OBJECTIVE: To explore the circadian distribution of premature ventricular contractions (PVCs) in patients with viral myocarditis (VM) according to the theory of chronomedicine in traditional Chinese medicine (TCM) in order to find out the scientific evidence for a reasonable administration time. METHODS: Two hundred and forty patients with VM were enrolled and electrocardiograms were examined for all by Holter monitor. The circadian distribution of PVCs was evaluated according to the theory of chronomedicine of TCM about time periods corresponding to five zang viscera. RESULTS: PVCs mostly happened in periods of 3:00-5:00, 5:00-7:00, 7:00-9:00 and 9:00-11:00, in which 5:00-7:00 was the most serious time. Less PVCs happened in periods of 17:00-19:00, 19:00-21:00 and 21:00-23:00. The frequency of PVCs in midnight also increased with aging. The time periods of the frequency peak of PVCs in patients with different syndromes were also different. In patients with syndrome of pathogenic heat invading heart (PHIH), the PVCs mostly appeared in midday. In patients with syndrome of flaring of fire due to yin-deficiency (FFYD), the PVCs were most serious in daytime and aggravated at noon. And in patients with syndrome of insufficiency of heart-qi and yang (IHQY), the PVCs mostly happened in early morning or midnight. CONCLUSION: There was a manifest regulation of the pathological circadian rhythm of PVCs in patients with VM. The circadian distributions of PVCs were variable in patients with different syndromes. Therefore the theory of chronomedicine of TCM may be used to guide the treatment based on syndrome differentiation.

Objective To assess the value of prenatal ultrasonography in diagnosing fetal absent pulmonary valve syndrome(APVS). Methods This was a retrospective study of 8 fetuses with absent pulmonary valve syndrome. Fetal echocardiography and segmental analysis were used to determine the atrial situs,atrioventricular connections and ventriculoarterial relationships. Cardiac chamber dimensions,Doppler studies of the atrioventricular valve and semilunar value were recorded, and cardiothoracic ratio were calculated. Results Levocardia,normal situs and atrioventricular connections were present in all cases. All cases showed typical signs:severe dilatation of the pulmonary trunk and it's branches, and concurrent occurrence of pulmonary valve stenosis and regurgitation. In 6/8 there was an associated ventricular septal defect,overriding aorta and absent arterial duct(Fallot-like APVS),while in 2/8 there was an assoiciated intact ventricular septal and patent arterial duct. Extracardiac malformations were detected in 5 cases.Conclusions APVS can be accurately diagnosed by prenatal ultrasonography but we should pay more attention to the ventricular septal and arterial duct,due to the existence of two variants.

Objective To explore the clinical significance of prenatal ultrasound examination in diagnosing twin reversed arterial perfusion sequence (TRAP). Methods This was a retrospective study on 5 cases of TRAP sequence conifrmed by prenatal ultrasound and clinical method. The clinical data and ultrasound images were analyzed. Cases were collected at Hubei Maternal and Child Health Hospital from 2001 January to 2013 February. Results Four-iffths of TRAP were not corrected diagnosed and another one was misdiagnosised as asymmetrical conjoined twins in early pregnancy. Five cases of TRAP were correctly diagnosed during the second trimester. Sonographic ifndings of ifve acardia without blood lfow were as follows:(1) All acardias had no blood perfusion in body and umbilical cord, were absence of the fetal head (acephalous) and heart (acaidia), without skin edema, and a linear object resemble as umbilical cord extend from umbilical region of acardia to plcenta could be seen. Four (case 2-5) had lower limbs or dysplasia of lower limbs (two had spine), and one (case 1) had an irregular mass with bone. (2) Four pump twins had no obvious abnormity, while one had two clubfeet (case 2). Three died in uterus, one underwent induced labor due to oligohydramnios and heart dysfunction, and another one survived. Prenatal ultrasound images were consistent with MRI, X-ray examination, autopsy and postnatal neonatal examination results. Conclusions Acardia without blood lfow which was generally misdiagnosed as single gestation in utero can be diagnosed according to the special disformity of acardia and the linear umbilical cord extend from umbilical region to placenta, besides, it still need to strengthen monitoring the pump twin even if there was no blood perfusion to acardia.

