Objective To determine the biomechanical parameters of left ventricular by using velocity vector imaging (VVI),and to indirectly assess the coronary artery stenosis with VVI in the patients with coronary artery disease (CAD).Methods 52 patients who had one coronary artery lesions at least diagnosed by coronary angiography (CAG)were divided into coronary artery mild stenosis group and severe stenosis group;2 1 patients in mild stenosis group had one coronary stenosis <75%;31 patients in severe stenosis group had one coronary artery stenosis ≥75% at least.At the same time,20 cases of normal people without coronary artery stenosis showed by CAG were selected as normal control group. VVI was used to detect the left ventricular wall segments of the overall longitudinal strain (GLS ), the overall circumferential strain (GCS ) and the overall radial strain (GRS ). Results The absolute values of GLS,GRS,GCS of the patients in mild and severe coronary artery stenosis groups were significantly decreased than those in normal control group(P<0.05),and the strain parameters in severe stenosis group were decreased more significantly, there were significant differences compared mild stenosis group (P<0.05 ). The distribution of the segments with decreased longitudinal strain matched the LV myocardial segment with the coronary stenosis rate ≥ 75%,and GLS had the most sensitivity.The GLS in normal control group,mild stenosis group and severe stenosis group were negatively correlated to left ventricular ejection fraction (LVEF)(r=-0.58,P<0.05;r=-0.51,P<0.05;r=-0.43,P<0.05).GLS-16.14 % was used to assess the severe coronary artery stenosis with requiring the implementation of PTCA treatment as the diagnostic cut-off point with sensitivity 96.8%, specificity of 70%, the highest Yuedden index 0.668. Conclusion The decreasing of left ventricular strain could be detected by VVI, which suggests that severe coronary artery stenosis exists in coronary artery;the distribution of the segments with significantly decreased strains can be used to assess the coronary lesions and stenosis degrees.

Objective To investigate the value of Doppler ultrasound in the eady diagnosis,monitoring and assessing of renal damage in neonatal asphyxia.Methods A total of 60 cases of neonates within 24 h were divided into severe asphyxia group (Apgar score 0-3),mild asphyxia group (Apgar score 4-7) and healthy control group (Apgar score 8-10) according to Apgar score at 1 min after born.Then the peak systolic velocity (PSV),end diastolic velocity (EDV) and resistance index (RI) of renal artery were obtained by Doppler ultrasound within 24 h,on day 3,day 7,and day 10.The level of serum cystain C (sCysC) was also recorded accordingly.Results Within 24 h,compared with healthy control group,the PSV and EDV in severe asphyxia group and mild asphyxia group decreased (all P＜0.05),while RI increased (all P＜0.05).The PSV in mild asphyxia group returned to normal in 3 days,EDV and RI returned to normal in 10 days,there were no statistically significant difference compared with healthy control group (all P＞0.05).The PSV,EDV and RI in severe asphyxia group were still significantly differences compared with healthy control group on day 10 (all P＜0.05).Within 24 h and on day 3,sCysC in the mild asphyxia group increased obviously compared with healthy control group (both P＜0.05).On day 7 and day 10,the differences of sCysC was not statistically significant between mild asphyxia group and healthy control group (both P＞0.05).Compared with healthy control group,the sCysC in severe asphyxia group increased significantly (all P＜0.05) on every time point.PSV and EDV were negatively correlated with sCysC,RI was positively correlated with sCysC.Conclusion Changes in renal function can be reflected soon by index of renal blood flow PSV,EDV and RI.

Objective To validate the accuracy of real-time three-dimensional echocardiography(RT3DE) in measuring spatial geometric parameters of mitral annulus.Methods Hearts in vivo of nine healthy hybrid canines were examined by RT 3DE.Three-dimensional full-volume images of mitral annuli were acquired.The annuli were annotated and measured by TomTec 4D MV-assessment software and MATLAB.The distance between anterolateral and posteromedial commissure (commissure-commissure, CC),septolateral distance (septal-lateral, SL) and height (H) of mitral annulus were measured.Parameters correlation coefficients of CC,SL and H derived by two methods were 0.83( P＜0.01),0.78( P＜0.05)well consistent with anatomic measurements, the mean differences of CC, SL and H between two methods were 0.22 cm,0.12 cm and-0.08 cm respectively.Conclusions RT-3DE is feasible in measuring mitral annulus, which provided a convenient, accurate and reliable new method for quantitative assessing annulus geometry configuration.

