超声诊断胎儿先天性心内膜垫缺损

目的探讨产前超声诊断胎儿心内膜垫缺损的临床价值。方法对2004年10月～2008年10月77832例孕18w以上的胎儿心脏应用超声检查,以胎儿四腔心切面为常规,多切面扫查观察胎儿心脏大小、形态、房室结构、房室瓣开闭、左右心室流出道。结果发现心内膜垫缺损16例,伴发其他畸形4例,漏诊1例。结论产前超声是诊断胎儿先天性心内膜垫缺损的可靠方法及技术,可阻止严重先天性畸形——心内膜垫缺损的胎儿出生。     

第四跖背动脉逆行岛状皮瓣在第二足趾再造手指供区趾蹼皮肤缺损中的临床应用

目的探讨第四跖背动脉逆行岛状皮瓣修复第二足趾再造手指后供区趾蹼皮肤缺损的临床应用效果。方法2007年1月~2009年12月,均为切取第二足趾再造手指时携带面积不等的跖背皮瓣13例患者的临床资料进行分析。结果术后13例转移皮瓣全部存活,术后随访时间为3~16个月,皮瓣质地、感觉良好,趾蹼外形满意,供足行走功能满意。结论最大限度地保护了供足的功能,减少了植皮后并发症,是较为理想的手术方式。     

可注射性纳米羟基磷灰石、壳聚糖复合材料修复骨缺损的实验研究

目的：观察可注射性羟基磷灰石/壳聚糖复合材料对兔桡骨骨缺损修复效果。方法：18只新西兰白兔双侧桡骨中段建立长度为10mm节段性缺损,将可注射性纳米羟基磷灰石/壳聚糖复合材料植入一侧骨缺损作为实验组,另一侧植入单纯羟基磷灰石材料作为对照组,于第4、8、12周末,分别行大体、X线检查、组织学、电镜检测,观察该材料对骨缺损的修复效果。结果：①大体观察、X线检查提示：实验组骨痂生长良好,骨缺损完全修复,对照组骨缺损部分修复,部分骨皮质不连续。②组织形态学: 术后12周,实验组新生骨皮质连接完整,髓腔完全再通;对照组少量新生骨形成,部分纤维组织填充③电镜检查:12周实验组材料基本降解,被新生骨组织替代。结论：可注射性纳米羟基磷灰石/壳聚糖复合材料骨缺损修复能力较单纯羟基磷灰石好,具有确实的骨缺损修复能力。     

The relationship between mother and infant plasma trace element and heavy metal levels and the risk of neural tube defect in infants

Objective: To determine levels of trace elements [copper (Cu), zinc (Zn), selenium (Se), and cobalt (Co)] and heavy metals [arsenic (As), mercury (Hg), lead (Pb), and cadmium (Cd)] in the plasma of mothers and infants and investigate the relationship between those levels and neural tube defects (NTD).

Methods: A total of 100 neonates diagnosed with NTD and placed in the Neonatal Intensive Care Unit of Yuzuncu Yil University, Turkey between May 2013 and December 2016 comprised the study group. The control group consisted of 70 healthy neonates not diagnosed with NTD or any other congenital anomalies. For both the groups, mother and infant plasma levels of Cu, Zn, Co, Cd, Se, Hg, As, and Pb were measured and compared. Plasma levels of Cu, Zn, Co, Cd, Se, Hg, As, and Pb were measured and compared between two groups of mothers and infants.

Findings: Mother and infant plasma levels of trace elements Zn and Se were determined to be significantly lower in the study group compared with the control group, while Cu levels were significant elevated in the study group (all p values p?p?>?.05). Differences in maternal age, birth weight, length of gestation, and infant gender for the two groups were also determined not to be statistically significant.

Results: High plasma levels of heavy metals As, Pb, and Cd and trace element Cu were identified as risk factors for the development of NTD. At the same time, low plasma levels of trace elements Zn and Se were also found to be risk factors for NTD. However, no association between Hg and Co plasma levels and increased risk for the development of NTD was observed. This study, while being the most comprehensive case study to date investigating the relationship between heavy metals and trace element levels and increased risk of NTD, nonetheless highlights the need for further research in order to make definite statements regarding this relationship.     

