宫外发育迟缓早产儿早期体格发育与IGF-Ⅰ相关性分析

目的:探讨宫外发育迟缓(EUGR)早产儿的早期体格发育与胰岛素样生长因子(IGF-Ⅰ)的关系.方法:早产儿60例,分为EUGR组及非EUGR组,以同期收治的足月并正常出生的新生儿30例为对照组,所有新生儿于出生后7d与2周时测量体格发育指标(体重、头围、身长),同时采集外周血测定血清中IGF-Ⅰ水平;随访3月后测量2组早产儿体格发育指标,记录体重、身长及头围发育落后例数和计算体格发育指标增长情况,同时测定血清IGF-Ⅰ水平,分析体格发育指标增长与IGF-Ⅰ水平相关性.结果:早产儿7d、14d时体重、头围、身长、IGF-Ⅰ水平均低于对照组(P＜0.05),EUGR组早产儿7d、14d时体重较非EUGR组低(P＜0.05);随访3月发现EUGR组早产儿体重、头围、身长及IGF-Ⅰ水平低于非EUGR组(P＜0.05),体重、身长及头围发育落后例数高于非EUGR组(P＜0.01、P＜0.01、P＜0.05),体重增长速度、头围及身长增长均低于非EUGR组(P＜0.05);EUGR组和非EUGR组IGF-Ⅰ水平与体重增长速度、头围及身长增长均呈正相关(r=0.399、0.453、0.377、0.615、0.443、0.435,P＜0.05).结论:IGF-Ⅰ水平变化与早产儿体格发育相关,EUGR早产儿更明显.     

不同蛋白质摄入量对早产儿生长发育的影响比较

目的探讨早期喂养不同剂量蛋白质对早产儿生长发育的影响。方法采用回顾性调查的方法 ,收集浙江大学丽水医院2014年2月~2016年5月120例住院早产儿的资料,分析早期不同蛋白质摄入营养治疗对早产儿生长发育的影响。将蛋白质平均摄入量3.3 g/(kg·d)为高蛋白质组(H组),将蛋白质平均摄入量≤3.3 g/(kg·d)为低蛋白质组(L组)。记录并比较两组间早产儿在纠正胎龄满40周(T1)、1个月(T2)、3个月(T3)、6个月(T4)、12个月(T5)时体重、身长、头围变化,最后行统计分析。结果两组早产儿在性别、胎龄、出生方式、出生头围、体重、身长及出生5 min Apgar评分比较差异无统计学意义(P0.05)。经喂养后H组在T1、T2、T3、T4的体重、身长、头围增长均高于L组,差异具有统计学意义(P0.05)。在T5时H组与L组早产儿头围变化比较,差异无统计学意义(P0.05),但T5时H组早产儿体重与身长变化显著高于L组,差异有统计学意义(P0.05)。结论早产儿行平均摄入3.3 g/(kg·d)的高蛋白质喂养,能提高出生后早产儿喂养效果,促进体格发育,利于早产儿的生长。     

不同喂养方式对早产低出生体重儿生后1～3个月生长指标增长值的影响

目的探讨早产儿出院后配方奶与母乳、足月儿配方奶、混合喂养等不同喂养方式对早产低出生体重儿生后1～3个月阶段的体重、身长、头围等生长指标增长值的影响。方法广州市与佛山市10家医院新生儿科出院的早产低出生体重儿(胎龄不足37周且出生体重小于2 500 g)489例,分为早产儿出院后配方奶喂养组(PDF组,n=323)、母乳喂养组(BM组,n=38)、足月儿配方奶喂养组(TF组,n=76)、早产儿出院后配方奶联合母乳喂养组(PDF/BM组,n=28)和足月儿配方奶联合母乳喂养组(TF/BM组,n=24),观察及比较各组在出生后1、2、3个月时体重、身长、头围增长值的差异。结果 PDF组在1、2、3个月时的体重增长值均大于BM组(P<0.05),1、3个月时的身长增长值大于BM组(P<0.05),2、3个月时的头围增长值大于BM组(P<0.05)。PDF组在1、2、3个月时的体重、身长、头围增长值均大于TF组(P<0.05)。结论出院后应用配方奶喂养能使早产低出生体重儿在生后1～3个月阶段的体重、身长、头围快速增长,从而帮助早产低出生体重儿实现追赶性生长,避免或减少宫外发育迟缓的发生。     

产前应用地塞米松对早产儿体格发育及新生儿行为神经测定评分的影响

目的 观察产前应用地塞米松对早产儿体重、头围、身长及新生儿行为神经测定(NBNA)评分的影响,以促进早产儿健康成长.方法 选择NICU收治的30～34周的早产儿60例,分为观察组30例及对照组30例.观察组早产儿母亲产前应用地塞米松,对照组早产儿母亲产前未应用地塞米松.临床测量早产儿出生体重、头围和身长.患儿于纠正胎龄至预产期时行NBNA.结果 观察组与对照组出生体重分别为(1 806.30±304.59)g和(1 797.90±221.34)g,两组比较差异无统计学意义(t=0.12,P＞0.05).观察组与对照组头围分别为(28.43±1.59)cm和(28.80±1.61)cm,两组比较差异无统计学意义(t=0.89,P＞0.05).观察组与对照组身长分别为(40.73±3.64)cm和(41.47±3.78)cm,两组比较差异无统计学意义(t=0.77,P＞0.05).观察组与对照组NBNA评分分别为34.93±1.89和35.87±2.11,两组比较差异无统计学意义(t=1.80,P＞0.05).结论 产前地塞米松治疗对早产儿体格发育及NBNA评分无明显影响.     

