导数—同步荧光光谱法测定尿液肾上腺素和去甲肾上腺素

为了解决肾上腺素（Ｅ）、去甲肾上腺素（ＮＥ）氧化产物的荧光光谱严重重叠难题，将同步荧光与导数光谱两种技术结合起来用于尿液Ｅ、ＮＥ测定。结果发现，在激发波长与发射波长相差Δλ＝４０ｎｍ时获得的Ｅ、ＮＥ二阶导数－同步荧光光谱中，４５０ｎｍ处Ｅ的荧光强度的导数信号不受ＮＥ的干扰；４３２ｎｍ处，ＮＥ的荧光强度的导数信号不受Ｅ的干扰，Ｅ、ＮＥ含量在１～２００ｎｇ／ｍｌ范围内成线性关系；最低检测限为０．５ｎｇ／ｍｌ；批内ＣＶ３．２１％～３．９５％，批间ＣＶ４．２６％～５．１０％，Ｅ和ＮＥ的回收率分别为９４．９％～９５．４％、９４．７％～９６．３％；该法操作简单、快速、成本低廉，适合于％批量测定，是测定尿液Ｅ、ＮＥ较为理想的常规方法。     

急性脑损伤后血儿茶酚胺与血糖浓度变化及其意义

测定４８例急性重型脑外伤患者伤后７天内血儿茶酚胺（ＣＡ）及伤后６小时内血糖含量，并与３５例正常人血ＣＡ含量值作对照。结果表明：外伤组血ＣＡ含量显著高于对照组；伤后７天内血去甲肾上腺素（ＮＥ）、肾上腺素（Ｅ）含量及其变化与格拉斯哥昏迷评分（ＧＣＳ）和预后均密切相关；入院时病情越重，ＧＣＳ评分越低，血ＮＥ、Ｅ含量越高；死亡组患者血ＮＥ、Ｅ含量明显高于存活组（Ｐ均＜０．０５），其与伤后２４小时内血ＮＥ、Ｅ含量分别显著正相关（ｒ＝０．５７４，Ｐ＜０．０５和ｒ＝０．４１０，Ｐ＜０．０５），而与ＧＣＳ和预后分别显著负相关（ｒ＝０．７８１，Ｐ＜０．０１和ｒ＝０．７０８，Ｐ＜０．０１）。     

胃癌及癌旁组织中神经内分泌细胞的超微结构与免疫组化诊断及其意义

本文应用透射电镜技术对２０例新鲜手术切除胃癌及癌旁粘膜、４例正常胃粘膜的神经内分泌（ＮＥ）细胞进行观察，并与抗ＣｇＡ抗体及９种激素抗体免疫组化技术进行对比观察。电镜下正常胃泌酸区粘膜可见ＥＣＬ细胞、Ｐ细胞、ＥＣ细胞、Ｘ细胞，偶见Ｄ细胞；胃窦粘膜可见Ｇ细胞、Ｄ细胞、ＥＣ细胞。２０例胃癌中含ＮＥ型癌细胞８例，依据内分泌颗粒的形态不同可分为三种类型。１６例癌旁粘膜ＮＥ细胞的形态与正常相似，但数量有明显变化。对正常胃粘膜ＮＥ细胞的超微形态与功能，胃癌中ＮＥ细胞超微诊断特点及临床病理意义进行了探讨。     

早产儿坏死性小肠结肠炎的观察与护理

早产儿坏死性小肠结肠炎的观察与护理北京协和医院（１００７３０）孙建伟，吕昆贤，杨帆新生儿坏死性小肠结肠炎（ＮＥＣ）临床上以腹胀、腹泻、呕吐、便血为主要表现；腹部Ｘ线平片以肠道充气，肠壁囊样积气为特征；病理上以小肠和结肠的坏死为特点。临床上确诊此病后主...     

