Investigação da Relação entre Índice de Triglicerídeos-Glicose e Fluxo Lento Coronariano: Um Estudo Retrospectivo de Caso-Controle / Investigation of the Relationship Between Triglycerides-Glucose İndex and Coronary Slow Flow: A Retrospective Case-Control Study

Resumo Fundamento O fluxo lento coronariano (FLC) refere-se à opacificação retardada dos vasos distais na ausência de estenose da artéria coronária epicárdica. O mecanismo etiopatogênico do FLC ainda não está claro. Objetivos Este estudo investiga a relação entre o FLC e o índice de triglicerídeos-glicose (TyG). Métodos A amostra do estudo consistiu de 118 pacientes com FLC e 105 pacientes com fluxo coronariano normal (FCN). A taxa de fluxo coronariano foi medida por medio do método de contagem de quadros (TFC) Thrombolysis in Myocardial Infarction (TIMI) em todos os pacientes. O índice TyG foi calculado como o logaritmo do valor [triglicerídeos em jejum (mg/dL)×glicose em jejum (mg/dL)]/2. Adotou-se como estatisticamente significativo o nível de significância < 0,05. Resultados O índice TyG, lipoproteína de baixa densidade (LDL), índice de massa corporal (IMC), relação neutrófilo-linfócito (RNL) e valores de TFC, proporção masculina e proporção de fumantes foram maiores, enquanto os níveis de lipoproteína de alta densidade (HDL) foram significativamente menores no grupo FLC em comparação com o grupo FNC (p<0,05). A análise de correlação revelou que o FLC estava significativamente correlacionado com os valores do índice TyG, IMC, RNL e HDL. A mais forte dessas correlações foi entre o FLC e o índice TyG (r= 0,57, p<0,001). Além disso, a análise multivariada revelou que o índice TyG, IMC, razão RNL e sexo masculino foram preditores independentes para FLC (p<0,05). A análise da curva ROC (Receiver Operating Characteristic) indicou que um valor de corte ≥ 9,28 para o índice TyG previu FLC com sensibilidade de 78% e especificidade de 78,1% [Área sob a curva (AUC): 0,868 e 95% intervalo de confiança (IC): 0,823-0,914]. Conclusão Os achados deste estudo revelaram uma relação muito forte entre o FLC e o índice TyG.

Abstract Background Coronary slow flow (CSF) refers to delayed distal vessel opacification in the absence of epicardial coronary artery stenosis. The etiopathogenic mechanism of CSF is still unclear. Objectives This study investigates the relationship between CSF and the triglyceride-glucose (TyG) index. Methods The study sample consisted of 118 CSF patients and 105 patients with normal coronary flow (NCF). The coronary flow rate was measured via the Thrombolysis in Myocardial Infarction (TIMI) frame count (TFC) method in all patients. The TyG index was calculated as the logarithm of the [fasting triglyceride (mg/dL)×fasting glucose (mg/dL)]/2 value. A significance level of < 0.05 was adopted as statistically significant. Results The TyG index, low-density lipoprotein (LDL), body mass index (BMI), neutrophil-to-lymphocyte ratio (NLR) and TFC values, male ratio, and the ratio of smokers were higher, whereas high-density lipoprotein (HDL) levels were significantly lower in the CSF group compared to the NCF group (p<0,05). The correlation analysis revealed that CSF was significantly correlated with TyG index, BMI, NLR, and HDL values. The strongest of these correlations was between CSF and TyG index (r= 0.57, p<0.001). Additionally, the multivariate analysis revealed that TyG index, BMI, NLR ratio, and male gender were independent predictors for CSF (p<0.05). Receiver operating characteristic (ROC) curve analysis indicated that a cut-off value of ≥ 9.28 for the TyG index predicted CSF with a sensitivity of 78% and a specificity of 78.1% [Area under the curve (AUC): 0.868 and 95% Confidence Interval (CI): 0.823-0.914]. Conclusion The findings of this study revealed a very strong relationship between CSF and TyG index.

Effects of intravenous thrombolysis combined with Xingnaojing injection on intracranial arterial hemodynamic indexes and neurological function in patients with cerebral infarction / 中国基层医药

