Objective To investigate the difference in cardiac structure and hemodynamics characteristics between fetuses with isolated persistent left superior vena cava (LSVC)and normal fetuses by using fetal echocardiography,in order to explore whether isolated PLSVC has some influence on the development of fetal heart structure development.Methods Twenty-two fetuses diagnosed with isolated PLSVC in the second and third trimester were enrolled in this study.The PLSVC fetuses were divided into two groups:group 1 ,twenty-two fetuses in the second trimester (23-27+6 W);group 2,twenty fetuses in the third trimester (28-39+6 W).Forty-nine fetuses without intra-cardiac and extra-cardiac anomalies with gestation age matched were involved as normal control groups:25 fetuses in the second trimester,and 24 fetuses in the third trimester.The parameters of cardiac structure and hemodynamics of the four groups were measured,including left and right sideheart size,the diameter of foramen ovale(FO),aorta(AO),aortic isthmus and pulmonary artery (PA).The ratio of RV/LV,RA/LA and PA/AO were calculated.The hemodynamic parameters included the flow velocity across mitral valve(MV),tricuspid valve(TV)and FO. All the parameters of PLSVC groups were compared with the normal groups respectively.Results In the second trimester group,the ratio of RV/LV and PA/AO of the PLSVC fetuses were significantly larger than normal,while the AO diameter,aortic isthmus diameter were smaller than normal group (P <0.05). However in the third trimester group,only the ratio of PA/AO of the PLSVC group was significantly greater,and the aortic isthmus diameter was still smaller than the normal group (P <0.05).Conclusions Isolated PLSVC connected with coronary sinus is associated with structural differences from normal.A dilated coronary sinus may have an influence on the development of fetal left heart structures.

Objective To evaluate the diagnostic value of the diameter ratio of left subclavian artery to aortic isthmus(LSA/AoIS)in fetuses with aortic coarctation(COA).Methods A retrospective study of 79 fetal echocardiographic data was undergone on 49 COA fetuses.The COA cases were divided into four groups according to different gestational week (cases in each group including follow-up review of different gestational weeks):group 1 ,24-27+6 W;group 2,28 -31+6 W;group 3,32 -35+6 W;group 4,36 -39+6 W.The normal fetuses with gestational age matched were also divided into four control groups.The diameter of left subclavian artery(LSA) and aortic isthmus (AoIS) were measured,the ratio of LSA/AoIS of each group were calculated,and the data between the COA and control groups were compared.ROC curve analysis was used for LSA/AoIS to predict the demarcation point of postnatal COA.Results ①There was no statistic difference in the LSA diameter between COA groups and control groups (P >0.05):group 1 (1 .87±0.42)mm vs (1 .75 ±0.25)mm;group 2 (2.25 ±0.36)mm vs (2.21 ±0.22)mm;group 3 (2.74±0.32)mm vs (2.90 ±0.29)mm;group 4 (2.83 ±0.28)mm vs (3.06 ±0.30)mm;②The ratio of LSA/AoIS was significantly increased in COA groups than those in control groups:group 1 (0.88± 0.15) vs (0.66±0.06),group 2 (0.85±0.13)vs(0.64±0.05),group 3 (0.94±0.17)vs(0.73±0.07), group 4 (0.94±0.18)vs(0.70±0.07),the difference was statistically significant(P <0.05);③The cut-off value of LSA/AoIS ratio were 0.78,0.73,0.83,0.78 in each group,respectively.Conclusions The ratio of LSA/AoIS can be used as a useful echocardiographic parameter which suggest the presence of aortic coarctation.This ratio≥0.8 may have a certain diagnostic significance.

