广西地区新生儿脐带血铅水平及影响因素调查

目的：了解广西地区人群的胎儿铅暴露水平及其影响因素。方法：在广西四市收集脐血标本1526份，其中1508份标本在严格质量控制下以石墨炉原子吸收光谱法进行血铅测定，并以面谈问卷的形式对脐血铅水平在第70百分位以上和30百分位以下者进行家庭社会环境及健康状况调查，用多因素统计分析方法，分析对脐血铅水平有明显作用的影响因素。结果：1508例的血铅水平呈正态分布，被测人群中脐血铅范围0．08～0．89umol／L，均值0．46umol／L，标准差0．12umol／L，脐血铅水平超过目前公认的安全界限(0．48umol／L)的占52．1％，研究发现，孕期被动吸烟，家庭成员接触铅、居室邻近马路、以煤作为家用燃料及孕期食用皮蛋、居室装饰涂料等均是胎儿期铅暴露的危险因素。多元logistic回归分析发现，被动吸烟及居室内涂料装饰对脐血铅水平影响较大。结论：目前广西地区环境铅污染状况可能对胎儿的发育生长产生不利影响。     

广州市新生儿脐血铅水平及其影响因素研究

目的：了解广州市新生儿脐带血血铅水平及其影响因素。方法：在广州市收集脐血标本287份，在严格质量控制下用Z／3030型石墨炉原子吸收分光光度计（PE公司）测定血铅值，并以面谈问卷的形式对相应的287例产妇进行家庭、社会环境调查，用多因素统计分析的方法，分析对脐血铅水平有明显作用的影响因素。结果：287例的脐血铅水平呈正态分布，被测产妇脐血铅水平20～175μg／L，中位数为77．38μg/L，标准差为28．08μg/L，其中脐带血铅水平超过目前认为的安全界限（100μg/L）者占18．82％。孕妇被动吸烟、孕期食用皮蛋、家庭多人居住和居住处新装修是胎儿期铅暴露的影响因素，但多元Logistic回归分析表明，这些因素对脐血铅水平的影响差异没有统计学意义（P〉0．05）。结论：广州市铅污染状况对胎儿的发育有不利的影响，仍需进一步改善。     

乌鲁木齐市维、汉族孕妇及新生儿脐血铅与环境因素的关系

目的：了解乌鲁木齐地区（乌市）维吾尔族（维族）、汉族孕妇及新生儿脐血铅现状及相关的影响因素。方法：2000年3－9月，对我院及乌市妇幼保健院正常产妇138例静脉血及其新生儿脐血进行血铅测定（汉族79例，维吾尔族59例）。血铅由上海儿童铅中毒防治中心采用石墨炉原子吸收光谱法测定。并对产妇家庭社会环境等相关因素进行问卷调查。结果：138例产妇血铅为12－267μg/L，新生儿脐血铅为10－252μg/L。维、汉两民族母子血铅均呈高度相关（r汉＝0.8047,r维＝0.7898,P均＜0．01）。其中维族孕妇及新生儿脐血铅均大于汉族（母血铅P＜0．01，脐血铅P＜0．05）。血铅≥100μg/L的孕妇53例（38．41％），新生儿48例（34．78％）。影响胎儿铅暴露的因素为孕期被动吸烟、家庭成员接触铅、居室周围有铅污染工厂、居室靠马路、母亲职业、母亲文化程度、孕期补钙、家庭人均收入、母亲上班乘公共汽车时间等。结论：孕妇及新生儿血铅值有差异，且和环境因素有关，新生儿铅中毒有一定比例，应引起高度重视。     