胃癌及癌旁组织中神经内分泌细胞的超微结构与免疫组化诊断及？…

本文应用透射电镜技术对２０例新鲜手术切除胃癌及癌旁粘膜，４例正常胃粘膜的神经内分泌（ＮＥ）细胞进行观察，并与抗ＣｇＡ抗体及９种激素抗体免疫组化技术进行对比观察。电镜下正常胃泌酸区粘膜可见ＥＣＬ细胞、Ｐ细胞，ＥＣ细胞、Ｘ细胞，偶见Ｄ细胞；胃窦粘膜可见Ｇ细胞，Ｄ细胞，ＥＣ细胞，２０例胃癌中含ＮＥ型癌细胞８例，依据内分泌颗粒的形态不同可分为三种类型。１６例癌旁粘膜ＮＥ细胞的形态与正常相似，但数量有明显变     

范可尼贫血互补群 Ｄ２ 基因突变与卵巢上皮癌患者行 新辅助化疗疗效及预后的相关性

摘要：目的 分析范可尼贫血互补群 Ｄ２（ｆａｎｃｏｎｉ ａｎｅｍｉａ ｃｏｍｐｌｅｍｅｎｔａｔｉｏｎ ｇｒｏｕｐ Ｄ２，ＦＡＮＣＤ２）突变与卵巢上皮癌（ｅｐｉｔｈｅｌｉａｌ ｏｖａｒ ｉａｎ ｃａｎｃｅｒ，ＥＯＣ）患者行新辅助化疗（ｎｅｏａｄｊｕｖａｎｔ ｃｈｅｍｏｔｈｅｒａｐｙ，ＮＡＣＴ）后的疗效及预后的相关性。方法 选取２０１７ 年４ 月至 ２０１９ 年 ４ 月兵器工业五二一医院收治的 １８４ 例 ＥＯＣ 患者为研究对象，取穿刺活检组织并提取 ＤＮＡ，采用实时荧光定量 ＰＣＲ 检测患者 ＦＡＮＣＤ２ 基因的突变情况，分析 ＦＡＮＣＤ２ 基因突变与 ＥＯＣ 患者临床病理参数的相关性；进一步分析 ＦＡＮＣＤ２ 突变 与 ＮＡＣＴ 治疗４ 周后的疗效及预后的关系。结果 实时荧光定量 ＰＣＲ 结果表明，ＦＡＮＣＤ２ 基因突变率为４２．３９％。ＦＡＮＣＤ２ 突 变型与野生型 ＥＯＣ 患者的肿瘤病灶直径、ＥＣＯＧ 评分、分化程度和病理分型比较的差异具有统计学意义（Ｐ 值分别为 ０．０２４， ０．０３７，＜０．００１，０．００２）。ＦＡＮＣＤ２ 突变型 ＥＯＣ 患者的疾病控制率（ｄｉｓｅａｓｅ ｃｏｎｔｒｏｌ ｒａｔｅ，ＤＣＲ）显著低于 ＦＡＮＣＤ２ 野生型 ＥＯＣ 患者 （６６．６７％ ｖｓ ８３．９６％，χ２ ＝ ７．５０６，Ｐ＝ ０．００６）。１８４ 例 ＥＯＣ 患者的总体生存率为 ６５．２２％，ＦＡＮＣＤ２ 突变型 ＥＯＣ 患者的 ２ 年生存 率显著低于 ＦＡＮＣＤ２ 野生型（３２．０７％ ｖｓ ４２．３１％，ｌｏｇ ｒａｎｋ χ２ ＝ ４．１５２，Ｐ＝ ０．０４２）。Ｃｏｘ 风险比例模型多因素显示，分化程度和病 理分型是 ＦＡＮＣＤ２ 突变的独立影响因素（Ｐ＜０．０５）。运用 Ｋａｐｌａｎ Ｍｅｉｅｒ 法对患者进行单因素生存分析发现，肿瘤大小（Ｐ ＝ ０．０３１）、肿瘤病理分型（Ｐ＜０．００１）、分化程度（Ｐ＜０．００１）、突变型 ＦＡＮＣＤ２ 的表达（Ｐ＝ ０．０４２）与患者的总生存期密切相关。Ｃｏｘ 风险比例模型多因素分析显示，肿瘤病理分型、分化程度和 ＦＡＮＣＤ２ 突变是 ＥＯＣ 患者预后的独立影响因素（Ｐ 值分别为０．０１４， ０．０３５，０．０３６）。结论 ＦＡＮＣＤ２ 基因突变与 ＥＯＣ 患者 ＮＡＣＴ 疗效相关，肿瘤病理分型、分化程度、ＦＡＮＣＤ２ 突变是 ＥＯＣ 患者预 后的独立影响因素。     