ObjectiveTo explore the contrast-enhanced ultrasonography features of postpartum placenta implantation and its clinical value in diagnosis of postpartum placenta implantation.MethodsBetween April 2009 and May 2013, twelve patients with clinically suspected placenta implantation underwent contrast-enhanced ultrasonography in Hubei Maternal and Child Health Hospital. The location and extent of intrauterine lesions and perfusion features of contrast agent were observed. The contrast-enhanced ultrasonography features of postpartum placenta implantation were analyzed and compared with postoperative pathological diagnosis.ResultsIn twelve patients with placenta implantation, eleven showed enhancement. Only one lesion showed no enhancement, which was diagnosed as placental degeneration and calcification on postoperative pathology. One case was placenta adhesions conifrmed by postoperative pathological diagnosis, which presented with a hyperenhanced lesion in uterine cavity with a clear boundary to myometrium. Six cases were placenta implantation confirmed by postoperative pathological diagnosis, which presented with a residual placenta surrounded with extremely thin or evendiscontinuous uterine serosa. Five cases were placenta penetration confirmed by postoperative pathological diagnosis, which presented with a residual placenta penetrating the uterine serosa and contrast agent spilling out. All cases in this study were cured by operation.ConclusionsContrast-enhanced ultrasound could diagnose placenta implantation via the difference of tissue perfusion. The lesion of placenta implantation showed enhancement after injection of contrast agent. If discontinuous uterine serosa and contrast agent spilling was observed, placenta penetrating uterine serosa should be considered. Contrast-enhanced ultrasound has important clinical value in diagnosing postpartum placenta implantation and observing postoperative recovery processes of uterine rupture.

Objective To study the relationship between Caspase-12 expression and the hyperoxia-induced corpus callosum damage. Methods A total of 12 groups of C57 / BL6 mice were randomly assigned into hyperoxia group (80% O2 ) and control group (21% O2 ) at day 6 after birth (P6). The pups were sacrificed after 24 h and 48 h of hyperoxia exposure and at P10, P12, P15 and P30. Immunohistochemical ( IHC) method was used to detect the expression of myelin basic protein (MBP) in corpus callosum. Real-time PCR, Western Blot and IHC were used to detect the expression of mRNA and protein of Caspase-12 in corpus callosum. The corpus callosum apoptosis was measured using terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling ( TUNEL ) method. Results The expression of MBP in hyperoxia group were significantly lower than the control group at P10 and P12 (P = 0. 004 and 0. 016); however, no significant differences existed between the two groups at P15 and P30 (P > 0. 05). The expression of Caspase-12 mRNA after 24 h and 48 h hyperoxia exposure were significantly higher than the control group [24 h: (1. 549 ± 0. 098) vs. (1. 080 ± 0. 101); 48 h:(1. 333 ± 0. 076) vs. (1. 022 ± 0. 089); P < 0. 05]. The expression of cleaved Caspase-12 protein after 24 h and 48 h hyperoxia exposure were also significantly higher than the control group [24 h: (1. 582 ± 0. 010) vs. (0. 994 ± 0. 078); 48 h: (1. 370 ± 0. 095) vs. (0. 978 ± 0. 069); P < 0. 05] . The Caspase-12 positive cell were significantly increased after 24 h and 48 h hyperoxia exposure comparing with the control group. The apoptosis index in hyperoxia group was significantly higher than the control group at P10 and P12 [P10: (18. 742 ± 2. 503) vs. (4. 587 ± 2. 353); P12 (36. 184 ± 3. 655) vs. (5. 351 ± 2. 678); P < 0. 05]. Conclusions Hyperoxia exposure induces corpus callosum damage in newborn mice. Over-expressed Caspase-12 may induce corpus callosum cell apoptosis excessively.

