Predictors of maternal mortality in institutional deliveries in Nigeria

Background

Maternal mortality in poor countries reflects the under-development in these societies. Global recognition of the burden of maternal mortality and the urgency for a reversal of the trend underpin the Millenium Development Goals (MDGs).

Objective

To determine risk factors for maternal mortality in institutional births in Nigeria.

Method

Twenty one health facilities in three states were selected using stratified multi-stage cluster sampling strategy. Information on all delivered mothers and their newborn infants within a three-month period was culled from medical records.

Results

A total of 9 208 deliveries were recorded. About one-fifth (20.5%) of women had no antenatal care while 79.5% had at least one antenatal visit during pregnancy. Four-fifths (80.5%) of all deliveries were normal deliveries. Elective and emergency caesarean section rates were 3.1% and 11.5% respectively. There were 79 maternal deaths and 8 526 live births, giving a maternal mortality ratio of 927 maternal deaths per 100 000 live births. No antenatal care, parity, level of education, and mode of delivery were significantly associated with maternal mortality. Low maternal education, high parity, emergency caesarean delivery, and high risk patients risk independently predicted maternal mortality.

Conclusion

Meeting goal five of the MDGs remains a major challenge in Nigeria. Multi-sectoral approaches and focused political will are needed to revert the high maternal mortality.     

矿物药青礞石对PTZ点燃癫痫大鼠脑组织、血浆中金属元素的影响

目的 研究青礞石对戊四氮（PTZ）点燃癫痫大鼠脑组织、血浆中金属元素的影响,探讨青礞石可能的效应物质基础。方法 采用PTZ点燃法建立癫痫大鼠模型,运用电感耦合等离子体质谱法（ICP-MS）和电感耦合等离子体发射光谱法（ICP-OES）测定空白组、模型组、卡马西平组（0.1 g·kg^-1）和青礞石组（2 g·kg^-1）大鼠脑组织、血浆中的金属元素含量,实验数据用SPSS 18.0软件进行统计学分析。结果 与空白组比较,模型组大鼠脑组织中Sr,Sb,Ba含量明显上升（P<0.05,P<0.01）;Zn,Fe,Cu,K,Li,Co,Sn,Pb含量明显下降（P<0.05,P<0.01）。与模型组比较,青礞石组大鼠脑组织中Zn,Fe,K,Li,Co,As,Pb含量明显上升（P<0.05,P<0.01）;Sr,Sb含量显著下降（P<0.01）。说明青礞石对大鼠脑组织中金属元素含量向正常水平的调节具有积极作用,干预效果明确,且总体效果优于卡马西平组。与空白组比较,模型组大鼠血浆中K,Sr,Cd含量明显上升（P<0.05）;Li,Al,Ti,Cr含量明显下降（P<0.05）。与模型组比较,青礞石组大鼠血浆中Ca,K,Li,Al,V含量明显上升（P<0.05,P<0.01）;Fe,Ti,Sr,Cd含量明显下降（P<0.05,P<0.01）。各组间金属元素相关性分析显示,大鼠脑组织中有17对元素存在显著正相关性,2对元素存在显著负相关性,大鼠血浆组织中有8对元素存在显著正相关性,6对元素存在显著负相关性。结论 以Zn,Fe,K,Li,Co,As,Pb,Sr,Sb,Ca,Al,V,Ti,Cd为代表的金属元素群可能是青礞石干预PTZ点燃癫痫模型大鼠的效应物质基础,作用机制可能与这些金属元素群干预影响神经递质的释放及神经元的电平衡、调节离子（Na⁺,K⁺,Ca²⁺等）通道失常诱发的异常同步放电及干预癫痫相关代谢通路等有关,使兴奋与抑制活动相互牵制,最终达到神经元、细胞电平衡等趋于正常生理状态。青礞石组的干预作用总体优于卡马西平组。     

