Relation of supplementary feeding to resumptions of menstruation and ovulation in lactating postpartum women

Background Resumption of menstrual cycles is one of the indicators for restoration of reproductive capability in postpartum women. However, menstruation does not necessarily mean that ovulation has taken place. The aim of this study was to investigate the relation of supplementary feeding to return of menstruation and ovulation after delivery. Methods A questionnaire was used to obtain data from 101 breastfeeding mothers. The following elements were analyzed: age, education level, breastfeeding practice, time of return of menstruation, contraceptive practice, and starting time of supplementary feeding during the lactation at intervals of 6 weeks to 18 months after delivery. The ovulation was continuously monitored by ultrasonography and basal body temperature (BBT) measurement.Results By ultrasonography, 53 of the 101 women (52.5%) had the first ovulation (follicle >1.8 cm in diameter) within 154 days after delivery on average, among whom 11 (10.9%, 11/101) had restoration of ovulation within 4 months and 42 (41.6%, 42/101) had it after 4 months. In women with follicles >1.8 cm in diameter (n=53), the menstruation resumed (138±84) days after delivery, and the supplementary feeding was started at (4.0±1.1) months, which were significantly earlier than those in the women with follicular diameter <1.7 cm (n=48; (293±88) days, (5.1±1.3) months; t=9.003, P<0.01 and t=4.566, P<0.01). In the women with follicles >1.8 cm in diameter, 30 had return of menstruation before the end of ultrasonographic monitoring, while only 8 in the women with follicular diameter <1.7 cm had menstrual resumption at the same time (χ²=16.91, P<0.01). The starting time of supplementary feeding was positively correlated with the time of the restoration of menstruation (n=100, r=0.4764, P<0.01) and first ovulation after delivery (n=53, r=0.5554, P<0.01). In this series, no woman had pregnancy within 18 months postpartum.Conclusion Supplementary feeding can affect the restoration of menstrual cycles and ovulation in lactating postpartum women.     

量化脑电分析方法及其在癫痫易发作期检测中的应用

对于癫痫患者,癫痫易发作期(seizure vulnerable period,SVP)的检测有助于预测癫痫发作并采取相应的治疗和抑制措施.本文采用量化脑电分析方法研究癫痫易发作期的临床诊断价值.对经过带通滤波预处理的量化脑电信号分析得到反映大脑状态的线性特征量(过零率和谱距)和非线性特征量(最大Lyapunov 指数、复杂度、相位同步和互信息),以及比较不同导联之间的特征差异,并将它们应用于慢性颞叶癲痫大鼠模型长时程连续脑电数据和癫痫病人临床脑电数据的分析.癫痫易发作期与正常状态期间对比,分析单个导联特征量变化趋势得到最大Lyapunov指数、复杂度和过零率的值下降,而相位同步、互信息和谱距的值上升;选择两个合适的导联,分析不同导联之间的特征差异是最大Lyapunov指数、复杂度、相位同步、互信息和过零率差异减小或趋于一致,而谱距的差异增大.结果表明量化脑电特征量可以反映癫痫易发作期相对正常状态期间的变化,并且有些特征变化在每次集中发作的第一次发作之前较长的一段时间内就开始了,即进入癲痫易发作期的时刻相对第一次发作时刻在时间上具有一个提前量,这个时间提前量为临床处置提供了前提.     

Mothers' health and work-related factors at 11 weeks postpartum

PURPOSE Many new mothers return to work soon after childbirth. This study examines personal and work-related factors associated with the postpartum health of employed women 11 weeks after childbirth.METHODS Using a prospective cohort design, we recruited 817 Minnesota mothers into the study while they were hospitalized for childbirth in 2001. Telephone interviews were conducted at 5 and 11 weeks postpartum. Eligible women were 18 years or older, employed, and spoke English and gave birth to a singleton infant. Multivariate models using instrumental variables (2-stage least squares) were used to estimate personal and employment characteristics associated with women’s physical and mental health and postpartum symptoms.RESULTS At 11 weeks postpartum, 661 participants (81% of enrollees) completed a full interview, and 50% of participants had returned to work. On average, women reported 4.1 (SD 3.2) childbirth-related symptoms, most frequently fatigue (43%). Factors significantly associated with better health outcomes included better preconception health, the absence of prenatal mood problems, more control over work and home activities, more social support at work and home, and less job stress.CONCLUSIONS The findings suggest postpartum women need to be evaluated regarding their fatigue levels and mental and physical symptoms. Women whose fatigue or postpartum symptoms limit daily role function may find it helpful to have health care clinicians counsel them on strategies to decrease job stress, increase social support at work and home, and certify their use of intermittent family and medical leave to help them manage their symptoms.     

