Abstract: Chuang Tzu (《庄子》), as a traditional Chinese canon, has been translated into English for more than 100 years since 1881, successfully carving a niche in the realm of world literature, which has become an earth-shattering cultural event in the academia of overseas sinology and world literature. According to statistics, the book has been translated into 12 full translations, 50 selected translations, and two adaptations. The metamorphosis process of “full translation - deep translation - diversified retranslation”, has passed through four stages, namely religious, literary, philosophical, and diversified reinterpretation phases. Thus, from the perspective of Damrosch’s view of world literature, this paper summarizes the characteristics of different stages based on different spatial-temporal contexts. In the light of translation form, translational outcomes, and translation mode of reading, the path in which Chuang Tzu entered into the field of world literature is specified for the operational mechanism of promoting national literature to world literature, which is dedicated to the enlightenment for practical translation work of introducing Chinese literature abroad. Meanwhile, by reviewing the history of English translations of Chuang Tzu, this paper sums up the deficiencies of current translation activities and research activities, with an attempt to provide constructive suggestions as well as to point out the direction for the future development of overseas studies of Chuang Tzu.

Resumo: Chuang Tzu (《庄子》), como um cânone tradicional chinês, foi traduzido para o inglês por mais de 100 anos, desde 1881, conquistando com sucesso um nicho no reino da literatura mundial, que se tornou um evento cultural devastador na academia de sinologia ultramarina e literatura mundial. Segundo as estatísticas, o livro foi traduzido em 12 traduções completas, 50 traduções selecionadas e duas adaptações. No processo de metamorfose da “tradução completa - tradução profunda - retradução diversificada”, passou por quatro fases, nomeadamente fases religiosas, literárias, filosóficas e reinterpretações diversificadas. Assim, na perspectiva da visão de Damrosch a respeito da literatura mundial, o artigo resume as características de diferentes estágios, com base em diferentes contextos espaço-temporais. À luz da forma tradutória, dos resultados tradutórios e do modo de leitura tradutória, especifica-se o caminho pelo qual Chuang Tzu entrou no campo da literatura mundial, para apreender o mecanismo operacional de promoção da literatura nacional à literatura mundial, que se dedica ao esclarecimento para o trabalho prático de tradução da introdução da literatura chinesa no exterior. Enquanto isso, revisando a história das traduções inglesas de Chuang Tzu, o artigo resume as deficiências das atuais atividades de tradução e pesquisa, com a tentativa de fornecer sugestões construtivas, bem como apontar a direção para o desenvolvimento futuro de estudos de Chuang Tzu no exterior.

Abstract Background Hypertrophic scar (HS), a fibroproliferative disorder caused by aberrant wound healing following skin injuries such as burns, lacerations and surgery, is characterized by invasive proliferation of fibroblasts and excessive extracellular matrix (ECM) accumulation. The dysregulation of autophagy is the pathological basis of HS formation. Previously, angiopoietin-2 (ANGPT2) was found to be overexpressed in HS fibroblasts (HSFs) compared with normal skin fibroblasts. However, whether ANGPT2 participates in the process of HS formation and the potential molecular mechanisms are not clear. Objective This study is intended to figure out the role of ANGPT2 and ANGPT2-mediated autophagy during the development of HS. Methods RT-qPCR was used to detect ANGPT2 expression in HS tissues and HSFs. HSFs were transfected with sh-ANGPT2 to knock down ANGPT2 expression and then treated with MHT1485, the mTOR agonist. The effects of sh-ANGPT2 or MHT1485 on the proliferation, migration, autophagy and ECM accumulation of HSFs were evaluated by CCK-8 assay, Transwell assay and western blotting. The expression of PI3K/Akt/mTOR pathway-related molecules (p-PI3K, p-Akt and p-mTOR) was assessed by western blotting. Results ANGPT2 expression was markedly upregulated in HS tissues and HSFs. ANGPT2 knockdown decreased the expression of p-PI3K, p-Akt and p-mTOR. ANGPT2 knockdown activated autophagy and inhibited the proliferation, migration, and ECM accumulation of HSFs. Additionally, the treatment of MHT1485, the mTOR agonist, on ANGPT2-downregulated HSFs, partially reversed the influence of ANGPT2 knockdown on HSFs. Study limitations The study lacks the establishment of more stable in vivo animal models of HS for investigating the effects of ANGPT2 on HS formation in experimental animals. Conclusions ANGPT2 downregulation represses growth, migration, and ECM accumulation of HSFs via autophagy activation by suppressing the PI3K/Akt/mTOR pathway. Our study provides a novel potential therapeutic target for HS.