Objective:To investigate the effects of intravenous thrombolysis combined with Xingnaojing injection on hemodynamic indexes and neurological function in patients with cerebral infarction. Methods:A total of 142 patients with cerebral infarction who were treated in Xing An Meng Hospital from April 2020 to May 2021 were included in this study. They were randomly divided into a control group ( n = 71, intravenous thrombolysis) and a Xingnaojing injection group ( n = 71, intravenous thrombolysis + Xingnaojing injection). Intracranial arterial hemodynamic indexes, National Institutes of Health Stroke Scale score, Fugl-Meyer Assessment Scale score, serum inflammatory factors, oxidative stress indexes, brain injury markers, and the incidence of adverse reactions were compared between the two groups. Results:After treatment, serum levels of interleukin-1β, interleukin-6, and tumor necrosis factor-α were significantly lower in the Xingnaojing injection group than the control group [interleukin-1β: (4.05 ± 0.83) ng/L vs. (6.85 ± 1.02) ng/L, interleukin-6: (43.61 ± 5.14) ng/L vs. (60.31 ± 7.04) ng/L, tumor necrosis factor-α: (35.93 ± 4.25) ng/L vs. (20.93 ± 3.11) ng/L, t = 17.94, 16.14, 15.37, all P < 0.001]. After treatment, the mean blood flow velocities of the anterior cerebral artery, middle cerebral artery, and posterior cerebral artery in the Xingnaojing injection group were significantly higher than those in the control group [anterior cerebral artery: (49.36 ± 5.28) cm/s vs. (41.15 ± 5.12) cm/s, middle cerebral artery: (61.27 ± 7.02) cm/s vs. (50.19 ± 6.08) cm/s, posterior cerebral artery: (44.92 ± 5.63) cm/s vs. (37.26 ± 4.93) cm/s, t = 9.40, 10.05, 8.62, all P < 0.001]. After treatment, the National Institutes of Health Stroke Scale score and Fugl-Meyer Assessment Scale score in the Xingnaojing injection group were superior to those in the control group [National Institutes of Health Stroke Scale score: (10.36 ± 1.52) points vs. (14.62 ± 2.05) points, Fugl-Meyer Assessment Scale score: (76.19 ± 8.08) points vs. (65.28 ± 7.14) points, t = 14.06, 8.52, both P < 0.05]. After treatment, the serum level of malondialdehyde in the Xingnaojing injection group was significantly higher than that in the control group [(6.35 ± 1.02) μmol/L vs. (10.05 ± 1.63) μmol/L), t = 16.21, P < 0.001]. The serum level of superoxide dismutase in the Xingnaojing injection group was significantly lower than that in the control group [(114.31 ± 13.69) U/L vs. (92.25 ± 10.16) U/L), t = 10.90, P < 0.001]. Serum levels of neuron-specific enolase and S100β in the Xingnaojing injection group were significantly lower than those in the control group [neuron-specific enolase: (24.01 ± 3.24) IU/L vs. (30.31 ± 4.02) IU/L, S100β: (0.73 ± 0.17) ng/L vs. (1.13 ± 0.22) ng/L, t = 10.28, 12.12, both P < 0.001). There was a significant difference in the incidence of adverse reactions between the two groups ( P > 0.05). Conclusion:Intravenous thrombolysis combined with Xingnaojing injection for the treatment of cerebral infarction can improve intracranial hemodynamics, reduce the inflammatory response and oxidative stress, and alleviate brain tissue injury. The combined therapy is beneficial to protect the neurological function of patients with cerebral infarction and is highly safe.

Strain Magnitude Assessed at Rest and During Stress Echocardiography in Patients with Normal Coronary Flow Reserve

Abstract Background Coronary flow and myocardial contractile performance assessed by strain magnitude increase during a dobutamine stress echocardiogram (DSE). Normal coronary flow reserve (CFR) can be attained upon completion of a DSE at age-predicted maximum heart rate (HR) (HRmax = 220 - age)] or submaximal HR [(0.85) HRmax] or before completion (early CFR). Objective To ascertain the association between delta strain and HR in patients with early normal CFR. Methods This prospective study included patients whose normal CFR was obtained before the DSE was completed. Percentage of resting HR (%HRrest) = [(HRrest ÷ HRmax) 100]% and %HR CFR = [(HR at the time of CFR attainment) ÷ (HRmax) 100]% were recorded. Strain was assessed in the left ventricular region of interest, and delta strain was calculated as the difference between the measures obtained at HRrest and after the DSE was completed. Strain agreement analysis for HRrest, %HRrest, and %HR CFR was performed using the kappa coefficient. The Shapiro-Wilk test was used to assess data normality, and the Mann-Whitney test was used to compare the groups. A p-value < 0.05 was considered statistically significant. Results Strain measured -23.3% ± 4.3% at baseline and -31.1% ± 4.9% during the DSE. In delta strain > 8 absolute points, the ROC curves showed an area under the curve of 0.874 ± 0.07 for %HRrest (p = 0.001) and an area under the curve of 0.862 ± 0.07 for %HR CFR (p = 0.001). In delta strain > 8 points, %HRrest ≤ 42.6% of HRmax and %HR CFR ≤ 62.5% of HRmax showed an accuracy of 82.9% and 79.8%, respectively. Conclusion In this study, lower HRrest and HR at the time of CFR attainment had a good association with better myocardial contractile performance, according to the change in strain magnitude.

