Objective To assess left ventricular(LV) regional and global systolic function of patients with coronary artery disease using strain parameter of velocity vector imaging(VVI) technique in quiescent condition. Methods Thirty patients with coronary artery disease and 30 healthy volunteers were enrolled in this study. The two-dimensional gray scale images were obtained in apical 4-chamber view,apical 2-chamber view and long axis view of left ventricle, and three levels of the short axis views(mitral valve, papillary muscle and cardiac apex). The LV wall was divided according to 18 segment model and the longitudinal,radial and circumferential systolic strain (SL, SR, SC) of each segment were analyzed. The difference between the epicardial and endocardial strain measurement were defined as strain gradient and the average of each strain component as global systolic strain. The correlation between global systolic strain of each strain component and the LV ejection fraction(LVEF) were analysed. Results Group A (coronary stenostic degree≤70%) included 176 segments, compared with control group, LS and LS gradient (LSG) decreased significantly from control group( P ＜0.05), while there was no significant difference in CS, RS and CS gradient (CSG) ( P ＞ 0.05). Group B ( coronary stenostic degree＞ 70% ) included 132 segments, compared with control group, LS, CS and RS decreased significantly in group B ( P ＜ 0.05), while there was no significantly difference in LSG and CSG( P ＞0.05). There were also significant difference in LS, RS,CS and LSG between group A and B( P ＜0.05). Global systolic strain of each strain component shown significant correlation with LVEF (P ＜ 0.0001 ). And the global longitudinal systolic strain (GLS) correlated with LVEF most tightly. Conclusions Strain parameter of VVI technique could not only accurately analyze the LV systolic dysfunction but also reflect the stenostic degree of coronary artery. GLS could be a new index for LV systolic function assessment in patients with coronary artery disease.

Objective Evaluation of left ventricular ( LV) function has great clinical significance in patients with early chro-nic kidney disease (CKD).The study was to evaluate whether two-dimensional speckle tracking imaging (2D-STI) technique can offer additional information of cardiac dysfunction in early CKD patients . Methods Conventional echocardiography and 2D-STI echocar-diography were performed in CKD group of 20 patients at stage Ⅱ-Ⅲ and control group of 20 healthy volunteers .LV structure and function were evaluated by conventional echocardiography .Multidirectional strain , strain rate and LV twist parameters were analyzed by 2D-STI technique. Results There was no statistical difference in conventional echocardiographic parameters such as left atrial diam -eter, end-diastolic LV diameter and ejection fraction between CKD group and control group .By applying 2D-STI technique, CKD group had significantly decreased value of global longitudinal strain (-19.8 ±2.4)%and strain rate(-1.1 ±0.3)S-1 in comparison to control group(-22.6 ±2.1)%、( -1.8 ±0.2)S-1, along with significant increase in the values of maximum LV rotation (11.6 ± 4.4)°and LV twist(19.6 ±3.8)°in comparison to control group(8.2 ±3.7)°、(13.5 ±3.6)°(P<0.05).There was no differences in both global circumferential and radial deformation parameters as well as maximum rotation value of LV assist device between two groups(P>0.05). Conclusion 2D-STI can detect subclinical LV dysfunction sensitively in early CKD patients .

Objective To assess the coronary flow reserve in the patients with systemic lupus erythematosus(SLE)by transthroracic echocardiography(TTE).Methods Coronary sinus blood flow of 24 SLE patients and 18 matched healthy controls were assessed by TTE.The coronary flow reserve was calculated as the ratio of hyperemic to baseline blood flow.Hyperemia was induced by intravenous administration of dipyridamole.Results Adequate recordings of blood flow in the coronary sinus under both conditions were obtained by TTE in all study subjects.Patients with SLE were found to have significantly decreased coronary flow reserve comparing with normal SUbiects(1.55±0.21 versus 2.51±0.33.P＜0.01).Conclusions Coronary flow reserve can be measured by TTE in SLE patients,Coronary flow reserve is impaired suggesting that SLE patients may have subclinical coronary artery disease.

To evaluate changes in quality- of- life of adults with concomitant exotropia before and after surgery.
●METHODS:A retrospective cohort method was used in this research. Sixty - five patients with concomitant exotropia ( ranged from 18 - 30 years) were enrolled. Quality of life was studied with 2 different questionnaires [the Adult Strabismus - 20 ( AS - 20) and the MOS 36 -item Short - Form health survey ( SF - 36 )], which patients completed preoperatively and at 3mo postoperatively.
●RESULTS: With the AS - 20, 3mo after surgery, the mean psychosocial and visual function scores of AS- 20 improved significantly (P<0. 01). Similarly, with the SF-36, the mean score in 7 of 8 areas improved significantly ( P < 0. 01 ), including physiological function, role limitations due to physiological health, general health, vitality, social function, role limitations due to emotional problems, mental health and the overall mean score. However, with respect to bodily pain, no significant improvement was found after surgery(P>0. 05).
● CONCLUSlON: Surgical treatment of concomitant exotropia in adults gives a highly significant improvement in quality - of - life scores. We should pay more attention to the impact of strabismus on quality of life clinically to improve the outcome of the surgery.