The genetic and clinical outcome of isolated fetal muscular ventricular septal defect (VSD)

Introduction: Our objective was to evaluate the incidence of chromosomal aberration (both microscopic and submicroscopic) and the clinical outcome of fetuses with isolated muscular ventricular septal defect (VSD).

Material and methods: The study included 40 pregnant women whose fetuses were diagnosed with isolated muscular ventricular septal defect (mVSD). Of these, 30 patients underwent amniocentesis and 10 declined. All samples were tested by chromosomal microarray analysis (CMA). Of the 40 women in the study, 32 gave birth and the clinical outcome of the children was retrieved from the patients’ medical records.

Results: Of the 30 patients who underwent amniocentesis, one was detected with mosaic Klinefelter syndrome and one was detected with a pathogenic copy number variant unrelated to the VSD. Clinical follow-up was performed on 26 children after birth. The first postnatal echocardiography did not detect a VSD in 13 (50%) of the followed-up children. Spontaneous closure occurred in another eight (30.8%) children during the postnatal follow-up period. In only five children (19.2%) VSD was still detected by echocardiography after the first year of life.

Discussion: Isolated muscular VSD diagnosed prenatally does not appear to be a significant risk factor for chromosomal abnormalities and has a favorable clinical outcome.     

First trimester combined screening biochemistry in detection of congenital heart defects

Objective: To evaluate the performance of first trimester biochemical markers, pregnancy-associated plasma protein-A (PAPP-A), free beta human chorionic gonadotropin (fβ-hCG), and nuchal translucency (NT) in detection of severe congenital heart defects (CHDs).

Methods: During the study period from 1 January 2008 to 31 December 2011, biochemical markers and NT were measured in 31,144 women as part of voluntary first trimester screening program for Down’s syndrome in Northern Finland. Data for 71 severe CHD cases and 762 controls were obtained from the hospital records and from the National Medical Birth Register, which records the birth of all liveborn and stillborn infants, and from the National Register of Congenital Malformations that receives information about all the CHD cases diagnosed in Finland.

Results: Both PAPP-A and fβ-hCG multiple of median (MoM) values were decreased in all severe CHDs: 0.71 and 0.69 in ventricular septal defects (VSDs), 0.58 and 0.88 in tetralogy of Fallot cases (TOFs), 0.82 and 0.89 in hypoplastic left heart syndromes (HLHSs), and 0.88 and 0.96 in multiple defects, respectively. NT was increased in all study groups except of VSD group. ROC AUC was 0.72 for VSD when combining prior risk with PAPP-A and fβ-hCG. Adding NT did not improve the detection rate. With normal NT but decreased (<0.5 MoM) PAPP-A and fβ-hCG odds ratios for VSD and HLHS were 19.5 and 25.6, respectively.

Conclusions: Maternal serum biochemistry improves the detection of CHDs compared to NT measurement only. In cases with normal NT measurement but low concentrations of both PAPP-A and fβ-hCG, an alert for possible CHD, especially VSD, could be given with thorough examination of fetal heart in later ultrasound scans.     

自体骨与同种异体骨治疗兔桡骨骨缺损的实验对比研究

目的:探讨采用同种异体骨治疗兔桡骨骨缺损疗效的实验研究。方法:将12只健康成年新西兰大白兔作为同种异体骨供体,28只作为实验受体。按美国组织库标准制备同种异体骨。将受体实验动物双侧桡骨中段切除10 mm,制成骨缺损模型。受体实验动物右侧桡骨骨缺损内植入自体髂骨骨粒(对照组);左侧取等量同种异体骨粒同法植入(实验组)。于术后2、4、8、12周,对骨缺损修复组织内OPG蛋白的表达检测采用免疫组织化学方法。术后12周,检测两组骨小梁相对体积、骨小梁数量和骨密度。结果:术后两组未见感染现象发生。术后2、4周实验组OPG蛋白表达低于对照组,差异有统计学意义(P<0.05)。术后8、12周两组OPG蛋白表达差异无统计学意义。术后12周两组骨小梁相对体积、骨小梁数量和骨密度比较,差异无统计学意义。结论:同种异体骨具有较好的组织相容性,其骨性愈合过程与自体骨移植相似,并且来源广泛,能够避免因自体骨移植带来的诸多并发症,可以成为治疗骨缺损的重要材料。     

