Objective To evaluate the effects of pregnancy weight control program based on structure- process- outcome model to improve women′s health status and pregnancy outcomes. Methods On the basis of Donabedian′s structure- process- outcome quality of care model, a pregnancy weight control program designed and carried out for the middle and late pregnancy. The structure, process and outcome of the pregnancy weight control program were evaluated to ensure the quality of the pregnancy weight control program. In addition, the women′s pregnancy outcomes were investigated after intervention. Results the prenatal BMI in the intervention group [ (23.06±1.11) kg/m2 ] were lower than those in the control group [(25.52±1.89) kg/m2 ], and the incidence of cesarean section (including cesarean section without indication), neonatal macrosomia, labor block, neonatal asphyxia, postpartum hemorrhage, pregnancy induced diabetes and hypertension in the intervention group were significantly lower than those in the control group, P<0.01 or 0.05. Conclusion Donabedian′s structure- process- outcome quality of care program is an effective approach to improve women′s pregnancy outcomes.

Objective To investigate the potential clinical factors associated with the prognosis and relapse of adult onset Still's disease(AOSD).Methods The factors possibly influencing the prognosis and relapse of AOSD were analyzed by logistic regression and COX regression in the cohort study.Ninety-six con- secutive inpatients of AOSD diagnosed based on Yamaguchi criteria in the hospital from March 1996 to September 2004 were included in the study.Results Nine cases(9.4%)were lost during the follow-up. Eleven patients(12.6%)were diagnosed as other diseases(5 with other rheumatic diseases,4 with tumor and 2 with infections)in the 87 follow-up cases.In 76 cases,3 patients(3.9%)died and 33 patients(43.4%) got remission over one year after treatment.Splenomegaly(OR=3.14,95%CI=1.01～9.74)and treated with methotrexate(OR=0.22,95%CI=0.07～0.67)were associated with the prognosis from the logistic regression analysis of the 76 cases.The serum ferritin(RR=I.05,95%CI=1.01～1.08)and treated with methotrexate (RR=0.13,95%CI=0.02～0.76)were associated with relapse from the COX regression analysis of the 61 remis- sion cases.Conclusion We need to be very cautious in the follow-up of AOSD patients because some of them may change to other diseases.Methotrexate may be an importent therapy of AOSD not only in improve- ment the prognosis but also in reduction of relapse.

Objective To investigate the effect of social support and childbirth self-efficacy-enhancing intervention on primiparas' childbirth self-efficacy,coping ability and pain during labor.Methods A randomized controlled trial was used with double blindness design.One hundredand six primiparas were recruited as the intervention group and control group,53 cases in each group.The two groups adopted the routine prenatal care.In addition,the intervention group participated in twice childbirth self-efficacy-enhancing educational courses.The Chinese Childbirth Self-Efficacy Inventory (CBSEI) was used to conduct the comparison between before and after intervention;the interventional effects in the natural childbirth pregnant women were compared between the two groups by adopting the Visual Analogue Scale (VAS) and Childbirth Coping Behavior Scale (CCB);the Multidimensional Scale of Perceived Social Support (MSPSS) was adopted to analyze correlation between the social support level with the CBSEI and CCB.Results The intervention group finally had 52 cases of effective sample and the control group had 51 cases of effective sample.The CBSEI score after intervention in the intervention group was 282.04± 27.38,which was higher than 236.69± 45.39 before intervention.The CCB score in the intervention group was 56.78 ± 6.95,which was significantly higher than 48.03 ± 6.26 in thecontrol group,and the VAS score in the intervention group was 6.96 ± 1.39,which was lower than 8.35 ± 1.43 in the control group,the difference was statistically significant(P＜0.01).The MSPSS score in the two groups was positively correlated with the OE score,efficacy expectancy (EE) score and CBSEI score before intervention(r=0.269,0.289,0.317,P＜0.01).Conclusion Launching the childbirth self-efficacy-enhancing educational intervention of the social support system can effectively improve the childbirth self-efficacy and coping ability of primiparas,and reduce the intrapartum pain level.

