实时三维超声心动图评估射血分数减低的左心力衰竭患者的右心室重构

目的 采用单心动周期实时三维超声心动图(sRT-3DE)结合传统二维超声心动图探讨左心室射血分数(LVEF)减低的左心力衰竭患者肺高压(PH)对右心室重构的影响。方法 对sRT-3DE检查LVEF<50%的60例患者(病例组)根据肺动脉收缩压(PASP)及肺血管阻力(PVR)不同分为3个亚组:HF-NPH亚组15例,HF-PPH亚组15例,HF-RPH亚组30例,正常健康人35名为对照组。对两组行常规二维超声及sRT-3DE检查,分析获得三维、二维及多普勒超声参数,进行组间对比分析和相关性分析。结果 与对照组比较:病例组右心室舒张末期容积指数(EDVI)、收缩末期容积指数(ESVI)、基底部横径(D1)、长径(LD)、D1/中间横部径(D2)、射血分数(EF)减小。与HF-NPH亚组比较,HF-PPH亚组右心室ESVI、D1/D2、LD/D2增大。与HF-PPH亚组比较,HF-RPH亚组右心室EDVI、ESVI、D2增大,右心室EF、LD/D2减低。PVR与PASP、右心室EF与左心室EF、右心室LD与左心室LD呈正相关性(r=0.765、0.628、0.725;P均<0.01),PVR与右心室EF呈负相关(r=-0.715,P<0.01),且高于与PASP的相关性(r=-0.623,P<0.01)。结论 sRT-3DE结合传统二维及多普勒超声可准确评估左心力衰竭患者的右心室重构,有助于判断右心室结构和功能状态。     

上腔静脉频谱在评价常压低氧致大鼠肺高压中的应用

目的 探讨上腔静脉（SVC）频谱在评价常压低氧所致大鼠肺高压（PH）中的应用价值。方法 将18只健康成年雄性SD大鼠随机分为PH组（n=12）和对照组（n=6）,PH组采用常压低氧法建立动物模型。对两组大鼠进行超声检查,测量肺动脉内径（PAD）和肺动脉峰值流速（PAV_max）、三尖瓣E峰峰值流速（TVE_max）、S波流速（S）、D波流速（D）、AR波流速（AR）,并计算AR/S和AR/D;采用右心导管测量右心房压力（RAP）、右心室收缩压（RVSP）,肺动脉收缩压（PASP）、肺动脉平均压（PAMP）;取血测量血清NO含量。处死大鼠后取心脏测量右心室肥厚指数,取肺组织进行病理学检查。结果 与对照组比较,PH组RAP、RVSP、PASP、PAMP增高,S波、D波速度减低,AR/D及AR/S升高,差异均有统计学意义（P均<0.05）。RVSP与AR/S、AR/D呈中等和极强相关（r=0.494,P<0.05;r=0.830,P<0.001）,PAMP与AR/D呈强相关（r=0.725,P<0.01）,与AR/S无相关性（r=0.517,P=0.07）。PH组大鼠肺小动脉出现不同程度内中膜增厚,管腔变小,平滑肌增生。两组右心室肥厚指数、体质量及NO含量差异无统计学意义（P均>0.05）。结论 PH时SVC频谱表现为S波、D波降低,AR/S、AR/D增大,且与肺动脉压力密切相关,可作为多普勒超声评价PH的指标。     

实时三维超声心动图评价酒精性心肌病患者右心室收缩功能

目的 应用实时三维超声心动图(RT-3DE)评价酒精性心肌病(ACM)患者右心室收缩功能的变化。方法 对30例ACM患者(ACM组)和30名正常人(对照组)分别进行常规超声及RT-3DE检查。常规超声测量参数包括左心室射血分数(LVEF)、右心室舒张末期面积(RVEDA)和收缩末期面积(RVESA),计算右心室面积变化分数(RVFAC);运用M型超声测量三尖瓣环收缩期位移(TAPSE);RT-3DE测量参数包括右心室舒张末期容积(RVEDV)、收缩末期容积(RVESV)、每搏量(RVSV)、射血分数(RVEF)。比较两组上述参数的差异,分析RVFAC、TAPSE与RVEF的相关性。结果 常规超声中,ACM组RVEDA和RVESA高于对照组,LVEF、RVFAC和TAPSE低于对照组(P均<0.05);RT-3DE中,ACM组RVEDV和RVESV高于对照组,RVEF低于对照组(P均<0.05),两组RVSV无明显差异(P>0.05)。RVFAC、TAPSE均与RVEF呈正相关(r=0.610、0.822,P均<0.05)。结论 RT-3DE能准确评价右心室收缩功能,具有一定临床应用价值。     