In order to evaluate the characteristics of the spray drying of total flavonoids of Epimedium extracts assisted with soybean polysaccharide, a certain percentage of soybean polysaccharide or polyvidone were added to the total flavonoids of Epimedium extract to conduct the spray drying. The effect of soybean polysaccharides against the wall sticking effect of the spray drying was detected, as well as the powder property of total flavonoids of Epimedium spray drying powder and the dissolution in vitro behavior of the effective component. Compared with the total flavonoids of Epimedium spray drying powder, soybean polysaccharide revealed a significant anti-wall sticking effect. The spray drying power which had no notable change in the grain size made a increase in the fluidity, improvement in the moisture absorption and remarkable rise in the dissolution in vitro behavior. It was worth further studying the application of soybean polysaccharide in spray drying power of traditional Chinese medicine.
Epimedium ; chemistry ; Flavonoids ; analysis ; Particle Size ; Polysaccharides ; chemistry ; Powders ; Soybeans ; chemistry

Objective Acute kidney injury (AKI) frequently occurs after catheter-based interventional procedures and increases mortality. How-ever, the implications of AKI before thoracic endovascular aneurysm repair (TEVAR) of type B acute aortic dissection (AAD) remain un-clear. This study evaluated the incidence, predictors, and in-hospital outcomes of AKI before TEVAR in patients with type B AAD. Meth-ods Between 2009 and 2013, 76 patients were retrospectively evaluated who received TEVAR for type B AAD within 36 h from symptom onset. The patients were classified into no-AKI vs. AKI groups, and the severity of AKI was further staged according to kidney disease:im-proving global outcomes criteria before TEVAR. Results The incidence of preoperative AKI was 36.8%. In-hospital complications was significantly higher in patients with preoperative AKI compared with no-AKI (50.0%vs. 4.2%, respectively;P<0.001), including acute renal failure (21.4%vs. 0, respectively;P<0.001), and they increased with severity of AKI (P<0.001). The maximum levels of body tem-perature and white blood cell count were significantly related to maximum serum creatinine level before TEVAR. Multivariate analysis showed that systolic blood pressure on admission (OR:1.023;95%CI:1.003–1.044;P=0.0238) and bilateral renal artery involvement (OR:19.076;95%CI:1.914–190.164;P=0.0120) were strong predictors of preoperative AKI. Conclusions Preoperative AKI frequently oc-curred in patients with type B AAD, and correlated with higher in-hospital complications and enhanced inflammatory reaction. Systolic blood pressure on admission and bilateral renal artery involvement were major risk factors for AKI before TEVAR.

Objective To evaluate the current situation of two-way referral system by qualitative study.Methods The qualitative study was carried out in Department of General Internal Medicine of Peking Union Hospital and 4 clinics under Beijing Gaobeidian Community Health Center from June to December 2009.In-depth interview was conducted on 6 patients,who were referring from community health center to tertiary hospital and 16 general practitioners in the community.The method of thematic framework was used for data analysis.Results Only 1 of the 6 patients,who made the appointment,completed the two-way referral.From the view of the patients,the interrupt of the two-way referral was due to long-time waiting,inconvenient transportation to the hospital,availability of specialists,unsmooth process of referral and unsatisfied doctors.However,the community health service staff thought that difficulties of the two-way referral originated from the system,doctors,patients,and doctor-patient relationship.Sometimes patients distrusted doctors both in hospital and in community; communications between doctors or between doctors and patients were less efficient; patients had multiple choice for their primary care and they may go to any hospital freely bypass community-based referral system; patients had excessive expectation for medicine and doctors; some patients paid less attention to their own health,and so on.For improvement of the two-way referral system,the community health service staff proposed concrete measures in terms of relevant policy,the hospital,community health service,the doctors and patients; they emphasized the importance of upgrading their own communication ability and professional skills for primary care.Conclusions Many factors may influence successful implement of two-way referral,so it is necessary to improve the relevant policy and procedures and to upgrade medical staff in community.

