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

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

Effect of Limited Laminectomy Combined with Foraminal Stenosis Decompression on Preventing C5Palsy / 中国康复理论与实践

@#Objective To observe the effect of limited laminectomy combined with foraminal stenosis decompression on preventing C5nerve root palsy and improving neurological function. Methods From March,2014 to May,2016,69 patients with multi-segment cervical spondylotic myelopathy underwent surgical treatment in our hospital were included.Thirty-eight patients(group A)were treated with limited lami-nectomy combined with foraminal stenosis decompression and internal fixation,and 31 patients(group B)under-went routine laminectomy and internal fixation.The postoperative neurological recovery rate,cervical curvature index(CCI)and C5palsy rate were recorded and analyzed. Results No spinal cord and nerve injury occurred during the operation.The width of laminectomy was(16.8±2.1)mm in group A,and was significantly less than(21.7±2.5)mm in group B(t=8.849,P<0.001).There was no significant difference in operation time and intraoperative blood loss between two groups(t<0.439,P>0.05).The Japanese Orthopaedic Association (JOA) score increased continuously after surgery in both groups (F>42.996, P<0.05), and no significant difference was found between them at each time point(t<1.021,P>0.05).The cervical curva-ture index improved after surgery(F>86.379,P<0.05),and no significant difference was found between them at each time point(t<0.943,P>0.05).The spinal cord drift distance was(3.6±0.7)mm in group A,and ws signifi-cantly shorter than(2.5±0.5)mm in group B(t=7.602,P<0.001).There was no significantly difference in the neu-rological recovery rate between two groups(t=0.724,P=0.471).The C5palsy rate was lower in group A(5.2%,2/38)than in group B(22.5%,7/31)(χ2=4.514,P=0.034). Conclusion Limited laminectomy combined with foraminal stenosis decompression could relieve the spinal cord com-pression and restrict the excessive back drift, promote the neurological function recovery and reduce the inci-dence of C5palsy.

Significance of preoperative peripheral blood inflammatory cytokines and blood routine in predicting post-operative DVT in patients with neurosurgery / 实用医学杂志

Objective To observe the significance of preoperative peripheral serum inflammatory cyto-kines and blood routine in predicting postoperative DVT in patients with neurosurgery.Methods A total of 156 pa-tients from the Department of Neurosurgery form April 2016 to April 2017 were recruited in this study.According to the incidence of postoperative deep venous thrombosis(DVT),patients were divided into DVT group(48 cases) and non-DVT group(108 cases). The date blood routine(including hematocrit,hemoglobin,neutrophil count, monocyte count,white blood cell count,platelet count)and serum inflammatory cytokines(including TNF-α,IL-1β,IL-1β,IL-6,IL-8)of two groups by t tests were compared.The possible risk factors for postoperative DVT in neurosurgical patients were analyzed by multivariate analysis logistic regression.The predicted cutoff value is deter-mined by plotting the subject's working characteristic(ROC)curve.Results Between the control group and DVT group,there were significant differences in preoperative blood neutrophil count,hemoglobin,TNF-α,IL-6 and IL-8(P < 0.05). Multivariate analysis logistic regression showed that the level of neutrophil count and concentration of serum TNF-α concentration were increased,indicating they may be the risk factors of DVT.For the neutrophilic granulocyte count,the value of specificity and sensibility was 82.7%and 61.7%respectively.For the TNF-α level, the value of specificity was 72.3% and the value of sensibility was 83.1%. Conclusion The level of preoperative neutrophil count and the concentration of TNF-α have value in predicting the occurrence of postoperative DVT in neurosurgical patients.

Effects of thickness of osteotomy on biomechanics of tibia cross-section in total knee arthroplasty / 医用生物力学

Objective To obtain biomechanical conditions of the tibia section with different osteotomy thickness under different activity states, so as to provide theoretical basis for osteotomy thickness in total knee arthroplasty (TKA) and activities of patients after operation. Methods The three-dimensional models of the lower limb were reconstructed and the proximal tibia was resected by 0 mm,5 mm,7 mm,9 mm respectively based on the principle of bone resection in TKA. The tibia model after osteotomy were assigned the material properties and the stress and strain of the tibia cross-section were analyzed under the following activity states: standing, walking, running and going upstairs. Results The stress and displacement of the tibia cross-section increased with the increase in osteotomy thickness under the same activity state. The maximum stress and displacement of tibia cross-section increased in general with the same osteotomy thickness, when the strength of activity increased. Conclusions During TKA in clinic, the stress and strain on tibia cross-section became larger as the tibia osteotomy became thicker and the postoperative activity became stronger. Excessive osteotomy in TKA and high intensive activity after TKA should be avoided, so as to reduce stress and strain of the tibia plateau and promote long-term life of the prosthesis.

