羊水板层小体计数的临床意义及影响因素研究

目的研究羊水板层小体计数在预测胎儿肺成熟时的界值,同时探讨促胎肺成熟治疗对LBC的影响.方法前瞻性收集136例孕妇的147份羊水,其中11人取2次羊水,128人随访新生儿结局.所有羊水均进行了LBC测定,同时比较11例不同孕周两次羊水的LBC结果.结果①羊水LBC有明显的孕周分布特点:羊水LBC随孕周增加而增长.②136例新生儿中共发生4例RDS,孕周均＜37周.以LBC19×1000/μl为界值,预测NRDS的敏感度100%:特异度98.4%:阳性预测值66.7%:阴性预测值100%.③经促胎儿肺成熟治疗后,LBC有明显增长:63.3±48.9比105.9±78.5(×1000/μl),t=-2.86,P=0.0168.结论①羊水LBC用于预测胎儿肺成熟度具有较高的敏感性及特异性.②妊娠34周以后,如果存在胎肺不成熟的证据,可进行促胎肺成熟治疗.     

胎肺成熟度预测在妊娠期糖尿病的应用及临床价值

目的:探讨GDM孕妇胎肺成熟度测定的应用及临床价值。方法:选择GDM孕妇共128例作为研究对象,根据血糖控制情况分为两组,血糖控制满意组,共89例;血糖控制不满意组,共39例;另外选取同期正常妊娠孕妇200例作为对照组;所有羊水标本均通过择期剖宫产时或分娩前3天经腹羊膜腔穿刺术穿刺羊膜腔获取。结果:GDM孕妇羊水LBC值随孕周增加而增多,且明显小于正常妊娠组(P>0.05);GDM血糖控制不满意组新生儿RDS发生率明显高于血糖控制满意组及正常妊娠组,差异具有统计学意义(P<0.05);GDM血糖控制满意组新生儿RDS发生率与正常妊娠组相比,差异无明显统计学意义(P>0.05);以LBC<2.0×109/L作为判断胎儿肺不成熟的临界值,以LBC>4.8×109/L作为判断胎儿肺成熟的临界值,具有较好的预测价值。结论:新生儿RDS的发生与孕期血糖控制密切相关,以羊水板层小体计数测定胎肺成熟度时,可以LBC<2.0×109/L作为判断胎儿肺不成熟的临界值,以LBC>4.8×109/L作为判断胎儿肺成熟的临界值。     

双胎合并胎儿畸形的产前超声诊断

目的探讨双胎合并胎儿畸形的规律,评价超声诊断双胎合并胎儿畸形的价值。方法分析10年间所发现的全部双胎合并胎儿畸形的资料和超声检查结果,并与产后结果对照。结果10年间超声诊断双胎合并胎儿畸形共13例,占同期产前诊断胎儿畸形的5.83%,孕妇平均年龄28.08±3.97岁,孕周25.08±6.06周。12例为G1P0,11例为一胎畸形另一胎正常,2例为联体畸形,大部分为多系统畸形。除1例有漏诊外均与产后结果相符合。结论超声诊断准确率高,可作为产前诊断双胎合并胎儿畸形的首选方法。     

The prediction of fetal maturity: a comparison between the bubble stability test and cytological evaluation of maturity

Amniotic fluid from fifty women soon to be delivered, or already in labour, was analysed in the Obstetric unit of University Teaching Hospital, Lusaka. A Bubble Stability Test (Clements et al, 1972) and cytological screening for maturity (Sharma & Trussell, 1970) was carried out on each specimen. The latter test has been routinely used in the Obstetric unit for three years. The intent was to discover which test was the most useful indicator of fetal maturity.     

