门控断层心室显像评价右室不同部位起搏患者的同步性

Objective To compare the effect of right ventricular outflow tract (RVOT) and right ventricular apex (RVA) pacing on ventricular systolic synchrony using gated blood pool SPECT (GBPS).Methods A total of 50 patients implanted with pacemaker due to high degree or complete atria-ventricular block were enrolled in the study. Twenty-three patients were RVOT paced ( Group A, n = 23) and 27 were RVA paced (Group B, n=27). Twenty-four patients with malignancy, normal echocardiographic findings and no history of cardiac diseases were scheduled for pre-chemotherapy evaluation of cardiac structure and function and were enrolled as control group ( Group C, n = 24). All patients underwent GBPS imaging and the values of phase angle (PS), mean phase of each wall, standard deviation (SD) of mean phase of each wall, lateral-septal motion delay of left ventricle ( LV Sep-Lat Delay), septal-right ventricular (RV) delay of LV ( LV Sep-RV Delay) and LV-RV Delay were acquired. The parameters of ventricular systolic synchrony among the three groups were compared using one-way ANOVA. Results The mean phase of LV lateral wall in Groups A and B were significantly higher than that in Group C: Group A (120.50 ±40.58) ms; Group B (103.23±28.34) ms; Group C (84.63 ±22.38) ms (F=7.72, P ＜0.05). There was no significant difference between Groups A and B ( t = 1.30, P ＞ 0.05 ). The mean phase of RV in Group A was significantly larger than those in Groups B and C: Group A ( 137.05 ± 39.27) ms, Group B ( 100.85 ± 23.79) ms,Group C (59. 13 ±30.52) ms (F=35.55, P＜0.05). PS, SD and LV Sep-Lat Delay in Groups A and B were significantly higher than those in Group C: (85.73 ± 12.00)°vs (89.85 ± 15.61 )°vs (58.95 ±9.87)°, (27.68±10.66) ms vs (26.15 ±13.02) ms vs (15.63 ±8.35) ms, (25.06±34.23) ms vs (2. 62 ± 60. 31 ) ms vs ( - 23.66 ± 31.39) ms, F = 41.54,8.55,6.81, all P ＜ 0.01 ), however, there was no significant difference between Groups A and B ( t = 0. 68, 0.68, 1.30, all P ＞ 0.05 ). LV Sep-RV Delay and LV-RV Delay were significantly different among the three groups ( LV Sep-RV Delay: Group A (57.60 ±56.77) ms, Group B (6.36 ±61.88) ms, Group C ( -41.89 ±35.78) ms; LV-RV Delay:Group A (47.36 ±42.59) ms, Group B ( 3.08 ± 38.81 ) ms Group C ( - 26.50 ± 20.99 ) ms, F = 20. 32,25.38, both P ＜ 0.01 ). Conclusion Both RVA and RVOT pacing increase the segmental phases detected by GBPS, causing inter- and intra- ventricular asynchrony compared with patients without pacemakers.     

实时三维经胸超声心动图评价右室不同部位起搏对左室收缩同步性和收缩功能的影响

目的 应用实时三维经胸超声心动图(RT-3D-TTE)评价右室流出道( RVOT)间隔部与右室心尖部(RVA)起搏对左室收缩同步性和收缩功能的影响.资料与方法 65例缓慢心律失常患者采用掷硬币随机法分为RVOT间隔起搏组35例,RVA起搏组30例.于起搏器植入术前当天、术后1个月、3个月、6个月及12个月分别行RT-3D-TTE检查并采集三维全容积图像,用Qlab软件测量左室16节段的最小容积点距离心电图QRS起始点平均时间的标准差(Tmsv 16-SD)和最大时间差(Tmsv 16-Dif).测量左室舒张末期内径( LVEDD)和左室射血分数(LVEF).结果 RVOT组和RVA组术前当天Tmsv 16-SD、Tmsv 16-Dif、LVEDD和LVEF差异无统计学意义(P＞0.05),但两组内术后1个月、3个月、6个月、12个月Tmsv16-SD、Tmsv 16-Dif均较术前增大(P＜ 0.05); RVOT组术后LVEDD和LVEF与术前比较差异无统计学意义(P＞0.05); RVA组术后6个月、12个月LVEDD较术前增大,LVEF减小(P＜0.05).两组间术后1个月、3个月Tmsv 16-SD、Tmsv 16-Dif、LVEDD和LVEF差异均无统计学意义(P＞0.05);RVOT组术后6个月、12个月Tmsv 16-SD、Tmsv 16-Dif、LVEDD较RVA组小;LVEF较RVA组大,差异有统计学意义(P＜0.05).结论 RVOT和RVA起搏均可引起心脏收缩不同步,对左室整体收缩功能有一定影响.RVOT间隔部起搏较RVA起搏对左室同步性的影响小,是较好的右室起搏部位.     

