胎儿唇腭裂畸形的产前超声诊断

目的 探讨胎儿唇腭裂畸形的产前超声诊断。方法 对20～42周的孕妇进行颜面部扫查采用冠状、横切、矢状切面，重点观察鼻、唇部、牙槽突、腭部。结果 共检出唇腭裂胎儿5例，单纯唇裂3例，唇裂伴腭裂及牙槽突裂2例，漏诊腭裂2例。结论 超声诊断唇裂畸形图像形象直观，完全性腭裂多伴发牙槽突裂，透过牙槽突裂可探测到腭裂。     

胎儿腭裂的超声诊断价值

目的 探讨超声诊断胎儿腭裂的价值。方法 妊娠20周以上孕妇2125例，常规探测胎儿颜面部，采用冠状、矢状及横切面扫查。结果 超声诊断完全性腭裂4例，均伴发完全性唇裂及牙槽突裂，漏诊不完全性腭裂2例。结论 完全性腭裂多伴发牙槽突裂及完全性唇裂，透过牙槽突裂可探测到腭裂。对于无唇裂或不完全性唇裂胎儿，其牙槽突常完整，超声无法探测上腭，不能显示腭裂。     

三维超声重建诊断胎儿腭裂的价值

目的 比较二维及三维超声重建对唇裂诊断明确的胎儿是否伴有腭裂的诊断价值.方法 对系统产科超声检查发现的23例唇腭裂胎儿进行回顾性分析,二维超声对鼻唇部进行横切、矢状及冠状切面扫查;同时对唇裂胎儿作三维超声检查并保存原始数据,再利用重建三维图像分析诊断,比较两种方法诊断腭裂的准确性.结果 检查5754例胎儿共发现23例唇腭裂(其中18例伴腭裂),二维超声诊断腭裂13例,三维超声诊断腭裂18例,诊断胎儿唇裂是否伴腭裂二维超声准确率为69.57%,三维超声准确率为95.65%(其中1例单纯唇裂三维超声重建无法确定是否伴腭裂);三维超声横切面及冠状面诊断腭裂准确率为100%,矢状切面诊断腭裂准确率为88.89%.结论 三维超声诊断唇腭裂准确性高,三维超声重建能更清晰、直观、准确、快速地显示胎儿唇腭裂的直接征象;在三维超声诊断腭裂中横切面及冠状面价值最大,矢状切面有辅助诊断价值.     

单纯腭裂的产前二维超声诊断

目的：探讨腭的标准切面在单纯腭裂产前超声诊断中的应用价值,总结单纯腭裂的二维超声图像特征。方法对孕龄分布在18~40周18073例胎儿利用二维超声经口裂、经面颊部、经颈侧部扫查胎儿腭结构,获取腭标准的矢状切面、横切面、冠状切面诊断单纯腭裂,并与引产和分娩结果对照分析。结果18073例胎儿中,发现单纯腭裂20例,产前超声检出19例,其中正确诊断18例,误诊1例,漏诊1例;产前超声检出的敏感性为95%,特异性为100%,准确性为95%。单纯腭裂的二维超声图像特征：缺裂均位于中线,软腭裂表现为软腭正中回声中断,缺裂呈“><”、“‖”、“/\”形,硬腭裂表现为硬腭正中回声中断,缺裂呈倒“U”形或倒“V”形。结论腭的标准切面在单纯腭裂的产前超声诊断中具有较高的应用价值,可评估裂隙形态、长度、宽度、走向、累及范围等。     

