门控断层心室显像评价右室不同部位起搏患者的同步性

目的 采用平衡法门控断层心室显像（GBPS）比较右室流出道（RVOT）和右室心尖部（RVA）起搏患者的心脏收缩同步性.方法 因三度或高度房室传导阻滞植入起搏器的患者50例,其中RVOT起搏组（A组）23例,RVA起搏组（B组）27例.另取24例初次化疗前肿瘤患者为对照组（C组）,对照组经心脏超声检查证实心脏结构和功能正常,既往无心脏疾病史.3组患者均行GBPS检查,获得相角程（PS）、各壁段平均位相、各壁段平均位相标准差（SD）、室间隔与左室侧壁延迟（LV Sep-Lat Delay）、室间隔与右室延迟（LV Sep-RV Delay）和左右室延迟（LV-RV Delay）等同步性数据,采用单因素方差分析对3组患者心室同步性参数进行比较.结果 A、B组中共分析48例患者.A、B 2组的左室侧壁平均位相均高于C组,分别为（120.50±40.58）ms、（103.23±28.34）ms、（84.63±22.38）ms（F=7.72,P＜0.05）,但A、B 2组间差异无统计学意义（t=1.30,P＞0.05）.右室游离壁平均位相3组间的差异均有统计学意义（F=35.55,P＜0.01）,A组为（137.05±39.27）ms,高于B组的（100.85±23.79）ms和C组的（59.13±30.52）ms.A、B 2组的PS、SD和LV Sep-Lat Delay均高于C组,差异有统计学意义（F=41.54,P＜0.01）,PS：A组（85.73±12.00）°,B组（89.85±15.61）°与C组（58.95±9.87）° SD：A组（27.68±10.66）ms,B组（26.15±13.02）ms与C组（15.63±8.35）ms（F=8.55,P＜0.01） LV Sep-Lat Delay：A组（25.06±34.23）ms,B组（2.62±60.31）ms与C组（-23.66±31.39）ms（F=6.81,P＜0.01）,但A、B 2组间差异无统计学意义（t=0.68,0.68,1.30,P均＞0.05）.A、B、C组间LV Sep-RV Delay[（57.60±56.77）,（6.36±61.88）和（-41.89±35.78）ms]和LV-RV Delay[（47.36±42.59）,（3.08±38.81）和（-26.50±20.99）ms]差异均有统计学意义（F=20.32,25.38,P均＜0.01）.结论 不论是RVA起搏还是RVOT起搏,起搏器植入术后患者心脏均存在节段性位相增加,左室内及双室间同步性均比未植入起搏器差.     

缬沙坦和卡托普利对急性前壁心肌梗死后左室整体及局部收缩功能的影响

Objective To compare the therapeutic effect of angiotensin Ⅱ antagonist (Valsartan)and angiotension-converting enzyme inhibitor (Captopril) for the improvement of left ventricular systolic function(LVSF) after acute myocardial infarction (AMI) at anterior wall. Methods A total of 75 patients with initial AMI at anterior wall were enlisted in the study. Patients were divided randomly into three groups: control group (n = 15), Captopril treated (n =30), and Valsartan treated (n =30). At 1 week and 28 weeks post AMI, the LVSF and left ventricular regional ejection fraction (LrEF) were measured by equilibrium radionuclide angiography (ERNA). The t-test was used to compare the dada. Results ( 1 ) At 28 weeks, left ventricular ejection fraction (LVEF) and left ventricular peak ejection rate (LPER) in Valsartan treated group were significantly increased as compared with those of control: ( 59.4 ± 8.6 ) % vs (44.9 ± 8.4)%, t = 3.87, P ＜ 0.01 for LVEF; (3.89 ± 1.01 ) end-diastolic volume (EDV)/s vs (2.84 ±1.05) EDV/s, t= 4.16, P ＜ 0.01 for LPER). The left ventricular time to peak ejection rate (LTPER) in Valsartan treated group was significantly decreased ( ( 116 ± 16 )ms vs ( 137 ±20) ms, t =2.16, P ＜ 0.05 ) as compared with control. (2)Compared with 1-week, 28-week Valsartan treated group had a significant increase inLrEF2, LrEF4, LrEF5, LrEF6: (71.6±18.8)% vs (57.0±11.4)%, t=2.11, P＜0.05;(78.1 ±16.8)% vs (68.9±21.0)%, t =2.06, P＜0.05; (70.5±16.9)% vs (59.9 ±23.4)%, t=1.99, P ＜ 0.05; and (58.1 ± 9.0) % vs (46.0 ± 18.9) %, t = 2.43, P ＜ 0.05, respectively. Conclusions Valsartan and Captopril are effective for the improvement of LVEF after AMI at anterior wall. The effects of the two drugs are similar.     

