心脏瓣膜置换术后妊娠30例临床分析

目的 探讨心脏瓣膜置换术后妇女妊娠期抗凝治疗及分娩期的处理方案.方法 回顾性分析2004年7月至2010年7月收治的30例心脏瓣膜置换术后孕妇,观察妊娠期、分娩前后抗凝药物应用、分娩方式及妊娠结局.结果 2例心脏瓣膜置换时间超过10年的孕妇于中期妊娠因机械表功能障碍,瓣口血栓急诊再次行瓣膜置换术,1例孕期停抗凝药物孕晚期出现瓣膜血栓、心功能衰竭.孕妇合并妊娠期糖耐量异常2例,妊娠期高血压1例.中孕引产3例(10.00%),阴道分娩2例(6.67%),剖宫产25例(83.33%),无产后出血发生.围产儿结局:脑积水2例(6.67%),胎死宫内2例(6.67%).新生儿出生体重1.95~4.20kg,平均2.90±0.43kg.低出生体重儿3例(10.00%),巨大儿1例(占3.33%),新生儿轻度窒息3例(10.00%),无新生儿缺血缺氧性脑病,无新生儿颅内出血.结论 心脏瓣膜置换时间、妊娠期抗凝治疗影响妊娠结局,心脏瓣膜置换术妇女最好在术后2~3年妊娠,口服小剂量华法林简便易行,患者依从性好,胎儿畸形率低,并可有效地预防孕产妇瓣膜血栓栓塞的发生;分娩期以剖宫产为首选方式,术前及时停用抗凝药物、术后24小时恢复用药对产妇及新生儿是一种安全的处理方案.     

妊娠期糖尿病合并子痫前期的临床特征及对妊娠结局的影响效果分析

目的 探讨妊娠期糖尿病合并子痫前期的临床特征及对妊娠结局的影响效果分析。方法 将2016年6月-2021年6月在本院治疗的84例妊娠期糖尿病(GDM)合并子痫前期(PE)患者作为观察组,将同期84例单纯GDM患者作为对照组,均为单胎妊娠,分娩孕周≥32周,对比两组的临床资料、孕期血糖水平、妊娠结局。结果 观察组年龄、孕次、孕期增重与对照组相当(P>0.05),但观察组产次、孕前BMI高于对照组,分娩孕周、新生儿出生体重低于对照组(P<0.05);观察组孕期FPG、2hPG、HbAlc水平明显高于对照组(P<0.05);观察组剖宫产、早产、产后出血、新生儿转NICU、FGR发生率明显高于对照组,新生儿1min Apgar评分、5min Apgar评分明显低于对照组(P<0.05),两组胎膜早破、巨大儿发生率相当(P>0.05)。结论 GDM合并PE的病情严重,孕前BMI较高是重要危险因素,且对妊娠结局有不良影响,临床应加强孕前BMI干预和孕期血糖、血压监测,有助于降低GDM合并PE风险,在发病早期即采取针对性措施,有助于改善妊娠结局。     

妊娠合并垂体泌乳素腺瘤11例临床分析

目的:探讨垂体泌乳素腺瘤患者在妊娠期间的安全性及孕期治疗此病对妊娠结局的影响。方法:回顾性分析安徽医科大学第一附属医院1988～2008年间收治的11例妊娠合并垂体泌乳素腺瘤(垂体微腺瘤9例,大腺瘤2例)患者孕前、孕期、分娩及分娩后的母儿预后情况。结果:垂体腺瘤在孕期体积增大出现压迫症状2例(大腺瘤与微腺瘤各1例),妊娠并发子痫前期(轻度)1例,妊娠期糖耐量异常1例,妊娠期肝内胆汁淤积症3例,巨大儿1例,早产1例。分娩方式均为剖宫产。新生儿及随访未见异常。结论:垂体微腺瘤在孕期停药是相对安全的,而腺瘤孕期发生体积增大的风险性较高。垂体泌乳素腺瘤并不增加妊娠的并发症,亦未发现新生儿出生缺陷。     

