Objective:To explore the relationship between macrophage infiltration in the coronary plaque and downstream myocardial perfusion in mice.Methods:The experimental group consisted of 20 ApoE knockout mice models of the coronary plaque established by feeding with cholesterol-rich diets, and the control group consisted of 20 sex- and age-matched C57BL/6 mice with the same genetic background as ApoE mice.Adenosine stress myocardial contrast echocardiography was performed on all experimental animals to obtain the values of A, β and A×β of the left ventricular myocardium in anteroseptal and posterior walls both in the resting status and during adenosine stress. Concentrations of serum interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were determined using mouse enzyme-linked immunosorbent assay kits according to the manufacturer′s instructions. The degree of macrophage infiltration in the coronary plaque was evaluated by pathological immunohistochemistry staining and the correlations with the above indicators were analyzed.Results:There were no statistically significant differences in heart rate and left ventricular structural parameters between two groups (all P>0.05). The experimental group had a lower left ventricular ejection fraction( P=0.021), and higher weight and serum levels of triglycerides, total cholesterol, high-density lipoprotein, low-density lipoprotein, IL-6, and TNF-α than the control group (all P<0.05). The values of A, β and A × β of the left ventricular myocardium in anteroseptal and posterior walls in the experimental group were significantly lower than those in the control group during adenosine stress (all P<0.05). In the experimental group, the value of the macrophage infiltration found in the plaque of the left main coronary artery correlated positively with the level of serum TNF-α ( r=0.63, P=0.003) and negatively correlated with the values of A×β of the left ventricular myocardium in anteroseptal and posterior walls during adenosine stress ( r=-0.74, P<0.001; r=-0.72, P<0.001; respectively). Conclusions:Myocardial perfusion in ApoE knockout mice models of the coronary atherosclerosis was related with degree of macrophage infiltration in the coronary plaque, and macrophages may play a role by releasing inflammatory mediator TNF-α.

Objective:To better understand the current status of master of public health (MPH) cultivation, establish a better training system, and improve its training quality.Methods:The students and teachers from many universities in Fujian province, as well as the public health workers, were investigated with a questionnaire on the "training model of master of public health", and SPSS 13.0 was used for data processing.Results:The survey results showed that 51.54%(67/130) of the survey respondents liked MPH major, and their understanding of MPH gradually increased with increasing working experience. However, there was no statistical significance in terms of the correlation between the abilities cultivated by the MPH training system and the working years. And 89.23%(116/130) of the survey respondents indicated that the direction of MPH training needed to be further refined, and the net promoter score for the evaluation of the MPH training model was -53.07%.Conclusion:At present, certain achievements have been made in MPH cultivation, and the development of MPH cultivation system needs more in-depth study.

