Objective To observe the effect of early enriched environmental intervention on synaptic ultrastructure and the synaptophysin expression (p38) in hippocampal CA1 area after hypoxia-ischemic brain damage(HIBD) in neonatal rats. Methods The rat model of HIBD was made by the method of Rice in 20 Sprague-Dawley rats, and divided randomly into 2 groups: the intervention group, non-intervention group. Another 10 rats underwent sham-operation as control. From the second day after HIBD, the rats of the intervention group were kept in an enriched environment for 20 d, the rats of non-intervention group and sham-operation group were raised in standard enviroment instead. The hippocampal ultrastructure was observed with electron microscope and the p38 expression was detected immunohistochemically in all rats. Results The ultrastructure of hippocampus CA1 pyramidal neuron in the non-intervention group were distorted as compared with that in the intervention group and control group. The corrected optical densities (COD) of immunoreactive products of the hippocampal p38 were significantly decreased in non-intervention group as compared with intervention group and control group (P0.05). Conclusion Early enriched environment intervention could improve the synaptic reconstruction and reduce the ultrastructural damage induced by hypoxic-ischemia.

Objective To observe the effects of different environment stimulation on the nestin expression in hippocampus and the ability of learning and memory of rats after hypoxic-ischemic brain damage (HIBD). Methods Rat HIBD models were established by the method of Rice in 45 SD rats, then randomly divided into three groups: standard environment stimulation group (SE), enriched environment stimulation group (EE), and impoverished environment stimulation group (IE). Another 15 rats only underwent sham-operation. Different environment intervention that was designed according to Puurunen and Bourgeon’s literatures was applied to the rats on day 2 after HIBD operation. On day 28, Morris water maze was used to evaluate the ability of learning and memory. Then the nestin expression in the hippocampus was measured by immunohistochemistry. Results The ability of learning and memory of IE group reduced and was much lower than that of sham-operation group, SE group and EE group, that of SE group was lower than that of sham-operation group and EE group, but no significant difference between sham-operation group and EE group. Immunohistochemical analysis showed that nestin expression in the hippocampus of EE group significantly increased as compared with that of other groups and that of SE group was stronger than that of sham-operation group and IE group. Conclusion The EE stimulation could increase the nestin expression in the hippocampus of neonatal rats with HIBD, enhance neuranagenesis, and improve the ability of learning and memory, while the IE stimulation could decrease the nestin expression, inhibit neuranagenesis, and impair the ability of learning and memory.

Objective To observe the effects of early enriched environment intervention on the expression of growth-associated protein-43(GAP-43) in the hippocampus of rats with hypoxic-ischemic brain injury (HIBI). Methods After the establishment of HIBI model in SD rats by the method of Rice, the animals were divided randomly into 2 groups: the intervention group and non-intervention group. The sham-operation rats were used as control group. Enriched environment intervention had been administrated to the rats of intervention group since the 2nd day after HIBI. On the 3rd, 7th, 14th, 21st and 28th day, immunohistochemistry and RT-PCR were used to measure the expressions of GAP-43 protein and mRNA in the hippocampus of rats. Results The expression of GAP-43 protein and mRNA in the rat hippocampus were increased in the non-intervention group than in the control group(P

Objective To observe the effects of environmental stimulation at different stages of development on postnatal rats with hypoxia-ischemic brain injury (HIBI). Methods HIBI postnatal SD rats models were established by dissecting and ligating the left common carotid artery, and after 2 h of recovery, exposing to 8% oxygen-92% nitrogen gas mixture for 2 h. The HIBI rats were randomly divided into early intervention groups, late intervention group, non-intervention group. Intervention group were kept in enriched environment before or after weaning for 20 d. Non-intervention group and control group were kept in a standard environment. Space learning and memory were tested with Morris water maze. Results The ability of space learning and memory in early intervention group was better than that in late intervention group (P

Objective To observe the expression of growth-associated protein-43(GAP-43) in the hippocampus of neonatal rats with hypoxic-ischemic brain damage (HIBD). Methods HIBD was established by the method of Rice in 48 SD rats aged 7 days and another 48 matched normal rats served as control. Immunohistochemistry and RT-PCR were respectively used to detect the expression of GAP-43 protein and mRNA in all rat hippocampus on day 8, 10, 14, 21, 28, 35 after HIBD (n=8 at each time point for each group). Results The expression of GAP-43 protein and mRNA in hippocampus was obviously increased in HIBD rats as compared with normal rats, the peak of GAP-43 protein appeared at 3rd week, and the peak of mRNA at 2nd week. Conclusion The expression of GAP-43 protein and mRNA increased in the hippocampus of rats following HIBD, which was possibly related to the recovery of injured hippocampus.

