产前超声多切面并节段分析法筛查胎儿圆锥动脉干畸形的应用价值

目的:探讨产前超声多切面并节段分析法筛查胎儿圆锥动脉干畸形的应用价值。方法:回顾性分析2013年1月~2016年10月我院应用多切面并节段分析法检出40例胎儿圆锥动脉干畸形的声像图特征。结果:产前超声诊断法洛四联症(TOF)10例,大动脉转位(TGA)8例,右室双出口(DORV)12例,永存动脉干(PTA)10例。40例均经我科三名副主任以上医师会诊,18例我院引产后部分经病理解剖证实,1例足月分娩后超声心动图证实,外院引产21例。结论:产前多切面并节段分析法是筛查胎儿圆锥动脉干畸形的可靠方法,具有较好的临床应用价值。     

胎儿圆锥动脉干畸形与染色体异常及临床结局的关系

目的探讨圆锥动脉干畸形（CTD）胎儿的产前诊断结果和临床结局,分析CTD与染色体异常的关系。方法选取2012年1月至2021年12月在苏北人民医院经产前胎儿畸形筛查确诊胎儿CTD并进行胎儿染色体检查的136例孕妇（均为单胎妊娠）为研究对象,结合CTD胎儿的产前诊断结果和临床结局,采用染色体G显带核型分析和染色体低深度全基因组高通量测序分析CTD与染色体异常的关系。结果136例CTD胎儿中检出染色体异常27例,检出率为19.85%,其中染色体数目异常13例,致病性拷贝数变异（CNV）14例;永存动脉干胎儿的染色体异常检出率最高,完全性大动脉转位胎儿的染色体异常检出率最低;合并心外畸形、同时合并心内、心外畸形胎儿的染色体异常率较高,单纯组胎儿的染色体异常率最低。结论CTD胎儿的染色体异常检出率较高,同时合并心内、心外畸形的胎儿更易伴有染色体异常。产前检查中若发现胎儿患有CTD或超声心动图检查提示CTD胎儿合并多器官异常时,应行介入性产前诊断排除染色体异常。     

圆锥动脉干畸形的产前超声诊断价值

目的 探讨圆锥动脉干畸形产前超声诊断方法,分析产前超声诊断圆锥动脉干畸形的临床价值.方法 回顾性分析2008-2012年36例胎儿圆锥动脉干畸形头侧偏转法和三阶段分析法检查的超声资料,总结产前诊断圆锥动脉于畸形的方法,探讨产前诊断圆锥动脉干畸形的价值.结果 法洛四联症12例,肺动脉闭锁7例,永存动脉干3例,大动脉转位5例,右心室双出口9例.结论 单一的四腔心切面较难发现圆锥动脉干畸形,双流出道切面及三血管-气管切面可提高其诊断率,对于部分大血管发育不良的病例,应用心脏三阶段分析法可进一步提高诊断率.产前超声诊断圆锥动脉干畸形,观察其心室及大动脉发育,有着重要的临床价值.     

产前超声心动图诊断胎儿永存动脉干的图像特征及意义

目的探讨产前超声心动图诊断胎儿永存动脉干(PTA)的图像特征及意义。方法回顾性分析2017年1月至2019年5月于四川省妇幼保健院超声医学科行产前胎儿超声心动图检查诊断为PTA 42例胎儿的图像特征,并随访观察胎儿PTA的类型、合并其他畸形情况及孕妇妊娠结局。结果 42例诊断为PTA的胎儿按照Van Praagh分类法共分为4型,其中A1型30例,占71%,合并心内畸形共22例,心外畸形15例; A2型7例,占17%,合并心内畸形3例,心外畸形2例; A3型4例,占10%,合并心内畸形1例,心外畸形0例; A4型1例,占2%,未合并心内外畸形。随访结局:41例因合并畸形引产,引产后病理均证实为永存动脉干,同时对具体分型及合并畸形情况也做了病理证实; 1例出生,患儿超声心动图证实为PTA A1型,生后6天家属放弃治疗。结论 PTA类型复杂且常合并其他畸形情况,详细的产前超声心动图检查对诊断胎儿PTA及其分型具有重要的临床意义,但应注意与胎儿其他复杂心脏病相鉴别。     

先天性异常与优生学

081630胎儿心脏大动脉畸形的产前超声心动图诊断技术探讨/王鸿…∥中国优生与遗传杂志.—2008,16(10).—94～95目的:探讨胎儿心脏大动脉畸形的产前超声心动图诊断方法及操作技术路线。方法:对已检出的117例胎儿复杂型先天性心脏病(先心病)合并大动脉畸形胎儿进行回顾性分析并与尸检和出生后手术及超声检查进行对比。结果:117例复杂先心病胎儿的大动脉交叉图显示无交叉关系及交叉关系异常65例(55.5%);检出大动脉内径及瓣膜异常为51例占43.5%(其中大动脉内径异常35例;主动脉瓣/肺动脉瓣狭窄16例)。结论:胎儿心脏大动脉畸形在胎儿心脏病诊断中属难度最大和最易发生漏诊,检查中应明确血流动力学异常改变及动态显示有无大动脉交叉切面及血管排列、内径、瓣膜形态及数量、瓣上和流出道等异常改变。表1参7(原文摘要)先天性异常与优生学     