Carotid doppler ultrasonography in patients with co-existing type 2 diabetes mellitus and hypertension in Nigeria

Background:The co-existence of diabetes mellitus (DM) and hypertension (HTN) has been rising globally with subclinical atherosclerotic complications. These vascular changes can be detected using carotid ultrasonography. Objectives: To determine and compare the carotid arterial structural wall changes and blood flow velocities of adults with co-existing DM and HTN with age-and sex-matched non-diabetic, non-hypertensive controls. Methods: A cross-sectional comparative study of 300 participants comprising 200 adults with co-existing DM and HTN and 100 age-and sex-matched controls was done. Their carotid arteries were examined bilaterally for plaques, carotid intima media thickness (CIMT) and flow velocities ­peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI) and resistive index (RI) using 4­12MHz linear array transducer. Visceral obesity and serum lipids were also assessed. Results: The mean age of the subjects was 56.13 ± 6.93 years; they comprised 38% males and 62% females. The subjects' CIMT was statistically significantly higher (p = 0.001) with a three-fold mean increase (45.5%) compared to the controls (13.7%). Lower flow velocities but higher indices were also observed in the subjects. Strong and significant correlations were observed between EDV and PI r =-0.663, p=>0.001), EDV and RI (r = -0.661, p=>0.001) and PI and RI (r =0.988, p= >0.001)among the subjects. Conclusion: Significant reduction in flow velocities with increased CIMT may be an early indication of subclinical atherosclerosis. Therefore, carotid ultrasonography should be mandatory in individuals at risk for early detection and possible prevention of atherosclerotic complications.

Research on inversion method of intravascular blood flow velocity based on convolutional neural network / 生物医学工程学杂志

Blood velocity inversion based on magnetoelectric effect is helpful for the development of daily monitoring of vascular stenosis, but the accuracy of blood velocity inversion and imaging resolution still need to be improved. Therefore, a convolutional neural network (CNN) based inversion imaging method for intravascular blood flow velocity was proposed in this paper. Firstly, unsupervised learning CNN is constructed to extract weight matrix representation information to preprocess voltage data. Then the preprocessing results are input to supervised learning CNN, and the blood flow velocity value is output by nonlinear mapping. Finally, angiographic images are obtained. In this paper, the validity of the proposed method is verified by constructing data set. The results show that the correlation coefficients of blood velocity inversion in vessel location and stenosis test are 0.884 4 and 0.972 1, respectively. The above research shows that the proposed method can effectively reduce the information loss during the inversion process and improve the inversion accuracy and imaging resolution, which is expected to assist clinical diagnosis.

Effects of acupuncture combined with Brunnstrom staging on upper-limb motor function, cerebral arterial blood flow velocity, and brain function remodeling after stroke / 针灸推拿医学（英文版）

Objective: To explore the effects of acupuncture combined with Brunnstrom staging on upper-limb motor function, cerebral arterial blood flow velocity, and brain function remodeling after stroke. Methods: A total of 77 patients after stroke were selected between January 2017 and December 2019 to perform a prospective study. All cases were divided into an observation group and a control group by the random number table method. Both groups were treated with conventional symptomatic treatment for stroke and functional exercise according to the Brunnstrom staging. The observation group was treated with additional acupuncture treatment based on the Brunnstrom staging therapy. The therapeutic efficacy was evaluated after six-week treatment. The traditional Chinese medicine (TCM) symptom scores of dizziness, headache, limb numbness, and language disorders before and after the treatment in the two groups were compared. According to the Fugl-Meyer motor function assessment (FMA), the upper-limb motor function before and after the treatment was compared. And the average systolic blood flow velocity of the anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) in the two groups before and after the treatment were compared. According to the modified Edinburgh-Scandinavia stroke scale (MESSS), the nerve function before and after the treatment was compared. Results: The total effective rate of the observation group was 94.9％, significantly higher than 79.0％ of the control group (P<0.05). After the treatment, the TCM symptom scores of dizziness, headache, limb numbness, and language disorders in both groups decreased, and the scores in the observation group were all significantly lower than those in the control group (P<0.05). The FMA score of upper limbs in both groups increased, and the score in the observation group was significantly higher than that in the control group (P<0.05). The average systolic blood flow velocities of the ACA, MCA and PCA in both groups increased, and were significantly higher in the observation group than in the control group (P<0.05). The MESSS score in both groups decreased, and the score in the observation group was significantly lower than that in the control group (P<0.05). Conclusion: Acupuncture combined with Brunnstrom staging is effective for patients after stroke. It can effectively improve the upper-limb motor function and cerebral artery blood flow velocity, promote brain function remodeling, and restore nerve function.

