空气与纯氧复苏患儿12个月体格发育及智力发育的随访研究

目的:纵向了解空气与纯氧复苏患儿的生长发育情况,为临床选择复苏用氧提供依据。方法:选择2012年6月~2013年1月在台州市第一人民医院产科出生、胎龄≥37周、体重>2 500 g的60例窒息新生儿为研究对象,依据复苏时用氧浓度的不同将其分为纯氧复苏组和空气复苏组,每组各30例患儿。在新生儿出生3、6、9和12个月后分别进行电话追踪随访,观察患儿运动、神经及心理发育状况,并采用电话预约的方式在患儿12个月(±7天)时进行身高、体重、头围测量及智力发育测评。比较两组患儿的体格发育情况,运动、神经、心理发育标志完成时间及智力发育情况。结果:两组新生儿体格发育指标间比较,差异无统计学意义(P<0.05);两组患儿运动、神经、心理发育完成月份和智力发育情况比较,差异均无统计学意义(P>0.05)。结论:空气复苏是安全有效的,复苏效果与纯氧相似,且可避免纯氧复苏带来的长期效应。     

新式新生儿窒息复苏措施临床效果观察

目的及时迅速地缓解及解除新生儿缺氧状态,提高新生儿复苏成功率.方法随机选择2001年1月～2003年6月窒息新生儿168例,采用新式复苏措施,即用呼吸复苏气囊+脐静脉注射纳洛酮注射液0.4 mg进行复苏;同时随机选择2000年1～12月窒息新生儿55例,采用传统的复苏措施,即进行口对口人工呼吸,并同时脐静脉注射5%碳酸氢钠注射液5 ml.两组新生儿出生前均未行特殊处理,出生1分钟Apgar评分基本一致.结果观察组1分钟评分4.7±0.2,5分钟8.0±1.0,10分钟9.0±1.1;而对照组1分钟4.8±0.5,5分钟6.3±0.8,10分钟8.0±0.5,两组新生儿Apgar评分,5分钟及10分钟有显著性差异(P<0.01).且观察组新生儿皮肤颜色、哭声、呼吸、心跳、反射及肌张力均比对照组恢复快,效果明显.两组新生儿各项指标恢复时间有明显差异(P<0.05).结论新生儿呼吸复苏气囊+纳洛酮脐静脉注射能迅速改善新生儿缺氧,恢复自主呼吸,提高新生儿窒息复苏成功率,提高新生儿存活力,减少儿童智力障碍,提高人口素质.     

新生儿窒息复苏后的观察与护理

新生儿窒息是新生儿伤残和死亡的重要原因之一，国内发病率约5％-10％^[1]。因此，新生儿窒息复苏成功后，仅是闯过了第一关，因为窒息虽已解除，但它对各系统造成的损害依然存在。复苏后的观察与护理，对减少并发症的发生及降低病死率，提高治愈率具有重要意义，否则会使复苏前功尽弃。     

实施新生儿新法复苏的效果

出生窒息是新生儿主要死亡原因之一。为了降低新生儿窒息的病死率 ,我院自 1996年开始坚持实施ABCDE复苏方案 ,坚持产、儿科合作 ,新生儿科医师提前进分娩室、手术室 ,在新生儿出生窒息的急救工作中 ,取得较好的效果。1　资料与方法1.1　一般资料新法复苏组为 1997年 1月～ 1998年 12月本院出生活产新生儿 2 4 78例 ,阿氏评分≤ 7分 131例 ,其中 0～ 3分 15例 ,占 11.4 5 % ;对照组为 1995年 1～12月本院出生活产新生儿 782例 ,阿氏评分≤ 7分119例 ,其中 0～ 3分 19例 ,占 15 .97% ,为旧法复苏组。1.2　指征与方法1.2 .1　对所有高危因素…     

新生儿窒息112例复苏体会

目的 探讨新生儿窒息的复苏措施.方法 存在窒息的患儿生后及时进行复苏,采用ABCDE复苏方案,分为4个步骤:(1)基本步骤包括快速评估、初步复苏及评估;(2)人工呼吸包括面罩或气管插管正压人工呼吸;(3)胸外按压;(4)给予药物或扩容输液.严格遵循:评估→决策→措施→再评估→再决策→再措施程序,循环往复,直到完成复苏....     

