A study on the efficacy of microwave ablation for benign thyroid nodules and related influencing factors.

OBJECTIVES: To explore the efficacy of microwave ablation (MWA) in the treatment of benign thyroid nodules, and analyze related influencing factors. METHODS: The clinical and ultrasound data of 115 patients with 115 benign thyroid nodules treated with MWA were retrospectively analyzed. The volume of nodules at 1, 3, 6, and 12 months after the procedure was obtained, and the volume reduction rate (VRR) at each time point was calculated. With VRR > 90% as the criterion for nodule cure, binary logistic regression was employed to screen the factors that affect the efficacy. RESULTS: ① At 1, 3, 6, and 12 months after the procedure, the volume of nodules continued to decrease, the VRR gradually increased, and the differences at each time point were statistically significant (p < 0.05). A total of 29 (25.21%) nodules disappeared completely at 12 months after the procedure; ② Multivariate stepwise logistic regression showed that there was a statistically significant difference for the internal component of nodules, enhancement mode, and immediate volume after the procedure in determining the ablation efficacy (p < 0.05); ③ The ROC curve was plotted for predicting the efficacy of MWA, with the results showing that the AUC, sensitivity, specificity, and accuracy were 0.82, 67.50, 88.00, 79.10%, respectively; ④ 11 cases (9.56%) had side effects, 10 cases (8.70%) had minor complications, and three cases (2.61%) had major complications. CONCLUSION: MWA is safe and effective in the treatment of benign thyroid nodules. The internal component of nodules, enhancement mode, and immediate volume after the procedure are independent factors that affect the efficacy of ablation.

Prognostic potential of layer-specific global longitudinal strain in patients with non-ST-segment elevated acute coronary syndrome and preserved left ventricular ejection fraction.

This study sought to investigate the prognostic potential of layer-specific global longitudinal strain (GLS) in predicting cardiac events among non-ST-segment elevated acute coronary syndrome (NSTE-ACS) patients with preserved LVEF. In this prospective study, we enrolled 160 consecutive NSTE-ACS patients with preserved LVEF (≥ 50%) who underwent successful percutaneous coronary intervention (PCI). Transthoracic two-dimensional echocardiography examinations were performed within 48 h of admission (before PCI). Cardiac events were defined as all-cause death, re-infarction, and hospitalization for heart failure. During a median follow-up of 30.2 months, 23 patients (14.4%) developed cardiac events. GLS for all three myocardial layers were reduced in patients with adverse outcome (all P < 0.001). Yet GLSendo (area under curves = 0.85) and GLSmid (area under curves = 0.83) showed relatively higher predictive power than GLSepi when identifying patients with cardiac events. The best cut-off value of GLSendo was - 20.8%, with a diagnostic sensitivity and specificity of 87% and 71% respectively. A significant increase in the risk of cardiac events development was shown among patients with impaired layer GLS (log-rank test, P < 0.001). In conclusion, NSTE-ACS patients with preserved LVEF, layer GLS assessed before PCI all had good abilities to predict cardiac events, which might provide more prognostic information against conventional echocardiographic risk factors.

Comparison of adipose­ and bone marrow­derived stem cells in protecting against ox­LDL­induced inflammation in M1­macrophage­derived foam cells.

Adipose­derived stem cells (ADSCs) and bone marrow­derived stem cells (BMSCs) are considered to be prospective sources of mesenchymal stromal cells (MSCs), that can be used in cell therapy for atherosclerosis. The present study investigated whether ADSCs co­cultured with M1 foam macrophages via treatment with oxidized low­density lipoprotein (ox­LDL) would lead to similar or improved anti­inflammatory effects compared with BMSCs. ADSCs, peripheral blood monocytes, BMSCs and ox­LDL were isolated from ten coronary heart disease (CHD) patients. After three passages, the supernatants of the ADSCs and BMSCs were collected and systematically analysed by liquid chromatography­quadrupole time­of­flight­mass spectrometry (6530; Agilent Technologies, Inc., Santa Clara, CA, USA). Cis­9, trans­11 was deemed to be responsible for the potential differences in the metabolic characteristics of ADSCs and BMSCs. These peripheral blood monocytes were characterized using flow cytometry. Following peripheral blood monocytes differentiation into M1 macrophages, the formation of M1 foam macrophages was achieved through treatment with ox­LDL. Overall, 2x106 ADSCs, BMSCs or BMSCs+cis­9, trans­11 were co­cultured with M1 foam macrophages. Anti­inflammatory capability, phagocytic activity, anti­apoptotic capability and cell viability assays were compared among these groups. It was demonstrated that the accumulation of lipid droplets decreased following ADSCs, BMSCs or BMSCs+cis­9, trans­11 treatment in M1 macrophages derived from foam cells. Consistently, ADSCs exhibited great advantageous anti­inflammatory capabilities, phagocytic activity, anti­apoptotic capability activity and cell viability over BMSCs or BMSCs+cis­9, trans­11. Additionally, BMSCs+cis­9, trans­11 also demonstrated marked improvement in anti­inflammatory capability, phagocytic activity, anti­apoptotic capability activity and cell viability in comparison with BMSCs. The present results indicated that ADSCs would be more appropriate for transplantation to treat atherosclerosis than BMSCs alone or BMSCs+cis­9, trans­11. This may be an important mechanism to regulate macrophage immune function.

