Value of multiparametric ultrasonography in the differential diagnosis of benign and malignant testicular lesions / 中华超声影像学杂志

Objective:To explore the value of multiparametric ultrasonography consisting of gray-scale ultrasound(US), color Doppler flow imaging (CDFI), real-time strain elastography(RTE), and contrast-enhanced ultrasound(CEUS) in the differential diagnosis of testicular lesions.Methods:Forty patients (40 lesions) detected by ultrasonography examination at the Ultrasound Medical Center of Lanzhou University Second Hospital from June 2020 to June 2022 were retrospectively analyzed, and further the CDFI, CEUS and RTE were performed. The presence of vascularization in the lesion was determined by CDFI and CEUS, avascular lesions were defined as benign, vascularization lesions were defined as malignant. The lesion tissue elasticity was assessed by real-time strain elastography, tissue stiffness was encoded as red(soft), green(intermediate), and blue(hard), and the hard lesions were defined as malignant, soft lesions were defined as benign. All lesions were subjected to pathological histologic examination after surgical resection or puncture biopsy as a reference standard. The correct classification rate, sensitivity, specificity and likelihood ratio of the multiparametric ultrasonography imaging for the diagnosis of benign and malignant testicular lesions were analyzed by ROC.Results:Of 40 testicular lesions, 24 (60.0%) were benign and 16 (40.0%) were malignant. The sensitivity of CDFI, CEUS and RTE in the diagnosis of testicular lesions was 0.875, 1.000 and 1.000, and the specificity was 0.833, 0.750 and 0.708, respectively. The correct classification rate was 85.0%, 85.0% and 82.5%, and the positive likelihood ratio was 5.24, 4.00 and 4.42, respectively. AUC was 0.781, 0.802, 0.771, respectively. By combining RTE and CDFI, a sensitivity of 1.000 and specificity of 0.875 and correct classification rate of 92.8% and positive likelihood ratio of 8.00 and AUC of 0.915 ( P<0.001) were achieved in differentiating testicular lesions. And combining RTE and CEUS, achieved sensitivity of 1.000 and specificity of 0.917 and correct classification rate of 95.0% and positive likelihood ratio of 12.0 and AUC of 0.958( P<0.001). Conclusions:Multiparametric US is of great value in the differential diagnosis of benign and malignant testicular lesions.

Effects of catgut embedding and PGLA embedding at "Zusanli" (ST 36) on skin mast cells, substance P and histamine in healthy rats / 中国针灸

OBJECTIVE@#To observe the effects of catgut embedding and polyglycolic acid/poly-lactic acid (PGLA) embedding at "Zusanli" (ST 36) on the activation of local skin mast cells (MC), and expression of substance P (SP) and histamine (HA), and to explore the mechanism of the temporal stimulation effect of acupoint catgut embedding and provide a foundation for further research on the initiation mechanism of acupoint catgut embedding.@*METHODS@#One hundred and sixty male SPF-grade SD rats were randomly divided into a blank group (10 rats), a sham-embedding group (50 rats), a catgut group (50 rats), and a PGLA group (50 rats). Each intervention group was further randomly divided into five subgroups according to the time points after intervention: 8 hours, 3 days, 7 days, 14 days, and 21 days, with 10 rats in each subgroup. One-time sham-embedding, catgut embedding and PGLA embedding was given at left "Zusanli" (ST 36) in each intervention group, respectively. The skin and subcutaneous connective tissue of the left "Zusanli" (ST 36) were collected at the corresponding time points after intervention, except for the blank group (only one day before intervention). Toluidine blue staining was used to detect MC count and degranulation, and immunohistochemical staining was used to detect the expression of SP and HA positive cells.@*RESULTS@#There was no significant difference in MC count between the subgroups of each intervention group and the blank group (P>0.05). There was no significant difference in MC count between the subgroups of the catgut group and the PGLA group (P>0.05). The MC count in the 8-hour subgroup of PGLA group was higher than that in the 8-hour subgroup of catgut group (P<0.05), while the MC count in the 21-day subgroup of PGLA group was lower than that in the 21-day subgroup of catgut group (P<0.05). Compared with the blank group, the degranulation rates of MC were increased in the 8-hour and 3-day subgroups of sham-embedding group, 8-hour, 3-day, and 7-day subgroups of catgut group, and 8-hour, 3-day, 7-day, and 14-day subgroups of PGLA group (P<0.01, P<0.05, P<0.001). There was no significant difference in the degranulation rate of MC between the subgroups of the catgut group and the PGLA group (P>0.05), and no significant difference in the degranulation rate of MC between the two embedding groups at the same time point (P>0.05). Compared with the blank group, the expression of SP positive cells was increased in the 8-hour subgroup of sham-embedding group, 8-hour, 3-day, 7-day, and 14-day subgroups of catgut group, and 3-day, 7-day, and 14-day subgroups of PGLA group (P<0.001, P<0.05). The expression of SP positive cells in the 7-day subgroup of catgut group was higher than that in the 8-hour subgroup of catgut group (P<0.05), while the expression of SP positive cells in the 14-day subgroup of catgut group was lower than that in the 7-day subgroup of catgut group (P<0.001). The expression of SP positive cells in the 7-day subgroup of PGLA group was higher than that in the 3-day subgroup of PGLA group (P<0.05), while the expression of SP positive cells in the 14-day subgroup of PGLA group was lower than that in the 7-day subgroup of PGLA group (P<0.01). There was no significant difference in the expression of SP positive cells between the subgroups of the two embedding groups at the same time point (P>0.05). Compared with the blank group, the expression of HA positive cells was increased in the 8-hour, 3-day subgroups of sham-embedding group, 8-hour, 3-day, 7-day, and 14-day subgroups of catgut group, and 8-hour, 3-day, 7-day, 14-day, and 21-day subgroups of PGLA group (P<0.001, P<0.01, P<0.05). The expression of HA positive cells in the 14-day subgroup of catgut group was lower than that in the 7-day subgroup of catgut group (P<0.05), while the expression of HA positive cells in the 3-day subgroup of PGLA group was higher than that in the 8-hour subgroup of PGLA group (P<0.05), and the expression of HA positive cells in the 14-day subgroup of PGLA group was lower than that in the 7-day subgroup of PGLA group (P<0.05). The expression of HA positive cells in the 3-day subgroup of PGLA group was higher than that in the 3-day subgroup of catgut group (P<0.05).@*CONCLUSION@#Catgut and PGLA embedding at "Zusanli" (ST 36) in healthy rats could induce changes in local skin MC, SP, and HA, which may be one of the mechanisms of the temporal stimulation effect after acupoint embedding. There are certain differences between different suture materials. A moderate inflammatory response in the acupoint area, mediated by MC and involving SP and HA, may be one of the initiating factors for the effect of acupoint catgut embedding.

