孕期铅暴露对婴儿听觉发育影响的研究

目的：探讨孕妇孕期低水平铅暴露对婴儿听觉发育的可能影响。方法：2006—2007年在广州市天河区妇幼保健院对100例孕中期血铅水平的产妇所生新生儿至婴儿6月龄时行脑干听觉诱发电位（BAEP）检测,作为铅暴露对婴儿听功能影响的研究指标。结果：①听觉异常的婴儿占调查胎儿的12．0％;②产妇血铅水平越高,婴儿听觉异常的发生率随之增加。结论：铅对胎儿的听觉影响没有最低值,低水平铅暴露是导致新生婴儿听觉异常的主要原因之一。     

孕妇血铅和脐血铅含量水平对新生儿及婴儿神经行为发育的影响

目的：探讨孕妇血铅和脐血铅含量水平对新生儿及婴儿神经行为发育的影响。方法：按标准选择１００例临产孕妇及所出生新生儿为研究对象。用日本岛津ＡＡ－６８０原子吸收分光光度计测孕妇末梢血铅及新生儿脐血铅含量，并按脐血铅水平分为低铅、中铅、高铅三组，并测定婴儿生后３月、６月、９月、ｌ２月时血铅含量。用新生儿２０项神经行为测定方法及盖泽尔（Ｇｅｓｅｌｌ）婴儿发育量表对新生儿及婴儿不同阶段进行神经行为发育评价，并进行相应的统计学分析。结果：①母血铅水平与脐血铅呈正相关（相关系数ｒ－０．９０９６，Ｐ＜０．０００１），②婴儿生后１年内血铅水平远渐上升，经方差分析差异有显著性（Ｐ＜０．０００１），③婴儿各阶段神经行为测定值在０、３、６月，低、中、高铅三组间方差分析均有差异性。进一步两两比较Ｑ检验差异有显著性。９、１２月则无统计学意义。结论：低水平宫内铅暴露对婴儿神经行为发育的影响在新生儿期即表现出来并持续存在，对婴幼儿早期神经发育影响尤为重要。     

脐血铅含量与婴儿神经行为发育的探讨

目的：了解广西地区儿童铅中毒状况，研究铅对婴儿神经发育的影响。方法：选择1020名婴儿，以脐血铅作为铅暴露示标，3月龄时在贝利（Bayley)婴儿发育表上以精神发育指数（MDI）和心理运动发育指数（PDI）为效应示标。结果：血铅≥0．48μmol/L的婴儿其MDI和PDI明显落后于相对低铅组，随着分界线的下移，两组间MDI和PDI差别渐趋缩小，当分界线为0.24μmol/L时，高、低铅组MDI和PDI已不存在统计学差异。结论：当血铅≥0.48μmol/L时，婴儿神经行为发育即可受到不利影响。     

胎儿期铅暴露对婴儿发育的影响

目的：研究出生前后低水平锅暴露对儿童发育的影响。方法：前瞻性观察了３８５例出生时血铅在０．１２～０．８８μｍｏｌ／Ｌ低水平铅暴露婴儿的发育,通过多因素统计评价其因果关系。结果：脐带血铅水平与出生３个月时在Ｂａｙｌｒｙ发育量表上的精神发育指数（ＭＤＩ）和心理运动发育指数（ＰＤＩ）呈明显负相关关系。血铅≥０．４８μｍｏｌ／Ｌ的婴儿在３月龄时的ＭＤＩ和ＰＤＩ明显低于血铅水平〈０．４８μｍｏｌ／Ｌ者,分别     

正常成年人脑诱发电位研究

本文报告了正常成年人体感、听觉脑干及视觉诱发电位的检查结果,3项诱发电位均各测定50人,体感诱发电位(SEP)出现P_1、N_1、P_2、N_2、P_3、N_3波,听觉脑干诱发电位(ABR)出现Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ波,视觉诱发电位(VEP)出现N_1、P_2、N_2波,各波的形态基本一致,波峰潜伏期均数值呈正态分布。发现男性SEP双侧P_1、N_1波峰潜伏期较女性延长(P<0.01),男女ABR右耳Ⅱ波峰潜伏期均较左耳延长(P<0.001)。     

1~12月龄早产儿与足月儿脑干听觉诱发电位对比分析

目的 对1~12月龄早产儿与足月儿脑干听觉诱发电位各波潜伏期和峰间期进行对比分析。方法 选取1~12月龄早产儿652例作为测试对象,足月儿454例作为对照组,通过对比不同月龄组早产儿组及对照组各波潜伏期和峰间期,分析早产儿脑干听觉诱发电位结果变化情况。结果 1月龄及2月龄组早产儿Ⅰ波、Ⅲ波、Ⅴ波潜伏期、Ⅰ~Ⅲ峰间期、Ⅲ~Ⅴ峰间期及Ⅰ~Ⅴ峰间期与足月儿比较,差异均有统计学意义(P<0.05);3月龄及4月龄组早产儿Ⅰ波、Ⅲ波潜伏期、Ⅰ~Ⅲ峰间期及Ⅰ~Ⅴ峰间期与足月儿比较,差异有统计学意义(P<0.05);5月龄、6月龄、8月龄、10月龄和12月龄组早产儿Ⅰ、Ⅲ、Ⅴ波潜伏期和Ⅰ~Ⅲ、Ⅲ~Ⅴ、Ⅰ~Ⅴ峰间期差异无统计学与意义(P>0.05)。结论 脑干听觉诱发电位可为早期发现早产儿脑损伤提供依据。     

