剖宫产子宫瘢痕缺损程度与再妊娠分娩方式及母婴结局的相关性

目的探讨剖宫产子宫瘢痕缺损程度与再次妊娠分娩方式及母婴结局的相关性。方法选取2017年3月-2019年5月在医院就诊的剖宫产后子宫瘢痕缺损(PCSD)再次妊娠产妇165例作为观察组,按照PCSD程度分为Ⅰ～Ⅱ度、Ⅲ度两个亚组,同期剖宫产非瘢痕子宫再次妊娠产妇94例作为对照组,比较不同亚组、观察组与对照组分娩方式及流产、早产、产后出血的发生比例,比较观察组和对照组胎盘异常(胎盘前置、胎盘粘连、胎盘植入)、新生儿体质量及1 min Apgar评分情况,并对PCSD不同程度与再次妊娠分娩方式及母婴结局的相关性进行分析。结果观察组产妇阴道分娩率显著低于对照组,早产、产后出血发生率显著高于对照组,差异均有统计学意义(P0.05)。PCSDⅢ度组产妇阴道分娩率显著低于Ⅰ～Ⅱ度组,早产、产后出血发生率显著高于Ⅰ～Ⅱ度组,差异均有统计学意义(P0.05)。观察组前置胎盘发生率高于对照组,新生儿体质量、1 min Apgar评分显著低于对照组,差异均有统计学意义(P0.05)。剖宫产后PCSD与再次妊娠时阴道分娩呈负相关(P0.05),与早产、产妇产后出血的发生呈正相关。结论剖宫产子宫瘢痕程度与再次妊娠阴道分娩呈负相关,与早产、产妇产后出血的发生呈正相关。瘢痕子宫对于新生儿体质量、Apgar评分有一定影响。     

瘢痕子宫患者再次妊娠经阴道分娩与剖宫产的临床结局和母婴预后比较

目的比较瘢痕子宫患者再次妊娠经阴道分娩与剖宫产的临床结局和母婴预后,为临床选择分娩方式提供参考。方法随机选取2015年1月-2016年12月北京和美妇儿医院196例再次妊娠的瘢痕子宫患者,其中172例行剖宫产者为对照组,24例经阴道分娩者为研究组。比较两组的产妇预后(产时出血量、住院时间、产后出血发生率、住院费用及产褥感染发生率)、新生儿预后(新生儿体质量、1 min Apgar评分及湿肺发生率)。结果研究组产妇产时出血量、住院时间、产后出血发生率、住院费用及产褥感染发生率均显著低于对照组(均P0.05)。两组新生儿体质量、新生儿1 min Apgar评分及新生儿湿肺发生率比较差异均无统计学意义(均P0.05)。结论在符合阴道试产条件与严格掌握适应证的基础上,瘢痕子宫患者再次妊娠经阴道分娩具有良好的可行性,能够促进产后恢复,改善临床结局及母婴预后。     

瘢痕子宫妊娠经阴道试产对母婴的安全性探讨

目的探讨瘢痕子宫妊娠经阴道试产对母婴的安全性及可行性。方法选取2015年12月-2017年4月该院接收的92例阴道分娩瘢痕子宫产妇为阴道分娩组,以95例同期瘢痕子宫再次剖宫产分娩者为剖宫产组,对比其母婴安全差异。同时以93例非瘢痕子宫阴道分娩者为对照组,观察瘢痕子宫与非瘢痕子宫的不同之处。结果与剖宫产组相比,阴道分娩组分娩后2 h及24 h出血量、住院时间明显减少(P<0.05),新生儿Apgar评分明显升高(P<0.05),新生儿窒息率及产妇分娩后产后感染、尿潴留、产后出血等并发症发生率均明显下降(P<0.05)。阴道分娩组与对照组相比,分娩后出血量、产程时间、住院时间、新生儿Apgar评分、新生儿窒息情况、阴道分娩成功率、产妇分娩后并发症发生率组间均无明显差异(P>0.05)。结论瘢痕子宫妊娠经阴道试产是安全可行的分娩方式。     

