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Objective:To explore the risk factors of microvascular invasion (MVI) in hepatocellular carcinoma (HCC), and to predict MVI preoperatively, non-invasively and accurately.Methods:A total of 150 HCC patients (183 HCC lesions) were retrospectively collected in the First Affiliated Hospital of Xi′an Jiaotong University from January 2016 to June 2022.The clinical data and hematological data, gray-scale ultrasonography (US), contrast-enhanced ultrasonography (CEUS), enhanced magnetic resonance imaging with gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (EOB-MRI) and pathological data of these patients were recorded. According to the pathological diagnosis of MVI, the lesions were divided into MVI (+ ) group and MVI (-) group. The indicators between the two groups were compared. All 183 lesions were put into the training set, and the prediction model with nomogram was constructed according to the risk factors of MVI selected by multivariate Logistic regression. The internal verification was carried out by ten-fold cross-validation method.Results:There were significant statistical differences in the following parameters between MVI (+ ) group ( n=109) and MVI (-) group ( n=74) (all P<0.05). These were cirrhosis, serological parameters (alpha-fetoprotein, albumin, total bilirubin), qualitative indexes of US (size, boundary, internal echo), qualitative indexes of CEUS (hyper/iso/hypovascularity of lesions in arterial phase, portal phase, and delayed phase compared with hepatic parenchyma), and quantitative indexes of EOB-MRI [post enhancement rate (post ratio) and gadolinium disodium rate (EOB ratio)] calculated mainly in terms of lesions and surrounding liver parenchyma in hepatobiliary phase and unenhanced T1 images). Finally, cirrhosis of patients, the size, boundary, internal echo of lesions in US; arterial phase (AP), portal phase (PP), post-vascular phase (PVP) features in CEUS; the EOB rate and post rate of EOB-MRI entered the prediction model of MVI. The training set exhibited good calibration and net gain rate. The areas under the ROC curve for the training set and the validation set were 0.981 and 0.961, respectively, while the diagnostic accuracy were 92.9% and 85.8%, respectively. Conclusions:The model constructed mainly by multimodality imaging methods can achieve favorable predictive performance for MVI, which provides valuable ideas for noninvasively predicting the incidence of MVI and optimizing the MVI-related treatment of MVI in HCC patients.
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Objective:To explore the application value of two-dimensional speckle tracking imaging (2D-STI) in evaluating diaphragm function, and to compare the ability of 2D-STI and conventional diaphragm ultrasonography in diagnosing diaphragmatic dysfunction and evaluating disease severity in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods:A total of 58 AECOPD patients admitted to the First Affiliated Hospital of Xi′an Jiaotong University from January to October 2021 were retrospectively enrolled as AECOPD group, and 34 healthy subjects were recruited as control group during the same period. Repeatability test of diaphragmatic 2D-STI was performed. According to modified Medical Research Council (mMRC) dyspnea scores system and COPD Assessment Test (CAT), mMRC 0-1 and CAT<10 was classified as group A, mMRC≥2 and CAT≥10 was classified as group B. The baseline characteristics, conventional diaphragm ultrasonography parameters(thickening fraction and excursion) and 2D-STI parameters (longitudinal and radial strains) were compared between the AECOPD group and the control group, and the Spearman correlation between parameters of AECOPD group and forced expiratory volume in one second (FEV1) was analyzed. The differences of these parameters between group A and B were also compared. The ROC curve of conventional diaphragm ultrasonography parameters and 2D-STI parameters was plotted to differentiate group A from group B, and the diagnostic efficacy was evaluated.Results:Great intra- and inter-observer reproducibility was found for all diaphragmatic 2D-STI parameters, with ICCs above 0.80 for all measurements. The control group and the AECOPD group did not differ in age, sex and body mass index( P>0.05), whereas there were significant differences in smoking history, lung function, bilateral thickening fraction, excursion, longitudinal and radial strains( P<0.05). Compared with control group, patients in group A had a significant increase in diaphragm thickness ( P<0.05), while there was no significant difference in that between group B and control group ( P>0.05). The bilateral longitudinal strains, radial strains and thickening fraction of diaphragm were linearly correlated with FEV1 (right side rs=0.828, 0.794, 0.843, respectively; all P<0.001; left side rs=0.757, 0.704, 0.752, respectively; all P<0.001 ), while the correlation between excursion and FEV1 was not significant(right side rs=0.247, left side rs=0.253; all P>0.05). There were significant differences in bilateral longitudinal strains, radial strains and thickening fraction between group A and group B(all P<0.05), whereas there was no significant difference in excursion between the two groups ( P>0.05). ROC analysis showed bilateral longitudinal and radial strains had higher accuracy in distinguishing group A from group B than thickening fraction and excursion(right side AUCs 0.90, 0.84, 0.78 and 0.62, respectively; left side AUCs 0.85, 0.83, 0.77 and 0.62, respectively). Conclusions:2D-STI is a real-time noninvasive technique for diaphragm function assessment, which has high clinical value. Compared with conventional ultrasonography, 2D-STI shows more accuracy and effectiveness in diagnosing diaphragmatic dysfunction and evaluating disease severity of patients with AECOPD.
