Objective To investigate the effects of Gegenqinlian decoction combined with berberine in the treatment of biguanides resistant type 2 diabetes in elderly patients in glycosylated hemoglobin and homocysteine.Methods 82 elderly patients from March 2015 to March 2016 in our hospital who were diagnosed with type 2 diabetes with biguanides resistant were selected,and randomly divided into two groups,41 cases in each groups.Control group receiced routine treatment,experimental group received more with Gegenqinlian Decoction combined with berberine treatment,and all the patients were treated for two weeks.Levels of FPG,2h PG,serum HbA1c,Hcy,hs-CRP,APN,TNF-α,ICAM-1 and clinical efficacy were compared,and the results were analyzed by statistical software SPSS 19 data analysis.ResultsCompared with before treatment,levels of serum FPG,2h PG,HbA1c,Hcy,hs-CRP,TNF-α and ICAM-1decreased in two groups after the treatment(P<0.05),levels of AFN increased(P<0.05),Compared with the control group,levels of serum FPG,2hPG,HbA1c,Hcy,hs-CRP,TNF-α and ICAM-1 in the experiment group were lower(P<0.05),levels of AFN were higher(P<0.05);The total effective rate of the experimental group was significantly higher than the control group(P<0.05).Conclusion Gegenqinlian decoction combined with berberine can effectively reduce the levels of FPG,2h PG,HbA1c,Hcy,hs-CRP,TNF-α in serum and ICAM-1 levels,increase serum APN level,and good curative effect,worthy of clinical application and promotion.

To evaluate the morphology of atrial septum by the live three-dimensional echocardiography (L3DE) and its value of clinical application, L3DE was performed in 62 subjects to observe the morphological characteristics and dynamic change of the overall anatomic structure of atrial septum. The study examined 49 patients with atrial septal defect (ASD), including 3 patients with atrial septal aneurysm, and 10 healthy subjects. ASD in the 35 patients was surgically confirmed. The maximal diameters of ASD were measured and the percentages of area change were calculated. The parameters derived from L3DE were compared with intraoperative measurements. The results showed that L3DE could directly and clearly display the morphological features of overall anatomic structure of normal atrial septum, repaired and artificially-occluded atrial septum, atrial septal aneurysm. The defect area in ASD patients changed significantly during cardiac cycle, which reached a maximum at end-systole and a minimum at end-diastole, with a mean change percentage of 46.6%, ranging from 14.8% to 73.4%. The sizes obtained from L3DE bore an excellent correlation with intraoperative findings (r=0.90). It is concluded that L3DE can clearly display the overall morphological features and dynamic change of atrial septum and measure the size of ASD area accurately, which is important in the decision to choose therapeutic protocols.
Atrial Septum/*ultrasonography ; Echocardiography, Three-Dimensional/*methods ; Heart Septal Defects, Atrial/*pathology ; Heart Septal Defects, Atrial/*ultrasonography ; Young Adult

Objective To determine the occurrence rate of liver toxicity and related risk factors after receiving highly active an-tiretroviral-therapy(HAART)by the non-nucleoside reverse transcriptase inhibittor.Methods To observe the changes of liver func-tion indexes before and after antiviral therapy in 102 patients receiving HAART,the incidence rates of the liver toxicity were com-pared between nevirapine(NVP)and efavirenz(EFV)and the risk factors of liver toxicity after treatment were analyzed.Results A-mong 102 patients,73 cases accepted the treatment of NVP,the incidence rate of hepatotoxicity was 35.6%,29 cases accepted the treatment of EFV,the incidence rate of hepatotoxicity was 13.8%,the hepatotoxicity incidence rate had statistically significant difference between the two treatment methods(χ2 =4.761,P =0.029).Co-infected by hepatitis C virus(HCV)and baseline ALT el-evation were the independent risk factors of hepatotoxicity occurrence(P <0.05).Conclusion The patients receiving the treatment of NVP are more likely to have hepatotoxicity than the patients receiving the treatment of EFV.Co-infected by HCV and baseline ALT elevation are the independent risk factors of hepatotoxicity occurrence.