早期营养对早产儿生长发育的影响临床研究

目的 分析早期营养对早产儿生长发育的影响.方法 收集我院儿科2015年5月—7月收治的120例早产儿为研究对象,根据其出生后2周内蛋白质将其分为高蛋白组与低蛋白组,2组均给予早期营养支持,对比分析2组早产儿纠正胎龄40周,纠正月龄1个月、3个月、6个月及12个月的体重、身长、头围增长情况.结果 2组早产儿纠正胎龄40周,纠正月龄1个月、3个月、6个月及12个月的体重和身长增长情况对比均有显著差异(P<0.05).结论 给予早产儿早期营养支持有助于其生长发育.     

新生儿抚触对早产儿生长发育的影响

目的 探讨新生儿抚触对早产儿生长发育的影响.方法 将病情平稳的住院早产儿54例,随机分为抚触组(27例)及对照组(27例),抚触组进行抚触每天2次,连续14d.观察两组早产儿体重、身长、头围、进乳量的差异. 结果 抚触组早产儿体重增长比对照组明显(P<0.05),而身长、头围增长与对照组无明显差异(P＞0.05),进乳量抚触组比对照组增多(P<0.05).结论 新生儿抚触可以促进早产儿生儿发育.     

低体重早产儿的临床护理

目的探讨低体重早产儿的临床护理措施。方法收集在我院出生40例早产低体重新生儿作为研究对象,将其随机分成对照组与实验组,每组20例,其中对照组早产儿实施常规护理措施,实验组患儿实施早产儿综合护理措施,对比两组早产儿的头围、身长与体质量。结果实验组早产儿的日均体质增长情况明显好于对照组,对比发现显著差异(P0.05),具有统计学意义。对比两组早产儿头围增长、日均身长等情况,发现无明显差别(P0.05),无统计学意义。结论对低体重早产儿实施早产儿综合护理措施,能够有助于早产儿迅速生长,提高早产儿存活率,应在临床工作中得到普遍推广应用。     

母亲焦虑和抑郁对NICU出院早产儿体格生长轨迹影响的研究

目的 探讨新生儿重症监护室(NICU)出院早产儿校正1、2、3、4月龄体格生长变化轨迹,并分析早产儿一般因素、母亲焦虑和抑郁对其的影响.方法 采用便利抽样法,选取2016年9月至2018年5月上海市某保健院NICU住院的205例早产儿及其母亲,对产后3～5 d的母亲行问卷调查,并对早产儿体格生长纵向随访.结果 早产儿体重、头围和身长均呈线性增长趋势.双胎与低出生体重早产儿校正1月龄时体重更低(P<0.05),母亲抑郁水平更高及女性早产儿体重增长速度更慢(P<0.05).女性早产儿校正1月龄时头围更小(P<0.05),母亲抑郁水平更高和更长NICU住院时间的早产儿头围增长速度更慢(P<0.05).存在宫外发育迟缓及女性早产儿校正1月龄时身长更短(P<0.05).结论 加强NICU出院早产儿体格生长评估,重点关注女性、双胎、低出生体重、存在宫外发育迟缓及住院时间更长的早产儿.此外,加强母亲抑郁情绪的管理有利于改善早产儿体重和头围发育.     

惠氏早产儿配方奶营养干预对早产儿追赶生长的效果分析

目的研究惠氏S-26[金装爱儿加]配方奶粉对早产儿体重、身长、头围追赶生长的影响效果。方法将2010年3月～2011年3月在本院住院的早产儿63例作为干预组研究对象。服用普通配方奶粉的早产儿63例作为对照。干预组早产儿出生后采用惠氏S-26[金装爱儿加]配方奶粉在医师指导下喂养,对照组采用普通配方奶粉喂养。结果两组早产儿出生时的胎龄、性别构成、体重、身长、头围差异无统计学意义（P〉0.05）,经过3个月的干预后,惠氏干预组早产儿体重、身长、头围出现追赶生长及追赶生长良好的比例高于对照组（〈0.01）。结论早期采用惠氏S-26[金装爱儿加]配方奶粉在医师指导下喂养早产儿,能够促进早产儿体重、身长和头围的追赶生长。     

出院后规范随访监控机制对早产儿生长发育的影响

目的 建立早产儿出院后规范随访监控机制，分析该管理模式下早产儿生长发育情况，为制订合理的营养支持和早期神经干预策略提供理论依据。方法 依据出生胎龄、出生体重及临床特征将613例早产儿分为高危早产儿与低危早产儿。对高危早产儿与低危早产儿分别制订随访计划表并定期评估，根据其生长发育情况给予相应干预，根据出院后是否定期回院随访分为规范随访组和非规范随访组。比较两组早产儿出院时、校正12～24月龄的体重Z值、身长Z值、头围Z值；比较两组早产儿校正0月龄、1月龄时的新生儿神经行为测定(NBNA)评分；比较早产儿校正3月龄、12～24月龄的Gesell发育量表评估情况。结果 (1)在校正12～24月龄时，两组高危早产儿的体重Z值、身长Z值和头围Z值均较出院时增大，且规范随访组高危早产儿上述Z值的增长量均大于非规范随访组高危早产儿(均P<0.05);但各组内低危早产儿的体重Z值、身长Z值和头围Z值与出院时比较差异均无统计学意义(均P>0.05),且两组之间低危早产儿上述Z值的增长量差异亦均无统计学意义(均P>0.05)。(2)校正1月龄时，两组高危早产儿和两组低危早产儿的NBNA评...     

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.