二维斑点追踪成像评价冠状动脉慢血流患者左心室收缩同步性

目的 应用二维斑点追踪成像（2D-STI）评价冠状动脉慢血流（CSF）患者左心室收缩同步性,为临床诊断和治疗提供可靠的量化评价和疗效观察指标。资料与方法 前瞻性选取2017年7月—2019年7月于成都市第一人民医院行冠状动脉造影确诊为CSF患者44例,另选取40例年龄、性别相匹配且冠状动脉造影结果正常者为对照组。行常规超声心动图,获取左心室壁厚度、整体收缩及舒张功能相关参数;应用2D-STI获得左心室18个节段的收缩期纵向应变达峰时间、径向应变达峰时间、周向应变达峰时间（PTcs）和峰值应变离散指数（PSD）,计算左心室18个节段PTrs、PTcs的标准差（PTrs-SD、PTcs-SD）。采用受试者工作特征曲线评价不同步指数对CSF患者左心室收缩同步性的预测价值。结果 CSF组舒张早期二尖瓣口前向血流速度（E）及E/A低于对照组（t=-3.27,P<0.01;t=-2.45,P=0.02）。CSF组左前降支、左回旋支及右冠状动脉的校正心肌梗死溶栓帧数（c TFC）及平均c TFC均高于对照组（t=7.05～10.35,P<0.01）。CSF组左心室心肌收缩不纵向应变达峰时...     

纵向峰值应变离散度及收缩期峰值应变评价系统性红斑狼疮患者左心室收缩功能

目的探讨纵向峰值应变离散度、收缩期峰值应变评价系统性红斑狼疮(SLE)患者左心室心肌收缩同步性及收缩功能的价值。资料与方法选取确诊为SLE的60例患者,根据病程分为Ⅰ组(病程≤5年)和Ⅱ组(病程>5年),每组30例;选取健康志愿者30例为对照组,比较3组受试者的一般资料、超声心动图常规参数、纵向峰值应变离散度(PSD)、纵向收缩期峰值应变(GLS)、圆周收缩期峰值应变(GCS)及径向收缩期峰值应变(GRS)的差异。结果3组受试者一般资料及超声心动图常规参数两两比较,差异均无统计学意义(P>0.05)。3组间两两比较,Ⅰ、Ⅱ组患者的PSD均高于对照组,且Ⅱ组的PSD高于Ⅰ组(P均<0.05)。Ⅰ、Ⅱ组患者的GLS均低于对照组(P<0.05),但Ⅰ、Ⅱ组患者GLS比较,差异无统计学意义(P>0.05)。Ⅱ组GCS及GRS较Ⅰ组和对照组均下降,差异均有统计学意义(P<0.05),Ⅰ组GCS及GRS与对照组接近,差异均无统计学意义(P>0.05)。结论PSD及GLS能早期评价SLE患者左心室收缩的同步性及收缩功能的变化。     

三维超声斑点追踪技术评价不同程度左前降支冠状动脉狭窄心肌应变

目的研究三维超声斑点追踪技术(3D-STI)评价左前降支冠状动脉狭窄患者心肌应变的临床应用价值。方法将60例冠心病患者作为观察组,根据冠状动脉造影LAD狭窄程度分为:A组(轻度狭窄,狭窄率≤50%)15例、B组(中度狭窄,50%狭窄率75%)19例、C组(重度狭窄,75%≤狭窄率100%)26例,另选健康者30例为D组(对照组,经CAG证实冠状动脉无明显狭窄)。采用3D-STI软件获得四组受检者LAD供血区域节段心肌及左心室心肌整体应变参数,包括纵向应变(LS)、径向应变(RS)、圆周应变(CS)、整体纵向应变(GLS)、整体径向应变(GRS)及整体圆周应变(GCS)。比较四组受检者应变参数的差异。结果与对照组和轻度狭窄组比较,中度狭窄组部分节段心肌应变减低,GLS较轻度狭窄组减低,GLS、GRS、GCS较对照组均减低;与对照组、轻度狭窄组和中度狭窄组比较,重度狭窄组各节段心肌应变及GLS、GRS、GCS均减低。结论 3D-STI可敏感检测不同程度单纯左前降支狭窄患者心肌应变减低。     