Thickness of osteotomy affecting biomechanics of tibia cross-section in total knee arthroplasty / 医用生物力学

Objective To obtain different biomechanical conditions of the tibia section with different osteotomy thickness under different activity states,so as to provide theoretical basis for total knee arthroplasty (TKA) and patient activities after operation.Methods The three-dimensional models of lower limb were reconstructed and the proximal tibia was resect by 0 mm,5 mm,7 mm,9 mm,respectively,based on the principle of bone resection in TKA.The tibia models after osteotomy were assigned with the material properties,and the stress and strain of the tibia cross-section were then analyzed under the following activity states:standing,walking,running and climbing upstairs.Results The stress and displacement of the tibia cross-section increased with the increase of osteotomy thickness under the same activity state.The maximum stress and displacement of tibia cross-section with the same osteotomy thickness showed an increasing trend when the strength of activity increased.Conclusions For TKA in clinic,the stress and strain on tibia cross-section become larger with the thicker tibia osteotomy and the stronger postoperative activity.Excessive osteotomy in TKA and activity too intensively after TKA should be avoided,so as to reduce stress and strain of the tibia plateau and promote long-term life of the prosthesis.

Thickness of osteotomy affecting biomechanics of tibia cross-section in total knee arthroplasty / 医用生物力学

Objective To obtain different biomechanical conditions of the tibia section with different osteotomy thickness under different activity states,so as to provide theoretical basis for total knee arthroplasty (TKA) and patient activities after operation.Methods The three-dimensional models of lower limb were reconstructed and the proximal tibia was resect by 0 mm,5 mm,7 mm,9 mm,respectively,based on the principle of bone resection in TKA.The tibia models after osteotomy were assigned with the material properties,and the stress and strain of the tibia cross-section were then analyzed under the following activity states:standing,walking,running and climbing upstairs.Results The stress and displacement of the tibia cross-section increased with the increase of osteotomy thickness under the same activity state.The maximum stress and displacement of tibia cross-section with the same osteotomy thickness showed an increasing trend when the strength of activity increased.Conclusions For TKA in clinic,the stress and strain on tibia cross-section become larger with the thicker tibia osteotomy and the stronger postoperative activity.Excessive osteotomy in TKA and activity too intensively after TKA should be avoided,so as to reduce stress and strain of the tibia plateau and promote long-term life of the prosthesis.

Differential Diagnosis of Solitary Pulmonary Inflammatory Lesions and Peripheral Lung Cancers with Contrast-enhanced Computed Tomography

OBJECTIVES: To clarify differences between solitary pulmonary inflammatory lesions and peripheral lung cancers with contrast-enhanced computed tomography. METHODS: In total, 64 and 132 patients with solitary pulmonary inflammatory masses/nodules and peripheral lung cancers, respectively, were enrolled in this study. Their computed tomographic findings were summarized and compared retrospectively. RESULTS: Compared with the peripheral lung cancers, the inflammatory lesions were located closer to the pleura (p<0.0001). The majority of the inflammatory lesions were patchy and oval-shaped (82.8%), whereas most of the tumors were lobulated (82.6%). Almost all the inflammatory cases were unclear (93.8%), whereas most of the tumors had spiculated margins (72.7%). Computed tomography values were significantly higher for the inflammatory lesions than for the cancers (p<0.0001). More than half of the inflammatory lesions had defined necrosis (59.3%). Furthermore, 49.2% of the cancers enhanced inhomogeneously, but only 24.6% had ill-defined necrosis or cavities. The peripheral zones of 98.4% of the inflammatory lesions and 72.7% of the tumors were unclear, with peripheral scattered patches (92.2%) and beam-shaped opacity (66.7%) being the most common findings, respectively. Adjacent pleural thickening was more frequent for the inflammatory lesions than the cancers (95.3% vs. 21.1%, p<0.0001), whereas pleural indentation was found in 67.4% of the subjects with cancer. In addition, hilar (p=0.034) and mediastinal (p=0.003) lymphadenopathy were more commonly detected in the cancers than in the inflammatory cases. CONCLUSIONS: Contrast-enhanced computed tomography findings for pulmonary inflammatory lesions and peripheral lung cancers were significantly different in many aspects. Developing a comprehensive understanding of these differences is helpful for directing their management.

