A Noninvasive Sonographic Study of Multisite Atherosclerosis in an Elderly Chinese Population.

OBJECTIVES: A sonographic study was conducted to determine the prevalence of atherosclerosis across multiple arterial beds in an elderly Chinese population and to examine relationships between detected atherosclerosis and traditional risk factors. METHODS: A total of 197 participants underwent sonography of the abdominal aorta and bilateral carotid, femoral, and lower limb arteries. Images were reviewed to determine the presence or absence of plaques in each artery. Plaque thickness was measured as the indicator of plaque burden. Plaque prevalence was estimated per site and correlated with age, sex, and the Framingham Risk Score (FRS). Plaque frequency and thickness were compared between different arterial beds. RESULTS: Of the 197 participants (54% female; age range, 58-86 years), 90% had plaques present in at least 1 artery, and 55% had plaques present in at least 4 arteries. The most common sites for plaques were the carotid arteries (80%), followed by the lower limb arteries (59%), femoral arteries (57%), and abdominal aorta (37%). Plaque prevalence in each arterial bed except the abdominal aorta was significantly associated with male participants (P < .05), increasing age (P < .003) and FRS (P < .04). Male participants were more likely to have carotid (P = .04), femoral (P = .045), and lower limb (P = .006) plaques than female participants, but there was no significant difference in aortic plaque prevalence between male and female participants (P = .9). CONCLUSIONS: Plaque prevalence increased significantly in the carotid and peripheral arteries with increasing FRS. These findings should be considered for designing screening programs for stroke and heart attack prevention.

Needle-Warming Moxibustion plus Multirehabilitation Training to Improve Quality of Life and Functional Mobility of Patients with Rheumatoid Arthritis after Medication.

Objective: Patients treated with medication for rheumatoid arthritis (RA) often improve but continue to have active diseases. The study aims to investigate whether needle-warming moxibustion (NWM) plus multirehabilitation training can improve quality of life (QoL) and functional mobility of RA patients after medication. Methods: Eighty-four RA patients were selected as study participants, including 42 patients receiving medication (medication group) and 42 patients receiving NWM plus multirehabilitation training (NWM + MRT group). The scores of disease symptoms, pain (visual analogue scale (VAS)), sleep quality (Pittsburgh Sleep Quality Index (PSQI)), functional mobility (Fugl-Meyer assessment scale (FMAS)), self-rating anxiety scale (SAS), self-rating depression scale (SDS), and QoL (SF-36) were compared before and after treatment. When patients were discharged from the hospital, they were given a questionnaire for treatment satisfaction. Results: After treatment, decreases in the scores of the VAS, PSQI, SAS, and SDS were observed in both cohorts, especially in the NWM + MRT group (P < 0.05). The FMAS scores of upper limbs and lower limbs were increased after treatment, which were higher in the NWM + MRT group in comparison with the medication group (P < 0.05). Of note, patients in the NWM + MRT group scored higher in various dimensions of the SF-36 scale (P < 0.05), showing better QoL. The satisfaction survey showed that the NWM + MRT group had a higher proportion of patients being satisfied and a lower proportion of patients being dissatisfied (P < 0.05). Conclusion: NWM plus multirehabilitation training could significantly attenuate disease symptoms, improve QoL, recover functional mobility, and reduce the risk of anxiety and depression in RA patients.

Quantitative assessment of carotid artery atherosclerosis by three-dimensional magnetic resonance and two-dimensional ultrasound imaging: a comparison study.

