• 【中国昆明女性青少年性工作者的脆弱性,健康需求和高风险性行为的预测因素。】 复制标题 收藏 收藏
    DOI:10.1136/sextrans-2012-050690 复制DOI
    作者列表:Zhang XD,Temmerman M,Li Y,Luo W,Luchters S
    BACKGROUND & AIMS: OBJECTIVES:This study assessed social and behavioural predictors for sexual risk taking and sexually transmitted infections (STIs) including HIV among adolescent female sex workers (FSWs) from Kunming, China. Additionally, health services needs and use were assessed. METHODS:A cross-sectional survey was conducted in 2010. Using snowball and convenience sampling, self-identified FSWs were recruited from four urban areas in Kunming. Women consenting to participate were administered a semi-structured questionnaire by trained interviewers identified from local peer-support organisations. Following interview, a gynaecological examination and biological sampling to identify potential STIs were undertaken. Descriptive and multivariable logistic regression analyses were performed. RESULTS:Adolescent FSWs had a mean age of 18.2 years and reported numerous non-paying sexual partners with very low rate of consistent condom use (22.2%). Half (50.3%) the respondents had sex while feeling drunk at least once in the past week, of whom 56.4% did not use condom protection. STI prevalence was high overall (30.4%) among this group. Younger age, early sexual debut, being isolated from schools and family, short duration in sex work, and use of illicit drugs were found to be strong predictors for unprotected sex and presence of an STI. Conversely, having access to condom promotion, free HIV counselling and testing, and peer education were associated with less unprotected sex. The majority reported a need for health knowledge, free condoms and low-cost STI diagnosis and treatment. CONCLUSIONS:There is an urgent need to improve coverage, accessibility and efficiency of existing interventions targeting adolescent FSWs.
    背景与目标:
  • 【青少年内在化和外在化症状作为创伤暴露和创伤后应激障碍类型的前瞻性预测指标的测试。】 复制标题 收藏 收藏
    DOI:10.1002/jts.21751 复制DOI
    作者列表:Haller M,Chassin L
    BACKGROUND & AIMS: :The present study utilized longitudinal data from a high-risk community sample (N = 377; 166 trauma-exposed; 202 males; 175 females; 73% non-Hispanic Caucasian) to test pretrauma measures of adolescent internalizing and externalizing symptoms as unique prospective predictors of type of trauma exposure and PTSD over and above the influence of correlated family adversity (a composite of family conflict, stress, and parental psychopathology). Data were analyzed with logistic and multinomial logistic regressions. Results indicated that females, but not males, with higher levels of internalizing (OR = 2.91) and externalizing (OR = 2.37) symptoms during adolescence were significantly more likely to be exposed to assaultive violence (over and above family adversity). In fact, males with higher levels of internalizing symptoms were significantly less likely to be exposed to assaultive violence (OR = 0.54). Neither internalizing nor externalizing symptoms uniquely predicted exposure to traumatic events that did not involve assaultive violence. Among trauma-exposed participants, the unique association between internalizing symptoms and later PTSD yielded an odds ratio of 1.79 (p = .07) over and above the influences of family adversity, type of trauma exposure, and gender. Assaultive violence exposure fully mediated the association between females' externalizing symptoms and future PTSD. Findings may help inform the prevention of both assaultive violence exposure and PTSD.
    背景与目标: : 本研究利用了来自高风险社区样本的纵向数据 (N = 377; 166创伤暴露; 202男性; 175女性; 73% 非西班牙裔高加索人) 测试青少年内在化和外在化症状的创伤前措施,作为创伤暴露类型和创伤后应激障碍的独特前瞻性预测因子,超越相关家庭逆境 (家庭冲突、压力和父母心理病理学的组合) 的影响。数据采用logistic和多项logistic回归分析。结果表明,女性而不是男性,在青春期具有较高水平的内在化 (或 = 2.91) 和外在化 (或 = 2.37) 症状的女性更容易遭受攻击性暴力 (超过家庭逆境)。事实上,具有较高水平内化症状的男性暴露于攻击性暴力的可能性显著降低 (OR = 0.54)。内部化或外部化症状都不能唯一地预测暴露于不涉及攻击性暴力的创伤事件。在创伤暴露的参与者中,内在化症状与后来的PTSD之间的独特关联产生了1.79的优势比 (p = .07),超出了家庭逆境,创伤暴露类型和性别的影响。攻击性暴力暴露充分介导了女性外在症状与未来创伤后应激障碍之间的关联。研究结果可能有助于预防攻击性暴力暴露和PTSD。
  • 【单绒毛膜和双绒毛膜双胎妊娠的早期胎儿丢失: 西南泰晤士河产科研究合作 (STORK) 多胎妊娠队列的分析。】 复制标题 收藏 收藏
    DOI:10.1002/uog.12363 复制DOI
    作者列表:D'Antonio F,Khalil A,Dias T,Thilaganathan B,Southwest Thames Obstetric Research Collaborative (STORK).
