目的 应用多种技术对1例特殊的特纳综合征胎儿进行产前诊断,探讨胎儿性染色体异常产前诊断技术存在的不足。方法 孕妇28岁,2018年5月因唐氏筛查提示13三体高危转诊至解放军总医院第一医学中心产前诊断中心,行无创DNA检测、羊水穿刺荧光原位杂交技术及染色体G显带技术,对胎儿异常染色体进行识别和定位。结果 荧光原位杂交技术证实胎儿为45,X/46,XX嵌合型,染色体G显带技术进一步确定胎儿存在两种异常核型。结论 性染色体异常的产前诊断中,应用多种技术联合检测可以避免漏检,并且能够明确各种染色体异常。

To explore the contents and the significance of experimental educational reform in the foundation of clinical laboratory medicine.The reform of the experimental teaching was carried our through reforming experimental teaching method,reorganizing experimental course content,establishing experimental teaching inspection and assessmemt system. The experimental educational reform of the clinical laboratory medicine foundation may remarkably enhance student's experimental skill and the clinical post skill, as well as teacher's teaching enthusiasm and teaching level. It has the vital significance to the culfivafion of medicine examination specialized talents with innovative ideology and practical ability.

目前,白内障的手术效果不仅仅局限于单纯的复明,更注重了“恢复自然的视觉”.当前的研究重点在于如何减少白内障术中散光和利用白内障手术切口的设计来矫正角膜散光.而随着屈光手术的日趋完善,对于白内障术后残余散光的矫正亦更加有效.通过手术切口的选择,来减少手术源性散光和改善术前散光是提高病人术后裸眼视力的有效方法.

Objective To explore the clinical application value of combined detection of D-dimer and Wells score in the diagnosis of venous thromboembolism (VTE).Methods For suspected venous thromboembolic disorders,including deep vein thrombosis(DVT) and pulmonary embolism (PE)patients,age,gender,major clinical symptoms and signs were recorded.According to Wells scale score,three groups were includied:low possibility group (0,＜2 points),moderate potential group (1-2 minutes,2-6 minutes) and highly likely group (3 or more points,＞ 6),at the same time for each patient to determine the D-dimer,screening out the diagnosis of patients with VTE,angiography with digital subtraction angiography (DSA) as a diagnostic gold standard was used,the accuracy of VTE was analyzed.Results Group with Wells score alone,low possibility of VTE diagnostic coincidence rate was 8％,false positive rate was 92％,moderate possibility of VTE coincidence rate was 30％,the high possibility of VTE coincidence rate 94.4％.Combined detection of D-dimer and Wells score,low possibility of VTE coincidence rate was 50％,false positive rate was 50％.Conclusion Relative to the Wells score alone,combined detection of D-dimer and Wells score can significantly decrease the false positive rate of low possibility group (P ＜ 0.05).

医学检验专业由五年制改为四年制,为了适应教改需求,使实验课教学跟进理论教学,对“临床血液学检验”实验课进行了一系列教学改革,包括实验课教学方法的改革,调整实验课教学内容,配备数码互动实验室,对实验课教学环节进行改革等,目的是培养学生的独立思考能力及动手能力,让学生早期接触临床,以适应实习及工作学习的需要,培养出新一代适应社会需要的四年制检验技师人才.

Objective To observe the effects of high-fat feeding on growth and the expression of insulin-like growth factor 1 (IGF-1),insulin receptor substrate 1 (IRS-1) in adolescent rats'liver with non-alcoholic fatty liver disease,and to elucidate the relationship between growth failure in adolescent rats with non-alcoholic fatty liver disease and IGF-1,IRS-1 turbulence.Methods Thirty-six Sprague-Dawley (SD) young rats of 21 days were randomly divided into normal control group(NC group,n =18) and high-fat feeding group(HF group,n =18).Non-alcoholic fatty liver disease(NAFLD) model was induced by feeding the SD rats with high-fat food.Immunohistochemistry was applied to detect the expression levels of IGF-1 and IRS-1 in liver tissue.The expressions of mRNA of IGF-1 and IRS-1 were measured by RT-PCR.Results Compared with NC group,the serum alanine amino transferase (ALT),total cholesterol (TC),triglyceride (TG) of HF group in the 6th,8 th,12th week were gradually increased.The serum ALT [(194.67 ± 11.15) U/L],TC [(1.81 ± 0.09) mmol/L],TG [(0.34 ± 0.05) mmol/L] contents of HF group at 8th week were higher than those at 6th week [(166.00 ± 22.01) U/L,(1.52 ± 0.22) mmol/L,(0.41 ±0.12) mmol/L,respectively],and the serum ALT[(213.0 ±27.67) U/L],TC[(2.15 ±0.37) mmol/L],TG[(0.38 ±0.15)mmol/L] contents of the 12th week were significantly increased compared with 6th week and 8th week.The constitution and body length of the HF group were lower than those of the normal control group.With time extended,the liver tissue steatosis,inflammation,the balloon like change of the liver tissue pathology of HF group in 6,8,12th week gradually increased.Immunohistochemistry results showed that HF group IRS-1 [(1.46 ± 0.23),(0.74 ± 0.17),(0.85 ± 0.31)],IGF-1 [(0.92 ± 0.02),(0.83 ± 0.02),(0.77 ± 0.03)] expression gradually decreased,the difference was statistically significant(F =36.024,P ＜ 0.05).IGF-1 and IRS-1 mRNA expressions in HF group were consistent.Conclusion The liver tissue IGF-1 and IRS-1 are correlated with the weight and body length.The growth failure of young rats induced by high-fat feeding may be related to the decreased expression of IGF-1 and IRS-1.