Deep learning applied to two-dimensional color Doppler flow imaging ultrasound images significantly improves diagnostic performance in the classification of breast masses: a multicenter study / 中华医学杂志(英文版)

BACKGROUND@#The current deep learning diagnosis of breast masses is mainly reflected by the diagnosis of benign and malignant lesions. In China, breast masses are divided into four categories according to the treatment method: inflammatory masses, adenosis, benign tumors, and malignant tumors. These categorizations are important for guiding clinical treatment. In this study, we aimed to develop a convolutional neural network (CNN) for classification of these four breast mass types using ultrasound (US) images.@*METHODS@#Taking breast biopsy or pathological examinations as the reference standard, CNNs were used to establish models for the four-way classification of 3623 breast cancer patients from 13 centers. The patients were randomly divided into training and test groups (n = 1810 vs. n = 1813). Separate models were created for two-dimensional (2D) images only, 2D and color Doppler flow imaging (2D-CDFI), and 2D-CDFI and pulsed wave Doppler (2D-CDFI-PW) images. The performance of these three models was compared using sensitivity, specificity, area under receiver operating characteristic curve (AUC), positive (PPV) and negative predictive values (NPV), positive (LR+) and negative likelihood ratios (LR-), and the performance of the 2D model was further compared between masses of different sizes with above statistical indicators, between images from different hospitals with AUC, and with the performance of 37 radiologists.@*RESULTS@#The accuracies of the 2D, 2D-CDFI, and 2D-CDFI-PW models on the test set were 87.9%, 89.2%, and 88.7%, respectively. The AUCs for classification of benign tumors, malignant tumors, inflammatory masses, and adenosis were 0.90, 0.91, 0.90, and 0.89, respectively (95% confidence intervals [CIs], 0.87-0.91, 0.89-0.92, 0.87-0.91, and 0.86-0.90). The 2D-CDFI model showed better accuracy (89.2%) on the test set than the 2D (87.9%) and 2D-CDFI-PW (88.7%) models. The 2D model showed accuracy of 81.7% on breast masses ≤1 cm and 82.3% on breast masses >1 cm; there was a significant difference between the two groups (P < 0.001). The accuracy of the CNN classifications for the test set (89.2%) was significantly higher than that of all the radiologists (30%).@*CONCLUSIONS@#The CNN may have high accuracy for classification of US images of breast masses and perform significantly better than human radiologists.@*TRIAL REGISTRATION@#Chictr.org, ChiCTR1900021375; http://www.chictr.org.cn/showproj.aspx?proj=33139.

