Contrast-enhanced ultrasound evaluation of renal perfusion before angioplasty and its predictive value for hypertension.

BACKGROUND: Atherosclerotic renal artery stenosis (ARAS) is a common disease in the elderly population. OBJECTIVE: The aim was to develop a contrast-enhanced ultrasound (CEUS)-based model for predicting post-angioplasty improvement in hypertension in patients with severe ARAS. METHODS: Thirty-five patients with severe ARAS (⩾ 70%) were included in this study, and 42 renal arteries received percutaneous transluminal renal arterial stenting. An optimal integral formula was developed from pre-interventional color-coded duplex sonography (CCDS) and CEUS parameters using least absolute shrinkage and selection operator (LASSO) regression and receiver operating characteristic (ROC) curve analysis. A model for predicting short-term hypertension improvement was established using the integral formula and clinical risk factors. Bootstrapping was used for internal validation. RESULTS: Two integral formulas, LASSO.CCDS and LASSO.CEUS, were established. ROC curves of the two integral formulas showed that LASSO.CEUS was the better formula for predicting hypertension improvement (AUC 0.816, specificity 78.6%). Univariate and multivariate regression analyses showed that duration of hypertension (OR 0.841, P= 0.027), diabetes (OR = 0.019, P= 0.010), and LASSO.CEUS (OR 7.641, P= 0.052) were predictors of short-term hypertension improvement after interventional therapy. Using LASSO.CEUS combined with clinical risk factors, the following prediction model was established: logit (short-term improvement in hypertension) = 1.879-0.173 × hypertension duration - 3.961 × diabetes + 2.034 × LASSO.CEUS (AUC 0.939). CONCLUSIONS: The model established using CEUS parameters and clinical risk factors could predict hypertension improvement after interventional therapy, but further research and verification are needed.

[Analyses of carotid intima-media thickness and quantitative arterial stiffness in type 2 diabetes mellitus patients with follow-ups].

OBJECTIVE: To explore the change pattern of carotid stiffness and its relationship between intima-media thickness (IMT) in type 2 diabetes mellitus (T2DM). METHODS: Quantitative intima-media thickness (QIMT) and quantitative arterial stiffness (QAS) were performed on bilateral carotids of 72 T2DM patients in May 2009 and February 2011 separately. IMT, compliance coefficient (CC), α, ß and pulse wave velocity (PWV) were measured. Their relationship was analyzed. RESULTS: Comparing with ultrasound result in 2009, CC of bilateral carotids increased (left 0.9 ± 0.4 vs 1.1 ± 0.4, P = 0.016; right 1.1 ± 0.5 vs 1.2 ± 0.5, P = 0.012). IMT increased while α, ß and PWV decreased (P > 0.05) in 2011. No correlation existed between carotid IMT and QAS parameters. CONCLUSION: The glycemic, lipid and blood pressure controls decrease the carotid stiffness of patients with T2DM. Carotid IMT and stiffness.

Comparison of the diagnostic performance and clinical role of different ultrasound-based thyroid malignancy risk stratification systems for medullary thyroid carcinoma.