Objective To evaluate the efficacy and safety of fludarabine and pirarubicin (FT) regimen in the treatment of refractory or relapsed indolent non-Hodgkin lymphoma (NHL). Methods A total of 40 patients with relapsed or refractory indolent NHL were treated with FT regimen, one cycle for 28 days, total 6 cycles. The data of indolent NHL patients treated with fludarabine, noventrene and dexamethasone (FND) regimen were collected as control. Results 40 patients were given 228 cycles chemotherapy, overall response rate was 62.5 %, median progression-free survival was more than 20 months and 2 years overall survival rate was 70.0 %. The main toxicities was leucopenia (80.0 %), but the incidence of WHO Ⅲ-Ⅳ leucopenia and pneumonia was less than that of in the control group, the rate were 12.5 % vs 29.0 % and 2.5 % vs 23.0 % respectively (P <0.05). Conclusion The efficacy of FT regimen was as good as FND regimen, but the incidence of leucopenia and pneumonia by Ⅲ-Ⅳ was lower in FT group than in FND group. So the FT regimen was an effective and safe second-line salvage regimen for relapsed or refractory indolent non-Hodgkin lymphoma.

Objective To investigate the clinical features and prognostic factors of primary thyroid lymphoma. Methods Records of 44 patients with pathologically confirmed primary thyroid lymphoma were reviewed. Detailed clinical and laboratory data were included in univariate analysis, and statistically significant factors in univariate analysis were then included in multivariate analysis.Results In univariate analysis, Ann Arbor stage, performance status, IPI, number of extra-lymphatic site, B symptoms, Hb, LDH and β_2-MG level, therapy model, histology type and tumor mass were found to be the prognostic factors associated with overall survival in primary thyroid lymphoma. In multivariate analysis, performance status, IPI, LDH, β_2-MG level, histology type, and tumor mass were independent prognostic factors of overall survival. Conclusion Performance status, IPI, LDH and β_2-MG level, histology type and tumor mass were demonstrated as independent prognostic factors of the overall survival in primary thyroid lymphoma.

Objective To investigate the relationship between maternal weight gain and the increasing speed of weight in different pregnant terms and macrosomia.In order to reasonably manage pregnancy and decrease the morbidity of maerosomia.Methods 106 newborns whose birth weights were equal to or greater than 4000 g were specified as macrosomia,while 106 newborn with birth weights lying in 2500-3999 g were under the control group.A case-control study was conducted to compare the corresponding factors such as maternal BMI.weight before pregnancy and the change of weight during pregnancy respectively.Results Indicated by both simple and multiple unconditional logistic regression analysis,the cause of fetal macrosomia Was mainly associated with the factors including the maternal weight before pregnancy(OR=2.204,95％CI:1.377-3.529),matemal weight gain in 12-pregnant weeks(kgper week)(OR=1.961,95％CI:1.204-3.194),maternal weight gain in 20-gestation weeks(kg perweek)(OR=1.811,95％CI:1.078-3.041),maternal weight gain in 30-pregnant weeks(kg per week)(OR=1.858,95％CJ:1.095-3.153)and virile newborn(OR=2.630,95％CJ:1.420.4.850.When in 30-pregnant weeks.the pregnant women with 0.5-1.0 kg weight gain per week had 1.13 fold risks comparing to those whose weight gains were lexq than 0.5 kg per week.Conclusion Maternal weight before pregnancy,weight gain during pregnancy and fetal sex appeared a closer relation to macrosomia.It is necessary to monitor the change of maternal weight during different pregnancy periods,especially for the 30th-pregnant weeks.

OBJECTIVETo assess the feasibility of evaluation of CFR for LAD and right coronary artery (RCA) as well as diagnostic accuracy for patency of each vessel by transthoracic Doppler echocardiography (TTDE).

