男童肥胖性性发育不良家庭病床的建立与实践

目的 探讨建立男童肥胖性性发育不良家庭病床的方法与意义.方法 对体检筛查出来的肥胖性性发育不良男童通过建立家庭病床的形式进行了治疗和监控,并收集治疗前后患儿生活方式、体重指数以及性发育测量等方面资料进行对比总结.结果 246例肥胖性性发育不良男童经过1～2个疗程的家庭病床治疗后,其肥胖以及性发育状况明显改善.男童肥胖性性发育不良治疗有效率达98%以上,创造了较好的社会效益和经济效益.结论 男童肥胖性性发育不良的治疗是一项较长期的、需要医务人员、患病儿童以及家长共同努力的工作,建立家庭病床管理是一种行之有效而又便利病人的好方法,值得推广.     

男童肥胖性性发育不良家庭病床的建立与实践

目的探讨建立男童肥胖性性发育不良家庭病床的方法与意义。方法对体检筛查出来的肥胖性性发育不良男童通过建立家庭病床的形式进行了治疗和监控,并收集治疗前后患儿生活方式、体重指数以及性发育测量等方面资料进行对比总结。结果246例肥胖性性发育不良男童经过1~2个疗程的家庭病床治疗后,其肥胖以及性发育状况明显改善。男童肥胖性性发育不良治疗有效率达98%以上,创造了较好的社会效益和经济效益。结论男童肥胖性性发育不良的治疗是一项较长期的、需要医务人员、患病儿童以及家长共同努力的工作,建立家庭病床管理是一种行之有效而又便利病人的好方法,值得推广。     

发育性髋关节发育不良

背景:发育性髋关节发育不良这一术语已经取代先天性髋关节脱位,因为它更能准确地反映导致未成熟髋部畸形形成所有范畴.目的:就发育性髋关节发育不良特性、危险因素以及治疗手段的研究进展进行综述.方法:由第一作者应用计算机检索PubMed数据库及中国期刊网全文数据库2006-01/2011-09有关发育性髋关节发育不良诊断、临床筛查、体格检查、物理检查及治疗等方面的文章,英文检索词为"developmental dysplasia of the hip,examination,treatment",中文检索词为"发育性髋关节发育不良,检查,治疗".排除重复性研究,共保留27篇文献进行综述.结果与结论:发育性髋关节发育不良判断危险因素包括臀先露和家族史,本病诊断是建立在医生体格检查的基础上.髋关节的不稳定、双下肢不等长及大腿皮肤皱褶不对称均可出现在新生儿发育性髋关节脱位的病例中;然而步态不稳及髋关节外展活动受限在大龄儿童更为常见.超声波扫描技术检查存在着一定的争议,然而一旦诊断确立后通常可以用来验证和评估髋关节的发育情况.支具相对于6个月以下的儿童而言是最重要的治疗手段;手术适应于超过6个月的患儿保守治疗失败.早期诊断髋关节发育不良对于改善治疗结果非常重要,同时降低了并发症发生的风险.     

综合治疗肥胖儿童阴茎短小74例体会

０引言肥胖儿童的发生率逐年上升，伴随肥胖的男童性发育不良在不断增加，如阴茎短小、隐匿性阴茎、睾丸发育不良等，已引起医学界和家长的高度重视。如不及时治疗，会导致性腺发育不良和成年期性功能异常。１材料和方法１．１材料７４例阴茎短小的肥胖男童均来自于本院２００１－１１／２００２－０２小儿遗传内分泌及外科门诊，年龄８～１２岁，平均（１０．２±１．２）岁。对来诊的肥胖伴阴茎短小的儿童均详细询问病史，包括现病史、个人史、家族史及生活习惯等，进行认真的体格检查，包括身高、体重、体型、头颅颜面等，重点检查外生殖…     

中医推拿减肥治疗肥胖男童阴茎短小的效果观察

目的：观察配合中医推拿减肥对儿童肥胖性性发育不良的典型症状阴茎短小的治疗效果。方法：纳入2001-06／2003—09河南省妇幼保健院小儿遗传内分泌及泌尿外科门诊单纯肥胖男童70例，随机数字表法分为推拿＋康复治疗组40例，康复治疗组30例；同时纳入同年龄，同身高体质量正常儿童20例。所有肥胖儿童采用阴茎短小治疗仪治疗，推拿＋康复治疗组儿童再加用循经推拿法进行减肥治疗，采用中医推，揉，点，按等推拿手法在患者身上循经络进行按摩，并对胃俞，脾俞，肾俞、上脘，中脘、下脘等重点穴位进行刺激，每天治疗30min。同时对肥胖儿童给予饮食，运动指导。检测两组肥胖儿童治疗前后的身高，体质量，阴茎大小；放免法测定各组儿童的血清黄体生成素、卵泡刺激素、总睾酮、雌二醇。结果：全部进入结果分析。①肥胖儿童血清黄体生成素、卵泡刺激素、雌激素均明显高于正常儿童，血清总睾酮水平明显低于正常儿童（P〈0．01）。②推拿＋康复治疗组和康复治疗组儿童治疗后，阴茎长度与治疗前相比均有显著增长[（3.31&;#177;0．45），（1．64&;#177;0．52）；（2．93&;#177;0.38），（1．61&;#177;0．41）cm；P〈0．01]；推拿＋康复治疗组治疗后阴茎长度增长大于康复治疗组儿童（P〈0．01）。③推拿＋康复治疗组体质量较治疗前下降，差异有显著性意义[（[65.32&;#177;9．22），（72．78&;#177;7．48）kg，P〈0．01]。结论：肥胖男童性发育滞后可能于男童性激素分泌紊乱有关，配合中医推拿减肥治疗，可显著降低患者的体质量，增加患儿的阴摹长度。     

