Differential diagnosis of gallbladder polypoid lesions by micro-flow imaging / 南方医科大学学报

OBJECTIVE@#To explore the value of micro-flow imaging (MFI) in evaluating blood flow characteristics and differential diagnosis of gallbladder polypoid lesions.@*METHODS@#We retrospectively analyzed the clinical data and ultrasound images of 73 patients with gallbladder polypoid lesions, including 24 patients with pathologically confirmed neoplastic polyps (n=24) and 49 with non-neoplastic polyps (n=49). All the patients underwent conventional ultrasound, MFI and contrast enhanced ultrasound (CEUS) before cholecystectomy. The blood flow characteristics of the lesions in color Doppler flow imaging (CDFI) and MFI were compared, and the consistency of the findings by these two modalities with those of CEUS were evaluated by weighted Kappa consistency test. The diagnostic performance of MFI for gallbladder polypoid lesions was assessed.@*RESULTS@#There were significant differences between MFI and CDFI in the evaluation of blood flow characteristics of gallbladder polypoid lesions (χ2=37.684, P < 0.001). MFI showed better performance than CDFI in displaying the blood flow characteristics of the polyps. The consistency in the findings was 0.118 between CDFI and CEUS and 0.816 between MFI and CEUS. The sensitivity, specificity and accuracy of MFI in distinguishing neoplastic polyps from non-neoplastic polyps were 75.00%, 93.88% and 87.67%, respectively.@*CONCLUSION@#MFI has a good consistency with CEUS in displaying the blood flow characteristics of gallbladder polypoid lesions and can accurately distinguish neoplastic polyps from non-neoplastic polyps, thus providing new ultrasound diagnostic evidence to support clinical decisions on optimal treatments of gallbladder polypoid lesions.

Research progress on application of shear wave elastography in kidney transplantation / 器官移植

Early detection of renal allograft dysfunction plays a critical role in the management of immunosuppression and the survival of renal allograft. However, early detection of renal allograft dysfunction still has certain challenges because no significant changes could be observed in clinical manifestations and biochemical parameters during the early stage. As a novel ultrasound examination tool in recent years, shear wave elastography has been successfully applied in the detection of thyroid, breast, liver and alternative organs. In addition, it also has promising application prospect in the examination of renal allograft due to multiple advantages of real-time, dynamic, accuracy and repeatability. In this article, the classification, principle, advantages, influencing factors of shear wave elastography and its application in the field of kidney transplantation were reviewed, aiming to provide reference for clinicians to make accurate decisions in the prevention and monitoring of renal allograft diseases.

Diagnosis and treatment of an elderly patient with gallbladder abdominal wall fistula / 中华消化外科杂志

Gallbladder abdominal wall fistula is usually due to the acute cholecystitis with-out timely treatment, which leads the formation of abscess around the gallbladder, the gallbladder adhering to the abdominal wall and the abscess infiltrating into the skin to form a spontaneous abdominal wall fistula. Patient with gallbladder abdominal wall fistula may have the symptoms of cholecystolithiasis and acute cholecystitis. Ultrasound examination can detect the situation of gallbladder conveniently, including the internal echo after formation of abscess, the connection between the gallbladder and abdominal cavity, and the blood flow signal, to clarify the diagnosis for the subsequent treatment. The authors share the diagnosis and treatment experiences of an elderly patient with gallbladder abdominal wall fistula.

Application of Micro-flow Imaging in the Differentiation of Benign and Malignant Thyroid Nodules / 中国医学科学院学报

Objective To evaluate the performance of micro-flow imaging(MFI)in the differential diagnosis of benign and malignant thyroid nodules. Methods Totally 50 patients with thyroid nodules examined by conventional ultrasound,MFI,and contrast-enhanced ultrasound and confirmed by histological or cytological pathology in the First Medical Center of Chinese PLA General Hospital from May to December in 2020 were enrolled in the study.The clinical data and ultrasound images were retrospectively analyzed.A binary logistic regression model was established to evaluate the performance of the model in predicting benign and malignant thyroid nodules. Results Logistic regression showed that composition and "S-W-C" sign were independent risk factors for predicting malignant thyroid nodule.The sensitivity,specificity,and Youden index of the logistic regression model were 73.33%,80.00%,and 0.53,respectively,and the area under receiver operating characteristic curve was 0.799(95%CI=0.662-0.899). Conclusion MFI facilitates the differential diagnosis of benign and malignant thyroid nodules and has the potential to be applied in the future.

