Maternal mortality and serious maternal morbidity in Jehovah's witnesses in the Netherlands

Objective  To determine the risk of maternal mortality and serious maternal morbidity because of major obstetric haemorrhage in Jehovah's witnesses in the Netherlands.
Design  A retrospective study of case notes.
Setting  All tertiary care centres, general teaching hospitals and other general hospitals in the Netherlands.
Sample  All cases of maternal mortality in the Netherlands between 1983 and 2006 and all cases of serious maternal morbidity in the Netherlands between 2004 and 2006.
Methods  Study of case notes using two different nationwide enquiries over two different time periods.
Main outcome measures  Maternal mortality ratio (MMR) and risk of serious maternal mortality.
Results  The MMR for Jehovah's witnesses was 68 per 100 000 live births. We found a risk of 14 per 1000 for Jehovah's witnesses to experience serious maternal morbidity because of obstetric haemorrhage while the risk for the total pregnant population was 4.5 per 1000.
Conclusions  Women who are Jehovah's witnesses are at a six times increased risk for maternal death, at a 130 times increased risk for maternal death because of major obstetric haemorrhage and at a 3.1 times increased risk for serious maternal morbidity because of obstetric haemorrhage, compared to the general Dutch population.     

Measurement of myocardial fatty acid esterification using [1-11C]palmitate and PET: comparison with direct measurements of myocardial triglyceride synthesis

Background  The purpose of the present study was to assess the accuracy of rates of myocardial fatty acid esterification (MFAE) obtained using positron emission tomography (PET). Methods and results  Sixteen dogs were studied after an overnight fast (FAST), during a euglycemic hyperinsulinemic clamp (CLAMP), or during infusion of intralipid (IL) or IL plus dobutamine (IL/DOB). MFAE was quantified using [1-¹¹C]palmitate and PET and compared to the rate of triglyceride (TG) synthesis measured using [1-¹³C]palmitate and tissue sampling. Plasma free fatty acid (FFA) concentration varied ~20-fold across groups, with this variation in FFA availability accompanied by a ~20-fold range in TG synthesis. MFAE varied ~12-fold across groups, and was significantly correlated with TG synthesis (R = 0.80, P < .001). MFAE, however, was 3- to 4-fold higher than TG synthesis in FAST, CLAMP, and IL, but only ~50% higher when cardiac work was increased in IL/DOB, suggesting that MFAE reflects, in part, the incorporation of label into amino acids via TCA cycle exchange reactions. Conclusions  Changes in MFAE parallel changes in TG synthesis, at least in the basal state. Although the data need to be interpreted cautiously, such measurements should be useful for quantifying acute changes in FFA storage by the heart in various pathophysiological states.     

The Impact of Healthcare Issues on the Future of the Nursing Profession: The Resulting Increased Influence of Community-Based and Public Health Nursing

Several key issues, such as the necessity for cost containment, role conflicts between healthcare professions, nursing shortages, and organizational difficulties of healthcare organizations, significantly influence current healthcare delivery. These circumstances, which constitute a compelling need for responsive and effective change, are examined in terms of their impact upon the nursing profession. A review of the referenced journals and textbooks reveals that national nursing efforts will shift from acute care hospital-oriented provisions to community-based public health orientations. This evolution will result in improved health outcomes, less need for tertiary treatment, and savings for hospitals and insurance companies.     

中药熏蒸治疗轻、中度寻常痤疮疗效观察及血清细胞因子水平检测

目的评价中药熏蒸治疗轻、中度寻常痤疮的疗效,并探讨其作用机制。方法选取本科门诊的56例轻、中度寻常痤疮患者,随机分为两组,中药治疗组(28例,2例失访)予中药熏蒸,安慰剂组(28例,4例失访)予生理盐水熏蒸,26min/d,共治疗2周。评价两组患者的治疗效果,并检测39例患者治疗前、后血清中可溶性白介素-2受体(sIL-2R),白介素-4(IL-4),γ干扰素(IFN-γ)和白介素-8(IL-8)的水平变化。结果中药治疗组有效率为61.54%,安慰剂组为25.00%,两组比较差异有统计学意义(P<0.05)。中药治疗组患者治疗后血清sIL-2R,IL-4,IFN-γ和IL-8水平均较治疗前降低(P均<0.05)。安慰剂组治疗前后细胞因子水平无明显改变(P均>0.05)。结论中药熏蒸治疗轻、中度寻常痤疮有效,其作用机制可能与其对细胞免疫和体液免疫的调节作用有关。     

