Objective To analyse the relationship between the left ventricular(LV)structure,function and changes of concentration of serum matrix metalloproteinase-1(MMP-1),tissue inhibitor of matrix metalloproteinase-1(TIMP-1),and evaluate the value of the change of serum MMP-1 and serum TIMP-1 in ventrieular remodeling of pregnant women complicating cardiac disease.Methods Fifty-eight cases of pregnant women with cardiac disease divided into three groups[group A had 17 cases who had clinical manifestations and no left ventricular hypertrophy(LVH)],group B had 15 cases who had clinical manifestations and LVH but no palmonaly hypertension(PH),group C had 26 cases who had clinical manifestations,LVH and PH which divided into three groups again:11 cases of slight group[PH from 30-49 mm Hg(1 mm Hg=0.133 kPa)],9 cases of moderate group(PH from 50-79 mm Hg)and 6 cases of severe group(PH≥80 mm Hg).Fifteen healthy pregnant women acted as control group.The left ventricular structure and function[(left ventrieular nlasS index(LVMI),left ventricular end-diastolic diameter(INEDd),Ejection fraction(EF),E peak(E),A peak(A)and E/A],pulmonary pressure and plasma MMP-1,TIMP-1 values were determined in the third trimester of pregnancy.Results(1)LVMI (148±7)g/m~2 and LVEDd(58.9±3.5)mm in group C increased significantly(totally P＜0.01),EF (51.0±4.4)% decreased significantly(P＜0.01),E(50±10)cm/s decreased significantly(P＜0.01),A(81±13)cm/s increased(P＜0.05)and E/A(0.6±0.3)decreased significantly(P＜0.01)compared with normal subjects,group A and group B.(2)LVMI(150±7)g/m~2,LVEDd(69.7±3.4)mm in severe pulmonary hypertension group increased significantly(P＜0.01),EF(45.6±2.6)% decreased significantly(P＜0.01),E(44±9)cm/s decreased(P＜0.05),A(86±8)cm/s increased(P＜0.05)and E/A(0.52±0.17)decreased significantly(P＜0.01)compared with slight and moderate pulmonary hypertension group.(3)Plasma MMP-1(41±10)μg/L and TIMP-1(393±37)μg/L values in group C increased significantly compared with normal subjects,group A and group B(P＜0.01).(4)Plasma MMP-1(42±7)μg/L and TIMP-1(411±31)μg/L values of severe pulmonary hypertension group increased significantly compared with slight pulmonary hypertension group(P＜0.05,P＜0.01).(5)The correlation analysis indicated that:There was positive correlation between the serum concentration of MMP-1 and TIMP-1(r=0.587.P＜0.01).The serum concentration of MMP-1 was positively correlated with LVMI and LVEDd significantly(r=0.782,P＜0.001;r=0.648,P＜0.01)and was negatively correlated with EF significantly(r:-0.587,P＜0.01).(6)Plasma MMP-1 values＞50μg/L and plasma TIMP-1 values ＞450μg/L in 3 cardiac disease failure cases.Conclusions (1)The ventricular remodeling can be found in the third trimester of pregnancy of women complicating cardiac disease,and the more serious the left ventricular hypertrophy and PH,the more obvious the ventricular remodeling.(2)The changes in the plasma MMP-1/TIMP-1 values and MMP-1/TIMP-1 balance may play an important role in the left ventrieular structural.functional,and clinical manifestations of pregnant women complicating cardiac disease.(3)An increased MMP-1 and TIMP-1 level maybe can predict the presence of cardiac disease failure.

Objective To investigate clinical value of Tei index used for monitoring right ventricular (RV) function in pregnant women complicating cardiac disease accompanying pulmonary hypertension(PH) and the influence on left ventricular(LV) function due to overload pressure of RV. Methods Fifty-eight pregnant women complicating cardiac disease (including 32 cases with congenital heart disease,14 cases with rheumatic heart disease and 8 cases with arrhythmia)were enrolled in this study, among 26 cases coexisted with pulmonary hypertension. According to the pressure of PH, those patients were divided into three groups:11 cases in mild group[30-49 mm Hg (1 mm Hg=0.133 kPa)],9 cases in moderate group (50-79 mm Hg)and 6 cases in severe group (≥80 mm Hg). In the mean time, 15 healthy pregnant women were matched as control. Tei index were measured for LV and RV respectively. Results (1) The isovolumetric relaxation time [IRT,(93±52) ms] and isovolumetric contraction time [ICT,(66±41) ms] of RV in PH group were significantly higher than normal controls [(39±19) ms in IRT and (38±20) ms in ICT] and the other patients without PH group[(59±12) ms in IRT and (43±19)ms in ICT, P<0.01, P<0.05;P<0.05,P<0.05]; however, ejection time (ET) was(239±46) ms significantly shortened in PH group (P<0.05,P<0.01) when compared with (250±41) ms in patients without PH and (299±38) ms in normal controls. Tei index in PH group were 0.72±0.49, which were significantly higher than 0.38±0.12 in normal controls and 0.43±0.16 in patients without PH (P<0.01,P<0.05). (2) The IRT[(99±27)ms] and ICT[(71±40) ms] of LV in PH group were significantly higher than in normal controls [(88±20) ms,(50±24)ms] (P<0.01,P<0.01). ET of LV in PH group [(202±26)ms] were significantly shortened that (290±21)ms in normal controls and (220±36)ms in patients without PH (P<0.01,P<0.05). Tei index of LV in PH group were significantly higher than 0.43±0.15 in normal controls and 0.58±0.21 in patients without PH (P<0.01,P<0.05). (3) Positive correlation between Tei index of RV and pressure of pumonaroy artery were observed (r=0.84, P<0.01). (4) Tei index of RV in severe PH were significantly higher than mild PH (0.75±0.43 vs. 0.68±0.35, P<0.01) and moderate PH (0.75±0.43 vs. 0.71±0.14, P<0.05). Conclusions (1)The Tei index is a novel efficient Doppler index in assessing RV function of pregnant women complicating cardiac disease accompanying PH. And the fluctuation of Tei index might reflect seriousness of the disease. (2) The overload pressure of RV pressure due to PH has significant influence on LV function.

Objective Preview and triage is significantly important in treating a large number of the wound-ed patients. Method From 12 May to 25 May, 2008, 2171 wounded patients from Wenchuan Earthquake weretaken to the Central Hospital of Mianyang. According to the injury degree, all the wounded were classified into se-vere, moderate and minor injuries, and wore red, yellow and blue label on the wrists (those who died in a shorting change, intramuscular injection of TAT after skin test. Emergency medical records, including examination re-sults and treatment time, were completed for each wounded. The severe wounded were transferred to the relevantried out in 985 wounded, 1418 wounded hespitalized, 13 died in emergency room within two weeks after earth-quake. Only 9 died of combined injury and 4 died of severe cerebral injury. Conclusions The preview and triagelet the emergence treatment effective for a large number of earthquake patients.