Objective To apply the real-time gray scale contrast-enhanced ultrasonography(CEUS) with quantitative analysis technique to monitor the change of the renal cortex blood perfusion before and after Salvia miltiorrhiza treatment of rabbit renal is-chemia-reperfusion injury and to investigate the application value of the ultrasound contrast for evaluating the effect of medication in the treatment of rabbit renal ischemia-reperfusion injury (IRI) .Methods The rabbit right kidney was resected and the left renal pedicle was occluded for 60 min ischemia ,then the perfusion was recovered for establishing the IRI model .Salvia miltiorrhiza injec-tion was given for observing the pathological changes of the left kidney and the renal cortex blood prefusion under the contrast-en-hanced ultrasonography .The parameters of renal cortex blood perfusion were quantitatively analyzed by the time-intension curves . Results After IRI occurrence ,the time-intensity curve (TIC) of the rabbit renal cortex was slowly ascended .The time to peak (TTP) was extened and the rising slope(Grad) of the curve ascending branch was declined (P< 0 .05);after Salvia miltiorrhiza treatment ,TTP decreased and Grad increased obviously(P<0 .05) .Conclusion CEUS combined with quantitative analysis can re-flect the renal blood perfusion abnormity caused by ischemia-reperfusion and discover the change of the renal blood perfusion after medication treatment .

In order to better construct important diseases of traditional Chinese medicine ( TCM ) clinical re-search base , and strengthen the construction of medical and clinical research of TCM information sharing sys-tem, Hubei Provincial Hospital of Traditional Chinese Medicine has constructed research type clinic. The con-struction idea of research type clinic is the mode of real world TCM clinical research . The construction of research type clinic mode was from three aspects, which were the clinical research, health management and distinctive diagnosis and treatment .

Objective To evaluate left ventricular geometry and function in elderly type 2 diabetic patients with normal and high pulse pressure by using three-dimensional speckle-tracking echocardiography (3DSTE).Methods A total of 76 elderly non-hypertensive type 2 diabetic patients were divided into type 2 diabetic combined with high pulse pressure group (n=36;24 h pulse pressure ≥60 mmHg) and type 2 diabetic combined with normal pulse pressure group (n=40).Forty age-and sex-matched healthy volunteers with normal 24 h pulse pressure were recruited as control group.3DSTE was performed in all participants.Results Significant differences in left ventricle geometry were found among the three groups (x2 =8.428,P=0.015),and concentric geometry was most prevalent in type 2 diabetic patients with high pulse pressure group.Global longitudinal strain in type 2 diabetic patients with normal pulse pressure group was significantly lower than that of control group (P＜0.001).The type 2 diabetic combined with high pulse pressure group showed severely lower strain values in all directions compared with control group and type 2 diabetic combined with normal pulse pressure group (all P＜0.05).Conclusion 3DSTEC can detect subclinical cardiac abnormalities in elderly type 2 diabetic patients with normal and high pulse pressure.

Objective To evaluate the long-term outcome of fully covered self-expandable metal stents(FCSEMS)for the treatment of benign biliary strictures(BBS). Methods Between June 2008 and September 2013, 68 patients with BBS receiving endoscopic retrograde cholangiopancreatography and FCSEMS placement were retrospectively enrolled. Data of endoscopic treatment, stricture resolution and recurrence were collected, and related risk factors were analyzed. Results FCSEMSs were successfully placed in all patients and removed in 93.4%(57/61). The median stent duration was 9.0(range 0.2-37.1)months. Stricture resolution occurred in 74.2%(46/62)patients. During median follow-up of 54.0 (range 2.5-96.0)months,stricture recurrences were seen in 16.7%(6/36)patients. Multivariate analysis revealed that distance between stricture and hepatic bifurcation of less than 1.5 cm(P=0.034,OR=6.395, 95%CI:1.153-35.464), and stent migration(P= 0.024, OR= 0.153, 95%CI:0.030-0.782)were significant risk factors for stricture resolution. Meanwhile, the stricture length longer than 1.0 cm(P=0.028, HR = 6.766, 95% CI:1.233-37.122)was a significant risk factor for stricture recurrence. Conclusion Endoscopic treatment combined with FCSEMS can achieve excellent efficacy in resolving BBS with low recurrence rate. However, location and length of BBS, as well as stent migration may impair its effectiveness.

