· Web viewGuangzhou Women and Children’s Medical Center 2017年第4期. 部分中、外文医学杂志文摘. 中华儿科杂志中华新生儿杂志中华妇产科杂志

广州市妇女儿童医疗中心Guangzhou Women and Children’s Medical Center

2017 年第 4 期部分中、外文医学杂志文摘

中华儿科杂志中华新生儿杂志中华妇产科杂志中华护理杂志Neonatology Lancet JAMA N Eng J Med Pediatrics

J Pediatrics J Perinatology Pediatric research Obstet Gynecol

Am J Obstet Gynecol BJOG Int J Nurs Stud Am J Manag Care Am J

Crit Care

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广州市妇女儿童医疗中心科教与数据管理部图书馆编2017-4-30

中华儿科杂志第 4 期我国开展新生儿先天性心脏病筛查的重要性黄国英2017,55(04):241-243|

进一步规范导管消融术治疗儿童心律失常李奋2017,55(04):244-247

原发性免疫缺陷病抗感染治疗与预防专家共识中华医学会儿科学分会免疫学组《中华儿科杂志》编辑委员会2017,55(04):248-255

美国儿童和先天性电生理协会、美国心律协会"儿童及先天性心脏病患者导管消融专家共识(2016 年版)"解读吴近近李奋2017,55(04):256-259

危重先天性心脏病新生儿产科医院出院前漏诊情况分析赵趣鸣刘芳吴琳叶明贾兵马晓静黄国英

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2017,55(04):260-266

心房扑动患儿射频消融治疗及临床资料分析江河李小梅张仪刘海菊李梅婷戈海延2017,55(04):267-271

低剂量影像策略在儿童室上性心动过速射频消融术中的辐射防护作用分析王凤陆颖袁超白家瑢杨昊晟吴琳2017,55(04):272-276

Dravet 综合征患儿癫痫持续状态导致急性脑病的临床及头颅影像学表现田小娟张月华刘爱杰杨小玲曾琦杨志仙叶锦棠刘晓燕姜玉武吴希如2017,55(04):277-282

进行性空泡脑白质病四例并文献复习任长红方方程华丁昌红陈春红张雨佳沈丹敏2017,55(04):283-287

ATP1A3 基因突变致儿童期起病快发病性肌张力障碍－帕金森综合征一家系并文献复习

张慈柳尹飞何芳盖楠石自清彭镜2017,55(04):288-293

健康儿童产毒艰难梭菌定植率研究王燕郭姝赵春娜徐樨巍

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2017,55(04):294-297

儿童肺部恶性肿瘤七例临床分析徐丹陈志敏顾伟忠王颖硕黄美霞唐兰芳张园园姜源2017,55(04):298-303

HYDIN 基因突变致儿童原发性纤毛运动障碍一例并文献复习陈莉莉杨运刚吴谨准陈先睿2017,55(04):304-307

发-肝-肠综合征一例陈军津施丽萍2017,55(04):308-309

GAMT 基因变异导致肌酸缺乏综合征一例杨蕾方方2017,55(04):309-310

胎儿肺动脉闭锁的介入治疗洪楠超孙锟2017,55(04):311-314

婴儿肠绞痛的研究进展朱庆龄盛晓阳2017,55(04):314-317

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循证临床指南的形成与应用石岩岩曾琳赵一鸣2017,55(04):259-259

中华新生儿科杂志第 4 期

产科母婴同室新生儿管理建议 .中国妇幼保健协会新生儿保健专业委员会中国医师协会新生儿科医师分会中华新生儿科杂志（中英文）2017,32(02):81-85

超早产儿出院时临床结局及影响因素分析庄严高喜容刘新晖吴运芹熊月娥李强刘雨张琼中华新生儿科杂志（中英文）2017,32(02):86-90

Wnt受体信号通路与严重早产儿视网膜病的关系研究孙慧清熊虹康文清李明超余增渊邢珊中华新生儿科杂志（中英文）2017,32(02):91-95

无创高频通气在新生儿呼吸窘迫综合征撤机后的应用张涛高薇薇陈佳黄晓睿肖苑红邝舒敏杨庆华陈运彬中华新生儿科杂志（中英文）2017,32(02):96-99

三种无创正压通气对呼吸窘迫综合征早产儿心脏指标影响的随机对照研究 5

雷红林高翔羽黄迪赵丹丹杨波任漪佟念念中华新生儿科杂志（中英文）2017,32(02):100-104

白细胞介素 10受体A 基因缺陷致新生儿极早发炎症性肠病五例分析姜毅陈东晖刘黎黎侯新琳汤泽中周丛乐中华新生儿科杂志（中英文）2017,32(02):105-109

胎膜早破新生儿脐血白细胞介素 6 和 C反应蛋白水平与早发型新生儿败血症的关系杨长仪张宝泉陈涵强中华新生儿科杂志（中英文）2017,32(02):110-114

不同病原菌新生儿败血症临床特点研究陈晓英仇丽华江倩男张立生袁可中华新生儿科杂志（中英文）2017,32(02):115-118

微阵列比较基因组杂交检测在新生儿染色体异常疾病筛查中的应用姜敏钟雁齐宇洁王亚娟杨彩云中华新生儿科杂志（中英文）2017,32(02):119-122

先天性葡萄糖-半乳糖吸收不良一例报告并文献复习陶莉王玲陈晓文赵宁耿岚岚林建丰文妍周伟中华新生儿科杂志（中英文）2017,32(02):123-127

新生儿高胆红素血症与 UGT1A1 基因 Gly71Arg多态性的关联性研究 6

李淑芬佐日汗·艾依萨阿依先木王然李雪香中华新生儿科杂志（中英文）2017,32(02):128-130

鼻塞鼻罩交替使用预防极低出生体重儿经鼻持续正压通气致鼻损伤的效果李磊王自珍孔祥永董建英中华新生儿科杂志（中英文）2017,32(02):131-133

外周放置中心静脉导管合并胸腔积液四例临床分析蒙景雯刘晓会张欣王瑾钱晶京王颖茹喜芳冯琪中华新生儿科杂志（中英文）2017,32(02):134-136

延迟脐带结扎对早产儿近期影响的 Meta 分析陈钇宇周瑾何雨蔚中华新生儿科杂志（中英文）2017,32(02):137-143

脂肪干细胞旁分泌提取物对新生大鼠脑白质损伤的影响黄超杨印祥汪兆艳王倩陈敬国栾佐中华新生儿科杂志（中英文）2017,32(02):144-149

脑室周围白质软化新生大鼠脑组织炎症因子变化李健欧阳颖黄科董红王琴中华新生儿科杂志（中英文）2017,32(02):150-154

胺碘酮治疗新生儿心房扑动一例 7

魏丽李静朱付立中华新生儿科杂志（中英文）2017,32(02):85-85

振幅整合脑电图动态监测胆红素脑病新生儿一例徐文瑞侯新琳中华新生儿科杂志（中英文）2017,32(02):155-156

颅骨锁骨发育不全综合征一例巴玉罗超

中华新生儿科杂志（中英文）2017,32(02):157-157

新生儿血糖监测方法刘宁程国强中华新生儿科杂志（中英文）2017,32(02):158-160

中华妇产科杂志第 4 期专家论坛做好孕前评估，保障高龄妇女安全生育二孩黄薇

临床研究单纯性侧脑室扩张胎儿产前 MRI检查诊断的临床价值及出生后随访李志何平亚罗志琴潘黎明陈亚宁沈国松费正华李茂宇方向明戚凌红刘明松

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孕前漏诊的孕前糖尿病的临床特点及对妊娠结局的影响魏玉梅杨慧霞子宫内膜异位症生育指数在腹腔镜手术后的子宫内膜异位症合并不孕患者中的应用价值钱睿亚吴霞盛洁郑萍周琦段爱红张建萍张亚兰卢丹

2013—2015 年阴道镜下阴道上皮内瘤变检出率的变化趋势丛青汪清高蜀君张宏伟杜明谢锋董晶丰华郑瑞莲陈敏朱彩英刁雯静宋昱郭奇桑李燕云陈丽梅曹远奎隋龙

子宫内膜非典型性息肉样腺肌瘤 27 例临床病理分析白塔吉鲍冬梅李艺王悦崔恒祝洪澜

基础研究顺铂腹腔化疗与静脉化疗对大鼠卵巢储备功能影响的比较樊伯珍夏红初磊童晓文

医学信息研究 2007—2016 年度国家自然科学基金对妇产科学领域的资助情况及分析覃舒行黄晴珊姚书忠

短篇论著转化生长因子 β1 及其受体基因多态性与原因不明复发性流产的关系郑加永徐晓敏夏虹汪海潘豪杰金艳慧

子宫内膜异位症患者异位内膜和在位内膜组织中 P2X3 的表达及其意义朱丽波丁少杰竺天虹黄秀峰张信美

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医源性寄生性肌瘤二例及文献复习侯弘毅王志启霍文杰张鑫邓浩鲍冬梅王建六

技术交流非产时胎儿心率量化参数的初步研究田宁闫亭亭陈奕马莹范玲张松

综述合并慢性肾脏疾病孕妇的妊娠结局及其远期肾脏功能赫英东刘婧陈倩子宫内膜异位症患者种植窗期子宫内膜容受性的研究进展才汗朱信信李战飞郎景和

前哨淋巴结活检技术在早期子宫内膜癌中应用的研究进展王宝晨刘乃富王颖梅薛凤霞

高级别子宫内膜间质肉瘤的研究进展谢伟民杨佳欣

中华护理杂志官网未刊出

Neonatology 新生儿（科）学

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编号：1

题名：A Comparison of the Thompson Encephalopathy Score and Amplitude-Integrated Electroencephalography in Infants with Perinatal Asphyxia and Therapeutic Hypothermia.

作者：Weeke LC;Vilan A;Toet MC;van Haastert IC;de Vries LS;Groenendaal F

出处：Neonatology.2017V112N1:24-29

机构：Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.

摘要： BACKGROUND: In previous studies clinical signs or amplitude-integrated electroencephalography (aEEG)-based signs of encephalopathy were used to select infants with perinatal asphyxia for treatment with hypothermia. AIM: The objective of this study was to compare Thompson encephalopathy scores and aEEG, and relate both to outcome. SUBJECTS AND METHODS: Thompson scores, aEEG, and outcome were compared in 122 infants with perinatal asphyxia and therapeutic hypothermia. Of these 122 infants, 41 died and 7 had an adverse neurodevelopmental outcome. A receiver operating characteristics (ROC) analysis was also performed. RESULTS: Thompson scores were higher in infants with more abnormal aEEG background patterns (ANOVA, p < 0.001). The ROC analysis demonstrated that a Thompson score of 11 or higher or an aEEG background pattern of continuous low voltage or worse was associated with an adverse outcome (AUC 0.84 for both). CONCLUSIONS: High Thompson scores and a suppressed aEEG background pattern are associated with an adverse outcome after perinatal asphyxia and therapeutic hypothermia. Further studies are needed to identify the best technique with which to select patients for therapeutic hypothermia.

编号：2

题名：The Burden of Respiratory Disease in Very-Low-Birth-Weight Infants: Changes in Perinatal Care and Outcomes in a Decade in Spain.

作者：Garcia-Munoz Rodrigo F;Losada Martinez A;Elorza Fernandez MD;Moreno Hernando J;Figueras Aloy J;Vento Torres M


机构：Division of Neonatology, CHUI Materno-Infantil, Las Palmas de Gran Canaria, Spain.

摘要： BACKGROUND: Advances in perinatal care have led to a significant reduction in morbidity and mortality among very-low-birth-weight (VLBW) infants. Much of this progress is related to the prevention and management of respiratory disease. OBJECTIVES: To evaluate changes in perinatal care and its influence on respiratory morbidity and mortality among VLBW infants in Spain in 2 consecutive periods (2002-2006 and 2007-2011). METHODS: This is a retrospective analysis of data prospectively collected of all VLBW infants included in the Spanish SEN1500 network. Patients with major congenital anomalies, those who died in the delivery room (DR) and infants <230 or >346 weeks of gestational age (GA) were excluded.

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RESULTS: During the study period, out of 27,205 eligible VLBW infants, 24,598 (90.4%) met inclusion criteria. The most striking and statistically significant results found in the second period were: (i) reduction in the proportion of "outborn" patients; (ii) an increase in prenatal steroid administration; (iii) enhanced non-invasive respiratory support in the DR and NICU; (iv) reduction in invasive mechanical ventilation, surfactant administration, and steroids for bronchopulmonary dysplasia (BPD). Moreover, survival to hospital discharge increased (83.5 vs. 84.7%; p = 0.015); however, survival without BPD increased only among the most immature (230 to 266 weeks' GA) from 26.6 to 31.6% (p < 0.001). CONCLUSIONS: Enhanced adherence to international recommendations in perinatal care and a significant reduction in mortality were found during the second period. Survival without BPD increased only among the most immature. Further investigation is needed to optimize the strategies to prevent and manage respiratory disease in this group of patients.

编号：3

题名：DHA Reduces Oxidative Stress after Perinatal Asphyxia: A Study in Newborn Piglets.

作者：Solberg R;Longini M;Proietti F;Perrone S;Felici C;Porta A;Saugstad OD;Buonocore G


机构：Department of Pediatric Research, University of Oslo, Oslo University Hospital Rikshospitalet, Oslo, Norway.

摘要： BACKGROUND: Perinatal hypoxic-ischemic brain damage is a major cause of acute mortality and chronic neurological morbidity in infants and children. Oxidative stress due to free radical formation and the initiation of abnormal oxidative reactions appears to play a key role. Docosahexanoic acid (DHA), a main component of brain membrane phospholipids, may act as a neuroprotectant after hypoxia-ischemia by regulating multiple molecular pathways and gene expression. OBJECTIVES: The aims of this study were to test the hypothesis that DHA provides significant protection against lipoperoxidation damage in the cerebral cortex and hippocampus in a neonatal piglet model of severe hypoxia-reoxygenation. METHODS: Newborn piglets, Noroc (LYLD), were subjected to severe global hypoxia. One group was resuscitated with ambient air (21% group, n = 11) and another also received 5 mg/kg of DHA 4 h after the end of hypoxia (21% DHA group, n = 10). After 9.5 h, tissues from the prefrontal cortex and hippocampus were sampled and the levels of isoprostanes, neuroprostanes, neurofurans, and F2-dihomo-isoprostanes were determined by the liquid chromatography triple quadrupole mass spectrometry technique. RESULTS: Lipid peroxidation biomarkers were significantly lower in both the cortex and hippocampus in the DHA-treated group compared with the untreated group. CONCLUSIONS: The present study demonstrates that DHA administration after severe hypoxia in newborn piglets has an antioxidative effect in the brain, suggesting a protective potential of DHA if given after injuries to the brain.

编号：4

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题名：The "Golden Age" of Probiotics: A Systematic Review and Meta-Analysis of Randomized and Observational Studies in Preterm Infants.

作者：Dermyshi E;Wang Y;Yan C;Hong W;Qiu G;Gong X;Zhang T


机构：Department of Gastroenterology, Hepatology, and Nutrition, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, PR China.

摘要： BACKGROUND: Over the last few years, probiotics have been one of the most studied interventions in neonatal medicine. OBJECTIVES: The aim of this work was to analyse all studies (randomized controlled trials, RCTs, and observational studies) assessing the use of probiotics in very low birth weight (VLBW) preterm infants. SEARCH METHODS: A systematic literature search was conducted using PubMed, Embase, Cochrane Library, and Web of Science. The data from RCTs and observational studies were pooled and analysed separately. SELECTION CRITERIA: RCTs and observational studies that enrolled VLBW infants with enteral administration of probiotics were considered. Extracted study data included probiotic characteristics and at least 1 clinical outcome (necrotizing enterocolitis [NEC], late-onset sepsis or all-cause mortality). DATA COLLECTION AND ANALYSIS: Forty-four studies were eligible for our review: 30 RCTs and 14 observational studies. Severe NEC rates (stage II or more) and all-cause mortality were reduced among the probiotic groups in both the RCTs (RR 0.57, 95% CI 0.47-0.70, and RR 0.77, 95% CI 0.65-0.92, respectively) and the observational studies (RR 0.51, 95% CI 0.37-0.70, and RR 0.71, 95% CI 0.62-0.81, respectively). Furthermore, there was a 12% reduction in the risk of sepsis in RCTs and a 19% reduction in observational studies. The meta-analysis of observational studies showed a reduction in the risk of NEC in extremely low birth weight infants. However, this was not statistically significant. CONCLUSIONS: This meta-analysis of RCT and observational studies found that the use of probiotics was beneficial for the prevention of severe NEC, late-onset sepsis, and all-cause mortality in VLBW infants.

编号：5

题名：New Insights on Early Patterns of Respiratory Disease among Extremely Low Gestational Age Newborns.

作者：Nobile S;Marchionni P;Vento G;Vendettuoli V;Marabini C;Lio A;Ricci C;Mercadante D;Colnaghi M;Mosca F;Romagnoli C;Carnielli V


机构：Neonatology Unit, Department of Maternal and Child Health, Salesi Children's Hospital, Marche Polytechnic University, Ancona, Italy.

摘要： BACKGROUND: The analysis of early patterns of lung disease among preterm infants may help to identify predictors of pulmonary deterioration. OBJECTIVES: To analyze FIO2 requirement in the first 14 days of life among preterm infants and to find predictors of bronchopulmonary dysplasia (BPD). METHODS: Retrospective cohort study. SETTING: 3 Italian

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level III NICUs. POPULATION: infants born between 240/7 and 276/7 weeks' gestational age (GA) who survived to 14 days. A consecutive sample of 588 infants was analyzed. Daily mode FIO2 in the first 2 weeks of life were analyzed according to the criteria defined by Laughon et al. [Pediatrics 2009;123:1124-1131], who found 3 early respiratory patterns: consistently low FIO2 (LowFIO2), pulmonary deterioration (PD), and early persistent pulmonary deterioration (EPPD). Factors associated with pulmonary deterioration were studied by univariate and multivariate analysis. RESULTS: Forty percent of infants had low FIO2, 18% had pulmonary deterioation, 21% had early persistent pulmonary deterioration, and 21% had a previously unreported pattern (pulmonary improvement, PI). The prevalence of BPD was 7% in the LowFIO2 group, 28% in the PI group, 44% in the PD group, and 62% in the EPPD group (p = 0.000). Infants with lung deterioration were more frequently males (OR = 2.019, CI: 1.319-3.090, p = 0.001), had lower GA (OR = 0.945, CI: 0.915-0.975, p = 0.000), higher incidence of severe respiratory distress syndrome (OR = 2.956, CI: 1.430-6.112, p = 0.003), and lack of postnatal caffeine (OR = 0.167, CI: 0.052-0.541, p = 0.003). CONCLUSIONS: We report 4 distinct patterns of early respiratory disease associated with significantly different prevalence of BPD and discuss risk factors for lung deterioration.

编号：6

题名：Neonatal Hypoglycaemia and Visual Development: A Review.

作者：Paudel N;Chakraborty A;Anstice N;Jacobs RJ;Hegarty JE;Harding JE;Thompson B


机构：School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand.

摘要： BACKGROUND: Many newborn babies experience low blood glucose concentrations, a condition referred to as neonatal hypoglycaemia (NH). The effect of NH on visual development in infancy and childhood is of interest because the occipital lobes, which include the primary visual cortex and a number of extrastriate visual areas, may be particularly susceptible to NH-induced injury. In addition, a number of case series have suggested that NH can affect eye and optic nerve development. OBJECTIVE: To review the existing literature concerning the effect of NH on the visual system. METHODS: A PubMed, Embase, Medline, and Google Scholar literature search was conducted using prespecified MeSH terms. RESULTS: The literature reviewed revealed no clear evidence for an effect of NH on the development of the eye and optic nerve. Furthermore, occipital and occipital-parietal lobe injuries following NH often occurred in conjunction with comorbid conditions and were not clearly linked to subsequent visual dysfunction, possibly due to difficulties in measuring vision in young children and a lack of studies at older ages. A recent, large-scale, prospective study of NH outcomes at 2 years of age found no effect of mild-to-moderate NH on visual development. CONCLUSION: The effect of NH on visual development is unclear. It is currently unknown whether NH affects visual function in mid-to-late childhood when many visual functions reach adult levels.

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编号：7

题名：Reliability of Pulse Oximetry during Progressive Hypoxia, Cardiopulmonary Resuscitation, and Recovery in a Piglet Model of Neonatal Hypoxic Cardiac Arrest.

作者：Hassan MA;Weber C;Waitz M;Huang L;Hummler HD;Mendler MR


机构：Department of Pediatrics, Faculty of Medicine, Sohag University, Sohag, Egypt.

摘要： BACKGROUND: Pulse oximetry is widely used in intensive care and emergency conditions to monitor arterial oxygenation and to guide oxygen therapy. OBJECTIVE: To study the reliability of pulse oximetry in comparison with CO-oximetry in newborn piglets during progressive hypoxia, cardiac arrest, cardiopulmonary resuscitation (CPR), and after return of spontaneous circulation (ROSC). METHODS: Thirty-three newborn piglets were exposed to hypoxia until asystole occurred and then resuscitated until ROSC. Arterial oxygen saturation was monitored continuously by pulse oximetry (SpO2) with one sensor applied to the wrist of the right forelimb (FL) and another to the thigh of the left hind limb (HL). Arterial functional oxygen saturation (SaO2) was measured at baseline and at predefined intervals during each phase of the experiment. SpO2 was compared with coinciding SaO2 values and bias considered whenever the difference (SpO2 - SaO2) was beyond +/-5%. RESULTS: Bias values were lower at the baseline measurements (-3.7 +/- 2.3% in FL and -4.1 +/- 3.4% in HL) as well as after ROSC (1.5 +/- 4.2% in FL and 0.2 +/- 4.6% in HL) with higher precision and accuracy than during other experiment phases. During hypoxia induction, cardiac arrest, and CPR, there was a marked decrease in precision and accuracy as well as an increase in bias up to 43 +/- 26 and 56 +/- 27% in FL and HL, respectively, over a range of SaO2 from 13 to 51%. CONCLUSION: Pulse oximetry showed increased bias and decreased accuracy and precision during marked hypoxemia in a model of neonatal hypoxic cardiac arrest.

编号：8

题名：A Regional Evaluation of Survival of Infants with End-Stage Renal Disease.

作者：Twichell SA;Fiascone J;Gupta M;Prendergast M;Rodig N;Hansen A


机构：Division of Nephrology, Department of Medicine, Boston Children's Hospital, Boston, MA, USA.

摘要： BACKGROUND: Information regarding morbidity and mortality of infants born with end-stage renal disease (ESRD) requiring dialysis early in life is critical to optimize patient care and better counsel families. OBJECTIVE: We evaluated outcomes of infants born regionally with ESRD, and those within our broader catchment area referred for dialysis. STUDY DESIGN: We screened deaths at 5 regional referral hospitals, identifying infants with ESRD who did not survive to transfer for dialysis. We also screened all infants <8 weeks old seen at our institution

15

over a 7-year period with ESRD referred for dialysis. We evaluated factors associated with survival to dialysis and transplant. RESULTS: We identified 14 infants from regional hospitals who died prior to transfer and 12 infants at our institution who were dialyzed. Because of the large burden of lethal comorbidities in our regional referral centers, overall survival was low, with 73% dying at birth hospitals. Amongst dialyzed infants, 42% survived to transplant. CONCLUSION: This study is unusual in reporting survival of infants with ESRD including those not referred for dialysis, which yields an expectedly lower survival rate than reported by dialysis registries.

编号：9

题名：Prognostic Value of the Apparent Diffusion Coefficient in Newborns with Hypoxic-Ischaemic Encephalopathy Treated with Therapeutic Hypothermia.

作者：Heursen EM;Zuazo Ojeda A;Benavente Fernandez I;Jimenez Gomez G;Campuzano Fernandez-Colima R;Paz-Exposito J;Lubian Lopez SP


机构：Radiology Department, "Puerta del Mar" University Hospital, Cadiz, Spain.

摘要： BACKGROUND: Apparent diffusion coefficient (ADC) quantification has been proven to be of prognostic value in term newborns with hypoxic-ischaemic encephalopathy (HIE) who were treated under normothermia. OBJECTIVES: To evaluate the prognostic value of ADC in standardized brain regions in neonates with HIE who were treated with therapeutic hypothermia (TH). METHODS: This prospective cohort study included 54 term newborns who were admitted with HIE and treated with TH. All magnetic resonance imaging examinations were performed between days 4 and 6 of life, and ADC values were measured in 13 standardized regions of the brain. At 2 years of age we explored whether ADC values were related to composite outcomes (death or survival with abnormal neurodevelopment). RESULTS: The severity of HIE is inversely related to ADC values in different brain regions. We found that lower ADC values in the posterior limb of the internal capsule (PLIC), the thalami, the semioval centre, and frontal and parietal white matter were related to adverse outcomes. ADC values in the PLIC and thalami are good predictors of adverse outcomes (AUC 0.86 and 0.76). CONCLUSIONS: Low ADC values in the PLIC, thalamus, semioval centre, and frontal and parietal white matter in full-term infants with HIE treated with TH were associated with a poor outcome.

编号：10

题名：Comparison of Umbilical Serum Copeptin Relative to Erythropoietin and S100B as Asphyxia Biomarkers at Birth.

作者：Summanen M;Seikku L;Rahkonen P;Stefanovic V;Teramo K;Andersson S;Kaila K;Rahkonen L

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机构：Department of Biosciences, University of Helsinki, Helsinki, Finland.

摘要： BACKGROUND: Birth asphyxia, estimated to account for a million neonatal deaths annually, can cause a wide variety of neurodevelopmental impairments. There is a need to develop new, swift methods to identify those neonates who would benefit from neuroprotective treatments such as hypothermia. OBJECTIVES: To examine the utility of cord serum copeptin, a stable byproduct of arginine vasopressin release, as a biomarker of birth asphyxia based on a comparison with 2 biomarkers of hypoxia and brain trauma: erythropoietin and S100B. METHODS: The study population consisted of 140 singleton, term neonates: 113 controls and 27 with birth asphyxia (2/3 criteria met: umbilical artery pH <7.10, base excess </=12 mmol/L, and 5-min Apgar score <7). All deliveries were planned vaginal, but 51 neonates were born by emergency cesarean section. Copeptin, S100B, and erythropoietin levels in umbilical artery samples were measured by immunoassays. RESULTS: Copeptin correlated in the entire study population more strongly with umbilical artery base excess than S100B and erythropoietin, and only copeptin correlated with arterial pH. Furthermore, only copeptin levels were significantly higher in cases of birth asphyxia, and in vaginally born neonates they were found to increase as a function of labor duration. Copeptin was elevated in neonates born via vacuum extraction, whereas erythropoietin levels showed a slight increase after emergency cesarean section. CONCLUSIONS: In this study population, S100B and erythropoietin were not valid biomarkers of birth asphyxia. In contrast, our work suggests that copeptin has high potential to become a routinely used biomarker for acute birth asphyxia and neonatal distress.

编号：11

题名：Retinopathy of Prematurity Is Associated with Increased Systolic Blood Pressure in Adults Who Were Born Preterm.

作者：Kistner A;Jacobson L;Ostergren J;Hellstrom A


机构：The Sahlgrenska Center for Pediatric Ophthalmology Research, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.

摘要： BACKGROUND: Adults born preterm are at risk of developing cardiovascular morbidities. OBJECTIVE: The aim of this study was to evaluate the relationship between retinopathy of prematurity (ROP) and blood pressure (BP) and salivary cortisol levels during adulthood. METHODS: Sixty-nine subjects (mean age 22.6 years) were included. Subjects were adults who were: (a) ex-preterm infants with severe ROP (n = 22), born at gestational age (GA) <30 weeks with a birth weight (BW) <1,000 g, (b) ex-preterm infants with no/mild ROP (n = 21), born at GA <28 weeks with a BW <1,000 g, or (c) full-term controls (n = 26). Anthropometric data, office BP, ambulatory BP, and morning and evening salivary cortisol were analyzed. RESULTS: As adults, ex-preterm infants with severe ROP had on average 7.4 mm Hg higher systolic office BP than those with no/mild ROP (p = 0.019) and controls (p = 0.007). A high cortisol level, tall height, and severe ROP were independent predictors of higher ambulatory systolic BP during adulthood in forward stepwise regression analysis, independent of GA. CONCLUSION: Our

17

results indicate that preterm infants with severe abnormal retinal vascular development during the neonatal period may be at an increased risk for increased BP during adulthood. We found no differences between those with no/mild ROP as infants and controls with regard to BP data.

编号：12

题名：Association between Brain and Kidney Near-Infrared Spectroscopy and Early Postresuscitation Mortality in Asphyxiated Newborn Piglets.

作者：Solevag AL;Schmolzer GM;Nakstad B;Saugstad OD;Cheung PY


机构：Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, AB, Canada.

摘要： BACKGROUND: Early outcome predictors after delivery room cardiopulmonary resuscitation (CPR) of asphyxiated newborns are needed. OBJECTIVES: To investigate if cerebral (rScO2) and renal (rSrO2) tissue oxygen saturation 30 min after return of spontaneous circulation (ROSC) are different between surviving versus nonsurviving piglets with asphyxia-induced cardiac arrest and CPR. Further, to investigate the relationship of rScO2 and rSrO2 to cardiac output (CO), blood pressure (BP), and biochemical variables 30 min and 4 h after ROSC. METHODS: Anesthetized, mechanically ventilated piglets (1-3 days, 1.7-2.4 kg) were used. rScO2, rSrO2, SpO2, right common carotid artery flow, and arterial BP were measured continuously. CO was measured with echocardiography. The piglets were asphyxiated until cardiac arrest and resuscitated. Piglets that survived 4 h after ROSC (n = 12) were compared with piglets that died before planned euthanasia at 4 h (n = 13). Left ventricular, and kidney and brain tissue lactate were analyzed. Correlations between variables were assessed. RESULTS: Thirty minutes after ROSC, median rSrO2 (43% [n = 10] vs. 25% [n = 2], p = 0.003) but not rScO2 (46% [41-55] [n = 10] vs. 40% [22-45] [n = 5], p = 0.08) was higher in survivors than in nonsurvivors. Arterial lactate was negatively correlated and pH positively correlated with rScO2 and rSrO2. Left ventricular, but not kidney or brain lactate was negatively correlated with rScO2 and rSrO2. There was no correlation between CO or BP and rScO2 or rSrO2. CONCLUSIONS: Despite satisfactory CO and BP vital organ oxygenation can be poor. Tissue oxygen saturation, pH, and lactate, as measures of anaerobic metabolism, may reflect vital organ oxygenation and outcome.

Lancet 柳叶刀

编号：1

题名：Diversity, creativity, and flexibility will be needed from the next generation of medical scientists.

作者：Lechler R

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出处：Lancet.2017V389 Suppl 1N:S1

机构：Academy of Medical Sciences, London, UK; King's College London, London, UK. Electronic address: [email protected].

摘要：

编号：2

题名：Supporting researchers in an era of team science.

作者：Saunders P

出处：Lancet.2017V389 Suppl 1N:S10-S12

机构：Academy of Medical Sciences, London W1B 1QH, UK; University of Edinburgh, Edinburgh EH16 4TJ, UK. Electronic address: [email protected].

摘要：

编号：3

题名：A life in science-and away from it.

作者：Watts G


机构：Academy of Medical Sciences, London, UK. Electronic address: [email protected].

摘要：

编号：4

题名：Science needs leaders who seek inspiration inside and outside work.

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作者：Lee M


机构：BTG International Ltd, London EC4M 7RD, UK. Electronic address: [email protected].

摘要：

编号：1

题名：Child-to-adult neurodevelopmental and mental health trajectories after early life deprivation: the young adult follow-up of the longitudinal English and Romanian Adoptees study.

作者：Sonuga-Barke EJS;Kennedy M;Kumsta R;Knights N;Golm D;Rutter M;Maughan B;Schlotz W;Kreppner J

出处：Lancet.2017V389N10078:1539-1548

机构：Developmental Brain-Behaviour Laboratory, Department of Psychology, University of Southampton, Southampton, UK; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. Electronic address: [email protected].;Developmental Brain-Behaviour Laboratory, Department of Psychology, University of Southampton, Southampton, UK.;Department of Genetic Psychology, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany.;The Amy Winehouse Foundation, London, UK.;Developmental Brain-Behaviour Laboratory, Department of Psychology, University of Southampton, Southampton, UK.;MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.;MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.;Max Planck Institute for Empirical Aesthetics, Frankfurt, Germany.;Developmental Brain-Behaviour Laboratory, Department of Psychology, University of Southampton, Southampton, UK.

摘要： BACKGROUND: Time-limited, early-life exposures to institutional deprivation are associated with disorders in childhood, but it is unknown whether effects persist into adulthood. We used data from the English and Romanian Adoptees study to assess whether deprivation-associated adverse neurodevelopmental and mental health outcomes persist into young adulthood. METHODS: The English and Romanian Adoptees study is a longitudinal, natural experiment investigation into the long-term outcomes of individuals who spent from soon after birth to up to 43 months in severe deprivation in Romanian institutions before being adopted into the UK. We used developmentally appropriate standard questionnaires, interviews completed by parents and adoptees, and direct measures of IQ to measure symptoms of autism spectrum disorder, inattention and overactivity, disinhibited social engagement, conduct or emotional problems, and cognitive impairment (IQ score <80) during childhood (ages 6, 11, and 15 years) and in young adulthood (22-25 years). For analysis, Romanian adoptees were split into those who spent less than 6 months in an institution and those who spent more than 6 months in an institution. We used a comparison group of UK adoptees who did not experience deprivation. We used mixed-effects regression models for ordered-categorical outcome variables to compare symptom levels and trends between groups. FINDINGS: Romanian adoptees who experienced less than 6 months in an institution (n=67 at ages 6 years; n=50 at young adulthood) and UK controls (n=52 at age 6 years; n=39 at young adulthood) had similarly low levels of symptoms across most ages and outcomes. By contrast, Romanian adoptees exposed to more than 6 months in an institution (n=98 at ages 6 years; n=72 at young adulthood) had persistently higher rates than UK controls of symptoms of autism spectrum disorder, disinhibited social engagement, and inattention and overactivity through to young adulthood (pooled p<0.0001 for all). Cognitive impairment in the group who spent more than 6 months in an institution remitted from markedly higher rates at ages 6 years (p=0.0001) and 11 years (p=0.0016) compared with UK controls, to normal rates at young adulthood (p=0.76). By contrast, self-rated emotional symptoms showed a late-onset pattern with minimal differences versus UK controls at ages 11 years (p=0.0449) and 15 years (p=0.17), and then marked increases by young adulthood (p=0.0005), with similar effects seen for parent ratings. The

20

high deprivation group also had a higher proportion of people with low educational achievement (p=0.0195), unemployment (p=0.0124), and mental health service use (p=0.0120, p=0.0032, and p=0.0003 for use when aged <11 years, 11-14 years, and 15-23 years, respectively) than the UK control group. A fifth (n=15) of individuals who spent more than 6 months in an institution were problem-free at all assessments. INTERPRETATION: Notwithstanding the resilience shown by some adoptees and the adult remission of cognitive impairment, extended early deprivation was associated with long-term deleterious effects on wellbeing that seem insusceptible to years of nurturance and support in adoptive families. FUNDING: Economic and Social Research Council, Medical Research Council, Department of Health, Jacobs Foundation, Nuffield Foundation.

编号：2

题名：Early life deprivation: is the damage already done?

作者：Verhulst FC

出处：Lancet.2017V389N10078:1496-1497

机构：Department of Child and Adolescent Psychiatry, Erasmus University Medical Centre, 3000 CB Rotterdam, Netherlands. Electronic address: [email protected].

摘要：

编号：3

题名：Does intensity matter in aphasia rehabilitation?

作者：Worrall L;Foster A

出处：Lancet.2017V389N10078:1494-1495

机构：School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD 4072, Australia. Electronic address: [email protected].;School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD 4072, Australia; Discipline of Speech Pathology, School of Allied Health, La Trobe University, Melbourne, VIC, Australia.

摘要：

编号：4

21

题名：Intensive speech and language therapy in patients with chronic aphasia after stroke: a randomised, open-label, blinded-endpoint, controlled trial in a health-care setting.

作者：Breitenstein C;Grewe T;Floel A;Ziegler W;Springer L;Martus P;Huber W;Willmes K;Ringelstein EB;Haeusler KG;Abel S;Glindemann R;Domahs F;Regenbrecht F;Schlenck KJ;Thomas M;Obrig H;de Langen E;Rocker R;Wigbers F;Ruhmkorf C;Hempen I;List J;Baumgaertner A

出处：Lancet.2017V389N10078:1528-1538

机构：Department of General Neurology (formerly Department of Neurology), University of Munster, Munster, Germany. Electronic address: [email protected].;Faculty of Health and Social Sciences, Fresenius University of Applied Sciences, Idstein and Hamburg, Germany.;NeuroCure Clinical Research Center, Charite-Universitatsmedizin Berlin, Berlin, Germany; Center for Stroke Research Berlin, Charite-Universitatsmedizin Berlin, Berlin, Germany; Department of Neurology, Charite-Universitatsmedizin Berlin, Berlin, Germany; Department of Neurology, University of Greifswald, Greifswald, Germany.;Clinical Neuropsychology Research Group, Institute of Phonetics and Speech Processing, Ludwig-Maximilians-University, Munich, Germany.;Clinical and Cognitive Neuroscience, Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany.;Institute for Clinical Epidemiology and Applied Biostatistics, University of Tubingen, Tubingen, Germany.;Clinical and Cognitive Neuroscience, Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany.;Neuropsychology, Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany.;Department of General Neurology (formerly Department of Neurology), University of Munster, Munster, Germany.;Center for Stroke Research Berlin, Charite-Universitatsmedizin Berlin, Berlin, Germany; Department of Neurology, Charite-Universitatsmedizin Berlin, Berlin, Germany.;Neuropsychology, Department of Neurology, University Hospital, RWTH Aachen University, Aachen, Germany; School of Biological Sciences, University of Manchester, Manchester, UK.;Neuropsychological Department, Bogenhausen Hospital, Munich, Germany.;Institute of Germanic Linguistics, University of Marburg, Marburg, Germany.;Clinic of Cognitive Neurology, University of Leipzig and Max Planck Institute for Cognitive and Brain Sciences, Leipzig, Germany.;m&i Fachklinik Enzensberg, Fuessen, Germany.;Department of General Neurology (formerly Department of Neurology), University of Munster, Munster, Germany.;Clinic of Cognitive Neurology, University of Leipzig and Max Planck Institute for Cognitive and Brain Sciences, Leipzig, Germany.;Reha-Centre Passauer Wolf, Bad Griesbach, Germany.;Department of General Neurology (formerly Department of Neurology), University of Munster, Munster, Germany.;Department of General Neurology (formerly Department of Neurology), University of Munster, Munster, Germany.;Department of General Neurology (formerly Department of Neurology), University of Munster, Munster, Germany.;Department of General Neurology (formerly Department of Neurology), University of Munster, Munster, Germany.;NeuroCure Clinical Research Center, Charite-Universitatsmedizin Berlin, Berlin, Germany; Center for Stroke Research Berlin, Charite-Universitatsmedizin Berlin, Berlin, Germany; Department of Neurology, Charite-Universitatsmedizin Berlin, Berlin, Germany.;Faculty of Health and Social Sciences, Fresenius University of Applied Sciences, Idstein and Hamburg, Germany.

摘要： BACKGROUND: Treatment guidelines for aphasia recommend intensive speech and language therapy for chronic (>/=6 months) aphasia after stroke, but large-scale, class 1 randomised controlled trials on treatment effectiveness are scarce. We aimed to examine whether 3 weeks of intensive speech and language therapy under routine clinical conditions improved verbal communication in daily-life situations in people with chronic aphasia after stroke. METHODS: In this multicentre, parallel group, superiority, open-label, blinded-endpoint, randomised controlled trial, patients aged 70 years or younger with aphasia after stroke lasting for 6 months or more were recruited from 19 inpatient or outpatient rehabilitation centres in Germany. An external biostatistician used a computer-generated permuted block randomisation method, stratified by treatment centre, to randomly assign participants to either 3 weeks or more of intensive speech and language therapy (>/=10 h per week) or 3 weeks deferral of intensive speech and language therapy. The primary endpoint was between-group difference in the change in verbal communication effectiveness in everyday life scenarios (Amsterdam-Nijmegen Everyday Language Test A-scale) from baseline to immediately after 3 weeks of treatment or treatment deferral. All analyses were done using the modified intention-to-treat population (those who received 1 day or more of intensive treatment or treatment deferral). This study is registered with ClinicalTrials.gov, number NCT01540383. FINDINGS: We randomly assigned 158 patients between April 1, 2012, and May 31, 2014. The modified intention-to-treat population comprised 156 patients (78 per group). Verbal communication was significantly improved from baseline to after intensive speech and language treatment (mean difference 2.61 points [SD 4.94]; 95% CI 1.49 to 3.72), but not from baseline to after treatment deferral (-0.03 points [4.04]; -0.94 to 0.88; between-group difference Cohen's d 0.58; p=0.0004). Eight patients had adverse events during

22

therapy or treatment deferral (one car accident [in the control group], two common cold [one patient per group], three gastrointestinal or cardiac symptoms [all intervention group], two recurrent stroke [one in intervention group before initiation of treatment, and one before group assignment had occurred]); all were unrelated to study participation. INTERPRETATION: 3 weeks of intensive speech and language therapy significantly enhanced verbal communication in people aged 70 years or younger with chronic aphasia after stroke, providing an effective evidence-based treatment approach in this population. Future studies should examine the minimum treatment intensity required for meaningful treatment effects, and determine whether treatment effects cumulate over repeated intervention periods. FUNDING: German Federal Ministry of Education and Research and the German Society for Aphasia Research and Treatment.

编号：5

题名：Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial.

出处：Lancet.2017V389N10078:1519-1527

编号：6

题名：Fixation methods in the management of hip fractures.

作者：Chughtai M;Khlopas A;Mont MA

出处：Lancet.2017V389N10078:1493-1494

机构：Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA.;Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA.;Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA. Electronic address: [email protected].

摘要：

编号：7

题名：Scleromyxoedema.

作者：van Leersum F;Abdul Hamid M;Steijlen P

出处：Lancet.2017V389N10078:1549

23

机构：Department of Dermatology, Maastricht University Medical Center, Netherlands. Electronic address: [email protected].;Department of Pathology, Maastricht University Medical Center, Netherlands.;Department of Dermatology, Maastricht University Medical Center, Netherlands.

摘要：

编号：8

题名：A rapid evidence review of the effectiveness and cost-effectiveness of alcohol control policies: an English perspective.

作者：Burton R;Henn C;Lavoie D;O'Connor R;Perkins C;Sweeney K;Greaves F;Ferguson B;Beynon C;Belloni A;Musto V;Marsden J;Sheron N

出处：Lancet.2017V389N10078:1558-1580

机构：Public Health England, London, UK; Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.;Public Health England, London, UK. Electronic address: [email protected].;Public Health England, London, UK.;Public Health England, London, UK.;Public Health England, London, UK.;Public Health England, London, UK.;Public Health England, London, UK; Department of Primary Care and Public Health, Imperial College London, London, UK.;Public Health England, London, UK; Department of Health Sciences, University of York, York, UK.;Public Health England, London, UK.;Public Health England, London, UK.;Public Health England, London, UK.;Public Health England, London, UK; Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.;Public Health England, London, UK; Faculty of Medicine, University of Southampton, Southampton, UK.

摘要： This paper reviews the evidence for the effectiveness and cost-effectiveness of policies to reduce alcohol-related harm. Policies focus on price, marketing, availability, information and education, the drinking environment, drink-driving, and brief interventions and treatment. Although there is variability in research design and measured outcomes, evidence supports the effectiveness and cost-effectiveness of policies that address affordability and marketing. An adequate reduction in temporal availability, particularly late night on-sale availability, is effective and cost-effective. Individually-directed interventions delivered to at-risk drinkers and enforced legislative measures are also effective. Providing information and education increases awareness, but is not sufficient to produce long-lasting changes in behaviour. At best, interventions enacted in and around the drinking environment lead to small reductions in acute alcohol-related harm. Overall, there is a rich evidence base to support the decisions of policy makers in implementing the most effective and cost-effective policies to reduce alcohol-related harm.

编号：9

题名：Syphilis.

作者：Hook EW Rd

出处：Lancet.2017V389N10078:1550-1557

24

机构：University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: [email protected].

摘要： Syphilis is a chronic bacterial infection caused by Treponema pallidum that is endemic in low-income countries and and occurs at lower rates in middle-income and high-income countries. The disease is of both individual and public health importance and, in addition to its direct morbidity, increases risk of HIV infection and can cause lifelong morbidity in children born to infected mothers. Without treatment the disease can progress over years through a series of clinical stages and lead to irreversible neurological or cardiovascular complications. Although syphilis is an ancient disease and the principles of recommended management have been established for decades, diagnosis and management are often challenging because of its varied manifestations and difficulty in interpretation of serological tests used to confirm diagnosis and evaluate response to therapy. In North America and western Europe, incidence of syphilis has increased dramatically in the past decade among men who have sex with men, particularly those with coexistent HIV infection. Only one drug, penicillin, is recommended for syphilis treatment and response to therapy is assessed based on changes over months in serological test titres. Treatment for patients who cannot receive penicillin and management of patients who do not serologically respond to treatment are common clinical problems.

编号：10

题名：Keith Martin-crusader for health and the planet.

作者：Das P

出处：Lancet.2017V389N10078:1508

编号：11

题名：The future of the NHS.

作者：The Lancet

出处：Lancet.2017V389N10078:1491

编号：12

题名：Syphilis: an ancient disease in a modern era.

作者：The Lancet

出处：Lancet.2017V389N10078:1492

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编号：13

题名：Defunding the UNFPA: sign of the times.

作者：The Lancet

出处：Lancet.2017V389N10078:1492

编号：14

题名：Palliative care in humanitarian crises: always something to offer.

作者：Powell RA;Schwartz L;Nouvet E;Sutton B;Petrova M;Marston J;Munday D;Radbruch L

出处：Lancet.2017V389N10078:1498-1499

机构：MWAPO Health Development Group, PO Box 459-00621, Village Market, Nairobi, Kenya. Electronic address: [email protected].;Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.;Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.;Burnet Institute, Melbourne, VIC, Australia.;Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.;International Consultant, Assagay, South Africa.;Palliative Medicine and Health Services Research, International Nepal Fellowship, Kathmandu, Nepal.;University Hospital Bonn, Bonn, Germany; Center of Palliative Care, Malteser Hospital Seliger Gerhard Bonn/Rhein-Sieg, Bonn, Germany.

摘要：

编号：15

题名：Offline: When The Lancet went to the Vatican.

作者：Horton R

出处：Lancet.2017V389N10078:1500

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编号：16

题名：Syria chemical attacks: preparing for the unconscionable.

作者：Zarocostas J

出处：Lancet.2017V389N10078:1501

编号：17

题名：Research needed to prevent MERS coronavirus outbreaks.

作者：Devi S

出处：Lancet.2017V389N10078:1502

编号：18

题名：Accounting for polio survivors in the post-polio world.

作者：Cousins S

出处：Lancet.2017V389N10078:1503-1504

编号：19

题名：Health systems resilience: meaningful construct or catchphrase?

作者：Haldane V;Ong SE;Chuah FL;Legido-Quigley H

出处：Lancet.2017V389N10078:1513

机构：Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549.;Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549.;Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549.;Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549; Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK. Electronic address: [email protected].

27

摘要：

编号：20

题名：Private water operators' contribution to realising the right to water.

作者：Moss J

出处：Lancet.2017V389N10078:1513-1514

机构：AquaFed, 75008 Paris, France. Electronic address: [email protected].

摘要：

编号：21

题名：Prevention of early-onset pre-eclampsia.

作者：Carbillon L

出处：Lancet.2017V389N10078:1514-1515

机构：Assistance Publique Hopitaux de Paris, Paris 13 University, Bondy 93140, France. Electronic address: [email protected].

摘要：

编号：22

题名：Maternal deaths and humanitarian crises.

作者：Erken A

出处：Lancet.2017V389N10078:1514

28

机构：Division of Communications and Strategic Partnerships, United Nations Population Fund, New York, NY 10158, USA. Electronic address: [email protected].

摘要：

编号：23

题名：Prevention of early-onset pre-eclampsia - Authors' reply.

作者：Rodger MA

出处：Lancet.2017V389N10078:1515

机构：The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada. Electronic address: [email protected].

摘要：

编号：24

题名：Prolonged glucocorticoid treatment in acute respiratory distress syndrome.

作者：Meduri GU;Siemieniuk RAC

出处：Lancet.2017V389N10078:1516

机构：Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Memphis Veterans Affairs Medical Center, Memphis, TN 38104, USA. Electronic address: [email protected].;Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

摘要：

编号：25

题名：Prolonged glucocorticoid treatment in acute respiratory distress syndrome - Authors' reply.

作者：Sweeney RM;McAuley DF

29

出处：Lancet.2017V389N10078:1516-1517

机构：Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, Northern Ireland, UK.;Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, Northern Ireland, UK; Centre for Experimental Medicine, Queen's University Belfast, Wellcome-Wolfson Institute for Experimental Medicine, Belfast BT9 7AE, Northern Ireland, UK. Electronic address: [email protected].

摘要：

编号：26

题名：Beyond ESPAC-4: better surgery and systemic therapy.

作者：Psarelli EE;Jackson R;Neoptolemos JP;Palmer DH;Ghaneh P;Halloran CM;Buchler MW

出处：Lancet.2017V389N10078:1517-1518

机构：Liverpool Clinical and Cancer Research UK Trials Unit, University of Liverpool, Liverpool L69 3GL, UK.;Liverpool Clinical and Cancer Research UK Trials Unit, University of Liverpool, Liverpool L69 3GL, UK.;Liverpool Clinical and Cancer Research UK Trials Unit, University of Liverpool, Liverpool L69 3GL, UK; Royal Liverpool University Hospital, Liverpool, UK. Electronic address: [email protected].;Liverpool Clinical and Cancer Research UK Trials Unit, University of Liverpool, Liverpool L69 3GL, UK; Clatterbridge Cancer Centre, Wirral, UK.;Liverpool Clinical and Cancer Research UK Trials Unit, University of Liverpool, Liverpool L69 3GL, UK; Royal Liverpool University Hospital, Liverpool, UK.;Liverpool Clinical and Cancer Research UK Trials Unit, University of Liverpool, Liverpool L69 3GL, UK.;Department of General, Abdominal and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.

摘要：

编号：27

题名：Stoop to conquer: preventing stroke and dementia together.

作者：Hachinski V

出处：Lancet.2017V389N10078:1518

机构：Western University, London, ON N6G 2N9, Canada. Electronic address: [email protected].

摘要：

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编号：28

题名：Department of Error.

出处：Lancet.2017V389N10078:1518

JAMA 美国医学会杂志

编号：1

题名：Association Between Serotonergic Antidepressant Use During Pregnancy and Autism Spectrum Disorder in Children.

作者：Brown HK;Ray JG;Wilton AS;Lunsky Y;Gomes T;Vigod SN

出处：JAMA.2017V317N15:1544-1552

机构：Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada2Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada3Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.;Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada4Department of Obstetrics and Gynaecology, St Michael's Hospital, Toronto, Ontario, Canada5Department of Medicine, University of Toronto, Toronto, Ontario, Canada.;Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.;Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada3Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada6Centre for Addiction and Mental Health, Toronto, Ontario, Canada.;Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada7Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.;Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada2Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada3Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.

摘要： Importance: Previous observations of a higher risk of child autism spectrum disorder with serotonergic antidepressant exposure during pregnancy may have been confounded. Objective: To evaluate the association between serotonergic antidepressant exposure during pregnancy and child autism spectrum disorder. Design, Setting, and Participants: Retrospective cohort study. Health administrative data sets were used to study children born to mothers who were receiving public prescription drug coverage during pregnancy in Ontario, Canada, from 2002-2010, reflecting 4.2% of births. Children were followed up until March 31, 2014. Exposures: Serotonergic antidepressant exposure was defined as 2 or more consecutive maternal prescriptions for a selective serotonin or serotonin-norepinephrine reuptake inhibitor between conception and delivery. Main Outcomes and Measures: Child autism spectrum disorder identified after the age of 2 years. Exposure group differences were addressed by inverse probability of treatment weighting based on derived high-dimensional propensity scores (computerized algorithm used to select a large number of potential confounders) and by comparing exposed children with unexposed siblings. Results: There were 35906 singleton births at a mean gestational age of 38.7 weeks (50.4% were male, mean maternal age was 26.7 years, and mean duration of follow-up was 4.95 years). In the 2837 pregnancies (7.9%) exposed to antidepressants, 2.0% (95% CI, 1.6%-2.6%) of children were diagnosed with autism spectrum disorder. The incidence of autism spectrum disorder was 4.51 per 1000 person-years among children exposed to antidepressants vs 2.03 per 1000 person-years among unexposed children (between-group difference, 2.48 [95% CI, 2.33-2.62] per 1000 person-years; hazard ratio [HR], 2.16 [95% CI, 1.64-2.86]; adjusted HR, 1.59 [95% CI, 1.17-2.17]). After inverse probability of treatment weighting based on the high-dimensional propensity score, the association was not significant (HR, 1.61 [95% CI, 0.997-2.59]). The association was

31

also not significant when exposed children were compared with unexposed siblings (incidence of autism spectrum disorder was 3.40 per 1000 person-years vs 2.05 per 1000 person-years, respectively; adjusted HR, 1.60 [95% CI, 0.69-3.74]). Conclusions and Relevance: In children born to mothers receiving public drug coverage in Ontario, Canada, in utero serotonergic antidepressant exposure compared with no exposure was not associated with autism spectrum disorder in the child. Although a causal relationship cannot be ruled out, the previously observed association may be explained by other factors.

编号：2

题名：Comparison of Recommended Eligibility for Primary Prevention Statin Therapy Based on the US Preventive Services Task Force Recommendations vs the ACC/AHA Guidelines.

作者：Pagidipati NJ;Navar AM;Mulder H;Sniderman AD;Peterson ED;Pencina MJ

出处：JAMA.2017V317N15:1563-1567

机构：Duke Clinical Research Institute, Duke University, Durham, North Carolina.;Duke Clinical Research Institute, Duke University, Durham, North Carolina.;Duke Clinical Research Institute, Duke University, Durham, North Carolina.;McGill University Health Centre, Montreal, Canada.;Duke Clinical Research Institute, Duke University, Durham, North Carolina.;Duke Clinical Research Institute, Duke University, Durham, North Carolina.

摘要： Importance: There are important differences among guideline recommendations for using statin therapy in primary prevention. New recommendations from the US Preventive Services Task Force (USPSTF) emphasize therapy based on the presence of 1 or more cardiovascular disease (CVD) risk factors and a 10-year global CVD risk of 10% or greater. Objective: To determine the difference in eligibility for primary prevention statin treatment among US adults, assuming full application of USPSTF recommendations compared with the American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Design, Setting, and Participants: National Health and Nutrition Examination Survey (NHANES) data (2009-2014) were used to assess statin eligibility under the 2016 USPSTF recommendations vs the 2013 ACC/AHA cholesterol guidelines among a nationally representative sample of 3416 US adults aged 40 to 75 years with fasting lipid data and triglyceride levels of 400 mg/dL or less, without prior CVD. Exposures: The 2016 USPSTF recommendations vs 2013 ACC/AHA guidelines. Main Outcomes and Measures: Eligibility for primary prevention statin therapy. Results: Among the US primary prevention population represented by 3416 individuals in NHANES, the median weighted age was 53 years (interquartile range, 46-61), and 53% (95% CI, 52%-55%) were women. Along with the 21.5% (95% CI, 19.3%-23.7%) of patients who reported currently taking lipid-lowering medication, full implementation of the USPSTF recommendations would be associated with initiation of statin therapy in an additional 15.8% (95% CI, 14.0%-17.5%) of patients, compared with an additional 24.3% (95% CI, 22.3%-26.3%) of patients who would be recommended for statin initiation under full implementation of the 2013 ACC/AHA guidelines. Among the 8.9% of individuals in the primary prevention population who would be recommended for statins by ACC/AHA guidelines but not by USPSTF recommendations, 55% would be adults aged 40 to 59 years with a mean 30-year cardiovascular risk greater than 30%, and 28% would have diabetes. Conclusions And Relevance: In this sample of US adults from 2009-2014, adherence to the 2016 USPSTF recommendations for statin therapy, compared with the 2013 ACC/AHA guidelines, could lead to a lower number of individuals recommended for primary prevention statin therapy, including many younger adults with high mean long-term CVD risk.

编号：3

32

题名：Revamping the US Federal Common Rule: Modernizing Human Participant Research Regulations.

作者：Hodge JG Jr;Gostin LO

出处：JAMA.2017V317N15:1521-1522

机构：Public Health Law and Policy Program, Sandra Day O'Connor College of Law, Arizona State University, Phoenix.;O'Neill Institute for Global and National Health Law, Georgetown University Law Center, Washington, DC.

摘要：

编号：4

题名：The DASH Diet, 20 Years Later.

作者：Steinberg D;Bennett GG;Svetkey L

出处：JAMA.2017V317N15:1529-1530

机构：Duke Global Digital Health Science Center, Duke Global Health Institute, Duke University, Durham, North Carolina.;Duke Global Digital Health Science Center, Duke Global Health Institute, Duke University, Durham, North Carolina2Department of Psychology and Neuroscience, Duke University, Durham, North Carolina.;Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.

摘要：

编号：5

题名：Adding Protective Genetic Variants to Clinical Reporting of Genomic Screening Results: Restoring Balance.

作者：Schwartz MLB;Williams MS;Murray MF

出处：JAMA.2017V317N15:1527-1528

机构：Genomic Medicine Institute, Geisinger Health System, Danville, Pennsylvania.;Genomic Medicine Institute, Geisinger Health System, Danville, Pennsylvania.;Genomic Medicine Institute, Geisinger Health System, Danville, Pennsylvania.

摘要：

33

编号：6

题名：The Hyde Amendment at 40 Years and Reproductive Rights in the United States: Perennial and Panoptic.

作者：Adashi EY;Occhiogrosso RH

出处：JAMA.2017V317N15:1523-1524

机构：Warren Alpert Medical School, Brown University, Providence, Rhode Island.;Warren Alpert Medical School, Brown University, Providence, Rhode Island.

摘要：

编号：7

题名：Medical Community Gathers Steam to Tackle Climate's Health Effects.

作者：Friedrich MJ

出处：JAMA.2017V317N15:1511-1513

编号：8

题名：US Public Opinion on Health Care Reform, 2017.

作者：Kirzinger A;Hamel L;Clark C;Rousseau D

出处：JAMA.2017V317N15:1516

编号：9

题名：Policing and Public Health-Strategies for Collaboration.

作者：Shepherd JP;Sumner SA

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出处：JAMA.2017V317N15:1525-1526

机构：Violence Research Group, Crime and Security Research Institute, Cardiff University, Cardiff, Wales, United Kingdom.;Division of Violence Prevention, National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia.

摘要：

编号：10

题名：JAMA.

出处：JAMA.2017V317N15:1497-1498

编号：11

题名：Forgotten Loss.

作者：Gorgens S

出处：JAMA.2017V317N15:1586

机构：Emory University School of Medicine, Atlanta, Georgia.

摘要：

N Eng J Med 新英格兰医学杂志

编号：1

题名：Antidrug Antibodies in Patients Treated with Alirocumab.

作者：Roth EM;Goldberg AC;Catapano AL;Torri A;Yancopoulos GD;Stahl N;Brunet A;Lecorps G;Colhoun HM

出处：N Engl J Med.2017V376N16:1589-90

35

机构：Sterling Research Group, Cincinnati, OH [email protected].;Washington University School of Medicine, St. Louis, MO.;University of Milan Multimedica IRCCS, Milan, Italy.;Regeneron Pharmaceuticals, Tarrytown, NY.;Regeneron Pharmaceuticals, Tarrytown, NY.;Regeneron Pharmaceuticals, Tarrytown, NY.;Sanofi, Bridgewater, NJ.;Sanofi, Chilly Mazarin, France.;University of Edinburgh, Edinburgh, United Kingdom.

文献类型：Letter;Comment

摘要：

编号：2

题名：Lipid-Reduction Variability and Antidrug-Antibody Formation with Bococizumab.

作者：Ridker PM;Tardif JC;Amarenco P;Duggan W;Glynn RJ;Jukema JW;Kastelein JJP;Kim AM;Koenig W;Nissen S;Revkin J;Rose LM;Santos RD;Schwartz PF;Shear CL;Yunis C

出处：N Engl J Med.2017V376N16:1517-1526

机构：From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Universite de Montreal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum Munchen, Technische Universitat Munchen, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital, Sao Paulo (R.D.S.).;From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Universite de Montreal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum Munchen, Technische Universitat Munchen, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital, Sao Paulo (R.D.S.).;From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Universite de Montreal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum Munchen, Technische Universitat Munchen, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital, Sao Paulo (R.D.S.).;From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Universite de Montreal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum Munchen, Technische

36

Universitat Munchen, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital, Sao Paulo (R.D.S.).;From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Universite de Montreal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum Munchen, Technische Universitat Munchen, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital, Sao Paulo (R.D.S.).;From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Universite de Montreal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum Munchen, Technische Universitat Munchen, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital, Sao Paulo (R.D.S.).;From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Universite de Montreal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum Munchen, Technische Universitat Munchen, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital, Sao Paulo (R.D.S.).;From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Universite de Montreal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum Munchen, Technische Universitat Munchen, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital, Sao Paulo (R.D.S.).;From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Universite de Montreal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum Munchen, Technische Universitat Munchen, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital, Sao Paulo (R.D.S.).;From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Universite de Montreal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum Munchen, Technische Universitat Munchen, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital, Sao Paulo (R.D.S.).;From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Universite de Montreal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum Munchen, Technische

37

Universitat Munchen, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital, Sao Paulo (R.D.S.).;From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Universite de Montreal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum Munchen, Technische Universitat Munchen, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital, Sao Paulo (R.D.S.).;From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Universite de Montreal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum Munchen, Technische Universitat Munchen, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital, Sao Paulo (R.D.S.).;From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Universite de Montreal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum Munchen, Technische Universitat Munchen, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital, Sao Paulo (R.D.S.).;From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Universite de Montreal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum Munchen, Technische Universitat Munchen, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital, Sao Paulo (R.D.S.).;From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Universite de Montreal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum Munchen, Technische Universitat Munchen, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital, Sao Paulo (R.D.S.).

文献类型：Journal Article;Research Support, Non-U.S. Gov't

摘要： Background Bococizumab, a humanized monoclonal antibody targeting proprotein convertase subtilisin-kexin type 9 (PCSK9), reduces levels of low-density lipoprotein (LDL) cholesterol. However, the variability and durability of this effect are uncertain. Methods We conducted six parallel, multinational lipid-lowering trials enrolling 4300 patients with hyperlipidemia who were randomly assigned to receive 150 mg of bococizumab or placebo subcutaneously every 2 weeks and who were followed for up to 12 months; 96% were receiving statin therapy at the time of enrollment. The patients were assessed for lipid changes over time, stratified according to the presence or absence of antidrug antibodies detected during the treatment period. Results At 12 weeks, patients who received bococizumab had a reduction

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of 54.2% in the LDL cholesterol level from baseline, as compared with an increase of 1.0% among those who received placebo (absolute between-group difference, -55.2 percentage points). Significant between-group differences were also observed in total cholesterol, non-high-density lipoprotein cholesterol, apolipoprotein B, and lipoprotein(a) (P<0.001 for all comparisons). However, high-titer antidrug antibodies developed in a substantial proportion of the patients who received bococizumab, which markedly diminished the magnitude and durability of the reduction in LDL cholesterol levels. In addition, among patients with no antidrug antibodies, there was wide variability in the reduction in LDL cholesterol levels at both 12 weeks and 52 weeks. Major cardiovascular events occurred in 57 patients (2.5%) who received bococizumab and in 55 (2.7%) who received placebo (hazard ratio, 0.96; 95% confidence interval, 0.66 to 1.39; P=0.83). The most common adverse event among patients who received bococizumab was injection-site reaction (12.7 per 100 person-years). Conclusions In six multinational trials evaluating bococizumab, antidrug antibodies developed in a large proportion of the patients and significantly attenuated the lowering of LDL cholesterol levels. Wide variation in the relative reduction in cholesterol levels was also observed among patients in whom antidrug antibodies did not develop. (Funded by Pfizer; SPIRE ClinicalTrials.gov numbers, NCT01968954 , NCT01968967 , NCT01968980 , NCT02100514 , NCT02135029 , and NCT02458287 .).

编号：3

题名：Cardiovascular Efficacy and Safety of Bococizumab in High-Risk Patients.

作者：Ridker PM;Revkin J;Amarenco P;Brunell R;Curto M;Civeira F;Flather M;Glynn RJ;Gregoire J;Jukema JW;Karpov Y;Kastelein JJP;Koenig W;Lorenzatti A;Manga P;Masiukiewicz U;Miller M;Mosterd A;Murin J;Nicolau JC;Nissen S;Ponikowski P;Santos RD;Schwartz PF;Soran H;White H;Wright RS;Vrablik M;Yunis C;Shear CL;Tardif JC

出处：N Engl J Med.2017V376N16:1527-1539

机构：From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon,

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Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich,

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Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and

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First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center,

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Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and

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Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.);

44

Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische

45

Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand

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(H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden

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University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).;From Brigham and Women's Hospital and Harvard Medical School, Boston (P.M.R., R.J.G.); Pfizer, New York (J.R., R.B., M.C., U.M., P.F.S., C.Y., C.L.S.); Paris-Diderot, Sorbonne Paris Cite University, Paris (P.A.); Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain (F.C.); University of East Anglia, Norwich (M.F.), and Central Manchester University Hospital, Manchester (H.S.) - both in the United Kingdom; the Montreal Heart Institute, Universite de Montreal, Montreal (J.G., J.-C.T.); Leiden University Medical Center, Leiden (J.W.J.), Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.), and Meander Medical Center, Amersfoort (A.M.) - all in the Netherlands; Russian Cardiology Research and Production Center, Moscow (Y.K.); Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich Heart Alliance, Munich, Germany (W.K.); Cordoba Hospital, Cordoba, Argentina (A.L.); University of the Witwatersrand, Johannesburg (P.M.); University of Maryland, Baltimore (M.M.); University of Comenius, Bratislava, Slovakia (J.M.); Heart Institute, University of Sao Paulo Medical School (J.C.N.), and Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital (R.D.S.), Sao Paulo; Cleveland Clinic Foundation, Cleveland (S.N.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.W.); Mayo Clinic, Rochester, MN (R.S.W.); and First Faculty of Medicine, Charles University, Prague, Czech Republic (M.V.).

文献类型：Journal Article

摘要： Background Bococizumab is a humanized monoclonal antibody that inhibits proprotein convertase subtilisin-kexin type 9 (PCSK9) and reduces levels of low-density lipoprotein (LDL) cholesterol. We sought to evaluate the efficacy of bococizumab in patients at high cardiovascular risk. Methods In two parallel, multinational trials with different entry criteria for LDL cholesterol levels, we randomly assigned the 27,438 patients in the combined trials to receive bococizumab (at a dose of 150 mg) subcutaneously every 2 weeks or placebo. The primary end point was nonfatal myocardial infarction, nonfatal stroke, hospitalization for

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unstable angina requiring urgent revascularization, or cardiovascular death; 93% of the patients were receiving statin therapy at baseline. The trials were stopped early after the sponsor elected to discontinue the development of bococizumab owing in part to the development of high rates of antidrug antibodies, as seen in data from other studies in the program. The median follow-up was 10 months. Results At 14 weeks, patients in the combined trials had a mean change from baseline in LDL cholesterol levels of -56.0% in the bococizumab group and +2.9% in the placebo group, for a between-group difference of -59.0 percentage points (P<0.001) and a median reduction from baseline of 64.2% (P<0.001). In the lower-risk, shorter-duration trial (in which the patients had a baseline LDL cholesterol level of >/=70 mg per deciliter [1.8 mmol per liter] and the median follow-up was 7 months), major cardiovascular events occurred in 173 patients each in the bococizumab group and the placebo group (hazard ratio, 0.99; 95% confidence interval [CI], 0.80 to 1.22; P=0.94). In the higher-risk, longer-duration trial (in which the patients had a baseline LDL cholesterol level of >/=100 mg per deciliter [2.6 mmol per liter] and the median follow-up was 12 months), major cardiovascular events occurred in 179 and 224 patients, respectively (hazard ratio, 0.79; 95% CI, 0.65 to 0.97; P=0.02). The hazard ratio for the primary end point in the combined trials was 0.88 (95% CI, 0.76 to 1.02; P=0.08). Injection-site reactions were more common in the bococizumab group than in the placebo group (10.4% vs. 1.3%, P<0.001). Conclusions In two randomized trials comparing the PCSK9 inhibitor bococizumab with placebo, bococizumab had no benefit with respect to major adverse cardiovascular events in the trial involving lower-risk patients but did have a significant benefit in the trial involving higher-risk patients. (Funded by Pfizer; SPIRE-1 and SPIRE-2 ClinicalTrials.gov numbers, NCT01975376 and NCT01975389 .).

编号：4

题名：Eltrombopag Added to Standard Immunosuppression for Aplastic Anemia.

作者：Townsley DM;Scheinberg P;Winkler T;Desmond R;Dumitriu B;Rios O;Weinstein B;Valdez J;Lotter J;Feng X;Desierto M;Leuva H;Bevans M;Wu C;Larochelle A;Calvo KR;Dunbar CE;Young NS

出处：N Engl J Med.2017V376N16:1540-1550

机构：From the Hematology Branch (D.M.T., T.W., R.D., B.D., O.R., B.W., J.V., J.L., X.F., M.D., H.L., A.L., C.E.D., N.S.Y.) and the Office of Biostatistics Research (C.W.), National Heart, Lung, and Blood Institute, and the Nursing Research and Translational Science Section, Department of Nursing (M.B.), and the Hematology Section, Department of Laboratory Medicine (K.R.C.), Clinical Center - all at the National Institutes of Health, Bethesda, MD; and the Division of Clinical Hematology, Antonio Ermirio de Moraes Cancer Center, Hospital A Beneficencia Portuguesa de Sao Paulo, Sao Paulo (P.S.).;From the Hematology Branch (D.M.T., T.W., R.D., B.D., O.R., B.W., J.V., J.L., X.F., M.D., H.L., A.L., C.E.D., N.S.Y.) and the Office of Biostatistics Research (C.W.), National Heart, Lung, and Blood Institute, and the Nursing Research and Translational Science Section, Department of Nursing (M.B.), and the Hematology Section, Department of Laboratory Medicine (K.R.C.), Clinical Center - all at the National Institutes of Health, Bethesda, MD; and the Division of Clinical Hematology, Antonio Ermirio de Moraes Cancer Center, Hospital A Beneficencia Portuguesa de Sao Paulo, Sao Paulo (P.S.).;From the Hematology Branch (D.M.T., T.W., R.D., B.D., O.R., B.W., J.V., J.L., X.F., M.D., H.L., A.L., C.E.D., N.S.Y.) and the Office of Biostatistics Research (C.W.), National Heart, Lung, and Blood Institute, and the Nursing Research and Translational Science Section, Department of Nursing (M.B.), and

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the Hematology Section, Department of Laboratory Medicine (K.R.C.), Clinical Center - all at the National Institutes of Health, Bethesda, MD; and the Division of Clinical Hematology, Antonio Ermirio de Moraes Cancer Center, Hospital A Beneficencia Portuguesa de Sao Paulo, Sao Paulo (P.S.).;From the Hematology Branch (D.M.T., T.W., R.D., B.D., O.R., B.W., J.V., J.L., X.F., M.D., H.L., A.L., C.E.D., N.S.Y.) and the Office of Biostatistics Research (C.W.), National Heart, Lung, and Blood Institute, and the Nursing Research and Translational Science Section, Department of Nursing (M.B.), and the Hematology Section, Department of Laboratory Medicine (K.R.C.), Clinical Center - all at the National Institutes of Health, Bethesda, MD; and the Division of Clinical Hematology, Antonio Ermirio de Moraes Cancer Center, Hospital A Beneficencia Portuguesa de Sao Paulo, Sao Paulo (P.S.).;From the Hematology Branch (D.M.T., T.W., R.D., B.D., O.R., B.W., J.V., J.L., X.F., M.D., H.L., A.L., C.E.D., N.S.Y.) and the Office of Biostatistics Research (C.W.), National Heart, Lung, and Blood Institute, and the Nursing Research and Translational Science Section, Department of Nursing (M.B.), and the Hematology Section, Department of Laboratory Medicine (K.R.C.), Clinical Center - all at the National Institutes of Health, Bethesda, MD; and the Division of Clinical Hematology, Antonio Ermirio de Moraes Cancer Center, Hospital A Beneficencia Portuguesa de Sao Paulo, Sao Paulo (P.S.).;From the Hematology Branch (D.M.T., T.W., R.D., B.D., O.R., B.W., J.V., J.L., X.F., M.D., H.L., A.L., C.E.D., N.S.Y.) and the Office of Biostatistics Research (C.W.), National Heart, Lung, and Blood Institute, and the Nursing Research and Translational Science Section, Department of Nursing (M.B.), and the Hematology Section, Department of Laboratory Medicine (K.R.C.), Clinical Center - all at the National Institutes of Health, Bethesda, MD; and the Division of Clinical Hematology, Antonio Ermirio de Moraes Cancer Center, Hospital A Beneficencia Portuguesa de Sao Paulo, Sao Paulo (P.S.).;From the Hematology Branch (D.M.T., T.W., R.D., B.D., O.R., B.W., J.V., J.L., X.F., M.D., H.L., A.L., C.E.D., N.S.Y.) and the Office of Biostatistics Research (C.W.), National Heart, Lung, and Blood Institute, and the Nursing Research and Translational Science Section, Department of Nursing (M.B.), and the Hematology Section, Department of Laboratory Medicine (K.R.C.), Clinical Center - all at the National Institutes of Health, Bethesda, MD; and the Division of Clinical Hematology, Antonio Ermirio de Moraes Cancer Center, Hospital A Beneficencia Portuguesa de Sao Paulo, Sao Paulo (P.S.).;From the Hematology Branch (D.M.T., T.W., R.D., B.D., O.R., B.W., J.V., J.L., X.F., M.D., H.L., A.L., C.E.D., N.S.Y.) and the Office of Biostatistics Research (C.W.), National Heart, Lung, and Blood Institute, and the Nursing Research and Translational Science Section, Department of Nursing (M.B.), and the Hematology Section, Department of Laboratory Medicine (K.R.C.), Clinical Center - all at the National Institutes of Health, Bethesda, MD; and the Division of Clinical Hematology, Antonio Ermirio de Moraes Cancer Center, Hospital A Beneficencia Portuguesa de Sao Paulo, Sao Paulo (P.S.).;From the Hematology Branch (D.M.T., T.W., R.D., B.D., O.R., B.W., J.V., J.L., X.F., M.D., H.L., A.L., C.E.D., N.S.Y.) and the Office of Biostatistics Research (C.W.), National Heart, Lung, and Blood Institute, and the Nursing Research and Translational Science Section, Department of Nursing (M.B.), and the Hematology Section, Department of Laboratory Medicine (K.R.C.), Clinical Center - all at the National Institutes of Health, Bethesda, MD; and the Division of Clinical Hematology, Antonio Ermirio de Moraes Cancer Center, Hospital A Beneficencia Portuguesa de Sao Paulo, Sao Paulo (P.S.).;From the Hematology Branch (D.M.T., T.W., R.D., B.D., O.R., B.W., J.V., J.L., X.F., M.D., H.L., A.L., C.E.D., N.S.Y.) and the Office of Biostatistics Research (C.W.), National Heart, Lung, and Blood Institute, and the Nursing Research and Translational Science Section, Department of Nursing (M.B.), and the Hematology Section, Department of Laboratory Medicine (K.R.C.), Clinical Center - all at the National Institutes of Health, Bethesda, MD; and the Division of Clinical Hematology, Antonio Ermirio de Moraes Cancer Center, Hospital A Beneficencia Portuguesa de Sao Paulo, Sao Paulo (P.S.).;From the Hematology Branch (D.M.T., T.W., R.D., B.D., O.R., B.W., J.V., J.L., X.F., M.D., H.L., A.L., C.E.D., N.S.Y.) and the Office of Biostatistics Research (C.W.), National Heart, Lung, and Blood Institute, and the Nursing Research and Translational Science Section, Department of Nursing (M.B.), and the Hematology Section, Department of Laboratory Medicine (K.R.C.), Clinical Center - all at the National Institutes of Health, Bethesda, MD; and the Division of Clinical Hematology, Antonio Ermirio de Moraes Cancer Center, Hospital A Beneficencia Portuguesa de Sao Paulo, Sao Paulo (P.S.).;From the Hematology Branch (D.M.T., T.W., R.D., B.D., O.R., B.W., J.V., J.L., X.F., M.D., H.L., A.L., C.E.D., N.S.Y.) and the Office of Biostatistics Research (C.W.), National Heart, Lung, and Blood Institute,

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and the Nursing Research and Translational Science Section, Department of Nursing (M.B.), and the Hematology Section, Department of Laboratory Medicine (K.R.C.), Clinical Center - all at the National Institutes of Health, Bethesda, MD; and the Division of Clinical Hematology, Antonio Ermirio de Moraes Cancer Center, Hospital A Beneficencia Portuguesa de Sao Paulo, Sao Paulo (P.S.).;From the Hematology Branch (D.M.T., T.W., R.D., B.D., O.R., B.W., J.V., J.L., X.F., M.D., H.L., A.L., C.E.D., N.S.Y.) and the Office of Biostatistics Research (C.W.), National Heart, Lung, and Blood Institute, and the Nursing Research and Translational Science Section, Department of Nursing (M.B.), and the Hematology Section, Department of Laboratory Medicine (K.R.C.), Clinical Center - all at the National Institutes of Health, Bethesda, MD; and the Division of Clinical Hematology, Antonio Ermirio de Moraes Cancer Center, Hospital A Beneficencia Portuguesa de Sao Paulo, Sao Paulo (P.S.).;From the Hematology Branch (D.M.T., T.W., R.D., B.D., O.R., B.W., J.V., J.L., X.F., M.D., H.L., A.L., C.E.D., N.S.Y.) and the Office of Biostatistics Research (C.W.), National Heart, Lung, and Blood Institute, and the Nursing Research and Translational Science Section, Department of Nursing (M.B.), and the Hematology Section, Department of Laboratory Medicine (K.R.C.), Clinical Center - all at the National Institutes of Health, Bethesda, MD; and the Division of Clinical Hematology, Antonio Ermirio de Moraes Cancer Center, Hospital A Beneficencia Portuguesa de Sao Paulo, Sao Paulo (P.S.).;From the Hematology Branch (D.M.T., T.W., R.D., B.D., O.R., B.W., J.V., J.L., X.F., M.D., H.L., A.L., C.E.D., N.S.Y.) and the Office of Biostatistics Research (C.W.), National Heart, Lung, and Blood Institute, and the Nursing Research and Translational Science Section, Department of Nursing (M.B.), and the Hematology Section, Department of Laboratory Medicine (K.R.C.), Clinical Center - all at the National Institutes of Health, Bethesda, MD; and the Division of Clinical Hematology, Antonio Ermirio de Moraes Cancer Center, Hospital A Beneficencia Portuguesa de Sao Paulo, Sao Paulo (P.S.).;From the Hematology Branch (D.M.T., T.W., R.D., B.D., O.R., B.W., J.V., J.L., X.F., M.D., H.L., A.L., C.E.D., N.S.Y.) and the Office of Biostatistics Research (C.W.), National Heart, Lung, and Blood Institute, and the Nursing Research and Translational Science Section, Department of Nursing (M.B.), and the Hematology Section, Department of Laboratory Medicine (K.R.C.), Clinical Center - all at the National Institutes of Health, Bethesda, MD; and the Division of Clinical Hematology, Antonio Ermirio de Moraes Cancer Center, Hospital A Beneficencia Portuguesa de Sao Paulo, Sao Paulo (P.S.).;From the Hematology Branch (D.M.T., T.W., R.D., B.D., O.R., B.W., J.V., J.L., X.F., M.D., H.L., A.L., C.E.D., N.S.Y.) and the Office of Biostatistics Research (C.W.), National Heart, Lung, and Blood Institute, and the Nursing Research and Translational Science Section, Department of Nursing (M.B.), and the Hematology Section, Department of Laboratory Medicine (K.R.C.), Clinical Center - all at the National Institutes of Health, Bethesda, MD; and the Division of Clinical Hematology, Antonio Ermirio de Moraes Cancer Center, Hospital A Beneficencia Portuguesa de Sao Paulo, Sao Paulo (P.S.).;From the Hematology Branch (D.M.T., T.W., R.D., B.D., O.R., B.W., J.V., J.L., X.F., M.D., H.L., A.L., C.E.D., N.S.Y.) and the Office of Biostatistics Research (C.W.), National Heart, Lung, and Blood Institute, and the Nursing Research and Translational Science Section, Department of Nursing (M.B.), and the Hematology Section, Department of Laboratory Medicine (K.R.C.), Clinical Center - all at the National Institutes of Health, Bethesda, MD; and the Division of Clinical Hematology, Antonio Ermirio de Moraes Cancer Center, Hospital A Beneficencia Portuguesa de Sao Paulo, Sao Paulo (P.S.).

