Changes in amniotic fluid phospholipids on treatment with glucocorticoids to prevent respiratory distress syndrome.

Amniotic fluid was obtained by transabdominal amniocentesis in 51 women in the 29th-36th week of pregnancy. The lecithin/sphingomyelin ratio was determined. In 28 patients,the ratio was less than 2.2. Beta-methasone was given for three days to 14 of them; the rest served as controls. On the fourth day, a second amniocentesis was performed on all patients. The lecithin/sphingomyelin ratio rose to a value greater than 2.2 in 4 of the patients in the betamethasone-treated group and in one of the controls. The percentage of palmitic acid in the lecithin increased concomitantly with increasing lecithin/sphingomyelin ratio. These results suggest that glucocorticoid induced acceleration of fetal pulmonary maturation may be reflected in the amniotic fluid as changes in its phospholipid composition. The lecithin/sphingomyelin ratio was found to be greater than 2.2 in 23 patients at the first amniocentesis. In such cases treatment with glucocorticoids can be avoided.     

Interrater reliability of videotaped observational gait-analysis assessments

The purpose of this study was to determine the interrater reliability of videotaped observational gait-analysis (VOGA) assessments. Fifty-four licensed physical therapists with varying amounts of clinical experience served as raters. Three patients with rheumatoid arthritis who demonstrated an abnormal gait pattern served as subjects for the videotape. The raters analyzed each patient's most severely involved knee during the four subphases of stance for the kinematic variables of knee flexion and genu valgum. Raters were asked to determine whether these variables were inadequate, normal, or excessive. The temporospatial variables analyzed throughout the entire gait cycle were cadence, step length, stride length, stance time, and step width. Generalized kappa coefficients ranged from .11 to .52. Intraclass correlation coefficients (2,1) and (3,1) were slightly higher. Our results indicate that physical therapists' VOGA assessments are only slightly to moderately reliable and that improved interrater reliability of the assessments of physical therapists utilizing this technique is needed. Our data suggest that there is a need for greater standardization of gait-analysis training.     

Early Contact versus Separation: Effects on Mother–Infant Interaction One Year Later

Background: A tradition of separation of the mother and baby after birth still persists in many parts of the world, including some parts of Russia, and often is combined with swaddling of the baby. The aim of this study was to evaluate and compare possible long‐term effects on mother‐infant interaction of practices used in the delivery and maternity wards, including practices relating to mother‐infant closeness versus separation. Methods: A total of 176 mother‐infant pairs were randomized into four experimental groups: Group I infants were placed skin‐to‐skin with their mothers after birth, and had rooming‐in while in the maternity ward. Group II infants were dressed and placed in their mothers’ arms after birth, and roomed‐in with their mothers in the maternity ward. Group III infants were kept in the nursery both after birth and while their mothers were in the maternity ward. Group IV infants were kept in the nursery after birth, but roomed‐in with their mothers in the maternity ward. Equal numbers of infants were either swaddled or dressed in baby clothes. Episodes of early suckling in the delivery ward were noted. The mother‐infant interaction was videotaped according to the Parent‐Child Early Relational Assessment (PCERA) 1 year after birth. Results: The practice of skin‐to‐skin contact, early suckling, or both during the first 2 hours after birth when compared with separation between the mothers and their infants positively affected the PCERA variables maternal sensitivity, infant's self‐regulation, and dyadic mutuality and reciprocity at 1 year after birth. The negative effect of a 2‐hour separation after birth was not compensated for by the practice of rooming‐in. These findings support the presence of a period after birth (the early “sensitive period”) during which close contact between mother and infant may induce long‐term positive effect on mother‐infant interaction. In addition, swaddling of the infant was found to decrease the mother’s responsiveness to the infant, her ability for positive affective involvement with the infant, and the mutuality and reciprocity in the dyad. Conclusions: Skin‐to‐skin contact, for 25 to 120 minutes after birth, early suckling, or both positively influenced mother‐infant interaction 1 year later when compared with routines involving separation of mother and infant.     

A model for determining immunogenic relationships between avian infectious bronchitis viruses

A model for determining immunogenic relationships between strains of infectious bronchitis virus is described that is based upon the vaccinating dose required to induce prevention of multiplication of a standard challenge dose of an homologous strain in the lungs of specific-pathogen-free chickens. The model has been used to demonstrate that: (1) Approximately 100 times the vaccinating dose must be used to produce immunity from one compared with two doses; (2) differences of immunogenicity of greater than 1,000-fold exist between Australian strains; (3) immunogenicity is greatest for live virus administered directly to the trachea, followed by live virus administered by the ocular route, inactivated virus administered intratracheally and inactivated virus administered intramuscularly; (4) for chickens inoculated with Australian vaccine strains, protection against challenge is unrelated to serotype.     