Background: This study sought to investigate the applicability of different ultrasound (US) thyroid risk stratification systems in diagnosing medullary thyroid carcinoma (MTC) and determining the need for biopsy. Methods: In total, 34 MTC nodules, 54 papillary thyroid carcinoma (PTC) nodules, and 62 benign thyroid nodules were examined in this study. All the diagnoses were histopathologically confirmed postoperatively. All the thyroid nodule sonographic features were recorded and categorized by 2 independent reviewers according to the Thyroid Imaging Reporting and Data System (TIRADS) of the American College of Radiology (ACR), the American Thyroid Association (ATA) guidelines, the European Thyroid Association (EU) TIRADS, the Kwak-TIRADS, and the Chinese TIRADS (C-TIRADS). The sonographic differences and risk stratifications of the MTCs, PTCs, and benign thyroid nodules were analyzed. The diagnostic performance and recommended biopsy rates for each classification system were evaluated. Results: The risk stratifications of MTCs were all higher than the benign thyroid nodules (P<0.01) and lower than PTCs (P<0.01) with each classification system. Hypoechogenicity and malignant marginal features were independent risk factors for identifying malignant thyroid nodules, and the area under the receiver operating characteristic curve (AUC) for identifying MTCs was lower than that for identifying PTCs (0.873 vs. 0.954, respectively). The AUCs, sensitivity, specificity, positive predictive values, negative predictive values, and accuracy values of the 5 systems for MTC were all lower than those for PTC. The best cut-off values for diagnosing MTC were TIRADS (TR) 4 in the ACR-TIRADS, intermediate suspicion in the ATA guidelines, TR 4 in EU-TIRADS, and TR 4b in both the Kwak-TIRADS and the C-TIRADS. The Kwak-TIRADS had the highest recommended biopsy rate for MTCs (97.1%), followed by the ATA guidelines, the EU-TIRADS (88.2%), the C-TIRADS (85.3%), and the ACR-TIRADS (79.4%). Conclusions: The US-based thyroid malignancy risk stratification systems analyzed in this study were able to satisfactorily identify MTC and recommend biopsy, but the diagnostic performance of these systems for MTC was not as good as that for PTC.

[Role of adiponectin and its receptors in anti-atherosclerotic effects of pioglitazone on ApoE knocked out mice].

OBJECTIVE: To study the effects of pioglitazone on atherosclerosis on ApoE-/- mice, and to investigate the roles of adiponectin and its receptors. METHODS: ApoE-/- mice were fed with high-fat chow for the induction of atherosclerosis and were divided into three subgroups: placebo(n=10), low-dose[10 mg/( kg.d), n=10] pioglitazone therapy, and high-dose[20 mg/( kg.d), n=10] pioglitazone therapy. C57BL/6J wild type mice (n=9) were used as control. Aortic atherosclerosis and intimajmedia thickness (intima-media thickness , IMT) of abdominal aorta were monitored, and plasma adiponectin was also measured. Expression levels of the adiponectin receptor 1(AdipoR1)and adiponectin receptor 2 (AdipoR2) in vessels were analyzed(RT-PCR). RESULTS: (1) Aortic atherosclerotic lesions were observed in ApoE-/- mice but not in wild type mice. Interestingly, these lesions were significantly prevented by high-dose pioglitazone therapy. Compared with wild type mice, ApoE-/- mice had increased IMT of abdominal aorta [(0.290+/-0.063 vs 0.178+/-0.012) cm, P<0.01] that was significantly reversed by high-dose pioglitazone therapy [(0.208+/-0.012 vs 0.290+/-0.063) cm, P<0.05]. (2) The level of plasma adiponectin was significantly lower in ApoE-/- mice [(12.41+/-3.84 vs 18.96+/-4.89) microg/L, P<0.05), which could be increased by low-and high-dose pioglitazone therapy (18.78+/-7.24 microg/L vs 12.41+/-3.84 microg/L, P<0.05; and 24.00+/-4.71 microg/L vs 12.41+/-3.84 microg/L, P<0.05). (3) Compared with wild type mice, ApoE-/- mice had reduced AdipoR1 mRNA level(0.789+/-0.167 vs 0.950+/-0.071, P<0.05) and reduced the ratio of AdipoR1/AdipoR2 (0.940+/-0.102 vs 1.039+/-0.062, P<0.05); high dose pioglitazone therapy could upregulate AdipoR1, AdipoR2 mRNA expression and increase the ratio of AdipoR1/AdipoR2 (1.063+/-0.051 vs 0.940+/-0.102,P<0.01). CONCLUSION: Pioglitazone inhibits aortic atherosclerosis in ApoE-/- mice, and these effects are correlated with increased plasma adiponectin level and the expression of AdipoR1 mRNA in vessels.

