Application and evaluation of ultrasound critical value in ruptured tubal pregnancy / 中华超声影像学杂志

Objective:To evaluate the diagnosis and critical value reporting of ruptured tubal pregnancy by ultrasound.Methods:The clinical and ultrasound data of 70 patients with ruptured tubal pregnancy diagnosed by surgery in Peking Union Medical College Hospital from August 2017 to May 2021 were retrospectively analyzed to evaluate the diagnosis and critical value reporting of ruptured tubal pregnancy by ultrasound.Results:Among the 70 patients, 68 patients underwent gynecological ultrasonography and two patients did not. Sixty-three cases (92.6%, 63/68) were accurately diagnosed as adnexal ectopic pregnancy mass, abdominal and pelvic effusion/blood clot, and 5 adnexal ectopic pregnancy masses (7.4%, 5/68) were missed.Among the 5 missed cases, 4 cases (80%, 4/5) were heterotopic pregnancy (2 cases of IVF-ET 2 embryos, 1 case of patient taking ovulation induction drugs, 1 case of gravida with twin family history) and 1 case (20%, 1/5) of single tubal pregnancy. Critical values were reported in the all 63 cases of ruptured tubal pregnancy diagnosed by preoperative ultrasound.Conclusions:Ultrasound could accurately diagnose tubal pregnancy and assess its rupture, and timely report the critical value, effectively guarantee the medical safety. The particularity and complexity of ultrasound diagnosis in early pregnancy with assisted reproductive technique deserve more attention.

Effect of bilateral greater splanchnic nerve transection on hepatic injury in dogs with acute necrotizing pancreatitis / 临床肝胆病杂志

ObjectiveTo investigate the effect of bilateral greater splanchnic nerve transection on hepatic injury in dogs with acute necrotizing pancreatitis (ANP). MethodsA total of 24 healthy adult mongrel dogs were randomly divided into sham-operation group (SO group with 8 dogs), ANP model group (ANP group with 8 dogs), and ANP+bilateral greater splanchnic nerve transection group (GSNT group with 8 dogs). Peripheral venous blood samples were collected at 2 hours before surgery and at 12 and 24 hours and 3, 5, and 7 days after surgery to measure the serum levels of amylase (AMY), alanine aminotransferase (ALT), and aspartate aminotransferase (AST). The dogs were sacrificed at 7 days after surgery, and the pancreatic and hepatic tissues were harvested to observe their pathological changes by visual inspection and under a light microscope. Western blot was used to measure the protein expression of p-NF-κB p65 in liver tissue. A one-way analysis of variance and a repeated-measures analysis of variance were used for comparison between groups, and the least significant difference t-test and wilcoxon rank sum test were used for further comparison between two groups. ResultsAt 2 hours before surgery, there were no significant differences in serum levels of AMY, ALT, and AST between the three groups (P＞0.05). Compared with the SO group, the ANP group and the GSNT group had significant increases in the serum levels of AMY, ALT, and AST, pancreatic and liver pathological scores, and the protein expression of p-NF-κB p65 in liver tissue after surgery (all P＜0.05). After surgery, the GSNT group had significantly lower serum levels of ALT and AST, pancreatic and liver pathological scores, and protein expression of p-NF-κB p65 in liver tissue than the ANP group (all P＜0.05), while there was no significant difference in the serum level of AMY between these two groups (P＞0.05). ConclusionThe activation of NF-κB plays an important role in the progression of ANP in dogs. Bilateral greater splanchnic nerve transection can alleviate liver injury in dogs with ANP, and such a protective effect may be associated with the downregulation of NF-κB activity in the liver.

Research advances in the role of autophagy and perineural invasion in pancreatic cancer / 临床肝胆病杂志

As a bi-directional tumor regulatory factor, autophagy plays an important role in the development, progression, and treatment of pancreatic cancer. Perineural invasion, a special pathway for tumor metastasis, has a high incidence rate in pancreatic cancer and is closely associated with high recurrence rate after pancreatic cancer surgery and pancreatic cancer-related pain. This article summarizes the research advances in the role of autophagy and perineural invasion in pancreatic cancer, so as to provide new research ideas for the diagnosis and treatment of pancreatic cancer.

