118例妊高征患者脐动脉S／D值分析

动态监测１１８例妊高征患者脐动脉Ｓ／Ｄ值，并与３２０例正常孕妇Ｓ／Ｄ值相比较，发现重度妊高征、先兆子痫患者Ｓ／Ｄ值明显升高，Ｐ＜０．０１，差异有显著意义。提示此类患者脐血流阻力增加，胎盘灌注量减少。且Ｓ／Ｄ值越高，妊高征病变程度越重，母儿预后越差。故监测Ｓ／Ｄ值，可辅助临床医师判断病情及疗效，适时终止妊娠，以阻断小于胎龄儿低百分位数倾向，有效改善婴儿状态。     

Angiolipoma located inside the obturator canal and supplied by the umbilical artery

During dissection of the retropubic region of a 55-year-old female cadaver, we encountered an angiolipoma located inside the obturator canal which was connected to the wall of the urinary bladder by a fibrous cord. The angiolipoma was supplied by a branch originating from the umbilical artery. Microscopically the benign soft tissue tumor was characterized by lobules of mature adipocytes and densely distributed networks of small and larger blood vessels, thus resembling typical histological features of an angiolipoma. Both the uncommon location of the angiolipoma and the abnormal branch of the umbilical artery entering the obturator canal should be taken into account during surgical procedures in this region, such as for orthopedic pelvic procedures, hernia repair or bladder/urethra-related interventions (e.g. transobturator tape, tension-free vaginal tape, colposuspension).     

Dietary composition and acid-base status: limiting factors in the performance of maximal exercise in man?

Summary Seven healthy male subjects exercised to exhaustion at a workload equivalent to 100% of their maximal oxygen uptake ( ) on 3 separate occasions. Each high intensity exercise test was performed on an electrically braked cycle ergometer; the first took place after a normal diet (46±8% carbohydrate (CHO), 41±7% fat and 13±3% protein); the second after 3 days of a low CHO diet (7±3% CHO, 64±5% fat and 29±4% protein) and the third after 3 days of a high CHO diet (76±6% CHO, 14±5% fat and 10±2% protein). Acid-base status and selected metabolites were measured on arterialised venous blood at rest prior to exercise and during the post-exercise period. Plasma urea concentration and urine total acidity were measured on each day of the experiment. Exercise time to exhaustion was longer after the normal (p<0.05) and high (p<0.01) CHO diets compared with the low CHO diet. Pre-exercise plasma bicarbonate concentration and blood were higher after the high CHO diet when compared with the normal (p=0.05, p<0.05 respectively) and low CHO conditions (p<0.05, p<0.05 respectively). Pre-exercise bicarbonate was also higher after the normal CHO diet when compared with the low CHO diet (p<0.05). Mean dietary acid intake for each 3 day period of dietary variation and plasma urea immediately prior to exercise were lower after the high CHO diet when compared to both normal (p<0.01, p<0.01) and low (p<0.01, p<0.001) CHO diets. They were also lower (p<0.01, p<0.01) after the normal when compared with the low CHO diet. Urine total acidity was higher after the low CHO diet when compared with both the normal (p<0.01) and high CHO (p<0.01) diets and near significance was found (p<0.06) when comparing the normal and high CHO diets. The present exsuggests that dietary variation alone can significantly affect the acid-base balance of the blood and may thereby influence endurance time during high intensity exercise.     

Relationship between hepatoportal blood flow and acid-base status in acute destructive cholecystitis

Acute destructive cholecystitis in cats is attended by the development of metabolic acidosis. Reduction of pH is marked in the portal vein blood. The liver contributes to the compensation of metabolic acidosis by vascular reactions comprising limitation of portal blood flow and intensification of blood flow in the hepatic artery. This made it possible to maintain pH of blood flowing from the vein on the level of arterial pH and led to increased production of bicarbonate by the liver into systemic circulation.     

Formation and action of prostacyclin in the isolated human umbilical artery

The transformation of [l-¹⁴C]arachidonic acid by homogenates of human umbilical arteries was studied. The major compund formed was the stable end product of PGI₂, i.e. 6-keto-PGF_1α (lactol form) as analyzed by gas-liquid chromatography-mass spectrometry. PGI₂ was generated by incubating PGH₂ with a lyophilized pig aorta microsome preparation. PGI₂ concentrations around 10 ng/ml relaxed the human umbilical artery preparation significantly. Formation of PGI₂ by umbilical arteries during pregnancy might be a mechanism for regulation of blood flow to the fetus.     