Effect of TGF-β1 on the expression of collagen in rat atrial and ventricular fibroblasts / 解放军医学杂志

Objective To observe the effect of transforming growth factor beta 1 (TGF-β1) on the expression of collagen in rat atrial and ventricular fibroblasts, and to investigate its specific molecular mechanisms. Methods Tissue explant attachment was used to culture fibroblasts obtained from the atrium and ventricle of rat heart, and they were identified with SABC immunocytochemical staining, and then the following experiments were carried out. (1) Hydroxyproline digestion was performed to study the effects of TGF-β1, within different concentrations (0, 5, 10ng/ml) and different action time (6, 12, 24, 48h) on the content of hydroxyproline in rat's atrial and ventricular fibroblasts. (2) Rat's atrial and ventricular fibroblasts were stimulated with TGF-β1 in optimal concentration and action time, the expression of α-smooth muscle actin (α-SMA) was determined with Western blotting, and the expressions of typeand III collagen mRNA were evaluated with reverse-transcription PCR. The contents of hydroxyproline in the respective cells were measured with hydroxyproline determination. Western blotting was used to measure the protein expression of Smad2/3, p-Smad2/3 and Smad7. Results (1) TGF-β1 was shown to stimulate the collagen synthesis in rat's atrial and ventricular fibroblasts, and the optimal stimulus was TGF-β1 concentration 5ng/ml with action time of 24h. (2) After being stimulated by optimal stimulation effect of TGF-β1, the expression of typeand III collagen and p-Smad2/3 increased, while that of Smad7 decreased significantly only in atrial fibroblasts (P1 under optimal stimulating conditions. Conclusion TGF-β1 can induce dysbolism of collagen of cardiac fibroblasts with abnormal expression of cytoskeletal protein, which may occur more obviously in rat's atrial fibroblasts than in ventricular fibroblasts, and its mechanism may be related with TGF-β1/SMAD pathway.

Advance on chemical compounds of Ainsliaea genus / 中国中药杂志

Plants in Ainsliaea genus, belongs to Compositae family, are traditional Chinese medicine and widely used in folk. These plants contain various types of chemical components, and main components are sesquiterpene lactone and its glycosides. In addition, there are triterpenoids, flavonoids, steroids, phenolic acid, long chain fatty acid and volatile oils. Recently, much attention has been payed to varlous research of A. fragrans. This paper reviewed and summarized the chemical components to provide the theoretical basis for the use of Ainsliaea.

Differential diagnosis of isolated calf muscle vein thrombosis and gastrocnemius hematoma by high-frequency ultrasound / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Differential diagnosis of isolated calf muscle vein thrombosis (ICMVT) and gastrocnemius hematoma is essential for early identification of deep vein thrombosis (DVT). This study aimed to investigate the diagnostic value of high-frequency color Doppler ultrasound for differential diagnosis of ICMVT and gastrocnemius hematoma.</p><p><b>METHODS</b>A retrospective case series of 35 ICMVT (M:F, 21:14; mean age (64.5 ± 10.6) years) and 23 gastrocnemius hematoma (M:F, 16:7; mean age (75.4 ± 11.8) years) patients with bilateral/unilateral lower limb pain was conducted between January 2006 and September 2012. Characteristics and the morphology of high-frequency color Doppler ultrasonography of the lower limb deep vein, great saphenous vein, calf muscles, skin, and soft tissue were examined.</p><p><b>RESULTS</b>ICMVT hypoechoic signals were characterized by long, tube-like masses on longitudinal sections and oval masses on transverse sections, with apparent muscle thrombosis boundaries, distal and proximal venous connections, and, often, lower limb DVT. Gastrocnemius hematoma hypoechoic signals were characterized by large volumes, enhanced posterior hematoma echo, hyperechoic muscle boundaries, no hematoma blood flow, and no DVT, and clear differences in trauma/exercise- and oral anticoagulant-induced hematomas were readily apparent. According to the measurement, the ratio of long diameter/transverse diameter (D/T) in ICMVT patients was about less than 2.0, whereas in gastrocnemius hematoma patients the ratio was more than 2.0. Early stage isoechoic and hypoechoic signals were detected with gradually increasing ovular anechoic areas. Partial muscle fibers in the hematoma due to muscle fractures were apparent.</p><p><b>CONCLUSION</b>High-frequency color Doppler ultrasound was found to be a sensitive and reliable method for differential diagnosis of ICMVT and gastrocnemius hematoma due to trauma and exercise or prolonged oral anticoagulant use.</p>

