Objective To develop Z-score reference ranges for tricuspid annular plane systolic excursion(TAPSE) in normal fetuses from the measurements of gestational age(GA),biparietal diameter (BPD) or femur length(FL) using fetal echocardiography.Methods A retrospective cross sectional study of 1012 singleton normal fetuses were performed.The gestation age ranged from 20 to 41 weeks.Non-cardiac fetal biometric parameters included GA and BPD and FL were measured and calculated GA based on menstrual age.TAPSE was measured in a standard apical four-chamber view by free angle M-mode echocardiography.Normal Z-score ranges were developed for TAPSE using GA,BPD and FL as independent variables.These were accomplished by using first standard regression analysis and then weighted regression of absolute residual values for each parameter in order to adjust for inconstant variance.Results Linear regression model was the best description of the data in each case and correlations between TASPE and independent variables (GA,BPD,FL) were excellent.Heteroscedasticity of standard deviation (SD) with increasing independent variables also could be modeled with a simple linear regression.According to these equations,TAPSE Z-score =(the actual measurement of TAPSE-predicted TAPSE)/prediction SD.Conclusions Normal reference ranges and Z-scores for TAPSE have been provided.These normative data may be useful tools for assessment of fetal TAPSE,to evaluate fetal right ventricular function more accurately and effectively.

Objective To obtain the annular plane systolic excursion difference (APSED)of fetuses in second and late trimester by free angle M-mode (FAM)and tissue motion of annular displacement (TMAD)in order to assess the fetal ventricular function.Methods The mitral annular plane systolic excursion(MAPSE)and tricuspid annular plane systolic excursion(TAPSE)of four hundred and fifty five normal fetuses from 20 to 41 weeks were measured by FAM echocardiography,and the difference between them were calculated.Early diastolic velocities (Em)of the mitral annular and early diastolic velocities (Em')of the tricuspid annular were estimated by pulsed-wave tissue Doppler imaging (TDI),meanwhile systolic velocities (Sm)of the mitral annular and systolic velocities (Sm')of the tricuspid annular were also estimated by TDI.Fifty normal fetuses in the second and late trimester were choosed randomly,two-dimension imaging was obtained at the apical four-chamber view,then mitral annular plane and tricuspid annular plane displacement curve were acquired at the same time by using off-line QLab 8.1 software,and the differences in the peak time between them were compared.The trace of annular displacement were recorded by color tissue tracking technology.Results There was a significant difference between FAM-TAPSE and FAM-MAPSE in different gestational weeks (P <0.05),FAM-TAPSE was growing with the increase of gestational weeks,FAM-APSED showed significant positive correlations with gestational week, Em,Sm,Em' and Sm'.Annular plane displacement curve showed that TMAD-TAPSE was higher than TMAD-MAPSE in the entire cardiac cycle,and there was no statistically significant difference in time to peak of the annular plane displacement curve between them(P >0.05).Conclusions The APSED existed in the second and late trimester continually.It was considering associated with fetal ventricular torsion.As the growth of gestational weeks,the increase of APSED reflected the enhanced reserve capacity of the fetal ventricular torsion.APSED can reflect the longitudinal motion and torsion movement of fetal ventricle quantitatively,and can be used as a new index to assess the fetal cardiac function.

Poly(ADP-ribose) polymerase(PARP) is a protein-modifying and nucleotide-polymerizing enzyme. As a critical element in DNA repair, PARP can be activated by DNA strand breaks. Excessive activation of PARP, however, can deplete NAD + and ATP, leads to cell death. Cleavage of PARP by activated caspase-3 play an important role in cell apoptosis.

Objective To establish z-score model for fetal tricuspid annular plane systolic excursion(FAM-TAPSE) and mitral annular plane systolic excursion(FAM-MAPSE) based on gestational age(GA),then to evaluate the ventricle systolic function of fetus with heart failure.Methods One thousand and twelve normal fetuses and 24 fetuses with heart failure were involved. FAM-TAPSE and FAM-MAPSE were measured by free angle M-mode echocardiography,and FAM-TAPSE and FAM-MAPSE z-score models of normal fetuses were constructed by using first standard regression analysis with GA as independent variable.The fetuses with heart failure were divided into left heart failure (LHF) group and right heart failure (RHF) group by Tei index.Subsequently,the two parameters between normal and fetuses with heart failure were compared. Results The models used to calculate z-score for FAM-TAPSE and FAM-MAPSE were constructed,and GA had close correlation with them. Compared with normal fetuses,the mean z-scores of FAM-TAPSE and FAM-MAPSE were statistically different in fetuses with heart failure(P<0.001). The FAM-MAPSE z-scores of LHF and the FAM-TAPSE z-scores of RHF were all less than-2 z-scores.Conclusions The FAM-TAPSE and FAM-MAPSE z-scores decline in fetuses with heart failure and they can provide quantitative evidence in evaluation of heart systolic function,FAM-TAPSE and FAM-MAPSE z-score would be markers for assessing heart systolic function in fetuses with heart failure.