Time-effect reaction observation of micro-invasion embedded poly glycolide-co-lactide suture in Sanyinjiao (SP6) in healthy subjects by using magnetic resonance / 针刺研究

OBJECTIVE: To observe the time-effect of stimulation of the embedded poly glycolide-co-lactide (PGLA) suture in Sanyinjiao (SP6) area in normal human body, so as to provide an experimental evidence for clinical application of micro-invasion suture-embedding at an appropriate interval. METHODS: A total of 8 healthy volunteer students (3 boys and 5 girls, ranging in age from 24 to 27 years) were recruited in the present study. A piece of sterilized PGLA suture was implanted into the left SP6 using minimally invasive surgery after strict local skin disinfection. The fat-suppression T2 weighted magnetic resonance images (MRI, displaying local lesion after eliminating interference of fat tissue signals), and T2 mapping 8-echo train images were acquired before and 8 h, 3, 7, 10 and 14 days after PGLA suture embedment by using a MR imaging system. After transformation of the T2-mapping 8-echo train images into T2-mapping images by using a relevant software, the T2 values (meaning the relaxation time of the local muscle) of the left SP6 were measured, followed by analysis of the signal intensity of T2 weighted fat-suppression images and T2 values at different time-points. RESULTS: Before the suture embedding, no abnormal signals were found in the signal intensity of T2 weighted fat-suppression images. After PGLA suture embedment, the local signal intensity of T2WI fat-suppression images was relatively increased at the 8th h, and on day 3, 7, 10 and 14 relevant to pre-embedment, but gradually atte-nuated on day 10 and 14. The T2 values were significantly increased at the 5 time-points of post-embedment (all P0.05), and being markedly lowered on day 14 relevant to day 7 (P<0.01) in spite of being still markedly higher than that of pre-embedding (P<0.01). CONCLUSION: The signal intensity of T2 weighted fat-suppression images and T2 values acquired from PGLA-suture-embedded SP6 acupoint area in healthy subjects may keep at least for 2 weeks, suggesting that the stimulating reaction of suture-embedment persists more than 14 days. Hence, when a micro-invasion embedding with PGLA suture performed, the interval of two weeks would be appropriate.

Observation on time-effect for the stimulating at Zusanli (ST 36) with minimally invasive embedding with PGLA in the healthy person / 中国针灸

OBJECTIVE@#To explore the objectivity and time-effect of stimulating effect at acupoint with PGLA in the healthy person, and to provide a basis for the rational interval of minimally invasive embedding of PGLA.@*METHODS@#Before embedding, 8 h, 3rd, 7th, 10th, 14th day after embedding, medical imaging magnetic resonance imaging (MRI) scanning technique was used to collect local T2WI pressure-lowering and T2-Mapping 8 echoes sequence image of left Zusanli (ST 36) in 8 cases of healthy person. The T2-Mapping 8 echoes sequence image was generated by the relevant software to the T2-Mapping image and the local T2 value was measured. The characteristics of local T2WI pressure-fat image signal intensity and the change of T2 value at left Zusanli (ST 36) with minimally invasive embedding with PGLA were observed and analyzed.@*RESULTS@#①There was no abnormal signal on the T2WI pressure-fat image on the left Zusanli (ST 36) point before the embedding. The high-signal was seen on the local T2WI pressure-fat image at each time point after embedding, there was no significant difference in local signal intensity between 8 h, 3rd and 7th day after embedding. The local signal intensity decreased on the 10th day after embedding, and the local signal intensity decreased significantly on the 14th day after embedding.②The T2 value at each time point after embedding increased significantly compared with that before embedding (all 0.05); there was no significant difference between the T2 value on the 7th and the 10th day after embedding (>0.05)，the T2 value on the 14th day after embedding was significantly lower than that on the 7th day after embedding (<0.01).@*CONCLUSION@#It has a stimulating effect on the local acupoints with minimally invasive embedding with PGLA in the healthy person, and the stimulating effect has certain time-effect. The effective stimulation time is about 2 weeks. The rational interval period for the minimally invasive embedding with the PGLA of the same specification type should be about 2 weeks.

Affinity characterization of GE11 peptide to brain metastases from epidermal growth factor receptor-overexpressing human breast cancer / 中华核医学与分子影像杂志

Objective@#To investigate the feasibility of GE11 peptide targeting to brain metastases from epidermal growth factor receptor (EGFR)-positive breast cancer and thereby explore the potential for the construction of specific targeting molecular probe.@*Methods@#The EGFR expression level of triple negative breast cancer cell line (MDA-MB-231-BR) was detected using Western blot and flow cytometry. GE11 peptide targeting property was tested using immunofluorescence staining and flow cytometry in MDA-MB-231-BR cells and in the subcutaneous tumor model. GK-13 peptide was selected as the control peptide. Two-sample t test was used for data analysis.@*Results@#Western blot and flow cytometry showed that EGFR expression in MDA-MB-231-BR cells was 88.60%, significantly higher than those in other cells. Flow cytometry results indicated that the cell binding rate of MDA-MB-231-BR with GE11 peptide (10 μmol/L) was significantly higher than that with control peptide (38.4% vs 0.6%; t=16.941, P<0.01). Cell immunofluorescence staining results showed GE11 peptides were detected with stronger signal after being incubated with cells, and the combination was concentration- and temperature-dependent. In vivo experiment results showed that the signal of GE11 peptide was stronger in tumor site than that in other organs or tissues.@*Conclusion@#GE11 peptide may specifically target the brain metastases of EGFR-positive breast cancer.

