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Objective To explore the pregnancy outcomes in women whose fetal/embryonic heart rate( FHR) were below 120 beats per minute( bpm) before 8 weeks pregnancy and determine the predictive value of FHR in pregnancy outcome . Methods The laboratory examinations ,clinical data and clinical history of the pregnant women whose FHR were below 120 bpm before 8 weeks pregnancy were retrospectively analyzed . Results When gestational age(GA) was less than 8 weeks ,pregnancy loss was observed in 11 .0% ( 110/998 ) cases with an FHR less than or equal to 120 bpm ,and pregnancy loss occurred in all the cases ( 23/23) with an FHR less than or equal to 70 bpm . The proportions of first trimester loss were 86 .4% (19/22) for pregnancies with an FHR of 71 －80 bpm ,75 .7% (28/37) for pregnancies with an FHR of 81－90 bpm ,25 .5% (14/55) for pregnancies with an FHR of 91 －100 bpm , 6 .3% (13/208) for pregnancies with an FHR of 101 －110 bpm ,and 2 .0% (13/653) for pregnancies with an FHR of 111 －120 bpm .ROC analysis showed that the best cut-off value to predict adverse pregnancy outcomes was an FHR of 94 bpm . The area under the ROC curve was 0 .906 ( P ＜ 0 .0001 ) and its sensitivity and specificity values were 97 .86% and 71 .43% respectively . Conclusions Fetal/embryonic heart monitoring before 8-weeks pregnancy can be an effective predictor for early pregnancy outcome . The best cut-off value to predict adverse pregnancy outcomes is an FHR of 94 bpm .
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Objective To evaluate the diagnosis value of three-dimensional speckle tracking echocardiography ( 3D-STE) in severe multi-vessel coronary stenosis at resting state . Methods Ninety-one patients with chest tightness ,chest pain ,other related clinical symptoms ,and suspected coronary heart disease were enrolled and underwent coronary angiography ( CAG ) , two and three-dimensional echocardiography(2D-STE ,3D-STE) . According to CAG results ,the patients were divided into 3 groups:severe multi-vessel stenosis group ( n = 38 ) ,severe single-vessel stenosis group ( n = 22 ) ,and control group ( n =31) . All patients underwent two and three-dimensional echocardiography .3D-STE was applied to obtain left ventricular global longitudinal strain ( 3D GLS) ,global circumferential strain ( 3D GCS) ,global area strain (3D GAS) and global radial strain(3D GRS) . Receiver operating curve analysis was conduct to evaluate the diagnosis value of 3D-STE in severe multi-vessel coronary stenosis at resting state . Results 3D GLS ,3D GCS ,3D GAS and 3D GRS were decreased in the severe multi-vessel group and single-vessel stenosis group compared to those in the control group( P <0 .05) ;and greater decreases was observed in the severe multi-vessel stenosis group( P <0 .001) . Furthermore ,3D GLS and 3D GAS in the severe multi-vessel stenosis group were lower than those in severe single-vessel stenosis group( P <0 .05) . ROC curve showed that the cutoff value for 3D GLS was ≤ -11％ with a measurement sensitivity of 84 .2％ and cutoff value for 3D GAS was ≤ -20％ with a measurement specificity of 79 .3％ . A joint diagnostic test showed that the sensitivity was increased when 3D GLS was combined with at least one other parameters . Conclusions 3D-STE shows a great diagnostic potential when applied to detect severe multi-vessel coronary stenosis . Moreover ,GLS and GAS may act as more valuable indicators .
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Objective:To research the correlation between the cobamamide photodegradation products in the visible light area at different wavelengths and the photodegradation rate intensity. Methods:The 40-minute illumination experiment was conducted for co-bamamide reference solution respectively at the wavelength of 400 nm,450 nm,500 nm,550 nm,600 nm,650 nm and 700 nm under the illumination of 50 Lx,100 Lx,200 Lx,300 Lx,400 Lx and 500 Lx,respectively. An HPLC method was used to detect the cobam-amide content after the irradiation, the contents and proportions of hydroxocobalamin and adenosine (two photodegradation products) were calculated and the two photodegradation products were confirmed by mass spectrum. Results:The main photodegradation products of cobamamide (impurity 1,adenosine and hydroxocobalamin) had the similar photodegradation tendency. Within the scope of 50 Lx-200 Lx,the illumination intensity affected the concentration ratio of hydroxocobalamin and adenosine obviously. Within the scope of 200 Lx-500 Lx,the illumination intensity showed smaller effect. Under the different wavelengths and photodegradation rate intensity, the content of hydroxocobalamin was higher than that of adenosine under the same experimental condition.Conclusion:This paper re-searched the cobamamide photodegradation products in the optimum dark condition. The method is accurate and reliable,which can be used for the control of photodegradation related substances of cobamamide.
