Objective:To explore the possibility of using a inferior gluteal artery perforator flap (IGAPF) for breast reconstruction in the patient who did not have suitable donor site in back and abdomen.Methods:In November 2024, a 25-year-old unmarried and childless woman with right breast cancer received immediate right breast reconstruction by a right free IGAPF after modified right mastectomy in the Department of Breast and Thyroid Surgery, Second Affiliated Hospital of Hainan Medical University. The locations of perforators were confirmed by both Multi-detector computed tomography angiography (MDCTA) and portable Doppler blood flow detector before surgery. The IGAPF was designed to take the inferior gluteal wrinkle as the lower edge, the axis of the flap was parallel to the inferior gluteal wrinkle, and the width of the flap was estimated where the incision could be directly closed. The size of right IGAPF was 6.0 cm×19.0 cm. Sharp dissection was performed between the sarcolemma and muscle fibres of gluteus, then the perforators were dissected along the direction of muscle fibres of gluteus. The vascular pedicle was kept at about 8.0 cm in length. The diameter of artery was about 2.0 mm and that for the veins was about 1.5 mm. End-to-end anastomoses with the right thoracodorsal artery and vein were successfully carried out. The donor site was directly closed, and it was hidden in the inferior gluteal wrinkle. Postoperative outpatient clinical review was made.Results:Pathological examination reported: an invasive carcinoma of right breast, axillary lymph node metastasis (2/10). The patient recovered well and the flap survived without any complication, i.e. ischemic necrosis, infection and haematoma. The patient was off-bed at 3 days and discharged at 13 days after surgery. At the 40 days of postoperative follow-up, the patient achieved a good recovery and the lower limb activity was not affected by the surgery. The patient was satisfied with the reconstructed breast and donor site recovery. The patient followed with scheduled chemotherapy and subsequent radiotherapy. The volume of reconstructed breast was smaller than the other breast, of which the patient was fully informed before the surgery.Conclusion:A free IGAPF provides an alternative donor sites for achieving a breast reconstruction due to the reliable pedicle vessels and invisible donor scars.

Objective To observe the value of right ventricular free wall longitudinal strain(RVFWLS)to pulmonary artery systolic pressure(PASP)ratio(RVFWLS/PASP)for evaluating systolic function of right ventricle(RV)in patients with hypertrophic cardiomyopathy(HCM).Methods Fifty-two HCM patients were retrospectively collected and divided into group A(RVFWLS/PASP≤0.75,n=26)and B(RVFWLS/PASP＞0.75,n=26)according to median RVFWLS/PASP.Meanwhile,26 healthy individuals were included as control group.Parameters of echocardiography and speckle tracking imaging(STI)were obtained and compared among 3 groups.The correlations of RVFWLS/PASP and other parameters were analyzed with linear regression.Results In group A and B,left ventricular ejection fraction(LVEF),RV septal longitudinal strain(RVSepLS),RVFWLS,RV end-diastolic volume index(RVEDVi),RV stroke volume(RVSV),RV fractional area change(RVFAC)and left ventricular global longitudinal strain(LVGLS)were all lower,while the ratio of peak E blood flow velocity at mitral orifice diastole to early mitral intervalal annulus diastole velocity(E/e′)were higher than those in control group(all adjusted P＜0.05).Compared with group B and control group,group A had higher PASP but lower RV ejection fraction(RVEF)(all adjusted P＜0.05).Furthermore,RVFWLS and LVGLS were both lower in group A than in group B(both adjusted P＜0.05).Linear regression analysis showed that RVSepLS and RVEF were independently linearly related to RVFWLS/PASP(both P＜0.05).Conclusion RVFWLS/PASP could be used to monitor changes of RV systoic function in HCM patients at early stage.

Objective To observe the value of right ventricular free wall longitudinal strain(RVFWLS)to pulmonary artery systolic pressure(PASP)ratio(RVFWLS/PASP)for evaluating systolic function of right ventricle(RV)in patients with hypertrophic cardiomyopathy(HCM).Methods Fifty-two HCM patients were retrospectively collected and divided into group A(RVFWLS/PASP≤0.75,n=26)and B(RVFWLS/PASP＞0.75,n=26)according to median RVFWLS/PASP.Meanwhile,26 healthy individuals were included as control group.Parameters of echocardiography and speckle tracking imaging(STI)were obtained and compared among 3 groups.The correlations of RVFWLS/PASP and other parameters were analyzed with linear regression.Results In group A and B,left ventricular ejection fraction(LVEF),RV septal longitudinal strain(RVSepLS),RVFWLS,RV end-diastolic volume index(RVEDVi),RV stroke volume(RVSV),RV fractional area change(RVFAC)and left ventricular global longitudinal strain(LVGLS)were all lower,while the ratio of peak E blood flow velocity at mitral orifice diastole to early mitral intervalal annulus diastole velocity(E/e′)were higher than those in control group(all adjusted P＜0.05).Compared with group B and control group,group A had higher PASP but lower RV ejection fraction(RVEF)(all adjusted P＜0.05).Furthermore,RVFWLS and LVGLS were both lower in group A than in group B(both adjusted P＜0.05).Linear regression analysis showed that RVSepLS and RVEF were independently linearly related to RVFWLS/PASP(both P＜0.05).Conclusion RVFWLS/PASP could be used to monitor changes of RV systoic function in HCM patients at early stage.

