RÉSUMÉ
Objective To investigate the screening strategy of group B streptococcus (GBS) in the reproductive tract of women in the third trimester and analyze its impact on pregnancy outcome. Methods A total of 85 461 pregnant women in 35-37 weeks of gestation from Bao′an Maternity and Child Health Hospital, Jinan University from January 2011 to June 2018 were enrolled. They were divided into 3 periods according to different GBS screening strategies, the unscreened period included 31 384 cases (36.72%), 33 267 cases (38.93%) were included in partial screening period, 20 810 cases (24.35%) were included in screening period. All GBS screening positive pregnant women were given intrapartum antibiotic prophylaxis (IAP). The impact on pregnancy outcomes, and the impact of different GBS collection transport and culture methods on the positive rate of GBS screening were analyzed. Results (1) The incidence of neonatal early onset GBS disease (EOGBSD) in unscreened period was 0.03% (11/31 773), in partial screening period was 0.02%(6/33 887), and in screening period, the incidence of neonatal EOGBSD decreased to 0, the difference was statistically significant (χ2=7.86, P=0.02).(2) The incidence of hematogenous infection of GBS in pregnant women was 0.02%(6/33 887) in partial screening period, and there was none in screening period, there was no significant difference (adjusted χ2=3.75, P=0.05). (3) In the screening period, the positive rate of GBS was 14.08%(2 719/19 306), which was significantly higher than the positive rate of GBS in the partial screening period (11.48%, 2 058/17 920; χ2=56.12, P=0.00). (4) Antibiotic sensitivity tests of 4 777 GBS strains showed that the antibiotics with higher resistance rate were tetracycline (81.52%, 3 896/4 777), erythromycin (66.59%, 3 181/4 777), and clindamycin (64.31%, 3 072/4 777). The combination of erythromycin, clindamycin and tetracycline was the most common resistant pattern, accounting for 48.80% (2 331/4 777). No penicillin, ceftriaxone or vancomycin resistant strains was found. Conclusions GBS screening strategy in different regions could combine the local neonatal EOGBSD incidence rate, maternal GBS colonization rate, and the socioeconomic factors to determine whether universal GBS screening or screening for high-risk maternal women. GBS screening positive rate is related to the population, scope of the investigation, the sample collection, delivery and culture methods. The multi-drug resistance rate of GBS is high.[Key words] Streptococcus agalactiae; Streptococcal infections; Neonatal sepsis; Prenatal diagnosis; Pregnancy trimester, third; Pregnancy outcome
RÉSUMÉ
Objective This study explored the effect of the multidisciplinary-team collaborative nursing model in physical examinations of people with critical conditions (based on test results).Methods We selected 962 patients with critical conditions based on test-result values found from February to April 2018 as the general process group treated through the routine nursing model,and we also selected 1009 patients with critical conditions based on test-result values found from May to July 2018 as the multidisciplinary collaborating group using a team nursing model.The multidisciplinary collaborative nursing team members included health management center nurses,outpatient nurses,resident nurses,and ward nurses.We compared visiting rates,hospitalization rates,average visiting times,and overall satisfaction after the patients received notification of their abnormal results.There were 488 male patients (50.7％) and 474 female patients (49.3％) in the general process group,with an average age of 51.9 ± 14.9 years;there were 537 male patients (53.2％) and 472 female patients (46.8％) in the multidisciplinary collaboration group,with an average age of 51.0 ± 13.0.Results For the multidisciplinary collaboration group and the general process group,respectively,the visiting rate was 53.0％ and 44.7％ (x2=13.65);the hospitalization rate was 26.7％ and 20.9％ (x2=4.38);overall satisfaction was 97.9％ and 95.9％ (x2=6.49);and the average visiting time was 4 days and 6 days (Z=5.04).The differences were statistically significant (P＜0.05).By category,the visiting rate for radiology and ultrasound patients among the multidisciplinary collaboration group was significantly higher than in the general process group (64.4％ vs.50.8％ for radiology,45.9％ vs.37.3％ for ultrasound,x2=7.65,7.11,P＜0.05).The hospitalization rate for ultrasound patients in the multidisciplinary collaboration group was significantly higher than in the general process group (12.5％ vs.6.4％,x2=10.17,P＜0.05).The average visiting time of ultrasound,abnormal blood pressure,and laboratory testing patients was significantly lower in the general process group (4 days vs.6 days,4 d vs.7 days,4 days vs.5 days,Z=3.37,1.97,2.62,P＜0.05).The overall satisfaction of radiology patients was significantly higher than in the general process group (98.6％ vs.94.3％,x2=5.39,P＜0.05).Conclusion The multidisciplinary team collaborative nursing model improves the rate of visiting and hospitalization of patients with critical conditions after physical examination,shortening their stays,helping patients get timely diagnoses and treatment,and improving patient satisfaction,making the model worth popularizing and applying more broadly.
RÉSUMÉ
Telomerase activity was examined in invasive cervical carcinoma to assess whether it is activated during cervical malignant transformation and to look for its possible association with human papillomavirus (HPV) infection. Histologically confirmed invasive cervical carcinomas and benign cervices were assayed for telomerase activity by using a modified telomere repeat amplification protocol (TRAP). The same cases were subjected to polymerase chain reaction (PCR) detection of HPV by using consensus primers and type-specific (HPV types 16 and 18) primers. Telomerase activity was detected in 40 of 45 (88.9%) invasive cervical carcinomas and 2 (all chronic cervicitis) of 50 (4%) benign cervical lesions. HPV was detected in 36 (24 HPV-16 and 4 HPV-18 cases) of 45 (80%) invasive cervical carcinomas and 20 (11 HPV-16 and 1 HPV-18 cases) of 50 (40%) benign cervical changes. There was a significant correlation between the expression of telomerase with histological grade (φ=0.44, P＜0.005), but no correlation was found between telomerase expression and HPV-18 (P＞0.05). Although larger sample studies are needed, there seems to be a clear association between telomerase upregulation and HPV status, mainly HPV-16 infection.