胎儿颅后窝积液超声检测的临床意义

目的:通过正常胎儿颅后窝积液即小脑延髓池深度测定,探讨胎儿小脑延髓池深度的正常值范围及与孕周的相关性。方法:在小脑平面对14~42孕周282例胎儿颅后窝积液即小脑延髓池深度进行检测。结果:189例可显示胎儿小脑延髓池深度范围在1~13mm,另93例未充分显示小脑延髓池积液,胎儿小脑延髓池深度与孕周的直线回归方程表明r=0.1174(P>0.05)?熏 两者无相关性。结论:胎儿小脑延髓池深度与孕周的大小无明显相关性。     

胎儿小脑延髓池宽度发育特点及其性别差异

目的 探讨胎儿小脑延髓池宽度发育特点及其性别差异。方法 选取行常规产科超声检查的孕妇574例为研究对象。收集孕妇年龄、孕周、胎儿性别等信息,用超声测量胎儿双顶径、头围、小脑半球横径、小脑延髓池宽度。分析小脑延髓池宽度与胎儿颅脑径线测量值相关性以及不同性别发育特点。结果 小脑延髓池平均宽度为(6.86±1.55) mm,平均孕周为(27.00±4.00)周,平均双顶径为(67.68±32.54) mm,平均头围为(241.78±43.93) mm,平均小脑半球横径为(29.36±7.72) mm。小脑延髓池宽度值与孕周、双顶径、头围、小脑半球横径均呈正相关(且与头围相关性最高)(P<0.05),其相关系数分别为0.269、0.105、0.309、0.189。头围和小脑半球横径对小脑延髓池宽度值具有影响,差异有统计学意义(P<0.05)。孕30周前小脑延髓池宽度值随孕周增加而增长,30～40周小脑延髓池宽度值变化不大。分析17～30周胎儿数据显示,小脑延髓池宽度与孕周、双顶径、头围、小脑半球横径的相关性升高,相关系数分别为0.552、0.549、0.567、0.416。小脑延髓...     

三维超声评价胎儿小脑体积

目的应用三维超声建立不同孕周胎儿小脑体积正常范围参考值。方法对16～40周正常单胎胎儿283例进行小脑三维超声容积扫查,采用VOCAL程序30°旋转法测定小脑体积,应用相关回归分析拟合小脑体积随孕周增长的回归模型。结果正常妊娠胎儿小脑体积三维超声测量值与孕周高度相关(r=0.924,P<0.0001)。小脑体积随孕周增长的最适方程为幂曲线方程(R2=0.975,F=10751.86,P<0.0001)。结论三维超声不同孕周胎儿小脑体积正常值的建立将为产前判断小脑发育不良及相关异常,准确推算孕周提供有价值的参考。     

三维超声容积自动测量技术评价胎儿小脑蚓部发育

目的 应用三维超声容积自动测量技术检测胎儿小脑蚓部的发育,为产前筛查胎儿小脑发育异常提供理论依据.方法 选择20～36孕周正常胎儿387例,应用经腹三维容积自动测量技术(VOCAL)测量小脑蚓部体积,观察胎儿小脑蚓部发育规律.结果 应用VOCAL软件测量胎儿小脑蚓部体积成功率为98%.胎儿小脑蚓部体积与孕周及小脑横径呈正相关,r分别为0.98、0.98(P<0.0001).以孕周为自变量X,小脑蚓部体积测量值为因变量Y,直线回归分析认为X与Y之间有直线关系,方程为Y=-2.17 0.12X.以小脑横径为自变量,小脑蚓部体积测量值为因变量,直线回归分析认为X与Y之间有直线关系,方程为Y=-0.94 0.06X.结论 三维超声容积自动测量技术测量胎儿小脑蚓部体积有助于评价胎儿小脑蚓部的发育.     