Feasibility of Aortic Dissection Occlusion via Mini-thoracotomy by Trans-esophageal Echocardiography Guidance / 中国循环杂志

Objectives: To explore the feasibility of aortic dissection (AD) occlusion via mini-thoracotomy by trans-esophageal echocardiography (TEE) guidance. Methods: Pre-operative TEE was conducted in 2 AD patients, the findings were compared with trans-thoracic echocardiography (TTE) to confirm the diagnosis with quantitative evaluation in order to accurately guiding the wire and sheath pipe into the rupture crevasse of AD for assessing the position, stability and the effect of closure device on local blood flow. Results: TEE confirmed that 2 patients could be treated by interventional plugging and the crevasses of AD were successfully blocked by TEE guidance. Case 1 had DeBakey II AD, crevasse shunt disappeared upon blocking, false lumen formed thrombosis, the diameter reduced form 40 mm to 28 mm and the cavity was retracted about 40%. Case 2 had the ulcer type AD located in aortic arch, closure device was closely suit to aortic wall, spread well and crevasse shunt disappeared;blood flow in aortic arch was about 110 cm/s which was similar at pre- and post-operation, no vascular stenosis and local dilatation were found, vital sign was stable. Follow-up TTE was performed at 1 month after the operation which showed the position of closure devices were normal in both patients. Conclusions: TEE could effectively confirm pre-operative AD diagnosis and provide intuitive image and quantitative information for accurately guiding closure position and evaluating surgical result. Mini-thoracotomy with TEE guidance is feasible for interventional therapy of AD.

Influence of lyophilized rhBNP on Chemerin and Gal-3 levels in aged AMI patients / 心血管康复医学杂志

Objective :To explore influence of lyophilized recombinant human brain natriuretic peptide (rhBNP) combined routine treatment on levels of Chemerin (a new adipocytokine) and Galectin (Gal)-3 in aged AMI patients.Methods :A total of 120 aged AMI patients treated in our hospital were randomly and equally divided into routine treatment group and rhBNP group (received rhBNP based on routine treatment ) ,both groups were treated for 3d.Vascular endothelial func-tion ,levels of Chemerin and Gal-3 before and after treatment and incidence rate of adverse reactions within one year were observed and compared between two groups .Results :Compared with before treatment ,after treatment ,there were signifi-cant rise in fore brachial artery endothelium dependent diastolic-systolic function (FMD) and NO level ,and significant re-ductions in levels of ET-1 ,Chemerin and Gal-3 in two groups ,P＝0.001 all.Compared with routine treatment group after treatment ,there were significant rise in FMD [ (9.5 ± 2.5)% vs.(14.1 ± 3.4)%] and NO level [ (37.2 ± 3.1) μmol/L vs.(43.2 ± 5.7) μmol/L] ,and significant reductions in levels of ET-1 [ (72.1 ± 9.9) ng/L vs.(61.8 ± 8.5) ng/L] , Chemerin [ (25.2 ± 3.8) μg/ml vs.(16.9 ± 4.2) μg/ml] and Gal-3 [ (9.3 ± 1.4) ng/ml vs.(6.7 ± 1.2) ng/ml] in rhB-NP group ,and each HRV index of rhBNP group was significantly higher than that of routine treatment group , P＝0.001 all.Compared with routine treatment group after one-year follow-up , there were significant reductions in mortality (13.3% vs.1.7%) and incidence rate of cardiac insufficiency (18.3% vs.5.0%) in rhBNP group , P＜0.05 both .Con-clusion :Lyophilized rhBNP can significantly improve vascular endothelial function and HRV , reduce serum levels of Chemerin and Gal-3 and improve prognosis in AMI patients .

Comparison of the value of contrast enhanced ultrasound and International Ovarian Tumor Analysis ( IOTA) simple rules in the differential diagnosis of adnexal tumors / 中华超声影像学杂志