文献类型：Journal Article;Research Support, N.I.H., Extramural

摘要： Background Acquired aplastic anemia results from immune-mediated destruction of bone marrow. Immunosuppressive therapies are effective, but reduced numbers of residual stem cells may limit their efficacy. In patients with aplastic anemia that was refractory to immunosuppression, eltrombopag, a synthetic thrombopoietin-receptor agonist, led to clinically significant increases in blood counts in almost half the patients. We combined standard immunosuppressive therapy with eltrombopag in previously untreated patients with severe aplastic anemia. Methods We enrolled 92 consecutive patients in a prospective phase 1-2 study of immunosuppressive therapy plus eltrombopag. The three consecutively enrolled cohorts differed with regard to the timing of initiation and the duration of the eltrombopag regimen

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(cohort 1 received eltrombopag from day 14 to 6 months, cohort 2 from day 14 to 3 months, and cohort 3 from day 1 to 6 months). The cohorts were analyzed separately. The primary outcome was complete hematologic response at 6 months. Secondary end points included overall response, survival, relapse, and clonal evolution to myeloid cancer. Results The rate of complete response at 6 months was 33% in cohort 1, 26% in cohort 2, and 58% in cohort 3. The overall response rates at 6 months were 80%, 87%, and 94%, respectively. The complete and overall response rates in the combined cohorts were higher than in our historical cohort, in which the rate of complete response was 10% and the overall response rate was 66%. At a median follow-up of 2 years, the survival rate was 97%; one patient died during the study from a nonhematologic cause. Marked increases in bone marrow cellularity, CD34+ cell number, and frequency of early hematopoietic progenitors were noted. Rates of relapse and clonal evolution were similar to our historical experience. Severe rashes occurred in two patients, resulting in the early discontinuation of eltrombopag. Conclusions The addition of eltrombopag to immunosuppressive therapy was associated with markedly higher rates of hematologic response among patients with severe aplastic anemia than in a historical cohort. (Funded by the National Heart, Lung, and Blood Institute; ClinicalTrials.gov number, NCT01623167 .).

编号：5

题名：Risankizumab versus Ustekinumab for Moderate-to-Severe Plaque Psoriasis.

作者：Papp KA;Blauvelt A;Bukhalo M;Gooderham M;Krueger J;Lacour JP;Menter A;Philipp S;Sofen H;Tyring S;Berner BR;Visvanathan S;Pamulapati C;Bennett N;Flack M;Scholl P;Padula SJ

出处：N Engl J Med.2017V376N16:1551-1560

机构：From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hopital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charite Universitatsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.).;From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hopital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charite Universitatsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.).;From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates,

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Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hopital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charite Universitatsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.).;From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hopital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charite Universitatsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.).;From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hopital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charite Universitatsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.).;From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hopital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charite Universitatsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.).;From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hopital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charite Universitatsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.).;From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hopital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charite Universitatsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.).;From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.),

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School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hopital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charite Universitatsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.).;From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hopital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charite Universitatsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.).;From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hopital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charite Universitatsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.).;From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hopital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charite Universitatsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.).;From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hopital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charite Universitatsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.).;From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hopital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charite Universitatsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los

54

Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.).;From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hopital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charite Universitatsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.).;From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hopital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charite Universitatsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.).;From K. Papp Clinical Research and Probity Medical Research, Waterloo, ON (K.A.P.), School of Medicine, Queen's University, Kingston, ON (M.G.), and Centre for Dermatology and Probity Medical Research, Peterborough, ON (M.G.) - all in Canada; Oregon Medical Research Center, Portland (A.B.); Altman Dermatology Associates, Arlington Heights, IL (M.B.); Rockefeller University, New York (J.K.); Hopital de l'Archet, University of Nice-Sophia Antipolis, Nice, France (J.-P.L.); Baylor Research Institute, Dallas (A.M.); Charite Universitatsmedizin Berlin, Berlin (S.P.), Boehringer Ingelheim Pharma, Biberach (B.R.B.), and Boehringer Ingelheim Pharma, Ingelheim, (S.J.P.) - all in Germany; University of Texas Health Science Center, Houston (S.T.); University of California, Los Angeles, School of Medicine, Los Angeles (H.S.); and Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.V., C.P., N.B., M.F., P.S.).

文献类型：Journal Article;Research Support, Non-U.S. Gov't

摘要： Background Interleukin-23 is thought to be critical to the pathogenesis of psoriasis. We compared risankizumab (BI 655066), a humanized IgG1 monoclonal antibody that inhibits interleukin-23 by specifically targeting the p19 subunit and thus prevents interleukin-23 signaling, and ustekinumab, an interleukin-12 and interleukin-23 inhibitor, in patients with moderate-to-severe plaque psoriasis. Methods We randomly assigned a total of 166 patients to receive subcutaneous injections of risankizumab (a single 18-mg dose at week 0 or 90-mg or 180-mg doses at weeks 0, 4, and 16) or ustekinumab (45 or 90 mg, according to body weight, at weeks 0, 4, and 16). The primary end point was a 90% or greater reduction from baseline in the Psoriasis Area and Severity Index (PASI) score at week 12. Results At week 12, the percentage of patients with a 90% or greater reduction in the PASI score was 77% (64 of 83 patients) for risankizumab (90-mg and 180-mg groups, pooled), as compared with 40% (16 of 40 patients) for ustekinumab (P<0.001); the percentage of patients with a 100% reduction in the PASI score was 45% in the pooled 90-mg and 180-mg risankizumab groups, as compared with 18% in the ustekinumab group. Efficacy was generally maintained up to 20 weeks after the final dose of 90 or 180 mg of risankizumab. In the 18-mg and 90-mg risankizumab groups and the ustekinumab group, 5 patients (12%), 6 patients (15%), and 3 patients (8%), respectively, had serious adverse events, including two basal-cell carcinomas and one major cardiovascular adverse event; there were no serious adverse events in the 180-mg risankizumab group. Conclusions In this phase 2 trial, selective blockade of interleukin-23 with risankizumab was associated with clinical responses superior to those associated with

55

ustekinumab. This trial was not large enough or of long enough duration to draw conclusions about safety. (Funded by Boehringer Ingelheim; ClinicalTrials.gov number, NCT02054481 ).

编号：6

题名：Frequency of Evidence-Based Screening for Retinopathy in Type 1 Diabetes.

出处：N Engl J Med.2017V376N16:1507-1516

文献类型：Journal Article;Research Support, N.I.H., Extramural;Research Support, Non-U.S. Gov't

编号：7

题名：A Citizen's Pathway Gone Astray - Delaying Competition from Generic Drugs.

作者：Feldman R;Wang C

出处：N Engl J Med.2017V376N16:1499-1501

机构：From the Institute for Innovation Law, University of California Hastings College of the Law, San Francisco.;From the Institute for Innovation Law, University of California Hastings College of the Law, San Francisco.


摘要：

编号：8

题名：Zika Virus Infection and Associated Neurologic Disorders in Brazil.

作者：de Oliveira WK;Carmo EH;Henriques CM;Coelho G;Vazquez E;Cortez-Escalante J;Molina J;Aldighieri S;Espinal MA;Dye C

出处：N Engl J Med.2017V376N16:1591-1593

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机构：Ministry of Health, Brasilia, Brazil.;Ministry of Health, Brasilia, Brazil.;Oswaldo Cruz Foundation, Brasilia, Brazil.;Ministry of Health, Brasilia, Brazil.;Pan American Health Organization, Brasilia, Brazil.;Pan American Health Organization, Brasilia, Brazil.;Pan American Health Organization, Brasilia, Brazil.;Pan American Health Organization, Washington, DC.;Pan American Health Organization, Washington, DC.;World Health Organization, Geneva, Switzerland [email protected].

文献类型：Research Support, Non-U.S. Gov't;Letter

摘要：

编号：9

题名：The Art of Repeal - Republicans' Health Care Reform Muddle.

作者：Oberlander J

出处：N Engl J Med.2017V376N16:1497-1499

机构：From the University of North Carolina, Chapel Hill.


摘要：

编号：10

题名：Reevaluating Eligibility Criteria - Balancing Patient Protection and Participation in Oncology Trials.

作者：Beaver JA;Ison G;Pazdur R

出处：N Engl J Med.2017V376N16:1504-1505

机构：From the Office of Hematology and Oncology Products, Center for Drug Evaluation and Research (J.A.B., G.I., R.P.) and the Oncology Center of Excellence (R.P.), Food and Drug Administration, Silver Spring, MD; and the Breast Cancer Program, Johns Hopkins Sidney Kimmel Cancer Center at Sibley Memorial Hospital, Washington, DC (J.A.B.).;From the Office of Hematology and Oncology Products, Center for Drug Evaluation and Research (J.A.B., G.I., R.P.) and the Oncology Center of Excellence (R.P.), Food and Drug Administration, Silver Spring, MD; and the Breast Cancer Program, Johns Hopkins Sidney Kimmel Cancer Center at Sibley

57

Memorial Hospital, Washington, DC (J.A.B.).;From the Office of Hematology and Oncology Products, Center for Drug Evaluation and Research (J.A.B., G.I., R.P.) and the Oncology Center of Excellence (R.P.), Food and Drug Administration, Silver Spring, MD; and the Breast Cancer Program, Johns Hopkins Sidney Kimmel Cancer Center at Sibley Memorial Hospital, Washington, DC (J.A.B.).


摘要：

编号：11

题名：Sickle Cell Disease.

作者：Piel FB;Steinberg MH;Rees DC

出处：N Engl J Med.2017V376N16:1561-1573

机构：From the Department of Epidemiology and Biostatistics, Medical Research Council-Public Health England (MRC-PHE) Centre for Environment and Health, School of Public Health, Imperial College London (F.B.P.), and the Department of Haematological Medicine, King's College Hospital, King's College London (D.C.R.), London; and the Department of Medicine, Boston University School of Medicine, Boston (M.H.S.).;From the Department of Epidemiology and Biostatistics, Medical Research Council-Public Health England (MRC-PHE) Centre for Environment and Health, School of Public Health, Imperial College London (F.B.P.), and the Department of Haematological Medicine, King's College Hospital, King's College London (D.C.R.), London; and the Department of Medicine, Boston University School of Medicine, Boston (M.H.S.).;From the Department of Epidemiology and Biostatistics, Medical Research Council-Public Health England (MRC-PHE) Centre for Environment and Health, School of Public Health, Imperial College London (F.B.P.), and the Department of Haematological Medicine, King's College Hospital, King's College London (D.C.R.), London; and the Department of Medicine, Boston University School of Medicine, Boston (M.H.S.).


摘要：

编号：12

题名：Addressing the Opioid Epidemic - Opportunities in the Postmarketing Setting.

作者：Psaty BM;Merrill JO

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出处：N Engl J Med.2017V376N16:1502-1504

机构：From the Cardiovascular Health Research Unit (B.M.P.) and the Departments of Medicine (B.M.P., J.O.M.) and Epidemiology and Health Services (B.M.P.), University of Washington, and the Kaiser Permanente Washington Health Research Institute (B.M.P.) - both in Seattle.;From the Cardiovascular Health Research Unit (B.M.P.) and the Departments of Medicine (B.M.P., J.O.M.) and Epidemiology and Health Services (B.M.P.), University of Washington, and the Kaiser Permanente Washington Health Research Institute (B.M.P.) - both in Seattle.


摘要：

编号：13

题名：Case 12-2017 - A 34-Year-Old Man with Nephropathy.

作者：Sise ME;Lo GC;Goldstein RH;Allegretti AS;Masia R

出处：N Engl J Med.2017V376N16:1575-1585

机构：From the Departments of Medicine (M.E.S., R.H.G., A.S.A.), Radiology (G.C.L.), and Pathology (R.M.), Massachusetts General Hospital, and the Departments of Medicine (M.E.S., R.H.G., A.S.A.), Radiology (G.C.L.), and Pathology (R.M.), Harvard Medical School - both in Boston.;From the Departments of Medicine (M.E.S., R.H.G., A.S.A.), Radiology (G.C.L.), and Pathology (R.M.), Massachusetts General Hospital, and the Departments of Medicine (M.E.S., R.H.G., A.S.A.), Radiology (G.C.L.), and Pathology (R.M.), Harvard Medical School - both in Boston.;From the Departments of Medicine (M.E.S., R.H.G., A.S.A.), Radiology (G.C.L.), and Pathology (R.M.), Massachusetts General Hospital, and the Departments of Medicine (M.E.S., R.H.G., A.S.A.), Radiology (G.C.L.), and Pathology (R.M.), Harvard Medical School - both in Boston.;From the Departments of Medicine (M.E.S., R.H.G., A.S.A.), Radiology (G.C.L.), and Pathology (R.M.), Massachusetts General Hospital, and the Departments of Medicine (M.E.S., R.H.G., A.S.A.), Radiology (G.C.L.), and Pathology (R.M.), Harvard Medical School - both in Boston.;From the Departments of Medicine (M.E.S., R.H.G., A.S.A.), Radiology (G.C.L.), and Pathology (R.M.), Massachusetts General Hospital, and the Departments of Medicine (M.E.S., R.H.G., A.S.A.), Radiology (G.C.L.), and Pathology (R.M.), Harvard Medical School - both in Boston.


摘要：

编号：1459

题名：Osteopetrosis.

作者：Yaga U;Panta P

出处：N Engl J Med.2017V376N16:e34

机构：MNR Dental College, Telangana, India [email protected].;MNR Dental College, Telangana, India [email protected].


摘要：

编号：15

题名：Candida Esophagitis.

作者：Kondo T;Terada K

出处：N Engl J Med.2017V376N16:1574

机构：Chiba University Hospital, Chiba, Japan [email protected].;Chiba University Hospital, Chiba, Japan [email protected].


摘要：

Pediatrics 儿科学

编号：1

题名：The Use of Oxytocin to Improve Feeding and Social Skills in Infants With Prader-Willi Syndrome.

作者：Tauber M;Boulanouar K;Diene G;Cabal-Berthoumieu S;Ehlinger V;Fichaux-Bourin P;Molinas C;Faye S;Valette M;Pourrinet J;Cessans C;Viaux-Sauvelon S;Bascoul C;Guedeney A;Delhanty P;Geenen V;Martens H;Muscatelli F;Cohen D;Consoli A;Payoux P;Arnaud C;Salles JP

出处：Pediatrics.2017V139N2:

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机构：Unite d'Endocrinologie, Obesite, Maladies Osseuses, Genetique et Gynecologie Medicale. Centre de Reference du Syndrome de Prader-Willi, [email protected].;Axe Pediatrique du Centre d'Investigation Clinique 9302/Intitut National de la Sante Et de la Recherche Medicale, and.;Institut National de la Sante Et de la Recherche Medicale Unite 1043, Centre de Physiopathologie de Toulouse Purpan, Universite Paul Sabatier, Toulouse, France.;Toulouse NeuroImaging Center, Universite de Toulouse, Institut National de la Sante Et de la Recherche Medicale, Universite Paul Sabatier, Toulouse, France.;Unite d'Endocrinologie, Obesite, Maladies Osseuses, Genetique et Gynecologie Medicale. Centre de Reference du Syndrome de Prader-Willi.;Institut National de la Sante Et de la Recherche Medicale, Unite Mixte de Recherche 1027, Universite Toulouse III, Hopital Paule de Viguier, Toulouse, France.;Unite d'Endocrinologie, Obesite, Maladies Osseuses, Genetique et Gynecologie Medicale. Centre de Reference du Syndrome de Prader-Willi.;Service de Psychiatrie de l'Enfant et de l'Adolescent, Hopital des Enfants, Toulouse, France.;Institut National de la Sante Et de la Recherche Medicale, Unite Mixte de Recherche 1027, Universite Toulouse III, Hopital Paule de Viguier, Toulouse, France.;Unite d'Endocrinologie, Obesite, Maladies Osseuses, Genetique et Gynecologie Medicale. Centre de Reference du Syndrome de Prader-Willi.;Unite d'Endocrinologie, Obesite, Maladies Osseuses, Genetique et Gynecologie Medicale. Centre de Reference du Syndrome de Prader-Willi.;Axe Pediatrique du Centre d'Investigation Clinique 9302/Intitut National de la Sante Et de la Recherche Medicale, and.;Institut National de la Sante Et de la Recherche Medicale Unite 1043, Centre de Physiopathologie de Toulouse Purpan, Universite Paul Sabatier, Toulouse, France.;Unite d'Endocrinologie, Obesite, Maladies Osseuses, Genetique et Gynecologie Medicale. Centre de Reference du Syndrome de Prader-Willi.;Axe Pediatrique du Centre d'Investigation Clinique 9302/Intitut National de la Sante Et de la Recherche Medicale, and.;Unite d'Endocrinologie, Obesite, Maladies Osseuses, Genetique et Gynecologie Medicale. Centre de Reference du Syndrome de Prader-Willi.;Axe Pediatrique du Centre d'Investigation Clinique 9302/Intitut National de la Sante Et de la Recherche Medicale, and.;Unite d'Endocrinologie, Obesite, Maladies Osseuses, Genetique et Gynecologie Medicale. Centre de Reference du Syndrome de Prader-Willi.;Unite d'Endocrinologie, Obesite, Maladies Osseuses, Genetique et Gynecologie Medicale. Centre de Reference du Syndrome de Prader-Willi.;Service de Psychiatrie de l'Enfant et de l'Adolescent, la Pitie Salpetriere, Paris, France.;Service de Psychiatrie de l'Enfant et de l'Adolescent, Hopital des Enfants, Toulouse, France.;Service de Psychiatrie de l'Enfant et de l'Adolescent, Hopital Bichat-Claude Bernard, Paris, France.;Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands.;Grappe Interdisciplinaire de Genoproteomique Appliquee-I3-Immunoendocrinologie, Universite de Liege, Sart Tilman, Liege, Belgium.;Grappe Interdisciplinaire de Genoproteomique Appliquee-I3-Immunoendocrinologie, Universite de Liege, Sart Tilman, Liege, Belgium.;Institut de Neurobiologie de la Mediterranee, Institut de la Sante Et de la Recherche Medicale Unite 901, Marseille, France.;Service de Psychiatrie de l'Enfant et de l'Adolescent, la Pitie Salpetriere, Paris, France.;Centre National de la Recherche Sscientifique, Unite Mixte de Recherche 7222, Institut des Systemes Intelligents et de Robotiques, and.;Service de Psychiatrie de l'Enfant et de l'Adolescent, la Pitie Salpetriere, Paris, France.;Groupe de Recherches Cliniques Abord dimensionnel des episodes psychotiques de l'enfant et de l'adolescent, Universite Pierre et Marie Curie, Paris France; and.;Toulouse NeuroImaging Center, Universite de Toulouse, Institut National de la Sante Et de la Recherche Medicale, Universite Paul Sabatier, Toulouse, France.;Institut National de la Sante Et de la Recherche Medicale, Unite Mixte de Recherche 1027, Universite Toulouse III, Hopital Paule de Viguier, Toulouse, France.;Unite de Soutien methodologique a la recherche, CHU Toulouse, Toulouse, France.;Unite d'Endocrinologie, Obesite, Maladies Osseuses, Genetique et Gynecologie Medicale. Centre de Reference du Syndrome de Prader-Willi.;Axe Pediatrique du Centre d'Investigation Clinique 9302/Intitut National de la Sante Et de la Recherche Medicale, and.;Institut National de la Sante Et de la Recherche Medicale Unite 1043, Centre de Physiopathologie de Toulouse Purpan, Universite Paul Sabatier, Toulouse, France.


摘要： BACKGROUND AND OBJECTIVES: Patients with Prader-Willi syndrome (PWS) display poor feeding and social skills as infants and fewer hypothalamic oxytocin (OXT)-producing neurons were documented in adults. Animal data demonstrated that early treatment with OXT restores sucking after birth. Our aim is to reproduce these data in infants with PWS. METHODS: We conducted a phase 2 escalating dose study of a short course (7 days) of intranasal OXT administration. We enrolled 18 infants with PWS under 6 months old (6 infants in each step) who received 4 IU of OXT either every other day, daily, or twice daily. We investigated the tolerance and the effects on feeding and social skills and changes in circulating ghrelin and brain connectivity by functional MRI. RESULTS: No adverse events were reported. No dose effect was observed. Sucking assessed by the Neonatal Oral-Motor Scale was abnormal in all infants at baseline and normalized in 88% after treatment. The scores of Neonatal Oral-Motor Scale and videofluoroscopy of swallowing significantly decreased from 16 to 9 (P < .001) and from 18 to 12.5 (P < .001), respectively. Significant improvements in Clinical Global Impression scale scores, social withdrawal behavior, and mother-infant interactions were observed. We documented a significant increase in acylated ghrelin and connectivity of the right superior

61

orbitofrontal network that correlated with changes in sucking and behavior. CONCLUSIONS: OXT is well tolerated in infants with PWS and improves feeding and social skills. These results open perspectives for early treatment in neurodevelopment diseases with feeding problems.

编号：2

题名：Effectiveness and Duration of Protection of One Dose of a Meningococcal Conjugate Vaccine.

作者：Cohn AC;MacNeil JR;Harrison LH;Lynfield R;Reingold A;Schaffner W;Zell ER;Plikaytis B;Wang X;Messonnier NE


机构：National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; [email protected].;National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.;Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.;Minnesota Department of Health, St Paul, Minnesota.;School of Public Health, University of California, Berkley, California; and.;Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee.;National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.;National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.;National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.;National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.


摘要： BACKGROUND: Meningococcal conjugate vaccines were licensed beginning in 2005 on the basis of serologic end points and recommended for use in adolescents. A single dose at age 11 to 12 years was expected to provide protection through late adolescence. We conducted a case-control evaluation of vaccine effectiveness (VE) and duration of protection of a meningococcal (groups A, C, W, and Y) polysaccharide diphtheria toxoid conjugate vaccine (MenACWY-D). METHODS: Cases of culture- or polymerase chain reaction-confirmed serogroup A, C, W, and Y meningococcal disease among adolescents were identified through meningococcal disease surveillance sites in the United States from January 1, 2006, through August 31, 2013. Attempts were made to enroll 4 friend and school controls per case. VE was calculated using the generalized estimating equation, controlling for underlying medical conditions and smoking. RESULTS: Serogroup C accounted for 88 (49%), serogroup Y 80 (44%), and serogroup W 13 (7%) of enrolled cases. Thirty-six (20%) cases and 87 (44%) controls received MenACWY-D. The overall VE estimate 0 to 8 years postvaccination was 69% (51% to 80%); VE was 79% (49% to 91%) at <1 year, 69% (44% to 83%) at 1 to <3 years, and 61% (25% to 79%) at 3 to <8 years. VE was 77% (57% to 88%) against serogroup C and 51% (1% to 76%) against serogroup Y. CONCLUSIONS: MenACWY-D was effective in the first year after vaccination but effectiveness waned 3 to <8 years postvaccination. The estimates of VE from this evaluation informed the Advisory Committee on Immunization Practices in its decision to add a booster dose of MenACWY.

编号：3

题名：Oxytocin Treatment May Improve Infant Feeding and Social Skills in Prader-Willi Syndrome.

62

作者：MacIver NJ


机构：Division of Pediatric Endocrinology, Duke University School of Medicine, Durham, North Carolina [email protected].


摘要：

编号：4

题名：Targeting Environmental Neurodevelopmental Risks to Protect Children.

作者：Hirtz D;Campbell C;Lanphear B


机构：Department of Pediatrics and Neurology, University of Vermont College of Medicine, Burlington, Vermont; [email protected].;Department of Public Health Sciences, College of Health Sciences, University of Texas at El Paso, El Paso, Texas; and.;Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada.


摘要：

编号：5

题名：Iatrogenic Cushing's Syndrome Due to Topical Ocular Glucocorticoid Treatment.

作者：Fukuhara D;Takiura T;Keino H;Okada AA;Yan K


机构：Departments of Pediatrics, and.;Departments of Pediatrics, and.;Ophthalmology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan.;Ophthalmology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan.;Departments of Pediatrics, and [email protected].


63

摘要： Iatrogenic Cushing's syndrome (CS) is a severe adverse effect of systemic glucocorticoid (GC) therapy in children, but is extremely rare in the setting of topical ocular GC therapy. In this article, we report the case of a 9-year-old girl suffering from idiopathic uveitis who developed CS due to topical ocular GC treatment. She was referred to the ophthalmology department with a complaint of painful eyes, at which time she was diagnosed with bilateral iridocyclitis and started on a treatment of betamethasone sodium phosphate eye drops. Six months after the initiation of topical ocular GC treatment, she was referred to our pediatric department with stunted growth, truncal obesity, purple skin striate, buffalo hump, and moon face. Because her serum cortisol and plasma adrenocorticotropic hormone levels were undetectable, she was diagnosed with iatrogenic CS. After the doses of topical ocular GC were reduced, the clinical symptoms of CS were improved. The fact that the amount of topical ocular GC with our patient was apparently less than that of similar previous cases tempted us to perform genetic analysis of her NR3C1 gene. We found that our patient had a single heterozygous nucleotide substitution in the 3' untranslated region of the NR3C1 gene, which may explain why she developed CS. However, additional investigations are required to determine if our findings can be extrapolated to other patients. In conclusion, clinicians should be aware that even extremely low doses of topical ocular steroid therapy can cause iatrogenic CS.

编号：6

题名：Chronic Conditions and Health Care Needs of Adolescents Born at 23 to 25 Weeks' Gestation.

作者：Holsti A;Adamsson M;Hagglof B;Farooqi A;Serenius F


机构：Units of Pediatrics and.;Units of Pediatrics and.;Child and Adolescent Psychiatry, Institute of Clinical Sciences, University of Umea, Umea, Sweden; and.;Units of Pediatrics and [email protected].;Units of Pediatrics and.;Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.


摘要： OBJECTIVE: We examined chronic conditions, functional limitations, and special health care needs in extremely preterm children (EPT; 23-25 weeks' gestation) born between 1992 and 1998 at 2 Swedish tertiary care centers that offered regional and active perinatal care to all live-born EPT infants. METHODS: Of 134 surviving EPT children, 132 (98%) were assessed at 10 to 15 years of age alongside 103 term-born controls. Identification of children with functional limitations and special health care needs was based on a questionnaire administered to parents. Categorization of medical diagnoses and developmental disabilities was based on child examinations, medical record reviews, and parent questionnaires. RESULTS: In logistic regression analyses adjusting for social risk factors and sex, the EPT children had significantly more chronic conditions than the term-born controls, including functional limitations (64% vs 6%; odds ratio [OR], 15; 95% confidence interval [CI], 6.1-37.2; P < .001), compensatory dependency needs (60% vs 29%; OR, 3.8; 95% CI, 2.2-6.6; P < .001), and services above those routinely required by children (64% vs 25%; OR, 5.4; 95% CI, 3.0-9.6; P < .001). Specific diagnoses and disabilities for the EPT group versus controls included cerebral palsy (9.1% vs 0%; P < .001), asthma (21.2% vs 6.8%; P = 001), IQ < -2 SD (31.1% vs 4.9%; P < .001), poor motor skills without neurosensory impairment (21.9% vs 1.9%; P < .001), and psychiatric conditions (15.2% vs 1.9%; P < .001). CONCLUSIONS: Adolescents born EPT have considerable long-term health and educational needs. Few had severe impairments that curtailed major activities of daily life.

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编号：7

题名：Reduced Emergency Department Utilization by Patients With Epilepsy Using QI Methodology.

作者：Patel AD;Wood EG;Cohen DM


机构：Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio; and [email protected].;Divisions of Neurology and.;Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio; and.;Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio; and.;Emergency Medicine, College of Medicine, The Ohio State University, Columbus, Ohio.


摘要： BACKGROUND: Epilepsy or seizure care is the most common neurologic condition that presents to an emergency department (ED) and accounts for a large number of annual cases. Our aim was to decrease seizure-related ED visits from our baseline of 17 ED visits per month per 1000 patients to 13.6 ED visits per month per 1000 patients (20%) by July 2014. METHODS: Our strategy was to develop a quality improvement (QI) project utilizing the Institute for Healthcare Improvement model. Our defined outcome was to decrease ED utilization for children with epilepsy. Rate of ED visits as well as unplanned hospitalizations for epilepsy patients and associated health care costs were determined. A QI team was developed for this project. Plan do study act cycles were used with adjustments made when needed. RESULTS: Nineteen months after implementation of the interventions, ED visits were reduced by 28% (from 17 visits per month per 1000 patients to 12.2 per month per 1000 patients) during the past year. The average number of inpatient hospitalizations per month was reduced by 43% from 7 admissions per month per 1000 patients to 4 admissions per month per 1000 patients. For both outcome measures, a 2-sample Poisson rate exact test yielded a P value < .0001. Health care claims paid were less with $115 200 reduction for ED visits and $1 951 137 reduction for hospitalizations. CONCLUSIONS: Applying QI methodology was highly effective in reducing ED utilization and unplanned hospitalizations for children with epilepsy at a free-standing children's hospital.

编号：8

题名：Involvement of Fathers in Pediatric Obesity Treatment and Prevention Trials: A Systematic Review.

作者：Morgan PJ;Young MD;Lloyd AB;Wang ML;Eather N;Miller A;Murtagh EM;Barnes AT;Pagoto SL


机构：Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia; [email protected].;Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia.;Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia.;Department of Community Health Sciences, Boston University, Boston, Massachusetts.;Department of Social and Behavioral Sciences, Harvard University, Boston, Massachusetts.;Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia.;Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia.;Department of Arts Education and Physical Education, Mary Immaculate College, University of Limerick, Limerick, Ireland; and.;Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia.;Department of Medicine, University of Massachusetts, Worcester, Massachusetts.

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文献类型：Journal Article;Review

摘要： CONTEXT: Despite their important influence on child health, it is assumed that fathers are less likely than mothers to participate in pediatric obesity treatment and prevention research. OBJECTIVE: This review investigated the involvement of fathers in obesity treatment and prevention programs targeting children and adolescents (0-18 years). DATA SOURCES: A systematic review of English, peer-reviewed articles across 7 databases. Retrieved records included at least 1 search term from 2 groups: "participants" (eg, child*, parent*) and "outcomes": (eg, obes*, diet*). STUDY SELECTION: Randomized controlled trials (RCTs) assessing behavioral interventions to prevent or treat obesity in pediatric samples were eligible. Parents must have "actively participated" in the study. DATA EXTRACTION: Two authors independently extracted data using a predefined template. RESULTS: The search retrieved 213 eligible RCTs. Of the RCTs that limited participation to 1 parent only (n = 80), fathers represented only 6% of parents. In RCTs in which participation was open to both parents (n = 133), 92% did not report objective data on father involvement. No study characteristics moderated the level of father involvement, with fathers underrepresented across all study types. Only 4 studies (2%) suggested that a lack of fathers was a possible limitation. Two studies (1%) reported explicit attempts to increase father involvement. LIMITATIONS: The review was limited to RCTs published in English peer-reviewed journals over a 10-year period. CONCLUSIONS: Existing pediatric obesity treatment or prevention programs with parent involvement have not engaged fathers. Innovative strategies are needed to make participation more accessible and engaging for fathers.

编号：9

题名：Azithromycin Prophylaxis for Laboring Mothers.

作者：Gerber JS;Zaoutis TE


机构：Division of Infectious Diseases and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Department of Pediatrics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania [email protected].;Division of Infectious Diseases and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Department of Pediatrics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.


摘要：

编号：10

题名：Prenatal Smoke Exposure and ADHD: Advancing the Field.

作者：Schechter JC;Kollins SH

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机构：Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina.;Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina [email protected].


摘要：

编号：11

题名：Smoking in Pregnancy and Child ADHD.

作者：Gustavson K;Ystrom E;Stoltenberg C;Susser E;Suren P;Magnus P;Knudsen GP;Smith GD;Langley K;Rutter M;Aase H;Reichborn-Kjennerud T


机构：Norwegian Institute of Public Health, Oslo, Norway; [email protected].;Department of Psychology, and.;Norwegian Institute of Public Health, Oslo, Norway.;Department of Psychology, and.;Norwegian Institute of Public Health, Oslo, Norway.;Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.;Mailman School of Public Health, Columbia University, New York, New York.;New York State Psychiatric Institute, New York, New York.;Norwegian Institute of Public Health, Oslo, Norway.;Norwegian Institute of Public Health, Oslo, Norway.;Norwegian Institute of Public Health, Oslo, Norway.;The MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom.;School of Psychology, and.;MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, United Kingdom; and.;Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.;Norwegian Institute of Public Health, Oslo, Norway.;Norwegian Institute of Public Health, Oslo, Norway.;Institute of Clinical Medicine, University of Oslo, Oslo, Norway.


摘要： BACKGROUND AND OBJECTIVE: There is a well-documented association between maternal smoking during pregnancy and offspring attention-deficit/hyperactivity disorder (ADHD). The degree to which this reflects causal intrauterine effects or is due to unmeasured confounding is not clear. We sought to compare the association between maternal smoking during pregnancy and offspring ADHD with the associations with paternal smoking, grandmother's smoking when pregnant with mother, and maternal smoking in previous pregnancies. Each of these exposures is expected to be influenced by much of the same confounding factors as maternal smoking during pregnancy, but cannot have direct intrauterine effects. A sibling control design was also used. METHODS: The current study used data from the Norwegian Mother and Child Cohort Study (n > 100 000 children). Mothers and fathers reported on smoking during pregnancy, and mothers reported on smoking in previous pregnancies and their mother's smoking when pregnant with them. Mothers reported on child ADHD symptoms at 5 years of age. Information about child ADHD diagnosis was obtained from the Norwegian Patient Registry. RESULTS: Maternal smoking during pregnancy was not more strongly associated with offspring ADHD diagnosis than was paternal smoking, grandmother's smoking when pregnant with mother, or maternal smoking in previous pregnancies. Sibling control analyses showed no association between maternal smoking in pregnancy and child ADHD symptoms among siblings discordant for maternal smoking. CONCLUSIONS: These results suggest that the association between maternal smoking during pregnancy and offspring ADHD is not due to causal intrauterine effects, but reflects unmeasured confounding.

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编号：12

题名：Validation of a Score to Determine Time to Postconcussive Recovery.

作者：Hearps SJ;Takagi M;Babl FE;Bressan S;Truss K;Davis GA;Godfrey C;Clarke C;Doyle M;Rausa V;Dunne K;Anderson V


机构：Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.;Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.;Melbourne School of Psychological Sciences and.;Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; [email protected].;Department of Paediatrics, University of Melbourne, Victoria, Australia.;Emergency Department.;Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.;Department of Women's and Children's Health, University of Padova, Padova, Italy.;Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.;Melbourne School of Psychological Sciences and.;Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.;Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.;Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.;Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.;Melbourne School of Psychological Sciences and.;Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.;Melbourne School of Psychological Sciences and.;Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.;Department of Paediatrics, University of Melbourne, Victoria, Australia.;Department of Rehabilitation Medicine, and.;Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.;Melbourne School of Psychological Sciences and.;Department of Paediatrics, University of Melbourne, Victoria, Australia.;Psychology Service, Royal Children's Hospital, Melbourne, Victoria, Australia; and.


摘要： BACKGROUND: A reliable, developmentally appropriate and standardized method for assessing postconcussive symptoms (PCS) is essential to accurately determine recovery postconcussion and to effectively manage return to normal activities. The aim of this study was to develop an evidence-based, psychometrically validated approach to determining clinically useful cutoff scores by using a commonly administered PCS measure. METHODS: The current study was a prospective, longitudinal observational study conducted between July 2013 and November of 2015 at a statewide tertiary pediatric hospital. Participants were 120 children (5-18 years of age) presenting to the emergency department with a concussion within 48 hours of injury. PCS were assessed by using the Postconcussion Symptom Inventory (PCSI), acutely, 1 to 4 days postinjury and 2 weeks postinjury. Using comprehensive clinical assessment as gold standard, we assessed the clinical cutoff discrimination ability of PCSI at 2 weeks postinjury by using published approaches, and then varying each approach to optimize their discrimination ability. RESULTS: Existing and potential clinical cutoff scores were explored in predicting delayed recovery. Receiver operating characteristic curve results returned acceptable discrimination and sensitivity when PCSI items increased in severity from preinjury by 1 or more. Compared with a published cutoff score being 3+ items with increased severity, the current study suggests a more stringent cutoff requirement of 2+ is better able to accurately classify symptomatic children. CONCLUSIONS: This study provides the first validated index (2+ items, 1+ severity) of concussion recovery for children and youth. Further studies in more varied samples are needed to establish the effectiveness of this method.

编号：13

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题名：The Mediterranean Diet and ADHD in Children and Adolescents.

作者：Rios-Hernandez A;Alda JA;Farran-Codina A;Ferreira-Garcia E;Izquierdo-Pulido M


机构：Departments of Nutrition, Food Science, and Gastronomy, and.;ADHD Unit, Child and Adolescent Psychiatry Department, Hospital Sant Joan de Deu, Barcelona, Spain; and.;Departments of Nutrition, Food Science, and Gastronomy, and.;ADHD Unit, Child and Adolescent Psychiatry Department, Hospital Sant Joan de Deu, Barcelona, Spain; and.;Personality, Evaluation, and Psychological Treatment, University of Barcelona, Barcelona, Spain.;Departments of Nutrition, Food Science, and Gastronomy, and [email protected].;CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.


摘要： OBJECTIVES: Although attention-deficit/hyperactivity disorder (ADHD) has been related to nutrient deficiencies and "unhealthy" diets, to date there are no studies that examined the relationship between the Mediterranean diet and ADHD. We hypothesized that a low adherence to a Mediterranean diet would be positively associated with an increase in ADHD diagnosis. METHODS: A total of 120 children and adolescents (60 with newly diagnosed ADHD and 60 controls) were studied in a sex- and age-matched case-control study. ADHD diagnosis was made according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Energy, dietary intake, adherence to a Mediterranean diet, and familial background were measured. Logistic regression was used to determine associations between the adherence to a Mediterranean diet and ADHD. RESULTS: Lower adherence to a Mediterranean diet was associated with ADHD diagnosis (odds ratio: 7.07; 95% confidence interval: 2.65-18.84; relative risk: 2.80; 95% confidence interval: 1.54-5.25). Both remained significant after adjusting for potential confounders. Lower frequency of consuming fruit, vegetables, pasta, and rice and higher frequency of skipping breakfast and eating at fast-food restaurants were associated with ADHD diagnosis (P < .05). High consumption of sugar, candy, cola beverages, and noncola soft drinks (P < .01) and low consumption of fatty fish (P < .05) were also associated with a higher prevalence of ADHD diagnosis. CONCLUSIONS: Although these cross-sectional associations do not establish causality, they raise the question of whether low adherence to a Mediterranean diet might play a role in ADHD development. Our data support the notion that not only "specific nutrients" but also the "whole diet" should be considered in ADHD.

编号：14

题名：Cerumen Impaction.



编号：15

题名：Improving Nasal Form and Function After Rhinoplasty.

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编号：16

题名：Diagnosis, Treatment, and Prevention of Congenital Toxoplasmosis in the United States.

作者：Maldonado YA;Read JS



编号：17

题名：Author's Response.

作者：Lanphear BP


机构：Simon Fraser University [email protected].

文献类型：Letter

摘要：

编号：18

题名：Pediatric Accountable Care Organizations: Insight From Early Adopters.

作者：Perrin JM;Zimmerman E;Hertz A;Johnson T;Merrill T;Smith D


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机构：Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts; [email protected].;Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.;American Academy of Pediatrics, Elk Grove Village, Illinois.;University Hospitals Rainbow Care Coalition, Cleveland, Ohio.;Department of Pediatrics, Case Western Reserve University Medical School, Cleveland, Ohio.;Valence Health, Chicago, Illinois; and.;Leavitt Partners, LLC, Salt Lake City, Utah.;Leavitt Partners, LLC, Salt Lake City, Utah.


摘要： Partly in response to incentives in the Affordable Care Act, there has been major growth in accountable care organizations (ACO) in both the private and public sectors. For several reasons, growth of ACOs in pediatric care has been more modest than for older populations. The American Academy of Pediatrics collaborated with Leavitt Partners, LLC, to carry out a study of pediatric ACOs, including a series of 5 case studies of diverse pediatric models, a scan of Medicaid ACOs, and a summit of leaders in pediatric ACO development. These collaborative activities identified several issues in ACO formation and sustainability in pediatric settings and outlined a number of opportunities for the pediatric community in areas of organization, model change, and market dynamics; payment, financing, and contracting; quality and value; and use of new technologies. These insights can guide future work in pediatric ACO development.

编号：19

题名：Prognostic Accuracy of Electroencephalograms in Preterm Infants: A Systematic Review.

作者：Fogtmann EP;Plomgaard AM;Greisen G;Gluud C


机构：Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark [email protected].;Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.;Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.;The Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen, Denmark.


摘要： CONTEXT: Brain injury is common in preterm infants, and predictors of neurodevelopmental outcome are relevant. OBJECTIVE: To assess the prognostic test accuracy of the background activity of the EEG recorded as amplitude-integrated EEG (aEEG) or conventional EEG early in life in preterm infants for predicting neurodevelopmental outcome. DATA SOURCES: The Cochrane Library, PubMed, Embase, and the Cumulative Index to Nursing and Allied Health Literature. STUDY SELECTION: We included observational studies that had obtained an aEEG or EEG within 7 days of life in preterm infants and reported neurodevelopmental outcomes 1 to 10 years later. DATA EXTRACTION: Two reviewers independently performed data extraction with regard to participants, prognostic testing, and outcomes. RESULTS: Thirteen observational studies with a total of 1181 infants were included. A meta-analysis was performed based on 3 studies (267 infants). Any aEEG background abnormality was a predictor of abnormal outcome. For prediction of a developmental quotient <70 points, cerebral palsy, or death, the pooled sensitivity was 0.83 (95% confidence interval, 0.69-0.92) and specificity 0.83 (95% confidence interval, 0.77-0.87). LIMITATIONS: All studies were at high risk of bias. Heterogeneity was evident among the studies with regard to the investigated aEEG and EEG variables, neurodevelopmental outcomes, and cutoff values. CONCLUSIONS: aEEG or EEG recorded within the first 7 days of life in preterm infants may have potential as a predictor for later

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neurodevelopmental outcome. We need high-quality studies to confirm these findings. Meanwhile, the prognostic value of aEEG and EEG should be used only as a scientific tool.

编号：20

题名：Authors' Response.

作者：Shaw KN;Blackstone MM;Lavelle JM


机构：Pediatric Emergency Medicine Attending, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania [email protected].;Pediatric Emergency Medicine Attending, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.;Pediatric Emergency Medicine Attending, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.


摘要：

编号：21

题名：My Recent Epiphany Regarding Major Cause of Lead Exposure.

作者：Marcus SM


机构：New Jersey Medical School, Rutgers University [email protected].


摘要：

编号：22

题名：Re: Two-Step Process for ED UTI Screening.

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作者：Chiang EL;Shaikh N


机构：Pediatric Resident, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania [email protected].;Associate Professor of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania.


摘要：

编号：23

题名：Growth in Prepubertal Children With Cystic Fibrosis Treated With Ivacaftor.

作者：Stalvey MS;Pace J;Niknian M;Higgins MN;Tarn V;Davis J;Heltshe SL;Rowe SM


机构：Department of Pediatrics, [email protected].;Pediatric Pulmonary Center, and.;Vertex Pharmaceuticals Incorporated, Boston, Massachusetts.;Vertex Pharmaceuticals (Europe) Ltd, London, United Kingdom.;Department of Pediatrics.;Pediatric Pulmonary Center, and.;Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.;Department of Pediatrics, University of Washington, Seattle, Washington; and.;CF Foundation Therapeutics Development Network, Seattle Children's Research Institute, Seattle, Washington.;Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.


摘要： BACKGROUND AND OBJECTIVES: Cystic fibrosis (CF) is known for its impact on the lung and pancreas of individuals; however, impaired growth is also a common complication. We hypothesized that targeting the biological defect in the CF transmembrane conductance regulator (CFTR) protein may affect growth outcomes. METHODS: In this post hoc analysis, we assessed linear growth and weight in 83 children (aged 6-11 years) enrolled in 2 clinical trials, the longitudinal-observation GOAL study and the placebo-controlled ENVISION study, to evaluate the effects of ivacaftor, a CFTR potentiator. We calculated height and weight z scores and height and weight growth velocities (GVs). RESULTS: In ivacaftor-treated children in GOAL, height and weight z scores increased significantly from baseline to 6 months (increases of 0.1 [P < .05] and 0.26 [P < .0001], respectively); height GV increased significantly from 3 to 6 months (2.10-cm/year increase; P < .01). In ivacaftor-treated children in ENVISION, height and weight z scores increased significantly from baseline to 48 weeks (increases of 0.17 [P < .001] and 0.35 [P < .001], respectively). Height and weight GVs from baseline to 48 weeks were also significantly higher with ivacaftor than with placebo (differences of 1.08 cm/year [P < .05] and 3.11 kg/year [P < .001], respectively). CONCLUSIONS: Ivacaftor treatment in prepubescent children may help to address short stature and altered GV in children with CF; results from these analyses support the existence of an intrinsic defect in the growth of children with CF that may be ameliorated by CFTR modulation.

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编号：24

题名：Percutaneous Patent Ductus Arteriosus (PDA) Closure During Infancy: A Meta-analysis.

作者：Backes CH;Rivera BK;Bridge JA;Armstrong AK;Boe BA;Berman DP;Fick T;Holzer RJ;Hijazi ZM;Abadir S;Justino H;Bergersen L;Smith CV;Kirpalani H


机构：Centers for Perinatal Research, [email protected].;Cardiovascular and Pulmonary Research, and.;The Heart Center, The Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, Columbus, Ohio.;Department of Pediatrics, The Ohio State University, Columbus, Ohio.;Centers for Perinatal Research.;Department of Pediatrics, The Ohio State University, Columbus, Ohio.;Innovation in Pediatric Practice, and.;Cardiovascular and Pulmonary Research, and.;The Heart Center, The Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, Columbus, Ohio.;Department of Pediatrics, The Ohio State University, Columbus, Ohio.;Cardiovascular and Pulmonary Research, and.;The Heart Center, The Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, Columbus, Ohio.;Department of Pediatrics, The Ohio State University, Columbus, Ohio.;Cardiovascular and Pulmonary Research, and.;The Heart Center, The Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, Columbus, Ohio.;Department of Pediatrics, The Ohio State University, Columbus, Ohio.;Department of Pediatrics, The Ohio State University, Columbus, Ohio.;Department of Pediatrics, Weill Cornell Medical College, New York, New York.;Cardiac Catheterization and Interventional Therapy, Sidra Cardiac Program, Sidra Medical and Research Center, Doha, Qatar.;Department of Pediatrics, Weill Cornell Medical College, New York, New York.;Cardiac Catheterization and Interventional Therapy, Sidra Cardiac Program, Sidra Medical and Research Center, Doha, Qatar.;Department of Pediatric Cardiology, CHU mere-enfant Sainte-Justine, Universite de Montreal, Quebec, Canada.;Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.;Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.;Center for Developmental Therapeutics, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, Washington; and.;Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.


摘要： CONTEXT: Patent ductus arteriosus (PDA) is a precursor to morbidity and mortality. Percutaneous (catheter-based) closure is the procedure of choice for adults and older children with a PDA, but use during infancy (<1 year) is not well characterized. OBJECTIVE: Investigate the technical success and safety of percutaneous PDA closure during infancy. DATA SOURCES: Scopus, Web of Science, Embase, PubMed, and Ovid (Medline) were searched through December 2015 with no language restrictions. STUDY SELECTION: Publications needed to clearly define the intervention as percutaneous PDA closure during infancy (<1 year of age at intervention) and must have reported adverse events (AEs). DATA EXTRACTION: The study was performed according to the Systematic Reviews and Meta-Analysis checklist and registered prospectively. The quality of the selected studies was critically examined. Data extraction and assignment of AE attributability and severity were independently performed by multiple observers. Outcomes were agreed on a priori. Data were pooled by using a random-effects model. RESULTS: Thirty-eight studies were included; no randomized controlled trials were found. Technical success of percutaneous PDA closure was 92.2% (95% confidence interval [CI] 88.8-95.0). Overall AE and clinically significant AE incidence was 23.3% (95% CI 16.5-30.8) and 10.1% (95% CI 7.8-12.5), respectively. Significant heterogeneity and publication bias were observed. LIMITATIONS: Limitations include lack of comparative studies, lack of standardized AE reporting strategy, and significant heterogeneity in reporting. CONCLUSIONS: Percutaneous PDA closure during infancy is feasible and associated with few catastrophic AEs; however, the limitations constrain the interpretability and generalizability of the current findings.

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编号：25

题名：The Effect of Price Information on the Ordering of Images and Procedures.

作者：Chien AT;Ganeshan S;Schuster MA;Lehmann LS;Hatfield LA;Koplan KE;Petty CR;Sinaiko AD;Sequist TD;Rosenthal MB


机构：Harvard Medical School, Boston, Massachusetts; [email protected].;Division of General Pediatrics, Department of Medicine, and.;Harvard Medical School, Boston, Massachusetts.;Harvard Medical School, Boston, Massachusetts.;Division of General Pediatrics, Department of Medicine, and.;Harvard Medical School, Boston, Massachusetts.;Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.;Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.;National Center for Ethics in Health Care, Veterans Health Administration, Washington, District of Columbia.;Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.;Kaiser Permanente of Georgia, Atlanta, Georgia; and.;Clinical Research Center, Boston Children's Hospital, Boston, Massachusetts.;Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.;Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.;Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.;Partners Healthcare System, Boston, Massachusetts.;Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.


摘要： BACKGROUND AND OBJECTIVES: Ordering rates for imaging studies and procedures may change if clinicians are shown the prices of those tests while they are ordering. We studied the effect of 2 forms of paid price information, single median price and paired internal/external median prices, on how often pediatric-focused and adult-oriented clinicians (most frequently general pediatricians and adult specialists caring for pediatric-aged patients, respectively) order imaging studies and procedures for 0- to 21-year-olds. METHODS: In January 2014, we randomized 227 pediatric-focused and 279 adult-oriented clinicians to 1 of 3 study arms: Control (no price display), Single Median Price, or Paired Internal/External Median Prices (both with price display in the ordering screen of electronic health record). We used 1-way analysis of variance and paired t tests to examine how frequently clinicians (1) placed orders and (2) designated tests to be completed internally within an accountable care organization. RESULTS: For pediatric-focused clinicians, there was no significant difference in the rates at which orders were placed or designated to be completed internally across the study arms. For adult-oriented clinicians caring for children and adolescents, however, those in the Single Price and Paired Price arms placed orders at significantly higher rates than those in the Control group (Control 3.2 [SD 4.8], Single Price 6.2 [SD 6.8], P < .001 and Paired Prices 5.2 [SD 7.9], P = .04). The rate at which adult-oriented clinicians designated tests to be completed internally was not significantly different across arms. CONCLUSIONS: The effect of price information on ordering rates appears to depend on whether the clinician is pediatric-focused or adult-oriented.

编号：26

题名：Socioeconomic Status, Smoke Exposure, and Health Outcomes in Young Children With Cystic Fibrosis.

作者：Ong T;Schechter M;Yang J;Peng L;Emerson J;Gibson RL;Morgan W;Rosenfeld M


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机构：Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, Washington; [email protected].;Division of Pulmonary Medicine, Department of Pediatrics, Virginia Commonwealth University, Children's Hospital of Richmond at VCU, Richmond, Virginia.;Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia; and.;Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia; and.;Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, Washington.;Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, Washington.;Departments of Pediatrics and Physiology, Pediatric Pulmonary Center, University of Arizona, Tucson, Arizona.;Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, Washington.


摘要： BACKGROUND: Lower socioeconomic status (SES) and environmental tobacco smoke (ETS) exposure are both associated with poorer disease outcomes in cystic fibrosis (CF), and children with low SES are disproportionately exposed to ETS. We analyzed a large cohort of young children with CF to distinguish the impact of SES and ETS on clinical outcomes. METHODS: The Early Pseudomonas Infection Control Observational study enrolled Pseudomonas-negative young children with CF <13 years of age. An enrollment survey assessed SES and ETS exposures. Forced expiratory volume in 1 second (FEV1), crackles and wheezes, and weight-for-age percentile were assessed at each clinical encounter over at least 4 years. Repeated measures analyses estimated the association of SES and ETS exposures with longitudinal clinical outcomes, adjusting for confounders. RESULTS: Of 1797 participants, 1375 were eligible for analysis. Maternal education was high school or less in 28.1%, 26.8% had household income <$40 000, and 43.8% had Medicaid or no insurance. Maternal smoking after birth was present in 24.8%, more prevalent in household with low SES. In separate models, lower SES and ETS exposure were significantly associated with lower FEV1% predicted, presence of crackles or wheezes, and lower weight percentile. In combined models, effect estimates for SES changed minimally after adjustment for ETS exposures, whereas estimates for ETS exposures were attenuated after adjusting for SES. CONCLUSIONS: ETS exposure was disproportionately high in low SES families in this cohort of children with CF. Lower SES and ETS exposure had independent adverse effects on pulmonary and nutritional outcomes. Estimated effect of SES on FEV1 decreased minimally after ETS adjustment, suggesting health disparity risks independent of ETS exposure.

编号：27

题名：Neonatal Abstinence Syndrome and High School Performance.

作者：Oei JL;Melhuish E;Uebel H;Azzam N;Breen C;Burns L;Hilder L;Bajuk B;Abdel-Latif ME;Ward M;Feller JM;Falconer J;Clews S;Eastwood J;Li A;Wright IM


机构：School of Women's and Children's Health, [email protected].;Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia.;Ingham Research Centre, Liverpool, New South Wales, Australia.;Early Start Research Institute and.;Department of Education, University of Oxford, Oxford, United Kingdom.;Department of Psychological Sciences, Birkbeck, University of London, London, United Kingdom.;School of Women's and Children's Health.;School of Women's and Children's Health.;National Drug and Alcohol Research Centre, and.;National Drug and Alcohol Research Centre, and.;National Perinatal Epidemiology and Statistics Unit, University of New South Wales, Sydney, New South Wales, Australia.;NSW Pregnancy and Newborn Services and.;Department of Neonatology, The Canberra Hospital, Garran, Australian Capital Territory, Australia.;Faculty of Medicine, the Australian National University, Deakin, Australian Capital Territory, Australia.;School of Women's and Children's Health.;Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia.;School of Women's and Children's Health.;Sydney Children's Hospital, Sydney Children's Hospital Network,

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Randwick, New South Wales, Australia.;The Langton Centre, Surry Hills, New South Wales, Australia.;The Langton Centre, Surry Hills, New South Wales, Australia.;School of Women's and Children's Health.;Ingham Research Centre, Liverpool, New South Wales, Australia.;Community Health Services, Sydney Local Health District, Sydney, New South Wales, Australia.;School of Public Health, Menzies Centre for Health Policy, and Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia; and.;School of Medicine, Griffith University, Gold Coast, Queensland, Australia.;School of Women's and Children's Health.;Early Start Research Institute and.;Illawarra Health and Medical Research Institute and School of Medicine, The University of Wollongong, Wollongong, New South Wales, Australia.;Department of Paediatrics, The Wollongong Hospital, Wollongong, New South Wales, Australia.


摘要： BACKGROUND AND OBJECTIVES: Little is known of the long-term, including school, outcomes of children diagnosed with Neonatal abstinence syndrome (NAS) (International Statistical Classification of Disease and Related Problems [10th Edition], Australian Modification, P96.1). METHODS: Linked analysis of health and curriculum-based test data for all children born in the state of New South Wales (NSW), Australia, between 2000 and 2006. Children with NAS (n = 2234) were compared with a control group matched for gestation, socioeconomic status, and gender (n = 4330, control) and with other NSW children (n = 598 265, population) for results on the National Assessment Program: Literacy and Numeracy, in grades 3, 5, and 7. RESULTS: Mean test scores (range 0-1000) for children with NAS were significantly lower in grade 3 (359 vs control: 410 vs population: 421). The deficit was progressive. By grade 7, children with NAS scored lower than other children in grade 5. The risk of not meeting minimum standards was independently associated with NAS (adjusted odds ratio [aOR], 2.5; 95% confidence interval [CI], 2.2-2.7), indigenous status (aOR, 2.2; 95% CI, 2.2-2.3), male gender (aOR, 1.3; 95% CI, 1.3-1.4), and low parental education (aOR, 1.5; 95% CI, 1.1-1.6), with all Ps < .001. CONCLUSIONS: A neonatal diagnostic code of NAS is strongly associated with poor and deteriorating school performance. Parental education may decrease the risk of failure. Children with NAS and their families must be identified early and provided with support to minimize the consequences of poor educational outcomes.

编号：28

题名：Outcomes From a Hearing-Targeted Cytomegalovirus Screening Program.

作者：Diener ML;Zick CD;McVicar SB;Boettger J;Park AH


机构：Departments of Family and Consumer Studies and [email protected].;Departments of Family and Consumer Studies and.;Utah Department of Health, Salt Lake City, Utah.;Utah Department of Health, Salt Lake City, Utah.;Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah; and.


摘要： BACKGROUND AND OBJECTIVES: Cytomegalovirus (CMV) is the most common congenital infection and nongenetic cause of congenital sensorineural hearing loss in the United States. Utah was the first state to pass legislation mandating CMV screening for newborns who fail newborn hearing screening (NBHS). The study objective was to present outcomes of hearing-targeted CMV screening and determine factors predicting CMV screening. METHODS: We used Utah Department of Health HiTrack and Vital Records databases to examine CMV screening from 509 infants who failed NBHS in the 24 months after implementation of the Utah legislation. Multivariate logistic regression analyses were conducted to identify predictors of compliance with CMV screening and diagnostic hearing evaluation. RESULTS: Sixty-two percent of infants who never passed hearing screening underwent CMV screening. Fourteen of

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234 infants tested within 21 days were CMV positive; 6 (42.9%) had hearing loss. Seventy-seven percent of eligible infants completed a diagnostic hearing evaluation within 90 days of birth. Compliance with CMV screening was associated with sociodemographic factors, time since the law was enacted, and NBHS protocol. Infants born after the legislation showed greater odds of achieving timely diagnostic hearing evaluation than infants born before the law. CONCLUSIONS: Incorporating CMV screening into an established NBHS program is a viable option for the identification of CMV in infants failing NBHS. The addition of CMV testing can help a NBHS program attain timely audiological diagnostics within 90 days, an important early hearing detection and intervention milestone.

编号：29

题名：Screening for Congenital Cytomegalovirus After Newborn Hearing Screening: What Comes Next?

作者：Grosse SD;Dollard SC;Kimberlin DW


机构：National Center on Birth Defects and Developmental Disabilities and [email protected].;National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and.;Division of Pediatric Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama.


摘要：

编号：30

题名：A Push for Progress With Shared Decision-making in Pediatrics.

作者：Opel DJ


机构：Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute and Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington [email protected].


摘要：

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编号：31

题名：Psychiatric Disorders and General Functioning in Low Birth Weight Adults: A Longitudinal Study.

作者：Laerum AM;Reitan SK;Evensen KA;Lydersen S;Brubakk AM;Skranes J;Indredavik MS


机构：Departments of Laboratory Medicine, Children's and Women's Health, [email protected].;Neuroscience.;Ostmarka Department of Psychiatry, and.;Departments of Laboratory Medicine, Children's and Women's Health.;Public Health and General Practice, and.;Department of Physiotherapy, Trondheim Municipality, Trondheim, Norway.;Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.;Departments of Laboratory Medicine, Children's and Women's Health.;Departments of Laboratory Medicine, Children's and Women's Health.;Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.;Department of Child and Adolescent Psychiatry, St. Olavs Hospital Trondheim University Hospital, Trondheim, Norway; and.


摘要： OBJECTIVE: To examine psychiatric morbidity and overall functioning in adults born with low birth weight compared with normal birth weight controls at age 26 years and to study longitudinal trajectories of psychiatric morbidity from early adolescence to adulthood. METHODS: Prospective cohort study wherein 44 preterm very low birth weight (</=1500 g), 64 term small for gestational age (SGA; <10th percentile), and 81 control adults were examined using the MINI-International Neuropsychiatric Interview: M.I.N.I. Plus, Norwegian version, the Global Assessment of Functioning, and questions on daily occupation and level of education. Prevalence of psychiatric disorders from previous follow-ups at age 14 and 19 years were included for longitudinal analysis. RESULTS: From adolescence to adulthood, the term SGA group had a marked increase in the estimated probability of psychiatric disorders from 9% (95% confidence interval, 4-19) to 39% (95% confidence interval, 28-51). At 26 years, psychiatric diagnoses were significantly more prevalent in the preterm very low birth weight group (n = 16, 36%; P = .003) and the term SGA group (n = 24, 38%; P = .019) compared with the control group (n = 11, 14%). Both low birth weight groups had lower educational level and functioning scores than controls and a higher frequency of unemployment and disability benefit. CONCLUSIONS: Low birth weight was a substantial risk factor for adult psychiatric morbidity and lowered overall functioning. The results underscore the need for long-term follow-up of low birth weight survivors through adolescence and adulthood, focusing on mental health. The longitudinal increase in psychiatric morbidity in the term SGA group calls for additional investigation.

编号：32

题名：Children's Hospital Characteristics and Readmission Metrics.

作者：Auger KA;Teufel RJ ,nd;Harris JM ,nd;Gay JC;Del Beccaro MA;Neuman MI;Tejedor-Sojo J;Agrawal RK;Morse RB;Eghtesady P;Simon HK;McClead RE Jr;Fieldston ES;Shah SS


机构：Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; [email protected].;Department of Pediatrics, Medical University of South Carolina,

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Charleston, South Carolina.;Children's Hospital Association, Washington, District of Columbia.;Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.;Seattle Children's Hospital and Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.;Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.;Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia.;Department of Pediatrics, Ann and Robert Lurie Children's Hospital of Chicago, Chicago, Illinois.;Children's Health System of Texas and University of Texas Southwestern Medical Center, Dallas, Texas.;Pediatric Cardiothoracic Surgery, Washington University in St Louis, St Louis, Missouri.;Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia.;Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia.;Office of the Chief Medical Officer, Nationwide Children's Hospital, Columbus, Ohio; and.;Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.;Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.


摘要： BACKGROUND AND OBJECTIVE: Like their adult counterparts, pediatric hospitals are increasingly at risk for financial penalties based on readmissions. Limited information is available on how the composition of a hospital's patient population affects performance on this metric and hence affects reimbursement for hospitals providing pediatric care. We sought to determine whether applying different readmission metrics differentially affects hospital performance based on the characteristics of patients a hospital serves. METHODS: We performed a cross-sectional analysis of 64 children's hospitals from the Children's Hospital Association Case Mix Comparative Database 2012 and 2013. We calculated 30-day observed-to-expected readmission ratios by using both all-cause (AC) and Potentially Preventable Readmissions (PPR) metrics. We examined the association between observed-to-expected rates and hospital characteristics by using multivariable linear regression. RESULTS: We examined a total of 1 416 716 hospitalizations. The mean AC 30-day readmission rate was 11.3% (range 4.3%-19.6%); the mean PPR rate was 4.9% (range 2.9%-6.9%). The average 30-day AC observed-to-expected ratio was 0.96 (range 0.63-1.23), compared with 0.95 (range 0.65-1.23) for PPR; 59% of hospitals performed better than expected on both measures. Hospitals with higher volumes, lower percentages of infants, and higher percentage of patients with low income performed worse than expected on PPR. CONCLUSIONS: High-volume hospitals, those that serve fewer infants, and those with a high percentage of patients from low-income neighborhoods have higher than expected PPR rates and are at higher risk of reimbursement penalties.

编号：33

题名：An Improvement Approach to Integrate Teaching Teams in the Reporting of Safety Events.

作者：Dunbar AE -rd;Cupit M;Vath RJ;Pontiff K;Evans N;Roy M;Bolton M


机构：Division of Pediatrics, Our Lady of the Lake Children's Hospital, Baton Rouge, Louisiana; [email protected].;Division of Health and Safety, and.;Division of Academic Affairs, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana.;Division of Pediatrics, Our Lady of the Lake Children's Hospital, Baton Rouge, Louisiana.;Division of Pediatrics, Our Lady of the Lake Children's Hospital, Baton Rouge, Louisiana.;Division of Pediatrics, Our Lady of the Lake Children's Hospital, Baton Rouge, Louisiana.;Division of Pediatrics, Our Lady of the Lake Children's Hospital, Baton Rouge, Louisiana.


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摘要： BACKGROUND AND OBJECTIVE: Patient safety events are underreported by physicians. Baseline data demonstrated that physicians submitted 3% of event reports at Our Lady of the Lake Children's Hospital. Our aim was to increase the proportion of safety reports filed by residents and faculty to 6% of all reports within a 9-month period. METHODS: We used the Model for Improvement and serial Plan, Do, Study, Act cycles to test interventions we hypothesized would improve physician recognition and reporting of patient safety events. We tracked the percentage of Our Lady of the Lake Children's Hospital event reports entered by residents or faculty over time as the primary outcome measure. Changes to teaching team processes included "patient safety rounds" prompted by text messages, an inpatient "superintendent" rotation with core patient safety responsibilities, and a "just-in-time" faculty development program called "QI on the Fly." RESULTS: Physician-reported events increased to a monthly average of 24% of all events reported, an improvement that has been sustained over 17 months. Resident reporting accounted for most of the increase in physician reports. Increased physician reporting was temporally associated with implementation of the "superintendent" rotation. The total number of events reported increased as a result of increased physician reporting. CONCLUSIONS: Incorporating patient safety responsibilities into a teaching team's workflow can increase physician safety event reporting. We plan additional Plan, Do, Study, Act cycles to spread this approach to other clinical settings and investigate the impact increased reporting might have on patient care.

编号：34

题名：Laterality of Oral Clefts and Academic Achievement.

作者：Gallagher ER;Collett BR;Barron S;Romitti P;Ansley T;Wehby GL


机构：Departments of Pediatrics and.;Psychiatry and Behavioral Sciences, Child Psychiatry at Seattle Children's Hospital, University of Washington, Seattle, Washington.;Iowa Testing Programs, and.;Departments of Epidemiology.;Iowa Testing Programs, and.;Psychological and Quantitative Foundations, and.;Health Management and Policy, Economics, and Preventive and Community Dentistry, and Public Policy Center, University of Iowa, Iowa City, Iowa; and [email protected].;National Bureau of Economic Research, Cambridge, Massachusetts.


摘要： BACKGROUND AND OBJECTIVES: Children with isolated oral clefts have lower academic performance when compared with unaffected peers, yet few studies have examined specific attributes of clefts that may modify this risk. Oral clefts have nonrandom laterality, with left-sided clefts being more common than right-sided clefts, a pattern that may be genetically or environmentally influenced. The objective of this study was to evaluate the association between cleft laterality and academic achievement in a population-based sample of children with and without isolated oral clefts. METHODS: The study included 292 children with isolated unilateral cleft lip with or without cleft palate identified by using the Iowa Registry for Congenital and Inherited Disorders matched with 908 unaffected classmates. This group provided 1953 child-grade observations for cases and 6829 for classmates. Academic achievement was evaluated by using high-quality standardized test data on multiple academic domains as well as use of special education. RESULTS: We found that children with right-sided clefts had similar achievement scores and usage of special education services compared with their unaffected classmates. Children with left-sided clefts had lower reading scores than children with right-sided clefts by nearly 7 percentiles (P < .05). They also had lower scores on all evaluated domains by 4 to 6 percentiles and greater use of special education services by 6 percentage points than their classmates. CONCLUSIONS: Children with left-sided clefts had poorer academic performance than their classmates or children with right-sided clefts, who showed similar academic achievement compared with their unaffected classmates.

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编号：35

题名：Improving Exclusive Breastfeeding in an Urban Academic Hospital.

作者：Ward LP;Williamson S;Burke S;Crawford-Hemphill R;Thompson AM


机构：Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; [email protected].;Women's Health Services and.;Women's Health Services and.;UCMC Patient Care Services, University of Cincinnati Medical Center, Cincinnati, Ohio; and.;Department of Obstetrics & Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio.


摘要： BACKGROUND AND OBJECTIVE: Breastfeeding has many well-established health benefits for infants and mothers. There is greater risk reduction in health outcomes with exclusive breastfeeding (EBF). Our urban academic facility has had long-standing low EBF rates, serving a population with breastfeeding disparities. We sought to improve EBF rates through a Learning Collaborative model by participating in the Best Fed Beginnings project. METHODS: Formal improvement science methods were used, including the development of a key driver diagram and plan-do-study-act cycles. Improvement activities followed the Ten Steps to Successful Breastfeeding. RESULTS: We demonstrated significant improvement in the median adherence to 2 process measures, rooming in and skin-to-skin after delivery. Subsequently, the proportion of infants exclusively breastfed at hospital discharge in our facility increased from 37% to 59%. We demonstrated an increase in sustained breastfeeding in a subset of patients at a postpartum follow-up visit. These improvements led to Baby-Friendly designation at our facility. CONCLUSIONS: This quality improvement initiative resulted in a higher number of infants exclusively breastfed in our patient population at "high risk not to breastfeed." Other hospitals can use these described methods and techniques to improve their EBF rates.

编号：36

题名：Diphenhydramine for Acute Extrapyramidal Symptoms After Propofol Administration.

作者：Sherer J;Salazar T;Schesing KB;McPartland S;Kornitzer J


机构：Department of Neurology, Rutgers New Jersey Medical School, Newark, New Jersey.;Department of Neurology, Rutgers New Jersey Medical School, Newark, New Jersey.;Department of Neurology, Rutgers New Jersey Medical School, Newark, New Jersey.;Department of Neurology, Rutgers New Jersey Medical School, Newark, New Jersey.;Department of Neurology, Rutgers New Jersey Medical School, Newark, New Jersey [email protected].


摘要： Extrapyramidal symptoms are an uncommon but well-recognized side effect after the administration of general anesthesia in patients without a significant neurologic history. Several case reports implicate propofol as the likely

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causative agent producing these symptoms, which include ballismus, dystonia, choreoathetosis, and opisthotonus. Currently, there is no clear consensus on first-line treatment of these symptoms. In each of the published cases, anticholinergic medications and benzodiazepines were central to initial management, although the speed and extent of symptom resolution were variable. Here we present a case of a 17-year-old boy with ulcerative colitis who presented with ballismus, torticollis, tongue thrusting, and oculogyric movements after colonoscopy under general anesthesia with propofol. The patient responded promptly to treatment with diphenhydramine. This is the first reported case in which diphenhydramine was successfully used as the primary treatment of severe extrapyramidal symptoms in a pediatric patient after propofol administration.

编号：37

题名：Performance of User-Friendly Screening Tools for Elevated Blood Pressure in Children.

作者：Ma C;Wang R;Liu Y;Lu Q;Lu N;Tian Y;Liu X;Yin F


机构：Department of Endocrinology, First Hospital of Qinhuangdao, Qinhuangdao, China.;Department of Endocrinology, First Hospital of Qinhuangdao, Qinhuangdao, China.;Department of Endocrinology, First Hospital of Qinhuangdao, Qinhuangdao, China.;Department of Endocrinology, First Hospital of Qinhuangdao, Qinhuangdao, China.;Department of Endocrinology, First Hospital of Qinhuangdao, Qinhuangdao, China.;Department of Endocrinology, First Hospital of Qinhuangdao, Qinhuangdao, China.;Department of Endocrinology, First Hospital of Qinhuangdao, Qinhuangdao, China.;Department of Endocrinology, First Hospital of Qinhuangdao, Qinhuangdao, China [email protected].


摘要： CONTEXT: Hypertension is frequently undiagnosed in children. Several methods have been developed to simplify screening for elevated blood pressure (BP) in children. OBJECTIVE: to assess the performance of different screening tools in identifying elevated BP in the pediatric population. DATA SOURCES: Data sources such as PubMed, Embase, Web of Science, Cochrane, and Scopus were searched up to March 2016. STUDY SELECTION: Studies providing measures of diagnostic performance of screening tools and that used age-, sex-, and height-specific BP percentile as the reference standard were included. DATA EXTRACTION: Data regarding the population, screening tools used to define elevated BP, and diagnostic criteria of BP were extracted. Available data on true-positive, false-positive, true-negative, and false-negative results were also extracted to construct a 2 x 2 contingency table. RESULTS: A total of 16 eligible studies that evaluated 366 321 children aged 3 to 18 years were included in the meta-analysis. Nine screening tools were included in this study, in which the BP-to-height ratio, the modified BP-to-height ratio, and tables based on age categories had the highest sensitivities (97-98%) but moderate specificities (71-89%). LIMITATIONS: Limitations included that BP measurements in most studies were based on 1 visit only and there was heterogeneity between the studies. CONCLUSIONS: Several user-friendly screening tools could improve the screening of elevated BP in the pediatric population.

编号：38

题名：Cybercycling Effects on Classroom Behavior in Children With Behavioral Health Disorders: An RCT.

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作者：Bowling A;Slavet J;Miller DP;Haneuse S;Beardslee W;Davison K


机构：Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.;Department of Health Sciences, Merrimack College, North Andover, Massachusetts.;Judge Baker Children's Center, Boston, Massachusetts.;Boston University School of Social Work, Boston, Massachusetts; and.;Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.;Judge Baker Children's Center, Boston, Massachusetts.;Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts.;Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.


摘要： BACKGROUND AND OBJECTIVES: Exercise is linked with improved cognition and behavior in children in clinical and experimental settings. This translational study examined if an aerobic cybercycling intervention integrated into physical education (PE) resulted in improvements in behavioral self-regulation and classroom functioning among children with mental health disabilities attending a therapeutic day school. METHODS: Using a 14-week crossover design, students (N = 103) were randomly assigned by classroom (k = 14) to receive the 7-week aerobic cybercycling PE curriculum during fall 2014 or spring 2015. During the intervention, children used the bikes 2 times per week during 30- to 40-minute PE classes. During the control period, children participated in standard nonaerobic PE. Mixed effects logistic regression was used to assess relationships between intervention exposures and clinical thresholds of behavioral outcomes, accounting for both individual and classroom random effects. RESULTS: Children experienced 32% to 51% lower odds of poor self-regulation and learning-inhibiting disciplinary time out of class when participating in the intervention; this result is both clinically and statistically significant. Effects were appreciably more pronounced on days that children participated in the aerobic exercise, but carryover effects were also observed. CONCLUSIONS: Aerobic cybercycling PE shows promise for improving self-regulation and classroom functioning among children with complex behavioral health disorders. This school-based exercise intervention may significantly improve child behavioral health without increasing parental burden or health care costs, or disrupting academic schedules.

编号：39

题名：Physical Activity, Sedentary Behavior, and Symptoms of Major Depression in Middle Childhood.

作者：Zahl T;Steinsbekk S;Wichstrom L


机构：NTNU Social Reseach, Trondheim, Norway; and [email protected].;Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.;Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.;NTNU Social Reseach, Trondheim, Norway; and.;Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.


摘要： OBJECTIVE: The prospective relation between physical activity and Diagnostic and Statistical Manual of Mental Disorders-defined major depression in middle childhood is unknown, as is the stability of depression. We therefore aimed to (1) determine whether there are reciprocal relations between moderate-to-vigorous physical activity (MVPA) and sedentary behavior, on one hand, and Diagnostic and Statistical Manual of Mental Disorders, Fourth

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Edition defined symptoms of major depressive disorder, on the other and (2) assess the extent of stability in depressive symptoms from age 6 to 10 years. METHODS: A community sample of children living in Trondheim, Norway, comprising a total of 795 6-year-old children was followed up at 8 (n = 699) and 10 (n = 702) years of age. Physical activity was recorded by accelerometry and symptoms of major depression were measured through semistructured clinical interviews of parents and children. Bidirectional relationships between MVPA, sedentary activity, and symptoms of depression were analyzed through autoregressive cross-lagged models, and adjusted for symptoms of comorbid psychiatric disorders and BMI. RESULTS: At both age 6 and 8 years, higher MVPA predicted fewer symptoms of major depressive disorders 2 years later. Sedentary behavior did not predict depression, and depression predicted neither MVPA nor sedentary activity. The number of symptoms of major depression declined from ages 6 to 8 years and evidenced modest continuity. CONCLUSIONS: MVPA predicts fewer symptoms of major depression in middle childhood, and increasing MVPA may serve as a complementary method to prevent and treat childhood depression.

编号：40

题名：Rudeness and Medical Team Performance.

作者：Riskin A;Erez A;Foulk TA;Riskin-Geuz KS;Ziv A;Sela R;Pessach-Gelblum L;Bamberger PA


机构：Coller School of Management, and [email protected].;Neonatology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.;Warrington College of Business Administration, University of Florida, Gainesville, Florida; and.;Warrington College of Business Administration, University of Florida, Gainesville, Florida; and.;Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel.;Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel.;Israel Center for Medical Simulation, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.;Israel Center for Medical Simulation, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.;Israel Center for Medical Simulation, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.;Coller School of Management, and.


