探讨左室压力-应变环评估妊娠期高血压孕妇心肌功能的价值

目的：应用超声应变新技术左室压力-应变环（LVPSL）定量评价妊娠期高血压孕妇心肌做功情况，探讨LVPSL的应用价值。方法：选取我院产科就诊的妊娠期高血压孕妇38例，另选取健康志愿者孕妇30例。应用LVPSL评估病例组和对照组心肌做功情况，参数包括整体有用功（GCW）、整体无用功（GWW）、整体做功指数（GWI）、整体做功效率（GWE）及左室整体纵向应变（GLS），观察各组间参数的差异，并分析心肌做功参数与GLS的相关性。结果：病例组GCW、GWW、GWI、GWE、GLS与对照组的差异具有统计学意义，在病例组中GLS与心肌做功指数GWW、GWE具有相关性。结论：LVPSL能够作为评估受损心肌的功能参考依据。     

左室压力-应变环评估肥胖合并高血压患者心肌做功的价值

目的 探讨左室压力-应变环评价肥胖合并高血压患者心肌做功的临床价值。方法 选取2020年5月～2022年8月就诊于山西白求恩医院的35例单纯性肥胖患者（肥胖组）、39例肥胖合并高血压患者（肥胖高血压组）及38例健康人（对照组）,测量常规超声心动图参数、整体纵向应变（GLS）及心肌做功参数,心肌做功参数包括整体有用功(GCW)、整体做功指数(GWI)、整体无用功(GWW)、整体做功效率(GWE),比较3组间上述参数的差异。结果 肥胖组和肥胖高血压组的GLS低于对照组(P<0.05)。与对照组相比,肥胖组GLS、GCW、GWI、GWE减小,GWW增大(P<0.05)。肥胖高血压组较肥胖组、对照组GCW、GWI、GWW增大,GWE减小(P<0.05)。收缩压、舒张压与GCW、GWI、GWW呈正相关、与GLS呈负相关(P<0.01)。BMI与GCW、GWI、GLS呈负相关,与GWW呈正相关(P<0.05)。结论 高血压会加重肥胖患者左心功能功能障碍,左室压力-应变环能够识别肥胖合并高血压左室心肌功能受损,具有一定临床价值。     

左室-压力应变环技术评估妊娠期高血压疾病患者左室功能的临床价值

目的 探讨左室压力-应变环技术定量评估妊娠期高血压疾病患者左室功能的临床价值。方法 选取38例妊娠期高血压疾病患者（病例组）和孕龄与之匹配的健康孕妇42例（对照组）,均行常规超声心动图检查,并应用左室压力-应变环技术测量左室整体纵向应变（GLS）、心肌整体做功指数（GWI）、整体有用功（GCW）、整体无用功（GWW）及整体做功效率（GWE）,比较两组一般资料、常规超声心动图参数及心肌做功参数的差异;采用Spearman相关性分析心肌做功参数与收缩压和舒张压的相关性;绘制受试者工作特征（ROC）曲线分析各参数评估妊娠期高血压疾病患者心功能的诊断效能。结果 与对照组比较,病例组收缩压、舒张压、LAD、IVSD、LVPWD、GWI、GCW、GWW均增高,GWE、GLS均降低,差异均有统计学意义（均P＜0.05）。相关性分析显示,GWI、GCW、GWW与收缩压、舒张压均呈正相关,GWE、GLS与收缩压、舒张压均呈负相关（均P＜0.05）。ROC曲线分析显示,心肌做功参数GWI、GCW和GWW诊断妊娠期高血压疾病患者左心室功能改变的灵敏度及特异度均明显高于GLS和左室射血分数,尤以GCW和GWW的诊断效能最高。结论 左室压力-应变环技术在评估妊娠期高血压疾病患者左室早期心肌损害方面具有一定的价值。     