    BACKGROUND & AIMS: OBJECTIVES:Monochorionic (MC) twins are at increased risk of early fetal loss secondary to vascular complications such as twin-twin transfusion syndrome (TTTS). This study compared the early perinatal loss rates between MC and dichorionic (DC) twins in an era of invasive treatment for TTTS. METHODS:This was a retrospective study of all twin pregnancies of known chorionicity from a large regional cohort of nine hospitals over a 10-year period. Ultrasound data were matched to hospital delivery records and to a mandatory national register of pregnancy losses. Prospective risk of pregnancy loss from 14 to 24 weeks' gestation was calculated and the survival trend of MC and DC twins was analyzed using Kaplan-Meier survival analysis. RESULTS:The analysis included 3117 twin pregnancies (605 MC and 2512 DC). The total risk of early pregnancy loss (miscarriage and neonatal death) before 24 weeks was significantly higher in MC twins (60.3 per 1000 fetuses) than in DC twins (6.6 per 1000 fetuses), with a relative risk of 9.18 (95% CI, 6.0-13.9). Survival analysis showed a significant difference in overall and early mortality between MC and DC twins (log-rank test, P < 0.0001), while no difference was noted after 24 weeks' gestation (log-rank test, P = 0.08). CONCLUSIONS:Early pregnancy loss is significantly more common in MC than in DC twins, but no difference in the prospective risk of mortality between MC and DC twins is evident after 24 weeks' gestation. The observed early mortality rate has almost halved in comparison with previous studies in the published literature. Early detection and prompt treatment of complications in MC twins are likely to have contributed to this improvement in outcome.
    背景与目标:
  • 【双胎妊娠的胎儿生长和围产儿死亡率-病假和住院的影响。】 复制标题 收藏 收藏
    DOI:10.1016/0020-7292(85)90054-2 复制DOI
    作者列表:Erkkola R,Ala-Mello S,Kero P,Sillanpää M
    BACKGROUND & AIMS: :Fetal growth, birth weight specific mortality rates and effect of sick leave or hospitalization on the fetal growth were investigated in a material of 476 twin pregnancies managed at University Central Hospital of Turku in years 1970-81. Birth weights of twin babies at any gestational age were slightly but not significantly higher than in earlier materials. When compared to growth curve of singleton fetuses, the growth rate of both twins is equal to singletons up to 30th week of pregnancy, being thereafter slower than in singleton pregnancies. Although duration of sick leave and hospitalization increased considerably during the study period, no change in the duration of pregnancy nor in the weight of twin babies occurred. Instead perinatal mortality decreased from 101/per thousand to 36.2/per thousand. Birth weight specific mortality rates did not differ from those in singleton fetuses.
    背景与目标: : 在图尔库大学中央医院1970-81年管理的476例双胎妊娠材料中,研究了胎儿生长,出生体重特定死亡率以及病假或住院对胎儿生长的影响。在任何胎龄的双胞胎婴儿的出生体重均略高于但不显着高于早期材料。与单胎胎儿的生长曲线相比,两个双胞胎的生长速度等于怀孕第30周的单胎,此后比单胎妊娠慢。尽管在研究期间病假和住院时间大大增加,但怀孕时间和双胞胎婴儿的体重没有变化。相反,围产期死亡率从101/每千下降到36.2/每千。出生体重特定死亡率与单胎胎儿没有差异。
  • 【产前超声检查与胎儿尸检结果之间的一致性: 妊娠中期终止的回顾性研究。】 复制标题 收藏 收藏
    DOI:10.1055/s-0032-1325538 复制DOI
    作者列表:Lomax L,Johansson H,Valentin L,Sladkevicius P
    BACKGROUND & AIMS: OBJECTIVES:To estimate the agreement between prenatal ultrasonography observations at 16 - 21 gestational weeks and fetal autopsy findings in pregnancies terminated because of fetal anomalies. STUDY DESIGN:This 4½ year retrospective study includes consecutive fetuses that were terminated because of fetal malformation and/or chromosomal anomaly diagnosed in the second trimester. Only fetuses that had undergone fetal anatomy scanning by an obstetrician trained in fetal ultrasound before the termination and with available fetal autopsy reports were included. The cases were identified through the malformation registry database of our ultrasound unit. The sensitivity and specificity of ultrasound were calculated per organ system. When estimating the agreement between ultrasound results and autopsy findings, the cases were allocated to one of four categories according to the degree of concordance between ultrasound and autopsy findings: full agreement, near match, partial agreement and unconfirmed ultrasound