磁感应加热和HSV-tk自杀基因及核素内照射联合治疗乳腺癌的实验研究

Objective To investigate the antitumor therapeutic effect of combined therapy of magnetic induction heating by nano-magnetic particles, herpes simplex virus thymidine kinase gene(HSV-tk suicide gene) and internal radiation in mice bearing MCF-7 breast carcinoma. Methods The transfection reagents, plasmids heat shock protein-HSV-tk (pHSP-HSV-tk), ferroso-ferric oxide nano-magnetic fluid flow and 188Re-ganciclovir-bovine serum albumin-nanopaticles (GCV-BSA-NP) were prepared. The heating experiments in vivo were carried out using ferroso-ferric oxide nano-magnetic fluid flow. Sixty mice tumor models bearing MCF-7 breast carcinoma were established and randomly divided into six groups. Group A was the control group, B was gene transfection therapy group, C was hyperthermia group, D was gene transfection therapy combined with radionuclide brachytherapy group, E was gene therapy combined with hyperthermia group, and F was gene therapy, hyperthermia combined with radionuclide brachytherapy group. The tumor growth, tumor mass and histopathological changes were evaluated. The expression of HSV-tk in the groups of B, D, E and F was detected by RT-PCR. Poisson distribution and one-way analysis of variance (ANOVA) were used for statistical analysis by SPSS 10.0 software. Results In the animal heating experiments, the temperature of tumor increased up to 39.6 ℃, 43.2 ℃, and 48.1 ℃ quickly with different injected doses (2, 4 and 6 mg respectively) of nano-magnetic particles and maintained for 40 min. The temperature of tumor tissue reduced to 36.8 ℃, 37.5 ℃ and 37.8 ℃ in 10 min when alternating magnetic field (AMF) stopped. The tumor mass in Groups C ((452.50 ±30.29) mg), D ((240.98 ±35.32)mg), E((231.87 ±27.41) mg) and F ((141.55 ±23.78) mg) were much lower than that in Group A ((719.12±22.65) mg) (F=800.07, P＜0. 01), with the most significant treatment effect in Group F.The tumor mass in Group B((684.05 ±24.02) mg) was higher than that in Group D (t =32. 805, P ＜0. 05). Semi-quantitative RT-PCR analysis showed that the expression of HSV-tk in Groups B and D (0.33 ±0. 13 and 0. 46 ±0.12) was significantly different from that in Groups E and F (0.66 ±0.13 and 0.74 ±0. 11)(F = 21. 573, P ＜ 0.05). Conclusion Combined use of hyperthermia, gene therapy and radionuclide brachytherapy could effectively depress the growth of MCF-7 breast carcinoma, thus possessing treatment potential for this tumor.     

不同镇痛方式对下肢骨折手术患者应激反应及焦虑状况的影响

Objective To observe the effect of different analgesic methods including patient controlled epidural analgesia (PCEA) and patient controlled intravenous analgesia (PCIA) on stress response and anxiety in surgical patients with lower limb fracture. Methods A total of 120 surgical patients with lower limb fractures were employed and divided randomly into Groups PCEA, PCIA and C (40per group). All patients were anaesthetized by using combined spinal-epidural anesthesia. After operation, PCEA and PCIA were applied in the patients of Groups PCEA and PCIA, respectively. No analgesic method was employed in the Group C. The dynamic indices including mean blood press (MAP) and heart rate (HR), blood serum cortisol (COR) and blood sugar (BS) were measured at different time points,ie, T0 ( pre-anesthesia), T1 ( the end of the operation), T2 (24 hours after operation) and T3 (48 hours after operation). The visual analogue pain score was conducted at time points of T1, T2 and T3. The measurement of anxiety score was done at pre-operation and at days 1 and 7 after operation. Results There were no significant changes in HR and MAP of Groups PCEA and PCIA (P＞0.05, compared with T0) at every time point after operation. Whereas, HR and MAP of Group C were increased at time points of T1 and T2 (P ＜ 0.05, compared with T0 ), with statistical difference compared with Groups PCEA and PCIA at the same time points (P ＜ 0.05 ). VAS in Group PCEA was lower than that in Group PCIA at time points of T2 and T3 ( P ＜ 0.05). Meanwhile, VAS in Groups PCEA and PCIA was lower than that in Group C (P＜0. 05). COR and BS in Group PCEA were significant lower than those in group PCIA at time points of T2 and T3 (P ＜ 0. 05 ). Meanwhile, COR and BS in Groups PCEA and PCIA was lower than that in Group C (P＜0.05 or ＜0.01 ). Moreover, the changes were more significant in Group PCIA than that in Group PCEA (P ＜ 0. 05 ). The anxiety score in Groups PCEA and PCIA was lower than that in Group C (P ＜ 0.05). Conclusions Two analgesic methods of PCEA and PCIA can provide safe and effective postoperative analgesia and attenuate the stress response and anxiety in surgical patients with lower limb fracture. Meanwhile, PCEA takes more advantages than PCIA.     

