产前超声检查对胎儿心脏大动脉畸形的诊断价值

目的 探讨胎儿心脏大动脉畸形产前超声诊断的操作技巧,提高产前超声诊断符合率.方法 回顾分析我院诊断并经产后证实的20例心脏大动脉畸形胎儿的超声图像,总结不同类型大动脉畸形的声像图特征.结果 20例心脏大动脉畸形胎儿均经产后新生儿超声心动图检查或引产后尸体解剖证实,大动脉畸形在三血管气管(3VT)切面上均呈阳性特征,分别表现为大动脉内径异常10例,包括肺动脉狭窄7例,主动脉狭窄1例,主动脉弓离断1例及主动脉弓缩窄1例;永存动脉干4例;大动脉交叉关系消失5例,包括右室双出口3例,大动脉转位2例;右位主动脉弓1例.17例胎儿合并心内其他结构异常.结论 3VT切面是诊断胎儿心脏大动脉异常敏感且有效的切面,其他切面可作为诊断和鉴别诊断的辅助切面.     

右位主动脉弓胎儿超声心动图诊断分析

目的总结右位主动脉弓胎儿超声心动图表现及其血管特征.方法对26例超声心动图诊断为右位主动脉弓胎儿的超声心动图表现进行总结分析并观察其临床结局.结果26例右位主动脉弓胎儿中12例为孤立右位主动脉弓,2例为双主动脉弓,2例合并永存左上腔静脉,7例合并法洛四联症,3例合并永存动脉干.26例右位主动脉弓胎儿超声心动图均在上纵隔三血管气管观作出诊断.其中21例为右位主动脉弓合并迷走左锁骨下动脉、左位动脉导管,形成围绕气管食管的“U”字形血管环;2例双主动脉弓形成围绕气管食管的“O”字形血管环;3例无上述典型超声心动图图像特征.26例中12例活产儿经产后超声心动图或X线检查证实为右位主动脉弓;2例双主动脉弓经外院胎儿磁共振检查证实为右位主动脉弓;10例合并复杂先天性心脏病的胎儿均引产(6例尸体解剖检查证实为右位主动脉弓,4例未行尸体解剖检查);2例失访.结论胎儿右位主动脉弓有特征性超声表现,上纵隔三血管气管观可作为诊断胎儿右位主动脉弓的主要切面观;右位主动脉弓可孤立存在或同时合并其他心脏畸形.     

产前超声诊断胎儿主动脉弓发育异常的应用价值

目的探讨产前超声诊断胎儿主动脉弓发育异常的应用价值。方法选取45例主动脉弓发育异常的胎儿,获取以下标准切面的超声图像:四腔心切面、左右室流出道切面、三血管切面、三血管气管(3VT)切面、主动脉弓长轴切面、上下腔静脉切面、气管及支气管冠状切面、胸主动脉上段冠状切面,各切面叠加彩色多普勒超声,重点观察主动脉弓位置、内径、形态及血流方向。结果 45例主动脉弓发育异常胎儿均经产后证实,其中主动脉弓缩窄15例(13例合并心内畸形,6例合并心外畸形);主动脉弓离断3例(均合并心内畸形);右位主动脉弓并迷走左锁骨下动脉、左位动脉导管12例(1例合并心内畸形);镜面右位主动脉弓14例(7例合并心内畸形,4例合并心外畸形);双主动脉弓1例(未合并心内畸形)。结论主动脉弓离断、主动脉弓缩窄、镜面右位主动脉弓常合并心内畸形,部分合并心外畸形,产前明确主动脉弓发育异常及其合并心内、心外畸形情况,对于评价胎儿预后有重要指导意义。     

无名静脉至三血管切面连续扫查诊断胎儿大血管及分支异常的研究

目的:于胎儿大血管和分支异常诊断中无名静脉至三血管切面连续扫查的效果进行探究。方法:对我院2018年1月—2020年1月的60例胎儿大血管及分支异常孕妇做研究,胎儿均做无名静脉至三血管切面连续扫查,总结检查结果。结果:在本课题的60例胎儿中,27例胎儿是血管环,其占比是45.0%,2例胎儿是肺动脉吊带,5例胎儿是主动脉双弓,20例胎儿是迷走锁骨下动脉,其中6例胎儿是右位主动脉弓伴迷走左锁骨下动脉,14例胎儿是左位主动脉弓伴右迷走左锁骨下动脉;15例胎儿是静脉异常,其占比是25.0%,其中,3例胎儿是右上腔静脉缺如伴永存左上腔静脉,4例是下腔静脉离断,8例是主动脉弓下左无名静脉;16例胎儿是主动脉弓内径异常,其占比是26.67%,其中6例胎儿是主动脉弓离断,10例胎儿是主动脉缩窄;2例胎儿是其他异常,其占比是3.33%,其中,1例胎儿是右肺动脉异常起源于主动脉,1例胎儿是主肺动脉窗。结论:通过无名静脉至三血管切面连续扫查,可助于胎儿大血管和分支异常的产前诊断。     

