实时三维超声心动图评价房间隔缺损患者右室整体及局部容积与功能

目的 应用实时三维超声心动图(RT3DE)技术评价房间隔缺损(ASD)患者右室整体及局部容积与功能.方法 对32例ASD患者及32例正常对照者行三维容积成像,应用实时三维右室定量法(3D RVQ)测量并比较两组右室各局部舒张、收缩末期容积及局部射血分数,并将上述方法与长轴八平面法(LA 8-plane)测量的右室整体容积及射血分数行相关分析.结果 ASD患者右室局部及整体舒张、收缩末期容积较正常对照组明显增加(P<0.05),右室心尖部及整体射血分数较正常对照组减低(P<0.001).3D RVQ法与LA 8-plane法测量的右室整体舒张、收缩末期容积及射血分数相关良好.结论 RT3DE能准确评价右室局部及整体容积与功能,ASD患者右室局部及整体容量负荷较正常人显著增加,右室心尖部和整体收缩功能均有降低.     

实时三维超声心动图评价正常人右心室整体和局部功能的临床研究

目的 应用实时三维超声心动图(RT-3DE)技术评价正常人右心室整体和局部容积与功能.方法 对36例正常人行三维容积成像,应用四维右心室定量分析法(4D-RVQ)测量右室流人道部、流出道部、心尖部和右室整体舒张末期容积、收缩末期容积及射血分数,并分别将各局部容积及射血分数行组间比较;将长轴8平面法(LA 8-plane)测量的右室整体容积及射血分数与上述相关指标行相关分析.结果 4D-RVQ法与LA 8-plane法测量的右室整体舒张、收缩末期容积及整体射血分数相关良好(r值分别为0.96、0.93及0.81).局部舒张、收缩末期容积测值从右室流人道部、心尖部到流出道部呈递减趋势.心尖部射血分数低于右室流出道部及流人道部测值,差异均有统计学意义(P＜0.05).结论 RT-3DE可准确评价右室整体及局部容积与功能,且右室局部收缩功能之间差异有统计学意义.     

实时三维超声心动图对法乐氏四联症右室整体及局部容积和收缩功能的评价

目的应用实时三维超声心动图(RT-3DE)评价法乐氏四联症(TOF)患儿右室整体及局部容积和收缩功能。方法 RT-3DE采集45例TOF患儿,平均年龄(1.37±2.91)岁及46例正常同龄匹配对照组,平均年龄(1.37±2.85)岁右室全容积声像图,应用TomTec RV-Function软件分析右室整体及局部容积和收缩功能,测量指标:舒张末期容积(EDV)、收缩末期容积(ESV)、射血分数(EF)、容积峰值收缩速率(PSVR)。结果右室整体、流入道、心尖小梁部EDV与正常对照组无显著差异(P0.05),但上述各容积值为体表面积标化后均大于正常对照组(P0.05),流出道EDV及标化后容积均较正常对照组减小(P0.05);右室整体EF、PSVR及三局部EF均较正常对照组减低(P0.05)。结论 TOF患儿右室流出道发育不良性狭窄导致右室流出道容积减小,而右室整体、流入道、心尖小梁部容积增大,并伴有右室收缩功能受损。     

实时三维超声心动图评价正常人右心室节段容积和收缩功能的研究

目的运用实时三维超声心动图(RT3DE)方法分析正常人右心室节段容积和收缩功能。方法应用PHILIPS-iE33超声显像仪及匹配的X3-1探头对53名正常成年人进行常规超声心动图及RT3DE检查。应用TomTec软件定量分析右心室RT3DE图像,获得右心室整体及流入道、体部和流出道三个节段的舒张末容积(EDV)、收缩末容积(ESV)、每搏输出量(SV)、射血分数(EF),计算各节段容积达最小值时间(Tmsv)及其所占心动周期的百分率(Tmsv%)的标准差(SD)和最大差(dif)作为右心室收缩同步性参数。结果正常人男性组右心室体部、流出道及整体EDV及SV大于女性组(P均<0.05),其右心室三个节段及整体ESV均大于女性组(P均<0.05),流入道EF略低于女性组(P<0.05)。组内比较结果显示,正常人右心室流入道EDV和SV均大于流出道和体部(P均<0.05),节段EF值大小关系均为流入道>流出道>体部(P均<0.05),整体和三个节段Tmsv及Tmsv%之间均无显著差异。相关性分析结果显示,正常人右心室整体EDV与右心室舒张末期内径及面积呈正相关(P均<0.05),右心室整体ESV与右心室收缩末期内径及面积呈正相关(P均<0.05)。结论正常人右心室三个节段容积和收缩功能具有不同的特点,男性和女性右心室整体和节段容积及收缩功能存在差异,右心室节段收缩活动具有较高的同步性,RT3DE分析右心室节段容积和收缩功能具有潜在的应用价值。     

