Objective To evaluate the effects of levosimendan on hemodynamics and cardiac function in patients with septic shock. Methods A prospective single-center randomized controlled trial was conducted. The patients with septic shock admitted to the Department of Critical Care Medicine of the Third Hospital of Hebei Medical University from June 2011 to October 2013 were enrolled. The patients with septic shock received the conventional treatment according to international guidelines for management of severe sepsis and septic shock. Thirty-six patients received the examination of echocardiography and left ventricular ejection fraction (LVEF)≤0.45 after fluid resuscitation were enrolled the study ,who were divided into two groups according to random number table ,with 18 cases in each group. After the conventional treatment,the patients in dobutamine group received intravenous injection of 5μg·kg-1·min-1 dobutamine for 48 hours immediately after fluid resuscitation,and those in levosimendan group received a 24-hour infusion of 5μg·kg-1·min-1 dobutamine followed by a 24-hour infusion of 0.2μg·kg-1·min-1 levosimendan. The hemodynamics and cardiac function were evaluated by pulse indicator continuous cardiac output (PiCCO) and ultrasound during treatment. Results Compared with dobutamine group,after the treatment in the levosimendan group,stroke volume index (SVI),cardiac index (CI)and left ventricular stroke work index(LVSWI) were significantly increased〔SVI(mL/m2):39.8±5.4 vs. 37.5±4.5,t=-2.762,P=0.020;CI(L·min-1·m-2):4.6± 0.7 vs. 3.6±0.7,t=-9.829,P=0.000;LVSWI (kg·min-1·m-2):33.7±2.4 vs. 28.2±1.2,t=-6.307,P=0.000〕, and central venous pressure (CVP),intrathoracic blood volume index (ITBVI)and extravascular lung water index (EVLWI)were significantly decreased〔CVP(mmHg,1 mmHg=0.133 kPa):8.2±0.9 vs. 12.1±0.8,t=3.928,P=0.002;ITBVI (mL/m2):820±42 vs. 978±69,t=9.472,P=0.000;EVLWI (mL/kg):6.1±1.6 vs. 8.9±1.7,t=4.467,P=0.001〕. Cardiac ultrasound showed that compared with dobutamine group,in the levosimendan group,left ventricular end-systolic volume (LVESI) and end-diastolic volume (LVEDI) were significantly lowered〔LVESI (mL/m2):32.7±9.2 vs. 48.2±13.4,t=0.882,P=0.000;LVEDI (mL/m2):61.7±11.4 vs. 78.6±13.6,t=2.453, P=0.032〕,and the LVEF was significantly increased (0.463 ±0.068 vs. 0.383 ±0.085,t=-2.439,P=0.035). Levosimendan also could decrease the lactic acid(mmol/L:3.4±1.1 vs. 5.2±1.2,t=3.346,P=0.007),and increase the lactate clearance rate(mL/min:73.2±13.5 vs. 47.6±11.8,t=-4.079,P=0.002),24-hour urinary output(mL:2 213.4±354.0 vs. 1 533.8±402.0,t=6.342,P=0.000)and 24-hour cumulative intake (mL:5 746.6±420.0 vs. 4 156.7 ±215.0,t=7.126,P=0.000). There were no significant differences in total volume of norepinephrine, mortality in intensive care unit (ICU)and 28-day mortality between two groups. Conclusion Levosimendan can increase cardiac ejection function,reduce the heart blood and vascular preload,intrathoracic lung water,improve heart function and systemic hemodynamic indexes of patients with septic shock.

