Objective To discuss the value of contrast-enhanced ultrasound and color Doppler in diagnosing esoph-ageal varices( EV) among patients suffering from portal hypertension. Methods The control group consisted of twenty nine patients without EV. Sixty patients with EV diagnosed by endoscopy were divided into two groups equal in number according to grade of EV. One being mild,the other was moderate to severe. All patients underwent color Doppler flow imaging and contrast-enhanced ultrasound, and the dynamic angiography data were collected. Time-in-tensity curves were drawn by software. The quantitative parameters including arrival time of hepatic artery ( HAAT) ,hepatic vein ( HVAT) and portal vein ( PVAT) ,damping index ( DI) of hepatic vein and portal vein ve-locity( PVV) were compared. Results The difference of PV-HV, PV-HA, PVV, DI showed statistically signifi-cant among the three groups(F=72.63,14.97,6.71,13.74,P<0.01). A comparison of the control and moderate to severe group among the above four parameters was statistically significant (P<0.01). PV-HV, PV-HA, DI in moderate to severe group showed statistically significant compared with mild group (P<0.01),however there exis-ted no significant difference grouping PVV between the two groups. Mild group contrasted to the control group,the differences of PV-HA were statistically significant (P<0.01), whereas PV-HV, DI, PVV displayed no significant difference. Conclusion Contrast-enhanced ultrasound and color Doppler are helpful in diagnosing EV,which is ex-pected to become a new noninvasive method.

Objective To assess the right ventricular (RV) performance in patients with type 2 diabetes mellitus (2-DM) by two-dimensional speckle tracking imaging (2D-STI),and to explore the clinical value of RV longitudinal strain and strain rate.Methods Thirty-seven patients with 2-DM only and thirtyone patients coexisting diabetes and hypertension (DM + HTN) were studied.Thirty-nine healthy age matched persons served as control subjects.In each patient a conventional two-dimensional echocardiography was performed and also an echocardiographic study with strain/strain rate imaging was studied.Analysis of RV longitudinal systolic strain were obtained in the apical four-chamber view of the RV for the assessment of the RV free wall(F-PLSS),interventricular septum (S-PLSS) and the global RV wall (G-PLSS).The entire RV longitudinal peak systolic strain rate (G-SRs),peak early-diastolic strain rate (G-SRe) and peak late-diastolic strain rate (G-SRa) were performed in the apical four-chamber view.Results Compared with controls,F-PLSS,S-PLSS,G-PLSS,G-SRs and G-SRe were decreased in 2-DM and DM + HTN (all P ＜0.01),with lower values in DM + HTN (P ＜0.05).In the patients coexisting diabetes and hypertension,G-SRa was significantly lower than those in the control group (P ＜ 0.05).Compared with 2-DM,this difference was not significant in controls and DM + HTN (P ＞0.05).Conclusions No matte the patients of 2-DM with or without hypertension,the early changes of RV dysfunction can be found by 2D-STI.Patients coexisting diabetes and hypertension may have worse RV dysfunction.

Objective To analyze the correlation between Doppler ultrasound parameters, blood biochemical indexes and the severity of esophageal varices (EV), and to explore the values of them in the diagnosis of severe EV.Methods A total of 102 hospitalized patients with liver cirrhosis was consecutively collected.All patients underwent endoscopic examination to determine the presence and severity of EV, then they were divided into moderate/severe EV group (n=78) and non/mild EV group (n=24).Congestion index of the portal vein (PV-CI), damping index of hepatic vein(HV-DI), hepatic vein arrival time(HVAT) and intrahepatic circulatory time (IHCT) were measured by Doppler ultrasound and contrast-enhanced ultrasound.And at same time, the level of yon Willebrand factor antigen (vWF-Ag) and soluble CD163 (sCD163) in peripheral blood were detected by enzyme linked immunosorbent assay (ELISA) method.The differences of these parameters between two groups were compared by independent samples t-test or Mann-Whitney rank sum test.The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy (DA) of related parameters in the prediction of EV were calculated according to receiver operating characteristic(ROC) curve.Results Ultrasound parameters PV-CI, HV-DI and peripheral blood vWF-Ag, sCD163 levels of moderate/severe EV group were all significantly higher than those of none/mild EV group 0.11 (0.05) cm · s vs 0.07(0.03) cm· s;0.72±0.11 vs0.52±0.12;1 824.00(558.00) U/Lvs 1 533.80(311.50) U/L;(72.57±10.94) μg/L vs (57.91±10.40) μg/L;Z=-4.949, t=-7.759, Z=-5.420, t=-5.804, all P＜0.05).However HVAT and IHCT were significantly shorter than those of non/mild EV group (17.00(4.25) s vs 27.78(6.75) s;(6.62±1.85) s vs (9.33±2.26) s, Z=-3.822, t=5.820, both P＜0.05).ROC curve analysis showed that the areas under the ROC curve of HVDI, vWF-Ag and sCD163 predicting moderate/severe EV were all more than 0.8, the appropriate cutoff value of HV-DI, vWF-Ag and sCD163 was 0.64, 1 693.8 U/L and 63.98 μg/L, respectively.The sensitivity were all more than 75％,PPV were all greater than 90％ and DA were all more than 80％.Conclusion HV-DI, peripheral blood vWF-Ag and sCD163 levels can be taken as noninvasive parameters, which can effectively predict the presence of severe EV, facilitate early detection of these high-risk bleeding patients and prevent bleeding.

