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BACKGROUND@#Three-dimensional shear wave elastography (3D-SWE) is a promising method in distinguishing benign and malignant thyroid nodules. By combining with conventional method, it may further improve the diagnostic value. The study aimed to assess the diagnostic value of American College of Radiology (ACR) thyroid imaging reporting and data system (TI-RADS) combined with 3D-SWE in ACR TI-RADS 4 and 5 thyroid nodules.@*METHODS@#All nodules were examined by conventional ultrasonography, ACR TI-RADS classification, and 3D-SWE examination. Conventional ultrasonography was used to observe the location, size, shape, margin, echogenicity, taller-than-wide sign, microcalcification, and blood flow of thyroid nodules, and then ACR TI-RADS classification was performed. The Young's modulus values (3D-C-Emax, 3D-C-Emean, and elastography standard deviation [3D-C-Esd]) were measured on the reconstructed coronal plane images. According to the receiver operating characteristic (ROC) curve, the best diagnostic efficiency among 3D-C-Emax, 3D-C-Emean, and 3D-C-Esd was selected and the cut-off threshold was calculated. According to the surgical pathology, they were divided into benign group and malignant group. And appropriate statistical methods such as t -test and Mann-Whitney U test were used to compare the difference between the two groups. On this basis, 3D-SWE combined with conventional ACR TI-RADS was reclassified as combined ACR TI-RADS to determine benign or malignant thyroid nodules.@*RESULTS@#Of the 112 thyroid nodules, 62 were malignant and 50 were benign. The optimal cut-off value of three-dimensional maximum Young's modulus in coronal plane (3D-C-Emax) was 51.5 kPa and the area under the curve (AUC) was 0.798. The AUC, sensitivity, specificity, and accuracy of conventional ACR TI-RADS were 0.828, 83.9%, 66.0%, and 75.9%, respectively. The AUC, sensitivity, specificity, and accuracy of combined ACR TI-RADS were 0.845, 90.3%, 66.0%, and 79.5%, respectively. The difference between the two AUC values was statistically significant.@*CONCLUSIONS@#Combined ACR TI-RADS has higher diagnostic efficiency than conventional ACR TI-RADS. The sensitivity and accuracy of combined ACR TI-RADS showed significant improvements. It can be used as an effective method in the diagnosis of thyroid nodules.
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Humans , Thyroid Nodule/pathology , Elasticity Imaging Techniques/methods , Retrospective Studies , Ultrasonography/methodsABSTRACT
Objective:To improve the multiple-link operation efficiency, effect and satisfaction of transaxillary dual-plane breast augmentation by optimizing and upgrading the configuration of auxiliary tools.Methods:From January 2019 to May 2021, breast augmentation was performed in 130 female patients (aged 32±8 years) in the Cosmetic and Plastic Center of the First Affiliated Hospital of Harbin Medical University. The study was conducted among 63 patients who were eligible for the criteria of high configuration surgery. 67 patients underwent standard configuration surgery. The average operation time, intraoperative blood loss, drainage volume (24 hours after operation), postoperative visual analog scale (VAS) pain score and satisfaction were statistically analyzed.Results:The data of high configuration method and standard configuration method were compared as follows: average operation time was (78.6±12.2) min / (93.1±12.1) min ( t=15.73, P<0.05); the average intraoperative blood loss was (3.1±1.0) ml / (14.4±3.5) ml ( t=13.83, P<0.05); the drainage volume (24 hours after operation) was (37.2±8.2) ml / (61.4±10.9) ml ( t=20.82, P<0.05); the pain score on the first day after surgery was (6.1±1.7) points / (7.5±1.6) points ( t=8.57, P<0.05). The overall satisfaction rate was 97.1±1.6 / 95.6±2.0 ( t=5.58, P>0.001), at 6 months after operation. No severe complications were found during the follow-up period, such as capsular contracture, hematoma, infection and double bubble deformity. Conclusions:The use of ultrasonic knife with delivery bag is an effective optimization and upgrade of the endoscopic assisted transaxillary dual plane breast augmentation. The advantages of this method are obvious, highly efficient, safe, effective and satisfactory. It is worthy of clinical application and promotion.
