Objective To evaluate the value of two-dimensional strain imaging in assessing right ventricular function of recipient fetus in TTTS pregnancies.Methods Sixteen TTTS pregnancies and 19 normal monochorionic diamniotic pregnancies(controls) were included.Doppler studies of the umbilical artery,umbilical vein,ductus venosus,middle cerebral artery,atrioventricular valve and semilunar value were recorded in both fetus,and myocardial performance index of both ventricles was calculated.Longitudinal peak systolic strain of right ventricular were calculated and compared between recipient fetus and other fetus.Results Cardiothoracic ratio and myocardial performance index of right ventricular showed significant differences between recipient fetus and controls.Right ventricular strain was decreased in recipient fetus compared with controls.Conclusions Two-dimensional strain imaging can be used to evaluate right ventricular myocardial function in the recipient fetus of TTTS.

Objective To establish a knowledge management skills evaluation tool for nursing undergraduates and then try to provide an objective basis for evaluation of their knowledge management skills.Methods After reviewing literature and research group discussion,defining the theoretical dimensions of the knowledge management skills system and developing this evaluation tool.A total of 1 139 nursing undergraduates were picked out and investigated.The data were analyzed with the SPSS 20.0 and AMOS 7.0 statistic software packages,including exploratory factor analysis,confirmatory factor analysis,reliability and validity analysis.Results The knowledge management skills evaluation tool of nursing undergraduates was a multilayered and multidimensional system,including 3 subscales (knowledge management cognition,knowledge management attitude,knowledge management behavior),8 factors (the cognition of knowledge management connotation,the intention and the belief of knowledge management,the ability of obtaining,storing,sharing,applying and innovating knowledge),36 items.Exploratory factor analysis showed that all items' factor loading were 0.433-0.851.Confirmatory factor analysis displayed a good degree of fitting.The total scale's Cronbach α was 0.933,sub-scales were 0.807-0.892.The total scale's split coefficient was 0.873,sub-scales were 0.700-0.870.The correlation coefficient between 3 sub-scales score and the total scale score were 0.875-0.912.Conclusions Because of its good reliability and validity,nursing undergraduates can evaluate their knowledge management skills by using this evaluation tool.

Objective To evaluate the application of echocardiography in the diagnosis of bicuspid aortic valve and its pathophysiologic development and to demonstrate the degree of aortic valve dysfunction. Methods The echocardiographic characteristics and clinical data were analyzed retrospectively in 135 patients with bicuspid aortic valve to demonstrate the variation of aortic valve dysfunction in the progression of the course of the disease. Results Isolated aortic regurgitation was present in 68 (50%) patients, 19 (14%)patients had isolated aortic stenosis and 29 (22%)patients had combined aortic stenosis and regurgitation, 19 (14%) patients had neither stenosis nor regurgitation. Aortic regurgitation were all more commen within each age group, aortic regurgitation were also more commen within each age group in patients in their advanced course who went to surgical treatment. Conclusions Echocardiography is an effective method in the early diagnosis of aortic valve dysfunction.

two-dimensional strain echocardiography can observe dynamic change of regional systolic function,combined with the two methods can more accurately assess the treatment results of coronary artery bypass surgery.

The clinically applied value of myocardial perfusion and systolic function in patients with coronary artery disease after coronary artery bypass surgery using real-time myocardial contrast echocardiography (RT-MCE) combined with two-dimensional strain echocardiography was assessed. Twenty patients underwent intravenous RT-MCE by intravenous injections of SonoVue before and after coronary artery bypass surgery. Two-dimensional images were recorded from the left ventricular four-chamber view, two-chamber view and the apical view before, and two weeks and three months after coronary artery bypass surgery, and the peak systolic longitudinal strain was measured. The results showed that myocardial perfusion was significantly increased after coronary artery bypass surgery in about 71.6% segments. In the group that myocardial perfusion was improved, the peak systolic longitudinal strain three months after bypass surgery was significantly higher than that before operation [(-15.78+/-5.91)% vs (-10.45+/-8.31)%, P<0.05]. However, the parameters did not change in the group without myocardial perfusion improvement [(-10.33+/-6.53)% vs (-9.41+/-6.09)%, P>0.05]. It was concluded that whether or not the improvement of myocardial perfusion can mirror the recovery trend of regional systolic function, two-dimensional strain echocardiography can observe dynamic change of regional systolic function. The combination of myocardial perfusion with two-dimensional strain echocardiography can more accurately assess the curative effectiveness of coronary artery bypass surgery.

