多普勒组织声像图对冠心病室壁运动的评价

目的　运用多普勒组织成像技术 (DTI)观察冠心病病变节段收缩波特征。方法　用DTI检测经冠脉造影确诊的 2 8例冠心病患者 (其中 15例心肌梗死 )室壁运动频谱。结果　心肌缺血段 :收缩波速度降低 ;心肌坏死段 :收缩波速度明显降低 ,可有时相缩短或延迟 ;也可有频谱紊乱 ,各波群难以区分 :收缩波也可出现负向。结论　多普勒组织成像技术 (DTl)可作为直观、有效、可靠的反映冠心病病变节段收缩波特征。     

PWDTI对急性心肌梗死不同方案治疗后局部室壁运动的评估

目的应用脉冲组织多普勒成像技术(pulse-wave doppler yissue imaging,PWDTI)评价急性心肌梗死(acute myocardial infarction,AMI)不同治疗方案后局部室壁功能的变化情况。方法 AMI 患者72例,分为3组,经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)组30例,溶栓组27例,保守治疗组15例。采用PWDTI 定量测定患者治疗一周时局部室壁运动速度同时结合常规16节段超声心动图资料,并在梗死后1个月及3个月进行随访。结果 72例中共出现异常室壁运动节段382个,3组间异常室壁节段,PCI 和溶栓组在1周时收缩波峰速度(peak systolic velocity,Vs),收缩波加速度(acceleration of S wave,ACCs)及舒张早期峰速度/舒张晚期峰速度(E/A)均高于保守治疗组,在治疗后1个月到3个月时 Vs、收缩波时间速度积分(systolic velocity-timeintegral,VTIs)、ACCs 及 E/A 明显高于保守治疗组,但 PCI 组各项指标与溶栓组比较无统计学差异。结论PWDTI 评估 AMI 不同治疗对心脏局部室壁功能的影响,提示 PCI 或溶栓治疗优于保守治疗。     

多普勒组织成像测定二尖瓣环运动速度评价急性心肌梗死后患者左心室功能

目的 :应用多普勒组织成像 (DTI)技术测定二尖瓣环运动速度 ,定量分析急性心肌梗死后患者左心室收缩和舒张功能。方法 :研究对象为 6 1例确诊首次急性心肌梗死的患者和 2 0例正常人。常规行超声心动图检查及DTI技术测定二尖瓣环运动速度频谱。记录心尖四腔、心尖二腔和心尖长轴切面多普勒组织成像二尖瓣环运动速度。测定二尖瓣环运动速度参数包括 :二尖瓣环收缩速度 (Sm) ,二尖瓣环舒张早期速度 (Em) ,二尖瓣环舒张晚期速度 (Am) ,二尖瓣环舒张早期速度的比值 (E Em)。结果 :与对照组相比 ,急性心肌梗死后患者DTI可敏感地显示出二尖瓣环收缩和舒张运动速度显著下降(P <0 0 5 ) ;E Em也有显著差别 (P =0 0 13)。DTI二尖瓣环收缩速度与二尖瓣环舒张早期速度之间 ,二尖瓣环收缩速度与左心室射血分数和室壁运动积分之间存在显著的相关性。平均二尖瓣环收缩期速度≥ 8 9cm s预测射血分数 (EF)≥ 5 5 %的敏感性、特异性分别为 88 2 %、70 % ,准确率为 81 5 %。结论 :DTI测量二尖瓣环运动速度 ,作为定量检测急性心肌梗死患者近期心脏功能状态的新方法 ,具有一定的应用价值。     

急性心肌梗死后近期二尖瓣环运动速度的测定

目的:应用多普勒组织成像(DTI)测定二尖瓣环运动速度,定量分析急性心肌梗死(AMI)后近期患者的左室收缩和舒张功能。方法:研究对象为68例确诊首次AMI的患者和22例正常人。所有患者于发病后第3天、出院前、发病后4周、发病后12周,行常规超声心动图检查及DTI测定二尖瓣环运动速度频谱。结果:68例患者中有56例患者完成了12周的随访。随访的12周内,患者二尖瓣环收缩期运动速度(Sm)、二尖瓣环舒张早期运动速度(Em)始终低于对照组;除AMI后第3天以外,患者的二尖瓣环舒张晚期运动速度(Am)始终低于对照组、E/Em始终高于对照组。AMI后12周时的Sm、Em及Am均低于AMI后第3天水平(均P<0·05)。结论:DTI测量二尖瓣环运动速度,可作为定量检测AMI患者近期心脏功能状态的一种方法,具有一定的应用价值。AMI患者近期组织多普勒参数的变化需进一步研究。     