Objective To assess right ventricular(RV) regional and global function in patients with repaired tetralogy of Fallot (TOF) by speckle tracking imaging (STI).Methods 36 asymptomatic patients with repaired TOF whose postoperative period is more than one year and 35 healthy controls were studied.RV longitudinal peak systolic strain (ε),strain rate (SRs) were measured in RV free wall and interventricular septum(IVS) for basal,mid and apical segments by STI from the apical 4-chamber view,RV global longitudinal peak systolic strain (GLS),strain rate (GLSRs),early diastolic strain rate (GLSRe) and late diastolic strain rate (GLSRa) were measured from the above view.The correlations between RV systolic functional parameters and the postoperative period,degree of pulmonary regurgitation (PR) and QRS duration were explored.Results ①Compared with controls,εand SRs of RV free wall and IVS for most segments,GLS,GLSRs,GLSRe,and GLSRa were significantly impaired in patients with repaired TOF (P ＜ 0.05 for all).Both GLS and GLSRs were lower in postoperative patients with transannular patch than in those with RV out tract patch.②In comparison with controls,GLS,GLSRs,GLSRe and GLSRa were decreased in postoperative patients with mild,mid and severe PR,Whereas,there was no difference in RV global function among the patients with varying degree of PR.③GLSRs of RV was correlated inversely with postoperative period and QRS duration(r1--0.431,P1 =0.009 ; r2 ==-0.469,P2-0.004),RV GLS and GLSRs had no correlation with PR.Conclusions RV regional and global function in patients with late repaired TOF are decreased,STI can early detect right ventricular dysfunction in asymptomatic patients with repaired TOF.The type of operation impacts on late prognosis,RV abnormal deformations are associated with electrical depolarization abnormalities.

Objective To explore the value of two-dimensional strain echocardiography for quantitative assessing the change of regional left ventricular myocardial function in rats following acute myocardial infarction. Methods Sixty Wistar rats were randomly divided into two groups. The study group consisted of 50 rats with occlusion of LAD for 30-45 minutes and the sham-operated group consisted of 10 rats without occlusion of LAD. Echocardiography were performed before operation, which was defined as baseline, and 1 week, 4 weeks and 8 weeks after operation. Left ventricular internal diameter at diastole ( LVIDd) and systole < LVIDs), fractional shortening( FS), ejection fraction (EF) and left ventricular mass(LVM) were measured by anatomical M-model echocardiography. High frame rate two-dimensional images were recorded in the left ventricular short-axis views at the papillary muscle level. Peak systolic radial strain(PRS) and circumferential strain(PCS) of each segment were measured using 2-dimensional strain software. The rats were sacrificed and the infarcted size of each segment was measured using triphenyl tetrazolium chloride (TTC) after echocardiography was performed. Fibrosis of left ventricular myocardium was displayed using Van Gieson stain in 1 weeks after infarction. Results Based on the TTC findings,the left ventricle of the study group was divided into three regions:infarcted,peri-infarct and remote myocardial regions. Van Gieson stain showed fibrosis existed in all the three regions. Compared with baseline and sham-operated group, PRS and PCS of infarcted, peri-infarct and remote myocardial regions of the study group significantly decreased within 1 week after operation ( P <0. 01) and persisted for 8 weeks. PCS and PRS of infarcted, peri-infarct and remote myocardial regions of the study group in 4 weeks and 8 weeks after operation showed no significant difference when compared with those in 1 week after operation ( P >0. 01). Compared with baseline and sham-operated group,LVIDd,LVIDs and LVM of study group all increased significantly ( P <0. 05) in 4 weeks and 8 weeks after operation,and FS and EF reduced significantly ( P <0. 05). Two-dimensional strain obtained in interobserver and intraobserver both showed high agreement. Conclusions Two-dimensional strain echocardiography can assess regional function of myocardium with different perfusion in rats following acute myocardial infarction, and provides a sensitive and reliable method to follow up the process of left ventricular remodeling after myocardial infarction.