findings. RESULTS:71 of 95 pregnancy terminations due to fetal malformations met the inclusion criteria and constitute our study population. The sensitivity of ultrasonography with regard to malformations in the brain and spine was 100 % (27/27) and with regard to malformations in the internal organ system (including malformations in the urogenital and gastrointestinal systems and in the abdominal wall and diaphragm) was 91 % (30/33). The corresponding figures for malformations in the cardiovascular and skeletal organ systems were 63 % (17/27) and 71 % (25/35), respectively. The specificity was lowest for malformations in the central nervous system and internal organ system (33/38, 87 % and 39/44, 89 %, respectively). There was full agreement between the ultrasound and autopsy findings in 44 % (31/71) of all cases and a near match in 46 % (33/71) of cases. In almost 10 % (7/71) of the pregnancies, the ultrasound findings were only partially confirmed or not confirmed by autopsy. In one case the discrepancy between the ultrasound and autopsy findings suggests that the pregnant woman might have decided to terminate the pregnancy on the basis of incorrect interpretation of ultrasound findings. CONCLUSION:Even though the agreement between ultrasound and autopsy findings was acceptable from a clinical point of view, agreement with regard to the detailed description of malformations was far from perfect. The detection rates were suboptimal for the cardiovascular and skeletal organ systems. :ZIEL:: Bewertung, inwieweit bei Schwangerschaftsabbrüchen aufgrund fetaler Anomalien die Befunde der pränatalen Ultraschalluntersuchung in der 16.–21. SSW mit dem Autopsiebefund des Feten übereinstimmen. METHODEN:Diese 4½ jährige retrospektive Studie schließt fortlaufend Feten ein, bei denen im 2. Trimenon ein Schwangerschaftsabbruch (TOP) aufgrund fetaler Fehlbildungen und/oder aufgrund von diagnostizierten Chromosomenanomalien erfolgt ist. Es wurden nur Feten einbezogen, bei denen vor dem Abbruch eine anatomische Untersuchung durch einen in der Fetalsonografie geübten Geburtshelfer durchgeführt wurde und bei denen fetale Autopsiebefunde vorlagen. Die Fälle wurden durch die Datenbank unserer Sonografieabteilung zur „Registrierung von Fehlbildungen“ ermittelt. Die Sensitivität und Spezifität der Sonografie wurde für jedes Organsystem berechnet. Zur Abschätzung der Übereinstimmung von Ultraschall- und Autopsiebefunden wurden die Fälle einer der vier Kategorien zugewiesen, je nach Grad der Übereinstimmung der Befunde: Solche mit völliger, sich fast entsprechender und nur teilweiser Übereinstimmung sowie nicht bestätigte Ultraschallbefunde. ERGEBNISSE:Die Einschlusskriterien erfüllten 71 von 95 Schwangerschaftsabbrüchen aufgrund fetaler Anomalien und bildeten somit unsere Studienpopulation. Die Sensitivität der Sonografie in Bezug auf Malformationen des Gehirns und Wirbelsäule betrug 100 % (27/27) und in Bezug auf Anomalien der inneren Organe (einschließlich der Fehlbildungen des Urogenital- und Magen-Darm-Systems, der Bauchdecke und des Diaphragmas) 91 % (31/33). Die entsprechende Rate für Anomalien des Herz-Kreislauf-Systems betrug 63 % (17/27) und für die des Skelettsystems 71 % (25/35). Die niedrigste Spezifität wurde für Malformationen des zentralen Nervensystems (33/38, 87 %) und der inneren Organe (39/44, 89 %) ermittelt. Eine völlige Übereinstimmung von Ultraschall- und Autopsiebefunden wurde in 44 % (31/71) und eine sich fast entsprechende Übereinstimmung in 46 % (33/71) aller Fälle gefunden. Bei beinahe 10 % (7/71) der Schwangerschaften konnten die Ultraschallbefunde nur teilweise beziehungsweise gar nicht durch die Autopsie bestätigt werden. In einem Fall mit diskrepanten Ultraschall- und Autopsiebefunden kann angenommen werden, dass die Schwangere die Entscheidung für einen Abbruch vermutlich aufgrund der fehlerhaften Interpretation des Ultraschallbefundes fällte. SCHLUSSFOLGERUNG:Obwohl die Übereinstimmung von Ultraschall- und Autopsiebefunden vom klinischen Standpunkt betrachtet akzeptierbar schien, war sie bezüglich der genauen Beschreibung der Fehlbildungen bei weitem nicht perfekt. Die Trefferquoten beim Herz-Kreislauf- und Skelettsystem waren suboptimal.
