定量组织速度成像及局部Tei指数评价急性心肌梗死患者经皮冠状动脉介入治疗术后局部左心功能变化

目的 探讨定量组织速度成像(QTVI)结合局部Tei指数在评估急性心肌梗死患者经皮冠状动脉介入治疗(PCI)术后局部左心功能变化中的应用价值.方法 选择冠状动脉左前降支(LAD)为"罪犯血管"的急性心肌梗死患者32例为病例组,左室壁被分成梗塞动脉相关室壁(A组)及非梗塞动脉相关室壁(B组).应用Simpson法测量病例组和对照组的左室射血分数(LVEF);PCI术后1周及1、3、6个月观察病例组 Tei指数、收缩期峰值位移(Ds)的变化.结果 病例组术前LVEF明显减低(40.5%±7.43%),术后1周时LVEF有所提高(47.2%±6.12%),1、3、6个月时达正常水平;术后病例组的Tei指数在各次检查中逐渐减低,Ds逐渐增高,但B组室壁的变化幅度明显高于A组,其Tei指数在术后3个月时与对照组差异无统计学意义.结论 QTVI结合局部Tei指数可无创、有效、定量地评价急性心肌梗死患者PCI术后局部左心功能的变化,具有重要的临床应用价值.     

脉冲多普勒组织成像及Tei指数评价急性心肌梗死患者左心室功能研究

目的:研究脉冲多普勒组织成像(pulsed-waveDoppler tissue imaging,PW-DTI)及Tei指数评价急性心肌梗死患者左心室功能的临床应用价值.方法:33例左心宣射血分数(ejection fraction,EF)正常急性心肌梗死患者(A组)、25例左心室EF减低急性心肌梗死患者(B纽),30例健康体检者(C组)均行常规超声心动图、PW-DTI和Tei指数检测,比较3组Tei指数、二尖瓣环收缩期运动峰值速度(systolic velocity,Sm)、舒张早期运动峰值速度(early diastolic velocity,Em)、Em与舒张晚期运动峰值速度(late diastolic velocity,Am)比值(Em/Am),二尖瓣口舒张早期血流峰值速度(transmitral early diastolic filling velocity,E)与Em比值(E/Em).结果:(1)A,B组Tei指教高于C组(P<0.01),B组Tei指数高于A组(P<0.01);3组E,A,E/A比较差异无统计学意义(P>0.05);Tei指数与EF呈负相关.(2)A,B组Sm、Em、Em/Am低于C组(P<0.01),E/Em高于C组(P<0.05,或P<0.01),B组Sm、Em、Em/Am低于A组(P<0.01),E/Em 高于A组(P<0.01);Sm 与EF呈正相关.结论:PW-DTI联合Tei指教评价急性心肌梗死患者左心室功能较常规超声心动图准确.     

Tei指数评价冠心病患者右心功能的临床研究

目的探讨Tei指数评价冠心病患者右心功能的临床价值。方法来我院行冠状动脉造影检查的患者71例,根据造影结果分为3组,右冠状动脉病变严重组(狭窄≥70%,A组),右冠状动脉病变轻微组(狭窄<70%,B组)和正常对照组(C组)。行超声心动图检查测量左室射血分数(EF)、肺动脉收缩压、左心Tei指数(L-Tei)和右心Tei指数(R-Tei)。结果A组和B组的L-Tei和R-Tei较C组延长(L-Tei:0.72±0.12,0.74±0.19和0.56±0.15,P均<0.01;R-Tei:0.62±0.14,0.59±0.18和0.40±0.12,P均<0.01)。结论Tei指数能简便、敏感、综合评价右心整体收缩舒张功能。     

Tei指数评价冠脉旁路移植术前后左室整体心功能变化

目的应用Tei指数评价冠脉旁路移植术(CABG)前后患者整体心室功能的变化.方法34例行CABG手术的冠心病患者根据术前LVEF测值分为A组(EF正常组)和B组(EF低下组),分别于术前、术后2～4周、3个月、6个月,应用Tei指数、左室射血分数(LVEF)和二尖瓣血流图检测左室整体心功能.结果术前,A、B两组Tei指数均较正常增高,且B组显著高于A组(P＜0.01).术后,两组Tei指数均逐渐下降,与术前比较以及术后各时间点间比较差异显著(P＜0.05或0.01),且术后不同时间点两组间比较差异显著(P＜0.01).采用LVEF和二尖瓣血流图评价时,术前A、B两组间均存在显著差异(P＜0.05);术后A组LVEF较术前增高不显著(P＞0.05),但E/A较术前明显增高(P＜0.01);B组LVEF较术前明显增高(P＜0.05),E/A早期减低,术后3个月至6个月逐渐升高.结论Tei指数综合考虑心室收缩和舒张功能,能较LVEF和E/A更准确地评价CABG前后患者整体心功能的变化.     