Objective To assess left ventricular (LV) global systolic function in patients with essential hypertension with normal geometric LV by 3-dimensional ultrasound speckle tracking imaging(3D-STI). Methods Fifty patients with essential hypertension were enrolled in this study, 29 normal subjects matched with age and sex were selected as control groups. LV global longitudinal peak systolic strain (GLS), radial peak systolic strain (GRS), circumferential peak systolic strain (GCS), LV global 3-dimentional radial peak systolic strain (3DGRS) were measured in all subjects by 3D-STI from the apical full-volume image and compared between groups. LV ejection fraction (LVEF) was acquired from 3D-STI.Results Compared with controls, LV GLS, GRS, GCS and 3DGRS were significantly reduced in patients with hypertension ( P ＜ 0.05 for all). A Pearson correlate revealed that LV GCS, GLS and GRS corresponded with LVEF( r1 =0.930, P1 ＜0.001; r2 = 0.705, P2 ＜0.001; r3 =0.474, P3 =0.001,respectively) in patients with hypertension, and LV GCS, GLS correlated with LVEF( r1 = 0. 838, P1 ＜0. 001; r2 = 0. 697, P2 ＜ 0. 001, respectively) in normal subjects. Conclusions LV global 3D strain decreases in patients with hypertension in the early period,3D-STI could evaluate the early change of heart function in patients with hypertension. LV circumferential movement plays a major role in the LV 3D movement and impacts on LVEF.

Objective To compare the diagnostic performance of prospective electrocardiogram (ECG)-gating 320-detectorcomputed tomography coronary angiography (CTCA) versus retrospective ECG-gating CTCA. Methods 500consecutive patients suspected coronary artery disease with heart rate of less than 65 bpm were performed coronary computed tomography angiography (CCTA) with prospective (group P)and retrospective (group R) ECG gating in turn. The image quality was divided into four levels. Success rates, effective radiation dose,image quality and diagnosis were evaluated. Results Success rates of examination in group P and R are100%.Mean patient radiation dose was significantly different in group P (3.28±1mSv) and R(14.36 ±2.3 mSv).131 and 142 of 3750 segments (250 patients x 15 segments per patient) were too small(1.5mm)tobe characterized in group P and R. 96. 51% (3619/3750) and 96.12% (3608/3750) characterized segments were not significantly different in group P and R. 95.09% segments received a score of 4 and 1.09% segments received a score of 3 in group P, while 95.23% and 0.74% in group R.The cause of 2 and 3 points in the two groups was motion artifact. Stair-step artifacts and images scored as 1were not found.Compared with CAG,the sensitivity,specificity,false positive andfalse negative value in group P(86. 49% ,98. 70% ,88. 89% ,98.38%) and R(83. 87% ,98.74% ,89. 65%,97.93%) were not significantly different. Conclusion Although the patient radiation exposure was significantly lower, the diagnostic performance of prospective ECG-gating 320-detector CTCA was comparable with that of retrospective ECG-gating 320-detector CTCA on patients with stable heart rates less than 65 bpm.