OBJECTIVETo compare the difference in clinical efficacy on bronchial asthma at chronic persistent stage between acupuncture for warming yang and benefiting qi and seretide.

METHODSOne hundred and eighty patients of bronchial asthma at chronic persistent stage were randomized into an acupuncture group and a western medication group, 90 cases in each one. In the acupuncture group, acupuncture for warming yang and benefiting qi was applied at Dazhui (GV 14), Feishu (BL 13), Danzhong (CV 17), Dingchuan (EX-B 1), Jianshi (PC 5), Zhigou (TE 6), Taixi (KI 3) and Zusanli (ST 36), once every two days. In the western medication group, inhalation therapy with seretide was applied, 1 to 2 inhalations each time, twice a day. The treatment for 20 days was as one session in the two groups, at the intervals of 2 days after each session. Four sessions of treatment were required. The immune function indices were observed before and after treatment in the patients of two groups, named immunoglobulin IgG, IgM and IgE; peripheral T lymphocytes (CD3+), helper T lymphocytes (CD4+), inhibitory T lymphocytes (CD8+) and the ratio of CD4+ and CD8+; as well as the pulmonary ventilation function indices, named maximum pulmonary expiratory flow (PEF), forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). The clinical efficacy was compared between the two groups.

RESULTSThe total effective rate was 93.3% (84/90) in the acupuncture group, better than 88.9% (80/90) in the western medication group (P < 0.05). After treatment, the immune function indices and pulmonary ventilation function indices were apparently improved as compared with those before treatment in the two groups (all P < 0.05). The improvements in the acupuncture group were much more significant (all P < 0.05).

CONCLUSIONAcupuncture for warming yang and benefiting qi effectively controls the symptoms of bronchial asthma at chronic persistent stage and improves immune and pulmonary functions. The efficacy is better than that of seretide.

Acupuncture Points ; Acupuncture Therapy ; instrumentation ; methods ; Adolescent ; Adult ; Asthma ; immunology ; physiopathology ; therapy ; Female ; Forced Expiratory Volume ; Humans ; Immunoglobulins ; immunology ; Male ; Middle Aged ; Qi ; T-Lymphocytes ; immunology ; Treatment Outcome ; Young Adult

Objective To observe and compare the effects of acupuncture and acupuncture plus speech therapy on activation of the brain areas in aphasic patients by use of oxygenation level dependent-functional magnetic resonance imaging (BOLD-fMRI).Methods Twenty patients with aphasia caused by stroke were randomized into two groups by use of random number table (10 cases in each group):an experimental group subject to acupuncture treatment combined with speech therapy,and a control group subject to speech therapy only.All the cases were dextromanuality.On admission and after 1 month of treatment,BOLD-fMRI was used to test signals of the activated brain areas of both group,and Aphasia Battery of the Chinese (ABC) was employed to evaluate the changes of speech ability of the patients.Results During the study,1 case from control group was unable to do the post-intervention evaluation due to onset of the second stroke.The effective rates of the control and experimental group were 55.56％ and 100.00％,respectively,and recovery of verbal ability in experimental group was significantly better than in control group (P ＜ 0.05).The active volume and extent in brain were significantly increased in both groups (P ＜0.05),and a comparison between the two groups showed that the changes in activation volume and extent of the brain were significantly greater extensive in experimental group than in the control group,especially in bilateral frontal lobe,cuneus,posterior cingulate gyrus,lingual gyrus,occipital lobe,splenium of corpus callosum,cerebellar hemisphere,and the left precentral gyrus,post-central gyrus,paracentral lobule,temporal lobes,angular gyrus,precuneus,and the right hippocampus,parahippocampus gyrus.Conclusion Acupuncture combined with speech therapy could cause changes in activation patterns of the brain areas,which may contribute to the improvement of verbal ability of the aphasic patients.

