2013-2017年新疆伊犁州艾滋病母婴传播现状分析

目的 了解新疆伊犁州2013-2017年艾滋病母婴传播发生情况,探讨母婴传播的影响因素,为今后工作提供参考.方法 收集2013-2017年新疆伊犁州HIV感染孕产妇及所分娩婴幼儿的相关信息.通过描述性分析,x2检验了解HIV感染孕产妇及婴幼儿的一般特征,采用多因素logistic回归分析法,对HIV母婴传播的影响因素进...     

Effectiveness of the PRECEDE-PROCEED model for improving the care knowledge,skill, and sense of competence in mothers of preterm infants

ObjectiveThis quasi-randomized controlled trial was performed to evaluate the effects of the PRECEDE-PROCEED model (PPM) in enabling mothers of preterm infants to develop care knowledge, skill, and a sense of competence.MethodsAmong 116 mothers of preterm infants, 60 received traditional discharge education (control group) and 56 received PPM discharge education (PPM group). Improvement in knowledge and skills was transformed into the mothers’ routine daily care of infants. The primary outcome was knowledge of preterm infant care. The secondary outcomes were preterm infant care skills and a sense of competence, routine intervention compliance among mothers, and the readmission rate of infants 6 months after discharge.ResultsSix months after discharge, the mean knowledge score and mean skills score were significantly higher in the PPM group than in the control group. The mothers’ sense of competence with respect to both self-efficacy and satisfaction was also significantly better in the PPM group than in the control group. Moreover, intervention behavior compliance and the readmission rate were significantly better in the PPM group than in the control group.ConclusionCare knowledge, skills, and sense of competence in mothers of preterm infants improved after implementation of the PPM.     

肿瘤标志物检测对卵巢成熟、未成熟畸胎瘤的诊断价值

背景与目的:卵巢成熟、未成熟畸胎瘤术前鉴别诊断较困难,本研究期望通过血清肿瘤标志物联合检测的方法,为其诊断及鉴别诊断提供有价值依据。方法:收集1995年1月至2005年12月在中山大学肿瘤防治中心初治并经病理确诊为单纯型卵巢畸胎瘤的272例患者的临床资料,统计分析血清糖链抗原125(carbohydrate antigen125,CA125)、糖链抗原153(CA153)、糖链抗原199(CA199)、神经元特异性烯醇化酶(neuron specific enolase,NSE)、甲胎蛋白(alpha-fetoprotein,AFP)、癌胚抗原(carcinoembryonic antigen,CEA)的检测水平在卵巢成熟及未成熟畸胎瘤中的差异。结果:254例卵巢成熟畸胎瘤患者,中位年龄30岁,血清CA125、CA153、CA199、NSE、AFP、CEA平均值分别为25.5×103u/L,11.8×103u/L,106.6×103u/L,12.6μg/L,2.7μg/L和2.5μg/L。18例卵巢未成熟畸胎瘤患者,中位年龄23岁,上述6项指标的平均值分别为140.3×103u/L,16.8×103u/L,112.0×103u/L,18.0μg/L,369.5μg/L和3.2μg/L。未成熟畸胎瘤患者血清中CA125、CA153、AFP平均水平及表达阳性率均高于成熟畸胎瘤患者,差异有统计学意义(P<0.05)。单独应用一项指标,CA125、CA153、AFP对未成熟畸胎瘤诊断性能的特异度均较高,而CA125的灵敏度最高(50.0%)。使用CA125、CA153、AFP三项指标联合检测明显提高了灵敏度(71.4%)。结论:术前肿瘤标志物,尤其是CA125、CA153、AFP联合检测对卵巢未成熟型与成熟型畸胎瘤的鉴别诊断有一定参考价值。     

发展性照顾护理模式对低出生体重儿生长发育和神经行为发育的影响

目的 探讨发展性照顾护理模式对低出生体重儿生长发育和神经行为发育的影响。方法 选取2019年3月至2021年3月我院收治的86例低出生体重儿作为研究对象,随机分为对照组（n=43）和观察组（n=43）。对照组采用常规护理干预,观察组在对照组基础上采用发展性照顾护理模式干预。比较两组的生长发育和神经行为发育情况。结果 出院时,观察组的身长、头围和体质量增长均显著优于对照组（P <0.05）。干预前,两组的MDI、 PDI评分比较,差异无统计学意义（P>0.05）;出院时,观察组的MDI、 PDI评分均显著高于对照组（P <0.05）。结论 发展性照顾护理模式在低出生体重儿中应用效果显著,可有效促进低出生体重儿的生长发育和神经行为发育。     

