应用智能时间-空间相关成像技术评估正常胎儿左心室容积的可行性和可重复性

目的 探讨应用智能时间-空间相关成像(iSTIC)技术评估正常胎儿左心室容积的可行性和可重复性。方法 对76名孕妇(共76胎)应用iSTIC技术行胎儿心脏实时三维成像检查,测量正常胎儿左心室舒张末期容积(EDV)和收缩末期容积(ESV),计算左心室每搏输出量(SV)。各指标由2名观察者采用盲法分别进行测算,并由同一观察者在间隔2周后再次采用盲法进行测算。对观察者内及观察者间的可重复性进行统计学分析。结果 同一观察者前后两次测量EDV的ICC为0.980(95%CI:0.969~0.988),测量ESV的ICC为0.988(95%CI:0.981~0.992),计算SV的的ICC为0.927(95%CI:0.887~0.953)。2名观察者间测量EDV的ICC为0.987(95%CI:0.980~0.992),测量ESV的ICC为0.979(95%CI:0.967~0.987),计算SV的ICC为0.948(95%CI:0.919~0.967)。Bland-Altman分析显示,观察者内及观察者间对SV的测值点均位于一致性界限之内。结论 应用iSTIC技术可准确评估正常胎儿左心室容积,且简便可行、重复性较好。     

4D flow心脏MRI测量左心室血流动力学参数的可靠性

目的 观察基于心脏MRI（CMRI）以局部区域性4D flow及全心4D flow技术测量左心室血流动力学参数的可靠性。方法 前瞻性对31名健康体健者采用心脏超声、三腔心4D flow（基于左心室流入流出道层面）及全心4D flow CMRI测量左心室血流动力学参数,以组内相关系数（ICC）评估其所测左心室血流动力学参数的一致性。结果 心脏超声与三腔心4D flow CMRI所测收缩期主动脉瓣上/瓣下峰值流速、舒张期二尖瓣E峰流速、主动脉瓣上/瓣下压力及主动脉瓣跨瓣压差的一致性均良好（ICC均>0.75）,所测舒张期二尖瓣A峰流速的一致性中等（ICC为0.718）;心脏超声与全心4D flow CMRI所测收缩期主动脉瓣上/瓣下峰值流速、舒张期二尖瓣A峰流速及主动脉瓣上/瓣下压力的一致性均良好（ICC均>0.75）,所测舒张期二尖瓣E峰流速及主动脉瓣跨瓣压差的一致性均为中等（ICC分别为0.600及0.628）;三腔心4D flow CMRI与全心4D flow CMRI测量上述指标结果的一致性均良好（ICC均>0.75）。结论 基于CMRI以局部区域性4D flow与全心4D flow技术测量左心室血流动力学参数可靠,与心脏超声测量结果具有良好一致性。     

Simpson法、基于阈值区域生长法和三维模型法评估左心室功能

目的 比较Simpson法、基于阈值的区域生长法（阈值法）和三维模型法（模型法）评估左心室功能的差异。方法 纳入60例因疑诊冠状动脉疾病而接受冠状动脉CT血管成像（CCTA）患者,分别采用Simpson法、阈值法和模型法计算左心室舒张末期容积（EDV）、收缩末期容积（ESV）和射血分数（EF）,并观察各值差异。结果 模型法、阈值法和Simpson法的EDV分别为166.55（144.55,209.53）ml、144.25（126.25,186.88）ml和137.23（121.78,159.29）ml,ESV分别为55.53（38.34,80.83）ml、47.50（29.00,74.25）ml和46.10（28.68,67.63）ml,EF分别为64.75%（58.25%,72.35%）、69.15%（60.05%,76.33%）和66.70%（58.48%,77.05%）。以Simpson法、阈值法和模型法所获左心室EDV、ESV及EF差异均有统计学意义（P均<0.001）;以模型法所获EDV和ESV均明显高于阈值法和Simpson法（P均<0.05）,而EF明显低于阈值法（P<0.05）。3种算法计算左心室EF的一致性均好,且阈值法与Simpson法所获左心室EDV及ESV差值均小于模型法与Simpson法（Z=-6.486、-6.574,P均<0.001）。3种算法所获左心室EDV、ESV及EF均呈极强相关（r均>0.8,P均<0.05）。结论 采用Simpson法、阈值法和模型法计算的左心室EDV、ESV及EF均有显著差异,但一致性均好,且EDV、ESV及EF均呈极强相关;以阈值法与Simpson法所获左心室EDV及ESV的差值均小于模型法与Simpson法差值。     

