Mechanism of physiologic and pathologic S3 gallop sounds.

Although the S3 gallop sound has long been used clinically as an indicator of left ventricular systolic dysfunction, the mechanism responsible for its production remains controversial. The same sound is often found in young healthy individuals, and whether a similar mechanism is responsible is also unknown. The relationship of the S3 gallop sound to the dynamics of left ventricular filling was compared in 18 healthy young triathletes and 15 older subjects with cardiac disease. Twenty healthy normal subjects without an S3 were included as controls. Phonocardiographic, two-dimensional echocardiographic, and Doppler echocardiographic analysis of left ventricular inflow were evaluated. The S3 in both groups always occurred close to peak early filling velocity (E), during early flow deceleration. Mean E deceleration rate was higher in the subjects with S3 (726 +/- 153 cm/sec2 in the triathletes and 819 +/- 274 cm/sec2 in those with cardiac disease) than in control subjects (563 +/- 131 cm/sec2, p less than 0.001 in both cases). Ten triathletes underwent examination both before and immediately after 30 degrees head-up tilt. E deceleration rate dropped significantly with head-up tilt (720 +/- 137 vs 590 +/- 174 cm/sec2, p less than 0.01), while concurrently the S3 disappeared or was diminished in amplitude. Similar changes were seen in subjects with cardiac disease. We conclude that both the "pathologic" and "physiologic" S3 are related to abnormally rapid deceleration of early diastolic left ventricular inflow. Although the presence of the S3 is not dependent on the state of left ventricular systolic function, diastolic filling is characterized by a predominance of early inflow with a rapid flow deceleration rate.     

The neural mechanism associated with the processing of onomatopoeic sounds

This event-related fMRI study was conducted to examine the blood-oxygen-level-dependent responses to the processing of auditory onomatopoeic sounds. We used a sound categorization task in which the participants heard four types of stimuli: onomatopoeic sounds, nouns (verbal), animal (nonverbal) sounds, and pure tone/noise (control). By discriminating between the categories of target sounds (birds/nonbirds), the nouns resulted in activations in the left anterior superior temporal gyrus (STG), whereas the animal sounds resulted in activations in the bilateral superior temporal sulcus (STS) and the left inferior frontal gyrus (IFG). In contrast, the onomatopoeias activated extensive brain regions, including the left anterior STG, the region from the bilateral STS to the middle temporal gyrus, and the bilateral IFG. The onomatopoeic sounds showed greater activation in the right middle STS than did the nouns and environmental sounds. These results indicate that onomatopoeic sounds are processed by extensive brain regions involved in the processing of both verbal and nonverbal sounds. Thus, we can posit that onomatopoeic sounds can serve as a bridge between nouns and animal sounds. This is the first evidence to demonstrate the way in which onomatopoeic sounds are processed in the human brain.     