Objective:To investigate the changes of left atrial structure and function in patients with apical hypertrophic cardiomyopathy (ApHCM) by three-dimensional (3D) echocardiography.Methods:From September 2020 to December 2022, 112 patients with ApHCM(ApHCM group) diagnosed at Tongji Hospital Tongji Medical College, Huazhong University of Science and Technology and 41 age- and sex-matched normal controls(control group) were finally enrolled. In 'pure’ ApHCM patients, cardiac hypertrophy was confined to the apical segment below the papillary muscle. The wall thickness of apical and intermediate segments in 'mixed’ ApHCM patients increased, but the wall thickness of apical segment was the largest. Two-dimensional(2D) and 3D volume and strain parameters of left atrium were compared between control group and ApHCM group, 'pure’ and 'mixed’ ApHCM patients.The correlations between 2D and 3D volume and strain parameters of left atrium and intraclass correlation coefficient (ICC) of those parameters were analyzed. The ROC curve was performed to determine the cutoff values of 3D left atrial volume abnormalities in all subjects. Logistics regression analysis was performed to analyze the impact factors of the left atrial enlargement in patients with ApHCM.Results:Compared with the control group, 2D left atrial maximum volume index (2D LAVimax), 2D left atrial minimum volume index (2D LAVimin), 3D left atrial maximum volume index (3D LAVimax), 3D left atrial minimum volume index (3D LAVimin), and 3D left atrial presystolic volume index (3D LAVipreA) significantly increased in ApHCM group( Z=-6.54, -6.38, -6.98, -7.40, -6.96; all P<0.001). However, 2D left atrial ejection fraction (2D LAEF) ( Z=-3.75, P<0.001), 2D left atrial expansion index (2D LAEI) ( t=-4.15, P<0.001), 3D left atrial ejection fraction (3D LAEF) ( Z=-5.09, P<0.001), 3D left atrial expansion index (3D LAEI) ( t=-5.49, P<0.001), 2D left atrial reservoir strain (2D LASr) ( t=-12.03, P<0.001), 2D left atrial conduit strain (2D LAScd) ( t=7.91, P<0.001), 2D left atrial contractile strain (2D LASct) ( t=6.06, P<0.001), 3D left atrial reservoir strain (3D LASr) ( t=-9.23, P<0.001), 3D left atrial conduit strain (3D LAScd) ( t=7.12, P<0.001) and 3D left atrial contractile strain (3D LASct) ( t=4.78, P<0.001) significantly decreased in ApHCM group. Compared with the 'pure’ ApHCM group, 2D LAVimax, 3D LAVimax, 2D LAVimin, 3D LAVimin, 3D LAVipreA in patients with mixed ApHCM increased more significantly, while 2D LAEF, 2D LAEI and 2D LASr decreased more significantly. The measurements of left atrial volume and strain by 3D echocardiography were significantly correlated with 2D measurements ( P<0.05). The correlations between 2D LAVimax and 3D LAVimax, 2D LAVimin and 3D LAVimin, 2D LAEF and 3D LAEF, 2D LASr and 3D LASr, 2D LAEI and 3D LAEI ( r=0.91, 0.93, 0.72, 0.76, 0.57; all P<0.05) were more than moderate. The repeatability of 3D left atrial strain was lower than 2D results, while the repeatability of 3D left atrial volume was higher than 2D results. ROC curve analysis showed that 3D echocardiography parameters could identify left atrial volume abnormality in all subjects. The cutoff values of 3D LAVimax, 3D LAVimin, 3D LAVipreA in all subjects were 36 ml/m 2, 18 ml/m 2 and 27 ml/m 2, respectively. Multivariate binary logistic regression analyses showed that ratio of LV systolic obliteration to cavity was independent factor affecting left atrial enlargement in ApHCM patients( OR=1.20, P<0.001). Conclusions:Three-dimensional echocardiography is significant for the accurate evaluation of left atrial structural changes in patients with ApHCM. Ratio of left ventricular systolic obliteration to cavity was an independent impact factor of left atrial enlargement in ApHCM patients.