心包大部分切除术治疗小儿急性心包炎

目的 评价心包大部分切除术治疗小儿急性心包炎的临床效果。方法 对1992～1999年收治的35例小儿急性心包炎的手术、术后并发症及预后进行了回顾分析。结果 术后引流时间3～10d，平均5d，全组均治愈，随访半年～7年疗效满意，无远期死亡及严重并发症。结论 小儿急性心包炎应早期诊断，及时手术。心包大部分切除术，简单易行，可彻底解除心包填塞症状，避免遗留心包粘连或缩窄，缩短住院时间。目前随着结核发病率的增高，结核性心包炎的发病亦随之增加，应引起足够重视。     

激光配合穴位注射治疗手部寻常疣疗效观察

目的评价激光配合穴位注射治疗手部寻常疣疗效。方法131例手部寻常疣患者随机分为两组,治疗组66例予以二氧化碳激光碳化疣体后,采用维生素B1100 mg,维生素B12500μg作内关穴注射,5~7天注射1次。对照组65例予以二氧化碳激光碳化疣体后,肌肉注射维生素B1100 mg,维生素B12500μg,3天注射1次。结果治疗组有效率95.46%,对照组有效率80.00%,两组比较差异有显著性(P<0.001)。结论激光配合穴位注射治疗手部寻常疣疗效显著。     

慢性疾病患者的营养与健康

目的 探索天津慢性病在社区卫生服务工作中的综合模式,更好的管理慢性病患者,提高生活质量,降低医疗费用.方法 选择已经确诊的糖尿病、高血压患者60例,随机分为强化管理治疗组及普通治疗组.强化管理治疗组采用量化饮食治疗、量化运动治疗、指导合理用药、健康教育和心理疏导,医生对患者一对一地指导等治疗方法 ;普通治疗组为药物治疗和一般性教育.观察两组连续治疗3个月病情控制与药费情况.结果 强化管理和治疗组的体重、腰围、血压、空腹及餐后血糖指标下降明显.平均体重下降1.93kg,体重指数下降0.84%,腰围下降6.00cm(均P＜0.01);空腹血糖下降0.07mmol/L,餐后2h血糖下降3.55mmol/L,糖化血红蛋白下降0.79%,血脂胆固醇下降0.26mmol/L,三酰甘油平均下降1.49mmol/L,高密度脂蛋白升高0.13mmol/L,低密度脂蛋白降低0.04mmol/L.结论 糖尿病高血压的社区强化管理治疗的疗效比普通治疗提高2～3倍,且医药费用平均降低23.6%.     

延迟小结追加反馈对基础护理操作技能学习的影响

目的 探讨基础护理操作技能教学中延迟小结追加反馈对教学效果的影响.方法 随机抽取护理专业2003级2个专科班的125名学生分为控制班(62人)、实验班(63人).在基础护理操作技能教学中控制班采用同步追加反馈,反馈频率为100%,反馈内容为操作错误的信息;实验班采用延迟小结追加反馈,反馈频率为25%～30%,反馈内容为操作错误以及正确操作的信息.结果 控制班在技能获得阶段操作成绩显著高于实验班(P＜0.01),但在随后保持阶段的测试中成绩逐渐下降并显著低于实验班(P＜0.01).结论 练习过程中追加反馈的内容、时机和频率对基础护理操作技能的教学效果有影响.同步追加反馈可以保证技能习得阶段的表现却不利于技能的保持;延迟小结性反馈最有利于基础护理操作技能的学习.     

2型糖尿病下肢血管病变超声诊断的临床应用价值

目的:评价彩色多普勒超声对2型糖尿病(DM)下肢血管病变(LEAD)的诊断应用价值。方法:2型DM患者91例与41例同期住院非2型DM患者进行下肢血管彩色多普勒超声检查对照,并以踝肱压指数(ABPI)对比观察。结果:2型DM动脉硬化为弥漫性或多节段病变,单纯动脉硬化多为血管分叉处局灶性病变,2型DM患者下肢血管管腔的硬化斑块、狭窄、闭塞的发生率明显高于对照组,呈显著性差异(P<0.01)。硬化斑块的发生率以股动脉最常见,而管腔狭窄、闭塞率以累及腘动脉以下的远端动脉血管多见,胫前动脉受累最为明显(P<0.05)。结论:彩色多普勒超声是2型DM患者下肢血管病变检查的有效手段,可评估病变部位、阻塞的性质、病变长度以及解剖的异常,对早期诊断、预防及治疗具有重要的临床应用价值。