Gates法测定肾小球滤过率的精确性及与病理对照分析

Objective To evaluate the precision of GFR using Gates method and compared with the results from renal pathological changes. Methods Twenty-seven patients whose 99Tcm-DTPA renograms had no obvious uptake phase were enrolled in Group A, and 27 patients whose 99Tcm-DTPA renograms had obvious uptake phase were enrolled in Group B. The measurement of GFR by Gates method was compared to the creatinine clearance measured and predicted by Cockroft-Gault (C-G), modification of diet in renal disease (MDRD) and SCr level. Renal pathological changes in two groups were compared using Pearson correlation and t test analysis. Results In Group A, GFR determined by Gates method did not show correlation with that estimated by C-G or 1/SCr (r = 0. 357,0. 376, both P ＞0.05), but was significantly correlated with GFR estimated by MDRD(r = 0. 440, P ＜ 0.05). In Group B, GFR determined by Gates method showed significantly correlation among GFR estimated by MDRD, C-G, and 1/SCr (r =0. 471, 0. 527,0. 452, all P ＜ 0.05). Renal tubulointerstitial damage score in Group A was higher than that in Group B (7.15±2.32, 3.70±3.06, t=4.66, P ＜0.001). Conclusions GFR determined by Gates method is less precise when 99Tcm-DTPA renogram has no obvious uptake phase than that when 99Tcm-DTPA renogram has obvious uptake phase. Renal tubulointerstitial damage is a strong indicator of no obvious uptake phase in 99Tcm-DTPA renogram.     

去铁胺对大鼠脑室出血后慢性脑积水的疗效观察

Objective To discuss the effect of deferoxamine in the treatment of chronic hydrocephalus (CH) after intraventricular hemorrhage (IVH) in rats. Methods A total of 184 female Sprague Dawley rats were randomly divided into normal saline group ( NS group), intracerebroventricular blood infusion group (Group A ) and deferoxamine plus intracerebroventricular blood infusion group ( Group B). The rat CH models were made by infusing autologous whole blood ( 130 μl) into the right lateral cerebral ventricle. The escape latency time was detected by Morris water maze at days 14 and 28.The rats were sacrificed 1,3, 7, 14, 28 days later, the transverse diameter of the lateral ventricle on the coronal slice of rat brain 0.4 mm posterior to the bregma was measured for evaluation of hydrocephalus and the index of ventricle. Pathological changes of the brain were observed. Results No CH was found in the NS group. The incidence of CH in the Group A was 73% (11/15), which was significantly higher than 27% (4/15) in Group B at day 28. The escape latency time in the NS group was (8.21 ± 2.00) s,which was significantly shorter than ( 16.36 ±5.93 ) s of the Group A ( P ＜0.01 ). There was no significant difference in the escape latency time between the NS group and Group B [(11.38 ± 2.57 )s] (P ＞0.05 ). The index of ventricle in the NS group was 1.05 ± 0.41, which was smaller than 4.53 ± 1.70 in Group A and 2.77 ± 1.53 in Group B (P ＜ 0.05 ). There were no obvious pathological changes in the NS group at different time points. There found edema of white matter surrounding the ventricle, twist and engorged callosum, proliferation of rhagiocrine cell as well as hemosiderin deposit in Group A. However, no hemosiderin deposit was found in Group B. Conclusions The content of iron in the cerebrospinal fluid may be correlated with hydrocephalus after IVH. Preventive use of deferoxamine can reduce incidence of hydrocephalus after ICH.     

