Relationship of the total atrial conduction time to subclinical atherosclerosis,inflammation and echocardiographic parameters in patients with type 2 diabetes mellitus

OBJECTIVES:

The aim of our study was to evaluate the total atrial conduction time and its relationship to subclinical atherosclerosis, inflammation and echocardiographic parameters in patients with type 2 diabetes mellitus.

METHODS:

A total of 132 patients with type 2 diabetes mellitus (mean age 54.5±9.6 years; 57.6% male) and 80 age- and gender-matched controls were evaluated. The total atrial conduction time was measured by tissue-Doppler imaging and the carotid intima-media thickness was measured by B-mode ultrasonography.

RESULTS:

The total atrial conduction time was significantly longer in the patients with type 2 diabetes mellitus than in the control group (131.7±23.6 vs. 113.1±21.3, p<0.001). The patients with type 2 diabetes mellitus had significantly increased carotid intima-media thicknesses, neutrophil to lymphocyte ratios and high-sensitivity C-reactive protein levels than those of the controls. The total atrial conduction time was positively correlated with the high-sensitivity C-reactive protein level, neutrophil to lymphocyte ratio, carotid intima-media thickness and left atrial volume index and negatively correlated with the early diastolic velocity (Em), Em/late diastolic velocity (Am) ratio and global peak left atrial longitudinal strain. A multiple logistic regression analysis demonstrated that the neutrophil to lymphocyte ratio, carotid intima-media thickness and global peak left atrial longitudinal strain were independent predictors of the total atrial conduction time.

CONCLUSIONS:

We suggest that subclinical atherosclerosis and inflammation may represent a mechanism related to prolonged total atrial conduction time and that prolonged total atrial conduction time and impaired left atrial myocardial deformation may be represent early subclinical cardiac involvement in patients with type 2 diabetes mellitus.     

Experimental model standardizing polyvinyl alcohol hydrogel to simulate endoscopic ultrasound and endoscopic ultrasound-elastography

BACKGROUND Endoscopic ultrasound(EUS) and endoscopic ultrasound elastography(EUS-E) simulation lessens the learning curve; however, models lack realism, diminishing competitiveness.AIM To standardize the mechanical properties of polyvinyl alcohol(PVA) hydrogel for simulating organs and digestive lesions.METHODS PVA hydrogel(Sigma Aldrich, degree of hydrolysis 99%) for simulating EUS/EUS-E lesions was investigated in Unidad de Investigación y Desarrollo Tecnológico at Hospital General de México "Dr. Eduardo Liceaga", Mexico City. We evaluated physical, contrast, elasticity and deformation coefficient characteristics in lesions, applying Kappa's concordance and satisfaction questionnaire(Likert 4-points).RESULTS PVA hydrogel showed stable mechanical properties. Density depended on molecular weight(MW) and concentration(C). PVA bblocks with the greatest density showed lowest tensile strength(r =-0.8, P = 0.01). Lesions were EUSgraphically visible. Homogeneous and heterogeneous examples were created from PVA blocks or PVA phantoms, exceeding(MW_2 = 146000-186000, C_9 = 15% and C_(10) = 20%) with a density under(MW_1 = 85000-124000, C_1 = 7% and C_2 = 9%). We calculated elasticity and deformation parameters of solid(blue) areas, contrasting with the norm(Kappa = 0.8; high degree of satisfaction).CONCLUSION PVA hydrogels were appropriate for simulating organs and digestive lesions using EUS/EUS-E, facilitating practice and reducing risk. Repetition amplified skills, while reducing the learning curve.     

斑点追踪成像技术在心血管领域的应用

心肌运动是一个复杂的运动模式,它与心肌纤维的解剖排列走向密切相关。正常心室肌分为三层：心外膜下层肌纤维呈左手螺旋状围绕心室腔,心内膜下肌纤维则呈右手螺旋状围绕心室腔,而室壁中层肌纤维呈环形走行。心肌纤维的排列方向决定了其收缩形变特点。     

台州地区非结核分枝杆菌流行趋势研究

目的 了解台州地区临床流行的非结核分枝杆菌的种类和感染趋势,为临床诊疗NTM肺病提供依据。方法 回顾性分析2015～2018年来源于台州市不同地区就诊和送检于恩泽医疗中心(集团)的1156株临床分离分枝杆菌菌株,采用基因芯片进行菌种鉴定。结果 1156例分枝杆菌分离出非结核分枝杆菌228例,其中胞内分枝杆菌125例,浅黄分枝杆菌45例,鸟分枝杆菌20例,龟/脓肿分枝杆菌11例,草分枝杆菌16例,不产色分枝杆菌4例,金色分枝杆菌2例,堪萨斯分枝杆菌2例,瘰疬分枝杆菌1例,戈登分枝杆菌1例,海/溃疡分枝杆菌1例。男141例,占61.84%,女87例,占38.16%。结论 台州地区非结核分枝杆菌感染有逐年上升的趋势,主要以胞内分枝杆菌为主,分离人群以男性居多。     

