Objective: To evaluate the accuracy of sonography-estimated fetal weight (EFW) and to determine the potential factors influencing EFW accuracy in the Chinese population. Methods: Eleven widely used formulae were chosen to evaluate the accuracy of EFW in 7016 cases in a retrospective cohort study. Nine potential factors (prenatal body mass index [BMI], gestational age [GA], birth weight [BW], fetal sex, fetal presentation, amniotic fluid volume [AFV], seniority of sonographers, the time interval between ultrasonic measurement and delivery, and diabetes mellitus) were analyzed by binary logistic regression to determine whether they influenced sonography-EFW. Results: All 11 models had high correlation coefficients between EFW and BW ( r = 0.819–0.843). Model 3 was the most accurate formula for the Chinese population. Compared to fetuses with EFW of 2500–3999 g, the accuracy of EFW decreased by 69.10% ( P <0.001) for fetuses less than 2500 g, and decreased by 54.10% ( P <0.001) for fetuses larger than 4000 g. The accuracy of EFW in female fetuses decreased by 12.70% compared with male fetuses ( P = 0.021). Compared to the EFW calculated 1-3 days before delivery, the accuracy of the EFW performed 4–7 days before delivery showed a significant decrease ( P = 0.014). The accuracy of EFW was influenced by the individual measurement accuracy of the sonographers. Maternal BMI, DM, GA, fetal presentation, and AFV did not influence the accuracy of EFW after adjustment. Conclusion: Model 3 was the most accurate model for the Chinese population. The BW, fetal sex, time interval, and technique of the sonographers had different influences on the accuracy of EFW.

目的:探究多学科协作(MDT)联合案例教学-团队学习(CBL-TBL)教学法在肿瘤学临床教学中的应用效果.方法:选取蚌埠医学院2018 级临床本科生60 名为研究对象,随机分为实验组和对照组,每组 30 名.实验组采用MDT联合CBL-TBL教学模式,对照组采用CBL-TBL教学模式,2 组学员均教学12 周.教学结束后,比较2 组学员理论和临床实践成绩、各维度能力评分及教学满意度.结果:教学结束后,实验组学员理论和临床实践成绩分别为(87.87±3.47)分、(85.90±4.20)分,均高于对照组的(85.67±3.65)分、(82.17±3.95)分,差异有统计学意义(P<0.05).实验组学员在文献检索分析能力、语言表达能力、学习兴趣激发能力、团队合作能力、理论知识掌握能力、自主学习能力、临床问题解决能力、临床思维能力、师生交流频率及课程总体满意度评分均高于对照组,差异有统计学意义(P<0.05).结论:在肿瘤学临床教学中应用MDT联合CBL-TBL教学方式有助于提高学员理论和临床实践成绩,可有效提升学员团队协作和解决问题的能力,且教学满意度高,值得在临床教学中推广应用.

目的:观察马来酸吡咯替尼治疗曲妥珠耐药的人表皮生长因子受体2(human epidermal growth factor receptor 2,HER-2)HER-2阳性晚期复发转移性乳腺癌的疗效和不良反应.方法:回顾性分析口服马来酸吡咯替尼为基础治疗病人88例,分析其客观有效率、疾病控制率、临床获益率、中位无进展生存时间(progress free survival,PFS)、预后因素及不良反应.结果:88例病人可评价近期疗效,1例完全缓解,33例部分缓解,34例病情稳定,20例病情进展;客观有效率38.6％,疾病控制率77.3％,临床获益率64.8％,中位PFS 11.335个月.采用秩和检验分析ECOG评分与近期疗效有关(P<0.05),采用Log-rank单因素分析,ECOG评分和曲妥珠耐药情况对PFS有影响.不良反应为腹泻、恶心呕吐、乏力、手足综合征、口腔溃疡症状.结论:以口服吡咯替尼为基础的方案可以有效应用于曲妥珠耐药的晚期复发转移性HER-2阳性乳腺癌病人,总体不良反应可以耐受.

