早产合并胎膜早破38例临床分析

目的探讨早产合并胎膜早破的原因,分析围产儿的并发症,寻找终止妊娠的时机。方法对2002年1月～2005年12月间38例早产合并胎膜早破病例资料进行回顾性分析。结果早产合并胎膜早破占分娩总数的2.27%。流产引产史、臀位、阴道炎、双胎为主要因素,在处理上积极保胎,尽可能让妊娠延续到34w以上,并争取促胎肺成熟治疗,减少新生儿RDS发生,但抑制宫缩治疗的效果不能肯定,同时预防性应用抗生素,一旦出现感染征象,不论胎龄高低均应终止妊娠。结论恰当处理早产合并胎膜早破,是减少早产儿并发症,降低早产儿病死率的关键。     

孕28～33~(+6)周胎膜早破期待治疗时间与妊娠结局的临床分析

目的:探讨孕28～33+6周胎膜早破(PROM)期待治疗时间对妊娠结局的影响。方法:回顾性分析103例孕28～33+6周PROM孕妇的临床资料。按孕周分为孕28～31+6周45例和孕32～33+6周58例。按期待治疗时间长短分为两个亚组:A组期待治疗时间<3 d;B组期待治疗时间≥3 d。比较各组孕产妇及早产儿并发症差异。结果:①孕28～31+6周PPROM组新生儿窒息率、新生儿呼吸窘迫综合征(NRDS)发生率和早产儿病死率及孕产妇宫内感染率均高于孕32～33+6周组,差异有统计学意义(P<0.05)。②孕28～31+6周A组早产儿病死率高于B组,差异均具有统计学意义(P<0.05),但两组新生儿窒息率和NRDS发生率差异无统计学意义(P>0.05);孕32～33+6周A组新生儿窒息率、NRDS发生率和早产儿病死率均高于B组,差异具有统计学意义(P<0.05)。③孕28～31+6周和孕32～33+6周B组宫内感染率均高于A组,差异均具有统计学意义(P<0.05),两组产褥感染率差异无统计学意义(P>0.05)。结论:针对不同孕周未足月胎膜早破患者的处理有不同策略,适当延长期待治疗时间可以改善妊娠结局。     

Coronary artery bypass grafting bundled payment proposal will have significant financial impact on hospitals

Objectives

The Centers for Medicare and Medicaid Services plans to institute a 5-year trial of bundled payments for coronary artery bypass grafting through 90 days after discharge. To investigate the impact, we reviewed actual inpatient costs for patients undergoing bypass surgery relative to the target price.

The value of patient-reported outcomes in colon and rectal surgery

Quality in surgery is often assessed in terms of perioperative complications, such as surgical site infections and readmissions. Although patients are the ultimate end-users of surgical care, the impact of surgical care on aspects of health that are most important to them, such as functional status, is rarely assessed. Value is in the eye of the beholder. Patient-reported outcomes provide patients a voice in the assessment of their care quality, and brings greater accountability into the assessment of value.     

Patient‐reported outcome measures (PROMs): A review of generic and condition‐specific measures and a discussion of trends and issues

BackgroundPatient‐reported outcome measures (PROMs) are questionnaires that collect health outcomes directly from the people who experience them. This review critically synthesizes information on generic and selected condition‐specific PROMs to describe trends and contemporary issues regarding their development, validation and application.MethodsWe reviewed academic and grey literature on validated PROMs by searching databases, prominent websites, Google Scholar and Google Search. The identification of condition‐specific PROMs was limited to common conditions and those with a high burden of disease (eg cancers, cardiovascular disorders). Trends and contemporary issues in the development, validation and application of PROMs were critically evaluated.ResultsThe search yielded 315 generic and condition‐specific PROMs. The largest numbers of measures were identified for generic PROMs, musculoskeletal conditions and cancers. The earliest published PROMs were in mental health‐related conditions. The number of PROMs grew substantially between 1980s and 2000s but slowed more recently. The number of publications discussing PROMs continues to increase. Issues identified include the use of computer‐adaptive testing and increasing concerns about the appropriateness of using PROMs developed and validated for specific purposes (eg research) for other reasons (eg clinical decision making).ConclusionsThe term PROM is a relatively new designation for a range of measures that have existed since at least the 1960s. Although literature on PROMs continues to expand, challenges remain in selecting reliable and valid tools that are fit‐for‐purpose from the many existing instruments.Patient or public contributionConsumers were not directly involved in this review; however, its outcome will be used in programmes that engage and partner with consumers.     

148例胎膜早破的治疗及护理研究

目的 探讨胎膜早破对母儿影响、处理方法及护理.方法 对148例胎膜早破临床资料进行回顾性分析.结果 我院从2009年1月至2010年12月2年来共分娩2135例,其中发生胎膜早破148例,占产科分娩总教的6.93%,经正确治疗与护理胎膜早破中自然分娩83例,占56.08%;剖宫产65例,占43.92%.无产妇及围生儿死...     

胎膜早破的防治与护理

胎膜早破（prematurerupture of membrane，PROM）是指在临产前胎膜破裂。是多种原因共同作用的结果，对母体、胎儿都有严重影响，所以应当积极的预防和治疗。     

Heterogeneity of hepatocellular carcinoma contributes to cancer progression

Hepatocellular carcinoma (HCC) is a highly heterogeneous disease displaying differences in angiogenesis, extracellular matrix proteins, the immune microenvironment and tumor cell populations. Additionally, genetic variations and epigenetic changes of HCC cells could lead to aberrant signaling pathways, induce cancer stem cells and enhance tumor progression. Thus, the heterogeneity in HCC contributes to disease progression and a better understanding of its heterogeneity will greatly aid in the development of strategies for the HCC treatment.     

Predictors and Clinical Outcomes of Next-Day Discharge After Minimalist Transfemoral Transcatheter Aortic Valve Replacement

Objectives

This study sought to investigate predictors and safety of next-day discharge (NDD) after transcatheter aortic valve replacement (TAVR).

Management of Patients With Aortic Valve Stenosis

With increased life expectancy and aging of the population, aortic stenosis is now one of the most common valvular heart diseases. Early recognition and management of aortic stenosis are of paramount importance because untreated symptomatic severe disease is universally fatal. The advent of transcather aortic valve replacement technologies provides exciting avenues of care to patients with this disease in whom traditional surgical procedures could not be performed or were associated with high risk. This review for clinicians offers an overview of aortic stenosis and updated information on the current status of various treatment strategies. An electronic literature search of PubMed, MEDLINE, EMBASE, and Scopus was performed from conception July 1, 2016, through November 30, 2017, using the terms aortic stenosis, aortic valve replacement, transcatheter aortic valve replacement (TAVR), transcatheter aortic valve insertion (TAVI), surgical aortic valve replacement, aortic stenosis flow-gradient patterns, low-flow aortic valve stenosis, natural history, stress testing, pathophysiology, bicuspid aortic valve, and congenital aortic valve disease.