12例双胎妊娠中孕期选择性减胎治疗临床分析

探讨双胎妊娠中孕期选择性减胎治疗的安全性、有效性及其影响因素。12例双胎妊娠患者因在中孕期发现其中一个胎儿存在结构或染色体异常而行选择性减胎治疗。回顾性分析12例患者选择性减胎手术情况、术后妊娠期并发症、产科结局及新生儿情况。12例患者均在中孕期成功减胎。其中4例足月分娩,3例早产,1例晚期流产、胎儿存活,1例流产,3例持续妊娠中;8例已分娩患者(剖宫产3例,阴道分娩5例)平均分娩孕周为34+1周,新生儿平均出生体质量(2 290.00±963.52)g,新生儿平均出生身长(44.88±6.01)cm,8例出生新生儿均未见缺陷。中孕期选择性减胎术对异常胎儿与正常胎儿并存的双胎妊娠是一种安全的治疗手段,可以有效地降低母胎并发症、防止先天性缺陷儿出生。     

孕期抗菌药物对孕妇妊娠结局影响分析

目的研究孕期抗菌药物使用对妊娠期感染性疾病患者的分娩结局影响,为临床孕期抗菌药物治疗提供指导。方法回顾性分析医院2013年1月-2015年4月收治的妊娠期合并感染性疾病患者161例,根据患者孕中是否使用抗菌药物分为使用组(72例)和未使用组(89例),另选门诊接受健康体检的正常孕妇80例为对照组,统计所有患者感染类型和使用组抗菌药物种类,采用SPSS19.0软件对3组孕妇妊娠结局、不良妊娠种类及新生儿发育指标进行统计分析,采用多因素logistic回归分析不良妊娠因素。结果使用组患者第三代头孢菌素类抗菌药物使用率明显高于其他种类抗菌药物(P<0.05),未使用组的不良妊娠发生率(53.93%)明显高于使用组(26.39%)(P<0.05),使用组和对照组胎儿在双顶径、股骨长度、出生胎龄及出生体质量均明显优于未使用组(P<0.01);多因素logistic分析结果显示,感染与不良妊娠发生存在明显相关性(P=0.003,95%CI:0.035~0.631)。结论妊娠期合并感染性疾病可明显增加孕妇不良妊娠发生率,严重危害母婴健康,同时合理使用抗菌药物治疗可有效预防不良妊娠的发生,改善新生儿生长发育。     

母亲孕前体重指数和孕期增重对母婴预后的影响

目的探讨孕前体重指数(BMI)和孕期增重与新生儿出生体重及妊娠结局的关系,为降低高危妊娠和巨大儿发生率及难产发生率提供依据。方法以BMI为标准分为低体重组、正常体重组和肥胖组,分析孕妇体重过度增重、巨大儿发生率、难产发生率以及体重指数与新生儿体重、分娩方式和孕期并发症的关系。结果3组间新生儿出生体重有明显差异,巨大儿发生率分别为5.00%、6.10%和11.96%,有统计学意义(P0.05)。孕期体重增重过重与新生儿体重成正相关(P0.05);肥胖组妊娠期糖尿病发病率明显增多,是正常组的3倍,且妊高征发病率明显增高。3组分娩方式、难产(剖宫产和产钳助产)的发生率比较,有非常显著性差异。结论肥胖组的巨大儿、妊娠期糖尿病和妊高征的发生率都高于正常体重组和低体重组,孕前BMI和孕妇体重过度增长与新生儿出生体重和妊娠结局有关。     

