Objective To explore the mechanism of intrathoracic pressure(ITP) influncing cardiac function and facilitate noninvasive determination of ventricular pressure theoretically.Methods With Valsalva and Mueller maneuver,two-dimension images of standard long axis views and the cross-sectional views were recorded in 20 volunteers,aged from 18 to 45 years,at the specific ITP levels(including-20 mmHg、-10 mmHg、0 mmHg、+ 10 mmHg and + 20 mmHg).The subjects were instructed to mantain for at least 10 s,and three successive measurements were recorded and averaged.The stroke volume(SV) and radius of curvature(R) were obtained from further off-line analysis.Results With the ITP maintaining at -20 mmHg,-10 mmHg,0 mmHg(end expiration),+ 10 mmHg and + 20 mmHg respectively,the corresponding radiuses of curvature were (2.35 ±0.24)cm,(2.25 ± 0.23)cm,(2.14 ± 0.21)cm,(2.02 ± 0.21) cm,(1.93 ± 0.19) cm,there were statistically significances between two groups (P =0.006,0.031,0.005 and ＜0.001,respectively].When the ITP were at 0 mmHg(end expiration),+ 10 mmHg and + 20 mmHg,the stroke volume were (71.54±8.81)ml,(73.20±9.52)ml and (78.81± 14.61)ml (P =0.674,0.135).When the intrathoracic pressure decreased from 0 mmHg to-20 mmHg,the stroke volume were (78.81±14.61)ml,(68.28 ±9.28)ml and (59.69±7.52)ml(P =0.029,0.037).Conclusions The ITP has different effects on the two ventricles,and subsequently generates a pressure gradient across the IVS which can alter its shape and position at end-diastole.With the IVS shifting,the preload and filling function of left ventricle gets changed acorrding to the Frank Starling principle.

Objective To investigate the clinical value of the bedside color Doppler in the assessment infants with periventricular-intraventricular hemorrhages (PIVH).Methods Sixty-eight cases of PIVH newborns and 156 healthy newborns were involved in the study,dynamic monitoring were undergone within a week after birth.The middle cerebral artery(MCA) hemodynamic parameters of velocity systolic (Vs),velocity diastolic(Vd) and resistance index (RI) were recorded,and the differences of the parameters were compared between different grades as well as those of the normal newborns at 1 d,4 d and 7 d after born.Results Total 68 PIVH infants were diagnosed by bedside color Doppler accurately.Prevalences of premature and low birth weight infants were higher than term infants and normal birth weight children,respectively (P ＜0.05).Vs and Vd of 4 groups of children with PIVH showed an increasing trend in a week after born.The differences of Vs between grade Ⅰ and normal newborns in 4 d and 7 d were not statistically significant (P＞ 0.05),the differences of the other three groups compared with normal newborn group in1 d,4 d and 7 d were statistically significant (P ＜0.05).Vd of grade Ⅱ newborns within 7 d were greater than those of other 4 groups (P ＜0.05),grade Ⅲ and grade Ⅳ within 7 d were less than healthy newborns (P ＜0.05).The difference of RI between all groups were not statistically significant (P ＞ 0.05).Conclusions The diagnostic accuracy rate of PIVH by bedside Doppler is high and the dynamic monitoring of neonatal hemodynamics could provide an important basis for assessing the occurrence and development of PIVH.

