Objective To assess right ventricular(RV) regional and global function in patients with repaired tetralogy of Fallot (TOF) by speckle tracking imaging (STI).Methods 36 asymptomatic patients with repaired TOF whose postoperative period is more than one year and 35 healthy controls were studied.RV longitudinal peak systolic strain (ε),strain rate (SRs) were measured in RV free wall and interventricular septum(IVS) for basal,mid and apical segments by STI from the apical 4-chamber view,RV global longitudinal peak systolic strain (GLS),strain rate (GLSRs),early diastolic strain rate (GLSRe) and late diastolic strain rate (GLSRa) were measured from the above view.The correlations between RV systolic functional parameters and the postoperative period,degree of pulmonary regurgitation (PR) and QRS duration were explored.Results ①Compared with controls,εand SRs of RV free wall and IVS for most segments,GLS,GLSRs,GLSRe,and GLSRa were significantly impaired in patients with repaired TOF (P ＜ 0.05 for all).Both GLS and GLSRs were lower in postoperative patients with transannular patch than in those with RV out tract patch.②In comparison with controls,GLS,GLSRs,GLSRe and GLSRa were decreased in postoperative patients with mild,mid and severe PR,Whereas,there was no difference in RV global function among the patients with varying degree of PR.③GLSRs of RV was correlated inversely with postoperative period and QRS duration(r1--0.431,P1 =0.009 ; r2 ==-0.469,P2-0.004),RV GLS and GLSRs had no correlation with PR.Conclusions RV regional and global function in patients with late repaired TOF are decreased,STI can early detect right ventricular dysfunction in asymptomatic patients with repaired TOF.The type of operation impacts on late prognosis,RV abnormal deformations are associated with electrical depolarization abnormalities.

Objective To investigate the effect of focal cerebral ischemic preconditioning (IPC) on brain edema and the expression of nuclear factor-?B( NF-?B) and its target gene MMP-9. Methods Forty-five SD rats were divided into 3 groups in which control group received sham surgery only, and the other two groups received 2 hours of middle cerebral artery occlusion (MCAO) followed by 22 hours of reperfusion with or without 10 minutes of IPC 3 days before. Brain water content, expression of NF-?B and MMP-9 mRNA were evaluated in each group by wet-dry weight method, immunohistochemistry staining and RT-PCR. Results Compared with the SS group, there was a lower NF-?B immunoreactivity and MMP-9 mRNA level (16 098.2?1 265.3 vs 23 565.8?1 978.4,50.7% vs 84.1%, P

Objective To assess left ventricular (LV) global systolic function in patients with essential hypertension with normal geometric LV by 3-dimensional ultrasound speckle tracking imaging(3D-STI). Methods Fifty patients with essential hypertension were enrolled in this study, 29 normal subjects matched with age and sex were selected as control groups. LV global longitudinal peak systolic strain (GLS), radial peak systolic strain (GRS), circumferential peak systolic strain (GCS), LV global 3-dimentional radial peak systolic strain (3DGRS) were measured in all subjects by 3D-STI from the apical full-volume image and compared between groups. LV ejection fraction (LVEF) was acquired from 3D-STI.Results Compared with controls, LV GLS, GRS, GCS and 3DGRS were significantly reduced in patients with hypertension ( P ＜ 0.05 for all). A Pearson correlate revealed that LV GCS, GLS and GRS corresponded with LVEF( r1 =0.930, P1 ＜0.001; r2 = 0.705, P2 ＜0.001; r3 =0.474, P3 =0.001,respectively) in patients with hypertension, and LV GCS, GLS correlated with LVEF( r1 = 0. 838, P1 ＜0. 001; r2 = 0. 697, P2 ＜ 0. 001, respectively) in normal subjects. Conclusions LV global 3D strain decreases in patients with hypertension in the early period,3D-STI could evaluate the early change of heart function in patients with hypertension. LV circumferential movement plays a major role in the LV 3D movement and impacts on LVEF.

