剖宫产1025例指征分析

目的分析我院妇产科剖宫产率上升的原因,探讨降低剖宫产率的对策。方法对1025例剖宫产的病例进行回顾性分析。结果2005年剖宫产率为139.84％,2006年剖宫产率为41.25％,2007年剖官产率为52．63％,平均剖宫产率为44．57％。主要指征依次为：胎儿窘迫3428％,社会因素28．23％,妊娠并发症17.50％．臀位10．76％,巨大儿4．93％,珍贵儿3．21％,高龄初产1．07％。结论胎儿窘迫、社会因素是剖官产率增加的主要原因,处理难产．严格掌握剖宫产指征,提倡责任助产,进行心理调控,控制因社会因素而致的不必要剖宫产是降低剖宫产率的关键。     

剖宫产术648例指征分析

目的：通过分析剖宫产指征，探讨剖宫产率增高的原因，寻找降低剖宫产率的对策，方法：对648例剖宫产病例进行回顾性分析。结果：剖宫产率为45．6％，难产、胎儿宫内窘迫、社会因素、疤痕子宫为前4位剖宫产主要指征。结论：严重掌握剖宫产指征，在产程中予以正确处理，是降低剖宫产率，提高产科质量的关键。     

1008例剖宫产指征分析

目的探讨2005年1月～2006年12月我院剖宫产指征掌握情况。方法对1008例剖宫产病例进行回顾性分析。结果2005年剖宫产率45．13％，2006年部宫产率50．89％，平均剖宫产率48．07％。主要指征：胎儿因素27．98％（其中臀位7．24％，胎儿窘迫8．53％，羊水过少3．97％，前置胎盘2．98％等），社会因素26．88％，母亲因素中妊高征8．13％，疤痕子宫11．71％，相对头盆不称12．40％，胎膜早破7．44％。结论剖宫产指征已放宽，社会因素的剖宫产显著增加是造成剖宫产率上升的主要原因，降低剖宫产率的关键是严格掌握剖宫产指征，控制因社会因素而致的不必要剖宫产。     

1999～2008年剖宫产指征变化的临床分析

目的：分析1999～2008年我院剖宫产指征变化及剖宫产率急剧增高的主要原因。方法：分析1999-2008年剖宫产孕妇的临床资料。结果：1999年～2008年我院剖宫产率逐年升高,1999年为25．1％,2008年为59.3％。剖官产指征中,社会因素和胎儿窘迫所占比例逐年升高,1999～2000年分别为15．0％、16．0％,2007～2008年分别为30.3％、26.3％。结论：剖宫产率升高主要为无医学指征行剖宫产和胎儿窘迫的“过度诊断”所致。降低剖宫产率的关键是严格掌握剖宫产的指征,尽量减少社会因素的剖宫产。     

剖宫产2509例临床分析

目的分析剖宫产指征构成,探讨降低剖宫产率临床措施。方法对郸城县人民医院2004年1月至2008年12月2509例剖宫产病例进行回顾性分析。结果（D剖宫产率为46．66％（2509／5377）,且逐年上升,但剖宫产率上升并未降低围生儿病死率。②剖宫产主要指征依次为：胎儿窘迫22．60％（567／2509）、社会因素21．12％（530／2509）、头位难产20．93％（525／2509）、瘢痕子宫15．34％（385／2509）。③5年来以社会因素、瘢痕子宫、臀位为剖宫产指征的比率明显升高,是我院剖宫产率升高的主要原因。其中瘢痕子宫剖宫产率为94．83％（385／406）,臀位剖宫产率为79．44％（143／180）。以胎儿窘迫、头位难产为剖宫产指征比率恒定于高水平是我院剖宫产率居高不下的基础。（多社会因素剖宫产中以认为剖宫产安全、担心难产、惧怕宫缩疼痛而手术为主要原因。结论应加强医患沟通,重视围生期保健,提高待产服务质量,正确识别处理难产,严格掌握剖宫产指征,降低剖宫产率。     

568例剖宫产指征分析

目的：分析2004年1月～2006年12月剖宫产指征掌握情况。方法：对568例剖宫产病例进行回顾性分析。结果：剖宫产率为54．04％，主要剖宫产指征为难产、胎儿窘迫、社会因素等。结论：规范术前诊断，提高产科质量，严格掌握剖宫产指征，排除社会因素的干扰，降低剖宫产率。     

剖宫产106例指征分析

目的：分析医院妇产科剖宫产率上升的原因，探讨降低剖宫产率的对策。方法：对106例剖宫产病例进行回顾性分析。结果：平均剖宫产率为23．54％。主要指征依次为：持续性枕后位、产程停滞26例。胎儿窘迫18例，瘢痕子宫16例，臀位14例，社会因素10例，巨大儿9例，珍贵儿4例，妊高症4例，无羊水或羊水过少3例，双胎2例。结论：持续性枕后位、胎儿宫内窘迫、瘢痕子宫二次妊娠、社会因素是医院妇产科2009年剖宫产率增加的主要原因，处理难产、严格掌握剖宫产指征、降低社会因素剖宫产、给予瘢痕子宫孕妇阴道试产机会是降低剖宫产率、提高产科质量的关键。     

4078例剖宫产指征分析

目的：分析2006年1月～2008年12月剖宫产指征掌握情况。方法：对4078例剖宫产病例进行回顾性分析。结果：剖宫产率为31．35％，主要剖宫产指征为难产、胎儿窘迫、社会因素等。结论：规范术前诊断，提高产科质量，严格掌握剖宫产指征，排除社会因素的干扰，降低剖宫产率。     

14年剖宫产率及主要剖宫产指征变化分析

回顾性分析吴江市第一人民医院近14年来剖宫产的临床资料。总结14年来剖宫产率及剖宫产指征的变化，寻求降低剖宫产率的方法。结果：（1）剖宫产率逐年上升，从1990年的13．12％上升到2003年的38．14％（P〈0．01）。（2）1990年至1999年剖宫产指征第1位是难产，2000年至2003年社会因素已跃居至第1位。（3）以难产、胎儿窘迫、妊娠合并症及并发症、臀位为指征的剖宫产增加。提示剖宫产指征普遍放宽，社会因素致剖宫产显著增加是造成剖宫产率上升的主要原因，降低剖宫产率的关键是严格掌握刮宫产指征，控制因社会因素而行的不必要剖宫产。     

456例剖宫产术指征分析与思考

目的 分析剖宫产术指征分布情况，为合理选择剖宫产术、降低剖宫产率提供参考依据。方法 对2005全年行剖宫产术病例进行回顾性分析。结果 2005剖宫产率44．8％，因单一因素行剖宫产术325例，占71．3％，因多因素指征行剖宫产术131例，占28．7％，其中单一因素中因脐带绕颈行剖宫产术排序位于第1位，其次因子痫前期、胎位异常、胎儿窘迫、瘢痕子宫、妊娠合并症、头盆不称分别排第2～7位。结论 目前，我院剖宫产率较高，原因与医患双方及社会因素影响均有关，降低剖宫产率应从这些环节入手。     

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.