Objective To explore the clinical value of high-frequency color Doppler ultrasound in the diagnosis of isolated calf muscle vein thrombosis (ICMVT). Methods Sonographic features of 175 patients with isolated calf muscular venous thrombosis were analyzed retrospectively and outcome of anticoagulant therapy in 1, 3, and 6 months was followed up. Diagnosis was established with high-frequency color Doppler ultrasound examination. Results One hundred and seventy-ifve patients presenting with 190 calf muscle vein thrombosis were included. One hundred and iffty-eight cases with 173 calf muscle vein thrombosis were diagnosed by high-frequency color Doppler ultrasound, 7 cases of misdiagnosis, missed diagnosis in 10 cases. The accuracy rate was 91.1%(173/190). Seven cases were misdiagnosed with 1 euroifbromatosis, 1 mixed hemangioma, 5 gastrocnemius hematoma. After diagnosis of ICMVT, all patients prescribed thrombolysis and anticoagulation therapy. High-frequency color Doppler ultrasound for 1, 3, 6 months after treatments revealed partial or complete recanalization without calf deep vein thrombosis. Typical sonographic features included:calf muscle venous lumen dilation, tortuous anechoic lumen or hypoechoic iflling, with tubular or branched shape in the longitudinal view and oval or round shape in the transversal view. Conclusion High-frequency color Doppler ultrasound is an accurate and reliable method in the diagnosis of the isolated calf muscular venous thrombosis.

Objective To investigate the value of color Doppler flow imaging(CDFI) in diagnosing lower limb artery in-stent restenosis (ISR), and to provide the evidences for clinical application. Methods Patients with lower limb artery percutaneous transluminal stent insertion in 12 months were enrolled in this study and divided into two groups, CT angiography (CTA) or digital subtraction angiography (DSA) was applied to diagnose ISR, 31 patients with 47 stenting which were diagnosed ISR was named as restenosis group, 63 patients with 89 stenting which were diagnosed no ISR was named as no stenosis group, and 30 normal person was enrolled and named as normal control group. Ultrasonic characteristics and peak systolic blood flow velocity (PSV), systolic blood flow acceleration time (AT) of proximal part, inner stents, distal part were recorded in restenosis group and no stenosis group, then compared with data in normal control group. Regression and receiver operator (ROC) curve were applied to analyse the correlation between PSV and AT. Results PSV of no stenosis group in common femoral artery, femoral artery, superifcial, popliteal artery stent respectively were (146.71±35.59) cm/s, (120.11±25.67) cm/s, (96.44±32.87) cm/s. PSV of normal control group in common femoral artery, femoral artery, superifcial, popliteal artery respective were (119.67±15.34) cm/s, (91.17±15.09) cm/s, (71.13±21.23) cm/s. There was statistically signiifcant difference between the two groups (t=2.457, 2.459, 2.321, all P<0.05). AT of no stenosis group in common femoral artery, femoral artery, superficial, popliteal artery stent respectively were (84.98±13.77) ms, (87.33±16.36) ms, (90.77±12.05) ms. AT of normal control group in common femoral artery, femoral artery, superficial, popliteal artery respective were (78.23±21.24) ms, (82.31±18.24) ms, (84.29±23.01) ms. There was no statistically signiifcant difference between the two groups (t=1.696, 1.904, 1.835, all P>0.05). PSV of restenosis group in proximal part, restenosis part, distal part respectively were (87.67±23.34) cm/s, (218.17±72.09) cm/s, (54.13±21.23) cm/s. PSV of no stenosis group in proximal part, inner stents, distal part respectively were (91.71±25.59) cm/s, (131.11±45.67) cm/s, (96.44±32.87) cm/s. There was statistically significant difference between restenosis part/inner stents, distal part (t=3.412, 3.511, both P<0.05). There was no statistically signiifcant difference between the two groups in proximal part (t=1.901, P>0.05). AT of restenosis group in proximal part, restenosis part, distal part respectively were (98.31±14.09) ms, (109.54±21.03) ms, (158.23±45.21) ms. AT of no stenosis group in proximal part, inner stents, distal part respectively were (84.98±13.77) ms, (86.34±19.36) ms, (83.77±17.05) ms. There was statistically signiifcant difference between restenosis part/inner stents, distal part (t=2.319, 3.610, both P<0.05). There was no statistically signiifcant difference between the two groups in proximal part (t=1.833, P>0.05). ROC curve showed that in ISR lower limb artery, PSV>168 cm/s had a sensitivity of 89.4%, speciifcity of 92.1%, the area under the ROC curve was 0.949;AT>127 ms, had a sensitivity of 86.8%, speciifcity of 98.0%, the area under the ROC curve was 0.867. Conclusions CDFI can detect the changes of PSV and AT, ISR can be detected and diagnosed earlier in lower limb artery. By combining PSV>168 cm/s with AT>127 ms, the value of ISR diagnosis can be increased.

