Objective To investigate value of real-time three-dimensional echocardiography timingexcursion parametric index and 17 segment volume curves index in patients with restrictive cardiomyopathy and constrictive pericardits.MethodsSeventeen patients with restrictive cardiomyopathy (proven by biopsy) ,six patients with constrictive pericardits (proven by CT or surgical),twenty subjects with normal left ventricular(LV) function were examined by Philips iE33 with X3-1 probe.Results Parameter index of Tmsv 16-SD,Tmsv 12-SD Tmsv 6-SD,Tmsv 16-Dif,Tmsv 12-Dif,Tmsv 6-Dif,Tmsv 16-SD(%) ,Tmsv 12-SD(%),Tmsv 6-SD(%),Tmsv 16-Dif(%),Tmsv 12-Dif(%),Tmsv 6-Dif(%) was significantly higher in patients with restrictive cardiomyopathy than that in subjects with normal LV function(all P ＜0.05).Average and maximum value and minimum of excursion was significantly lower in patients with restrictive cardiomyopathy than that in subjects with normal LV function (all P ＜0.005).Whereas,compare with subjects with normal LV function,the parametric indexes of timing-excursion and 17 segment volume curves were not significantly difference in patients with constrictive pericardits(all P ＞0.05).Conclusions Realtime three-dimensional echocardiography can evaluate and diagnose fastly restrictive cardiomyopathy and constrictive pericardits.

Objective To evaluate left ventricular systolic synchrony in patients with Ⅲ grade atrio-ventricular block(Ⅲ grade AVB) after pacemaker implantation by real-time three-dimensional echocardiography. Methods Methods Twelve patients with Ⅲ grade AVB implanted by VVI pacemaker, seven patients with Ⅲ grade AVB implanted by DDD pacemaker, twenty subjects with normal LV function were examined by Philips iE33 with a X3-1 probe. Results The minimal excursion in patients with Ⅲ grade AVB implanted by VVI pacemaker and DDD pacemaker was less than that in subjects with normal LV function (P <0.05) ,and two "bull eyes" displayed that some regional systolic timing delayed or ahead, but also some regional systolic excursion hypokinesis or dykinesis. Parameter index [including Tmsv 16-SD, Tmsv 12-SD, Tmsv 6-SD, Tmsv 16-Dif, Tmsv 12-Dif, Tmsv 6-Dif, Tmsv 16-SD (%), Tmsv 12-SD (%), Tmsv 6-SD (%), Tmsv 16-Dif (%), Tmsv 12-Dif (%), Tmsv 6-Dif(%)] of 17 segment time to minimal systolic volume in patients with Ⅲ grade AVB implanted by VVI pacemaker and DDD pacemaker was more than that in subjects with normal LV function (all P < 0.05). Conclusions Real-time three-dimensional echocardiography can rapidly evaluate left ventricular systolic synchrony in patients with Ⅲ grade AVB implanted by DDD pacemaker and VVI pacemaker.

Objective To investigate the value of real-time three-dimensional echocardiography timing-excursion parametric index and 17 segment volume curves index in patients with restrictive cardiomyopathy.Methods Eight patients with restrictive cardiomyopathy (proven by biopsy),twenty eight subjects with normal left ventricular(LV) function were examined by Philips iE33 with X3-1 probe.Results Parameter index of the SD and maximum difference of Tmsv of 16 segments,12 segments,and 6 basal segments(Tmax 16SD,Tmsv-12SD Tmsv -6SD,Tmsv-16Dif,Tmsv-12 Dif,Tmsv-6Dif,Tmsv 16-SD%,Tmsv 12-SD%,Tmsv 6-SD%,Tmsv 16-Dif%,Tmsv 12-Dif%,Tmsv 6-Dif%) was significantly higher in patients with restrictive cardiomyopathy than that in subjects with normal LV function(all P＜0.001).Average and maximum value and minimum of excursion was significantly lower in patients with restrictive cardiomyopathy than that in subjects with normal LV function(P＜0.001,P＜0.005,P＜0.005).And parameter index of 17 segment volume curves index showed higher sensitivity,specificity,positive predictive value and negative predictive value for diagnose restrictive cardiomyopathy.Conclusions Real-time threedimensional echocardiography can evaluate and diagnose restrictive cardiomyopathy fastly.