B超测量小脑横径监护胎儿生长发育

应用B超测量孕16～40周正常胎儿小脑横径,发现小脑横径与孕周呈直线相关(r=0.9866),随机取样50例分娩前1周测的胎儿小脑横径与新生儿出生体重比较,相关系数高(r=09193)。说明小脑横径可作为监测胎儿生长发育,诊断胎儿宫内生长发育迟缓的重要指标之一。     

胎儿小脑蚓部发育及小脑蚓部缺失的超声评价

超声在孕18周即可完整显示胎儿小脑蚓部。研究表明,超声对胎儿小脑蚓部发育及小脑蚓部缺失的观察是可信的、有意义的。掌握小脑蚓部缺失声像表现可对相关疾病的临床诊断提供可靠依据。     

胎儿单侧小脑发育不全的产前超声诊断

目的探讨胎儿单侧小脑发育不全（UCH）产前超声声像图特征。 方法总结2018年1月至2019年12月于南方医科大学附属深圳妇幼保健院,在胎儿系统超声检查中诊断为UCH的6例胎儿的产前超声声像图表现,与MRI、引产后超声及病理解剖结果进行对比,并结合产前诊断该疾病的相关文献对UCH胎儿产前超声诊断特点及临床预后进行分析。 结果6例UCH胎儿产前超声声像图典型表现：两侧小脑半球不对称和（或）小脑横径减小,伴或不伴蚓部异常,发育不全侧小脑减小,形态失常,其中3例受累侧小脑半球边界不规则,对侧小脑形态及大小均正常。临床预后：6例胎儿中1例活产,随访至1岁,未出现神经症状。结合本研究6例UCH胎儿及文献报道的36例胎儿产前和产后检查结果分析均显示：单纯UCH胎儿、不合并颅内异常的UCH胎儿以及无产前生长受限、早产等不良孕产史的UCH胎儿短期预后均好于合并颅内异常的UCH胎儿。 结论UCH有特征性产前超声表现,产前超声发现小脑半球不对称,一侧小脑减小、形态失常时可作出诊断,诊断不明确时可结合MRI进行鉴别诊断。     

胎儿小脑延髓池增宽的产前超声与MRI对比研究

目的探讨胎儿小脑延髓池（枕大池）增宽病例的产前超声诊断价值。 方法回顾性收集2017年10月至2019年10月北京协和医院因产前筛查发现小脑延髓池增宽（＞10 mm）的进行系统超声检查的胎儿73例,所有病例均在超声检查后行胎儿颅脑MRI检查,并对检查结果进行对比,计算超声诊断符合率。 结果73例胎儿小脑延髓池增宽胎儿经胎儿颅脑MRI检查最终提示Dandy-Walker畸形4例,小脑蚓部发育不良2例,小脑发育不良4例,颅后窝蛛网膜囊肿8例,Blake's囊肿1例,单纯小脑延髓池增宽54例。与胎儿颅脑MRI检查结果比较,产前超声诊断颅后窝异常的符合率为84.9%（64/73）。本组中MRI诊断合并其他颅内异常者17例（23.3%,17/73）,其中超声诊断13例（76.5%,13/17）。 结论与MRI相比,超声对胎儿小脑延髓池增宽相关疾病的诊断准确率较高。对于Dandy-Walker畸形、小脑发育不良等相对较严重的疾病,超声声像图特点典型,不易漏误诊,对于小脑蚓部发育不良、Blake's囊肿、颅后窝蛛网膜囊肿等疾病需仔细鉴别。     