Objective To investigate the structural and functional changes of mitral valve in patients with functional mitral regurgitation (FMR) by real-time three-dimensional transthoracic echocardiography (RT-3D-TTE).Methods RT-3D-TTE were performed on 70 patients with at least moderate mitral regurgitation (FMR group;including 35 cases of ischemic cardiomyopathy [ICM] subgroup and 35 cases of dilated cardiomyopathy [DCM] subgroup) and 30 normal controls (control group).The mitral valve parameters were analyzed by TomTec assessment software to detect dynamic changing pattern of mitral valve size and shape during cardiac systole.The differences of parameters between control group and FMR group were compared.The parameters included mitral annulus structural parameters:Anterior-posterior (AP),anterolateral-posteromedial (AL-PM),sphericity (SPI;SPI=AP/AL-PM),annular circumference (AC),commissural diameter (CD),nonplanarity angle (NPA),annular height (AH),tenting height (TH),tenting volume (TV),three-dimensional annular area (AA3D);dynamic parameters..Maximum annular displacement (ADmax),maximum annular displacement velocity (ADVmax).Results The mitral valve parameters present phasic variation law in FMR group.Compared with control group,AH,ADmax and ADVmaxwere smaller and the other parameters were larger than those in FMR group (all P＜0.05).Compared with control group,AH,ADmax and ADVmax were smaller and the other parameters were larger than those in both ICM subgroup and DCM subgroup (all P＜0.05).Compared with ICM subgroup,AH was smaller in DCM subgroup (P＜0.05),there was no statistical difference in ADmax and ADVmax between ICM subgroup and DCM subgroup (P＞0.05),the rest parameters were greater in DCM group (all P＜0.05).Conclusion RT-3D-TTE can be used to quantitatively assess the structural and functional changes of mitral valve in patients with FMR and provide a reference for the clinical treatment of FMR.

Objective To evaluate the value of MicroPure imaging system of ultrasonography in display of breast calcification,and explore its clinical application value.Methods One hundred and forty-one patients underwent by mammography,conventional ultrasound imaging and MicroPure imaging,the mammography results were reference standard,observing the display rate of MicroPure imaging for calcification,and the value of MicroPure imaging in the display of calcification with different shapes on mammography.As the pathologic diagnosis was golden standard,the accuracy of diagnosis of conventional ultrasound,conventional ultrasound combined with MicroPure imaging,conventional ultrasound combined with mammography were evaluated with receiver operating characteristic(ROC) curve.Results The display case of calcifications within breast masses:the specificity of MieroPure imaging was lower than conventional ultrasound(88.14％ vs 100％,P ＜ 0.05),the sensitivity and accuracy were higher than conventional ultrasound(100％ vs 62.79％,93.14％ vs 84.31 ％,P ＜0.05).The display case of microcalcifications within normal breast tissue:the specificity and accuracy of MicroPure software system were lower than conventional ultrasound(9.26％ vs 100％,43.87％ vs 65.96％,P ＜0.05),the sensitivity was higher than conventional ultrasound (100％ vs 20.00％,P ＜0.05).The punctate calcification,amorphous calcification,rough uneven,pleomorphic calcifications on mammography were all hyperechoic spots on MicroPure software system.The area under the ROC curve of the conventional ultrasound,conventional ultrasound combined with MicroPure imaging,conventional ultrasound combined with MicroPure imaging was 0.881,0.858,0.932,respectively.Conclusions MicroPure imaging has some clinical value on microcalcifications within breast masses,which can improve its sensitivity and accuracy.The specificity of MicroPure imaging diagnostic ultrasound imaging of microcalcifications were lower,and it can not distinguish between different shapes of calcifications.Compared with conventional ultrasound,MicroPure imaging system can not improve the accuracy of diagnosis of benign and malignant breast lesions.