三维斑点追踪成像技术评价继发性甲旁亢治疗后左心室收缩功能

目的 应用三维斑点追踪成像技术（3D-STI）评价老年肾源性继发性甲状旁腺功能亢进（SHPT）患者治疗前、治疗后左心室收缩功能。方法 选取2019年6月～2020年6月在我院行维持性血液透析治疗的45例老年患者：低水平PTH组（LPTH）15例、高水平PTH组（H-PTH）15例;正常水平PTH组15例作为对照组,比较三组受试者治疗前、后左心室整体纵向应变GLS）、左室整体圆周应变（GCS）、左室整体径向应变（GRS）及左室整体面积应变（GAS）。结果 西那卡塞治疗前L-PTH组、H-PTH组左室GLS、GAS、GCS、GRS、较对照组减低,差异有统计学意义（P<0.05）;L-PTH组、H-PTH组治疗后左室GLS、GCS较治疗前显著增高,差异有统计学意义（<0.05）;西那卡塞治疗后GRS、GAS较治疗前增高,差异无统计学意义（P>0.05）;结论 SHPT患者经治疗后左心室收缩功能有所改善,3D-STI可以早期、准确对其进行评价。     

三维超声联合斑点追踪对2型糖尿病患者心脏功能早期损伤应用分析

目的 探讨三维超声联合斑点追踪(3D-STI)对2型糖尿病(T2DM)患者心脏功能早期损伤的应用。方法选取我院35例无明显心血管疾病的初诊T2DM患者为观察组,随机选取同期在我院体检35名健康成人为对照组。比较两组的二维常规超声心动图检查参数[左心房内径(LAD)、室间隔厚度(IVST)、左心室收缩末内径(LVESD)、左心室舒张末内径(LVEDD)、左心室射血分数(LVEF)、E/A峰值比]、3D-STI相关参数[左心室整体圆周应变(GCS)、整体纵向应变(GLS)、整体径向应变(GRS)、整体面积应变(GAS)],左心房相关参数[最大容积指数(LAVImax)、最小容积指数(LAVImin)、主动脉收缩前容积指数(LAVIp)、左心房被动射血分数(LAPEF)、主动射血分数(LAAEF)及总排空分数(LATEF)]。结果 两组观察对象的LAD、IVST、LVESD、LVEDD、LVEF、E/A峰值比等,差异无统计学意义(P> 0.05)。观察组的GCS、GLS、GRS、GAS的绝对值、LAPEF、LATEF均显著低于对照组,LAVImax、LAVImin、LAVIp均显著高于...     

三维斑点追踪成像技术评价尿毒症患者左心室整体收缩功能

目的探讨三维斑点追踪成像(3D-STI)技术评价左心室不同构型尿毒症患者左心室整体收缩功能的价值。方法 57例尿毒症患者按照左心室不同构型分为左心室构型正常组(LVN组,27例)和左心室肥厚组(LVH组,30例),选取31例健康志愿者作为对照。采用3D-STI技术获取各组左心室整体纵向收缩期峰值应变(GLS)、左心室整体径向收缩期峰值应变(GRS)、左心室整体圆周收缩期峰值应变(GCS)、左心室整体面积收缩期峰值应变(GAS),比较三组指标间的差异。结果与正常对照组比较,LVN组GLS减低(P0.05),GCS、GRS、GAS无明显变化(P0.05),LVH组GLS、GCS、GRS、GAS均减低(P0.05);与LVN组比较,LVH组GLS、GAS、GRS均减低(P0.05)。结论 3D-STI技术可以早期、敏感地反映尿毒症患者左心室收缩功能的改变,为临床治疗提供参考依据。     