XPLANE技术评价经皮介入封堵房间隔缺损前后右心室功能

目的 探讨采用XPLANE技术测量右心室纵向缩短分数（LSF）评估经皮介入封堵（PI）房间隔缺损（ASD）前后右心室功能变化的应用价值，分析及其影响因素。方法 收集68例经超声检查诊断ASD并接受PI患者，分别于术前及术后1、3个月行超声心动图检查，采用XPLANE技术测量并比较其二腔心切面（LSF_AP2）和四腔心切面（LSF_AP4）图像LSF及其均值（LSF_APM）、三尖瓣环收缩期位移（TAPSE）、肺动脉高压（PH）分级、右心室与左心室舒张末期内径比（RVEDD/LVEDD）分级的差异；分析LSF_AP2、LSF_AP4、LSF_APM与TAPSE的相关性及LSF_APM的影响因素。结果 术后1、3个月RVEDD/LVEDD（H=76.07、77.74）及PH分级（H=42.02、49.83）均较术前降低（P均<0.05）。3个时间点之间右心室LSF_AP2、LSF_AP4、LSF_APM及TAPSE差异均有统计学意义（F=6.11、3.18、8.35、20.28，P均<0.05）；术前与术后3个月LSF_AP4、LSF_APM差异无统计学意义（P均>0.05），LSF_AP2、LSF_AP4、LSF_APM及TAPSE两两比较差异均有统计学意义（P均<0.05）。PI前后LSF参数均与TAPSE呈正相关（P均<0.05）。年龄、术前PH分级为LSF_APM的共同影响因素。结论 利用XPLANE技术可有效观察ASD患者PI前后右心室功能变化。PI术后ASD患者右心室形态及功能均获改善，且术前及术后LSF参数与TAPSE变化趋势基本一致。年龄和术前PH分级为ASD患者右心功能的影响因素。     

心血管MR组织追踪技术定量评估肥厚型心肌病右心室心肌应变

目的 探讨心脏MR组织追踪（CMR-TT）技术评价肥厚型心肌病（HCM）右心室功能的可行性及右心室应变与左心室应变的相关性。方法 对32例HCM患者（HCM组）及32名健康志愿者（对照组）行CMR电影序列扫描,测量心功能及左、右心室应变参数。结果 HCM组左心室质量较对照组明显增高（t=11.26,P<0.001）,其余左心功能参数（左心室射血分数、舒张末期容积、收缩末期容积）2组间差异均无统计学意义（P均>0.05）。与对照组比较,HCM组左心室、右心室整体圆周应变（GCS）、整体径向应变（GRS）和整体纵向应变（GLS）均明显减低（P均<0.05）;除左、右心室基底部径向应变外,HCM组各节段局部应变较对照组减低（P均<0.05）。HCM组右心室GRS与左心室GRS呈正相关（r=0.375,P=0.034）,与左心室GLS呈负相关（r=-0.466,P=0.007）;右心室GCS与左心室GCS、GLS均呈正相关（r=0.531、0.462,P=0.002、0.008）。结论 右心室节段应变、整体应变能敏感地反映HCM右心室心肌收缩功能;HCM患者在左心室射血分数减低前左、右心室心肌收缩功能已存在受损;HCM右心室与左心室心肌收缩功能受损存在一定相关性。     

