Lactation Duration: Influences of Human Milk Replacements and Formula Samples on Women Planning Postpartum Employment

Objective: To examine the influences of i hospital administration of breast milk replacement and receipt of formula samples on lactation duration among women planning postpartum employment.
Design: Prospective design.
Setting: Telephone interviews conducted prenatally and at 6 weeks, 3 months, and 6 months postpartum.
Participants: Sixty-nine participants entered the study; 53 completed all scheduled interviews.
Main Outcome Measures: Incidence and type. of in-hospital human milk replacement, incidence ar sources of formula samples, incidence of breastfeeding at 6 weeks postpartum, and duration of lactation.
Results: During hospitalization, 19% of in fants received formula; the incidence of breastfeeding at 6 weeks and duration of breastfeeding were significantly shorter in these infants compared with infants who were not fed formula. Fifty-nine percent of participants received formula samples from the hospital, 30% received samples from a physician's office, and 51% received samples by mail Receipt of formula samples by mail was associate with reduced incidence of breastfeeding at 6 weeks and shortened duration of lactation.
Conclusions: Early formula feeding and receipt of formula samples by mail may be barriers I lactation in women employed outside the home.     

Obtaining funding for fertility services through the NHS

There is considerable anecdotal evidence that where a coherent, consistent and concise message, coupled with an active and resilient lobby campaign has been taken to a health authority and local MPs, funding has followed. The key feature of these efforts has been clinicians and patients working together. Also, campaigns are the more successful with the more patients that can be involved and this is an area where clinicians could play a major role in motivating patients to apply pressure on health authorities. Many infertility specialists and other professional colleagues have been very active in arguing the case both on their own account and when backing the work of the National Infertility Awareness Campaign and patients generally. Others have not. For them, this article is their call to arms.      

Dummies and the sudden infant death syndrome

The association between dummy use and sudden infant death syndrome (SIDS) was investigated in 485 deaths due to SIDS in the postneonatal age group and compared with 1800 control infants. Parental interviews were completed in 87% of subjects. The prevalence of dummy use in New Zealand is low and varies within New Zealand. Dummy use in the two week period before death was less in cases of SIDS than in the last two weeks for controls (odds ratio (OR) 0.76, 95% confidence interval (CI) 0.57 to 1.02). Use of a dummy in the last sleep for cases of SIDS or in the nominated sleep for controls was significantly less in cases than controls (OR 0.44, 95% CI 0.26 to 0.73). The OR changed very little after controlling for a wide range of potential confounders. It is concluded that dummy use may protect against SIDS, but this observation needs to be repeated before dummies can be recommended for this purpose. If dummy sucking is protective then it is one of several factors that may explain the higher mortality from SIDS in New Zealand than in other countries, and may also explain in part the regional variation within New Zealand.     

Chest radiography: a survey of techniques and exposure levels currently used

In diagnostic radiology, the routine measurement of exposure levels for a reference patient is an important part of an effective quality assurance program. In the United States, chest radiography is the most frequent examination and has the lowest exposure level of all radiologic examinations. We estimated the amount of exposure an average patient received from both manual and automatic exposure-controlled radiographic techniques by using a "patient-equivalent" chest phantom during measurements. A densitometric procedure was used to assess processor performance. The mean exposure from 194 chest systems was 20 mR (5.16 X 10(-5) C/kg); the mean film density, 1.38; and the mean processing speed, 108. It is interesting to note that a wide range of radiographic techniques, processing conditions, and screen-film speeds are currently being used. With the information given in our study, investigators can begin to identify the problems that lead to unusual exposure levels and, perhaps, poor image quality.     

The predictors of complications in patients with drug‐induced liver injury caused by antimicrobial agents

Aliment Pharmacol Ther 31 , 1200–1207

Summary

Background Antimicrobials are the leading cause of idiosyncratic drug‐induced liver injury in most series. Aim To determine the incidence and the predictors of complications in patients with drug‐induced liver injury caused by antimicrobial agents requiring hospitalization. Methods Medical records of patients with drug‐induced liver injury caused by antimicrobial agents were identified by ICD‐10, for the period between 2002 and 2006. Clinical information and blood tests during hospitalization were recorded. The causality assessment of drug‐induced liver injury was determined by the Roussel UCLAF causality assessment method (RUCAM) scale. Results Of 47 594 in‐patient admissions per year, the annual incidence of drug‐induced liver injury was 0.03%. Male: female ratio was 7:3 with a median age of 47 years. Eighty reactions of drug‐induced liver injury were caused by anti‐tuberculosis drugs (85%) and by antibiotics (15%). The median (IQR) of RUCAM scale was 6 (5–8). A total of 36% had HIV infection and 9% of patients had diabetes mellitus. Median (IQR) duration of hospitalization was 9 (5–15) days. Serious complications and death were found in 27.5% and 26%, respectively. By a multivariable logistic analysis, the presence of jaundice was found to be significantly associated with an unfavourable outcome. Conclusion Although rare, antimicrobial agents‐related drug‐induced liver injury requiring hospitalization has a high mortality rate. The presence of jaundice predicts poor outcome.     

