Objective To study the value of echocardiography in diagnosis of prenatal closure of fetal ductus arteriosus(FDA) and discuss its characteristics. Methods Two cases with prenatal closure and one case with constriction of the FDA were examined.The echocardiographic characteristics were analyzed and the literature was reviewed. Results Right atrial and ventricular dilatation and severe tricuspid valve insufficiency were observed. After timely delivery, impaired right ventricular function improved significantly. Conclusions Fetal echocardiography plays an important role in diagnosis of prenatal closure of the FDA.

Objective To explore the follow‐up value of ultrasound in fetal tricuspid regurgitation . Methods 44 fetuses who presented with moderate tricuspid regurgitation with differential pressure over 20 mmHg ,dilation of right atria and ventricles were chosen as the observation group .Examinations ,in terms of the degree ,velocity and differential pressure of reflux ,size of heart chamber and the presence pericardial or pleural effusion were carried out once every four weeks from 24 weeks of pregnancy to 9 weeks after birth . Results 40 9.% (18/44) of cases had been getting better before birth .The degree of regurgitation of 56 8.%(25/44) cases significantly decreased or even disappeared from 1 to 62 days after birth .Especially ,3 cases whose regurgitation velocity reached to 4 2. m/s with the differential pressure over 70 mmHg as well as onset of heart failure symptoms had been recovered gradually after born in advance 1. case (2 3.% ) with the persistence of both tricuspid regurgitation and heart failure symptoms after birth died in right heart failure , even though using different active treatments ,such as oxygen ,strong heart and diuresis .Conclusions High‐speed tricuspid regurgitation in fetuses without pathological changes can be almost reversed ,and the prognosis is good .Once the fetal tricuspid regurgitation pressure is over 70 mmHg or a fetus appears the onset of heart failure symptoms ,pre‐term delivery should be advised in a bid to prevent accidents in uterine cavity .

Objective To explore the corresponding relationship between isolated Q waves in lead Ⅲ on the electrocardiography(ECG) and echocardiographie segmental diagnosis of myocardial infarction(MI).Methods The shape magnitude of Q waves of 27 patients with MI and the relationship with eehocardiographie features were investigated. Results Twenty-four patients with inferior wall myocardial infarction had close relationship with isolated Q waves in lead Ⅲ on the ECG. Conclusions There is definite corresponding relation between isolated Q waves in lead Ⅲ and inferior wall myocardial infarction.