三血管及三血管气管切面在超声产前诊断胎儿心脏大血管畸形中的应用价值

目的:回顾性分析三血管及三血管气管切面在超声产前诊断胎儿心脏大血管畸形中的应用价值。方法 :统计我院66例大血管畸形胎儿超声心动图检查情况,回顾分析四腔心、流出道、三血管、三血管气管切面在各个疾病的超声心动图特点,对患者进行复诊、随访。结果:大血管畸形在三血管及三血管气管切面有特征性表现,出现大血管排列顺序、内径、血流方向、分支等异常,结合彩色多普勒血流显像,表现出"V""O""C""U""Ioo""o Vo"型结构,该切面在主动脉弓离断、缩窄,右位主动脉弓,永存动脉干,永存左上腔静脉全部出现异常表现。而四腔心、左、右室流出道等切面在部分大血管畸形不出现异常表现。二者联合观察可提高胎儿先心病的诊断率。大血管畸形最常合并的心内畸形是室间隔缺损,最常合并的心外畸形是单脐动脉。结论:三血管及三血管气管切面可提示胎儿大血管畸形,尤其对于主动脉弓离断、缩窄,右位主动脉弓,永存动脉干,永存左上腔静脉有重要的诊断价值。有利于为孕妇及早作出产前诊断,减轻身心痛苦,提高生育质量。     

胎儿双主动脉弓的产前超声心动图诊断

目的探讨双主动脉弓胎儿产前超声心动图特征及产前诊断临床意义。方法对南京医科大学附属苏州医院2012年1月至2013年2月产前超声心动图检出的5例双主动脉弓胎儿的超声心动图特征、分型及临床结局进行总结分析。结果5例双主动脉弓胎儿超声心动图表现：（1）三血管气管观中主动脉与动脉导管失去正常“V”字形结构,升主动脉发出左、右主动脉弓围绕气管,彩色多普勒血流成像示环状血流信号围绕气管。（2）超声心动图示5例胎儿中3例为右主动脉弓优势型,2例为左、右主动脉弓平衡型。（3）1例（例2）胎儿合并膜部室间隔缺损、永存左上腔静脉：1例（例4）胎儿合并半椎体畸形,3例胎儿未发现合并其他畸形。5例胎儿均行磁共振检查并随访至引产或产后3个月,随访检查均证实胎儿为双主动脉弓畸形。结论双主动脉弓是胎儿严重的先天性心脏病,超声心动图是产前首选的诊断方法,三血管气管观是诊断双主动脉弓的有效切面。     

胎儿双主动脉弓的超声心动图特征

目的 总结分析胎儿双主动脉弓的超声心动图特征,探讨产前超声心动图诊断胎儿双主动脉弓的应用价值。方法 回顾性分析我院经产前超声心动图诊断为双主动脉弓胎儿的超声心动图及临床资料,分析超声心动图特征,随访产后诊断结果,总结产前超声心动图诊断经验。 结果 共计17例胎儿产前超声心动图诊断为双主动脉弓,其中右弓优势型11例,对称型6例;合并室间隔缺损1例,合并双上腔静脉并冠状静脉增宽2例,无合并其他心内畸形14例;出生6例,终止妊娠2例,9例失访;出生后出现症状2例,无症状4例;接受手术治疗1例。与胎龄相匹配的正常胎儿比较,病例组胎儿的左右心房内径、左右心室内径、卵圆孔大小、升主动脉与肺动脉内径及峰值流速差异均无统计学意义（p＞0.05）。双主动脉弓胎儿典型的超声心动图特征表现为：（1）在三血管-气管（3VT）切面显示两条主动脉,将气管与食管包绕,并与动脉导管形成“9”字形血管环;（2）在3VT切面均显示左位动脉导管;（3）升主动脉冠状切面可见升主动脉发出两条主动脉弓,降主动脉冠状切面可见两条主动脉弓汇入降主动脉;（4）主动脉弓长轴切面可见左、右主动脉弓各发出两个分支;（5）3VT向头侧连续扫查显示两条主动脉弓及分支走行。结论 双主动脉弓胎儿具有独特的产前超声心动图特征,三血管-气管切面对诊断胎儿双主动脉弓具有重要意义,发现左、右两个主动脉弓及分支走行是诊断的关键。     

