定量组织速度成像在肥厚型梗阻性心肌病化学消融术前后的应用

目的 应用定量组织速度成像(QTVI)评价肥厚型梗阻性心肌病化学消融术前及术后左心室局部收缩功能,并探讨前间隔基底段(靶组织)收缩速度与左室流出道压差关系.方法 23例肥厚型梗阻性心肌病患者于化学消融术前及术后3 d,超声心动图测量左室流出道压差;应用QTVI技术在心尖左室长轴观及心尖四腔观测量前间隔、后壁、后间隔和侧壁基底段与中间段的纵向收缩期峰值速度(Vp),在胸骨旁左心室长轴观测量前间隔及后壁基底段与中间段的横向Vp.结果 肥厚型梗阻性心肌病患者前间隔基底段的纵向及横向Vp术后[分别为(3.25±0.63)cm/s、(2.93±0.47)cm/s] 技术前[分别为(5.73±0.96)cm/s、(4.87±0.69)cm/s]减低(P＜0.05).肥厚型梗阻性心肌病患者左室流出道压差术后[(23.7±7.8) mm Hg] 较术前[(78.3±16.5) mm Hg]下降 (P＜0.01),左室流出道压差下降与前间隔基底段Vp下降显著相关(r=0.95,P＜0.01).结论 肥厚型梗阻性心肌病化学消融术后前间隔基底段收缩功能下降,左室流出道压差下降与前间隔基底段收缩功能下降有关.     

斑点追踪技术评价肥厚型梗阻性心肌病化学消融术前后左心室收缩同步性的研究

目的 应用二维斑点追踪显像(2D-STI)技术评价肥厚型梗阻性心肌病(HOCM)化学消融术前后患者左室收缩同步性,并探讨左室收缩同步性与左室流出道压差的关系.方法 21例HOCM患者于化学消融术前及术后6d,超声心动图测量左室流出道压差;获取左室短轴观(二尖瓣环、乳头肌和心尖水平)二维灰阶图像,应用2D-STI测量左室短轴观各节段收缩期径向应变达峰时间(TRS).计算左室整体径向应变达峰时间的标准差(TRS-SD).结果 21例HOCM患者左室流出道压差术后较术前明显下降,差异有统计学意义(P＜0.01).术后6d,前间隔基底段及中段径向TRS较术前明显延迟(P＜0.05),左室短轴观水平整体径向TRS-SD与术前比较差异无统计学意义(P＞0.05).前间隔基底段TRS延迟与左室流出道压差下降呈中等相关(r =0.657,P＜0.01).结论 2D-STI能准确检测HOCM患者化学消融术前后左室收缩同步性.     

组织多普勒评价经皮室间隔化学消融术对肥厚梗阻型心肌病左心室收缩舒张功能的影响

目的 应用多普勒组织成像测量室间隔、后壁和二尖瓣环各点速度.以评价肥厚梗阻型心肌病患者在经皮室间隔化学消融术(PTSMA)前后左室收缩舒张功能的改变.方法 在PTSMA术前、术后急性期对肥厚梗阻型心肌病患者分别测量室间隔、左室后壁和二尖瓣环各点收缩期、舒张期早期和舒张晚期峰值速度.结果 肥厚型心肌病患者术后急性期室间隔、左室后壁和二尖瓣环各点收缩期、舒张期早期峰值速度均较术前减低,差异有统计学意义(P＜0.05).舒张晚期峰值也较术前减低,大部分差异有统计学意义(P＜0.05).结论 肥厚型心肌病患者PTSMA术后急性期左室长轴收缩功能及主动松弛功能较术前减低.     

斑点追踪技术评价糖尿病早期左室心内膜下心肌收缩功能

目的 应用斑点追踪成像技术评价糖尿病早期患者及糖尿病合并高血压患者左室心内膜下心肌的收缩功能.方法 应用斑点追踪成像技术测量无明显冠心病及左室心肌质量指数相近的30例单纯糖尿病患者、25例糖尿病合并高血压患者、30例正常人的超声心动图常规参数及左室心内膜下心肌长轴观基底段、中段、心尖段收缩期纵向二维应变值,比较三组间的差异.结果 除E/A的差异有统计学意义(P＜0.01)外,两糖尿病组较正常对照组之间各常规参数的差异无统计学意义.两糖尿病组整体心肌纵向收缩期峰值应变较对照组虽有所减低,但仅部分节段差异有统计学意义(P ＜0.01),而心内膜下心肌纵向收缩期峰值应变较对照组均减低,差异有统计学意义(P＜0.01～0.001).除少数心肌节段外,糖尿病合并高血压组心内膜下心肌纵向收缩期峰值应变均比单纯糖尿病组减低,差异有统计学意义(P＜0.01).结论 斑点追踪成像可用于早期诊断无明显冠心病的糖尿病患者左心室收缩功能受损情况.     

