胎教存在的问题及改进方法

胎教对胎儿几乎没有直接的积极作用,相反,现在的胎教可能会对胎儿产生伤害。医生擅自使用未经科学验证和卫生部门批准的胎教方法进行临床试验,是有违医学论理的。本文论述了胎教存在的问题,胎教中对胎儿的不良影响,并提出了胎教对母体的心理学价值,同时对现在的胎教改进提出了新的观点。

Variation and Influence Factors of Yield Gravity Center of Flue-cured Tobacco in Hunan

The variation and influence factors of yield gravity center of flue-cured tobacco in Hunan were studied in 2006-2015 by regional gravity center method and grey correlation analysis. The results showed that the yields of flue-cured tobacco in various areas in Hunan were mainly of the growing with fluctuation type. The yield gravity centers in the whole province and eastern, southern and western Hunan tobacco-growing areas overall moved in the north by west, south by west, west by south, and south by east directions, respectively; and the movements in the south-north direction were in order of eastern Hunan tobacco-growing area 〉whole province 〉western Hunan tobacco-growing area 〉southern Hunan tobacco-growing area, and the movements inthe east-west direction showed an order of eastern Hunan tobecco-growing area〉western Hunan tobacco-growing area〉whole province〉 southern Hunan tobacco-growing area. The main influence factors of the coordinates of the longitudes and the latitudes differed. The main influence factor was planting area in most cities or counties in the whole province, and was per unit area yield in a few cities or counties. It is advised to construct the ＂one main body and two wings＂ development pattern of flue-cured tobacco production in Hunan with southern Hunan tobacco-growing area as the main body and western and eastern Hunan tobacco-growing areas as the two wings.

心影

有许多花朵簇拥在我周围 捧出颗颗善良而芬芳的心灵 当我用孤寂筑起了每一个黄昏 蓝天将生命的背景都简化 纯净深远如我

CORONARY ANGIOGRAPHY WITH DUAL SOURCE COMPUTED TOMOGRAPHY:INITIAL EXPERIENCE

Objective To explore the scan technique and image quality of coronary angiography with dual source computed tomography(CT) without oral metoprolol preparation.Methods Plain and enhanced dual source CT coronary angiography without oral metoprolol preparation was prospectively performed in 600 patients.Calcium scoring with plain scan images as well as multi-planar reconstruction(MPR),maximum intensity projection(MIP),and volume rendering technique(VRT) reconstruction with enhanced scan images were performed in all cases.The scan technique and post-reconstruction experience was summarized.The image quality was classified as 1 to 4 points,and coronary segments classified according to the American Heart Association standards were evaluated.Results The average calcium score of the 600 cases was 213.6±298.7(0-3 216.5).The average heart rate of the enhanced scan was 82.1±16.2(47-139) bpm.The post-reconstruction methods with which coronary segments could be shown as best as possible consisted of single phase reconstruction method,two or more phases supplemented method,and electrocardiogram editing method.Altogether 8 457 coronary segments were evaluated,among which 97.2% were evaluated as point 1,1.7% point 2,0.5% point 3,and 0.6% point 4.The coronary segments in 261 cases were completely normal,while 360 segments were diagnosed with <50% stenosis and 625 segments with ≥50% stenosis.Conclusions Excellent coronary artery image can be obtained with dual source CT in patients with any heart rate without oral metoprolol preparation.Heart rate is not a major source of the artifact,coronary segments can be well shown with single or multiple-phase reconstruction method.

ASSESSMENT OF LEFT VENTRICULAR FUNCTION IN HEALTHY SUBJECTS BY PUSLED WAVE DOPPLER TISSUE IMAGING

Objective To examine the clinical application of pulsed Doppler tissue imaging(DTI)for regional left ventricular function assessment in normal subjects. Methods We examined 50 healthy subjects(range 12-42 years,mean age 28.3 ± 6.9 years)using pulsed Doppler tissue imaging to characterize the diastolic and systolic velocity profiles of mitral annulus. Recordings were made along the long axis in the apical 4-chamber, 2-chamber, and long apical views of 6 sites(posterior-septum, lateral, anterior, inferior, anterior-septum, posterior)at the mitral annulus. Myocardial velocities were determined with use of variance F statistical analysis. Correlation analysis was employed to test the relationship between age and mitral annular velocities. Results Both early diastolic and systolic velocities at the septum were lower than other sites. There were no differences in mitral annulus late diastolic velocities. Mean early diastolic and systolic velocities was negatively correlated with age. Conclusions Doppler tissue imaging can directly reflect regional left ventricular function.