    背景与目标:
  • 【月经大量出血的青春期女性缺铁和乏力。】 复制标题 收藏 收藏
    DOI:10.1111/hae.12046 复制DOI
    作者列表:Wang W,Bourgeois T,Klima J,Berlan ED,Fischer AN,O'Brien SH
    BACKGROUND & AIMS: :Iron deficiency and fatigue are common problems in adolescent females. Heavy menstrual bleeding (HMB) is associated with both iron deficiency and fatigue. The aim of this study was to define baseline ferritin values and fatigue symptoms in a population of young females with excessive menstrual blood loss, as compared to healthy controls. The study population included 11 to 17-year-old menstruating females presenting to an Adolescent Gynaecology Clinic, Menorrhagia Clinic or Sports Medicine clinic. To evaluate the degree and effects of menstrual blood loss, we utilized the Ruta Menorrhagia Severity Score. We investigated the symptoms of fatigue using the Fatigue Severity Scale. We evaluated possible predictors of ferritin level (age, body mass index, fatigue scores and Menorrhagia Severity Score) using generalized linear models. A total of 48 adolescents with HMB and 102 healthy adolescents completed the study. Iron deficiency and elevated fatigue scores were common findings in young women with HMB. Both fatigue severity scores and menorrhagia severity scores were significantly higher in young women with HMB as compared to healthy controls. In adolescents with HMB, 87.5% had ferritin levels ≤40 ng mL(-1), and 29.2% had ferritin levels ≤15 ng mL(-1). Our generalized linear models did not identify any significant univariate relationships between ferritin levels and patient age, body mass index, fatigue score or menorrhagia score. Iron deficiency and symptoms of fatigue are common findings in young women with HMB. Fatigue severity scores are significantly higher in young women with HMB as compared to healthy controls.
    背景与目标: : 缺铁乏力是青春期女性的常见问题。大量月经出血 (HMB) 与铁缺乏和乏力有关。这项研究的目的是确定与健康对照组相比,月经失血过多的年轻女性人群的基线铁蛋白值和乏力症状。研究人群包括11至17岁的经期女性,这些女性在青春期妇科诊所,月经过多诊所或运动医学诊所就诊。为了评估月经失血的程度和影响,我们使用了Ruta月经过多严重程度评分。我们使用乏力严重程度量表调查乏力症状。我们使用广义线性模型评估了铁蛋白水平的可能预测因子 (年龄,体重指数,乏力评分和月经过多严重程度评分)。共有48名HMB青少年和102名健康青少年完成了这项研究。铁缺乏和乏力评分升高是HMB年轻女性的常见发现。与健康对照组相比,患有HMB的年轻女性乏力严重程度评分和月经过多严重程度评分均显着更高。在患有HMB的青少年中,87.5% 的铁蛋白水平 ≤ 40 ng mL(-1),29.2% 的铁蛋白水平 ≤ 15 ng mL(-1)。我们的广义线性模型没有确定铁蛋白水平与患者年龄,体重指数,乏力评分或月经过多评分之间的任何显着的单变量关系。铁缺乏和乏力症状是HMB年轻女性的常见发现。与健康对照组相比,患有HMB的年轻女性乏力严重程度评分明显更高。
  • 【妊娠晚期二尖瓣腱索断裂引起的急性充血性心力衰竭。】 复制标题 收藏 收藏
    DOI:10.1111/j.1447-0756.2012.02014.x 复制DOI
    作者列表:Ohishi S,Nitta H,Chinen Y,Kinjo T,Masamoto H,Sakumoto K,Maeda T,Kuniyoshi Y,Aoki Y
    BACKGROUND & AIMS: :A 31-year-old woman complained of dyspnea and orthopnea at 38 weeks of gestation. A grade 3/6 pansystolic murmur was heard, and echocardiography revealed severe mitral regurgitation with a hyperechoic obstacle on the posterior mitral valve leaflet, consistent with a diagnosis of acute heart failure due to a ruptured chordae tendineae or an infectious endocarditis. An emergency cesarean section was performed under general anesthesia. A male infant was born weighing 2928 g with Apgar scores of 7 and 8 at 1 and 5 min, respectively. The patient was managed in the intensive care unit and underwent open-heart surgery for mitral valve repair on postpartum day 3. The two chordal tendineae appeared torn and frail, and a mitral annuloplasty was performed. No finding of infectious endocarditis was observed. Because it is a dramatic and life-threatening clinical situation, proper diagnosis and treatment in the intensive care unit assure a good outcome for both mother and fetus.
