Effects of chromosomal abnormalities on pregnancy outcomes in female undergoing artificial insemination with donor's sperm

This study aimed to evaluate the clinical characteristics, pregnancy outcomes and prognostic factors for pregnancy of female with chromosomal abnormalities (CAs) after artificial insemination with donor''s sperm (AID) treatment.A retrospective case–control study was analyzed by using the data of 29 female patients with CA and 116 controlled patients with normal karyotype (1:4 ratio) who underwent AID cycles at Guangdong Family Planning Special Hospital from January 2011 to December 2017. In all cases, reproductive histories were collected, and the cytogenetic analysis was performed by Trypsin-Giemsa banding and karyotyping. The embryos were fertilized via intracervical or intrauterine insemination. Clinical characteristic variables were compared.The prevalence of CA was found to be 0.29% in the whole AID population. The live birth rates of CA group and controlled group were 41.4% and 31.0% (P = .29) respectively. Compared to normal karyotype group, patients with CA showed higher rate of primary infertility (93.1% vs 75.9%, P = .049); Multivariate analysis demonstrated that ovarian stimulation (odds ratio, 3.055; 95% confidence interval, 1.421–6.568; P = .004) was associated with adverse pregnancy outcomes in female patients with AID treatment.For the infertility CA patients who were phenotypically normal, AID was a suitable choice, whereas ovarian stimulation results in an improvement in the pregnancy rate.     

精液处理前后精液参数对夫精人工授精妊娠结局的影响

目的：探讨精液处理前、后精液参数对以男性因素为主的宫腔内人工授精（ IUI）妊娠结局的影响。方法回顾性分析530个以男性因素为适应证在我中心接受IUI治疗的临床资料,按处理前、后的精子前向运动数和精子回收率进行分组,比较各组临床妊娠率。结果（1）根据处理前前向运动数分成三组：＜20×106/ml组、＞20～＜100×106/ml组和≥100×106/ml组,各组周期临床妊娠率分别为10.08％、12.79％和12.50％,各组妊娠率比较差异无统计学意义（P＞0.05）;（2）根据处理后前向运动数分成三组：＜10×106/ml组、＞10～＜20×106/ml组和≥20×106/ml组,各组周期临床妊娠率分别为8.42％、10.59％和12.57％,各组妊娠率比较差异无统计学意义（P＞0.05）;（3）根据处理后精子回收率分成两组：＜25％组和≥25％组,两组周期临床妊娠率分别为10.45％和12.76％,两组妊娠率比较差异无统计学意义（ P＞0.05）。结论 IUI的妊娠率随着精液处理前、后前向运动精子数和精子回收率的升高逐渐提高,但差异无统计学意义。     

Achieving pregnancy safely: perspectives on timed vaginal insemination among HIV-serodiscordant couples and health-care providers in Kisumu,Kenya

In female-positive HIV-serodiscordant couples desiring children, home timed vaginal insemination (TVI) of semen during the fertile period along with consistent condom use may reduce the risk of HIV transmission when the man is HIV-uninfected. In sub-Saharan Africa, up to 45% of HIV-infected women desire to have more children. HIV viral load assessment is not routinely available in low-resource countries for monitoring adherence and response to antiretroviral therapy. Therefore, in these settings, timed unprotected intercourse without assurance of HIV viral suppression may pose unnecessary risks. TVI, a simple and affordable intervention, can be considered an adjunct method and option of safer conception for HIV prevention with treatment of the HIV-infected partner and/or pre-exposure prophylaxis. We conducted five mixed and single-sex focus group discussions comprised of 33 HIV-serodiscordant couples and health-care providers in the Nyanza region of Kenya to assess the acceptability and feasibility of TVI as a safer method of conception. The transcribed data were analyzed using a grounded theory approach. We found that educating and counseling HIV-serodiscordant couples on TVI could make it an acceptable and feasible safer conception method when associated with frequent communication and home visits by health-care providers. The findings of this study indicate that implementation studies that integrate training and counseling of HIV-serodiscordant couples and health-care providers on TVI combined with consistent condom use are needed. Acknowledging and supporting the reproductive choice and needs of female positive, male negative HIV-serodiscordant couples who desire children should also include the use of assisted reproductive services at the same time as pharmaceutical options that prevent sexual HIV transmission.     