三维超声心动图评价糖尿病患者左心室功能及其与血清学代谢指标的相关性

目的 探讨应用三维超声心动图评价糖尿病患者早期左心室功能改变及其指标与血清学代谢指标的相关性。方法 收集90例2型糖尿病患者[早期糖尿病患者48例（早期糖尿病组）、早期糖尿病肾病患者42例（早期糖尿病肾病组）]和47名健康志愿者（对照组）。以二维超声心动图测量左心室舒张末期内径（LVEDd）、左心室收缩末期内径（LVESd）、二维左心室射血分数（2D-LVEF）、等容舒张时间（TVRT）、二尖瓣口舒张早期血流速度（Ea）、二尖瓣口舒张晚期血流速度（Aa）和E峰下降时间（EDT）,并计算E/E''值及左心室Tei指数;以实时三维超声心动图测量左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）、三维左心室射血分数（3D-LVEF）及左心室心肌层整体纵向应变（GLS）。记录血清胱抑素C、β₂微球蛋白、血肌酐及糖化血红蛋白水平,比较3组间上述指标的差异,并评价超声心动图指标与血清学指标间的相关性。结果 与对照组比较,早期糖尿病组LVEDV、E/E''、Tei指数增高,3D-LVEF及GLS降低（P均<0.05）;早期糖尿病肾病组LVDd、LVEDV、LVESV、Tei指数、E/E''、Aa、IVRT及EDT增高,2D-LVEF、GLS、3D-LVEF及Ea降低（P均<0.05）。与早期糖尿病组比较,早期糖尿病肾病组LVDd、LVEDV、Tei指数、E/E''及EDT增高,GLS及3D-LVEF降低（P均<0.05）。相关性分析显示,血清β₂微球蛋白与Tei指数、LVEDV呈正相关（r=0.732、0.604,P均<0.05）,与GLS呈负相关（r=-0.703,P<0.05）;糖化血红蛋白水平与LVEDV呈正相关（r=0.663,P<0.05）,与3D-LVEF、GLS呈负相关（r=-0.701、-0.742,P均<0.05）。结论 糖尿病患者早期左心室舒张及收缩功能均受损,其左心室功能与血清β₂微球蛋白及糖化血红蛋白水平具有相关性。     

超声血流向量成像联合二维组织追踪技术评价心房纤颤左心房心肌功能及血流能量损耗

目的 应用超声血流向量成像技术（VFM）联合二维组织追踪技术（2DTT）同步评价不同类型心房颤动（AF）患者左心房心肌功能及血流能量损耗（EL）。方法 对45例持续性AF（CAF组）、30例阵发性心房纤颤（PAF组）患者及41例健康志愿者（对照组）测量左心房常规结构及功能参数，采用2DTT技术获取左心房收缩期峰值应变及应变率（SLA_s、SRLA_s）、左心房舒张早期峰值应变及应变率（SLA_ed、SRLA_ed）、左心房舒张晚期峰值应变及应变率（SLA_ac、SRLA_ac）；以VFM技术测量心室收缩期和舒张期左心房整体能量损耗（EL-S、EL-D）；比较3组间各参数差异，分析不同时相EL与左心房结构及功能参数的相关性。结果 ①CAF组SLA_s、SRLA_s和PAF组各时相左心房应变及应变率均低于对照组（P均<0.05）；且CAF组SLA_s、SRLA_s低于PAF组（P均<0.01）；②CAF组和PAF组EL-S、EL-D均低于对照组（P均<0.01）；③各组EL-S与左心房整体排空分数（LATEF）、SLA_s、SRLA_s均呈正相关（r=0.26、0.33、0.19，P均<0.05），与左心房前后径（LAD）、左心房最大容积指数（LAVI_max）、左心房最小容积指数（LAVI_min）均呈负相关（r=-0.34、-0.25、-0.29，P均<0.01）；EL-D与LATEF、SLA_s、SRLA_s均呈正相关（r=0.30、0.38、0.25；P均<0.01），与LAD、LAVI_max、LAVI_min均呈负相关（r=-0.46、-0.36、-0.37，P均<0.01）。结论 各型AF均可致左心房心肌功能及血流能量受损。VFM联合2DTT技术能定量评估不同类型AF患者左心房心肌功能及血流能量损耗。     

时空关联成像-M模式评价胎儿右心室收缩功能

目的 应用时空关联成像-M模式(STIC-M)评价正常胎儿右心室收缩功能。方法 对胎儿正常的150名孕妇进行STIC-M检测,测量胎儿三尖瓣半环平面收缩位移(f-TAPSE);应用体器官计算机辅助分析自动测量技术测量胎儿右心室舒张末期容积和收缩末期容积,计算右心室每搏输出量和射血分数(RVEF),分析胎儿f-TAPSE、孕周、RVEF之间的相关性。结果 f-TAPSE与孕周呈显著正相关(r=0.964,P<0.01),与RVEF之间无相关性(r=0.040,P=0.773);胎儿RVEF相对恒定,不随孕周增加而变化,与孕周之间无相关性(r=-0.231,P=0.310)。结论 STIC-M评价正常胎儿右心室收缩功能简单、重复性好,值得临床推广应用。     

