Objective To investigate the values of echocardiogram for evaluating the changes of left ventricular structure and cardiovascular function of the acute mountain sickness (AMS) patient before and after returning the plain.Methods A total of 33 light AMS patients returning to the plain in time underwent echocardiogram examinations on some cardiovascular indexes before and after returning the plain,including stroke volume (SV),cardiac output (CO),left atrial volume index (LAVI),left ventricular end-diastolic volume (LVEDV),early diastolic mitral flow velocity (E),late diastolic mitral flow velocity (A) and so on.Results The values of heart rate (HR),systolic blood pressure (SBP),diastolic blood pressure (DBP),CO,A and LAVI after going to the plateau were all significantly higher than those before going to the plateau (P＜0.05),while the values of SV,E,E/A and LVEDV were obviously lower (P＜0.05).The values of HR,SBP,DBP,CO,A,E and E/A recovered respectively 1 month after going to the plateau when compared with those before going to the plateau (P＜0.05),while did not restore to the ones before going to the plateau (P＜0.05),and the values of LVEDV,LAVI and SV reached the level before going to the plateau (P＜0.05).The values of LVEDV,SV,SBP,LAVI and E 1 week after returning to the plain came to the level before going to the plateau (P＜0.05),and the values of CO,HR,DBP and A were significantly higher (P＜0.05) while the value of E/A was statistically lower (P＜0.05).Conclusion Echocardiogram can be used to evaluate the left ventricular structure and cardiovascular function of the AMS patient,especially for those light AMS patients in acclimatization period or before and after returning to the plain.

Objective To investigate the effects of echocardiography-guided pacemaker parameters optimization in order to enhance the efficacy of cardiac resynchronization therapy(CRT).Methods Seventeen patients with chronic heart failure received biventricular resynchronous pacing therapy.A-V delay and V-V delay was optimized under the guiding of spectral Doppler echocardiography and tissue Doppler imaging.Results The indices of heart function in all patients were significantly improved after the treatment.The NYHA class of the patients was improved from class Ⅲ～Ⅳ to class Ⅱ～Ⅲ.Since PAV/SAV was optimized to 130-180/100-150 ms,left ventricular filling time(LVFT) was increased from (354±147)ms to (420±112)ms,mitral reflux (MR) was decreased from (8.41±4.55)cm2 to (5.36±4.71)cm2.After VV delay was optimized to 4-40ms,standard deviation of time to regional peak systolic velocity (Ts-SD-12) was decreased from (48.4±17.9)ms to (30.2±18.6)ms,left ventricular outflow tract velocity time integral(VTI LVOT) was increased from (20.6±9.0)cm/s to (26.1±3.1)cm/s.Conclusions Echocardiography-guided optimization of the pacemaker parameters is necessary in order to enhance the efficacy of CRT.

Objective To evaluate the value and feasibility of tissue mitral annular displacement (TMAD) in the assessment of left ventricular global and segmental longitudinal systolic function and synchronization in patients with hypertrophic cardiomyopathy.Methods The study population consisted of 39 on-obstructive hypertrophic cardiomyopathy (nHCM) patients and 39 healthy volunteers matched by gender and age.Left ventricular global and segmental longitudinal were measured by speckle tracking imaging(STI).The mitral annular displacement (MAD) (anterioseptal,posterioseptal,anterior,lateral,posterior and inferior sites,respectively),peak of time (PT) and left ventricular systolic dyssynchrony index (SDI) were measured by TMAD.The correlation between LSR and MAD was analyzed,and the parameters of MAD and SDI for tow groups were compared.Results The rate of effectively track segments of TMAD was significantly higher than that of STI(98.7％ vs 77.9％,P ＜0.001).There were high correlationship between segmental LSR and MAD(r =-0.784,P ＜0.001),and global and MADglobal (r =-0.897,P ＜0.001).Compared with the control group,MAD of six spots and MADglobal were significantly decreased (P ＜ 0.001,respectively),SDI was significantly increased(P ＜0.001).Conclusions TMAD is a sensitive and reproducible method for the assessment of LV longitudinal functionin patients with nHCM.