    背景与目标: : 一名31岁的妇女在妊娠38周时抱怨呼吸困难和正呼吸。听到了3/6级的全收缩期杂音,超声心动图显示严重的二尖瓣反流,二尖瓣后叶上有高回声障碍,这与由于腱索破裂或感染性心内膜炎引起的急性心力衰竭的诊断一致。在全身麻醉下进行紧急剖宫产。出生时体重为2928  g的男婴,分别在1和5  min时Apgar评分为7和8。该患者在重症监护病房接受治疗,并于产后第3天接受心脏直视手术进行二尖瓣修复。两个腱索出现撕裂和脆弱,并进行了二尖瓣环成形术。未发现感染性心内膜炎。由于这是一个戏剧性的,危及生命的临床情况,因此在重症监护病房中进行适当的诊断和治疗可确保母亲和胎儿的良好结局。
  • 【土耳其西部不同孕期和产后初期产妇白细胞总数和差异计数的参考值。】 复制标题 收藏 收藏
    DOI:10.1080/01443615.2016.1268575 复制DOI
    作者列表:Sanci M,Töz E,Ince O,Özcan A,Polater K,Inan AH,Beyan E,Akkaya E
    BACKGROUND & AIMS: :The aim of this study was to investigate alterations in the leukocyte and differential leukocyte counts in different trimesters of pregnancy and the initial postpartum period. The study population consisted of 40,325 pregnant women. A full blood count and automated differential leukocyte count were performed and all the haemogram results in the different trimesters of pregnancy were recorded. Percentiles were calculated using statistical software. A total of 82,786 complete blood count evaluations were performed in 40,325 subjects from the 6th to 41st week of pregnancy and in the initial postpartum period. The leukocyte counts increased from the 1st to the 3rd trimester and peaked in the initial postpartum period. Our reference values for the total and differential leukocyte counts may assist clinicians in distinguishing between leukocytosis and pathological elevation of the white blood cell count during pregnancy and the initial postpartum period. Impact statement Pregnancy requires profound adaptation by multiple systems to accommodate the demands of the developing foetus. Similar to all other systems, many haematological changes occur during pregnancy. Studies of normal variation in leukocyte counts were insufficient to distinguish normal from abnormal leukocyte counts during pregnancy and in the initial postpartum period, due to small numbers of patients and a lack of differential leukocyte counts. Without reference leukocyte levels, infections may be more difficult to assess during pregnancy and in the postpartum period. In this study, we report the 3rd, 5th, 10th, 50th, 95th and 99th percentile values for the total and differential leukocyte counts according to trimester in normal pregnancy and the initial postpartum period. Our reference values for the total and differential leukocyte counts in each trimester and the initial postpartum period may assist clinicians in distinguishing between normal leukocytosis and pathological elevation of the white blood cell count during pregnancy and the initial postpartum period. Our results may prevent misdiagnosis of physiological elevated leukocytes as bacterial infection that leads to unnecessary medication use that may compromise the foetus.
    背景与目标: : 这项研究的目的是调查妊娠不同三个月和产后初期白细胞和白细胞计数差异的变化。研究人群由40,325名孕妇组成。进行了全血细胞计数和自动差异白细胞计数,并记录了妊娠不同三个月的所有血象结果。使用统计软件计算百分位数。从怀孕的第6周至第41周和产后初期,对40,325名受试者进行了总共82,786次全血细胞计数评估。白细胞计数从第1个月到第3个月增加,并在产后初期达到峰值。我们的总白细胞计数和差异白细胞计数参考值可以帮助临床医生区分白细胞增多和妊娠和产后初期白细胞计数的病理升高。影响声明怀孕需要多个系统进行深刻的适应,以适应发育中的胎儿的需求。与所有其他系统相似,许多血液学变化发生在怀孕期间。由于患者人数少且缺乏差异的白细胞计数,对白细胞计数正常变化的研究不足以区分妊娠期间和产后初期的正常白细胞计数与异常白细胞计数。如果没有参考白细胞水平,则在怀孕期间和产后期间可能更难评估感染。在这项研究中,我们根据正常妊娠和产后初期的三个月报告了总白细胞计数和差异白细胞计数的第3、5、10、50、95和99个百分位数值。我们在每个孕期和产后初期的总白细胞计数和差异白细胞计数的参考值可以帮助临床医生区分正常的白细胞增多和妊娠和产后初期的白细胞计数的病理升高。我们的结果可以防止将生理性白细胞升高误诊为细菌感染,从而导致不必要的药物使用,从而可能损害胎儿。
  • 【anakinra在患有抗秋水仙碱的家族性地中海发热的青少年中的功效。】 复制标题 收藏 收藏
    DOI:10.1007/s00431-007-0547-3 复制DOI
    作者列表:Calligaris L,Marchetti F,Tommasini A,Ventura A
    BACKGROUND & AIMS: :Colchicine is the treatment of choice in familial Mediterranean fever (FMF) for the prevention of both attacks and secondary amyloidosis. The overall nonresponder rate is about 5-10%. Anakinra is known to have good effectiveness in a severe autoinflammatory syndrome [chronic infantile neurological cutaneous and articular (CINCA) syndrome] and other recurrent hereditary periodic fevers. Pyrin--the protein involved in FMF--has a role in activating the proinflammatory cytokine interleukin (IL)-1beta. We report the effectiveness of the addition of an IL-1-receptor inhibitor (anakinra) to colchicine in controlling the febrile attacks and acute phase response in an adolescent with FMF resistant to colchicine.
