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胎儿大脑中动脉血流速度测定的可靠性研究：一项超声医师培训的随机对照试验
Reliability of Fetal Middle Cerebral Artery Velocity Measurements: A Randomized Controlled Trial of Sonographer Training
Clark EAS, Lacoursiere DY, Byrne JLB  2009/9/21 19:30:53 
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J Ultrasound Med, 2009,
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Objective:
The purpose of this study was to determine the reliability of fetal middle cerebral artery (MCA) peak systolic velocity (PSV) measurements at a tertiary care center and to evaluate the effect of targeted training for sonographers.

Methods:
Six sonographers were randomized to training modules for fetal MCA PSV or amniotic fluid volume (AFV) measurements. Six fetuses of uncomplicated pregnancies were selected for participation. Middle cerebral artery and AFV measurements were obtained before and after a training module. The intraobserver and interobserver variability (reliability) was calculated with intraclass correlation coefficients and was compared between groups.

Results:
Administration of the MCA training module increased the number of technically adequate MCA images obtained (odds ratio, 3.95; 95% confidence interval, 1.07–14.65). The intraobserver and interobserver variability for MCA measurements was significantly reduced after the targeted training module (P=.05).

Conclusions:
The reliability of fetal MCA PSV measurements improved after a targeted training program.
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甲状腺功能亢进合并黄疸

 王燕燕 王曙

上海交通大学附属瑞金医院内分泌科

患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。
 

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