Objective:To compare the sedative and analgesic effect and safety of dexmedetomidine at different doses combined with lidocaine with intravenous administration after modified radical mastectomy for breast cancer. Methods:Sixty ASAⅠ-Ⅱpatients aged from 18 to 65 years with body weight index of 18-30 kg·m-2 were treated by modified radical mastectomy. The patients were randomly divided into 3 groups:lidocaine group (group L, n=20), low dosage dexmedetomidine and lidocaine group (group D1, n=20) and high dosage dexmedetomidine and lidocaine group (group D2, n=20). Group L was intravenously given lidocaine 1. 5 mg·kg-1 before the operation and intravenously infused lidocaine 1. 5 mg·kg-1 ·h-1 during the whole operation process. Group D1 was intravenously infused dexme-detomidine 0. 3μg·kg-1 in 10min before the operation, and intravenously infused lidocaine 1. 5 mg·kg-1 ·h-1 during the whole opera-tion process. Group D2 was intravenously infused dexmedetomidine 0. 6 μg·kg-1 in 10min before the operation, and intravenously in-fused lidocaine 1. 5 mg·kg-1 ·h-1 during the whole operation process. The propofol Ce was recorded when the modified OAA/S reached 3 (Ce3) and BIS reached 80 (Ce80) during the up period, the VAS in the 1st, 6th and 24th hour after the surgery (VAS1-24), and nausea and vomiting in the first postoperative day were also recorded and observed. Results:No difference was found in the demographic data among the 3 groups with modified OAA/S of 3 (Ce3) and BIS of 80 (Ce80). VAS of group D1 and D2 was significantly decreased when compared with group L in the 1st postoperative hour(P<0. 05). In the 6th and 24th postoperative hour, VAS of group D2 was much lower than that of group L and D1(P<0. 05), however, no difference was found between group L and D1. There was no significant difference in the propofol Ce during the up period and the adverse reactions in the 1st postoperative day among the 3 groups. Conclusion:Dexmedetomidine at the dosage of 0. 6 μg·kg-1 combined with lidocaine can significantly reduce the pain and optimize the short-term prognosis after modified radical mastectomy.

The left ventricular regional systolic functions in patients with hypertrophic cardiomyopathy (HCM) were assessed by using quantitative tissue velocity imaging (QTVI). Left ventricular (LV) regional myocardial velocity along long- and short-axis in 31 HCM patients and 20 healthy subjects were analyzed by QTVI, and the regional myocardial systolic peak velocities (MVS) were measured. Mean MVS at each level including mitral annular, basal, middle and apical segments were calculated. The ratio of MVS along long-axis to that along short-axis (Ri) at basal and middle segments of the LV posterior wall and ventricular septum were calculated. The results showed that mean MVS was slower at each level including mitral annular, basal, middle and apical segments in the HCM patients than that in the healthy subjects (P < 0.01). There were no significant differences in mean MVS between obstructive and non-obstructive groups in HCM patients. MVS of all regional myocardial segments along long-axis in the HCM patients were significantly slower than that in the healthy subjects (P < 0.05), but there was no significant difference in MVS of all regional myocardial segments along long-axis between hypertrophied and non-hypertrophied group in the HCM patients. Ri was significantly lower in the HCM patients than that in the healthy subjects. The LV regional myocardial contractility along long-axis was impaired not only in the hypertrophied wall but also in the non-hypertrophied one in patients with HCM, suggesting that QTVI can assess accurately LV regional systolic function in patient with HCM and provides a novel means for an early diagnosis before and independent of hypertrophy.
Cardiomyopathy, Hypertrophic/*physiopathology ; Cardiomyopathy, Hypertrophic/ultrasonography ; *Echocardiography, Doppler/methods ; Ventricular Function, Left/*physiology

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.

To study reliability and reliable indices of quantitative assessment of right ventricular systolic function by time-intensity curve (TIC) with right ventricular contrast, 5% sonicated human albumin was injected intravenously at a does of 0.08 ml/kg into 10 dogs at baseline status and cardiac insufficiency. Apical four-chamber view was observed for washin and washout of contrast agent from right ventricle. The parameters of TIC were obtained by curve fitting. The differences of parameters were analyzed in different states of cardiac functions. Among the parameters derived from TIC, the time constant (k) was decreased significantly with decline of cardiac function (P<0.001). But half-time of decent of peak intensity (HT) and mean-transit-time (MTT) of washout were increased significantly (P<0.001). The k was strongly related to cardiac output of right ventricle (CO) and ejection fraction (EF) of left ventricle and fractional shortening (FS) of left ventricle. Right ventricular systolic function could be assessed reliably by the parameters derived from TIC with right ventricular contrast echocardiography. The k, HT and MTT are reliable indices for quantitative assessment of right ventricular systolic function.
Blood Flow Velocity/physiology ; Cardiac Output ; Contrast Media ; Echocardiography ; Image Processing, Computer-Assisted ; Indicator Dilution Techniques ; Reproducibility of Results ; Systole ; Ventricular Function, Right/*physiology

