Syncytin-1和HtrA4在子痫前期患者母血及胎盘组织中的表达及临床意义

目的探讨子痫前期(PE)患者母血及胎盘组织中Syncytin-1及Htr A4的表达变化及其与新生儿出生体质量及脐动脉血流动力学参数的相关性,研究Syncytin-1和Htr A4在PE患者母血及胎盘组织中的表达及临床意义。方法选取2016年1月-2017年6月于该院住院分娩的重度PE患者110例(研究组),其中晚发型PE组52例,早发型PE组58例,同期随机选取正常分娩孕妇50例设为正常组。检测各组胎儿脐动脉收缩压与舒张压的比值(S/D)、搏动指数(PI)及阻力指数(RI)。采用ELISA法和免疫组化法测定母血和胎盘中Syncytin-1和Htr A4的含量变化。结果研究组母血和胎盘组织中Syncytin-1表达水平显著低于正常组,早发型PE组显著低于晚发型PE组(均P<0.05);早发型PE组母血和胎盘组织中Htr A4表达水平显著高于晚发型PE组,晚发型PE组高于正常组(均P<0.05)。早发型PE组S/D值显著高于晚发型PE组和正常组(均P<0.05)。早发型PE组PI值及RI值显著高于晚发型PE组,晚发型PE组高于正常组,差异均有统计学意义(均P<0.05)。结论 Htr A4和Syncytin-1参与PE发病,且与疾病的严重程度相关。PE孕妇胎盘组织和母血中Syncytin-1表达与脐动脉S/D、PI、RI值及新生儿出生体质量均呈负相关,而Htr A4表达与脐动脉上述指标及新生儿出生体质量均呈正相关。Syncytin-1与Htr A4呈负相关。Htr A4可能抑制Syncytin-1的融合分化作用,带来胎盘血管重铸障碍及胎盘浅着床,进而导致PE的发生。     

硫酸镁联合酚妥拉明和硝苯地平治疗妊高症临床应用疗效

目的观察硫酸镁联合酚妥拉明和硝苯地平治疗妊娠高血压综合征临床疗效。方法将2012-09/2014-07宿迁市中医院产房收治的105例妊娠高血压综合征(PIH)患者,随机分为观察组(联合用药)53例,对照组(单一用药)52例,其中对照组单用25%硫酸镁(Mg SO4)静脉滴注,每日总量25 g;观察组采用联合用药治疗即在与对照组相同静脉滴注25%Mg SO4的基础上,给以酚妥拉明20 mg加入5%葡萄糖250 ml静注,需30 min内滴入酚妥拉明10 mg,后根据PIH患者血压水平调节滴速,同时口服硝苯地平控释片10 mg,3~4次/d。两组患者均治疗7 d,观察患者疗效和治疗前后平均动脉压(MAP)、红细胞比容(HCT)、24 h尿蛋白定量(PRO-U)及脐动脉血流速度峰谷比(S/D)的变化。结果通过7 d治疗后,观察组总有效率96.2%,对照组总有效率75.0%,差异有统计学意义(χ2=4.726,P=0.026);两组MAP、HCT、PRO-U及S/D观察指标治疗后较治疗前均有明显改善,组内比较差异有统计学意义(P0.05),且治疗后各观察指标观察组优于对照组差异具有统计学意义(P0.05)。结论硫酸镁联合酚妥拉明和硝苯地平治疗妊娠高血压综合征,降压平稳,解痉作用强,临床疗效显著,可有效减少围生期并发症的发生。     

