股静脉采血30°角斜刺在1～3个月婴儿静脉采血中的应用效果

目的探讨股静脉采血30°角斜刺在1~3个月婴儿静脉采血中的应用效果。方法将需要静脉采血的160例1~3个月婴儿随机分为观察组和对照组,对照组采用直刺股静脉采血,观察组采用30°斜刺股静脉采血,比较2组的采血情况以及家长的护理满意度。结果观察组的一次采血成功率高于对照组,疼痛程度轻于对照组,舒适度高于对照组,采血时间、压迫时间短于对照组,标本溶血率低于对照组,差异均有统计学意义(P0.05)。观察组家长对采血的护理满意度高于对照组,差异有统计学意义(P0.05)。结论股静脉采血30°角斜刺的穿刺成功率高,操作时间短,有利于减轻1~3个月婴儿静脉采血时的疼痛,提高患儿的舒适度,减少皮下血肿。     

Diagnostic challenges of aminoacidopathies and organic acidemias in a developing country: A twelve-year experience

Background

Diagnosis of aminoacidopathies and organic acidemias constitutes a real challenge in a developing country with high consanguinity rate and no systematic newborn screening. We report a twelve-year experience with the identification of these disorders in Lebanon, based on their clinical and biochemical profiles.

Methods

In this retrospective study, we reviewed clinical presentation and biochemical investigations of 294 patients. Traditional chromatographic methods were used for analyses. Findings were linked to the identified disorders.

Results

Out of 2921 patients, presenting to our metabolic program with neurological, digestive, family history and/or other symptoms suggestive of aminoacidopathy or organic acidemia, 294 patients were included with confirmed amino or organic acid disorder. The overall analytical yield was 10%. Aminoacidopathies were three-fold higher than organic acidemias. Phenylketonuria and methylmalonic acidemia were the most frequent. The majority of patients (79%) were symptomatic (median age: 14 months, range: 1 day–44 years), mainly with neurological manifestations (87%). Intellectual disability was mostly due to phenylketonuria (73%). Chronic liver failure was frequent in maple syrup urine disease (53%). Plasma amino and urine organic acid chromatography were diagnostic in 8.8% and 3.9% of analyzed cases, respectively. Change in chromatographic technique from reversed-phase to ion-exchange enhanced the detection of many aminoacidopathies.

Conclusions

In the absence of newborn screening, the majority of aminoacidopathy and organic acidemia cases are still diagnosed clinically. This study emphasizes the importance of clinical awareness and accurate biochemical analyses as key tools for diagnosis in countries like ours, and the necessity for a comprehensive national newborn screening program.     

Severe malnutrition in infants aged <6 months—Outcomes and risk factors in Bangladesh: A prospective cohort study

Severe acute malnutrition (SAM) affects ~4 million infants under 6 months (u6m) worldwide, but evidence underpinning their care is “very low” quality. To inform future research and policy, the objectives of our study were to identify risk factors for infant u6m SAM and describe the clinical and anthropometric outcomes of treatment with current management strategies. We conducted a prospective cohort study in infants u6m in Barisal district, Bangladesh. One group of 77 infants had SAM (weight‐for‐length Z‐score [WLZ] <?3 and/or bipedal oedema); 77 others were “non‐SAM” (WLZ ≥?2 to <+2, no oedema, mid‐upper‐arm circumference ≥125 mm). All were enrolled at 4–8 weeks of age and followed up at 6 months. Maternal education and satisfaction with breastfeeding were among factors associated with SAM. Duration of exclusive breastfeeding was shorter at enrolment (3·9 ± 2.1 vs. 5.7 ± 2.2 weeks, P < 0.0001) and at age 6 months (13.2 ± 8.9 vs. 17.4 ± 7.9 weeks; P = 0.003) among SAM infants. Despite referral, only 13 (17%) reported for inpatient care, and at 6 months, 18 (23%) infants with SAM still had SAM, and 3 (3.9%) died. In the non‐SAM group, one child developed SAM, and none died. We conclude that current treatment strategies have limited practical effectiveness: poor uptake of inpatient referral being the main reason. World Health Organization recommendations and other intervention strategies of outpatient‐focused care for malnourished but clinically stable infants u6m need to be tested. Breastfeeding support is likely central to future treatment strategies but may be insufficient alone. Better case definitions of nutritionally at‐risk infants are also needed.     