心与影

人生途中，你总在与自己的影子对话， 你呼吸，他亲密地在你的周围穿来穿， 没有嘴巴，没有听觉，也没有言语。

心随景影

林少华是汕头房地产界的一位老总、高级工程师，业余酷爱风光、民俗摄影，其摄影作品选集《心影》已由中国摄影出版社出版。本刊现从该书选出12幅作为今年各期封面，并将其跋语转载于下。

Endovascular management of patients with coronary artery disease and diabetic foot syndrome： A long-term follow-up

Background To investigate the long-term results of global coronary and peripheral interventional treatment of diabetic foot patients. Methods We retrospectively included 220 diabetic patients （78.5 ±15.8 years, 107 females, all with Fontaine Ⅲor Ⅳclass） who were referred to our centre for diabetic foot syndrome and severe limb ischemia from January 2006 to December 2010. Patients were evaluated by a team of interventional cardiologists and diabetologists in order to assess presence of concomitant coronary artery disease （CAD） and eventual need for coronary revascularization. Stress-echo was performed in all patients before diagnostic peripheral angiography. Patients with indications for coronary angiography were submitted to combined diagnostic angiography and then to eventual staged peripheral and coronary interventions. Doppler ultrasonography and foot transcutaneous oximetry of transcutaneous oxygen pressure （TcPO2） before and after the procedure were performed as well as stress-echocardiography and combined cardiologic and diabetic examination at 1 and 6 month and yearly. Results Stress-echocardiography was performed in 94/220 patients and resulted positive in 56 patients who underwent combined coronary and peripheral angiography. In the rest of 126 patients, combined coronary and peripheral angiography was performed directly for concomitant signs and symptoms of coronary heart disease in 35 patients. Coronary revascularization was judged necessary in 85/129 patients and was performed percutaneously after peripheral interventions in 72 patients and surgically in 13 patients. For Diabetic foot interventions the preferred approach was ipsilateral femoral antegrade in 170/220 patients （77.7%） and contralateral cross-over in 40/220 patients （18.8%） and popliteal retrograde ＋ femoral antegrade in 10/220 patients （4.5%）. Balloon angioplasty was performed in 252 legs （32 patients had bilateral disease）： the procedure was successful in 239/252 legs with an immediate success rate of 94.8% and a significant improvement in TcPO2 and ABI with ulcer healing in 233/252 legs （92.4%）. Freedom from major amputation was 82.8% at a mean follow-up of 3.1 ±1.8 years （range 1 to 5 years） whereas survival was 88%. Conclusions Global coronary and peripheral endovascular management of diabetic foot syndrome patients seems to lead to an high immediate success and limb salvage rates and increasing survival compared to historical series.

ASSESSMENT OF MYOCARDIAL VIABILITY WITH CONTRAST-ENHANCED MAGNETIC RESONANCE IMAGING AND COMPARISON WITH SINGLE-PHOTON EMISSION COMPUTED TOMOGRAPHY

Objective To compare contrast-enhanced magnetic resonance imaging （ceMRI） with nuclear metabolic imaging for the assessment of myocardial viability in patients with chronic ischemic heart disease. Methods Twenty patients with suspected chronic ischemic heart disease underwent ceMRI and technetium-99m sestamibi single-photon emission computed tomography （SPECT）. Patients with positive SPECT results also underwent 18 F-fluorodeoxyglucose （FDG） SPECT. In a 17-segment model, the segmental extent of hyperenhancement （SEH） by ceMRI was compared with segmental FDG and sestamibi uptake by SPECT. Correlation between the extent of hyperenhancement by ceMRI and left ventricular function was analyzed. Seven patients got negative results both in ceMRI and technetium-99m sestamibi SPECT. The rest 13 patients with positive results then underwent ^18F-FDG SPECT. In 221 segments of 13 patients, SEH was （2. 1±8.2）%, （25.0±13.7 ）%, and （57. 7±23.6 ）% in segments with normal metabolism/perfusion, metabolism/perfusion mismatch, and matched defects, respectively, and there were significant differences between either two of them （ all P 〈 0.05）. By receiver operating characteristic curve analysis, the area under the curve was 0. 95 for the differentiation between viable and non-viable segments. At the cutoff value of 34%, SEH optimally differentiated viable from non-viable segments defined by SPECT. Using this threshold, the sensitivity and specificity of ceMRI to detect non-viable myocardium as defined by SPECT were 92% and 93%, respectively. Hyperenhancement size by ceMRI was correlated negatively with the left ventricular ejection fraction （ r = - 0.90, P 〈 0.01 ） and positively with left ventricular volumes （ r = 0. 62 for end-diastolic volume, r = 0.75 for end-systolic volume, both P 〈 0.05 ）. Conclusion CeMRI allows assessment of myocardial viability with a high accuracy in patients with chronic ischemic heart disease.

