Clinical Practice Report of Contrast-Enhanced Ultrasound in Renal Artery Disease.

OBJECTIVES: To evaluate the diagnostic performance of renal artery contrast-enhanced ultrasound (CEUS) with modified inspection section and summarize subsequent changes in imaging assessment of renal artery disease. METHODS: A total of 1015 patients underwent renal artery CEUS were included in the study. Among them, 79 patients (156 renal arteries) suspected with renal artery stenosis (RAS) underwent digital subtraction angiography (DSA) subsequently. DSA was used as the gold standard to evaluate the diagnostic performance of CEUS in detecting RAS (≥30%) and severe stenosis (≥70%), as well as the diagnostic accuracy of classification of stenosis degree. Besides, 127 of the 1015 patients underwent other imaging examinations such as computed tomography angiography (CTA) or magnetic resonance angiography (MRA) after CEUS and annual proportion of these imaging examinations was assessed. RESULTS: The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of CEUS for detecting RAS (≥30%) was 96.4%, 88.6%, 94.2%, 95.6% and 90.7%, respectively and the kappa value was .857 (P < .01). CEUS had a good performance in distinguishing severe stenosis (≥70%) with a sensitivity of 91.1%, specificity of 95.5%, accuracy of 92.9%, PPV of 96.5%, NPV of 88.7% and the kappa value was 0.857(P < .01). There was no significant difference between CEUS and DSA in detecting stenosis (P = 1.0) and severe stenosis (P = .227). The diagnostic accuracy of CEUS in grading RAS was 85.3% and the kappa value was 0.753 (P < .01). Besides, the annual proportion of other imaging examinations decreased for 4 consecutive years. CONCLUSIONS: CEUS is a non-invasive, safe and valuable technique for the assessment of renal artery disease and worthy of promotion.

Renal elasticity and perfusion changes on ultrasonography in an early-stage diabetic rat model.

Background: Renal hemodynamic changes in early diabetes occur before the onset of significant structural abnormalities or clinical manifestations, and timely detection of these changes has clinical significance. This study aimed to evaluate renal elasticity and perfusion changes in an early-stage diabetic rat model by shear wave elastography (SWE) and contrast-enhanced ultrasound (CEUS), and to explore the potential correlations between renal elasticity and perfusion parameters. Methods: A total of 18 male Sprague-Dawley rats were randomly divided into three groups: a control group (group 1, n=6), a diabetic group (group 2, n=6), and a diabetic group receiving drug therapy (group 3, n=6). An intraperitoneal injection of streptozotocin (STZ) for 2 days combined with a high-fat diet (HFD) was used as the early-stage diabetic rat model. The diabetic rats in group 3 were treated with canagliflozin and losartan for 6 weeks, whereas the rats in groups 1 and 2 were given equal amounts of purified water. Renal stiffness on SWE and perfusion parameters on CEUS were measured and compared among the three groups, then the rats were sacrificed, and serum, urine, and renal histopathology were evaluated to confirm the development of early diabetes. Results: The early-stage diabetic rats without significant pathological changes exhibited bigger kidneys and higher blood glucose (all P<0.05). Among the CEUS parameters, peak enhancement (PE), wash-in area under the curve (WiAUC), wash-in perfusion index (WiPI), wash-out AUC (WoAUC), wash-in and wash-out AUC (WiWoAUC), rise time (RT), and time to peak (TTP) of diabetic rats in group 2 were significantly increased (all P<0.05), and the hyperperfusion ameliorated significantly after drug treatment. The renal elasticity measured by SWE varied in accordance with certain perfusion parameters, and was strongly positively correlated with WiAUC (r=0.701, P<0.001), WoAUC (r=0.647, P<0.001), and WiWoAUC (r=0.655, P<0.001), and moderately positively correlated with PE (r=0.539, P=0.001), WiPI (r=0.555, P<0.001), RT (r=0.425, P=0.010), and TTP (r=0.439, P=0.007). Conclusions: Renal elasticity and perfusion changes in the early stage of diabetes, and renal elasticity was positively associated with delayed and increased perfusion.

Numerical Study on the Impact of Locked-In Stress on Rock Failure Processes and Energy Evolutions.

Locked-in stress refers to internal stress present within rock formations that can influence the failure process of rocks under specific conditions. A simplified mechanical model is applied, drawing on elasticity and the hypothesis of locked-in stress, to explore the influence of locked-in stress on the mechanical properties of loaded rocks. An analytical solution is obtained for the stress distribution in a failure model of rocks that include locked-in stress. The findings demonstrate that the geometry and orientation of stress inclusions within the rock influence the initiation and propagation of cracks under the combined influence of locked-in stress and high-stress conditions. Moreover, the presence of locked-in stress substantially reduces the rock's capacity to withstand maximum stress, thereby increasing its susceptibility to reaching a state of failure. The increase in closure stress leads to a significant increase in the magnitude of the maximum stress drop and radial strain variation within the rock, resulting in reduced strength and a shortened life of the ageing failure of the rock. In addition, the influence of stress inclusions on energy dissipation is investigated, and a novel relationship is established between the roughness coefficient of the rock structure surface and the angle of the rock failure surface. This relationship serves to characterize the linear dynamic strength properties of rock materials containing locked-in stress. This investigation not only advances the comprehension of stress distribution patterns and the effects of locked-in stress on rock failure patterns but also facilitates a more precise portrayal of the nonlinear features of alterations in the rock stress-strain curve under the influence of confined stress. These findings provide a solid theoretical foundation for ensuring the safety of excavations in various deep engineering projects.