Objective To evaluate peak left ventricular(LV) apical rotation velocity during early diastole by speckle tracking echocardiography in normal peopleand patients with myocardial hypertrophy because of hypertension. Methods Two dimensional images of left basal and apical ventricular short axis view were recorded in 20 healthy people and 20 patients with hypertension and left ventricular hypertrophy(LVH). Rotation velocity-time curves of six segments in LV apex and base were obtained using Qlab software. The peak rotation velocity in early diastole of LV apex(A-Vel) and base (B-Vel) were acquired through Excel software. Results In LVH group,A-Vel was significantly decreased(P<0. 05) while B-Vel appeared no difference (P = 0.58) compared with healthy individuals. Conclusions Peak LV apical rotation velocity in early diastole can evaluate the change of LV diastolic function in patients with hypertension and LVH.

Objective To explore the preliminary evaluation of transesophageal echocardiography in percutaneous edge-to-edge repair of mitral regurgitation.Methods Ten consecutive patients were treated with percutaneous edge-to-edge repair of mitral regurgitation using the MitraClip system.All of them had moderate-severe (n =1) or severe (n =9) central MR and high operative risk.MitraClip implantation performed under echocardiographic and fluoroscopic guidance in general anaesthesia.Preoperative and postoperative immediate echocardiographic data were prospectively collected.Results All operations succeed with one MitraClip implanted to 5 patients and two MitraClips implanted to 5 patients.Postoperative immediate echocardiography observed MR reduction,6 cases to mild,2 cases to mild-to-moderate and 2 cases to moderate.No complications occurred in all patients,such as Clip off,pericardial effusion/tamponade,or mitral valve damage.Conclusions Echocardiography guarentees the success of MitraClip based transcatheter mitral valve repair operations with safety and effectiveness.

Objective To evaluate the accuracy of a novel echocardiographic three-dimensional automated software for the assessment of the aortic root in candidates for transcatheter aortic valve replacement(TAVR).Methods Four patterns(Lax,Lax-Res,Sax,Sax-Res) of 3D-TEE imaging of aortic root were gotten preoperatively in 18 patients with severe tricuspid aortic stenosis who were referred to our center for TAVR.The specialized 3D-TEE reconstruction software,eSie Valves,then automatically configured a geometric model of the aortic root from the images obtained by 3D-TEE and performed a quantitative analysis of these structures:the minimal diameter(Dmin),maximal diameter(Dmax),area and perimeter(Peri) of aortic annulus,height of the ostia of the left/right coronary artery above the aortic annulus(LOH/ROH).The echo dimensions were compared with the MDCT measurements.Results No statistically significant difference were found in above parameters between the ZOOM pattern (Sax-Res and Lax-Res) and CT measurements(all P>0.05).Lax-Res pattern measurements had good correlation with MDCT,with r valves of 0.81,0.77,0.89,0.84 for Lax-Res-Dmin,Lax-Res-Dmax,Lax-Res-Area,Lax-Res-Peri,respectively(all P<0.05).3D-TEE LOH/ROH had poor correlation with MDCT LOH/ROH (all r<0.7).Conclusions The new automatic 3D-TEE software allows modelling and quantifying the aortic annulus dimensions from 3D-TEE data in patients with tricuspid aortic valves,and Lax-Res pattern is recommended.Quantified assessment of LOH/ROH is not ideal and needs to be improved.