不同时段介入治疗对心肌梗死室壁瘤患者心室收缩同步性及血浆脑钠肽的影响

目的对比经皮冠状动脉介入（PCI）治疗对急性心肌梗死（AMI）后左心室室壁瘤（LVA）形成、心室收缩同步性及血浆脑钠肽（BNP）的影响。方法选择2001年1月至2004年7月收治的首次急性前壁心肌梗死及左心室造影（LVG）确定合并室壁瘤者共326例,根据PCI施行的时间分为4组：A组32例（〈3h）、B组89例（≥3h且〈6h）、C组129例（≥6h且〈12h）、D组76例（AMI后1周）,4组患者于PCI后1周时行平衡法核素心室显像（ERNA）,测定左室整体和局部收缩功能、舒张功能和收缩同步性功能参数及反常室壁容积指数（PVI）;AMI后6个月随访时重复测定上述参数,并随访3年,记录主要恶性心脏事件（MACE）的发生率。所有患者于发病后18h,第5天及24周测定血浆BNP质量浓度。对数据行方差分析和,检验。结果AMI后6个月随访时,A、B、C3组左心室射血分数（LVEF）较D组明显增高（F=5．81,P〈0．05）,而相角程（PS）、半高宽（FWHM）明显降低（F=5．90和6．80,P均〈0．05）;A组反常容积消失病例数明显高于B、C、D组,且A组PVI明显低于B、C、D组[分别为（12．08±2．07）％、（15．43±2．39）％、（16．49±2．47）％、（20．41±3．68）％,F=4．32,P〈0．05]。D组发病后18h、第5天和第24周血浆BNP质量浓度均明显高于A组[（12．30±2．24）彬L与（9．85±2．60）μg／L,（9．47±1．95）μg／L与（6．65±1．56）μg／L,（5．36±1．43）μg／L与（3．27±1．12）μg／L,F=5．19,P〈0．05],B、C组差异无统计学意义（F=5．19,P〈0．05）,但均低于D组。住院期间及术后3年随访A,B,C3组梗死后心绞痛发生率和3年随访时死亡率[6．25％（2／32）与3．12％（1／32）,8．99％（8／89）与5．62％（5／89）,9．30％（12／129）与7．76％（10／129]均低于D组[21．05％（16／76）与17．11％（13／76）]∥分别为91．3和10．05,P均〈0．05。结论对AMI患者梗死相关动脉开通越早、越充分,才能越有效地抑制并逆转LVA的形成,提高左心室功能,最终改善患者预后。     

速度向量成像评估单心室腔肺分流术后心室收缩同步性

目的 探讨速度向量成像技术（velocity vector imaging,ⅤⅥ）评估单心室腔肺分流术后心肌收缩活动同步性的可行性及准确性.方法 应用Simense Sequoia C512超声仪,通过ⅤⅥ技术对47例单心室术后及年龄匹配的47名正常儿童进行研究.结果 单心室腔肺分流术后任意两心肌节段间速度达峰时间最大差值明显高于正常儿童[（169.87±85.10）ms vs （88.30±29.88）ms,P＜0.01],术后组任意两心肌节段间应变达峰时间最大差值明显高于正常儿童[（211.70±106.06）msvs （82.23±63.44）ms,P＜0.01],术后组收缩期速度达峰时间标准差高于正常儿童[（71.47±35.07） vs （39.72±14.96）,P＜0.01],术后组应变达峰时间标准差高于正常儿童[（87.16±44.48）vs （32.47±23.66）,P ＜0.01].结论 单心室腔肺分流术后患者仍然存在心室收缩活动不同步,ⅤⅥ技术可以比较准确地反映心室收缩同步性.     

小儿心脏大血管CTA低kVp扫描的应用价值

目的 探讨低kVp扫描技术在小儿心脏大血管CTA检查中降低辐射剂量的价值.方法 选取小儿先天性心脏病CTA检查病例39例分为两组,A组24例,B组1 5例.A组使用常规kVp 120,B组使用低kVp 90.记录两组病例扫描时机器自动显示的扫描长度（L）、容积CT剂量指数（CTDIvol）及剂量长度乘积（DLP）.测量并计算左心房中部水平胸主动脉信噪比（SNR）、对比噪声比（CNR）以客观评价图像质量;双盲法主观评价心脏大血管后重组图像对肺动脉六分支的显示情况并给予优、良、差分级.对L、CTDIvol、DLP、E值、SNR及CNR进行t检验,主观图像质量评价采用x2检验.结果 A组和B组L分别为（10.40±1.97）cm和（9.54±1.72）cm,两组比较无统计学差异（P=0.169）.A组和B组的CTDIvol分别为（11.6±0）mGy和（5.0±0）mGy,DLP为（120.67±22.55）mGy·cm和（47.68±8.61）mGy·cm,两组比较均有统计学差异（P＜o.0001）,B组比A组分别降低56.9％、60.5％.A组和B组SNR分别为（41.86±12.05）和（42.11±7.83）（P=0.944）,CNR分别为（33.15±10.82）和（33.75±6.76）（P=0.850）,两组比较无统计学差异.A组和B组的图像质量主观评判诊断满意率均达1oo％,统计学比较无差异.结论 小儿心脏大血管CTA检查使用低kVp扫描技术可以较大幅度降低辐射剂量,且不影响图像质量,具有较大的临床应用价值.     

