超声引导下鞘内注射诺西那生钠治疗儿童脊髓性肌萎缩症

脊髓性肌萎缩症(spinal muscular atrophy, SMA)是以近端肢体进行性肌无力及肌萎缩为主要特征的常染色体隐性遗传病,多由5q13运动神经元存活基因(survival motor neuron gene, SMN)1突变或缺失导致,是儿童最常见的神经肌肉病^([1])。鞘内注射诺西那生钠为治疗SMA的有效手段,但对于脊柱严重侧凸者,常需于影像学引导下完成^([2-3])。

超声诊断儿童甲亢合并甲状腺胸腺组织异位1例

患儿女,12岁,因＂发现突眼伴心慌1个月＂入院.专科体检：甲状腺中度肿大,气管居中,声音无嘶哑.实验室检查：游离三碘甲腺原氨酸31.19ρmol/L,游离四碘甲腺原氨酸111.9ρmol/L,促甲状腺激素0.04μU/L,抗甲状腺过氧化物酶抗体276.3 U/ml,抗甲状腺球蛋白抗体44.9 U/ml. 常规超声检查：甲状腺弥漫性肿大,实质回声增粗,分布不均匀,左侧叶中部背侧见一大小约7.7 mm×4.1 mm稍低回声病灶,边界模糊,内部见多个点状强回声（图1）,颈部未见肿大淋巴结回声;CDFI示甲状腺内血流信号增多,左侧叶稍低回声病灶边缘见短条状血流信号,内部未见血流信号.

智能电网下电力网络的营销模式研究

智能化的时代随之到来。智能电网的出现,使得传统的营销模式向电力网络营销模式转变,这就引发了对电力网络营销模式的研究。如何使现在的网络营销模式适应发展的需求,是本研究的关键。

在班集体中培养学生健康的心境

在班集体中培养学生健康的心境,是全面实施素质教育中不可忽视的一环。每一个教育工作者都应重视小学生心理的健康发展。

Real-time Three-dimensional Echocardiographic Assessment of Left Ventricular Remodeling Index in Patients with Hypertensive Heart Disease and Coronary Artery Disease

Left ventricular remodeling index （LVRI） was assessed in patients with hypertensive heart disease （HHD） and coronary artery disease （CAD） by real-time three-dimensional echocardiography （RT3DE）. RT3DE data of 18 patients with HHD, 20 patients with CAD and 22 normal controis （NC） were acquired. Left ventricular end-diastolic volume （EDV） and left ventricular end-diastolic epicardial volume （EDVepi） were detected by RT3DE and two-dimensional echocardiography Simpson biplane method （2DE）. LVRI （left ventricular mass/EDV） was calculated and compared. The results showed that LVRI measurements detected by RT3DE and 2DE showed significant differences inter-groups （P〈0.01）. There was no significant difference in NC group （P〉0.05）, but significant difference in HHD and CAD intra-group （P〈0.05）. There was good positive correlations between LVRI detected by RT3DE and 2DE in NC and HHD groups （t=0.69, P〈0.01; r=0.68, P〈0.01）, but no significant correlation in CAD group （r=0.30, P〉0.05）. It was concluded that LVRI derived from RT3DE as a new index for evaluating left ventricular remodeling can provide more superiority to LVRI derived from 2DE.

Assessment of Left Atrial Function in Diabetes Mellitus by Left Atrial Volume Tracking Method

The value of the left atrial volume tracking (LAVT) method in the evaluation of left atrial (LA) function in patients with diabetes mellitus (DM) was examined in this study.Fifty-eight DM patients as DM group and 40 healthy people as normal control group were enrolled in this study.EUB-6500 echocardiographic imaging system with LAVT was applied to display and analyze the LA volume curve imaging on LV apical two and four chamber views.The maximal LA volume at end-systole (LAV max),LA volume at the onset of ECG-P wave (LAV p),the minimal LA volume at end-diastole (LAV min) from the LA volume curve were acquired and recorded.All values above were standardized by body surface area (BSA).Then the passive,active and total LA volume (LAVIpass,LAVIact,LAVItotal) and empting rate (%LAVIpass,%LAVIact,%LAVItotal),effective passive and active empting rate (%eLAVIpass,%eLAVIact),and the proportionality of passive empting volume and active empting volume were calculated.The LAVIp,LAVIact,LAVItotal,%LAVIact,%LAVItotal and %eLAVIact were significantly higher in the DM group than those in the control group,whereas the LAVIpass,%LAVIpass,%eLAVIpass and LAVIpass/act were lower (all P【0.05).For the LA volume change in DM,the active empting volume was enhanced at end-diastole.It was concluded that LAVT is a potentially useful tool to evaluate the function of LA.