女性腰椎峰值骨量与骨骼大小的关系

目的　了解女性腰椎骨骼大小对峰值骨密度 (BMD)的影响。方法　采用QDR 450 0A型扇形束DXA骨密度仪 ,测量 52 7例年龄 2 5～ 3 9岁健康女性前后位 (正位AP)腰椎 1～ 4椎体和侧位 (Lat)腰椎 2～ 4椎体的投射骨面积 (BA)、骨矿含量 (BMC)和面积BMD(aBMD)及AP/Lat相伴扫描测量腰椎的体积BMD(vBMD)。用直线和多元线性回归分析骨量与BA、身高和体重之间的关系。按不同BA分组 ,了解各组之间骨量的差异。结果　BA与BMC(r =0 .79和 0 .78,均P <0 .0 1)和aBMD(r =0 .40和 0 .3 8,均P<0 .0 0 1)呈正相关 ,Lat BA与vBMD相关有显著意义 (r =0 .14 ,P <0 .0 1)。AP BA每变化 1个标准差 ,AP BMC和AP aBMD在平均值的基础上分别相应变化 13 .1%和 4.47% ;Lat BA每变化 1个标准差 ,Lat BMC、Lat aBMD和vBMD在平均值的基础上分别相应变化 13 .3 %、4.4%和 1.5% ;AP BA的全距变化所致AP BMC和AP aBMD的变化分别约为 78.6%和 2 6.8% ,Lat BA的全距变化所致Lat BMC、Lat aBMD和vBMD的变化分别约为 79.8%、2 6.3 %和 8.94%。不同BA组之间的身高、体重、BMC和aBMD均具有非常显著性意义 (均P <0 .0 0 1)。影响BA、BMC和Lat aBMD的主要因素为身高 ,影响AP aBMD的主要因素为体重。结论　BMC除以BA不能完全消除骨骼大小对aBMD的影响     

Relationship between plasma lipids and all-cause mortality in nondemented elderly

OBJECTIVES: To investigate the relationship between plasma lipids and risk of death from all causes in nondemented elderly. DESIGN: Prospective cohort study. SETTING: Community-based sample of Medicare recipients, aged 65 years and older, residing in northern Manhattan. PARTICIPANTS: Two thousand two hundred seventy-seven nondemented elderly, aged 65 to 98; 672 (29.5%) white/non-Hispanic, 699 (30.7%) black/non-Hispanic, 876 (38.5%) Hispanic, and 30 (1.3%) other. MEASUREMENTS: Anthropometric measures: fasting plasma total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and non-HDL-C, body mass index, and apolipoprotein E (APOE) genotype. clinical measures: neuropsychological, neurological, medical, and functional assessments; medical history of diabetes mellitus, heart disease, hypertension, stroke, and treatment with lipid-lowering drugs. Vital status measure: National Death Index date of death. Survival methods were used to examine the relationship between plasma lipids and subsequent mortality in younger and older nondemented elderly, adjusting for potential confounders. RESULTS: Nondemented elderly with levels of total cholesterol, non-HDL-C, and LDL-C in the lowest quartile were approximately twice as likely to die as those in the highest quartile (rate ratio (RR)=1.8, 95% confidence interval (CI)=1.3-2.4). These results did not vary when analyses were adjusted for body mass index, APOE genotype, diabetes mellitus, heart disease, hypertension, stroke, diagnosis of cancer, current smoking status, or demographic variables. The association between lipid levels and risk of death was attenuated when subjects with less than 1 year of follow-up were excluded (RR=1.4, 95% CI=1.0-2.1). The relationship between total cholesterol, non-HDL-C, HDL-C, and triglycerides and risk of death did not differ for older (>or=75) and younger participants (>75), whereas the relationship between LDL-C and risk of death was stronger in younger than older participants (RR=2.4, 95% CI=1.2-4.9 vs RR=1.6, 95% CI=1.02-2.6, respectively). Overall, women had higher mean lipid levels than men and lower mortality risk, but the risk of death was comparable for men and women with comparable low lipid levels. CONCLUSION: Low cholesterol level is a robust predictor of mortality in the nondemented elderly and may be a surrogate of frailty or subclinical disease. More research is needed to understand these associations.     

