心内组织多普勒超声显像标测心脏传导系统心肌兴奋心肌电和机械兴奋多参数显像

目的 探讨高分辨力心内超声组织组织勒显像技术标测心脏传导系统心肌电兴奋诱导心肌收缩的可行性和应用范围。方法 用5条狗开胸模型,通过11F血管鞘从右颈内静脉或股静脉插入10F心内超声导管分别置留于上腔静脉、右心房和右心室,刺激电极随机置入心室壁内（心外膜下心肌和心内膜下心肌）,应用二维灰阶超声观察并测量窦房结、右心房壁、房室交界区,室间隔和左心室游离壁的解剖结构;采用心内超声组织多普勒显像技术获取窦性心律上述各点的二维、M型心肌速度和加速度图像;在心室起搏时记录心肌速度和加速度起始的分布,其心肌机械兴奋的空间部位和时相分别与刺激电极的部位与电刺激时相比较。结果 心内起声清晰显示窦房结、心房壁、房室交界是区和室室间隔及心室游离壁的细微解剖结构。心电图P波起始后,窦房结区域内速度和加速度明显增高,窦性尽律心房壁心肌收缩和舒张期为均匀一致速度和加速度分布,心电图P-R间期内,房室交界区心肌速度或加速度增高起始于其上部并向下分布传导至室间隔上部,心电图QRS波起始处,室间隔内心肌速度和加速度分布呈“Y”字形,人工电刺激诱导心肌速度和加速度增高的起始点位于电刺激局部,直径小于5mm;心肌机械收缩延迟小于7 s(帧频为140帧/s）;心室壁内心肌速度和加速度传播分布呈同心圆状。结论 心内超声组织多普勒显像技术能够实时同步精确标测心脏传导系统解剖和与电活动相关的心肌机械运动,此超声成像技术对心律扮演的诊断和治疗具重要潜在影响。有助于准确指导心脏介入治疗,观察心室壁内心肌速度和加速度时间顺序的分布和大小变化,有可能提示心室心肌纤维的结构和功能。     

心脏超声的诊断进展

一、目前心脏超声诊断的常规方法(一)M型超声心动图(下简称“M型”)M型系一维的,可获得心脏某一局部结构的动态图像。系利用单探头发出一条声束,投射到心脏不同声阻的组织介面而产生的一系列反映心脏不同介面和深度的回声图像。     

改进的解剖M型超声心动图对左室短轴局部心肌运动速度的评价

目的了解应用改进的解剖M型超声心动图技术评价局部心肌运动速度的可行性。方法随机选取40例正常人和25例扩张型心肌病(DCM)心衰患者,应用改进的解剖M型超声对胸骨旁左室短轴切面三个水平的前间隔和后壁的收缩期、舒张早期及舒张晚期的峰值速度(即S峰、E峰、A峰)分别进行采集和测量。并在组织多普勒超声定量组织速度成像模式(QTVI)下,分别检测相应的峰值速度,比较两种技术在测量相同部位和时相峰值速度的差异及相关性。同时应用改进的解剖M型技术对短轴同一平面(乳头肌水平)各个节段局部心肌的三个时相运动速度进行比较。再由两个检测者应用此技术在双盲条件下,对乳头肌水平部分峰值速度进行重复性检验。结果改进的解剖M型超声测值与组织多普勒测值较接近,但前者多数略高于后者。一致性检验显示,在正常组和DCM心衰组有部分数据两种技术的测值差异具有统计学意义(P<0.05)。相关性分析显示,两种技术检测结果相关性好。应用改进的解剖M型技术对同一平面各个节段局部心肌运动速度进行比较,仅在小部分峰值速度略有差异。两个检测者的重复性检验结果未见统计学差异(P>0.05)。结论改进的解剖M型超声在评价心肌局部运动方面是一种可行的、有待开发完善的新技术。     