Objectives To investigate the expression and clinical significance of HOXA10 gene in the eutopic and ectopic endometrium of endometriosis.Mehtods Between Jan.2009 to Aug.2010,30 patients with endometriosis undergoing laparoscopic surgery in Maternal and Children's Hospital of Foshan.Eutopic and ectopic endometrium were obtained.In the mean time,30 patients with benign ovary cyst or tubal infertihty undergoing laparoscopic surgery were selected as controls.Their uterine endometrium were obtained real-time fluorescent quantitation,western blot and immunohistochemistry technique were used to detect mRNA and protein expression of HOXA10 gene in the eutopic endometrium group,ectopic endometrium group and control group.Results The mRNA and protein expression of HOXA10 gene were 0.61 ±0.07 and 0.47 ±0.05 in the eutopic endometrium of endometriosis,0.64 ±0.06 and 0.50 ±0.05 in ectopic endometrium of endometriosis,which were significantly lower than 1.22 ± 0.14 and 1.42 ± 0.14 in control group ( P ＜ 0.01 ).However,the mRNA and protein expression of HOXA 10 between eutopic and ectopic endometrium of endometriosis did not reach statistical difference ( P ＞ 0.05 ).The expression of HOXA10 in eutopic and ectopic endometrium of endometriosis were decreased by immunohistochemistry staining.Conclusion The lower expression of HOXA10 gene in the eutopic and ectopic endometrium of endometriosis might be associated with pathogenesis and infertility of endometriosis.

Objective To evaluate the dyssynchrony of left ventricle in patients with coronary artery disease(CAD) by two-dimensional strain echocardiography (2-DS). Methods The myocardium of left ventricle of 33 patients with CAD and 30 nomal controls were detected by 2-DS. The time from onset QRS complexes to peak systolic longitudinal strain(Ts) and the standard deviation of Ts of 18 left ventricular segments (Ts-SD)were measured. Results There were 168 segments whose flow was provided by coronary artery with stenosis≤75% ,210 segments whose flow was provided by coronary artery with stenosis 75 %. ①Ts was delayed significantly and Ts-SD was obviously higher in patients with stenosis≥75% when compared with the control group. ②Ts was delayed and Ts-SD was higher in patients with stenosis≥75% compared with those whose stenosis was ≤75%. ③There were no statistical differences in Ts and Ts-SD between the patients with stenosis ≤75% and the control group. ④When left ventricular systolic dyssynchrony was defined as Ts-SD≥33.0 ms, there were 22 patients with systolic dyssynchrony of all 26 patients whose coronary artery stenosis≥75%, there were no patient with systolic dyssynchrony of all 7 patients whose stenosis ≤75%. Conclusions Although there are no evident regional wall motion abnormalities by routine echocardiography,in patients with severe coronary artery stenosis,2-DS can detect exactly the dyssynchrony of left ventricle.

Objective To evaluate the effectiveness and safety of ultrasound-enhanced thrombolysis for acute ischemic stroke.Methods Fifty stroke patients with acute middle cerebral artery occlusion were randomly divided into either a ultrasound-enhanced thrombolysis group (recombinant tissue-plasminogen activator [rtPA] +2 MHz ultrasound monitoring for 2 h) or a standard thrombolysis group (rtPA alone).The demographic characteristics,vascular risk factors,blood pressure before treatment,thrombolysis in brain ischemia (TIBI) grade before thrombosis,and vascular occlusion site of the patients were collected.The primary outcome endpoint was the good outcome rate (defined as the modified Rankin Scale score 0-1) at 3 months.The secondary outcome endpoints were complete recanalization at 2 h after thrombolysis,sustained complete recanalization,symptomatic intracerebral hemorrhage,and mortalitY.Results The good outcome rate of the ultrasound-enhanced thrombolysis group at 3 months after treatment was significantly higher than that of the standard thrombolysis group (64％ vs.36％;P=0.011).The sustained complete recanalization rate (40％ vs.8％;P =0.018) and complete recanalization rate (48％ vs.12％;P =0.012) of the ultrasound-enhanced thrombolysis group were significantly higher than those of the standard thrombolysis group,but there were no significant differences in the reocclusion rate (8％ vs.12％;P =0.637),incidence of symptomatic intracerebral hemorrhage (4％ vs.4％;P=1.000),and mortality (4％ vs.4％;P=1.000) compared with the standard thrombolysis group.Conclusions Ultrasoundenhanced thrombolysis can improve the sustained complete recanalization rate,complete recanalization rate,and good outcome rate after using rtPA within 2 h,and it does not increase the risks of symptomatic cerebral hemorrhage and death.It is a safe and effective adjunctive thrombolytic therapy.