Objective To campare the diagnostic value of contrast-enhanced ultrasound(CEUS) and International Ovarian Tumor Analysis (IOTA) simple rules in the differential diagnosis of adnexal tumors . Methods For the 101 suspicious malignant adnexal tumors discovered by conventional ultrasound ,IOTA simple rules and CEUS were performed before operation . Tumors were divided into benign ,uncertain and malignant according to IOTA simple rules . Tumors were scored by CEUS according to the membrane integrity ,coating thickness uniformity ,separation enhancement ,enhance strength ( no enhancement ,low enhancement ,equal or high enhancement) ,and enhanced performance( uniform and non-uniform) . The ROC curve was drawn with the pathological results as the gold standard ,and the best boundary value was obtained . Finally ,the diagnostic efficiency of the diagnostic methods were analyzed . Results ①According to the ROC curve analysis ,the area under the curve of IOTA simple rules was 0 .757( P ＝0 .000) . When the uncertainty type was classified as benign ,the random index was 0 .41 ,the sensitivity was 61 .54% ,and the specificity was 79 .59% . When the uncertainty type was classified as malignant ,the random index was 0 .31 ,the sensitivity was 96 .15% ,and the specificity was 34 .69% . When the uncertain types were excluded the Youden index was 0 .77 ,the sensitivity was 76 .19% ,and the specificity was 89 .47% . ②The differences in the membrane integrity , coating thickness uniformity , separation enhancement , enhance strength , enhanced performance between benign and malignant tumors were statistically significant( P ＜ 0 .01) . ③According to the ROC curve analysis ,the area under the curve of CEUS was 0 .914( P ＝ 0 .000) ,cut-off value was 3 score . The Youden index ,sensitivity and specificity of evaluating benign and malignant adnexal tumors were 0 .80 ,78 .85% and 91 .84% respectively . ④ The tumors evaluated as benign by IOTA simple rules was classified as benign . The tumors evaluated as malignant by IOTA simple rules were classified as malignant . The tumors evaluated as uncertain by IOTA simple rules and scored less than or equal to 3 points according to CEUS were classified as benign . The tumors evaluated as uncertain by IOTA simple rules and scored more than 3 points according to CEUS were classified as malignant . According to the ROC curve analysis ,the area under the curve of CEUS combined with IOTA simple rules was 0 .831 ( P ＝0 .000) . The Youden index ,sensitivity and specificity in evaluating benign and malignant adnexal tumors were respectively 0 .66 ,86 .54% and 79 .59% respectively . Conclusions CEUS has a higher diagnostic efficiency than IOTA Simple Rules and the two combined in the diagnosis of adnexal tumors .

Craniocerebral ultrasonography in evaluation on correlation between brain development with gestational age and birth weight of neonatal brain / 中国医学影像技术

Objective To explore the value of craniocerebral ultrasonography in evaluation on neonatal brain development.Methods Totally 135 newborns were collected in neonatal intensive care unit.The sagittal length of the corpus callosum and the sagittal length of the cerebellar vermis were measured on the day of birth.The impact of gestational age and birth weight on the development of the corpus callosum and cerebellar vermis were analyzed.Results The mean sagittal length of corpus callosum at birth in premature infants and term infants was (39.18 ± 2.53) mm and (41.62 ± 3.28) mm,respectively (t =4.87,P＜0.05).The sagittal length of cerebellar vermis in premature infants and term infants was (19.03 ±2.00)mm and (20.91 ±2.29)mm,respectively (t=5.05,P＜0.05).The length of the corpus callosum was positively correlated with gestational age and birth weight (rs =0.45,0.51,both P ＜ 0.05),while the sagittal length of cerebellar vermis was positively correlated with gestational age and birth weight (rs =0.42,0.46,both P＜0.05).The length of the corpus callosum was positively correlated with the length of cerebellar vermis (rs =0.43,P ＜0.05).Conclusion Craniocerebral ultrasonography can be used to dynamically observe the neonatal intracranial structure and the development of corpus callosum and cerebellar vermis,therefore providing reliable references for clinical intervention.

Feasibility of transesophageal echocardiography guided transthoracic incision closure of aortic sinus aneurysm rupture / 中国医学影像技术

Objective To explore the feasibility of transesophageal echocardiography (TEE) guided transthoracic incision closure of aortic sinus aneurysm rupture (RASA).Methods Data of 30 patients with RASA underwent TEE guided transthoracic incision closure of RASA were retrospectively analyzed.The distance between the coronary artery ostium and crevasse was measured in right coronary sinus aneurysm rupture patients.During the operation,the guide wire and sheath pipe were guided accurately into rupture mouth of aortic sinus aneurysm with TEE.After the operation,the position of closure and the function of aortic valves were checked carefully,while in right coronary sinus aneurysm rupture patients,coronary ostium should not be occluded by the occluder.Results Totally 20 of 30 patients accepted interventional treatment successfully.Right coronary sinus aneurysm rupture was found in 10 patients,including 7 with rupture developing into right ventricle and 3 with rupture into right atrium.Posterior coronary sinus tumor rupture was found in 10 patients,including 8 with rupture developing into right atrium and 3 with rupture into right ventricle.Patients who received intervention treatment successfully had stable vital signs,and no obvious changes of heart cavity structure and cardiac function was found.Postoperative multiple reexaminations showed all patients had normal closure position,aortic valve opening and closing movement was normal.No stenosis,reflux signal nor residual shunt were found.Conclusion RASA can be diagnosed accurately with TEE,and the occluder can be placed guided by TEE.TEE guided transthoracic incision closure of RASA is a feasible method.

