三尖瓣环的M型运动曲线和瓣环多普勒组织成像的运动频谱在下壁合并右室心肌梗死后评价右室功能中的作用

目的探讨对下壁合并右室心肌梗死后的患者,三尖瓣环的M型运动曲线与瓣环多普勒组织成像(DTI)的运动频谱在评价右室功能中的价值.方法分别检测下壁合并右室心梗组(A组)、前壁心梗组(B组)和正常对照组(C组)的三尖瓣环的运动幅度、瓣环的收缩期峰值运动速度、舒张早期峰值运动速度(E)与舒张晚期峰值运动速度(L).结果我们发现与B、C两组比较,A组的三尖瓣环运动幅度明显减小(A组与B组分别为1.93与2.42cm,P<0.01;A组与C组分别为1.93与2.68cm,P<0.01);A组的瓣环收缩期峰值运动速度明显减小(A组与B组分别为11.3与15.2cm/s,P<0.01;A组与C组分别为11.3与15.7cm/s,P<0.01);同时A组瓣环的舒张早期峰值运动速度亦减小(A组与B组分别为9.1与12.6cm/s,P<0.01;A组与C组分别为9.1与12.7cm/s,P<0.01).结论三尖瓣环的M型运动曲线和瓣环的DTI运动频谱可用来评价下壁合并右室心肌梗死后的右室功能.     

组织多普勒超声评价急性肺动脉栓塞患者右室功能的研究

目的　探讨应用组织多普勒成像 (TDI)评价急性肺动脉栓塞 (PE)患者右室功能的价值。方法　应用TDI观察13例应用螺旋CT诊断的急性PE患者治疗前后右室功能参数的改变 ,并分析TDI参数与肺动脉栓塞指数之间的关系。结果　急性PE患者治疗后右室侧壁基底段VE较治疗前显著增高 ( 10 .2 7± 3 .83 )cm/svs ( 13 .48± 3 .82 )cm/s ,P <0 .0 5 ,VA显著降低 ( 2 3 .16± 6.89)cm/svs ( 17.88± 3 .79)cm/s ,P <0 .0 5 ,右室侧壁各节段VE/VA增高显著 ;右室侧壁基底段VE/VA与螺旋CT肺动脉阻塞指数之间显著相关 (r =-0 .45 9,P <0 .0 5 )。结论　TDI参数对急性PE患者病变程度及疗效判定有一定的临床应用价值。     

超声心动图评价高效抗病毒疗法对艾滋病患者右室功能的影响

目的利用超声心动图技术对照评价接受高效抗逆转录病毒治疗(HAART)的艾滋病(AIDS)患者和未接受HAART治疗者的右室功能,分析评价目前国内AIDS治疗所采用的HAART方案是否对AIDS患者右室功能造成影响。方法对59例未接受HAART治疗的AIDS患者及52例接受HAART治疗的AIDS者行超声心动图检查,测量各项常规超声心动图参数,采集三尖瓣环位点组织多普勒(TDI)运动频谱,测量各位点的收缩期峰值速度(Vs)、舒张早期峰值速度(Ve)、舒张晚期峰值速度(Va),计算各位点Ve/Va值及右心平均V-s、-Ve、V-a和-Ve/V-a值。两组间进行对照分析。结果未治疗组和治疗组间常规超声心动图指标及三尖瓣环各位点TDI测值包括Vs、Ve、Va、Ve/Va。-Vs[(11.35±2.00)cm/s,(11.32±1.40)cm/s]、-Ve[(11.63±2.38)cm/s,(12.14±1.98)cm/s]、-Va[(11.18±2.78)cm/s,(11.02±2.54)cm/s]和V-e/-Va(1.10±0.37,1.15±0.28),差异无统计学意义。结论国内AIDS治疗采用的HAART治疗方案对AIDS患者右室功能未见明显影响。     