Objective:To determine the expression of matrix metalloproteinase 13 (MMP13) in patients with psoriasis, and to evaluate the effect of tazarotene and narrow-band ultraviolet B (NB-UVB) on the expression of MMP13 in mice with psoriasis-like dermatitis.Methods:Lesional skin tissues and normal skin tissues were collected from 18 patients with psoriasis vulgaris and 10 healthy controls respectively, who were enrolled from General Hospital of Tianjin Medical University between May 2019 and August 2019, and serum samples were collected from all the subjects. A total of 25 specific pathogen-free (SPF) male BALB/c mice were randomly divided into control group, imiquimod group, imiquimod+NB-UVB group, imiquimod+tazarotene group and imiquimod+tazarotene+NB-UVB group. The control group received topical vaseline cream on the back once every morning; imiquimod group and imiquimod+NB-UVB group received imiquimod cream on the back once every morning; imiquimod+tazarotene group and imiquimod+tazarotene+NB-UVB group received imiquimod cream on the back once every morning, and tazarotene cream on the back once at night; imiquimod+NB-UVB group and imiquimod+tazarotene+NB-UVB group received NB-UVB irradiation on the back every other day at noon, with the dose being 300 mJ/cm 2 in the first session and increasing by 50 mJ/cm 2 in every session. The modeling lasted 7 days. After successful modeling, blood samples were obtained from the eyeballs of the mice, and skin tissues were resected from the back of the mice after being sacrificed by cervical dislocation on day 8. Changes in the epidermal thickness and pathological manifestations were observed by hematoxylin and eosin (HE) staining, protein expression of MMP13 in skin tissues was determined by immunohistochemical study, and the serum level of MMP13 was detected by enzyme-linked immunosorbent assay. Comparisons between 2 groups were performed by using two-independent-sample t test, comparisons among several groups by using one-way analysis of variance, multiple comparisons by using least significant difference- t test, and comparisons of enumeration data by using chi-square test. Results:The skin lesions of the patients with psoriasis were strongly positive for MMP13, and the MMP13 expression levels in the epidermis and serum (84.11±17.16, 13.29±3.95 μg/L, respectively) were significantly higher in the patients with psoriasis than in the healthy controls (11.98±4.08, 7.46±1.58 μg/L, respectively, both P< 0.01) . Compared with the control group (1.26±0.04 μm, 25.40±2.34, 185.76±7.22 μg/L, respectively) , a significant increase was observed in the epidermis thickness (7.93±0.59 μm, P< 0.01) , as well as MMP13 levels in the epidermis and serum in the imiquimod group (147.14±5.53, 215.98±15.17 μg/L, respectively, both P< 0.01) . Compared with the imiquimod group, the imiquimod+tazarotene group, imiquimod+NB-UVB group, and imiquimod+tazarotene+NB-UVB group all showed significantly decreased epidermal thickness (3.56±0.37 μm, 3.83±0.39 μm, 2.14±0.34 μm, respectively, all P< 0.05) , MMP13 levels in the epidermis (120.42±3.23, 91.08±0.46, 71.12±7.11, respectively, all P< 0.05) and serum (197.39±3.92 μg/L, 196.13±11.76 μg/L, 183.21±14.99 μg/L, respectively, all P< 0.05) . Conclusions:MMP13 protein expression markedly increased in the skin lesions and sera of patients with psoriasis, and decreased in skin lesions and sera of mice with psoriasis-like dermatitis after the treatment with tazarotene and NB-UVB. MMP13 may be involved in the development of psoriasis, and tazarotene and NB-UVB may inhibit the development of psoriasis by reducing the expression of MMP13.

Objective To compare the therapeutic effect of rotating reduction manipulation with that of trinity orthopedic-spinal manipulation combined with injection of Shenmai Injection(SI) through intervertebral foramen for the treatment of lumbar disc herniation(LDH).Methods Ninety LDH patients were equally divided into 3 groups: group A received trinity orthopedic-spinal manipulation,group B received trinity orthopedic-spinal manipulation combined with injection of SI through intervertebral foramen,and group C received rotating reduction manipulation.Score of lower back pain,and scores of symptoms,signs and activities of daily life evaluated by the modified scale issued by Japanese Orthopaedics Association were examined for the comparison of therapeutic effect in the three groups.Results The score of lower back pain in the three groups after treatment differed from that before treatment(P

