A prospective study of super-thin anterolateral thigh flap harvesting assisted by high-frequency color Doppler ultrasound in detecting perforators in deep adipose layers / 中国修复重建外科杂志

OBJECTIVE@#To investigate the clinical application of high-frequency color Doppler ultrasound (HFCDU) in detecting perforators in the deep adipose layers for harvesting super-thin anterolateral thigh flap (ALTF).@*METHODS@#Between August 2019 and January 2023, 45 patients (46 sides) with skin and soft tissue defects in the foot and ankle were treated, including 29 males and 16 females, aged from 22 to 62 years, with an average of 46.7 years. The body mass index ranged from 19.6 to 36.2 kg/m 2, with an average of 23.62 kg/m 2. The causes of injury included traffic accident injury in 15 cases, heavy object crush injury in 20 cases, mechanical injury in 8 cases, heat crush injury in 1 case, and chronic infection in 1 case. There were 20 cases on the left side, 24 cases on the right side, and 1 case on both sides. After thorough debridement, the wound size ranged from 5 cm×4 cm to 17 cm×11 cm. All patients underwent free super-thin ALTF transplantation repair. HFCDU was used to detect the location of the perforators piercing the deep and superficial fascia, as well as the direction and branches of the perforators within the deep adipose layers before operation. According to the preoperative HFCDU findings, the dimensions of the super-thin ALTF ranged from 6 cm×4 cm to 18 cm×12 cm. The donor sites of the flaps were directly sutured.@*RESULTS@#A total of 55 perforators were detected by HFCDU before operation, but 1 was not found during operation. During operation, a total of 56 perforators were found, and 2 perforators were not detected by HFCDU. The positive predictive value of HFCDU for identifying perforator vessels was 98.2%, and the sensitivity was 96.4%. Among the 54 perforators accurately located by HFCDU, the orientation of the perforators in the deep adipose layers was confirmed during operation. There were 21 perforators (38.9%) traveled laterally and inferiorly, 12 (22.2%) traveled medially and inferiorly, 14 (25.9%) traveled laterally and superiorly, 5 (9.3%) traveled medially and superiorly, and 2 (3.7%) ran almost vertically to the body surface. Among the 54 perforators accurately located by HFCDU, 35 were identified as type 1 perforators and 12 as type 2 perforators (HFCDU misidentified 7 type 2 perforators as type 1 perforators). The sensitivity of HFCDU in identifying type 1 perforators was 100%, with a positive predictive value of 83.3%. For type 2 perforators, the sensitivity was 63.2%, and the positive predictive value was 100%. The surgeries were successfully completed. The super-thin ALTF had a thickness ranging from 2 to 6 mm, with an average of 3.56 mm. All super-thin ALTF survived, however, 1 flap experienced a venous crisis at 1 day after operation, but it survived after emergency exploration and re-anastomosis of the veins; 1 flap developed venous crisis at 3 days after operation but survived after bleeding with several small incisions; 3 flaps had necrosis at the distal edge of the epidermis, which healed after undergoing dressing changes. All 45 patients were followed up 6-18 months (mean, 13.6 months). Three flaps required secondary defatting procedures, while the rest had the appropriate thickness, and the overall appearance was satisfactory.@*CONCLUSION@#Preoperative application of HFCDU to detect the perforator in the deep adipose layers can improve the success and safety of the procedure by facilitating the harvest of super-thin ALTF.

Value of the strain ratio in the differential diagnosis of intraocular tumors by elastosonography: A retrospective case-control study

Purpose: To examine the role of the strain ratio in elastosonography for the differential diagnosis of common intraocular tumors such as choroidal melanoma, choroidal hemangioma, choroidal metastatic carcinoma, and retinoblastoma. Methods: This study included patients suffering from intraocular space?occupying lesions and who visited Beijing Tongren Eye Center of Beijing Tongren Hospital affiliated to Capital Medical University from June 2016 to March 2020. All patients underwent a physical examination, fundus examination with mydriasis, color Doppler ultrasonography, elastosonography, magnetic resonance imaging (MRI), and fundus angiography within 1 week. All patients were grouped as choroidal melanoma, choroidal metastatic carcinoma, retinoblastoma, choroidal hemangioma, and optic disk melanocytoma. A receiver operating characteristic (ROC) curve analysis was performed to assess the strain ratio for diagnosing malignant intraocular tumors. Results: A total of 155 patients (161 eyes) were recruited. The strain ratios measured were 39.59 ± 15.92 for choroidal melanoma, 36.85 ± 13.64 for choroidal metastatic carcinoma, 38.93 ± 17.27 for retinoblastoma, 13.42 ± 10.93 for choroidal hemangioma, and 3.84 ± 1.32 for optic disk melanocytoma. The strain ratios of the three malignant lesions were significantly higher than those of the two benign lesions (all P < 0.001). The area under the ROC curve was 0.95 ± 0.028. The optimal cutoff point was 22.67, with 85.7% sensitivity and 96.4% specificity. Conclusion: There were significant differences in elasticity between the malignant and benign intraocular tumors. The strain ratio using elastosonography could serve as an important auxiliary examination to distinguish between benign and malignant intraocular tumors

Grayscale, subjective color Doppler, combined grayscale with subjective color Doppler in predicting thyroid carcinoma: a retrospective analysis / Escala de cinza, doppler colorido subjetivo, combinação de escala de cinza com doppler colorido subjetivo na previsão de carcinoma da tireoide: uma análise retrospectiva

