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Objective:To determine the clinical application value of transcranial sonography (TCS) in the diagnosis of attention deficit hyperactivity disorder (ADHD) in children.Methods:A total of 50 children aged 6-12 years diagnosed with ADHD (ADHD group) and 45 age-matched healthy children (control group) who presented to Suzhou Municipal Hospital and Children′s Hospital of Soochow University from August 2021 to August 2022 were prospectively enrolled for TCS examination. ADHD was diagnosed in accordance with the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-Ⅴ) criteria established by the American Psychiatric Association.Based on clinical symptom characteristics, ADHD was further classified into 3 subtypes, including 14 cases of predominantly inattentive, 3 cases of predominantly hyperactive/impulsive, and 33 cases of combined presentation. The substantia nigra(SN) hyperechoic area and the ratio of SN hyperechoic area to midbrain area (S/M) were measured and compared between the two groups. The examination of the correlation was performed between SN hyperechoic area, S/M ratio, and DSM-Ⅴ scores within the ADHD group.Results:Semi-quantitative analysis: the proportion of the SN grade Ⅲ or more in ADHD group was significantly higher than that in control group [96.00%(48/50) vs 13.3%(6/45), P<0.05]. Quantitative analysis: the area of SN hyperechogenicity and the ratio of S/M were significantly larger in ADHD group than in control group [0.32(0.22, 0.38)cm 2 vs 0.00(0.00, 0.00)cm 2, 7.08(5.11, 8.75)% vs 0.00(0.00, 0.00)%, all P<0.05]. Correlation analysis: The SN hyperechoic area and S/M ratio showed no significant correlations with DSM-Ⅴ scores in the ADHD group ( r=0.144, 0.142, all P>0.05). Conclusions:TCS can detect the SN echo enhancement of ADHD children, and the proportion of SN echo enhancement, SN hyperechoic area and S/M ratio are significantly higher than those of normal children, but the SN hyperecho area and S/M ratio are not significantly correlated with DSM-Ⅴ scores.
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BACKGROUND@#Three-dimensional shear wave elastography (3D-SWE) is a promising method in distinguishing benign and malignant thyroid nodules. By combining with conventional method, it may further improve the diagnostic value. The study aimed to assess the diagnostic value of American College of Radiology (ACR) thyroid imaging reporting and data system (TI-RADS) combined with 3D-SWE in ACR TI-RADS 4 and 5 thyroid nodules.@*METHODS@#All nodules were examined by conventional ultrasonography, ACR TI-RADS classification, and 3D-SWE examination. Conventional ultrasonography was used to observe the location, size, shape, margin, echogenicity, taller-than-wide sign, microcalcification, and blood flow of thyroid nodules, and then ACR TI-RADS classification was performed. The Young's modulus values (3D-C-Emax, 3D-C-Emean, and elastography standard deviation [3D-C-Esd]) were measured on the reconstructed coronal plane images. According to the receiver operating characteristic (ROC) curve, the best diagnostic efficiency among 3D-C-Emax, 3D-C-Emean, and 3D-C-Esd was selected and the cut-off threshold was calculated. According to the surgical pathology, they were divided into benign group and malignant group. And appropriate statistical methods such as t -test and Mann-Whitney U test were used to compare the difference between the two groups. On this basis, 3D-SWE combined with conventional ACR TI-RADS was reclassified as combined ACR TI-RADS to determine benign or malignant thyroid nodules.@*RESULTS@#Of the 112 thyroid nodules, 62 were malignant and 50 were benign. The optimal cut-off value of three-dimensional maximum Young's modulus in coronal plane (3D-C-Emax) was 51.5 kPa and the area under the curve (AUC) was 0.798. The AUC, sensitivity, specificity, and accuracy of conventional ACR TI-RADS were 0.828, 83.9%, 66.0%, and 75.9%, respectively. The AUC, sensitivity, specificity, and accuracy of combined ACR TI-RADS were 0.845, 90.3%, 66.0%, and 79.5%, respectively. The difference between the two AUC values was statistically significant.@*CONCLUSIONS@#Combined ACR TI-RADS has higher diagnostic efficiency than conventional ACR TI-RADS. The sensitivity and accuracy of combined ACR TI-RADS showed significant improvements. It can be used as an effective method in the diagnosis of thyroid nodules.