Objective To explore the predictive value for coronary heart disease by epicardial adipose tissue(EAT) thickness and carotid intima-media thickness(IMT) measured with high-frequency ultrasound.Methods According to the results of coronary angiography, the cases were divided into the normal control group (29 patients),coronary artery disease group with single-vessel lesion (43 patients),coronary artery disease group with multi-vessels lesion (28 patients), respectively. EAT and IMT were measured by high-frequency ultrasound. Results The EAT in the three groups were (4.8 ± 1.3) mm, (7.6 ± 1.8) mm,(10.1±2.6) mm respectively, and the IMT were (0.8±0.1)mm,(1.0±0.2)mm,(1.1 ± 0.2)mmrespectively. In either coronary artery disease group with single-vessel lesion or multi-vessels lesion, the EAT and IMT were significantly higher than those in the normal control group ( P＜ 0.01 ). And the difference between groups of single-vessel lesion and multi-vessels lesion was also statistically significant (P＜ 0.01). The areas under receive operating characteristic(ROC) curve to predict coronary heart disease by EAT and IMT was 0.947 and 0.917, respectively, there was no significant difference between the two areas. For patient with coronary artery stenosis＞50%, the sensitivity and specificity of EAT＞6 mm were 90.1% and 86.2% ,respectively,the sensitivity and specificity of IMT＞0.85 mm were 87.3% and 82.8%,respectively. Conclusions EAT and IMT measured by high-frequency ultrasound can precisely predictcoronary heart disease. EAT can be a new predictor to diagnose coronary heart disease.

Objective:To investigate the anti-oxidative stress effects of microRNA 125b (miR-125b) on lens epithelial cells (LECs) and its possible mechanism.Methods:Twenty-four anterior capsule specimens were collected from 24 eyes of 24 age-related cataract patients during phacoemulsification and 20 normal anterior capsule specimens were obtained from 20 eyes of 20 donors in Henan Eye Hospital from July 2018 to March 2019 under the approval of a Medical Ethics Committee of Henan Eye Hospital (No.YKYY20193151).The reverse transcription PCR and Western blot assay were employed to detect and compare the relative expression levels of miR-125b and nuclear factor E2-related factor 2 (Nrf2) in different specimens.The human lens epithelial cell line HLEB-3 was divided into control group and oxidative stress model group.The oxidative stress models were established by coculture with different concentrations (100, 200, 400 μmol/L) of H 2O 2 for 24 hours, and the cells were cultured with normal medium without H 2O 2 in the control group.The reactive oxygen species (ROS) content was detected by DCFH-DA fluorescent probe, and the activities of total-antioxidative capability (T-AOC), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) as well as malondialdehyde (MDA) concentration were detected by ELISA, and compared among the groups.The expression levels of miR-125b and Nrf2 were detected by reverse transcription PCR and Western blot assay, respectively.The cells were transfected with miR-125b mimics, miR-125b control and miR-125b inhibitor for 24 hours, respectively, and ROS content was detected by DCFH-DA fluorescent probe and T-AOC, SOD and GSH-Px activities as well as MDA concentration were detected by ELISA and compared among different transfected groups.A dual luciferase reporter assay was used to assess an association between miR-125b and Nrf2.The expression level of Nrf2 protein was detected by Western blot assay and the expression levels of Nrf2 and Keap1 were assayed and located by immunofluorescence double staining. Results:The relative expression levels of miR-125b and Nrf2 in the normal lens anterior capsule specimens were 0.21±0.03 and 0.27±0.06, which were significantly lower than 0.89±0.05 and 0.84±0.12 in the cataract specimens, respectively ( t=15.355, P<0.05; t=18.647, P<0.05).The relative expression levels of miR-125b and Nrf2 were significantly increased in various H 2O 2 treated groups in comparison with the control group and were gradually elevated with the increase of H 2O 2 concentration (all at P<0.05).Compared with the control group, the T-AOC, SOD and GSH-Px activities were reduced, and ROS content and MDA concentration were significantly ascended (all at P<0.05).Compared with the miR-125b control group, the T-AOC, GSH-Px and SOD activities were increased, and ROS content and MDA concentration were decreased in the miR-125b mimics group (all at P<0.05).In addition, the T-AOC, GSH-Px and SOD activities were significantly weakened, and ROS content and MDA concentration were significantly increased in the miR-125b inhibitor group in comparison with the miR-125b control group (all at P<0.05).Dual luciferase reporter assay showed that miR-125b targeted to the expression of Nrf2 in the H 2O 2 model cells.The fluorescence of Nrf2 in the cytoplasm was the strongest with more nuclear transfer in the miR-125b mimics group, and the expression intensity of Keap1 in the cytoplasm was weaker.The expression of Nrf2 was the weakest with less nuclear transfer in the miR-125b inhibitor group, and the expression level of Keap1 in the cytoplasm was stronger. Conclusions:MiR-125b can enhance the anti-oxidative stress of LECs in age-related cataractous eyes probably by upregulating the expression of Nrf2 and activating the Keap1/Nrf2 signaling pathway.