静息ECG QRS波切迹或扭结在冠心病诊断中的意义

目的：通过与冠状动脉造影及左室造影对照，评价静息ＥＣＧ ＱＲＳ波Ｎ或Ｓ检测ＣＡＤ、ＷＭＡ的价值。方法；对连续３３６例于冠状动脉造影及左室造影前进行常规１２导ＥＣＧ检查，观测Ｎ或Ｓ及异常Ｑ波，尔后与造影结果进行对照分析。结果：３３６例中２５３例有ＣＡＤ，其中１５１例伴有ＷＭＡ，８３例无ＣＡＤ，２组病人Ｎ或Ｓ在肢体导联上分布基本相似，单一肢体导联上Ｎ或Ｓ无诊价值，至少２个前壁导联出现Ｎ或Ｓ诊断ＣＡＤ及     

高原肺原性心脏病患者日间PaO_2>6.66kPa伴和不伴夜间减氧饱和与生存的关系

目的：探讨高原肺原性心脏病（肺心病）夜间减氧饱和（ＮＯＤ）与生存的关系。方法：对４６例日间动脉血氧分压（ＰａＯ２）＞６．６６ｋＰａ高原肺心病缓解期患者作日间动脉血气分析、肺功能和夜间血氧饱和度（ＳａＯ２）连续监测。结果：①与非ＮＯＤ组比较，ＮＯＤ组日间ＰａＯ２明显低于非ＮＯＤ组；ＰａＣＯ２明显高于非ＮＯＤ组；１秒钟用力呼气容积（ＦＥＶ１．０）／身高（Ｈｔ）、ＦＥＶ１．０／ＦＶＣ（用力肺活量）、Ｖ５０／Ｈｔ、Ｖ２５／Ｈｔ也明显低于非ＮＯＤ组；ＮＯＤ组睡眠平均ＳａＯ２和最低ＳａＯ２明显低于非ＮＯＤ组；平均生存时间和５年生存率ＮＯＤ组明显低于非ＮＯＤ组。②ＦＥＶ１．０／Ｈｔ、ＦＥＶ１．０／ＦＶＣ、Ｖ５０／Ｈｔ与生存时间也有相关性。③结论：高原肺心病ＮＯＤ与其预后有明显关系，ＦＥＶ１．０／Ｈｔ、ＦＥＶ１．０／ＦＶＣ、Ｖ５０／Ｈｔ对判断预后也有价值，建议此类患者应监测夜间ＳａＯ２及进行长期氧疗。     

人类Rh血型系统的分子生物学研究进展

人类Ｒｈ血型系统自１９３９年被发现以来，因导致新生儿溶血病（ＨＤＮ）、溶血性输血反应而成为红细胞血型中仅次于ＡＢＯ的系统，其中ＲｈＤ抗原因具有高免疫原性而最具临床意义［１］。主要的Ｒｈ抗原有ＲｈＤ和ＲｈＣＥ，ＲｈＣＥ为对偶抗原，有可供选择的等位基因产...     

