Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births

Objective  To compare perinatal mortality and severe perinatal morbidity between planned home and planned hospital births, among low-risk women who started their labour in primary care.
Design  A nationwide cohort study.
Setting  The entire Netherlands.
Population  A total of 529 688 low-risk women who were in primary midwife-led care at the onset of labour. Of these, 321 307 (60.7%) intended to give birth at home, 163 261 (30.8%) planned to give birth in hospital and for 45 120 (8.5%), the intended place of birth was unknown.
Methods  Analysis of national perinatal and neonatal registration data, over a period of 7 years. Logistic regression analysis was used to control for differences in baseline characteristics.
Main outcome measures  Intrapartum death, intrapartum and neonatal death within 24 hours after birth, intrapartum and neonatal death within 7 days and neonatal admission to an intensive care unit.
Results  No significant differences were found between planned home and planned hospital birth (adjusted relative risks and 95% confidence intervals: intrapartum death 0.97 (0.69 to 1.37), intrapartum death and neonatal death during the first 24 hours 1.02 (0.77 to 1.36), intrapartum death and neonatal death up to 7 days 1.00 (0.78 to 1.27), admission to neonatal intensive care unit 1.00 (0.86 to 1.16).
Conclusions  This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system.     

人骨关节炎滑膜组织cDNA文库的构建及分析

目的:构建骨关节炎滑膜组织的cDNA文库,为筛选与骨关节炎的发生特异相关的基因及探讨骨关节炎发病机制奠定基础。方法:实验于2006-01/10在深圳市人民医院骨关节科完成,选取骨关节炎患者滑膜,以Trizol一步法从骨关节炎滑膜组织中提取总RNA,分离纯化mRNA,反转录合成双链cDNA,以pBlueScriptII为载体,构建关节炎滑膜组织cDNA文库,对随机挑取的克隆进行鉴定。结果:①总RNA及mRNA的质量:总RNA经分光光度计测定,测得mRNA的A260nm吸光度值为0.245,平均得率为0.45g/L,A260nm/A280nm=1.84,无DNA、蛋白质及小分子污染。符合建库要求。②cDNA的合成及分析:10μg mRNA反转录合成cDNA,合成的cDNA大小为0.5￣9.0kb,且主要集中在1.0￣2.0kb之间。③文库的鉴定:将50ng的cDNA与质粒载体pBlueScriptII连接过夜,采用电转化法转化受体菌DH5A,经稀释铺板测定原始文库的滴度为1.45×109pfu/L,总克隆数为4.6×105,重组率为96.2%,扩增后文库总滴度为6.4×1012pfu/L,插入片段多分布在0.5～2.6kb之间。结论:构建关节炎滑膜组织cDNA文库具有较好的库容量、较高的重组率以及较大的插入片段,为克隆关节炎相关功能基因的研究奠定了基础。     

早产儿维生素D需求

美国儿科学会建议新生儿、儿童、青少年尽早开始补充维生素D,推荐补充量为400IU/d,同时建议早产儿也应补充维生素D,但未指出早产儿维生素D的具体需要量.早产儿需要综合考虑胎儿及新生儿的健康需求,因此,调研维生素D的需要量,明确体内维生素D的状态,评价补充剂量的安全性及有效性对保证早产儿的健康有决定性意义.     

Concomitant administration of granulocyte transfusions and amphotericin B in neutropenic patients: absence of significant pulmonary toxicity

One hundred and ninety-five series of granulocyte transfusions in 144 patients were evaluated with respect to possible severe pulmonary toxicity from concomitant administration of granulocytes and amphotericin B. Dyspnea as a side effect of granulocyte transfusion was equally common among patients receiving amphotericin B and those in a matched control group not receiving amphotericin B. Granulocyte transfusions and amphotericin B were given simultaneously in 35 transfusion series, involving 32 patients. Respiratory deterioration, defined as the appearance of new pulmonary infiltrates on chest x-ray, occurred in 11 of these 35 episodes. Patients developing respiratory deterioration were similar to those not developing respiratory deterioration in age, diagnosis, disease status, duration of concomitant therapy, and outcome, but more often had positive fungal cultures as an indication for treatment (91% versus 58%; p = 0.1). In 8 patients, the episodes of respiratory deterioration were readily explained by congestive heart failure, by simultaneous bacteremia or fungemia, or by fungal pneumonia discovered at autopsy. One patient had a leukoagglutinin reaction (responsive to steroids) and the other 2 had unexplained, but reversible respiratory deterioration. We concluded that concomitant administration of granulocyte transfusions and amphotericin B is not associated with unexpected or rapidly fatal pulmonary toxicity and when appropriate, can be safely accomplished.     

Reduced length of hospital stay after the introduction of a rapid recovery protocol for primary THA procedures

Background and purpose Rapid recovery protocols after total hip arthroplasty (THA) have been introduced worldwide in the last few years and they have reduced the length of hospital stay. We show the results of the introduction of a rapid recovery protocol for primary THA for unselected patients in our large teaching hospital.

Patients and methods In a retrospective cohort study, we included all 1,180 patients who underwent a primary THA between July 1, 2008 and June 30, 2012. These patients were divided into 3 groups: patients operated before, during, and after the introduction of the rapid recovery protocol. There were no exclusion criteria. All complications, re-admissions, and reoperations were registered and analyzed.

Results The mean length of hospital stay decreased from 4.6 to 2.9 nights after the introduction of the rapid recovery protocol. There were no statistically significant differences in the rate of complications, re-admissions, or reoperations between the 3 groups.

Interpretation In a large teaching hospital, the length of hospital stay decreased after introduction of our protocol for rapid recovery after THA in unselected patients, without any increase in complications, re-admissions, or reoperation rate.