不同剂量羟考酮联合丙泊酚对无痛人工流产术后患者宫缩痛和情绪量值的影响

目的探讨不同剂量羟考酮联合丙泊酚对无痛人工流产术后患者宫缩痛和情绪量值的影响。方法选取医院2015年2月至2018年12月收治的自愿行无痛人工流产术患者160例,按随机数字表法分为A组(丙泊酚联合芬太尼)、B组(丙泊酚联合0.06 mg/kg羟考酮)、C组(丙泊酚联合0.08 mg/kg羟考酮)和D组(丙泊酚联合0.10 mg/kg羟考酮),各40例。结果B组、C组、D组患者丙泊酚用量显著少于A组,C组、D组患者的苏醒时间显著短于B组,B组、C组、D组患者苏醒后即刻(T1)、术后10 min(T2)、术后30 min(T3)、术后60 min(T4)视觉模拟评分(VAS)均显著低于A组,B组、C组、D组患者T4时的正性负性情绪量表(PANAS)中正性情绪量值均显著高于A组,C组患者T4时的负性情绪量值均显著低于其他3组(P<0.05);4组患者术后不良反应发生率无显著差异(P>0.05)。结论羟考酮联合丙泊酚用于无痛人工流产术麻醉,可有效改善患者术后宫缩痛和正性、负性情绪量值,其中以0.08 mg/kg羟考酮改善负性情绪量值效果最佳。     

地尔硫■控释片与戊四硝酯片对老年冠心病心绞痛与收缩时间间期的疗效比较

目的：比较盐酸地尔硫控释片（下简称地片）与戊四硝酯（下简称硝片）治疗老年冠心病心绞痛的疗效及对收缩时间间期（ＳＴＩ）的影响。方法：冠心病心绞痛病人４５例（男性２９例，女性１６例；年龄６４±ｓ４ａ）以随机、双盲、交叉对照法分别先后采用地片３０～９０ｍｇ，ｐｏ，ｔｉｄ，加外观似硝片的安慰剂（淀粉）１～３片，ｐｏ，ｔｉｄ，共４ｗｋ，为治疗组；或以硝片１０～３０ｍｇ，ｐｏ，ｔｉｄ，加外观似地片的安慰剂１～３片，ｐｏ，ｔｉｄ，共４ｗｋ，为对照组。２组于４ｗｋ疗程结束时，各给２种安慰剂１ｗｋ，待体内药物排尽然后２组交叉服药４ｗｋ。结果：地片组与硝片组比较，心绞痛症状疗效分别为９６％对４２％（Ｐ＜０．０１）；心电图疗效分别为４４％对２９％（Ｐ＞０．０５）；治疗组有显著降低高血压病人的舒张压及ＰＥＰ／ＬＶＥＴ比值的作用。结论：地片对心绞痛症状疗效、对原有高血压和ＳＴＩ不正常者疗效优于硝片。     

Chronic alcoholism and myocardial disease

Myocardial function was determined by echocardiographic and systolic time interval measurements in 24 abstinent chronic alcoholics and matched non-alcoholic controls. In the patients, the measurements were taken sequentially 24-48 h after their last drink, 5-7 days later and 14-21 days after the second testing. All measurements were done without the investigators' knowledge of whose tracing he was evaluating. The results showed no significant deviation from normal values in any of the patients at any time and are in keeping with the assumption that chronic, excessive alcohol use by itself has no toxic effect on a healthy myocardium; excessive alcohol use probably plays a role by further impairing myocardial function in an already diseased heart.     

