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Objective:To evaluate the effect of acupuncture of Zhukeyuanluo principle and Buzhong Yiqi Decoction on obstructive sleep apnea hypopnea syndrome (OSAHS).Methods:Randomized controlled trial. A total of 104 patients with OSAHS in our hospital from January 2017 to January 2022 who met the inclusion criteria were divided into 2 groups according to random number table method, with 52 patients in each group. The Traditional Chinese Medicine (TCM) group was treated with Buzhong Yiqi Decoction on the basis of conventional western medicine treatment, and the acupuncture and medicine group was treated with the combination of primary and primary collaterals and acupoints. Both groups were treated continuously for 2 months. Epworth Lethargy Scale and Stanford Self-Rated Lethargy Scale (SSS) were used to assess the degree of lethargy. The serum levels of TNF-α, IL-6 and IL-8 were detected by ELISA. The hemoglobin, RBC and mean RBC volume levels were detected by automatic blood cell analyzer. apnea hypopnea index (AHI), apnea index (AI), hypopnea index (HI) and arterial oxygen saturation (SaO 2) were monitored by polysomnographic sleep monitor to evaluate the clinical effect. Results:The total effective rate was 94.2% (49/52) in the acupuncture group and 82.7% (43/52) in the TCM group, and there was significant difference between the two groups ( χ2=6.73, P=0.035). After treatment, the Epworth Lethargy Scale and SSS scores in the acupuncture and medicine group were significantly lower than those in the TCM group ( t=-8.19 and -5.48, respectively, P<0.01); AHI [(15.64±2.81) times/h vs. (19.82±3.05) times/h, t=-7.27], HI [(5.53±1.28) times/h vs. (7.37±1.34) times/h, t=-7.16], AI [(8.13±1.95) times/h vs. (10.98±2.26) times/h, t=-6.89] in the acupuncture and medicine group were significantly lower than those in the TCM group ( P<0.01), SaO 2 [(92.77±2.91) % vs. (89.53±2.44) %, t=6.15] in the acupuncture and medicine group was significantly higher than that of the TCM group ( P<0.01). The levels of TNF-α, IL-6 and IL-8 in serum in the acupuncture and medicine group were significantly lower than those in the TCM group ( t=-2.62, -3.14 and -6.58, P<0.01). The levels of hemoglobin, RBC and mean red blood cell volume were in the acupuncture and medicine group were significantly lower than those in the TCM group ( t=-2.11, -2.92, -2.48, P<0.05 or P<0.01). Conclusion:The acupuncture of Zhukeyuanluo principle combined with Buzhong Yiqi Decoction can reduce the serum inflammatory cytokines level in OSAHS patients, increase SaO 2, reduce AHI, HI, AI and lethargy degree, and improve clinical effects.
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Objective:To observe the changes of left ventricular energy loss(EL) and apical wall shear stress(WSS) in patients with ventricular aneurysm by using vector flow mapping (VFM).Methods:Twenty-seven patients with ventricular aneurysm were selected as the case group, and they were divided into the ventricular aneurysm group(16 cases) and ventricular aneurysm thrombus group(11 cases) according to whether the apex of the heart was accompanied by thrombosis. Twenty healthy people were collected as the control group. Ventricular structure and cardiac function parameters were measured and the VFM offline analysis was performed. Systolic and diastolic phases were determined based on time-flow curve(T-F curve) and the open-close of valves, the corresponding left ventricular energy loss and the parameters of the WSS of the apex segment of the heart were obtainedand then compared between groups.Results:①In diastolic and systolic phases, EL values of left ventricular apical segment in ventricular aneurysm group and ventricular aneurysm thrombus group were lower than that in control group (all P<0.05). ②In diastolic phase, the peak WSS values of septal apical, lateral apical and anterior apical segments in ventricular aneurysm group and ventricular aneurysm thrombus group were lower than those in control group (all P<0.05), and the mean WSS of anterior apical segment in aneurysm group was lower than that in control group ( P<0.05). ③In systolic phase, the peak WSS values of anterior wall in ventricular aneurysm group and ventricular aneurysm thrombus group were lower than those in control group, and the mean WSS of anterior wall in ventricular aneurysm group was lower than that in control group (all P<0.05). The mean WSS of anterior wall in ventricular aneurysm thrombus group was higher than that in ventricular aneurysm group( P<0.05). Conclusions:VFM technology can quantitatively evaluate the EL and WSS of patients with left ventricular aneurysm, and provide a new perspective for further understanding of intracardiac hemodynamics in patients with left ventricular aneurysm with or without thrombus.
