早期卵裂与常规体外受精胚胎质量的相关性研究

目的探讨早期卵裂(EC)与常规体外受精(IVF)胚胎质量的关系,评估EC能否作为胚胎体外发育潜能的一个预测指标。方法对619个IVF周期共3 646枚正常受精胚胎进行早期卵裂观察和第3天(D3)卵裂期胚胎质量评估;对其中682枚D3优质胚胎和2 180枚D3非优质胚胎进行囊胚培养,于第5天(D5)和第6天(D6)进行囊胚期胚胎质量评估。根据EC观察结果,将胚胎分成三组:EC组、原核消失(PNBD)组和原核还在(NPNBD)组。结果 D3胚胎平均卵裂球数EC组胚胎显著多于PNBD组和NPNBD组(P 0. 05),NPNBD组最低; D3优质胚胎率EC组与PNBD组差异无统计学意义(P 0. 05),但是两组均显著高于NPNBD组; EC组D3可冻胚胎率和D3可用胚胎率均显著高于PNBD组和NPNBD组(P 0. 05),NPNBD组最低。D3优胚行囊胚培养,D5囊胚形成率和D5优质囊胚率三组之间差异无统计学意义(P 0. 05),D5可冻囊胚率PNBD组显著高于NPNBD组(P 0. 05);总囊胚形成率、总优质囊胚率和总可冻囊胚率在三组之间差异无统计学意义(P 0. 05)。D3非优胚行囊胚培养,EC组D5囊胚形成率、D5优质囊胚率、D5可冻囊胚率、总囊胚形成率、总优质囊胚率和总可冻囊胚率均显著高于PNBD组和NPNBD组(P 0. 05)。结论发生EC的胚胎发育速度较快,更容易发育成高质量的D3卵裂期胚胎,EC可以作为D3胚胎质量的一个预测指标。早期卵裂D3优质卵裂胚胎体外囊胚发育结局与非早期卵裂D3优质胚胎相比没有明显差异,EC可能不足以作为D3优质卵裂胚胎囊胚体外发育潜能的额外预测指标。     

体外胚胎培养液代谢组学分析在评价胚胎发育潜能的研究进展

代谢组学是对溶液、组织、细胞等生物样本中的小分子代谢物进行定性和定量分析,从而得到生物体受外界刺激后其代谢水平的整体变化的结果。其研究过程包括代谢组数据的采集、预处理、多变量数据分析、标记物识别和途径分析等步骤。代谢组学作为一种新兴技术,在辅助生殖技术中具有很好的应用前景。胚胎的发育和代谢是个动态过程,应用质谱分析、光谱分析和磁共振波谱技术能客观、全面、准确、无创地反映胚胎质量及其发育潜能,可作为胚胎形态学评估的补充,从而提高胚胎种植率,提高单胚胎移植的妊娠率。     

胚胎干细胞在预测毒理学中的应用前景

建立和完善既短期、经济,又能大通量筛检环境污染物对人类的毒性一直是预测毒理学中主要研究热点。胚胎干细胞具有自我更新和多向分化的特性,有望成为毒性安全性评价的体外替代实验模型。本文主要对预测毒理学现有方法的缺陷、胚胎干细胞的生物学特性和在预测毒理学中的应用研究进展进行综述。     

优质护理在妊娠高血压综合征中的应用价值及顺产率分析

目的研究优质护理在妊娠高血压综合征中的应用价值及顺产率。方法根据随机数字表法将2018年7月至2019年6月期间本院接收的妊娠高血压综合征患者76例分为两组,对照组38例进行常规护理,观察组38例采取优质护理。将两组的血压水平、24h尿蛋白、顺产率、护理满意度进行比对。结果观察组妊娠高血压综合征患者干预后的舒张压、收缩压、24h尿蛋白均低于对照组,顺产率及护理满意度高于对照组(P<0.05)。结论对妊娠高血压综合征患者采用优质护理的临床应用价值高,可提升血压控制效果和顺产率,效果令人满意。     

头面部望诊在脑梗死发病中的预测价值研究

目的探索头面部望诊在预测及诊断脑梗死中的规律。方法通过对头面部望诊信息的采集,并与颅脑磁共振成像(MRI)检查结果相对照,进行统计分析,归纳脑梗死患者头面部望诊与颅脑MRI检查结果的相关性。结果 76例望诊有异常的患者行即刻头颅MRI检查,确诊患有脑梗死者13例;63例望诊有异常的头颅MRI阴性患者中,6个月后行头颅MRI检查,新出现脑梗死者3例;第6个月时段的60例望诊有异常的头颅MRI阴性患者中,1年后行头颅MRI检查,新出现脑梗死者5例。76例望诊有异常的患者病例纳入时及纳入1年后出现脑梗死总计21例(27.6%)。结论头面部望诊具有预测和诊断脑梗死存在的价值。     