Objective:To evaluate the efficacy and safety of immediate intraoperative transapical beating-heart septal myectomy (TA-BSM) in patients with hypertrophic obstructive cardiomyopathy (HOCM) and explored the clinical value of three-dimensional transesophageal echocardiography (3D-TEE) during the procedure of TA-BSM.Methods:One hundred and thirty-seven HOCM patients who underwent TA-BSM surgery in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from April 2022 to March 2023 were selected.During the operation, 3D-TEE was used to locate the position of the myocardial circumcision system and navigate the range of myocardial circumcision. The interventricular septal thickness( IVST) and peak pressure gradient of the left ventricular outflow tract (LVOT-PG) were measured, and the degree of mitral systolic anterior motion (SAM) and mitral regurgitation (MR) were evaluated in HOCM patients before and after the operation. The range of the incisal margin was measured, and the number of resection knives and the weight of the removed myocardium were recorded.Results:TA-BSM under 3D-TEE navigation was successfully performed in 137 HOCM patients. The number of resection was 7(5, 9), and the weight of the removed myocardium was 5.6(3.4, 8.9)g. During the operation, there were no adverse events such as death, aortic valve injury, and iatrogenic interventricular septal perforation. Compared with those before the operation, the wall thickness of basal and middle segments of the anterior and posterior interventricular septum decreased significantly (all P<0.001), and LVOT-PG decreased significantly ( P<0.001). After TA-BSM, the number of patients with SAM≥3 decreased from 94 cases (68.6%) to 2 cases (1.5%), and the number of patients with MR≥3+ decreased from 86 cases (62.8%) to 9 cases (6.6%)(all P<0.001). For the patients with different degrees of ventricular septal hypertrophy (mild, moderate, and severe), the postoperative IVST and LVOT-PG were significantly lower than the preoperative values, and the degree of MR and SAM signs was relieved considerably. The length of the incisal margin, the weight of excised myocardium, and the number of resection in the group with extensive septal hypertrophy in all three regions were significantly higher than those in the group with localized interventricular septal hypertrophy in single or two areas (all P<0.05). Conclusions:3D-TEE can guide and monitor the process of TA-BSM myocardial resection in real-time. By accurately evaluating the IVST and the range and hemodynamic characteristics of HOCM patients, it can effectively relieve LVOTO and significantly reduce MR to ensure the safety and effectiveness of TA-BSM in HOCM patients with different degrees and ranges of hypertrophy.

Objective:To investigate the relationship between vulnerability of mouse coronary artery plaque and downstream myocardial perfusion and myocardial strain.Methods:Thirteen ApoE knockout mice with stable coronary plaques (stable plaque group)and 13 ApoE knockout mice with vulnerable coronary plaques(vulnerable plaque group) were selected as the experimental group, and 15 sex- and age-matched C57BL/6 mice with the same genetic background as ApoE mice were chosed as the control group. Myocardial contrast echocardiography (MCE) was carried out to quantify regional myocardial perfusion at rest and during adenosine stress using a Vevo 2100 system (Visual sonics). Replenishment curves of myocardial contrast were obtained, and rates of signal rise (β) and plateau intensity (A) were recorded. MBF was estimated by the product of A and β. Speckle tracking imaging combined with adenosine stress test was used to evaluate the longitudinal strain of left ventricular myocardium in mice. The vulnerability of the plaque was assessed by histopathology in serial tissue sections of proximal and middle left coronary artery according to the previously reported method.Results:There were no significant differences in body weight, heart rate, left ventricular end diastolic volume, left ventricular end systolic volume, left ventricular mass and ejection fraction among the three groups( P>0.05). The levels of serum triglyceride, total cholesterol, high density lipoprotein and low density lipoprotein in stable plaque group and vulnerable plaque group were significantly increased when compared with those in control group (all P<0.05). The pathological results showed that the coronary luminal stenosis rates in the stable plaque group and the vulnerable plaque group were (74.3±4.9)% and (75.5±7.1)% respectively, with no significant difference between the two groups( P>0.05). MBF of the middle anterior septum and left ventricular posterior wall in the experimental groups were significantly decreased when compared with that in the control group both in the resting status and during adenosine stress(all P<0.05). There were no significant differences in the MCE parameters between the stable plaque group and the vulnerable plaque group at rest( P>0.05). However, during adenosine stress, MBF of the vulnerable plaque group was decreased more significantly than that of the stable plaque group ( P<0.05). Compared with the control group, the values of longitudinal strain of the left ventricle in both experimental groups were decreased during resting status, without statistical significance (all P>0.05), but decreased significantly during adenosine stress and with more decrease in the vulnerable plaque group (all P<0.05). Conclusions:For the same degree of coronary artery stenosis in mice, the coronary artery vulnerable plaque group has less downstream myocardial perfusion and myocardial strain than the stable plaque group during adenosine stress. That is, the plaque vulnerability can affect the downstream myocardial perfusion and myocardial strain in the mouse model.