ABSTRACT Background: Betula platyphylla Sukaczev is one of important tree species due to its ecological and economic value. It is a cold-tolerant tree species which also faces heat stress during summer. In the current study, RNA-Seq profiling of two-month-old B. platyphylla seedlings were conducted utilizing the MGISEQ-2000 platform. Results: In total, 856,347,961 clean reads were obtained from 26 RNA-Seq libraries. Totally, 822,552,820 reads were successfully mapped to B. platyphylla reference genome. Further, a total of 360 and 264 DEGs were discovered under cold and heat exposure, respectively, while a total of 104 DEGs were identified under both cold and heat exposure. It was found that several pathways including response to cold, response to heat, response to temperature stimulus, response to stress, lipid metabolic, jamonic acid and ethylene, even developmental processes were significantly enriched in GO enrichment analysis of cold and heat stress in biological process term. Several transcription factors (TFs), including MYB66, CBF2, bHLH96and bZIP7 take a pivotal role in response to temperature stresses. Furthermore, heat shock proteins were identified under cold and heat stress, respectively, suggesting these genes participate in reducing cold and heat stress detrimental effect by interacting with TFs or other genes related to abiotic stresses, chlorophyll and photosynthesis, osmoprotectants, and phytohormone as well. Conclusion: This study not only underlying B. platyphylla’s molecular mechanism in response to temperature stresses but also provides candidate genes involved in response to temperature stresses.

Resumo: Para Paul Auster, um quarto é, em essência, “a própria substância da solidão”, uma solidão espacialmente definida. Nesse sentido, o fenômeno transcendeu suas limitações físicas e assumiu significado existencial e filosófico. Em seus escritos, uma sala é, antes de tudo, um espaço arquitetônico que um escritor solitário ocupa; além disso, é metaforizado como a mente que é a sala - um espaço construído intelectualmente; e, por fim, é um lugar narrado em suas histórias, onde seus personagens meditam e compõem, um espaço que existe em palavras. O artigo realiza estudos sobre os escritos da vida de Auster e uma de suas ficções, Homem no Escuro, para apresentar a complexidade das três formas de quartos solitários e sua mútua inclusão na solidão intersubjetiva.

Abstract: For Paul Auster, a room is in essence “the substance of solitude itself”, a spatially defined solitude. In this respect, the phenomenon has transcended its physical limitations and assumed existential and philosophical significance. In his writings, a room is first and foremost an architectural space that a solitary writer occupies. Besides, it is metaphorized as the mind that is the room - an intellectually constructed space; and lastly, it is a place narrated in his stories where his characters meditate and compose, a space that exists in words. This paper studies Auster’s life writings and one of his fictions, Man in the Dark, to present the complexity of the three forms of solitary rooms and their mutual inclusion in intersubjective solitude.