新生儿溶血病的产前诊断方法研究进展

新生儿溶血病 (Ｈｅａｍｏｌｙｔｉｃｄｉｓｅａｓｅｏｆｔｈｅｆｅｔｕｓａｎｄｔｈｅｎｅｗｂｏｒｎ ,ＨＤＮ)是发生在胎儿和早期新生儿的一种自限性免疫溶血性疾病。该病由母婴血型不合引起 ,常导致早期流产 ,轻者出现贫血、水肿、肝脾肿大 ,严重者造成新生儿死亡或发生核黄疸且产生后遗症。由于我国ＲｈＤ(- )人群仅占0 .2 4 % ,大大低于白种人的 15 % [1] ,因此 ,Ｒｈ引起的ＨＤＮ相对ＡＢＯ较为少见。Ｒｈ血型Ｄ抗原是引起中等和严重程度的ＨＤＮ的最常见原因 ,引起ＨＤＮ的其它Ｒｈ血型抗原还有Ｃ、Ｃｗ、ＣＸ、Ｅ、ｅ、Ｅｗ、ｃｅ、…     

Abdominal Distention and Emesis in a Term Neonate

BackgroundNecrotizing enterocolitis (NEC) is a gastrointestinal emergency characterized by ischemic necrosis of the intestinal mucosa, leading to bacterial translocation and pneumatosis of the bowel wall. Although there are numerous studies on clinical presentations of preterm NEC, approximately 10–15% of cases occur in full-term neonates. Nearly 10% of all infants with NEC will develop a rapidly progressive and fatal form of the disease called NEC totalis.Case ReportA 24-day-old term male infant presented to the Emergency Department (ED) with emesis. The infant was ill-appearing with a tense abdomen and had significant tachycardia and hypotension. The patient was immediately volume resuscitated and started on empiric antibiotics. Initial radiographs revealed no evidence of bowel obstruction or pneumatosis. Pediatric Surgery was consulted, and upper gastrointestinal and abdominal computed tomography scans were obtained, which were nondiagnostic. The patient was taken to the operating room for an exploratory laparotomy after continued clinical deterioration and was diagnosed with NEC totalis and passed away within 6 days.Why Should an Emergency Physician Be Aware of This?This case demonstrates an uncommon presentation of NEC in an otherwise healthy term neonate without any known risk factors. The diagnosis of NEC is challenging because imaging studies may be inconclusive, particularly early in the clinical course. Regardless of the etiology, all infants who present to the ED with signs and symptoms of severe gastrointestinal distress should be treated with basic emergency care, including rapid fluid resuscitation, empiric antibiotics, bowel decompression, and early surgical consultation.     

Transient renal medullary hyperechogenicity in ultrasound studies of neonates: Is it a normal phenomenon and what are the causes?

A prospective ultrasound study of the renal morphology of 51 neonates with no clinical signs of renal impairment showed transient medullary hyperechogenicity of varying intensity in 37%. These findings were made in the first few postnatal days, were not accompanied by any other echographic changes, and disappeared again within the first week of life. They were encountered twice as often in full-term as in premature babies. In parallel with this phenomenon, the concentration of Tamm–Horsfall protein, calcium, and uric acid, and the osmolality were determined in the daily urine of 44 of these neonates. The analyses did not provide any definite clues as to the etiology of the ultrasound findings. It is therefore suggested that the term “Tamm-Horsfall nephropathy or proteinuria” should no longer be used for such sonographic phenomena in the neonatal kidney, but rather, they should be regarded as normal. Furthermore, the term “tubular stasis nephropathy” should be reserved for cases with clinically demonstrable impairment of renal function. © 1993 John Wiley & Sons, Inc.     

江门市新会区早产儿甲状腺功能检测及分析

目的:探讨早产儿甲状腺功能特点及临床意义.方法:本院2008年7月至2010年7月收治的120例早产儿纳入研究,胎龄28-37周,产重1.105-3.014 kg,同期40例正常足月新生儿作为对照.分别在生后第1天和第7天检测上述新生儿静脉血血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺激素(FT4) 以及总促甲状腺激素(TSH).结果:新生儿第1天FT3、FT4以及TSH水平均高于第7天,而早产儿上述指标均显著低于足月新生儿,且胎龄越低、产重越轻的早产儿越明显(P＜0.05).结论:早产儿下丘脑-垂体-甲状腺轴发育不成熟,生后甲状腺功能可降低,有必要对早产儿生后进行甲状腺功能监测.     