TDx—FLMⅡ和卵磷脂鞘磷脂比预测胎儿肺成熟的比较

目的：评估检测荧光偏极化分析Ⅱ（TDx—FLMⅡ）和卵磷脂鞘磷脂比（L／S）预测胎儿肺成熟的有效性。研究设计：回顾分析了218例连续成对的TDx—FLMⅡ和L／S结果。对采集羊水72h内活产的109例妇女进行灵敏度和特异度分析。对研究期间所有妇女及采集羊水72h内活产的妇女都进行了一致性检验。结果：研究期间，9例呼吸窘迫综合征（RDS）婴儿出生。TDx—FLMⅡ和L／S最佳界值检测RDS均有100％的灵敏度。与TDx—FLMⅡ相比，L／S存在特异度增加趋势（L／S：80％粥FLMⅡ：73％）。TDx—FLMⅡ和L／S总一致性接近75％。结论：TDx—FLMⅡ和L／S均为检测RDS灵敏度较高的试验，但二者之间一致性较低。本研究结果为最优应用TDx—FLMⅡ和L／S检测（连续或反射级联反应）胎儿肺成熟提供了参考。     

全自动胎儿肺部超声分析预测妊娠晚期胎儿肺成熟度的研究

目的 探讨全自动胎儿肺部超声分析预测妊娠晚期胎儿肺成熟度的应用价值。 方法 选取在我院分娩的80例单胎孕妇,给予全自动胎儿肺部超声分析,比较新生儿呼吸窘迫综合征（neonatal respiratory distress syndrome,NRDS)和非NRDS肺部超声参数差异。 结果 80例新生儿中,有34例发生NRDS;NRDS新生儿左肺容积（left lung volume,LLV）、右肺容积（right lung volume,RLV）、总肺容积（total lung volume,TLV）和TLV/体质量比值（fetal lung to body weight ratio,FLB）分别为（33.03±3.75）cm3、（44.07±3.16）cm3、（75.57±4.69）cm3和（0.25±0.04）cm3/10 g,明显低于非NRDS新生儿（35.12±2.84）cm3、（46.68±3.19）cm3、（81.95±6.03）cm3和（0.28±0.05）cm3/10 g。（P＜0.05）。NRDS新生儿肺动脉血流参数搏动指数(pulsatile index,PI）和阻力指数（resistance index,RI）分别为（2.14±0.29）和（0.92±0.12）,明显高于非NRDS新生儿（2.00±0.28）和（0.83±0.08）（P＜0.05）。PI、RI与LLV、RLV、TLV无明显相关性（P＞0.05）,而PI、RI与FLB呈负相关（r=-0.485,-0.401,P＜0.05）。全自动胎儿肺部超声预测胎儿肺成熟的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为91.18%、91.30%、91.25%、88.57%和93.33%。 结论 全自动胎儿肺部超声分析能有效预测妊娠晚期胎儿肺成熟度,值得临床使用。     

医科大学生职业成熟度和职业价值观研究

为了给医学生职业生涯教育提供科学依据,使用大学生职业成熟度量表(CSCMI)和职业价值观问卷对山西医科大学2007级学生进行调查,共获得有效问卷863份.结果发现医科大学生职业成熟度处于中等水平.职业成熟度的职业价值、职业自主和亲友依赖维度存在显著的性别差异(P<0.01,P<0.05,P<0.01).不同家庭所在地、家庭月收入、父亲学历和母亲学历医科大学生的职业成熟度在亲友依赖维度有显著差异(P<0.05,P<0.05,P<0.01,P<0.01).不同家庭月收入的医科大学生的职业成熟度在职业目标维度有显著差异(P<0.05).不同父亲学历的医科大学生的职业成熟度在职业自信维度有显著差异(P<0.05).不同家庭月收入的医科大学生在职业价值观的声望地位因素有显著差异(P<0.01).职业价值观和职业成熟度在多维度上显著相关.     

B超测量双顶径预测胎儿体重方法的评价

０引言目前Ｂ超测量双顶径已成为超声产前检查的一项常规,以此可以估计胎儿体重．为评价其准确性,我们对３８０例产妇检测结果进行回顾性分析,现报道如下．１对象和方法１．１对象收集１９９８－０１～１９９８－０６西京医院妇产科入院待产分娩的单胎产妇３８０例,产...     

