高原地区超声诊断羊水过少对围产儿的影响

目的：分析高原地区超声对羊水过少的诊断价值。方法：采用最大羊水池深度(AFD)及羊水指数(AFI)指标，对120例妊娠晚期拟诊羊水过少患者，经腹部扫查，分娩后核实羊水量，评估超声对羊水过少的诊断价值。选择年龄相近羊水正常孕妇120例作对照组，比较其胎儿窘迫、新生儿窒息、新生儿体重等指标的差异。结果：①应用AFD和AFI在妊娠晚期超声对羊水过少的诊断准确率为99％。②妊娠晚期经超声诊断的羊水过少孕妇发生胎儿窘迫、新生儿窒息、低体重儿的机会明显增加，与对照组相比，各指标间差异均有极显著性(P＜0.01)。结论：超声诊断羊水过少准确率高，高原地区羊水过少是围产儿危险的征兆，须给予重视及治疗。     

晚期妊娠羊水过少的临床分析

目的探讨晚期妊娠羊水过少的并发症与围产不良结局的关系。方法采用回顾性分析方法，对晚期妊娠羊水过少的216例病例和羊水正常对照组216例孕妇就羊水过少的并发症及妊娠结局进行对比分析。结果超声羊水指数（AFI）法估测羊水量比单一的羊水池深度测量更客观、更准确。羊水过少组胎儿生长受限、妊娠高血压疾病、胎儿畸形、胎儿窘迫、新生儿窒息发生率较对照组高（P〈O．05）。羊水过少组中AFI≤3．0cm孕妇，其胎儿窘迫、新生儿窒息发生率较AFI3．1～5．0cm组高（P〈O．05）。结论羊水过少孕妇妊娠和分娩并发症发生率高是造成不良围产结局的高危因素。对于AFI≤3．0cm有并发症者应于孕36周前适时终止妊娠。剖宫产是此类孕妇分娩方式的最佳选择。     

羊水过少的超声诊断及对围产儿的影响

目的：分析超声对羊水过少的诊断价值。方法：应用SIEMENS黑白超声诊断仪，采用最大羊水池深度（AFD）及羊水指数（AFI）指标，对140例妊娠晚期拟诊羊水过少患者，经腹部扫查；分娩后核实羊水量，评估超声对羊水过少的诊断价值。选择年龄相近羊水正常孕妇140例作为对照组，比较其分娩方式、胎儿窘迫、新生儿窒息、新生儿体重等指标的差异。结果：①应用AFD和AFI在妊娠晚期超声对羊水过少的诊断准确率为96．43％。②妊娠晚期经超声诊断的羊水过少孕妇发生胎儿窘迫、新生儿窒息、低体重儿的机会明显增加，与对照组相比，各指标间差异均有极显著性（P＜0．01）。结论：超声羊水过少准确率高，羊水过少是围产儿危险的征兆，须给予重视。     

羊水过少216例临床分析

目的 :探讨羊水过少患者的宫颈Bishop评分与分娩方式、围产儿预后的关系。比较B超羊水指数法 (AFI法 )与最大羊水池测定法 (AFD法 )在临床诊断羊水过少中的准确率。方法 :对 2 16例羊水过少患者的临床资料进行回顾性分析。结果 :①胎儿宫内窘迫、新生儿窒息发生率随羊水量减少而升高 (P <0 .0 5 ) ;②宫颈Bishop评分 >6分者剖宫产率明显低于≤ 6分者 (P <0 .0 5 ) ,其新生儿窒息发生率无显著性差异 (P >0 .0 5 ) ;③AFI法检测羊水过少的准确率高于AFD法 (P <0 .0 5 )。结论 :羊水过少严重影响围产儿预后。产前B超监测羊水AFI法优于AFD法。羊水过少不是剖宫产的绝对指针 ,临床中可结合宫颈Bishop评分、催产素激惹试验及胎心监护无反应激实验及AFI值选择相应分娩方式     

羊水过少115例分析

目的探讨妊娠晚期羊水过少对围生期结局的影响。方法 2008-01-2010-12我院分娩2 485例,通过超声测定羊水指数(AFI)诊断为羊水过少115例妊娠妇女临床情况及围生期结局进行分析。结果羊水过少高发于妊娠≥41周,羊水过少的孕妇常合并有一定的高危因素,当AFI≤5.0cm时,胎儿宫内窘迫发生率明显增高。结论加强围产期检查及早发现羊水过少,选择最佳分娩方式及时终止妊娠,改善围生儿预后。     

