Objective To evaluate clinically electroanatomical mapping and ablation of cardiac arrhythmias under the Carto system. Methods Fifty-six patients with various tachycardias indicated for electrophysiological study and radiofrequency ablation were included in this study, among of whom, 49 suffered from supraventricular tachycardia, and 7 ventricular tachycardia (VT). Carto system was utilized during ongoing tachycardia or sinus rhythm, 7F Navi-Star catheter was introduced into the interested cardiac chamber and underwent three-dimensional electroanatomical mapping. The mechanism and origin of cardiac arrhythmia were assessed by activation and propagation map, with which to guide radiofrequency ablation. Results The success ablation rate was 94.6% (53/56). One right accessory pathway (AP), one atrial tachycardia (AT) and one atypical atrial flutter (AF) had failed session. The procedure time was 128?59 minutes, and the fluoroscopic time 14?12 minutes. One patient had complcation of pneumothorax. No conduction block occurred. After follow-up of 1-14 months, one left AT recurred and had another succssful session. Conclusion The study demonstrates that Carto system is a safe and effective tool and may be applied for mapping and ablation of various tachyarrhythmias. It is helpful to guide catheter ablation and shorten fluorocopic time by its ability of associate intracardiac electrograms with their three-dimensional anatomic structure. It also lessen complication and recurrence by tagging the critical cardiac structures and utilize its location memory function. Our experience suggest that carto system has important role in the guidance of mapping and ablation in AT、AF、VT and complex or recurrent AP cases.

ObjectiveTo evaluate left ventricular systolic synchrony in patients with coronary artery disease (CAD) by speckle tracking imaging (STI) and real-time three-dimensional echocardiography (RT3DE) and investigate the correlation with ECG-gated myocardial perfusion single-photon emission computed tomography (GMPS).MethodsA total of thirteen patients with CAD diagnosed by coronary angiography underwent STI and RT-3DE examinations.The data was analysed off-line using Qlab 8.0 software.STI systolic synchrony indexes included the standard deviation of times to peak strain in radial and circumferial direction in 12 left ventricular segments (Trs12-SD and Tcs12-SD),the standard deviation of times to peak longitudinal strain in 16 left ventricular segments (Tls16-SD).RT-3DE systolic synchrony indexes included the standard deviation of times to the minimum systolic volume in 16 and 12 left ventricular segments (Tmsv16-SD and Tmsv12-SD).GMPS was performed within one week before or after echocardiography.Phase analysis was performed offline using Emory Cardiac Toolbox software.Peak phase,phase SD,bandwidth,skewness and kurtosis were calculated.Results Trs12-SD derived from STI had a positive correlation with phase SD and bandwidth ( r =0.800,P ＜0.05 ; r =0.607,P ＜0.05).Tmsv16-SD derived from RT-3DE had a better positive correlation with phase SD and bandwidth ( r =0.847,P =0.001 ; r =0.890,P ＜0.001).ConclusionsTmsv16-SD derived from RT-3DE had a better correlation with GMPS parameters than STI parameters.RT-3DE assessment of left ventricular systolic parameters is expected to become the ideal synchronization indicator.

Objective To investigate the shape and function of right ventricles in patients received heart transplantation(HT). Methods Sixty healthy volunteers(control group) and 31 HT patients(HT group) were enrolled, and the HT group was further divided into the nonrejected(HTn) group and the rejected(HTp) group based on the endomyocardial biopsy(EMB) results. All the participants received routine echocardiography. Single beat real-time three-dimensional echocardiography (sRT-3DE) was performed in all to evaluate parameters concerning modality and systolic function of participants' right ventricles. Results 1) Right ventricular stroke volume (RVSV) and right ventricular ejection fraction (RVEF) were significantly different among the groups[RVSV: control group vs HTn group vs HTp group was (56.18 ± 23.72)ml vs (36.08 ± 10.94)ml vs (26.22 ± 9.84)ml, P ＜0.0001; RVEF:control group vs HTn group vs HTp group was (62.09± 7.18)% vs (51.04 ± 7.58) vs (35.86 ± 9.86)%, P ＜0.00001＝.2＝ When taking the influence of rejection into consideration,RVEF was proved to be a stable and sensitive indicator. Conclusions sRT-3DE can quickly assess shape and systolic function of right ventricle.RVEF was the most stableand sensitive among all the RV-related indicators and is a promising indicator in the clinic follow-up of HT patients.

