Objective To explore the value of the application of vascular enhancement technology (VET) in the diagnosis of Budd-Chiari syndrome (BCS) and the evaluation of the therapeutic efficacy of interventional therapy.Methods B-mode ultrasound,color Doppler and VET were performed on 93 patients with BCS for the systematic detection of intrahepatic vessels and the inferior vena cava (IVC),with the static and dynamic images of these vessels stored prior to interventional therapy.Subsequent to the operation,the same procedures were repeated on the vessels concerned and the images were recorded.The definitions of B-mode and VET images of the detected vessels were compared by two sonography experts.Regarding DSA as standard,the diagnostic accordance rate of VET and B-mode imaging of the diseased vessels was compared.Results Of the 613 vessels detected prior to intervention therapy,440 vessels images were distinct by B-mode and 533 by VET(P<0.05).VET demonstrated 37 intrahepatic collaterals which were invisible by B-mode.Regarding DSA as the gold standard,the diagnostic accordance rate of affected vessels of B-mode and VET was 69.2% and 92.5%,respectively(P<0.05).In total 103 therapeutic vessels,B-mode sonography and VET revealed 81 and 95 distinct vessels,respectively(P<0.05).Conclusions VET can improve the definition of veins and venous stents.The combination of VET and color Doppler can improve the clinical value of ultrasound in the diagnosis of BCS and evaluation of the therapeutic efficacy of interventional therapy.

Angiopoietin-2 levels were 5. 80 ( 3. 83-8. 00 ) , 4. 42 ( 2. 56-5. 55 ) , and 2. 75 ( l. 40-4. 64 )ng/ml in type 2 diabetic patients with proliferative retinopathy, patients with non-proliferative retinopathy, and patients without retinopathy, respectively. Statistical significances existed between any two groups (all P ＜0. 01 ). Angiopoietin-1 level in patients with non-proliferative retinopathy was higher than that in patients without retinopathy [10. 57 ( 8. 99-12. 05 ) vs 9. 21 (7. 71-11.2 ) ng/ml, P＜0. 05]. No difference in receptor Tie-2 was found among the 3 groups (P＞0. 05 ). The results suggested that serum angiopoietin-2 level might be associated with the severity of retinopathy in type 2 diabetic patients.

Objective To discuss the recent effect of professional instruction on patients with type 2 diabetes mellitus. Methods 200 patients with type 2 diabetes mellitus were divided into the observation group and the control group. The observation group received professional instruction while the control group only got doctors'simple advice about the characteristic, results and attentions of diabetes mellitus. Various in dices were determined before and 3 months after intervention and patients compliance was evaluated 3 months after intervention. Results The indices such as blood glucose,glycosylated hemoglobin, urine trace protein, blood lipid, weight index, blood pressue and waistline were different between the two groups(P＜0.05) after intervention although no difference was seen between them before intervention(P＞0.05).The patients compliance in the observation was better compared with the control group(P＜0.01). Conclusion Application of professional instruction proved to be an effective method to alleviate the symptoms of patients with type 2 diabetes mellitus.

ObjectiveTo investigate the ability of three-dimensional(3D) speckle tracking imaging (STI) for assessing left ventricular (LV) strain,and measure the value and angle of myocardial main strain vector.MethoodsLongitudinal,circumferential and radial strain of LV were measured in 31 healthy adults by 3D-STI and two-dimensional(2D) STI.The main strain vector and the angle between main strain vector and the LV short-axis plane were calculated from longitudinal and circumferential strains.Results The global longitudinal,circumferential strains and strains at basal,middle,apical level of LV by 3D-STI were significantly smaller than those by 2D-STI,whereas radial strain showed an opposite trend.The 3D strains presented significant difference between different levels of LV,longitudinal,circumferential and radial 3D strains were greater at middle level than at basal and apical level of LV,meantime 2D stain didn't show such obvious trend.Calculated from three-dimensional longitudinal and circumferential strain,the main strain vector was greatest at middle level of LV,whereas the angle between main strain vector and LV short axis plane didn't show any significant difference between three levels of LV.Conclusions3D-STI provides us a new and reproducible method for the evaluation of LV regional function by measuring LV strains.

