超声心动图曲线M型应变率成像研究冠心病心肌缺血

目的应用曲线M型应变率成像（CMM-SRI）技术研究冠心病缺血心肌的图像特点，重点探讨收缩-舒张转换时间（Tcec）的改变。方法冠心病组和正常对照组各60例，观察左心室CMM-SRI图像特点，定量检测各节段Tcec，冠状动脉造影确定缺血节段，比较冠心病组左心室壁各节段与对照组之间Tcec的差异。结果无缺血节段的室壁，CMM-SRI图像红、蓝颜色转换的交界线基本呈直线，有缺血节段的室壁，交界线呈不规则曲线；缺血节段Tcec延长，与对照组比较绝大多数缺血节段差异有统计学意义。结论CMM-SRI可定量分析缺血心肌Tcec的改变，提示CMM-SRI技术可用于检测缺血心肌。     

大鼠冠状动脉微栓塞模型的建立

目的建立大鼠冠状动脉微栓塞（Coronary Microembolization，CME）模型。方法S-D雄性大鼠随机分为假手术组（S0组），微栓塞组（CME组）；CME组再按微球数目不同分为1000、2000、3000、4000个微球亚组（分别计为CME1、CME2、CME3、CME4组，各组存活大鼠均n=10）；大鼠麻醉后开胸，夹闭升主动脉10s，从左心室注射微栓塞球到达冠状动脉记为CME组，以注射生理盐水为假手术组；分别于术后6h心脏超声检测左室射血分数（LVEF）、HBFP检测心肌微梗死面积和TUNEL检测心肌细胞凋亡卒。结果①与s。组比较，CME，组LVEF下降，但没有统计学意义；与S0组比较，CME2、CME3、CME4组LVEF均显著下降（均P〈0．05）；CME组均出现心肌微梗死灶与心肌细胞凋亡。②不同微栓塞亚组之间比较，LVEF与微栓塞球数目成负相关（γ=0．78，P〈0．05）、心肌微梗死面积和心肌细胞凋亡率均与微栓塞数目成正相关（γ分别为0．85、0．80，均P〈0．05）。③3000个微球是较理想的建立大鼠CME模型所需的微球数日。结论开胸大鼠，从左室注入微栓塞球3000个，可成功建立大鼠CME模型。     

超声斑点追踪成像评价不同构型高血压患者左室心肌应变

目的采用二维超声斑点追踪成像(STI)技术探讨原发性高血压患者左心室心肌纵向、径向、周向应变特点,评价不同构型的原发性高血压患者左室收缩功能。方法原发性高血压患者63例,根据左室心肌质量指数(LVMI)将其分为左室非肥厚组33例(A组)与左室肥厚组30例(B组),选取健康者49例(对照组),获取左室长轴及短轴各切面的收缩期纵向、径向、圆周峰值应变。结果 B组各心肌节段及整体纵向收缩期峰值应变(LS)均显著低于正常组及A组,(P<0.01);左心室短轴切面A组3个短轴水平径向收缩峰值应变(RS)高于正常组(P<0.01);B组3个短轴水平RS明显低于正常组及A组(P<0.01);B组圆周收缩峰值应变(CS)均明显低于正常组及A组(P<0.05)。结论 STI能准确评价高血压患者左心室心肌整体及局部收缩功能的异常,对高血压患者早期左心室收缩功能异常诊断有着重要的临床意义。     

SRI对急性前壁STEMI患者心肌存活的早期预测价值

目的探讨应变率成像（SRI）对急性前壁ST段抬高心肌梗死（STEMI）患者心肌存活的早期预测价值。方法行急诊经皮冠状动脉介入术（PCI）的前壁STEMI患者在术后测量室间隔心尖段的SRI指标,当收缩末期应变（SES）≥-7%时则纳入研究,并于6个月后复查,评价急性期SRI指标对心肌存活的预测价值。结果 46例前壁STEMI患者纳入研究,其中25例在6个月时SES〈-7%,我们定义为存活心肌;21例随访时SES≥-7%,我们定义为失活心肌。存活心肌组SES、收缩后应变（SPS）、收缩期应变率（SRS）及舒张早期应变率（SRE）等指标明显优于失活心肌组（P〈0.01）,而收缩后应变率、舒张晚期应变率两组间无明显差异（P〉0.05）。SRS、SRE、SPS、SES均能预测心肌的存活,其中SRS曲线下面积最大（0.803,P〈0.01）,当临界值取-0.31s-1时,其预测存活心肌的敏感性、特异性、阳性预测值、阴性预测值分别为83%、68%、76%、71%。结论在行急诊PCI的前壁STEMI患者中,SRI技术能早期预测受累心肌的存活性。     

