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.

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 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 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 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.

Objective To evaluate the changes of left ventricular (LV) bulk rotation and untwisting in transplanted hearts using 2-dimensional speckle tracking imaging(STI).Methods Basal and apical LV short-axis images were acquired in 15 heart transplant recipients 3 months post surgery(HT group) and 56 healthy control subjects.Basal and apical rotation versus time profiles were drawn using 2-dimensional STI software.Appropriate values were chosen from the dataset obtained and compared between two groups.Results ①Compared with the control group,the heart rate,anterior-posterior diameter of left atrium,enddiastolic interventricular septum thickness,left ventricular posterior wall thickness,isovolumic relaxation time and E/e ratio were significantly increased,e and a values were decreased significantly in HT group (P ＜ 0.05).② No significant difference was noticed in the peak degrees of LV bulk rotation,the degrees of LV bulk rotation at the time of aortic valve closure and mitral valve opening (P =0.700,0.984,0.495,respectively) between 2 groups.In both groups,systolic rotation reached its maximum at end-systole [(96.1 ± 8.4) ％ in HT group vs (100.5 ± 6.3) ％ in control group,P =0.065].③Significant decreases in untwisting rate and trend untwisting variables were observed in the HT group(P ＜0.001).Conclusions 3 months after transplanted,left ventricular bulk rotation of cardiac allografts remained normal,and significant decreases in both untwisting rate and trend untwisting variables showed that the diastolic function of cardiac allografts was impaired.

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 correlation between left ventricular function and arterial stiffness of left femoral artery in patients with lower extremity atherosclerotic disease (LEAD).Methods Thirty-three patients with LEAD and 37 healthy subjects (control group) were enrolled in this study.The intima-media thickness (IMT),diameter and parameters of arterial stiffness [dispensability coefficient (DC),compliance coefficient (CC),stiffness α,stiffness β,pulse wave velocity (PWVβ) ]were measured by ultrasonography with the technology of QIMT and QAS.The thickness of the interventricular septum (IVSd),end-diastolic left ventricular diameter (LVDd) and left ventricular mass (LVM),and parameters of the left ventriculsr function (EF,E/A,E'/A',E/E' and Tei index) were measured by echocardiography.These parameters were compared between two groups.Correlations between the parameters of the arterial stiffness and those of the cardiac function were evaluated by Pearson correlative analysis.Results ①The IVSd,LVM and E/E' ratio were significantly higher in LEAD group than those in control group ( P ＜0.05).There were no significant differences in EF,E/A,E'/A',and Tei index between two groups ( P ＞0.05).②The IMT,α,β,PWVβ of left femoral artery were significantly higher in LEAD group than those in control group,while DC and CC were significantly lower in LEAD group than those in control group ( P ＜0.05).③The E/E' ratio,one of the parameters representing the left ventricular diastolic function,was correlated negatively with CC and positively with α,β,and PWVβ ( P ＜0.05 or P ＜0.01 ).The E'/A' ratio was correlated positively with DC and CC,and negatively with α,β,and PWVβ ( P ＜0.05 or P ＜0.01 ).Both EF and Tei index were not significantly correlated with the above parameters of arterial stiffness ( P ＞0.05).Conclusions Patients with LEAD have thickened femoral IMT,higher arterial stiffness of left femoral artery,as well as impaired left ventricular function.There is a close correlation between the atherosclerosis of the femoral artery and the early left vcntricular dysfunction.

Objective To evaluate the structural and elastic changes of the arteries of chronic kidney disease (CKD) patients before dialysis by echo-tracking technique.Methods Thirty-nine CKD patients were enrolled in the study before dialysis and subdivided into CKD stage 2-3 group (n =19) and CKD stage 4-5 group (n =20).Forty age matched healthy subjects were selected as the control group.The parameters of arterial structural and stiffness such as intima-media thickness (IMT),stiffness parameter (β),pressure strain elastic modulus(Ep),arterial compliance(AC),augmentation index(AI),carotid pulse wave velocity (PWVβ),carotid-femoral pulse-wave velocity (PWVcf),carotid diameter (D) were measured by echotracking technique and compared among groups.Stepwise multiple linear regression analysis was performed to identify the associated factors of arterial stiffness.Results Compared with healthy group,PWVcf and Dwere significantly increased in CKD stage 2-3 group (P ＜0.05,P ＜0.001),PWVβ significantly increased in CKD stage 4-5 group(P ＜0.05) ;when compared CKD4-5 group with CKD2-3 group,PWVcf and D were significantly increase in CKD stage 4-5 group(P ＜0.05,P ＜ 0.001).The results of stepwise multiple regression analysis demonstrated that the age and estimated glomerular filtration rate (eGFR) were independent impact factors of PWVcf.Conclusions Echo-tracking technique can assess the structural and stiffness changes of arteries in patients with CKD in the early stage and provide valuable information for clinical management.

Objective To explore the value of echocardiography in the diagnosis of the parachute mitral valve(PMV).Methods The echocardiographic characteristics of 12 patients with PMV between 2005 and 2012 were reviewed retrospectively,including the morphology,movement and blood flow of mitral valve apparatus,and other associated cardiac abnormalities.Results Of the mitral valve leaflets in these 12 cases,all were thickened and opened restricted in diastole.Axial view showed that in all cases mitral valves opened eccentrically and in 2 cases they didn't close tightly.Each patient only had single papillary muscle in left ventricle,which received all chords of mitral valves.Of papillary muscles in these patients,4 were located at posteromedial wall,3 at anterolateral wall,2 at middle posterior wall,2 at apical wall,and 1 at posterolateral wall.Of the 12 patients,only one were simple PMV,11 had associated cardiovascular anomalies,2 had mild regurgitation in systolic period and 11 had increased trans-valve peak flow velocity.Conclusions Echocardiography is reliable in the diagnosis of PMV,which could provide a comprehensive evaluation of valvular lesions and other associated cardiovascular anomalies.