浅谈多胎妊娠减胎的疾病与手术编码

多胎妊娠的母婴并发症明显高于单胎妊娠,而多胎妊娠减胎术是避免母婴并发症发生的一种重要的补救方法.本文从以下5个方面讲解了多胎妊娠减胎的疾病编码,分别是：O31.1与O31.2的区别、O31.1与O31.0的区别、为行减胎术而入院的疾病编码、减胎术后复入院的疾病编码、多胎妊娠减胎后分娩结局的编码.关于多胎妊娠减胎手术,列举了当前常用的手术方法,并对手术编码的选择与查找展开讨论.多胎妊娠减胎的编码比较复杂,编码员要熟练掌握相关的编码原则和方法,才能做到编码的准确.     

Veganism does not reduce the risk of the metabolic syndrome in a Taiwanese cohort

The purpose of the present study was to assess the risk of the metabolic syndrome (MS) with vegan, pescovegetarian, lactovegetarian and nonvegetarian diets in Taiwan. The design was a retrospective cohort study using secondary data analysis from a Taiwan longitudinal health check-up database provided by MJ Health Screening Center during 1996-2006. A total of 93209 participants were classified as vegans (n=1116), pescovegetarians (n=2461), lactovegetarians (n=4313) and nonvegetarians (n=85319) by food frequency list of self-administered questionnaire at baseline. The association between MS or MS components and different dietary groups was evaluated using Cox proportional-hazards regression models with adjustment for confounders. During the mean 3.75 years of follow up, a total 8006 MS incident cases occurred and the incidence of MS was 229 (95% CI, 224, 234) per 10000 person year. Compared with vegans, hazard ratios of MS for nonvegetarians, pescovegetarians, lactovegetarians were 0.75 (95% CI, 0.64, 0.88), 0.68 (95% CI, 0.55, 0.83) and 0.81 (95% CI, 0.67, 0.97) after adjusting for sex, age, education status, smoking status, drinking status, physical activity at work and leisure, respectively. As for MS components, nonvegetarians and pescovegetarians had 0.72 (95% CI, 0.62, 0.84), 0.70 (95% CI, 0.57, 0.84) times risk of developing low high density lipoprotein cholesterol (HDL-C), while nonvegetarians had 1.16 (95% CI, 1.02, 1.32) times risk of developing high fasting plasma glucose. Our data suggest that the vegan diets did not decrease the risk of metabolic syndrome compared with pescovegetarian, lactovegetarian and nonvegetarian diets in a Taiwanese cohort.     

新生儿颅内出血90例观察与护理

目的:探讨新生儿颅内出血(ICH)患儿的护理方法及其效果.方法:对90例新生儿颅内出血患儿进行回顾性分析,总结其护理方法及效果.结果:本组90例,治愈78例(86.7%),死亡12例(13.3%).对治愈的78例随访3个月,70例(89.7%)精神、发育、运动、智力正常.结论:认真观察新生儿颅内出血患儿的生命体征、有无惊厥、意识和精神状态、囟门、摄入情况,采取吸氧并保持呼吸道通畅、降低颅内压、保持正常体温、营养支持、并发症的治疗等治疗护理措施,可提高ICH的治愈率,降低后遗症的发生率与病死率.     

