Quantification of left ventricular performance in different phenotypes of hypertrophic cardiomyopathy / 中华超声影像学杂志

Objective@#To evaluate the characteristics of left ventricular structure, function, myocardial mechanics, hemodynamics and synchrony in different phenotypes of hypertrophic cardiomyopathy (HCM) using state-of-the-art echocardiography.@*Methods@#A consecutive series of 85 adult HCM patients who were admitted to the Xi Jing HCM center from January 2016 to November 2017 were collected. According to the peak left ventricular outflow tract pressure gradient in exercise stress echocardiography, the patients were divided into three groups: patients with non-obstructive HCM (n=28), those with labile-obstructive HCM (n=27), and those with obstructive HCM (n=30). In addition, 16 normal family members of HCM patients were included as control group. Two-dimensional speckle tracking imaging, tissue Doppler imaging and exercise stress echocardiography were used to evaluate the left ventricular function in resting and exercise states.@*Results@#①As compared with the control group, left ventricular end-diastolic diameter decreased and left ventricular ejection fraction increased in all three HCM groups(all P<0.05). Left ventricular maximum wall thickness and left ventricular mass index were the highest in obstructive HCM, followed by labile-obstructive and non-obstructive HCM, and the lowest in the control group (all P<0.05). ②At rest, the left ventricular global longitudinal, circumferential and radial strain (GLS, GCS and GRS), as well as the twist of obstructive HCM were significantly lower than the other three groups (all P<0.05). As compared with the control group, the GLS and twist decreased in the labile-obstructive and non-obstructive HCM(all P<0.05), but there were no significant changes of GCS and GRS (all P>0.05). The obstructive HCM had the lowest mitral annular plane systolic excursion (MAPSE) and s′, and the longest systolic peaking time standard deviation(Ts-SD) and early diastolic peaking time standard deviation(Te-SD) (all P<0.05). The left ventricular diastolic function of obstructive HCM (e′, the E/e′ ratio and the left atrial volume index) was the worst, labile-obstruction and non-obstructive HCM were better, and the control group was the best (all P<0.001). ③During exercise, the GLS, GCS, GRS, twist of the left ventricle and the MAPSE were the lowest in the obstructive HCM, which increased in the labile-obstructive and non-obstructive HCM, and were best in the control group. The Ts-SD and Te-SD were the shortest in the control group, were prolonged in non-obstructive and labile-obstruction HCM, and were longest in obstructive HCM (all P<0.05). Additionally, the exercise time of the control group was the longest, followed by non-obstructive and labile-obstruction HCM, and the shortest in the obstructive HCM (all P<0.05). The METs of obstructive HCM were significantly lower than the other three groups (all P<0.05).@*Conclusions@#In obstructive HCM, the left ventricular systolic strain and synchronization, as well as the MAPSE, are significantly impaired in patients both at rest and during exercise. The patients with labile-obstructive and non-obstructive HCM have reduced left ventricular GLS, twist, and e′, but normal left ventricular GCS, GRS, synchrony, and MAPSE at rest, which are all impaired during exercise.

Quantification of left ventricular performance in different phenotypes of hypertrophic cardiomyopathy / 中华超声影像学杂志