Objective To investigate the value of MR imaging methods for the quantification of fat content in a customized lipid phantom at 3.0 T.Methods Eleven homogeneous fat-water phantoms (50 ml)with fat volume percentages from 0 to 100％ were constructed with reference to Bernard's methods.Fat tractions of the lipid phantom were acquired using water selective saturation (WS),fat selective saturation (FS),in-and out-of-phase imaging (IOP),iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) gradient echo imaging and IDEAL Quant imaging methods on a 3.0 T MRI system.For statistical comparisons,paired-sample t test,Pearson correlation test,and Bland-Ahman maps were applied.Results Evaluated fat fractions acquired by WS,IDEAL Gradient echo imaging and IDEAL Quant were (49.6±28.8)％,(46.0±28.4)％,(51.0±32.0)％,the result has no significant difference with the true fat contents(t values were-0.186,-2.218,2.713;P values were 0.856,0.051,0.055).Evaluated fat fractions acquired by FS,corrected algorithm and IOP were (64.2±26.7)％,(58.9±31.9)％ and (45.3±32.3)％,these three kinds of methods have significant difference with the true fat contents (t values were 5.168,4.273,-6.441;P＜0.01).All the chemical shift imaging methods correlated with the true phantom model fat fractions,r values were 0.977(FS),0.978 (corrected algorithm),0.982 (WS),0.99 8(IOP),0.993 (IDEAL Gradient echo imaging),0.999 (IDEAL Quant) (all P＜0.01).Each method's 95％ confidence interval of the mean difference acquired by Bland-Altman map was WS (-14.7％ to 13.8％),FS (-3.6％ to 32.0％),corrected algorithm (-4.6％ to 22.5％),IOP(-9.4％ to 0.0％),IDEAL gradient echo imaging (-15.9％ to 7.8％),IDEAL Quant(-2.0％ to 4.0％).IDEAL Quant had the best correlation and confidence with the true fat fraction.Conclusions Chemical shift imaging methods (IOP,IDEAL Gradient echo imaging,IDEAL Quant) can acquire more accurate fat quantification results than chemical saturation imaging methods (FS,Corrected algorithm,WS) in a customized lipid phantom at 3.0 T.IDEAL Quant can acquire the best fat quantification result compared with the other imaging methods.

Objective To investigate a new method for detecting fetal cardiac arrhythmia.Methods Used two kinds of superposition:①left ventricular outflow tract color flow image with right atrium wall motion curves superposition,②left ventricular outflow tract color flow image with left ventricular inflow tract colour flow image superposition,167 cases of fetal arrhythmia were detected.Results Among them,84 fetuses with atrial premature heat,39 with ventricular premature beat,23 with temporal sinus bradycardia,12 with sinus tachycardia,4 with Ⅱ°atrioventricular block(AVB),2 with Ⅲ°AVB,3 with atrial fibrillation.Conclusions Using superposition of M-mode echocardiagraphy with color Doppler imaging to diagnose fetal cardiac arrhythmia is easier and more accurate.

OBJECTIVE: To explore the effects of septonasal bidirectional mucoperiosteal flap in the treatment of refractory choanal atresia in adults. METHOD: Analysis of 9 cases for choanal atresia was conducted. Two cases were of congenital origin and 7 cases of acquired origin, which was a complication of radiotherapy for nasopharyngeal carcinoma. The patients received transnasal endoscopic surgery using the septonasal bidirectional mucoperiosteal flap, without positioning the postoperative expansion tube. After the operation, the changes of symptoms were observed and the recurrent rate of restenosis or atresia was investigated in the follow-up time. RESULT: The symptoms of nasal obstruction and mouth breathing improved significantly in the 9 patients. At an average follow-up time of 19.3 months, the new forming posterior nare remained patent. The mucoperiosteal flap had no shift or necrosis. No restenosis or atresia happened. Nasal adhesion occurred in two patients. Granulation tissue hyperplasia was found in 1 patient, who underwent endoscopic revision without recurrence. CONCLUSION The application of mucoperiosteal flap in transnasal endoscopic surgery for the choanal atresia can reduce the incidence of restenosis or atresia. Postoperative expansion tube is not mandatory.
Adult ; Carcinoma ; Choanal Atresia ; etiology ; surgery ; Endoscopy ; Female ; Humans ; Hyperplasia ; Male ; Nasal Cavity ; Nasal Obstruction ; etiology ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; radiotherapy ; Necrosis ; Postoperative Period ; Radiation Injuries ; complications ; Recurrence ; Surgical Flaps ; transplantation