    背景与目标: : 秋水仙碱是家族性地中海发热 (FMF) 预防发作和继发性淀粉样变性的首选治疗方法。总体无应答率约为5-10%。众所周知,Anakinra在严重的自身炎症综合征 (慢性婴儿神经性皮肤和关节 (CINCA) 综合征) 和其他复发性遗传性周期性发烧中具有良好的疗效。Pyrin (参与FMF的蛋白质) 在激活促炎细胞因子白介素 (IL)-1β 中起作用。我们报告了在秋水仙碱中添加IL-1-receptor抑制剂 (anakinra) 在控制FMF对秋水仙碱耐药的青少年的发热发作和急性期反应中的有效性。
  • 【人类怀孕和妊娠对运动过程中呼吸不适的影响。】 复制标题 收藏 收藏
    DOI:10.1016/j.resp.2006.08.004 复制DOI
    作者列表:Jensen D,Webb KA,Wolfe LA,O'Donnell DE
    BACKGROUND & AIMS: :This study examined the effects of human pregnancy and advancing gestation on the intensity of respiratory discomfort (dyspnea) during cycle exercise. Fourteen pregnant women (PG) performed a progressive cycle ergometer exercise test involving 20 W/min increases in work rate to symptom limitation and/or a heart rate of 170-175 beats/min at 19.7+/-1.2 weeks (ENTRY), 28.2+/-0.3 weeks (TM2) and 36.3+/-0.3 weeks (TM3) gestation. Eight, age-matched, sedentary non-pregnant women (CG) were also studied for comparison purposes. Measurements included dyspnea intensity (Borg scale), minute ventilation (VE), breathing pattern and other cardiorespiratory parameters. At peak exercise, neither pregnancy nor advancing gestation had an effect on dyspnea, VE, breathing pattern, oxygen uptake or work rate (p>0.05). VE was significantly greater (by 11 L/min at 100 W) in the PG at TM3 versus CG (p<0.05) at all submaximal work rates. VE also increased progressively from ENTRY to TM2 and TM3 during submaximal exercise. Dyspnea was not significantly different at any submaximal work rate in the PG at TM3 versus CG or with advancing gestation in the PG. In addition, dyspnea at a standardized exercise VE of 40 L/min was not different at TM3 versus ENTRY or in the PG at TM3 versus CG. Neither pregnancy nor advancing gestation were associated with increased respiratory discomfort during strenuous non-weight bearing cycle ergometer exercise, despite substantial increases in VE and progressive mechanical adaptations of the respiratory system to accommodate the increasing size of the gravid uterus.
    背景与目标: : 这项研究检查了人类怀孕和妊娠对周期运动期间呼吸不适 (呼吸困难) 强度的影响。14名孕妇 (PG) 进行了渐进式循环测力计运动测试,包括在19.7周 +/-1.2周 (进入) 时,工作速率增加20 W/min,以达到症状限制和/或心率170-175次/min,28.2 +/-0.3周 (TM2) 和36.3 +/-0.3周 (TM3)。为了比较目的,还研究了八名年龄匹配的久坐不动的非孕妇 (CG)。测量包括呼吸困难强度 (Borg量表),分钟通气量 (VE),呼吸模式和其他心肺参数。在运动高峰时,怀孕和妊娠均不会影响呼吸困难,VE,呼吸方式,摄氧量或工作效率 (p>0.05)。在所有次最大工作速率下,TM3的PG相对于CG (p<0.05) 的VE显着更高 (在100 W下为11 l/min)。在次最大运动期间,VE也从进入TM2和TM3逐渐增加。在TM3相对于CG的PG中,在任何亚最大工作速率下,或在PG中进行妊娠时,呼吸困难均无显着差异。此外,在标准化运动VE为40 l/min时的呼吸困难在TM3与ENTRY或PG在TM3与CG时没有差异。尽管VE的显着增加和呼吸系统的进行性机械适应以适应妊娠子宫的增加,但在剧烈的非负重循环测力计运动中,怀孕和妊娠都不会增加呼吸不适。
  • 【青少年特发性脊柱侧凸病因学的最新进展。】 复制标题 收藏 收藏
    DOI:10.1007/s00264-007-0393-y 复制DOI
    作者列表:Cheung KM,Wang T,Qiu GX,Luk KD
    BACKGROUND & AIMS: :The aetiology of adolescent idiopathic scoliosis (AIS) is still unknown despite many years of research effort. Theories on AIS's aetiology have included mechanical, hormonal, metabolic, neuromuscular, growth, and genetic abnormalities. Amongst these, some factors may be epiphenomena rather than the cause itself. Other factors may even contribute to curve progression, rather than curve initiation. Current views maintain that AIS is a multifactorial disease with genetic predisposing factors [Lowe et al. in J Bone Joint Surg [Am] 82:1157-1168, 2000]. With improvements in diagnostic methods, imaging and genomics, there has been considerable recent work on aetiology. This review aims to bring readers up-to-date with the latest developments in scoliosis research.
