Pregnancy outcomes in women with type 1 diabetes in China during 2004 to 2014: A retrospective study (the CARNATION Study)

BackgroundWe aimed to report pregnancy outcomes of women with type 1 diabetes (T1D) in China, on which data were sparse.MethodsThis is a nationwide retrospective study conducted in 11 general medical centers in 8 cities across China. We investigated the clinical data of all women who attended these centers with a singleton pregnancy and whose pregnancy ended between 1 January 2004 and 31 December 2014. Pregnancies of women with pregestational T1D were ascertained and compared with those of women without T1D.ResultsFrom over 300 000 pregnancies over the 11‐year study period, we identified 265 singleton pregnancies of women with T1D. One maternal death was documented among 265 (0.37%) women with T1D and 83 among 318 486 (0.03%) women without T1D. Women with T1D suffered from higher rates of pregnancy loss (13.21% vs 2.92%, crude risk ratio [cRR] 5.08 [95% CI, 3.56‐7.26]) and preeclampsia (17.74% vs 4.20%, cRR 4.94 [95% CI, 3.60‐6.77]) compared with those without T1D. Infants of these women with T1D had elevated rates of neonatal death (5.65% vs 0.16%, cRR 37.36 [95% CI, 21.21‐65.82]) and congenital malformation(s) (8.26% vs 3.53%, cRR 2.46 [95% CI, 1.54‐3.93]) compared with those of women without T1D. No significant improvement in pregnancy outcomes in women with T1D was observed over the period 2004 to 2014.ConclusionsPregnancy outcomes were persistently poor in women with T1D during 2004 to 2014 in China. Pregnancy care needs to be improved to reduce adverse pregnancy outcomes among Chinese women with T1D.     

胰腺肌周细胞瘤的病理特征及诊治（附1例报告并文献复习）

目的探讨胰腺肌周细胞瘤的病理特征及其诊治。方法报告本院收治的1例胰腺肌周细胞瘤,并复习近年来国内外文献肌周细胞瘤的临床病理特征、诊断、鉴别诊断、治疗及预后。结果胰腺肌周细胞瘤为具有嗜酸性/嗜双性的圆形、卵圆形细胞围绕血管腔形成的典型的同心圆状结构。血管周同心圆Υ排列的肌样细胞表达SMA及Actin阳性,而其他肌性标记物Desmin、S-100蛋白、HBM45及CD34等为阴性。结论胰腺肌周细胞瘤属于良性肿瘤,临床表现无特异性,确诊须靠病理组织学检查,完整切除肿瘤是本病的理想治疗方法。     

重症甲型H1N1流感并发急性呼吸窘迫综合征的临床特点及危险因素分析

目的：分析重症甲型H1N1流感并发急性呼吸窘迫综合征（ARDS）的临床特点及危险因素。方法采用回顾性研究方法分析2009年10月至2010年2月首都医科大学附属北京地坛医院收治的28例重症甲型H1N1流感并发ARDS患者的临床特征,比较治愈组（13例）和死亡组（15例）患者的临床特点,采用多变量Logistic回归分析其危险因素。结果28例患者中男性14例,女性14例,年龄11～80岁,肥胖6例（21%）,妊娠5例（18%）,主要临床表现是高热、肌痛、呼吸困难及咯血痰。28例患者都继发细菌或真菌感染。入组患者均给予机械通气、奥司他韦抗病毒及糖皮质激素治疗,4例（14%）患者给予体外膜肺氧合（ECMO）治疗;治愈13例（46%）,死亡15例（54%）。89%（25/28）患者血糖升高,基础患有糖尿病4例患者死亡,病死组患者白细胞计数及APACHEⅡ评分显著升高,死亡组继发消化道出血的比例显著高于治愈组,差别有统计学意义。结论咯血痰及APACHEⅡ评分升高是重症甲型H1N1流感并发ARDS患者死亡的高危因素。     

临床药师对初诊糖尿病患者的教育计划

目前糖尿病患者一般需终身服药,制定初诊糖尿病患者的系统教育计划,对提高患者治疗的依从性,减少慢性并发症的发生,提高生存率有重要意义.本文依据2005版《中国糖尿病防治指南》"糖尿病的管理和教育",制定本计划.旨在帮助患者了解糖尿病的基本知识,糖尿病的治疗方法,掌握自我管理的技巧.     

