A new risk model of assessing left atrial appendage thrombus in patients with atrial fibrillation - Using multiple clinical and transesophageal echocardiography parameters.

BACKGROUNDS: Predicting left atrial appendage thrombus (LAAT) in non-valvular atrial fibrillation (NVAF) patients need more precisely quantified risk models. In this study, we attempted to review the risk markers for LAAT and develop a simple and reliable model for LAAT prediction. METHODS: The study included 307 patients with NVAF who were scheduled for transesophageal echocardiography (TEE) to exclude LAA thrombus before synchronized electrical cardioversion or radiofrequency ablation for atrial fibrillation (AF). We analyzed the relationship between echo, clinical parameters and the presence or absence of LAAT. RESULTS: A total of 33 patients were found having LAAT (10.7%, 33/307). The age, left atrial appendage emptying velocity (LAAEV), left atrial or left atrial appendage spontaneous echocardiographic contrast (SEC), less than moderate to severe mitral regurgitation (≤mild MR), and left atrial enlargement showed association with LAAT. The multivariate logistic regression analysis revealed that LAAEV, SEC and ≤mild MR were independent risk factors of the LAAT. We used LAAEV ≤ 21.5 cm/s, SEC and ≤mild MR to construct a combined predictive model for LAAT in NVAF patients (the area under receiver operator characteristic curve: 0.88; 95% confidence interval: 0.82-0.95, P < 0.0001). CONCLUSION: Comprehensive evaluation of LAAEV, SEC, and MR with associated LAAT may help risk stratifying the NVAF patients, especially if the LAA imaging quality was suboptimal for identifying thrombus. These parameters may facilitate the decision-making process at the time of TEE.

Differential diagnosis of isolated calf muscle vein thrombosis and gastrocnemius hematoma by high-frequency ultrasound.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Effects of apolipoprotein E genotype on the off-line memory consolidation.

Spontaneous brain activity or off-line activity after memory encoding is associated with memory consolidation. A few recent resting-state functional magnetic resonance imaging (RS-fMRI) studies indicate that the RS-fMRI could map off-line memory consolidation effects. However, the gene effects on memory consolidation process remain largely unknown. Here we collected two RS-fMRI sessions, one before and another after an episodic memory encoding task, from two groups of healthy young adults, one with apolipoprotein E (APOE) ε2/ε3 and the other with APOE ε3/ε4. The ratio of regional homogeneity (ReHo), a measure of local synchronization of spontaneous RS-fMRI signal, of the two sessions was used as an index of memory-consolidation. APOE ε3/ε4 group showed greater ReHo ratio within the medial temporal lobe (MTL). The ReHo ratio in MTL was significantly correlated with the recognition memory performance in the APOE ε3/ε4 group but not in ε2/ε3 group. Additionally, APOE ε3/ε4 group showed lower ReHo ratio in the occipital and parietal picture-encoding areas. Our results indicate that APOE ε3/ε4 group may have a different off-line memory consolidation process compared to ε2/ε3 group. These results may help generate future hypotheses that the off-line memory consolidation might be impaired in Alzheimer's disease.

[The study in detection of microcalcification in early breast cancer by ultrasound and its correlation with pathohistology].

OBJECTIVE: To discuss the role of ultrasound in examining microcalcification of early breast cancer and its correlation with pathohistological type and grade. METHODS: 178 lesions in 165 cases of early breast cancer confirmed by pathology after surgical resection were examine by high frequency ultrasound, meanwhile microcalcification were detected and reported. 39 lesions in 32 cases are carcinoma in situ and microinvasive carcinoma of breast. 139 lesions in 133 cases are early invasive breast carcinoma that is below 2 cm in diameter and doesn't invasive the lymph node and other parts of the body. To analyse the sensitivity of detection micro-calcification of early breast cancer by ultrasound and its correlation with pathohistological type and grade. RESULTS: The sensitivity is 81.6% in detecting microcalcification of early breast cancer by ultrasound. There is no significant statistical difference in detecting microcalcification between the two group (P = 0.217). There is no significant statistical difference in detecting microcalcification of early invasive breast cancer between the different pathologic types (P > 0.05), and there are no significant differences in detecting microcalcification of early breast cancer between the different pathologic grades (group I: P = 0.202, group II: P = 0.415). There is significant difference in detecting microcalcification of solid tumor by ultrasonic examination in group I between the different pathologic grades (P = 0.029). CONCLUSION: There is higher sensitivity in detecting microcalcification of early breast cancer by ultrasonography. Microcalcification of early breast cancer may be no closely related to pathologic grades. US has a certain value to clinic in detecting microcalcification of early breast cancer.