组织多普勒成像评价艾滋病患者右室功能的临床研究

目的应用组织多普勒成像技术(TDI)测量三尖瓣环运动速度评价艾滋病(AIDS)患者右室功能,探讨组织多普勒评价AIDS患者右室功能的临床价值。方法对72例AIDS患者行超声心动图检查,测量各项常规参数。应用TDI采集三尖瓣环三个位点的运动频谱,测量各位点的收缩期峰值速度(Vs)、舒张早期峰值速度(Ve)、舒张晚期峰值速度(Va),计算右心平均-Vs、-Ve、-Va。并与健康对照者进行对照分析。结果病例组三尖瓣环各位点Vs、Ve、Va及-Vs(11.33±1.91)cm/s、-Ve(11.69±2.41)cm/s、-Va(10.61±2.45)cm/s较对照组明显降低,差异具统计学意义。结论AIDS患者右室心肌的收缩和舒张均较正常人减弱,右室功能降低。TDI可准确、定量、无创地评价AIDS患者右室功能。     

Valsalva动作对评价左室舒张功能三种常用指标的影响

目的研究正常人Valsalva动作后前负荷降低是否引起舒张期二尖瓣口血流频谱、二尖瓣环运动速度及舒张早期左室血流传播速度三种指标变化以及如何变化。方法50例健康人,Valsalva动作前后分别测定舒张期二尖瓣口血流频谱、二尖瓣环运动频谱(DTI)和M型彩色多普勒舒张早期左室内血流传播速度(FPV),并进行Val-salva动作前后对照分析。结果Valsalva动作前后比较,舒张期二尖瓣口血流频谱E峰速度减低〔(80.6±16.3)cm/svs(65.9±13.3)cm/s,P＜0.01〕,A峰速度、E/A比值减低〔(54.2±10.2)cm/svs(49.5±10.4)cm/s和1.51±0.23vs1.37±0.29,P＜0.05),E峰减速时间DT延长〔(0.161±0.031)svs(0.192±0.05)s,P＜0.01〕。侧壁处二尖瓣环运动速度Eal降低〔(18.7±3.8)em/svs(16.3±3.7)cm/s,P＜0.01〕,Aal和Eal/Aal比值无显著变化〔(11.3±2.5)cm/svs(10.5±1.9)cm/s和1.72±0.46vs1.60±0.44,P＞0.05〕,室间隔侧Eas、Aas降低〔(14.7±2.8)cm/svs(13.1±2.4)cm/s和(9.9±1.7)cm/svs(8.8±1.9)cm/s,P＜0.01〕,Eas/Aas比值无显著变化(1.53±0.37vs1.54±0.33,P＞0.05),FPV无显著变化〔(55.87±6.66)cm/svs(55.32±10.22)cm/s,P＞0.05〕。结论作为评价左室舒张功能的指标,二尖瓣口血流易受前负荷影响,舒张期二尖瓣环运动速度与FPV相对不受前负荷影响,但二尖瓣环运动速度这一指标实际应用中更为优越。     

三尖瓣环运动速度多普勒组织成像评价下壁心肌梗塞后右室功能

目的 探讨多普勒组织成像(DTI)记录三尖瓣环运动速度评价下壁心肌梗塞后右室功能的价值。方法 急性下壁心肌梗塞病人28例，年龄匹配的健康者20例，于心尖四腔观三尖瓣环相对应的右室游离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(VA)。结果 急性下壁心肌梗塞组三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三尖瓣环运动速度可作为评价下壁心肌梗塞后右室功能的新方法。     

定量组织速度成像评价急性心肌梗死后的右室功能

目的 应用QTVI技术测定三尖瓣环的运动速度和幅度评价初次急性心肌梗死后的右室功能。方法 研究对象分为急性下壁心梗组20例。急性前壁心梗组16例和对照组20例，用QTVI技术中的时间速度积分测定三尖瓣环右室收缩期，舒张早期与晚期运动幅度；应用QTVI技术中的组织速度成像测量右室收缩期，舒张早期与晚期的运动峰速度。结果 下壁心梗组和前壁心梗组右室游离壁三尖瓣环Vs,VE,VE/VA,SD与DED均显著低于对照组，下壁心梗组患者降低尤为显著。下壁心梗组和前壁心梗组LVEF均显著低于对照组。前壁心梗组LVEF减低更明显。结论 应用QTVI测量右室游离壁三尖瓣环运动速度和幅度可作为评价心肌梗死患者右室舒缩功能的新指标。有助于指导治疗和随访观察。心肌梗死患者左、右室功能相互影响。     

