Isolated Tricuspid Valve Repair and Right Atrial Plication Performed Using a Beating-Heart Technique for Atrial Functional Tricuspid Valve Regurgitation

Background: Isolated tricuspid valve disease remains a controversial indication for surgical intervention. Many patients referred for surgery already have a poor clinical condition and an advanced New York Heart Association functional class. There is no consensus on the optimal surgical technique for this condition, including on whether to perform the procedure on a beating or an arrested heart and whether to perform valve repair or replacement. Methods: We analyzed four case series between 2015 and 2022 in which patients with secondary tricuspid regurgitation (TR) underwent valve repair on a beating heart and right atrial plication for a dilated right atrium. The TRI-SCORE was calculated for each patient. Results: All patients experienced a favorable postoperative course with significant improvements in heart failure symptoms. TR was markedly reduced;however, in one patient with concomitant mitral regurgitation (MR) and a high TRI-SCORE, MR worsened postoperatively. This patient later died from unknown causes due to multiple comorbidities in the late phase. Conclusions: Tricuspid valve repair on a beating heart was effective for improving the cardiac function, and the TRI-SCORE proved useful as a preoperative risk assessment tool. The underlying mechanism by which TR exacerbates MR requires further investigation.

Evaluation of Right Ventricular Volume and Systolic Function by Real-time Three-dimensional Echocardiography

The optimal plane for measurement of the right ventricular (RV) volumes by real-time three-dimensional echocardiography (RT3DE) was determined and the feasibility and accuracy of RT3DE in studying RV systolic function was assessed. RV “Full volume” images were acquired by RT3DE in 22 healthy subjects. RV end-diastolic volumes (RVEDV) and end-systolic volumes (RVESV) were outlined using apical biplane, 4-plane, 8-plane, 16-plane offline separately. RVSV and RVEF were calculated. Meanwhile tricuspid annual systolic excursion (TASE) was measured by M-mode echo. LVSV was outlined by 2-D echo according to the biplane Simpson's rule. The results showed: (1) There was a good correlation between RVSV measured from series planes and LVSV from 2-D echo (r=0.73; r=0.69; r=0.63; r=0.66, P<0.25—0.0025); (2) There were significant differences between RVEDV in biplane and those in 4-, 8-, 16-plane (P<0.001). There was also difference between RV volume in 4-plane and that in 8-plane (P<0.05), but there was no significant difference between RV volume in 8-plane and that in 16-plane (P>0.05); (3) Inter-observers and intro-observers variability analysis showed that there were close agreements and relations for RV volumes (r=0.986, P<0.001; r=0.93, P<0.001); (4) There was a significantly positive correlation of TASE to RVSV and RVEF from RT3DE (r=0.83; r=0.90). So RV volume measures with RT3DE are rapid, accurate and reproducible. In view of RV's complex shape, apical 8-plane method is better in clinical use. It may allow early detection of RV systolic function.

Quantitative Assessment of Right Ventricular Systolic Function by the Analysis of Right Ventricular Contrast Time-intensity Curve

Summary: To study reliability and reliable indices of quantitative assessment of right ventricular systolic function by time-intensity curve (TIC) with right ventricular contrast, 5 % sonicated human albumin was injected intravenously at a does of 0.08 ml/kg into 10 dogs at baseline status and cardiac insufficiency. Apical four-chamber view was observed for washin and washout of contrast agent from right ventricle. The parameters of TIC were obtained by curve fitting. The differences of parameters were analyzed in different states of cardiac functions. Among the parameters derived from TIC, the time constant (k) was decreased significantly with decline of cardiac function (P<0.001). But half-time of decent of peak intensity (HT) and mean-transit-time (MTT) of washout were increased significantly (P<0.001). The k was strongly related to cardiac output of right ventricle (CO) and ejection fraction (EF) of left ventricle and fractional shortening (FS) of left ventricle. Right ventricular systolic function could be assessed reliably by the parameters derived from TIC with right ventricular contrast echocardiography. The k, HT and MTT are reliable indices for quantitative assessment of right ventricular systolic function.