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 assess the clinical value of vascular enhancement technology (VET) in diagnosis of fetal pulmonary sequestration (PS).Methods Color Doppler velocity (CDV),color Doppler energy (CDE) and VET were performed in 11 fetus with PS to display the vessels in region of interest.Results The abnormal vessels in region of interest were displayed in distinct degree with CDV,CDE and VET.The courser and disposition of the great vessels were displayed with CDV and CDE,while lumen of blood vessel was clearly discriminated with VET,while CDV depicted the direction of blood flow.Satisfaction assessment of the VET image was superior than those of CDV and CDE image (P<0.05).No difference was found between the satisfaction assessment of the CDV and CDE images (P>0.05).Conclusion VET can improve the contrast resolution,having superiority in displaying vessels and fine branches,therefore has clinical value in the diagnosis of fetal PS.

ObjectiveTo investigate the diagnostic value of ultrasound on patients with papillary thyroid carcinoma(PTC) coexisted with Hashimoto thyroiditis(HT).Methods The preoperative ultrasonography data of 2144 cases with PTC from January 2006 to December 2011 who treated with operation and diagnosed by pathology were analyzed retrospectively.Among them,265 cases coexisted with HT (PTC coexisted with HT group),1879 cases were not coexisted with HT (non-PTC coexisted with HT group).ResultsMost of the cancerous nodes in two groups exhibited in the ultrasonographic performance just like irregular shape,unclear boundary and so on (P ＞ 0.05).Most of the cancerous nodes in non-PTC coexisted with HT group exhibited hypoechoic nodules with microcalcifications,those in PTC coexisted with HT group exhibited various internal echoes with mainly microcalcifications,and the coarse calcification occupied a certain proportion(P＜ 0.01 ).The cancerous nodes in PTC coexisted with HT group were not rich in blood flow compared with non-PTC coexisted with HT group,but mostly exhibited blood disorders.When compared with non-PTC coexisted with HT group,the rate of ultrasound diagnosis in PTC coexisted with HT group was lower [ 52.8 ％( 140/265 ) vs.75.0 ％ (1409/1879),P ＜ 0.01 ],and the false positive rate in lymph node was higher [84.0％(487/580) vs.74.8％ (77/103)] (P ＜0.05).ConclusionsThe nodules are malignant when they appear as hypoechoic solid nodules,have unclear boundary and have microcalcifications should be highly suspected.The hyperechoic solid nodules or coarse calcification nodules should also be awared and taken further observation of the characteristics around the echoes and the internal blood flow,making comprehensive analysis to determine whether it could be malignant transformation and try best to reduce the misdiagnosis and missed diagnosis rates of this disease.

Objective To investigate the nutrition status and quality of life(QOL)in the perioperative patients with laryngeal cancer and to analyze the effect of nutrition status on quality of life.Methods Sixty-six patients with laryngeal cancer were surveyed respectively by self-designed general situation questionnaire,nutritional risk srcreening 2002(NRS2002)and European organization for research and treatment of cancer quality of life core questionnaire(EORTC QLQ-C30).The impact of nutritional status on QOL was analyzed by the multiple linear regression analysis.Results The total score of nutritional risk of perioperative patients with laryngeal cancer was 3.53±1.51 and the incidence of nutritional risk was 28.79%.The nutrition status influenced on QOL, physiological function,cognitive function and pain area(P<0.05).Conclusion Nurses should assess the nutritional status of the patients and correct malnutrition without delay in order to improve the physical function and QOL of the patients.

To investigate the scientificity of patient-reported outcome (PRO) scale for myasthenia gravis (MG), which was used to evaluate the clinical effects of traditional Chinese and Western medicine treatment on MG patients. Psychometric performance of the MG-PRO scale was also expected to be evaluated in this study.