Tei指数评价心脏整体功能的临床应用进展

目前利用超声心动图评价心脏收缩或舒张功能的指标较多,评价收缩功能的指标有左室射血分数(EF),心搏量(SV),心输出量(CO),短轴缩短分率数(FS);评价舒张功能的指标有心室舒张早期二尖瓣血流峰值和舒张晚期二尖瓣血流峰值之比(E/     

应用多普勒组织成像记录二尖瓣环运动速度评价心肌梗塞后

目的　探讨多普勒组织成像 (DTI)记录二尖瓣环运动速度评价心肌梗塞后左室收缩功能和舒张功能的价值。方法　急性心肌梗塞 3 8例 ,年龄匹配的健康者 2 0例 ,于心尖位四腔观、心尖位二腔观二尖瓣环相对应的室间隔、左室前壁、侧壁和后壁记录收缩期峰值速度 (VS)、舒张早期峰值速度 (VE)、舒张晚期峰值速度 (VL)。结果　二尖瓣环收缩期峰值速度、舒张早期峰值速度均降低。结论　多普勒组织成像测定二尖瓣环运动速度开辟了评价心肌梗塞后左室收缩功能和舒张功能的新途径。     

超声心动图评价高血压患者心脏结构及功能的改变

目的 应用超声心动图探讨高血压患者左室结构与功能的改变。方法 取正常对照组26例，并按1999年WHO／ISH标准把357例高血压患者分为1、2、3级。分别应用超声心动图测量各组心脏结构、收缩功能、舒张功能各项指标。对各项指标应用单因素方差分析。结果 高血压患者与正常人心房收缩期峰值流速(APFV)与E／A有差异，但高血压各组间无差异。高血压患者室间隔、左室后壁、左室质量及左室质量指数较正常人增加，中、重度高血压患者左房及主动脉内径增大。心脏收缩功能及舒张早期血流峰值流速(EPFV)各组间无差异。结论 室间隔及左室后壁厚度是反映血压升高的敏感指标。心房收缩期峰值流速(APFV)反映收缩功能正常的高血压患者左室舒张功能减低。     

多普勒组织成像定量分析155例冠心病左心室局部收缩和舒张功能

目的 应用多普勒组织成像（ＤＴＩ）技术定量定位分析生理和病理（心肌缺血）状态下左心室局部收缩和舒张功能。方法 研究对象为１５５例确诊冠心病的患者（冠心病组）和４１例年龄匹配的正常人（对照组）。采用心尖四腔、心尖二腔和心尖长轴切面,每个室壁又选择两个取样点分别位于该室壁的基底部和中部,分别显示左心室６个室壁１２个节段运动的情况。ＤＴＩ测量参数包括收缩功能指标：心肌收缩峰值速度（Ｖｓ）和ＶＥ与舒张晚期峰值速度（ＶＡ）的比值（ＶＥ／ＶＡ）。结果 与对照组相比,冠心病组ＤＴＩ可敏感地定量显示出收缩和舒张峰值速度显著下降以及峰值时间的显著延长;前壁心肌梗死时可见病变区多个节段多项ＤＴＩ收缩和舒张功能参数异常,ＤＴＩ收缩与舒张速度指标之间、收缩速度与左室射血分数之间以及舒张功能参数ＶＥ／ＶＡ均值与二尖瓣血流频谱Ｅ／Ａ比值之     

应变率成像评价肥厚型心肌病左心室局部功能

目的探讨应变成像技术评价肥厚型心肌病患者左心室功能的价值。方法对17例肥厚型心肌病患者和42例健康志愿者行心脏超声检查,获取标准心尖四腔、二腔和长轴观以及胸骨旁短轴观,脱机分析测量纵向峰值收缩速度、应变、应变率,径向应变、应变率,周向应变、应变率。结果肥厚型心肌病组纵向峰值收缩速度S峰和舒张早期速度E峰明显低于正常对照组,且从基底段至心尖段的纵向速度（S峰、E峰、A峰）存在递减趋势。肥厚型心肌病组的舒张早期纵向应变率和周向应变率也明显低于对照组。结论应变成像技术能够定量评价左室功能。肥厚型心肌病患者虽然左室射血分数在正常范围内,但其局部心肌已经存在收缩和舒张功能异常。     

速度向量成像技术评价正常QRS波群心力衰竭患者左心室收缩同步性的初步临床研究

目的 探讨速度向量成像（VVI）技术评估正常QRS波群慢性心力衰竭（CHF）患者左室心肌收缩同步性的应用价值。方法 QRS≤120ms CHF患者和健康志愿者各30例，常规测量左室舒张末期内径（LVDd）、舒张末期容积（LVEDV）、收缩末期容积（LVESV）和射血分数（LVEF）。在系列心尖长轴及胸骨旁短轴观上，VVI成像显示所有受试者的左室速度向量图。心尖长轴观测量各节段收缩期纵向速度达峰时间（Tvl）和纵向应变达峰时间（Tsl），胸骨旁短轴观测量收缩期径向速度达峰时间（Tvr）和环向应变达峰时间（Tsc），计算节段达峰时间的标准差（Tvl—SD，Tsl—SD，Tvr-SD，Tsc-SD）及任意两节段间最大达峰时间差值（Tvl—diff，Tsl-diff，Tvr-diff，Tsc—diff）。结果 与对照组相比，CHF组LVDd，LVESV，LVEDV均显著增加（P〈0．05或0．01），LVEF显著降低（P〈0．01）。左室心肌收缩不同步指标Tvl—SD，Tsl—SD，Tvr—SD，Tsc-SD及Tvl—diff，Tsl-diff，Tvr-diff，Tsc-diff均显著增加（P〈0．01）。结论 QRS波群正常的CHF患者左室心肌在纵向、径向与环向上均存在显著的收缩不同步。VVI技术可准确评价CHF患者左室心肌收缩的同步性。     

