超声三切面筛查早孕期胎儿颚裂的价值

目的:探讨超声三切面在早孕期胎儿颚裂筛查中的应用价值。方法:选取2016年1月-2017年1月于本院进行胎儿颚裂筛查的孕妇280例,利用二维超声探查胎儿颜脸部正中矢状切面、上牙槽突长轴切面以及鼻后三角冠状切面,根据检查结果对胎儿颚裂进行诊断,针对超声检出的颚裂胎儿予以引产。分析超声对胎儿颚裂的检出情况,并记录不同超声切面对颚裂类型的检出率,以引产及生产后的诊断结果为金标准,分析超声不同切面诊断早孕期胎儿颚裂的敏感度、特异度、准确率及kappa检验值。结果:在280例胎儿中,超声三切面检出7例胎儿颚裂,占2.50%,产后及引产后追踪证实在7例腭裂患者中,单侧完全唇裂合并上牙槽突裂4例,单侧完全唇腭裂1例,双侧完全唇腭裂1例,单纯腭裂(Ⅱ度不完全腭裂)1例。在7例超声检出的颚裂胎儿中,经鼻后三角冠状面检出6例,上牙槽突长轴切面检出6例,颜脸部正中矢状切面检出3例。以引产及生产结果为金标准,提示鼻后三角冠状面与金标准的一致性Kappa检验值为0.921,上牙槽突长轴切面诊断的一致性Kappa检验值为0.921,颜脸部正中矢状切面诊断的一致性Kappa检验值为0.594。结论:超声三切面对早孕期颚裂筛查的特异度高,尤其鼻后三角冠状面、上牙槽突长轴切面与金标准诊断的一致性较好。     

三维超声对胎儿胼胝体发育不良的诊断价值

目的探讨三维超声在诊断胎儿胼胝体发育不良(ACC)中的应用及价值.方法分析50例正常胎儿及25例ACC的胎儿的临床资料,两组胎儿均经三维超声检查,在正中矢状切面上观察ACC胎儿的声像表现.结果正常胎儿的胼胝体均位于中间部,显示清晰、附于透明隔腔上方的弓形偏高回声.25例ACC胎儿中有20例整个胼胝体未显示,侧脑室与大脑镰之间显示脑回声,5例仅显示嘴、膝部.结论三维超声能更直观的显示胼胝体缺失,提供更多的诊断信息,提高了超声图像的分辨力,可较客观的评价胎儿胼胝体的发育,有较高的诊断价值.     

胎儿颅脑正中矢状切面在复杂颅脑畸形超声诊断中的意义分析

目的 探讨胎儿颅脑正中矢状切面在复杂颅脑畸形超声诊断中的意义.方法 整群选取2014年5月—2016年5月在该医院进行产检的6425名孕妇作为该次研究对象,给予6425名孕妇进行20~32孕周的超声检查,6425名孕妇的常规胎儿测量使用头围、双顶径、观测颅内结构等常规检查,分析6425名孕妇颅内异常、复杂颅脑畸形检查情况及诊断准确率情况,正中矢状面超声诊断情况,胎儿复杂颅脑畸形正中矢状切面声像图情况.结果 6425名孕妇颅内异常、复杂颅脑畸形分别为189、18名,占比2.94%、0.28%,随访后,复杂颅脑畸形为17名,诊断准备率为94.44%(17/18);正中矢状面超声诊断后颅窝蛛网膜囊肿3名、Dandy-Walker畸形4名、小脑下蚓部发育不全5名、前脑无裂畸形4名、胼胝体发育不全3名.结论 经腹检查、经阴道二维、三维等联合超声检查诊断效果显著,有效提高了中、晚期孕胎儿的颅脑畸形检出率.     

产前三维超声定量分析Dandy-Walker综合征胎儿小脑蚓部的辅助诊断价值

目的探讨产前三维超声第三平面成像方法定量分析Dandy-Walker综合征胎儿小脑蚓部发育的辅助诊断价值。方法采用经腹三维超声方法观察和比较571例正常中晚孕期胎儿和39例Dandy-Walker综合征胎儿小脑蚓部,采用小脑蚓部最大切面面积指标分析正常胎儿小脑蚓部面积与孕周的关系,比较正常与异常组测量数据。结果经腹三维超声第三平面成像方法成功检测529例正常胎儿小脑蚓部最大切面面积,其测值与孕周呈正相关(r2=0.854,P<0.05)。39例Dandy-Walker综合征包括14例Dandy-Walker畸形(DWM)和25例Dandy-Walker变异型(DWV),其中12例DWM和2例DWV未显示蚓部结构,其余蚓部切面面积均明显小于相应孕周正常测值。结论三维超声第三平面成像能够克服二维扫查难以获取胎儿头颅正中矢状切面的不足,得到满意的小脑正中矢状切面图像,有助于分析正常和异常小脑蚓部发育的变化规律,为DWS的产前诊断提供一个新的量化指标。     

超声诊断早孕期致死性侏儒的临床价值

【摘要】目的 探讨超声诊断早孕期致死性侏儒（thanatophoric dysplasia,TD）的临床价值。方法 分析2013年7月～2015年8月确诊为TD的5例胎儿早孕期声像图特点,将TD胎儿与563例12～13+6周正常胎儿的胎儿颈项部透明层（NT）、头臀长（CRL）、双顶径（BPD）、股骨长（FL）测值比较并进行统计学分析,将正常胎儿按孕周进行分组研究。 结果 TD胎儿NT测值均明显增厚,其余声像表现特点与中孕期相似,但异常程度明显轻于中孕期。TD胎儿FL/CRL、FL/BPD比值与正常胎儿比较差异均有统计学意义（P ＜0.05）。结论 早孕期超声检查可对致死性侏儒进行较准确的诊断,通过对FL/CRL及FL/BPD比值的进一步研究,有望作为早孕期超声判断长骨测值明显异常的标准。     