Usefulness of myocardial performance index for assessing right ventricular function after percutaneous closure of atrial septal defect

Objective Assessment of right ventricular function in patients with atrial septal defect (ASD) is difficult. The Doppler myocardial performance index (MPI) may provide a method of assessing function in these patients. The purposes of this study were to evaluate the right ventricular function and its changes in patients with ASD after transcatheter closure of ASD. Methods MPI, defined as the sum of isovolumic relaxation time and isovolumic contraction time derived by ejection time, was measured from tricuspid inflow and right ventricular outflow;Doppler velocity profiles recorded during routine echocardiography.Twenty nine patients (13 men, 16 women;mean age 25.28±12.69, range 6 to 57 years) were diagnosed to secundum ASD [the stretched diameters of ASD were from 9 To 36 (24.91±7.98) mm], and had a successfully placed Amplatzer septal occluder (ASO) (the sizes of ASO were from 11 to 40 mm );there were 81 sex-matched, age-matched healthy people (control group 41men, 40 women;mean age 29.02 ± 14.22, range 4 to 45 years ). MPI was measured again on 3 days and 1 month after closure of ASD. Change in the study group was assessed and compared to the control subjects with structurally normal hearts. A complete 2-dimensional and Doppler echocardiographic examination was performed in all study groups. Results 1) The isovolumic relaxation and isovolumic contraction times [respectively(77.59 ± 14.39)ms vs (60.93 ±12.94)ms, P<0.0001;(28.28 ±10.88)ms vs (23.64 ±9.01)ms, P=0.027] were prolonged, and ejection time [(260.65 ±21.86 )ms vs (271.85 ± 21.92)ms, P=0.033] was shortened in patients with ASD compared with that in control subjects, resulting in a marked increase in the MPI(0.40 ± 0.07 vs 0.31 ± 0.05, P<0.0001) from normal values;2) by Pearson's correlations, the MPI had no correlation with heart rate and blood pressure in control subjects and patients with ASD, but it correlated positively with age in patients with ASD;3) by Pearson's correlations, the MPI correlated positively with the diameter of ASD and pulmonary artery pressure;4) after transcatheter closure of ASD, the MPI decreased markedly. Conclusions 1) MPI is a conceptually new, simple, and reproducible Doppler index in patients with ASD;2) MPI is free from the effect of age, heart rate and blood pressure;(3) MPI appears to be relatively dependent on changes in the diameter of ASD and pulmonary artery pressure;4) the right ventricular function was improved after transcatheter closure of ASD.(J Geriatr Cardiol 2007;4:220-224.)

Correlation between ductus venosus spectrum and right ventricular diastolic function in isolated single-umbilical-artery foetus and normal foetus in third trimester

BACKGROUND Single umbilical artery(SUA)is the most common umbilical cord malformation in prenatal diagnosis.The presence of an SUA can cause blood circulation disorder in the foetus and functional changes of the foetal heart,affecting foetal circulation.The right ventricular diastolic functions in foetuses with isolated SUA and in normal foetuses in the third trimester were evaluated using the spectral Doppler of blood flow in the foetal ductus venosus(DV).AIM To evaluate the right ventricular diastolic functions in foetuses with isolated SUA and in normal foetuses in the third trimester.METHODS Colour Doppler was used to measure the spectrum of foetal DV and tricuspid orifice in 34 foetuses with isolated SUA aged 28-39 wk and in age-matched healthy controls.The DV flow velocities and velocity ratios were measured.The early passive/late active(E/A)ratio at the tricuspid orifice and tissue Doppler Tei index of the foetal right ventricular in the two groups were also measured.RESULTS During the third trimester,the isolated SUA group showed a lower‘a’-wave peak velocity in the DV than the control group(P<0.05).The correlations between the velocity ratios and E/A ratio at the tricuspid orifice in the two groups were analysed,and the correlation between the ventricular late diastolic velocity/ventricular diastolic peak flow velocity and E/A ratios was the best(R^2of the isolated SUA group:0.520;R2 of the control group:0.358).The correlations between the velocity ratios and tissue Doppler Tei index of foetal right ventricular in the two groups were analysed,and the correlation between the pulsatility index for veins(PIV)and tissue Doppler Tei index ratios was the best(R2 of the isolated SUA group:0.865;R2 of the control group:0.627).CONCLUSION In the isolated SUA group,the atrial systolic peak velocity‘a’decreased,and this finding might be related to the changes in foetal cardiac functions.The ratio of ventricular late diastolic velocity to ventricular diastolic peak flow velocity was closely related to the E/A ratio at the tricuspid valve and can be used to identify changes in the right ventricular diastolic functions of isolated SUA and healthy foetuses.PIV was closely related to the tissue Doppler Tei index of the foetal right ventricular and can be used to identify the right ventricular overall functions of isolated SUA and healthy foetuses.