母婴血铅水平相关性及其影响因素的研究

目的了解新生儿血铅与母亲血铅水平相关性及其影响因素。方法采用石墨炉原子吸收光谱法测母-婴血铅值,以面谈问卷的形式对60例产妇进行社会环境和冢庭生活因素调查,并对测得的血铅值及调查表内容进行相关性分析。结果60例新生儿中血铅最高值为162．5μg／L,最低值为12μg／L,均值为75．52μg／L,脐血铅值超过相对安全水平（100μg／L）的15例,占总例数的25％,新生儿脐血铅水平与其母血铅水平呈正相关（r=0．812,P〈0．001）;新生儿血铅水平与被动吸烟、吃皮蛋、丈夫饮酒、丈夫吸烟、房屋装潢、喝牛奶、孕期补钙等因素有显著相关性;多元Logistic回归分析发现,被动吸烟、孕期补钙在考虑了各个因素的交互作用后仍有统计学意义,其中被动吸烟为危险因素,孕期补钙为保护因素。结论新生儿血铅水平与母亲血铅及环境因素、孕期保健等因素有关。加强健康教育和孕妇孕期保健是预防新生儿铅中毒的有效途径。     

妊娠期铅暴露水平对母婴的影响及相关因素分析

目的研究孕妇和脐血中血铅的暴露水平及其对新生儿生长发育、妊娠结局、妊娠并发症的影响,分析脐血中血铅暴露水平的影响因素,为孕产妇优生优育提供参考。方法选取2010年6月至2011年2月在本院分娩的400例病例,采用微波消解和质谱分析方法测定孕妇和脐血中血铅含量,分析铅暴露水平对母婴的影响。对孕妇居住环境、生活方式、膳食等情况等进行问卷调查,对脐血铅影响因素进行分析。结果新生儿脐血铅水平与其母血铅水平呈正相关（r=0．99,P〈0．05）;新生儿脐血铅水平与新生儿身长、头围、体重呈负相关（分别为r=-0．15,-0．16,-0．17,P〈0．05）。血铅升高组的妊娠不良结局发生率和妊娠并发症发生率分别高于血铅正常组（分别为X^2=39．08,37．28,P均〈0．05）。多元线性回归结果显示被动吸烟、染发、吃皮蛋为铅暴露的危险因素（分别为Wald’f=18．28,12．21,7．52,P均〈O．05）;孕期补钙和孕妇高文化程度为预防铅暴露的保护性因素（分别为Waldf=9．02,8．05,P均〈0．05）。结论新生儿脐血铅水平与母亲血铅水平及环境因素、孕期保健等因素有关;加强健康教育和孕妇孕期保健是预防新生儿铅中毒的有效途径。     

新生儿的神经行为发育与脐血血铅的关系

目的以脐血血铅水平作为胎儿期铅暴露示标,评价胎儿期铅暴露对新生儿期神经行为发育的影响。方法检测脐血血铅水平,并分别于出生3天、14天和28天进行新生儿神经行为检查(NBNA),用SPSS 12.0对脐血血铅与NBNA的评分进行相关分析。结果脐血血铅水平与出生3天、14天和28天的新生儿神经行为检查(NBNA)的总分、行为能力、非生物视定向反应呈显著的负相关关系。结论胎儿期的铅暴露即使在较低水平,已影响到新生儿期的神经行为发育,减少胎儿期铅暴露有重要意义。     

孕妇低血铅暴露与胎儿脐血铅相关性及对胎儿影响分析

目的 探讨孕妇低血铅暴露与胎儿脐血铅相关性,并分析对胎儿骨代谢的影响。方法 收集2016 年8月—11月清远市妇幼保健院产科分娩产妇临床资料,根据孕妇分娩时血铅水平分为相对高血铅组（45例）和相对低血铅组（17例）。以Pearson相关分别分析孕妇血铅水平与胎儿脐血铅、新生儿出生时体重、身高、头围、胸围的相关性。比较两组胎儿体检指标和骨代谢指标差异。结果 孕妇62例血铅水平分布范围（28.9~187.52） μg/L,中位数为95.85 μg/L;62例胎儿脐血血铅平均水平为（76.19±36.84） μg/L。孕妇血铅与胎儿脐血铅显著正相关(r=0.760,P=0.000),与新生儿头围呈负相关(r=-0.305,P=0.034)。两组新生儿出生时体检指标差异均无统计学意义（P>0.05）。相对高铅组新生儿的血清碱性磷酸酶为(173.55±56.13) U/L,高于相对低血铅组（134.46±52.08） U/L,差异有统计学意义（P<0.05）。相对高铅组新生儿血清骨钙素和血钙水平分别为 （11.68±5.96） ng/mL和 (0.325±0.04） mmol/L,均低于相对低铅组 (18.14±5.12 U/L)和（0.359±0.05 U/L）,差异均有统计学意义（P<0.05）。结论 孕妇血铅值越高,胎儿脐血铅浓度也越高,孕妇低血铅暴露可直接影响新生儿骨代谢。     

