三维超声对胎儿体表畸形的诊断价值

目的:探讨三维超声成像在胎儿体表畸形诊断的临床价值。方法:利用三维超声仪对在我院进行产前检查的妊娠20~41周的3241例孕妇、共3277个胎儿进行二维及三维超声检查,统计并比较超声诊断与随访结果。结果:140例各种发育异常胎儿,其中体表畸形胎儿34例,二维超声诊断正确者21例,9例体表畸形胎儿二维超声检查不能作出明确诊断;三维超声进一步检查诊断正确者共30例;二维及三维超声检查误诊1例胎儿足内翻,生后证实正常,漏诊1例耳廓缺失、2例多指畸形,生后随访证实。三维超声对胎儿体表畸形检出的敏感性、特异性及准确性分别为90.91%、99.97%、99.88%;二维超声对胎儿体表畸形检出的敏感性、特异性及准确性分别为63.64%、99.97%、99.60%。结论:三维超声能直观显示胎儿体表结构,三维超声检查诊断胎儿体表畸形的敏感性、特异性及准确性高,是二维超声检查的重要补充,与二维超声联合应用,可提高胎儿体表畸形的检出率。     

免疫组化法检测非甲-非庚型肝炎患者肝组织中输血传播病毒

目的　检测非甲-非庚型肝炎患者肝组织输血传播病毒(TTV)感染状况,TTV感染与肝组织炎症程度 及与血液学指标的相关性。方法　应用免疫组织化学法检测52例非甲-非庚型肝炎患者肝组织中TTV,并经原位 杂交证实;对TTV阳性和阴性组的血液学生化指标,诸如血清丙氨酸转氨酶(ALT)、血清天冬氨酸转氨酶(AST)、血 清总胆红素(TBIL)、白蛋白(ALB)、γ 球蛋白(γ G)、凝血酶原活动度(PTA)及组织学活动指数(HAI)进行了比较。 结果　非甲-非庚型肝炎患者肝组织中TTV抗原(TTVAg)阳性15例,检出率为28.8%;阳性物质主要定位于肝细 胞浆内,呈棕黄色细小颗粒,偶见肝细胞核内有表达;TTV阳性表达细胞呈单个、散在或片簇状分布;TTVAg阳性的 组织切片经苏木素-伊红(HE)染色后,可观察到病毒性肝炎的一些病理变化,如肝细胞胞浆疏松化、气球样变、嗜酸 样变、灶性坏死、凋亡、小叶内及汇管区炎细胞浸润;从15例TTVAg阳性病例中任选10例进行TTV DNA原位杂交 检测,结果8例阳性,二者符合率80.0%;同时对5例免疫组化TTVAg阴性肝组织进行TTV DNA原位杂交检测,结 果5例均为阴性,二者符合率100%;TTVAg阳性组ALT、AST、TBIL、γ G均值均高于TTVAg阴性组,ALB、PTA 均值均低于TTVAg阴性组,但两组比较差异无统计学意义(P>0.0     

一种适用于聚合酶链反应的常见念珠菌基因组DNA提取方法的研究

目的介绍一种简单、快速的真菌DNA提取方法,提高真菌DNA提取效率,减少毒性和污染性,以适应临床研究需要。方法同时用溶细胞酶结合Biospin真菌基因组DNA提取试剂盒和十六烷基三甲基溴化铵(CTAB)法,提取白色念珠菌、热带念珠菌、克柔念珠菌和净平滑念珠菌基因组DNA,用A260/A280的比值检测DNA的纯度并计算质量浓度,同时行聚合酶链反应(PCR)以评价其可靠性。结果溶细胞酶结合Biospin真菌基因组DNA提取试剂成功提取所用真菌基因组DNA,其纯度及质量浓度能满足PCR反应的要求。结论用溶细胞酶结合Biospin真菌基因组DNA提取试剂提取DNA,简单、快速、高效,可用于PCR反应。     

脾切除治疗原发性骨髓纤维化适应证的探讨

目的：探讨脾切除治疗原发性骨髓纤维化的可行性及其效果。方法：回顾性分析我院2000年1月至2006年12月间收治的5例行脾切除治疗原发性骨髓纤维化的病人资料。结果：本组病人均行脾切除术，其中2例加行贲门周围血管离断术．术后发生脾窝积液1例，肺部感染1例。随访3月至5年，病人贫血状况、左上腹疼痛症状均得到缓解．生活质量得到改善。结论：脾切除对有适应证的原发性骨髓纤维化是可行的治疗手段，可明显改善病人的症状，提高生活质量。     

