The evaluation by pulmonary wedge angiography of children with pulmonary artery hypertension ;associated with congenital heart disease / 中国介入心脏病学杂志

Objective To study pulmonary wedge angiography ( PWA ) with hemodynamic the evaluation of children with congenital heart disease and pulmonary artery hypertension ( PAH) . Methods Hemodynamic measurement and pulmonary wedge angiography were performed in 50 children with congenital heart disease. Comparison and analysis were made from the data obtained from PWA and catheterization. Results After PWA, the patients were categorized into 3 groups according to the measured hemodynamics parameters:group A [ n=15, patients with normal mean pulmonary artery pressure ( mPAP≤25 mmHg) and normal pulmonary vessel resistance (PVR﹤300 dyne?s?cm5)], group B [n=24, patients with PAH (mPAP﹥25 mmHg) but normal PVR] and group C (n=11, patients with PAH and elevated PVR (PVR≥300 dyne?s?cm5). Rote of tapering (ROT) was significant lower in group C than in group A and B (F=42. 559,P﹤0. 05). Pulmonary circulation time (PCT) was higher in group C than in group A and B (F=6. 037,P﹤0. 05). ROT correlated negatively with PVR (r = -0. 606, P ﹤0. 05). PCT index correlated positively with PVR (r=0. 783,P=0. 01). There was no significant correlation between PCT and mean pulmonary artery hypertension (mPAP). Conclusions PWA may help to make quantitative analysis of the pulmonary vascular status in patients with congenital heart disease.

Approximate entropy of oxygen saturation and saturation impairment time index for the assessment of hypoxemia severity in obstructive sleep apnea hypopnea syndrome / 中华内科杂志

Objective To explore the clinical significance of two new indexes including approximate entropy of oxygen saturation (SpO2ApEn) and saturation impairment time index (SITi) in assessing the severity of hypoxemia in obstructive sleep apnea hypopnea syndrome (OSAHS) patients.In addition,to investigate the correlation betewwn new indexes and other parameters.Methods The six hour polysomnography (PSG) of 500 patients with OSAHS and snorers in our hospital was retrospectively analyzed.According to the level of apnea hypopnea index (AHI),subjects were divided into four subgroups,namely 113 healthy controls,121 mild OSAHS,118 moderate OSAHS,and 148 severe OSAHA patients.SpO2 ApEn and SITi values among the four groups were compared.the correlations between SpO2 ApEn,SITi and other parameters were analyzed,including AHI,oxygen desaturation index (ODI),the lowest oxygen saturation(LSpO2) and the duration of oxygen saturation lower than 90％ (T ＜ 90％).Next,taking AHI as the gold standard,the significance of SpO2ApEn and SITi in assessing the severity of hypoxemia in OSAHS patients was explored by ROC curve analysis.Results SpO2ApEn and SITi between two each groups were significantly different (P ＜ 0.001) and increased synchronously with AHI.Spearman correlation analysis showed that SpO2ApEn and SITi had a good correlation with AHI (correlation coefficient r =0.765,r =0.678,P ＜ 0.O1).SpO2ApEn and SITi also had a good correlation with ODI,LSpO2and T ＜ 90％.According to the ROC analysis,the Boundary values of SpO2ApEn for mild,moderate and severe OSAHS patients were 16.70,17.81,and 20.03,respectively,and the corresponding SITi values were 3.685,4.055,and 4.445.Conclusion In this study,SpO2ApEn and SITi increased synchronously with AHI,SpO2ApEn and SITi had good correlations with AHI,ODI,LSpO2and T ＜90％.SpO2ApEn and SITi have important clinical significance for assessment of hypoxia severity in OSAHS patients.

Variación del índice tiempo de aceleración/tiempo de eyección sistólico (TA/TE) del tronco de arteria pulmonar por efecto de los corticoides en fetos prematuros

Introducción: No se cuenta con estudios de las modificaciones de la onda de velocidad de flujo del tronco de la arteria pulmonar por el uso de corticoides. Objetivos: Evaluar el efecto del uso de corticoides prenatales sobre la medida del índice Doppler tiempo de aceleración/tiempo de eyección sistólico (TA/TE) en el flujo del tronco de la arteria pulmonar fetal en el embarazo pretérmino, y correlacionar una posible variación en el índice TA/TE con la inducción de madurez pulmonar fetal. Diseño: Estudio descriptivo, prospectivo y longitudinal. Institución: Hospital Regional Honorio Delgado, Arequipa, Perú. Participantes: Fetos pretérmino. Intervenciones: Evaluación ultrasonográfica obstétrica con biometría fetal y medición del flujo sanguíneo en el tronco de la arteria pulmonar fetal, usando el Doppler pulsado, antes y después de la administración de corticoides para maduración pulmonar fetal. Se muestra los resultados mediante estadística descriptiva y se los compara mediante pruebas pareadas y con pruebas de correlación. Principales medidas de resultados: Variación del índice TA/TE del tronco de la arteria pulmonar por el uso de corticoides. Resultados: Se evaluó 35 gestantes con edad promedio 27,2 años, edad gestacional promedio 33,1 semanas. El índice TA/TE luego de la administración de corticoides se elevó de 0,26 a 0,29 (p < 0,05). El incremento del índice TA/TE en relación a la basal inferior al 20% se encontró en la necesidad de intubación del neonato, de realización de masaje cardiaco, administración de medicamentos, presentación de neumonía congénita, necesidad de admisión en UCI y ventilación mecánica, así como con mortalidad de los neonatos. Conclusiones: La medición del índice TA/TE en el flujo del tronco de la arteria pulmonar fetal en el embarazo pretérmino aumenta significativamente con la administración de corticoides prenatales, y su elevación por encima de 20% en relación a la medición basal disminuye la presencia de complicaciones importantes en el recién nacido pretérmino.

