BACKGROUND & AIMS: STUDY DESIGN:A cross-sectional study of the spine in 40 young adults after solid organ transplantation in childhood. OBJECTIVE:To evaluate the impact of organ transplantation and long-term immunosuppressive treatment on growing spine using magnetic resonance imaging (MRI). SUMMARY OF BACKGROUND DATA:A review of the current literature reveals no systematic evaluation of the spine after transplantation in childhood. METHODS:A total of 40 adult patients (mean age 22.1 years, range, 16.0-27.0), who received either kidney, liver, or heart transplant as children, were evaluated. Mean follow-up after transplantation was 11.2 years (range 3.0-18.0). All patients filled in a questionnaire, underwent an interview and physical examination, as well as had MRI of the spine. Standing spinal radiographs were taken from patients with a rib hump > or = 6 degrees. RESULTS:There were 8 (20%) patients who had a history of vertebral fracture. Eleven (28%) patients reported frequent back pain at rest. There were 15 (38%) patients who had scoliosis > 10 degrees (range 10 degrees -69 degrees ). On MRI, narrowed disc spaces were noted in 32 (80%) patients, and irregular endplates were noted in 24 (60%). There were 14 (35%) patients who had at least 1 compressed or wedged vertebra (> 20%). Patients treated for acute rejection had wedged vertebrae, speckled or black disc spaces, and irregular endplates more often than patients without rejections. Males had wedged vertebrae more often than females (P = 0.0067). CONCLUSIONS:Back pain, scoliosis, wedged vertebrae, and narrowed, degenerated disc spaces are common after solid organ transplantation in childhood.

背景与目标： 研究设计：儿童实体器官移植后对40位年轻人的脊柱进行的横断面研究。
目的：利用磁共振成像（MRI）评估器官移植和长期免疫抑制治疗对生长中脊柱的影响。
背景资料摘要：对当前文献的回顾表明，儿童期移植后没有对脊柱进行系统评价。
方法：总共评估了40名成年患者（平均年龄22.1岁，范围16.0-27.0），他们从小就接受了肾脏，肝脏或心脏移植手术。移植后的平均随访时间为11.2年（范围3.0-18.0）。所有患者均填写了问卷，接受了访谈和体格检查，并对脊柱进行了MRI检查。肋骨隆起>或= 6度的患者拍摄站立式脊柱X光片。
结果：有8例（20％）有椎体骨折病史。 11名（28％）患者报告休息时经常出现背痛。脊柱侧弯> 10度（范围10度-69度）的患者为15（38％）。在MRI上，发现32例（80％）患者的椎间盘间隙变窄，发现24例（60％）的不规则端板。有14名（35％）患者至少有1块受压或楔入的椎骨（> 20％）。接受急性排斥反应的患者比没有排斥反应的患者更经常出现椎体楔形，斑点或黑色椎间盘间隙以及不规则的终板。男性比女性更经常楔住椎骨（P = 0.0067）。
结论：儿童实体器官移植后，背部疼痛，脊柱侧弯，椎骨楔形和椎间盘狭窄变窄是常见的。

BACKGROUND & AIMS: Magnetic resonance has assumed a preeminent role in the imaging evaluation of the spine. Owing to its multiplanar capability and superior soft tissue contrast, magnetic resonance imaging is the procedure of choice for a host of spinal disorders including degenerative disc disease, tumor evaluation, trauma, and spinal deformities. It represents the most accurate means of distinguishing between recurrent disc herniation and epidural fibrosis, and it excels at the assessment of many postoperative abnormalities such as infection, adjacent segment disc degeneration, and arachnoiditis. Magnetic resonance imaging is also helpful in the evaluation of numerous diagnostic challenges that are less well resolved by other means. This includes the distinction between disc herniation and epidural hematoma, synovial cyst from nonspecific fibrous thickening of a facet capsule, and the evaluation of numerous other soft tissue abnormalities. Computed tomography, computed tomography myelography, and scintigraphy continue to be useful for numerous specific disorders and in those patients with metal hardware or contraindications to magnetic resonance scanning. Overall, however, magnetic resonance is the imaging procedure preferred for many spinal disorders. This article is the first installment of a 3-part series discussing the role of magnetic resonance imaging of spinal disorders. Section 1 will describe the varying imaging modalities available and their relative advantages and disadvantages. A consideration of magnetic resonance imaging techniques will follow, followed by a discussion of the imaging manifestations of early degenerative disc disease. Section 2 will be devoted to an in depth discussion of specific pathologic processes encountered in patients with degenerative disc disease. Section 3 will end the series with a consideration of postoperative imaging followed by a discussion of spinal deformities, trauma, and neoplasms.