Objective To observe the hemodynamic changes of acute after cardiac resynchronization therapy(CRT) interruption in patients with chronic heart failure (CHF),and explore the benefit of hemodynamic of the reverse remodeling and non-reverse remodeling CHF patients during CRT.Methods 46 CHF patients who had undergone implantation of CRT device for more than 6 months were enrolled in the study.The reverse remodeling and non-reverse remodeling were identified by reduction of LV end-systolic volumes ≥ 15％.The two groups underwent echocardiography,and mitral regurgitation area (MRA),velocity time integral of aortic valve (VTI-AV),velocity time integral of mitral valve(VTI-MV),maximum rising rate of left intra-ventricular pressure(+ dp/dtmax),LVFT/T were measured in on and off mode of CRT.Hemodynamic indicators of two groups were compared in CRT on and off modes.The rate of changes of above mentioned parameters ΔMRA,ΔVTI-AV,ΔVTI-MV,Δdp/dt and ΔLVFT/T were calculated and compared in the two groups.Results MRA had significant increasing in both group after 10 minutes intereuption of CRT (P ＜0.01).Two groups had significant worsening of VTI-AV,VTI-AV,+ dp/dtmax and LVFT/T after 10 minutes interruption of CRT as compared to CRT-on mode (P ＜0.05).ΔMRA,ΔVTI-MV,Δdp/dt of reverse remodeling group significantly higher than non-reverse remodeling group(P ＜0.05).But there was no difference in ΔVTI-AV and ΔLVFT/T(P ＞0.05).Conclusions The hemodynamic index become worsening after 10 minutes interruption of CRT in both group of medium-and long-term CRT patients especially in reverse remodeling group,suggesting that patients of both groups have obtained hemodynamic benefits continuously during CRT.Reverse remodeling group get more benefits than non reverse remodeling group.

With the improvement in quality of life and the development of medical science and technology， people's requirements for postoperative beauty are correspondingly improved. On the premise of ensuring safety and feasibility， the advantages of endoscopic small incisions are used to treat breast diseases. With the vigorous promotion of scholars all over the world， endoscopic treatment of breast cancer has changed from concept to reality. This article will briefly describe the development history of endoscopic treatment of breast cancer， introduce the indications obtained by experts from all over the world through practice， as well as the surgical methods of endoscopic treatment of breast cancer that have evolved based on traditional breast cancer surgery， and discuss the controversy and prospect of endoscopic treatment of breast cancer.

Objective: To establish a set of rules for autoverification of blood analysis, in order to provide a way to validate autoverification rules for different analytical systems, which can ensure the accuracy of test results as well as shorten turnaround time (TAT) of test reports. Methods: A total of 34 629 EDTA-K2 anticoagulated blood samples were collected from multicenter cooperative units including the First Hospital of Jinlin University during January 2017 to November 2017. These samples included: 3 478 cases in Autoverification Establishment Group, including 288 cases for Delta check rules; 5 362 cases in Autoverification Validation Group, including 2 494 cases for Delta check; 25 789 cases in Clinical Application Trial Group. All these samples were analyzed for blood routine tests using Sysmex XN series automatic blood analyzers.Blood smears, staining and microscopic examination were done for each sample; then the clinical information, instrument parameters, test results and microscopic results were summarized; screening and determination of autoverification conditions including parameters and cutoff values were done using statistical analysis. The autoverification rules were input into Sysmex Laboman software and undergone stage Ⅰ validation using simulated data, and stage Ⅱ validation for post-analytical samples successively. True negative, false negative, true positive, false positive, autoverification pass rate and passing accuracy were calculated. Autoverification rules were applied to autoverification blood routine results and missed detection rates were validated, and also data of autoverification pass rate and TAT were obtained. Results: (1)The selected autoverification conditions and cutoff values included 43 rules involving WBC, RBC, PLT, Delta check and abnormal characteristics. (2)Validation of 3 190 cases in Autoverification Establishment Group showed the false negative rate was 1.94%(62/3 190)(P<0.001), autoverification pass rate was 76.74%, passing accuracy was 97.47%; Validation of 2 868 cases in Autoverification Validation Group, the false negative rate was 3.38%(97/2 868)(P=0.002), autoverification pass rate was 42.26%, passing accuracy was 92.00%; Validation of Delta check on 288 cases in Autoverification Establishment Group and 2 494 cases in Autoverification Validation Group showed the false negative rates were respectively 1.39% and 2.61%(P<0.001). (3)Three hospitals adopted these rules of autoverification for 25 789 blood routine samples, and found that the average TAT of blood routine test reports were shortened by 24min, 32min and 7min respectively, the rate of samples reported within 30min were elevated by 33%, 53% and 7%. The autoverification pass rates were 72%-74%. Conclusions The application of this set of 43 autoverification rules in blood sample analysis can ensure test quality while shortenTAT and improve work efficiency. It is worth pointing out that for the same analytical systems in this research, validation is necessary before application of this set of rules, and periodic validation is required during application to make necessary adjustment; for different analytical systems, as this research provide a way to establish autoverification rules for blood routine tests.Clinical labs may establish their own suitable autoverification rules on the basis of technological parameters. (Chin J Lab Med, 2018, 41: 601-607)