99Tcm-N-NOET负荷和延迟门控心肌灌注显像对高血压患者的临床价值

Objective To investigate clinical significance of the 99Tcm-bis (N-ethoxy-N-ethyl-dithiocarbamato) nitridotechnetium(99Tcm-N-NOET) exercise and delayed myocardial perfusion imaging (MPI) in hypertensive patients. Methods Sixty patients with hypertension and 19 normal subjects were carried out 99Tcm-N-NOET exercise and delayed MPI, and analyzed the results of MPI, exercise electrocardiography (ECG), cardiac function parameters end-diastolic volume(EDV), end-systolic volume(ESV), left ventricular ejection fraction(LVEF), △ LVEF (LV EF exercis-LVEF delay) and coronary angiography(CAG). Results ① Sixty patients with hypertension, 22 cases(36.7%)of exercise ECG were abnormal, 16 cases (26.7%)were the chest tightness in exercise, 13 cases (21.7%) were blood pressure excessive reaction in exercise; control group, 2 cases (10.5%) of exercise ECG were abnormal, 1 case (5.3%, 1/19) was chest tightness in exercise,no per-son was blood pressure response in excessive. ②The positive rate of myocardial perfusion in hyper tensive group was significantly higher than the control group (31.75％ vs.5.30％, P<0.05). ③Cardial function parameters in hypertension group [exercise EDV =(79.75 ±29.10)ml, ESV =(28.82 ± 15.73)ml, LVEF =(65.78 ±1.27)%; delay EDV=(81.42±3.47)ml, ESV=(30.62±2.05)ml, LVEF=(64.20±9.70)%] and control group[exercise EDV=(79.63 ±21.65)ml, ESV=(27.37±10.71)ml, LVEF=(66.42±1.55)%; delay EDV=(82.89±4.96)ml,ESV=(31.42±3.06)ml, LVEF=(63.16 ±7.54)%] were no statistical difference(exercise EDV: t=0.161, ESV: t=0.112, LVEF: t=0.261; delay EDV: t=0.276, ESV: t=0.197, LVEF: t=0.184, P>0.05), △ LVEF<0%, 28 cases (46.7%) in hypertension group, 4 cases (21.1%) in control group, χ2=3.929, P<0.05; 11 cases (57.9%) in MPI positive group, 12 cases (29.3％) in MPI negative group, χ2=4.501, P<0.05. ④Nineteen hypertension underwent CAG, 11 cases were abnormal, 8 cases were normal. MPI results: 9 cases were ischemia, 10 cases were normal, and they were no statistical difference (χ2=0.25, P>0.05). The sensitivity,specificity and accuracy of 99Tcm-N-NOET MPI were 72.7％, 87.5％ and 78.9％. Conclusions ①99Tcm-N-NOET exercise and delayed MPI can diagnose whether hypertension patients with myocardial ischemia or not. ② △ LVEF of hypertensive patients reduced, △ LVEF is lower in hypertensive patients of MPI-positive.     

中国汉族正常成人颞叶体积的高分辨率MRI测量

Objective To explore the morphological features of temporal lobe of healthy Chinese Han adults on the high-resolution MRI and provide morphological data of temporal lobe for the construction of database for Chinese Standard Brain.Methods This is a clinical multi-center study.Three hundred healthy Chinese volunteers (male 150, and female 150) recruited from 15 hospitals were divided equally into five groups according to their age, i.e., 18-30 ( Group A ), 31-40 ( Group B ), 41-50 ( Group C ), 51-60(Group D), 61-70( Group E).All subjects were scanned using T1WI 3D MPRAGE sequence and volumes of standardized temporal lobe were collected.The bilateral volumes of standardized temporal lobe were compared by variance analysis between male and female subjects and among five age groups.Results The mean volumes of left and right temporal lobe were (97 126±15 703) mm3 and (97 015±15 545) mm3 respectively for men, and (95 123±14 564) mm3 and (96 423±13 407) mm3 for women.The difference temporal lobe volume between male and female wasn't significant on the same side (F = 1.336, 0.127 ,P =0.249, 0.722).The left temporal lobe volumes of Group A-E were (93 873±13 351 ), (95 566±11 964), (10 1890±14 511 ), (93 972±14 050) and (95 636±19 864)mm3 respectively, and those on the right side were (93 409±10 984), (98 158±16 392), (102 079±15 112), (95 448±11 123 ) and (94 658±16 928) mm3.There were significant differences among 5 groups between left and right temporal lobe volume( F = 2.940, 3.514, P = 0.021, 0.008 ).Further pairwise comparison revealed that left and right temporal lobe volume in Group C is higher than those of Group A and D(P<0.05), while there were no significant differences between the other groups ( P > 0.05 ).Conclusion High-resolution MRI could offer detailed images and precise morphological data of temporal lobe, which provides morphological data of temporal lobe for the construction of database for Chinese Standard Brain.     

