Significance of real-time three-dimensional transesophageal echocardiography in mitral valvuloplasty / 中华医学超声杂志（电子版）

Objective To evaluate the value of real-time three-dimensional transesophageal echocardiography (TEE) in the diagnosis of mitral valve structure in mitral valve prolapse, the significance of determining the prosthetic mitral valve ring size in the surgical treatment and the evaluation of immediate postoperative effect. Methods From November 2016 to March 2017, 19 patients with mitral prolapse performed with surgical treatment were diagnosed by transthoracic echocardiography at the echocardiography and vascular ultrasound center in the First Affiliated Hospital of Zhejiang University. All 19 patients underwent real-time three-dimensional TEE examination after anesthesia and before cardiopulmonary bypass. When the heart was recovered immediately after the operation, TEE was performed again to check the valve and the images were recorded in real time. During the whole examination, the images were observed by sonologists, surgeons and anesthesiologists, and the sonographic results were compared with the intraoperative findings. Totally 19 patients with moderate to severe mitral valve prolapse were examined and measured with real time three-dimensional ultrasound reconstruction. The mitral valve and tendons were observed and the mitral valve ring, the length of the valve and the diameter of the fiber triangle were measured. Results Intraoperative TEE examination could clearly display the anatomical structure and movement of mitral valve, annulus, chordae tendineae and papillary muscles from any angle. Real time observation of mitral valve thickness, mobility, calcification, vegetations and chordae tendineae rupture was effective. It was able to diagnose the thrombosis and patent foramen ovale. In the 19 patients, the TEE diagnosis of mitral valve prolapse was almost consistent with operative findings, and P2 was the most common area. The etiology was detected in 15 cases caused by rupture of mitral chordae tendineae, which was consistent with operative findings, and the accuracy rate was 100%. The size of the prosthetic ring provided by TEE in 14 cases was consistent with operative findings among 19 patients. The accuracy rate was 73.7% (4/9). Four cases were selected 1 size down than TEE, and 1 case was selected 1 size up than TEE. Conclusions The application of real-time three-dimensional ultrasound reconstruction can objectively reflect the pathogeny and pathological changes of prolapse, and provide a visual stereoscopic image, which is of great reference value for the formulation of the operation scheme. It also provides a basis for selecting the size of the forming ring and saves the operative time. It has practical clinical guiding significance. The function of the autologous valve is evaluated immediately after the operation, and the ventricular wall movement and left ventricular systolic function are detected in real time, and the left heart gas could be monitored. It is helpful to the intraoperative monitoring of the anesthesiologist and increase the success rate of the operation.

Diagnostic Value of 64-Slice Dual-Source CT Coronary Angiography in Patients with Atrial Fibrillation: Comparison with Invasive Coronary Angiography

OBJECTIVE: We wanted to evaluate the image quality and diagnostic value of 64-slice dual-source computed tomography (DSCT) coronary angiography in patients with atrial fibrillation (Afib). MATERIALS AND METHODS: The coronary arteries of 22 Afib patients seen on DSCT were classified into 15 segments and the imaging quality (excellent, good, moderate and poor) and significant stenoses (> or = 50%) were evaluated by two radiologists who were blinded to the conventional coronary angiography (CAG) results. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting important coronary artery stenosis were calculated. McNemar test was used to determine any significant difference between DSCT and CAG, and Cohen's Kappa statistics were calculated for the intermodality and interobserver agreement. RESULTS: The mean heart rate was 89 +/- 8.3 bpm (range: 80-118 bpm). A range from 250 msec to 300 msec within the RR interval was the optimal reconstruction interval for the patients with Afib. The respective overall sensitivity, specificity, PPV and NPV values were 74%, 97%, 81% and 96% for reader 1 and 72%, 98%, 85% and 96% for reader 2. No significant difference between DSCT and CAG was found for detecting a significant stenosis (reader 1, p = 1.0; reader 2, p = 0.727). Cohen's Kappa statistics demonstrated good intermodality and interobserver agreement. CONCLUSION: 64-slice DSCT coronary angiography provides good image quality in patients with atrial fibrillation without the need for controlling the heart rate. DSCT can be used for ruling out significant stenosis in patients with atrial fibrillation with its high NPV for detecting in important stenosis.

Application of Stata software to test heterogeneity in Meta-analysis method / 中华流行病学杂志

To introduce the application of Stata software to heterogeneity test in meta-analysis.A data set was set up according to the example in the study,and the corresponding commands of the methods in Stata 9 software were applied to test the example.The methods used were Q-test and Ⅰ2statistic attached to the fixed effect model forest plot,H statistic and Galbraith plot.The existence of the heterogeneity among studies could he detected hy Q-test and H statistic and the degree of the heterogeneity could be detected by,Ⅰ2 statistic.The outliers which were the sources of the heterogeneity could be spotted from the Galbraith plot.Heterogeneity test in Meta-analysis can be completed by the four methods in Stata software simply and quickly.H and Ⅰ2 statistics are more robust,and the outliers of the heterogeneity can be clearly seen in the Galbraith plot among the four methods.

Ultrasonic diagnosis of isolated noncompaction of the ventricular myocardium in adults / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To apply echocardiography in diagnosis of isolated noncompaction of ventricular myocardium (INVM) in adults.</p><p><b>METHODS</b>Six patients with INVM underwent echocardiographic examination using HP5500 ultrasound system with the frequency of 2 approximately equals 4 MHz, and the observation was focused on ventricularmyocardium and endocardium at one-third of the apex.</p><p><b>RESULTS</b>All 6 patients showed typical echocardiographic images characterized by an altered structure of the ventricular myocardium with extremely thickened, hypokinetic segments consisting of two layers: a thin, compacted epicardium and an extremely thickened endocardium, resulting in an extremely thickened ventricular wall.</p><p><b>CONCLUSION</b>Echocardiography should be the first choice to be applied in diagnosis of INVM, which is a distinct entity of specific cardiomyopathy in adults.</p>

Alterations of phospholamban expression and cardiac sarcoplasmic reticulum Ca ～(2+)-ATPase activity in diabetic rats / 中国病理生理杂志

AIM:To investigate the alterations of phospholamban(PLB)expression and cardiac sarcoplasmic reticulum(SR)Ca 2+-ATPase activity,and the change of cardiac function in rats with diabetes mellitus(DM).METHODS:The diabetes mellitus in male Wistar rats was induced by intraperitoneal injection of streptozotocin.The levels of PLB mRNA and PLB protein,the activity of SR Ca 2+-ATPase and the left ventricular hemodynamics parameters were measured 4 weeks,6 weeks and 8 weeks after DM was induced in rats,while the normal rats served as control group.RESULTS:There was no significant difference in PLB mRNA level and protein level between 4-week-DM rats and normal control rats.6-week-DM rats and 8-week-DM rats had markedly increased PLB mRNA and protein level compared with normal control rats.SR Ca 2+-ATPase activity was not significantly changed in 4-week-DM rats compared with normal control rats,and was markedly depressed in 6-week-DM rats and 8-week-DM rats.LVSP,LVEDP and ?dp/dt max were not significantly changed in 4-week-DM rats compared with normal control rats.In 6-week-DM rats and 8-week-DM rats,LVSP and ?dp/dt max were decreased,LVEDP was increased compared with normal control rats.CONCLUSION:The elevated levels of PLB mRNA and PLB protein contribute to SR Ca 2+-ATPase activity reduction,which leads to cardiac dysfunction in DM rats.