

Effect of administration of thyroxine on the risk of postpartum recurrence of hyperthyroid Graves' disease.

In our previous study, we reported that the administration of T4 to patients with Graves' disease who were under treatment with methimazole (MMI) decreased the level of antibodies to thyroid-stimulating hormone (TSH) receptors and the rate of recurrence of hyperthyroidism. In this study, the effect of T4 administration on the rate of postpartum recurrence of hyperthyroidism was examined. Seventy-eight patients with Graves' disease had been treated with MMI for 1-3 yr before pregnancy, and MMI was discontinued 5-6 months after the onset of pregnancy because the levels of antibodies to TSH receptors decreased during early pregnancy. The patients were then divided into two groups. Group A (n = 40) was given T4 (100 micrograms/day) and group B (n = 38) was not given any drugs from 5 months after the onset of pregnancy until 1 yr after delivery. The levels of the antibodies to TSH receptors and serum concentrations of thyroxine-binding globulin (TBG) and T4 were not different between the two groups before and during pregnancy, although a transient increase in serum T4 and TBG concentrations were observed during the pregnancy in both groups. After delivery, levels of antibodies to TSH receptors increased in both groups. The rate of increase, however, was more rapid in group B than in group A. The levels were significantly higher in group B than A at 3, 6, 9, and 12 months after delivery. Serum T4 and TBG concentrations decreased after delivery in both groups. Serum concentrations of T4 increased after delivery in group B but not in group A. The concentration of T4 was significantly higher in group B than in group A at 9 and 12 months after delivery. Postpartum recurrence of hyperthyroidism was 5.0% in group A and 31.6% in group B, respectively, during the first year after delivery. These results suggest that administration of T4 during pregnancy and after delivery is effective in decreasing the level of antibodies to TSH receptors and to prevent the postpartum recurrence of hyperthyroidism.     

复方二氯醋酸二异丙胺治疗慢性病毒性肝炎合并酒精性肝损伤的临床疗效观察

观察应用复方二氯醋酸二异丙胺治疗慢性病毒性肝炎合并酒精性肝损伤的临床疗效。选择确诊慢性病毒性肝炎合并酒精性肝损伤58例,随机分成两组。A组（n=30）在常规保肝治疗基础上,加用复方二氯醋酸二异丙胺（0.4-0.8）克溶于生理盐水中静脉滴注,每日一次;B组（n=28）常规保肝治疗,两组均4周为一疗程。两种药物临床总有效率分别为86.7%、64.3%,血清胆红素下降A组较B组明显（P〈0.05）。复方二氯醋酸二异丙胺对改善慢性病毒性肝炎合并酒精性肝损伤症状和降低血清转氨酶有较好的疗效,伴有高胆红素血症患者应用复方二氯醋酸二异丙胺优于常规保肝治疗。     

Prognostic significance of serum CA19-9 levels in resected pancreatic cancer

Twenty-eight patients with histologically proven pancreatic adenocarcinoma were investigated to evaluate the utility of serum CA19-9 levels as a prognostic indicator after pancreatic resection. Three patients were excluded from the study because their serum CA19-9 levels remained normal throughout the course of the disease. Of the remaining 25 patients, those with preoperative serum CA19-9 levels ≤200U/ml had a better prognosis than those with serum CA19-9 levels >200 U/ml; however, the difference between the two groups was not significant (P=0.13). Serum CA19-9 levels 30 days after pancreatic resection were normalized (≤37 U/ml) in 11 patients (group A), and the survival rate of this group was significantly higher than that of the group of patients with persistently elevated CA19-9 levels (>37 U/ml) (group B) (P<0.005). Other factors i.e., preoperative CA19-9 values, tumor size, lymph node metastasis, histology, and stage classification showed no significant differences between group A and group B. Univariate analysis of the findings for the 25 patients showed that the stage classification and postoperative CA19-9 levels were of prognostic significance for prolonged survival. Other factors, i.e., gender, age, histology, preoperative CA19-9 levels, location of the tumor, and mode of operation, had no significance as prognostic indicators. Multivariate analysis showed that postoperative CA19-9 level was the only significant independent predictor of poor survival. Postoperative serum CA19-9 level appears to be useful as a prognostic indicator after resection of pancreatic cancer.     