METHODS65 consecutive patients (age 58 +/- 14, ejection fraction 49% +/- 8%, 48 men and 17 women) were studied for CFR by TTDE with adenosine infusion (140 microg.kg(-1).min(-1)). LAD flow was interrogated nearby the apex in modified 2-ch apical view. RCA flow was interrogated at mid posterior wall on distal part of the posterior descending branch (PDA) in modified 2-ch apical view for PDA.

RESULTSFlow for LAD was detected in all patients (4 with use of contrast agent) and for RCA in 55 patients (5 with contrast agent). Two patients had an occluded RCA. Feasibility of RCA flow detection was 55/63 (87%). In all patients maximal flow of each branch was detected in less than 2 min of adenosine infusion (140 mg.kg(-1).min(-1)). Total time for both CFR estimation was 7.3 +/- 1.6 min. Selecting 2.0 or 1.8 as CFR cut-off value for diagnosis of coronary stenosis (> or = 50% in diameter) or severe stenosis (> or = 70%) was found fitted for both LAD and RCA with similar diagnostic performance (sensitivity 89%/93%, specificity 86%/84%, area under curve 0.89/0.92 respectively, in stenosis diagnosis and sensitivity 88%/89%, specificity 90%/83%, area under curve 0.94/0.95 respectively in severe stenosis diagnosis).

CONCLUSIONSCFR evaluation of both distal LAD and PDA is of high feasibility and can provide high diagnostic yield for relevant vessel patency.

Adult ; Coronary Circulation ; Coronary Disease ; diagnostic imaging ; Coronary Vessels ; diagnostic imaging ; Echocardiography, Doppler ; methods ; Feasibility Studies ; Female ; Humans ; Male ; Middle Aged

OBJECTIVETo analyse the clinical features of children with obstructive sleep apnea-hypopnea syndrome (OSAHS), accompanying with risk factors.

METHODSThe clinic data of 19 patients treated in the Department of Otorhinolaryngology of Guangzhou Children's Hospital between January 2005 to January 2008 were investigated retrospectively. Among them, 5 were < 2 years old, 6 with craniofacial deformity: small mandible and (or) mandibular retrusion (5 cases), transverse facial cleft (1 case), Down's syndrome (2 cases), cerebral palsy (2 cases), chronic bronchitis (3 cases) and mucopolysaccharidoses (1 case). Nineteen patients with symptoms of snoring, mouth breathing, were diagnosed as OSAHS by polysomnography (PSG) and treated by tonsillectomy and (or) adenoidectomy in hospital. All patients were closely followed-up.

RESULTSFourteen patients underwent PSG 6 months to 1 year after operation, 11 patients recovered, the median [percentiles 25; percentiles 75] apnea-hypopnea index (AHI) decreased from the pre-operative 22.5 [16.5; 24.3] times/h to 2.0 [1.5; 4.3] times/h, and the lowest oxygen saturation (LSaO(2)) before operation was 0.63, and was higher than 0.92 after operation, 1 case accompanying with chronic bronchitis, the pulmonary hypertension was improved after operation. One case with Down's syndrome was not significantly improved, preoperative AHI and LSaO(2) was 22.4 times/h and 0.67, and after operation was 14.2 and 0.84; 2 cases accepted adenoidectomy only, snoring, mouth breathing reappeared 3 months after operation, pre-operative PSG results showed AHI 24.6 times/h and 26.6 times/h, LSaO(2) was 0.69 and 0.73, after operation the AHI was 10.6 times/h and 8.5 times/h, LSaO(2) was 0.90 and 0.88, the symptoms disappeared after adenotonsillectomy. Five cases did not have PSG because they lived far away in the other cities, their pre-operative PSG showed AHI 16.4 to 26.2 times/h, LSaO(2) was 0.65 to 0.76. One year after operation, these patients were followed-up by telephone, 4 children were significantly improved, 1 case with mandibular symptoms showed no improvement.

