ObjectiveTo explore the sonographic features of gouty arthritis.MethodsThe sonographic features of gouty arthritis were summarized by retrospectively studying the sonogram of 19 joints of 5 patients.ResultsFive the first metatarsophalangeal joints,8 knees,2 ankles,2 elbows and 2 wrists were investigated.Out of 19 joints,17(89.4％) had double contour signs,a hyperechoic and irregular band over the superficial margin of the articular cartilage.Joint effusions were seen in 13 of 19 joints (68.4％).Multiple hyperreflective foci could be seen in the joint fluid,which were obvious by shaking the probe.In 19 joints,11 (57.9 ％) had proliferation of the synovium identified,and proliferative synovium were revealed as hyperperfusion or hypoperfusion by color Doppler ultrasound.In one knee,the synovium proliferated obviously with involved area about 5 cm × 2 cm,and hyperechoic aggregates with acoustic shadow could be seen in it.Articular cartilage became irregularly thin and the hyperechoic outline of subchondral bone cortex became rough or even broke in 6 of 19 joint (31.6％).H omogeneous,hyperechoic aggregates with or without acoustic shadow in the soft tissue around the joint were seen in four joints (21.1 ％).Three in these 4 joints exited bone cortex erosions adjacent to aggregates.ConclusionsGouty arthritis has some specific sonographic features,ultrasound maybe usefully discover this disease in early period.

ObjectiveTo evaluate the value of uhrasonography for arthrocentesis in the hip and the advance of the femoral head/acetabulum as the puncture location in patients without sonographically obvious joint effusion.Methods Forty-three patients diagnosed with ankylosing spondylitis or osteoarthritis were included,82 hip joints were involved and received ultrasounded-guided intra-articular injections.The puncture site was the joint space between the femoral head and the acetabulum.The times,depth,procedure time,side effects and complications of each injection were recorded.ResultsAll 82 hips could be explicitly displayed.The depths from the skin surface to the joint space were (3.4 ± 0.9)cm (left)and (3.1 ± 0.8)cm (right),respectively.Overall,100％ of hip joints were punctured successfully,and 95.1％ of them were succeeded with the first arthrocentesis.The procedure time was (287.9 ± 45.8) s.No side effects or complications were observed.ConclusionsThe sonographic technique could be used as a primary method of image guidance for performing hip arthrocentesis and the joint space between the femoral head and the acetabulum could be a choice of target location for the patients without joint effusion.

Objective To investigate the clinical features of neonatal invasive fungal infection(IFI) so as to guide diagnosis,prevention and treatment of IFI.Methods Seventy-six neonates with IFI admitted to the Neonatal Intensive Care Unit (NICU) at Children's Hospital of Fudan University from 2004 to 2014 were included in the study.Pathogens,clinical manifestation,risk factor exposure,laboratory findings,complications,and clinical outcome of neonatal IFI were analyzed.Results Seventy-six cases were diagnosed as IFI between 2004 and 2014,with an yearly increasing trend.Sixty-eight patients were premature infants (89.5％).Of the 76 cases,except one with unknown birth weight,11(14.7％),34(45.3％),20(26.7％)and 10 (13.3％) cases had birth weight ＜ 1 000 g,(≥ 1 000-＜1 500) g,(≥ 1 500-＜2 500) g and ≥ 2 500 g,respectively.The pathogens were mainly Candida (74/76,97.4％),including 26 cases of Candida albicans (34.2％).However,the incidence of non-Candida albicans infection was increasing.Candida guilliermondii was the most common in nonCandida albicans,accounting for 29.2％ (14/48).All Candida albicans were sensitive to fluconazole.One strain of Candida glabrata was resistant to fluconazole.The most common risk factors included use of broad-spectrum antibiotics(93.3％,56/60),parenteral nutrition(70.0％,42/60),central vein catheterization(53.3％,32/60),invasive ventilation(40.0％,24/60) and history of abdominal surgery(21.7％,13/60).Clinical manifestations of IFI included temperature instability,frequent apnea,increased requirement of respiratory support and feeding intolerance.Among all cases,six were diagnosed as central nervous system infection.Of the patients who received cranial MRI,46.8％(22/47) showed multiple abnormal signals in cerebral parenchyma.Fiftytwo patients were cured and seven patients died before discharge,including one death due to fungal infection.Conclusions There is an increasing trend of IFI cases in NICU,especially in premature infants.Non-Candida albicans has become the main pathogenic fungus.There are no specific clinical manifestations in neonatal IFI.Use of broad-spectrum antibiotics,parenteral nutrition and central venous catheterization are common risk factors,and preventive measures should be taken in high-risk infants.In addition,IFI in neonates may affect important organs such as central nervous system,thus early treatment is necessary in suspected patients.