Relationship between size at birth and hypertension in a genetically homogeneous population of high birth weight

OBJECTIVE: To investigate the association between birth size and hypertension within a genetically homogeneous population of high birth weight. DESIGN: Cohort-study with retrospectively collected data on size at birth. SUBJECTS AND SETTING: The study included 4601 men and women born 1914-1935 in Reykjavik, Iceland, who participated in the Reykjavik Study of the Icelandic Heart Association. MAIN OUTCOME MEASURES: Birth size measurements, adult blood pressure (BP) and body mass index (BMI), and family history of hypertension. RESULTS: Birth weight was inversely related to hypertension in adulthood in women (P for trend < 0.001). The relationship was of borderline significance in men (P for trend = 0.051). A low ponderal index was significantly associated with high BP in women (P for trend = 0.025) but not men (P > 0.05). For women with an adult BMI > 26 kg/m2, the odds ratio for hypertension for those born weighing < 3.45 kg was 2.1 [95% confidence interval, 1.3-3.3, compared with women born weighing > 3.75 kg. The association was only significant in women without a family history of hypertension. CONCLUSIONS: An inverse association between size at birth and adult hypertension was seen in a population of greater birth size than has previously been investigated. The relation was strongest among women born small who were overweight in adulthood, and for those without a family history of hypertension. The results support the hypothesis that the association between birth weight and hypertension is not of genetic origin only. The large birth size of Icelanders might be protective and partly explain the lower mean systolic blood pressure in Iceland than in related nations.     

Relationship between pruritus and autotaxin in intrahepatic cholestasis of pregnancy

ObjectiveIntrahepatic cholestasis of pregnancy is a temporary, pregnancy-specific disease that resolves with delivery, characterized by itching (pruritus), as well as high transaminase and serum bile acid levels in the third trimester of pregnancy. Due to the effects of Autotaxin on the physiology of pregnancy, we aimed to investigate Autotaxin activity in patients with intrahepatic cholestasis of pregnancy.Patients and methodsSixty-nine patients diagnosed with intrahepatic cholestasis of pregnancy and 20 healthy pregnant women were enrolled in the study. Fasting serum bile acid, pruritus intensity, serum parameters, gestational week of the patients at the time of diagnosis were recorded, and birth week and birth weight were monitored. Autotaxin serum level was measured enzymatically.ResultsThe mean serum bile acid level (n = 69; 38.74 ± 35.92 μmol/L) in patients with intrahepatic cholestasis of pregnancy (n = 69) was detected to be higher than healthy pregnant women (n = 20; 5.05 ± 1.88 μmol/L) (p < 0.001). Weak correlation was detected between serum bile acid level and itch intensity (p = 0.014, r = 0.295), while no relation was detected between Autotaxin and itch intensity (p = 0.446, r = 0.09). Although mean Autotaxin (intrahepatic cholestasis of pregnancy: 678.10 ± 424.42 pg/mL, control: 535.16 ± 256.47 pg/mL) levels were high in patients with intrahepatic cholestasis of pregnancy, it was not statistically significant (p = 0.157).ConclusionIn our study, we observed that the serum Autotaxin level did not make a significant difference in patients with intrahepatic cholestasis of pregnancy compared to healthy pregnant women. These findings suggest that larger clinical studies are required to reveal the physio-pathological effects of Autotaxin on pregnancy.     