左心室收缩期纵向峰值应变及应变率早期评估紫杉醇联合顺铂方案化疗对左心室收缩功能的影响

目的:运用二维斑点追踪成像技术(two-dimensional speckle tracking imaging, 2D-STI)获取使用紫杉醇联合顺铂方案化疗的恶性肿瘤患者左心室收缩期应变参数,寻找能评估紫杉醇联合顺铂方案致心肌早期收缩功能损伤的最有效的指标。方法:选取笔者医院病理诊断的恶性肿瘤患者36例,并且所有患者均使用紫杉醇联合顺铂方案化疗,在患者化疗前(T0)和化疗第2周期后(T2)、第4周期后(T4)及第6周期后(T6)用二维超声心动图检查并存储清晰图像。双平面Simpson’s法测定左室射血分数(left ventricular ejection fraction, LVEF)。2D-STI分析获取左心室收缩期纵向峰值应变(GLS)、左心室收缩期纵向峰值应变率(GLSRs)。结果 (1)左心室射血分数(LVEF):与T0比较,LVEF在化疗T2、T4及T6有逐渐减低的趋势,但所有患者的LVEF均未<50%且差异无统计学意义;(2)左心室收缩期应变参数:与T0比较,GLSRs在T4差异有统计学意义;GLS及GLSRs在T6差异均有显著的统计学意义。结论:用2D-STI获取GLS及GLSRs可早期发现使用紫杉醇联合顺铂方案化疗的恶性肿瘤患者左心室收缩功能损伤,与LVEF相比GLS及GLSRs可作为左心室收缩功能损伤的敏感参数。     

三维斑点追踪成像评价射血分数保留的家族性高胆固醇血症患者左心室收缩功能

目的 应用三维斑点追踪成像（3D-STI）评价射血分数保留的家族性高胆固醇血症（FH）患者左心室收缩功能。资料与方法 本研究资料来自北京安贞医院FH疾病筛查与研究的宁夏地区数据,筛选出24例FH,选取宁夏医科大学总医院同期健康体检的30例健康成年人作为对照组。两组均行常规经胸超声心动图和3D-STI检查,收集总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、甘油三酯（TG）等,以及左心室常规指标和左心室整体纵向应变（GLS）、整体圆周应变（GCS）、整体径向应变（GRS）,比较两组上述指标的差异,采用Pearson相关分析LDL-C与GLS、GRS、GCS及LVEF的相关性。结果 FH组的TC和LDL-C明显高于对照组（t=7.748、8.796,P<0.01）,HDL-C明显低于对照组（t=8.226,P<0.01）。FH组与对照组左心室常规指标比较,差异均无统计学意义（P>0.05）。FH组的GLS、GCS及GRS明显低于对照组,差异有统计学意义（t=5.701、3.500、4.703,P均<0.01）。FH组LDL-C与...     

三维斑点追踪成像早期检测慢性肾脏病患者心肌功能的价值

目的:探讨三维斑点追踪成像技术(3D-STI)早期评价慢性肾脏病(CKD)患者心肌功能的价值.方法:90例CKD按肾小球滤过率(GFR)分为GFR轻度降低组(Ⅰ组)、中度降低组(Ⅱ组)、重度降低组(Ⅲ组)各30例;40例健康志愿者作为对照组.测量并比较4组的常规超声心动图参数,以及3D-STI应变参数,即左心室整体径向...     

斑点追踪技术评价冠状动脉慢血流患者左心室纵向收缩功能

目的探讨二维斑点追踪技术(2D-STE)评价平板运动负荷前后冠状动脉慢血流(Coronary slow flow,CSF)患者左心室纵向收缩功能的变化,为临床提供可靠的信息。方法选取临床诊断CSF患者33例(CSF组)及冠状动脉造影检查结果正常者30例(对照组),分别在静息状态和运动负荷后,采集左心室长轴、心尖四腔及心尖两腔动态二维图像,计算两组左心室收缩末期的内径(LVEDS)、左心室舒张末期的内径(LVEDD),左心室舒张末期的容积(LVEDV)、左心室射血分数(LVEF)、左心室整体纵向应变(GSL)及负荷前后GLS变化幅度(ΔGLS)。结果静息状态下:两组LVEDD、LVESD、LVEDV、LVEF差异均无统计学意义(P>0.05),两组GLS差异有统计学意义(P<0.001);两组负荷LVEF均较静息状态下明显升高(P<0.01),但是两组间比较差异无统计学意义(P>0.05);两组的负荷GLS均较静息状态明显升高,且两组间差异有统计学意义(P<0.01),对照组的静息状态下及负荷峰值状态下左心室GLS均大于CSF组。结论静息状态下,CSF患者左心室纵向收缩功能减低;运动负荷状态下,CSF患者左心室纵向收缩显著改善;左心室心肌纵向应变值GLS能早期识别CSF患者的心肌纵向收缩功能的细微变化,为临床提供可靠的诊疗价值。     