超声弹性成像技术在IgG4相关唾液腺炎诊断和随访中的应用

目的: 探讨超声弹性成像技术在IgG4相关唾液腺炎诊断和随访中的应用价值。方法: 回顾分析2018年5月—10月就诊于上海交通大学医学院附属第九人民医院口腔外科,诊断为IgG4相关唾液腺炎3例患者的临床资料。所有患者均接受口服小剂量糖皮质激素治疗,采用超声弹性成像技术应变率比值法和声辐射力脉冲成像法,对治疗前、后患者下颌下腺进行弹性超声检查,观察超声影像学特点及疗效。结果: 3例患者临床表现均为双侧下颌下腺无痛性肿大超过3个月,血清IgG和IgG4浓度均异常升高,下颌下腺活检病理及免疫组织化学染色结果提示符合IgG4相关唾液腺炎。治疗前弹性超声成像显示腺内大范围蓝色区域对应低回声区,应变率比值（SR）较正常腺体减小而剪切波速值（SWV）较正常腺体增大,表示该区域腺体质地比正常腺体明显较硬。所有患者经小剂量糖皮质激素治疗1个月后随访,临床表现原本肿大的下颌下腺明显消退,触诊质地软化,血清IgG和IgG4浓度明显下降,弹性超声显示蓝色区域范围明显缩小,黄色和绿色区域范围增大,对应SR增大而SWV减小,客观且半量化地反映腺体质地较治疗前软化。结论: 超声弹性成像技术通过测量SR或SWV,可以客观半量化地反映病变唾液腺质地。结合患者的临床表现、血清学指标和组织病理学表现,可以辅助IgG4相关唾液腺炎的诊断,并初步评价疾病的严重性和进展程度。     

Right ventricular involvement in anterior myocardial infarction: a tissue Doppler-derived strain and strain rate study

OBJECTIVE:

Strain and strain rate imaging is currently the most popular echocardiographic technique that reveals subclinical myocardial damage. There are currently no available data on this imaging method with regard to assessing right ventricular involvement in anterior myocardial infarction. Therefore, we aimed to evaluate right ventricular regional functions using a derived strain and strain rate imaging tissue Doppler method in patients who were successfully treated for their first anterior myocardial infarction.

METHODS:

The patient group was composed of 44 patients who had experienced their first anterior myocardial infarction and had undergone successful percutaneous coronary intervention. Twenty patients were selected for the control group. The right ventricular myocardial samplings were performed in three regions: the basal, mid, and apical segments of the lateral wall. The individual myocardial velocity, strain, and strain rate values of each basal, mid, and apical segment were obtained.

RESULTS:

The right ventricular myocardial velocities of the patient group were significantly decreased with respect to all three velocities in the control group. The strain and strain rate values of the right mid and apical ventricular segments in the patient group were significantly lower than those of the control group (excluding the right ventricular basal strain and strain rate). In addition, changes in the right ventricular mean strain and strain rate values were significant.

CONCLUSION:

Right ventricular involvement following anterior myocardial infarction can be assessed using tissue Doppler based strain and strain rate     

运动负荷超声评价主动脉瓣置换术后左心室收缩功能储备

目的:应用二维超声斑点追踪技术,评价主动脉瓣置换术后运动负荷试验中的左心室收缩功能储备。方法:21例因重度主动脉瓣狭窄进行瓣膜置换术的患者(左心室射血分数>50%)行运动负荷超声心动图检查,应用二维超声斑点追踪技术测量运动负荷试验中静息状态下及峰值负荷时的左心室收缩期长轴整体应变率(GLSRs),同时记录峰值负荷时的心肌摄氧量(pVO2)。结果与21例正常健康对照者进行比较。结果:静息状态下,病例组与对照组超声指标无明显差异。峰值负荷时,病例组pVO2低于正常组(P<0.05);GLSRs及二尖瓣环心肌收缩速度(Sm)均明显低于正常组(P<0.001)且与pVO2呈正相关(GLSRs:r=0.60,P=0.0007;Sm:r=0.65,P=0.002)。多重线性回归分析,病例组峰值负荷时的左心室收缩期应变率为pVO2的唯一影响因素。结论:主动脉瓣狭窄患者瓣膜置换术后,尽管静息状态下左心室功能正常,但运动负荷试验后,左心室收缩功能储备仍然低于正常。     