剖宫产史孕妇再次妊娠分娩方式对母儿结局的影响

目的:探讨瘢痕子宫孕妇不同分娩方式对母儿结局的影响。方法:回顾性收集236例在本院产科分娩的瘢痕子宫孕妇,根据分娩方式的不同分为瘢痕剖宫产组(168例,剖宫产分娩)与瘢痕阴道产组(68例,经阴道分娩)。另选取本院同期80例非瘢痕子宫孕妇,根据分娩方式的不同分为正常剖宫产组(37例,剖宫产分娩)和正常阴道产组(43例,经阴道分娩)。对比4组的出血量、住院时间及母儿结局。结果:瘢痕剖宫产组的术中出血量及产后出血率明显高于正常剖宫产组,手术时间明显长于正常剖宫产组(P0.05),新生儿Apgar评分、住院时间比较两剖宫产组无差异(P0.05)。瘢痕剖宫产组的出血量、产褥感染率及住院时间均高于瘢痕阴道产组(P0.05),新生儿Apgar评分、新生儿窒息发生率瘢痕剖宫产组与瘢痕阴道产组比较无差异(P0.05)。瘢痕阴道产组出血量、产程时间、新生儿Apgar评分、住院时间与正常阴道产组比较无差异(P0.05)。结论:剖宫产有较高的出血风险,对于符合阴道试产条件的瘢痕子宫再妊娠孕妇,应鼓励产妇进行阴道试产,以降低产后出血、产褥感染风险。     

瘢痕子宫再次妊娠经阴道分娩可行性与安全性探讨

目的对瘢痕子宫再次妊娠分娩方式进行探讨。方法选择天津市红桥医院产科2016年1-12月收治的瘢痕子宫妊娠分娩产妇325例,分为疤痕子宫阴道分娩组(VBAC组)45例和再次剖宫产组(RCS组)280例,另选非疤痕子宫阴道分娩(VBNC)45例,对瘢痕子宫再次妊娠孕妇的分娩方式以及分娩结局进行回顾性分析。结果 VBAC组与VBNC组产妇产后出血量、产褥感染率、新生儿Apgar评分及住院时间比较,差异无统计学意义(P0.05)。VBAC组产后出血量、产褥感染率及住院时间均少于RCS组,差异有统计学意义(P0.05);两组新生儿Apgar评分差异无统计学意义(P0.05)。结论产前全面充分评估,产时严密监测,瘢痕子宫再次妊娠阴道分娩为一种可行,安全,有效,经济的分娩方式。     

研究瘢痕子宫再次妊娠孕妇分娩方式及妊娠结局

目的:研究与分析瘢痕子宫再次妊娠孕妇分娩方式及妊娠结局。方法:从本院2016年12月～2017年12月期间内接收的瘢痕子宫再次妊娠孕妇中,随机抽取800名孕妇,根据分娩方式将其分为剖宫产组400例,阴道分娩组400例。观察两组孕妇产后出血量、住院时间;观察两组新生儿体重情况,以及新生儿Apgar评分。结果:阴道分娩组产妇产后出血量、住院时间均优于剖宫产组;阴道分娩组新生儿体重、Apgar评分均优于剖宫产组;p 0.05,差异具有统计学意义。结论:瘢痕子宫产妇再次妊娠时应根据产妇具体情况来选择适合的分娩方式,在严密监测的情况下给予产阴道分娩的机会,尽量降低产妇剖宫产率以及并发症的发生。     

“二胎全面放开”背景下瘢痕子宫再次妊娠产妇分娩方式的选择及对母婴结局的影响

目的探讨"二胎全面放开"背景下瘢痕子宫再次妊娠孕妇最佳的分娩方式,并分析不同分娩方式对母婴结局的影响。方法选取2016年1月-2018年12月台州当地两家医院收治的300例瘢痕子宫再次妊娠产妇为研究对象,根据分娩方式将其分为阴道分娩组和剖宫产组,比较两组产程时间、产时出血量、产后2 h出血量、产褥感染、新生儿Apgar评分、住院时间及住院费用等情况。结果剖宫产组204例产妇均成功完成分娩手术,阴道分娩组96例产妇中8例中转剖宫产术,阴道试产成功率为91. 67%(88/96)。两组产妇年龄、孕周、新生儿5 min Apgar评分比较,差异无统计学意义(P0. 05);但阴道分娩组产时出血量、产后2 h出血量、产褥感染率、住院时间和住院费用均显著低于剖宫产组,差异均有统计学意义(均P0. 05)。结论对符合阴道试产指征的瘢痕子宫再次妊娠产妇,建议优先采用阴道分娩方式,可改善产妇妊娠结局且不增加新生儿窒息风险,但必要时仍需行剖宫产分娩。     