无创心肌做功评价STEMI患者PCI术后左室收缩功能恢复程度及其预测价值

目的：探讨无创心肌做功技术定量评估ST段抬高型心肌梗死（STEMI）患者在经皮冠状动脉介入术（PCI）后左心室收缩功能恢复情况及其预测价值。方法：选取2021年1月—2022年7月我院初发STEMI行急诊PCI治疗的患者59例，根据术后3月左室射血分数（LVEF）较术后24 h内是否增加>5%将患者分为左心室收缩功能恢复组（36例）和未恢复组（23例）。所有患者均应用超声心动图获取常规左心室结构及功能指标，应用自动功能成像技术获取左室整体纵向应变（GLS）与峰值应变离散度（PSD），应用无创心肌做功技术获取左心室整体心肌做功参数：左心室整体有用功（GCW），整体无用功（GWW），做功效率（GWE）以及整体做功指数（GWI）。结果：(1)超声参数分析：各时期两组间LVEF、GLS、GWI、GCW、GWE PSD、GWW具有明显差异性（P<0.05）。与24 h内相比，3月时功能恢复组LVEF、GLS、GCW、GWI、GWE明显升高，GWW、PSD明显减低（P<0.05）；功能未恢复组LVEF、GLS、GCW、GWI略升高（P<0.05）,PSD、GWW、GWE变化...     

左室压力-应变环技术评估急性ST段抬高型心肌梗死患者左心功能及左室重构的价值

目的 探讨左室压力-应变环（LV-PSL）技术评估急性ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入（PCI）术后左心功能及左室重构的临床价值。方法 选取我院收治的90例STEMI患者（观察组）和同期体检的健康成人90例（对照组），比较对照组和观察组术前及术后3 d常规超声心动图指标、左室整体纵向应变（GLS），以及左室心肌做功指标，包括整体有效功（GCW）、整体做功效率（GWE）、整体做功指数（GWI）、整体有效做功（GCW）的差异。进一步将STEMI患者分为单支冠状动脉狭窄组61例与多支冠状动脉狭窄组29例，比较两组上述指标的差异。应用Spearman相关分析法分析左室心肌做功指标与常规超声心动图指标、GLS的相关性。结果 观察组术前及术后3 d左室收缩末期容积（LVESV）、左室舒张末期容积（LVEDV）、GWW均高于对照组，左室射血分数（LVEF）、GLS、GWE、GWI、GCW均低于对照组，差异均有统计学意义（均P<0.05）。观察组术后3 d LVEDV、LVESV、GWW均低于术前，LVEF、GLS、GWE、GCW、GWI均高于术前，差异均有统计学意义（均P...     

超声压力-应变环评价诺欣妥治疗慢性心衰患者左室心肌做功改变

目的：应用超声压力-应变环评价经诺欣妥治疗的慢性心衰患者的左室心肌做功改变。方法：选取2019年12月—2020年12月吉林大学第一医院临床确诊为射血分数降低型慢性心力衰竭患者40例，用药前、用药后1月及用药后3月进行经胸超声心动图检查、血浆NT-proBNP浓度及6 min步行试验，获得以下压力应变环技术参数：左室整体纵向应变（GLS）、整体有用功（GCW）、整体做功效率（GWE）、左室心肌整体做功指数（GWI）、整体无用功（GWW）。其他参数：血浆NT-proBNP浓度及6 min步行试验结果，比较用药前后各个参数之间的差异及LVEF与左室心肌做功参数的相关性。结果：用药前、用药后1月、用药后3月GLS绝对值逐渐增加，心肌做功参数中GWI、GCW、GWE均较用药前增加，GWW较用药前减小，GWI、GCW、GWE与LVEF呈正相关（用药后1月r=0.945、0.922、0.925；用药后3月r=0.621、0.706、0.799，均P<0.001）,GWW与LVEF呈负相关（用药后1月r=-0.960；用药后3月r=-0.789，均P<0.001），且各个指标用药前、后对...     