Study of endorectal ultrasonography in the staging of rectal cancer.

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.

[Retrospective analysis of ultrasonography for autoimmune pancreatitis].

OBJECTIVE: To explore the sonographic characteristics of autoimmune pancreatitis (AIP). METHODS: The ultrasonographic features and clinical data of 8 AIP patients were analyzed retrospectively and compared with the findings of computed tomography and magnetic resonance imaging. RESULTS: Ultrasound images showed diffuse pancreatic swelling (n = 6), focal pancreatic head thickening (n = 1) and tail enlargement (n = 1). In 7 patients, pancreatic echogenicities were of Grade 1 or less while the other 1 patient Grade 2. Among them, 6 showed hyperechoic "pseudocapsule". And enlarged gallbladder, dilated biliary and pancreatic ducts were seen in 2 patients with jaundice. CONCLUSION: Ultrasonic features play an important role in an early diagnosis of AIP.

[Assessment of synovitis in the knee of patients with newly-diagnosed rheumatoid arthritis using high frequency and color Doppler ultrasonography].

OBJECTIVE: To investigate the value of high frequency and color Doppler ultrasonography in detection of synovitis and the intra-articular vascularization in the knee joint of patients with newly-diagnosed rheumatoid arthritis (RA). METHODS: Forty-one patients (30 women, 11 men) with newly-diagnosed RA were recruited to a cross sectional study (RA group). Forty-one age and gender-matched healthy volunteers were used as control group. The thickness of hydatid fluid, synovium hyperplasia, color flow imaging, peak systolic velocity (PSV), end diastolic velocity (EDV), resistance index (RI), venous blood flow and intra-articular perfusion were evaluated by high frequency and color Doppler ultrasonography. RESULTS: Totally 91.46% knee joints with synovial hyperplasia (> 2 mm) were found in 41 patients with RA (75/82 knee joints), and the thickness of the synovial membrane was 2.2 - 19.7 mm (average 6.3 ± 3.4 mm). In aspect of blood flow, the percentage of 0 to 3 grade were 18.67% (14/75), 29.33% (22/75), 45.33% (34/75) and 6.67% (5/75), respectively; the results of arterial blood were indicated with PSV (10.82 ± 3.71 cm/s), EDV (3.86 ± 1.12 cm/s) and RI (0.61 ± 0.07), while the average of venous blood velocity was 2.72 ± 1.02 cm/s. Joint effusion was found in 69 joints (84.15%) with the anteroposterior diameter 2.4 - 16.1 mm (average 6.9 ± 3.2 mm). The thickness of synovial membrane was 1.2 - 1.8 mm (average 1.4 ± 0.4 mm) and no significant difference were observed in joint effusion, signal of blood flow and thickness of synovial membrane in the control group. CONCLUSIONS: High frequency and power Doppler ultrasonography may be a valuable and optimal clinical tool to accurately and objectively detect synovial hyperplasia, vascular pannus formation and joint effusion in the knee joint of patients with RA.

[Application of ROC curve for the evaluation of arterial stiffness and heart function in hypertensive patients by quantitative artery stiffness].

OBJECTIVE: To apply the receiver operating characteristic (ROC) curves and QAS technology in exploring sensitive and feasible indices about the structure and function of heart and arterial stiffness so as to determine the optimal operating point (OOP) and evaluate its value of cardiovascular changes in hypertensive patients. METHODS: The parameters of arterial stiffness and heart function were measured and calculated in hypertensive patients (n = 167) and control (n = 165). The results were compared and critical values obtained by receiver operating characteristic (ROC) curves. RESULTS: Interventricular septal thickness, posterior wall thickness of left ventricle, E/e and Tei of hypertensive group were significantly higher than those of control group (P < 0.05). In hypertensive group, the parameters of arterial stiffness including beta, and PWVbeta were significantly higher than those of control group (P < 0.05). The areas of under the ROC curves were 0.808, 0.843, 0.816, 0.827, 0.779 and 0.632. The sensitivity and specificity of detecting the cardiovascular changes of hypertension for interventricular septal thickness, posterior wall thickness of left ventricle, E/e, Tei, PWVbeta and beta were 78.6%/78.9%, 82.1%/84.2%, 67.9%/89.5%, 100%/52.6%, 82.1%/68.4% and 57.1%/63.2% respectively. CONCLUSION: The arterial stiffness and heart dysfunction may result from hypertension. Arterial stiffness can be one of monitoring indices in early-stage damage of heart function.

[Local cellular immune response induced by ultrasound-guided tumor bed superantigen injection after percutaneous microwave coagulation therapy for liver cancer].