Effect of arotinolol on right ventricular function in patients with dilated cardiomyopathy

Objective Dilated cardiomyopathy(DCM) is generally considered to be accompanied by both left and right ventricular dysfunction,but most studies only analyze the left ventricular function. In this study,we evaluated the effect of arotinolol on right ventricular function in patients with DCM. Methods Right ventricular ejection fraction(RVEF) and right ventricular diameter(RVD) were measured by two-dimensional echocardiography(2-DE) in 33 DCM patients;RVEF measured by first-pass radionuclide angiography(FPRA) was compared with that by 2-DE. Results The treatment with arotinolol for one year resulted in a reduction in the right ventricular diameter(baseline,23.0 ± 8.3 mm vs after one-year treatment,20.7 ± 5.4 mm;P=0.004 ) and an associated increase in ejection fraction(baseline,36.9 ± 10.3% vs after one-year treatment,45.8 ± 9.6%;P < 0.001 ) ;there is a high correlation between the 2-DE method and radionuclide ventriculographic method. The correlation coefficient is 0.933(P<0.001) . Conclusion Arotinolol therapy could not only improve left ventricular function,but also improve right ventricular function in DCM patients.

Evaluation of Right Ventricular Global Longitudinal Function in Patients with Tetralogy of Fallot by Two-dimensional Ultrasound Speckle Tracking Imaging

Quantification of right ventricular(RV)volume and function remains a challenge because of RV complex geometry by conventional echocardiography.The purpose of this study was to assess RV global longitudinal function in patients with tetralogy of Fallot(TOF)by 2-dimensional ultrasound speckle tracking imaging(STI).Thirty-eight patients with TOF were enrolled in this study and divided into child group(n=25)and adult group(n=13)according to age.Thirty-eight age-and sex-matched normal subjects were selected as c...

On the Human Rights Function of the Olympic Movement

The Olympic Movement is an essential contemporary international social movement with a unique ability to transform and promote the human rights.This human rights function of the Olympic Movement is mainly reflected in two aspects:First,the Olympic Movement accelerates the dissemination of the basic concepts and values of human rights and helps build a broader consensus in a wider field;second,the Olympic Movement expands and enriches the rights system of human rights.It has greatly contributed to realizing individual human rights and collective human rights both inside and outside the Olympic field.The human rights function of the Olympics needs be correctly understood and rationally utilized to maximize its effectiveness in promoting the development of and guaranteeing the realization of human rights.