Abstract Introduction: Fine needle aspiration cytology is preferred for thyroid nodules preoperatively, but has disadvantages of false-negative and false-positive results. Objective: To compare the diagnostic performance of grayscale ultrasound, subjective color Doppler ultrasound, and combined features of grayscale ultrasound and subjective color Doppler ultrasound in predicting thyroid carcinoma, using results of the fine needle aspiration cytology as the reference standard. Methods: Data from gray-scale ultrasound images, subjective color Doppler ultrasound images, and the fine needle aspiration cytology of 325 nodules of 250 patients (age ≥ 18 years) were collected and analyzed. Hypo-echogenicity than adjacent strap muscle, micro-lobulated or irregular margins, micro- or mixed calcifications, and taller-than-wide shapes were considered as a suspicious malignant nodule in grayscale ultrasound. Marked vascularity was considered as a suspicious malignant nodule in color Doppler ultrasound. The Bethesda system for classification of thyroid nodules was used for cytopathology. Results: With respect to the results of fine-needle aspiration cytology for detecting suspicious malignant nodules, for grayscale ultrasound, subjective color Doppler ultrasound, and combined gray-scale with subjective color Doppler ultrasound, sensitivities were 0.564, 0.600 and 0.691, respectively and accuracies were 0.926, 0.919 and 0.959, respectively. Suspicious malignant nodules detectability for grayscale ultrasound, subjective color Doppler ultrasound, and combined gray-scale with subjective color Doppler ultrasound were 0.09-0.56 diagnostic confidence, 0.08-0.61 diagnostic confidence, and 0.063-0.7 diagnostic confidence, respectively. Conclusion: The combined gray-scale with subjective color Doppler ultrasound-guided fine-needle aspiration biopsies are recommended for the diagnosis of thyroid carcinoma. Level of Evidence: III.

Resumo Introdução: A citologia da punção aspirativa com agulha fina é preferida para nódulos tireoidianos no pré-operatório, mas apresenta desvantagens de resultados falso-negativos e falso-positivos. Objetivo: Comparar o desempenho diagnóstico da ultrassonografia em escala de cinza, do doppler colorido subjetivo e da combinação dos recursos da ultrassonografia em escala de cinza e do doppler colorido subjetivo na previsão do carcinoma da tireoide com os resultados da citologia da punção aspirativa com agulha fina como padrão de referência. Método: Dados de imagens de ultrassonografia em escala de cinza, imagens subjetivas da ultrassonografia com doppler colorido e citologia da punção aspirativa com agulha fina de 325 nódulos de 250 pacientes (idade ≥ 18 anos) foram coletados e analisados. A hipoecogenicidade da musculatura adjacente, as margens microlobuladas ou irregulares, as microcalcificações ou calcificações mistas e os formatos mais altos do que largos foram considerados como um nódulo maligno suspeito na ultrassonografia em escala de cinza. A vascularização acentuada foi considerada um nódulo maligno suspeito na ultrassonografia com doppler colorido. O sistema Bethesda para classificação de nódulos tireoidianos foi usado para a citopatologia. Resultados: Com relação aos resultados da citologia por punção aspirativa com agulha fina para detecção de nódulos malignos suspeitos, as sensibilidades foram de 0,564, 0,600 e 0,691 para a ultrassonografia em escala de cinza, ultrassonografia com doppler colorido subjetivo e escala de cinza combinada com ultrassonografia com doppler colorido subjetivo, respectivamente, e as acurácias foram 0,926, 0,919 e 0,959, respectivamente. A detectabilidade de nódulos suspeitos malignos para ultrassonografia em escala de cinza, ultrassonografia com doppler colorido subjetivo e escala de cinza combinada com ultrassonografia com doppler colorido subjetivo foram de 0,09-0,56, 0,08-0,61 e 0,063-0,7 de confiança diagnóstica, respectivamente. Conclusões: A ultrassonografia em escala de cinza combinada com o doppler colorido subjetivo e biópsias por punção aspirativa com agulha fina guiadas por ultrassonografia são recomendados para o diagnóstico de carcinoma da tireoide. Nível de evidência: III.

The influence of the superior mesenteric artery blood flow on umbilical cord milking of premature infants assessed by Doppler ultrasound / 中华实用儿科临床杂志

Objective:To investigate the correlation between the dynamic changes of the superior mesenteric artery (SMA) blood flow after umbilical cord milking (UCM)detected and feeding tolerance in premature infants.Methods:This was a prospective study a total of 88 premature infants delivered in Shanghai Jiading Maternal and Child Health Care Hospital from June 2018 to February 2020 were randomly divided into UCM group(45 cases) and early cord clamping group (ECC group, 43 cases). SMA blood flow indexes 15 min before the first feeding (prefeed) and 60 min after the first feeding (post-feed) were detected using the GE Voluson 730 Ultrasound Machine, including the peak systolic velocity (PSV), time-averaged mean velocity (TAMV), pulsatility index (PI) and resistance index (RI). The gestational age, birth weight, the weight at discharge, SMA blood flow indexes, time to achieve enteral nutrition, length of stay and incidence of complications between the two groups were analyzed using t test, Chi- square test or Fisher′ s exact test. Results:(1)There were no significant differences in the gestational age, birth weight, the mother′s hemoglobin before deliver, and the incidence of complications between UCM group and ECC group (all P>0.05). (2) Except for RI, all SMA blood flow indexes were higher in UCM group than those of ECC group.However, only prefeed TAMV[(24.74±11.47) cm/s vs.(20.24±7.71) cm/s], post-feed TAMV[(42.11±15.74 )cm/s vs.(28.31±9.99) cm/s] and TAMV change before and after feeding [(13.89-20.86) cm/s vs.(5.31-10.82) cm/s]were detected to be significantly higher in UCM group than those of ECC group (all P<0.05). (3) Multivariable linear regression analysis showed that the gestational age, birth weight, PSV elevation and PI reduction were negatively correlated with the length of adequate feeding (all P<0.05). (4) The time to achieve enteral nutrition[(11.75±7.36) d vs.(13.38±8.12) d] and the incidence of feeding intolerance [13.3% (6/45 cases) vs.20.9%(9/43 cases)] were lower in UCM group than those of ECC group, although no significant differences were detected (all P>0.05). Conclusions:UCM increases the hemoglobin level in premature infants, which is beneficial to feeding tolerance of premature infants by improving SMA blood flow.