Background: Twin to twin transfusion syndrome (TTTS) is a serious syndrome that can affect twin pregnancies involving a single placenta, impacts some of twin gestations with monochorionic diamniotic (MCDA) placentas. We validated the ultrasound characteristics of 11-13 weeks' gestation to predict TTTS and selective intrauterine growth restriction (sIUGR) in MCDA pregnancies. Methods: We retrospectively included all of the MCDA twin pregnancies with ultrasound characteristics, including the crown-rump length (CRL), ductus venosus pulsatility index for veins (DV PIV), and nuchal translucency (NT) thickness, at 11-13 weeks' gestation, followed by mean difference and discordance comparison. Receiver operating characteristic (ROC) curves were constructed for the comparison of values of these predictive markers for identification of MCDA pregnancies with high-risk of adverse outcomes. Results: A total of 98 MCDA pregnancies were included in this study. Among the 98, 34 (34.7%) developed sIUGR, whereas 10 (10.2%) expressed TTTS. Significant differences in NT discordance were found among the normal, sIUGR, and TTTS groups; moreover, a significant difference was found between pregnancies with normal outcomes and sIUGR (P<0.001), normal and TTTS (P<0.001), and sIUGR and TTTS (P<0.001). Difference in NT was determined to be the best predictive marker for sIUGR [area under the curve (AUC) =0.769; 95% confidence interval (CI): 0.591 to 0.992], and NT discordance was considered the best predictive marker for TTTS (AUC =0.802; 95% CI: 0.485 to 0.936). Conclusions: Significant differences in NT discordance were found between the normal, sIUGR, and TTTS groups, while NT difference and NT discordance were identified as predictive markers for sIUGR and TTTS, respectively.

Purpose: The aim of this study was to explore the impact of anatomical subtypes in fetal heart disease on decreased middle cerebral artery (MCA) pulsatility index (PI) and head growth. Methods: The fetal echocardiograms of pregnancies with fetal hypoplastic left heart syndrome (HLHS; n=28) with and without anatomic coarctation, isolated severe aortic coarctation (n=28), D-transposition of the great arteries (TGA; n=28) and pulmonary outflow tract obstruction without forward flow across the pulmonary valve (POTO; n=28) were retrospectively reviewed. The data of MCA and umbilical artery (UA) PI, the cerebral placental ratio (CPR), and neonatal head circumference (HC) were collected and compared. Results: Significantly lower MCA-PI, higher UA-PI and lower CPR were found in fetuses with HLHS and isolated coarctation of the aorta. No difference was found in HLHS fetuses with or without anatomical coarctation. Positive correlation was found on between MCA-PI and HC in newborns with HLHS (r=0.232, P=0.046) or severe coarctation of aorta (r=0.418, P=0.022). Conclusions: Severe left heart obstruction with retrograde aortic arch flow influences fetal cerebral blood flow. Association was found between MCA-PI and head growth.

Research on the association between maternal periodontal disease and the risk of preeclampsia has generated inconsistent results. This meta-analysis was conducted to evaluate the association between maternal periodontal disease and the risk of preeclampsia. A literature search of PubMed and Embase was performed to identify relevant papers published before March 2013. Only observational studies that assessed maternal periodontal disease and the risk of preeclampsia were selected. Patients’ periodontal status was examined at different time points during pregnancy or after delivery (at 14–32 weeks of gestation, within 48 h prior to or within 5 days after delivery). Pooled odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated for cases and controls. Cases were defined as women with concurrent hypertension and proteinuria after 20 weeks of gestation. Eleven studies involving 1118 women with preeclampsia and 2798 women without preeclampsia were identified and analyzed. Women with periodontal disease before 32 weeks of gestation had a 3.69-fold higher risk of developing preeclampsia than their counterparts without periodontal disease (OR=3.69; 95% CI=2.58–5.27). Periodontal disease within 48 h prior to delivery was associated with a 2.68-fold higher risk of preeclampsia (OR=2.68; 95% CI=1.39–5.18). Pregnant women with periodontal disease within 5 days after delivery had a 2.22-fold higher risk of preeclampsia than women without periodontal disease (OR=2.22; 95% CI=1.16–4.27). In conclusion, this meta-analysis suggests that maternal periodontal disease is an independent predictor of preeclampsia.