To evaluate the morphology of atrial septum by the live three-dimensional echocardiography (L3DE) and its value of clinical application, L3DE was performed in 62 subjects to observe the morphological characteristics and dynamic change of the overall anatomic structure of atrial septum. The study examined 49 patients with atrial septal defect (ASD), including 3 patients with atrial septal aneurysm, and 10 healthy subjects. ASD in the 35 patients was surgically confirmed. The maximal diameters of ASD were measured and the percentages of area change were calculated. The parameters derived from L3DE were compared with intraoperative measurements. The results showed that L3DE could directly and clearly display the morphological features of overall anatomic structure of normal atrial septum, repaired and artificially-occluded atrial septum, atrial septal aneurysm. The defect area in ASD patients changed significantly during cardiac cycle, which reached a maximum at end-systole and a minimum at end-diastole, with a mean change percentage of 46.6%, ranging from 14.8% to 73.4%. The sizes obtained from L3DE bore an excellent correlation with intraoperative findings (r=0.90). It is concluded that L3DE can clearly display the overall morphological features and dynamic change of atrial septum and measure the size of ASD area accurately, which is important in the decision to choose therapeutic protocols.
Atrial Septum/*ultrasonography ; Echocardiography, Three-Dimensional/*methods ; Heart Septal Defects, Atrial/*pathology ; Heart Septal Defects, Atrial/*ultrasonography ; Young Adult

Objective To investigate the effects of Gegenqinlian decoction combined with berberine in the treatment of biguanides resistant type 2 diabetes in elderly patients in glycosylated hemoglobin and homocysteine.Methods 82 elderly patients from March 2015 to March 2016 in our hospital who were diagnosed with type 2 diabetes with biguanides resistant were selected,and randomly divided into two groups,41 cases in each groups.Control group receiced routine treatment,experimental group received more with Gegenqinlian Decoction combined with berberine treatment,and all the patients were treated for two weeks.Levels of FPG,2h PG,serum HbA1c,Hcy,hs-CRP,APN,TNF-α,ICAM-1 and clinical efficacy were compared,and the results were analyzed by statistical software SPSS 19 data analysis.ResultsCompared with before treatment,levels of serum FPG,2h PG,HbA1c,Hcy,hs-CRP,TNF-α and ICAM-1decreased in two groups after the treatment(P<0.05),levels of AFN increased(P<0.05),Compared with the control group,levels of serum FPG,2hPG,HbA1c,Hcy,hs-CRP,TNF-α and ICAM-1 in the experiment group were lower(P<0.05),levels of AFN were higher(P<0.05);The total effective rate of the experimental group was significantly higher than the control group(P<0.05).Conclusion Gegenqinlian decoction combined with berberine can effectively reduce the levels of FPG,2h PG,HbA1c,Hcy,hs-CRP,TNF-α in serum and ICAM-1 levels,increase serum APN level,and good curative effect,worthy of clinical application and promotion.

Objective To determine the occurrence rate of liver toxicity and related risk factors after receiving highly active an-tiretroviral-therapy(HAART)by the non-nucleoside reverse transcriptase inhibittor.Methods To observe the changes of liver func-tion indexes before and after antiviral therapy in 102 patients receiving HAART,the incidence rates of the liver toxicity were com-pared between nevirapine(NVP)and efavirenz(EFV)and the risk factors of liver toxicity after treatment were analyzed.Results A-mong 102 patients,73 cases accepted the treatment of NVP,the incidence rate of hepatotoxicity was 35.6%,29 cases accepted the treatment of EFV,the incidence rate of hepatotoxicity was 13.8%,the hepatotoxicity incidence rate had statistically significant difference between the two treatment methods(χ2 =4.761,P =0.029).Co-infected by hepatitis C virus(HCV)and baseline ALT el-evation were the independent risk factors of hepatotoxicity occurrence(P <0.05).Conclusion The patients receiving the treatment of NVP are more likely to have hepatotoxicity than the patients receiving the treatment of EFV.Co-infected by HCV and baseline ALT elevation are the independent risk factors of hepatotoxicity occurrence.