A case of acute carbon monoxide poisoning with secondary intestinal obstruction and thrombosis / 中华劳动卫生职业病杂志

Acute carbon monoxide poisoning can cause multiple organ damage due to hypoxia. In severe cases, it can be life-threatening and has a high fatality rate. Intestinal obstruction and thrombosis are rare complications of carbon monoxide poisoning. A case of carbon monoxide poisoning was reported. In addition to the central nervous system lesion, intestinal obstruction and lower limb thrombosis were also found. In the treatment of carbon monoxide poisoning patients, the clinician was able to treat the common complications, attention should be paid to gastrointestinal tract, thrombotic disease and other rare complications, so as to avoid missed diagnosis.

Preliminary exploration of SpyGlass direct visualization system in diagnosis and treatment of biliary stricture after liver transplantation / 器官移植

Objective To preliminarily evaluate the application value of SpyGlass direct visualization system in the diagnosis and treatment of biliary stricture after liver transplantation. Methods Clinical data of 4 patients presenting with biliary stricture after liver transplantation who underwent SpyGlass direct visualization system examination were collected. The examination, treatment and prognosis of biliary stricture were analyzed. Results The examination results of color Doppler ultrasound, magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) in 4 patients suggested biliary anastomotic stricture with intrahepatic biliary dilatation, and 2 of them were complicated with intrahepatic biliary calculi. Repeated placement of biliary stent under ERCP yielded poor effect in 3 cases. SpyGlass direct visualization system examination hinted biliary anastomotic stricture in 4 patients, 3 cases of intrahepatic biliary dilatation, 3 cases of intrahepatic biliary calculi, 2 cases of purulent bile and 3 cases of floccules within the biliary tract, 1 case of congestion and edema of biliary tract wall and 2 cases of local epithelial necrosis and stiffness changes of intrahepatic biliary tract wall. The wire could not be inserted in 1 patient due to severe biliary anastomotic stricture. Four patients were treated with biliary stricture resection + biliary stone removal + biliary end-to-end anastomosis, biliary stricture resection + biliary-intestinal anastomosis, ERCP lithotomy + biliary metal stent implantation, and biliary metal stent implantation + percutaneous transhepatic bile duct lithotomy, respectively. Relevant symptoms were relieved without evident complications. All patients survived during the follow-up until the submission date. Conclusions Compared with traditional imaging examination, SpyGlass direct visualization system may more directly display the morphological characteristics of biliary tract wall and structural changes within biliary tract cavity, which is an effective examination tool for biliary stricture after liver transplantation. In addition, individualized treatment methods may be adopted for different biliary tract diseases, which is expected to improve clinical prognosis of patients.

Clinical application of modified infrared thermal imaging assisted design of peroneal artery perforator propeller flap / 中华显微外科杂志

Objective:To explore the clinical value of modified infrared thermal imaging assisted design of peroneal artery perforator propeller flap.Methods:From March 2019 to May 2021, tourniquet-reperfusion augmented thermal imaging method (TRATIM) was used to locate the perforating vessels in 14 patients for surgery or peroneal artery perforator propeller flap. The sensitivity, positive predictive value and detection time were calculated and compared with the perforating vessels located by color Doppler ultrasound(CDU), P<0.05 is statistially significant. Results:After operation, 13 flaps survived completely, but 1 flap with distal surface necrosis and healed after dressing change. Only one linear scar was left in 12 cases, and 2 cases healed well by skin grafts. Followed-up for 6-13 months, and showed that the colour and texture of the flaps were similar to the surrounding skin, without obvious swelling. The sensitivity of TRATIM and CDU in location of peral perforator vessels were 88.0% and 92.0%, respectively, and the positive predictive value was 93.6% and 95.8%, with no statistical difference between TRATIM and CDU( P>0.05). The time of positioning perforator was (3.71±0.80) min for TRATIM and(16.21±4.97) min for CDU, There was significant difference between TRATIM and CDU( P<0.01). Conclusion:With TRATIM, a surgeon can locate the peroneal perforator vessels simply, quickly and accurately, and help in design more accurate peroneal artery perforator propeller flap.