Case report: Congenital mitral and tricuspid valve insufficiency in a patient with Axenfeld-Rieger syndrome.

Axenfeld-Rieger syndrome (ARS) is an autosomal dominant disorder that is primarily due to disruption of the development of neural crest cells. The onset of associated symptoms in both eyes accompanied by extraocular developmental defects is referred to as ARS. Cardiac defects associated with ARS have been reported, but the extent of the cardiac defects has yet to be defined. We report a case of a 17-year-old girl with ARS with typical facial malformations and severe mitral and tricuspid valve insufficiency. The patient was diagnosed with secondary glaucoma detected on ophthalmologic examination. Echocardiography showed severe mitral and tricuspid valve insufficiency. This case provides further evidence of the association of ARS with cardiac malformations and extends the reported range of cardiac malformations in patients with ARS.

Age and Gender-Specific Reference Intervals for Uric Acid Level in Children Aged 5-14 Years in Southeast Zhejiang Province of China: Hyperuricemia in Children May Need Redefinition.

Context: Hyperuricemia is defined when the plasma uric acid concentration is above 416 µmol/L (7 mg/dl) in male adults, or 357 µmol/L (6 mg/dl) in female adults. However, there are no explicit criteria yet for children. Objective: It is necessary to set up reference intervals for the uric acid level in different age groups among children. Materials and Methods: A total of 5,439 individuals (3,258 males, 2,181 females) were included in the final statistical analysis. Reference values of all age groups were determined by statistical descriptions. Multiple linear regression analysis was applied to determine the relationship between uric acid level, BMI, and age. Results: The level of uric acid increased with age. Gender differences in uric acid level occurred after the onset of puberty. Additionally, linear regression revealed a positive correlation between the uric acid level and BMI. Discussion and Conclusion: The reference range of the uric acid level in children is inconsistent with the previous viewpoint. Body mass index plays an important role in uric acid metabolism.

Lowe syndrome with extremely short stature: growth hormone deficiency may be the pathogeny.

Lowe syndrome is an x-linked disorder characterized by congenital cataracts, nervous system abnormalities and renal tubular dysfunction. With the rising number of reported cases, more patients are found to suffer from endocrine abnormalities. Hereby, three Chinese patients with typical symptoms and extremely short stature were described. The OCRL gene was analyzed. A combination of blood biochemistry and radiological examinations were performed. Growth hormone provocation test was taken in one patient. Nucleotide sequence analysis revealed a de novo novel hemizygous mutation (c.2290_2291delinsCT) in exon 21 in an adolescent boy. As indicated by the growth hormone provocation test, the boy had growth hormone deficiency. The other two patients were brothers with extremely short stature, and manifested the same hemizygous mutation (c.2581G > A) in exon 23. It was speculated that the mutation of OCRL gene could lead to deficiency of growth hormone, for which an early growth hormone intervention may be beneficial.

Palygorskite modified with N-doped carbon for sensitive determination of lead(II) by differential pulse anodic stripping voltammetry.

A glassy carbon electrode (GCE) was coated with N-doped carbon-modified palygorskite and used as an electrochemical sensor for determination of Pb(II) by differential pulse anodic stripping voltammetry. To obtain high reproducibility and sensitivity, optimum experimental conditions for lead deposition are studied. Voltammetric responses of the modified GCE prepared with different ratios of carbon and palygorskite are examined under same conditions. Compared with a bare GCE, a N-doped carbon modified/GCE and a bismuth-modified GCE, N-doped carbon-modified palygorskite greatly improves the performance of GCE. Response is the best and the interfacial impedance is minimized if the fraction of carbon coating is 31%. This indicates that its performance is due to the synergies between palygorskite and N-doped carbon. Figures of merit for the modified GCE include (a) a preconcentration time of 180 s, (b) a detection limit of 0.42 µg·L-1 (2σ criterion), and (c) a linear response in the 4.0 µg·L-1 to 10.0 mg·L-1 Pb(II) concentration range. The method is successfully applied to the determination of Pb(II) in spiked tape water and gives recoveries between 97.1 and 104.3%. Graphical abstract Schematic representation of different adsorption sites of Pb(II) and the optimal carbon content. The wide detection range is attributed to the synergetic effect of N-doped carbon modified palygorskite.