放射性125I粒子植入针芯对CT图像质量的影响

目的 研究CT引导放射性125I粒子植入治疗实体肿瘤时,针芯对CT图像质量的影响.方法 选取CT引导下125I粒子植入患者术中42个圆形感兴趣区(ROI),分别测量每个ROI对应的无植入针、有植入针拔针芯、有植入针未拔针芯的CT值和CT值噪声标准差(SD).得到3组CT值、SD,其中无植入针组为A组、有植入针拔针芯组为B组、有植入针未拔针芯组为C组,以A组数据为基准,分别计算B组与A组、C组与A组CT值、SD的差值百分比.结果 A、B、C3组CT值的平均数分别为(17.09±39.40)、(106.86±52.28)、(120.05±73.47)HU,组间差异有统计学意义(F =40.19,P＜0.05);A、B、C3组SD的平均数分别为(41.42±38.71)、(106.86±52.28)、(239.88±112.08) HU,组间差异有统计学意义(F =75.26,P＜0.05);B组与A组、C组与A组CT值的差值百分比分别为(121.34±160.35)％、(438.00±441.30)％,组间差异有统计学意义(Z=-5.63,P＜0.05);B组与A组、C组与A组SD差值百分比分别为(251.53±240.25)％、(785.67±766.91)％,组间差异有统计学意义(Z=-5.66,P＜0.05).结论 CT成像参数条件相同的情况下,粒子植入针明显影响图像质量,拔出一定距离的针芯可明显减少该影响,提高图像质量,有利于粒子的准确布源.     

完全植入式静脉输液港3种植入途径临床对比

【摘要】 目的 评价完全植入式静脉输液港（TIVAP）3种植入途径的临床效果。 方法 回顾性分析2018年1月至2019年12月在北京世纪坛医院接受TIVAP植入术患者320例。根据植入方式不同分为经颈内静脉穿刺组（A组,n=205）、经锁骨下静脉穿刺组（B组,n=60）、经头静脉切开植入组（C组,n=55）。比较3组患者一般资料、早期并发症、晚期并发症及患者满意度情况。 结果 3组患者均未出现血胸、空气栓塞等严重并发症。A组置管长度（33.8±5.1） cm,为3组中最长（P＜0.05）;B组患者气胸（6.7%）、损伤动脉（5.0%）、局部血肿（8.3%）发生率均为3组中最高（P＜0.05）;C组手术时间为（39.8±10.6） min,高于其他两组（P＜0.05）。A、B、C组置管失败率分别为0、3.3%、3.6%（P＜0.05）。3组患者伤口感染、堵管、血栓形成发生率差异无统计学意义（P＞0.05）。A、B组导管成角折叠或卡压、体位性堵管发生率明显高于C组（P＜0.05）。术后随访3～6个月,3组患者疼痛视觉模拟评分（VAS）、影响穿衣、影响睡眠、上肢活动不适感及总体满意度差异均无统计学意义（P＞0.05）。 结论 3种TIVAP植入方法均安全有效。穿刺植入途径普及率高,简单易学,结合超声导引成功率高;头静脉切开植入途径严重并发症发生率最低,但置管失败率较穿刺途径高。     

