Objective To assess left ventricular systolic and diastolic function in patients with hypertrophic cardiomyopathy(HCM) with the aid of pulsed Doppler tissue imaging (DTI) to measure the four sides of mitral annular. Methods Thirty subjects with HCM and Twenty five age and sex matched controls were performed 2D and Doppler echocardiography . Two groups were studied with pulsed tissue Doppler imaging of the 4 sides of the mitral annulus (septal, lateral, inferior, anterior) in 4 and 2 chamber views. The velocities of systolic wave(Sa)、early diastolic filling wave (Ea)、late filling wave (Aa) and isovolumetric relaxation time were measured by DTI. Results Compared with normal control group, HCM group shows: (1) conventional data: LV wall thickness and mass indices were significantly greater. There were no significant difference in mitral flow Velocity. (2) DTI: There were more lower velocities of systolic and early diastolic filling wave. But isovolumetric relaxation time、mitra flow velocity / mitral annual early diastolic velocity ratio(E/Ea) increased. The velocities of systolic and early diastolic of septal site were the lowest among the 4 sides of the mitral annular and were the most closely with the average velocities of systolic and early diastolic of mitral annual. In addition, DTI may detect the pseudonormalization of mitral inflow. Conclusions DTI is more sensitive than conventional echocardiogram data and may be clinically used in exactly detecting left ventricular systolic and diastolic dysfunction in patients with HCM

Objective To investigate the feasibility and accuracy of velocity vector imaging(VVI)to assess strain and strain rate of right ventrieule(RV)during varying myocardial functional states.Methods VVI of the longitudinal RV were recorded in 7 closed-chest anesthetized mongrel dogs from the apical 4-chamber view during 3 different inotropic states.Peak dp/dt from the RV contraction during the right cardiac catheterization,which was used as the gold standard of RV contractility,was obtained simultaneously in each inotropic state.Peak systolic velocities(V), peak systolic strain rates(SR),peak systolic strains(S)at the basal, middle and apical segments of RV free wall and septal from the longitudinal axis were quantitatively measured by using VVI software system respectively.Results The peak systolic strain and strain rate of the longitudinal RV free wall and septal were increased with the infusion of dobutamine and decreased with the infusion of metoprolol.A significant correlation was found between peak RV dp/dt and RV mean strain and mean strain rate(r=0.79, 0.75;P <0.01).Among all RV segments, the peak systolic S,SR of RV basal free wall had the most significant correlation to peak dp/dt (r=0.83,0.78;P<0.01).Conclusions Strain rate imaging drived from VVI could quantitatively and sensitively detect the longitudinal RV contractile function.Peak systolic S and SR determined at the longitudinal RV basal free wall were the strong noninvasive indices of RV contractility.

Objective To investigate strain and strain rate of right ventricular(RV)based on twodimensional image by velocity vector imaging in normal subjects.Methods Thirty-two healthy adults were rolled in this study.Echocardiographic images in 4 chamber view were analyzed by conventional manual tracing for volumes and ejection fractions,which were also measured by velocity vector imaging.Myocardial velocity,strain rate,and strain were determined at the basal,mid,and apical segments of the RV free wall and ventricular septum by velocity vector imaging.Results RV ejection fractions obtained with manual tracing correlated strongly with the same indexes obtained by velocity vector imaging method in all subjects(r=0.91,P＜0.01).The strain and strain rate value of middle segment and basal segment in RV free wall were higher than those of apical segment.There were same trend in ventricular septal.The strain and strain rate of middle segment and basal segment in RV free wall were higher than those of homologous segments in ventricular septal,but the indexes of apical segment in free wail and septal had no difference.The strain and strain rate in RV were not correlated with age.Conclusions Velocity vector imaging could accurately and quantitatively assess the strain and strain rate of RV.

