心肌声学造影视频法与射频法定量分析方法比较研究

目的　比较超声组织定征视频法与射频法在心肌声学造影定量分析中的应用价值。方法　 8只开胸犬 ,经静脉滴注全氟显进行谐波触发显像 ,分别采用DFY型超声图像定量分析诊断仪和声学密度定量 (AD)技术获得心肌声学造影感兴趣区回声强度 (EI)和背向散射积分 (IBS)值 ,并绘制时间 强度曲线 (TIC)。结果　心肌缺血后 ,峰值回声强度 (PEI)、峰值背向散射积分值 (PIBS)降低 ,P值均 <0 .0 5 ;而达PEI及PIBS所需时间 (PT)延长 ,P值均 <0 .0 1。冠脉闭塞后 ,PEI及PIBS显著降低 ,P值均 <0 .0 1。结论　超声组织定征视频法与射频法均能用于心肌声学造影的定量分析 ,两者均能区分缺血与梗塞心肌。     

超声背向散射积分和回声强度在急性心肌梗死诊断中的？…

目的 探讨心肌组织背向散射积分（ＩＢ）和回声强度（ＥＩ）是否可用于临床急性心肌梗死的诊断及其应用价值。方法 在３５例急性心肌梗死患者发病２周内，用ＨＰ－５５０型超声诊断仪和ＤＦＹ型超声图像定量分析诊断仪，在胸骨旁左室乳头肌短轴切面，分别测量冠状动脉左前降支，左回旋支和右冠动脉支配区域心肌组织（分别相当于左室乳头肌短轴切面上１２、４、８点的位置）的ＩＢ和ＥＩ心动周期变化幅度（ＣＶＩＢ和ＣＶＥＩ）值，     

扩张型心肌病心肌组织超声背向散射积分特性的临床研究

目的 应用心肌组织超声背向散射积分(IBS)技术研究扩张型心肌病患者的声学特性及临床意义。方法 采用HPSONOS 5500彩色多普勒超声诊断仪配备声学密度定量(AD)分析软件,对比检测20例扩张型心肌病患者和20例正常人胸骨旁长轴观室间隔基底段及后壁、乳头肌水平短轴观中段室间隔及后壁的背向散射信号,获得IBS平均值、IB最大值及CVIB(周期变异率)及曲线形态。其中病例组5例进行复检。结果 扩张型心肌病组各节段的IBS校正平均值、IBS校正最大值均显著高于正常组(P<0.05),CVIB值则低于正常组(P<0.05),曲线形态多数呈不规则类型。5例复检患者中2例随临床症状改善而心肌IBS值较前有所降低、CVIB值有所增高。结论 扩张型心肌病患者的心肌IBS值升高、CVIB值减低、曲线形态异常,提示该病患者心肌间质纤维化增多,心肌收缩力呈某种程度丧失。心肌IBS值与心肌收缩力相关联,经治疗心功能改善者心肌IBS值有所降低、CVIB值有所增高。提示此类患者心肌间质纤维化较轻。     

心肌超声背向散射积分与心肌线粒体相关性实验研究

目的 :探讨心肌超声背向散射积分测值与心肌线粒体的关系。方法 :12只开胸犬 ,随机分为 2组 ,分别静脉注射高钾、高钙溶液 ,使心脏停搏于舒张状态、收缩状态 ,用 HP-550 0型超声诊断仪 ,于停搏即刻、停搏后 3 0 min、停搏后 60 min分别从胸骨旁乳头肌短轴观采集射频图像 ,并用声学密度定量 (AD)技术获得感兴趣区心肌背向散射积分 (IBS)值 ,在上述各时间点取心肌组织行透射电镜观察 ,用计算机图像分析系统测量并计算线粒体体视学参数。结果 :随着犬心脏停搏时间延长 ,心肌线粒体肿胀、出现空泡 ,基质内电子密度降低 ,嵴排列紊乱、变短、消失 ;线粒体体视学参数 :体密度 (Vv)、表面积密度 (Sv)、平均体积 (V)、平均表面积(S)均增大 (P<0 .0 5) ,表面积与体积比 (Rsv)减小 (P<0 .0 5) ,数密度 (Nv)无明显改变 (P>0 .0 5) ;收缩状态与舒张状态 IBS值均减小 (P<0 .0 5)。IBS与 Vv、Sv、V、S、Rsv的相关性均具有显著性意义。结论 :线粒体可能是心肌组织中对 IBS起较主要作用的散射体之一     