实时三维超声心动图定量评价风湿性二尖瓣狭窄患者的右心室功能

目的应用实时三维超声心动图(RT-3DE)技术评价风湿性二尖瓣狭窄(MS)患者右心室整体及局部容积与功能。方法 41例MS患者分为A组18例,轻度三尖瓣反流;B组23例,中度及中度以上三尖瓣反流。应用四维右心室定量分析法(4D-RVQ)测量41例MS患者和25例正常对照者右心室整体及局部舒张末期容积、收缩末期容积及射血分数。结果与正常对照组和A组相比,B组的右心室整体和局部舒张末和收缩末容积均增大,差异均有统计学意义(均P<0.01)。A组和B组的右心室整体射血分数较正常对照组降低,差异有统计学意义(P<0.01)。在右心室局部收缩功能的比较中,A组和B组的流入道和流出道的射血分数降低,而且B组流入道收缩功能较A组进一步降低,差异具有统计学意义(P<0.01)。而心尖肌小梁部收缩功能差异没有统计学意义。结论 RT-3DE可以定量评价MS患者右心室整体及局部容积与收缩功能。三尖瓣反流程度影响右心室整体及局部收缩功能。     

实时三维超声心动图评价房间隔缺损右心室整体及节段收缩功能

目的探讨实时三维超声心动图(real-time three-dimensional echocardiography,RT-3DE)评价房间隔缺损患者右心室整体及节段收缩功能的可行性及准确性。方法使用RT-3DE采集27例房间隔缺损(atrial septal defect,ASD)患者和32例健康志愿者心脏全容积图像,应用Tomtec公司的Manual4D RV-Function CAP分析软件测量右心室整体及3节段收缩功能,得到右心室整体和节段舒张末期容积、收缩末期容积,射血分数,并通过软件自动生成右室节段容积-时间变化曲线。结果RT-3DE可以同步评价右心室整体及节段收缩功能。ASD患者的右室收缩功能下降(P=0.017),3节段中流出道部和小梁部的收缩功能下降最为明显(P=0.036,0.008),流入道部收缩功能下降无统计学意义(P=0.554)。结论RT-3DE可有效评价右室整体及节段收缩功能,对于房间隔缺损患者的手术治疗及预后评价有重要意义。     

实时三维超声心动图评价正常儿童右心室整体及局部容积和收缩功能

目的 应用实时三维超声心动图(RT-3DE)评价不同年龄正常儿童右室整体及局部容积和收缩功能.方法 192例正常儿童按年龄分为5组:Ⅰ组,＜1岁,32例;Ⅱ组,≥1岁-＜3岁,46例;Ⅲ组,≥3岁-＜6岁,36例;Ⅳ组,≥6岁-＜9岁,41例;Ⅴ组,≥9岁-＜14岁,37例.应用RT-3DE于心尖偏胸骨旁四腔心采集右室全容积声像图,使用TomTec RV-Function软件分析右室整体和局部(包括流入道、流出道、心尖肌小梁部)舒张末期容积(EDV)、收缩末期容积(ESV)及射血分数(EF),计算各局部EDV占右室EDV的比率,对右室三局部容积和收缩功能进行相互比较,并对各年龄组右室整体及局部EF和各局部所占右室容积比率进行相互比较;同时对右室整体和局部EDV与年龄及体格指标进行相关性和曲线估计回归分析.结果 在右室三局部容积和收缩功能的相互比较中:右室流入道EDV及EF均大于流出道、心尖肌小梁部(P＜0.05),流出道EDV与心尖肌小梁部差异无统计学意义(P＞0.05),但流出道EF大于心尖肌小梁部(P＜0.05);各年龄组间右室整体及局部EF差异无统计学意义(P＞0.12);三局部所占右室容积比率在各年龄组间差异无统计学意义(P＞0.58).右室整体及局部EDV与年龄、身高、体质量、体表面积(BSA)呈显著正相关(r＞0.77,P=0.000),其中与体表面积的相关性最显著(r＞0.83,P=0.000),曲线估计分析表明右室整体及局部EDV与各体格指标之间的回归模型以幂模型最佳,其中与体表面积建立的回归模型最佳.结论 在右室三局部中,右室流入道和流出道的容积和收缩功能是右室泵血功能的重要组成部分,右室容积的增长在儿童时期并非随年龄体格指标呈线性增长,而以指数模式增长.