Value of color Doppler ultrasonography in evaluating Abernethy malformation and postoperative complications in children / 中华超声影像学杂志

Objective:To analyze the preoperative and postoperative color Doppler ultrasonographic features of Abernethy malformation in children, and to investigate the value of ultrasound diagnosis of Abernethy malformation and postoperative complications.Methods:A retrospective analysis was performed on the clinical and ultrasound data of twelve cases of Abernethy malformation confirmed by surgical treatment in the General Surgery Department of the Children′s Hospital Affiliated to Capital Institute of Pediatrics from February 2017 to November 2021. A comparison was made between preoperative ultrasound and intraoperative portal vein angiography after shunt ligation to explore the accuracy of preoperative ultrasound in diagnosing Abernethy malformation; The common location of thrombosis after shunt ligation was summarized by comparing postoperative ultrasound with CT angiography.Results:Preoperative ultrasonography showed no main portal vein or cable shape in 9 cases, and they were diagnosed as probable Abernethy type Ⅰ; The main portal vein was narrow in 3 cases, and they were diagnosed as Abernethy type Ⅱ. The main portal veins of 11 case were developing and they were confirmed as Abernethy malformation type Ⅱ by portal vein angiography after blocking of portosystemic shunt; the main portal vein of 1 case was not developing which was confirmed as Abernethy type Ⅰ. The classification accuracy of preoperative ultrasound diagnosis of Abernethy malformation was 33.3%. Preoperative ultrasound diagnosis of shunt vessel location: the coarse inferior mesenteric veins of 7 cases flowed into the iliac vein, the coarse inferior mesenteric vein of 1 case flowed into the inferior vena cava, splenic vein and superior mesenteric vein converged and flowed into inferior vena cava in 2 cases, splenic vein and left renal vein communicated in 2 cases. The location of shunt vessels diagnosed by portal vein X-ray angiography was basically consistent with preoperative ultrasonography. At the same time, inferior mesenteric vein shunt combined with tortuous and dilated vein network on colorectal surface was observed. After ligation of shunt vessels, all of shunt vessels were occluded or thrombolized in varying degrees.Splenic vein retropancreatic segment of three cases occured secondary thrombosis, and one case of blocked portal vein occured secondary cavernous change. All the thrombi were confirmed by CT angiography.Conclusions:①The main portal vein of Abernethy malformation type Ⅱ is tenuous, and is easily misdiagnosed Abernethy malformation type Ⅰ by preoperative ultrasound examination; ②Preoperative ultrasound can determine the location of Abernethy malformed shunt vessels; ③The shunt between the inferior mesenteric vein-iliac vein/inferior vena cava should be emphatically explored in children with recurrent hematochezia; ④Postoperative ultrasound can detect portal vein thrombosis early and provide help for clinical anticoagulant therapy.

Clinical significance of transvaginal color Doppler ultrasound for the differential diagnosis of benign and malignant ovarian cysts / 中国辐射卫生

@#<b>Objective</b> To evaluate the clinical significance of transvaginal color Doppler ultrasound for the differential diagnosis of benign and malignant ovarian cysts. <b>Methods</b> Patients who were diagnosed with clinically suspected or palpable adnexal masses and underwent gray-scale ultrasonography, transvaginal color Doppler ultrasonography, and ultrasound-guided fine-needle aspiration cytology (FNAC) during the period from 2018 to 2021 were enrolled in this study. The pulsatility index (<i>PI</i>) and resistance index (<i>RI</i>) were estimated, and an ovarian cyst with the lowest <i>PI</i> value of < 1.0 or the lowest <i>RI</i> value of < 0.4 was considered as malignant. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of gray-scale ultrasound and transvaginal color Doppler ultrasound for the differential diagnosis of benign and malignant ovarian cysts were estimated with FNAC as the gold standard. <b>Results</b> A total of 180 patients with ovarian cysts were recruited, and FNAC revealed that 81 of them had malignant lesions and 99 of them had benign lesions. The transvaginal color Doppler ultrasonograms showed that 75 patients (92.59%) with malignant lesions had blood-flow signals in their cysts and 42 patients (42.24%) with benign lesions had blood-flow signals in their cysts, with a significant difference in the proportion between the two groups (<i>χ</i>² = 49.29, <i>P</i> < 0.01). Among the 75 patients with blood-flow signals in malignant ovarian cysts, 75 had <i>PI</i> < 1.0 and 24 had <i>RI</i> < 0.4; among the 42 patients with blood-flow signals in benign ovarian cysts, 15 had <i>PI</i> < 1.0 and no one had <i>RI</i> < 0.4; there were significant differences in the proportions of <i>PI</i> < 1.0 and <i>RI</i> < 0.4 between the two groups (<i>χ</i>² = 62.68, <i>P</i> < 0.01; <i>χ</i>² = 16.91, <i>P</i> < 0.01). In addition, compared with the combination of gray-scale ultrasound and transvaginal color Doppler ultrasound, gray-scale ultrasound alone had significantly lower sensitivity (51.85% <i>vs</i> 81.48%; <i>χ</i>² = 16.00, <i>P</i> < 0.01), specificity (75.76% <i>vs</i> 93.94%; <i>χ</i>² = 12.73, <i>P</i> < 0.01), PPV (63.64% <i>vs</i> 91.67%; <i>χ</i>² = 15.90, <i>P</i> < 0.01), and NPV (65.79% <i>vs</i> 86.11%; <i>χ</i>² = 12.44, <i>P</i> < 0.01) for the differential diagnosis of benign and malignant ovarian cysts. <b>Conclusion</b> Gray-scale ultrasound is effective for diagnosing ovarian cysts; however, gray-scale ultrasound combined with transvaginal color Doppler ultrasound can improve the differential diagnosis of benign and malignant ovarian cysts.

Model construction and empirical study of location selection model for portable color Doppler ultrasound equipment configuration in county medical community / 中华医院管理杂志

Carrying out the optimal location selection of medical equipment in the medical community plays an important role in scientifically allocating equipment resources and improving the service capacity of medical community. Aiming at minimizing the operating cost of the location selection and configuration of the portable color Doppler ultrasound instrument in the county medical community and the shortest time spent on medical visits for residents, the authors established the total value objective function of the medical community configuration according to the value engineering method; and considered the relevant constraints such as distance, time and personnel quality, the mathematical model of optimal planning for the selection and configuration of portable color Doppler ultrasound equipment in county medical community was constructed. The empirical research results showed that based on the established constraints, after 5 000 iterations, the model output 5 relatively optimized allocation points among the 9 allocation points, and when the allocation number of each allocation point was 1, the total allocation value in the medical community reached the maximum. This study could provide a new idea and feasible method for the allocation of equipment resources of county medical community in China.

