计算机声学测试在功能性发音障碍诊断和治疗中的应用

目的:观察功能性发音障碍嗓音声学参数及声谱罔特征并进行视听反馈性发声训练,探讨计算机声学测试技术在功能性发音障碍诊断和治疗中的应用价值。方法:采用计算机嗓音声学测试系统对68例功能性发音障碍患者及50例正常成人嗓音元音信号"α"进行测试,观察分析声学参数jitter、shimmer、NNE及声谱图特征,同时利用同一软件对功能性发音障碍患者进行视听反馈性发声训练,并观察治疗前后声学特征的改变。结果:功能性发音障碍嗓音shimmer、NNE值较正常升高并有统计学意义:声谱图主要表现中、高频区谐波及共振峰病理改变。75%(51/68)患者能在某次元音信号的一段或几段声样中找到正常声学特征。通过视听反馈矫治86%(59/68)患者首次门诊就诊时即能掌握正确的发声方法,声学测试可显示一次元音信号的全程声样出现正常或明显改善的声学参数及声谱图。结论:计算机声学测试可通过观察嗓音的声学特征与器质性发音障碍相鉴别,视听反馈性发声训练简单、直观、有效。     

喉良恶性增生疾病嗓音的元音声谱图分析

目的 :观察喉良恶性增生疾病嗓音声谱图特征 ,探讨在喉疾病鉴别诊断及预后观察中计算机声学测试技术的应用价值。方法 :采用计算机嗓音声学测试系统 (DrSpeechScienceforWindows软件 )检测 80例正常成人及 140例声带良恶性增生疾病患者的元音信号 ,并分析比效其声谱图特征 (谐波、共振峰、噪声成分等 )。结果 :正常成人声谱图由连续、规律、清晰的谐波波纹构成 ,图形清晰、整齐 ,低、中、高频区分别可见声能增强的第 1、2、3共振峰 (F1、F2、F3) ,高频区偶见极少量噪声成分。各类病态嗓音声谱图特征为谐波及共振峰不规则、断裂甚至消失 ,噪声成分增加 ;根据谱图损害程度可将其分为 4型 ,声带良性病变多为 1,2型 ,声带恶性病变多见 3,4型。结论 :计算机声学检测的声谱图特征可作为评价嗓音质量的客观指标 ,有助于初步鉴别喉部病变性质及动态观察预后等。     

喉良恶性增生疾病噪音的元音声谱图分析

目的：观察喉良恶性增生疾病噪音声谱图特征、探讨在喉疾病鉴别诊断及预后观察中计算机声学测试技术的应用价值。方法：采用计算机噪音声学测试系统（Dr Speech Science for Windows软件）检测80例正常成人及140例声带良恶性增生疾病患者的元音信号,并分析比效其声谱图特征（谐波、共振峰、噪声成分等）。结果：正常成人声谱图由连续,规律,清晰的谐波波纹构成,图形清晰,整齐,低,中,高频区分别可见声能增强的第1、2、3共振峰（F1,F2,F3）,高频区偶见极少量噪声成分。各类病态噪音声谱图特征为谐波及共声带恶性病变多见3,4型,结论：计算机声学检测的声谱图特征可作为评价噪声质量的客观指标,有助于初步鉴别喉部病变性质及动态观察预后等。     

嗓音声学检测的临床应用

目的 应用声谱图对喉科临床嗓音疾病进行嗓音声学检测和分析,探讨嗓音声学分析在喉科及嗓音方面应用的规律。方法 共检574例,其中正常85例,喉疾病489例（声带息肉162例,声带小结40例,慢性喉炎57例,环杓关节区肿胀86例,环杓关节错位46例,声带麻痹13例,声带炎症64例,喉肿瘤21例）。声谱图检测参数有：基频、第一、二、三共振峰、基音周期、平均微扰、频率均值、频率微扰商、频率变动幅度、振幅微扰商、谐噪比、音调微扰系数等十二个参数。结果 病变各组与正常组比较,8个病变组在谐噪比,6个病变组在振幅微扰商,5个病变组在音调微扰系数,4个病变组分别在平均微扰、频率均值、频率微扰商的差异有统计学意义。结论 表明谐噪比、频率微扰商、振幅微扰商、音调微扰系数可以作为对病变嗓音进行判定的指标,另外对声带息肉手术前后疗效判定有一定帮助。     

声谱图在喉科的临床应用

目的应用声谱图对喉科临床嗓音疾病进行检测和分析,探讨声谱图在喉科及嗓音方面应用的规律。方法共检574例,其中正常85人,喉疾病489例(声带息肉162例,声带小结40例,慢性喉炎57例,环杓关节区肿胀86例,环杓关节错位46例,声带麻痹13例,声带炎肿64例,喉肿瘤21例)。声谱图检测参数有:基频、第一、二、三共振峰、基音周期、平均微扰、频率均值、频率微扰商、频率变动幅度、振幅微扰商、谐噪比、音调微扰系数等12个参数。结果病变各组与正常组比较,声带小结有6个参数,慢性喉炎、声带麻痹有5个参数,声带息肉、喉肿瘤有4个参数有统计学差异。结论表明谐噪比、频率微扰商、振幅微扰商、音调微扰系数可以作为对病变嗓音进行判定的指标,另外多参数综合分析对嗓音判定和喉病诊断有一定帮助。     