超声心动图在筛查胎儿心脏畸形中的应用体会

目的探讨产前超声心动图筛查胎儿心脏畸形的必要性。方法 以胎儿四腔心、左室流出道、右室流出道、三血管-气管、主动脉弓、动脉导管弓这六个切面为标准切面,观察胎儿心脏结构、形态。结果 1863例胎儿中发现61例心脏畸形:室间隔缺损21例,法洛氏四联症10例,左心发育不良5例,永存左上腔静脉4例,右室双出口4例,心内膜垫缺损3例,右心发育不良3例,单心腔2例,三尖瓣下移畸形2例,主动脉弓离断2例,肺动脉狭窄2例,永存动脉干2例,右位主动脉弓伴血管环1例。漏诊室间隔缺损3例,肺动脉瓣轻度狭窄1例;诊断符合率99.8%(1859/1863);敏感性为93.8%,特异性为100.0%。结论以上述6个切面为标准切面进行胎儿心脏超声筛查,可发现绝大多数的心脏畸形,特别是复杂畸形无1例漏诊,应逐渐将胎儿超声心动图检查纳入产前检查常规工作中并建立标准化扫查切面。     

胎儿主动脉弓发育异常产前超声诊断

目的 探讨胎儿主动脉弓发育异常的产前超声诊断价值。方法 回顾性分析45例胎儿主动脉弓发育异常产前超声图像特征。结果 经产后证实胎儿主动脉弓发育异常45例, 其中主动脉弓缩窄15例(13例合并心内畸形,6例合并心外畸形);主动脉弓离断3例(均合并心内畸形);右位主动脉弓并迷走左锁骨下动脉、左位动脉导管12例(1例合并心内畸形);镜面右位主动脉弓14例(7例合并心内畸形,4例合并心外畸形);双主动脉弓1例(未合并心内畸形)。结论 主动脉弓离断、主动脉弓缩窄、镜面右位主动脉弓常合并心内畸形,部分合并心外畸形,产前明确主动脉弓发育异常及其合并心内、心外畸形情况,对于评价胎儿预后有重要指导意义。     

先天性肺动脉闭锁的产前超声诊断

目的探讨先天性肺动脉闭锁的胎儿期超声图像特征、检测技巧及其鉴别诊断,提高此类畸形的产前检出率。方法对33200例胎儿均采取胎儿心脏四腔心切面加胎儿头侧偏转法获得四腔心切面及左右心室流出道及主、肺动脉长轴切面快速筛查胎儿心脏畸形,对疑有胎儿心脏畸形者则行更详细的胎儿彩色多普勒超声心脏检查。分析22例产前及产后诊断的肺动脉闭锁的声像特征和病理特征。结果产前共诊断肺动脉闭锁20例,误诊为永存动脉干2例,根据产前和产后声像图及病理资料将其分为3型:I型,肺动脉闭锁不伴室间隔及不同程度的右室发育不良和三尖瓣异常;Ⅱ型,法洛四联症并肺动脉闭锁,即肺动脉闭锁伴室间隔缺损和主动脉骑跨;Ⅲ型,肺动脉闭锁合并其他大血管异常。主要声像图表现为:肺动脉内径细小、绝大部分病例于三血管-气管平面彩色多普勒显示动脉导管内血流反向。结论肺动脉内径细小,主动脉相对粗大,三血管-气管平面显示动脉导管内血流反向是肺动脉闭锁的主要声像特征,三血管-气管平面是诊断先天性肺动脉闭锁的关键切面,需注意与永存动脉干和主动脉闭锁进行鉴别。     

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。     

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.     

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。     

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.

     

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。     

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。     

Quality and suitability of antimicrobial discs: theoretical and practical sources of error and variability

ABSTRACT

Introduction: The use of antimicrobial discs remains one of the main methods for assessing antibiotic activity. Most discs are made to one of three main standards (FDA, WHO, DIN); these all describe an assay method for assessing the quality of discs using a linear method. Theory predicts a curved relationship, and this is backed up in many cases in practice. In such cases, the assays are potentially invalid. Other sources of uncertainty arising from the manufacturing processes employed are also discussed.

Areas covered: This includes error arising from applying FDA, WHO, and DIN standards, the manufacturing techniques employed, and variation in the materials used in production. The need for a specification that relates directly to the use of the discs is also discussed.

Expert opinion: Manufactured discs, some of which may be out of specification due to curvature and other sources of error, have been used to establish quality zone sizes. Quality zone sizes have then been used to measure the quality of discs. This circular quality system where there is no quantitative check is potentially unsafe. In the many decades of their use, there has been no comprehensive check on the quality of manufactured discs using quantitative, validated assays.