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Objective To evaluate the effect of propofol on high-mobility group box 1 protein (HMGB1)/Toll-like receptor 4 (TLR4) signaling pathway during hepatic ischemia-reperfusion (I/R) injury in rats.Methods Thirty-six clean-grade healthy male Sprague-Dawley rats,aged 3 months,weighing 250 -300 g,were divided into 3 groups (n=12 each) using a random number table method:sham operation group (group S),hepatic I/R group (group I/R) and propofol group (group P).Hepatic I/R injury was induced by occluding the portal vein and hepatic artery supplying the left and middle lobes of the liver for 1 h followed by 6-h reperfusion in anesthetized rats.Propofol was infused via the tail vein at a rate of 12 mg ·kg-1 · h-1 starting from 20 min before ischemia until 6 h of reperfusion in group P.The rats were sacrificed at 6 h of reperfusion,and the left lobe of the liver was removed for microscopic examination of the pathological changes which were scored and for determination of the expression of HMGB1,TLR4,tumor necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-6) in liver tissues (by Western blot).Results Compared with group S,pathological scores of liver tissues were significantly increased,and the expression of HMGB1,TLR4,TNF-α and IL-6 was up-regulated in I/R and P groups (P＜0.05).Compared with group I/R,pathological scores of liver tissues were significantly decreased,and the expression of HMGB1,TLR4,TNF-α and IL-6 was down-regulated in group P (P＜ 0.05).Conclusion The mechanism by which propofol reduces liver I/R injury is associated with blocking HMGB-1/TLR4 signaling pathway and inhibiting inflammatory responses in rats.
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Objective To explore the surgical procedures of reduction and lifting mammaplasty with the short vertical scar and breast lateral fibrous septum vascular pedicle to improve the clinical effect and reduce the complications.Methods Sixty-four patients underwent reduction and lifting mammaplasty:a incision around the areola and under the breast,using the breast lateral fibrous septum vascular pedicle and medial superior dermal pedicle to ensure the blood supply of the nipple.The skin and glands of the lower part of the breast were resected with suspension;upper part was lifting,with skin shaping and sutured.Results There were no postoperative complications such as hematoma,infection,skin and nipple areolar necrosis.The breasts were tall,plump and symmetry with little scar.Conclusions The breast reduction and lifting mammaplasty with breast lateral fibrous septum vascular pedicle and verical incision is effective in the treatment of macromastia and ptosis breast;breast form is satisfied and the complication is less;the operation is simple,safe,effective and worth promoting.
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Objective To introduce our clinical method of filler injection with the posterior space of temporalis myofascia for temporal hollows,and to discuss the practical practicability,safety and aesthetic outcomes.Methods From Jan.2014 to Jan.2016,female patients with temporal hollows who had underwent the filler injecting into the posterior space of temporalis myofascia were involved in our study.The patients with previous history of surgery or trauma on temporal region were excluded.Hyaluronic acid or autologous fat was selected as filler material based on patients' preference.Then,aesthetic outcomes were followed up.120 cases were selected in this study.Among them,52 cases preferred hyaluronic acid,and the average follow-up time was 7.5 months.68 cases acceped autologous fat grafting with average follow-up for 9.5 months.Results All patients got aesthetic and safe outcome.No serious complications were noted,such as infection,embolism,uneven appearance and so on.The satisfactory rate was high in both patients and surgeons.Conclusions The posterior temporalis myofascia space that is relatively closed,stable,lack of vessels has proved to be the safe plane for temporal injection.Not only our injection method could meet the need for injection procedure safety,but also it could ensure the aesthetic outcomes.In clinical practice,the aesthetic surgeons should be well familiar with the temporal anatomy.