[Comparison of safety and sensitivity in diagnosis of liver lesion between ultrasound-guided 16 gauges and 18 gauges core needle biopsy].

OBJECTIVE: To compare safety and sensitivity in diagnosis of liver lesion between ultrasound-guided 16 gauges (G) and 18 G core needle biopsy. METHODS: Ultrasound-guided 16 G needle biopsy was performed in 141 patients, 77 males and 64e females, aged 51.2, and ultrasound-guided 18 G needle biopsy was performed in 105 patients, 54 males and 51 females, aged 60.1. The final diagnosis was based on the post-operative pathological examination and/or the results of 6-month follow-up. RESULTS: In the In the ultrasound-guided 16 G needle biopsy, 171 passes were performed with an average of 1.21 pass, a sensitivity rate of 95.9%, and a specificity rate of 100%, and abdominal pain occurred in 51 cases, and bleeding occurred in 3 cases. In the ultrasound-guided 18 G needle biopsy, 161 passes were performed with an average of 1.53 passes, a sensitivity rate of 83.8%, and a specificity rate of 100%, and abdominal pain occurred in 37 cases, and bleeding occurred in 2 cases. The number of pass of the 16 G was significantly less then that of the 128 G group (P = 0.000). The sensitivity rate of the 16 G needle biopsy was significantly higher than that of the 18 G group (P = 0.46). CONCLUSION: Ultrasound-guided 16 gauges core needle biopsy is safe for the diagnosis of hepatic disease and more sensitive than the 18 G biopsy.

[Effect of Interleukin-17 on neutrophil apoptosis].

OBJECTIVE: To study the effect of Interleukin(IL)-17 on neutrophil apoptosis and try to explain the possible mechanism involved. METHODS: Neutrophils isolated from healthy donors were incubated in enriched RPMI 1640 cell culture medium at 37 degrees C in 5% carbon dioxide. Subgroups were incubated with IL-17, heat-denatured IL-17 (X-IL-17), dexamethasone (DEX), or buffer alone. Apoptosis was assessed by morphologic changes, by detecting DNA strand breaks. Production of proapoptotic protein Bax by neutrophils was evaluated by immunocytochemistry. RESULTS: At the time of neutrophil incubation, neutrophils in the control subsets exhibited morphologic evidence of apoptosis. A steady rise in apoptosis index (AI) was noted, with (1.54+/-0.08)% for 0 h, (11.48+/-1.80)% (compared with 0 h, P<0.05) for 12 h and (34.19+/-1.92)% (compared with 0 h, P<0.01) for 24 h, respectively. IL-17 at concentration of 50 microg/L resulted in increased AI of neutrophils, with (1.43+/-0.17)% (compared with control 0 h, P>0.05) for 0 h, (20.47+/-6.22)% (compared with control 12 h, P<0.01) for 12 h and (40.74+/-3.48)% (compared with control 24 h, P<0.05) for 24 h, respectively. While at concentrations of 5 mug/L and 0.5 microg/L, IL-17 resulted in decreased AI, with (14.24+/-4.26)% (compared with control 24 h, P<0.01) for 24 h, and (19.86+/-4.39)% (compared with control 24 h, P<0.01) for 24 h, respectively. AI of neutrophils treated with X-IL-17 at concentration of 50 ng/ml for 24 h was (33.22+/-1.61)% (compared with control 24 h, P>0.05). Neutrophils apoptosis was accompanied by DNA fragmentation. In all groups, the increasing of Bax immunoreactivity was strongly related with more apoptotic neutrophils (r=0.932, P<0.01). CONCLUSION: In vitro, IL-17 modulates apoptosis of neutrophils. At higher concentrations, it accelerates neutrophils apoptosis. At lower concentrations, it delays neutrophils apoptosis. Modulation of the expression of Bax by IL-17 may be one of the possible inner mechanisms.