Objective: To compare aortic annular diameter measured by transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and multislice computed tomography (MSCT) in patients with severe aortic stenosis, and to evaluate the impact on selection of prosthetic valve type in transcatheter aortic valve implantation (TAVI). Methods: Clinical data of 138 patients with severe aortic stenosis referred for TAVI between January 2014 and June 2016 in our hospital were retrospectively analyzed.The difference of aortic annular diameter measured by TTE, TEE, and MSCT were compared.TTE was performed after TAVI to evaluate the accuracy of measurement before TAVI. Results: (1) Aortic annular diameter was (23.37±2.22) mm by TTE and (23.52±1.70) mm by TEE (P=0.12). Pearson correlation analysis showed that aortic annular diameter measured by TTE was correlated to that measured by TEE (r=0.87, P<0.05). (2)The long-axis diameter and the short-axis diameter measured by MSCT multiplanar reconstruction were significantly different ((27.86±2.87) mm vs. (21.91±2.53) mm, P<0.05). There was no significant difference between the mean of the long- and short-axis diameters and the diameter derived from cross-sectional area by MSCT ((24.92±2.38) mm vs. (24.84±2.25) mm, P=0.08). However, the diameter derived from the circumference ((25.35±2.34) mm) was significantly larger than the mean of the long- and short-axis diameters and the diameter derived from cross-sectional area by MSCT, and the difference were (0.43±0.62) mm and (0.51±0.62) mm respectively(both P<0.05). (3) Measurements of the aortic annulus diameter by MSCT including the mean of the long- and short-axis diameters, diameter derived from cross-sectional area, and diameter derived from the circumference were larger than the measurement by TTE and TTE (all P<0.05). (4) Implantation was successful in all patients.Moderate to severe paravalvular leakage was detected in 3 patients at 7 days post TAVI, and 1 patient developed severe prosthetic valve restenosis at 6 months post TAVI and received valve-in-valve implantation. Conclusions In severe aortic stenosis patients referred for TAVI, the aortic annular diameter derived from TTE and TEE measurements are smaller than that from MSCT.In the absence of a gold standard, selection of prosthetic valve type in TAVI procedure should rely on comprehensive considerations, which is of importance to get good clinical results for severe aortic stenosis patients underwent TAVI.

OBJECTIVETo investigate the value of transesophageal echocardiography to guide the implantation of 2 pieces of MitraClip during transcatheter mitral valve repair operation.

METHODSFrom October 2013 to June 2014, 6 transcatheter mitral valve repair operations were performed in our hospital for symptomatic patients with severe functional mitral regurgitation (MR), transesophageal echocardiography was applied to guide the implantation of 2 pieces of MitraClip. Clinical data are retrospectively analyzed to evaluate implantation timing and approach of the 2nd piece of MitraClip, as well as the immediate effect of the interventional therapy.

RESULTSAfter implantation of 1st piece of MitraClip, transesophageal echocardiography evidenced MR ≥ grade 2 with central regurgitation and immediate mitral average transvalvular pressure gradient < 3 mmHg (1 mmHg = 0.133 kPa) in these 6 patients and 2nd piece of MitraClip was implanted in these patients. After implantation of 2nd piece of MitraClip, it is observed via transesophageal echocardiography that mitral regurgitations were reduced by ≥ 2 grades for all 6 patients. For 3 patients, MR was reduced to grade 1. For the other 3 patients, MR is reduced to grade 2. Among the 3 patients whose MR was reduced to grade 2, 2 operations were stopped because immediate mitral average transvalvular pressure gradient equaled to 3 mmHg, and the rest 1 operation was stopped because MR was too diverse and not able to select proper position to implant the next MitraClip. All 6 operations are completed successfully.There were no myocardial infarction, death or complications requiring mitral valve surgery after the MitraClip procedure. There were also no MitraClip detachment, thrombus embolism, mitral valve apparatus injuries, mitral stenosis, pericardial tamponade post procedure.

CONCLUSIONSTransesophageal echocardiography plays an important role to guide the implantation of 2 pieces of MitraClip in transcatheter mitral valve repair operation. Mitral average transvalvular pressure gradient and initial position of regurgitation after implantation of the previous MitraClip are critical determinants for decision making if the next piece of MitraClip can be implanted or not.

Echocardiography, Transesophageal ; Humans ; Mitral Valve ; Mitral Valve Insufficiency ; surgery ; Mitral Valve Stenosis ; surgery ; Prostheses and Implants ; Prosthesis Implantation ; methods ; Retrospective Studies