Objective:To explore the value of increased fetal cardio thoracic ratio(CTR)in predicting adverse fetal pregnancy outcome during 11-13+6 weeks.Methods:The ultrasonographic features,chromosome or gene detection and the...Objective:To explore the value of increased fetal cardio thoracic ratio(CTR)in predicting adverse fetal pregnancy outcome during 11-13+6 weeks.Methods:The ultrasonographic features,chromosome or gene detection and the pregnancy outcome of 86 fetuses with increased CTR at 11-13+6 weeks’gestation were retrospectively analyzed.Fetuses were divided into non-structural malformation group(46 cases)and structural malformation group(40 cases)according to results of fetal ultrasound examination.The differences of CTR and nuchal translucency thickness(NT)between the two groups were compared by t test.The area under the curve(AUC)was calculated by constructing the receiver operating curve(ROC)to determine the best diagnostic threshold,sensitivity and specificity of CTR and NT in predicting chromosomal abnormalities.Results:All the 86 fetuses had serious problems such as chromosome or gene abnormalities,or structural malformations.The CTR and NT of the structural malformation group were significantly higher than those of the non-structural malformation group,and the difference was statistically significant(P<0.05).Through villous biopsy of 60 fetuses,47 cases(78.3%,47/60)with haemoglobin Bart’s disease,10 cases(16.7%,10/60)with chromosomal abnormalities were detected,and none abnormalities were detected in other 3 cases.According to the ROC curve,the AUC for CTR and NT to predict chromosomal abnormalities are 0.691 and 0.954,respectively,and the diagnostic cut-off values are 0.57 and 3.6 mm,respectively.The sensitivity is 60.0%and 100%,the specificity is about 79.6%and 85.7%,respectively.Follow-up showed that 5 cases of fetal were death intrauterine,and the remaining 81 cases were induced to labor.The specificity of CTR increase in predicting adverse pregnancy outcome was 100%.Conclusion:The increase of CTR in 11-13+6 weeks of gestation indicates that the fetus may have serious problems and poor clinical prognosis.Attention should be paid to the accurate evaluation of CTR in early pregnancy so as to provide reference for the prediction of fetal pregnancy outcome.展开更多
The goal of the paper is to conduct an exploratory review and analyses of the dynamics of the pandemic focusing on two themes:pandemic morbidity and vulnerable populations.Method:Review of literature,anecdotal evidenc...The goal of the paper is to conduct an exploratory review and analyses of the dynamics of the pandemic focusing on two themes:pandemic morbidity and vulnerable populations.Method:Review of literature,anecdotal evidence,and reports on the morbidity of COVID-19;including scope of its devastating effects in selected countries.Findings:The devastating effects of the coronavirus are felt across different vulnerable populations.These include the elderly,front line workers,marginalized communities,visible minorities,and more.Inadequate and sometimes conflicting remarks by“experts”have only contributed in exacerbating the confusion in the general population.However,compassion and empathy from different communities have had positive effects on mitigating some of the health outcomes like mental health and other health-related effects of the pandemic.Institutional support needs to be strengthened,especially with regard to individual risks and supply chain coordination:personal protection equipment(PPE),masks,swabs,reagents,etc.The challenge in Africa is especially daunting,because of limited and inadequate financial resources and infrastructure,as confirmed by the health budget allocations as a percentage of their respective GDP(gross domestic product).Discussion:The effects of the COVID-19 are producing unprecedented and catastrophic outcomes in many countries.These have been exacerbated by the level of unpreparedness and inadequate degrees of prevention and intervention strategies.With a few exceptions,the common and current intervention approach is driven by many unknowns including compilation of relevant reliable and compelling data sets.Vulnerable communities continue to suffer