Objective:To investigate the diagnostic value of postsystolic shortening (PSS) and early systolic lengthening (ESL) on myocardial microvascular dysfunction in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI).Methods:A total of 83 patients with STEMI who received emergency PCI in Renmin Hospital of Wuhan University from June to October 2021 were retrospectively collected. All patiets underwent two-dimensional echocardiography and myocardial contrast echocardiography (MCE) within 7 days after PCI. The patients were divided into global normal perfusion group and poor perfusion group according to global myocardial perfusion score index (MPSI). Left ventricular myocardium was divided into left anterior descending branch (LAD), left circumflex branch (LCx) and right coronary artery (RCA) regions, which were divided into regional normal perfusion group and poor perfusion group based on whether there were segments with microvascular dysfunction. Left ventricular end-systolic volume (LVESV) and left ventricular ejection fraction (LVEF) were measured by modified biplane Simpson method. Tomtec software was used to obtain conventional echocardiographic parameters, global longitudinal strain (GLS), as well as PSS and ESL parameters including postsystolic index (PSI), duration of postsystolic shortening (PSSduration), early systolic index (ESI) and duration of early systolic lengthening (ESLduration). Differences of parameters of global normal and poor perfusion groups, as well as regional normal and poor perfusion groups were compared. ROC curve was used to analyze the diagnostic value of PSS and ESL parameters and GLS in myocardial regions with microvascular dysfunction.Results:Significant differences were observed in LVEF, LVESV, GLS, PSI, ESI and PSSduration between global poor perfusion group and global normal perfusion group (all P<0.05). Compared with regional normal perfusion group, PSI, ESI and ESLduration of LAD and LCx regions, as well as PSI of RCA region in regional poor perfusion group were increased (all P<0.05). For GLS in different myocardial regions, LAD-GLS was the only parameter that decreased in regional poor perfusion group compared to regional normal perfusion group ( P<0.05). ROC curve analysis showed LAD-PSI, LAD-GLS, LCx-PSI, LCx-ESLduration and RCA-PSI were valuable parameters for diagnosis of myocardial microvascular dysfunction in different regions, among which LAD-PSI had the highest area under curve (AUC=0.809). Conclusions:PSS and ESL parameters are helpful for early diagnosis of myocardial microvascular dysfunction in STEMI patients after PCI, and can provide regional myocardial perfusion information according to the blood supply of different coronary arteries.

Objective:To explore the effect of systolic anterior motion (SAM) of mitral valves on the morphology and function of left ventricular outflow tract (LVOT) in patients with hypertrophic obstructive cardiomyopathy (HOCM) using computer fluid dynamics based on three-dimensional echocardiography with inverted grey values.Methods:A total of 40 patients with hypertrophic cardiomyopathy were divided into SAM group (24 cases) and non SAM group (16 cases) in Renmin Hospital of Wuhan University from April 2016 to October 2019. Two dimensional and three-dimensional echocardiographic data of the patients were collected. The LVOT morphological model was constructed based on the post-processing of three-dimensional echocardiography data, and the LVOT flow field model was constructed based on the time-volume curve of left ventricle. LVOT peak velocity was obtained to assess the agreement with echocardiography measurements. Area of LVOT, average velocity, flow rate and iso-surface area of vortex of different levels were obtained and compared between the two groups.Results:There was a good correlation between cardiac fluid model and echocardiographic measurement ( r=0.943, P<0.01). The Bland-Altman consistency interval was -75.0-111.3, and 92.5% of the points were within the consistency limit. Compared with non-SAM group patients, the peak velocity of LVOT increased, the area of LVOT decreased, the flow rate decreased and the area of vortex increased in SAM patients (all P<0.01). In the SAM group, in 16 patients the double orifice LVOT was observed due to the contact between mitral valve and septum, in 1 patient the single orifice LVOT structure was observed with contact between mitral value and septum, and in 7 patients, single orifice LVOT without contact between mitral value and septum. In SAM patients, compared with single orifice LVOT, patients with double orifice LVOT were observed with higher LVOT velocity, smaller LVOT area and higher vortex area with high level(all P<0.05). Conclusions:Accurate fluid models can be obtained using three-dimensional echocardiography with inverted grey values. In SAM patients, contact between mitral valve and septum leads to the formation of double orifice structure and the increase of vortex level in LVOT.