QUANTIFICATION OF RIGHT VENTRICULAR FUNCTION IN ATRIAL SEPTAL DEFECT USING ULTRASOUND- BASED STRAIN RATE IMAGING

Objective To study the validation of ultrasound-based strain rate imaging in the quantitative assessment of right ventricular (RV) function in atrial septal defect (ASD). Methods Tissue Doppler images (TDI) of RV longitudinal and short axes were recorded from the apical 4-chamber view and the subcostal short-axis view in 18 normal controls, 28 children with ASD and 14 children after Amplazter closure of ASD respectively. Peak systolic velocities (V), peak systolic strain rates (SR), peak systolic strains (S) at the basal segment, middle segment of RV lateral wall and the basal septum from the longitudinal axis, the middle segment of RV free wall from the short axis were quantitatively measured using QLAB TM tissue velocity quantification software system respectively. Peak dp/dt from the RV isovolumic contraction determined during the right cardiac catheterization in 28 ASD patients was used as the gold standard of RV contractility. Peak systolic indices were compared against max dp/dt by linear correlation. Results Peak systolic indices at the basal and middle segments of RV lateral wall from the longitudinal axis increased significantly in 28 ASD patients.Peak systolic indices at the basal septum also increased in patient group, but not significantly. Significant decreases in peak systolic indices at the basal and middle segments of RV lateral wall were observed after the Amplatzer closure in 14 ASD patients. There was no significant difference at the middle segment of RV free wall from the short axis between patient group and normal control. A strong correlation was found between max dp/dt and peak systolic indices at the basal and middle segments of RV lateral wal l (P<0.05). Conclusion Ultrasound-based strain rate imaging can assess quantitatively RV function in CHD. Peak systolic strains determined at the basal and middle segments of RV lateral wall are strong noninvasive indices of RV contractility.

Evaluation of right ventricular volume and systolic function in normal fetuses using intelligent spatiotemporal image correlation

BACKGROUND Heart defects are the most common congenital malformations in fetuses.Fetal cardiac structure and function abnormalities lead to changes in ventricular volume.As ventricular volume is an important index for evaluating fetal cardiovascular development,an effective and reliable method for measuring fetal ventricular volume and cardiac function is necessary for accurate ultrasonic diagnosis and effective clinical treatment.The new intelligent spatiotemporal image correlation(iSTIC)technology acquires high-resolution volumetric images.In this study,the iSTIC technique was used to measure right ventricular volume and to evaluate right ventricular systolic function to provide a more accurate and convenient evaluation of fetal heart function.AIM To investigate the value of iSTIC in evaluating right ventricular volume and systolic function in normal fetuses.METHODS Between October 2014 and September 2015,a total of 123 pregnant women received prenatal ultrasound examinations in our hospital.iSTIC technology was used to acquire the entire fetal cardiac volume with off-line analysis using QLAB software.Cardiac systolic and diastolic phases were defined by opening of the atrioventricular valve and the subsequent closure of the atrioventricular valve.The volumetric data of the two phases were measured by manual tracking and summation of multiple slices and recording of the right ventricular end-systolic volume and the right ventricular end-diastolic volume.The data were used to calculate the right stroke volume,the right cardiac output,and the right ejection fraction.The correlations of changes between the above-mentioned indices and gestational age were analyzed.The right ventricular volumes of 30 randomly selected cases were measured twice by the same sonographer,and the intraobserver agreement measurements were calculated.RESULTS Among the 123 normal fetuses,the mean right ventricular end-diastolic volume increased from 0.99±0.34 mL at 22 wk gestation to 3.69±0.36 mL at 35+6 wk gestation.The mean right ventricular end-systolic volume increased from 0.43±0.18 mL at 22 wk gestation to 1.36±0.22 mL at 35+6 wk gestation.The mean right stroke volume increased from 0.62±0.29 mL at 22 wk gestation to 2.33±0.18 mL at 35+6 wk gestation.The mean right cardiac output increased from 92.23±40.67 mL/min at 22 wk gestation to 335.83±32.75 mL/min at 35+6 wk gestation.Right ventricular end-diastolic volume,right ventricular end-systolic volume,right stroke volume,and right cardiac output all increased with gestational age and the correlations were linear(P<0.01).Right ejection fraction had no apparent correlation with gestational age(P>0.05).CONCLUSION Fetal right ventricular volume can be quantitatively measured using iSTIC technology with relative ease and high repeatability.iSTIC technology is expected to provide a new method for clinical evaluation of fetal cardiac function.