most:a situation that is highlighted in this essay as one attempt to remind institutions of their duty to provide appropriate support,including compassion and empathy to these populations.The repercussions of no or inadequate action are numerous,significant,and mind-boggling with unpredictable future outcomes and possible dire consequences.The continuous carnage caused by COVID-19 is a wake-up call reminding all stakeholders(public and private institutions)that once again the inequality infiltrating vulnerable populations needs to be effectively addressed with emphasis on affordability,improved quality of life,and an inclusive long-term strategic plan.Ubiquitous and inadequate supply chain coordination mechanisms have been a major deterrent towards mitigating the effects of this coronavirus pandemic.展开更多
目的:探讨先兆流产患者保胎后不良妊娠结局的影响因素。方法:选取2020年7月至2023年2月本院收治的先兆流产患者96例为研究对象,均接受保胎治疗。依据治疗后妊娠结局情况分为良好组79例、不良组17例。分析比较两组临床资料。多因素Logis...目的:探讨先兆流产患者保胎后不良妊娠结局的影响因素。方法:选取2020年7月至2023年2月本院收治的先兆流产患者96例为研究对象,均接受保胎治疗。依据治疗后妊娠结局情况分为良好组79例、不良组17例。分析比较两组临床资料。多因素Logistic回归分析不良妊娠结局的影响因素。结果:孕产次数、流产次数、黄体功能不全、焦虑评分、宫内大血肿、尿完整型人绒毛膜促性腺激素(Intact human chorionic gonadotropin,I-HCG)/人绒毛膜促性腺激素相关蛋白(Human chorionic gonadotropin related protein,HCGRP)阳性2为不良妊娠结局的独立危险因素(P<0.05)。结论:孕产次数、流产次数、黄体功能不全、焦虑评分、宫内大血肿、尿I-HCG/HCGRP阳性2为先兆流产患者保胎后不良妊娠结局的高危因素。展开更多
目的:探讨可优化性肺保护通气策略(LPVS)在中-重型创伤性颅脑损伤(TBI)患者围术期肺部等转归中的作用。方法:选取2020年2月—2021年2月德阳市人民医院收治的52例创伤性中-重型颅脑损伤患者作为研究对象,实施围术期LPVS,所有患者均采取...目的:探讨可优化性肺保护通气策略(LPVS)在中-重型创伤性颅脑损伤(TBI)患者围术期肺部等转归中的作用。方法:选取2020年2月—2021年2月德阳市人民医院收治的52例创伤性中-重型颅脑损伤患者作为研究对象,实施围术期LPVS,所有患者均采取压力调节容量控制(PRVC)通气,PRVC参数设置:Vol 6~8 mL/kg,RR 10~15 bpm,Ti∶Te=1∶2,呼气未正压(PEEP) 5 cmH_(2)O,FiO_(2) 50%,氧流量1~2 L/min,每隔120 min采取压力控制法(PCV)肺复张。记录麻醉诱导前(T0)、PRVC开始(T1)、PRVC后首次监测ICP (T2)、PRVC+PCV后关颅(T3)以及术后12 h (T4)、24 h(T5)、48 h (T6)、72 h (T7)、5 d (T8)的平均动脉压(MAP)、SPO_(2)、PetCO_(2)、ICP,测算脑灌注压(CPP);于各观察时点记录PRVC+PCV前后PaO_(2)、PaCO_(2)、记录手术时长、失血量、PRVC时长。结果:接受LPVS的患者采取PRVC,给予PCV肺复张,PaO_(2)、SpO_(2)、OI明显升高,T7、T8值改善明显高于T0、T1、T2,肺氧合功能改善。结论:可优化性LPVS拥有较好地预防肺不张、肺损伤,优化肺氧合功能,改良肺部转归,是中-重型围术期肺部非生理条件下机械通气呼吸的较理想管理方法。展开更多
基金Guangdong Provincial Medical Research Fund(No.A2018159)。
文摘Objective:To explore the value of increased fetal cardio thoracic ratio(CTR)in predicting adverse fetal pregnancy outcome during 11-13+6 weeks.Methods:The ultrasonographic features,chromosome or gene detection and the pregnancy outcome of 86 fetuses with increased CTR at 11-13+6 weeks’gestation were retrospectively analyzed.Fetuses were divided into non-structural malformation group(46 cases)and structural malformation group(40 cases)according to results of fetal ultrasound examination.The differences of CTR and nuchal translucency thickness(NT)between the two groups were compared by t test.The area under the curve(AUC)was calculated by constructing the receiver operating curve(ROC)to determine the best diagnostic threshold,sensitivity and specificity of CTR and NT in predicting chromosomal abnormalities.Results:All the 86 fetuses had serious problems such as chromosome or gene abnormalities,or structural malformations.The CTR and NT of the structural malformation group were significantly higher than those of the non-structural malformation group,and the difference was statistically significant(P<0.05).Through villous biopsy of 60 fetuses,47 cases(78.3%,47/60)with haemoglobin Bart’s disease,10 cases(16.7%,10/60)with chromosomal abnormalities were detected,and none abnormalities were detected in other 3 cases.According to the ROC curve,the AUC for CTR and NT to predict chromosomal abnormalities are 0.691 and 0.954,respectively,and the diagnostic cut-off values are 0.57 and 3.6 mm,respectively.The sensitivity is 60.0%and 100%,the specificity is about 79.6%and 85.7%,respectively.Follow-up showed that 5 cases of fetal were death intrauterine,and the remaining 81 cases were induced to labor.The specificity of CTR increase in predicting adverse pregnancy outcome was 100%.Conclusion:The increase of CTR in 11-13+6 weeks of gestation indicates that the fetus may have serious problems and poor clinical prognosis.Attention should be paid to the accurate evaluation of CTR in early pregnancy so as to provide reference for the prediction of fetal pregnancy outcome.