Objective To compare and analyze MRI characteristics of medical patellofemoral ligament(MPFL) injury patterns in adolescents and adults after acute lateral patellar dislocation.Methods MR images of 42 adolescents and 45 adults after acute lateral patellar dislocation were retrospectively reviewed.Routine MR scanning was performed in axial,sagittal and coronal planes,including T1 WI,T2 WI and fat saturation sequence.The x2-tests were performed to analyze the MPFL injury patterns between adolescent group and adult group.Results The prevalence rate of MPFL injury was 97.6％ (41/42) in adolescent group after acute lateral patellar dislocation,including 57.1％ (24/42) of complete tear and 40.5％ (17/42) of partial tear.The prevalence rate of MPFL injury was 100.0％ (45/45) in adult group,including 64.4％ (29/45) of complete tear and 35.6％ (16/45) of partial tear.There were no statistical difference between adolescents and adults in prevalence rate of MPFL injury,complete MPFL tear,partial MPFL tear (x2 =1.084,0.486,0.223 ; P ＞ 0.05).The prevalence rate of MPFL injury at femoral attachment,patellar attachment and midsubstance were 31.0％ (13/42),78.6％ (33/42) and 26.2％ (11/42) respectively in adolescent group,whereas they were 64.4％ (29/45),40.0％ (18/45) and 15.6％ (7/45) respectively in adult group.It occurred at multiple sites in 33.3％ (14/42) of adolescents,and in 15.6％ (7/45) of adults.There were significant differences between adolescents and adults in the prevalence rate of MPFL tear at femoral attachments and patellar attachments (x2 =9.759,13.324 ; P ＜ 0.05),but there was no statistical difference at its midsubstance (x2 =1.497,P ＞ 0.05).Although not statistically significant (x2 =3.749,P ＞ 0.05),MPFL tear at multiple locations were seen more in adolescents than in adults (33.3％ vs.15.6％).Conclusion The injury degree and distribution of MPFL are similar in adolescents and adults after acute lateral patellar dislocation,but there is significant difference in the site of MPFL injury distribution between adolescents and adults.MPFL is most easily injured at femoral attachment,secondly at patellar attachment in adults,while MPFL is most easily injured at patellar attachment,secondly at femoral attachment in adolescents.Adolescents are more likely to have multiple-site MPFL injury than adults.

To explore the relationship between inactivation of TGF-beta signaling pathway and acute leukemia, the expressions of TGF-beta1, TbetaRII and c-myc in the bone marrow mononuclear cells were detected by S-P immunocytochemical staining. The results showed that no significant difference of TGF-beta1 exepression was found between the patients and the control (P > 0.05), the expression of TbetaRII was significantly lower in patients than in control (P < 0.05) and the expression of c-myc was significantly higher in patients than in control (P < 0.05). There was no significant difference of TGF-beta1, TbetaRII and c-myc exepression between acute nonlymphoid leukemia and acute lymphoid leukemia (P > 0.05). Expressions of TbetaRII and c-myc were negatively correlated (r = -0.474, P < 0.01). In conclusion, the leukemic cells escape from the growth inhibitory effect because of the inactivation of TGF-beta signaling pathway; downregulation of TGF-beta receptor II cause c-myc overexepression and leukemogenesis.
Acute Disease ; Adolescent ; Adult ; Aged ; Bone Marrow Cells ; metabolism ; Child ; Female ; Humans ; Immunohistochemistry ; Leukemia ; metabolism ; pathology ; Male ; Middle Aged ; Proto-Oncogene Proteins c-myc ; biosynthesis ; Receptors, Transforming Growth Factor beta ; biosynthesis ; Transforming Growth Factor beta1 ; biosynthesis

Objective To evaluate whether global 2-dimensional strain imaging can offer additional benefit over conventional echocardiography to detect subclinical myocardial damage in patients with chronic kidney disease(CKD). Methods Conventional echocardiography and global 2-dimension strain imaging were performed in 39 patients with CKD [23 men and 16 women,mean age (45.6± 14.6) years] and 29 control subjects. Twenty patients had CKD stage 2 or 3(group 1 ) and nineteen patients had CKD stage 4 or 5(group 2). Left ventricular structure and function were evaluated by conventional echocardiography. Global longitudinal and circumferential strain and strain rate were analyzed. Results There were no differences in ejection fraction and fraction shortening between CKD patients and controls. Compared with controls, CKD groups had significantly decreased value of global longitudinal strain and strain rate. Global longitudinal strain decreased from - (23.8 ± 3.1 ) % in controls to - ( 18. 5 ± 2.4) % in group 1 and to - (15.2 ± 3.2) % in group 2 ( P ＜0. 001 ). Compared with controls, there was no difference in global circumferential strain and strain rate between group 1 and controls, but global circumferential strain and strain rate of group 2 was reduced [ - (17.1± 3. 0) % vs -(21.2±2.8)%, P＜0.05;-(1.0±0.2)% vs -(1.3±0.3)%, P＜0.05]. In correlation analyses, global longitudinal strain was positively related to eGFR( r =0. 376, P ＜0. 001 ) and inversely related to left ventricular mass index( r = - 0. 473, P ＜0.01). Conclusions Global 2-dimensional strain imaging may represent a useful tool for the assessment of subclinical myocardial dysfunction in patients with CKD.