输卵管妊娠腹腔镜术后持续性异位妊娠的预防

目的 探讨输卵管妊娠腹腔镜术后持续性异位妊娠（PEP）发生的可能病因及预防措施。方法 回顾性分析该院2001年10月～2004年6月异位妊娠腹腔镜手术135例。结果发生PEP2例，发生率为1．48％，均为腹腔镜保守性手术后。结论 输卵管妊娠腹腔镜保守性手术后PEP发生可能性大，仔细、彻底清除妊娠组织，术中常规病灶两端输卵管及系膜注入氨甲喋呤（MTX），正确选择保守性手术病例，可以有效避免输卵管妊娠保守性手术后PEP的发生。术后严密监测β-HCG下降情况，及时静脉滴注MTX，可降低PEP的危险。     

输卵管妊娠保守性手术后持续性异位妊娠的相关因素分析

目的探讨输卵管妊娠腹腔镜保守性手术治疗后,发生持续性异位妊娠(PEP)的相关影响因素及预防。方法回顾性分析该院2000年1月￣2004年12月期间,326例输卵管妊娠腹腔镜保守性手术治疗患者的临床资料,并与同期240例输卵管妊娠经腹保守性手术治疗患者的临床资料进行对比分析。结果腹腔镜组持续性异位妊娠的发生率为2.76%,经腹组持续性异位妊娠的发生率为2.50%,两组比较差异无显著性(P<0.05),PEP的发生与孕龄大小、术前血清β-HCG水平、手术者的技能、术后氨甲喋呤(MTX)预防性应用有关。结论腹腔镜保守性手术治疗输卵管妊娠是安全有效的。严格掌握手术适应证,提高手术技巧,术后严密监测血清β-HCG变化,预防性使用MTX,对于降低术后并发症及PEP的发生尤为重要。     

甲氨蝶呤联合黄体剥除预防腹腔镜手术后持续性异位妊娠

目的观察甲氨蝶呤(MTX)联合黄体剥除防治输卵管妊娠腹腔镜保守性手术后持续性异位妊娠(PEP)的疗效。方法 有生育要求的输卵管型异位妊娠患者共102例,随机分成观察组60例,对照组42例,观察组腹腔镜下行输卵管切开清胚术,同时术中在患侧输卵管系注射甲氨蝶呤10 mg,并行黄体剥除,对照组腹腔镜下单纯行输卵管切开清胚术,两组患者均于术前,术后1、3、7、14 d监测血β-HCG至正常。结果观察组术后发生PEP例数为0,对照组术后发生PEP为3例(7.14%),差异有统计学意义(P0.01),术后β-HCG降至正常值时间:观察组为(12.1±5.6)d,对照为(19.7±6.2)d,差异有统计学意义(P0.01)。结论腹腔镜下输卵管妊娠保守性手术同时在患侧输卵管系膜注射MTX并黄体剥除,是预防PEP有效的方法,其疗效优于单纯腹腔镜保守性手术,值得临床推广。     

不同治疗方案对输卵管妊娠患者生活质量及血清因子水平的影响

目的探究不同治疗方案对输卵管妊娠患者生活质量及血清因子水平的影响。方法选取2018年2月～2020年2月我院收治的68例腹腔镜保守治疗的输卵管妊娠患者,随机分为对照组和试验组各34例。试验组在腹腔镜术前24～48h前给予甲氨蝶呤(MTX)50mg/m2肌内注射,对照组行腹腔镜术后于输卵管近端的浆肌层注射20mgMTX,两组患者术后均口服米非司酮。对比治疗前后两组患者血清血管内皮生长因子(VEGF)、人绒毛膜促性腺激素(β-HCG)水平;对比两组患者治疗后持续性异位妊娠(PEP)发生率、生活质量量表(SF-36)评分和不良反应发生率。结果治疗前,两组患者的β-HCG、VEGF水平比较,无显著性差异(P0.05);治疗后,试验组VEGF、β-HCG水平低于对照组,SF-36评分高于对照组(P0.05)。治疗后,试验组患者PEP发生率为5.88%,低于对照组26.47%(P0.05);两组患者不良反应发生率比较,差异无统计学意义(P0.05)。结论使用腹腔镜术前肌内注射MTX,术后口服米非司酮方案进行治疗能够降低输卵管妊娠患者VEGF、β-HCG水平和PEP发生率,提升患者生活质量,且不会显著增加不良反应。     

输卵管妊娠保守性手术后血HCG监测MTX应用探讨

【目的】探讨输卵管妊娠保守性手术后持续性异位妊娠（persistent ectopic pregnancy,PEP）发生与血HCG的关系及MTX应用对PEP的影响。【方法】回顾性分析本院2008年1月至2009年6月因输卵管妊娠行保守性手术120例的临床资料。【结果】保守性手术后发生PEP者5例,PEP的发生与停经时间、术前高水平的血清HCG值、术后24h血HCG下降率、妊娠部位、术后预防性使用甲氨蝶呤（MTX）等多因素有关（P〈0．01）,与手术方式无关（P〉0．05）。【结论】提高手术技巧、术后早期严密监测血清HCG值变化、预防性使用MTX是降低术后PEP发生率的关键。     