羧甲基纤维素钠水凝胶的制备及其生物降解性研究

用羧甲基纤维素钠(CMC—Na)制得了含水量高达98％的水凝胶，考察了防腐剂、交联剂、无机态氮素、有机态氮素、碳水化合物的加入量以及环境中pH值等因素对生物降解性的影响。结果表明：制备条件不同，水凝胶的生物降解性不同；环境中一定量铵根离子的存在有利于水凝胶的生物降解；在pH=5．2的环境中纤维素酶活性最高，降解程度最大。     

Association between morphologic distortion of sickle cells and deoxygenation-induced cation permeability increase

We hypothesized that the deoxygenation-induced increase in cation permeability of sickle cells was related to mechanical distention of the membrane by growing HbS polymer within the cell. To test this hypothesis, we determined the effect of deoxygenation on cation fluxes in sickle cells under conditions that restricted or permitted extensive growth of polymer, producing different degrees of membrane distention. Manipulation of suspending medium osmolality for density-isolated high and low mean cell hemoglobin concentration (MCHC) cells was used to regulate the extensional growth of polymer bundles and hence membrane distortion. For initially low MCHC cells, the deoxygenation-induced increase in both Na and K fluxes was markedly suppressed when the MCHC was increased by increasing the osmolality. This suppression corresponded to the inhibition of extensive morphologic cellular distortion. For initially high MCHC, ISC-rich cells, deoxygenation had minimal effect on K permeability. However, reduction of MCHC by a decrease in osmolality produced a concomitant increase in cation permeability and cellular distortion. These observations support the idea that the sickling-associated increase in membrane permeability is related to mechanical stress imposed on the membrane by bundles of HbS polymer.     

NOR polyagglutination and Sta glycophorin in one family: relation of NOR polyagglutination to terminal alpha-galactose residues and abnormal glycolipids

BACKGROUND: This report describes the characterization of polyagglutinable red cells (RBCs), identified in two generations of a Polish family. CASE REPORT: Untreated and modified RBCs of the proposita (TS) were tested by serologic methods, using human sera, antibodies, lectins, and inhibitors of agglutination. Moreover, glycophorins were characterized by sodium docecyl sulfate- polyacrylamide gel electrophoresis and Western blotting, and glycolipids were purified, fractionated by thin-layer chromatography, and detected with Ricinus communis agglutinin I (RCA-I, specific for galactose residues) and Griffonia simplicifolia IB4 lectin (GSL-IB4, specific for Gal alpha1-3Gal- structure). Some of the experiments were also performed on RBCs of members of TS's family. RESULTS: Polyagglutination, found in four members of TS's family, was identified as the second case of an earlier described NOR polyagglutination. The polyagglutination was decreased by treating the RBCs with alpha- galactosidase and was inhibited by a neutral glycolipid fraction from NOR+ RBCs. Detection of neutral glycolipids of TS's RBCs on the thin- layer plate by RCA-I and GSL-IB4 revealed the presence of components that were not detectable in control RBCs. Moreover, Western blotting of RBC membranes from five family members with glycophorin monoclonal antibodies and agglutination assays with anti-St(a) and anti-Dantu sera identified the presence of St(a) glycophorin in four members of the family, two of whom were NOR+ and two NOR-. CONCLUSION: Our results showed that two rare features of TS's RBCs, NOR polyagglutination and St(a) glycophorin, are inherited independently, and that NOR+ RBCs contain neutral glycolipids with an abnormal oligosaccharide structure, most likely terminated with alpha-galactosyl residues.