硫酸镁联合硝苯吡啶对妊娠期高血压疾病的治疗效果及对妊娠相关蛋白A、血液流变学的影响

目的观察硫酸镁联合硝苯吡啶对妊娠期高血压疾病的临床疗效及对妊娠相关蛋白A(pregnancy associated plasma protein A,PAPP-A)、血液流变学的影响。方法选择2014年12月至2016年12月达州市达川区人民医院收治的妊娠期高血压疾病患者345例,根据入院先后顺序分为观察组(173例)和对照组(172例)。对照组患者采用25%硫酸镁静脉滴注,控制每日硫酸镁摄入量为25~30 g,观察组在对照组治疗基础上口服硝苯吡啶片,10 mg/次,Q 8 H,连续治疗5~7 d。观察两组患者治疗前后血压、血流动力学指标、PAPP-A、总抗氧化能力(total antioxidant capacity,TAC)、血管内皮功能水平变化情况。结果治疗前,两组患者血压、血液流变学指标水平比较差异无统计学意义(P0.05)。治疗1个疗程后,观察组血压、全血黏度(高切、中切、低切)和全血还原黏度(高切、中切、低切)水平均低于对照组(P0.05)。治疗前,两组PAPP-A、TAC、血管内皮生长因子(vascular endothelial growth factor,VEGF)、内皮素(endothelin,ET)、一氧化氮(nitric oxide,NO)水平比较差异无统计学意义(P0.05)。治疗1个疗程后,观察组PAPP-A、VEGF、ET水平低于对照组,TAC、NO水平高于对照组(P0.05)。两组不良反应发生率比较差异无统计学意义(P0.05)。结论硫酸镁联合硝苯吡啶治疗妊娠期高血压疾病可有效降低血压,改善血液流变学水平和血管内皮功能,降低血清PAPP-A水平,且不增加不良反应,安全性较高。     

白蛋白联合血液净化对毛细血管渗漏综合征患儿的血容量及预充量的影响

目的探讨白蛋白联合血液净化对毛细血管渗漏综合征患儿血容量/预充量的影响。方法以2014年7月至2017年11月期间,我院收治的59例毛细血管渗漏综合征患儿为研究对象,根据患儿家属意愿及治疗措施随机分为2组,其中以白蛋白联合血液净化治疗的30例为观察组,以常规治疗的29例为对照组,比较两组临床治疗效果、血容量与预充量及CVP、MAP等监测指标的变化。结果观察组患儿全身水肿改善时间及肺水肿改善时间明显短于对照组(P0.05),观察组死亡率明显低于对照组(P0.05)。两组治疗后CVP及MAP水平均明显上升,且观察组MAP水平显著高于对照组(P0.05)。但治疗后两组CVP水平相比差异无统计学意义(P0.05)。两组患儿经过治疗后血容量及血容量/预充量比值明显上升,且观察组显著高于对照组(P0.05)。结论白蛋白联合血液净化可有效改善CLS患儿水肿,降低患儿死亡率,有效提高或维持血容量。     

小剂量硫酸镁联合低分子肝素治疗对早发型重度子痫前期患者血压、24 h尿蛋白及母婴并发症的影响

目的探讨小剂量硫酸镁联合低分子肝素治疗对早发型重度子痫前期患者血压、24 h尿蛋白及母婴并发症的影响,为临床治疗提供参考。方法选取2015年2月-2016年8月湖南省人民医院收治的早发型重度子痫前期患者98例,采用随机数字表将其分为对照组和观察组,每组各49例。对照组患者仅接受小剂量硫酸镁治疗,在此基础上,观察组患者接受低分子肝素治疗。比较两组患者治疗前后的收缩压(SBP)、舒张压(DBP)及24 h尿蛋白水平,同时比较两组母体并发症发生率和围生儿不良结局发生率。结果治疗前,两组患者的SBP、DBP及24 h尿蛋白水平比较差异均无统计学意义(均P0.05);治疗后,观察组患者的SBP、DBP及24 h尿蛋白水平均明显低于对照组(均P0.05)。在两组中,治疗前后的SBP、DBP及24 h尿蛋白水平比较差异均有统计学意义(均P0.05)。观察组患者母体并发症发生率为24.48%,显著低于对照组(59.17%)(P0.05)。观察组围生儿不良结局发生率为14.28%,显著低于对照组(48.97%)(P0.05)。结论小剂量硫酸镁联合低分子肝素治疗早发型重度子痫前期的临床疗效显著,能够降低血压及尿蛋白水平,同时能改善母婴围生期结局,降低并发症发生率。     

