健康新西兰兔上腔静脉的二维超声及多普勒血流频谱分析

目的 利用二维、彩色及频谱多普勒超声对健康新西兰兔上腔静脉(SVC)内径及血流频谱进行分析,探讨其正常值范围。 方法 健康成年新西兰兔84只,经双侧锁骨上窝切面显示SVC长轴,同步连接呼吸曲线及心电图,获取SVC管腔内径及血流频谱,分析双侧SVC内径及多普勒血流频谱。 结果 经锁骨上窝SVC长轴切面获取其二维、彩色及多普勒图像成功率为100%。二维超声测量吸气末右侧SVC内径[(0.29±0.06)cm]大于左侧SVC内径[(0.20±0.04)cm,P＜0.01]。频谱多普勒显示S波、D波的血流速度峰值吸气相较呼气相增高(P＜0.01);VR波、AR波的血流速度峰值吸气相与呼气相相比差异无统计学意义(P均＞0.05)。 结论 经锁骨上窝长轴切面能获得较满意的SVC二维、彩色及频谱多普勒图像;兔双侧SVC的内径存在差异;兔SVC的血流频谱随呼吸周期呈规律性变化。     

超声评价子痫前期患者胎儿主动脉峡部血流指数

目的 通过测量峡部血流指数（IFI）定量分析子痫前期（PE）患者胎儿主动脉峡部（AOI）血流变化特点与规律。方法 纳入38例PE患者（PE组）和孕周相匹配的38名正常单胎妊娠孕妇（对照组）。采集胎儿AOI、脐动脉（UA）、静脉导管（DV）的多普勒频谱,计算IFI,并分为Ⅰ~Ⅲ型,计算PE组胎儿AOI、UA舒张期血流及心房收缩波（DA-a）消失或反向率。结果 对照组胎儿IFI均为Ⅰ型,IFI值为1.40±0.09,AOI舒张期血流均为前向;PE组胎儿IFI Ⅰ型21胎,Ⅱ型10胎,Ⅲ型7胎,IFI值为0.81±0.80;2组IFI差异有统计学意义（t=4.439,P<0.001）。PE组胎儿AOI、UA舒张期血流和DV-a波消失或反向率分别为44.74%（17/38）、13.16%（5/38）和0,与对照组比较差异有统计学意义（χ²=25.796,P<0.001）。结论 PE患者胎儿IFI降低。检测胎儿AOI多普勒频谱可于胎儿循环缺氧早期检测其血流动力学变化。     

心脏纵隔移位角用于预测肺部肿块胎儿围产期不良结局

目的 评价心脏纵隔移位角(CMSA)用于预测肺部肿块胎儿围产期不良结局的价值。方法 基于产前超声声像图测量并计算52胎肺部肿块胎儿的CMSA及其与先天性囊性腺瘤样畸形的体积比(CVR);比较不同结局及有、无水肿胎儿CMSA和CVR测值的差异。采用Spearman相关系数评价CMSA与CVR的相关性;绘制受试者工作特征曲线,计算曲线下面积(AUC),评价CMSA和CVR预测肺部肿块胎儿转归的效能,并以DeLong检验进行比较。结果 不良结局胎儿的CMSA及CVR均大于结局良好者(P均<0.05)。水肿胎儿CMSA及CVR均大于无水肿者(P均<0.05)。CMSA与CVR呈正相关(r=0.78,P<0.05)。以CMSA、CVR预测胎儿不良结局的AUC分别为0.92及0.99,敏感度分别为82.00%及100%,特异度分别为90.00%及95.00%;二者效能差异无统计学意义(Z=1.54,P=0.13)。结论 CMSA可用于预测肺部肿块胎儿围产期结局,其价值与CVR相当。     

母体抗SSA/SSB抗体阳性胎儿完全性房室传导阻滞超声表现

目的 观察母体抗SSA/SSB抗体阳性胎儿完全性房室传导阻滞（CAVB）超声表现。方法 以二维、M型及多普勒超声技术观察7胎母体抗SSA/SSB抗体阳性CAVB胎儿心脏,获取二尖瓣、左心室流入道及流出道、脐动脉（UA）、静脉导管（DV）及大脑中动脉（MCA）血流频谱。结果 7名孕妇抗SSA抗体、抗Ro52抗体均呈阳性,其中4名抗SSB抗体呈阳性。7胎均见房室分离,心房律正常而心室律缓慢,二尖瓣、UA、DV及MCA血流异常;其中4胎心房壁、房间隔、二尖瓣环或腱索回声增强。7胎均未合并其他心内外结构畸形。结论 母体抗SSA/SSB抗体阳性可致胎儿发生CAVB;超声观察胎儿心脏及血流动力学变化有利于判断胎儿预后。     