Resumo Fundamento A cardiopatia isquêmica atraiu muito atenção devido às altas taxas de mortalidade, custos do tratamento e a crescente morbidade na população jovem. Estratégias de reperfusão reduziram a mortalidade. Porém, a reperfusão pode levar à morte do cardiomiócito e subsequente dano irreversível ao miocárdio. No momento, não há um tratamento eficiente e direcionado para a lesão de isquemia-reperfusão (I/R). Objetivos Avaliar se a dexmedetomidina (DEX) tem efeito protetivo na I/R do miocárdio e explorar os possíveis mecanismos por trás dela. Métodos Corações de ratos foram perfundidos com o sistema de perfusão de Langendorff e aleatoriamente distribuídos em cinco grupos: grupo controle, perfundido com solução de Krebs-Henseleit (K-H) por 205 minutos sem isquemia; e quatro grupos de teste que foram submetidos a 40 minutos de isquemia global e 120 minutos de reperfusão. O Grupo DEX, o grupo ioimbina (IO) e o grupo DEX + IO foram perfundidos com DEX (10 nM), IO (1 μM) ou a combinação de DEX e IO antes da reperfusão, respectivamente. A hemodinâmica cardíaca, o tamanho do infarto do miocárdio e a histologia do miocárdio foram avaliados. A expressão da proteína-78 regulada pela glicose (GRP78), a proteína quinase do retículo endoplasmático (PERK), a PERK fosforilada, o fator de iniciação eucariótico 2α (eIF2α), eIF2α fosforilado, o fator de transcrição 4 (TCF-4) e a proteína homóloga à proteína ligadora do acentuador CCAAT (CHOP) foram avaliados. P< 0,05 foi considerado para indicar a diferença estatisticamente significativa. Resultados O pré-condicionamento com DEX melhorou a função cardíaca nos corações com I/R, reduziu o infarto do miocárdio, a apoptose do miocárdio e a expressão de GRP78, p-PERK, eIF2α, p-eIF2α, TCF-4 e CHOP. Conclusões O pré-tratamento com DEX reduziu a lesão de I/R no miocárdio ao suprimir a apoptose, o que foi induzido pela via PERK.

Abstract Background Ischemic heart disease has attracted much attention due to its high mortality rates, treatment costs and the increasing morbidity in the young population. Strategies for reperfusion have reduced mortality. However, reperfusion can lead to cardiomyocyte death and subsequent irreversible myocardial damage. At present, the timely and targeted treatment of ischemia-reperfusion (I/R) injury is often lacking. Objectives To evaluate if dexmedetomidine (DEX) has a protective effect in myocardiual I/R and explore the possible mechanism behind it. Methods Rat hearts were perfused with a Langendorff perfusion system, and randomly assigned to five groups: control group, perfused with Krebs-Henseleit (K-H) solution for 205 minutes without ischemia; and four test groups that underwent 40 minutes of global ischemia and 120 min of reperfusion. The DEX group, the yohimbine (YOH) group and the DEX + YOH group were perfused with DEX (10 nM), YOH (1 μM) or the combination of DEX and YOH prior to reperfusion, respectively. Cardiac hemodynamics, myocardial infarct size, and myocardial histology were evaluated. The expression of glucose-related protein 78 (GRP78), protein kinase R-like ER kinase (PERK), phosphorylated PERK, eukaryotic initiation factor 2α (eIF2α), phosphorylated eIF2α, activating transcription factor 4 (ATF4), and CCAAT/enhancer-binding protein homologous protein (CHOP) were assessed. P<0.05 was considered to indicate a statistically significant difference. Results DEX preconditioning improved the cardiac function of I/R hearts, reduced myocardial infarction, myocardial apoptosis, and the expression of GRP78, p-PERK, eIF2α, p-eIF2α, ATF4 and CHOP. Conclusions DEX pretreatment reduced myocardial I/R injury by suppressing apoptosis, which was induced by the PERK pathway.

ABSTRACT Purpose To investigate the relationship between atherosclerotic abdominal aortic aneurysm (AAA) and CXC chemokine receptor type 2 (CXCR2). Methods Mouse AAA model was established by embedding angiotensin-II pump (1000 ng/kg/min) in ApoE-/- mice. Mice were received SB225002, a selective CXCR2 antagonist, for treatment. Blood pressure was recorded, and CXCR2+ macrophages were examined by flow cytometry analysis. Terminal-deoxynucleotidyl transferase mediated nick end labeling (TUNEL) staining was performed to detect cell apoptosis of abdominal aortic aneurysms. Macrophages were isolated from ApoE-/- mice and treated with Ang II and/or SB225002. Dihydroethidium staining was carried out to determine reactive oxygen species (ROS) activity. Enzyme-linked immunosorbent assay (ELISA) was performed to determine the production of IL-1β and TNF-α. The corresponding gene expressions were measured using real-time polymerase chain reaction (PCR), western blot, and immunohistochemistry staining. Results We found that Ang II activated the expression of CXCR2 in monocytes during the formation of AAA. Inhibition of CXCR2 significantly reduced the size of AAA, attenuated inflammation and phenotypic changes in blood vessels. Ang II-induced macrophages exhibited elevated ROS activity, and elevated levels of 1β and TNF-α, which were then partly abolished by SB225002. Conclusions CXCR2 plays an important role in AAA, suggesting that inhibiting CXCR2 may be a new treatment for AAA.