心肌内控制释放bFGF血管再生治疗对急性心肌梗死犬心脏局部功能的影响

目的 :采用超声心动图评价心肌内控制释放碱性成纤维细胞生长因子 (bFGF)的血管再生治疗对急性心肌梗死 (AMI)犬局部收缩与舒张功能的影响。方法 :18只成年健康杂种犬于麻醉开胸后暴露心脏 ,结扎左前降支 (LAD)制作AMI模型。动物平均分为 3组 ,单纯心肌梗死 (MI)组 ,直接关胸 ;激光心肌血运重建 (TMR)组 ,于AMI 30min后行透壁心肌打孔 ;bFGF组 ,则于AMI 30min后行非透壁心肌打孔 ,并随后向孔道内注射含有bFGF的纤维蛋白胶 (FG)。 8周后行超声心动图检查评价局部收缩与舒张功能。结果 :与MI组相比 ,TMR组和bFGF组室间隔和 (或 )左心室前壁的局部室壁增厚率 (△T % )更大 ,局部半轴缩短率 (△H % )更高 ,左室前壁的运动幅度 (MA)更大 (均P <0 .0 5 )。而与TMR组相比 ,bFGF组室间隔与左室前壁的△T %更大 ,左室前壁的MA更大 (均P <0 .0 5 )。另外 ,采用组织多普勒成像 (DTI)技术评价左心室前壁局部舒张功能发现 ,bFGF组的左室前壁运动频谱E/A比值明显高于MI组 ,而TMR组与MI组相比无明显差异。结论 :采用FG在心肌内控制释放bFGF的血管再生治疗能显著改善犬AMI局部的收缩与舒张功能 ,其疗效明显优于TMR。     

急性Q波性和非Q波性心肌梗死后存活心肌及其对晚期血运重建术后心功能的影响

目的:比较急性Q波性心肌梗死(QMI)和非Q波性心肌梗死(NQMI)患者临床和冠状动脉病变特征以及梗死相关区域存活心肌的情况,并随访观察其对心肌梗死晚期血运重建术后心功能的影响。方法:连续收集121例急性心肌梗死(AMI)患者,分为QMI组(79例)和NQMI组(42例)。详细记录和分析所有患者的病史资料。于AMI后2周左右行经皮冠状动脉介入治疗,术前采用小剂量多巴酚丁胺超声负荷试验,检查梗死相关区域存活心肌的情况,并且于术前和术后6个月时常规超声心动图检查左室功能和室壁节段性运动障碍情况。随访6个月内主要心血管事件的发生率。结果:AMI前有心绞痛发作史者和冠状动脉病变血管的数量在NQMI组明显多于QMI组(P<0.05),而梗死相关部位平均管腔残余狭窄以NQMI组明显小于QMI组(P<0.05)。NQMI组中86%的患者有存活心肌,明显高于QMI组(61%)(P<0.01)。术后6个月随访,2组左室射血分数较术前明显提高,左室舒张末期及收缩末期容积指数、室壁运动积分均较术前明显降低(分别为P<0.05和P<0.01),以NQMI组更明显。结论:与QMI相比,NQMI患者有较多的存活心肌;心肌梗死后晚期血运重...     

用多普勒组织显像速度模式评价左心室收缩及舒张功能

目的 :初步评价多普勒组织显像 （DTI）检查左心室收缩和舒张功能的临床应用价值。方法 :用 DTI速度模式检测了正常健康组 114例和左室收缩功能降低 （左室缩短率 FS<2 5 % ）组 40例二尖瓣后叶瓣环位及左室后壁心肌的运动速度。结果 :各参数在正常男女间无显著差异 ,心功能降低组较正常组明显降低 （P<0 .0 1） ;正常组左室后壁心肌收缩速度与 FS间呈正相关 （r=0 .38）。结论 :用 DTI的速度模式检测局部室壁运动速度是评价心室收缩和舒张功能的一种较简便、直观、全面、准确的新方法     

