Objective To explore the value of echocardiography in percutaneous left atrial appendage (LAA)closure for stroke prevention in patients with nonvalvular atrial fibrillation during procedure and for short-term follow-up.Methods Twenty patients were enrolled to undergo percutaneous LAA closure with the LAmbre device.Rheumatic valvular diseases were excluded by transthoracic echocardiography (TTE) and transesophageal echocardiography(TEE)before the closure procedure.TEE was performed during the procedure for the trans-septal puncture and the release of the closure device.Combined TEE with angiographic measurements,guidance for the optimal device size was provided.The closure effect and procedure-related complications were observed immediately by TEE and also evaluated by TTE at 1-day and 1-month follow-up.Results All patients underwent LAA occlusion successfully.TEE color Doppler evaluation have shown nine patients with complete closure immediately,one with a ≤ 1 mm residual LAA leak,and ten with a 1 -3 mm jet.There were no other complications during the procedure.One day after the closure,small pericardial effusions were observed for three patients while two of the three were free of the pericardial effusion at the 1-month follow-up.During the short-term follow-up,no damage was found at any anatomical structures near LAA due to the closure process,and there was no significant difference of cardiac function before and after the procedure.Conclusions With the guidance of TEE,the successful rate of percutaneous LAA closure procedure was preferable and the occurrence rate of compliance was acceptable. And TTE played an important role in patients'short-term follow-up.

Objective To observe the dynamic changes of vascular endothelial growth factor (VEGF) levels in the patients with acute intracerebral hemorrhage during different phases and study the relationships between the VEGF levels and the volume of hemorrhage or stroke severity. Methods Fifty-six patients with acute intracerebral hemorrhage were divided into three groups by the volume of hemorrhage:group A(＜ 20 ml,23 caees),group B(20-30 ml, 18 cases),group C(＞ 30 ml, 15 cases) and light group (1-15 scores,22 cases),midrange group (16-30 scores,20 cases),severe group (31-45 scores, 14 cases)by China stroke scale (CSS) score in 24 hours of hospitalization. The serum VEGF level was determined at 24 h,48 h,72 h,7 d and 14 d after the onset of disease by enzyme linked immunosorbent assay(ELISA).Results The serum levels of VEGF during different phases (within 24 h,48 h,72 h,7 d,14 d) had statistical differences between group A and group C (P ＜0.01). Within 24 h,48 h,72 h,7 d,there was statistical difference between group B and group C (P ＜0.01).Within 48 h,72 h,7 d,14 d,there was statistical significance between group A and group B (P＜ 0.05). The serum levels of VEGF during different phases(24 h,48 h,72 h,7 d, 14 d) were higher in severe group than those in light group(P＜ 0.01). Within24 h,48 h,72 h,7 d,there was statistical difference between severe group and midrange group (P＜ 0.01).Within 48 h, 72 h, 7 d, 14 d, there was significant difference between midrange group and light group (P ＜0.05). The volume of hemorrhage had positive correlation with the CSS scores of neurologic impairment on admission (r = 0.916, P ＜ 0.05). Conclusion The serum VEGF levels might be related to the volume of hemorrhage and the severity of the disease.

Objective serous endotoxin(ET) were measured to determine the relationship between serous endotoxin and differ‐ent type of intestinal obstruction in children .Methods 25 inguinal hernia patients and 43 intestinal obstruction patients were classi‐fied into control group(n=25) ,incomplete intestinal obstruction (n=20) and complete intestinal obstruction group without necrosis of intestine (n=23) according to degree of obstruction .Serous endotoxin were measured in different time (the day of admission ,one day after admission or ,preoperation and one day postoperation ) ,and t test is used to determine the difference between them . Results ET in different group was(6 .53 ± 14 .96) ,(4 .40 ± 1 .15) ,(4 .20 ± 1 .20) ,(4 .09 ± 1 .31) ,(3 .70 ± 1 .46)EU/mL ,respec‐tively .There were no difference between each group .Conclusion ET examination suggests there is no difference between different type of intestinal obstruction in children and endotoxemia is not found in intestinal obstruction according to the results .