Objective To evaluate the effect of methylene blue pertreatment on acute kidney injury induced by sepsis in rats.Methods Ninety male Sprague-Dawley rats,aged 1.5-2.5 months,weighing 200-250 g,were randomly assigned into 3 groups (n =30 each) using a random number table:sham operation group (S group),cecal ligation and puncture (CLP) group and methylene blue group (MB group).The rats were anesthetized with 10％ chloral hydrate 350 mg/kg.Normal saline 0.8 ml was injected via the caudal vein in and CLP groups,while 10％ methylene blue 15 mg/kg (in normal saline 0.8 ml) was injected via the caudal vein in group MB.Sepsis was induced by CLP after the end of administration in CLP and MB groups.Twenty animals in each group were chosen and observed for 72 h survival rate.Ten animals were sacrificed in each group at 18 h after operation and kidney specimens were removed for microscopic examination and for determination of the expression of poly (ADP-ribose) polymerase (PARP-1) using immunohistochemistry and Western blot.Blood samples were taken from the heart for determination of serum concentrations of blood urea nitrogen (BUN),creatinine (Cr),cystatin C and neutrophil gelatinase-associated lipocalin (NGAL).Results Compared with group S,the survival rate was significantly decreased at 24,48 and 72 h after operation,and the serum concentrations of BUN,Cr,cystatin C and NGAL and expression of PARP-1 in kidney tissues were increased in CLP and MB groups (P ＜ 0.05).Compared with group CLP,the survival rate was significantly increased at 24 and 48 h after operation,and the serum concentrations of BUN,Cr,cystatin C and NGAL and expression of PARP-1 in kidney tissues were decreased in group MB (P ＜ 0.05).The pathological changes were significantly attenuated in group MB as compared with group CLP.Conclusion Methylene blue pertreatment can attenuate acute kidney injury induced by sepsis in rats through down-regulating the expression of PARP-1.

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 analyze the changes of bone mineral density (BMD) and the incidence of osteoporosis in elderly people in Xuzhou area by measuring BMD, and provide reference to osteoporosis prevention and control. Methods From 2005 to 2008, BMD were measured in 1204 elderly people by dual energy X-ray absorptiometry (DEXA). The measurement included the neck of femur and L2-4 of lumbar. All subjects were divided into multiple sections with every 5 year interval. Osteoporosis was diagnosed according to the criteria of BMD peak minus 2. 5 SD. BMD values and the incidence of osteoporosis were analyzed among different age and gender groups. Results BMD of different sites decreased year by year in both male and female in Xuzhou area. After 55years of age BMD decreased more in female than in male ( P ＜ 0. 01 ). The incidence of osteoporosis in female was higher than that in male. Conclusions We should reinforce the health education on osteoporosis prevention. Intervention should be conducted in females older than 55 years and males older than 65 years to decrease the occurrence of osteoporosis.

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 Evaluating the main risk factors of thyroid cancer systematicaly,to provide reference for the further development of thyroid cancer prevention strategies.Methods Such databases as PubMed,Cochrane Library,CBM,CNKI,VIP and WanFang were searched from the date of their establishment to June 10 2016 to collect the case-control studies on thyroid cancer.After study selection,assessment and data extraction was conducted by two reviewers independently,meta-analysis was performed by using the RevMan 5.1 software.Results Nineteen studies involving 4 813 thyroid cancer patients and 6 068 comparions were selected.The results of metaanalysis showed that:the risk factors of thyroid cancer mainly included history of benign thyroid disease [odds ratio (OR) =7.31,95％ confidence interval (95％CI,4.37,12.23)],family history of thyroid cancer [OR =5.13,95％CI (3.20,8.23)],high iodine diet [(marine animal food,OR =4.15,95％CI (2.47,6.99)],CT inspection history [OR =3.99,95％CI (2.10,7.60)],Negative emotions [sulking,OR =3.31,95％CI (2.23,4.91)],BMI greater than 25 [OR =2.62,95％CI (1.73,3.97)],high pressure and anxious [OR =2.60,95％CI (1.61,4.21)],getting along with people not harmoniously [OR =2.46,95％CI (1.59,3.81)],the number of pregnancies of women more than three times [OR =2.03,95％CI (1.50,2.76)],age of menarche less than 13,14 years old [OR =1.59,95％CI (1.06,2.37)].Conclusions Thyroid benign disease history,family history of thyroid cancer,high iodine diet,CT examination,BMI greater than 25,bad mood,social interaction,number of pregnancies and other factors are the independent risk factors for thyroid cancer.Corresponding prevention and control measures should be taken according to these risk factors.