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Humanos , Nódulo da Glândula Tireoide/patologia , Técnicas de Imagem por Elasticidade/métodos , Estudos Retrospectivos , Ultrassonografia/métodosRESUMO
Objective To observe the effect of transcatheter arterial embolization(TAE)with Glubran-2 glue for treating hemorrhage after percutaneous transhepatic cholangial drainage(PTCD).Methods Data of 17 patients with hemorrhage after PTCD who underwent TAE with Glubran-2 glue were retrospectively analyzed.The technical success rate,clinical success rate and complications were observed.The red blood cell(RBC)and hemoglobin(Hb)on the day of TAE and the next day of TAE were compared,also the glutamic-pyruvic transaminase(GPT)level before TAE,on the next day of TAE,on the second and the fourth day after TAE,respectively.Results The offending vessel of bleeding was successfully embolized in all 17 cases,both technical success rate of TAE and clinical success rate of hemostasis were 100%.There was no serious complication such as liver abscess,septicemia nor pulmonary embolism.No significant difference of RBC nor Hb was found between the day of TAE and the next day of TAE(both P>0.05).GPT before TAE was lower than the next day of TAE and the second day after TAE(P<0.05),while no significant difference of GPT was found before TAE and 4 days after TAE(P>0.05).Conclusion TAE with Glubran-2 glue for treating hemorrhage after PTCD was safe and effective.
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Objective To observe the effect of Bushen Gutai mixture on uterine blood supply of rat model of abortion induced by hydroxyurea tablets combined with mifepristone through PKA-CREB signal pathway and its mechanism of calming fetus.Methods 60 pregnant rats of SPF grade SD rats were prepared by closing cages at 2∶1.According to the order of pregnancy,60 pregnant rats were randomly divided into 6 groups with 10 rats in each group:Bushen Gutai mixture group(low,middle and high dose),normal pregnancy group,model group and Di qu progesterone group.On the 1st to 9th day of pregnancy,except the normal group,the pregnant rats in each group were gavaged with hydroxyurea tablets at 5∶00 pm every day(450 mg·kg-1),and at 10∶00 am on the 10th day of pregnancy.Mifepristone tablets were given by intragastric administration(4.0 mg·kg-1).At 9∶00 am every day from the 1st to 9th day of pregnancy,Bushen Gutai mixture was given to the low,middle and high dose groups(0.5,1.0,2.0 g·kg-1),didrone group(3.02 mg·kg-1),model group and normal pregnancy group with 0.9%normal saline.24 hours after the last administration of pentobarbital sodium(50 mg kg-1),all pregnant rats were killed by intraperitoneal injection of pentobarbital sodium,and the uterine decidual tissue of pregnant rats was bluntly isolated in sterile environment.Hematoxylin-eosin(HE)staining was used to observe the lumen diameter and wall thickness of spiral artery in uterine decidual tissue.Immunohistochemical staining(IHC)was used to detect the expression of vascular endothelial growth factor(VEGF)in decidual tissues.Western blot was used to detect the protein expression of phosphorylated protein kinase A,protein kinase A,phosphorylated cyclic adenosine monophosphate response element binding protein,Cyclic Adenosine monophosphate response element binding protein and aquaporin 5 in the decidua of pregnant rats.The apoptosis of decidual cells was detected by in situ end labeling(TUNEL)of DNA fragmentation.Results Compared with the model group,the wall thickness of spiral artery was higher than that in other groups(P<0.05),the lumen diameter was lower than that in other groups(P<0.05)and the expression of VEGF protein was lower than that of other groups(P<0.01).Compared with the model group,the apoptosis level of decidual cells in uterine decidua of abortive rats in high,middle and low dose groups of Bushen Gutai mixture and diqu progesterone group decreased in varying degrees.Bushen Gutai mixture can up-regulate the levels of p-PKA/PKA and p-CREB/CREB in uterine decidua(P<0.01)and promote the expression of AQP5 protein in uterine decidua of abortion rats(P<0.01).Conclusion Bushen Gutai mixture can improve uterine blood supply of aborted rats by activating PKA and CREB phosphorylation,up-regulating AQP5 expression,promoting physiological recasting of spiral artery and high expression of Vascular endothelial growth factor.
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Objective:To analyse the changes in color Doppler and contrast-enhanced ultrasound (CEUS) blood flow parameters in patients with septic acute kidney injury (AKI) from the perspective of macroscopic circulation and microscopic circulation perfusion, in order to explore the value of clinical application of ultrasound in this disease.Methods:A total of 53 ICU-admitted patients diagnosed with septic AKI at the Second Affiliated Hospital of Soochow University from January 2021 to May 2022 were selected.Patients with septic AKI were classified into stages 1-3 according to the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) AKI diagnostic criteria, with stage 1 being the mild group(17 cases), stages 2 and 3 being the severe group(21 cases), and septic patients without AKI in the same period being the control group(15 cases). The ultrasound parameters such as the relative blood flow(RBF) and time-averaged velocity(TAV) of the renal artery as well as the cardiac output (CO) and cardiac index (CI) in the macroscopic circulation were measured, and the time-intensity curve was analysed by the CEUS analysis software to calculate the microscopic parameters such as time to peak(TTP), rise time(RT), fall half time(FHT) and mean transit time(MTT), and the cardiac output and cardiac index were also measured. The differences in ultrasound Doppler and CEUS parameters among the various groups were compared. The diagnostic effectiveness of each parameter for severe AKI was assessed using ROC curve analysis.Results:①In macrocirculation, the renal blood flow (RBF) and time-averaged velocity (TAV) gradually decreased ( P=0.004, P<0.001) as the disease progressed in AKI patients. But the difference of CO and CI among the three groups were not statistically significant in each group ( P=0.17, 0.12). ②In microcirculation, the renal interlobar artery Doppler parameters pulsatility index (PI), resistance index (RI), and systolic/diastolic flow ratio (S/D) gradually increase in patients with septic AKI ( P<0.05) and the CEUS parameters TTP, RT, FHT and MTT were prolonged ( P<0.001, P=0.003, P=0.004, P=0.009). ③The combined diagnosis of RI and TTP was more beneficial in diagnosing septic AKI in critically ill patients [AUC=0.93(0.85-1.00)]. Conclusions:Color Doppler ultrasound combined with CEUS can detect reduced macroscopic and microscopic circulation in patients with septic AKI, especially in those with severe AKI, and this is independent of changes in CO or CI.