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

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

Effects of Ciwujia in inducing marrow stromal cell differentiation into neuron-like cells in vitro / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the effect of the traditional Chinese herbal drug Ciwujia in inducing the differentiation of marrow stromal cells (MSCs) into neuron-like cells.</p><p><b>METHODS</b>Rat MSCs isolated from the whole bone marrow were amplified by adherent culture in vitro and induced to differentiate into neuron-like cells using serum-free DMEM/F12 containing Ciwujia. The protein and mRNA expressions of nestin, beta-Tubulin III and glial fibrillary acidic protein (GFAP) in the differentiated cells were detected by indirect immunofluorescence method, Western blotting and RT-PCR.</p><p><b>RESULTS</b>The third-passage MSCs showed positive expression rates for CD44 and CD54 beyond 90% with decreased CD14 expression rate to 2.37%. Induction by Ciwujia of the MSCs resulted in cell body shrinkage and protrusion of the cell processes resembling those of neurons. The differentiated cells were positive for nestin and beta-Tubulin III expression and negative for GFAP as shown by immunofluorescence assay, Western blotting and RT-PCR.</p><p><b>CONCLUSION</b>Ciwujia can induce the differentiation of rat MSCs into neuron-like cells in vitro.</p>

Study on corresponding areas the liver and lung channels in brain with fMRI / 中国针灸

<p><b>OBJECTIVE</b>To explore distribution of the Liver and Lung Channels in the brain so as to provide imaging basis for construction of channel theory in the brain.</p><p><b>METHODS</b>Sixty healthy student volunteers were randomly divided into a Liver Channel group (I) and a Lung Channel group (II), and the each group was further divided into five subgroups with 6 volunteers in each subgroup, based on five-shu-point principles which, were Dadun (LR 1, I 1), Xingjian (LR 2, I 2), Taichong (LR 3, I 3), Zhongfeng (LR 4, I 4), Ququan (LR 8, I 5), Shaoshang (LU 11, II 1), Yuji (LU 10, II 2), Taiyuan (LU 9, II 3), Jingqu (LU 8, II 4), and Chize (LU 5, II 5), respectively. In order to observe the brain activating patterns during acupuncture at the different acupoints, functional magnetic resonance imaging (fMRI) technique was adopted. All image data were then analyzed with SPM 2 software. The statistical parameter gram was composed of the pixel P < 0.01, and anatomic location was made according to Talairach coordinate, attaining experimentally activated areas, and the commonly activated area of five-shu-point of each channel was considered as the brain distribution of the Liver and Lung Channels.</p><p><b>RESULTS</b>The common areas activated by the five-shu-points of the Liver Channel were homolateral Brodmann area (BA) 34, BA 47, red nucleus, contralateral BA 19, BA 30, BA 39, the superior parietal lobule, cerebellum decline, and bilateral BA 3 and culmen. The common areas activated by the five-shu-points of the Lung Channels included homolateral BA 2, BA 18, BA 35, and contralateral BA 9 and substania nigra.</p><p><b>CONCLUSION</b>There are relatively specific corresponding brain areas for the Liver and Lung Channels, indicating that there is possible relatively specific connection between channels and the brain.</p>

Functional magnetic resonance image study on the brain areas involved in reading Chinese, English, and Nepali in Nepalese / 中南大学学报(医学版)

OBJECTIVE@#To explore the different brain areas activated by Chinese, English, and Nepali word tasks in Nepalese by using the functional magnetic resonance image (fMRI).@*METHODS@#To determine the neuroanatomic functional brain areas responsible for Chinese, English and Nepali reading as well as sentence-formation, blood oxygenation level dependent (BOLD) block design by fMRI was performed in 6 healthy Nepalese volunteers.@*RESULTS@#During Chinese reading, the activated areas included bilateral motor area, subfrontal gyri, superior temporal gyri, and superior parietal lobule; during English reading, the activated areas were left motor area, left subfrontal gyrus, left supra temporal gyrus, left insula and bilateral cerebellum; and the Nepali task demonstrated the activation of left anterior central gyrus, superior frontal gyrus, superior temporal gyrus. Aside from the bilateral occipital lobes, both English and Nepali activated areas were the left cerebral hemisphere dominant.@*CONCLUSION@#The more familiar with the language, the fewer areas are activated. Superior temporal gyrus might be involved in sentence-formation.