Objective:To evaluate the predictive value of mechanical power (MP) on the risk of in-hospital mortality in critical ill patients in emergency department.Methods:A total of 105 critical ill patients with invasive mechanical ventilation in the Department of Emergency of Second Affiliated Hospital of Guangzhou Medical University between December 1, 2017 and October 31, 2020 were retrospectively analyzed. Based on the clinical prognosis, the patients were divided into the in-hospital survival group (80 patients) and the in-hospital death group (25 patients). The clinical data and ventilator parameters were recorded, and the MP of the two groups was calculated in order to assess the predictive efficacy of MP on in-hospital death.Results:Compared to the in-hospital death group, the oxygenation index PaO 2/FiO 2 was significantly higher (271 mmHg vs. 217 mmHg, P=0.020) and blood lactate (1.59 mmol/L vs. 2.56 mmol/L, P<0.001) and procalcitonin (0.31 ng/mL vs. 3.55 ng/mL, P=0.028), minute ventilation (7.03 L/min vs.8.32 mmol/L, P=0.013), MP (14.37 J/min vs. 16.12 J/min, P=0.041), SOFA score (5 vs. 8, P=0.001) and APACHE II score (16 vs. 22, P=0.041) were significantly lower in the in-hospital survival group. Multivariate Logistic regression analysis showed that PaO 2/FiO 2( OR=1.015, P=0.044), MP ( OR=1.813, P=0.039) and SOFA score( OR=2.651, P=0.010) were independent risk factors for predicting hospital mortality in patients with mechanical ventilation. The areas under the ROC curves (AUC) were 0.62, 0.63 and 0.75, respectively. Moreover, the MP combined with SOFA score for predicting in-hospital death was significantly higher than that of MP alone (0.77 vs. 0.63, P<0.05). Conclusions:MP is associated with in-hospital death in patients with invasive mechanical ventilation in emergency department. MP combined with SOFA score can enhance its predictive efficacy

To evaluate the right ventricular systolic function in uremia patients and the effects of maintenance hemodialysis on right ventricular systolic function by volume and strain parameters obtained by 4D RV Volume . Methods Seventy‐six patients with uremia and twenty‐two controls were selected . According to left ventricular ejection fraction ( LVEF) ,uremia patients were divided into normal LVEF uremia group and decreased LVEF uremia group . T hen normal LVEF uremia group was divided into maintenance hemodialysis group and non‐dialysis group . Conventional ultrasound parameters included :LVEF ,pulmonary artery systolic pressure ( PASP) and tricuspid annular plane systolic excursion ( T APSE‐2D) . 4D RV Volume parameters included : right ventricular end‐diastolic volume ( RVEDV ) , tricuspid annular plane systolic excursion ( T APSE‐4D ) ,right ventricular area change rate ( FAC ) ,right ventricular ejection fraction ( RVEF) and right ventricular free wall longitudinal systolic strain ( RV‐GLSfree ) . Results①Compared with the control group ,T APSE‐2D decreased significantly in the decreased LVEF uremia group ( P ＜0 .05) ,w hile there was no significant difference of T APSE‐2D in normal LVEF uremia group ( P ＞ 0 .05) . Compared with the control group and normal LVEF uremia group ,PASP increased significantly in the decreased LVEF uremia group ( P ＜ 0 .05 ) . Compared with the control group ,RVEDV increased significantly both in the normal LVEF and decreased LVEF uremia group ,w hich showed an increasing trend in these three groups ( P ＜0 .05) ,while T APSE‐4D ,FAC ,RVEF and RV‐GLSfree all decreased significantly and showed a decreasing trend in these three groups ( P ＜ 0 .05 ) . ② Compared with the control group , T APSE‐2D decreased significantly in non‐dialysis group ( P ＜0 .05) ,but there was no significant difference in uremia hemodialysis group ( P ＞0 .05) . Compared with the control group ,PASP and RVEDV increased and T APSE‐4D ,FAC ,RVEF and RV‐GLSfree decreased significantly in uremia hemodialysis group and non‐dialysis group ( P ＜ 0 .05 ) . Compared with non‐dialysis group , T APSE‐2D and T APSE‐4D increased significantly in hemodialysis group ( P ＜0 .05) ,while there was no significant difference in RVEDV ,FAC , RVEF and RV‐GLSfree in uremia hemodialysis group ( P ＞0 .05) . Conclusions 4D RV Volume could early and accurately evaluate the right ventricular systolic dysfunction in uremia patients . Furthermore ,w hen evaluating right ventricular systolic function in uremia patients treated with maintenance hemodialysis , indices such as right ventricular strain and volume parameters should be comprehensively considered .

