郴州市某医院儿科0～6岁儿童家长铅中毒防治知识调查

目的 了解郴州市儿童家长对铅中毒防治相关知识的认知现状,以便更好地做好儿童铅中毒的预防.方法 对146名郴州市某医院儿科的0～6岁儿童家长就儿童铅中毒的防治知识了解情况进行问卷调查.结果 城乡差异、不同文化程度、不同年龄段儿童家长等因素会影响家长对儿童铅中毒知识的了解,城市地区、文化程度高、婴幼儿期(0～3岁)的家长对儿童铅中毒防治知识得分相对更高,分别为(6.90±1.82)分、(6.87±2.02)分和(6.76±1.70)分(P＜0.05);不同性别家长的铅中毒防治知识差异无统计学意义.结论 家长对儿童铅中毒有不同程度的认识,但还存在一些误区和不足,应当加大铅中毒知识的健康教育.     

低含量铅的接触时对儿童健康的危害

目的：探讨低含量铅的接触对儿童健康的危害。随着都市化、工业化的发展，环境日益污染，生活中铅的利用逐渐增多，人们对铅的接触也在逐渐增多。如农药的使用，植物中铅污染，燃油的燃烧及排放，家庭中的化妆品、染发剂、增白剂等的使用。造成了儿童对低度铅接触，直接危害到儿童消化系统、血液循环系统、神经系统。危害了儿童的身体健康和身体发育。方法：对包头市青山区医院医保体检及就诊儿童的150名儿童从2001年1月至2001年10月份，采用全组Znop检测，测定血红蛋白（Hb）值。根据1985年美国疾病控制中心（CDC）儿童铅中毒指南的诊断标准，Znpp超过0.622μmol/L,提示可能中毒。结果：儿童的铅水平随着年龄增长，呈逐步上升趋势。根据美国CDC儿童中毒指南的诊断标准，本次调查了150名儿童，有117名儿童呈现铅中毒现象。其中Ⅱ级铅中毒72名，占铅中毒儿童的61.5％；Ⅲ级铅中毒45例，占铅中毒儿童的38.46%。结果显示城市日常生活中铅接触导致儿童中毒以轻中度居多。结论；铅可通过皮肤、消化道、呼吸道进入体内与多种器官亲和，对神经系统、血液循环系统、消化道系统、泌尿系统等造成损害；严重影响体内的新陈代谢，阻塞金属离子的代谢通道；造成低钙、低锌、低铁，导致补充困难，出现神经系统症状，代谢障碍等；使儿童智商降低，反应迟钝，活动差，记忆力减退，直接危害儿童身心健康。所以要加强环境保护，加大防止铅污染对儿童铅中毒知识及健康教育的宣传，保障儿童的健康成长。     

儿童血铅1810例分析

随着现代化工业及交通业的迅猛发展，铅对环境的污染日趋严重。铅具有很强的神经毒性，能影响神经系统的多种功能，造成儿童多动、烦躁、注意力不集中、学习闲难、反应迟钝、弱视等症状，儿童神经系统正处于生长发育的阶段，对铅毒性尤为敏感。研究表明，即使是轻度铅中毒在引起明显神经系统症状前即可有神经毒性作用，因此，儿童铅中毒越来越受到儿童家长及社会各界的关注。我们于2004年1月-2006年12月对来我院儿童保健门诊就诊的1810例儿童进行铅测定，现将结果报道如下。     

承德市998例儿童血铅检测结果临床分析

目的：为了解承德市学龄前儿童血铅水平及铅中毒表现和危害，为儿童铅中毒防治提供科学依据。方法：采集2011年1月至2011年11月间，承德市妇幼保健院儿童保健科体检儿童和幼儿园体检儿童998例，年龄0—6岁，采用原子吸收光谱法测定未稍血的血铅水平。结果：儿童随着年龄的增长，铅中毒的百分率在增加，承德市双桥市区、郊区和双滦钢厂区，3个不同区域血铅中毒率的差异亦有统计学意义。结论：承德市学龄前儿童的血铅中毒率较高，血铅中毒与儿童生活区域有密切的关系，改善环境中的铅污染水平是减少儿童铅中毒的有效措施。铅对胎儿生长发育有很大影响，对于生长发育的儿童来说，铅对其智力发育、体格生长、心理行为有不可逆损害，儿童是中毒的易感人群，在同环境同水平下，铅对儿童的危害远高于成人。     

对儿童开展防治铅中毒健康教育初探

目的:是通过对3~6岁儿童筛检,探讨铅中毒的现状从而找到脱离铅源的对策和方法,为防治铅中毒提供依据。方法:是对家长的问卷,血清铅的测定,问诊和表现以及辅助检验找到铅源和对儿童的危害,制定和实施脱离铅源的对策和方法。结果:对儿童(血铅水平≤250μg/L)来说,通过健康教育和综合干预的方法,儿童的血铅水平会在短时间内降到正常范围,而不需要任何驱铅药物进行治疗。结论:通过对儿童铅中毒的筛检,开展对铅中毒的健康教育,对降低儿童铅中毒具有重要的意义。     