左室压力-应变环评估原发性高血压不同分级患者心肌功能障碍的价值

目的应用超声心动图左室压力-应变环(LVPSL)定量评价原发性高血压不同分级患者心肌做功情况,探讨LVPSL在评估原发性高血压(EHP)患者心肌功能障碍中的应用价值。方法选取我院就诊的EHP患者160例,其中高血压1级组52例,高血压2级组72例,高血压3级组36例,另选取健康志愿者42例,作为正常血压组。应用LVPSL评估每位受试者心肌做功状况,其参数包括整体有用功(GCW)、整体无用功(GWW)、整体做功指数(GWI)、整体做功效率(GWE),同时比较各组间左室整体纵向应变(GLS)、达峰时间离散度(PSD),观察四组间上述参数的差异。结果四组间GWW、GWE、GLS、PSD的差异具有统计学意义。随着血压分级的增高,GWW、PSD呈逐渐增大趋势,而GWE、GLS绝对值逐渐下降;GWW、GWE在高血压2级组与3级组患者比较差异有统计学意义,而斑点追踪超声心动图GLS无统计学意义。结论 LVPSL可早期评估EHP患者心肌功能障碍,GWW、GWE在高血压2级组与3级组患者心肌功能障碍鉴别中较斑点追踪超声心动图GLS灵敏。     

左室压力—应变环技术评估左室射血分数保留的慢性主动脉瓣关闭不全患者心肌功能

目的 应用左室压力-应变环技术评估左室射血分数（LVEF）保留的慢性主动脉瓣关闭不全（CAR）患者主动脉瓣置换或修复（AVR）术前术后心肌功能，探讨其临床应用价值。方法 选取扬州大学附属苏北人民医院确诊为中重度CAR并行AVR治疗的LVEF保留患者52例（CAR组），以及同期健康成人40例为健康对照组，检测两组左室整体纵向应变（GLS），并应用左室压力-应变环技术获取无创心肌做功参数，包括整体做功指数（GWI）、整体有效功（GCW）、整体无效功（GWW）、整体做功效率（GWE）；比较CAR组术前术后GLS及无创心肌做功参数的差异。分析无创心肌做功参数与GLS、LVEF的相关性。根据术后GLS、GWI损伤情况将CAR患者进一步分为术后GLS及GWI均保留患者15例（Ⅰ组）、术后GLS损伤而GWI保留患者23例（Ⅱ组）、术后GLS及GWI均损伤患者14例（Ⅲ组），比较各亚组超声心动图检查结果的差异。绘制受试者工作特征（ROC）曲线分析GWI预测左室重构的诊断效能。评估观察者内和观察者间测量无创心肌做功参数的一致性。结果 CAR组术前LVEF、GLS、GWI、GCW、GWW、GWE与健康对照...     

无创心肌做功在射血分数保留型主动脉瓣关闭不全患者治疗中的应用

目的 应用无创心肌做功评估左室射血分数保留（LVEF>50%）的慢性主动脉瓣关闭不全患者及其在主动脉瓣置换或修复 (AVR)术后的改变。方法 纳入2019年4月至 2021年5月确诊为中度或重度主动脉瓣关闭不全并通过AVR治疗的保留左室射血分数的患者52例，应用左室压力－应变环（PSL）评价患者左心室整体纵向应变 (GLS)及左室心肌做功指数，包括心肌整体做功指数(GWI)、整体有效功(GCW)、整体无效功(GWW)、整体做功效率(GWE)，并与之前报道的正常参考范围及其他超声心动图指数进行比较分析。 结果 ①与正常参考值相比，保留LVEF的慢性主动脉瓣关闭不全患者左心室整体做功指数（GWI）、整体有效做功（GCW）正常或增加，整体做功效率（GWE）正常。② GWI、GCW与主动脉瓣反流（AR）严重程度指标以及左室收缩功能指数呈正相关。③ AVR术后GWI、GCW、GWE减低 (P <0.001)，但是整体无效做功（GWW）无明显变化(P =.28)。④AVR后LV GLS的损伤比LV GWI损伤更为普遍（72%对28%），28%患者出现术后GWI损伤，与左心室不良逆重构密切相关。 结论 在保留LVEF的CAR患者中，无创左室心肌做功可能比其他超声心动图指数更好地了解心肌力学和能量学改变及术后左室逆重构的过程。     