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After the promulgation and implementation of the Vaccine Administration Law of the People’s Republic of China， the compensation of suspected adverse reactions in China is to be reformed and innovated. There have been attempts at compensation through government finance and insurance， but there has been no precedent for a fund of vaccine-related compensation in China， which means that this could be a new method of solving disputes of compensation for vaccine-related incidences and enhancing public confidence in vaccination. It is suggested that under the current system， we can select a province as a pilot to explore the fund compensation mechanism. The fund comes from special financial allocation， special taxation of vaccine enterprises， fund investment income， charitable donation and other channels. Through a special fund management organization， the independent identification and compensation process can be realized， so as to shorten the current compensation procedure， improve the amount of compensation， ultimately protect the interests of all parties， and promote the steady development of vaccination.
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ObjectiveTo investigate the role of hepatic stellate cell (HSC) inflammation in the pathogenesis of acute-on-chronic liver failure (ACLF). MethodsA total of 45 male Kunming mice were randomly divided into control group, model group, and N-acetylcysteine (NAC) group. The mice in the model group and the NAC group were given injection of human serum albumin to establish a model of chronic liver disease, followed by intraperitoneal injection of the endotoxins lipopolysaccharide (LPS) and D-galactosamine (D-GlaN) to induce ACLF, and those in the control group were given injection of an equal volume of normal saline; the mice in the NAC group were given NAC since 1 week before the induction of NAC. The mice in the model group and the NAC group were sacrificed at 48 hours after the injection of LPS and D-GlaN. ELISA was used to measure the serum levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) and the levels of malondialdehyde (MDA) and superoxide dismutase (SOD) in liver tissue; HE staining was used to determine liver pathological score; ELISA was used to measure the serum levels of LPS and interleukin-1β (IL-1β). LX2 cells were stimulated by LPS and H2O2 with the presence or absence of NAC, and ELISA was used to measure the levels of IL-1β and interleukin-6 (IL-6) in medium. LX2 cells were stimulated by LPS and H2O2, and then HL7702 cells were cultured with LX2 medium; Western blot was used to measure the expression of caspase-3 and caspase-8 in HL7702 cells, and flow cytometry was used to measure the apoptosis of HL7702 cells. A one-way analysis of variance was used for comparison of continuous data between multiple groups; the least significant difference t-test was used for comparison of data with homogeneity of variance between two groups, and the Tamhane’s T2 test was used for comparison of data with heterogeneity of variance. The Kaplan-Meier survival analysis was used to evaluate survival time, and the log-rank test was used for comparison. ResultsAt 48 hours, all mice in control group survived, while 3 mice in the model group and 8 mice in the NAC group survived, suggesting that the NAC group had a better survival rate of mice than the model group (P＜0.001). Compared with the control group and the NAC group, the model group had significant increases in the serum levels of AST and ALT and the level of MDA in liver tissue, as well as a significant reduction in the level of SOD in liver tissue (all P＜0.01). The model group had a significantly higher liver pathological score than the control group and the NAC group (both P＜0.05). Both LPS and H2O2 promoted the secretion of IL-1β and IL-6 in LX2 cells, and NAC effectively inhibited the pro-inflammatory effect of H2O2 and LPS (all P＜0.05). H2O2 and LPS acted on LX2 cells and promoted the apoptosis of HL7702 cells (all P＜0.05). ConclusionLPS can promote HSC inflammation via reactive oxygen species and participates in the progression of liver failure by inducing hepatocyte apoptosis.
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CEUS is a pure blood pool imaging depending on the non-linear effect and strong backscatter of gas-filled microbubbles in blood to obtain contrast-enhanced images.With the advantages of displaying tumor microvascular dynamically and intuitively,CEUS has been widely used for diagnosis and evaluating prognosis of breast cancers.CEUShas high sensitivity and specificity in detecting early breast cancers and identifying sentinel lymph nodes,with wide application prospects in assessing the efficacy of neoadjuvant therapy,predicting molecular typing and targeted therapy of breast cancers.The features of CEUS in breast cancers and the relationships with biomarkers,progresses in assessing neoadjuvant therapy and assisting sentinel lymph node biopsy were reviewed in the article.