Abstract：

Objective To evaluate right ventricular(RV) global and regional volume and systolic function by real-time three-dimensional echocardiography (RT-3DE) in normal children with different age.Methods One hundred and ninty-two normal children were divided into five groups by age:group Ⅰ,＜1 years old,32 cases;group Ⅱ,≥1 years old-＜3 years old,46 cases;group Ⅲ,≥3 years old-＜6 years old,36 cases;group Ⅳ,≥6 years old-＜9 years old,41 cases;group Ⅴ,≥9 years old-＜14 years old,37 cases.Full volume imaging of RV was obtained at the parasternal four-chamber view near the apex by RT-3DE.RT-3DE data set were analyzed off-line by TomTec RV-Function.RV were divided into three parts:inflow,body,outflow.The measurements were including RV global and regional end-diastolic volume (EDV),end-systolic volume (ESV),ejection fraction (EF) and the ratio of regional parts EDV to RVEDV. The volume and systolic function were compared in three regional parts.RV global and regional parts EF and the ratio of regional parts EDV to RVEDV were also compared in five age groups.Correlation analysis and curve estimation were studied on RV global and regional EDV with age and physical development indexes.Results In the comparison of three regional parts:inflow EDV and EF were higher than outflow and body parts (P＜0.05).No significant different was found between outflow EDV and body EDV (P＞0.05),however,outflow EF was significant higher than body EF(P＜0.05).The comparison of RV global and regional EF in five age groups were no statistical different (P＞0.12). The ratio of regional parts EDV to RVEDV remained constant in five age groups(P＞0.58).Correlation analysis showed the global and regional RV volume were strongly correlated with age,height,weight and BSA (r＞0.77,P=0.000).The best correlation was found with BSA (r＞0.83,P=0.000).Curve estimation demonstrated that the relationship of RV global and regional EDV with age and physical development indexes could be best expressed by power model,the best matched model were found with BSA.Conclusions Among three regional parts of RV,inflow and outflow parts volume contraction were the two main contribution factors for RV function.In childhood RV volume didn't increase linearly with age and physical development indexes,but in an exponential model.     

实时三维超声心动图右心室容积-时间曲线评价正常人右心整体和局部心肌功能的临床研究

目的 利用实时三维超声心动图右室容积一时间曲线评价正常人右室整体和局部收缩及舒张功能.方法 选取正常人65例,进行实时三维超声心动图全容积采集,将图像导入TomTec工作站,4DRV-function软件行图像处理,半自动勾画心内膜,通过半自动探测出右室轮廓线,构建右室三维模型,软件将右室划分成三个节段:流人道(inflow)、流出道(outflow)和体部(body);获取右室整体和局部容积-时间曲线,记录右室整体及各节段舒张末容积(EDV)、收缩末容积(ESV)、射血分数(EF)、峰值排空率(PER)、峰值充盈率(PFR)等;同时观察各测量指标随年龄增加的变化规律.结果 ①正常人整体和局部右室容积-时间曲线均显示为"U"型曲线.各节段EF不同,右室流人道部最大,右室流出道部最小,差异具有统计学意义(P＜0.05);各节段PER和PFR不同,流人道和体部较流出道大,差异具有统计学意义(P＜0.05).②整体及局部EF和PER随年龄增加未见明显变化(r=-0.16～0.12,P＞0.05;r=0.10～0.23,P＞0.05),而PFR随年龄增加呈下降趋势(r=-0.35～-0.56,P＜0.05).结论 实时三维超声心动图右室容积-时间曲线可以准确、客观地评价右心整体和局部心肌收缩和舒张功能.右室流人道对右室舒缩功能贡献最大.临床评价右心舒张功能时,应充分考虑年龄因素的影响.     

实时三维超声心动图对房间隔缺损患者右心室收缩功能的评价

目的：应用实时三维超声心动图（Real-time three-dimensional echocardiography，RT-3DE）评价房间隔缺损患者右心室收缩功能。方法：将18例房间隔缺损（ASD）患者与22例正常人（NOR组）进行比较。使用RT-3DE采集心脏全容积图像，应用4D RV-Function 1.1软件分析，得出右心室整体和三节段各自的舒张末期容积（EDV）、收缩末期容积（ESV），射血分数（EF）。结果：ASD患者的右室整体及节段EDV、ESV均较正常人增高，右室整体及节段的EF均较正常人下降（P<0.05）；同时得出ASD组的三节段间收缩趋势也不同于NOR组。结论：RT-3DE可以准确的评价ASD患者的右室整体和节段功能改变，而且可以同步分析节段间的差别，是评估右心室功能的优越技术。     

实时三维超声心动图评价法洛四联症患者右心室收缩功能的研究

目的：应用实时三维超声心动图（RT-3DE）研究法洛四联症（TOF）患者右心室收缩功能的改变。方法：应用RT-3DE及二维方法测量29例TOF患者及10例正常儿童的右心室舒张末期容积（RVEDV）、收缩末期容积（RVESV）、每搏量（RVSV）及射血分数（RVEF）。结果：二维及RT-3DE均测得29例患者中41%术前RVEF低于50%,两种方法测得的TOF患者术前RVEDV及RVESV比较有统计学差异,RVSV及RVEF无统计学差异。TOF患者三维右心室容积曲线（RVVC）幅度较正常人减小,收缩峰值后移。结论：RT-3DE能通过测量右室容积及射血分数来评价TOF患者右室功能的变化。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."