Objective To study the repeatability and consistency of normal female pelvic floor structure using transperineal real‐time three‐dimensional ultrasound .Methods Forty‐two cases of normal adult female were evaluated by two different experience operator ,using the real‐time three‐dimensional ultrasound diagnostic apparatus .The bladder neck movement degrees and the levator hiatus area were observed after Valsalva condition .Differences between the groups were compared .Intraclass correlation coefficient (ICC) ,the coefficient of variation (CV) and Bland‐Altman analysis of consistency were evaluated . Results The bladder neck movement degrees and the levator hiatus area measured by the experienced operator (operator 1) and less experienced operator(operator 2) were (18 4.8 ± 5 8.4)cm and (17 7.9 ± 5 4.8) cm ,(17 5.3 ± 3 9.5)cm2 and (17 3.1 ± 4 3.2)cm2 ,respectively .There was no significant difference between the two operators ( P > 0 0.5) .The intra‐ICC were 0 8.9 and 0 9.0 ,CV were 7 2.6% and 3 0.3% .Experienced operator repeatability (ICC= 0 9.9 ,0 9.4) was slightly higher than the less experienced researchers (ICC 0 9.2 ,0 8.1) .The analysis results of Bland‐Altman image showed good consistency between two different operators .Conclusions The current study proves real‐time three‐dimensional ultrasound is a reproducible method for female pelvic floor structure assessment ,and the reproducibility is very well .The detection performance of experienced operator slightly better than the one with less experience ,strengthen the training of junior doctors may further improve the accuracy of measurement .

Objective To evaluate the value of contrast-enhanced ultrasound (CEUS) in diagnosing ischemic-type biliary lesion (ITBL) and analyze the relation between the enhancement patterns of bile duct wall of ITBL and its outcome.Methods 36 patients confirmed with ITBL (24 cases),anastomotic biliary stricture (3 cases),cholangitis (4 cases),biliarysludge (1 cases),and acute rejection (4 cases),who underwent CEUS examination,were enrolled in this study.The images were retrospectively analyzed in consensus by 2 readers.After reviewing the images,the readers were asked to make a diagnosis of ITBL.The diagnostic standard was hypo-or non-enhancement of hilar bile duct wall in arterial phase on CEUS.Results The diagnostic sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 66.7％,83.3％,72.2％,88.9％,and 55.6％ for reader 1;62.5％,83.3％,69.4％,88.2％,and 52.6 ％ for reader 2,respectively.The interobserver agreement was good (κ =0.83).In 24 ITBL patients,the ratio of mortality or retransplantation with non enhancing hilar bile duct wall in arterial phase was much higher than that with enhancing hilar bile duct wall (non-enhancement 54.5％,hypo-enhancement 20％,hyper-or iso-enhancement 12.5％).Conclusions CEUS had diagnostic value of ITBL.Non-enhancing hilar bile duct wall in arterial phase on CEUS predicated the poor outcome.

Objective To investigate the application value of transperineal ultrasound in female patients with cystocele.Methods Transperineal ultrasound were performed in 36 female patients with cystocele and the bladder neck movement degrees (BND),retrovesical angle and the degree of urethral rotation were observed at maximum Valsalva.The ultrasonic manifestation of 36 female patients with cystocele were summarized.Results On maximal Valsalva bladder neck mobility all increased in 36 patients,32 patients with open retrovesical angle (≥140°) and 30 female patients with urethral rotation ≥ 45°.There were 6 cases with type Ⅰ,bladder neck was lower than inferoposterior margin of the symphysis pubis,cystocele with open retrovesical angle (≥140°) and urethral rotation ＜45°.There were 26 cases with type Ⅱ,bladder neck was lower than inferoposterior margin of the symphysis pubis,cystocele with open retrovesical angle (≥140°) and urethral rotation ≥45°.There were 4 cases with type Ⅲ,bladder was lower than inferoposterior margin of the symphysis pubis,cystocele with intact retrovesical angle (＜ 140°) and urethral rotation ≥45°.Conclusions The transperineal ultrasound can be used for classification of cystocele in female patients and which may provide more reliable information for clinical diagnosis.

