Rationale and study design for one-stop assessment of renal artery stenosis and renal microvascular perfusion with contrast-enhanced ultrasound for patients with suspected renovascular hypertension / 中华医学杂志(英文版)

BACKGROUND@#Renal artery stenosis (RAS) is always associated with abnormalities in renal microvascular perfusion (RMP). However, few imaging methods can simultaneously evaluate the degree of luminal stenosis and RMP. Thus, this study will aim to evaluate the feasibility of using contrast-enhanced ultrasound (CEUS) for assessing both RAS and RMP to achieve a one-stop assessment of patients with suspected renovascular hypertension.@*METHODS@#This will be a single-center diagnostic study with a sample size of 440. Patients with chronic kidney disease (CKD) and suspected of having resistant hypertension will be eligible. Patients with Stages 1-3 CKD will undergo CEUS and computed tomography (CT) angiography (CTA). Values obtained by CEUS and CTA for diagnosing low-grade (lumen reduced by <60%) and high-grade (lumen reduced by ≥60%) RAS will be compared. Moreover, all patients will also undergo radionuclide imaging. The diagnostic value for RAS will be assessed by the receiver operating characteristic curve, including the accuracy, sensitivity, specificity, positive predictive values, negative predictive values, and area under the ROC. Pearson correlation analysis will be performed to assess the association between CEUS findings for RMP and glomerular filtration rate measured by a radionuclide imaging method.@*CONCLUSION@#The data gathered from this study will be used to evaluate the feasibility of expanding clinical applications of CEUS for evaluation of patients with suspected renovascular hypertension.@*TRIAL REGISTRATION@#Chinese Clinical Trial Registry, ChiCTR1800016252; https://www.chictr.org.cn.

Improving rational use of antimicrobial agents by infection prevention and control / 中国感染控制杂志

Objective To evaluate the efficacy of infection prevention and control measures on the management of rational use of antimicrobial agents.Methods Patients who were admitted in a hospital from 2011 to 2015 were as the research object,a series of infection prevention and control intervention measure were taken,efficacy of intervention measures were evaluated.Results After the implementation of comprehensive intervention measures,compliance rate of hand hygiene increased year by year,from 38.17 ％ in 2011 to 87.16 ％ in 2015,difference was statistically significant (x2 =48.50,P＜0.05).Incidence of healthcare-associated infection dropped from 1.45％ to 1.06％,difference was statistically significant (x2 =42.50,P＜0.05);antimicrobial use density in 2011-2015 were 63.1,44.4,40.0,40.8,and 40.5 respectively,which showed a decreasing tendency.Conclusion Effective infection prevention and control measures have obvious effect on promoting management of rational use of antimicrobial agents,it is helpful for reducing the clinical use density of antimicrobial agents.

Study of endorectal ultrasonography in the staging of rectal cancer / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There is no consensus regarding the performance for endorectal ultrasonography (ERUS) at every stage of rectal cancer. Thus, the purpose of our study was to further assess the value of ERUS in the preoperative staging of rectal cancer.</p><p><b>METHODS</b>A retrospective study was performed with 44 consecutive patients (mean age: (63.3 ± 10.2) years) who underwent surgical treatment for endorectal carcinoma and were preoperatively evaluated using Biplane ERUS between September 2008 and December 2010. We compared the ERUS staging with the pathological findings based on surgical specimens.</p><p><b>RESULTS</b>ERUS staging agreed with the histologic staging in 39 of the 44 (88.6%) patients: the agreement on the depth of transmural invasion was good (κ = 0.73; 95%CI: 0.60 - 0.86, P = 0.000). The detection sensitivities of rectal cancer with ERUS were as follows: T1 85.7%, T2 87.5%, T3 88.9%, and T4 100.0% with specificity values of T1 97.3%, T2 92.9%, T3 96.2%, and T4 97.6%. ERUS correctly staged patients with T1 95.5%, T2 90.9%, T3 70.5%, and T4 97.7%. The positive predictive value of ERUS was lowest for T4 (75%), but highest for T3 (94.1%) followed by T2 (87.5%) and T1 (85.7%); the negative predictive values of ERUS from high to low were ordered as T4 (100%), T1 (97.3%), T2 (92.9%), and T3 (92.6%). The percentage of total over-staged cases was 4.5% and the under-staged cases was 6.8%. The extent of perirectal lymph node metastases was determined with a sensitivity of 68.4% (13/19), specificity of 80.0% (20/25), and diagnostic accuracy of 75.0% (33/44).</p><p><b>CONCLUSION</b>Biplane ERUS has a high diagnostic accuracy for tumoral invasion of the rectal wall at every T stage, but relatively low diagnostic accuracy for lymph node metastases.</p>

Monitoring of ultrasonography in artificial vascular graft for arteriovenous fistula / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the monitoring of ultrasonography in artificial vascular graft for arteriovenous fistula and its complications in patients with chronic renal failure.</p><p><b>METHODS</b>Eighteen cases of artificial vascular graft arteriovenous fistula after four to six weeks were enrolled. The diameter, the peak velocity and blood flow were examined in arterial fistula. And the artificial vascular diameter, the peak velocity and blood flow of artificial vessels next to artery were all examined and analyzed. And the patients with symptoms in the upper extremity were tested by ultrasound.</p><p><b>RESULTS</b>Intravascular blood showed good filling in fistula and artificial blood vessels in four to six weeks after artificial vascular graft for arteriovenous fistula by color doppler ultrasonography. The arterial fistula diameter, the peak velocity and blood flow were (3.61 +/- 0.68) mm and (298.56 +/- 93.42) cm/s and (583.62 +/- 216.77) ml/min. Artificial vascular diameter in (4.47 +/- 0.61) mm, the peak velocity and blood flow were (219.37 +/- 68.42) cm/s and (325.23 +/- 117.12) ml/min in the artificial blood vessels next to artery. Seven patients with upper extremity discomfort were examined by ultrasonography. One case was serum swollen. Three cases were thrombosis in artificial vessels. One case was pseudoaneurysm. Two cases were edema.</p><p><b>CONCLUSIONS</b>Ultrasonography plays a significant clinic role in testing artificial vascular graft for arteriovenous fistula and its complications.</p>