经胸超声心动图术前及术中指导房间隔缺损封堵术

目的评价经胸超声心动图(TTE)术前测量房间隔缺损(ASD)大小及术中监测ASD封堵的作用.方法60例ASD患者,年龄1.17～65(25.0±18.6)岁.术前用HP Sonos 1500及5500型彩色多普勒超声诊断仪经胸测量各切面ASD大小及周缘情况,经心导管ASD封堵术中TTE监测封堵过程、伞释出后牢固程度及彩色多普勒有无分流.结果用TTE术前检查ASD大小2～36(17.8±7.3)mm,选用ASD封堵器大小为5～40(22.9±8.0)mm.超声测量ASD大小与封堵器大小相关良好,r＝0.94(P＜0.001).硬缘ASD的封堵器选择比超声所测ASD大1～6mm.软缘ASD通常不考虑摆动较大部分为有效缘而予以去除,封堵器选择比超声所测ASD大7～13mm不等.所有封堵器封堵牢固,无脱落.结论TTE术前检查及术中指导ASD封堵是一种可行、有效、简便的方法.缺损较大、边缘较短或TTE不易显示清楚的薄缘ASD应进行术中经食道超声监测.     

经胸实时三维超声心动图指导房间隔缺损封堵器选择

目的 评价经胸实时三维超卢心动图(RT-3DE)指导房间隔缺损(ASD)封堵器选择的临床应用价值.方法 30例ASD患者,术前应用二维经胸超声心动图观测ASD大小及周缘情况,RT-3DE及彩色RT-3DE观察ASD形态,测量ASD面积及最大径,并计算出圆形面积代换内径.封堵器释放后测量其面积及腰径.结果 ASD以非类圆形为主22例(73.3%).在各种ASD形态中,封堵器释放后腰部形态仍为类圆形,其面积与RT-3DE及彩色RT-3DE所测量ASD面积差异无统计学意义(P>0.05).二维测量ASD内径小于封堵器释放后腰径,RT-3DE测量ASD最大内径大于封堵器释放后腰径,但圆形面积代换内径与封堵器释放后腰径差异无统计学意义(P>0.05).ASD圆形面积代换内径与封堵器大小(Y=0.29+1.132 X,r=0.93,P<0.0001)及释放后封堵器腰径(Y=一0.160+1.063 X,r=0.98,P<0.0001)显著相关.所有患者ASD封堵器牢固无脱落.结论 经胸RT-3DE在指导ASD封堵器选择中有肯定价值.     

实时三维经食管超声心动图在房间隔缺损中的诊断价值

目的 探讨实时三维经食管超声心动图(RT3D-TEE)对房间隔缺损(ASD)的诊断价值.方法 36例ASD患者分别行二维经食管超声心动图(2DTEE)和RT3DTEE检查.评价ASD的解剖特征并测量相关数据,将所得结果 进行对比分析.结果 36例患者中,31例(86.1%)获得了可供对ASD进行完整形态学观察及测量的满意图像,诊断为继发孔型ASD 19例;原发孔型ASD 3例,其中2例合并二尖瓣前叶裂;静脉窦型ASD 1例,为上腔静脉型;筛孔型ASD 3例;卵圆孔未闭5例.并有7例合并房间隔膨出瘤.2DTEE和RT3D-TEE测得ASD最大径分别为(21.4±12.7) mm和(21.7±12.6) mm (P＞0.05).应用RT3D-TEE可清晰显示ASD多为椭圆形或不规则形,近圆形较少,并能实时、快速观察ASD残缘状况、缺损大小及随心动周期的变化.结论RT3D-TEE能更科学、直观地评价ASD的形态特征及与毗邻结构的空间关系,在ASD的诊断及指导治疗方面具有重要的临床应用价值.     

封堵未成功的房间隔缺损超声心动图诊断与外科手术对比研究

目的：回顾分析房间隔缺损（ASD）封堵未成功病例,从而评价经胸超声心动图（TTE）及经食管超声心动图（TEE）在房间隔封堵术前筛选中的作用。方法：临床主张外科修补而患者自愿要求试封堵的16例ASD患者的TTE及TEE检查结果与心胸外科手术结果进行对比研究。结果：16例ASD患者TTE及TEE结果与手术结果大致相同,其中9例巨大型ASD;7例边缘不全型ASD。TTE、TEE测量ASD最大值与外科手术值具有较高的相关性（r=0.748,P＜0.01;r=0.928,P＜0.01）,其中TEE值与手术值相关性更高（r=0.928,P＜0.01）。结论：TTE及TEE可以明确ASD的部位、大小及缺损残缘情况等,为ASD介入封堵筛选合适病人提供可靠依据。     