背向散射积分技术评价PTCA术前后左室肌回声与收缩功能

目的：用超声背向散射积分(IBS)评价经皮冠状动脉成形术(PTCA)前后左室肌回声及收缩功能变化。方法：对33例择期行PTCA 支架术的冠心病患者用HP 5500型超声诊断仪，于PTCA术前及术后3天、1～3个月对胸骨旁乳头肌短轴切面的前间壁、下壁、后壁、侧壁行二维超声心动图(2DE)检测各节段的室壁运动情况、声学密度一背向散射积分(AD-IBS)检测心肌背向散射积分平均值及其标化值，心肌整层及心内外膜下心肌层的周期变化幅度并计算跨壁梯度指数。结果：左室存活心肌背向散射积分参数值于术后3天就有了改善，与术前相比有统计学意义；术后1～3个月检测，左室存活心肌回声及收缩功能均有明显改善。结论：PTCA能够有效地挽救存活心肌，背向散射积分技术能够为早期检测存活心肌及早期评价或预测PTCA疗效提供敏感指标。     

不同心脏切面心肌背向散射积分参数评价心肌缺血的临床研究

目的：探讨胸骨旁左心室长轴及乳头肌水平短轴切面的心肌背向散射积分在评价心肌缺血中的临床应用。方法：研究30例冠心病患者和12例正常人的左心室长轴及乳头肌水平短轴切面的心肌背向散射积分，按不同心肌节段分别比较狭窄冠脉供血心肌与非狭窄冠脉供血心肌，以及狭窄冠脉供血心肌与正常对照组心肌的CVIB及CVIB％值。结果：无论在长轴芬面还是在短轴切面，狭窄冠脉供血心肌的CVIB和CVIB％均显著低于后二者。结论：不同切面多点分析心肌的背向散射积分能够敏感，客观并比较全面地了解心肌缺血的状况。     

背向散射技术与彩色室壁运动技术评价慢性冠状动脉狭窄存活心肌的实验研究

目的　研究超声背向散射及彩色室壁运动技术对猪慢性冠状动脉狭窄、侧支循环形成后存活心肌的检出价值。方法　健康小型猪 10只 ,开胸放置Ameroid缩窄器 ,分别于手术前、术后 1d、3d、1周、2周、3周、4周利用超声背向散射、彩色室壁运动技术采集胸骨旁长轴、乳头肌短轴、心尖四腔、两腔观的标准切面图像 ,术前、术后 1周、2周、3周、4周进行冠状动脉造影 ,4周处死动物行病理检查。结果　除1只猪由于技术原因被剔除外 ,其余 9只均成功地建立了慢性冠状动脉狭窄侧支循环模型 ;术后 3d时背向散射积分值 (IBS % )升高 ,背向散射积分周期变化 (CVIB % )降低 ,1周时变化最明显 ,4周时未恢复至正常 ;而术后 3d左室后壁增厚率 (ΔT % )降低 ,室壁运动积分指数 (WMSI)升高 ,1周变化最明显 ,至 4周时与术前相比仍有明显差异 (P <0 .0 5 )。结论　背向散射与彩色室壁运动技术可以检出猪慢性冠状动脉狭窄、侧支循环形成后的存活心肌。     