脐血皮质醇的表达差异与双胎生长不一致的关系

目的 研究胎儿脐血皮质醇的表达差异与双胎生长不一致的关系。方法 选取2021年1月至2022年12月于嘉兴市妇幼保健院诊断为双绒毛膜双胎的52对胎儿为研究对象，根据双胎出生体质量差是否≥15%将其分为DT组（胎儿生长不一致，25对）和CT组（胎儿生长一致，27对）。收集两组孕妇及胎儿的相关临床资料，比较两组孕妇、双胎胎儿间基本情况和两组胎儿脐血的皮质醇水平。结果 两组孕妇的年龄、分娩孕周、产次、孕前体质量指数、受孕方式、分娩时间、双胎是否同性比较，差异均无统计学意义（P>0.05）；DT组和CT组胎儿的羊水深度、脐动脉SD值、脐带绕颈情况、胎盘形状、双胎性别比较，差异均无统计学意义（P>0.05）。DT组低体质量胎儿的皮质醇水平显著高于高体质量胎儿（P<0.05），而CT组两胎儿的皮质醇水平比较差异无统计学意义（P>0.05）。结论 双胎胎儿脐血中皮质醇水平的差异可能与双绒毛膜双胎胎儿生长不一致有关。     

日本患者中IBD5和克罗恩病之间缺乏相关性揭示了炎症性肠病的人种特异性差异

目的：对于克罗恩病（CD），日本患与高加索患的CARD15变异体没有任何共同点，提示在炎症性肠病（IBD）的基因易感性方面也存在人种特异性差异。最近，IBD5单倍体致病性突变体已被分离出来。据报道，由SLC22A4的L503F和SLC22A5启动子的-207G／C组成的TC单倍体具有调节机体阳离子载体的功能，并与高加索人的CD有关。为了揭示TC单倍体是否与日本人种的IBD有关，作对日本的受试对象检测了LS03F和-207G／C变异体基因型。此外，应用被报道的日本患连锁不平衡范围的信息设立一个与IBD5中有代表性的单核苷酸多态性（SNP）相关的病例对照研究，以揭示IBD5变异体与日本人种IBD之间是否具有特殊关系。材料与方法：共758例受试参与了该项研究，包括241例CD患，247例溃疡性结肠炎（UC）患和270例健康对照。采用聚合酶链反应-限制性片段长度多态性分析方法确定SNP的基因型。     

Using quantitative CT to predict postoperative pulmonary function in patients with lung cancer

Background At present, the therapy for patients with lung cancer that achieves a high rate of cure is surgical resection at an early stage of the disease. The aim of this study is to evaluate quantitative computed tomography (QCT) for predicting postoperative pulmonary function in patients with lung cancer. Methods The data of thirty-one patients with lung cancer who underwent both pulmonary functional tests and QCT scan before operations were collected. A CT program was used to quantify the volume of whole lung parenchyma with attenuation of -910 HU to -600 HU, which was defined as total functional lung volume (TFLV). Similarly, the volume of lung (lobes or segments) with attenuation of -910 HU to -600 HU was defined as regional functional lung volume (RFLV). Forced vital capacity (FVC), forced expiratory volume in first second (FEV1), FVC% and FEV1% (ratio to reference values of the matched population) were obtained from preoperational pulmonary functional tests. According to the formula: predicted FVC (pre-FVC)=preoperative FVC×［1－（RFLV/TFLV）］; predicted FEV1 (pre-FEV1)=preoperative FEV1×［1－（RFLV/TFLV）］, we obtained values of predicted FVC, predicted FEV1, predicted FVC% (pre-FVC/reference values of the matched population), and predicted FEV1% (pre-FEV1/reference values of the matched population). The paired t test and Pearson correlation test were used to assess significance of differences and correlations between CT predicted values and postoperative measured results of FVC, FEV1, FVC% and FEV1%. Results QCT predicted values correlated well with postoperative FVC, FEV1, FVC% and FEV1% （r=0.873, 0.809, 0.849 and 0.801 respectively, all P&lt;0.01).Conclusions QCT is an effective and accurate way to predict postoperative pulmonary function in patients undergoing pulmonary resection, regardless of the patients’ preoperative pulmonary functional status.     