超声心动图观察房间隔缺损封堵术后右心血流动力学及形态的改变

目的应用经胸超声心动图评价房间隔缺损（ASD）封堵术前后右心血流动力学及形态学的变化。方法对30例成功经导管ASD封堵术的患者进行研究。所有患者在术前、术中、术后6月分别进行超声心动图检查，观察右心血流动力学及形态的改变。结果30例ASD封堵术均成功，患者术后右心房、右心室内径均恢复至正常范围，未见封堵器移位及ASD再通。结论ASD封堵术纠正了心脏解剖畸形和血流动力学异常；超声心动图对ASD封堵前后右心形态学评价及疗效观察起重要作用。     

机器学习在孤独症谱系障碍疾病中的研究进展

孤独症谱系障碍(Autism spectrum disorder,ASD)是一组起病于儿童早期的神经发育障碍,主要临床表现为社会交流与交往障碍,限制性的异常兴趣及重复性行为[1]。近年来ASD发病率快速增长,据美国疾病预防控制中心最新报道,美国每54名儿童当中就有1名被诊断为ASD[2]。ASD具有高发病率及高致残率的特点,早期诊断及治疗可以明显改善ASD儿童的整体功能[3]。     

三维超声心动图测量房间隔缺损面积变化率的临床意义初探

目的应用三维超声心动图(3-DE)初步评价房间隔缺损(ASD)面积变化率的临床意义。方法应用三维超声心动图测量ASD最大面积和最小面积,并由此计算出面积变化率;同时应用三维超声进行左右心室容积及心功能测量,观察各指标间有无关系。结果三维超声心动图能精确进行ASD面积测量,ASD面积变化率与RVEDV和RVEF分别呈中度正相关和中度负相关,ASD最大面积与最小面积存在高度相关性。结论面积变化率的测量有助于评估ASD患者右心室功能,并可全面掌握ASD大小,有利于临床医生进行ASD封堵或手术。     

经胸超声心动图预测房间隔封堵器直径的主要影响因素

随着介入医学的发展,应用进口或国产房间隔封堵器闭合继发孔型房间隔缺损(ASD)已成为ASD的主要治疗方法.以往介入封堵ASD术需要经食管超声心动图(TEE)测定ASD大小及进行封堵器的定位.自国内张玉顺等[1]最早采用经胸超声心动图(TTE)用于ASD封堵术后,我院超声科学习、吸收其介绍的方法,自2006年开展ASD封堵术.现将体会总结如下.     

房间隔膨出瘤及合并畸形52例临床报告

目的：探讨房间隔膨出瘤（IASA）合并畸形的诊断特征及治疗适应证。方法：32例IASA合并畸形的住院患者及20例孤立性IASA门诊随诊患者,经心电图（ECG）、胸片、体表超声（TTE）、食道超声（TEE）及心导管检查,选择外科开胸,内科介入及门诊随诊观察的IASA患者。结果：32例IASA合并畸形的住院患者,16例（50%）合并畸形行外科开胸手术治疗,其中7例合并多发性房间隔缺损（ASD）。16例（50%）IASA合并ASD行内科介入治疗,其中6例为多发性ASD。结论：IASA合并畸形最常见的为ASD,而ASD中多发性ASD较为常见,通过TTE及TEE准确诊断,选择内、外治疗适应证。     

房间隔缺损的经胸多平面三维超声心动图剖析诊断研究

目的:探讨影响继发孔房间隔缺损(ASD)经胸三维超声心动图(3DTTE)重建的采样途径和三维剖析诊断方案。方法:选取ASD 21例,应用经胸多平面探头分别在胸骨旁、心尖部和剑突下采集图像,脱机三维重建,利用任意剖切功能,显示ASD及周边结构,测量缺损最大长轴径和短轴径。结果:20例ASD三维重建成功。从右房侧正对房间隔选择性剖切,正面动态成像了ASD完整的形状和在房隔的空间部位,除心尖部外,余部位采样测量ASD大小与手术测值均具有高度相关性。额面四腔顺序剖切能较好地观察ASD与周边结构的关系。结论:3DTTE能理想重建ASD,右房侧剖切剖视能完整显示ASD,结合额面四腔心剖视有利于ASD解剖分型。     