围产期护理在妊娠合并糖尿病患者中的应用价值及母婴并发症率分析

目的体会在妊娠合并糖尿病患者临床护理中,应用围产期综合护理干预的临床价值。方法将56例该院于2018年1—12月内收治的妊娠合并糖尿病患者为研究对象,护理模式差异为分组原则,设对照组行常规护理,设观察组行围产期综合护理干预;观察两组血糖水平、母婴并发症发生率。结果观察组血糖水平较低,母婴并发症发生率7.1%,对照组28.5%(P<0.05)。结论对妊娠合并糖尿病患者实施护理措施,建议采纳围产期综合护理干预,可降低血糖水平的同时改善妊娠结局,值得推广。     

鼻胃镜的临床应用价值及评估

目的探讨超细电子经鼻胃镜(简称鼻胃镜)的临床诊断价值及其可行性。方法按照随机抽样的原则,从来我院消化内镜中心行胃镜检查的患者中随机抽取160例,组成超细胃镜经鼻插入组(A组,80例)和普通胃镜经口插入组(B组,80例)。用心电监护仪动态监测其胃镜检查前及检查过程中的收缩压、舒张压、心率及血氧饱和度。结果两组患者的血氧饱和度在胃镜检查过程中均略有降低,但差异无统计学意义(P0.05);两组患者的收缩压、舒张压有变化和心率都加快,但B组的加快更明显(P0.05)。结论鼻胃镜经鼻腔插入不接触舌根,其耐受性更好,安全性更高,有更广泛的临床应用前景。     

Spondin-2在肝细胞癌组织中的表达及对预后的预测价值

目的 探讨脊椎蛋白-2(Spondin-2)在肝细胞癌（HCC）组织中的表达及对患者预后的预测价值。方法 选择2019年5月至2020年1月连云港市第一人民医院收治的89例HCC患者作为研究对象,患者均接受HCC根治术,术后随访3年。术中采集入组患者的HCC组织和癌旁组织,采用免疫组织化学法检测组织中Spondin-2的表达水平,并分析HCC组织中Spondin-2的表达与患者临床病理特征的关系。采用Kaplan-Meier法绘制生存曲线,以log-rank检验分析HCC组织中Spondin-2的表达与患者无瘤生存率的关系。采用Cox比例风险回归模型分析影响HCC患者复发的因素。结果 HCC组织中Spondin-2的阳性表达率显著高于癌旁组织（82.02%比51.69%）,差异有统计学意义（P<0.001）。低分化、肿瘤包膜不完整、TNM分期Ⅲ期、有微血管侵犯者的HCC组织中Spondin-2的阳性表达率分别高于中高分化、肿瘤包膜完整、TNM分期Ⅰ～Ⅱ期、无微血管侵犯者,组间差异均有统计学意义（P均<0.05）。多因素Cox回归模型分析结果显示,肿瘤包膜完整性、分化程度、微...     

妊娠中期心血管超声参数与肝功能的相关性及对不良妊娠结局的预测价值

目的 探讨妊娠中期心血管超声参数与肝功能的相关性,以及两者对孕妇不良妊娠结局的预测价值。方法 回顾性分析2021年1月至2023年1月于上海市闵行区中心医院定期产前检查并生产的200名产妇,根据其妊娠结局分为非不良妊娠结局组(n=108)和不良妊娠结局组(n=92)。对比两组妊娠中期的基线资料、孕期心血管超声参数[左心室后壁厚度(LVPWd)、左心室收缩末期内径(LVESd)、左心室舒张末期内径(LVEDd)和室间隔厚度(IVSd)、左心室射血分数(LVEF)、左心房直径(LAD)、二尖瓣口舒张早期血流峰值速度/二尖瓣口舒张晚期血流峰值速度(E/A)、E/二尖瓣环室间隔侧和侧壁舒张期早期峰值速度平均值(e’)]及肝功能指标[谷草转氨酶(AST)、谷丙转氨酶(ALT)、总胆红素(TBIL)]。Pearson相关分析评估妊娠中期心血管超声参数与肝功能指标间的相关性,ROC分析评估妊娠中期心血管超声参数与肝功能对孕妇不良妊娠结局的预测价值。结果 不良妊娠结局组孕妇妊娠中期的收缩压、舒张压显著高于非不良妊娠结局组(P <0.05),出现轻度高血压的孕妇的比例显著高于非不良妊娠结局组的孕妇...     