Relationship between basal metabolic rate and cortisol secretion throughout pregnancy

The role of cortisol in mediating basal metabolic rate (BMR) changes that accompany the adjustment of maternal body weight (BW) and body composition during pregnancy is unknown. We tested whether increase in BMR during pregnancy is explained by variations in cortisol secretion. Longitudinal changes in BW, fat mass (FM), fat-free mass (FFM), BMR, hormonal, and metabolic parameters in 31 parous Caucasian women at gestational weeks 12, 26, and 36 were examined. Individual differences (Δ) between the last and the first measurement occasions for each variable were calculated. By gestational week 36, BW and BMR increased while both FFM/FM and BMR/BW ratio decreased (P < 0.001 for all) suggesting higher proportion of FM accretion. Cortisol, leptin, and insulin-like growth factor-1 (IGF-1) concentration rose, whereas non-placental growth hormone (GH) and thyroid hormones declined (P < 0.001 for all). Insulin resistance changed; basal glucose (P < 0.001) and ghrelin (P < 0.014) declined, whereas insulin (P < 0.001), homeostatic model index (HOMA-IR) (P = 0.041), and free fatty acid (FFA) concentration (P = 0.007) increased. The elevation in BMR showed inverse correlations with ΔBW (r = 0.37, P = 0.047) and Δcortisol (r = −0.53, P = 0.004). Significant portion (51.6%) of the variation in BMR change was explained by increases of cortisol (27.1%), FFA (13.4%), and free triiodothyronine (11.1%). In conclusion, the changes in maternal cortisol concentration are in relationship with changes in BMR and BW, further suggesting that increased cortisol secretion during pregnancy could be linked with the maintenance of maternal BW and body composition.     

Relationship between electrocardiographically and enzymatically estimated size in anterior myocardial infarction

In 179 patients with anterior myocardial infarction the electrocardiographically estimated infarct size was related to serum enzyme activity. A precordial map containing 24 precordial positions and the peak activity of heat stable dehydrogenase (LD; EC 1.1.1.27) were used. A positive correlation was found between the area at risk (initial sum of ST-elevation) and the peak LD activity (r = 0.48 - 0.55; p less than 0.001). When the final Q-and R-wave amplitude were related to peak enzyme activity a better correlation was observed (r = 0.56 - 0.68; p less than 0.001). The sum of R-waves (sigma R) and the sum of Q-waves (sigma Q) in the 24 precordial leads were related to sigma R and sigma Q in five precordial standard leads. A good correlation was found between the two ECG methods (r = 0.75 - 0.83; p less than 0.001), indicating that an increased number of precordial leads gives information regarding the extent of infarction similar to that obtained with the routinely used standard leads. It is concluded that in the individual patient, serum enzyme activity and the final Q-and R-wave changes can give different information about infarct size. If, however, these two independent methods are used in a large number of patients in intervention studies they will probably give similar information about relative influence of the intervention on the mean infarct size.     

促红细胞生成素及血红蛋白与老年慢性心力衰竭患者的相关性

目的探讨促红细胞生成素(EPO)和血红蛋白(Hb)与慢性心力衰竭(CHF)的相关性。方法选择老年CHF患者1 69例,根据本次住院确诊的心功能(NYHA)Ⅰ、Ⅱ、Ⅲ和Ⅳ级依次分为1组33例、2组34例、3组59例和4组4 3例。对4组患者Hb、EPO及是否死亡进行logistic回归分析。结果与1组比较,2、3和4组lg EPO水平明显上升,Hb水平明显下降(P<0.01);4组患者lg EPO和Hb水平两两比较,差异均有统计学意义(P<0.01)。Hb、EPO及肌酐(OR=0.978,35.820,1.013,P<0.01)均是影响老年CHF患者住院死亡的危险因素。结论 EPO随患者CHF程度的加重而升高,Hb值则降低。Hb、EPO及肌酐均为影响CHF患者住院死亡的危险因素。     

Relationship between blood glucose level and mortality in Type 2 diabetes mellitus: a systematic review