Objective To investigate the level and the source of inflammatory factors in patients with paroxysmal atrial fibrillation.Methods Thirty patients with paroxysmal atrial fibrillation were selected as observation group,and 20 cases of patients with paroxysmal supraventricular tachycardia were selected as control group.The blood samples of coronary sinus,right atria,left atria and femoral vein were consecutively collected during the procedure of radiofrequency ablation.The level of tumor necrosis factor (TNF)-α,soluble tumor necrosis factor receptor-1 (sTNFR1),and interleukin(IL)-6 was detected by ELISA separately and compared between two groups.Results The level of TNF-α and IL-6 of coronary sinus,right atria,left atria and femoral vein in observation group was significantly higher than that in control group [TNF-α:(4.45 ± 1.76) ng/L vs.(0.59 ± 0.36) ng/L,(6.67 ± 1.43) ng/L vs.(0.51 ± 0.30) ng/L,(8.35 ± 2.03) ng/L vs.(0.85 ± 0.50) ng/L,(9.97 ± 2.70) ng/L vs.(0.28 ± 0.29) ng/L,P=0.000;IL-6:(2.02 ± 0.87) ng/L vs.(1.04 ± 0.63) ng/L,(1.51 ± 0.68) ng/L vs.(0.74 ± 0.26) ng/L,(2.00 ± 0.51) ng/L vs.(0.88 ± 0.35) ng/L,(1.32 ±0.47) ng/L vs.(0.48 ±0.28) ng/L,P =0.000].The level of high sensitivity C reactive protein (hs-CRP) in observation group was significantly higher than that in control group [(2.41 ± 1.35) mg/L vs.(1.10 ±0.53) mg/L,P =0.002].The level of TNF-αof left atrium in observation group was significantly higher than that of other three sites (P=0.000).The level of IL-6 in the coronary sinus and femoral vein was significantly increased,compared with that in the right atria and left atria (P ＜ 0.05).The level of sTNFR 1 in the femoral vein,right atria and coronary sinus difference was not statistically significant (P ＞ 0.05),but was significantly higher than that in the left atria(P ＜ 0.05).The level of TNF-α,IL-6 and hs-CRP was correlated with the diameter of left atrium (LAD) (P ＜ 0.01 or ＜ 0.05).The level of sTNFR1 in left atria was positively correlated with LAD,and the level of sTNFR1 in right atria was negatively correlated with LAD (P ＜ 0.01).Conclusions The level of TNF-α,IL-6 and hs-CRP is increased in patients with paroxysmal atrial fibrillation.TNF-α and IL-6 may come from the heart and is related with the enlargement of left atrium.

Objective To discuss the value of prenatal ultrasound and MRI in diagnosis of fetal agenesis of corpus callosum (ACC). Methods Sixty-seven fetuses from Hubei Maternal and Children's Hospital performed fetal MRI from July 2013 to December 2014 were included in this study. All fetuses (67 cases) with suspected ACC were studied with a 1.5T MR unit within 3 days after ultrasound examination. Prenatal ultrasound and MRI findings were studied. Results All the 67 ACCs previously suspected on ultrasound were confirmed by MRI. Among the 67 ACCs, 58 cases were complete ACC and 9 cases were partial ACC. Corpus callosum body and/or splenium absence was found in all 9 partial ACC cases. In all cases, on MRI, corpus callosum complete or partial absence was showed on the median sagittal images, and mild to moderate ventriculomegaly and abnormal morphology in lateral ventricle was shown on the axial or coronary images. Conclusions MRI has high value in diagnosis of ACC. When ACC is found or suspected by ultrasonophy, MRI examination is suggested to confirm the diagnosis.

Objective To observe efifcacy and safety of catheter ablation for atrial ifbrillation (AF) occurring after surgical valve replacement in patients with rheumatic heart disease (RHD). Methods A total of 23 RHD patients with atrial ifbrillation after surgical valve replacement were enrolled in this study from 2008 to 2013. The clinical characteristics, ablation strategies and successful rate were investigated. Results All the cases included 8 males and 15 females (age, 51.0 ± 9.2 years). Valves replaced were isolated mitral valves (13/23, 56.5%) and multiple valves (10/23, 43.5%). Postoperative AF after cardiac surgery was paroxysmal in 14 patients (60.9%) and nonparoxysmal in 9 cases. Nine patients (39.1%) was in sinus rhythm before cardiac surgery, 4 in paroxysmal AF and 10 in non-paroxysmal AF. The mean interval between the catheter ablation AF and the surgical intervention was (6.9±5.8) years. The postoperative AF duration was (3.1±3.2) years, left and right atrial diameters were (44.1±5.9) mm and (48.1±9.0) mm respectively, left ventricular ejection fraction was 64.0%±8.3%, the mean ablation procedure duration was (156.8±46.6) min, and lfuoroscopy exposure averaged (27.3±11.2) min. Standard pulmonary vein isolation was performed in all cases by using ipsilateral circumferential ablation technique. Additional ablation, including complex fractionated atrial electrograms, mitral and tricuspid isthmus, and left atrial roof, was applied in most of the cases. After a mean follow-up of (29.7±21.2) months (median, 24 months), 60.9%of the patients remained free of AF, 1 died, and 2 lost to follow-up. Conclusions Catheter ablation for AF is effective and safe in patients with RHD after surgical valve replacement. Stepwise ablation strategy may be better for these patients.