构建急性心肌梗死模型犬梗死区的跨壁力学变化

背景：急性心肌梗死起病急,病情凶险,但目前对超急性期的辅助诊断主要靠心电图,实验主要利用组织多普勒应变成像的优点,对急性心肌梗死的早期诊断提供帮助。 目的：应用组织多普勒应变成像技术观测犬急性心肌梗死前、后心内膜下层心肌、中层心肌、心外膜下层心肌径向峰值应变及应变达峰时间,分析其力学变化特征。 方法：16只Beagle犬,开胸结扎左冠状动脉前降支的第一对角支建立急性心肌缺血模型。同步记录心电图,在组织速度成像模式下,分别在急性心肌梗死前、后采集标准心尖短轴切面的连续5个完整心动周期内的二维动态组织多普勒速度图像,存于TDI-Q工作站。分别观测梗死区缺血前、后局部及心内膜下层心肌、中层心肌、心外膜下层心肌径向峰值应变及应变达峰时间。 结果与结论：急性心肌梗死后,梗死区局部以及心内膜下层心肌、中层心肌、心外膜下层心肌的峰值应变较梗死前明显降低(P < 0.05);梗死区心肌各层次间峰值应变梯度消失;梗死区局部以及各层次心肌达峰时间均较缺血前延长(P < 0.05)。同时观察到梗死区基础状态心内膜下心肌及中层心肌分别与其局部心肌的峰值应变呈正相关(r=0.617,P < 0.01;r=0.556,P < 0.01),而与梗死区则无相关性(r=0.338,P > 0.05;r=0.218,   P > 0.05)。提示急性心肌梗死后,梗死区不同层次心肌间峰值应变梯度消失,局部及不同层次心肌峰值应变明显减低,而达峰时间明显延长,是梗死区心肌结构异常、功能障碍的反映,从而导致心脏整体运动不协调,引起心脏整体的非同步化运动,是触发心力衰竭的重要力学机制之一。 中国组织工程研究杂志出版内容重点：肾移植;肝移植;移植;心脏移植;组织移植;皮肤移植;皮瓣移植;血管移植;器官移植;组织工程全文链接：     

实时心肌声学造影结合多巴酚丁胺负荷试验检测存活心肌的临床研究

存活心肌是心肌缺血后的一种特殊形式，前骆性地检测出存活心肌对冠心病患者临床诊疗决策有重要的意义。理想的评价心肌存活性的方法应能提供准确无创地测量心肌的灌注、代谢、细胞膜的完整性及收缩功能，但目前临床尚无任何一种检测方法完全满足上述要求。本研究以完全血运重建后室壁节段收缩功能改善为判断存活心肌的金标准，对实时心肌声学造影技术（RT—MCE）结合小剂量多巴酚丁胺负荷试验（LD—DSE）检测存活心肌的临床应用价值作一探讨。     

基于三维斑点追踪成像技术的心肌形变生物力学特征分析——左心室心肌纵向应变

目的 应用三维斑点追踪技术分析冠脉造影正常者心肌纵向应变,探讨该方法可行性的同时了解心肌的形变力学特征.方法 三维斑点追踪技术（three dimensional speckled tracking image,3DT）是基于实时三维超声心动图技术,对全容积实时三维数据进行自动的室壁运动追踪和定量分析的一种新技术.入选冠状动脉造影正常的患者24例,常规超声心动图检查,计算测量左心室内径、容积及功能,应用3DT技术测量左室心肌前间隔、后间隔、前壁、侧壁、下壁、后壁的基底段、中间段及心尖段共18个节段收缩期峰值应变.结果 冠脉造影正常者左室整体运动协调一致,纵向应变为负,收缩期整体峰值应变为-14.27％±4.29％.心尖段峰值应变绝对值最大,基底段最小.心尖段与基底段、中间段各室壁节段纵向峰值应变差异有统计学意义（P＜0.01）,基底段与中间段比较,差异无统计学意义（P＞0.05）.结论 3DT可通过纵向应变评估冠脉造影正常者左心室心肌形变生物力学特征.     