超声二维应变成像评价肥厚型心肌病患者左心室收缩功能

目的应用超声二维应变成像评价肥厚型心肌病（HCM）患者左室局部心肌收缩功能。方法HCM患者21例，正常对照者21例，获取左室短轴观二尖瓣环水平、乳头肌水平、心尖水平，心尖位四腔观、二腔观及左室长轴观的二维图像，测定左室心尖位二维纵向应变收缩期峰值，左室短轴二尖瓣水平、乳头肌水平、心尖水平各心肌节段心内膜下、心外膜下及整体心肌径向收缩期峰值应变。结果①HCM组与正常组心尖位二维纵向收缩期峰值应变比较，HCM组绝大多数节段心肌峰值应变显著降低（P〈0．05）；②HCM组与正常组左室短轴心内膜下心肌二维径向收缩期峰值应变比较，HCM组心肌收缩期峰值应变明显减低，二尖瓣水平及乳头肌水平绝大多数节段差异有统计学意义（P〈0．05）；③HCM组与正常组左室短轴心外膜下心肌二维径向收缩期峰值应变比较，绝大多数节段差异无统计学意义；④HCM组与正常组左室短轴心肌整体二维径向收缩期峰值应变比较，HCM组绝大多数节段心肌峰值应变显著降低（P〈0.05），尤以肥厚节段较多的乳头肌水平明显（P〈0．01）。结论HCM患者肥厚与非肥厚节段于左室纵向及左室短轴径向收缩功能均受损，并且径向收缩功能受损以心内膜下心肌为主。     

应用实时三维斑点追踪技术评价肥厚型心肌病左室整体和局部的收缩功能

目的 应用实时三维斑点追踪技术测量肥厚型心肌病左室整体和局部心肌应变特征,以评价其收缩功能.方法 应用实时三维斑点追踪技术测量20例肥厚型心肌病患者和22例正常对照组的左室心肌整体及各节段纵向、圆周向、径向及面积峰值应变值,并进行比较.结果 与正常组比较,病例组左室心肌整体及各节段应变值均小于正常对照组,其中病例组整体长轴应变(P＜0.01)、径向应变(P＜0.05)、面积应变(P＜0.01)差异有统计学意义;病例组心肌室间隔、前壁及下壁中间段及心尖段各应变值降低,差异有统计学意义(P＜0.01或P＜0.05).结论 实时三维斑点追踪应变为定量评价整体和局部心肌收缩功能提供了新的方法.     

斑点追踪成像技术对扩张型心肌病患者左心室长轴二维应变的初步研究

目的 应用超声斑点追踪成像技术探讨扩张型心肌病(DCM)患者左心室长轴各节段心肌二维应变的变化.方法 对16例经临床诊断证实的DCM患者,获取心尖左室长轴连续三个心动周期图像.应用GE EchoPAC软件分析图像,得到各切面的收缩期整体应变峰值及各节段时间-应变曲线,记录纵向、横向应变的收缩期峰值及其达峰时间.对照组为20例健康体检者,获取左室相同切面超声心动图图像及参数.结果 DCM组各切面的收缩期整体应变峰值、各节段纵向应变峰值、多数节段(16/18)横向应变峰值均较对照组明显降低,多数节段(14/18)纵向应变达峰时间提前(P＜0.05);除前壁心尖段和中间段外,DCM组横向应变达峰时间延后,但仅后壁基底段间差异有统计学意义(P＜0.05);DCM组左室18节段间最大达峰时间差增大(P＜0.05).结论 DCM患者左室长轴各节段收缩期纵向应变峰值及多数节段横向应变峰值均明显低于正常人,18节段间最大达峰时间差增大,提示其左室收缩功能明显受损并出现左室收缩不同步.     

肥厚型心肌病患者左心房功能的应变率评价

目的 探讨应变率成像技术评价肥厚型心肌病(HCM)患者左心房功能的价值.方法 根据左室流出道压差将36例HCM患者分为两组:非梗阻性HCM组[左室流出道压差<20 mmHg(1 mm Hg=0.133 kPa)]和梗阻性HCM组(左室流出道压差≥20mmHg).分别采集各受试者的心尖二腔、心尖四腔和心尖左室长轴观TVI图像,测量心室收缩期左心房峰值应变率(LASRs)、心室舒张早期左心房峰值应变率(LASRe)、心房收缩期左心房峰值应变率(LASRa)和心室舒张早期空间隔峰值应变率(LVSRe),计算其平均值(mLASRs、mLASRe、mLASRa和mLVSRe).结果 与对照组比较,非梗阻性HCM组和梗阻性HCM组mLASRs、mLASRe和mLVSRe减低,mLASRa增高,差异均有统计学意义(P<0.05).与非梗阻性HCM组比较,梗阻性HCM组mLASRe和mLVSRe减低,mLASRa增高,差异均有统计学意义(P<0.05).梗阻性HCM组与非梗阻性HCM组的mLASRa和mLVSRc均呈现著负相关(r=-0.67,-0.75;P<0.01,0.01).结论 HCM患者左心房功能发生改变,表现为储蓄功能和管道功能减低,辅泵功能增加.应变率成像技术能够评价左心房功能,为临床提供有价值的信息.     