超声心动图诊断及随访胎儿单纯室间隔缺损

目的 探讨超声心动图在胎儿单纯室间隔缺损(VSD)的产前诊断及随访中的应用价值。方法 纳入产前超声心动图诊断为VSD的胎儿35胎,分析胎儿超声心动图特征,对其进行宫内及出生后超声随访,观察缺损大小及闭合情况。结果 误诊2胎;非高危胎儿26胎、高危胎儿7胎;肌部缺损18胎(18/33,54.55%)、膜周缺损13胎(13/33,39.39%)、干下缺损1胎(1/33,3.03%)、隔瓣下缺损1胎(1/33,3.03%);失访1胎,宫内缺损闭合2胎,出生后3年内缺损闭合21例,未闭合9例。非高危胎儿缺损闭合率高于高危胎儿(P<0.05),肌部缺损闭合率明显高于膜周及其他部位缺损(P均<0.05),缺损直径≤3.0 mm者缺损闭合率明显高于缺损3.1~5.0 mm和>5.0 mm者(P均<0.05)。结论 超声心动图在胎儿单纯VSD的产前诊断、随访观察及治疗方案的选择等方面具有重要临床价值。     

单脐动脉与伴发畸形的关系及胎儿围生期预后

目的 探讨单脐动脉(SUA)与其伴发畸形的关系及单纯SUA对胎儿生长发育的影响。 方法 回顾性分析产前超声筛查的12 542胎,将其中92胎SUA分为2组:单纯SUA组(A组,n=46)及SUA合并畸形组(B组,n=46)。正常组(C组)为与SUA胎儿同期出生、经随访追踪无异常的46胎。观察SUA合并畸形的种类和比例,对比A、B组SUA胎儿围生期死亡率,并分析SUA胎儿与正常胎儿出生时的体质量、体长及孕龄等。 结果 B组围生期死亡率(78.26%, 36/46)显著高于A组(2.17%, 1/46, P<0.01)。SUA伴发畸形几乎涵盖所有系统,与多种严重复杂畸形相关联。与正常胎儿相比,SUA胎儿出生体质量、体长及孕龄较正常胎儿偏小,但胎儿宫内生长受限(FGR)及小于胎龄儿(SGR)发生率的差异无统计学意义。 结论 SUA可伴发多种畸形;SUA伴发畸形胎儿的围生期死亡率显著高于单纯SUA,后者因脐带动脉的代偿功能而相对预后良好。     

孕早期超声检查胎儿NT、DV血流频谱异常在先天性心脏病筛查中的应用价值及相关参数分析

目的:探究孕早期超声检查胎儿颈后透明层(NT)、静脉导管(DV)血流频谱异常在先天性心脏病(CHD)筛查中的应用价值及相关参数。方法:选取2020年8月—2022年9月于德州市德城区妇幼保健院就诊已明确诊断为CHD胎儿30例纳入研究组,另选择同期于我院例行产检的发育正常的胎儿30名纳入对照组,均行超声NT厚度及DV血流频谱检查。对比两组NT厚度及DV血流频谱水平[心室收缩峰值流速(S)/最大心房收缩回流流速(A)值、前负荷指数(PLI)、静脉搏动指数(PIV)、静脉峰值流速指数(PVIV)];将对照组设为对照,绘制受试者工作特征(ROC)曲线以评价NT厚度及DV血流频谱异常在CHD中的诊断价值。结果:研究组NT值、S/A值、PLI指数、PIV指数、PVIV指数均高于对照组(P<0.05);ROC曲线显示:NT值在CHD中诊断价值最高,其次为PVIV指数,而S/A值、PIV指数、PLI指数诊断准确性较低。结论:孕早期超声检查胎儿NT、DV血流频谱异常在CHD诊断中存在一定的预测及诊断价值,各指标发挥不同的诊断优势,有助于帮助胎儿尽早明确诊断。     