肺心病的超声诊断及其评价

从前,以慢性阻塞性肺病(COPD)为首的呼吸系统疾病患者,由于肺气肿很难用探头置于胸骨左缘的超声心动图检查心脏.但     

骨骼肌内良性病变的超声研究

目的 探讨超声在骨骼肌良性病变中的术前定性、定位价值。方法 用声像图观察35例患者骨骼肌内有无肿块以及肿块的大小、边界、形态,并用彩色多普勒血流显像观察其病灶内的血流情况。结果 根据骨骼肌内病变的声像图特征将本组患者的声像图大致分为3大类：①囊性回声型;②混合回声型;③实性团块型。超声对骨骼肌内良性病变的定位正确,且对肿块的定性正确率可达97％。结论 超声检查是发现骨骼肌内良性病变比较好的方法,可以为临床医师的术前定位、定性提供参考。     

心脏电机械标测与核素心肌显像评估急性心肌梗死患者存活心肌的比较

目的：比较心脏电机械标测系统(electromechanieal mapping，NOGA^TM)、核素心肌显像和超声心动图在评估急性心肌梗死患者存活心肌状况的作用。方法：选择2003-01／04南京医科大学附属南京第一医院心内科住院并符合纳入标准的急性心肌梗死患者5例，均为男性，平均年龄(56&;#177;3)岁。急诊经皮冠状动脉腔内成形术后第7天分别进行NOGA^TM系统、心脏超声及核素心肌显像测定。结果：NOGA^TM系统测定出梗死区域的单极电压(unipolar voltage potenrims，UVP)[(5．8&;#177;2)mV]显著低于非梗死区域的心肌[(11．9&;#177;3)mV，P&;lt;0．01]，同时测得梗死区域心肌的内膜下心肌短缩率(linear local shortening，LLS)[(0．7&;#177;0．2)％]明显小于非梗死区域心肌[(11．2&;#177;4)％，P&;lt;0．01]。特征性曲线分析NOGA^TM判断心肌存活状态的UVP界定值为8．0mV(敏感性及特异性均为88％)。结论：LLS与心脏超声相关性良好，当UVP≥8．0mV时提示心肌处于存活状态。     

心脏电机械标测与核素心肌显像评估急性心肌梗死患者存活心肌的比较

目的:比较心脏电机械标测系统(electromechanicalmapping,NOGA)、TM核素心肌显像和超声心动图在评估急性心肌梗死患者存活心肌状况的作用。方法:选择2003-01/04南京医科大学附属南京第一医院心内科住院并符合纳入标准的急性心肌梗死患者5例,均为男性,平均年龄(56±3)岁。急诊经皮冠状动脉腔内成形术后第7天分别进行NOGATM系统、心脏超声及核素心肌显像测定。结果:NOGA系统测定出梗死区域的单极电压(unipolarvoltagepoten-TMtials,UVP)犤(5.8±2)mV犦显著低于非梗死区域的心肌犤(11.9±3)mV,P<0.01犦,同时测得梗死区域心肌的内膜下心肌短缩率(linearlocalshortening,LLS)犤(0.7±0.2)%犦明显小于非梗死区域心肌犤(11.2±4)%,P<0.01犦。特征性曲线分析NOGATM判断心肌存活状态的UVP界定值为8.0mV敏感性及特异性均为88%。()结论:LLS与心脏超声相关性良好,当UVP≥8.0mV时提示心肌处于存活状态。     

超声心动图评价慢性肾脏疾病患者的左心室功能

目的：采用超声心动图技术,尤其是组织多普勒显像（TDI）技术,评价不同阶段慢性肾脏疾病（CKD）患者的左心室（LV）收缩及舒张功能。方法：根据Cockroft-Gault公式所计算的校正肌酐清除率（CCr）,将54例CKD患者分为2组。第1组为CKD早、中期组（CCr〉29mL/min）,第2组为CKD晚期组（CCr≤29mL/min）;另选择27名健康对照者作为第3组。所有研究对象均接受常规UCG和TDI检查,观察TDI评估LV功能的价值。结果：与第3组相比,第1组和第2组的二尖瓣环舒张早期峰值速度（Em）显著降低（P均〈0.01）,第3、1、2组分别为（8.2±1.3）cm/s、（5.5±1.8）cm/s和（5.3±1.7）cm/s;第1组、第2组舒张早期与晚期峰值速度之比（Em/Am）均显著降低（P均〈0.01）,分别为（1.3±0.3）、（0.8±0.3）和（0.8±0.4）。第1组、第2组左心房均显著增大（P均〈0.01）,第3、1、2组左心房内径依次为（34.2±3.3）mm、（39.3±4.2）mm和（39.0±7.0）mm;左心室质量指数（LVMI）显著增高（P均〈0.01）,依次为（65.9±11.4）g/m^2、（97.6±26.9）g/m^2和（116.0±42.2）g/m^2。结论：早、中期CKD患者在LV收缩功能未显著降低时已存在舒张功能异常,超声心动图检查尤其是TDI技术有助于早期检出这些心脏改变。     