Using neutrosophic graph cut segmentation algorithm for qualified rendering image selection in thyroid elastography video.

Recently, elastography has become very popular in clinical investigation for thyroid cancer detection and diagnosis. In elastogram, the stress results of the thyroid are displayed using pseudo colors. Due to variation of the rendering results in different frames, it is difficult for radiologists to manually select the qualified frame image quickly and efficiently. The purpose of this study is to find the qualified rendering result in the thyroid elastogram. This paper employs an efficient thyroid ultrasound image segmentation algorithm based on neutrosophic graph cut to find the qualified rendering images. Firstly, a thyroid ultrasound image is mapped into neutrosophic set, and an indeterminacy filter is constructed to reduce the indeterminacy of the spatial and intensity information in the image. A graph is defined on the image and the weight for each pixel is represented using the value after indeterminacy filtering. The segmentation results are obtained using a maximum-flow algorithm on the graph. Then the anatomic structure is identified in thyroid ultrasound image. Finally the rendering colors on these anatomic regions are extracted and validated to find the frames which satisfy the selection criteria. To test the performance of the proposed method, a thyroid elastogram dataset is built and totally 33 cases were collected. An experienced radiologist manually evaluates the selection results of the proposed method. Experimental results demonstrate that the proposed method finds the qualified rendering frame with 100% accuracy. The proposed scheme assists the radiologists to diagnose the thyroid diseases using the qualified rendering images.

Ultrasound utility for predicting biological behavior of invasive ductal breast cancers.

PURPOSE: The aim of the study was to evaluate the correlation of ultrasound features with breast cancer molecular status. MATERIALS AND METHODS: A retrospective review was performed of ultrasound findings in 263 patients diagnosed with breast invasive ductal carcinoma for comparison with immunohistochemistric results were obtained from each lesion. Relationships between ultrasound findings and molecular status were investigated by using multiple regression analysis by means of stepwise logistic regression. Differences in ultrasound criteria were assessed among women with different molecular status. RESULTS: ER positivity was associated with small size, lobulate, angular or spiculated margin contours, absence of calcification, posterior tumor shadowing and low elasticity score; PR positivity was associated with small size, lobulate or angular or spiculated margin contours and absence of calcification; HER2 positivity was associated with presence of calcification and absence of any echogenic halo. The calculated models of predicted molecular status were accurate and discriminating with AUCs of 0.78, 0.74, and 0.74, respectively. CONCLUSIONS: Breast cnacer ultrasound features show some correlation with the molecular status. These models may help to expand the scope of ultrasound in predicting tumor biology.

Association of conventional risk factors for cardiovascular disease with IMT in middle-aged and elderly Chinese.

To study the association between known risk factors for cardiovascular disease and intima-media thickness (IMT) in the carotid and popliteal arteries in middle-aged and elderly Chinese adults. 686 middle aged and elderly Chinese adults from the China Da Qing Diabetes Prevention Study who had full clinical, laboratory, ultrasound examination results were enrolled in the study. Common carotid artery (CCA) and popliteal artery (PA) IMT were obtained using high resolution ultrasound machine. Pearson's or Spearman's correlation analysis and logistic regression analysis were used to determine association between risk factors [age, gender, tobacco smoking, body mass index (BMI), diabetes mellitus (DM), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol, total triglyceride, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, glycosylated hemoglobin (HbA1c)] and CCA- or PA-IMT. The age range of the study population was 45-87 years, 384 of them (56 %) were women. The prevalence of high blood pressure and DM was 60.6 and 68.8 %, respectively. Participants in DM group tended to be older, had greater value for SBP, HbA1c and PA-IMT, but smaller value for DBP than those in control group. Smoke status, BMI, blood lipids and CCA-IMT were not statistically different between groups. Pearson's or Spearman's rank correlation analysis showed that CCA-IMT had a positive correlation with age, gender, DM, SBP, BMI and HbA1c, negative correlation with HDL-C. PA-IMT showed a positive correlation with age, gender and SBP. Univariate logistic regression analysis showed that elevation of age, SBP, BMI, HbA1c and having DM were significant predictors of CCA-IMT thickening, so was reduction of HDL-C. Risk factors that predicted significant thickening of PA-IMT were age, gender, tobacco smoking. After adjusted for age and gender, except HDL-C, the other four risk factors (SBP, BMI, HbA1c and having DM) that predicted CCA-IMT thickening remained significant; however none of the risk factors predicted PA-IMT thickening after adjusted for age and gender. The current results provide evidence that CCA-IMT is a superior marker for atherosclerosis compared with PA-IMT. Aggressive control of SBP, HbA1c and proper control of weight may postpone thickening of CCA-IMT.

The value of strain ratio in differential diagnosis of thyroid solid nodules.