Objective:To explore the predictive value of renal resistive index (RRI) joint with semiquantitative power Doppler ultrasound (PDU) score to acute kidney injury (AKI) in non-septic critically ill patients.Methods:This prospective observational study enrolled non-septic critically ill patients admitted to the Emergency Intensive Care Unit of Cangzhou Central Hospital from January 2018 to August 2019. In addition to general data, RRI and PDU scores were measured with medical ultrasonic instrument within 6 h after admission. Renal function was assessed on the 5th day in accordance with kidney disease: Improving Global Outcomes criteria. The patients who progressed to AKI stage 3 within 5 days after admission were classified into the AKI 3 group, and the rest were classified into the AKI 0-2 group. The difference of each index was compared between the two groups in non-septic critically ill patients and patients with acute heart failure (AHF). Normal distributed continuous variables were compared using independent sample t-tests, whereas Mann-Whitney U tests were used to examine the differences in variables without a normal distribution. Categorical data were compared with the Chi-square test. Receiver operator characteristic curves were plotted to examine the values of RRI, PDU score, RRI-RDU/10 (subtraction of RRI and 1/10 of PDU score), RRI/PDU (the ratio of RRI to PDU score), and RRI+PDU (the prediction probability of the combination of RRI and PDU score for AKI stage 3 obtained by logistic regression analysis) in predicting AKI 3. Delong's test was used to compare the area under the curve (AUC) between predictors. Results:A total of 110 non-septic critically ill patients (51 patients with no AKI, 21 with AKI stage 1, 11 with AKI stage 2, and 27 with AKI stage 3) were recruited. Among them, there were 63 patients with AHF (21 patients with no AKI, 15 with AKI stage 1, 7 with AKI stage 2, and 20 with AKI stage 3). Among the non-septic critically ill patients as well as its subgroup of AHF, compared with the AKI 0-2 group, acute physiology and chronic health evaluation-Ⅱ score, sequential organ failure assessment score, arterial lactate concentration, mechanical ventilation rate, proportion of vasoactive drugs, 28-day mortality, serum creatinine, RRI, RRI-RDU/10, RRI/PDU, RRI+PDU, and rate of continuous renal replacement therapy were higher in the AKI 3 group, and urine output and PDU score were lower ( all P<0.05). As for non-septic critically ill patients, RRI/PDU [AUC=0.915, 95% confidence interval ( CI): 0.846-0.959, P<0.01] and RRI+PDU (AUC=0.914, 95% CI: 0.845-0.959, P<0.01) performed best in predicting AKI 3, and the AUCs were higher than RRI (AUC=0.804, 95% CI: 0.718-0.874, P<0.01) and PDU score (AUC=0.868, 95% CI: 0.791-0.925, P<0.01). The optimal cutoff for RRI/PDU was > 0.355 (sensitivity 92.6%, specificity 81.9%, Youden index 0.745). The predictive value of RRI-RDU/10 for AKI 3 (AUC=0.899, 95% CI: 0.827-0.948, P<0.01) was also better than RRI and PDU scores, but slightly worse than RRI/PDU and RRI+PDU, with statistically difference only between RRI and RRI-RDU/10 ( P<0.05). As for patients with AHF, RRI/PDU (AUC=0.962, 95% CI: 0.880-0.994, P<0.01) and RRI+PDU (AUC=0.962, 95% CI: 0.880-0.994, P<0.01) also performed best in predicting AKI 3, and the AUCs were higher than RRI (AUC=0.845, 95% CI: 0.731-0.924, P<0.01) and PDU score (AUC=0.913, 95% CI: 0.814-0.969, P<0.01) with statistically differences (all P<0.05). The optimal cutoff for RRI/PDU was > 0.360 (sensitivity 95.0%, specificity 90.7%, Youden index 0.857). The predictive value of RRI-RDU/10 for AKI 3 (AUC=0.950, 95% CI: 0.864-0.989, P<0.01) was also better than RRI and PDU score, but slightly worse than RRI/PDU and RRI+PDU, with statistically difference only between RRI and RRI-RDU/10 ( P<0.05). Conclusions:The combination of RRI and PDU score could effectively predict AKI 3 in non-septic critically ill patients, especially in patients with AHF. The ratio of RRI to PDU score is recommended for clinical application because of its excellent predictive value for AKI and its practicability.

Objective To investigate the effect of curcumol on apoptosis of human gastric carcinoma cell line BGC823 and the molecular nechanisms.Methods BGC823 cells were cultured and treated with different curcumol concentration (12.5,25,50 and 100 mg/L) for 24 h and 48 h,and the growth inhibition were tested by thiazolyl blue terazolium bromide (MTF) assay.Flow cytometry (FCM) were used to measure the cell apoptosis rate and cell cycle of BGC823 cells.Caspase-3 activity was assessed by colorimetric assay.Cells treated with 100 mg/L curcunol for 48 h were collected and subjected to RTPCR and Western blot assays for the expression of Caspase-3,Bcl-2,Bax and Survivin.Results There was a time-and dose-dependent inhibition of cell proliferation of BGC823 cells by curcumol.Tbe cells in G0/G1 phase increased,and in S phase decreased on exposure to curcumol for 24 h.FCM analysis also indicated that the apoptosis rate of BGC823 cells increased in dose-dependent manner (P ＜ 0.05).Curcumol increased the activity of Caspase-3 dose-dependently (P ＜ 0.05).RT-PCR and Western blot indicated that curcumol decreased Bcl-2 and Survivin expression as well as increased Caspase-3 and Bax expression (P ＜ 0.05).Conclusions Curcumol inhibits BGC823 cell growth,arresting cells in G0/G1 phase and inducing cell apoptosis.The mechanism may be related with increasing the activity of Caspase-3,down-regulating the expression of Bcl-2 and Survivin,and up-regulating the expression of Caspase-3 and Bax.