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Objective:To explore the adjunctive diagnostic value of transcranial sonography (TCS) combined with olfactory test in early Parkinson′s disease (PD) and the clinical value of both in the cognitive function of PD patients.Methods:TCS and olfactory test were performed in 157 early PD patients(PD group) and 157 healthy controls(control group) in the Second Affiliated Hospital of Soochow University from January 2018 to January 2022. The differences in clinical characteristics, TCS, and olfactory test results between the two groups were analyzed. The values of TCS, olfactory test, and their combination in diagnosing early PD were evaluated using clinical diagnosis as the gold standard. The correlations of the midbrain area, the midbrain substantia nigra hyperechoic area, and the third ventricle width in TCS examination with the cognitive score were analyzed in the PD group. According to the olfactory test scores, 157 patients with early PD were divided into two groups: 110 cases of PD with olfactory dysfunction (PD-OD) and 47 cases of PD without olfactory dysfunction (PD-NOD). The differences in clinical scores and TCS results between the two groups were compared.Results:The midbrain substantia nigra hyperechoic area, substantia nigra hyperechoic positivity rate, third ventricle width, and olfactory dysfunction rate were higher in the PD group compared to the control group, while the midbrain area and olfactory test scores were lower than those in the control group (all P<0.001). The sensitivity and the coincidence rate of TCS combined with the olfactory test for early PD diagnosis (90.0%, 77.1%) were higher than those of TCS alone (60.0%, 71.3%) and olfactory test alone (70.1%, 72.3%), but the specificity (63.7%) was lower than that of both alone (82.8% for TCS and 75.2% for olfactory test), (all P<0.001). MoCA score, visual space and executive ability, memory, attention, and language were positively correlated with the area of the midbrain ( rs=0.38, 0.32, 0.27, 0.25, 0.23; all P<0.05) and negatively correlated with the width of the third ventricle ( rs=-0.39, -0.22, -0.39, -0.22, -0.32; all P<0.05), and orientation was negatively correlated only with the width of the third ventricle ( rs=-0.24, P<0.05). The MoCA score of PD-OD group[22(18, 25)] was lower than that of PD-NOD group[24(20, 26)]( P=0.040). Conclusions:The combination of TCS and olfactory test can enhance the sensitivity and diagnostic agreement rate for early PD diagnosis, providing some auxiliary value. The cognitive function of PD patients is positively correlated with the midbrain area and negatively correlated with the width of the third ventricle. The cognitive function of PD patients with olfactory dysfunction is lower than that of PD patients without olfactory dysfunction. TCS and olfactory test may help assess cognitive function in PD patients.
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Objective:To explore the pathological mechanism of SN hyperechogenicity by investigating the characteristics of substantia nigra (SN) hyperechogenicity on transcranial sonography (TCS) and serum iron metabolism parameters in the postural instability gait difficulty and tremor dominant subtypes of Parkinson′s disease (PD), and the correlation between them.Methods:A total of 155 PD patients recruited in Parkinson′s Disease Specialty in the Second Affiliated Hospital of Soochow University from January 2019 to December 2021 were divided into postural instability gait difficulty group( n=95) and tremor dominant group( n=60). Meanwhile, 49 healthy gender- and age-matched healthy individuals who sought for physical examination during the same period were included as the control group. All subjects underwent TCS and blood test, and the echo of SN between the postural instability gait difficulty group and tremor dominant group, serum iron metabolism parameters among the three groups were compared. The postural instability gait difficulty group and tremor dominant group were subdivided into with SN hyperechogenicity (SN+ )subgroup and without SN hyperechogenicity (SN-) subgroup respectively according to TCS results, and the differences in serum iron metabolism parameters between the subgroups were further compared. The association between SN hyperechogenicity and serum iron metabolism parameters of the postural instability gait difficulty group and tremor dominant group were further analyzed. Results:The total area of bilateral SN+ , the area of SN+ on the larger side, and the ratio of the total area of SN+ to the midbrain area (S/M) in postural instability gait difficulty group were larger than those in tremor dominant group (all P<0.001). The value of serum ceruloplasmin and transferrin in both postural instability gait difficulty group and tremor dominant group were lower than those in control group (all P<0.001), and compared with tremor dominant group and control group, the postural instability gait difficulty group had lower serum ferritin(all P<0.01). In both postural instability gait difficulty group and tremor dominant group, serum ceruloplasmin in SN+ subgroup was lower than that in SN-subgroup ( P=0.001, 0.032). Moreover, there was a negative correlation between serum transferrin and the area of SN hyperechogenicity in two subgroups(postural instability gait difficulty group: rs=-0.454, P<0.001; tremor dominant group: rs=-0.494, P<0.001). Conclusions:Compared with the tremor dominant patients, the postural instability gait difficulty patients have larger area of SN hyperechogenicity and lower serum ferritin level. The area of SN hyperechogenicity is significantly negatively correlated with serum transferrin level, indicating that the production of this imaging characteristics is related to iron metabolism.