Objective:To understand the applicability of different thyroid volume correction methods for school-age children in Wuhan, and to explore the appropriate thyroid volume correction methods for school-age children in Wuhan.Methods:From May to August 2019, Hongshan, Hanyang, Hannan, Jiangxia and Dongxihu districts of Wuhan were divided into five sampling areas according to five directions: east, west, south, north and middle. One primary school was selected from each area, and 40 non-boarding students aged 8 - 10 years old (gender balanced) were selected from each primary school as survey subjects. Random urine sample and household edible salt sample were collected to detect urinary iodine and salt iodine contents, and the height, weight and thyroid volume of the children were measured. At the same time, the thyroid volume was corrected by height corrected volume index 1 (HVI1), weight and height corrected volume index (WHVI), body mass index corrected volume (BMIV), body surface area corrected volume (BSAV) and height corrected volume index 2 (HVI2).Results:A total of 1 000 children aged 8- 10 years old were investigated, including 499 boys and 501 girls; among them, there were 269, 321 and 410 children aged 8, 9 and 10 years old, respectively. The median urinary iodine was 247.50 μg/L; the median salt iodine was 23.20 mg/kg; the height, weight and thyroid volume were 140.00 (133.00, 146.00) cm, 31.00 (27.00, 37.00) kg and 2.56 (2.13, 3.21) ml, respectively. A total of 30 children with goiter were detected, and the goiter rate was 3% (30/1 000). The thyroid volumes of boys and girls were 2.57 (2.16, 3.28) and 2.56 (2.10, 3.16) ml, respectively, and the difference was not statistically significant ( U = - 0.981, P > 0.05). The thyroid volumes of children aged 8, 9 and 10 years old were 2.31 (1.98, 2.81), 2.68 (2.13, 3.30) and 2.74 (2.28, 3.35) ml, respectively, and the differences were statistically significant ( H = 47.585, P < 0.01). Spearman correlation analysis showed that the original thyroid volume was positively correlated with height and weight in children aged 8, 9 and 10 years old ( P < 0.01). After HVI1 correction, no correlation was found between thyroid volume and height in children aged 8 years old ( P > 0.05), but thyroid volume was positively correlated with weight ( P < 0.01); thyroid volume was positively correlated with height and weight in children aged 9 and 10 years old ( P < 0.01). After WHVI correction, the thyroid volumes of children aged 8, 9, and 10 years old were negatively correlated with height and weight ( P < 0.01). After BMIV correction, the thyroid volume was positively correlated with height in children aged 8, 9, and 10 years old ( P < 0.01); thyroid volume was negatively correlated with weight in children aged 10 years old ( P < 0.05). After BSAV correction, thyroid volume was positively correlated with weight in children aged 9 years old ( P < 0.05). After HVI2 correction, thyroid volume was positively correlated with weight in children aged 9 years old ( P < 0.01). The thyroid volume obtained by the 5 correction methods were all smaller than the original thyroid volume, and the thyroid volume after BSAV correction was the closest to the original thyroid volume, with a difference of 0.87% - 13.87%. Conclusions:The thyroid volume of school-age children in Wuhan is affected by age, height, and weight, judgment of goiter should be corrected for these factors. BSAV is relatively independent and stable, it can eliminate the effect of height and weight on thyroid volume. It is initially considered that BSAV is suitable for the correction of thyroid volume in school-age children in Wuhan.

