Objective To discuss the prenatal diagnosis of abnormalities of fetal limb bone.Methods We selected 18 cases which long bone of fetus less than 2SD of average volume of gestational weeks or long bone changed into angle or other fetus's abnormalities by first B-mode ultrasonic. All above cases was delivered at Capital Medical University of Obstetric and Gynecological Hospital during Jan. 2006 to Dec. 2009. We B-mode ultrasonic was used to measure fetus's biparietal diameter (BPD) ,femur length (FL) ,abdominal circumference(AC) ,head circumference(HC) ,humerus length (HL) ,amniotic fluid index (AFI) and structures of organ and calculated FL/AC, growth speed of long bone. The standard of achondroplasia is that FL and HL are less than 4SD of average of gestational weeks or FL/AC less than 0. 16. The standard of Osteogenesis Imperfecta is fetal long bone of fetus shows short and thick, curves into angle, fracture in uterus by X-ray, or skull shows thin or sink by X-ray. Results (1) By B-mode ultrasonic and X-ray exam of all 18 cases: 7 cases shows that HC ＞2SD, 10 cases shows too much amniotic fluid, 12 cases shows AFI ＞ 18.0, 9 cases shows abnormalities of narrow cavitas thoracis, disordered vertebral column, or unusual architecture of heart. For cases 1 to 14 are achondroplasia, among which,11 cases are FL＜4SD and HL＜4SD, 2 cases are FL ＜3SD and HL ＜4SD, 1 case is not only FL ＜2SD and HL ＜3SD but also hydroncus all over the body of fetus. The growth velocity of long bone of fetus in all the 14 cases is more slowly than the normal rate. For all the above 14 cases, 12 cases FL/AC ＜0. 16, 1 case FL/AC =0. 19, 1 case FL/AC =0. 20. The length of femur or humerus is shorter than the normal rate and have other abnormalities the above last two cases. For case 15 and 16, they don't show any abnormalities of bone growth though one year's follow up studying. For case 17 and 18, they are osteogenesis imperfecta. (2) The result of fetal perinatal period fate and autopsy: there are 8 female and 10 male in all the 18 cases. One case is labored after 39 weeks pregnancy, and it is low birth weight infant, weight ＜3%th. All the other cases are normally birth weight infant. All the 18 cases of abnormalities of fetal limb bone are examined by chromosomes check, among which, 9 cases are amniocentesis, 7 cases are cordocentesis,2 cases are checked chromosomes by fetus cord blood, all the caryotype are normal. In the 16 autopsy cases,14 cases are achondroplasia or hypochondroplasis. It can be seen amplifying extremities, hyperplasia chondrocytes of tubiform born, karyomegaly, anachromasis, hyperplasia capillaries though microscope and grow up into cartilage irregularly. Also can be seen hyperplasia chondrocytes of epiphyses, delaying osteosis.2 cases are osteogenesis imperfecta. It can be seen broadening of metaphyses, exility of bone trabeculae. For the other two cases which the fetus is alive, we do the follow up studying to their one year old one of them is low birth weight new born, their limb and height are all normal. Conclusions To diagnose fetal Achondroplasia, it is not only based on the significantly shorter of femur or humerus length but also based on the dynamics observing the long bone growth velocity and calculating FL/AC. For osteogenesis imperfecta fetus, it should be diagnosed by fractures in uterus though X-ray.

Ovarian cancer is the highest death rate of gynecologic malignant tumor .Currently,people rec-ognize standard treatment for ovarian cancer was that reduction -Tumor cells of platinum based chemotherapy af-ter surgery.But for those patients who have developed into advanced cancer that cannot be operated the surgeries directly,the application of preoperative Neoadjuvant chemotherapy ( NACT) does have the superiority .which is recognized by the majority of clinical doctors ,and has been widely used in the treatment of advanced malignant tumor.It is worthy to discussing which part of patients should choose the initial treatment of Neoadjuvant chemo -therapy,rather than a direct treatment of destroying tumor cells .This article is summarizing the empirical cases based on related research ,in order to help clinicians to make a decision on the treatment of ovarian cancer .

Acupuncture Therapy ; Adolescent ; Adult ; Aged ; Cardiac Surgical Procedures ; adverse effects ; Coma ; etiology ; psychology ; therapy ; Consciousness ; Female ; Heart Diseases ; surgery ; Humans ; Male ; Middle Aged ; Young Adult

Clinicians monitor the gastric residual volume(GRV) of critical ill patients to minimize or prevent side effect of EN.Nevertheless,recommendations about the threshold GRV in critically ill patients treated with EN are not uniform.Many recent clinical studies had demonstrated that increasing the limit of GRV was associated with the increase in the diet volume ratio of ICU patients receiving EN,and it was not associated with adverse effects in gastrointestinal complications.This review summarizes the influence factors of GRV monitoring to evaluate the feasibility and necessity of increasing the threshold of GRV.

