超声评估多囊卵巢综合征的应用进展

正多囊卵巢综合征(polycystic ovary syndrome,PCOS)是一组以排卵障碍、雄激素增多、伴或不伴胰岛素抵抗为表现的全身内分泌系统综合征。PCOS不仅严重影响了育龄期女性生育,还与肥胖、2型糖尿病、非酒精性脂肪肝等疾病的发生、发展密切相关。有研究显示,PCOS患者罹患心脑血管疾病的风险较正常人群增大~([1])。在我国,PCOS患者约占育龄期妇女的7.4%~([2]),已经成为目前导致不孕的主要病因,占育龄     

高雄激素和胰岛素抵抗对多囊卵巢综合征孕妇胎盘病理影响的研究进展

多囊卵巢综合征(PCOS)是育龄期女性常见的内分泌疾病,可影响患者的生殖、代谢等。胎盘是影响妊娠和分娩结局及子代发育状况的关键介质,PCOS患者产前高雄激素和胰岛素抵抗所致糖脂代谢异常引起的胎盘结构和功能异常,可能是其子代出现低体质量出生儿、巨大儿甚至成年后发生内分泌及代谢系统疾病的主要原因。本文综述高雄激素和胰岛素抵抗对PCOS患者胎盘的病理影响,总结PCOS相关胎盘功能障碍的研究现状,探讨PCOS患者妊娠期胎盘结构和功能异常的原因及相应胎盘病理学特征,以期为预防PCOS相关妊娠并发症以及PCOS患者子代相关疾病的发生提供参考依据。     

炔雌醇环丙孕酮与克罗米芬治疗多囊卵巢综合征的临床效果比较

多囊卵巢综合征（PCOS）是育龄女性内分泌疾病中最常见的一种，患病率为5％-20％。对于本病原因至今尚未定论，主要涉及中枢神经系统下丘脑一垂体-卵巢轴、肾上腺、胰岛及遗传等方面。对于PCOS的治疗，临床上一直多采用克罗米芬进行治疗，但有文献报道其存在低妊娠的缺点。为了提高PCOS患者的妊娠率，本院对炔雌醇环丙孕酮治疗PCOS的效果进行了研究，取得了一定的临床效果。现将情况报道如下。     

维生素D对多囊卵巢综合征患者生育影响的研究进展

多囊卵巢综合征(PCOS)是常见的妇科内分泌疾病,常见临床表现包括月经不规律、高雄激素血症、胰岛素抵抗及排卵障碍性不孕等.目前关于PCOS的确切病因与发病机制尚不清楚.研究发现PCOS患者普遍存在维生素D的缺乏,适当补充维生素D可能有助于改善PCOS患者的临床相关症状及生育情况.本文就目前维生素D对PCOS患者影响的相...     

多囊卵巢综合征患者血清C反应蛋白与胰岛素抵抗的关系

多囊卵巢综合征（PCOS）是育龄妇女最常见的生殖内分泌紊乱疾病，主要表现为月经失调、排卵障碍、不孕和肥胖等，占育龄妇女的5％～21％。现代观点认为胰岛素抵抗和高胰岛素血症是PCOS重要的病理生理变化之一。近年来有研究证明，PCOS存在慢性炎症反应的机制，不同研究的结果不一。本组旨在了解PCOS患者体内CRP水平变化及其与胰岛素抵抗的相关性。     

应用肥胖国际功能、失能和健康分类综合核心组合描述肥胖型多囊卵巢综合征的疾病特征

目的使用肥胖ICF综合核心组合对肥胖型多囊卵巢综合征（PCOS）的疾病特征进行描述,揭示和探讨符合肥胖型PCOS疾病特征功能障碍的相关领域。 方法使用肥胖ICF综合核心组合对60例肥胖型PCOS患者进行评估,大于30%的患者报告作为障碍的条目才被考虑与PCOS患者的功能相关。 结果参与研究的60例肥胖型PCOS患者中,肥胖ICF综合核心组合条目的109条中有20个条目被选择与PCOS疾病特征相关。其中,身体功能领域有6条（占全部被选择条目的30%）,身体结构领域有1条（占全部被选择条目的5%）,环境因素领域有13条（占全部被选择条目的65%）。 结论肥胖ICF综合核心组合可用于描述肥胖型PCOS的疾病特征和功能障碍,为临床应用ICF核心组合评估PCOS患者的功能障碍提供了可能。     

多囊卵巢综合征生酮饮食治疗临床路径

多囊卵巢综合征(PCOS)是常见的妇科内分泌疾病,以高雄激素表现、持续无排卵、卵巢多囊样改变为特征,易导致育龄妇女不孕。PCOS病因尚不清楚,肥胖等代谢相关性疾病与PCOS关系密切。生活方式干预是PCOS的首选基础治疗,减重是有效的治疗措施。与传统饮食相比,生酮饮食能够较快降低体质量。基于《生酮饮食干预多囊卵巢综合征中国专家共识(2018年版)》及既往相关研究成果,本研究制订《多囊卵巢综合征的生酮治疗临床路径》,为PCOS的生酮治疗提供临床标准。     

多囊卵巢综合征易感基因研究进展

多囊卵巢综合征(PCOS)是育龄期妇女常见的生殖内分泌和代谢紊乱疾病之一,是导致女性不孕最常见的原因之一,其发病机制复杂,具有多种临床表现。PCOS单卵双生子的高共患率、发病的家族聚集倾向及种族差异提示遗传易感性在其发病机制中起重要作用。近年来研究认为PCOS是一种多基因遗传性疾病,相关基因已成为研究热点。本文就近年来PCOS相关易感基因的研究进展作一综述。     

代谢相关性多囊卵巢综合征及其理论基础

多囊卵巢综合征(PCOS)是导致女性不孕的常见因素.肥胖等代谢相关性疾病与PCOS有着密切的联系.基于临床实践和基因组学的研究结果,伴有代谢综合征的PCOS可以认为是代谢综合征在女性生殖系统的特殊表现,可将其作为PCOS的主要亚型单独命名,即代谢相关性多囊卵巢综合征(metabolic associated polyc...     

基于数据挖掘探讨肥胖型多囊卵巢综合征的中医用药规律

目的 探索基于数据挖掘的肥胖型多囊卵巢综合征（PCOS）中医用药规律。方法 通过“中医传承辅助平台（V2.5）软件”,利用数据挖掘技术,对自文献数据库建库以来至今的肥胖型PCOS临床研究类文献进行整理归纳,分析用药频次、性味归经、药物关联规则及熵层次聚类药物规律特点。结果 肥胖型PCOS临床用药多选用健脾补肾、化痰通络等之品。本研究挖掘出以“肝、脾、肾”三脏为主的“健脾补肾、疏肝理气、化痰除湿、活血通络、滋补肝肾、温阳利水、通泄下焦”等治法的新方组合。结论 基于数据挖掘的肥胖型PCOS中医用药规律研究,为临床运用中医药辨治思维诊治此类疾病提供指导意义。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.