超声用于发育性髋关节发育不良研究进展

发育性髋关节发育不良(DDH)是髋臼发育不良、髋关节半脱位及髋关节脱位等一系列病理变化的统称，早期诊断和治疗DDH具有重要临床意义。超声是影像学诊断DDH的首选方法，可全面观察髋关节结构，有助于临床评估DDH分型、制定治疗方案及评估预后。本文介绍超声用于DDH研究进展。     

中医推拿减肥治疗肥胖男童阴茎短小的效果观察

目的:观察配合中医推拿减肥对儿童肥胖性性发育不良的典型症状阴茎短小的治疗效果。方法:纳入2001-06/2003-09河南省妇幼保健院小儿遗传内分泌及泌尿外科门诊单纯肥胖男童70例,随机数字表法分为推拿 康复治疗组40例,康复治疗组30例;同时纳入同年龄、同身高体质量正常儿童20例。所有肥胖儿童采用阴茎短小治疗仪治疗,推拿 康复治疗组儿童再加用循经推拿法进行减肥治疗,采用中医推、揉、点、按等推拿手法在患者身上循经络进行按摩,并对胃俞、脾俞、肾俞、上脘、中脘、下脘等重点穴位进行刺激,每天治疗30min。同时对肥胖儿童给予饮食、运动指导。检测两组肥胖儿童治疗前后的身高、体质量、阴茎大小;放免法测定各组儿童的血清黄体生成素、卵泡刺激素、总睾酮、雌二醇。结果:全部进入结果分析。①肥胖儿童血清黄体生成素、卵泡刺激素、雌激素均明显高于正常儿童,血清总睾酮水平明显低于正常儿童(P<0.01)。②推拿 康复治疗组和康复治疗组儿童治疗后,阴茎长度与治疗前相比均有显著增长[(3.31±0.45),(1.64±0.52);(2.93±0.38),(1.61±0.41)cm;P<0.01];推拿 康复治疗组治疗后阴茎长度增长大于康复治疗组儿童(P<0.01)。③推拿 康复治疗组体质量较治疗前下降,差异有显著性意义[(65.32±9.22),(72.78±7.48)kg,P<0.01]。结论:肥胖男童性发育滞后可能于男童性激素分泌紊乱有关,配合中医推拿减肥治疗,可显著降低患者的体质量,增加患儿的阴茎长度。     

发育性髋关节发育不良儿童的社区护理指导

[目的]总结发育性髋关节发育不良(DDH)儿童的社区护理指导。[方法]对发育性髋关节发育不良儿童的早期筛查、心理护理、生活护理、功能锻炼及并发症预防性护理等内容进行护理指导。[结果]针对该病的预防和护理,提高了儿童家长的护病意识和护理水平,减少了并发症的发生。[结论]通过有效的社区护理指导可提高DDH儿童的生活质量和治疗效果。     

MRI在儿童发育性髋关节发育不良中的应用及进展

发育性髋关节发育不良(DDH)是儿童最常见的先天四肢畸形之一,是指于出生前及出生后股骨头和髋臼在发育和(或)解剖关系中出现异常的一系列髋关节病症。早期诊断及治疗对该病预后影响很大,MRI在其辅助诊断及治疗方案制订中起到了显著的作用。本文重点阐述MRI在发育性髋关节发育不良病例中的应用价值及进展。     

雌二醇增高对青春期肥胖男童性腺轴负反馈抑制的探讨

目的探讨体内脂肪含量（FM）增多、血清雌二醇（E2）增高对单纯肥胖男童下丘脑-垂体-性腺轴（HPGA）的负反馈抑制作用。方法选择12~14岁中、重度的肥胖男童88例（12、13岁各选取30例,14岁28例）;正常儿童90例（12~14岁均为30例）,分别进行体内脂肪百分率（BF%）、FM及睾丸平均容积（MTV）的测量;并应用化学发光方法测定血清E2、黄体生成激素（LH）、促卵泡激素（FSH）及睾酮（T）的含量,分别进行上述检测项目均值差异性分析,以及FM与E2、E2与LH的相关性分析。结果肥胖男童组BF%、FM值明显高于正常男童组,FM值与E2呈显著相关关系;而MTV值明显低于正常组。肥胖男童组血清E2值显著高于正常男童组,并与LH呈显著负相关;肥胖男童LH、T均值较正常男童明显偏低;血清FSH值2组无统计学差异。结论单纯性肥胖男童FM增加、血清E2增高、对HPGA可产生负反馈抑制作用,可能是导致脑垂体LH分泌减少、肥胖男童性发育程度滞后、睾丸发育及血清睾酮低下的重要原因之一。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.