AIM: To observe the changes in expression and activity of the transcription factor myocyte enhancer factor 2A (MEF2A) during hepatic stellate cells (HSC) activation, and to study the roles of MEF2A in the process of HSC activation. METHODS: Cultured HSC was isolated from male sprague-dawley rat liver on plastic dishes and were used as model of activation. The freshly isolated (0 day) and cultured HSC at time points of 1st, 2nd, 3rd, 4th, 5th, 6th, 7th and 8th day were collected. Expression of MEF2A mRNA was detected by real-time quantitative PCR. MEF2A and α-smooth muscle actin (α-SMA, a marker for activated HSC) were tested by Western blotting. Meanwhile, the MEF2A DNA binding activity was determined by electrophoretic mobility shift assays (EMSA). RESULTS: The expression of MEF2A mRNA was small amounts in the freshly isolated HSC and increased gradually after culture on plastic dishes. Western blotting revealed that the freshly isolated HSC expressed very low levels of MEF2A and α-SMA. The proteins of MEF2A and α-SMA were increased gradually in the process of HSC activation. Increased MEF2A protein was correlated with α-SMA. EMSA revealed that MEF2A DNA binding activity was increased gradually during HSC activation. CONCLUSION: In the process of HSC activation, expression and activity of MEF2A are increased gradually, indicating a role in HSC activation.

Objective To study the value of dual-source CT(DSCT)in assessing aortic mechanical valve with 3D cardiovascular imaging technique.Methods Thirty-four patients with mechanical aortic valve transplantation were enrolled.Nineteen cases transplanted with On-x valve and 15 cases with St jude valre.CT scan was performed in all 34 patients and MRI scan in 30 patients.The CT imaging quality of On-x valve with St jude valve was compared by two independent samples Wilcoxon rank test.Two independent sampies test was used to compare tlle valve angle in the two kinds of valve and also in the same group.The relative functional index of left ventricle in CT and MR analysis by paired-samples t Test. Results The image quality was dirided into three grades.Six hundred and eighty phases in all 34 patients.which included 391 phases with grade 1,171 phases with grade 2 and 118 phases with grade 3.There were no significant different between two kinds of mechanical valve in image quality(image quality of grade 1:Z=-1.084,P=0.286;grade 2:Z=-0.088,P=0.945;grad 3:Z=-1.045,P=0.319).The mean bileaflet angle of 34 cases was 82.0°±4.4°in completely opening and 34.5°±5.7°in completely closing.The mean radian gradient over openess and closure was 47.5°±7.5°.The radian gradient of St iude group(55.0°±1.8°)was obviously larger than On-x group(41.5°±4.1°)(t=-11.732,P=0.000).But,there were no significant difference between dual-source CT and 1.5 T MR when evaluate the left ventrical fuction,including EF[MR.EF(57.2-1-2.8)%,CT-EF(57.9±2.8)%,f:-0.496,P=0.623],EDV[MR-EDV (121.6±9.1)ml,CT-EDV(132.9±11.2)ml,t=-1.198,P:0.240],ESV[MR-ESV(55.1±6.9)ml,CT-ESV(59.5±7.6)ml,t=-1.094,P=0.283],myocardium mass at ED[MR-Myo.mass (155.5 ±12.6)g,CT-Myo.mass(147.9±11.6)g,t=1.823,P=0.079]and CO[MR-CO(5.7±0.4)ml/min,CT-CO(5.9±0.5)ml/min,t=-3.211,P=0.775].Conclusions Dual source CT with 3D cardiovascular imaging technique is valuable and effective for evaluating aortic mechanical valve.The shape of the whole valve and movement of bileaflet reappears well.With the postprocessing software,it allows evaluating aortic mechanical valve function,reliable measurements of opening and closing leaflet angles and left ventrieal function.