三维超声心动图评价房间隔缺损面积及其动态特征的临床研究

目的 应用三维超声心动图(3-DE)观察房间隔缺损(ASD)面积大小及其动态特征，并探讨其与分流量的关系。方法 应用3-DE重建ASD，测量其大小，并观察其动态变化。分析ASD面积与ASD直径和肺循环量／体循环量(Qp／Qs)之间是否存在相关性。结果 ASD在心室收缩末期最大，在心室舒张末期最小，但形状变化不大。ASD面积与直径不存在相关性，但与Qp／Qs高度相关。结论 3-DE较二维超声心动图(2-DE)能精确测量ASD大小，观察其形态和动态变化，故更有助于全面了解ASD，面积测量更能体现ASD大小，并反映分流量多少，故3-DE更有助于ASD手术前治疗方案的制订。     

经胸超声心动图指导软缘房间隔缺损封堵的价值

目的 评价经胸超声心动图(TTE)指导软缘房间隔缺损(ASD)封堵术的可行性和作用.方法 62例软缘ASD患者,术前用彩色多普勒超声心动图结合组织谐波功能经胸测量各切面ASD大小及观察周缘软硬情况,将菲薄且来回明显摆动、无支撑力的软缘剔除测量"ASD支撑径".再根据ASD大小和"ASD支撑径"大小综合判断选择适当的封堵器型号.封堵器释放后测量其腰部大小,并与术前TTE测量的ASD最大径以及"ASD支撑径"进行比较.结果 TTE术前检查ASD最大径11～35 mm[平均(21.6±5.2)mm],剔除软缘后的"ASD支撑径"15～37 mm[平均(25.6±5.0mm],选用的封堵器18～44 mini-平均(30.7±5.5)mm,释放后封堵器腰径13～35 mini平均(24.2±5.6)mm].TTE测量的ASD最大径与释放后封堵器腰径相关性良好(r=0.86,P＜0.0001);TTE测量的剔除软缘后"ASD支撑径"与释放后封堵器腰径相关性进一步改善(r=0.89,P＜0.0001).所有患者ASD封堵器固定牢固,无脱落.结论 TTE结合组织谐波功能可以测量软缘ASD大小以及剔除软缘后的"ASD支撑径"大小,是指导软缘ASD封堵的简便、可行的方法.     

经胸超声心动图在引导房间隔缺损经右心导管封堵术中的临床价值

目的　评价经胸彩色多普勒超声引导经导管房间隔缺损 (ASD)封堵术的可靠性及应用方法。方法37例房间隔缺损患者 ,采用经胸彩色超声心动图检查 ,多个切面综合判断房间隔缺损的伸展径。比较超声测量值与封堵成功所选用的封堵器大小之间的相关性。结果　 35例患者经胸超声引导经右心导管封堵房间隔缺损术成功 ,超声测量的最大伸展径与ASD实际最大伸展径一致 ,r =0 .97,P <0 .0 0 1。 33例ASD封堵器一次放置成功 ,2例测量偏小 ,第二次放置成功 ;封堵术成功后即刻彩超显示穿隔血流消失 ;术后 3月复查 ,房间隔无穿隔血流 ,右心系统明显回缩。结论　经胸彩色多普勒超声引导经右心导管房间隔缺损封堵术准确性高 ,方法简便 ,无痛苦 ,值得推广。     

Stereotypy in Adults with Autism Spectrum Disorders: Relationship and Diagnostic Fidelity

Autism Spectrum Disorders (ASD), are characterized by severe and debilitating symptoms including stereotypic behaviors. Stereotypies constitute core features of ASD and markedly impede attempts to remediate the disorder. Little previous research has examined characteristics of stereotypies in adults with ASD, or differentiated these behaviors as they present in ASD, from persons with intellectual disability (ID) only. In the present study 336 adults, those with ASD and ID versus ID alone were evaluated with respect to the nature and extent of their stereotypied behavior. A comparison of autistic to PDD-NOS participants was also conducted to offer a more fine-grained analysis specific to the ASD population. The nature and implications of these data for differential diagnosis in adults with ASD are discussed.     

彩色多普勒超声心动图在房室间隔缺损封堵术中的应用价值

目的探讨经彩色多普勒超声心动图(color doppler echocardiography,CDE)在封堵器介入治疗先天性房间隔缺损(ASD)、室间隔缺损(VSD)中的临床应用价值。方法 9例ASD、12例VSD患者在CDE监测下行经心导管封堵术。结果6例SD、10例VSD封堵成功;3例ASD、2例VSD封堵失败。结论 CDE在筛选ASD及VSD封堵术病例、术中指导封堵器定位和释放、疗效评估和预后评价方面有不可替代的临床重要价值。     

Ventricular septal flattening at end systole falsely predicts right ventricular hypertension in patients with ostium primum atrial septal defects.