整形外科临床教学模式浅析

随着整形美容外科专业在我国的蓬勃发展,国内不同等级的医疗机构对经过正规培训的整形美容外科医生的需求逐年在增加。为了提高教学效果,针对整形外科不同层次的学生,我们采用了多种形式、有针对性的教学模式,并取得了一定的效果。本文分别从教学查房、手术带教、读书报告、技能培训、学术交流、专题讲座等多个层面浅析了整形外科临床教学模式。     

甲状腺癌淋巴结微转移的研究

目的:探讨MUC1检测在甲状腺癌淋巴结微转移的可靠性和敏感性。方法:对488例甲状腺疾病手术患者于术前24h用1%美兰1.0~2.0mL注射于甲状腺结节或周围腺体，术中显示蓝染淋巴结，采用RT-PCR法测定临床蓝染淋巴结中的MUC1。 结果:蓝染淋巴结显示率甲状腺癌为93%，良性病例为0。研究组80个蓝染淋巴结中发现有MUC1mＲＮＡ表达的为95%,与病理诊断率(86%)相比有提高（P<0.05）;良性病变（阴性对照组）淋巴结均不存在MUC1mRNA的表达;阳性对照组的癌转移性淋巴结均存在MUC1mRNA的表达。结论:MUC1较病理检查敏感，PCR产物点杂交进一步证实MUC1作为PCR标志物有较好的可靠性。     

兔肢体爆炸伤合并海水浸泡后在不同复温速率及维持浅低体温下机体炎症反应的特征

Objective To investigate effects of different rewarming rates and maintenance of light hypothermia on inflammatory response in rabbits after limb blast injury, coupled with seawater immersion. Methods First, the model of limb blast injury coupled with seawater immersion was reproduced [the animals were immersed to low body temperature of (31.0±0.5℃)]. Then, 24 adult rabbits were randomly divided into group Ⅰ [the rapid rewarming group, n=6, rewarmed to (38±0.5)℃ at a rate of (8.94±0.93)℃/h], group Ⅱ [the slow rewarming group, n=6, rewarmed to (38±0.5)℃ at a rate of (3.88±0.22)℃/h], group Ⅲ [another slow rewarming group, n=6, rewarmed to (38±0.5)℃ at a rate of (2.18±0.12)℃/h], and the H group [the hypothermia group, n =6, rewarmed to (34 - 35)℃ at a rate of (4.49±0.66)℃/h and kept at that temperature till termination of the experiment]. Regulation of ambient temperature and warm transfusion were used to restore body temperature to target levels and maintained there for 6 hours. Blood samples were taken at 5 different times, I.e. Pre-injury time(T0), post-immersion time (T1), the time when rewarming started (T2), 3 h after rewarming (T3), and 6 h after rewarming (T4). Tissue samples from heart, liver, intestinum, lung and kidney were also collected. Levels of TNF-α (tumor necrosis factor-α), IL-1β (interleukin-1β) and IL-6 (interleukin-6) in plasma and MPO (myeloperoxidase) in homogenate were detected. Results Following rewarming, TNF-α, IL-1β, IL-6 concentrations in the plasma of the animals in group Ⅰ and group H were significantly higher when compared with those of the animals in group Ⅱ and group Ⅲ (P<0.05, P<0.01), and MPO activity in homogenate was significantly higher when compared with that of the animals in group Ⅱ and group Ⅲ(P<0.01, P<0.05), and no statistical difference could be seen between group Ⅱ and Ⅲ (P>0.05). Conclusions Rapid rewarming and maintenance of light hypothermia could obviously elevate TNF-α, IL-1β, IL-6 concentrations in plasma and MPO activity in homogenate, following limb blast injury coupled with hypothermia induced by seawater immersion, while slow rewarming (with a rewarming rate of 2-4℃/h) could significantly inhibit TNF-α, IL-1β, IL-6 levels and PMN activity.     

Health Information System Implementation: A Qualitative Meta-analysis

Healthcare information systems (HISs) are often implemented to enhance the quality of care and the degree to which it is patient-centered, as well as to improve the efficiency and safety of services. However, the outcomes of HIS implementations have not met expectations. We set out to organize the knowledge gained in qualitative studies performed in association with HIS implementations and to use this knowledge to outline an updated structure for implementation planning. A multi-disciplinary team performed the analyses in order to cover as many aspects of the primary studies as possible. We found that merely implementing an HIS will not automatically increase organizational efficiency. Strategic, tactical, and operational actions have to be taken into consideration, including management involvement, integration in healthcare workflow, establishing compatibility between software and hardware and, most importantly, user involvement, education and training. The results should be interpreted as a high-order scheme, and not a predictive theory.