RESUMO OBJETIVO Explorar a viabilidade do cultivo da competência em saúde na prevenção e controle da hipotermia perioperativa inadvertida (IPH). MÉTODOS Pacientes com cirurgia espinhal marcada foram divididos em dois grupos, A e B, pelo método de números aleatórios. O grupo B foi conduzido com base na gestão rotineira para prevenção de IPH; já no grupo A, foram implementadas medidas de treinamento em competência de saúde. As pontuações do questionário sobre competência em saúde, a temperatura aferida em diferentes momentos, complicações relacionadas à IPH e hospitalização dos dois grupos foram observadas e comparadas. RESULTADOS Os principais índices de avaliação, como a pontuação do questionário sobre competência em saúde, a variação de temperatura e as complicações relacionadas à IPH durante o período perioperatório foram significativamente melhores no grupo A do que no grupo B (p<0,05). Os índices de anestesia, despesas hospitalares totais e satisfação com o serviço de saúde também foram significativamente melhores no grupo A do que no B, o que demonstra as vantagens do cultivo da competência de saúde tanto em médicos como em pacientes. CONCLUSÃO Por meio do cultivo de competências de saúde e de medidas viáveis de gestão da saúde, a equipe médica pode melhorar a qualidade da prevenção e gestão da IPH.

SUMMARY OBJECTIVE To explore the feasibility of health competence cultivation on the prevention and control of Inadvertent Perioperative Hypothermia (IPH). METHODS Patients with expected spinal surgery were divided into group A and group B by the random number method. Group B followed routine IPH management, and health training measures for performance and ability were implemented in Group A. The scores of the health competence questionnaire, the temperature at different times, IPH complications, and hospitalization for the two groups were observed and compared. RESULTS The main evaluation indexes, such as the health competence questionnaire score, temperature fluctuations, and IPH complications, during the perioperative period in group A were significantly better than those in group B (p < 0.05). The indexes of anesthesia, total hospital expenses, and health service satisfaction in group A were also significantly better than those in group B, which shows the advantages of cultivating health capabilities in both doctors and patients. CONCLUSION Through health competence cultivation and feasible health management measures, the medical staff can improve the quality of IPH prevention and management.

Resumo Objetivo: A bilirrubina total é benéfica para proteger contra doenças cardiovasculares em adultos. Nosso objetivo foi investigar a associação dos níveis de bilirrubina total, glóbulos vermelhos e hemoglobina com a prevalência de pressão arterial elevada em crianças e adolescentes. Métodos: Um total de 3.776 estudantes (com idade entre 6-16 anos) foram examinados utilizando uma amostra em blocos. A pressão arterial elevada anterior e a pressão arterial elevada foram definidas como o 90° e 95° percentil, respectivamente, com base nos critérios do Quarto Relatório sobre Diagnóstico, Avaliação e Tratamento da Pressão Arterial elevada em Crianças e Adolescentes. A pressão arterial sistólica e pressão arterial diastólica foram padronizadas no escore z. Resultados: Os níveis periféricos de bilirrubina total, glóbulos vermelhos e hemoglobina foram significativamente correlacionados à idade, que também variou de acordo com o sexo. A bilirrubina total periférica apresentou uma correlação negativa com a pressão arterial sistólica em meninos com 6 e 9 anos, ao passo que apresentou uma correlação positiva com a pressão arterial diastólica em meninos de 12 anos e meninas de 13 a 15 anos (p < 0,05). Foram observados níveis mais elevados de glóbulos vermelhos e hemoglobina em estudantes com pressão arterial elevada anterior e pressão arterial elevada em comparação a indivíduos normotensos (p < 0,01). Os aumentos de glóbulos vermelhos e hemoglobina tiveram uma associação significativa com a pressão arterial elevada após ajuste dos fatores de confusão. As RC (IC de 95%) de cada um dos aumentos foram 2,44 (1,52-3,92) e 1,04 (1,03-1,06) respectivamente. Não foi observada nenhuma associação estatística entre o nível de bilirrubina total e a pressão arterial elevada (p > 0,05). Conclusão: A bilirrubina total pode ter correlações fracas com a pressão arterial sistólica e a pressão arterial diastólica, variando de acordo com a idade e o sexo em crianças e adolescentes, enquanto isso, propõe-se que o aumento dos níveis de glóbulos vermelhos e hemoglobina está positivamente associado à prevalência de pressão arterial elevada.