Introduction: No studies were encountered determining changes of the pulmonary artery trunk flow velocity waveform with the use of corticosteroids. Objectives: To determine the effect of antenatal corticosteroids on the pulmonary artery trunk acceleration time/systolic ejection time index (AT/ET index) in preterm fetal pregnancies and to correlate a possible variation in the AT/ET ratio with the induction of lung maturity. Design: Descriptive, prospective, longitudinal study. Setting: Hospital Regional Honorio Delgado, Arequipa, Peru. Participants: Preterm fetuses. Interventions: Fetuses had ultrasound evaluation with biometry and measurement of the pulmonary artery trunk blood flow by using pulsed Doppler, before and after administration of corticosteroids for fetal lung maturity. Results used descriptive statistics and were compared by paired tests and correlation tests. Main outcome measures: Variation of the fetal pulmonary artery trunk AT/ET index by use of corticosteroids. Results: We studied 35 pregnant women with mean age 27.2 years, mean gestational age 33.1 weeks. Mortality of preterm infants was 11.4% of all births. AT/ET index following corticosteroids administration rose from 0.26 to 0.29 (p <0.05). AT/ET index increase in relation to baseline below 20% was associated with need for neonatal intubation, cardiac massage, drugs use, congenital pneumonia, need of ICU admission, mechanical ventilation, and mortality. Conclusions: Preterm pulmonary artery trunk flow AT/ET ratio increased significantly with the administration of antenatal steroids, and its elevation above 20% from baseline diminished the presence of important complications in the preterm newborn.

A predictive method of small intestinal lesion location with wireless capsule endoscopy / 中华消化内镜杂志

Objective To investigate the method of locating intestinal lesions by scatter diagram which simulating the movement of capsule endoscopy in small intestine and its significance. Methods A total of 30 consecutive patients with lesions in small intestine which was diagnosed by wireless capsule endoscopy (WCE) and confirmed by following surgery were enrolled in the study as group A. The time index was defined as the ratio of the transition time from the duodenojejunal flexure to the lesion to that to the ileocaecal valve. For each case in group A, the time index was marked on a horizontal axis with the distance between duodenojejunal flexure and the lesion on a vertical axis. The best curve was obtained to simulate the intestinal movement, and 30 other patients selected by the same criteria were used as group B to testify the accuracy of the curve. Results Parabola and quadratic equation were obtained from group A to simulate the intestinal peristalsis. Calculation of errors in group B showed a minimal error of 0. 79 cm, a maximal error of 41.49 cm and a mean error of ( 19. 64± 13. 98 ) cm. Patients with errors less than 20 cm accounted for 50%(15/30), those with errors less than 30 cm were 67% (20/30), and those with errors less than 50 cm amounted to 100% (30/30). Conclusion Locating the lesion in small intestine by transition time of WCE is of high accuracy and is able to facilitating the diagnosis yield of WCE.

Study on noninvasive assessment of respiratory effort in patients undergoing weaning from mechanical ventilation by mean inspiratory pressure / 中华急诊医学杂志