Objective:To explore the protective effect of puerarin on hypoxia/reoxygenation (H/R)-induced acute kidney injury(AKI)in vitro.Methods:HK-2 cells were treated with H/R for simulating ischemia reperfusion injury(IRI)in vivo. The experimental groups included control group, H/R treatment group(0/6/12/24 h), H/R 24 h + puerarin treatment group(puerarin, Pue), H/R 24 h + Pue+ 3-methyladenine(3-MA)treatment group and H/R 24 h+ 3-MA treatment group. Immunoblotting was employed for detecting the expression changes of autophagy-related proteins, CCK-8 for examining cell proliferation, electron microscopy for observing autophagosome formation and TUNEL for detecting apoptosis.Results:As compared with control group, the expression of LC3-II rose in H/R 24 h group, the expression of autophagy marker P62 declined, count of autophagosome increased, cell viability decreased and cellular inflammation occurred. Puerarin had similar effects to 3-MA. As compared with H/R 24 h group, puerarin could reverse the changes in the expression levels of LC3 and P62 induced by H/R( P<0.05). There were greater cell viability, reduced autophagosome count and lessened cell apoptosis( P<0.05). At the same time, protein expression levels of HMGB1, TLR4 and NF-κB dropped( P<0.05). Conclusions:Puerarin suppresses autophagy through HMGB1/TLR4/NF-κB axis for lessening ischemia-reperfusion injury an in vitro model.

Objective:To study the learning curve and inflection point of robot-assisted L 4 and L 5 pedicle screw insertion for lumbar spondylolisthesis. Methods:A retrospective study was conducted on the data of 43 patients with L 4 and L 5 pedicle screw insertion for lumbar spondylolisthesis from January 2016 to December 2020 using surgical robot, including 19 males and 24 females, aging 59 (48, 66) years old. According to Meyerding classification, there were 23 grade I slippage, 18 grade II slippage, and 2 grade III slippage. The screw deviation and screw accuracy grade were assessed. The operation time, intraoperative blood loss, the number of intraoperative fluoroscopies, postoperative complications, and postoperative hospital stay were recorded. Cumulative Sum (CUSUM) was used to analyze the learning curve, and the learning curve is divided into early and late learning stages according to morphology. T test and Wilcoxon rank-sum test were used for statistical analysis and comparison of indicators between early and late learning stages. Results:43 patients with lumbar spondylolisthesis successfully completed the operation, with 60 L 4 pedicle screws and 70 L 5 pedicle screws inserted. The accuracy of L 4 pedicle screw placement began to improve since the 23rd placement, and the accuracy of L 5 pedicle screw placement began to improve since the 20th placement. Using the 23rd pedicle screw (the 14th patient) to divide the learning curve as the early stage and the late stage. There was no statistically significant difference in the operation time (225.0±74.0 min vs. 207.0±81.2 min, t=0.65, P=0.521), intraoperative blood loss[200 (75, 500) ml vs. 100 (60, 200) ml, Z=1.30, P=0.195], the number of intraoperative fluoroscopies[10 (6, 10) vs. 10 (6, 10), Z=-0.37, P=0.712] and postoperative complications (8% vs. 0, P=0.302) between the early stage and late stage of learning curve. In the late stage of learning, the postoperative hospital stay was shorter[4.5 (3, 6) d vs. 6.0 (5, 9) d, Z=2.00, P=0.046]and the pedicle screw insertion accuracy was higher[L 4: 1.33 (1.06, 1.79) mm vs. 2.23 (1.12, 4.55) mm, Z=2.43, P=0.015; L 5: 1.47 (0.98, 1.87) mm vs. 3.21 (1.64, 4.87) mm, Z=3.90, P=0.001]. The accuracy of screw placement was similar between the early and late stages[L 4: 95%(21/22) vs. 97%(37/38), P=1.000; L 5: 91%(20/22) vs. 96%(46/48), P=0.585]. Conclusion:Robot-assisted L 4 and L 5 pedicle screw placement in the treatment of lumbar spondylolisthesis had a relatively obvious learning curve. Starting from the placement of the 23rd screws, the accuracy of screw placement gradually increased.

Objective To develop a newly transparent sheath and explore the application value of the sheath in neuroendoscopic intra-axial surgery Methods Sixty-eight patients,admitted to our hospital from August 2010 to February 2013,underwent endoscopic surgery with the help of new sheath.Pre-operated CT or MRI were performed to locate the puncture direction;the transparent sheath was used to provide a trajectory in the brain parenchyma,and offer the clear vision surround the sheath tube and the puncture direction.Results Forty-eight patients adopted lateral ventricle anterior horn approach and 46 (95.83％) achieved lesions in the first puncture.Three patients with septum pellucidum cyst and one with Monro obstruction were successfully received the cystic wall fenestration or recanalization with the sheath directly.After the entry point were determined with CT in 10 intracerebral hematoma,the sheath was inserted into the hemorrhage cavity simply and easily;and a smash-suction tube was inserted to evacuate the hematoma safely.Conclusion The transparent sheath can be inserted into lateral ventricle,hemorrhage cavity or cyst efficiently,and provide perfect surgical vision around the sheath and the puncture direction to estimate the brain parenchyma,hemorrhage cavity or the hemorrhage remains;therefore,this transparent sheath,as a safely neuroendoscopic intra-axial surgical instrument,is deserved to be spread.