Objective To evaluate the application of liver ultrasound hemodynamic parameters in diagnosing moderate to severe esophageal varices(EV) among patients suffering from portal hypertension.Methods The control group consisted of twenty nine patients without EV.Sixty patients with EV diagnosed by endoscopy were divided into two groups equal in number according to grade of EV.One being mild,the other was moderate to severe.All patients underwent color Doppler flow imaging and contrastenhanced ultrasound,and the dynamic angiography data were collected.Time intensity curves were drawn by software to acquire the arrive time of hepatic artery (HAAT),hepatic vein (HVAT) and portal vein (PVAT).Then HV-HA interval time,PV HA interval time and PV-HV interval time were calculated.The quantitative parameters including HV-HA,PV-HA,PV-HV,damping index (DI) of hepatic vein and portal vein velocity(PVV) were compared.ROC curve was used to assess the value of the parameters above in predicting moderate to severe esophageal varices.Results The difference of PV-HV,PV HA,HV-HA,PVV,DI between the control and the moderate to severe group were statistically significant (P =0.000).PV-HV,PV-HA,HV-HA,DI in moderate to severe group showed statistically significant compared with mild group (P =0.000,P =0.002,P =0.000,P =0.002),however,PVV had no significant (P ＞0.05) difference between the two groups.Mild group contrasted to the control group,the differences of PV-HA and HV-HA were statistically significant (P =0.000),whereas PV-HV,DI,PVV displayed no significant (P ＞0.05) difference.The areas under ROC curve of PV-HV,PV-HA,HV-HA,PVV,DI were 0.952,0.775,0.847,0.699,0.808 respectively.The best cutoff value of PV-HV for diagnosing moderate to severe EV was 0.5 second,with sensitivity and specificity of 86.2％ and 94.8％ respectively.Conclusions The liver ultrasound hemodynamic parameters is helpful in the diagnosis and evaluation of moderate to severe esophageal varices,which is expected to become a new noninvasive method.

BACKGROUND/AIMS: In recent years, greater assessment accuracy after transjugular intrahepatic portosystemic shunt (TIPS) to ascertain prognosis has become important in decompensated cirrhosis due to portal hypertension. The aim of this study was to assess the ratio of the portal pressure gradient (PPG) pre-TIPS (pre-PPG) to albumin (PPA), which influence ascites formation in cirrhotic patients in the 6-months after TIPS placement, and is a metric introduced in our study. METHODS: This was a retrospective cohort study of 58 patients with decompensated cirrhosis admitted to an academic hospital for the purpose of TIPS placement. We collected the following data: demographics, laboratory measures, and PPG during the TIPS procedure. Then we analyzed the association between the above data and ascites formation post-TIPS in cirrhosis patients. RESULTS: Twenty-two patients with ascites and 28 without ascites were evaluated. Univariate and binary logistic regression analysis were adjusted for the following variables: to determine prognosis; Child-Pugh scores, lymphocyte count, platelet count, hemoglobin level, albumin level and pre-PPG or PPA. The outcome showed that PPA was better than pre-PPG and albumin for predicting ascites according to area under receiver operating characteristic curves and a statistical model that also showed PPA’s influence 6-months post-TIPS. CONCLUSIONS: The combined measurement of pre-PPG and albumin, defined as PPA, may provide a better way to predict post-TIPS ascites in decompensated cirrhosis, which underlines the need for a large clinical trial in the future.
Ascites ; Cohort Studies ; Demography ; Fibrosis ; Humans ; Hypertension, Portal ; Logistic Models ; Lymphocyte Count ; Models, Statistical ; Platelet Count ; Portal Pressure ; Portasystemic Shunt, Surgical ; Prognosis ; Retrospective Studies ; ROC Curve ; Serum Albumin