植物雌激素染料木素对狗体外冠状血管的舒张作用及其机制

目的:以血管张力变化为指标,对染料木素和17β-雌二醇的心血管保护作用及相关机制进行探讨和比较。方法:①实验于2005-04/10在湖南学院机能实验室完成。选用雄性杂交家狗心脏,把狗心放在冰冷的K-H液中从屠宰场取回进行实验。染料木素(存在于大豆的植物雌激素),17β-雌二醇,吲哚美辛,Nω-L-硝基精氨酸,放线菌酮,前列腺素F2α和缓激肽,正矾酸钠,均购自Sigma公司;甲烯蓝由上海润捷化学试剂有限公司提供,用蒸馏水溶解,它莫西酚、染料木素、17β-雌二醇用二甲亚砜溶解配制,吲哚美辛用体积分数0.2乙醇溶解。②制备狗冠状动脉血管环,固定于恒温肌槽内,观察染料木素与17β-雌二醇对KCl预收缩离体冠状血管环的舒张作用:血管环稳定后,向浴槽中加入50mmol/LKCl,待血管环收缩张力达坪值后,用K-H液冲洗。然后,20min换液1次,平衡30min后重复上述实验,待血管环张力达高峰并稳定后,分别加入染料木素与17β-雌二醇,累积浓度为1,4,8,40和80μmol/L,观察血管环张力变化。观察阻断剂及内皮细胞对染料木素与17β-雌二醇舒血管作用的影响:重复前述实验内容后,用K-H液冲洗,每20min换液1次,温育1.5h,血管环稳定后,向浴槽中分别加入Nω-L-硝基精氨酸1×10-4mol/L,它莫西酚10-5mol/L,吲哚美辛1×10-5mol/L,正矾酸钠1×10-5mol/L或放线菌酮1×10-5mol/L,甲烯蓝1×10-5mol/L,温育15min或用棉签擦除内皮细胞后,重复前述实验内容。对比染料木素与17β-雌二醇对KCl50mmol/L预收缩血管平滑肌的舒张作用的变化,并随时记录张力的变化值。③用线性回归法计算染料木素与17β-雌二醇的使激动剂效应降低50%时所采用的拮抗剂的浓度。两组间计量资料差异比较采用t检验,3组或3组以上资料差异比较采用单因素方差分析。结果:①染料木素与17β-雌二醇作用相似,均可使50mmol/LKCl预收缩冠状动脉血管环产生剂量依赖性舒张作用(r=0.96,P<0.01),使激动剂效应降低50%时所采用的拮抗剂的浓度分别为(16.37±5.19)μmol/L和(22.64±8.26)μmol/L。②除内皮细胞或加入一氧化氮合酶抑制剂Nω-L-硝基精氨酸1×10-4mol/L,甲烯蓝1×10-5mol/L或正矾酸钠1×10-5mol/L温育,染料木素对50mmol/LKCl预收缩动脉血管环产生的量效舒张作用无明显改变(P>0.05),但17β-雌二醇对50mmol/LKCl预收缩动脉血管环产生的量效舒张作用有明显改变(P<0.01),1×10-5mol/L吲哚美辛,它莫西酚与放线菌酮对两者量效舒张血管的作用均无明显影响(P>0.05)。结论:①染料木素和17β-雌二醇对冠状动脉血管的舒张作用与前列腺素类物质的合成和血管壁传统雌激素受体无关,与雌激素经典核内作用途径无关。②17β-雌二醇的作用部分与内皮细胞释放的一氧化氮有关。③酪氨酸蛋白激酶系统可能参与了冠状动脉血管张力的调节。     