背景与目标： 磁共振在脊柱的成像评估中发挥了重要作用。由于其多平面能力和出色的软组织对比度，磁共振成像是许多脊柱疾病（包括退行性椎间盘疾病，肿瘤评估，创伤和脊柱畸形）的一种选择程序。它代表了区分复发性椎间盘突出症和硬膜外纤维化的最准确方法，并且擅长评估许多术后异常，例如感染，邻近节段性椎间盘退变和蛛网膜炎。磁共振成像还有助于评估许多诊断挑战，而这些挑战很难通过其他方式解决。这包括区分椎间盘突出症和硬膜外血肿，小囊囊的非特异性纤维增厚引起的滑膜囊肿，以及许多其他软组织异常的评估。计算机体层摄影术，计算机体层摄影术脊髓造影和闪烁显像术继续对许多特定疾病以及那些具有金属硬件或磁共振扫描禁忌症的患者有用。但是，总的来说，磁共振是许多脊柱疾病首选的成像方法。本文是由3部分组成的系列文章的第一部分，该系列讨论了磁共振成像对脊柱疾病的作用。第1节将描述可用的各种成像方式及其相对优缺点。随后将考虑磁共振成像技术，然后讨论早期退行性椎间盘疾病的成像表现。第2节将专门讨论变性椎间盘疾病患者遇到的特定病理过程。第三部分将在结束本系列文章时考虑术后影像学，然后讨论脊柱畸形，创伤和肿瘤。

BACKGROUND & AIMS: OBJECTIVE:To investigate clinically relevant intra-individual and mean changes in health-related quality of life (HRQoL) with the Short Form-36 Health Survey (SF-36) need to acknowledge that SF-36 is trademarked ie: SF-36(R) following cardiac intervention for Australian and Danish patients. DESIGN:Prospective observational study in tertiary cardiac centres in Townsville, Queensland, Australia and Copenhagen, Denmark. Two hundred coronary artery bypass graft surgery (CABG) patients of two Townsville hospitals, and 47 CABG or percutaneous coronary intervention (PCI) patients of a Copenhagen hospital. The main outcome measures are eight SF-36 health subscales at baseline and six months post-intervention. RESULTS:Australian and Danish patients experienced similar HRQoL pre-intervention. By six months post-intervention, patients experienced a significant mean improvement in all subscales of the SF-36 survey (p < or = 0.05), although up to 27% of patients had a clinically significant decline in HRQoL from baseline. CONCLUSIONS:These results demonstrate that it is necessary to investigate intra-individual changes in HRQoL as well as group mean changes as they produce different conclusions. In addition, establishing clinically significant intra-individual change standards may assist researchers and clinicians in determining whether an individual may benefit from therapy or intervention.

背景与目标： 目的：要通过36型健康调查（SF-36）调查与健康相关的生活质量（HRQoL）的临床相关个人和平均变化，需要承认SF-36是商标，即：SF-36（ R）对澳大利亚和丹麦患者进行心脏干预后。
设计：在澳大利亚昆士兰州汤斯维尔和丹麦哥本哈根的三级心脏中心进行前瞻性观察研究。两家汤斯维尔医院的200例冠状动脉搭桥术（CABG）患者，以及哥本哈根医院的47例CABG或经皮冠状动脉介入治疗（PCI）患者。主要结果指标是基线时和干预后六个月的八个SF-36健康子量表。
结果：澳大利亚和丹麦患者经历了类似的HRQoL干预前。干预后六个月，患者在SF-36调查的所有子量表中均经历了显着的平均改善（p <或= 0.05），尽管高达27％的患者的HRQoL与基线相比有临床上的显着下降。
结论：这些结果表明，有必要研究HRQoL的个体内部变化以及群体均值变化，因为它们会产生不同的结论。此外，建立具有临床意义的个体内部变更标准可能有助于研究人员和临床医生确定个人是否可以从治疗或干预中受益。