153例月经过少患者的性激素检测结果分析

目的:通过了解月经过少患者性激素情况,为临床诊疗提供重要参考。方法:对153例月经过少患者的性激素即雌二醇(E_2)、睾酮(T)、催乳素(PRL)、促黄体生成激素(LH)、促卵泡激素(FSH)、孕酮(P)等结果进行回顾性分析。结果:实验组与对照组比较,PRL结果的差异有统计学意义(P<0.05),LH、E_2、P、T、FSH结果的差异无统计学意义(P>0.05)。但有24例(15.7%)的患者E_2检测结果低于正常对照的下限;有28例(18.3%)的患者T检测结果比正常对照上限高。结论:性激素检测结果对月经过少的的诊治有重要意义。     

Seasonal Pattern of Preterm Births in Korea for 2000–2012

The aim of this study was to investigate a seasonal pattern of preterm births in Korea. Data were obtained from the national birth registry of the Korean Statistics Office and included all births in Korea during the period 2000–2012 (n = 6,310,800). Delivery dates were grouped by month of the year or by season (winter [December, January, February], spring [March, April, May], summer [June, July, August], and autumn [September, October, November]). The seasonal patterns of prevalence of preterm births were assessed. The rates of preterm births at 37 weeks were highest twice a year (once in winter and again in summer). The rates of preterm births increased by 13.9% in summer and 7.5% in winter, respectively, than in spring (OR, 1.139; 95% CI, 1.127–1.152, and OR, 1.075; 95% 1.064–1.087, respectively) after controlling for age, the educational level of the parents, maternal parity, and neonatal gender. The pattern for spontaneous preterm births < 34 weeks was similar. In Korea, a seasonal pattern of preterm births was observed, with peak prevalence in summer and winter. A seasonal pattern of preterm births may provide new insights for the pathophysiology of preterm births.     

外敷内服冬病夏治肺病的思路和治疗方法

在分析肺病产生原因的基础上,结合冬病夏治理论,提出了利用三伏天人体应四时而阳气最旺易逐寒邪而进行外敷内服补阳益肾综合治理肺病的思路,并介绍了临床应用时具体治疗方法,具有较好的疗效。     

Prolonged unsupervised Nordic walking and walking exercise following six months of supervision in adults with overweight and obesity: A randomised clinical trial

Background and aimsThis study is a randomized trial that examined the effects of 6 months of unsupervised Nordic walking (NW) and walking (W) exercise following 6 months of supervised training in overweight/obese adults.Methods and resultsAfter a 6-month program of diet and supervised training participants (n = 27) of NW (66 ± 7 yrs, body mass index (BMI) 34 ± 5) and W (66 ± 8 yrs, BMI 32 ± 5) group continue the training without supervision for other 6 months. Steps count and mean heart rate (HR_mean) were performed in each session; anthropometric and body composition, aerobic capacity and strength of the upper and lower limbs were evaluated at baseline, after 6 months of supervised and 6 months of unsupervised training. In the unsupervised training, monthly sessions and steps count decreased over time in both groups (p < 0.05), with no significant changes in HR_mean. Compared to the supervised phase, adherence decreased significantly only in the W group in the last 3 months of unsupervised training. Compared to baseline in both groups BMI did not change, but W group lost total fat; only the NW group maintained (p < 0.05) the gains in arm curl (33%) and chair stand (31%); both groups improved in six-minute walking test (p < 0.05).ConclusionDespite unsupervised training was not effective for a further increase in performance, participants, especially in NW, maintained some of the improvements achieved during the supervision. However, the presence of instructor that guides training, may enhance adherence and health benefits of NW and W exercise.Clinical trial registrationclinicaltrials.gov Identifier: NCT03212391 (July 11, 2017).