Impaired biventricular deformation in Marfan syndrome: a strain and strain rate study in adult unoperated patients

Objective: To investigate the presence of any regional myocardial deformation abnormalities in Marfan syndrome (MFS) and determine the benefits of using advanced echocardiography compared to conventional techniques. Background: Myocardial dysfunction in MFS may be caused by extracellular matrix remodeling thus, resulting in uniform reduced functionality. However, increased aortic stiffness may cause segmental ventricular abnormalities. Strain rate imaging (SRI) constitutes a validated technique to assess regional deformation in various clinical conditions. With this in mind, we aimed to investigate biventricular function in MFS using SRI. Methods: Forty‐four MFS patients (mean age 30 ± 12 years, 26 men) and 49 controls without valvular disease were examined using SRI. Ejection fraction (EF) was calculated by the Simpson's biplane method. Biventricular deformation was assessed by measuring strain/strain rate. Strain values were divided by left ventricular (LV) end‐diastolic volume to adjust LV deformation for geometry changes providing a strain index (SI). Aortic stiffness was evaluated using the β‐stiffness index. Results: EF (%) was reduced in MFS patients (59 ± 5 vs 72 ± 4, P < 0.001), whereas β‐stiffness was increased (P < 0.001). LV radial and LV and right ventricular (RV) long‐axis strain values (%) were reduced in the patient group (70 ± 17 vs 93 ± 10; 19 ± 2 vs 25 ± 2; 30 ± 9 vs 36 ± 8, respectively, P < 0.001). Strain rate measurements were also reduced (P < 0.001). In a multiple regression analysis, MFS diagnosis was negatively associated with LV SI (?0.262 [?0.306, ?0.219], P < 0.001). β‐Stiffness was negatively associated with SI obtained from the septum, inferior and anterior walls. ROC analyses demonstrated that SRI, when compared with conventional echocardiography, had higher sensitivity and specificity in predicting biventricular dysfunction in MFS. Conclusions: Our study showed a uniform reduction in biventricular deformation in MFS. These findings suggest that assessment of myocardial function using advanced echocardiographic techniques could be more accurate in MFS patient evaluation than conventional echocardiography alone. (Echocardiography 2011;28:416‐430)     

Physiologic determinants of left ventricular systolic torsion assessed by speckle tracking echocardiography in healthy subjects

Background: The associations of left ventricular (LV) systolic torsion with clinical and echocardiographic variables in physiological conditions have not been fully investigated. We explored the independent determinants of LV systolic torsion in a population of normal subjects. Methods: In 119 healthy subjects, peak twist angle (LVtw) and torsion (LVtor) during ejection, and the QRS‐LVtw interval (time‐to‐peak LVtw) were measured by speckle tracking. LV twisting rate and rotational deformation delay were also determined. Results: Stepwise multiple regression showed that LVtw was independently associated with indexed end‐systolic volume (β=–0.200, P < 0.0001), peak early diastolic mitral annulus velocity (β=–0.186, P = 0.0001), heart rate (β= 0.178, P = 0.0003), and male gender (β=–0.174, P = 0.0004). Similar results were found for LVtor. Age was the only parameter, which has demonstrated an independent correlation with time‐to‐peak LVtw (β= 0.329, P < 0.0001). Despite significance of these associations, the proportions of variability explained by regression models were relatively low (range 11–26%), and no accurate predictive models were identifiable for LV twisting rate and rotational deformation delay. Conclusion: In normal individuals, indexed end‐systolic LV volume, LV relaxation, heart rate, gender, and age correlate independently with LV torsion mechanics. However, conventional echocardiographic and clinical variables are not able to predict LV torsion mechanics. (Echocardiography 2011;28:641‐648)     

Thioredoxin 1 enhances neovascularization and reduces ventricular remodeling during chronic myocardial infarction: a study using thioredoxin 1 transgenic mice