应用二维斑点追踪技术评估阻塞性睡眠呼吸暂停综合征患者右心室功能

目的 :应用二维斑点追踪技术(2D-STI)技术评价阻塞性睡眠呼吸暂停综合征(OSAS)患者右心室收缩功能的改变。方法:纳入经多导睡眠监测确诊OSAS患者49例为OSA组,根据睡眠呼吸暂停低通气指数(AHI)进行分度,轻度12例,中度9例,重度28例,同期选择年龄、性别相匹配无打鼾史的健康志愿者40例为对照组。应用常规超声心动图和2D-STI技术测量所有受试者的超声心动图参数,比较两组参数的差异。结果:与对照组相比,OSA组右房容积指数(RAVI)显著增大(P=0.04),三尖瓣口舒张晚期血流峰值速度(A-tv)显著升高(P=0.025),三尖瓣口舒张早期血流峰值速度/三尖瓣口舒张晚期血流峰值速度(E/A)减低(P=0.047),组织多普勒(TDI)三尖瓣环舒张早期峰值速度(Ea)显著减低(P=0.014)。OSA组右心室整体纵向应变(RV-GLS)(P=0.036)和右心室游离壁纵向应变(RV-FWLS)(P=0.039)显著减低。轻中度组与重度组比较,重度组RV-GLS(P=0.002)、RV-FWLS(P=0.030)显著减低,重度组RVFW基底段纵向应变(P=0.033)、心尖段纵向应变(P=0.028)显著减低,两组RVFW中间段纵向应变差异无统计学意义(P>0.05)。结论:OSAS患者右心室舒张和收缩功能均出现异常改变,2D-STI可早期发现OSAS患者右心室收缩功能的改变,且随着病情严重程度的增加,收缩功能呈减低趋势,右心室纵向应变可作为临床重要的参数,为临床治疗和预后提供有价值的信息。

“城乡两栖”视角下农村宅基地“三权分置”问题研究

“三权分置”改革有助于化解“城乡两栖”背景下宅基地的制度困境。在我国城镇化进程和乡村振兴过程中,城乡人口双向流动以及异地居住的“城乡两栖”现象日益明显。人口迁居带来了宅基地及其地上房屋所承载的居住功能弱化,而它们的财产功能和社会情感功能则逐渐增强。总体来看,现有部分制度抑制了宅基地的产权权能开发和资产价值挖掘,造成了闲置、低效利用与隐性流转共存的困局,需要合理推进“三权分置”改革。宅基地“三权分置”改革受到乡村治理机制不完善、产权边界不清晰、农民宅基地权属观念模糊等因素掣肘,面临所有权主体虚置、过度“资本化”等诸多问题,阻碍了相关体制机制创新。为此,“三权分置”改革需要清晰界定“三权”边界,明确宅基地的法权属性,在保障农户资格权的基础上适度拓展宅基地使用权,推动实现宅基地的财产价值;引入市场机制多元盘活闲置宅基地,进而提高土地资源利用效率。

To Actively Perform the Judicial Administration Function and Promote the Development of Cause of Human Rights

Respect for human rights and protection of human rights are significant rules in the Constitution of the People’s Republic of China.In 2015,judicial administration departments at all levels legally exercised their duties,implemented the principles and rules in constitution,and kept strengthening propagation of human rights through creation of contents and methods which had acquired great effects.What they have done contributes significantly toward the development of human rights in China.

