The value of pulse wave velocity in the diagnosis of coronary heart disease

Objective: Using receiver operating characteristics (ROC) curve to evaluate the value of pulse wave velocity (PWV) in the diagnosis of coronary heart disease (CHD). Methods: By using coronary angiography as golden diagnostic standard of CHD, 218 patients were divided into both CHD group (n=121) and non-CHD group (n = 97). All these patients received PWV test. The efficacy of PWV of each artery segments in the diagnosis of CHD was evaluated by ROC curve. The sensitivity and specificity were calculated with the golden diagnostic standard of CHD. Results:The PWV of right carotid to femoral artery (Rc-f), left carotid to femoral artery (Lc-f), right radial to carotid artery (Rc-r), left radial to carotid artery (Lc-r) in CHD group were significantly higher than that of non-CHD group (9. 31±1. 75 vs 7.60±1.59, P<0. 01; 9. 02±1.71 vs 7. 52±1.50, P<0. 01; 8. 69±1. 37 vs 8. 00±1. 27, P<0. 01; 8.52±1. 03 vs 8. 03±1. 2, P<0. 01 respectively). However, the PWV of both right and left femoral to ankle artery (Rf-a and Lf-a) had no significant differences between the two groups. We then compared the area under curve (AUC) of each ROC(AUCROC) of PWV of Rc-f, Lc-f Rc-r and Lc-r to evaluate their diagnostic efficacy for CHD. We found that AUCROC of Rc-f PWV was the biggest (AUCROC = 0. 818), at the peak point of its ROC curve, the PWV was 8. 32 m/s. PWV>8. 32 m/s of Rc-f could predict the presence of CHD with a sensitivity of 79% and specificity of 77%. Conclusion: The PWV of Rc-f, Lc-f, Rc-r, Lc-r are significantly higher in CHD group than that in non-CHD group, and PWV of Rc-f is the most accurate in the detection of CHD. The PWV>8. 32 m/s of RC-F is a valuable predictor of CHD.     

Pregnancy complicated with Buerger's disease.

Buerger's disease is an inflammatory occlusive vascular disorder involving small- and medium-sized arteries in the distal extremities and is usually complicated with thrombophlebitis. Since Buerger's disease develops most frequently in men who smoke, pregnancy complicated with this disease is extremely rare. Only three pregnancies have been reported previously. All cases indicate that Buerger's disease worsens during pregnancy. However, anti-coagulant therapy appeared to be effective in this case. Accordingly, careful observation is mandatory in pregnancies complicated with Buerger's disease.     

The epidemiology of preterm labour—why have advances not equated to reduced incidence?

The major burden of preterm birth is in the developing world, where most of the increasing death and morbidity is secondary to infectious diseases such as malaria, HIV, tuberculosis, bacterial vaginosis and intestinal parasites. In some developing countries, the growth of medical care has outstripped the growth of preventive public health, with an associated increase in iatrogenic preterm births. In developed countries, more than one-third of preterm births are medically indicated because of conditions such as fulminating pre-eclampsia or severe intrauterine growth restriction. Neither of these conditions is currently preventable. One in five preterm births is associated with multiple pregnancy, and these have been greatly increased by assisted reproduction techniques. The use of tocolytics has proved disappointing perhaps because inflammation rather than spontaneous uterine activity is increasingly recognised as the final common pathway. Inappropriate antibiotics used late in pregnancy are ineffective and may have adverse effects. Currently, the most promising interventions are public health related and include reducing the transmission of communicable diseases, improvements in the management of diabetes and reduction in harmful behaviours such as smoking and drug abuse.     

围生因素与新生儿肺透明膜病发病关系的探讨

目的探讨围生因素与新生儿肺透明膜病(HMD)发病的关系。方法对481例早产儿围生因素进行Logistic回归分析,筛选出与HMD有关的因素,列出回归方程,然后对其进行率的比较及卡方检验。结果HMD危险因素的主效应模型是logit(p)=6.254-0.204胎龄-1.556出生体重 0.834窒息/宫内窘迫 1.635胎膜早破。对于有围生期合并症的早产儿,其胎龄越小,HMD发病率越高。结论30周以下早产儿HMD发病主要与胎龄、出生体重关系密切,而30周以上早产儿HMD发病除与胎龄、出生体重有关外,还与围生因素密切相关,其发病机制有待进一步研究。     

口服葡萄糖对新生儿心率的影响

目的探讨口服葡萄糖能否增加健康新生儿心率及健康新生儿心率与葡萄糖水平、喂养途径的关系。方法对73例健康新生儿采用随机、对照研究。在无任何疼痛应激情况下,随机分为3组,A组(n=25)用注射器予50%葡萄糖溶液口服;B组(n=21)用注射器予10%葡萄糖溶液口服;对照组(n=27)用注射器予蒸馏水口服。待心率恢复一段时间后,改变喂养方式,同组分别用橡皮奶头吸吮上述同组液体。记录两种喂养方式:3组开始时3 min、给液后1、2、3 min不同时间点心率。结果同一喂养方式中予50%、10%葡萄糖溶液组两组心率变化无显著意义(P>0.05),但两组心率变化分别较蒸馏水组明显增快(P<0.01)。不同喂养方式中吸吮喂养组心率增快分别高于同一种溶液注射器喂养组(P<0.05)。喂养过程中心率达高峰,随后渐降低。结论在无疼痛刺激下,口服葡萄糖本身能增加健康新生儿心率,但心率增加与葡萄糖水平无关。健康新生儿心率与喂养途径有关,吸吮动作可增加新生儿心率。     

充血性心力衰竭患儿血清白细胞介素-18和淋巴细胞CD54变化

目的探讨IL-18和CDs4在小儿充血性心力衰竭（CFIF）发病中的作用，及其对z],JLCFIF的诊断价值。方法CFIF患儿52例，心功能按修订的Ross和Reithman评分系统。心功能Ⅱ级（3～6分）18例、Ⅲ级（7～9分）17例，Ⅳ级（10～12分）17例。原发疾病为扩张性心肌病、心内膜弹力纤维增生症及先天性心脏病等。对照组15例为上呼吸道感染患儿。血清IL-18水平用ELISA法进行测定，采用流式细胞术检测外周血淋巴细胞CDs4表达。结果CFIF患儿血清IL-18及CDs4均显著增高（P均〈0．001），且随CFIF加重渐增加，治疗后两者均较治疗前明显降低（P均〈0．05）；且两者在心肌病组、先天性心脏病组及其他病组3组间比较差异无显著性（P均〉0．05），但均显著高于对照组（P均〈0．01）。结论IL-18和CDs4可能参与小儿CFIF发生发展。可以作为评价CHF严重程度的生物化学标记；CFIF作为一种临床综合征，无论最初病因是否相同，免疫反应可能都具有某些共同特征。     

1 548例结肠炎症的结肠镜结果分析

目的探讨结肠镜检查对结肠炎症病因诊断的价值。方法本院2003年7月。2006年2月行肠镜检查2112例，发现结肠炎症病例l548例，回顾性分析结肠炎症疾病病因。结果本地区结肠炎症的发生以慢性结肠炎、结肠息肉、结肠癌为最常见，溃疡性结肠炎次之，克罗恩病较少。结论结肠镜检查对慢性结肠炎症的病因诊断及鉴别有重要的临床价值。