BACKGROUND & AIMS: :The aim of this pilot study was to investigate anaesthetists' assessment of the ability of patients to increase cardiac output over a range of clinical scenarios and of their perceived 'likelihood of transfusion' in these scenarios. Specialist anaesthetists were given a questionnaire with clinical cues in the form of diagnoses about theoretical patients. They were asked to use 100 mm visual analogue scales (VAS) for their assessments of each patient's cardiac reserve and their 'likelihood of transfusion' of these patients; the endpoints of the VAS being 'Very low' (0 mm) to 'High' (100 mm), and 'Do not transfuse' (0 mm) to 'Transfuse' (100 mm) respectively. The assessment of patients' cardiac output reserve by anaesthetists (n = 54) showed great variation; for example, a patient with severe aortic stenosis was perceived overall to have a limited ability to increase cardiac output (mean VAS 16 mm) but there was considerable variation between anaesthetists (25-75 percentiles 10 mm to 21 mm). Assessment of 'likelihood of transfusion' (n = 42) also had great variation; as an example a patient with 'angina' with a haemoglobin of 95 g l(-1) was perceived overall to have an average likelihood of transfusion of 50 mm, but the 25-75 percentiles ranged from 33 mm to 71 mm. This study suggests that inter-anaesthetist variability in the assessment of a patient's 'cardiac output reserve' and his 'likelihood of transfusion' is large.

背景与目标： ：这项初步研究的目的是调查麻醉师对患者在一系列临床情况下增加心输出量的能力以及他们在这些情况下感知的“输血可能性”的评估。专家麻醉师接受了有关临床线索的问卷调查，形式是对理论患者的诊断。他们被要求使用100 mm视觉模拟量表（VAS）评估每个患者的心脏储备和这些患者的“输血可能性”。 VAS的端点分别为“非常低”（0毫米）至“高”（100毫米）和“请勿输液”（0毫米）至“输液”（100毫米）。麻醉师对患者心输出量储备的评估（n = 54）显示出很大的差异。例如，总的来说，严重的主动脉瓣狭窄患者的心输出量增加能力有限（平均VAS 16毫米），但是麻醉师之间的差异很大（10毫米至21毫米为25-75％）。对“输血可能性”的评估（n = 42）也有很大差异。例如，患有“心绞痛”且血红蛋白为95 g l（-1）的患者总体上被认为平均输血的可能性为50 mm，但25-75％的范围为33 mm至71 mm。这项研究表明，麻醉师之间在评估患者的“心输出量储备”和“输血可能性”方面存在很大差异。

BACKGROUND & AIMS: The effect of bacteriorhodopsin (BR) on the percolation properties of dimyristoylphosphatidylcholine/distearoylphosphatidylcholine bilayers was examined by studying the quenching of a lipid-bound fluorophore by a lipid-bound quencher, and by spin-spin interactions of a nitroxide-labeled lipid using electron spin resonance (ESR). At the low concentrations of BR used, differential scanning calorimetry showed that although the transition enthalpy was reduced in a concentration-dependent manner by incorporation of BR, the solidus and fluidus phase boundaries and overall shape of the heat capacity profiles were essentially unchanged. However, fluorescence quenching and spin-label ESR data showed that the domain topology, as reflected in the percolation properties, is strongly affected by the protein. In contrast to our previous fluorescence data for the pure lipid mixtures, quenching in the coexistence region is independent of the fluid phase fraction when BR is present. In addition, the percolation threshold estimated by spin-label ESR is shifted in the presence of BR to a higher gel phase fraction at a given lipid composition. Both the fluorescence quenching and spin-label ESR data, together with the results of earlier simulations, strongly suggest that the fluid phase domains are substantially larger and/or less ramified in the presence of BR than in its absence. We have previously reported a similar effect of a transmembrane peptide, pOmpA (Escherichia coli outer membrane protein A signal peptide), on fluid domain connectivity in binary phosphatidylcholine mixtures.