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 evaluate the practical value of the method of contrast enhanced ultrasoundguided reduced-fine needle aspiration (CEUS-FNA) in decreasing the complications of prostate nodule puncture.Methods Nine hundred patients with suspected prostate cancer(PCa) who underwent traditional 10-point blind transperineal prostate nodule puncture(n =548) or CEUS-FNA(n =352) were collected retrospectively and classfied into normal group or CEUS group,respectively.The ratio of prostate cancer diagnosis,number of punctur and compliations were observed in both groups.Results Altogether 362 PCa were diagnosed from 900 patients.Among these cases the diagnosis ratio of normal group was 38.0％ (208/548) and that of CEUS group was 43.8 ％ (154/352).There was no significant difference in diagnosis ratio between two groups (x2 =2.992,P =0.084).The puncture number of normal group were more than that of CEUS group(P ＜0.01).There were 134 cases occurred infection and other complications in tradition group and 56 cases in CEUS group.The complication rate in normal group was higher than that in CEUS group (24.5 ％ vs 15.9 ％),with significant differences between the two groups (x2 =9.393,P =0.002).Conclusions CEUS-FNA could reduce puncture number,but not decrease the PCa diagnsis rate.And also that could reduce the complication rate of prostate puncture.

Objective To estimate the impact of various extent of coronary stenosis at rest on myocardial perfusion and functional indices from myocardial contrast echocardiography(MCE) and two-dimensional strain echocardiography(2D-Strain) and characterize the relationship between them. Methods Three levels of coronary stenosis:mild (50%～75%),moderate (76%～89%),severe (≥90%) in 25 patients with coronary artery stenosis and 15 healthy subjects in the control group were examined. Plateau videointensity (value A) and time to plateau (value β) of the replenishment curve from MCE were calculated for perfusion analysis,and longitudinal peak systolic strain(SL) from 2D-Strain were measured for functional analysis. Results Value A tended to decrease with increasing severity of stenosis,ahhough these differences did not reach the level of statistical significance, β and SL were significantly increased in the context of moderate and severe coronary stenosis when compared with control group (β, moderate 0.75±0.67 and severe 0.67±0.53 vs normal 0.97±0.65;SL,moderate 11.60±5.89 and severe 9.58±6.51 vs normal 19.46±6.17, P <0.05, respectively). β was positively correlated with SL (r = 0.65, P <0.05).Conclusions β of the replenishment curve from MCE and SL from 2D-Strain both can detect greater than 75% coronary stenosis inducing myocardial ischemia,and they had good correlation.

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.

Objective To compare the diagnostic performance of prospective electrocardiogram (ECG)-gating 320-detectorcomputed tomography coronary angiography (CTCA) versus retrospective ECG-gating CTCA. Methods 500consecutive patients suspected coronary artery disease with heart rate of less than 65 bpm were performed coronary computed tomography angiography (CCTA) with prospective (group P)and retrospective (group R) ECG gating in turn. The image quality was divided into four levels. Success rates, effective radiation dose,image quality and diagnosis were evaluated. Results Success rates of examination in group P and R are100%.Mean patient radiation dose was significantly different in group P (3.28±1mSv) and R(14.36 ±2.3 mSv).131 and 142 of 3750 segments (250 patients x 15 segments per patient) were too small(1.5mm)tobe characterized in group P and R. 96. 51% (3619/3750) and 96.12% (3608/3750) characterized segments were not significantly different in group P and R. 95.09% segments received a score of 4 and 1.09% segments received a score of 3 in group P, while 95.23% and 0.74% in group R.The cause of 2 and 3 points in the two groups was motion artifact. Stair-step artifacts and images scored as 1were not found.Compared with CAG,the sensitivity,specificity,false positive andfalse negative value in group P(86. 49% ,98. 70% ,88. 89% ,98.38%) and R(83. 87% ,98.74% ,89. 65%,97.93%) were not significantly different. Conclusion Although the patient radiation exposure was significantly lower, the diagnostic performance of prospective ECG-gating 320-detector CTCA was comparable with that of retrospective ECG-gating 320-detector CTCA on patients with stable heart rates less than 65 bpm.