CONCLUSIONSFor OSAHS children accompanying with risk factors, if they have adenoid and tonsil hypertrophy, adenotonsillectomy is the major treatment. Because of the existence of risk factors, perioperative risk increased, even the failure of operation. so these patients must be comprehensively assessed before operation. Satisfied results can be achieved by close observation after operation and management of complications as soon as possible.

Adenoidectomy ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Retrospective Studies ; Risk Factors ; Sleep Apnea, Obstructive ; complications ; surgery ; Tonsillectomy

BACKGROUND: Although the porcine small intestinal submucosa is very similar to the skin in the structure, its pore size and porosity are not beneficial to the growth of seed cells as the skin does. OBJECTIVE: To observe the morphological and cytocompatibility of porcine small intestinal submucosa after chemical modification using 1-ethyl-3-(3-dimethylaminopropyl) carbod imide (EDC). METHODS: A porcine small intestinal submucosa sample was immersed in 3% acetic acid solution containing 0.2% pepsin to make 1%, 2%, 3%, 4% small intestine submucosa solutions. After magnetic stirring and freeze-drying, small intestinal submucosa sponge was obtained and modified by cross-linking with 50, 100, 150 mmol/L EDC. Based on the detection of pore size and water absorption, we selected the best concentrations of small intestinal submucosa and EDC, which were further used for cell culture. Passage 2 bone marrow mesenchymal stem cells were cocultured with the small intestinal submucosa sponge, and observed under scanning electron microscope at 1, 2, 3 weeks after co-culture. RESULTS AND CONCLUSION: When cross-linked with 100 mmol/L EDC, the small intestinal submucosa sponge at a mass concentration of 1% showed a reasonable structure and good elasticity with no appearance of voids, and the pore size ranged 100-150 μm. Moreover, the small intestinal submucosa sponge at a mass concentration of 1% showed a 0.35-fold increase in the compared with that at a mass concentration of 2%, and its structure was more conducive to water flows and changes. The small intestinal submucosa sponges at a mass concentration of 3% and 4% showed no difference in the water absorbing capacity. After cross-linked with 100 mmol/L EDC, the small intestinal submucosa sponge at a mass concentration of 1% showed the best structure, pore size and water absorption, which were used for cell culture. At 3 weeks after cell culture, cell deformation was relatively intact and fast; there were many cells in the pores that were relatively large and approximately spindle-shaped, while there were less cells around the pores that were relatively small and disk-shaped. A paving stone-like alteration was observed in cells that covered the most of the scaffold surface with a large number of particle-like substances, especially in the site of cell concentration. All these findings indicate that EDC-modified small intestinal submucosa sponge has good cytocompatibility.

OBJECTIVETo develop a convenient method for isolation and purification of human extravillous cytotrophoblasts (EVCTs) and decidual stromal cells (DSCs) and establish a co-culture system.

METHODSThe DSCs were digested with trypsin and purified by Percoll gradient. The EVCTs were digested with trypsin and purified by BSA gradient. Immunohischemistry and immunofluorescent study are performed to characterize these isolated cells. The EVCTs and DSCs were placed in Matrigel-coated Transwell upper and lower chamber, respectively, to study the invasive ability of the EVCTs.

RESULTSImmunohischemistry revealed that the purity of EVCTs and DSC exceeded 95%. Cultured EVCTs retained their capacity to invade Matrigel-coated Transwell filters with the invasion index of 3.22-/+0.04.

CONCLUSIONThis co-culture model established by isolating highly purified EVCTs and DSCs in vitro can be useful for studying the trophoblast invasion mechanisms.

Cell Communication ; physiology ; Cells, Cultured ; Chorion ; cytology ; Coculture Techniques ; Decidua ; cytology ; Female ; Humans ; Models, Biological ; Stromal Cells ; cytology ; Trophoblasts ; cytology ; physiology