新型生物可吸收房间隔缺损封堵器的生物相容性研究

目的评价自主研究的新型房间隔封堵器的生物相容性,为动物实验提供依据。方法封堵器框架由生物可吸收聚左旋乳酸(poly-L-lactic acid,PLLA)单丝网编织成型。通过对PLLA单丝进行体外细胞毒性测试、体外溶血测试、全身急性毒性测试、肌肉植入实验,评价新型房间隔封堵器的生物相容性。结果 PLLA房间隔缺损封堵器无体外细胞毒性,体外溶血率0.9%,无急性全身毒性反应。通过分析样品植入肌肉1个月、3个月和6个月后组织病理,观察样品与组织之间的反应,未发现明显的组织损伤和组织增生。结论生物可吸收PLLA房间隔封堵器的生物相容性良好,可进行下一步的动物实验研究。     

氟伐他汀与丁苯酞软胶囊联合治疗对急性脑梗死患者的影响

目的 探讨急性脑梗死病人进行丁苯酞软胶囊与氟伐他汀联合治疗的临床效果及对患者血清C反应蛋白的动态影响.方法 选取我院2013年6月-2014年5月急性脑梗死病人100例,根据随机数字表法分为研究组、对照组,每组50例,两组均进行血压控制、抗感染、脱水、营养脑细胞、降低颅压等常规疗法,研究组在此基础上进行丁苯酞软胶囊与氟伐他汀疗法,对照组仅服用氟伐他汀,两组均治疗2W,比较两组的临床效果;比较两组治疗前后的神经功能缺损程度评分量表(NIHSS)评分、Barthel指数评分、FMA评分情况;比较两组治疗前后的纤维蛋白原、红细胞压积等血液流变指标;比较两组治疗前、治疗后3d、治疗后1W、治疗后2W的血清C反应蛋白(CRP)水平的动态改变.结果 研究组的临床有效率为84.0％,对照组的临床有效率为52.0％,两组比较差异有统计学意义(P＜0.05);治疗后,研究组神经功能缺损程度量表(NIHSS)评分情况显著优于对照组(P＜0.05);研究组治疗后的Bar-thel指数评分、FMA评分情况显著优于对照组(P＜0.05);治疗后研究组的纤维蛋白原、红细胞压积等血液流变指标显著优于对照组,差异有统计学意义(P＜0.05);研究组治疗后3d、治疗后1W、治疗后2W的血清CRP水平优于对照组,差异有统计学意义(P＜0.05).结论 对急性脑梗死病人进行丁苯酞软胶囊与氟伐他汀联合疗法,可显著改善病人的神经功能缺损程度,提高其日常生活能力,改善其血流动力学指标及血清C反应蛋白,临床效果确切,值得临床推广.     

2型糖尿病合并急性脑梗死患者血糖水平及血糖漂移对神经功能缺损的影响

目的：观察血糖水平及血糖漂移对2型糖尿病(type 2 diabetes mellitus,T2DM)合并急性脑梗死(acute cerebral infarction,ACI)患者神经功能缺损的影响。方法：选取2014年3月至2015年6月在我院治疗的ACI患者作为观察对象,根据其是否合并2型糖尿病史,将其分为2组：合并2型糖尿病组(DMCI组,42例)和不合并2型糖尿病组(NDMCI组,45例)。比较两组患者平均血糖水平(mean blood glucose,MBG)、血糖水平标准差(standard deviation of blood glucose,SDBG)、血糖波动频数(number of effective glucose excursions,NEGE)、最大血糖波动幅度(largest amplitude of glycemic excursions,LAGE)以及平均血糖波动幅度(mean amplitude of glycemic excursions,MAGE)的差异;观察两组患者神经功能缺损评分的差异,分析血糖水平及血糖漂移与神经功能缺损的相关性。结果：DMCI组患者神经功能缺损评分(National Institutes of Health Stroke Scale,NIHSS)明显高于NDMCI组,差异具有统计学意义(P<0.05);DMCI组患者MBG、SDBG、NEGE、LAGE和MAGE水平均明显高于NDMCI组,差异具有统计学意义(P<0.05);NIHSS评分与MBG、SDBG、NEGE、LAGE和MAGE水平均明显正相关(r=0.356、0.412、0.389、0.435和0.397,P<0.05)。结论：血糖及血糖漂移的高水平可加重T2DM合并ACI患者的神经功能缺损程度。