香港公立醫院中外陰切開術的應用情況

OBJECTIVE. To review the use of episiotomy during vaginal delivery in Hong Kong public hospitals. DESIGN. Prospective observational survey. SETTING. Public hospitals, Hong Kong. PARTICIPANTS. Women who underwent normal vaginal delivery of a singleton foetus with cephalic presentation. MAIN OUTCOME MEASURES. Number of women having an episiotomy, severe-degree (third- or fourth-degree) tear, other types of tear, blood loss at delivery, postpartum haemorrhage, need for blood transfusion, puerperal pyrexia, wound infection, gaping wound that required suture removal, and drainage or resuturing of a perineal wound. RESULTS. Between 1 January and 31 March 2003, there were 6222 singleton spontaneous normal vaginal deliveries in the public hospitals of Hong Kong. Of the 6167 women in whom the status of the perineum was known, episiotomy was performed in 5274 (85.5%). Primiparous women were more likely to undergo episiotomy at delivery than multiparous women (97.9% vs 71.4%). Women with episiotomy had significantly less perineal tearing of any kind than those without. The occurrence of any type of perineal tear and severe-degree (third- or fourth-degree) tear was significantly lower in primiparous women who had an episiotomy than those without (P<0.05). Women with episiotomy had increased mean blood loss at delivery but other complications were not significantly increased. CONCLUSIONS. In Hong Kong, episiotomy is routinely performed during normal vaginal delivery. It is associated with a significantly lower overall rate of perineal tearing. This study was observational, nonetheless the occurrence of other complications was likely to increase when episiotomy was performed. Firm evidence from several randomised controlled studies shows that routine episiotomy is unjustified and possibly harmful. Routine episiotomy should not be promoted in Hong Kong without further randomised controlled study.published_or_final_versio

Representative elementary volume (REV) of cementitious materials from three-dimensional pore structure analysis

The representative elementary volume (REV) is a fundamental property of a material, but no direct measurements exist for cementitious materials. In this paper, the REV of cement pastes with supplementary cementitious materials (GGBS, PFA, SF) was determined by analysing the three-dimensional pore structure (> 0.2 μm) using laser scanning confocal microscopy (LSCM). The effect of axial distortion inherent to LSCM on 3D pore structure was also investigated. A range of 3D pore parameters was measured using skeletonisation, maximal ball and random walker algorithms. Results show that axial distortion has insignificant effects on most parameters except Euler connectivity, average pore and throat volumes and directional diffusion tortuosities. Most pore parameters become independent of sampling volume at ≈ 603 μm3 except diffusion tortuosities and formation factor. The REV for porosity calculated based on a statistical approach at eight realisations and 5% relative error was found to be ≈ 1003 μm3

Transport properties of concrete after drying-wetting regimes to elucidate the effects of moisture content, hysteresis and microcracking

Drying and wetting induce a number of microstructural changes that could impact transport properties and durability of concrete structures, but their significance is not well-established. This research examines pastes, mortars and concretes with different w/b ratios, binders, aggregate sizes, curing and conditioning regimes. 50 mm thick samples were dried to equilibrium at either 105 °C, 50 °C/7% RH, 21 °C/33% RH or gentle stepwise at 21 °C/93% RH → 3% RH, and then rewetted stepwise by humidification at 21 °C/33% RH → 86% RH and full saturation to produce varying degrees of damage and moisture content. Oxygen diffusivity and permeability, electrical conductivity, microcracking, accessible and total porosity were measured at different conditioning stages over 3-year period to better understand the effects of shrinkage, hysteresis and drying-induced damage on transport properties. The effect of supplementary cementitious materials (GGBS, SF) and implications of drying-wetting on concrete durability are discussed

3D Monte Carlo simulation of backscattered electron signal variation across pore-solid boundaries in cement-based materials

Three-dimensional (3D) Monte Carlo simulation was used to study the variation of backscattered electron (BSE) signal across pore-solid boundaries in cement-based materials in order to enhance quantitative analysis of pore structure. The effects of pore size, depth and boundary inclination angle were investigated. It is found that pores down to 1 nm can generate sufficient contrast to be detected. Visibility improves with larger pore size, smaller beam probe size and lower acceleration voltage. However, pixels in shallow pores or near pore boundaries display higher grey values (brightness) than expected due to sampling sub-surface or neighbouring solid material. Thus, cement-based materials may appear less porous or the pores appear smaller than they actually are in BSE images. Simulated BSE images were used to test the accuracy of the Overflow pore segmentation method. Results show the method is generally valid and gives low errors for pores that are 1 μm and greater