MSCT诊断慢性阻塞性肺疾病合并慢性肺源性心脏病

目的 比较不同严重程度慢性阻塞性肺疾病（COPD）及COPD合并慢性肺源性心脏病患者右心室功能,评价MSCT诊断COPD合并慢性肺源性心脏病的价值。方法 对53例COPD患者（轻中度组13例、重度组22例及合并慢性肺源性心脏病组18例）和36名健康志愿者（对照组）行肺功能和MSCT检查。记录肺功能和右心室功能参数。比较各组右心室功能差异,分析COPD患者肺功能与右心室功能的相关性。分别绘制右心室每搏输出量（SV）、射血分数（EF）的ROC曲线,评价MSCT在COPD合并慢性肺源性心脏病中的诊断价值。以预试验确定的右心室SV<48 ml或EF<40%作为诊断慢性肺源性心脏病的标准,计算诊断敏感度和特异度。结果 4组间右心室舒张末容积（EDV）、EDV/体质量指数（BMI）、SV、SV/BMI及EF差异有统计学意义（P均<0.05）,而收缩末容积（ESV）及ESV/BMI差异无统计学意义（P均>0.05）。COPD患者右心室SV/BMI、EF与第1秒用力呼气容积（FEV1）（r=0.321、0.296,P=0.019、0.031）、第1秒用力呼气容积/用力肺活量（FEV1/FVC）（r=0.305、0.280,P=0.026、0.043）及FEV1占预计值百分比（FEV1%_pred;r=0.457、0.351,P=0.001、0.001）均呈正相关。分别绘制右心室EF、SV ROC曲线,AUC分别为0.973、0.930（P均<0.001）,MSCT诊断慢性肺源性心脏病的敏感度分别为77.77%、77.77%,特异度分别为98.59%、88.63%。结论 COPD患者在未达到慢性肺源性心脏病诊断标准前右心室功能已出现减退,且其肺功能与右心室功能呈正相关。MSCT能早期发现COPD患者右心室功能不全,且对于诊断慢性肺源性心脏病具有重要价值。     

特发性间质性肺炎患者18F-FDG PET/CT与肺功能及炎性指标的相关性

目的 观察特发性间质性肺炎（ⅡP）患者¹⁸F-FDG PET/CT显像与肺功能及实验室炎性指标的关系。方法 回顾性分析20例ⅡP患者（ⅡP组）和20例肺部正常患者（对照组）的PET/CT图像,测量全肺最大标准摄取值（SUV_max）和平均标准摄取值（SUV_mean）,并校正获得最大靶背景比（TBR_max）和平均靶背景比（TBR_mean）,比较ⅡP组与对照组间SUV和TBR的差异,评价ⅡP组TBR与肺功能及炎性指标的相关性。结果 ⅡP组SUV_max、SUV_mean、TBR_max和TBR_mean均显著高于对照组（P均<0.001）。ⅡP组TBR_mean与用力肺活量（FVC,r=-0.811,P=0.004）、肺一氧化碳弥散量（DLCO,r=-0.715,P=0.020）、第1秒用力呼气量（FEV1,r=-0.698,P=0.025）、残气量（RV,r=-0.844,P=0.002）、肺总量（TLC,r=-0.693,P=0.026）及RV/TLC（r=-0.711,P=0.021）呈负相关,与FEV1/FVC（r=0.888,P=0.001）呈正相关。TBR_max与FVC（r=-0.667,P=0.035）和RV（r=-0.643,P=0.045）呈负相关,与DLCO、FEV1、FEV1/FVC、TLC、RV/TLC无明显相关性（P均>0.05）。ⅡP组TBR_max和TBR_mean分别与红细胞沉降率、C反应蛋白均无明显相关性（P均>0.05）。结论 ⅡP患者¹⁸F-FDG放射性摄取增高,其程度与肺功能具有一定相关性。     

儿童遗传性心律失常的诊治进展

回顾在遗传性心律失常领域最新发表的相关研究,主要关注与儿童心源性猝死关系密切的离子通道病,包括长QT综合征（LQTS）、短QT综合征（SQTS）、Brugada综合征（BrS）和儿茶酚胺敏感性多形性室性心动过速（CPVT）,总结它们在发病机制及诊治方面的进展。     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

Organ Preservation: Current Concepts and New Strategies for the Next Decade

SUMMARY: Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years.     

