胎儿心脏畸形超声筛查漏诊误诊原因分析

目的 探讨如何更好使用超声心动图筛查中晚孕胎儿心脏畸形,避免漏诊.方法 超声筛查中晚期孕妇7020例,对检出的胎儿心脏畸形及可疑先天性心脏病者进行每4周一次追踪观察,对产前超声未发现心脏结构异常的胎儿进行每8周一次追踪观察,出生后每6个月一次追踪观察,至出生后6～12个月.所有异常胎儿均经尸检、出生后手术结果证实(部分术前行心血管造影).对比分析同类畸形产前超声诊断正确的经验与超声漏诊的教训.结果 通过引产后病理证实或出生后心血管造影和(或)手术证实的53例心脏大血管异常中,产前超声检出并诊断正确43例,误诊2例,漏诊8例.误诊2例包括1例肺动脉瓣闭锁和1例法洛四联症.产前超声漏诊8例包括6例小于5 mm的室间隔缺损和2例下腔静脉异位引流.产前超声筛查胎儿心脏大血管畸形正确率为81.1％ (43/53).结论 采用高频探头、图像的缩放功能以及注重右室流出道-肺动脉长轴切面和静脉-心房连接关系的扫查是避免漏诊或不全面诊断的重要因素.     

替米沙坦对葡萄糖调节受损合并高尿酸血症和微量白蛋白尿患者的影响

目的 观察替米沙坦干预12个月对糖调节受损(IGR)合并高尿酸血症(HUA)和微量白蛋白尿(MAU)患者的影响以及糖代谢转归情况.方法 对60例IGR合并HUA及MAU患者随机分为替米沙坦组30例和对照组30例,分析干预12个月后两组HUA和MAU的变化及IGR患者的糖代谢转归情况.结果 干预12个月后替米沙坦组和对照组HUA和MAU均明显降低,HUA(372.3±61.7) μmol/L vs (447.2±49.4) μmol/L(P＜0.01),MAU(47.9±38.1) μmol/L vs (75.2±37.4) μmol/L,与对照组比较,替米沙坦组HUA和MAU下降更明显(P＜0.01),且替米沙坦组转为正常葡萄糖耐量(NGT)的人数比对照组多,73.0%(19/26)vs 42.9%(12/28)(P<0.05).结论 对IGR合并 HUA和MAU的患者,在生活方式及危险因素干预的基础上积极应用替米沙坦可降低早期肾病和糖尿病的发生率.     

颈肩胸区皮瓣修复颈颏部软组织缺损

目的:讨论颈额部软组织缺损的最佳治疗方法。方法:对6例不同原因所致颈额部软组织缺损的患者,采取颈肩胸区皮瓣修复。其中2例采用单侧颈胸皮瓣转移,2例采用双侧颈胸皮瓣覆盖,2例采用单侧颈肩皮瓣转移覆盖。结果:6例患者术后8个皮瓣全部成活,无一例皮瓣坏死。术后随访1-2年,所有患者颈颏部形态和功能满意,无再度挛缩。结论:颈肩胸区皮瓣操作简单,一次手术完成,皮肤质地色泽与颈部相近,是修复颈颏部软组织缺损的有效方法之一。     

溶解氧控制与发酵过程摄氧率及鸟苷积累的关系

采用华东理工大学国家化工程技术研究中心（上海）生产的全自动多参数FUS－50L（A）生物反应器，在不同的控制方式下，研究了溶解氧水平对菌体代谢活力及鸟苷发酵水平的影响。结果表明：发酵过程中，用调节转速的方式控制发酵液中溶氧水平的效果比用空气流量好；发酵液中氧中溶氧水平控制在10％－20％时鸟苷积累量高，发酵液中溶氧水平低（5％）和高（30％）均不利于发酵液中的鸟苷积累。     