The influence of denture supporting tissue properties on pressure-pain threshold: –Measurement in dentate subjects–

PurposeThe present study was designed to clarify the relationship between the properties of the palatal mucosa and the pressure-pain threshold.MethodsThree parts of the palatal mucosa of 17 dentate subjects were measured: the median part of the palate, the lateral part of the first molar, and the midpoint between these two parts. The subjects were instructed to press a pushbutton when he or she felt pressure-pain. The probe pressure was gradually increased (1 N/s). The thickness (T) (mm) and elasticity (E) (MPa) were used as the parameters of the properties of the palatal mucosa, whereas pressure (P) (MPa), compressibility (C) (%), and subsidence (S) (mm) were used as the parameters of the pressure-pain threshold. The Shapiro–Wilk test was used to consider the data of distribution of normality for each measurement point, as obtained from the 17 subjects. A Kruskal–Wallis test and a Wilcoxon signed rank test were performed for multiple comparisons, the Bonferroni method was used to compensate for the P-value. Spearman's rank correlation coefficient was calculated.ResultsT correlated with the values of S at the median points (P = 0.001) and midpoints (P = 0.011).ConclusionThickness can be an index of the amount of relief where pain is caused easily. In addition, modulus of elasticity is important as an indicator of the bearing ability of denture support tissues, it is necessary to consider how to evaluate the modulus of elasticity and to evaluate the relationship between the parameters of the pain threshold.     

超声弹性成像技术对提高肝肿瘤穿刺活检确诊率的应用价值

目的探讨超声弹性成像技术对提高肝肿瘤穿刺活检确诊率的应用价值。方法将126例肝肿瘤患者(共141个肝脏肿块)随机分为弹性组(70个肿块)和对照组(71个肿块)。对弹性组行超声弹性成像检查,分别对肿块进行弹性评分及应变率比值测定,然后参照弹性图特点行超声引导下肝肿瘤穿刺活检;对照组只采用常规超声引导肝肿瘤穿刺活检。以病理结果为金标准,对比分析两种方法对肝肿瘤的穿刺成功率、取材满意度和确诊率。结果以1针为穿刺成功标准,对照组和弹性组的穿刺成功率分别为29.58%(21/71)、64.29%(45/70),二者差异有统计学意义(χ~2=17.05,P0.01);以≤2针为穿刺成功标准,弹性组穿刺成功率明显高于对照组[95.71%(67/70)vs 85.92%(61/71),χ~2=4.04,P=0.04]。以取出长度约10~22mm的完整组织条或取材量满足病理诊断为取材满意,对照组和弹性组的取材满意度分别为81.20%(108/133)、93.88%(92/98),差异有统计学意义(χ~2=7.80,P=0.01)。弹性组与对照组总确诊率差异有统计学意义[95.71%(67/70)vs 84.51%(60/71),χ~2=4.95,P=0.03]。结论超声弹性成像可敏感反应肿瘤组织的软硬程度、准确分辨肝肿瘤内的液化坏死区,对提高肝肿瘤穿刺活检确诊率具有重要的价值。     

Effect of lesion boundary conditions on axial strain elastograms: a parametric study

Ultrasound elastography produces strain images of compliant tissues under quasi-static compression. When a material is compressed, there are several parameters that affect the stress-distribution and, hence, the strain distribution in the material. The state of bonding of an inclusion to the background material is a critical parameter. Heretofore, in the field of elastography, the inclusion was considered to be firmly bonded to the background material and analytical solutions were derived for the elasticity problem involving simple geometries like circular inclusion (for two dimensional [2D]) and spherical inclusion (three dimensional [3D]). Under these conditions, simple analytical expressions relating the strain contrast to the modulus contrast were derived. However, it is known that the state of bonding of some tumors to their surrounding tissues depends on the type of the lesion. For example, benign lesions of the breast are known to be loosely bonded to the surrounding tissue, while malignant breast lesions are firmly bonded. In this study, we perform a parametric study using finite element modeling (FEM) to investigate the validity of the analytical expression relating the strain contrast to the modulus contrast, when the state of bonding at the inclusion/background interface spans a large dynamic range. The results suggest that estimated modulus contrast using the analytical expression is sensitive to the region-of-interest within the inclusion that is considered in the computation of the strain contrast. By considering the inclusion region lying along the axis of lateral symmetry instead of whole region of the inclusion, the estimated modulus contrast (obtained using the analytical expression present in the literature) can be computed to within a systematic error of 10% of the actual modulus contrast. Additional estimation errors are expected to accrue in experimental and in vivo conditions.