Oxidative stress plays a crucial role in disruption of neovascularization by alterations in thioredoxin 1 (Trx1) expression and its interaction with other proteins after myocardial infarction (MI). We previously showed that Trx1 has angiogenic properties, but the possible therapeutic significance of overexpressing Trx1 in chronic MI has not been elucidated. Therefore, we explored the angiogenic and cardioprotective potential of Trx1 in an in vivo MI model using transgenic mice overexpressing Trx1. Wild-type (W) and Trx1 transgenic (Trx1^Tg/+) mice were randomized into W sham (WS), Trx1^Tg/+ sham (TS), WMI, and TMI. MI was induced by permanent occlusion of LAD coronary artery. Hearts from mice overexpressing Trx1 exhibited reduced fibrosis and oxidative stress and attenuated cardiomyocyte apoptosis along with increased vessel formation compared to WMI. We found significant inhibition of Trx1 regulating proteins, TXNIP and AKAP 12, and increased p-Akt, p-eNOS, p-GSK-3β, HIF-1α, β-catenin, VEGF, Bcl-2, and survivin expression in TMI compared to WMI. Echocardiography performed 30 days after MI revealed significant improvement in myocardial functions in TMI compared to WMI. Our study identifies a potential role for Trx1 overexpression and its association with its regulatory proteins TXNIP, AKAP12, and subsequent activation of Akt/GSK-3β/β-catenin/HIF-1α-mediated VEGF and eNOS expression in inducing angiogenesis and reduced ventricular remodeling. Hence, Trx1 and other proteins identified in our study may prove to be potential therapeutic targets in the treatment of ischemic heart disease.     

Reduced preload elicits increased LV twist in healthy humans: an echocardiographic speckle-tracking study during lower body negative pressure

Background: In normal left ventricles (LV), counterclockwise rotation (CCR) and net twist angle (NTA) have shown important roles during ejection. We investigated the effect of reduced preload by lower body negative pressure (LBNP) on CCR and NTA. Methods and Results: Twelve healthy men were examined at rest, LBNP ?20 and ?40 mmHg. By two‐dimensional speckle‐tracking imaging, we measured rotation at four short‐axis levels: basal, papillary, sub‐papillary and apical. LV NTA was calculated as apex‐to‐base difference in rotation. Additionally, regional end‐diastolic (EDA) and end‐systolic area (ESA) were measured and regional area fraction (RAF) calculated [(EDA‐ESA)/EDA] × 100). From rest to LBNP ?40 mmHg, rotation at basal and papillary levels was unchanged. At sub‐papillary level, rotation increased from 3·2 ± 3·6 to 5·8 ± 4·7° (P<0·05), while apical rotation increased from 9·3 ± 3·4 to 12·8 ± 4·7° (P<0·05). Correspondingly, LV NTA increased for each load reduction by 1·6 ± 1·8° (P<0·05) and 4·2 ± 2·3° (P<0·05). RAF increased at sub‐papillary and apical levels from 57·6 ± 3·7 to 64·7 ± 8·8% and from 63·4 ± 8·8 to 74·8 ± 10·1%, respectively (P<0·05). From rest to LBNP ?40 mmHg, changes in rotation and RAF correlated significantly at sub‐papillary and apical levels (r = 0·94, P<0·01, and r = 0·63, P<0·05, respectively). Conclusions: Preload reduction in normal LV elicits increased systolic CCR and regional area fraction at sub‐papillary and apical levels as well as net twist angle. These findings might be of physiological importance to minimize reduction in stroke volume and maintain arterial blood pressure.     

定量组织速度成像和组织追踪成像对正常人左心室收缩运动的评价

目的:应用定量组织速度成像和组织追踪成像评价正常人左心室局部收缩运动并探讨有关的影响因素。方法:应用定量组织速度成像和组织追踪成像离线分析获得32例正常人的左心室长轴方向的心肌组织速度和位移曲线,测量平均峰值收缩速度(Vs)、加速度(acc)及峰值位移(Ds)。结果:①正常人左心室收缩运动在长轴方向有其规律性,即由心尖部向基底段收缩速度和位移逐渐降低,左心室游离壁的速度和位移大于前间隔、室间隔及下壁。②二尖瓣环水平Vs、acc及Ds与年龄存在负相关的关系,而与心率无相关。结论:定量组织速度成像和组织追踪成像能够有效的评价左心室局部心肌的收缩运动。