    背景与目标: : 尽管经过多年的研究,青少年特发性脊柱侧凸 (AIS) 的病因仍然未知。AIS病因学的理论包括机械,激素,代谢,神经肌肉,生长和遗传异常。其中,某些因素可能是现象,而不是原因本身。其他因素甚至可能导致曲线进展,而不是曲线启动。目前的观点认为,AIS是具有遗传易感因素的多因素疾病 [Lowe等人在J骨关节外科 [Am] 82:1157-1168,2000]。随着诊断方法,影像学和基因组学的改进,最近在病因学方面开展了大量工作。这篇综述旨在使读者了解脊柱侧弯研究的最新进展。
  • 【在家庭支持薄弱,父母关系薄弱的青少年中,青春期前的关系可以作为心理病理学的缓冲。】 复制标题 收藏 收藏
    DOI:10.1007/BF02353350 复制DOI
    作者列表:Bachar E,Canetti L,Bonne O,De-Nour AK,Shalev AY
    BACKGROUND & AIMS: This study examines the degree to which the existence of a pre-adolescent "chum" interacts with family and social environments to buffer mental distress in adolescents. 831 high school students participated in this study, (male476; mean age 16.7 +/- 1.0). Subjects were administered questionnaires assessing psychopathology and support systems. A pathway analyses model was used to investigate pathways and their interrelationships from chum to psychopathology and from social and family support to psychopathology. Only when adolescents experience weak parental bonding does chumship have a role in buffering distress.

    背景与目标: 这项研究考察了青春期前 “chum” 的存在与家庭和社会环境相互作用以缓解青少年精神困扰的程度。831名高中生参加了这项研究 (male476; 平均年龄16.7 +/- 1.0)。对受试者进行了评估心理病理学和支持系统的问卷调查。使用途径分析模型来研究从chum到心理病理学以及从社会和家庭支持到心理病理学的途径及其相互关系。只有当青少年经历弱的父母关系时,才能在缓解痛苦中发挥作用。
  • 【正常妊娠期间对活化蛋白C反应的变异性。】 复制标题 收藏 收藏
    DOI:10.1097/00001721-199706000-00005 复制DOI
    作者列表:Bokarewa MI,Wramsby M,Bremme K,Blombäck M
    BACKGROUND & AIMS: The response to activated protein C (APC) was investigated in 28 healthy women, non-carriers of the Arg506-Gln mutation in factor V, throughout pregnancy (gestation weeks 12, 20, 28, 32 and 37) and after the delivery. A suppression of APC response was observed which reached lowest values by week 28 (nAPC-ratio 0.78 +/- 0.13), sustained low up to the end of pregnancy and rose after delivery (1.11 +/- 0.22; P < 0.05). APC resistance (nAPC ratio < 0.75) was registered in 16 of the 28 women (57%). A reduction of APC ratio was directly related to its value in the non-pregnant state, being most pronounced in the women with the highest APC ratio. Factor VIII increased during pregnancy and correlated inversely to APC ratio (Z coefficient = -0.645, P < 0.0001). The correlation became weaker in the course of pregnancy, losing significance by week 32. This was explained by the differences in profiles of the two variablesthe lowest measured APC ratio preceded the peak of factor VIII in most cases. The most pronounced rise of factor VIII was found in the women with minimal levels of APC ratio between 0.8 and 0.7. These results allowed us to speculate that APC response is closely regulated during pregnancy, aiming to maintain a certain relevant level. Transitory reduction of APC response is connected to factor VIII and discussed as a prevalent mechanism of functional APC resistance during pregnancy.

    背景与目标: 在整个妊娠期间 (妊娠第12、20、28、32和37周) 和分娩后,对28名健康妇女 (非因子V Arg506-Gln突变携带者) 的活化蛋白C (APC) 的反应进行了研究。观察到APC反应的抑制,其在第28周达到最低值 (nAPC比0.78 +/- 0.13),持续到妊娠结束并在分娩后上升 (1.11 +/- 0.22; P <0.05)。28名女性中有16名 (57% 名) 出现APC耐药 (nAPC比值 <0.75)。APC比率的降低与其在非怀孕状态下的价值直接相关,在APC比率最高的女性中最为明显。因子VIII在怀孕期间增加,并与APC比率成反比 (Z系数 = -0.645,P <0.0001)。相关性在怀孕过程中变弱,到第32周失去意义。这可以通过两个变量的分布差异来解释,在大多数情况下,最低的APC比率先于因子VIII的峰值。在0.8和0.7之间APC比率最低的女性中发现了因子VIII的最明显升高。这些结果使我们能够推测APC反应在怀孕期间受到密切调节,旨在维持一定的相关水平。APC反应的暂时性降低与因子VIII有关,并被认为是怀孕期间功能性APC抵抗的普遍机制。
  • 【妊娠唾液皮质醇分泌模式及其对评估方案的影响。】 复制标题 收藏 收藏
    DOI:10.1016/j.biopsycho.2006.07.005 复制DOI
    作者列表:Harville EW,Savitz DA,Dole N,Herring AH,Thorp JM,Light KC
    BACKGROUND & AIMS: :Cortisol is used in research as a biomarker of psychological stress. Logistical considerations argue for collecting as few samples as possible, balanced against diurnal rhythms and intra-individual variations. 100 pregnant women gave five saliva samples a day for 3 days, at waking, 30 min after waking, and 11:00 a.m., 5:00 p.m., and 9:00 p.m. Timing of collection was confirmed by monitors. Another sample was taken during a clinic visit. Using the 15 measures as the gold standard, correlations and mean area under the curve (AUC) were compared with subsets and the single clinic sample to evaluate alternate collection protocols. Five samples in 1 day, or protocols involving morning and night samples, had the highest correlations with mean AUC (correlation coefficient ranging from 0.82 to 0.88). Standardizing the clinic measurement to a single time of day did not substantially improve correlations with mean AUC. Correlations with measures of reported stress were also not strong.