Objective To investigate the value of left ventricular global two-dimensional strain and strain rate index measured by two-dimensional speckle tracking imaging (2D-STI) in assessing myocardial injury in various degree of rats following acute myocardial infarction. Methods Fifty-five Wistar rats were randomly divided into myocardial infarction(MI) group ( n =45) and sham-operation(SO) group ( n = 10).To establish rats acute myocardial infarction model with different infarct extent, MI group were randomly divided into MI15 group,MI30 group and ML60 group( n = 15,respectively) which underwent occlusion of left anterior descending coronary artery for 15 minutes, 30 minutes and 60 minutes respectively. Echocardiography was performed at baseline and 24 hours after reperfusion. High frame rate twodimensional images were recorded from the left ventricular short-axis views at the papillary muscle level.Left ventricular global circumferential strain(GSc) and strain rate(GSRc) were measured using EchoPAC work station. Left ventricular internal diameter at diastole (LVIDd) and systole ( LVIDs), fractional shortening(FS) and ejection fraction(EF) were measured by anatomical M-model echocardiography. Area of necrosis(AN) of each segment was measured after triphenyl tetrazolium chloride(TTC) staining. Results ① Compared with baseline and SO group, LVIDd and LVIDs of MI15, MI30 and MI60 group significantly increased respectively,whereas FS and EF significantly decreased( P <0. 05). Compared with MI15 group and MI30 group, LVIDd and LVIDs of MI60 group significantly increased, whereas FS and EF significantly decreased(P <0. 05). ② Compared with baseline and SO group,GSc and GSRc of MI15 group, MI30 group and MI60 group significantly decreased. GSc and GSRc of MI group decreased with ischemia duration ( P <0.05). ③ GSc and GSRc significantly correlated with AN respectively ( P <0. 01) while the correlation coefficient was 0. 90 and 0. 88 respectively, and GSc and GSRc were significantly predictors of AN( P <0.01) while the Beta was 0.558 and 0.491 respectively.④AN increased with ischemia duration( P <0.05). Conclusions Left ventricular global circumferential strain and strain rate index measured by 2D-STI,which decreased significantly as the area of necrosis increased, can accurately assess myocardial injury after myocardial infarction in various degree.

Objective To investigate the performance of left ventricular torsion (LVtor) or twist with cardiac dysfunction patients by speckle tracking imaging (STI). Methods Standard left ventricular short-axis views images were acquired by rountine two-dimensional echocardiography in thirty-two healthy humans and twenty-four patients with cardiac dysfunction. LVtor angle,left ventricular rotation (LVrot) angle,the peak value and time of LVtor and LVrot were measured respectively. The data were compared and analyzed between the two groups. Results Compared with normal group,the peak of LVtor and LVrot angle was decreased in cardiac dysfunction group at both apical and basal planes (P<0.05). The peak time of LVtor in patients with cardiac dysfunction was delayed (P<0.05). The peak time of clockwise rotation at the apical level segments was longer than control group (P<0.05). Conclusions There is a temporal sequence difference of left ventricular rotation between basal and apical planes during left ventricular contraction and decreased LVtor has been demonstrated to influence left ventricular function.

Objective To estimate the impact of various extent of coronary stenosis at rest on myocardial perfusion and functional indices from myocardial contrast echocardiography(MCE) and two-dimensional strain echocardiography(2D-Strain) and characterize the relationship between them. Methods Three levels of coronary stenosis:mild (50%～75%),moderate (76%～89%),severe (≥90%) in 25 patients with coronary artery stenosis and 15 healthy subjects in the control group were examined. Plateau videointensity (value A) and time to plateau (value β) of the replenishment curve from MCE were calculated for perfusion analysis,and longitudinal peak systolic strain(SL) from 2D-Strain were measured for functional analysis. Results Value A tended to decrease with increasing severity of stenosis,ahhough these differences did not reach the level of statistical significance, β and SL were significantly increased in the context of moderate and severe coronary stenosis when compared with control group (β, moderate 0.75±0.67 and severe 0.67±0.53 vs normal 0.97±0.65;SL,moderate 11.60±5.89 and severe 9.58±6.51 vs normal 19.46±6.17, P <0.05, respectively). β was positively correlated with SL (r = 0.65, P <0.05).Conclusions β of the replenishment curve from MCE and SL from 2D-Strain both can detect greater than 75% coronary stenosis inducing myocardial ischemia,and they had good correlation.