OBJECTIVETo develop an ultra performance liquid chromatography (UPLC) method for simultaneous determination of five ellagic acids in Euscaphis japonica.

METHODAnalysis was carried out on an Acquity BEH C18 (2.1 mm x 100 mm, 1.7 microm) column at 40 degrees C eluted with acetonitrile-0.1% phosphoric acid aqueous solution as mobile phases in gradient elution. The flow rate was 0.2 mL x min(-1), and the detection wavelength set was monitored at 245 nm.

RESULTAll calibration curves showed good linear relationship within test ranges (r >0.9997), and the overall recoveries were in the range of 97.2%-102.1%, with RSD less than 3.2% (n = 6). The overall RSD of precision test were less than 2.9%.

CONCLUSIONThe developed method was simple, rapid, accurate and reproducible, and can be used for the quality control of E. japonica.

ObjectiveTo investigate the regulatory effects of traditional Chinese medicine (TCM) Shufengxuanfeijiedu formula on Janus kinase signal transducer and activators of transcription (JAK-STAT) of lung tissues in mice with influenza viral pneumonia.Methods According to random number table, 60 mice were randomly divided into six groups with 10 mice in each group: normal group (N), model group (M), Tamiflu control group (C) and low (SL), medium (SM), high dose (SH) Shufengxuanfeijiedu formula groups. The mouse model of influenza virus pneumonia was reproduced by dropping of 0.05 mL 4LD50 inflluenza virus FM1 strain which can be adapted to lung tissue into the nose; while the N received nose instillation of 0.05 mL normal saline. After successful modeling for 2 hours, distilled water was given orally (by lavage) to N and M; Duffy (oseltamivir) 2.5 g·mL-1·d-1 was administrated to C; the TCM SL, SM, SH were intragastrically administered with different doses of shufengxuanfeijiedu decoction into the corresponding groups respectively (the ingredients of prescription: chrysanthemum, mulberry leaf, almond, platycodon root, forsythia, bupleurum etc. forming granules), according to the suitable dose of granules used for human body surface, the dose used for mouse surface area was calculated, the high dose means the dose used in the medium dose group doubled, the low dose means 1/2 dose used in medium group, once a day, once 0.2 mL for consecutive 4 days. Afterwards, the lung tissues were collected, the mouse differential gene expressions related to JAK-STAT pathway were detected by gene chip technology, the standards for screening of differential gene expression were as follows: up-regulated gene was P < 0.05, and the log2ratio > 1; down-regulation gene wasP < 0.05, and log2ratio < -1. The levels in lung tissue kinase (JAK) andγinterferon (IFN-γ) mRNA expressions were determined by real-time fluorescence quantitative reverse transcription polymerase chain reaction (RT-qPCR).Results Compared with those in N, the differential expression gene transcription activator, STAT5 [log2 (N/M) = 2.32], interleukin 4 receptor alpha subunit [IL4RA, log2 (N/M) = 4.77], interleukin 12 receptor [IL12R, log2 (N/M) = 1.58], JAK [log2 (N/M) = 2.41] were all obviously up-regulated, and IFN was significantly down-regulated [log2 (N/M) = -1.45] in M. Compared with those in M, C group IFN [log2 (C/M) = 1.51], various TCM dose groups [log2 (SL/M) = 1.46, log2 (SM/M) = 1.72, log2 (SH/M) = 1.40] differential expression gene IFN was significantly up-regulated, STAT5 [log2 (C/M) = -2.06, log2 (SL/M) = -1.41, log2 (SM/M) = -2.10, log2 (SH/M) = -1.89], IL4RA [log2 (C/M) = -2.52, log2 (SL/M) = -1.85, log2 (SM/M) = -2.74, log2 (SH/M) = -1.39), IL12R [log2 (C/M) = -1.48, log2 (SL/M) = -0.10, log2 (SM/M) = -1.58, log2 (SH/M) = -0.53], JAK [log2 (C/M) = -1.44, log2 (SL/M) = -0.88, log2 (SM/M) = -1.74, log2 (SH/M) = -0.53] were significantly down-regulated. In M, the JAK mRNA expression was obviously elevated (2-ΔΔCt: 3.17±0.94 vs. 1.01±0.13,P < 0.05), while the IFN-γ mRNA expression was decreased (2-ΔΔCt: 0.15±0.48 vs. 1.01±0.12,P < 0.05); compared with M, the JAK mRNA expressions in C, SM and SH groups were all obviously decreased (2-ΔΔCt: 2.02±0.63, 1.19±0.30, 1.59±0.67 vs. 3.17±0.94, allP < 0.05); while the IFN-γmRNA expressions in C, SL, SM and SH groups were elevated (2-ΔΔCt: 0.61±0.12, 0.41±0.13, 0.85±0.14, 0.78±0.20 vs. 0.15±0.48, allP < 0.05).Conclusions Shufengxuanfeijiedu formula can ameliorate the mice immune pathological injury of lung tissues induced by influenza virus by regulating JAK-STAT signal pathway and balancing Th1/2 via up-regulating the expression of IFN-γ.

