Objective To evaluate the detection rate of congenital heart defect (CHD) during the first trimester screening for chromosomal abnormalities,the role of ultrasound soft markers including increased nuchal translucency (NT),tricuspid regurgitation (TR) and abnormal ductus venosus (DV) flow in the screening for cardiac anomalies was also investigated.Methods From January 2009 to January 2012,4 673 fetuses were scanned at 11-14 weeks at Department of Fetal Medicine,the First Affiliated Hospital of Jinan University.The ultrasound findings and follow up outcomes were recorded,False-positive rate of different first-trimester ultrasound markers for the detection of CHD was calculated,sensitivity of the markers for all major CHD was calculated as well.Results There was a significant association between major CHD and first trimester ultrasound markers.(1) Overall findings:among the 4 673 fetuses,31 fetuses were diagnosed CHD prenatally,17,12 and 2 of which were detected in the first,second and third trimester,respectively.In 22 of the 31 CHD cases,invasive procedure was performed,fetal karyotype was abnormal in 12 cases,including triosmy 21 (5 cases),trisomy 18 (2 cases),trisomy 13 (2 cases),Turner syndrome (2 cases) and pericentric inversion of chromosome 9 (1 cases).(2) NT measurement and prenatal detected CHD:in 4 673 cases,NT measurement between 95th-99th percentile were present in 206 (4.41％),5 cases were diagnosed CHD prenatally,in 4 of 5 cases were detected in first trimester; NT measurement ＜ 95th percentile were present in 4 430(94.80％),16 cases were diagnosed CHD prenatally,in 5 of 16 cases were detected in first trimester; NT measurement ＞ 99th percentile (＞ 3.5 mm) were present in 37 (0.79％,37/4 673),10 cases were diagnosed CHD prenatally,in 8 of 10 cases were detected in first trimester.(3) TR and inverted a-wave at the DV and prenatal detected CHD:among 4 673 cases,TR or inverted a-wave at the DV were present in 51 (1.09％),98 (2.10％) respectively.TR was present in 8 of 31 CHD cases,inverted a-wave at the DV was present in 7 of 31 CHD cases.(4)Sensitivity of different first trimester ultrasound markers for detection of major CHD cases:in 31 CHD cases diagnosed prenatally,23 eased were defined as major CHD.Sensitivity of at least one of the ultrasound narkers,NT measurement between 95th-99th percentile,＞ 99th percentile(＞ 3.5 mm),TR or inverted a-wave at the DV for detection of major CHD eases was 74％ (17/23),22％ (5/23),39％ (9/23),35％ (8/23),30％ (7/23),respectively.(5) Specificity of different first trimester ultrasound markers for detection of CHD cases:specificity of NT measurement between 95th-99th percentile,＞ 99th percentile(＞ 3.5 mm),TR or inverted a-wave at the DV for detection of major CHD cases was 4.30％ (201/4 673),0.58％ (27/4 673),0.92％ (43/4 673),1.94％ (91/4 673).Conclusions Routine first trimester soft markers for chromosomal abnormalities screening combined with cardiac assessment can detect quite a number of major heart defects.Increased NT,TR and abnormal DV flow can be important indicators for echocardiography,which is favorable to early prenatal diagnosis of CHD.

Objective To study and evaluate various therapeutic means for upper urinary tract calculi. Methods 3 218 cases of upper urinary tract calculi were reviewed.1 365 were pure kidney stones,651 complicated kidney stones,558 group Ⅰ ureteral stones,452 group Ⅱ ureteral stones and 192 group Ⅲ ureteral stones. Results ESWL (extracoporeal shock wave lithotripsy) has been the treatment of choice for pure kidney stones and for groupⅠ ureteral stones.Open surgery has been the best for complicated kidney stones and group Ⅱ,Ⅲ ureteral stones.1 164 patients underwent lithotomy and 1 923 ESWL.131 cases of group Ⅱ ureteral stones in the middle or lower segment of ureter were treated by ureteroscopic lithotripsy.Of the complicated kidney stones,residual stones were observed in 57 (8.8%).1.8%( n =12) of such cases underwent nephrectomy.The complete stone elimination rate in 3 months after ESWL was 81.6% whereas open operation was needed in 18.4%.Ure teroscopic lithotripsy yielded the poorest outcome,nephrectomy being undertaken afterwards in 0.8% and lithotomy in 6.1%. Conclusions ESWL,ureteroscopic lithotripsy,ballast lithotripsy or the combined use of 2 methods makes the surgical management of upper urinary tract calculi easier with less suffering to the patients.The use of double internal stent could reduce the surgical complications.Stone street after ESWL should be well taken care of and inflammation should be well controlled.Skilled technique is needed for ureteroscopic lithotripsy.