Objective: To investigate plasma interleukin-35 (IL-35) expression in sepsis patients, and to assess the regulatory activity of IL-35 on CD4⁺ and CD8⁺ T cells in sepsis patients. Methods: A prospective study was conducted. Forty-one sepsis patients and nineteen healthy controls were enrolled in this study. According to the survival outcome on 28 day after admission, sepsis patients were further divided into the survival group (n=30) and death group (n=11). Peripheral blood samples were collected within one hour of visit. Plasma IL-35 level was measured by enzyme linked immunosorbent assay (ELISA), while CD3+, CD4⁺, and CD8⁺ T cell counts were measured by flow cytometry. The correlation between IL-35 expression/T cell counts and sequential organ failure assessment (SOFA) score was also assessed. Peripheral CD4⁺ and CD8⁺ T cells from sepsis patients were purified and stimulated with recombinant human IL-35 for 48 h. mRNA relative levels of T-bet, GATA-3, FoxP3, and RORγt in CD4⁺ T cells and perforin, granzyme B, and FasL in CD8⁺ T cells were measured by real-time PCR. Interferon-γ (IFN-γ), IL-4, IL-10, IL-17, and tumor necrosis factor-α (TNF-α) levels in the cultured supernatants were measured by ELISA. Transcription factor level and cytokine expression was compared prior to and post IL-35 stimulation. Results: Plasma IL-35 was significantly elevated in sepsis patients when compared with controls [(76.76±10.33) pg/mL vs (27.53±8.31) pg/mL, P<0.01], however, it did not correlate with SOFA score (r=0.172, P=0.281). Plasma IL-35 was also notably increased in the death group when compared with the survival group [(83.18±6.48) pg/mL vs (74.40±10.55) pg/mL, P=0.014]. Plasma IL-35 level in the death and survival groups were analyzed by receiver operating characteristic curve with an area under curve of 0.770 (P=0.009). There were no remarkable differences of CD3⁺, CD4⁺, and CD8⁺ T cell counts between sepsis patients and controls, or between the death and survival groups (all P>0.05). Moreover, T cell counts were negatively correlated with SOFA score (P<0.01). IL-35 stimulation resulted in the reduction of mRNA relative level of Th1 transcription factor T-bet and Th17 transcription factor RORγt in CD4⁺ T cells from sepsis patients (P<0.01), while elevation in regulatory T cell transcription factor FoxP3 mRNA (P<0.01). However, IL-35 stimulation did not affect Th2 transcription factor GATA-3 mRNA in CD4⁺ T cells (P=0.745). IFN-γ and IL-17 production by CD4⁺ T cells was significantly decreased in response to IL-35 stimulation (P<0.05), while IL-10 was increased (P<0.01) and IL-4 was comparable (P=0.536) between CD4⁺ T cells with and without IL-35 stimulation. IL-35 stimulation led to the down-regulation of mRNA relative level of perforin and granzyme B (P<0.01). However, FasL mRNA was comparable between CD8⁺ T cells with and without IL-35 stimulation (P=0.795). IFN-γ and TNF-α secretion was also reduced in response to IL-35 stimulation (P<0.05). Conclusion Elevated plasma IL-35 level is an important indicator for poor prognosis of sepsis patients. IL-35 inhibits the activity of CD4⁺ and CD8⁺ T cells in sepsis patients, and might take part in the pathogenesis of sepsis.

Objective: To analyze the clinical manifestation, imaging characteristics and prevention of medication-related osteonecrosis of the jaw (MRONJ) after intravenous bisphosphonate (BP) for cancer patients with bone metastases. Methods: The clinical data and radiographic findings of 6 primary breast cancer patients with bone metastases diagnosed as MRONJ from January 2014 to April 2018 in Shanxi Dayi Hospital were retrospectively analyzed. Results: All 6 patients were female, with the median age of 65.5 years old. All patients had no history of systemic application of hormone therapy, no history of diabetes, no history of radiation therapy, no history of metastasis of the jaw, and no history of infection. The average usage time of BP was 28 months. MRONJ occurred in 2 cases on maxilla and 4 cases on mandible. There were 2 patients with tooth extractions history in BP treatment. Clinical symptoms included maxillofacial pain, loosened teeth, fistula suppuration, and exposed sequestrum. Radiographic findings included osteolysis and bone sclerosis or the mixed manifestation of both, with or without periosteal reaction. In addition, nonhealing tooth sockets and sequestrum separation imaging were also included. Conclusions Tooth extraction is considered as an increased risk for MRONJ in patients with malignant bone metastases after BP therapy. MRONJ is more likely to appear in the mandible, but it can also appear in the maxilla. Early screening and initiation of appropriate dental care are necessary for the patients before using BP therapy.

This study was to investigate the effects of the combination of deoxynivalenol (DON) and zearalenone (ZON) on pigs. Twenty-four weaning piglets were divided into a control group fed a diet free of mycotoxins and a toxin group fed a diet containing 1 mg/kg DON and 250 microgram/kg ZON. The results showed that supplementation of DON and ZON in diets had extensive effects on pigs. More specifically, DON and ZON caused levels of total protein, albumin, and globulin in sera to decrease (p < 0.05) by 14.5%, 6.5% and 11.3%, respectively, and at the same time increased (p < 0.05) the serum enzyme activities of gamma-glutamyltransferase, aspartate aminotransferase and alanine aminotransferase by 72.0%, 32.6% and 36.6%, respectively. In addition, DON and ZON decreased (p < 0.05) the level of anticlassical swine fever antibody titers by 14.8%. Real-time PCR showed that DON and ZON caused the mRNA expression levels of IFN-gamma, TNF-alpha, IL-2, to decrease (p < 0.05) by 36.0%, 29.0% and 35.4%, respectively. Histopathological studies demonstrated that DON and ZON caused abnormalities in the liver, spleen, lymph nodes, uterus, and kidney. The concentrations of DON and ZON used in this study are in line with the published critical values permitted by BML. Our study clearly put the standard and adequacy of safety measures for these toxins into question. The authors suggest that with the increasing availability of cellular and molecular technologies, it is time to revisit the safety standards for toxins in feeds so as to make feeds safer, providing consumers with safer products.
Animal Feed/*analysis ; Animal Nutritional Physiological Phenomena ; Animals ; Diet/veterinary ; Drug Therapy, Combination ; Female ; Swine ; Swine Diseases/blood/*chemically induced/*physiopathology ; Trichothecenes/*administration & dosage/*adverse effects/pharmacology ; Zearalenone/*administration & dosage/*adverse effects/pharmacology