Effect of umbilical vein catheterization on portal vein blood flow and its relationship with gastrointestinal complications in neonates / 中华围产医学杂志

Objective:To explore the effect of umbilical vein catheterization (UVC) on portal vein blood flow velocity (PBFVe) and its relationship with gastrointestinal (GI) complications in neonates.Methods:A prospective study was conducted on neonates with indications for UVC and achieving one-time successful catheterization at Gansu Provincial Women and Child-care Hospital from March 2019 to March 2021. Successful UVC was defined as the umbilical catheter reaching the entrance of the inferior vena cava and right atrium through the ductus venosus. PBFVe was measured by bedside ultrasound before and after UVC. All subjects were divided into two groups as those with GI complications anytime from insertion to withdrawal (complication group), and those with no GI complications (no complication group) to compare the PBFVe value before UVC and the percentage of decrease in PBFVe after UVC. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curve were used to analyze the risk factors of GI complications and the predictive value of the percentage of decrease in PBFVe after UVC.Results:Of 91 subjects included, 59.3% (54/91) had no GI complications, and 40.7% (37/91) had. After UVC, PBFVe was decreased than before in neonates both with and without GI complications [(11.3±1.8) vs (14.7±2.4) cm/s; (12.4±1.7) vs (14.2±1.8) cm/s, t=－16.92 and－17.62, respectively, both P<0.05]. PBFVe before UVC were similar between the two groups. However, the complications group had a lower PBFVe after UVC ( t=－2.98, P=0.004) and a higher percentage of decrease in PBFVe [(22.5±6.0)% vs (12.6±4.9)%, t=8.65, P<0.001] when compared with the no complications group. Multivariate logistic regression analysis showed that the body weight was the protector of GI complications ( OR=0.294, 95% CI:0.089-0.974, P=0.045), and the percentage of decrease in PBFVe was the risk factor ( OR=1.478, 95% CI:1.249-1.749, P<0.001). The area under the curve of the percentage of decrease in PBFVe for predicting GI complications was 0.919 (95% CI:0.843-0.966, P<0.001). The cut-off value was 16.9% with a sensitivity of 89.2% and a specificity of 85.2%. Conclusions:UVC can reduce the PBFVe of neonates. The more the PBFVe decreases, the greater the possibility of GI complications.

Signal Conversion and Isolation Processing Technology Used in the Cerebrovascular Stroke Detector / 中国医疗器械杂志

By using Doppler sensor and pressure sensor, the cerebrovascular stroke detector can be used to measure the blood flow velocity and blood pressure of the carotid artery. In this study, a variety of signal conversion and isolation processing techniques are proposed for processing and feature extraction of the output signals from the sensors. Finally, effective signal output waveforms that can be used to evaluate the cerebrovascular hemodynamics index (CVHI) are obtained, and the sound signal outputs that can reflect the change characteristics of blood flow velocity and blood pressure signals are generated, which realizes the application functional requirements of the detector.

Microsurgical arterial anastomosis in young and adult rats: an evolutive and comparative study

Purpose: To evaluate the caliber of an arterial micro-anastomosis in the young growing animal using a continuous suture technique. Additionally, late morphological changes and blood flows distal to the anastomosis were evaluated. Methods: Seventy-four Wistar rats were submitted to laparotomy to access the aorta for blood flow measurement. The aorta was sectioned using microsurgery technique and an end-to-end anastomosis with continuous suture. After a period of six months to one year, the anastomosis was checked. Results: Regarding the size of the aortas, comparing the pre- and postoperative values, there was an increase of 13.33% in adult animals and 25% in young animals, without any difference in the blood flows. Conclusions: The arteries of young rats show signs of growth at the site of the anastomosis performed with continuous suture.

The analysis of venous blood flow velocity increase during ankle exercise / 体力科学

Ankle exercises are useful for preventing deep vein thrombosis, as they increase venous blood flow velocity. The cause for the increased venous blood flow velocity during ankle exercises may be the skeletal-muscle pump, but the mechanism is not clearly understood. The purpose of this study was to investigate the effects of the dorsiflexion angle and gastrocnemius muscle contraction on venous blood flow velocity during ankle exercises and to investigate the mechanism of the increase in venous blood flow velocity. The blood flow velocity in the popliteal vein, ankle joint angle, and surface electromyographic activity of the gastrocnemius muscle were measured at rest and during ankle exercises in the prone position in young healthy volunteers. The significant increase in venous blood flow velocity was observed during dorsiflexion phase, max dorsiflexion and during planter flexion phase. The peak venous blood flow velocity was different in each subject and classified into four types. The correlations of venous blood velocity to ankle joint angle and with the surface electromyographic activity of the gastrocnemius muscle were not statistically significant. These findings suggest that venous blood flow velocity increases not only during plantar flexion and dorsiflexion.

