正常儿童三维左室心肌应变特征及Z-score建立的研究

目的分析正常儿童左室心肌应变的变化特征并建立其Z-score。方法获取173例正常儿童的三维左室整体纵向、径向、圆周应变(GLS、GRS、GCS)参数。比较不同体表面积(BSA)组正常儿童三维应变参数的差异。有明显变化趋势者做进一步回归分析,并建立Z-score。结果随着儿童BSA增加,GLS、GRS递减,差异有统计学意义;不同BSA组GCS较为均一,差异无统计学意义。年龄、身高、体质量、BSA与GLS、GRS均存在非线性相关,选取BSA作为生长发育指标建立正常儿童GLS、GRS的Z-score优于年龄、身高、体质量。结论不同BSA组正常儿童左室心肌功能存在不均一性,建立正常儿童GLS、GRS的Z-score,为临床定量评估儿童心肌功能提供科学、准确的方法。     

Chorea-acanthocytosis: Time-dependent changes of symptoms and imaging findings

Background and purposeChorea-acanthocytosis, a rare neurodegenerative disease, affects both the striatum and the medial temporal lobe which may cause involuntary movements and epilepsy, respectively. We examined the imaging changes of the hippocampus/amygdala and the striatum as well as clinical symptoms.Materials and methodsWe retrospectively reviewed 29 MRI and 13 SPECT studies and the clinical findings of seven genetically confirmed chorea-acanthocytosis patients. We evaluated the time-dependent imaging changes of the hippocampus/amygdala and striatum and examined the relationships among these images and symptoms.ResultsThe initial symptom was epilepsy in four patients and involuntary movements in three patients. These symptoms were eventually noted in five and all seven patients, respectively. On MRI, most patients showed striatum atrophy before a hippocampus/amygdala abnormality emerged, but one patient showed a hippocampus/amygdala abnormality before striatum atrophy. Abnormal MRI findings of hippocampus/amygdala were noted in five patients and atrophy of striatum in all seven patients. SPECT demonstrated hypoperfusion of hippocampus/amygdala in three patients and that of striatum in all five available patients. Four patients demonstrated hypoperfusion of striatum earlier than that of hippocampus/amygdala and one patient showed hypoperfusion of both simultaneously. Many imaging abnormal lesions were accompanied by their corresponding symptoms, but not always so.ConclusionStriatum abnormalities were the initial imaging findings in many chorea-acanthocytosis patients, but epilepsy or hippocampus/amygdala imaging abnormalities may be the only findings at the early stage. It is important to understand the detailed clinical and imaging time courses for the diagnosis of chorea-acanthocytosis.     

Malnutrition in Infants Aged under 6 Months Attending Community Health Centres: A Cross Sectional Survey

A poor understanding of malnutrition burden is a common reason for not prioritizing the care of small and nutritionally at-risk infants aged under-six months (infants u6m). We aimed to estimate the anthropometric deficit prevalence in infants u6m attending health centres, using the Composite Index of Anthropometric Failure (CIAF), and to assess the overlap of different individual indicators. We undertook a two-week survey of all infants u6m visiting 18 health centres in two zones of the Oromia region, Ethiopia. We measured weight, length, and MUAC (mid-upper arm circumference) and calculated weight-for-length (WLZ), length-for-age (LAZ), and weight-for-age z-scores (WAZ). Overall, 21.7% (95% CI: 19.2; 24.3) of infants u6m presented CIAF, and of these, 10.7% (95% CI: 8.93; 12.7) had multiple anthropometric deficits. Low MUAC overlapped with 47.5% (95% CI: 38.0; 57.3), 43.8% (95% CI: 34.9; 53.1), and 42.6% (95% CI: 36.3; 49.2) of the stunted, wasted, and CIAF prevalence, respectively. Underweight overlapped with 63.4% (95% CI: 53.6; 72.2), 52.7% (95% CI: 43.4; 61.7), and 59.6% (95% CI: 53.1; 65.9) of the stunted, wasted, and CIAF prevalence, respectively. Anthropometric deficits, single and multiple, are prevalent in infants attending health centres. WAZ overlaps more with other forms of anthropometric deficits than MUAC.     