小干扰RNA抑制核因子-κB增强131I治疗甲状腺癌疗效的研究

目的 探讨小干扰RNA (siRNA)抑制核因子-κB (NF-κB)对131I致DTC细胞凋亡能否产生协同作用.方法 2×104 MBq/L 131I作用人甲状腺乳头状癌细胞株KTC-1 24 h后做DNA结合实验,48 h后做细胞存活分析.Western blot鉴定131I作用6h后细胞NF-κB p65的变化,24 h后凋亡抑制因子[X-染色体相关凋亡抑制蛋白(XIAP)、细胞凋亡抑制因子1(clAP1)、B细胞淋巴瘤因子大亚基(Bcl-xL)]、凋亡关键因子[半胱氨酸蛋白酶(caspase 3)和多聚腺苷二磷酸核糖聚合酶(PARP)]的变化.p65和凋亡抑制因子的Western blot检测分4组:未转染(A)组、未转染+131I(B)组、转染对照siRNA+ 131I(C)组和转染p65 siRNA+131I(D)组;其余实验分为6组:未转染(1)组、转染对照siRNA(2)组、转染p65 siRNA(3)组、未转染+131I(4)组、转染对照siRNA+131I(5)组和转染p65 siRNA+131I(6)组.多组间均数比较采用单因素方差分析,均数两两比较采用q检验.结果 1至6组DNA结合率分别为(100.00±11.65)％、(96.00±17.98)％、(9.28±5.01)％、(322.72±50.81)％、(311.36±44.81)％和(36.96±15.66)％,差异有统计学意义(F=137.74,P＜0.01);131I作用后KTC-1细胞NF-κB活性均增强(q4∶1组=10.90,q5∶2组=11.38,均P＜0.01);p65 siRNA可抑制NF-κB功能(q1∶3组=18.25,q4∶6组=13.71,均P＜0.01).6组细胞存活率分别为(100.00±11.65)％、(96.32±9.44)％、(70.88±7.41)％、(64.16±9.50)％、(62.24±9.37)％和(28.64±6.74)％ (F=52.76,P＜0.01);3、4和6组比,q=10.76和7.79,均P＜0.01.Western blot结果显示A、B、C和D组p65相对表达水平分别为(56.60 ±7.37)％、(111.07±13.31)％、(113.16±15.04)％和(12.46±2.74)％,差异有统计学意义(F=60.17,P＜0.01);131I作用后p65浓度增高(qB∶A组=6.20,qc∶A组=5.85,均P＜0.01);p65 siRNA可抑制其浓度增高(qB∶D组=12.57,qc∶D组=11.41,均P＜0.01).4组XIAP、cIAP1和Bcl-xL分别为(17.59±1.96)％、(16.45±1.85)％和(19.92±2.22)％,(98.37±17.92)％、(109.81±19.16)％和(95.59±22.20)％,(98.43±18.71)％、(98.86±15.88)％和(100.99±21.70)％,(7.00±0.95)％、(5.86±0.35)％和(9.52±0.90)％,差异均有统计学意义(F =44.22、56.51和29.11,均P＜0.01);131I作用后三者表达增加(qB∶A组 =7.76、8.40和5.88,均P＜0.01);p65 siRNA可抑制三者表达(qB∶D组=8.82、9.40和6.71,均P＜0.01).6组caspase 3亚基p19和p17、PARP活性蛋白p116和失活产物p89差异均有统计学意义(F=39.03、48.45、32.56和52.20,均P＜0.01);3、4和6组比q =3.18 ～9.98,均P＜0.05.结论 131I通过活化NF-κB导致甲状腺癌细胞内凋亡抑制因子表达升高,p65 siRNA可抑制这种变化;联合使用p65 siRNA对131I致DTC细胞凋亡产生协同效应.     

MSCT测量肝硬化体积与肝脏储备功能关系研究

目的 探讨肝硬化患者肝脏体积(LV)的变化趋势及与肝功能有关指标的相关性.方法 收集在本院接受MSCT扫描肝硬化患者45例,测量、分析LV数值范围的差异;收集MSCT检查前1周内的肝功能指标谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、白蛋白(ALB)和凝血酶原时间(PT)的检验结果.设定P值,检验是否具有统计学意义.结果 肝硬化A、B、C级LV数值分别为(985.87±147.29)cm3、(818.77±138.49)cm3、(677.01±118.58)cm3,各级之间体积差异具有统计学意义(P＜0.05).A级中LV与肝功能指标均没有密切的相关关系(P＞0.05),B级中LV与ALB呈正相关(r=0.548,P＜0.05),与ALT、AST、TBIL(P＞0.05)及PT(r=-0.508,P＜0.05)呈负相关,与ALB、PT的相关系数r具有统计学意义;C级中与各项指标均有密切的相关关系,与ALB呈正相关(r=0.545,P＜0.05),与ALT(r=-0.711,P＜0.05)、AST(r=-0.537,P＜0.05)、TBIL(r=-0.878,P＜0.05)及PT(r=-0.597,P＜0.05)呈负相关.结论 肝硬化时LV数值与临床常规肝功能检查指标之间有一定的相关性,MSCT测量方法能定量评价LV变化,评价病肝储备功能状况具有一定的参考价值.     

磁感应加热和HSV—tk自杀基因及核素内照射联合治疗乳腺癌的实验研究

目的 观察纳米磁粒磁感应加热、单纯疱疹病毒-胸苷激酶（HSV-tk）基因及核素内照射联合治疗MCF-7乳腺癌的作用,探讨联合治疗的有效性与可行性.方法 制备转染试剂脂质体（Lipofectamine）/含热休克蛋白启动子的HSV-tk基因表达质粒（pHSP-HSV-tk）、四氧化三铁纳米磁流液、188Re-丙氧鸟苷白蛋白纳米微球（GCV-BSA-NP）;进行四氧化三铁纳米磁流液的体内加热实验;建立MCF-7乳腺癌模型,并用单纯随机抽样法将60只荷瘤鼠分成6组,每组10只.A组为空白对照组,B组为单纯基因转染治疗组,C组为单纯热疗组,D组为基因转染联合核素内照射治疗组,E组为基因转染联合热疗组,F组为基因、热疗、核素内照射联合治疗组.各组经不同方法处理后,观察肿瘤生长情况,测肿瘤质量,观察肿瘤组织病理变化;RT-PCR法检测B、D、E、F组HSV-tk基因表达（与内参β-actin mRNA吸光度比值）情况.各组与对照组比较采用泊松分布及单因素方差分析,所用统计软件为SPSS 10.0.结果 在动物体内加热实验中,交变磁场（AMF）作用下,不同注射剂量磁粒都引起肿瘤组织温度快速升高,2,4和6 mg磁粒分别使肿瘤温度升至39.6 ℃,43.2 ℃和48.1 ℃,且持续40 min.当AMF作用停止后,肿瘤组织温度10 min内分别降至36.8 ℃,37.5 ℃和37.8 ℃.成功建立MCF-7乳腺癌模型,治疗结果显示：C、D、E、F组肿瘤质量[（452.50±30.29）、（240.98±35.32）、（231.87±27.41）、（141.55±23.78）mg]较A组[（719.12±22.65）mg]差异有统计学意义（F=800.007,P＜0.01）,且以F组疗效最好;C组与E组肿瘤质量大于F组,差异有统计学意义（t=25.533,7.872,P均＜0.05）;D组较B组肿瘤质量明显减小,且差异有统计学意义（t=32.805,P＜0.05）.RT-PCR半定量分析显示：B、D组的表达量（0.33±1.30,0.46±0.12）与E、F组（0.66±0.13,0.74±0.11）相比差异有统计学意义（F=21.573,P＜0.05）.结论 热疗、基因治疗联合核素治疗能有效抑制MCF-7乳腺癌的生长,对乳腺癌治疗有潜在的应用前景.     