Objective To evaluate the clinical value of artificial hydrothorax combined with one-lung ventilation to aid ablation treatment of liver carcinoma in the hepatic dome.Methods Twenty-one patients with liver carcinoma located in the hepatic dome and affected by the lung gas were enrolled.Double lumen endobronchial intubation anesthesia was used and thoracical tube was used to apply artificial pleural effusion.The lesions'ultrasound image were recorded for the patients without artificial hydrothorax,or with artificial hydrothorax only and artificial hydrothorax combined with one-lung ventilation.Ultrasound images were reviewed and scored as 1-5 according to the clarity and completeness of the lesion.Ablation efficacy and adverse reactions were recorded in the follow-up.Results Twenty-one patients were successfully applied artificial hydrothorax and one lung ventilation.The average normal saline used for artificial hydrothorax were (738± 260)ml.The ultrasound score for not using artificial hydrothorax,using artificial hydrothorax only and artificial hydrothorax combined with one lung ventilation were 1.13 ± 0.35 (1-2),3.00 ± 0.85 (2-5) and 4.53 ± 0.64(3-5),respectively,statistical difference was found between each method(P ＜0.05).Artificial hydrothorax combined with one-lung ventilation had much higher ultrasound score than the other 2 methods.No complication related to artificial hydrothorax or one-lung ventilation was found.CT/MRI at one month after ablation showed that all the lesions were completely ablated.In the follow-up for 2-14 months on average,1 case of local tumor progression and 1 case of intrahapetic relapse were found.Conclusions Artificial hydrothorax combine one-lung ventilation could effectively enhance ultrasound image for the lesions in the dome whose acoustic window was affected by lung gas.

Objective To evaluate the efficacy of ultrasound-guided laryngeal mask airway (LMA) in children.Methods ASA Ⅰ and Ⅱ children (aged 1 to 6 years) scheduled for orthopedic surgery of limbs were recruited in this study.ALMA was inserted after induction of general anesthesia.After mechanical ventilation for 5 minutes,the air-filled cuff was deflated and then inflated with saline.Ultrasonography was then performed by a high frequency linear-array transducer to confirm the correct placement of the LMA.Results The LMA can be easily recognized on the transverse view of the thyroid cartilage notch,appearing as a circle around the glottis,which was called the dumbbell sign.On the sagittal view of the thyroid cartilage,the LMA has an archlike appearance which ended below the thyroid cartilage.Oblique scan over the cricoid cartilage shows the tip of LMA is located at the upper portion of the esophagus.Conclusions Filling the LMA cuff with saline instead of air allows better LMA visualization by ultrasound.This method enhances correct positioning of the LMA,which is crucial to ensure safe ventilation.

Objective To explore the application value of tissue dispersion quantitative analysis in rat liver fibrosis stages and provide a reference for clinical non-invasive diagnosis of liver fibrosis.Methods Seventy-two male Wistar rats were randomly divided into experimental group (n =64) and control group (n =8).The experimental groups of rats were gavaged with the volume fraction of 60％ CCl4 olive oil solution to form different stages of liver fibrosis,the control group did wvith normal saline,All the rat underwent tissue dispersion quantitative analysis to obtain 12 elastic parameters,the differences in above parameters were compared among rats with different liver fibrosis stages,then the correlation with pathological stages were analyzed.Results Except for COMP,ASM,CORR,there were significant differences in all parameters among rats of different liver fibrosis (P ＜0.05),which were correlated with pathological stages(P ＜0.05).Among these parameters,％ AREA had the highest correlation coefficient (r =0.891,P =0.001).The ROC curve was made by ％AREA to estimate the fibrosis stage.the area under ROC curve for ％ AREA was 0.914 (≥ the control group + S0),0.963 (≥early liver fibrosis S1 + S2),0.969 (≥middle liver fibrosis S3),0.948 (early cirrhosis S4),respectively.Conclusions The technique of tissue dispersion quantitative analysis has a good evaluation value for liver fibrosis stages,it is able to provide a preliminary reference for clinical non-invasive diagnosis of liver fibrosis.