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Objective:To construct a chronic obstructive pulmonary disease (COPD) assessment test (CAT) score prediction model based on a deep network fused with air data, and to explore its significance.Methods:From February 2015 to December 2017, the outdoor environmental monitoring air data near the residential area of the patients with COPD from the Respiratory Outpatient Clinics of Peking University Third Hospital, Peking University People′s Hospital and Beijing Jishuitan Hospital were collected and the daily air pollution exposure of patients was calculated. The daily CAT scores were recorded continuously. The CAT score of the patients in the next week was predicted by fusing the time series algorithm and neural network to establish a model, and the prediction accuracy of the model was compared with that of the long short-term memory model (LSTM), the LSTM-attention model and the autoregressive integrated moving average model (ARIMA).Results:A total of 47 patients with COPD were enrolled and followed up for an average of 381.60 days. The LSTM-convolutional neural networks (CNN)-autoregression (AR) model was constructed by using the collected air data and CAT score, and the root mean square error of the model was 0.85, and the mean absolute error was 0.71. Compared with LSTM, LSTM-attention and ARIMA, the average prediction accuracy was improved by 21.69%.Conclusion:Based on the air data in the environment of COPD patients, the fusion deep network model can predict the CAT score of COPD patients more accurately.
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Objective:To evaluate the clinical value of musculoskeletal ultrasound in the diagnosis of sarcopenia by measuring the muscle mass and hardness of medial head of gastrocnemius.Methods:According to the diagnostic criteria of Asian Working Group for Sarcopenia(AWGS), 60 patients with sarcopenia were selected as the case group and 24 normal elderly people with matched age as the control group.Two dimensional gray-scale ultrasound was used to measure the muscle thickness, pinnate angle and fascicle length of the right gastrocnemius muscle, and the shear wave elastography was used to measure the Young's modulus(the dynamic stiffness)of the muscle in the states of relaxation and contraction, respectively.The differences of various ultrasound parameters between the two groups were compared, and the relativity of muscle thickness of the medial head of the right gastrocnemius muscle, the feather horn, fascicle length in the case group with sarcopenia was analyzed.The value of the ultrasound measurements in predicting sarcopenia was analyzed by ROC curve.Results:The muscle thickness(10.0±2.1)mm, pinnate angle(16.9±3.2)°, fascicle length(30.5±3.2)mm and Young's modulus[(11.5±2.2)kPa in relaxation state, (23.2±4.0)kPa in contraction state]of the right gastrocnemius muscle were lower in the sarcopenia group than in the control group with matched age[(14.8±1.2)mm, (21.7±2.5)°, (34.2±1.6)mm, (15.0±1.5)kPa, (30.6±2.8)kPa, respectively, t=10.454, 3.612, 5.631, 6.922, 8.173, all P<0.05]. The Young's modulus value was lower in relaxed state than in the contraction state.Pearson correlation analyses showed the muscle thickness and Young modulus were negatively correlated with the age( r=-0.307, -0.285, P<0.05), and the muscle thickness was positively correlated with the limb skeletal muscle mass index( r=0.838, 0.761, P<0.01). Logistic regression analysis showed the muscle thickness and Young's modulus were significantly correlated with sarcopenia( OR=4.576, 3.867). ROC analysis revealed that the threshold values of ultrasound examination of the right gastrocnemius muscle medial head for diagnosis of sarcopenia were as follows: muscle thickness of 11 mm, pinnate angle of 17 degrees, fascicle length of 32 mm, Young modulus at the relaxation state of 12.4 kPa.The sensitivity and specificity of muscle thickness for diagnosis of sarcopenia were the best(86.7% and 100%, respectively)as compared with other measurements. Conclusions:The measurement of muscle mass and muscle hardness of the medial head of gastrocnemius by ultrasound can reflect the decrease of muscle mass and muscle hardness quantitatively, and provide imaging indicators for the prediction of sarcopenia.