Efficacy of penile low-intensity shockwave treatment for erectile dysfunction: correlation with the severity of cavernous artery disease / 亚洲男科学杂志(英文版)

We analyzed the efficacy of penile low-intensity extracorporeal shockwave treatment for erectile dysfunction (ED) combined with cavernous artery disease (CAD). ED was evaluated by the International Index of Erectile Function, subdividing patients into mild and moderate/severe forms. CAD was assessed using penile color Doppler ultrasonography. Patients (n = 111) with a positive outcome after treatment, based upon the minimal clinically important difference of the International Index of ED, were followed up for 3 months and 6 months. We found a significant mean increase in the index of erectile function, with an overall improvement in hemodynamic parameters of the cavernous artery. In particular, 93.9% of the patients with mild ED without CAD responded to treatment and 72.7% resumed normal erectile function. Only 31.2% of the patients with moderate/severe ED and CAD responded to treatment, and none resumed normal erectile function. All patients with mild ED and no CAD maintained the effects of therapy after 3 months, while no patients with moderate/severe ED and CAD maintained the benefits of treatment after 3 months. Thus, patients with mild ED and no CAD have better and longer lasting responses to such treatment, with a higher probability of resuming normal erectile function than patients with moderate/severe ED and CAD.

The analysis of the relationship between the atrioventricular interval of patients with coronary heart disease measured by electrocardiogram and the patients' condition, cardiac color Doppler ultrasound and coronary artery lesions / 中国医师进修杂志

Objective:To analyze the relationship between the left atrioventricular (AR) interval of patients with coronary heart disease (CHD) measured by electrocardiogram and the patients′ condition, cardiac color Doppler ultrasound and coronary artery lesions.Methods:The CHD patients undergoing esophageal ECG examination in Yantai Mountain Hospital from June 2018 to April 2020 are divided into three groups according to the AR interval: AR interval <100ms, AR interval 100 to 150 ms, and AR interval>150 ms; The general data, condition, cardiac color Doppler ultrasound and coronary artery lesions indicators of the three groups were compared. Disorderly multiple Logistic regression was used to analyze the relationship between coronary heart disease AR interval and condition, cardiac color Doppler ultrasound and coronary artery lesions indicators.Results:There were no statistical difference in gender, age, diabetes, smoking history, blood lipids, blood uric acid (UA) and diastolic blood pressure (DBP) among 3 groups ( P>0.05); but there were statistical differences in proportion of hypertension, systolic blood pressure (SBP), CHADS2 score, CHADS2 -VASc score and Gensini score among 3 groups: 54.72% (29/53), 31.25% (20/64) and 46.81% (35/72); (138.84 ± 4.97), (122.47 ± 7.45) and (139.23 ± 7.05) mmHg (1 mmHg = 0.133 kPa); (1.47 ± 0.08), (1.02 ± 0.15) and (1.67 ± 0.10) scores; (1.49 ± 0.28), (1.00 ± 0.24) and (1.74 ± 0.22) scores; (38.27 ± 5.84), (24.45 ± 6.08) and (39.42 ± 5.71) scores, P<0.05. There was no statistical difference in stroke volume (SV) among 3 groups ( P>0.05), but there were statistical differences in the incidence of AP, incidence of AMI, left ventricular end -diastolic volume (LVEDV), left ventricular end -systolic volume (LVESV), left ventricular ejection fraction (LVEF), the ratio of early diastolic mitral valve blood flow velocity to late diastolic mitral valve blood flow velocity (E/A) and single branch/ double branches/ ≥3 branches lesions of coronary artery: 41.51% (22/53), 65.62% (42/64) and 37.50% (27/72); 58.49% (31/53), 34.38% (22/64) and 62.50% (45/72); (150.73 ± 15.09), (141.49 ± 28.68) and (151.49 ± 14.47) ml; (42.15 ± 10.49), (39.82 ± 8.37) and (40.94 ± 11.02) ml; (56.27 ± 4.94)%, (62.20 ± 3.69)% and (57.64 ± 4.99)%; 0.98 ± 0.29, 1.22 ± 0.35 and 0.97 ± 0.34); 14/18/21, 37/13/14 and 9/22/41, P<0.05. Disorderly multiple Logistic regression analysis showed hypertension, AMI, LVEDV, LVESV, LVEF, Gensini score, coronary artery double branches lesions and ≥3 branches lesions of coronary artery were significantly associated with the AR interval of coronary heart lesions ( OR = 2.349, 1.893, 2.754, 2.872, 0.414, 2.201, 4.336 and 3.401; P<0.05). Conclusions:The AR interval of coronary heart disease is closely related to the condition, cardiac color Doppler ultrasound and coronary artery lesions indicators, which deserves clinical attention.