Background::Ciprofol (HSK3486; Haisco Pharmaceutical Group Co., Ltd., Chengdu, China), developed as a novel 2,6-disubstituted phenol derivative showed similar tolerability and efficacy characteristics as propofol when applicated as continuous intravenous infusion for 12 h maintenance sedation in a previous phase 1 trial. The phase 2 trial was designed to investigate the safety, efficacy, and pharmacokinetic characteristics of ciprofol for sedation of patients undergoing mechanical ventilation.Methods::In this multicenter, open label, randomized, propofol positive-controlled, phase 2 trial, 39 Chinese intensive care unit patients receiving mechanical ventilation were enrolled and randomly assigned to a ciprofol or propofol group in a 2:1 ratio. The ciprofol infusion was started with a loading infusion of 0.1-0.2 mg/kg for 0.5-5.0 min, followed by an initial maintenance infusion rate of 0.30 mg·kg -1·h -1, which could be adjusted to an infusion rate of 0.06 to 0.80 mg·kg -1·h -1, whereas for propofol the loading infusion dose was 0.5-1.0 mg/kg for 0.5-5.0 min, followed by an initial maintenance infusion rate of 1.50 mg·kg -1·h -1, which could be adjusted to 0.30-4.00 mg·kg -1·h -1 to achieve -2 to +1 Richmond Agitation-Sedation Scale sedation within 6-24 h of drug administration. Results::Of the 39 enrolled patients, 36 completed the trial. The median (min, max) of the average time to sedation compliance values for ciprofol and propofol were 60.0 (52.6, 60.0) min and 60.0 (55.2, 60.0) min, with median difference of 0.00 (95% confidence interval: 0.00, 0.00). In total, 29 (74.4%) patients comprising 18 (69.2%) in the ciprofol and 11 (84.6%) in the propofol group experienced 86 treatment emergent adverse events (TEAEs), the majority being of severity grade 1 or 2. Drug- and sedation-related TEAEs were hypotension (7.7% vs. 23.1%, P = 0.310) and sinus bradycardia (3.8% vs. 7.7%, P = 1.000) in the ciprofol and propofol groups, respectively. The plasma concentration-time curves for ciprofol and propofol were similar. Conclusions::ciprofol is comparable to propofol with good tolerance and efficacy for sedation of Chinese intensive care unit patients undergoing mechanical ventilation in the present study setting.Trial registration::ClinicalTrials.gov, NCT04147416.

Objective To investigate the outcome of fetus with abnormal increase of pulmonary artery systolic pressure at second and third trimester by color Doppler ultrasound . Methods Ninety-five fetuses with a little or mild tricuspid regurgitation ( control group) and 60 fetuses with moderate and severe tricuspid regurgitation (observation group) were included . The degree ,velocity ,and differential pressure of tricuspid regurgitation were measured and the variations of baseline information and the measured value of pulmonary systolic pressure between the two groups were compared . As for the follow -up on observation group ,the pressure of fetus with high pulmonary systolic pressure ( > 20 mmHg) was repeatedly measured every 4 weeks until it return to normal . Results There were significant differences in terms of gestational weeks ,velocity and pressure of tricuspid regurgitation ,as well as pulmonary systolic pressure between the two groups ( P < 0 .001) . Pulmonary systolic pressure was positively correlated with gestational weeks , velocity and pressure of tricuspid regurgitation ( r = 0 .442 ,0 .998 ,0 .999 ;all P < 0 .001 ) ,but had no correlations with the age of pregnant women ( r = - 0 .001 , P = 0 .674) . The follow-up revealed that ,in observation group , 47 cases ( 78 .3％ , systolic pressure < 50 mmHg ) presented with the decreased pulmonary systolic pressure ,the disappeared or the slight appeared regurgitation before birth ,meanwhile , 13 ( 21 .7％ ,systolic pressure ≥ 50 mmHg) exhibited severe tricuspid regurgitation and persistent pulmonary elevation ,with the highest of more than 70 mmHg accompanying the varying degrees of right heart failure . Only one of 13 fetuses died due to persistent pulmonary hypertension and hypoxia ( oxygen saturation <45％ ) . The fetal pulmonary artery systolic pressure of the remaining 12 cases recovered from 5 to 105 days after birth ,with normal heart function . Conclusions The majority of fetal pulmonary arterial hypertension complicated with obvious tricuspid regurgitation is reversible functional alteration , which can restore normality in most cases before or after birth .