BACKGROUND: It has been proven that magnetic resonance (MR) and ultrasound imaging are useful tools in the quantification of carotid atherosclerotic plaques. However, there are only a few pieces of evidence to illustrate the links of quantitative measurements of carotid plaques between MR and ultrasound imaging. This study looked to compare the quantitative measurements of carotid plaques and investigate their relationship between three-dimensional (3D) MR vessel wall imaging and two-dimensional (2D) ultrasound imaging. METHODS: Seventy-five asymptomatic elderly subjects (mean age: 73.3±5.7 years; 45 males) with carotid atherosclerotic plaques diagnosed by both ultrasound and MR imaging were included in this study. The plaque size, including the maximum wall thickness (Max WT), plaque length, and plaque area, was measured by 3D MR and ultrasound imaging on longitudinal and cross-sectional views. The quantitative assessments of carotid plaque size were compared and correlated between 3D MR and 2D ultrasound imaging. RESULTS: In total, the quantitative measurements of 101 plaques on longitudinal views or 44 plaques on cross-sectional views of both MR and ultrasound imaging were compared. The Max WT of the plaques (longitudinal: 2.9±0.8 vs. 2.4±0.9 mm; cross-sectional: 3.2±1.1 vs. 2.6±0.7 mm) and plaque areas (longitudinal: 24.3±13.4 vs. 17.0±12.7 mm2; cross-sectional: 24.9±24.6 vs. 16.8±13.3 mm2) measured by MR imaging were found to be significantly higher than those measured by ultrasound imaging (all P<0.001). Moderate to strong correlations were found in Max WT, plaque area, plaque length between 3D MR and ultrasound imaging. CONCLUSIONS: The quantitative measurements of carotid plaques using 3D MR and 2D ultrasound are significantly correlated. The plaque area and Max WT measured by 3D MR imaging are more significant than these parameters measured by 2D ultrasound imaging, which might be explained by the resolution of MR imaging and the workflow of measurements.

Interoperator Reproducibility of Carotid Elastography for Identification of Vulnerable Atherosclerotic Plaques.

Ultrasound-based carotid elastography has been developed to evaluate the vulnerability of carotid atherosclerotic plaques. The aim of this study was to investigate the in vivo interoperator reproducibility of carotid elastography for the identification of vulnerable plaques, with high-resolution magnetic resonance imaging (MRI) as reference. Ultrasound radio-frequency data of 45 carotid arteries (including 53 plaques) from 32 volunteers were acquired separately by two experienced operators in the longitudinal view and then were used to estimate the interframe axial strain rate (ASR) with a two-step optical flow method. The maximum 99th percentile of absolute ASR of all plaques in a carotid artery was used as the elastographic index. MRI scanning was also performed on each volunteer to identify the vulnerable plaque. The results showed no systematic bias in the Bland-Altman plot and an intraclass correlation coefficient of 0.66 between the two operators. In addition, no statistical significance was found between the receiver operating characteristic (ROC) curves from the two operators ( ), and their areas under the ROC curves were 0.83 and 0.77, respectively. Using the mean measurements of the two operators as the classification criterion, a sensitivity of 71.4%, a specificity of 87.1%, and an accuracy of 82.2% were obtained with a cutoff value of 1.37 [Formula: see text]. This study validates the interoperator reproducibility of ultrasound-based carotid elastography for identifying vulnerable carotid plaques.

Non-Invasive Identification of Vulnerable Atherosclerotic Plaques Using Texture Analysis in Ultrasound Carotid Elastography: An In Vivo Feasibility Study Validated by Magnetic Resonance Imaging.

The aims of this study were to quantify the textural information of strain rate images in ultrasound carotid elastography and evaluate the feasibility of using the textural features in discriminating stable and vulnerable plaques with magnetic resonance imaging as an in vivo reference. Ultrasound radiofrequency data were acquired in 80 carotid plaques from 52 patients, mainly in the longitudinal imaging view, and axial strain rate images were estimated with an ultrasound carotid elastography technique based on an optical flow algorithm. Four textural features of strain rate images-contrast, homogeneity, correlation and angular second moment-were derived based on the gray-level co-occurrence matrix in plaque regions to quantify the deformation distribution pattern. Conventional elastographic indices based on the magnitude of the absolute strain rate, such as the maximum, mean, median, standard deviation and 99th percentile of the axial strain rate, were also obtained for comparison. Composition measurement with magnetic resonance imaging identified 30 plaques as vulnerable and the other 50 as stable. The four textural features, as well as the magnitude of strain rate images, significantly differed between the two groups of plaques. The best performing features for plaque classification were found to be the contrast and 99th percentile of the absolute strain rate, with a comparative area under the receiver operating characteristic curve of 0.81; a slightly higher maximum accuracy of plaque classification can be achieved by the textural feature of contrast (83.8% vs. 81.3%). The results indicate that the use of texture analysis in plaque classification is feasible and that larger local deformations and higher level of complexity in deformation patterns (associated with the elastic or stiffness heterogeneity of plaque tissues) are more likely to occur in vulnerable plaques.