超声在中孕期筛查胎儿唇裂及唇腭裂的价值

目的总结中孕期胎儿唇裂及唇腭裂的超声声像图特征.方法2009年1月至2012年12月以规范化二维口唇冠状切面和上牙槽突冠状切面作为常规超声筛查切面对60007例中孕期(孕20~24周)胎儿行颜面部超声筛查,并与引产及产后检查结果进行对照分析.结果产前超声于60007例中孕期胎儿中检出唇裂及唇腭裂畸形214例,检出率为0.36%(214/60007);超声未发现胎儿唇腭部异常59793例(99.64%,59793/60007).214例胎儿唇裂及唇腭裂超声声像图表现:(1)单纯唇裂36例,超声显示上唇回声中断但未达鼻根部,上牙槽突未见连续中断;(2)唇腭裂178例,超声显示上唇连续中断达鼻根部伴鼻变形,同时伴上牙槽突中断、排列不齐或上腭回声中断;三维超声成像能直观显示唇裂及唇腭裂程度.214例唇裂和唇腭裂胎儿产后随访到170例(79.44%,170/214),失访44例(20.56%,44/214);随访结果显示:(1)因胎儿唇裂(其中单纯唇裂24例)及唇腭裂(130例)孕妇选择于孕28周前引产154例(71.96%,154/214);引产胎儿颜面部检查证实均有不同程度的唇裂;(2)唇裂或唇腭裂不合并其他系统异常的胎儿足月分娩16例,1例产前诊断唇裂,足月分娩后检查为唇裂合并腭裂;3例产前诊断唇腭裂,足月分娩后检查仅为唇裂,12例出生后检查与产前超声诊断相符合.(3)60007例中孕期胎儿产前超声未发现唇腭部异常59793例,足月分娩后检查发现超声漏诊1例Ⅰ度唇裂;2例新生儿颜面部检查发现胎儿期唇裂和唇腭裂宫内自愈.超声检查后共随访到胎儿妊娠结局171例,与引产或产后检查结果对照显示,产前超声诊断唇裂及唇腭裂的符合率为99.42%(170/171),漏诊率为0.58%(1/171).结论中孕期超声筛查重视胎儿唇腭部检查,二维与三维多切面扫查及规范化留存超声图像可增加更多诊断信息,提高胎儿唇腭裂检出率,降低漏诊率.     

唇腭裂的超声筛查及诊断价值

目的：研究常规鼻唇冠状切面加特殊切面在胎儿唇腭裂畸形筛查中的应用价值.材料与方法：对11688例,孕24 ～ 30周胎儿唇腭部采用常规鼻唇冠状切面加特殊切面（经唇部冠状面、经双眼标准横断面、经鼻腔标准横断面、经上牙槽突标准横断面、经舌标准横断面、经下牙槽突标准横断面和经鼻正中矢状面）行产前超声筛查,并与出生儿颜面部检查结果进行对照分析,总结鼻唇冠状切面加特殊切面超声扫查法的诊断符合率.结果：11688例胎儿共查出59例阳性患者,阳性率0.50％（59/11688）,单纯唇裂13例,占阳性病例的22.03％ （13/59）,唇裂合并腭裂的46例,占阳性病例的77.97％（46/59）,左侧唇腭裂38例,占64.4％ （38/59）,右侧唇腭裂10例,占16.9％（10/59）,正中唇裂2例占3.39％（2/59）,双侧唇腭裂9例,占12.25％（9/59）.结论：超声诊断胎儿唇腭裂畸形通过观察鼻唇部冠状切面加特殊切面（上牙槽突标准横断面、下牙槽突标准横断面、鼻腔横断面、双眼标准横断面、舌标准横断面、胎儿头颅矢状面）及配合一定手法,可明显提高其诊断率.     

