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@#Objective To investigate the correlation between the anatomical structure of patent foramen ovale(PFO)observed by transesophageal echocardiography(TEE)and the right to left shunt(RLS)grade of contrast-enhanced transthoracic echocardiography(c-TTE).Methods Ninety cases in which the presence of PFO was suggested by TEE examination as a diagnostic criterion from November 2021 to December 2022 in the First Hospital of Nanchang were retrospectively analysed.According to the c-TTE results of patients,the RLS was divided into 4 levels,and the correlation between PFO structural characteristics and RLS grading was analyzed.Results There was a positive correlation between PFO diameter size and RLS grading in resting state(r=0.381,P<0.05);The PFO diameter of patients with hypermobile interatrial septum(HIS)was larger and the difference was statistically significant(P<0.05);The PFO diameter of patients with persistent RLS was larger than that of excited phase patients,and the difference was statistically significant(P<0.05);There was no significant difference in RLS shunt degree between patients with long tunnel and those without long tunnel;There was no significant difference in RLS grade and PFO diameter size under Valsalva state.Conclusion Research has shown that certain anatomical structures of PFO interact with RLS grading,and PFO anatomical structures can also interact with each other(the opening diameter of the foramen ovale with HIS is larger);At the same time,TEE can clearly show the morphological characteristics of PFO and predict the degree of RLS,so as to further evaluate the possibility of ischemic stroke in patients with PFO,and provide more evidence for the indications for foramen ovale closure.
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Objective:To review the imaging characteristics and evaluate the diagnostic value of echocardiography for fetal congenitally unguarded tricuspid valve orifice (CUTVO).Methods:Clinical data and ultrasonic images of two pregnant women diagnosed with fetal CUTVO through ultrasound and confirmed by pathology in Nanchang First Hospital between April 2019 and December 2021 were retrospectively analyzed. Relevant literature on confirmed CUTVO diagnosis cases with ultrasonic diagnosis results was searched in the Wanfang database, CNKI database, VIP database, Chinese Medical Journal database, PubMed, and Web of Science database. Descriptive statistical analysis was used to analyze the data.Results:The study involved 17 patients, 15 of whom were retrieved from the databases and two cases from our hospital. Among the 17 cases, 16 were singleton pregnancies, while one case involved a monochorionic monoamniotic twin pregnancy. The tricuspid valve was completely absent or hypoplastic in ten cases, and partial absence of the tricuspid leaflet was found in seven cases. Nine cases had pulmonary atresia with intact ventricular septum and two with ventricular septal defect, while complications were not described in the other six cases. Among the six misdiagnosed cases, four were prenatally misdiagnosed as fetal Ebstein malformation, two cases for Uhl's disease and suspected noncompaction of the ventricular myocardium. CUVTO were confirmed after pregnancy termination. Both cases of missed diagnosis were in the second trimester with no significant enlargement in the right heart, including one with twin transfusion syndrome and one with pulmonary valve stenosis. Nine cases terminated their pregnancies and seven of them had confirmed CUTVO by autopsy after an induced labor. Eight fetuses were delivered. Except for two deaths due to severe conditions, six neonates survived and underwent surgical treatment due to atrial septal defect and patent ductus arteriosus on postnatal echocardiography examination. Among them, two cases underwent tricuspid valve plasty and the tricuspid valve regurgitated moderately during follow-up within one year after surgery; two underwent tricuspid valve replacement with mechanical valves and postoperative less moderate regurgitation was also found; modified Fontan surgery was conducted in one case and the cardiac function turned normal; in one case, no surgical modality was described. Typical echocardiographic features of CUTVO were as follows: normal atrioventricular structure and the connection to arteries; total or partial absence of tricuspid leaflets and papillary muscles; the annulus of the tricuspid valve can be described as "empty" in the apical four-chamber view; Doppler evaluation shows to-and-fro flow across the tricuspid orifice with low velocity and a two-way spectrum.Conclusion:Typical echocardiography features of CUTVO were absence of tricuspid leaflets and moderate to massive regurgitation with a two-way spectrum. It is essential to make efforts to minimize missed and misdiagnoses through dynamic observation of multiple sections.