摘要： OBJECTIVES: Rudeness is routinely experienced by medical teams. We sought to explore the impact of rudeness on medical teams' performance and test interventions that might mitigate its negative consequences. METHODS: Thirty-nine NICU teams participated in a training workshop including simulations of acute care of term and preterm newborns. In each workshop, 2 teams were randomly assigned to either an exposure to rudeness (in which the comments of the patient's mother included rude statements completely unrelated to the teams' performance) or control (neutral comments) condition, and 2 additional teams were assigned to rudeness with either a preventative (cognitive bias modification [CBM]) or therapeutic (narrative) intervention. Simulation sessions were evaluated by 2 independent judges, blind to team exposure, who used structured questionnaires to assess team performance. RESULTS: Rudeness had adverse consequences not only on diagnostic and intervention parameters (mean therapeutic score 3.81 +/- 0.36 vs 4.31 +/- 0.35 in controls, P < .01), but also on team processes (such as information and workload sharing, helping and communication) central to patient care (mean teamwork score 4.04 +/- 0.34 vs 4.43 +/- 0.37, P < .05). CBM mitigated most of these adverse effects of rudeness, but the postexposure narrative intervention had no significant effect. CONCLUSIONS: Rudeness has robust, deleterious effects on the performance of medical teams. Moreover, exposure to rudeness debilitated the very collaborative mechanisms recognized as essential for patient care and safety. Interventions focusing on teaching medical professionals to implicitly avoid cognitive distraction such as CBM may offer a means to mitigate the adverse consequences of behaviors that, unfortunately, cannot be prevented.

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编号：41

题名：Surrogate Pregnancy After Prenatal Diagnosis of Spina Bifida.

作者：Mazur LJ;Kisthardt MK;Kim HH;Rosas LM;Lantos JD


机构：University of Texas Health Sciences Center, Houston, Texas.;University of Missouri-Kansas City School of Law, Kansas City, Missouri.;Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois; and.;University of Texas Health Sciences Center, Houston, Texas.;Children's Mercy Kansas City, Kansas City, Missouri [email protected].


摘要： Some pregnancies today involve infertile individuals or couples who contract with a fertile woman to carry a pregnancy for them. The woman who carries the pregnancy is referred to as a "gestational carrier." The use of such arrangements is increasing. Most of the time, these arrangements play out as planned; sometimes, however, problems arise. This article discusses a case in which a fetal diagnosis of spina bifida led the infertile couple to request that the gestational carrier terminate the pregnancy, and the gestational carrier did not wish to do so. Experts in the medical and legal issues surrounding surrogacy discuss the considerations that should go into resolving such a conflict.

编号：42

题名：Parental Obesity and Early Childhood Development.

作者：Yeung EH;Sundaram R;Ghassabian A;Xie Y;Buck Louis G


机构：Epidemiology Branch, [email protected].;Biostatistics and Bioinformatics Branch.;Epidemiology Branch.;Glotech, Inc, and.;Office of the Director, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland.


摘要： BACKGROUND: Previous studies identified associations between maternal obesity and childhood neurodevelopment, but few examined paternal obesity despite potentially distinct genetic/epigenetic effects related to developmental programming. METHODS: Upstate KIDS (2008-2010) recruited mothers from New York State (excluding New York City) at approximately 4 months postpartum. Parents completed the Ages and Stages Questionnaire (ASQ) when their children were 4, 8, 12, 18, 24, 30, and 36 months of age corrected for gestation. The ASQ is validated to screen for delays in 5 developmental domains (ie, fine motor, gross motor, communication, personal-social functioning, and problem-solving ability). Analyses included 3759 singletons and 1062 nonrelated twins with >/=1 ASQs returned. Adjusted odds ratios (aORs) and 95% confidence intervals were estimated by using generalized linear mixed models accounting for maternal covariates (ie, age, race, education, insurance, marital status,

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parity, and pregnancy smoking). RESULTS: Compared with normal/underweight mothers (BMI <25), children of obese mothers (26% with BMI >/=30) had increased odds of failing the fine motor domain (aOR 1.67; confidence interval 1.12-2.47). The association remained after additional adjustment for paternal BMI (1.67; 1.11-2.52). Paternal obesity (29%) was associated with increased risk of failing the personal-social domain (1.75; 1.13-2.71), albeit attenuated after adjustment for maternal obesity (aOR 1.71; 1.08-2.70). Children whose parents both had BMI >/=35 were likely to additionally fail the problem-solving domain (2.93; 1.09-7.85). CONCLUSIONS: Findings suggest that maternal and paternal obesity are each associated with specific delays in early childhood development, emphasizing the importance of family information when screening child development.

编号：43

题名：Dietary Supplements and Young Teens: Misinformation and Access Provided by Retailers.

作者：Herriman M;Fletcher L;Tchaconas A;Adesman A;Milanaik R


机构：Division of Developmental and Behavioral Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, North Shore-Long Island Jewish Health System, Lake Success, New York.;Division of Developmental and Behavioral Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, North Shore-Long Island Jewish Health System, Lake Success, New York.;Division of Developmental and Behavioral Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, North Shore-Long Island Jewish Health System, Lake Success, New York.;Division of Developmental and Behavioral Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, North Shore-Long Island Jewish Health System, Lake Success, New York.;Division of Developmental and Behavioral Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, North Shore-Long Island Jewish Health System, Lake Success, New York [email protected].


摘要： BACKGROUND AND OBJECTIVE: Despite the American Academy of Pediatrics' recommendations against pediatric use of creatine and testosterone boosters, research suggests that many young teenagers take these dietary supplements. Our objective was to determine to what extent health food stores would recommend and/or sell creatine and testosterone boosters to a 15-year-old boy customer. METHODS: Research personnel posing as 15-year-old high school athletes seeking to increase muscle strength contacted 244 health food stores in the United States via telephone. Researchers asked the sales attendant what supplements he/she would recommend. If a sales attendant did not mention creatine or testosterone boosters initially, each of these supplements was then specifically asked about. Supplement recommendations were recorded. Sales attendants were also asked if a 15-year-old could purchase these products on his own in the store. RESULTS: A total of 67.2% (164/244) of sales attendants recommended creatine: 38.5% (94/244) recommended creatine without prompting, and an additional 28.7% (70/244) recommended creatine after being asked specifically about it. A total of 9.8% (24/244) of sales attendants recommended a testosterone booster. Regarding availability for sale, 74.2% (181/244) of sales attendants stated a 15-year-old was allowed to purchase creatine, whereas 41.4% (101/244) stated one could purchase a testosterone booster. CONCLUSIONS: Health food store employees frequently recommend creatine and testosterone boosters for boy high school athletes. In response to these findings, pediatricians should inform their teenage patients, especially athletes, about safe, healthy methods to improve athletic performance and discourage them from using creatine or testosterone boosters. Retailers and state legislatures should also consider banning the sale of these products to minors.

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编号：44

题名：Wahakura Versus Bassinet for Safe Infant Sleep: A Randomized Trial.

作者：Baddock SA;Tipene-Leach D;Williams SM;Tangiora A;Jones R;Iosua E;Macleod EC;Taylor BJ


机构：School of Midwifery, Otago Polytechnic, Dunedin, New Zealand; [email protected].;Departments of Women's and Children's Health, and.;Departments of Women's and Children's Health, and.;Preventive and Social Medicine, and.;Departments of Women's and Children's Health, and.;Departments of Women's and Children's Health, and.;Preventive and Social Medicine, and.;Departments of Women's and Children's Health, and.;Departments of Women's and Children's Health, and.;Dean's Department, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.


摘要： OBJECTIVES: To compare an indigenous sleep device (wahakura) for infants at high risk for sudden unexpected death with a bassinet, for measures of infant sleep position, head covering, breastfeeding, bed-sharing, and maternal sleep and fatigue. METHODS: A total of 200 mainly Maori pregnant women were recruited from deprived areas of New Zealand. They were randomized to receive a bassinet or wahakura and asked to sleep the infant in this device from birth. Questionnaires at 1, 3, and 6 months and an overnight infrared video in the home at 1 month were completed. RESULTS: An intention-to-treat and an "as-used" analysis of questionnaires showed no group differences at 1, 3, and 6 months in infant-adult direct bed-sharing (7% vs 12%, P = .24 at 1 month), and at the 6-month interview, the wahakura group reported twice the level of full breastfeeding (22.5% vs 10.7%, P = .04). Maternal sleep and fatigue were not significantly different between groups. Video identified no increase in head covering, prone/side sleep position, or bed-sharing in the wahakura group, either from intention-to-treat analysis, or when analyzed for actual sleep location. CONCLUSION: There were no significant differences in infant risk behaviors in wahakura compared with bassinets and there were other advantages, including an increase in sustained breastfeeding. This suggests wahakura are relatively safe and can be promoted as an alternative to infant-adult bed-sharing. Policies that encourage utilization are likely to be helpful in high-risk populations.

编号：45

题名：Update on Pediatric Overuse.

作者：Coon ER;Young PC;Quinonez RA;Morgan DJ;Dhruva SS;Schroeder AR


机构：Divisions of Pediatric Inpatient Medicine, Primary Children's Hospital, and [email protected].;General Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.;Section of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.;Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland.;VA Maryland Healthcare System, Baltimore, Maryland.;Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut.;VA Connecticut Healthcare System, West Haven, Connecticut; and.;Department of Pediatrics, Stanford University School of Medicine, Stanford, California.

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摘要： As concerns over health care-related harms and costs continue to mount, efforts to identify and combat medical overuse are needed. Although much of the recent attention has focused on health care for adults, children are also harmed by overuse. Using a structured PubMed search and manual tables of contents review, we identified important articles on pediatric overuse published in 2015. These articles were evaluated according to the quality of the methods, the magnitude of clinical effect, and the number of patients potentially affected and were categorized into overdiagnosis, overtreatment, and overutilization. Overdiagnosis: Findings included evidence for overdiagnosis of hypoxemia in children with bronchiolitis and skull fractures in children suffering minor head injuries. Overtreatment: Findings included evidence that up to 85% of hospitalized children with radiographic pneumonia may not have a bacterial etiology; many children are receiving prolonged intravenous antibiotic therapy for osteomyelitis although oral therapy is equally effective; antidepressant medication for adolescents and nebulized hypertonic saline for bronchiolitis appear to be ineffective; and thresholds for treatment of hyperbilirubinemia may be too low. Overutilization: Findings suggested that the frequency of head circumference screening could be relaxed; large reductions in abdominal computed tomography testing for appendicitis appear to have been safe and effective; and overreliance on C-reactive protein levels in neonatal early onset sepsis appears to extend hospital length-of-stay.

编号：46

题名：A Targeted Approach for Congenital Cytomegalovirus Screening Within Newborn Hearing Screening.

作者：Fowler KB;McCollister FP;Sabo DL;Shoup AG;Owen KE;Woodruff JL;Cox E;Mohamed LS;Choo DI;Boppana SB


机构：Department of Pediatrics and Epidemiology, [email protected].;Department of Special Education (Retired), University of Alabama, Tuscaloosa, Alabama.;Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania.;Department of Otolaryngology, University of Texas Southwestern Medical Center at Dallas, Parkland Hospital, Children's Health, Dallas, Texas.;Department of Otolaryngology, University of Texas Southwestern Medical Center at Dallas, Parkland Hospital, Children's Health, Dallas, Texas.;Civitan-Sparks Clinics, Department of Pediatrics, and.;Department of Speech and Audiology, Carolinas Rehabilitation, Carolinas HealthCare System, Charlotte, North Carolina; and.;Department of Speech and Audiology, Carolinas Rehabilitation, Carolinas HealthCare System, Charlotte, North Carolina; and.;Department of Otolaryngology - Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.;Department of Pediatrics and Microbiology, University of Alabama at Birmingham, Birmingham, Alabama.


摘要： BACKGROUND AND OBJECTIVE: Congenital cytomegalovirus (cCMV) infection remains a leading cause of childhood hearing loss. Currently universal CMV screening at birth does not exist in the United States. An alternative approach could be testing infants who do not pass their newborn hearing screening (NHS) for cCMV. This study was undertaken to evaluate whether a targeted approach will identify infants with CMV-related sensorineural hearing loss (SNHL). METHODS: Infants born at 7 US medical centers received NHS and were also screened for cCMV while in the newborn nursery. Infants who tested positive for CMV received further diagnostic audiologic evaluations to identify or confirm hearing loss. RESULTS: Between 2007 and 2012, 99 945 newborns were screened for both hearing impairment and cCMV. Overall, 7.0% of CMV-positive infants did not pass NHS compared with 0.9% of CMV-negative infants (P < .0001). Among the cCMV infants who failed NHS, diagnostic testing confirmed that 65% had SNHL. In addition, 3.6% of CMV-infected infants who passed their NHS had SNHL confirmed by further evaluation during early infancy. NHS in this cohort identified 57% of all CMV-related SNHL that occurred in the neonatal period.

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CONCLUSIONS: A targeted CMV approach that tests newborns who fail their NHS identified the majority of infants with CMV-related SNHL at birth. However, 43% of the infants with CMV-related SNHL in the neonatal period and cCMV infants who are at risk for late onset SNHL were not identified by NHS.

编号：47

题名：Tonsillectomy for Obstructive Sleep-Disordered Breathing: A Meta-analysis.

作者：Chinnadurai S;Jordan AK;Sathe NA;Fonnesbeck C;McPheeters ML;Francis DO


机构：Departments of Otolaryngology, [email protected].;Pediatrics.;Health Policy and the Vanderbilt Evidence-based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee.;Biostatistics, and.;Health Policy and the Vanderbilt Evidence-based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee.;Departments of Otolaryngology.


摘要： CONTEXT: The effectiveness of tonsillectomy or adenotonsillectomy (hereafter, "tonsillectomy") for obstructive sleep-disordered breathing (OSDB) compared with watchful waiting with supportive care is poorly understood. OBJECTIVE: To compare sleep, cognitive or behavioral, and health outcomes of tonsillectomy versus watchful waiting with supportive care in children with OSDB. DATA SOURCES: Medline, Embase, and the Cochrane Library. STUDY SELECTION: Two investigators independently screened studies against predetermined criteria. DATA EXTRACTION: Two investigators independently extracted key data. Investigators independently assessed study risk of bias and the strength of the evidence of the body of literature. Investigators synthesized data qualitatively and meta-analyzed apnea-hypopnea index (AHI) scores. RESULTS: We included 11 studies. Relative to watchful waiting, most studies reported better sleep-related outcomes in children who had a tonsillectomy. In 5 studies including children with polysomnography-confirmed OSDB, AHI scores improved more in children receiving tonsillectomy versus surgery. A meta-analysis of 3 studies showed a 4.8-point improvement in the AHI in children who underwent tonsillectomy compared with no surgery. Sleep-related quality of life and negative behaviors (eg, anxiety and emotional lability) also improved more among children who had a tonsillectomy. Changes in executive function were not significantly different. The length of follow-up in studies was generally <12 months. LIMITATIONS: Few studies fully categorized populations in terms of severity of OSDB; outcome measures were heterogeneous; and the durability of outcomes beyond 12 months is not known. CONCLUSIONS: Tonsillectomy can produce short-term improvement in sleep outcomes compared with no surgery in children with OSDB. Understanding of longer-term outcomes or effects in subpopulations is lacking.

编号：48

题名：Tonsillectomy Versus Watchful Waiting for Recurrent Throat Infection: A Systematic Review.

作者：Morad A;Sathe NA;Francis DO;McPheeters ML;Chinnadurai S

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机构：Departments of Pediatrics.;Health Policy, and Vanderbilt Evidence-based Practice Center, Institute for Medicine and Public Health, and.;Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee.;Health Policy, and Vanderbilt Evidence-based Practice Center, Institute for Medicine and Public Health, and.;Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee [email protected].


摘要： CONTEXT: The effectiveness of tonsillectomy or adenotonsillectomy ("tonsillectomy") for recurrent throat infection compared with watchful waiting is uncertain. OBJECTIVE: To compare sleep, cognitive, behavioral, and health outcomes of tonsillectomy versus watchful waiting in children with recurrent throat infections. DATA SOURCES: MEDLINE, Embase, and the Cochrane Library. STUDY SELECTION: Two investigators independently screened studies against predetermined criteria. DATA EXTRACTION: One investigator extracted data with review by a second. Investigators independently assessed risk of bias and strength of evidence (SOE) and confidence in the estimate of effects. RESULTS: Seven studies including children with >/=3 infections in the previous 1 to 3 years addressed this question. In studies reporting baseline data, number of infections/sore throats decreased from baseline in both groups, with greater decreases in sore throat days, clinician contacts, diagnosed group A streptococcal infections, and school absences in tonsillectomized children in the short term (<12 months). Quality of life was not markedly different between groups at any time point. LIMITATIONS: Few studies fully categorized infection/sore throat severity; attrition was high. CONCLUSIONS: Throat infections, utilization, and school absences improved in the first postsurgical year in tonsillectomized children versus children not receiving surgery. Benefits did not persist over time; longer-term outcomes are limited. SOE is moderate for reduction in short-term throat infections and insufficient for longer-term reduction. SOE is low for no difference in longer-term streptococcal infection reduction. SOE is low for utilization and missed school reduction in the short term, low for no difference in longer-term missed school, and low for no differences in quality of life.

编号：49

题名：Newborn Sequencing in Genomic Medicine and Public Health.

作者：Berg JS;Agrawal PB;Bailey DB Jr;Beggs AH;Brenner SE;Brower AM;Cakici JA;Ceyhan-Birsoy O;Chan K;Chen F;Currier RJ;Dukhovny D;Green RC;Harris-Wai J;Holm IA;Iglesias B;Joseph G;Kingsmore SF;Koenig BA;Kwok PY;Lantos J;Leeder SJ;Lewis MA;McGuire AL;Milko LV;Mooney SD;Parad RB;Pereira S;Petrikin J;Powell BC;Powell CM;Puck JM;Rehm HL;Risch N;Roche M;Shieh JT;Veeraraghavan N;Watson MS;Willig L;Yu TW;Urv T;Wise AL


机构：Departments of Genetics and [email protected].;Divisions of Newborn Medicine and.;Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.;RTI International, Research Triangle Park, North Carolina.;Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.;University of California, Berkeley, California.;American College of Medical Genetics and Genomics, Bethesda, Maryland.;Rady Children's Institute for Genomic Medicine, San Diego, California.;Laboratory for Molecular Medicine.;Chicago School of Public Health, University of Illinois, Chicago, Illinois.;Institute for Human Genetics.;Genetic Disease Screening Program, California Department of Public Health, Sacramento, California.;Department of Pediatrics and Division of Neonatology, Oregon Health & Science University, Portland, Oregon.;Division of Genetics, and.;Institute for Human Genetics.;Institute for Health and Aging.;Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School,

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Boston, Massachusetts.;National Human Genome Research Institute and.;Department of Anthropology, History, and Social Medicine.;Rady Children's Institute for Genomic Medicine, San Diego, California.;Institute for Health and Aging.;Institute for Human Genetics.;Cardiovascular Research Institute, and Department of Dermatology.;Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri.;Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri.;RTI International, Research Triangle Park, North Carolina.;Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas; and.;Departments of Genetics and.;University of Washington, Seattle, Washington.;Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.;Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas; and.;Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri.;Departments of Genetics and.;Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.;Department of Pediatrics, University of California, San Francisco, California.;Laboratory for Molecular Medicine.;Institute for Human Genetics.;Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.;Institute for Human Genetics.;Department of Pediatrics, Benioff Children's Hospital, and.;Rady Children's Institute for Genomic Medicine, San Diego, California.;American College of Medical Genetics and Genomics, Bethesda, Maryland.;Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri.;Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.;National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland.;National Human Genome Research Institute and.


摘要： The rapid development of genomic sequencing technologies has decreased the cost of genetic analysis to the extent that it seems plausible that genome-scale sequencing could have widespread availability in pediatric care. Genomic sequencing provides a powerful diagnostic modality for patients who manifest symptoms of monogenic disease and an opportunity to detect health conditions before their development. However, many technical, clinical, ethical, and societal challenges should be addressed before such technology is widely deployed in pediatric practice. This article provides an overview of the Newborn Sequencing in Genomic Medicine and Public Health Consortium, which is investigating the application of genome-scale sequencing in newborns for both diagnosis and screening.

编号：50

题名：How Does Incarcerating Young People Affect Their Adult Health Outcomes?

作者：Barnert ES;Dudovitz R;Nelson BB;Coker TR;Biely C;Li N;Chung PJ


机构：Department of Pediatrics, David Geffen School of Medicine at UCLA, [email protected].;UCLA Children's Discovery and Innovation Institute, Mattel Children's Hospital, and.;Department of Pediatrics, David Geffen School of Medicine at UCLA.;UCLA Children's Discovery and Innovation Institute, Mattel Children's Hospital, and.;Department of Pediatrics, David Geffen School of Medicine at UCLA.;UCLA Children's Discovery and Innovation Institute, Mattel Children's Hospital, and.;Department of Pediatrics, David Geffen School of Medicine at UCLA.;UCLA Children's Discovery and Innovation Institute, Mattel Children's Hospital, and.;Department of Pediatrics, David Geffen School of Medicine at UCLA.;Departments of Biomathematics and.;Department of Pediatrics, David Geffen School of Medicine at UCLA.;UCLA Children's Discovery and Innovation Institute, Mattel Children's Hospital, and.;Health, Policy, and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California; and.;RAND Health, RAND Corporation, Santa Monica, California.


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摘要： BACKGROUND AND OBJECTIVES: Despite the widespread epidemic of mass incarceration in the US, relatively little literature exists examining the longitudinal relationship between youth incarceration and adult health outcomes. We sought to quantify the association of youth incarceration with subsequent adult health outcomes. METHODS: We analyzed data from 14 344 adult participants in the National Longitudinal Study of Adolescent to Adult Health. We used weighted multivariate logistic regressions to investigate the relationship between cumulative incarceration duration (none, <1 month, 1-12 months, and >1 year) before Wave IV (ages 24-34 years) and subsequent adult health outcomes (general health, functional limitations, depressive symptoms, and suicidal thoughts). Models controlled for Wave I (grades 7-12) baseline health, sociodemographics, and covariates associated with incarceration and health. RESULTS: A total of 14.0% of adults reported being incarcerated between Waves I and IV. Of these, 50.3% reported a cumulative incarceration duration of <1 month, 34.8% reported 1 to 12 months, and 15.0% reported >1 year. Compared with no incarceration, incarceration duration of < 1 month predicted subsequent adult depressive symptoms (odds ratio [OR] = 1.41; 95% confidence interval [CI], 1.11-1.80; P = .005). A duration of 1 to 12 months predicted worse subsequent adult general health (OR = 1.48; 95% CI, 1.12-1.96; P = .007). A duration of >1 year predicted subsequent adult functional limitations (OR = 2.92; 95% CI, 1.51-5.64; P = .002), adult depressive symptoms (OR = 4.18; 95% CI, 2.48-7.06; P < .001), and adult suicidal thoughts (OR = 2.34; 95% CI, 1.09-5.01; P = .029). CONCLUSIONS: Cumulative incarceration duration during adolescence and early adulthood is independently associated with worse physical and mental health later in adulthood. Potential mechanisms merit exploration.

编号：51

题名：The Adolescent's Right to Confidential Care When Considering Abortion.



编号：52

题名：E-Cigarettes and Adolescents' Risk Status.

作者：Wills TA


机构：Cancer Prevention and Control Program, University of Hawaii Cancer Center and Department of Native Hawaiian Health, John A. Burns School of Medicine, Honolulu, Hawaii [email protected].


摘要：

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编号：53

题名：Adolescent Risk Behaviors and Use of Electronic Vapor Products and Cigarettes.

作者：Demissie Z;Everett Jones S;Clayton HB;King BA


机构：Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention and [email protected].;US Public Health Service Commissioned Corps, Rockville, Maryland.;Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention and.;Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention and.;Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; and.


摘要： BACKGROUND: Adolescent use of tobacco in any form is unsafe; yet the use of electronic cigarettes and other electronic vapor products (EVPs) has increased in recent years among this age group. We assessed the prevalence and frequency of cigarette smoking and EVP use among high school students, and associations between health-risk behaviors and both cigarette smoking and EVP use. METHODS: We used 2015 national Youth Risk Behavior Survey data (N = 15 624) to classify students into 4 mutually exclusive categories of smoking and EVP use based on 30-day use: nonuse, cigarette smoking only, EVP use only, and dual use. Prevalence of cigarette smoking and EVP use were assessed overall and by student demographics and frequency of use. Prevalence ratios were calculated to identify associations with health risk-behaviors. RESULTS: In 2015, 73.5% of high school students did not smoke cigarettes or use EVPs, 3.2% smoked cigarettes only, 15.8% used EVPs only, and 7.5% were dual users. Frequency of cigarette smoking and EVP use was greater among dual users than cigarette-only smokers and EVP-only users. Cigarette-only smokers, EVP-only users, and dual users were more likely than nonusers to engage in several injury, violence, and substance use behaviors; have >/=4 lifetime sexual partners; be currently sexually active; and drink soda >/=3 times/day. Only dual users were more likely than nonusers not to use a condom at last sexual intercourse. CONCLUSIONS: EVP use, alone and concurrent with cigarette smoking, is associated with health-risk behaviors among high school students.

编号：54

题名：Disparities in HIV/AIDS Risk Behaviors After Youth Leave Detention: A 14-Year Longitudinal Study.

作者：Abram KM;Stokes ML;Welty LJ;Aaby DA;Teplin LA


机构：Departments of Psychiatry and Behavioral Sciences, and.;Departments of Psychiatry and Behavioral Sciences, and.;Departments of Psychiatry and Behavioral Sciences, and.;Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.;Departments of Psychiatry and Behavioral Sciences, and.;Departments of Psychiatry and Behavioral Sciences, and [email protected].

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摘要： OBJECTIVES: To examine changes in the prevalence of 15 HIV/AIDS sex and drug risk behaviors in delinquent youth during the 14 years after they leave detention, focusing on sex and racial/ethnic differences. METHODS: The Northwestern Juvenile Project, a prospective longitudinal study of 1829 youth randomly sampled from detention in Chicago, Illinois, recruited between 1995 and 1998 and reinterviewed up to 11 times. Independent interviewers assessed HIV/AIDS risk behaviors using the National Institutes on Drug Abuse Risk Behavior Assessment. RESULTS: Fourteen years after detention (median age, 30 years), one-quarter of males and one-tenth of females had >1 sexual partner in the past 3 months. One-tenth of participants reported recent unprotected vaginal sex with a high-risk partner. There were many sex and racial/ethnic differences. For example, African American males had 4.67 times the odds of having >1 partner than African American females (95% confidence interval [CI], 3.22-6.76). Over time, compared with non-Hispanic white males, African American males had 2.56 times the odds (95% CI, 1.97-3.33) and Hispanic males had 1.63 times the odds (95% CI, 1.24-2.12) of having multiple partners, even after adjusting for incarceration and age. Non-Hispanic white females were more likely to have multiple partners than racial/ethnic minority females. CONCLUSIONS: Although rates decrease over time, prevalence of sex risk behaviors are much higher than the general population. Among males, racial/ethnic minorities were at particular risk. The challenge for pediatric health is to address how disproportionate confinement of racial/ethnic minority youth contributes to disparities in the HIV/AIDS epidemic.

编号：55

题名：Consent by Proxy for Nonurgent Pediatric Care.

作者：Fanaroff JM



编号：56

题名：Increasing Awareness of Sudden Death in Pediatric Epilepsy Together.

作者：Lapham G;Gaillard WD;Sexter J;Berl MM


机构：Center for Neuroscience, and.;Division of Neurology, Children's National Health System, Washington, District of Columbia.;Center for Neuroscience, and.;Division of Neurology, Children's National Health System, Washington, District of Columbia.;Department of Pediatrics and Behavioral Science, George Washington University School of Medicine, Washington, District of Columbia.;Department of Pediatrics and Behavioral Science, George Washington University School of Medicine, Washington, District of Columbia.;Department of Pediatrics, Spring Valley Pediatrics, Washington, District of Columbia; and.;Georgetown University Hospital, Washington, District of Columbia.;Center for Neuroscience, and [email protected].;Division of Neurology, Children's National Health System,

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Washington, District of Columbia.;Department of Pediatrics and Behavioral Science, George Washington University School of Medicine, Washington, District of Columbia.


摘要：

编号：57

题名：Characterization of Inpatient Cystic Fibrosis Pulmonary Exacerbations.

作者：Cogen JD;Oron AP;Gibson RL;Hoffman LR;Kronman MP;Ong T;Rosenfeld M


机构：Divisions of Pulmonary Medicine and Sleep Medicine and [email protected].;Core for Biomedical Statistics, Center for Clinical & Translational Research, Seattle Children's Research Institute, Seattle, Washington.;Divisions of Pulmonary Medicine and Sleep Medicine and.;Divisions of Pulmonary Medicine and Sleep Medicine and.;Infectious Diseases, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington; and.;Divisions of Pulmonary Medicine and Sleep Medicine and.;Divisions of Pulmonary Medicine and Sleep Medicine and.


摘要： BACKGROUND AND OBJECTIVES: Pulmonary exacerbations lead to significant morbidity and mortality in patients with cystic fibrosis (CF). National consensus guidelines exist, but few studies report current practice in the treatment and monitoring of pulmonary exacerbations. The goal of this study was to characterize consistency and variability in the inpatient management of CF-related pulmonary exacerbations. We focused on the use of guideline-recommended maintenance therapies, antibiotic selection and treatment regimens, use of systemic corticosteroids, and frequency of lung function testing. We hypothesized that significant variability in these treatment practices exists nationally. METHODS: This trial was a retrospective cross-sectional study. It included patients with CF aged </=18 years hospitalized for pulmonary exacerbations between July 1, 2010, and June 30, 2015, at hospitals within the US Pediatric Health Information System database that are also Cystic Fibrosis Foundation-accredited care centers. One exacerbation per patient was randomly selected over the 5-year study period. RESULTS: From 38 hospitals, 4827 individual pulmonary exacerbations were examined. Median length of stay was 10.0 days (interquartile range, 6-14.0 days). Significant variation was seen among centers in the use of hypertonic saline (11%-100%), azithromycin (5%-83%), and systemic corticosteroids (3%-61%) and in the frequency of lung function testing. Four different admission antibiotic regimens were used >10% of the time, and the most commonly used admission antibiotic regimen comprised 2 intravenous antibiotics with no additional oral or inhaled antibiotics (29%). CONCLUSIONS: Significant variation exists in the treatment and monitoring of pulmonary exacerbations across Pediatric Health Information System-participating, Cystic Fibrosis Foundation-accredited care centers. Results from this study can inform future research working toward standardized inpatient pulmonary exacerbation management to improve CF care for children and adolescents.

编号：58

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题名：Growth Hormone With Aromatase Inhibitor May Improve Height in CYP11B1 Congenital Adrenal Hyperplasia.

作者：Hawton K;Walton-Betancourth S;Rumsby G;Raine J;Dattani M


机构：Bristol Royal Hospital for Children, Bristol, United Kingdom; [email protected].;Genetics and Epigenetics in Health and Disease Section, Genetics and Genomic Medicine Programme, UCL Institute of Child Health and Great Ormond Street Hospital, London, United Kingdom.;University College London Hospital, London, United Kingdom; and.;Whittington Hospital, London, United Kingdom.;Genetics and Epigenetics in Health and Disease Section, Genetics and Genomic Medicine Programme, UCL Institute of Child Health and Great Ormond Street Hospital, London, United Kingdom.


摘要： With an estimated prevalence of 1 in 100 000 births, 11beta-hydroxylase deficiency is the second most common form of congenital adrenal hyperplasia (CAH) and is caused by mutations in CYP11B1 Clinical features include virilization, early gonadotropin-independent precocious puberty, hypertension, and reduced stature. The current mainstay of management is with glucocorticoids to replace deficient steroids and to minimize adrenal sex hormone overproduction, thus preventing virilization and optimizing growth. We report a patient with CAH who had been suboptimally treated and presented to us at 6 years of age with precocious puberty, hypertension, tall stature, advanced bone age, and a predicted final height of 150 cm. Hormonal profiles and genetic analysis confirmed a diagnosis of 11beta-hydroxylase deficiency. In addition to glucocorticoid replacement, the patient was commenced on growth hormone and a third-generation aromatase inhibitor, anastrozole, in an attempt to optimize his growth. After the initiation of this treatment, the patient's growth rate improved significantly and bone age advancement slowed. The patient reached a final height of 177.5 cm (0.81 SD score), 11.5 cm above his mid-parental height. This patient is only the second reported case of the use of an aromatase inhibitor in combination with growth hormone to optimize height in 11beta-hydroxylase-deficient CAH. This novel treatment proved to be highly efficacious, with no adverse effects. It may therefore provide a promising option to promote growth in exceptional circumstances in individuals with 11beta-hydroxylase deficiency presenting late with advanced skeletal maturation and consequent short stature.

编号：59

题名：The Hidden Value of Variation in Practice.

作者：McBride JT;Stokes DC


机构：Robert T. Stone Respiratory Center, Akron Children's Hospital, Northeast Ohio Medical University, Akron, Ohio; and [email protected].;LeBonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee.


摘要：

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编号：60

题名：A Quality Improvement Project to Decrease Human Milk Errors in the NICU.

作者：Oza-Frank R;Kachoria R;Dail J;Green J;Walls K;McClead RE Jr


机构：Center for Perinatal Research, [email protected].;Research Institute, and.;Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio.;Center for Perinatal Research.;Research Institute, and.;Quality Improvement Services, and.;Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio; and.;Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio; and.;Quality Improvement Services, and.;Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio; and.


摘要： BACKGROUD AND OBJECTIVE: Ensuring safe human milk in the NICU is a complex process with many potential points for error, of which one of the most serious is administration of the wrong milk to the wrong infant. Our objective was to describe a quality improvement initiative that was associated with a reduction in human milk administration errors identified over a 6-year period in a typical, large NICU setting. METHODS: We employed a quasi-experimental time series quality improvement initiative by using tools from the model for improvement, Six Sigma methodology, and evidence-based interventions. Scanned errors were identified from the human milk barcode medication administration system. Scanned errors of interest were wrong-milk-to-wrong-infant, expired-milk, or preparation errors. The scanned error rate and the impact of additional improvement interventions from 2009 to 2015 were monitored by using statistical process control charts. RESULTS: From 2009 to 2015, the total number of errors scanned declined from 97.1 per 1000 bottles to 10.8. Specifically, the number of expired milk error scans declined from 84.0 per 1000 bottles to 8.9. The number of preparation errors (4.8 per 1000 bottles to 2.2) and wrong-milk-to-wrong-infant errors scanned (8.3 per 1000 bottles to 2.0) also declined. CONCLUSIONS: By reducing the number of errors scanned, the number of opportunities for errors also decreased. Interventions that likely had the greatest impact on reducing the number of scanned errors included installation of bedside (versus centralized) scanners and dedicated staff to handle milk.

编号：61

题名：The Continuing Rise of Gun Violence in PG-13 Movies, 1985 to 2015.

作者：Romer D;Jamieson PE;Jamieson KH


机构：Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, Pennsylvania [email protected].;Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, Pennsylvania.;Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, Pennsylvania.

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摘要：

编号：62

题名：Ataxia Telangiectasia and Juvenile Idiopathic Arthritis.

作者：Pasini AM;Gagro A;Roic G;Vrdoljak O;Lujic L;Zutelija-Fattorini M


机构：Children's Hospital Zagreb, Zagreb, Croatia [email protected].;Children's Hospital Zagreb, Zagreb, Croatia.;Children's Hospital Zagreb, Zagreb, Croatia.;Children's Hospital Zagreb, Zagreb, Croatia.;Children's Hospital Zagreb, Zagreb, Croatia.;Children's Hospital Zagreb, Zagreb, Croatia.


摘要： We report, to the best of our knowledge, the first case of a child with typical ataxia telangiectasia (A-T) who developed juvenile idiopathic arthritis (JIA). The patient was a 15-year-old boy with A-T who presented with noninfectious polyarthritis. A-T is a rare, autosomal recessive disorder characterized by cerebellar atrophy, oculocutaneous telangiectasia, immunodeficiency, radiosensitivity, and predisposition to cancer. The gene responsible for A-T is the A-T mutated (ATM) gene. Clinical manifestations of the disorder are the result of lacking ATM protein, which is involved in DNA repair, apoptosis, various checkpoints in the cell cycle, gene regulation, translation, initiation, and telomere maintenance. There are a few articles that describe deficiency of the DNA repair enzyme, ATM, in rheumatoid arthritis, but the connection between the absence of ATM protein and JIA has not been presented or studied yet. JIA is a heterogeneous group of diseases characterized by arthritis of unknown origin with onset before the age of 16 years. It is the most common childhood chronic rheumatic disease and causes significant disability. Because immunodeficiency can be part of A-T, infectious arthritis can occur, but chronic autoimmune arthritis in these patients is rare. We report a rare case of a 15-year-old boy with A-T and JIA. This case shows a possible relationship between altered function of ATM protein and the pathogenesis of JIA.

编号：63

题名：Improving Early Identification and Intervention for Children at Risk for Autism Spectrum Disorder.

作者：Rotholz DA;Kinsman AM;Lacy KK;Charles J


机构：Department of Pediatrics, Center for Disability Resources, University of South Carolina School of Medicine, Columbia, South Carolina; [email protected].;Department of Pediatrics, Children's Hospital, Greenville

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Health System, Greenville, South Carolina.;South Carolina Department of Disabilities and Special Needs, Columbia, South Carolina; and.;Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.


摘要： OBJECTIVES: To provide an example of a successful, novel statewide effort to increase early identification of young children at risk for autism spectrum disorder (ASD) using a 2-tiered screening process with enhanced quality assessment, interagency policy collaboration and coordination. METHODS: The South Carolina Act Early Team (SCAET) provided focused collaboration among leaders representing state agencies, universities, health care systems, private organizations, and families to improve quality of life for children with ASD. Specific focus was on implementing policy changes and training to result in earlier identification and home-based behavioral intervention for young children at risk for ASD. RESULTS: Policy changes, training, and modified state agency practices were accomplished. Presumptive eligibility, on the basis of a 2-tiered screening process was implemented by BabyNet (South Carolina's Early Intervention Program) in collaboration with the lead agency for developmental disability services. There was a fivefold increase in children eligible for early intensive behavioral intervention without waiting for a diagnosis of ASD, avoiding long waits for diagnostic evaluations. Only 16 children (2.5%) were later found not to have ASD from a comprehensive evaluation. CONCLUSIONS: Improvements in early identification and intervention are feasible through collaborative policy change. The South Carolina Act Early Team and its key stakeholders committed to improving outcomes for this population used existing tools and methods in new ways to improve early identification of children with ASD and to make available evidence-based intervention services. This example should be replicable in other states with key stakeholders working collaboratively for the benefit of young children with ASD.

编号：64

题名：What Pediatricians Can Do to Address Malnutrition Globally and at Home.

作者：Suchdev PS


机构：Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia; and Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia [email protected].


摘要：

编号：65

题名：Bleeding Disorders in Congenital Syndromes.

作者：Sarangi SN;Acharya SS

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机构：Bleeding Disorders and Thrombosis Program, Cohen Children's Medical Center of New York, New Hyde Park, New York.;Bleeding Disorders and Thrombosis Program, Cohen Children's Medical Center of New York, New Hyde Park, New York [email protected].


摘要： Pediatricians provide a medical home for children with congenital syndromes who often need complex multidisciplinary care. There are some syndromes associated with thrombocytopenia, inherited platelet disorders, factor deficiencies, connective tissue disorders, and vascular abnormalities, which pose a real risk of bleeding in affected children associated with trauma or surgeries. The risk of bleeding is not often an obvious feature of the syndrome and not well documented in the literature. This makes it especially hard for pediatricians who may care for a handful of children with these rare congenital syndromes in their lifetime. This review provides an overview of the etiology of bleeding in the different congenital syndromes along with a concise review of the hematologic and nonhematologic clinical manifestations. It also highlights the need and timing of diagnostic evaluation to uncover the bleeding risk in these syndromes emphasizing a primary care approach.

编号：66

题名：Family Strategies to Support Siblings of Pediatric Hematopoietic Stem Cell Transplant Patients.

作者：White TE;Hendershot KA;Dixon MD;Pelletier W;Haight A;Stegenga K;Alderfer MA;Cox L;Switchenko JM;Hinds P;Pentz RD


机构：East Carolina University School of Medicine, Greenville, North Carolina.;Cooper Medical School of Rowan University, Camden, New Jersey.;Department of Hematology and Oncology, Emory School of Medicine, and.;Haemotology/Oncology/Stem Cell Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada.;Department of Hematology and Oncology, Emory School of Medicine, and.;Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia.;Hematology/Oncology/Bone Marrow Transplantation, Children's Mercy Hospital, Kansas City, Missouri.;Department of Psychology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.;Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.;Winship Cancer Institute, Atlanta, Georgia; and.;Winship Cancer Institute, Atlanta, Georgia; and.;Department of Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia.;Children's National Medical Center, Nursing Research and Quality Outcomes, Washington, District of Columbia.;Department of Hematology and Oncology, Emory School of Medicine, and [email protected].;Winship Cancer Institute, Atlanta, Georgia; and.


摘要： OBJECTIVE: To describe the strategies families report using to address the needs and concerns of siblings of children, adolescents, and young adults undergoing hematopoietic stem cell transplant (HSCT). METHODS: A secondary semantic analysis was conducted of 86 qualitative interviews with family members of children, adolescents, and young adults undergoing HSCT at 4 HSCT centers and supplemented with a primary analysis of 38 additional targeted qualitative interviews (23 family members, 15 health care professionals) conducted at the primary center. Analyses focused on sibling issues and the strategies families use to address these issues. RESULTS: The sibling issues identified included: (1) feeling negative effects of separation from the patient and caregiver(s); (2) experiencing difficult

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emotions; (3) being faced with additional responsibilities or burdens; (4) lacking information; and (5) feeling excluded. Families and health care providers reported the following strategies to support siblings: (1) sharing information; (2) using social support and help offered by family or friends; (3) taking siblings to the hospital; (4) communicating virtually; (5) providing special events or gifts or quality time for siblings; (6) offering siblings a defined role to help the family during the transplant process; (7) switching between parents at the hospital; (8) keeping the sibling's life constant; and, (9) arranging sibling meetings with a certified child life specialist or school counselor. CONCLUSIONS: Understanding the above strategies and sharing them with other families in similar situations can begin to address sibling issues during HSCT and can improve hospital-based, family-centered care efforts.

编号：67

题名：Azithromycin in Labor Lowers Clinical Infections in Mothers and Newborns: A Double-Blind Trial.

作者：Oluwalana C;Camara B;Bottomley C;Goodier S;Bojang A;Kampmann B;Ceesay S;D'Alessandro U;Roca A


机构：Medical Research Council Unit, Banjul, The Gambia.;Medical Research Council Unit, Banjul, The Gambia.;London School of Hygiene and Tropical Medicine, London, United Kingdom.;London School of Economics, London, United Kingdom.;Medical Research Council Unit, Banjul, The Gambia.;Medical Research Council Unit, Banjul, The Gambia.;Imperial College, London, United Kingdom.;Ministry of Health and Social Welfare, Banjul, The Gambia; and.;Medical Research Council Unit, Banjul, The Gambia.;London School of Hygiene and Tropical Medicine, London, United Kingdom.;Institute of Tropical Medicine, Antwerp, Belgium.;Medical Research Council Unit, Banjul, The Gambia; [email protected].;London School of Hygiene and Tropical Medicine, London, United Kingdom.


摘要： BACKGROUND AND OBJECTIVES: We have recently completed a proof-of-concept trial showing that bacterial colonization decreased in women and newborns after the administration of azithromycin during labor. Here, we aim to assess the effect of the intervention on maternal and neonatal clinical infections. METHODS: This was a double-blind, placebo-controlled randomized trial. Gambian women in labor were given either an oral dose of azithromycin (2 g) or placebo. Follow-up was conducted for 8 weeks after delivery. RESULTS: From April 2013 to April 2014, we recruited 829 mothers and their 830 newborns. Sixteen infants died during the follow-up period (8 per arm). No maternal deaths or serious adverse events related to the intervention were reported. Maternal infections were lower in the azithromycin group (3.6% vs 9.2%; relative risk [RR], 0.40; 95% confidence interval [CI], 0.22-0.71; P = .002), as was the prevalence of mastitis (1.4% vs 5.1%; RR, 0.29; 95% CI, 0.12-0.70; P = .005) and fever (1.9% vs 5.8%; RR, 0.33; 95% CI, 0.15-0.74; P = .006). Among newborns, the overall prevalence of infections was also lower in the azithromycin group (18.1% vs 23.8%; RR, 0.76; 95% CI, 0.58-0.99; P = .052) and there was a marked difference in prevalence of skin infections (3.1% vs 6.4%; RR, 0.49; 95% CI, 0.25-0.93; P = .034). CONCLUSIONS: Azithromycin given to women in labor decreases infections in both women and newborns during the puerperal period. Larger studies designed to evaluate the effect of the intervention on severe morbidity and mortality are warranted.

编号：68

题名：E-cigarettes and National Adolescent Cigarette Use: 2004-2014.

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作者：Dutra LM;Glantz SA


机构：Center for Tobacco Control Research and Education, and.;Center for Tobacco Control Research and Education, and [email protected].;Department of Medicine, University of California San Francisco, San Francisco, California.


摘要： BACKGROUND: E-cigarette use is rapidly increasing among adolescents in the United States, with some suggesting that e-cigarettes are the cause of declining youth cigarette smoking. We hypothesized that the decline in youth smoking changed after e-cigarettes arrived on the US market in 2007. METHODS: Data were collected by using cross-sectional, nationally representative school-based samples of sixth- through 12th-graders from 2004-2014 National Youth Tobacco Surveys (samples ranged from 16 614 in 2013 to 25 324 in 2004). Analyses were conducted by using interrupted time series of ever (>/=1 puff) and current (last 30 days) cigarette smoking. Logistic regression was used to identify psychosocial risk factors associated with cigarette smoking in the 2004-2009 samples; this model was then applied to estimate the probability of cigarette smoking among cigarette smokers and e-cigarette users in the 2011-2014 samples. RESULTS: Youth cigarette smoking decreased linearly between 2004 and 2014 (P = .009 for ever smoking and P = .05 for current smoking), with no significant change in this trend after 2009 (P = .57 and .23). Based on the psychosocial model of smoking, including demographic characteristics, willingness to wear clothing with a tobacco logo, living with a smoker, likelihood of smoking in the next year, likelihood of smoking cigarettes from a friend, and use of tobacco products other than cigarettes or e-cigarettes, the model categorized <25% of current e-cigarette-only users (between 11.0% in 2012 and 23.1% in 2013) as current smokers. CONCLUSIONS: The introduction of e-cigarettes was not associated with a change in the linear decline in cigarette smoking among youth. E-cigarette-only users would be unlikely to have initiated tobacco product use with cigarettes.

编号：69

题名：Changing Risk Trajectories and Health Outcomes for Vulnerable Adolescents: Reclaiming the Future.

作者：DiClemente RJ;Wingood GM


机构：Rollins School of Public Health and [email protected].;Center for AIDS Research, Emory University, Atlanta, Georgia.;Mailman School of Public Health, Columbia University, New York, New York; and.;Lerner Center for Public Health Promotion, New York, New York.


摘要：

J Pediatrics 儿科学杂志103

编号：1

题名：Six-Minute Walk Test Results Predict Risk of Hospitalization for Youths with Cystic Fibrosis: A 5-Year Follow-Up Study.

作者：Donadio MV;Heinzmann-Filho JP;Vendrusculo FM;Frasson PX;Marostica PJ

出处：J Pediatr.2017V182N:204-209.e1

机构：Centro Infant, Institute of Biomedical Research, Pontificia Universidade Catolica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil; Graduate Program in Pediatrics and Child Health, PUCRS, Porto Alegre, Rio Grande do Sul, Brazil. Electronic address: [email protected].;Graduate Program in Pediatrics and Child Health, PUCRS, Porto Alegre, Rio Grande do Sul, Brazil.;Graduate Program in Pediatrics and Child Health, PUCRS, Porto Alegre, Rio Grande do Sul, Brazil.;School of Physiotherapy, Universidade Veiga de Almeida (UVA), Rio de Janeiro, Brazil.;School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.


摘要： OBJECTIVE: To evaluate the association of 6-minute walk test (6MWT) and other variables (anthropometry, chronic Pseudomonas aeroginosa colonization, pulmonary function, and respiratory muscle strength) with the risk of hospitalization for pulmonary exacerbation in children and adolescents with cystic fibrosis (CF). STUDY DESIGN: Cohort study that included patients with CF aged 6-18 years. All participants underwent spirometry, manovacuometry, and 6MWT during the 5-year follow-up. Anthropometric and clinical data were collected and the time to first hospitalization, total days of hospitalization, and antibiotic use during follow-up was recorded. RESULTS: A total of 26 patients with CF, mean age 10.2 +/- 2.8 years, were included. The group had mild impairment of lung function with a significant decline in forced expiratory volume in 1 second (P = .019) over the 5 years. Respiratory muscle strength and 6MWT proved to be preserved, although maximum inspiratory pressure increased (P < .001) and maximum expiratory pressure and 6-minute walk distance (6MWD) remained stable. There were inverse associations of 6MWD in meters (r = -0.813, P < .001) and z score (r = -0.417, P = .015) with total days of hospitalization. Moreover, there was a reduction in the risk of a first hospitalization (Cox HR 0.32; P = .037) in patients with a greater 6MWD. CONCLUSIONS: We found an association between the 6MWT and the risk of hospitalization in children and adolescents with CF. Furthermore, functional capacity apparently does not follow the expected decline in pulmonary function over time, whereas inspiratory muscle strength increases with disease progression. KEYWORDS:NOTNLM;

编号：2

题名：Benefits of Oxygen Saturation Targeting Trials: Oximeter Calibration Software Revision and Infant Saturations.

作者：Whyte RK;Nelson H;Roberts RS;Schmidt B

出处：J Pediatr.2017V182N:382-384

机构：Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.;Neonatal Trials Group, McMaster University, Hamilton, Ontario, Canada.;Department of Clinical Epidemiology and Biostatistics, McMaster

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University, Hamilton, Ontario, Canada.;Division of Neonatology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.


摘要： It has been reported in the 3 Benefits of Oxygen Saturation Targeting (BOOST-II) trials that changes in oximeter calibration software resulted in clearer separation between the oxygen saturations in the two trial target groups. A revised analysis of the published BOOST-II data does not support this conclusion. KEYWORDS:NOTNLM;

编号：3

题名：Hospitalizations for Respiratory Syncytial Virus and Vaccine-Preventable Infections in the First 2 Years After Pediatric Liver Transplant.

作者：Feldman AG;Sundaram SS;Beaty BL;Kempe A

出处：J Pediatr.2017V182N:232-238.e1

机构：Department of Pediatrics, Digestive Health Institute, Children's Hospital Colorado, Section of Gastroenterology, Hepatology and Nutrition, University of Colorado School of Medicine, Aurora, CO; Pediatric Liver Transplant Program, Digestive Health Institute, Children's Hospital Colorado, Section of Gastroenterology, Hepatology and Nutrition, University of Colorado School of Medicine, Aurora, CO; Adult and Child Consortium for Health Outcomes Research and Delivery Science, Anschutz Medical Campus & Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO. Electronic address: [email protected].;Department of Pediatrics, Digestive Health Institute, Children's Hospital Colorado, Section of Gastroenterology, Hepatology and Nutrition, University of Colorado School of Medicine, Aurora, CO; Pediatric Liver Transplant Program, Digestive Health Institute, Children's Hospital Colorado, Section of Gastroenterology, Hepatology and Nutrition, University of Colorado School of Medicine, Aurora, CO.;Adult and Child Consortium for Health Outcomes Research and Delivery Science, Anschutz Medical Campus & Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO.;Adult and Child Consortium for Health Outcomes Research and Delivery Science, Anschutz Medical Campus & Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO; Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO.


摘要： OBJECTIVES: To examine in liver transplant recipients at centers participating in the Pediatric Health Information System dataset the number of hospitalizations for respiratory syncytial virus (RSV) and vaccine-preventable infections (VPIs) in the first 2 years after transplantation, morbidity and mortality associated with these hospitalizations, and costs associated with these hospitalizations. STUDY DESIGN: A retrospective cohort study of patients <18 years of age who underwent liver transplantation at a Pediatric Health Information System center between January 1, 2004, and December 31, 2012. Hospitalizations for RSV/VPIs during the first 2 years post-transplant were ascertained using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Data were collected on clinical care, outcomes, and costs during these hospitalizations. RESULTS: There were 2554 liver transplant recipients identified; 415 patients (16.3%) had 544 cases of RSV/VPIs. RSV, rotavirus, and influenza were the most common infections resulting in hospitalization. Ninety-two patients (3.6%) had RSV/VPI during their transplant hospitalization. Transplant hospitalizations complicated by RSV/VPI were longer (44 days vs. 21 days; P < .001), had higher rejection rates (37% vs. 26%; P = .02), and were more expensive ($259 697 vs. $190 860; P < .001). Multivariate analyses identified age <2 years at transplant (P < .001) and multivisceral recipient (P = .04) as predictors of a hospitalization for RSV. CONCLUSIONS: VPIs occurred in 1 of 6 liver transplant recipients in the first 2 years

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post-transplant, a significantly higher rate than in the general pediatric population. These hospitalizations had substantial morbidity, mortality, and costs, demonstrating the importance of vaccinating patients before transplantation. KEYWORDS:NOTNLM;

编号：4

题名：Promoting Resilience in Academic Medicine: Fertile Ground for Future Work.

作者：O'Brien SE;Simpkin AL;Spector ND


机构：Department of Pediatrics, Boston University School of Medicine, Boston, MA. Electronic address: [email protected].;Department of Medicine, Massachusetts General Hospital, Boston, MA.;Department of Pediatrics, Drexel University School of Medicine, Philadelphia, PA.

文献类型：Editorial

摘要：

编号：5

题名：Clinical Relevance of the Nonvisualized Appendix on Ultrasonography of the Abdomen in Children.

作者：Nah SA;Ong SS;Lim WX;Amuddhu SK;Tang PH;Low Y

出处：J Pediatr.2017V182N:164-169.e1

机构：Pediatric Surgery, KK Women's and Children's Hospital, Singapore. Electronic address: [email protected].;Yong Loo Lin School of Medicine, National University of Singapore, Singapore.;Yong Loo Lin School of Medicine, National University of Singapore, Singapore.;Yong Loo Lin School of Medicine, National University of Singapore, Singapore.;Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore; Duke-National University of Singapore Medical School, Singapore.;Pediatric Surgery, KK Women's and Children's Hospital, Singapore; Duke-National University of Singapore Medical School, Singapore.


摘要： OBJECTIVES: To evaluate the clinical relevance of the nonvisualized appendix on ultrasound imaging in children with right lower quadrant pain. STUDY DESIGN: We reviewed 1359 children admitted for abdominal pain between January and December 2013 who had abdominal ultrasound imaging for right lower quadrant pain. Patients who had scans for genitourinary symptoms or intussusception were excluded from the study. When the appendix was not visualized, secondary signs indicating right lower quadrant inflammatory pathology were noted. RESULTS: Of all admissions for abdominal pain, 810 had ultrasound scans. Thirty-eight did not evaluate the appendix and 131 were

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excluded for suspected intussusception, leaving 641 reports for children with a median age of 10.8 years (range, 1.3-21.3); 297 were boys (46.3%). There were 17 of 160 patients with a nonvisualized appendix (10.6%) who underwent appendectomy. Of these, 14 had secondary signs on ultrasound imaging and 3 (1.9%) had normal ultrasound reports. The 3 patients with normal ultrasound imaging had computed tomography imaging confirming appendicitis. There were 51 patients with a partially visualized appendix. The segment of appendix that could be seen was normal in 34 patients, none of whom had appendectomy. The remaining 17 had appendectomy, in whom the appendix seemed to be inflamed in 13 and equivocal in 4, all with histologically confirmed appendicitis. Overall, 232 children underwent appendectomy; 58 had no ultrasound imaging done, and 5 had a histologically normal appendix (overall negative appendectomy rate, 2.2%). Only 35 of 1359 patients (0.03%) had computed tomography scans. CONCLUSION: In patients with a nonvisualized appendix on ultrasound imaging and no evidence of secondary inflammatory changes, the likelihood of appendicitis is less than 2%. Generous use of ultrasonography as an adjunct to clinical examination can achieve low negative appendectomy rates without underdiagnosis of acute appendicitis. KEYWORDS:NOTNLM;

编号：6

题名：Antibiotic Use in Children - A Cross-National Analysis of 6 Countries.

作者：Youngster I;Avorn J;Belleudi V;Cantarutti A;Diez-Domingo J;Kirchmayer U;Park BJ;Peiro S;Sanfelix-Gimeno G;Schroder H;Schussel K;Shin JY;Shin SM;Simonsen GS;Blix HS;Tong A;Trifiro G;Ziv-Baran T;Kim SC

出处：J Pediatr.2017V182N:239-244.e1

机构：Division of Infectious Diseases, Boston Children's Hospital, Boston, MA. Electronic address: [email protected].;Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA.;Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.;Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.;Health Services Research Unit, Center for Public Health Research, Valencia, Spain.;Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.;Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.;Health Services Research Unit, Center for Public Health Research, Valencia, Spain.;Health Services Research Unit, Center for Public Health Research, Valencia, Spain.;Wissenschaftliches Institut der AOK WIdO (Scientific Institute of the AOK), Berlin, Germany.;Wissenschaftliches Institut der AOK WIdO (Scientific Institute of the AOK), Berlin, Germany.;Korea Institute of Drug Safety and Risk Management, Seoul, Republic of Korea.;Korea Institute of Drug Safety and Risk Management, Seoul, Republic of Korea.;Department of Microbiology and Infection Control, University Hospital of North Norway, Tromso, Norway.;Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway.;Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA.;Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.;Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.;Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA.


摘要： OBJECTIVES: To describe the rates of pediatric antibiotic use across 6 countries on 3 continents. STUDY DESIGN: Cross-national analysis of 7 pediatric cohorts in 6 countries (Germany, Italy, South Korea, Norway, Spain, and the US) was performed for 2008-2012. Antibiotic dispensings were identified and grouped into subclasses. We calculated the rates of antimicrobial prescriptions per person-year specific to each age group, comparing the rates across different countries. RESULTS: A total of 74 744 302 person-years from all participating centers were included in this analysis. Infants in South Korea had the highest rate of antimicrobial consumption, with 3.41 prescribed courses per child-year during the first 2 years of life. This compares with 1.6 in Lazio, Italy; 1.4 in Pedianet, Italy; 1.5 in Spain; 1.1 in the US; 1.0 in Germany; and 0.5 courses per child-year in Norway. Of antimicrobial prescriptions written in Norway,

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64.8% were for first-line penicillins, compared with 38.2% in Germany, 31.8% in the US, 27.7% in Spain, 25.1% in the Italian Pedianet population, 9.8% in South Korea, and 8% in the Italian Lazio population. CONCLUSIONS: We found substantial differences of up to 7.5-fold in pediatric antimicrobial use across several industrialized countries from Europe, Asia, and North America. These data reinforce the need to develop strategies to decrease the unnecessary use of antimicrobial agents. KEYWORDS:NOTNLM;

编号：7

题名：Birth Weight for Gestational Age, Anthropometric Measures, and Cardiovascular Disease Markers in Children.

作者：Kuhle S;Maguire B;Ata N;MacInnis N;Dodds L


机构：Perinatal Epidemiology Research Unit, Departments of Obstetrics and Gynaecology and Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada. Electronic address: [email protected].;Perinatal Epidemiology Research Unit, Departments of Obstetrics and Gynaecology and Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Mathematics and Statistics, Dalhousie University, Halifax, Nova Scotia, Canada.;School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada.;Perinatal Epidemiology Research Unit, Departments of Obstetrics and Gynaecology and Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.;Perinatal Epidemiology Research Unit, Departments of Obstetrics and Gynaecology and Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.


摘要： OBJECTIVE: To examine the association of birth weight for gestational age with anthropometric measures and cardiometabolic markers in a population-based sample of Canadian children. STUDY DESIGN: The study used data from 2016 children aged 6-12 years from the first 2 cycles of the Canadian Health Measures Survey, a population-based survey of Canadian residents. The main exposure was birth weight for gestational age (small [SGA], large [LGA], and appropriate for gestational age [AGA]). The outcomes were anthropometric measures, blood pressure, and laboratory cardiovascular disease markers. The association between the exposure and the outcomes was examined using multiple regression. Analyses were weighted to account for the complex sampling design and for nonresponse. RESULTS: SGA infants had lower and LGA infants had higher z scores for anthropometric measures compared with the AGA group but most differences were not statistically significant. There were no differences between the SGA or LGA infants and the AGA group in blood pressure or individual cardiometabolic markers but SGA infants were significantly less likely to have elevated levels of 3 or more components of the metabolic syndrome compared with their AGA peers. CONCLUSIONS: Former SGA and LGA infants have lower (SGA) and higher (LGA) body mass index and waist circumference, respectively, than their AGA peers. The known long-term increased cardiovascular disease risk among SGA or LGA infants was not reflected in the blood pressure and laboratory measurements at age 6-12 years. KEYWORDS:NOTNLM;

编号：8

题名：Respiratory Distress in a 3-Month-Old Infant with a Mass Obstructing the Right Main-Stem Bronchus: An Unusual Localization of Infantile Hemangioma.

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作者：Sacco O;Moscatelli A;Nozza P;Rossi GA

出处：J Pediatr.2017V182N:397-397.e1

机构：Pediatric Pulmonary and Allergy Disease Unit and Cystic Fibrosis Center.;Neonatal and Pediatric Intensive Care Units.;Pathology Unit.;Pediatric Pulmonary and Allergy Disease Unit and Cystic Fibrosis Center Istituto Giannina Gaslini Genoa, Italy.


摘要： KEYWORDS:NOTNLM;

编号：9

题名：Epiploic Appendagitis: A Rare Cause of Chronic Right Lower Quadrant Pain in a Child.

作者：Ullah I;Mahajan L;Magnuson D

出处：J Pediatr.2017V182N:400-400.e1

机构：Department of Pediatrics Charleston Area Medical Center (CAMC) West Virginia University - Charleston Division Charleston, West Virginia; Department of Pediatric Gastroenterology Cleveland Clinic Children's Hospital Cleveland, Ohio.;Department of Pediatrics Charleston Area Medical Center (CAMC) West Virginia University - Charleston Division Charleston, West Virginia; Department of Pediatric Gastroenterology Cleveland Clinic Children's Hospital Cleveland, Ohio.;Department of Pediatrics Charleston Area Medical Center (CAMC) West Virginia University - Charleston Division Charleston, West Virginia; Department of Pediatric Gastroenterology Cleveland Clinic Children's Hospital Cleveland, Ohio.



编号：10

题名：Congenital Cases of Concomitant Harlequin and Horner Syndromes.

作者：Miquel J;Piyaraly S;Dupuy A;Cochat P;Phan A


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机构：Unit of Pediatric Dermatology, Femme-Mere-Enfant Hospital, University Hospital of South Reunion, Saint-Pierre, Reunion, France. Electronic address: [email protected].;Department of Pediatrics, Femme-Mere-Enfant Hospital, University Hospital of South Reunion, Saint Pierre, Reunion, France.;Department of Dermatology, University Hospital of Pontchaillou, Rennes, France.;Department of Pediatric Dermatology, Femme-Mere-Enfant Hospital, Hospices Civils de Lyon, Claude-Bernard-Lyon 1 University, Lyon, France.;Department of Pediatric Dermatology, Femme-Mere-Enfant Hospital, Hospices Civils de Lyon, Claude-Bernard-Lyon 1 University, Lyon, France.


摘要： We report three pediatric cases of concomitant congenital Horner and Harlequin syndromes. This association suggests a lesion at the superior cervical ganglion or just inferior. Often, no underlying lesion is documented. KEYWORDS:NOTNLM;

编号：11

题名：Reply.

作者：Sung SI;Park WS

出处：J Pediatr.2017V182N:407

机构：Department of Pediatrics Samsung Medical Center Sungkyunkwan University School of Medicine Seoul, South Korea.


摘要：

编号：12

题名：Maternal depression, vitamin D, and offspring obesity.

作者：Cerit Z


机构：Department of Pediatrics Near East University Hospital Nicosia, Cyprus.


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摘要：

编号：13

题名：Left Ventricular Function in Healthy Term Neonates During the Transitional Period.

作者：Jain A;El-Khuffash AF;Kuipers BC;Mohamed A;Connelly KA;McNamara PJ;Jankov RP;Mertens L

出处：J Pediatr.2017V182N:197-203.e2

机构：Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada. Electronic address: [email protected].;Department of Neonatology, The Rotunda Hospital, Dublin, Ireland; Department of Pediatrics, The Royal College of Surgeons in Ireland, School of Medicine, Dublin, Ireland.;Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatric Cardiology, Radboud UMC, Nijmegen, The Netherlands.;Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.;Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada; The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.;Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.;Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada; The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.;Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Heart and Stroke Richard Lewar Center of Excellence in Cardiovascular Research, Toronto, Canada.


摘要： OBJECTIVES: To evaluate whether incorporating conventional, tissue Doppler imaging and speckle tracking echocardiography are reliable and can characterize changes in left ventricular (LV) function properly in healthy neonates in the early transitional newborn period. STUDY DESIGN: A prospective observational study was conducted in 50 healthy term neonates with a mean +/- SD gestational age and birth weight of 39.3 +/- 1.2 weeks and 3.5 +/- 0.44 kg, respectively. All infants underwent serial echocardiograms at 15 +/- 2 (day 1) and 35 +/- 2 hours (day 2) of age. The LV dimensions and various functional indices including tissue Doppler imaging velocities and speckle tracking echocardiography-derived peak longitudinal strain, and systolic and diastolic strain rate were acquired and compared between time points. RESULTS: All measurements were feasible from each scan except speckle tracking echocardiography in 10% and 20% of images on days 1 and 2 of age, respectively. LV dimensions, but not functional measures, demonstrated a small to moderate positive correlation with birth weight. On day 2, a small reduction was observed in LV basal diameter, mitral valve inflow velocity time integral, and systolic velocity of the lateral wall and septum. Other indices remained unchanged. Tissue Doppler imaging-derived functional and flow-derived hemodynamic measures demonstrated the least measurement bias, and strain measurements demonstrated better reliability than strain rate, fractional shortening, and ejection fraction. CONCLUSION: The relative reliability of various echocardiographic indices to quantify LV function in neonates establish a normative dataset and provide evidence for their validity during the first 2 days of life. KEYWORDS:NOTNLM;

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编号：14

题名：Mandatory closure versus nonintervention for patent ductus arteriosus in very preterm infants.

作者：Mimouni FB;Hammerman C


机构：Department of Neonatology Shaare Zedek Medical Center Jerusalem, Israel; Sackler Faculty of Medicine Tel Aviv University Tel Aviv, Israel.;Department of Neonatology Shaare Zedek Medical Center Jerusalem, Israel; Faculty of Medicine Hebrew University Jerusalem, Israel.


摘要：

编号：15

题名：Reply.

作者：Braungart-Rieker JM;Lefever JB;Planalp EM;Moore ES


机构：University of Notre Dame Notre Dame, Indiana.;University of Notre Dame Notre Dame, Indiana.;University of Wisconsin Madison, Wisconsin.;University of Notre Dame Notre Dame, Indiana.


摘要：

编号：16

题名：Molecular Changes in Children with Heart Failure Undergoing Left Ventricular Assist Device Therapy.

作者：Medina E;Sucharov CC;Nelson P;Miyamoto SD;Stauffer BL

出处：J Pediatr.2017V182N:184-189.e1

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机构：Division of Cardiology, Department of Medicine, University of Colorado Denver, Aurora, CO.;Division of Cardiology, Department of Medicine, University of Colorado Denver, Aurora, CO.;Division of Cardiology, Department of Medicine, University of Colorado Denver, Aurora, CO.;Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO.;Division of Cardiology, Department of Medicine, University of Colorado Denver, Aurora, CO; Division of Cardiology, Department of Medicine, Denver Health and Hospital Authority, Denver, CO.


摘要： OBJECTIVE: To determine whether left ventricular assist device (LVAD) treatment in children with heart failure would result in the modification of molecular pathways involved in heart failure pathophysiology. STUDY DESIGN: Forty-seven explanted hearts from children were studied (16 nonfailing control, 20 failing, and 11 failing post-LVAD implantation [F-LVAD]). Protein expression and phosphorylation states were determined by receptor binding assays and Western blots. mRNA expression was measured with real-time quantitative polymerase chain reaction. To evaluate for interactions and identify correlations, 2-way ANOVA and regression analysis were performed. RESULTS: Treatment with LVAD resulted in recovery of total beta-adrenergic receptor expression and beta1-adrenergic receptor (beta1-AR) in failing hearts to normal levels (beta-adrenergic receptor expression : 67.2 +/- 11.5 fmol/mg failing vs 99.5 +/- 27.7 fmol/mg nonfailing, 104 +/- 38.7 fmol/mg F-LVAD, P </= .01; beta1-AR: 52.2 +/- 10.3 fmol/mg failing vs 83.0 +/- 23 fmol/mg non-failing, 76.5 +/- 32.1 fmol/mg F-LVAD P </= .03). The high levels of G protein-coupled receptor kinase-2 were returned to nonfailing levels after LVAD treatment (5.6 +/- 9.0 failing vs 1.0 +/- 0.493 nonfailing, 1.0 +/- 1.3 F-LVAD). Interestingly, beta2-adrenergic receptor expression was significantly greater in F-LVAD (27.5 +/- 12; P < .005) hearts compared with nonfailing (16.4 +/- 6.1) and failing (15.1 +/- 4.2) hearts. Phospholamban phosphorylation at serine 16 was significantly greater in F-LVAD (7.7 +/- 11.7) hearts compared with nonfailing (1.0 +/- 1.2, P = .02) and failing (0.8 +/- 1.0, P = .01) hearts. Also, atrial natriuretic factor (0.6 +/- 0.8) and brain natriuretic peptide (0.1 +/- 0.1) expression in F-LVAD was significantly lower compared with failing hearts (2.8 +/- 3.6, P = .01 and 0.6 +/- 0.7, P = .02). CONCLUSION: LVAD treatment in children with heart failure results in reversal of several pathologic myocellular processes, and G protein-coupled receptor kinase-2 may regulate beta1-AR but not beta2-adrenergic receptor expression in children with heart failure. KEYWORDS:NOTNLM;

编号：17

题名：Obesity as a Mediator between Cardiorespiratory Fitness and Blood Pressure in Preschoolers.

作者：Pozuelo-Carrascosa DP;Sanchez-Lopez M;Cavero-Redondo I;Torres-Costoso A;Bermejo-Cantarero A;Martinez-Vizcaino V

出处：J Pediatr.2017V182N:114-119.e2

机构：Social and Health Care Research Center, University of Castilla-La Mancha, Cuenca, Spain.;Social and Health Care Research Center, University of Castilla-La Mancha, Cuenca, Spain; School of Education, University of Castilla-La Mancha, Ciudad Real, Spain.;Social and Health Care Research Center, University of Castilla-La Mancha, Cuenca, Spain.;School of Nursing and Physiotherapy, University of Castilla-La Mancha, Toledo, Spain.;Social and Health Care Research Center, University of Castilla-La Mancha, Cuenca, Spain.;Social and Health Care Research Center, University of Castilla-La Mancha, Cuenca, Spain; Faculty of Health Sciences, Autonomous University of Chile, Talca, Chile. Electronic address: [email protected].


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摘要： OBJECTIVES: To analyze the relationships between body mass index (BMI), cardiorespiratory fitness (CRF), and blood pressure (BP), and to examine whether obesity acts as a mediator between fitness and BP in children. STUDY DESIGN: A cross-sectional analysis using a population-based sample of 1604 school children aged 4-7 years attending 21 schools from the provinces of Ciudad Real and Cuenca, Spain, was undertaken. Data on anthropometric variables, BP measurements, and CRF were collected. The relationships between body composition (BMI, percent body fat, and waist circumference), CRF, and mean arterial pressure was estimated using Pearson correlation coefficients. ANCOVA tested the differences in BP measurements by categories of BMI and CRF, controlling for different sets of confounders. The PROCESS macro developed by Preacher and Hayes was used for mediation analysis. RESULTS: BP values were significantly higher in school children with excess weight and poorer CRF. In addition, BMI acts as a full mediator in the association between CRF and mean arterial pressure in boys at 62.28% (z = -5.433; P </= .001) and a partial mediator in girls at 35.24% (z = -5.246; P </= .001). CONCLUSIONS: BMI mediates the relationship between CRF and mean arterial pressure. These findings highlight the importance of maintaining a healthy weight for the prevention of high BP levels in childhood. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01971840. KEYWORDS:NOTNLM;

编号：18

题名：Cardiac Arrest in Pediatric Patients Receiving Azithromycin.

作者：Valdes SO;Kim JJ;Niu MC;de la Uz CM;Miyake CY;Moffett BS

出处：J Pediatr.2017V182N:311-314.e1

机构：Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX. Electronic address: [email protected].;Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.;Oklahoma Children's Heart Center, Oklahoma University Health Sciences Center, Oklahoma City, OK.;Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.;Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.;Department of Pharmacy, Texas Children's Hospital, Houston, TX.


摘要： OBJECTIVE: To compare outcomes of pediatric patients treated with azithromycin compared with penicillin or cephalosporin. We hypothesized that azithromycin use would not be associated with increased cardiac mortality in the pediatric population. STUDY DESIGN: Retrospective cohort study from the Pediatric Health Information System database between 2008 and 2012. Patients <19 years of age with a principal diagnosis of community-acquired pneumonia who received an antibiotic were included. Primary outcomes were cardiopulmonary resuscitation (CPR) and mortality. Secondary outcomes were ventricular arrhythmias incidences and readmission for ventricular arrhythmia. Statistical analysis was performed with the chi2 test. Multivariable analysis was performed to control for potential confounders among patient, event, and treatment characteristics. RESULTS: A total of 82 982 patients (54.3% males) met study criteria. Median age was 2.6 years (IQR 1.2-5.9 years) and median length of stay was 2 days (IQR 2-4 days). Azithromycin was used in 5039 (6.1%); penicillin or cephalosporin was used in 77 943 (93.9%). Overall prevalence of antibiotic-associated CPR was 0.14%. Patients receiving a macrolide antibiotic had a lower prevalence of CPR compared with patients receiving a penicillin or cephalosporin (0.04% vs 0.14%, P = .04), and there was no difference in mortality. Multivariable analysis did not find an association between macrolide use and CPR. CONCLUSIONS: In contrast to recent adult studies, among children hospitalized for community-acquired pneumonia, azithromycin use was not associated with a greater prevalence of cardiac arrest compared with penicillin or cephalosporin use. KEYWORDS:NOTNLM;

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编号：19

题名：Effects of Prophylactic Indomethacin on Vasopressor-Dependent Hypotension in Extremely Preterm Infants.

作者：Liebowitz M;Koo J;Wickremasinghe A;Allen IE;Clyman RI

出处：J Pediatr.2017V182N:21-27.e2

机构：Department of Pediatrics, University of California San Francisco, San Francisco, CA.;Department of Pediatrics, University of California San Francisco, San Francisco, CA.;Department of Pediatrics, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA.;Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA.;Department of Pediatrics, University of California San Francisco, San Francisco, CA; Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA. Electronic address: [email protected].


摘要： OBJECTIVE: To determine whether a moderate-to-large patent ductus arteriosus (PDA) is responsible for vasopressor-dependent hypotension, occurring at the end of the first postnatal week. STUDY DESIGN: We performed a retrospective, double cohort controlled study of infants delivered at </=27+6 weeks' gestation (n = 313). From January 2004 through April 2011, all infants were treated with prophylactic indomethacin ([PINDO] epoch). From May 2011 through December 2015, no infant was treated with indomethacin until at least 8 postnatal days (conservative epoch). Echocardiograms were performed on postnatal days 6 or 7. Hypotension was managed by a predefined protocol. The primary outcome was the incidence of dopamine-dependent hypotension, defined as having received at least 6 microg/kg/min dopamine for at least 24 hours during postnatal days 4-7. RESULTS: As expected, the incidence of moderate-to-large PDA at the end of the first week differed significantly between epochs (PINDO = 8%; conservative = 64%). In multivariate analyses, infants in the PINDO epoch had a significantly lower incidence of vasopressor-dependent hypotension (11%) than infants in the conservative epoch (21%; OR = 0.40, 95% CI 0.20-0.82). Infants in the PINDO epoch also required less mean airway pressure, had a lower respiratory severity score, and lower mode of ventilation score than infants in the conservative epoch during postnatal days 4-7. The effects of PINDO on both the incidence of vasopressor-dependent hypotension and the need for respiratory support were no longer significant when analyses were adjusted for "presence or absence of a moderate-to-large PDA." CONCLUSION: PINDO decreases vasopressor-dependent hypotension and the need for respiratory support at the end of the first postnatal week. These effects are mediated by closure of the PDA. KEYWORDS:NOTNLM;

编号：20

题名：Caring for Children with Medical Complexity: Perspectives of Primary Care Providers.

作者：Foster CC;Mangione-Smith R;Simon TD

出处：J Pediatr.2017V182N:275-282.e4

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机构：Department of Pediatrics, University of Washington, Seattle, WA; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA.;Department of Pediatrics, University of Washington, Seattle, WA; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA.;Department of Pediatrics, University of Washington, Seattle, WA; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA.


摘要： OBJECTIVE: To describe typical care experiences and key barriers and facilitators to caring for children with medical complexity (CMC) from the perspective of community primary care providers (PCPs). STUDY DESIGN: PCPs participating in a randomized controlled trial of a care-coordination intervention for CMC were sent a 1-time cross-sectional survey that asked PCPs to (1) describe their experiences with caring for CMC; (2) identify key barriers affecting their ability to care for CMC; and (3) prioritize facilitators enhancing their ability to provide care coordination for CMC. PCP and practice demographics also were collected. RESULTS: One hundred thirteen of 155 PCPs sent the survey responded fully (completion rate = 73%). PCPs endorsed that medical characteristics such as polypharmacy (88%), multiorgan system involvement (84%), and rare/unfamiliar diagnoses (83%) negatively affected care. Caregivers with high needs (88%), limited time with patients and caregivers (81%), and having a large number of specialists involved in care (79%) were also frequently cited. Most commonly endorsed strategies to improve care coordination included more time with patients/caregivers (84%), summative action plans (83%), and facilitated communication (eg, e-mail, phone meetings) with specialists (83%). CONCLUSIONS: Community PCPs prioritized more time with patients and their families, better communication with specialists, and summative action plans to improve care coordination for this vulnerable population. Although this study evaluated perceptions rather than actual performance, it provides insights to improve understanding of which barriers and facilitators ideally might be targeted first for care delivery redesign. KEYWORDS:NOTNLM;

编号：21

题名：Reply.

作者：Shin SH;Kim SY;Kim HS


机构：Department of Pediatrics Seoul National University College of Medicine Seoul, Republic of Korea.;Department of Pediatrics Seoul National University College of Medicine Seoul, Republic of Korea; Department of Pediatrics Kangwon National University Hospital Chuncheon, Republic of Korea.;Department of Pediatrics Seoul National University College of Medicine Seoul, Republic of Korea.


摘要：

编号：22

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题名：Caffeine for apnea in bronchiolitis.

作者：Maheux A;Pladys P;Laviolle B


机构：Pediatrics Department Hopital Sud CHU Rennes.;Pediatrics Department Neonatology and CIC Inserm 1414 Hopital Sud CHU Rennes; Faculty of Medecine Rennes 1 University.;Faculty of Medecine Rennes 1 University; Department of Clinical Pharmacology Hopital de Pontchaillou CHU de Rennes Rennes, France.


摘要：

编号：23

题名：Cerebellar Microstructural Organization is Altered by Complications of Premature Birth: A Case-Control Study.