背景与目标： 通过研究脂质结合的猝灭剂对脂质结合的荧光团的猝灭以及使用电子自旋的一氧化氮标记的脂质的自旋-自旋相互作用，研究了细菌视紫红质（BR）对二肉豆蔻酰基磷脂酰胆碱/二硬脂酰磷脂酰胆碱双层渗透特性的影响。共振（ESR）。在使用低浓度的BR时，差示扫描量热法显示，尽管通过掺入BR以一定的浓度依赖性降低了转变焓，但固相线和液相线的边界和热容曲线的总体形状基本不变。但是，荧光猝灭和自旋标记ESR数据表明，渗透特性所反映的域拓扑结构受到蛋白质的强烈影响。与我们以前的纯脂质混合物的荧光数据相反，当存在BR时，共存区域的猝灭与液相分数无关。另外，在给定脂质组成下，在BR的存在下，自旋标记ESR估计的渗透阈值会转移到较高的凝胶相分数。荧光猝灭和自旋标记ESR数据以及早期模拟的结果都强烈表明，在存在BR的情况下，与不存在BR的情况相比，液相域的分支和/或分枝显着增加。我们以前曾报道过跨膜肽pOmpA（大肠杆菌外膜蛋白A信号肽）对二元磷脂酰胆碱混合物中的流体域连通性具有类似作用。

BACKGROUND & AIMS: :Isolated cleft mitral valve (ICMV) is a rare entity not known to be related to pulmonary atresia with ventricular septal defect (PA-VSD). This report describes the use of cardiovascular magnetic resonance (CMR) imaging to diagnose ICMV in a patient with repaired PA-VSD who presented with incidental severe mitral regurgitation (MR) on follow-up echocardiography. An associated pulmonary varix secondary to the severe MR also was shown by CMR.

背景与目标： ：孤立的二尖瓣裂开（ICMV）是一种罕见病，未知与室间隔缺损的肺动脉闭锁（PA-VSD）相关。本报告介绍了在后续超声心动图检查中出现偶发性严重二尖瓣关闭不全（MR）的PA-VSD修复患者中，使用心血管磁共振（CMR）成像诊断ICMV的情况。 CMR还显示了继发于严重MR的相关肺静脉曲张。

BACKGROUND & AIMS: :In a prospective magnetic resonance imaging and cognitive study of 38 demented patients and 15 control subjects, 11 of 27 patients with Alzheimer's disease and 8 of 11 patients with vascular dementia had significant periventricular hyperintensities. Memory and language testing in the early investigation of dementia is useful to distinguish patients with or without periventricular hyperintensities on magnetic resonance imaging. Patients without periventricular hyperintensities are worse on memory and conceptualization tests than patients with periventricular hyperintensities, who tend to be worse on comprehension and attention tests. These differences in cognitive pattern are present between patients with different pathogenesis who are otherwise matched for dementia severity. Language and some nonverbal cognitive deficits correlate with the extent of cortical and ventricular atrophy in Alzheimer's disease.

背景与目标： ：在一项针对38名痴呆患者和15名对照受试者的前瞻性磁共振成像和认知研究中，27名阿尔茨海默氏病患者中的11名和11名血管性痴呆患者中的8名出现了明显的脑室高信号。痴呆症早期调查中的记忆和语言测试有助于区分磁共振成像中是否伴有脑室高信号的患者。没有脑室高信号的患者在记忆力和概念化测试方面比脑室高信号的患者在理解和注意力测试方面更差。这些认知模式上的差异存在于具有不同发病机理的患者之间，这些患者在其他方面与痴呆严重程度相匹配。语言和一些非语言认知缺陷与阿尔茨海默氏病的皮质和心室萎缩程度有关。

BACKGROUND & AIMS: :We investigated the effect of homogeneous and inhomogeneous static magnetic field (SMF) exposure on the thermal nociceptive threshold of snail in the hot plate test (43 °C). Both homogeneous (hSMF) and inhomogeneous (iSMF) SMF increased the thermo-nociceptive threshold: 40.2%, 29.2%, or 41.7% after an exposure of 20, 30, or 40 min hSMF by p < 0.001, p < 0.0001, or p < 0.001, and 32.7% or 46.2% after an exposure of 20 or 40 min iSMF by p < 0.05 or p < 0.0001. These results suggest that SMF has an antinociceptive effect in snail. On the other hand, naloxone as an atypical opioid antagonist in an amount of 1 μg/g was found to significantly decrease the thermo-nociceptive threshold (41.9% by p < 0.002), which could be antagonized by hSMF exposure implying that hSMF exerts its antinociceptive effect partly via opioid receptors.

