[Quantitative Assessment of Skin Thickness using High Frequency Ultrasound in Systemic Sclerosis].

OBJECTIVE: To investigate the performance of high frequency ultrasound in the assessment of skin thickness in patients with systemic sclerosis (SSc). METHODS: The study included 82 SSc (SSc group) and 67 healthy volunteers (control group) from 2014 to 2016. The skin thickness at bilateral middle fingers and forearms,anterior chest and abdominal wall was measured using high frequency ultrasound. All the patients with SSc underwent the modified rodnan skin score (mRSS) over 17 anatomical sites by an experienced dermatologist. The differences in age,sex,height,body mass,body mass index (BMI) and skin thickness between SSc patients and healthy controls were compared. Receiver operating characteristic (ROC) curve analysis was performed to determine the performance of high frequency ultrasound in the differentiation of SSc from healthy skin,and the correlation of mRSS with skin thickness were analyzed. RESULTS: SSc patients and healthy controls shared similar demographic features (age,sex ratio,height,body mass,BMI) (P>0.05). Skin thickness values in SSc patients were increased significantly at fingers and forearms compared with healthy controls (P<0.05). The area under the curve (AUC) was 0.938, 0.905, 0.608, 0.586, 0.398, 0.321 at right and left finger,right and left forearm,chest and abdominal wall. Among them,AUC>0.9 of right and left fingers can be used for diagnosis,The skin thickness cut-off value for determining the diagnosis of SSc were as follows: 1.35 mm at the right finger with 84.1% sensitivity and 95.5% specificity,1.26 mm at the right forearm with 86.6% sensitivity and 89.6% specificity,respectively. Skin thickness increased significantly with mRSS. The correlation of total mRSS scores with total skin thickness was 0.599 (P<0.001),and the correlation of local mRSS score with local skin thickness were 0.400-0.623 (P<0.001),with the highest correlation coefficient at right finger and the lowest at abdomen. CONCLUSION: High frequency ultrasound may reflect extent of skin involvement of SSc,and skin thickness assessed with high frequency ultrasound appeared to be highly specific and sensitive at fingers.

[The Value of High Frequency Color Doppler Ultrasonography in the Diagnosis of Solid Skin Tumorsa-a Preliminary Study].

OBJECTIVES: To explore the value of high frequency color doppler ultrasonography in differentiating benign and malignant skin solid tumors. METHODS: Clinical and ultrasonic data of cutaneous solid tumors confirmed by pathology in our hospital were collected. The differences in clinical and sonographic features between benign and malignant tumors were statistically analyzed. RESULTS: A total of 512 patients, involving 527 cases of skin solid tumors, were enrolled in this study. The ultrasonic detected 99.43% of the cases, with 99.02% accuracy in locating the lesions. The benign and malignant tumors showed differences in patient age, location, multiple occurance, location and depth, surface skin condition, tumor size, echo, morphology, uniformity, calcification, blood flow status, tumor rear area and peripheral echo, and pathological requests ( P<0.05). CONCLUSIONS: High frequency ultrasound has excellent detection rate of skin tumors, which can locate invasion depth of skin accurately. Benign and malignant skin tumors show differences in a number of clinical and ultrasound features.

[Ultrasonic Features of Enthesitis: a Comparison Between Patients with Psoriasis Vulgaris and Patients with Psoriatic Arthritis].

OBJECTIVE: To compare the ultrasonic features of enthesitis between psoriatic arthritis and psoriasis vulgaris. METHODS: A total of 39 patients with psoriatic arthritis (PsA group), 60 with psoriasis vulgaris (non-PsA group) and 60 healthy people (control group) participated in this study. They were examined by two-dimensional and color Doppler ultrasound on the entheses of bilateral femoral quadriceps tendons, patella tendons, Achilles tendons, plantar fasciae, common flexor tendons and common extensor tendons. RESULTS: About 45% (27 cases) healthy controls had enthesitis, with Achilles tendons and femoral quadriceps tendons being most likely affected. No blood flow signal was observed on the affected sites. About 63% (38 cases) of non-PsA patients had enthesitis, with Achilles tendons and femoral quadriceps tendons being most likely affected. Blood flow signals were observed on 4 affected sites. More than 84% (33 cases) PsA patients had enthesitis, with all locations being likely affected but mostly on Achilles tendons, femoral quadriceps tendons, and plantar fasciae. Blood flow signals were observed on 18 affected sites. The differences in prevalence of enthesitis were statistically significant (PsA group>non-PsA group>control group, all P<0.01), although the differences in tendon hypoechogenicity and enthesophytes among the groups showed no statistical significance. PsA and non-PsA patients were more likely to have tendon thickening than the controls (both P<0.01); but no difference appeared between PsA and non-PsA patients. PsA patients had higher prevalence of intratendinous calcifications, bony erosions and color Doppler signals than non-PsA patients and the controls (all P<0.01). CONCLUSION: Enthesitis in healthy people and non-PsA patients are most likely to affect Achilles tendon and femoral quadriceps tendons. By contrast, Achilles tendons, femoral quadriceps tendon and plantar fascia are more likely to be affected in patients with PsA. PsA patients have high prevalence of enthesitis and are more likely to have intratendinous calcifications, bony erosions and color Doppler signals.

[Enhanced local gene transfection in rats with injured achilles tendons and granulation tissues using ultrasound and microbubble].