Assessment of Age-related Changes in Left Ventricular Twist by Two-dimensional Ultrasound Speckle Tracking Imaging

To assess the normal value of left ventricular twist （LVtw） and examine the changes with normal aging by 2-dimensional ultrasound speckle-tracking imaging （STI）, 121 healthy volunteers were divided into three age groups： a youth group （19-45 y old）, a middle-age group （46-64 y old ） and an old-age group （≥65 y old）. Basal and apical short-axis images of left ventricular were acquired to analyse LV rotation （LVrot） and LVrot velocity. LVtw and LVtw velocity was defined as apical LVrot and LVrot velocity relative to the base. Peak twist （Ptw）, twist at aortic valve closure （AVCtw）, twist at mitral valve opening （MVOtw）, untwisting rate （UntwR）, half time of untwisting （HTU）, peak twist velocity （PTV）, time to peak twist velocity （TPTV）, peak untwisting velocity （PUV）, time to peak untwisting velocity （TPUV） were separately measured. The results showed that the normal LV performs a wringing motion with a clockwise rotation at the base and a counterclock- wise rotation at the apex （as seen from the apex）. The LVtw velocity showed a systolic counterclockwise twist followed by a diastolic clockwise twist. Peak twist develops near the end of systole （96%±4.2% of systole）. With aging, Ptw, AVCtw, MVOtw, HTU and PUV increased significantly （P〈0.05） and UntwR decreased significantly （P〈0.05）. However, no significant differences in TPUV, PTV and TPTV were noted among the 3 groups （P〉0.05）. It is concluded that LV twist can be measured non-invasively by 2-dimensional ultrasound STI imaging. The age-related changes of LVtw should be fully taken into consideration in the assessment of LV function.

Real-time Three-dimensional Echocardiography in Assessment of Congenital Double Orifice Mitral Valve

The application of real-time three-dimensional echocardiography （RT 3DE） in the diagnosis of double orifice mitral valve （DOMV） was explored. Five cases of DOMV were examined by using 2-dimensional echocardiography （2DE） and RT 3DE. The spatial morphology of malformed mitral valve and its change in hemodynamics were observed. DOMV associated with partial atrioventricular septal defect was found in 3 cases （in which 2 cases had cleft mitral valve） and isolated DOMV in 2 cases; and moderate to severe mitral regurgitation was detected in 3 cases, and mild mitral regurgitation in 1, and no regurgitation in 1 case; 1 case had complicated rhumatic heart disease. Three cases were preoperatively discovered by 2DE, while 2 missed （1 case was discovered postoperatively）. Four cases were diagnosed by RT 3DE preoperatively, and 1 case was diagnosed postoperatively （not examined by RT 3DE preoperatively）. It was suggested that RT 3DE is a reliable technique in the diagnosis of DOMV; it permitted comprehensive and noninvasive assessment of mitral valve and may supplement 2D TTE in the assessment of DOMV.

589例单纯性房间隔缺损病变的超声诊断与手术结果对照分析

目的:回顾性分析超声心动图技术评价单纯性房间隔缺损(ASD)病变的临床应用价值。方法:对589例手术证实为单纯性ASD病变患者进行回顾性分析,术前所有患者均进行了经胸二维超声、多普勒超声、声学造影显像、经食管超声心动图检查。对术前超声心动图诊断与手术结果进行对照分析:①超声定性诊断与手术结果的比较;②超声分型诊断与手术结果的比较;③不同超声检查技术评价单纯性ASD的价值分析。结果:①589例ASD患者术前超声检出率为100%;②501例术前超声分型诊断与术后临床诊断一致,符合率85.1%(501/589例),其中中央型490例,符合率99.2%(490/494例);下腔静脉窦型2例,符合率3.3%(2/60例);上腔静脉窦型6例,符合率54.5%(6/11例);混合型4例,符合率16.7%(4/24例);③以经胸二维超声定性诊断率为99.5%,漏诊率0.5%;声学造影造影检出率为92.3%;术前经TTE联合声学造影显像诊断准确率为100%,TTE、TEE及声学造影显像联合应用诊断准确率为100%。结论:超声心动图检查是临床上准确诊断ASD病变的首选方法。结合ASD病变特征和超声表现可提高ASD诊断准确性。

超声二维斑点追踪显像评价健康人左心室扭转-位移环的初步研究

目的应用超声二维斑点追踪显像技术探讨不同年龄正常成人左室扭转与径向位移的关系。方法健康成年志愿者121例，按年龄分为青年组（18～45岁）、中年组（46～64岁）和老年组（≥65岁）。取胸骨旁左室心尖和心底短轴观对左室各水平旋转及径向位移进行测量分析，计算出左室扭转与左室径向位移，构建左室扭转-位移环，并比较不同年龄组的差别。结果三组左室心尖部与心底部心肌旋转角度及各节段径向位移曲线随心动周期规律变化。三组左室扭转-位移环均呈“8”字构型。收缩期及等容舒张期左室扭转与径向位移均呈线性相关；随年龄增加，收缩期扭转-位移环的变化斜率明显增加，差异有统计学意义（P〈0．05）；与青年组比较，中年组及老年组等容舒张期扭转-位移环的变化斜率均明显增加，差异均有统计学意义（P〈O．05），但中年组与老年组间比较差异无统计学意义（P〉0．05）。结论应用超声二维斑点追踪显像技术可无创性构建左室扭转-位移环，年龄影响收缩期左室扭转-位移环。

心脏外伤的超声心动图特征及其诊断价值

目的：探讨心脏外伤的超声心动图显像特征，评价其诊断心脏外伤的临床价值。方法：对11例心脏外伤患者的经胸超声心动图图像特征进行回顾性分析，并与手术结果相对照。结果：11例患者中，超声心动图检出心包积液5例，室间隔穿孔4例，游离壁损伤1例，室壁瘤3例，假性室壁瘤1例，瓣膜损伤2例，心腔内血栓1例。与手术结果对照，超声心动图除对游离壁损伤检出率低（20％）外，对其余损伤的敏感性和特异性均为100%。结论：超声心动图可及时准确地诊断心脏外伤，并能为手术治疗提供可靠信息。