背景与目标： ：我们在热板测试（43°C）中研究了均匀和不均匀的静磁场（SMF）暴露对蜗牛的热伤害感受性阈值的影响。均质（hSMF）和不均质（iSMF）SMF均可在暴露20、30或40分钟的hSMF时通过p <0.001，p <0.0001或p提高热伤害感受性阈值：40.2％，29.2％或41.7％ iSMF暴露p≤0.05或p≤0.0001后，<0.001，以及32.7％或46.2％。这些结果表明，SMF对蜗牛具有镇痛作用。另一方面，发现纳洛酮作为一种非典型的阿片类药物拮抗剂，可显着降低热伤害感受性阈值（41.9％，p <0.002），可被hSMF暴露所拮抗，暗示hSMF发挥了其作用。部分通过阿片样物质受体产生抗伤害感受作用。

BACKGROUND & AIMS: BACKGROUND:Central venous oxygen saturation (ScvO2) remains the gold standard surrogate for tissue oxygen extraction in paediatric cardiac surgery. Near-infrared spectroscopy (NIRS) has been developed as a non-invasive diagnostic tool for regional oxygen saturation. The aim was to compare regional oxygen saturation measured by NIRS with ScvO2 in postoperative paediatric cardiac patients. METHODS:In this prospective study, we included newborns and infants younger than 45 days undergoing heart surgery. We recorded continuous ScvO2 and NIRS regional saturation placed on the forehead (B) and right flank (S) for 48 h postoperatively. A Bland-Altman's analysis was used to assess the agreement between these measurements. RESULTS:A total of 23 patients were included with a median age of 12 days (2-46) and median weight of 3.1 kg (2.3-4.47). The mean difference (MD) ScvO2- B NIRS was 10.45% with limits of agreement (LOA) -17.23 to 38.13% and ScvO2- S NIRS MD 7.16% with LOA: -25.51 to 39.84%. The single ventricle ScvO2- S NIRS subgroup had MD within ± 5%; however, wide LOA was observed. The remaining subgroups showed MD nearly above ± 5%, with wide LOA. CONCLUSIONS:The regional oxygen saturation of brain and kidney did not match ScvO2 as estimation of global tissue perfusion. Nevertheless, NIRS may still provide information regarding regional circulation that may help in the management of neonatal cardiac surgery patients.

背景与目标： 背景：中央静脉血氧饱和度（ScvO2）仍然是小儿心脏外科手术中组织氧提取的金标准。近红外光谱法（NIRS）已被开发为一种用于区域血氧饱和度的非侵入性诊断工具。目的是比较由NIRS和ScvO2测得的小儿心脏术后患者的局部血氧饱和度。
方法：在这项前瞻性研究中，我们纳入了接受心脏手术的45天以下的新生儿和婴儿。我们记录了连续的ScvO2和NIRS区域饱和度放置在术后48 h的前额（B）和右胁（S）上。用布兰德-奥特曼（Bland-Altman）分析来评估这些测量之间的一致性。
结果：总共纳入23名患者，中位年龄为12天（2-46），中位体重为3.1 kg（2.3-4.47）。 ScvO2-B NIRS的平均差异（MD）为10.45％，协议限制（LOA）为-17.23至38.13％，Slovo2- S NIRS MD的7.16％LOA为-25.51至39.84％。单心室ScvO2-S NIRS亚组的MD≤±5％。但是，观察到广泛的LOA。其余亚组的MD值接近±5％，LOA较宽。
结论：脑和肾脏的局部血氧饱和度与ScvO2不符，无法估计整体组织灌注。尽管如此，NIRS仍可能提供有关区域循环的信息，这可能有助于新生儿心脏外科手术患者的管理。

BACKGROUND & AIMS: :Myocardial extracellular volume fraction (ECV) reflecting diffuse myocardial fibrosis can be measured with T1 mapping cardiovascular magnetic resonance (CMR) before and after the application of a gadolinium-based extracellular contrast agent. The equilibrium between blood and myocardium contrast concentration required for ECV measurements can be obtained with a primed contrast infusion (equilibrium contrast-CMR). We hypothesized that equilibrium can also be achieved with a single contrast bolus to accurately measure diffuse myocardial fibrosis in patients with congenital heart disease (CHD). Healthy controls (n = 17; median age 24.0 years) and patients with CHD (n = 19; 25.0 years) were prospectively enrolled. Using modified Look-Locker inversion recovery T1 mapping before, 15 min after bolus injection, and during constant infusion of gadolinium-DOTA, T1 values were obtained for blood pool and myocardium of the left ventricle (LV), the interventricular septum (IVS), and the right ventricle (RV) in a single midventricular plane in short axis or in transverse orientation. ECV of LV, IVS and RV by bolus-only and bolus-infusion correlated significantly in CHD patients (r = 0.94, 0.95, and 0.74; p < 0.01, respectively) and healthy controls (r = 0.96, 0.89, and 0.64; p < 0.05, respectively). Bland-Altman plots revealed no significant bias between the techniques for any of the analyzed regions. ECV of LV and RV myocardium measured by bolus-only T1 mapping agrees well with bolus-infusion measurements in patients with CHD. The use of a bolus-only approach facilitates the integration of ECV measurements into existing CMR imaging protocols, allowing for assessment of diffuse myocardial fibrosis in CHD in clinical routine.