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Objective:To investigate the risk factors of non-valvular paroxysmal atrial fibrillation (NVPAF) with cerebral ischemic stroke(CIS) and analyze NVPAF by using left atrial automatic imaging (AFILA). Logistic regression model was established for left atrial(LA) function parameters.Methods:A total of 205 patients with NVPAF were included in the study and divided into the NVPAF group without ischemic stroke (154 patients) and the CIS group (51 patients). The clinical baseline data, blood biochemical results and AFILA ultrasound data of all patients were collected. Univariate analysis was performed to compare the above data between the two groups of patients. The independent risk factors were obtained by multivariate logistic regression analysis. Logistic regression model was compared with CHA2DS2-VASc scoring system in terms of area under ROC curve, sensitivity and specificity.Results:There were significant differences in age, CHA2DS2-VASc score, taking anticoagulant drugs, history of hypertension, diabetes and coronary heart disease, LAEF, S_R, S_CT, WBC, NEUT, HCY, UREA, NDD, NT-proBNP, Fibrinogen(Fib), Cardiac troponin I(cTnI) and NLR between the two groups (all P<0.05). The results of multifactor analysis showed that: age, hypertension, S_ CT, UREA, NLR, Fib and cTnI were independent risk factors associated with CIS in patients with paroxysmal atrial fibrillation[ OR value: 1.608 ( P=0.003), 3.821 ( P=0.019), 1.259 ( P=0.001), 1.326( P=0.001), 1.352 ( P=0.011), 1.502 ( P=0.042), 7.651( P=0.001)]. After adjusting for the age, sex and history of hypertension included in CHA2DS2-VASc score, S_CT significantly led to NVPAF complicated with stroke[ OR value 1.259 (1.095-1.447), P=0.001]. The diagnostic efficacy of Logistic regression model is better than that of CHA2DS2-VASc scoring (AUC of 0.931 vs 0.717, 95% CI: 0.896-0.967 vs 0.634-0.799, sensitivity of 0.883 vs 0.755, specificity of 0.849 vs 0.713, all P<0.001). Conclusions:Age, hypertension, S_CT, UREA, NLR, fibrinogen, cTnI are independently associated risk factors for patients with combined CIS; The diagnostic efficacy of Logistic regression model is better than that of CHA2DS2-VASc scoring model.And the sensitivity and specificity are high.
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To analyze the relationship between hospital non-price competition behavior and market structure, analyze the relationship between hospital market construction and health care costs gtowth. Methods:Using cross-province data(SCP) theory to establish the regression function of health cost expenditure, hospital market concentration ratio and the occupancy of public hospital market, process the empirical analysis based on the two-factor effectiveness model of panel data. Results: There is no medical arms race in hospital business under the current market concentration. Conclusion: The reinforcement of market competition played a more important role in the improvement of operational efficiency rather than the differences in the nature of property rights and the profit of hospitals.
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Objective:To investigate the function of the quality factor in the growth of the total heath expenditure, in order to provide references for making the object of the health policy. Methods: Through the decomposition the identical equation of the growth of the total expenditure on health, to analyze the contribution of medical service quality and its factor. Results: The sustaining improvement of medical service quality in the important factor on the constant growth of the total expenditure on health. Conclusion: The primary objective of health policy is to improve the quality of medical services, and the secondary is to control the expense.
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Objective To evaluate the diastolic function and relationship between diastolic function and early diastolic synchrony in patients with dilated cardiomyopathy (DCM) by real-time three-dimensional echocardiography (RT-3DE) volume-time curves (VTC) after cardiac resynchronization therapy (CRT).Methods Thirty-nine patients with DCM were enrolled by RT-3DE VTC before and 1 week,6 months,12 months after CRT,draw the left ventricular (LV) 16,12,6 segments LV diastolic early volume standard deviation of the time (Tedv-SD),and with the R-R interval normalized as early diastolic unsynchronized index (DDI) ;draw end-systolic volume (LVESV),LV end-diastolic volume (LVEDV),LV ejection fraction (LVEF) ;and calculate the diastolic peak filling rate(PFR),the ratio of early diastolic volume and enddiastolic volume(EDVearly/EDV).Results LVEDV,LVESV had no significant improvement.Compared with the before and 1 week after CRT,but the improvement was statistically significant after 6 months and 12 months (P ＜0.05,P ＜0.01); LVEF after 1 week,6 months and 12 months were statistically significant (P ＜0.05) ;Compared with before,PFR after 6 months was significantly increased (P ＜0.05),EDVearly/EDV at 12 months after CRT was significantly reduced (P ＜ 0.01); There was a significantly shortened in each segment (Tedv-SD)/R-R 1 week after CRT (P ＜0.01),but the parameters had no obvious improvement later.Correlation analysis:△ DDI and △ EDVearly/EDV reduction was significant positive correlation (r =0.52,P ＜0.01),△DDI and PFR has negative correlation (r =-0.40,P ＜ 0.05),△ EDVearly/EDV and △PFR also had a good relationship (r =-0.56,P ＜0.01).Conclusions The LV synchrony and diastolic function were improved after CRT in patients with DCM; PFR,EDVearly/EDV can be used as evaluation of left ventricular diastolic function effectively targets.
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Objective: To investigate the function of the heath expenditure in the role of the economic growth through the research on the effect by the human capital. Methods: To establish endogenous growth models and human capital growth models of simultaneous equations, to analyze the mechanism by the method of a three-stage least squares. Results: Growth of human capital is positively related to economic growth, health expenditure growth is negatively related to economic growth, health expenditure growth and growth of human capital is positively correlated. Conclusion: Influences of health expenditure growth on economic growth depends on the comprehensive response.