妊娠晚期羊水过少82例临床分析

目的探讨羊水过少的相关因素及围产儿的预后,寻求羊水过少较好的处理方法以降低围产儿死亡率。方法对我院2006年9月至2009年4月82例羊水过少患者进行综合分析。结果 82例羊水过少者行剖宫产术72例,剖宫产率87.80%。羊水过少组发生胎儿窘迫、新生儿窒息、羊水粪染、低体质量儿及新生儿死亡率均高于对照组,差异有统计学意义（P〈0.05）。结论妊娠晚期羊水过少是胎儿宫内慢性缺氧的标志,严重影响围产儿预后。加强产前监测,及时剖宫产是处理妊娠晚期羊水过少及降低围产儿死亡率的重要措施。     

羊水过少187例临床分析

目的：探讨羊水过少的早期诊断及处理与围产儿预后的关系。方法：对187例羊水过少(羊水过少组)患者的临床资料进行回顾性分析，并与同期正常分娩者(正常对照组)的围产儿情况进行比较。结果：187例羊水过少患者中，发生率为4．3％(187／4356)；羊水过少组的胎儿宫内发育迟缓、胎儿宫内窘迫、新生儿吸人性肺炎及新生儿窒息发生率均明显高于对照组(P均＜0．05)。产前B超羊水指数法(AFI法)诊断率为68．48％(129／187)，符合率为97．67％(126／129)。结论：应重视产前B超检查对羊水的动态监测；在分娩方式上．应结合是否合并高危因素、胎心监护以及宫颈条件等情况综合分析．采取必要的措施，尽量以剖宫产终止妊娠为宜。     

妊娠晚期羊水过少112例临床分析

目的:探讨羊水过少的相关因素及围产儿的预后。方法:采用回顾性分析方法,对妊娠晚期羊水过少112例与羊水正常100例进行对比分析。结果:羊水过少多发生在孕40周后,与胎儿宫内发育迟缓(IUGR)和延期、过期妊娠有关;羊水过少组围产儿不良预后明显高于羊水正常组(P<0.01)。结论:妊娠晚期羊水过少是胎儿宫内慢性缺氧的标志,对围产儿预后有严重影响,应加强产前监测。剖宫产是处理妊娠晚期羊水过少及降低围产儿死亡率的重要措施。     

羊水过少90例临床分析

目的：探讨羊水过少的主要妊娠合并症及与围产儿预后的关系。方法：对90例羊水过少病例进行回顾性分析，将同期分娩的羊水过少组与羊水正常组作对照，分析羊水过少的主要妊娠合并症及与围产儿预后的关系。结果：羊水过少的主要妊娠合并症为过期妊娠，羊水量的多少与胎盘的成熟情况及羊水污染程度存在高度相关。结论：加强产前监护对于羊水过少要适当放宽剖宫产指征。     

未足月胎膜早破患者残余羊水指数与妊娠结局和新生儿预后的关系

目的探究未足月胎膜早破(PPROM)患者残余羊水指数(AFI)与妊娠结局、新生儿预后的临床关系。方法对该院收治的327例PPROM患者的临床资料进行回顾性分析,统计所有患者妊娠结局和新生儿预后,依据B超检测AFI结果将其分为羊水正常组(60例)、羊水偏少组(170例)和羊水过少组(97例),比较3组妊娠结局和新生儿预后,并采用R×C诊断试验确定AFI与妊娠结局和新生儿预后的临床关系。结果羊水正常组剖宫产、羊膜腔感染构成比均较羊水过少组、羊水偏少组明显降低,差异有统计学意义(P0.05);羊水偏少组羊膜腔感染和胎儿宫内窘迫构成比均较羊水过少组明显降低,差异有统计学意义(P0.05);羊水正常组胎儿宫内窘迫构成比较羊水过少组明显降低,差异有统计学意义(P0.05);羊水偏少组新生儿败血症和死亡构成比均较羊水过少组明显降低,差异有统计学意义(P0.05);羊水正常组新生儿败血症和感染均较羊水过少组和羊水偏少组明显降低,差异有统计学意义(P0.05);羊水偏少组和羊水正常组不良妊娠结局和不良新生儿预后构成比均明显低于羊水过少组,差异有统计学意义(P0.05),且羊水正常组数据明显低于羊水偏少组,差异有统计学意义(P0.05);羊水过少和不良妊娠结局、不良新生儿预后均呈明显正相关(r=0.427、0.364,P0.05)。结论 PPROM患者AFI和不良妊娠结局、新生儿预后呈明显正相关,推测可用于妊娠结局和新生儿预后评估。     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.