Objective To evaluate the feasibility of three-dimensional (3D) printing of mitral annulus with transesophageal echocardiographic volume images as the data source ,and to assess the accuracy of the 3D printing mitral annulus models based on three dimensional transesophageal echocardiography ( 3D-TEE) images preliminarily . Methods A retrospective study was performed in 25 patients with mild or slight mitral regurgitation and 10 patients with moderate to severe mitral regurgitation . All the subjects were underwent 3D-TEE . The 3D-TEE volume images of mitral annulus at the end diastole were post-processed by Mimics software to create images of the mitral annulus in standard tessellation language format . The STL file was output to the 3D printer and the 3D printing models of mitral annulus were obtained . The mitral annulus size parameters including the diameter between anterior and posterior ,the diameter between anterolaterior and posteromedial ,sphericity index and mitral annulus circumference were measured from 3D printing models and 3D-TEE images ,respectively . From which the absolute difference of the measurements between 3D printing models and the 3D-TEE images were calculated . Results All of the 3D-TEE images were successfully post-processed ,and the corresponding 3D printing models were acquired by high-precision 3D printer . It showed no significant difference in all the mitral annulus size parameters between 3D printing modelsand3D-TEEimages(allP >0.05) .Morever,thesizeparameterswereconcordantwellbetweenthe two methods ,all of the data points fell within the limits of agreement . It showed little absolute difference in value of the mitral annulus size parameters between the 3D printing mitral annulus models and the 3D-TEE images . Conclusions It is technically feasible to print 3D models of mitral annulus using 3D-TEE images as the data source . 3D printing mitral annulus models based on transesophageal echocardiographic volume images have high precision .

Objective To increase the transfection of EGFP-N3 plasmids into 293T cells using ultrasound-targeted microbubbles delivery(UTMD) mediated a peptide nucleic acid (PNA) binding nuclear localization signal (NLS).Methods Antibody-targeted microbubbles were used in the experiments which can specifically recognize the SV40T antigen receptor.The SV40T antigen receptors were expressed on the membranes of 293T cells.The PNA containing the NLS were inserted in the EGFP-N3 plasmid DNA,which increased nuclear localization.Ultrasound-targeted microbubble delivery (UTMD) and the PNA binding NLS were utilized to improve the cytoplasmic import of plasmids and the nuclear intake of the plasmid from the cytoplasm,respectively.The study was divided into five groups:Contrast (group A),Common microbubble + DNA (group B),Antibody-targeted microbubbles + DNA (group C),Common microbubbles + NLS-PNA-DNA (group D),Antibody-targeted microbubbles + NLS-PNA-DNA (group E).Fluorescence microscope was used to observe the fluorescent light in each group;flow cytometry to test the transfection;RT-PCR and Western blot to detect genes' mRNA and protein expression level.Results Ultrasound and antibody-targeted microbubble delivery (UTMD) significantly enhanced the cytoplasmic intake of exogenous genes and maintained high cell viability(＞80％).Fluorescent microscope showed that the quantities of green fluorescence in cells were increased successfully.The transfection results of flow cytometry were 0,(9.30 ± 0.46)％,(26.46 ± 2.01)％,(29.54 ± 0.62)％,(45.72 ± 1.86)％,respectively,and the differences were statistically significant(P ＜0.05).The relative mRNA and protein expression in group E were greater than those in group C and D respectively (P ＜0.05).Conclusions UTMD combined with antibody-targeted microbubbles and a PNA binding NLS plasmid can significantly improve transfection efficiency of exogenous genes by enhancing both cytoplasmic and nuclear DNA import.

Objective To discuss the feasibility and reproducibility of left ventricular volume and function of patients with left atrial remodeling and left ventricular remodeling by 3-dimensional echocardiography HeartModel (3D-HM).Methods Three-dimensional images of 156 subjects were collected under HMACQ imaging mode.They were assigned into three groups:① control group (group A,n =70);② group of left ventricular remodeling after,acute myocardial infarction (group B,n =17);③group of hypertension left atrial remodeling (group C,n =69).3D-HM method was used for quantifying left ventricular end-diastolic volume (LVEDV),left ventricular end-systolic volume (LVESV),left atrial end-systolic volume (LAESV) and left ventricular ejection fraction (LVEF),and the results were compared with conventional 3D-manual results.The reproducibility of the 3D-HM method within one group and among different groups was evaluated.Results There was a significant difference in all the parameters measured with the 3D-HM method in different groups(P ＜0.05).LVEDV,LVESV,and LAESV in group B were higher than those in group A and group C(P ＜0.05),and LVEF was lower than that in group A and group C(P ＜0.05),LAESV of group C was higher than that of group A(P ＜0.05).The difference in the measurements of LVEDV and LVESV between the two methods was greatest in group B compared with group C and group A(P ＜0.05).In group C,the measured value difference of LAESV between two methods was greater than that of group A (P =0.03).There was closer correlation among LVEDV,LVESV,LAESV and LVEF measured values of 3D-HM method as well as measured values of the 3D-manual method (r =0.94,0.97,0.91 and 0.90).The data post-processing time of 3D-HM was significantly shorter than that of 3D-manual (P ＜0.05).The inter-observer and intra-observer difference of measured values of 3D-HM method had no statistical significance (P ＞0.05).Conclusions 3D-HM is a fast and feasible technique with high reproducibility for quantifying the left ventricular volume and function in patients with left atrial remodeling and left ventricular remodeling.