Current status and prospect of imaging examination methods for rejection after lung transplantation / 器官移植

Lung transplantation is the only effective therapeutic option for end-stage lung diseases, and postoperative rejection is the main factor affecting clinical prognosis of the recipients. Imaging examination can be utilized as a noninvasive tool to assist other examinations in monitoring rejection after lung transplantation. At present, multiple imaging examination methods have been reported. The advantages and disadvantages of various imaging examinations have been clarified, which may promote early diagnosis of rejection, deliver timely treatment for lung transplant recipients and improve the quality of life and clinical prognosis. In this article, the advantages, disadvantages and research progress upon different imaging examinations for rejection after lung transplantation were reviewed, aiming to provide reference for identifying the optimal noninvasive examination approach for rejection after lung transplantation and enhance the long-term survival of the recipients.

Ultrasound evaluation value of portal vein stenosis after pediatric liver transplantation / 器官移植

Objective To investigate the ultrasonographic features and its diagnostic value in portal vein stenosis (PVS) after pediatric liver transplantation. Methods Clinical data of 84 pediatric recipients undergoing liver transplantation who were followed up by routine ultrasound were retrospectively analyzed. According to ultrasound and digital subtraction angiography (DSA) results, all recipients were divided into the normal group (n=57) and PVS group (n=27). The incidence of PVS was assessed by ultrasound. The measurement parameters consisted of diameter of portal vein anastomosis, flow velocity of portal vein anastomosis, hepatic artery velocity, resistance index (RI) of hepatic artery and maximum diameter of the spleen, etc. The ultrasound parameters were statistically compared between the PVS and normal groups. The diagnostic value of ultrasound parameters for PVS after pediatric liver transplantation was evaluated. Results The diameter of portal vein anastomosis in the normal group was significantly larger than that in the PVS group[(0.44±0.08) cm vs. (0.27±0.10) cm], and the flow velocity of portal vein anastomosis in normal group was significantly lower than in the PVS group[(43±12) cm/s vs. (119±58) cm/s] (both P < 0.001). The hepatic artery velocity, RI of hepatic artery and maximum diameter of the spleen did not significantly differ between two groups (all P > 0.05). The diameter of portal vein anastomosis for the optimal diagnosis of PVS in pediatric liver transplantation, pediatric liver transplantation from organ donation after citizen's death and living-related donor pediatric liver transplantation was 0.35 cm, 0.35 cm and 0.33 cm, respectively. The corresponding area under curve (AUC) was 0.906, 0.916 and 0.906, the sensitivity was 0.947, 0.951 and 0.938, and the specificity was 0.852, 0.833 and 0.889, respectively. The flow velocity of portal vein anastomosis for the optimal diagnosis of PVS was 62.7 cm/s, 69.6 cm/s and 61.2 cm/s. The AUC was 0.990, 0.993 and 1.000, the sensitivity was 1.000, 1.000 and 1.000, and the specificity was 0.930, 0.951 and 1.000. Conclusions Ultrasound features of the pediatric recipients with PVS after liver transplantation include the smaller diameter of portal vein anastomosis and faster anastomotic flow velocity, which possess high diagnostic value.