压力-应变环评估代谢综合征患者早期左室心肌做功

目的应用压力-应变环(PSL)评价代谢综合征(MS)患者左室心肌做功的早期改变。方法选取2020年9月至2021年4月河北医科大学附属秦皇岛市第一医院就诊的尚未发生左室重构的MS患者70例作为MS组, 同期选择65例健康志愿者作为对照组, 进行心肌做功分析, 包括整体做功指数(GWI) 、整体做功效率(GWE)、整体有用功(GCW)、整体无用功(GWW), 比较两组心肌做功参数的改变及与生化指标的相关性分析。结果 MS组左室整体纵向应变(GLS)、GWI、GCW、GWE低于对照组, GWW高于对照组(均P<0.05)。Pearson相关分析表明, GWI与高密度脂蛋白胆固醇(HDL-C)呈正相关(r=0.194, P<0.05), 与舒张压(DBP)、腰围(WC)、空腹血糖(Glu)、三酰甘油(TG)及GLS呈负相关(r=-0.257、-0.452、-0.239、-0.193、-0.758, 均P<0.05);GWE与收缩压(SBP)、DBP、WC、Glu、TG及GLS呈负相关(r=-0.360、-0.269、-0.326、-0.352、-0.265、-0.663, ...     

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。     

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。     

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.     

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.     

Real‐life effectiveness of biological therapies on symptoms in severe asthma with comorbid CRSwNP

BackgroundWe aimed to evaluate the effectiveness of different antibody therapies on nasal polyp symptoms in patients treated for severe asthma.MethodsWe performed a retrospective analysis of patients with severe asthma and comorbid CRSwNP who were treated with anti‐IgE, anti‐IL‐5/R or anti‐IL‐4R. CRSwNP symptom burden was evaluated before and after 6 months of therapy.ResultsFifty patients were included hereof treated with anti‐IgE: 9, anti‐IL‐5/R: 26 and anti‐IL‐4R: 15 patients. At baseline median SNOT‐20 was similar among groups (anti‐IgE: 55, anti‐IL‐5/R: 52 and anti‐IL‐4R: 56, p = 0.76), median visual analogue scale (VAS) for nasal symptoms was 4, 7 and 8 (p = 0.14) and VAS for total symptoms was higher in the anti‐IL‐4R group (4, 5 and 8, p = 0.002). After 6 months SNOT‐20 improved significantly in all patient groups with median improvement of anti‐IgE: −8 (p < 0.01), anti‐IL‐5/R: −13 (p < 0.001) and anti‐IL‐4R: −18 (p < 0.001), with larger improvement in the anti‐IL‐4R group than in anti‐IgE (p < 0.001) and anti‐IL‐5/R (p < 0.001) groups. VAS nasal symptoms improved by median anti‐IgE: 0 (n.s.), anti‐IL‐5/R: −1 (p < 0.01) and anti‐IL‐4R: −3 (p < 0.001), VAS total symptoms by anti‐IgE: −1 (n.s.), anti‐IL‐5/R: −2 (p < 0.001) and anti‐IL‐4R: −2 (p < 0.001).ConclusionsTreatment by all antibodies showed effectiveness in reducing symptoms of CRSwNP in patients with severe asthma, with the largest reduction observed in anti‐IL‐4R‐treated patients.     

经颅黑质超声诊断帕金森病的临床评价

目的 通过对帕金森病患者及正常对照组进行经颅超声(transcranial sonography,TCS)检查,结合帕金森病患者的Hoehn Yahr（H Y）分级及帕金森病统一评分量表评分结果,了解我国大陆地区帕金森病患者有无黑质(substantia nigra, SN)回声增强表现。方法 对入选对象进行TCS检查,并对检查结果进行评价。结果 帕金森病患者 SN阳性率明显高于正常对照者（P＜0.05）。帕金森病SN异常组 H Y 分期明显高于帕金森病SN正常组(P＜0.05),表明帕金森病患者SN高回声面积与H Y分期相关。TCS检查对帕金森病的敏感性为80.5%,特异性为79.9%。结论 我国帕金森病患者SN强回声检出率显著高于对照组,说明我国帕金森病患者也存在SN回声增强这一现象,与国内外报道相一致。TCS检查对帕金森病的诊断具有一定的意义,敏感性及特异性较高。