5.0T MR心脏成像:与3.0T MR对比

目的 观察5.0T MR用于心脏成像的可行性。方法 前瞻性对3例心脏疾病患者和17名健康志愿者行5.0T及3.0T 心脏MR(CMR)电影序列和黑血序列成像;比较5.0T与3.0T CMR图像质量和伪影程度分级,并分析以其所获左心室参数的一致性。结果 5.0T与3.0T CMR图像质量和伪影程度分级差异均无统计学意义(P均>0.05),基于不同场强电影图像获得的左心室舒张末期容积(EDV)、收缩末期容积(ESV)、射血分数(EF)、每搏输出量(SV)及舒张末期心肌质量(EDM)的一致性均好(ICC均>0.75,P均<0.001)。结论 5.0T MR可用于心脏成像,其电影序列及黑血序列图像质量与3.0T MR相当。     

声触诊弹性成像技术量化评估孕晚期妊娠糖尿病患者胎盘弹性

目的 评价声触诊弹性成像(STE)技术量化评估孕晚期妊娠糖尿病(GDM)患者胎盘弹性的价值。方法 前瞻性纳入51例确诊的孕晚期GDM患者,由2名医师分别以STE技术测量胎盘母体面及胎儿面弹性模量,其中1名医师测量2次;以组内相关系数(ICC)及Bland-Altman图评价观察者内及观察者间测量结果的一致性,比较胎盘母体面及胎儿面平均弹性模量(E_mean)差异。结果 观察者内及观察者间测量GDM患者胎盘母体面及胎儿面弹性模量的一致性均好(观察者内:ICC=0.908、0.887;观察者间:ICC=0.827~0.905)。Bland-Altman图示STE量化评估胎盘弹性的一致性良好。胎盘母体面及胎儿面的中位E_mean分别为6.01(5.62,6.51) kPa及5.02(4.46,5.52) kPa,差异有统计学意义(P＜0.001)。结论 STE可稳定地量化评估孕晚期GDM患者胎盘弹性;胎盘母体面及胎儿面弹性存在差异。     

MSCT评价冠状动脉软斑块狭窄程度与左心室收缩功能

目的 探讨MSCT在评价冠状动脉软斑块狭窄的同时测定左心室功能的临床应用价值。方法 回顾性分析232例接受MSCT冠状动脉造影的患者,包括46例单纯软斑块致冠状动脉狭窄(软斑块组,又分为轻、中、重度狭窄组)和186例冠状动脉正常者(正常组)。以测量血管直径法,按照冠状动脉狭窄程度分为I~Ⅳ组,并计算左心室舒张末期容积(EDV)、左心室收缩末期容积(ESV)、左心室每搏输出量(SV)、左心室射血分数(EF)。结果 轻度、中度狭窄组与正常组间EF的差异无统计学意义,其他组间差异有统计学意义(P＜0.01);轻度狭窄组、中度狭窄组与正常组间ESV值差异性无统计学意义,其他组间差异有统计学意义(P＜0.01);EDV、SV、心率组间差异无统计学意义(P＞0.05)。结论 冠状动脉CTA可评估冠状动脉狭窄情况。当冠状动脉管径狭窄＞50%时,左心室收缩功能有不同程度下降;当冠状动脉管径狭窄＞75%时,左心室收缩功能下降明显。MSCT可准确、可靠地定量评价冠状动脉硬化狭窄及左心室收缩功能。     