Correlation between serum free fatty acids levels and Gensini score in elderly patients with coronary heart disease

Objectives To investigate the relationship between serum fxee fatty acids （FFAs） levels and the severity of coronary artery lesions in elderly patients with coronary heart disease （CAD）. Methods A total of 172 elderly patients who underwent coronary angiography were divided into CAD group （n = 128） and non-CAD group （n = 44） according to the results of coronary angiography. Serum FFAs and lipid levels were measured and the Gensini score were calculated. Results No matter the differences between age, gender and the usage of stat- ins or not, there was no statistical significance in FFAs levels （P 〉 0.05）. In terms of the Gensini score, it was higher in patients aged 70-79 years than in patients 60-69 years old [15.00 （5.00, 34.00） vs. 10.00 （2.00, 24.00）, P 〈 0.05], higher in men than women [14.00 （4.00, 34.00） vs. 7.00 （2.50, 19.75）, P 〈 0.05], and higher in patients on statins [13.50 （4.25, 33.50）vs. 6.50 （2.00, 18.00）, P 〈 0.05]. The serum FFAs lev- els [449.50 （299.00, 624.75） mEq/L vs. 388.00 （258.50, 495.25） mEq/L, P 〈 0.05J and Gensini score [17.50 （8.00, 41.75） vs. 1.00 （0, 5.00）, P 〈 0.05] were higher in the CAD group than in the non-CAD group. In the CAD group, there was no statistical significance in FFAs levels among patients with different numbers of diseased coronary vessels （P 〉 0.05）. Furthermore, the FFAs levels were positively correlated with the Gensini score （r = 0.394, P = 0.005）. Regression analysis showed that the FFAs levels were related to the Gensini score independently after adjusting for the other risk factors. Conclusions The serum FFAs levels were associated with the Gensini score in elderly patients with CAD. It might indicate FFAs as a biomarker predicting the severity of coronary artery lesions.

RETROSPECTIVE ANALYSIS OF MAGNETIC RESONANCE MYOCARDIAL DELAYED ENHANCEMENT

Objective To explore the imaging and related clinical characteristics of magnetic resonance （MR） delayed enhancement in patients with ischemic or nonischemic heart disease. Methods Thirty-two cases who underwent MR myocardial cine and delayed enhancement imaging from January 2004 to October 2006 were retrospectively analyzed. The cine sequence imaging included the four-chamber view and the left ventricular short axis view. The delayed enhancement imaging was taken 10 minutes after the infusion of gadolinium from the antecubital vein with a segmented inversion-recovery-prepared Tl-weighted fast gradient echo sequence. Patients underwent coronary computed tomography angiography （CTA） two weeks before or after the MR imaging examination. Combined with clinical history, the clinical and MR imaging characteristics of the patients who had delayed enhancement were analyzed. Results MR delayed enhancement could be found in 16 cases. Among them, 12 cases had ischemic heart disease. Their coronary CTA showed one to three vessel diseases. The delayed enhancement was transmural or subendocardium, and the area of delayed enhancement corresponded well with one or more coronary arteries which had severe stenosis or occlusion. Four cases had nonischemic heart diseases One case was dilated cardiomyopathy, with diffuse small midwall spots in delayed enhancemen and only 30% stenosis of the anterior descending coronary artery in coronary CTA. One case was hypertrophic cardiomyopathy, with delayed enhancement of strip- and patch-shaped at midwall of the hypertrophic myocardiurn. One case was restrictive cardiomyopathy, and the delayed enhancement was located in the area of subendocardium of both the right and left ventricles. Coronary CTA of these two cases were normal The other case was a mass of the lateral wall of the left ventricle, and the delayed enhancement with a clumpy shape was located in the lateral wall of the left ventricle. Conclusions MR myocardial delayed enhancement is not a specific sign of myocardial infarction of ischemic heart disease. Nonischemic heart diseases including all kinds of primary cardiomyopathy and some other diseases affecting myocardium can also cause delayed enhancement, but their characteristics are different. The differentiation of the etiology of the nonischemic heart disease with delayed enhancement relies upon the intimate connection with clinical history and the cine sequence MR images.