Objective To evaluate the early change of left ventricular (LV) systolic function in patients with type 2 diabetes mellitus(T2DM) by ultrasound speckle tracking imaging. Methods Ninety-five subjects were included:40 T2DM with normal LV ejection fraction (LVEF≥50% ,group A),20 T2DM with abnormal LVEF (LVEF<550 %) (group B), and 35 normal controls. Two-dimensional strain images were acquired from LV short-axis view. LV peak systolic global and segmental radial strain and circumferential strain at the levels of mitral annulus, papillary muscle and apex, and LV systolic global and segmental rotation at the levels of mitral annulus and apex and LV peak systolic global twist were assessed. Results In group A, compared with control group, LV peak systolic radial strain parameters were not significant difference (P >0.05), peak systolic circumferential strain of part segments, average peak strain of each plane and global strain were reduced (P <50.05～0.001) ,and LV peak systolic rotation of all apical segments, peak systolic global rotation at the levels of mitral annulus and apex,and peak systolic global twist were significantly increased (P <0.05～0.001). Compared with control group and group A,all LV systolic radial strain and circumferential strain parameters, LV systolic global and segmental rotation and peak systolic global twist in group B were significantly reduced (P <0.05 ～ 0.001). Conclusions Speckle tracking imaging could be used to evaluate the early change of LV torsional deformation and LV systolic function in T2DM.

Objective To investigate standard diagnosis and treatment of cerebrospinal fluid (CSF) leakage to improve the prognosis of the patients. Methods A retrospective study was done on 75 patients with CSF leakage from January 2004 to March 2007 in our hospital. There were 51 patients with rhinorrhea, nine with otorrhea and 15 with wound/incision leakage. Of all, 39 patients had traumatic leakage, 32 postoperative leakage and four spontaneous leakage. In the study, 23 patients were cured by position testing and drug therapy and 16 by cerebrospinal fluid drainage and/or wound debridement but 36 were treated with surgeries including craniotomy repair in 17, extracranial repair in 17 and CSF shunt in five (three received CSF shunt after repair). Results Of all, 64 patients were cured, 10 gained im-provement but one died. Conclusion Standard diagnosis and treatment of CSF leakage helps improve cure rate and reduce complications.

Objective To investigate the prevalence of hypothyroidism during the second trimester and its relationship with thyroid peroxidase antibody (TPOAb). Methods Two thousand one hundred and forty one pregnant women whose gestational age between 14 to 28 weeks,accepted their prenatal care at the outpatient clinic of International Peace Maternity & Child Health Hospital from March 1,2010 to July 31,2010 were enrolled into this study. Serum TPOAb,thyroidstimulating hormone (TSH) and free thyroxine (FT4) of these women were detected. Logistic regression model was used to analyze the risk factors of subclinical hypothyroidism and positive TPOAb,while Spearman rank correlation was used to analyze the relationship between the levels of TSH,FT4 and TPOAb. Results (1) Subclinical hypothyroidism was detected in 13.36％ (286/2141) patients. Isolated maternal hypothyroxinemia occurs in 0.14％ (3/2141) of pregnant women.No overt hypothyroidism patient was detected and 6.26％ (134/2141) of all pregnant women exhibited positive TPOAb(≥50 U/ml).(2) Positive rate of TPOAb in subclinical hypothyroidism group,isolated maternal hypothyroxinemia group and normal thyroid function group was 13.64％ (39/286),0/3 and 5.06％ (86/1701) respectively,and there was difference among the three groups (x2 =30.82,P＜0.01).The positive rate of TPOAb did not relate to fetal gender,maternal age,gestational age,gravidity and parity.(3) TPOAb had positive relationship with TSH level (r=0.12,P＜0.01),while did not relate to FT4 level (r=-0.04,P=0.09). (4) Positive TPOAb (OR 3.18,95％ CI:2.10-4.83,P＜0.01) and gravidity (OR=1.21,95％ CI:1.02-1.43,P=0.030)were risk factors of subclinical hypothyroidism. Conclusions Hypothyroidism is common during the second trimester. It is necessary to screen TPOAb in pregnant women as TPOAb is an independent and important predictor of subclinical hypothyroidism.

