期待我国的孕前和孕期保健检查走向规范化

孕前和孕期保健（产前保健）检查是产科医师的主要工作之一，作为初级保健内容，长期以来没有得到足够的重视，许多基层医院医师对产前检查的内容不甚了解，提供的检查通常是若干次B超和血、尿常规检查的堆积；而大型医院产科医师比较重视产前筛查、产前诊断和高危妊娠的诊治，

为什么年度检查对健康仍然很重要?

虽然有些健康专家越来越觉得没有必要每年体检，但每年检查却有许多益处。 每年进行一次妇女保健检查的必要性可能越来越低。定期盆腔检查和年度子宫颈抹片检查已成为过去式。进行年度检查时，由初级保健医师决定需要检查什么。你的医生、护师或医生助理将测量你的身高和重量，测量血压，听诊心脏和肺部。他可能评估你的健康史，看你是否接种最新的疫苗接种和筛查，提供降低高血压、糖尿病、心脏疾病和癌症风险的建议。你可能需要测定胆固醇和血糖的血液检查。

唐仁健检查新型冠状病毒感染的肺炎疫情防控工作时强调 盯紧看牢严防死守严之又严细之又细 坚决有力有效做好疫情防控各项工作

1月23日,省委副书记、省长唐仁健在兰州市检查新型冠状病毒感染的肺炎疫情防控工作,并看望慰问奋战在一线的医务人员。他强调,要深入学习贯彻习近平总书记重要指示精神,坚决落实党中央、国务院决策部署,把新型冠状病毒感染的肺炎疫情防控工作作为当前最重要的一项工作,盯紧看牢、严防死守,严之又严、细之又细,坚决有力有效做好疫情防控工作。

国家基本药物临床应用（基层版）指导

病历摘要 患者，女，35岁，妊娠24周开始，自觉无诱因出现乏力、头晕、心悸、气短开始以为妊娠所致，未予重视．其后上述症状逐渐加重，并有食欲缺乏、恶心、呕吐、腹胀、厌食时有手足麻木、针刺、冰冷等异常感觉，以致行走困难．孕期保健检查，妊娠及胎儿均正常，建议到内科进一步检查确诊.

医院不必为医疗技术的局限性担责

案例回放 杨某于2005年8月4日到某市妇幼保健院进行产前检查,并进行了孕产期常规体检和保健检查。其后杨某先后3次在该市妇幼保健院进行产前B超检查,均未发现异常。在此期间,该市妇幼保健院为杨某进行了常规的血细胞分析,结果亦为正常,

妊娠期骨盆痛 并非是缺钙

“我在怀孕前曾听说过，妇女怀孩子期间容易缺钙，小腿会出现抽筋的状况。于是，在平时的饮食中，我注意添加虾皮、牛奶、海带、骨头汤等含钙多的食物。我每次去做产前保健检查时，医生说母体和胎儿情况很正常，也从没说过我缺钙。可最近一段时间以来，下身（骨盆）的前面和屁股（骨盆）的后面部位都出现了疼痛，同事得知后提醒说可能是孕期缺钙引起了骨盆痛，婆婆和老公也这么说。我注意从食物中摄取钙，又专门吃了钙片，怎么还会缺钙并引起骨盆痛呢？“瑶敏一脸焦急地叙说着。

Analysis of risk factors for polypoid lesions of gallbladder among health examinees

AIM: To investigate the prevalence and risk factors of polypoid lesions of gallbladder (PLG) among the health examinees in the Shanghai region, China. METHODS: A total of 11 816 subjects who underwent health examinations in our hospital between August 2010 and February 2011 were analyzed retrospectively. Among them, there were 7174 men and 4642 women. PLG was diagnosed by the real-time ultrasonography. Those with the body mass index (BMI) ≥ 28 were considered to be obese. Blood biochemical indices were detected with the fully automatic biochemical analyzer and hepatitis B surface antigen (HBsAg) was tested by the automated enzyme immunoassay. The correlations between the prevalence of PLG and age, sex, BMI, serum cholesterol (T-Cho), triglycerides (TG),blood sugar, HBsAg, high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), gallstone and fatty liver were investigated. After univariate analysis of 11 variables, stepwise logistic regression analysis was performed to explore the risk factors of PLG. RESULTS: There was a significant difference in sex, T-Cho, HBsAg, HDL-C, LDL-C and fatty liver between the PLG-positive group and the PLG-negative group (332/163 vs 6842/4479, P = 0.003; 22/473 vs 295/11 026, P =0.013; 92/403 vs 993/10 328, P = 0.001; 47/448 vs 332/10 989, P = 0.001; 32/463 vs 381/10 940, P = 0.001; 83/412 vs 3260/8061, P = 0.001). No significant difference was found in the age, BMI, TG, blood sugar and gallstone between the two groups (47.3 ± 26 vs 45.1 ± 33, P = 0.173; 59/436 vs 1097/10 224, P = 0.102; 52/443 vs 982/10 339, P = 0.158; 17/478 vs 295/11 026, P = 0.26; 24/471 vs 395/10 926, P = 0.109). Logistic regression analysis showed that the sex, HBsAg and HDL-C were independent risk factors for the development of PLG in a descending order of HDL-C > HBsAg > sex. CONCLUSION: In healthy people, the male gender, positive HBsAg, and low HDL-C confer higher risks of PLG development.