新生儿窒息的复苏过程和体会

新生儿窒息是新生儿死亡的主要原因之一。为了降低新生儿的死亡率,我科采用以下方法对窒息儿36例进行复苏,取得了良好效果。现报告如下。 1 资料与方法 1.1 新生儿窒息诊断标准使用Apgar评分法。出生1min评为7分以下为新生儿窒息,4分～7分为轻度,0分～3分为重度。本组36例窒息儿4分～7分为30例,重度窒息6例。 1.2 复苏方法 (1)尽量吸净呼吸道的粘液,建立通畅的呼吸道。(2)建立呼吸、增加通气,保证供氧,行人工呼吸30次     

Reoxigenation after neonatal asphyxia with 21% or 100% oxygen in piglets

Birth asphyxia represents a serious problem worldwide, resulting in 1 million deaths and an equal number of neurologic sequelae annually. It is therefore important to develop new and better ways to treat asphyxia. In the present study we tested the effect of reoxygenation with room air or 100% oxygen following experimental pneumothorax induced asphyxia on blood oxidative stress indicators, early neurologic outcome and cerebral histopathology of newborn piglets. 26 animals were studied in three experimental groups: sham-operated (SHAM, n = 6), reoxygenation with room air after pneumothorax (RORA, n = 10) and reoxygenation with 100% oxygen after pneumothorax (RO100, n = 10). In RORA and RO100 asphyxia was induced under anesthesia with bilateral intrapleural room air insufflation. Gasping, bradyarrhythmia, arterial hypotension, hypoxemia, hypercarbia and severe combined acidosis occurred 62 +/- 6 (RORA) and 65 +/- 7 min (RO100) after the start of the experiments, when the pneumothorax was relieved and ten min of reoxygenation period was started with mechanical ventilation with room air (RORA) or 100% oxygen (RO100). Then the spontaneously breathing animals were followed on room air during the next three hours. Blood oxidative stress indicators--as oxidized and reduced glutathione, plasma hemoglobin and malondialdehyde concentrations--were also measured at different stages of the experiments and early neurologic examinations (neurological score: 20 = normal, 5 = brain dead) were performed at the end of the study. Then the brains were fixed and stained. In SHAM blood gases and acid/base status differed significantly from values measured in RORA and RO100. In RO100 PaO2 was significantly higher at 5 (13.8 +/- 1.8 kPa) and 10 min (13.2 +/- 2.0 kPa) than in RORA (8.7 +/- 0.9, 9.2 +/- 1.0 kPa), respectively. All the measures of oxidative stress indicators remained unchanged in the study groups (SHAM, RORA, RO100). Neurologic examination scores from SHAM were 18 +/- 0, from RORA 13.5 +/- 1.0 and from RO100 9.5 +/- 1.3 (significant differences between SHAM and RORA and RO100, significant difference between RORA and RO100). Cerebral histopathology showed marked damage with similar severity in both asphyxiated groups. We conclude that blood oxidative stress indicators and cerebral histopathology did not differ significantly after 10 min reoxygenation either with room air or with 100% oxygen following pneumothorax induced asphyxia, but reoxygenation with 100% oxygen might impair the early neurologic outcome of newborn pigs.     

太原市某焦炉厂焦炉作业工人血清rasP21蛋白表达的5年随访研究

[目的]探讨rasP21蛋白在焦炉工血清中随接触时间的表达变化,以期用于焦炉工肺癌的早期筛选。[方法]2004~2008年对某煤气化公司焦化厂25名焦炉工连续进行血清rasP21蛋白检测,并与16名同集团公司的不接触职业性致癌物的库房管理人进行比较。[结果]2004~2008年血清P21水平,16名对照者有逐年增高的趋势(P<0.05),25名焦炉工均保持在较高水平(P>0.05);各年接触组均高于对照组(P<0.01或<0.05)。广义估计方程分析结果,分组、观察时间、起始年龄、饮茶(保护因素)与血清P21蛋白水平有统计学意义(P<0.01)。[结论]焦炉工血清P21高于对照组,随着时间的延长2组P21水平均越高,喝茶者血清P21水平较低。     

Vascular Outcomes in Patients With Screen-Detected or Clinically Diagnosed Type 2 Diabetes: Diabscreen Study Follow-up

PURPOSE

Screening guidelines for type 2 diabetes recommend targeting high-risk individuals. Our objective was to assess whether diagnosis of type 2 diabetes based on opportunistic targeted screening results in lower vascular event rates compared with diagnosis on the basis of clinical signs or symptoms.

METHODS

In a prospective, nonrandomized, observational study, we enrolled patients aged 45 to 75 years from 10 family practices in the Netherlands with a new diagnosis of type 2 diabetes, detected either by (1) opportunistic targeted screening (n = 359) or (2) clinical signs or symptoms (n = 206). Patients in both groups received the same guideline-concordant diabetes care. The main group outcome measure was a composite of death from cardiovascular disease (CVD), nonfatal myocardial infarction, and nonfatal stroke.