Prevalence rate and high-risk factors of preoperative lower-limb deep venous thrombosis in patients with hip fracture / 中国组织工程研究

BACKGROUND: Patients with hip fracture are prone to be complicated with deep vein thrombosis of the lower extremity during the perioperative period, but there are few studies on the occurrence of deep vein thrombosis of the lower extremity in patients with hip fracture, especially the risk factors of deep vein thrombosis before surgery are not clear. OBJECTIVE: To explore the preoperative prevalence rate of lower-limb deep venous thrombosis in patients with hip fracture, and to investigate the high-risk factors of lower-limb deep venous thrombosis in patients with hip fracture. METHODS: A retrospective analysis was performed in 242 cases of hip fracture admitted to the Second Hospital of Anhui Medical University from January 2017 to December 2018, including 99 males and 143 females, with an average age of 69.1 years. There were 189 cases of femoral neck fracture and 53 cases of intertrochanteric fracture. All patients signed the formed consent. This study was approved by the Hospital Ethics Committee. All patients had no contraindications to anticoagulation. After admission, they were given prophylactic anti-coagulation with low molecular heparin. According to the results of color Doppler ultrasound examination of blood vessels in both lower limbs, the patients were divided into the lower-limb deep venous thrombosis group and the lower-limb non-deep venous thrombosis group (intraluminal filter placement before surgery for lower-limb deep venous thrombosis). Risk factors for thrombosis received univariate analysis, including age, sex, fracture type (femoral neck fractures and intertrochanteric fractures), time from injury to operation, laboratory examination (hematocrit, fibrinogen, D-dimer, and hemoglobin), and combination with chronic diseases (hypertension and diabetes). Multivariate logistic regression analysis was used to determine independent risk factors. RESULTS AND CONCLUSION: (1) Among 242 patients with hip fracture, 58 patients (24%) experienced lower-limb deep venous thrombosis. (2) There was no significant difference in gender, fracture type, D-dimer, fibrinogen, and combination with chronic diseases (hypertension and diabetes) between the lower-limb deep venous thrombosis group and the lower-limb non-deep venous thrombosis group (P > 0.05). The age, the time from injury to operation, and hemoglobin level were statistically significant between the two groups (P < 0.05). (3) Multivariate regression analysis showed that age ≥ 70 years old and time from injury to operation ≥ 5 days were independent risk factors for lower-limb deep venous thrombosis in patients with hip fracture. (4) It is indicated that patients with hip fracture are prone to lower-limb deep venous thrombosis even under the condition of prophylactic anticoagulant therapy. Among them, the elderly patients and the longer waiting time before surgery are the high-risk factors for thrombosis.

Application of contrast-enhanced ultrasound-assisted superficial inferior epigastric artery perforator flap to repair oral and maxillofacial defects / 中国修复重建外科杂志

Objective: To investigate the application value of contrast-enhanced ultrasound (CEUS) technique to assist the repair of oral and maxillofacial defects by superficial inferior epigastric artery perforator flap. Methods: Sixteen oral cancer patients, 10 males and 6 females, who were to undergo superficial inferior epigastric artery perforator flap repair between June 2018 and February 2020, were selected, with an average age of 55.8 years (range, 24-77 years). There were 13 cases of squamous cell carcinoma, 2 cases of adenoid cystic carcinoma, and 1 case of mucinous epidermis-like carcinoma. The color Doppler ultrasound (CDUS) and CEUS were used to screen the superficial inferior epigastric artery, assisted in the design of the flap, and compared it with the actual intraoperative exploration. The sensitivity, specificity, positive predictive value, and negative predictive value of CEUS and CDUS examinations were analyzed. Fourteen of 16 patients were repaired with superficial inferior epigastric artery perforator flap, and 2 patients were repaired with superficial iliac artery flap because the source artery was not found. After surgery, regular follow-up was performed to check for disease recurrence and metastasis and to evaluate the appearance of the patien's donor area, the recovery of transoral feeding function, and the presence of complications. Results: Comparison of preoperative CDUS and CEUS findings and intraoperative exploration showed that CEUS had 100% sensitivity, specificity, positive predictive value, and negative predictive value for vascular exploration of the superficial inferior epigastric artery perforator flap, compared with 57%, 100%, 100%, and 25% for CDUS. The preoperative CDUS identified 25 penetrating vessels in 14 cases repaired with superficial inferior epigastric artery flaps. All vessel signals were enhanced by CEUS enhancement, and an additional 11 penetrating vessels were identified confirmed intraoperatively. The preoperative CEUS measurements of the initial diameter of superficial arteries in the abdominal wall were significantly higher than both CDUS and intraoperative measurements ( P<0.05); the difference in peak systolic velocity between CEUS and CDUS measurements was significant ( t=3.708, P=0.003). One case of superficial epigastric artery perforator flap developed venous embolism crisis at 48 hours after operation, the wound healing delayed. The other incisions in donor sites healed by first intention. All the patients were followed up 3-12 months, with an average of 8 months. No recurrence or metastasis appeared during the follow-up. There was no serious complications such as abdominal wall hernia, the location of abdominal scarring was hidden, and transoral feeding was resumed. Conclusion: The superficial inferior epigastric artery perforator flap with small injury in supply area and hidden scar location is a better choice for repairing oral and maxillofacial defects. The use of CEUS technique to assist the preoperative design of the superficial inferior epigastric artery perforator flap has good feasibility and high accuracy.