Right atrial angiosarcoma and electrocardiogram-gated cardiac computed tomography:a case report

Primary cardiac tumors are quite rare and most of these tumors are benign.In this report,a patient presented with chest distress and shortness of breath after activity.Echocardiography of other hospital showed a hyperechoic right atrial mass.Electrocardiogram-gated cardiac computed tomography(ECG-Gated CT) of our hospital provided accurate information about the site and extent of the tumor,and the involvement of neighboring structures,even about the malignant nature of the lesion.The pathological study indicated angiosarcoma.The role of ECG-Gated CT in the assessment of cardiac masses and tumors was discussed.Cardiac tumors are extremely rare and can be divided into benign and malignant lesions.Myxomas are the most common type of cardiac benign tumor,while angiosarcomas are the most common type of cardiac malignant tumor.Imaging studies play an important role in the diagnosis of cardiac angiosarcomas.Echocardiogram,computed tomography(CT) and magnetic resonance imaging(MRI) are the most common imaging studies for tumors evaluation.However,the precise tumor location is often difficult to evaluate precisely on the basis of two-dimensional source images.We conducted ECG-gated cardiac CT examination with 3D reconstruction for preoperative assessment in a patient with a angiosarcoma arising in the right atrium.

Rebellion and Remodeling of individual consciousness for Contemporary Collective Memory ——Taking Online Movie as an Example

In this paper, the network movie as the research object, quoted in the theory of ＂collective memory＂ from Mauric Halbwachs, the academic circles in recent years on the Internet Movie different viewpoint for reference, consult a lot of literatures, the method of interdisciplinary research in the field of psychology, culture, to ＂memory＂, ＂culture＂, ＂group （SOCIAL）＂ in three aspects, analysis of network movie as an expression of individual consciousness, contradiction between individual and collective in the expression of the collective memory of the film, through the analysis of the network specific expression, expression, the expression of an important role in the formation of rebellious sense for people aesthetic psychology, the awakening of individual consciousness and group identity. Therefore, it is necessary to culture the appearance and development of Internet Movie, is bound to the mode of expression, the people＇s cultural psychology and social individual to collective identity have significant influence.

Private Car Travel Characteristics and Influencing Factors in Chinese Cities——A Case Study of Guangzhou in Guangdong,China

Taking Guangzhou as a case,this paper adopted a questionnaire survey to gather first-hand data and analyzed the characteristics and influencing factors of private car travel in Chinese cities.As the research indicated,trip purposes of private car travel are mainly commute and business affairs with a more flexible trip in the urban core area.And trip intensities are concentrated in a certain extent,with trip frequency being lower in the urban core area than the peripheral area.In addition,the trip time has two significant peaks occurring in the morning and afternoon,and one trough in the midday.And trip spatial distribution is mainly within commute with both residence and employment in urban area and inward commute with residence in suburban area while employment in urban area.Both kinds of commutes direct to the urban area.The study also shows that the characteristics of private car travel are principally influenced by two aspects:travelers' attributes and urban characteristics.The main travelers' social and economic attributes influenced it include the gender,education attainment,age,driving experience and per capita monthly household income.The urban characteristics influenced it mainly cover the land use pattern,public traffic facilities and spatial attributes of residential environment.