Objective To analyze the related risk factors for Lisfranc injury resulting from low energy violence.Methods A retrospective study was performed for 61 cases (35 males,26 females) with low-energy foot injury hospitalized from June 2008 to June 2014.Mean age was 36.7 years (range,16-57 years).Fall injuries were noted in 24 cases,sports injuries in 21 cases,and twist injuries in 16 cases.The cases were divided into Lisfranc injury group(n =23) and non-Lisfranc injury group (n =38) according to the different diagnosis.Univariate analysis and multi-factor logistic regression analysis were used to identify the factors that may lead to the occurrence of Lisfranc injury including age,gender,body mass index,operation history,smoking,alcohol abuse,injury reason,medial depth of the mortise/ second metatarsal length (b/a),lateral depth of the mortise/ second metatarsal length (c/a),first metatarsal-to-talus angle,first intermetatarsal angle,second metatarsal length/foot length(a/g),calcaneal inclination angle and cuboid-navicular overlap/cuboid vertical height (e/e + f).Results Univariate analysis showed between-group differences were significant in age (x2 =7.385,P ＜0.05),injury reason (x2 =8.663,P ＜ 0.05),calcaneal inclination angle (t =3.958,P ＜ 0.05),b/a (t =5.051,P ＜ 0.05) and a/g(t =4.618,P ＜ 0.05).Logistic regression analysis identified b/a(OR =1.036,95 ％ CI 0.018-0.450,P ＜ 0.01) and a/g(OR =1.013,95％ CI 0.005-0.374,P ＜ 0.01) as independent risk factors for low-energy Lisfranc injury.Conclusion Low-energy Lisfranc injury is independently associated with b/a and a/g,and may relate to the decreased medial depth of the mortise and increased foot length.

Objective To investigate the value of two-dimensional and three-dimensional transesophageal echocardiography (3DTEE) in transcatheter aortic valve implantation (TAVI). Methods Eleven patients with severe aortic stenosis and one patient with moderate to severe prosthetic valve regurgitation underwent TAVI in Zhongshan Hospital of Fudan University from May 2010 to December 2015. All patients received two-dimensional and three-dimensional transthoracic and transesophageal echocardiographic examination before surgery, during and after surgery.Results Procedural success was achieved in eleven patients, but one patient died in pericardial tamponade and aortic dissection three days after TAVI. The maximum and minimum diameter of aortic annule, the area of aortic annule and aortic valve were measured by multidetector computed tomography (MDCT) and 3DTEE before surgery. All parameters had strong correlations between MDCT and 3DTEE (r=0.98,P<0.01 for maximum diameter;r=0.97,P<0.01 for minimum diameter;r=0.97,P<0.01 for the area of aortic annule;r=0.99, P<0.01 for the area of aortic valve). There were good correlations for the area of aortic valve among MDCT, 3DTEE and equation of continuity (allr=0.99,P<0.01).ConclusionTwo-dimensional and three dimensional transesophageal echocardiography can quantify the size of aortic annular and comprehensively evaluate the anatomical structure of aorta rapidly and accurately, which can be used in guiding TAVI and monitoring its complications in real time.