Objective:To evaluate the left ventricular rotation and twist in patients with constrictive pericarditis (CP) after pericardiectomy by using speckle tracking echocardiography (STE), and observe its trend over time.Methods:A total of 29 patients with CP from Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from September 2014 to December 2017 underwent echocardiography 1 week before and 1 month, 6 months, 12 months after pericardiectomy. STE was performed to obtain peak values of basal and apical rotation and left ventricular twist. Twenty-nine healthy subjects were recruited as controls in the same period.Results:The left ventricu1ar apical rotation[before surgery(6.62±3.19)°, 1 month after surgery(7.07±4.02)°, 6 months after surgery(7.88±4.46)°, 12 months after surgery(7.85±4.51)°], the left ventricu1ar twist [before surgery(10.50±4.94)°, 1 month after surgery(9.42±5.40)°, 6 months after surgery(9.59±4.62)°, 12 months after surgery(9.70±4.45)°] were significantly lower in patients with CP than those in controls [(11.22±5.17)°, (16.35±5.21)°](all P<0.05); while basal rotation in patients with CP after surgery among different time points were all significantly lower than those in controls[1 month after surgery(-3.85±3.20)°, 6 months after surgery(-3.49±2.09)°, 12 months after surgery(-3.53±2.01)°; controls(-5.57±2.78)°] (all P<0.05), with no significant difference between patients with CP before surgery (-5.22±3.14)° and controls (-5.57±2.78)°( P>0.05). There were no significant differences in left ventricular twist, basal and apical rotation in CP groups before and after surgery among different time points (all P>0.05). Conclusions:Although the left ventricular global function of patients with CP in the long postoperative period seems "normal" , the left ventricular twist, basal and apical rotation are still significantly lower than those in controls. STE can be used to assess the changes of left ventricular twist and rotation in patients with CP long-term after pericardiectomy.

Objective:To explore the clinical effect of repairing the ankle soft tissue defects with bone exposure using descending branch of lateral circumflex femoral artery (LCFA-db) perforator flap.Methods:From May 2014 to March 2018, 11 patients with ankle soft tissue defect with bone and tendon exposure were treated in the First Central Hospital of Baoding City ( 9 males and 2 females, aged from 19 to 47 years). VSD treatment was performed after debridement. When the wound show no signs of infection, the secondary repair was performed using the LCFA-db perforator flap. The area of the flap was 6.5 cm×4.5 cm-16.5 cm×8.5 cm. Followed-up was acquired to be used for evaluating the clinical effect.Results:There were no complications such as vasospasm or vascular crisis for transplanted flap after surgery. In 11 cases, 2 cases had necrosis of 0.5-1.0 cm in the distal part of the flap. Both were completely healed after dressing and related treatment. The flaps in the rest of patients survived successfully. The patients were followed up for 4-16 months with a mean time of 10.4 months. These flaps survived with good appearance, no swelling, no need for secondary surgery, soft texture, abrasion resistant and no pigmentation. Protective sense was restored. At the last follow-up, the American Orthopedic Foot and Ankle Society Score (AOFAS) score was ranging from 74 to 98 in 11 cases with the average score of 90.55. The outcomes were excellent in 8 cases, good in 2 cases and fair in 1 case. The donor site of the flap healed well. The flexion and extension of knee joint were normal with the good appearance and no impaired function.Conclusions:LCFA-db perforator flap may serve as an alternative option for reconstructing the ankle with soft-tissue defect.