OBJECTIVE: To investigate the local cellular immune response after injection of superantigen, the highly agglutinative staphylococin (HAS), into the tumor bed after ultrasound-guided percutaneous microwave coagulation therapy (PMCT) in the liver cancer patients. METHODS: Ninety-two patients with pathologically proven primary liver cancer were divided into two groups: 45 in group A were treated by PMCT alone and 47 in the group B by combined with ultrasound-guided percutaneous injection of highly agglutinative staphylococin (HAS). Before and after PMCT and HAS treatment, the patients underwent ultrasound-guided percutaneous biopsy from the tumor bed and the samples were examined by pathology and immunohistochemistry. The infiltration of CD3+, CD4+, CD57+ and CD68+ lymphocytes in treatment zone was compared between the two groups. Moreover, the infiltrating immunocytes were observed by transmission electron microscopy. RESULTS: One week after HAS injection, the densities of CD3+, CD4+, CD57+ and CD68+ cells in the group B were 54.50 +/- 18.44, 38.14 +/- 12.44, 33.38 +/- 10.79 and 45.56 +/- 16.53, respectively. All the above mentioned parameters increased significantly in varying degrees compared with that before PMCT or HAS injection (P < 0.05). Four weeks after HAS injection, the density of CD3+, CD4+, CD57+ and CD68+ cells in the group B were 32.67 +/- 10.42, 23.43 +/- 6.99, 18.63 +/- 7.89 and 30.01 +/- 11.05, respectively, still significantly higher than those before PMCT (P < 0.05). Five weeks after PMCT and HAS injection, the densities of CD3+, CD4+, CD57+ and CD68+ cells in the group B were 54.50 +/- 18.44, 38.14 +/- 12.44, 33.38 +/- 10.79 and 45.56 +/- 16.53, versus 32.03 +/- 8.11, 15.67 +/- 8.32, 15.23 +/- 8.26 and 29.67 +/- 11.98 in the group A, respectively, still with a significant difference between the two groups (P < 0.05). A lot of lysosomes, endoplasmic reticulum and mitochondria in the immune cells after injection of HAS were observed by transmission electron microscopy. CONCLUSION: The local cellular immunity in liver cancer treatment area can be significantly improved by ultrasound-guided injection of highly agglutinative staphylococin after percutaneous microwave coagulation therapy.

[Monitoring of ultrasonography in artificial vascular graft for arteriovenous fistula].

OBJECTIVE: To evaluate the monitoring of ultrasonography in artificial vascular graft for arteriovenous fistula and its complications in patients with chronic renal failure. METHODS: Eighteen cases of artificial vascular graft arteriovenous fistula after four to six weeks were enrolled. The diameter, the peak velocity and blood flow were examined in arterial fistula. And the artificial vascular diameter, the peak velocity and blood flow of artificial vessels next to artery were all examined and analyzed. And the patients with symptoms in the upper extremity were tested by ultrasound. RESULTS: Intravascular blood showed good filling in fistula and artificial blood vessels in four to six weeks after artificial vascular graft for arteriovenous fistula by color doppler ultrasonography. The arterial fistula diameter, the peak velocity and blood flow were (3.61 +/- 0.68) mm and (298.56 +/- 93.42) cm/s and (583.62 +/- 216.77) ml/min. Artificial vascular diameter in (4.47 +/- 0.61) mm, the peak velocity and blood flow were (219.37 +/- 68.42) cm/s and (325.23 +/- 117.12) ml/min in the artificial blood vessels next to artery. Seven patients with upper extremity discomfort were examined by ultrasonography. One case was serum swollen. Three cases were thrombosis in artificial vessels. One case was pseudoaneurysm. Two cases were edema. CONCLUSIONS: Ultrasonography plays a significant clinic role in testing artificial vascular graft for arteriovenous fistula and its complications.

[Distribution characters and linkage disequilibrium analysis of APOM gene polymorphisms in Han population of North China].

OBJECTIVE: To investigate the distribution characters and linkage disequilibrium of apolipoprotein M gene (APOM) polymorphisms in Han population of North China. METHODS: The single nucleotide polymorphisms (SNPs) in six exons and five introns of APOM gene of 330 normal subjects in Han population of North China were detected by PCR-restriction fragment length polymorphism and DNA sequencing analysis. RESULTS: Three SNPs in Han Chinese were found, including rs805264 of intron 1, rs707922 and rs707921 of intron 5 of APOM gene. The frequency distribution of these SNPs was different among different races and territory. In addition, linkage disequilibrium among the SNPs of rs805264, rs707922 and rs707921 of APOM gene was found and A-T-A and G-G-C were predominant haplotypes. CONCLUSION: There is apparent linkage disequilibrium among SNPs of APOM gene in Han population of North China.