应用背向散射积分技术评价糖尿病心肌病变的临床研究

目的　应用背向散射积分技术研究糖尿病患者的心肌超声组织特征 ,旨在探讨背向散射积分 (integrated backscatter,IBS)参数测定在评价糖尿病患者心肌病变方面的临床应用价值。方法　采用 HP Sonos5 5 0 0型超声诊断仪 ,该机配置声学密度定量 -背向散射积分 (AD- IBS)联机采样分析软件 ,检测了 17例无微血管并发症的 2型糖尿病患者 (I组 )和 17例有微血管并发症的糖尿病患者 (II组 )以及 16例正常人 (对照组 )心肌的心动周期时间平均背向散射积分 (IBS)、背向散射积分标化值 (IBS% )、背向散射积分周期变异幅度 (CVIB)、背向散射积分跨壁梯度 (TGIB)等超声背向散射积分参数 ,采样部位为胸骨旁左室长轴切面室间隔及左室后壁心肌的中间段。同时测定糖尿病患者的糖化血红蛋白 (Hb A1c)水平。运用 t检验进行 3组受检者心肌超声背向散射积分参数的显著性检验 ,对糖尿病患者的 TGIB与Hb A1c进行相关性分析 ,P<0 .0 5定义为有统计学意义。结果　 (1)糖尿病 I组、II组室间隔及左室后壁心肌的 IBS%均明显高于对照组 ;(2 )糖尿病 I组、II组室间隔及左室后壁心肌的 CVIB均明显低于对照组 ;(3)糖尿病 I组、II组室间隔及左室后壁心肌的 TGIB均显著高于对照组 ;(4 )糖尿病 II组室间隔及左室后壁心肌的 IBS%均明显高于糖     

超声背向散射技术评价尿毒症患者心肌组织特征的临床研究

目的本研究旨在应用超声背向散射技术研究尿毒症患者的心肌组织特征.方法应用HP Sonos-5500型超声诊断仪及其配置的AD-IBS软件,对30例尿毒症患者和20例正常人进行了心肌背向散射参数(IB%,CVIB,THIB%)的测定,采样部位为胸骨旁左室长轴切面室间隔及左室后壁中段.结果尿毒症患者IB%及THIB%较正常人增大(前者P＜0.05,后者P＜0.01),而CVIB减小(P＜0.05).结论尿毒症患者心肌组织特征较正常人明显不同,背向散射技术可定量客观地评价尿毒症患者的心肌病变.     

左心室壁显微结构与心肌背向散射积分周期变化的关系

目的：探讨心肌组织超声背向散射积分呈周期变化的组织学基础。方法：SD大鼠60只，随机分为2组，分别向冠状动脉注入高钾或高钙溶液使心脏停搏于舒张期或收缩期，对照研究心肌组织学结构与超声背向散射积分值的相关性。结果：收缩期和舒张期单位面积心肌内的血管数目、血管平均内径、心肌纤维长度、心肌纤维宽度、结缔组织截面积等均有显著差别。结论：收缩期和舒张期心肌组织学结构的差别是心肌背向散射积分呈周期性变化的组织学基础。     

现代残疾康复理念、政策与社区康复体系研究

本研究分析了当代残疾康复的理念和理论架构,构建了以国际公约、决议和政策、国内法律和政策以及操作性工具3个层次的康复理论体系;运用包容性发展,分析探讨了当代社区康复的体系和特点;就发展康复事业、为残疾人提供全面系统的康复服务提出相关的政策建议。     

我院文职护士管理和培训的实践与体会

目的构建文职护士培训、使用及管理的科学方法。方法通过规范管理、科学施训、作为骨干大胆任用等多种管理方式,使文职护士得到充分的发展。结果文职护士群体成长为医院优秀骨干,首批满3年的文职护士顺利通过续聘考核。结论科学的管理培训是文职护士成长的重要基石,对医院护理管理有着重要作用。     

国内外唇腭裂专科护理发展现状的文献研究及分析

目的了解和分析国内唇腭裂专科护理工作发展的现状。方法检索并分析万方医学网、中国知网、Springer Link及PubMed英文数据库近6年有关唇腭裂手术的围术期护理、患儿的喂养、手术安全管理、围术期疼痛研究以及心理护理的相关文献。结果共检索出国内文献89篇(核心期刊20篇)、国外文献22篇,其中围术期护理38篇、患儿的喂养16篇、手术安全管理10篇、围术期疼痛研究10篇、心理护理15篇。结论与国外文献相比,国内论文总结和回顾性居多,应增加研究探讨性论文,从而促进唇腭裂临床护理工作专科化的发展。     