作者：Brossard-Racine M;Poretti A;Murnick J;Bouyssi-Kobar M;McCarter R;du Plessis AJ;Limperopoulos C


机构：Montreal Children's Hospital, Division of Pediatric Neurology, McGill University Health Centre, Montreal, Quebec, Canada; School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.;Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD.;Division of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC.;Division of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC; Developing Brain Research Laboratory, Children's National Health System, Washington, DC.;Center for Translational Science, Children's National Health System, Washington, DC.;Fetal and Transitional Medicine, Children's National Health System, Washington, DC.;Division of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC; Developing Brain Research Laboratory, Children's National Health System, Washington, DC. Electronic address: [email protected].


摘要： OBJECTIVES: To compare regional cerebellar microstructure, as measured by diffusion tensor imaging (DTI), between preterm infants at term-equivalent age and healthy term-born control neonates, and to explore associations between DTI findings and clinical risk factors. STUDY DESIGN: In this case-control study, DTI studies were performed in 73 premature infants born </=32 weeks and </=1500 g birth weight and 73 full-term-born controls from healthy pregnancies. Using a region of interest approach, fractional anisotropy (FA) and mean diffusivity (MD) were extracted in 7 cerebellar regions including the anterior vermis, the right/left superior cerebellar peduncles, the middle cerebellar peduncle, and the dentate nuclei. To validate further our DTI measurements, we measured FA and MD in the genu of the corpus callosum and splenium. FA and MD were compared between groups using analyses of multiple linear regression models. RESULTS: Preterm infants at term-equivalent age presented with higher FA in the dentate nuclei (<.001) and middle cerebellar peduncle (.028), and lower MD in the vermis (.023) compared with controls. Conversely, preterm infants showed reduced FA and increased MD in both the genu of the corpus callosum and splenium (P < .001). Independent risk factors associated with altered FA and MD in the cerebellum included low Apgar score, supratentorial injury, compromised cardiorespiratory function, and surgery for necrotizing enterocolitis and

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patent ductus arteriosus. CONCLUSIONS: This DTI study provides evidence that complications of premature birth are associated with altered cerebellar microstructural organization when compared with term-born control infants. KEYWORDS:NOTNLM;

编号：24

题名：Maternal Education Is Associated with Disparities in Breastfeeding at Time of Discharge but Not at Initiation of Enteral Feeding in the Neonatal Intensive Care Unit.

作者：Herich LC;Cuttini M;Croci I;Franco F;Di Lallo D;Baronciani D;Fares K;Gargano G;Raponi M;Zeitlin J


机构：Research Unit of Perinatal Epidemiology, Clinical Care and Management Innovation Research Area, Bambino Gesu Children's Hospital, IRCCS, Rome, Italy.;Research Unit of Perinatal Epidemiology, Clinical Care and Management Innovation Research Area, Bambino Gesu Children's Hospital, IRCCS, Rome, Italy. Electronic address: [email protected].;Research Unit of Perinatal Epidemiology, Clinical Care and Management Innovation Research Area, Bambino Gesu Children's Hospital, IRCCS, Rome, Italy.;Hospital Network Planning and Research Area, Lazio Regional Health Authority, Rome, Italy.;Hospital Network Planning and Research Area, Lazio Regional Health Authority, Rome, Italy.;Hospital Care Services, General Directorate for Health and Social Policies, Emilia Romagna Region, Bologna, Italy.;Neonatal Intensive Care Unit, Salesi Children's Hospital, Ancona, Italy.;Neonatal Intensive Care Unit, Department of Obstetrics and Pediatrics, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy.;Clinical Care and Management Innovation Research Area, Bambino Gesu Children's Hospital, IRCCS, Rome, Italy.;INSERM, Obstetrics, Perinatal and Paediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics (U1153), and DHU Risks in Pregnancy, Paris Descartes University, Paris, France.


摘要： OBJECTIVE: To investigate the relationship between maternal education and breastfeeding in very preterm infants admitted to neonatal intensive care units. STUDY DESIGN: This prospective, population-based cohort study analyzed the data of all very preterm infants admitted to neonatal care during 1 year in 3 regions in Italy (Lazio, Emilia-Romagna, and Marche). The use of mothers' own milk was recorded at initial enteral feedings and at hospital discharge. We used multilevel logistic analysis to model the association between maternal education and breastfeeding outcomes, adjusting for maternal age and country of birth. Region was included as random effect. RESULTS: There were 1047 very preterm infants who received enteral feeding, and 975 were discharged alive. At discharge, the use of mother's own milk, exclusively or not, and feeding directly at the breast were significantly more likely for mothers with an upper secondary education or higher. We found no relationship between maternal education and type of milk at initial enteral feedings. However, the exclusive early use of the mother's own milk at initial feedings was related significantly with receiving any maternal milk and feeding directly at the breast at discharge from hospital, and the association with feeding at the breast was stronger for the least educated mothers. CONCLUSION: In this population-based cohort of very preterm infants, we found a significant and positive association between maternal education and the likelihood of receiving their mother's own milk at the time of discharge. In light of the proven benefits of maternal milk, strategies to support breastfeeding should be targeted to mothers with less education. KEYWORDS:NOTNLM;

编号：25

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题名：A Teenager with Sudden Unilateral Breast Enlargement.

作者：Pellegrin MC;Naviglio S;Cattaruzzi E;Barbi E;Ventura A


机构：University of Trieste.;University of Trieste.;Institute for Maternal and Child Health IRCCS Burlo Garofolo.;Institute for Maternal and Child Health IRCCS Burlo Garofolo.;University of Trieste; Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste, Italy.



编号：26

题名：Recalcitrant Facial Eruption.

作者：Herz-Ruelas ME;Gonzalez-Gonzalez G;Bodden-Mendoza BA;Martinez-Cabriales SA

出处：J Pediatr.2017V182N:393-393.e1

机构：Department of Dermatology.;Department of Microbiology.;Department of Microbiology.;Department of Dermatology University Hospital "Dr Jose E. Gonzalez" Universidad Autonoma de Nuevo Leon Monterrey, Mexico.



编号：27

题名：Predicting Undernutrition at Age 2 Years with Early Attained Weight and Length Compared with Weight and Length Velocity.

作者：Schwinger C;Fadnes LT;Shrestha SK;Shrestha PS;Chandyo RK;Shrestha B;Ulak M;Bodhidatta L;Mason C;Strand TA

出处：J Pediatr.2017V182N:127-132.e1

机构：Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. Electronic address: [email protected].;Centre for International Health, Department of Global Public

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Health and Primary Care, University of Bergen, Bergen, Norway; Department of Clinical Dentistry, University of Bergen, Bergen, Norway.;Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Research Unit, Walter Reed/Armed Forces Research Institute of Medical Sciences, Kathmandu, Nepal.;Department of Child Health, Institute of Medicine, Tribuhvan University, Kathmandu, Nepal.;Department of Child Health, Institute of Medicine, Tribuhvan University, Kathmandu, Nepal.;Research Unit, Walter Reed/Armed Forces Research Institute of Medical Sciences, Kathmandu, Nepal.;Department of Child Health, Institute of Medicine, Tribuhvan University, Kathmandu, Nepal.;Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand.;Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand.;Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Research, Innlandet Hospital Trust, Lillehammer, Norway.


摘要： OBJECTIVE: To estimate the abilities of weight and length velocities vs attained growth measures to predict stunting, wasting, and underweight at age 2 years. STUDY DESIGN: We analyzed data from a community-based cohort study (The Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development study [MAL-ED] study) in Bhaktapur, Nepal. A total of 240 randomly selected children were enrolled at birth and followed up monthly up to age 24 months. Linear and logistic regression models were used to predict malnutrition at 2 years of age with growth velocity z scores at 0-3, 0-6, 3-6, 6-9, 6-12, and 9-12 months (using the World Health Organization Growth Standards) or attained growth at 0, 3, 6, and 12 months as predictors. RESULTS: At age 2 years, 4% of the children were wasted, 13% underweight, and 21% stunted. Children who were malnourished at age 2 years had lower mean growth z scores already at birth and throughout the study period. Anthropometric indicators in infancy were significant predictors for growth at the age of 2 years during most periods and at most ages in infancy. Weight-for-age z score, length-for-age z score, and weight-for-length z score at age 12 months had excellent areas under the curve (91-95) to predict the value of the same indicator at age 24 months. Maximum area under the curve values for weight and length velocity were somewhat lower (70-84). CONCLUSIONS: Growth measured at one time point in infancy was better correlated with undernutrition at age 2 years than growth velocity. KEYWORDS:NOTNLM;

编号：28

题名：Lower Basal Insulin Dose is Associated with Better Control in Type 1 Diabetes.

作者：Strich D;Balagour L;Shenker J;Gillis D


机构：Clalit Health Services, Jerusalem District, Israel; Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel.;Department of Medical Students, Hadassah-Hebrew University School of Medicine, Jerusalem, Israel.;Clalit Health Services, Jerusalem District, Israel.;Department of Pediatrics and Pediatric Endocrine Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Electronic address: [email protected].


摘要： OBJECTIVE: To test the hypothesis that lower basal insulin doses may be paradoxically associated with better diabetic control, we assessed the association between the basal insulin dose and hemoglobin A1c (HbA1c) level in a group of children and young adults with type 1 diabetes. STUDY DESIGN: This was a retrospective study of 89 patients with type 1 diabetes (mean age, 14.67 +/- 4.8 years; range, 3-29 years) treated in a single outpatient clinic.

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Forty-six of the 89 patients were treated with continuous subcutaneous insulin infusion, and the other 43 were treated with multiple daily injections (glargine as basal insulin). The daily basal insulin dose was taken either as downloaded from the insulin pump or as registered in the chart at the most recent clinic visit. Glucose data were taken from computerized registration of downloaded patient glucometers. The mean time between data download and HbA1c determination was 0.9 +/- 0.78 months. HbA1c level and basal insulin dose were entered with other variables in a multivariable linear regression model. RESULTS: There was a significant correlation between injection of less total daily basal insulin and lower HbA1c level (Pearson correlation, 0.441; P < .001). Optimal HbA1c level was associated with use of 0.28 +/- 0.08 U/kg/day of basal insulin (35 +/- 10% basal/total). CONCLUSION: With lower basal insulin levels, lower HbA1C was achieved despite the same total bolus dose. The optimal basal dose as determined by this study is similar to that found in fasting individuals of similar age. KEYWORDS:NOTNLM;

编号：29

题名：A Case Report of Reversible Takotsubo Cardiomyopathy after Amphetamine/Dextroamphetamine Ingestion in a 15-Year-Old Adolescent Girl.

作者：Toce MS;Farias M;Bruccoleri R;Brown DW;Burns MM

出处：J Pediatr.2017V182N:385-388.e3

机构：Harvard Medical Toxicology Program, Boston Children's Hospital, Boston, MA. Electronic address: [email protected].;Department of Medicine, Division of Cardiology, Boston Children's Hospital, Boston, MA.;Harvard Medical Toxicology Program, Boston Children's Hospital, Boston, MA.;Department of Medicine, Division of Cardiology, Boston Children's Hospital, Boston, MA.;Harvard Medical Toxicology Program, Boston Children's Hospital, Boston, MA; Department of Medicine, Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.


摘要： Stimulant medications are used in the treatment of attention deficit hyperactivity disorder and serious cardiac complications can occur when these medications are abused. We present a 15-year-old adolescent girl who was found to have a Takotsubo cardiomyopathy after acute amphetamine/dextroamphetamine ingestion. KEYWORDS:NOTNLM;

编号：30

题名：Differences in Infant Care Practices and Smoking among Hispanic Mothers Living in the United States.

作者：Provini LE;Corwin MJ;Geller NL;Heeren TC;Moon RY;Rybin DV;Shapiro-Mendoza CK;Colson ER

出处：J Pediatr.2017V182N:321-326.e1

机构：Department of Pediatrics, Yale University School of Medicine, New Haven, CT.;Slone Epidemiology Center, Boston University, Boston, MA.;Slone Epidemiology Center, Boston University, Boston, MA.;Department of Biostatistics, Boston University School of Public Health, Boston, MA.;Department of Pediatrics, University of Virginia

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School of Medicine, Charlottesville, VA.;Data Coordinating Center, Boston University School of Public Health, Boston, MA.;Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.;Department of Pediatrics, Yale University School of Medicine, New Haven, CT. Electronic address: [email protected].


摘要： OBJECTIVE: To assess the association between maternal birth country and adherence to the American Academy of Pediatrics safe sleep recommendations in a national sample of Hispanic mothers, given that data assessing the heterogeneity of infant care practices among Hispanics are lacking. STUDY DESIGN: We used a stratified, 2-stage, clustered design to obtain a nationally representative sample of mothers from 32 US intrapartum hospitals. A total of 907 completed follow-up surveys (administered 2-6 months postpartum) were received from mothers who self-identified as Hispanic/Latina, forming our sample, which we divided into 4 subpopulations by birth country (US, Mexico, Central/South America, and Caribbean). Prevalence estimates and aORs were determined for infant sleep position, location, breastfeeding, and maternal smoking. RESULTS: When compared with US-born mothers, we found that mothers born in the Caribbean (aOR 4.56) and Central/South America (aOR 2.68) were significantly more likely to room share without bed sharing. Caribbean-born mothers were significantly less likely to place infants to sleep supine (aOR 0.41). Mothers born in Mexico (aOR 1.67) and Central/South America (aOR 2.57) were significantly more likely to exclusively breastfeed; Caribbean-born mothers (aOR 0.13) were significantly less likely to do so. Foreign-born mothers were significantly less likely to smoke before and during pregnancy. CONCLUSIONS: Among US Hispanics, adherence to American Academy of Pediatrics safe sleep recommendations varies widely by maternal birth country. These data illustrate the importance of examining behavioral heterogeneity among ethnic groups and have potential relevance for developing targeted interventions for safe infant sleep. KEYWORDS:NOTNLM;

编号：31

题名：Abdominal Pain-Associated Functional Gastrointestinal Disorder Prevalence in Children and Adolescents with Celiac Disease on Gluten-Free Diet: A Multinational Study.

作者：Saps M;Sansotta N;Bingham S;Magazzu G;Grosso C;Romano S;Pusatcioglu C;Guandalini S


机构：Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH.;Department of Pediatrics, University of Verona, Verona, Italy.;Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH. Electronic address: [email protected].;Pediatric Gastroenterology, University of Messina, Messina, Italy.;Department of Pediatrics, University of Messina, Messina, Italy.;Department of Internal Medicine, University of Verona, Verona, Italy.;Division of Pediatric Gastroenterology Hepatology & Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.;Department of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Chicago Celiac Disease Center, The University of Chicago Medicine, Chicago, IL.


摘要： OBJECTIVE: To test the hypothesis that children with celiac disease (CD) on gluten-free diet are at increased risk of abdominal pain (AP) associated-functional gastrointestinal disorders (FGIDs). STUDY DESIGN: This was a multinational cross-sectional study performed from 2014 to 2015. Patients 4-18 years of age with CD on gluten-free diet for longer than 6 months were recruited from pediatric CD clinics in US and Italy. Control groups included siblings of children with CD (with normal tissue transglutaminase levels) and unrelated controls. Subjects or parents completed

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the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III. RESULTS: Children (n = 289) were recruited (55% US, 45% Italy): 96 children with CD, 96 sibling controls, and 97 unrelated controls. Chronic AP was present in 30 (30.9%) subjects with CD, 22 (22.7%) sibling controls, and 21 (21.6%) unrelated controls (P = .26 patients with CD vs siblings; P = .18 patients with CD vs unrelated; P = .96 siblings vs unrelated). AP-FGIDs were present in 8 (8.2%) subjects with CD, 8 (8.2%) sibling controls, and 2 (2.1%) unrelated controls (P = 1.00 subjects with CD vs sibling controls; P = .06 subjects with CD vs unrelated controls; P = .06 sibling controls vs unrelated controls). CONCLUSION: This multinational study evaluated the prevalence of chronic abdominal pain and AP-FGIDs in the pediatric population with CD. We found that subjects with CD and controls have a similar prevalence of chronic AP and AP-FGIDs. This suggests that not all types of gastrointestinal inflammation result in AP-FGIDs in children. KEYWORDS:NOTNLM;

编号：32

题名：Impact of Chronic Conditions on Emergency Department Visits of Children Using Medicaid.

作者：Berry JG;Rodean J;Hall M;Alpern ER;Aronson PL;Freedman SB;Brousseau DC;Shah SS;Simon HK;Cohen E;Marin JR;Morse RB;O'Neill M;Neuman MI


机构：Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA. Electronic address: [email protected].;Children's Hospital Association, Overland Park, KS.;Children's Hospital Association, Overland Park, KS.;Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL.;Section of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, CT.;Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children's Hospital and Research Institute, University of Calgary, Calgary, Alberta, Canada.;Division of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI.;Divisions of Hospital Medicine and Infectious, Diseases, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.;Division of Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, and Children's Healthcare of Atlanta, Atlanta, GA.;Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.;Departments of Pediatrics and Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.;Children's Health System of Texas, Dallas, TX; Department of Pediatrics, University of Texas Southwestern, Dallas, TX.;Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.;Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.


摘要： OBJECTIVE: To assess the impact of chronic conditions on children's emergency department (ED) use. STUDY DESIGN: Retrospective analysis of 1 850 027 ED visits in 2010 by 3 250 383 children ages 1-21 years continuously enrolled in Medicaid from 10 states included in the Truven Marketscan Medicaid Database. The main outcome was the annual ED visit rate not resulting in hospitalization per 1000 enrollees. We compared rates by enrollees' characteristics, including type and number of chronic conditions, and medical technology (eg, gastrostomy, tracheostomy), using Poisson regression. To assess chronic conditions, we used the Agency for Healthcare Research and Quality's Chronic Condition Indicator system, assigning chronic conditions with ED visit rates >/=75th percentile as having the "highest" visit rates. RESULTS: The overall annual ED visit rate was 569 per 1000 enrollees. As the number of the children's chronic conditions increased from 0 to >/=3, visit rates increased by 180% (from 376 to 1053 per 1000 enrollees, P < .001). Rates were 174% higher in children assisted with vs without medical technology (1546 vs 565, P < .001). Sickle cell anemia, epilepsy, and asthma were among the chronic conditions associated with the highest ED

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visit rates (all >/=1003 per 1000 enrollees). CONCLUSIONS: The highest ED visit rates resulting in discharge to home occurred in children with multiple chronic conditions, technology assistance, and specific conditions such as sickle cell anemia. Future studies should assess the preventability of ED visits in these populations and identify opportunities for reducing their ED use. KEYWORDS:NOTNLM;

编号：33

题名：United States Adolescents' Television, Computer, Videogame, Smartphone, and Tablet Use: Associations with Sugary Drinks, Sleep, Physical Activity, and Obesity.

作者：Kenney EL;Gortmaker SL


机构：Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA. Electronic address: [email protected].;Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA.


摘要： OBJECTIVE: To quantify the relationships between youth use of television (TV) and other screen devices, including smartphones and tablets, and obesity risk factors. STUDY DESIGN: TV and other screen device use, including smartphones, tablets, computers, and/or videogames, was self-reported by a nationally representative, cross-sectional sample of 24 800 US high school students (2013-2015 Youth Risk Behavior Surveys). Students also reported on health behaviors including sugar-sweetened beverage (SSB) intake, physical activity, sleep, and weight and height. Sex-stratified logistic regression models, adjusting for the sampling design, estimated associations between TV and other screen device use and SSB intake, physical activity, sleep, and obesity. RESULTS: Approximately 20% of participants used other screen devices for >/=5 hours daily. Watching TV >/=5 hours daily was associated with daily SSB consumption (aOR = 2.72, 95% CI: 2.23, 3.32) and obesity (aOR = 1.78, 95% CI: 1.40, 2.27). Using other screen devices >/=5 hours daily was associated with daily SSB consumption (aOR = 1.98, 95% CI: 1.69, 2.32), inadequate physical activity (aOR = 1.94, 95% CI: 1.69, 2.25), and inadequate sleep (aOR = 1.79, 95% CI: 1.54, 2.08). CONCLUSIONS: Using smartphones, tablets, computers, and videogames is associated with several obesity risk factors. Although further study is needed, families should be encouraged to limit both TV viewing and newer screen devices. KEYWORDS:NOTNLM;

编号：34

题名：Altered Cerebellar Development in Preterm Newborns: Chicken or Egg?

作者：Gano D;Ferriero DM


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机构：Department of Neurology Department of Pediatrics University of California, San Francisco San Francisco, California. Electronic address: [email protected].;Department of Neurology Department of Pediatrics University of California, San Francisco San Francisco, California.



编号：35

题名：Clinical Features and Outcome of Ebola Virus Disease in Pediatric Patients: A Retrospective Case Series.

作者：Damkjaer M;Rudolf F;Mishra S;Young A;Storgaard M

出处：J Pediatr.2017V182N:378-381.e1

机构：GOAL Global, Freetown, Sierra Leone; Danish Armed Forces Health Services, Skalstrup Air Base, Skalstrup, Denmark; Hans Christian Andersen Children's Hospital, Odense, Denmark; Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark. Electronic address: [email protected].;GOAL Global, Freetown, Sierra Leone; Danish Armed Forces Health Services, Skalstrup Air Base, Skalstrup, Denmark; Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.;Division of Infectious Diseases, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.;GOAL Global, Freetown, Sierra Leone.;GOAL Global, Freetown, Sierra Leone; Danish Armed Forces Health Services, Skalstrup Air Base, Skalstrup, Denmark; Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark.


摘要： Clinical and outcome data on pediatric Ebola virus disease are limited. We report a case-series of 33 pediatric patients with Ebola virus disease in a single Ebola Treatment Center in 2014-2015. The case-fatality rate was 42%, with the majority of deaths occurring within 10 days of admission. KEYWORDS:NOTNLM;

编号：36

题名：The Effect of Skin Pigmentation on the Accuracy of Pulse Oximetry in Infants with Hypoxemia.

作者：Foglia EE;Whyte RK;Chaudhary A;Mott A;Chen J;Propert KJ;Schmidt B

出处：J Pediatr.2017V182N:375-377.e2

机构：Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA. Electronic address: [email protected].;Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.;Division of

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Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA.;Department of Pediatrics, Baylor Medical College, Houston, TX.;Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.;Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.;Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.


摘要： To compare pulse oximetry measurement bias between infants with hypoxemia with either dark skin or light skin with Masimo Radical 7 and Nellcor Oximax. There was no significant difference in systematic bias based on skin pigment for either oximeter. KEYWORDS:NOTNLM;

编号：37

题名：A Randomized Controlled Trial of End-Tidal Carbon Dioxide Detection of Preterm Infants in the Delivery Room.

作者：Hawkes GA;Finn D;Kenosi M;Livingstone V;O'Toole JM;Boylan GB;O'Halloran KD;Ryan AC;Dempsey EM


机构：Department of Pediatrics and Child Health, Neonatal Intensive Care Unit, Wilton, Cork, Ireland; Irish Center for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.;Department of Pediatrics and Child Health, Neonatal Intensive Care Unit, Wilton, Cork, Ireland; Irish Center for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.;Department of Pediatrics and Child Health, Neonatal Intensive Care Unit, Wilton, Cork, Ireland; Irish Center for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.;Department of Pediatrics and Child Health, Neonatal Intensive Care Unit, Wilton, Cork, Ireland; Irish Center for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.;Department of Pediatrics and Child Health, Neonatal Intensive Care Unit, Wilton, Cork, Ireland; Irish Center for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.;Department of Pediatrics and Child Health, Neonatal Intensive Care Unit, Wilton, Cork, Ireland; Irish Center for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.;Department of Physiology, School of Medicine, University College Cork, Cork, Ireland.;Department of Pediatrics and Child Health, Neonatal Intensive Care Unit, Wilton, Cork, Ireland; Irish Center for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.;Department of Pediatrics and Child Health, Neonatal Intensive Care Unit, Wilton, Cork, Ireland; Irish Center for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland. Electronic address: [email protected].


摘要： OBJECTIVE: To compare the ability of qualitative versus quantitative methods of end-tidal carbon dioxide (EtCO2) detection to maintain normocarbia during face mask ventilation (FMV) of preterm infants (<32 weeks) in the delivery room. STUDY DESIGN: Preterm infants <32 weeks were randomly assigned to the use of a disposable PediCap EtCO2 detector (Covidien, Dublin, Ireland) (qualitative) or a Microstream side stream capnography device (Covidien) (quantitative) for FMV in the delivery room, via a NeoPuff T-piece resuscitator (Fisher and Paykel, Auckland, New Zealand). The primary outcome was the presence of normocarbia, based on partial pressure of CO2 (PaCO2) readings obtained in the neonatal intensive care unit within an hour of birth. Normocarbia was defined as a PaCO2 measure between 37.5 and 60 mm Hg (5-8 kPa). RESULTS: Of the 59 infants included, 59% (35/59) were

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within the PaCO2 target range within an hour of birth. There was no difference in the primary outcome; 64% (21/33) of infants in the quantitative group were within the PaCO2 range compared with 54% (14/26) in the qualitative group (P = .594); and 93% of participants <28 weeks' gestation were within the PaCO2 normocarbic range (90% [9/10] in quantitative group and 100% [5/5] in the qualitative group [P = 1]). There was no difference in the intubation rate, days of ventilation, or bronchopulmonary dysplasia rates between the 2 groups. CONCLUSIONS: Quantitative or qualitative EtCO2 detection methods are both feasible for FMV in the delivery room. Although there was no difference in the incidence of normocarbia, the use of either form of EtCO2 monitoring should be considered during newborn stabilization, especially in infants less than 28 weeks' gestation. TRIAL REGISTRATION: ISRCTN: ISRCTN10934870. KEYWORDS:NOTNLM;

编号：38

题名：Sleep Patterns and Mental Health Correlates in US Adolescents.

作者：Zhang J;Paksarian D;Lamers F;Hickie IB;He J;Merikangas KR


机构：Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR.;Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Amsterdam, The Netherlands.;Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Amsterdam, The Netherlands; GGZ in Geest/VU University Medical Center, Amsterdam, Department of Psychiatry, EMGO Institute for Health and Care Research and Neuroscience Campus Amsterdam, VU University Medical Center/GGZ in Geest, Amsterdam, The Netherlands.;Brain & Mind Research Institute, University of Sydney Camperdown, NSW 2050, Australia.;Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Amsterdam, The Netherlands.;Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Amsterdam, The Netherlands. Electronic address: [email protected].


摘要： OBJECTIVE: To investigate systematically the associations of sleep patterns with a range of mental disorders and other outcomes among a nationally representative sample of US adolescents. STUDY DESIGN: Using the National Comorbidity Survey Adolescent Supplement, a nationally representative cross-sectional survey of 10 123 US adolescents 13-18 years of age, we assessed associations between adolescent-reported sleep patterns (tertiles of weeknight bedtime, weeknight sleep duration, weekend bedtime delay, and weekend oversleep) and past-year mental disorders based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, smoking, injury, suicidality, and perceived mental and physical health, assessed via direct diagnostic interview. RESULTS: The average weeknight bedtime was at 22:37 and sleep duration was 7.72 hours. Average weekend bedtime delay was 1.81 hours and average weekend oversleep was 1.17 hours. Later weeknight bedtime, shorter weeknight sleep duration, greater weekend bedtime delay, and both short and long periods of weekend oversleep were associated with increased odds of mood, anxiety, substance use, and behavioral disorders, as well as suicidality, tobacco smoking, and poor perceived mental and physical health. ORs ranged from 1.27 to 2.15. The only outcomes not associated with any sleep patterns were past-year injury and eating disorder. CONCLUSIONS: Suboptimal sleep patterns were associated with an array of mental disorders and other health-related outcomes among adolescents. Abnormal sleep patterns may serve as markers of prodromal or untreated mental disorders among adolescents, and may provide opportunities for prevention and intervention in mental disorders. KEYWORDS:NOTNLM;

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编号：39

题名：Radiologic Response Assessment in Pediatric Soft Tissue Sarcoma: Computed-Assisted Volume Evaluation.

作者：Orsatti G;Beltrame V;Crimi F;Frigo AC;Bisogno G;Stramare R

出处：J Pediatr.2017V182N:327-334.e2

机构：Department of Medicine, Radiology Section, University of Padua, Padua, Italy. Electronic address: [email protected].;Department of Medicine, Radiology Section, University of Padua, Padua, Italy.;Department of Medicine, Radiology Section, University of Padua, Padua, Italy.;Department of Cardiac, Thoracic and Vascular Sciences, Biostatistics, Epidemiology and Public Health Unit, University of Padova, Padova, Italy.;Department of Pediatrics, Oncohematology Unit, University of Padova, Padova, Italy.;Department of Medicine, Radiology Section, University of Padua, Padua, Italy.


摘要： OBJECTIVES: To compare 3 methods of dimensional assessment, with particular attention to a new software assisted method of volume calculation, in soft tissue sarcoma, and to investigate the interobserver agreement and the intermethod agreement in chemotherapy response classification and resultant clinical repercussions. STUDY DESIGN: We studied 34 pediatric patients with nonmetastatic soft tissue sarcoma who had undergone only diagnostic biopsy. Tumor size was measured both at diagnosis and after induction chemotherapy by 3 observers and using 3 measurement methods: maximum axis (1 diameter), estimated volume (3 diameters), and computed volume (software-assisted volume calculation). We used overall concordance correlation coefficient and Bland-Altman statistical methods to assess interobserver agreement and overall concordance correlation coefficient and the kappa Cohen coefficient to assess intermethod agreement. RESULTS: According to overall concordance correlation coefficient, the interobserver agreement was very high for each method, with a slight superiority of the software assisted method; this agreement was not confirmed in Bland-Altman plots for maximum axis and estimated volume methods. According to kappa coefficients, the intermethod agreement in chemotherapy response evaluation was poor. CONCLUSIONS: Computed volume was the most accurate method in soft tissue sarcoma tumor size assessment. One- and 3-dimensional methods are not concordant in chemotherapy response classification. In particular, the maximum axis method underestimates chemotherapy response and can lead to switching the chemotherapy regimen erroneously. KEYWORDS:NOTNLM;

编号：40

题名：Pulmonary arterial hypertension after ibuprofen treatment in the first week of life?

作者：Levy PT;El-Khuffash A


机构：Department of Pediatrics Washington University School of Medicine St Louis, Missouri; Department of Pediatrics Goryeb Children's HospitalMorristown, New Jersey.;Department of Neonatology The Rotunda Hospital; Department of Pediatrics School of Medicine Royal College of Surgeons in Ireland Dublin, Ireland.

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编号：41

题名：Cocontribution of Rotavirus and Pneumococcal Conjugate Vaccines to the Reduction of Pediatric Hospital Visits in Young Children.

作者：Ben-Shimol S;Givon-Lavi N;Greenberg D;Dagan R

出处：J Pediatr.2017V182N:253-259.e2

机构：The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.;The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.;The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.;The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. Electronic address: [email protected].


摘要： OBJECTIVE: To assess rotavirus vaccine and pneumococcal conjugate vaccines (PCVs) cumulative impact on the pediatric emergency department visits and hospitalization rates in children <2 years of age in southern Israel between April 2006 and March 2014. STUDY DESIGN: This prospective, population-based observational study calculated the rates of rotavirus gastroenteritis (RVGE), non-RVGE, community-acquired alveolar pneumonia (CAAP), nonalveolar lower respiratory tract infection, and all-cause hospital visits. PCV7, PCV13, and rotavirus vaccination programs were implemented in Israel in July 2009, November 2010, and January 2011, respectively. RESULTS: From 2006-2009 to 2013-2014, the rates of hospitilizations for RVGE, non-RVGE, CAAP, and nonalveolar lower respiratory tract infection decreased by 78%, 21%, 46%, and 7%, respectively. In outpatients, the respective decreases were 80%, 16%, 67%, and 14%. All-cause outpatient pediatric emergency department visits and hospitalization rates were reduced by 12% and 11%, respectively. During the peak season (October through March), RVGE, non-RVGE, CAAP, and nonalveolar lower respiratory tract infection hospitalization rates decreased significantly by 86%, 44.6%, 23.3%, and 10.5%, respectively. In outpatients, the respective decreases were 81.7%, 73.5%, 13.8%, and 10.7%. The proportion of RVGE and CAAP (grouped) of all-cause hospitalizations and outpatient pediatric ED visits decreased from 19.9% to 12.3% and from 6.9% to 1.8%, respectively. CONCLUSIONS: Rotavirus vaccine and PCV introduction cocontributed to a rapid, considerable reduction in hospital burden in children <2 years of age. Because seasonalities of both diseases overlap, this reduction is particularly helpful in relieving burdens of disease and care during the most cumbersome morbidity season. KEYWORDS:NOTNLM;

编号：42

题名：Variations in Utilization of Inpatient Rehabilitation Services among Pediatric Trauma Patients.

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作者：Nguyen HT;Newton C;Pirrotta EA;Aguilar C;Wang NE

出处：J Pediatr.2017V182N:342-348.e1

机构：Divisions of Pediatric Surgery and Trauma Services, University of California, San Francisco Benioff Children's Hospital Oakland, Oakland, CA; Department of Emergency Medicine, School of Medicine, Stanford University, Stanford, CA.;Divisions of Pediatric Surgery and Trauma Services, University of California, San Francisco Benioff Children's Hospital Oakland, Oakland, CA.;Department of Emergency Medicine, School of Medicine, Stanford University, Stanford, CA.;Division of Pediatric Rehabilitation Medicine, UCSF Benioff Children's Hospital Oakland, Oakland, CA.;Department of Emergency Medicine, School of Medicine, Stanford University, Stanford, CA. Electronic address: [email protected].


摘要： OBJECTIVE: To assess clinical and nonclinical characteristics associated with the use of pediatric inpatient rehabilitation services among children with traumatic injuries. We hypothesized there would be no nonclinical variations in the use of pediatric inpatient rehabilitation services. STUDY DESIGN: Retrospective analysis of 1139 patients who were injured seriously (0-18 years of age) from our institutional trauma registry (2004-2014). Patients' nonclinical and clinical characteristics were analyzed. We used a full matching technique to compare characteristics between those admitted to rehabilitation (cases) to those discharged home (controls). We matched patients by age category, sex, maximum Abbreviated Injury Scale, and body region of maximum Abbreviated Injury Scale. We used survey-based multivariate logistic regression to identify characteristics associated with inpatient rehabilitation services, controlling for multiple injuries, distance from home to rehabilitation center, year of service, hospital length of stay, and clinically relevant interactions. RESULTS: Ninety-eight patients (8.6%) were admitted to inpatient rehabilitation and 968 (85.0%) were discharged home. Black and other minority patients had increased odds of receiving inpatient rehabilitation compared with white patients (OR, 7.6 [P< .001] and OR, 1.6 [P= .03], respectively). Patients with private compared with public insurance had increased odds of receiving inpatient rehabilitation (OR, 2.4; P< .001). CONCLUSIONS: Pediatric inpatient rehabilitation beds are a scarce resource that should be available to those with the greatest clinical need. The mechanism creating differences in the use of inpatient rehabilitation based on nonclinical characteristics such as race/ethnicity or insurance status must be understood to prevent disparities in access to inpatient rehabilitation services. KEYWORDS:NOTNLM;

编号：43

题名：Outbreaks of Invasive Kingella kingae Infections in Daycare Facilities: Approach to Investigation and Management.

作者：Yagupsky P;El Houmami N;Fournier PE


机构：Clinical Microbiology Laboratory, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.;Unite de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Unite Mixte de Recherche 63, Centre National de la Recherche Scientifique 7278, Institut de Recherche pour le Developpement 198, Institut National de la Sante et de la Recherche Medicale 1095, Institut Hospitalo-Universitaire Mediterranee-Infection, Aix-Marseille University, Marseille, France.;Unite de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Unite Mixte de Recherche 63, Centre National de la Recherche Scientifique 7278, Institut de Recherche pour le Developpement 198, Institut National de la Sante et de la Recherche Medicale 1095, Institut Hospitalo-Universitaire Mediterranee-Infection, Aix-Marseille University, Marseille, France.

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编号：44

题名：Do Growing Rods for Idiopathic Early Onset Scoliosis Improve Activity and Participation for Children?

作者：Sewell MD;Platinum J;Askin GN;Labrom R;Hutton M;Chan D;Clarke A;Stokes OM;Molloy S;Tucker S;Lehovsky J

出处：J Pediatr.2017V182N:315-320.e1

机构：Department of Pediatric Spinal Deformity, The James Cook University Hospital, Middlesbrough, United Kingdom.;Department of Pediatric Spinal Deformity, The James Cook University Hospital, Middlesbrough, United Kingdom. Electronic address: [email protected].;The Lady Cilento Children's Hospital, Brisbane, Australia.;The Lady Cilento Children's Hospital, Brisbane, Australia.;The Royal Devon and Exeter Hospital, Exeter, United Kingdom.;The Royal Devon and Exeter Hospital, Exeter, United Kingdom.;The Royal Devon and Exeter Hospital, Exeter, United Kingdom.;The Royal Devon and Exeter Hospital, Exeter, United Kingdom.;The Royal National Orthopaedic Hospital, Stanmore, United Kingdom.;The Royal National Orthopaedic Hospital, Stanmore, United Kingdom.;The Royal National Orthopaedic Hospital, Stanmore, United Kingdom.


摘要： OBJECTIVE: To investigate whether growing rod surgery for children with progressive idiopathic early onset scoliosis (EOS) effects activity and participation, and investigate factors that may affect this. STUDY DESIGN: Multicenter retrospective cohort study using prospectively collected data on 60 children with idiopathic EOS and significant scoliosis (defined as a Cobb angle >40 degrees ). Thirty underwent brace treatment, and 30, growth rod surgery. Questionnaire and radiographic data were recorded at 1 year. The validated Activities Scale for Kids performance version (ASKp) questionnaire was used to measure activity and participation. RESULTS: In the brace group, Cobb angle increased from 60 degrees to 68 degrees . There was no change in ASKp score. In the operative group, Cobb angle decreased from 67 degrees to 45 degrees . ASKp decreased from 91 to 88 (P < .01). Presence of spinal pain correlated with greater reduction in activity and participation scores in both groups, as did occurrence of complications in the operative group (P < .05). Both treatments permitted growth of the immature spine. CONCLUSIONS: In children with significant idiopathic EOS (Cobb angle>40 degrees ), growth rod surgery was associated with a reduction in activity and participation and Cobb angle, whereas brace treatment was associated with an increase in Cobb angle and no change in activity and participation. Pain was the most important factor affecting activity and participation in both groups. KEYWORDS:NOTNLM;

编号：45

题名：Comparisons of Office and 24-Hour Ambulatory Blood Pressure Monitoring in Children with Obstructive Sleep Apnea.

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作者：Kang KT;Chiu SN;Weng WC;Lee PL;Hsu WC

出处：J Pediatr.2017V182N:177-183.e2

机构：Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan.;Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.;Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.;Sleep Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.;Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Sleep Center, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: [email protected].


摘要： OBJECTIVE: To compare office blood pressure (BP) and 24-hour ambulatory BP (ABP) monitoring to facilitate the diagnosis and management of hypertension in children with obstructive sleep apnea (OSA). STUDY DESIGN: Children aged 4-16 years with OSA-related symptoms were recruited from a tertiary referral medical center. All children underwent overnight polysomnography, office BP, and 24-hour ABP studies. Multiple linear regression analyses were applied to elucidate the association between the apnea-hypopnea index and BP. Correlation and consistency between office BP and 24-hour ABP were measured by Pearson correlation, intraclass correlation, and Bland-Altman analyses. RESULTS: In the 163 children enrolled (mean age, 8.2 +/- 3.3 years; 67% male). The prevalence of systolic hypertension at night was significantly higher in children with moderate-to-severe OSA than in those with primary snoring (44.9% vs 16.1%, P = .006). Pearson correlation and intraclass correlation analyses revealed associations between office BP and 24-hour BP, and Bland-Altman analysis indicated an agreement between office and 24-hour BP measurements. However, multiple linear regression analyses demonstrated that 24-hour BP (nighttime systolic BP and mean arterial pressure), unlike office BP, was independently associated with the apnea-hypopnea index, after adjustment for adiposity variables. CONCLUSIONS: Twenty-four-hour ABP is more strongly correlated with OSA in children, compared with office BP. KEYWORDS:NOTNLM;

编号：46

题名：Mucopolysaccharidosis Type I Newborn Screening: Best Practices for Diagnosis and Management.

作者：Clarke LA;Atherton AM;Burton BK;Day-Salvatore DL;Kaplan P;Leslie ND;Scott CR;Stockton DW;Thomas JA;Muenzer J


机构：Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: [email protected].;Children's Mercy Hospital, Kansas City, MO.;Ann and Robert H. Lurie Children's Hospital and Northwestern University Feinberg School of Medicine, Chicago, IL.;Saint Peter's University Hospital, New Brunswick, NJ.;The Children's Hospital of Philadelphia, Philadelphia, PA.;Cincinnati Children's Hospital, Cincinnati, OH.;University of Washington, Seattle, WA.;Children's Hospital of Michigan and Wayne State University, Detroit, MI.;University of Colorado, Aurora, CO.;University of North Carolina at Chapel Hill, Chapel Hill, NC.


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摘要：

编号：47

题名：Oxygen Saturation and Heart Rate Ranges in Very Preterm Infants Requiring Respiratory Support at Birth.

作者：Phillipos E;Solevag AL;Aziz K;van Os S;Pichler G;O'Reilly M;Cheung PY;Schmolzer GM


机构：Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada.;Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lorenskog, Norway.;Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.;Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada.;Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, Medical University Graz, Graz, Austria.;Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada; Department of Physiology, University of Alberta, Edmonton, Alberta, Canada.;Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.;Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lorenskog, Norway.


摘要： OBJECTIVE: To evaluate the changes in preductal oxygen saturation (SpO2) and heart rate in preterm infants receiving continuous positive airway pressure (CPAP) and/or positive-pressure ventilation (PPV) at birth. STUDY DESIGN: A prospective observational study at birth of infants aged <32 weeks separated into 2 gestational age (GA) groups: 230/7-276/7 weeks (group 1) and 280/7-316/7 weeks (group 2). Infants received delayed cord clamping (DCC) in accordance with institutional protocol. CPAP and/or PPV was applied at the clinical team's discretion. SpO2 and heart rate were recorded every minute for 10 minutes. Preductal SpO2 was targeted according to published nomograms. For heart rate, the goal was to maintain a stable heart rate >100 bpm. RESULTS: The study cohort comprised 96 group 1 infants (mean GA, 26 +/- 1 weeks; mean birth weight, 818 +/- 208 g) and 173 group 2 infants (mean GA, 30 +/- 1 weeks; mean birth weight, 1438 +/- 374 g). In general, infants requiring respiratory support reached target values for heart rate and SpO2 more slowly than the published nomograms for spontaneously breathing preterm infants without respiratory support. Infants receiving CPAP reached SpO2 and heart rate targets faster than infants receiving PPV. In group 1, but not group 2 infants, DCC resulted in higher SpO2 and heart rate. CONCLUSION: SpO2 and heart rate do not quickly and reliably reach the values achieved by spontaneously breathing preterm infants not requiring respiratory support. KEYWORDS:NOTNLM;

编号：48

题名：Reply.

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作者：Alansari AK;Davidson BB


机构：Department of Pediatrics Division of Pediatric Emergency Medicine Hamad Medical Corporation Doha, Qatar; Department of Pediatrics Division of Pediatric Emergency Medicine Sidra Medical and Research Centre Doha, Qatar; Weill Cornell Medical College in Qatar Doha, Qatar.;Pulmonary-Critical Care Medicine Division University of Washington School of Medicine Seattle, Washington.


摘要：

编号：49

题名：A simple metric for cystic fibrosis respiratory exacerbations.

作者：Abman SH



编号：50

题名：Ebola virus disease in children presents special challenges.

作者：Long SS



编号：51

题名：50 Years Ago in The Journal of Pediatrics: Diencephalic Syndromes of Infancy: Report of 3 Children with Emaciation Syndrome and Disproportionately Large Hands and Feet.

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作者：Heikamp EB;Blaney SM


机构：Department of Pediatrics; Baylor College of Medicine; Houston, Texas.


摘要：

编号：52

题名：Optimize vaccination of patients with liver transplant.

作者：Long SS



编号：53

题名：Mechanical circulatory support - a potential pathway to heart function recovery.

作者：Steinberger J



编号：54

题名：Talk with and not around the child.

作者：Fisher PG

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编号：55

题名：Low rate of viral respiratory infections in infants in the NICU.

作者：Long SS



编号：56

题名：Oxygen saturation targets: The wrinkle in the pulse oximeter calibration software provides another wrinkle.

作者：Wright CJ



编号：57

题名：Early life linear growth but not weight gain, impacts adult human capital.

作者：Steinberger J



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编号：58

题名：Lactated Ringers versus normal saline in children with sepsis.

作者：Toltzis P



编号：59

题名：RNA signature test to distinguish bacterial from viral infection.

作者：Ramilo O;Mejias A;Mahajan P;Kuppermann N


机构：The Ohio State University Columbus, Ohio.;University of Michigan Ann Arbor, Michigan.;University of California Davis Sacramento, California.


摘要：

编号：60

题名：Triple-drug antiretroviral therapy results in lower HIV maternal-fetal transmission rates but increased adverse effects compared with zidovudine alone.

作者：Rawizza H


机构：Harvard University Boston, Massachusetts.


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摘要：

编号：61

题名：Foster care is associated with poor mental health in children.

作者：Greiner MV;Beal SJ


机构：Cincinnati Children's Hospital Medical Center Cincinnati, Ohio.


摘要：

编号：62

题名：Early steroid therapy reduces Kawasaki disease coronary complications.

作者：Shulman ST


机构：Northwestern University Chicago, Illinois.


摘要：

编号：63

题名：M-CHAT autism screening may be inaccurate among toddlers born very preterm.

作者：Gray PH

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机构：University of Queensland South Brisbane, Queensland, Australia.


摘要：

编号：64

题名：Does macrocephaly require MRI, CT, ultrasound, or a tape measure?

作者：Fisher PG



编号：65

题名：Differences between Pediatricians and Internists in Advance Care Planning for Adolescents with Cancer.

作者：Yotani N;Kizawa Y;Shintaku H


机构：Kobe University Graduate School of Medicine, Kobe, Japan; Osaka City University Graduate School of Medicine, Osaka, Japan. Electronic address: [email protected].;Kobe University Graduate School of Medicine, Kobe, Japan.;Osaka City University Graduate School of Medicine, Osaka, Japan.


摘要： OBJECTIVE: To evaluate differences between pediatricians and internists in the practice of and barriers to advance care planning (ACP) for adolescent patients with cancer. STUDY DESIGN: A self-reported questionnaire was administered to assess the practice of ACP, advance directives, and barriers to ACP for adolescent patients with cancer. All 3392 Japanese board-certified hematologists were surveyed, and 600 hematologists (227 pediatricians, 373 internists) who take care of adolescent patients with cancer with decision-making capacity were analyzed. RESULTS: If a patient's prognosis for survival was <3 months, pediatricians were significantly less likely to discuss ACP with their patients than internists, including discussions regarding the patient's medical condition (59% vs 70%), the patient's understanding of his/her medical condition (55% vs 66%), do not attempt resuscitation orders (17% vs 24%), and ventilator treatment if the patient's condition worsened (19% vs 25%). More than 75% of hematologists (both pediatricians and internists) discussed all ACP topics with patients' families. Similarly, with regard to advance

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directives, pediatricians were less likely than internists to discuss cardiopulmonary resuscitation (24% vs 47%) and the use of ventilators (31% vs 51%), vasopressors (24% vs 42%), and antibiotics (21% vs 31%) with their patients. Both pediatricians and internists discussed these issues more often with patients' families than with patients, especially cardiopulmonary resuscitation (98%) as well as the use of ventilators (98%) and vasopressors (91%). CONCLUSIONS: Pediatricians were less likely than internists to discuss ACP and advance directives with patients, and both pediatricians and internists tended to discuss ACP and advance directives more often with patients' families. KEYWORDS:NOTNLM;

编号：66

题名：How Well Do Children with Cystic Fibrosis Sleep? An Actigraphic and Questionnaire-Based Study.

作者：Vandeleur M;Walter LM;Armstrong DS;Robinson P;Nixon GM;Horne RS


机构：The Ritchie Centre, Department of Pediatrics, Monash University and Hudson Institute of Medical Research, Melbourne, Victoria, Australia; Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.;The Ritchie Centre, Department of Pediatrics, Monash University and Hudson Institute of Medical Research, Melbourne, Victoria, Australia.;The Ritchie Centre, Department of Pediatrics, Monash University and Hudson Institute of Medical Research, Melbourne, Victoria, Australia; Department of Sleep and Respiratory Medicine, Monash Children's Hospital, Melbourne, Victoria, Australia.;Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.;The Ritchie Centre, Department of Pediatrics, Monash University and Hudson Institute of Medical Research, Melbourne, Victoria, Australia; Department of Sleep and Respiratory Medicine, Monash Children's Hospital, Melbourne, Victoria, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia.;The Ritchie Centre, Department of Pediatrics, Monash University and Hudson Institute of Medical Research, Melbourne, Victoria, Australia. Electronic address: [email protected].


摘要： OBJECTIVE: To measure sleep patterns and quality, objectively and subjectively, in clinically stable children with cystic fibrosis (CF) and healthy control children, and to examine the relationship between sleep quality and disease severity. STUDY DESIGN: Clinically stable children with CF and healthy control children (7-18 years of age) were recruited. Sleep patterns and quality were measured at home with actigraphy (14 days). Overnight peripheral capillary oxygen saturation was measured via the use of pulse oximetry. Daytime sleepiness was evaluated by the Pediatric Daytime Sleepiness Scale (PDSS) and subjective sleep quality by the Sleep Disturbance Scale for Children and Obstructive Sleep Apnea-18. RESULTS: A total of 87 children with CF and 55 control children were recruited with no differences in age or sex. Children with CF had significantly lower total sleep time and sleep efficiency than control children due to frequent awakenings and more wake after sleep onset. In children with CF, forced expiratory volume in 1 second and overnight peripheral capillary oxygen saturation nadir correlated positively with total sleep time and sleep efficiency and negatively with frequency of awakenings and wake after sleep onset. Patients with CF had significantly greater Sleep Disturbance Scale for Children (45 vs 35; P < .001), Obstructive Sleep Apnea-18 (35 vs 24; P < .001), and PDSS scores (14 vs 11; P < .001). There was a negative correlation between PDSS and forced expiratory volume in 1 second (r = -0.23; P < .05). CONCLUSIONS: Even in periods of clinical stability, children with CF get less sleep than their peers due to more time in wakefulness during the night rather than less time spent in bed. Objective measures of sleep disturbance and subjective daytime sleepiness were related to disease severity. In contrast, parents of children with CF report high levels of sleep disturbance unrelated to disease severity. KEYWORDS:NOTNLM;

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编号：67

题名：Should Extracorporeal Membrane Oxygenation Be Offered? An International Survey.

作者：Kuo KW;Barbaro RP;Gadepalli SK;Davis MM;Bartlett RH;Odetola FO


机构：Division of Pediatric Critical Care, Department of Pediatrics, University of Michigan, Ann Arbor, MI. Electronic address: [email protected].;Division of Pediatric Critical Care, Department of Pediatrics, University of Michigan, Ann Arbor, MI.;Department of Surgery, University of Michigan, Ann Arbor, MI.;Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, IL.;Department of Surgery, University of Michigan, Ann Arbor, MI.;Division of Pediatric Critical Care, Department of Pediatrics, University of Michigan, Ann Arbor, MI.


摘要： OBJECTIVES: To assess the current attitudes of extracorporeal membrane oxygenation (ECMO) program directors regarding eligibility for ECMO among children with cardiopulmonary failure. STUDY DESIGN: Electronic cross-sectional survey of ECMO program directors at ECMO centers worldwide within the Extracorporeal Life Support Organization directory (October 2015-December 2015). RESULTS: Of 733 eligible respondents, 226 (31%) completed the survey, 65% of whom routinely cared for pediatric patients. There was wide variability in whether respondents would offer ECMO to any of the 5 scenario patients, ranging from 31% who would offer ECMO to a child with trisomy 18 to 76% who would offer ECMO to a child with prolonged cardiac arrest and indeterminate neurologic status. Even physicians practicing the same specialty sometimes held widely divergent opinions, with 50% of pediatric intensivists stating they would offer ECMO to a child with severe developmental delay and 50% stating they would not. Factors such as quality of life and neurologic status influenced decision making and were used to support decisions for and against offering ECMO. CONCLUSIONS: ECMO program directors vary widely in whether they would offer ECMO to various children with cardiopulmonary failure. This heterogeneity in physician decision making underscores the need for more evidence that could eventually inform interinstitutional guidelines regarding patient selection for ECMO. KEYWORDS:NOTNLM;

编号：68

题名：Prediabetes in Pediatric Recipients of Liver Transplant: Mechanism and Risk Factors.

作者：Perito ER;Lustig RH;Rosenthal P

出处：J Pediatr.2017V182N:223-231.e3

机构：Department of Pediatrics, University of California, San Francisco Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA. Electronic address: [email protected].;Department of Pediatrics, University of California, San Francisco Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA.;Department of Pediatrics, University of California, San Francisco Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA;

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Department of Surgery, University of California, San Francisco Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA.


摘要： OBJECTIVE: To investigate the role of calcineurin inhibitor exposure and states of insulin resistance-obesity and adolescence-in prediabetes after pediatric liver transplant via oral glucose tolerance testing, which previously has not been done systematically in these at-risk youths. STUDY DESIGN: This was a cross-sectional study of 81 pediatric recipients of liver transplant. Prediabetes was defined as impaired glucose tolerance (IGT; glucose >/=140 mg/dL at 2 hours) or impaired fasting glucose (IFG, >/=100 mg/dL). Corrected insulin response (CIR) was calculated as measure of insulin secretion, corrected for glucose (CIR30, CIR60, CIR120). RESULTS: Subjects were aged 8.1-30.0 years and 1.1-24.7 years post-transplant; 44% had prediabetes-27% IGT, 14% IFG, and 3% both. IGT was characterized by insulin hyposecretion, with lower CIR60 and CIR120 in IGT than subjects with normal glucose tolerance. Subjects with tacrolimus trough >6 microg/mL at study visit had lower CIR120 than those with trough </=6 microg/mL and those off calcineurin-inhibitors. Mean of tacrolimus troughs preceding the study visit, years since transplant, and rejection episodes were not associated significantly with lower CIR. CIR suppression by tacrolimus was most pronounced >6 years from transplant. Overweight/obese subjects and adolescents who retained normal glucose tolerance had greater CIR than those who were IGT. CONCLUSION: IGT after pediatric liver transplant is driven by inadequate insulin secretion. It is quite common but not detectable with fasting laboratory values-the screening recommended by current guidelines. Calcineurin inhibitors suppress insulin secretion in these patients in a dose-dependent manner. Given the recent focus on long-term outcomes and immunosuppression withdrawal in these children, longitudinal studies are warranted to investigate whether IGT is reversible with calcineurin inhibitor minimization. KEYWORDS:NOTNLM;

编号：69

题名：Zoophilic Tinea Faciei.

作者：Chen KL;Chien MM;Lu CY;Chiu HC

出处：J Pediatr.2017V182N:395-395.e1

机构：Department of Dermatology National Taiwan University Hospital Hsin-Chu Branch Hsin-Chu, Taiwan.;Department of Pediatrics National Taiwan University Children's Hospital.;Department of Pediatrics National Taiwan University Children's Hospital.;Department of Dermatology National Taiwan University Hospital Taipei, Taiwan.



编号：70

题名：An Unpleasant Encounter with Termites.

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作者：Alves AO;Bernardes Filho F

出处：J Pediatr.2017V182N:396-396.e1

机构：Medical School Centro Universitario Barao de Maua.;Dermatology Division Department of Medical Clinics Ribeirao Preto Medical School University of Sao Paulo Ribeirao Preto, Sao Paulo, Brazil.



编号：71

题名：Viral Respiratory Infections in Preterm Infants during and after Hospitalization.

作者：Caserta MT;Yang H;Gill SR;Holden-Wiltse J;Pryhuber G


机构：Department of Pediatrics, University of Rochester Medical Center, Rochester, NY. Electronic address: [email protected].;Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY.;Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, NY.;Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY.;Department of Pediatrics, University of Rochester Medical Center, Rochester, NY; Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY.


摘要： OBJECTIVE: To determine the burden of viral respiratory infections in preterm infants both during and subsequent to neonatal intensive care unit (NICU) hospitalization and to compare this with term infants living in the community. STUDY DESIGN: From March 2013 through March 2015, we enrolled 189 newborns (96 term and 93 preterm) into a prospective, longitudinal study obtaining nose/throat swabs within 7 days of birth, weekly while hospitalized and then monthly to 4 months after hospital discharge. Taqman array cards were used to identify 16 viral respiratory pathogens by real-time polymerase chain reaction. Demographic, clinical, and laboratory data were gathered from electronic medical records, and parent interview while hospitalized with interval histories collected at monthly visits. The hospital course of all preterm infants who underwent late-onset sepsis evaluations was reviewed. RESULTS: Over 119 weeks, we collected 618 nose/throat swabs from at risk preterm infants in our level IV regional NICU. Only 4 infants had viral respiratory infections, all less than 28 weeks gestation at birth. Two infants were symptomatic with the infections recognized by the clinical team. The daily risk of acquiring a respiratory viral infection in preterm infants in the NICU was significantly lower than in the full term cohort living in the community. Once discharged from the hospital, viral respiratory infections were common in all infants. CONCLUSIONS: Viral respiratory infections are infrequent in a NICU with strict infection prevention strategies and do not appear to cause unrecognized illness. Both preterm and term infants living in the community quickly acquire respiratory viral infections. KEYWORDS:NOTNLM;

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编号：72

题名：Management of Patent Ductus Arteriosus: Are We Looking at the Right Outcomes?

作者：Bancalari E;Jain D


机构：Department of Pediatrics Division of Neonatology University of Miami Miller School of Medicine Miami, Florida. Electronic address: [email protected].;Department of Pediatrics Division of Neonatology University of Miami Miller School of Medicine Miami, Florida.



编号：73

题名：Long-Term Outcome of Interdisciplinary Management of Patients with Duchenne Muscular Dystrophy Receiving Daily Glucocorticoid Treatment.

作者：Wong BL;Rybalsky I;Shellenbarger KC;Tian C;McMahon MA;Rutter MM;Sawnani H;Jefferies JL

出处：J Pediatr.2017V182N:296-303.e1

机构：Comprehensive Neuromuscular Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Electronic address: [email protected].;Comprehensive Neuromuscular Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.;Comprehensive Neuromuscular Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.;Comprehensive Neuromuscular Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.;Comprehensive Neuromuscular Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.;Comprehensive Neuromuscular Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.;Comprehensive Neuromuscular Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.;Comprehensive Neuromuscular Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.


摘要： OBJECTIVE: To evaluate clinical outcomes and steroid side effects in a cohort of patients with Duchenne muscular dystrophy (DMD) treated with long-term daily glucocorticoid therapy. Although daily glucocorticoid therapy has been shown to extend ambulatory function in DMD, less frequent dosing is often used because of side effect concerns. STUDY DESIGN: Retrospective study of 97 patients with DMD aged 10 to <16 years treated with daily glucocorticoid (89% on deflazacort) for a mean of 8.5 years. Outcome measures were motor, pulmonary, and cardiac function, and scoliosis. Side effects were growth failure and weight gain, facial fullness, blood pressure, bone health, cataracts, gastrointestinal symptoms, behavior, hypertrichosis, and need for medication interventions. RESULTS: For

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13- to 16-year-old patients, 40% could rise from the floor and 50% could perform the 30-foot run test. Forced vital capacity for the entire cohort was well preserved. Thirteen percent of younger (10- to <13-year-old) and 21% of older patients had findings of left ventricle systolic dysfunction. Six percent (all aged 16 years) developed scoliosis (Cobb angle >20 degrees). Eighty-six percent had normal weight velocities; 30% had no increased facial fullness; 72% had short stature; and 19% had asymptomatic cataracts. Asymptomatic spine compression deformities were noted in 76% and long bone fractures in 30%. One patient stopped glucocorticoid because of behavioral concerns. CONCLUSIONS: With evidence for improved outcomes and manageable side effects, we recommend use of daily glucocorticoid therapy for patients with DMD with anticipatory management of side effects and a coordinated interdisciplinary care approach. KEYWORDS:NOTNLM;

编号：74

题名：Hemiconvulsion-Hemiplegia-Epilepsy Syndrome.

作者：Stephens JR;Sams C


机构：Department of Pediatrics.;Department of Radiology University of North Carolina Chapel Hill, North Carolina.



编号：75

题名：Neonatal Surgery for Noncardiac Congenital Anomalies: Neonates at Risk of Brain Injury.

作者：Stolwijk LJ;Keunen K;de Vries LS;Groenendaal F;van der Zee DC;van Herwaarden MY;Lemmers PM;Benders MJ

出处：J Pediatr.2017V182N:335-341.e1

机构：Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands; Department of Brain Center Rudolf Magnus, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands; Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands.;Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands; Department of Brain Center Rudolf Magnus, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands.;Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands; Department of Brain Center Rudolf Magnus, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands.;Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands.;Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands.;Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands.;Department of Neonatology, Wilhelmina Children's Hospital,

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University Medical Center Utrecht, The Netherlands.;Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands; Department of Brain Center Rudolf Magnus, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands. Electronic address: [email protected].


摘要： OBJECTIVE: To evaluate the incidence of brain injury after neonatal surgery for noncardiac congenital anomalies using magnetic resonance imaging (MRI). STUDY DESIGN: An MRI was obtained in 101 infants at 7 days [range: 1-115] after neonatal surgery for major noncardiac congenital anomalies. Brain injury was assessed using T1, T2, diffusion weighted imaging, and susceptibility-weighted imaging. RESULTS: Thirty-two preterm infants (<37 weeks of gestation) and 69 full-term infants were included. MRI abnormalities were found in 24 (75%) preterm and 40 (58%) full-term infants. Parenchymal lesions were noted in 23 preterm (72%) and 29 full-term infants (42%). These consisted of punctate white matter lesions (n = 45), punctate cerebellar lesions (n = 17), thalamic infarction (n = 5), and periventricular hemorrhagic infarction (n = 4). Nonparenchymal abnormalities were found in 9 (28%) preterm and 26 (38%) full-term infants. These included supra- and infratentorial subdural hemorrhages (n = 30), intraventricular hemorrhage grade II (n = 7), and asymptomatic sinovenous thrombosis (n = 1). A combination of parenchymal lesions was present in 21 infants. Of infants who had an MRI within 10 days after surgery, punctate white matter lesions were visible on diffusion weighted imaging in 22 (61%), suggestive of recent ischemic origin. Type of congenital anomaly and prematurity were most predictive of brain injury. CONCLUSIONS: Infants who have neonatal surgery for noncardiac congenital anomalies are at risk of brain injury, potentially accounting for the neurodevelopmental delay frequently observed in this population. Further research is warranted into potential mechanisms of brain injury and its timing of onset. Long-term neurodevelopmental follow-up is needed in this vulnerable population. KEYWORDS:NOTNLM;

编号：76

题名：Mortality in Children with Human Immunodeficiency Virus Initiating Treatment: A Six-Cohort Study in Latin America.

作者：Luque MT;Jenkins CA;Shepherd BE;Padgett D;Rouzier V;Succi RC;Machado DM;McGowan CC;Vermund SH;Pinto JA

出处：J Pediatr.2017V182N:245-252.e1

机构：Department of Pediatrics, Social Security Honduran Institute, Tegucigalpa, Honduras.;Departments of Biostatistics, Medicine, and Pediatrics, Vanderbilt University School of Medicine, and Vanderbilt Institute for Global Health, Nashville, TN.;Departments of Biostatistics, Medicine, and Pediatrics, Vanderbilt University School of Medicine, and Vanderbilt Institute for Global Health, Nashville, TN.;Department of Pediatrics, Social Security Honduran Institute, Tegucigalpa, Honduras.;Haitian Group for Studies of Kaposi Sarcoma and Opportunistic Infections, Port-au-Prince, Haiti.;Department of Pediatrics, School of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil.;Department of Pediatrics, School of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil.;Departments of Biostatistics, Medicine, and Pediatrics, Vanderbilt University School of Medicine, and Vanderbilt Institute for Global Health, Nashville, TN.;Departments of Biostatistics, Medicine, and Pediatrics, Vanderbilt University School of Medicine, and Vanderbilt Institute for Global Health, Nashville, TN.;Department of Pediatrics, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil. Electronic address: [email protected].


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摘要： OBJECTIVES: To assess the risks of and factors associated with mortality, loss to follow-up, and changing regimens after children with HIV infected perinatally initiate combination antiretroviral therapy (cART) in Latin America and the Caribbean. STUDY DESIGN: This 1997-2013 retrospective cohort study included 1174 antiretroviral therapy-naive, perinatally infected children who started cART age when they were younger than 18 years of age (median 4.7 years; IQR 1.7-8.8) at 1 of 6 cohorts from Argentina, Brazil, Haiti, and Honduras, within the Caribbean, Central and South America Network for HIV Epidemiology. Median follow-up was 5.6 years (IQR 2.3-9.3). Study outcomes were all-cause mortality, loss to follow-up, and major changes in cART. We used Cox proportional hazards models stratified by site to examine the association between predictors and times to death or changing regimens. RESULTS: Only 52% started cART at younger than 5 years of age; 19% began a protease inhibitor. At cART initiation, median CD4 count was 472 cells/mm3 (IQR 201-902); median CD4% was 16% (IQR 10-23). Probability of death was high in the first year of cART: 0.06 (95% CI 0.04-0.07). Five years after cART initiation, the cumulative mortality incidence was 0.12 (95% CI 0.10-0.14). Cumulative incidences for loss to follow-up and regimen change after 5 years were 0.16 (95% 0.14-0.18) and 0.30 (95% 0.26-0.34), respectively. Younger children had the greatest risk of mortality, whereas older children had the greatest risk of being lost to follow-up or changing regimens. CONCLUSIONS: Innovative clinical and community approaches are needed for quality improvement in the pediatric care of HIV in the Americas. KEYWORDS:NOTNLM;

编号：77

题名：Eliminating Disparities in Mother's Milk Feeding in the Neonatal Intensive Care Unit.

作者：Engstrom JL;Patel AL;Meier PP


机构：College of Nursing Rush University. Electronic address: [email protected].;College of Nursing Rush University; Pediatrics Rush University Medical Center Chicago, Illinois.;College of Nursing Rush University; Pediatrics Rush University Medical Center Chicago, Illinois.



编号：78

题名：The Placebo Response in Pediatric Abdominal Pain-Related Functional Gastrointestinal Disorders: A Systematic Review and Meta-Analysis.

作者：Hoekman DR;Zeevenhooven J;van Etten-Jamaludin FS;Douwes Dekker I;Benninga MA;Tabbers MM;Vlieger AM

出处：J Pediatr.2017V182N:155-163.e7

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机构：Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands.;Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands.;Medical Library, Academic Medical Center, Amsterdam, the Netherlands.;Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.;Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands.;Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands.;Department of Pediatrics, St. Antonius Hospital, Nieuwegein, the Netherlands.


摘要： OBJECTIVE: To investigate the magnitude and determinants of the placebo response in studies with pediatric abdominal pain-related functional gastrointestinal disorders. STUDY DESIGN: The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and CINAHL were searched for systematic reviews and randomized placebo-controlled trials concerning children 4-18 years of age with an abdominal pain-related functional gastrointestinal disorder. The primary outcome was the pooled proportion of subjects assigned to placebo with improvement as defined by the authors. The effect of trial characteristics on the magnitude of the placebo response was investigated using univariate meta-regression analysis. RESULTS: Twenty-one trials were identified. The pooled proportion of subjects with improvement was 41% (95% CI, 34%-49%; 17 studies) and with no pain was 17% (95% CI, 8%-32%; 7 studies). The pooled standardized mean difference on the Faces Pain Scales compared with baseline was -0.73 (95% CI, -1.04 to -0.42; 8 studies). There was significant heterogeneity across studies with respect to both outcomes. Lower dosing frequency (P = .04), positive study (P = .03), longer duration of treatment (P < .001), and higher placebo dropout (P < .001) were associated with higher report of no pain. Response on Faces Pain Scales was greater in studies conducted in the Middle East (P = .002), in studies that did not report the randomization schedule (P = .02), and in studies with a higher percentage of females (P = .04). CONCLUSIONS: Approximately 41% of children with abdominal pain-related functional gastrointestinal disorders improve on placebo. Several trial characteristics are correlated significantly with the proportion of patients with no pain on placebo and with the magnitude of the placebo response on Faces Pain Scales. These data could be valuable for the design of future studies. KEYWORDS:NOTNLM;

编号：79

题名：Impact of Latency Duration on the Prognosis of Preterm Infants after Preterm Premature Rupture of Membranes at 24 to 32 Weeks' Gestation: A National Population-Based Cohort Study.

作者：Lorthe E;Ancel PY;Torchin H;Kaminski M;Langer B;Subtil D;Sentilhes L;Arnaud C;Carbonne B;Debillon T;Delorme P;D'Ercole C;Dreyfus M;Lebeaux C;Galimard JE;Vayssiere C;Winer N;L'Helias LF;Goffinet F;Kayem G


机构：Inserm Unite Mixte de Recherche (UMR) 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epope), Center for Epidemiology and Statistics Sorbonne Paris Cite, Departement Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France; Sorbonne Universites, University Pierre and Marie Curie, Paris 06, Institut de Formation Doctorale, Paris, France. Electronic address: [email protected].;Inserm Unite Mixte de Recherche (UMR) 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epope), Center for Epidemiology and Statistics Sorbonne Paris Cite, Departement Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France; Unite de Recherche Clinique-Centre d'Investigations Cliniques P1419, Cochin Hotel-Dieu Hospital, Assistance Publique - Hopitaux de Paris (AP-HP), Paris, France.;Inserm Unite Mixte de Recherche (UMR) 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epope), Center for Epidemiology and Statistics Sorbonne Paris Cite, Departement Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France.;Inserm Unite Mixte de Recherche (UMR) 1153, Obstetrical, Perinatal and Pediatric

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Epidemiology Research Team (Epope), Center for Epidemiology and Statistics Sorbonne Paris Cite, Departement Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France.;Department of Obstetrics and Gynecology, Hautepierre Hospital, Strasbourg, France.;Department of Obstetrics and Gynecology, Jeanne de Flandre Hospital, Lille, France.;Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France.;Research Unit on Perinatal Epidemiology, Childhood Disabilities and Adolescent Health, Inserm UMR 1027, Paul Sabatier University, Toulouse, France.;Department of Obstetrics and Gynecology, Princess Grace Hospital, Monaco.;Department of Neonatal Pediatrics, University Hospital, Grenoble, France.;Inserm Unite Mixte de Recherche (UMR) 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epope), Center for Epidemiology and Statistics Sorbonne Paris Cite, Departement Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France; Department of Obstetrics and Gynecology, Cochin, Broca, Hotel Dieu Hospital, AP-HP, Paris, France.;Department of Obstetrics and Gynecology, Nord Hospital, Assistance Publique des Hopitaux de Marseille (AP-HM), Aix Marseille Universite, Marseille, France.;Department of Gynecology and Obstetrics, University Hospital, Caen, France.;Inserm Unite Mixte de Recherche (UMR) 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epope), Center for Epidemiology and Statistics Sorbonne Paris Cite, Departement Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France.;Department of Biostatistics and Medical Information (ECSTRA Team), Centre of Research in Epidemiology and Statistics Sorbonne, Inserm UMR 1153, Universite Paris Diderot, Paris, France.;Research Unit on Perinatal Epidemiology, Childhood Disabilities and Adolescent Health, Inserm UMR 1027, Paul Sabatier University, Toulouse, France; Department of Obstetrics and Gynecology, University Hospital, Toulouse, France.;Department of Obstetrics and Gynecology, University Hospital, National Institute for Agricultural Research, UMR 1280 Physiologie des adaptations nutritionnelles, Nantes, France.;Inserm Unite Mixte de Recherche (UMR) 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epope), Center for Epidemiology and Statistics Sorbonne Paris Cite, Departement Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France; Department of Neonatal Pediatrics, Trousseau Hospital, AP-HP, Paris, France.;Inserm Unite Mixte de Recherche (UMR) 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epope), Center for Epidemiology and Statistics Sorbonne Paris Cite, Departement Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France; Department of Obstetrics and Gynecology, Cochin, Broca, Hotel Dieu Hospital, AP-HP, Paris, France.;Inserm Unite Mixte de Recherche (UMR) 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epope), Center for Epidemiology and Statistics Sorbonne Paris Cite, Departement Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France; Sorbonne Universites, University Pierre and Marie Curie, Paris 06, Institut de Formation Doctorale, Paris, France; Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP, Paris, France.


摘要： OBJECTIVE: To assess the impact of latency duration on survival, survival without severe morbidity, and early-onset sepsis in infants born after preterm premature rupture of membranes (PPROM) at 24-32 weeks' gestation. STUDY DESIGN: This study was based on the prospective national population-based Etude Epidemiologique sur les Petits Ages Gestationnels 2 cohort of preterm births and included 702 singletons delivered in France after PPROM at 24-32 weeks' gestation. Latency duration was defined as the time from spontaneous rupture of membranes to delivery, divided into 4 periods (12 hours to 2 days [reference], 3-7 days, 8-14 days, and >14 days). Multivariable logistic regression was used to assess the relationship between latency duration and survival, survival without severe morbidity at discharge, or early-onset sepsis. RESULTS: Latency duration ranged from 12 hours to 2 days (18%), 3-7 days (38%), 8-14 days (24%), and >14 days (20%). Rates of survival, survival without severe morbidity, and early-onset sepsis were 93.5% (95% CI 91.8-94.8), 85.4% (82.4-87.9), and 3.4% (2.0-5.7), respectively. A crude association found between prolonged latency duration and improved survival disappeared on adjusting for gestational age at birth (aOR 1.0 [reference], 1.6 [95% CI 0.8-3.2], 1.2 [0.5-2.9], and 1.0 [0.3-3.2] for latency durations from 12 hours to 2 days, 3-7 days, 8-14 days, and >14 days, respectively). Prolonged latency duration was not associated with survival without severe morbidity or early-onset sepsis. CONCLUSION: For a given gestational age at birth, prolonged latency duration after PPROM does not worsen neonatal prognosis. KEYWORDS:NOTNLM;

编号：80

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题名：Rapid Resolution of Blended or Composite Multigenic Disease in Infants by Whole-Exome Sequencing.

作者：Theunissen TE;Sallevelt SC;Hellebrekers DM;de Koning B;Hendrickx AT;van den Bosch BJ;Kamps R;Schoonderwoerd K;Szklarczyk R;Mulder-Den Hartog EN;de Coo IF;Smeets HJ

出处：J Pediatr.2017V182N:371-374.e2

机构：Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Genetics and Cell Biology, School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.;Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands.;Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands.;Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands.;Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands.;Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands.;Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands.;Department of Clinical Genetics, Erasmus Medical Centre (MC), Rotterdam, The Netherlands.;Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands.;Department of Neurology, Erasmus MC, Rotterdam, The Netherlands.;Department of Neurology, Erasmus MC, Rotterdam, The Netherlands.;Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Genetics and Cell Biology, School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands. Electronic address: [email protected].


摘要： Whole-exome sequencing identified multiple genetic causes in 2 infants with heterogeneous disease. Three gene defects in the first patient explained all symptoms, but manifestations were overlapping (blended phenotype). Two gene defects in the second patient explained nonoverlapping symptoms (composite phenotype). Whole-exome sequencing rapidly and comprehensively resolves heterogeneous genetic disease. KEYWORDS:NOTNLM;

编号：81

题名：Extubation Failure after Neonatal Cardiac Surgery: A Multicenter Analysis.

作者：Mastropietro CW;Cashen K;Grimaldi LM;Narayana Gowda KM;Piggott KD;Wilhelm M;Gradidge E;Moser EA;Benneyworth BD;Costello JM

出处：J Pediatr.2017V182N:190-196.e4

机构：Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN. Electronic address: [email protected].;Division of Critical Care, Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI.;Division of Cardiovascular Intensive Care, Phoenix Children's Hospital, Department of Child Health, University of Arizona, College of Medicine - Phoenix, Phoenix, AZ.;Division of Pediatric Critical Care Medicine, Department of Pediatrics, Cleveland Clinic, Cleveland, OH.;The Heart Center at Arnold Palmer Hospital for Children, Division of Pediatric Cardiac Intensive Care, Department of Pediatrics, University of Central Florida College of Medicine, Orlando, FL.;Division of Pediatric Cardiac Intensive Care, Department of Pediatrics, University of Wisconsin, Madison, WI.;Division of Critical Care at Phoenix Children's Hospital, Department of Child Health, University of Arizona, College of Medicine - Phoenix, Phoenix, AZ.;Department of Biostatistics, Indiana University School of Medicine &

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Richard M. Fairbanks School of Public Health, Indianapolis, IN.;Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN.;Divisions of Cardiology & Critical Care Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL.


摘要： OBJECTIVES: To describe the epidemiology of extubation failure and identify risk factors for its occurrence in a multicenter population of neonates undergoing surgery for congenital heart disease. STUDY DESIGN: We conducted a prospective observational study of neonates </=30 days of age who underwent cardiac surgery at 7 centers within the US in 2015. Extubation failure was defined as reintubation within 72 hours of the first planned extubation. Risk factors were identified with the use of multivariable logistic regression analysis and reported as OR with 95% CIs. Multivariable logistic regression analysis was conducted to examine the relationship between extubation failure and worse clinical outcome, defined as hospital length of stay in the upper 25% or operative mortality. RESULTS: We enrolled 283 neonates, of whom 35 (12%) failed their first extubation at a median time of 7.5 hours (range 1-70 hours). In a multivariable model, use of uncuffed endotracheal tubes (OR 4.6; 95% CI 1.8-11.6) and open sternotomy of 4 days or more (OR 4.8; 95% CI 1.3-17.1) were associated independently with extubation failure. Accordingly, extubation failure was determined to be an independent risk factor for worse clinical outcome (OR 5.1; 95% CI 2-13). CONCLUSIONS: In this multicenter cohort of neonates who underwent surgery for congenital heart disease, extubation failure occurred in 12% of cases and was associated independently with worse clinical outcome. Use of uncuffed endotracheal tubes and prolonged open sternotomy were identified as independent and potentially modifiable risk factors for the occurrence of this precarious complication. KEYWORDS:NOTNLM;

编号：82

题名：The Longitudinal Effects of Persistent Apnea on Cerebral Oxygenation in Infants Born Preterm.

作者：Horne RS;Fung AC;NcNeil S;Fyfe KL;Odoi A;Wong FY


机构：The Ritchie Center, Hudson Institute of Medical Research and Department of Pediatrics, Monash University, Melbourne, Australia. Electronic address: [email protected].;Department of Pediatrics, Chinese University of Hong Kong, Hong Kong, China.;The Ritchie Center, Hudson Institute of Medical Research and Department of Pediatrics, Monash University, Melbourne, Australia.;The Ritchie Center, Hudson Institute of Medical Research and Department of Pediatrics, Monash University, Melbourne, Australia.;The Ritchie Center, Hudson Institute of Medical Research and Department of Pediatrics, Monash University, Melbourne, Australia.;The Ritchie Center, Hudson Institute of Medical Research and Department of Pediatrics, Monash University, Melbourne, Australia; Monash Newborn, Monash Health, Melbourne, Australia.