Prevalence of Metabolic Syndrome and Its Associations with Other Metabolic Disorders and Cardiovascular Changes in Health Examination Population in Beijing

Objective To investigate the prevalence of metabolic syndrome(MS) and its associations with other metabolic disorders and cardiovascular changes in health examination population in Beijing.Methods Totally,10 916 individuals who received health examination in Health Examination Center of Peking Union Medical College Hospital were enrolled.The height,weight,blood pressure,serum levels of triglyceride,high-density lipoprotein cholesterol(HDL-C),and fasting blood glucose were recorded.MS was diagnosed based on the working criteria of Chinese Diabetes Society 2004(CDS2004).Meanwhile,other metabolic disorders,including fatty liver and hyperuricemia,were recorded.The cardiovascular changes were reflected by the reports of electrocardiogram(ECG) ST-T changes and atherosclerosis of retinal arteries.Results The overall prevalence rate of MS was 6.1%(666/10 916) in the population.The prevalence rate of MS in male was much higher than that in female(9.0% vs.2.7%,P=0.000).For individuals with MS,the prevalence rates of fatty liver and hyperuricemia were significantly higher than those without MS,respectively(70.4% vs.35.4%,P=0.000;29.9% vs.17.7%,P=0.000).As for cardiovascular changes,the prevalence rates of ECG ST-T changes and atherosclerosis of retinal arteries were significantly higher in individuals with MS than those without MS,respectively(13.8% vs.11.7%,P=0.012;12.0% vs.6.8%,P=0.000).Conclusions The prevalence of MS in Beijing population is high.The individuals with MS have a higher risk for other metabolic disorders and cardiovascular changes.

Prevalence of Abnormity of Blood Lipid and Associated Factors in Health Examination Population in Beijing

Objective To investigate the prevalence of abnormity of blood lipid and associated factors in healthy population in Beijing. Methods Totally, 38 462 individuals who received health examination were enrolled in our study. We divided them into eight groups according to their ages. The levels of serum total cholesterol, triglyceride, high density lipoprotein cholesterol, and low density lipoprotein cholesterol were tested, and the relationship of blood lipid abnormity with body mass index (BMI) and fasting blood glucose was analyzed. Results The incidences of hypercholesterolemia, hyperglyceridemia, low high-density lipoprotein cholesterolemia, and hyper low-density lipoprotein cholesterolemia presented increasing trend in this population. The incidence rate of abnormity of blood lipid in health examination population increased with BMI increase. The incidence of abnormity of blood lipid in overweight and obesity population was significantly higher than that in low weight and normal weight populations (P<0.05). Meanwhile, the trend of abnormal blood lipid incidence coincided with that of abnormal fasting blood glucose. Conclusions The prevalence of overweight, obesity, and abnormity of blood lipid in Beijing presents increasing trend. The incidence of abnormity of blood lipid increases with BMI increase, in coincidence with that of fasting blood glucose.

The distribution of 10-year cardiovascular risk in Chinese adults： analysis of the China Health Examination Database （CHED） 2008

Objective Global cardiovascular risk assessment has been incorporated into current Chinese guidelines for the management of hypertension and hypercholesterolemia. The aim of our study is to determine the distribution of 10-year risk for ischemic cardiovascular disease （ICVD） among middle-aged Chinese adults, and to evaluate the usefulness of global risk assessment tools in the primary prevention of ICVD in Chinese population.Methods Simplified prediction tools derived from the USA-PRC Collaborative Study of Cardiovascular Epidemiology cohort were applied to the Chinese Health Examination Database （CHED） 2008. 10-year risk for ICVD was estimated in 461 157 ICVD-free subjects （264 432 male and 196 725 female） aged 35 to 59 years. Results Among the male subjects, 82.4% had a 10-year risk for ICVD of 〈5%, 14.4% of 5% to 12.1% and 3.4 of≥ 12.2%, and in female subjects, 86.7% had a 10-year risk for ICVD of 〈5%, 12.1% of 5% to 12.0% and 1.2% of ≥ 12.1%. All subjects with predicted high level ICVD risk （≥ 12.2% in male or ≥ 12.1% in female） had either remarkably elevated （≥ 160 mmHg） blood pressure, significantly increased （≥ 6.22 mml/L） total serum cholesterol or diabetes.Conclusion Using the currently recommended prediction tools, only very small proportions of middle-aged Chinese men and women who were free of ICVD would be classified into high level risk group. These prediction tools are unlikely to help for the medical intervention decision making in Chinese adult patients with hypertension and/or hypercholesterolemia