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Objective To explore the value of medical three-dimensional visualization technology in preoperative precise assessment for hepatocellular carcinoma (HCC).Methods The clinical data of 24 HCC patients were analyzed retrospectively from Jan 2015 to Dec 2016 in our department.Thin-layer 320-slice CT scaning was performed and data stored in the form of DICOM.Three dimensional reconstruction and simulated hepatectomy were conducted,and correlation test analysis was performed.Results The volume of simulated resected liver was (565 ± 296)ml,while the actual liver resection volume was(523 ± 252)ml.There was no significant difference between the predicted and the actual values (t =1.734,P ＞ 0.05).The actual liver resection volume was positively correlated with the predicted liver resection volume (r =0.920,P ＜ 0.05).The stimulated resection margin was (1.2 ± 0.6)cm,while the actual resected tumor margin was (1.0 ± 0.5) cm.There was no significant difference between the predicted and the actual values (t =1.853,P ＞0.05).The actual margin was positively correlated with the predicted one (r =0.956,P ＜ 0.05).Conclusion The three-dimensional visualization technology has a certain degree of clinical value in the preoperative evaluation of HCC.
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Objective To investigate the relationship between cow's milk protein allergy(CMPA)and gastroesophageal reflux disease(GERD)and the prognosis of GERD combined with CMPA.Methods Fifty patients(24 boys and 26 girls)with GERD were enrolled in this study from January 2015 to June 2016 at Department of Pediatrics,Tangdu Hospital of the Fourth Military Medical University.All children were treated with serum milk protein soluble IgE(sIgE)and milk protein avoidance test,and those with positive results of children's milk protein by provocation test and those with milk serum protein sIgE negative by milk protein provocation tests were diagnosed as CMPA children with GERD according to the CMPA diagnostic criteria and received diet therapy for 1 month and then their blood eosinophil ratio and 24-hour esophageal pH were monitored.Results Twenty-three cases(46％)of 50 children with GERD were diagnosed as CMPA.There was significant difference in clinical symptoms between GERD group and GERD combined with CMPA group(x2=22.78,P0.05).For children with GERD combined with CMPA,the patients received dietary treatment for 1 month.There was significant improvement in vomiting,runny nose/wheezing/cough and diarrhea(P0.05).The proportions of blood eosinophils were decreased after treatment compared with those before treatment [(2.7±1.8)％vs.(8.2±2.7)％,t=10.006,P<0.01].The results of 5 children's 24-hour esophageal pH monitoring showed that the reflux index and the number of acid GERD episodes were lower than before,and the difference was all statistically significant before and after(all P<0.05).Conclusions The occurrence of GERD in infants is partly related to CMPA,and the treatment of CMPA can relieve the clinical symptoms of GERD.
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Objective To evaluate the design formulas of the optimal location for splitting pectoralis major in terms of making type Ⅰ or Ⅱ dual-plane implant pocket.Methods Sixty-five patients with micromastia were collected.Breasts were divided into two types according to the soft-tissue pinch thickness of the lower pole:type Ⅰ (thickness＞2 cm;34 cases) and type Ⅱ (thickness ≤2 cm;31 cases).The optimal levels at which the pectoralis major (PM) was severed were 3/4 or 2/4 of the distance of new inframammary fold for type Ⅰ or Ⅱ dual-plane pockets,respectively.All patients completed the pre-and post-operative BREAST-Q augmentation modules before and 6 months after surgery.The scores were changed into hundred-mark system by QScore software.Results The recovery processes were well-off.The breasts contour was good.Patients reported higher scores of satisfaction with breasts,psychosocial well-being and sexual well-being after surgery than before surgery (62.0±8.9 vs 27.9± 4.3,65.0± 17.2 vs 17.4±8.3,60.5± 14.2 vs 30.3±5.5,P＜0.05).The mean satisfaction score for the overall outcome was 90.6±5.4.However,there was no significant difference in physical well-being between before operation and aftre operation (85.3±9.5 vs 84.7± 10.6).No complications such as severe capsular contracture,or displacement occurred.Conclusions The design formulas make the determining procedure of the optimal location for pectoralis major splitting for two types dual-plane implant pockets easier and more exactly.Our modified design method can provide the implant with the optimal soft tissue coverage,and bring desired and stable breast aesthetic outcomes.The higher satisfaction and quality of life reported by patients indicate that the formulas are feasible and worth to recommend.