Referral for a Bariatric Surgical Consultation: It is Time to Set a Standard of Care

Indications for bariatric surgery have been clear for some time and many would say that they are conservative. Unfortunately few eligible candidates seek or are referred for bariatric surgery, with less than 1% currently treated annually. In recent years, the evidence base supporting surgical therapy has strengthened with demonstrable improvements in both safety and efficacy. We now have evidence of remarkable improvements in health, quality of life, and increased life expectancy. There is continued frustration with the poor efficacy of non-surgical therapies and no indication that this is about to change. A caring physician should, as best care, refer the seriously ill morbidly obese patient for a surgical opinion. It is no different from their obligation to adequately manage type-2 diabetes, depression or unstable angina. Currently, even discussion of a surgical referral is optional. It is time we articulated and defined a group of patients where referral for a surgical opinion is no longer merely an option but a physician’s responsibility as best care for the patient. It is time to provide leadership towards the delivery of better care for these patients.     

腹腔镜联合肾镜液电碎石仪在基层医院胆道结石手术的运用

【摘要】〓目的〓探讨与研究基层医院在胆道结石手术中运用腹腔镜联合肾镜液电碎石仪的可行性与实用性。方法〓选取我院于2013年1月至2014年1月在我院行手术治疗的胆囊结石合并肝内外胆管结石患者53例,均采用腹腔镜联合肾镜探查液电碎石仪治疗术式,通过观察患者手术时间、术中术后胆道出血、术后胆道结石残余、术后住院时间。结果〓53例患者均顺利完成手术,无中转开腹。术中35例采用液电碎石,每例碎石次数约3~10次,每次持续放电约2~3秒,其中2例较大者反复击打约15次。术中胆道出血者3例,没有出现难以控制的出血以及胆管穿透或胆管壁撕裂病例。术后平均住院时间7.1±2.6天,无腹腔感染病例。所有患者均得到术后半年随访,2例发现术后结石残余,经消化内镜取石。未发现胆总管狭窄病例。 结论〓腹腔镜联合肾镜液电碎石仪治疗胆道结石,在基层医院中有一定的可行性与实用性。     

肺放线菌病的临床和CT表现特征分析

肺放线菌病是一种少见的慢性肺化脓性肉芽肿性炎症,病变以局部化脓或肉芽肿性炎症、多发脓肿、瘘管窦道形成和分泌含硫磺颗粒脓液为特征[1].放线菌感染可侵及全身各个器官,肺放线菌病约占人体放线菌病15％,仅次于头颈部(55％)和盆腹部(20％)放线菌病[2-3].肺放线菌病无特征性临床表现,常误诊为肺结核、肺脓肿、肺癌等[4...     

黄体期长方案中人绒毛膜促性腺激素注射日血清孕酮水平与临床妊娠关系的研究

目的探讨黄体期长方案中人绒毛膜促性腺激素(HCG)注射日血清孕酮水平与临床妊娠的关系。方法回顾性分析2009年1月～2010年10月在温州医学院附属第二医院生殖中心行黄体期长方案且有完整资料的370个IVF周期。以1.0、1.5、2.0、2.5、3.0ng/ml分别作为截断值,比较不同截断值时高低孕酮组的一般临床资料、实验室指标及临床妊娠率。结果不同截断值时,两组的临床妊娠率无明显差别(P>0.05);当以1.0、1.5、2.0和2.5ng/ml为截断值时,高孕酮组获卵数、成熟卵数、HCG日雌二醇水平高于低孕酮组,差异有统计学意义(P≤0.05)。结论 IVF-ET黄体期长方案中HCG注射日孕酮水平在一定范围内升高对临床妊娠无影响,高孕酮水平可能是较多的卵泡同步发育造成的。     

述情障碍的发生机制及干预对策

本文目的是对述情障碍的发生机制及干预对策进行综述,以期为述情障碍的临床治疗和研究提供新的方向。述情障碍不仅与多种心身疾病有关,也广泛存在于抑郁症、焦虑症和进食障碍等精神疾病中,严重影响患者生活质量。本文从认知、神经和社会心理因素三个层面对述情障碍及其在不同疾病下的发生机制进行综述,并总结干预对策,旨在为述情障碍的临床治疗提供参考。     

奥沙利铂联合替吉奥治疗胃癌患者的疗效探讨

目的：对奥沙利铂联合替吉奥胶囊治疗胃癌的临床效果进行观察与有效性探讨。方法整群选取2013年7月—2015年7月医院住院收治的52例胃癌患者,男27例,女25例,随机分为对照组与实验组各26例,对照组主要利用替吉奥胶囊治疗,而实验组主要利用奥沙利铂联合替吉奥胶囊治疗,疗程均为3个月。评价疗效及不良反应。利用SPSS 17.0统计软件对两组患者的临床效果与不良反应进行对比性分析。结果治疗后,实验组患者RR为73.1%,对照组为38.4%,两组对比差异有统计学意义(P<0.05),“病症”(症状)与体征分别得到有效控制。结论利用奥沙利铂联合替吉奥胶囊治疗胃癌疾病效果显著,在临床应用与研究中都有极其显著的价值。