妊娠期肝内胆汁淤积症胎儿不良预后原因探索

妊娠期肝内胆汁淤积时,在各种机制作用下,往往在妊娠晚期发生胎儿猝死等不良预后,但机制尚不清楚,还在不断的探索之中.主要从胎盘结构因素、胆汁酸的作用、血管及血管调节因素三个方面分析妊娠期肝内胆汁淤积症不良预后的原因,旨在研究妊娠期肝内胆汁淤积症患者胎儿不良预后的原因中所体现的哲学观点.     

妊娠期肝内胆汁淤积症胎儿不良预后原因探索

妊娠期肝内胆汁淤积时,在各种机制作用下,往往在妊娠晚期发生胎儿猝死等不良预后,但机制尚不清楚,还在不断的探索之中。主要从胎盘结构因素、胆汁酸的作用、血管及血管调节因素三个方面分析妊娠期肝内胆汁淤积症不良预后的原因,旨在研究妊娠期肝内胆汁淤积症患者胎儿不良预后的原因中所体现的哲学观点。     

音响环境与胎儿及新生儿的心理发展

当前国际上关于婴儿行为和发展的研究非常盛行,随着对新生儿心理研究的不断深入,人们追朔到胎儿的行为和心理发展状态并进行了大量的研究,发现胎儿在妊娠5周起就能对刺激作出反应,在妊娠8周时能作出许多诸如蹬脚、摇头等动作来表示他的喜好或厌恶,妊娠20周时具有听觉能力.     

妊娠期甲亢诊疗决策

由于甲亢的一些症状和体征类似于正常妊娠中发生的正常生理变化,且孕期甲亢及其治疗对妊娠结果和胎儿可能的不良影响,所以给孕期甲亢的诊疗带来困难.孕期甲亢息者应尽快接受抗甲状腺药物(antitlayroid drugs,ATD)的治疗并应经常接受胎儿和孕妇甲亢及甲减征象的监测.孕妇和围产期的并发症发生率直接与母亲甲亢的控制有关,应对所有甲亢妇女进行促甲状腺受体抗体(thyrotrophin receptor antibody,TRAb)的评估.所有妊娠剧吐患者均应测定甲状腺功能,少数妊娠剧吐短暂甲亢孕妇需ATD治疗.     

多角度认识妊娠期肝内胆汁淤积症

妊娠期肝内胆汁淤积症是妊娠晚期特发性疾病,以皮肤瘙痒、胆汁酸增高及肝功能损害为特征.对孕产妇危害较小,对围产儿产生严重后果,使围产儿患病率、死亡率增加.其发病机制尚不明确,许多研究表明它是一种多因素疾病.任何事物都是辨证统一的,在临床中运用辨证的眼光看待疾病,可以促进对疾病的认识.     

妊娠肝内胆汗淤积症的回顾和启示

1883年Ahlfeld首次报道一种发生于妊娠晚期而在以后妊娠中有复发倾向的一种黄疸疾病,从此拉开了人类认识妊娠肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)的帷幕.至1954～1955年,Svanborg与Thorling在斯堪的那维亚报道较多病例,并对本病的临床、生化、组织学改变进行了研究,才明确提出是独立新的疾病[1,2].     

对妊娠晚期畸形胎儿实施致死性引产的可行性分析

在妊娠晚期发现胎儿畸形,许多胎儿父母要求引产。一些患儿父母因为在医院引产出活体畸形婴儿而与医院产生纠纷。本文考虑采用医疗方法在引产前或引产中使胎儿心跳停止,确保引产出的胎儿为死婴（即致死性引产）以减少纠纷,利于社会。本文试图从医疗、伦理、法律的角度,探讨在胎儿父母要求下,对妊娠晚期畸形胎儿实施致死性引产的可行性。     