Objective:To explore the monitoring value of left ventricular functional parameters obtained by bedside ultrasound combined with clinically relevant indicators in patients with veno-arterial extracorporeal membrane oxygenation (VA-ECMO).Methods:A retrospective study was conducted. A total of 24 patients receiving VA-ECMO adjuvant support in Renmin Hospital of Wuhan University from June 2018 to January 2020 were selected. The bedside ultrasound was performed on the first day of ECMO support, the day before weaning, the clinical indicators before weaning were obtained. The differences in clinical indicators and the left ventricular functional parameters between the two groups of whether weaning successfully were compared; univariate Logistic regression analysis was used to screen out the related factors affecting weaning.Results:Sixteen patients were successful weaned and 8 patients failed. Compared with the weaning failure group, patients in the weaning success group required less continuous renal replacement therapy (CRRT, cases: 4 vs. 6, P < 0.05), mean arterial pressure (MAP) before weaning was higher [mmHg (1 mmHg = 0.133 kPa): 84.64±9.55 vs. 62.30±8.79, P < 0.05], and the pulse oxygen saturation (SpO 2) was also higher (0.966±0.670 vs. 0.866±0.061, P < 0.05), while vasoactive-inotropic score (VIS), serum creatinine (SCr) and serum lactic acid (Lac) were lower [VIS score: 7.27±1.42 vs. 16.93±8.52, SCr (μmol/L): 123.60±83.64 vs. 213.10±117.39, Lac (mmol/L): 1.94±0.91 vs. 5.62±5.48, all P < 0.05]. Univariate Logistic regression analysis showed that the MAP, VIS, SCr, Lac, SpO 2 before weaning were the related factors affecting weaning [odds ratio ( OR) were 0.306, -0.740, -0.011, -0.632, -4.069; 95% confidence interval (95% CI) were 1.065-1.732, 0.235-0.899, 0.979-0.999, 0.285-0.992 and 0.001-0.208; P values were 0.014, 0.022, 0.038, 0.047, 0.002]. In the weaning success group, left ventricular ejection fraction (LVEF), velocity of mitralannulus in systolic (LatSa), maximum flow velocity of aortic valve (AV-Vmax), velocity-time integral (VTI), left ventricular global longitudinal strain (LVGLS), left ventricular global longitudinal strain rate (LVGLSr) were all increased on the day before ECMO weaning compared with the first day of ECMO support [LVEF: 0.40±0.05 vs. 0.28±0.07, LatSa (cm/s): 6.81±0.91 vs. 4.62±1.02, AV-Vmax (cm/s): 104.81±33.98 vs. 64.44±16.85, VTI (cm): 14.56±3.11 vs. 7.96±1.98, LVGLS: (-8.95±2.59)% vs. (-5.26±1.28)%, LVGLSr (1/s): -0.48±0.11 vs. -0.29±0.09], whereas the ECMO flow was significantly reduced (L/min: 1.46±0.47 vs. 2.64±0.31), the differences were statistically significant (all P < 0.05). There was no significant difference in left ventricular functional parameters between the first day of ECMO support and the day before ECMO weaning in the weaning failure group. Compared with the weaning failure group, the weaning success group had higher LVEF, LatSa, AV-Vmax, VTI, LVGLS, LVGLSr on the day before ECMO weaning [LVEF: 0.40±0.05 vs. 0.26±0.07, LatSa (cm/s): 6.81±0.91 vs. 4.31±1.03, AV-Vmax (cm/s): 104.81±33.98 vs. 67.67±18.46, VTI (cm): 14.56±3.11 vs. 7.75±2.77, LVGLS: (-8.95±2.59)% vs. (-4.81±1.81)%, LVGLSr (1/s): -0.48±0.11 vs. -0.30±0.10, all P < 0.05] and lower ECMO flow (L/min: 1.46±0.47 vs. 2.20±0.62, P < 0.05). Conclusion:Bedside echocardiographic left ventricular function parameters (LVEF, LatSa, AV-Vmax, VTI, LVGLS, LVGLSr) combined with clinical indicators (MAP, VIS, SCr, Lac, SpO 2) were helpful to evaluate the therapeutic effect of patients receiving VA-ECMO support and can provide important guiding value in the selection of VA-ECMO weaning timing and the judgment of prognosis.