孕前体质指数对妊娠并发症和妊娠结局的影响

目的:探讨孕妇孕前体质指数(BMI)与妊娠期并发症、妊娠结局的关系。方法:以江西省贵溪市人民医院2010年8月～2011年10月住院分娩的单胎初产、足月妊娠妇女1 200例为对象,收集其围产保健、妊娠并发症和妊娠结局资料,参照中国肥胖问题工作小组标准将对象分为消瘦组(A组)、正常组(B组)、超重组(C组),分析孕前BMI与妊娠期高血压、糖尿病、贫血等妊娠并发症以及与新生儿出生体重、分娩方式、产后出血、新生儿窒息等不良妊娠结局的关系。结果:A、B、C组新生儿出生体重差异有统计学意义(P<0.01),产后出血、新生儿窒息发生率组间差异无统计学意义(P>0.05);孕前低BMI组孕晚期贫血率达到37.96%,低体重儿发生率达到5.55%,均显著高于其余两组(P<0.05);孕期超重组妊娠期高血压发生率7.52%,妊娠期糖尿病发病率为2.86%,巨大儿出生率为29.17%,剖宫产率44.80%,高于其余两组(P<0.05)。结论:孕前BMI影响妊娠期并发症及出生体重、分娩方式等,即使在中小城市问题亦比较严重,如何进行健康教育对促进母婴安全和健康有重要意义。     

70例重度妊娠期高血压疾病患者终止妊娠时机对围生儿结局影响的临床分析

目的:探讨重度妊娠期高血压疾病患者终止妊娠的时机和方式对母儿的影响。方法:对辽源市卫生学校附属医院收治的70例重度妊娠期高血压疾病患者资料进行回顾性分析,观察新生儿的窒息率和死亡率。结果:所有患者经及时终止妊娠,选择适当的分娩方式,患者全部存活。剖宫产率为84.29%,新生儿的窒息率为27.14%,围生儿死亡率为10.00%。≤32周分娩的新生儿窒息、围生儿死亡率明显升高(P0.01),33～36周与≥37周无显著性差异(P0.05)。结论:重度妊娠期高血压疾病患者如病情需要,在促胎肺成熟治疗后可于孕32周终止妊娠,终止妊娠方式首选剖宫产。     

12例双胎妊娠中孕期选择性减胎治疗临床分析

探讨双胎妊娠中孕期选择性减胎治疗的安全性、有效性及其影响因素。12例双胎妊娠患者因在中孕期发现其中一个胎儿存在结构或染色体异常而行选择性减胎治疗。回顾性分析12例患者选择性减胎手术情况、术后妊娠期并发症、产科结局及新生儿情况。12例患者均在中孕期成功减胎。其中4例足月分娩，3例早产，1例晚期流产、胎儿存活，1例流产，3例持续妊娠中；8例已分娩患者（剖宫产3例，阴道分娩5例）平均分娩孕周为34+1周，新生儿平均出生体质量（2 290.00±963.52）g，新生儿平均出生身长（44.88±6.01）cm，8例出生新生儿均未见缺陷。中孕期选择性减胎术对异常胎儿与正常胎儿并存的双胎妊娠是一种安全的治疗手段，可以有效地降低母胎并发症、防止先天性缺陷儿出生。     

心脏瓣膜置换术后妊娠期抗凝治疗效果分析

目的 探讨心脏瓣膜置换术后孕妇适合的抗凝方案以及华法林对妊娠和分娩过程的影响.方法 回顾性分析经治的22例心脏瓣膜置换术后妊娠患者的临床表现、处理及结局.心脏机械瓣膜置换术后均采用口服华法林抗凝.其中12例(组1,华法林组)妊娠期继续口服低剂量(<5mg/d)华法林抗凝治疗,10例(组2,低分子肝素组)孕妇确诊早孕后即用低分子肝素皮下注射,至孕12周后恢复华法林口服抗凝治疗,至分娩前2周改用低分子肝素皮下注射剂,比较两组的妊娠结局.结果 22例心脏瓣膜置换术后妊娠患者经过合理抗凝,适时剖宫产分娩,无胎儿畸形发生.组1母体并发症2例(16.67%),与组2的1例(10.00%)比较无显著性差异(直接概率P=0.43).组1围产儿并发症2例(16.67%),与组2(0例)比较无显著性差异(直接概率P=0.29).两组新生儿出生体重比较有显著性差异(t=1.50,P<0.05).结论 妊娠期间口服华法林能有效防止血栓形成,未增加胎儿畸形等围产不良结局发生的风险.     

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.