Objective To investigate the technical charactenstics ot SYSMEX XS1000i 5-part differential automated hematological analyzer and its clinical applications.Methods 209 samples were analyzed with the analyzer of XS1000i and compared to the results from Beckman-Coulter LH750 analyzer.The main parameters from XS1000i,such as precision within-run,day to day precision and carryover contamination rates etc,were recorded respectively in 509 samples to compare the difference between the instrumental and optical examination.Results All variation coefficients of precision from XSI000i were within the manufacturer.The carryover contamination rates of WBC,RBC,Hb,HCT and PLT were 0.19%,0.93%,0,-0.88%,-0.76%,respectively.The parameters of XS1000i were correlated with the results of LH750 except basophil granulocyte.The correlation coefficients of WBC,RBC, HGB and PLT were 0.994 5,0.996 8,0.997 0 and 0.974 6 ,respectively.The sensitivity of warning flags in immature leukocytes was 100% and the specificity was 69.7%,the sensitivity of warning flags in atypical lymphocyte was 100% and the specificity was 66.7%.Especially in 3 leukocytopenia that was induced by chemotherapy in patients with leukemia who had only few immature cells existed in the peripheral blood,the parameters of XS1000i were positive,and correlated with the results of detection of minimal residual disease with flow cytometry.Conclusions The warning system of XSIO00i provides more valuable information for manual microscopic examination.If it is combined with flow cytometry,the advantages in detection of residual leukemic cell will be fully displayed.

Objective To investigate the differential diagnostic signiifcance of different calciifcation types in thyroid benign and malignant nodules with high-frequency ultrasound. Methods Totally 195 patients with thyroid lesions were examined on conventional high-frequency ultrasound pre-operatively. The evaluation was foucsed on the number and echo of thyroid nodules and the size, shape and distribution of calciifcation inside. Different calciifcation patterns were divided into 3 types:type 1 micro-calciifcation, type 2 coarse calciifcation, type 3 peripheral calciifcation. Results The calciifcation rate of thyroid malignant nodules 68.6%(81/118) was signiifcantly higher than that of benign nodules 40.0%(56/140) (χ2=21.096, P<0.01). The ratio of type 1 calciifcation in malignant nodules 72.8%(59/81) was obviously higher than that of benign nodules 41.1%(23/56) (χ2=13.906, P<0.01). There was no signiifcant difference of type 2 calciifcation between malignant and benign nodules (χ2=3.159, P>0.05). The incidence of type 3 calcification in malignant lesions 3.7%(3/81) was lower than that of benign nodules 21.4%(12/56) (χ2=10.669, P<0.05). The malignancy incidence of solitary thyroid nodule 85.3%(58/68) and extremely low echo nodules with calciifcation 76.2%(48/63) was higher than that of multiple thyroid nodules 33.3%(23/69) and other echo nodules 44.6%(33/74) (χ2=38.261, 14.057, both P<0.01). Conclusions There was potential risk of malignancy in each calciifcation of thyroid nodules. Different calciifcation types had important value for differential diagnosis of benign and malignant thyroid nodules.

Molecular imaging is a newly rising branches of science which comes from molecular biology technology and modern medical imaging,and it would be the development tendency of mendiacl imaging. This article briefly introduces the basal principle of molecular imaging,the difference and correlation between molecular imaging and traditional medical imaging and the development prospect of medical imaging.