Dealing with cancer--conversations with radiotherapy patients

Thirty in-patients treated by radiotherapy were questioned in qualitative interviews about the information they had received from the physicians and their way to deal with the disease and the physicians. Furthermore 18 persons out of this group were accompanied continuously. The confidential relationships between the patients and the author of the study brought about spontaneous conversations showing some new aspects of the way to experience disease and therapy. Despite a poor prognosis and an initially insufficient information, the patients formulated their questions openly. Generally they desired a clearer communication. They criticized above all the lack of information and attention from the physicians. A need for confidence, frankness, and the conveyance of a justified hope was expressed. The physician's stress and resulting lack of time was complained of. During the time of accompanying which lasted several weeks, it became evident that information means a way to deal with the disease to which the patient can make his individual contribution. The majority of questions as well as emotional reactions as fear or depression came from those patients who seemed to be quiet persons.     

湿润烧伤膏与手术联合治疗褥疮的护理

目的 :减少溃疡期褥疮的术前准备时间 ,缩短褥疮的总病程。方法 :将 1996年 5月至 2 0 0 2年 5月收住院的 4 2例溃疡期褥疮病人按随机原则分为 2组 ,2 1例术前用湿润烧伤膏纱换药处理 ,为A组 (试验组 ) ;2 1例用庆大霉素紫草油纱布换药处理 ,为B组 (对照组 )。 2组病例的年龄、性别、发病原因、病灶部位、病灶范围等经统计学处理 ,无显著性差别 ,有可比性。两组病人均换药至创面新鲜行皮瓣转移手术 ;比较两组平均术前换药时间 ,及换药 +手术的总住院日。术前术后两组患者均运用护理程序施行整体护理。结果 :A组术前平均换药时间为 8 4 9± 2 2 3天 ,B组为 15 6 0± 6 70天 ;A组平均治愈时间为 2 0 5 0± 4 81天 ,B组为 35 31± 7 70天。结论 :湿润烧伤膏换药与庆大霉素紫草油纱布换药比较 ,前者可明显缩短褥疮手术的术前准备时间及病人的总住院天数。     

Radiochemotherapy with temozolomide for patients with glioblastoma

Background

The objective of this retrospective analysis was to assess long-term outcome and prognostic factors of unselected patients treated for glioblastoma (GB) at a single center with surgery, standard radiotherapy (RT), and concomitant temozolomide (TMZ). From 1999?C2005, the institutional protocol included surgery and RT with TMZ. From 2005 on, adjuvant TMZ was routinely added.

Patients and Methods

Between April 1999 and September 2009, 181 patients with GB were treated with RT (60 Gy in 30 fractions) and concomitant TMZ (75 mg/m²/day throughout RT). Biopsy only had been performed in 53 patients (29.3%), 128 patients (70.7%) had undergone resection, which was complete based on postoperative MRI in 51 patients (28.2%). Adjuvant TMZ was applied in 67 of 181 patients (37%).

Results

Median overall survival (OS) and progression-free survival (PFS) were 15.0 (95% CI, 13.1?C16.8) and 7.2 months (95% CI, 5.9?C8.5), respectively. After complete resection, partial/subtotal resection and biopsy, median OS was 23.20, 14.75, and 7.89 months (p < 0.001), respectively. In multivariate Cox proportional hazards regression models, extent of resection (p < 0.0001), Karnofsky??s performance score (p < 0.0001) and adjuvant TMZ (p = 0.001) were significant independent prognostic factors for OS. RT with concomitant TMZ was well tolerated in the majority of patients and could be completed as scheduled in 146 patients (80.7%), while 11 patients (6.1%) discontinued RT. Another 35 patients (19.3%) interrupted concomitant chemotherapy.

Conclusion

RT with concomitant TMZ is a feasible regimen with acceptable toxicity in routine practice. Our data are compatible with a beneficial effect of adjuvant TMZ on OS and PFS.     