2009年AASLD慢性乙型肝炎指南(摘登)

一、HBeAg阳性和HBeAg阴性患者慢性乙型肝炎诊断标准1.慢性乙型肝炎·HBsAg阳性＞6个月 *血清HBV DNA＞20000 IU/mL(10~5拷贝/mL).较低水平HBV DNA 2000～20 000 IU/mL或10~4～10~5拷贝/mL,常见于HBeAg阴性的慢性乙型肝炎*持续或间歇性ALT/AST水平升高*肝活组织检查显示伴随中度或重度坏死炎症反应的肝脏炎症2.非活动HBsAg携带状态·HBsAg阳性＞6个月*HBeAg阴性、抗-HBe阳性*血清HBV DNA＜2000 IU/mL*ALT/AST水平持续正常*肝组织学活检证实无明显的肝炎     

Egg sharing and egg donation: attitudes of British egg donors and recipients

The question of payment to egg donors has recently focused the attention of both the Human Fertilisation and Embryology Authority (HFEA) and licensed clinics. An acute shortage of egg donors and the rising costs of assisted conception treatment are matters of grave concern to many patients. To understand the emotional and social effects of egg sharing and egg donation, we conducted a survey of attitudes in a group of women who had some knowledge or experience of egg donation. A total of 750 questionnaires were sent out of which 217 were returned within the specified time limit. From these, 107 respondents had experience of egg donation and 110 had made enquiries about donation. The data from these questionnaires were collated and tabulated by the National Opinion Polls (NOP) Research Group. An analysis of the data produced the following key findings: (i) donating or sharing eggs is a social issue, 94% discuss it with partners/family/friends; (ii) altruistic motives are not the prerogative of non-patient volunteers-egg share donors felt that helping the childless was as important as having a chance of in-vitro fertilization (IVF) for themselves; (iii) the treatment procedure causes the most anxiety for egg donors. The recipients were most concerned about delays, donor characteristics and how the eggs were allocated; (iv) most respondents (65%) with prior experience of egg sharing would do it again - 63% of egg share donors, 72% of egg share recipients; (v) cash rewards to egg donors and outright advertising for donors were rejected by 64 and 62% of the sample respectively; and (vi) counselling was highly valued and there were no instances of 'shattered lives' after treatment. The findings do not support the recently announced intentions of the HFEA to disallow payment to gamete donors on the grounds of devalued consent. There is no precedent in modern medicine for egg sharing. The patients surveyed drew a clear distinction between egg sharing and financial rewards. As long as egg donation is not covered by the National Health Service, it is fairer to offer egg sharing than to refuse treatment to those unable to pay.      

Treatment of lipomas assisted with tumescent liposuction

BACKGROUND: Lipoma is a common soft-tissue tumour of mature fat cells. Although surgical excision is effective, treatments that are less invasive and not associated with disfigurement of scar would be ideal for the treatment of lipomas. Recently, tumescent liposuction has been used for the treatment of lipomas. OBJECTIVE: To evaluate the efficacy of tumescent liposuction in lipoma treatment, we reviewed our experience of lipoma treatment by tumescent liposuction. METHODS: A total of 21 patients presenting with 31 lipomas were treated with tumescent liposuction. After liposuction, remaining stromas were removed by a haemostat through the small incision. Tumour size and post-operative complications were recorded before and after treatment. RESULTS: A total of 31 lipomas of 21 patients were treated by tumescent liposuction. The size of lipomas ranged between 1.2 and 11 cm (mean size, 4.1 cm). In 23 cases, there were no complications. However, remnant lipomas, bruise, haematoma and immediate dimpling were found as complications. CONCLUSION: Tumescent liposuctions with extracting remnant fat tissue and fibrous tissue through the opening for liposuction can be an effective treatment technique in lipoma treatment in the efficacy and cosmetic outcomes and this method can be a substitute for excision in treating large lipomas.     

常人运动中达无氧阈前后动脉血乳酸、丙酮酸与血气变化的关系

文章探讨了10名健康人在进行递增负荷运动时动脉血乳酸、丙酮酸与血气指标的变化及其关系:在达无氧阈前,上述指标变化不显,达无氧阈后,随负荷功率的增加,变化逐渐显著。本文研究将有助于对运动员无氧阈的深入了解。