The effects of dietary manipulation on blood acid-base status and the performance of high intensity exercise

Summary The effect of a pattern of exercise and dietary modification, which is normally used to alter muscle glycogen content, upon the acid-base status of the blood and the ability to perform high intensity exercise was studied. Eleven healthy male subjects cycled to exhaustion on an electrically braked cycle ergometer at a workload equivalent to 100% of their maximal oxygen uptake ( ) on three separate occasions. The first exercise test took place after a normal diet (46.2±6.7% carbohydrate (CHO)), and was followed by prolonged exercise to exhaustion to deplete muscle glycogen stores. The second test was performed after three days of a low carbohydrate diet (10.1±6.8% CHO) and subsequently after three days of a high CHO diet (65.5±9.8% CHO) the final test took place. Acid-base status and selected metabolites were measured on arterialised venous blood at rest prior to exercise and during the post-exercise period. Exercise time to exhaustion was longer after the normal (p<0.05) and high (p<0.05) CHO dietary phases compared with the low CHO phase. Resting pre-exercise pH was higher after the high CHO diet (p<0.05) compared with the low CHO diet. Pre-exercise bicarbonate, PCO₂ and base excess measurements were higher after the high CHO treatment compared with both the normal (p<0.01,p<0.05,p<0.01 respectively) and low CHO phases (p<0.001,p<0.01,p<0.001 respectively). Daily dietary acid intake, estimated from food composition tables, was higher than normal during the low CHO diet and lower than normal during the high CHO diet. The present investigation suggests that a predetermined regimen of dietary and exercise variation can significantly affect blood acid-base status and may thereby influence high intensity exercise performance.     

细胞压积、脐动脉S/D与子痫前期胎儿生长受限的相关性研究

目的探讨细胞压积、脐动脉S/D与子痫前期胎儿生长受限的相关性。方法将2008-2009年在我院住院分娩的子痫前期病例（单胎妊娠）分为轻度及重度子痫前期两组,分析其孕周、红细胞压积（HCT）、脐动脉S/D与胎儿生长受限的相关性。结果重度子痫前期组中的未足月妊娠、HCT≥0.35,脐动脉SD≥3.0的FGR发生明显高于轻度子痫前期组,统计结果有统计学差异（P〈0.05）。轻、重两组子痫前期在HCT〈0.35、脐动脉SD〈3.0情况下FGR发生率无统计学差异（P〉0.05）。结论未足月妊娠、HCT≥0.35及脐动脉SD≥3.0时与子痫前期合并FGR的发生密切相关。加强对这些指标的监测可及时诊治子痫前期中的FGR,避免不良围产儿事件的发生。     

Phenotype and function of lymphocytes from the neonatal umbilical cord compared to paired maternal peripheral blood cells isolated during delivery

In the present study, we analyzed the immunological characteristics of mononuclear cells (MNC) isolated from both neonatal umbilical cord blood (UCB) and maternal peripheral blood (MPB) during the delivery. The in vitro proliferative response of UCB T lymphocytes was significantly reduced compared to the maternal response to phytohemagglutinin A, pokeweed mitogen, and alloantigen stimulation, in correlation with the lower percentage of UCB than MPB lymphocytes, but not with that of B cells. The mean cytotoxic activity level of interleukin-2 (IL-2)-activated natural killer (NK) was higher in UCB than in MBP, whereas the percentage of CD56(+) NK cell count was similar. Our results show differences in the immune reactivity of T and B lymphocytes from neonate and adult isolated under similar physiological conditions.     

NST、脐血流S/D值预测胎儿缺氧的比较

目的评价这两种指标预测胎儿缺氧的价值.方法选取单胎足月高危妊娠200例作为研究对象,同时进行两项指标测定:1.常规行非应激试验,(NST)试验,2.脐血流S/D值测定.不良围产结局评定:5′Apgar评分≤7分,脐血pH≤7.20,胎儿预后不良.结果 NST(-)27例,脐血流S/D值≥3.0 24例.5′ Apgar评分≤7分 21例, 胎儿预后不良11例(1 例围产儿死亡).2种试验方法的的特异性、阴性预测值、准确性较高 ,假阴性率较低,敏感性、阳性预检值较低,假阳性率较高,NST与S/D值比较,无显著差异 (P>0.05).结论 NST、有较高的阴性预测价值,预测胎儿缺氧的阳性预测价值较低 ,NST( )能高度预示胎儿良好,而S/D值无论正常或异常均不能对胎儿安危作出明确评价 .     