Impact of balloon-occluded retrograde transvenous obliteration on management of isolated fundal gastric variceal bleeding

Aim: Although endoscopic injection of cyanoacrylate (CA) is the only effective method for treating isolated fundal gastric variceal bleeding, the rebleeding rate is relatively high. This study investigated the efficacy of balloon‐occluded retrograde transvenous obliteration (B‐RTO) for management of isolated fundal gastric variceal bleeding. Methods: Patients (n = 110) with acute or recent bleeding from isolated fundal gastric varices (GV) were retrospectively studied. Acute bleeding was treated by CA injection or balloon tamponade. 44 patients underwent additional endoscopic injection of CA and ethanolamine oleate (EO) weekly until obturation of GVx from 1994 to 2002 (group A). 42 patients from 2003 to 2010 underwent B‐RTO after initial hemostasis (group B). Both groups were assessed for the number of sessions required to achieve GV obturation, hospital stay, recurrent bleeding rate, morbidity and mortality. Results: Acute gastric variceal bleeding was successfully treated in all patients by CA injection or balloon tamponade. B‐RTO was successfully performed except in two patients in group B. The average number of sessions required for obturation was 3.8 for groups A and 2.2 for B (P < 0.05). Recurrent bleeding was observed in 16 and two patients in groups A and B, respectively. The cumulative non‐rebleeding rate at 5 years was 58.3% and 98.1% in groups A and B, respectively. The cumulative survival rate at 5 years was 53.8% and 87.6% in groups A and B, respectively. Conclusion: Balloon‐occluded retrograde transvenous obliteration may be superior to endoscopic injection with CA and EO for prevention of rebleeding in patients with isolated fundal GVs with a major shunt.     

硝苯地平不同用药方案治疗妊娠高血压综合征的临床疗效观察

目的观察硝苯地平不同用药方案治疗妊娠高血压综合征的临床疗效。方法选取2011年3月—2014年3月上栗县妇幼保健院收治的妊娠高血压综合征患者118例,按照不同用药方案分为长效组61例和短效组57例。长效组患者口服硝苯地平缓释片治疗,短效组患者口服短效硝苯地平片治疗,均连续服用7 d为1个疗程。比较两组患者治疗2个疗程后临床疗效、分娩方式及妊娠结局,并观察治疗期间不良反应发生情况。结果治疗2个疗程后,长效组总有效率为95.1%,高于短效组的82.5%(P0.05)。长效组患者剖宫产率(18.0%)低于短效组(35.1%)、胎儿窘迫发生率(8.2%)低于短效组(21.1%)(P0.05);两组患者不良反应发生率(8.2%比10.5%)比较,差异无统计学意义(P0.05)。结论长效硝苯地平治疗妊娠高血压综合征在降压、降低剖宫产率及改善妊娠结局方面优于短效硝苯地平。     