Objective:To explore the clinical effect of repairing the ankle soft tissue defects with bone exposure using descending branch of lateral circumflex femoral artery (LCFA-db) perforator flap.Methods:From May 2014 to March 2018, 11 patients with ankle soft tissue defect with bone and tendon exposure were treated in the First Central Hospital of Baoding City ( 9 males and 2 females, aged from 19 to 47 years). VSD treatment was performed after debridement. When the wound show no signs of infection, the secondary repair was performed using the LCFA-db perforator flap. The area of the flap was 6.5 cm×4.5 cm-16.5 cm×8.5 cm. Followed-up was acquired to be used for evaluating the clinical effect.Results:There were no complications such as vasospasm or vascular crisis for transplanted flap after surgery. In 11 cases, 2 cases had necrosis of 0.5-1.0 cm in the distal part of the flap. Both were completely healed after dressing and related treatment. The flaps in the rest of patients survived successfully. The patients were followed up for 4-16 months with a mean time of 10.4 months. These flaps survived with good appearance, no swelling, no need for secondary surgery, soft texture, abrasion resistant and no pigmentation. Protective sense was restored. At the last follow-up, the American Orthopedic Foot and Ankle Society Score (AOFAS) score was ranging from 74 to 98 in 11 cases with the average score of 90.55. The outcomes were excellent in 8 cases, good in 2 cases and fair in 1 case. The donor site of the flap healed well. The flexion and extension of knee joint were normal with the good appearance and no impaired function.Conclusions:LCFA-db perforator flap may serve as an alternative option for reconstructing the ankle with soft-tissue defect.

Objective To explore the effects of adenosine stress on myocardial perfusion in healthy mice by myocardial contrast echocardiography ( MCE) . Methods MCE was carried out to quantify regional myocardial perfusion at rest and during adenosine stress using a VEVO 2100 system in 26 C57BL/6 mice . Echocardiography images from standardized parasternal long axis and short axis at papillary muscle level were consecutively acquired in real‐time . All dynamic images were recorded for off‐line analysis . Left ventricular myocardial perfusion quantitative parameters were acquired both under resting status and during adenosine stress . Replenishment curves of myocardial contrast were obtained and myocardial blood flow ( MBF) was calculated . Results Twenty‐six experimental animals successfully underwent MCE before and during adenosine stress . T here was no significant difference in heart rate ,left ventricular structure and functional parameters before and during adenosine stress ( all P ＞0 .05) . Rates of signal rise β values which were used to estimate blood velocity of middle anterior septum and posterior wall in left ventricular long‐axis view and anterior wall ,lateral wall ,inferior wall and septal wall in short‐axis view at papillary muscle increased significantly during stress compared with those at rest ( all P ＜0 .05 ) . T here was no significant difference in the plateau intensity A values( all P ＞0 .05 ) . T he MBF in each segment of the myocardium increased significantly during stress compared with those in resting state ( all P ＜0 .05) . Conclusions T he physiological characteristics of myocardial perfusion in mice before and during adenosine stress were preliminarily obtained ,w hich provided a basis for the application of adenosine stress echocardiography in cardiovascular disease models such as coronary heart disease in mice .

Objective To explore the effects of adenosine stress on myocardial strain in healthy mice by speckle tracking imaging (STI).Methods A high-resolution rodent ultrasound machine Vevo 2100 was used to perform conventional transthoracic echocardiography at baseline and after intravenous infusion of adenosine in 34 C57BL/6 mice.Echocardiography images from standardized parasternal long axis and short axis at papillary muscle level were consecutively acquired in real-time.All dynamic images were recorded for off-line analysis.Left ventricular myocardial mechanical strain parameters were acquired both under resting status and during adenosine stress.Results Thirty-four experimental animals successfully underwent STI before and during adenosine stress. There was no significant difference in heart rate,left ventricular structure and functional parameters between before and after the adenosine stress ( P >0.05).Global peak longitudinal strain value in left ventricular long-axis view was significantly increased during stress compared with those at resting status ( P < 0.05);while there was no significant increase in the global peak circumferential strain and global peak radial strain values in short-axis view at papillary muscle ( P >0.05).Conclusions Myocardial strain is obtained in healthy mice before and after adenosine stress.This provides an evidence to the application of stress echocardiography in mice with coronary heart disease or other cardiovascular disease in the future.