灰阶超声造影定量分析骨骼肌血流灌注的实验研究

目的 探讨灰阶超声造影在定量分析四肢骨骼肌血流灌注的应用价值.方法 应用自制超声造影剂及脉冲反向谐波造影技术对8只正常雄性新西兰大白兔下肢骨骼肌组织进行超声造影及定量分析.结果 造影剂剂量为0.05～0.6ml/kg时,骨骼肌显像良好,除50%清除斜率外,其造影开始增强时间、绝对峰值强度、上升支斜率、降支减半时间在各剂量组与肌内动脉主干造影参数比较均差异显著(P＜0.05).剂量为0.8 ml/kg和1.0ml/kg时,增强峰值后出现短暂的声衰减.在剂量0.025～0.6ml/kg范围内,骨骼肌开始增强时间、绝对峰值强度和降支减半时间与造影剂剂量呈直线相关(r=-0.9032,P＜0.01;r=0.9882,P＜0.01;r=0.9718,P＜0.01),上升支斜率,50%清除率与剂量无相关关系(r=0.6774,P＜0.05;r=0.6845.P＞0.05).结论 灰阶超声造影可用于骨骼肌血流灌注的定量研究,定量分析时应注意造影剂剂量及肌内动脉主干血流对结果的影响.     

应用组织多普勒显像技术测定飞行人员左室舒张功能

多普勒组织成像（Doppler tissue imaging，DTI）又称多普勒心肌成像（Doppler myocardial imaging，DMI），是近年来开发的一项超声心动图新技术，可选择性地实时显示心肌运动的方向与速度，弥补了传统二维及M型超声心动图的一些局限，为定量分析心肌运动及功能提供了新的方法。初步研究表明，DTI对冠心病的无创诊断具有较大潜力，应用前景较为乐观。     

剪切波弹性成像评估骨骼肌生物力学特征的应用进展

剪切波弹性成像作为一种经济、无创、精确定量的影像学方法,可以评估健康及疾病状态下的骨骼肌生物力学特征,为疾病的诊断提供可靠参考。本文就剪切波弹性成像的基本原理和其在骨骼肌力学特征的评估应用、局限性及进展进行综述。     

超声多普勒对颈总动脉云雾样声像的临床研究

目的探讨颈总动脉（CCA）云雾样声像（CUI）的血流动力学特点，以此论证其性质。方法将原发性高血压患者和正常人双侧CCA内CUI观察区限于分叉部以下长约3～4cm，高频超声在其两端分别测量上游最大流量（UFQ-max），下游最大流量（DFQmax），二者差值为最大返流量（RQmax）；返流最大截面积（RAmax）和对应2D截面积（Acui）；偏离轴心流体（DAVF）最大流速至轴心距离（r—a）。结果原发性高血压组（观察组）CUI内返流频谱特点呈脉动流模式，两组RQmax、Acui、RAmax及r—a值比较差异有非常显著性（P〈0．01），观察组RQmax与r—a值相关性好（P〈0．05）。结论观察组CUI所致血流动力学改变符合达西定律，其CUI充当了多孔介质。     

1例右侧肛提肌乳腺型肌成纤维细胞瘤多模态超声表现

<正>患者女,45岁,2个月余前发现外阴右侧3.0cm×2.0cm包块,无疼痛;既往体健。查体：于右侧大阴唇下份近肛门处扪及直径约2.0cm包块,质韧,活动度好,无明显触痛及压痛。实验室检查未见明显异常。盆腔CT：阴道右侧坐骨海绵体肌内2.6cm×2.3cm×2.0cm较均匀稍低密度包块,增强扫描动脉期轻度、静脉期明显强化（图1A）;提示肿瘤性病变,考虑前庭大腺来源可能。超声：会阴部右侧2.7cm×2.4cm×2.1cm稍低回声包块,形态规则,边界清,其内回声不均匀,与右侧肛提肌关系密切;     

