与婴儿围产期动脉卒中相关的母婴临床表现

Context: Perinatal arterial ischemic stroke (PAS) is a common cause of hemiple gic cerebral palsy. Risk factors forthis condition have not been clearly defined . Objective: To determine maternal and infant characteristics associated with PA S. Design, Setting, and Patients: Case-control study nested within the cohort o f all 199176 infants born from 1997 through 2002 in the Kaiser Permanente Medica l Care Program, a managed care organization providing care for more than 3 milli on residents of northern California. Case patients were confirmed by review of brain imaging and medical records (n = 40). Three controls per case were randomly selected from the study population .Main Outcome Measure: Association of maternaland infant complications with risk of PAS. Results: The population prevalence of PAS was 20 per 100000 live births . The majority (85%) of infants with PAS were delivered at term. The following prepartum and intrapartum factors were more common among case than control infan ts:primiparity (73%vs 44%, P=.002), fetal heart rate abnormality (46%vs 14%, P < .001), emergency cesarean delivery (35%vs 13%, P=.002), chorioamnionitis (27%vs 11%, P=.03), prolonged rupture of membranes (26%vs 7%, P=.002), prolo nged second stage of labor (25%vs 4%, P < .001), vacuum extraction (24%vs 11%, P=.04), cord abnormality (22%vs 6%, P=.01), preeclampsia(19%vs 5%, P=.01), and oligohydramnios (14%vs 3%,P=.01). Risk fa ctors independently associated with PAS on multivariate analysis were history of infertility (odds ratio [OR], 7.5; 95%confidence interval [CI], 1.3-45.0), pr eeclampsia (OR, 5.3; 95%CI, 1.3-22.0), prolonged rupture of membranes (OR, 3.8 ; 95%CI, 1.1-12.8), and chorioamnionitis (OR, 3.4; 95%CI, 1.1-10.5). The rat e of PAS increased dramatically when multiple risk factors were present. Conclus ions: Perinatal arterial ischemic stroke in infants is associated with several i ndependent maternal risk factors. How these complications, along with their pote ntial effects on the placenta and fetus, may play a role in causing perinatal st roke deserves further study.

与围生期动脉缺血性中风有关的母亲和婴幼儿的特征

Context: Perinatal arterial ischemic stroke (PAS) is a common cause of hemiplegic cerebral palsy.Risk factors for this condition have not been clearly defined.Objective: To determine maternal and infant characteristics associated with PAS.Design, Setting, and Patients: Case-control study nested within the cohort of all 199176 infants born from 1997 through 2002 in the Kaiser Permanente Medical Care Program, a managed care organization providing care for more than 3 million residents of northern California.Case patients were confirmed by review of brain imaging and medical records (n = 40).Three controls per case were randomly selected from the study population.Main Outcome Measure: Association of maternal and infant complications with risk of PAS.Results: The population prevalence of PAS was 20 per 100000 live births.The majority (85%) of infants with PAS were delivered at term.The following prepartum and intrapartum factors were more common among case than control infants: primiparity (73%vs 44%, P=.002), fetal heart rate abnormality (46%vs 14%, P<.001), emergency cesarean delivery (35%vs 13%, P=.002), chorioamnionitis (27%vs 11%, P=.03), prolonged rupture of membranes (26%vs 7%, P=.002), prolonged second stage of labor (25%vs 4%, P<.001), vacuum extraction (24%vs 11%, P=.04) , cord abnormality (22%vs 6%, P=.01), preeclampsia (19%vs 5%, P=.01), and oligohydramnios (14%vs 3%, P=.01).Risk factors independently associated with PAS on multivariate analysis were history of infertility (odds ratio [OR], 7.5; 95%confidence interval [CI], 1.3-45.0)-, preeclampsia (OR, 5.3; 95%CI, 1.3-22.0), prolonged rupture of membranes (OR, 3.8; 95%CI, 1.1-12.8), and chorioamnionitis (OR, 3.4; 95%CI, 1.1-10.5).The rate of PAS increased dramatically when multiple risk factors were present.Conclusions: Perinatal arterial ischemic stroke in infants is associated with several independent maternal risk factors.How these complications, along with their potential effects on the placenta and fetus, may play a role in causing perinatal stroke deserves further study.