In recent years, ultrasound elastography, as a new technique for evaluating soft tissue elasticity, has been progressively used in musculoskeletal system. Shear-wave elastography (SWE) is considered to be more objective, quantitative, and reproducible than other ultrasonic elastography techniques with increasing applications to the musculoskeletal system. A number of studies have shown that SWE has high application value in determining severity and prognosis of the musculoskeletal tissue diseases (including tendons, muscles, nerves and ligaments). This article describes the applications of SWE in the evaluation of musculoskeletal system.

Objective:To investigate the clinical value of conventional ultrasound combined with contrast-enhanced ultrasound (CEUS) in diagnosis of chromophobe renal cell carcinoma (ChRCC).Methods:We retrospectively analyzed the ultrasound features of 40 cases with ChRCC which were confirmed by operation and pathology from January 2012 to January 2018 in our hospital. The site, shape, size, capsule, internal echo and blood supply of the lesions were observed by routine ultrasound. Then CEUS showed the modality of enhancement, including the arrival time, peak time, peak intensity, distribution and the washout time.Results:Among the 40 cases, 38 cases were single, 2 cases were multiple, 17 cases were left kidney, 22 cases were right kidney, 1 case was double kidney. The tumors were located in the upper part of the kidney in 8 cases (20.0%), the lower part of the kidney in 9 cases (22.5%), and the middle part of the kidney in 23 cases (57.5%). One of the tumors was located in the right renal pelvis, and the lesion invaded the renal capsule in 11 cases (27.5%). The tumor was round, quasi round or oval, with clear boundary in 35 cases (87.5%), unclear boundary in 5 cases (12.5%), and the maximum diameter was 2.0-11.2 (5.1±0.8)cm. The lesions were hypoechoic in 23 cases (57.5%), isoechoic in 7 cases (17.5%), slightly hyperechoic in 7 cases (17.5%), cystic and solid mixed echo in 3 cases (7.5%), homogeneous echo in 23 cases (57.5%), heterogeneous echo in 17 cases (42.5%), and calcification in 5 cases (12.5%). Color Doppler flow imaging (CDFI) showed that blood vessels could be seen around the lesions, and no obvious blood flow signal was detected in 15 cases (37.5%) of the lesions; few star shaped blood flow signals could be detected in 12 cases (30%) of the lesions, short strip shaped blood flow signals could be detected in 7 cases (17.5%) of the lesions, and abundant blood flow signals could be seen in 6 cases (15%) of the lesions. Four patients underwent contrast-enhanced ultrasound examination at the same time. The lesions began to strengthen rapidly and evenly at the same time in the renal cortex, showing slightly low enhancement, and disappeared earlier than the renal cortex, showing a " fast forward and fast backward" perfusion mode. No tumor thrombus in draining vein, perirenal tissue and lymph node metastasis were found in all cases.Conclusions:Conventional ultrasound show ChRCC to be poor blood supply of solid tumors in the renal parenchyma, most of which are hypoechoic or isoechoic, with clear boundaries. CEUS show the lesions taking on high wash-in and wash-out, low enhancement than the surrounding renal cortex. These features are helpful for preoperative ultrasound diagnosis of ChRCC.

