不同基质对复方卡力孜然凝胶剂主要活性成分体外透皮吸收的影响

目的研究不同基质对复方卡力孜然凝胶剂(补骨脂、蛇床子、斑鸠菊、何首乌等)3种有效成分体外经皮渗透的影响,优选复方卡力孜然凝胶剂的基质。方法采用改良Franz扩散池法、离体大鼠皮肤进行体外透皮实验,高效液相色谱法测定,考察卡波姆(CP)、羟丙甲纤维素(HPMC)、羧甲基纤维素钠(CMC-Na)、卡波姆+聚乙烯吡咯烷酮(CP+PVP)4种基质对3种有效成分补骨脂素、异补骨脂素及蛇床子素的累积透过量及透皮速率的影响。结果 4种基质对复方卡力孜然凝胶剂中补骨脂素、异补骨脂素及蛇床子素体外透皮吸收产生不同的影响,其中以CP+PVP为基质的体外透皮速率最大。各基质的体外透皮释放均符合Higuchi方程。结论 CP与PVP联用是复方卡力孜然凝胶剂的最适基质。     

产时胎儿手术应用欣母沛预防母体产后出血的临床研究

目的观察在产时胎儿手术中应用欣母沛的母体产后出血量及预后,探讨产时胎儿手术预防产时和产后出血的最佳措施及在产时胎儿手术中应用欣母沛的可行性和安全性。方法回顾性分析2008年8月-2010年12月成功施行产时胎儿手术的15例患者[产时胎儿手术组(IFO组),n=15],其中应用缩宫素+卡孕栓者7例(常规IFO组,n=7),应用欣母沛+缩宫素+卡孕栓者8例(欣母沛组,n=8),观察两组患者术中及术后24 h内出血量,术前和术后24 h的血红蛋白水平,宫缩情况,产褥感染的发生情况,产后42 d随访情况,并与同期因拒绝试产行择期剖宫产手术的10例健康孕妇进行对照。结果三组患者的子宫复旧情况均正常,均无早期及晚期产后出血的发生,无产褥感染发生。IFO组母体术中出血量、术后24 h及术中+术后24 h总出血量与对照组相比差异均无统计学意义(P>0.05)。其中欣母沛组术中出血量、术后24 h及术中+术后24 h总出血量显著少于常规组(P<0.05)。IFO组与对照组之间术前和术后及产后42 d复查的血红蛋白浓度差异均无统计学意义(P>0.05),而欣母沛组术前术后血红蛋白浓度差值显著低于常规组(P<0.05)。应用欣母沛后有1例出现腹胀,12 h后缓解;1例出现呃逆,6 h后消失,未见其他药物不良反应。结论于产时胎儿手术期间应用欣母沛较常规使用缩宫素可明显减少术中和产后出血量,是一项有效的预防产后出血的措施。     

Clinical risk factors for poor neonatal outcomes in umbilical cord prolapse

Objectives: To clarify the clinical risk factors associated with poor neonatal outcomes due to umbilical cord prolapse (UCP).

Methods: A postal questionnaire survey was attempted in Japan. The clinical risk factors and managements associated with poor neonatal outcomes were analyzed in cases of UCP treated in Japan.

Results: A total of 267 cases of UCP (out of 2?037?460 total deliveries) were analyzed. The rates of intrauterine death, neonatal death and survival with disability were 3.4%, 5.6% and 7.1%, respectively. The multivariate regression analysis for these poor neonatal outcomes revealed that the significant risk factors included a prolapsed amniotic sac (adjusted odds ratio (aOR), 4.49), preterm labor (aOR, 2.99) and replacement of the prolapsed umbilical cord into the uterus (aOR, 2.87). However, UCP that occurred during labor (aOR, 0.28) and emergency cesarean section (aOR, 0.11) were associated with a reduction in the rates of poor outcomes. The interval between the diagnosis of UCP and delivery was significantly longer in the infants with a poor outcome than intact survival (median 30 versus 24?min, p?=?0.048).

Conclusion: An emergency cesarean section should be carried out immediately to ensure a better outcome for the infant.     