OBJECTIVE: To assess the clinical value of strain ratio in differentiating thyroid solid nodules and explore its distribution characters based on pathological results. MATERIALS AND METHODS: The study was approved by the ethic committee and the informed consents were signed. Ninety nine solid thyroid nodules (67 benign and 32 malignant) from 71 female (mean age 46.3 ± 9.8 years) and 28 male (mean age 54.9 ± 11.7 years) patients were evaluated. Five radiologists evaluated the nodules based on a four-degree elastography score system. Strain ratio was calculated on-line. Diagnostic performances of the two evaluations were compared using Receiver Operating Characteristic (ROC) curves. Values of different pathological nodules were compared by one-way ANOVA. RESULTS: Areas under the ROC curve (AUC) of the five readers were 0.82, 0.81, 0.79, 0.73 and 0.83, respectively. The AUC of strain ratio evaluation was higher (0.88 vs. 0.79, p < 0.001) than that of the ES score evaluation. Best cut-off points of the two evaluations were 3.5 (82% sensitivity, 72% specificity) and 4.225 (81% sensitivity, 83% specificity), respectively. Both the ES score and strain ratio were higher for malignant nodules than that for benign ones (p < 0.001). CONCLUSIONS: Strain ratio was a useful index in differential diagnosis of thyroid solid nodules. It can provide quantitative information on thyroid nodule characterization and improve diagnostic confidence. The best cut-off point for benign and malignant nodules was 4.2.

[Quantitative evaluation of myocardial perfusion and regional systolic function by myocardial contrast stress echocardiography with computer-assisted technique in ischemic myocardium of rabbits].

OBJECTIVE: To evaluate the feasibility and value of determining myocardial perfusion and regional systolic function by myocardial contrast stress echocardiography (MCSE) with computer-assisted technique in a rabbit model of ischemia/reperfusion injury. METHODS: Rabbits underwent 30-(Group I, n = 15) and 120-(Group II, n = 15) minute left ventricular branch of the left circumflex coronary artery occlusion foll owed by 60-minute reperfusion, dobutamine at increasing doses (5, 10, 15 and 20 microg.kg(-1).min(-1)) was then infused after reperfusion for 15 min. Bolus myocardial contrast agent was injected and MCSE performed at baseline, at the end of coronary occlusion and reperfusion, at the end of each dobutamine infusion. Images were analyzed by computer-assisted technique and myocardial calibrated contrast intensity (CI) of each segment was measured and a color-coded map was then obtained automatically (yellow: from 0 to -20 pix, blue:from -21 to -40 pix, green: from -41 to -70 pix, red: < -70 pix). The area at risk and infarct area obtained by red-coded map were compared with ex vivo results determined by fluorescent microsphere and triphenyl-tetrazolium chloride (TTC) staining. Percentage wall thickening (WT) of each risk segment at each stage were also measured. RESULTS: (1) During occlusion, WT in the areas at risk decreased to zero or negative and the calibrated CI values were significantly lower than those at baseline. Area at risk obtained by red-coded map correlated well with that obtained by fluorescent staining (r = 0.91, P < 0.01). (2) After reperfusion and 5 microg.kg(-1).min(-1) dobutamine administration, WT and calibrated CI in all rabbits remained depressed. Calibrated CI at -70 pix was an optimal cutoff point to identify infarcted segments (sensitivity 95%, specificity 87%). The correlation between the infarct size by red-coded image and TTC was 0.89 (P < 0.01). (3) Calibrated CI and WT significantly improved in Group I rabbits while these parameters remained unchanged in Group II rabbits after increasing doses of dobutamine post ischemia. CONCLUSIONS: Myocardial contrast stress echocardiography in combination with computer-assisted analysis technique are valuable techniques to quantitatively assess myocardial perfusion and regional systolic function and exactly identify stunned myocardium and infarcted myocardium.

Study of normal Chinese vertebral-basilar arteries with transcranial color Doppler flow imaging.

OBJECTIVE: The aim of this study was to evaluate the blood flow characteristics of intracranial vertebral-basilar artery (V-BA) in healthy Chinese adults with transcranial color Doppler flow imaging (TCDFI) and provide reference values of healthy people of different ages and genders. METHODS: Three hundred healthy Chinese adults were divided into three groups based on their ages: Group I: 20-39 years, Group II: 40-59 years, Group III: >/=60 years. Each group was subdivided into two subgroups according to their gender. Peak systolic velocity (Ps), end-diastolic velocity (Vd), time average maximum velocity (TAMAX), pulsatility index (PI), and resistance index (RI) were measured from intracranial V-BA scanning. RESULTS: Ps, Vd, and TAMAX decreased with age, while PI and RI increased in all groups. Flow velocity in women was slightly higher than that of men, and there was significant differences in group III between men and women (P<.05). However, no difference was found in the flow parameters between left and right vertebral arteries. CONCLUSIONS: This study offered reference values of intracranial V-BA flow parameters in healthy Chinese adults and indicated that these parameters varied with age and gender.