Mini clinical evaluation exercise ( mini-CEX ) is an educational and assessable tool to evaluate the clinical skills among resident doctors .An examiner directly examines an examinee and the evaluate the process including history collection , physical examination , and the communication skills with the patients , diagnosis and treatment .This evaluation method is widely used for its convenience , time saving, and high availability.It is also applied to student nurses assessment but arises some problems during the practice at present.The main problems include inappropriate application without items adjustment , absence of the marking criterion establishment , and the non-standard teacher training system .This paper is mainly focus on the analysis of the existing problems , in order to provide references for further investigation and application of mini-CEX in the nursing education field .

Objective To explore the protective role of lipoxin A4 (LXA4) during early process of atherosclerosis formation in rats with juvenile metabolic syndrome (MS).Methods Rat models of juvenile MS were established with 3-week Sprague-Dawley (SD) rats fed on high-carbonhydrates and high-fat diet for 6 weeks.The other qualified ones were randomly grouped into model group,LXA4 low-dose group,LXA4 middle-dose group,and LXA4high dose group,and a control group fed with normal forage.The low,middle,high-dose groups were injected different doses of LXA4 daily,while the model group and control group were injected with the same dose of isotonic NaCl solution for 2 consecutive weeks.After 2-week medication,the visceral adipose tissue were isolated by laparotomy and heart blood collected by thoracotomy under anesthesia,followed the fixation of thoracic and abdominal aortas in the immobilized rats.The mRNA expression level of inflammation cytokines interleukin-6 (IL-6),tumor necrosis factor-α (TNF-α),C-reactive protein (CRP) in the adipose tissue were determined by semi-quantitative reverse transcription PCR (RT-PCR),respectively.Secretions of IL-6,and TNF-α in serum were determined by enzyme linked immunosorbent assay (ELISA).Immunocytochemistry was used to label endomembrane and middle-membrane of thoracic aorta,and endothelial cell layer in each group and the ratios of thickness of endomembrane and middle-membrane were compared.Results Compared with the control group,weight,body length and abdominal circumference of juvenile MS rats increased significantly (all P ＜ 0.05),and levels of fasting plasma glucose (FPG),triglyceride (TG),high density lipoprotein cholesterol (HDL-C) and insulin in models increased significantly (P ＜ 0.05).RT-PCR showed that the mRNA expressions of inflammatory cytokines IL-6,TNF-α and CRP in adipose tissue in model rats were upexpressed (all P ＜ 0.05).Compared with model rats,mRNA of IL-6,TNF-oα,and CRP in mid,high-dose rats were downexpressed (all P ＜ 0.05),mRNA of TNF-α in low-dose rat downexpressed (all P ＜ 0.05),and there were no significant differences between mRNA expressions of IL-6,CRP in low-dose and model rats according to statistics (all P ＞0.05).Compared with control group,inflammatory cytokines IL-6,TNF-α secreted in serum of model rats were increased significantly (all P ＜ 0.05),and inflammatory cytokines secreted in serum of intervention rats were decreased significantly compared with model rats (P ＜ 0.05).Pathological changes were as follows:HE staining:compared to model group,aortic tunica intima of model rats were remarkably thickened and endothelial cell layer was fragmented and incomplete,which was attenuated in each intervention group.The ratios of endomembrane and middle-membrane in rats:at the end of consecutive medication for 2 weeks,the ratios of endomembrane and middle-membrane in model rats were significantly greater than those of control group (P ＜ O.05),and the ratios of endomembrane and middle-membrane in high-dose intervention rats were significantly smaller than those of the model group (P ＜ 0.05),but still greater than control group,while there were no statistical differences between the ratios in low,middle-dose intervention rats and model rats (P ＞ 0.05).Conclusions The increasing inflammatory cytokines are involved in early process of atherosclerosis formation in rats with juvenile MS.LXA4 by reducing the expression of inflammatory factor level in adipose tissue,thereby reducing the inflammatory cytokines in serum,alleviate the damage of arterial wall.