肥厚型心肌病左心室整体与节段纵向收缩功能及同步性的组织运动瓣环位移研究

目的 采用组织运动瓣环位移技术(TMAD)定量分析肥厚型心肌病(HCM)患者左室整体与节段纵向收缩功能及同步性,探讨其应用价值和可行性.方法 连续选择非梗阻型肥厚型心肌病患者(nHCM)39例,同期选择性别、年龄相匹配的健康人39例作为对照组.采用二维斑点追踪技术(2D-STI)测量左室整体与节段纵向应变(LSR)以及采用QLAB8.1软件测量二尖瓣环6个位点(室间隔,侧壁,前间隔,后壁,前壁和下壁)二尖瓣环位移(MAD)以及达峰时间,计算二尖瓣环整体位移(MADglobal)以及左心室收缩期不同步化指数(SDI).分析LSR与MAD的相关性,比较两组MAD、SDI等参数.结果 TMAD有效跟踪节段数显著高于STI(98.7％对77.9％,P＜0.001).TMAD测量MAD与STI测量左室节段纵向应变(r=-0.784,P＜0.001)和整体应变(r=-0.897,P＜0.001)显著相关.与对照组比较,nHCM患者左室六个位点MAD以及MADglobal均显著减低(P均＜0.001),SDI显著增加(P＜0.001).结论 TMAD是评价nHCM患者左室纵向整体与节段收缩功能以及同步性的新方法.     

1例梗阻性肥厚型心肌病行室间隔消融术的护理

梗阻性肥厚型心肌病目前多采用药物、心室起搏的方法或外科手术治疗 ,但疗效欠佳 ,1998年 12月 2 8日我院成功地进行第 1例室间隔消融术 ,术后恢复良好。梗阻性肥厚型心肌病的主要特征是由于心肌显著肥厚 (累及室间隔 )。左室流出道梗阻造成心排血量下降。冠脉灌注不足引起一系列临床症状。室间隔消融术的主要原理是 :在局麻下选择性行冠状动脉造影术 ,找出室间隔供血动脉 ,注入无水酒精 ,堵塞该血管 ,人为造成室间隔局限性小范围的心肌梗塞 ,使梗塞部位纤维化 ,从而改善左室流出道狭窄和心输出量 ,大大减轻了病人行外科手术的痛苦 ,并提高…     

儿童遗传性心律失常的诊治进展

回顾在遗传性心律失常领域最新发表的相关研究,主要关注与儿童心源性猝死关系密切的离子通道病,包括长QT综合征（LQTS）、短QT综合征（SQTS）、Brugada综合征（BrS）和儿茶酚胺敏感性多形性室性心动过速（CPVT）,总结它们在发病机制及诊治方面的进展。     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

Organ Preservation: Current Concepts and New Strategies for the Next Decade

SUMMARY: Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years.     

2017年呼吸疾病主要进展

2017年,国内外学者在呼吸系统疾病的临床和基础领域均进行了深入研究,不仅对相关指南进行了更新,并且针对一些临床热点、难点问题达成专家共识,现就2017年呼吸疾病相关进展作一简单介绍。     

COVID‐19 and COVID‐19 vaccine‐related dermatological reactions: An interesting case series with a narrative review of the potential critical and non‐critical mucocutaneous adverse effects related to virus,therapy, and the vaccination

This narrative review article was conducted to lay out a summarized but exhaustive review of current literature over mucocutaneous manifestations in 4 dimensions of SARS‐CoV‐2 pandemic: virus itself, treatment‐related, vaccine‐induced, and alteration of chronic dermatologic diseases following infection. Virus and vaccine‐related were mainly self‐limited and non‐severe. Treatment‐related reactions could be life‐threatening.     

家族性噬血细胞性淋巴组织细胞增生症1例并文献复习

目的加强对家族性噬血细胞性淋巴组织细胞增生症（familially hemophagocytic lymphohistiocytosis,FHL）的认识。方法报道确诊为FHL的新病例1例,结合国内外报道的FHL的病例,对该病的临床特点进行汇总分析。结果FHL2常与PRF1基因突变相关,约20%~40%的患者存在穿孔素基因突变。结论对于有阳性家族史,基因诊断明确,应尽早行化疗或者造血干细胞移植。若无家族史,未发现与继发性HLH相关的原发病因,可考虑行基因筛查以明确是否存在FHL的可能。     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

Recalcitrant giant orf recurrence after amputation: A case report and review of the literature

Orf is caused by a parapoxvirus. We present a recurrent, giant digital orf case in a female patient with a history of hairy cell leukemia. In spite of shave excision, the lesion progressed and recurred after digital amputation. Treatment with topical imiquimod cream and systemic subcutaneous interferon alfa‐2a was successful.     

动态心电图临床操作标准化方法

动态心电图,又称Holter或Holter检查,是一种评价各种心脏病患者心电图异常的简便、高效、准确、安全的无创检查,广泛用于心律失常的相关症状评价,心肌缺血的诊断,心脏病患者的预后和日常生活能力评估,药物疗效评价,起搏器等埋藏式心脏电治疗装置监测等领域。目前动态心电图已广泛用于于临床各级医疗机构,为了更好地发挥其作用,有必要对该项技术进行规范化培训。本文参考相关指南、共识及专家建议,结合作者经验,撰写动态心电图临床操作标准化方法供临床使用时参考。