右心声学造影定量分析技术评价肺心病患者右心室收缩功能对预后的预测效能

目的探讨右心声学造影定量分析技术评价肺源性心脏病(简称“肺心病”)患者右心室收缩功能对预后的预测效能。方法前瞻性选取2020年4月至2022年12月郑州大学第一附属医院收治的113例肺心病患者,根据治疗后6个月内是否发生主要不良心血管事件(MACE)分为预后不良组30例和预后良好组83例。比较两组患者的临床资料及右心室收缩功能指标[右心室收缩末期容积(RVESV)、右室舒张末容积(RVEDV)、右室每搏量(RVSV)、右室射血分数(RVEF)]、右心声学造影定量参数[时间常数(K)、三尖瓣环收缩期峰值速度(Vs)、峰值强度减半时间(HT)、平均通过时间(MTT)],采用Pearson相关系数分析各定量参数与右心室收缩功能指标的相关性,采用受试者工作特征曲线(ROC)评价各参数单独及联合应用对预后的预测效能。结果预后不良组患者的RVESV、RVEDV分别为(58.35±8.42)mL、(84.56±13.97)mL,明显高于预后良好组的(43.77±6.17)mL、(64.50±10.48)mL,RVSV、RVEF分别为(20.61±3.80)mL、(40.48±5.22)%,明显低于预后良好组的(25.87±5.29)mL、(48.10±6.35)%,差异均有统计学意义(P<0.05);预后不良组患者的K、Vs分别为(0.23±0.07)、(3.19±1.06)cm/s,明显低于预后良好组患者的(0.41±0.13)、(4.86±1.61)cm/s,HT、MTT分别为(42.77±10.21)s、(72.15±18.93)s,明显长于预后良好组患者的(25.52±7.33)s、(48.07±10.67)s,差异均有统计学意义(P<0.05);经Pearson相关系数分析结果显示,K、Vs与RVESV、RVEDV呈负相关(r=-0.625、-0.618,-0.651、-0.642),与RVSV、RVEF呈正相关(r=0.639、0.707,0.650、0.619),HT、MTT与RVESV、RVEDV呈正相关(r=0.636、0.665,0.704、0.629),与RVSV、RVEF呈负相关(r=-0.628、-0.641,-0.652、-0.701)(P<0.05);ROC分析结果显示,K、Vs、HT、MTT预测肺心病患者预后的曲线下面积(AUC)分别为0.843、0.750、0.767、0.838,敏感度分别为80.00%、83.33%、73.33%、80.00%,特异度分别为77.11%、60.24%、75.90%、81.93%,联合预测预后的AUC为0.945,敏感度为90.00%,特异度为86.75%;K、Vs低值的肺心病患者预后不良风险分别是高值患者的6.512倍、4.741倍,HT、MTT高值的肺心病患者预后不良风险分别是低值患者的4.648倍、7.590倍,差异有统计学意义(P<0.05)。结论右心声学造影定量参数K、Vs、HT、MTT与肺心病患者右心室收缩功能及预后有关,可作为临床评估预后情况的有效检查方式之一。

“三生”空间视角下土地利用功能演变与障碍诊断——以新一线城市南京市为例

基于“三生”空间视角构建土地利用多功能评价指标体系,运用改进的熵权TOPSIS法评价新一线城市南京市的土地利用多功能及其时变特征、权衡协同关系与障碍因素等,得到的结果显示:南京市在研究期间内土地利用多功能呈倒U型变化趋势,其中生产功能和生活功能提高,生态功能呈衰退态势;南京市土地生产、生活、生态功能空间存在程度不一的协同权衡关系;土地生产功能与生态功能的障碍度持续增大,其中SO 2年均浓度、森林覆盖率影响较突出,生活功能的障碍度持续减小。因此新一线城市应在权衡土地生活、生产与生态功能协同关系中强化土地生态空间服务功能,减少生活与生产活动带来的生态负效应,引导土地功能向高度协调方向演化。

心脏磁共振评估结缔组织病伴重度肺动脉高压的价值

目的评估心脏磁共振(CMR)对重度结缔组织病相关肺动脉高压(CTD-PAH)患者的诊断价值。方法纳入经右心导管(RHC)检查确诊为CTD-PAH的患者。在CMR图像上手动勾画并经体表面积校正获得右心室(RV)形态、功能及室间隔(IVS)的相关参数;在心肌延迟强化(LGE)图像上手动勾画并计算得到LGE心肌质量(MM)及其占左心室(LV)MM百分比。依照平均肺动脉压(mPAP)将其分为轻中度组和重度组,比较2组患者CMR参数差异,采用受试者工作特征(ROC)曲线分析CMR对重度患者的诊断价值。结果本研究共纳入48例CTD-PAH患者。重度组患者室间隔曲率(CIVS)及RV射血分数(EF)低于轻中度组,IVS形变时间占比、RV舒张末期容积指数(EDVI)、RV收缩末期容积指数(ESVI)及RV MM高于轻中度组(均P<0.05)。ROC曲线分析显示RV MM、IVS形变时间占比及RV ESVI对重度患者具有较好的诊断效能(AUC分别为0.792、0.766、0.731)。联合检测曲线下面积为0.840,敏感度为79.4%,特异度为85.7%。结论CMR测得的RV及IVS参数能够有效地评估重度CTD-PAH患者,从形态和功能学的角度直接反映了重度CTD-PAH患者的心脏受损程度。