Objective To investigate the value of color Doppler ultrasonography in metaplastic breast carcinoma(MBC).Methods The ultrasonic characteristics of 23 MBC and 1 1 8 invasive ductal carcinoma (IDC) confirmed by pathology were analyzed retrospectively.And the ultrasound characteristics of different types of MBC was analyzed according to pathology.Results Mean maximum diameter of(3.73±1 .74)cm in MBC was larger than that in IDC[(2.57 ± 1 .19)cm,P = 0.005].Most MBC lesions showed larger diameter(>3 cm),clear border(56.5%),irregular shape(65.2%),lack of hyperechoic halos(65.2%), posterior enhancement(60.9%),no calcification(60.9%) and grade 2 - 3 of blood flow (56.5%).The detection rate of unclear border,unsmooth edge and hyperechoic halos of MBC was lower than those of IDC (P <0.05).But MBC had a higher detection rate in the masses with larger than 3 cm in diameter and posterior enhancement than IDC.Five (45.5%) lesions of 1 1 squamous cell carcinoma showed cystic constituent.The mean maximum diameter of 5 MBC with mecenchymal tissue lesions was larger than spindle cell carcinoma,but smaller than squamous cell carcinoma.And 4 lesions of the 5 MBC with mecenchymal tissue showed calcification,which occupied the highest proportion among different pathological types of MBC. The ultrasonic coincidence rate for MBC was 86.96%.Conclusions The ultrasonic appearances of MBC have a certain characteristics,and different pathological types of MBC also have corresponding characteristics.It shows important value of ultrasonography in preoperative diagnosis for MBC.

Objective To investigate the correlation between the hemodynamic characteristics of time intensity curve(TIC) by contrast enhanced ultrasound(CEUS) and the expression of antigen Ki-67 of the 4 different clinic stages (T0 andTis,T1 ,T2,T3) in ductal carcinoma in order to predict the grade of the expression of antigen Ki-67 and clinic stages.Methods Masses founded in 80 cases proved by pathological test after resection or needle biopsy were divided into 4 groups base on clinic stages:group 1(T0 andTis) , group 2(T1),group 3(T2),and group 4(T3).Some parameters gained after analyzing TIC of CEUS would be used to make a rank correlation analysis with the expression grade of antigen Ki-67 through immunohistochemical diagnosis.A regression equation would be gained from those parameters which had a correlation with the expression grade of antigen Ki-67 (P < 0.05). Results Most TIC of ductal carcinomas were possessed of the characteristics of fast in and slow-out.Compared to the other three groups,group 4(T3) had significant differences in arrive time,time to peak,arrive intensity,peak intensity and area under curve.Compared to group 1(T0 andTis),group 4(T3) had significant differences in continuous time and rising curve's slope and group 3(T2) has significant differences in arrive intensity and area under curve. Parameters entered the regression equation through mult-variable linear regression analysis were arrive time,continuous time,peak intensity and rising curve's slope.R square was 0.83 1 and adjust R square was 0.822.Through the regression equation verification,5 cases accorded with the clinic stages standard of ductal carcinoma.Conclusions The hemodynamic characteristics of time intensity curve (TIC) by contrast enhanced ultrasound had a good correlation with the expression grade of antigen Ki-67 of the 4 different clinic stages in ductal carcinoma.The regression equation had a good explanatory and degree of fitting,it can be used to predict the expression grade of antigen Ki-67 and indirectly forecasts clinic stages of ductal carcinoma.

Objective To discuss the value of double contrast-enhanced ultrasound(DCEUS) as a method to predict the pathologic grade of regression to preoperative neoadjuvant chemotherapy(NAC) in advanced gastric cancer(AGC) patients,the contrast parameters of gastric carcinoma were measured and its correlation with pathologic response degree was analyzed.Methods Fifty seven patients with endoscopic biopsy-proven AGC were considered for a complete resection of the lesion and had a DCEUS prior to and following XELOX pre-operative NAC therapy for 3 cycles.The arrival time (AT),time-to-peak (TTP), baseline intensity(BI) and peak intensity(PI) of the primary gastric tumor were measured.The enhanced intensity(EI)was defined as PI minus BI.The percentage of change of DCEUS parameters before and after NAC therapy and its correlation with phathologic grades of regression was calculated.Patients were divided into responder and nonreponder group according to different pathologic response grade.The differences of DCEUS parameters between two groups were compared.The diagnostic accuracy of DCEUS in prediction of benefit from preoperative NAC was represented by means of receive operating characteristic(ROC)curves. Results After NAC,the PI and EI values of local gastric cancer were significantly lower than before NAC. There were significant differences in PI and EI after NAC between the responder and nonresponder groups. Among the DCEUS parameters showed significant correlation with pathologic grade of regression,the correlation factor was highest in percentage of EI reduction of primary gastric tumor(ρ= -0.501 ,P =0.007).When the optimal cutoff value of EI reduction rate of gastric tumor determined was 27%,a sensitivity of 81 .8% and specificity of 66.7% were achieved.Conclusions DCEUS might be a novel, noninvasive,liable and potential method to select the benefit responder from the preoperative NAC in AGC patient.

