Objective To evaluate the safety,efficacy,experience and techniques of percutaneous nephrostolithotomy (PCNL) in treating renal staghorn calculi.Methods The clinical data of 60 patients with staghorn renal stone who underwent PCNL were analyzed retrospectively.Results The stone free rate was 68.3％(41/60) in the first procedure.Three patients were performed a secondary procedure.The stone free rate was 73.3％ (44/60) in the second procedure.The total stone free rate was 93.3％(56/60) after the procedure of extracorporeal shock wave lithotripsy (ESWL) and ureteroscopic lithotripsy (URL).Conclusions PCNL is a safe and effective method for the staghorn renal calculi.The stone free rate may be improved with skilled operation experience and combination with ESWL and/or URL.

ObjectiveTo assess myocardial perfusion by the end-systolic and end-diastolic replenishment parameters of real-time myocardial contrast echocardiography (MCE).MethodsTwenty-one patients with myocardial infarction(MI) and normal control group of 6 cases underwent intravenous realtime myocardial contrast echocardiography via slow and homogeneous venous injections of SonoVue.MCE images were obtained from the apical 4-chamber,2-chamber,and long-axis views.According to the exponential function:y(t) =A [1 - e-kt] + B,the time intensity curves were obtained.By an off-line ECG triggering and curve fitting,the replenishment parameters A value,k value,A × k value were obtained separately from end-systolic and end-diastolic images.ResultsIn normal control group,the end-systolic replenishment parameters A value,k value,A × k value were all lower than that of the end-diastolic replenishment parameters[(6.21 ± 2.69)dB vs (7.93 ± 3.66)dB,P ＜0.05；0.36 ± 0.15 vs 0.42 ± 0.19,P ＜ 0.01 ;2.88 ± 1.29 vs 3.39 ± 1.61,P ＜0.05,respectively].The end-diastolic replenishment parameters were found significantly greater variability than the end-systolic values (variation coefficient CV:A value 46.2％ vs 43.3％,k value 45.2％ vs 41.4％,A× k value 47.5％ vs 44.8％,all P ＜0.05).In 21 patients,the end-systolic replenishment parameters in myocardial segments supplied by infarct-related coronary artery were significantly lower than that in myocardial segments supplied by non - infarct - related coronary artery.ConclusionsThe end-systolic and end-diastolic replenishment parameters of real time myocardial contrast echocardiography can assess myocardial perfusion.The variability of the end-systolic replenishment parameters is smaller than that of the end diastolic parameters.Significant variability in k-value suggests that this parameter is best suited for before-after study in the same patient.

AIM: To evaluate the effect of simvastatin on the left ventricular mass in patients with essential hypertension (EH). METHODS: 50 patients with hypertension without severe complication were randomly divided into two treatment groups: combination treatment group and hydragogue group, and 25 normal subjects without any treatment were taken as the control. The 25 patients in combination treatment group were given simvastatin and hydragogue for 12 weeks while the other patients in hydragogue group were given hydragogue during the same time. The left ventricular mass was examined from ultrasonography in all patients before and after treatment. RESULTS: The left ventricular mass index (LVMI) was higher in the two treatment groups of patients (133.61±31.02, 118.04±39.62 g·m-2) than that in the control group (88.79±22.73 g·m-2) before treatment (P<0.01, 0.0001, respectively) while the blood pressure was higher. There was no significantly difference in age, serum concentrations of total cholesterol or triglyceride, sugar and blood pressure between the two treatment groups and the control group (P>0.05). There was no significant difference in all variables between the two treatment groups before treatment. After treatment, the LVMI was decreased (133.61±31.02 vs 91.07±16.01 g·m-2, P<0.01) in the combination treatment group while there was no significant change in LVMI in the hydragogue group compared with the control group. The blood pressure in the two treatment groups was decreased to the normal. Compared with hydragogue group, the change of LVMI was higher in the combination group though the serum concentrations of total cholesterol, triglyceride or sugar were not significantly different. No significant change in serum concentrations of total cholesterol, triglyceride or sugar was found during treatment in the two groups. The change of LVMI did not correlate with the change of blood pressure, serum concentrations of total cholesterol , triglyceride or sugar in the combination treatment group(P>0.05). CONCLUSION: Being independent of the changes of serum concentrations of total cholesterol, triglyceride or sugar and blood pressure, simvastatin can inhibit the increase of left ventricular mass in patients with essential hypertension.