Balthazar computed tomography severity index is superior to Ranson criteria and APACHE Ⅱ scoring system in predicting acute pancreatitis outcome

AIM： Acute pancreatitis （AP） is a process with variable involvement of regional tissues or organ systems. Multifactorial scales included the Ranson, Acute Physiology and Chronic Health Evaluation （APACHE Ⅱ） systems and Balthazar computed tomography severity index （CTSI）. The purpose of this review study was to assess the accuracy of CTSI, Ranson score, and APACHE II score in course and outcome prediction of AP. METHODS： We reviewed 121 patients who underwent helical CT within 48 h after onset of symptoms of a first episode of AP between 1999 and 2003. Fourteen inappropriate subjects were excluded; we reviewed the 107 contrastenhanced CT images to calculate the CTSI. We also reviewed their Ranson and APACHE Ⅱ score. In addition, complications, duration of hospitalization, mortality rate, and other pathology history also were our comparison parameters. RESULTS： We classified 85 patients （79%） as having mild AP （CTSI 〈5） and 22 patients （21%） as having severe AP （CTSI ≥5）. In mild group, the mean APACHE II score and Ranson score was 8.6±1.9 and 2.4±1.2, and those of severe group was 10.2±2.1 and 3.1±0.8, respectively. The most common complication was pseudocyst and abscess and it presented in 21 （20%） patients and their CTSI was 5.9±1.4. A CTSI ≥5 significantly correlated with death, complication present, and prolonged length of stay. Patients with a CTSI ≥5 were 15 times to die than those CTSI 〈5, and the prolonged length of stay and complications present were 17 times and 8 times than that in CTSI 〈5, respectively. CONCLUSION： CTSI is a useful tool in assessing the severity and outcome of AP and the CTSI ≥5 is an index in our study. Although Ranson score and APACHE II score also are choices to be the predictors for complications, mortality and the length of stay of AP, the sensitivity of them are lower than CTSI.

Gastrointestinal symptoms in a Japanese population:A health diary study

AIM： To investigate the incidence of gastrointestinal symptoms and the nature of consequent utilization of health care services in a Japanese population. METHODS： Using self-report, we conducted a prospective cohort study of a nationally representative sample of the Japanese population over a one-month period to determine the incidence of gastrointestinal symptoms of all kinds and resultant health care utilization. Both information on visits to physicians and use of complementary and alternative medicine therapies were collected. RESULTS： From a total of 3568 in the recruitment sample, 3477 participants completed a health diary （response rate 97%）. The data of 112 participants with baseline active gastrointestinal diseases were excluded from the analysis, leaving 3365 participants in the study. The incidence of gastrointestinal symptoms was 250 and the mean number of symptomatic episodes was 0.66 in a month. Abdominal pain, diarrhea, nausea, constipation and dyspepsia were the most frequent symptoms. Female gender, younger age, and low baseline quality of life were risk factors for developing these symptoms. The participants were more likely to treat themselves, using dietary, complementary or alternative medicines, than to visit physicians, except in the case of vomiting.CONCLUSION： Gastrointestinal symptoms are common in the Japanese population, with an inddence of 25%. Abdominal pain, diarrhea, nausea, constipation and dyspepsia are the most frequent symptoms. Risk factors for developing these symptoms include female gender, younger age, and low baseline quality of life.

Results and analysis:a pilot study on quality of life of soldiers in the first response army

Objective： To explore the fundamental theory, methods and data of the quality of life （QOL） of soldiers and its influence factors in the first response army. Methods： Totally 215 soldiers in the first response army of a military area in China were inquired by using self-regulating questionnaire and WHOQOL-BREF （Chinese Edition）. Resalts： WHOQOL-BREF had good acceptability, reliability and validity in the first response army. QOL of soldiers in the first response army was middling. The influencing factors of QOL of the soldiers in first army includes self-report health, different areas where the army men come from, different arms of services, whether only child in family. And the difference was statistically significant. Conclusion： WHOQOL-BREF is fit for evaluating the quality of life of soldiers in the first response army. There are differences of the quality of life among the soldiers in the first response army. So we should take appropriate measures to improve the soldiers＇ quality of life.