Modified Delphi Study on Nursing Practice and Science in Fetal Care

ObjectiveTo identify essential structures, processes, outcomes, and challenges of nursing practice in fetal care and to identify research priorities for nurses in fetal care.DesignWe used a modified Delphi method to achieve consensus.SettingA secure online survey platform.ParticipantsThe expert panel included nurses from the Fetal Therapy Nurse Network. In addition, a multidisciplinary research jury included members of the North American Fetal Therapy Network (NAFTNet).MethodsWe collected data in three consecutive rounds with online questionnaires that were e-mailed to panelists. We used content analysis to generate statements from an initial round of open-ended questions. Statements met consensus if 75% of the panelists ranked it as greater than or equal to 6 on a 1-to-7 Likert scale.ResultsThe 48 nurse panelists and 11 multidisciplinary jury members described a range of nursing processes. Consensus was reached on 96 statements related to the structure, processes, outcomes, and research priorities of nurses in fetal care.ConclusionThe participants agreed that an expert fetal care nursing team is necessary to provide care to women and families during fetal diagnosis and treatment. Ideally, these nurses should coordinate care and provide direct clinical care (e.g., patient counseling) in outpatient prenatal settings and inpatient settings when fetal surgery is involved. Nurses should be supported to take on leadership roles in program development, research, quality improvement, and professional development with relevant professional organizations.     

Clinical features of polyhydramnios associated with fetal anomalies

The purpose of this study was to examine the clinical features of pregnancy complicated by polyhydramnios associated with fetal anomalies. Sixty-nine patients with a singleton pregnancy complicated by polyhydramnios were retrospectively analyzed. Based on prenatal ultrasonographic findings, 13 cases were considered to have idiopathic polyhydramnios and the remaining 56 cases were associated with fetal anomalies. Between these two groups, no significant difference was found in the gestational weeks when polyhydramnios developed. However, significant difference was noted in the maximum amniotic fluid index (AFI) values during the pregnancy period; 25.4 +/- 2.7 cm in the former, and 30.6 +/- 8.9 cm in the latter (P = 0.0004). In all of 13 cases with idiopathic polyhydramnios, AFI values remained less than 30 cm until delivery. Twenty-two patients (39%) with fetal anomalies required a prenatal treatment such as amnioreduction and tocolysis, whereas only one patient (7.7%) with idiopathic polyhydramnios needed tocolysis therapy (P = 0.03). There was a significant risk of premature delivery with fetal anomalies (35.6 +/- 3.9 weeks' gestation vs. 38.8 +/- 1.5 weeks' gestation, P = 0.004) because of refractory polyhydramnios, rupture of membranes, non-reassuring fetal status, and intrauterine fetal death, and although most infants with idiopathic polyhydramnios were appropriate-for-dates, many of the infants with congenital anomalies were small-for-dates. Significant risk of fetal anomalies should be considered in pregnant women with severe polyhydramnios (AFI > or = 30 cm), an increased trend of amniotic fluid during the pregnancy period, polyhydramnios requiring a prenatal treatment, or fetal growth restriction. On the other hand, based on our experience, a fetus without these conditions seems to have a low risk of congenital anomalies even if polyhydramnios is noted.     

脐血CD3AK细胞和其培养上清诱导K562细胞凋亡

目的　探讨脐血CD3 AK细胞和其培养上清 (CS)诱导K562 细胞凋亡。方法　用细胞形态学观察 ,DNA琼脂糖电泳 ,原位末端标记法检测K562 ,CD3 AK细胞诱导的K562 ,CS诱导的K562 细胞凋亡率。结果　K562 细胞自然凋亡率 3.5 0± 0 .97% ;CD3 AK细胞诱导的K562 细胞凋亡率 2 7.38± 4.91% ,P <0 .0 1,CS诱导的K562 细胞凋亡率为 33.0 9± 5 .2 2 % ,P <0 .0 1。结论　脐血CD3 AK细胞和其培养上清能诱导K562 凋亡。     

糖皮质激素促肺成熟作用的研究进展

大量研究证实围生期使用糖皮质激素可促进肺成熟,显著降低新生儿呼吸窘迫综合征的发病率和病死率.其作用机制主要是促进肺泡发育和肺表面活性物质系统的成熟.同时,围生期使用糖皮质激素对胎儿和新生儿造成的不良影响正受到越来越多的关注.产前重复使用糖皮质激素和生后早期静脉使用糖皮质激素的安全性仍不确定.糖皮质激素的给药途径、不同剂量糖皮质激素的作用效果和机制仍需深入研究.该文对近年来产前使用糖皮质激素和新生儿早期使用糖皮质激素促肺成熟作用的临床研究和动物实验研究进行综述.