基于5.0T MRI定量肝脏质子密度脂肪分数

目的 观察5.0T MRI用于定量肝脏质子密度脂肪分数(PDFF)的价值。方法 前瞻性对30名受试者分别行5.0T、3.0T、1.5T 肝脏化学位移编码(CSE)MR扫描,测量CSE-PDFF;之后行5.0T、1.5T MR波谱(MRS),测量MRS-PDFF。分析不同方法所测肝脏PDFF的一致性,评估5.0T MRI定量肝脏PDFF的价值。结果 以不同场强MR设备所测肝脏CSE-PDFF总体一致性良好(ICC均＞0.75,P均＜0.001);基于5.0T MR与3.0T、1.5T MR所测肝脏CSE-PDFF的一致性均好(ICC=0.989、0.992,P均＜0.001)。基于5.0T MR所测CSE-PDFF与5.0T、1.5T MR所测MRS-PDFF一致性均好(ICC均＞0.75,P均＜0.001);其中,5.0T MR所测CSE-PDFF与MRS-PDFF一致性好(ICC=0.988,P＜0.001),5.0T MR所测CSE-PDFF与1.5T MR所测MRS-PDFF一致性好(ICC=0.978,P＜0.001)。结论 5.0T MRI对定量肝脏PDFF具有较高价值。     

实时三维超声心动图对健康人右心功能的初步探讨

目的探讨单心动周期实时三维超声心动图测量健康人右心室容积及收缩功能的可行性及准确性。方法应用三维矩阵探头采集122名健康成人的右心室、左心室三维图像,使用RV Analysis及LV Analysis软件分别检测左、右心室收缩功能参数,包括收缩末期容积(ESV)、舒张末期容积(EDV)、每搏心输出量(SV)及射血分数(EF),将多种参数(性别、年龄、体表面积)分别与右心室功能参数进行相关分析,同时将左心室及右心室各参数进行比较及相关分析,验证实时三维超声心动图测量右心室功能的可靠性。结果健康人三维右心室EF为(55.66±13.97)%,EDV为(68.24±40.19)ml,ESV为(30.09±19.14)ml,SV为(38.30±26.10)ml;男性受试者右心室SV、EF高于女性,但无统计学差异[(40.15±26.15)ml vs(36.11±25.60)ml,(55.69±14.57)%vs(55.62±13.36)%,P均>0.05];右心室的相关功能参数与受试者年龄无相关性(P>0.05);体表面积(BSA)与右室EDV、ESV及SV呈弱相关性(r=0.236、0.247、0.178,P均<0.05),但与右心室EF无相关性(P>0.05)。左心室SV与右心室SV及左心室EDV与右心室EDV之间存在弱正相关关系(r=0.201、0.215,P均<0.05)。双室的EF之间及ESV之间无相关性(P>0.05)。结论单心动周期实时三维超声心动图技术是一种简单易行的评价右心功能的方法,能较准确地评估右心室的收缩功能。     

超声心动图评价肥厚型心肌病和高血压左心室肥厚患者左心房收缩功能

研究背景 心肌梗死后,左心室局部及整体心肌运动障碍,收缩功能降低。准确评价心肌梗死后左心室整体及节段心功能的改变对指导治疗及判断预后具有重要的临床意义。与传统M 型和二维超声技术相比,实时三维超声心动图(RT-3DE)技术不仅可以客观地显示整个心脏的形状和运动状态,而且可以对各节段心肌的容积及运动状态进行定量分析,具有独特的优势。目的 运用RT-3DE技术定量评价陈旧性前壁心肌梗死患者左心室整体及节段收缩功能改变,初步探讨其临床应用价值。方法 采用PhilipsiE33彩色多普勒超声成像仪,配备X3-1探头(1~3MHz)和Qlab6.0定量分析软件,检查25名正常人与20例陈旧性前壁心肌梗死患者,获取左心室整体和17节段容积-时间曲线及17种不同色彩的“牛眼图”,并将超声图像信息储存于硬盘上脱机分析。获取左室整体及各节段舒张末期容积(EDV、rEDV)和整体及各节段收缩末期容积(ESV、rESV);在由公式:rEF= [(rEDV -rESV)/rEDV]×100%,rgEF= [(rEDV-rESV)/EDV]×100%计算出整体及局部射血分数(EF、rEF)和局部-整体射血分数(rgEF)。然后比较两组整体和节段舒张末期容积(EDV、rEDV)、收缩末期容积(ESV、rESV)、射血分数(EF、rEF)及节段整体射血分数(rgEF)是否具有统计学差异。结果与正常组比较,陈旧性心肌梗死组整体EDV、ESV及梗死节段rEDV、rESV较对照组增大,整体EF和梗死节段rEF、rgEF降低(P<0.05);心尖部rEDV、rESV 增大,rEF、rgEF较对照组降低(P<0.05);非梗死节段中部分节段rEF、rgEF较正常组增大(P<0.05),余节段无明显差异。结论 心肌梗死后,左心室重构,左心室整体舒张末期容积和收缩末期容积增大,左心室整体、梗死节段及心尖部收缩功能下降,部分未梗死节段心功能代偿性增强。RT-3DE可准确定量评价心肌梗死后左心室整体及局部容积及收缩功能的改变。     