Objective To observe the effect of acupuncture plus rehabilitation in treating deglutition disorders due to cerebral stroke and its effect on each link of the neural pathway of deglutition function. Method By adopting the prospective randomized controlled method, ninety-nine patients with deglutition disorders after cerebral stroke were recruited and divided into an acupuncture-rehabilitation group, a pharyngeal acupuncture group, and a control group, respectively 33 cases, 34 cases, and 32 cases in each group. The acupuncture-rehabilitation group was intervened by acupuncture respectively at scalp, pharyngeal, and the root of tongue plus basic treatment, the pharyngeal acupuncture group was by acupuncture at the deglutition point (Extra) plus basic treatment, while the control group was by the basic treatment alone, once a day, 4 weeks in total. The Functional Oral Intake Scale (FOIS) and Clinical Nursing Swallowing Assessment Tool (CNSAT) were evaluated and statistically analyzed before and after intervention. Result The component scores of CNSAT were significantly improved after intervention in the acupuncture-rehabilitation group (P<0.01); the component scores of CNSAT were significantly changed after intervention in the pharyngeal acupuncture group (P<0.05);the CNSAT component scores in the acupuncture-rehabilitation group were significantly different from that in the pharyngeal acupuncture group and control group after intervention (P<0.01); the CNSAT component scores in the pharyngeal acupuncture group were significantly different from that in the control group after intervention (P<0.05). The FOIS scores were enhanced in the three groups after treatment; the FOIS score was significantly changed in the acupuncture-rehabilitation group after intervention (P<0.01);the FOIS score was markedly changed in the pharyngeal acupuncture group after intervention (P<0.05);the FOIS scores in the acupuncture-rehabilitation group and pharyngeal acupuncture group were both significantly higher than that in the control group (P<0.01,P<0.05). Conclusion The scalp-pharyngeal-root of tongue sequential-acupuncture plus rehabilitation can effectively mitigate the deglutition problems after cerebral stroke, improve the food-intake ability of the patients, and reduce the risk of mistake inhalation.

Objective To observe the effect of focal cerebral ischemic preconditioning on the expression of glial fibrillary acidic protein (GFAP) and to investigate the significance of astrocyte activation in cerebral ischemic tolerance.Methods Thirty-six healthy male SpragueDawley rats were randomly divided into reischenmic,ischemic and control groups (n = 12 in each group) after ischemic preconditioning.The former two groups received 10 minutes middle cerebral artery occlusion (MCAO) preconditioning or sham operation 3 days before the 2-hour MCAO.The rats were killed 24 hours after the second MCAO.The control group only receivedthe two sham operations with an interval of three days.The infarct volume,histopathological changes,and GFAP expression in each group were compared.Results The infarct volume after ischemic preconditioning in the reischenmic and ischemic groups was 136.85 ± 14.51 mm3and 281.37 ± 29.93 mm3 respectively.The former was significantly reduced 53.15%compared to the latter (P =0.007).At the same time,neuronal degeneration and necrosis was reduced significantly,and GFAP expression was upregulated significantly (the mean absorbance for immunohistochemical staining in both groups was 102.66 ± 8.39 and 86.28 ± 6.19respectively,P = 0.009) after ischemic preconditioning in the reischemic group.Conclusions Focal ischemic preconditioning may induce brain ischemic tolerance and promote GFAP expression.The activation of astrocytes may be one of the mechanisms of cerebral ischemic tolerance.

Objective:To investigate the values of right ventricular free wall longitudinal strain (RVFWLS) by three-dimensional speckle tracking echocardiography (3D-STE) in predicting the degree of RV myocardial fibrosis (MF) in patients with end-stage heart failure (HF).Methods:A total of 102 consecutive patients with end-stage HF undergoing heart transplantation were enrolled in the Union Hospital of Tongji Medical College, Huazhong University of Science and Technology from June 2018 to December 2019. Echocardiographic examinations were performed in these patients before heart transplantation. The conventional RV function parameters were obtained, including fractional area change, tricuspid annular plane systolic excursion(TAPSE), myocardial performance index, tricuspid lateral annular systolic velocity(Tricuspid s′). Two-dimensional (2D) RVFWLS was calculated by two-dimensional speckle tracking echocardiography (2D-STE). Right ventricular (RV) end-diastolic volume (RVEDV), RV end-systolic volume (RVESV), RV stroke volume (RVSV), RV ejection fraction (RVEF) and 3D-RVFWLS were measured by 3D-STE. The degree of MF was quantified using Masson′s trichrome stain in RV myocardial samples after heart transplantation. Patients were divided into mild, moderate, and severe groups according to the degree of MF on histology, then echocardiographic parameters were compared among the 3 groups. Pearson correlation analysis and the multiple linear regression analysis between echocardiographic parameters and RV MF were analyzed.Results:Compared with patients with mild and moderate MF, 3D-RVFWLS, 2D-RVFWLS and conventional parameters of RV function were significantly decreased in patients with severe MF.RV MF strongly correlated with 3D-RVFWLS ( r=-0.71, P<0.01), modestly correlated with 2D-RVFWLS ( r=-0.53, P<0.01), and weakly correlated with RVFAC, TAPSE, RVEF, Tricuspid s′, RVSV ( r=-0.47, -0.44, -0.35, -0.29, -0.38; all P<0.01). 3D-RVFWLS correlated best with the degree of MF compared with 2D-RVFWLS and conventional RV function parameters ( r=-0.71 vs r=-0.29~-0.53, all P<0.05). A stepwise multivariate analysis showed that 3D-RVFWLS was independently associated with RV MF (β=1.554, P<0.01, adjusted R2=0.539). Conclusions:3D-RVFWLS can provide an important imaging reference for detecting the degree of RV MF in patients with end-stage HF.