背景与目标： ：应用基于g的细胞外造影剂前后，可通过T1映射心血管磁共振（CMR）来测量反映弥漫性心肌纤维化的心肌细胞外体积分数（ECV）。 ECV测量所需的血液和心肌造影剂浓度之间的平衡可通过灌注造影剂（平衡造影剂CMR）获得。我们假设通过单次对比推注也可以达到平衡，以准确测量先天性心脏病（CHD）患者的弥漫性心肌纤维化。前瞻性纳入健康对照组（n = 17）；中位年龄24.0岁； CHD患者（n = 19； 25.0岁）。使用改良的Look-Locker反转恢复T1映射，在推注大剂量，之后15分钟以及在持续输注--DOTA期间，获得了左心室（LV），心室间隔（IVS）的血池和心肌的T1值，右心室（RV）在短心轴或横向方向的单个心室中平面内。仅推注和推注输注的LV，IVS和RV的ECV在CHD患者（分别为r = 0.94、0.95和0.74； p <0.01）和健康对照者（r = 0.96、0.89和0.64； p中显着相关）分别<0.05）。布兰德-奥特曼（Bland-Altman）图显示，任何被分析区域的技术之间均无明显偏差。通过仅推注T1测绘测得的LV和RV心肌的ECV与CHD患者的推注量测量非常吻合。仅推注方法的使用有助于将ECV测量值集成到现有的CMR成像协议中，从而可以在临床常规中评估CHD中弥漫性心肌纤维化。

BACKGROUND & AIMS: OBJECTIVE:Echocardiography is used for the detection of cardiac sarcoid involvement in patients with non-cardiac sarcoidosis. Little information is available regarding temporal changes in left ventricular ejection fraction (LVEF) and left ventricular end-diastolic dimension (LVDd) in non-cardiac sarcoidosis patients. METHODS AND RESULTS:Fifty-four sarcoidosis patients who received periodic follow-up with echocardiography at our institute were enrolled in this study. At the time of initial ultrasonography, 13 patients were diagnosed with cardiac sarcoid involvement. All of the remaining 41 patients with extra-cardiac sarcoidosis only had a LVEF of >50%. During the median follow-up period of 39 months, two (4.9%) of the non-cardiac sarcoidosis patients were diagnosed with cardiac sarcoid involvement; one patient showed a progressive decline in the LVEF over a short period of time. It was also found that two of 41 non-cardiac sarcoidosis patients showed declines in the LVEF of >10% per year; however, they were not diagnosed with cardiac sarcoidosis during the follow-up period. CONCLUSION:Rapid deterioration of left ventricular function may increase the suspicion of sarcoid involvement of the heart in non-cardiac sarcoidosis patients; however, we must be aware that a certain subfraction of patients may not demonstrate significant abnormalities in LVEF or LVDd on periodic echocardiographic follow-up.

背景与目标： 目的：超声心动图用于检测非心脏结节病患者的心脏结节样病变。关于非心脏结节病患者左心室射血分数（LVEF）和左心室舒张末期尺寸（LVDd）随时间变化的信息很少。
方法与结果：54例结节病患者在我院接受了定期超声心动图随访。在初次超声检查时，有13例患者被诊断出患有心脏结节样病变。其余所有41例心外结节病患者的LVEF均仅> 50％。在39个月的中位随访期内，有2名（4.9％）非心脏结节病患者被诊断出患有心脏结节病。一名患者在短时间内LVEF逐渐下降。还发现41例非心脏结节病患者中有2例的LVEF下降每年> 10％。但是，在随访期间并未诊断出他们患有心脏结节病。
结论：非心脏结节病患者左心功能的迅速恶化可能增加对心脏结节累及的怀疑。但是，我们必须意识到，在定期超声心动图随访中，患者的某些亚分类可能未显示LVEF或LVDd的明显异常。

