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Purpose To evaluate changes of left ventricular systolic function in patients with different-stage chronic renal insufficiency using three-dimensional speckle tracking imaging (3D-STI).Materials and Methods Twenty-six patients with mild chronic renal insufficiency (CKD2-3 group),20 patients with moderate-severe chronic renal insufficiency (CKD4-5 group),who accepted treatment in the West Coast Medical Center,Qingdao University Affiliated Hospital from June 2015 to June 2016,and 20 healthy volunteers (control group) were enrolled.Routine two-dimensional echocardiography was carried out,and the indicators were compared,including inter-ventricular septum end-diastolic thickness (IVSTd) and left ventricular posterior wall end-diastolic thickness (LVPWTd).In addition,3D-STI analysis was conducted,and the indicators were compared,including left ventricular end-diastolic volume (LVEDV),left ventricular end-systolic volume (LVESV),three-dimensional left ventricular ejection fraction (3D-LVEF),left ventricular global longitudinal strain (GLS),global radial strain (GRS) and global circumferential strain (GCS).The efficacy of GLS,GCS and GRS in the diagnosis of left ventricular systolic dysfunction in patients with chronic renal insufficiency was compared by ROC curve analysis.Results Compared with the control group,serum creatinine and triglyceride increased (t=22.152 and 2.655),glomerular filtration rate (GFR) and hemoglobin content decreased (t=-36.527 and-19.610),IVSTd increased (t=6.035),and 3D-LVEF,GLS,GRS and GCS decreased (t=-2.958,-5.336,-9.552 and-4.384) in CKD2-3 group.Compared with the control group,systolic blood pressure,serum creatinine,total cholesterol and triglyceride increased (t=15.060,29.461,8.210 and 6.512),GFR and hemoglobin content decreased (t=-67.557 and-28.071),IVSTd increased (t=10.959),and 3D-LVEF,GLS,GRS and GCS decreased (t=-7.315,-7.460,-17.99 and-6.052) in CKD4-5 group.Compared with CKD2-3 group,systolic blood pressure,serum creatinine and total cholesterol increased (t=14.551,28.902 and 8.555),GFR and hemoglobin content decreased (t=-18.455 and-16.832),IVSTd increased (t=7.331),and 3D-LVEF,GRS,GCS and GLS decreased (t=-4.977,-3.847,-4.929 and-2.553) in CKD4-5 group.All the above differences were statistically significant (P＜0.05).ROC curve showed that determining left ventricular systolic dysfunction in patients with chronic renal insufficiency using GLS,GCS and GRS,when the cutoff value of GLS was 17.80％,the sensitivity was the highest (88.89％),and the Youden index was 0.673;however,when the cutoff value of GCS was 14.70％,the specificity was the highest (89.47％),and the Youden index was 0.561.Conclusion In patients with chronic renal insufficiency,left ventricular systolic function reduces,and with the progress of the disease,the cardiac function also gradually reduces.3D-STI can accurately assess changes of left ventricular systolic function in patients with different-stage chronic renal insufficiency.
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Objective To study the correlation between the changes of sex hormone level in different perinatal periods and perinatal depression (PND). Methods Between February 2014 and February 2015, 300 pregnant women from the Third Affiliated Hospital of Guangzhou Medical University were enrolled in this study. In the first trimester (12 weeks), the third trimester (34 weeks) and postpartum period (7 and 42 days), blood samples were collected and radioimmunoassay was performed to detect the levels of sex hormones, including estrogen, progesterone, prolactin, luteinizing hormone and follicle-stimulating hormone. Self Depression Scale and Edinburgh Postnatal Depression Scale were used for psychological assessment, and PND was diagnosed by psychiatrists as PND group, and non-PND cases served as control group. Two-sample t-test, variance analysis and Bonferroni test were used to compare the changes of sex hormones at different time points between the two groups. Results A total of 180 pregnant women completed the four stages of research. Fifity-four cases were diagnosed as PND, including 10 cases in the first trimester, 16 new cases in the third trimester, 14 new cases at postpartum 7 days, and 14 new cases at postpartum 42 days. (1) Comparison of the sex hormone levels between the two groups:The estrogen levels of the first trimester, the third trimester and postpartum 7 and 42 days in PND group were (4 107.30±344.68), (13 261.60±593.32), (1 281.70±151.54) and (161.40±12.21) pmol/L, and lower than in the control group [(8 619.60±514.92), (14 330.00±353.15), (3 585.90±150.83) and (270.50±11.86) pmol/L, respectively] (all P<0.05). The progesterone levels of the first trimester and postpartum 7 and 42 days in PND group were (105.49±20.40), (24.23±3.53) and (6.40±3.53) nmol/L, and higher than those in the control group [(85.80±19.06), (5.71±2.36) and (3.87±2.03) nmol/L] (t=-2.389, -2.660 and -2.103, all P<0.05). The prolactin and luteinizing hormone levels of the postpartum 42 days in PND group were lower than in the control group [(9.40±1.69) vs (17.50±1.64)μg/L, t=-4.059;(0.32±0.21) vs (2.21±0.17) mU/L, t=-12.302] (both P<0.05). The levels of follicle-stimulating hormone in the first trimester, the third trimester and postpartum 7 days were not detectable in both groups, but PND group had a lower level at postpartum 42 days than the control group [(2.22±0.58) vs (3.15±0.29) mU/L, t=-15.525, P=0.000]. (2) Sex hormone levels at different time points:There were significant differences in estrogen levels between the four time points in both groups. There was significant difference in progesterone in the PND group at four time points, while in the control group, significant differences were found between postpartum 42 days and the first and third trimester. Prolactin levels were lowest at postpartum 42 days in both groups among the four time points (Bonferroni test, all P<0.05). Conclusions Low estrogen levels and high progesterone levels and their changes in perinatal period may be correlated with PND.
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Objective To discuss the diagnosis and management options of fetal nuchal cystic hygroma(NCH). Methods Ten cases of fetal nuchal cystic hygroma from Mar 1996 to Mar 2003 were retrospectively analyzed. The sonographic images, fetal karyotype examination after amniocentesis, TORCH results and pathology were reviewed. Results The sonogram detected a large cystic mass around the posterior of the neck. The smallest one was 5.3 cm?4.8 cm?4.0 cm in size and the biggest 12.6 cm?6.6 cm?4.0 cm. The nuchal ligament could be seen inside the mass. Four cases complicated with pleural effusions and 4 with pleural effusions, ascites and skin edema. One case was deliveried in full term and the other 9 cases were induced (including 4 fetal death). Seven cases were examined for TORCH of amniotic fluid among which only one TOX PCR positive. The karyotype examination was performed in 6 cases. The results were 45XO(3 cases), 45XO/46XX (60:40) and 45XX,-21,-22,+t(21;22). The only alive baby is 46XX. Conclusions Ultrasound and invasive amniocentesis to detect the fetal karyotype have an important role in early diagnosis and management of nuchal cystic hygroma. Nuchal cystic hygromas are associated with Turner’s syndrome and other chromosomal abnormalities.
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Placenta implantation is a rare but dangerous postpartum complication. In this study, 17 cases of placenta implantation were allocated to two groups. The treatment group?(9?cases)was treated with modified Xuefu Zhuyu Decoction on the basis of intravenous drip of methotrexate. The control group(8?cases)was treated with intravenous drip of methotrexate combined with oxytocin and antibiotic. The results showed that all of the cases in the treatment group were cured and no one case received uterine curettage or uterectomy.But in the control group,5 received uterine curettage and 1 total uterectomy. It is indicated that Chinese herbal medicine combined with western medicine is a better therapy for placenta implantation.