Clinical value of virtual touch tissue quantification technique in diagnosing acute rejection of transplant kidney at different stages / 器官移植

Objective To explore the clinical value of virtual touch tissue quantification (VTQ) technique in the diagnosis of acute rejection of transplant kidney at different stages. Methods Clinical data of 170 renal transplant recipients were retrospectively analyzed. According to the time of VTQ examination and the occurrence of acute rejection after renal transplantation, the recipients within 4 weeks and after 4 weeks post-renal transplantation were assigned into the normal renal function group (n=41, 51) and acute rejection group (n=22, 56). Clinical ultrasound parameters at different stages after renal transplantation were compared between two groups. The diagnostic value of ultrasound parameters in acute rejection at different stages after renal transplantation was evaluated. Results Within 4 weeks post-renal transplantation, the resistance index (RI) and shear wave velocity (SWV) in the acute rejection group were significantly higher than those in the normal renal function group (both P < 0.001). After 4 weeks post-renal transplantation, the SWV in the acute rejection group was significantly higher than that in the normal renal function group (P < 0.001). The area under curve (AUC) of RI and SWV in the diagnosis of acute rejection were 0.729 and 0.803 respectively within 4 weeks post-renal transplantation, which were 0.478 and 0.794 respectively after 4 weeks post-renal transplantation. The diagnostic value of SWV was higher than RI (P < 0.05). The cutoff value of SWV in the diagnosis of acute rejection within 4 weeks post-renal transplantation was considerably higher than that after 4 weeks post-renal transplantation. Conclusions VTQ technique can effectively assist in diagnosing acute rejection of transplant kidney at different stages.

Pre-operation MSCTA combined with intraoperative ultrasound for application of laparoscopic kidney-preserving surgery for treatment of small renal cancer / 中国介入影像与治疗学

Objective: To observe the value of preoperative multi-slice spiral CT angiography (MSCTA) and intraoperative assisted ultrasound in application of laparoscopic kidney-preserving surgery for treating small renal cancer (tumor diameter ≤4 cm). Methods: A total of 85 patients with small kidney cancer underwent retroperitoneal laparoscopic nephron-sparing surgery, including 43 underwent preoperative MSCTA and intraoperative assisted ultrasound (observe group) and 42 underwent preoperative routine renal ultrasound and CT examination (control group). The relevant indicators were compared between the two groups. Results: Preoperative MSCTA findings of observe group were consistent with intraoperative findings. The operative time, intraoperative heat ischemia time, intraoperative blood loss and postoperative hospital stay in observe group were all less than those in control group (all P0.05), while the postoperative GFR of control group was lower than that before surgery (P=0.040). Conclusion: Preoperative MSCTA and intraoperative auxiliary ultrasound during retroperitoneal laparoscopic nephron-sparing surgery for patients with small renal carcinoma can reduce intraoperative blood loss and positive rate of resection margin, reserve as much nephrons as possible to promote the recovery of renal function.

Correlation of thickened nuchal fold with fetal chromosomal abnormalities among 919 cases / 中华医学遗传学杂志

Objective@#To explore the correlation between fetal nuchal fold (NF) thickening and fetal chromosomal abnormality.@*Methods@#In total 919 pregnant women undergoing ultrasound examination were selected for interventional prenatal diagnosis in order to detect fetal chromosomal abnormality.@*Results@#The detection rate of chromosomal abnormality has significantly increased with NF thickness, advanced maternal age, presence of other ultrasound abnormalities (P<0.05). Trisomy 21 was the most common abnormality, and there was a prepondance for male fetuses.@*Conclusion@#Increased NF thickness is strongly associated with the risk of fetal chromosomal abnormalities, advanced maternal age and presence of additional ultrasound abnormalities.

Core-needle biopsy histology vs fine needle aspiration cytology for the diagnosis of malignant thyroid nodules: a comparative study / 介入放射学杂志

Objective To retrospectively analyze and compare the clinical application value of core-needle biopsy (CNB) histology and fine needle aspiration (FNA) cytology in diagnosing malignant thyroid nodules. Methods A total of 134 patients with 137 thyroid nodules (93 malignant nodules and 44 benign nodules) were included in this study. Under ultrasound guidance, successive use of 22 G fine needle and18 G core-needle to puncture each nodule was performed for sampling of thyroid nodule. Surgical findings and pathological manifestations were compared with clinical follow-up results. The success rate of sampling and the diagnostic accuracy, sensitivity as well as specificity for malignant thyroid nodules were compared among FNA, CNB, and CNB/FNA. Results The success rate of puncture sampling with FNA, CNB and FNA/CNB for thyroid nodules was 89.1％, 97.8％ and 100％ respectively. For malignant thyroid nodules, the diagnostic accuracy of FNA, CNB and FNA/CNB was 79.6％, 91.9％ and 96.4％ respectively, the sensitivity was 81.7％, 94.6％ and 97.8％ respectively, and the specificity was 75.0％, 86.4％ and 93.2％ respectively. The success rate of puncture sampling by using CNB or FNA/CNB was significantly higher than that by using FNA (P<0.01), moreover, the diagnostic accuracy and sensitivity for malignant thyroid nodules by using CNB or FNA/CNB was also remarkably higher than those by using FNA (P<0.01) . Conclusion In making diagnosis of malignant thyroid nodules, CNB is accurate, safe and reliable. CNB can be used as a complementary or alternative technique to FNA in clinical practice.

