OBJECTIVETo determine the anatomical variation and classification of ventricular septal defect (VSD) using echocardiography for percutaneous catheter closure in eligible cases.

METHODThe isolated ventricular septal defect was diagnosed with echocardiography in 240 patients , and 167 patients screened by transthoracic echocardiography were suitable for percutaneous catheter closure, but only 62 with isolated perimembranous VSD voluntarily received the procedure.

RESULTSThe procedure was successful in 58 patients, with a success rate of 93.5% with Amplatzer device. The diameter of VSD ranged from 2.4 to 13.9 (mean 5.3-/+2.0) mm with echocardiography, and the size of Amplatzer device ranged from 4-18 (mean 8.3-/+2.9) mm. Perimembranous ventricular septal defect was complicated by aneurysm formation in 22 patients. Residual trivial or mild shunt was seen in seven (12%) patients at 24 h and one (1.7%) patient at 3 months. Seven (12.1%) patients developed heart block, 3 (5.2%) had intermittence and transient complete heart block, and one had transient second degree atrioventricular block disappearing in 3 to 10 days, and 3 (5.2%) patients had complete right bundle branch block lasting for one month. None of the patients developed significant aortic regurgitation (P>0.05), although 22 showed a superior margin of the defect less than 3 mm from the aortic valve. The mean distance from the aortic valve was 3.7-/+2.7 (1.0 to 10.5) mm. No significant mitral and tricuspid regurgitation occurred in these patients. Four patients had unsuccessful procedures.

CONCLUSIONSPercutaneous closure with Amplatzer device can be carried out successfully in a majority of suitable defects screened using transthoracic echocardiography. Echocardiography can exactly demonstrate the anatomical variation and classification of ventricular septal defect in adults. Attention should be given to the misdiagnosis by echocardiography of a doubly committed defect as a perimembranous outflow defect. Heart block can be an important complication of the procedure.

Adolescent ; Adult ; Aged ; Balloon Occlusion ; instrumentation ; methods ; Cardiac Catheterization ; methods ; Child ; Child, Preschool ; Echocardiography ; methods ; Female ; Heart Septal Defects, Ventricular ; classification ; diagnostic imaging ; therapy ; Humans ; Male ; Middle Aged ; Prosthesis Implantation ; methods ; Septal Occluder Device ; Young Adult

OBJECTIVETo describe the morphological features of congenital heart defects and their spatial orientations to the neighboring structures in special two-dimensional echocardiographic views.

METHODSConventional two-dimensional echocardiographic sections were obtained in 45 patients with atrial septal defect (ASD) and 15 with ventricular septal defect (VSD) before the en face imaging, a special echocardiographic view, was performed using a transthoracic probe for morphological characterization of the ASD and VSD. En face views of the secundum ASD and perimembranous and outflow tract or doubly committed subarterial VSD were imaged on the interatrial septal section and inflow and outflow interventricular septal section at parasternal or apical position, respectively.

RESULTSThe special echocardiographic section provided en face plane views of the congenital heart defects in 35/43 (81%) of secundum ASD and 10/15 (67%) of VSD patients, and allowed full assessment of their size, shape, circumference and spatial orientations to the neighboring structures, showing also the relationship between two or multiple defects.

CONCLUSIONThe special transthoracic two-dimensional echocardiography not only displays the morphological features of ASD and VSD, but also provides additional information for making clinical decisions.

Adolescent ; Adult ; Child ; Child, Preschool ; Echocardiography ; methods ; Female ; Heart Defects, Congenital ; diagnostic imaging ; Heart Septal Defects, Atrial ; diagnostic imaging ; Heart Septal Defects, Ventricular ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Young Adult

OBJECTIVETo explore the relationship between Tpeak-Tend interval (Tpe) and the extent and severity of coronary artery stenosis, and evaluate the effect of percutaneous transluminal coronary angioplasty and stent implantation (PCI) on Tpe in the patients with coronary heart disease (CHD).

METHODSThe ECG data were collected from 187 CHD patients undergoing coronary angiography and PCI to evaluate the extend and severity of coronary artery stenosis before and after the interventions.

RESULTSThe Tpe of patients with severe stenosis increased significantly as compared with that in patients with moderate stenosis (138.9-/+16.2 ms vs 116.5-/+13.7 ms, P<0.05), and a significant difference was also noted between the moderate stenosis and mild stenosis (86.4-/+12.9 ms) groups (P<0.05). The Tpe decreased significantly in the patients in the order of multi-vessel involvement (140.7-/+17.8 ms), double vessel involvement (118.6-/+14.9 ms), singly vessel involvement (100.5-/+13.2 ms), and stenosis-free (84.3-/+12.4 ms) groups (P<0.05). Tpe was correlated to the extent and severity of coronary artery stenosis (r>0.4). In patients with severe stenosis, the Tpe was significantly reduced at 1 h, 24 h, and 1 week after PCI (115.8-/+14.5, 92.7-/+12.9, and 88.2-/+11.3 ms, respectively, P<0.05).

