孕妇弓形虫感染对妊娠的影响

目的　探讨孕妇弓形虫感染对妊娠的影响。方法　采用酶联免疫吸附试验三联诊断法对 35 6例孕妇及其新生儿进行血清弓形虫抗原及抗体检测。结果　孕妇弓形虫感染率平均为 15 .17% ,不同年龄组孕妇感染率无显著性差异 ,但高龄产妇组略高 ;不同职业孕妇感染率无显著差别 ,但农民组感染率明显较高。 4例畸形儿中弓形虫感染阳性 2例。有早产史的孕妇弓形虫阳性率为 2 0 % ,明显高于平均感染率。此外还发现第 2胎怀孕出生的新生儿其循环抗原阳性率为 42 .86 % ,显著高于第 1胎出生者 (19.15 % )。结论　孕妇弓形虫感染可引起早产、畸胎 ,对新生儿有一定影响     

Sleeve gastrectomy prior to liver transplantation is superior to medical weight loss in reducing posttransplant metabolic complications

Strategies to optimize the management of obesity-related metabolic complications after liver transplantation (LT) are needed. We examined the effect of pre-LT sleeve gastrectomy (SG), as compared to medical weight loss (MWL), on post-LT outcomes. This is a cohort study of adults (≥18 years) with medically complicated obesity who were eligible for pre-LT SG and underwent LT from January 1, 2006 to June 1, 2016. Logistic regression models evaluated the association of SG on post-LT diabetes and hypertension, defined as new-onset or progressive disease post-LT. Cox regression models evaluated the association of SG on recurrent and de novo nonalcoholic fatty liver disease (NAFLD). Among 70 LT recipients who were eligible for pre-LT SG, 14 (20%) underwent SG and 56 (80%) underwent MWL only. Mean follow-up was 5.2 years post-LT. The SG cohort sustained higher % total body weight loss at 3 years post-LT (28.9% vs. 5.4%, p < .001). In multivariable analyses, SG was associated with significantly lower risk of post-LT diabetes (OR 0.04, 95% CI 0.00–0.41, p = .01), hypertension (OR 0.15, 95% CI 0.04–0.67, p = .01), and recurrent and de novo NAFLD (HR 0.19, 95% CI 0.04–0.91, p = .04). When compared to MWL, SG resulted in sustained weight loss and significantly lower risk of diabetes, hypertension, and recurrent and de novo NAFLD post-LT.     

Patients' and family members' perspectives on the benefits and working mechanisms of family nursing conversations in Dutch home healthcare

The aim of this study is to propose a model of the benefits and working mechanisms of family nursing conversations in home healthcare from the perspective of participating patients and their family members. Family nursing conversations in this study are intended to optimise family functioning, improve collaboration between family and professional caregivers and ultimately prevent or reduce overburden of family caregivers. In a qualitative grounded theory design, data were collected in 2017 using intensive interviewing with participants of family nursing conversations in home healthcare. A total of 26 participants (9 patients and 17 family members) from 11 families participated in a family nursing conversation and the study. Seven nurses who received extensive education in family nursing conversations conducted them as part of their daily practice. Interviews occurred 4–6 weeks after the family nursing conversation. The model that was constructed in close collaboration with the families consists of three parts. The first part outlines working mechanisms of the conversation itself according to participants, i.e. structured and open communication about the care situation and the presence of all of the people who are involved. The second part consists of the benefits that participants experienced during and immediately after the conversation – an increased sense of overview and improved contact among the people involved – and the related working mechanisms. The last part consists of benefits that emerged in the weeks after the conversation – reduced caregiver burden and improved quality of care – and the related working mechanisms. Insight into the benefits and working mechanisms of family nursing conversations may assist healthcare professionals in their application of the intervention and provides directions for outcomes and processes to include in future studies.     

改良新产程模式管理硬膜外麻醉无痛分娩产程对母婴结局的影响

目的探讨应用改良新产程模式管理硬膜外麻醉无痛分娩产程对母婴结局的影响。方法选取2018年1月-2020年2月在长春市妇产医院自愿行硬膜外麻醉无痛分娩的单胎初产足月妊娠产妇220例为研究对象,随机分为观察组和对照组,每组各110例。观察组产妇应用改良新产程模式管理无痛分娩,对照组产妇应用新产程模式管理产程无痛分娩。观察两种产程管理模式管理产程对母婴结局影响。结果观察组产妇潜伏期、加速期及第二产程时间均较对照组明显缩短,差异均有统计学意义(均P<0.01)。两组产妇剖宫产率和产后出血率比较,差异无统计学意义(P>0.05)。观察组产妇阴道助产率明显低于对照组,差异有统计学意义(P<0.05)。观察组产妇产后出血量明显少于对照组,差异有统计学意义(P<0.05)。观察组新生儿脐动脉血pH值<7.2比例低于对照组,差异有统计学意义(P<0.05)。结论采用改良新产程模式管理的硬膜外麻醉无痛分娩产妇产程时限明显缩短,阴道助产率降低,产后出血量明显减少,新生儿脐动脉血pH值<7.2比例明显降低,因此改良新产程模式管理产程,可有效保证母婴安全。     

综合护理干预对急性左心衰患者的影响

目的 探究基于自我调节理论的综合性护理干预对急性左心衰患者无创呼吸机治疗依从性的影响。方法 选取来我院就诊的急性左心衰患者83例,随机分成对照组41例和观察组42例。对照组采用常规护理模式,观察组采用基于自我调节理论的综合性护理。比较两组患者干预前后使用无创呼吸机依从性,比较干预后两组患者对无创呼吸机耐受情况、出院3个月后生活质量及干预过程中并发症发生率。结果 两组患者干预后,观察组依从性指数(85.18±4.13)高于对照组(80.45±3.68)(t=5.512,P=0.000);经干预后,观察组无创呼吸机耐受率(92.68%)与对照组(83.33%)无差异(χ2=1.711,P=0.190);两组患者出院3个月后,观察组在生活质量评分中社会功能(83.23±13.45,75.35±12.7,t=2.736,P=0.007)、情绪职能(74.31±13.64,65.34±8.45,t=3.611,P=0.001)、精神健康(76.38±10.24,68.23±11.53,t=3.402,P=0.001)方面分数高于对照组;干预期间,观察组并发症发生率(26.83%)低于对照组(59.52%)(χ2=9.029,P=0.002)。结论 基于自我调节理论的综合性护理干预能提高急性左心衰患者无创呼吸机治疗依从性,适当改善患者对无创呼吸机的耐受性,减轻并发症发生率,改善患者出院后生活质量。     

New syndrome: Mother and son with hypertelorism,downslanting palpebral fissures,malar hypoplasia,and apparently low-set ears associated with joint and scrotal anomalies

We report on a mother and son with a similar syndrome of hypertelorism and telecanthus, epicanthal folds, downslanting palpebral fissures, ptosis, broad nasal bridge, malar hypoplasia, thin upper lip, smooth philtrum, and apparently low-set prominent ears. The son also has a hypoplastic shawl scrotum, cryptorchidism, and genu valgum. His language development was delayed at 18 months, but subsequently improved and was normal at age 3. The mother has the additional findings of marked cubitus valgus, hyperextensible joints, dull normal intelligence and a bleeding diathesis. This pattern of multiple congenital anomalies may represent a new syndrome.