Advances in the clinical application of ultrasonic measurement in optic nerve sheath diameter / 中国综合临床

Due to the special anatomic structure of optic nerve,the optic nerve sheath diameter( ONSD) increases along with the elevated intracranial pressure(ICP). The normal value or cut?off point of ONSD has not been unified in adults and children. The change of ONSD in children is different from that of adults as the children are at the stage of growth. With the deep understanding of ONSD,ultrasonic measurement of ONSD has a wide range of applications in adults and children.

PTC: The correlation between sonographic characteristics of ultrasound and metastasis of cervical lymph node / 中国医学装备

Objective: To analyze the correlation between sonographic characteristics of ultrasound and metastasis of cervical lymph node of papillary thyroid carcinoma (PTC). Methods: 498 patients with PTC who once received radical operation of thyroid cancer and cervical lymph node dissection were divided into metastasis group (n=163) and non-metastasis group (n=335) according to results post pathology. Gender, age, the number of lesion, maximum diameter, aspect ratio, margin, whether contacted with tunica, border, halo of ultrasound, whether existed hypoecho in interior, whether the echo was uniform, whether existed difference about some characteristics of calcification and blood flow between the two groups were compared and analyzed. The correlation of characteristics and cervical lymphatic metastasis was analyzed by using single factor analysis, and the malignancy phenomenon of ultrasonogram that was closely relevant with cervical lymph node metastasis of patients with PTC were screened out by using Logistic regression. Results: As the results of single factor analysis, there were a certain correlation between series of factors, such as gender, age, the number of lesion, maximum diameter, margin, whether contacted with tunica, blood flow and whether contained tiny calcification, and cervical lymph node metastasis, and these correlations were significant (x2=33.094, x2=126.566, x2=127.961, x2=145.087, x2=53.757, x2=6.807, P<0.05). The results of Logistic regression indicated that these factors, included multi- lesions, maximum diameter more than 10.0mm, irregular margin, contacted with tunica of thyroid and abundant blood flow, were closely correlative with the malignancy phenomenon of ultrasonogram of cervical lymphatic metastasis of patients with PTC, and their correlation coefficient were significant (OR=3.103, OR=3.595, OR=2.822, OR=6.317, OR=2.078, P<0.05). Conclusion: The characteristics of ultrasonogram contributes to increase the detectable rate of ultrasound for cervical lymph node metastasis of patients with PTC, and it can provide reference for clinical decision.

Study on the relationship between ultrasonographic features of papillary thyroid carcinoma and central cervical lymph node metastasis / 中华肿瘤杂志