Purpose To explore the value of monitoring liver-shear wave elastography(L-SWE)and spleen-shear wave elastography(S-SWE)by two-dimensional shear wave elastography after transjugular intrahepatic portosystemic shunt(TIPS)in predicting stent dysfunction.Materials and Methods A total of 40 patients with hepatitis B cirrhosis in the First Affiliated Hospital of Anhui Medical University from January 2016 to September 2022 who underwent TIPS were retrospectively selected.Among them,22 patients without stent dysfunction within 1 month were included in the normal group,and 18 patients without stent dysfunction within 1 week but with stent dysfunction within 1 month were included in the dysfunction group.The changes of L-SWE and S-SWE were monitored 1 day before operation,1 week and 1 month after operation.Results Mauchly test showed that the data corresponded to sphericity(P>0.05).There was no significant difference in L-SWE within the two groups before and after operation(Ftime=0.003,Ftime×group=0.842,Fgrous=0.027;all P>0.05),while the S-SWE differences were statistically significant(Ftime=51.249,Ftime×group=30.676,Fgrous=11.986;all P<0.01).The S-SWE in the normal group showed a gradually decreasing trend 1 day before operation,1 week after operation and 1 month after operation,and the difference was statistically significant(P<0.05).The L-SWE in the dysfunction group decreased 1 week after operation compared with 1 day before operation(P<0.05),and the L-SWE increased 1 month after operation,with no significant difference compared with 1 day before operation(P>0.05).The difference of ΔS-SWE(1 month after operation-1 week after operation)and ΔS-SWE(1 month after operation-1 day before operation)was statistically significant(t=-2.612,4.368,P<0.05).Conclusion Quantitative measurement of S-SWE before and after TIPS and observation of its variation trend are helpful to estimate whether there is stent dysfunction and evaluate the surgical effect.

Objective:To investigate the value of using ultrasound excited contrast agents to assess extracorporeal hydrostatic pressure on the basis of ultrasound contrast imaging.Methods:An extracorporeal hydrostatic pressure evaluation system was established. The changes in contrast intensity was first evaluated for the same concentration of microbubble contrast agent at ambient pressures of 20, 25, 30, 35, 40, and 45 cmH 2O. Contrast agents with the same initial intensity were placed at different pressures for 1 s, 3 s, and 5 s, and the percentage change in contrast agent intensity was analyzed to select the optimal excitation time. Finally, the contrast agent at different pressures was stimulated using an acoustic excitation device, and correlation analysis was performed using the Pearson product moment correlation coefficient. Linear regression analysis was used to establish the relationship between different pressures and the percentage change in intensity. Results:When the ambient pressure was varied under 6 gradients of 20, 25, 30, 35, 40, and 45 cmH 2O, the contrast strength decreased with the pressure increased, and there was a negative correlation between contrast strength and the pressure ( r=-0.971, P<0.001). Under different pressures, the contrast agent intensity showed different degrees of natural decrease in 1 s, 3 s, and 5 s. The difference in the percentage change in contrast agent intensity in each pressure gradient was not statistically significant in 1 s ( P>0.05), whereas the differences in the percentage change in contrast agent intensity in 3 s and 5 s were statistically significant in each pressure gradient (all P<0.05). After microbubble contrast agent was stimulated by ultrasound excitation for 1s, the percentage change in contrast agent intensity was significantly correlated with ambient pressure ( r=-0.976, P<0.001). A linear regression model was fitted with the percentage change in contrast agent intensity after 1 s of stimulation as the independent variable and the pressure as the dependent variable, with the model equation: y=60.075-2.559×x1, where x1 is the percentage change in contrast agent ( R2=0.952, P<0.001). Conclusions:The percentage change in contrast intensity after 1 s of ultrasound excitation of microbubble contrast agent is a favorable predictor of hydrostatic pressure at 6 pressure gradients of 20, 25, 30, 35, 40, and 45 cmH 2O, which may provide a new method for noninvasive monitoring of portal vein pressure for clinicans.