兔肘关节尺侧副韧带急性损伤手术与非手术治疗后的生物力学比较

目的 比较兔急性肘关节尺侧副韧带损伤后手术修复与非手术治疗效果的差异.方法 选取新西兰兔81只,完全随机分为三组,27只暴露出右尺侧副韧带后,但不切断,作为正常对照组(A);27只为切断右肘尺侧副韧带后随即缝合韧带,称为韧带缝合组(B);27只切断尺侧副韧带后不缝合,称为韧带不缝合组(C).分别在术后3,6,12周三个阶段取材,进行生物力学检测.结果 术后12周,B组断裂时的位移为(6.06±0.48)mm,C组为(7.72±0,44)mm(P＜0.05),B组位移接近A组[(5.87±0.46)mm](P＞0.05);B组的最大载荷为(68.23±5.64)N,C组为(42.45±3.66)N(P＜0.05),B组接近A组[(72.86±2.99)N](P＞0.05);B组的轴向刚度为(11.33±1.52)N/mm,C组为(5.52±0.67)N/nan(P＜0.05),B组接近A组[(12.49±1.44)N/mm](P＞0.05);B组的功耗为(0.206±0.017)J,C组为(0.163±0.013)J(P＜0.05),B组接近A组[(0.213±0.010)J](P＞0.05).结论 肘关节尺侧副韧带急性损伤后手术治疗明显优于非手术治疗.     

Gated blood pool SPECT improves reproducibility of right and left ventricular Fourier phase analysis in radionuclide angiography

OBJECTIVES: The ventricular phase angle, a parametric method applied to Fourier phase analysis (FPA) in radionuclide ventriculography, allows the quantitative analysis of ventricular contractile synchrony. However, FPA reproducibility using gated blood pool SPECT (GBPS) has not been fully evaluated. The present study evaluates whether by using GBPS, the reproducibility of FPA could be improved over that in planar radionuclide angiography (PRNA). METHODS: Forty-three subjects underwent both GBPS and PRNA, of which 10 subjects were normal controls, 25 had dilated cardiomyopathy, and 8 had various heart diseases. Interventricular contractile synchrony was measured as the absolute difference in RV and LV mean ventricular phase angle as delta(phi) (RV - LV). Intraventricular contractile synchrony was measured as the standard deviation of the mean phase angle for the RV and LV blood pools (RVSD(phi), LVSD(phi)). Two nuclear physicians processed the same phase images of GBPS to evaluate the interobserver reproducibility of the phase angles using data from the 43 study participants. Phase images acquired from PRNA were processed in the same manner. RESULTS: Excellent reproducibility of delta(phi) (RV - LV) was obtained with both GBPS (Y = -3.10 + 0.89 x X; r = 0.901) and PRNA (Y = -4.51 + 0.81 x X; r = 0.834). In regard to RVSD(phi) reproducibility was not adequate with PRNA (Y = 18.56 + 0.35 x X; r = 0.424), while it was acceptable with GBPS (Y = 5.22 + 0.85 x X; r = 0.864). LVSD(phi) reproducibility was superior using both GBPS (Y = 4.15 + 0.97 x X; r = 0.965) and PRNA (Y = -0.55 + 0.98 x X; r = 0.910). CONCLUSION: Our results demonstrate FPA obtained using GBPS to be highly reproducible for evaluating delta(phi) (RV - LV), RVSD(phi) and LVSD(phi), in comparison with the PRNA method. We thus consider GBPS appropriate for evaluating ventricular contractile synchrony.     

Electrocardiographically gated blood-pool SPECT and left ventricular function: comparative value of 3 methods for ejection fraction and volume estimation.