Objective:To explore the predictive value of bedside ultrasound monitoring of optic nerve sheath diameter (ONSD) for short-term neurological prognosis in critically ill patients without primary brain injury.Methods:An observational prospective study was conducted to enroll critically ill patients without primary brain injury admitted to the emergency intensive care unit (ICU) of Cangzhou Central Hospital from January 2021 to April 2022. The exclusion criteria were as follows: age < 18, combined ocular and optic nerve pathology or injuries, impaired consciousness due to prior neuropathy, primary brain injury, ICU stay < 3 days, death or loss of follow-up within 28 days. Bedside ultrasound measurements of ONSD were performed within 24 hours of ICU admission and on day 3 of ICU admission. The consciousness status was assessed daily during ICU hospitalization. If the Glasgow Coma Scale (GCS) is 15 and the confusion assessment method intensive care unit (CAM-ICU) is negative, the consciousness status will be defined as nonconsciousness disorder. While if the GCS score is less than 15 or the CAM-ICU is positive, the consciousness status will be defined as consciousness disorder. According to the status of consciousness at 28 days, patients were divided into a nonconscious disorder group and a conscious disorder group, and the difference in each index was compared between the two groups. Univariate and multivariate Cox regression were used to analyze the factors influencing 28-day neurological function prognosis, and a Kaplan?Meier survival curve was plotted to analyze the relationship between ONSD and 28-day neurological function prognosis.Results:Sixty-one critically ill patients without primary brain injury (48 in the nonconscious disorder group and 13 in the conscious disorder group) were recruited. Compared to patients in the unconscious disorder group, those in the conscious disorder group had lower GCS upon ICU admission [7(4, 8) vs. 8(6, 14), P<0.05], longer length of mechanical ventilation (MV) [28(15, 28) days vs. 10(4, 14) days, P<0.001], and longer length of ICU stay [28(28, 28) days vs. 12(7, 20) days, P<0.001]. Patients in the conscious disorder group had a higher ONSD within 24 hours of ICU admission [(5.75±0.53) mm vs. (5.45±0.60) mm, P=0.114] and a higher ONSD 3 days after ICU admission [(5.54±0.64) mm vs. (5.22±0.65) mm, P=0.124] than patients in the unconscious disorder group, but the differences were not statistically significant. Multivariate Cox regression analysis showed that use of MV, GCS upon ICU admission and ONSD on day 3 of ICU admission were independent risk factors. Kaplan?Meier survival analysis showed that patients with an ONSD < 5.30 mm on day 3 had a better 28-day neurological prognosis. Moreover, among the patients with ONSD within 24 hours ≥5.30 mm, the patients with ONSD decreased to < 5.30 mm on day 3 had significantly better 28-day neurological prognosis than those with ONSD ≥ 5.30 mm on day 3 ( P=0.042). Conclusions:ONSD within 24 hours of ICU admission, especially ONSD levels and changes in ONSD on day 3, had predictive value for the short-term neurological prognosis of critically ill patients without primary brain injury.