Objective:To explore the method of sequential sector scan with 2D ultrasound through oral fissure (SSTOF) and its utilization in the cleft palate screening.Methods:Based on features of oral anatomy and ultrasonic beam, SSTOF was designed to screen cleft palate and the accuracy had been verified using specimens of aborted fetuses. This study recruited 7 154 women with singleton pregnancy who were screened for fetal malformations during 20-28 gestational weeks in the First Affiliated Hospital of Anhui Medical University from May 2020 to October 2020. In medical addition to routine screening, these subjects also underwent SSTOF to further verify its feasibility and imaging performance. Follow-up was performed by telephone and medical record review.Results:Clear images of the upper palate were acquired in five specimens of induced fetuses using SSTOF. Except for 56 cases lost to follow-up, a total of 7 098 fetuses were finally enrolled, of which 6 885 acquired satisfactory images using SSTOF, 213 did not due to inappropriate position, with a success image rate of 97%. SSTOF found cleft palate in 31cases, which were all confirmed after birth or induction, noting an accuracy rate of 100%.Conclusion:Sequential sector scan through oral fissure has a high clinical value on cleft palate screening in the second trimester with advantages of clear image, easy operation, and access to section views.

Objective: To investigate the value of left ventricular global longitudinal strain( LVGLS) in predicting early chemotherapy related cardiotoxicity in breast cancer patients after chemotherapy． Methods : Eighty-six breast cancer patients were enrolled in this study and received 6 cycles of doxorubicin + cyclophosphamide．Conventional echocardiography parameters were measured before chemotherapy ( T0 ) ，immediately after chemotherapy ( T1 ) ，6 months(T2) and 12 months after chemotherapy ( T3 ) ． LVGLS was obtained by 2D speck tracing imaging (2DSTI) ，and the relative change of LVGLS( △LVGLS) was calculated at T1．With the occurrence of cardiotoxicity as the clinical outcome，receiver operating characteristic ( ROC) curve was plotted．The parameters were analyzed at T1 to evaluate the value of △LVGLS in predicting cardiotoxicity. Results: ① Although the change in LVEF was not different between T0 and T1 (P ＞0. 05) ，LVEF decreased significantly at T2 and T3 (P ＜0. 05) . ② Compared with T0，LVGLS decreased at T1，which was further damaged at T2 and T3 (P＜0. 05) . ③ Seven patients (8. 1% ) developed chemotherapy-related cardiotoxicity．LVGLS and △LVGLS were correlated with cardiotoxicity at T1 stage ，and △LVGLS was more significant ( r = 0. 64，P ＜0. 001 ) . ROC curve analysis showed that a △LVGLS ＞12% at T1 predicted cardiotoxicity，with sensitivity of 92. 2% ，specificity of 76% ，and area under the curve was 0. 88. Conclusion The LVGLS decreased earlier than LVEF in breast cancer patients after doxorubicin treatment. △LVGLS ＞12% is a good predictor of cardiotoxicity in patients with breast cancer.

Objective:To investigate the prevalence of depression and to analyze its determinants among centenarians in Hainan.Methods:A cross-sectional study on centenarians was conducted in Hainan from June 2014 to December 2016.A total of 910 centenarians, including 166 males and 744 females, were interviewed in their domiciles by trained investigators.A 15-item Geriatric Depression Scale(GDS-15)was used to assess depression for centenarians, and general sociodemographic details, sleep quality, cognitive function, activities of daily living, and lifestyles were recorded.Multivariate logistic regression analysis was used to determine major related factors for depression in centenarians.Results:Of the 910 centenarians, 292 were regarded as depressed and the prevalence was 32.1%.Univariate analysis showed that there were significant differences in gender, education, marital status, self-reported health, incontinence, dietary habits, sleep quality, activities of daily living, cognitive function, outdoor activities, watching TV, and social engagement between subjects with and without depression( P<0.05). Multivariate logistic regression analysis showed that living conditions, self-reported health, activities of daily living, and sleep quality were independent related factors for depression in centenarians( P<0.05). Among the above related factors, living with families( OR=0.50, P=0.026)and good sleep quality( OR=0.67, P=0.010)were protective factors for depression, whereas poor self-reported health( OR=3.34, P<0.001)and disability( OR=2.37, P=0.002)were risk factors for depression in centenarians. Conclusions:Living conditions, self-reported health, activities of daily living, and sleep quality were independently correlated with depression in Hainan centenarians.This study provides empirical evidence for depression interventions and mental health improvement in centenarians.