Aim To review the relationship between blood glucose level and mortality in patients with Type 2 diabetes mellitus (DM) as reported in the literature. Methods Literature search using Medline Search: January 1966 – April 1998. Keywords: Diabetes, Non Insulin Dependent, Mortality. Inclusion criteria for papers were: Type 2 DM; follow-up for at least 3 years; glucose or glycated haemoglobin (HbA_1c) was used as parameter; published in the form of an article. Additionally all references in the selected articles that dealt with the relationship between blood glucose level and mortality in Type 2 DM were included in the search. Results Twenty-seven eligible articles were found. Twenty-three of them showed a positive association: measures of elevated blood glucose concentrations were associated with higher mortality; in 15 out of 23 studies the positive association was statistically significant, in two only for postprandial blood glucose. One study found a nonsignificant negative relationship in a very old population. Conclusion In the literature there is a positive, but rather weak, association between the measures of blood glucose control and the risk of dying of patients with Type 2 DM. In the six larger studies (more than 100 deceased patients) that used a continuous categorization of glycaemia, the Risk ratio per unit varies from 1.03 to 1.12. Diabet. Med. 16, 2–13 (1999)     

Relationship between coronary collateral growth in the dog and ischemic bed size

Summary Two models of gradual coronary occlusion (Ameroid method) were compared in this study: 3 months circumflex and 3 months right coronary occlusion. Following coronary occlusion, the collaterals developed in intact, normally active dogs. The collateral flows were assessed in an isolated heart preparation. The results indicated a pattern for collateral development. Collateral flow was directed primarily toward the left heart with circumflex occlusion, and toward the right heart with right occlusion. Although dominant collateralization was via epicardial collaterals, intramyocardial septal collaterals strongly participated in growth development of both models. Collateral growth to the circumflex with circumflex occlusion was 6.54 fold greater than collateral growth to the right coronary artery with right occlusion. The data suggest a relationship between collateral growth and ischemic bed size.This work was supported by the American Heart Association, and by USPHS grant HL-24323.     

Relationship between electrocardiographically estimated infarct size and morbidity during a two-year follow-up

In 587 patients with a first myocardial infarction (MI) the electrocardiographically (ECG) estimated infarct size was related to morbidity during a two-year follow-up. Patients with transmural MI (Q- or R-wave changes in standard ECG) were more often treated for heart failure and returned to work less frequently than patients with subendocardial MI (ST-T-wave changes only). There were trends indicating a higher reinfarction rate in patients with subendocardial MI, whereas angina pectoris was observed as frequently in both groups. In a subset of patients with anterior MI, infarct size was estimated from the total Q- and R-wave amplitude in 24 precordial leads 4 days after arrival in hospital. A positive relationship was observed between ECG-estimated infarct size and treatment for heart failure, and patients with smaller infarctions according to ECG criteria returned to work less frequently. A higher reinfarction rate was observed in patients with smaller infarctions. In patients with inferior MI there were mostly weaker correlations between ECG-estimated infarct size (Q- and R-wave changes in leads II, III, and a VF) and morbidity during the two-year follow-up.     