Objective To create an left atrial appendage(LAA) occlusion preoperative simulation system by three dimensional transesophageal echocardiography(3DTEE) and three dimensional printing (3DP),and simulate the process of LAA occlusion including the selection and deployment of devices,leaks around devices and the compression rate of the devices in vitro.Methods Fifteen cases of LAA occlusion in patients with atrial fibrillation were selected in this study. Preoperative and intraoperative TEE was performed to acquire the volume data of LAA.Replicas of LAAs were created by 3DP.Then the simulation system was created by 3DTEE and the models.The models were scanned by 3DTEE to evaluate the accuracy of models,leaks around devices and the compression rate of the devices.The results were compared with intraoperative measurements.Results 3DP models of 15 patients were created based on the 3DTEE data.There was no significant difference in the values of measurements between models and cases in vivo by 3DTEE and there were agreements between these two methods.The compression rate of devices was higher in models than in case(P =0.04).Compression rate in models correlated with that in cases (r =0.949, P < 0.01).Four cases were observed with leaks in 3DP models and 6 cases were observed with leaks intraoperatively,the Kappa value of agreement was 0.706. Conclusions Preoperative exercise and evaluation of LAA occlusion can be acquired by the preoperative simulation system based on 3DTEE and 3DP,which can be an important supplement for preoperative preparation.

Breast Feeding ; Canada ; Caregivers ; education ; Child ; Cross Infection ; prevention & control ; Feeding Behavior ; Humans ; Infant, Newborn ; Infant, Premature ; Intensive Care Units, Neonatal ; organization & administration ; Intensive Care, Neonatal ; methods ; Neonatal Nursing ; methods ; Parents ; education ; Practice Patterns, Physicians'

Objective To evaluate the application of real-time three-dimensional transesophageal echocardiography (RT-3D TEE)in left atrial appendage (LAA)closure.Methods After excluding valvular disease,21 of 36 atrial fibrillation (AF)patients suffered the percutaneous LAA closure were chosen to measure left ventricular ejection fraction (LVEF)and to observe if the thrombus or the cloudiness echo will occur.The multiple planner reconstruction function was applied to rebuild sections and to observe the LAA anatomical morphology and its internal structure.During operation,the Flexi Slice function was used to measure the dimensions of LAA ostium,RT-3D mode was used to monitor sheath transport and closure device release,and to immediately evaluate the effect of blocking and complications after the operation. Results The exam before the closure procedure showed 5 of 36 patients' left ventricular ejection fraction (LVEF)<40% and one or more thrombus or the cloudiness echo were found in other 10 patients' which were thus excluded from the study.RT-3D TEE examination in the 21 patients revealed 8 single-lobe cases, 8 double-lobes cases and 5 patients with multi-lobe.Two patients of them need a special device.The maximum dimensions of LAA ostium was (22.24±4.35)mm,the fixed plate size of conventional LAmbreTM device was (28.26±5.23)mm.All patients choiced an average (1 .1 ±0.30)closure device and get the best sealing effect evaluated by RT-3D TEE immediately after operation,10 cases of them has about 1 -3 mm residual leakage exist around the closure.None of the patients with a new pericardial effusion and cardiac tapenade,no closure shift and embolism events.Conclusions RT-3D TEE can real-time and dynamically observe LAA anatomical morphology and its internal structure,compared with other imaging techniques, RT-3D TEE has irreplaceable advantages in the percutaneous LAA closure.

Objective To acquire volume rendered images of left atrial appendage ( LAA ) chambers by three dimensional transesophageal echocardiography (3DTEE) using a novel image mode of grey values inverted imaging ( GVI) . Methods Forty patients with atrial fibrillation were performed with TEE and cardiac CT examination before intervention treatment . Three‐dimensional transesophageal echocardiography images were acquired and displayed as a gray values inverted mode . Threshold segmentation and interactive segmentation were used to 3D digital replicas of LAA chambers . Morphology information including morphology type of LAAs and number of lobes and measurements of LAAs were recorded and compared with CT volume reconstruction(CT‐VR) images .Results Morphology information and measurements were successfully acquired by CT and 3DTEE‐GVI images in all 40 cases . The consistence of LAA morphology type by 3D‐GVI and CT was 97 .5% . The consistence of number of LAA lobes by 3D‐GVI and CT was 92 .5% . The measurements of long axis ,short axis ,area of ostiums of LAAs ,and depth of LAAs by CT were larger than those by 3D‐GVI ( P < 0 .01 ) . There were agreements between two methods of measurement . Conclusions LAA chambers can be reconstructed by 3D TEE‐GVI ,which can achieve similar effect to CT‐VR . 3DTEE‐GVI promises to be one of the most effective methods in assessment of LAAs′morphology information for planning of LAA occlusion .