Factors influencing survival of patient with in-hospital ventricular fibrillation： experience of a single center

Objective To evaluate the factors influencing the outcome of patients who suffered in-hospital ventricular fibrillation （IHVF）. Methods Data of patients with IHVF in a single center were collected. Clinical characteristics of patients were compared between those survived （n=112） and those died （n=94）, and those with IHVF occurred in inpatient ward and in emergency center. Multiple logistic regression analysis was used to identify factors associated with survival. Results There were 206 events in the analysis. The most common underlying disease was coronary artery disease （CAD）, especially acute myocardial infarction （AMI）. On multiple logistic regression analysis, independent predictors for failure to survive were higher NYHA class （odds ratio 1.7, 95% CI, 1.3-2.2, P〈 0.001）, lower serum potassium concentration （ [K＋] ） （odds ratio, 2.9, 95% CI, 1.9-4.3, P--0.007） and adrenaline usage （odds ratio, 25, 95% CI 11.5-55.1, P〈 0.001）. Emergency group have better NYHA class （P = 0.012）, lower [K-] （P 〈 0.001） than in inpatient ward group. Hypokalemia （serum potassium level 〈4.5 mmol/L） was found in all patients with AMI in emergency group. In AMI sub-group, 56.9% of IHVF events occurred within the first day after AMI, and decreasing within 2 weeks. Patients with fight coronary artery as infarction related artery （IRA） oRen （8/9, 88.9~,5） had bmdycardia （R-R interval 〉 ls） before the occurrence of IHVF, while those with left anterior descending artery as IRA often showed tachycardia （R-R interval 〈 0.6s） （8/12, 66.7%）. Conclusion The most common disease causing IHVF is CAD. Keeping [K＋] above 4.5mmol/1 could prevent on-setting IHVF, especially to AMI patients. The worse heart function is associated with higher rate of IHVF and worse pmgnosis （J Geriatr Cardio12010; 7：21-24）.

Influence of Societal Values on the Outdoor Advertising of Staple Commodities in Lagos State, Nigeria

Societal values are polysemous and its dimensions are imported into advertising to give it rich content. The polysemous character makes it sensitive and complex phenomena. For instance, value that is acceptable in the western part of Nigeria may be unacceptable in the north or east. This clearly implies that value, although may be of the people, is relative and subjective. This study made use of survey research design with a single research question set to guide it. Data were collected from 362 respondents who were purposively selected in the study area （Lagos State, Nigeria） as sample size. Data gathering were done on the field with the aid of questionnaire and analyzed with descriptive statistics. Specifically, a Table of frequency and percentage distribution was employed and scoring of variables was done vis-h-vis the responses of the consumers of staple commodities to look at the extent to which societal values have influenced product advertisements in the State. The Mean and standard deviation was calculated. The result of the study presented in Table 1 shows that all the societal values scoped for this study （culture, moral, religion, taste, language and color） influence consumers in one way or the other but the portrayal of religious design concept to influence consumers to patronize staple commodities ranked best of all. The study observed that of all the societal values traceable to advertising campaign in Lagos State, religion-inclined advertising designs are gaining a rising number of influences. It therefore concludes that religious and cultural designs, when appropriately applied help outdoor advertising to thrive well in Lagos State.

Short-term effects of air pollution on acute myocardial infarctions in Shanghai, China, 2013-2014

Background Although particulate matter, with diameters 〈 2.5 μm （PM2.5） and 〈 10 μm （PM10）, and other pollutants have been associated with cardiovascular morbidity and mortality, the effect of pollutants on acute myocardial infarctions （AMIs） has rarely been investigated in Asia, especially in Shanghai, China. Methods Between 1 November 2013 and 27 April 2014, 972 patients from the Pudong District, Shanghai City, were assessed by the Emergency Medical Service. A case-crossover design was used to analyze exposure to air pollution and the AMI risk. Exposures to PM2.5, PM10, nitrogen dioxide （NO2）, sulphurdioxide （SO2）, and carbon monoxide （CO） were based on the mean urban background levels. The associations among AMI admissions, the included pollutants, temperature, and relative humidity were analyzed using correlation and logistic regression. Results The urban background levels of PM2.5, PM10 and CO were associated with an increased risk of AMI, unlike NO2 and SO2 levels. The OR （95% CI） for AMI were 1.16 （1.03-1.29）, 1.05 （1.01-1.16）, 0.82 （0.75-1.02）, 0.87 （0.63-1.95）, and 1.08 （1.02-1.21） for PM2.5, PM10, NO2, SO2, and CO, respectively. Increases in the air quality index （AQI） were associated with more AMI occurrences. There was no correlation between fluctuations in temperature and relative humidity with AMI hospital admissions. Conclusions Short-term exposure to moderate-serious pollution levels is associated with increased risk of AMI. Increased PM2.5, PM10 and CO levels are related to increased AMI admissions.