MEBO药纱门诊治疗烧(烫)伤71例的体会

作者报道用MEBO药纱敷盖门诊治疗烧（烫）伤71例，均获治愈。经随访1年，深Ⅱ度创面疤痕发生率为15％（3／20），浅Ⅲ度创面疤痕发生率为38．9％（7／18）。     

Bronchogenic carcinoma: staging with MR compared with staging with CT and surgery

Thirty-three patients suspected of having bronchogenic carcinoma were studied prospectively using magnetic resonance (MR). In this group, 30 underwent examination with computed tomography (CT), 15 underwent thoracotomy, six had mediastinal biopsy procedures performed, and eight underwent bronchoscopy. MR studies, which included transaxial spin-echo imaging (TR, 0.5 and 2.0 sec; TE, 28 and 56 msec) of all patients and sagittal or coronal imaging of 18, were performed without knowledge of CT findings, using only plain radiographs as a guide. CT and MR studies were interpreted separately. CT and MR provided comparable information regarding the presence and size of mediastinal lymph nodes. MR better discriminated mediastinal nodes from vascular structures. However, in two of 11 patients who had multiple mediastinal lymph nodes that were normal in size at CT examination and surgery, MR suggested a confluent abnormal mass, probably because of its poorer spatial resolution. MR was superior to CT in showing enlarged hilar lymph nodes, but CT was better for demonstrating bronchial abnormalities. In three of four patients who had a proved hilar mass with distal obstructive pneumonia, MR (TR, 2.0 sec) helped distinguish between the mass and collapsed lung.     

多虑平、雷尼替丁治疗消化性溃疡81例临床观察

1995年 1月～ 1 998年 2月 ,我们采用多虑平、雷尼替丁治疗消化性溃疡 (ＰＵ) ,并与雷尼替丁为对照组进行治疗观察 ,疗效满意 ,现总结报告如下。1　临床资料1 1　一般资料　本组 81例ＰＵ均因上腹痛、返酸、腹胀及食欲不振等症状 ,经胃镜诊断为溃疡活动期患者。病程 2个月～ 5ａ,平均 1 7ａ。伴有焦虑、抑郁及夜眠欠佳等症者59例。随机分为 2组 :治疗组 4 1例 ,男 3 8例 ,女 3例 ;年龄 1 8～ 3 6岁 ,平均 2 4岁。其中胃溃疡 1 1例 ,十二指肠球部溃疡 3 0例。对照组 4 0例 ,男 3 7例 ,女 3例 ;年龄 1 9～ 3 5岁 ,平均 2 4 5岁 ;胃溃疡 1 2…     

Tumor Burden Assessment with Positron Emission Tomography with

Objective: In patients with advanced cancer, total tumor burden affects the likelihood of tumor response and has important implications for prognosis. The aim of this study was to select the optimum 2-[F-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG PET) tumor uptake parameter to accurately measure tumor burden in advanced metastatic renal cell cancer, in comparison with volumes measured with computed tomography (CT), as a reference test.Materials and Methods: Six patients with metastatic renal cell carcinoma measurable on CT were studied. CT and FDG PET scans were carried out on all patients within 4 weeks prior to their entry into a phase I-II radioimmunotherapy trial. CT-based evaluation of disease extent (tumor volume) and 4 PET-based measurements (standardized uptake value[SUVmax], SUVav, volume, and total lesion glycolysis [TLG]) were performed independently by a radiologist (VN) and a nuclear medicine physician (TA). The degree of correlation between conventional (CT) extent of disease and parameters describing tumor concentration of FDG was then determined.Results: Fifty-seven CT-measurable metastatic lesions in lung, abdomen, and scalp were evaluated in 6 patients. There was a high correlation between CT and FDG PET volume estimates for lesions greater than 5 cm(3) in size. However, a PET-derived parameter that embodies both FDG uptake and lesion size, the TLG, correlated better with CT-derived tumor volume than did FDG PET volume alone.Conclusion: Using CT volume as a gold standard, the optimal PET-based estimate of total tumor burden in patients with metastatic renal cancer is the sum over all lesions of the total lesion glycolysis.     

臭氧治疗船员下肢损伤89例

2006年10月至2007年4月,我科采用引进的德国赫尔曼Medozon型臭氧发生装置系统产生的臭氧治疗船员下肢损伤89例,疗效满意.现报告如下.