彩超下探讨颈动脉斑块与脑梗死的相关性研究

目的:通过彩超分析颈动脉斑块,探讨其与脑梗死发病的相关性。方法:选择2016年5月-2018年5月邓州市中心医院收治的100例脑梗死患者和100例健康体检者分别作为观察组和对照组,应用彩色多普勒超声诊断仪分别检测和比较两组患者的内中膜厚度(IMT)、斑块类型、斑块形态以及斑块发病部位。结果:与对照组相比,观察组颈动脉内中膜增厚发生率(92%vs31%),内中膜厚度(1.3±0.4mm)vs(0.7±0.3mm),颈动脉粥样硬化斑块形成率显著增高(82%vs22%),斑块类型多为不稳定型软斑,发病部位多为颈总动脉分叉处。结论:颈动脉粥样硬化斑块形成与脑血管疾病密切相关,颈动脉粥样硬化是造成脑梗死的重要致病因素,通过彩超可以明确脑梗死患者颈动脉粥样硬化斑块特征,具有较高的诊断价值,并通过彩超早期筛查,可以早期发现脑梗死危险患者,预防脑梗死的发生。     

脑梗死患者颈动脉粥样硬化的相关性分析

目的　探讨颈动脉粥样硬化与脑梗死的关系及其危险因素。方法　应用彩色超声诊断仪对16 0例脑梗死患者进行颈动脉超声检查 ,观察动脉粥样硬化程度 ,同时检测血脂、血糖、纤维蛋白原含量。结果　脑梗死患者有颈动脉粥样硬化斑块者 132例 (82 .5 % ) ,颈动脉狭窄 7例 (4 .4 % )。斑块发生部位以颈总动脉分叉处最多 (5 4 .8% )。颈动脉有斑块组其高血压发生率、总胆固醇、低密度脂蛋白、血糖、纤维蛋白原含量较无斑块组显著增高 (P <0 .0 1)。结论　颈动脉粥样硬化斑块是脑梗死的危险因素。年龄、糖尿病、高血压、高脂血症、纤维蛋白原增高与颈动脉粥样硬化斑块形成密切相关。     

糖尿病患者颈动脉粥样硬化斑块的超声评估及影响因素分析

目的探讨糖尿病患者颈动脉粥样硬化斑块的超声特点,并分析相关危险因素。方法选取2012年4月~2015年8月在我院内分泌科诊治的糖尿病病房230例患者为观察组,另选同期健康体检人群120例为对照组,分别进行超声检查,并对颈动脉粥样硬化斑块的危险因素进行调查分析。结果 (1)观察组颈总动脉主干、颈总动脉分叉处、颈内动脉IMT值均高于对照组,差异有统计学意义(P0.05)。观察组颈总动脉主干、颈总动脉分叉处、颈内动脉斑块发生率明显高于对照组,差异有统计学意义(P0.05)。(2)对230例糖尿病患者采用单、多因素相关分析发现,年龄、高脂血症和高血压是颈动脉粥样硬化斑块的危险因素(P0.05)。结论超声可发现颈动脉内径厚度变化,能清晰的显示颈动脉斑块的形态、结构和大小,并且发现年龄、高脂血症和高血压是颈动脉粥样硬化斑块的危险因素,临床上对于伴有这些疾病的糖尿病患者应该尽早行超声检查,可以早期干预治疗。     

缺血性脑梗死与颈动脉斑块及危险因素的研究

目的：探讨脑梗死与颈动脉粥样斑块及危险因素的相关性。材料与方法：对102例经CT、MRI证实的脑梗死患者和43例对照组进行颈动脉颅外段彩色多普勒检查，观察斑块情况，同时检测血压、血脂、血糖等项目。结果：（1）脑梗死组颈动脉斑块的发生率为81．21％，对照组为22．96％，（P〈0．01）。斑块发生部位以颈总动脉最多，尤其是颈总动脉分叉部。（2）年龄、高血压、甘油三酯、载脂蛋白B的升高是缺血性脑梗死颈动脉粥样斑块的危险因素。结论：颈动脉粥样硬化斑块与脑梗死发生有密切关系，年龄、高血压、糖尿病等与粥样硬化斑块形成有关，对颈动脉硬化斑块及其危险因素控制有重要临床意义。利用高频超声可实时检测颈动脉斑块的存在，对脑梗死的预防及预后有很大指导作用。     

颈动脉粥样硬化斑块危险因素分析

目的探讨颈动脉粥样硬化斑块形成的相关危险因素。方法 142例意识清楚的脑梗死患者和78例非脑血管病患者(对照组)的颈动脉行彩色Doppler超声检查。结果脑梗死组颈动脉粥样硬化斑块检出率64.8%,对照组检出率28.0%(P<0.01)。Logistic回归分析显示,年龄、高血压、糖尿病与颈动脉粥样硬化斑块形成相关(P<0.01)。结论颈动脉粥样硬化斑块形成是脑梗死的危险因素,年龄、高血压、糖尿病与颈动脉粥样硬化斑块形成有关。     