Abstract Objective: Total bilirubin is beneficial for protecting cardiovascular diseases in adults. The authors aimed to investigate the association of total bilirubin, red blood cell, and hemoglobin levels with the prevalence of high blood pressure in children and adolescents. Methods: A total of 3776 students (aged from 6 to 16 years old) were examined using cluster sampling. Pre-high blood pressure and high blood pressure were respectively defined as the point of 90th and 95th percentiles based on the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. Both systolic and diastolic blood pressure were standardized into z-scores. Results: Peripheral total bilirubin, red blood cell and hemoglobin levels were significantly correlated with age, and also varied with gender. Peripheral total bilirubin was negatively correlated with systolic blood pressure in 6- and 9-year-old boys, whilst positively correlated with diastolic blood pressure in the 12-year-old boys and 13- to 15-year-old girls (p < 0.05). Higher levels of red blood cell and hemoglobin were observed in pre-high blood pressure and high blood pressure students when compared with their normotensive peers (p < 0.01). The increases in red blood cell and hemoglobin were significantly associated with high blood pressure after adjusting for confounding factors. The ORs (95% CI) of each of the increases were 2.44 (1.52-3.92) and 1.04 (1.03-1.06), respectively. No statistical association between total bilirubin and high blood pressure was observed (p > 0.05). Conclusion: Total bilirubin could be weakly correlated with both systolic and diastolic blood pressure, as correlations varied with age and gender in children and adolescents; in turn, the increased levels of red blood cell and hemoglobin are proposed to be positively associated with the prevalence of high blood pressure.

Abstract A new 3-node triangular hybrid displacement function Mindlin-Reissner plate element is developed. Firstly, the modified variational functional of complementary energy for Mindlin-Reissner plate, which is eventually expressed by a so-called displacement function F, is proposed. Secondly, the locking-free formulae of Timoshenko’s beam theory are chosen as the deflection, rotation, and shear strain along each element boundary. Thirdly, seven fundamental analytical solutions of the displacement function F are selected as the trial functions for the assumed resultant fields, so that the assumed resultant fields satisfy all governing equations in advance. Finally, the element stiffness matrix of the new element, denoted by HDF-P3-7β, is derived from the modified principle of complementary energy. Together with the diagonal inertia matrix of the 3-node triangular isoparametric element, the proposed element is also successfully generalized to the free vibration problems. Numerical results show that the proposed element exhibits overall remarkable performance in all benchmark problems, especially in the free vibration analyses.

Background: Previous study revealed that the link between dental caries and obesity has been controversial. The purpose of this research is to investigate the association between dental caries and obesity among primary school children in Wannan area, China. Methods: A cross-sectional study was designed to collect the routine health screening data for primary school children aged 5-14 years inWannan area,China, Overweight and obesity status were determined using the International Obesity Task Force standard (IOTF) BMI cut-off points. Caries status was recorded based on WHO recommendations. Results: Our results revealed that the overall caries prevalence of the subjects was 44.9%, Maximum number of caries affected children belonged to underweight and normal group, followed by overweight, and the least number was obesity. These differences were statistically significant (chi-square test, P < 0.001). Children with obesity were 1.908 times (OR =1.908; CI95%=1.750, 2.079) more likely have caries than children with underweight or health weight. Overweight children were 1.547 times (OR = 1.547; CI95% = 1.479, 1.618) more likely to have caries than children with underweight or health weight. After adjusted the gender and age, a statistically significant association was also observed between body mass index categories and caries. Conclusions: Obesity may have a significant effect on caries prevalence of primary school children in Wannan area, China. The importance of obesity should not only be emphasized with respect to general diseases but also with regard to carious lesions.

