应变成像对肥厚型心肌病左室纵向局部心肌收缩功能的研究

目的　评价肥厚型心肌病 (HCM)患者左心室纵向局部心肌收缩功能。方法　应变成像模式下 ,对 18例HCM患者和 17例正常人左心室各室壁不同水平心肌节段在长轴方向上的应变曲线进行分析 ,测量收缩期峰值应变。结果　HCM组各室壁节段收缩期峰值应变均显著低于正常对照组相应室壁节段 (P <0 .0 5 ) ;室间隔中段局部心肌收缩期峰值应变分别与室间隔厚度以及IVS/PW比值具有相关性 (r1=0 .76 2 ,r2 =0 .6 70 ,P <0 .0 1)。结论　HCM患者局部心肌收缩功能受损 ,且左室形态学异常与局部心肌功能的异常具有相关性 ;应变成像能够定性、定量地评价局部心肌收缩功能     

二维斑点追踪成像评价正常人左室心肌应变

目的 运用二维斑点追踪成像(STI)评价正常人左室心肌应变.方法 对50例正常人采集左心室长轴和短轴方向的二维动态图像,测量分析心肌收缩期峰值纵向应变(LS)、径向应变(RS)和圆周应变(CS).结果 (1)左心室各节段心内膜层心肌LS、RS、CS均显著高于心外膜层心肌(P<0.05);(2)LS由基底部到心尖部递增;RS在同一水平不同节段分布较一致;同一水平前室间隔的CS较高;结论 STI可以准确测量左室壁节段心肌应变,能够定量评价局部心肌收缩功能.     

二维斑点追踪成像评价正常人左室心肌应变

目的运用二维斑点追踪成像(STI)评价正常人左室心肌应变。方法对50例正常人采集左心室长轴和短轴方向的二维动态图像,测量分析心肌收缩期峰值纵向应变(LS)、径向应变(RS)和圆周应变(CS)。结果左心室各节段心内膜层心肌LS、RS、CS均显著高于心外膜层心肌(P0.05);LS由基底部到心尖部递增;RS在同一水平不同节段分布较一致;同一水平前室间隔的CS较高。结论 STI可以准确测量左室壁节段心肌应变,能够定量评价局部心肌收缩功能。     

斑点追踪显像技术评价肥厚型心肌病患者心肌应变的研究

目的应用二维斑点追踪显像(2DSTI)技术评价肥厚型心肌病患者的心肌应变特点。方法选择正常对照组30例,肥厚型心肌病组30例。应用STI技术测定左心室各壁基底段、中间段和心尖段收缩期峰值应变(Ss),并对检测结果进行分析。结果与对照组比较,肥厚型心肌病组室间隔增厚(P0.05),肥厚型心肌病组心肌纵向应变值在左室基底段和中间段、心尖段均较对照组低(P0.05)。直线相关分析显示各组间LVEF与收缩期纵向峰值应变之间均存在正相关(r=0.589、0.797)。IVS在对照组与收缩期纵向峰值应变之间无明显相关性,但在肥厚型心肌病组与收缩期纵向峰值应变之间呈负相关(r=-0.538)。结论在肥厚型心肌病患者的整体左室收缩功能减低之前,其左室各节段心肌应变改变已经出现,STI可以发现患者早期局部左室功能的改变。肥厚型心肌病患者的收缩期峰值应变与其LVEF水平呈正相关,与IVS厚度呈负相关。应用二维斑点追踪显像技术测量肥厚型心肌病患者收缩期左室纵向应变值,有助于了解患者心脏收缩时心肌纵向运动和应变值的变化情况,能够判断和评价局部心肌功能。     

二维斑点追踪技术在心肌梗死患者经皮冠状动脉介入术后左室心肌应变评价中的应用

目的 应用超声二维斑点追踪技术(2D-STE)评价心肌梗死患者经皮冠状动脉介入(PCI)术后的左室心肌应变情况.方法 行PCI术的心肌梗死患者245例,于PCI术前、术后7d进行64排螺旋CT冠状动脉造影、2D-STE检查.结果 245例患者均成功实施PCI治疗,梗死相关血管430支中,PCI术后获成功开通249支(57.9％),开通不良113支(26.3％),开通差63支(14.7％),开通后重新阻塞5支(1.2％).PCI术后7 d,2D-STE检查提示左室异常节段室壁运动曲线的收缩峰值应变(PSS)、收缩峰值应变率(PSSR)、径向应变(RS)、环向应变(HS)较前明显降低(P＜0.05),但1 19例(48.6％)仍存在节段性室壁运动异常或不良,表现为PSS＜ 10％,PSSR ＜3％,RS＞-7％及HS＞-5％.开通后阻塞者牛眼图节段颜色异常,变为淡粉色.结论 PCI术后7d,心肌梗死患者心肌梗死面积已发生左心室重构,室壁张力增加,心脏收缩功能增强,但近半数的患者仍存在节段性室壁运动异常或不良情况,应加强观察和治疗.2D-STE可以定量观察心肌梗死患者PCI术后的心肌应变情况,客观评价PCI术后心脏收缩功能.     