Differences in heparin-released lipolytic activity in the superficial and deep veins of the human forearm

Various doses of heparin were given as a single injection into the brachial artery of each of twelve fasting healthy males. Plasma lipolytic activity was measured in samples obtained before and at frequent time intervals after heparin injection, in the artery and the deep and superficial veins of the same forearm. As little as 0.15 U heparin produced a rapid and detectable release of lipolytic activity in both deep and superficial veins. A series of tenfold increases in the dose produced correspondingly greater releases in the veins but the increments in the release were smaller than the increments in the dose. Three repeated 15 U doses of heparin, separated by 30 min, in the same subject gave a high degree of reproducibility of the release of lipolytic activity in both deep and superficial veins. 90% of the lipase activity in the vein was inhibited by 1 M NaCl. In all subjects the release of lipolytic activity was higher in the deep vein, which predominantly drains muscle, than in the superficial vein, which drains mostly subcutaneous tissues such as skin and adipose tissue. This indicates that muscle is a tissue of considerable importance as a source of post heparin plasma lipolytic activity.     

Ultrasound Imaging of Muscle Contraction of the Tibialis Anterior in Patients with Facioscapulohumeral Dystrophy

A need exists for biomarkers to diagnose, quantify and longitudinally follow facioscapulohumeral muscular dystrophy (FSHD) and many other neuromuscular disorders. Furthermore, the pathophysiological mechanisms leading to muscle weakness in most neuromuscular disorders are not completely understood. Dynamic ultrasound imaging (B-mode image sequences) in combination with speckle tracking is an easy, applicable and patient-friendly imaging tool to visualize and quantify muscle deformation. This dynamic information provides insight in the pathophysiological mechanisms and may help to distinguish the various stages of diseased muscle in FSHD. In this proof-of-principle study, we applied a speckle tracking technique to 2-D ultrasound image sequences to quantify the deformation of the tibialis anterior muscle in patients with FSHD and in healthy controls. The resulting deformation patterns were compared with muscle ultrasound echo intensity analysis (a measure of fat infiltration and dystrophy) and clinical outcome measures. Of the four FSHD patients, two patients had severe peroneal weakness and two patients had mild peroneal weakness on clinical examination. We found a markedly varied muscle deformation pattern between these groups: patients with severe peroneal weakness showed a different motion pattern of the tibialis anterior, with overall less displacement of the central tendon region, while healthy patients showed a non-uniform displacement pattern, with the central aponeurosis showing the largest displacement. Hence, dynamic muscle ultrasound of the tibialis anterior muscle in patients with FSHD revealed a distinctively different tissue deformation pattern among persons with and without tibialis anterior weakness. These findings could clarify the understanding of the pathophysiology of muscle weakness in FSHD patients. In addition, the change in muscle deformation shows good correlation with clinical measures and quantitative muscle ultrasound measurements. In conclusion, dynamic ultrasound in combination with speckle tracking allows the study of the effects of muscle pathology in relation to strength, force transmission and movement generation. Although further research is required, this technique can develop into a biomarker to quantify muscle disease severity.     

Increase of the lipoprotein-lipase activity in human skeletal muscle during clof ibrate administration

Lipoprotein-lipase activity was determined in tissue from the skeletal muscle of the leg and the subcutaneous adipose tissue of the abdomen in fourteen patients before and after 1 month of clofibrate administration. The concentrations of serum triglycerides decreased by, on the average, 37% in a group of thirteen patients which mainly consisted of subjects with type-IV hyperlipoproteinaemia. Clofibrate administration was associated with an average increase of the skeletal muscle-tissue lipoprotein-lipase activity of 50% (P less than 0.005). There was a significant correlation between the percentage changes in skeletal muscle-tissue lipoprotein-lipase activity and those of the triglycerides concentrations and the K2-values in an intravenous fat tolerance test during clofibrate treatment. Adipose-tissue lipoprotein-lipase activity did not change significantly. One patient with type-I hyperlipoproteinaemia had very low values of skeletal muscle-tissue lipoprotein-lipase activity and moderately low adipose-tissue lipoprotein-lipase activity. In this patient, neither the tissue lipoprotein-lipase activity nor the triglycerides concentration changed during clofibrate therapy. Fasting serum insulin concentrations decreased significantly during clofibrate administration and the percentage decrease was significantly correlated to the percentage increase of skeletal-muscle lipoprotein-lipase activity. It is suggested that the lowering of insulin levels is a possible mechanism through which glucagon activity is enhanced and this may increase skeletal muscle-tissue lipoprotein-lipase activity.     