Clinical value of color Doppler ultrasonography in evaluating the degree of atherosclerotic renal artery stenosis in the elderly by ROC curve analysis / 中国基层医药

Objective To evaluate the clinical value of color Doppler ultrasonography (CDFI) in evaluating the degree of atherosclerotic renal artery stenosis (ARAS) in the elderly by using ROC curve analysis.Methods From March 2015 to September 2018,117 patients with ARAS admitted to Anji Branch of the First Affiliated Hospital of Medical College of Zhejiang University were selected.All patients underwent color Doppler ultrasonography and renal artery angiography.Renal artery angiography was used as the gold standard.The diagnostic value of color Doppler ultrasonography for ARAS was analyzed.The changes of color Doppler ultrasonography indicators of renal artery in different degrees of stenosis were compared.The ROC curve was used to analyze the value of color Doppler ultrasound in evaluating the degree of atherosclerotic renal artery stenosis in the elderly.Results Using renal arteriography as the gold standard,the sensitivity of color ultrasonography for ARAS was 82.17％ (129/157),and the specificity of diagnosis was 80.52％ (62/77).The PSV [(227.59 ± 34.28) cm/s] and EDV [(57.39 ± 6.48) cm/s] in the severe stenosis group were higher than those in the moderate stenosis group [(183.84 ±41.05) cm/s and(50.29 ± 5.22) cm/s] (t =6.269,6.506,all P ＜ 0.05) and the mild stenosis group [(128.47 ± 52.35) cm/s and(37.52 ± 7.15) cm/s] (t =10.517,12.813,all P ＜ 0.05) and the non-stenosis group [(86.49 ± 28.94) cm/s and (26.48 ± 5.02) cm/s] (t =18.598,21.971,all P ＜ 0.05).The RI in the severe stenosis group [(0.41 ±0.07)] was lower than that in the moderate stenosis group [(0.47 ± 0.06)] (t =4.966,P ＜ 0.05) and the mild stenosis group [(0.52 ±0.07)] (t =8.496,P ＜0.05) and the no stenosis group [(0.70 ±0.11)] (t =17.101,P ＜ 0.05).The ROC curve was used to analyze the diagnostic value of color ultrasound parameters for moderate and severe stenosis.The area under the diagnostic curve of PSV,EDV and RI for moderate and severe stenosis was 0.869,0.932 and 0.937,respectively.Conclusion CDFI plays an important role in the early diagnosis and clinical screening of elderly patients with ARAS.It is helpful to judge the degree of renal artery stenosis and evaluate the condition of the patients.It is non-invasive,simple and inexpensive,and worthy of clinical application.

Assessment of left atrial function using tissue motion annual displacement of mitral valve in patients with coronary slow flow / 中国医学影像技术

Objective: To explore the value of tissue motion annual displacement of the mitral valve (TMAD) for assessment of left atrial function in patients with coronary slow flow (CSF). Methods: Routine echocardiography was performed in 44 CSF patients (CSF group) and 42 patients without CSF (control group),and Left atrial ejection fraction (LAEF), left atrial passive ejection fraction (LAPEF) and active ejection fraction (LAAEF) were calculated with Simpson method. Then left atrial filling period displacement (TMAD_D), passive emptying period displacement (TMAD_P) and active emptying period displacement (TAMD_S) were assessed using TMAD. Results: Compared with control group, LAEF and LAAEF decreased, so did TMAD_D and TAMD_S in CSF group (all P<0.01). TMAD_D and TAMD_S were negatively correlated with mean thrombolysis in myocardial infarction frame count (TFC) of coronary artery in CSF group(r=-0.31, -0.36, both P<0.01). Conclusion: In CSF patients, left atrial reservoir and pump function were damaged, which become worse with the decreasing velocity of coronary flow. TMAD is reliable and feasible for evaluating left atrial function in patients with CSF, therefore providing important evidences for clinical treatment and prognosis.

Effects of sand therapy on hemodynamics in the femoral artery bifurcation at different degrees of stenosis / 中国组织工程研究

BACKGROUND: Sand therapy has been shown to exhibit a positive effect on reducing femoral atherosclerosis and inhibiting thrombosis. OBJECTIVE: To investigate the effects of sand therapy on hemodynamic parameters of different stenosis models of femoral bifurcation through comparing the hemodynamic parameters and wall shear stress in four stenosis models before and after sand therapy. METHODS: The study protocol was performed in strict accordance with the relevant ethical requirements of School of Mechanical Engineering of Xinjiang University. Each participant provided written informed consent. Medical software Mimics10.01, reverse engineering software Geomagic Studio 2012 and three-dimensional CAD software UG8.5 were used to separate and optimize the CT data of a subject’s lower extremities and the geometric model of the femoral artery bifurcation was obtained. According to the classification criteria of vascular stenosis caused by femoral atherosclerotic plaque in the lower extremity, the degree of plaque stenosis on the side wall of the femoral bifurcation tube was set as 0% (normal), 15% (normal), 30% (mild) and 50% (moderate). Computational fluid dynamics method was used for numerical simulation. The Laminar flow model was selected for blood flow before sand therapy, and the standard turbulence model κ-ε was selected for blood flow after sand therapy. Blood flow velocity and wall shear stress were analyzed before and after sand therapy. RESULTS AND CONCLUSION: The maximum blood flow velocity after sand therapy was 0.35-0.45 m/s higher than that before sand therapy. After sand therapy, the wall shear stress at the stenosis was increased by 5-11 Pa compared with that before sand therapy, and the wall shear stress at 50% vascular stenosis rate model reached 41 Pa. These results suggest that the trend of atherosclerotic plaque enlargement is decreased after sand therapy, but patients with 50% (moderate) vascular stenosis have the risk of plaque rupture.

