高危儿早期规范化干预的临床效果研究

目的:探讨早期规范化干预对高危儿生长发育及智能发育的影响。方法:将108例高危儿按家长的意愿分为干预组和对照组,干预组实施在医生指导下的家庭干预与医院综合康复治疗相结合的干预模式,对照组只实施家庭干预。测量身高、体重等体格发育指标,使用婴幼儿智力发育测量表(CDCC量表)进行智能测评。结果:(1)干预组高危儿1岁时身高、体重高于对照组,差异有统计学意义(P<0.05);(2)干预组在发育商(DQ)、精细动作、认知能力、语言、社会交往能力方面的发育水平均明显好于对照组,差异有统计学意义(P<0.01)。结论:早期进行规范化管理对高危儿体格及智能发育可以起到积极作用。     

478例儿童智力测验结果分析

目的：分析478例儿童智力测验结果，为早期教育、早期干预提供依据。方法：采用婴幼儿智能发育测验(CDCC)，对发育指数进行分析。结果：智力缺陷及智力临界状态占有一定比例，同时出现有智力分离情况。结论：及早发现儿童智力发育偏离情况，引起家长对儿童早期教育、早期干预的重视。     

461例0～3岁儿童的智力发育现状分析

目的 通过对三亚市0～3岁健康儿童智能发育检查,及早发现智力发育偏离情况,以便对其早期干预提供依据,并促进其发展.方法 采用婴幼儿智能发育测验(CDCC)软件电脑测评对461例0～3岁婴幼儿进行测评,分析发育指数.结果 461例0～3岁婴幼儿智力及动作发育商多数集中于90～109之间,两侧逐渐减少,接近正态分布,符合人类婴幼儿智能发育分布规律,并有一定比例的智力临界状态和智商分离情况.结论 在日常的儿童保健工作中,应常规进行婴幼儿智能发育检测,及早发现儿童智力发育偏离情况,引起家长对儿童早期教育、早期干预的重视,对促进小儿的智能发育有着极其重要的意义.     

早期干预在新生儿缺氧缺血性脑病智能发育中的评价

目的观察早期干预对新生儿缺氧缺血性脑病在智力发育中的疗效.方法对29例诊断缺氧缺血性脑病患儿除综合抢救治疗外,应用早期教育和家长合作,实施早期干预,以探索患儿智能发育情况,采用贝莱智力量表改编和标化的婴幼儿智力发育测验表(CDCC量表)来评价;对照组为同期的27例缺氧缺血性脑病患儿,仅做综合抢救治疗.结果早期干预组CDCC评分与对照组比较有显著性差异(P<0.05).结论对新生儿缺氧缺血性脑病实施早期干预能及时弥补脑损伤后发育的不足,减少小儿后遗症的发生和减轻伤残的程度.     

早期干预对高危新生儿智能发育的影响

目的:探讨早期综合教育对高危新生儿智能发育的影响。方法:采用早期干预方法,对高危儿干预组(29例)进行综合干预,用CDCC婴幼儿发育量表进行早期智能发育监测,并与高危对照组(31例)和正常对照组(33例)进行比较。结果:高危儿干预组各能区发育商(DQ)和总DQ均大于对照组;但与正常对照组无显著性差异。结论:早期综合干预对高危新生儿智能发育有一定的促进效果。     

早期干预对早产儿行为发育影响的初步观察

目的通过早期干预促进早产儿的行为发育.方法将60例早产儿随机分成干预组（30例）和未干预组（30例）,干预组从新生儿期开始接受早期干预,定期随访,未干预组患儿仅进行常规体检和育儿指导,用CDCC婴幼儿智能量表进行评估.结果 6、9月龄、1岁时干预组患儿智力发育指数（MDI）及运动发育指数（PDI）均优于未干预组（P《0.05）.1岁时干预组患儿智力发育指数（MDI）及运动发育指数（PDI） 达到正常百分数89.4%,高于未干预组（P《0.05）.结论对早产儿进行早期干预可以促进其行为发育,降低伤残率,提高远期生存质量.     

窒息新生儿发育研究及发育干预模式探索

目的研究新生儿窒息对儿童智能发育的影响及补救方法,以及如何提高家长对儿童发育落后的认识,使窒息儿从出生开始即得到系统的、科学的、有效的智能开发。方法①从生后2个月开始,采用家庭化早期干预模式。②用中国儿童发展中心(CDCC)婴幼儿智能发育测验量表测定小儿精神发育指数。③采取抽样的方法比较窒息新生儿组(26例)和正常新生儿组(18例)的发育指数。对不同职业和文化程度的家长对早期干预的重视、接纳程度进行比较。结果新生儿窒息组发育落后发生率明显高于正常新生儿组(χ2=15.48,P<0.01)。15例坚持早期干预后,11例(73.33%)能够回到正常的发育轨道,拥有正常的发育商,与疗前比较,疗效显著(χ2=9.90,P<0.01)。结论新生儿窒息是儿童发育落后的重要影响因素,可通过早期干预使发育落后儿童的发育回到正常的发育轨道。提高家长乃至全社会对儿童发育落后问题的关注是做好早期干预工作,使儿童健康成长的前提。     

405例婴儿智能发育测验结果分析

为及时发现智力发育偏离,并对其早期干预提供依据,采用婴幼儿智能发育测验(CDCC)软件电脑测评,分析发育指数.结果 ,本组测评对象符合婴幼儿智力发育的分布规律,并有一定比例的智力临界状态和智商分离情况.婴幼儿智力发育偏离情况,应引起家长对早期教育和早期干预的重视.     

足月婴儿气质类型与智能发育的关系探讨

目的分析足月婴儿气质与智能发育的关系,探讨气质对智能发育的近期影响。方法采用上海第二医科大学附属新华医院修订的儿童气质测查问卷的4个月-1岁婴幼儿气质量表及Gesell0～3岁婴幼儿生长发育评估量表对222名足月出生的婴儿气质与智能发育水平进行评价。结果气质类型分布无性别异常。与积极的气质类型相比,消极气质类型婴儿的智能发育存在落后倾向。结论足月婴儿气质与智能发育有着密切的关系,评价气质维度的特点类型,对婴儿智能发展有着重要意义。     

早期干预对高胆红素血症儿童智能发育的作用

目的 探讨早期干预对高胆红素血症儿童智力发育的作用。方法将88例高胆红素血症儿童随机分为早期干预组44例，对照组44例，早期干预组自新生儿期开始干预治疗至2岁，两组高胆红素血症儿童均于1岁、2岁时进行智能发育检测。结果早期干预组1岁、2岁时智力发育指数（MDI）和心理运动发育指数（PDI）均高于对照组，差别有统计学意义。结论早期干预可以促进高胆红素血症儿童的智力发育，有利于减少高胆红素血症对儿童智能发育的影响。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.