RESULTS

Baseline vascular disease was more prevalent in the opportunistic targeted screening group, mainly ischemic heart disease (12.3% vs 3.9%, P = .001) and nephropathy (16.9% vs 7.1%, P = .002). After a mean follow-up of 7.7 years (SD = 2.4 years) and 7.1 years (SD = 2.7 years) for the opportunistic targeted screening and clinical diagnosis groups, respectively, composite primary event rates did not differ significantly between the 2 groups (9.5% vs 10.2%, P = .78; adjusted hazard ratio 0.67, 95% confidence interval, 0.36–1.25; P = .21). There were also no significant differences in the separate event rates of deaths from CVD, nonfatal myocardial infarction, and nonfatal strokes.

CONCLUSIONS

Opportunistic targeted screening for type 2 diabetes detected patients with higher CVD morbidity at baseline when compared with clinical diagnosis but showed similar CVD mortality and major CVD morbidity after 7.7 years. Opportunistic targeted screening and guided care appears to improve vascular outcomes in type 2 diabetes in primary care.     

A Pilot Study Comparing the Effects of Consuming 100% Orange Juice or Sucrose-Sweetened Beverage on Risk Factors for Cardiometabolic Disease in Women

Overconsumption of sugar-sweetened beverages increases risk factors associated with cardiometabolic disease, in part due to hepatic fructose overload. However, it is not clear whether consumption of beverages containing fructose as naturally occurring sugar produces equivalent metabolic dysregulation as beverages containing added sugars. We compared the effects of consuming naturally-sweetened orange juice (OJ) or sucrose-sweetened beverages (sucrose-SB) for two weeks on risk factors for cardiometabolic disease. Healthy, overweight women (n = 20) were assigned to consume either 3 servings of 100% orange juice or sucrose-SB/day. We conducted 16-hour serial blood collections and 3-h oral glucose tolerance tests during a 30-h inpatient visit at baseline and after the 2-week diet intervention. The 16-h area under the curve (AUC) for uric acid increased in subjects consuming sucrose-SB compared with subjects consuming OJ. Unlike sucrose-SB, OJ did not significantly increase fasting or postprandial lipoproteins. Consumption of both beverages resulted in reductions in the Matsuda insulin sensitivity index (OJ: −0.40 ± 0.18, p = 0.04 within group; sucrose-SB: −1.0 ± 0.38, p = 0.006 within group; p = 0.53 between groups). Findings from this pilot study suggest that consumption of OJ at levels above the current dietary guidelines for sugar intake does not increase plasma uric acid concentrations compared with sucrose-SB, but appears to lead to comparable decreases of insulin sensitivity.     

The Leicestershire Perinatal Mortality Study: a case study of multi-group discriminant analysis with complex sampling

Case-control studies are usually analysed by two-group discriminant analysis or by a related method. However, in case-control studies of perinatal mortality the cases (perinatal deaths) are far from homogeneous, and it is likely that some risk factors are relevant only to certain subgroups of cases. This paper proposes a seven-category classification of perinatal deaths and reports an analysis using multi-group discriminant analysis. The problem is further complicated by non-random sampling of controls.     

Associations of Serum Ferritin and Transferrin % Saturation With All-cause,Cancer, and Cardiovascular Disease Mortality: Third National Health and Nutrition Examination Survey Follow-up Study

Objectives

Even though experimental studies have suggested that iron can be involved in generating oxidative stress, epidemiologic studies on the association of markers of body iron stores with cardiovascular disease or cancer remain controversial. This study was performed to examine the association of serum ferritin and transferrin saturation (%TS) with all-cause, cancer, and cardiovascular mortality.

Methods

The study subjects were men aged 50 years or older and postmenopausal women of the Third National Health and Nutrition Examination Survey 1988-1994. Participants were followed-up for mortality through December 31, 2006.

Results

Serum ferritin was not associated with all-cause, cancer, or cardiovascular mortality for either men or postmenopausal women. However, all-cause, cancer, and cardiovascular mortality were inversely associated with %TS in men. Compared with men in the lowest quintile, adjusted hazard ratios for all-cause, cancer, and cardiovascular mortality were 0.85, 0.86, 0.76, and 0.74 (p for trend < 0.01), 0.82, 0.73, 0.75, and 0.63 (p for trend < 0.01), and 0.86, 0.81, 0.72, and 0.76 (p for trend < 0.01), respectively. For postmenopausal women, inverse associations were also observed for all-cause and cardiovascular mortality, but cancer mortality showed the significantly lower mortality only in the 2nd quintile of %TS compared with that of the 1st quintile.

Conclusions

Unlike speculation on the role of iron from experimental studies, %TS was inversely associated with all-cause, cancer and cardiovascular mortality in men and postmenopausal women. On the other hand, serum ferritin was not associated with all-cause, cancer, or cardiovascular mortality.     

Social Frailty Has a Stronger Impact on the Onset of Depressive Symptoms than Physical Frailty or Cognitive Impairment: A 4-Year Follow-up Longitudinal Cohort Study

Objectives

To examine the association between each type of frailty status and the incidence rate of depressive symptoms among community-dwelling older adults.