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Objective To explore the causes,clinical characteristics and prognosis of children′s completely at-rioventricular block(CAVB).Methods The clinical data of 73 patients with CAVB were analyzed retrospectively from January 2004 to December 201 3 at the Cardiology Department,Nanjing Children′s Hospital Affiliated to Nanjing Medi-cal University.Within those 73 patients,34 patients were male and the others were female,from 3 months old to 1 2.5 years old,the mean age of 6 years.Results There were 21 congenital CAVB patients and 52 acquired CAVB patients with myocarditis undergoing ventricular septal defect (VSD)closure operation.All congenital CAVB patients were re-fractory to drug therapy.Electrocardiogram and echocardiogram were performed in 1 9 cases without clinical symptoms during follow -up,but 2 cases had permanent pacemaker implanted.Among 27 fulminant myocarditis,Adams -Stokes attacks were found in 1 5 cases,3 cases had Adams -Stokes attack in 1 5 cases with sequelae of myocarditis,and 2 out of 6 cases undergoing VSD closure operation had Adams -Stokes attack,and other 4 cases without clinical symptoms were followed up periodically.The acquired CAVB patients were given energy composition and intravenous megavitamin C. The cases with fulminant myocarditis were given adrenal cortical hormone and intravenous gamma globulins simulta-neously.A total of 27 acquired CAVB patients were implanted temporary pacemaker and 5 with permanent pacemaker. Among 52 acquired CAVB patients,31 cases were cured,9 cases were improved,1 1 cases were ineffective,and 1 case died.Conclusions Most congenital CAVB children without clinical symptoms need clinical follow -ups.Myocarditis is a major cause of acquired CAVB.The CAVB prognosis caused by fulminant myocarditis may be related to antimely im-planting the temporary pacemaker timely.Permanent pacemaker should be implanted in patients who have no response to drug therapy with frequent Adams -Stokes or heart failure.
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Objective To assess the value of the myocardial segment number of color change in the bull's eyes of three-dimensional speckle tracking echocardiography (3D-STE)in the detection of multi-vessel coronary stenosis at the resting state.Methods A total of 125 consecutive patients were enrolled and divided into the following three groups according to the coronary angiography(CAG):multi-vessel coronary stenosis group (n=48),single-vessel stenosis group(n =34)and control group (n =43).All patients underwent two-dimensional (2D)and three-dimensional echocardiography (3D)and three-dimensional speckle tracking echocardiography (STE).The bull's eyes of left ventricular 17 myocardial segments including longitudinal strain(LS),circumferential strain (CS),area strain(AS)and radial strain(RS)were acquired by 3D-STE.The homogeneous colors were regarded as normal wall motion myocardial segment (LS,CS,AS is a uniform red,RS for uniform blue ),the colors were uneven or shallower,or changes were regarded as abnormal wall motion myocardial segment.The myocardial segment number of color change in the bull's eyes can be calculated.Receiver operating characteristic (ROC ) curves were computed to determine optimal strain cutoff values to predict multi-vessel coronary stenosis.Results The myocardial segments of abnormal wall motion in the bull's eyes (LS,CS,AS,and RS)were significantly increased compared with the control group(P <0.001).In particular,the multi-vessel coronary stenosis group were dramatically increased than the single-vessel coronary stenosis group.Meanwhile,these parameters were higher in patients with multi-vessel coronary stenosis than in those with single-vessel coronary stenosis (P <0.05).ROC analysis demonstrated areas under the curve of 0.84 for 3D GLS,0.89 for 3D GCS,0.95 for 3D GAS,and 0.89 for 3D GRS.An optimal cutoff value of magnitude,sensitivity and specificity were LS,12,89.6%,76.7%;CS,11,89.6%,74.4%;AS,12,91.7%,88.4%;RS,13,81.2%,86.0%,respectively. Conclusions The myocardial segment number of color change in the bull's eyes by 3D-STE is useful to detect multi-vessel coronary stenosis,where in GAS are more valuable indicators with higher sensitivity and specificity.