Fetal lung maturity

Respiratory distress syndrome of the newborn infant caused by immaturity of the fetal lung continues to be a clinical problem. Measurement of pulmonary surfactant production is the most effective way to evaluate pulmonary maturity. Since the first fetal lung maturity test was described more than two decades ago, advances in methodology have produced diagnostically sensitive tests that are both rapid and precise. Unfortunately, currently available tests continue to demonstrate low diagnostic specificity and remain poor predictors of fetal lung immaturity. We review the background, methodology, pre-analytical and analytical concerns, and clinical performance of various fetal lung maturity assays, and discuss the appropriate use and interpretation of these tests.     

Ultrasonically determined menstrual age as an indicator of fetal lung maturity

The usefulness of ultrasonically determined menstrual age as a predictor of fetal lung maturity has been evaluated in patients without fetal or maternal disease undergoing repeat cesarean section. The menstrual age of each fetus was determined at 18–32 wk using biparietal diameter (BPD) measurements and previously established BPD growth curves. Lung maturity prior to delivery was assessed by measuring the lecithin/sphingomyelin (L/S) in amniotic fluid. The menstrual age at the time of the amniocentesis was derived by extrapolation from the results of the first scan. When the Sabbagha Composite BPD growth curve was used for menstrual age determinations, the L/S was <2.0 in all cases before 34 wk, both <2.0 and ≥2.0 between 34 and 38 wk, and ≥2.0 in all but one case after 38 wk. This one case represents 1.2% of fetuses studied. These results suggest that in the absence of fetal and maternal disease, a menstrual age of 38 wk or older, based on an early BPD measurement and use of the Sabbagha Composite BPD growth curve, is indicative of lung maturity in most cases.     

外周血中性粒细胞与淋巴细胞比值在非酒精性脂肪肝诊断中的应用

目的外周血中性粒细胞与淋巴细胞比值(NLR)在非酒精性脂肪肝(NAFLD)临床诊断中的价值。方法随机选取214例临床明确诊断为NAFLD且未经过药物治疗的患者作为NAFLD患者组,同时随机选取214例年龄及性别匹配的健康受试者作为健康对照组。两组研究对象均接受血常规检查并计算NLR,比较两组间NLR差异是否有统计学意义。结果 NAFLD患者组外周血平均NLR为(1.87±0.69),显著高于健康对照组的(1.66±0.26),差异有统计学意义(P0.05)。受试者工作特征曲线下面积为0.791,其95%置信区间为0.706~0.876,当cut off值取1.63时,敏感度为79.6%,1-特异性为69.0%,提示NAFLD可能存在肝损害。结论 NAFLD患者血清NLR明显高于健康人群,NLR对NAFLD的诊断有一定价值。     

慢性肝炎肝硬化病肝左右肝叶体积变化规律

目的用实测法观察肝脏移植手术中切除的慢性肝炎肝硬化患者的病肝左、右叶体积分别占全肝体积比例的变化趋势。方法选择华西医院肝移植中心从2005年6月至2006年6月肝移植术中切除的48例慢性肝炎肝硬化病肝,用排水法测量体积,测量其左肝体积及其占全肝的体积比例的平均值,再探讨肝硬化左肝比率的变化规律。结果慢性肝炎终末期肝硬化的肝脏,左肝叶体积占全肝的体积比率的平均值为（45.8±11.3）%;右肝体积占全肝的体积比率的平均值为（54.2±11.3）%。终末期肝硬化肝脏与正常肝脏比较,在左右肝叶体积都减小的前提下,右肝叶减小的程度显著大于左肝叶。结论慢性肝炎肝硬化时肝左叶体积占全肝体积比率比正常肝脏有明显的增大。     

The international normalized ratio to prioritize patients for liver transplantation: problems and possible solutions

Summary.  The prothrombin time (PT) test once designed by Dr Quick to investigate patients with obstructive jaundice was later adapted and standardized by means of the international normalized ratio (INR) to monitor patients on treatment with vitamin K antagonists (VKA). After more than 70 years from its introduction it is now time to think about its standardization for those very patients for whom it was intended at the beginning of its history. Two studies carried out independently and published recently in the same issue of a specialized journal do exploit the very same idea on how to accomplish this standardization. Both of them confirm previous anecdotal observations that the INR as devised for patients on VKA (INR_vka) is not valid to harmonize PT results for patients with chronic liver disease. This fact, that at first sight may appear academic, has important consequences because the PT INR is used to construct the model for end-stage liver disease (MELD) scores, which is widely used to prioritize patients for liver transplantation. The two studies further demonstrate that an alternative calibration model, modified from that recommended by the World Health Organization for patients on VKA, may be feasible also for patients with chronic liver disease. This alternative calibration model, which calls for the substitution of plasmas from patients on VKA with those from patients with chronic liver disease, may be highly beneficial to harmonize the calculation of the MELD score, with important implications for the prioritization of patients for liver transplantation.     