NICU早产儿PICC导管相关血流感染高危因素的Meta分析

目的 通过Meta分析客观地确定NICU早产儿PICC导管相关血流感染的主要高危因素,为预防早产儿PICC导管相关血流感染提供一定的循证证据支持。方法 在线检索CNKI、万方、维普、Cochrane Library、PubMed、EMBASE等数据库,检索年限从各数据库建库起始至2019年1月,有关公开发表的早产儿PICC导管相关血流感染高危因素的文献,由两名研究员独立完成文献筛选、质量评价及资料提取,采用RevMan5.3软件进行Meta分析。结果 经筛选共纳入10篇文献（中文1篇,英文9篇）进行Meta分析。胎龄＜32周(OR=0.26, 95%CI:0.10~0.66),出生体重＜750g(OR=0.53, 95%CI:0.41~0.69),股三角部位置管(OR=1.67, 95%CI:1.31~2.11),置管耗时≥60min(OR=0.61, 95%CI:0.38~0.97),留置管时间≥30天(OR=2.41, 95%CI:1.75~3.31),留置CVC导管数量≥2个(OR=0.21, 95%CI:0.17~0.25)是高危因素。结论 胎龄愈小、出生体重越低、经股三角部位置管、置管耗时和导管留置时间越长、留置多个CVC导管是早产儿PICC置管后发生导管相关血流感染的高危因素,医护人员可采取有效预防措施,降低导管相关血流感染的发生率。     

不同起始时间使用咖啡因对极低出生体质量早产儿呼吸暂停防治作用的系统评价

目的:探讨不同起始时间使用咖啡因防治极低出生体质量早产儿呼吸暂停的疗效和安全性。方法:检索PubMed、the Cochrane Library、EMBase、中国期刊全文数据库(CNKI)、万方数据、生物医学文献数据库(CBM)及维普等数据库,收集各数据库从建库至2020年6月有关极低出生体质量早产儿早期应用咖啡因防治呼吸暂停的病例对照研究,并采用Cochrane系统评价手册5.1.0和Newcastle-Ottawa量表(NOS)对不同类型研究进行质量评价,采用RevMan 5.3进行系统评价。结果:10项文献中,包括5项随机临床对照研究(RCT)和5项回顾性队列研究,文献质量评价结果显示,5项RCT质量等级为B级,5项回顾性队列研究NOS评分为7～9分。共2 665例患儿,其中早期用药组1 515例,晚期用药1 150例。Meta分析结果显示,早期用药组呼吸暂停(AOP)发生率(RR=0.48,95%CI 0.38～0.60,P<0.01)、吸氧时间(SMD=-0.97,95%CI-1.13～-0.80,P<0.01)、机械通气时间(SMD=-0.82,95%CI-1...     

Application of Machine Learning Approaches to Predict Postnatal Growth Failure in Very Low Birth Weight Infants

PurposeThe aims of the study were to develop and evaluate a machine learning model with which to predict postnatal growth failure (PGF) among very low birth weight (VLBW) infants.Materials and MethodsOf 10425 VLBW infants registered in the Korean Neonatal Network between 2013 and 2017, 7954 infants were included. PGF was defined as a decrease in Z score >1.28 at discharge, compared to that at birth. Six metrics [area under the receiver operating characteristic curve (AUROC), accuracy, precision, sensitivity, specificity, and F1 score] were obtained at five time points (at birth, 7 days, 14 days, 28 days after birth, and at discharge). Machine learning models were built using four different techniques [extreme gradient boosting (XGB), random forest, support vector machine, and convolutional neural network] to compare against the conventional multiple logistic regression (MLR) model.ResultsThe XGB algorithm showed the best performance with all six metrics across the board. When compared with MLR, XGB showed a significantly higher AUROC (p=0.03) for Day 7, which was the primary performance metric. Using optimal cut-off points, for Day 7, XGB still showed better performances in terms of AUROC (0.74), accuracy (0.68), and F1 score (0.67). AUROC values seemed to increase slightly from birth to 7 days after birth with significance, almost reaching a plateau after 7 days after birth.ConclusionWe have shown the possibility of predicting PGF through machine learning algorithms, especially XGB. Such models may help neonatologists in the early diagnosis of high-risk infants for PGF for early intervention.     

转运早期早产儿对其脑室内出血的影响及其对策探讨

目的探讨搬运早期早产儿对其脑室内出血(IVH)的影响,并研究其对策。方法以1998年1月到2007年10月我院收治的206例早期早产儿为研究对象。设为三组:A组,无搬运组;B组,有搬运组,且搬运前未预防性使用苯巴比妥;C组,有搬运组,但搬运前半小时预防性地使用了苯巴比妥。再比较三组早产儿IVH的发生率。结果三组早产儿IVH发生率明显不同,A组、B组、C组分别为36.4%(24/66)、82.8%(72/87),56.6%(30/53),经统计学处理有非常显著性意义。结论搬运早期早产儿易使其IVH发生率明显增加,因此对于早期早产儿应尽量避免搬运,以减少其脑室内出血(IVH)的发生率;若必须搬运则可在搬运前半小时预防性地运用苯巴比妥,便可部分地减少其脑室内出血的发生率。