二维斑点追踪显像技术评估窒息新生儿左心室纵向收缩功能与心肌损害的相关性

【摘要】目的 探讨二维斑点追踪显像技术(2D-STI)评估新生儿窒息合并心肌损害后左心室整体及局部心肌的纵向收缩功能在早期诊断窒息新生儿心肌损害中的临床价值。方法 选择2019年07月至2020年12月期间在右江民族医学院附属医院新生儿科住院的足月窒息新生儿61例，经临床确诊合并心肌损害，根据Apgar评分分为轻度组31例和重度组30例，选择同期住院出生的正常足月新生儿30例作为对照组。检测受检者的血清肌酸激酶同工酶（CK-MB）、肌钙蛋白（cTnT）、左室舒张期前后径（LVDId）、左室射血分数（LVEF）、左室短轴缩短率（LVFS）、辛普森法左室射血分数（Simpson EF）、左室三腔心整体应变（GLS-LAX）、左室四腔心整体应变（GLS-A4C）、左室两腔心整体应变（GLS-A2C）、左室整体应变（GLS-AVG）,分析GLS-AVG和CK-MB、cTnT三者的相关性。结果 三组间CK-MB和cTnT比较差异有统计学意义（P<0.05）。三组间性别、体重、胎龄均无统计学差异（P>0.05）。三组间LVDId、LVEF、LVFS、Simpson EF比较差异无统计学意义（P>0.05）。GLS-AVG与CK-MB呈负性相关（r=-0.515，P=0.000），GLS-AVG与cTnT呈负性相关（r=-0.912，P=0.000）。结论 GLS-AVG与CK-MB、cTnT具有相关性，GLS-AVG可作为窒息新生儿心肌损害早期诊断指标。     

基于弥散张量成像的脑白质微结构分析方法在视路损伤中的应用进展

视觉通路包括视神经、视交叉、视束、视放射及视皮质。常规磁共振检查技术难以发现视路损伤后白质纤维微结构改变,眼科学检查也存在一定的局限性及主观性,且不能探测后视路的变化。弥散张量成像(diffusion tensor imaging,DTI)作为一种新兴的磁共振成像技术,通过各种后处理分析方法结合不同的参数进行分析,可提供组织的微结构信息,并能够直观显示活体白质纤维束,在无创地探索疾病的神经病理机制、评估预后方面起着重要的作用。近年来随着DTI后处理方法的不断创新,其在视路损伤中的研究越来越多。本文在介绍DTI的主要参数及常见脑白质微结构分析方法的同时,阐述了其在视路损伤研究中的应用,并进一步对各种分析方法的优缺点进行总结。     

Multimodal examination of emotion processing systems associated with negative affectivity across early childhood

High Temperamental Negative Affectivity in early childhood has been found to predict later emotion dysregulation. While much work has been conducted to separately probe bio-behavioral systems associated with Negative Affectivity, very little work has examined the relations among multiple systems across age. In this study, we use multi-modal methods to index neurobiological systems associated with Negative Affectivity in 53 4-7-year-old children. Prefrontal activation during emotion regulation was measured using functional near-infrared spectroscopy over the lateral prefrontal cortex (PFC) while children played a game designed to elicit frustration in Social (Happy and Angry faces) and Nonsocial contexts. Gaze behaviors while free-viewing Happy and Angry faces were also measured. Finally, Negative Affectivity was indexed using a score composite based on factor analysis of parent-reported temperament. Using mixed-effects linear models, we found an age-dependent association between Negative Affectivity and both PFC activation during frustration and fixation duration on the mouth area of Happy faces, such that older children high in Negative Affectivity spent less time looking at the mouths of Happy faces and had lower PFC activation in response to frustration (ps<0.034). These results provide further insight to how Negative Affectivity may be associated with changes in affective neurobiological systems across early childhood.     

Visual fixations and visually induced dizziness: An exploratory study

BackgroundVisually induced dizziness can develop as a sequala of a vestibular disorder and is characterized by symptoms of nausea, dizziness, and imbalance in rich visual environments such as supermarkets and shopping malls. To date the mechanisms underlying visually induced dizziness are poorly understood.Research questionWhat are the characteristics of visual fixations and postural sway in adults with visually induced dizziness compared to healthy adults when exposed to increasingly complex visual environments?MethodsWe recruited 20 adults with visually induced dizziness and 20 healthy adults to this cross-sectional exploratory study. Participants were instructed to maintain gaze on letters projected on a large screen with backgrounds of differing visual complexity. The number of visual refixations, movement of the centre of pressure, and movement of the head and body centres of mass were recorded.ResultsAdults with visually induced dizziness showed a significantly higher number of visual refixations (F= 10.592, p < 0.01), and increased mean velocity of head and body centres of mass movement (F= 14.034, p < 0.01 and F= 6.553, p < 0.05 respectively) compared to healthy adults.SignificanceAdults with visually induced dizziness exhibited visual fixational instability and increased postural and head sway compared to healthy adults. This was mainly observed in conditions with complex and moving backgrounds. This may account for reports from adults with visually induced dizziness of worsening symptoms in busy environments. The results from the study may assist in guiding intervention development to reduce symptoms of visually induced dizziness.     