胎儿小脑延髓池扩张的临床预后及意义

目的 探讨小脑延髓池(CM)扩张胎儿产后的生长发育差别.方法 对孕中、晚期胎儿进行系统超声检查,在小脑横切面测量CM宽度,在排除非中枢神经系统结构畸形后,对深度＞10 mm的42例胎儿进行随访观察.产后按照CM增大的不同情况,将CM增大分成单纯性和非单纯性,其中非单纯性包括后脑蛛网膜囊肿、Dandy Walker综合征.根据婴幼儿发育量表从大运动、精细运动、适应能力、语言能力、社会行为5个方面对其进行评估,继而得出发育商.另选择同期与病例组孕龄匹配的正常胎儿60例作为对照组进行比较.结果 引产2例,单纯性小脑延髓池扩张34例,非单纯性小脑延髓池扩张6例.患有单纯性小脑延髓池扩张胎儿产后大运动发育迟缓,非单纯性小脑延髓池扩张胎儿其产后各个测试部分均较正常胎儿及单纯性CM增大胎儿差,与正常组的差异有统计学意义(P＜0.05).结论 单纯性小脑延髓池扩张胎儿产后婴幼儿只是大运动发育迟缓,非单纯性小脑延髓池扩张胎儿产后婴幼儿发育商低于正常.     

三维超声评价先天性心脏病胎儿小脑发育的临床价值

目的：应用三维超声对比评价先天性心脏病胎儿和正常胎儿小脑容积发育的差异。方法采集孕20~36+6周龄168例正常胎儿和73例先天性心脏病胎儿的小脑三维图像,采用虚拟器官计算机辅助分析技术(VOCAL)30°旋转法勾勒计算小脑容积,比较两组之间差异,在各孕周应用秩和检验探讨容积差异出现的最初孕龄,应用多元回归分析先天性心脏病各亚型对胎儿小脑发育的影响。结果两组胎儿的小脑容积均随孕周增加而增长,但从孕28周开始,先天性心脏病胎儿小脑容积进行性小于正常组(P <0.01)。先心病类型与小脑容积发育迟缓有明显相关性(R2=0.852,P <0.001),左心发育不良综合征胎儿小脑发育迟缓最明显,随后是主动脉发育不良、完全性大动脉转位和法洛四联症。结论先天性心脏病胎儿存在一定程度的小脑发育迟缓,特别是左心发育不良综合征、主动脉发育不良和完全性大动脉转位胎儿。产前监测先天性心脏病胎儿小脑发育有利于产前咨询和产后及早神经保护干预。     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

Calcified primary tumors of the gastrointestinal tract

The dominant pattern and location of calcifications occurring within 23 primary gastrointestinal tumors have been analysed and correlated with the data from the literature. The provided guidelines for radiologic diagnosis of such calcified tumors include: (1) a retrocardiac mass containing amorphous calcifications is typical of leiomyoma of the esophagus; (2) calcific deposits similar to that in uterine fibroids may be the feature of gastric leiomyoma or intestinal leiomyosarcoma; (3) sand-like deposits within the wall of the stomach or colon are characteristic of a mucinous adenocarcinoma; (4) clusters of phleboliths in the gastrointestinal wall suggest a hemangioma particularly if recurrent intestinal bleeding and cutaneous hemangiomas are associated; (5) sunburst type of calcification in the pancreas indicates a cystadenoma or cystadenocarcinoma of that organ; and (6) aggregates of granular calcifications in the liver are diagnostic for metastatic adenocarcinoma of the colon but may rarely be seen in a primary malignancy of the liver.     

康养人才培养产教融合生态圈的构建研究

近年来,我国人口老龄化程度加快,高龄化、空巢化对于康养需求激增,职业教育通过产教融合打造康养人才培养生态圈,对于整合各方资源、提高提高行业适应性具有积极意义。基于康养行业的发展趋势,打造康养人才培养产教融合生态圈需要具有有拓展性、现代化和先进性,要服务国家发展战略规划找准产教融合生态圈的出发点,明确人才培养问题导向确立产教融合生态圈的支撑点,明确产教融合生态圈的结合点。由此,提出通过建立基本架构、做优专业链条、深化三教改革、聚焦创新链条、拓宽培训渠道等方面打造康养人才培养产教融合生态圈。     

他汀时代对高甘油三酯血症再认识

近年来,越来越多的证据表明降低低密度脂蛋白胆固醇可以减少心血管事件的发生,降低死亡率,但不容忽视的是,即使经标准治疗后低密度脂蛋白胆固醇达标,仍然存在发生大血管和微血管事件的风险（即心血管剩留风险）。我国成人高甘油三酯血症患病率高,与心血管疾病剩留风险关系密切,应该引起足够的重视。     

Preoperative diagnosis of angiomyolipoma of the liver

We experienced a case of surgically proven hepatic angiomyolipoma, a rare primary benign lipomatous tumor, which was preoperatively diagnosed by defining of its characteristic histologic components and benign radiologic nature with various imaging modalities. It was the first case that full radiologic evaluation was taken and internal vascular proliferation was defined by using dynamic bolus computed tomography (CT) prior to angiography.An invited commentary on this article follows on pp. 552–553.     