CONCLUSIONThe Tpe can reflect the severity and range of coronary artery stenosis, which can be reduced by PCI. Tpe can be a new index for evaluating myocardial ischemia in CHD patients.

Aged ; Angioplasty, Balloon, Coronary ; Coronary Stenosis ; physiopathology ; therapy ; Electrocardiography ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome

OBJECTIVETo assess the value of Tpeak-end interval (Tpe) in predicting myocardial infarction (MI).

METHODSTpe and Tpeak-end internal after correcting the heart rate (TpeRR) were measured and analyzed in 234 MI patients, who were followed-up for an average of 32 ± 10 months.

RESULTSClinical events occurred in 45 (19.2%) patients at the end TpeRR of the follow-up. Tpe and of the patients with clinical events were significantly higher than those in patients without the clinical events (P < 0.001). The incidence of clinical events in patients with Tpe > 140 ms were significantly higher than that in patients with Tpe ≤ 140 ms by Kaplan-Meier analysis (P < 0.001). With clinical event as the end point, the proportional hazards rate was 2.48 in univariate COX analysis (P < 0.01). After controlling for risk factors, the hazards rate was 2.66 by multvariate COX regression (P < 0.01).

CONCLUSIONTpe is positively correlated to the prognosis of MI and serves as an new index for predicting the clinical events in MI patients.

Aged ; Electrocardiography ; methods ; statistics & numerical data ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; diagnosis ; physiopathology ; Predictive Value of Tests ; Prognosis ; Risk Factors ; Survival Analysis

OBJECTIVETo summarize the echocardiographic features of a wide spectrum of congenital mitral valve anomalies.

METHODSThe medical records, echocardiograms, cardiac catheterization studies, and surgical reports were reviewed. The mitral valve anomalies evaluated in the study included parachute mitral valve, double orifice mitral valve, congenital mitral stenosis with 2 papillary muscles, anomalous papillary muscle rotation, and 3 commissures and papillary muscles in 15 cases. Surgeries were performed in 11 patients, and 1 patient underwent transcatheter closure of the patent ductus arteriosus.

RESULTSThe echocardiograms of 6 cases of parachute mitral valve were characterized by a hypoplastic mitral valve with short chordal attachments to a single posterior medial papillary muscle. The mitral valve demonstrated restricted motion. The double orifice mitral valve were featured by two separate mitral valve orifice, with each suborifice supported by its own tension apparatus in 4 patients. Asymmetric hypoplastic mitral valve stenosis with two papillary muscles was found in 1 patient with short and unbalanced chordal attachments to the anterior lateral major papillary muscle. Anomalous papillary muscle rotation was found in 1 patient. Mirtal anomaly with 3 major commissures and 3 papillary muscles was found in 3 patients.

CONCLUSIONSEchocardiography offers clear demonstration of the mitral valve thickness and chordal attachments, and allows visualization of the position and the number of the papillary muscles and interpapillary spaces for evaluation of the mobility of the valve leaflets, therefore can be a valuable diagnostic modality for congenital mitral valve anomalies, especially congenital mitral stenosis.

Adolescent ; Adult ; Child ; Child, Preschool ; Echocardiography, Doppler, Color ; Female ; Humans ; Infant ; Middle Aged ; Mitral Valve ; abnormalities ; diagnostic imaging ; Mitral Valve Stenosis ; congenital ; diagnostic imaging ; Papillary Muscles ; abnormalities ; diagnostic imaging ; Young Adult