妊娠晚期孕妇阴道B族链球菌带菌状况与早产的相关性研究

目的:探讨妊娠晚期孕妇B族链球菌(GBS)带菌状况与早产关系。方法:以2012年1月-2013年1月我院产科出生的部分早产儿147例为早产组,以同期出生的足月儿作为足月组,按照性别比例1:1配对进行病例对照研究。比较所有研究对象产科临床资料和孕妇宫颈分泌物GBS培养结果。结果:早产组孕妇GBS感染携带率为28.5%(42/147),足月组孕妇GBS感染携带率仅为11.5%(17/147),早产组GBS携带率显著高于足月组(P0.05)。因素配比条件Logistic回归分析显示,反复流产、多/双胎病史、胎膜早破、产前出血、子痫前期、胎儿窘迫及孕妇GBS带菌均为早产独立危险因素,P均0.05,其中孕妇GBS带菌的OR值为2.073(95%CI:1.774-4.706)。结论:妊娠期GBS携带孕母早产的发生率较GBS非携带明显升高。     

早产儿坏死性小肠结肠炎的临床分析

目的：了解早产儿坏死性小肠结肠炎（NEC）的临床特点，探讨及时诊断和防治早产儿NEC的方法。方法：分析32例早产儿NEC的临床表现、影像学特点、病程发展、预后，并与27例足月儿NEC进行比较。结果：早产儿NEC更多表现为反应差（46．9％）、胃纳差（34．4％），肠穿孔率（21．9％），明显高于足月儿组；病死率（28．1％）也高于足月儿组（3．7％）。结论：与足月儿比较，早产儿NEC临床表现中以反应低下和纳差比较突出，穿孔发生率高，病死率也比较高。     

Portal venous gas by ultrasound in advance of impending necrotizing enterocolitis of a very low birth weight infant

Necrotizing enterocolitis (NEC) is a serious complication of premature infants, portal venous gas (PVG) under X-ray, and ultrasound is a typical manifestation of this disease. We report a case of a very low birth weight (VLBW) infant with PVG unexpectedly detected by ultrasound before the onset of NEC. After positive ultrasound result, clinical manifestations, X-ray, and lab tests confirmed the diagnosis of NEC. This is the first report of a similar case, demonstrating the value of ultrasonography in prediction or early diagnosis of NEC, which may change our understanding of the disease and the timing of examination.     

Is “transfusion‐associated necrotizing enterocolitis” an authentic pathogenic entity?

BACKGROUND: Necrotizing enterocolitis (NEC) sometimes occurs after a transfusion, but it is unclear whether this is a chance association or cause and effect. STUDY DESIGN AND METHODS: We compared features of neonates that developed surgical NEC within 48 hours after transfusion with others that developed NEC not preceded by transfusion. We assessed the blood used for transfusion and feeding practices among NEC cases and controls. RESULTS: Forty neonates developed surgical NEC after a transfusion and 72 developed NEC unrelated to a transfusion. Those with NEC after transfusion were born at earlier gestation (mean 27 weeks, 90% confidence interval [CI] 26‐28 years vs. mean 30, 90% CI 29‐31; p < 0.001) and were of lower birth weight (mean 981 g, 90% CI 835‐1128 g vs. mean 1371 g, 90% CI 1245‐1496; p < 0.001) and developed NEC later during their neonatal intensive care unit course (day of life: mean 23, 90% CI 20‐27 vs. mean 16, 90% CI 13‐19; p < 0.001). Transfusions were more prevalent among those that developed NEC (p < 0.001). The blood transfused to those that developed NEC was not older, but those who developed NEC had been fed larger volumes of milk in the 24 hours before and during transfusion (p = 0.04) and were more likely to have been fed a bovine product during that period (p = 0.004). CONCLUSION: Approximately one‐third of surgical NEC cases in our system occurred after a transfusion. We speculate that a target area for reducing the prevalence of posttransfusion NEC involves feeding practices immediately before and during RBC transfusion.     