超声评价维生素C和维生素E对糖尿病血管内皮舒张功能的影响

目的超声观察维生素C、维生素E对2型糖尿病患者肱动脉内皮依赖性舒张功能的影响.方法 46例糖尿病患者随机分为维生素C、维生素E治疗组(A组)和对照组 (B组),采用高分辨率超声观察治疗前后血流介导的肱动脉内皮依赖性血管舒张和硝酸甘油介导的非内皮依赖性血管舒张.结果服用维生素C、维生素E 12个月后,A组血流介导的血管扩张明显改善[(6.33±1.89)%对(4.4±2.67)%,P＜0.01],B组无变化[(4.53±1.99 )%对(4.62±2.47)%,P＞0.05];硝酸甘油介导的血管扩张两组均较治疗前无显著差异性[分别为(20.67±3.29)%对(19.68±2.26)%,(19.45±3.03)%对(20.38 ±1.82)%,P＞0.05];A组24 h尿蛋白排泄率较治疗前减低[(121.87±104.47) mg/24 h对(238.52±231.26) mg/24 h,P＜0.05],B组无明显变化[(211.78±2 08.07) mg/24 h 对(209.78±210.04) mg/24 h,P＞0.05].结论服用维生素C、维生素E可改善糖尿病患者受损的内皮依赖性血管舒张功能,并对肾脏具有一定的保护作用.     

蒽环类药物对肿瘤患者心脏Tei指数影响的临床研究

目的探讨利用心肌做功指数(MPI,Tei指数)早期检测和评估蒽环类药物(ATC)对肿瘤患者心脏毒性的临床价值。方法用多普勒法测定46例恶性肿瘤患者ATC化疗前和化疗后3~6个月左心Tei指数,常规超声心动图EF、FS和E/A指标。结果与化疗前比较,Tei指数相关参数中ATC化疗后左心室等容舒张时间(IRT)延长,等容舒张指数(IRT/ET)增大,E/A指标降低(P<0.05)。左心室等容收缩时间(ICT),等容收缩指数(ICT/ET),EF和FS指标较化疗前无显著性差异。结论在早期评价ATC对肿瘤患者心脏功能损害方面,Tei指数、等容舒张指数是敏感的指标,E/A指标虽然在应用上有局限性,但也有一定参考意义。     

Tei指数及其相关参数定量评估子痫前期孕妇胎儿右室功能

目的 探讨Tei指数及等容收缩指数(ICT/ET)、等容舒张指数(IRT/ET)等相关参数在评价正常胎儿和子痫前期孕妇胎儿心室功能中的临床价值.方法 应用组织多普勒(tissue Doppler imaging,TDI)测量64例孕妇胎儿右室等容收缩时间(ICT),射血时间(ET)及等容舒张时间(IRT),获得右室Tei指数及其相关参数,其中正常孕妇30例(A组)、子痫前期轻度孕妇21例(B组)及子痫前期重度孕妇13例(C组).并比较A、B和C三组间Tei指数及其相关参数.结果 C组胎儿右室Tei指数及IRT/ET明显高于A组,差异有统计学意义(分别为P<0.01与P<0.05);A、B两组间胎儿右室Tei指数及IRT/ET差异不明显,无统计学意义(P>0.05);A、B及C三组间的ICT、IRT、ET及ICT/ET差异均无统计学意义(P>0.05);结论子痫前期重度不仅损害母体脏器,而且累及胎儿心室舒张功能;Tei指数及其相关参数是一种定量评价心室功能的多普勒指数,能简便、敏感、准确地评估胎儿心室功能.     