论投资性居住权的扩张与限制

投资性居住权的设立顺应市场经济的发展,合理设计投资性居住权具有重要意义。在参照社会性居住权制度设计规则时,应充分考虑投资性居住权的经济属性以及二者的相互联系,在居住权制度的框架内与社会性居住权保持正向的、补充的、有限制的扩张。投资性居住权在主体上可以扩张至一般民事主体,但与社会性居住权发生矛盾时,应优先保护社会性居住权人的利益;客体上可以将住宅的含义扩张至居住性质的房屋;增设裁判取得、时效取得居住权的设立方式,且同样适用登记生效主义;允许自由转让,但需局限于原居住权人的居住期限内;增设多种消灭方式,但需居住权人秉持物尽其用之原则,禁止浪费住房资源。

论阿玛蒂亚·森可行能力视域下的人权理念

阿玛蒂亚·森为回应功利主义的效用平等和罗尔斯主义的基本善平等提出了可行能力平等,认为可行能力强调基于获取重要功能性活动的实质性自由,凸显了发展和倡导人权的重要性,能够很好地解决和处理人权的一致性、共同性和合法性问题。在其可行能力人权观基础上,努斯鲍姆、罗宾斯、安德森等一批支持可行能力哲学思想的学者试图不断发展和拓展可行能力的可及性,他们更加关注从社会实践层面推进具体的人权。阿玛蒂亚·森的可行能力人权观对于发展民主与法治,推进人权保障工作具有一定的借鉴意义。

Autostrain RV技术联合TDI-Tei指数对肺心病患者右心室收缩功能的评估价值

目的 探讨右心室自动应变定量技术(Autostrain RV)联合组织多普勒(TDI)-Tei指数对慢性肺源性心脏病(CPHD)患者右心室收缩功能的评估价值。方法 根据肺动脉收缩压(PASP)将111例CPHD伴三尖瓣反流患者分为3组:A组(35~49 mmHg, 1 mmHg=0.133 kPa)40例,B组(50~69 mmHg)36例,C组(≥70 mmHg)35例,纳入同期40名健康体检者作为对照组,测量4组常规超声参数及TDI-Tei指数,应用Autostrain RV技术获取右心室整体长轴应变(RV4CSL)、右心室游离壁纵向应变(RVFWSL)、游离壁基底部纵向应变(B-RVFWSL)、中部纵向应变(M-RVFWSL)及心尖部纵向应变(A-RVFWSL)数据,比较各组间差异。结果 与对照组相比,A、B、C组RV4CSL、RVFWSL、B-RVFWSL、M-RVFWSL、A-RVFWSL绝对值及三尖瓣环收缩期平面位移(TAPSE)均减小(P<0.05),且随着PASP升高依次降低,TDI-Tei指数升高(P<0.05),且随着PASP升高依次升高,组间比较差异均有统计学意义(P<0.05)。相关分析显示TDI-Tei指数与RVFWSL相关性较高(r=0.553,P<0.001)。ROC曲线显示Autostrain RV技术、TDI-Tei指数单独及联合评估右心室收缩功能的AUC均大于0.70,联合评估价值更高。结论 Autostrain RV技术能够敏感、准确地评价CPHD患者早期心肌功能障碍,联合TDI-Tei指数可进一步提高评估效能,为临床及时干预提供客观依据。