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Purpose@#This study was conducted to evaluate the hypothesis that an enlarged prostate in old rats may lead to complications associated with voiding dysfunction involving ionotropic P2X2/3-type purinergic receptors @*Methods@#Intact animals were divided into male young (MYR; 8–10 weeks old) and male old (MOR; 20 months old) rats. The animals underwent simultaneous detrusor electromyography (EMG) and suprapubic cystometry (CMG) under urethane anesthesia. Immunofluorescence techniques were used to evaluate prostatic autonomic innervation and P2X3R expression in bladder urothelial cells. The functional role of P2X3R was characterized by intramuscular application of AF-353, a selective P2X2/3R antagonist. @*Results@#The prostate index significantly increased in MOR, suggestive of an enlarged prostate affecting micturition patterns. Significant EMG and CMG differences were found between MYR and MOR. Higher immunoreactivity for P2X2/3R in the urothelial layer and for prostatic neurofilaments was seen in MOR. Systemic inhibition of P2X2/3R had minimal effects on MYR responsiveness, but improved voiding function in MOR with a marked decrease of intravesical pressure and bladder contractile responses. @*Conclusions@#The data support the hypothesis that an enlarged prostate in MOR may contribute to voiding dysfunction involving activation of P2X2/3R, which enhances a prostate-bladder reflex. This reflex may increase bladder afferent transmission and activation of increased prostate innervation, leading to voiding dysfunction.
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Objective To discuss the neuroimaging characteristics of transcranial ultrasound in end‐stage renal disease ( ESRD ) with restless legs syndrome . Methods T ranscranial sonography ( TCS ) was performed in ESRD with restless legs syndrome ( RLS + group , n = 41 ) ,ESRD without restless legs syndrome ( RLS - group , n =57) and control group ( n =47) ,w ho were enrolled in the Second Affiliated Hospital of Soochow University from January 2017 to December 2018 . T he differences of the neuroimaging characteristics of TCS in substantia nigra ( SN ) ,brainstem raphe ( BR) and red nucleus ( RN ) among the three groups were analyzed . Results T he rate of SN hypoechogenicity was significantly higher in RLS +group ( 36 .6% ,15/41) than that in RLS - group ( 19 .3% ,11/57) and control group( 8 .5% ,4/47) ( χ2 =10 .6 ,P<0 .05) . T he rate of abnormal BR echogenicity was significantly higher in RLS + group ( 34 .1% , 14/41) and RLS - group ( 29 .8% ,17/57) than that in control group( 10 .6% ,5/47) ( χ2 =7 .7 , P <0 .05) . T he rate of RN hyperechogenicity was significantly higher in RLS + group ( 51 .2% ,21/41 ) than that in RLS - group ( 21 .1% ,12/57) and control group ( 10 .6% ,5/47) ( χ2 =19 .8 , P <0 .05 ) . Between RLS+and RLS - groups ,when SN ,BR and RN were all of positive performance ,the accuracy of diagnosing RLS+ reached 70% ( 7/10 ) . Conclusions The echogenicity changes of SN ,BR and RN on TCS could provide valuable neuroimaging information for the clinical diagnosis and treatment of ESRD with restless legs syndrome .
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Objective@#To discuss the neuroimaging characteristics of transcranial ultrasound in end-stage renal disease (ESRD) with restless legs syndrome.@*Methods@#Transcranial sonography (TCS) was performed in ESRD with restless legs syndrome (RLS+ group, n=41), ESRD without restless legs syndrome (RLS- group, n=57) and control group (n=47), who were enrolled in the Second Affiliated Hospital of Soochow University from January 2017 to December 2018. The differences of the neuroimaging characteristics of TCS in substantia nigra (SN), brainstem raphe (BR) and red nucleus(RN) among the three groups were analyzed.@*Results@#The rate of SN hypoechogenicity was significantly higher in RLS+ group (36.6%, 15/41) than that in RLS- group (19.3%, 11/57) and control group(8.5%, 4/47) (χ2=10.6, P<0.05). The rate of abnormal BR echogenicity was significantly higher in RLS+ group (34.1%, 14/41) and RLS- group (29.8%, 17/57) than that in control group(10.6%, 5/47) (χ2=7.7, P<0.05). The rate of RN hyperechogenicity was significantly higher in RLS+ group (51.2%, 21/41) than that in RLS- group (21.1%, 12/57) and control group (10.6%, 5/47) (χ2=19.8, P<0.05). Between RLS+ and RLS- groups, when SN, BR and RN were all of positive performance, the accuracy of diagnosing RLS+ reached 70% (7/10).@*Conclusions@#The echogenicity changes of SN, BR and RN on TCS could provide valuable neuroimaging information for the clinical diagnosis and treatment of ESRD with restless legs syndrome.