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Objective:To explore the clinical value of point-of-care ultrasonography(PoCUS) in the diagnosis of acute pulmonary embolism(PE).Methods:Consecutive 196 patients suspected of acute PE were enrolled in East Branch, the Second Hospital of Hebei Medical University from January 2017 to November 2017. All the patients were categorized into no PE group( n=143) and PE group( n=53) based on CTPA results. PoCUS was performed and considered diagnostic for PE if one or more right ventricular dysfunction (right ventricular dilation, right ventricular free wall hypokinesia, increased tricuspid regurgitation velocity or decreased tricuspid annular plane systolic excursion), deep venous thrombosis(DVT) or subpleural infarcts were detected. Results:With CTPA as the gold standard for diagnosis, the sensitivity (94.34%), Youden index (0.531) and the area under the ROC curve(AUC) (0.765) of the combined diagnosis of PE by transthoracic echocardiography(TTE), lower limb vein compression ultrasonography(CUS) and lung ultrasonography (LUS) were the highest. The specificity (94.41%) and accuracy (81.63%) of LUS in the diagnosis of PE were the highest, and the misdiagnosis rate (5.59%) of LUS the lowest. The sensitivity of the combined triple PoCUS (TTE, CUS, and LUS) diagnosis of PE was higher than TTE and CUS combined diagnosis ( P=0.016), and the sensitivity and specificity were higher than TTE and CUS combined diagnosis as a whole ( P<0.005). Conclusions:The combined triple PoCUS (TTE, CUS, and LUS) has the highest accuracy in the diagnosis of PE, while LUS has a high specificity and a low misdiagnosis rate in the diagnosis of PE. Therefore, it is recommended to apply the combined triple PoCUS in clinical practice.
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Objective To investigate the value of prenatal echocardiographic diagnosis of anomalies of the right aortic arch ( RAA ) and its branch type ,and provide rapid diagnostic methods . Methods A retrospective analysis of 55 cases of RAA of prenatal ultrasound diagnosis results ,and their imaging characteristics were summarized . Results There were 55 cases of anomalies of the RAA ,included 42 cases of RAA with aberrant left subclavian artery ( RAA-ALSA ) and 13 cases of RAA with mirror image branching pattern( RAA-MB) ,1 case of double aortic arch(DAA) was misdiagnosed as RAA . The prenatal echocardiographic characteristics of RAA-ALSA :in three-vessel-aortic arch view ,the first branch of the aortic arch was the left carotid artery ,which ran in front of the trachea ,and ALSA ran behind the trachea and esophagus . The prenatal echocardiographic characteristics of RAA-MB :the first branch of the aortic arch was the brachiocephalic trunk ,which ran in front of the trachea and was divided to the left carotid artery and the left subclavian artery . Conclusions Prenatal ultrasound can qunickly and accurately diagnose anomalies of the right aortic arch and its branch type according to the direction ,thickness and secondary branches of the first branch of the aortic arch . The location of arterial duct is helpful to judge the formation of vascular ring .
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Resident standardization training is a major part of education of medical students after graduation , and is extremely important for high-level physician training and raising the quality of medical treatment. We trained the residents comprehensively according to the characteristics of echocardiography in terms of theoretical knowledge, clinical manipulative skills, clinical thinking ability, scientific research ability and communication and team cooperation ability, and carried out the relative examination according to the training. On the basis of practice, we explored the establishment of a standardized training mode and evaluation system suitable for echocardiography resident doctors in China.
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Objective To evaluate the incidence of hyponatremia in patients with Guillain-Barré syndrom (GBS) and to explore whether hyponatremia is an important predictor of poor outcome.Methods All 455 GBS patients met the inclusion criteria and were divided into three groups as mild,moderate and severe GBS according to Medical Research Council sumscore (MRC sumscore) at nadir.Hyponatremia is defined as serum sodium concentration below 135 mmol/L at nadir.The incidences of hyponatremia in GBS patients with different MRC sumscore were analyzed by x2 tests.Logistic regression models were performed to determine risk factors of hyponatremia and poor prognosis.Results Of all the 455 GBS patients,mild,moderate and severe groups patients were 178,100 and 177 respectively,and 98 (21.5％) GBS patients had hyponatremia.Hyponatremia was more often detected in severe GBS cases (64,36.2％),than in mild (21,11.8％) or moderate (13,13.0％,x2 =28.921,17.074 respectively; all P ＜ 0.01) cases,but there was no significant difference between mild and moderate patients (x2 =0.086 ; P =0.769).Logistic regression analysis identified 3 predictors of hyponatremia:age ＞ 50 (OR =2.013,95％ CI 1.155-3.508,P =0.014),facial weakness (OR =2.493,95％ CI 1.423-4.369,P =0.001) and mechanical ventilation (OR =12.871,95％ CI 5.484-30.207,P =0.001).The presence of hyponatremia (OR =12.770,95％ CI3.419-47.701,P =0.001) and bulbar weakness (OR =3.391,95％ CI 1.182-9.733,P =0.023)predicted death in acute stage.Conclusion As an important predictor of poor outcome in GBS patients,hyponatremia is more likely occurred in patients with older age,facial weakness or respiratory failure.