Objective:To meet the requirements of hospital consultation management, promote the hospital consultation work in order to make the hospital a huge consultation data processing becomes simple, reduce the burden of management personnel and medical personnel management information system.Methods: Through the on-site investigation to collect the needs of the management personnel and the clinical front-line personnel, visit the application of other hospitals, and combine with the actual work, the development of suitable for hospital consultation management information system, the consultation for effective management and monitoring.Results: Based on the analysis of the needs of all kinds of personnel and consultation management information system, the basic function of the consultation management information system is realized.Conclusion: The realization of the consultation management information system can meet the needs of all kinds of people in the process of hospital consultation management, so as to meet the high efficiency management of hospital consultation, so as to improve the level of hospital information resource utilization.

The basic nature of medical ethics education is the cultivation of morality for medical students,in which humanistic spirit is the fundamental element.Humanistic spirit is in great need for the development of medical ethics,the transformation of medical mode,the harmonious development of physician-patient relationship,and the healthy growth of medical students.Based on present realistic conditions,humanistic spirit should be developed in the fields of classroom training,medical professional education,and other aspects of campus culture.It would be necessary to find multi-path training modes of humanistic spirit.

Objective To understand the air pollution by microorganisms in the underground spaces. Methods 51 underground spaces were investigated, the impact and sedimentation sampling methods were employed and the total bacterial count, mycetes, streptococcus and anaerobes in air were determined. ELESA was used to detect aflatoxin B1 in aspergillus flavus isolated from air. Results The total bacterial count in the air in underground spaces accorded with the military health standard. In the semi-closed spaces,the mycetes counts were 5 950 cfu/m3 and 9 500 cfu/m3 in aisle and rooms respectively, significantly higher than those in control group (P

Objective To observe the effect of air disinfection with chlorine dioxide(ClO2)in the saps and determine the concentration change in order to ensure the safety for people to enter the saps.Methods The disinfection was done at the concentration of 1 000 mg/L and the spray dose of 10 ml/m3 and then to count the total bacteria and fungi with the cascade impactors in the saps before and after air disinfection and to monitor the concentration of ClO2 with the air ClO2 monitor(iTX).Results The 94.6% of the total bacteria and 92.1% of the fungi died in 30 minutes after disinfection.The concentration of ClO2 in the air decreased from 10 mg/m3 to 0.8 mg/m3 81 minutes later and to 0.3 mg/m3 96 minutes later,after 120 minutes,it was 0 mg/m3.Conclusion The air disinfection effect of ClO2 used at the dose of 10 ml/m3 and the concentration of 1 000 mg/L is satisfactory.96 minutes after disinfection,the concentration of ClO2 is safe for human health.

Esophagus ; pathology ; Foreign Bodies ; diagnosis ; Humans ; Retrospective Studies

The specialization of medical science determines the objective existence of asymmetric information in medical and health industry.These different understandings in the psychological and behavioral area influenced the development of physician-patient relationship.Medical personnel should look squarely at the professional attributes and dare to play a leading role.Meanwhile,the exchange of the role of patient and medical personnel,understanding patient,clearing of communication channels and enlarging patients′ means of communication will promote harmonious relations between doctors and patients.

Objective To clarify the expression and clinicopathological significances of mTOR and Merlin proteins in spinal schwannoma.Methods Immunohistochemical SP method was used to detect the expression levels of mTOR and Merlin proteins in tumor tissues from 21 spinal schwannoma patients.The meaning of the two proteins expression changes on schwannoma was analyzed.Results In 21 cases of schwannoma patients,the mTOR was positive expression in 16 cases,negative expression in 5 cases,while in the normal neural tissue,mTOR was all negative expression.In 21 cases of schwannoma patients,the Merlin protein was negative expression in 18 cases,positive expression in 3 cases,but it was positive in all of normal neural tissue.Merlin protein expression was negatively correlated with mTOR protein expression (r =-0.785,P ＜ 0.001).Conclusion The expression level of mTOR proteins in schwannoma is significantly higher than that in normal nerve tissue,while the expression level of Merlin protein in schwannoma tissue is significantly lower than that in normal nerve tissue.There is an internal relationship between mTOR and Merlin.