腹腔镜下局部应用甲氨蝶呤治疗输卵管妊娠的临床观察

【目的】探讨输卵管妊娠行腹腔镜保守手术时局部应用甲氨蝶呤的疗效。【方法1248例确诊为输卵管妊娠未破裂型的患者随机分成4组：A纽腹腔镜下清除病灶后局部注射生理盐水；B组腹腔镜下不行局部注射，而是立即行单次肌注甲氨蝶呤（MTX）50mg；C组腹腔镜下在病灶局部注射MTX20mg；D组腹腔镜下在病灶局部注射MTX50mg。观察术后持续性异位妊娠（PEP）发生率、血清β-绒毛膜促性腺激素（pHCG）水平变化、输卵管通畅情况及药物不良反应。【结果】A组PEP发生率为16．1％，B组为8．06％；C组和D组均为1．61％，A组明显高于其余组（P〈0．05），B组高于C组和D组（P〈0．05）；A组β-HCG水平在各个时点均高于其他各组（P〈0．05），C组和D组较B组下降更快，在术后3d、7d及12d均低于B组（P〈0．05）；A组手术侧通畅率59．7％，B组74．2％，C组91．9％，D组90．3％，A组通畅率低于其余组（P〈0．05），C组和D组通畅率高于B组（P〈0．05）；B组、C组和D组MTX不良反应无统计学差异（P〉0．05）。局部注射效果优于单次肌注，局部注射20mg与50mg无统计学差异。【结论】腹腔镜保守手术联合局部应用MTX20mg是要求保留生育功能的输卵管妊娠患者的适宜选择。     

垂体后叶素和甲氨蝶呤在异位妊娠腹腔镜保守手术中的应用

目的 探讨垂体后叶素和甲氨蝶呤(MTX)用于腹腔镜治疗输卵管妊娠的临床价值.方法 将未破裂输卵管妊娠患者136例,分观察组(腹腔镜开窗取胚术+局部注射垂体后叶素和MTX)及对照组(腹腔镜开窗取胚术)各68例,观察两组临床指标变化.结果 观察组较对照组术中出血减少,手术时间缩短;β-HCG值术后下降快;持续异位妊娠(PEP)发生率降低,差异均有统计学意义(P<0.05).结论 垂体后叶素和MTX用于异位妊娠腹腔镜保守手术可减少术中出血及预防术后PEP.     

小剂量甲氨蝶呤联合腹腔镜术保守治疗异位妊娠40例的疗效

目的：探讨采用小剂量甲氨蝶呤（MTX）联合腹腔镜保守治疗异位妊娠的临床疗效。方法将80例确诊为异位妊娠的患者按随机数字表法分为试验组和对照组,每组40例。对照组仅实施腹腔镜保守治疗,试验组在对照组腹腔镜保守治疗的基础上,给予MTX 25 mg＋0.9%氯化钠注射液5 mL进行稀释,于输卵管妊娠部位下方的肌层进行注射。对2组患者的手术时间、术中出血情况、住院时间、术后β-HCG的恢复时间,持续性异位妊娠（PEP）发生、输卵管再通及异位妊娠再发等情况进行比较。结果试验组患者的手术时间、住院时间及术后β-HCG恢复时间明显短于对照组、术中出血量明显少于对照组、PEP及异位妊娠再发率均明显低于对照组、输卵管再通率明显高于对照组（均P＜0.05）。结论采用小剂量MTX联合腹腔镜对异位妊娠患者实施保守治疗,疗效显著、安全可靠。     

异位妊娠腹腔镜保守手术及联合不同途径单次化疗的研究

目的目的探讨输卵管妊娠保守手术并发持续性异位妊娠的预防措施。方法选择未破输卵管妊娠患者共148例,随机分为3组,第1组单纯腹腔镜保守手术;第2组为腹腔镜保守手术联合患侧输卵管MTX20mg注射;第3组为腹腔镜保守手术联合术后24 h内单次MTX（1 mg/kg）肌注。全部病例于术前、术后3、71、2 d测血-βhcG后每隔4 d复查血-βhcG至非孕水平。持续组患者再给予MTX治疗。结果三组患者持续性异位妊娠发生率无显著差异（P〉0.05）。结论输卵管妊娠腹腔镜保守手术与是否联合不同途径单次化疗对持续性异位妊娠发生无密切相关,故输卵管妊娠腹腔镜保守手术无需加用MTX化疗。但术后必须严密观测血-βhcG,若第12天血-βhcG不下降或上升应诊断为持续性异位妊娠,并使用MTX治疗,可避免再次手术的危险。     

腹腔镜下保守性手术后的持续性异位妊娠的探讨

目的:探讨腹腔镜下保守性手术后持续性异位妊娠(PEP)发生的可能病因及预防措施。方法:本组回顾性分析235例异位妊娠腹腔镜手术的临床资料。结果:其中108例异位妊娠行腹腔镜下保守性手术,11例发生了PEP,发生率为4.68%。结论:异位妊娠腹腔镜保守性手术后PEP发生的可能性大,应正确选择保守手术病例,彻底清除病灶,术中常规在着床部位的浆肌层及系膜内注入MTX,加上术后严密观察血-βHCG的下降,及时采用MTX保守治疗,可有效地预防和降低PEP的发生。     

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.     

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.     

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.