羊水板层小体检测胎肺成熟度在妊娠期糖尿病中的应用

目的：评价羊水板层小体检测诊断胎肺成熟度在妊娠期糖尿病中的应用。方法：对18例妊娠期糖尿病孕妇,在终止妊娠前行经腹羊膜腔穿刺抽取羊水10ml,5ml羊水检测羊水板层小体,5ml羊水行羊水泡沫试验测定。结果：18例羊水板层小体的测量值,未离心33×10^9／L～272×10^9／L,平均值为182±81．3×10^9／L,离心后26×10^9／L～174×10^9／L,平均值为109±58．6×10^9／L。结论：羊水板层小体与泡沫试验同样是安全、可靠的评价胎肺成熟度的方法。     

正常中晚期妊娠羊水板层小体增长特征及其判断胎肺成熟的意义

目的探讨羊水板层小体数量在正常中、晚期妊娠的增长规律及其对判断胎肺成熟度的意义。方法采用自动血细胞计数仪血小板通道测量310份正常单胎妊娠16～42周的无污染羊水板层小体数目。结果羊水板层小体数目在32孕周前处于低值状态,其于16、24、31孕周时中位数分别为0、5×109/L、7×109/L;满32孕周时中位数达27×109/L,后增长速度开始逐渐加快;满37孕周时中位数为147×109/L。羊水板层小体数目与孕周呈正指数曲线相关,随孕周的增加呈指数增长,相关系数(r)为0.9386,确定系数(R2)为0.881。羊水板层小体数目对孕周的指数方程为Y(LBC)+1=0.0273e0.2201X(孕周)(P0.0001)。利用指数模型预测36、37、38孕周的羊水板层小体数值分别为74×109/L、92×109/L、115×109/L。结论正常中晚期妊娠羊水板层小体数量随孕周进展呈指数增长,可利用板层小体数目对孕周的指数模型对胎肺成熟度做判断。     

羊水板层小体计数预测胎肺成熟度

[目的]评价羊水板层小体计数(lamellarbodycount,LBC)预测胎肺生化成熟度的价值.[方法]对妊娠26～41周的88例羊水标本进行LBC、卵磷脂与鞘磷脂比值(lecithin/sphingomyelin,L/S)和磷脂酰甘油(phosphatidylglycerol,PG)测定.L/S比值或PG提示成熟定义为生化成熟,L/S比值和PG均不成熟定义为生化不成熟,根据ROC曲线获得LBC界值.[结果]①羊水LBC与孕周有明显的相关性,随着孕周的增加,LBC呈指数增加(r=0.834,P<0.001).②羊水LBC与L/S比值、PG之间存在正相关,相关系数分别为r=0.819,P<0.001;r=0.807,P<0.001.③LBC≥35×109/L预测胎肺成熟,灵敏性97.1%,阴性预测值97.9%.特异性87.0%,阳性预测值82.5%;LBC≤10×109/L预测胎肺不成熟,特异性100%,阳性预测值100%,灵敏性67.1%.[结论]在LBC为(10～35)×109/L需进一步检测L/S比值和PG,可使L/S比值和PG测定的人数减少80%.羊水LBC作为胎肺成熟度的筛查试验具有简单、快速、可靠、准确的特点.     

羊水板层小体计数的临床意义及影响因素研究

目的研究羊水板层小体计数在预测胎儿肺成熟时的界值,同时探讨促胎肺成熟治疗对LBC的影响.方法前瞻性收集136例孕妇的147份羊水,其中11人取2次羊水,128人随访新生儿结局.所有羊水均进行了LBC测定,同时比较11例不同孕周两次羊水的LBC结果.结果①羊水LBC有明显的孕周分布特点:羊水LBC随孕周增加而增长.②136例新生儿中共发生4例RDS,孕周均＜37周.以LBC19×1000/μl为界值,预测NRDS的敏感度100%:特异度98.4%:阳性预测值66.7%:阴性预测值100%.③经促胎儿肺成熟治疗后,LBC有明显增长:63.3±48.9比105.9±78.5(×1000/μl),t=-2.86,P=0.0168.结论①羊水LBC用于预测胎儿肺成熟度具有较高的敏感性及特异性.②妊娠34周以后,如果存在胎肺不成熟的证据,可进行促胎肺成熟治疗.     

正常妊娠羊水板层小体增长特征及临床意义

目的:探讨羊水板层小体数量在正常妊娠时的增长规律及其对判断胎肺成熟度的意义。方法:测量302份正常单胎妊娠24～41周的羊水板层小体数目,其中33例为采集两次羊水,并在第一次穿刺时羊膜腔内注射地塞米松10 mg。结果:妊娠24～31周羊水中板层小体一直处于相对较低的数值,妊娠32周后,羊水板层小体数目增长速度开始逐渐加快,至妊娠35周,LBC已达到35×109/L。另外,将LBC与取材孕周做曲线拟和显示LBC与孕周呈指数相关,相关系数(r)为0.938 6,决定系数(r2)为0.881,y=e0.021 8+0.253 1x,显著性检验:P<0.001,差异具有统计学意义。33例收集两次羊水的孕妇,使用地塞米松前羊水的LBC平均值为(21+2.9)×109/L,使用地塞米松后羊水的LBC值为(56+3.7)×109/L,两组比较差异有统计学意义。结论:正常妊娠羊水板层小体数量随孕周呈指数增长,可利用板层小体数目对孕周的指数模型对胎肺成熟度做判断。     