血液灌流联合血液滤过治疗脓毒症休克的临床疗效及预后分析

目的探讨血液灌流联合血液滤过治疗脓毒症休克患者的临床疗效和预后。方法选取我院2015年12月至2018年8月收治的脓毒症休克患者64例,分为对照组和观察组各32例。对照组采用连续性高容量血液滤过治疗,观察组采用连续性高容量血液滤过联合血液灌流治疗,两组患者共治疗28 d。比较两组患者治疗前后的IL-6、 IL-10、 TNF-α、内毒素、 MAP、 NE、HR水平,采用生化仪检测乳酸和PO_2/FiO_2水平。统计两组患者治疗28 d的病死率。结果治疗前,两组患者的血浆炎性因子和内毒素水平、血流动力学、乳酸和氧合指数比较无统计学差异(P>0.05)。治疗后,两组的IL-6、 IL-10、 TNF-α和内毒素水平均明显降低,且观察组的IL-6、 IL-10、 TNF-α和内毒素水平均明显低于对照组(P均<0.05)。治疗后,两组的MAP、 PO_2/FiO_2水平均明显升高, NE、 HR、乳酸水平均明显下降,且观察组的MAP、 NE、 HR、乳酸、 PO_2/FiO_2均明显优于对照组(P均<0.05)。两组患者的病死率比较无统计学差异(P>0.05)。结论采用血液灌流联合血液滤过治疗脓毒症休克患者可有效改善炎性因子、血流动力学指标,且不会增加患者的病死率,预后情况良好。     

药物三联法治疗早发型子痫前期的疗效及对血栓前状态的影响

目的探讨低分子肝素钙、硫酸镁及维生素D联合治疗早发型子痫前期(PE)的疗效,并探讨其对血栓前状态的影响。方法根据随机双盲法将2018年9月-2019年9月来在丽水市妇幼保健院进行治疗的150例早发型PE产妇随机分为对照组(75例)和研究组(75例),对照组患者给予低分子肝素钙、硫酸镁治疗,研究组患者给予低分子肝素钙、硫酸镁联合维生素D治疗,观察比较两组患者的收缩压、舒张压,妊娠结局及新生儿结局。并对两组患者的血小板计数(PLT)、活化部分凝血活酶(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)及栓溶二聚体(D-Dimer)等血栓前状态分子标志物进行比较。结果治疗后,低分子肝素钙、硫酸镁及维生素D联合治疗组患者的收缩压和舒张压均低于对照组,差异有统计学意义(P0.05);研究组患者的低蛋白血症发生率、胎盘早剥发生率、肾功能不全发生率及HELLP综合征的发生率均显著低于对照组,差异有统计学意义(P0.05);且研究组胎儿平均孕龄、新生儿平均体质量均显著高于对照组,新生儿窒息率和胎儿/新生儿死亡率显著低于对照组,差异有统计学意义(P0.05);治疗后研究组患者APTT、PT及TT均显著高于对照组,D-Dimer水平显著低于对照组,差异均具有统计学意义(P0.05)。结论低分子肝素钙、硫酸镁及维生素D联合治疗早发型PE效果明显,可有效降低产妇血压,抑制血液高凝状态,改善母婴结局,值得临床推广。     

硝苯地平联合拉贝洛尔对重度子痫前期患者血流动力学指标、妊娠相关血浆蛋白A及血管内皮生长因子的影响

目的探讨硝苯地平联合拉贝洛尔对重度子痫前期患者血流动力学指标、妊娠相关血浆蛋白A(PAPP-A)及血管内皮生长因子(VEGF)的影响。方法选取2013年10月-2015年10月在该院入院治疗的106例重度子痫前期患者作为研究对象,将其按照随机数字法分为对照组与观察组,每组53例。对照组患者给予硫酸镁静脉滴注,观察组患者开通两条静脉通路,一侧与对照组相同,另一侧给予拉贝洛尔静脉滴注联合硝苯地平口服,两组患者疗程均为7 d。观察并比较两组患者治疗前后的血流动力学指标、PAPP-A及VEGF水平。结果治疗前两组患者血流动力学指标比较,差异无统计学意义(P0.05),治疗后两组患者的血液黏度、红细胞比容和脐动脉舒张压血流峰值比值(S/D)均显著下降,且观察组低于对照组(P0.05);心脏指数显著上升,且观察组高于对照组(P0.05)。治疗前两组患者PAPP-A、VEGF水平比较,差异无统计学意义(t_(PAPP-A)=-0.173,P0.05;t_(VEGF)=-0.531,P0.05),治疗后两组患者PAPP-A、VEGF水平均明显下降,且观察组低于对照组(t_(PAPP-A)=5.252,P0.05;t_(VEGF)=7.968,P0.05)。结论硝苯地平联合拉贝洛尔可明显改善重度子痫前期患者的血流动力学指标,降低PAPP-A、VEGF水平,临床效果显著。     