彩超在高血压患者颈动脉粥样硬化与血流动力学变化评价中的应用

以我院86例高血压患者为观察组,86例健康体检者为对照组,两组均接受颈动脉彩超检查,比较颈总动脉内膜-中层厚度、颈总动脉斑块和血流动力学指标。结果观察组颈总动脉内膜-中层厚度0.88±0.18mm,斑块检出率67.4%,对照组颈总动脉内膜-中层厚度0.58±0.24mm,斑块检出率9.3%,组间比较差异显著(P<0.05);观察组收缩期峰值血流速度、舒张末期血流速度、平均流速明显低于对照组(P<0.05),血管阻力指数、血管搏动指数明显高于对照组(P<0.05)。彩超检测可较准确反映颈动脉损害情况,对颈动脉粥样硬化的诊断有较好的指导价值。     

超声检查评价代谢综合征患者颈动脉结构和功能变化

目的:观察超声检测代谢综合征患者颈动脉结构和功能的变化特点,并与健康者、单纯高血压、糖尿病患者比较。方法:①纳入2001-02/2003-01广州邮电医院内科门诊或住院高血压、糖尿病、代谢综合征患者115例。其中代谢综合征患者47例(代谢综合征组),单纯高血压患者36例(高血压组),糖尿病患者32例(糖尿病组)。选择同期本院体检健康者19例(对照组)。所有入选者均对实验目的知情同意。②采用美国ALTHDI3000彩色多普勒超声显像仪对双侧颈动脉进行超声检查。对受检者双侧颈动脉进行测量,在颈总动脉分叉近心端10,20,30mm3处分别测取前壁和后壁内膜-中层厚度,双侧共测得12个值,取其平均值作为颈总动脉内膜-中层厚度。颈动脉斑块指数用Crouse方法计算。颈动脉扩张性=(颈总动脉舒张内径2-颈总动脉收缩内径2)/颈总动脉舒张内径2×脉压,颈动脉僵硬度=脉压×颈总动脉直径/颈总动脉每搏血管内径变化幅度。③组间比较用t检验。结果:单纯高血压患者36例,糖尿病患者32例,代谢综合征患者47例,健康者19例均进入结果分析。代谢综合征组患者颈动脉内膜-中层厚度、颈动脉斑块指数、颈动脉僵硬度明显大于和高于其他3组(P<0.05～0.01),颈动脉扩张性明显低于其他3组(P<0.05～0.01)。结论:代谢综合征患者颈动脉粥样硬化程度及颈动脉扩张性和顺应性改变较糖尿病及单纯高血压患者严重,代谢综合征患者特有的多重危险因子聚集的情况,对颈动脉结构和功能损害可能起协同作用。     

超声对高血压患者颈动脉粥样硬化的相关性观察

目的运用高频超声探讨高血压患者颈动脉的超声改变与动脉粥样硬化程度的相关性。方法应用高频超声对188例年龄≥60岁的原发性高血压患者和200例同龄健康者行颈动脉超声检查。结果高血压组颈总动脉内径(CADIA)扩大、颈总动脉内-中膜厚度(CAIMT)增厚显著,且与年龄、病期呈正相关。斑块检出率高血压组为64%,对照组为18%(P<0.01),其中高血压期患者斑块检出率为100%。结论CADIA扩大、CAIMT增厚可提示动脉硬化,粥样硬化斑块的特征和数目、大小可反映动脉硬化的病变程度。颈动脉可作为一个良好的体表窗口,反映高血压患者颈动脉粥样硬化的病变程度。     

颈动脉粥样硬化斑块与脑梗死的关系

目的:探讨脑梗死与颈动脉粥样硬化斑块的关系.方法:应用彩色多普勒超声检查急性脑梗死患者(观察组)80例和同期健康体检者(对照组)40例颈动脉内膜中层厚度、斑块数、性质,并化验血脂.结果:观察组检出斑块63例(78.75%),对照组检出13例(32.50%),差异有统计学意义(P＜0.05).有斑块者与无斑块者相比,血清总胆固醇、低密度脂蛋白胆固醇水平升高(P＜0.05).结论:颈动脉粥样硬化斑块与脑梗死密切相关,高低密度脂蛋白胆固醇血症是颈动脉粥样硬化的危险因素.     

彩色超声多普勒评价颈动脉粥样硬化与脑梗死发生的相关性

目的评价颈动脉粥样硬化与脑梗死的相关性。方法对178例脑梗死患者进行颈动脉彩色多普勒检测。结果脑梗死患者颈总动脉和颈内动脉内膜-中层厚度(IMT)分别为(1.27±0.24),(0.98±0.09)mm,与对照组犤0.79±0.07),(0.72±0.08)mm犦比较差异有非常显著性意义(P<0.01)。脑梗死组颈总动脉及分叉、颈内动脉的粥样硬化斑块发生率较对照组明显增高(P<0.01)。椎基底动脉系统脑梗死患者锁骨下动脉起始处的斑块发生率明显多于颈动脉系统脑梗死患者(P<0.01)。脑梗死患者颈内动脉的IMT值与血浆总胆固醇、三酰甘油、纤维蛋白原的含量成正相关(P<0.01)。结论彩色多普勒可作为颈动脉粥样硬化检测的可靠方法。颈动脉粥样硬化的形成与脑梗死的发病密切相关。     

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.     

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.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.