胎儿肾积水的产前超声诊断及产后观察

目的探讨应用超声诊断胎儿肾积水的价值,并观察产后预后情况。方法对2010年1月-2011年1月的3000例25～40周的单胎孕胎儿行超声检查,对胎儿进行常规性的生物学测量,并测量双肾大小、肾实质的厚度以及集合系分离前后径的宽度,在首次诊断确认胎儿肾积水后,需在产前给予定期复查,并在产后给予1周复查,随访时间2年。结果产前超声检测56例胎儿出现肾积水,单侧43例,双侧13例。产后随访患儿肾积水情况有不同的改变。结论产前行超声检查,是诊断胎儿肾积水的较佳方法,值得临床普遍性予以推广应用。     

胎儿肾积水的产前超声诊断及预后观察

目的:应用产前超声检测胎儿肾积水程度及其预后观察.方法:对4 000例单胎孕20～40周胎儿进行超声检查:(1)常规进行胎儿生物学测量.(2)测量胎儿双肾大小、集合系分离前后径的宽度、肾实质的厚度、羊水指数及观察有无胎儿其他畸形.(3)首次诊断胎儿肾积水后,于产前定期复查,产后1周复查,随访2年.结果:4 000例胎儿检出胎儿肾脏积水63例(78只肾),占1.57％,其中双侧15例,单侧48例.10例双侧、27例单侧肾积水最终消退;1例双侧、5例单侧肾积水产后渐减轻;1例双侧、7例单侧肾积水,产后追踪无变化;1例双侧肾、9例单测肾积水产后逐渐加重;2例双侧肾积水随访中引产.结论:产前超声是诊断胎儿肾积水和追踪观察的首选方法.     

不同频率的超声随访方案在胎儿期肾积水患儿随访的应用价值

目的:通过对胎儿期肾积水的长期随访观察,对比两种随访方案(严密随访、普通随访),选择更为适合的监测随访方案。方法:对65例孕期肾积水的产妇长期随访至产后,产后利用SFU分级标准,选择Ⅲ级积水的患儿长期随访跟踪。将65例患儿,共计74只患肾完全随机分组为两组。A组随访方式:在出生后第一周进行超声检查,之后第一年每隔三个月复查一次(3、6、9、12个月),第二年每隔6个月复查一次(18、24个月);B组随访方式:随访频率下降,在第一个月复查一次,之后每6个月复查一次(6、12、18、24个月)进行超声泌尿系检查,观察肾盂扩张APD的数值变化。结果:65例肾积水患儿,74只积水肾脏,单侧积水56例,双肾积水9例。其中左侧肾积水34例(45.95%),右侧22例(29.73%),双侧18例(24.32%)。采用A组随访方式,能更早的干预肾积水。结论:对于SFU评级为Ⅲ度的肾积水患儿,更早、更积极的彩超随访方式(自胎儿娩出后第1周即开始监测肾盂积水,并在患儿3、6、9、12、18、24月龄分别进行超声泌尿系检查),尽早外科手术干预治疗,能够得到更好的预后。     

胎儿肾积水的超声诊断

目的：探讨胎儿肾积水的超声诊断价值及预后,指导临床采取适当的应对措施。方法：对产前常规超声检查中发现的15例肾盂分离5-15mm的胎儿,进行详细记录并进行产前、产后随访观察。结果：胎儿肾积水15例中,Ⅰ组13例,肾盂分离前后径为5-10mm,出生后随访发现肾盂分离全部消失;Ⅱ组2例,肾盂分离前后径为10-15mm,出生后3d肾盂分离消失1例,另1例出生后3个月肾盂分离消失。结论：出生后两组胎儿肾盂分离均自然消退,为可复性。超声检查可作为胎儿肾积水的首选检查方法。     

Ⅱ级产前超声检查在胎儿室间隔缺损诊断中的价值

目的探讨Ⅱ级产前超声检查对胎儿室间隔缺损的诊断价值。方法使用彩色多普勒超声对2024例孕18～26周胎儿进行Ⅱ级产前超声检查。在胎儿四腔心切面、五腔心切面、左室流出道切面及右室流出道切面进行扫查,观察室间隔有无中断及穿隔血流信号。同时对曾做Ⅱ级产前超声检查的孕妇进行随访,对产后新生儿心脏听诊发现有杂音者均行超声心动图检查。结果Ⅱ级产前超声检查共诊断胎儿室间隔缺损19例,产后超声检查证实8例,经引产尸体解剖证实11例。另外对产后随访中有心脏杂音的新生儿行超声心动图检查,发现产前未查出的室间隔缺损3例。产后用各种方法证实胎儿室间隔缺损22例,与Ⅱ级产前超声检查诊断的例数（19例）比较,差异无统计学意义（P〉0．05）。结论Ⅱ级产前超声检查能对大部分的胎儿室间隔缺损做出诊断,对进一步诊断及治疗方案的选择有重要的临床价值。     