Angiographic demonstration of an aberrant abdominal umbilical artery in a patient with penoscrotal transposition and caudal regression

Penoscrotal transposition (PST) is a rare congenital anomaly characterized by caudal location of the penis with respect to the scrotum. PST may be seen in isolation or associated with caudal regression syndrome. We present a case of an infant born with penoscrotal transposition, bladder agenesis, a solitary dysplastic kidney, and caudal regression. The patient developed anuria and was referred for angiography for preoperative planning for renal transplantation and genital reconstruction. Angiography demonstrated an aberrant abdominal umbilical artery, an anomaly classically associated with sirenomelia but also has been described in caudal regression.     

超声引导脐静脉穿刺术在孕中晚期产前诊断中的应用价值

目的探讨超声引导脐静脉穿刺术在孕中晚期产前诊断中的安全性及应用价值。方法对875例孕周为18~33+4的孕中晚期孕妇因各种原因行超声引导脐静脉穿刺术,并对所抽取的脐静脉血进行核型分析。结果超声引导脐静脉穿刺成功率为99.5%;胎盘或脐带一过性渗血发生率22.5%;胎儿短暂心动过缓发生率4.0%;胎儿丢失发生率0.5%。染色体核型分析发现核型异常65例,异常率为7.4%,其中数目异常41例;结构异常24例。另发现重型地中海贫血8例,巨细胞病毒感染2例。异常诊断结果总检出率为8.6%。结论超声引导下脐静脉穿刺术具有很高的成功率和安全性,弥补了孕中晚期产前诊断方法的空缺,并能从多方面进行病因学诊断。     

The effects of a glycogen loading regimen on acid-base status and blood lactate concentration before and after a fixed period of high intensity exercise in man

Summary Six healthy male subjects exercised after an overnight fast for a fixed 3 min period at a workload equivalent to 100% of their maximal oxygen uptake ( ) on 3 separate occasions. The first test took place after subjects had consumed a mixed diet (43±3% carbohydrate (CHO), 41±5% fat and 16±3% protein) for 3 days, and was followed 2 h later by prolonged cycling to exhaustion at 77±3% to deplete muscle glycogen stores. Following this, subjects consumed a low CHO diet (4±1% CHO, 63±5% fat and 33±6% protein) for the remainder of the day and for the subsequent 2 days; on the morning of the next day a second high intensity test took place. Finally subjects followed a 3 day high CHO diet (73±7% CHO, 17±6% fat and 10±1% protein) before their last test. Acid-base status and selected metabolites were measured on arterialised-venous blood at rest prior to exercise and at intervals for 15 min following exercise. Prior to exercise, plasma pH and blood lactate concentration were higher (p<0.05) after the high CHO diet when compared with the low CHO diet. Pre-exercise plasma bicarbonate, blood PCO₂ and blood base excess were all higher after the high (p<0.001,p<0.01,p<0.01 respectively) and normal (p<0.05,p<0.05,p<0.05 respectively) CHO diets when compared with the low CHO diet. During the post-exercise period there were no differences in plasma pH or blood base excess between the three experimental situations; plasma bicarbonate was higher (p<0.05) at 2 min post-exercise after the high CHO diet when compared with the low CHO diet; blood PCO₂ was higher throughout the post-exercise period after the high CHO diet when compared with the low CHO diet and at 2 min post-exercise was higher after the normal CHO diet than after the low CHO diet (p<0.5). The post-exercise blood lactate concentration after the high CHO diet was at all times higher than the corresponding values recorded after the normal CHO diet and until 15 min post-exercise was significantly higher than the values recorded after the low CHO diet. The present experiment further substantiates the view that a pattern of dietary and exercise manipulation can significantly influence the acid-base status of the blood and by doing so may influence high intensity exercise performance.     