AAI监测下不同麻醉镇静深度对肿瘤患者围术期炎性因子的影响

目的:探讨不同镇静麻醉深度对肿瘤患者围术期炎性细胞因子的影响,为肿瘤患者选择适宜的麻醉深度,减少围术期炎症反应维护术后免疫力,保护患者免疫功能,提供依据。方法:选择2017年08月-2019年01月我院普外科择期行消化道肿瘤根治性切除患者66例,年龄34~88岁,体重40~95 kg,采用随机数字表法,将患者随机分为3组。应用听觉诱发电位指数（AAI）监测镇静麻醉深度,分为浅镇静麻醉组(AAI值在40-30范围内)、深镇静麻醉组(AAI值在29-20范围内)、传统麻醉组,根据血压、心率波动及制动、流泪、呛咳等指标及麻醉医师的经验调控镇静麻醉深度。分别于手术开始前即刻（T1）、手术开始后2 h（T2）、手术后24 h（T3）、手术后48 h（T4）及72 h（T5）时点检测患者血清白介素-2(IL-2 )、白介素-4(IL-4)和肿瘤坏死因子(TNF-α)浓度。结果:组间比较,IL-2血浆浓度T1时点浅麻醉组与传统组比较,浅麻醉组明显降低（P＜0.05）;T4和T5时点深麻醉组与传统组比较,深麻醉组明显降低（P＜0.05）,其余时点比较无统计学差异。IL-4血浆浓度比较,T2和T4时点浅麻醉组与传统组比较,浅麻醉组明显降低（P＜0.05）;T4时点浅麻醉组与深麻醉组比较,深麻醉组明显升高（P＜0.05）。TNF-α血浆浓度比较,T1、T2和T4时点浅麻醉组与传统组比较,浅麻醉组明显降低（P＜0.05）,T1时点浅麻醉组与深麻醉组比较,深麻醉组明显升高（P＜0.05）。结论:浅镇静麻醉即AAI值在40-30范围比深镇静麻醉即AAI值在29-20时可以更好的保护肿瘤患者围术期Th1细胞介导的细胞免疫功能,降低IL-4对细胞免疫的抑制作用,控制过度的炎症反应,保护患者免疫状态,帮助患者更好的康复。     

四维超声对前列腺运动靶体积分辨能力的研究

目的 探究四维(4D)超声对运动靶体积分辨能力。方法 选用前列腺超声模型,分组对比研究应用4D超声在不同运动振幅(A)及运动周期(T)下勾画前列腺靶区,模拟A值分别设置为0.5、1.0、2.0、3.0、4.0、5.0 mm,t值设为1、2、3、4s。分别计算模体前列腺靶体积,并以靶区静止时超声图像作为对照,分析两者间差异。结果 模体静止时超声靶体积与CT靶体积大小有较高一致性(P>0.05)。A值为0.5、1.0 mm,t值为1~4s时的体积与静止时超声靶体积相近(均P>0.05);A值为2.0、3.0 mm,t值为1~3s时靶体积与静止时超声靶体积不同(均P<0.05)。A值为2.0 mm,t值为4s时靶体积与静止时超声靶体积相近(P=0.710),组内极差为6.7cm³,标准差为1.15cm³;A值为3.0 mm,t值为4.0s时靶体积重复性差,组内极差为14.4cm³;A值为4.0、5.0 mm,t值为1~4s时组内极差分别为3.27~17.63cm³、6.51~21.02cm³。各周期下靶体积重复性很差,不能满足临床要求。结论 4D维超声可在患者运动周期1~4s内、运动幅度≤1 mm内为患者靶区勾画提供可靠参考数据,探头初始位置无影响。     

The co-occurrence of smoking and a major depressive episode among mothers 15 months after delivery

OBJECTIVE: To examine the association between maternal smoking 15 months after delivery and the occurrence of a major depressive episode in the prior 12 months. METHODS: Data were obtained from the Fragile Families and Child Wellbeing Study, a birth cohort study. In 20 U.S. cities, 4898 mothers were surveyed at delivery in the years 1998 to 2000. In a survey 15 months later, 4353 (89%) of the mothers reported their smoking behavior and symptoms of a major depressive episode during the prior 12 months. RESULTS: At the follow-up survey, 26.6% of mothers reported that they were current smokers and 13.6% reported that they had symptoms of a major depressive episode during the prior 12 months. After adjusting for sociodemographic characteristics, the prevalence (95% confidence interval) of a major depressive episode was higher among smokers than nonsmokers: 17.7% (15.7%, 19.8%) vs. 12.1% (10.9%, 13.3%). Smoking was also more common among mothers with a major depressive episode than in those without one: 34.0% (30.6%, 37.4%) vs. 25.5% (24.1%, 26.8%). CONCLUSION: Smoking and depression often co-occur among mothers with infants. This suggests that these conditions should not be diagnosed or treated in isolation from each other and that the care of mothers and children should be integrated.     