Objective The aim of the study was to evaluate the association of fasting plasma glucose (FPG) level over 5.3 mmol/L to the development of abnormal glucose metabolism and cardiovascular diseases (CVD).Methods This was a retrospective cohort study with 1 064 non-diabetic subjects(980 males;84 females) aged 60 or over, who carried out annual health check-up in Chinese PLA General Hospital from May, 1996 to May, 2015.Based on the average FPG level of 3 years before enrollment, the subjects were divided into four groups : ＜ 5.3 mmol/L, 5.3-＜ 5.6 mmol/L, 5.6-＜ 6.1 mmol/L and 6.1-＜ 7.0 mmol/L.Glucose metabolic changes, complications and mortality were follow-up until May, 2015.Results (1)The initial 3-year average FPG levels were (4.9 ±0.4) mmol/L in the total 1 064 subjects.Among them, 126 subjects developed diabetes mellitus (DM) and 144 subjects developed impaired glucose regulation (IGR) during the follow-up visits.The proportions of IGR and diabetes increased with the FPG levels (P ＜ 0.05).The risk for developing IGR was significantly higher in subjects with FPG≥5.3 mmol/L than in those with FPG ＜ 5.3 mmol/L (RR =3.08, 95％ CI 2.02-4.81, P ＜0.01).The risk for incident DM was markedly increased in subjects with FPG ≥ 5.6 mmol/L than in those with FPG ＜5.6 mmol/L (RR =6.73, 95％ CI 3.90-11.52, P ＜0.01);(2)The risk for CVD was eight folds higher in subjects with FPG ≥5.3 mmol/L than in subjects with FPG ＜ 5.3 mmol/L (RR =8.42,95％ CI 5.11-13.82, P ＜ 0.05);(3) Survival analysis showed that the risk of death was 1.47 times higher in subjects with FPG ≥ 5.3 mmol/L than in subjects with FPG ＜ 5.3 mmol/L after years of followed-up (RR=l.47, 95％CI 1.09-1.98, P=0.0127).Conclusion The risks for IGR, CVD and mortality are higher in the elderly with FPG ≥5.3 mmol/L, which highlights the importance for the disease prevention in elder people with FPG 5.3 mmol/L or more.

Objective To examine the effect of ultrasonic debridement combined with continuous skin stretching to repair refractory infective wound bed.Methods From January 2016 to July 2016,we treated 15 cases of chronic,refractory infective wound beds using ultrasonic debridement combined with skin stretching technique.Results All the 15 (100％) cases were cured without necrosis of the stretched skin edges.Conclusions Ultrasonic debridement combined with continuous skin stretching is an appropriate technique for repairing the refractory wound bed in the patients who are older,in poor general condition,or poor condition of local skin and soft tissue,or have poor postoperative effect,or surgical contraindication or at higher risk of surgery.

This study evaluated the change in regional left ventricular myocardial function in rats following acute occlusion of the left anterior descending coronary artery (LAD) by using two-dimensional speckle tracking imaging (2D-STI). Sixty Wistar rats were randomly divided into two groups, a myocardial infarction (MI) group, in which 50 rats were subjected to LAD occlusion for 30-45 min, and a sham-operated (SHAM) group that contained 10 rats serving as control. Echocardiography was performed at baseline and 1, 4 and 8 week(s) after the operation. High frequency two-dimensional images of left ventricular short axis at papillary muscle level were recorded. Peak systolic radial strain (PRS) and circumferential strain (PCS) were measured in the mid-ventricle in short-axis view by using EchoPAC workstation. 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. Infarct size was measured using triphenyl tetrazolium chloride (TTC) staining 1 week and 8 weeks after the operation. Fibrosis of left ventricular myocardium was displayed using Van Gieson staining 1 week after the infarction. In terms of the TTC staining results, the left ventricle fell into three categories: infarcted, peri-infarcted and remote myocardial regions. Compared with those at baseline and in the SHAM group, (1) PRS and PCS in the infarcted, peri-infarcted and remote myocardial regions were significantly decreased in the MI group within 1 week after the operation (P<0.05) and the low levels lasted 8 weeks; (2) Compared with those at baseline, LVIDd, LVIDs, FS, EF and LVM in the MI group showed no significant difference 1 week after the operation (P>0.05). However, LVIDd, LVIDs and LVM were increased significantly 4 and 8 weeks after the operation (P<0.05), and FS and EF were decreased substantially (P<0.05). Van Gieson staining showed that fibrosis developed in all the three myocardial regions to varying degrees. It is concluded that 2D-STI is non-invasive and can be used to assess regional function of myocardium with different blood supply in rats following acute occlusion of the LAD, and can be used as a sensitive and reliable means to follow up the process of left ventricular remodeling.