阻塞性睡眠呼吸暂停低通气综合征患者耳蜗功能的研究

目的：通过观察阻塞性睡眠呼吸暂停低通气综合征患者（OSAHS）的听性脑干反应（ABR）测试结果评价OSAHS患者的耳蜗功能变化.方法：收集本院耳鼻咽喉科2004年2月至2004年9月40例符合本研究纳入标准的OSAHS住院病例,根据AHI结果将全部病例分为轻度OSAHS组（5≤AHI≤20）和中重度OSAHS组（AHI＞20）进行ABR测试.记录ABR波Ⅰ、Ⅲ、Ⅴ潜伏期,波Ⅰ-Ⅲ、Ⅲ-Ⅴ、Ⅰ-Ⅴ波间期.比较轻度OSAHS组和中重度OSAHS组患者各波潜伏期和波间期与正常对照值之间的差异.结果：中重度OSAHS组患者ABR的波Ⅰ、Ⅲ、Ⅴ潜伏期及波Ⅰ-Ⅲ、Ⅰ-Ⅴ波间期比正常对照值延长,差异具有显著性（P＜0.05）;与轻度OSAHS组相比,中重度OSAHS组患者ABR的波Ⅰ、Ⅲ潜伏期延长,差异具有显著性（P＜0.05）;轻度OSAHS组患者各波潜伏期和波间期与正常对照值相比无统计学意义改变（P＞0.05）.结论：反复发作的中重度OSAHS能够损害耳蜗功能,且OSAHS对耳蜗功能的影响是一个渐进的过程.ABR可以作为OSAHS是否影响耳蜗功能的一项监测指标.     

铅暴露对婴幼儿神经行为发育的影响

目的探讨出生前后铅暴露对婴幼儿神经行为发育的影响。方法采用前瞻性流行病学调查,测定298名正常足月新生儿脐血铅的水平,并对其神经行为发育进行纵向追踪,分别于出生后3、6、12、18和24个月进行指血液铅检测,同时利用Bayley婴儿发育量表监测其精神发育指数和心理运动发育指数,并对可能影响神经行为发育的因素进行问卷调查和多元逐步回归分析。结果1岁以内婴儿血铅水平处于稳定状态,1岁以后血铅水平有所升高。出生时脐血≥58μg／L和脐血〈58μg／L的婴幼儿1岁以内精神发育指数和心理运动发育指数值存在明显差异。多元逐步回归分析结果显示,1岁以内婴儿精神发育指数和心理运动发育指数值与脐血血铅水平呈负相关,而与出生后血铅水平无明显相关;出生后血铅水平更多的与1岁以后精神发育指数和心理运动发育指数存在负相关。结论胎儿期铅暴露对婴幼儿神经行为发育存在影响,1岁以内可能为其敏感期。     

高胆红素血症新生儿听性脑干反应观察

目的探讨高胆红素血症新生儿听性脑干反应（ABR）的改变及特点。方法根据血清胆红素水平把40例高胆红素血症新生儿分为A组（21例，42耳，血清间接胆红素浓度在204～342μmol／L之间）和B组（19例，38耳，血清间接胆红素浓度大于342μmol／L），两组进行ABR检测，测定Ⅰ、Ⅲ、Ⅴ各波潜伏期（PL）、峰间潜伏期（IPL）、V波反应阈等数值。结果高胆红素血症新生儿ABR的异常率为58％。主要表现为Ⅰ、Ⅲ、Ⅴ波PL延长，Ⅰ-Ⅴ IPL延长，Ⅰ、Ⅲ、Ⅴ波消失和反应阈升高。与A组比较，B组患儿ABR异常率显著增高（P〈0．01），其中Ⅰ、Ⅴ波PL异常率，Ⅰ-VIPL异常率及V波反应阈异常率的差异有显著性（P〈0．01）。结论新生儿高胆红素血症对其听力和中脑下部有一定程度损害，血清间接胆红素浓度与ABR异常程度直接相关。     

先天性心脏病患儿短声诱发听性脑干反应的探讨

目的：探讨先天性心脏病（先心病）对患儿脑干发育的影响。方法：探讨先心病患儿听性脑干反应（ABR）,并以正常儿为对照组。结果：年龄＜12月,青紫型先心病（CCHD）,患儿Ⅰ波潜伏期（LP）正常,Ⅰ～Ⅴ波峰期潜伏期（IPL）较正常儿显著延长,非青紫型先天病（NCCHD）患儿Ⅰ波LP、Ⅰ～Ⅴ波LPL均显著延长;4－6岁者NCCHD和CCHD无反复缺氧发作者LP和Ⅰ～Ⅴ波LPL与正常儿无差异,CCHD反复缺氧发作者Ⅰ～Ⅴ波LPL较正常儿显著延长,异常率2．3％。结论：先心病不延迟婴儿期脑干发育,缺氧发作可损害脑干功能,对缺氧发作者应尽早进行干预。     

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.