Objective Non -alcoholic fatty liver (NAFL)model was induced by feeding the Sprague -Dawley (SD)rats with a high -fat diet.To investigate the expression of insulin Receptor substrate -1(IRS -1)in the liver of NAFL.Method Thirty SD (N =30)young rats of 21 days were randomly divided into two groups,normal group (NG,n =15)and high -fat feeding group (HF,n =15).The rats of normal group were fed with common forage and those of the high -fat feeding group were given high -fat diet.Fifteen rats in each group were terminated at 8 week respectively.Their weight and growth condition were measured.Serum bio-chemical indexes were tested by biochemical analyzer.Observe the pathological changes of the liver tissue dynamically after Hema-toxylin -eosin (HE ) staining.Immunohistochemistry and RT -PCR methods were applied to detect the expression&nbsp;levels of IRS -1 in liver tissue.Results Compared to the group,the alanine aminotransferase (ALT),triglyceride(TG)and total cholesterol(TC)levels in the HF group increased significantly after 8 weeks,the diference was statistically significant (P <0.05), the rats in the HF group were diagnosed with fatty liver disease.The liver tissue mRNA and protein levels of IRS -1 were signifi-cantly reduced in HF group than in NG group,the difference was statistically significant (P <0.01).Conclusion High -fat diet may decrease NAFL in SD rats.The expression of IRS -1 protein in the liver was lower in SD rats than that in NG.

迷你临床演练评估(Mini-Clinical Evaluation Exercise,Mini-CEX)是国外行之有效的评价住院医师临床能力的测评工具,但是在国内应用和推广存在问题和困难,主要包括评分标准与方法,是否应该将其纳入总成绩,教学与评估主导地位的探讨,教师评估与反馈方面的问题,与学生存在的困难等.

Objective To investigate and analyze the dwarf reasons for children among 3 ~ 14 years old. Methods Retrospectively analyzed the data of 198 cases of children with short stature in the affiliated hospital of Xuzhou medical col-lege,including pathography,physical and laboratory tests results. Results GHD was the most common disease among the 198 children. There were 75 case(37. 88% )diagnosed as growth hormone deficiency(GHD);43 cases(21. 72% )idiopathic short stature(ISS);20 cases(10. 10% )constitutional delay of growth and puberty(CDGP),13 cases(6. 56% )Sexual pre-cocity(SP). Conclusion The causes of short stature are complicated . GHD,ISS,SP are the common cause among them.

本文通过超声生物显微镜(ultrasound biomicroscopy,UBM)对原发性闭角型青光眼患者行Nd:YAG虹膜激光术前和术后的检查并观察前房、房角、虹膜的变化,探讨激光孔径的大小与手术疗效的相关性. 1 资料与方法 1.1 临床资料 选取2013年1月至2014年12月在我院门诊及住院治疗的原发性闭角型青光眼患者,包括原发性闭角型青光眼患者和慢性闭角型青光眼患者共35例46眼.男16例,女19例,年龄48～72岁,平均57.88岁.其中临床诊断为急性闭角型青光眼18例(21眼),一眼为急性发作史,对侧眼为临床前期或先兆期,为一眼有急性发病史,药物控制后眼压正常,房角粘连＜1/2象限,对侧眼为临床前期或先兆期.

Objective The clinical characteristics and therapeutic efficacy of methylprednisolone treatment of acquired paralytic strabismus .Methods A retrospec-tive analysis of 2010 January to 2012 December in our hospital with methylprednisolone therapy on clinical data of 46 cases of acquired paralytic strabismus patients ,and compared with routine treatment of 46 cases of acquired paralytic strabismus patients as control.Results Observation group to cure 32 cases,12 cases improved,and 2 had no effect,and the total effective rate was 95.65%.23 cases of control group cure,improvement in 14 cases,9 no effect,the total effective rate was 80.43%.Treatment group total effectiveness is significantly higher than control group;the difference was statistically significant(P<0.05).Conclusion methylprednisolone impact treatment of acquired paralytic strabismus patients clinical curative effect is good ,is worth promoting.