Using nutritional assessment to predict gender-specific risks of sarcopenia among the elderly receiving health check-up in Taipei

Quality of life for the elderly in an ageing society is receiving more attention than ever. After age 40, muscle mass loses at the rate of 3% to 8% every 10 years. More- over, the decline intensifies after 60 years old. Although many people do not experience changes in total body weight, their muscle mass is slowly replaced by body fat. Decreased muscle mass means lower muscle strength, which affects physical functioning. As a result, daily activities become con- strained, risks of fall and bone fracture elevated,

Anorectal functional outcome after repeated transanal endoscopic microsurgery

AIM： TO evaluate the status of anorectal function after repeated transanal endoscopic microsurgery （TEN）. METHODS： Twenty-one patients undergoing subtotal colectomy with ileorectal anastomosis were included. There were more than 5 large （〉 1 cm） polyps in the remaining rectum （range： 6-20 cm from the anal edge）. All patients, 19 with villous adenomas and 2 with low-grade adenocarcinomas, underwent TEM with submucosal endoscopic excision at least twice between 2005 and 2011. Anorectal manometry and a question- naire about incontinence were carried out at week 1 before operation, and at weeks 2 and 3 and 6 mo after the last operation. Anal resting pressure, maxi- mum squeeze pressure, maximum tolerable volume （MTV） and rectoanal inhibitory reflexes （RAIR） were recorded. The integrity and thickness of the internal anal sphincter （IAS） and external anal sphincter （EAS） were also evaluated by endoanal ultrasonography. We determined the physical and mental health status with SF-36 score to assess the effect of multiple TEM on patient quality of life （QoL）. RESULTS： All patients answered the questionnaire. Apart from negative RAIR in 4 patients, all of the anorectal manometric values in the 21 patients were normal before operation. Mean anal resting pressure decreased from 38±5 mmHg to 19±3 mmHg （38±5 mmHg vs 19±3 mmHg, P = 0.000） and MTV from 165± 19mLto60± 11mL（165± 19mLvs60± 11 mL, P = 0.000） at month 3 after surgery. Anal resting pressure and MTV were 37 ± 5 mmHg （38 ± 5 mmHg vs 37 ± 5 mmHg, P = 0.057） and 159 ± 19 mL （165 ± 19 mL vs 159 ± 19 mL, P = 0.071）, respectively, at month 6 after TEM. Maximal squeeze pressure de- creased from 171 ± 19 mmHg to 62 ± 12 mmHg （171 ± 19 mmHg vs 62 ± 12 mmHg, P = 0.000） at week 2 after operation, and returned to normal values by postoperative month 3 （171 ± 19 vs 166 ± 18, P = 0.051）. RAIR were absent in 4 patients preoperatively and in 12 （χ2 = 4.947, P = 0.026） patients at month 3 after surgery. PAIR was absent only in 5 patients at postoperative month 6 （χ2 = 0.141, P = 0.707）. Endo- sonography demonstrated that IAS disruption occurred in 8 patients, and 6 patients had temporary inconti- nence to flatus that was normalized by postoperative month 3. IAS thickness decreased from 1.9 ± 0.6 mm preoperatively to 1.3 ± 0.4 mm （1.9 ± 0.6 mm vs 1.3 ± 0.4 mm, P = 0.000） at postoperative month 3 and increased to 1.8 ± 0.5 mm （1.9 ± 0.6 mm vs 1.8 ± 0.5 mm, P = 0.239） at postoperative month 6. EAS thickness decreased from 3.7 ± 0.6 mm preoperatively to 3.5 ± 0.3 mm （3.7 ± 0.6 mm vs 3.5 ± 0.3 mm, P = 0.510） at month 3 and then increased to 3.6 ± 0.4 mm （3.7 ± 0.6 mm vs 3.6 ± 0.4 mm, P = 0.123） at month 6 after operation. Most patients had frequent stools per day and relatively high Wexner scores in a short time period. While actual fecal incontinence was exceptional, episodes of soiling were reported by 3 pa- tients. With regard to the QoL, the physical and mental health status scores （SF-36） were 56.1 and 46.2 （50 in the general population）, respectively.CONCLUSION： The anorectal function after repeated TEM is preserved. Multiple TEM procedures are useful for resection of multi-polyps in the remaining rectum.

