胎儿宫内窘迫剖宫产87例

分析胎儿宫内窘迫行剖宫产87例术后Apgar评分、羊水、胎盘情况及脐带等因素，结果：B组胎儿宫内窘迫发生率高于A组。表明临产时出现羊水粪染伴胎心率改变，应及时终止妊娠，以降低新生儿死亡率。     

胎儿宫内窘迫剖宫产87例

分析胎儿宫内窘迫行剖宫产８７例术后Ａｐｇａｒ评分、羊水、胎盘情况及脐带等因素，结果：Ｂ组胎儿宫内窘迫发生率高于Ａ组。表明临产时出现羊水粪染伴胎心率改变，应及时终止妊娠，以降低新生儿死亡率。     

电子胎心监护的临床应用及效果分析

目的探讨孕晚期胎心变化、胎儿宫内窘迫与妊娠分娩结局的关系。方法我院围产门诊建卡的孕妇500例,在妊娠满35周时行电子胎心监护,出生后行Apgar评分并进行临床分析。结果胎儿电子监护可早期预见胎儿安危,对于有变异减速的产妇可及时实施干预。结论加强产前监测,孕晚期常规行电子胎心监护可早期发现胎儿宫内窘迫,降低围产儿死亡率,是当前产科临床值得开展的工作。     

足月妊娠头位脐带脱垂12例

目的探讨头位脐带脱垂对围生儿的影响及其临床表现、诊断处理和预防措施。方法回顾性分析我院8年来12例头位脐带脱垂的临床情况。结果胎死宫内1例，新生儿轻度窒息6例，新生儿重度窒息3例，新生儿无异常2例。结论头位脐带脱垂对围生儿危害极大，预防的关键在于对胎头高浮者破膜时的及时监护和处理。临床处理主要根据胎儿的存活及宫口开大的情况尽快结束分娩。     

妊娠末期胎心监护临床应用

目的 评价妊娠末期胎心监护临床应用对母婴结局的影响.方法 对326例妊娠末期妇女进行胎心监护,从新生儿评分﹑剖宫产率﹑脐带异常等方面进行对比分析.结果 262例无应激试验(NST)有反应型的孕妇,发生胎儿宫内窘迫21例(8.02%),新生儿窒息10例(3.82%);25例NST可疑型孕妇,胎儿宫内窘迫7例(28.00%),新生儿窒息4例(16.00%);39例NST无反应型孕妇,胎儿宫内窘迫20例(51.28%),新生儿窒息11例(28.21%).NST有反应型、可疑型、无反应型孕妇胎儿宫内窒息、新生儿窒息的发生率比较,差异均有统计学意义(P＜0.05).NST有反应型孕妇脐带异常49例,NST无反应型孕妇脐带异常14例,NST有反应型与无反应型孕妇脐带异常率比较,差异有统计学意义(P＜0.05).因胎儿宫内窘迫行剖宫产率(35.5%)是平均剖宫产率(11.3%)的2.3倍.结论 妊娠末期胎心监护显示绝大多数NST 有反应型提示胎儿在宫内生长良好,可继续安全待产.NST有反应型孕妇脐带异常者多可安全经阴道分娩.多次NST可疑型孕妇需密切观察,适时剖宫产终止妊娠.NST无反应型的高危妊娠宜尽早剖宫产终止妊娠.     

200例脐绕颈分娩结局分析

目的 提高脐绕颈围产期处理水平,降低新生儿窒息率.方法 随机抽样2003年1月～2007年2月在本院分娩脐绕颈200例,分析妊娠末期、分娩期的临床表现、胎心监护特点.结果 彩超准确率95.O%,误诊率为6.87%.初产头浮12.0%,臀位占8%.分娩中胎儿宫内窘迫新生儿窒息发生率混合型最高49.5%,胎心型13.3%.羊水型5.65%.胎心型与羊水型比较差异无显著性(P>0.05),混合型与胎心型比较差异有极显著性(P<0.005).难产主要表现为胎头下降阻滞.结论 对混合型胎儿宫内窘迫伴有中、重度变异减速,应立即终止妊娠,第二产程中阻滞者适当助产.     

脐带异常与难产的关系附90例临床分析

脐带异常在产程中严重时可造成胎儿宫内窘迫，甚至导致围产儿死亡。为降低围产儿死亡率，必须及时准确诊治脐带导致所致胎儿窘迫。我院１９９４年内９０例脐带因素行手术助产，占难产手术的５１．１１％，临床上我们采取听诊胎儿，Ｂ超与胎儿电子监护仪监测三结合诊断脐带异常引起的胎儿宫内窘迫，并及时手术终止妊娠，明显降低了围产儿死亡率。     

孕期胎心监护无刺激试验110例临床观察

目的：阐述孕期胎心监护无刺激试验的重要性、方法：高危妊娠者从孕28周始，正常妊娠者自36周始，据临床情况，每周作无刺激试验1-2次，了解胎儿宫内安危，必要时配合E3及B超检查胎盘、羊水、脐带等情况判断胎儿健康状况．结果：孕期胎儿监护无刺激试验能早期发现胎儿在宫内的急慢性缺氧表现，便于及时采取治疗措施，改善围产儿预后?结论：孕期胎心监护无刺激试验对母儿无害，简单易行，经济实用．是了解胎儿胎盘状况的较为理想的手段，可接受性强，可做为妊娠期常规检查项目，参与妊娠期胎儿管理，推广使用。     

产时胎心监护563例临床研究

目的:探讨产时胎心监护及早发现胎儿宫内窘迫,及时处理以降低新生儿窒息率,围产儿死亡率,提高产科质量.方法:回顾分析2009年1月～2010年1月563例阴道分娩时胎心监护的异常波形.结果:无刺激试验(NST)反应型375例,无反应型53例,收缩刺激试验(CST)正常型115例,CST异常型20例.无反应者均于临产前行剖宫产终止妊娠.结论:常规使用电子胎心监护,能对胎儿是否存在宫内缺氧做出及时的评价,从而指导临床采取正确处理方案,改善新生儿预后,减少新生儿并发症及后遗症.     

脐带异常与胎儿宫内窘迫相关因素探讨

目的：分析和探讨胎儿宫内窘迫与脐带因素影响的关系。方法：采用回顾性研究方法，总结分析我院1992年－1999年，因脐带因素致胎儿宫内窘迫而行剖宫产的1117例的临床资料。结果：显示脐带过短，脐带绕颈，脐带脱垂，脐带旋转过甚，脐带发育不良是产程中发生胎儿宫内窘迫的主要原因。脐带异常而胎儿宫内窘迫的剖宫产率与非脐带异常行剖宫产率的对照有极显性差异（P＜0．001）。结论：产前，产时加强胎儿宫内监护，临产前及临产后先露持续下降，胎儿心音变化经处理后不能纠正或B超证实脐带绕颈，应首先考虑脐带异常因素。为降低新生儿窒息及围产儿死亡率，探讨急诊间宫产的重要性。     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.