BACKGROUND: Quiet a number of researches has reported the morphological changes of global ischemic reperfusion model. However, there are few reports on the ultrastructural changes of cortex in early reperfusion, especially the change of blood brain barrier.OBJECTIVE: To explore the changes of brain cortex neurons, glial cells and blood brain barrier in order to provide reliable evidence for clinical treatment.DESIGN: A randomized and controlled trial.SETTING: Department of Neurosurgery, Departnent of Anesthesia and Electron Microscope Room of Beijing Tiantan Hospital.MATERIALS: The experiment was conducted to 6 Wistar rats in Beijing Neurological Surgery Research Institute of Capital University of Medical Sciences during February 2003 to February 2004. The rats were randomly divided into two groups with one of ischemia-reperfusion group and sham operation group with 3 rats in each group.INTERVENTIONS: To prepare global ischemic reperfusion model of rats. Brain was removed from ischemic group in one hour of reperfusion and from sham operation group one hour after the operation. Electronic microscope technique was used to observe the ultrastructural changes of cortex.MAIN OUTCOME MEASURES: Ultrastructural changes of cortex.RESULTS: The neurons of cortex shrank to certain degree in the early stage of ischemic reperfusion(1 hour) . The glial cells were swollen with dissolved chromosome in nucleus and unclear nuclear membrane. The foot protrusions around blood vessel slightly swelled and separated from basement membrane. Mircro-tubes were partially dissolved.CONCLUSION: In early stage of reperfusion injury, the cortex neurons, glial cells, cellular framework and blood brain barrier already changed which suggested that the protective treatment such as reducing brain edema, protecting blood brain barrier should start as early as possible.

Objective To discuss the efficacy and safety of retroperitoneal laparoscopic ureterolithotomy in treatment of ureteral calculi.Methods All 33 cases with upper or midst ureter calculi were treated by laparoscopic ureterolithotomy,ESWL or URSL ineffective for 26 cases.The diameters of calculi ranged from 0.7 to 2.1 cm.Results All the operations were successful.The operation time was 30～120 min with a mean of 55 min.The intraoperative bleeding volume Was 40 ml (20～80 ml) on average no complication Was observed duing the follow-up of 6～12 months.All the hydronephrosis Was alleviated.Conclusion Laparoscopic ureterolithotomy is suitable for ureteral calculi treated unsuccesfully by open surgery.It is effective,safety and miniinvasive.

Objective To investigate the effect of ketamine on cAMP response element binding protein pbosphorylation(p-CREB)in hippocampus of neonatal rats.Methods Seventy-five 7-day old SD rats of both sexes were randomly divided into 3 groups(n=25 each):control group(group C)and 2 ketamlne groups(group K1,K2)which received 7 subcutaneous injections of ketamine 10 and 20 mg/kg respectively at 90 min intervals.The animsla were decapitated at 24 h after fwst ketamine injection.The brains were immediately removed and the hippocampi were isolated for detection of neuronal apoptosis by TUNEL.Apoptosis index wag calculated.The expression of p-CREB Wag meagured by immuno-histochemistry and the expression of BDNF mRNA and Bcl-2 mRNA was detected by RT-PCR.Cognitive function Wag agsessed using Morris water maze test at 6 weeks after first ketamine injection.Results The apoptosis index Wag significantly increased while the expression of CREB,BDNF mRNA and Bcl-2 mRNA was down-regulated in group K1 and K2 as compared with group C.The apoptosis index Wag significantly higher and the expression of p-CREB and BDNF mRNA and Bcl-2 mRNA Wag significantly lower in group K2 than in group K1.The latent period of escape was significantly longer in group K2 than in group C and K1.Conclusion Ketamine 20 mg/kg administered in neonatal rats can decrease cognitive function when they grow up by increasing neuronal apoptosis induced by down-regulatlon of the expression of p-CREB,BDNF and Bcl-2.

OBJECTIVE To study the causes and mechanism of auditory neuropathy. METHODS Auditory neuropathy is characterized by the DPOAE being normal, the shape of the pure tone loss being mostly in low frequencies, but the ABR being absent or the threshold elevated disproportionally to the pure tone threshold. Patients were screened from the deaf patients through asking the ill history and taking the exams of pure tone audiometry, auditory brain stem response, distortion product of otoaccoustic emissions (DPOAE). Thirty six patients were met the above standard. Deparaffined sections of cochlea of the guinea pigs were used as antigens to test whether the sera of patients had the autoantibodies with immunofluorescence method. RESULTS In the total of 36 patients with this type of hearing loss, autoantibodies were positive in 31 patients(86.1%). Twenty of the 31 patients had autoantibodiesto connective tissue of osseous spiral lamina where the nerve fiber connecting the hair cells and spiral ganglion cells go through. The autoantibodies to capsula surrounding the spiral ganglion and inner ear nerve fiber was also seen in these patients. In additional 7 patients, the autoantibodies to spiral ganglion cell nucleus and inner ear nerve fiber was detected. In the 44 control persons, 9.1% of them have the autoantibodies to inner ear tissues(P