主动脉弓形态在诊断胎儿法洛四联症中的应用

目的 探讨产前超声观察胎儿主动脉弓形态对法洛四联症(TOF)的诊断价值.方法 收集2012年10月—2014年10月收治的TOF胎儿109胎(TOF组),另选正常胎儿97胎(对照组),回顾性分析产前超声检查主动脉弓切面动态图像,计算最大曲率位置,对比两组间差异,并探讨最大曲率位置与孕龄的关系.结果 对照组最大曲率位置为(65.63±11.01)%,TOF组为(43.28±9.10)%,差异有统计学意义(t=8.95,P<0.01).以47.18%为诊断胎儿法洛四联症的最优最大曲率位置点,此时敏感度为97.13%,特异度为73.50%.对照组最大曲率位置与孕龄呈正相关(r=0.776,P <0.05);TOF组最大曲率位置与孕龄呈负相关(t=－0.537,P <0.05).结论 胎儿主动脉弓形态的超声表现对丰富胎儿TOF的诊断信息和提高诊断率具有重要意义.     

骨髓MRI在重型β-地中海贫血造血干细胞移植中的价值

目的 探讨骨髓MRI在重型β地中海贫血造血干细胞移植(HSCT)中的价值。方法 对27例拟行HSCT重型地中海贫血患儿的股骨骨髓进行MRI检查。进行FSE的T1WI及T2WI、STIR、同相位及反相位快速场回波序列(FFE)股骨近段斜冠状位成像。在T1WI、T2WI及STIR图像上判断红黄骨髓的分布,并测量股骨近段红骨髓总面积及其百分比。在同相位、反相位FFE图像上序列判断骨髓是否有铁沉积。比较不同病情及不同移植结局患者的红骨髓面积及其百分比及骨髓内铁沉积,并与临床实验室指标进行相关性分析。运用Logistic回归分析红骨髓面积及其百分比、骨髓铁沉积与HSCT结局之间的关系。结果 27例重型地中海贫血中,10例出现骨髓铁沉积,骨髓铁沉积与临床指标无相关性(P>0.05),对HSCT结局无影响(P＝0.775)。红骨髓面积及其百分比与病程及血清铁蛋白正相关(r=0.727、0.428,P<0.05;r=0.487、0.511,P＝0.01、0.006)。27例中2例死于预处理,余25例进行了HSCT。进行HSCT的25例中,移植成功及移植失败病例中红骨髓面积及其百分比分别为(7.94±2.71) mm²(90.25%±4.14%),(10.54±3.31) mm²(94.54%±2.93%),两组之间均有统计学差异(P＝0.04、0.01)。回归分析显示红骨髓面积百分比与HSCT结局密切相关(OR=1.383,P＝0.005)。结论 MRI上股骨近段红骨髓面积百分比可作为重型地中海贫血HSCT病情分类的一个独立危险因素。     

胎儿脐带绕颈动态监测

目的 观察脐带绕颈在孕期中的自然变化。方法 收集整个孕期均于我院完成规定的超声检查并分娩的孕妇,最终纳入8016胎,根据超声诊断脐带绕颈情况分为脐带绕颈组与无绕颈组。评估脐带绕颈的发生与脐带长度、羊水量及胎儿预后的相关性。结果 超声检出脐带绕颈5091胎(5091/8016,63.51%);其中脐带绕颈自然复位2680胎(2680/5091,52.64%)。晚孕期持续脐带绕颈者分娩后绕颈变化率最低(329/1294,25.43%)。脐带绕颈组脐带长度为(53.98±7.70)cm,无脐带绕颈组(51.34±6.20)cm,二者差异有统计学意义(t=15.32,P<0.001)。与羊水量正常、羊水量少相比,羊水量多时,脐带绕颈发生率最高(136/187,72.73%,P<0.05),脐带绕颈与脐带长度、羊水量均呈正相关(P<0.05)。剖宫产及经阴道分娩者中,是否发生脐带绕颈胎儿出生后的Apgar评分差异均无统计学意义(P均>0.05)。脐带绕颈组剖宫产率高于无绕颈组(χ²=10.23,P<0.05)。结论 脐带绕颈多集中发生于中晚孕期,与脐带长度、羊水量具有一定的相关性。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.