Objective To evaluate the predictive value of radiofrequency catheter ablation (RFCA) in patients with atrial fibrillation by measuring the left atrial structure and functional parameters with quantitative echocardiography.Methods One hundred and two patients with atrial fibrillation underwent radiofrequency ablation and 22 healthy cases as control group were enrolled in this study.Early diastolic strain(Se),global diastolic strain(Sg),late diastolic strain (Sa =Sg-Se),early diastolic strain rate (SRe),late diastolic strain rate(SRa),systolic strain rate (SRs) were measured.The standard deviations were calculated by time to peak of strain and strain rate.Left atrial maximum volume (LAVmax) and left atrial minimum volume (LAVmin) were measured.Left atrial stroke volume (LASV) and left atrial ejection fraction (LAEF) were calculated.The regression equation was obtained by binary logistic regression analysis.The individual probabilistic variables generated in the SPSS worksheet were selected to plot the multivariate ROC curve to determine the area undercurve (AUC) and the optimal cutoff point.Results In the group of paroxysmal atrial fibrillation:Sg,Se,Em decreased and TPSR-SD,TPSRs-SD increased significantly (P ＜0.05) in the relapsed patients;The logistic regression equation was P =1/[1 + e-(3.994+0.22×Se+0.115×Sg+0.04×TPSReSD-0.354×Em+0.02×TPSRsSD)].With P≥0.202 as thecut-off,the sensitivity and specificity of recurrence were the highest,88.9％ and 89.4％ respectively.In the group of persistent atrial fibrillation:the SRs,LAEF and LASV decreased and E/Em increased (P ＜0.05) in the relapsed patients.The logistic regression equation was P =1/[1 + e-(1.139-0.102LASV +0.348×E/Em-3.266×LAEF 0.417×SRs)].With P≥ 0.502 as thecut off,the sensitivity and specificity of recurrence were the highest,77.3％ and 79.2％ respectively.Conclusions Left atrial ultrasound quantitative analysis techniques to atrial fibrillation ablation recurrence have good predictive value.The recurrence of paroxysmal atrial fibrillation can be predicted by the strain rate and the standard deviation of time to peak of strain rate,and the persistent atrial fibrillation by LASV,LAEFand SRs.The multivariate analysis shows a higher predictive value.

Objective To evaluate the accuracy of three-dimensional printing atrial septal defect (ASD)models from three dimensional transesophageal echocardiography(3D-TEE)images and to lay the foundation for the application of 3D printing technology in the diagnosis and treatment of ASD.Methods Twenty patients with ASD were analyzed retrospectively.2D-TEE and 3D-TEE were performed before ASD occlusion.The 3D-TEE data were post-processed by Mimics software and the volume images of ASD in STL format were developed.Then the STL file was output and the ASD 3D models were printed.The ASD size parameters included the maximal diameter(Dmax),the minimal diameter(Dmin),circumference(C)and area(A),which were measured from 2D-TEE images,3D-TEE images and 3D printing models,respectively. The absolute difference value of ASD size parameters between 3D printing models and 2D-TEE images,or 3D-TEE images were calculated.The sizes of occluder were recorded during the operation and the preoperative exercises on 3D printing models were performed.Results There were no significant difference in ASD size parameters among 3D printing models,2D-TEE and 3D-TEE images(all P > 0.05),the ASD size parameters were concordant well between 3D printing models and 2D-TEE or 3D-TEE images. Moreover,the absolute difference value of ASD size parameters between 3D printing models and 2D-TEE or 3D-TEE images were little.In addition,linear regression analysis revealed a significant correlation in the Dmaxmeasured from 3D printing models and the sizes of occulder used in the operation(r =0.94,P <0.05).In the ASD 3D printing models the preoperative exercise had an impressive effect.Conclusions It is quite feasible to use 3D-TEE images as the data source of ASD 3D printing models.Ultrasound-derived ASD 3D printing models are of highly accuracy,which have the potential to provide evidence for the clinical application of 3D printing technology.