Study on correlation between pathology and the contrast-enhanced ultrasound characteristics of primary liver cancer

Objective:The aim of this study was to evaluate the value of contrast-enhanced ultrasound(CEUS) for blood perfusion of primary liver cancer(PHC) and investigate the correlation between microvascular architecture of PHC and pathological differentiation.Methods:Two hundred and seventy-eight patients with 329 PHC lesions were examined by CEUS and analysised the contrast enhancement pattern and correlation with pathology.Results:1.CEUS patterns of PHC:71.7%(236/329) showed "swift enhancement in the arterial phase and swift expurgation in the portal phase",13.4%(44/329) for as "swift enhancement and slow expurgation",7.3%(24/329) as "swift enhancement and simultaneity expurgation",4.3%(14/329) for the "slow enhancement and swift expurgation",2.1%(7/329) as "slow enhancement and expurgation",1.2%(4/329) as "not fast forward".2.90.3%(297/329) of PHC lesions were hypervascular liver cancer and 9.7%(32/329) were hypovascular.Hepatocellular carcinoma(HCC) were hypervascular lesions and intrahepatic cholangiocarcinoma(ICC) were hypovascular lesions.3.PHC size had a significant difference on the contrast media purfusion pattern(P < 0.05),but not on the contrast media expurgation pattern.4.The accuracy of PHC by CEUS were 97.3% and compared to pathology,9 lesions of PHC were misdiagnosed.Conclusion:CEUS can show the different blood perfusion characteristics of PHC with closely related to pathological differentiation,which be valuable to diagnose liver cancer.

Pharmaceuticalization and Biomedicalization： An Examination of Problems Relating to Depression in Japan

The growing number of people suffering from depression has become a social problem in Japan. The problems associated with depression in Japan have been influenced by the pharmaceuticalization of mental health. Since selective serotonin reuptake inhibitors were introduced to Japan＇s pharmaceutical market in 1999, demand for anti-depressant medications has rapidly expanded. It seems likely then that the efforts of pharmaceutical companies, as part of their marketing strategies, to increase people＇s awareness of mental illness have led people who are not actually depressed to have medical consultations and drug treatments for it. This phenomenon is known as ＂disease mongering＂ and has been reported on. Problems exist from the medical perspective also and include the following： expansion of the diagnostic criteria for depression as formulated in the American Psychiatric Association＇s Diagnostic and Statistical Manual of Mental Disorders; treatments that rely heavily on drugs; and biomedicalization. Another reason for the increase in medical consultations is the declining function of communal bodies. This has resulted in individuals struggling psychologically, for example, with anxiety, worry, and depression. In summary, this sociological research analyzed the problems of depression in ｜apan and revealed how the pharmaceuticalization of mental health accelerates the individualization of social problem.

Seroprevalence of Porcine Cysticercosis and Associated Risk Factors in Pigs Slaughtered in Abattoirs in Thika, Kiambu County, Kenya

Taenia solium is an important food-bome pathogen worldwide and is emerging as a serious public health risk in both rural and urban communities where pigs are raised and consumed. Adult tapeworms are found in the intestines of humans while the developmental larval forms occur in the muscles and organs constituting cysticercosis of pigs and humans. Cysticercosis has a worldwide distribution, mainly related to poor hygiene and sanitation and consumption of infected pork. Pigs get infected through consumption of food and contaminated with human faeces containg eggs. In recent years pork consumption has increased with the opening up of pork eating centres. Porcine cysticercosis has previously been reported in Kenya, however, there are scarce data on the occurrence of the disease, as well as on the risk factors for transmission, in key production and consumption areas including Thika. The purpose of the study was to determine the seroprevalence of porcine cysticercosis in slaughtered pigs and associated risk factors for occurrence of the disease in selected abattoirs in Thika. Systematic random sampling was used to select a total of 276 pigs. The source of the slaughter pigs was derived fi＇om the movement permits, the breed, sex and estimation of age was done at ante mortem examination. The slaughter and meat inspection processes were carried out by the slaughter house personnel and the investigators only observed and received the outcome of the inspection. Blood samples were collected fi＇om each identified pig at slaughter, processed and analyzed using purified Taenia solium antigen ELISA commercial kit. The results meat inspection showed that none of the pigs in this study had any visible cysts whereas 4.35% of the pigs were seropositive which poses public health risk.

走出看牙误区

笔者在长期的临床工作中发现，不少人对看牙病存在着一些误区，以至一拖再拖，带来更大的痛苦。 误区之一：牙齿不疼不用去医院。人的一生可以不得其他病，但不可能不患牙病。很多牙病患者往往都是在疼痛难忍时才去看医生。其实，牙病的发展有一个缓慢的过程，约1～2年，如果每半年进行一次牙齿的保健检查，是完全可以预防的。