目的 探讨分析上睑提肌腱膜固定在重睑术中的应用价值.方法 将2010年1月——2012年1月间在我院收治的90例行重睑术的患者,随机分为治疗组和对照组各45例,治疗组采用改良的眼轮匝肌-上睑提肌腱膜固定术进行治疗,对照组行传统皮肤-上睑提肌腱膜固定法.结果 术后经过平均24个月的随访,治疗组的整体疗效评价中优良率为97.78％,对照组的整体疗效评价中优良率为85.56％,治疗组整体疗效评价优良率显著高于对照组(x2 =8.8000,P＜0.05).结论 改良的眼轮匝肌-上睑提肌腱膜固定在重睑术中上提效果良好,重睑线自然流畅,安全性高,值得推广应用.

目的 探讨分析保留睑板前眼轮匝肌在切开法重睑成形术的应用价值.方法 回顾性分析2012年3月至2013年3月间于我院行切开法重睑成形术的84例患者的临床记录资料.观察组42例,行切开法重睑成形术时保留睑板前眼轮匝肌;对照组42例,行传统的皮肤-上睑提肌腱膜固定法.结果 治疗后,观察组的优良率为97.62％,明显高于对照组的89.29％,具有统计学意义(P＜0.05).结论 保留睑板前眼轮匝肌在切开法重睑成形术中具有重要的应用价值,重睑效果十分自然,符合先天性重睑的形成机制,还能够防止睑上三重皱褶的出现和重睑线消失,值得推广应用.

早在19世纪人们就开始关注角膜内皮细胞的研究,近年来,各种新设备和技术应用使角膜内皮损伤进一步研究成为可能.很多全身及眼部疾病、手术、激光等都能够对角膜内皮细胞产生重大影响.角膜的高度透明是实现视觉器官正常生理功能的重要条件之一,而解剖形态完整和生理功能正常的角膜内皮层则是保持角膜透明的关键[1].本文就引起角膜内皮损伤的各种原因作一综述.

目的 调研我院临床使用白内障超声乳化联合房角分离手术治疗闭角青光眼合并白内障的临床治疗效果.方法 回顾性分析2009年12月至2013年8月间我院采用超声乳化并结合房角分离治疗的86例(94眼)闭角型青光眼合并白内障患者的临床资料.结果 术后6个月随访,94眼中房角粘连患者经分离手术后房角均已开放,粘连情况得到有效控制;中央前房深度显著增加,眼压显著下降,术前视力明显提高,(P＜0.01).结论 临床使用白内障超声乳化联合房角分离手术对于闭角型青光眼合并白内障的治疗效果显著.

目的观察以改良介入技术植入人工鼻泪管治疗鼻泪管阻塞性疾病的临床疗效。方法对筛选出的符合手术适应证的46例(50眼)鼻泪管阻塞性患者,施行改良式人工鼻泪管植入术;术后随访观察3～6月,评估手术效果。结果患者术中均成功植入人工鼻泪管支架,术后显效32例(34眼)、有效12例(13眼)、无效2例(3眼),总有效率为94%。结论采用改良介入技术植入人工鼻泪管治疗鼻泪管阻塞性疾病简单、安全、微创、有效,不改变解剖结构,明显缩短了手术时间,值得广泛推广。

Objective To prepare edomin-polylactic-co-glycolic acid nanoparticles(EMD-PLGA NPs),and to observe its diameter,electronic speculum,stability,encapsulation efficiency and drugloading rate of the NPs.Methods EMD-PLGA NPs were made with emulsion solvent evaporand method and orthogonal design.Firstly the appearance was observed under trasmission electron microscope and we detected the diameter,distribution and zeta potential of the nanoparticles.The stability of laser particles was measured by sedimentation method,and the light absorption,the encapsulation efficiency,and drugloading were calculated.Results The best preparation condition was obtained.the end product of the drug under the best condition was globle or elliptic;the diameter of the particles was about(100±50) nm.The disperse system of nanoparticles in water scattered from the top to the bottom without sedimentation;the encapsulation efficiency was about(24.5±1.9)%;and the drugloading was about(18.5±3.7) %.Conclusion The method is superior to the previous solid lipid nanoparticle method,and the EMD-PLGA NPs have many advantages such as mini-size,better distribution and higher drugloading rate.Both the light absorbance and the stability meet the standard of demand.The method has laid a foundation for clinical target drugs.

通过对2例EDTA依赖性假性PLT减少症(EDTA-PTCP)的处理分析,探讨其鉴别诊断以及采取的措施,旨在提示临床遇到类似情况时加以重视,从而避免误诊误治给患者带来不必要的痛苦。