Tissue tracking of segmental strain as a predictor of provoked dynamic left ventricular outflow tract obstruction

BackgroundLeft ventricular outflow tract obstruction (LVOTO) is commonly observed in patients with hypertrophic cardiomyopathy (HCM) or left ventricular hypertrophy (LVH). Some patients develop LVOTO provoked by physical exertion, and hence termed dynamic LVOTO (DLVOTO). However, its precise prevalence and mechanism are still unclear.AimTwo-dimensional speckle tracking echocardiography (2D STE) seems to be helpful for the detection of early LV structural abnormalities. This study aimed to examine the possible role of segmental as well as global longitudinal strain in identifying DLVOTO non-HCM patients as detected by dobutamine stress echocardiography (DSE).Methods and resultsTwo hundred and fifty patients without structural heart disease had undergone conventional transthoracic echocardiography, 2D STE, and DSE. All patients with non-ischemic evidence were divided into two groups according to the DSE results; DLVOTO (+) and DLVOTO (?).Among 250 patients, 50 patients (36%) had shown DLVOTO after DSE (15 males, 35 females; mean age 55±7years). They were compared with 90 non -LVOTO obstruction patients (43 males, 47 females; mean age 57±6years). Based on multivariate logistic regression analysis, the independent predictors of provoked DLVOTO during DSE were resting basal septal longitudinal strain BS-LS _average (p < 0.001), resting LA reservoir strain (p < 0.001), and systolic LVOT diameter (p = 0.03). Resting BS-LS _average with cut-off - 17.5% was recognized as a critical indicator of DLVOTO, with sensitivity 78%, and specificity 95% (better than systolic LVOT diameter of sensitivity 76%, and specificity 15% and resting LA reservoir strain which showed poor AUC at ROC curve 0.007).ConclusionWe demonstrate that provoked LVOTO during DSE in non HCM symptomatic patients is directly correlated to resting regional LS, where the increased BS-LS of ≥ ?17.5% was a key determinant of LVOT gradient provocation. Assessment of baseline BS-LS _average might be a bedside simple tool for detection of patients with DLVOTO not able to do DSE.     

On the body of the consumer: performance‐seeking with wearables and health and fitness apps

Contributing to critical digital health research and the sociology of health consumption, this study investigates the phenomenon of self‐tracking and interpretation of consumer data via wearable technology and mobile fitness software applications (apps). It critically analyses qualitative data collected from members of running communities in the UK who are heavy users of apps and wearables. The study seeks to understand the meaning and practise of long‐term use of apps and wearables targeted at consumers interested in tracking fitness, and the collection of personal health information over time. The paper offers an interpretative perspective on runners as performance‐seeking fitness consumers engaged in long‐term self‐management of health. These consumers are driven by a profound motivation to visualise and embody a long‐term state of fitness. Participants were also hyper‐aware of advertising and promotional methods used to engage consumers. The findings raise concerns about the validity of personal fitness data, and how its collection promises improved personal health while visually promoting sought‐after fit bodies. Further research is required to understand the transformative impact of fitness‐tracking and how individuals negotiate personal classifications of health.     

3D-STI技术联合SYNTAX评分在评价复杂冠心病中的价值

[摘要]目的 探讨实时三维斑点追踪（RT3D-STI）技术联合冠状动脉SYNTAX评分（SS）在评价复杂冠心病患者左室心肌功能中的价值。方法 78例复杂冠心病患者根据SS收集我院拟行冠状动脉造影术（CAG）患者141例，根据CAG影结果分为复杂冠心病组（三支主要冠状动脉和/或左主干狭窄>50%，n=78），非复杂冠心病组（单支/双支主要冠状动脉狭窄>50%，n=30）和对照组（冠状动脉狭窄≤50%，n=33），根据SS将复杂冠心病组分为低分亚组（SS<23，n=26），中分亚组（23≤SS<33，n=25）及高分亚组（SS≥33，n=27）。，应用3D-STI技术获取左心室整体纵向、径向、圆周、三维应变（GLS、GRS、GCS、G3DS）及各节段纵向、径向、圆周、三维应变（LS、RS、CS、3DS），计算平均基底段LS、RS、CS、3DS，中间段LS、RS、CS、3DS，心尖段LS、RS、CS、3DS，行组间比较分析获取相应测值，比较各组间的差异。结果 ①三组间整体、平均节段应变呈减小趋势（P<0.05）。2.三亚组的GLS、GRS、GCS、G3DS呈减小趋势（P<0.05），基底段LS、3DS，中间段LS、RS、CS、3DS，心尖段LS、RS、CS、3DS呈减小趋势LS-BAS、3DS-BAS、LS-MID、RS-MID、CS-MID、3DS-MID、LS-AP、RS-AP、CS-AP、（P<0.05）。②ROC曲线分析示GLS、GCS、GRS、G3DS对不同程度复杂冠心病有一定检测价值，以G3DS及GLS曲线下面积最大。③相关性分析示复杂冠心病组GLS、GCS、GRS、G3DS与冠状动脉SS呈负相关（r=-0.548，-0.366，-0.411，-0.556，P均<0.05）。④重复性检验：3D-STI参数在观察者内及观3DS-AP呈减小趋势（P<0.05）。3.ROC曲线分析：GLS、GCS、GRS、G3DS对不同程度复杂冠心病有一定检测价值，以G3DS及GLS曲线下面积最大。 4.相关性分析：复杂冠心病组GLS、GCS、GRS、G3DS与冠状动脉SS呈负相关（r=-0.548，-0.366，-0.411，-0.556，P均<0.05）。.察者间测量有良好的一致性。结论 RT3D-STI技术可在一定程度上反应复杂冠心病患者的冠状动脉病变程度，联合SYNTAX评分在复杂冠心病的诊断和指导治疗上有一定的积极意义。