Objective To evaluate the characteristics of left ventricular structure ,function ,myocardial mechanics ,hemodynamics and synchrony in different phenotypes of hypertrophic cardiomyopathy ( HCM ) using state‐of‐the‐art echocardiography . Methods A consecutive series of 85 adult HCM patients w ho were admitted to the Xi Jing HCM center from January 2016 to November 2017 were collected . According to the peak left ventricular outflow tract pressure gradient in exercise stress echocardiography ,the patients were divided into three groups :patients with non‐obstructive HCM ( n ＝28) ,those with labile‐obstructive HCM ( n ＝27) ,and those with obstructive HCM ( n ＝ 30 ) . In addition ,16 normal family members of HCM patients were included as control group . T wo‐dimensional speckle tracking imaging ,tissue Doppler imaging and exercise stress echocardiography were used to evaluate the left ventricular function in resting and exercise states . Results ① As compared with the control group ,left ventricular end‐diastolic diameter decreased and left ventricular ejection fraction increased in all three HCM groups ( all P ＜ 0 .05 ) . Left ventricular maximum wall thickness and left ventricular mass index were the highest in obstructive HCM , followed by labile‐obstructive and non‐obstructive HCM ,and the lowest in the control group ( all P ＜0 .05) . ②A t rest ,the left ventricular global longitudinal ,circumferential and radial strain ( GLS ,GCS and GRS) ,as well as the twist of obstructive HCM were significantly lower than the other three groups ( all P ＜0 .05) . As compared with the control group ,the GLS and twist decreased in the labile‐obstructive and non‐obstructive HCM ( all P ＜0 .05 ) ,but there were no significant changes of GCS and GRS ( all P ＞ 0 .05 ) . T he obstructive HCM had the lowest mitral annular plane systolic excursion ( M APSE ) and s′,and the longest systolic peaking time standard deviation( T s‐SD) and early diastolic peaking time standard deviation ( Te‐SD) ( all P ＜0 .05) . T he left ventricular diastolic function of obstructive HCM ( e′,the E/e′ratio and the left atrial volume index ) was the worst ,labile‐obstruction and non‐obstructive HCM were better ,and the control group was the best ( all P ＜ 0 .001 ) . ③ During exercise ,the GLS ,GCS ,GRS ,twist of the left ventricle and the M APSE were the lowest in the obstructive HCM ,which increased in the labile‐obstructive and non‐obstructive HCM ,and were best in the control group . T he T s‐SD and Te‐SD were the shortest in the control group ,were prolonged in non‐obstructive and labile‐obstruction HCM ,and were longest in obstructive HCM ( all P ＜ 0 .05 ) . Additionally ,the exercise time of the control group was the longest , followed by non‐obstructive and labile‐obstruction HCM ,and the shortest in the obstructive HCM ( all P ＜0 .05) . T he M ET s of obstructive HCM were significantly lower than the other three groups ( all P ＜0 .05) . Conclusions In obstructive HCM ,the left ventricular systolic strain and synchronization ,as well as the M APSE ,are significantly impaired in patients both at rest and during exercise . T he patients with labile‐obstructive and non‐obstructive HCM have reduced left ventricular GLS , twist ,and e′,but normal left ventricular GCS ,GRS ,synchrony ,and M APSE at rest ,which are all impaired during exercise .

Relationship between electrocardiographic and genetic mutation (MYH7-H1717Q, MYLK2-K324E and KCNQ1-R190W) phenotype in patients with hypertrophic cardiomyopathy / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the relationship between electrocardiographic (ECG) and genetic mutations of patients with hypertrophic cardiomyopathy (HCM), and early ECG changes in HCM patients.</p><p><b>METHODS</b>Clinical, 12-lead ECG and echocardiographic examination as well as genetic examinations were made in a three-generation Chinses HCM pedigree with 8 family members (4 males). The clinical characterization and ECG parameters were analyzed and their relationship with genotypes in the family was explored.</p><p><b>RESULTS</b>Four missense mutations (MYH7-H1717Q, MYLK2-K324E, KCNQ1-R190W, TMEM70-I147T) were detected in this pedigree. The proband carried all 4 mutations and 5 members carried 2 mutations. Corrected QTc interval of KCNQ1-H1717Q carriers was significantly prolonged and was consistent with the ECG characterization of long QT syndrome. MYLK2-K324E and KCNQ1-R190W carriers presented with Q wave and(or) depressed ST segment, as well as flatted or reversed T waves in leads from anterolateral and inferior ventricular walls. ECG results showed ST segment depression, flat and inverted T wave in the gene mutation carriers with normal echocardiographic examination results. ECG and echocardiographic results were normal in TMEM70-I147T mutation carrier.</p><p><b>CONCLUSIONS</b>The combined mutations of the genes associated with cardiac ion channels and HCM are linked with the ECG phenotype changes in this HCM pedigree. The variations in ECG parameters due to the genetic mutation appear earlier than the echocardiography and clinical manifestations. Variation in ECG may become one of the indexes for early diagnostic screening and disease progression of the HCM gene mutation carriers.</p>

Early hepatic encephalopathy after transjugular intrahepatic portosystemic shunt: the risk factors and long-time survival / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To identify the risk factors of early post-TIPS hepatic encephalopathy (HE) and the long-time survival of patients with or without early post-TIPS HE.</p><p><b>METHODS</b>Consecutive cirrhotic patients who underwent TIPS for variceal rebleeding or refractory ascites in our center from January 2003 to December 2008 were included in this study. More than 60 clinical characteristics were enrolled in univariate analysis and logistic regression analysis to define the risk factors of HE in 3 months after TIPS procedure (early post-TIPS HE). The long-time survival of patients with or without early post-TIPS HE was compared by Cox regression with several covariates.</p><p><b>RESULTS</b>According to our inclusion criteria, 190 patients were included. The median follow-up was 30.5 months. Lower serum concentration of fibrinogen and higher Child-Pugh score were the independent risk factors for suffering early post-TIPS HE. Patients without early post-TIPS HE after TIPS showed better prognosis than those with early post-TIPS HE after TIPS (P = 0.044).</p><p><b>CONCLUSION</b>Patients with lower serum fibrinogen and higher Child-Pugh score before TIPS might be more probably attacked by early post-TIPS HE which indicated worse long-term survival.</p>

