产前超声诊断婴儿型泛发性动脉钙化1例

孕妇33岁,G1P0,非近亲婚配,无传染病及遗传病家族史.孕17周超声示:左心室内可见强回声斑,三尖瓣瓣环回声略增强;孕22周左心室内强回声斑较前增大,二尖瓣腱索局部回声增强,肺动脉根部及左、右肺动脉起始部管壁回声增强;孕26周三尖瓣前叶及瓣环回声增强,见图1a,主动脉根部及动脉导管管壁节段性增厚、回声增强,动脉导管内...     

超声诊断胎儿左心发育不全1例

孕妇,31岁.孕30周时在我院行产前胎儿心脏超声检查.超声显示：胎儿右心室扩大,左心室发育不良,心腔呈一窄缝状,室壁增厚,心肌呈强回声（图1）.二尖瓣小,三尖瓣发育尚可.     

妊娠梅毒致胎死宫内胎儿超声心动图表现1例

孕妇26岁,孕4产0,孕35+4周,外院疑为胎儿心包积液.胎儿超声心动图:心房正位,房室及大动脉连接正常,冠状动脉起源及走行未见异常;心胸比例增大,心室壁增厚,各瓣口血流速度均加快,峰值流速达120 cm/s;左右冠状动脉内血流明显加快,峰值流速达118 cm/s(图1、2).产前超声诊断:胎儿心肌肥厚,高动力性循环状态.7天后无明显诱因胎动消失,次日于我院引产下一死男婴.尸检示心脏增大,心室壁增厚,左心室心内膜下心肌较之右心室颜色明显偏深、偏暗(图3).     

二维斑点追踪成像技术对超重及肥胖女性孕中晚期胎儿心室构型变化的评估

目的应用二维斑点追踪成像（2D-STI）评价孕前超重及肥胖女性孕中晚期胎儿心室构型变化。 方法回顾性选取2019年6月至2020年3月于空军军医大学唐都医院进行胎儿超声心动图检查的孕妇80例,根据孕前体质量指数（BMI）将其分为正常对照组30例、超重组27例和肥胖组23例。应用胎儿超声心动图获得常规胎儿心脏形态学指标,采用2D-STI技术并利用Fetal HQ软件获得孕24周及孕32周胎儿双侧心室24节段舒张末期横径及球形指数（SI）,3组间进行单因素方差分析,并采用LSD-t检验进一步行组间两两比较。 结果常规方法测量肥胖组、超重组与正常对照组孕妇胎儿的左、右心室舒张末期横径,左、右心室舒张末期长径,心胸面积比及左心室每搏输出量,3组间差异均无统计学意义（P均＞0.05）。孕中期（孕24周）肥胖组室间隔厚度较正常对照组增厚［（2.10±0.41）mm vs（1.85±0.33）mm］,孕晚期（孕32周）肥胖组室间隔厚度较正常对照组及超重组均增厚［（3.10±0.65）mm vs（2.46±0.52）mm、（2.55±0.53）mm］,差异均有统计学意义（P均＜0.05）。2D-STI测得肥胖组左心室横径孕24周第6~12节段及孕32周第7~12节段分别较同孕龄正常对照组明显增宽,肥胖组左心室SI孕32周第4~12节段较正常对照组明显降低（P均＜0.05）。2D-STI测得肥胖组右心室横径孕24周第3~10节段及孕32周第1~8节段分别较同孕龄正常对照组明显增宽,肥胖组右心室SI孕32周第1~9节段较正常对照组明显降低（P均＜0.05）。 结论孕前肥胖的孕妇胎儿左心室中间段、右心室基底段节段性横径增宽,与正常对照者相比更接近球形,提示测量左心室中间段及右心室基底段横径可更敏感地反映孕前肥胖孕妇胎儿心室形态的改变。     

超声诊断胎儿心内膜纤维弹力增生症1例

孕妇,40岁,孕3产1,孕31周.平素体健,无近亲结婚史和遗传性疾病史,无明显化学药品和放射线接触史.第一胎为健康男孩,无心脏畸形或心肌病等病.现超声检查:胎头位于耻骨联合上方,双顶径81 mm,头围294 mm,股骨长57 mm,胎心率144次/min.四腔心切面显示胎儿左、右心室大小不对称,左心室明显扩大,大小约40 mm×36 mm,心内膜增厚,回声增强,室壁运动明显减低(图1A).心包腔可见宽度约5 mm的无回声区,胸、腹腔内可见片状无回声区,最大深度20 mm.胎儿皮肤明显水肿、增厚,最厚处约15 mm.彩色多普勒血流成像:二尖瓣可见中等量反流血流信号(图1B).     

脉压指数与新疆维吾尔族原发性高血压左心室舒张功能的相关性研究

目的 探讨脉压指数(PPI)与新疆维吾尔族原发性高血压患者左心室舒张功能的关系.方法 106例经外周肱动脉压力测定收缩压(SBP)、舒张压(DBP),以PPI≤0.40和＞0.40分为两组进行分析.比较两组左心形态、左心室收缩功能和舒张功能情况.结果 PPI＞0.40组左心房内径明显增大(P＜0.05);左心室内径无明显改变(P＞0.05);室间隔、左心室后壁明显增厚,E/A值降低(P＜0.05),而左心室射血分数差异无显著性(P＞0.05).结论 对于新疆维吾尔族原发性高血压患者来说,高血压可导致左心形态发生改变,以左心房内径增大、室间隔及左心室后壁增厚为主要特征;左心室舒张功能异常出现早于左心室收缩功能异常.PPI＞0.40提示新疆维吾尔族原发性高血压患者早期合并有舒张功能障碍.     