Objective To investigate the diagnostic value of ultrasound and MRI in fetal bronchopulmonary sequestration (BPS). Methods The 7 pregnant women with suspected fetal BPS were examined with a 1.5 T MR unit within 24 h after prenatal ultrasound in Hubei Maternal and Children's Hospital during July 2013 to February 2015. The imaging protocol included half-fourier acquisition single shot turbo SE (HASTE), true fast imaging with steady state precession (True FISP) in axial, frontal and sagittal planes relative to the fetal thorax. Prenatal MRI findings have been compared with postnatal enhanced computed tomography or biopsy. Results The locations of BPS were in left side in 5 cases and in right side in 2 cases. One case was complicated with congenital cystic adenomatoid malformation (CCAM) of lung. Ultrasound showed the intrathoracic mass as a hyperechoic lesion and the feeding artery could be found by Doppler ultrasonography. T2WI could reveal not only the hyperintense lesions with clear boundary, but also the hypointense feeding artery originating from systemic circulation. Compared with pathological examination or enhanced CT, both of the ultrasound and the MRI could locate the lesions;however 2 feeding arteries were misjudged. Conclusions Prenatal ultrasound is the first-choice diagnostic modality for BPS. MRI can demonstrate the location, morphology and the feeding arteries of the fetal BPS, and also estimate the volume of normal lungs, which could be an important supplement to prenatal ultrasound in prenatal diagnosis and prognostic prediction of BPS.

Objective To analyze the clinical characteristics and follow-up data of catheter ablation of recurrent atrial tachycardias (ATs) after Mini-Maze surgery,and to explore prognostic factors for recurrence.Methods 59 patients in Guangdong General Hospital with ATs post Mini-Maze and concomitant open-heart surgery from April.2010 to June.2015 were included.According to high density precise mapping,activation mapping,voltage mapping and entrainment mapping,they underwent electrophysiological study and ablation which was guided by three-dimensional mapping system.All patients were followed up regularly.We explored the prognostic factors for recurrence by the Cox regression analysis.Results There were 88 types of ATs being mappedwith mean (1.49 ± 0.75) types of ATs identified per case.Most ATs were macro-reentry ATs(67/88,76.1％)and focal ATs (20/88,22.7％),respectively.56 patients (94.9％) achieved immediate ablation success.In a mean follow-up of (30.8 ± 17.7) months,recurrences were observed in 12 patients after the first time catheter ablation.Recurrent time was 3.5 (1.3,12.0) months and the overall ablation success rate was 74.6％ (44/59).6 patients received second ablation and the achievement of freedom from arrhythmias reached 79.7％ (47/59).Multivariate analysis showed that the LA diameter was the independent predictor for recurrence (HR 1.108,95％ CI 1.002 to 1.226,P =0.045).Conclusion Catheter ablation of ATs post Mini-Maze with concomitant surgery is save and feasible.LA diameter is the independent predictor for recurrence.

OBJECTIVETo investigate the stages of health-related behaviors, family and peer support situation about adolescent in Wuhan, and to provide evidence for health intervention and health promotion.

METHODSBased on the principle of multi-stage stratified cluster sampling, extracted two junior middle school and two high school in two cities in Wuhan from March 2012 to May. A total of 1 200 students, which were part of the first and second grade class in middle school and high school, toke as the investigation object. The study surveyed following content, including the demographic situation, adolescent health-related behavior (physical activity, sedentary behavior, high-fat diet behavior, fruit and vegetable intaking behavior), stages of adolescent health related behavior (precontemplation, contemplation, preparation, action, maintenance) and adolescent support got from family and peer. The questionnaire was distributed in 1 200 copies, the valid questionnaires were 1 052 and the effective rate was 87.67%. Using χ² test to compare the different stages of change in health related behavior, t test was used to compare different groups of social support and using analysis of variance and post test to analyze social support of the four types behavior.