Z-综合评分法优化葛粉速溶颗粒的制备工艺

摘要：目的 探讨和优化葛粉速溶颗粒的制备工艺,并对葛粉速溶颗粒进行溶化性试验、总黄酮含量测定作为质量考察。方法 本实验以糖粉与葛粉的比例、泡打粉与葛粉的比例、干燥温度为因素,每因素采取3个水平,以颗粒的溶化时间和颗粒中总黄酮的含量为指标,用Z-综合分析法选出最优制备工艺。用最优工艺制备3批样品进行溶化性试验、水分含量测定及Al(NO3)3显色法测定总黄酮。 结果 经过优化后,最佳制备工艺为等量递增法往研钵中依次加入泡打粉1.2g、糊精1.8g、糖粉24g、和葛粉33g混合均匀,加入约5ml 35℃～40℃的温水混匀,捏成团块状保持在35℃的环境下放置40min,使其内部充满多而密的孔洞,体积膨大,质地松软,挤压过筛（10-14目）,60℃干燥40min,整粒,即得葛粉速溶颗粒。制得3批样品,大小均匀,呈乳白色,色泽一致,无吸潮、结块、潮解现象,溶化性试验合格,85℃左右热水冲溶全部糊化。颗粒水分含量小于6.0%,总黄酮的含量为0.327mg/g。结论　葛粉速溶颗粒的制备工艺简便可行,性质稳定,总黄酮含量可用于其质量评价。     

eZIS在脑血流灌注SPECT诊断神经退行性痴呆中的临床应用

简易Z评分成像系统（eZIS）是一种基于统计参数图和三维立体定向表面投影的辅助脑血流灌注SPECT图像自动诊断的统计分析方法,可以用于痴呆、帕金森病、共济失调和运动神经元病等神经系统疾病的诊断。与其他计算机辅助分析方法相比,eZIS可提供正常数据库,并通过图像转换程序实现不同机构的数据共享,使未来多中心、大样本量的临床研究成为可能。笔者就eZIS在脑血流灌注SPECT诊断神经退行性痴呆中的临床应用进行综述,旨在提高临床医师对eZIS的认识,促进其在临床及科研工作中的应用。     

Relationship between Obstetric Mode of Delivery and Risk of Overweight/Obesity in 1- to 4-Year-Old Children

IntroductionChildhood obesity is an important public health problem, which may lead to increased risk of obesity in adulthood. The relationship between the incidence of obesity and the mode of delivery is not clear. Cesarean section (CS) may be one of the risk factors of obesity in children. We investigated the relationship between the mode of delivery of pregnant women and the risk of overweight/obesity in children of all ages from 1 to 4 years.MethodsRegistered in the maternal and child registration system of Xiamen city, newborns born between January 2011 and December 2012 were followed up to 4 years old.Results9,964 cases were included in the study, of which 3,462 cases (34.7%) were cesarean deliveries. From 1 to 4 years of age, BMI Z-scores and the risk for overweight/obesity of children delivered by CS were higher than by the vagina. Longitudinal analysis of anthropometric outcomes assessed during study visits in 1- to 4-year-old offspring exposed to CS showed that after adjustment for kinds of effect factors, the changes in BMI Z-scores were 0.04 (95% CI: 0.01–0.09, p = 0.003), significantly higher than vaginal delivery, and the risk incidence of overweight/obesity by increased 8% in CS offspring; OR = 1.08 (1.01–1.21, p< 0.05).ConclusionThe mode of cesarean delivery is related to the risk of overweight and obesity in children aged 1–4 years. When pregnant women choose cesarean delivery without medical indications, they should be concerned that their offspring may have a higher risk of obesity.     

INTERGROWTH-21st标准评价胎儿宫内生长受限的临床价值

 目的  探讨INTERGROWTH 21st标准评价胎儿宫内生长受限的应用价值。方法  本研究为前瞻性队列研究。收集2015年3月至2016年3月在复旦大学附属妇产科医院建卡,进行常规产前检查并入院分娩的单胎妊娠孕妇。所有入选病例孕28周之后入组,每4周做一次产前超声生长测量,直至分娩前。胎儿生长径线以INTERGROWTH 21st标准计算Z score值。分娩后随访新生儿体重等相关信息。应用Logistic回归方程建立预测公式。最后将新公式与Hadlock法预测IUGR的准确性进行对比。结果  共收集符合入组条件的孕妇834例。排除失访143例后,得到对照组565例和IUGR组126例。新预测公式的敏感性、特异性、阳性预测值、阴性预测值、假阳性率、假阴性率分别为:88.9%、85.4%、57.7%、97.2%、14.6%、11.1%。Hadlock法预测的敏感性、特异性、阳性预测值、阴性预测值、假阳性率、假阴性率分别为:81.7%、82.7%、51.2%、95.3%、17.3%、18.3%。结论  以INTERGROWTH-21st标准计算Z-score建立新公式预测胎儿宫内生长受限的方法,与传统的Hadlock预测法相比,改善了产前诊断的敏感性和特异度,减少了假阳性和假阴性的病例,全面提高了超声预测胎儿宫内生长受限的准确性。