超声结构筛查对16～18周胎儿染色体核型正常而NT增厚的价值

目的 探讨孕16～18周行超声结构筛查在染色体核型正常而颈项透明层(NT)增厚胎儿筛查中的应用价值.方法 308例NT增厚但染色体核型正常的胎儿在孕16～18周、孕20～24周分别行超声结构筛查和超声心动图检查,对超声检查结果与新生儿/尸检结果进行对比分析.结果 产前诊断出结构异常87例(孕11～13周检出52例、孕1...     

胎儿颜面部血管瘤超声表现1例

孕妇,26岁.孕1产0,孕31周.产前超声检查见双顶径:80 mm,股骨长58 mm,肱骨52 mm,胎儿左侧脸颊及左侧颈部皮下组织稍厚,厚约8.3mm.增厚组织呈稍低回声,内可见网格状回声.CDFI示增厚组织内血流信号不明显.胎儿上唇连续,眼鼻可见.2周后复查彩超示:双顶径:83mm,股骨长63 mm,肱骨长56 mm,左侧脸颊及左侧颈部皮下组织明显稍厚,厚约13 mm.CDFI示增厚组织内可见条状血流信号,呈低速静脉频谱.超声提示:左侧脸颊及左侧颈部皮下组织增厚,考虑血管瘤(图1).引产后所见:胎儿左侧脸颊及颈部软组织明显增厚,皮肤呈紫红色.病理诊断:海绵状血管瘤.     

3.0T磁共振与双源CT在经导管射频消融治疗房颤术前评估左心房与肺静脉结构的应用

目的 探讨MRI在肥厚性心肌病诊断中的应用价值。方法 经临床、超声或MRI综合评价诊断为肥厚性心肌病的患者12例,其中男10例,女2例,年龄36~53岁,平均48.6岁。所有患者均接受超声心动图和MR检查,MR检查应用SiemensAvanto1.5T扫描仪,全景成像矩阵(TIM)线圈,成像序列采用TrueFISP和HASTE序列。扫描程序包括:①定位像快速扫描:包括轴位、冠状位以及矢状面在内的三种不同方位定位像图像。②采用快速自旋回波序列,以8mm 层厚,覆盖主动脉和心脏全部的多层轴位扫描。③分别做出心脏垂直长轴位、水平长轴位和左心室流入、流出道位的定位像,并以长轴位为定位图像,扫描出短轴位图像定位。垂直长轴位图像是在轴位图像上沿心尖至二尖瓣中心的连线扫描获得平行于室间隔的长轴位图像。水平长轴位图像是在垂直长轴位图像上,沿心尖至二尖瓣中心的连线扫描获得垂直于室间隔的长轴位图像。左心室流入、流出道位以心脏短轴位近左心室基底部层面作为定位像,沿心尖、二尖瓣的中心以及主动脉瓣的中心连线扫描。④采用心脏电影成像序列,进行心脏长轴位和四腔心位不同时相扫描,以连续动态方式快电影回放;对左心室短轴位多层面进行不同时相扫描,左心室短轴位多层面扫描从二尖瓣所在的平面开始扫描至心尖。扫描层厚6~8mm,层间隔10mm。结果 所有12例患者的MR图像均明确显示心肌增厚的部位和范围,其中以心尖为主3例,室间隔为主4例,同时有心尖和室间隔增厚的4例,左心室弥漫性增厚1例。左心室收缩期显示流出道狭窄1例。牛眼图分17个节段明确显示心壁异常增厚及收缩期心肌增厚率减低部位。3例左心室射血分数严重偏高,左心室收缩末期容积指数偏低,左心室心肌厚度偏大;5例心输出量偏高,心脏指数偏高,左心室重量偏高,左心室重量指数偏高,右心室射血分数偏高,左心室部分区域心肌增厚程度偏小,左心室部分区域心肌厚度偏大;4例左心室重量指数偏高,右心室射血分数偏高,左心室部分区域心肌厚度偏大。结论 MRI可全面显示肥厚性心肌病的解剖形态、心脏局部和整体功能、左心室流入、流出道形态、左心室室壁异常增厚和收缩期增厚率减低等改变,结合心脏MR电影分析,为临床诊断、治疗提供直观、动态的心脏影像学评价信息。     

高血压与左心室重构的关系

目的：探讨高血压与左心室重构的关系。方法：采用超声心动图和动态血压对９０例高血压病患者和１０１例正常人进行对比研究。结果：９０例高血压患者中左心室形态正常２２例，单独室间隔增厚４０例，左室后壁和室间隔增厚２８例，还发现后二者仅左室后壁厚度存在明显差别，但室间隔增厚的程度则无显著性差别。结论：高血压患者左室重构为非对称性，以室间隔增厚为主。     

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.