AIM:To study the effects of extracellular potassium on the protein expression of wild-type HERG and its mutant L539fs/47.METHODS:Wild-type HERG (WT) or its mutant HERG-L539fs/47 (MT) were transfected into HEK293 cells for 36 h.The cells were incubated in different media containing 0.8, 4.3 or 10 mmol/L potassium.Af-ter 6 h of incubation, the protein expression of HERG was detected by flow cytometry.After 12 h of incubation, the locali-zation and quantity of the proteins were detected by laser confocal imaging and Western blot.RESULTS: Different from the retention of mutant protein in cytoplasm, wild-type HERG protein was mainly distributed in the cell membrane.The 2 proteins both increased with the changes of extracellular potassium.Flow cytometry showed that the fluorescence in the 2 groups both increased with the changes of extracellular potassium ( P<0.01 ) .The fluorescence in WT group was signifi-cantly higher than that in MT group (P<0.01).Western blot showed that mutant HERG protein included only one 60 kD band, different from the 135 kD and 155 kD bands in wild-type HERG, which were affected by the changes of extracellular potassium (P<0.05).CONCLUSION:The retention of HERG mutant L539fs/47 protein in the cytoplasm is more than wild-type HERG.Chronic high extracellular potassium keeps the stability of wild-type and mutant HERG proteins on the cell membrane.Chronic low potassium reduces the expression of HERG channel proteins in a time-dependent manner.

Objective To asses the value of ST segment elevation of aVR lead (aVRSTE) in patients with acute ST segment elevation myocardial infarction (STEMI). Method Myocardial enzymes detection, electrocar-dingraphy, emergency eornary artery angiography, echoeardiography [taken(10±2) days after emergency cornary artery angiography] were obtained and analyzed in 140 consecutive patients with STEMI enrolled in this study. The value of aVRSTE (≥0.05 mV) was assessed for detecting left main stem lesions(defined as ≥50% stenosis of or acute embolism of left main stem)or its equivalent (defined as total or subtotal acute occlusion of left anterior de-scending artery), and predicting the left ventricular systolic function after myocardial infarction. Results The sensitivity, specificity, positive predictive value and negative predictive value of aVRSIE in detection of left main stem lesions were 72.73 % (8/11), 83.72 % (108/129),27.59 % (8/29) and 97.30% (108/111), respectively; in detection of left main stem lesions or its equivalent, they were 41.86 % (18/43), 88.66% (86/97), 62.07 % (18/29), 77.48% (86/111); aVRSYE were combined with STaVR-STv1>0 to detect left main stem lesions, the semi-tivity, specificity, positive predictive value and negative predictive value were 63.64% (7/11),98.45%(127/129),77.78%(7/9),96.95% (127/131). Patients were divided into two groups: groups A with aVRSIE and group B without aVRSYE. KIIJJP class,and left ventricular ejection fraction (LVEF) in group A was higher than those in group B (P<0.05). Conclusions For patients with STEMI: (1) aVRSTE indicated left main stem le-sions or its equivalent; if combined with STaVR-STv1>0, it indicated left main stem lesions more strongly; (2)aVRSTE predicted poorer left ventricular systohc function short time after STEMI.

Objective To evaluate the impact of individualized occluder application on efficacy and complications of transcatheter closure treatment for multi-feneatrated atrial septal defects (mfASD).Methods Seventy six patients with mfASD who were hospitalized at Fudan University Zhongshan Hospital from July 2006 to July 2015 were retrospectively enrolled.Clinical and follow-up data were collected and analyzed.Results Among the 76 patients including 18 males and 58 females,transcatheter closure was successfully performed in 73 patients (96.1%).The morphological features of ASD included: 60 cases (78.9%) with two defects and 16 cases (21.1%) with cribriform defects, 3 cases (3.9%) combined with patent foramen ovale (PFO),13 cases (17.1%) with atrial septal aneurysm (ASA).Dual occluders were used for closure in 26 patients (35.6%),while single occluder was implanted in 47 patients (64.4%).In single-occluder group,measuring balloon was used to assist occlusion in 7 patients (14.9%).3 patients versus 11 patients required the small-waist-big-edge occluders in the dual-occluder group and the single-occluder group respectively (11.5% vs.23.4%, P=0.352).The complication rate in the dual-occluders group was higher than that in the single-occluder group (19.2% vs.4.3%, P=0.037),while the incidence of residual shunt showed no significant difference between these two groups (11.5% vs.10.6%, P=0.906).Conclusions The occluder for transcatheter closure of multiple atrial septal defects needs to be individually chosen according to the morphological characters.Transcatheter closure of mfASD using two devices is feasible,safe and effective for selected patients.