超声监测筛选分析胎先天性心脏畸形

目的：探讨超声监测筛选胎儿先天性心脏畸形。方法：对中、晚期孕妇进行常规超声检查，在发现胎儿结构或节律异常时，再进行超声心动图检查，以观察胎儿四腔心切面为基础，酌情增加长轴、短轴、主动脉弓等切面进行观察分析，并配合彩色多普勒及脉冲多普勒超声检查，结果：产前心超发现17例胎儿心脏畸形中有8例为复杂畸形。5例为单一室缺、2例为单一房缺、1例产前诊断为卵圆孔偏大，产后复查为房缺，1例为心脏肿瘤。17例中有11例合并其他系统畸形，其中13例尸解病理证实，4例产后1－6个月复查证实。结论：产前超声可筛查胎儿先天性心脏畸形，还能诊断心血管以外畸形。     

超声诊断胎儿肾盂扩张及预后56例分析

目的超声检出胎儿肾盂扩张后,产前产后随访,为临床干预提供帮助。方法对56例孕期18周-40周常规产检发现胎儿肾盂扩张,记录肾盂扩张前后径数据,进行产前及产后跟踪随访。轻度肾盂扩张为肾盂前后径分离〈10mm,中度扩张为10-15mm,重度为肾盂分离〉15mm。结果 56例肾盂扩张胎儿中,43例肾盂轻度扩张胎儿中有5例孕晚期复检时肾盂回复正常,17例产后复查肾盂扩张消失,1例孕晚期复检肾盂扩张呈进行性加重;10例中度肾盂扩张,有8例产后4d-3个月复查肾盂积水消失,另2例产后随访至12个月肾积水仍然存在;3例重度肾积水产后1例肾积水减轻,2例随访至18个月后肾积水未见消失,后经手术证实1例为先天性输尿管狭窄,另1例为后尿道瓣膜。结论肾盂分离〈10mm多为生理性肾积水;肾盂分离10-15mm病理性肾积水风险性大大增高;肾盂分离〉15mm、肾皮质〈0.5cm多为病理性肾积水。     

产前超声诊断68例胎儿腹部囊性占位的分析

目的：分析胎儿腹部囊性占位在产前超声中的声像图特点和相应的鉴别点,以降低误诊率,提高产前超声在腹部囊性占位诊断中的准确率。方法：回顾2014年6月至2016年6月在我院进行产前超声检查并检查出腹部囊性占位的68例病例,对其产前超声结果与产后复查及尸检结果进行比较。结果：对比产前超声诊断和产后或尸检的结果发现,产前超声诊断出现3例误诊,误诊率为4.4%。在产前超声诊断的68例胎儿腹部囊性占位中,产后或尸检发现卵巢囊肿9例,十二指肠梗阻10例,小肠梗阻3例,大肠梗阻1例,肛门闭锁1例,肠重复畸形8例,肠系膜囊肿2例,胆道闭锁2例,肾囊肿4例,多囊肾3例,多囊性发育不良肾11例,III级及以上肾积水8例,输尿管扩张2例,巨膀胱3例,胰腺癌1例。结论：产前超声通过观察胎儿腹部囊肿的位置、形态、大小、血流和相邻脏器等指标,同时结合孕周,能较为准确地诊断出病变,对产前和围产期管理提供重要的线索,对某些疾病起到早期治疗的效果。     

超声监测筛选分析胎儿先天性心脏畸形

目的 :探讨超声监测筛选胎儿先天性心脏畸形。方法 :对中、晚期孕妇进行常规超声检查 ,在发现胎儿结构或节律异常时 ,再进行超声心动图检查 ,以观察胎儿四腔心切面为基础 ,酌情增加长轴、短轴、主动脉弓等切面进行观察分析 ,并配合彩色多普勒及脉冲多普勒超声检查。结果 :产前心超发现 17例胎儿心脏畸形中有 8例为复杂畸形。 5例为单一室缺、2例为单一房缺、1例产前诊断为卵圆孔偏大、产后复查为房缺、1例为心脏肿瘤。 17例中有 11例合并其他系统畸形 ,其中 13例尸解病理证实 ,4例产后 1～ 6个月复查证实。结论 :产前超声可筛查胎儿先天性心脏畸形 ,还能诊断心血管以外畸形。     

超声诊断胎儿肾积水的临床转归分析

目的用超声方法检测胎儿肾积水程度,指导临床采取适当的应对措施,避免不必要的终止妊娠。方法采用实时三维彩色多普勒超声诊断仪对定期在本院行产前检查的孕妇行超声检查,发现胎儿肾盂积水107例,141只肾,并对肾积水的初发时间,积水程度,有无伴随畸形等进行随访分析。结果 107例胎儿肾积水141只肾中Ⅰ级73只、Ⅱ级45只、Ⅲ级以上23只,其中8例终止妊娠,6例手术,88例肾积水在1年的随访中完全消失,5例在随访3年中逐渐消失。结论产前胎儿肾积水大部分都是生理性的,可随着个体的发育而自然消退;胎儿肾积水的转归与初发时间、肾积水程度有关;对于生后仍存在肾积水的患儿,仍应定期随访观察。     

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.