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.

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 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 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.

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 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.

Objective To evaluate the relationship between carotid plaque neovascularization and other cardiovascular risk factors and acute coronary syndrome(ACS) using contrast-enhanced ultrasound.Methods The study population consisted of 128 patients with coronary heart disease associated carotid plaque thicker than 2.0mm,including 63 patients with ACS and 65 patients with stable coronary artery disease (sCAD).Contrast-agent enhancement in the plaque was evaluated by visual interpretation and quantitative analysis.All blood samples of the patients were sent to the same hospital laboratory for biochemical detection and correction.Results The percentage of contrast-agent enhancement in patients with ACS was significantly greater than that in patients with sCAD by visual interpretation [63%(39/63) vs 37%(24/65),P<0.001].The quantitative analysis showed that 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 greater than those in patients with sCAD (P=0.001,P=0.035,respectively).Logistic regression analysis revealed that age older than 65 years and contrast-agent enhancement within plaque were independent predictor for patients with ACS(OR=2.630,95%CI 0.933-7.409,P=0.006;OR=2.687,95%CI 1.002-8.025,P=0.047).Conclusions Age older than 65 years and contrast-agent enhancement in the carotid plaque may be used as independent predictors for ACS.

The effects of angiotensin II receptor antagonist losartan on elastic properties of aorta in patients with mild to moderate essential hypertension were assessed. The ascending aortic distensibility in 26 patients (48 +/- 3 years) with mild to moderate essential hypertension before and after 12 weeks of treatment with losartan (50 mg/day) was evaluated by using two-dimensional echocardiography. M-mode measurements of aortic systolic (Ds) and diastolic diameter (Dd) were taken at a level approximately 3 cm above the aortic valve. Simultaneously, cuff brachial artery systolic (SBP) and diastolic (DBP) pressures were measured. Aortic pressure-strain elastic modulus (Ep) was calculated as Dd x (SBP-DBP)/(Ds-Dd) x 1333 and stiffness index beta (beta) was defined as Dd x Ln (SBP/DBP)/(Ds-Dd). Blood pressure significantly decreased from 148 +/- 13/95 +/- 9 mmHg to 138 +/- 12/88 +/- 8 mmHg (systolic blood pressure, P = 0.001; diastolic blood pressure, P = 0.003). There was no significant difference in pulse pressure before and after treatment with losartan (53 +/- 10 mmHg vs 50 +/- 7 mmHg). The distensibility of ascending aorta increased significantly as showed by the significant decrease in pressure-strain elastic modulus from 4.42 +/- 5.79 x 10(6) dynes/cm2 to 1.99 +/- 1.49 x 10(6) dynes/cm2 (P = 0.02) and stiffness index beta from 27.4 +/- 32.9 to 13.3 +/- 9.9 (P = 0.02). Although there was a weak correlation between the percent changes in pressure-strain elastic modulus and stiffness index beta and that in diastolic blood pressure after losartan treatment (r = 0.40, P = 0.04 and r = 0.55, P = 0.004, respectively), no correlation was found between the percent changes in pressure-strain elastic modulus and stiffness index beta and that in systolic blood pressure (r = 0.04, P = 0.8 and r = 0.24, P = 0.2, respectively). Our study demonstrated that angiotensin II receptor antagonist losartan has a beneficial effect on aortic distensibility in patients with mild to moderate essential hypertension and this effect is partly independent of blood pressure reduction.
Aorta/*physiopathology ; Aorta/ultrasonography ; Echocardiography ; Elasticity ; Hypertension/*drug therapy ; Hypertension/*physiopathology ; Hypertension/ultrasonography ; Losartan/*therapeutic use ; Receptors, Angiotensin/*antagonists & inhibitors

To assess the left ventricular regional relaxation abnormalities in patients with hypertrophic cardiomyopathy (HCM) by quantitative tissue velocity imaging (QTVI), Doppler echocardiography and QTVI were performed in HCM (n=10) and healthy subjects (n=11) at apical long-axis, two-chamber and four-chamber views. Regional early diastolic velocity (rVe) and regional atrial contraction (rVa) were measured at each segment of ventricular middle, basal and annular levels. Mean rVe and mean rVa at three levels as well as mean rVe/rVa ratio were calculated. Our results showed that transmitral inflow peak velocities during early diastole (E) and atrial contraction (A) were also measured and E/A ratio was calculated. The rVe of all left ventricular segments in HCM were lower than those in healthy subjects (P<0.05), but compared with healthy subjects majority of rVa in HCM were not different except inferior wall and anterior wall. E between HCM and healthy subjects was different (P=0.036), while mean rVe between them was significantly different (P<0.0001). Mean rVa and mean rVe/rVa of three levels were lower in HCM than in healthy subjects (P<0.05), but there were no differences in A and E/A between them (P=0.22, P=0.101). Left ventricular regional myocardial relaxation is reduced in HCM. Transmitral inflow E and A are influenced by preload, relaxation of myocardium and atrial contraction, etc., while rVe and rVa reflect myocardial relaxation function independently. QTVI is more sensitive and more accurate than conventional Doppler imaging for characterizingregional diastolic properties in HCM.
Cardiomyopathy, Hypertrophic/*physiopathology ; Cardiomyopathy, Hypertrophic/*ultrasonography ; Diastole ; Echocardiography, Doppler, Color/methods ; Hypertrophy, Left Ventricular/*physiopathology ; Hypertrophy, Left Ventricular/ultrasonography ; Ventricular Function, Left