镁剂对急性心肌梗死再灌注损伤的影响

目的评价急性心肌梗死早期镁剂治疗的临床疗效和安全性。方法对132例急性心肌梗死患者随机分为硫酸镁干预组（n=67）和对照组（n=65），干预组在接受溶栓前30分静脉给25％硫酸镁20ml，两组病人均接受静脉溶栓治疗，观察溶栓成功病例（镁剂治疗组n=39，对照组n=36）的心律失常、心肌酶、超声心动图负荷试验心肌顿抑的情况。结果与对照组比较，硫酸镁干预组室性心律失常发生较少（P〈0．02），心肌酶峰值较低（P〈0．001），梗死心肌和顿抑心肌节段较少（P〈0．005），左室收缩功能优于对照组（P〈0．05）。结论镁剂可以减少急性心肌梗死再灌注损伤，可作为急性心肌梗死的辅助治疗手段。     

应变率成像在胎儿房性心律失常诊断中应用的初步探讨

目的探讨应用速度向量成像（VVI）技术对胎儿房性心律失常时心肌结构力学及形变学影响的应变与应变率研究，评价胎儿心律失常时对心肌应激状态、运动传导就及功能的影像。方法对检出的77例胎儿心律失常（其中室上性心动过速（SVT）12例、65例为频发性房性早搏（PAC））进行VVI成像技术分析，检测心律失常时胎儿心肌运动速度向量变化及对应变与应变率影响，对照组80例心率正常胎儿。结果胎儿SVT12例中7例持续发作48h者治疗前心室率250—310bpm，均合并心衰及出现水肿，VVI速度向量振幅明显降低，其应变与应变率明显低于对照组（P〈0．01）；阵发一陛SVT5例VVI速度向量振幅-过性降低，心肌应变与应变率无变化；频发PAC组示早搏时速度向量振幅改变，且运动方向同步，心肌运动三维数据定量可显示旱搏及代偿间期的三维模式，应变与应变率与对照组无差异（P〉0．05）。结论VVI成像通过心律失常心肌结构力学变化解析胎儿心律失常，特别是对胎儿心动过速时的快速心率可进行实时动态分析。及应用M型扫描法确认心动周期使胎儿心肌应变与应变率分析成为可行。     

二维斑点追踪技术评价冠心病患者心肌功能的研究

目的：应用二维斑点追踪成像（ speckle tracking imaging， STI）技术对常规方法显示室壁运动正常的冠心病患者进行定量分析，探讨STI技术用于诊断冠心病的临床应用价值。方法采集经冠状动脉造影证实的50例冠心病和40例对照组患者的心尖长轴、四腔和两腔观的二维灰阶动态图像，测量比较两组各节段纵向收缩期峰值应变（ global longitudinal systolic peak strain， GLPS）及整体纵向平均应变（ GLPS?Avg），应用受试者工作特征曲线（ receiver operating characteristic curve， ROC曲线）评价GLPS?Avg对筛选冠心病的敏感性和特异性。结果冠心病组各节段心肌的GLPS均明显低于对照组，差异性具统计学意义（P＜0?05）。 GLPS?Avg 冠心病组（－15?79％±3?35％）绝对值低于正常组（－19?02％±2?78％）的绝对值，有统计学差异（P＜0?05）。 ROC曲线显示以GLPS?Avg－17?7％作为筛选冠心病的截断值，其诊断敏感性为77?5％，特异性为60?0％，AUC＝0?777。结论 STI作为早期诊断冠心病的指标是可行的。     

对缺血缺氧性脑病新生儿心功能的超声研究

目的运用超声应变率显像(SRI)技术测定缺氧缺血性脑病(HIE)患儿左心室侧壁的位移,以此评价患儿心功能受损情况,及早为临床提供治疗信息。方法选取2009年1月至2011年5月40例HIE新生患儿,按临床轻、中度分级各20例,胎龄37.8～40.9周,平均胎龄39.5周;体质量2.83～3.89kg,平均体质量3.34kg。并选取20例正常出生足月儿做对照组,胎龄38.2～41.1周,平均胎龄40.1周;体质量2.92～3.68kg,平均体质量3.26 kg。分别采集大脑中动脉(MCA)的收缩期峰值血流速度(Vs)、舒张末期血流速度(Vd)和阻力指数(RI);标准四腔心切面,应用应变率技术测量左心室侧壁基底段及中间段的收缩期应变率(SSR)、舒张早期应变率(ESR)、舒张晚期应变率(ASR);二、三尖瓣口血流舒张早期峰值流速(E)、舒张晚期峰值流速(A)及左心室射血分数(LVEF),对所获指标进行定量分析。结果轻度和中度HIE组与正常对照组比较,其MCA血流的Vs和Vd均减低(P<0.01),RI均增加(P<0.05);中度HIE组LVEF较正常新生儿LVEF低,轻度者无明显变化,但两组患儿的左心室壁基底段、中间段位点的收缩期位移低于对照组(P<0.05),差异具有统计学意义。结论超声应变率技术可无创、敏感、准确地评价HIE患儿的心功能变化,为临床提供治疗信息。     