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A liquid chromatography_tandem mass spectrometric method was established for the determination of 25 kinds of veterinary antibiotics in manure, soil and water by ultrasonic_solid phase extraction. Purification efficiency of SAX cartridges for soil and manure samples extract and the procedure that manure samples defatted with hexane was also verified. The results showed that the average recoveries of the 25 target antibiotics were 50. 0%-121. 9%, the relative standard deviations (RSD) were 1. 1%-14. 71% (n=9), and the limits of detection (LOD) ranged from 0. 0002-0. 0560 μg/kg for soil and manure and ranged from 0. 002-0. 28 ng/L for water; After adding SAX cartridges, the matrix effects of manure samples reduced to 55%-120%, and soil samples to 75%-160%; after defatting by hexane extraction, the matrix effects of manure sample reduced to 55%-120%. This method has been employed to detect the veterinary antibiotics in environmental samples of livestock farm.
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Objective To evaluate catheter-directed thrombolysis via the popliteal vein in the treatment of the lower limb acute deep venous thrombosis.Methods From July 2009 to October 2010,32patients of the lower limb acute deep venous thrombosis including 3 patients with concurrent pulmonary embolism underwent uhrasound-guided catheter-directed thrombolysis via the popliteal vein.The thrombolytic catheter was inserted into thrombus,through which urokinase was infused at a dosage of 100 × 104U/d.The venous patency score and the rate of patency improvement were observed by venograms before and after therapy.Results In every patient,the lower limb swell and pulomonary symptoms relieved.The circumferences between affected and normal thigh before and after the thrombolysis were(5.4 ± 1.4)cm and (1.7 ± 1.3)cm(t =9.92,P ＜0.01).The circumferences between affected and normal leg before and after the thrombolysis were(4.1 ± 1.5)cm and(1.5 ±0.7)cm(t =7.65,P ＜0.01).The venous patency score before and after the thrombolysis were(15 ± 4)and(4 ± 3)(t =7.12,P ＜ 0.01).The mean rate of venous patency was 88.21％.In the 3 patients with pulmonary embolism,thrombus was complete dissolved in 1 case and partial dissolved in 2 cases.No major complications occurred in all these patients.29 patients were followed up for 3-12 months.There were no thrombosis relapsed.Conclusions Catheter-directed thrombolysis via the popliteal vein with urokinase for acute lower limb deep venous thrombosis is safe and effective.