中国汉族正常成人颞叶体积的高分辨率MRI测量

Objective To explore the morphological features of temporal lobe of healthy Chinese Han adults on the high-resolution MRI and provide morphological data of temporal lobe for the construction of database for Chinese Standard Brain.Methods This is a clinical multi-center study.Three hundred healthy Chinese volunteers (male 150, and female 150) recruited from 15 hospitals were divided equally into five groups according to their age, i.e., 18-30 ( Group A ), 31-40 ( Group B ), 41-50 ( Group C ), 51-60(Group D), 61-70( Group E).All subjects were scanned using T1WI 3D MPRAGE sequence and volumes of standardized temporal lobe were collected.The bilateral volumes of standardized temporal lobe were compared by variance analysis between male and female subjects and among five age groups.Results The mean volumes of left and right temporal lobe were (97 126±15 703) mm3 and (97 015±15 545) mm3 respectively for men, and (95 123±14 564) mm3 and (96 423±13 407) mm3 for women.The difference temporal lobe volume between male and female wasn't significant on the same side (F = 1.336, 0.127 ,P =0.249, 0.722).The left temporal lobe volumes of Group A-E were (93 873±13 351 ), (95 566±11 964), (10 1890±14 511 ), (93 972±14 050) and (95 636±19 864)mm3 respectively, and those on the right side were (93 409±10 984), (98 158±16 392), (102 079±15 112), (95 448±11 123 ) and (94 658±16 928) mm3.There were significant differences among 5 groups between left and right temporal lobe volume( F = 2.940, 3.514, P = 0.021, 0.008 ).Further pairwise comparison revealed that left and right temporal lobe volume in Group C is higher than those of Group A and D(P<0.05), while there were no significant differences between the other groups ( P > 0.05 ).Conclusion High-resolution MRI could offer detailed images and precise morphological data of temporal lobe, which provides morphological data of temporal lobe for the construction of database for Chinese Standard Brain.     

99Tcm-MIBI显像用于骨肉瘤术前化疗疗效的评价

Objective To investigate the value of 99Tcm-methoxyisobutylisonitrile (MIBI) scintigraphy in assessing the preoperative chemotherapy response and multidrug resistance of osteosarcoma.Methods From January 2007 to October 2008, 12 patients (female:4, male:8; mean age:16.3 years,range:8-27 years) underwent early (10min) and delayed (120 min) 99Tcm-MIBI scintigraphy before and after preoperative chemotherapy.Seven cases had osteosarcoma at the distal femurs, 2 at the proximal tibias, 2 at the upper end of humerus and 1 at the fibula.The tumor-to-background ratio (T/B) and washout rate (WR) were calculated.Tumor necrosis was classified according to Huvos criterion after limb salvage surgery.Immunohistochemical staining for P-glycoprotein(gp) was examined.Spearman correlation analysis and t-test were performed.Results According to Huvos criterion, 7 patients were classified as good responders with more than 90% of tumor cell necrosis and 5 as poor responders with less than 90% of tumor cell necrosis.R value (ratio of early phase T/B after and before chemotherapy) was significantly lower in good responders than that in poor responders (0.473 ± 0.21 vs 0.998 ± 0.06, t= 5.342, P= 0.000 ).R value was significantly correlated with the degree of tumor cell necrosis ( rs=- 0.87, P= 0.000 ).WR was significantly higher in patients with positive P-gp expression than that in patients with negative P-gp expression ((38.36 ±18.64)% vs (6.40±5.87)%, t= -3.278, P=0.008).There was significant correlation between the WR and P-gp expression (rs = 0.91, P= 0.001 ).Conclusion 99Tcm-MIBI scintigraphy is a feasible non-invasive technique to assess the chemotherapy response and to detect P-gp expression of osteosarcoma.