二维斑点追踪成像检测正常人左心室心肌应变

目的 运用二维斑点追踪成像(2D-STI)评价正常人左心室心肌应变.方法 选择50例正常人,其中男性31例,女性19例;年龄48～54岁,平均年龄51.16岁.收缩压为(15.63±1.77)kPa[(117.53±13.30)mmHg],舒张压为(9.87±1.04)kPa[(74.18±7.84)mmHg];心率(...     

Morphometric parameters of the radial neck: an anatomical study

Introduction The purpose of this study was to describe the anatomy of the intramedullary canal of the radial neck for stem design of radial head prostheses. Methods Radial neck measurement was performed from the proximal edge of the radial tuberosity to the distal border of the articular surface on 40 macerated proximal radii using X-rays and Optosil imprints of the intramedullary canal. Radial neck to shaft angle was measured under image intensification. Results The neck length was 13.3 mm (range 8.0–20.0 mm) measured on X-rays and 13.5 mm (range 9.9–18.8 mm) on Optosil imprints. Concerning the neck’s intramedullary canal we obtained a minimum diameter of 9.7 mm (range 6.3–16.4 mm) on X-ray. Corresponding Optosil imprints had a mean diameter of 11.6 mm (range 6.6–18.6 mm) at their proximal end, 10.5 mm (range 5.5–16.3 mm) in the middle and a minimum of 9.8 mm (range 6.0–16.9 mm) at the distal end. Differences between left and right sides were not significant between X-ray and Optosil imprints, nor between left X-ray and right imprints and vice versa at a P-level of 0.001. Radial neck to shaft angle was 167.8° (range 160.5–178°) measured under image intensification at a rotation angle of 58.6° (range 50–70°) supination. Conclusion Geometry of the radial neck’s intramedullary canal has been described for stem design. The minimum diameter was seen at the distal end, just proximal to the radial tuberosity. A forearm rotation of 58.6° to full supination should be considered during implantation of monopolar prostheses. The wide variety of lengths and diameters complicates standard prosthetic design, but ipsilateral and contralateral X-rays can be useful for preoperative stem size calculation.     

Deformation of the dog aortic valve ring during the cardiac cycle

Changes in strain in the line of aortic valve leaflet attachment (aortic ring) were measured during the cardiac cycle by means of an inductive technique. To that purpose coils were sutured to each commissure and base point of the aortic ring, when the animals were on a cardiopulmonary bypass. After bypass and stabilization of the hemodynamic variables changes in the aortic strain were measured at aortic pressures ranging from 4 to 20 kPa. Aortic pressure at the level of the commissure points and left ventricular pressure were measured to assess transvalvular pressure. Commissure strain appeared to depend on aortic and transvalvular pressure throughout the cardiac cycle. At an aortic pressure of 10 kPa (75 mm Hg), the derivative of commissure strain to aortic pressure was found to be 1.9×10^–5±1.2×10^–5 Pa^–1 (mean ±SD). During the ventricular ejection phase commissure strain was 0.04±0.03 higher than during ventricular filling. Maximum variations in basal strain during the cardiac cycle ranged from 0.03 to 0.15. During the ejection phase the basal segments adjoining the myocardium shortened whereas the segment close to the non-contracting anterior mitral valve leaflet lengthened. Strain between a base and a commissure point of the aortic ring were synchronous with the cardiac cycle, but no specific pattern could be found.     

