Objective To investigate the relationship between serum cystatin C (Cys C) level and the occurrence of in-stent restenosis after coronary drug-eluting stent implantation.Methods A retrospective analysis of coronary drug-eluting stent implantation was curried out in 592 patients.All patients were from Shengjing Hospital of China Medical University by coronary angiography,and were divided into restenosis group (142 cases) and non restenosis group (450 cases).The Cys C levels before and after surgery and follow-up angiography were analyzed.The biochemical indicators,and transcatheter arterial restenosis were analyzed.Results Either before or after operation and follow-up angiography,serum cystatin C levels were higher in restenosis group patients than that in non restenosis group [before operation:(1.622 ± 1.063) mg/L vs (1.369 ± 0.860) mg/L;after the operation:(1.769 ± 1.062) mg/L vs (1.458 ± 0.883) mg/L;review:(1.924 ± 1.085) mg/L vs (1.440 ± 0.874) mg/L;P ＜ 0.05].Multivariate COX regression analysis showed that serum cystatin C level was an independent risk factor of in-stent restenosis in drugeluting area (P ＜ 0.05).Conclusions The serum cystatin C level is closely related to in-stent restenosis in drug-eluting stents area.High level of serum cystatin C is an independent risk factor of in-stent restenosis after drug-eluting stents implantation.

Objective To assess the coronary flow reserve in the patients with systemic lupus erythematosus(SLE)by transthroracic echocardiography(TTE).Methods Coronary sinus blood flow of 24 SLE patients and 18 matched healthy controls were assessed by TTE.The coronary flow reserve was calculated as the ratio of hyperemic to baseline blood flow.Hyperemia was induced by intravenous administration of dipyridamole.Results Adequate recordings of blood flow in the coronary sinus under both conditions were obtained by TTE in all study subjects.Patients with SLE were found to have significantly decreased coronary flow reserve comparing with normal SUbiects(1.55±0.21 versus 2.51±0.33.P＜0.01).Conclusions Coronary flow reserve can be measured by TTE in SLE patients,Coronary flow reserve is impaired suggesting that SLE patients may have subclinical coronary artery disease.

Objective To investigate the relationship between serum of type Ⅲ collagen and arterial compliance in hypertensive patients.Methods One hundred fifty-eight in-patients of hypertension were enrolled.All subjects underwent laboratory measurements including serum PⅢNP,blood-lipid,glucose and high sensitivity C-reactive protein.Carotid to femoral pulse wave velocity(PWVcf),C1 and C2 were measured by a Complior Colson device and DO-2020.Results(1)PWVcf positively correlated with serum PⅢNP(P

Objective To investigate hepatic parenchyma and kidney cortex's gray-scale ratio as a new index in evaluating hepatic fibrosis degree.Methods Sixty patients with hepatic fibrosis verified by liver biopsy and 40 normal individuals used as controls were scanned with Acuson Sequoia 512 with the same set-up of all the parameters.The hepatic-right kidney section was selected for offline analysis.The gray-scale value of near-area hepatic,mid-area hepatic,far-area hepatic parenchyma and right kidney cortex were measured by histogram of Photoshop software.The gray-scale ratio of hepatic parenchyma to kidney cortex was calculated and compared with the hepatic firbrosis degree.Results With development of hepatic fibrosis,the ratio of hepatic and kidney gray-scale value was increased.The results between control and experimental groups were significant(P＜0.01).Conclusions Hepatic and kidney gray-scale ratio obtained from gray scale ultrasound was rarely affected by individual conditions of acoustic windows.It could be used as a new index for diagnosing of hePatic fibrosis and evaluating its therapeutic effects.