应变率显像评价冠心病患者的左室心肌功能

目的:应用应变率成像(SRI)技术评价冠心病患者的左室功能,探讨SRI评价左室功能的临床价值。方法:正常组30例,冠心病组30例,取心尖四腔、心尖两腔、心尖左室长轴切面的心肌应变率曲线,测定左室各室壁的收缩期、舒张早期、舒张晚期的峰值应变率(SRS、SRE、SRA),统计两组左室各壁出现的收缩后缩短(PSS)的节段数;定量检测各节段收缩-舒张转换时间(TCEC),比较各组左室壁各节段TCEC的差异。结果:冠心病组的SRS、SRE、SRA明显降低(P<0.05),PSS的检出率明显增多(P<0.05),与非缺血节段比较,缺血节段TCEC延长(P<0.05)。结论:应变率成像(SRI)技术为定量、准确评价冠心病左室心肌功能提供了新的方法。     

斑点追踪技术对心肌梗死患者短轴节段性室壁运动异常的研究

目的 应用二维超声心动图斑点追踪成像(STI)技术检测心肌梗死患者短轴室壁的应变,评价节段性室壁运动异常的价值.方法 对30例经临床证实的心肌梗死患者及对照组30例正常人,记录胸骨旁左室短轴二尖瓣、乳头肌、心尖水平18个室壁节段高帧频二维灰阶图像.应用GE Echo PAC软件测量左室短轴各室壁节段收缩期峰值径向应变(SR)、收缩期峰值圆周应变(SC).结果 正常人的径向应变曲线为正向峰值曲线、圆周应变曲线为负向峰值曲线.正常人SR呈现乳头肌水平最高,心肌水平最低的变化趋势.心肌梗死患者梗死节段SR、SC均较对照组减低(P＜0.05).结论 STI能够准确评价左室短轴切面局部室壁运动异常,为临床评价心肌梗死患者左心收缩功能提供无创性新方法.     

超声应变显像技术评价正常人及肥厚型心肌病患者左室局部心肌的纵向收缩功能

目的应用应变显像技术评价正常人及肥厚型心肌病患者局部心肌的收缩功能。方法非梗阻性肥厚型心肌病(NHCM)组(静息时左室流出道压差<20 mm Hg)22例,梗阻性肥厚型心肌病(HOCM)组(静息时左室流出道压差>30mm Hg)18例,正常对照(NOR)组23例,在应变成像模式下测量其基底及中间各节段心肌收缩期峰值应变(Ssys),统计其出现反向应变及收缩后收缩(PSS)的节段数。并在组内各节段之间以及3组之间进行两两比较。结果NOR组各节段Ssys之间差异无统计学意义。而HCM及HOCM组室壁中间段Ssys较基底段降低(P<0．01)。与NOR组相比,HCM组各室壁中段及前间隔,前壁及侧壁基底段Ssys均显著降低(P<0．05或0．01)。且后间隔中段Ssys(绝对值)同局部室壁厚度呈负相关(P=0．737)。与NOR组相比,HOCM组除下壁基底段外各节段Ssys均降低(P<0．05或0．01)。与HCM组相比,HOCM组后间隔基底段应变较低(P< 0．01)。且后间隔及下壁基底段应变同左室流出道压差呈负相关(P分别为-0．792及-0．508)。HCM组7％节段出现收缩期负向应变,其中78％的负向应变出现在各室壁中间段。HOCM组有19％的节段出现收缩期负向应变,且除后间隔基底段外,各节段均有负向应变出现。NOR、HCM以及HOCM三组分别有21％、42％及45％的节段出现PSS,HCM及HOCM组出现PSS的节段较NOR组多,HCM及HOCM组之间PSS的出现率差异无统计学意义。结论肥厚型心肌病患者的心肌收缩功能降低,且以肥厚的节段为著。流出道梗阻对局部室壁的收缩有影响。应变显像技术能够准确评价局部心肌功能。     

斑点追踪成像技术评价心肌梗死急诊介入治疗后早期左室长轴应变及其与重构的关系

目的 应用二维斑点追踪成像技术评价急性心肌梗死冠脉介入治疗后早期左室心肌纵向应变及其与左室重构的关系.方法 分析36例正常对照组和48例心肌梗死急诊介入治疗术后组的患者,分别测量左室心尖二腔观、三腔观、四腔观节段及整体纵向收缩峰值应变,并分析其与左室舒张末期容积(LVEDV)、收缩末期容积(LVESV)、左室射血分数(LVEF)的相关性.结果 心肌梗死急诊冠脉介入治疗术后组左室各心肌节段收缩峰值应变均不同程度低于对照组(P<0.05),尤以前壁基底段、中间段;侧壁中间段;下壁基底段、中间段;前间隔中间段;后间隔中间段;心尖部降低程度明显(P<0.01);左室心肌整体收缩峰值应变与LVEDV、LVESV、LVEF相关良好.结论 斑点追踪成像技术能定量测定左室长轴局部和整体的心肌收缩峰值应变,评价局部和整体心肌的收缩功能;与反映左室重构的指标间相关良好.     

超声评价扩张型心肌病心脏损害

为了解扩张型心肌病（DCM）的心脏损害状况，采用超声心动图检测20例DCM患者心脏结构、功能指标，并与对照组比较，结果发现DCM患者心脏结构明显异常，并有收缩功能低下、室壁应力增高及左室舒张未压增高。且相关分析表明，舒张未左室容量与左室肌重正相关，r=0．84（P＜0．001），左室搏功指数与体循环阻力负相关，r=-0．73（P＜0．01），左室收缩期最大壁应力与相对空壁厚度负相关，r=-0．70（P＜0．001），左室收缩未期壁应力与短轴缩短率负相关，r=-0．46（P＜0．05）。表明DCM前后负荷匹配不佳，形成恶性循环；相对室壁厚度减低可致室壁应力明显增高，示其心肌肥厚代偿不足；收缩功能损害同时伴左室舒张末压升高。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.