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Objective To assess the volume and function of right atrium(RA) in patients with chronic pulmonary hypertension(PH) by echocardiography and explore the influencing factors of these changes.Methods The study include 20 healthy participants as the control group and 57 patients with chronic PH as the case group.The patients were divided into three groups: low-grade PH, midrange PH and severe PH.Maximal RA volume index(VmaxI), minimal RA volume index(VminI), pre-atrial contraction RA volume index( VpreI), reservoir volume index(RVI), conduit volume index(CVI), contraction-chamber volume index (CCVI) were measured and calculated.The diameter of tricuspid valve and the late-diastole peak velocity of the bloodstream(Va) were measured,and then RA ejection force(RAEF) could be calculated.Systolic strain rate(RASRs), early diastolic strain rate (RASRe), and late diastolic strain rate (RASRa) of RA free wall were measured respectively.The correlation between pulmonary arterial systolic pressure (PASP), right ventricular ejection fraction(RVEF),the tissue Doppler of RV free wall(Ea/Aa) and the parameters of RA were analysed,and the main factors influencing the volume and function of RA were exploxed.Results With the rising of PASP, the RA volume changed obviously.And CCVI, RAEF, RVI, RASRs and the absolute value of RASRa increased gradually, but CVI decreased gradually.PASP, RVEF and Ea/Aa correlated with the parameters of RA.The main factors influencing the Vprel were EDVI, Ea/Aa and the course of disease,and VpreI and PASP mainly influenced the RAEF.Conclusions In patients with chronic PH the volume and function of RA changed,and some index of which was infuenced by PASP, RVEF, Ea/Aa and so on.
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Objective To assess the influence of the wall motion state and the infarct size of myocardial on left atrial(LA) function in patients with myocardial infarction(MI), and to investigate the main determinants of LA function. Methods LA function of the small area of MI group (group A), the large area of MI group (group B) and control.group were compared,and the influence of the infarct size on LA function was evaluated. The correlation between parameters of LA function and wall motion score index (WMSI) was analyzed. Stepwise regression was made to determine the influencing factors of LA function. index (VpreⅠ),LA active emptying volume index (AEVI), LA ejection force index (EFI) of group A and group B were larger than those of control group,and the parameters of group B were also larger than those of group A(P<0.05). LA passive emptying fraction (PEF) and atrial expansion index (AEI) of group A and group B were smaller than those of control group,and the parameters of group B were also smaller than regression equation. Conclusions With the increasing of areas of infarction and the aggravating of wall motion sate,the LA remodeling aggravated. The boost pump function of LA augmented, and the function of conduit and reservoir of LA was reduced. Wall motion state, LV remodeling and LV diastolic function were the major determinants of augmented LA function in MI patients.
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Objective To investigate right ventricular(RV) dyssynchrony in patients with pulmonary hypertension(PH)by strain imaging.Methods Sixty PH patients were divided into three groups according to the pulmonary artery systolic pressure(PASP),20 healthy volunteers served as control group.RV structures parameters included RV end-diastolic area(RVEDA),end-systolic area(RVESA),the ratio of RV diameter and LV diameter(RVTD/LVTD).RV function parameters included RV fractional area change (RVFAC)and Tei index.RV strain parameters included the maxmal differences of the peak systolic strain(Max-ΔPST)and the maxmal differences of the time to peak systolic strain(Max-ΔT_(Q-S))of each segment.Results Compared with control group, Max-ΔT_(Q-S) and Max-ΔPST of PH groups were significantly larger (P<0.01).Max-ΔT_(Q-S) had strong correlations with PASP and RV structure and function parameters(P<0.01).Max-ΔPST had good correlations with PASP and Tei-index(P<0.05,P<0.01).Conclusions PH patients exhibit right ventricular dyssynchrony which correlates with right ventricular function and structure parameters.Right ventricular dyssynchrony parameters could evaluate right ventricular function in PH patients early by strain imaging.