The current major limitation to development of electrocardiographically (ECG) gated blood-pool SPECT (GBPS) for measurement of the left ventricular (LV) ejection fraction (LVEF) and volumes is the lack of availability of clinically validated automatic processing software. Recently, 2 processing software methods for quantification of the LV function have been described. Their LVEFs have been validated separately, but no validation of the LV volume measurement has been reported. METHODS: We compared 3 processing methods for evaluation of the LVEF (n = 29) and volumes (n = 58) in 29 patients: automatic geometric method (GBPS(G)), semiautomatic activity method (GBPS(M)), and 35% maximal activity manual method (GBPS(35%)). The LVEF provided by the ECG gated equilibrium planar left anterior oblique view (planar(LAO)) and the LV volumes provided by LV digital angiography (Rx) were used as gold standards. RESULTS: Whereas the GBPS(G) and GBPS(M) methods present similar low percentage variabilities, the GBPS(35%) method provided the lowest percentage variabilities for the LVEF and volume measurements (P < 0.04 and P < 0.02, respectively). The LVEF and volume provided by the 3 methods were highly correlated with the gold standard methods (r > 0.98 and r > 0.83, respectively). The LVEFs provided by the GBPS(35%) and GBPS(M) methods are similar and higher than those of the GBPS(G) method and planar(LAO) method, respectively (P < 0.0001). For the LVEF, there is no correlation between the average and paired absolute difference for the 3 GBPS methods against the planar(LAO) method, and the limits of agreement are relatively large. LV volumes are lower when calculated with the GBPS(M), GBPS(G), and Rx methods (P < 0.0001). However, the GBPS(35%) and Rx methods provide LV volumes that are similar. There is no linear correlation between the average and the paired absolute difference of volumes calculated with the GBPS(G) and GBPS(35%) methods against Rx LV volumes. However, a moderate linear correlation was found with the GBPS(M) method (r = 0.6; P = 0.0001). The 95% limits of agreement between the Rx LV volumes and the 3 GBPS methods are relatively large. CONCLUSION: GBPS is a simple, highly reproducible, and accurate technique for the LVEF and volume measurement. The reported findings should be considered when comparing results of different methods (GBPS vs. planar(LAO) LVEF; GBPS vs. Rx volume) and results of different GBPS processing methods.     

99Tc．MDP联合“骨康灵”治疗兔骨质疏松的生物力学研究

目的探讨99Tc．MDP联合中药“骨康灵”治疗骨质疏松兔模型在治疗前后的骨生物力学变化。方法制作兔骨质疏松动物模型（C组）与对照组（A组）,以证实骨质疏松模型建立。设正常对照组（B组）和骨质疏松对照组（D组）,用于在实验结束时对照;同时设99Tc—MDP治疗组（E组）、“骨康灵”治疗组（F组）和99Tc—MDP联合“骨康灵”治疗组（G组）,治疗时间16周。疗效评判指标或方法：骨生物力学、细胞病理学、骨形态计量、骨密度、X线、CT、核素骨显像和血清骨碱性磷酸酶（BALP）、骨钙素（BGP）测定。疗效分为显效、有效和无效。采用SPSS13．0软件,多组比较行方差分析,2组间比较采用t检验。结果实验兔连续6周肌内注射地塞米松（按体质量2mg／kg）,A组病理细胞学切片无骨小梁破坏;12组实验兔病理切片见骨小梁排列稀疏、断裂,存在较明显的骨破坏现象,C组的骨生物力学[左股骨头为（265．914±52．773）N,第4腰椎L4为（369．671±94．919）N]、骨密度[左股骨头（0．238±0．016）g／cm^2,L。（0．236±0．016）g／cm^2]、骨形态计量[（66．230±10．848）％]较A组[各指标依次为（405．343±55．410）N,（750．870±53．718）N,（0．294±0．017）g／c-,（0．3024-0．023）∥cm^2,（131．500±21．846）％]明显降低（t均≥4．550,P均〈0。01）。核素骨显像示c组各大关节放射性摄取较A组明显增强,椎体显示不清;BALP、BGP与A组相比差异有统计学意义［分别为（45．000±7．303）比（12．485±1．512）U／L,（0．168±0．018）比（0．115±0．017）斗g／L,￡=4．126,5．476,P均〈0．01],证实兔骨质疏松模型成功建立。E组、F组、G组经16周治疗后,病理切片显示：E组、G组表现为骨组织结构和骨小梁明显得到修复,骨小梁增粗;F组修复较差。E组、G组骨生物力学指标[左股骨头分别为（386．457±77．077）N和（432．771±17．525）N,L4分别为（649．550±126．859）N和（655．443±76．555）N]明显改善,骨显像表现与B组基本相似,而F组放射性摄取略低于D组。治疗后各组骨生物力学、骨形态计量、骨密度和血清BALP、BGP结果差异有统计学意义（F值8．556—31．608,P均〈0．01）,G组的骨生物力学略强于E组（f=2．625,P〈0．05）。疗效评判G组和E组均为显效,F组为有效。结论99Tc-MDP联合“骨康灵”治疗兔骨质疏松在骨生物力学改善方面较明显,在提高骨抗外力的骨强度中可能有潜在的优势。     

