Caffeine and Pregnancy Outcome

Caffeine is a drug which easily crosses the placental barrier and enters the fetal circulation. To date, most studies that demonstrate caffeine's teratogenic potential have been conducted in animal models. Although no definite relationship in humans has been confirmed, it is suggested that a pregnant woman should limit or discontinue her intake of caffeine.     

The Cesarean Birth Method

As the incidence of cesarean deliveries has increased, so, too, has professional concern for the psychological well-being of cesarean families. The authors of the following article have pioneered the country's first method for prepared cesarean childbirth, called the Cesarean Birth Method, a comprehensive approach for enhancing the childbirth experiences of cesarean families. In this article they discuss the philosophy of their work and present the details of their method, which consists of two approaches, one that anticipates, in prenatal care and education, the possibility of emergency cesarean births, and one of classes designed specifically for elective and repeat cesarean births. For both approaches, the method includes guidelines for intrapartum and postpartum nursing support.     

血管紧张素Ⅱ在血管中经由氧化张力引起的讯息传递

高血压、动脉粥状硬化、高血脂症以及糖尿病都会以起血管功能性及结构性的异常。这些异常包括内皮功能失常、改变血管收缩力以及血管重组。在这些变化过程中常会牵涉到血管平滑肌的增生、细胞雕零、细胞迁移、发炎以及纤维化。在许多影响因子中，血管紧张素（angiotensionⅡ，AngⅡ）无疑是属最重要的一个。血管紧张素会诱发内皮（endothelin-1）的产生，而内皮素在血管紧张素的作用中，扮演重要的调节角色。此外，血管紧张素会诱使氧游离基（reactive oxygen species．ROS）上升。在本报告中我们将焦点集中在血管紧张素、内皮素以及ROS在血管平滑肌增生过程中所扮演的角色。     

Experimental Measures of Ventricular Activation and Synchrony

Background: A widened QRS complex as a primary indication for cardiac resynchronization therapy (CRT) for heart failure patients has been reported to be an inconsistent indicator for dyssynchronous ventricular activation. The purpose of this study was to conduct a detailed experimental investigation of total ventricular activation time (TVAT), determine how to measure it accurately, and compare it to the commonly used measure of QRS width. In addition, we investigated a measure of electrical synchrony and determined its relationship to the duration of ventricular activation. Methods: Unipolar electrograms (EGs) were recorded from the myocardial volume using plunge needle electrodes, from the epicardial surface using “sock” electrode arrays, and from the surface of an electrolytic torso‐shaped tank. EGs were analyzed to determine a root mean square (RMS)‐based measure of ventricular activation and electrical ventricular synchrony. Results: The RMS‐based technique provided an accurate means of measuring TVAT from unipolar EGs recorded from the heart, the entire tank surface, or the precordial leads. In normal canine hearts, a quantification of ventricular electrical synchrony (VES) for normal ventricular activation showed that the ventricles activate, on average, within 3 ms of each other with the left typically activating first. Conclusion: Conclusions from this study are: (1) ventricular activation was reflected accurately by the RMS width obtained from direct cardiac measurements and from precordial leads on the tank surface and (2) VES was not strongly correlated with TVAT.     

Prediction of Clinical Outcomes in Patients with Unprotected Left Main Trifurcation Lesions Treated by Drug‐Eluting Stents: Importance of 2‐Stent Technique and SYNTAX Score

Background: There were insufficient data on the prognosis of stenting for patients with trifurcated unprotected left main lesions (UPLMS). Methods: From the SPEED (stents for percutaneous treatment of coronary artery disease) registry of all percutaneous coronary interventions (PCI) for all types of UPLMS, data of 44 patients with trifurcated UPLMS were selected and analyzed. Results: Patients were divided into one‐stent (N = 23) or 2‐stent (N = 21) groups. Clinical follow‐up was available for 100%, and angiographic follow‐up at 8 month was available for 91.3%. There were no differences in myocardial infarction, cardiac death, and stent thrombosis between groups. However, the target lesion revascularization (TLR) and target vessel revascularization (TVR) in the 1‐stent group was lower when compared to the 2‐stent group (13.0% vs. 23.8%, P = 0.004; 13.0% vs. 28.6%, P = 0.003, respectively). Cumulative survival free from major adverse cardiovascular events (MACE) in the 1‐stent group was higher than the 2‐stent group (65.2% vs. 57.1%, P = 0.033). Analysis of the receiver operator curve (ROC) of the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score showed the area under the curve was 0.414 (standard error = 0.089, 95% CI 0.240–0.589, P = 0.348). Conclusions: In patients with trifurcated UPLMS, higher TLR/TVR and lower cumulative survival from MACE were seen in the 2‐stent group when compared to the 1‐stent group. The SYNTAX scoring system had no predictive value of outcomes for patients with stenting of trifurcated UPLMS. (J Interven Cardiol 2010;23:352–357)     

Strategies of Normalization Used by Parents of Chronically Ill School Age Children

The concept of normalization is examined in relation to chronically ill children. From this conceptual base, the responses of 365 parents in a survey of chronically ill children's use of time out of school, were analyzed to determine the normalization strategies used pertaining to the life of the child and family. This article discusses the appropriateness and importance of normalization, and presents implications for the professional nurse working with families of chronically ill children.     

Binge Eating Among the Overweight Population: A Serious and Prevalent Problem

Obesity is a major public health problem in the United States and is now recognized as a heterogeneous condition. This suggests that treatment effectiveness may be improved with an increased understanding of the multiple factors contributing to obesity. Recent data clearly indicate that one common and serious factor among a subset of the overweight population is binge eating. Dietitians in research settings, clinical settings, or private practice are likely to treat obese patients who are seeking weight-related treatment. This article provides an overview of current knowledge about obese persons who binge eat and recommends that dietitians who treat patients for weight-related conditions take a proactive role by screening them for binge eating problems or, at a minimum, screen those who are suspected of binge eating and then refine treatment approaches accordingly. J Am Diet Assoc. 1996; 96:58-61.     

Tray Service Generates More Food Waste in Dining Areas of a Continuing-Care Retirement Community

Objective To determine if the type of service system affects the amount of service food waste (SFW) generated in dining areas of a continuing-care retirement community.Research design A waste stream analysis was conducted for 7 days to determine quantity of SFW generated in three service systems: health care tray service, health care dining room with wait-staff service, and ambulatory dining room with family style service. Weight and volume were determined.Setting Health care tray service and wait-staff service were provided to 70 residents in a health care unit. Family-style service was provided as an optional service for 130 residents in independent-living units. An average of 229 meals were served per day.Statistical analysis performed Analysis of variance and a multiple comparison method were used to compare mean weight and volume of SFW on a per meal, per day, and per week basis.Results During the 7-day period, 482.8 lb, or 83 gal, of SFW was disposed of. Health care tray service generated more SFW by weight for all three meals than either family-style service or wait-staff service, and it generated the greatest total volume of service waste. Residents eating in the dining room with family-style service disposed of significantly less SFW by weight at lunch and dinner than those receiving the other two service styles.Applications Changing the style of service can affect not only quantity of solid waste generated and associated disposal costs but also food and supply costs, meal acceptability, and quantity of natural resources required. The systems approach should be used to assess the feasibility of changing service system so that all costs are considered. J Am Diet Assoc. 1997;97:879-882.