Objective:To explore the diagnostic accuracy of bedside ultrasound measurement of limb skeletal muscle thickness for intensive care unit-acquired weakness (ICU-AW) in patients receiving mechanical ventilation.Methods:A prospective observational study was conducted. Patients receiving mechanical ventilation admitted to the emergency ICU of Cangzhou Central Hospital from June 2018 to March 2020 were enrolled. The demographic data were collected. Medical Research Council (MRC) score was used to assess muscle strength and to determine the presence of ICU-AW once the patients were awake. The thicknesses of biceps brachii (BB), flexor carpi radialis (FCR), rectus femoris (RF) and tibialis anterior (TA) were measured by bedside ultrasound. The difference of each index was compared between the patients in ICU-AW group and in non-ICU-AW group. Receiver operator characteristic (ROC) curves were plotted to examine the values of the thicknesses of these four muscles in diagnosing ICU-AW.Results:Forty-one patients receiving mechanical ventilation (15 patients with ICU-AW, 26 patients without ICU-AW) were recruited. Compared with the non-ICU-AW group, the MRC score, the thicknesses of FCR, RF and TA were lower in the ICU-AW group [MRC score: 36 (30, 40) vs. 60 (56, 60), FCR (cm): 1.09±0.19 vs. 1.30±0.28, RF (cm): 1.57±0.58 vs. 2.23±0.58, TA (cm): 1.76±0.33 vs. 2.21±0.43, all P < 0.05], and the length of ICU stay was longer [days: 15 (9, 26) vs. 10 (4, 12), P < 0.05]. Although the thickness of BB was also lower in the ICU-AW group, there was no statistical difference between the two groups (cm: 2.45±0.57 vs. 2.70±0.61, P = 0.205). ROC curve showed that the thicknesses of FCR, RF and TA had diagnostic values for ICU-AW [area under ROC curve (AUC) and 95% confidence interval (95% CI) was 0.742 (0.582-0.866), 0.787 (0.631-0.899), 0.817 (0.665-0.920), respectively, all P < 0.01]. The thicknesses of BB couldn't diagnose ICU-AW (AUC = 0.597, 95% CI was 0.433-0.747, P = 0.296). Conclusion:The thicknesses of FCR, RF and TA measured by bedside ultrasound in patients with mechanical ventilation had diagnostic values for ICU-AW, while the thickness of BB could not diagnose ICU-AW.

Objective:This study aimed to explore the performance of renal resistive index (RRI), semiquantitative power Doppler ultrasound (PDU) score, and renal venous Doppler waveform (RVDW) pattern in predicting 28-day renal dysfunction in critically ill patients and establish nomogram model.Methods:This was a prospective, observational study. Critically ill patients admitted to the emergency intensive care unit (ICU) of Cangzhou Central Hospital from January 2018 to October 2022 were included. Patients underwent renal ultrasound examination to obtain RRI, PDU score and RVDW pattern within 24 h after ICU admission. The following clinical variables were collected during the renal ultrasound examination session, including heart rate, mean arterial pressure, type and dose of vasoactive drugs, oxygen therapy parameters, and average urine volume per hour derived from a period of 6 h prior to the ultrasound examination. The data on duration of AKI and mortality were recorded on the 28th day of follow-up. Patients were divided into 28-day normal renal function group and 28-day renal dysfunction group according to 28-day renal dysfunction. 28-days of renal dysfunction was defined as failure to achieve renal function recovery within 28 days of ICU admission. The difference of each index between the two groups was compared. Associated factors for 28-day renal dysfunction were determined by univariate and multivariate COX regression analyses. A nomogram was developed based on the independently factors associated with 28-day renal dysfunction. Survival receiver operator characteristic (ROC) curves were plotted to assess diagnostic performance in predicting 28-day renal dysfunction. Delong’s test was used to compare area under the curves (AUC) between each predictor.Results:187 patients were enrolled for the final analysis: 97 with no AKI, 48 with AKI stage 1, 24 with AKI stage 2, and 18 with AKI stage 3 upon enrollment. At 28-day follow up, 16 patients had renal dysfunction and 2 required continuous renal replacement therapy (CRRT). The multivariate COX regression showed that RVDW and SCr upon enrollment were the independent risk predictors. Nomogram based on RVDW and SCr upon enrollment showed the best performance in predicting 14-day renal dysfunction (AUC = 0.918, 95% CI:0.871-0.964, P<0.05), and the AUC was statistically significantly higher than single index (all P<0.05). Nomogram also showed the best performance in predicting 28-day renal dysfunction (AUC = 0.924, 95% CI:0.865-0.983, P<0.05), and the AUC was statistically significantly higher than single index (all P<0.05) except for SCr upon enrollment. The optimal cutoff for nomogram in predicting 28-day renal dysfunction was ≤89.5 (sensitivity, 81.2%; specificity, 90.6%; Youden index, 0.719). Kaplan-Meier analysis showed that the median duration of renal dysfunction in the groups with total nomogram score >85.9 and ≤85.9 was 0 and 22 days (HR=0.220, 95% CI:0.129-0.376, P<0.001). Conclusions:SCr and RVDW pattern within 24 h from ICU admission were independent factors associated with 28-day renal dysfunction in critically ill patients. The value of the nomogram model based on these two factors in predicting 28-day renal dysfunction is superior to each single intrarenal Doppler spectrum indicator and clinical indicator.