桡动脉血管生物力学性质实验研究

研究了正常国人新鲜尸体桡动脉血管的一维拉伸力学性质，得出了桡动脉血管的破坏载荷、伸长比、Lagrange张应力、Lagrange张应变、Euler应力等数据。以多颈式用最小二乘法对实验数据进行拟合，得出了桡动脉的应力——应变关系表达式及曲线。得出了一些结论。     

Radial strain assessment of the interventricular septum wall by a new technique in healthy subjects

The aim of this study was to design a new approach for the acquisition of regional radial strain from the middle portion of the interventricular septum. We designed and wrote a program in Matlab (computer-assisted method) for use on a personal computer so that the septum thickness throughout the cardiac cycle could be measured instantaneously. Computer-assisted and conventional manual methods were used on the same 2D echocardiography image frames. Then, real-time 2D color Doppler myocardial imaging and conventional 2D imaging of the septum walls of 12 healthy participants at rest using apical four-chamber view were acquired. Wall thickness was measured using both the computerized program and velocity data used for tracking the segment and intensity line profile modification automatically. Then, the radial strain was estimated. Bland-Altman statistical analysis shows good agreement between the computer-assisted method and conventional manual method. The average of the peak and mean radial strains from the mid-septum of 12 healthy participants were 63.5 ± 10.7 and 31.7 ± 7.5%, respectively. We introduced a simple approach that is capable of radial strain estimation of the septum wall, which cannot be measured by current Doppler based methods in echocardiography systems.     

The relation of sulcus nervi radialis with the fracture line of humerus fracture and radial nerve injury

Purpose  Radial nerve is closely in contact with the bone in sulcus nervi radialis (SNR). Location of SNR shows ethnic differences. Radial nerve is a big problem in humerus fractures and its surgery. In this study, we aimed to examine if humerus fractures of this region increases the probability of radial nerve injury. Methods  Total length of humerus and the distance of SNR to proximal and distal anatomical points were measured on 57 human dry cadaver bones. The mean values of these data were calculated. The 58 cases of treated humerus fractures in our orthopedics department, whose radiological film techniques were available, were involved in the study and their measurements were made at the same anatomic reference points, retrospectively. Proximal and distal safe zones to total length ratios of both groups were determined. The ratios of the cases were compared with the confidence intervals of dry bones. Location of the fracture line according to SNR and the relationship between radial nerve injury and this location were evaluated. Results  Sulcus nervi radialis region was located at the middle of humerus. Of 24 cases which had radial nerve injury, only nine cases had fracture of SNR region. Of the 34 cases which had no radial nerve injury, 16 had fracture of SNR region. Conclusions  As a result; radial nerve injury rate was 37.5% for the fractures of SNR region and it was higher compared to other studies. We concluded that the fractures of SNR region do not increase the risk of radial nerve injury.     

Does personal initiative training work as a stress management intervention?

An experimental trial is reported that compares 2 stress management intervention programs and a waitlist control. Both programs involved training in problem-focused strategies of identifying and changing the sources of stress. One of the programs contained additional content on how to display more personal initiative (PI). Both programs involved 2 sessions held 1 week apart, each session lasting 3-4 hr. Strain was measured before training and at 7 and 13 weeks after the initial session. Results show that both programs were effective at reducing strain, whereas the waitlist group showed no change in strain. The PI program increased proactive behavior at 7 weeks as determined by independent evaluations, although the same pattern was not observed for PI self-reports. Proactive behavior did not appear to mediate the effects of training programs on strain.     

婴幼儿桡动脉穿刺的应用解剖学研究

目的：积累婴幼儿桡血管的解剖学资料，为临床婴幼儿桡动脉穿刺提供形态学基础。方法：在20例40侧婴幼儿尸体上肢防腐标本上和32例64侧婴幼儿活体上肢上，分别解剖和超声观测桡动脉、桡静脉和桡神经浅支的位置关系及血管的内径。结果：（1）桡动脉两侧有伴行桡静脉，桡神经浅支偏向桡动脉的外侧；超声诊断仪显示桡动脉、桡静脉无重叠现象。（2）桡动脉在前臂前区下1／3部变浅，可供穿刺的桡动脉暴露长度为（50．6±5．1）mm。（3）桡动脉、桡静脉的内径18～24月龄及25～36月龄分别为（1．43±0．08）mm、（1．52±0．07）mm及（0．78±0．07）mm、（0．87±0．12）mm。（4）皮肤表面距桡动脉前壁的深度18～24月龄及25～36月龄分别为（5．21±0．19）mm及（5．54±0．19）mm。结论：穿刺部位宜选在桡动脉暴露段上1／3处。