ObjectiveTo explore the feasibility of detecting liver stiffness by virtual touch tissue quantification (VTQ) technique and establish a reference range of shear-wave velocity in healthy liver of adults.MethodsOne hundred and sixty-one healthy adults underwent VTQ detection to obtain the shearwave velocities of livers.Each subject received VTQ measurement in four parts of liver.Ten subjects were performed twice by two sonographers,respectively.Results① The liver shear-wave velocities of 161 healthy adults had a 95％ confidence interval from 1.089 to 1.105 m/s.Shear-wave speed values of intrahepatic different parts had no statistically significant.The ICC of measurement value of four parts in healthy liver was 0.80(95 ％ CI:0.75- 0.85).②The difference of shear-wave velocities in healthy livers in different age groups had no statistically significant,whereas the mean values in different gender had statistically significant (P =0.001).③No statistically significant was observed between the mean shear-wave velocity values obtained by different operators (P =0.82).ConclusionsThe liver shear-wave velocities of the healthy group have a reference range from 1.089 to 1.105 m/s.VTQ technique has a good reproduction and stability,therefore,using this technology to assess hepatic stiffness is noninvasive and feasible.

Objective To explore the correlativity between liver shear-wave velocities and liver fibrosis stages in chronic hepatitis B patients.Methods One hundred and twelve patients with chronic hepatitis B accepted virtual touch tissue quantification (VTQ) testing to obtain shear-wave speed and compared to histological stages.Each patient received VTQ measurements in right lobe of liver.The standards of histological examination of the stages of fibrosis refered to the Hepatitis Pathology Diagnostic Standard Xi'an formulated in 2000.Results Of 112 patients,S0,S1,S2,S3 and S4 were 15,17,15,23 and 42 respectively.There was no significant statistically difference of the mean values of liver shear-wave speed between S0 and S1,while among the rest subgroup had significant statistically differences by multiple comparisons.The areas under the ROC curves were 0.94 for S2,0.87 for S3,and 0.95 for S4.The cut-off values of the shear wave velocity were as follows:1.27 m/s for S2(sensitivity 80.0％,specificity 89.5％),1.43 m/s for S3 (sensitivity 71.8 ％,specificity 87.7 ％ ) and 1.79 m/s for S4 (sensitivity 83.3 ％,specificity 89.4％).Hepatic fibrosis expressed by the histological scale correlated well with the VTQ values of all patients ( r =0.92).Conclusions Along with the increase of liver fibrosis degree,the hepatic parenchyma shear wave velocities increase gradually.The more advanced the degree of fibrosis,the higher the shear wave velocities.

This paper retrospectively analyzed nursing care of 20 critically ill patients with human infections of avian influenza A(H7N9) virus treated by oxygen therapy.According to the severity of hypoxia in patients admitted to the hospital,individualized oxygen therapy strategy was selected,such as humidified high flow nasal cannula or mechanical ventilation.Oxygen therapy strategy was adjusted in a timely manner according to patients' condition,such as prone position ventilation and extracorporeal membrane oxygenation.As a resuh,15 cases were transferred to the general ward when the virus associated test was negative,and 5 cases died.

Objective:To preliminarily evaluate the efficacy and safety of stereotactic body radiotherapy (SBRT) for pulmonary oligometastatic tumors from head and neck carcinoma.Methods:Clinical data of 24 patients with pulmonary oligometastasis from head and neck carcinoma undergoing SBRT in Zhejiang Cancer Hospital from January 2014 to May 2019 were retrospectively analyzed. Survival analysis was performed by Kaplan- Meier method. Results:Among the 24 patients, 12 cases were diagnosed with nasopharyngeal origin and 12 cases of non-nasopharyngeal origin. A total of 34 pulmonary metastatic lesions were treated with SBRT. The median follow-up time was 19.5 months. Thirteen cases developed new lesions after SBRT, and 9 of them occurred within 1 year after SBRT treatment. The actual 1-year local control rate was 95%. The median progression-free survival was 15.2 months, and the 1-and 2-year progression-free survival were 59% and 46%, respectively. The 2-and 3-years overall survival rate at were 71% and 51% fter lung metastasis, respectively. Univariate analysis showed that the patients with primary lesions located in nasopharynx and disease-free interval of more than 1 year had survival advantage. No more than grade 3 radiation-induced injury was observed in the whole cohort after SBRT, and the incidence of mild radiation-induced injury was 13%.Conclusions:SBRT is safe and effective in the treatment of pulmonary oligometastatsis from head and neck carcinoma, and it may be more effective for patients with primary tumors located in nasopharynx.