ObjectiveTo test the reproducibility of wave intensity (WI)analysis derived measurements of pulse wave velocity (PWV),and to compare it with the traditional method-applanation tonometry.MethodsOne hundred and ten outpatient volunteers were enrolled in the study.The R-W1 of right brachial artery and right posterior tibial artery were measured through WI in diagnostic ultrasound equipment (Aloka α10),and were used to calculate the right brachial artery PWV which were also measured by tonometry (VP-1000) simutaneously;thus 30 of these volunteers were randomly selected to repeat the above examinations in the same session.Differences between the two methods were investigated by means of a paired t-test,and their linear correlations were also analyzed.Bland-Altman method was used to analyze the agreement between the two methods and their intraobserver intrasession variabilities.ResultsMean baPWVs determined by WI and tonometry were (13.03 ± 1.93) m/s and ( 12.05 ± 2.02) m/s,respectively (P ＜0.001),and the mean of their difference was (0.98 ± 1.1)m/s giving 95 ％ limits of agreement of ( - 1.18 m/s,3.14 m/s).Values of PWV obtained by the two systems were highly correlated( r =0.85,P＜ 0.001 ),with their intraobserver intrasession variabilities being 8.2％ and 7.0％,respectively.ConclusionsWI provides a new noninvasive and convenient method to measure PWV with good agreement and similar reproducibility to the standard tonometry system.

Objective To measure cerebral circulation time(CCT) of a group of normal adults by contrast-enhanced ultrasound. Methods Forty-seven cases of healthy volunteers without any cardio-cerebral disease history were enrolled in the study. Internal carotid artery and vertebral artery were observed and the blood flow was measured with high frequency probe. Contrast-enhanced agent SonoVue was injected bolus into median cubital vein. CCT was measured and calculated according to the contrast curve analysis. Contralateral CCT measurement was repeated when the blood flow signal resume to the baseline intensity. Cerebral blood volume was then calculated according to CCT and cerebral blood flow. Results All the imaging of carotid vessels was presented clearly in all objects. Cerebral blood flow was 603 ～ 990 ml/min with an average (778 ± 171)ml/min. Bi-lateral CCT was measured successfully,the value ranged 4. 1 ～ 10.2 s with average (6.22 ± 1.47) s. There were no significant differences both in contrast of left and right side of the carotid vessels and in contrast of three dosage groups ( P ＞0.05). The cerebral blood volume was 54～96ml with average (76 ± 27)ml. Conclusions Contrast-enhanced ultrasound can be useful in measurement and calculation of CCT and cerebral blood volume.

Objective To determine the central venous pressure (CVP) noninvasively based on hemodynamics principles using ultrasound location of the collapse point of the internal jugular vein.Methods Forty patients were enrolled in this study.The collapse point of the internal jugular vein was located and marked by a linear transducer,the body mark of right atrium was marked on the right lateral wall of the chest.The noninvasive CVP was calculated according to the vertical distance between those two points.The invasive CVP determination by central venous catheter was also carried out on all the patients.Correlation analysis was used to compare the invasive and noninvasive methods.With invasive determination of CVP as the gold standard,the ROC curve of the noninvasive ultrasound method was sketched to explore the optimal cut-off points.Results The correlation analysis reveal high positive correlation between CVPs determined by ultrasound imaging and central venous catheter (r =0.906,P ＜0.01).By the ROC curve test,fluid column height of 10.75 cm by ultrasound method was determined as the cut-off point,with the sensitivity and specificity of diagnosing elevation of CVP being 88.9％ and 93.5 ％ respectively.The corresponding area under the curve was 0.971.Conclusions Ultrasound imaging could be used to determine CVP noninvasively,which would be helpful in diagnosis of the circulating load of patients.