超速起搏预适应的延迟保护作用与血红素氧合酶-1的关系

目的：探讨超速心室起搏（VOP）预适应的延迟保护作用与心肌血红素氧合酶-1（HO—1）表达的关系。方法：健康的新西兰兔24只,按数字表法随机均分为（1）：对照组（单纯结扎组）：将电极送至右心室旷置70min;（2）起搏组：以500次／min起搏右心室10min×4次;（3）起搏＋放线菌素D组：予静脉注射放线菌素D0．1mg／kg后按起搏组方法起搏右心室。24h后所有实验动物开胸结扎冠脉前降支造成缺血再灌注模型,缺血再灌注前后检测肌酸激酶（CK）和肌酸激酶同工酶（CK—MB）,动态描记再灌注时心电图;免疫组织化染色检测心肌组织H0—1表达。结果：（1）缺血再灌注后,与单纯结扎组比较,起搏组在再灌注不同时相CK[60min：（3723±735）IU／L比（2163±602）IU／L]和CK—MB[60min：（1709±163）IU／L比（904±149）IU／L]水平均显著降低（P〈0.01）;起搏＋放线菌素D组介于起搏组与单纯结扎组之间（P〈0.01）;（2）单纯结扎组在再灌注过程中共有5只、62．5％）发生心律失常,起搏＋放线菌素D组有4只（50％）,而起搏组无心律失常发生。起搏组心律失常发生率显著低于单纯结扎组（0比62．5％,P〈0.05）;（3）起搏组HO-1的阳性表达的程度明显高于单纯结扎组和起搏＋放线菌素D组（P〈0.05,〈0．01）。结论：超速起搏预适应可以模拟缺血预适应,产生延迟保护作用,减少心肌组织的坏死和心律失常的发生,并伴有血红素氧合酶-1表达增加,其作用可能与心肌组织血红素氧合酶-1的表达增加有关。     

A型急性主动脉夹层患者入院时血小板计数与住院死亡率的相关性研究

目的：探讨A型急性主动脉夹层患者入院时血小板计数与住院死亡率的相关性。方法：连续入选2012-02至2013-05就诊于我院并经计算机断层扫描（CT）证实的A型急性主动脉夹层患者183例,男性126例（68.9%）。分组：①根据患者住院期间是否存活分为存活组（n=157）,死亡组（n=26）;②根据血小板计数五分位值将患者分五组,即血小板计数第1分位（≤119×109/L）组（Q1组,n=36）,血小板计数第2分位（120~149×109/L）组（Q2组,n=37）,血小板计数第3分位（150~173×109/L）组（Q3组,n=36）,血小板计数第4分位（174~228×109/L）组（Q4组,n=37）,血小板计数第5分位（>228×109/L）组（Q5组,n=37）;③按入院时血小板计数分为≤119×109/L组（n=36）和>119×109/L组（n=147）,再根据是否接受手术治疗将其分为≤119×109/L手术者（n=18）、≤119×109/L非手术者（n=18）和>119×109/L手术者（n=96）、>119×109/L非手术者（n=51）。采集患者入院时的基线资料及静脉血标本,检测血小板计数、白细胞、D-二聚体等值。主要终点事件为住院死亡率。结果：183例A型急性主动脉夹层患者总住院死亡率为14.3%。死亡组与存活组比较,血小板计数显著减少、血压较低、D-二聚体水平较高; Q1组患者死亡率（38.9%）显著高于Q2、Q3、Q4和Q5四组（10.8%、11.1%、8.1%和2.7%）,差异均有统计学意义（P<0.001）。Q5组较Q1组死亡风险增加（HR=11.2,95%CI 2.13~123.3,P=0.007）,在调整了年龄、性别等影响预后的因素后,血小板计数≤119×109/L无论在手术治疗进入Cox模型前（HR3.90,95%CI 1.67~9.09, P=0.002）还是进入模型后（HR2.67,95%CI 1.15~6.19,P=0.023）均增加住院死亡风险。结论：A型急性主动脉夹层患者入院时血小板计数≤119×109/L住院死亡率风险明显增加。即使接受手术治疗,血小板计数值较低的患者仍与住院死亡风险相关。     

Relationship between serum lactate dehydrogenase and mortality after cardiac arrest: A retrospective cohort study

