彩色多普勒超声诊断胎儿脐带绕颈250例分析

目的探讨彩色多普勒超声对胎儿脐带绕颈诊断的价值。方法应用彩色多普勒超声对250例胎儿脐带绕颈进行诊断并检测胎儿脐动脉血流参数,与临床分娩结果进行对照分析。结果250例彩色多普勒超声诊断脐带绕颈中,产时有脐带绕颈243例,诊断符合率97．2％;胎儿脐动脉S／D比值〉3．0,RI〉0．8的17例,其中9例经孕妇吸氧后好转,7例即行剖宫产,1例胎儿于产前死亡。结论彩色多普勒超声诊断胎儿脐带绕颈准确率高,对围产期保健和临床选择分娩方式等具有重要的指导意义。     

彩色多普勒血流显像对胎儿脐带绕颈137例的诊断分析

目的 探讨彩色多普勒血流显像在诊断胎儿脐带绕颈的应用价值。方法 对产前来我院进行彩超检查的孕妇137例的二维超声检查结果与彩色多普勒血流显像的结果进行对照分析，并与分娩结果进行对照。结果 二维超声发现41例脐带绕颈，彩色多普勒超声发现137例孕妇有72例脐带绕颈，且脐动脉RI（阻力指数）及S／D（脐动脉收缩期血流速度与舒张期血流速度比值）较正常组差异有统计学意义（P〈0．05）。结论 彩色多普勒血流显像比二维超声在诊断胎儿脐带绕颈具有明显的优势。     

二维及彩色多普勒超声诊断胎儿脐带绕颈

目的 探讨二维及彩色多普勒技术联合应用诊断胎儿脐带绕颈的临床应用价值。方法对263例足月临产孕妇行常规超声检查，首先用二维超声观察胎儿，然后在此基础上观察脐带“彩带”的特点，并测量脐动脉的阻力指教(RI)、搏动指数(PI)及收缩期舒张期流速比(S/D)，选60例无脐带绕颈胎儿作对照。结果超声诊断脐带绕颈69例，分娩后证实66例，超声诊断符合率95．7％，脐绕颈组脐动脉的RI及对S/D值均高于对照组。结论 二维超声与彩色多普勒血流显像(CDFI)联合应用，可有效提高胎儿脐带绕颈的确诊率，对指导临床，提高国产儿保健有重要意义。     

彩色多普勒对胎儿脐带绕颈的诊断价值

目的 探讨彩色多普勒超声对胎儿脐带绕颈诊断的价值。方法 通过彩色多普勒超声诊断胎儿脐带绕颈并检测胎儿脐动脉血流参数，与临床分娩结果进行对照分析。结果 305例彩色多普勒超声诊断脐带绕颈中，产时有脐带绕颈300例，诊断符合率98．4％；胎儿脐动脉A／B比值〉3．0的17例，其中12例经孕妇吸氧后好转，5例即行剖宫产。结论 彩色多普勒超声诊断胎儿脐带绕颈准确率高，对围产期保健和临床选择分娩方式等具有重要意义。     

彩色多谱勒超声观察脐动脉S/D值对评估脐带绕颈预后的临床意义

目的：探讨彩色多谱勒超声在胎儿脐带绕颈诊断中的临床价值及脐动脉S/D值测定对评估脐带绕颈预后的临床意义。方法：选择孕37～42周产前常规B超检查发现脐带绕颈209例孕产妇为脐带绕颈组,另选同期B超检查无脐带绕颈60例为对照组,两组均行彩色多谱勒超声检查。并对胎儿颈部进行观察,同时测定脐动脉S/D值、RI值,最后结合分娩方式、羊水粪染、Apgar评分进行分析。结果：（1）脐带绕颈组分娩后证实脐带绕颈205例,彩色多谱勒超声诊断符合率达98.1%。脐带绕颈组脐动脉S/D值、RI值与对照组相比,差异有统计学意义（P〈0.001）;（2）205例脐带绕颈孕产妇中,脐动脉S/D值≥3.0时羊水2度污染、新生儿Apgar评分、分娩方式等与S/D值〈3.0相比较,差异均有统计学意义（P〈0.01）。结论：彩色多谱勒超声诊断脐带绕颈准确率高,检测脐动脉S/D值对预测胎儿宫内窘迫、指导分娩方式的选择有重要参考意义。     