Objective To investigate the feasibility and efficiency of monitoring noninvasive respiratory effort and respiratory load-capacity ratio in patients undergoing weaning from mechanical ventilation by mean inspiratory pressure(Pi) which were calculated on the basis of the formula, Pi = 5 × P 0.1 × Ti, as well as the noninvasire tension index calculated from Pi(TTIi). Method Totally 12 patients undergoing weaning from mechanical ventilation were enrolled in the study and their underlying diseases included COPD( n = 9), ARDS( n = 2) and status asthmaticus(n = 1) respectively. Esophageal pressure(PesoM) was monitored via the insertion of esophageal balloon and corrected esophageal pressure(Peso) was acquired by subtracting elastic pressure of chest wall from PesoM. P 0.1, Maximal inspiratory pressure on esophageal pressure curve(MIPeso) and on airway pressure curve(MIPaw) was measured with conventional technique. Pi was calculated on Pi = 5 × P 0.1 × Ti. Pi and MIPaw were used to calculate the noninvasive tension-time index TTIi, whereas Peso and MIPeso were used to calculate the invasive counterpart TTIeso. Comparisons, Correlation and Bland-Altman agreement analysis were made between P0.1 and Peso as well as between TIIi and TTIeso. Results There were no significant differences between Pi and Peso as well as between TTIi and TTIeso(P > 0.05) ,and the correlation coefficients were 0.974 and 0.957 respectively. In the agreement analysis, the mean difference between Pi and Peso, and between TTIi and TTIeso were lower than the minimal values of(Peso + PiSB )/2 and of(TIIi + TTIeso)/2, respectively. Conclusions There is a good correlation between Pi and Peso as well as between TTIi and TTIeso, in which Pi is calculated calculated from P 0.1 and in turn the TTIi is calculated from Pi. The noninvasive indices including Pi and TTIi can be used to monitor respiratory effort and respiratory load-capacity in patients undergoing weaning from mechanical ventilation.

The Role of Doppler Time Index for Evaluation of Left Ventricular Diastolic Function by Patterns of Left Ventricular Hypertrophy in Hypertensive Patients

OBJECTIVE: Recent studies have shown that easily recordable, non-invasive Doppler time index correlates with left ventricular systolic and diastolic function. The aim of present study was to evaluate the significance of Doppler time index by patterns of left ventricular hypertrophy in hypertensives patients. SUBJECTS AND METHOD: This echocardiographic and Doppler study investigated the relationship between left ventricular geometric shape (normal, concentric remodelling, concentric hypertrophy and eccentric hypertrophy) and diastolic function in a 87 patients with essential hypertension and 55 normal subjects. Doppler time index was defined as the summation of isovolumetric contraction (ICT) and relaxation time (IRT) divided by ejection time (ET). RESULTS: Among left ventricular geometric patterns in hypertensive patients, high prevalence of eccentric hypertrophy (32%). Except IVRT in concentric hypertrophic group, no difference were found in Doppler determination of diastolic function between the geometric groups. The Doppler time index significantly correlated with IVRT and deceleration time (DT) of E wave. However, Doppler time index had 71% sensitivity and 89% specificity in assessment of diastolic dysfunction. CONCLUSION: The Doppler time index was significantly correlate with Doppler index of mitral flow. But, this index can be a lesser sensitive indicator of pure diastolic dysfunction.

Evaluation of Left Ventricular Diastolic Function Using New Doppler Time Index

BACKGROUND: There is a clinical need for a simpler measurement of global cardiac function incorporating elements of both systole and diastole. Doppler time index is theoretically regarded as a sensitive index of global left ventricular perfomance and defined as the sum of isovolumetric contraction time (IVCT) and isovolumetric relaxation time (IVRT) divided by ejection time (ET). This study was designed to determine the clinical usefulness of the Doppler time index in patients with left ventricular diastolic dysfunction as well as systolic dysfunction. METHODS: The study population consisted of 23 patients with hypertension as a diastolic dysfunction group, 16 patients with low ejection fraction as a systolic dysfunction group and 31 subjects with normal LV function. The ejection fraction (EF) was measured using M-mode echocardiography. Doppler profiles such as IVCT, IVRT and ET were obtained from Doppler echocardiography. The Doppler time index [ (IVCT+RT)/ET] was calculated from each Doppler velocity profiles. RESULTS: IVRT, IVRT/ET and (IVCT+VRT)/ET were significantly increased in the diastolic dysfunction group (120.5+/-19.5 msec, 0.45+/-0.1, 0.64+/-0.2, respectively:p<0.001, p<0.001, p<0.001, respectively) compared with normal subjects (66.1+/-17.4 msec, 0.25+/-0.0, 0.41+/-0.1). IVCT and IVRT were significantly increased and ET was significantly shortened in systolic dysfunction group (75.4+/-25.7, 144.0+/-39.5 msec, 242.7+/-46.5 msec respectively:p<0.001, p<0.05, p<0.05, respectively) compared with diastolic dysfunction group (50.4+/-23.0 msec, 120.5+/-19.5 msec, 276.8+/-44.6 msec, respectively). IVCT/ET, IVRT/ET and (IVCT+IVRT)/ET also were increased in patients with systolic dysfunction group (0.32+/-0.1, 0.61+/-0.2, 0.93+/-0.2 respectively:p<0.01, p<0.01, p<0.001, res-pectively) compared with diastolic dysfunction group (0.19+/-0.1, 0.45+/-0.1, 0.64+/-0.2). Ejection fraction calculated by M-mode parameters was significantly correlated with (IVCT+IVRT)/ET (correlation coefficient - 0.605, p<0.001). CONCLUSION: The Doppler time index was significantly difficient from normal subjects in patients with isolated LV diastolic dysfunction as well as in those with systolic dysfunction. Thus, this index can be used as a sensitive indicator of myocardial performance.