恩替卡韦初治ALT小于2ULN的HBeAg阴性慢性乙型肝炎患者的2年疗效观察

目的研究恩替卡韦治疗ALT小于2ULN(正常值上限)的HBe Ag阴性慢性乙型肝炎患者2年的疗效观察。方法前瞻性研究37例HBe Ag阴性慢性乙型肝炎患者,其中17例是ALT小于2ULN(A组),20例是ALT大于2ULN(B组),均接受恩替卡韦治疗,检测基线、24周、48周、96周时2组的HBV DNA和HBs Ag水平,同时比较治疗前及96周的无创纤维化评分(SZFibro S模型)。结果治疗24周时A组、B组的病毒学应答(HBV DNA<100 IU/m L)分别是15/17、18/20,2组48,96周后病毒学应答没有进一步提高,2组比较无显著性差异。A组治疗前和治疗96周时,HBs Ag水平分别是(3.766±0.775)log10IU/m L和(3.207±0.415)log10IU/m L(P=0.041)。B组治疗前和治疗96周时,HBs Ag水平分别是(3.966±0.665)log 10IU/m L和(3.251±0.385)log10IU/m L(P=0.002)。但2组24周、48周、96周时HBs Ag下降的幅度无显著性差异。A组治疗前和治疗96周的SZFibro S评分分别是(5.75±0.42)和(5.70±0.54)(P=0.752)。B组治疗前和治疗96周的SZFibro S评分分别是(5.96±0.65)和(5.51±0.22)(P=0.007)。结论 ALT水平不影响恩替卡韦治疗HBe Ag阴性慢性乙型肝炎患者的病毒学应答及HBs Ag的下降。ALT水平可能与纤维化评分改善相关。     

鸡枞菌粉提取物镇痛抗炎作用的研究

目的:研究鸡枞菌粉提取物的镇痛抗炎作用。方法:采用醋酸扭体实验,甲醛致痛模型,二甲苯致耳肿胀模型及角叉菜胶致足肿胀模型观察鸡枞菌粉及其提取物镇痛抗炎作用。同时对小鼠炎症渗出液中PGE2,SOD,MDA,NO和NOS进行测定。结果:鸡枞菌粉提取物均能降低小鼠醋酸引起的扭体次数,减少甲醛致痛实验中小鼠舔足时间;抑制二甲苯致小鼠耳肿胀及角叉菜胶引起的小鼠足肿胀。对炎症介质也有较好的抑制作用。结论:鸡枞菌粉提取物具有明显镇痛抗炎作用。     

血胱抑素与肾功能损伤程度的相关性研究

目的观察血胱抑素C（cysC）在不同程度急性。肾损伤（AKI）及终末期肾病（ESRD）患者血清中的浓度变化,探讨其对AKI的早期诊断价值及其与肾功能损伤程度的相关性。方法搜集ICUAKI患者,“5．12”汶川地震伤员,ESRD患者及健康对照者的血清、尿液及临床表现等资料;按照RIFLE标准,分为轻度AKI组20例、中重度AKI组30例,另外,地震外伤组48例、ESRD组32例和健康对照组20例;采用微粒子增强免疫比浊法检测血清cysC,比色法检测尿N-乙酰-β-D-氨基葡萄糖苷酶（NAG酶）,酶法检测血肌酐（Scr）;对血cysC与Scr的相关性进行统计学分析,并绘制受试者工作特征曲线（ROC曲线）,评价血cysC在AKI早期诊断中的敏感性和特异性及其与肾功能损伤程度的相关性。结果与健康对照组比较,轻度AKI组、中重度AKI组和ESRD组血cysC均有明显升高（P〈0．05或P〈0．01）,其中ESRD组升高更明显（P〈0．01）;血cysC与Scr呈正相关关系（P〈0．01）;地震外伤组血清cysC较健康对照组升高（P〈0．05）,且血cysC在AKI诊断中的ROC曲线下面积为0．931（P〈0．01）。结论AKI发生时检测血cysC有助于AKI的早期临床诊断;血cysC与肾功能损伤程度呈正相关关系,能准确反应肾功能变化。     

高分辨MRI成像对基底动脉狭窄患者斑块分布、成分及相关特征分析

目的采用高分辨MRI成像分析有症状和无症状基底动脉狭窄患者斑块分布、成分及相关特征。方法回顾性分析2018年3月~2021年3月我院收治的106例行高分辨MRI检查的基底动脉狭窄患者,根据是否存在后循环卒中分为症状性组（n=45）和无症状组（n=61）,收集所有纳入对象影像学资料,分析两组斑块分布、成分、重构等相关特征。结果症状性组斑块主要分布在背侧壁,无症状组斑块主要分布在腹侧壁,两组斑块分布差异存在统计学意义（P < 0.05）;症状性组合并斑块内出血、纤维帽断裂概率高于无症状组（P < 0.05）;症状性组患者最狭窄层的血管面积、管壁面积、管腔面积、最大管壁厚度、狭窄率、血管重构指数（RI）均高于无症状组（P < 0.05）,两组斑块负荷差异无统计学意义（P > 0.05）;两组斑块强化等级分布存在明显差异,其中症状性组斑块2级强化率高于无症状组（P < 0.05）。结论有症状和无症状基底动脉狭窄患者斑块分布、成分、重构等特征存在一定差异,而高分辨MRI成像能为识别斑块特征和及早干预提供可靠影像学参考。     