Objective: To evaluate the efficacy of the third-generation instrumentation including TSRH, CD and ISOLA in the treatment of adult scoliosis. Methods:Thirty-five adult patients with idiopathic or degenerative scoliosis who received treatment with third-generation instrumentation (TSRH,CD and ISOLA) between July 1999 to January 2003 were retrospectively reviewed. The mean preoperative cobb angle of major curves of the frontal plane was 58.1°(42°-95°). The patients received a combined anteroposterior approach or a single posterior procedure. The mean follow-up time was 20 months(10-48 months). Preoperative and postoperative Cobb angles of the frontal plane and sagittal plane and the distance between C7 and CVLS were measured. The subjective assessment was judged by questionnaire. Results: Postoperative clinical appearance of all patients improved significantly. Mean correction of major curves of the coronal plane was 53.2%. Mean loss of correction of the coronal plane in the last follow-up was 4.3°. The distance between the midline of C7 and CVSL was corrected from 2.6 cm to 0.24 cm. The results of follow-up showed that 89.3% patients were satisfied with the outcome. Pneumatothorax and haematothorax occurred in 2 patients. Three patients still complained of low back pain one year after operation because of adjacent degeneration in 2 patients and pseudoarthrosis in the remaining 1 patient. Conclusion: Imageologic findings and subjective assessment of the patients showed that the third-generation instrumentation can achieve good correction and trunk balance in the treatment of adult scoliosis with fewer complications.

Objective To explore the mechanism of intrathoracic pressure(ITP) influncing cardiac function and facilitate noninvasive determination of ventricular pressure theoretically.Methods With Valsalva and Mueller maneuver,two-dimension images of standard long axis views and the cross-sectional views were recorded in 20 volunteers,aged from 18 to 45 years,at the specific ITP levels(including-20 mmHg、-10 mmHg、0 mmHg、+ 10 mmHg and + 20 mmHg).The subjects were instructed to mantain for at least 10 s,and three successive measurements were recorded and averaged.The stroke volume(SV) and radius of curvature(R) were obtained from further off-line analysis.Results With the ITP maintaining at -20 mmHg,-10 mmHg,0 mmHg(end expiration),+ 10 mmHg and + 20 mmHg respectively,the corresponding radiuses of curvature were (2.35 ±0.24)cm,(2.25 ± 0.23)cm,(2.14 ± 0.21)cm,(2.02 ± 0.21) cm,(1.93 ± 0.19) cm,there were statistically significances between two groups (P =0.006,0.031,0.005 and ＜0.001,respectively].When the ITP were at 0 mmHg(end expiration),+ 10 mmHg and + 20 mmHg,the stroke volume were (71.54±8.81)ml,(73.20±9.52)ml and (78.81± 14.61)ml (P =0.674,0.135).When the intrathoracic pressure decreased from 0 mmHg to-20 mmHg,the stroke volume were (78.81±14.61)ml,(68.28 ±9.28)ml and (59.69±7.52)ml(P =0.029,0.037).Conclusions The ITP has different effects on the two ventricles,and subsequently generates a pressure gradient across the IVS which can alter its shape and position at end-diastole.With the IVS shifting,the preload and filling function of left ventricle gets changed acorrding to the Frank Starling principle.

ObjectiveTo quantify the underestimation of cardiac blood flow velocities measured by Doppler echocardiography and to explore a method for correction using a new explored dual PW/TDI technique.MethodsThe dual PW/DTI mode was used to simultaneously record the aortic,mitral,tricuspid and pulmonary valvular blood flow velocity and the adjacent valvular annulus velocity in forty healthy volunteers,then the underestimations of the flow velocities were calculated.ResultsThe true blood flow velocity relative to the valvular annulus could be obtained by dual PW/TDI technique.Conventional Doppler echocardiographic measurements significantly underestimated the true velocity ( P ＜ 0.001).The actual aortic blood flow velocity had a significant underestimation of (8.5 ± 1.2) ％,the actual flow velocity of the pulmonary artery had a significant underestimation of (6.6 ± 1.1) ％,the underestimations of E and A wave of mitralvalve's were (13.4 ± 1.7)％ and (16.7± 3.4)％,the underestimations of E and A wave of tricuspid valve' s were ( 18.7 ± 1.9) ％ and (26.0 ± 16.1 ) ％.ConclusionsThe cardiac blood flow velocity measured by Doppler ultrasound has been significantly underestimated and this underestimation can bequantified and corrected using dual PW/DTI technique based on the principle of motion relativity.