床旁颅脑超声在新生儿颅内出血诊断中的应用

目的探讨床旁超声在新生儿颅内出血诊断中的应用价值。方法应用床旁超声对1400例新生儿(男752例、女648例;早产儿1050例、足月儿350例)在出生后3d内行床旁颅脑超声检查并与CT检查结果进行比较分析。结果 (1)新生儿颅内出血患病率:1050例早产儿颅内出血166例,患病率15.81%,其中<32周的早产儿100例(60.2%)、≥32周的早产儿66例(39.8%)。350例足月儿颅内出血38例,患病率10.86%,其中<40周足月儿27例(71.1%)、≥40周11例(28.9%)。早产儿颅内出血患病率高于足月儿(χ2=5.17,P<0.05)。752例男新生儿中出血患儿113例(15.0%),648例女新生儿中出血患儿91例(14.0%),性别比较差异无统计学意义。(2)新生儿颅内出血类型:166例颅内出血早产儿脑室出血155例(93.4%),脑实质出血11例(6.6%);38例颅内出血足月儿脑室出血35例(92.1%),脑实质出血2例(5.2%),硬膜下出血1例(2.6%)。早产儿和足月儿在出血类型和脑室出血程度上差异无统计学意义。(3)204例新生儿颅内出血病例中,141例(69.1%)有明显异常围生史,其余63例(30.9%)无明显异常围生史。结论低胎龄早产新生儿颅内出血患病率较高,部分患儿无明显临床表现及异常围生史,应进行常规筛查。床旁超声检查能够为新生儿颅内出血诊断提供可靠、准确的信息,并且便捷、无创、易于随访,应作为筛查、监测新生儿颅内出血的首选方法。     

Toll-like receptor 4–mediated lymphocyte influx induces neonatal necrotizing enterocolitis

The nature and role of the intestinal leukocytes in necrotizing enterocolitis (NEC), a severe disease affecting premature infants, remain unknown. We now show that the intestine in mouse and human NEC is rich in lymphocytes that are required for NEC development, as recombination activating gene 1–deficient (Rag1^–/–) mice were protected from NEC and transfer of intestinal lymphocytes from NEC mice into naive mice induced intestinal inflammation. The intestinal expression of the lipopolysaccharide receptor TLR4, which is higher in the premature compared with full-term human and mouse intestine, is required for lymphocyte influx through TLR4-mediated upregulation of CCR9/CCL25 signaling. TLR4 also mediates a STAT3-dependent polarization toward increased proinflammatory CD3⁺CD4⁺IL-17⁺ and reduced tolerogenic Foxp3⁺ Treg lymphocytes (Tregs). Th17 lymphocytes were required for NEC development, as inhibition of STAT3 or IL-17 receptor signaling attenuated NEC in mice, while IL-17 release impaired enterocyte tight junctions, increased enterocyte apoptosis, and reduced enterocyte proliferation, leading to NEC. Importantly, TLR4-dependent Th17 polarization could be reversed by the enteral administration of retinoic acid, which induced Tregs and decreased NEC severity. These findings identify an important role for proinflammatory lymphocytes in NEC development via intestinal epithelial TLR4 that could be reversed through dietary modification.     

The neonate with suspected congenital heart disease

Congenital heart disease (CHD) occurs in 8 per 1000 live births, with approximately one third of these neonates requiring intervention in the first month of life. Neonates with respiratory distress, cyanosis, feeding difficulties, low cardiac output, or dysmorphic syndromes commonly have CHD. Clinical suspicion increases in a symptomatic infant with a heart murmur, but the presence or absence of a murmur does not assure either the presence or absence of significant congenital heart disease. Infants suspected to have CHD may be divided into premature and term infants, as well as infants with duct-dependent pulmonary blood flow, infants with duct-dependent systemic blood flow, and infants with unrestricted pulmonary blood flow. This article will also address the specialized clinical situations of total anomalous pulmonary venous return, transposition of the great arteries, and hypoplastic left heart syndrome with intact atrial septum.