三维超声扩展成像诊断胎儿唇腭裂的价值

目的 探讨应用三维超声扩展成像诊断胎儿唇腭裂的临床应用价值,寻求提高胎儿唇腭裂诊断准确性的有效方法.方法 应用三维扩展成像(3DXI)对唇腭裂胎儿和正常胎儿唇腭部位的三维容积数据进行分析.结果 20例正常胎儿唇部显示率100%,上牙槽突显示率100%,硬腭显示率75%(15/20).28例唇腭裂胎儿包括9例单纯唇裂,18例上唇裂合并硬腭裂和1例唇裂合并软腭裂.3DXI诊断了所有9例单纯唇裂,诊断率100%;诊断了唇裂合并腭裂15例,包括单侧11例,双侧3例和正中裂1例,有3例单侧唇裂合并腭裂仅诊断了唇裂而漏诊了腭裂,诊断率83.3%(15/18).另外1例唇裂合并软腭裂仅诊断了唇裂而漏诊了软腭裂.结论 三维超声扩展成像对胎儿唇裂,尤其是唇裂合并牙槽突及硬腭裂的诊断具有较大的应用价值,对胎儿未合并牙槽突裂的软腭裂及部分硬腭裂做出诊断,仍具有很大的难度.     

胎儿唇腭部的产前超声研究

目的 探讨与胎儿唇腭裂有关解剖结构显示的重要超声切面及先天性唇腭裂畸形的产前诊断.方法 将13例颜面部正常的引产畸形胎儿标本置于水盆内,采用冠状切面、横切面、矢状切面、经口裂斜冠切面及经颏下三角斜冠状切面直接扫查.用相同的超声切面对1524例胎儿的颜面部进行扫查.胎儿唇腭裂的诊断采用敏感性、特异性、假阳性率和假阴性率进行评价.结果 ①离体胎儿标本：超声扫查显示与唇腭裂相关的重要解剖结构主要为胎儿鼻、上唇、上颌牙槽突、继发腭的融合线、硬腭及软腭.②宫内胎儿：冠状切面上胎儿鼻与上唇显示率为96%,横切面上上唇与上颌牙槽突显示率为95%,矢状切面上继发腭的融合线显示率为23%,经口裂斜冠状切面硬软腭显示率为66%,经颏下三角腭部显示率仅为5%.在该组病例中,胎儿唇腭裂31例,产前超声检出28例,敏感性为 90.32%,特异性为 99.93%,假阳性率为 0.07%,假阴性率为 9.68%.腭裂的产前超声检出敏感性为 95.00%,特异性为 99.93%,假阳性率为 0.07%,假阴性率为 5.00%.结论 对于胎儿唇腭裂畸形的产前超声诊断,冠状切面、横切面及经口裂斜冠状切面是三个最重要的切面,而矢状切面及经颏下三角切面仅作为补充.     

胎儿硬腭的三维超声显像方法及其应用

目的探讨胎儿硬腭的三维超声显像方法及其在产前诊断胎儿腭裂中的应用价值。方法采集100胎孕13～35周正常胎儿及32胎唇裂胎儿颜面部的三维容积数据,通过旋转x、y、z轴、调节灰度阈值和片层,显示观察胎儿硬腭矢状面、冠状面和横断面声像图。结果正常胎儿硬腭矢状面显示率为93.00%(93/100),呈前后走向的带状稍强回声,表面光滑,前方与上牙槽突强回声相延续;冠状面显示率为91.00%(91/100),冠状面上硬腭位于中部,呈连续的弧形带状稍强回声,与上方鼻骨强回声构成三角关系;横断面显示率为90.00%(90/100),横断面上硬腭呈拱门形稍强回声,前方、左、右侧被上牙槽突强回声所包围;88.00%(88/100)的胎儿硬腭在3个位面上均可显示。32胎唇裂胎儿中,检出9胎合并腭裂并经随访证实,其腭裂部位、裂隙宽度、整体形态及走向显示清楚。结论应用三维超声观察胎儿硬腭简便易行。掌握正常胎儿硬腭三维超声声像图特征有助于提高胎儿腭裂的检出率及评判预后。     

二维超声诊断胎儿唇裂的探讨

目的探讨二维超声产前诊断胎儿唇裂的价值。方法应用二维超声对2457例中、晚期孕妇的胎儿行颜面部检查。结果产前诊断胎儿唇裂5例,均经分娩证实,唇裂检出率100％。结论二维超声是筛选及诊断胎儿唇裂的重要手段。     

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.     

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.     

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.