Objective To evaluate the relationship between carotid plaque instability and coronary heart disease by contrast-enhanced ultrasound. Methods Thirty-five patients with acute coronary syndrome (ACS) and 32 patients with stable coronary artery disease(sCAD) were included. Inclusion criteria were at least 1 carotid atherosclerotic plaque with thickness larger than 2.0 mm. Contrast-agent enhancement in the plaque was evaluated by visual interpretation and quantitative analysis. Results The percentage of soft plaque in ACS group was significantly higher than that in sCAD group ( P ＜0.001 ). The proportion of contrast-agent enhancement in patients with ACS was significantly than that in patients with sCAD( P =0. 037). The enhanced intensity in the plaque and the ratio of enhanced intensity in the plaque to that in the carotid artery lumen in patients with ACS were significantly larger than those in patients with sCAD ( P ＜0.001, P = 0.026, respectively). Sensitivity and specificity of prediction ACS were 74% and 60%,respectively,for enhanced intensity in the plaque and 86% and 67%, respectively, for ratio of enhanced intensity in the plaque to that in the lumen of the carotid artery. Conclusions The subjects with ACS had more intense contrast-agent enhancement than the subjects with sCAD. Contrast-enhanced ultrasound can be used to evaluate the relationship between carotid plaque instability and coronary heart disease.

Objective To evaluate the microcirculation abnormalities in the patients with hypertrophic cardiomyopathy(HCM). Methods Twenty patients with HCM and 20 healthy volunteers were included in the study. Two-dimensional images on the apical four-chamber, two-chamber and long-axis views, including 5 cardiac cycles before 'flash' and 15 cardiac cycles after 'flash', were reeorded and stored for off-line analysis in EchoPAC workstation. Then,contrast time-intensity curves were obtained for each available left ventrieular segment. Results There were significant differences in the A,k and the product A×k between the hypertrophic wall segments (P = 0.01, P<0.001, P = 0.036,respectively) and nonhypertrophic wall segments (P<0.001,respectively) and healthy subjects. A,k and the product A×k in hypertrophic wall segments were significantly different from those in nonhypertrophic wall segments in patients with HCM (P = 0.021, P = 0.016, P = 0. 001,respectively). Accordingly,the normalized value of A and the product A × k were lower in hypertrophied wall segments (P = 0.031, P<0.001, respectively) and nonhypertrophied wall segments(P = 0.002, P<0.001,respectively) in patients with HCM than those in normal segments of healthy controls. The normalized value of A and the product A × k were lower in hypertrophic wall segments than nonhypertrophic wall segments in patients with HCM(P = 0.045, P = 0.021,respectively). Conclusions Myocardial contrast echocardiography is a useful method to investigate myocardial perfusion abnormalities in patients with HCM.

Objective:To evaluate the left ventricular rotation and twist in patients with constrictive pericarditis (CP) after pericardiectomy by using speckle tracking echocardiography (STE), and observe its trend over time.Methods:A total of 29 patients with CP from Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from September 2014 to December 2017 underwent echocardiography 1 week before and 1 month, 6 months, 12 months after pericardiectomy. STE was performed to obtain peak values of basal and apical rotation and left ventricular twist. Twenty-nine healthy subjects were recruited as controls in the same period.Results:The left ventricu1ar apical rotation[before surgery(6.62±3.19)°, 1 month after surgery(7.07±4.02)°, 6 months after surgery(7.88±4.46)°, 12 months after surgery(7.85±4.51)°], the left ventricu1ar twist [before surgery(10.50±4.94)°, 1 month after surgery(9.42±5.40)°, 6 months after surgery(9.59±4.62)°, 12 months after surgery(9.70±4.45)°] were significantly lower in patients with CP than those in controls [(11.22±5.17)°, (16.35±5.21)°](all P<0.05); while basal rotation in patients with CP after surgery among different time points were all significantly lower than those in controls[1 month after surgery(-3.85±3.20)°, 6 months after surgery(-3.49±2.09)°, 12 months after surgery(-3.53±2.01)°; controls(-5.57±2.78)°] (all P<0.05), with no significant difference between patients with CP before surgery (-5.22±3.14)° and controls (-5.57±2.78)°( P>0.05). There were no significant differences in left ventricular twist, basal and apical rotation in CP groups before and after surgery among different time points (all P>0.05). Conclusions:Although the left ventricular global function of patients with CP in the long postoperative period seems "normal" , the left ventricular twist, basal and apical rotation are still significantly lower than those in controls. STE can be used to assess the changes of left ventricular twist and rotation in patients with CP long-term after pericardiectomy.