医学生职业选择量表的汉化及信效度检验

目的：引进、汉化医学生职业选择量表,并在医学生中进行信度和效度检验。方法：对医学生职业选择量表进行翻译、回译和跨文化调试,形成中文版医学生职业选择量表;方便抽取某医学院校医学生280例,使用该量表进行调查,评价量表的信度和效度。 结果：中文版医学生职业选择量表内容效度指数为0.971;共提取6个公因子,累积方差贡献率为60.996%;量表总的Cronbach’s α系数为0.869,根据奇偶数折半,奇数条目18条折半信度为0.805,偶数条目17条为0.824。结论：中文版医学生职业选择量表具有良好的信效度,可作为医学生职业选择的测量工具。     

Ultrasound examination of the liver: Variations in the vascular anatomy

The hepatic vasculature is highly complex. The hepatic artery (a branch of the celiac tripod) and the portal vein (formed by the confluence of the splenic and superior mesenteric veins) provide a dual blood supply while venous drainage is guaranteed by the hepatic veins. There are also numerous anatomic variants that can involve one or more of the system’s three components.Hepatic artery variants are the least common. Ten types have been identified, including several that are fairly frequent and others that are quite rare, and the variation generally involves the extrahepatic portion of the vessel. Portal vein variants are found in around 20% of the population. They can involve the main portal trunk or segmental branches. Variants of the hepatic veins are the most common. They involve the number and course (supernumerary veins) or the number, course, and openings (accessory veins).Knowledge of portal vein and hepatic vein variants, which are extremely common, is of prime importance for precise localization of lesions. Hepatic artery variants are equally important for surgical treatment of hepatic disease, especially liver transplantation, where it is essential for preoperative workup and postoperative follow-up of the recipient as well as for assessment of potential donors.     

Management of acute and chronic vascular conditions of the hand

Management of acute and chronic vascular disorders of the hand in patients with vasospastic and vaso-occlusive disorders is a complex problem and requires a multidisciplinary approach. The ischemia-related pain, skin ulcerations, and ultimately the threat of digital gangrene require a concerted effort to improve perfusion using a combination of medications and surgery. The purpose of this work is to review our experience over the past 2 decades with this cohort of patients including the variability of the clinical presentation, a method of classification, and a practical treatment philosophy.     

Sonography of subacute thyroiditis: changes in the findings during the course of the disease

Fifteen patients with subacute thyroiditis were studied with thyroid sonography. There were local hypoechoic areas in all patients during the active phase of the disease. Among 6 patients who underwent follow-up studies during the course of treatment, 3 had recurrence or aggravation of clinical symptoms such as painful swelling of the thyroid region, which was associated with, and sometimes preceded by, spread or reappearance of the sonographic abnormality. All 6 patients showed complete disappearance of the hypoechoic area when they were in remission. The thyroid sonography is useful not only for the initial diagnosis but also for the follow-up of these patients during the course of the disease.     

护理本科实习生毕业论文回顾分析

目的了解我院2003—2007年本科实习生毕业论文情况,改善科研带教的方法。方法对2003—2007年178篇毕业论文的选题范围、研究方法、统计学方法等进行分析。结果论文选题范围广,模仿偏多;调查研究篇数多,试验研究需要加强数量和质量;加强统计学的学习;应多参考近期核心期刊。结论护理本科生具有基础的科研能力,但应避免一味模仿,加强科研学习。