产前超声诊断大动脉转位的临床价值

目的探讨产前超声诊断大动脉转位的临床价值。方法对受检胎儿采用二维超声心动图检查,包括四腔心、左室流出道、右室流出道、心底短轴、主动脉弓、动脉导管弓、三血管切面及三血管气管切面等的扫查,重点观察胎儿房室连接、心室与大动脉的连接关系。对产前诊断的18例大动脉转位的超声心动图征象及合并心内畸形情况与产后随访结果进行回顾性分析。结果产前超声诊断大动脉转位18例（完全性大动脉转位14例,矫正型大动脉转位4例）,超声诊断符合率为88.9%,误诊2例,15例合并心内畸形。结论产前超声诊断大动脉转位方便可靠、简洁无创。     

产前超声检查对胎儿心脏大动脉畸形的诊断价值

目的：探讨产前超声检查对胎儿心脏大动脉畸形诊断价值。方法收集2010年3月-2014年7月该院明确诊断30例心脏大动脉畸形胎儿临床资料进行研究,分析其胎儿超声图像,总结大动脉畸形超声图像特征。结果30例患者中均被明确诊断为胎儿心脏大动脉畸形,大动脉畸形患儿在三血管气管(3VT)切面上均表现为阳性,检查结果得出大动脉内径异常18例,其中包括主动脉弓缩窄2例,主动脉弓断离3例,主动脉狭窄3例,肺动脉狭窄10例;大动脉交叉关系消失8例,其中包括大动脉转位4例,右室双出口4例;永存动脉干3例;右位主动脉弓1例。结论3VT切面诊断胎儿心脏大动脉畸形具有较高敏感性,可作为胎儿心脏大动脉畸形重要辅助方法。     

胎儿心脏连续扫查方法在产前诊断圆锥干畸形中的意义

目的分析胎儿心脏连续扫查法在产前诊断胎儿心脏圆锥动脉干畸形中的诊断价值。方法选取2016年1月至2018年6月5000例至医院进行产前检查的单胎妊娠孕妇作为观察对象,所有孕妇均行胎儿心脏超声筛查,对于可疑的胎儿使用连续扫查法进行进一步观察。同时产后检查或尸检结果与产前超声检查进行对比,分析超声节段检查以及超声节段检查联合连续扫查的诊断准确率。结果在5000例孕妇中有13例产后超声心动图或尸检检查证实为心脏圆锥动脉干畸形。超声节段检查诊断10例,漏诊1例,误诊2例,诊断准确率为76.9%;超声节段检查联合连续扫查诊断12例,漏诊1例,诊断准确率为92.3%,两种检查方法之间的比较差异有统计学意义(P0.05)。结论胎儿心脏连续扫查法在产前诊断胎儿心脏圆锥动脉干畸形中具有较高的诊断价值,能够提高心脏圆锥动脉干畸形产前筛查的检出率与诊断率,提高出生人口的质量。     

2DE联合STIC技术对孕妇产前胎儿心脏大动脉畸形的诊断价值

目的探讨二维超声心动图(2DE)联合四维超声时空关联成像(STIC)技术对孕妇产前胎儿心脏大动脉畸形的诊断价值。方法选取2016年3月至2018年4月郑州人民医院收治的137例疑似伴有胎儿心脏大动脉畸形的孕妇,均接受2DE、STIC技术检查。对比两者联合与单项诊断的特异度、敏感度及符合率。结果以引产后胎儿心脏病理检查或出生后新生儿超声心动图检查为金标准。137例疑似伴有胎儿心脏大动脉畸形的孕妇中,35例伴有心脏大动脉畸形。两者联合诊断的敏感度和符合率高于2DE、STIC单独诊断(P<0.05)。结论 2DE联合STIC技术可提高胎儿心脏大动脉畸形诊断符合率及敏感度,为产前筛查提供准确的科学依据。     

三血管观联合双弓切面在超声诊断胎儿大血管畸形中的应用

目的 探讨三血管观联合双弓切面在胎儿大血管畸形产前超声诊断中的临床意义.方法 对2004年2月-2011年12月孕22~35周60例胎儿心血管异常的超声检查资料进行回顾性分析.结果 60例胎儿大动脉异常包括大动脉血管内径异常19例、大动脉排列异常38例、大动脉数目异常3例.结论 三血管观联合主动脉弓、动脉导管弓切面检查方法简便、安全、可靠,是诊断先天性心脏大血管畸形的主要方法,可以提高胎儿大动脉畸形的检出率和准确性.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.