定量组织速度成像测定Tei指数评价表阿霉素心脏毒性致左心功能的改变

目的应用定量组织速度成像(QTVI)测定Tei指数评价乳腺癌患者表阿霉素心脏毒性的左室功能的变化。方法133例乳腺癌患者分为3组A组45例,给予表阿霉素总剂量180~240mg/m2。B组48例,给予表阿霉素总剂量≥360mg/m2。C组为对照组,40例,未给予化疗。对3组进行常规超声参数及QTVI参数测定,包括等容舒张时间(IRT)、等容收缩时间(ICT)、射血时间(ET),并计算Tei指数。结果A组与C组间常规超声参数及Tei指数无显著性差异,B组与C组间参数E/A及Tei指数有显著性差异(P<0.01),B组与A组间常规超声参数无显著性差异,而Tei指数有显著性差异(P<0.01)。结论QTVI测定Tei指数可准确评价表阿霉素心脏毒性对左心功能的影响。     

急症高血糖对N端脑钠肽原评价心功能的影响

目的 对不同血糖状态下的N端脑钠肽原(N terminal proBNP,NT-proBNP)与组织多普勒(TDI)测定的心功能指数(Tei指数)相关性进行分析,探讨急症高血糖状态对NT-proBNP评价心功能的影响.方法 前瞻性纳入广东省人民医院心内科连续收入的急性冠脉综合征患者,根据入院后空腹血糖水平分为急症高血糖组(空腹血糖≥6.1 mmol/L)和正常血糖组(空腹血糖＜6.1 mmol/L),两组均接受经胸超声心动图检查,并应用TDI测定所有患者的Tei指数,比较两组Tei指数与NT-proBNP的相关性.结果 急症高血糖组(27例)TDI-Tei指数较正常血糖组(35例)显著延长[(0.68±0.14) vs.(0.61 ±0.10),P=0.03],相关收缩指数与舒张指数也显著延长[(0.29±0.07) vs.(0.26±0.05),P=0.045;(0.38±0.08) vs.(0.35±0.05),P=0.03];两组TDI-Tei指数与NT-proBNP自然对数值均呈直线关系.高血糖组TDI-Tei=0.175+0.068 In NT-proBNP,R2=0.702,回归系数检验t=7.675,P＜0.01.正常血糖组TDI-Tei =0.185+0.060 In NT-proBNP,R2=0.405,回归系数检验t=4.738,P＜0.01.结论 与正常血糖水平的急性冠脉综合征患者相比,伴急症高血糖状态的患者左室整体功能更差;无论在正常血糖水平,还是在急症高血糖状态下,NT-proBNP与TDI-Tei指数都具有显著的直线回归关系.NT-proBNP可以用于准确评价急症高血糖状态下的急性冠脉综合征患者的心脏整体功能.     

血管内皮功能对急性心肌梗死相关血管自发性再通和预后的影响

目的:对比观察急性心肌梗死自发性再通和无再通患者的血管内皮功能,探索血管内皮功能在自发性再通中的作用及对预后的影响.方法:2008年1-6月入住我院的急性ST抬高性心肌梗死患者63例,根据急诊PCI时TIMI血流分级,分为自发性再通组2l例和无再通组42例.PCI之前,Rentrop法评价侧支循环情况,QCA软件测量血栓体积,然后导入ZEEK抽吸导管到梗死病变,抽吸冠状动脉血,集中用放免法测定一氧化氮(NO)和内皮素(ET)水平.PCI之后,床边检测内皮舒张功能(FMD).术后6个月门诊随访死亡、再发心肌梗死和靶血管再次血运重建等主要不良心血管事件以及左室射血分数(EF)值.结果:两组患者年龄、性别、高血压、吸烟、糖尿病、高脂血症和EF值等临床资料差异无统计学意义,但无再通组年龄更高,高血压、吸烟、糖尿病人数较自发性再通组多,自发性再通组梗死前心绞痛发生率明显高于无再通组(P＜0.01).两组间侧支循环分级差异无统计学意义,自发性再通组和无再通组的血栓负荷[(14.21±2.37)mm3 vs(31.45±4.66)mm3]、冠状动脉血NO和ET水平[(50.65±13.67)μmol/mL vs(28.83 ±9.26)μmol/mL、(63.49±10.58)pg/mL vs(92.51±16.45)pg/mL]、FMD[(8.42±2.36)%vs(4.68±1.75)%]差异均有显著性(P＜0.01).术后6个月随访,总不良心血管事件自发性再通组1例(4.8%),无再通组3例(7.1%),EF值比较差异有显著性(0.54±0.12 vs 0.35±0.08,P＜0.05).结论:血管内皮功能与急性心肌梗死自发性再通有关,自发性再通改善预后.     

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.     

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.     

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.     

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."