Objective To explore the long term effects of gestational diabetes mellitus (GDM)on offsprings of affected women.Methods One hundred and twenty-four singleton pregnant women with GDM,who delivered in Department of Obstetrics and Gynecology,Peking University First Hospital from June 14,2006 to December 31,2007,were enrolled as the study group.Ninety-eight singleton pregnant women with normal glucose metabolism who delivered at the corresponding period were enrolled as the control group.The follow-up study was performed from November 6,2010 to January 31,2011 on their offsprings.Anthropometry indexes,including height,weight,waist circumference,systolic and diastolic blood pressure (DBP),triceps skin fold (TSF) and sub-scapular skin fold (SSF) were measured.According to the development standard of children less than five years old issued by World Health Organization in 2006,there were six detailed evaluation indicators including length/height for age z-score (HAZ),weight for age z-score (WAZ),weight for length/ height z score (WHZ),body mass index (BMI) for age z-score (BAZ),triceps skin folds for agez-score (TSFZ) and sub-scapular skin folds for age z-score (SSFZ).Chi-square,t-test or variance analysis were applied.Results (1) No statistical difference on age,birth weight,sex,height,weight,BMI,waist circumference,blood pressure,TSF and SSF was found between offsprings of study and control group (P＞0.05).(2) Offsprings in both groups were further divided into macrosomia and non-microsomia subgroups,i.e.GDM macrosomic subgroup (n =15),GDM nonmacrosomic subgroup (n=109),control macrosomia subgroup (n=6) and control non-macrosomia subgroup (n=92).Significant difference was shown amont the four subgroups in weight [(19.8±3.9),(17.0±1.9),(17.7±1.7)and (17.2±1.7) kg,F=6.238,P＜0.001],BMI (17.6±2.6,16.0±1.2,16.6±1.1 and 16.2±1.1,F=5.901,P＜0.001),waist circumference [(53.6±5.3),(49.9±2.7),(50.9±3.3) and (50.4±0.9) cm,F=5.307,P＜0.001],WHZ (1.40±1.44,0.45±0.81,0.88±0.75 and 0,60±0.87,F=5.269,P=0.002),HAZ (1.22±0.78,0.47±0.82,0.98±0.74 and 0.50±1.00,F=3.668,P=0.013),WAZ (1.68±1.23,0.58±0.79,1.15±0.85and 0.71±0.93,F=7.361,P＜0.001) and BAZ (1.41±1.52,0.42±0.84,0.81±0.76 and 0.60±0.90,F=5.210,P =0.002).While comparing between each two subgroups,there was statistical difference between GDM macrosomia subgroup and GDM non macrosomia subgroup,and between GDM marosomia subgroup and control non-macrosomia group.(3) While comparing GDM macrosomia and GDM non-macrosomia subgroup with control group [weight (17.2±2.5) kg,BMI (16.2± 1.4),waist circumference (50.5 ± 3.6) cm,DBP (55.2 ± 6.9)mm Hg,SSF(6.1 ± 1.8) mm,WHZ (0.62±0.87),HAZ (0.53±0.99),WAZ (0.73±0.92),BAZ(0.61±0.89)],the weight (F=9.283,P＜0.001),BMI (F=8.707,P＜0.001),waist circumference (F=7.934,P＜0.001),DBP(F=3.123,P=0.046),SSF (F=3.499,P=0.032),WHZ (F=7.639,P＜0.001),HAZ(F=4.709,P=0.010),WAZ (F=10.302,P＜0.001) and BAZ (F=7.689,P＜0.001) was higher in GDM group than the control group.(4) The proportions of overweight and obesity were higher in GDM macrosomia subgroup than in GDM non-macrosomia and control groups [overweight:9/15 vs24.8％ (27/109) and 24.5％ (24/98),x2 =8.870,P=0.012; obesity:5/15 vs 7.3％(8/109) and 9.2％(9/98),x2=10.083,P=0.006].If all subjects were divided into macrosomia and non-macrosomia group,then the proportion of overweight and obesity was higher in the former group [overweight:52.4％ (11/21) vs24.4％(49/201),x2=7.560,P=0.006; obesity:28.6％ (6/21)vs 7.9％(16/201),x2 =9.047,P=0.003].Conclusions GDM may have long term adverse effect on the development of offsprings at three-four-year-old with higher incidence of obesity or high diastolic blood pressure in macrosomic babies of GDM mothers than in non macrosomic babies of GDM mothers or babies of non GDM mothers.

Objective To study the influence of minocycline combined with azithromycin on serum CRP, D-Dimer and lung function in the children with refractory mycoplasma. Methods From April 2015 to August 2016, 42 children with refractory mycoplasma pneumonia were enrolled in the second hospital in Tianjing. The patients were divided into the observation group and the control group according to the order of admission. The control group was treated with azithromycin sequential therapy, the observation group were given minocycline combined with azithromycin to complete the treatment. The levels of serum CRP, D-D, lung function, clinical symptoms and signs, and the adverse effects were observed. Results After treatment, the total effective rate of the observation group was significantly higher than that in the control group (P<0.05). The levels of CRP and D-D in the observation group were significantly lower than those in the control group (P<0.05). The highest expiratory flow velocity (PEE), first-second forced expiratory volume (FEV1), forced vital capacity (FVC) and forced expiratory 25% flow rate (MEF25) in the observation group were significantly higher than those in the control group (P<0.05). The time of X-ray recovery time, the time of fever, the time of cough and the disappearance of lung rales were significantly shorter than those in the control group (P<0.05). Compared with the control group, there were no significant differences in diarrhea, abdominal pain, nausea, vomiting, pleural effusion, otitis media, mild anemia and rash adverse reaction rate in the observation group. Conclusion Minocycline combined with azithromycin in the treatment of severe Mycoplasma pneumoniae pneumonia can effectively reduce serum levels of CRP and D-D, improve pulmonary function and clinical symptoms, and have good clinical efficacy.

Objective To explore the clinical effect of sitagliptin combined insulin compared to those patients whose sugars were not well controlled by insulin alone.Methods The eighty type 2 Diabetes patients whose BMI≥24 kg/m2 and used insulin alone were randomly divided into sitagliptin combined insulin group (40 cases) who were given sitagliptin 100mg/d allied with insulin,an insulin group (40 cases) who were given insulin alone.After 12 weeks,the change of body mass index (BMI),fasting plasma glucose (FPG),2 h postprandial blood glucose (2 h PBG),glycosylated hemoglobin (HbA1 c),β-cell function index(HOMA-β),insulin resistance index (HOMA-IR),insulin quantities,and hypoglycemia rates were observed in two groups.Results Compared with pretherapy,the levels of FPG,2 h BG,HbAlc,HOMA-IR,and hypoglycemia rates were significantly decreased (P ＜0.05) ; BMI was increased in insulin group,while was not increased in sitagliptin combined insulin group.After the treatment,the insulin quantities were decreased in the combined group while increased in the control group (P ＜ 0.05).Conclusions Sitagliptin combined insulin can effectively control glucose levels of type 2 diabetes patients,decrease the insulin quantities and the risk of hypoglycemia,and does not increase the weight.