OBJECTIVE: To identify best local ukrasound transfection conditions in rats with injured achilles tendons and granulation tissues. METHODS: Rat models with bilateral injured achilles tendons were established. A mixture of microbubbles and enhanced green fluorescent protein (EGFP) plasmids were injected into the achilles tendons. The injured tendons were subject to ultrasound irradiation under different output intensity, duty cycle and irradiation time. The rats were divided into four groups: (1) plasmid+microbubbles- ultrasound (PL+MB+US); (2)plasmid + microbubble (PL+MB); (3)plasmid + ultrasound (PL+US); (4) plasmid only (PL). We identified the best ultrasound conditions based on the highest transfection efficiency in the achilles tendons and granulation tissues and the least normal tissue damage. RESULTS: Under the condition of 2 W/cm2 power output and 20% duty cycle of ultrasound irradiation for 10 min, EGFP expression was demonstrated in the achilles tendons and granulation tissues without showing significant damage to normal tissues. Higher levels of EGFP expression were found in the group of PL+ MB+ US than the other groups (no significant differences in EGFP expression were found among the other three groups). CONCLUSION: Under proper conditions, ultrasound and microbubble can enhance in vivo gene transfection efficiency in rats with injured achilles tendons and granulation tissues without causing obvious normal tissue damage, which could provide a sound basis for experimental study of gene therapy for injured tendons.

[Correlation between quantitative results of contrast-enhanced ultrasonography and clinical and laboratory indexes for synovium of patients with rheumatoid arthritis ].

OBJECTIVE: To determine the correlation between quantitative results of contrast enhanced ultrasound and clinical and laboratory index for synovium of patients with rheumatoid arthritis (RA). METHODS: Thirty five RA patients participated in this study, with ten normal adults serving as controls. They were given a score of DAS28 and underwent laboratory tests, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Contrast-enhanced ultrasound examinations were performed to detect thickness of synovium (2D and Power Dopple). RESULTS: Peak intensity (PI) and area under the curve (AUC) were positively correlated with ESR, CRP and DAS28 score, respectively (P<0. 01). The rest of ultrasound parameters had no significant correlations with ESR, CRP and DAS28 score (P>0. 05). Synovium thickness identified by contrast enhanced ultrasound had significant correlations with ESR, CRP and DAS28 score (P < 0. 01). CONCLUSION: Synovium thickness determined by contrast enhanced ultrasound, PI and AUC can serve as an index estimating inflammatory activity of RA, and provide evidence for clinical diagnosis and treatment.

[Diagnostic value of ultrasound imaging in chronic gouty arthritis].

OBJECTIVE: To determine the diagnostic value of ultrasound imaging in chronic gouty arthritis. METHODS: Ultrasound imaging of 32 patients with chronic gouty arthritis were compared with those of 36 patients with non-gouty joint diseases. A logistic model was obtained to establish the associations between ultrasound appereances and gouty arthritis. Receiver operator characteristic (ROC) curve was constructed to evaluate the performance of the logistic model. RESULTS: A double contour sign of articular cartilage, a snowstorm appearance of the joint fluid, and a hyperecho around the periarticular tendon had diagnostic value for chronic gouty arthritis. According to the logistic regression analysis, the accuracy of predicting chronic gouty arthritis was 95.59% (65/ 68), and the area under curve of ROC was 3.987 +/- 0.011 (P < 0.05). CONCLUSION: A double contour sign of articular cartilage, a snowstorm appearance of the joint fluid, and a hyperecho around the periarticular tendon have diagnostic value. The combination of these appearances can improve diagnosis of chronic gouty arthritis.

[Study on the parameter optimization for therapeutic ultrasound mediated microbubble destruction enhancs gene transfection in rat muscle in vivo].

OBJECTIVE: To search for the most suitable gene transfection conditions for rat muscle in vivo by therapertic ultrasound-mediated microbubble destruction (UMMD). METHODS: A mixture of microbubbles and enhanced green flurescence protein (EGFP) plasmids was injected into rat tibialis anterior muscle and the muscels treated with ultrasound irradiation by different output intensity, duty cycle and irradiation time of therapeutic ultrasound. The transfection efficiency was demonstrated by the EGFP expression results under fluorescent staining and immunohistochemical staining. And the most favorable ultrasound conditions as well as local intra-muscle and intravenous injection methods were selected based on the best transfection efficiency and the least muscle damage under HE staining. The rats were divided into four groups: 1) ultrasound + microbubbles + plasmid; 2) microbubble + plasmid; 3) ultrasound + plasmid; 4) plasmid only. The favorable ultrasound conditions and injection method were selected out on the basis of above steps. EGFP expression was observed in the tibialis anterior muscle of each group. The rats were sacrificed in groups at 5 days after they underwent ultrasound irradiation, the EGFP expression in muscle was observed after fluorescent and immunohistochemical stainingand the muscle damage was also observed under HE staining. RESULTS: The most favorable conditions consisted of a 1-MHz therapeutic ultrasound irradiation applied for 3 min, a power output of 2 W/cm2 and a 20% duty cycle. Under these conditions, the muscle showed significant EGFP expression, and the muscle was not significantly damaged. The EGFP expression induced by the local intra-muscle injection was more significantly increased than that induced by the intravenous injection. Among the four groups, the EGFP expression under fluorescence staining and immunohistochemical staining in the muscle of the ultrasound + microbubbles + plasmid group was significantly higher than that of the other three groups, and the microbubbles + plasmid group was higer than that of the other two groups (P<0.05). No muscle damage caused by the ultrasound and microbubbles was detected under HE staining. CONCLUSION: Under the optimal transfection conditions, the therapeutic ultrasound-mediated microbubble destruction method can significantly enhance the in vivo gene transfection efficiency of rat muscle and found no damage to the muscle. Thus, these conditions can be used as part of a safe and effective non-viral gene transfection procedure for gene therapy.