Objective@#To investigate the correlation between ultrasonographic features of papillary thyroid carcinoma and central cervical lymph node metastasis.@*Methods@#We retrospectively analyzed 486 patients with papillary thyroid carcinoma(PTC), pathologically confirmed after surgery in Tianjin Medical University Cancer Institute & Hospital. All patients were divided into central cervical lymph node metastasis group and non-metastasis group. No lateral cervical lymph node metastasis was found in preoperative ultrasonography and postoperative pathology. The characteristics of the ultrasound was observed and analyzed.@*Results@#297 out of 486 patients with papillary thyroid carcinomahad central metastasis, and the other 189 cases did not. Take pathology results as a standard, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate of preoperative ultrasound diagnosis in PTC patients with central cervical lymph node metastasis were 35.3%, 88.6%, 83.2%, 47.4%, 56.6%, respectively. Univariate analysis showed that multi-focus, taller-than-wide, diameter>1 cm, located in the lower pole, ill-defined margin, hypoechogenicity, micro-calcification, capsule invasion more than 1/4 perimeter of papillary thyroid carcinoma were significantly associated with central cervical lymph node metastasis (all P<0.05). Multivariate analysis showed that diameter>1 cm, micro-calcification, capsule invasion more than 1/4 perimeter of papillary thyroid carcinoma became independent risk factors of central cervical neck lymph node metastasis (all P<0.05).@*Conclusions@#Preoperative description of ultrasonographical features has important value to assess central cervical lymph node metastasis in patients with papillary thyroid carcinoma. More information could be provided for clinical treatment. When the papillary thyroid carcinoma presented as diameter>1 cm, micro-calcification, and capsule invasion more than 1/4 perimeter of, there will be a greater risk of central cervical lymph node metastasis, and we shall suggest prophylactic central lymph cervical node dissection.

Clinical analysis of prenatal ultrasound diagnosis of fetal hydronephrosis / 中国基层医药

Objective To investigate the clinical effect of prenatal B ultrasound in the diagnosis of fetal hydronephrosis.Methods 105 pregnant women with advanced hydronephrosis in the Department of Ultrasound of our hospital were selected as the research subjects from November 2013 to September 2015.Grignon classification was performed according to the first B ultrasound results,including 2 cases of level Ⅴ,3 cases of level Ⅳ,6 cases of level Ⅲ,30 cases of level Ⅱ and 64 cases of level Ⅰ.The hydronephrosis was reexamined by ultrasonography within the postnatal 24h.Meanwhile,the B ultrasound reexamination was performed in the postnatal 1,3,6 and 12 months.The change of hydronephrosis was observed.Results Among 105 cases of fetal hydronephrosis,64 cases of kidneys at level Ⅰ were improved in the postnatal 6 months,including 46 cases during 1 month and 16 cases during 3 months;30 cases of kidneys at level Ⅱ were improved during 6 months,including 24 cases during 3 months;6 cases of kidneys at level Ⅲ were progressing;Among 3 cases,2 cases of hydronephrosis at level Ⅳ underwent the surgery and 1 case was progressing;2 cases of hydronephrosis at level Ⅴ underwent the surgery.98 cases of hydronephrosis were physiological (93.33％).2 cases of hydronephrosis progression at level Ⅲ required to follow up.MRU examination suggested no surgical indication at present;1 case belonged to the hydronephrosis progression at level Ⅳ.The family members asked to be reviewed.Conclusion The fetal hydronephrosis can be classified accurately through the prenatal B ultrasound examination.The prenatal B ultrasound examination is the best method for the diagnosis and prognosis of fetal hydronephrosis.

The Prenatal and Postnatal Incidence of Congenital Anomalies of the Kidneys and Urinary Tract (CAKUT) Detected by Ultrasound

PURPOSE: Congenital anomalies of the kidneys and urinary tract (CAKUT) are the most common anomalies identified in newborns. This study aims to demonstrate the prevalence of CAKUT including hydronephrosis diagnosed by antenatal and postnatal ultrasound over a five-year period. METHODS: The records of births between May 1st, 2009 and April 30th, 2014 at our hospital were collected. The number of infants who underwent renal ultrasound after birth for the detection of CAKUT was counted. The incidence of each type of CAKUT such as hydronephrosis, size abnormality, horseshoe kidney, and Multicystic dysplastic kidney (MCDK) was retrospectively evaluated for antenatal screening and postnatal follow-up examination. RESULTS: During the study period, 33,276 infants were born and 521 neonates underwent postnatal renal ultrasound. 183 cases of CAKUT were detected prenatally and 140 postnatally using ultrasonographic examinations at the following time: (i) 3-7 days postnatally in 123 newborns (87.9%), (ii) during 1-3 months in 11 newborns (7.9%), and (iii) later than 3 months in 6 newborns (4.3%). Among diagnosed CAKUT, hydronephrosis was the most common anomaly with 113 newborns diagnosed prenatally and 46 postnatally. Duplex kidney was the second most common anomaly followed by horseshoe kidney, simple cysts in the kidney and so on. CONCLUSION: The detection of CAKUT is an important part of the prenatal ultrasound. This study analyzed the prevalence of CAKUT detected on prenatal screening and compared the results to those detected postnatally. Prenatal ultrasound screening fulfills the needs of postnatal examinations and therefore, both antenatal and postnatal sonographic investigations are of vital importance for diagnosis of renal and urinary tract anomalies.