组织多普勒测定高血压非肺动脉高压性右心室重构

目的　观测高血压心脏病 (HHD)患者肺动脉压正常时右心室心肌脉冲组织多普勒 (PW TDI)频谱 ,评价右心功能。方法　组Ⅰ为正常对照组 2 0例 ,平均年龄 ( 5 4± 7)岁 ;组Ⅱ为原发性高血压心脏病患者 2 0例 ,平均年龄 ( 5 8± 8)岁。取标准心尖四腔观 ,用PW TDI技术测量右心室收缩期右房室环最大运动速率 (Sm )、舒张早期最大运动速率 (Em )、舒张晚期最大运动速率 (Am)和Em /Am值 ,以及右心室等容收缩时间 (RIVCT )和等容舒张时间 (RIVRT) ;应用M型超声测量该处收缩期最大运动幅度 (SD)、舒张早期运动幅度 (DED)、舒张晚期运动幅度 (DAD)和DED/DAD值。结果　高血压心脏病组右心室Em下降 [( 16.0± 2 .7)cm/s对 ( 19.5± 3.4)cm /s ,P <0 .0 1] ,Am增高 ,Em/Am比值降低 ( 0 .72± 0 .11对 0 .98± 0 .15 ,P <0 .0 1) ,以及RIVRT延长 [( 115± 17)ms对 ( 71± 9)ms ,P <0 .0 1] ;右心室Sm、SD、RIVCT差异均无显著性意义。两组肺动脉收缩压均正常。结论　高血压病早期肺动脉压正常时右心室即发生肥厚和舒张功能的改变。PW TDI技术可用于评价其右心室功能     

妊高征患者分娩前后肾动脉血流参数变化的多普勒超声研究

目的　利用超声多普勒技术评价妊高征 (PIH)患者分娩前后肾动脉血流动力学变化。方法　重度妊高征患者 2 5例 ,正常妊娠 2 4例 ,彩色多普勒超声引导下利用脉冲多普勒超声检测肾动脉收缩期最大、最小、平均血流速度 (Vs,Vd ,Vm)及阻力指数 (RI)、搏动指数 (PI)等。产后复查。结果　妊高征患者肾动脉血流速度与正常妊娠组(Vs:6 5 33± 18 0 7cm/svs 6 5 0 6± 19 98cm/s;Vd :2 4 90± 7 81cm/svs 2 5 94± 8 6 8cm/s;Vm :44 2 1± 13 91cm/svs 42 18± 10 0 9cm/s)无显著差别 (P >0 0 5 ) ;RI、PI两组间亦无显著差别 (P >0 0 5 ) ;妊高征组及正常妊娠组分娩后上述指标均有不同程度增高 ,但相差不显著 (P >0 0 5 )。结论　妊高征患者肾动脉血流速度及RI与正常妊娠组无显著差别 ,正常妊娠及妊高征患者分娩前后肾动脉血流动力学未发生显著变化。     

平静呼吸对正常人心内血流速度影响的超声心动图研究

目的　研究呼吸对心脏血流动力学的影响 ,为建立我国正常人呼吸性血流速度波动指数 (RVI)提供参考 ,验证呼吸影响心功能新假说。方法　 79名健康志愿者 ,采用AcusonSequoia 5 12和 12 8XP/10彩色电脑声像仪 ,记录各瓣口血流速度、同步心电图和呼吸曲线。不同呼吸相所测的各瓣口血流速度分别取平均值 ,计算RVI。结果　二尖瓣E峰血流速度和主动脉瓣血流速度在呼气相均高于吸气相 [( 83.79± 17.74)cm/svs ( 76.5 5± 15 .5 0 )cm/s ,P <0 .0 0 0 1;( 10 9.36± 14 .0 9)cm /svs ( 10 4.2 2± 13.75 )cm/s ,P <0 .0 0 0 1] ;三尖瓣E峰血流速度和肺动脉瓣血流速度在吸气相高于呼气相 [( 62 .19± 17.2 1)cm/svs ( 5 2 .79± 14 .10 )cm/s ,P <0 .0 0 0 1;( 89.80± 15 .78)cm/svs ( 84.76± 15 .0 3)cm /s ,P <0 .0 0 0 1]。二、三尖瓣 ,主、肺动脉瓣的RVI均值分别为8.39%、16.40 %、4.71%和 5 .73%。结论　平静呼吸对心脏血流动力学影响具有规律性。RVI可作为评定呼吸影响心功能的客观指标 ,为呼吸影响心功能假说提供了临床实验依据     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.