Insulin-like growth factor binding-protein-7 (IGFBP7) was obtained from our previous colonic adenocarcinoma (CRC) and normal mucosa suppression subtraction hybridization (SSH) cDNA libraries. By RT-PCR and immunohistochemistry, we found that IGFBP7 was overexpressed in CRC tissue compared to normal tissue. However, our in vitro experiments performed in 10 CRC cell lines showed that IGFBP7 expressed only in SW480 and Caco2 cell lines, which implied an underlying reversible regulatory mechanism. Using methylation-specific PCR (MSP) and bisulfite sodium PCR (BSP), we found that its expression was associated with DNA hypomethylation of exon1. This was further supported by the in vitro study which showed restored IGFBP7 expression after demethylation agent 5-aza-2'-deoxycytidine treatment. Correlation analysis between IGFBP7 expression and prognosis indicated that overexpression of IGFBP7 in CRC tissue correlated with favourable survival. Investigation of the functional role of IGFBP7 through transfection studies showed that IGFBP7 protein could inhibit growth rate, decrease colony formation activity, and induce apoptosis in RKO and SW620 cells, suggesting it a potential tumor suppressor protein in colorectal carcinogenesis. In conclusion, our study clearly demonstrated that IGFBP7 plays a potential tumor suppressor role against colorectal carcinogenesis and its expression is associated with DNA hypomethylation of exon 1.
Adenocarcinoma ; genetics ; metabolism ; Apoptosis ; genetics ; Cell Line, Tumor ; Colorectal Neoplasms ; genetics ; metabolism ; DNA Methylation ; Exons ; Gene Expression Regulation, Neoplastic ; genetics ; Humans ; Insulin-Like Growth Factor Binding Proteins ; genetics ; metabolism ; Transfection ; Tumor Suppressor Proteins ; genetics ; metabolism

Insulin-like growth factor binding-protein-7 (IGFBP7) was obtained from our previous colonic adenocarcinoma (CRC)and normal mucosa suppression subtraction hybridization (SSH) cDNA libraries. By RT-PCR and immunohistochemistry, we found that IGFBP7 was overexpressed in CRC tissue compared to normal tissue. However, our in vitro experiments performed in 10 CRC cell lines showed that IGFBP7 expressed only in SW480 and Caco2 cell lines, which implied an underlying reversible regulatory mechanism. Using methylation-specific PCR (MSP) and bisulfite sodium PCR (BSP), we found that its expression was associated with DNA hypomethylation of exon 1. This was further supported by the in vitro study which showed restored IGFBP7expression after demethylation agent 5-aza-2'-deoxycytidine treatment. Correlation analysis between IGFBP7 expression and prognosis indicated that overexpression of IGFBP7 in CRC tissue correlated with favourable survival. Investigation of the functional role of IGFBP7 through transfecfion studies showed that IGFBP7 protein could inhibit growth rate, decrease colony formation activity, and induce apoptosis in RKO and SW620 cells, suggesting it a potential tumor suppressor protein in colorectal carcinogenesis. In conclusion, our study clearly demonstrated that IGFBP7 plays a potential tumor suppressor role against colorectal carcinogenesis and its expression is associated with DNA hypomethylation of exon 1.

Objective To investigate the role of ultrasound in the decision-making of surgery for thyroid nodules.Methods The cases receiving surgical excision of thyroid nodules in Peking Union Medical College Hospital during the period of January 2004 to December 2014 were collected.We randomly sampled 10%-15%cases from the collections in 2004, 2006, 2008, 2010, 2012 and 2014, and reviewed the outpatient and inpa-tient records of these sampled cases, extracting information about whether preoperative ultrasonography examina-tion was ordered, whether the ultrasound report provided specific diagnostic suggestion, and whether that diagno-sis was correct judging from pathological results.The rates of preoperative ultrasound, ultrasound diagnostic sug-gestion, specific diagnostic suggestion, and correct ultrasound diagnosis were calculated.Results The number of thyroid nodule surgery increased year by year from 2004 to 2014, with the proportion of malignant nodules ris-ing from 15.65% in 2004 to 69.91% in 2014.The rate of preoperative ultrasound ranged from 80.65% to 96.65%.The rate of ultrasound diagnostic suggestion demonstrated a constantly ascending trend, ranging from 46.94%to 92.36%.The rate of specific diagnostic suggestion was in the range of 78.26%-93.61%, while the rate of correct ultrasound diagnosis grew year by year, from 36.73% to 81.40%.Conclusions The num-bers of patients with thyroid nodules and thyroid cancer have been soaring in the past 11 years.With the improve-ment in its diagnostic capacity, ultrasonography is playing an increasingly important role in the decision-making of surgery for thyroid nodules.