人血白蛋白联合小剂量肝素对子痫前期患者胎盘缺血缺氧损伤的影响

目的探讨人血白蛋白联合小剂量肝素对子痫前期患者胎盘缺血缺氧损伤的影响,减轻胎盘缺血缺氧性损伤。方法收集2015年1月-2016年12月在该院接受治疗的子痫前期患者30例,按照随机数表法分为对照组和观察组,每组各15例。在常规治疗的基础上,对照组患者加入小剂量肝素,观察组患者加入人血白蛋白与小剂量肝素。对比两组患者的血浆白蛋白、子宫动脉血流参数、胎盘缺血缺氧指标含量的差异。结果两组患者治疗前血浆白蛋白及子宫动脉参数水平差异无统计学意义(P0.05)。观察组患者治疗后血浆白蛋白含量高于对照组患者,子宫动脉血流参数S/D、RI、PI水平低于对照组患者(P0.05)。观察组患者治疗后脐静脉血缺氧指标HIF-1α、HSP70、EPO、LP含量低于对照组患者,胎盘组织中上述缺氧指标的蛋白表达量也低于对照组患者(P0.05)。结论人血白蛋白联合小剂量肝素可有效改善子痫前期患者的低白蛋白血症,增加子宫动脉血流、减轻胎盘缺血缺氧性损伤。     

拉贝洛尔治疗妊娠高血压对患者炎症因子和血液流变指标影响

目的:探讨拉贝洛尔治疗对妊娠高血压患者炎症因子和血液流变指标影响。方法:选择2015年9月—2016年9月本院接诊的100例妊娠高血压患者为研究对象,随机数字表法将患者分为对照组和观察组各50例。对照组采用硫酸镁治疗,观察组采用硫酸镁联合拉贝洛尔治疗。比较两组治疗前后炎症因子和血液流变指标变化及妊娠结局。结果:治疗前,两组患者炎症因子和血流变学指标水平未见差异(P0.05)。治疗后,两组患者炎症因子高迁移率族蛋白1、同型半胱氨酸、血清胱抑素、血液流变学指标全血粘度、血浆粘度和红细胞压积水平均明显降低,且观察组均低于对照组(均P0.05),观察组自然顺产率(70.0%)高于对照组,剖宫产发生率(16.0%)、产后出血率(6.0%)及产后并发症发生率(8.0%)低于对照组(P0.05)。结论:拉贝洛尔联合硫酸镁治疗可明显缓解妊娠高血压患者炎症应激,改善血流动力学指标和妊娠结局。     

Management of pregnancy and childbirth in England and Wales and in France

This paper reviews national data on obstetric and neonatal practices in England and Wales, and in France between 1970 and 1980. The data have been derived from national statistics and surveys on national samples of births in 1970, 1975 and 1980 in England and Wales, and 1972, 1976 and 1981 in France. The analysis shows that there was no major difference in pregnancy outcome, but wide variations in medical practices, and their trend over time. The main differences were: in England and Wales a higher number of antenatal visits, a higher percentage of inpatient admissions during pregnancy, a higher rate of induction, more episiotomies, a higher rate of resuscitation at birth, and admission to neonatal special care units; in France, a higher rate of caesarean sections before and during labour, some evidence of a more active management of labour, and a longer hospital post-natal stay. These differences in practice reflect differences in objectives and assessment of the effectiveness of care between the two countries: they point out the need for better monitoring and evaluation of obstetric and neonatal practices.     