定量组织速度成像与应变率成像评价急性前壁心肌梗死患者心功能的应用价值

目的:观察急性前壁心肌梗死患者心肌速度(V)、应变率(SR)的变化特点,探讨定量组织速度成像(QTVI)及应变率成像(SRI)技术定量评价急性心肌梗死(AMI)患者的左室局部梗死心肌功能的临床应用价值。方法:应用QTVI及SRI对20例AMI患者和30例正常人左室前壁及前间壁节段纵向收缩期(S)、舒张早期(E)及房缩期(A)的峰值速度(VS、VE、VA)、峰值应变率(SRS、SRE、SRA)进行测定,并以冠脉造影结果为标准进行对比分析。结果:VS:AMI组心梗室壁的不同水平均较正常对照组显著性减低;VE:除前间隔的心尖水平外,心梗室壁较正常对照组显著性减低;VA:前壁的不同水平及前间隔的心尖水平AMI组较对照组显著性减低;SRS、SRE:AMI组不同水平左室心梗室壁较对照组显著性减低;SRA:前壁的不同水平及前间隔的基底水平AMI组较对照组显著性减低(分别P<0.01和P<0.05)。结论:QTVI及SRI技术是临床无创、定量评价急性心肌梗死局部心肌功能的有效方法。     

多普勒组织成像检测冠心病患者梗死心肌的研究

目的　测算比较正常室壁心肌和梗死心肌的运动速度 ,评估多普勒组织成像 (DTI)对冠心病梗死心肌的诊断价值。方法　心肌梗死患者 4 6例 ,分成前壁梗死组 2 9例和下壁梗死组 17例 ,健康人 4 8例作对照 ;在心尖左室长轴切面 (alax)上测得室壁节段厚度 ;于心尖四腔心切面(ap4cv)、心尖二腔心切面 (ap2cv)、胸骨旁左室长轴切面(pslax)和alax应用DTI ,按左室壁 16节段 ,测量各室壁节段心肌运动曲线的速度指标 :收缩期峰值运动速度 (Sm) ;舒张早期峰值运动速度 (Em) :收缩期峰值速度梯度 (PVGs) :舒张早期峰值速度梯度 (PVGe) :收缩期跨壁速度梯度 (MVGs) :舒张早期跨壁速度梯度 (MVGe) ,并分别作组间和组内比较。结果　 (1)心梗患者内膜下心肌绝大多数节段性的室壁运动速度降低 ,与对照组存在显著差异 (P <0 0 1或 <0 0 5 ) :(2 )前壁梗死患者前间隔峰值速度梯度 (PVG)与跨壁速度梯度、(MVG)降低 ,中间段明显降低 (P <0 0 1或 <0 0 5 ) ,后壁基底段的MVGs 显著升高 (P <0 0 5 ) ;前间隔PVG、MVG明显小于后壁 (P <0 0或 <0 0 5 ) ;(3)下壁梗死患者各室壁节段舒张早期峰值速度梯度 (PVGe)除后壁基底段外均降低 ;同水平节段内膜下心肌峰值运动速度 (Sm、Em)趋于一致。结论　梗死心肌运动速度明显低于正常     

冠心病患者左心功能的改变

目的:观察不同程度冠心病患者左心功能的变化。方法;78例冠心病患者分成稳定性心绞痛(SA)、不稳定性心绞痛(UA)、急性心肌梗死(AMI)和陈旧性心肌梗死(OMI)4组,并与30例健康成人(对照组)比较。采用无创伤自动检测仪及彩色多普勒血流显像仪测定心功能指标;心排血指数(CI),外周阻力(TPR),左室射血前期(PEP)及左室射血时间(LVET);左室收缩功能:射血分数,每搏量,心搏出量;左室舒张功能:A峰,E峰,峰值速度比值,峰值充盈,标准化充盈速度。结果:AMI和OMI组心功能明显减低(P<0.01):CI减少,TPR增高,PEP延长,LVET缩短,左室收缩功能减弱,舒张功能降低;UA和SA组心功能减低(P<0.05～<0.01);AMI和OMI组比UA和SA组心功能减低有显著差异(P<0.05)。结论;冠心病随病情加重,心功能明显恶化。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.