左心室压力-应变环定量评价房间隔缺损封堵前后心肌做功变化

目的 采用左心室压力-应变环(LV PSL)定量评估房间隔缺损(ASD)患者接受介入封堵术前后左心室心肌做功变化。方法 纳入32例接受介入封堵术治疗的中央型ASD患者(ASD组)及30名健康成人(对照组),比较术前、术后2天和3个月ASD组与对照组、ASD组内各时间点二维超声心动图及LV PSL参数,包括左心室舒张末内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室舒张末容积(LVEDV)、左心室整体纵向应变(GLS)、整体做功指数(GWI)、整体有用功(GCW)、整体无用功(GWW)及整体做功效率(GWE)等的差异;采用Bland-Altman分析法评价观察者内及观察者间测量GWI、GCW结果的一致性。结果 ASD组术前LVEDD、LVESD、LVEDV、GLS、GWI及GCW均小于对照组(P均＜0.05),术前其余参数及术后全部参数与对照组差异均无统计学意义(P均＞0.05)。ASD组内,术后各时间点LVEDD、LVESD、LVEDV、GLS、GWI及GCW均大于术前(P均＜0.05),而术后2天与3个月差异均无统计学意义(P均＞0.05);其余参数各时间点间差异均无统计学意义(P均＞0.05)。Bland-Altman分析结果显示,观察者内及观察者间测量GWI、GCW结果的一致性良好。结论 LV PSL可无创量化ASD患者接受介入封堵术前后左心室整体心肌做功,有效评价术后左心室功能变化。     

现代残疾康复理念、政策与社区康复体系研究

本研究分析了当代残疾康复的理念和理论架构,构建了以国际公约、决议和政策、国内法律和政策以及操作性工具3个层次的康复理论体系;运用包容性发展,分析探讨了当代社区康复的体系和特点;就发展康复事业、为残疾人提供全面系统的康复服务提出相关的政策建议。     

我院文职护士管理和培训的实践与体会

目的构建文职护士培训、使用及管理的科学方法。方法通过规范管理、科学施训、作为骨干大胆任用等多种管理方式,使文职护士得到充分的发展。结果文职护士群体成长为医院优秀骨干,首批满3年的文职护士顺利通过续聘考核。结论科学的管理培训是文职护士成长的重要基石,对医院护理管理有着重要作用。     

国内外唇腭裂专科护理发展现状的文献研究及分析

目的了解和分析国内唇腭裂专科护理工作发展的现状。方法检索并分析万方医学网、中国知网、Springer Link及PubMed英文数据库近6年有关唇腭裂手术的围术期护理、患儿的喂养、手术安全管理、围术期疼痛研究以及心理护理的相关文献。结果共检索出国内文献89篇(核心期刊20篇)、国外文献22篇,其中围术期护理38篇、患儿的喂养16篇、手术安全管理10篇、围术期疼痛研究10篇、心理护理15篇。结论与国外文献相比,国内论文总结和回顾性居多,应增加研究探讨性论文,从而促进唇腭裂临床护理工作专科化的发展。     