Objective    To investigate the diagnostic value of tuberculosis T cell spot test (T-SPOT.TB) and erythrocyte sedimentation rate (ESR) test in the diagnosis of simple pulmonary nodules in Xinjiang. Methods    A retrospective analysis of 72 patients with asymptomatic simple pulmonary nodules in the Department of Thoracic Surgery, the First Affiliated Hospital of Xinjiang Medical University from October 2017 to July 2019 was performed. According to the pathological results, the patients were divided into a tuberculoma group [n=23, including 14 males and 9 females, aged 37-84 (56.91±12.73) years] and a lung cancer group [n=49, including 31 males and 18 females, aged 34-83 (61.71±10.15) years]. The predictive value of T-SPOT.TB and ESR results for the diagnosis of simple pulmonary nodules was evaluated. Results    The positive rate of T-SPOT.TB in the tuberculoma group (69.60%) was higher than that in the lung cancer group (42.90%) (χ2=5.324，P=0.021), with a sensitivity of 69.56% and specificity of 57.14%; the positive ESR was 47.80%in the tuberculoma group and 59.20% in the lung cancer group, and no statistical difference was found between the two groups (χ2=0.981, P=0.322), with a sensitivity of 47.82% and specificity of 40.81%; the area under receiver operating characteristic curve (AUC) was 0.618, the 95% confidence interval of AUC was (0.479, 0.758), and the Youden’s index was 0.267 with a sensitivity of 69.60% and specificity of 57.10%. Difference in the T-SPOT.TB and ESR test results was statistically significant (χ2=4.986, P=0.026), but the correlation between the tests was weak with a Pearson contingency coefficient of 0.199. ESR results in patients with different ages were statistically different (χ2=7.343, P=0.025), but the correlation between age and ESR results was weak with a Pearson contingency coefficient of 0.239; T-SPOT.TB results in patients with different ages were not statistically different (χ2=0.865, P=0.649), and the correlation between age and ESR results was weak with a Pearson contingency coefficient of 0.084. Conclusion    The diagnostic value of T-SPOT.TB and ESR tests is small in the diagnosis of simple pulmonary nodules.

Objective:To investigate the molecular mechanism of SUMO specific protease 1 (SENP1) regulating endoplasmic reticulum stress transcription regulator X-box binding protein 1 (XBP1) in the proliferation of liver cancer cells.Methods:The pathological samples of 180 patients with primary liver cancer in the Department of Hepatobiliary Surgery of Inner Mongolia People′s Hospital from January 2012 to January 2020 were collected. The expressions of SENP1 and XBP1 in liver cancer, adjacent tissues and different liver cancer cell lines were detected. The correlation between SENP1 positive expression and clinicopathological features of liver cancer patients was analyzed. Immunofluorescence and flow cytometry were used to detect the effect of SENP1 siRNA on XBP1 and apoptosis. SUMO1 expression on XBP1 surface was detected and the effect of SENP1 siRNA on SUMO formation of XBP1 was detected by immunoprecipitation.Results:The expression levels of SENP1 in liver cancer and adjacent tissues were 16.332±4.371 and 6.840±2.238, with a statistically significant difference ( t=-5.073, P=0.017). The expression levels of XBP1 in liver cancer and adjacent tissues were 6.641±2.482 and 16.051±4.452, with a statistically significant difference ( t=3.592, P=0.032). The expression of SENP1 was correlated with stage ( χ2=6.724, P=0.010) and metastasis ( χ2=6.265, P=0.012). Immunofluorescence staining showed that the expressions of XBP1 in L02 (0.509±0.219), MHCC97-L (0.092±0.022) and HCCLM3 (0.086±0.014) cells were significantly different ( F=6.378, P=0.004), while the expression of XBP1 in MHCC97-L and HCCLM3 cells was significantly lower than that in L02 cells ( P=0.023; P=0.021). The expression levels of SENP1 in L02, MHCC97-L and HCCLM3 cells were 0.109±0.079, 0.802±0.392 and 0.921±0.352, with a statistically significant difference ( F=7.783, P=0.004), while the expression level of SENP1 in MHCC97-L and HCCLM3 cells was significantly higher than that in L02 cells ( P=0.039; P=0.016). After transfection of SENP1 siRNA into MHCC97-L and HCCLM3 cells, the expressions of XBP1 increased (0.462±0.192, t=3.664, P=0.022; 0.524±0.203, t=3.383, P=0.028); the expressions of SENP1 decreased (0.153±0.093, t=2.790, P=0.049; 0.165±0.104, t=3.568, P=0.023). The results of flow cytometry showed that the apoptosis rates of L02, MHCC97-L, HCCLM3, MHCC97-L+ SENP1 siRNA and HCCLM3+ SENP1 siRNA cells were (20.80±3.11)%, (2.02±1.20)%, (0.12±0.01)%, (7.01±1.80)%, (6.20±2.01)%, with a statistically significant difference ( F=1.025, P=0.030). The apoptosis rate of MHCC97-L and HCCLM3 cells was significantly lower than that of L02 cells ( P=0.040; P=0.010), the apoptosis rate of MHCC97-L+ SENP1 siRNA and HCCLM3+ SENP1 siRNA cells was significantly higher than that of MHCC97-L and HCCLM3 cells (both P=0.009). Immunoprecipitation results showed that the expression levels of XBP1 in L02, MHCC97-L, HCCLM3, MHCC97-L+ SENP1 siRNA, HCCLM3+ SENP1 siRNA cells were 11.943±5.043, 7.467±1.903, 2.051±0.913, 9.532±3.012, 8.731±3.102, and SUMO1 expression levels were 10.158±4.005, 5.871±3.075, 1.941± 0.907, 8.658±4.878, 7.169±4.677, and the differences were statistically significant ( F=11.730, P=0.010; F=8.548, P=0.001). The expressions of XBP1 and SUMO1 in MHCC97-L ( P=0.028; P=0.038) and HCCLM3 ( P<0.001; P<0.001) cells were lower than those in L02 cells, XBP1 expression in HCCLM3+ SENP1 siRNA cells was higher than that in HCCLM3 cells ( P=0.001), and SUMO1 expression in MHCC97-L+ SENP1 siRNA cells and HCCLM3+ SENP1 siRNA cells respectively was higher than that in MHCC97-L ( P=0.045) and HCCLM3 ( P=0.039) cells. Conclusion:SENP1 siRNA can promote the apoptosis of liver cancer cells by up regulating SUMO modification of XBP1.

Objective: To investigate the accuracy and repeatability of contrast-enhanced transthoracic echocardiography for measurements of right ventricular structure and function. Methods: The apical four-chamber views and the three-dimensional full-volume images of the right heart were collected from 12 beagles with unenhanced and contrast-enhanced transthoracic echocardiography. The intimal display rate of the right ventricular segments, right ventricular end diastolic longitudinal dimension (RVLD), right ventricular end diastolic area (RVEDA), right ventricular end systolic area (RVESA) and right ventricular fractional area change (RVFAC) were evaluated respectively with two-dimensional unenhanced and contrast-enhanced echocardiography. Right ventricular three-dimensional full-volume images were processed and analyzed by TomTec software, and right ventricular end diastolic volume (RVEDV), right ventricular end systolic volume (RVESV) and right ventricular ejection fraction (RVEF) were measured respectively with three-dimensional unenhanced and contrast-enhanced echocardiography. The measurements of pathological specimen were taken as the gold standard, the accuracies of measuring RVEDVand RVLD by different methods were evaluated. All indexes were measured repeatedly by the same observer and different observers to assess the intraobserver and interobserver reproducibilities of different methods. Results: ①The intimal display rate of the right ventricular segments was higher with contrast-enhanced echocardiography than that with unenhanced echocardiography (P<0.05). ②The measurements of RVEDV by three-dimensional contrast-enhanced echocardiography correlated well with the measurements by anatomical specimens. And the correlation was higher (0.916 vs 0.843), the consistency was better than that by unenhanced echocardiography. The measurements of RVLD by two-dimensional contrast-enhanced echocardiography correlated well with the measurements by anatomical specimens. And the correlation was higher (0.928 vs 0.850), the consistency was better than that by unenhanced echocardiography. ③For inter- and intraobservers reproducibilities, the interclass correlation coefficients of RVLD, RVEDV, RVESV, RVEF, RVEDA, RVESA, RVFAC with contrast-enhanced echocardiography were higher and 95% confidence interval ranges were smaller than those with unenhanced echocardiography. Conclusions Contrast-enhanced transthoracic echocardiography can improve the accuracy and repeatability for measurements of right ventricular structure and function, providing a new evaluation method for patients with poor image quality of the right ventricle in clinical practice.

