超声测量胎儿颈褶厚度的临床意义

目的：建立胎儿颈褶厚度（Nuchal Skinfold Thickness,NT）的正常参考值,以便为产前超声诊断胎儿染色体异常提供参照。方法：经腹超声测量1555例次中晚孕期胎儿颈褶厚度,并进行统计分析。结果：初步得出各孕周胎儿NT的参考值范围。NT随孕周增加而增长（r＝0．767,P＜0．0001）。男女性别之间,壮、汉民族之间无差异,与出生体重亦无明显关系（P均＞0．05）。结论：NT的变化遵循胎儿发育的规律,其有本身的固定图像特征。本文提出的各孕周的NT超声测值,对胎儿染色异常的筛查有重要参考价值。     

孕早期颈项透明层厚度测量在胎儿产前诊断中的应用分析

目的探讨孕早期超声测量胎儿颈项透明层(nuchal translucency,NT)厚度在产前诊断胎儿染色体疾病及其他结构畸形中的临床价值。方法对2008年9月—2009年8月期间的227名孕11~13+6周胎儿进行NT厚度标准测量,分析NT增厚胎儿的染色体核型、结构及妊娠结局。结果 NT厚度<2.5 mm的胎儿中,染色体及结构正常211例,染色体或结构异常2例。NT厚度≥2.5 mm的胎儿中,6例染色体异常(13-三体综合征1例、18-三体综合征1例、21-三体综合征3例、45X0 1例);3例结构畸形(胎儿多发性结构异常1例、先天性心脏病2例);1例孕20周前不明原因流产;4例无染色体及其他结构异常。正常胎儿的NT厚度呈正态分布,NT厚度随胎龄增加而增厚,男性与女性的NT厚度差异无统计学意义。正常胎儿与异常胎儿头臀长差异无统计学意义;NT厚度异常胎儿的孕妇年龄大于NT厚度正常的孕妇。超声测量NT厚度值设为2.5 mm时,检测胎儿早期异常的灵敏度与特异度比较平衡,分别为80.0%和97.0%。结论 NT厚度的标准化测量是一个早期对胎儿染色体异常、结构异常,尤其是胎儿先天性心脏病筛查的重要指标,有助于早期诊断染色体疾病及其他结构异常,对评价胎儿预后具有较高的临床价值。     

孕11—13^＋6周胎儿颈项透明层厚度的超声测量

目的分析孕11～13^＋6周正常胎儿颈项透明层（NT）厚度及其与头臀径的关系。方法选择孕11～13^＋6周头臀径为45～84mm的正常胎儿3224例,超声测量胎儿NT厚度和头臀径,并对头臀径与颈NT厚度进行相关性研究。结果胎儿NT厚度随着头臀径的增加而增厚;中位数预测值从头臀径为45mm时的0．9mm至头臀径为84mm时的1．7mm。结论孕11-13^＋6周正常胎儿NT厚度的参考值范围为早孕期胎儿染色体异常和其他先天性异常的筛查提供了帮助。     

超声探测颈部透明带检出胎儿染色体异常

目的：评价超声探测颈部透明带或颈部水肿在检出胎儿染色体异常方面的作用。方法：于孕10－14周测量胎儿颈部透明带厚度，或孕14周后测量胎儿颈部皮肤厚度，并随诊观察，结果：通过超声探测共检出12例非整倍体型染色体异常的胎儿，5例正常染色体但随诊发现严重并发症的胎儿，与颈部透明带增厚但染色体及颈后正常的胎儿相比，上述异常胎儿在孕10－14周时的颈部透明带显著增厚（平均厚度6．1mm对3．6mm)，且大多数进展为妊娠中期时的颈部水肿，并合并其他超声异常。结论：超声测量颈部透明带厚度能早期有效地检出染色体异常及合并其他严重并发症的胎儿，且超声随诊观察颈部透明带厚度的变化对于鉴别诊断及评价预后有很大帮助。     

孕早期NT增厚胎儿的染色体核型与妊娠结局探讨

目的:分析孕早期胎儿颈项透明层厚度(nuchal translucency,NT)增厚与染色体异常情况以及妊娠结局.方法:选择2019年1月—2020年12月在我院经腹超声检查胎儿超声检查颈项透明层(NT)增厚(NT值＞相应孕周95?th%)胎儿55例,对照染色体核型分析,根据NT厚度分为4组,NT＜3.5?mm为第1...     

对胎儿10～14周颈项透明层厚度正常值的超声探讨

目的 通过超声检查,对10～14孕周正常单胎胎儿颈项透明层(nuchal translucency,NT)进行正常值调查以探讨其范围.方法 数据的收集从2007年1月至2009年4月在我院就诊的单胎妊娠孕妇,共2 060例孕周为10～14结局正常的胎儿,应用超声测量NT厚度和头臀长(CRL).按不同孕周,NT厚度的第5、第50和第95百分位数用线性回归的方法 计算.结果 NT随着孕周的增加而增厚.孕10周胎儿NT厚度的第50百分位数为1.00 mm,第95百分位数为1.90 mm;孕14周胎儿NT厚度的第50百分位数为1.60 mm,第95百分位数为2.30 mm.结论 由于10～14周胎儿NT厚度随孕周的变化而增厚,不应使用一个恒定值,应按不同孕周使用其对应的正常值.     