Clinical study on Yishen Qufeng Shengshi Recipe () for glomerular proteinuria patients: A randomized controlled trial / 中国结合医学杂志

<p><b>OBJECTIVE</b>To explore the therapeutic effect of Yishen Qufeng Shengshi Recipe (, YQSR) in patients with glomerular proteinuria METHODS: A total of 145 patients with glomerular proteinuria were selected and randomly assigned to the treatment group (108 cases) and the control group (37 cases) according to a random number table in a ratio of 3:1. All patients received conventional and symptomatic treatment. In addition, patients in the treatment and control groups were given YQSR (200 mL, twice per day, orally) and losartan (50 mg/d orally), respectively for 6 months. The 24-h urine protein quantity, blood urea nitrogen, and serum creatinine in the two groups were measured at multiple time points before and after treatment.</p><p><b>RESULTS</b>At the end of the study, 5 cases were lost to follow-up in the treatment group and 1 in the control group. Finally, the statistical data included 103 cases in the treatment group and 36 cases in the control group. The total effectiveness after 2, 4, and 6 months was 81.6% (84/103), 87.4% (90/103), and 92.2% (95/103), respectively, in the treatment group and 47.2% (17/36), 55.6% (20/36), and 61.1% (22/36), respectively, in the control group, with significant difference between the two groups (P<0.01 at all observation points). In the treatment group, the curative effect after 6 months was better than that after 2 months (P<0.05). The 24-h urine protein quantity was significantly lower in the treatment group at 3, 4, 5, and 6 months than that in the control group (P<0.05 or P<0.01, respectively) CONCLUSION: YQSR could significantly reduce the amount of glomerular proteinuria in the early stage.</p>

Ultrasonographic Evaluation of Infundibular Bladder Neck Formation in Female Stress Urinary Incontinence / 中国医学影像学杂志

Purpose To investigate the relationship of infundibular bladder neck formation with pelvic floor support structure injury and urethral sphincter defect and its significance in female stress urinary incontinence.Materials and Methods The pelvic floor images of seventy-four female patients with stress urinary incontinence treated in the outpatient Department of Lanzhou University Second Hospital from April 2015 to August 2016 were analyzed retrospectively.The location of the bladder neck,posterior vesicourethral angle and the infundibular bladder neck formation were observed by the transperineal ultrasound under the resting state and the maximum Valsalva status.Meanwhile the thickness of middle urethral sphincter was measured under resting state.At the same time,eighty-one women visiting our hospital for regular physical examination were enrolled as control group.Results The infundibular urinary bladder neck formation rate (66.2％) in the stress urinary incontinence group was significantly higher than that in the control group (4.9％) under maximum Valsalva state,the difference was statistically significant (P＜0.05).The extent of the bladder neck descending and posterior vesicourethral angle in the stress urinary incontinence group were notably higher than those in the control group,both of the difference was statistically significant (P＜0.05).Stress urinary incontinence was confirmed with urethral sphincter defect by urodynamics in nine patients,in whom the infundibular bladder neck occurred.The thickness of the middle urethral sphincter in these nine patients showed no obvious difference with that in patients without sphincter defect and subjects in normal control group (P＞0.05).Conclusion The infundibular bladder neck formation,which is closely related to the pelvic floor support structure dysfunction and urethral sphincter defect,is an important indication of stress urinary incontinence.However,the assessment of urethral sphincter defect through urethral sphincter thickness need to be further studied.

Application of contrast enhanced ultrasound combined biopsy in qualitative diagnosis of peripheral pulmonary lesions / 中国介入影像与治疗学

Objective To investigate the application value of CEUS combined with biopsy in qualitative diagnosis of pe ripheral pulmonary lesions.Methods A total of 158 patients with peripheral pulmonary lesions underwent percutaneous puncture biopsy.Among them,97 cases underwent CEUS before biopsy (experiment group),and 61 cases underwent conventional ultrasound (control group).Puncture times,positive rate of samples pathological diagnosis and occurrence rate of complications were compared between the two groups.The time intensity curve (TIC) was used to obtain the rise time (RT),time to peak (TTP),wash-in slope (WIS) and peak intensity (PI).The parameters of TIC between the two groups were compared.The enhanced morphology of lesions was also observed and recorded.Results The positive rate of samples pathological diagnosis was 94.85 ％ (92/97) in experiment group and 83.61％ (51/61) in control group.The difference of the positive rate was significant between the two groups (P=0.02).In experiment and control group,the average puncture times were 2.11±0.48 and 2.20±0.44;While the occurrence rate of complications were 2.06％ (2/97) and 4.91％ (3/61).No significant difference was found of the average puncture times and the occurrence rate of complications between the two groups (both P＞0.05).While the statistical differences of RT,PI and WIS were found between benign and malignant lesions (all P＜0.05) in experiment group.And no statistical difference of TTP was found (P =0.08).Totally 77.50％ (31/40) of the benign lesions showed inhomogeneous enhancement,while the proportion was 88.46％ (46/52) in malignant lesions.There was no statistical difference of enhanced morphology between benign and malignant lesions (P=0.16).Conclusion CEUS is helpful in distinguishing benign and malignant peripheral pulmonary lesions.And it has great value in guiding percutaneous biopsy in peripheral pulmonary lesions.