Antecedentes: Un estudio previo reveló que la asociación entre la caries dental y la obesidad es controvertida. El propósito de esta investigación fue investigar la asociación entre la caries dental y la obesidad en niños de escuela primaria en el área de Wannan, China. Métodos: Se diseñó un estudio transversal para recoger los datos del chequeo rutinario de salud de los niños de escolarización primaria con edades de 5-14 en el área de Wannan, China. Se determinó el estado de sobrepeso y obesidad utilizando los puntos de corte estándar del IMC del Grupo de Trabajo Internacional en Obesidad (GTIO). El estado de las caries se registró de acuerdo con las recomendaciones de la OMS. Resultados: Nuestros resultados revelaron que la prevalencia global de caries en los sujetos fue del 44,9%. El máximo número de niños afectados por las caries estaba en los grupos normal y con peso bajo, seguido por el grupo con sobrepeso y por último en el grupo de obesidad. Estas diferencias fueron estadísticamente significativas (test Chi-cuadrado, P < 0,001). Los niños con sobrepeso tenían una probabilidad 1,547 veces superior (OR = 1,547; IC al 95% = 1,479, 1,618) de tener caries dental que los niños con un peso bajo o normal. Tras ajustar por sexo y edad, también se observó una asociación estadísticamente significativa entre el índice de masa corporal y la caries. Conclusiones: La obesidad puede tener un efecto significativo sobre la prevalencia de caries en niños en escolarización primaria en el área de Wannan, China. No sólo se debería poner el énfasis de la importancia de la obesidad en relación con las enfermedades generales sino también en relación con las lesiones cariales.

Our objective was to examine associations of adult weight gain and nonalcoholic fatty liver disease (NAFLD). Cross-sectional interview data from 844 residents in Wan Song Community from October 2009 to April 2010 were analyzed in multivariate logistic regression models to examine odds ratios (OR) and 95% confidence intervals (CI) between NAFLD and weight change from age 20. Questionnaires, physical examinations, laboratory examinations, and ultrasonographic examination of the liver were carried out. Maximum rate of weight gain, body mass index, waist circumference, waist-to-hip ratio, systolic blood pressure, diastolic blood pressure, fasting blood glucose, cholesterol, triglycerides, uric acid, and alanine transaminase were higher in the NAFLD group than in the control group. HDL-C in the NAFLD group was lower than in the control group. As weight gain increased (measured as the difference between current weight and weight at age 20 years), the OR of NAFLD increased in multivariate models. NAFLD OR rose with increasing weight gain as follows: OR (95%CI) for NAFLD associated with weight gain of 20+ kg compared to stable weight (change <5 kg) was 4.23 (2.49-7.09). Significantly increased NAFLD OR were observed even for weight gains of 5-9.9 kg. For the “age 20 to highest lifetime weight” metric, the OR of NAFLD also increased as weight gain increased. For the “age 20 to highest lifetime weight” metric and the “age 20 to current weight” metric, insulin resistance index (HOMA-IR) increased as weight gain increased (P<0.001). In a stepwise multivariate regression analysis, significant association was observed between adult weight gain and NAFLD (OR=1.027, 95%CI=1.002-1.055, P=0.025). We conclude that adult weight gain is strongly associated with NAFLD.

OBJECTIVE: To assess the effectiveness of a three-stage intervention to reduce caesarean deliveries in a Chinese tertiary hospital. METHODS: A retrospective study was conducted to assess whether educating staff, educating patients and auditing surgeon practices (introduced in 2005) had reduced caesarean delivery rates. Multiple logistic regression was used to check for a potential association between caesarean rates and rates of admission to the neonatal intensive care unit (NICU). FINDINGS: The caesarean delivery rate ranged from 53.5% to 56.1% in 2001-2004 and from 43.9% to 36.1% in 2005-2011. When 2001-2004 and 2005-2011 were treated as "before" and "after" periods to evaluate the intervention's impact on the mean caesarean section rate, a significant reduction was noted: from 54.8% to 40.3% (odds ratio, OR: 0.56; 95% confidence interval, CI: 0.52-0.59; χ2 test: P < 0.001). The overall drop in the caesarean section rate was significant (χ2 test: P < 0.001) and inversely correlated with the years (Spearman's ρ: -0.096; P < 0.001). Although complicated pregnancies increased after 2004, the primary caesarean section rate decreased annually by 20% on average in 2005-2011, after practice audits were implemented. Multiple logistic regression showed a positive association between the caesarean delivery rate and the rate of admission to the NICU (adjusted OR: 1.26; 95% CI: 1.14-1.40). CONCLUSION: Patient and staff education and practice audits reduced the Caesarean section rate in a tertiary referral hospital without an increase in admissions to the NICU.