Serum lactate dehydrogenase (LDH) has been identified as an independent risk factor for predicting all-cause mortality in patients with multiple diseases. However, the prognostic value of LDH levels in post-cardiac arrest patients remains uncertain. This study aimed to assess the association between LDH and mortality in intensive care unit (ICU) patients after cardiac arrest. This retrospective observational study is based on data from the Dryad Digital Repository, which included 374 consecutive adult patients after cardiac arrest. Patients were divided into 2 groups based on median LDH values. A multivariate Cox proportional hazards model was established to assess the independent relationship between LDH and ICU mortality. Cumulative mortality was compared using Kaplan–Meier curves. The cohort included 374 patients, of which 51.9% (194/374) died in the ICU. The overall death rate from cardiac arrest was significantly higher for patients with LDH ≥ 335 IU/L (59.6%) than for those with LDH < 335 IU/L (44.1%). In multiple Cox regression models, hazard ratios (HR) and corresponding 95% confidence intervals (CI) for logLDH and the 2 LDH groups were 1.72 (1.07, 2.78) and 1.42 (1.04, 1.93), respectively. Participants with LDH ≥ 335IU/L had a higher incidence of ICU mortality than LDH < 335 IU/L, as shown by the Kaplan–Meier curves (P = .0085). Subgroup analysis revealed that the association between LDH and ICU mortality was vitally stable, with all P interactions from different subgroups >.05. Serum LDH levels are positively associated with ICU mortality in patients after cardiac arrest, especially for patients with LDH ≥ 335 IU/L.     

中医体质分型与妊娠期肝内胆汁淤积症的关系

[目的]结合中医体质学说,探讨妊娠期肝内胆汁淤积（ICP）的孕妇体质类型的分布,以及体质与ICP病情严重程度的关系.[方法]以2011年5月～2013年5月在我院住院的34例ICP的孕产妇为观察组,30例正常孕妇为对照组,进行中医体质和ICP病情评估,整理数据并进行统计分析.[结果]观察组偏颇体质孕妇占73.53％（25/34）,显著高于对照组的43.33％（13/30）,差异有统计学意义（x2=6.025,P＜0.05）.观察组25例偏颇体质患者中以湿热质、痰湿质和血瘀质为最多见类型,分别占26.47％,26.47％和20.59％.其中血瘀质患者ICP病情严重程度明显重于湿热质患者,差异有统计学意义（x2 =6.349,P＜0.05）,也重于痰湿质患者,但差异无统计学意义（x2=3.654,P＞0.05）.[结论]偏颇体质孕妇较平和体质孕妇易发生ICP,尤其是湿热质、痰湿质和血瘀质体质孕妇,而且以血瘀质型孕妇ICP病情更重.     

Relationship between hospital volume and operative mortality for liver resection: Data from the Japanese Diagnosis Procedure Combination database

Aim: The present study aimed to conduct a nationwide investigation on the relationship between hospital volume and outcomes following liver resection in Japan. We also discuss health policy implications of the results. Methods: Using the Japanese Diagnosis Procedure Combination database, we identified 18 046 patients who underwent hepatic resection between July and December 2007–2009. Patients were subdivided into hospital‐volume quartiles: very low‐ (<18/year), low‐ (18–35), high‐ (36–70) and very high‐volume groups (>70). Multivariate logistic regression analysis for in‐hospital mortality within 30 days of surgery was performed to analyze adjusted effects of various factors. Results: Patients in the very high‐volume group had a higher Charlson Comorbidity Index (P < 0.001) than those in the very low‐volume group. Very low‐volume hospitals were significantly less likely to perform extended lobectomy than very high‐volume hospitals (5.4% vs 17.6%, P < 0.001). Crude in‐hospital mortality within 30 days of surgery was 1.1% (0.6%, 0.8%, 1.9% and 3.0% for limited resection, segmentectomy, lobectomy and extended lobectomy, respectively). With reference to the very low‐volume group, risk‐adjusted odds ratios (95% confidence intervals) of low‐, high‐ and very high‐volume groups for overall mortality were 0.70 (0.48–1.02; P = 0.060), 0.52 (0.34–0.81; P = 0.004) and 0.16 (0.09–0.30; P < 0.001), respectively. Conclusion: There is a linear trend between higher hospital volume and lower in‐hospital mortality of liver resection in Japan, particularly for lobectomy and extended lobectomy. Based on these results, regionalization of lobectomy and extended lobectomy in high‐volume centers could be effective for reducing postoperative mortality.