RESULTSIn 1 052 students, there was 555 (52.8%) middle school students, 497 (47.2%) high school students, and 553 (52.6%) boys, 499 (47.4%) girls. In physical exercise and sedentary behavior, numbers of precontemplation was respectively accounting for 42.2% (444/1 200) and 28.4% (299/1 200). In high-fat diet behavior, the stages of preparation and maintain was occupied 46.7% (492/1 200). In fruit and vegetable intake behavior, there was 32.9% (346/1200) students in contemplation. Numbers in action stage was both less in the above four behavior, accounting for 6.2% (65/1 200), 8.9% (94/1 200), 14.0% (147/1 200) and 6.3% (66/1 200) separately. Adolescent peer support score respectively (2.9 ± 0.7), (2.8 ± 0.8) and (2.9 ± 0.9), which was higher than the family support scores ((2.7 ± 1.1), (2.5 ± 1.2) and (2.9 ± 1.2)) (t values were -8.72, -11.22 and -2.59, respectively. All P values were < 0.001) in physical exercise, sedentary behavior and high fat diet, but in the intake of fruits and vegetables behavior, family support score was higher than peer support (score was respectively (3.3 ± 0.9) and (3.5 ± 1.2); t < 9.97, P < 0.001). ANOVA and post hoc comparison showed that the score of family and peer support in the after-action stage was significantly higher than that the before-action stage in physical exercise, high-fat diet and fruit and vegetable intake behavior, while the differences in sedentary behavior was not significant.

CONCLUSIONYouth health-related behaviors remained in its infancy, there was a certain impact on its stages which showed that the higher social support the more advanced stages of behavior.

Adolescent ; Adolescent Behavior ; Diet, High-Fat ; Exercise ; Family ; Feeding Behavior ; Female ; Fruit ; Health Behavior ; Humans ; Male ; Peer Group ; Schools ; Social Support ; Students ; Surveys and Questionnaires ; Vegetables

OBJECTIVETo learn the dietary fat intake behavior status and influencing psychological factors in teenagers.

METHODSAccording to the multi-stage stratified cluster sampling method, students were recruited from middle and high schools in Hangzhou, Wuhan and Xi'an from March to May, 2012. Chinese version of adolescent dietary fat intake behavior of psychological measurement scales was utilized in field investigations with 3 448 effective questionnaires. Under the transtheoretical model, the status quo of teenagers fat intake behavior was analyzed and it shows the relationship between stages and psychological variables, including strategy of change, decision balance and self-efficacy.

RESULTSIn the 3 448 participants, the proportion of girls were 52.4% (1 806/3 448) and boys were 47.6% (1 642/3 448), while the mean age was (14.85 ± 1.46). There are significant differences among distributed stages of behavior change, grouped by gender, grade and region (χ(2) values were 33.59, 20.53, 27.92, P < 0.001). In different gender groups, the number of boys in precontemplation came to the first and accounted for 24.2% (438/1 806), and the number of girls were more in contemplation and preparation stage, which accounted for 49.5% (813/1 642), and it was the least both in the action stage with the ratio 12.1% (218/1 806) and 14.7% (241/1 642) respectively; in different grade groups, the numbers of student in middle school and high school were the largest in contemplation and precontemplation stage, accounted for 24.9% (494/1 986) and 23.4% (343/1 462); and among different regions, the proportion in precontemplation, contemplation and preparation stage was not a few, and this ratio in Hangzhou, Wuhan, Xi'an area was 70.6% (801/1 135), 61.7% (649/1 052) and 68.8% (867/1 261), respectively. The number in action stage was the least of all, which were 144, 147, 168, respectively. Ordinal logistic mode showed that the four variables, including the scores of process of change, decision balance (pros), decision balance (cons) and self-efficacy, were factors which significantly affected the stages of behavior change, which showed a significant difference (F values were 155.12, 19.86, 44.59, 94.27, P < 0.001) in different stages. From precontemplation stage to action stage, the score of the process of change, decision balance (pros) and self-efficacy showed an upward trend, and achieved the highest score in the action stage (from 32.6 ± 12.8, 8.4 ± 2.9, 19.7 ± 6.9 to 48.4 ± 12.6, 10.1 ± 2.5, 25.9 ± 6.9, respectively); contrarily, the decision balance (cons) decreased with the development of behavioral stage (from 14.7 ± 4.4 to 12.2 ± 3.9). Post hoc comparison also found that the score of process of change, decision balance (pros) and self-efficacy after action stages were higher than those before action, while the score of decisional balance (cons) in the precontemplation stage was higher than that in the other 4 stages.

CONCLUSIONFat intake behavior in teenagers showed different stages, whose psychological factors had significant influences, with decision balance (pros) hindered the progress of stages of behavior change, while other three factors played a positive role.

Adolescent ; Adolescent Behavior ; Decision Making ; Dietary Fats ; Female ; Humans ; Male ; Models, Theoretical ; Self Efficacy ; Students ; Surveys and Questionnaires