瘢痕子宫再次阴道分娩的安全性及分娩过程中子宫破裂的早期识别与诊断

目的探讨研究瘢痕子宫再次阴道分娩的安全性及分娩过程中子宫破裂的早期识别与诊断方法。方法选择佛山市妇幼保健院2013年6月-2016年6月的68名瘢痕子宫再次妊娠的产妇作为观察组,同期所有剖宫产再孕计划手术者52人作为对照组。观察组产妇拟采用阴道分娩,设专人密切观察产程进展,对照组产妇常规采用剖宫产。比较两组新生儿1min Apgar评分,产妇的产后出血、产褥感染及住院时间。结果观察组经阴道成功分娩46例,成功率为67.65%,两组新生儿1 min Apgar评分比较,产妇产后出血情况比较差异无统计学意义(P0.05);产褥感染和住院时间观察组明显少于对照组,差异均有统计学意义(P0.05)。结论只要做好对瘢痕子宫孕妇产程的观察,掌握好子宫破裂的早期诊断要点,做到及时识别和干预,本研究认为瘢痕子宫孕妇阴道分娩的安全性较高,可以根据孕妇的具体身体素质和意愿选择给予阴道试产。     

瘢痕子宫孕妇经阴道分娩的妊娠结局及与子宫下段瘢痕厚度关系探讨

目的:分析剖宫产后瘢痕子宫再次妊娠行阴道分娩妊娠结局及与子宫瘢痕厚度关系。方法:回顾性收集本院2016年1月—2018年5月行剖宫产术后再次妊娠阴道试产孕妇159例为观察组,根据超声测量子宫下段瘢痕组织厚度分为Ⅰ级瘢痕子宫组(85例)(厚度2～3mm),Ⅱ级瘢痕子宫组(74例)(厚度3～7mm)。并选择同期非瘢痕子宫经阴道分娩孕妇120例为对照组,分析各组围产结局,不同瘢痕子宫厚度孕妇阴道试产成功率。结果:阴道试产成功率66.7%,成功组孕妇的总产程、产后出血比例、产后出血量、住院时间、新生儿体重、新生儿Apgar评分、新生儿并发症、转新生儿科比例与对照组均无差异(P0.05);孕龄、孕前BMI指数、孕周、新生儿体重均低于失败孕妇,子宫下段肌层厚度大于失败孕妇(P0.05)。Ⅰ级瘢痕子宫厚度孕妇成功率(87.1%)高于Ⅱ级瘢痕子宫孕妇(43.2%)(P0.05)。结论:剖宫产术后再次妊娠产妇阴道分娩安全可行。子宫肌层瘢痕厚度≥2mm时安全性较好,越厚分娩成功率增加,将子宫瘢痕厚度纳入阴道试产评价指征有一定临床参考价值。     

瘢痕子宫再次妊娠的分娩方式选择及经阴道分娩可行性、安全性研究

目的探讨瘢痕子宫再次妊娠的分娩方式选择及经阴道分娩的可行性与安全性,为临床选择更合适的分娩方式提供参考依据。方法选取2015年2月-2017年2月于该院产科住院分娩的瘢痕子宫再次妊娠孕妇120例,根据孕妇分娩方式分为观察组(50例)与对照组(70例)。观察组采用经阴道试产,对照组行再次剖宫产术。观察两组患者的经阴道试产成功率,并对比两组孕妇产后情况、并发症发生情况及新生儿Apgar评分。结果观察组患者经阴道试产成功率为78.00%;观察组患者产后24 h出血量、住院时间及住院费用均明显低于观察组,观察组孕妇并发症发生率明显低于对照组,差异均有统计学意义(均P0.05);两组新生儿一般情况(新生儿体质量及Apgar评分)对比,差异均无统计学意义(均P0.05)。结论在严格掌握阴道分娩与剖宫产术指征的前提下,经阴道试产对瘢痕子宫再次妊娠具有可行性、安全性,有助于改善孕妇结局,且对新生儿状况未造成影响。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.