Objective To explore the correlation between epicardial adipose tissue(EAT) thickness and cardiovascular risk factors in patients with coronary artery disease.Methods According to the results of coronary angiography,84 cases of patients undergone coronary angiography were divided into the normal control group(28 patients),coronary artery disease group with single-vessel lesion (28 patients),coronary artery disease group with multi-vessels lesion(28 patients),respectively,then measured the EAT thickness and carotid intima-media thickness(IMT) by high-frequency ultrasound.A correlation analysis was carried out between the EAT and IMT and cardiovascular risk factors.Results In either coronary artery disease group with single-vessel lesion or multi-vessels lesion,the thicknesses of EAT and IMT were significantly higher than those in the normal control group(P ＜0.01),and the difference between group of single-vessel lesion and multi-vessels lesion was also statistically significant (P ＜0.01).A correlation analysis between the EAT and IMT and cardiovascular risk factors showed that there were significantly positive correlations between EAT and the IMT,age,weight,waist circumference,body mass index,low-density lipoprotein,Creactive protein (r = 0.124～0.790,P ＜0.05 or P ＜0.01),and the significantly negative correlation between EAT and high-density lipoprotein (r = - 0.203,P ＜ 0.05).Correlation between EAT and the IMT was 0.678,0.713,0.737 in the normal control group,group with single-vessel lesion,group with multivessels lesion,respectively.Conclusions There were favorable correlation between EAT and carotid IMT in cardiovascular risk factors.The more severity of coronary heart disease,the more high correlations of EAT and IMT.EAT can be a valuable index in evaluating coronary artery disease.

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.

Objective To investigate the effect of right ventricular(RV)volume and RV pressure overload on left ventricular(LV)rotation and twist in patients with atrial septal defecl(ASD).Methods Using speckle tracking imaging(STI),the peak rotation of 6 segments in basal and apical short-axises was measured respectively in 35 patients with ASD(18 of which with pulmonary hypertension)and 21 healthy subjects as controls.The average peak rotation and duration time of the 6 segments in basal and apical short-axises in negative direction during early systolic phase were also measured respectively.LV twist versus time profile was drawn and the peak twist and time to peak twist were calculated.LV ejection fraction(EF)was measured by biplane Simpson method.Results Compared to ASD patients without pulmonary hypertension and healthy subjects,the peak rotation of posterior wall,inferior wall and postsept wall in basal was lower(P＜0.05).And at the basal level,the averagepeak rotation of 6 segments in negative direction during early systolic phase was higher(P＜0.05),and the average duration time was delayed(P＜0.05).LV peak twist was also lower(P＜0.05),and had a significant negative correlation with pulmonary arterial systolic pressure(r=-0.57,P=0.001).There were no significant differences in LVEF among 3 groups.Conclusions Although RV volume overload due to ASD has no significant effects on LV rotation and twist,LV peak twist is lower in ASD patients with pulmonary hypertension.Thus LV twist may be a new index which predicting whether ASD patients also has pulmonary hypertension or not.

Objective To evaluate the characteristics and efficacy of microscope-assisted bilateral decompression via unilateral approach for the treatment of lumbar stenosis. Methods From June 2007 to June 2010, Sixty case lumbar stenosis with bilateral decompression were treated via unilateral approach under microscopy. Patients were followed up from 6 to 24 months, average (12 ± 4.7) months. Results The pain level of each patient was assessed both before and after the opeartion, using a visual analogue scale (VAS). Intermittent claudication was completely relieved in 57 out of 60 cases, moderately relieved in 3 cases. VAS score decreased from pre-operational 9.08 ± 0.76 to post-operational 2.33 ± 1.43, and there was significantly difference between them. There was no recurrent case during the whole follow-up. Conclusion Bilateral decompression via unilateral approach under microscope is proved to be an effective and safe procedure for the treatment of lumbar stenosis, and have the advantages of minimal invasion, less pain, quick recovery, better effect, little influence on the spinal stability.