妊娠合并糖尿病孕妇新生儿呼吸窘迫综合征的预防

[目的]探讨预防妊娠合并糖尿病孕妇的新生儿呼吸窘迫综合征的有效措施.[方法]2000年1月～2005年1月在我院分娩的妊娠合并糖尿病孕妇49例,妊娠36～38周或有母儿并发症需提前终止妊娠前行羊水泡沫试验,羊膜腔内注射地塞米松10 mg.必要时重复.[结果] 49例糖尿病孕妇的新生儿中剖宫产35例(71.4%),阴道分娩14例(28.6%);足月儿41例(83.7%),早产儿8例(16.3%);促胎肺成熟前第一次羊水泡沫试验提示胎儿成熟的有31例,可疑成熟的有8例,未成熟的10例,不同孕周的羊水泡沫试验分级程度有统计意义(x2=6.094,P＜0.05).仅1例血糖控制不良,孕龄31.5周,未予促胎肺成熟治疗的新生儿发生呼吸窘迫综合征.[结论]控制血糖,监测和促进胎肺成熟,适时终止妊娠,是预防妊娠合并糖尿病孕妇新生儿呼吸窘迫综合征,提高新生儿存活率的关键.     

羊水泡沫试验预测新生儿呼吸窘迫综合征临床观察

目的通过肺成熟度预测对可能发生新生儿呼吸窘迫综合征的早产儿进行积极预防,同时避免部分早产儿不必要的气管插管及PS使用。方法对136例正常新生儿及早产儿进行羊水泡沫试验,统计其对肺成熟度的阳性预测值、阴性预测值、敏感性、特异性,观察通过此试验使多少34周以下的早产儿避免了不必要的气管插管及PS的使用。结果羊水泡沫试验预测新生儿肺成熟度的阴性预测值为97.44%;阳性预测值为24.14%;敏感性87.5%,特异性为65%。预测肺成熟度避免不必要气管插管及PS使用:胎龄27～31周早产儿几乎无预测作用;31+1～33周早产儿阴性预测值75%;33+1～34周早产儿阴性预测值100%;34周以内的阴性预测值70%。结论羊水泡沫试验有较高的阴性预测值及敏感性,而阳性预测值、特异性及胎龄34周以内的阴性预测率均较低,其实验结果还需与相关影响因素进行分析。     

预测胎肺成熟在未足月胎膜早破期待治疗中的价值

目的探讨应用羊水泡沫振荡试验预测胎儿肺成熟在未足月胎膜早破期待治疗中的价值。方法采用前瞻性研究方法把2011年9月～2012年12月妊娠28周～36〈周胎膜早破需期待治疗的孕妇分为研究组和对照组,研究组116例,孕周35周时或终止妊娠72 h前取阴道内羊水行泡沫振荡试验,试验阴性再次予地塞米松治疗1个疗程;对照组103例,孕周〈35周按常规促胎儿肺成熟,孕周〉35周终止妊娠。对两组围生儿结局进行统计学分析。结果羊水泡沫振荡试验预测胎肺成熟度敏感性66.7%,特异性96.3%,不成熟预测准确率33.3%,成熟预测准确率99.1%。研究组的新生儿窒息、肺透明膜病和围生儿死亡等发生率低于对照组。结论未足月胎膜早破期待治疗中预测并促进胎肺成熟能显著改善围生儿结局,在临床上易推广应用。     

胎肺成熟度预测在妊娠期糖尿病的应用及临床价值

目的:探讨GDM孕妇胎肺成熟度测定的应用及临床价值。方法:选择GDM孕妇共128例作为研究对象,根据血糖控制情况分为两组,血糖控制满意组,共89例;血糖控制不满意组,共39例;另外选取同期正常妊娠孕妇200例作为对照组;所有羊水标本均通过择期剖宫产时或分娩前3天经腹羊膜腔穿刺术穿刺羊膜腔获取。结果:GDM孕妇羊水LBC值随孕周增加而增多,且明显小于正常妊娠组(P>0.05);GDM血糖控制不满意组新生儿RDS发生率明显高于血糖控制满意组及正常妊娠组,差异具有统计学意义(P<0.05);GDM血糖控制满意组新生儿RDS发生率与正常妊娠组相比,差异无明显统计学意义(P>0.05);以LBC<2.0×109/L作为判断胎儿肺不成熟的临界值,以LBC>4.8×109/L作为判断胎儿肺成熟的临界值,具有较好的预测价值。结论:新生儿RDS的发生与孕期血糖控制密切相关,以羊水板层小体计数测定胎肺成熟度时,可以LBC<2.0×109/L作为判断胎儿肺不成熟的临界值,以LBC>4.8×109/L作为判断胎儿肺成熟的临界值。     

羊水磷脂酰甘油与泡沫试验联检在高危妊娠中的应用价值

应用羊水磷脂酰甘油（ＰＧ）和泡沫试验两种方法联检４５例高危妊娠住院孕妇胎儿肺成熟度。结果表明ＰＧ阳性者新生儿无呼吸窘迫综合征发生,并可纠正受分泌物污染的泡沫试验;同时泡沫试验可弥补ＰＧ假阴性之不足。提示此两种方法联检有利于判断胎肺成熟情况,指导高危妊娠计划分泌,减少高危新生儿死亡。     

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.     

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.     

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.