BACKGROUND:Abnormal hippocampal neurogenesis during aging has been reported to result in learning and memory dysfunction. But its mechanism is unclear.
OBJECTIVE: To understand the changes of mouse neurogenesis in the hippocampal subgranular zone during aging.
METHODS:C57BL/6 mice 2, 6 and 20 months of age were used. Immunochemistry was used to count the number of neural stem cels (nestin+), neuroblasts (Doublecortin+, DCX+), and proliferative cels (proliferating cel nuclear antigen+, PCNA+) in the hippocampal subgranular zone. mRNA expressions of aging-related genes, p19Arf and p21Cip1/Waf1, in the hippocampus were detected by reverse transcription-PCR.
RESULTS AND CONCLUSION: Compared with the young and middle age groups, the number of PCNA+ cels, nestin+ and DCX+ cels in the hippocampal subgranular zone of the aged group decreased dramaticaly; the expression of p19Arf and p21Cip1/Waf1 mRNA increased in the aged group. Proliferation activity, the number of neural stem cels and neuronal differentiation al decreased. These findings indicate that the decline of hippocampal neurogenesis may be associated with increased expression of aging-related genes p19Arf and p21Cip1/Waf1 in the p19Arf-Mdm2-p53-p21Cip1/Waf1pathway.

Objective To explore the clinicopathologic features,diagnosis,treatment and prognosis of ACTH-independent subclinical Cushing syndrome caused by cortisol-secreting and hypo-androgen black adrenal cortical adenomas with lipomatous metaplasis.Methods The clinical and pathologic features of 1 patient presented with hypo-androgen and atypical signs and symptoms of Cushing syndrome were reported.The patient's 24 h UFC (235.62 μg) was higher than normal range,his plasma ACTH concentrations (＜1.1 pmol/L,was lower than normal range and his serum cortisol concentrations lacked diurnal rhythm.There was absence of serum cortisol suppression in overnight dexamethasone suppression tests.Serum levels of androgens (1.2 nmol/L) were lower than normal range.24 h urine catecholamine was normal,NE was 160.5 nmol/24 h (5-591 nmol/24 h),E was 23.1 nmol/24 h (0-82 nmol/24 h),DA was 1496nmol/24 h (424-2612 nmol/24 h).Aldosterone lying and standing test:ALD1 138-415 pmol/L,AT-Ⅱ1 64.54 ng/L,PRA1 0.80 μg · L-1 · h-1 Abdomen CT showed right adrenal mass (3.1 cm).131Ⅰ-MIBG scanning was normal.Adrenocortical carcinoma was considered as a possible diagnosis based on cortisol hypersecretion,hypo-androgen and the imaging characteristics.This patient accepted laparoscopic adrenal adenoma resection.Results The adrenal tumor size was 3.5 cm.Immunohistochemical (IHC) staining showed Melan-A,CgA,α-inhibin and Syn positive and Ki-67 ＜ 1％.Histopathologic results showed black adrenal cortical adenomas with myelolipomatous change.After surgery,patient's serum androgen was normal,and the signs and symptoms of Cushing syndrome and oligo-androgen disappeared.There was recurrence after 1.5 years follow-up.Conclusions Although most patients with corticotropin-independent Cushing syndrome associated with abnormal androgen proved to have adrenocortical carcinoma,the clinician should be aware of the possibility of benign,black adrenal adenoma.