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Objective To assess whether the plaque volume of carotid artery evaluated by three-dimensional ultrasound can predict the risk of cardiovascular events earlier in patients with coronary heart disease, in comparison with plaque thickness.Methods A total of 99 patients were enrolled, including 66 patients with asymptomatic carotid plaque and 33 patients with coronary heart disease (CHD) and carotid plaque.Three-dimensional ultrasound was performed in all the patients.Coronary angiography was performed in all the patients in CHD group.Coronary artery Gensini score was calculated.Plaque thickness, plaque area and plaque volume were compared between the two groups.We analyzed the relationship of plaque volume with Gensini score and other cardiovascular risk factors.Results Plaque volume was significantly higher in CHD group [(1312.38±513.70)mm3] than in asymptomatic group [(947.54±321.41)mm3] (P=0.023).However, plaque thickness and plaque area were not significantly different between the two groups (P>0.05).Plaque volume was positively correlated with Gensini score (r=0.519, P=0.002), homocysteine (r=0.569, P=0.002), and cardiovascular risk factors such as diabetes, blood glucose and glycosylated hemoglobin.There was a negative correlation between plaque volume and high-density lipoprotein (HDL), a factor protecting against cardiovascular events (r=-0.387, P=0.038).Conclusion Compared with plaque thickness, the volume of carotid plaques assessed by three-dimensional imaging technique may be a better predictor of the risk of cardiovascular events in patients with coronary heart disease.
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Objective To explore the ultrasonographic features of the gallbladder with malaria in stage of attack (MSA) at Sudan.Methods A total of 67 cases of MSA patients were divided into common type of malaria (CM) and sever malaria (SM).All patients underwent routine abdominal ultrasound examination and the ultrasonographic features of the gallbladder were divided into type Ⅰ,Ⅱ and Ⅲ according to the volume of gallbladder,thickness of the gallbladder wall and chole stasis.The relationship between clinical types and the ultrasonic types were analyzed.Then the differences of liver function among normal,Ⅰ,Ⅱ and Ⅲ types were compared statistically.Results In all of the 67 MSA patients,52 cases were CM and 15 cases were SM.The gallbladder ultrasonography showed that normal gallbladder were in 14 cases,type Ⅰ in 28 ca ses,type Ⅱ in 19 cases,type Ⅲ in 6 cases.The ultrasonic types of the gallbladder had significant difference in SM patients (type Ⅰ 3 cases,type Ⅱ 7 cases,type lⅢ 5 cases) and CM patients (normal 14 cases,type Ⅰ 25 cases,type Ⅱ 12 cases,type Ⅲ 1 case;P＜0.001).Ultrasonic types of the gallbladder had no difference between Chinese and Sudanese (P＞ 0.05).There were statistical significant differences of liver function among normal,Ⅰ,Ⅱ and Ⅲ types of the gallbladder (P＜0.001).Conclusion Most of the MSA patients have ultrasonic changes of gallbladder.And there are more serious pathological changes of gallbladder in SM than that in CM.
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Objective To discuss the clinical application of ultrasound-guided preoperative guide-wire localization in diagnosing tiny breast lesions. Methods A total of 56 patients with impalpable tiny breast lesions were enrolled in this study . Preoperative guide-wire localization of the lesion was performed under high-frequency ultrasound guidance, which was followed by tracking resection of the lesion. The clinical data were retrospectively analyzed. Results Successful localization and complete resection of the lesion was accomplished in all 56 patients. The lesions included invasive ductal carcinoma (n=11), intraductal carcinoma (n=5), ductal carcinoma in situ (n=2), mucinous carcinoma (n=2), fibroadenoma (n=24), atypical hyperplasia (n=6), intraductal papilloma (n=4) and plasma-cell mastitis (n=2). Conclusion Ultrasound-guided preoperative guide-wire localization is a safe and reliable technique for the diagnosis of impalpable tiny breast lesions. It can precisely localize the lesion , which is very helpful for making a complete resection of the lesion and avoiding unnecessary breast injury. Therefore , this technique should be recommended in clinical practice.
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Objective To discuss the clinical application of ultrasound-guided preoperative guide-wire localization in diagnosing tiny breast lesions. Methods A total of 56 patients with impalpable tiny breast lesions were enrolled in this study. Preoperative guide-wire localization of the lesion was performed under high-frequency ultrasound guidance, which was followed by tracking resection of the lesion. The clinical data were retrospectively analyzed. Results Successful localization and complete resection of the lesion was accomplished in all 56 patients. The lesions included invasive ductal carcinoma (n=11), intraductal carcinoma (n=5), ductal carcinoma in situ (n=2), mucinous carcinoma (n=2), fibroadenoma (n=24), atypical hyperplasia (n=6), intraductal papilloma (n=4) and plasma-cell mastitis (n=2). Conclusion Ultrasound-guided preoperative guide-wire localization is a safe and reliable technique for the diagnosis of impalpable tiny breast lesions. It can precisely localize the lesion, which is very helpful for making a complete resection of the lesion and avoiding unnecessary breast injury. Therefore, this technique should be recommended in clinical practice.