Repair of maxillofacial soft tissue defect with superficial abdominal artery flap assisted by color doppler ultrasound / 中华整形外科杂志

Objective@#To investigate the clinical effect of free lower abdominal perforator flaps assisted by color Doppler ultrasound in repairing oral maxillofacial soft tissue defects.@*Methods@#From June 2018 to March 2019, five patients with oral cancer underwent surgical treatment. There were 2 males and 3 females, age from 45-69 years old. At the same time, free lower abdominal flaps pedicled with superficial circumflex iliac artery or superficial inferior epigastric artery were used to repair oral maxillofacial soft tissue defects under preoperative color Doppler ultrasound evaluation and localization.@*Results@#All the five cases survived. Three cases were repaired with superficial inferior epigastric artery flap and two cases were repaired with superficial circumflex iliac artery flaps. These flaps ranged from 5 cm ×6 cm to 7 cm×9 cm. The follow-up period ranged from 3 to 12 months, with an average of 6 months. The flaps were soft, without obvious swelling, hairless growth, scarless contracture and limited mouth opening. All donor and recipient areas were healed in one stage.@*Conclusions@#The lower abdominal perforator flaps assisted by color Doppler ultrasound for repairing oral and maxillofacial soft tissue defects are characterized by accurate selection and localization of blood vessels, convenient extraction of skin flaps and minimal morbidity of donor site. It is a good method for repairing oral and maxillofacial soft tissue defects.

Effect of tamoxifen on endometrium of patients after breast cancer operation / 中国实用妇科与产科杂志

OBJECTIVE: To investigate the clinicopathological effects of taking tamoxifen(TAM)on endometrium after breast cancer operation.METHODS: From January 2011 to December 2017,622 cases of breast cancer were treated in Beijing Obstetrics and Gynecology Hospital,Capital Medical University.Among them,197 patients took TAM,and 59 patients who took TAM underwent hysteroscopic surgery due to abnormal vaginal bleeding or ultrasound endometrial abnormalities.The 59 patients were divided into premenopausal and postmenopausal groups to analyze the pathological condition;the medication time was defined as 3 years and 5 years,so as to observe the endometrial pathology.Set the endometrial abnormal hyperplasia includes: endometrial cancer and the endometrial atypical hyperplasia, and the rest are benign endometrial lesions and the normal endometrium, and then analyze the ultrasound criteria for abnormal endometrial thickening in premenopausal and postmenopausal according to the endometrial pathology.RESULTS: Among the 197 patients who took TAM after breast cancer,59 patients underwent hysteroscopic surgery,32.2%(19/59)of them visited the hospital because of abnormal vaginal bleeding,76.3%(45/59)were pathologically confirmed to have a lesion,in which the endometrial polyps was with the highest incidence.The incidence of endometrial cancer after menopause was 20.0%(6/30),premenopausal endometrial cancer 3.4%(1/29),and atypical hyperplasia before menopause was 20.7%(6/29).When taking TAM for more than 3 or 5 years,the incidence of endometrial cancer and atypical hyperplasia increased.Premenopausal ultrasound endometrial thickness is associated with abnormal endometrial hyperplasia(P=0.035).The endometrial thickness 15 mm can be used as the best diagnostic ultrasound cut-off for the diagnosis of premenopausal abnormal endometrial thickening. Postmenopausal ultrasound endometrial thickness was not associated with abnormal endometrial hyperplasia(P=0.631).CONCLUSION: Taking TAM after breast cancer surgery can result in endometrial polyps and endometrial hyperplasia.Premenopausal patients can also have endometrial cancer and atypical hyperplasia,so the endometrial monitoring should not be ignored.Those who take TAM for more than 3 years need to be more alert to the occurrence of endometrial lesions.The premenopausal B-ultrasound endometrial thickness 15 mm can be used as the best diagnostic ultrasound cut-off for the diagnosis of abnormal endometrial thickening. After the menopause, the endometrial thickness of 5 mm was still used as the standard for abnormal endometrial thickening.

Application of high frequency color Doppler ultrasound combined with wide-field imaging in the preoperative navigation of anterolateral thigh perforator flap surgery / 中国修复重建外科杂志

Objective: To investigate the application of high frequency color Doppler ultrasound (HFCDU) combined with wide-field imaging in the preoperative navigation of anterolateral thigh perforator flap graft. Methods: Between January 2017 and March 2018, 28 patients with skin and soft tissue defects were treated, including 22 males and 6 females, with an average age of 33.5 years (range, 17-66 years). The causes of injury included 2 cases of scald scar, 7 cases of heavy object crushing injury, 12 cases of traffic accident injury, 4 cases of fall injury, 2 cases of machine injury, and 1 case of infection ulcer. Injury sites included 6 cases of hand and wrist, 12 cases of lower leg, 10 cases of foot. After debridement, the wound area ranged from 6.0 cm×3.5 cm to 24.0 cm×9.0 cm, and all patients were treated with free circumflex femoral artery perforator flap graft. Combo of HFCDU and wide-field imaging navigation were done preoperatively to detect the origin, quantity, course, surface location, hemodynamic characteristics, and the relationship with body area of perforator branch of lateral circumflex femoral artery. According to the perforator information displayed by wide-field imaging of source artery, the dominant perforator was determined to be a pedicle for designed flap. The flap size ranged from 7.0 cm×4.5 cm to 26.0 cm×7.0 cm. The flap donor area was sutured directly. Results: The dominant perforator was successfully detected by HFCDU combined with wide-field imaging in 28 patients before operation. The existence of the perforator was confirmed during operation, and the location was accurate. The course characteristics of the perforate were consistent with the results of wide-field imaging. The grafted flaps survived completely among 27 patients after operation. Necrosis at the edge of the flap was observed in 1 patient, which healed after dressing change. All patients were followed up 3-12 months, with an average of 9 months. All the flaps have good blood supply, good elasticity and shape. The donor areas healed perfectly. Conclusion: Using HFCDU and wide-field imaging navigation for designing of anterolateral thigh perforator flaps can clearly show the characteristics of perforators, hemodynamic information, and the relationship with body area, so that the surgeons can understand the perforators more accurately and intuitively, and improve the success and efficiency of flap graft surgery.