城乡学童个性行为特征调查

目的探讨农村与城市儿童的个性行为特征。方法将97名农村学龄儿童设为农村组,97名城市学龄儿童设为城市组,采用艾森克个性问卷一儿童版和Achenbach’s 行为量表一儿童版进行评定分析。结果两组学龄儿童艾森克个性问卷各维度评分均无显著性差异（P均〉0．05）,且与全国常模相一致（P均〉0．05）;农村组男学童Achenbach’s行为量表违纪行为、攻击行为及外向型因子分均显著高于城市组,女学童退缩、社交问题因子分均显著高于城市组（P〈0．05或0．01）,其他因子分均无显著性差异（P均〉0．05）。结论农村与城市儿童个性无显著差异,而农村儿童存在较多的行为问题,可能与其所受教养和生活方式有关。     

Comparison of short-term and long-term protocols for stabilization and preservation of RNA and DNA of Leishmania, Trypanosoma, and Plasmodium

Molecular tools continue to be important in the prevention and control of parasitic diseases. However, using these techniques directly in the field remains a major challenge. Therefore, the preservation of clinical samples collected from endemic field areas for later analysis remains an important preanalytical process. This study aimed at identifying a suitable protocol for stabilization and preservation of RNA and DNA in bioclinical specimens for Trypanosoma, Leishmania, and Plasmodium research. Both spiked and unspiked blood samples were preserved in 7 protocols (different media; storage temperatures). Samples were evaluated for possible degradation of DNA and RNA along the storage duration up to the 10th week. Nucleic acid targets were assessed as follows: (i) Trypanosoma and Plasmodium RNA analysis was done using real-time nucleic acid sequence-based amplification (RT-NASBA) for 18S rRNA and for stage-specific Pfs25 mRNA, respectively; (ii) Trypanosoma DNA assessment analysis was conducted by using a conventional PCR for 18S rDNA; (iii) Leishmania RNA analysis was performed with a quantitative NASBA for 18S rRNA and Leishmania DNA assessment with an RT-PCR for 18S rDNA. Findings suggested that a newly developed L3™ buffer proved to be reliable and suitable for both short- and long-term preservation of parasite nucleic acid material. This buffer is envisaged to be suitable for utilization in field situations where resources are limited.     

Rates and risks of transmission of smallpox and mechanisms of prevention

In 1980, the World Health Organization declared smallpox eradicated from the world; the last known natural case had occurred in Somalia in 1977, and the United States had stopped routinely vaccinating its citizens in 1972. However, with increasing concerns regarding domestic and international terrorism, smallpox has resurfaced as a potential threat to global health. We review the direct and indirect modes of smallpox transmission and how patterns of transmission vary substantially, depending on the severity of circulating disease, vaccination status, environmental and socioeconomic factors, and the setting of an outbreak. We examine mechanisms for controlling outbreaks of disease and preventing further transmission in the event of an outbreak, with an emphasis on smallpox vaccination.     

胃癌DNA含量与E-cad、EGFR表达的关系及其意义

目的　探讨胃癌组织DNA含量与E cad、EGFR表达的关系 ,评价其在浸润、转移潜能及预后判断中的作用。方法　应用图像分析仪及SP免疫组化法检测 30例正常胃黏膜上皮、30例不典型增生和 5 0例胃癌组织DNA含量与E cad、EGFR蛋白表达情况。结果　①正常胃黏膜上皮、Ⅰ、Ⅱ、Ⅲ级不典型增生及胃癌组的DI、PI、S %、>5c %逐渐增高 ,与胃癌分期、淋巴结转移显著相关 (P <0 0 1)。②E cad在正常胃黏膜上皮阳性表达率 10 0 % ,EGFR呈阴性表达 ;Ⅰ、Ⅱ、Ⅲ级不典型增生及胃癌E cad阳性表达率逐渐降低 ,EGFR的阳性表达率逐渐升高 ,且差异显著 (P <0 0 5 ) ;E cad表达减弱、EGFR表达升高与胃癌分化差、淋巴结转移显著相关 (P <0 0 1)。③E cad表达阴性的胃癌DNA指数及EGFR表达水平显著高于E cad阳性 (P <0 0 1)。结论　检测DNA含量及E cad、EGFR蛋白表达有助于胃癌的早期诊断及转移潜能和预后的判断。     

Prevalence and severity of nausea and vomiting of pregnancy and effect of vitamin supplementation.