健康教育在预防接种工作中的应用与效果分析

目的：对健康教育在预防接种工作中的应用情况以及效果进行分析。方法：资料选自2012年1月~2013年12月在本院预防接种门诊实行接种的儿童家长600例,儿童（含双胞胎儿童）624例,将儿童家长平均分为2组,各300例,将进行健康教育的家长当作观察组,将未进行健康教育的家长当作对照组,观察组儿童314例,对照组儿童310例。调查接种儿童家长知晓预防接种知识的机率,并观察2组儿童接种后的不良反应情况。结果：对2组家长的预防接种知识的知晓率进行比较,观察组家长对预防接种知识的知晓率明显高于对照组;而观察组儿童接种后的不良反应发生率为7.96%,对照组儿童接种后的不良反应发生率为11.94%,2组比较差异有统计学意义（P＜0.05）。结论：在预防接种工作中开展健康教育,取得儿童和家长的信任,可明显提高接种儿童家长对预防接种知识的知晓率,从而提升接种率,使预防接种工作能顺利地进行,值得进一步推广应用。     

和田地区维吾尔族儿童家长预防接种知识知晓情况调查

目的了解和田地区维吾尔族儿童家长预防接种知识知晓情况,为探求当地有效宣传策略,做好预防接种工作提供依据。方法对和田地区3个县(市)的418名儿童家长进行预防接种知识知晓率及预防接种实施中遇到的困难问卷调查。结果和田地区儿童家长对预防接种目的、禁忌证、接种地点等知识知晓率高,预防接种证的相关知识(办理时间47.13%、地点及保留时间48.09%)知晓率低;随着文化水平的提高,儿童家长对预防接种知识的知晓率呈上升趋势,随着年龄的增长,儿童家长对预防接种知识知晓率呈下降趋势。电视、广播、村/社区干部、宣传资料为主要预防接种知识宣传途径。结论采取4种宣传途径引导和田地区儿童家长重视、妥善保管、充分使用预防接种证,提高预防接种率,保护儿童健康。     

系统保健监测对婴幼儿贫血、佝偻病患病率的影响

目的：探讨儿童系统保健监测对婴幼儿贫血、佝偻病患病率的影响。方法：对巴州镇经济、文化类似的东城、西城、江北、南坝社区的0．3岁的2374名婴幼儿进行了贫血、佝偻病普查，对婴儿坚持纯母乳喂养以及婴幼儿家长对科学喂养、“四病”防病知识的知晓情况进行了调查；对其中实行儿童系统保健监测的1301名婴幼儿和未实行儿童系统保健监测的1073名婴幼儿的贫血、佝偻病的患病情况和婴儿坚持纯母乳喂养以及婴幼儿家长对科学喂养、“四病”防治知识的知晓情况进行了比较。结果：各年龄组的贫血患病率、佝偻病患病率都是实施儿童系统保健监测婴幼儿低于未实施儿童系统保健监测婴幼儿，经统计学处理，差异均有显著性差异（P〈0．01）。实施儿童系统保健监测婴儿的纯母乳喂养率达87．40％。婴幼儿家长对科学喂养知识的知晓率达91．94％，对“四病”防治知识的知晓率达79．80％；未实施儿童系统保健监测婴儿的纯母乳喂养率仅35．79％，婴幼儿家长对科学喂养知识的知晓率仅46．23％，对“四病”防治知识的知晓率仅20．78％。结论：实施儿童系统保健监测可以显著降低婴幼儿贫血、佝偻病患病率。     

学龄前儿童家长的睡眠知识现状调查与分析

目的:了解学龄前儿童家长的睡眠知识现状,并采取相应措施。方法:采用分层整体抽样的方法,抽取城乡5所幼儿园1 452名学龄前儿童家长进行儿童睡眠知识问卷调查,对家长获取睡眠知识来源和不同辈份、不同文化程度对掌握儿童睡眠知识的影响进行统计学分析。结果:80%以上的家长主要是通过电视、广播获得儿童睡眠知识。家长对学龄前儿童睡眠知识的知晓率为47.95%,父母知晓率高于(外)祖父母(P<0.05),家长掌握睡眠知识知晓率随文化程度的升高而增加(P<0.05)。结论:家长对学龄前儿童睡眠知识知晓率低;睡眠知识受家长的辈份及文化程度影响,应加强宣传,提高家长对儿童睡眠知识的掌握。     

环境因素对儿童铅中毒的影响

目的：探讨环境因素对儿童铅中毒的影响,为预防儿童铅中毒提供依据。方法：选取凉城县范围内在儿童保健门诊健康体检的儿童329名,测其头发铅值,观察县城居民区与农村儿童铅中毒的情况。结果：儿童平均铅中毒发生率为47.10%,其中县城居民区儿童铅中毒发生率为62.65%,农村儿童铅中毒发生率为31.29%,县城居民区与农村相比,其儿童铅中毒发生率差异有统计学意义（P〈0.01）,县城居民区明显高于农村。结论：环境污染和不良的生活习惯可以导致儿童铅中毒     

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.