正常胎儿胸腹纵径比、总肺面积和肺纵径与肺发育的相关性研究

目的 应用二维超声观察不同孕周正常胎儿胸腹纵径比、总肺面积及肺纵径的参数值,探讨胎儿胸腹纵径比等参数对评估肺发育的应用价值.方法 对592例正常单胎妊娠18～40周胎儿进行肺二维超声扫查,采用标准四腔心观及胎儿躯干冠状切面,分别测定心脏面积、胸廓面积,肺尖至相应膈肌穹窿顶部的直线距离与膈肌穹窿顶部至胎儿膀胱底部的距离之比(胸腹纵径比),应用相关回归分析拟合总肺面积及肺纵径随孕周增长的回归方程.结果 正常妊娠胎儿总肺面积及肺纵径随着孕龄的增加而增大,总肺面积、肺纵径随着孕周增长的最适回归方程分别为:总肺:y =0.83X +13.894,R2 =0.914;肺纵径:y=0.669 X+3.124,R2=0.892.不同孕周胎儿胸腹纵径比在恒定范围内(0.44～0.59).结论 18～40周胎儿胸腹纵径比在恒定范围内,总肺面积与肺纵径值随孕周增长,上述参数可为产前评估胎肺发育提供有价值的参考指标.     

产前超声评估胎儿肺成熟度研究进展

肺发育不成熟是新生儿、尤其是早产儿患病和死亡的主要原因.目前早产新生儿存活率明显提高,但其中肺脏发育不成熟引起的呼吸系统疾病发病率仍保持较高水平;产前准确评估胎儿肺成熟度对降低新生儿呼吸系统疾病发病率及优化临床治疗方案具有重要意义.随着超声技术的发展,产前超声无创评估胎儿肺成熟度已取得较大进展.本文对产前超声评估胎儿肺...     

急性胰腺炎胰腺外炎症CT评分及其与肝/脾CT值比的相关性研究

目的探讨急性胰腺炎(acute pancreatitis,AP)胰腺外炎症CT评分(extra-pancreatic inflammation on CT,EPIC)与肝/脾CT值比的相关性。方法 75例经临床确诊的AP患者,均进行腹部CT平扫。两名放射科医师根据EPIC评分标准进行盲法评分并分别测量肝脏、脾脏CT值及计算肝/脾CT值比。分析AP的EPIC评分与肝/脾CT值比之间的相关关系。结果75例患者中有39例患者肝/脾CT值比<1,占52%。AP的EPIC评分与肝/脾CT值比呈负相关(rs=-0.293,P=0.011)。结论肝损伤是AP常见的并发症,随着AP严重程度的增加,肝损伤发生率也逐渐增加,损伤程度也逐渐加重。     

超声评估胎儿肺脏成熟度研究进展

肺发育不成熟是早产儿死亡和新生儿患病的最常见原因。评估胎肺成熟度在围生期管理中具有重要意义,产前评价胎儿肺成熟度能够提高新生儿尤其是早产儿的存活率。超声在产前评估中发挥重要作用。本文对超声评估胎儿肺成熟度的研究进展进行综述。     

肝尾叶与右叶径线及比值变化与非酒精性脂肪性肝病的关系

目的探讨肝尾叶与肝右叶的各径线及比值的变化与非酒精性脂肪性肝病之间的关系。方法选择在我院诊断为非酒精性脂肪性肝病变的病例147例及普通健康体检者227人为研究对象,分别测量其肝尾叶上下径、前后径、横径及肝右叶横径、最大斜径,计算肝尾叶横径与肝右叶的横径和肝尾叶上下径与肝右最大斜径比值,分析其与非酒精性脂肪性肝病之间的关系。结果健康成人肝尾叶与不同程度的脂肪肝病人肝尾叶的上下径、前后径、横径及肝右叶横径、最大斜径均在统计学上显著性差异（P<0.05）,在各径线中重度脂肪肝>中度脂肪肝>轻度脂肪肝>正常肝脏;轻、中、重度脂肪肝肝尾叶横径与肝右叶横径比值,以及肝尾叶上下径与肝右叶最大斜径比值均比较接近,无显著性差异。结论肝尾状叶与右叶各径线变化与非酒精性脂肪性肝病轻重程度密切相关,肝尾叶与右叶径线的（P>0.05）比值变化与非酒精性脂肪肝病轻重程度关系不密切。     