CEUS in diagnosis of TI-RADS 3, 4 thyroid nodules / 中国医学影像技术

Objective To explore the diagnostic value of CEUS for thyroid TI-RADS 3,4 nodules.Methods The CEUS performence of 95 patients with thyroid TI-RADS 3,4 nodules (all were confirmed by surgery pathology) diagosed by conventional ultrasound were reviewed retrospectively,and the value of CEUS in the revision and differential diagnosis of thyroid TI-RADS 3,4 nodules were analyzed.Results Compared with pathological pattern,conventional ultrasound TI-RADS classifications in assessing the property of thyroid nodule had no statistical differences (χ2 =3.56,P =0.06).For thyroid TI-RADS 3,4 nodules,compared with conventional ultrasound TI-RADS classifications,the diagnosis accuracy of CEUS score and revised CEUS TI-RADS classifications showed significant differeces respectively (P=0.03,＜0.01) for thyroid papillary carcinoma greater than 1 cm.But no statistical difference were found respectively (P=0.25,1.00) for thyroid papillary carcinoma smaller than 1 cm.According to the ROC curve analysis,the area under the curve of traditional ultrasound TI-RADS classifications,CEUS score and revised CEUS TI-RADS classifications were 0.64,0.75,0.81 respectively,cut-off value was TI-RADS 4a,1 score,TI-RADS 4a respectively,the sensitivity and specificity of evaluating benign and malignant nodules was 45.3％ and 80.0％,69.3％ and 65.0％,82.7％ and 60.0％,respectively.The area under the ROC curve were statistical difference between CEUS score,revised CEUS TI-RADS classifications and conventional ultrasound TI-RADS classifications (both P＜0.05),while CEUS score and revised CEUS TI-RADS classifications without statistical difference.Conclusion CEUS had the revised and improved identification value for thyroid TI-RADS 3,4 nodules.

Acoustic radiation force impulse imaging technique in differential diagnosis of renal tumors / 中国医学影像技术

Objective To evaluate the value of acoustic radiation force impulse imaging (ARFI) technique in differential diagnosis of renal tumors.Methods Totally 86 patients with 86 renal tumors underwent conventional ultrasound and ultrasound with ARFI technique.The shear wave velocity (SWV),virtual touch tissue imaging (VTI) score between tumors and the surrounding renal parenchyma,benign and malignant tumors were compared.Results In 86 patients with renal tumors,32 cases were renal benign tumors and all them were angiomyolipomas (AML),54 cases were renal malignant tumors,inculding 26 cases of renal clear cell carcinoma (ccRCC),8 cases of renal color cell carcinoma (cRCC),5 cases of renal papillary carcinoma (pRCC),15 cases of invasive urothelial carcinoma (IUC).The difference of SWV and VTI scores between lesions and the surrounding renal parenchyma were statistically significant (both P＜0.05).The SWV and VTI score renal benign tumors were lower than those of malignant tumors (both P＜0.05).The area under the ROC curve with SWV＞1.37 m/s or VTI score＞3.83 to distinguish benign and malignant renal tumors were 0.898,0.847,sensitivity were 88.9％,83.3％,specificity were 84.4％,78.1％,respectively (P＜0.05).Among renal malignant tumors,SWV and VTI score of ccRCC significantly higher than those of other malignant tumors,and the area under the ROC curve with SWV＞2.06 m/s or VTI score＞4.31 to distinguish ccRCC and other renal malignant renal tumors were 0.766,0.729,sensitivity were 65.4％,57.7％,specificity was 82.1％,78.6％,respectively (P＜0.05).Conclusion ARFI has important value in differential diagnosis of renal tumors,and can help to distinguish ccRCC with other renal malignant tumors.

Optimization of process for standardizing antimicrobial use opportunity in consecutive operations / 中国感染控制杂志

Objective To optimize antimicrobial use process,ensure the rational use of preoperative antimicrobial prophylaxis during consecutive operations.Methods Antimicrobial use process in a hospital in December 2015 was optimized,6 072 cases of consecutive operations in May-November 2015 were selected as control group,5 832 cases of consecutive operations in December 2015-May 2016 were as trial group,the qualified rate of rational use of antimicrobial agents was compared between two groups,causes for delayed/prior use was analyzed.Results Before and after the optimization of antimicrobial use process,rates of antimicrobial use were 77.16％ and 78.80％ respectively,there was significant difference between two groups(x2 =8.305,P =0.004).After the optimization of antimicrobial use process,rate of antimicrobial use within 0.5-1 hour was significantly higher than that before the optimization (82.36％ vs 41.11％);rate of antimicrobial use ＜0.5 hour before skin incision decreased from 57.11％ before optimization to 4.32％ after optimization;but rate of antimicrobial use ＞1 hour before skin incision increased from 1.78％ to 13.32％.Causes for delay/prior use of antimicrobial agents was due to the lack of effective communication between doctors and nurses,which resulted in circuit nurses' inaccurate assessment on interval of consecutive operations(62.13％),the duration of intubation or puncture was too long for anesthesiologists (13.57％).Conclusion Optimizing antimicrobial use process in consecutive operations can improve prophylactic antimicrobial use rate within 0.5-1 hour,and is helpful for ensuring the efficacy of antimicrobial prophylaxis.