    背景与目标: : 皮质醇在研究中被用作心理压力的生物标志物。后勤方面的考虑主张收集尽可能少的样本,并与昼夜节律和个体内部变化保持平衡。100名孕妇每天在醒来时,醒来后30分钟以及上午11:00,下午5:00和下午9:00时每天提供五个唾液样本收集时间由监视器确认。在诊所就诊时采集了另一个样本。使用15项措施作为金标准,将相关性和曲线下平均面积 (AUC) 与子集和单个临床样本进行比较,以评估替代收集方案。1天内的5个样品或涉及早晨和夜间样品的方案与平均AUC的相关性最高 (相关系数范围从0.82到0.88)。将临床测量标准化为一天中的单个时间并没有显着改善与平均AUC的相关性。与报告的压力度量的相关性也不强。
  • 15 The role of γδ-T cells during human pregnancy. 复制标题 收藏 收藏

    【Γ δ-T细胞在人类怀孕期间的作用。】 复制标题 收藏 收藏
    DOI:10.1111/aji.12713 复制DOI
    作者列表:Huang C,Zeng Y,Tu W
    BACKGROUND & AIMS: :Pregnancy is an evolutionarily important and mysterious process. The placenta, as the nutrient and gas exchange organ, plays an essential role during this process. In addition, the interaction between trophoblast and maternal immune cells at the maternal-fetal interface is also associated with successful pregnancy. Human leukocyte antigen (HLA) molecules on trophoblast cells are involved in protecting the fetus from maternal rejection. Trophoblast cells comprise three subpopulations, including syncytiotrophoblast cells, cytotrophoblast cells, and extravillous trophoblast cells, and these cells express different HLA molecules. Syncytiotrophoblast and extravillous trophoblast cells encounter maternal immune cells from different sources, such as blood or decidua. The increased γδ-T cells during human normal pregnancy indicate that these cells may play a role in this process. In peripheral blood, Vγ9Vδ2-T cells display cytotoxicity through the recognition of phosphoantigens derived from pathogens. However, HLA-E molecules protect the trophoblast cells from the cytotoxicity of Vγ9Vδ2-T cells through binding to the inhibitory receptor, CD94/NKG2A. In decidua, the main Vδ1-T cells maintain the pregnancy through the secretion of cytokines. In addition, the imbalance between Vγ9Vδ2-T and Vδ1-T cells, and the abnormal expression of the receptors on γδ-T cells were observed in adverse pregnancy.
    背景与目标: 怀孕是一个进化上重要而神秘的过程。胎盘作为营养和气体交换器官,在此过程中起着至关重要的作用。此外,滋养细胞与母体-胎儿界面处的母体免疫细胞之间的相互作用也与成功怀孕有关。滋养细胞上的人类白细胞抗原 (HLA) 分子参与保护胎儿免受母体排斥。滋养层细胞包括三个亚群,包括合体滋养层细胞,细胞滋养层细胞和绒毛外滋养层细胞,这些细胞表达不同的HLA分子。合体滋养层细胞和绒毛外滋养层细胞会遇到来自不同来源的母体免疫细胞,例如血液或蜕膜。在人类正常怀孕期间增加的 γ δ-T细胞表明这些细胞可能在此过程中发挥作用。在外周血中,Vγ9Vδ2-T细胞通过识别源自病原体的磷酸抗原而显示出细胞毒性。然而,hla-e分子通过与抑制性受体CD94/NKG2A结合,保护滋养层细胞免受Vγ9Vδ2-T细胞的细胞毒性。在蜕膜中,主要的Vδ1-T细胞通过分泌细胞因子来维持妊娠。此外,在不良妊娠中观察到Vγ9Vδ2-T和Vδ1-T细胞之间的失衡以及 γ δ-t细胞上受体的异常表达。

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