Acquired premature ejaculation and male accessory gland infection: Relevance of ultrasound examination / 亚洲男科学杂志(英文版)

We have previously demonstrated a high frequency of premature ejaculation (PE) among patients with male accessory gland infection (MAGI). The aim of this study was to evaluate the ultrasound (US) features of patients with MAGI and acquired premature ejaculation (APE) associated (MAGI-APEpos). US evaluation of 50 MAGI-APEpos patients compared to 50 patients with MAGI without PE (MAGI-PEneg) which represent the control group. The diagnosis of APE was made through the evaluation of Intravaginal ejaculation latency time (IELT) and confirmed with the questionnaire PEDT (Premature Ejaculation Diagnostic Tool). The main outcome measure was represented by the frequency of US criteria suggestive of P (prostatitis), V (vesiculitis), and E (epididymitis) in MAGI-APEpos and MAGI-PEneg patients. MAGI-APEpos patients showed a total number of US criteria significantly higher compared to MAGI-PEneg patients. MAGI-APEpos showed a higher frequency of US criteria of V and E (complicated forms of MAGI). Finally, in MAGI-APEpos group, it was found a positive relationship between the anteroposterior diameter (APD) of the caudal tract of the epididymis and the APD of the seminal vesicles, as well as between both diameters and the PEDT score. MAGI-APEpos patients have a peculiar US characterization compared to MAGI-PEneg patients. According to these results, US evaluation of the epididymal and of the prostato vesicular tract should be considered in the practical clinical approach of patients with MAGI and APE. In particular, it could be a support for a possible pathophysiological interpretation of this clinical problem in these patients.

Ovarian nonspecific steroid cell tumor:A case report and literature review / 吉林大学学报(医学版)

Objective:To study the clinical features, experiences of diagnosis and treatment, and treatment process of ovarian nonspecific steroid cell tumor. Methods:The clinical materials of one case of ovarian nonspecific steroid cell tumor were retrospectively analyzed,and the related literaturels were reviewed. Results:The patient displayed amenorrhea and masculine characteristics.Preoperative ultrasonography demonstrated the solid tumor of 53 mm ×39 mm on the right ovary,consideration for the right side of ovarian malignant tumor,and laparotomy was performed.The pathologic results showed that the tumor cells were arranged in nests,and the cytoplasm was bright or eosinophilic, and the nucleus were round or oval with nucleolus.The immunohistochemical staining results revealed that calretinin,vimentin and inhibin were positive in the tumor cells.The patient was diagnosed with ovarian nonspecific steroid cell tumor.The postoperative follow-up of 3 months was performed,and there was no recurrence.Conclusion:The diagnosis of ovarian nonspecific steroid cell tumor should be combined with the clinical manifestation and pathologic results,and operion is the main treatment method.