OBJETIVO: Evaluar la eficacia de una intervención en tres etapas para reducir los partos por cesárea en un hospital de atención terciaria en China. MÉTODOS: Se realizó un estudio retrospectivo para evaluar si el programa educativo para el personal y los pacientes y la auditoría de las prácticas de los cirujanos (que se pusieron en marcha en el año 2005) habían disminuido la tasa de partos por cesárea. Se empleó una regresión logística múltiple para comprobar la posible relación entre la tasa de cesáreas y la tasa de admisión en la unidad de cuidados intensivos neonatales (UCIN). RESULTADOS: La tasa de partos por cesárea osciló entre el 53,5% y el 56,1% entre 2001 y 2004 y entre el 43,9% y el 36,1% entre 2005 y 2011. Se constata una reducción significativa en la misma si se consideran los años 2001-2004 y 2005-2011 como periodos «antes» y «después» para evaluar el impacto de la intervención sobre la tasa media de partos por cesárea: del 54,8% al 40,3% (razón de posibilidades, OR: 0,56; intervalo de confianza, IC, del 95%: 0,54 - 0,59; χ2test P<0,001). La disminución general en la proporción de cesáreas fue significativa (χ2 test: P<0,001) y estuvo relacionada de forma inversa con los años (correlación de Spearman ρ: -0,096; P<0,001). A pesar del aumento de embarazos complicados después de 2004, la tasa de cesáreas primarias disminuyó anualmente hasta un 20% de media entre los años 2005-2011 después de haber puesto en marcha las auditorías de las prácticas. La regresión logística múltiple mostró una relación positiva entre la tasa de partos por cesárea y la tasa de admisión en la unidad de cuidados intensivos neonatales UCIN (OR ajustada: 1,26; IC del 95%: 1,14-1,40). CONCLUSIÓN: El programa educativo para el personal y los pacientes, así como las auditorías de las prácticas redujeron la tasa de cesáreas en un hospital de atención terciaria sin aumentar el número de admisiones en la UCIN.

OBJECTIF: Evaluer l'efficacité d'une intervention en trois étapes pour réduire les accouchements par césarienne dans un hôpital de troisième ligne chinois. MÉTHODES: Une étude rétrospective a été menée afin de déterminer si l'éducation du personnel, l'éducation des patients et l'audit des pratiques des chirurgiens (introduit en 2005) avaient réduit les taux d'accouchement par césarienne. Une régression logistique multiple a été utilisée pour vérifier une éventuelle corrélation entre les taux de césarienne et les taux d'admission à l'unité de soins intensifs néonataux. RÉSULTATS: Le taux de césarienne variait de 53,5% à 56,1% en 2001-2004 et de 43,9% à 36,1% en 2005-2011. Lorsque 2001-2004 et 2005-2011 ont été traités en tant que périodes "avant" et "après" pour évaluer l'impact des interventions sur le taux moyen de césarienne, une réduction significative a été mise en évidence: de 54,8% à 40,3% (rapport des chances, OR: 0,56; intervalle de confiance à 95%, IC: 0,52 à 0,59; test de χ2: P <0,001). La baisse globale du taux de césarienne était significative (test de χ2: P <0,001) et inversement corrélée avec les années (ρ de Spearman: -0,096; P <0,001). Bien que les grossesses compliquées aient augmenté après 2004, le taux de césarienne primaire a diminué chaque année de 20% en moyenne en 2005-2011, après que l'audit de bonnes pratiques ait été mis en œuvre. Une régression logistique multiple a montré une corrélation positive entre le taux de naissance par césarienne et le taux d'admission à l'unité de soins intensifs néonataux (OR ajusté: 1,26, IC 95%: 1,14 à 1,40). CONCLUSION: L'éducation des patients et du personnel ainsi que l'audit de bonnes pratiques ont réduit le taux de césarienne dans un hôpital de troisième ligne, sans augmentation des admissions en soins intensifs néonataux.