2011年温州城乡九所中小学生超重肥胖患病状况调查

【目的】 调查温州城乡中小学生超重肥胖的患病状况。 【方法】 2011年5-8月随机抽取温州城区、城乡结合部及农村中小学共9所学校进行整群调查。记录学生的一般资料,同时测量身高体重两项发育指标,计算体质指数,按照2004年中国肥胖问题工作组(WGOC)推荐的诊断标准,评价温州市中小学生的超重及肥胖患病状况。 【结果】 共9 657名在校学生参与调查,其中男生5 114 名,女生4 543名,平均年龄(14.95±4.53)岁,被调查人群中超重占7.6%,肥胖占2.6%,男生超重和肥胖患病状况均显著高于女生(9.8% vs 5.2%,5.2% vs 1.2%,P值均<0.01),各年龄段中以7岁儿童肥胖及超重状况最为严重(27.15% vs 7.955%),城区及城乡结合部超重肥胖患病状况明显高于农村(P值均<0.01)。 【结论】 温州中小学校肥胖和超重总患病约为10%,男性,尤其是城区及城乡结合部男生超重肥胖患病情况最为严重,需要引起高度重视。     

Efficacy of single and double doses of albendazole and mebendazole alone and in combination in the treatment of Trichuris trichiura in school-age children in Uganda

A randomised clinical trial was conducted in Kabale District, southwestern Uganda, to compare the efficacies of single and double doses of a combination of 400 mg albendazole (ALB) and 500 mg mebendazole (MBZ) with those of single and double doses of each drug given alone in the treatment of Trichuris trichiura. Infected pupils (n = 611) were randomised to six treatment groups. Three groups received either a single dose of ALB, MBZ or the combination (ALB+MBZ). The other three groups received either a double dose of ALB (ALB/ALB), MBZ (MBZ/MBZ) or the combination (ALB+MBZ/ALB+MBZ). All double doses were given 8 h apart. Children were followed-up weekly for 1 month. Cure rates were significantly higher using double doses compared with single doses (irrespective of drug; z = −4.02, P < 0.0005) as well as using the drug combination compared with single drugs (irrespective of doses; z = −7.64, P < 0.0005). Cure rates measured at Day 7 were significantly higher than on Days 14 and 21 after treatment (Day 14, z = 9.90, P < 0.0005; Day 21, z = 7.36, P < 0.0005). Geometric mean (GM) intensities of positives were significantly lower on Day 7 compared with all other subsequent days (P < 0.00005), and on Day 28 GM intensities reached pre-treatment levels (P = 0.096). Whilst there was no difference in egg excretion between single and double doses of the same drug or drug combination (F_(df1) = 0.28, P = 0.60), the combination treatment resulted in lower egg excretion than use of single drugs (F_(df2) = 50.90, P < 0.00005). All the tested regimens of ALB and MBZ had low cure rates against T. trichiura in Uganda, but both combination treatments showed satisfactory egg reduction rates 3 weeks after treatment. [ClinicalTrials.gov identifier: NCT01050452]     

儿童铁和锌缺乏与营养素补充

营养性铁和锌缺乏症是严重影响儿童健康的常见营养素缺乏问题,在发展中国家是导致疾病负担加重和高死亡率的重要因素.铁和锌缺乏症每年引起约数万名5岁以下儿童死亡.婴幼儿是铁和锌缺乏的高危人群,摄入不足是造成铁和锌缺乏的主要原因.6～24个月婴幼儿的铁缺乏可对其智力发育产生不可逆的损害;锌缺乏是引起2岁以下幼儿生长发育迟缓的主要原因之一.补充微量营养素以及应用微量营养素强化食品可减少儿童铁和锌缺乏的发生,并具有较高的成本效益,应作为优先推荐的干预措施.该文就铁和锌缺乏的危害和干预研究进展作以综述.     