医源性多胎妊娠的伦理问题及对策

1　医源性多胎妊娠的概念、现状和趋势医源性多胎妊娠是经医疗干预 (主要指辅助生殖技术 )获得的多胎妊娠 ,孕妇单次妊娠孕育的胎儿数≥ 2 ,隶属医源性疾病。人类生殖活动中 ,自然多胎妊娠非常稀少。若将单次妊娠的胎儿数用n表示 ,则自然多胎妊娠机会可用 1/ 80 (n - 1)公式粗略估算。就双胞胎妊娠而言 ,80次自然妊娠中仅有 1次双胞胎妊娠的机会 ;就三胞胎妊娠而言 ,6 40 0次自然妊娠中仅约 1次三胞胎妊娠的机会 ;以此类推 ,5 12 0 0 0次自然妊娠中只有 1次四胞胎妊娠的机会。更多胎数的自然妊娠机会则更为罕见。文献中有一次多达 7个胎儿的…     

胆汁酸再认识的进展

早在古希腊人们对胆汁就有所认识,而祖国医学很早就使用动物胆汁来治疗疾病.现代医学则应用胆汁酸来治疗肝胆疾病,如鹅脱氧胆酸和熊脱氧胆酸.近年来对胆汁酸的研究又有了新的突破.因此,我们有必要对其生理功能进行再认识,为临床相关疾病的病因和治疗提供新思路.     

妊娠和Graves'病诊治

甲状腺激素是胎儿发育的重要激素,妊娠合并Graves'病(GD)使得妊娠更加复杂化,而孕期甲状腺发生生理性变化,使孕期甲状腺疾病的诊断异于非妊娠妇女。本文就妊娠对GD发生风险的影响、早孕期甲状腺功能的变化及对甲亢诊断的影响,妊娠期GD的诊断和抗甲状腺药物的选择、孕前咨询及合并GD妇女的胎儿甲亢和甲减的风险做一综述。结合最新的研究结果,尤其指出,抗甲状腺药物在特殊的早孕周使用可能增加新生儿出生缺陷风险,这对于有怀孕打算的GD患者需要考虑在内。     

妊娠期肝内胆汁淤积症研究中的认识论

妊娠期肝内胆汁淤积症是一种常见的妊娠晚期并发症,临床上以皮肤瘙痒和黄疸为特征,伴有胆汁酸、肝酶等生化指标的异常。其对母体影响较小,但可以引起早产、胎窘和不明原因的死胎,对围生儿的严重危害使其受到了产科医生的重视。因此,有必要通过回顾妊娠期肝内胆汁淤积症的认识过程来看医学认识发展中所体现的哲学观点。     

Biobehavioral factors in sudden cardiac death

The authors examine the recent literature on psychological factors and sudden cardiac death and explore the mediating psychophysiological processes by which these variables may be associated. Direct evidence that psychosocial stressors and their correlates may be causally linked with sudden cardiac death in humans is not conclusive, but there is abundant convergent evidence that several physiological precursors of sudden death may be promoted by psychological challenge, especially in persons with coronary heart disease. The authors call for increased attention to the acute effects of psychological events on cardiovascular health.     

胆汁酸再认识的进展

早在古希腊人们对胆汁就有所认识,而祖国医学很早就使用动物胆汁来治疗疾病。现代医学则应用胆汁酸来治疗肝胆疾病,如鹅脱氧胆酸和熊脱氧胆酸。近年来对胆汁酸的研究又有了新的突破。因此,我们有必要对其生理功能进行再认识,为临床相关疾病的病因和治疗提供新思路。     

Medium-chain acyl CoA dehydrogenase deficiency: Its relationship to SIDS and the impact on genetic counseling

Sudden infant death syndrome (SIDS) is defined as the sudden and unexpected death of an apparently healthy infant under 1 year of age. Routine autopsies often provide few clues as to the cause of death and rarely include a biochemical evaluation. Genetic counseling for SIDS can be difficult as recurrence risks vary depending on the age at death and the number of deaths which have occurred in the family. Biochemical disorders may account for up to 5% of SIDS. Of the metabolic disorders known to be involved in SIDS, the most commonly found is medium-chain acyl CoA dehydrogenase deficiency (MCAD). MCAD is an autosomal recessive disorder of fatty acid oxidation which accounts for up to 1% of SIDS. For some families, the addition of a postmortem biochemical investigation can identify an unsuspected metabolic disorder as the cause of death. Once the diagnosis is established, accurate genetic counseling can then be provided. Metabolic testing of the surviving siblings of victims of sudden death, and the subsequent identification of those due to MCAD can prevent the tragedy of recurrent SIDS in some families. In addition, screening the survivors of an acute life threatening event (ALTE) may also prevent a recurrence.     