OBJECTIVE: To explore clinical effects of repairing skin and soft tissue defect of finger with free posterior interosseous artery perforator flap. METHODS: Totally 8 patients with finger skin and soft tissue defect repaired with free posterior interosseous artery perforator flap were treated from May 2021 to November 2022, including 7 males and 1 female aged from 24 to 54 years old, and soft tissue defect area ranged from 3.0 cm×1.5 cm to 5.0 cm×3.0 cm. The time from injury to flap repair ranged from 3 to 83 h. The free posterior interosseous artery perforator flap was applied to repair finger defect, the area of the flap ranged from 3.5 cm×2.0 cm to 5.2 cm×3.5 cm, the donor area of flap was sutured directly. The survival, appearance, texture and donor complications of the flap were observed after operation, and Dargan functional standard was used to evaluate clinical effect of finger function. RESULTS: All flap of 8 patients were survived, and followed up from 3 to 12 months. There was no obvious swelling, soft texture, obvious pigmentation, linear intaglio in donor area only, and without obvious complications were found. Among them, 3 patients'skin flaps were repaired for the defect of palm of the fingers, and sensory recovery was good, two-point discrimination ranged from 5 to 9 mm. According to Dargan functional evaluation, 3 patients excellent, and 5 good. CONCLUSION Free posterior interosseous artery perforation branch flap could be used to repair the defect of finger. The thickness of flap is moderate, operation is convenient, appearance and texture of the operative flap are good, and the donor site is small without obvious complications, and obtain satisfactory clinical effect.
Male ; Humans ; Female ; Young Adult ; Adult ; Middle Aged ; Perforator Flap ; Fingers ; Upper Extremity ; Ulnar Artery ; Skin

Objective:To explore the prevalence and independent associated factors of vascular calcification (VC) in non-dialysis chronic kidney disease (CKD) patients of stage 3-5.Methods:It was a single-center cross-sectional observational study. Non-dialysis stage 3-5 CKD patients ≥18 years old who were admitted to the Department of Nephrology, the First Affiliated Hospital of Sun Yat-sen University from May 1, 2022 to December 31, 2022 with VC evaluation were enrolled. The patients' general information, laboratory examination and imaging data were collected. Coronary artery calcification (CAC), thoracic aorta calcification (TAC), abdominal aorta calcification (AAC), carotid artery calcification and aortic valve calcification (AVC) were evaluated by cardiac-gated electron-beam CT (EBCT) scans, lateral lumbar x-ray, cervical macrovascular ultrasound and echocardiography, respectively. The differences in clinical data and the prevalence of VC at different sites of patients with different CKD stages were compared, and the prevalence of VC at different sites of patients in different age groups [youth group (18-44 years old), middle-aged group (45-64 years old) and elderly group (≥65 years old)] and patients with or without diabetes were compared. Multivariate logistic regression analysis was used to analyse the independent associated factors of VC for different areas.Results:A total of 206 patients aged (51±14) years were included, including 129 (62.6%) males. There were 44 patients with CKD stage 3 (21.4%), 51 patients with CKD stage 4 (24.8%), and 111 patients with CKD stage 5 (53.9%). CKD was caused by chronic glomerulonephritis [104 cases (50.5%)], diabetic kidney damage [35 cases (17.0%)], hypertensive kidney damage [29 cases (14.1%)] and others [38 cases (18.4%)]. Among 206 patients, 131 (63.6%) exhibited cardiovascular calcification, and the prevalence of CAC, TAC, AAC, carotid artery calcification, and AVC was 37.9%, 43.7%, 37.9%, 35.9% and 9.7%, respectively. The overall prevalence of VC in young, middle-aged and elderly patients was 24.6%, 73.6% and 97.4%, respectively. With the increase of age, the prevalence of VC in each site gradually increased, and the increasing trend was statistically significant (all P<0.001). The overall prevalence of VC in CKD patients with diabetes was 92.5% (62/67), and the prevalence of VC at each site in the patients with diabetes was significantly higher than that in the patients without diabetes (all P<0.001). Multivariate logistic regression analysis revealed that age (every 10 years increase, OR=2.51, 95% CI 1.77-3.56, P<0.001), hypertension ( OR=5.88, 95% CI 1.57-22.10, P=0.009), and diabetes ( OR=4.66, 95% CI 2.10-10.35, P<0.001) were independently correlated with CAC; Age (every 10 years increase, OR=6.43, 95% CI 3.64-11.36, P<0.001) and hypertension ( OR=6.09, 95% CI 1.33-27.84, P=0.020) were independently correlated with TAC; Female ( OR=0.23, 95% CI 0.07-0.72, P=0.011), age (every 10 years increase, OR=3.90, 95% CI 2.42-6.29, P<0.001), diabetes ( OR=5.37, 95% CI 2.19-13.19, P<0.001) and serum magnesium ( OR=0.01,95% CI 0-0.35, P=0.014) were independently correlated with AAC. Moreover, age and diabetes were independently correlated with carotid artery calcification, AVC and overall VC Conclusions:The prevalence of VC in non-dialysis CKD patients of stage 3-5 is 63.59%, of which CAC reaches 37.9%, TAC is the most common one (43.7%), while AVC is the least one (9.7%). Age and diabetes are the independent associated factors for VC of all sites except TAC, while hypertension is an independent associated factor for both CAC and TAC.