摘要： OBJECTIVE: To assess the incidence and impact of persistent apnea on heart rate (HR), oxygen saturation (SpO2), and brain tissue oxygenation index (TOI) over the first 6 months after term equivalent age in ex-preterm infants. STUDY DESIGN: Twenty-four preterm infants born between 27 and 36 weeks of gestational age were studied with daytime polysomnography at 2-4 weeks, 2-3 months, and 5-6 months post-term corrected age. Apneas lasting >/=3 seconds were included and maximal percentage changes (nadir) in HR, SpO2, and tissue oxygenation index (TOI, NIRO-200 Hamamatsu) from baseline were analyzed. RESULTS: A total of 253 apneas were recorded at 2-4 weeks, 203 at 2-3 months, and 148 at 5-6 months. There was no effect of gestational age at birth, sleep state, or sleep position

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on apnea duration, nadir HR, SpO2, or TOI. At 2-4 weeks, the nadirs in HR (-11.1 +/- 1.2 bpm) and TOI (-4.4 +/- 1.0%) were significantly less than at 2-3 months (HR: -13.5 +/- 1.2 bpm, P < .05; TOI: -7.5 +/- 1.1 %, P < .05) and at 5-6 months (HR: -13.2 +/- 1.3 bpm, P < .01; TOI: -9.3 +/- 1.2%, P < .01). CONCLUSIONS: In ex-preterm infants, apneas were frequent and associated with decreases in heart rate and cerebral oxygenation, which were more marked at 2-3 months and 5-6 months than at 2-4 weeks. Although events were short, they may contribute to the adverse neurocognitive outcomes that are common in ex-preterm children. KEYWORDS:NOTNLM;

编号：83

题名：Crystalloid Fluid Choice and Clinical Outcomes in Pediatric Sepsis: A Matched Retrospective Cohort Study.

作者：Weiss SL;Keele L;Balamuth F;Vendetti N;Ross R;Fitzgerald JC;Gerber JS

出处：J Pediatr.2017V182N:304-310.e10

机构：Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. Electronic address: [email protected].;McCourt School of Public Policy and Department of Government, Georgetown University, Washington, DC.;Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA; Division of Emergency Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.;Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA.;Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA.;Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.;Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA; Division of Infectious Diseases, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.


摘要： OBJECTIVE: To test the hypothesis that resuscitation with balanced fluids (lactated Ringer [LR]) is associated with improved outcomes compared with normal saline (NS) in pediatric sepsis. STUDY DESIGN: We performed matched analyses using data from 12 529 patients <18 years of age with severe sepsis/septic shock at 382 US hospitals between 2000 and 2013 to compare outcomes with vs without LR as part of initial resuscitation. Patients receiving LR were matched 1:1 to patients receiving only NS (NS group), including separate matches for any (LR-any group) or exclusive (LR-only group) LR use. Outcomes included 30-day hospital mortality, acute kidney injury, new dialysis, and length of stay. RESULTS: The LR-any group was older, received larger crystalloid volumes, and was less likely to have malignancies than the NS group. After matching, mortality was not different between LR-any (7.2%) and NS (7.9%) groups (risk ratio 0.99, 95% CI 0.98, 1.01; P = .20). There were no differences in secondary outcomes except longer hospital length of stay in LR-any group (absolute difference 2.4, 95% CI 1.4, 5.0 days; P < .001). Although LR was preferentially used as adjunctive fluid with large-volume resuscitation or first-line fluid in patients with lower illness severity, outcomes were not different after matching stratified by volume and proportionate LR utilization, including for patients in the LR-only group. CONCLUSIONS: Balanced fluid resuscitation with LR was not associated with improved outcomes compared with NS in pediatric sepsis. Although the current practice of NS resuscitation is justified, selective LR use necessitates a prospective trial to definitively determine comparative effectiveness among crystalloids. KEYWORDS:NOTNLM;

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编号：84

题名：Associations of Linear Growth and Relative Weight Gain in Early Life with Human Capital at 30 Years of Age.

作者：Horta BL;Victora CG;de Mola CL;Quevedo L;Pinheiro RT;Gigante DP;Motta JV;Barros FC


机构：Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Brazil. Electronic address: [email protected].;Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Brazil.;Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Brazil.;Postgraduate Program in Health and Behavior, Universidade Catolica de Pelotas, Brazil.;Postgraduate Program in Health and Behavior, Universidade Catolica de Pelotas, Brazil.;Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Brazil.;Postgraduate Program in Health and Behavior, Universidade Catolica de Pelotas, Brazil.;Postgraduate Program in Health and Behavior, Universidade Catolica de Pelotas, Brazil.


摘要： OBJECTIVE: To assess the associations of birthweight, nutritional status and growth in childhood with IQ, years of schooling, and monthly income at 30 years of age. STUDY DESIGN: In 1982, the 5 maternity hospitals in Pelotas, Brazil, were visited daily and 5914 live births were identified. At 30 years of age, 3701 subjects were interviewed. IQ, years of schooling, and income were measured. RESULTS: On average, their IQ was 98 points, they had 11.4 years of schooling, and the mean income was 1593 reais. After controlling for several confounders, birthweight and attained weight and length/height for age at 2 and 4 years of age were associated positively with IQ, years of years of schooling, and income, except for the association between length at 2 years of age and income. Conditional growth analyses were used to disentangle linear growth from relative weight gain. Conditional length at 2 years of age >/=1 SD score above the expected value, compared with >/=1 SD below the expected, was associated with an increase in IQ (4.28 points; 95% CI, 2.66-5.90), years of schooling (1.58 years; 95% CI, 1.08-2.08), and monthly income (303 Brazilian reais; 95% CI, 44-563). Relative weight gain, above what would be expected from linear growth, was not associated with the outcomes. CONCLUSION: In a middle-income setting, promotion of linear growth in the first 1000 days of life is likely to increase adult IQ, years of schooling, and income. Weight gain in excess of what is expected from linear growth does not seem to improve human capital. KEYWORDS:NOTNLM;

编号：85

题名：Influence of Musculoskeletal Manifestations as the Only Presenting Symptom in B-Cell Acute Lymphoblastic Leukemia.

作者：Kang S;Im HJ;Bae K;Park SS

出处：J Pediatr.2017V182N:290-295.e1

机构：Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea.;Department of Pediatrics, Division of Pediatric Hematology/Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.;Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea.;Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address: [email protected].

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摘要： OBJECTIVE: To evaluate the clinical and prognostic impact of musculoskeletal manifestations as the only initial presenting symptom in childhood acute lymphoblastic leukemia (ALL). STUDY DESIGN: We retrospectively reviewed 158 children with precursor B-cell type ALL who were followed up for >2 years. The patients were assigned to the groups musculoskeletal manifestations (n = 24) or nonmusculoskeletal manifestations (n = 134) based on initial presenting symptom. The symptom duration (regarding any initial presenting symptom) and the leukemic symptom duration (regarding symptoms of systemic manifestation, such as fever, bleeding, or pallor) were assessed, along with other clinical characteristics. RESULTS: The musculoskeletal manifestations group exhibited a longer symptom duration than the nonmusculoskeletal manifestations group (43 days vs 22 days, P = .006), but overall survival did not significantly differ between the groups. Multivariate analysis indicated that a longer symptom duration did not affect prognosis but that a longer leukemic symptom duration was associated with a poorer prognosis (hazard ratio, 7.720; P = .048). CONCLUSION: Musculoskeletal manifestations are associated significantly with diagnostic delay, but this delay does not affect the prognosis. Diagnostic delay after the onset of leukemic symptoms, however, does appear to affect the prognosis. Intensive evaluations for hematologic malignancies may be unnecessary in children who complain of limb pain without any definite cause, unless they also present with accompanying leukemic symptoms. KEYWORDS:NOTNLM;

编号：86

题名：Clinical Risk Factors for Punctate White Matter Lesions on Early Magnetic Resonance Imaging in Preterm Newborns.

作者：Wagenaar N;Chau V;Groenendaal F;Kersbergen KJ;Poskitt KJ;Grunau RE;Synnes A;Duerden EG;de Vries LS;Miller SP;Benders MJ


机构：Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.;Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, University of British Columbia, British Columbia Children's and Women's Hospitals, Child and Family Research Institute, Vancouver, British Columbia, Canada.;Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.;Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.;Department of Pediatrics, University of British Columbia, British Columbia Children's and Women's Hospitals, Child and Family Research Institute, Vancouver, British Columbia, Canada.;Department of Pediatrics, University of British Columbia, British Columbia Children's and Women's Hospitals, Child and Family Research Institute, Vancouver, British Columbia, Canada.;Department of Pediatrics, University of British Columbia, British Columbia Children's and Women's Hospitals, Child and Family Research Institute, Vancouver, British Columbia, Canada.;Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.;Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.;Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, University of British Columbia, British Columbia Children's and Women's Hospitals, Child and Family Research Institute, Vancouver, British Columbia, Canada.;Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: [email protected].


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摘要： OBJECTIVE: To identify clinical risk factors for punctate white matter lesions (PWML) on early magnetic resonance imaging (MRI) in 2 cohorts of newborns born extremely preterm in different neonatal centers. STUDY DESIGN: A total of 250 newborns born preterm at less than 28 weeks of gestation (mean 26.4 +/- 1.1 weeks) with an early MRI were identified from 2 neonatal centers, in Vancouver, Canada (cohort A, n = 100) and Utrecht, the Netherlands (cohort B, n = 150). Cohort A was imaged as part of a prospective research study and cohort B was imaged as part of routine clinical care. PWML were defined as cluster type foci of hyperintensity on T1-weighted imaging and were identified at a mean postmenstrual age of 31.1 (+/-1.9) weeks. Multivariable analysis was used to identify clinical factors predictive of PWML. RESULTS: Cluster type PWML were found in 47 newborns born extremely preterm (18.8%) and were more common in cohort A (32%) than in cohort B (10%). Newborns in cohort A generally were sicker than those in cohort B. Multivariable analyses revealed that greater birth weight (B = 0.002; P < .02), grade II-III intraventricular hemorrhage (B = 0.83; P < .02), and cohort A (B = 1.34; P < .0001) were independent predictors of PWML. CONCLUSION: Several risk factors for PWML on early MRI were identified. The interaction among birth weight, intraventricular hemorrhage, and other aspects of postnatal illness as risk factors for PWML warrants further investigation in newborns born extremely preterm and may help to identify modifiable risk factors for PWML. KEYWORDS:NOTNLM;

编号：87

题名：Identification of Suspected Hepatocellular Carcinoma with Contrast-Enhanced Ultrasound.

作者：Squires JH;Bill A;Thieret J;Squires JE

出处：J Pediatr.2017V182N:398-398.e1

机构：Department of Radiology.;Department of Radiology.;Department of Hepatology Children's Hospital of Pittsburgh Pittsburgh, Pennsylvania.;Department of Hepatology Children's Hospital of Pittsburgh Pittsburgh, Pennsylvania.



编号：88

题名：Features of Heart Rate Variability Capture Regulatory Changes During Kangaroo Care in Preterm Infants.

作者：Kommers DR;Joshi R;van Pul C;Atallah L;Feijs L;Oei G;Bambang Oetomo S;Andriessen P


机构：Department of Neonatology, Maxima Medical Center, Veldhoven, The Netherlands; Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands.;Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Clinical Physics, Maxima Medical

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Center, Veldhoven, The Netherlands. Electronic address: [email protected].;Department of Clinical Physics, Maxima Medical Center, Veldhoven, The Netherlands; Department of Applied Physics, Eindhoven University of Technology, Eindhoven, The Netherlands.;Patient Care and Measurements Department, Philips Research, Eindhoven, The Netherlands.;Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands.;Department of Gynecology, Maxima Medical Center, Veldhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.;Department of Neonatology, Maxima Medical Center, Veldhoven, The Netherlands; Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands.;Department of Neonatology, Maxima Medical Center, Veldhoven, The Netherlands; Department of Pediatrics, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.


摘要： OBJECTIVE: To determine whether heart rate variability (HRV) can serve as a surrogate measure to track regulatory changes during kangaroo care, a period of parental coregulation distinct from regulation within the incubator. STUDY DESIGN: Nurses annotated the starting and ending times of kangaroo care for 3 months. The pre-kangaroo care, during-kangaroo care, and post-kangaroo care data were retrieved in infants with at least 10 accurately annotated kangaroo care sessions. Eight HRV features (5 in the time domain and 3 in the frequency domain) were used to visually and statistically compare the pre-kangaroo care and during-kangaroo care periods. Two of these features, capturing the percentage of heart rate decelerations and the extent of heart rate decelerations, were newly developed for preterm infants. RESULTS: A total of 191 kangaroo care sessions were investigated in 11 preterm infants. Despite clinically irrelevant changes in vital signs, 6 of the 8 HRV features (SD of normal-to-normal intervals, root mean square of the SD, percentage of consecutive normal-to-normal intervals that differ by >50 ms, SD of heart rate decelerations, high-frequency power, and low-frequency/high-frequency ratio) showed a visible and statistically significant difference (P <.01) between stable periods of kangaroo care and pre-kangaroo care. HRV was reduced during kangaroo care owing to a decrease in the extent of transient heart rate decelerations. CONCLUSION: HRV-based features may be clinically useful for capturing the dynamic changes in autonomic regulation in response to kangaroo care and other changes in environment and state. KEYWORDS:NOTNLM;

编号：89

题名：Family-Based Smoking Cessation Intervention for Smoking Fathers and Nonsmoking Mothers with a Child: A Randomized Controlled Trial.

作者：Chan SS;Cheung YT;Fong DY;Emmons K;Leung AY;Leung DY;Lam TH

出处：J Pediatr.2017V182N:260-266.e4

机构：School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong.;School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong; School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong. Electronic address: [email protected].;School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong.;Kaiser Foundation Research Institute, Menlo Park, CA.;School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong.;The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong.;School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong.


摘要： OBJECTIVE: To examine whether a family-based intervention targeting both smoking fathers and nonsmoking mothers in well-child health clinics is effective in increasing fathers' abstinence from cigarette smoking. STUDY

156

DESIGN: This parallel 2-arm randomized controlled trial recruited a total of 1158 families with a daily-smoking father, a nonsmoking mother, and a child aged 0-18 months from the 22 maternal and child health centers in Hong Kong. The intervention group received the family-based intervention, including 6 nurse-led individual face-to-face and telephone counseling sessions within 1 month after recruitment and a voluntary face-to-face family counseling session (FCS). The control group received a leaflet, a self-help booklet, and brief quitting advice only. Father-reported 7-day and 6-month abstinence, smoking reduction, quit attempts, mother-reported help and support, and child salivary cotinine level were assessed at 12 months. Generalized estimating equation models were used to compare these outcomes between the 2 study groups. RESULTS: Compared with the control group, the intervention group reported a greater prevalence of 7-day (13.7% vs 8.0%; OR, 1.92; 95% CI, 1.16-3.17; P < .01) and 6-month self-reported abstinence (13.4% vs. 7.5%; OR, 2.10; 95% CI, 1.30-3.40; P < .01). Within the intervention group, compared with receipt of individual counseling only, participation in the FCS was associated with increases in fathers' self-reported abstinence (20.2% vs 12.3%; P = .02), mothers' help (66.1% vs 43.8%; P < .01), and support to the fathers (55.0% vs 45.4%; P < .01). CONCLUSIONS: The family-based smoking cessation intervention for the families in the well-child healthcare setting was effective in increasing the fathers' self-reported abstinence. Additional participation in the FCS increased mothers' help and support to the fathers. TRIAL REGISTRATION: Controlled-trials.com: ISRCTN99111655; Hkuctr.com: HKUCTR-465. KEYWORDS:NOTNLM;

编号：90

题名：Estimating Premium and Out-of-Pocket Outlays Under All Child Dental Coverage Options in the Federally Facilitated Marketplace.

作者：Vujicic M;Yarbrough C

出处：J Pediatr.2017V182N:349-355.e1

机构：Health Policy Institute, American Dental Association, Chicago, IL.;Health Policy Institute, American Dental Association, Chicago, IL. Electronic address: [email protected].


摘要： OBJECTIVE: To estimate premium and out-of-pocket costs for child dental care services under various dental coverage options offered within the federally facilitated marketplace. STUDY DESIGN: We estimated premium and out-of-pocket costs for child dental care services for 12 patient profiles, which vary by dental care use and spending. We did this for 1039 medical plans that include child dental coverage, 2703 medical plans that do not include child dental coverage, and 583 stand-alone dental plans for the 2015 plan year. Our analysis is based on plan data from the Center for Consumer Information and Insurance Oversight and Data.HealthCare.Gov. RESULTS: On average, expected total financial outlays for child dental care services were lower when dental coverage was embedded within a medical plan compared with the alternative of a stand-alone dental plan. The difference, however, in average expected out-of-pocket spending varied significantly for our 12 patient profiles. Older children who are very high users of dental care, for example, have lower expected out-of-pocket costs under a stand-alone dental plan. For the vast majority of other age groups and dental care use profiles, the reverse holds. CONCLUSIONS: Our results show that embedding dental coverage within medical plans, on average, results in lower total financial outlays for child beneficiaries. Although our results are specific to the federally facilitated marketplace, they hold lessons for both state-based marketplaces and the general private health insurance and dental benefits market, as well. KEYWORDS:NOTNLM;

157

编号：91

题名：The Burden of Ionizing Radiation Studies in Children with Ventricular Shunts.

作者：Antonucci MC;Zuckerbraun NS;Tyler-Kabara EC;Furtado AD;Murphy ME;Marin JR

出处：J Pediatr.2017V182N:210-216.e1

机构：Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. Electronic address: [email protected].;Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.;Department of Neurological Surgery, Division of Pediatric Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA.;Department of Radiology, Division of Pediatric Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA.;Department of Pediatrics, Division of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.;Department of Pediatrics, Division of Pediatric Emergency Medicine and Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.


摘要： OBJECTIVES: To quantify the number of shunt-related imaging studies that patients with ventricular shunts undergo and to calculate the proportion of computed tomography (CT) scans associated with a surgical intervention. STUDY DESIGN: Retrospective longitudinal cohort analysis of patients up to age 22 years with a shunt placed January 2002 through December 2003 at a pediatric hospital. Primary outcome was the number of head CT scans, shunt series radiograph, skull radiographs, nuclear medicine, and brain magnetic resonance imaging studies for 10 years following shunt placement. Secondary outcome was surgical interventions performed within 7 days of a head CT. Descriptive statistics were used for analysis. RESULTS: Patients (n = 130) followed over 10 years comprised the study cohort. The most common reasons for shunt placement were congenital hydrocephalus (30%), obstructive hydrocephalus (19%), and atraumatic hemorrhage (18%), and 97% of shunts were ventriculoperitoneal. Patients underwent a median of 8.5 head CTs, 3.0 shunt series radiographs, 1.0 skull radiographs, 0 nuclear medicine studies, and 1.0 brain magnetic resonance imaging scans over the 10 years following shunt placement. The frequency of head CT scans was greatest in the first year after shunt placement (median 2.0 CTs). Of 1411 head CTs in the cohort, 237 resulted in surgical intervention within 7 days (17%, 95% CI 15%-19%). CONCLUSIONS: Children with ventricular shunts have been exposed to large numbers of imaging studies that deliver radiation and most do not result in a surgical procedure. This suggests a need to improve the process of evaluating for ventricular shunt malfunction and minimize radiation exposure. KEYWORDS:NOTNLM;

编号：92

题名：Changes in Gustatory Function and Taste Preference Following Weight Loss.

作者：Sauer H;Ohla K;Dammann D;Teufel M;Zipfel S;Enck P;Mack I


机构：Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tubingen, Germany.;Psychophysiology of Food Perception, German Institute of Human Nutrition Potsdam-Rehbrucke, Potsdam-Rehbrucke, Germany.;Children Rehabilitation Hospital for Respiratory Diseases, Allergies and Psychosomatics, Wangen i.A., Germany.;Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital

158

Tubingen, Germany.;Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tubingen, Germany.;Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tubingen, Germany.;Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tubingen, Germany. Electronic address: [email protected].


摘要： OBJECTIVE: To investigate taste changes of obese children during an inpatient weight reduction treatment in comparison with normal weight children. STUDY DESIGN: Obese (n = 60) and normal weight (n = 27) children aged 9-17 years were assessed for gustatory functions using taste strips (taste identification test for the taste qualities sour, salty, sweet, and bitter), taste preferences, and experienced taste sensitivity. Obese children were examined upon admission (T1) and before discharge (T2). Normal weight children served as the control group. RESULTS: Irrespective of taste quality, obese children exhibited a lower ability to identify taste (total taste score) than normal weight children (P < .01); this overall score remained stable during inpatient treatment in obese children. Group and treatment effects were seen when evaluating individual taste qualities. In comparison with normal weight children, obese children exhibited poorer sour taste identification performance (P < .01). Obese children showed improvement in sour taste identification (P < .001) and deterioration in sweet taste identification (P < .001) following treatment. Subjective reports revealed a lower preference for sour taste in obese children compared with normal weight children (P < .05). The sweet and bitter taste ability at T1 predicted the body mass index z score at T2 (R2 = .23, P < .01). CONCLUSIONS: We identified differences in the ability to discriminate tastes and in subjective taste perception between groups. Our findings of increased sour and reduced sweet taste discrimination after the intervention in obese children are indicative of an exposure-related effect on taste performance, possibly mediated by increased acid and reduced sugar consumption during the intervention. Because the sweet and bitter taste ability at T1 predicted weight loss, addressing gustatory function could be relevant in individualized obesity treatment approaches. TRIAL REGISTRATION: Germanctr.de: DRKS00005122. KEYWORDS:NOTNLM;

编号：93

题名：A Noninvasive Surfactant Adsorption Test Predicting the Need for Surfactant Therapy in Preterm Infants Treated with Continuous Positive Airway Pressure.

作者：Autilio C;Echaide M;Benachi A;Marfaing-Koka A;Capoluongo ED;Perez-Gil J;De Luca D


机构：Department of Biochemistry and Molecular Biology, Faculty of Biology, and Research Institut Hospital 12 de Octubre, Complutense University, Madrid, Spain; Clinical Molecular Biology Laboratory, Department of Clinical Molecular Diagnostics, A. Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy.;Department of Biochemistry and Molecular Biology, Faculty of Biology, and Research Institut Hospital 12 de Octubre, Complutense University, Madrid, Spain.;Division of Obstetrics and Gynecology, A. Beclere Medical Center, South Paris University Hospitals, APHP, Paris, France.;Division of Hematology, A. Beclere Medical Center, South Paris University Hospitals, Assistance Publique-Hopitaux de Paris, Paris, France.;Clinical Molecular Biology Laboratory, Department of Clinical Molecular Diagnostics, A. Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy.;Department of Biochemistry and Molecular Biology, Faculty of Biology, and Research Institut Hospital 12 de Octubre, Complutense University, Madrid, Spain. Electronic address: [email protected].;Division of Pediatrics and Neonatal Critical Care, A. Beclere Medical Center, South Paris University Hospitals, APHP, Paris, France.


159

摘要： OBJECTIVE: To determine the diagnostic accuracy of the surfactant adsorption test (SAT) as a predictor for the need for surfactant replacement therapy in neonates with respiratory distress syndrome (RDS). STUDY DESIGN: Amniotic fluid samples were collected from 41 preterm neonates with RDS treated with continuous positive airway pressure (CPAP) and 15 healthy control term neonates. Purified porcine surfactant served as a further control. Lamellar bodies and lung ultrasound score were also measured in a subset of the neonates treated with CPAP. Surfactant was administered according to the European guidelines, and clinical data were collected prospectively. Surfactant activity was measured as adsorption at the air/liquid interface and given in relative fluorescent units (RFU). RESULTS: Surfactant activity differed among native porcine surfactant (median, 4863 RFU; IQR, 4405-5081 RFU), healthy term neonates (median, 2680 RFU; IQR, 2069-3050 RFU), and preterm neonates with RDS (median, 442 RFU; IQR, 92-920 RFU; P <.0001). The neonates who failed CPAP had lower surfactant activity compared with those who did not fail CPAP (median, 92 RFU; IQR, 0-315 RFU vs 749 RFU; IQR, 360-974 RFU; P = .0002). Differences between groups were more evident beyond 20-30 minutes of fluorescence; the 30-minute time point showed the highest area under the curve (0.84; P <.001) and the best cutoff level (170 RFU; specificity, 72%; sensitivity, 96%) for the prediction of CPAP failure. Surfactant activity at 30 minutes was significantly correlated with lamellar bodies (r = 0.51, P = .006) and lung ultrasound score (r = -0.39, P = .013). CONCLUSION: This technique has the potential to be developed into a fast, simple-to-interpret clinical test. The SAT can reliably identify preterm infants with subsequent CPAP failure and shows promise as a screening test for surfactant replacement in preterm neonates. KEYWORDS:NOTNLM;

编号：94

题名：Conceptual Design of Future Children's Hospitals in Europe: Planning, Building, Merging, and Closing Hospitals.

作者：Ehrich J;Molloy E;Pettoello-Mantovani M

出处：J Pediatr.2017V182N:411-412.e1

机构：European Paediatric Association/Union of National Paediatric Societies and Associations, Berlin, Germany; Children's Hospital, Hannover Medical School, Hannover, Germany. Electronic address: [email protected].;Trinity College, The University of Dublin, Tallaght Hospital, Dublin, Ireland.;European Paediatric Association/Union of National Paediatric Societies and Associations, Berlin, Germany; Institute of Pediatrics, University of Foggia, Scientific Institute "Casa Sollievo", Foggia, Italy.


摘要：

编号：95

题名：A Retrospective Analysis of the Utility of Head Computed Tomography and/or Magnetic Resonance Imaging in the Management of Benign Macrocrania.

作者：Haws ME;Linscott L;Thomas C;Orscheln E;Radhakrishnan R;Kline-Fath B

160

出处：J Pediatr.2017V182N:283-289.e1

机构：Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Electronic address: [email protected].;Cincinnati Children's Hospital Medical Center, Cincinnati, OH.;Cincinnati Children's Hospital Medical Center, Cincinnati, OH.;University of Cincinnati Medical Center, Cincinnati, OH.;Cincinnati Children's Hospital Medical Center, Cincinnati, OH.;Cincinnati Children's Hospital Medical Center, Cincinnati, OH.


摘要： OBJECTIVE: To assess whether computed tomography (CT), magnetic resonance imaging (MRI), and neurosurgical evaluations altered the diagnosis or management of children diagnosed with benign macrocrania of infancy by ultrasonography (US). STUDY DESIGN: We queried our radiology database to identify patients diagnosed with benign macrocrania of infancy by US between 2006 and 2013. Medical records of those with follow-up CT/MRI were reviewed to determine clinical/neurologic status and whether or not CT/MRI imaging resulted in diagnosis of communicating hydrocephalus or required neurosurgical intervention. RESULTS: Patients with benign macrocrania of infancy (n = 466) were identified (mean age at diagnosis: 6.5 months). Eighty-four patients (18.0%) received subsequent head CT/MRI; of these, 10 patients had neurologic abnormalities before 2 years of age, of which 3 had significant findings on MRI (temporal lobe white matter changes, dysmorphic ventricles, thinned corpus callosum). One patient without neurologic abnormalities had nonspecific white matter signal abnormality (stable over 6 months) but no change in management. None required neurosurgical intervention. Another 9/84 patients had incidental findings including Chiari I (3), small subdural bleeds (2), arachnoid cyst (1), small cavernous malformation (1), frontal bone dermoid (1), and a linear parietal bone fracture after a fall (1). CONCLUSIONS: Children diagnosed with benign macrocrania of infancy on US without focal neurologic findings do not require subsequent brain CT/MRI or neurosurgical evaluation. Decreasing unnecessary imaging would decrease costs, minimize radiation and sedation exposures, and increase clinic availability of neurology and neurosurgery specialists. KEYWORDS:NOTNLM;

编号：96

题名：Lactate and Lactate: Pyruvate Ratio in the Diagnosis and Outcomes of Pediatric Acute Liver Failure.

作者：Feldman AG;Sokol RJ;Hardison RM;Alonso EM;Squires RH;Narkewicz MR

出处：J Pediatr.2017V182N:217-222.e3

机构：Digestive Health Institute, Children's Hospital Colorado, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO. Electronic address: [email protected].;Digestive Health Institute, Children's Hospital Colorado, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.;Epidemiology Data Center Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.;Division of Gastroenterology, Hepatology and Nutrition, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL.;Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA.;Digestive Health Institute, Children's Hospital Colorado, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.


161

摘要： OBJECTIVES: To assess the accuracy of blood lactate and lactate: pyruvate molar ratio (L:P) as a screen for mitochondrial, respiratory chain, or fatty acid oxidation disorders in children with pediatric acute liver failure (PALF); to determine whether serum lactate >/= 2.5 mmol/L or L:P >/= 25 correlated with biochemical variables of clinical severity; and to determine whether lactate or L:P is associated with clinical outcome at 21 days. STUDY DESIGN: Retrospective review of demographic, clinical, laboratory, and outcome data for PALF study group participants who had lactate and pyruvate levels collected on the same day. RESULTS: Of 986 participants, 110 had lactate and pyruvate levels collected on the same day. Of the 110, the etiology of PALF was a mitochondrial disorder in 8 (7%), indeterminate in 65 (59%), and an alternative diagnosis in 37 (34%). Lactate, pyruvate, and L:P were similar among the 3 etiologic groups. There was no significant association between the initial lactate or L:P and biochemical variables of clinical severity or clinical outcome at 21 days. CONCLUSIONS: A serum lactate >/= 2.5 mmol/L and/or elevated L:P was common in all causes of PALF, not limited to those with a mitochondrial etiology, and did not predict 21-day clinical outcome. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00986648. KEYWORDS:NOTNLM;

J Perinatology 围产期学杂志

编号：1

题名：Thematic analysis of barriers and facilitators to implementation of neonatal resuscitation guideline changes.

作者：Lee HC;Arora V;Brown T;Lyndon A

出处：J Perinatol.2017V37N3:249-253

机构：Division of Neonatal & Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.;California Perinatal Quality Care Collaborative, Stanford, CA, USA.;Department of Pediatrics, Kaiser Permanente Downey Medical Center, Downey, CA, USA.;Division of Neonatal & Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.;Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, CA, USA.


摘要： OBJECTIVE: To evaluate experiences regarding implementation of Neonatal Resuscitation Program (NRP) guideline changes in the context of a collaborative quality improvement (QI) project. STUDY DESIGN: Focus groups were conducted with local QI leaders and providers from nine sites that participated in a QI collaborative. Thematic analysis identified facilitators and barriers to implementation of NRP guideline changes and QI in general. RESULTS: Facilitators for QI included comparative process measurement and data tracking. Barriers to QI were shifting priorities and aspects of the project that seemed inefficient. Specific to NRP, implementation strategies that worked involved rapid feedback, and education on rationale for change. Changes that interrupted traditional workflow proved challenging to implement. Limited resources and perceptions of increased workload were also barriers to implementation. CONCLUSION: Collaborative QI methods are generally well accepted, particularly data tracking, sharing experience and education. Strategies to increase efficiency and manage workload may facilitate improved staff attitudes toward change.

编号：2

162

题名：A comparison of 7-day versus 10-day course of low-dose dexamethasone for chronically ventilated preterm infants.

作者：Cuna A;Govindarajan S;Oschman A;Dai H;Brophy K;Norberg M;Truog W


机构：University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.;Division of Neonatology, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA.;Center for Infant Pulmonary Disorders, Children's Mercy Kansas City, Kansas City, MO, USA.;University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.;Division of Neonatology, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA.;Division of Neonatology, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA.;University of Kansas School of Medicine, Kansas City, MO, USA.;Division of Neonatology, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA.;Center for Infant Pulmonary Disorders, Children's Mercy Kansas City, Kansas City, MO, USA.;University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.;Division of Neonatology, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA.;Center for Infant Pulmonary Disorders, Children's Mercy Kansas City, Kansas City, MO, USA.


摘要： OBJECTIVE: The objective of the study was to compare the effect of two different dexamethasone regimens on respiratory outcomes of ventilator-dependent preterm infants. STUDY DESIGN: Retrospective study of ventilated preterm infants <29 weeks gestational age treated with either 7-day or 10-day dexamethasone course. Primary outcome was days to successful extubation. Other outcomes included rate of successful extubation and need for repeat steroid therapy. RESULTS: Fifty-nine infants were identified; 32 (54%) received 7 days of dexamethasone and 27 (46%) received 10 days of dexamethasone. Both groups had comparable baseline demographics and clinical characteristics. Mean time to successful extubation was similar between the two groups (5.1+/-2.7 days in 7-day group and 6.0+/-3.7 days in 10-day group, P=0.42). Successful extubation by end of treatment (56% versus 67%, P=0.44) and need for repeat steroid therapy (47% versus 33%, P=0.43) were also similar. CONCLUSION: 7-day and 10-day course of dexamethasone have comparable efficacy in facilitating extubation of ventilator-dependent preterm infants.

编号：3

题名：Congenital hypothyroidism with delayed thyroid-stimulating hormone elevation in premature infants born at less than 30 weeks gestation.

作者：Kaluarachchi DC;Colaizy TT;Pesce LM;Tansey M;Klein JM


机构：Division of Neonatology, Department of Pediatrics, University of Iowa, Iowa City, IA, USA.;Division of Neonatology, Department of Pediatrics, University of Iowa, Iowa City, IA, USA.;Division of Endocrinology, Department of Pediatrics, University of Iowa, Iowa City, IA, USA.;Division of Endocrinology, Department of Pediatrics, University of Iowa, Iowa City, IA, USA.;Division of Neonatology, Department of Pediatrics, University of Iowa, Iowa City, IA, USA.


163

摘要： OBJECTIVE: Congenital hypothyroidism (CH) with delayed thyroid-stimulating hormone (TSH) elevation is a common form of thyroid dysfunction among premature infants. Routine newborn screening (NBS) may miss infants with CH with delayed TSH elevation. The objective of the study is to determine the prevalence of CH with delayed TSH elevation in premature infants and to identify associated risk factors. STUDY DESIGN: Retrospective analysis of serum thyroid function screening (TFS) at day of life 30 in premature infants <30 weeks gestation, admitted to University of Iowa Neonatal Intensive Care Unit between 1 July 2012 to 30 June 2015. Serum free thyroxine and TSH levels were obtained in premature infants <30 weeks gestation on day of life 30. Follow-up testing and pediatric endocrinology consultation were done according to the institutional protocol. RESULT: In total, 286 infants were included. All infants underwent routine NBS and 280 patients underwent TFS. Twenty-six patients (9.1%) were diagnosed with thyroid dysfunction. NBS identified only three patients. CH with delayed TSH elevation was diagnosed in 20 patients (6.9%) and was significantly associated with multiple gestation, lower birth weight, higher gestational age and lower 5 min APGAR score. CONCLUSION: Thyroid dysfunction is common among premature infants born before 30 weeks gestation. The majority of cases with thyroid dysfunction had CH with delayed TSH elevation, which was not detected by NBS. We recommend measurement of serum TSH and free T4 levels on day of life 30 in premature infants born at <30 weeks gestation to identify patients with CH with delayed TSH elevation.

编号：4

题名：Population-based reference curve for umbilical cord arterial pH in infants born at 28 to 42 weeks.

作者：Skiold B;Petersson G;Ahlberg M;Stephansson O;Johansson S


机构：Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.;Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden.;Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.;Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.;Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.;School of Public Health, University of California, Berkeley, CA, USA.;Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.;Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.


摘要： OBJECTIVE: The objective of the study was to examine normal variations of umbilical cord arterial pH by gestational age (GA). STUDY DESIGN: Population-based cohort study of 46 199 infants born from 2008 to 2014 in Stockholm, Sweden, with GA 28 to 42 weeks, Apgar score 7 at 5 min, non-instrumental vaginal delivery, and birth weight for GA3rd and 97th percentile. Quantile regression was used to investigate the associations between GA and infant sex, and pH. RESULTS: The mean umbilical cord arterial pH (s.d.) was 7.29 (0.10), 7.27 (0.07), 7.25 (0.07) and 7.23 (0.07) among infants born at 28 to 31, 32 to 36, 37 to 41 and 42 weeks, respectively. Arterial pH decreased linearly with increasing GA, and female infants had higher pH than male infants (P<0.001). CONCLUSION: Umbilical cord arterial pH varied in a linear fashion by GA and was influenced by infant sex. The provided reference curve taking GA into account may yield a more accurate definition of acidosis at birth.

编号：5

164

题名：Treatment and follow-up of venous thrombosis in the neonatal intensive care unit: a retrospective study.

作者：Bohnhoff JC;DiSilvio SA;Aneja RK;Shenk JR;Domnina YA;Brozanski BS;Good M


机构：University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.;Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.;Division of Newborn Medicine, Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.;Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.;University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.;Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.;Division of Pediatric Critical Care Medicine, Departments of Critical Care Medicine and Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.;Department of Pharmacy, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.;University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.;Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.;Division of Pediatric Critical Care Medicine, Departments of Critical Care Medicine and Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.;University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.;Division of Newborn Medicine, Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.;Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.;University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.;Division of Newborn Medicine, Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.;Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.


摘要： OBJECTIVE: The critically ill, premature patients of neonatal intensive care units are susceptible to venous thrombosis, an adverse event associated with short- and long-term morbidity. Venous thrombosis is frequently treated with low-molecular-weight heparins (LMWHs) such as enoxaparin, but optimal dosing of LMWH must balance the morbidity of venous thrombosis with the potential adverse affects of anticoagulation. The optimal dosing of enoxaparin for premature infants is unclear. The objective of this study was to describe enoxaparin therapy and follow-up in critically ill neonates diagnosed with venous thrombosis. STUDY DESIGN: Retrospective medical record review in the neonatal intensive care unit (NICU) in a single tertiary care institution. Infants with venous thrombosis diagnosed in the NICU were identified using preexisting quality improvement lists and medical records. RESULTS: Twenty-six infants with 30 venous thromboses were identified with a median gestational age of 31 weeks at birth. Eighteen (69%) infants received enoxaparin for venous thrombosis during their hospitalization, beginning with a median dose of 1.5 mg kg-1 every 12 h. This dose was increased to a median of 2.1 mg kg-1 every 12 h to achieve target anti-factor Xa levels. The target dose was significantly higher in patients with a postmenstrual age of <37 weeks. Enoxaparin treatment was documented after discharge in 12 patients, continuing for a median of 99 days. Four patients died during hospitalization and their deaths were not attributable to venous thrombosis or anticoagulation complication. Follow-up documentation between 6 and 24 months after venous thrombosis diagnosis revealed no major morbidity of venous thrombosis or enoxaparin therapy. CONCLUSION: Our data reinforce the relative safety and necessity of enoxaparin doses above 1.5 mg kg-1 per 12 h in most neonates. This was particularly true for infants at lower postmenstrual age.

编号：6

题名：Pill aversion in HIV-infected pregnant women: Theory to practice.

作者：Dorman RM;Yee LM;Sutton SH


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机构：Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.;Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.;Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.


摘要： In our perinatal HIV cohort, we have observed difficulty swallowing pills as a frequent and significant barrier to adherence to highly active antiretroviral therapy. We refer to this problem as pill aversion and define it as difficulty swallowing pills with no persistent medical or structural cause as well as the anxiety and physical symptoms associated with pill swallowing. By applying cognitive behavioral theory to behavioral patterns within our pregnant HIV-infected population, we seek to better understand the development and reinforcement of pill aversion behavior. On the basis of this theory, our experience, and the pediatric pill-swallowing literature, we propose a conceptual framework for understanding the multiple causes of pill aversion and applying therapeutic interventions to a perinatal population. In a theoretical discussion, we address the roles of classical conditioning and cognitive theory in the development and experience of pill aversion in an HIV-infected pregnant population. We propose future steps for characterizing these behaviors and testing theories and interventions.

编号：7

题名：Diurnal variations of short-term variation and the impact of multiple recordings on measurement accuracy.

作者：Seliger G;Petroff D;Seeger S;Hoyer D;Tchirikov M;Schneider U


机构：Martin Luther University, Maternity Clinic/Perinatal Treatment Center, Halle (Saale), Germany.;Clinical Trial Centre, University of Leipzig, Leipzig, Germany.;St Elisabeth Hospital's Clinic for Women's Health and Perinatal Care, Halle (Saale), Germany.;Hans Berger Department of Neurology, Biomagnetic Center, Jena University Hospital, Jena, Germany.;Martin Luther University, Maternity Clinic/Perinatal Treatment Center, Halle (Saale), Germany.;Department of Obstetrics, Jena University Hospital, Jena, Germany.


摘要： OBJECTIVE: Short-term variation (STV) from computerized cardiotocogram heart rate analysis is a parameter that complements decision making, regarding the delivery of fetuses in several high-risk situations. Although studies on the effects of gestational age and fetal pathology are convincing, there is a lack of data exploring diurnal variation and the adequacy of a single measurement. STUDY DESIGN: In this prospective observational study, fetal STV was monitored with the AN24 fetal ECG monitor (Monica Healthcare) each hour for at least 10 h in total, beginning at different times. This resulted in data covering all 24 h of the day. Seventy fetuses, low risk with respect to conditions accessible to heart rate monitoring (median 37th week of gestation) were monitored for an average of 12 h. Results of STV per hour were categorized as 'compromised' (STV<4 ms) or 'healthy', (STV4 ms) to calculate the model of predictability. RESULTS: The model proposed (STV of 'healthy' fetuses: 9.6+/-2.6 ms, 'compromised' fetuses 3.0+/-0.5 ms, prevalence 1%) leads to a positive predictive value of 39%, which increased to 68 or 80% given two or three pathological (STV<4 ms) measurements, respectively. Diurnal variation was not observed. CONCLUSIONS: Single pathological STV values should be corroborated by further measurements in a 24-h interval in otherwise low-risk fetuses before inducing delivery. This may help to avoid unnecessary early births and give the fetus valuable days for intrauterine maturity.

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编号：8

题名：Recombinant tissue plasminogen activator to restore catheter patency: efficacy and safety analysis from a multihospital NICU system.

作者：Scott DM;Ling CY;MacQueen BC;Baer VL;Gerday E;Christensen RD


机构：Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake City, Utah, USA.;Department of Pharmacy Practice, Intermountain Medical Center, Murray, Utah, USA.;Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake City, Utah, USA.;Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA.;Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA.;Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake City, Utah, USA.;Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake City, Utah, USA.;Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA.;Division of Neonatology, Utah Valley Regional Medical Center, Provo, Utah, USA.;Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake City, Utah, USA.;Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA.;Division of Hematology/Oncology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA.


摘要： OBJECTIVE: In 2001, the US Food and Drug Administration approved recombinant tissue plasminogen activator (alteplase, Cathflo Activase) to reestablish patency of central catheters occluded, presumably, by a fibrin clot. We conducted a multicenter quality improvement study to determine the value of this procedure in our Neonatal Intensive Care Unit (NICUs), including analyses of efficacy, safety and costs. STUDY DESIGN: We conducted a retrospective quality analysis of neonates in level III NICUs, who received alteplase for the purpose of reestablishing patency of occluded central catheters. RESULTS: Alteplase was administered to 169 neonates, each given one to four doses, totaling 205 episodes of administration. The most common type of catheter where alteplase was used was percutaneously inserted central catheter (PICC) lines (78% of uses), 8% were umbilical venous catheters (UVCs), 6% arterial lines, 5% chest tubes and 3% other catheters. Postnatal age at first dose ranged from 0 to 132 days (median, 12); dosed patients were 22 to 41 weeks gestation at birth (median, 31). Fifty-eight percentage of administrations restored catheter function. Success was more likely at younger postnatal age (10+/-2 days old in successful vs 14+/-1 days in unsuccessful treatments; P=0.023). Seventy-two percentage of the re-canalized catheters remained functional until they were no longer needed (2 to 30 days later). Nine percentage of episodes were treated with a second dose 1 to 17 days later for re-occlusion and 50% of those were successful. Bleeding consequences were identified in only one case, where three separate lines were treated (chest tube, PICC and UVC) within a 6-h period. Costs to the health system of doses, minus savings to the system by not needing to replace lines, averaged a net of $34 per dose. CONCLUSIONS: The apparent safety and favorable value analysis prompted us to develop a consistent approach to alteplase usage in the Intermountain Healthcare NICUs, using the data in this report to standardize the guidelines across our health system.

编号：9

题名：A novel, more efficient, staged approach for critical congenital heart disease screening.

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作者：Mouledoux J;Guerra S;Ballweg J;Li Y;Walsh W


机构：Department of Pediatrics, Oschner Medical Center, New Orleans, LA, USA.;Tennessee Department of Health, Andrew Johnson Tower, Nashville, TN, USA.;Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN, USA.;Tennessee Department of Health, Andrew Johnson Tower, Nashville, TN, USA.;Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.


摘要： OBJECTIVE: Screening for critical congenital heart disease (CCHD) using pulse oximetry has been endorsed by the American Academy of Pediatrics and the American Heart Association. The recommended screening requires two saturation readings. We sought to determine the incidence of undetected CCHD in Tennessee for the 2 years following implementation of an algorithm that assigned an immediate pass to a single lower extremity saturation of 97% or higher. STUDY DESIGN: State Genetic Screening records and reports of missed cases from the Tennessee Initiative for Perinatal Quality Care were used to determine if CCHD cases were missed by the new screening algorithm. RESULT: During the study, 232 infants failed the screen with 51 or 22% true positives, 13 infants had undetected CCHD (10 coarctations, 2 anomalous veins and 1 Tetralogy of Fallot). CONCLUSION: This approach eliminated over 150 000 pulse oximetry determinations in Tennessee without affecting the ability of pulse oximetry to detect CCHD before discharge.

编号：10

题名：Changing antiepileptic drug use for seizures in US neonatal intensive care units from 2005 to 2014.

作者：Ahmad KA;Desai SJ;Bennett MM;Ahmad SF;Ng YT;Clark RH;Tolia VN


机构：Pediatrix Medical Group, San Antonio, TX, USA.;Department of Pediatrics, Baylor College of Medicine, San Antonio, TX, USA.;Pediatrix Medical Group, Austin, TX, USA.;Office of The Chief Quality Officer, Baylor Scott & White Health, Dallas, TX, USA.;Department of Pediatrics, Baylor College of Medicine, San Antonio, TX, USA.;Department of Pediatrics, Baylor College of Medicine, San Antonio, TX, USA.;Pediatrix Medical Group, Sunrise, FL, USA.;Pediatrix Medical Group, Dallas, TX, USA.;Department of Pediatrics, Baylor University Medical Center, Dallas, TX, USA.


摘要： OBJECTIVE: Neonatal seizures are a common problem in the neonatal intensive care unit and are frequently treated with antiepileptic drugs. Limited data exist on current or changing antiepileptic drug use for seizures in the neonatal intensive care unit.We sought to describe trends of antiepileptic drug exposure in a large volume of US neonatal intensive care unit from 2005 to 2014 and we hypothesized increasing levetiracetam exposure over the 10-year study period. STUDY DESIGN: Retrospective cohort study of infants from the Pediatrix Medical Group Clinical Data Warehouse, a large, multicenter, deidentified data set. Data were analyzed for trends in 2-year time periods. Our cohort included infants with a diagnosis of seizures who received an antiepileptic drug that were discharged from the neonatal intensive care unit from 1 January 2005 to 31 December 2014. RESULTS: Among 778 395 infants from 341 facilities, we identified 9134 infants with a seizure diagnosis who received an antiepileptic drug. Phenobarbital was used in 98%

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of the cohort. From 2005-2006 to 2013-2014 phenobarbital exposure declined from 99 to 96% (P<0.001), phenytoin exposure decreased from 15 to 11% (P<0.001) and levetiracetam exposure increased 10-fold from 1.4 to 14% (P<0.001). Overall, <1% of infants were exposed to carbamazepine, lidocaine or topiramate. CONCLUSIONS: Infants with seizures were overwhelmingly exposed to phenobarbital, despite a significant increase in levetiracetam exposure. The use of phenytoin declined and has been surpassed by levetiracetam as the second most widely used antiepileptic in the neonatal intensive care unit. These changes in antiepileptic drug usage patterns have occurred in the absence of novel efficacy data in neonates.

编号：11

题名：Burnout in the neonatal intensive care unit and its relation to healthcare-associated infections.

作者：Tawfik DS;Sexton JB;Kan P;Sharek PJ;Nisbet CC;Rigdon J;Lee HC;Profit J


机构：Division of Pediatric Critical Care, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA.;Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, NC, USA.;Duke Patient Safety Center, Duke University Health System, Durham, NC, USA.;Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA.;California Perinatal Quality Care Collaborative; Palo Alto, CA, USA.;California Perinatal Quality Care Collaborative; Palo Alto, CA, USA.;Center for Quality and Clinical Effectiveness, Lucile Packard Children's Hospital, Palo Alto, CA, USA.;Division of Pediatric Hospitalist Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, USA.;California Perinatal Quality Care Collaborative; Palo Alto, CA, USA.;Division of Pediatric Hospitalist Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, USA.;Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.;Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA.;California Perinatal Quality Care Collaborative; Palo Alto, CA, USA.;Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA.;California Perinatal Quality Care Collaborative; Palo Alto, CA, USA.


摘要： OBJECTIVE: To examine burnout prevalence among California neonatal intensive care units (NICUs) and to test the relation between burnout and healthcare-associated infection (HAI) rates in very low birth weight (VLBW) neonates. STUDY DESIGN: Retrospective observational study of provider perceptions of burnout from 2073 nurse practitioners, physicians, registered nurses and respiratory therapists, using a validated four-item questionnaire based on the Maslach Burnout Inventory. The relation between burnout and HAI rates among VLBW (<1500 g) neonates from each NICU was evaluated using multi-level logistic regression analysis with patient-level factors as fixed effects. RESULTS: We found variable prevalence of burnout across the NICUs surveyed (mean 25.2+/-10.1%). Healthcare-associated infection rates were 8.3+/-5.1% during the study period. Highest burnout prevalence was found among nurses, nurse practitioners and respiratory therapists (non-physicians, 28+/-11% vs 17+/-19% physicians), day shift workers (30+/-3% vs 25+/-4% night shift) and workers with 5 or more years of service (29+/-2% vs 16+/-6% in fewer than 3 years group). Overall burnout rates showed no correlation with risk-adjusted rates of HAIs (r=-0.133). Item-level analysis showed positive association between HAIs and perceptions of working too hard (odds ratio 1.15, 95% confidence interval 1.04-1.28). Sensitivity analysis of high-volume NICUs suggested a moderate correlation between burnout prevalence and HAIs (r=0.34). CONCLUSION: Burnout is most prevalent among non-physicians, daytime

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workers and experienced workers. Perceptions of working too hard associate with increased HAIs in this cohort of VLBW infants, but overall burnout prevalence is not predictive.

编号：12

题名：Alarm safety and oxygen saturation targets in the Vermont Oxford Network iNICQ 2015 collaborative.

作者：Hagadorn JI;Sink DW;Buus-Frank ME;Edwards EM;Morrow KA;Horbar JD;Ferrelli K;Soll RF


机构：Division of Neonatology, Connecticut Children's Medical Center, Hartford, CT, USA.;Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA.;Division of Neonatology, Connecticut Children's Medical Center, Hartford, CT, USA.;Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA.;Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.;Department of Pediatrics, University of Vermont, Burlington, VT, USA.;Vermont Oxford Network, Burlington, VT, USA.;Vermont Oxford Network, Burlington, VT, USA.;Department of Mathematics and Statistics, University of Vermont, Burlington, VT, USA.;Vermont Oxford Network, Burlington, VT, USA.;Department of Pediatrics, University of Vermont, Burlington, VT, USA.;Vermont Oxford Network, Burlington, VT, USA.;Vermont Oxford Network, Burlington, VT, USA.;Department of Pediatrics, University of Vermont, Burlington, VT, USA.;Vermont Oxford Network, Burlington, VT, USA.


摘要： OBJECTIVES: To assess progress of neonatal intensive care units (NICUs) participating in the Vermont Oxford Network iNICQ 2015: Alarm Safety Collaborative in achieving Joint Commission 2014 alarm safety goals with respect to oximeters, and to compare patient-level oxygen saturation (SpO2) and oximeter alarm data to local policies. STUDY DESIGN: Prospective multicenter audits in February and August 2015 assessed implementation of policies addressing Joint Commission 2014 Alarm Safety goals, and ascertained SpO2 targets, oximeter alarm settings and compliance with policy-specified SpO2 targets and alarms. RESULTS: Eighty-six NICUs completed both audits. Of 13 policies addressing mandated goals, median (interquartile range) 8 (5, 9) policies were implemented at audit 1 and 9 (6, 11) at audit 2 (P=0.004). At audit 1, 28 NICUs had implemented 9 policies versus 47 at audit 2. For 794 infants <31 weeks gestation, <36 weeks postmenstrual age, and on supplemental oxygen, median SpO2 target lower limit was 88% (interquartile range 87%, 90%; range 75% to 94%), upper limit 95% (interquartile range 94%, 96%; range 85% to 100%). High oximeter alarm was set according to local policy for 63% of infants, for whom SpO2 >97% was less frequent than when high alarm was not set to policy (10.1% vs 21.5%, P=0.006). CONCLUSIONS: Participating NICUs showed significant progress between audits in their implementation of Joint Commission Alarm Safety goals for oximeter monitoring. Oximeter high alarm not set per local policy is associated with increased hyperoxemia in preterm infants. Recommendations to standardize oxygen saturation targets for infants at risk for oxygenation-related outcomes have not been widely adopted.

编号：13

题名：The relationship between three signs of fetal magnetic resonance imaging and severity of congenital diaphragmatic hernia.

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作者：Hattori T;Hayakawa M;Ito M;Sato Y;Tamakoshi K;Kanamori Y;Okuyama H;Inamura N;Takahashi S;Fujino Y;Taguchi T;Usui N


机构：Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan.;Department of Pediatrics, Anjo Kosei Hospital, Anjo, Japan.;Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan.;Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan.;Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan.;Department of Nursing, Nagoya University Graduate School of Medicine, Nagoya, Japan.;Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan.;Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.;Department of Pediatrics Kindai University, Faculty of Medicine, Osaka-sayama, Osaka, Japan.;Division of Neonatology, Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.;Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.;Department of Pediatric Surgery, Reproductive and Developmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.;Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan.


摘要： OBJECTIVE: To seek a simple approach for prenatally classifying congenital diaphragmatic hernia (CDH) severity using fetal magnetic resonance imaging (MRI) markers. STUDY DESIGN: A retrospective, multicenter study using questionnaires to investigate fetal MRI findings. We included fetuses prenatally diagnosed with isolated left-sided CDH and delivered after 36 weeks of gestation. We focused on three fetal MRI morphological signs: incomplete pulmonary baseline (IPB), liver up (LU) and retrocardiac stomach (RCS). We also evaluated the fetal MRI score defined as the total number of positive signs; the primary outcome was survival at discharge. RESULTS: In 256 patients (from 56 institutions), IPB, LU and RCS findings correlated with lower survival: odds ratio (95% confidence interval), 0.16 (0.08 to 0.33); 0.24 (0.12 to 0.51); and 0.14 (0.07 to 0.28); respectively. Patients with higher fetal MRI scores had a higher mortality rate. CONCLUSION: IPB, LU and RCS on fetal MRI are related to CDH severity.

编号：14

题名：Heart sounds at home: feasibility of an ambulatory fetal heart rhythm surveillance program for anti-SSA-positive pregnancies.

作者：Cuneo BF;Moon-Grady AJ;Sonesson SE;Levasseur S;Hornberger L;Donofrio MT;Krishnan A;Szwast A;Howley L;Benson DW;Jaeggi E


机构：The Heart Institute, Department of Pediatrics, Children's Hospital Colorado, Aurora CO, USA.;Section of Cardiology, Department of Pediatrics, University of California-San Francisco Benioff Children's Hospital, San Francisco, CA, USA.;Department of Woman and Child Health, Karolinska Institute, Stockholm, Sweden.;Section of Cardiology, Department of Pediatrics, Columbia University Medical Center, Morgan Stanley Children's Hospital, New York, NY, USA.;Stollery Children's Hospital, Edmonton, AB, Canada.;Section of Cardiology, Department of Pediatrics, Washington National Children's Hospital, Washington, DC, USA.;Section of Cardiology, Department of Pediatrics, Washington National Children's Hospital, Washington, DC, USA.;Section of Cardiology, Department of Pediatrics, Children's Hospital Philadelphia, Philadelphia, PA, USA.;The Heart Institute, Department of Pediatrics, Children's

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Hospital Colorado, Aurora CO, USA.;Section of Cardiology, Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, WI, USA.;The Hospital for Sick Children, Toronto, ON, Canada.


摘要： OBJECTIVE: Fetuses exposed to anti-SSA (Sjogren's) antibodies are at risk of developing irreversible complete atrioventricular block (CAVB), resulting in death or permanent cardiac pacing. Anti-inflammatory treatment during the transition period from normal heart rhythm (fetal heart rhythm (FHR)) to CAVB (emergent CAVB) can restore sinus rhythm, but detection of emergent CAVB is challenging, because it can develop in 24 h. We tested the feasibility of a new technique that relies on home FHR monitoring by the mother, to surveil for emergent CAVB. STUDY DESIGN: We recruited anti-SSA-positive mothers at 16 to 18 weeks gestation (baseline) from 8 centers and instructed them to monitor FHR two times a day until 26 weeks, using a Doppler device at home. FHR was also surveilled by weekly or every other week fetal echo. If FHR was irregular, the mother underwent additional fetal echo. We compared maternal stress/anxiety before and after monitoring. Postnatally, infants underwent a 12-lead electrocardiogram. RESULTS: Among 133 recruited, 125 (94%) enrolled. Among those enrolled, 96% completed the study. Reasons for withdrawal (n=5) were as follows: termination of pregnancy, monitoring too time consuming or moved away. During home monitoring, 9 (7.5%) mothers detected irregular FHR diagnosed by fetal echo as normal (false positive, n=2) or benign atrial arrhythmia (n=7). No CAVB was undetected or developed after monitoring. Questionnaire analysis indicated mothers felt comforted by the experience and would monitor again in future pregnancies. CONCLUSION: These data suggest ambulatory FHR surveillance of anti-SSA-positive pregnancies is feasible, has a low false positive rate and is empowering to mothers.

编号：15

题名：Postpartum hemorrhage following vaginal delivery: risk factors and maternal outcomes.

作者：Miller CM;Cohn S;Akdagli S;Carvalho B;Blumenfeld YJ;Butwick AJ


机构：Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.;Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.;Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.;Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.;Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA.;Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.


摘要： OBJECTIVE: Limited understanding of risk factors exists for postpartum hemorrhage (PPH) post-vaginal delivery. The aim of this study was to identify risk factors for PPH post-vaginal delivery within a contemporary obstetric cohort. STUDY DESIGN: Retrospective case-control study. PPH was classified by an estimated blood loss 500 ml. Risk factors for PPH were identified using univariable and multivariable logistic regression. We secondarily investigated maternal outcomes and medical and surgical interventions for PPH management. RESULTS: The study cohort comprised 159 cases and 318 controls. Compared with a second-stage duration <2 h, a second stage3 h was associated with PPH (adjusted odds ratio=2.3; 95% CI=1.2 to 4.6). No other clinical or obstetric variables were identified as independent risk factors for PPH. Among cases, 4% received red blood cells and 1% required intensive

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care admission. CONCLUSION: Although PPH-related morbidity may be uncommon after vaginal delivery, PPH should be anticipated for women after a second stage 3 h.

编号：16

题名：Durations of second stage of labor and pushing, and adverse neonatal outcomes: a population-based cohort study.

作者：Sandstrom A;Altman M;Cnattingius S;Johansson S;Ahlberg M;Stephansson O


机构：Clinical Epidemiology Unit, T2, Department of Medicine Solna, Karolinska University Hospital and Institutet, Stockholm, Sweden.;Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska University Hospital and Institutet, Stockholm, Sweden.;Clinical Epidemiology Unit, T2, Department of Medicine Solna, Karolinska University Hospital and Institutet, Stockholm, Sweden.;Istituto Clinico Humanitas, Humanitas University, Rozzano, Milan, Italy.;Clinical Epidemiology Unit, T2, Department of Medicine Solna, Karolinska University Hospital and Institutet, Stockholm, Sweden.;Clinical Epidemiology Unit, T2, Department of Medicine Solna, Karolinska University Hospital and Institutet, Stockholm, Sweden.;Department of Clinical Science and Education, Karolinska Institutet, Sweden.;Clinical Epidemiology Unit, T2, Department of Medicine Solna, Karolinska University Hospital and Institutet, Stockholm, Sweden.;Department of Obstetrics and Gynecology, South General Hospital, Stockholm, Sweden.;Clinical Epidemiology Unit, T2, Department of Medicine Solna, Karolinska University Hospital and Institutet, Stockholm, Sweden.;Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska University Hospital and Institutet, Stockholm, Sweden.


摘要： OBJECTIVE: The associations between duration of second stage of labor, pushing time and risk of adverse neonatal outcomes are not fully established. Therefore, we aimed to examine such relationships. STUDY DESIGN: A population-based cohort study including 42 539 nulliparous women with singleton infants born in cephalic presentation at 37 gestational weeks, using the Stockholm-Gotland Obstetric Cohort, Sweden, and the Swedish Neonatal Quality Register, 2008 to 2013. Poisson regression was used to analyze estimated adjusted relative risks (RRs), with 95% confidence intervals (CIs). Outcome measures were umbilical artery acidosis (pH <7.05 and base excess <-12), birth asphyxia-related complications (including any of the following conditions: hypoxic ischemic encephalopathy, hypothermia treatment, neonatal seizures, meconium aspiration syndrome or advanced resuscitation after birth) and admission to neonatal intensive care unit (NICU). RESULTS: Overall rates of umbilical artery acidosis, birth asphyxia-related complications and admission to NICU were 1.08, 0.63 and 6.42%, respectively. Rate of birth asphyxia-related complications gradually increased with duration of second stage: from 0.42% at <1 h to 1.29% at >/=4 h (adjusted RR 2.46 (95% CI 1.66 to 3.66)). For admission to NICU, corresponding rates were 4.97 and 9.45%, and adjusted RR (95% CI) was 1.80 (95% CI 1.58 to 2.04). Compared with duration of pushing <15 min, a duration of pushing 60 min increased rates of acidosis from 0.57 to 1.69% (adjusted RR 2.55 (95% CI 1.51 to 4.30)). CONCLUSION: Prolonged durations of second stage of labor and pushing are associated with increased RRs of adverse neonatal outcomes. Clinical assessment of fetal well-being is essential when durations of second stage and pushing increases.

编号：17

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题名：Risk of preterm birth among women using drugs during pregnancy with elevated alpha-fetoprotein.

作者：Baer RJ;Chambers CD;Ryckman KK;Oltman SP;Norton ME;Jelliffe-Pawlowski LL


机构：Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA.;Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA.;Department of Epidemiology and Pediatrics, University of Iowa, Iowa City, IA, USA.;Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.;Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.;Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.


摘要： OBJECTIVE: Examine the risk of preterm birth (PTB) among women who use drugs during pregnancy and have elevated alpha-fetoprotein (AFP). STUDY DESIGN: The sample included California singleton live births in 2005 to 2010 contained within a hospital discharge database linked to the Prenatal Screening Program. A selection of mothers who did not use drugs was selected at a ratio of 4:1. Risk of PTB was calculated using adjusted odds ratios and 95% confidence intervals (CIs) for women who did or did not use drugs by their AFP percentile. RESULTS: We identified 7190 women who used drugs and selected 28 760 women who did not. Of women using cocaine with AFP 95th percentile, 43.8% delivered prematurely. Women using drugs with AFP 95th percentile were 11 to 35 times as likely to deliver <32 weeks. CONCLUSION: The combination of drug use and elevated AFP results in high rates of PTB. This combination results in an additive risk.

编号：18

题名：Utility of a precursor-to-product ratio in the evaluation of presumptive positives in newborn screening of congenital adrenal hyperplasia.

作者：Tieh PY;Yee JK;Hicks RA;Mao CS;Lee WN


机构：Division of Pediatric Endocrinology, Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.;Division of Pediatric Endocrinology, Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.;Pediatric Endocrinologist, Miller Children's Hospital, Long Beach, CA, and University of California, Irvine, CA, USA.;Division of Pediatric Endocrinology, Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.;Division of Pediatric Endocrinology, Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.


摘要： OBJECTIVE: Screening for congenital adrenal hyperplasia (CAH) caused by 21-alpha-hydroxylase deficiency is challenging because factors such as prematurity and stress increase intermediate steroid metabolite levels in newborn infants. The objective of this study was to explore the use of the 17-alpha-hydroxyprogesterone (17-OHP)/11-deoxycortisol ratio as an adjunct measure in the follow-up evaluation of infants with presumptive positive newborn screens for CAH to distinguish between infants with no disorder and those with CAH. STUDY DESIGN: This was a

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retrospective cohort study of infants with presumptive positive newborn screens for CAH. The precursor-to-product ratio of 17-OHP/11-deoxycortisol was compared between infants with no disorder (n=47) and infants with CAH (n=5). RESULTS: The CAH infants had higher 17-OHP/11-deoxycortisol ratios than infants with no disorder: 26 (18 to 58) and 1.05 (0.69 to 1.46), respectively (P<0.05). Among infants with no disorder, higher levels of serum 17-OHP did not reflect higher ratios, indicating sufficient enzyme activity. CONCLUSION: The results suggest that a low 17-OHP/11-deoxycortisol ratio represents 21-alpha-hydroxylase sufficiency among presumptive positives in newborn screening of CAH.

编号：19

题名：Effects of delayed cord clamping on residual placental blood volume, hemoglobin and bilirubin levels in term infants: a randomized controlled trial.

作者：Mercer JS;Erickson-Owens DA;Collins J;Barcelos MO;Parker AB;Padbury JF


机构：College of nursing, University of Rhode Island, Kingston, RI, USA.;Department of Pediatrics, Alpert School of Medicine, Brown University, Providence, RI, USA.;Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI, USA.;College of nursing, University of Rhode Island, Kingston, RI, USA.;Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI, USA.;Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI, USA.;Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI, USA.;Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI, USA.;Department of Pediatrics, Alpert School of Medicine, Brown University, Providence, RI, USA.;Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI, USA.


摘要： OBJECTIVE: The objective of the study was to measure the effects of a 5-min delay (DCC) versus immediate cord clamping (ICC) on residual placental blood volume (RPBV) at birth, and hemoglobin and serum bilirubin at 24 to 48 h of age. STUDY DESIGN: In this prospective randomized controlled trial, 73 women with term (37 to 41 weeks) singleton fetuses were randomized to DCC (5 min; n=37) or ICC (<20 s; n=36). RESULTS: Maternal and infant demographics were not different between the groups. Mean cord clamping time was 303+/-121 (DCC) versus 23+/-59 (ICC) s (P<0.001) with 10 protocol violations. Cord milking was the proxy for DCC (n=11) when the provider could not wait. Infants randomized to DCC compared with ICC had significantly less RPBV (20.0 versus 30.8 ml kg-1, P<0.001), higher hemoglobin levels (19.4 versus 17.8 g dl-1, P=0.002) at 24 to 48 h, with no difference in bilirubin levels. CONCLUSION: Term infants had early hematological advantage of DCC without increases in hyperbilirubinemia or symptomatic polycythemia.

编号：20

题名：Neonatologists' opinions about the 'foreseeable risks' in comparative effectiveness research: Results from an online survey.

作者：Feltman DM;Lantos JD

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机构：Division of Neonatology, Department of Pediatrics, Evanston Hospital, NorthShore University HealthSystem, Evanston, IL, USA.;University of Chicago Pritzker School of Medicine Chicago, IL, USA.;Children's Mercy Hospital, Kansas City, MO, USA.


摘要： OBJECTIVE: To examine how neonatologists determine which risks require inclusion for informed consent per the 'Common Rule' and 'Draft Guidance' regulations in comparative effectiveness research (CER). STUDY DESIGN: Neonatologists active in research were invited to complete an online survey. Questions focused on clinical practices for treating hyperbilirubinemia in premature infants and about risk disclosure related to a hypothetical randomized trial. RESULTS: Response rate was 57%. 43% were primarily researchers; 31% primarily clinicians. 69% had conducted CER. 81% thought hypothetical study enrollment was not riskier than receiving routine care. 76% labeled the study 'minimal risk' by comparing study risks to clinical care risks. Respondents would not currently disclose many of the treatment risks but would disclose more if the Draft Guidance were enacted into law. CONCLUSION: Findings suggest the Draft Guidance requires disclosure of more risks than does the Common Rule; applying either rule results in disclosure of more risks than in standard clinical care.

Pediatric research 儿科研究

编号：1

题名：The future of pediatric research: European perspective.

作者：Molloy EJ;Modi N;Greenough A;Lagercrantz H;Bearer CF;Turner M

出处：Pediatr Res.2017V81N1-2:138-139

机构：Professor & Chair of Paediatrics and Child Health, Trinity College Dublin, The University of Dublin, Dublin, Ireland.;President, Royal College of Paediatrics and Child Health, London, UK.;Professor of Neonatal Medicine, Imperial College London, London, UK.;Professor of Chelsea and Westminster Hospital, London, UK.;President, Royal College of Paediatrics and Child Health, London, UK.;Vice-President (Science and Research), Royal College of Paediatrics and Child Health, London, UK.;Professor of Neonatology and Clinical Respiratory Physiology, Division of Asthma, Allergy and Lung Biology MRC & Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, UK.;Senior Professor, Karolinska Institutet, Solna, Sweden.;Astrid Lindgren Children s Hospital, Solna, Sweden.;Editor -in-Chief, Acta Paediatrica.;Mary Gray Cobey Professor of Neonatology, Chief, Division of Neonatology,Associate Chair for Research, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland.;Editor-in-Chief, Pediatric Research, International Pediatric Research Foundation (IPRF).;GRiP Co-Scientific Co-ordinator; Director of Research and Development and Honorary Consultant Neonatologist to Liverpool Women's NHS Foundation Trust (LWH), Liverpool, UK.;Associate Director of NIHR Medicines for Children Research Network (European Affairs), London, UK.


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摘要：

编号：2

题名：Making the next seven great achievements in pediatric research a reality.

作者：Chung PJ


机构：Department of Pediatrics, UCLA, Los Angeles, California.;Department of Health Policy and Management, UCLA, Los Angeles, California.;RAND Health, RAND Corporation, Santa Monica, California.;Children's Discovery & Innovation Institute, Mattel Children's Hospital UCLA, Los Angeles, California.


摘要：

编号：3

题名：Pediatric kidney transplantation: a historical review.

作者：Verghese PS


机构：Pediatric Nephrology, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota.

文献类型：Review;Journal Article

摘要： Successful renal transplantation is the optimal treatment for chronic kidney failure, but this was not always so for children. Beginning with the first kidney transplants in the 1950s, children experienced poorer patient and graft survival rates than adult patients. But over the last 6 decades, an improved understanding of the immune system which has steered pediatric multi-center clinical/pharmacokinetic and mechanistic studies that have sculpted our immunosuppression with markedly better patient and graft survivals. In addition, uniquely pediatric issues related to growth, development, neurocognitive maturation, increased complications from primary viral infections, and comorbid congenital/inherited disorders, are now diagnosed and effectively managed in these children. Refined pretransplant preparation

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(vaccinations for preventable diseases, attention to cognitive delays, effective dialysis and nutrition) improved donor selection, and more potent immunosuppression have all contributed to enhanced outcomes. Similarly, improvements in pediatric surgical techniques, postoperative care and better antiviral prophylaxis have all shortened hospitalizations and reduced morbidity. Today pediatric kidney transplant outcomes are markedly improved and younger children today experience better long-term graft survival than adults! While difficult problems remain, we have made tremendous progress and anticipate even more advances in the future of pediatric kidney transplantation.

编号：4

题名：Quality improvement in pediatrics: past, present, and future.

作者：Schwartz SP;Rehder KJ


机构：Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital, Durham, North Carolina.;Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital, Durham, North Carolina.;Physician Quality Officer, Patient Safety Center, Duke University Health System, Durham, North Carolina.


摘要： Almost two decades ago, the landmark report "To Err is Human" compelled healthcare to address the large numbers of hospitalized patients experiencing preventable harm. Concurrently, it became clear that the rapidly rising cost of healthcare would be unsustainable in the long-term. As a result, quality improvement methodologies initially rooted in other high-reliability industries have become a primary focus of healthcare. Multiple pediatric studies demonstrate remarkable quality and safety improvements in several domains including handoffs, catheter-associated blood stream infections, and other serious safety events. While both quality improvement and research are data-driven processes, significant differences exist between the two. Research utilizes a hypothesis driven approach to obtain new knowledge while quality improvement often incorporates a cyclic approach to translate existing knowledge into clinical practice. Recent publications have provided guidelines and methods for effectively reporting quality and safety work and improvement implementations. This review examines not only how quality improvement in pediatrics has led to improved outcomes, but also looks to the future of quality improvement in healthcare with focus on education and collaboration to ensure best practice approaches to caring for children.

编号：5

题名：Does prenatal stress alter the developing connectome?

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作者：Scheinost D;Sinha R;Cross SN;Kwon SH;Sze G;Constable RT;Ment LR


机构：Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut.;Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.;Department of Child Study, Yale School of Medicine, New Haven, Connecticut.;Department of Neuroscience, Yale School of Medicine, New Haven, Connecticut.;Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut.;Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut.;Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut.;Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut.;Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut.;Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut.;Department of Neurology, Yale School of Medicine, New Haven, Connecticut.


摘要： Human neurodevelopment requires the organization of neural elements into complex structural and functional networks called the connectome. Emerging data suggest that prenatal exposure to maternal stress plays a role in the wiring, or miswiring, of the developing connectome. Stress-related symptoms are common in women during pregnancy and are risk factors for neurobehavioral disorders ranging from autism spectrum disorder, attention deficit hyperactivity disorder, and addiction, to major depression and schizophrenia. This review focuses on structural and functional connectivity imaging to assess the impact of changes in women's stress-based physiology on the dynamic development of the human connectome in the fetal brain.

编号：6

题名：Fifty years of brain imaging in neonatal encephalopathy following perinatal asphyxia.

作者：Groenendaal F;de Vries LS


机构：Department of Neonatology, and Brain Center Rudolf Magnus, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.;Department of Neonatology, and Brain Center Rudolf Magnus, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.


摘要： In the past brain imaging of term infants with hypoxic-ischemic encephalopathy (HIE) was performed with cranial ultrasound (cUS) and computed tomography (CT). Both techniques have several disadvantages sensitivity and specificity is limited compared with magnetic resonance imaging (MRI) and CT makes use of radiation. At present MRI including diffusion

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weighted MRI during the first week of life, has become the method of choice for imaging infants with HIE. In addition to imaging, blood vessels and blood flow can be visualized using MR angiography, MR venography, and arterial spin labeling. Since the use of these techniques additional lesions in infants with HIE, such as arterial ischemic stroke, sinovenous thrombosis, and subdural hemorrhages can be diagnosed, and the incidence appears to be higher than shown previously. Phosphorus magnetic resonance spectroscopy (MRS) has led to the concept of secondary energy failure in infants with HIE, but has not been widely used. Proton MRS of the basal ganglia and thalamus is one of the best predictors of neurodevelopmental outcome. cUS should still be used for screening infants admitted to a NICU with neonatal encephalopathy. In the future magnetic resonance techniques will be increasingly used as early biomarkers of neurodevelopmental outcome in trials of neuroprotective strategies.

编号：7

题名：Congenital central hypoventilation syndrome: a bedside-to-bench success story for advancing early diagnosis and treatment and improved survival and quality of life.

作者：Weese-Mayer DE;Rand CM;Zhou A;Carroll MS;Hunt CE


机构：Center for Autonomic Medicine in Pediatrics (CAMP), Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, Illinois.;Feinberg School of Medicine, Northwestern University, Chicago, Illinois.;Center for Autonomic Medicine in Pediatrics (CAMP), Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, Illinois.;Center for Autonomic Medicine in Pediatrics (CAMP), Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, Illinois.;Center for Autonomic Medicine in Pediatrics (CAMP), Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, Illinois.;Feinberg School of Medicine, Northwestern University, Chicago, Illinois.;Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, Maryland.;Pediatrics, George Washington University, Washington, D.C.


摘要： The "bedside-to-bench" Congenital Central Hypoventilation Syndrome (CCHS) research journey has led to increased phenotypic-genotypic knowledge regarding autonomic nervous system (ANS) regulation, and improved clinical outcomes. CCHS is a neurocristopathy characterized by hypoventilation and ANS dysregulation. Initially described in 1970, timely diagnosis and treatment remained problematic until the first large cohort report (1992), delineating clinical presentation and treatment options. A central role of ANS dysregulation (2001) emerged, precipitating evaluation of genes critical to ANS development, and subsequent 2003 identification of Paired-Like Homeobox 2B (PHOX2B) as the disease-defining gene for CCHS. This breakthrough engendered clinical genetic testing, making diagnosis exact and early tracheostomy/artificial ventilation feasible. PHOX2B genotype-CCHS phenotype relationships were elucidated, informing early recognition and timely treatment for phenotypic manifestations including Hirschsprung disease, prolonged sinus pauses, and neural crest tumors. Simultaneously, cellular models of CCHS-causing PHOX2B mutations were developed to delineate molecular mechanisms. In addition to new insights regarding genetics and

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neurobiology of autonomic control overall, new knowledge gained has enabled physicians to anticipate and delineate the full clinical CCHS phenotype and initiate timely effective management. In summary, from an initial guarantee of early mortality or severe neurologic morbidity in survivors, CCHS children can now be diagnosed early and managed effectively, achieving dramatically improved quality of life as adults.

编号：8

题名：Drugs, guns and cars: how far we have come to improve safety in the United States; yet we still have far to go.

作者：Dodington J;Violano P;Baum CR;Bechtel K


机构：Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut.;Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.;Department of Injury Prevention, Community Outreach and Research, Yale-New Haven Children's Hospital, New Haven, Connecticut.;Injury Free Coalition for Kids of New Haven, New Haven, Connecticut.;Department of Injury Prevention, Community Outreach and Research, Yale-New Haven Children's Hospital, New Haven, Connecticut.;Injury Free Coalition for Kids of New Haven, New Haven, Connecticut.;Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut.;Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.;Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut.;Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.;Department of Injury Prevention, Community Outreach and Research, Yale-New Haven Children's Hospital, New Haven, Connecticut.;Injury Free Coalition for Kids of New Haven, New Haven, Connecticut.


摘要： Significant breakthroughs in the field of injury prevention and childhood safety have occurred during the past half-century. For example, the Poison Prevention Packaging Act of 1970 and the institution of child passenger safety laws are responsible for a significant reduction in injuries among children and adolescents. This review will focus on the following three topics because of their significant contribution to pediatric injury morbidity, especially among adolescents, and their promise for further effective prevention research. Opioid overdoses by adolescents and young adults are increasing; however, the use of naloxone by bystanders represents a life-saving development in opioid overdose prevention that deserves further investigation. Youth firearm injury remains a major cause of death and disability in adolescents. Despite a lack of robust injury prevention research on the topic, the development of novel approaches to access and examine firearm injury data is leading to exploration of public health approaches to reduce these injuries. Finally, despite legislative and educational efforts surrounding child passenger safety and graduated driver license laws, motor vehicle crashes are still a leading cause of injury for both children and adolescents; however, research on these laws holds the opportunity for significant reduction in injuries. Focused efforts to reduce unintentional injuries from opiate overdoses, firearms and motor vehicle crashes may produce a breakthrough in the field of injury prevention similar to that of the Poison Prevention Packaging Act.