Objective To evaluate the relationship between carotid atherosclerotic plaques stability and the clinical symptoms of carotid atherosclerosis by contrast-enhanced ultrasonography. Methods Fifty patients with carotid atherosclerotic plaques were examed with contrast-enhanced ultrasonography,the contrast agent visualization of the carotid atherosclerotic plques were analyzed and compared with their clinical symptoms. Results Twenty-three patients who suffered from obvious clinical symptom were entirely visualized. Twenty-weven patients had not apparent clinical symptom,of these patients,15 were sparse visualized,there was no visualization in other 12 patients. Conclusions Conlrast enhanced ultrasonography can real-time observe microcirculation in carotid atherosclerotic piques,and assess the stability of carotid atherosclerotic plaques.

Objective To evaluate left ventricular function in the way of intracavitary vortex by vector flow mapping(VFM),and to demonstrate the formation and variation of the vortex. Methods Twenty-six patients with dilated cardiomyopathy(DCM) and 44 healthy controls were involved. The velocity distribution imagings on the section plane of the flow in the left ventricle were obtained by VFM, the location of the vortex and its variation in every phase of cardiac cycle were focused,and series parameters were measured,such as the diameter of the vortex (transverse diameter, vertical diameter), number of the vertex. Results relaxation(e) period. Vortices were observed mostly during diastolic period, nearby the anterior leaflet of mitral valve,middle upper 1/3 of left ventricle,and their shapes changed 2 - 3 times. The diameters of the vortex (transverse diameter,vertical diameter) , number of the vertices in one cardiac cycle during 7 phases mostly nearby the cardiac apex, middle lower 2/3 of left ventricle, and their shapes changed 4 - 5 times.Compared with control group,the diameters of the vortex (transverse diameter, vertical diameter) during 7 phases in DCM group were bigger,and number of the vertices were more ( P ＜0.01 ). The diameters of the vortex (transverse diameter, vertical diameter), number of the vertices within DCM group in one cardiac cycle during 7 phases were significantly different ( P ＜ 0.01 ). Conclusions VFM can demonstrate the variation of intracavitary vortex. Vortex in DCM group were significantly bigger than those of control group.

two-dimensional strain echocardiography can observe dynamic change of regional systolic function,combined with the two methods can more accurately assess the treatment results of coronary artery bypass surgery.

Objective To evaluate the feasibility and clinical efficacy of laparoscopic nephron-sparing surgery without renal wound suturing.Methods From December 2012 to February 2014,9 patients (4 male,5 female) with renal tumor underwent laparoscopic nephron-sparing surgery without suturing in our hospital.The mean age in those patients was 56 years (range 42-72 years).The mass size ranged from 1.1to 3.8 cm (mean 2.4 cm).The location of tumor included 2 in left kidney,7 in right kidney.Meanwhile,6 tumors were found in the middle part of kidney,2 tumors were demonstrated in the lower part of kidney,and 1 tumor located in the upper part of kidney.The imaging examination confirmed that all tumors protruded the renal surface and infiltrated into the renal parenchyma about 0.1-1.2 cm,which could be defined as the peripheral renal tumor without the invasion of collective system.The retroperitoneal approach was used in all patients with 3 trocars.During the operation,the renal artery was exposed and fats surrounding or on the surface of the tumor were resected.The renal artery was occluded.Tumor excision was then performed using scissors.An incision was made at the point 0.5 cm away from the margin of the tumor,extending deeply to completely cut the tumor.Meanwhile,bleeding was controlled with bipolar diathermy.Then,the clamping of the renal artery was removed and the retroperitoneal pressure was reduced in order to check the site of bleeding.If the bleeding occurred severely,the kidney wound was sutured with 2-0 absorbable sutures.Otherwise,the coagulative glue was sprayed on the wound surface.Results In all the patients,the procedures were done without conversion to open surgeries.The renal wound suturing appeared in one case because the tumor infiltrated into the deep of the kidney and the bleeding could not be completely controlled by bipolar diathermy.Eight of 9 cases were successfully performed without suturing.The mean time of renal artery occlusion was 8 min (range 3-18 min).In our patients,the mean operation time was 120 min (90-180 min),and the mean blood loss was 60 ml (10-200 ml).None of the patients received blood transfusion during the surgery.The mean postoperative hospital stay was 7 days (5-9 days).No complications,such as urine leakage,bleeding occurred after the operation.All the patients were followed up with no recurrence of tumor.Conclusions Laparoscopic nephron-sparing surgery without renal wound suturing is feasible and safe for patients with the small and the depth of infiltration less than 0.5 cm tumor in the kidney.