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Objective To investigate the therapeutic effect of endoscopic plastic stent and metal stent placement in relieving obstructive jaundice in patients with pancreatic cancer,and to analyse the cost effectiveness.Methods A retrospective review was performed on the clinical data of 102 pancreatic cancer patients with obstructive jaundice in General Hospital of Northern Theater Command between January 2013 to January 2014.The patients were divided into plastic stent group (n =26) and metal stent group (n =76)based on the type of biliary stent placed under endoscopy.The complication and short-term therapeutic effect were compared between two groups.The number of endoscopic stent placement,treatment interval,hospitalization cost and median survival time were recorded.Results The levels of alanine aminotransferase (ALT) and total bilirubin (TBiL) in the two groups 5-7 days after endotherapy were significantly lower than those before treatment,but the difference was not statistically significant between the two groups (P <0.05).No severe complication was observed.The average number of treatments in the metal stent group was significantly lower than that in the plastic stent group (1.7 times vs 2.9 times),and the treatment interval was significantly longer[(271.7 ± 42.3) d vs (113.4 ± 38.2) d].The difference above between these two groups was statistically significant (P<0.05).However,there was no significant difference on the average total hospitalization cost (84227.2 yuan vs 86906.8 yuan) or median survival time (15.6 months vs 13.1 months)between these two groups.Conclusions Primary placement of metal biliary stents for obstructive jaundice in adult patients with metastatic pancreatic carcinoma was cost-effective than plastic stents,and their effects were comparable.
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Objective To analyze the multimodal imaging findings of nonspecific granulomatous prostatitis (NSGP)and improve our understanding of the disease.Methods 1 427 patients underwent transrectal ultrasoundGguided prostate biopsies in our department,then 1 3 nodules in 11 patients were proven NSGP by pathology,of which 3 nodules were in inner gland and 10 were in outer gland.The characteristics of these nodules on MRI,transrectal ultrasound elastography (TRE)and contrastGenhanced ultrasonography (CEUS)were retrospectively analyzed. Results MRI:All of the nodules showed similar performances:hypointensity on T1 WI and T2 WI,low ADC and high signal on DWI (highGbGvalue),early enhancement and faded fast or slow,depressed citrate (Cit)and relatively elevated choline (Cho)peak.TRE:The cutGoff point of strain ratio (SR)was determined as 5.97 to diagnose prostate cancer and the SRs of 8 nodules were greater than 5.9 7.CEUS:1 1 nodules showed early enhancement and great intensity,but the rest of nodules showed same performance with normal tissue.Conclusion The multimodal imaging helps to improve the understanding of NSGP and plays a positive role in guiding targeted biopsy.Moreover,the operators could lessen the number of needle punctures properly according to the multimodal imaging findings, which would reduce the risk of puncture complications on patients.
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<p><b>OBJECTIVE</b>To evaluate the clinical therapeutic effects and safety on infertility of polycystic ovary syndrome (PCOS) in the patients with ovulation induction with letrozole in the treatment with the formula for regulating menstruation and removing phlegm and electroacupuncture (EA).</p><p><b>METHODS</b>A total of 120 patients of PCOS infertility were randomized into 3 groups, 40 cases in each one. In the group A, diane-35 was prescribed for oral administration (one tablet a day since the 5th day of menstruation, continuously for 21 days). After 1 course of treatment (3 months), letrozole was used (one tablet a day since the 5th day of menstruation, continuously for 5 days) for ovulation induction for another 1 course (3 months). In the group B, on the basis of the treatment as the group A, since the 5th day of menstruation, the Chinese herbal formula was combined to regulate menstruation and remove phlegm, one dose a day and discontinued during menstruation. In the group C, on the basis of the treatment as the group B, EA was added since the 5th day of menstruation. The main acupoints were Guanyuan (CV 4), Zusanli (ST 36) and Fenglong (ST 40), etc. EA was applied once every 2 days and discontinued during menstruation. In all of the 3 groups, the treatment for 3 months was as 1 course and the 2 courses were required continuously. Before and after treatment, the menstruation improvements, body weight, body mass index (BMI), serum sex hormones [luteal production hormone (LH), follicle stimulating hormone (FSH), LH/FSH, total testosterone (T) and estradiol (E)] were observed in the patients of each group. The enzyme linked immunosorbent assay was adopted to determine the content of anti-mullerian hormone (AMH) and inhibin B (IHNB). The therapeutic effects, safety, ovulation rate and pregnancy rate were compared among the 3 groups.