Objective To evaluate the feasibility and accuracy of three-dimensional (3D) printed left atrial appendage (LAA) models based on 3D transesophageal echocardiography (3D-TEE) data and the application value for treating special anatomic LAA.Methods Data of 18 patients of atrial fibrillation who were underwent LAA occlusion were retrospectively analyzed,including 3D-TEE and CT volume data of the patients.The 3D-TEE data of the LAA were post-processed and a flexible material was used to print the LAA model by 3D printer.The morphological classification and lobulated classifications of LAAs were assessed by the 3D printed models.The measurements of long axis,short axis and depth of LAAs were also performed.And the measurement and classification results were compared with those based on 3D-TEE and CT volume images.A occluder release test was performed on the 3D printed models for patients with challenging LAA morphology.Results For all 18 patients,3D-TEE full volume data of the LAA were successfully reprocessed and printed as 3D LAA models.The consistency of morphological classifications and lobulated classifications of LAAs based on 3D printed models and cardiac CT were 0.92 and 0.83,respectively.No significant differences of LAA ostium dimensions (long axis and short axis) and depth were found between the measurement results based on 3D printed models and 3D-TEE (all P＞0.05).A simulation of LAA occlusion rehearsal was successfully performed on 3D models of two challenging cases.Conclusion The echocardiographic 3D printing technique has high feasibility and accuracy,and can be promising for personalized planning in cases of transcatheter special morphological LAA occlusion.

Objective To explore the clinical value of two‐dimensional transesophageal echocardiography (2D‐TEE) and real‐time three‐dimensional transesophageal echocardiography (RT3D‐TEE) for the left atrial appendage (LAA) closure procedures by the visualization of LAA shape by 2D‐TEE and RT3D‐TEE and the comparison between the measurement of LAA ostium and the sized LAmbreTM device during the procedure .Methods Forty‐one atrial fibrillation patients ,who had undergone 2D‐TEE examination at our hospital ,were enrolled in the study .At the mid‐esophageal ,dimensions of inner and outer ostium and depth of LAA were measured at the 2D‐TEE views of 0 ,45 ,90 and 135 degree respectively . RT3D‐TEE views were acquired and the maximal and the minimal dimensions of LAA inner ostium were measured .The measurement by RT3D‐TEE and 2D‐TEE were compared to find the difference and correlation .Eleven of 41 patients who have complied with the requirements for the LAA closure ,were undergone the procedures ,measured the dimension of LAA inner ostium at selective angiography intraoperative .Sizes of closure disks of the closure device and the measurement at selective angiography were recorded to compare the measurement at RT3D‐TEE and 2D‐TEE .Results Forty‐one atrial fibrillation patients were completed TEE examination successfully .Inner ostial dimension of LAA was (20.0±04.3)cm,(19.7±03.8)cm,(21.2±04.6)cm,(23.0±05.0)cmat2D‐TEEviewsof0,45,90and135 degree ,respectively .The maximum dimensions of LAA inner ostium by RT3D‐TEE was (2 4.9 ± 0 5.2)cm . At 2D‐TEE views ,the maximum dimensions of LAA inner ostium was at 135 degree ,there was a difference between it and the measurement by RT3D‐TEE ( P =0 0.12) .Monitoring by TEE ,LAA closure procedures with LAmbreTM device were successful for all 11 patients ,the landing zone by selective angiography was (2 4.9 ± 0 4.4)cm ,and the appropriate sized closure disk of the LAmbreTM device was 2 4. - 3 6. cm . Correlation between the measurements by RT3D‐TEE and selective angiography and the sized closure disk were r =0 8.16 ,P =0 0.02 and r =0 9.14 ,P =0 0.00 ,respectively .Correlation between the measurements by 2D‐TEE and selective angiography and the sized closure disk were r =0 6.93 ,P =0 0.18 and r =0 6.88 , P=0 0.19 ,respectively .Conclusions There was better correlation among the measurements by RT3D‐TEE and selective angiography and the size of closure device .Therefore ,compared to 2D‐TEE ,the guidance of RT3D‐TEE was more accurate during LAA closure procedures for LAmbreTM device selection .

Objective To investigate the antiproliferation and induction differentiation of human gas- tric carcinoma which human gastric lower-differentiation mucinous carcinoma MGC-803 cells transplanted in- to nude mice by using rosiglitazone(ROS),and to preliminarily explore the mechanism of differentiation. Methods The mice were randomly divided into five groups:model,ATRA,ROS 25 mg?kg~(-1),ROS 50 mg/kg, ROS 100 mg/kg.After that the volumes were measured and inhibition rates were calculated.The cell cycle was detected by FCM.The protein expression level of Mucin SAC was detected by immunohistochemistry. Results The volume of tumor decreased significantly in ROS treatment groups,the differences had statistical significance compared with model group(P0.05).The xenograft tumors of ROS groups demonstrated the characteristics of differentiation.Xenograft tumor cells were arrested in G_0/G_1 phase,and the cells in S phase decreased significantly,and up-regulated Mucin SAC gene expression.Conclusion ROS could inhibit the growth of tumor,and the effect were dose-dependent with ROS.ROS could induce the differentiation of Xenograft tumor cells of gastric cancer.Its mechanism might be related to the inhibit of transition from G_1 to S phase,degrade the activity of proliferation,regulate the expres- sion of Mucin 5AC.