Early Gut Microbiota Colonisation of Premature Infants Fed with Breastmilk or Formula with or without Probiotics: A Cohort Study

Premature infants have a fragile ecology of the gut microbiota, which is associated with many health problems and may be influenced by formula versus breast feeding. The present study investigated differences in the process of gut microbiota colonisation in preterm infants fed with breastmilk or formula with or without probiotics before 12 weeks. This cohort study recruited 138 premature infants; 31 in the breastmilk (BM) group, 59 in the probiotics formula (PF) group and 48 in the non-probiotics formula (NPF) group, according to the feeding practice they received at birth. Gut bacterial composition was identified with 16S rRNA gene sequencing in faecal samples collected at 1 week, 6 weeks and 12 weeks after birth. The alpha diversity was higher in the PF group compared to the other groups at week 1 and 6 (both p < 0.01) but showed no difference at week 12. The beta diversity of the three groups showed a trend towards similarity at the first two stages (p < 0.001 and p = 0.009, respectively) and finally showed no difference at week 12. Canonical redundancy analysis showed that feeding type could explain the difference in gut microbiota composition at week one and six (both p < 0.01). At genus level, Bifidobacterium was enriched in the PF group, while the Enterococcus and Streptococcus was enriched in the NPF group. In summary, formula with probiotics feeding after birth can affect gut microbiota colonisation and lead to a bacterial community with less potential pathogens.     

Case Report: The University of Michigan Dioxin Exposure Study: A Follow-up Investigation of a Case with High Serum Concentration of 2,3,4,7,8-Pentachlorodibenzofuran

Context

Polychlorinated dibenzo-p-dioxins, polychlorinated dibenzofurans, and dioxin-like polychlorinated biphenyls that have toxic equivalency factors (TEFs) were measured in serum of 946 subjects in five Michigan counties. The study was motivated by concerns about human exposure to dioxin-contaminated sediments in the Tittabawassee River (TR). Most of the toxic equivalency in TR sediments is from two furan congeners, 2,3,7,8-tetrachlorodibenzofuran and 2,3,4,7,8-pentachlorodibenzofuran (2,3,4,7,8-pentaCDF).

Case presentation

The individual with the highest adjusted (for age, age squared, and body mass index) serum level of 2,3,4,7,8-pentaCDF in the study (42.5 ppt) reported a unique history of raising cattle and vegetables in the floodplain of the TR. Interviews and serum samples were obtained from the index case and 15 other people who ate beef and vegetables raised by the index case. 2,3,4,7,8-pentaCDF in beef lipid was estimated to have been more than three orders of magnitude greater than background (1,780 vs. 1.1 ppt). The mean, median, and 95th percentile for serum 2,3,4,7,8-pentaCDF in the study control population were 6.0, 5.4, and 13.0 ppt, respectively, and were 9.9, 8.4, and 20.5 ppt among beef and vegetable consumers, respectively. Back extrapolation for the index case suggests that his increase in serum concentration of 2,3,4,7,8-pentaCDF above background may have been as high as 146 ppt.

Discussion

Consumption of beef and/or vegetables raised on dioxin-contaminated soil may be an important completed pathway of exposure.

Relevance to public health practice

Animals and crops should not be raised for human consumption in areas contaminated with dioxins.     

Metabolic Effects of a 24-Week Energy-Restricted Intervention Combined with Low or High Dairy Intake in Overweight Women: An NMR-Based Metabolomics Investigation

We investigated the effect of a 24-week energy-restricted intervention with low or high dairy intake (LD or HD) on the metabolic profiles of urine, blood and feces in overweight/obese women by NMR spectroscopy combined with ANOVA-simultaneous component analysis (ASCA). A significant effect of dairy intake was found on the urine metabolome. HD intake increased urinary citrate, creatinine and urea excretion, and decreased urinary excretion of trimethylamine-N-oxide (TMAO) and hippurate relative to the LD intake, suggesting that HD intake was associated with alterations in protein catabolism, energy metabolism and gut microbial activity. In addition, a significant time effect on the blood metabolome was attributed to a decrease in blood lipid and lipoprotein levels due to the energy restriction. For the fecal metabolome, a trend for a diet effect was found and a series of metabolites, such as acetate, butyrate, propionate, malonate, cholesterol and glycerol tended to be affected. Overall, even though these effects were not accompanied by a higher weight loss, the present metabolomics data reveal that a high dairy intake is associated with endogenous metabolic effects and effects on gut microbial activity that potentially impact body weight regulation and health. Moreover, ASCA has a great potential for exploring the effect of intervention factors and identifying altered metabolites in a multi-factorial metabolomic study.