الملخص
Objective To investigate the assessment of fetal lung maturity using main pulmonary artery accelerated systolic time(AT)/ejection time(ET)ratio in patients with severe preeclampsia.Methods A total of 65 pregnant women who were hospitalized in our hos-pital due to severe preeclampsia,from January 2021 to December 2022,and voluntarily underwent ultrasound examination were enrolled in this study.The patients were divided into early-onset(20 to 33+6 weeks gestation)severe preeclampsia group(group A,n= 30)and late-onset(34 to 40 weeks)severe preeclampsia group(group B,n= 35).Healthy pregnant women with gestational age-matched to groups A and B via ultrasound examination were selected as controls(n= 30 andn= 35,respectively).Fetal main pulmonary artery blood flow parameters were measured using ultrasound Doppler:AT,ET,AT/ET,and peak systolic flow rate(PSV).Amniotic fluid(approximately 15 mL)was collected immediately after delivery,and the lecithin/sphingomyelin(L/S)values were measured.The blood flow parameters of the main pulmonary artery of the fetuses in groups A and B were compared,and whether there was any difference between them and the control group was analyzed.The correlation between the blood flow parameters and amniotic fluid L/S was also analyzed.Results There were statistically significant differences in AT,ET,AT/ET,and PSV in the fetal main pulmonary artery between groups A and group B(P＜0.05),and all of them were smaller than those in the control group(P＜0.05).The AT/ET ratio of the fetal main pulmonary artery in groups A and B was positively correlated with amniotic fluid L/S(r= 0.821 and 0.383,respectively,P＜0.05).Receiver operating charac-teristic curve analysis showed that the area under the curve of AT/ET in the diagnosis of early-onset and late-onset preeclampsia was 0.839 and 0.833,respectively,and the sensitivity was 0.853 and 0.912,the specificity was 0.583 and 0.611,and the cut-off values were 0.185 and 0.255,respectively.The false positive rate was 5%.Conclusion The AT/ET value of the fetal main pulmonary artery can be used to make a preliminary diagnosis of severe preeclampsia and quantitatively assess fetal lung maturity,which can provide a new,simple,non-invasive,and reproducible assessment method for clinical practice.
الملخص
Objective To explore the changes of bone metabolic markers during early stage of preterm infants, as well as the relationship with their nutrition status. Methods Preterm infants with gestational age 30-35 weeks admitted to our Hospital were collected from November 2012 to April 2013. Venous blood samples obtained within 24 hours after birth and between 8:00-9:00 AM two weeks after birth were used to determine the Serum β-CTx, osteocalcin ( OC) and propeptide of type I procollagen (PINP) levels by Electro-Chemiluminescence. Analysis of changes of these bone metabolic markers and their relationship with early stage nutrition related indicators were also performed. Results A total of 60 premature infants were collected. There was no significant correlation among serum β-CTx, OC and PINP within 24 hours after birth ( r=0. 170, P＞0. 05 ) . The Serum β-CTx within 24 hours after birth was negatively correlated with gestational age (r= -0. 603, P＜0. 05), whereas the serum OC within 24 hours after birth was positively correlated with gestational age ( r=0. 581, P＜0. 05 ) . However, PINP wasn′t correlated with gestational age significantly (r=0. 134,P＞0. 05). Serumβ-CTx, OC and PINP at 2 weeks after birth increased significantly from the baseline level detected within 24 hours after birth ( P＜0. 05 ) .Δβ-CTx was positively correlated with ΔOC (r=0. 600,P＜0. 05). There was no significant correlation between ΔPINP and Δβ-CTx (r=0. 045,P＞0. 05), as well as ΔOC and ΔPINP (r=0. 110,P＞0. 05).ΔOC was positively correlated with average daily calorie ( P＜0. 05 ) and average daily P/E ( P＜0. 05 ) , negatively correlated with cumulative loss of caloric ( P＜0. 05 ) . There was no significant correlation between Δβ-CTx or ΔPINP with nutrition related indicators of this study. Conclusions Serum OC within 24 hours after birth of preterm infants and their gestational age are positively correlated, while β-CTx detected at the same time and gestational age are negatively correlated. Vigorous metabolism of premature bone occurs during the first two weeks after birth, as the serum β-CTx, OC and PINP levels increased significantly. We suggest that reasonable calorie intake and appropriate protein calorie ratio at early stage after birth is very important for the development of bone of preterm infants.
الملخص
Objective:To calculate the health efficiency of government health expenditures in 1990 , 2000 and 2010 and analyze its determinants. Methods:To calculate the health efficiency of government health expenditures and analyze its determinants by using the DEA-Tobit model. Results:Health efficiency of government health expenditures has been increasing gradually;the same provinces are found to be on the productive frontier, but the provinces off the frontier are different;eastern provinces have a higher efficiency than those in the middle and western regions. Fiscal decentralization has a significant negative impact on health efficiency. Conclusion:The current Chinese fiscal decen-tralization system reform is important to improve the health efficiency of government health expenditures.