Objective:To explore the possibility of using a inferior gluteal artery perforator flap (IGAPF) for breast reconstruction in the patient who did not have suitable donor site in back and abdomen.Methods:In November 2024, a 25-year-old unmarried and childless woman with right breast cancer received immediate right breast reconstruction by a right free IGAPF after modified right mastectomy in the Department of Breast and Thyroid Surgery, Second Affiliated Hospital of Hainan Medical University. The locations of perforators were confirmed by both Multi-detector computed tomography angiography (MDCTA) and portable Doppler blood flow detector before surgery. The IGAPF was designed to take the inferior gluteal wrinkle as the lower edge, the axis of the flap was parallel to the inferior gluteal wrinkle, and the width of the flap was estimated where the incision could be directly closed. The size of right IGAPF was 6.0 cm×19.0 cm. Sharp dissection was performed between the sarcolemma and muscle fibres of gluteus, then the perforators were dissected along the direction of muscle fibres of gluteus. The vascular pedicle was kept at about 8.0 cm in length. The diameter of artery was about 2.0 mm and that for the veins was about 1.5 mm. End-to-end anastomoses with the right thoracodorsal artery and vein were successfully carried out. The donor site was directly closed, and it was hidden in the inferior gluteal wrinkle. Postoperative outpatient clinical review was made.Results:Pathological examination reported: an invasive carcinoma of right breast, axillary lymph node metastasis (2/10). The patient recovered well and the flap survived without any complication, i.e. ischemic necrosis, infection and haematoma. The patient was off-bed at 3 days and discharged at 13 days after surgery. At the 40 days of postoperative follow-up, the patient achieved a good recovery and the lower limb activity was not affected by the surgery. The patient was satisfied with the reconstructed breast and donor site recovery. The patient followed with scheduled chemotherapy and subsequent radiotherapy. The volume of reconstructed breast was smaller than the other breast, of which the patient was fully informed before the surgery.Conclusion:A free IGAPF provides an alternative donor sites for achieving a breast reconstruction due to the reliable pedicle vessels and invisible donor scars.

Objective To evaluate diagnostic value of mitral regurgitation jet volume(MRvol) in the quantification of mitral regurgitation severity by general imaging three-dimensional quantification (GI3DQ) using the guideline recommended 2D integrative method as a reference.Methods Ninety-three patients with MR were divided into central MR group(n =41) and eccentric MR group(n =52).The American Society of Echocardiography (ASE)-recommended 2D integrative method was used as a reference for MR grading and MRvol was directly measured by GI3DQ method.Results In central MR,as assessed by receiver operating characteristic (ROC) analysis,the area under the curve(AUC)was 0.87(P <0.0001), and MRvol by GI3DQ at a cutoff value of 16.2 ml yielded 96.2% of sensitivity and 63.6% of specificity to differentiate mild from moderate MR;the AUC was 0.98(P < 0.0001),and a cutoff value of 47.8 ml yielded 98.6% of sensitivity and 96.2% of specificity to differentiate moderate from severe MR. In eccentric MR,the AUC was 0.76(P =0.086),and MRvol at a cutoff value of 14.8 ml yielded 90.9% of sensitivity and 60.0% of specificity to differentiate mild from moderate MR;the AUC was 0.84(P <0.0001) and a cutoff value of 40.7 ml yielded 80.0% of sensitivity and 79.7% of specificity to differentiate moderate from severe MR.Conclusions MRvol measured directly by GI3DQ could more exactly evaluate MR severity,and have better sensitivity and specificity to differentiate moderate from severe MR in central MR.