Objective To express the major allergen of Blattella germanica (Bla g 2) in Pichia pastoris and obtain the soluble protein. Methods The known Bla g 2 gene was used to design the primers which had the restriction enzyme sites. PCR method was applied to obtain the Bla g 2 gene. The gene fragment was then cut and ligated with the Pichia expression vector pGAPZaA, resulting in a recombinant plasmid pGAPZaA-Bla g 2. The linearized pGAPZaA-Bla g 2 was transformed into Pichia pastoris GS115 through electroporation, then screened to positive transformants, and the protein was expressed in YPD medium. Purification of the recombinant protein was achieved by metal (Ni2+) chelating affinity chromatography and Western-blotting assay indicated its IgE binding capacity. Results With the expressed reeombinanl protein, SDS-PAGE showed the presence of the product in the supernatant of the culture with Mr 45 000. After 3 days culture, the recombinant protein occupied 50% of the total proteins in the supernatant. The recombinant protein was purified and Western-blot demonstrated an adequate IgE binding capacity of the product. Conclusion A recombinant protein of Bla g 2 has been obtained, which is soluble in the supernatant and therefore can avoid a process of denaturalization and renaturation of the recombinant.

Objective To investigate the psychological status of family members of patients with depression, and discuss the health education pathway. Methods The families of 200 inpatients with major depression accepted systemic health education about depression according to the investigation of the self-designed questionnaire. They were assessed with Self-rating Depression Scale (SDS) and Self-rating Anxiety Scale (SAS) when the patients admitted and accepted 8 weeks of treatment. Results The score of SDS was more than 50 in 76.5% families of patients, and it was 79.0% for SAS when admission. The scores of SDS and SAS reduced after education (P<0.01). Conclusion Health education can improve the psychology of family members of patients with depression.

Objective To assess the value of echocardiography in guiding surgical operation approach of ventricular septal defect (VSD). Methods A total of 200 patients with VSD underwent surgical repair. The type of VSD was determined with echocardiography before operation and the results were analyzed in comparison with operation approach. Results There was significant accordance in the type of VSD detected with echocardiography and the surgical findings, and the coincidence rate of 80.00%. The transatrial approach was chosen in patients with perimembranous VSD, subseptal cusp VSD and simple membranous;the anspulmonary approach was chosen in subarterial VSD, while transventricular approach was chosen in muscular VSD or VSD with large size. Combined approach was suitable in VSD complicated with intracardiac malformations. Conclusion The type of VSD determined with echocardiography plays a key role in the selection of operation approach, and is benefit to reducing complications.

Objective To assess the value of two-dimentional strain/strain rate (2D-S/SR) imaging compared with endomyocardial biopsy (EMB) in detecting acute rejection (AR) reaction after heart transplantation (HT). Methods Twenty-five patients who required HT underwent echocardiography within 12 h after EMB. Ten patients of grade 0 AR were regarded as group A, 8 patients with grades Ⅰa-Ⅰb were considered as group B, 7 patients with grades ≥Ⅱa were considered as group C. Thirty age-matched normal controls were considered as group D. The longitudinal, radial and circumferential stain and strain rate of different ventricular wall in systolic were measured and compared among groups. Results Compared with the group D, longitudinal stain (LS) of basal-septum, circumferential strain rate (CSR) of ant-septum at the level of mitral valve, radial strain (RS) of all segments at the level of mitral valve reduced in groups A, B and C. Conclusion The RS of 2D-S/SR is an effective and sensitive technique for the detection of acute rejection, and longitudinal stain can be used as an early index of AR for grade ≥Ⅱ after HT.

Objective By exploring echocardiographic ch aracters and pathologic examination of noncompacted ventricular myocardium(NVM), to prevent life-threatening arrhythmias and embolism. Methods Echocardiographic examinations included four-chamber view, two-chamber view and short axis view of left ventricle, with an emphasis on observing left ventricular myocardium and endocardium approach to one-third of apex of heart. Results All 24 patients showed obvious echocardiographic findings characterized by prominent and excessive myocardial trabeculations and deep intratrabecular recesses in the affected ventricular cavity. Three cases complicated with other congenital heart malformations, 20 cases with congestive heart failure and only 2 cases were asymptomatic. Coronary arteriography was performed in 13 cases and revealed normal findings. Two cases eventually underwent heart transplantation because of severe congestive heart failure. Gross and histological findings demonstrated prominent muscular trabeculations, with deep intratrabecular recesses into lesion heart. Serial section from the base of the ventricle toward the apex revealed gradually weaker myocardium. Noncompaction of ventricular myocardium showed a thin, compacted epicardial and an extremely thickened endocardium by fibrous tissue. Conclusions Noncompaction of ventricular myocardium has characteristic echocardiographic manifestations and specific pathologic changes, which are different from those of primary enlarged type of cardiomyopathy.