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Objective To explore the value of integrate d backscatter technique (IBS) in quantitative evaluation of myocardial viability and left ventricular remodeling (LVRM) in patients with acute myocardial infarction(AMI). Methods In 18 healthy subjects (control group) and 36 patients with first onset AMI, IBS images were obtained at apical long axis, 2- and 4-chamber views within one week, at 1 and 3 months after percutaneous intracoronary stenting. The dynamic changes of IBS and its cyclic variation (CVIB) at middle segments of six different walls of left ventricle were compared with normal control, and the relations of these changes with the remodeling and the function of left ventricle were analyzed. Results Based on the existence of LVRM, the patients were divided into two groups: group A without LVRM and group B with LVRM. In group A, IBS of both infarct and non-infarct segments were not significantly different from control group within one week while CVIB of infarct segments decreased significantly than that of control group. CVIB improved gradually with the recovery of LV function whereas IBS showed no change. In group B, IBS of infarct segments increased significantly than that of control group and CVIB of both infarct and non-infarct segments decreased significantly. IBS of both infarct and non-infarct segments increased gradually while only CVIB of non-infarct segments recovered. Meanwhile, ventricular aneurysm appeared and LV enlarged gradually with LV function not improved. Conclusions The dynamic changes of IBS are different in patients with AMI from normal subjects and it may be clinically useful to evaluate myocardial viability quantitatively and predict LVRM and the recovery of LV function.
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Objective To evaluate the variation of aortic distensibility and its relation with left ventricular concentric remodeling in patients with primary hypertension.Methods Using two-dimensional and Doppler echocardiography,aortic distensibility (AD) and relative wall thickness (RWT),a parameter of left ventricular concentric remodeling were measured in 23 normal subjects (control group) and 32 patients with primary hypertension (hypertensive group).Taking the mean- 1.645 s of control group as the normal cut off value of AD,the hypertensive group was divided into two subgroups: group I with AD value lower than normal and group II within the normal range.Related clinical variables and echo parameters were compared between the two groups and stepwise regression was made to determine the relationship between AD and RWT.Results AD of hypertensive group was lower than that of control group; Univariate analysis showed that AD was significantly related to RWT,age and systolic blood pressure in hypertensive group; Multivariate regression demonstrated that RWT,age and systolic blood pressure entered the regression equation.Conclusions Aortic distensibility decreased in patients with hypertension and its reduction showed close relations with concentric remodeling of left ventricle,aging and increased systolic blood pressure.
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ObjectiveTo explore the wall structural ch anges of the carotid with integrated backscatter and their effects on wall distensibility in patients with primary hypertension. MethodsForty-three patients with primary hypertension and 25 normal subjects were enrolled in the study. The corrected integrated backscatter (CIBS) and its cyclic variability (CVIB), the thickness of intima-media (IMT) and the carotid distensibility (CD) were compared between hypertensive group and normal control group. ResultsCIBS and IMT were increased while CD was decreased more significantly in hypertensive patients than in normal subjects. Demonstrated a negative correlation with CD but a positire correlation with IMT in hypertensive patients. ConclusionsThe wall structural changes of the carotid are closely correlated with the functional disorder in patients with primary hypertension.
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Objective To evaluate the variation of left atrial ejection force index (LAEFI) and its determinants in patients with primary hypertension. Methods Using two-dimensional and Doppler echocardiography, LAEFI was measured in 28 normal subjects (control group) and 54 patients with primary hypertension (hypertensive group). Taking the mean + 2SD of LAEFI of the control group as the upper cut-off value, the hypertensive group was divided into two subgroups: group I of LAEFI within the normal range and group II above that. Related clinical variables and echo parameters were compared between the two groups, and stepwise regression was made to determine the influencing factors of LAEFI variation in hypertensive group. Results (1) LAEFI of hypertensive group was larger than that of control group. (2) Multivariate regression demonstrated that LAPVI, AGE and LVMI entered the regression equation.Conclusions (1) LAEFI increased in patients with hypertension, indicating that left atrial systolic function is strengthened for compensation. (2) LAPVI, AGE and LVMI are the most important determinants of LAEFI variation in patients with hypertension.