Objective To evaluate the left ventricular diastolic function in patients with uremia by two-dimensional speckle tracking technology ( 2D-STI ) . Methods Ninety-three patients with uremia ( serum creatinine value≥ 700 μmol/l) and 29 controls were included . Uremia patients were divided into group with decreased LVEF ( LVEF < 50％ ,group C ,19 cases) and group with normal LVEF ( LVEF≥50％ ) . The latter were divided into group with normal diastolic function ( group A ,31 cases) and group with diastolic dysfunction ( group B ,23 cases) according to the diastolic function;pulsed wave tissue Dopper imaging datas included:diastolic velocity e1′,a1′ and e2′,a2′ at septal or lateral sites of mitral annulus , average E/e′and e′/a′. 2D-STI strain and strain rate parameters included:the longitudinal peak systolic strain ( GLS) ,the longitudinal peak systolic strain rate ( LSRs) ,longitudinal peak strain rate in early diastole (LSRe)andE/LSRe.Results ①Systolicfunctionparameters:comparedwithcontrolgroup,LVEF decreased significantly only in group C( P <0 .05) ,while there was no significant difference among group A ,B and control group ( P> 0 .05 ) ;GLS in group A ,B and C decreased significantly and showed a decreasing trend among these three groups( P <0 .05) ;LSRs in group B and C decreased significantly ,while there was no significant difference between group A and control group( P > 0 .05) . ② Diastolic function parameters:compared with control group ,the average E/e′decreased significantly in group B and C( P <0 .05) ,while group A showed no significant difference( P > 0 .05) . Compared with group A ,the average E/e′increased significantly in group B and C ( P < 0 .05) . Compared with control group ,LSRe in three uremia groups decreased significantly ,which showed a decreasing trend among these three groups ( P <0 .05) ;however ,E/LSRe in three uremia groups increased significantly and showed an increasing trend among these three groups ( P < 0 .05 ) . ③ The correlation analysis showed that there were positive correlations between average e′ and LSRe and between average E/e′ and E/LSRe in uremic patients . Conclusions In patients with uremia ,left ventricular systolic and diastolic function impaired in the early phase . Strain rate parameters in diastole especially E/LSRe obtained by 2D-STI can be used as sensitive , early parameter for evaluation of left ventricular diastolic dysfunction .

Objective To compare the effect of the conventional teaching programs and logical thinking ability training program of ultrasound medical profession. Methods 85 ultrasound medical junior students were randomly divided into control group (n=40) and experimental group (n=45) re-spectively. Experimental group was provided with logical thinking ability cultivation to develop logical thinking of students, and the key was to enable students to find the key problems of ultrasound in the diagnosis of the disease and put forward measures to solve them and control group carried on the con-ventional teaching. Teaching effect, the medical record analysis test scores, clinical skills examination and questionnaire score were compared between the two groups, using SPSS 18.0 software for statisti-cal analysis of the data. Results (1)Students in the experimental group thought that compared with the control group, their interest in learning improved, the ability of clinical analysis enhanced, inter-action between teachers and students and learning efficiency and self-study ability increased and the difference has statistical significance. (2)The experimental group's scores of medical records analysis, the assessment scores of clinical skills and the student questionnaire score were higher than those of the control group and the two groups' score difference was statistically significant. Conclusion To strengthen the training of medical ultrasound medical imaging direction students' logical thinking ability can significantly improve the quality of teaching, and it is worthy to be promoted and applied.

OBJECTIVETo determine the role of serine residues at position 63-84 of CITED1 in the nuclear translocation of CITED1 and osteoblast differentiation.

METHODSWe engineered all the 9 phosphorylated serine residues of CITED1 with a serine-to-alanine mutation at position 63-84. MC3T3E1 cells transfected with pCDNA3-CFP-CITED1 63-84 (9S>A), pCDNA3-CFP-CITED1, and vehicle plasmid were examined with confocal laser scanning microscopy before and after treatment with 100 nmol/L parathyroid hormone [PTH(1-34)] to observe the changes in the intracellular localization of CITED1. The transfected cells were induced for osteoblastic differentiation with mineralized solution in the absence or presence of 10 nmol/L PTH(1-34), and the changes in ALP activity and Ca(2+) concentration were measured; RT-PCR was used to detect the changes in ALP2, RUNX2, and OC gene expressions after the treatments.

RESULTSs PTH(1-34) promoted the nuclear translocation of CITED1 in MC3T3-E1 cells. The (63-84) 9S>A mutation of CITED1 obviously suppressed its translocation and increased ALP activity and Ca(2+) levels in the cells, which led to enhanced mineralization in the cells with also increased expressions of ALP2, RUNX2, and OC.

CONCLUSIONThe serine residues at position 63-84 of CITED1 play a vital role in the nuclear translocation of CITED1 and osteoblast differentiation.

Active Transport, Cell Nucleus ; Animals ; Cell Differentiation ; Cell Line ; Cell Nucleus ; Mice ; Mice, Inbred C57BL ; Mutation ; Nuclear Proteins ; metabolism ; Osteoblasts ; cytology ; Plasmids ; Serine ; metabolism ; Trans-Activators ; metabolism