Objective:To establish autoverification rules for coagulation tests in multicenter cooperative units, in order to reduce workload for manual review of suspected results and shorten turnaround time (TAT) of test reports, while ensure the accuracy of results.Methods:A total of 14 394 blood samples were collected from fourteen hospitals during December 2019 to March 2020. These samples included: Rules Establishment Group 11 230 cases, including 1 182 cases for Delta check rules; Rules Validation Group 3 164 cases, including 487cases for Delta check; Clinical Application Trial Group 77 269 cases. Samples were analyzed for coagulation tests using Sysmex CS series automatic coagulation analyzers, and the clinical information, instrument parameters, test results, clinical diagnosis, medication history of anticoagulant and other relative results such as HCT, TG, TBIL, DBIL were summarized; on the basis of historical data, the 2.5 and 97.5 percentile of all data arranged from low to high were initially accumulated; on the basis of clinical suggestions, critical values and specific drug use as well as relative guidelines, autoverification rules and limits were established.The rules were then input into middleware, in which Stage I/Stage II validation was done. Positive coincidence, negative coincidence, false negative, false positive, autoverification pass rate, passing accuracy (coincidence of autoverification and manual verification) were calculated. Autoverification rules underwent trial application in coagulation results reports.Results:(1) The autoverification algorisms involve 33 rules regarding PT/INR, APTT, FBG, D-dimer, FDP,Delta check, reaction curve and sample abnormalities; (2)Autoverification Establishment Group showed autoverification pass rate was 68.42% (7 684/11 230), the false negative rate was 0%(0/11230), coincidence of autoverification and manual verification was 98.51%(11 063/11 230), in which positive coincidence and negative coincidence were respectively 30.09% (3 379/11 230) and 68.42%(7 684/11 230); Autoverification Validation Group showed autoverification pass rate was 60.37%(1 910/3 164), the false negative rate was 0%(0/11 230), coincidence of autoverification and manual verification was 97.79%(3 094/3 164), in which positive coincidence and negative coincidence were respectively 37.42%(1 184/3 164) and 60.37%(1 910/3 164); (3) Trialed implementation of these autoverification rules on 77 269 coagulation samples showed that the average TAT shortened by 8.5 min-83.1 min.Conclusions:This study established 33 autoverification rules in coagulation tests. Validation showedthese rules could ensure test quality while shortening TAT and lighten manual workload.

Monoclonal antibody-based therapy has achieved great success and is now one of the most crucial therapeutic modalities for cancer therapy. The first monoclonal antibody authorized for treating human epidermal growth receptor 2 (HER2)-positive breast cancer is trastuzumab. However, resistance to trastuzumab therapy is frequently encountered and thus significantly restricts the therapeutic outcomes. To address this issue, tumor microenvironment (TME) pH-responsive nanoparticles (NPs) were herein developed for systemic mRNA delivery to reverse the trastuzumab resistance of breast cancer (BCa). This nanoplatform is comprised of a methoxyl-poly (ethylene glycol)-b-poly (lactic-co-glycolic acid) copolymer with a TME pH-liable linker (Meo-PEG-Dlink _m -PLGA) and an amphiphilic cationic lipid that can complex PTEN mRNA via electrostatic interaction. When the long-circulating mRNA-loaded NPs build up in the tumor after being delivered intravenously, they could be efficiently internalized by tumor cells due to the TME pH-triggered PEG detachment from the NP surface. With the intracellular mRNA release to up-regulate PTEN expression, the constantly activated PI3K/Akt signaling pathway could be blocked in the trastuzumab-resistant BCa cells, thereby resulting in the reversal of trastuzumab resistance and effectively suppress the development of BCa.