通过羊水中磷脂成份测定预测胎儿肺成熟度

目的 建立一种测定羊水中磷脂成份的一维薄层色谱方法。方法 流动相为氯仿：甲醇：乙醇：乙酸：水=24：4：2：6：0.5,薄层板为硅胶H板,碘蒸汽显色,在460nm下测量反射吸光度,用外标光密度法测定磷脂含量。结果 本工作采用一维薄层色谱法能够同时分离测定羊水中卵磷脂（L）、鞘磷脂（S）、磷脂酸甘油、（PG）磷脂酰乙醇胺（PE）、磷脂酰丝氨酸（PS）、磷脂酰肌醇（PI）6种磷脂成份。结论 本方法具有操作简例,结果准确的优点,适合临床应用。     

Diagnostic performances of neutrophil to lymphocyte ratio and lymphocyte to monocyte ratio in acute ischemic stroke caused by cervicocranial arterial dissection

BackgroundInflammation plays an important role in the initiation and progression of cervicocranial arterial dissection (CCAD). New inflammatory indices derived from full cell blood count may be associated with increased risk of acute ischemic stroke (AIS) caused by CCAD. The goal of this study is to evaluate the diagnostic performances of neutrophil to lymphocyte ratio (NLR) and lymphocyte to monocyte ratio (LMR) in CCAD.MethodWe retrospectively analyzed 52 patients with AIS caused by CCAD from emergency room (group I), 51 patients with CCAD from emergency room or clinic(group II) and 52 controls (group III), age and sex matched. Data were collected on the admission including NLR and LMR.ResultsNeutrophil to lymphocyte ratio and LMR have significant differences among three groups, especially in group I vs both groups II and III (P < .001). There was a negative correlation between admission NLR and LMR. Low LMR level and high NLR level may be associated with severity of AIS caused by CCAD and significantly predict AIS in CCAD. The area under the curve of NLR and LMR were 0.77 and 0.71, respectively, on receiver operating characteristic curve analysis. The optimal cutoff values of NLR and LMR that best discriminated AIS were 2.35 (81% sensitivity and 63% specificity) and 3.67 (64% sensitivity and 77% specificity).ConclusionsNeutrophil to lymphocyte ratio neutrophil to lymphocyte ratio and LMR may contribute to the diagnostic evaluation and prompt immediate therapy in patients with CCAD.     

NLR联合MLR在非ST段抬高型心肌梗死危险分层中的预测价值

目的探讨中性粒细胞/淋巴细胞比率(NLR)联合单核细胞/淋巴细胞比率(MLR)在非ST段抬高型心肌梗死(NSTEMI)危险分层中的价值。方法纳入2013年6月至2014年12月于第三军医大学附属新桥医院行冠状动脉照影的患者288例,分为对照组(110例),稳定性心绞痛(SAP)组(66例)和NSTEMI组(112例),对NSTEMI组患者计算GRACE评分,并根据GRACE评分分为低危组和中高危组。收集所有受试者的血常规指标并计算NLR、MLR。结果 NSTEMI组的NLR、MLR明显高于对照组和SAP组(P0.01)。Spearman相关分析表明NLR、MLR与GRACE评分呈正相关(r=0.342,P0.01;r=0.398,P0.01);中高危组比低危组的NLR(P0.01)、MLR(P0.01)高。通过受试者工作曲线(ROC)分析,预测NSTEMI危险分层的ROC曲线下面积(AUC)分别是NLR的AUC为0.747(95%CI:0.656~0.837,P0.01);MLR的AUC为0.765(95%CI:0.677~0.852,P0.01);NLR联合MLR的AUC为0.778(95%CI:0.693~0.863,P0.01)。结论NLR、MLR与GRACE评分呈正相关,NLR联合MLR对NSTEMI患者的危险分层有一定的预测价值。     

Correlation between C-reactive protein/albumin ratio and prognosis in patients with lung adenocarcinoma

ObjectiveThis study was performed to examine the relationship between the C-reactive protein/albumin ratio (CAR) and the prognosis of patients with lung adenocarcinoma and thus provide a reference for evaluating the prognosis of lung adenocarcinoma.MethodsThe clinical data of 130 patients with lung adenocarcinoma were retrospectively collected and analyzed. The patients’ overall survival (OS) time was calculated, and the factors affecting OS were statistically analyzed.ResultsThe CAR was correlated with sex, clinical stage, brain metastasis, S100 calcium-binding protein B (S100B), interleukin 17, myelin basic protein, squamous cell carcinoma antigen (SCC-Ag), and the lymphocyte count. The median OS was significantly shorter in the high- than low-CAR group (18 vs. 64 months, respectively). The CAR, clinical stage, brain metastasis, S100B, interleukin 17, SCC-Ag, C-reactive protein, albumin, and neutrophil count affected the OS of patients with lung adenocarcinoma. The CAR and clinical stage were independent risk factors for a poor prognosis in patients with lung adenocarcinoma.ConclusionsThe CAR and clinical stage are independent risk factors for OS in patients with lung adenocarcinoma.     