超声筛查孕11～13+6周胎儿畸形的初探

目的探讨经腹部超声在孕11～13+6周筛查胎儿畸形的临床价值。方法在本院建卡的1 153名孕妇,孕11～13+6周超声系统观察胎儿解剖结构,测量胎儿颈后透明层厚度和鼻骨长度,并跟踪随访。结果⑴1 153例胎儿的全程随访中发现孕期及新生儿期异常者26例,正常儿1 126例,失访1例;⑵建立孕11～13+6周胎儿颈后透明层厚度和鼻骨长度正常参考值;⑶胎儿颈后透明层厚度及鼻骨长度的检测成功率分别为98.04%和95.02%;⑷26例异常胎儿中包括孕期发现胎儿畸形16例(孕11～13+6周超声诊断胎儿畸形5例,孕11～13+6周后超声诊断胎儿畸形11例)、染色体异常3例,胎死宫内5例,产前无异常发现、新生儿发现异常者2例。结论孕11～13+6周超声检查可筛查严重解剖结构畸形和染色体异常胎儿,在早孕期终止妊娠能大大降低孕妇身体和心理的伤害。     

胎儿颈项透明层厚度异常与宫内感染和染色体异常的相关性研究

目的探讨胎儿颈项透明层厚度(NT)异常与病原体组合(TORCH)宫内感染和染色体异常的关系。方法2015年7月-2017年7月在广西壮族自治区人民医院进行产前检查并分娩的单胎孕妇138例作为研究对象,孕11～13周时超声检查显示胎儿NT≥2.5mm。根据检测结果将138例孕妇分为NT 2.5～2.9mm组、3.0～3.4mm组、3.5～4.4mm组、≥4.5mm组和颈部水囊瘤组。比较各组胎儿TORCH感染、染色体异常和结构异常的发生率。结果 NT 2.5～2.9mm组40例、3.0～3.4mm组36例、3.5～4.4mm组26例、≥4.5mm组25例和颈部水囊瘤组11例。138例胎儿染色体正常98例,占71.01%;异常40例,占28.99%。胎儿宫内TORCH感染8例,感染率为5.80%。36例胎儿合并结构异常,占26.09%。NT2.5～2.9mm组胎儿TORCH感染率、染色体异常率和结构异常率分别为0、10.00%和7.50%;3.0～3.4mm组分别为0、11.11%和13.89%;3.5～4.4mm组分别为3.85%、30.77%和26.92%;≥4.5mm组分别为8.00%、56.00%和44.00%;颈部水囊瘤组分别为45.45%、90.91%和90.91%。随着NT值的增大,TORCH感染率、染色体异常率和胎儿结构异常率升高。结论NT异常增厚可能对TORCH宫内感染、胎儿染色体异常和结构异常有较好的预测价值。     

胎儿颈项透明层厚度与孕妇羊水细胞染色体核型的相关性分析

目的 探讨孕早期中期胎儿颈项透明层厚度(NT)与羊水染色体核型的关系分析。方法：对我院2016年9月至2020年6月孕11~13⁺⁶周的孕妇检查给予超生胎儿颈项透明层厚度检查,其中398例NT增厚的孕妇进行羊水穿刺染色体核型分析,398例NT增厚的胎儿检出染色体异常核型20例,异常率为5.03%。其中3.5mm≤NT≤4.5mm共240例,检查异常染色体5例,检出率为2.08%;4.5mm≤NT≤5.5mm共97例,检查异常染色体7例,检出率为7.22%;5.5mm≤NT≤6.5mm共51例,检查异常染色体7例,检出率为13.73%; NT≥6.5mm共10例,检查异常染色体1例,检出率为10%。结论 胎儿NT增厚是孕中期筛查胎儿染色体异常的较为敏感的指标,胎儿NT值较高者,胎儿发生染色体异常的机率越高。     

孕早期超声测量胎儿颈项透明层厚度在产前诊断中的应用价值

目的探讨孕早期应用超声测量胎儿颈项透明层(NT)厚度在产前诊断中的应用价值。方法选取我院接受孕早期胎儿系统性产前超声筛查的单胎胎儿2850例,分别测量其头臀径、NT厚度、鼻骨及静脉导管血流频谱等,对孕早期NT增厚(≥2.5 mm)的孕妇于中晚期复查超声,分析NT厚度与异常妊娠的关系。结果孕早期超声检查发现NT厚度<2.5 mm胎儿染色体异常、结构畸形、水囊状淋巴管瘤及胚胎停止发育等异常妊娠的发生率为0.89%,较NT厚度≥2.5 mm胎儿异常妊娠发生率(77.20%)低,差异有统计学意义(P<0.05);44例NT厚度≥2.5 mm胎儿检出染色体核型异常13例,正常21例;NT厚度的增加与异常妊娠的发生率呈正相关(r=0.734,P<0.05)。结论孕早期胎儿NT增厚与胎儿染色体异常及结构畸形等异常妊娠的发生具有相关性,可作为胎儿产前超声筛查的常规项目。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."