绒毛膜促性腺激素及其游离β亚单位对不良妊娠的诊断价值

目的：探讨β绒毛膜促性腺激素（β‐HCG）及其游离β亚单位（fβ‐HCG）在不良妊娠中的诊断价值。方法运用化学发光分析技术分别检测早期不良妊娠患者（先兆流产组、稽留流产组、异位妊娠组）及正常妊娠孕妇（对照组）的血清β‐HCG、fβ‐HCG、黄体酮水平，计算各组48h后β‐HCG的倍增率，对结果进行分析。结果与先兆流产组相比较，稽留流产组和异位妊娠组的β‐HCG、fβ‐HCG、黄体酮水平及β‐HCG倍增率差异均有统计学意义（P＜0．05）。稽留流产组与异位妊娠组之间各指标差异则无统计学意义（P＞0．05）。结论β‐HCG和fβ‐HCG水平变化可反映不良妊娠。     

米非司酮配伍甲氨喋呤治疗宫外孕临床分析

目的探讨米非司酮配伍甲氨喋呤治疗宫外孕的临床疗效。方法米非司酮组44例，米非司酮配伍甲氨喋呤组45例。结果两者保守治疗宫外孕成功率有显著差异（P〈0．01）。米非司酮配伍甲氨喋呤组血中β人绒毛膜促性腺激素（β-HCG）下降速度大于米非司酮组（P〈0．01）。结论推荐使用米非司酮配伍甲氨喋呤进行宫外孕保守治疗。     

带宫内节育器妊娠行药物流产的可行性观察

目的：探讨药物流产应用于带器妊娠的临床效果。方法：研究112例带器妊娠者及与之配对120例早孕者，均服用米非司酮及米索前列醇行药物流产。观察流产过程情况。结果：完全流产率：带器妊娠组91．07％，对照组90．83％，两者无显著差异（P〉0．05）。流血时间及出血量无显著差异（P〉0．05）。结论：米非司酮合并米索列醇药物流产可用于带器妊娠。     

中药神阙穴贴敷联合黄体酮对肾虚型早期先兆流产患者的护理干预

目的：探讨中药神阙穴贴敷联合黄体酮护理干预肾虚型早期先兆流产患者的临床疗效。方法将60例肾虚型早期先兆流产患者随机分为对照组和治疗组,2组在实施先兆流产常规护理的基础上,对照组30例单纯采用黄体酮肌肉注射治疗,治疗组30例给予中药神阙穴贴敷联合黄体酮治疗,然后对2组治疗后的临床疗效及阴道出血和腰痛、腹痛的消失时间进行比较,同时动态监测血清黄体酮和β－HCG 水平。结果治疗组临床治疗有效率显著优于对照组（P ＜0．05）;治疗组临床症状的消失时间显著短于对照组（P ＜0．05）;治疗组、对照组血清黄体酮水平与治疗前相比差异有统计学意义（P ＜0．05）,治疗后2组间比较差异无统计学意义（P ＞0．05）;治疗组、对照组β－HCG 水平与治疗前相比差异有统计学意义（P ＜0．05）,治疗后2组间比较差异有统计学意义（P ＜0．05）。结论中药穴位贴敷联合黄体酮治疗早期先兆流产可以缩短治疗时间,提高孕激素水平,改善黄体功能,能够有效避免流产的继续发展,提高了保胎成功率。     

氨甲喋呤单次肌肉注射治疗异位妊娠37临床观察

对37例生命体征稳定，无腹腔内活跃出血表现的异位妊娠患者采用MTX单次肌肉注射（50mg/m^2），不用四氢叶酸解毒的方案治疗，治愈标准为血β－HCG正常，结果33例成功，成功率89．2％，成功与失败患者的孕龄，异位妊娠包块直径间的差异无显著性（P＜0．05），但治疗前腹痛症状的发生率及血β－HCG间的差异有显著性（P＜0．05）。结论：早期诊断和严格筛选病例是此方法治疗成功的关键。无腹疼症状、异位妊娠包块直径≤5cm、血β－HCG＜2000IU／L为药物治疗的适应症。     

米非司酮配伍米索前列醇终止早孕的效果观察

目的：观察米非司酮配伍米索前列醇终止早孕的效果及影响因素。方法：750例平素月经规律、妊娠3个月未使用激素治疗，无药物流产禁忌证的患者，采用序贯口服米非司酮及米索前列醇，观察孕周孕次、孕囊直径、子宫位置对流产成功率的影响。结果：初孕与经孕流产成功率差异无统计学意义（P〉0．05）；孕周分为停经〈50d及≥50d，两组流产成功率分别为89．28％及77．05％，差异有统计学意义（P〈0．05）；以孕囊直径≤20mm与21～25mm、≥26mm三组问流产成功率差异无统计学意义（P〉0．05）；前屈位、前倾位、水平位、后倾位与后屈位流产成功率差异有统计学意义（P〈0．001）。结论：米非司酮配伍米索前列醇终止早孕能取得较满意的效果，流产效果与孕周及子宫位置有关。     