To explore the feasibility and accuracy for evaluating mitral regurgitation (MR) severity with MR jet volume (MRvol) by means of general imaging three-dimensional quantification (GI3DQ). Methods: A total of 93 MR patients were divided into 2 groups: Central MR group, n=41 and Eccentric MR group, n=52. According to real-time three-dimensional echocardiography (RT3DE) examined planimetry of effective regurgitation orifice area (EROA), the patients were graded into mild MR, moderate MR and severe MR. MRvol was directly measured by GI3DQ. Results: In Central MR group, ROC analysis showed that as GI3DQ measured MRvol>16.2 ml, AUC=0.93, P<0.0001, the sensitivity and specificity for distinguishing mild MR and moderate MR were 96.0% and 70.0%respectively; as MRvol>44.5 ml, AUC=0.96, P<0.0001, the sensitivity and specificity for distinguishing moderate MR and severe MR were 97.6% and 91.7% respectively. In Eccentric MR group, as MRvol>14.2 ml, AUC=0.77, P=0.0243, the sensitivity and specificity for differentiating mild MR and moderate MR were 91.8% and 62.5% respectively; as MRvol>40.5 ml, AUC=0.83, P<0.0001, the sensitivity and specificity for differentiating moderate MR and severe MR were 82.3% and 77.9% respectively. Conclusion: Taking RT3DE examined EROA as reference, GI3DQ directly measured MRvol could more accurately assess MR severity especially in patients with central MR, it may distinguish moderate MR and severe MR with the higher sensitivity and specificity.

ObjectiveTo investigate the effect of arterial stiffness on systolic deformation in hypertensive disease.MethodsSixty essential hypertensive patients were enrolled, including 25 cases with left ventricular normal geometric (group LVN) and 35 cases with left ventricular hypertrophy (group LVH) in the Affiliated Hospital of Qingdao University during July 2013 to March 2014. Thirty patients in the control group were enrolled in the same period. The peak systolic strains and strain rates were determined by using velocity vector imaging. Stroke volume was obtained by using real-time three-dimensional echocardiography. And pulse pressure/stroke volume was used as a surrogate index of arterial stiffness. Pulse pressure/stroke volume, the differences of strain and strain rate in three groups were compared by analysis of variance, and SNK-q test was used for further comparison between two groups. Multiple linear regression was performed to estimate predictors for systolic longitudinal deformation. Pearson?s correlation was used to analysis the relevance of systolic longitudinal strain and body mass index, triglyceride, left ventricular ejection fraction, age, left ventricular mass index, pulse pressure/stroke volume.ResultsPulse pressure/stroke volume were (1.26±0.45) mmHg·m2·ml-1, (1.53±0.59) mmHg·m2·ml-1, (1.82±0.43) mmHg·m2·ml-1 (1 mmHg=0.133 kPa) in the control group, LVN, LVH respectively. The systolic strains and strain rates in the control group, LVN, LVH were recorded as follows:systolic longitudinal strains were (23.60±1.94)%, (19.69±2.56)%, (17.34±2.48)%, the systolic longitudinal strain rates were (1.64±0.17) s-1, (1.52±0.14) s-1, (1.38±0.18) s-1; the systolic radial strains were (28.69±5.2)%, (30.81±4.14)%, (26.53±3.50)%, the systolic radial strain rates were (2.51±0.56) s-1, (2.60±0.45) s-1, (2.00±0.41) s-1; the circumferential strains were (24.50±5.21)%, (24.01±4.60)%, (21.00±3.70)%, the circumferential strain rates were (1.38±0.38) s-1, (1.30±0.30) s-1, (1.10±0.26) s-1. Pulse pressure/stroke volume was higher in LVN and was more pronounced in the LVH group compared with the control (LVN/LVH with the control group:q=2.90, 6.56, LVN with LVH:q=3.22, allP<0.05). The strains and strain rates in LVH were lower than those of LVN and the control group, and the differences were statistically significant. (longitudinal strains:q=15.22, 5.43; longitudinal strain rates:q=8.88, 4.54; radial strains:q=2.85, 5.36; radial strain rates:q=6.10, 6.81; circumferential strains:q=4.42, 3.61; circumferential strain rates:q=5.04, 3.42; allP<0.05). The strains and strain rates in LVN were lower than the normal group, the signiifcant differences of the longitudinal strains and longitudinal strain rates were found (q=8.73, 3.77, bothP<0.05) while there were no statistically signiifcant differences of radial strains and radial strain rates, circumferential rates and circumferential strain rates. In a multivariate analysis, LVMI and AS were found to be predictors for systolic longitudinal strain. Body mass index, triglyceride, left ventricular ejection fraction, age, left ventricular mass index and pulse pressure/stroke volume were negatively related to systolic longitudinal strain (r=-0.10,-0.09,-0.14,-0.42,-0.56, allP<0.05) by Pearson?s correlation, while LVEF was positively related to mean systolic longitudinal strain (r=0.13,P<0.05).ConclusionArterial stiffness is suitable as an predictor for left ventricular systolic deformation in hypertensive disease.