大鼠局灶脑缺血中心区与边缘区VEGF表达及mRNA变化

目的 探讨VEGF、VEGFmRNA在局灶脑缺血中心区和边缘区的表达和动态变化。方法 SD大鼠54只。根据缺血时间和再灌时间分为9组，采用线栓并环扎的方法建立局灶脑缺血再灌模型。LSAB法免疫组化染色观察VEGF免疫阳性表达。RT—PCR法检测VEGFmRNA动态变化。结果 在缺血3～6h，缺血中心区与边缘区VEGF免疫阳性反应达高峰，VEGFmRNA转录水平明显升高，两者24h基本降至正常水平。结论 VEGF在缺血早期的高表达可能与神经细胞和内皮细胞的自身保护作用有关。     

代谢综合征患者肱动脉血管顺应性的超声研究

目的:探讨代谢综合征(MS)患者肱动脉血管顺应性的改变。方法:选择MS患者38例为研究组(MS组)、健康查体者35例为对照组(NC组),采用彩色多普勒超声诊断仪检测肱动脉在静息、反应性充血和舌下含服硝酸甘油后血管舒张末期内径的变化。结果:MS组的内皮依赖性血流介导的舒张功能(FMD)及非内皮依赖性硝酸甘油介导的舒张功能(NID)明显低于对照组(P<0.05),FMD与年龄、体重指数、三酰甘油、收缩压、舒张压、血糖呈负相关。结论:代谢综合征患者存在较严重的血管顺应性减低及血管内皮功能失调,FMD及NID的测定对MS动脉粥样硬化的预测和防治具有重要意义。     

股骨转子间骨折3种内固定效果比较

目的探讨股骨转子间骨折3种内固定方法的效果差异。方法30例股骨转子间骨折内固定方法分别采用Gamma钉12例，滑动加压鹅头钉12例，AO角钢板6例。术后随访时间为6～60个月(平均29个月)，3～30个月(平均18个月)。4～36个月(平均26个月)。结果30例皆愈合，关节功能优良率分别为91．66％，83．33％，50．0％。结论结果说明，股骨转子间骨折3种内固定治疗方法中，Gamma钉技术操作简单，固定牢靠，手术损伤小，并发感染率低等优点。     

Rapid hydrolysis of proteins and peptides by means of microwave technology and its application to amino acid analysis

A rapid heating method of hydrolysis by the use of microwave oven has been applied to amino acid analysis of proteins and peptides. This convenient method has been compared with the conventional 6 n HCl hydrolysis at 110° for 24 h. The advantages of this new method are its expedition and the accurate and comparable results as compared to the tedious conventional technique. The method provides a rapid processing of multiple samples within minutes instead of days and inexpensive access to the important data of amino acid compositions of proteins by the commonly used microwave oven. The necessary change in the design of hydrolysis vials and the safety precautions accompanying this novel use of microwave acid-digestion method are also described.     

Bleeding peptic ulcer: An evolving role for surgical intervention

Abstract Early surgical intervention was previously advocated in patients > 60 years with bleeding peptic ulcer presenting with haemodynamic instability or ongoing transfusion requirements. It is, however, well recognized that emergency surgical intervention with its inherent risks must be reserved for highly selected patients in whom endoscopy initially fails to control exsanquinating haemorrhage or in whom life-threatening bleeding recurs. Therapeutic endoscopy for bleeding ulcer has led to a remarkable decline in rebleeding rates, the need for emergency surgery and mortality. Octogenarians are at risk, particularly when ulcer size exceeds 2 cm. Poor surgical candidates make up two-thirds of patients with major ulcer bleeding and operation is to be avoided if at all possible. Medical therapy with proton pump inhibitor and subsequent eradication of Helicobacter pylori following endoscopic treatment has been shown to be beneficial to outcomes. Should surgery be deemed necessary, it is likely that laparoscopic techniques to control bleeding, with or without the addition of an acid-reducing procedure, will find a role in haemodynamically stable patients undergoing operation on an early elective basis.