Sudden Unexpected Versus Violent Death and PTSD Symptom Development

Changes to posttraumatic stress disorder (PTSD) trauma criterion in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) have been an area of much scrutiny and debate. One of the proposed changes included removing sudden unexpected death (SUD) from the list of potentially traumatic events. This study tested the extent to which unexpected death differed from violent death and other traumas as measured by PTSD symptoms. Our results indicated a significant difference in symptom development between those experiencing sudden violent death and sudden unexpected, but nonviolent, death. Additional analyses at the DSM–IV symptom cluster level, as well as with Simms, Watson, and Doebbeling’s (2002) factor structure of PTSD symptoms, suggested further distinctions between event types and symptom development. The extent to which SUD should be included in the trauma criterion is considered.     

Predicting Grief Symptomatology among the Suddenly Bereaved

Social scientists have long been interested in the study of grief and bereavement, but only recently has research focused on the aftereffects of sudden loss. Theory and research alike suggest that grief is multidimensional and that specific grief reactions have a unique set of predictors. The purpose of this study is to examine the relative contribution of risk factors in explaining variations in specific grief reactions following a sudden death. Data for this study come from medical examiners' reports and mail-back surveys of survivors of sudden loss from suicide or accident. The results indicate that several characteristics of the survivor, mode of death, and social support are important determinants of grief symptomatology. This research concludes by directing future theoretical and empirical endeavors to examine more fully the role of relational factors in influencing grief experiences following bereavement.     

高血压左室肥厚的QT离散度及左室Tei指数的关系探讨

心脏是最常见的高血压损伤靶器官,首先引起左心室肥厚,然后导致心功能下降,并可导致心律失常。高血压患者中约有1/3会出现左室肥厚（LVH）,可致心血管病事件发病率增加,病死率升高,是猝死、冠心病和充血性心力衰竭的独立的、主要的危险因素和预后信号。QT间期离散度（QTd）是反映心室肌复极的不均匀性和电不稳定性预测恶性室性心...     

Motivation to Pursue Genetic Testing in Individuals with a Personal or Family History of Cardiac Events or Sudden Cardiac Death

Genetic testing is becoming increasingly available for cardiac channelopathies, such as long QT syndrome and Brugada syndrome, which can lead to sudden cardiac death. Test results can be used to shape an individual’s medical management and to identify at-risk family members. In our qualitative study, all participants had a personal or family history of a diagnosed cardiac arrhythmia syndrome or sudden cardiac death. Open-ended interviews were conducted individually and in focus groups. Interviews were audio recorded, transcribed verbatim, and analyzed using a qualitative grounded-theory approach. Of 50 participants, 37 described their motivations for pursuing genetic testing for long QT syndrome or another cardiac channelopathy. Participants’ motivations included: to find an explanation for a family member’s sudden death, to relieve uncertainty regarding a diagnosis, to guide future medical management, to allay concern about children or other family members, and to comply with recommendations of physicians or family members. Perceived reasons not to pursue genetic testing included denial, fear, and lack of information. The genetic counseling and informed consent process can be enhanced by understanding and addressing an individual’s internal and external motivations either for or against pursuing genetic testing.     

Psychiatric Disorders and Childhood Parental Loss in Obesity: Relationship with the Mode of Weight Gain

We assessed the association between psychiatric disorders, childhood parental loss, and weight gain mode in 150 obese patients seeking bariatric surgery and with a history of sudden or gradual weight gain mode. Subjects with sudden weight gain mode (47%) showed significantly higher bipolar II disorder (p < .001), childhood parental death (p < .01), and separation (p < .01), but lower pure hypomania (p < .001) prevalence than subjects with gradual weight gain mode. We found preliminary evidence that lifetime bipolar spectrum disorders and childhood parental loss may influence weight gain mode in obese subjects. These findings may contribute to predict patients’ weight trajectories and implement preventive interventions.