Endovascular angioplasty for the treatment of long iliac artery chronic total occlusions / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the effectiveness, safety and feasibility of endovascular angioplasty in treating long iliac artery chronic total occlusions (CTO).</p><p><b>METHODS</b>The clinical data from a consecutive series of patients with long (> 5 cm) iliac artery CTO who treated by endovascular angioplasty from January 2006 to December 2010 was retrospectively analyzed. There were 139 patients (157 limbs) with long iliac artery CTO treated by endovascular angioplasty in this study [male 93 and female 46, mean age (77 ± 10) years]. According to TASC II classification, there were 18 patients in type B, 89 patients in type C and 32 patients in type D. Recanalization of the occluded lesions was attempted with the left brachial and/or femoral access.</p><p><b>RESULTS</b>The ankle brachial index increased from 0.42 ± 0.19 before treatment to 0.81 ± 0.26 after treatment. The rate of technical success was 96.2% (151/157) and the patency rate of iliac artery was 94.1% (111/118) during the follow-up. Significant restenosis or reocclusion was found in 7 iliac lesions and there were no major interventional complications, such as iliac artery rupture, stent displacement, pseudoaneurysms, and arteriovenous fistula.</p><p><b>CONCLUSIONS</b>Endovascular angioplasty is an effective, safe and feasible method in treating long iliac CTO with high patency rate. Combined left brachial and femoral access can increase the technical success rate significantly.</p>

Innovative "Case-Based Integrated Teaching" in an undergraduate medical curriculum: development and teachers' and students' responses

<p><b>INTRODUCTION</b>We developed "Case-Based Integrated Teaching (C-BIT)" in our medical school to integrate the content of various disciplines through a core patient design that introduces major diseases to students. This article presents the concepts, development and initial evaluation of the teachers' and students' responses to C-BIT.</p><p><b>MATERIALS AND METHODS</b>Teachers' manuals for 18 major diseases were completed. Eighty teachers from various disciplines participated in writing the first 10 manuals. On the basis of this experience, 57 teachers subsequently prepared another 8 manuals. Each manual is composed of a brief summary of a patient with a major disease, learning objectives, case presentation, questions, a teaching guide and references for all disciplines. Teachers' and students' responses to a questionnaire were recorded.</p><p><b>RESULTS</b>Most respondents agreed that C-BIT is patient-centred and can be used to improve curriculum integration, reduce duplication in teaching and enhance communication among the faculty members from various disciplines. One-third of the teachers contributed to more than one C-BIT manual, indicating their enthusiasm for the development of C-BIT. Most of the students agreed that C-BIT can enhance discussion, integrate the curriculum and promote active learning.</p><p><b>CONCLUSION</b>We have developed a new format for teaching materials that enhance teacher-student and teacher-teacher interactions, reduces redundant content and integrates disciplines through patient-oriented medical education.</p>

Surveillance program set for influenza A virus (H1N1) in children in Taiyuan, China, 2005-2006 / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the epidemic situation and dominant strain of influenza in children with acute respiratory infection (ARI) during Flu season from Oct. 2005 to Mar. 2006 in Taiyuan.</p><p><b>METHODS</b>Madin-darby canine kidney (MDCK) cell culture and hemagglutination inhibition (HI) assay were used to isolate and identify type A influenza viruses (H1N1 and H3N2) and B influenza viruses from clinical samples collected from outpatients who visited the Department of Pediatric because of ARI from Oct. 2005 to Mar. 2006. Oct. 2005 and Mar. 2006, we collected 415 blood samples from children and adults to detect the influenza virus antibody titers by HI test to exclude respiratory diseases.</p><p><b>RESULTS</b>7 strains of H1N1 were isolated from 87 clinical specimens, with a positive rate of H1N1 as 8.04%. Out of 415 blood samples being collected, the positive rates and the geometric mean titer of H1N1 antibody Mar. 2006 were significantly higher in 0-3, 3-7 and 7-18 year-olds than Oct.2005.</p><p><b>CONCLUSION</b>H1N1 epidemic influenza did occur among children in winter and spring of 2005--2006 in Taiyuan city.</p>