Lansoprazole in the treatment of gastrooesophageal reflux disease in childhood

BACKGROUND: Acid suppressive therapy is the mainstay of pharmacologic treatment of gastro-oesophageal reflux disease. Use of proton pump inhibitors in children is still limited and has only included omeprazole in a few controlled studies. AIM: To determine efficacy of lansoprazole, a relatively new proton pump inhibitor, on symptoms and oesophagitis in a group of children with gastro-oesophageal reflux disease refractory to H2 receptor antagonists. The required dose of the drug for inhibiting gastric acidity was also determined. PATIENTS AND METHODS: A series of 35 children (median age: 7.6 years, range: 3-15) with oesophagitis refractory to H2 receptor antagonists received a 12-week therapeutic course with lansoprazole. Prior to the study children underwent symptomatic and endoscopic assessment, oesophageal manometry and 24-hour intragastric and intra-oesophageal pH test. The latter was repeated after one week of therapy while patients were on treatment in order to monitor the degree of acid suppression and adjust the dose of the drug. Symptomatic assessment and endoscopy were repeated at the end of the trial RESULTS AND CONCLUSIONS: In 12 patients (group A), the initial dose of the drug was efficacious (1.3 to 1.5 mg/kg/day), whereas in 23 [group B) the initial dose (0.8 to 1.0 mg/kg/day) was increased by half because of insufficient inhibition of intragastric acidity (i.e., when the intra-gastric pH remained below 4.0 for more than 50% of the recording time). Nine patients in group A (75%) and 8 in group B (53.5%) healed (chi2: 3.6, p<0.05); 1 patient in group A [8.3%) and 7 in group B (30.5%) remained unchanged (chi2: 6.9, p<0.01); 2 patients in group A and 8 in group B improved and underwent a further month of therapy. The two groups did not differ as far as concerns baseline pH, endoscopic and clinical variables. In both groups, those patients failing to respond at the end of the trial showed a more impaired oesophageal motility than improved or healed patients. The drug was well tolerated and no significant laboratory abnormalities occurred. In children with gastro-oesophageal reflux disease refractory to H2 receptor antagonists, a 12-week course of lansoprazole is effective both in healing oesophagitis and improving symptoms. An initial dose of 1.5 mg/kg/day of the drug is suggested. However, if during treatment, patients remain symptomatic the dose should be increased and a prolonged intra-gastric and intra-oesophageal pH test performed to evaluate the acid suppression efficacy of the adjusted dose. A short course of lansoprazole appears to be safe and well tolerated in paediatric age.     

Macrophage colony-stimulating factor (M-CSF) as a candidate for the tumor marker of breast cancer

Macrophage--colony stimulating factor (M-CSF) is one of the glycoproteins called colony-stimulating factors (CSFs). Some clinical investigations have shown autologous production of M-CSF various human cell lines in vitro and by tumors in vivo. We have investigated the plasma level of M-CSF and commonly accepted tumour markers, such as CA 15-3 in breast cancer. The plasma levels of cytokines were measured in 30. patients with breast cancer before surgery and 20. healthy subjects. The patients were divided into two groups: A (stage I) and B (stage II). M-CSF was determined using enzyme-linked immunosorbent assay (ELISA), CA 15-3 was measured by microparticle enzyme immunoassay (MEIA). Mean M-CSF and CA 15-3 plasma levels were significantly higher in breast cancer patients compared to the control group. The M-CSF level was significantly higher (statistical significance) in group B (II stage) when compared to group A (I stage) and group B to control group. The diagnostic sensitivity of M-CSF were related to the stage of disease (group A--10%, group B--40%) and combined use with CA 15-3 (group A--30%, group B--65%). These results suggest a potential role for M-CSF as tumour marker for breast cancer.     

Timing of antibiotic prophylaxis in acute pancreatitis: a controlled randomized study with meropenem

OBJECTIVES: Antibiotic prophylaxis improves the outcome of acute pancreatitis. Since bacterial translocation from the gut occurs in the first h of disease, early therapy is likely to achieve the maximal effect. The study compares early antibiotic treatment with treatment started after the demonstration of pancreatic necrosis. METHODS: Two hundred fifteen patients with pancreatitis were randomized to either group A (N=108), who started antibiotic therapy (meropenem 500 mg t.i.d.) at admission, or group B (N=107), who received antibiotics after the demonstration of necrosis at computed tomography (CT). CT was performed in both groups after at least 48 hr of hospitalization. The clinical course of disease was compared in the two groups. RESULTS: Thirty patients in group A and 29 in B showed necrosis on CT. The two groups were similar in demographics and characteristics of disease. Antibiotic treatment was started after 4.56+/-1.2 days from hospitalization in group B and after 1.07+/-0.6 days in A. Pancreatic infection occurred in four patients in group A (13.3%) and in nine in B (31%) (p=0.1). Extrapancreatic infection occurred in 16.6% of patients in group A and in 44.8% in B (p<0.05). Need for surgery and length of hospitalization were also higher in group B. Mortality rates were similar in the two groups, but, 3 of 4 patients with infected necrosis in group A and only 2 of 9 in group B died. CONCLUSIONS: Early antibiotic treatment is associated with a significant improvement in the prognosis of necrotizing acute pancreatitis (AP), because of a reduction in the occurrence of septic complications.