BACKGROUND & AIMS: PURPOSE:The issue of unidentified volume expansion is well recognized as a cause for resistance to antihypertensive therapy. The aim of study is to identify contribution of negative fluid balance to hypertension control and impact on endothelial and cardiac functions among primary hypertensive patients who do not have kidney failure. MATERIALS AND METHODS:This is a prospective interventional study with one-year follow-up. Preceded by volume status measurements were performed by a body composition monitor (BCM), the patients were put on ambulatory blood pressure monitoring for 24 hours. Then, echocardiographic assessments and flow-mediated dilation (FMD) and carotid intima-media thickness (CIMT) measurements were completed. Patients in one of the two groups were kept negative hydrated during trial with diuretic treatment. RESULTS:At the end of one-year follow-up, patients in negative hydrated group were found to have significantly lower CIMT, left ventricle mass index, left ventricular end-diastolic diameter, mean systolic and diastolic BP, non-dipper patient ratio, and higher FMD. In negatively hydrated group, target organ damage significantly reduced during trial. CONCLUSIONS:The significance of negative hydration status with respect to blood pressure control, endothelial and cardiac functions within primary hypertensive patients who do not suffer from kidney failure has been demonstrated.

背景与目标： 目的：不明原因的体积膨胀问题已被公认为是抗高血压治疗耐药的原因。研究的目的是在没有肾衰竭的原发性高血压患者中确定负流体平衡对高血压控制的贡献以及对内皮和心脏功能的影响。
材料与方法：这是一项为期一年的随访的前瞻性干预研究。在通过身体成分监测仪（BCM）进行体积状态测量之前，将患者进行动态血压监测24小时。然后，完成了超声心动图评估以及血流介导的扩张（FMD）和颈动脉内膜中层厚度（CIMT）的测量。两组中的一组患者在利尿剂治疗试验期间保持负水分状态。
结果：在一年的随访结束时，负水合组患者的CIMT，左心室质量指数，左心室舒张末期直径，平均收缩压和舒张压，非北斗星患者比率显着降低，和更高的FMD。在负水合组中，试验期间靶器官损伤显着减少。
结论：在没有肾脏衰竭的原发性高血压患者中，负水合状态对血压控制，内皮和心脏功能的重要性已得到证实。

BACKGROUND & AIMS: :Prostatic magnetic resonance images of 22 male volunteers less than 30 years old and with no known genito-urinary tract disease were obtained at 1.5 T. Normal anatomical features of the prostate were studied with spin-echo techniques. Different zones of the normal gland are shown by T2-weighted images: the anterior fibromuscular fascia, the central prostate, the peripheral prostate and the periurethral zone can be differentiated. The normal prostate gland is shown on T1-weighted images as a homogeneous appearance. It is important to recognize the normal zonal anatomy of the prostate since prostatic disorders arise in different anatomical zones.

背景与目标： ：在1.5 T下获得了22名30岁以下且无已知泌尿生殖道疾病的男性志愿者的前列腺磁共振图像。使用自旋回波技术研究了前列腺的正常解剖特征。 T2加权图像显示了正常腺体的不同区域：可以区分前纤维肌筋膜，中央前列腺，周围前列腺和尿道周围区域。正常的前列腺在T1加权图像上显示为均一的外观。重要的是要认识到前列腺的正常区域解剖结构，因为前列腺疾病出现在不同的解剖区域中。