lmpact of Virtual Dementia Tbur on empathy leVel Of nursing Students:A quasi-experimental study

Objective:As a developable ability,empathy is significantly associated with patient-centered care.The authors intended to evaluate the effect of Virtual Dementia Tour(VDT)upon nursing students'empathy level and propose practical rationales for optimizing future dementia care.Methods:A total of 45 second-year undergraduate nursing students were organized to watch a theme movie entitled Still Alice and participate in an 8-min VDT.Jefferson Scale of Empathy-Health Professional Students(JSE-HPS)was employed for evaluating the empathy level of nursing students.After VDT,all nursing students participated in a structured interview.Descriptive statistics and paired t-tests were performed using SPSS 24.0.Results:Their empathy levels demonstrated significant overall improvements(106.69±9.49 vs 115.51±10.16,P<0.01).During the course of VDT,nursing students experienced varying levels of anxiety and frustration.All of them were satisfied with the program since they had gained a deeper understanding of demented patients and the program could change their attitudes toward demented elders.Conclusion:Watching a specially selected movie and participating in VDT may be an effective method for enhancing empathy and caring during nursing student education.

Primary percutaneous coronary intervention on older patients with acute ST-segment elevation myocardial infarction: analysis of its risk factors

Objective: The aim of the present study was to assess the early clinical outcome and risk factors in old patients with acute ST elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (PCI). Methods: A total of 136 patients older than 60 years with STEMI who received successful PCI were included in this study. The patients were classified in 2 age groups: patients ≥75 years and <75 years of age. The extent of coronary artery lesions was measured by quantitative coronary artery angiography (QCA). Subjects were tracked for subsequent cardiovascular events: cardiac death, myocardial infarction, heart failure, percutaneous coronary intervention, coronary artery bypass and stroke. Results: Though the older group had a higher prevalence of adverse baseline characteristics and lower final TIMI flow than patients<75y (P<0.05), the procedural success did not make difference between the two groups. In 12 months follow-up of 136 study participants, there occurred 39 CV events : cardiac death (five patients), heart failure (nineteen patients), and stroke (six patients). Three patients received coronary bypass grafts and six patients underwent PCI. Heart failure and overall cardiovascular event rates were higher in older patients compared with those in patients<75y. The main adverse clinical events (MACE) for the old group were a little higher comparing with the younger in 12-month follow-up (P=0.029 6 and P=0.043 4). Multivariate cox analysis identified that a diagnosis of diabetes (HR 2.495, 95%CI 1.224 to 5.083, P= 0.011 8) and time from symptom(HR 1.450, 95%CI 1.143 to 1.841, P= 0.008 2) to PCI as independent predictors of CV events after adjustment of all entered baseline variables. Conclusion: Our study suggests that drug-eluting stent implantation in older patients with acute ST elevation myocardial infarction has high initial procedural success rates despite having more severe baseline risk characteristics, and to shorten the time from symptom onset to PCI may decrease cardiovascular events in old patients following PCI.

Current understanding of coronary artery calcification

Coronary artery calcification （CAC） is highly prevalent in patients with coronary heart disease （CHD） and is associated with major adverse cardiovascular events. There are two recognized type of CAC--intimal and medial calcification, and each of them have specific risk factors. Several theories about the mechanism of vascular calcification have been put forward, and we currently believe that vascular calcification is an active, regulated process. CAC can usually be found in patients with severe CHD, and this asymptomatic phenomenon make early diagnosis of CAC important. Coronary computed tomographic angiography is the main noninvasive tool to detect calcified lesions. Measurement of coronary artery calcification by scoring is a reasonable metric for cardiovascular risk assessment in asymptomatic adults at intermediate risk. To date, effective medical treatment of CAC has not been identified. Several strategies of percutaneous coronary interven- tion have been applied to CHD patients with CAC, but with unsatisfactory results. Prognosis of CAC is still a major problem of CHD pa- tients. Thus, more details about the mechanisms of CAC need to be elucidated in order to improve the understanding and treatment of CAC.