Objective To explore the roles of interleukin-6 (IL-6) and high sensitive C-reactive protein (hsCRP) in coronary heart disease (CHD). Methods One hundred and fifty patients diagnosed as angina pectoris by coronary angiography were enrolled and randomly divided into unstable angina pectoris group ( UAP group n =78) and stable angina group (SAP group n =72). At the same time,50 cases with normal coronary angiography were selected as control. The plasma level of IL-6 was measured by ELISA, and hsCRP was measured by immunonephelometry. Results The mean plasma levels of IL-6 and hsCRP were significantly higher in UAP group compared with SAP group ( IL-6 ( 36. 98 ± 9. 35 ) pg/L vs. ( 23.19 ± 7. 35 ) pg/L; hsCRP ( 2. 25 ± 0. 73 ) μg/Lvs 1.88 ± 0. 68 ) μg/L; P ＜ 0. 01 respectively), both were significantly higher than those of control group ( IL-6 (16. 93 ± 6. 15 )pg/L and hsCRP (1.28 ± 0.40)μg/L,P ＜0.01 respectively). We also found significantly positive relationship between IL-6 and hsCRP plasma level ( r = 0. 875, P ＜ 0. 05 ). Conclusions Inflammatory response might play an important role in CHD. IL-6 and hsCRP were of high value in prediction of angina pectoris and development of CHD.

Objective To assess the short-axis and long-axis systolic function of the left ventricle (LV) in patients with type 2 diabetes mellitus and without coronary artery disease using two-dimensional strain echocardiography.Methods Eighty-nine subjects with normal ejection fraction were included:37 with diabetes mellitus(DM group),22 with both diabetes and left ventricular hypertrophy(DH group), and 30 normal controls.Two-dimensional strain images were acquired from the LV short-axis view at the levels of mitral annulus, papillary muscle and apex, and the apical four-chamber view, two-chamber view and long-axis views of the LV respectively.The longitudinal strain was measured in the apical views.The radial strain and the rotation were measured in the LV short-axis views.The LV twist was defined as the apical rotation relative to the base.Results The average peak systolic longitudinal strain of different segments and the peak longitudinal global strain in DM group and DH group were significantly reduced when compared with those in control groups ( P＜0.001 ),and these parameters in DH group were significantly lower than those in DM group (P＜0.001 or P＜0.05).There was no significant difference in the average peak systolic radial strain of different segments and peak radial global strain among all groups ( P＞0.05).The LV rotations and the LV twist were significantly higher both in DM group and in DH group than in control group ( P＜0.001 or P＜0.01),and the basal LV rotation and the LV twist were larger in DH group than in DM group ( P＜0.01, P＜0.05).Conclusions Two-dimensional strain echocardiography may be used to identify the LV systolic function in patients with type 2 diabetes mellitus.

Objective To assess the motion asynchrony of left ventricle(L V)wall in patients with chronic heart failure(CHF)by ultrasound two dimensional speckle-tracking imaging(2D-STI).Methods Thirty-seventy patients with CHF were divided into two groups:CHF1 group,22 with QRS≤120 ms;CHF2 group,15 with QRS ＞120 ms.Thirty healthy subjects(control group)were enrolled.2D-STI was applied to display and analyze the strain rate imaging on the three standard LV apical views and parasternal LV short-aix views,respectively.The time from the onset of QRS complexes to peak strain rate during systole(Tsrs)and early-diastole(Tsre)were measured from the longitudinal,radial and circumferential vector respectively(Tsrsl,Tsrel,Tsrsr.Tsrer,Tsrsc,Tsrec).The standard deviation of all above parameters(Tsrsl-SD.Tsrel-SD,Tsrsr SD,Tsrer-SD,Tsrsc-SI).Tsrec-SD)and the maximal temporal difference(Tsrsl-diff.Tsrel-diff,Tsrsr-diff,Tsrer-diff,Tsrsc-diff,Tsrec-diff)of 18 segments were calculated as indicator of dyssynchrony.Results The systolic dyssynehrony indices Tsrsl-SD,Tsrsl-diff,Tsrsr-SD,Tsrsr-diff,Tsrsc-SD Tsrsc-diff and diastolic dyssynchrony indices Tsrel-SD,Tsrel-diff,Tsrer-SD,Tsrer-diff,Tsrec-SD,Tsrec-diff were significantly higher in the CHF1 and CHF2 group than those in the control group(all P＜0.05).Compared with the values in the CHF1 group,the systolic indices of dyssynchrony and the radial and circumferential diastolic indicator of dyssynchrony in CHF2 group were longer(P＜0.05).Conclusions The longitudinal,radial and circumferential systolic and diastolic dyssynchrony of the LV were commonly existed in patients with CHF,regardless of QRS duration.2D-STI is a potientially useful tool to evaluate the systolic and diastolic synchrony of the LV wall motion in patients with CHF.