多普勒组织成像对正常人左室功能分析

目的：本文应用多普勒组织成像（DTI）脉冲技术检测正常人左室局部运动功能,并将DTI测得局部舒张速度与左室整体舒张功能检测方法行相关性分析。方法：经心尖显示左心长轴切面,运用多普勒技术获取舒张期二尖瓣血流频谱,测量E峰和A峰速度,转换DTI速度图模式,将取样容积分别放置左室中部乳头肌水平的前间值速度。结果：左室后壁收缩和舒张速度均高于前间壁测值,两者之间存在显著性差异,按年龄分级对比发现：收缩期峰值速度在不同年龄组无显著性差异。但舒张早期速度和舒张晚期速度在不同年龄组间比较均有显著性差异。年龄瑟DTI测值相关性分析表明：随着年龄增加,舒张早期和晚期峰值速度比值（VE/VA)变小。结论：随着年龄增大,正常人室壁主动松弛功能减低,心肌顺应性下降,舒张早期充盈减少。DTI能定量测定室壁运动速度,可更精确反映收缩和舒张功能变化。     

超声二维斑点追踪显像技术评价不同年龄正常成人左心室扭转运动的初步研究

目的应用超声二维斑点追踪显像技术探讨不同年龄正常成人左室扭转运动特征。方法健康成年志愿者121例，按年龄分为青年组（18～45岁）、中年组（46～64岁）和老年组（≥65岁）。取胸骨旁左室心尖和心底短轴观对左室旋转进行测量分析，计算出扭转角度峰值（Ptw）、收缩末期扭转角度（AVCtw）、等容舒张末期扭转角度（MVOtw）、解旋率（UntwR）、解旋减半时间（HTU）、扭转速度峰值（PTV）、扭转速度达峰时间（TPTV）、解旋速度峰值（PUV）和解旋速度达峰时间（TPuV），比较不同年龄组的差别。结果正常人左室扭转运动主要表现为心底部顺时针旋转和心尖部逆时针旋转，心脏整体表现为心动周期内逆时针方向为主的扭转运动。扭转速度参数的方向在收缩期主要表现为逆时针方向扭转；舒张期则表现为顺时针方向扭转。扭转角度于收缩末期达峰值。随年龄增加，Ptw、AVCtw、MVOtw、HTU和PuV测值逐渐增加，UntwR测值逐渐减低，三组间比较差异均有统计学意义（P〈0．05）。而TPuV、PTV、TPTV测值三组间比较差异均无统计学意义（P〉O．05）。结论应用超声二维斑点追踪显像技术可无创性评价正常人左室扭转运动特征。临床在应用扭转评价左室功能时，应充分考虑年龄因素的影响。     

室壁中层缩短率评价早期2型糖尿病患者左室收缩功能的价值

目的使用超声心动图多种指标全面评价2型糖尿病患者左心结构及其功能,从中筛选敏感指标。方法对24例2型糖尿病患者(糖尿病组)和30例健康志愿者(正常对照组)进行超声心动图检查,测定左房、左室、左室质量指数、射血分数、短轴缩短率、室壁中层缩短率(MFS)、等容舒张时间、二尖瓣口舒张早期峰值流速、二尖瓣口舒张晚期峰值流速、二尖瓣环舒张早期运动峰值速度(Em)及二尖瓣环舒张晚期运动峰值速度(Am)等指标。结果与正常对照组比较,糖尿病组舒张功能指标中,Em和Em/Am显著降低(P﹤0.05),收缩功能指标中,除MFS外,其余均无统计学意义。结论早期2型糖尿病患者不仅左室舒张功能有不同程度的减退,而且已经出现心肌收缩功能损害,MFS是评价左室收缩功能的敏感指标。     

组织多普勒成像技术评价肢端肥大症患者左室功能

目的 探讨组织多普勒成像技术(TDI)评价肢端肥大症患者左心室收缩及舒张功能的价值. 方法 通过TDI研究62例肢端肥大症患者和30例对照者左室收缩及舒张功能,进行参数比较. 结果 肢端肥大症组左室收缩功能指标收缩期峰值速度(Sm)与对照组相比,差异有统计学意义(P＜0.05);左室舒张功能指标与对照组相比,舒张早期峰值速度(Em)、舒张晚期峰值速度(Am)、Em/Am的差异均有统计学意义(P＜0.05). 结论 肢端肥大症患者存在左室收缩及舒张功能障碍,TDI可定量分析其左室收缩及舒张功能,为早期发现左室功能障碍提供客观依据.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.