An analysis for a cross-over cohort study with an application to the study of triggers of Menière's disease

When studying the effect of a transient exposure on the risk of a rare illness, for time and cost effectiveness it is desirable to follow a cohort of individuals who are 'prone' to the illness over an observation period. In this paper, we present a method of analysis for data arising from such a study. The proposed method can be used to estimate the relative risk of an exposure triggering the illness and the distribution of the time delay from exposure to the onset of illness. The model is extended to include covariate effects and to the situation where there are two types of exposure. For the two types of exposures situation, a model to handle a possible synergism of the exposures is proposed. Finally, the method is applied to study the potential triggers of attacks of Menière's disease.     

新生期肺炎链球菌肺炎对气道平滑肌表型的影响

目的研究新生期肺炎链球菌肺炎(Streptococcus pneumoniae pneumonia,S.pp)对气道平滑肌表型的影响。方法Balb/c小鼠出生后第7天鼻腔滴注2×107CFU肺炎链球菌5μl建立新生期S.pp模型,对照组滴注等量PBS。感染5周后收集肺组织标本,免疫组织化学检测气道平滑肌肌层厚度;RT-PCR检测气道平滑肌Acta2-mRNA、My11-mRNA、Tagln-mRNA表达量;Western blot检测α-SMA、SMMHC、SM22α蛋白表达量。结果 S.pp组气道平滑肌面积(α-SMA+area/Pbm)较对照组显著增加(46.06±10.74 vs 22.50±9.131,P<0.01),平滑肌收缩蛋白SMMHC面积(SMMHC+area/Pbm)较对照组明显增加(58.33±29.40 vs19.75±13.10,P<0.05),2组间平滑肌收缩蛋白SM22α面积(SM22α+area/Pbm)无统计学差异(37.20±10.67 vs 41.33±5.871,P>0.05);Western blot分析发现S.pp组小鼠肺组织α-SMA、SMMHC蛋白较对照组显著升高(分别为1.352±0.552 9 vs 0.633 0±0.157 5,P<0.05;1.291±0.487 2 vs 0.776 8±0.279 3,P<0.01),肺组织SM22α蛋白表达水平差异无统计学意义(1.435±0.436 5 vs 1.398±0.437 3,P>0.05);RT-PCR检测发现S.pp组Acta2-mRNA、My11-mRNA表达水平较对照组显著增加(分别为2.704±1.044 vs0.906 5±0.214 8,P<0.01;1.780±0.454 6 vs 1.183±0.369 9,P<0.05),而2组间Tagln-mRNA表达水平无统计学差异(1.438±0.321 3vs 1.207±0.334 5,P>0.05)。结论新生期肺炎链球菌肺炎可诱导气道平滑肌表型改变,促进气道高反应性形成。     

影像导航引导椎体成形术治疗疼痛性骨质疏松压缩性骨折围手术期护理

目的探讨导航条件下椎体成形术治疗疼痛性骨质疏松压缩性骨折围手术期护理。方法重点对48例(76个椎体)用虚拟X线导航引导经皮椎体成形术治疗骨质疏松脆性骨折的患者进行心理护理,做好各种术前准备、术前宣教,术后加强观察和护理,积极预防可能出现的并发症及早期进行功能锻炼。结果该组患者手术在导航指引下均获成功,配合围手术期的精心护理,疼痛强度VAS评分在术后明显改善,注射椎体无塌陷,无严重护理并发症发生。结论在影像导航引导下,能提高经皮椎弓根穿刺的安全性、缩短术时、减少X线辐射,加强心理护理、详细的健康教育以及安全的术前术后护理,是提高手术成功率和患者恢复的重要保证。     

高职护生实习期间人文关怀能力的调查研究

目的 本研究通过对泰州市人民医院护理实习生的人文关怀能力现状进行调查和分析,以期对护理专业高职院校和教学医院开展连续性、高效性的护理人文关怀教育提供一定的依据.方法 本研究采用"自评"和"他评"两者相结合的方法.其中,"自评"选用的是黄戈冰研制的《护理专业大学生人文关怀能力量表》,采用问卷调查法对262名在本院实习满8个月及以上的实习护生进行调研;"他评"选用的是台湾学者李皎正研制的关怀行为量表,采用问卷调查法从本院102例住院患者的角度评价这些护生的人文关怀行为.结果 "自评"结果显示,"3+2"五年制高职护生和三年制高职护生的人文关怀能力总得分分别为(106.45±19.48)分和(121.65±20.67)分(P<0.05);"他评"结果显示,"3+2"五年制高职护生和三年制高职护生的人文关怀行为得分分别为(87.29±16.76)分和(94.71±17.55)分(P<0.05).结论 三年制高职护生的人文关怀能力高于"3+2"五年制高职护生,但两组护生的人文关怀能力总体均偏低,这提示护理专业高职院校和教学医院应加强合作,借鉴、探索切实有效的培养策略,构建连续性护理人文关怀教育模式.