Clinical and ultrasound imaging features of pancreatic acinar cell carcinoma / 中华医学超声杂志（电子版）

Objective To explore the clinical and sonographic characteristics of pancreatic acinar cell carcinoma (PACC).Methods The clinical data and abdominal sonographic findings of 13 cases of PACC identified with pathology were reviewed,including contrast-enhanced ultrasound (CEUS) images.There were 9 males and 4 females with the average of 53.9 years old.Symptoms included upper abdominal pain,nausea,chest distress and weight loss.Results The serum level of tumor maker was elevated in only 5 cases.Eight masses (61.5％) were located in the pancreatic body-tail,4 (30.8％) in the head,the whole pancreas was involved in 1 case.The mean maximal diameter was 8.0 cm.Four lesions (30.8％) presented as solid-cystic mass.Well-defined border was showed in 6 cases (60.0％).Exophytic type was observed in 5 cases (38.5％).Pancreatic ductal dilation was seen in 3 cases (23.1％),in which 2 cases showed obstruction of common biliary duct.Liver metastasis was assessed in 4 patients (30.8％),and lymph node metastasis in 3 cases (23.1％).Vessels were invaded in 4 cases (30.8％).In 2 cases by CEUS,one showed arterial iso-enhancement,the other with strong enhancement.Conclusion Certain characteristic clinical and ultrasonographic features could be revealed in PACC,as a sizable,exophytic,solid-cystic and relatively hypervascular mass with well-definded border.

Efficacy of EGFR Tyrosine Kinase Inhibitors in Non-small Cell Lung Cancer Patients Harboring Different Types of EGFR Mutations: A Retrospective Analysis / 华中科技大学学报（医学）（英德文版）

With the development of molecular pathology,many types of epidermal growth factor receptor (EGFR) mutations have been identified.The efficacy of EGFR tyrosine kinase inhibitors (EGFR-TKIs) in non-small cell lung cancer (NSCLC) patients with different types of EGFR mutations,especially in patients with single rare mutations or complex mutations (co-occurrence of two or more different mutations),has not been fully understood.This study aimed to examine the efficacy of EGFR-TKIs in NSCLC patients with different types of EGFR mutations.Clinical data of 809 NSCLC patients who harbored different types of EGFR mutations and treated from January 2012 to October 2016 at Renmin Hospital and Zhongnan Hospital,Wuhan,were retrospectively reviewed.The clinical characteristics of these patients and the efficacy of EGFR-TKIs were analyzed.Among these patients,377 patients had only the EGFR del-19 mutation,362 patients the EGFR L858R mutation in exon 21,33 patients single rare mutations and 37 patients complex mutations.Among these 809 patients,239 patients were treated with EGFR-TKIs.In all the 239 patients,the disease control rate (DCR) was 93.7％ with two patients (0.2％) achieving complete response (CR),the median progression free survival (PFS) was 13.0 months (95％ confidence interval [CI],11.6-14.4 months),and the median overall survival (OS) was 55.0 months (95％ CI,26.3-83.7 months).Subgroup analysis revealed that the DCR in patients harboring single rare or complex mutations of EGFR was significantly lower than in those with del-19 or L858R mutation (P＜0.001).Patients with classic mutations (del-19 and/or L858R mutations) demonstrated longer PFS (P＜0.001) and OS (P=0.017) than those with uncommon mutations (single rare and/or complex mutations).Furthermore,the patients with single rare mutations had shorter median OS than in those with other mutations.Multivariate Cox regression analysis identified that the type of EGFR mutations was an independent risk factor for PFS (hazard ratio [HR]=0.308,95％ CI,0.191-0.494,P＜0.001) and OS (HR=0.221,95％ CI,0.101-0.480,P＜0.001).The results suggest that the single rare or complex EGFR mutations confer inferior efficacy of EGFR-TKIs treatment to the classic mutations.The prognosis of the single rare EGFR mutations is depressing.EGFR-TKIs may be not a good choice for NSCLC patients with single rare mutations of EGFR.Further studies in these patients with uncommon mutations (especially for the patients with single rare mutations) are needed to determine a better precision treatment.

Ultrasound diagnosis and analysis of pregnancy with ovarian tumor / 中华医学超声杂志（电子版）

Objective To summarize the sonographic features and pathological features of ovarian tumor during pregnancy. Methods One hundred and five women with 114 pathologically proved ovarian tumors during pregnancy in Peking Union Medical College Hospital were retrospectively recruited. According to pathological diagnosis, the clinical treatment, the result of the pregnancy and sonographic examinations were reviewed and analyzed. The sonographic features of benign tumors were compared with low-grade malignant tumors. Results Among the 105 pregnant women with a total of 114 ovarian tumors, 65 tumors were found by ultrasound exam. The other 49 tumors were found during cesarean section. The sonographic features of pathologically proved ovarian tumors include regular shape and well-deifned margins, with 58 of benign tumors and 7 of borderline or low-grade malignant tumors. Compared with borderline or low-grade malignant tumors, benign tumors manifested as strong echoes or high echogenic mass without papillae in the tumors (50/58). As for borderline or low-grade malignant group, tumors manifested as papillae within the tumors (5/7). Pathological classiifcation of the 114 ovarian tumors included 84 germ cell tumors, 19 epithelial tumors, 9 sex cord-stromal tumors, and 2 germ cell tumors combined epithelial tumors. Surgical treatments were performed in 7 cases during the ifrst trimester, while 11 cases during the second trimester, and 87 cases during the third trimester. Pregnancy outcome of the 105 pregnant women included term delivery in 82 cases, premature delivery in 18 cases, artiifcial abortion during ifrst trimester in 4 cases, and induced abortion during second trimester in 1 case. Conclusions Most ovarian tumors treated in pregnancy are benign. The sonographic features of benign tumors include regular shape with well-deifned margins, strong echoes or high echogenic mass within the tumors. While the sonographic features of borderline or malignant tumors include papillae within the tumors. Ultrasound assessment of ovarian tumors can help to determine the risk of malignancy and guide the surgical management.