Analysis of the clinical value of B ultrasound combined with real-time color doppler ultrasound in percutaneous nephrolithotomy / 中国基层医药

Objective@#To explore the application value of B-mode ultrasound combined with real-time color doppler ultrasound in percutaneous nephrolithotomy and provide guidance for clinical application.@*Methods@#A total of 150 patients underwent percutaneous nephrolithotomy from December 2015 to December 2017 in the People's Hospital of Lishui were selected.According to different ultrasound guidance methods, the patients were divided into two groups.The single group(70 cases) received B-guided puncture.In the combined group(80 cases), B-ultrasound combined with real-time color doppler ultrasound-guided puncture was applied.The incidence of complications and the success rate of lithotomy were compared between the two groups.The changes in renal artery blood flow parameters[end diastolic velocity(EDV), peak systolic velocity(PSV) and resistance index(RI)] before and after surgery in the combined group were observed.@*Results@#The incidence of complications in the combined group was 2.50%(2/80), which was lower than that in the single group[14.29%(10/70)](χ2=7.046, P<0.05). The success rate of stone extraction in the combined group was 98.75%(79/80), which was higher than that in the single group[85.71%(60/70)](χ2=9.336, P<0.01). The EDV and PSV of the renal interlobar arteries of the combined group before and after surgery had statistically significant differences (t=3.794, 5.385, all P<0.05), but the RI had no statistically significant difference (P>0.05). The EDV and PSV of renal segment arteries in the combined group before and after surgery had statistically significant differences (t=4.535, 4.884, all P<0.05), while the RI had no statistically significant difference (P>0.05). The EDV and PSV of renal aorta of the combined group before and after surgery showed no statistically significant differences (all P>0.05), while the RI showed statistically significant difference (t=4.360, P<0.05).@*Conclusion@#B-mode ultrasound combined with real-time color doppler ultrasound guidance for percutaneous nephrolithotomy can help reduce the incidence of complications and improve the success rate of stone extraction to a certain extent.

Application of the superior thyroid artery peak systolic velocity in differentiating Graves′ disease from autoimmune thyroiditis / 中华内科杂志

Objective@#To evaluate the clinical value of the superior thyroid artery peak systolic velocity (STA-PSV) for the differential diagnosis of autoimmune thyrotoxicosis.@*Methods@#A total of 301 patients with newly diagnosed thyrotoxicosis and without any anti-thyroid drug intervention were collected from the Department of Endocrinology and Metabolism, Peking University People′s Hospital from Jan. 2015 to Oct. 2018. Among them, 241 patients were with Graves′ disease (GD) and 60 patients were with autoimmune thyroiditis (AIT). STA-PSV, thyroid function and thyrotropin receptor antibody (TRAb) were determined. A multiple linear regression was used to identify factors associated with STA-PSV. A receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the discriminating ability of STA-PSV to GD.@*Results@#STA-PSV leves in GD group were significantly higher than those in AIT group [61.00 (41.00, 86.50) cm/s vs. 34.50 (25.25, 46.00) cm/s, P<0.001]. The ROC curve analysis showed that the AUC was 0.790 (95%CI 0.734-0.845), and 49.5cm/s was the optimal cutoff point for the diagnosis of GD, in which the sensitivity was 64.3% and the specificity was 83.3%. In all patients with thyrotoxicosis, multiple linear regression analyses showed free thyroxine (FT4) (β=0.371, 95%CI 0.005-0.010, P<0.001) and TRAb (β=0.138, 95%CI 0.001-0.014, P=0.035) were positively associated with STA-PSV.@*Conclusions@#The STA-PSV is positively associated with FT4 and TRAb levels, and it is a helpful marker in differential diagnosis between GD and AIT.

