SIMPLE: implementation of recommendations from international evidence-based guidelines on caesarean sections in the Netherlands. Protocol for a controlled before and after study

Background

Caesarean section (CS) rates are rising worldwide. In the Netherlands, the most significant rise is observed in healthy women with a singleton in vertex position between 37 and 42 weeks gestation, whereas it is doubtful whether an improved outcome for the mother or her child was obtained. It can be hypothesized that evidence-based guidelines on CS are not implemented sufficiently. Therefore, the present study has the following objectives: to develop quality indicators on the decision to perform a CS based on key recommendations from national and international guidelines; to use the quality indicators in order to gain insight into actual adherence of Dutch gynaecologists to guideline recommendations on the performance of a CS; to explore barriers and facilitators that have a direct effect on guideline application regarding CS; and to develop, execute, and evaluate a strategy in order to reduce the CS incidence for a similar neonatal outcome (based on the information gathered in the second and third objectives).

Methods

An independent expert panel of Dutch gynaecologists and midwives will develop a set of quality indicators on the decision to perform a CS. These indicators will be used to measure current care in 20 hospitals with a population of 1,000 women who delivered by CS, and a random selection of 1,000 women who delivered vaginally in the same period. Furthermore, by interviewing healthcare professionals and patients, the barriers and facilitators that may influence the decision to perform a CS will be measured. Based on the results, a tailor-made implementation strategy will be developed and tested in a controlled before-and-after study in 12 hospitals (six intervention, six control hospitals) with regard to effectiveness, experiences, and costs.

Discussion

This study will offer insight into the current CS care and into the hindering and facilitating factors influencing obstetrical policy on CS. Furthermore, it will allow definition of patient categories or situations in which a tailor-made implementation strategy will most likely be meaningful and cost effective, without negatively affecting the outcome for mother and child.

Trial registration

http://www.clinicaltrials.gov: NCT01261676     

氟化物对家蚕耐氟和氟化物敏感品种幼虫中肠羧酸酯酶及全酯酶活性的影响

为了探讨氟化物在家蚕Bombyx mori体内的代谢途径, 以家蚕耐氟品种T6和氟化物敏感品种734为研究材料, 在5龄幼虫1-7 d内分别添食经50, 100, 200和400 mg/kg NaF溶液浸泡后的新鲜桑叶, 检测家蚕中肠羧酸酯酶（CarE）和全酯酶活性的变化。结果表明： 734添氟组的CarE活性是对照组的1.21~1.98倍, 而T6添氟组约是对照组的0.72~1.10倍。734和T6添氟组的全酯酶活性数值变化规律与其各自对照组相似, 且2品种之间的酶活性数值很相近。2品种在相同浓度下, 不同天数之间的全酯酶活性差异均显著（P＜0.05）。推测氟化物对敏感家蚕中肠CarE有促进作用, 对耐氟家蚕中肠CarE有抑制作用, 但是对全酯酶活性影响不大。     

人体肠道细菌群落与疾病

肠道定植有100万亿细菌,这占到了人体细菌总量的绝大多数。一旦肠道菌群失调,就会产生一系列疾病。本文介绍了人体肠道细菌群落异常与5种肠道疾病和5种肠道外疾病的关系,并推荐用益生菌和益生素来治疗人体肠道细菌群落异常。为了解人体肠道细菌群落和人体健康的关系,美国国立卫生研究院已启动了人类微生物组计划,欧洲委员会也正在资助人类肠道宏基因组学项目,而中国在此项目中亦取得了可喜进步。基于肠道宏基因组的个体化医疗时代已不再遥远。     

Plant fossil record and survival analyses

Cascales‐Miñana, B. & Cleal, C.J. 2011: Plant fossil record and survival analyses. Lethaia, Vol. 45, pp. 71–82. Survival analysis is a classic palaeobiological method widely used on the animal fossil record. This study reports the first application of survivorship analyses on the plant fossil record from a global viewpoint and provides a new comparative approach of this methodology. The results reveal three important plant extinction events in the history of plant life at a global scale. The results also clearly suggest that the origination events are more intensive than extinction processes and that the origination moment of several lineages of vascular plants is an important factor that conditions their longevity. This study supports the general idea that vascular plants tended to be less affected by the environmental changes that caused mass extinction in other groups of organisms. □Extinction events, fossil record, survival patterns, taxonomic survivorship curves, vascular plants.     