OBJECTIVE: Although nausea and vomiting of pregnancy is the most common medical condition during pregnancy, there are many unanswered questions regarding its cause, epidemiologic features and optimal management. The objectives of this study were to ascertain the prevalence of nausea and vomiting in a sample of Canadian women, to characterize the distribution of their severity and to investigate the role of vitamin B6 deficiency in their etiology. DESIGN: Prospective study. SETTING: Antenatal counselling service for pregnant women. PATIENTS: Three cohorts of women: a prospective, population-based cohort of 193 women, to estimate the rate and severity of nausea and vomiting (cohort A); a cohort of 555 women who sought advice for nausea with or without vomiting, to study the correlation between the maximal daily number of episodes of vomiting and maximal weight loss (cohort B); and a prospective cohort of 301 women who reported vomiting, to correlate vitamin supplementation with vomiting (cohort C). INTERVENTIONS: All 3 cohorts were interviewed during the counselling session, and cohort B was followed up prospectively. OUTCOME MEASURES: Frequency of nausea and vomiting, weight loss, maximal number of daily episodes of vomiting, rate of multivitamin supplementation. RESULTS: Overall, 67% of the women in cohort A reported experiencing nausea or vomiting, or both; 22% reported vomiting, and 9% experienced weight loss. In cohort B there was a significant correlation between the maximal number of daily episodes of vomiting and maximal weight loss, although there was wide variation (r2 = 0.25, p < 0.001). There was a highly significant correlation between the number of daily vomiting episodes and mean weight loss (r2 = 0.99). In cohort C, vomiting was significantly associated with lack of supplementation with multivitamins before 6 weeks' gestation (p = 0.002). CONCLUSIONS: The relation between number of daily vomiting episodes and mean weight loss may serve as a clinical tool to assess the severity of nausea and vomiting in pregnancy and the success of anti-emetics and rehydration regimens. Further study is needed to elucidate the biologic basis of the observed association between vomiting and lack of multivitamin supplementation in early pregnancy.     

History of violence and subjective health of mother and child

Objective: To study the self-reported prevalence of experienced violence among a cohort of women about two years after giving birth, their health during pregnancy, pregnancy outcomes and their experience of their child’s health.

Setting and subjects: In 2011, a total of 657 women participated in phase III of the Childbirth and Health Cohort Study in Icelandic Primary Health Care, 18 to 24 months after delivery. The women had previously participated in phase I around pregnancy week 16 and phase II 5–6 months after delivery. Data were collected by postal questionnaires.

Main outcome measures: Women’s reported history of experienced violence, sociodemographic and obstetric background, self-perceived health, the use of medications and their child’s perceived health.

Results: In phase III, 16% of women reported experiencing violence. These women felt less support from their current partner (p?p?p?p?p?p?=?0.008).

Conclusions: Our study confirms that a history of violence is common among women. A history of violence is associated with various maternal health problems during and after pregnancy, a higher rate of caesarean sections and maternal reports of health problems in their child 18–24 months after birth.

• KEY POINTS

• Violence is a major concern worldwide. Understanding the impact of violence on human health and developing effective preventive measures are important elements of any public health agenda.

• ??The reported prevalence of experiencing violence was 16% among women attending antenatal care in the primary health care setting in Iceland.

• ??Women with a history of violence reported worse health in general during pregnancy and delivered more often by caesarean section, compared to women with no such history.

• ??Mothers with a history of violence also evaluated the general health of their child as worse than women with no such history.

• ??The findings of this study support the importance of recognizing and addressing experienced violence among women in primary care.

     

皮肤麻风病6例临床病理观察及误诊分析

目的 探讨皮肤麻风病的临床病理特征,讨论需要鉴别诊断的疾病并吸取误诊教训.方法 收集皮肤麻风病6例,回顾性分析其临床资料、HE、免疫组化、抗酸染色及病理诊断结果 .结果 6例中除3例因临床及病理特征典型首次活检即被确诊外,其余3例初始均被误诊.1例误诊为皮肤假性淋巴瘤和皮肤非霍奇金淋巴瘤, 1例误为皮肤纤维组织细胞瘤,1例误为炎性肉芽肿伴化脓性炎和皮肤脂膜炎样T细胞淋巴瘤,后经多家医院会诊并加做抗酸染色方确诊.结论 麻风病现已较为少见,非典型病例较易误为肿瘤或其他炎性疾病.