Valor pronóstico del strain longitudinal, medido por velocity vector imaging, en la estenosis aórtica grave asintomática con fracción de eyección conservada / Prognostic Value of Longitudinal Strain Measured by Velocity Vector Imaging, in Asymptomatic Severe Aortic Stenosis with Preserved Ejection

RESUMEN Introducción: Se han descripto alteraciones en el strain longitudinal sistólico (SLS) en pacientes con fracción de eyección (FE) conservada. El valor pronóstico del SLS en la estenosis aórtica (EAo) grave asintomática está en discusión. Objetivos: Evaluar si la medición de SLS mediante velocity vector imaging (VVI) predice la progresión y la indicación de reemplazo valvular aórtico (RVA) en pacientes asintomáticos con EAo grave y FE conservada, inicialmente asintomáticos. Materiales y métodos: Se seleccionaron pacientes con EAo grave y FE conservada que fueron considerados asintomáticos sin indicación inicial de RVA. A todos los pacientes se les realizó un ecocardiograma que evaluó el SLS de cada segmento en dos y tres y cuatro cámaras y el SLS global por el método VVI. Además, se realizó la medición del NT-proBNP. Se consideró como punto final el requerimiento de RVA. Resultados: Se evaluaron 57 pacientes con una edad de 69 ± 8 años, 49% mujeres. Luego de dos años de seguimiento 13 pacientes (22,8%) requirieron RVA. El grupo que requirió RVA presentó menor SLS global (-15,5 ± 3,4 versus -18,9 ± 3,1, p = 0,03) y SLS en dos cámaras (-12,8 ± 5,5 versus -16,3 ± 5,6, p = 0,04). En el análisis univariado, el SLS global, en NT-proBNP y la relación E/e´ fueron predictores del punto final, mientras que, en el multivariado, solo el SLS global se comportó como predictor independiente de requerimiento de RVA (HR: 1,28 (IC 95% 1,04-1,58), p = 0,01). Conclusiones: El SLS global medido por VVI fue predictor independiente de requerimiento de RVA.

ABSTRACT Background: Longitudinal systolic strain (LSS) abnormalitiess have been described in patients with preserved ejection fraction (EF). The prognostic value of LSS in asymptomatic severe aortic stenosis (AoS) is under discussion. Objetive: The aim of this study was to assess whether LSS assessment using velocity vector imaging (VVI) predicts the progression and indication of aortic valve replacement (AVR) in asymptomatic patients with severe AoS and preserved EF. Methods: The study included patients with severe AoS and preserved EF who were considered asymptomatic and without initial indication for AVR. They underwent two, three and four-chamber echocardiography that evaluated LSS of each segment and global longitudinal strain (GLS) by VVI, as well as NT-proBNP assessment. The primary endpoint was need for AVR. Results: A total of 57 patients with mean age 69±8 years, 49% women, were included in the study. After two years of follow-up, 13 patients (22.8%) required AVR. This group had lower GLS (-15.5±3.4 vs.-18.9±3.1, p=0.03) and two-chamber LSS (-12.8±5.5 vs.-16.3±5.6, p=0.04). In univariate analysis, GLS, NT-proBNP and the E/e' ratio were predictors of the endpoint, while in the multivariate analysis, only GLS was an independent predictor of need for AVR (HR: 1.28 (95% CI 1.04-1.58), p=0.01). Conclusions: Global longitudinal strain measured by VVI was an independent predictor of need for AVR.

Accuracy of ultrasound-determined end-diastolic velocity of central retinal artery in diagnosing postoperative low cerebral perfusion pressure in patients with craniocerebral trauma / 中华麻醉学杂志

Objective@#To evaluate the accuracy of ultrasound-determined end-diastolic velocity (EDV) of central retinal artery (CRA) in diagnosing postoperative low cerebral perfusion pressure (CPP) in the patients with craniocerebral trauma.@*Methods@#Forty-nine patients of both sexes with brain injury, aged 18-64 yr, with body mass index of 18.5-23.9 kg/m2, were enrolled.The peak systolic velocity and EDV of CRA were determined using ultrasound at 1 day after operation.Mean arterial pressure and intracranial pressure were recorded, and CPP was calculated (CPP=mean arterial pressure-intracranial pressure).@*Results@#EDV was positively correlated with CPP (r=0.746, P<0.01), and peak systolic velocity was not correlated with CPP (P>0.05). The area under the receiver operating characteristic curve for EDV in diagnosing low CPP was 0.938 (95% confidence interval 0.871-1.000), and the critical value was 3.205 (sensitivity 94.4%, specificity 76.9%).@*Conclusion@#Ultrasound-determined EDV of central retinal artery can accurately diagnose postoperative low CPP in the patients with craniocerebral trauma.

Accuracy of ultrasound-determined end-diastolic velocity of central retinal artery in diagnosing postoperative low cerebral perfusion pressure in patients with craniocerebral trauma / 中华麻醉学杂志

Objective To evaluate the accuracy of ultrasound-determined end-diastolic velocity (EDV) of central retinal artery (CRA) in diagnosing postoperative low cerebral perfusion pressure (CPP)in the patients with craniocerebral trauma.Methods Forty-nine patients of both sexes with brain injury,aged 18-64 yr,with body mass index of 18.5-23.9 kg/m2,were enrolled.The peak systolic velocity and EDV of CRA were determined using ultrasound at 1 day after operation.Mean arterial pressure and intracranial pressure were recorded,and CPP was calculated (CPP =mean arterial pressure-intracranial pressure).Results EDV was positively correlated with CPP (r =0.746,P＜0.01),and peak systolic velocity was not correlated with CPP (P＞0.05).The area under the receiver operating characteristic curve for EDV in diagnosing low CPP was 0.938 (95％ confidence interval 0.871-1.000),and the critical value was 3.205 (sensitivity 94.4％,specificity 76.9％).Conclusion Ultrasound-determined EDV of central retinal artery can accurately diagnose postoperative low CPP in the patients with craniocerebral trauma.