The effect of birth order in twins on fetal umbilical blood gas and apgar score

Although recent reports have revealed no difference in perinatal mortality between a set of twins, more sensitive means other than perinatal mortality are necessary to evaluate differences in twins. This study examined differences between 34 twin pairs with respect to Apgar score, umbilical venous and arterial blood gas, and acid-base data. The parameters were measured in paired samples and compared with the paired t test and Fisher's exact probability test. The most coherent findings were a higher umbilical venous PO2 and umbilical arterial PO2 in twin A. Their differences were not due to the route of delivery, interval between twins, presentation or chorionicity. The data suggest that the second-born twin has potentially greater susceptibility to hypoxia and trauma.     

前瞻性羊水分析及B型超声检查联合判定胎儿成熟度的探讨

本文总结我院妇产科1984年10月～12月间,对于高危妊娠的胎儿,前瞻性地应用了羊水生化分析及B型超声多项指标检查,综合判定胎儿成熟度五例报道,其中重症妊娠高血压综合征一例,中央性前置胎盘两例、胎膜早破两例。此五例均适时终止了妊娠,其中三例行选择性剖宫产,两例行催产素引产后经阴道分娩。新生儿胎龄最低者34周,体重最低者2100g。新生儿出生后1分钟Apgar评分均为8～10分,出生后无一例RDS发生。产妇及新生儿愈后均良好。     

Establish a normal fetal lung gestational age grading model and explore the potential value of deep learning algorithms in fetal lung maturity evaluation

Background:Prenatal evaluation of fetal lung maturity (FLM) is a challenge, and an effective non-invasive method for prenatal assessment of FLM is needed. The study aimed to establish a normal fetal lung gestational age (GA) grading model based on deep learning (DL) algorithms, validate the effectiveness of the model, and explore the potential value of DL algorithms in assessing FLM.Methods:A total of 7013 ultrasound images obtained from 1023 normal pregnancies between 20 and 41 + 6 weeks were analyzed in this study. There were no pregnancy-related complications that affected fetal lung development, and all infants were born without neonatal respiratory diseases. The images were divided into three classes based on the gestational week: class I: 20 to 29 + 6 weeks, class II: 30 to 36 + 6 weeks, and class III: 37 to 41 + 6 weeks. There were 3323, 2142, and 1548 images in each class, respectively. First, we performed a pre-processing algorithm to remove irrelevant information from each image. Then, a convolutional neural network was designed to identify different categories of fetal lung ultrasound images. Finally, we used ten-fold cross-validation to validate the performance of our model. This new machine learning algorithm automatically extracted and classified lung ultrasound image information related to GA. This was used to establish a grading model. The performance of the grading model was assessed using accuracy, sensitivity, specificity, and receiver operating characteristic curves.Results:A normal fetal lung GA grading model was established and validated. The sensitivity of each class in the independent test set was 91.7%, 69.8%, and 86.4%, respectively. The specificity of each class in the independent test set was 76.8%, 90.0%, and 83.1%, respectively. The total accuracy was 83.8%. The area under the curve (AUC) of each class was 0.982, 0.907, and 0.960, respectively. The micro-average AUC was 0.957, and the macro-average AUC was 0.949.Conclusions:The normal fetal lung GA grading model could accurately identify ultrasound images of the fetal lung at different GAs, which can be used to identify cases of abnormal lung development due to gestational diseases and evaluate lung maturity after antenatal corticosteroid therapy. The results indicate that DL algorithms can be used as a non-invasive method to predict FLM.