儿童传染性软疣的流行病学调查

Molluscum contagiosum(MC) is a viral disorder of the skin and mucous membranes characterized by discrete single or multiple, flesh-colored papules. Although MC as a clinical entity is well defined and commonly observed, few data regarding its epidemiology in the pediatric population exist. Our purpose was to collect epidemiologic data on children with MC with regard to age, gender, ethnicity, degree of involvement, relation to pre-existing atopic dermatitis (AD), and immune status. A retrospective chart review was conducted. All subjects were seen at 3 tertiary pediatric dermatology referral centers with two of the sites based at a Children s Hospital. A total of 302 patient charts with the Current Procedural Terminology code diagnosis of MC seen over a 6-to 8-month period were reviewed. Approximately 80% of the patients were younger than 8 years old. The majority of patients (63% ) had more than 15 lesions. All but one patient were otherwise healthy, as determined by history and clinical examination. Approximately 24% of the patients presented with a history of previous or active coexistent AD. However, children with AD were at risk for an increased number of lesions. These data provide valuable updated information on the demographics and clinical presentation of MC in pediatric patients in the United States. Limitations include that this was a retrospective study with a population limited to tertiary pediatric dermatology referral centers.

APOE∈2/∈4多态性和梯度回波MRI脑微出血的关系研究

The association of APOE genotypes with cerebral microbleeds (CMBs) was examined on the basis of the location of CMBs in 414 patients who were admitted primarily because of stroke. With respect to possession of the ∈2 or ∈4 allele, the adjusted odds ratio was 1.94 (1.05 to 3.58) for lobar CMBs but 1.21 (0.69 to 2.11 ) for nonlobar CMBs. This suggests that the pathogenesis of CMBs may differ depe nding on their location.

缺血性卒中后的院内医源性并发症和远期死亡率

Background and Purpose-Inhospital medical complications account for a considerable portion of deaths during the early stage of stroke. However, relatively few studies have examined their long-term effects on mortality in stroke patients. Methods -We prospectively and consecutively collected data on 579 patients with acute ischemic stroke from November 1998 to February 2001. Mortality was confirmed using national death certificate data from 1999 to 2003. Results -During admission, one or more medical complications requiring intervention developed in 160 of these 579 patients (27.6%). For these 160 subjects, the 30-day, 90-day, 1-year, 2-year, 3-year, and 4-year mortalities were 16.3, 29.4, 46.9, 55. 6, 61.3, and 70.7%, whereas the mortality figures for those without such compli cations (n=419) were 1.4, 3.8, 8.8, 15.0, 19.1, and 22.4 (P < 0.001 with log-ra nk test). To eliminate the short-term effects of these complications and thus r eveal their long-term effects, we investigated differences in mortality versus the presence of inhospital complications at more than 30 days, 90 days, 1 year, 2 years, and 3 years after stroke, respectively. Cox’s proportional hazard regr ession analysis was applied at these times after stroke and showed that all haza rd ratios of medical complications in terms of mortality were statistically larg er than one, regardless of adjusting for effects of potential predictors on mort ality. Conclusions -Our study shows that stroke patient mortality is influenced by inhospital medical complications significantly up to the chronic stage. This finding suggests that the appropriate prevention and management of inhospital complications could improve shortterm and long-term prognoses after stroke.

儿童牙科恢复诊疗实践指南:COVID-19流行期间儿童牙科恢复诊疗的指南

COVID-19危机的到来使得我们面临着人生中前所未有的巨大挑战。我们的医疗系统、经济以及整个国家的民众还尚未准备好面对该病毒带来的影响。我们和我们所做的一切还远远不足以应对此次全球性流行病的深远影响,直到现在,我们才开始将注意力转到重启关停的医疗机构以及将诊疗范围从仅处理口腔急症恢复到日常保护儿童口腔健康上。