植物雌激素染料木素对狗体外冠状血管的舒张作用及其机制

目的：以血管张力变化为指标，对染料木素和17β-雌二醇的心血管保护作用及相关机制进行探讨和比较。方法：①实验于2005—04／10在湖南学院机能实验室完成。选用雄性杂交家狗心脏，把狗心放在冰冷的K—H液中从屠宰场取回进行实验。染料木索（存在于大豆的植物雌激素），17β-雌二醇，吲哚美辛，Nω-L-硝基精氨酸。放线菌酮，前列腺索F2α和缓激肽，正矾酸钠，均购自Sigma公司；甲烯蓝由上海润捷化学试剂有限公司提供。用蒸馏水溶解，它莫西酚、染料术紊、17β-雌二醇用二甲亚砜溶解配制，吲哚美辛用体积分数0.2乙醇溶解。②制备狗冠状动脉血管环，固定于恒温肌槽内，观察染料木紊与17β-雌二醇对KCl预收缩离体冠状血管环的舒张作用：血管环稳定后，向浴槽中加入50mmol／LKCl。待血管环收缩张力达坪值后。用K-H液冲洗。然后，20min换液1次，平衡30min后重复上述实验，待血管环张力达高峰并稳定后，分别加入染料木索与17β-雌二醇，累积浓度为1，4，8，40和80μmol／L，观察血管环张力变化。观察阻断剂及内皮细胞对染料木紊与17β-雌二醇舒血管作用的影响：重复前述实验内容后，用K-H液冲洗，每20min换液1次，温育1,5h，血管环稳定后，向浴槽中分别加入Nω-L-硝基精氨酸1&;#215;10^-4mol／L，它奠西酚10^-5mol／L，吲哚美辛1&;#215;10^-5mol／L，正矾酸钠1&;#215;10^-5mol／L或放线菌酮1&;#215;10^-5mol／L，甲烯蓝1&;#215;10^-5mol／L，温育15min或用棉签擦除内皮细胞后，重复前述实验内容。对比染料木紊与17β-雌二醇对KCl50mmol／L预收缩血管平滑肌的舒张作用的变化，并随时记录张力的变化值。③用线性回归法计算染料木素与17β-雌二醇的使激动剂效应降低50％时所采用的拮抗剂的浓度。两组间计量资料差异比较采用t检验，3组或3组以上资料差异比较采用单因素方差分析。结果：①染料木素与17β-雌二醇作用相似，均可使50mmol／L KCl预收缩冠状动脉血管环产生剂量依赖性舒张作用（r=0．96，P〈0．01），使激动剂效应降低50％时所采用的拮抗剂的浓度分别为（16．37&;#177;5．19）μmol／L和（22．64&;#177;8．26）μmol／L。②除内皮细胞或加入一氧化氮合酶抑制剂Nω-L-硝基精氨酸1&;#215;10^-4mol/L，甲烯蓝1&;#215;10^-4mol／L或正矾酸钠1&;#215;10^-5mol／L温育，染料木素对50mmol／LKCl预收缩动脉血管环产生的量效舒张作用无明显改变（P〉0．05）。但17β-雌二醇对50mmol／LKCl预收缩动脉血管环产生的量效舒张作用有明显改变（P〈0．01），1&;#215;10^-5mol／L吲哚美辛，它莫西酚与放线菌酮对两者量效舒张血管的作用均无明显影响（P〉0．05）。结论：①染料木索和17β-雌二醇对冠状动脉毗管的舒张作用与前列腺素类物质的合成和血管壁传统雌激素受体无关，与雌激素经典核内作用途径无关。②17β-雌二醇的作用部分与内皮细胞释放的一氧化氮有关。③酪氨酸蛋白激酶系统可能参与了冠状动脉血管张力的调节。     

第45讲兼症病学(各论部分)第5节舒张期心衰

1 概况 1.1 定义 DHF因多种疾病、病因导致心肌的舒张功能障碍而引发的舒张功能不全性心力衰竭.是一综合征,是复杂的兼症.     

Modern Assessment of Diastolic Function

Purpose of Review

The goal of this review is to outline the new guidelines released by the ASE/EACVI that seek to simplify the assessment of diastolic function and evaluate the use and potential application of new and emerging technologies.

Recent Findings

The latest guidelines have decreased the number of parameters needed to evaluate diastolic function to 3. The parameters necessary include peak tricuspid regurgitation (TR) velocity, average E/e′, and indexed left atrial volume (LAVi). At least 2 out of 3 must be positive to determine diastolic dysfunction. There are certain disease states that limit the application of the new guidelines and diastolic stress testing may be indicated in inconclusive cases. New and emerging technologies such as global longitudinal strain (GLS) may provide new opportunities to determine LV filling pressures.

Summary

New guidelines issued by the ASE and EACVI have simplified the assessment of diastolic function and should be implemented in daily practice.

     

多普勒超声测舒张早期室内充盈减射评价左室舒张功能

应用多普勒测量正常人及扩张型心肌病和缺血性心肌病患者舒张早期血流速度在左室内的改变，以估测此种改变对判断左室舒张功能的价值。结果表明：正常组二尖瓣及瓣下１ｃｍ、２ｃｍ、３ｃｍ处心室内不同部位的舒张早期充盈速度（Ｅ０、Ｅ１、Ｅ２、Ｅ３）及各点与瓣尖速度比值（Ｅ１／Ｅ０、Ｅ２／Ｅ０、Ｅ３／Ｅ０）均无统计学差异。而扩张型心肌病和缺血性心肌病患者Ａ／Ｅ＞１、器质性房颤及Ａ／Ｅ＜１“假性正常化”分组中一般Ｅ２开始降低，Ｅ３显著降低Ｅ３／Ｅ０比值与Ｅ１／Ｅ０比较存在差异（Ｐ值＜０．０５；Ｐ值＜０．０１）。同时Ｅ３速度及Ｅ３／Ｅ０比值与对照组比较存在差异。作者认为多普勒测量舒张早期左室血流充盈减射可用于评价左室舒张功能。