Ultrasound-Based Carotid Elastography for Detection of Vulnerable Atherosclerotic Plaques Validated by Magnetic Resonance Imaging.

Ultrasound-based carotid elastography has been developed to estimate the mechanical properties of atherosclerotic plaques. The objective of this study was to evaluate the in vivo capability of carotid elastography in vulnerable plaque detection using high-resolution magnetic resonance imaging as reference. Ultrasound radiofrequency data of 46 carotid plaques from 29 patients (74 ± 5 y old) were acquired and inter-frame axial strain was estimated with an optical flow method. The maximum value of absolute strain rate for each plaque was derived as an indicator for plaque classification. Magnetic resonance imaging of carotid arteries was performed on the same patients to classify the plaques into stable and vulnerable groups for carotid elastography validation. The maximum value of absolute strain rate was found to be significantly higher in vulnerable plaques (2.15 ± 0.79 s(-1), n = 27) than in stable plaques (1.21 ± 0.37 s(-1), n = 19) (p < 0.0001). Receiver operating characteristic curve analysis was performed, and the area under the curve was 0.848. Therefore, the in vivo capability of carotid elastography to detect vulnerable plaques, validated by magnetic resonance imaging, was proven, revealing the potential of carotid elastography as an important tool in atherosclerosis assessment and stroke prevention.

[Clinically randomized controlled trials of moxibustion with salt in bamboo circle for treatment of periarthritis of shoulder].

OBJECTIVE: To assess the clinical therapeutic effect of moxibustion with salt in bamboo circle on periarthritis of shoulder. METHODS Eighty-six cases were randomly divided into a salt-moxibustion group and an electroacupuncture group, 43 cases in each group. The salt-moxibustion group was treated by moxibustion with salt in bamboo circle on the part of obvious pain and hot compress moxibustion on its periphery. The electroacupuncture group was treated with electroacupuncture at Jianyu (LI 15), Jianliao (TE 14), Jianzhen (SI 9), etc. After treatment, the analgesic effect and improvement degrees of active function of the shoulder joint were observed and 3 months later they were followed-up. RESULTS: The two therapies had analgesic effect and could improve active function of shoulder joint, but the salt-moxibustion group in the transient analgesic effect and the improvement degree of active function of the shoulder joint was better than the electroacupuncture group (P< 0.01, P < 0.05). Follow-up survey showed good clinical therapeutic effects in the two groups. The effective rates of pain and active function of shoulder joint were 97.7% and 93.0% in the salt-moxibustion group and 93.0% and 88.4% in the electroacupuncture group, respectively, with no significant differences between the two groups. CONCLUSION: Moxibustion with salt in bamboo circle has an obvious therapeutic effect on periarthritis of shoulder, and it has transient analgesic effect and improves active function of shoulder joint, with a stable and long-term therapeutic effect.

[Observation on therapeutic effect of aponeurotic system penetration needling on peripheral facial paralysis].

OBJECTIVE: To observe therapeutic effect of aponeurotic system penetration needling on peripheral facial paralysis. METHODS: One hundred and ten cases of peripheral facial paralysis were randomly divided into a Jingjin group (n=68) and a control group (n=42). The therapeutic effects of acute stage, resting stage and sequela stage, and the relation between the facial nerve lesion degree and the therapeutic effect were investigated. RESULTS: The effective rates of the two needling methods were respectively 98.5% and 90.5%, the Jing1in group being better than the control group (P < 0.05); at the acute stage, the therapeutic effect of acupuncture was obvious, and the therapeutic effect at the sequela stage and for the patient of nerve faulty type in the Jingjin group were better than that of the control group (P < 0.05). CONCLUSION: Acupuncture and moxibustion has definite therapeutic effect on facial paralysis at the acute stage and in the patient of nerve active type, and aponeurotic system penetration needling can be used for the patient of facial paralysis at the sequela stage or with nerve faulty type.