左侧声带麻痹的嗓音声学参数及电声门图分析

目的 通过观察左侧声带麻痹患者的嗓音声学参数、电声门图的特征,了解嗓音电声学分析及声门图在声带麻痹中的作用。探讨左侧声带麻痹的声带振动规律。方法 采用Dr.Speech软件。利用多媒体技术,对20例左侧声带麻痹患者及50例正常人的嗓音声学客观指标做比较,分析电声门图（EGG）波形,结果 左侧声带麻痹患者的嗓音声学参数 比正常人增高,差异有显著性,EGG波形明显变化。其参数声门接触率（CQ）减少,声门接触幕（CI）、声门的接触率微扰（CQP）增大。结论 我们认为计算机嗓音声学及EGG测试,提供了观察声带振动规律的一个客观依据。对声带麻痹的治疗及术前、术后的效果有一定的意义。     

声谱图在喉科的临床应用

目的 应用声谱图对喉科临床嗓音疾病进行检测和分析,探讨声谱图在喉科及嗓音方面应用的规律.方法 共检574例,其中正常85人,喉疾病489例(声带息肉162例,声带小结40例,慢性喉炎57例,环杓关节区肿胀86例,环杓关节错位46例,声带麻痹13例,声带炎肿64例,喉肿瘤21例).声谱图检测参数有基频、第一、二、三共振峰、基音周期、平均微扰、频率均值、频率微扰商、频率变动幅度、振幅微扰商、谐噪比、音调微扰系数等12个参数.结果 病变各组与正常组比较,声带小结有6个参数,慢性喉炎、声带麻痹有5个参数,声带息肉、喉肿瘤有4个参数有统计学差异.结论 表明谐噪比、频率微扰商、振幅微扰商、音调微扰系数可以作为对病变嗓音进行判定的指标,另外多参数综合分析对嗓音判定和喉病诊断有一定帮助.     

嗓音的定量检测与分析

对１００名正常成人及１２３名喉病患者嗓音进行了定量检测，测试了周期变异系数、频率微扰商，振幅微扰商，频率变动幅度、相对于平均微扰、谐噪比六个声学参数。结果显示：正常成人六个参数年龄组及性别组间差异无显著性；病态嗓音谐噪比低于正常，差异有显著性，其余参数高于正常，有统计学差异。提示：声学参数对嗓音优劣有客观定量评价作用，是喉科辅助诊断的客观定量指标。     

良性喉疾病的声学参数分析

目的分析慢性单纯性喉炎、声带小结、声带息肉患者的声学参数,探讨嗓音声学分析对喉疾病的诊断价值。方法采用计算机嗓音声学测试系统(Dr.Speech Science for Windows软件)对50例嗓音正常人(对照组)及80例良性喉疾病患者(患者组)进行嗓音声学检测,对其基频微扰(jitter)、振幅微扰(shimmer)、标准化噪声能量(NNE)进行比较分析。结果慢性单纯性喉炎、声带小结、声带息肉三类喉疾病患者的各参数平均值均较对照组平均值不同程度升高,各参数差别均有统计学意义(P<0.01)。声带小结jitter、shimmer值与慢性单纯性喉炎比较,差异无统计学意义(P>0.05),而NNE值差异有统计学意义(t=-3.467,P<0.01)。声带息肉的jitter、shimmer、NNE参数值与慢性单纯性喉炎参数值比较,差异均有统计学意义(P<0.01)。声带息肉shimmer、NNE值与声带小结参数值相比较,差异有统计学意义(P<0.01),而jitter值差异无统计学意义(t=-1.133,P>0.05)。结论嗓音声学分析对诊断慢性单纯性喉炎、声带小结、声带息肉有价值。     

慢喉喑证候分型与嗓音声学检测的关系

目的 探讨正常人及慢喉喑患者的嗓音声学检测结果变化在嗓音障碍程度评估及辨证分型中的作用.方法 对32例正常嗓音者和48例慢喉喑患者进行嗓音声学检测.同时对患者进行辨证分型及与病理诊断关系进行分析.结果 慢喉喑各证型的基频微扰、振幅微扰、标准化噪声能量、谐噪比及信噪比与正常组比较均有显著性差异.从气虚组到阴虚组再到痰凝血瘀组,前三项均呈现逐渐升高趋势,而后两项呈下降趋势,但各组间比较.部分参数值有显著性差异.结论 嗓音声学检测有助于对疾病发展过程及程度和辨证分型的评估.     

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.