城乡学童个性行为特征调查

目的探讨农村与城市儿童的个性行为特征。方法将97名农村学龄儿童设为农村组,97名城市学龄儿童设为城市组,采用艾森克个性问卷一儿童版和Achenbach’s 行为量表一儿童版进行评定分析。结果两组学龄儿童艾森克个性问卷各维度评分均无显著性差异（P均〉0．05）,且与全国常模相一致（P均〉0．05）;农村组男学童Achenbach’s行为量表违纪行为、攻击行为及外向型因子分均显著高于城市组,女学童退缩、社交问题因子分均显著高于城市组（P〈0．05或0．01）,其他因子分均无显著性差异（P均〉0．05）。结论农村与城市儿童个性无显著差异,而农村儿童存在较多的行为问题,可能与其所受教养和生活方式有关。     

Comparison of short-term and long-term protocols for stabilization and preservation of RNA and DNA of Leishmania, Trypanosoma, and Plasmodium

Molecular tools continue to be important in the prevention and control of parasitic diseases. However, using these techniques directly in the field remains a major challenge. Therefore, the preservation of clinical samples collected from endemic field areas for later analysis remains an important preanalytical process. This study aimed at identifying a suitable protocol for stabilization and preservation of RNA and DNA in bioclinical specimens for Trypanosoma, Leishmania, and Plasmodium research. Both spiked and unspiked blood samples were preserved in 7 protocols (different media; storage temperatures). Samples were evaluated for possible degradation of DNA and RNA along the storage duration up to the 10th week. Nucleic acid targets were assessed as follows: (i) Trypanosoma and Plasmodium RNA analysis was done using real-time nucleic acid sequence-based amplification (RT-NASBA) for 18S rRNA and for stage-specific Pfs25 mRNA, respectively; (ii) Trypanosoma DNA assessment analysis was conducted by using a conventional PCR for 18S rDNA; (iii) Leishmania RNA analysis was performed with a quantitative NASBA for 18S rRNA and Leishmania DNA assessment with an RT-PCR for 18S rDNA. Findings suggested that a newly developed L3™ buffer proved to be reliable and suitable for both short- and long-term preservation of parasite nucleic acid material. This buffer is envisaged to be suitable for utilization in field situations where resources are limited.     

History of violence and subjective health of mother and child

Objective: To study the self-reported prevalence of experienced violence among a cohort of women about two years after giving birth, their health during pregnancy, pregnancy outcomes and their experience of their child’s health.

Setting and subjects: In 2011, a total of 657 women participated in phase III of the Childbirth and Health Cohort Study in Icelandic Primary Health Care, 18 to 24 months after delivery. The women had previously participated in phase I around pregnancy week 16 and phase II 5–6 months after delivery. Data were collected by postal questionnaires.

Main outcome measures: Women’s reported history of experienced violence, sociodemographic and obstetric background, self-perceived health, the use of medications and their child’s perceived health.

Results: In phase III, 16% of women reported experiencing violence. These women felt less support from their current partner (p?p?p?p?p?p?=?0.008).

Conclusions: Our study confirms that a history of violence is common among women. A history of violence is associated with various maternal health problems during and after pregnancy, a higher rate of caesarean sections and maternal reports of health problems in their child 18–24 months after birth.

• KEY POINTS

• Violence is a major concern worldwide. Understanding the impact of violence on human health and developing effective preventive measures are important elements of any public health agenda.

• ??The reported prevalence of experiencing violence was 16% among women attending antenatal care in the primary health care setting in Iceland.

• ??Women with a history of violence reported worse health in general during pregnancy and delivered more often by caesarean section, compared to women with no such history.

• ??Mothers with a history of violence also evaluated the general health of their child as worse than women with no such history.

• ??The findings of this study support the importance of recognizing and addressing experienced violence among women in primary care.

     

Rates and risks of transmission of smallpox and mechanisms of prevention

In 1980, the World Health Organization declared smallpox eradicated from the world; the last known natural case had occurred in Somalia in 1977, and the United States had stopped routinely vaccinating its citizens in 1972. However, with increasing concerns regarding domestic and international terrorism, smallpox has resurfaced as a potential threat to global health. We review the direct and indirect modes of smallpox transmission and how patterns of transmission vary substantially, depending on the severity of circulating disease, vaccination status, environmental and socioeconomic factors, and the setting of an outbreak. We examine mechanisms for controlling outbreaks of disease and preventing further transmission in the event of an outbreak, with an emphasis on smallpox vaccination.     