融合功能磁共振影像的神经导航在脑皮质运动区肿瘤术中的应用

目的　探讨功能磁共振成像 (fMRI)的血液氧饱和水平检测 (BOLD)技术在脑皮质运动区肿瘤神经导航术中的应用价值。方法　将 5 8例脑肿瘤随机分组为试验组和对照组 ,试验组 30例 ,对照组 2 8例。肿瘤涉及第一运动区 (PMA) 18例 ;运动前区 (PM) 18例 ;第一运动感觉区 (PMSA) 11例 ;第一感觉区 (PSA) 9例 ;辅助运动区 (SMA) 2例。试验组运用手运动激发模式 ,行BOLD成像定位皮质运动区 ,并与MR的导航序列影像融合 ,应用于神经导航 ;对照组采用常规MR影像导航。结果　试验组肿瘤全切率为 86 7% ,对照组为 6 0 7% ,P <0 0 5。试验组术后患侧肢体肌力为 4 3度±1 1度 ,对照组为 2 5度± 1 9度 ,P <0 0 0 1。试验组术后致瘫率为 2 3 3% ,对照组为 71 4 %。试验组远期预后Karnofsky评分 (KPS)为 88± 2 7,对照组为 6 5± 32 ,P <0 0 1。结论　应用融合BOLD影像的神经导航术 ,可实现个体化、实时、精确地定位肿瘤及毗邻的脑皮质运动区 ,提高全切率 ,降低术后致瘫率。     

丙泊酚静脉全麻下人工流产围手术期的护理干预

目的:探讨门诊日间手术人工流产术在丙泊酚静脉全麻时,护理技术的管理水平.更好地预防并发症,提高手术质量.方法:收集2006年1月～2007年12月我院应用丙泊酚静脉全麻做人工流产的患者1820例,行一般护理,围手术期护理,术后观察的相关护理和心理护理.结果:在丙泊酚静脉全麻下,成功率达98%,病人的平均手术时间(53.7±9.2)min,A组视觉模拟评分(1.69±0.63)分;病人术后头痛头晕、恶心呕吐、皮肤搔痒发生率(18.0%、9.0%、4.0%);第一次排气时间、第一次排尿时间[(20.29±8.16)h、(5.06±1.86)h].结论:患者满意度大幅度提高,很好的预防了相关并发症的发生.     

微波辅助介入治疗肝癌43例

目的 观察肝癌患者动脉灌注与栓塞配合热疗的治疗效果。方法 1999/2003对43例肝癌患者进行动脉超选灌注加热至43℃的顺铂80mg+阿毒素20mg,然后经导管灌注混有阿霉素20mg+丝裂霉素20mg的超液态碘油乳化剂进行栓塞,术中和术后4d,8d,12d,16d运用WF-2102A微波热疗治疗仪进行配合治疗,每次40min,电脑显示测温要求在43℃。结果半年生存率(39/43)90％,la生存率(27/23)62.7％,2a生存率(9/43)20.9％,3a生存率(6/43)13.9％。结论肝癌动脉灌注与栓塞配合热疗临床观察表明,该方法疗效显著,应成为一项重要的非手术治疗方案。     

Molecular cloning and identification of mouse epididymis-specific gene mHong1, the homologue of rat HongrES1

Previous studies have shown that rat epididymis-specific gene HongrES1 plays important roles in sperm capacitation and fertility. In this study, we cloned the mouse homologue gene by sequence alignment and RT-PCR methods and designated it as mHong1. The mHong1 gene is located on chromosome 12p14, spanning five exons. The cDNA sequence consists of 1257 nucleotides and encodes a 419 amino-acid protein with a predicted N-terminal signal peptide of 20 amino acids. The mHong1 mRNA shows similarity with HongrES1 in the expression patterns: (i) specific expression in epididymal tissue, especially in the cauda region; and (ii) androgen-dependence but testicular fluid factor independence. Its protein product shows 71% similarity with HongrES1 and contains a classical serpin domain as does HongrES1. A polyclonal antibody against mHong1 with high specificity and sensitivity was raised. Like HongrES1, the mHong1 protein shows a checker-board expression pattern in the epididymal epithelium and is secreted into the epididymal lumen. The mHong1 protein shows higher glycosylation than HongrES1. Although both of them are deposited onto the sperm head surface, mHong1 is localized to the equatorial segment, which is different from that of HongrES1. The mHong1 protein can be removed from the sperm membrane by high ionic strength and therefore can be classed as an extrinsic membrane protein. Collectively, we conclude that mHong1 is the homologue of HongrES1 and the present work paves the way for establishing animal models to elucidate the precise functions of HongrES1 and mHong1.