Effect of butylphthalide combined with edaravone on cerebral hemodynamics, vascular endothelial function and cytokines in elderly patients with acute cerebral infarction / 中国基层医药

Objective@#To investigate the effects of butylphthalide combined with edaravone on cerebral hemodynamics, vascular endothelial function and cytokines in elderly patients with acute cerebral infarction.@*Methods@#From May 2017 to May 2018, 82 elderly patients with acute cerebral infarction admitted to the First People's Hospital of Wenling were selected and randomly divided into two groups according to the digital table, with 41 cases in each group.The patients in the control group were treated with edaravone, while the patients in the treatment group were treated with butylphthalide on the basis of the control group.The two groups were treated for 2 weeks.The neurological deficit scale (NIHSS), cerebral hemodynamics, vascular endothelial function and cytokines were compared between the two groups before and after treatment.@*Results@#The NIHSS score of the treatment group was (18.49±1.87)points, which was lower than (22.17±1.32)points of the control group at 2 weeks after treatment (t=10.294, P<0.05). The mean flow velocity [(31.70±3.25)cm/s], vascular resistance index (0.79±0.12) and maximum peak flow velocity [(54.21±2.65)cm/s] in the treatment group were higher than those in the control group [(26.91±4.39)cm/s, (0.61±0.05) and (43.76±3.10)cm/s] (t=5.615, 8.866, 16.407, all P<0.05). The contents of NO [(71.27±6.58)μmol/L] and eNOS [(66.37±3.65)U/mL] in the treatment group were higher than those in the control group [(62.30±2.71)μmol/L and (57.89±4.08)U/mL] (t=8.071, 9.919, all P<0.05). After 2 weeks of treatment, the contents of IL-6 [(27.36±2.71)pg/mL], CRP [(2.87±0.76)mg/L] and TNF- α[(98.24±10.48)ng/mL] in the treatment group were lower than those in the control group [(43.25±4.10)pg/mL, (4.59±0.91)mg/L and (160.27±15.42)ng/mL] (t=20.702, 9.289, 21.303, all P<0.05). The total effective rate of treatment group (90.24%) was higher than that of control group (68.29%) (χ2=6.011, P<0.05).@*Conclusion@#Butylphthalide combined with edaravone can improve cerebral hemodynamics, vascular endothelial function and alleviate cellular inflammatory reaction in elderly patients with acute cerebral infarction, and the curative effect is significant, which is worthy of clinical study.

Assessment of cerebrovascular reactivity in obstructive sleep apnea hypopnea syndrome with transcranial Doppler ultrasonography / 中华老年心脑血管病杂志

Objective To investigate the value of transcranial Doppler ultrasonography(TCD)for assessing the cerebrovascular reactivity (CVR)in obstructive sleep apneahypopnea syndrome (OSAHS)patients.Methods Sixty OSAHS outpatients and inpatients admitted to our neurology department from August 2015to December 2016served as an OSAHS group,then further divided into mild group(n=15),moderate group(n=27)and severe group(n=18)according to apneahypopnea index(AHI).Meanwhile,20healthy individuals served as a control group.They underwent TCD on admission to detect their CVR,including the average velocity of cerebral artery blood flow(Vm)during calm breathing and after breath holding.The breath holding index(BHI) was calculed.The relationship between BHI and CVR was analized by pearson linear correlation analysis. Results There was no statistically significant difference in Vm during calm breathing between the OSAHS and control groups(73.64±9.87cm/s vs 72.79±8.68cm/s,P＞0.05).Both of Vm after breath holding and BHI of the OSAHS group were lower than those of the control group(88.63±6.65cm/s vs 93.26±7.12cm/s,0.71±0.16 vs 0.93±0.37,P＜0.01).Both of Vm after breath holding and BHI of the mild group were the highest,while the severe group had the lowest values and the moderate group was in between(P＜0.05).No significant correlation was found between AHI and Vm during calm breathing(r=0.197,P=0.052),while AHI was negatively correlated with Vm after breath holding and BHI(r=-0.557,P =0.011;r=-0.605,P=0.000).Conclusion TCD can detect CVR changes in OSAHS patients,whose Vm after breath holding and BHI decrease significantly.The more severe the OSAHS is,the lower the CVR is.