Correlation between fetal right aortic arch and chromosome abnormality / 国际儿科学杂志

Objective To analyze the correlation between fetal right aortic arch and chromosome ab-normality by ultrasound.Methods From January Jan 2009 to Dec 2014,nineteen cases with fetal right aortic arch were enrolled.They were all determined by chromosome karyotype analysis.The correlation of fetal right aortic arch and chromosome abnormalities detected by ultrasound were evaluated.Results Left lock,a “U”shaped vascular structure,were found in 15 cases.One case of fetal aortic arch was surrounded by a “O”shaped package.Three cases of right aortic arch showed fetal left artery catheter and brachiocephalic artery ima-ging branch.Echocardiography mainly for arterial catheter in three vessel trachea view did not show up.Artery catheter,in front of the trachea,did not form the vascular ring.Nineteen cases of right aortic arch were exam-ined by fetal karyotype analysis.Three patients with trisomy 18-karyotype presented ventricular septal defect, single artium,three tricuspid atresia,pulmonary artery stenosis.Four cases with trisomy 18-karyotype presen-ted ventricular septal defect,complete atrioventricular canal,single artium,double outlet right ventricle,pul-monary artery stenosis in atresia.Three cases with trisomy 21 -karyotype showed single ventricle,single atri-um.One case was with tetralogy of Fallot and one case with dextrocardia,aortic stenosis,accompanied by 22q 1 1.2.Conclusion In prenatal ultrasound screening,we should pay attention to three vessels-trachea view on ultrasound image,which can improve the detection rate of right aortic arch.Fetal right aortic arch and triso-my 18-,trisomy 21 -,chromosomal diseases are substantially correlated.Further analysis of chromosome kary-otype is needed to exclude chromosomal lesions,so as to achieve the purpose of prenatal and postnatal care.

Relationship between postoperative intra-abdominal hypertension and fluid management during liver transplantation / 中华器官移植杂志

Objective To study the correlation between fluid management during liver transplantation and postoperative intra-abdorninal hypertension (IAH),and the correlation between intra-abdominal pressure and hemodynamics during liver transplantation.Method From Sep.2008 to Sep.2014,95 cases were admitted to ICU following liver transplantation were enrolled.All recipients were given abdominal color ultrasound examinations,and the IAH was measured.The preoperative Child-Pugh score,total operating time,anhepatic phase time,intraoperative blood loss,crystal solution input,colloidal fluid input,red blood cell infusion,plasma infusion,intraoperative total fluid input,intraoperative fluid input per h,and urinary volume per h and their correlation with postoperative IAH were analyzed by the Logistic regression method.The relationship between hemodynamics data and IAH intra-abdominal pressure was analyzed by the correlation analysis of two variables.Result IAH occurred in 18.94％ (18/95) recipients at 72nd h after operation.Fluid input per h (＞2000 ml/h) was risk factor (B=1.62;P＜0.05;OR=5.07,95％ CI:1.41-18.23) of IAH.Urinary volume per h (＜200 ml/h) is risk factor (B=-3.21 ;P＜0.01:OR =0.04,95％ CI:0.01-0.18) of IAH.There was correlation between hepatic artery peak flow velocity (r =0.83,P＜0.01),portal vein peak flow velocity (r =-0.182,P＜0.05),and retrohepatic inferior vena cava peak flow velocity (r=-0.184,P＜0.05) with IAH.Conclusion Fluid input per h should be controlled in a low level and urinary volume per h should be increased in order to prevent IAH.There is correlation between hepatic artery peak flow velocity,portal vein peak flow velocity and retrohepatic inferior vena cava peak flow velocity with IAH.

Contrast-enhanced ultrasound and ultrasonic elastography in diagnosis of breast tumor / 中国基层医药

Objective To evaluate the value of contrast-enhanced ultrasound and ultrasonic elastography in the diagnosis of breast lesions with BI -RADS Ⅲ -Ⅴ.Methods 169 patients with BI -RADS Ⅲ -Ⅴ breast lesions were underwent contrast -enhanced ultrasound and ultrasonic elastography 1 week before surgery.Pathological findings were used as the gold standard to evaluate the diagnostic accuracy of contrast -enhanced ultrasound and ultrasonic elastography in diagnosis of BI -RADS Ⅲ -Ⅴ breast lesions.Results The combination of contrast -enhanced ultrasound and ultrasonic elastography in diagnosis of BI -RADS Ⅲ -Ⅴ breast lesions,with the sensitivi-ty,specificity and accuracy of 96.15%,94.34%,and 95.11%,respectively.The difference was statistical signifi-cance compared with single method(χ2 =4.659,P =0.032,χ2 =4.146,P =0.041).Conclusion The combination of contrast -enhanced ultrasound and ultrasonic elastography improves the diagnostic accuracy of Ⅲ-Ⅴ breast lesions.