泉州市产妇和新生儿血铅水平及其影响因素研究

目的：为调查研究泉州市产妇及新生儿铅的浓度水平及其影响因素,方法：选择2011-04～2011-07在泉州市妇幼保健院分娩的本地户籍产妇及其新生儿作为研究对象,采集产妇血及其新生儿脐带血样品,并进行书面问卷调查,采用原子吸收分光光度计进行样品测试。结果：母血铅含量均值为92.9μg/L;新生儿脐带血铅含量平均值为69.3μg/L。母血中铅含量和脐带血中铅含量呈显著正相关。铅的暴露风险对性别发育的影响没有选择性。产妇孕期被动吸烟、居住地靠马路边、住房新装修、孕期染发等环境因素与新生儿脐带血铅高有统计学意义。结论：新生儿脐带血铅水平与母体的血铅水平有显著相关,同时与多个环境因素有关。因此,对孕妇加强宣传教育,让孕妇养成良好的生活习惯,对预防血铅中毒有重要意义。     

铅暴露区产妇血铅、脐血铅及初乳铅测定的意义

目的确定铅暴露环境中产妇血铅、脐血铅及乳汁铅测定的意义。方法前瞻性选择45名电子垃圾拆解场周围产妇作为观察组,对其分娩时母血铅、脐血铅及乳汁铅进行测定,同时随机选取非铅高暴露环境的40名产妇作为对照组。比较2组产妇血铅、脐血铅及乳汁铅测定值和新生儿出生情况。结果观察组39名、对照组38名完成研究。观察组新生儿体质量较对照组降低（P < 0.05）,观察组新生儿身长与对照组差异无统计学意义（P>0.05）,观察组产妇血铅、脐血铅、初乳铅水平均明显高于对照组（P < 0.01）。结论电子垃圾拆解场周围产妇妊娠期暴露在铅高环境中,可导致胎儿宫内铅暴露,且较高初乳铅亦可能导致哺乳期铅暴露,建议加强铅暴露环境中妇女孕期的防铅工作。     

妇女孕前至孕期血镉和脐血镉水平及其影响因素

目的 探究妇女孕前、孕中期和孕晚期血镉及脐血镉水平的变化趋势及其影响因素。方法 以复旦孕前队列研究（PLOTS）为基础,对来自上海市嘉定区的92名妇女,采用电感耦合等离子体质谱法检测孕前至孕期全血和脐血,共368份血样的镉浓度,并分析孕期血镉和脐血镉水平的影响因素。结果 孕前、孕中期和孕晚期血镉及脐血镉的中位数浓度分别为1.32、0.94、1.65和1.16 μg/L,所有血样镉浓度均未超过一般人群参考值（5 μg/L）。血镉浓度比较：孕中期低于孕前,孕晚期高于孕中期,脐血低于孕晚期（P<0.01）。孕前血镉水平与孕期血镉和脐血镉水平呈正相关（P<0.01）。上海本地户籍、大学及以上文化程度和孕期喝纯果蔬汁至少每周1次的妇女孕期血镉和脐血镉浓度较低（P<0.05）,孕期被动吸烟的妇女孕期血镉和脐血镉浓度较高（P<0.05）。结论 建议妇女在孕前降低血镉水平,并在孕期避免被动吸烟。孕期喝果蔬汁可能是降低血镉浓度的保护因素。     

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.