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Objective To investigate the distribution of biliary bacteriology and their sensitivity to antibiotics in patients with biliary tract infection in Jinshan area in recent 3 years.Methods Bile specimens collected from 367 patients with cholelithiasis between June 2006 and June 2009 were cultured and tested for drug sensitivity to aerobic bacteria.The results were statistically analyzed.Results One hundred and fifty-six bacterial strains were found in 142 (38.7%) bile specimens including gram negative strains (97,62.2%),gram positive strains (51,32.7% ),and fungal strains (8,5.1%).Enterococcus (17.9%) was major pathogen and follwed by Escherichia coli (12.8%),staphylococcus (11.5%),Klebsiella pneumoniae (8.3%),Pseudomonas aeruginosa (7.7%).Whereas the mixed infection was found in 26 (18.3%) specimens.The positive rate of bacterial infection was 53.1% in patients over 60 years of age (X2=8.36,P<0.01 ) and 47.1% in patients with acute biliary infection(X2=4.68,P<0.05).The drug susceptibility revealed that gram negative strains had low resistance to Meropenem (7.5 %),and followed by Imipenem (8.8 %),Cefoperazone +Sulbactam (19.7%),Amikacin (21.9%) and Tazobactam+Piperacillin (TZP,25.3%),but they were highly resistant to Ampicillin,Quinolones and some third generation of Cephalosporins (>50% ).In gram positive strains,none was resistant to Vancomycin,11.3% to fosfomycin and 11.6% to chloromycetin.They were highly resistant to Penicillins,Ampicillin and Cefazollin (>40%).ConclusionsEnterococcus,Escherichia coli,Sstaphylococcus and Klebsiella pneumoniae are commonly seen pathogens in biliary tract infection in Jinshan area.Use of Sulperazone or TZP plus Amikacin and metronidazole is recommended.Imipenem and Vancomycins may be second choice in treatment of severe biliary infection and refractory infection.
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Objective To explore the clinical characteristic and diagnosis and treatment of HLAP.Methods The clinical data of 38 patients with HLAP were reviewed retrospectively.Results 38 cases were diagnosed as HLAP(10.7%),that included 29 cases with mild acute panereatitis(76.3%) and 9 cases with severe acute panereatitis(23.7%).34 patients were treated by nonsurgical methods(89.5% ),4 by surgery(10.5%),As a result,36 cases were cured and 2 cases with severe acute pancreatitis died.Conclusions HLAP are common,and have particular clinical manifestations.Treatment for HLAP is mainly by nonoperative management.Reducing the blood triglyceride could quickly alleviate symptoms.Surgical treatment should be adopted according to the severity of panereatitis.
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In order to investigate the effect of sequence-specific small interfering RNA on suppressing cyclin D1 expression and proliferation and cell cycle and expression of G1 phase regulators of fibroblasts derived from keloid, the plasmid expression vector of siRNA targeted against cyclin D1 was constructed and transfected into fibroblasts with LipofectamineTM 2000. The changes of cyclin D1 expression were detected by fluorescent quantitative PCR(FQ-PCR), semi-quantitative RT-PCR. The effect of sequence- specific small interfering RNA in suppressing the proliferation of fibroblasts was detected by MTT assay. Flow cytometry were used for evaluation ofceU cycle. The expression of cyclin D1, CDK4, pRb and P16 was detected by immunohistochemical method. The results showed that: (1) The sequence- specific siRNA effectively suppressed cyclin D1 expression at both mRNA levels with inhibition rate of 63.68% and 92.83% (P<0.01). (2) Significantly inhibited the proliferation of fibroblasts, and changed cell cycle in percentage of G0/G1 phase cells was increased compared with the controls groups in fibroblasts(P < 0.05). (3) 72 h after transfection, the expression of cyclin D1, CDK4 and pRb decreased, and the expression of P16 increased. It can be concluded that the plasmid expression vector for the RNAi against cyclin D1 constructed in the study can effectively and specifically suppress cyclin D1 expression, and progression of G1/S is effected by G1 phase related regulatory protein, and suppresses proliferation of fibroblasts derived fiom keloid.
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Objective To evaluated the role of wt-P53 protein in telomerase regulation in keloid fibroblasts(KFBs). Methods The fibroblasts were derived from human keloid tissue which was proved by pathological diagnosis. KFBs were divided into 2 groups, the transfection group and the untransfection group. wt-p53 gene was transfected into the fibroblasts by adenovirus vectors in the transfection group. The KFBs untransfected with wt-p53 gene served as control (untransfection group). After 48 hours of transfection, the expression of wt-P53 protein was analyzed by both Western blotting and immunofluorescence method, respectively. The telomerase activity was evaluated by TRAP-ELISA after 1-7 days of transfection.Results All the KFBs from 2 groups expressed wt-P53 protein. But the expression level of wt-P53 protein in the transfection group was significantly higher than that in the untransfection group. At the same time of high expression of wt-P53 protein, the telomerase activity of KFBs in transfection group was significantly lower than that in the untransfection group( P＜0.05). Conclusion High level expression of wt-P53 protein can transiently inhibit the telomerase activity of KFBs.