Objective To evaluate right ventricular(RV) global and regional volume and systolic function by real-time three-dimensional echocardiography (RT-3DE) in normal children with different age.Methods One hundred and ninty-two normal children were divided into five groups by age:group Ⅰ,＜1 years old,32 cases;group Ⅱ,≥1 years old-＜3 years old,46 cases;group Ⅲ,≥3 years old-＜6 years old,36 cases;group Ⅳ,≥6 years old-＜9 years old,41 cases;group Ⅴ,≥9 years old-＜14 years old,37 cases.Full volume imaging of RV was obtained at the parasternal four-chamber view near the apex by RT-3DE.RT-3DE data set were analyzed off-line by TomTec RV-Function.RV were divided into three parts:inflow,body,outflow.The measurements were including RV global and regional end-diastolic volume (EDV),end-systolic volume (ESV),ejection fraction (EF) and the ratio of regional parts EDV to RVEDV. The volume and systolic function were compared in three regional parts.RV global and regional parts EF and the ratio of regional parts EDV to RVEDV were also compared in five age groups.Correlation analysis and curve estimation were studied on RV global and regional EDV with age and physical development indexes.Results In the comparison of three regional parts:inflow EDV and EF were higher than outflow and body parts (P＜0.05).No significant different was found between outflow EDV and body EDV (P＞0.05),however,outflow EF was significant higher than body EF(P＜0.05).The comparison of RV global and regional EF in five age groups were no statistical different (P＞0.12). The ratio of regional parts EDV to RVEDV remained constant in five age groups(P＞0.58).Correlation analysis showed the global and regional RV volume were strongly correlated with age,height,weight and BSA (r＞0.77,P=0.000).The best correlation was found with BSA (r＞0.83,P=0.000).Curve estimation demonstrated that the relationship of RV global and regional EDV with age and physical development indexes could be best expressed by power model,the best matched model were found with BSA.Conclusions Among three regional parts of RV,inflow and outflow parts volume contraction were the two main contribution factors for RV function.In childhood RV volume didn't increase linearly with age and physical development indexes,but in an exponential model.

Objective To evaluate the right ventricular global systolic function by real-time three dimensional echocardiography (RT-3DE) and two dimensional echocardiography (2DE) in normal children,and investigate their correlation with age,height,weight,body surface area (BSA) and cardiac cycle time.Methods In 192 normal children,2DE right ventricular systolic function indexes were obtained at the apical four chamber view,including:tricuspid annular lateral wall peak systolic excursion (TAPSE),tricuspid annular peak systolic velocity (TRV) and right ventricular systolic area shortening (RVa).Full volume imaging of right ventricle was obtained at the parasternal four-chamber view near the apex by RT-3DE.The right ventricular ejection fraction (RVEF) was analyzed by TomTec RV-Function.The correlation analysis was performed between RT-3DE and 2DE indexes.The correlation and regression analysis on RT-3DE and 2DE indexes with above physical development indexes were also studied.At the same time 192 normal children were divided into five groups by age.2DE and RT-3DE indexes were compared with each other among five age groups.Results RVEF had no statistical correlation with all 2DE indexes (P ＞0.05).The correlation analysis on RT-3DE and 2DE indexes with physical development indexes demonstrated that TAPSE,TRV had strong positive correlation with the above indexes (P =0.000),while RVa had no statistical correlation with the above indexes (P ＞0.05).RVEF had weak positive correlation with cardiac cycle time r =0.180,P =0.014),but it had no statistical correlation with the other indexes (P ＞0.05).Stepwise regression analysis showed that the significant factor for TAPSE and TRV was height (R2 =0.508,P =0.000)and BSA (R2 =0.130,P =0.000)separately.In five age groups RVEF and RVa remained constant (P ＞0.05).However for TAPSE and TRV significant difference were found in part of comparisons between groups(P ＜0.05).Conclusions Although RVEF assessed by RT-3DE was slightly influenced by heart rate,it was independent of age,height,weight,BSA.It was a stable index for evaluating right ventricular systolic function among different age and physical development population.