To explore the effect of growth hormone releasing peptide (GHRP) on myocardial cell apoptosis in heart failure (HF) rats. Methods: Rat's HF model was established by the ligation of left anterior descending coronary artery induced ischemia. 40 male SD rats were randomly assigned into 4 groups: Normal control group, Sham operation group, HF group and GHRP treated HF group. n=10 in each group and the rats were fed for 4 weeks after the operation. Cardiac function was examined and myocardial cell morphology was observed; protein expressions of Smac/DIABL0 and Bcl-2 were measured by Western blot analysis; cell apoptosis was evaluated by FCM technique. The differences for above parameters were compared among groups to explore the effect of GHRP on myocardial cell apoptosis in HF rats. Results: Compared with HF group, GHRP treated HF group showed the less heart dilation, higher LVEF, lighter pathological changes in myocardial cells and decreased protein expression of Smac/DIABL0, all P<0.05. Bcl-2 level was lower in HF group than the other 3 groups, P<0.05. Compare with Normal control group, GHRP treated HF group had elevated Bcl-2 level, all P<0.05. Myocardial cell apoptosis index was different between HF group and GHRP treated HF group, P<0.05. Conclusion: The effect of GHRP on anti-HF should be via inhibiting myocardial cell apoptosis; the mechanism may partly be through promoting Bcl-2 protein expression and depressing Smac/DIABLO mediated mitochondrial pathway of apoptosis.

BACKGROUND: Gene therapy and cell transplantation therapy, especially their combined use, have certain therapeutic effects on retinitis pigmentosa. However, little attention has been paid to the combination of gene therapy and cell transplantation in the treatment of retinitis pigmentosa.OBJECTIVE: To investigate the protective effect of adipose-derived mesenchymal stem cells (ADMSCs) modified by growth-associated protein-43 (GAP-43) gene on the retina of rats with retinitis pigmentosa. METHODS: ADMSCs from rats with retinitis pigmentosa were isolated and cultured, and then transfected with GAP-43 lentiviral vector. Sixty retinitis pigmentosa rats were randomized into experimental group (subretinal injection of GAP-43-transfected ADMSCs), control group (subretinal injection of ADMSCs) and sham operation group (PBS injection). The expressions of GAP-43 protein, Rho protein and GS protein in the retina of rats were determined by western blot. The outer nuclear layer thickness of the retina was determined by hematoxylin-eosin staining. RESULTS AND CONCLUSION: After transfected cell transplantation, the expression of GAP-43 protein in the retina was gradually increased with time and showed significant differences at different time post-transplantation (P < 0.05).The expression levels of Rho protein and GS protein in the retina of experimental and control groups were higher than that in the sham operation group (P < 0.05). The expression of Rho protein in the retina of the experimental group was higher than that in the control group (P < 0.05). The expression of GS protein in the retina of the experimental group was lower than that in the control group (P < 0.05). The thickness of retinal outer nuclear layer was ranked as follows: the experimental group > the control group > the sham group, and there was significant difference between groups (P < 0.05). These results show that the ADMSCs modified by GAP-43 gene have protective effect on the retina of rats with retinitis pigmentosa.

Objective To observe the clinical curative effect of ginseng cream stickon in patients suffering from lack of lactation after parturition .Methods Ninety patients suffering from lack of lactation after parturition were divided into three groups :the treatment group (patients with ginseng cream stick by acupoint application ) ,and 2 control groups (control with lactation elixir ,and control with decavitamin) .The treatment last for 5 days for each group .And the breast filling degree ,the lactigenous volume ,the neonatal weight ,artificial feeding times ,the artificial feeding volume and the prolactin level before and after the treatment were all recorded .Results Ginseng cream stick by acupoint application dramatically improved breast filling ,the lactigenous volume ,the neo‐natal weight ,artificial feeding times ,the artificial feeding volume and the neonatal urination frequency ,there was a significant differ‐ence between the treatment group and the two control groups (P<0 .05) .Conclusion Ginseng cream stick by acupoint application could significantly relieve lack of lactation ,meet the need of breastfeeding ,and increase the breast‐feeding rate .

Objective To evaluate the color Doppler ultrasonographic findings of active ankylosing sacroiliitis.Methods Thirty three patients (66 sacroiliac joints in total) with active ankylosing sacroiliitis identified by MRI and twenty eight healthy volunteers (56 sacroiliac joints) underwent color Doppler ultrasound examinations of sacroiliac joints.Degree of blood flow within and around the sacroiliac joints was evaluated by semi-quantitative scale (0 - 4 grade).For arteries, resistive index was also measured.Statistical analyses were performed to compare blood flow demonstration rate, blood flow signal scale distribution,degree of blow flow and RI value between the two groups.Results Higher blood flow demonstration rate was found in patients with active ankylosing sacroiliitis(60/66,90.1%) than control group (25/56,44.6%)( P = 0.000).The scale distribution and degree of blow flow between these two groups were statistically different (all P = 0.000) ,with mainly 2～3 grade for the patients and 0～1 grade for the control.Mean value of RI in the patients was 0.57 ± 0.07, which was lower than the control (0.66 ± 0.04, P = 0.000).Conclusions Patients with active ankylosing sacroiliitis tend to have higher degree of blood flow in sacroiliac joints and lower RI values of artery.Color Doppler ultrasound may help to evaluate the activity of ankylosing sacroiliitis.