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Objective:To investigate a large Chinese family in which 9 patients over 4 generations were diagnosed with a form of autosomal dominant spondyloepimphyseal dysplasia(SEMD).Mothods:X-Ray radiograph of proand at 18-month showed absence of secondary ossification centra of femoral heads.His father at 24-year presented severe spondyloepiphyseal changes that principally involved the vertebral bodies,the femoral necks and femoral heads and characterized by generalized platyspondyly with thoracolumbar scoliosis,irregular femoral necks,absent ossification of femoral heads,flat acetabular roofs and coxa vara.The other patients had similar clinical and radiological features.Haplotyping was performed with leukocyte DNA for 5 micosatellite repeat markers from chromosome 12 and the result showed COL2A1 gene as a candidate gene.A total of 54 exons and promoter of COL2A1 gene were amplified and sequenced from all patients and available normal relatives.In addition,exon 23 of COL2A1 gene was amplified and sequenced from 10 controls simultaneously.Results:All patients were identified a 1510(G→A) transition in exon 23 of COL2A1 gene that caused a change from a COL2A1 coding region in available glycine to serine at amino acid position 504.No mutation was found in the normal relatives and 10 controls. Conclusion:The mutation of COL2A1 gene is responsible for this form of SEDC of the family.This is the first familial report of SEDC relating to 1510G→A mutation of COL2A1 gene.The detailed clinical radiogram data will be useful for extending the phenotypic spectrum of type Ⅱcollagenopathies.
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Objective To study wt-p53 gene's influence on the proliferation of keloid fibroblasts in vitro. Methods wt-p53 gene was transfected into keloid fibroblasts by adenovirus vector. wt-p53 mRNA was analyzed by RT-PCR; wt-p53 protein was evaluated by indirectiy immunofluorescence; The ability of proliferation of keloid fibroblasts was analyzed by cell growing curves; The cell cycle of KFB was checked by FCAS. Results The expression of wt-p53 mRNA and protein was obviously higher in the fibroblasts of the experimental group than those of control group; the rate of G_0~G_1 in cell cycle was higher in the fibroblasts of the experimental group than those of control group; at the same time, the rate of G_2~M was lower in fibroblasts of the experimental group than those of control group (P
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Objective To investigate the protective effect of the first window(FW)of liver ischemic preconditioning(IPC),the second window(SW) of remote(leg) ischemic preconditioning(RPC) and conbined applications of liver and lges IPC to against liver ischemia/reperfusion(I/R) injury in the rat,and to investigate the mechanism of the protection.Methods Rats were randomly divided into five groups(n=8 each):(1) Sham group(S group),rats without IPC,(2) Rats with 5 min IPC(IPC group);(3) Rat wiht both liver and lower limbs IPC and repeated three times(RPC group);(4) IPC 24 h after RPC group;(5) IR without IP(I/R group);except S group,the rats were subjected to 60 min sustained liver ischemia followed by 180 min reperfusion.All ischemia rats were only subjected to 70% liver ischemia.Finally,blood and liver samples were obtained to determine the activity of ALT and AST,the expressions of TNF-? and HSP70 protein,and liver wet/dry weight(W/D) and pathology.Results All IPC group and RPC group and IPC+RPC group had obviously lower levels of ALT,AST,W/D,TNF-? than that of the I/R group(P0.05).Conclusions The FW of the IPC,the SW of the RPC and combined applications can lessen hepatic I/R injury.There is no significant difference in the protective intensity of the 3 motheds.The protective effects possibly are due to suppression of TNF-? production,induction of protein HSP70 expression and improvement of liver microcirculation.