Objective To evaluate the regional long-axis systolic function of left ventricular in patients with coronary artery disease and healthy subjects by two-dimensional strain rate imaging (2D-SRI). Methods During October 2011 to August 2012 , 53 inpatients with coronary artery disease in the department cardiology from the Afifliated Hospital of Medical College, Qingdao University were enrolled. Twenty-nine patients with anterior wall infarction induced by left front-descending coronary artery disease (group LCA) and twenty-four with interior wall infarction induced by right coronary artery disease (group RCA) proved by coronary angiography and echocardiography were enrolled into the study and thirty healthy volunteers in the control group. High frame rate two-dimensional dynamic images were recorded in apical four-chamber view and two-chamber view of the left ventricle. Using two-dimensional strain software, peak systolic longitudinal strain rate (PSRs) of interventricular septum, anterior wall, lateral wall and interior wall of left ventricle were measured. All data of 3 groups were analyzed using One-Way analysis of variance, and LSD-q test used to compare the 2 groups. Results The PSRs were (4.61±0.60) s-1, (5.18±0.87) s-1, (5.60±0.70) s-1, (6.05±0.74) s-1 from interventricular septum, anterior wall, lateral wall to interior wall in the control group. There were signiifcant differences among the groups (F=20.95, P=0.00), and there were signiifcant gradient changes from intervetrivular septum, anterior wall, lateral wall to interior wall in the control group. The PSRs were (4.31±0.85) s-1, (1.96±0.93) s-1, (5.54±0.83) s-1, (5.93±0.80) s-1 from interventricular septum, anterior wall, lateral wall to interior wall in the LCA group respectively. There were signiifcant differences among the different walls (F=127.25, P=0.00), which was signiifcant lower in ischemic anterior wall than interventricular septum, lateral wall and interior wall, and the significant differences were identified in anterior wall with lateral wall and interior wall (q=22.62, 25.04, both P<0.01). The PSRs were (4.51±0.62) s-1, (4.99±1.13) s-1, (5.31±0.81) s-1, (2.84±0.85) s-1 from interventricular septum, anterior wall, lateral wall to interior wall in RCA group respectively. There were signiifcant differences among the different walls (F=38.12, P=0.00), which were signiifcant lower in ischemic interior wall than interventricular septum, anterior wall, and lateral wall, and the signiifcant differences were identiifed in interior wall with lateral wall and interior wall (q=13.88, 12.08, both P<0.01). Comparing the same part among 3 groups, signiifcant differences were identiifed as following:the PSRs of anterior wall in group LCA vs control group (q=20.17, P<0.01), the PSRs of interior wall in group RCA vs control group (q=19.98, P<0.01). Conclusions Longitudinal systolic function changes of left ventricular regional myocardium in patients with coronary artery disease and healthy subjects could be accurately analyzed by 2D-SRI. The early changes in ischemic myocardium would be assessed quickly in patients with coronary artery disease using 2D-SRI.

ObjectiveTo screen the items of Advanced Cancer patient Needs Questionnaire (ACNQ)and develop a short version.MethodsA total of 80 cancer patients of middle and advanced stage were recruited.The items were screened with variation degree method and factor analysis method,combined with clinical meaning of the items.The reliability and validity of newly-development scale were confirmed with new sample of 60 cancer patients.ResnltsThrough statistical methods 12 items were removed from the original scale,forming a short version of Advanced Cancer patient Needs Questionnaire:ACNQ-29.The correlation coefficient of split half reliability was 0.913.The Cronbach′s α coefficient of all items was 0.923.Through principal components and factor analysis,7 principal components were gained including basically the 4 dimensions of physiological,psychological,spiritual and social domain with accumulation contribution of 75.478％.ConclusionsNew scale has good reliability and validity,and more easily for patients to complete.It has feasibility and practicability.

Objective To evaluate the feasibility of real-time triplane strain rate imaging for the quantitative assessment of left atrial function in normal subjects. Methods Totally 40 healthy volunteers were enrolled. Left atrial expansion index (LAEI), left atrial passive emptying fraction (LAPEF) and left atrial active emptying fraction (LAAEF) were measured using real-time triplane volume analysis. Mean systolic peak strain rate (MSRs), mean early diastolic peak strain rate (MSRe) and mean late diastolic peak strain rate (MSRa) were measured using real-time triplane strain rate imaging. The results were compared respectively. Results MSRs correlated positively with LAEI (r=0.61, P<0.01). MSRe correlated inversely with LAPEF (r=-0.67, P<0.01), so did MSRa with LAAEF (r=-0.78, P<0.01). Conclusion Real-time triplane strain rate imaging is feasible for the quantification of left atrial function in normal subjects.