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编号：9

题名：Treatment of perinatal viral infections to improve neurologic outcomes.

作者：Muller WJ


机构：Department of Pediatrics, Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.


摘要： Viral infections in the fetus or newborn often involve the central nervous system (CNS) and can lead to significant morbidity and mortality. Substantial progress has been made in identifying interventions decreasing adverse neurodevelopmental outcomes in this population. This review highlights progress in treatment of important viruses affecting the CNS in these susceptible hosts, focusing on herpes simplex virus (HSV), cytomegalovirus (CMV), human immunodeficiency virus (HIV), and enteroviruses. The observation that high-dose acyclovir improves mortality in neonatal HSV disease culminated decades of antiviral research for this disease. More recently, prolonged oral acyclovir was found to improve neurologic morbidity after neonatal HSV encephalitis. Ganciclovir, and more recently its oral prodrug valganciclovir, is effective in improving hearing and neurodevelopment after congenital CMV infection. Increasing evidence suggests early control of perinatal HIV infection has implications for neurocognitive functioning into school age. Lastly, the antiviral pleconaril has been studied for nearly two decades for treating severe enteroviral infections, with newer data supporting a role for this drug in neonates. Identifying common mechanisms for pathogenesis of viral CNS disease during this critical period of brain development is an important research goal, highlighted by the recent emergence of Zika virus as a potential cause of fetal neurodevelopmental abnormalities.

编号：10

题名：Idiopathic nephrotic syndrome: the EBV hypothesis.

作者：Dossier C;Jamin A;Deschenes G


机构：Department of Pediatric Nephrology, Assistance Publique Hopitaux de Paris, Hopital Robert-Debre, Paris, France.;Department of Pediatric Nephrology, Assistance Publique Hopitaux de Paris, Hopital Robert-Debre, Paris, France.;Center of Research on Inflammation, Institut National de la Sante et de la Recherche Medicale UMR 1149, University Sorbonne-Paris-Cite,

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Paris, France.;Department of Pediatric Nephrology, Assistance Publique Hopitaux de Paris, Hopital Robert-Debre, Paris, France.;Center of Research on Inflammation, Institut National de la Sante et de la Recherche Medicale UMR 1149, University Sorbonne-Paris-Cite, Paris, France.


摘要： Steroid sensitive nephrotic syndrome is marked by a massive proteinuria and loss of podocytes foot processes. The mechanism of the disease remains debated but recent publications suggest a primary role of Epstein-Barr Virus (EBV). EBV replication in the peripheral blood is found in 50% of patients during the first flare of the disease. The genetic locus of steroid sensitive nephrotic syndrome was also identified as influencing antibodies directed against EBNA1. EBV is able to establish, latent benign infection in memory B cells that display phenotypes similar to antigen-selected memory B cells. Consistently, memory B cells reconstitution after rituximab infusion is a predictor of the relapse of proteinuria. We suggest that a specific anti-EBNA1 antibody internalized in the podocytes via the neonatal Fc receptor might cross-react with a major protein present in the same cell trafficking compartment. The diversion of this major podocyte protein in the urinary space and the subsequent depletion is supposed to result in podocyte damages with loss of foot processes and massive proteinuria. Immunosuppression of B cells and subsequent clearance of anti-EBNA1 antibodies would lead to a restoration of the normal level of the protein allowing recovery of proteinuria and of normal podocyte morphology.

编号：11

题名：Hirschsprung's disease: clinical dysmorphology, genes, micro-RNAs, and future perspectives.

作者：Sergi CM;Caluseriu O;McColl H;Eisenstat DD


机构：Department of Orthopedics, Wuhan University of Science and Technology, Hubei, P.R. China.;Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada.;Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.;Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.;Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada.;Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.;Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.;Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada.


摘要： On the occasion of the 100th anniversary of Dr. Harald Hirschsprung's death, there is a worldwide significant research effort toward identifying and understanding the role of genes and biochemical pathways involved in the pathogenesis as well as the use of new therapies for the disease harboring his name (Hirschsprung disease, HSCR). HSCR (aganglionic megacolon) is a frequent diagnostic and clinical challenge in perinatology and pediatric surgery, and a major cause of neonatal intestinal obstruction. HSCR is characterized by the absence of ganglia

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of the enteric nervous system, mostly in the distal gastrointestinal tract. This review focuses on current understanding of genes and pathways associated with HSCR and summarizes recent knowledge related to micro RNAs (miRNAs) and HSCR pathogenesis. While commonly sporadic, Mendelian patterns of inheritance have been described in syndromic cases with HSCR. Although only half of the patients with HSCR have mutations in specific genes related to early embryonic development, recent pathway-based analysis suggests that gene modules with common functions may be associated with HSCR in different populations. This comprehensive profile of functional gene modules may serve as a useful resource for future developmental, biochemical, and genetic studies providing insights into the complex nature of HSCR.

编号：12

题名：Bronchopulmonary dysplasia: new becomes old again!

作者：Day CL;Ryan RM


机构：Department of Pediatrics, Division of Neonatology, The Medical University of South Carolina, Charleston, South Carolina.;Department of Pediatrics, Division of Neonatology, The Medical University of South Carolina, Charleston, South Carolina.


摘要： Despite the many advances in neonatology, bronchopulmonary dysplasia (BPD) continues to be a frustrating disease of prematurity. BPD is a disease which is defined oddly by its treatment rather than its pathophysiology, leading to frequently changing nomenclature which has widespread implications on our ability to both understand and follow the progression of BPD. As various treatment modalities for BPD were developed and a larger number of extremely preterm infants survived, the "old" BPD based on lung injury from oxygen therapy and mechanical ventilation transitioned into a "new" BPD focused more on the interruption of normal development. However, the interruption of normal development does not solely apply to lung development. The effects of prematurity on vascular development cannot be overstated and pulmonary vascular disease has become the new frontier of BPD. As we begin to better understand the complex, multifactorial pathophysiology of BPD, it is necessary to again focus on appropriate, pathology-driven nomenclature that can effectively describe the multiple clinical phenotypes of BPD.

编号：13

题名：Hypoplastic left heart syndrome: from comfort care to long-term survival.

作者：Yabrodi M;Mastropietro CW

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机构：Department of Pediatrics, Section of Critical Care, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana.;Department of Pediatrics, Section of Critical Care, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana.


摘要： The management of hypoplastic left heart syndrome (HLHS) has changed substantially over the past four decades. In the 1970s, children with HLHS could only be provided with supportive care. As a result, most of these unfortunate children died within the neonatal period. The advent of the Norwood procedure in the early 1980s has changed the prognosis for these children, and the majority now undergoing a series of three surgical stages that can support survival beyond the neonatal period and into early adulthood. This review will focus on the Norwood procedure and the other important innovations of the last half century that have improved our outlook toward children born with HLHS.

编号：14

题名：Identification of Helicobacter pylori and the evolution of an efficacious childhood vaccine to protect against gastritis and peptic ulcer disease.

作者：Blanchard TG;Czinn SJ


机构：Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland.;Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland.


摘要： Establishment of Helicobacter pylori infection as an etiologic agent of peptic ulcer disease and other gastric pathologies marked a revolution in gastroenterology which spurred an enormous interest in gastric physiology and immunology research. The association was soon also demonstrated in children as well. Application of antimicrobial therapies have proven remarkably efficacious in eradicating H. pylori and curing pediatric patients of duodenal ulcers as well as gastritis, negating a lifetime of ineffective therapy and life-threatening disease. Countries with high H. pylori prevalence and where H. pylori associated gastric cancer remains a primary cause of death due to cancer however would benefit from childhood vaccination. Studies in rodents and humans utilizing oral vaccination with bacterial exotoxin adjuvants demonstrated potential for limiting H. pylori colonization in the stomach. Almost 25 y of vaccine research recently culminated in a phase III clinical trial of over 4,000 children aged 6-15 y old to test an oral vaccine consisting of the H. pylori urease B subunit genetically fused to the E. coli heat labile toxin. Vaccination was demonstrated to have an efficacy of over 70%.

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Vaccination may now serve as an effective strategy to significantly reduce H. pylori associated disease in children throughout the world.

编号：15

题名：Pediatric sickle cell disease: past successes and future challenges.

作者：Meier ER;Rampersad A


机构：Pediatric Hematology, Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana.;Pediatric Hematology, Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana.


摘要： Once a fatal disease of childhood, more than 95% of patients born today with sickle cell disease (SCD) in developed countries are expected to survive into adulthood, largely because of improvements in supportive and preventive care (newborn screening, penicillin prophylaxis, transcranial Doppler (TCD) screening). Hydroxyurea (HU) therapy, the only oral medication currently available to prevent SCD complications, has become more widespread over the past 20 y. The NHLBI recommends that HU be offered to all patients with HbSS beginning at 9 mo of age, and the recently published Abnormal TCD with Transfusions Changing to HU (TWiTCH) trial has shown HU as an acceptable alternative to transfusion therapy for patients at high risk of stroke. While hematopoietic stem cell transplant (HSCT) is a curative option for SCD, less than 25% of patients have a suitable donor. Alternative stem cell sources from unrelated donors and haplo-identical donors are currently under investigation as are gene therapy trials. This review will focus on early efforts to elucidate SCD pathophysiology as well as supportive and preventive care improvements. Findings from recent multi-center studies (Silent Infarct Transfusion (SIT) Trial and TWiTCH) will be summarized. Finally, HSCT trials and gene therapy will be reviewed.

编号：16

题名：Evolution of surfactant therapy for respiratory distress syndrome: past, present, and future.

作者：Sardesai S;Biniwale M;Wertheimer F;Garingo A;Ramanathan R


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机构：Department of Pediatrics, Division of Neonatal Medicine, LAC+USC Medical Center and Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California.;Department of Pediatrics, Division of Neonatal Medicine, LAC+USC Medical Center and Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California.;Department of Pediatrics, Division of Neonatal Medicine, LAC+USC Medical Center and Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California.;Department of Pediatrics, Division of Neonatal Medicine, LAC+USC Medical Center and Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California.;Department of Pediatrics, Division of Neonatal Medicine, LAC+USC Medical Center and Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California.


摘要： Respiratory distress syndrome (RDS) due to surfactant deficiency is the most common cause of respiratory failure in preterm infants. Tremendous progress has been made since the original description that surfactant deficiency is the major cause of RDS. Surfactant therapy has been extensively studied in preterm infants and has been shown to significantly decrease air leaks and neonatal and infant mortality. Synthetic and animal-derived surfactants from bovine as well as porcine origin have been evaluated in randomized controlled trials. Animal-derived surfactants generally result in faster weaning of respiratory support, shorter duration of invasive ventilation, and decreased mortality when compared to first- or second-generation of synthetic surfactants, but some of the second-generation synthetic surfactants are at least not inferior to the animal-derived surfactants. Using a higher initial dose of porcine derived surfactant may provide better outcomes when compared with using lower doses of bovine surfactants, likely, due to compositional difference and/or the dose. Third-generation synthetic surfactant containing peptide analogs of surfactant protein B and C are currently being studied. Less invasive intra-tracheal surfactant administration techniques in spontaneously breathing neonate receiving noninvasive ventilator support are also being evaluated. In the present era, prophylactic surfactant is not recommended as it may increase the risk of lung injury or death. In the future, surfactants may be used as vector to deliver steroids, or used in combination with molecules, such as, recombinant Club Cell Protein-10 (rhCC-10) to improve pulmonary outcomes. Also, noninvasive surfactant administration techniques, such as aerosolization or atomization of surfactant may play a greater role in the future.

编号：17

题名：Tuberculosis: Is the landscape changing?

作者：Khatua S;Geltemeyer AM;Gourishankar A


机构：Division of Community and General Pediatrics, Department of Pediatrics, University of Texas Health Science Center, McGovern Medical School, Houston, Texas.;Division of Community and General Pediatrics, Department of Pediatrics, University of Texas Health Science Center, McGovern Medical School, Houston, Texas.;Division of Community and General Pediatrics,

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Department of Pediatrics, University of Texas Health Science Center, McGovern Medical School, Houston, Texas.


摘要： Robert Heinrich Herman Koch, a German physician and microbiologist, received Nobel Prize in 1905 for identifying the specific causative agent of tuberculosis (TB). During his time it was believed that TB was an inherited disease. However he was convinced that the disease was caused by a bacterium and was infectious, tested his postulates using guinea pigs, and found the causative agent to be slow growing mycobacterium tuberculosis. TB is the second most common cause of death from infectious diseases after HIV/AIDS. Drug-resistant TB poses serious challenge to effective management of TB worldwide. Multidrug-resistant TB accounted for about half a million new cases and over 200,000 deaths in 2013. Whole-genome sequencing (first done in 1998) technologies have provided new insight into the mechanism of drug resistance. For the first time in 50 y, new anti TB drugs have been developed. The World Health Organization (WHO) has recently revised their treatment guidelines based on 32 studies. In United States, latent TB affects between 10 and 15 million people, 10% of whom may develop active TB disease. QuantiFERON TB Gold and T-SPOT.TB test are used for diagnosis. Further research will look into the importance of newly discovered gene mutations in causing drug resistance.

编号：18

题名：Renal injury in neonates: use of "omics" for developing precision medicine in neonatology.

作者：Joshi MS;Montgomery KA;Giannone PJ;Bauer JA;Hanna MH


机构：Department of Pediatrics, University of Kentucky College of Medicine, Lexington, Kentucky.;Department of Pediatrics, University of Kentucky College of Medicine, Lexington, Kentucky.;Department of Pediatrics, University of Kentucky College of Medicine, Lexington, Kentucky.;Department of Pediatrics, University of Kentucky College of Medicine, Lexington, Kentucky.;Department of Pediatrics, University of Kentucky College of Medicine, Lexington, Kentucky.


摘要： Preterm birth is associated with increased risks of morbidity and mortality along with increased healthcare costs. Advances in medicine have enhanced survival for preterm infants but the overall incidence of major morbidities has changed very little. Abnormal renal development is an important consequence of premature birth. Acute kidney injury (AKI) in the neonatal period is multifactorial and may increase lifetime risk of chronic kidney disease.Traditional biomarkers in newborns suffer from considerable confounders, limiting their use for early identification of AKI. There is a need to develop novel biomarkers that can identify, in real time, the evolution of renal dysfunction in an early diagnostic, monitoring and prognostic fashion. Use of "omics", particularly metabolomics, may provide valuable

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information regarding functional pathways underlying AKI and prediction of clinical outcomes.The emerging knowledge generated by the application of "omics" (genomics, proteomics, metabolomics) in neonatology provides new insights that can help to identify markers of early diagnosis, disease progression, and identify new therapeutic targets. Additionally, omics will have major implications in the field of personalized healthcare in the future. Here, we will review the current knowledge of different omics technologies in neonatal-perinatal medicine including biomarker discovery, defining as yet unrecognized biologic therapeutic targets, and linking of omics to relevant standard indices and long-term outcomes.

编号：19

题名：Introduction-Standing on each other's shoulders.

作者：Cheng TL;Tarazi C;Molloy E;Bearer CF

出处：Pediatr Res.2017V81N1-2:137

机构：Professor and Chair, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.;Communications Editor, Pediatric Research, International Pediatric Research Foundation, Boston, Massachusetts.;Chair and Professor of Paediatrics and Child Health, Trinity College, the University of Dublin, Ireland.;Professor and Chief, Division of Neonatology, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland.


摘要：

编号：20

题名：Acknowledgments.

出处：Pediatr Res.2017V81N1-2:277


编号：21

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题名：Therapeutic hypothermia translates from ancient history in to practice.

作者：Gunn AJ;Laptook AR;Robertson NJ;Barks JD;Thoresen M;Wassink G;Bennet L


机构：Department of Physiology, School of Medical Sciences, University of Auckland, Auckland, New Zealand.;Department of Neonatology, Warren Alpert Medical School, Brown University, Women & Infants Hospital, Providence, Rhode Island.;Institute for Women's Health, University College London, London, UK.;Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan.;Neonatal Neuroscience, School of Clinical Sciences, University of Bristol, Bristol, UK.;Department of Physiology, University of Oslo, Oslo, Norway.;Department of Physiology, School of Medical Sciences, University of Auckland, Auckland, New Zealand.;Department of Physiology, School of Medical Sciences, University of Auckland, Auckland, New Zealand.


摘要： Acute postasphyxial encephalopathy around the time of birth remains a major cause of death and disability. The possibility that hypothermia may be able to prevent or lessen asphyxial brain injury is a "dream revisited". In this review, a historical perspective is provided from the first reported use of therapeutic hypothermia for brain injuries in antiquity, to the present day. The first uncontrolled trials of cooling for resuscitation were reported more than 50 y ago. The seminal insight that led to the modern revival of studies of neuroprotection was that after profound asphyxia, many brain cells show initial recovery from the insult during a short "latent" phase, typically lasting ~6 h, only to die hours to days later during a "secondary" deterioration phase characterized by seizures, cytotoxic edema, and progressive failure of cerebral oxidative metabolism. Studies designed around this conceptual framework showed that mild hypothermia initiated as early as possible before the onset of secondary deterioration, and continued for a sufficient duration to allow the secondary deterioration to resolve, is associated with potent, long-lasting neuroprotection. There is now compelling evidence from randomized controlled trials that mild induced hypothermia significantly improves intact survival and neurodevelopmental outcomes to midchildhood.

Obstet Gynecol

编号：1题名：Predictors of Low Uptake of Prenatal Tetanus Toxoid, Reduced Diphtheria Toxoid, and

Acellular Pertussis Immunization in Privately Insured Women in the United States.作者：Butler AM;Layton JB;Li D;Hudgens MG;Boggess KA;McGrath LJ;Weber DJ;Becker-Dreps S出处：Obstet Gynecol.2017V129N4:629-637机构：Departments of Epidemiology, Biostatistics, Obstetrics & Gynecology, and Family

Medicine and the Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, and RTI Health Solutions, Research Triangle Park, North Carolina.语种：eng摘要： OBJECTIVE: To examine the uptake of prenatal tetanus toxoid, reduced diphtheria

toxoid, and acellular pertussis (Tdap) immunization among pregnant women in the United States. METHODS: Using MarketScan data, we conducted a historical cohort study among

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pregnant women with employer-based commercial insurance in the United States who delivered between January 1, 2010, and December 31, 2014. We examined temporal trends of uptake, predictors of uptake, and timing of Tdap immunization. RESULTS: Among 1,222,384 eligible pregnancies in 1,147,711 women, receipt of prenatal Tdap immunization increased from 0.0% of women who delivered in January 2010 to 9.8% who delivered in October 2012 (the date of the recommendation by the Advisory Committee on Immunization Practices for Tdap during every pregnancy) to 44.4% who delivered in December 2014. Among women who received Tdap during pregnancy, the majority were immunized between 27 weeks and 36 6/7 weeks of gestation per the Advisory Committee on Immunization Practices recommendation. In multivariable analyses among women who delivered between November 2012 and December 2014, rates of prenatal Tdap immunization were lower for women younger than 25 years of age (eg, 20-24 compared with 30-34 years rate ratio [RR] 0.83, 95% confidence interval [CI] 0.85-0.88), with other children (eg, three compared with zero children: RR 0.86, 95% CI 0.84-0.88), residing in the South compared with the Midwest (RR 0.81, 95% CI 0.80-0.82), or with emergency department visits in early pregnancy (RR 0.93, 95% CI 0.92-0.95). The proportion of pregnant women who received prenatal Tdap increased with increasing gestational age at birth. CONCLUSION: By the end of 2014, fewer than half of pregnant women in the United States were receiving prenatal Tdap immunization. Implementation and dissemination strategies are needed to increase Tdap coverage among pregnant women, especially those who are young, have other children, or reside in the South.

编号：2题名：Access to Contraception in the Context of Zika: Health System Challenges and

Responses.作者：Darney BG;Aiken AR;Kung S出处：Obstet Gynecol.2017V129N4:638-642机构：Instituto Nacional de Salud Publica, Centro de Investigacion en Sistemas de Salud,

Cuernavaca, Mexico; Oregon Health & Science University, Portland, Oregon; LBJ School of Public Affairs and the Population Research Center, University of Texas at Austin, Austin, Texas; and Columbia University Mailman School of Public Health, New York, New York.语种：eng摘要： Women in areas of the Americas with endemic Aedes mosquito populations are at risk

for exposure to Zika virus, which can cause fetal brain abnormalities and associated congenital microcephaly. Individual health care providers may encounter health system barriers to providing evidence-based care. We focus on Mexico and the state of Texas to highlight the role of health system factors in contraceptive access in the context of Zika and highlight efforts in Puerto Rico as an example of initiatives to improve access to contraception. In Mexico, states with the highest unmet need for contraception are low-lying coastal states. The government recently announced an investment to combat Zika but made no mention of family planning initiatives to assist women in preventing pregnancy. In Texas, the Department of State Health Services has issued recommendations to help women and men avoid mosquito bites; the issue of whether women should plan or avoid pregnancy is not addressed. Puerto Rico has the largest number of confirmed cases of Zika virus in the U.S. states and territories. Recently, the

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Centers for Disease Control and Prevention Foundation launched the Zika Contraception Access Network, which provides contraceptives at no cost to participating clinics in Puerto Rico. The Zika virus highlights weaknesses in health systems that make it difficult for women to use contraception if they want to delay births. Women across the globe, with or without Zika virus, need access to contraception to prevent unintended pregnancy, and health care providers require functioning health systems that offer support to ensure access is a reality.

编号：3题名：Missed Opportunities for Prevention of Mother-to-Child Transmission of Human

Immunodeficiency Virus.作者：Scott GB;Brogly SB;Muenz D;Stek AM;Read JS出处：Obstet Gynecol.2017V129N4:621-628机构：Division of Pediatric Infectious Disease and Immunology University of Miami Miller

School of Medicine, Miami, Florida; the Department of Surgery, Queen's University, Kingston, Ontario, Canada; the Department of Biostatistics, University of Michigan, Ann Arbor, Michigan; the Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles, California; and the Pediatric, Adolescent and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.语种：eng摘要： OBJECTIVE: To identify missed opportunities for prevention of mother-to-child

transmission of human immunodeficiency virus (HIV). METHODS: Data regarding HIV-infected children born between 2002 and 2009 to HIV-infected women enrolled in the U.S. International Maternal Pediatric Adolescent AIDS Clinical Trials prospective cohort study (protocol P1025) were reviewed. The characteristics of the HIV-infected infants and their mothers and the mothers' clinical management are described. RESULTS: Twelve cases of mother-to-child transmission of HIV occurred among 1,857 liveborn neonates, for a prevalence of 0.65 per 100 live births to HIV-infected women (95% confidence interval 0.33-1.13). Four transmissions occurred in utero, three were peripartum transmissions, and the timing of transmission for five neonates was unable to be determined. None were breastfed. Seven women had plasma viral loads greater than 400 copies/mL near delivery. Six women had less than 11 weeks of antiretroviral therapy during pregnancy; three of these women had premature deliveries. One woman received no antiretroviral therapy during pregnancy because she was diagnosed with HIV postpartum. Six had poor to moderate adherence to antiretroviral therapy. Four of the five mothers with viral loads greater than 1,000 copies/mL delivered preterm neonates. There were five women who delivered by cesarean; four were nonelective cesarean deliveries and only one was an elective cesarean delivery for HIV prevention. CONCLUSION: Despite access to high-level care and follow-up, a small proportion of HIV-infected women transmitted the virus to their neonates. This case series provides insight into factors contributing to HIV perinatal transmission and can inform the development of new strategies for prevention of mother-to-child transmission of HIV. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, https://clinicaltrials.gov, NCT00028145.

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编号：4题名：Vaginal Microbiome and Its Relationship to Behavior, Sexual Health, and Sexually

Transmitted Diseases.作者：Lewis FM;Bernstein KT;Aral SO出处：Obstet Gynecol.2017V129N4:643-654机构：Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and

Prevention, and the Philadelphia Department of Public Health, Philadelphia, Pennsylvania.语种：eng摘要： The vaginal microbiota has great significance in maintaining vaginal health and

protecting the host from disease. Recent advances in molecular techniques and informatics allow researchers to explore microbial composition in detail and to compare the structure of vaginal microbial communities with behavior and health outcomes, particularly acquisition and transmission of sexually transmitted diseases (STDs) and poor birth outcomes. Vaginal flora have been found to cluster into a limited number of communities, although community structure is dynamic. Certain community types are more associated with poor reproductive outcomes and STDs; communities dominated by Lactobacillus species, particularly Lactobacillus crispatus, are most associated with vaginal health. Modifiable and nonmodifiable factors are strongly associated with community composition, including behavior, race or ethnicity, and hygiene. In this review, we describe the state of the science on the vaginal microbiome and its relationship to behavior, sexual health, and STDs, including determinants of the microbiome that go beyond an individual level.

编号：5题名：Association of Catastrophic Neonatal Outcomes With Increased Rate of Subsequent

Cesarean Deliveries.作者：Dan O;Hochner-Celnikier D;Solnica A;Loewenstein Y出处：Obstet Gynecol.2017V129N4:671-675机构：Departments of Neurobiology and Cognitive Science, the Federmann Center for the

Study of Rationality, and the Edmond and Lily Safra Center for Brain Sciences, Hebrew University of Jerusalem, Jerusalem, and the Department of Obstetrics and Gynecology-Hadassah University Hospital, Mount Scopus, Israel.语种：eng摘要： OBJECTIVE: To evaluate whether full-term deliveries resulting in neonates diagnosed

with hypoxic-ischemic encephalopathy are associated with a significant increase in the rate of subsequent unscheduled cesarean deliveries. METHODS: We conducted a retrospective chart review study and examined all deliveries in the Department of Obstetrics and Gynecology at Hadassah University Hospital, Mt. Scopus campus, Jerusalem, Israel, during 2009-2014. We reviewed all cases of hypoxic-ischemic encephalopathy in singleton, term, liveborn neonates and identified seven such cases, three of which were attributed to obstetric mismanagement and four that were not. We measured the rate of unscheduled cesarean deliveries before and after the events and their respective hazard ratio. RESULTS: Before a mismanaged delivery resulting in hypoxic-ischemic encephalopathy, the baseline rate of unscheduled cesarean

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deliveries was approximately 80 unscheduled cesarean deliveries for every 1,000 deliveries. In the first 4 weeks immediately after each of the three identified cases, there was a significant increase in the rate of unscheduled cesarean deliveries by an additional 48 unscheduled cesarean deliveries per 1,000 deliveries (95% confidence interval [CI] 27-70/1,000). This increase was transient and lasted approximately 4 weeks. We estimated that each case was associated with approximately 17 additional unscheduled cesarean deliveries (95% CI 8-27). There was no increase in the rate of unscheduled cesarean deliveries in cases of hypoxic-ischemic encephalopathy that were not associated with mismanagement. CONCLUSION: The increase in the rate of unscheduled cesarean deliveries after a catastrophic neonatal outcome may result in short-term changes in obstetricians' risk evaluation.

编号：6题名：Sildenafil Citrate Therapy for Oligohydramnios: A Randomized Controlled Trial.作者：Maher MA;Sayyed TM;Elkhouly N出处：Obstet Gynecol.2017V129N4:615-620机构：Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University,

Shebin-Elkom, Egypt.语种：eng摘要： OBJECTIVE: To compare sildenafil plus hydration with hydration alone in improving the

amniotic fluid index and neonatal outcomes in pregnancies complicated by idiopathic oligohydramnios ( amniotic fluid index less than 5 cm without underlying maternal or fetal causes and with normal fetal growth). METHODS: This was an open-label randomized trial for women carrying singleton pregnancies at 30 weeks of gestation or more with idiopathic oligohydramnios detected during routine ultrasonogram. Women received either oral sildenafil citrate (25 mg every 8 hours) plus intravenous infusion of 2 L isotonic solution or fluids only until delivery. The primary study outcome was the amniotic fluid volume at 6 weeks of follow-up or the final volume before delivery, whichever occurred first. Secondary outcomes were duration of pregnancy prolongation, mode of delivery, and select neonatal outcomes. The study was powered to detect a 45% difference between groups, so, at an alpha level of 0.05 and 80% power, a sample size of 167 women was required. RESULTS: From February 24, 2015, through April 2016, 196 women were screened and 184 were randomized. Follow-up was completed in 166 (90%): 82 in the sildenafil group and 84 in the hydration group. Baseline characteristics were similar between groups. The amniotic fluid volume was higher in the sildenafil group at the final assessment (11.5 compared with 5.4 cm, P=.02). The sildenafil group delivered later (38.3 compared with 36.0 weeks of gestation, P=.001), had a lower rate of cesarean delivery (28% compared with 73%), and their neonates were less likely to be admitted to the neonatal intensive care unit (11% compared with 41%, P=.001). CONCLUSION: Sildenafil citrate increases amniotic fluid volume in pregnancies complicated by oligohydramnios. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT02372487.

编号：7

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题名：Risk of Adverse Pregnancy Outcome After Paternal Exposure to Methotrexate Within 90 Days Before Pregnancy.

作者：Eck LK;Jensen TB;Mastrogiannis D;Torp-Pedersen A;Askaa B;Nielsen TK;Poulsen HE;Jimenez-Solem E;Andersen JT

出处：Obstet Gynecol.2017V129N4:707-714机构：Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg, and

the Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, the Department of Rheumatology, Copenhagen University Hospital Rigshospitalet, Glostrup, and the Department of Urology, Copenhagen University Hospital Roskilde, Roskilde, Denmark; the Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois.语种：eng摘要： OBJECTIVE: To study the association between paternal exposure to methotrexate within

the 90-day period before pregnancy and congenital malformations and stillbirth in the offspring. METHODS: We conducted a nationwide register study. Our cohort consisted of all live births in Denmark between 1997 and 2011 identified from the Medical Birth Registry. Methotrexate-exposed fathers were identified from the National Prescription Registry. From the national Hospital Registry we identified paternity, live births, and stillbirths as well as discharge diagnoses on congenital malformations. RESULTS: We identified 849,676 live births with known paternity. There were 127 live births of methotrexate-exposed fathers. Of these, four (3.2%) had major malformations compared with 28,814 (3.4%) of the unexposed. The odds ratio (OR) for major congenital malformation among exposed fathers compared with unexposed was 0.93 (95% confidence interval [CI] 0.34-2.51) and when adjusted for year of birth, maternal age, educational length, household income, and parity, the adjusted OR was 1.01 (95% CI 0.37-2.74). There were no stillbirths in the methotrexate-exposed group compared with 2,541 (0.3%) in the unexposed group and no increased risk of preterm birth (adjusted OR 1.31, 95% CI 0.66-2.59) among the children from exposed fathers. CONCLUSION: We found no association between paternal exposure to methotrexate within 90 days before pregnancy and congenital malformations, stillbirths, or preterm birth. Available data suggest that prepregnancy paternal methotrexate exposure should not be of major concern. Multinational recommendations should be changed accordingly.

编号：8题名：Activity Restriction Recommendations and Outcomes After Reconstructive Pelvic

Surgery: A Randomized Controlled Trial.作者：Mueller MG;Lewicky-Gaupp C;Collins SA;Abernethy MG;Alverdy A;Kenton K出处：Obstet Gynecol.2017V129N4:608-614机构：Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of

Obstetrics & Gynecology and Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, John Hopkins University School of Medicine, Baltimore, Maryland.语种：eng

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摘要： OBJECTIVE: To assess the relationship between prescribed postoperative activity recommendations (liberal compared with restricted) after reconstructive prolapse surgery and patient satisfaction and pelvic floor symptoms. METHODS: In our multicenter, randomized, double-blind clinical trial, women undergoing reconstructive prolapse surgery were randomized to liberal compared with restricted postoperative activity recommendations. Liberal recommendations instructed women to resume postoperative activity at the woman's own pace with no restrictions on lifting or high-impact activities. Conversely, restricted recommendations instructed women to avoid heavy lifting or strenuous exercise for 3 months. The primary outcome, patient satisfaction, was assessed on a 5-point Likert scale at 3 months postoperatively with the question, "How satisfied are you with the result of your prolapse surgery?" Secondary outcomes included anatomic outcomes and pelvic floor symptoms. RESULTS: From September 2014 to December 2015, 130 women were screened and 108 were randomized. Ultimately, 95 were allocated to study intervention (n=45 liberal, n=50 restricted) and completed the primary outcome. Baseline characteristics (including pelvic organ prolapse quantification stage and demographics) and surgical intervention did not differ between groups. Most women underwent a minimally invasive sacrocolpopexy (58) followed by vaginal suspension (27) or vaginal closure procedures (nine). Rates of satisfaction were similarly high in the liberal and restricted recommendations groups (98% compared with 94%, odds ratio 0.36 [0.036-3.55], P=.619). Anatomic outcomes did not differ between groups; however, fewer pelvic floor symptoms were reported in the liberal group. CONCLUSION: Satisfaction was equally high 3 months after prolapse surgery in women who were instructed to liberally resume activities compared with those instructed to restrict postoperative activities. Women who liberally resumed their activities reported fewer prolapse and urinary symptoms and had similar short-term anatomic outcomes suggesting that allowing women to resume their normal activities postoperatively may result in improved pelvic floor outcomes. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT02138487.

编号：9题名：Pregnancy Intention and Maternal Alcohol Consumption.作者：Pryor J;Patrick SW;Sundermann AC;Wu P;Hartmann KE出处：Obstet Gynecol.2017V129N4:727-733机构：Department of Pediatrics, the Mildred Stahlman Division of Neonatology, the Vanderbilt

Center for Health Services Research, the Department of Health Policy, the Vanderbilt Center for Addiction Research, the Institute for Medicine and Public Health, the Department of Biostatistics, and the Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee.语种：eng摘要： OBJECTIVE: To evaluate whether women planning a pregnancy are less likely to use

alcohol in early pregnancy than those with unintended pregnancies. METHODS: Right From the Start (2000-2012) is a prospective, community-based pregnancy cohort. Maternal demographic, reproductive, and behavioral data were collected in telephone interviews at enrollment (mean+/-standard deviation 48+/-13 days of gestation) and later in the first trimester (mean+/-standard deviation 85+/-21 days of gestation). Alcohol consumption

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characteristics were included in the interviews. We used logistic regression to investigate the association of pregnancy intention with alcohol use. RESULTS: Among 5,036 women, 55% reported using alcohol in the first trimester with 6% continuing use at the first-trimester interview. Pregnancy was planned by 70% of participants. Alcohol use occurred in 55% and 56% of intended and unintended pregnancies, respectively (P=.32). Adjusting for confounders, women with intended pregnancies were 31% less likely to consume any alcohol in early pregnancy (adjusted odds ratio [OR] 0.69, 95% confidence interval [CI] 0.60-0.81) or binge drink (adjusted OR 0.68, 95% CI 0.54-0.86). Most women, regardless of intention, stopped or decreased alcohol consumption in early pregnancy. CONCLUSION: The majority of women, irrespective of intention, stopped or decreased drinking after pregnancy recognition. This suggests promoting early pregnancy awareness could prove more effective than promoting abstinence from alcohol among all who could conceive.

编号：10题名：In Pursuit of Progress Toward Effective Preterm Birth Reduction.作者：Martin JN Jr;D'Alton M;Jacobsson B;Norman JE出处：Obstet Gynecol.2017V129N4:715-719机构：University of Mississippi Medical Center, Jackson, Mississippi; Columbia University, New

York Presbyterian Hospital, New York, New York; Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Tommy's Centre for Maternal & Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom.语种：eng摘要： Recently the March of Dimes and the International Federation of Gynecology and

Obstetrics Working Group on Preterm Birth released its findings from an extensive cross-country individual patient data analysis of 4.1 million singleton births in five high-income, very high human development index countries. The specific contributions of 21 risk factors for both spontaneous and health care provider-initiated preterm birth were assessed to better understand how these vary among the countries selected for intensive study. We also wished to evaluate whether currently used clinical interventions to prevent preterm birth are associated with lower rates of preterm delivery. Individual and population-attributable preterm birth risks were determined and an assessment made to identify any contribution to cross-country differences. With this massive data set it was possible to assess the ability to predict preterm birth given various sets of known risk factors. It was also possible to estimate the potential effects of successful interventions to reduce preterm birth in relation to advances in the research, health care policy, and clinical practice sectors. In this article we summarize the seven most important findings from these analyses. Clearly there is a paucity of explicit and currently identifiable factors that are amenable to intervention with current clinical practice or changes in public health policy. Thus, we see an urgent and critically important need for research efforts to elucidate the underlying biological causes of spontaneous preterm birth. The need for new innovative and effective interventions to successfully pursue progress toward effective preterm birth reduction has never been more apparent.

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编号：11题名：Postabortion Contraceptive Use and Continuation When Long-Acting Reversible

Contraception Is Free.作者：Goyal V;Canfield C;Aiken AR;Dermish A;Potter JE出处：Obstet Gynecol.2017V129N4:655-662机构：Population Research Center and LBJ School of Public Affairs, University of Texas at

Austin, and Planned Parenthood of Greater Texas, Austin, Texas.语种：eng摘要： OBJECTIVE: To compare preference for long-acting contraception (LARC) and

subsequent use, year-long continuation, and pregnancy among women after induced abortion who were and were not eligible to participate in a specialized funding program that provided LARC at no cost. METHODS: Between October 2014 and March 2016, we conducted a prospective study of abortion patients at Planned Parenthood in Austin, Texas (located in Travis County). We compared our primary outcome of interest, postabortion LARC use, among women who were eligible for the specialized funding program (low-income, uninsured, Travis County residents) and two groups who were ineligible (low-income, uninsured, non-Travis County residents, and higher income or insured women). Secondary outcomes of interest included preabortion preference for LARC and 1-year continuation and pregnancy rates among the three groups. RESULTS: Among 518 women, preabortion preference for LARC was high among all three groups (low-income eligible: 64% [91/143]; low-income ineligible: 44% [49/112]; and higher income 55% [146/263]). However, low-income eligible participants were more likely to receive LARC (65% [93/143] compared with 5% [6/112] and 24% [62/263], respectively, P<.05). Specifically, after adjusting for age, race-ethnicity, and education, low-income eligible participants had a 10-fold greater incidence of receiving postabortion LARC compared with low-income ineligible participants (incidence rate ratio 10.13, 95% confidence interval [CI] 4.68-21.91). Among low-income eligible and higher income women who received postabortion LARC, 1-year continuation was 90% (95% CI 82-97%) and 86% (95% CI 76-97%), respectively. One-year pregnancy risk was higher among low-income ineligible than low-income eligible women (hazard ratio 3.28, 95% CI 1.15-9.31). CONCLUSION: Preference for postabortion LARC was high among all three eligibility groups, yet women with access to no-cost LARC were more likely to use and continue these methods. Low-income ineligible women were far more likely to use less effective contraception and become pregnant. Specialized funding programs can play an important role in immediate postabortion contraceptive provision, particularly in settings where state funding is limited.

编号：12题名：Vaginal Delivery After Duhrssen Incisions in a Patient With Bladder Exstrophy and

Uterine Prolapse.作者：Lachica R;Chan Y;Uquillas KR;Lee RH出处：Obstet Gynecol.2017V129N4:689-692机构：Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine,

University of Southern California, Los Angeles, California.语种：eng

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摘要： BACKGROUND: Bladder exstrophy is a rare congenital anomaly affecting the lower abdominal wall, pelvis, and genitourinary structures. Pregnant women with bladder exstrophy present a unique challenge to the obstetrician. CASE: The patient is a 35-year old pregnant woman with bladder exstrophy, an extensive surgical history, and uterine prolapse with an abnormal, rubbery consistency to her cervix. Prenatally, she was counseled on the potential use of Duhrssen incisions to facilitate vaginal delivery. Labor was induced at 36 4/7 weeks of gestation after her pregnancy was complicated by recurrent pyelonephritis. Vaginal delivery was achieved 8 minutes after the creation of Duhrssen incisions. CONCLUSION: The care of pregnant women with bladder exstrophy requires multidisciplinary management and careful delivery planning. Successful vaginal delivery can be attained in these patients.

编号：13题名：Uptake of a Guideline for the Administration of a Rescue Course of Antenatal

Corticosteroids.作者：Datkhaeva I;Dray D;Has P;Stifani B;Hughes BL;Rouse DJ出处：Obstet Gynecol.2017V129N4:720-726机构：Department of Obstetrics & Gynecology, Warren Alpert Medical School of Brown

University, Women & Infants Hospital, Providence, Rhode Island.语种：eng摘要： OBJECTIVE: To evaluate use (both appropriate and inappropriate) of rescue

corticosteroids before and after the implementation of a guideline for their use. METHODS: We conducted a retrospective cohort study using a pharmacy log to identify women who received an initial course of antenatal corticosteroids in the year before (2008) and in the 4 years (2009-2012) after implementation of the guideline. The charts were then reviewed to determine eligibility and assess receipt of rescue corticosteroids according to the guideline. Our primary study outcome was a temporal change in the percentage of appropriate rescue corticosteroid administration. RESULTS: Of 2,528 women who received a first course of corticosteroids, 142 (5.6%) were eligible for a rescue course, of whom 103 (73%) received it. The rate of appropriate administration increased from 18.2% (95% confidence interval [CI] 5-40%) in 2008 to 65.4% (95% CI 44-83%) in 2009, 93.5% (95% CI 79-99%) in 2010, 96.1% (95% CI 80-99%) in 2011, and 75.7% (95% CI 59-88%) in 2012 (P for test of trend <.001). Only 25 of these 103 eligible women (24.3%) delivered within 2-7 days of receipt of the rescue course. The rate of inappropriate administration among women who were not eligible for a rescue course (n=2,381) also rose from 0.4% (95% CI 0.04-1.4%) in 2008 to 1.9% (95% CI 0.9-3.5%) in 2009, 1.8% (95% CI 0.8-3.6%) in 2010, 2.4% (95% CI 1.2-4.3%) in 2011, and 2.2% (95% CI 1.1-4.0%) in 2012 (P for test of trend=.03). Among all recipients of rescue corticosteroids, 28% (41/144) were ineligible according to the guideline. CONCLUSION: Implementation of an institutional guideline for rescue corticosteroids was associated with a high rate of use among eligible women.

编号：14

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题名：Fetoscopic Open Neural Tube Defect Repair: Development and Refinement of a Two-Port, Carbon Dioxide Insufflation Technique.

作者：Belfort MA;Whitehead WE;Shamshirsaz AA;Bateni ZH;Olutoye OO;Olutoye OA;Mann DG;Espinoza J;Williams E;Lee TC;Keswani SG;Ayres N;Cassady CI;Mehollin-Ray AR;Sanz Cortes M;Carreras E;Peiro JL;Ruano R;Cass DL

出处：Obstet Gynecol.2017V129N4:734-743机构：Departments of Obstetrics and Gynecology, Neurosurgery, Surgery, Anesthesiology,

Pediatrics, and Radiology, Baylor College of Medicine, and Texas Children's Fetal Center, Houston, Texas; and the Departments of Obstetrics and Gynecology and Surgery, Vall D'Hebron Hospital, Barcelona, Spain.语种：eng摘要： OBJECTIVE: To describe development of a two-port fetoscopic technique for spina bifida

repair in the exteriorized, carbon dioxide-filled uterus and report early results of two cohorts of patients: the first 15 treated with an iterative technique and the latter 13 with a standardized technique. METHODS: This was a retrospective cohort study (2014-2016). All patients met Management of Myelomeningocele Study selection criteria. The intraoperative approach was iterative in the first 15 patients and was then standardized. Obstetric, maternal, fetal, and early neonatal outcomes were compared. Standard parametric and nonparametric tests were used as appropriate. RESULTS: Data for 28 patients (22 endoscopic only, four hybrid, two abandoned) are reported, but only those with a complete fetoscopic repair were analyzed (iterative technique [n=10] compared with standardized technique [n=12]). Maternal demographics and gestational age (median [range]) at fetal surgery (25.4 [22.9-25.9] compared with 24.8 [24-25.6] weeks) were similar, but delivery occurred at 35.9 (26-39) weeks of gestation with the iterative technique compared with 39 (35.9-40) weeks of gestation with the standardized technique (P<.01). Duration of surgery (267 [107-434] compared with 246 [206-333] minutes), complication rates, preterm prelabor rupture of membranes rates (4/12 [33%] compared with 1/10 [10%]), and vaginal delivery rates (5/12 [42%] compared with 6/10 [60%]) were not statistically different in the iterative and standardized techniques, respectively. In 6 of 12 (50%) compared with 1 of 10 (10%), respectively (P=.07), there was leakage of cerebrospinal fluid from the repair site at birth. Management of Myelomeningocele Study criteria for hydrocephalus-death at discharge were met in 9 of 12 (75%) and 3 of 10 (30%), respectively, and 7 of 12 (58%) compared with 2 of 10 (20%) have been treated for hydrocephalus to date. These latter differences were not statistically significant. CONCLUSION: Fetoscopic open neural tube defect repair does not appear to increase maternal-fetal complications as compared with repair by hysterotomy, allows for vaginal delivery, and may reduce long-term maternal risks. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, https://clinicaltrials.gov, NCT02230072.

编号：15题名：Intrauterine Hyperoxemia and Risk of Neonatal Morbidity.作者：Raghuraman N;Temming LA;Stout MJ;Macones GA;Cahill AG;Tuuli MG出处：Obstet Gynecol.2017V129N4:676-682

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机构：Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri.语种：eng摘要： OBJECTIVE: To test the hypothesis that intrauterine hyperoxemia is associated with an

increased risk of neonatal morbidity. METHODS: This was a secondary analysis of a prospective study of singleton, nonanomalous deliveries at or beyond 37 weeks of gestation at an institution with a universal umbilical cord gas policy from 2010 to 2014. The primary outcome was a composite of neonatal morbidity including neonatal death, meconium aspiration syndrome, intubation, mechanical ventilation, hypoxic-ischemic encephalopathy, and hypothermic therapy. Intrauterine hyperoxemia was defined as umbilical vein partial pressure of oxygen 90th percentile or greater of the cohort. Adjusted relative risks (RRs) were estimated for neonatal morbidity controlling for confounders. Analysis was performed for the entire cohort and stratified by the presence of acidemia defined as umbilical artery pH less than 7.1. RESULTS: Of 7,789 patients with validated paired cord gases, 106 (1.4%) had the composite neonatal morbidity. There was no difference in composite neonatal morbidity in patients with and without intrauterine hyperoxemia in the entire cohort (1.5% compared with 1.3%, adjusted RR 1.5, 95% confidence interval [CI] 0.9-2.7). The rate of acidemia was not significantly different in the two groups (1.9% compared with 1.8%, adjusted RR 1.5, 95% CI 0.9-2.5). In stratified analysis, there was evidence of effect modification (P for interaction <.001) with a significant association between intrauterine hyperoxemia and neonatal morbidity in the presence of acidemia (41.2% compared with 21.4%, adjusted RR 2.3, 95% CI 1.1-3.5), but not in its absence (0.8% compared with 1.0%, adjusted RR 1.0, 95% CI 0.5-2.2). CONCLUSION: Intrauterine hyperoxemia, compared with normoxemia, is associated with a small but significantly increased risk of neonatal morbidity in acidemic neonates.

编号：16题名：Association of Group Prenatal Care With Gestational Weight Gain.作者：Kominiarek MA;Crockett A;Covington-Kolb S;Simon M;Grobman WA出处：Obstet Gynecol.2017V129N4:663-670机构：Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, and the

Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and the Department of Obstetrics and Gynecology, Greenville Health System University Medical Center, Greenville, South Carolina.语种：eng摘要： OBJECTIVE: To compare gestational weight gain among women in group prenatal care

with that of women in individual prenatal care. METHODS: In this retrospective cohort study, women who participated in group prenatal care from 2009 to 2015 and whose body mass indexes (BMIs) and gestational weight gain were recorded were matched with the next two women who had the same payer type, were within 2-kg/m prepregnancy BMI and 2-week gestational age at delivery, and had received individual prenatal care. Bivariate comparisons of demographics and antenatal complications were performed for women in group and individual prenatal care, and weight gain was categorized as "below," "met," or "exceeded" goals according to the 2009 Institute of Medicine guidelines. Logistic regression analysis estimated

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the association between excessive weight gain and model of care, with adjustment for confounders, stratified by BMI. RESULTS: Women in group prenatal care (n=2,117) were younger and more commonly non-Hispanic black, nulliparous, and without gestational diabetes (P</=.005 for all). Women in group prenatal care more commonly exceeded the weight gain goals (55% compared with 48%, P<.001). The differences in gestational weight gain were concentrated among normal-weight (mean 34.2 compared with 32.1 pounds, P<.001; 47% compared with 41% exceeded, P=.008) and overweight women (mean 31.5 compared with 27.1 pounds, P<.001; 69% compared with 54% exceeded, P<.001). When adjusted for age, race-ethnicity, parity, education, and tobacco use, the increased odds for excessive gestational weight gain persisted among normal-weight (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.09-1.51) and overweight (OR 1.84, 95% CI 1.50-2.27) women. Nulliparity was associated with increased excessive gestational weight gain (OR 1.49, 95% CI 1.33-1.68), whereas Hispanic ethnicity was associated with decreased excessive gestational weight gain (OR 0.68, 95% CI 0.59-0.78). CONCLUSION: Among normal-weight or overweight women, group prenatal care, compared with individual prenatal care, is associated with excessive gestational weight gain.

编号：17题名：Association of Maternal Obesity With Maternal and Neonatal Outcomes in Cases of

Uterine Rupture.作者：Yao R;Goetzinger KR;Crimmins SD;Kopelman JN;Contag SA出处：Obstet Gynecol.2017V129N4:683-688机构：Department of Obstetrics, Gynecology and Reproductive Sciences, University of

Maryland School of Medicine, Baltimore, Maryland.语种：eng摘要： OBJECTIVE: To describe the risk of adverse outcomes associated with uterine rupture in

the setting of maternal obesity. METHODS: This was a retrospective cohort analysis of singleton nonanomalous neonates born after uterine rupture between 34 and 42 weeks of gestation. We derived data from the U.S. Natality Database from 2011 to 2014. Maternal prepregnancy body mass index (BMI) was categorized according to the World Health Organization classification. The rates of neonatal and maternal complications were calculated for each BMI class. Multivariable logistic regression analysis was used to estimate the risks of these complications among obese pregnancies compared with normal-weight pregnancies. RESULTS: There were 3,942 cases of uterine rupture identified among 15,860,954 births (0.02%) between 2011 and 2014. Of these, 2,917 (74%) met inclusion criteria for analysis. There was an increased risk of low 5-minute Apgar score (22.9% compared with 15.9%; adjusted odds ratio [OR] 1.49 [1.19-1.87]), neonatal intensive care unit admission (31% compared with 24.6%; adjusted OR 1.51 [1.23-1.85]), and seizure (3.7% compared with 1.9%; adjusted OR 1.80 [1.05-3.10]) in obese compared with normal-weight pregnancies. The rate of prolonged assisted ventilation was 8.5% compared with 6.2% (P=.13), which, after adjustment for confounders, was a statistically significant difference (adjusted OR 1.47 [1.05-2.07]). The rate of neonatal death was similar (12.4 compared with 6.5/1,000 births; adjusted OR 2.03 [0.81-5.05]). The rates of various maternal complications were similar between groups. CONCLUSION: In the setting of uterine rupture, maternal obesity moderately increases the risks of low Apgar score, neonatal intensive

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care unit admission, prolonged ventilation, and seizure. Risk of maternal complications and the risk of neonatal death, however, are similar to risks in patients of normal BMI.

编号：18题名：Executive Summary of the reVITALize Initiative: Standardizing Gynecologic Data

Definitions.作者：Sharp HT;Johnson JV;Lemieux LA;Currigan SM出处：Obstet Gynecol.2017V129N4:603-607机构：Departments of Obstetrics and Gynecology, University of Utah Health Care, Salt Lake

City, Utah and UMassMemorial Medical Center, Worcester, Massachusetts; and the American College of Obstetricians and Gynecologists, Washington, DC.语种：eng摘要： Effective care coordination across the women's health continuum is critically

important. Unlike obstetric care, which tends to be more episodic and limited to pregnant and postpartum women, women receive health care, whether around pregnancy or for nonobstetric issues, in a variety of care settings by members of multiple health disciplines. Having access to standardized clinical data is imperative to providing optimal patient care. The reVITALize Gynecology Data Definitions Initiative leads a national multidisciplinary movement to offer standard gynecologic data definitions for use in written and verbal clinical communication, electronic health record data capture, quality improvement, and clinical research.

编号：19题名：What Is New in Labor Management?: Best Articles From the Past Year.作者：Dunsmoor-Su R出处：Obstet Gynecol.2017V129N4:745-746机构：Dr. Dunsmoor-Su is from the Obstetrix Medical Group, Seattle, Washington; email:

[email protected].语种：eng摘要： This month, we focus on current research in labor management. Dr. Dunsmoor-Su

discusses five recent publications, and each is concluded with a "bottom line" that is the take-home message. The complete reference for each can be found in on this page, along with direct links to the abstracts.

编号：20题名：Route of Delivery in Women With Stillbirth: Results From the Stillbirth Collaborative

Research Network.作者：Boyle A;Preslar JP;Hogue CJ;Silver RM;Reddy UM;Goldenberg RL;Stoll BJ;Varner

MW;Conway DL;Saade GR;Bukowski R;Dudley DJ出处：Obstet Gynecol.2017V129N4:693-698机构：Department of Obstetrics and Gynecology, University of Virginia School of Medicine,

Charlottesville, Virginia; the Schools of Medicine and Public Health, Emory University, Atlanta, 203

Georgia; the Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; the Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, New York; the Department of Pediatrics and Dean's Office, UTHealth McGovern Medical School, Houston, Texas; the Department of Obstetrics and Gynecology, University of Texas School of Medicine-San Antonio, San Antonio, Texas; the Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas; and the Department of Women's Health, University of Texas at Austin Dell Medical School, Austin, Texas.语种：eng摘要： OBJECTIVE: To describe delivery management of singleton stillbirths in a population-

based, multicenter case series. METHODS: We conducted a retrospective chart review of 611 women with singleton stillbirths at 20 weeks of gestation or greater from March 2006 to September 2008. Medical and delivery information was abstracted from medical records. Both antepartum and intrapartum stillbirths were included; these were analyzed both together and separately. The primary outcome was mode of delivery. Secondary outcomes included induction of labor and indications for cesarean delivery. Indications for cesarean delivery were classified as obstetric (abnormal fetal heart tracing before intrapartum demise, abruption, coagulopathy, uterine rupture, placenta previa, or labor dystocia) or nonobstetric (patient request, repeat cesarean delivery, or not documented). RESULTS: Of the 611 total cases of stillbirth, 93 (15.2%) underwent cesarean delivery, including 43.0% (46/107) of women with prior cesarean delivery and 9.3% (47/504) of women without prior cesarean delivery. No documented obstetric indication was evident for 38.3% (18/47) of primary and 78.3% (36/46) of repeat cesarean deliveries. Labor induction resulted in vaginal delivery for 98.5% (321/326) of women without prior cesarean delivery and 91.1% (41/45) of women with a history of prior cesarean delivery, including two women who had uterine rupture. Among women with a history of prior cesarean delivery who had spontaneous labor, 74.1% (20/27) delivered vaginally, with no cases of uterine rupture. CONCLUSION: Women with stillbirth usually delivered vaginally regardless of whether labor was spontaneous or induced or whether they had a prior cesarean delivery. However, 15% underwent cesarean delivery, often without a documented obstetric indication.

编号：21题名：Diagnostic Tests for Evaluation of Stillbirth: Results From the Stillbirth Collaborative

Research Network.作者：Page JM;Christiansen-Lindquist L;Thorsten V;Parker CB;Reddy UM;Dudley DJ;Saade

GR;Coustan D;Rowland Hogue CJ;Conway D;Bukowski R;Pinar H;Heuser CC;Gibbins KJ;Goldenberg RL;Silver RM

出处：Obstet Gynecol.2017V129N4:699-706机构：University of Utah School of Medicine and Intermountain Health Care, Salt Lake City,

Utah; Rollins School of Public Health, Emory University, Atlanta, Georgia; RTI International, Research Triangle Park, North Carolina; the Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; the University of Texas Health Science Center at San Antonio,

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San Antonio, and the University of Texas Medical Branch at Galveston, Galveston, Texas; Brown University School of Medicine, Providence, Rhode Island; and Columbia University, New York, New York.语种：eng摘要： OBJECTIVE: To estimate the usefulness of each diagnostic test in the work-up for

potential causes of stillbirth. METHODS: A secondary analysis of 512 stillbirths enrolled in the Stillbirth Collaborative Research Network from 2006 to 2008 was performed. The Stillbirth Collaborative Research Network was a multisite, geographically, racially, and ethnically diverse, population-based study of stillbirth in the United States. Participants underwent standardized evaluations that included maternal interview, medical record abstraction, biospecimen collection, fetal autopsy, and placental pathology. Also, most participants had a clinical work-up that included karyotype, toxicology screen, syphilis serology, antibody screen, fetal-maternal hemorrhage testing, and testing for antiphospholipid antibodies as well as testing performed on biospecimens for research purposes. Previously, each participant had been assigned probable and possible causes of death using the Initial Causes of Fetal Death classification system. In this analysis, tests were considered useful if a positive result established (or helped to establish) this cause of death or a negative result excluded a cause of death that was suspected based on the clinical history or other results. RESULTS: The usefulness of each test was as follows: placental pathology 64.6% (95% confidence interval [CI] 57.9-72.0), fetal autopsy 42.4% (95% CI 36.9-48.4), genetic testing 11.9% (95% CI 9.1-15.3), testing for antiphospholipid antibodies 11.1% (95% CI 8.4-14.4), fetal-maternal hemorrhage 6.4% (95% CI 4.4-9.1), glucose screen 1.6% (95% CI 0.7-3.1), parvovirus 0.4% (95% CI 0.0-1.4), and syphilis 0.2% (95% CI 0.0-1.1). The utility of the tests varied by clinical presentation, suggesting a customized approach for each patient. CONCLUSION: The most useful tests were placental pathology and fetal autopsy followed by genetic testing and testing for antiphospholipid antibodies.

编号：22题名：Table of Contents for Online Material in the April 2017 Issue.出处：Obstet Gynecol.2017V129N4:759语种：eng

编号：23题名：Practice Bulletin No. 176 Summary: Pelvic Organ Prolapse.出处：Obstet Gynecol.2017V129N4:763-765语种：eng

编号：24题名：Practice Bulletin No. 177 Summary: Obstetric Analgesia and Anesthesia.出处：Obstet Gynecol.2017V129N4:766-768语种：eng

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编号：25题名：Committee Opinion No. 692 Summary: Emergent Therapy for Acute-Onset, Severe

Hypertension During Pregnancy and the Postpartum Period.出处：Obstet Gynecol.2017V129N4:769-770语种：eng

编号：26题名：Committee Opinion No. 693 Summary: Counseling About Genetic Testing and

Communication of Genetic Test Results.出处：Obstet Gynecol.2017V129N4:771-772语种：eng

编号：27题名：Committee Opinion No. 694 Summary: Management of Mesh and Graft Complications in

Gynecologic Surgery.出处：Obstet Gynecol.2017V129N4:773-774语种：eng

编号：28题名：Committee Opinion No 695 Summary: Sterilization of Women: Ethical Issues and

Considerations.出处：Obstet Gynecol.2017V129N4:775-776语种：eng

编号：29题名：Committee Opinion No. 696: Nonobstetric Surgery During Pregnancy.出处：Obstet Gynecol.2017V129N4:777-778语种：eng

编号：30题名：Committee Opinion No 697 Summary: Planned Home Birth.出处：Obstet Gynecol.2017V129N4:779-780语种：eng

编号：31题名：Practice Bulletin No. 176: Pelvic Organ Prolapse.

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出处：Obstet Gynecol.2017V129N4:e56-e72语种：eng

编号：32题名：Practice Bulletin No. 177: Obstetric Analgesia and Anesthesia.出处：Obstet Gynecol.2017V129N4:e73-e89语种：eng

编号：33题名：Committee Opinion No. 692: Emergent Therapy for Acute-Onset, Severe Hypertension

During Pregnancy and the Postpartum Period.出处：Obstet Gynecol.2017V129N4:e90-e95语种：eng

编号：34题名：Committee Opinion No. 693: Counseling About Genetic Testing and Communication of

Genetic Test Results.出处：Obstet Gynecol.2017V129N4:e96-e101语种：eng

编号：35题名：Committee Opinion No. 694: Management of Mesh and Graft Complications in

Gynecologic Surgery.出处：Obstet Gynecol.2017V129N4:e102-e108语种：eng

编号：36题名：Committee Opinion No. 695: Sterilization of Women: Ethical Issues and Considerations.出处：Obstet Gynecol.2017V129N4:e109-e116语种：eng

编号：37题名：Committee Opinion No. 697: Planned Home Birth.出处：Obstet Gynecol.2017V129N4:e117-e122语种：eng

编号：38207

题名：Green Journal Update: reVITALize Definitions and Introducing a More Responsive Website.

作者：Fischer JR;Chescheir NC出处：Obstet Gynecol.2017V129N4:601-602机构：Dr. Fischer is the Consultant Editor for the Web, and Dr. Chescheir is the Editor-in-Chief

of Obstetrics & Gynecology; email: [email protected] and [email protected]. (Photo of Nancy Chescheir is courtesy of the Central Association of Obstetricians and Gynecologists, 2016.).语种：eng摘要：

编号：39题名：Connect the Dots-April 2017.作者：Villavicencio J;Gillespie K;Bortoletto P;Chescheir NC出处：Obstet Gynecol.2017V129N4:747-748语种：eng

编号：40题名：Reverse Vesicouterine Fold Dissection for Laparoscopic Hysterectomy After Prior

Cesarean Deliveries.作者：Sheth SS出处：Obstet Gynecol.2017V129N4:749-750机构：Breach Candy Hospital, Saifee Hospital, Mumbai, India.语种：eng摘要：

编号：41题名：In Reply.作者：Grace L出处：Obstet Gynecol.2017V129N4:750机构：Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, California.语种：eng摘要：

编号：42题名：Skin Preparation for Prevention of Surgical Site Infection After Cesarean Delivery: A

Randomized Controlled Trial.作者：Maiwald M出处：Obstet Gynecol.2017V129N4:750-751

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机构：Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital and Department of Microbiology, National University of Singapore and Duke-National University of Singapore Graduate Medical School, Singapore.语种：eng摘要：

编号：43题名：In Reply.作者：Garry DJ;Ngai I;Bernstein PS;Judge NE出处：Obstet Gynecol.2017V129N4:751机构：Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical

Center/Albert Einstein College of Medicine, Bronx, New York.语种：eng摘要：

编号：44题名：Risk Factors and Outcomes for Conversion to Laparotomy of Laparoscopic

Hysterectomy in Benign Gynecology.作者：Howard DL出处：Obstet Gynecol.2017V129N4:751-752机构：WellHealth Quality Care, Las Vegas, Nevada.语种：eng摘要：

编号：45题名：In Reply.作者：Lim CS;Kamdar N;Morgan DM;As-Sanie S出处：Obstet Gynecol.2017V129N4:752机构：Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.语种：eng摘要：

编号：46题名：Hysteroscopic Sterilization With Essure: Summary of the U.S. Food and Drug

Administration Actions and Policy Implications for Postmarketing Surveillance.作者：Steward R出处：Obstet Gynecol.2017V129N4:752-753机构：FPA Women's Health, Long Beach, California.语种：eng摘要：

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编号：47题名：In Reply.作者：Walter JR;Ghobadi CW;Hayman E;Xu S出处：Obstet Gynecol.2017V129N4:753机构：Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois

Department of Radiology, University of Chicago Medical Center, Chicago, Illinois Department of Radiology, Northwestern University, Chicago, Illinois Department of Dermatology, Northwestern University, Chicago, Illinois.语种：eng摘要：

编号：48题名：Oregon's Hard-Stop Policy Limiting Elective Early-Term Deliveries: Limitations of Before-

and-After Studies in Evaluating Obstetric Policies.作者：Hutcheon JA;Harper S;Strumpf EC出处：Obstet Gynecol.2017V129N4:753-754机构：Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver,

British Columbia, Canada Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada Departments of Epidemiology, Biostatistics, and Occupational Health and Economics, McGill University, Montreal, Quebec, Canada.语种：eng摘要：

编号：49题名：In Reply.作者：Snowden JM;Darney BG;Caughey AB出处：Obstet Gynecol.2017V129N4:754机构：Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland,

Oregon.语种：eng摘要： Am J Obstet Gynecol

编号：1题名：Exercise in pregnancy!作者：Berghella V;Saccone G出处：Am J Obstet Gynecol.2017V216N4:335-337机构：Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney

Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA. Electronic address: 210

[email protected].;Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.摘要：

编号：2题名：An ounce of prevention....作者：Coustan DR出处：Am J Obstet Gynecol.2017V216N4:338-339机构：Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown

University, and Women & Infants Hospital of Rhode Island, Providence, RI. Electronic address: [email protected].摘要：

编号：3题名：Minimal important change in the pelvic floor distress inventory-20 among women

opting for conservative prolapse treatment.作者：Wiegersma M;Panman CM;Berger MY;De Vet HC;Kollen BJ;Dekker JH出处：Am J Obstet Gynecol.2017V216N4:397.e1-397.e7机构：University of Groningen, University Medical Center Groningen, Department of General

Practice, Groningen, The Netherlands.;University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, The Netherlands.;University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, The Netherlands.;Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.;University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, The Netherlands.;University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, The Netherlands. Electronic address: [email protected].摘要： BACKGROUND: The Pelvic Floor Distress Inventory-20 is used to evaluate symptoms

and treatment effects in women with pelvic floor disorders. To interpret changes in the scores of this inventory, information is needed about what patients and clinicians perceive as the minimal important (meaningful) change. Although this change in the inventory score has been investigated previously in women who have undergone pelvic floor surgery, the results could not be generalized to women with milder symptoms (ie, lower scores) who often require only conservative treatment. OBJECTIVE: We aimed to estimate the minimal important change in the Pelvic Floor Distress Inventory-20 that was needed to demonstrate clinical improvement in women who qualify for conservative pelvic floor treatment. STUDY DESIGN: The data of 214 women aged >/=55 years were used. All participants were from 2 randomized controlled trials that compared conservative prolapse treatments in primary care in The Netherlands. The degree of prolapse was assessed with the use of the Pelvic Organ Prolapse Quantification system; participants completed the Pelvic Floor Distress Inventory-20 at baseline and at 12 months, with a global perception of improvement question at 12 months. To assess both the patient perspective and the clinical perspective, 2 anchors were assessed: (1) the global

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perception of improvement was considered the anchor for the patients' perspective, and (2) the difference in the degree of prolapse was considered the anchor for the clinical perspective. Provided that the anchors were correlated by at least 0.3 to the Pelvic Floor Distress Inventory-20 change scores, we estimated the following minimal important changes: (1) the optimal cutoff-point of the receiver operating characteristics curve that discriminates between women with and without improvement in the global perception of improvement scale and (2) the mean Pelvic Floor Distress Inventory-20 change score of participants who improved 1 assessment stage. We then calculated the smallest detectable change to check whether the minimal important change was larger than the measurement error of the questionnaire. RESULTS: Using the global perception of improvement as the anchor, we found a minimal important change for improvement of 13.5 points (95% confidence interval, 6.2-20.9). The Pelvic Organ Prolapse Quantification change scores correlated poorly to the Pelvic Floor Distress Inventory-20 change scores and therefore could not be used as an anchor. The smallest detectable change at the group level was 5.5 points. Thus, the minimal important change was larger than the smallest detectable change at the group level. CONCLUSION: In women with relatively mild pelvic floor symptoms, an improvement of 13.5 points (or a 23% reduction) in the Pelvic Floor Distress Inventory-20 score can be considered clinically relevant. This minimal important change can be used for clinical trial planning and evaluation of treatment effects in women whose condition is considered suitable for conservative treatment. KEYWORDS:NOTNLM;

编号：4题名：Catechol-O-methyltransferase gene polymorphism and vulvar pain in women with

vulvodynia.作者：Patanwala IY;Lamvu G;Ledger WJ;Witzeman K;Marvel R;Rapkin A;Bongiovanni

AM;Feranec J;Witkin SS出处：Am J Obstet Gynecol.2017V216N4:395.e1-395.e6机构：Department of Obstetrics and Gynecology, Florida Hospital, Orlando, FL. Electronic

address: [email protected].;Division of Surgery, Gynecology Section, Veteran Affairs Medical Center, Orlando, FL.;Division of Immunology and Infectious Diseases, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY.;Women's Integrated Pelvic Health Program, Denver Health, Denver, CO.;The Center for Pelvic Pain at Annapolis, Annapolis, MD.;Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California-Los Angeles, CA.;Division of Immunology and Infectious Diseases, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY.;Division of Surgery, Gynecology Section, Veteran Affairs Medical Center, Orlando, FL.;Division of Immunology and Infectious Diseases, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY.摘要： BACKGROUND: The underlying causes of vulvar pain in women with vulvodynia remain

poorly understood. Catechol-O-methyltransferase, an enzyme that metabolizes catecholamines, is a neuromodulator that is involved with perception and sensitivity to pain. The catechol-O-methyltransferase gene is polymorphic, and a single nucleotide polymorphism is associated with low activity and heightened pain sensitivity. The variant allele that encodes this polymorphism commonly is called the "L allele" because of its low enzyme activity as

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opposed to the normal H (high activity) allele. OBJECTIVE: The methionine-containing catechol-O-methyltransferase protein coded by the L allele results in elevated catecholamine levels, reduced inactivation of the dopaminergic and adrenergic systems, and increased sensitivity to pain. This polymorphism not only may decrease the pain threshold in response to acute pain but also may facilitate the development of chronic pain. Therefore, the objective of our study was to assess whether a variation in the catechol-O-methyltransferase genotype is involved in increased pain sensitivity in women with vulvodynia. STUDY DESIGN: We conducted a prospective cohort study. METHODS: Buccal swabs were collected from 167 white women with vulvodynia and 107 control subjects; the DNA was tested for a single nucleotide polymorphism at position 158 (rs4680) in the catechol-O-methyltransferase gene. RESULTS: Women with vulvodynia had a marginally increased, yet not significant, prevalence of the catechol-O-methyltransferase genotype that is associated with high activity of the coded protein: 32.9% in the women with vulvodynia, as opposed to 21.5% in the control subjects (odds ratio, 1.80; 95% confidence interval, 1.02-3.15). Subgrouping the cases based on pain frequency revealed that the elevated occurrence of this catechol-O-methyltransferase genotype was present in 40.6% of the subset of women who experienced pain only with sexual intercourse vs only 21.5% of control subjects (odds ratio, 2.50; 95% confidence interval, 1.27-4.93). Also, women with primary vulvodynia had a significantly higher prevalence of the H allele than did the control subjects (62.9% vs 48.1%; odds ratio, 1.82; 95% confidence interval, 1.05-3.17). CONCLUSION: Increased pain sensitivity in women with vulvodynia is not due to a genetically determined low catechol-O-methyltransferase enzyme activity. Other mechanisms may account for alterations in catechol-O-methyltransferase activity in women with pain that is limited to intercourse or primary vulvodynia that contributes to pain sensitivity. KEYWORDS:NOTNLM;

编号：5题名：Urinary incontinence after hysterectomy.作者：Baron MG;Quicray M;Cornu JN出处：Am J Obstet Gynecol.2017V216N4:425-426机构：Department of Urology, Rouen University Hospital, Rouen, France.;Department of

Urology, Rouen University Hospital, Rouen, France.;Department of Urology, Rouen University Hospital, Rouen, France. Electronic address: [email protected].摘要：

编号：6题名：Reply.作者：Bohlin KS;Ankardal M;Milsom I出处：Am J Obstet Gynecol.2017V216N4:426机构：Department of Obstetrics and Gynecology, Sahlgrenska University Hospital,

Gothenburg, Sweden. Electronic address: [email protected].;Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.;Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.摘要：

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编号：7题名：The Edinburgh Postnatal Depression Scale in routine screening: errors and cautionary

advice.作者：Matthey S;Della Vedova AM;Agostini F出处：Am J Obstet Gynecol.2017V216N4:424机构：Liverpool Hospital, Sydney, Australia. Electronic address:

[email protected].;Clinical and Experimental Sciences Department, Universita degli Studi di Brescia, Brescia, Italy.;Department of Psychology, Universita di Bologna, Bologna, Italy.摘要：

编号：8题名：Reply.作者：Venkatesh KK;Kaimal AJ出处：Am J Obstet Gynecol.2017V216N4:424-425机构：Brigham and Women's Hospital, Department of Obstetrics and Gynecology,

Massachusetts General Hospital, Boston, MA. Electronic address: [email protected].;Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA.摘要：

编号：9题名：Comment on treatment for recurrent vulvovaginal candidiasis.作者：Grinceviciene S;Donders GG出处：Am J Obstet Gynecol.2017V216N4:426-427机构：Department of Biothermodynamics and Drug Design, Vilnius University Institute of

Biotechnology, Vilnius, Lithuania; Femicare Clinical Research for Women, Tienen, Belgium. Electronic address: [email protected].;Femicare Clinical Research for Women, Tienen, Belgium; Department of OB/Gyn, Antwerp University, Antwerp, Belgium.摘要：

编号：10题名：Reply.作者：Sobel JD出处：Am J Obstet Gynecol.2017V216N4:427机构：Wayne State University School of Medicine, Detroit, MI. Electronic address:

[email protected].摘要：

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编号：11题名：Giant vulvar verruciform xanthoma can mimic a common vulvar mass, genital warts.作者：Lee SR;Jeon JH;Jeong K;Chung HW出处：Am J Obstet Gynecol.2017V216N4:422.e1-422.e2机构：Department of Obstetrics and Gynecology, Ewha Womans University, School of

Medicine, Seoul, South Korea. Electronic address: [email protected].;Department of Obstetrics and Gynecology, Ewha Womans University, School of Medicine, Seoul, South Korea.;Department of Obstetrics and Gynecology, Ewha Womans University, School of Medicine, Seoul, South Korea.;Department of Obstetrics and Gynecology, Ewha Womans University, School of Medicine, Seoul, South Korea.摘要：

编号：12题名：Opioid dependence and pregnancy: minimizing stress on the fetal brain.作者：Ruan X;Luo JJ;Kaye AD出处：Am J Obstet Gynecol.2017V216N4:430机构：Department of Anesthesiology, Louisiana State University Health Science Center, New

Orleans, LA. Electronic address: [email protected].;Temple University School of Medicine, Philadelphia, PA.;Department of Anesthesiology, Louisiana State University Health Science Center, New Orleans, LA.摘要：

编号：13题名：Preeclampsia and the risk of cataract extraction in life.作者：Auger N;Rheaume MA;Paradis G;Healy-Profitos J;Hsieh A;Fraser WD出处：Am J Obstet Gynecol.2017V216N4:417.e1-417.e8机构：Hospital Research Center, University of Montreal, Montreal, Quebec, Canada; Institut

national de sante publique du Quebec, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada. Electronic address: [email protected].;Hospital Research Center, University of Montreal, Montreal, Quebec, Canada; Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada.;Institut national de sante publique du Quebec, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.;Hospital Research Center, University of Montreal, Montreal, Quebec, Canada; Institut national de sante publique du Quebec, Montreal, Quebec, Canada.;Faculty of Medicine, McGill University, Montreal, Quebec, Canada.;Department of Obstetrics and Gynecology, Sherbrooke University Hospital Research Center, Sherbrooke, Quebec, Canada.摘要： BACKGROUND: Pregnancy-related risk factors for cataract are understudied, including

the possibility that preeclampsia increases the risk of cataract later in life. OBJECTIVE: We sought to evaluate the long-term risk of cataract extraction following a preeclamptic pregnancy. STUDY DESIGN: We carried out a historic cohort study of 1,108,541 women who

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delivered at least 1 infant in any hospital in the province of Quebec, Canada, from 1989 through 2013, including 64,350 with preeclampsia and 5732 with cataract extractions. We categorized preeclampsia by onset time and severity, and followed up women for up to 25 years after delivery. We calculated the incidence of inpatient cataract extraction for women with and without preeclampsia, and used Cox proportional hazard models to estimate hazard ratios and 95% confidence intervals for later risk of cataract extraction, adjusting for age at first delivery, total parity, metabolic disease, asthma, socioeconomic deprivation, and time period. RESULTS: Women with preeclampsia had a higher incidence of cataract extraction compared with no preeclampsia (21.0 vs 15.9/1000) and 1.20 times the risk (95% confidence interval, 1.08-1.34). Women with early-onset preeclampsia had 1.51 times the risk of cataract extraction compared with no preeclampsia (95% confidence interval, 1.14-2.00), whereas women with late-onset preeclampsia had 1.16 times the risk (95% confidence interval, 1.04-1.30). Risk was elevated by about 20% for both severe and mild preeclampsia. Preeclampsia with diabetes was associated with significantly greater risk (hazard ratio, 4.32; 95% confidence interval, 3.60-5.19). CONCLUSION: Women with preeclampsia, particularly preeclampsia of early onset or with diabetes, may have greater risk of cataract later in life. The underlying pathways linking preeclampsia with cataract require further investigation. KEYWORDS:NOTNLM;

编号：14题名：A longitudinal study of sleep duration in pregnancy and subsequent risk of gestational

diabetes: findings from a prospective, multiracial cohort.作者：Rawal S;Hinkle SN;Zhu Y;Albert PS;Zhang C出处：Am J Obstet Gynecol.2017V216N4:399.e1-399.e8机构：Epidemiology Branch, Division of Intramural Population Health Research, Eunice

Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.;Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.;Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.;Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.;Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD. Electronic address: [email protected].摘要： BACKGROUND: Both short and prolonged sleep duration have been linked to impaired

glucose metabolism. Sleep patterns change during pregnancy, but prospective data are limited on their relation to gestational diabetes. OBJECTIVE: We sought to prospectively examine the trimester-specific (first and second trimester) association between typical sleep duration in pregnancy and subsequent risk of gestational diabetes, as well as the influence of compensatory daytime napping on this association. STUDY DESIGN: In the prospective, multiracial Eunice Kennedy Shriver National Institute of Child Health and Human Development

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Fetal Growth Studies-Singleton Cohort, 2581 pregnant women reported their typical sleep duration and napping frequency in the first and second trimesters. Diagnosis of gestational diabetes (n = 107; 4.1%) was based on medical records review. Adjusted relative risks with 95% confidence intervals for gestational diabetes were estimated with Poisson regression, adjusting for demographics, prepregnancy body mass index, and other risk factors. RESULTS: From the first and second trimester, sleep duration and napping frequency declined. Sleeping duration in the second but not first trimester was significantly related to risk of gestational diabetes. The association between second-trimester sleep and gestational diabetes differed by prepregnancy obesity status (P for interaction = .04). Among nonobese but not obese women, both sleeping >8-9 hours or <8-9 hours were significantly related to risk of gestational diabetes: 5-6 hours (adjusted relative risk, 2.52; 95% confidence interval, 1.27-4.99); 7 hours (adjusted relative risk, 2.01; 95% confidence interval, 1.09-3.68); or >/=10 hours (adjusted relative risk, 2.17; 95% confidence interval, 1.01-4.67). Significant effect modification by napping frequency was also observed in the second trimester (P for interaction = .03). Significant and positive association between reduced sleep (5-7 hours) and gestational diabetes was observed among women napping rarely/never (adjusted relative risk, 2.48; 95% confidence interval, 1.20-5.13), whereas no comparable associations were observed among women napping most/sometimes. CONCLUSION: Our data suggest a U-shaped association between sleep duration and gestational diabetes, and that napping and prepregnancy obesity status may modify this association. KEYWORDS:NOTNLM;

编号：15题名：Anatomic relationships of the pelvic autonomic nervous system in female cadavers:

clinical applications to pelvic surgery.作者：Ripperda CM;Jackson LA;Phelan JN;Carrick KS;Corton MM出处：Am J Obstet Gynecol.2017V216N4:388.e1-388.e7机构：Department of Obstetrics and Gynecology, University of Texas Southwestern Medical

Center, Dallas, TX. Electronic address: [email protected].;Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.;Department of Cell Biology, University of Texas Southwestern Medical Center, Dallas, TX.;Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX.;Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.摘要： BACKGROUND: The integrity of the pelvic autonomic nervous system is essential for

proper bowel, bladder, and sexual function. OBJECTIVE: The purpose of this study was to characterize the anatomic path of the pelvic autonomic system and to examine relationships to clinically useful landmarks. STUDY DESIGN: Detailed dissections were performed in 17 female cadavers. Relationships of the superior hypogastric plexus to aortic bifurcation and midpoint of sacral promontory were examined; the length and width of plexus was documented. Path and width of right and left hypogastric nerves were recorded. The origin and course of the pelvic splanchnic nerves were documented. Individual nerve tissue that contributed to the inferior hypogastric plexus was noted. Relative position of nerves to arteries, viscera, and ligaments was documented. In a subset of specimens, biopsy specimens were obtained to confirm gross

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findings by histologic analysis. Descriptive statistics were used for data analyses and reporting. RESULTS: In all specimens, the superior hypogastric plexus was embedded in a connective tissue sheet within the presacral space, just below the peritoneum. In 14 of 17 specimens (82.4%), the plexus formed a median distance of 21.3 mm (range, 9-40 mm) below aortic bifurcation; in the remaining specimens, it formed a median distance of 25.3 mm (range, 20.5-30 mm) above bifurcation. In 58.8% of specimens, the superior hypogastric plexus was positioned to the left of midline. The median length and width of the plexus was 39.5 (range, 11.5-68) mm and 9 (range, 2.5-15) mm, respectively. A right and left hypogastric nerve was identified in all specimens and formed a median distance of 23 mm (range, 5-32 mm) below the promontory. The median width of the hypogastric nerve was 3.5 mm (range, 3-4.5 mm) on the right and 3.5 mm (range, 2-6.5 mm) on the left. The median distance from midportion of uterosacral ligament to the closest nerve branch was 0.5 mm (range, 0-4.5 mm) on right and 0 mm (range, 0-27.5 mm) on left. In all specimens, the inferior hypogastric plexus was formed by contributions from the hypogastric nerves and branches from S3 and S4. In 47.1% of hemipelvises, S2 branches contributed to the plexus. The sacral sympathetic trunk contributed to the plexus in 16 of 34 hemipelvises where this structure was identified. The inferior hypogastric plexus formed 1-3 cm lateral to the rectum and upper third of the vagina. From this plexus, 1-3 discrete branches coursed deep to the ureter toward the bladder. A uterine branch that coursed superficial to the ureter followed the ascending branch of the uterine artery. An S4 branch was found directly attaching to lateral walls of the rectum in 53% of specimens. Pelvic splanchnic nerves merged into the inferior hypogastric plexus on the lower and medial surface of the coccygeus muscle. Histologic analysis confirmed neural tissue in all tissues that were sampled. CONCLUSION: Anatomic variability and inability to visualize the small caliber fibers that comprise the inferior hypogastric plexus grossly likely underlines the reasons that some postoperative visceral and sexual dysfunction occur in spite of careful dissection and adequate surgical technique. These findings highlight the importance of a discussion with patients about the risks that are associated with interrupting autonomic fibers during the preoperative consent. KEYWORDS:NOTNLM;

编号：16题名：Pregnancy in advanced age and the risk of stroke in postmenopausal women: analysis

of Women's Health Initiative Study.作者：Qureshi AI;Saeed O;Malik AA;Suri MF出处：Am J Obstet Gynecol.2017V216N4:409.e1-409.e6机构：Zeenat Qureshi Stroke Institute, St. Cloud, MN. Electronic address:

[email protected].;Zeenat Qureshi Stroke Institute, St. Cloud, MN.;Zeenat Qureshi Stroke Institute, St. Cloud, MN.;Zeenat Qureshi Stroke Institute, St. Cloud, MN.摘要： BACKGROUND: The incidence of pregnancy in advanced age among women is

increasing because of the availability of assisted reproduction, although the long-term health consequences are not known. OBJECTIVE: The purpose of this study was to determine the effect of pregnancy in advanced age on the occurrence of cardiovascular events in a large cohort of postmenopausal women. STUDY DESIGN: We analyzed the data for 72,221 women aged 50-79 years who were enrolled in the observational arm of the Women's Health Initiative

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study. We determined the effect of pregnancy in advanced age (last pregnancy at age >/=40 year) on the risk of ischemic stroke, hemorrhagic stroke, myocardial infarction, and cardiovascular death over a mean period (+/-standard deviation) of 12+/-1 years using Cox Proportional Hazards analysis after adjusting for potential confounders. RESULTS: A total of 3306 of the 72,221 participants (4.6%) reported pregnancy in advanced age. Compared with pregnancy in normal age, the rates of ischemic stroke (3.8% vs 2.4%), hemorrhagic stroke (1.0% vs 0.5%), and cardiovascular death (3.9% vs 2.3%) were significantly higher among women with pregnancy in advanced age. In multivariate analysis, women with pregnancy in advanced age were 50% more likely to experience a hemorrhagic stroke (hazard ratio, 1.5; 95% confidence interval, 1.0-2.1) after adjustment for age, race/ethnicity, congestive heart failure, systolic blood pressure, atrial fibrillation, alcohol use, and cigarette smoking. There was no significant difference in the risk of ischemic stroke, myocardial infarction, and cardiovascular death among women with pregnancy in advanced age after adjustment for potential confounders. CONCLUSION: Women with pregnancy at an advanced age have a higher risk for hemorrhagic stroke in the postmenopausal period. KEYWORDS:NOTNLM;

编号：17题名：Syphilis during pregnancy: a preventable threat to maternal-fetal health.作者：Rac MW;Revell PA;Eppes CS出处：Am J Obstet Gynecol.2017V216N4:352-363机构：Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.