Objective:To explore the role of 17β-estradiol(17β-E2) derived from the hippocampus and gonad in the cognitive memory during the reconsolidation period of fear memory in rats with post-traumatic stress disorder(PTSD).Methods:The 8-week-old clean grade female SD rats were used for this study. Single prolonged stress combined with context fear conditioning was used to prepare the rat PTSD model.(1) Gonad estradiol experiment: 50 female rats were randomly divided into blank control group, model group, sham ovariectomy group, ovariectomy group, and ovariectomy+ estradiol group by random number table method, with 10 rats in each group. The rats in model group, sham ovariectomy group, ovariectomy group, and ovariectomy+ estradiol group were established PTSD model. Rats in ovariectomy group and ovariectomy+ estradiol group underwent ovariectomy, while rats in sham ovariectomy group only were removed adipose tissue of the same mass around the ovaries. And the rats in ovariectomy+ estradiol group were injected with 17β-E2(1 mg/kg, once a day for 14 days) 7 days after ovariectomy.(2) Hippocampal estradiol experiment: 40 female rats were randomly divided into blank control group, model group, hippocampal solvent control group and hippocampal estradiol inhibitor group by random number table method, with 10 rats in each group.The rats in model group, hippocampal solvent control group and hippocampal estradiol inhibitor group were established PTSD model.Rats in hippocampal estradiol inhibitor group were given letrozole once(bilateral, 0.5 μL per side) during the fear memory consolidation period) and rats in the hippocampus solvent control group were injected once with dimethyl sulfoxide in the hippocampus(bilateral, 0.5 μL per side) . The open field test and elevated cross maze test were used to evaluate the anxiety level and autonomous exploration ability, the freeze test was used to evaluate the fear memory, the new object recognition test was used to evaluate the non-spatial memory, and ELISA was used to detect serum 17β-E2 level. SPSS 25.0 software was used for data analysis, and one-way ANOVA was used for inter group comparisons, LSD test was used for further pairwise comparisons.Results:(1)In the gonad estradiol experiment, there were statistical differences in various indicators among the five groups of rats in the open field test, elevated cross maze test, freeze test, and new object recognition test( F=20.200, 12.702, 7.514, 10.094, 7.899, 13.211, all P<0.05). The number of upright times, central area activity time, distance and frequency of entering the open arm, and cognitive index of the model group rats were all lower than those of the blank control group(all P<0.05), and the freezing time was higher than that of the blank control group( P<0.05). The number of upright positions((11.20±1.55) times), central area activity time((11.33±1.80) s), distance((1.49±0.26) m) and times((10.00±1.50) times) entering the open arm, the freezing time((92.20±6.07) s) and cognitive index((60.40±3.71)%) in ovariectomy+ estradiol group were all higher than those of ovariectomy group((4.90±0.65) times, (4.31±1.07) s, (0.49±0.06) m, (3.10±0.62) times, (60.30±5.28) s, (32.60±8.08)%)(all P<0.05). (2) In the hippocampal estradiol experiment, there were statistical differences in various indicators among the four groups in the open field test, elevated cross maze test, freeze test, and new object recognition test( F=40.831, 5.553, 9.087, 5.848, 7.657, 9.191, all P<0.05). The numbers of upright positions, distance and frequency of entering open arms of the model group rats were lower than those of the blank control group(all P<0.05). The number of upright positions((3.00 ± 0.39) times), distance of entering open arm((1.17±0.37) m), freezing time((46.70±3.57)s), and cognition index((29.60±2.70)%) in the hippocampal estradiol inhibitor group were all lower than those in the hippocampal solvent control group((10.10±1.40) times, (4.02±0.79) m, (93.70±9.73) s, (54.20±5.08)%)(all P<0.05). Conclusion:17β-E2 derived from the hippocampus and gonad both had ameliorative effect on cognitive memory and anxiety-like behavior in the reconsolidation period of fear memory in PTSD model rats.

Objective To standardize the selection of clinical research outcome indicators,which can objectively evaluate the clinical efficacy or effect of traditional Chinese medicine in the treatment of myasthenia gravis.This study aims to standardize the construction of the core outcome set of clinical research of traditional Chinese medicine in the treatment of myasthenia gravis.Methods We followed the core outcome set development specification(COS-STAD)to carry out research,established a research working group,which set up a Delphi-method advisory group.Two graduate students of working group conducted a document research and meetings of patients to establishe an outcome set item pool of myasthenia gravis in clinical trials of Chinese medicine under the instruction of other members.With the questionnaire based on the content of item pool,we then carried out Delphi-method expert consultations and a consensus meeting.Results The core outcome set of clinical research on myasthenia gravis treated with traditional Chinese medicine included five outcome domains:endpoint outcome,myasthenia gravis symptom evaluation,medication evaluation,quality of life evaluation and safety outcome;Nine outcome measures:recurrence rate,incidence of hormone complications,incidence of crisis,QMGS scale(MGFA quantitative myasthenia gravis score),daily activity scale of MG patients(ADL),analysis of immunosuppressant dosage,analysis of glucocorticoid dosage,analysis of cholinesterase inhibitor dosage,and incidence of adverse events.Conclusion The five outcome domains and nine outcome measures included in the core outcome set can be used as outcome options for the efficacy evaluation of myasthenia gravis clinical research.