大鼠骨髓源树突状细胞吞噬功能的超微结构观察

目的:利用透射电镜对体外扩增并纯化的大鼠骨髓来源树突状细胞的吞噬过程进行超微结构观察。方法:利用粘附法诱导分离大鼠骨髓细胞,延长树突状细胞的培养时间,在透射电镜下观察树突状细胞对坏死细胞碎片的吞噬过程。结果:树突状细胞识别坏死的细胞碎片后,伸出粗大突起将坏死的细胞碎片环形包裹吞噬;吞噬坏死细胞后,树突状细胞呈不规则形,细胞表面可见明显突起,消化过程中细胞内形成大量大小不等、电子密度不均一的次级溶酶体及髓鞘样膜结构。结论:树突状细胞对凋亡或坏死细胞的提呈对于保持机体内环境的稳定非常重要;利用树突状细胞的吞噬作用进行肿瘤免疫、自身免疫研究,将为树突状细胞临床治疗提供新的途径。     

噬菌体治疗细菌性感染的进展

噬菌体是自然界中广泛存在的细菌病毒,作为细菌的天然杀手,在细菌性感染尤其是多重耐药菌感染的治疗方面具有抗生素无法比拟的优势。综述了利用活噬菌体治疗细菌性感染的早期研究及近几年的初步临床试验结果、利用噬菌体裂解酶治疗细菌性感染的最新进展,指出了噬菌体治疗真正得以应用所面临的主要障碍并综述分析了一些具有一定可行性的解决方案,以期为噬菌体治疗的研究和应用提供参考,并推动噬菌体治疗研究的进一步发展。     

黑河中游绿洲区不同土地利用类型表层土壤水分空间变异的尺度效应

了解表层土壤水分空间变异及其尺度效应,可获取土壤水分真实变异,并可为客观揭示土壤水分空间变异制定合理采样方案提供参考.用“再采样”方法对黑河中游张掖绿洲区林地和农地表层土壤水分空间变异的尺度性进行研究.结果表明： 研究区林地和农地表层土壤水分变异程度随土壤水分含量的增加而增加;变异系数随采样尺度的增大而更接近真实变异值.在干旱和湿润条件下,当采样幅度在一定范围内增大时,林地和农地土壤水分的变异系数、Moran I指数、块金值、基台值及林地变程均不断变大,而农地在干旱条件下的变程无固定变化规律.当采样密度在一定范围内增大时,块金值、变程不断增大,但变异系数、Moran I指数、基台值均不受影响.
     

黑鸢消化系统形态学的初步研究

对黑鸢消化系统的形态学作了初步的观察与研究,结果表明：黑鸢舌尖钝圆,舌根分叉,叉粘膜上具有尖端指向后方的栉状突;食管宽而扁,无明显可见的嗉囊;肌胃无明显的类角质膜;肠道长是体长2．3倍,小肠较发达,K1275mm,古肠道总长的93．6％,具有不发达的双侧盲肠：胰腺短而厚、并与蛇雌、毛脚鸢的消化系统进行了比较。     

DMSO抑制杂交瘤增殖促进抗体的分泌

利用DMSO促进杂交瘤细胞分泌单克隆抗体,并对其作用机制进行了研究。结果表明在杂交瘤细胞对数生长后期添加0.6%浓度的DMSO与对照相比可提高抗体的产量2倍;流式细胞仪检测细胞周期表明此时837%的细胞处于G1期;免疫印记结果显示在有DMSO作用下杂交瘤细胞P27 蛋白表达显著升高。因此,DMSO 可通过促进P27蛋白的表达,抑制杂交瘤细胞的增殖,从而提高杂交瘤细胞分泌抗体的能力。对DMSO进一步在高密度大规模培养杂交瘤细胞中的应用具有重要意义。     

鸡胚蛋孵化期间氨基酸含量的测定

鸡胚蛋在孵化期间 ,其蛋白质、总氨基酸、游离氨基酸从孵化开始逐渐增加 ,1 0d～ 1 9d稳定在一个较高的水平 ,比未孵化的鲜鸡蛋提高 1 %以上 ,胎水氨基酸从第 7d开始形成 ,以后含量稳定在 2 .6～ 2 .6 3g/kg,这些氨基酸组成符合各种人群营养需要。