Electronic address: [email protected].;Department of Pathology and Pediatrics, Baylor College of Medicine, Houston, TX.;Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.摘要： Syphilis remains the most common congenital infection worldwide and has tremendous

consequences for the mother and her developing fetus if left untreated. Recently, there has been an increase in the number of congenital syphilis cases in the United States. Thus, recognition and appropriate treatment of reproductive-age women must be a priority. Testing should be performed at initiation of prenatal care and twice during the third trimester in high-risk patients. There are 2 diagnostic algorithms available and physicians should be aware of which algorithm is utilized by their testing laboratory. Women testing positive for syphilis should undergo a history and physical exam as well as testing for other sexually transmitted infections, including HIV. Serofast syphilis can occur in patients with previous adequate treatment but persistent low nontreponemal titers (<1:8). Syphilis can infect the fetus in all stages of the disease regardless of trimester and can sometimes be detected with ultrasound >20 weeks. The most common findings include hepatomegaly and placentomegaly, but also elevated peak systolic velocity in the middle cerebral artery (indicative of fetal anemia), ascites, and hydrops fetalis. Pregnancies with ultrasound abnormalities are at higher risk of compromise during syphilotherapy as well as fetal treatment failure. Thus, we recommend a pretreatment ultrasound in viable pregnancies when feasible. The only recommended treatment during pregnancy is benzathine penicillin G and it should be administered according to maternal stage of infection per Centers for Disease Control and Prevention guidelines. Women with a penicillin allergy should be desensitized and then treated with penicillin

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appropriate for their stage of syphilis. The Jarisch-Herxheimer reaction occurs in up to 44% of gravidas and can cause contractions, fetal heart rate abnormalities, and even stillbirth in the most severely affected pregnancies. We recommend all viable pregnancies receive the first dose of benzathine penicillin G in a labor and delivery department under continuous fetal monitoring for at least 24 hours. Thereafter, the remaining benzathine penicillin G doses can be given in an outpatient setting. The rate of maternal titer decline is not tied to pregnancy outcomes. Therefore, after adequate syphilotherapy, maternal titers should be checked monthly to ensure they are not increasing four-fold, as this may indicate reinfection or treatment failure. KEYWORDS:NOTNLM;

编号：18题名：Randomized clinical trial between hourly titrated and 2 hourly static oral misoprostol

solution for induction of labor.作者：Rouzi AA;Alsahly N;Alamoudi R;Almansouri N;Alsinani N;Alkafy S;Rozzah R;Abduljabbar

H出处：Am J Obstet Gynecol.2017V216N4:405.e1-405.e6机构：Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi

Arabia. Electronic address: [email protected].;Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia.;Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia.;Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia.;Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia.;Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia.;Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia.;Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia.摘要： BACKGROUND: Misoprostol is an effective agent for the induction of labor. Existing

guidelines recommend oral misoprostol solution 25 mug every 2 hours. However, more research is required to optimize the use of oral misoprostol solution for the induction of labor. OBJECTIVE: The purpose of this study was to compare efficacy and safety of hourly titrated-dose oral misoprostol solution with static-dose oral misoprostol solution every 2 hours for labor induction. STUDY DESIGN: In this randomized controlled study, oral misoprostol solution was administered as (1) 20 mug hourly (</=4 doses) that was increased in the absence of regular uterine contractions to 40 mug hourly (</=4 doses) and then to 60 mug hourly (</=16 doses) or (2) 25 mug every 2 hours until active labor began (</=12 doses). A sample size of 146 women was planned with the use of a projected 95% rate for the primary endpoint (vaginal delivery within 24 hours) for hourly titrated-dose misoprostol and 80% rate for static-dose misoprostol every 2 hours. Safety outcomes included maternal morbidity and adverse neonatal outcomes. RESULTS: From December 2013 to July 2015, 146 women were assigned randomly to treatment. Demographic and clinical factors were similar between groups, except for age. Vaginal delivery was achieved within 24 hours in 47 women (64.4%) who received hourly titrated-doses of misoprostol solution and 48 women (65.8%) who received 2-hourly static-dose misoprostol solution (P=1.00). Rates of vaginal delivery within 24 hours did not differ significantly between treatment groups for women who were nulliparous (P=1.00) or who had

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postterm pregnancies (P=.66), a Bishop score of </=3 (P=.84), or oxytocin augmentation (P=.83). Cesarean deliveries were performed within 24 hours in 9 women who received hourly titrated-dose misoprostol solution and 2 women who received 2-hourly static-dose misoprostol solution (P=.056). Pyrexia and meconium-stained liquor occurred more frequently with the hourly titrated-dose regimen. CONCLUSION: The static-dose oral misoprostol solution every 2 hours has similar efficacy as hourly titrated-dose misoprostol solution but with fewer side-effects and lower complication rates. KEYWORDS:NOTNLM;

编号：19题名：Validity of self-reported history of Chlamydia trachomatis infection.作者：Frisse AC;Marrazzo JM;Tutlam NT;Schreiber CA;Teal SB;Turok DK;Peipert JF出处：Am J Obstet Gynecol.2017V216N4:393.e1-393.e7机构：Division of Clinical Research, Department of Obstetrics and Gynecology, Washington

University, St Louis School of Medicine, St Louis, MO.;Division of Infectious Diseases, Department of Internal Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL.;Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University, St Louis School of Medicine, St Louis, MO.;Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.;Department of Obstetrics and Gynecology, University of Colorado, Aurora, CO.;Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT.;Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University, St Louis School of Medicine, St Louis, MO. Electronic address: [email protected].摘要： BACKGROUND: Chlamydia trachomatis infection is common and largely asymptomatic

in women. If untreated, it can lead to sequelae such as pelvic inflammatory disease and infertility. It is unknown whether a patient's self-reported history of Chlamydia trachomatis infection is a valid marker of past infection. OBJECTIVE: Our objective was to evaluate the validity of women's self-reported history of Chlamydia trachomatis infection compared with Chlamydia trachomatis serology, a marker for previous infection. STUDY DESIGN: We analyzed data from the Fertility After Contraception Termination study. We compared participants' survey responses with the question, "Have you ever been told by a health care provider that you had Chlamydia?" to serological test results indicating the presence or absence of antibodies to Chlamydia trachomatis as assessed by a microimmunofluorescence assay. Prevalence of past infection, sensitivity, specificity, predictive values, and likelihood ratios were calculated. The Cohen's kappa statistic was computed to assess agreement between self-report and serology. RESULTS: Among 409 participants, 108 (26%) reported having a history of Chlamydia trachomatis infection, whereas 146 (36%) had positive serological test results. Relative to positive microimmunofluorescence assay, the sensitivity and specificity of self-reported history of Chlamydia trachomatis infection were 52.1% (95% confidence interval, 43.6-60.4%) and 87.8% (95% confidence interval, 83.3-91.5%), respectively. The positive predictive value of the self-report was 70.4% (95% confidence interval, 60.8-78.8%), and the negative predictive value was 76.7% (95% confidence interval, 71.6-81.4%). The likelihood ratio was found to be 4.28. Agreement between self-report and serology was found to be moderate (kappa = 0.42, P < .001). CONCLUSION: Self-reported history of Chlamydia trachomatis infection commonly

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yields false-negative and false-positive results. When definitive status of past Chlamydia trachomatis infection is needed, serology should be obtained. KEYWORDS:NOTNLM;

编号：20题名：Risk perception regarding drug use in pregnancy.作者：Widnes SF;Schjott J出处：Am J Obstet Gynecol.2017V216N4:375-378机构：Regional Medicines and Pharmacovigilance Centre (RELIS Vest), Haukeland University

Hospital, Bergen, Norway. Electronic address: [email protected].;Regional Medicines and Pharmacovigilance Centre (RELIS Vest), Haukeland University Hospital, Bergen, Norway; Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway; Section of Pharmacology, Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.摘要： Pregnant women, but also physicians, have unrealistically high perceptions of

teratogenic drug effects. This may result in suboptimal treatment of disease and even influence decisions of whether to continue pregnancy. To attain more realistic teratogenic risk perceptions, several factors that influence this issue should be considered, and these are further discussed in this Clinical Opinion. Importantly, drug use may have several benefits, both for the pregnant woman's health and to avoid negative fetal effects of untreated maternal disease. A greater focus on this aspect may act to balance risk perceptions. Furthermore, both pregnant women and physicians need access to drug information sources that provide realistic risk estimates to increase confidence in appropriate drug use and prescribing. We suggest that access to decision support and individually tailored information provided by drug information centers may contribute to this goal. KEYWORDS:NOTNLM;

编号：21题名：Reply.作者：Cain MA;Salemi JL出处：Am J Obstet Gynecol.2017V216N4:429机构：Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College

of Medicine, University of South Florida, Tampa, FL. Electronic address: [email protected].;Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX.摘要：

编号：22题名：Progressive uterorenal denervation may contribute to both placental and

cardiovascular syndromes?作者：Quinn MJ出处：Am J Obstet Gynecol.2017V216N4:428-429

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机构：Department of Obstetrics and Gynecology, Medical University of Wenzhou, First Affiliated Hospital, Wenzhou, China. Electronic address: [email protected].摘要：

编号：23题名：Effects of high-intensity training on cardiovascular risk factors in premenopausal and

postmenopausal women.作者：Mandrup CM;Egelund J;Nyberg M;Lundberg Slingsby MH;Andersen CB;Logstrup

S;Bangsbo J;Suetta C;Stallknecht B;Hellsten Y出处：Am J Obstet Gynecol.2017V216N4:384.e1-384.e11机构：Department of Biomedical Sciences, University of Copenhagen, Denmark. Electronic

address: [email protected].;Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.;Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.;Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.;Department of Biomedical Sciences, University of Copenhagen, Denmark.;Department of Biomedical Sciences, University of Copenhagen, Denmark.;Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.;Department of Clinical Physiology, Nuclear Medicine, and Positron Emission Tomography, Rigshospitalet, Glostrup, Denmark.;Department of Biomedical Sciences, University of Copenhagen, Denmark.;Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.摘要： BACKGROUND: Menopause is associated with increased risk of cardiovascular disease

and the causal factors have been proposed to be the loss of estrogen and the subsequent alterations of the hormonal milieu. However, which factors contribute to the deterioration of cardiometabolic health in postmenopausal women is debated as the menopausal transition is also associated with increased age and fat mass. Furthermore, indications of reduced cardiometabolic adaptations to exercise in postmenopausal women add to the adverse health profile. OBJECTIVE: We sought to evaluate risk factors for type 2 diabetes and cardiovascular disease in late premenopausal and early postmenopausal women, matched by age and body composition, and investigate the effect of high-intensity training. STUDY DESIGN: A 3-month high-intensity aerobic training intervention, involving healthy, nonobese, late premenopausal (n = 40) and early postmenopausal (n = 39) women was conducted and anthropometrics, body composition, blood pressure, lipid profile, glucose tolerance, and maximal oxygen consumption were determined at baseline and after the intervention. RESULTS: At baseline, the groups matched in anthropometrics and body composition, and only differed by 4.2 years in age (mean [95% confidence limits] 49.2 [48.5-49.9] vs 53.4 [52.4-54.4] years). Time since last menstrual period for the postmenopausal women was (mean [95% confidence limits] 3.1 [2.6-3.7] years). Hormonal levels (estrogen, follicle stimulation hormone, luteinizing hormone) confirmed menopausal status. At baseline the postmenopausal women had higher total cholesterol (P < .001), low-density lipoprotein-cholesterol (P < .05), and high-density lipoprotein-cholesterol (P < .001) than the premenopausal women. The training intervention reduced body weight (P < .01), waist circumference (P < .01), and improved body composition by increasing lean body mass (P < .001) and decreasing fat mass (P < .001) similarly in both

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groups. Moreover, training resulted in lower diastolic blood pressure (P < .05), resting heart rate (P < .001), total cholesterol (P < .01), low-density lipoprotein-cholesterol (P < .01), total cholesterol/high-density lipoprotein-cholesterol index (P < .01), and improved plasma insulin concentration during the oral glucose tolerance test (P < .05) in both groups. CONCLUSION: Cardiovascular risk factors are similar in late premenopausal and early postmenopausal women, matched by age and body composition, with the exception that postmenopausal women have higher high- and low-density lipoprotein-cholesterol levels. A 3-month intervention of high-intensity aerobic training reduces risk factors for type 2 diabetes and cardiovascular disease to a similar extent in late premenopausal and early postmenopausal women. KEYWORDS:NOTNLM;

编号：24题名：Delayed villous maturation in term placentas exposed to opioid maintenance therapy: a

retrospective cohort study.作者：Serra AE;Lemon LS;Mokhtari NB;Parks WT;Catov JM;Venkataramanan R;Caritis SN出处：Am J Obstet Gynecol.2017V216N4:418.e1-418.e5机构：Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and

Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address: [email protected].;School of Pharmacy, University of Pittsburgh, Pittsburgh, PA.;Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA.;Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA.;Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA.;School of Pharmacy, University of Pittsburgh, Pittsburgh, PA.;Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA.摘要： BACKGROUND: Opioid use disorder among pregnant women is associated with adverse

perinatal outcomes and is increasing in the United States. The standard of care for pregnant women with opioid use disorder is opioid maintenance therapy including either methadone or buprenorphine, which can be initiated at any time during pregnancy. These medications are known to cross the placenta but their placental and fetal effects have not been well characterized. Delayed villous maturation, a placental finding associated with stillbirth, was observed in placentas exposed to opioid maintenance therapy. Given the association of delayed villous maturation with stillbirth, and the possible relationship between opioid maintenance therapy and delayed villous maturation, this study was undertaken to explore the association between opioid maintenance therapy and this placental finding. Delayed villous maturation was not previously reported in placentas exposed to opioids or opioid maintenance therapy. OBJECTIVE: This study sought to compare risk of delayed villous maturation in term placentas exposed and unexposed to opioid maintenance therapy with buprenorphine or methadone. STUDY DESIGN: This was a retrospective cohort study conducted between 2010 through 2012 at Magee-Womens Hospital comparing delayed villous maturation in placentas of

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women with opioid use disorder exposed to either buprenorphine (n = 86) or methadone (n = 268) versus women without opioid use disorder (n = 978). Potential covariates were assessed in univariate analyses with none significantly associated with delayed villous maturation. The final model used conditional logistic regression adjusting for smoking status alone. RESULTS: Among women without opioid use disorder (and therefore not exposed to opioid maintenance therapy), delayed villous maturation was identified in 5.7% of placentas while the prevalence among women treated with buprenorphine or methadone was 8.1% and 10.8%. Overall, the crude odds of being diagnosed with delayed villous maturation were significantly greater in those exposed to opioid maintenance therapy compared to those not exposed (odds ratio, 1.86; 95% confidence interval, 1.20-2.89). When considered separately, women treated with methadone had significantly greater odds of having a placenta with delayed villous maturation than women without exposure to opioid maintenance therapy (odds ratio, 2.00; 95% confidence interval, 1.52-3.20). Women treated with buprenorphine did not have significantly greater odds of this placental diagnosis when compared to the women unexposed to opioid maintenance therapy (odds ratio, 1.46; 95% confidence interval, 0.64-3.31). Results were similar after accounting for smoking. CONCLUSION: Delayed villous maturation was more common in the placentas of women exposed to opioid maintenance therapy. Further studies are required to characterize rates and extent of delayed villous maturation in the general population as well as to differentiate between possible effects of opioid exposure (eg, heroin, illicit use of prescription opioids) vs those of opioid maintenance therapy (buprenorphine and methadone). KEYWORDS:NOTNLM;

编号：25题名：Reducing health disparities by removing cost, access, and knowledge barriers.作者：Goodman M;Onwumere O;Milam L;Peipert JF出处：Am J Obstet Gynecol.2017V216N4:382.e1-382.e5机构：Department of Biostatistics, College of Global Public Health, New York

University.;Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO.;Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO.;Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN. Electronic address: [email protected].摘要： BACKGROUND: While the rate of unintended pregnancy has declined in the United

States in recent years, unintended pregnancy among teens in the United States is the highest among industrialized nations, and disproportionately affects minority teens. OBJECTIVE: Our objective of this secondary analysis was to estimate the risk of unintended pregnancy for both Black and White teens age 15-19 years when barriers to access, cost, and knowledge are removed. Our hypothesis was that the Black-White disparities would be reduced when access, education, and cost barriers are removed. STUDY DESIGN: We performed an analysis of the Contraceptive CHOICE Project database. CHOICE is a longitudinal cohort study of 9256 sexually active girls and women ages 14-45 years in the St Louis, MO, region from 2007 through 2013. Two measures of disparities were used to analyze teenage pregnancy rates and pregnancy risk from 2008 through 2013 among teens ages 15-19 years. These rates were then compared to

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the rates of pregnancy among all sexually active teens in the United States during the years 2008, 2009, 2010, and 2011. We estimated an absolute measure (rate difference) and a relative measure (rate ratio) to examine Black-White disparities in the rates of unintended pregnancy. RESULTS: While national rates of unintended pregnancy are decreasing, racial disparities in these rates persist. The Black-White rate difference dropped from 158.5 per 1000 in 2008 to 120.1 per 1000 in 2011; however, the relative ratio disparity decreased only from 2.6-2.5, suggesting that Black sexually active teens in the United States have 2.5 times the rate of unintended pregnancy as White teenagers. In the CHOICE Project, there was a decreasing trend in racial disparities in unintended pregnancy rates among sexually active teens (age 15-19 years): 2008 through 2009 (rate difference, 18.2; rate ratio, 3.7), 2010 through 2011 (rate difference, 4.3; rate ratio, 1.2), and 2012 through 2013 (rate difference, -1.5; rate ratio, 1.0). CONCLUSION: When barriers to cost, access, and knowledge were removed, such as in the Contraceptive CHOICE Project, Black-White disparities in unintended pregnancy rates among sexually active teens were reduced on both absolute and relative scales. The rate of unintended pregnancy was almost equal between Black and White teens compared to large Black-White disparities on the national level. KEYWORDS:NOTNLM;

编号：26题名：Long-acting reversible contraception in adolescents: a systematic review and meta-

analysis.作者：Diedrich JT;Klein DA;Peipert JF出处：Am J Obstet Gynecol.2017V216N4:364.e1-364.e12机构：Department of Obstetrics and Gynecology, University of California, Riverside, Riverside,

CA. Electronic address: [email protected].;Departments of Family Medicine and Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD.;Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN.摘要： BACKGROUND: Among adolescent pregnancies, 75% are unintended. Greater use of

highly-effective contraception can reduce unintended pregnancy. Although multiple studies discuss adolescent contraceptive use, there is no consensus regarding the use of long-acting reversible contraception as a first-line contraception option. OBJECTIVE: We performed a systematic review of the medical literature to assess the continuation of long-acting reversible contraceptives among adolescents. STUDY DESIGN: Ovid-MEDLINE, Cochrane databases, and Embase databases were searched using key words relevant to the provision of long-acting contraception to adolescents. Articles published from January 2002 through August 2016 were selected for inclusion based on specific key word searches and detailed review of bibliographies. For inclusion, articles must have provided data on method continuation, effectiveness, or satisfaction of at least 1 long-acting reversible contraceptive method in participants <25 years of age. Duration of follow-up had to be >/=6 months. Long-acting reversible contraceptive methods included intrauterine devices and the etonogestrel implant. Only studies in the English language were included. Guidelines, systematic reviews, and clinical reviews were examined for additional citations and relevant points for discussion. Of 1677 articles initially identified, 90 were selected for full review. Of these, 12 articles met criteria for inclusion. All studies selected for full review were extracted by multiple reviewers; inclusion

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was determined by consensus among authors. For studies with similar outcomes, forest plots of combined effect estimates were created using the random effects model. The meta-analysis of observational studies in epidemiology guidelines were followed. Primary outcomes measured were continuation of method at 12 months, and expulsion rates for intrauterine devices. RESULTS: This review included 12 studies, including 6 retrospective cohort studies, 5 prospective observational studies, and 1 randomized controlled trial. The 12 studies included 4886 women age <25 years: 4131 intrauterine device users and 755 implant users. The 12-month continuation of any long-acting reversible contraceptive device was 84.0% (95% confidence interval, 79.0-89.0%). Intrauterine device continuation was 74.0% (95% confidence interval, 61.0-87.0%) and implant continuation was 84% (95% confidence interval, 77.0-91.0%). Among postpartum adolescents, the 12-month long-acting reversible contraceptive continuation rate was 84.0% (95% confidence interval, 71.0-97.0%). The pooled intrauterine device expulsion rate was 8.0% (95% confidence interval, 4.0-11.0%). CONCLUSION: Adolescents and young women have high 12-month continuation of long-acting reversible contraceptive methods. Intrauterine devices and implants should be offered to all adolescents as first-line contraceptive options. KEYWORDS:NOTNLM;

编号：27题名：Neonatal outcomes following preterm birth classified according to placental features.作者：Catov JM;Scifres CM;Caritis SN;Bertolet M;Larkin J;Parks WT出处：Am J Obstet Gynecol.2017V216N4:411.e1-411.e14机构：Department of Obstetrics, Gynecology, and Reproductive Sciences, University of

Pittsburgh School of Medicine, Pittsburgh, PA; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; Magee-Womens Research Institute, Pittsburgh, PA. Electronic address: [email protected].;Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK.;Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA; Magee-Womens Research Institute, Pittsburgh, PA.;Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.;Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA; Magee-Womens Research Institute, Pittsburgh, PA.;Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA; Magee-Womens Research Institute, Pittsburgh, PA; Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA.摘要： BACKGROUND: Preterm birth has staggering health implications, and yet the causes of

most cases are still unknown. Placental features have been understudied as an etiology for preterm birth, and the association between placental pathologic lesions and neonatal outcomes are incompletely understood. OBJECTIVE: We sought to characterize births according to placental pathology and relate these to adverse neonatal outcomes. STUDY DESIGN: We studied 20,091 births (15,710 term and 4381 preterm) with placental evaluations. Births were classified according to the presence or absence of placental lesions consistent with malperfusion (vasculopathy, infarct, advanced villous maturation, perivillous fibrin, fibrin

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deposition) and intrauterine inflammation/infection (chorioamnionitis, funisitis, vasculitis). Outcomes were gestational week of delivery, birthweight z-score, neonatal respiratory distress syndrome, and intraventricular hemorrhage. RESULTS: Among all preterm births, evidence of placental malperfusion was identified more often than inflammation/infection (50.6% vs 27.3%, P < .0001). Placental malperfusion was associated with reduced fetal growth (adjusted birthweight z-score, -0.83, P < .0001) and lesions of inflammation/infection were associated with earlier delivery (adjusted difference -2.08 weeks, P < .0001) than those with no lesions. When both placental lesions were present, earlier delivery (adjusted difference -2.28 weeks, P < .0001) and reduced fetal growth (adjusted birthweight z-score difference, -0.24, P = .001) were observed more often than when neither lesion was present. Findings were similar when restricted to cases of spontaneous preterm birth. Intraventricular hemorrhage was higher in preterm births with malperfusion lesions than cases with no lesions (7.6% vs 3.4%; odds ratio, 1.98; confidence interval, 1.18-3.32), accounting for gestational age and other covariates. CONCLUSION: Placental pathology provides important insight into subtypes of preterm birth with adverse neonatal outcomes. Co-occurrence of malperfusion and inflammation/infection, especially among spontaneous preterm births, may be a novel pattern of placental injury linked to severe adverse outcomes. KEYWORDS:NOTNLM;

编号：28题名：The power of meta-analysis to address an important clinical question in obstetrics.作者：Berghella V出处：Am J Obstet Gynecol.2017V216N4:379.e1-379.e4机构：Jefferson Medical College, Philadelphia, PA. Electronic address:

[email protected].摘要： After 17 years of collaborative research, a meta-analysis of randomized controlled

trials on cerclage for singleton gestations with a prior spontaneous preterm birth and with a short transvaginal ultrasound cervical length <25mm before 24 weeks led to new clinical recommendations worldwide. This is an example of the power of meta-analyses, of why I like them, and why I think you should like them too. Many societies rank meta-analyses of randomized controlled trials as the best level of evidence, even above that of a single randomized controlled trial. KEYWORDS:NOTNLM;

编号：29题名：Early standardized treatment of critical blood pressure elevations is associated with a

reduction in eclampsia and severe maternal morbidity.作者：Shields LE;Wiesner S;Klein C;Pelletreau B;Hedriana HL出处：Am J Obstet Gynecol.2017V216N4:415.e1-415.e5机构：Maternal-Fetal Medicine, Marian Regional Medical Center, Santa Maria, CA; Department

of Patient Safety, Dignity Health, San Francisco, CA. Electronic address: [email protected].;Department of Patient Safety, Dignity Health, San Francisco, CA.;Department of Patient Safety, Dignity Health, San Francisco, CA.;Department of

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Patient Safety, Dignity Health, San Francisco, CA.;Sacramento Maternal-Fetal Medicine Medical Group Inc, Sacramento, CA.摘要： BACKGROUND: Hypertensive disorders of pregnancy result in significant maternal

morbidity and mortality. State and national guidelines have been proposed to increase treatment of patients with hypertensive emergencies or critically elevated blood pressures. There are limited data available to assess the impact of these recommendations on maternal morbidity. OBJECTIVE: The purpose of this prospective quality improvement project was to determine if maternal morbidity would be improved using a standardized approach for treatment of critically elevated blood pressures. STUDY DESIGN: In all, 23 hospitals participated in this project. Treatment recommendations included the use of an intravenous blood pressure medication and magnesium sulfate when there was a sustained blood pressure of >/=160 mm Hg systolic and/or >/=110 mm Hg diastolic. Compliance with the metric recommendations was monitored based on the number of patients treated with an intravenous blood pressure medication, use of magnesium sulfate, and if they received a timely postpartum follow-up appointment. The metric was scored as all or none; missing any of the 3 metric components was considered noncompliant. From January through June 2015 baseline data were collected and hospitals were made aware that ongoing monitoring of compliance would begin in July 2015 through June 2016. The primary outcomes were composite metric compliance, the incidence of eclampsia per 1000 births, and severe maternal morbidity. RESULTS: During the 18 months of this study there were 69,449 births. Within this population, 2034 met criteria for a critically elevated blood pressure, preeclampsia, or superimposed preeclampsia with severe features. Of this group, 1520 had a sustained critical blood elevation. Initial compliance with treatment recommendations was low (50.5%) and increased to >90% after April 2016 (P < .001). Compliance with utilization of intravenous blood pressure medication increased by 33.2%, from a baseline of 57.1-90.3% (P < .01) during the last 6 months of monitoring. Compliance with utilization of magnesium sulfate increased by 10.8%, from a baseline of 85.4-96.2% (P < .01). The incidence of eclampsia declined by 42.6% (1.15 +/- 0.15/1000 to 0.62 +/- 0.09/1000 births). Severe maternal morbidity decreased by 16.7% from 2.4 +/- 0.10% to 2.0 +/- 0.15% (P < .01). CONCLUSION: We noted 3 important findings: (1) compliance with state and national treatment guidelines is low without monitoring; (2) high levels of compliance can be achieved in a relatively short period of time; and (3) early intervention with intravenous blood pressure medication and magnesium sulfate for verified sustained critical maternal blood pressures resulted in a significant reduction in the rate of eclampsia and severe maternal morbidity. The reduction in the rate of eclampsia could only partially be attributed to the increase in the use of magnesium sulfate, suggesting an additive or synergistic effect of the combined treatment of an antihypertensive medication and magnesium sulfate on the rate of eclampsia and severe maternal morbidity. KEYWORDS:NOTNLM;

编号：30题名：Planned home births: the need for additional contraindications.作者：Grunebaum A;McCullough LB;Sapra KJ;Arabin B;Chervenak FA出处：Am J Obstet Gynecol.2017V216N4:401.e1-401.e8

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机构：Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY. Electronic address: [email protected].;Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY.;Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY.;Center for Mother and Child, Philipps University, Marburg, Germany and Clara Angela Foundation, Berlin, Germany.;Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY.摘要： BACKGROUND: Planned home births in the United States are associated with fewer

interventions but with increased adverse neonatal outcomes such as perinatal and neonatal deaths, neonatal seizures or serious neurologic dysfunction, and low 5-minute Apgar scores. The American College of Obstetricians and Gynecologists' Committee on Obstetric Practice states that, to reduce perinatal death and to improve outcomes at planned home births, strict criteria are necessary to guide the selection of appropriate candidates for planned home birth. The committee lists 3 absolute contraindications for a planned home birth: fetal malpresentation, multiple gestations, and a history of cesarean delivery. OBJECTIVE: The aim of this study was to evaluate whether there are risk factors that should be considered contraindications to planned home births in addition to the 3 that are listed by the American College of Obstetricians and Gynecologists. STUDY DESIGN: We conducted a population-based, retrospective cohort study of all term (>/=37 weeks gestation), normal weight (>/=2500 grams), singleton, nonanomalous births from 2009-2013 using the Centers for Disease Control and Prevention's period-linked birth-infant death files that allowed for identification of intended and unintended home births. We examined neonatal deaths (days 0-27 after birth) across 3 groups (hospital-attended births by certified nurse midwives, hospital-attended births by physicians, and planned home births) for 5 risk factors: 2 of the 3 absolute contraindications to home birth listed by the American College of Obstetricians and Gynecologists (breech presentation and previous cesarean delivery) and 3 additional risk factors (parity [nulliparous and multiparous], maternal age [women <35 and >/=35 years old], and gestational age at delivery [37-40 and >/=41 weeks]). RESULTS: The overall risk of neonatal death was significantly higher in planned home births (12.1 neonatal death/10,000 deliveries; P<.001) compared with hospital births by certified nurse midwives (3.08 neonatal death/10,000 deliveries) or physicians (5.09 neonatal death/10,000 deliveries). Neonatal mortality rates were increased significantly at planned home births, with the following individual risk factors: breech presentation (neonatal mortality rate, 127.52/10.000 births), nulliparous pregnant women (neonatal mortality rate, 22.5/10,000), previous cesarean delivery (18.91/10,000 births), and a gestational age >/=41 weeks (neonatal mortality rate, 17.17/10,000 births). Planned home births with >/=1 of the 5 risk factors had significantly higher neonatal death risks compared with deliveries with none of the risks. Neonatal death risk was further increased when a woman's age of >/=35 years was combined with either a first-time birth or a gestational age of >/=41 weeks. CONCLUSIONS: In this study, we show 2 risk factors with significantly increased neonatal mortality rates at planned home births in addition to the 3 factors that are listed by the American College of Obstetricians and Gynecologists. These additional risks factors have neonatal mortality rates that are approaching or exceeding those for planned home birth after cesarean delivery: first-time births and a gestational age of >/= 41 weeks. Therefore, 2 additional risk factors (first-time births and a gestational age of >/=41 weeks) should be added

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to the 3 absolute contraindications of planned home births that are listed by the American College of Obstetricians and Gynecologists (previous cesarean delivery, malpresentation, multiple gestations) for a total of 5 contraindications for planned home births. KEYWORDS:NOTNLM;

编号：31题名：Attempted operative vaginal delivery vs repeat cesarean in the second stage among

women undergoing a trial of labor after cesarean delivery.作者：Son M;Roy A;Grobman WA出处：Am J Obstet Gynecol.2017V216N4:407.e1-407.e5机构：Division of Maternal Fetal Medicine, Northwestern University, Feinberg School of

Medicine, Chicago, IL. Electronic address: [email protected].;Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, IL.;Division of Maternal Fetal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL.摘要： BACKGROUND: It is not well-characterized whether attempting operative vaginal

delivery is a safe and effective alternative among women who undergo a trial of labor after cesarean delivery who are unable to complete second-stage labor with a spontaneous vaginal delivery. OBJECTIVE: The purpose of this study was to compare maternal and neonatal outcomes that are associated with attempted operative vaginal delivery with those that are associated with second-stage repeat cesarean delivery without an operative vaginal delivery attempt among women who undergo a trial of labor after cesarean delivery. STUDY DESIGN: This is a retrospective secondary analysis of data from Cesarean Registry of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Women who underwent a trial of labor after cesarean delivery who were at least 36 weeks gestation were eligible for analysis if they had a live, singleton, nonanomalous gestation in cephalic presentation and reached second-stage labor (defined as complete cervical dilation) with a fetal station of at least +2. The data for women who had an attempted operative vaginal delivery with either forceps or vacuum were compared with those of women who underwent second stage repeat cesarean delivery without operative vaginal delivery attempt. Outcomes of maternal and neonatal complications were compared between groups with bivariable and multivariable analyses. RESULTS: Of 1230 women whose cases were eligible for analysis, 945 women (76.8%) had an attempted operative vaginal delivery. Of those who underwent attempted operative vaginal delivery, 914 women (96.7%) achieved a vaginal delivery. Women who attempted operative vaginal delivery had a lower mean body mass index (30.4+/-6.0 vs 31.8+/-5.9 kg/m2; P=.001) and gestational age (39.5+/-1.3 vs 39.8+/-1.2 weeks; P=.012) at delivery and were more likely to be of non-Hispanic black race (30.0% vs 22.1%; P=.002), to have had a previous vaginal delivery (34.9% vs 20.4%; P<.001), and to have fetal descent greater than +2 station at complete dilation (55.6% vs 16.8%; P<.001) and were less likely to have chorioamnionitis (6.8% vs 19.3%; P<.001). The frequency of endometritis was significantly lower among women who had an attempted operative vaginal delivery compared with those who had repeat cesarean delivery (2.5% vs 9.1%; P<.001). However, other serious maternal or neonatal adverse outcomes were not statistically different

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between the groups. These findings persisted after adjustment for potential confounders. CONCLUSION: In the setting of a trial of labor after cesarean delivery in the second stage with a fetal station of at least +2, attempted operative vaginal delivery resulted in a vaginal birth after cesarean delivery in most women and was not associated with increased adverse maternal and neonatal outcomes but was associated with a reduced frequency of endometritis compared with repeat cesarean delivery without operative vaginal delivery attempt. KEYWORDS:NOTNLM;

编号：32题名：Obesity and cell-free DNA "no calls": is there an optimal gestational age at time of

sampling?作者：Livergood MC;LeChien KA;Trudell AS出处：Am J Obstet Gynecol.2017V216N4:413.e1-413.e9机构：Department of Obstetrics and Gynecology, Mercy Hospital St Louis, St Louis, MO.

Electronic address: [email protected].;Department of Obstetrics and Gynecology, Mercy Hospital St Louis, St Louis, MO.;Department of Obstetrics and Gynecology, Mercy Hospital St Louis, St Louis, MO; Midwest Maternal-Fetal Medicine, Obstetrix Medical Group, St Louis, MO.摘要： BACKGROUND: Cell-free DNA screen failures or "no calls" occur in 1-12% of samples

and are frustrating for both clinician and patient. The rate of "no calls" has been shown to have an inverse relationship with gestational age. Recent studies have shown an increased risk for "no calls" among obese women. OBJECTIVE: We sought to determine the optimal gestational age for cell-free DNA among obese women. STUDY DESIGN: We performed a retrospective cohort study of women who underwent cell-free DNA at a single tertiary care center from 2011 through 2016. Adjusted odds ratios with 95% confidence intervals for a "no call" were determined for each weight class and compared to normal-weight women. The predicted probability of a "no call" with 95% confidence intervals were determined for each week of gestation for normal-weight and obese women and compared. RESULTS: Among 2385 patients meeting inclusion criteria, 105 (4.4%) had a "no call". Compared to normal-weight women, the adjusted odds ratio of a "no call" increased with increasing weight class from overweight to obesity class III (respectively: adjusted odds ratio, 2.31; 95% confidence interval, 1.21-4.42 to adjusted odds ratio, 8.55; 95% confidence interval, 4.16-17.56). A cut point at 21 weeks was identified for obesity class II/III women at which there is no longer a significant difference in the probability of a "no call" for obese women compared to normal weight women. From 8-16 weeks, there is a 4.5% reduction in the probability of a "no call" for obesity class II/III women (respectively: 14.9%; 95% confidence interval, 8.95-20.78 and 10.4%; 95% confidence interval, 7.20-13.61; Ptrend < .01). CONCLUSION: The cut point of 21 weeks for optimal sampling of cell-free DNA limits reproductive choices. However, a progressive fall in the probability of a "no call" with advancing gestational age suggests that delaying cell-free DNA for obese women is a reasonable strategy to reduce the probability of a "no call". KEYWORDS:NOTNLM;

编号：33232

题名：Skin closure at cesarean delivery, glue vs subcuticular sutures: a randomized controlled trial.

作者：Daykan Y;Sharon-Weiner M;Pasternak Y;Tzadikevitch-Geffen K;Markovitch O;Sukenik-Halevy R;Biron-Shental T

出处：Am J Obstet Gynecol.2017V216N4:406.e1-406.e5机构：Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel;

Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: [email protected].;Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.;Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.;Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.;Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.;Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Genetics Institute, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.;Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.摘要： BACKGROUND: The optimal choice of skin closure at cesarean delivery has not yet

been determined. OBJECTIVE: This study compared wound complications and scar healing following cesarean delivery between 2 methods of skin closure: glue (Dermabond; Ethicon, Somerville, NJ) and monofilament (Monocryl; Ethicon) epidermal sutures. STUDY DESIGN: We conducted a randomized controlled trial in which pregnant women undergoing a scheduled cesarean delivery were randomly assigned to skin (epidermis) closure with glue or with a monofilament synthetic suture. The subcutaneous tissue was sutured for all patients. Outcome assessors were blinded to group allocation. Scars were evaluated >8 weeks. Primary outcome measures were Patient and Observer Scar Assessment Scale scores. Secondary outcome measures were surgeon satisfaction, duration of surgery, duration of hospitalization after the cesarean delivery, and complications of surgical site infection or wound disruption (hematoma or seroma). A sample of 104 women was needed to achieve a clinically significant effect with a power of 80%. RESULTS: Demographic characteristics, patients' clinical background, prepregnancy body mass index, and subcutaneous thickness were similar in both groups. Length of surgery between the groups (37 +/- 10 minutes for glue vs 39 +/- 13 minutes for sutures, P = .515) was similar. Scores immediately after the wound closure were similar for both groups regarding surgeons' time estimate of closure (P = .181) and closure appearance (P = .082). Surgeons' satisfaction with the technique was significantly higher in the suture group (P = .003). No significant differences were found between the groups in blood loss, surgical site infection, length of postpartum hospitalization, or wound disruption. Glue and suture skin closure scores using Patient and Observer Scar Assessment Scale were similar 8 weeks after surgery, at P = .710 for patients and P = .568 for a physician observer. CONCLUSION: Skin closure using glue or a monofilament synthetic suture had similar results. Both methods were shown to be safe and successful for skin closure after a scheduled cesarean delivery and, therefore, can be used based on surgeon and patient preferences.

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编号：34题名：A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes

mellitus and improve pregnancy outcome in overweight and obese pregnant women.作者：Wang C;Wei Y;Zhang X;Zhang Y;Xu Q;Sun Y;Su S;Zhang L;Liu C;Feng Y;Shou C;Guelfi

KJ;Newnham JP;Yang H出处：Am J Obstet Gynecol.2017V216N4:340-351机构：Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing,

China.;Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.;Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.;Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.;Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.;Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.;Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.;Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.;Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.;Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.;Division of Hospital Medicine, Hallmark Health System, Medford, MA.;Schools of Sport Science, Exercise, and Health, University of Western Australia, Perth, Australia.;Women's and Infants' Health, University of Western Australia, Perth, Australia.;Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China. Electronic address: [email protected].摘要： BACKGROUND: Obesity and being overweight are becoming epidemic, and indeed, the

proportion of such women of reproductive age has increased in recent times. Being overweight or obese prior to pregnancy is a risk factor for gestational diabetes mellitus, and increases the risk of adverse pregnancy outcome for both mothers and their offspring. Furthermore, the combination of gestational diabetes mellitus with obesity/overweight status may increase the risk of adverse pregnancy outcome attributable to either factor alone. Regular exercise has the potential to reduce the risk of developing gestational diabetes mellitus and can be used during pregnancy; however, its efficacy remain controversial. At present, most exercise training interventions are implemented on Caucasian women and in the second trimester, and there is a paucity of studies focusing on overweight/obese pregnant women. OBJECTIVE: We sought to test the efficacy of regular exercise in early pregnancy to prevent gestational diabetes mellitus in Chinese overweight/obese pregnant women. STUDY DESIGN: This was a prospective randomized clinical trial in which nonsmoking women age >18 years with a singleton pregnancy who met the criteria for overweight/obese status (body mass index 24</=28 kg/m2) and had an uncomplicated pregnancy at <12+6 weeks of gestation were randomly allocated to either exercise or a control group. Patients did not have contraindications to physical activity. Patients allocated to the exercise group were assigned to exercise 3 times per week (at least 30 min/session with a rating of perceived exertion between 12-14) via a cycling program begun within 3 days of randomization until 37 weeks of gestation. Those in the control group continued their usual daily activities. Both groups received standard prenatal care, albeit without special dietary recommendations. The primary outcome was incidence of gestational diabetes mellitus. RESULTS: From December 2014 through July 2016, 300 singleton women at

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10 weeks' gestational age and with a mean prepregnancy body mass index of 26.78 +/- 2.75 kg/m2 were recruited. They were randomized into an exercise group (n = 150) or a control group (n = 150). In all, 39 (26.0%) and 38 (25.3%) participants were obese in each group, respectively. Women randomized to the exercise group had a significantly lower incidence of gestational diabetes mellitus (22.0% vs 40.6%; P < .001). These women also had significantly less gestational weight gain by 25 gestational weeks (4.08 +/- 3.02 vs 5.92 +/- 2.58 kg; P < .001) and at the end of pregnancy (8.38 +/- 3.65 vs 10.47 +/- 3.33 kg; P < .001), and reduced insulin resistance levels (2.92 +/- 1.27 vs 3.38 +/- 2.00; P = .033) at 25 gestational weeks. Other secondary outcomes, including gestational weight gain between 25-36 gestational weeks (4.55 +/- 2.06 vs 4.59 +/- 2.31 kg; P = .9), insulin resistance levels at 36 gestational weeks (3.56 +/- 1.89 vs 4.07 +/- 2.33; P = .1), hypertensive disorders of pregnancy (17.0% vs 19.3%; odds ratio, 0.854; 95% confidence interval, 0.434-2.683; P = .6), cesarean delivery (except for scar uterus) (29.5% vs 32.5%; odds ratio, 0.869; 95% confidence interval, 0.494-1.529; P = .6), mean gestational age at birth (39.02 +/- 1.29 vs 38.89 +/- 1.37 weeks' gestation; P = .5); preterm birth (2.7% vs 4.4%, odds ratio, 0.600; 95% confidence interval, 0.140-2.573; P = .5), macrosomia (defined as birthweight >4000 g) (6.3% vs 9.6%; odds ratio, 0.624; 95% confidence interval, 0.233-1.673; P = .3), and large-for-gestational-age infants (14.3% vs 22.8%; odds ratio, 0.564; 95% confidence interval, 0.284-1.121; P = .1) were also lower in the exercise group compared to the control group, but without significant difference. However, infants born to women following the exercise intervention had a significantly lower birthweight compared with those born to women allocated to the control group (3345.27 +/- 397.07 vs 3457.46 +/- 446.00 g; P = .049). CONCLUSION: Cycling exercise initiated early in pregnancy and performed at least 30 minutes, 3 times per week, is associated with a significant reduction in the frequency of gestational diabetes mellitus in overweight/obese pregnant women. And this effect is very relevant to that exercise at the beginning of pregnancy decreases the gestational weight gain before the mid-second trimester. Furthermore, there was no evidence that the exercise prescribed in this study increased the risk of preterm birth or reduced the mean gestational age at birth. KEYWORDS:NOTNLM;

编号：35题名：Temporal relationship between posterior vaginal prolapse and defecatory symptoms.作者：Handa VL;Munoz A;Blomquist JL出处：Am J Obstet Gynecol.2017V216N4:390.e1-390.e6机构：Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address:

[email protected].;Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.;Greater Baltimore Medical Center, Baltimore, MD.摘要： BACKGROUND: Posterior vaginal prolapse is thought to cause difficult defecation and

splinting for bowel movements. However, the temporal relationship between difficult defecation and prolapse is unknown. Does posterior vaginal prolapse lead to the development of defecation symptoms? Conversely, does difficult defecation lead to posterior prolapse? This prospective longitudinal study offered an opportunity to study these unanswered questions. OBJECTIVE: We sought to investigate the following questions: (1) Are symptoms of difficult defecation more likely to develop (and less likely to resolve) among women with posterior

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vaginal prolapse? (2) Is posterior vaginal prolapse more likely to develop among women who complain of difficult defecation? STUDY DESIGN: In this longitudinal study, parous women were assessed annually for defecatory symptoms (Epidemiology of Prolapse and Incontinence Questionnaire) and pelvic organ support (POP-Q examination). The unit of analysis for this study was a visit-pair (2 sequential visits from any participant). We created logistic regression models for symptom onset among those women who were symptom-free at the index visit and for symptom resolution among those women who had symptoms at the index visit. To investigate the change in posterior vaginal support (assessed at point Bp) as a function of symptom status, we created a standard regression model that controlled for Bp at the index visit for each visit-pair. RESULTS: We derived 3888 visit-pairs from 1223 women (each completed 2-7 annual visits). At the index visit, 1143 women (29%) reported difficulty with bowel movements, and 643 women (17%) reported splinting for bowel movements. Posterior vaginal prolapse (Bp>/=0) was observed among 80 women (2%). Among those women without symptoms, posterior vaginal prolapse did not significantly increase the odds that defecatory symptoms would develop (difficult bowel movements, P=.378; splinting, P=.765). In contrast, among those with defecatory symptoms, posterior vaginal prolapse reduced the probability of symptom resolution (difficult bowel movements, P<.001; splinting, P=.162). The mean rate of change in posterior wall support was +0.13 cm. Among women without posterior vaginal prolapse, the presence of defecatory symptoms at the index visit did not have an effect on changes in Bp over time; however, among those with posterior vaginal prolapse (Bp>/=0), defecatory symptoms were associated with more rapid worsening of posterior support (difficulty with bowel movements, P=.005; splinting, P=.057). CONCLUSION: Posterior vaginal prolapse did not increase the odds that new defecatory symptoms would develop among asymptomatic women but did increase the probability that defecatory symptoms would persist over time. Furthermore, among those women with established posterior vaginal prolapse, defecatory symptoms were associated with more rapid worsening of posterior vaginal wall descent. KEYWORDS:NOTNLM;

编号：36题名：Bupropion sustained release for pregnant smokers: a randomized, placebo-controlled

trial.作者：Nanovskaya TN;Oncken C;Fokina VM;Feinn RS;Clark SM;West H;Jain SK;Ahmed

MS;Hankins GD出处：Am J Obstet Gynecol.2017V216N4:420.e1-420.e9机构：Department of Obstetrics and Gynecology, The University of Texas Medical Branch at

Galveston, Galveston, TX. Electronic address: [email protected].;University of Connecticut School of Medicine, Farmington, CT.;Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX.;Frank H. Netter, MD, School of Medicine, Quinnipiac University, North Haven, CT.;Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX.;Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX.;Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX; Department of Pediatrics, The University of Texas Medical Branch at Galveston, Galveston,

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TX.;Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX.;Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX.摘要： BACKGROUND: Bupropion is used to treat depression during pregnancy. However, its

usefulness as a smoking cessation aid for pregnant women is not fully known. OBJECTIVE: The objective of the study was to evaluate the preliminary efficacy of bupropion sustained release for smoking cessation during pregnancy. STUDY DESIGN: We conducted a randomized, prospective, double-blind, placebo-controlled, pilot trial. Pregnant women who smoked daily received individualized behavior counseling and were randomly assigned to a 12 week, twice-a-day treatment with 150 mg bupropion sustained release or placebo. The primary study objectives were to determine whether bupropion sustained release reduces nicotine withdrawal symptoms on the quit date and during the treatment period compared with placebo and whether it increases 7 day point prevalence abstinence at the end of the treatment period and at the end of pregnancy. RESULTS: Subjects in the bupropion (n = 30) and placebo (n = 35) groups were comparable in age, smoking history, number of daily smoked cigarettes, and nicotine dependence. After controlling for maternal age and race, bupropion sustained release reduced cigarette cravings (1.5 +/- 1.1 vs 2.1 +/- 1.2, P = .02) and total nicotine withdrawal symptoms (3.8 +/- 4.3 vs 5.4 +/- 5.1, P = .028) during the treatment period. Administration of bupropion sustained release reduced tobacco exposure, as determined by levels of carbon monoxide in exhaled air (7.4 +/- 6.4 vs 9.1 +/- 5.8, P = .053) and concentrations of cotinine in urine (348 +/- 384 ng/mL vs 831 +/- 727 ng/mL, P = .007) and increased overall abstinence rates during treatment (19% vs 2%, P = .003). However, there was no significant difference in 7 day point prevalence abstinence rates between the 2 groups at the end of medication treatment (17% vs 3%, P = .087) and at the end of pregnancy (10% vs 3%, P = .328). CONCLUSION: Individual smoking cessation counseling along with the twice-daily use of 150 mg bupropion sustained release increased smoking cessation rates and reduced cravings and total nicotine withdrawal symptoms during the treatment period. However, there was no significant difference in abstinence rates between groups at the end of medication treatment and at the end of pregnancy, likely because of the small sample size. A larger study is needed to confirm these findings and to examine the potential benefit/ risk ratio of bupropion sustained release for smoking cessation during pregnancy. KEYWORDS:NOTNLM;

编号：37题名：Vaginal birth after cesarean: neonatal outcomes and United States birth setting.作者：Tilden EL;Cheyney M;Guise JM;Emeis C;Lapidus J;Biel FM;Wiedrick J;Snowden JM出处：Am J Obstet Gynecol.2017V216N4:403.e1-403.e8机构：Department of Nurse-Midwifery, School of Nursing, Oregon Health and Science

University, Portland, OR. Electronic address: [email protected].;Anthropology department, Oregon State University, Corvallis, OR.;Department of Obstetrics & Gynecology, Oregon Health and Science University, Portland, OR.;Department of Nurse-Midwifery, School of Nursing, Oregon Health and Science University, Portland, OR.;Biostatistics & Design Program, Oregon Health and Science University, Portland, OR; Oregon Clinical and Translational Research Institute, Oregon Health and Science University, Portland, OR.;Department of Obstetrics &

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Gynecology, Oregon Health and Science University, Portland, OR.;Biostatistics & Design Program, Oregon Health and Science University, Portland, OR.;Department of Obstetrics & Gynecology, Oregon Health and Science University, Portland, OR.摘要： BACKGROUND: Women who seek vaginal birth after cesarean delivery may find limited

in-hospital options. Increasing numbers of women in the United States are delivering by vaginal birth after cesarean delivery out-of-hospital. Little is known about neonatal outcomes among those who deliver by vaginal birth after cesarean delivery in- vs out-of-hospital. OBJECTIVE: The purpose of this study was to compare neonatal outcomes between women who deliver via vaginal birth after cesarean delivery in-hospital vs out-of-hospital (home and freestanding birth center). STUDY DESIGN: We conducted a retrospective cohort study using 2007-2010 linked United States birth and death records to compare singleton, term, vertex, nonanomolous, and liveborn neonates who delivered by vaginal birth after cesarean delivery in- or out-of-hospital. Descriptive statistics and multivariate regression analyses were conducted to estimate unadjusted, absolute, and relative birth-setting risk differences. Analyses were stratified by parity and history of vaginal birth. Sensitivity analyses that involved 3 transfer status scenarios were conducted. RESULTS: Of women in the United States with a history of cesarean delivery (n=1,138,813), only a small proportion delivered by vaginal birth after cesarean delivery with the subsequent pregnancy (n=109,970; 9.65%). The proportion of home vaginal birth after cesarean delivery births increased from 1.78-2.45%. A pattern of increased neonatal morbidity was noted in unadjusted analysis (neonatal seizures, Apgar score <7 or <4, neonatal seizures), with higher morbidity noted in the out-of-hospital setting (neonatal seizures, 23 [0.02%] vs 6 [0.19%; P<.001]; Apgar score <7, 2859 [2.68%] vs 139 [4.42%; P<.001; Apgar score <4, 431 [0.4%] vs 23 [0.73; P=.01]). A similar, but nonsignificant, pattern of increased risk was observed for neonatal death and ventilator support among those neonates who were born in the out-of-hospital setting. Multivariate regression estimated that neonates who were born in an out-of-hospital setting had higher odds of poor outcomes (neonatal seizures [adjusted odds ratio, 8.53; 95% confidence interval, 2.87-25.4); Apgar score <7 [adjusted odds ratio, 1.62; 95% confidence interval, 1.35-1.96]; Apgar score <4 [adjusted odds ratio, 1.77; 95% confidence interval, 1.12-2.79]). Although the odds of neonatal death (adjusted odds ratio, 2.1; 95% confidence interval, 0.73-6.05; P=.18) and ventilator support (adjusted odds ratio, 1.36; 95% confidence interval, 0.75-2.46) appeared to be increased in out-of-hospital settings, findings did not reach statistical significance. Women birthing their second child by vaginal birth after cesarean delivery in out-of-hospital settings had higher odds of neonatal morbidity and death compared with women of higher parity. Women who had not birthed vaginally prior to out-of-hospital vaginal birth after cesarean delivery had higher odds of neonatal morbidity and mortality compared with women who had birthed vaginally prior to out-of-hospital vaginal birth after cesarean delivery. Sensitivity analyses generated distributions of plausible alternative estimates by outcome. CONCLUSION: Fewer than 1 in 10 women in the United States with a previous cesarean delivery delivered by vaginal birth after cesarean delivery in any setting, and increasing proportions of these women delivered in an out-of-hospital setting. Adverse outcomes were more frequent for neonates who were born in an out-of-hospital setting, with risk concentrated among women birthing their second child and women without a history of vaginal birth. This information urgently signals the need to increase availability of in-hospital vaginal birth after cesarean delivery and suggests that there may be benefit

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associated with increasing options that support physiologic birth and may prevent primary cesarean delivery safely. Results may inform evidence-based recommendations for birthplace among women who seek vaginal birth after cesarean delivery. KEYWORDS:NOTNLM;

编号：38题名：Assessment of vulvar discomfort with sexual activity among women in the United

States.作者：Flynn KE;Carter J;Lin L;Lindau ST;Jeffery DD;Reese JB;Schlosser BJ;Weinfurt KP出处：Am J Obstet Gynecol.2017V216N4:391.e1-391.e8机构：Center for Patient Care and Outcomes Research, Department of Medicine, Medical

College of Wisconsin, Milwaukee, WI. Electronic address: [email protected].;Departments of Surgery and Psychiatry, Memorial Sloan Kettering Cancer Center, New York, NY.;Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.;Departments of Obstetrics-Gynecology and Medicine-Geriatrics, University of Chicago, Chicago, IL.;Defense Health Agency, Department of Defense-Health Affairs, Falls Church, VA.;Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA; Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA.;Departments of Dermatology and Obstetrics-Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL.;Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC.摘要： BACKGROUND: Multidimensional self-report measures of sexual function for women do

not include the assessment of vulvar discomfort, limiting our understanding of its prevalence. In an effort to improve the measurement of patient-reported health, the National Institutes of Health funded the creation of the Patient Reported Outcomes Measurement Information System (PROMIS). This included the development of the PROMIS Sexual Function and Satisfaction measure, and version 2.0 of the Sexual Function and Satisfaction measure included 2 scales to measure vulvar discomfort with sexual activity. OBJECTIVES: The objectives of the study were to describe the development of 2 self-reported measures of vulvar discomfort with sexual activity, describe the relationships between these scales and scales for lubrication and vaginal discomfort, and report the prevalence of vulvar discomfort with sexual activity in a large, nationally representative sample of US women. STUDY DESIGN: We followed PROMIS measure development standards, including qualitative development work with patients and clinicians and psychometric evaluation of candidate items based on item response theory, in a probability sample of 1686 English-speaking US adult women. We tested 16 candidate items on vulvar discomfort. We present descriptive statistics for these items, correlation coefficients among the vulvar and vaginal scales, and mean PROMIS scores with 95% confidence intervals separately by menopausal status for the 1046 women who reported sexual activity in the past 30 days. RESULTS: Based on the psychometric evaluation of the candidate items, we created 2 separate 4 item scales, one to measure labial discomfort and pain and one to measure clitoral discomfort and pain. Additional items not included in the scales assess pain quality, numbness, and bleeding. The correlations between the lubrication, vaginal discomfort, and the 2 vulvar discomfort measures ranged from 0.46 to 0.77, suggesting that these measures represent

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related yet distinct concepts. In our nationally representative sample, 1 in 5 US women endorsed some degree of vulvar discomfort with sexual activity in the past 30 days. Menopausal status was associated with lower lubrication and higher vaginal discomfort but not with vulvar discomfort. CONCLUSION: The PROMIS Vulvar Discomfort with Sexual Activity-Labial and Vulvar Discomfort with Sexual Activity-Clitoral scales are publicly available for use in research and clinical settings. There is limited overlap between vulvar discomfort and lubrication or vaginal discomfort. The importance of measuring vulvar discomfort as part of a comprehensive assessment of sexual function is underscored by its prevalence. KEYWORDS:NOTNLM;

编号：39题名：The effect of intrauterine devices on acquisition and clearance of human

papillomavirus.作者：Averbach SH;Ma Y;Smith-McCune K;Shiboski S;Moscicki AB出处：Am J Obstet Gynecol.2017V216N4:386.e1-386.e5机构：Department of Obstetrics, Gynecology, and Reproductive Sciences, University of

California, San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA. Electronic address: [email protected].;Department of Pediatrics, University of California, San Francisco, San Francisco, CA.;Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA.;Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.;Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA.摘要： BACKGROUND: Previous studies have shown a decrease in cervical cancer associated

with intrauterine device use. It has been hypothesized that intrauterine device use may alter the natural history of human papillomavirus infections, preempting development of precancerous lesions of the cervix and cervical cancer, but the effect of intrauterine devices on the natural history of human papillomavirus infection and subsequent development of cervical cancer is poorly understood. OBJECTIVE: The purpose of this study was to evaluate the association between intrauterine device use and cervical high-risk human papillomavirus acquisition and clearance. STUDY DESIGN: This is a prospective cohort study conducted from October 2000 through June 2014 among 676 sexually active young women and girls enrolled from family planning clinics in San Francisco, CA. Data were analyzed using a Cox proportional hazards model, including time-varying indicators of intrauterine device use, and adjusting for fixed and time-dependent predictor variables. RESULTS: A total of 85 women used an intrauterine device at some time during follow-up. Among 14,513 study visits, women reported intrauterine device use at 505 visits. After adjusting for potential behavioral confounders, there was no association between intrauterine device use and human papillomavirus acquisition (hazard ratio, 0.50; 95% confidence interval, 0.20-1.23; P = .13) or clearance of human papillomavirus infection (hazard ratio, 1.44; 95% confidence interval, 0.76-2.72; P = .26). CONCLUSION: Current intrauterine device use is not associated with acquisition or persistence of human papillomavirus infection. Intrauterine device use is safe among women and girls with human papillomavirus infections and at risk for human papillomavirus acquisition. Intrauterine

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device use may play a role further downstream in the natural history of cervical cancer by inhibiting the development of precancerous lesions of the cervix in human papillomavirus-infected women, or enhancing clearance of established precancerous lesions. KEYWORDS:NOTNLM;

BJOG

编号：1题名：Complications of external cephalic version: a retrospective analysis of 1121 patients at a tertiary hospital in Sydney.作者：Rodgers R;Beik N;Nassar N;Brito I;de Vries B出处：BJOG.2017V124N5:767-772机构：Department of Gynaecology, Royal Hospital for Women, Sydney, NSW, Australia.;Department of Women and Babies, Royal Prince Alfred Hospital, Sydney, NSW, Australia.;Department of Women and Babies, Royal Prince Alfred Hospital, Sydney, NSW, Australia.;Department of Obstetrics and Gynaecology, Royal North Shore Hospital, Sydney, NSW, Australia.;Department of Gynaecology, Royal Hospital for Women, Sydney, NSW, Australia.;Department of Women and Babies, Royal Prince Alfred Hospital, Sydney, NSW, Australia.摘要： OBJECTIVE: To report the complication rate associated with external cephalic version (ECV) at term. DESIGN: Single-centre retrospective study. SETTING: A major tertiary hospital in Sydney, Australia. POPULATION OR SAMPLE: All women who underwent an ECV at Royal Prince Alfred Hospital from 1995-2013 were included. METHODS: ECV was attempted on all consenting women with a breech presentation at term in the absence of contraindications. Complications were classified as minor (transient cardiotocography abnormalities, ruptured membranes, small antepartum haemorrhage) or serious (fetal death, placental abruption, fetal distress requiring emergency caesarean section, fetal bone injury, cord prolapse). ECV success rates and rate of reversion to breech were recorded. MAIN OUTCOME MEASURES: The primary outcome was the incidence of serious complications. Secondary outcome measures were the rate of minor complications and reversion to breech. RESULTS: Of 1121 patients that underwent ECV, five (0.45%) experienced a serious complication. There was one placental abruption, one emergency caesarean section for fetal distress and two cord prolapses. There was one fetal death attributable to a successful ECV. Forty-eight women (4.28%) experienced a minor complication. Reversion to the breech occurred in sixteen patients (3.32%). CONCLUSION: ECV at term is associated with a low rate of serious complications. TWEETABLE ABSTRACT: Study of 1121 consecutive ECV attempts shows low rate of complications although one fetal death reported. KEYWORDS:NOTNLM;

编号：2题名：Induction of labour with retrievable prostaglandin vaginal inserts: outcomes following retrieval due to an intrapartum adverse event.作者：Rugarn O;Tipping D;Powers B;Wing DA出处：BJOG.2017V124N5:796-803机构：Ferring Pharmaceuticals, Copenhagen, Denmark.;Tipping Consulting LLC, Green Lane, PA, USA.;Independent Consultant, Phoenixville, PA, USA.;Department of Obstetrics and Gynecology, University of California, Irvine, CA, USA.;Miller Children's and Women's Hospital, Long Beach, CA, USA.

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摘要： OBJECTIVE: To assess adverse event (AE) resolution, delivery mode and neonatal outcomes after misoprostol or dinoprostone vaginal insert (MVI or DVI) retrieval due to AE during induction of labour (IOL). DESIGN: Randomised, double-blind trial, EXPEDITE. SETTING: Thirty five obstetric departments, USA. POPULATION: Consisted of 1358 pregnant women with modified Bishop score </=4 eligible for pharmacological IOL. METHODS: Post hoc analysis. MAIN OUTCOME MEASURES: AEs prompting insert retrieval, times to AE resolution, delivery, delivery mode and neonatal intensive care unit (NICU) admissions. RESULTS: 77/678 (11.4%) and 27/680 (4.0%) women had MVI and DVI retrieved due to AE, respectively (P < 0.001). The most common AEs prompting retrieval were uterine tachysystole with fetal heart rate (FHR) involvement and category II/III FHR pattern. Time to AE resolution varied for both treatments depending on the type of AE. For uterine tachysystole with FHR involvement, median resolution times were 1 hour 34.5 minutes (n = 36) and 8.5 minutes (n = 8) for MVI and DVI, respectively. Caesarean delivery occurred in a high proportion of women with insert retrieved due to AE (MVI: 44/77 (57.1%); DVI: 19/27 (70.4%)); the majority of caesareans were performed at least several hours after insert retrieval. Median times from retrieval to any delivery were not increased for women with insert retrieved due to AE. NICU admissions were 8/77 (10.4%) and 1/27 (3.7%) for MVI and DVI, respectively (P = 0.440). CONCLUSIONS: AEs leading to insert retrieval were primarily uterine tachysystole with FHR involvement and category II/III FHR patterns. Insert retrieval due to an AE did not prolong time to delivery for either prostaglandin insert. TWEETABLE ABSTRACT: Induction with prostaglandin vaginal inserts: outcomes following retrieval due to intrapartum adverse event. KEYWORDS:NOTNLM;

编号：3题名：Migration and perinatal mental health in women from low- and middle-income countries: a systematic review and meta-analysis.作者：Fellmeth G;Fazel M;Plugge E出处：BJOG.2017V124N5:742-752机构：Nuffield Department of Population Health, University of Oxford, Oxford, UK.;Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.;Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.摘要： BACKGROUND: Migrant women are at risk of perinatal mental disorders due to stressors experienced before, during and after migration. OBJECTIVES: This systematic review and meta-analysis summarises the prevalence, associated factors and interventions for perinatal mental disorders in migrant women from low- and middle-income countries (LMIC). SEARCH STRATEGY: We systematically searched nine electronic databases and the grey literature using a predefined search strategy. SELECTION CRITERIA: Studies were included if they assessed pregnant or postpartum migrants from LMIC, used a structured tool and a case-control, cross-sectional, cohort or intervention study design. DATA COLLECTION AND ANALYSIS: Data was double-extracted. We calculated pooled prevalence of depression and weighted mean anxiety and depression scores. We calculated crude odds ratios from risk factor studies and summarised intervention studies descriptively. MAIN RESULTS: Forty studies were identified from 10 123 references. Pooled prevalence was 31% [95% condidence interval (CI) 23%-40%] for any depressive disorder and 17% (95% CI 12-23%) for major depressive disorder. Previous depression and lower social support were associated with perinatal depression. There were insufficient data to assess the burden of anxiety, post-traumatic stress disorder or psychosis in this population. CONCLUSIONS: One in three migrant women from LMIC experiences symptoms of perinatal depression. Social support is an important protective factor. Evidence on LMIC women relocating to other LMIC is lacking. Given the adverse consequences of perinatal mental illness on women and their children, further

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research in low-resource settings is a priority. TWEETABLE ABSTRACT: One in three migrant women from low- and middle-income countries has symptoms of perinatal depression. KEYWORDS:NOTNLM;

编号：4题名：Induction of labour: many choices, but still in search of the perfect protocol.作者：Robinson JN出处：BJOG.2017V124N5:803机构：Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA.摘要：

编号：5题名：Revisiting the diagnostic criteria of clinical chorioamnionitis in preterm birth.作者：Sung JH;Choi SJ;Oh SY;Roh CR;Kim JH出处：BJOG.2017V124N5:775-783机构：Department of Obstetrics and Gynaecology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea.;Department of Obstetrics and Gynaecology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea.;Department of Obstetrics and Gynaecology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea.;Department of Obstetrics and Gynaecology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea.;Department of Obstetrics and Gynaecology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea.摘要： OBJECTIVE: To re-evaluate the utility of the conventional criteria for clinical chorioamnionitis in the prediction of early-onset neonatal sepsis (EONS) in preterm birth. DESIGN: Retrospective cohort study. SETTING: Seoul, Republic of Korea. SAMPLE: A total of 1468 singleton births between 24 and 34 weeks due to preterm labour (n = 713) or preterm prelabour rupture of membranes (n = 755). METHOD: We evaluated three diagnostic categories of clinical chorioamnionitis: Criteria 1, conventional criteria; Criteria 2, combination of any three conventional parameters without prerequisite fever; Criteria 3, Criteria 1 plus positive maternal C-reactive protein and neutrophil left-shift into minor criteria. EONS included proven or suspected sepsis within 7 days following birth. Neonatal morbidity and mortality of EONS were also reviewed. MAIN OUTCOME MEASURES: Diagnostic performance of three combinations. RESULTS: The prevalence of EONS was 13.8%. Among 203 cases of EONS, maternal manifestation of clinical chorioamnionitis by criteria 1 was evident in only one out of seven, indicating 15.3% sensitivity for EONS prediction. However, with application of criteria 2, sensitivity significantly increased to 34.0%, while compromising specificity from 92.3% to 78.7%. Criteria 3 showed similar diagnostic performance compared with criteria 1 (sensitivity 16.7%, specificity 91.6%). Overall, neonatal mortality and neonatal composite morbidity in EONS were 14.9% and 67.8%, respectively, and there was no difference in neonatal morbidity and mortality between neonates whose mothers showed fever as a sign of clinical chorioamnionitis and those whose mothers did not. CONCLUSION: The renouncement of fever as a prerequisite for the criteria of clinical chorioamnionitis could increase sensitivity for the identification of EONS, a serious outcome of preterm birth. TWEETABLE ABSTRACT: The renouncement of fever as an essential can increase sensitivity for prediction of neonatal sepsis. KEYWORDS:NOTNLM;

编号：6题名：Perinatal mental health in low- and middle-income country migrants.

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作者：Stewart DE出处：BJOG.2017V124N5:753机构：University Health Network and Departments of Psychiatry and Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada.摘要：

编号：7题名：Women with intellectual disability are at a higher risk of adverse maternal and offspring outcomes.作者：Goldacre MJ出处：BJOG.2017V124N5:766机构：Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, UK.摘要：

编号：8题名：Gestational diabetes in the United States: temporal changes in prevalence rates between 1979 and 2010.作者：Lavery JA;Friedman AM;Keyes KM;Wright JD;Ananth CV出处：BJOG.2017V124N5:804-813机构：Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.;Biostatistics Coordinating Center, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.;Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.;Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA.;Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.;Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.;Biostatistics Coordinating Center, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.;Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA.摘要： OBJECTIVE: To examine age-period-cohort effects on trends in gestational diabetes mellitus (GDM) prevalence in the US, and to evaluate how these trends have affected the rates of stillbirth and large for gestational age (LGA)/macrosomia. DESIGN: Retrospective cohort study. SETTING: USA, 1979-2010. POPULATION: Over 125 million pregnancies (3 337 284 GDM cases) associated with hospitalisations. METHODS: Trends in GDM prevalence were examined via weighted Poisson models to parse out the extent to which GDM trends can be attributed to maternal age, period of delivery, and maternal birth cohort. Multilevel models were used to assess the contribution of population effects to the rate of GDM. Log-linear Poisson regression models were used to estimate the contributions of the increasing GDM rates to changes in the rates of LGA and stillbirth between 1979-81 and 2008-10. MAIN OUTCOME MEASURES: Rates and rate ratios (RRs). RESULTS: Compared with 1979-1980 (0.3%), the rate of GDM has increased to 5.8% in 2008-10, indicating a strong period effect. Substantial age and modest cohort effects were evident. The period effect is partly explained by period trends in body mass index (BMI), race, and maternal smoking. The increasing prevalence of GDM is associated with a 184% (95% CI 180-188%) decline in the rate of LGA/macrosomia and a 0.75% (95% CI 0.74-0.76) increase in the rate of stillbirths for 2008-10, compared with 1979-81. CONCLUSIONS: The temporal increase in GDM can be attributed to period of pregnancy and age. Increasing BMI

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appears to partially contribute to the GDM increase in the US. TWEETABLE ABSTRACT: The increasing prevalence of GDM can be attributed to period of delivery and increasing maternal age. KEYWORDS:NOTNLM;

编号：9题名：Collect and report accurate early gestational age birth data.作者：Goldenberg RL;McClure EM出处：BJOG.2017V124N5:795机构：Columbia University, New York, NY, USA.;RTI International, Durham, NC, USA.摘要：

编号：10题名：Women's autonomy versus societal pressure to control fertility.作者：Rowlands S出处：BJOG.2017V124N5:824机构：Centre of Postgraduate Medical Research and Education, Bournemouth University, Bournemouth, UK.摘要：

编号：11题名：Maternal and perinatal mortality and morbidity associated with tuberculosis during pregnancy and the postpartum period: a systematic review and meta-analysis.作者：Sobhy S;Babiker Z;Zamora J;Khan KS;Kunst H出处：BJOG.2017V124N5:727-733机构：Women's Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.;Department of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK.;Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE.;Women's Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.;Multidisciplinary Evidence Synthesis Hub (mEsh), Centre of Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK.;Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS) and CIBER Epidemiology and Public Health, Madrid, Spain.;Women's Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.;Multidisciplinary Evidence Synthesis Hub (mEsh), Centre of Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK.;Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.摘要： BACKGROUND: There is a dearth of data on the clinical features and outcomes of active tuberculosis (TB) in pregnancy. Studies have shown varied results and the relationship between TB and adverse pregnancy outcomes remains unclear. OBJECTIVES: We conducted a systematic review and meta-analysis to evaluate pregnancy outcomes associated with TB. SEARCH STRATEGY: Major databases were searched from inception until December 2015 without restrictions using the terms: 'TB', 'pregnancy', 'maternal morbidity', 'mortality' and 'perinatal morbidity', 'mortality'. SELECTION CRITERIA: We included studies that compared the outcomes of pregnant women with and without active TB. DATA COLLECTION AND ANALYSIS: We computed odds ratios for maternal and perinatal complications, and pooled them using a random effects model. We assessed for heterogeneity using chi-squared tests

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and evaluated its magnitude using the I2 statistic. We used the Newcastle-Ottawa scale for quality assessment. MAIN RESULTS: Thirteen studies, including 3384 pregnancies with active TB and 119 448 without TB were included. Compared with pregnant women without TB, pregnant women with active TB was associated with increased odds of maternal morbidity [odds ratio (OR) 2.8, 95% CI 1.7-4.6; I2 = 60.3%], anaemia (OR 3.9, 95% CI 2.2-6.7; I2 = 29.8%), caesarean delivery (OR 2.1, 95% CI 1.2-3.8; I2 = 61.1%), preterm birth (OR 1.7, 95% CI 1.2-2.4; I2 = 66.5%), low birth weight (OR 1.7, 95% CI 1.2-2.4; I2 = 53.7%), birth asphyxia (OR 4.6, 95% CI 2.4-8.6; I2 = 46.3), and perinatal death (OR 4.2, 95% CI 1.5-11.8; I2 = 57.2%). AUTHOR'S CONCLUSION: Active TB in pregnancy is associated with adverse maternal and fetal outcomes. Early diagnosis of TB is important to prevent significant maternal and perinatal complications. TWEETABLE ABSTRACT: Active tuberculosis in pregnancy is associated with adverse maternal and perinatal outcomes. KEYWORDS:NOTNLM;

编号：12题名：Multidisciplinary care ensures successful pregnancy following intestinal transplantation: a case report.作者：Blackwell V;Holdaway L;Hogan J;Gilbert J;Sinha S;Vrakas G;Reddy S;Friend P;Mackillop L;Harrington D;Greenwood C;Vaidya A;Allan PJ出处：BJOG.2017V124N5:825-828机构：Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.;Oxford Transplant Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.;Department of Obstetrics and Gynaecology, Women's Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.;Oxford Transplant Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.;Oxford Transplant Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.;Oxford Transplant Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.;Oxford Transplant Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.;Oxford Transplant Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.;Department of Obstetrics and Gynaecology, Women's Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.;Department of Obstetrics and Gynaecology, Women's Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.;Department of Obstetrics and Gynaecology, Women's Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.;Oxford Transplant Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.;Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.;Oxford Transplant Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.摘要：

编号：13题名：Prevention and Management of Postpartum Haemorrhage: Green-top Guideline No. 52.出处：BJOG.2017V124N5:e106-e149

编号：14题名：On-site test to detect syphilis in pregnancy: a systematic review of test accuracy studies.作者：Rogozinska E;Kara-Newton L;Zamora JR;Khan KS出处：BJOG.2017V124N5:734-741

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机构：Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK.;Multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK.;Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK.;Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK.;Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS) and CIBER Epidemiology and Public Health, Madrid, Spain.;Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK.;Multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK.摘要： BACKGROUND: Syphilis in pregnancy can lead to fetal and neonatal death or congenital anomalies. Accurate on-site tests are an essential part of effective prevention of mother-to-child transmission of the disease. OBJECTIVE: This systematic review assessed the accuracy of on-site tests to detect infection with Treponema pallidum in pregnant women. SEARCH STRATEGY: Major databases were searched from inception to January 2016 using terms: 'pregnancy', 'antenatal', 'syphilis', 'Treponema pallidum' with their variations, and the search limit for the relevant study design. SELECTION CRITERIA: We included studies that used dual reference standard (non-treponemal and treponemal tests) to detected syphilis in pregnancy. DATA COLLECTION AND ANALYSIS: Extracted accuracy data were tabulated and pooled using hierarchical, bivariate random effects model. MAIN RESULTS: Seven studies (combined sample 17 546) reporting the accuracy of four on-site tests met the eligibility criteria. On average, Determine and SD BioLine Syphilis 3.0 had the highest sensitivity of all the evaluated tests: 0.83 (95% CI 0.58, 0.98) and 0.86 (95% CI 0.82, 0.89), respectively, with a high specificity 0.96 (95% CI 0.89, 1.00) and 0.99 (95% CI 0.94, 1.00), respectively. The Qualitative Rapid Plasma Reagin card commonly used in clinical practice had a pooled sensitivity of 0.70 (95% CI 0.54, 0.88) and specificity of 0.97 (95% CI 0.96, 0.99). CONCLUSION: Immunochromatographic tests such as Determine and SD BioLine Syphilis 3.0 seem to be acceptable options in antenatal testing for syphilis, especially in resource-limited settings. Future research should seek more evidence to strengthen this claim. TWEETABLE ABSTRACT: On-site test to detect syphilis-options during antenatal care. KEYWORDS:NOTNLM;

编号：15题名：Author's reply re: Symphysiotomy for obstructed labour: a systematic review and meta-analysis.作者：Wilson A出处：BJOG.2017V124N5:834机构：Birmingham Women's Hospital Foundation Trust, University of Birmingham, Birmingham, UK.摘要：

编号：16题名：Elective single-embryo transfer (eSET) reduces pregnancy rates and should only be used in exceptional circumstances: FOR: The statistically flawed model of eSET.作者：Gleicher N;Kushnir VA;Barad DH出处：BJOG.2017V124N5:755机构：The Center for Human Reproduction, New York, NY, USA.;The Foundation for Reproductive Medicine, New York, NY, USA.;The Rockefeller University, New York, NY, USA.;Medical University of Vienna, Vienna, Austria.;The Center for Human Reproduction, New York, NY, USA.;Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston Salem, NC, USA.;The Center for Human Reproduction, New York, NY, USA.