Objective: To preliminary explore the feasibility of three-dimensional transesophageal echocardiography (3D-TEE) as images data source for 3D printing model by comparing the 3D-TEE with CT of the aortic root Digital Imaging and Communications in Medicine(DICOM) data into 3D printing models respectively. Methods: Fifteen patients who underwent surgical aortic valve replacement in the hospital were enrolled, and the aortic root 3D-TEE and CT DICOM data were obtained in perioperative. The images were imported into Mimics software to generate digital model standard tessellation language file, and to print the aortic root models by 3D printer. The structural morphology of both 3D-TEE and CT models were qualitatively evaluated respectively. The aortic annular area, perimeter, maximal diameter and minimal diameter of the original data, digital model, model and aortic valve replacement were quantitatively evaluated, and the consistency of each parameter value were analyzed. The mean diameter of 3D-TEE and CT model were calculated. The correlation of mean diameter with the number of replacement was analyzed. Results: ①Both 3D-TEE and CT images data were successfully printed into 3D models, and the positive rate of aortic valve structure were 93.3% (14/15) and 80.0% (12/15) respectively. ②The measured values of the aortic annular 3D-TEE and digital model were smaller than CT, CTdigital model and replacement (P<0.05), and the measurement consistency among groups was high. ③The parameter values of 3D-TEE model were smaller than CT model (P<0.05), and the measured values were all within the consistency range. The mean diameters were highly correlated with the replacement values (r>0.95, P<0.05). Conclusions 3D printing aortic root model based on 3D-TEE image data is of high feasibility.

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 preliminary explore the feasibility of three‐dimensional transesophageal echocardiography ( 3D‐T EE) as images data source for 3D printing model by comparing the 3D‐T EE with CT of the aortic root Digital Imaging and Communications in M edicine ( DICOM ) data into 3D printing models respectively . Methods Fifteen patients w ho underwent surgical aortic valve replacement in the hospital were enrolled ,and the aortic root 3D‐T EE and CT DICOM data were obtained in perioperative . T he images were imported into M imics software to generate digital model standard tessellation language file ,and to print the aortic root models by 3D printer . T he structural morphology of both 3D‐T EE and CT models were qualitatively evaluated respectively . T he aortic annular area ,perimeter ,maximal diameter and minimal diameter of the original data , digital model , model and aortic valve replacement were quantitatively evaluated ,and the consistency of each parameter value were analyzed . T he mean diameter of 3D‐T EE and CT model were calculated . T he correlation of mean diameter with the number of replacement was analyzed . Results ①Both 3D‐TEE and CT images data were successfully printed into 3D models ,and the positive rate of aortic valve structure were 93 .3% ( 14/15) and 80 .0% ( 12/15) respectively . ②T he measured values of the aortic annular 3D‐T EE and digital model were smaller than CT ,CTdigital model and replacement ( P＜0 .05) ,and the measurement consistency among groups was high . ③ T he parameter values of 3D‐T EE model were smaller than CT model ( P ＜0 .05 ) ,and the measured values were all within the consistency range . T he mean diameters were highly correlated with the replacement values ( r ＞ 0 .95 , P ＜ 0 .05 ) . Conclusions 3D printing aortic root model based on 3D‐TEE image data is of high feasibility .

Objective To evaluate the accuracy of simulated operation before the left atrial appendage ( LAA ) occlusion by filed LAA model with soft materials ,which is based on transesophageal three-dimensional echocardiography ( 3D-TEE) . Methods Silica and hydrogel were mixed to imitate cardiac tissue . Silica and hydrogel mixed materials ,silica and Tangoplus were subjected to mechanical detection and ultrasonic shear wave elastography ( SWE) . The preoperative and postoperative 3D-TEE image processing was performed on 21 patients undergoing LAA occlusion . The silica and hydrogel LAA 3D model ,silicone model and Tangoplus model were acquired to evaluate the accuracy of 3D model . LAA closure was simulated using the 3D models and the compression ratio of the device in models was compared with the value measured in operation . Results The silica and hydrogel mixed materials were successfully prepared . The elastic modulus and stress-strain curve were closer to the myocardial tissue . Twenty-one 3D printing models of three materials were obtained in 21 patients based on 3D-TEE images .There was no significant difference in the anchor zone between the 3D model and 3D-TEE ( P > 0 .05) .The 3D model measurements were consistent with the 3D-TEE measurements .The compression ratios of the decive in the 3D models of all three materials were greater than those measured in operation ,and the compression ratio of the device in the 3D model of silica and hydrogel materials had a better correlation with that measured in operation ( r =0 .900 ,P < 0 .01) .Conclusions The 3D model of LAA made of silica and hydrogel material based on 3D-TEE can improve the accuracy of the LAA occlusion simulation ,also can optimize the preparation of LAA occlusion .