Umbilical arterial blood gas and perinatal outcome in the second twin according to the planned mode of delivery

Purpose: To compare umbilical arterial gas parameters in the second twin of twin pregnancies according to the mode of deliveryMethods: We retrospectively analyzed the medical records of twin deliveries after 34 weeks of gestation for 3 years. Excluding the cases which underwent emergency cesarean delivery during trial of labor, a total of 79 twin gestations had umbilical arterial blood gas values available and were and divided into cesarean delivery group (N=40) and vaginal delivery group (N=39). The mean differences of umbilical arterial blood parameters and the Apgar score between the first and second twin in each pregnancy were compared according the mode of delivery.Results: The differences of umbilical arterial gas parameters between twin siblings showed no significant difference according to the mode of delivery. With regard to the 1 minute and 5 minute Apgar scores, the differences between twin siblings are significantly increased in vaginal delivery group compared to cesarean delivery group (p=0.048, and p=0.038, respectively). In comparing the 28 cases delivered vaginally with an inter-twin delivery interval < 10 minutes and 40 cases delivered by cesarean section, no significant differences were observed in the umbilical arterial gas parameters and Apgar scores.Conclusion: The inter-twin umbilical arterial blood gas parameters according to the mode of delivery showed no difference. For twin deliveries, it is relatively safe to plan for a vaginal delivery, but an effort should be made to reduce the inter-twin delivery interval time.     

Effect of continuous and interval exercise training on the PETCO2 response during a graded exercise test in patients with coronary artery disease

OBJECTIVE:

The purpose of this study was to evaluate the following: 1) the effects of continuous exercise training and interval exercise training on the end-tidal carbon dioxide pressure (PETCO₂) response during a graded exercise test in patients with coronary artery disease; and 2) the effects of exercise training modalities on the association between PETCO₂ at the ventilatory anaerobic threshold (VAT) and indicators of ventilatory efficiency and cardiorespiratory fitness in patients with coronary artery disease.

METHODS:

Thirty-seven patients (59.7±1.7 years) with coronary artery disease were randomly divided into two groups: continuous exercise training (n = 20) and interval exercise training (n = 17). All patients performed a graded exercise test with respiratory gas analysis before and after three months of the exercise training program to determine the VAT, respiratory compensation point (RCP) and peak oxygen consumption.

RESULTS:

After the interventions, both groups exhibited increased cardiorespiratory fitness. Indeed, the continuous exercise and interval exercise training groups demonstrated increases in both ventilatory efficiency and PETCO₂ values at VAT, RCP, and peak of exercise. Significant associations were observed in both groups: 1) continuous exercise training (PETCO₂VAT and cardiorespiratory fitness r = 0.49; PETCO₂VAT and ventilatory efficiency r = -0.80) and 2) interval exercise training (PETCO₂VAT and cardiorespiratory fitness r = 0.39; PETCO₂VAT and ventilatory efficiency r = -0.45).

CONCLUSIONS:

Both exercise training modalities showed similar increases in PETCO₂ levels during a graded exercise test in patients with coronary artery disease, which may be associated with an improvement in ventilatory efficiency and cardiorespiratory fitness.     

Relationship between coronary artery calcium score by multidetector computed tomography and plaque components by virtual histology intravascular ultrasound

The aim of this study was to evaluate the relationship between coronary artery calcium score (CACS) assessed by multidetector computed tomography (MDCT) and plaque components assessed by virtual histology-intravascular ultrasound (VH-IVUS) in 172 coronary artery disease (CAD) patients with 250 coronary lesions. CACS was assessed according to Agatston scoring method by MDCT and patients were divided into four groups: Group I (CACS = 0 [n = 52]); Group II (CACS = 1-100 [n = 99]); Group III (CACS = 101-400 [n = 84]); and Group IV (CACS > 400 [n = 15]). Total atheroma volume was greatest in Group IV (152 ± 132 μL vs 171 ± 114 μL vs 195 ± 149 μL vs 321±182 μL, P < 0.001). The absolute dense calcium (DC) and necrotic core (NC) volumes were greatest, and relative DC volume was greatest in Group IV (5.5 ± 6.6 μL vs 11.0 ± 10.3 μL vs 15.6 ± 13.6 μL vs 36.6 ± 18.2 μL, P < 0.001, and 14.8 ± 18.2 μL vs 19.5 ± 18.9 μL vs 22.5 ± 19.1 μL vs 41.7 ± 27.9 μL, P < 0.001, and 6.4 ± 5.3% vs 11.0 ± 6.2% vs 14.0 ± 6.5% vs 20.0 ± 7.8%, P < 0.001, respectively). The absolute plaque and DC and NC volumes and the relative DC volume correlated positively with calcium score. CAD patients with high calcium score have more vulnerable plaque components (greater DC and NC-containing plaques) than those with low calcium score.     