Objective To compare the contrast-enhanced ultrasonography (CEUS) manifestations of pNENs with the pathological changes and to explore the clinical value of CEUS in diagnosis of pNENs. Methods The CEUS of sixteen pathologically diagnosed pNENsfrom April,2012 to February,2014 were retrospectively observed.The CEUS of thirty pathologically diagnosed pancreatic carcinomas during the same period were taken as the control group.The enhancement extent and enhancement patterns of CEUS in pancreatic tumors were analyzed. The specimens of pNENs were stained with HE and CD34 immunochemistry.The grading of interstitial content and Ki-67 index were obtained on HE-stained slices and microvascular density(MVD) were obtained on CD34 immunochemistry stained slices.Spearman rank test analysis was employed to analyze the correlation.Results Among the 16 cases of pNENs,12 cases (75.0%) demonstrated hyper-or iso-enhancement,which included 6 cases (37.5%) showing homogeneous enhancement and 6 cases (37.5%) showing inhomogeneousen hancement,and the other 4 cases demonstrated hypo-enhancement. Among 30 cases of pancreatic carcinomas,25 cases (83.3%) demonstrated hypo-enhancement and 5 cases (16.7%) hyper- or iso-enhancement,and 21 cases (70.0%) demonstrated homogenous enhancement,and 9 cases(30.0%)inhomogeneous enhancement.Taking hyper-or iso-enhancement on CEUS as the diagnostic criteria,its diagnostic sensitivity,specificity,positive predictive value,negative predictive value,and accuracy were 75.0%,83.3%,70.6%,86.2%,80.4%respectively.Negative and positive correlation of the enhancement extent of pNENs with the interstitial content(r =-0.880,P < 0.001) and MVD (r =0.658,P =0.003) were observed,respectively.Six tumors with inhomogeneous enhancement contained cystic degradation or necrosis under microscope. Conclusions CEUS is an effective and non-invasive diagnostic approach for pNENs and can reflect the pathological changes.Hyper-or iso-enhancement of CEUS is typical appearance of pNENs.

Objective To quantitatively study the distance between the left atrial posterior wall and the descending aorta(DLD)in the normal fetal four-chamber view using fetal echocardiography.Methods The distances between the left atrial posterior wall and the descending aorta in end-systole (DLDs) and in end-diastole(DLDd) were measured in a standard apical four-chamber view using fetal echocardiography in 300 normal fetuses.The gestation ages ranged from 20 to 40 weeks.Fetal non-cardiac biometric parameters included femoral length(FL),biparietal diameter(BPD) and gestation age (GA) based on menstrual age. The correlation between DLDs,DLDd and non-cardiac biometric parameters were analyzed.Results In normal fetuses,the DLDs was (0.32±0.08)cm with a range of 0.19 -0.48 cm,the DLDd was (0.43 ± 0.10)cm with a range of 0.25-0.62 cm.The DLDs and DLDd increased with the growth of GA,and were correlated with GA and BPD and FL significantly (r = 0.545,0.556,0.574,0.530,0.563 and 0.576, respectively,all P <0.001).The linear regression equations between DLDs,DLDd and GA,BPD,FL were:Y =0.009GA+0.041 ,Y =0.038BPD+0.028,Y =0.044 FL+0.073,Y =0.01 1 GA+0.083,Y =0.048 BPD+0.063,Y = 0.054 FL + 0.124,respectively.Conclusions In normal fetuses,the DLDs and DLDd increase with the growth of GA,and have good correlation with GA,BPD,and FL respectively.Normal reference ranges of DLDs and DLDd have been provided.These normative data may be a new tool for assessment of fetal heart,especially has potential applications in screening of total anomalous pulmonary venous connection(TPVAC),absent pulmonary valve syndrome(APVS)or other complex congenital heart defects.