Dissipation and Residues of Difenoconazole and Azoxystrobin in Bananas and Soil in Two Agro-Climatic Zones of China

Residues of a fungicide suspension (12 % difenoconazole, 18 % azoxystrobin) in bananas and soil were studied under tropical and subtropical monsoon climates, in Hainan and Yunnan provinces, respectively. The half-lives in bananas were shorter in Hainan (difenoconazole: 8.4–10.7 days; azoxystrobin: 7.8–8.4 days) than Yunnan (difenoconazole: 11.3–13.0 days; azoxystrobin: 10.4–11.6 days), possibly because of the higher temperatures and solar radiation levels in Hainan. The half-lives in soil were shorter in Yunnan (difenoconazole: 15.5–16.7; azoxystrobin: 11.9–13.9 days) than Hainan (difenoconazole: 23.1–23.2 days; azoxystrobin: 16.0–16.1 days), possibly because the organic carbon content was higher and rainfall lower in Yunnan than Hainan. Their physico-chemical properties suggest difenoconazole and azoxystrobin should be stable in bananas and soil, but both decreased to safe concentrations by the minimum harvest time after spraying the mixture at the recommended dosage and 1.5 times that dosage, through physical, chemical, and biological processes.     

Concentrations of tetrachloroethene in blood and trichloroacetic acid in urine in workers and neighbours of dry-cleaning shops

Summary Tetrachloroethene concentrations in blood and trichloroacetic acid concentrations in urine were determined — primarily over the course of a week — for 29 persons living in the vicinity of dry-cleaning shops. The mean levels of tetrachloroethene increased during the week. In some neighbours concentrations were exceeding the German biological threshold limit value for tetrachloroethene (1000 g/l blood), persisting over the whole week in one case. The concentrations of tetrachloroethene in blood depended on the floor and the construction type of the building where these people were living, but not of the type of system used in the dry-cleaning shops. 5 of 12 drycleaners were found to have tetrachloroethene levels exceeding the German biological threshold limit value, some of them by a considerable amount.     

Toxicity and uptake of TRI- and dibutyltin in Daphnia magna in the absence and presence of nano-charcoal

Butyltins (BTs), such as tributyltin (TBT) and dibutyltin (DBT), are toxic to aquatic organisms, but the presence of the strong adsorbent, black carbon (BC), can markedly influence BT toxicity and uptake in organisms. In the present study, the acute toxicity and uptake of TBT and DBT in the crustacean, Daphnia magna, were investigated with and without addition of nano-charcoal at different pHs and water hardnesses. The results showed that the toxicity of TBT and DBT increased by lowering the pH from 8 to 6. This reflects a relatively higher toxicity of cationic BT species than of the neutral species. At pH 6, by enhancing the water hardness of the media from 0.6 to 2.5?mM, the toxicity of TBT and DBT consistently decreased due to competitive binding of bivalent cations (Mg2?, Ca2?) to biotic ligands of D. magna. Furthermore, the toxicity of TBT to D. magna significantly decreased in the presence of nano-charcoal compared with experiments without nano-charcoal at pH 6 and 8, while no significant decrease in toxicity of DBT was observed in the presence of nano-charcoal. This can be attributed to the insignificant decrease of free DBT concentration in the presence of nano-charcoal compared with that for TBT. Conversely, it was observed that more TBT and DBT were taken up in D. magna in the presence of nano-charcoal due to the uptake of TBT or DBT associated with nano-charcoal by Daphnia in gut systems, as seen by light microscopy. This indicated that only free nonadsorbed BTs were toxic to D. magna, at least during short periods of exposure.     

Relationships between distribution of lead in erythrocytes in vivo and in vitro and inhibition of ALA-D.

Proteins in the ALA-D (delta-aminolaevulinic acid dehydratase) fraction from gel filtration of erythrocyte supernatant (ES) have the highest affinity for lead among erythrocyte constituents in vivo and in vitro. It takes 20-40 hours for erythrocyte components to be equilibrated with lead added in vitro. AT low lead concentrations, under 60 micrograms/100 ml ES, the extent of decrease in ALA-D activity indicates the extent of lead saturation of ALA-D fraction proteins. The saturation is attained at 80-110 micrograms/100 ml ES. Although an appreciable amount of lead is also found in the haemoglobin fraction that contains certain factors concerned in ALA-D inhibition, lead responsible for inducing the inhibition is not bound to haemoglobin fraction proteins but to ALA-D fraction proteins. Of three treatments or agents recovering the enzyme from lead effects, zinc is the only one that can fully restore the inhibition.