心率变异、心室晚电位、Q-T离散度对心肌梗塞患者心脏事件发生的预测价值

５０例心肌梗塞（ＭＩ）患者短时心率变异（短时ＨＲＶ）、心室晚电位（ＶＬＰ）、和Ｑ－Ｔ离散度（Ｑ－Ｔｄ）三项指标的测定，与３０例正常人进行对比分析，结果表明：梗塞组短时ＲＲ标准差（ＳＤＲＲ）及立卧位心率差值均较对照组明显缩小（Ｐ＜０．００１，Ｐ＜０．００５），ＶＬＰ阳性率明显增高（Ｐ＜０．０２５），Ｑ－Ｔｄ明显延长（Ｐ＜０．００１）。梗塞患者事件组与非事件组三项指标比较相差显著（Ｐ＜０．００１～０．００５）。事件组分类后三项指标对“猝死”的价值最大。在对心脏事件发生的预测方面，敏感性最高的是短时ＳＤＲＲ，特异性最高是ＶＬＰ，有效性最高的是Ｑ－Ｔｄ，相对危险性依次为ＶＬＰ、Ｑ－Ｔｄ、短时ＳＤＲＲ，说明该三项指标均有较高的预测价值。如果同时监测可见随着异常指标项目的增加其预测价值更可靠，临床意义更大。     

Systolic murmurs in pregnancy: value of echocardiographic assessment

A systolic murmur discovered in antenatal care is the most common reason for cardiological assessment during pregnancy. We have assessed the value of clinical and echocardiographic assessment in 50 consecutive patients who were referred to our cardiac clinic following the discovery of a cardiac murmur at an antenatal clinic. Most of the murmurs occurred at 10-12 weeks gestation; 46 subjects had cardiac murmurs confirmed at the cardiac clinic, of whom 16 gave a history suggestive of a previous cardiovascular disorder. Of the 16 patients, 13 had been found to have a murmur earlier in life which was thought to be of no clinical significance. Complications during pregnancy were infrequent. The most frequent murmur discovered was a soft midsystolic murmur heard with greatest intensity at the left sternal edge. The results of electrocardiography and echocardiography were not helpful in assisting with the diagnosis or substantially altering antenatal management in these patients. We do not feel that echocardiography has an important role in the assessment of systolic murmurs in pregnancy in the absence of other clinical or ECG abnormalities.     

Application of non-invasive central aortic pressure assessment in clinical trials: Clinical experience and value

Pressure measured with a cuff and sphygmomanometer in the brachial artery is accepted as an important predictor of future cardiovascular (CV) events. However, recent clinical evidence suggests that central aortic pressure (CAP) provides additional information for assessing CV risk than brachial blood pressure (BrBP). Central hemodynamics can now be non-invasively assessed with a number of devices, however, the methodology employed to measure CAP, in order to better identify the patients at higher CV risk in clinical practice, is still controversial. The purpose of this article is to review the technology behind the non-invasive measurement of CAP via the effects of different classes of antihypertensive drugs on CAP and the data supporting the predictive value of assessing CAP on clinical outcomes, and to foster the transfer of methodological knowledge from clinical trials into routine clinical practice.     

心率震荡对心脑血管疾病危险性的预测价值

心率震荡(HRT)是指正常个体自发性室性早搏(室早)后窦性心率先是短暂的加速,随后短暂的心率逐渐减速的现象。这种现象也可发生于程控性室早或室上性早搏之后,反映了自主神经在早搏后     

Phenotype and hematopoietic potential of side population cells throughout embryonic development

Adult murine bone marrow hematopoietic stem cells (HSCs) can be purified by sorting Hoechst 33342-extruding side population (SP) cells. Herein we investigated whether SP cells reside within embryonic tissues and exhibit hematopoietic progenitor activity. We isolated yolk sac (YS) and embryonic tissues 7.5 to 11.5 days after coitus (dpc), resolved an SP in each, and demonstrated that these SP cells exhibit distinct phenotypic and functional characteristics throughout development. YS and embryonic SP isolated 8.0 dpc expressed vascular endothelial-cadherin (VE-cadherin) and vascular endothelial receptor 2 (Flk-1), markers not expressed by bone marrow SP but expressed by endothelial cells and progenitors. SP at this stage did not express CD45 or produce hematopoietic colonies in vitro. In contrast, SP isolated 9.5 to 11.5 dpc contained a significantly higher proportion of cells expressing cKit and CD45, markers highly expressed by bone marrow SP. Furthermore, YS SP isolated 9.5 to 11.5 dpc demonstrated 40- to 90-fold enrichment for hematopoietic progenitor activity over unfractionated tissue. Our data indicate that YS and embryonic SP cells detected prior to the onset of circulation express the highest levels of endothelial markers and do not generate blood cells in vitro; however, as development progresses, they acquire hematopoietic potential and phenotypic characteristics similar to those of bone marrow SP.     