Heritability and "environmentability" of electroencephalogram in infants: the twin study

We estimated relative contribution of genetic and environmental factors to electroencephalogram (EEG) frequency and amplitude parameters in infants. EEG was registered in 49 pairs of monozygotic and 45 pairs of dizygotic twins aged 7-12 months during (1) visual attention and (2) darkness. The variability of occipital alpha frequency depended mainly on genetic, probably nonadditive factors. The mean heritability for the spectral amplitudes in the delta, theta, and alpha bands were 0.37, 0.13, and 0.22 during visual attention, and 0.22, 0.40, and 0.10 during darkness. The influence of shared environment was probable for many of the EEG parameters. It was greatest for the amplitude of the theta rhythm during visual attention. The theta amplitude depended on such a parameter of early social environmental enrichment as the number of caregivers in the family. The possible relationship between infant theta rhythm and developmental outcome is discussed. For many of the EEG parameters, heritability increased during the second half of the first year of life, thus supporting the hypothesis about amplification of genetic effects and decrease of common environmental influences with age.     

不同分娩方式对脐血瘦素及新生儿免疫功能的影响

目的探讨不同分娩方式对脐血瘦素浓度、新生儿免疫功能的影响;以及瘦素与新生儿免疫功能的关系。方法2006年1月至2006年9月青岛海慈医疗集团产科足月单胎分娩产妇,其中经阴道自然分娩40例,择期剖宫产50例,采用速率散射法免疫浊度测定系统检测脐血瘦素,IgG、IgA、IgM;采用单抗桥联酶标法测定T细胞亚群。同时行血常规化验。结果阴道分娩脐血瘦素浓度、免疫球蛋白水平和细胞免疫水平高于剖宫产分娩。结论不同分娩方式对脐血瘦素与新生儿免疫功能有影响,阴道分娩可促进新生儿免疫功能的增加。     

Structural relationships between the endothelial actin system and the underlying elastic layer in the distal interlobular artery of the rat kidney

Summary The structure of the intracellular actin filaments and the extracellular matrices was studied in the distal interlobular arteries in the rat kidney, employing three different morphological techniques, including rhodamin-phalloidin staining of cryosections, resorcin-fuchsin staining of paraffin sections, and a cold dehydration procedure for electron microscopy. The endothelial cells possess longitudinally running stress fibers. The inner elastic layer is composed of meshworks of elastic fibers encompassing numerous pores. The smooth muscle cells containing abundant actin filaments are arranged circumferentially around the vascular axis. The endothelial stress fibers are found mainly in the basal half of the endothelial cells, and anchor onto the basal cell membranes. The elastic meshworks send off longitudinal branch fibers to contact the endothelial cell membranes at the anchoring sites of stress fibers. In addition circumferential branches run toward the smooth muscle cells. The functional significance of the intracellular contractile apparatus and the extracellular tensile component in small arteries was discussed.     

脐血铅与初乳铅含量与新生儿神经行为发育关系

目的 探讨在宫内低水平铅暴露状态下,新生儿脐血铅含量及初乳铅铅含量与神经行为发育的关系。方法 随机选取南京市妇幼保健院医院产科2010-01/04出生的足月新生儿170例。以脐血铅和初乳铅铅含量作为新生儿铅暴露的指标,新生儿神经行为（NBNA）发育评分作为效应指标,根据初乳铅中位数48.3μg/l,新生儿被分为高低铅两组。结果 高暴露组在新生儿主动肌张力、原始反射,和神经行为发育总评分上低于低暴露组,差异有统计学意义（P〈0.05）,在新生儿行为能力、被动肌张力、一般估价上差异无统计学意义。结论 初乳铅脐血铅水平和与婴儿的早期发育有关,铅可通过乳汁和脐血造成新生儿的铅接触,对新生儿婴儿早期神经行为发育产生不良影响。