</p><p><b>RESULTS</b>(1) The differences were significant statistically in the total effective rate, ovulation rate and pregnancy rate in comparison of the 3 groups (all<0.05). The results in the group C were the best and those in the group B were the better in the comparison of the 3 groups. (2) After treatment, the menstrual cycle was remarkably shortened in the 3 groups (all<0.05). The result in the group C was better than that in the group A (<0.05). After treatment, the body weight in the group B and group C was all reduced (both<0.05). The reducing degree in the group C was better than that in the group A (<0.05). The differences in BMI were not significant statistically before and after treatment in each group as well as in comparison among the groups (all>0.05). (3) After treatment, the levels of LH and LH/FSH were all reduced remarkably in the 3 groups (all<0.05). The differences were not significant statistically in comparison among the three groups (all>0.05). After treatment, in the group B and group C, the levels of T and AMH were all reduced remarkably (all<0.05), in which, T value in the group C was lower than that in the group A and group B, that in the group B was lower than the group A (all<0.05). AMH value in the group C was lower than that in the group A (<0.05). The differences were not significant statistically in FSH, Eand IHNB before and after treatment in each group as well as in comparison among the 3 groups (all>0.05). (4) The luteinized unreuptured follicle syndrome (LUFS) did not happen in the group C. There were 3 cases of LUFS (7.5%) in the group B and 5 cases (12.5%) in the group A.</p><p><b>CONCLUSION</b>For PCOS infertility patients receiving ovulation induction with letrozole, the combined treatment with the Chinese herbal formula for regulating menstruation and removing phlegm and EA remarkably improves the menstrual cycle, reduces body weight and the levels of LH, LH/FSH, T and AMH, improves ovulation and pregnancy rates. This therapy does not induce adverse reactions and the therapeutic effects are better than the simple application of letrozole or the combined therapy of letrozole and Chinese herbal medicine.</p>
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PURPOSE: To characterize the electromyographic activity of abdominal striated muscles during micturition in urethane-anesthetized female mice, and to quantitatively evaluate the contribution of abdominal responses to efficient voiding. METHODS: Cystometric and multichannel electromyographic recordings were integrated to enable a comprehensive evaluation during micturition in urethane-anesthetized female mice. Four major abdominal muscle domains were evaluated: the external oblique, internal oblique, and superior and inferior rectus abdominis. To further characterize the functionality of the abdominal muscles, pancuronium bromide (25 μg/mL or 50 μg/mL, abdominal surface) was applied as a blocking agent of neuromuscular junctions. RESULTS: We observed a robust activation of the abdominal muscles during voiding, with a consistent onset/offset concomitant with the bladder pressure threshold. Pancuronium was effective, in a dose-dependent fashion, for partial and complete blockage of abdominal activity. Electromyographic discharges during voiding were significantly inhibited by applying pancuronium. Decreased cystometric parameters were recorded, including the peak pressure, pressure threshold, intercontractile interval, and voiding duration, suggesting that the voiding efficiency was significantly compromised by abdominal muscle relaxation. CONCLUSIONS: The relevance of the abdominal striated musculature for micturition has remained a topic of debate in human physiology. Although the study was performed on anesthetized mice, these results support the existence of synergistic abdominal electromyographic activity facilitating voiding in anesthetized mice. Further, our study presents a rodent model that can be used for future investigations into micturition-related abdominal activity.
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Animais , Feminino , Humanos , Camundongos , Músculos Abdominais , Eletromiografia , Sintomas do Trato Urinário Inferior , Músculo Estriado , Junção Neuromuscular , Pancurônio , Fisiologia , Reto do Abdome , Relaxamento , Roedores , Bexiga Urinária , MicçãoRESUMO
OBJECTIVE:To investigate therapeutic efficacy of ezetimibe combined with tirofiban in the treatment of acute coronary syndrome patients and its influence on the content of ischemia modified albumin (IMA) in peripheral blood.METHODS:A total of 82 patients with acute coronary syndrome in our hospital from Jan.2016 to Jan.2017 were divided into observe group and control group according to random number table,with 41 cases in each groups.All patients were given general treatment containing statins,glyceryl trinitrate and so on.Control group was additionally given Ezetimibe tablet 10 mg orally once a day.Observation group was additionally given Tirofiban hydrochloride sodium chloride injection 5 mg intravenously once a day,on the basis of control group,for consecutive 15 d.Clinical efficacies of 2 groups were evaluated.The dose of glyceryl trinitrate,duration and frequency of angina pectoris attack,left ventricular function indexes (SV,LVDD,CO,LVEF) were compared before treatment and after last medication.The contents of IMA in peripheral blood were detected before treatment and 3,6,9,12,15 h after the first day medication.ADR of the 2 groups were observed closely during the treatment.RESULTS:The total response rate of observation group was 92.7%,which was significantly higher than 72.3% of control group (P<0.05).Compared with before treatment,dose of glyceryl trinitrate and the content of IMA in 2 groups were decreased significantly after last medication,duration and frequency of angina pectoris attack were shortened significantly;the levels of SV,CO and LVEF were increased significantly while the level of LVDD was decrease significantly;the effect of observation group was significantly better than that of control group,with statistical significance (P<0.05).No severe ADR was found in all patients during the treatment.CONCLUSIONS:Based on general treatment of glyceryl trinitrate therapeutic efficacy of ezetimibe combined with tirofiban is better than that of ezetimibe alone in the treatment acute coronary syndrome patients,and can decrease the content of IMA in peripheral blood more quickly.