Objective To show left anterior descending artery and interventricular septal branch Doppler flow and Doppler flow spectrum using coronary Doppler flow imaging,provide reference to select target artery,and judge collateral circulation formation after percutaneous transluminal septal myocardial ablation (PTSMA) of hypertrophic cardiomyopathy. Methods In 28 patients with hypertrophic cardiomyopathy left anterior descending artery and interventricular septum branch flow were displayed using coronary flow Doppler imaging system before and after PTSMA,and flow velocity were measured by Doppler spectrum. Results In 22 patients the target arteries were successfully selected in the first time using coronary flow Doppler imaging combined with coronary angiography and proved by the results of PTSMA. In 2 patients PTSMAs were performed successfully after additional choosing other interventricular septal branch. Therefore,PTSMAs in 24 patients were performed effectively in total. In 4 patients PTSMAs were given up due to vessel thinness and suffusion of interventricular septal branch in 2 patients,myocardial contrast agent distributing right ventricular and right ventricular papillary muscle during operation in one patient and contrast agent distributing left ventricular papillary muscle in another patient. Left ventricular flow tract pressure rebounded in 5 patients postoperatively,and neighboring interventricular septum branch extending to melting area were seen in 3 patients accompanied by flow velocity increasing. Melted vessel nub markedly prolonged in 1 patient. Conclusions Coronary Doppler flow imaging can directly reveal interventricular septum branch flow in hypertrophic cardiomyopathy,provide detailed hemodynamic information for myocardial PTSMA and monitor PTSMA for hypertrophic cardiomyopathy effectively and reliably.

Objective To investigate the value of screening bridge vessels before coronary artery bypass graft(CABG) by ultrasonic examination. Methods To analyze the ultrasonic result of internal mammary arteries,carotid arteries,and radial arteries before CABG. Results Among the 140 cases,11 internal mammary arteries were not qualified,14 of 74 radial arteries were not qualified. And the stenosis of carotid arteries were present in 28 cases. Conclusions It is valuable to examine the bridge vessels before CABG.

Objective To evaluate the role of myocardial contrast echocardiography (MCE) to select target vessel, to monitor the opacification zone and to avoid complications during transcoronary ablation of septal hypertrophy(TASH) for hypertrophic obstructive cardiomyopathy(HOCM). Methods In 37 HOCM patients cardiac apex four chamber view, parasternal left ventricular long axis view and left ventricular short axis view were recorded after injection of the myocardial agents and absolute ethanol 5 minutes later respectively. And the opacification zones of the myocardial agents and absolute ethanol were observed. Results Among 37 patients,2 patients gave up treatment because of no appropriate vessel to provide ablation by coronary Doppler flow imaging.Two of 37 patients gave up treatments and did not undergo myocardial contrast echocardiography because of diffused coronary arteries in coronary angiography. Among 33 patients who underwent MCE, 5 patients gave up TASH including one of the opacification of left ventricular mammary muscles, one of the opacification of right ventricular and right ventricular mammary muscles, one for the opacification zone out of the target area and two for the large opacification zone. Other 28 patients underwent TASH successfully. Just after operations and 7 days, left ventricular outflow tract pressure gradient decreased at no less than 50%. Distribution zone of absolute ethanol was smaller than that of myocardial opacification zone in some patients. Conclusions MCE is a credible reference for selection of target vessels in TASH for HOCM.