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Objective To explore the relationship between the degree of intraplaque neovascularization in carotid artery and the level of serum homocysteine.Methods Contrast-enhanced ultrasound were performed on 72 carotid atherosclerotic plaques of 48 patients.Contrast-enhancement within the plaque was categorizde as grade 1 to grade 3.The level of serum homocysteine were detected in the fasting state during the same period.Results According to the degree of contrast enhancement(grade 1 to 3),patients were divided into 3 groups.The more new vessels in plaque,the higher the level of homocysteine.The levels of homocysteine in three groups increased in turn.There were distinct differences among the three groups(F =18.49,P ＜0.05),and there was significant difference between every two groups (P ＜0.05).The linear correlation analysis showed that the level of homocysteine was positively correlated with the degree of carotid plaque enhancement (r =0.66,P ＜ 0.01).Conclusions Contrastenhanced ultrasonography could semi-quantitate new vessles in plaque.There was positive correlation between the degree of intraplaque neovascularization with the level of serum homocysteine.Combine with the level of serum homocysteine based on intraplaque neovascularization detected by contrast-enhanced ultrasound,the plaque stability could be more accurately evaluated.
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Objective To study the value of measurement of aortomesenteric angle in diagnosis and treatment of varicocele. Methods Fifteen varicocele patients with testicular vein diameters greater than 3 mm were studied,the aortomesenteric angles and the velocity of bilateral renal veins were measured. Results The aortomesenteric angle in varicocele patients with testicular vein diameters greater than 3 mm was significantly greater than that of control group( 36.31 ?? 8.55 ?vs 25.58 ?? 9.02 ?,P
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Objective Through transmission electron microsco pe to observe the ultrastructural changes in external iliac arteries of hyperhomocysteinemia rabbits with endothelial dysfunction.Methods Eighteen rabbits were randomized into two groups (n=9 per group).Control group (N group) was poured water into stomach,Methionine group (M group) were poured L-methionine ( 5.0 g/kg weight) into stomach.Endothelium-dependent dilation (EDD),endothelium-independent dilation (EID) were examined by high resolution ultrasound at 0,4,8,12,24 h,at same time and external iliac arteries were observed by transmission electron microscope after 24 h.Results ① In acute hyperhomocysteinemia,EDD of external iliac artery in M group was time-dependent reduced more significantly than that in N group,but EID was not affected. ② Under transmission electron microscope,external iliac arteries of rabbits showed endothelial cells dropping,mitochondrion swelling in endothelial cells and smooth muscle cells,internal elastic lamina disruption,migration of smooth muscle cell to subendothelial space.Conclusions In hyperhomocysteinemia,homocysteine could lead to endothelial dysfunction in rabbits and ultrastructural damage of endothelial cells,smooth muscle cells and internal elastic lamina.High resolution ultrasound could find the endothelial dysfunction accurately.
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Objective To study the effect of different concentrations of homocysteine (Hcy) on production of nitric oxide (NO) and endothelin (ET) by cultured human umbilical vein endothelial cells (HUVEC). Methods HUVECs were collected and cultured to the third passage. Then HUVECs were co cultured with Hcy in different concentrations for 24 hours. The contents of NO and ET in culture medium were examined at 4,6,8,24 hours. Results After HUVECs were exposed to different concentrations of Hcy for 24 hours, the content of NO in culture medium was significantly reduced compared with the control group ( P
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Objective To study the diagnostic value of CDE in moyamoya disease.Methods The intra-and-extracranial arteries in 17 patients with moyamoya disease and 25 healthy volunteers were studies by CDE.The resistance index(RI),pulsatility index(PI),time-averaged flow velocity(Vm)were examined in arteries,including MCA、MCA、ACA、PCA、CCA、ICA、ECA and TSA.Results ①The diagnosis rate of the occlusion or stenosis in intracranial arteries was 87.25%.②The hemodynamic characteristics of CCA and ICA were high flow velocky and low resistance opposite to that of TSA.③The moyamoya vessels were seaned in 10 of all 17 patients with moyamoya disease by CDE.The diagnosis rate of moyamoya disease was 58.82%.Conclusions CDE technique could image the moyamoya vessels as scattered color dots. So CDE had a higher clinic value in diagnosis of moyamoya disease.