COVID‐19 and COVID‐19 vaccine‐related dermatological reactions: An interesting case series with a narrative review of the potential critical and non‐critical mucocutaneous adverse effects related to virus,therapy, and the vaccination

This narrative review article was conducted to lay out a summarized but exhaustive review of current literature over mucocutaneous manifestations in 4 dimensions of SARS‐CoV‐2 pandemic: virus itself, treatment‐related, vaccine‐induced, and alteration of chronic dermatologic diseases following infection. Virus and vaccine‐related were mainly self‐limited and non‐severe. Treatment‐related reactions could be life‐threatening.     

2017年呼吸疾病主要进展

2017年,国内外学者在呼吸系统疾病的临床和基础领域均进行了深入研究,不仅对相关指南进行了更新,并且针对一些临床热点、难点问题达成专家共识,现就2017年呼吸疾病相关进展作一简单介绍。     

家族性噬血细胞性淋巴组织细胞增生症1例并文献复习

目的加强对家族性噬血细胞性淋巴组织细胞增生症（familially hemophagocytic lymphohistiocytosis,FHL）的认识。方法报道确诊为FHL的新病例1例,结合国内外报道的FHL的病例,对该病的临床特点进行汇总分析。结果FHL2常与PRF1基因突变相关,约20%~40%的患者存在穿孔素基因突变。结论对于有阳性家族史,基因诊断明确,应尽早行化疗或者造血干细胞移植。若无家族史,未发现与继发性HLH相关的原发病因,可考虑行基因筛查以明确是否存在FHL的可能。     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

动态心电图临床操作标准化方法

动态心电图,又称Holter或Holter检查,是一种评价各种心脏病患者心电图异常的简便、高效、准确、安全的无创检查,广泛用于心律失常的相关症状评价,心肌缺血的诊断,心脏病患者的预后和日常生活能力评估,药物疗效评价,起搏器等埋藏式心脏电治疗装置监测等领域。目前动态心电图已广泛用于于临床各级医疗机构,为了更好地发挥其作用,有必要对该项技术进行规范化培训。本文参考相关指南、共识及专家建议,结合作者经验,撰写动态心电图临床操作标准化方法供临床使用时参考。     

Circular RNA hsa_circ_0000285 regulates the microRNA‐599/G‐protein subunit gamma 12 (miR‐599/GNG12) axis to promote glioma progression

ObjectiveGlioma is the most common, rapidly progressing, lethal brain tumor. However, underlying mechanisms behind its abnormal progression remain largely unknown. This study aimed to investigate mechanism of action and effects of the hsa_circ_0000285 on glioma progression.MethodsRT‐qPCR was utilized to study RNA expression in glioma tissues and cell lines. The effects of hsa_circ_0000285 on glioma progression were studied by measuring cell proliferation and migration, apoptosis, tumor volume and weight in both glioma cells and xenograft glioma mice. The features of hsa_circ_0000285 were identified using chromatin fractionation and RNase digestion. Its mechanism of action was analyzed using bioinformatics, RNA‐binding protein immunoprecipitation, and luciferase reporter assay.ResultsWe found glioma tissues and cell lines were overexpressing hsa_circ_0000285. While hsa_circ_0000285 promoted cell proliferation and migration, it inhibited apoptosis in vitro. It also increased tumor volume and weight in vivo. Using bioinformatic analysis and verification experiments for studying its mechanisms, we confirmed that hsa_circ_0000285 sponged miR‐599, which negatively regulated GNG12 by binding to its mRNA.ConclusionHsa_circ_0000285 is overexpressed in the glioma and promotes its progression by directly regulating the miR‐599/GNG12 axis. This novel mechanism, therefore, shows that the hsa_circ_0000285/miR‐599/GNG12 axis may be a promising therapeutic target for glioma treatment.