三维超声OMNIVIEW技术评价胎儿小脑蚓部及胼胝体

目的 探讨三维超声OMNIVIEW技术评价胎儿胼胝体及小脑蚓部的应用价值.方法 应用三维超声获取胎儿颅脑三维容积数据,分别应用TUI(tomographic ultrasonographic imaging)及OMNIVIEW技术显示胎儿胼胝体及小脑蚓部的矢正中切面.在重建矢正中切面测量胼胝体长径、小脑蚓部上下径及前后径.结果 三维超声可获得全部254例胎儿的胎头矢正中切面,TUI可显示196/254胎的胼胝体,显示率77.2％,可显示188/254胎的小脑蚓部,显示率74.0％;OMNIVIEW可显示203/254胎的胼胝体,显示率79.9％,可显示200/254胎的小脑蚓部,显示率78.7％.TUI及OMNIVIEW技术均可较好地显示胎儿胼胝体及小脑蚓部,但OMNIVIEW操作更灵活,更简便.胼胝体长径、小脑蚓部上下径及前后径与孕周高度相关.结论 三维超声OMNIVIEW技术操作简单,可较好地显示胎儿胼胝体及小脑蚓部的矢正中切面,在常规产前超声检查中可能更有应用价值.     

三维超声OmniView在妊娠早期诊断鼻骨缺失的临床价值

目的：探讨三维超声OmniView在早孕期诊断胎儿鼻骨缺失中的应用价值。方法选取300例早孕期来我院行常规超声检查的孕妇,按胎儿头臀径分为四组,分别为45~54 mm组65例、55~64 mm组74例、65~74 mm组85例、75~84组76例,应用二维及三维超声OmniView对其鼻骨进行观察及图像分析,对比各组间鼻骨的显示率,并重点对鼻骨缺失者进行图像分析。结果①各组三维超声OmniView对胎儿鼻骨的显示率均高于二维超声,除55~64 mm组(显示率相同)外,各组两者比较差异无统计学意义(P>0.05);②三维OmniView对胎儿鼻骨的总显示率稍高于二维超声,但两者比较差异无统计学意义(P>0.05)。其中6例二维超声在颜面正中矢状面未探及鼻骨,三维超声OmniView可通过颜面部正中矢状面描画解剖线,获取鼻后三角冠状切面和其相垂直的横断切面,显示了胎儿鼻骨。另外7例二维超声及三维OmniView均未显示胎儿鼻骨,诊断为鼻骨缺失。结论三维超声OmniView操作简单,能在二维超声的基础上提供更多鼻骨的诊断信息,减少对操作者技术和经验的依赖,为妊娠早期诊断鼻骨缺失提供了新的思路和方法,是二维超声检查的重要补充。     

前列腺各径值观测

经34例盆腔正中矢状切面教学标本上测得正常成人前列腺各径值,供临床参考。     

超声检查对孕11～13~(+6)周胎儿畸形的诊断价值

目的:探讨超声检查对孕11～13~(+6)周胎儿畸形的诊断价值。方法:选取本院2011年1月-2015年1月接受超声检查的4154例孕11～13~(+6)周孕妇作为研究对象,全部孕妇均采用超声检查,比较不同孕周切面图像质量和胎儿畸形检出情况。结果:在腹围切面、四肢切面、双肾横切面、四腔心切面、小脑横切面、脊柱矢状切面、丘脑切面、侧脑室切面和NT切面等9个标准切面中,孕13~13+6周2分切面率均明显高于孕11~11+6周和12~12+6周,孕12~12+6周明显高于孕11~11+6周,比较差异具有统计学意义(P0.05);4154例接受超声检查的产妇中,神经系统畸形检出率为0.17%(7/4154),4147例早孕期超声检查受检者选择继续妊娠,中晚孕期超声对神经系统畸形检出率为0.05%(2/4147),比较差异无统计学意义(P0.05)。孕11～13~(+6)周超声还发现心血管异常10例,骨骼四肢异常2例,泌尿系统异常3例,消化系统异常1例,呼吸系统异常1例,颜面部异常1例。结论:超声检查对孕11～13~(+6)周胎儿畸形的诊断价值,通过超声不同标准切面有助于改善胎儿多系统和器官畸形的检出情况。     

超声标准切面在孕11～13^＋6周胎儿系统超声检查中的应用价值

目的 探讨超声标准切面在孕11～13^＋6周胎儿系统超声检查中的应用价值.方法 选取2010年3月～2013年1月来我院产检的2 938例孕11～13^＋6周孕妇,采用GE-E8、PHILIPS IU-22仪器,经腹部扫查,对11～13^＋6周胎儿行胎儿系统超声检查,同时对胎儿各系统畸形进行筛查,按不同孕龄将2 938例胎儿分为三组：A组（11^＋0～11^＋6周）、B组（12^＋0～12^＋6周）和C组（13＋0～13^＋6周）,对三组胎儿10个标准切面显示情况进行组间对比分析.结果 对2938例孕妇进行超声检查后,发现早孕期筛查异常人数50例,中孕期超声标准切面在11～13^＋6周胎儿系统超声检查中的显示情况见文中表格.结论 中孕期超声标准切面在早孕期11～13^＋6周胎儿系统超声检查中有重要价值,通过标准切面的应用,早孕期基本可筛查出卫生部规定中孕期系统筛查必须检出的六大畸形.     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.