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Fifty postherpetic neuralgia (PHN) patients with a course ≥3 years and the Pain Numeric Rating scale (NRS)≥5 were included in the analysis.All patients were treated with nerve block and subcutaneous injection in the affected area.The paravertebral nerve blocks were performed by injecting 5 ml lidocaine in the concentrations of 0.3%;the concentration of lidocaine for branch blockage and peripheral nerves was 1.0%,and that for subcutaneous injection was 0.3%,respectively;2 mg dexamethasone and 0.5 mg vitamin B12 were added in the injections.The NRS scores and quality of life scores were documented before and after the treatment.The NRS score was significantly decreased at different time points of treatment (F=279.6,P<0.01).At the end of the treatment and at 1 month,3months,6months of follow-up,the scores were significantly lower than those before the treatment.All patients showed enormous improvement in the quality of life at 1,3 and 6 months after treatment.The pain relief was "excellent" or "good" in 38 cases.The efficacy of treatment is associated with skin scar and allodynia.The study indicates that nerve block and subcutaneous injection has a satisfactory efficacy in treatment of chronic postherpetic neuralgia.
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Objective The present research aimed to explore the relationship of serum CA19-9,CEA,CA125 and sICAM-1 concentration with the diagnosis valuation and tumor metastasis of pancreatic cancer.Methods Ninety pancreatic cancer patients in First Affiliated Hospital of Hebei North University from January 2014 to December 2016 were enrolled in this study.The concentrations of serum CA19-9,CEA,CA125 and sICAM-1 were assayed in different stage of pancreatic cancer patients.The concentrations of these parameters were also detected in metastasis patients and non-metastasis patients.In the same period,90 cases of health examination as contrd group.Measurement data were represented as ~ ± s.Comparison between groups was analyed using t test.single-factor analysis of variance (ANOVA) was used for comparison among groups,and the resuhs were compared by F test.The correlation analysis was performed by spearman method.Results The results showed that CA19-9/ β-actin (control group and Ⅰ / Ⅱ / Ⅲ/Ⅳ stage pancreatic cancer were 0.25 ± 0.03,0.27 ± 0.04,0.31 ± 0.06,0.38 ± 0.09,0.68 ± 0.10,respectively),CEA/β-actin (control group and Ⅰ / Ⅱ / Ⅲ/Ⅳ stage pancreatic cancer were 0.29 ±0.07,0.34 ±0.08,0.47 ±0.09,0.58 ±0.12,0.68 ±0.14,respectively),CA125/β-actin(control group and Ⅰ/Ⅱ/Ⅲ/Ⅳ stage pancreatic cancer were 0.31 ±0.05,0.36 ±0.07,0.55 ±0.13,0.58 ±0.14,0.63 ± 0.14,respectively),sICAM-1/β-actin (control group and Ⅰ/Ⅱ/ Ⅲ /Ⅳ stage pancreatic cancer were 0.34 ± 0.05,0.36 ± 0.08,0.41 ± 0.08,0.49 ± 0.10,0.58 ± 0.12,respectively) were higher in pancreatic cancer than control(P <0.05).The tumor metastasis group was higher than tumor un-metastasis group CA19-9/β-actin(un-metastasis group and metastasis group was 0.36 ± 0.09,0.58 ± 0.12),CEA/β-actin (un-metastasis group and metastasis group was 0.42 ± 0.09,0.61 ± 0.14),CA125/β-actin (un-metastasis group and metastasis group was 0.48 ± 0.09,0.60 ± 0.14),sICAM-1/β-actin (un-metastasis group and metastasis group was 0.42 ±0.09,0.52 ± 0.10) (P < 0.05).The results showed that CA19-9,CEA,CA125 and sICAM-1 concentrations are positively (r value were 0.832,0.698,0.748 and 0.845) with the metastasis of pancreatic cancer patients while negatively with the prognosis (r value were-0.867,-0.832,-0.916 and-0.908) and clinical stage (r value were-0.815,-0.896,-0.798,and0.912) of pancreatic cancer patients.Conclusion CA19-9,CEA,CA125 and sICAM-1 concentrations are positively related with the metastasis of pancreatic cancer patients while negatively with the clinical stage and prognosis of pancreatic cancer patients.
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Effects of high frequency repetitive transcranial magnetic stimulation (rTMS) with a subthreshold intensity on hemodynamic response in brain cortices (both motor and prefrontal cortices) was investigated using the functional near infrared spectroscopy (fNIRS) technique. FNIRS signals of the motor and prefrontal cortices were acquired in healthy volunteers (n=7) at rest and during rTMS intervention. A significant reduction in oxygenated hemoglobin (HbO) concentration during the entire stimulation process was observed from both motor and prefrontal cortices. Results showed that the fNIRS technique can provide a reliable measure of regional cortical brain activation that could be valuable in studying cortical excitability connectivity in combination with rTMS.