Objective To evaluate left atrial(LA) function in patients with prophase type 2 diabetes mellitus(T2DM) combinated with or without hypertension using left atrial volume tracking method(LAVT). Methods Thirty-one simple T2DM(T2DMI group) ,21 T2DM accompany with hypertension(T2DM2 group) and forty-five healthy subjects (control group) were enrolled in this study. Ultrasound LAVT(EUB-6500, Hitachi Medical Corporation) was applied to display and analyzed the LA volume loop imaging on the standard LV apical two and four chamber views. The maximal and the minimal LA volume (LAVmax, LAVmin) and the volume before LA contraction (LAVp) were recorded from the LA volume loop. The body surface area was used to correct these volume indexs. The LA reservoir function was assessed by calculating the total of LA filling volume (LAVItotal) and the expansion index(iLAVIe). The passive and active emptying percentage of the total emptying volume(LAVIpass, LAVIact) and the emptying index(iLAVIpass,iLAVIact) were caculated as the parameters of the LA conduit and booster pump function. Results Compared with the values in the control group, the LAVhotal,LAVIact were significantly higher and the LAVlpass,iLAVlpass were lower in the T2DM group (all P<0.05) ,while the iLAVIact was higher only seen in the T2DM2 group(P<0. 05). The LAVlact, iLAVIact were higher and the LAVIpass was lower in T2DM2 group than those in the T2DM1 group (all P<0.05). Conclusions The LA conduit hypofunction in primary in the prophase T2DM,when combinated with hypertension the LA constriction function compensatorily increased, LAVT can evaluate the function of LA in patients with T2DM accurately and rapidly.

Objective To assess the characteristics of left ventricular(LV) systolic dyssynchrony in patients with chronic heart failure (CHF) using two dimensional speckle-tracking imaging(2D-STI) and validate the correlation between LV systolic dyssynchrony and its ejection fraction (EF) measured by traditional two dimensional echocardiography. Methods Forty-two patients with CHF, which were divided into group CHF1 with 35% ＜EF≤50% and group CHF2 with EF≤35%, and 35 healthy subjects as control group were enrolled in this study. Two-dimensional echocardiography Simpson's method was used to measure EF of LV. The time from the onset of QRS complexes to systole peak strain rate from the longitudinal, radial and circumferential vectors(Tsrsl, Tsrsr, Tsrsc)was recorded and measured using 2D-STI, respectively. The standard deviation and the maximal temporal difference of Tsrsl, Tsrsr, Tsrsc (Tsrsl-SD,Tsrsr-SD,Tsrsc-SD,Tsrsl-diff,Tsrsr-diff, Tsrsc-diff)of 18 segments were calculated as indicator of LV systolic dyssynchrony. Results The indices of LV systolic dyssynchrony Tsrsl-SD,Tsrsl-diff, Tsrsr-SD, Tsrsr-diff,Tsrsc-SD,Tsrsc-diff in group CHF1 and CHF2 were significantly higher than those in the control group (P<0.05). Compared with group CHF1, those indices in CHF2 were significantly longer (P<0.05). Meanwhile, Tsrsl-SD, Tsrsr-SD, Tsrsc-SD(r = - 0.904～0.912, all P<0.05) and Tsrsl-diff, Tsrsr-diff, Tsrsc-diff(r = - 0.916～0.967, all P<0.01) had singnificantly negative correlations with LVEF, and the correlation coefficients between radial and circumferential 2D-STI dyssynchrony parameters and LVEF were higher than those between the longitudinal parameters and LVEF. Conclusions 2D-STI is a useful modality to evaluate the LV systolic asynchrony of the CHF and there is a good correlation between LVEF and the LV systolic dyssynchrony indices derived from 2D-STI.