缬沙坦和卡托普利对急性前壁心肌梗死后左室整体及局部收缩功能的影响

目的 对比血管紧张素Ⅱ受体拮抗剂（AⅡA）和血管紧张素转换酶抑制剂（ACEI）对急性前壁心肌梗死（AMI）后左室整体及局部收缩功能的影响.方法 将75例首次前壁AMI患者按随机数字表法分为常规治疗组15例、卡托普利治疗组30例、缬沙坦治疗组30例,并于AMI后1和28周分别行平衡法核素心室显像,测定左室整体收缩功能（LVSF）和左室局部射血分数（LrEF1～9）,了解2种药物对AMI后左室收缩功能的影响.计量资料组间及自身前后比较行t检验.结果 （1）AMI后28周时,缬沙坦治疗组与常规治疗组比较,左心室射血分数（LVEF）增加[（59.4±8.6）%与（44.9±8.4）%,t=3.87,P＜0.01],左室峰射血率（LPER）升高[（3.89±1.01）舒张末期容积（EDV）/s与（2.84±1.05）EDV/s,t=4.16,P＜0.01],LPER时间（LTPER）下降[（116±16）ms与（137±20）ms,t=2.16,P＜0.05],而与卡托普利组比较差异无统计学意义（t=1.58,1.09,1.77,P＜0.05）.（2）AMI后28周与1周比较,缬沙坦组不同部位左室局部射血分数LrEF2、LrEF4、LrEF5和LrEF6均明显升高[（71.6±18.8）%与（57.0±11.4）%,t=2.11 （78.1±16.8）%与（68.9±21.0）%,t=2.06 （70.5±16.9）%与（59.9±23.4）%,t=1.99 （58.1±9.0）%与（46.0±18.9）%,t=2.43 P均＜0.05].AMI后28周时,缬沙坦和卡托普利组LrEF2、LrEF3、LrEF4、LrEF5、LrEF6、LrEF7较常规治疗组均有所提高（t=1.96～2.27,P均＜0.05）,且2组间差异无统计学意义（t=1.06～1.77,P均＞0.05）.结论 血管紧张素Ⅱ受体拮抗剂缬沙坦能明显减轻前壁AMI后LVSF和LrEF的下降,且其效果与ACEI类药物卡托普利相近.     

The value of a completely automatic ECG gated blood pool SPECT processing method for the estimation of global systolic left ventricular function

OBJECTIVES: Electrocardiographically gated blood pool SPECT (GBPS) is an interesting method for measuring left ventricular (LV) ejection fraction (LVEF) and volume. Recently, the availability of completely automatic GBPS processing software has been reported. We aimed to evaluate its reliability in measuring global LV systolic function. In addition, using the same population, we compared its reliability to that of three previously reported methods for processing GBPS. METHODS: We studied the performances of the new GBPS system for the evaluation of LVEFs and volumes in 29 patients. The LVEF provided by the planar equilibrium radionuclide angiography (planarLAO) and LV volumes provided by radiological LV contrast angiography (X-rays) were used as 'gold standards'. RESULTS: The new GBPS system failed in one patient. It shows good reproducibility for the measurement of both LVEF and volume. LVEF provided by this system is moderately correlated to planarLAO (r = 0.62; P < 0.001). The new GBPS constantly overestimates LVEF (P < 0.05). Results for LV volumes are moderately correlated to those obtained by X-ray investigation (r = 0.7; P < 0.001) but are significantly lower (P < 0.0001). There is a linear correlation between the average and the paired absolute difference for LV volumes (r = 0.52, P = 0.0001). CONCLUSIONS: The new, completely automatic, GBPS processing software is an interesting, moderately reliable method for measuring LVEF and volume. The performance of the method is lower than that previously reported for the same population for the other three GBPS processing methods.     

超声造影引导下联合止血剂注射治疗肾挫裂伤的实验研究

目的 探讨超声造影引导下联合止血剂注射治疗肾挫裂伤的可行性.方法 18只新西兰大白兔开腹建立Ⅲ～Ⅳ级模拟钝性挫裂伤,随机数字表法分成三组:在超声造影引导下分别注射血凝酶(A组)、血凝酶联合α-氰基丙烯酸酯止血(B组)和等渗盐水(C组),观察止血时间、止血效果、肾周血肿等情况.结果 治疗后1 h,A、B、C组的肾周积液宽度分别为(0.200±0.012)cm,(0.050±0.002)cm和(0.400±0.009)cm,A、B组与C组比较,差异有统计学意义(P＜0.05).治疗后7,14 d复查,A组病灶长径分别为(1.107±0.143)cm和(0.433±0.163)cm,B组分别为(0.567±0.082)cm和(0.160±0.078)cm,C组分别为(0.980±0.203)cm和(0.686±0.157)cm,治疗后14 d,A、B组与C组间比较,差异有统计学意义(P＜0.01).A组病灶较B组大(P＜0.01).但B组治疗1个月后出现轻度肾积水的情况.结论 单纯注射血凝酶与联合注射血凝酶和α-氰基丙烯酸酯均能够达到止血效果,但后者的止血效果更加迅速、可靠.     