Objective To study cinical features of patients with idopathic submitral left ventricular aneurysm(ISLVA) and evaluate their global and segmental systolic function as well as diastolic function through echocardiography.Methods Clinical features of eight patients with ISLVA were analysed retrospectively.Standard 2-dimentional and real-time 3-dimentional echocardiography were performed in all the eight cases and other twenty subjects with normal left ventricular(LV) function (defined as control group).Results Two patients were diagnosed as ISLVA due to ventricular arrythmia and the other six case sowing to congestive heart failure.Coronary angiography was normal in all patients.Apical systolic murmur was audible in 6 cases.Four patients received mitral valve surgical repair,one underwent aneurysm resection and radiofrequency ablation,implantable cardioverter defibrillator was implanted in one case,one was only treated by medication.One case died.Patients with ISLVA demonstrated significanly larger left atrium(LA) and LV diameter (both end-diastolic and end systolic),thinner LV posterior wall,and lower LV ejection fraction (LVEF) than controls (P ＜0.05).Indexes of the LV 17 segments time-volume curves including the time to minimal systolic volume(Tmsv) 16-SD,Tmsv 12 SD,Tmsv 6-SD,Tmsv 16-Dif,Tmsv 12-Dif,Tmsv 6-Dif,Tmsv 16-SD％,Tmsv 12-SD％,Tmsv 6-SD％,Tmsv 16-Dif％,Tmsv 12-Dif％,Tmsv 6-Dif％ were significantly higher in patients with ISLVA than those in controls(all P ＜0.05).All patients with ISLVA showed mitral regurgitation and decreased LV diastolic function in varying degrees,five patients accompanied by elevated LA pressure.Conclusions Clinical features of patients with ISLVA are nonspecific.Echocardiography can evaluate systematically their functional and structural abnormalities.

ObjectiveTo investigate the accuracy of percutaneous iliosacral screw fixation in sacroiliac joint fracture-dislocation with minimally invasive guider with CT-guided.MethodsFrom January 2011 to May 2011,8 patients with sacroiliac joint fracture-dislocation were treated using percutaneous iliosacral screw fixation assist with minimally invasive guider in CT-guided,which included 5 males and 3 females,with the average age of 32 years (ranged from 26 to 56 years).All patients suffered with vertically unstable pelvic fractures.Bone traction was used in femoral condyle for 6 cases which displaced more than 2cm in sacroiliac joints.Patients were prone position on the CT bed.First sacroiliac joint CT-scan was performed,then marked the needle position on affected side buttocks after measure the best position and track of needle that expected on CT computer screen.According to the data of CT-scan,the angle of the devices was adjusted,which could control 3D direction of the minimally invasive guider,then insert the Kirschner wire into sacroiliac joint guided with the front end of the sleeve of the minimally invasive guider,confirmed the track of needle was excellent with CT-scan (3D),then the guider was moved out and put the hollow screw (dia 7.3 mm Synthes) into the sacroiliac joint along the Kirschner wire.ResultsAll 8 patients were successfully insert the Kirschner wire.The operation time was from 10 to 20 min(mean,14 min).All screws were in the position expected before surgery,no cut out of bone with the CT-scan immediately after operation,the shape of sacroiliac joint was restored satisfied and the fixation was stable.No numbness and radiation-like pain appeared among the operation in the lower limb for all patients,no case had vascular and neurological complications postoperative.ConclusionThe minimally invasive guider can improve the accuracy,security and simplicity of the percutaneous iliosacral screw fixation with CT-guided,and also avoid the deviation of needle insertion angle that determined by operator himself.