The role of quantitative analysis of contrast-enhanced ultrasound combined with tumor marker in the diagnosis of peripheral pulmonary lesions / 中华超声影像学杂志

Objective To explore the value of contrast enhanced ultrasound (CEUS) in the diagnosis of peripheral pulmonary lesions,and to evaluate the diagnostic efficiency of CEUS combined with tumor markers peripheral lung cancer.Methods According to the pathological results,105 patients with 105 peripheral pulmonary lesions were divided into benign (50 cases) and malignant group (55 cases).Before CEUS examination,lesions' location,size,shape and internal echogenicities were recorded by twodimensional (2D) ultrasound.After contrast agent injection,arrive time (AT) in the lesion,difference of AT between the lesion and lung (tAT),and lesions' enhanced morphology were observed.The time intensity curve (TIC) was used to obtain the rise time (RT),mean transit time (MTT),time from peak to one half of peak(TPH),time to peak (TTP),peak intensity (PI) and wash-in slope (WIS).The parameters of TIC between the two groups were compared.Serum carcino-embryonic antigen (CEA),neuron specific enolase (NSE) and cyrokeratin fragment antigen 21-1 (CYFRA21-1) level were detected and analyzed between the two groups.Results Lesions' shape and intralesional bronchial syndrome had significant difference in the diagnosis of peripheral pulmonary benign and malignant lesions (P ＜0.01).In benign group,27 lesions (54.00％,27/50) were enhanced in late pulmonary arterial phase and 32 lesions(64.00％,32/50) showed homogeneous enhancement.At the meantime,in malignant group,most of lesions (76.36％,42/55) were enhanced in bronchial arterial phase and 36.00％ (18/50) of lesions indicated inhomogeneous enhancement.The difference of enhanced phase and morphology between benign and malignant lesions were significant (all P ＜0.05).While the statistical differences of such quantitative parameters AT,tAT,RT,TTP,PI and WIS,except to MTT and TPH were found between benign and malignant lesions (all P ＜0.05) in experiment group.In the diagnosis of peripheral lung cancer,the accuracy and specificity of tAT combined with joint detection of 3 kinds of tumor markers were 76.37％ and 75.00％,respectively,and higher than any single detection,but the sensitivity was a little lower (76.47％).Conclusions CEUS quantitative analysis has certain value in the diagnosis of benign and malignant peripheral lung lesions,and combined with tumor markers can improve the diagnostic efficiency of peripheral lung cancer.

Application of intraoperative transesophageal echocardiography for occluding the rupture of aortic sinus aneurysm by cardiac interventional therapy via mini-thoracotomy / 中华超声影像学杂志

Objective To assess the application of intraoperative transesophageal echocardiography for occluding the rupture of aortic sinus aneurysm ( RASA ) by cardiac interventional therapy via mini thoracotomy . Methods After anesthesia transesophageal echocardiography ( TEE ) was performed in patients with RASA to confirm or correct primary diagnosis from transthoracic echocardiography( TTE) and to predict the operative effect . During the operation the guide wire and Sheath pipe were accurately guided into rupture mouth of aortic sinus aneurysm by TEE . After the operation ,the position of closure and the function of aortic valve need to check carefully . Results Collection of 38 patients with aortic sinus aneurysm rupture ,20 patients who can be received interventional therapy were select by TEE . Sixteen patients accepted interventional treatment successfully ,including 8 cases with non‐coronary sinus tumor to break into the right atrium ,5 cases with non‐coronary sinus tumor to break into the right ventricle ,and 3 cases with right coronary sinus tumor to break into the right ventricular outflow tract ( 3 cases) . The patients who received intervention treatment successfully had stable vital signs ,and no obvious changes of heart cavity structure and cardiac function in normal . Postoperative multiple reexamination ,all patients showed the normal closure position ,aortic valve opening and closing movement . And no stenosis and reflux signal ,no residual shunt was detected . Conclusions TEE can confirm or correct primary diagnosis of TTE before the operation and guide the surgery operator to place the closure correctly during the operation and evaluate the effect of the treatment after the operation .

Biocompatible and biodegradable nanoparticles for enhancement of anti-cancer activities of phytochemicals / 中国天然药物

Many phytochemicals show promise in cancer prevention and treatment, but their low aqueous solubility, poor stability, unfavorable bioavailability, and low target specificity make administering them at therapeutic doses unrealistic. This is particularly true for (-)-epigallocatechin gallate, curcumin, quercetin, resveratrol, and genistein. There is an increasing interest in developing novel delivery strategies for these natural products. Liposomes, micelles, nanoemulsions, solid lipid nanoparticles, nanostructured lipid carriers and poly (lactide-co-glycolide) nanoparticles are biocompatible and biodegradable nanoparticles. Those nanoparticles can increase the stability and solubility of phytochemicals, exhibit a sustained release property, enhance their absorption and bioavailability, protect them from premature enzymatic degradation or metabolism, prolong their circulation time, improve their target specificity to cancer cells or tumors via passive or targeted delivery, lower toxicity or side-effects to normal cells or tissues through preventing them from prematurely interacting with the biological environment, and enhance anti-cancer activities. Nanotechnology opens a door for developing phytochemical-loaded nanoparticles for prevention and treatment of cancer.