Gated blood-pool SPECT automated versus manual left ventricular function calculations

Planar gated blood-pool imaging (GBPI) is a standard method for non-invasive assessment of left ventricular (LV) function. Gated blood-pool single photon emission computed tomographic (GBPS) data acquisition can be accomplished in the same time as GBPI, with the benefit of enabling visualization of all cardiac chambers simultaneously. The purpose of this investigation was to evaluate the degree to which automated and manual LVEF calculations agree with one another and with conventional GBPI LVEF measurements. GBPI studies were performed in 22 consecutive, unselected patients, followed by GBPS data acquisition. GBPS left ventricular ejection fraction (LVEF) calculations were performed by available software (NuSMUGA, Northwestern University, Chicago, IL) automatically and manually, using all LV gated short axis slices. Automatic LVEF assessed by GBPS correlated well with conventional planar GBPI (r = 0.88, P < 0.001). Mean planar GBPI LVEF was 50% +/- 12%, and mean GBPS automatic LVEF was significantly lower at 45% + 14% (P = 0.001), with a mean difference of 6% +/- 5%. Manual GBPS LVEF also correlated well with conventional planar GBPI (r = 0.90, P < 0.0001). Mean LVEF measurement by manual GBPS versus GBPI was significantly higher at 59% +/- 13%, with a mean difference of 10% +/- 6% (P < 0.001). Manual GBPS LVEF values were also significantly higher than automatically determined GBPS LVEF values (P < 0.001). It is concluded that LVEF values assessed by NuSMUGA GBPS software were reproducible, and automatic and manual values correlated well with conventional GBPI values. However, both automatic and manual GBPS calculations were significantly different from one another and from GBPI values, so that GBPI and NuSMUGA calculations cannot be considered to be equivalent.     

无心率控制第二代双源CT前门控序列扫描冠状动脉造影的临床评价

目的：分析无心率控制下的患者不同采集窗设置,明确前瞻性心电门控序列扫描对图像质量与辐射剂量的影响。方法前瞻性选取75例患者行CT冠状动脉造影(CTCA)扫描,中位年龄55岁。所有患者均无心率控制。心率≤65次/min采集期相设置为65%~75%,65次/min<心率≤80次/min采集期相设置30%~75%,心率>80次/min采集期相设置为35%~45%。分析患者辐射剂量与冠状动脉图像质量主观评分。结果75例患者有效剂量(ED)为(2.44±1.21)mSv,其中A组为(1.54±0.41)mSv,B组为(3.57±0.53)mSv,C组为(1.64±0.27)mSv;A组vs B组P=0.000,A组vs C组P=0.854,B组 vs C组P=0.000。75例患者共评价1043段冠状动脉节段,平均显示13.9段,(3.66±0.51)分。其中A组(3.75±0.44)分;B组(3.60±0.54)分;C组(3.38±0.67)分;A组vs B组P=0.000,A组vs C组P=0.004,B组vs C组P=0.032。结论前瞻性心电门控序列扫描通过适应不同心率修改采集窗范围可以获得可评估的图像质量,并且避免不必要的辐射剂量产生,值得进一步研究与应用。     

Incidence, severity and clinical course of right ventricular involvement after acute inferior myocardial infarction; assessment by sequential 99Tcm-pyrophosphate scan and gated blood pool scan

To evaluate the incidence, severity and clinical course of right ventricular (RV) involvement after acute inferior myocardial infarction (IMI), 78 patients (pts) with IMI were investigated by both 99Tcm-pyrophosphate (PYP) scan and gated blood pool scan (GBPS). GBPS was performed at admission and 10 days, whereas 99Tcm-PYP scan was performed at 3 to 6 days. RV uptake of PYP was demonstrated in 25 (32%) pts on 99Tcm-PYP scan and RV akinesis or moderate hypokinesis by GBPS was observed in 39 (50%) pts on the acute scan; 25 pts (Group A) with positive RV uptake and 14 pts (Group B) with no RV uptake. In the remaining 39 pts (Group C) had normal RV wall motion. Severely depressed RVEF improved nearly 10 points on the tenth day in Group A (from 30.8 +/- 12.3 to 40.9 +/- 6.7%, p less than 0.01) and Group B (from 35.6 +/- 8.2 to 44.5 +/- 10.5%, p less than 0.01), respectively. Group C showed normal RVEF (from 47.4 +/- 7.6 to 50.1 +/- 10.2%). Fourteen pts of 39 (Groups A and B) who had developed shock or hypotension improved strikingly after appropriate therapy except for one death during their hospital course. Our data demonstrated: some patients with RV dysfunction in IMI do not have severe necrosis as judged by PYP scanning, those with positive RV uptake and depressed RV function show a lower degree of recovery than those with no RV uptake, but start from a lower initial value of RV function, and the combination of 99Tcm-PYP scan and GBPS offers prognostic information in IMI with RV dysfunction.