文摘The goal of the paper is to conduct an exploratory review and analyses of the dynamics of the pandemic focusing on two themes:pandemic morbidity and vulnerable populations.Method:Review of literature,anecdotal evidence,and reports on the morbidity of COVID-19;including scope of its devastating effects in selected countries.Findings:The devastating effects of the coronavirus are felt across different vulnerable populations.These include the elderly,front line workers,marginalized communities,visible minorities,and more.Inadequate and sometimes conflicting remarks by“experts”have only contributed in exacerbating the confusion in the general population.However,compassion and empathy from different communities have had positive effects on mitigating some of the health outcomes like mental health and other health-related effects of the pandemic.Institutional support needs to be strengthened,especially with regard to individual risks and supply chain coordination:personal protection equipment(PPE),masks,swabs,reagents,etc.The challenge in Africa is especially daunting,because of limited and inadequate financial resources and infrastructure,as confirmed by the health budget allocations as a percentage of their respective GDP(gross domestic product).Discussion:The effects of the COVID-19 are producing unprecedented and catastrophic outcomes in many countries.These have been exacerbated by the level of unpreparedness and inadequate degrees of prevention and intervention strategies.With a few exceptions,the common and current intervention approach is driven by many unknowns including compilation of relevant reliable and compelling data sets.Vulnerable communities continue to suffer most:a situation that is highlighted in this essay as one attempt to remind institutions of their duty to provide appropriate support,including compassion and empathy to these populations.The repercussions of no or inadequate action are numerous,significant,and mind-boggling with unpredictable future outcomes and possible dire consequences.The continuous carnage caused by COVID-19 is a wake-up call reminding all stakeholders(public and private institutions)that once again the inequality infiltrating vulnerable populations needs to be effectively addressed with emphasis on affordability,improved quality of life,and an inclusive long-term strategic plan.Ubiquitous and inadequate supply chain coordination mechanisms have been a major deterrent towards mitigating the effects of this coronavirus pandemic.
文摘目的:探讨先兆流产患者保胎后不良妊娠结局的影响因素。方法:选取2020年7月至2023年2月本院收治的先兆流产患者96例为研究对象,均接受保胎治疗。依据治疗后妊娠结局情况分为良好组79例、不良组17例。分析比较两组临床资料。多因素Logistic回归分析不良妊娠结局的影响因素。结果:孕产次数、流产次数、黄体功能不全、焦虑评分、宫内大血肿、尿完整型人绒毛膜促性腺激素(Intact human chorionic gonadotropin,I-HCG)/人绒毛膜促性腺激素相关蛋白(Human chorionic gonadotropin related protein,HCGRP)阳性2为不良妊娠结局的独立危险因素(P<0.05)。结论:孕产次数、流产次数、黄体功能不全、焦虑评分、宫内大血肿、尿I-HCG/HCGRP阳性2为先兆流产患者保胎后不良妊娠结局的高危因素。
文摘目的:探讨可优化性肺保护通气策略(LPVS)在中-重型创伤性颅脑损伤(TBI)患者围术期肺部等转归中的作用。方法:选取2020年2月—2021年2月德阳市人民医院收治的52例创伤性中-重型颅脑损伤患者作为研究对象,实施围术期LPVS,所有患者均采取压力调节容量控制(PRVC)通气,PRVC参数设置:Vol 6~8 mL/kg,RR 10~15 bpm,Ti∶Te=1∶2,呼气未正压(PEEP) 5 cmH_(2)O,FiO_(2) 50%,氧流量1~2 L/min,每隔120 min采取压力控制法(PCV)肺复张。记录麻醉诱导前(T0)、PRVC开始(T1)、PRVC后首次监测ICP (T2)、PRVC+PCV后关颅(T3)以及术后12 h (T4)、24 h(T5)、48 h (T6)、72 h (T7)、5 d (T8)的平均动脉压(MAP)、SPO_(2)、PetCO_(2)、ICP,测算脑灌注压(CPP);于各观察时点记录PRVC+PCV前后PaO_(2)、PaCO_(2)、记录手术时长、失血量、PRVC时长。结果:接受LPVS的患者采取PRVC,给予PCV肺复张,PaO_(2)、SpO_(2)、OI明显升高,T7、T8值改善明显高于T0、T1、T2,肺氧合功能改善。结论:可优化性LPVS拥有较好地预防肺不张、肺损伤,优化肺氧合功能,改良肺部转归,是中-重型围术期肺部非生理条件下机械通气呼吸的较理想管理方法。