Two female patients with acute onset of sporadic food-borne botulism are reported. Both patients presented cranial nerve palsy symptoms and rapidly involving respiratory muscles causing respiratory failure. The tracheal intubation, mechanical ventilation and active supportive measures were given at admission. The skull imaging and cerebrospinal fluid examination were negative, and the electromyography showed peripheral motor nerve damage. One patient was complicated with severe pneumonia. The botulinum toxin test was positive, and botulism poisoning was diagnosed. After early targeted treatment, patients were improved and discharged. Both patients had no complications and recurrence after discharge in 8 months of follow-up.

Objective: To analyze the image features of shear wave elastrography (SWE) in breast masses, and to evaluate their values in the differentiation of benign and malignant breast lesions. Methods: A total of 361 patients with 403 breast lesions who simultaneously underwent conventional ultrasound and SWE examination from February 2015 to January 2018 were selected. Diagnosis in all patients was confirmed by aspiration biopsy or operative pathology. The SWE images were collected and the elastic images were divided into 5 types. The SWE image features of different breast pathological types were summarized, and their values in benign and malignant breast lesion diagnoses were evaluated. Results: The main features of benign breast lesion were type Ⅰ and Ⅱ, the main features of the malignant lesion were type Ⅳ and Ⅴ, and the proportion of which were 43.6% (71/163), 37.4% (61/163), 22.1% (53/240) and 57.9% (139/240), respectively. Type Ⅲ accounted for a certain proportion in both benign and malignant lesions. The SWE image features of benign and malignant lesions were compared and a significant difference was observed (P<0.001). The type Ⅴ features were mainly observed in invasive ductal carcinoma, invasive lobular carcinoma and other types of invasive carcinoma, while the type Ⅳ features were mostly presented in ductal carcinoma in situ and mucinous carcinoma. Fibroadenoma, fibroadenosis accompanied with fibroadenoma, and fibroadenosis were featured with type Ⅰ. Both intraductal papilloma and benign phyllodes tumor were mostly type Ⅱ, while type Ⅲ and Ⅴ were more common in chronic granulomatous mastitis. When type Ⅰ and typeⅡof breast lesions were classified as benign features while type Ⅳ and Ⅴ were malignant features, the sensitivity and specificity of breast malignant lesion diagnosis were 91.2% and 84.7% by application of SWE combined with breast imaging reporting and data system (BI-RADS). The sensitivity of combined diagnosis was slightly lower than that of conventional ultrasound (P>0.05), but the specificity was significantly higher than conventional ultrasound (P<0.01). Conclusion The SWE is a simple and effective method. Combination of SWE with conventional ultrasound may improve the diagnostic differentiation of benign and malignant breast lesions.

Clopidogrel was believed to be superior to aspirin by the well-known CAPRIE trial. However, no other large clinical trials demonstrated the same results, but all focused on the combination use of clopidogrel with aspirin, and combination therapy in CREDO was called the "Emperor's New Clothes". However, no one overturned the results of these clinical trials by quantitatively analyzing them. We reviewed ten large-scale clinical trials about clopidogrel. On the basis of results of CAPRIE, CREDO and CHARISMA trials, we re-estimated their minimal sample sizes and their powers by three well-established statistical methodologies. From the results of CAPRIE, we inferred that the minimal sample size should be 85 086 or 84 968 but its power was only 30.70%. A huge gap existed. The same was also true of CREDO and CHARISMA trials. Moreover, in CAPRIE trial, 0 was included in the 95% confidence interval and 1 was included in the 95% confidence interval for the relative risk. There were some paradoxical data in CAPRIE trial. We are led to conclude that the results in CAPRIE, CREDO, and from the subgroup analysis in CHARISMA trials were questionable. These results failed to demonstrate that clopidogrel was superior to aspirin or that clopidogrel used in combination with aspirin was better than aspirin alone. The cost-effectiveness analyses by some previous studies were not reliable.