Ultrasound radiofrequency-data technique assessment of carotid: a reproducibility study / 中华超声影像学杂志

Objective To evaluate the reproducibility of quality intima-media thickness(QIMT) and quality arterial stiffness (QAS) technique in assessment of carotid under different measuring methods.Methods Between December 2012 and January 2014,carotid QIMT and QAS examinations were carried out in 30 health volunteers.QIMT and QAS indicators included IMT in QIMT and distensibility coefficient (DC),compliance coefficient(CC),stiffness index α(α),stiffness index β(β),pulse wave velocity(PWV) in QAS.The measurement employed unilateral/once,bilateral/twice,and unilateral/twice methods.Using intra observer and inter-observer variability,the reproducibility was compared between different QIMT and QAS indicators and measuring methods.Results Extremely high level of intra-observer reproducibility was found for both QIMT and QAS technique (ICC＞0.8).QIMT also showed an excellent inter observer reproducibility (ICC＞0.8).In contrast,the reproducibility of QAS technique varied in different indicators (PWV ＞ β ≈ α ＞ CC ＞ DC) and method ( unilateral/once ＞ bilateral/twice ＞ unilateral/twice).Conclusions QIMT measurement was highly reproducible.Whereas the reproducibility of QAS technique varied in different indicators and methods.Due to low reproducibility,the study result did not support the clinical application of DC indicator and unilateral/once method.

Application of damage control surgery idea in the treatment of severe pancreatic duodenal injury / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the significance of damage control surgery (DCS) in the treatments of severe pancreaticoduodenal injuries.</p><p><b>METHODS</b>Clinical data of 19 patients with severe pancreaticoduodenal injuries managed with DCS approach in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine and the First Affiliated Hospital of Wenzhou Medical College from March 2005 to January 2013 were analyzed retrospectively.</p><p><b>RESULTS</b>Three cases were cured after damage control operation and postoperative ICU resuscitation treatment. Twelve cases underwent definite operations (distal pancreaticojejunal Roux-en-Y anastomosis, proximal duodenojejunal Roux-en-Y anastomosis or pancreaticoduodenectomy) after damage control operation and postoperative ICU resuscitation treatment and cured. Four cases died after damage control operation due to multiple organ failure and the mortality was 21.1%.</p><p><b>CONCLUSION</b>Application of DCS approach can improve the prognosis of patients with severe pancreaticoduodenal injuries.</p>

Effect of qiming granule on retinal blood circulation of diabetic retinopathy: a multicenter clinical trial / 中国结合医学杂志

<p><b>OBJECTIVE</b>To objectively assess the effect of Qiming Granule in the treatment of diabetic retinopathy (DR) by fluorescence fundus angiography (FFA).</p><p><b>METHODS</b>In a multi-center, randomized, parallel controlled clinical trial, patients with DR were randomly assigned to the control group (calcium dobesilate capsule) and the test group (Qiming Granule). Changes in the retinal blood circulation time were recorded by FFA after 3 months of medication.</p><p><b>RESULTS</b>Significant reduction was observed in the retinal arterio-venous circulation time (AVCT) in both groups (P<0.01), the value was 7.635+/-3.149 s before treatment and 5.165 +/-3.382 s after treatment in the treated group, and 7.737+/-3.413 s and 5.313+/-3.472 s in the control group respectively. Qiming Granule also reduced the arm-to-retinal circulation time (ARCT, P<0.05). The value was 17.867+/-3.872 s before treatment and 15.643+/-4.648 s after treatment in the treated group, and 17.217+/-3.833 s and 16.312+/-3.613 s in the control group (P>0.05) respectively. The ARCT in the tested group was reduced, with a statistically significant difference post-medication (P<0.01).</p><p><b>CONCLUSION</b>As a Chinese medicine complex prescription, Qiming Granule may alleviate retinal hypoxia and ischemia by increasing retinal blood flow and improving the blood circulation.</p>