Quantitative processed images acquired by histogram-SNR imaging used to evaluate parenchymal heterogeneity in the liver

Purpose: To evaluate a new system for displaying processed images of liver parenchyma based on quantitative estimation of heterogeneity by texture analysis.Methods: We measured the signal to noise ratio, one of the first-order statistics in the histogram of enveloped amplitude of radio-frequency backscattered echoes, using a 3.75-MHz transducer with texture analysis in conjunction with a new method in which the small ROI (region of interest) is segmented into multiple layers to minimize the influence of tissue attenuation and beam diffraction. In our computerized system, gray-display and color-display images, two types of processed images, were produced from the visual intensity of each small ROI, which was based on its signal to noise ratio. We studied 10 cases of normal liver, 10 cases of fatty liver, and 10 cases of cirrhotic liver. The processed images obtained from these livers were reviewed to observe their features and to compare their usefulness in estimating the heterogeneity of the liver parenchyma with that of conventional B-mode images.Results: Gray-display images of cirrhotic livers appeared much blacker than the images produced from other disorders, and color-display images of cirrhotic liver appeared much bluer or greener than the others. Rate of correct diagnosis from B-mode images was 68.3 ±6.8%; from gray-display images, 85.8±7.4%; and from color-display images, 91.7±8.2%. Rate of correct assessment from B-mode images and gray-display images was significantly correlated (p=0.0015), as was rate of correct assessment from the B-mode images and the color-display images (p=0.0060).Conclusion: The processed images obtained using this computerized system contributed to the correct and objective interpretation of the heterogeneity of the liver parenchyma.     

产前三维超声测量胎儿肺体积

目的 利用三维超声测量胎儿各个孕周肺体积,并得出孕周与胎儿肺体积的相关性公式.方法 收集228例胎儿肺三维图像,使用Philips Qlab软件,采用轮廓堆叠法三维重建功能,手动勾勒胎儿胸腔轮廓及胸腔内非肺区域轮廓,在勾勒轮廓的基础上重建胸腔和非肺区域的三维模型,并计算它们的体积,二者相减得到胎肺体积.结果 测量总例数.228例,胎儿肺体积逐周增加,孕20周时平均为8.85cm3,至孕36周平均为70.5 cm3,平均每个孕周增加3～4 cm3,24周之前增长稍慢,孕33～34周有一个增长飞跃.用二次线性拟合、指数和对数拟合对胎肺体积和孕周的关系进行拟合,二次线性拟合方程:Volume=39.52 - 4.48×GA+ 0.149×GA2,指数拟合方程:Ln(Volume)=-8.233+1.747×Ln( GA2),对数拟合方程:Ln(Volume)=-2.413+0.29×GA -0.003×GA2,相关系数均为0.99,P＜0.001.胎肺体积与孕周之间存在强相关性.结论 采用三维超声测量胎儿肺体积,评估胎儿肺成熟度,可以为临床提供重要的参考.     

Simultaneous assessment of fetal lung maturity and sebaceous gland function by gas chromatography

Lipid profiles were analysed by gas chromatography of underivatised extracts from pellets and supernatant fractions of amniotic fluid (AFP and AFS). Peaks, identified as diglycerides resulting from on column decomposition of phosphoglycerides at high temperature, were obvious in gas chromatograms of AFS. The C₃₂ diglyceride, mainly derived from dipalmityl lecithin, was not a prominent peak in AFS from pregnancies from which babies subsequently developed respiratory distress syndrome. There was evidence of a moderate increase of squalene in AFS and AFP for 10 pregnancies of 36–38 weeks gestation resulting in the birth of small for gestational age babies. The increase was not obvious for 21 out of 22 control pregnancies delivering appropriate for gestational age babies. This demonstrated that we had an assessment of two fetal functions in one chromatographic run, the ratio of C₃₂/C₃₄ diglycerides providing a measure of lung maturity and squalene providing an index of proximity to term or of the presence of intrauterine growth retardation.     

中性粒细胞/淋巴细胞比率联合血小板/淋巴细胞比率检测对于重症急性胰腺炎早期预测价值

目的:评估中性粒细胞／淋巴细胞比率（Neutrophil to lymphocyte ratio,NLR）联合血小板/淋巴细胞比率（platelet to lymphocyteratio,PLR）检测(NLR-PLR)对于重症急性胰腺炎(severe acute pancreatitis,SAP)早期预测价值。方法:连...