国内医学模拟教育模式初探——深港合作麻醉危机处理模拟培训班现状概述

总结深港合作麻醉危机处理模拟培训班课程开发与应用的经验与心得:(1)危机管理训练应用模拟教学正成为医学教育领域新的发展方向;(2)深港合作为国内医学模拟教育模式搭建创造条件;(3)深港合作麻醉危机处理模拟培训班课程具体流程;(4)创建麻醉危机情景典型模拟病例并编程是实现情景模拟教学的关键环节;(5)政府支持必不可少。对开发与应用培训班课程过程遇到的一些问题分析,并对国内医学模拟教育模式作初步探讨。     

磷酸二酯酶4B基因多态性与精神分裂症的关联研究

目的 探讨磷酸二酯酶4B基因多态性与精神分裂症的相关性.方法 运用聚合酶链反应扩增及单核苷酸多态性的分子生物学技术,收集符合精神分裂症诊断标准的98个先证者及其父母组成的核心家系,对其磷酸二酯酶4B基因rs1040716,rs2180335,rs3767311,rs472952多态性分型,进行精神分裂症的磷酸二酯酶4B基因多态性的关联分析和单体型相对风险率分析.结果 rs2180335等位基因与精神分裂症相关联(P=0.02131),其中等位基因A是保护因素(Z=-2.184),G为危险因素(Z=2.184),A等位基因频率为0.452.G为0.548;rs1040716,rs3767311,rs472952与精神分裂症无关联.五种单体型rs2180335-rs3767311的A/A、rs 3767311-rs472952的A/A、rs2180335-rs3767311-rs472952中的A/A/A、rs1040716-rs2180335-rs 3767311-rs472952中的A/G/G/A,T/A/A/A与精神分裂症有关联(P值分别为0.028715,0.034845,0.024177,0.023967,0.010839,基因型频率分别为0.223,0.223,0.127,0.081,0.073).结论 磷酸二酯酶4B基因rs1335042与精神分裂症相关联.     

Factors affecting proprioceptive recovery after anterior cruciate ligament reconstruction

Background Proprioception plays an important role in knee movements. Since there are controversies surrounding the overall recovery time of proprioception following surgery, it is necessary to define the factors affecting proprioceptive recovery after anterior cruciate ligament （ACL） reconstruction and to investigate the relationship between proprioception and muscle strength. Methods A total of 36 patients who had their ACL reconstructed with a semitendinosus/gracilis graft （reconstructed group： 6 months post-surgery） and 13 healthy adults without any knee injury （control group） were included in the study. Knee proprioception was evaluated with a passive reproduction test. Isokinetic strength was measured using the Biodex System. Statistical analysis was used to compare proprioception of the reconstructed group versus the control group, and to define causal factors, including sex, hamstring/quadriceps ratio, and the course of injury before reconstruction, We also investigated the correlation between the passive reproduction error and quadriceps index. Results There was a significant difference in proprioception between the reconstructed and control groups （P 〈0.05）. When the course of injury before reconstruction was less than 4 months, there was a linear correlation with proprioception 6 months after the operation （r=0.713, P 〈0.05）. There was a positive correlation between post-surgery proprioception and the quadriceps index at 6 months post-surgery. Conclusions Impaired knee proprioception is observed 6 months after ACL reconstruction. Within 4 months of injury, early undertaking of reconstruction is associated with better proprioception outcome. Patients with enhanced proprioception have a better quadriceps index.     

尿胰蛋白酶原Ⅱ用于40例急性胰腺炎的筛检及诊断价值分析

目的为探讨尿胰蛋白酶原Ⅱ（Try-Ⅱ）对急性胰腺炎（AP）筛检与诊断价值,为AP的诊断提供一种微量、操作简单、快速,结果准确可靠的常规检测方法。方法选择急性胰腺炎40例为实验组,非急性胰腺炎（NAP）52例为对照组,分别用免疫屡析法测尿中Try-Ⅱ,速率法测血、尿中的淀粉酶（Amy）。结果40例急性胰腺炎患者38例Try-Ⅱ为阳性,34例血Amy阳性,35倒尿Amy阳性。尿Try-Ⅱ诊断灵敏度95％。特异性94．2％。诊断符合率94．5％。血Amy灵敏度85％,特异性80．7％,诊断符合率82．6％。尿Amy灵敏度88％,特异性79％,诊断符合率82．6％。结论尿Try-Ⅱ作为急性胰腺炎新的生化标志物,对急性胰腺炎的快速检测度疗效观察优于血、尿Amy,具有较高的诊断价值,是诊断AP的良好指标。