Ultrasound characteristics of testicular Leydig cell tumors , , , 1 / 中华男科学杂志

Objective@#To explore the color Doppler ultrasonic characteristics of testicular Leydig cell tumors (LCT) and improve the clinical diagnosis of the disease.@*METHODS@#We retrospectively analyzed 4 cases of testicular LCT diagnosed and treated in our hospital and summarized the experience in the ultrasonic diagnosis of LCT with a review of the relevant literature.@*RESULTS@#All the 4 testicular LCTs were solitary and quasi-round, 1 in the left and 3 in the right. The smallest mass was 1.8 × 1.5 cm and the largest 3.1 × 2.5 cm, and 2 were complicated by hydrocele of tunica vaginalis. The margins of tumors were distinct in 2 cases and indistinct in 1, and changed from distinct to indistinct in another during the follow-up. Hypoechoes were revealed in all the 4 cases in ultrasonography, 2 with abundant internal blood flow, 1 with abundant peripheral blood flow, and the other with abundant internal blood flow changed from circular blood flow surrounding the mass.@*CONCLUSIONS@#A typical sporadic LCT was ultrasonically manifested as an isolated hypoechoic infracentimetric mass with a clear demarcation from the adjacent pulp. It exhibited intrinsic hypervascularization associated with a typical peripheral rim pattern. Larger lesions more often presented a lobulated shape and intense hypervascularization. Although these ultrasonic characteristics do not reveal the nature of LCT with certainty, they can help the surgeon with the decision on testis-sparing surgery or perhaps even on the active monitoring for the smallest lesions in a population with impaired fertility.

Ultrasound-guided para-aneurysmal saline injection for the treatment of iatrogenic femoral pseudoaneurysm: preliminary results in 18 patients / 介入放射学杂志

Objective To assess the clinical value of ultrasound-guided para-aneurysmal saline injection (PASI) in the treatment of iatrogenic femoral pseudoaneurysm, i.e. postcatheterization femoral artery pseudoaneurysm (FAP). Methods A total of 18 patients developed FAP after receiving interventional therapy through femoral artery puncturing, the diagnosis was confirmed by clinical and color ultrasonography examinations in all patients. Under real-time color Doppler ultrasound guidance and ECG monitoring, PASI was carried out. Local anesthesia was performed by injection of 5-10 ml of 1％ lidocaine, which was followed by percutaneous puncturing with a 21-gauge needle, that was connected to a plastic syringe filled with 0.9％ sodium chloride solution, into the site about 2-5mm away from the fistula between the pseudoaneurysm and the formal artery, then, the saline was continuously and slowly injected into this area until the abnormal blood flow signal within the fistula disappeared. Manual compression was applied on the local area for about 5 minutes. The dose of injected saline and the total time of the procedure were recorded. Clinical and color Doppler ultrasound reexaminations were conducted at 24 hours, one week and one month after the treatment, and the local pulsation, murmur, intra-pseudoaneurysmal blood flow and thrombosis were tested. Results Successful treatment with single procedure was achieved in 17 patients (17/18, 94.4％). In one patient continuous blood flow signal within the pseudoaneurysm was still observed at 24 hours after PASI, and successful closure of the pseudoaneurysm was obtained after the second time of PASI. The time of the procedure was 14-30 min, with a mean of (19.2±8.0) min. The injection volume of saline was 40-150 mL, with a mean of (67.2±29.3) mL. The treatment process could be well tolerated by all patients, only one patient developed transient bradycardia due to vagus reflex. Postoperative 30-day follow-up examination showed that no recurrent blood flow was detected within the pseudoaneurysm, no complications such as venous thrombosis, limb ischemia or local infection were observed, and the pseudoaneurysmal hematoma was completely absorbed. Conclusion For the treatment of postcatheterization FAP, ultrasound-guided PASI is technically-simple and clinically-safe with low medical cost, besides, this therapy can be well tolerated by patients. Therefore, PASI is worthy of clinical application.

Application of high frequency color Doppler ultrasonography combined with detections of serum FIB and CA199 in preoperative diagnosis of breast cancer / 中国医学装备

Objective: To investigate the application value of high frequency color Doppler flow imaging(CDFI)combined with serum fibrinogen(FIB)and sugar antigen 19-9(CA199)in the preoperative diagnosis of breast cancer.Methods: The clinical data of 226 patients with space occupying lesion of breast were analyzed retrospectively.According to the confirmed situation of postoperative pathological examination,they were divided into breast cancer group(158 cases)and breast disease group(68 cases).All patients received examination of preoperative CDFI and detections of preoperative serum FIB and CA199,and the values of single CDFI examination and it combined with detection of serum FIB and CA199 in preoperative diagnosis of breast cancer were compared.Results: In breast cancer group(158 patients),the ultrasonographic images of 146 patients showed the lumps were hypoechoic or weak echoes,irregular shape and uneven surface,and showed the change of lump appeared cauliflower shape,lobulated or crab foot shape.And the levels of serum FIB and CA199 of breast cancer group were significantly higher than those of breast disease group(t=6.821,t=20.061,P＜0.05),respectively.The sensitivity,negative predictive value and diagnostic coincidence rate of CDFI examination combined with detections of FIB and CA199 for diagnosis of breast cancer were 89.24％,79.76％and 92.04％,respectively.And these were significantly higher than those of single CDFI examination(x2=100.148,x2=37.666,x2=79.636,P＜0.05),respectively.Conclusion: The value of high frequency CDFI examination combined with serum FIB and CA199 in the preoperative diagnosis of breast cancer is significantly higher than that of single examination and single detection,and it has clinical application value.