BACKGROUND & AIMS: BACKGROUND:Reductions in admissions for myocardial infarction (MI) have been reported in locales where smoke-free workplace laws have been implemented, but no study has assessed sudden cardiac death in that setting. In 2002, a smoke-free restaurant ordinance was implemented in Olmsted County, Minnesota, and in 2007, all workplaces, including bars, became smoke free. METHODS:To evaluate the population impact of smoke-free laws, we measured, through the Rochester Epidemiology Project, the incidence of MI and sudden cardiac death in Olmsted County during the 18-month period before and after implementation of each smoke-free ordinance. All MIs were continuously abstracted and validated, using rigorous standardized criteria relying on biomarkers, cardiac pain, and Minnesota coding of the electrocardiogram. Sudden cardiac death was defined as out-of-hospital deaths associated with coronary disease. RESULTS:Comparing the 18 months before implementation of the smoke-free restaurant ordinance with the 18 months after implementation of the smoke-free workplace law, the incidence of MI declined by 33% (P < .001), from 150.8 to 100.7 per 100,000 population, and the incidence of sudden cardiac death declined by 17% (P = .13), from 109.1 to 92.0 per 100,000 population. During the same period, the prevalence of smoking declined and that of hypertension, diabetes mellitus, hypercholesterolemia, and obesity either remained constant or increased. CONCLUSIONS:A substantial decline in the incidence of MI was observed after smoke-free laws were implemented, the magnitude of which is not explained by community cointerventions or changes in cardiovascular risk factors with the exception of smoking prevalence. As trends in other risk factors do not appear explanatory, smoke-free workplace laws seem to be ecologically related to these favorable trends. Secondhand smoke exposure should be considered a modifiable risk factor for MI. All people should avoid secondhand smoke to the extent possible, and people with coronary heart disease should have no exposure to secondhand smoke.

背景与目标： 背景：在已实施无烟工作场所法律的地区，已有报道称心肌梗死（MI）的住院人数有所减少，但尚无研究评估该地区的突发性心脏病死亡。 2002年，明尼苏达州的奥尔姆斯特德县实施了无烟餐厅条例，2007年，包括酒吧在内的所有工作场所都实现了无烟。
方法：为了评估无烟法律对人口的影响，我们通过罗切斯特流行病学项目测量了在实施每项无烟条例前后的18个月内，奥尔姆斯特德县的心肌梗死和心源性猝死的发生率。使用严格的标准化标准（依赖于生物标志物，心脏疼痛和心电图的明尼苏达州编码），对所有MI进行连续提取和验证。猝死定义为与冠心病相关的院外死亡。
结果：与实施无烟餐厅条例之前的18个月与实施无烟餐厅工作场所法之后的18个月相比，心梗的发生率下降了33％（P <.001），从每15万人的150.8下降到100.7心脏猝死的发生率下降了17％（P = 0.13），从每10万人口中的109.1下降到92.0。在同一时期，吸烟率下降，而高血压，糖尿病，高胆固醇血症和肥胖症的发生率则保持不变或上升。
结论：实施无烟法律后，心肌梗死的发生率显着下降，除吸烟率外，社区共同干预措施或心血管危险因素的变化均不能解释其严重程度。由于其他危险因素的趋势似乎无法解释，因此，无烟工作场所法律似乎与这些有利趋势在生态上相关。二手烟暴露应被视为可改变的心梗危险因素。所有人都应尽可能避免二手烟，患有冠心病的人也不应接触二手烟。

BACKGROUND & AIMS: UNLABELLED:Auscultation skills are in decline, but few studies have shown which specific aspects are most difficult for trainees. We evaluated individual aspects of cardiac auscultation among pediatric residents using recorded heart sounds to determine which elements pose the most difficulty. METHODS:Auscultation proficiency was assessed among 34 trainees following a pediatric cardiology rotation using an open-set format evaluation module, similar to the actual clinical auscultation description process. RESULTS:Diagnostic accuracy for distinguishing normal from abnormal cases was 73%. Findings most commonly correctly identified included pathological systolic and diastolic murmurs and widely split second heart sounds. Those least likely to be identified included continuous murmurs and clicks. Accuracy was low for identifying specific diagnoses. CONCLUSIONS:Given time constraints for clinical skills teaching, this suggests that focusing on distinguishing normal from abnormal heart sounds and murmurs instead of making specific diagnoses may be a more realistic goal for pediatric resident auscultation training.

背景与目标： 没标签：听诊技能在下降，但是很少有研究表明哪些方面对受训者最困难。我们使用记录的心音评估了小儿居民心脏听诊的各个方面，以确定哪些元素构成了最大困难。
方法：采用开放式格式评估模块，对34名受过小儿心脏病学培训的学员进行听诊能力评估，与实际临床听诊描述过程相似。
结果：区分正常与异常病例的诊断准确性为73％。最常正确识别的发现包括病理性收缩期和舒张期杂音和广泛分裂的第二心音。那些最不可能被识别出的声音包括连续的杂音和咔嗒声。识别特定诊断的准确性较低。
结论：鉴于临床技能教学的时间限制，这表明着眼于区分正常和异常的心音和杂音而不是进行特定的诊断可能是儿科住院医师听诊培训的一个更现实的目标。