彩色多普勒超声检查诊断胎儿脐带绕颈56例观察分析

目的：探讨彩色多普勒超声检查诊断胎儿脐带绕颈（UCAN）的临床价值。方法：对行彩色多普勒超声检查诊断为胎儿脐带绕颈56例产前孕妇的结果进行回顾性分析。描述脐带绕颈的声像图特点,检测胎儿脐动脉血流参数,并将检出结果与分娩后临床资料进行对比。结果：彩色多普勒超声产前诊断脐带绕颈的准确率明显提高,准确率达100％。结论：彩色多普勒超声是产前诊断胎儿脐带绕颈的准确方法,具有安全、可靠、准确的特点,可为临床预测胎儿宫内窘迫提供可靠依据和恰当的分娩方式。脐动脉VS／VD值、砌值检测对于提示脐带缠绕程度及预测胎儿预后有重要意义。     

彩色多普勒血流显像诊断脐带绕颈80例分析

彩色多普勒血流显像诊断脐带绕颈８０例分析王蔚蔚，张宏才（南京医科大学第二附属医院特检科，南京２１００１１）关键词彩色多普勒血流显像；脐带绕颈；脐动脉胎儿脐带绕颈的发生率国外统计为１３．３％～１７％，在我国占分娩总数的２０％～２５％。阶带绕颈是胎儿宫内...     

脐带绕颈致胎儿窘迫的临床预测性研究

目的：探讨足月头位妊娠脐带绕颈孕妇脐动脉血流速度波形和胎心率在加压试验前后的变化,及其与胎儿窘迫之间的关系。方法：2004年1月-2006年6月滨州市结核病防治院采用彩色多普勒超声检测33例孕足月头位妊娠脐带绕颈孕妇的脐动脉S／I、阻力指数（RI）、搏动指数（PI）及胎心率（FHT）值在加压试验前后的变化。追踪受检测者在临产前或产程中有无发生胎儿窘迫。结果：脐带绕颈致胎儿窘迫组脐动脉S／I、RI、PI在加压试验后升高值明显高于未发生胎儿窘迫组,胎心异常变化发生率明显高于未发生胎儿窘迫组,两组间差异有显著性意义（P〈0．01）。以加压试验后脐动脉血流收缩期振幅与舒张期振幅比值（S／D）升高值〉0．5、RI升高值〉0．1、PI升高值〉0．2或S／I≥2．6、RI≥0．6、PI≥0．9为预测警戒值,其符合率72．7％～75．8％、特异性61．5％-69．2％、敏感性75．0％-85．0％、阳性预测值76．2％-78．9％、阴性预测值64．3％～72．7％。结论：检测脐带绕颈处胎儿脐动脉血流S／I、RI、PI及FHI值在加压试验前后的变化,可作为预测足月头位妊娠脐带绕颈致胎儿窘迫的一项较可靠指标,有较高临床价值。     

胎儿脐带绕颈的彩超诊断

目的：探讨胎儿脐带绕颈的彩色多普勒特点及应用价值。方法：对214例住院分娩的胎儿脐绕颈的彩色多普勒显像（CDFI），脐带动脉阻力指数（RI）及胎心率变化等进行回顾性分析。结果：CDFI诊断脐带绕颈的符合率为100%。脐带动脉阻力指数的测量可用于观察脐带绕颈的松紧，RI＜0.68提示脐带绕颈松弛，RI＞0.68提示脐带绕颈较紧，易出现胎儿心动过速或过缓，引起胎儿宫内窘迫。结论：CDFI的应用可明显提高胎儿脐带绕颈的准确率，脐带阻力指数的测定对胎儿宫内窘迫的检出有重要价值。     

脐带绕颈对分娩方式及围产儿预后的影响

目的探讨脐带绕颈的诊断方法及其对分娩方式、围产儿预后的影响。方法回顾性分析脐带绕颈病例417例。结果彩色多普勒超声诊断脐带绕颈的准确率达94．8％；脐带绕颈的胎儿宫内窘迫率为28．29％，新生儿窒息率为15．35％，自然分娩率为28．78％，阴道助产率为21．34％，剖宫产率为49．88％，分别与对照组相比，差异有显著性（P〈0．01）。结论彩色多普勒超声是诊断胎儿脐带绕颈的可靠方法；脐带绕颈能够明显增加胎儿窘迫、新生儿窒息、阴道助产及剖宫产的发生率。     

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.