Objective To assess the characteristic of left ventricular systolic longitudinal strain(SL) in healthy children and its relationship with age by speckle tracking imaging(STI). Methods One hundred and thirty healthy children were divided into 5 groups: classing 0 to 3 years old children together as group A,and 3 to 5 years old as group B,6 to 9 years old as group C,10 to 12 years old as group D,13 to 18 years old as group E. SL of left ventricular wall during the systole was measured. Results ①The apical SL of left ventricular wall during the systole was larger than the middle one and the basal one. Significant differences were found between apical and basal segments in group A. The apical segments of posterior wall, inferior wall ,lateral wall and ventricular septum presented significant differences with the basal one in group D. Significant difference was found between apical segments of the posterior ventricular septum and the basal one in group E. ②These parameters of the five groups trend to decrease as well as the growth of age . Compared with group D and E,SL of left ventricular wall during the systole were significantly increased in group A except anterior wall,and SL of left ventricular wall during the systole were significantly increased in group B except apical segments of the posterior wall and apical segments of the anterior ventricular septum. ③The intra-observer and inter-observer variabilities were 2.0% and 2.5% for SL measured by STI in two chamber view,1.9% and 2.3% SL in three chamber view, and 2.1% and 2. 8% in four chamber view. Conclusions The parameters of strain were not similar in left ventricular different walls and segments,and there is some relationship between SL and increasing-age.

Objective To assess right ventricular systolic function in normal subjects and patients with pulmonary arterial hypertension (PAH) by using 2-dimensional strain (2DS) and tissue Doppler imaging(TDI), and to investigate the feasibility of 2DS for quantitative assessment of myocardial longitudinal systolic function. Methods Longitudinal peak systolic velocity (V), peak systolic strain(ε), peak systolic strain rate(SRS) were measured in right ventricular free wall for basal,mid and apical segment in 42 patients with PAH and 31 healthy controls by 2DS and TDI from the apical 4-chamber view and compared between 2DS and TDI. Results ①Compared with controls,ε and SRS of the mid segment of the right ventricular free wall by TDI were significantly reduced in patients with PAH (P<0.05),but these of the basal and apical segment were normal (P>0.05). ε and SRS of all segments by 2DS were markedly reduced in patients with PAH (all P<0.05), V of all segments by TDI and 2DS were not decreased (P>0.05). ②In normal subjects,values(V,ε,SRS) of basal and apical segment of right ventricular free wall measured by 2DS were significantly different from those by TDI (P<0.05), Values of mid segment by 2DS and TDI were not significantly different (P>0.05); In patients with PAH, values (V, ε, SRS) of apical segment of right ventricular free wall by 2DS were significantly different from those by TDI,values of basal and mid segment by 2DS and TDI were not significantly different. ③ There were good correlations between 2DS and TDI in patients with PAH (r = 0.406～0.760, P<0.05 for all). Conclusions Right ventricular longitudinal systolic function in patients with PAH was decreased, 2DS is more accurate and objective than TDI in assessment of right ventricular longitudinal systolic function.