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摘要：

编号：17题名：Re: Prolonged latency of preterm prelabour rupture of membranes and neurodevelopmental outcomes: a secondary analysis.作者：Roberts CL;Ford JB;Algert CS;Morris JM出处：BJOG.2017V124N5:830-831机构：Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.;Sydney Medical School Northern, University of Sydney, St Leonards, NSW, Australia.;Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.;Sydney Medical School Northern, University of Sydney, St Leonards, NSW, Australia.;Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.;Sydney Medical School Northern, University of Sydney, St Leonards, NSW, Australia.;Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.;Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, NSW, Australia.摘要：

编号：18题名：Perinatal mental health in migrant women.作者：Chien P出处：BJOG.2017V124N5:711-712

编号：19题名：Authors' reply re: A comparison of the recommendations for pharmacologic thromboembolism prophylaxis after caesarean delivery from the major guidelines.作者：Friedman A;Palmerola K;D'Alton M出处：BJOG.2017V124N5:832-833机构：Department of Obstetrics & Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA.;Department of Obstetrics & Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA.;Department of Obstetrics & Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA.摘要：

编号：20题名：A century of changing views on ECV.作者：Steer PJ出处：BJOG.2017V124N5:774机构：BJOG, UK.摘要：

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编号：21题名：Maternal fever, prematurity and early-onset sepsis.作者：Higgins R;Silver R出处：BJOG.2017V124N5:784机构：Pregnancy and Perinatology Branch, NICHD/NIH, Bethesda, MD, USA.;Obstetrics & Gynaecology, University of Utah, Salt Lake City, UT, USA.摘要：

编号：22题名：Re: A comparison of the recommendations for pharmacologic thromboembolism prophylaxis after caesarean delivery from the major guidelines: Impact on thromboprophylaxis rates of implementing Royal College of Obstetricians and Gynaecologists' guidance for reducing the risk of ante- and postnatal venous thromboembolism.作者：Omunakwe HE;Roberts LN;Patel JP;Subramanian D;Arya R出处：BJOG.2017V124N5:831-832机构：King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK.;King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK.;King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK.;Institute of Pharmaceutical Science, King's College London, London, UK.;Women's Health, King's College Hospital NHS Foundation Trust, London, UK.;King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK.摘要：

编号：23题名：BJOG Referees 2016.出处：BJOG.2017V124N5:836-839

编号：24题名：Erratum.出处：BJOG.2017V124N5:840

编号：25题名：'Elective single embryo transfer (eSET) reduces pregnancy rates and should only be used in exceptional circumstances': AGAINST: SET maintains live birth rates and provides unique advantages.作者：Miller LM出处：BJOG.2017V124N5:756机构：Fertility Plus, Reproductive Endocrinology and Fertility Unit of National Women's Hospital, Greenlane Clinical Centre, Auckland, New Zealand.摘要：

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编号：26题名：Re: Symphysiotomy for obstructed labour: a systematic review and meta-analysis.作者：Verkuyl D出处：BJOG.2017V124N5:833机构：CASA Klinieken Leiden, Driebergen, The Netherlands.摘要：

编号：27题名：Re: The effect of maternal haematocrit on offspring IQ at 4 and 7 years age: a secondary analysis.作者：Esmyot ML;Bonsu S;Immesaoudene S;Viegas A;Vusirikala K;Mahran M出处：BJOG.2017V124N5:829机构：Obstetrics and Gynaecology Department, Bedford Hospital NHS Trust, Bedford, UK.;Obstetrics and Gynaecology Department, Bedford Hospital NHS Trust, Bedford, UK.;Obstetrics and Gynaecology Department, Bedford Hospital NHS Trust, Bedford, UK.;Obstetrics and Gynaecology Department, Bedford Hospital NHS Trust, Bedford, UK.;Obstetrics and Gynaecology Department, Bedford Hospital NHS Trust, Bedford, UK.;Obstetrics and Gynaecology Department, Bedford Hospital NHS Trust, Bedford, UK.摘要：

编号：28题名：A report from #BlueJC: How can we improve care for pregnant and postpartum migrants?作者：Leung EY出处：BJOG.2017V124N5:835机构：Wolfson Wohl Cancer Research Centre, Glasgow, UK.摘要：

编号：29题名：Authors' reply re: The effect of maternal haematocrit on offspring IQ at 4 and 7 years age: a secondary analysis.作者：Drassinower D;Friedman AM;Ananth CV出处：BJOG.2017V124N5:829-830机构：Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, MedStar Georgetown University Hospital, Washington, DC, USA.;Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.;Department of Obstetrics and Gynecology, Biostatistics Coordinating Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA.;Department of Epidemiology, Joseph L. Mailman School of Public Health, New York, NY, USA.摘要：

编号：30

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题名：Authors' reply re: Prolonged latency of preterm prelabour rupture of membranes and neurodevelopmental outcomes: a secondary analysis.作者：Drassinower D;Friedman A;Gyamfi-Bannerman C出处：BJOG.2017V124N5:831机构：Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, MedStar Georgetown University Hospital, Washington, DC, USA.;Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, MedStar Georgetown University Hospital, Washington, DC, USA.;Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, MedStar Georgetown University Hospital, Washington, DC, USA.摘要：

编号：31题名：The baby is for turning: external cephalic version.作者：Paul C出处：BJOG.2017V124N5:773机构：Whittington Hospital, Women's Health, London, UK.摘要：

编号：32题名：Postpartum haemorrhage: a single definition is no longer enough.作者：Kerr RS;Weeks AD出处：BJOG.2017V124N5:723-726机构：Sanyu Research Unit, Department of Women's and Children's Health, University of Liverpool, Liverpool Women's Hospital, Liverpool, UK.;Sanyu Research Unit, Department of Women's and Children's Health, University of Liverpool, Liverpool Women's Hospital, Liverpool, UK.摘要：

编号：33题名：Variations in very preterm birth rates in 30 high-income countries: are valid international comparisons possible using routine data?作者：Delnord M;Hindori-Mohangoo AD;Smith LK;Szamotulska K;Richards JL;Deb-Rinker P;Rouleau J;Velebil P;Zile I;Sakkeus L;Gissler M;Morisaki N;Dolan SM;Kramer MR;Kramer MS;Zeitlin J出处：BJOG.2017V124N5:785-794机构：Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epope), Centre for Epidemiology and Statistics Sorbonne Paris Cite, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.;Department Child Health, TNO, The Netherlands Organisation for Applied Scientific Research, Leiden, The Netherlands.;Department Public Health, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname.;The Infant Mortality and Morbidity Studies Group (TIMMS), Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.;Department of Epidemiology and Biostatistics, National Research Institute of Mother and Child, Warsaw, Poland.;Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.;Surveillance and Epidemiology Division, Centre for Chronic Disease Prevention, Public Health Agency of Canada, Ottawa, ON, Canada.;Surveillance

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and Epidemiology Division, Centre for Chronic Disease Prevention, Public Health Agency of Canada, Ottawa, ON, Canada.;Institute for the Care of Mother and Child, Prague, Czech Republic.;Centre for Disease Prevention and Control of Latvia, Riga, Latvia.;Estonian Institute for Population Studies, Tallinn University, Tallinn, Estonia.;THL National Institute for Health and Welfare, Helsinki, Finland.;Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Stockholm, Sweden.;Department of Lifecourse Epidemiology, Department of Social Medicine, National Centre for Child Health and Development, Setagayaku, Tokyo, Japan.;Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.;Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.;Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, QC, Canada.;Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epope), Centre for Epidemiology and Statistics Sorbonne Paris Cite, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.摘要： OBJECTIVE: Concerns about differences in registration practices across countries have limited the use of routine data for international very preterm birth (VPT) rate comparisons. DESIGN: Population-based study. SETTING: Twenty-seven European countries, the United States, Canada and Japan in 2010. POPULATION: A total of 9 376 252 singleton births. METHOD: We requested aggregated gestational age data on live births, stillbirths and terminations of pregnancy (TOP) before 32 weeks of gestation, and information on registration practices for these births. We compared VPT rates and assessed the impact of births at 22-23 weeks of gestation, and different criteria for inclusion of stillbirths and TOP on country rates and rankings. MAIN OUTCOME MEASURES: Singleton very preterm birth rate, defined as singleton stillbirths and live births before 32 completed weeks of gestation per 1000 total births, excluding TOP if identifiable in the data source. RESULTS: Rates varied from 5.7 to 15.7 per 1000 total births and 4.0 to 11.9 per 1000 live births. Country registration practices were related to percentage of births at 22-23 weeks of gestation (between 1% and 23% of very preterm births) and stillbirths (between 6% and 40% of very preterm births). After excluding births at 22-23 weeks, rate variations remained high and with a few exceptions, country rankings were unchanged. CONCLUSIONS: International comparisons of very preterm birth rates using routine data should exclude births at 22-23 weeks of gestation and terminations of pregnancy. The persistent large rate variations after these exclusions warrant continued surveillance of VPT rates at 24 weeks and over in high-income countries. TWEETABLE ABSTRACT: International comparisons of VPT rates should exclude births at 22-23 weeks of gestation and terminations of pregnancy. KEYWORDS:NOTNLM;

编号：34题名：Comparison of postpartum haemorrhage guidelines: discrepancies underline our lack of knowledge.作者：Sentilhes L;Goffinet F;Vayssiere C;Deneux-Tharaux C出处：BJOG.2017V124N5:718-722机构：Department of Obstetrics and Gynaecology, Bordeaux University Hospital, Bordeaux, France.;INSERM U1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Centre for Epidemiology and Statistics Sorbonne Paris Cite, DHU Risks and Pregnancy, Paris Descartes University, Paris, France.;Port-Royal Maternity Unit, Cochin Broca Hotel-Dieu University Hospital, APHP, Paris Descartes University, Paris, France.;Department of Obstetrics and Gynaecology, Paule de Viguier University Hospital, Toulouse, France.;UMR 1027 Inserm Toulouse III University 'Epidemiologie Perinatale et handicap de l'enfant, Sante des adolescents', Toulouse, France.;INSERM U1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Centre for Epidemiology and Statistics Sorbonne Paris Cite, DHU Risks and Pregnancy, Paris Descartes University, Paris, France.摘要：

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编号：35题名：Caution in clinical interpretation of population level administrative data.作者：Abell SK;Zoungas S;Teede HJ出处：BJOG.2017V124N5:814机构：Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Vic., Australia.;Monash Diabetes, Monash Health, Clayton, Vic., Australia.;Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Vic., Australia.;Monash Diabetes, Monash Health, Clayton, Vic., Australia.;Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Vic., Australia.;Monash Diabetes, Monash Health, Clayton, Vic., Australia.摘要：

编号：36题名：Maternal and offspring outcomes in women with intellectual and developmental disabilities: a population-based cohort study.作者：Brown HK;Cobigo V;Lunsky Y;Vigod SN出处：BJOG.2017V124N5:757-765机构：Women's College Research Institute and University of Toronto, Toronto, ON, Canada.;Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.;Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.;School of Psychology, University of Ottawa, Ottawa, ON, Canada.;Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.;Centre for Addiction and Mental Health and University of Toronto, Toronto, ON, Canada.;Women's College Research Institute and University of Toronto, Toronto, ON, Canada.;Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.摘要： OBJECTIVE: To compare the risks for adverse maternal and offspring outcomes in women with and without intellectual and developmental disabilities. DESIGN: Population-based cohort study. SETTING: Ontario, Canada. POPULATION: Singleton obstetrical deliveries to 18- to 49-year-old women with and without intellectual and developmental disabilities (n = 3932 in the exposed cohort, n = 382 774 in the unexposed cohort; 2002-2011 fiscal years). METHODS: Women with intellectual and developmental disabilities were identified based on diagnoses in health administrative data or receipt of disability income support. The unexposed cohort comprised women without intellectual and developmental disabilities. Modified Poisson regression was used to compute adjusted relative risks (aRR) and 95% confidence intervals (CI) comparing the two cohorts. MAIN OUTCOME MEASURES: Primary maternal outcomes were: gestational diabetes, gestational hypertension, pre-eclampsia, eclampsia, and venous thromboembolism. Primary offspring outcomes were: preterm birth, small for gestational age, and large for gestational age. RESULTS: The exposed cohort, compared with the unexposed cohort, had increased risks for pre-eclampsia (aRR 1.47, 95% CI 1.11-1.93) and venous thromboembolism (aRR 1.60, 95% CI 1.17-2.19). Their offspring had increased risks for preterm birth (aRR 1.63, 95% CI 1.47-1.80) and small for gestational age (aRR 1.35, 95% CI 1.25-1.45). CONCLUSIONS: These findings suggest that there is a need to address modifiable risk factors for adverse outcomes among women with intellectual and developmental disabilities prior to and during pregnancy. Moreover, there is a need to enhance monitoring for maternal and offspring complications in this population. TWEETABLE ABSTRACT: Large cohort study: intellectual and developmental disabilities predispose women/babies to adverse outcomes. KEYWORDS:NOTNLM;

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编号：37题名：Pregnancy following intestinal transplant: feasible with multidisciplinary team.作者：Chauhan SP;Thorp JM Jr出处：BJOG.2017V124N5:828机构：McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.;Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA.摘要：

编号：38题名：Contraceptive method preferences and provision after termination of pregnancy: a population-based analysis of women obtaining care with the British Pregnancy Advisory Service.作者：Aiken A;Lohr PA;Aiken CE;Forsyth T;Trussell J出处：BJOG.2017V124N5:815-824机构：LBJ School of Public Affairs, University of Texas at Austin, Austin, TX, USA.;Population Research Center, University of Texas at Austin, Austin, TX, USA.;British Pregnancy Advisory Service, Warwickshire, UK.;University Department of Obstetrics and Gynaecology, NIHR Cambridge Comprehensive Biomedical Research Centre, University of Cambridge, Cambridge, UK.;British Pregnancy Advisory Service, Warwickshire, UK.;Office of Population Research, Princeton University, Princeton, NJ, USA.;Chalmers Center, University of Edinburgh, Edinburgh, UK.摘要： OBJECTIVE: To examine contraceptive choices among women seeking termination of pregnancy (TOP) and the provision of the chosen methods. DESIGN: Population-based study. SETTING: British Pregnancy Advisory Service (BPAS) clinics in England and Wales. POPULATION: Between 1 January 2011 and 31 December 2014, 211 215 women had a TOP at BPAS, were offered contraceptive counselling, and were eligible to obtain contraception at no cost. METHODS: We examined electronic records from BPAS and assessed the proportions of women who accepted contraceptive counselling and chose a contraceptive method, as well as the distributions of methods chosen, analysed by provider and by TOP type. We calculated the proportions receiving their chosen method and the methods chosen by women using no method at conception. We used logistic regression to examine the factors associated with choice of an intrauterine contraceptive (IUC) or implant. MAIN OUTCOME MEASURES: Post-TOP contraceptive method choice. Receipt of chosen method post-TOP. RESULTS: Eighty-five per cent of women accepted contraceptive counselling and 51% chose to obtain a method from BPAS rather than from a GP or contraception and sexual health clinic post-TOP. [correction added on 25 November 2016 after first online publication: 51% has been inserted in the preceding sentence.] Among those who wanted to receive contraception from BPAS, 51% chose an IUC or implant and 19% chose oral contraceptives. Ninety-one per cent of women who obtained contraception from BPAS received their chosen method. Women were more likely to choose an IUC or implant if they obtained contraception from BPAS, had a surgical TOP, were parous, young, white, or had one or more previous TOPs. CONCLUSIONS: The standards set for patient-centred TOP care should emphasise the need for a full range of contraceptive options to be offered and provided post-TOP. TWEETABLE ABSTRACT: Uptake targets for long-acting reversible methods do not reflect women's post-TOP contraceptive preferences. KEYWORDS:NOTNLM;

Int J Nurs Stud

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编号：1题名：Workplace violence against nurses: A cross-sectional study.作者：Zhang L;Wang A;Xie X;Zhou Y;Li J;Yang L;Zhang J出处：Int J Nurs Stud.2017V72N:8-14机构：Medical College, Hunan Normal University, No. 371 Tongzipo Road, Yuelu District, Changsha, Hunan, China; Nursing Psychology Research Center of Xiangya Nursing School, Central South University, No. 172 Tongzipo Road, Yuelu District, Changsha, Hunan, China.;Nursing Psychology Research Center of Xiangya Nursing School, Central South University, No. 172 Tongzipo Road, Yuelu District, Changsha, Hunan, China.;Intensive Care Unit of Thoracic Surgery, The Second Xiangya Hospital of Central South University, No. 139 Middle Renmin Road, Furong District, Changsha, Hunan, China.;Intensive Care Unit of Thoracic Surgery, The Second Xiangya Hospital of Central South University, No. 139 Middle Renmin Road, Furong District, Changsha, Hunan, China.;School of Nursing, Wannan Medical College, No. 22 Wenchang Road, Wuhu, Anhui, China.;Department of Nursing, Tibet University, No. 36 Jiangsu Road, Lhasa, Tibet, China.;Nursing Psychology Research Center of Xiangya Nursing School, Central South University, No. 172 Tongzipo Road, Yuelu District, Changsha, Hunan, China. Electronic address: [email protected].摘要： BACKGROUND: Workplace violence is a serious problem for clinical nurses, as it leads to a series of adverse consequences. However, little information is available on the prevalence and influencing factors of workplace violence in China. OBJECTIVES: To determine the prevalence of workplace violence against Chinese nurses, and its influencing factors. DESIGN: A multi-center, cross-sectional study. SETTINGS: The seven geographical regions (i.e., northeast, north, central, east, south, northwest, and southwest) of China. PARTICIPANTS: Four thousand one hundred and twenty-five nurses. METHODS: We randomly selected 28 hospitals, located in 14 cities over 13 provinces across the seven geographical regions. We distributed 4125 questionnaires between May 4 and September 23, 2014. The questionnaire included demographic information, the Workplace Violent Incident Questionnaire, the Jefferson Scale of Empathy-Health Professionals, and the Practice Environment Scale of Nursing Work Index. Workplace violence was assessed in terms of physical violence, non-physical violence, sexual harassment, and organized healthcare disturbances. We then performed descriptive analyses and logistic regressions on the collected data. RESULTS: The response rate was 92.97% (n=3835). Additionally, we obtained valid questionnaires from 3004 individuals. Of these, 25.77% reported experiencing physical violence, 63.65% non-physical violence, 2.76% sexual harassment, and 11.72% organized healthcare disturbances. A logistic regression analysis revealed that nurses who have less experience, work a rotating roster, work in emergency rooms and pediatrics departments, have low empathy levels, and who work in poor nursing environments have greater odds of experiencing violence. CONCLUSIONS: Experiences of workplace violence are prevalent among Chinese nurses, and several complex factors are associated with a greater risk of such violence, including nurses' personal characteristics, work settings, and work environments. Our results might help nursing managers understand their employees' work status. We recommend that nursing leaders provide and enhance education and support for high-risk groups to help protect Chinese nurses from workplace violence. KEYWORDS:NOTNLM;

编号：2题名：Tourniquet application after local forearm warming to improve venodilation for peripheral intravenous cannulation in young and middle-aged adults: A single-blind prospective randomized controlled trial.作者：Yamagami Y;Tomita K;Tsujimoto T;Inoue T出处：Int J Nurs Stud.2017V72N:1-7机构：Department of Health Science, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka 565-0871, Japan; Japan Society for the Promotion of Science, Kojimachi Business Centre Building, 5-3-1 Kojimachi,

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Chiyoda-ku, Tokyo 102-0083, Japan. Electronic address: [email protected].;Department of Health Science, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka 565-0871, Japan. Electronic address: [email protected].;Department of Health Science, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka 565-0871, Japan. Electronic address: [email protected].;Department of Health Science, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka 565-0871, Japan. Electronic address: [email protected].摘要： BACKGROUND: Local forearm warming before tourniquet application is often used to promote venodilation for peripheral intravenous cannulation; however, few studies have compared the effect of tourniquet application with and without local warming on vein size. OBJECTIVE: To evaluate the effectiveness of tourniquet application after local forearm warming with that of tourniquet application alone in young and middle-aged adults. DESIGN: A single-blind, prospective, parallel group, randomized controlled trial. SETTING: A national university in Japan. PARTICIPANTS: Seventy-two volunteers aged 20-64 years. METHODS: Participants were randomly allocated to one of two groups: tourniquet application for 30s after forearm application of a heat pack warmed to 40 degrees C+/-2 degrees C for 15min (active warming group; n=36) or tourniquet application for 30s after applying a non-warmed heat pack for 15min (passive warming group; n=36). The primary outcomes were vein cross-sectional area on the forearm, measured after the intervention by blinded research assistants using ultrasound. Secondary outcomes were shortest diameter, and longest diameter of vein on the forearm, forearm skin temperature, body temperature, pulse, systolic blood pressure, and diastolic blood pressure. All outcomes were assessed at the same site before and immediately after the intervention, once per participant. RESULTS: Vein cross-sectional area, shortest vein diameter, and longest vein diameter were significantly increased in the active warming group compared with the passive warming group (p <0.01). Tourniquet application after local warming was superior to tourniquet application alone in increasing vein cross-sectional, shortest diameter, and longest diameter (between-group differences of 2.2mm2, 0.5mm, and 0.5mm, respectively), and in raising skin temperature (between-group difference: 5.2 degrees C). However, there were no significant differences in body temperature, pulse, or systolic or diastolic blood pressure between the groups. There were no adverse events associated with either intervention. CONCLUSION: Tourniquet application after local warming was associated with increased forearm vein size when compared with tourniquet application alone, and was demonstrated as being safe. Thus, with demonstrable effects on vein size, we recommend local warming before tourniquet application as a safe and effective technique for improving venodilation. KEYWORDS:NOTNLM;

Am J Manag Care

编号：1题名：Applying organizational behavior theory to primary care.作者：Mullangi S;Saint S出处：Am J Manag Care.2017V23N3:194-196机构：Department of Internal Medicine, University of Michigan Health System, 1500 E Medical Center Drive, Ann Arbor, MI 48109. E-mail: [email protected].摘要： Addressing the mounting primary care shortage in the United States has been a focus of educators and policy makers, especially with the passage of the Affordable Care Act in 2010 and the Medicare Access and CHIP Reauthorization Act in 2015, placing increased pressure on the system. The Association of American Medical Colleges recently projected a shortage of as many as 65,000 primary care physicians by 2025, in part because fewer than 20% of medical

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students are picking primary care for a career. We examined the issue of attracting medical students to primary care through the lens of organizational behavior theory. Assuming there are reasons other than lower income potential for why students are inclined against primary care, we applied various principles of the Herzberg 2-factor theory to reimagine the operational flow and design of primary care. We conclude by proposing several solutions to enrich the job, such as decreasing documentation requirements, reducing the emphasis on specialty consultations, and elevating physicians to a supervisory role.

编号：2题名：Impact of a pharmacy-based transitional care program on hospital readmissions.作者：Ni W;Colayco D;Hashimoto J;Komoto K;Gowda C;Wearda B;McCombs J出处：Am J Manag Care.2017V23N3:170-176机构：University of Southern California, 635 Downey Way, VPD Ste 210, Los Angeles, CA 90089-3333. E-mail: [email protected].摘要： OBJECTIVES: Avoidable readmissions of patients discharged from hospitals are a major concern. This study evaluates the impact of pharmacist-provided postdischarge services on hospital readmissions for members of a US managed Medicaid health plan. STUDY DESIGN: Prospective cohort study. METHODS: Synergy Pharmacy Solutions (SPS) initiated a transition of care (TOC) service for high-risk members of the Kern Health Systems (KHS) managed Medicaid plan. Over 1100 patients were referred to SPS between April 2013 and March 2015. KHS classified hospitalized members as high risk for readmission based on prior healthcare utilization, a health risk assessment questionnaire, and the use of the Johns Hopkins predictive modeler. This study compares SPS TOC recipients with a matched sample of KHS members discharged from nonintervention hospitals. Thirty-day and 180-day readmissions and time-to-readmission were defined as outcomes. Logistic regression and Cox model were estimated, controlling for demographics, diagnostic and drug profiles, and prior hospital utilization. RESULTS: KHS identified 1763 high-risk discharges from nonintervention hospitals, of which 1005 and 669 were matched to 830 and 558 selected SPS patients in 30-day and 180-day populations, respectively. The SPS postdischarge intervention reduced the risk of readmission within 30 days by 28% (odds ratio [OR], 0.720; 95% confidence interval [CI], 0.526-0.985) and within 180 days by 31.9% (OR, 0.681; 95% CI, 0.507-0.914). The estimated effect of the SPS intervention from the Cox model was a reduction in risk of 25% (hazard ratio, 0.749; 95% CI, 0.566-0.992). CONCLUSIONS: A community pharmacy-based postdischarge TOC program can significantly reduce readmission rates at 30 and 180 days compared with usual discharge care.

编号：3题名：Patient experience midway through a large primary care practice transformation initiative.作者：Swankoski KE;Peikes DN;Dale SB;Clusen NA;Morrison N;Holland JJ;Day TJ;Brown RS出处：Am J Manag Care.2017V23N3:178-184机构：Mathematica Policy Research, PO Box 2393, Princeton, NJ 08543. E-mail: [email protected].

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摘要： OBJECTIVES: To determine how the multipayer Comprehensive Primary Care (CPC) initiative that transforms primary care delivery affects the patient experience of Medicare fee-for-service beneficiaries. The study examines how experience changed between the first and second years of CPC, how ratings of CPC practices have changed relative to ratings of comparison practices, and areas in which practices still have opportunities to improve patient experience. STUDY DESIGN: Prospective study using 2 serial cross-sectional samples of more than 25,000 Medicare fee-for-service beneficiaries attributed to 496 CPC practices and nearly 9000 beneficiaries attributed to 792 comparison practices. METHODS: We analyzed patient experience 8 to 12 months and 21 to 24 months after CPC began, measured using 6 domains of the Consumer Assessment of Healthcare Providers and Systems Clinician and Group 12-Month Survey with Patient-Centered Medical Home supplemental items. We compared changes over time in patients giving the best responses between CPC and comparison practices using a regression-adjusted difference-in-differences analysis. RESULTS: Patient ratings of care over time were generally comparable for CPC and comparison practices, with slightly more favorable differences-generally of small magnitude-for CPC practices than expected by chance. There were small, statistically significant, favorable effects for 2 of 6 composite measures measured using both the proportion giving the best responses and mean responses: getting timely appointments, care, and information; providers support patients in taking care of their own health; and providers discuss medication decisions. There was an additional small favorable effect on the proportion of patients giving the best response in getting timely appointments, care, and information; there was no effect on the mean. CONCLUSIONS: During the first 2 years of CPC, CPC practices showed slightly better year-to-year patient experience ratings for selected items, indicating that transformation did not negatively affect patient experience and improved some aspects slightly. Patient ratings for the 2 groups were generally comparable, and both faced substantial room for improvement.

编号：4题名：Private sector accountable care organization development: a qualitative study.作者：Scheck McAlearney A;Hilligoss B;Song PH出处：Am J Manag Care.2017V23N3:151-158机构：Department of Family Medicine, College of Medicine, The Ohio State University, 273 Northwood and High Bldg, 2231 North High St, Columbus, OH 43201. E-mail: [email protected].摘要： OBJECTIVES: To explore accountable care organizations (ACOs) as they develop in the private sector, including their motivation for development, perspectives from consumers regarding these emerging ACOs, and the critical success factors associated with ACO development. STUDY DESIGN: Comprehensive organizational case studies of 4 full-risk private sector ACOs that included in-person interviews with providers and administrators and focus groups with local consumers. METHODS: Sixty-eight key informant interviews conducted during site visits, supplemented by document collection and telephone interviews, and 5 focus groups were held with 52 consumers associated with the study ACOs. RESULTS: We found 3 main motivators for private sector ACO development: 1) opportunity to improve quality and efficiency, 2) potential to improve population health, and 3) belief that payment reform is

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inevitable. With respect to consumer perspectives, consumers were unaware they received care from an ACO. From the perspectives of ACO stakeholders, these ACOs noted that they prefer to focus on patients' relationships with providers and typically do not emphasize the ACO name or entity. Critical success factors for private sector ACO development included provider engagement, strategic buy-in, prior experience managing risk, IT infrastructure, and leadership, all meant to shift the culture to a focus on value instead of volume. CONCLUSIONS: These organizations perceived that pursuing an accountable care strategy allowed them to respond to policy changes anticipated to impact the way healthcare is delivered and reimbursed. Increased understanding of factors that have been important for more mature private sector ACOs may help other healthcare organizations as they strive to enhance value and advance in their ACO journeys.

编号：5题名：Scaling Lean in primary care: impacts on system performance.作者：Hung DY;Harrison MI;Martinez MC;Luft HS出处：Am J Manag Care.2017V23N3:161-168机构：Palo Alto Medical Foundation Research Institute, 2350 W El Camino Real #447, Mountain View, CA 94040. E-mail: [email protected].摘要： OBJECTIVES: We examined a wide range of performance outcomes after Lean methodology-a leading strategy to enhance efficiency and patient value-was implemented and scaled across all primary care clinics in a nonprofit, ambulatory care delivery system. STUDY DESIGN: Using a stepped wedge approach, we assessed changes associated with the phased introduction of Lean-based redesigns across 46 primary care departments in 17 different clinic locations. Longitudinal analysis of operational metrics included: workflow efficiency, physician productivity, operating expenses, clinical quality, and satisfaction among patients, physicians, and staff. METHODS: We used interrupted time series analysis with generalized linear mixed models to estimate Lean impacts over time. Projected outcomes in the absence of changes (ie, counterfactuals) were compared with observed outcomes after Lean redesigns were implemented, and mean differences were assessed using 95% bias-corrected bootstrap confidence intervals (CIs). RESULTS: We observed systemwide improvements in workflow efficiencies (eg, 95% CI, 5.8-10.4) and physician productivity (95% CI, 3.9-27.2), with no adverse effects on clinical quality. Patient satisfaction increased with respect to access to care (95% CI, 15.2-20.7), handling of personal issues (95% CI, 2.1-6.9), and overall experience of care (95% CI, 11.0-17.0), but decreased with respect to interactions with care providers (95% CI, -13.4 to -5.7). Departmental operating costs decreased, and annual staff and physician satisfaction scores increased particularly among early adopters, with key improvements in employee engagement, connection to purpose, relationships with staff, and physician time spent working. CONCLUSIONS: Lean redesigns can benefit primary care patients, physicians, and staff without negatively impacting the quality of clinical care. Study results may lead other delivery system leaders to innovate using Lean techniques and may further enhance support for Lean learning among public and private payers.

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编号：6题名：A better way: leveraging a proven and utilized system for improving current medication reconciliation processes.作者：Dhavle AA;Joseph S;Yang Y;DiBlasi C;Whittemore K出处：Am J Manag Care.2017V23N3:e98-e99机构：Surescripts LLC 2800 Crystal Dr, Arlington, VA 22202. E-mail: [email protected].摘要： In this reply to the commentary, "A Call for a Statewide Medication Reconciliation Program," published in the October 2016 issue of The American Journal of Managed Care(R), authors note that although they agree with the authors' assessment of the problem, they believe there is a proven and scalable solution to improve medication reconciliation that is already available to, and used by, clinicians.

编号：7题名：Effects of an enhanced primary care program on diabetes outcomes.作者：Goff SL;Murphy L;Knee AB;Guhn-Knight H;Guhn A;Lindenauer PK出处：Am J Manag Care.2017V23N3:e75-e81机构：Baystate Medical Center, 280 Chestnut St, 3rd Fl, Rm 305, Springfield, MA 01004. E-mail: [email protected].摘要： OBJECTIVES: To evaluate the effectiveness of Buena Salud, a multidisciplinary enhanced primary care program for Medicaid Managed Care patients at a community health center serving a low-income Hispanic community. STUDY DESIGN: Controlled before-and-after observational study. METHODS: We extracted data from the electronic health record for patients aged 18 to 64 years with a) type 2 diabetes (T2D) enrolled in the Buena Salud program between August 2011 and January 2012 and b) randomly selected control patients with T2D who had been seen at the study health center during the same time frame. Outcomes included process measures (eg, number of glycosylated hemoglobin measures in a year), target lab and blood pressure values, and utilization measures (eg, emergency department visits). Demographics and other potential confounders were also extracted. We used a difference-in-differences (DID) analysis to estimate the effect of the intervention. RESULTS: A total of 72 Buena Salud patients with T2D and 247 control patients with T2D were included in the analysis. The Buena Salud group had a greater increase in the percentage of patients with guideline-concordant measurement of microalbumin/creatinine (DID = 22.2%; P = .008), a trend toward fewer hospitalizations than controls, and a mean rise in diastolic blood pressure. We did not find differences in other outcome or utilization measures. CONCLUSIONS: A recently implemented enhanced primary care program had minimal impact on T2D process, outcome, and utilization measures for patients in this study. However, there were some promising trends, and it is possible that the intervention may demonstrate more of an effect as the program matures.

编号：8题名：Improvements in access and care through the Affordable Care Act.

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作者：Schmittdiel JA;Barrow JC;Wiley D;Ma L;Sam D;Chau CV;Shetterly SM出处：Am J Manag Care.2017V23N3:e95-e97机构：Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612. E-mail: [email protected].摘要： OBJECTIVES: To examine the impact of enrolling in a healthcare plan through the Affordable Care Act (ACA) healthcare exchanges on self-reported access to care. STUDY DESIGN: Cohort study using self-reported data of patients newly enrolled in Kaiser Permanente California and Kaiser Permanente Colorado through the ACA healthcare exchanges for coverage beginning January 1, 2014. METHODS: Baseline and follow-up surveys conducted via mail and telephone, with response rates of 45% and 51%, respectively. RESULTS: We found significant increases in the percentage of people who reported having a personal healthcare provider (59% vs 73%; P <.01) and significant decreases in those who reported delaying needed medical care due to costs (37% vs 25%; P <.01) before and after ACA enrollment. There was also a significant increase in the percentage of patients who reported receiving a flu shot during the prior year (41% vs 52%; P <.01). Among the people who reported having less than 4 months of healthcare coverage in 2013, these improvements were even more pronounced. This group also showed significant increases in the percentages who felt they had a place to go when they needed medical care (43% vs 56%; P <.01) and who reported they received advice to quit smoking or using tobacco (46% vs 72%; P <.05). CONCLUSIONS: These findings are an important addition to the evidence base that the ACA is improving the healthcare experience and reducing barriers due to costs for individuals obtaining insurance coverage through the healthcare exchanges.

编号：9题名：Consumer-directed health plans: do doctors and nurses buy in?作者：Leung LB;Escarce JJ出处：Am J Manag Care.2017V23N3:e89-e94机构：UCLA Robert Wood Johnson Foundation VA Clinical Scholars Program, 10940 Wilshire Blvd, Ste 710, Los Angeles, CA 90024. E-mail: [email protected].摘要： OBJECTIVES: Aiming to increase healthcare value, consumer-directed health plans (CDHPs)-high-deductible health insurance plus a personal spending account-equip enrollees with decision-support tools and expose them to the financial implications of their medical decisions. This study examines whether medically knowledgeable consumers are more or less likely to select a CDHP than individuals without medical knowledge. STUDY DESIGN: Using University of California Los Angeles (UCLA) human resources data, our observational cross-sectional study analyzed the health plan enrollment choices of 3552 faculty and 8429 staff employees. METHODS: We compared CDHP selection in 2 cohorts: 1) physicians and nonphysician faculty and 2) nurses and nonmedical staff. We used probit regression models to predict CDHP selection, adjusted for job title, demographics (ie, age, gender, race/ethnicity, education, employee income), and coverage type (eg, single). RESULTS: Approximately 5% of UCLA employees chose the CDHP. After adjusting for sociodemographic characteristics and coverage type, physicians were less likely to choose these plans than nonmedical faculty, when all other covariates were fixed at their means (predicted probability change [DeltaP], -1.6%;

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standard error [SE], 0.8%; P = .05). Nurses also appeared less inclined to choose these plans than nonmedical staff, which approached statistical significance (DeltaP, -1.9%; SE, 1.0%; P = .07). CONCLUSIONS: Overall low rates of CDHP selection were observed in consumers with and without medical knowledge. Although physicians and nurses seem to be better positioned as CDHP consumers, they appeared less likely to select these health plans compared with nonmedical faculty and staff in our study.

编号：10题名：Does paid versus unpaid supplementary caregiving matter in preventable readmissions?作者：Chen HF;Oluyomi Popoola T;Suzuki S出处：Am J Manag Care.2017V23N3:e82-e88机构：Department of Health Policy and Management, University of Arkansas for Medical Sciences 4301 West Markham St, Mail Slot 820-12 Little Rock, AR 72205. E-mail: [email protected].摘要： OBJECTIVES: To examine the impact of paid and unpaid supplementary caregiving on preventable readmissions among Medicare home health beneficiaries with diabetes. STUDY DESIGN: A retrospective cohort study with a home health episode as the unit of analysis. METHODS: We gathered multiple 2009 Medicare data and national datasets (eg, Area Health Resources File). We used propensity score matching based on beneficiaries' predisposing, enabling, and health need factors to create matched cohorts for episodes solely assisted by paid supplementary caregivers versus those solely assisted by unpaid supplementary caregivers. We applied Cox regression on the matched cohorts to estimate the 30-day preventable readmissions, including diabetes-related conditions, heart disease-related conditions, chronic obstructive pulmonary disease, urinary tract infection (UTI), pneumonia, and dehydration. RESULTS: Among beneficiaries (81,481) who received assistance several times during the day and night or several times during only the day, 7.34% were solely assisted by paid supplementary caregivers and 86.34% were solely assisted by unpaid supplementary caregivers. In the matched cohorts, we found that beneficiaries with paid supplementary caregivers had 68% higher hazards of readmission due to UTIs than those with unpaid supplementary caregivers. CONCLUSIONS: The Medicare program is moving toward value-based purchasing and penalizing home health agencies with poor quality of care. It is critical for home health professionals to invite paid and unpaid supplementary caregivers to initiate care plans and assess their competence. Policies that support unpaid supplementary caregivers can also assist caregivers to care for their loved ones and prevent them from using expensive hospital resources.

Am J Crit Care

编号：1题名：Servant Leadership: The Primacy of Service.作者：Savel RH;Munro CL出处：Am J Crit Care.2017V26N2:97-99

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机构：Richard H. Savel is coeditor in chief of the American Journal of Critical Care. He is director, Adult Critical Care Services, at Maimonides Medical Center and a professor of clinical medicine at the Albert Einstein College of Medicine, both in New York City. Cindy L. Munro is coeditor in chief of the American Journal of Critical Care. She is associate dean for research and innovation at the University of South Florida, College of Nursing, Tampa, Florida.;Richard H. Savel is coeditor in chief of the American Journal of Critical Care. He is director, Adult Critical Care Services, at Maimonides Medical Center and a professor of clinical medicine at the Albert Einstein College of Medicine, both in New York City. Cindy L. Munro is coeditor in chief of the American Journal of Critical Care. She is associate dean for research and innovation at the University of South Florida, College of Nursing, Tampa, Florida.摘要：

编号：2题名：Clinical Pearls.作者：Board R出处：Am J Crit Care.2017V26N2:100

编号：3题名：Perceptions of Adult Hospitalized Patients on Family Presence During Cardiopulmonary Resuscitation.作者：Bradley C;Keithline M;Petrocelli M;Scanlon M;Parkosewich J出处：Am J Crit Care.2017V26N2:103-110机构：Carolyn Bradley is a service line educator, Michelle Keithline, Meghan Petrocelli, and Mary Scanlon are clinical nurses, and Janet Parkosewich is the nurse researcher, Yale New Haven Hospital, New Haven, Connecticut. [email protected].;Carolyn Bradley is a service line educator, Michelle Keithline, Meghan Petrocelli, and Mary Scanlon are clinical nurses, and Janet Parkosewich is the nurse researcher, Yale New Haven Hospital, New Haven, Connecticut.;Carolyn Bradley is a service line educator, Michelle Keithline, Meghan Petrocelli, and Mary Scanlon are clinical nurses, and Janet Parkosewich is the nurse researcher, Yale New Haven Hospital, New Haven, Connecticut.;Carolyn Bradley is a service line educator, Michelle Keithline, Meghan Petrocelli, and Mary Scanlon are clinical nurses, and Janet Parkosewich is the nurse researcher, Yale New Haven Hospital, New Haven, Connecticut.;Carolyn Bradley is a service line educator, Michelle Keithline, Meghan Petrocelli, and Mary Scanlon are clinical nurses, and Janet Parkosewich is the nurse researcher, Yale New Haven Hospital, New Haven, Connecticut.摘要： BACKGROUND: Family presence during cardiopulmonary resuscitation in acute care is not widespread. Patients are not likely to be asked about their wishes for family presence or if they wish to be the decision makers about who should be present. OBJECTIVE: To explore the perceptions of patients on general medical units and to find factors independently associated with family presence during cardiopulmonary resuscitation. METHODS: A cross-sectional study of 117 randomly selected adult patients was conducted at an academic medical center. Participants were interviewed via a survey to obtain information on demographics, knowledge

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of cardiopulmonary resuscitation, sources of information on resuscitation, and preferences for family presence. RESULTS: About half of the participants agreed or strongly agreed that family presence during cardiopulmonary resuscitation was important (52.1%), that the participant should be the decision maker about who should be present (50.4%), and that the patient should give consent ahead of time (47.0%). Participants indicated that they would want an adult sibling, parents, or others (20.5%); spouse (14.5%); adult child (8.5%); close friend (5.1%); or companion (4.3%) present during cardiopulmonary resuscitation. Younger participants (20-45 years old) were 6.28 times more likely than those >/= 66 years old (P = .01) and nonwhite participants were 2.7 times more likely than white participants (P = .049) to want family presence. CONCLUSION: Patients have strong preferences about family presence during cardiopulmonary resuscitation, and they should have the opportunity to make the decision about having family present.

编号：4题名：Show Your Stuff and Watch Your Tone: Nurses' Caring Behaviors.作者：Weyant RA;Clukey L;Roberts M;Henderson A出处：Am J Crit Care.2017V26N2:111-117机构：Ruth A. Weyant is a staff registered nurse in the cardiac intensive care unit, Medical Center of the Rockies, Loveland, Colorado. Lory Clukey is an associate professor, University of Northern Colorado, Greeley, Colorado. Melanie Roberts is a critical care clinical nurse specialist, Medical Center of the Rockies. Ann Henderson is an education nurse specialist, Medical Center of the Rockies. [email protected].;Ruth A. Weyant is a staff registered nurse in the cardiac intensive care unit, Medical Center of the Rockies, Loveland, Colorado. Lory Clukey is an associate professor, University of Northern Colorado, Greeley, Colorado. Melanie Roberts is a critical care clinical nurse specialist, Medical Center of the Rockies. Ann Henderson is an education nurse specialist, Medical Center of the Rockies.;Ruth A. Weyant is a staff registered nurse in the cardiac intensive care unit, Medical Center of the Rockies, Loveland, Colorado. Lory Clukey is an associate professor, University of Northern Colorado, Greeley, Colorado. Melanie Roberts is a critical care clinical nurse specialist, Medical Center of the Rockies. Ann Henderson is an education nurse specialist, Medical Center of the Rockies.;Ruth A. Weyant is a staff registered nurse in the cardiac intensive care unit, Medical Center of the Rockies, Loveland, Colorado. Lory Clukey is an associate professor, University of Northern Colorado, Greeley, Colorado. Melanie Roberts is a critical care clinical nurse specialist, Medical Center of the Rockies. Ann Henderson is an education nurse specialist, Medical Center of the Rockies.摘要： BACKGROUND: Although it is perceived as essential, documentation of caring behaviors executed by nurses is rarely done. To facilitate what is important to patients and their family members, we need to understand what behaviors are perceived as caring or not caring. OBJECTIVE: To explore perceptions of nurses' caring behaviors among intubated patients and their family members. METHODS: A phenomenological study of 14 patients who were intubated, restrained, sedated, and received pain medication in an acute cardiovascular intensive care unit. The 14 patients and 8 of their family members were interviewed about their perceptions of this experience. A semistructured interview guide was used. Data were analyzed by using an inductive method consistent with qualitative research. RESULTS: Themes that

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emerged most often were providing information, providing reassurance, demonstrating proficiency, and being present. Other behaviors identified as caring behaviors were nurses giving guidance and using a soothing tone of voice. Behavior that was contrary to the perception of caring appeared as isolated incidents. These included negative attitude, interrupting sleep, not receiving information, and poor pain management. CONCLUSION: When patients and family members are asked directly about their experience, valuable insight is gained into what they perceive as caring and what contributes to recovery as perceived by those in crisis and in high-intensity medical settings. Capturing these data is elemental to designing high-quality, safe environments that facilitate healing.

编号：5题名：Evidence-Based Review and Discussion Points.作者：Hickman RL出处：Am J Crit Care.2017V26N2:126-127机构：Ronald L. Hickman is an associate professor, Case Western Reserve University, and an acute care nurse practitioner at University Hospitals Case Medical Center, Cleveland, Ohio.摘要：

编号：6题名：Stress and Coping of Critical Care Nurses After Unsuccessful Cardiopulmonary Resuscitation.作者：McMeekin DE;Hickman RL Jr;Douglas SL;Kelley CG出处：Am J Crit Care.2017V26N2:128-135机构：Dawn E. McMeekin was a DNP student at Case Western Reserve University, Cleveland, Ohio, when the study was done. She is now an advanced clinical education specialist at Baycare Health System, Dunedin, Florida. Ronald L. Hickman, Jr, is an associate professor, Carol G. Kelley is an assistant professor, and Sara L. Douglas is a professor, Case Western Reserve University. [email protected].;Dawn E. McMeekin was a DNP student at Case Western Reserve University, Cleveland, Ohio, when the study was done. She is now an advanced clinical education specialist at Baycare Health System, Dunedin, Florida. Ronald L. Hickman, Jr, is an associate professor, Carol G. Kelley is an assistant professor, and Sara L. Douglas is a professor, Case Western Reserve University.;Dawn E. McMeekin was a DNP student at Case Western Reserve University, Cleveland, Ohio, when the study was done. She is now an advanced clinical education specialist at Baycare Health System, Dunedin, Florida. Ronald L. Hickman, Jr, is an associate professor, Carol G. Kelley is an assistant professor, and Sara L. Douglas is a professor, Case Western Reserve University.;Dawn E. McMeekin was a DNP student at Case Western Reserve University, Cleveland, Ohio, when the study was done. She is now an advanced clinical education specialist at Baycare Health System, Dunedin, Florida. Ronald L. Hickman, Jr, is an associate professor, Carol G. Kelley is an assistant professor, and Sara L. Douglas is a professor, Case Western Reserve University.摘要： BACKGROUND: Participation by a critical care nurse in an unsuccessful resuscitation can create a unique heightened level of psychological stress referred to as postcode stress,

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activation of coping behaviors, and symptoms of posttraumatic stress disorder (PTSD). OBJECTIVES: To explore the relationships among postcode stress, coping behaviors, and PTSD symptom severity in critical care nurses after experiencing unsuccessful cardiopulmonary resuscitations and to see whether institutional support attenuates these repeated psychological traumas. METHODS: A national sample of 490 critical care nurses was recruited from the American Association of Critical-Care Nurses' eNewsline and social media. Participants completed the Post-Code Stress Scale, the Brief COPE (abbreviated), and the Impact of Event Scale-Revised, which were administered through an online survey. RESULTS: Postcode stress and PTSD symptom severity were weakly associated (r = 0.20, P = .01). No significant associations between coping behaviors and postcode stress were found. Four coping behaviors (denial, self-distraction, self-blame, and behavioral disengagement) were significant predictors of PTSD symptom severity. Severity of postcode stress and PTSD symptoms varied with the availability of institutional support. CONCLUSIONS: Critical care nurses show moderate levels of postcode stress and PTSD symptoms when asked to recall an unsuccessful resuscitation and the coping behaviors used. Identifying the critical care nurses most at risk for PTSD will inform the development of interventional research to promote critical care nurses' psychological well-being and reduce their attrition from the profession.

编号：7题名：A Novel Approach to Explore How Nursing Care Affects Intracranial Pressure.作者：Olson DM;Parcon C;Santos A;Santos G;Delabar R;Stutzman SE出处：Am J Crit Care.2017V26N2:136-139机构：DaiWai M. Olson is an associate professor, neurology and therapeutics, Sonja E. Stutzman is research program manager, and Guilla Santos is staff nurse, University of Texas Southwestern Medical Center, Dallas, Texas. Camille Parcon is a staff nurse, Baylor University Medical Center, Dallas, Texas. Aljean Santos is a registered nurse, Texas Woman's University, Denton, Texas. Ryan Delabar is a medical resident, Washington University, St Louis, Missouri. [email protected].;DaiWai M. Olson is an associate professor, neurology and therapeutics, Sonja E. Stutzman is research program manager, and Guilla Santos is staff nurse, University of Texas Southwestern Medical Center, Dallas, Texas. Camille Parcon is a staff nurse, Baylor University Medical Center, Dallas, Texas. Aljean Santos is a registered nurse, Texas Woman's University, Denton, Texas. Ryan Delabar is a medical resident, Washington University, St Louis, Missouri.;DaiWai M. Olson is an associate professor, neurology and therapeutics, Sonja E. Stutzman is research program manager, and Guilla Santos is staff nurse, University of Texas Southwestern Medical Center, Dallas, Texas. Camille Parcon is a staff nurse, Baylor University Medical Center, Dallas, Texas. Aljean Santos is a registered nurse, Texas Woman's University, Denton, Texas. Ryan Delabar is a medical resident, Washington University, St Louis, Missouri.;DaiWai M. Olson is an associate professor, neurology and therapeutics, Sonja E. Stutzman is research program manager, and Guilla Santos is staff nurse, University of Texas Southwestern Medical Center, Dallas, Texas. Camille Parcon is a staff nurse, Baylor University Medical Center, Dallas, Texas. Aljean Santos is a registered nurse, Texas Woman's University, Denton, Texas. Ryan Delabar is a medical resident, Washington University, St Louis, Missouri.;DaiWai M. Olson is an associate professor, neurology and therapeutics, Sonja E.

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Stutzman is research program manager, and Guilla Santos is staff nurse, University of Texas Southwestern Medical Center, Dallas, Texas. Camille Parcon is a staff nurse, Baylor University Medical Center, Dallas, Texas. Aljean Santos is a registered nurse, Texas Woman's University, Denton, Texas. Ryan Delabar is a medical resident, Washington University, St Louis, Missouri.;DaiWai M. Olson is an associate professor, neurology and therapeutics, Sonja E. Stutzman is research program manager, and Guilla Santos is staff nurse, University of Texas Southwestern Medical Center, Dallas, Texas. Camille Parcon is a staff nurse, Baylor University Medical Center, Dallas, Texas. Aljean Santos is a registered nurse, Texas Woman's University, Denton, Texas. Ryan Delabar is a medical resident, Washington University, St Louis, Missouri.摘要： BACKGROUND: Intracranial pressure is measured continuously, and nursing behaviors have been associated with variations in the measurements. METHODS: A prospective pilot observational study was done to develop a comprehensive list of nursing behaviors that affect patients' intracranial pressure. Data on nurses were obtained by self-reports and video recording. Patient-level data were collected via chart abstraction, video recording, and patients' monitors. RESULTS: Data on 9 patients and 32 nurses were analyzed. A total of 6244 minutes of data were video recorded. Intracranial pressure was changed because of a nursing intervention during 3394 observations. Compared with baseline levels, intracranial pressure was significantly higher if a nursing intervention was performed (odds ratio, 1.96; 95% CI, 1.71-2.24; P < .001). CONCLUSION: Studying nursing behaviors is feasible. Synchronizing and analyzing mutually exclusive and exhaustive behaviors indicated that nursing behaviors have an effect on patients' intracranial pressure.

编号：8题名：Obesity Paradox: Comparison of Heart Failure Patients With and Without Comorbid Diabetes.作者：Lee KS;Moser DK;Lennie TA;Pelter MM;Nesbitt T;Southard JA;Dracup K出处：Am J Crit Care.2017V26N2:140-148机构：Kyoung Suk Lee is an assistant professor, Chungnam National University, College of Nursing, Dae Jeon, South Korea. Debra K. Moser is a professor, the Gill Endowed Chair of Nursing, and a codirector of the RICH Heart Program, University of Kentucky, College of Nursing, Lexington, Kentucky, and a professor of cardiovascular nursing, University of Ulster, Belfast, Ireland. Terry A. Lennie is a professor and a codirector of the RICH Heart Program, University of Kentucky, College of Nursing. Michele M. Pelter is an assistant professor and Kathleen Dracup is a professor emeritus, University of California San Francisco, School of Nursing, San Francisco, California. Thomas Nesbitt is a professor and associate vice chancellor for strategic technologies and alliances, and Jeffrey A. Southard is an associate clinical professor of medicine, and director of the transcatheter aortic valve replacement program, University of California, Davis, California. [email protected].;Kyoung Suk Lee is an assistant professor, Chungnam National University, College of Nursing, Dae Jeon, South Korea. Debra K. Moser is a professor, the Gill Endowed Chair of Nursing, and a codirector of the RICH Heart Program, University of Kentucky, College of Nursing, Lexington, Kentucky, and a professor of cardiovascular nursing, University of Ulster, Belfast, Ireland. Terry A. Lennie is a professor and a codirector of the RICH Heart Program, University of Kentucky, College of Nursing. Michele M.

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Pelter is an assistant professor and Kathleen Dracup is a professor emeritus, University of California San Francisco, School of Nursing, San Francisco, California. Thomas Nesbitt is a professor and associate vice chancellor for strategic technologies and alliances, and Jeffrey A. Southard is an associate clinical professor of medicine, and director of the transcatheter aortic valve replacement program, University of California, Davis, California.;Kyoung Suk Lee is an assistant professor, Chungnam National University, College of Nursing, Dae Jeon, South Korea. Debra K. Moser is a professor, the Gill Endowed Chair of Nursing, and a codirector of the RICH Heart Program, University of Kentucky, College of Nursing, Lexington, Kentucky, and a professor of cardiovascular nursing, University of Ulster, Belfast, Ireland. Terry A. Lennie is a professor and a codirector of the RICH Heart Program, University of Kentucky, College of Nursing. Michele M. Pelter is an assistant professor and Kathleen Dracup is a professor emeritus, University of California San Francisco, School of Nursing, San Francisco, California. Thomas Nesbitt is a professor and associate vice chancellor for strategic technologies and alliances, and Jeffrey A. Southard is an associate clinical professor of medicine, and director of the transcatheter aortic valve replacement program, University of California, Davis, California.;Kyoung Suk Lee is an assistant professor, Chungnam National University, College of Nursing, Dae Jeon, South Korea. Debra K. Moser is a professor, the Gill Endowed Chair of Nursing, and a codirector of the RICH Heart Program, University of Kentucky, College of Nursing, Lexington, Kentucky, and a professor of cardiovascular nursing, University of Ulster, Belfast, Ireland. Terry A. Lennie is a professor and a codirector of the RICH Heart Program, University of Kentucky, College of Nursing. Michele M. Pelter is an assistant professor and Kathleen Dracup is a professor emeritus, University of California San Francisco, School of Nursing, San Francisco, California. Thomas Nesbitt is a professor and associate vice chancellor for strategic technologies and alliances, and Jeffrey A. Southard is an associate clinical professor of medicine, and director of the transcatheter aortic valve replacement program, University of California, Davis, California.;Kyoung Suk Lee is an assistant professor, Chungnam National University, College of Nursing, Dae Jeon, South Korea. Debra K. Moser is a professor, the Gill Endowed Chair of Nursing, and a codirector of the RICH Heart Program, University of Kentucky, College of Nursing, Lexington, Kentucky, and a professor of cardiovascular nursing, University of Ulster, Belfast, Ireland. Terry A. Lennie is a professor and a codirector of the RICH Heart Program, University of Kentucky, College of Nursing. Michele M. Pelter is an assistant professor and Kathleen Dracup is a professor emeritus, University of California San Francisco, School of Nursing, San Francisco, California. Thomas Nesbitt is a professor and associate vice chancellor for strategic technologies and alliances, and Jeffrey A. Southard is an associate clinical professor of medicine, and director of the transcatheter aortic valve replacement program, University of California, Davis, California.;Kyoung Suk Lee is an assistant professor, Chungnam National University, College of Nursing, Dae Jeon, South Korea. Debra K. Moser is a professor, the Gill Endowed Chair of Nursing, and a codirector of the RICH Heart Program, University of Kentucky, College of Nursing, Lexington, Kentucky, and a professor of cardiovascular nursing, University of Ulster, Belfast, Ireland. Terry A. Lennie is a professor and a codirector of the RICH Heart Program, University of Kentucky, College of Nursing. Michele M. Pelter is an assistant professor and Kathleen Dracup is a professor emeritus, University of California San Francisco, School of Nursing, San Francisco, California. Thomas Nesbitt is a professor and associate vice chancellor for strategic technologies and alliances, and Jeffrey A.

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Southard is an associate clinical professor of medicine, and director of the transcatheter aortic valve replacement program, University of California, Davis, California.;Kyoung Suk Lee is an assistant professor, Chungnam National University, College of Nursing, Dae Jeon, South Korea. Debra K. Moser is a professor, the Gill Endowed Chair of Nursing, and a codirector of the RICH Heart Program, University of Kentucky, College of Nursing, Lexington, Kentucky, and a professor of cardiovascular nursing, University of Ulster, Belfast, Ireland. Terry A. Lennie is a professor and a codirector of the RICH Heart Program, University of Kentucky, College of Nursing. Michele M. Pelter is an assistant professor and Kathleen Dracup is a professor emeritus, University of California San Francisco, School of Nursing, San Francisco, California. Thomas Nesbitt is a professor and associate vice chancellor for strategic technologies and alliances, and Jeffrey A. Southard is an associate clinical professor of medicine, and director of the transcatheter aortic valve replacement program, University of California, Davis, California.摘要： BACKGROUND: Diabetes is a common comorbid condition in patients with heart failure and is strongly associated with poor outcomes. Patients with heart failure who have diabetes are more likely to be obese than are those without diabetes. Obesity is positively associated with survival in patients with heart failure, but how comorbid diabetes influences the relationship between obesity and favorable prognosis is unclear. OBJECTIVE: To explore whether the relationship between body mass index and survival differs between patients with heart failure who do or do not have diabetes. METHODS: The sample consisted of 560 ambulatory patients with heart failure (mean age, 66 years; mean body mass index, 32; diabetes, 41%). The association between body mass index and all-cause mortality was examined by using multivariate Cox proportional hazards regression after adjustments for covariates. RESULTS: In patients without diabetes, higher body mass index was associated with a lower risk for all-cause mortality after adjustments for covariates (hazard ratio, 0.952; 95% CI, 0.909-0.998). In patients with diabetes, body mass index was not predictive of all-cause death after adjustments for covariates. CONCLUSION: Obesity was a survival benefit in heart failure patients without comorbid diabetes but not in those with comorbid diabetes. The mechanisms underlying the difference in the relationship between obesity and survival due to the presence of diabetes in patients with heart failure need to be elucidated.

编号：9题名：Cortrak-Assisted Feeding Tube Insertion: A Comprehensive Review of Adverse Events in the MAUDE Database.作者：Bourgault AM;Aguirre L;Ibrahim J出处：Am J Crit Care.2017V26N2:149-156机构：Annette M. Bourgault is an assistant professor, University of Central Florida, College of Nursing, and a nurse scientist, Orlando Health, Orlando, Florida. Lillian Aguirre is a clinical nurse specialist in trauma critical care, Orlando Regional Medical Center, a part of Orlando Health, Orlando, Florida. Joseph Ibrahim is trauma medical director and associate program director, Orlando Regional Medical Center, a part of Orlando Health. [email protected].;Annette M. Bourgault is an assistant professor, University of Central Florida, College of Nursing, and a nurse scientist, Orlando Health, Orlando, Florida. Lillian Aguirre is a clinical nurse specialist in trauma critical care, Orlando Regional Medical

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Center, a part of Orlando Health, Orlando, Florida. Joseph Ibrahim is trauma medical director and associate program director, Orlando Regional Medical Center, a part of Orlando Health.;Annette M. Bourgault is an assistant professor, University of Central Florida, College of Nursing, and a nurse scientist, Orlando Health, Orlando, Florida. Lillian Aguirre is a clinical nurse specialist in trauma critical care, Orlando Regional Medical Center, a part of Orlando Health, Orlando, Florida. Joseph Ibrahim is trauma medical director and associate program director, Orlando Regional Medical Center, a part of Orlando Health.摘要： BACKGROUND: Electromagnetic devices to guide feeding tube placement such as the CORTRAK Enteral Access System have shown promising results; however, researchers in recent studies have expressed concern that a higher level of user expertise may be required for safe use. OBJECTIVES: To review adverse events related to CORTRAK-assisted feeding tube insertion reported in the Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database. METHODS: A retrospective, secondary analysis of the MAUDE database was performed to evaluate adverse events (ie, injury or death of patient) related to CORTRAK. RESULTS: Fifty-four adverse events between January 1, 2006 and February 29, 2016 were identified and reviewed. Most events (98%) involved feeding tube placement in the lungs (37%, left lung; 46%, right lung; 15%, not specified). Lung complications included pneumothorax (77%) and pneumonitis (21%). Death occurred in 17% of lung placements. Clinicians failed to recognize placement in 89% of CORTRAK insertion tracings reviewed. CONCLUSIONS: Lung placement is not unique to CORTRAK and is an inherent risk of all feeding tube insertions. In known or suspected lung placement, feeding tubes should be removed and radiography performed to assess for pneumothorax. Clinicians must observe closely for lung placement and discriminate lung from gastric placement on insertion tracings. Clinicians require specialized training and experience to develop competency in using the CORTRAK device, although the exact amount of experience needed is unknown.

编号：10题名：Update on Effectiveness of an Electromagnetic Feeding Tube-Placement Device in Detecting Respiratory Placements.作者：Metheny NA;Meert KL出处：Am J Crit Care.2017V26N2:157-161机构：Norma A. Metheny is a professor of nursing and holds the Dorothy A. Votsmier Endowed Chair in Nursing at Saint Louis University School of Nursing, St Louis, Missouri. Kathleen L. Meert is a professor of medicine in the Department of Pediatrics, Wayne State University, and chief, Division of Critical Care Medicine, Children's Hospital of Michigan, Detroit, Michigan. [email protected].;Norma A. Metheny is a professor of nursing and holds the Dorothy A. Votsmier Endowed Chair in Nursing at Saint Louis University School of Nursing, St Louis, Missouri. Kathleen L. Meert is a professor of medicine in the Department of Pediatrics, Wayne State University, and chief, Division of Critical Care Medicine, Children's Hospital of Michigan, Detroit, Michigan.摘要： BACKGROUND: Radiography is the accepted gold standard for testing feeding tube placement; however, an electromagnetic tube-placement device (ETPD) is sometimes used in lieu of radiography for this purpose. High success rates have been reported when the device

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was used by well-trained individuals. However, authors previously described 20 cases that occurred between 2007 and 2012 in which clinicians voluntarily reported inability to detect inadvertent tube insertions in the respiratory tract while using an ETPD. OBJECTIVE: To describe case reports to the US Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database between 2013 and 2015 regarding inadvertent respiratory placement of feeding tubes by operators using an ETPD. METHODS: The MAUDE database was searched for cases dated from January 1, 2013, through December 31, 2015, along with selected brand names. A total of 34 cases (25 after removal of duplicates) were located in which a feeding tube was inserted into the respiratory tract during insertions assisted by an ETPD. RESULTS: Sites of the malpositioned tubes included the right lung (n = 13), left lung (n = 6), unspecified lung (n = 4), and bronchus (n = 2). A pneumothorax occurred in 17 of the 25 misplacements; feedings were administered in 6 cases. CONCLUSIONS: Many case reports involved clinicians failing to recognize tube misplacements in the respiratory tract while using an ETPD. These reports provide evidence that not all clinicians can use the device effectively to detect malpositioned tubes. Thus, one must continue to question the wisdom of eliminating radiographic confirmation of tube position before starting feedings.

编号：11题名：Electromagnetic Tube-Placement Device: The Replacement for the Radiographic Gold Standard?作者：Park J;Krzeminski S;Tan J;Bandlamuri M;Carlson RW出处：Am J Crit Care.2017V26N2:162-163机构：Julia Park, Joshua Tan, and Sylvia Krzeminski are residents at the Maricopa Medical Center in Phoenix, Arizona. Meghana Bandlamuri is a student at the Maricopa Medical Center. Richard W. Carlson is a faculty member at the Maricopa Medical Center, and is affiliated with the University of Arizona College of Medicine, and the Mayo Clinic College of Medicine, Scottsdale, Arizona.;Julia Park, Joshua Tan, and Sylvia Krzeminski are residents at the Maricopa Medical Center in Phoenix, Arizona. Meghana Bandlamuri is a student at the Maricopa Medical Center. Richard W. Carlson is a faculty member at the Maricopa Medical Center, and is affiliated with the University of Arizona College of Medicine, and the Mayo Clinic College of Medicine, Scottsdale, Arizona.;Julia Park, Joshua Tan, and Sylvia Krzeminski are residents at the Maricopa Medical Center in Phoenix, Arizona. Meghana Bandlamuri is a student at the Maricopa Medical Center. Richard W. Carlson is a faculty member at the Maricopa Medical Center, and is affiliated with the University of Arizona College of Medicine, and the Mayo Clinic College of Medicine, Scottsdale, Arizona.;Julia Park, Joshua Tan, and Sylvia Krzeminski are residents at the Maricopa Medical Center in Phoenix, Arizona. Meghana Bandlamuri is a student at the Maricopa Medical Center. Richard W. Carlson is a faculty member at the Maricopa Medical Center, and is affiliated with the University of Arizona College of Medicine, and the Mayo Clinic College of Medicine, Scottsdale, Arizona.;Julia Park, Joshua Tan, and Sylvia Krzeminski are residents at the Maricopa Medical Center in Phoenix, Arizona. Meghana Bandlamuri is a student at the Maricopa Medical Center. Richard W. Carlson is a faculty member at the Maricopa Medical Center, and is affiliated with the University of Arizona College of Medicine, and the Mayo Clinic College of Medicine, Scottsdale, Arizona. [email protected].

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摘要：

编号：12题名：Preventing Venous Thromboembolism: The Role of Nursing With Intermittent Pneumatic Compression.作者：Dunn N;Ramos R出处：Am J Crit Care.2017V26N2:164-167机构：Nancy Dunn is the clinical excellence coordinator and Rebecca Ramos is the stroke clinical nurse specialist at Salem Health, An OHSU Partner in Salem, Oregon. [email protected].;Nancy Dunn is the clinical excellence coordinator and Rebecca Ramos is the stroke clinical nurse specialist at Salem Health, An OHSU Partner in Salem, Oregon.摘要：

编号：13题名：Similar ECG Features in 2 Different Diagnoses.作者：Pelter MM;Kozik TM;Al-Zaiti SS;Carey G出处：Am J Crit Care.2017V26N2:169-170机构：Michele M. Pelter is an assistant professor at the the Department of Physiological Nursing at University of California, San Francisco, California. Teri M. Kozik is a nurse researcher at St. Joseph's Medical Center, Stockton, California. Salah S. Al-Zaiti is an assistant professor at the Department of Acute and Tertiary Care Nursing, University of Pittsburgh, Pennsylvania. Mary G. Carey is associate director for clinical nursing research, Strong Memorial Hospital, Rochester, New York.;Michele M. Pelter is an assistant professor at the the Department of Physiological Nursing at University of California, San Francisco, California. Teri M. Kozik is a nurse researcher at St. Joseph's Medical Center, Stockton, California. Salah S. Al-Zaiti is an assistant professor at the Department of Acute and Tertiary Care Nursing, University of Pittsburgh, Pennsylvania. Mary G. Carey is associate director for clinical nursing research, Strong Memorial Hospital, Rochester, New York.;Michele M. Pelter is an assistant professor at the the Department of Physiological Nursing at University of California, San Francisco, California. Teri M. Kozik is a nurse researcher at St. Joseph's Medical Center, Stockton, California. Salah S. Al-Zaiti is an assistant professor at the Department of Acute and Tertiary Care Nursing, University of Pittsburgh, Pennsylvania. Mary G. Carey is associate director for clinical nursing research, Strong Memorial Hospital, Rochester, New York.;Michele M. Pelter is an assistant professor at the the Department of Physiological Nursing at University of California, San Francisco, California. Teri M. Kozik is a nurse researcher at St. Joseph's Medical Center, Stockton, California. Salah S. Al-Zaiti is an assistant professor at the Department of Acute and Tertiary Care Nursing, University of Pittsburgh, Pennsylvania. Mary G. Carey is associate director for clinical nursing research, Strong Memorial Hospital, Rochester, New York.摘要：

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编号：14题名：Acknowledgment of Reviewers.出处：Am J Crit Care.2017V26N2:171

编号：15题名：Education Directory.出处：Am J Crit Care.2017V26N2:172

编号：16题名：Administering Polyethylene Glycol Electrolyte Solution Via a Nasogastric Tube: Pulmonary Complications.作者：Metheny NA;Meert KL出处：Am J Crit Care.2017V26N2:e11-e17机构：Norma A. Metheny is a professor of nursing and holds the Dorothy A. Votsmier Endowed Chair in Nursing at Saint Louis University School of Nursing, St Louis, Missouri. Kathleen L. Meert is a professor of medicine in the Department of Pediatrics, Wayne State University, and chief, Division of Critical Care Medicine, Children's Hospital of Michigan, Detroit, Michigan. [email protected].;Norma A. Metheny is a professor of nursing and holds the Dorothy A. Votsmier Endowed Chair in Nursing at Saint Louis University School of Nursing, St Louis, Missouri. Kathleen L. Meert is a professor of medicine in the Department of Pediatrics, Wayne State University, and chief, Division of Critical Care Medicine, Children's Hospital of Michigan, Detroit, Michigan.摘要： BACKGROUND: Patients sometimes require insertion of a nasogastric tube for the administration of a large volume of a polyethylene glycol electrolyte solution. If the tube is malpositioned, the risk for direct instillation of the solution into the lung increases. The risk for aspiration also increases if the infusion rate exceeds gastrointestinal tolerance. PURPOSE: To review published cases of patients' experiencing adverse pulmonary events after administration of polyethylene glycol electrolyte solution via a nasogastric tube and to offer suggestions to prevent these outcomes. METHODS: A search of the literature from 1993 through 2014 was performed by using the PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and Scopus databases. RESULTS: In the 12 case reports located, none of the patients had radiographs to verify tube location before infusion of polyethylene glycol electrolyte solution. After symptoms developed in 3 children (ages 8-11 years), radiographs showed their tubes incorrectly positioned in the bronchus, lung, or esophagus; ports of a fourth child's tube were in the oropharynx. The remaining 8 patients (ages 5-86 years) never had radiographs to determine tube placement. Pulmonary complications from the infusions of polyethylene glycol electrolyte solution contributed to the death of 5 of the patients. CONCLUSION: Relatively simple maneuvers to reduce the likelihood of adverse pulmonary events following the administration of large volumes of polyethylene glycol electrolyte solution via a nasogastric tube are well worth the cost and effort to protect patients from potential serious injury.

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编号：17题名：Maternal Stress and Anxiety in the Pediatric Cardiac Intensive Care Unit.作者：Lisanti AJ;Allen LR;Kelly L;Medoff-Cooper B出处：Am J Crit Care.2017V26N2:118-125机构：Amy Jo Lisanti is a postdoctoral fellow at the University of Pennsylvania School of Nursing, and a clinical nurse specialist/nurse researcher at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Lois Ryan Allen and Lynn Kelly are professors emeritus of nursing, Widener University School of Nursing, Chester, Pennsylvania. Barbara Medoff-Cooper is a professor, University of Pennsylvania School of Nursing, and a nurse scientist at Children's Hospital of Philadelphia. [email protected].;Amy Jo Lisanti is a postdoctoral fellow at the University of Pennsylvania School of Nursing, and a clinical nurse specialist/nurse researcher at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Lois Ryan Allen and Lynn Kelly are professors emeritus of nursing, Widener University School of Nursing, Chester, Pennsylvania. Barbara Medoff-Cooper is a professor, University of Pennsylvania School of Nursing, and a nurse scientist at Children's Hospital of Philadelphia.;Amy Jo Lisanti is a postdoctoral fellow at the University of Pennsylvania School of Nursing, and a clinical nurse specialist/nurse researcher at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Lois Ryan Allen and Lynn Kelly are professors emeritus of nursing, Widener University School of Nursing, Chester, Pennsylvania. Barbara Medoff-Cooper is a professor, University of Pennsylvania School of Nursing, and a nurse scientist at Children's Hospital of Philadelphia.;Amy Jo Lisanti is a postdoctoral fellow at the University of Pennsylvania School of Nursing, and a clinical nurse specialist/nurse researcher at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Lois Ryan Allen and Lynn Kelly are professors emeritus of nursing, Widener University School of Nursing, Chester, Pennsylvania. Barbara Medoff-Cooper is a professor, University of Pennsylvania School of Nursing, and a nurse scientist at Children's Hospital of Philadelphia.摘要： BACKGROUND: Mothers whose infants are born with complex congenital heart disease (CCHD) experience stress during their infant's hospitalization in a pediatric cardiac intensive care unit (PCICU). OBJECTIVES: This study addressed 2 research questions: (1) What are the parental stressors for mothers whose infants with CCHD are in the PCICU? And (2) What are the relationships of trait anxiety and 3 parental stressors to the parental stress response of state anxiety in mothers whose infants with CCHD are in the PCICU? METHODS: This descriptive correlational study included 62 biological mothers of infants admitted to a PCICU within 1 month of birth who had undergone cardiac surgery for CCHD. Maternal and infant demographics and responses to the Parental Stressor Scale: Infant Hospitalization and the State-Trait Anxiety Inventory were collected at 3 major PCICUs across the United States. RESULTS: Mothers' scores revealed that infant appearance and behavior was the greatest stressor, followed by parental role alteration, then sights and sounds. The combination of trait anxiety and parental role alteration explained 26% of the variance in maternal state anxiety. Mothers with other children at home had significantly higher state anxiety than did mothers with only the hospitalized infant. CONCLUSIONS: Results from this study revealed factors that contribute to the stress of mothers whose infants are born with CCHD and are hospitalized in a PCICU. Nurses are in a critical position to provide education and influence care to reduce

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maternal stressors in the PCICU, enhance mothers' parental role, and mitigate maternal state anxiety.

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· Web viewGuangzhou Women and Children’s Medical Center 2017年第4期. 部分中、外文医学杂志文摘. 中华儿科杂志 中华新生儿杂志 中华妇产科杂志

· Web viewGuangzhou Women and Children’s Medical Center 2017年第4期. 部分中、外文医学杂志文摘. 中华儿科杂志中华新生儿杂志中华妇产科杂志