通用设计原则与产品研发策略

本文介绍了通用设计的概念和设计原则,并阐述了根据此原则实施通用设计的产品研发策略。通用设计惠及的不仅是残疾人,也惠及了包括普通公众在内的广泛人群,以及企业。应将通用设计的原理应融入政府相关政策和未来发展的规划中,为残疾人以及更多人群提供合理便利的通用设计产品。     

胃癌DNA含量与E-cad、EGFR表达的关系及其意义

目的　探讨胃癌组织DNA含量与E cad、EGFR表达的关系 ,评价其在浸润、转移潜能及预后判断中的作用。方法　应用图像分析仪及SP免疫组化法检测 30例正常胃黏膜上皮、30例不典型增生和 5 0例胃癌组织DNA含量与E cad、EGFR蛋白表达情况。结果　①正常胃黏膜上皮、Ⅰ、Ⅱ、Ⅲ级不典型增生及胃癌组的DI、PI、S %、>5c %逐渐增高 ,与胃癌分期、淋巴结转移显著相关 (P <0 0 1)。②E cad在正常胃黏膜上皮阳性表达率 10 0 % ,EGFR呈阴性表达 ;Ⅰ、Ⅱ、Ⅲ级不典型增生及胃癌E cad阳性表达率逐渐降低 ,EGFR的阳性表达率逐渐升高 ,且差异显著 (P <0 0 5 ) ;E cad表达减弱、EGFR表达升高与胃癌分化差、淋巴结转移显著相关 (P <0 0 1)。③E cad表达阴性的胃癌DNA指数及EGFR表达水平显著高于E cad阳性 (P <0 0 1)。结论　检测DNA含量及E cad、EGFR蛋白表达有助于胃癌的早期诊断及转移潜能和预后的判断。     

Prevalence and severity of nausea and vomiting of pregnancy and effect of vitamin supplementation.

OBJECTIVE: Although nausea and vomiting of pregnancy is the most common medical condition during pregnancy, there are many unanswered questions regarding its cause, epidemiologic features and optimal management. The objectives of this study were to ascertain the prevalence of nausea and vomiting in a sample of Canadian women, to characterize the distribution of their severity and to investigate the role of vitamin B6 deficiency in their etiology. DESIGN: Prospective study. SETTING: Antenatal counselling service for pregnant women. PATIENTS: Three cohorts of women: a prospective, population-based cohort of 193 women, to estimate the rate and severity of nausea and vomiting (cohort A); a cohort of 555 women who sought advice for nausea with or without vomiting, to study the correlation between the maximal daily number of episodes of vomiting and maximal weight loss (cohort B); and a prospective cohort of 301 women who reported vomiting, to correlate vitamin supplementation with vomiting (cohort C). INTERVENTIONS: All 3 cohorts were interviewed during the counselling session, and cohort B was followed up prospectively. OUTCOME MEASURES: Frequency of nausea and vomiting, weight loss, maximal number of daily episodes of vomiting, rate of multivitamin supplementation. RESULTS: Overall, 67% of the women in cohort A reported experiencing nausea or vomiting, or both; 22% reported vomiting, and 9% experienced weight loss. In cohort B there was a significant correlation between the maximal number of daily episodes of vomiting and maximal weight loss, although there was wide variation (r2 = 0.25, p < 0.001). There was a highly significant correlation between the number of daily vomiting episodes and mean weight loss (r2 = 0.99). In cohort C, vomiting was significantly associated with lack of supplementation with multivitamins before 6 weeks' gestation (p = 0.002). CONCLUSIONS: The relation between number of daily vomiting episodes and mean weight loss may serve as a clinical tool to assess the severity of nausea and vomiting in pregnancy and the success of anti-emetics and rehydration regimens. Further study is needed to elucidate the biologic basis of the observed association between vomiting and lack of multivitamin supplementation in early pregnancy.