Predictive clinical value of nutritional assessment factors in COPD

Thirty-nine stable outpatients with moderate-to-severe chronic obstructive pulmonary disease (COPD) were studied prospectively to determine the predictive value of several nutritional factors on the clinical outcome. Physiologic evaluation including FEV1, diffusing capacity, PaO2, as well as nutritional evaluation including triceps skin fold (TSF), midarm muscle circumference, body weight percentage of standard, history of 5 percent weight loss in the year prior to clinic visit, and average daily caloric intake based on a three-day diet record were all done at the clinic visit. Hospitalization or death during the six months to one year following the initial evaluation were the clinical outcome factors evaluated. Five of the 16 patients (31 percent) needing hospitalization during that time had weight loss during the year prior to the initial evaluation, while eight out of the 23 (35 percent) not requiring hospitalization had weight loss. There was a significantly lower TSF percent standard (TSF%) in the subgroup who subsequently required hospitalization (p less than 0.05). Nonhospitalized patients with severe depletion of body fat (TSF% less than 60) at initial evaluation ingested significantly more calories per kilogram than the severely depleted patients requiring hospitalization in the next six to 12 months (p less than 0.05) suggesting a protective effect of increased caloric intake. Increased caloric intake did not improve mortality statistics.     

Added value of co-morbidity in predicting health-related quality of life in COPD patients.

The extent to which a chronic obstructive pulmonary disease (COPD) patient is impaired in health-related quality of life (HRQoL) is only to a small extent reflected in clinical and demographical measures. As the influence of comorbidity on HRQoL is less clear, we investigated the added value of 23 common diseases in predicting HRQoL in COPD patients with mild to severe airways obstruction. COPD patients from general practice who appeared to have an forced expiratory volume in 1 sec/inspiratory vital capacity (FEV1/IVC) < predicted -1.64 SD, FEV1 <80% predicted, FEV1 reversibility < 12% and a smoking history, were included (n=163). HRQoL was assessed with the short-form-36 (SF-36) and the presence of comorbidity was determined by a questionnaire, which asked for 23 common diseases. All domains of the SF-36 were best predicted by the presence of three or more co-morbid diseases. FEV1 % predicted, dyspnoea and the presence of one or two diseases were second-best predictors. Co-morbidity explained an additional part of the variance in HRQoL, particularly for emotional functioning (delta R2=0.11). When individual diseases were investigated, only insomnia appeared to be related to HRQoL. As HRQoL is still only partly explained, co-morbidity and other patient characteristics do not clearly distinguish between COPD patients with severe impairments in HRQoL and COPD patients with minor or no impairments in HRQoL. Therefore, it remains important to ask for problems in daily functioning and well-being, rather than to rely on patient characteristics alone.     

心率变异性在预测脑卒中后感染的应用价值

目的探究心率变异性在脑卒中感染中的预测价值。方法脑卒中患者75例,入院后24 h内进行24 h动态心电图监测,随访入院后3~5 d内发生感染、脓毒血症及全身炎症反应综合征(SIRS)的发病情况,分析心率变异性指标分析心率变异性总功率(TP)、低频功率(LF)、极低频功率(VLF)、LF与高频功率(HF)的比值(LF/HF)、R-R间期的标准差(SDNN)等指标与感染的相关性,Logistic回归模型及受试者工作特征曲线下面积(AUC)值验证各指标在预测感染的适用性。结果通过单因素分析显示梗死面积、糖尿病病史、美国国立卫生研究院脑卒中量表(NIHSS)评分及A2DS2为脑卒中后感染的危险因素;白天VLF与感染的发生具有相关性,AUC=0.68(0.55~0.79,P<0.05);夜间VLF与脓毒血症及全身炎症反应综合征的发生相关(P<0.05)。结论VLF在预测脑卒中后感染中有应用价值,脑卒中患者入院后立即进行24 h心电图监测,可及时发现脑卒中后感染的高危患者,为临床的进一步治疗提供依据。