Pressure pain threshold mapping of the trapezius muscle reveals heterogeneity in the distribution of muscular hyperalgesia after eccentric exercise

This study aimed at investigating in details the spatial characteristics of muscular hyperalgesia after development of delayed onset muscle soreness (DOMS) in the trapezius muscle. High density pressure pain mapping consisting of 36 pain pressure threshold (PPT) recording points were assessed over the trapezius muscle from 20 subjects. PPT were recorded before, immediately after and 24 h after eccentric exercise/rest for the exercise group (N = 10) and the control group (N = 10). A 36 points geometric grid was used on both the exercise and control groups. The eccentric exercise used to elicit DOMS consisted of 50 contractions against a downward pressing force at 100% maximum voluntary contraction in bouts of 10 contractions followed by 2 min break. For the exercise group, PPT values decreased significantly over time for all points (P < 0.001) but not for the control group. At baseline, both muscle belly sites and upper part of the trapezius were more sensitive than muscle belly sites and middle and lower parts (P < 0.001 for both). The hyperalgesia was also mostly developed in the muscle belly sites (P < 0.001), further enhancing its position as the most sensitive part of the muscle. The present results showed the topographical distribution of pressure pain sensitivity over the trapezius muscle and also that hyperalgesia developed in a heterogeneous manner over the trapezius muscle in response to eccentric exercise underlining sensory partitioning of the muscle. The technique of high density pressure pain topographical mappings can be helpful in characterizing muscle hyperalgesia and its heterogeneity.     

运动对2型糖尿病大鼠骨骼肌细胞腺苷酸活化蛋白激酶表达和活性的影响

目的观察运动对正常大鼠和2型糖尿病大鼠骨骼肌中腺苷酸活化蛋白激酶（AMPK）的蛋白表达和活性的影响。方法采用OLETF大鼠作为2型糖尿病组，LETO大鼠作为正常对照组，并分别随机分为2组，即运动组和对照组，每组5只。运动组进行急性游泳运动3h后，采用Western blot法对大鼠比目鱼肌和趾长伸肌中AMPK蛋白进行检测。结果OLETF大鼠和LETO大鼠的比目鱼肌和趾长伸肌中AMPKα蛋白表达和磷酸化均无明显差异（P〉0．05）；OLETF大鼠和LETO大鼠在急性运动3h后，趾长伸肌中AMPKαThr^172。磷酸化明显高于对照组（P〈0．05），比目鱼肌中AMPKα蛋白表达和Thr^172。磷酸化则无明显变化（P〉0．05）。结论AMPKα的表达和激活在2型糖尿病大鼠比目鱼肌和趾长伸肌中无缺陷，AMPK对运动的反应在不同肌纤维类型中存在差异，AMPK可能参与了快肌（趾长伸肌）中运动所引发的信号传导机制。     

The ultrasonic evaluation of skin thickness in scleredema

The skin thickness in a group of patients with scleredema was measured using ultrasonic techniques and then compared with a group of normal individuals. The mean dermal thickness in scleredema was 7.7 mm, compared to 3.3 mm in the normal control group. Ultrasonic evaluation of skin thickness may be of value in following the natural history or response to therapy of certain diseases that affect dermal thickness.     

The ultrasonic appearance of the umbilical cord.

We have used a combination of linear-array real time and contact sector scanning to image the umbilical veins and arteries. The best images are made perpendicular to the cord. The arteries spiral the vein and the cord is a tortuous structure. Thus there is considerable variability of the appearance of the arteries and veins depending upon the plane of the section.