甲氨喋呤联合米非司酮治疗异位妊娠

目的：探讨甲氨喋呤（MTX）不同的给药方式联合米非司酮保守治疗异位妊娠的临床疗效。方法：回顾分析2005年1月～2010年12月确诊为异位妊娠行MTX联合米非司酮保守治疗的103例异位妊娠患者的临床资料。所有患者按不同的给药方式分为A、B、C3组,其中A组35例,肌肉注射MTX加口服米非司酮;B组41例,静脉滴注MTX加口服米非司酮;C组27例,在超声引导下穿刺异位妊娠囊注入MTX加口服米非司酮。比较3组患者的治疗成功率、血D人绒毛膜促性腺激素（pHCG）值下降率及用药后不良反应发生率。结果：（1）3组患者治疗成功率分别为A组71．4％（25／35）、B组82．9％（34／41）、C组96．3％例（26／27）。3组患者治疗成功率差异有统计学意义（P〈0．05）;（2）治疗前后血β—HCG值下降率分别为A组（44．9±7．5）％、B组（54．7±2．9）％、C组（63．0±6．2）％。3组患者治疗前后血β－HCG值下降率差异有统计学意义（P〈0．01）;（3）不良反应发生率A组和B组间差异无统计学意义（P〉0．05）,而A组和C组间、B组和C组间差异有统计学意义（P〈0。05）,C组的不良反应发生率最小。结论：对早期未破裂型异位妊娠,在超声引导下穿刺异位妊娠囊注入MTX加口服米非司酮治疗安全、可行、疗效肯定。     

保守治疗异位妊娠临床探讨

目的探讨各种保守治疗异位妊娠方法的成功率。方法对已用三种保守治疗方法（分别为米非司酮配伍甲氮蝶呤、单用甲氨蝶呤、5-氟尿嘧啶）治疗70例异位妊娠的临床资料作回顾性分析总结。结果孕龄≤45d,附件包块≤3cm,B—HCG≤2000u／L,无腹痛及无活动性腹腔内出血者,治疗成功率高于孕龄〉45d,附件包块〉3cm,有腹痛,但无活动性内出血者（P〈0．05或0．01）;其中米非司酮配伍甲氨蝶呤成功率最高（94．1％）,单用甲氨蝶呤次之（78．8％）,5-氟尿嘧啶法最低（50％）（P〈0．05或0．01）。结论孕龄、包块、B—HCG、腹痛是影响保守治疗疗效的四个重要因素,严格掌握适应证是治疗成功的关键,米非司酮配合甲氨蝶呤的杀胚保守治疗成功率最高。     

血清β-HCC及孕酮检测在先兆流产的临床应用

目的分析血清pHCG及孕酮检测在先兆流产中的临床应用价值。方法选取2007年1月-2012年12月在本院就诊的早孕患者90例,将孕期4-6周的孕妇作为研究对象,按其临床表现分为正常妊娠组、先兆流产组和流产组,每组各30例,在妊娠第4、5、6周,测定和比较3组孕妇血清孕酮和β-人绒毛膜促性腺激素（β—HCG）水平。结果在妊娠第4、5、6周,3组孕妇孕酮水平差异有统计学意义（组问差异P〈0．05）,流产组显著低于先兆流产组（P〈0．05）,先兆流产组显著低于正常妊娠组（P〈0．05）,而不同时点孕酮水平的差异无统计学意义（组内差异P〉0．05）;3组孕妇之间、不同时点之间β-HCG水平差异和不同组与不同时点的交互作用差异均有统计学意义（组间差异、组内差异、交互作用P均〈0．05）,流产组孕妇β-HCG水平显著低于先兆流产组（P〈0．05）,先兆流产组显著低于正常妊娠组（P〈0．05）。结论在妊娠早期,血清孕酮和β-HCG水平可作为反映胎儿状态和胎盘功能的重要指标以及早期诊断先兆流产的辅助指标,对孕妇血清孕酮和β-HCG水平的监测具有十分重要的临床意义。     

甲氨蝶呤联合米非司酮治疗异位妊娠的护理

目的：探讨甲氨蝶呤联合米非司酮治疗异位妊娠的临床护理措施。方法对128例异位妊娠患者行甲氨蝶呤联合米非司酮药物保守治疗,测定患者血β-人绒毛膜促性腺激素（HCG）水平,B超检查妊娠包块大小,用药过程中给予心理、饮食和日常活动、病情观察、药物不良反应等综合护理,并对患者进行出院指导。结果128例患者中,121例治疗成功,成功率为94．5％。治疗后1周与治疗前相比,患者血β-HCG水平和异位妊娠包块直径均下降,差异有统计学意义（ t值分别为33．2,8．9;P ＜0．05）;治疗后2,3,4周,患者血β-HCG水平低于治疗后1周,差异有统计学意义（t值分别为64．2,78．3,105．9;P＜0．05）;治疗后2,3,4周,患者包块直径小于治疗后1周,差异有统计学意义（t值分别为6．4,7．5,8．3;P＜0．05）。治疗过程中有5例（3．9％）患者出现胃肠道反应,分别有3例（2．3％）患者转氨酶轻度升高与白细胞减少,分别有2例（1．6％）患者出现口腔溃疡与骨髓抑制,给予相应处理后均恢复正常。结论甲氨蝶呤联合米非司酮保守治疗异位妊娠时,应给予患者积极的心理护理,加强临床护理,密切观察患者病情变化,以促进患者康复。     

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.