PURPOSE: To assess the reliability of ventricular septal position in predicting elevated right ventricular pressure (RVP) in patients with ostium primum atrial septal defects (ASD 1). METHODS: Echocardiograms of 4 groups were retrospectively analyzed: Patients with ASD 1 and low RVP, patients with ASD 1 and high RVP, and 2 age-matched control groups: one with isolated ostium secundum atrial septal defects (ASD 2), and 1 with normal cardiac findings. End-systolic left ventricular sectional diameters along the midmitral diameter (D1) and a diameter orthogonal to it (D2) were measured off-line by a blinded observer. The ratio D2/D1, the eccentricity index (EI), was calculated; a higher index represents greater septal flattening. RESULTS: The mean EI in the ASD 1 with low RVP group was significantly higher than both the group with ASD 2 and the healthy control group. The mean EI of the ASD 1 group with high RVP was significantly higher than the mean EI of the ASD 1 group with low RVP, although there was a poor correlation between EI and RVP in this group, r = 0.54. CONCLUSION: The ventricular septum is flatter in the ASD 1 patients with low RVP than in an age-matched control group with ASD 2 and compared with an age-matched control group of healthy subjects, giving a false impression of elevated RVP in the ASD 1 group. Although the mean EI is significantly higher in the ASD 1 group with high RVP than in the group with low RVP, there is a poor correlation between EI and RVP, which limits the reliability of this index.     

Modified CBT for Treatment of OCD in a 7‐Year‐Old Boy With ASD—A Case Report

Children and adolescents with autism spectrum disorder (ASD) frequently experience obsessive–compulsive disorder (OCD). Cognitive behavioral therapy (CBT) is recommended for OCD but may need modification in children and adolescents with ASD because of cognitive differences, but guidance for therapists planning CBT for OCD in young people with ASD is sparse. This report discusses syndromes of OCD and ASD and their overlapping clinical features and etiologies, difficulties in applying CBT in the ASD population, and relevant literature. We present a case report on CBT treatment of a 7‐year‐old boy with ASD and OCD and modifications to CBT that were helpful.     

二维超声心动图显示房间隔缺损的平面图像

目的对缺损的大小和形态学特征的准确评估，是房间隔缺损（ASD）临床决策至关重要的信息；然而，二维超声心动图（2DE）常规切面难以显示ASD的整个缺损VI的形态，本研究探讨特殊的2DE切面显示ASD形态学特征的全貌和ASD与周边结构的空间关系。 方法2DE常规切面诊断237例成人继发孔型ASD，再使用房间隔切面显示ASD完整的平面形态学特征。比较任何一个常规切面测量的ASD最大直径和房间隔切面显示完整的ASD平面的情况下测量ASD最大直径。 结果220／237例（92．8％）患者使用胸骨旁房间隔切面成功地显示ASD的整个缺损平面，其中单个缺损口的194例患者，常规切面与房间隔切面显示的ASD最大直径的差异有非常显著的统计学意义（P〈0．001），2种方法测量的最大直径呈直线相关，相关系数有高度显著性（r=0．935，P〈0．001）。胸骨旁房间隔切面能显示ASD的大小、形状、边缘情况及与周边结构的空间关系，也能显示2个或2个以上缺损口之间的关系。 结论作者首次提出使用经胸2DE胸骨旁房间隔切面能清晰显示ASD完整的平面图像，提供ASD的大小、形状、位置及周边关系的信息，如此精确的显像对临床决策和确定是单个或多个缺损具有重要的意义。     

Atypical neural substrates of Embedded Figures Task performance in children with Autism Spectrum Disorder

Superior performance on the Embedded Figures Task (EFT) has been attributed to weak central coherence in perceptual processing in Autism Spectrum Disorder (ASD). The present study used functional magnetic resonance imaging to examine the neural basis of EFT performance in 7- to 12-year-old ASD children and age- and IQ-matched controls. ASD children activated only a subset of the distributed network of regions activated in controls. In frontal cortex, control children activated left dorsolateral, medial and dorsal premotor regions whereas ASD children only activated the dorsal premotor region. In parietal and occipital cortices, activation was bilateral in control children but unilateral (left superior parietal and right occipital) in ASD children. Further, extensive bilateral ventral temporal activation was observed in control, but not ASD children. ASD children performed the EFT at the same level as controls but with reduced cortical involvement, suggesting that disembedded visual processing is accomplished parsimoniously by ASD relative to typically developing brains.