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Hedgehog was first described in Drosophila melanogaster by the Nobel laureates Eric Wieschaus and Christiane Nüsslein-Volhard. The hedgehog (Hh) pathway is a major regulator of cell differentiation, proliferation, tissue polarity, stem cell maintenance, and carcinogenesis. The first link of Hh signaling to cancer was established through studies of a rare familial disease, Gorlin syndrome, in 1996. Follow-up studies revealed activation of this pathway in basal cell carcinoma, medulloblastoma and, leukemia as well as in gastrointestinal, lung, ovarian, breast, and prostate cancer. Targeted inhibition of Hh signaling is now believed to be effective in the treatment and prevention of human cancer. The discovery and synthesis of specific inhibitors for this pathway are even more exciting. In this review, we summarize major advances in the understanding of Hh signaling pathway activation in human cancer, mouse models for studying Hh-mediated carcinogenesis, the roles of Hh signaling in tumor development and metastasis, antagonists for Hh signaling and their clinical implications.
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Animals , Humans , Antineoplastic Agents , Therapeutic Uses , Basal Cell Nevus Syndrome , Drug Therapy , Metabolism , Carcinoma, Basal Cell , Drug Therapy , Metabolism , Cell Differentiation , Cerebellar Neoplasms , Drug Therapy , Metabolism , Hedgehog Proteins , Metabolism , Medulloblastoma , Drug Therapy , Metabolism , Models, Animal , Neoplasms , Drug Therapy , Metabolism , Patched Receptors , Receptors, Cell Surface , Genetics , Metabolism , Signal Transduction , Skin Neoplasms , Drug Therapy , MetabolismABSTRACT
The link of hedgehog (Hh) signaling activation to human cancer and synthesis of a variety of Hh signaling inhibitors raise great expectation that inhibiting Hh signaling may be effective in human cancer treatment. Cyclopamine (Cyc), an alkaloid from the Veratrum plant, is a specific natural product inhibitor of the Hh pathway that acts by targeting smoothened (SMO) protein. However, its poor solubility, acid sensitivity, and weak potency relative to other Hh antagonists prevent the clinical development of Cyc as a therapeutic agent. Here, we report properties of cyclopamine tartrate salt (CycT) and its activities in Hh signaling-mediated cancer in vitro and in vivo. Unlike Cyc, CycT is water soluble (5-10 mg/mL). The median lethal dose (LD50) of CycT was 62.5 mg/kg body weight compared to 43.5 mg/kg for Cyc, and the plasma half-life (T1/2) of CycT was not significantly different from that of Cyc. We showed that CycT had a higher inhibitory activity for Hh signaling-dependent motor neuron differentiation than did Cyc (IC50 = 50 nmol/L for CycT vs. 300 nmol/L for Cyc). We also tested the antitumor effectiveness of these Hh inhibitors using two mouse models of basal cell carcinomas (K14cre:Ptch1(neo/neo) and K14cre:SmoM2(YFP)). After topical application of CycT or Cyc daily for 21 days, we found that all CycT-treated mice had tumor shrinkage and decreased expression of Hh target genes. Taken together, we found that CycT is an effective inhibitor of Hh signaling-mediated carcinogenesis.
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Animals , Mice , Carcinoma, Basal Cell , Pathology , Cell Differentiation , Embryonic Stem Cells , Cell Biology , Hedgehog Proteins , Metabolism , Motor Neurons , Cell Biology , Plants, Medicinal , Chemistry , Receptors, G-Protein-Coupled , Metabolism , Signal Transduction , Skin Neoplasms , Pathology , Smoothened Receptor , Solubility , Tartrates , Blood , Pharmacology , Tumor Burden , Veratrum , Chemistry , Veratrum Alkaloids , Blood , PharmacologyABSTRACT
@#Objective To investigate the effect of early rehabilitation on neurological function and cerebral blood flow of patients with acute cerebral infarction.Methods100 cases of acute cerebral infarction were randomly divided into the rehabilitation group(53 cases) and control group(47 cases).Both groups received the routine treatment;besides,patients in the rehabilitation group were treated with early rehabilitation training.The treatment efficacy was assessed by neurological function deficit evaluation,and the cerebral blood flow was measured by transcranial Doppler(TCD) before and 30 days after treatment.ResultsThe scores of neurological function deficit evaluation of all patients in each group decreased after treatment,but the scores of the rehabilitation group were obviously lower than that of the control group(P<0.01);and the results of TCD of the rehabilitation group were also superior to that of the control group(P<0.01).ConclusionEarly rehabilitation training may obviously improve neurological function and cerebral blood flow of patients with acute cerebral infarction.