Objective To detect the correlations between vascular endothelial growth factor (VEGF) expression, microvessel density ( MVD) and time intensity parameters of contrast enhanced ultrasound in hepatocellular carcinoma (HCC). Methods Seventy-three patients of HCC were analyzed with time intensity curve of contrast enhanced ultrasound. VEGF and CD34 in different degree of differentiated HCC specimens were detected by immunohistochemistry. The correlations between VEGF, MVD and time intensity parameters were analyzed. Results Arrival time had no significant difference among different differentiated groups. However, the area under the curve, enhanced time and washout time had significant difference among different differentiated groups respectively ( P <0. 05). There was a positive correlation between VEGF expression and MVD in HCC. MVD was associated with enhanced time and the area under the curve ( r = - 0. 615,0. 563,respectively). The area under the curve,enhanced time and washout time of VEGF positive expression group had significant difference comparing to those of VEGF negative expression group ( P < 0. 05). Conclusions It was helpful to assess HCC differentiated degree with time intensity parameters of contrast enhanced ultrasound.

Objective To evaluate clinical use of adaptive statistical iterative reconstruction (ASiR) method in low-dose scan on children temporal bone by comparison of radiation dose delivered by GE Discovert HD CT 750 scan and GE Lightspeed VCT64 scan.Method Sixty patients with congenital deafness were divided into two groups according to gender,age (each N =30).Group a received low-dose CT scan on temporal bone by GE Discovery HDCT 750 (preset NI =12),and the original images were reconstructed with ASiR (weighted value =40％).Group B received CT scan by GE Lightspeed VCT 64 (preset NI =8),and the original images were reconstructed with filter back projection (FBP).Data were collected and analysed using the SPSS 18.0 software.Resultes The mean value of electric current of average tube and CTDIvol were significantly different between group A and B [(110.40 ± 21.72) mA vs.(168.56±24.36) mA,and (26.43 ±3.48) mGy vs.(39.66 ±4.17) mGy,respectively (t=-9.76,-3.31,P＜0.05)].The noise index was (33.13 ±2.68) in group A and (33.79 ±2.93) in group B respectively,and the results had no statistical significance (P ＞ 0.05).Subjective scores of the images were (4.06 ± 0.03) and (4.05 ± 0.03),with no statistical significance either (P ＞ 0.05).Conclusions On a condition of achieving same image quality,CT scan program using GE Discovery HD CT 750 with 40％ ASiR reconstruction and 4 units NI value enhancement could effectively reduce radiation dose on children's temporal bone compared to FBP method using GE Lightspeed VCT 64.

Objective To explore the value of transrectal elastography and contrast-enhanced ultrasound in evaluation of the efficacy of neoadjuvant therapy for rectal cancer.Methods Forty patients with final diagnosis of advanced(T≥3) rectal cancer were respectively examined with transrectal ultrasound (TRUS),endorectal elastography and contrast-enhanced ultrasound(CEUS) before and after neoadjuvant therapy(NET).The tumor size,strain ratio and quantitative parameters of contrast-enhanced ultrasound including arrival time(AT),time-to-peak (TTP),peak intensity(PI) and area under the curve(AUC) were recorded and compared before and after NET.In addition,the TRUS stages and postoperative pathological diagnosis were compared after NET.Results ①There were significant decreases in tumor size and strain ratio after the therapy compared with pre-therapy in all these patients(t =-6.13,P ＜0.001;t =-24.92,P ＜ 0.001).②PI and AUC were lower after NET than those of pre-therapy and the differences were significant(t =-9.66,P =0.001;t =-13.58,P ＜0.001).However,the changes of AT and TTP were no statistical significances (t =-1.17,P =0.307;t =-1.26,P =0.275).③The accuracys of preoperative TRUS for T stage and N stage of tumor evaluated according to pathology were respectively 75.0 ％ (30/40,Kappa =0.593,P =0.000) and 72.5 ％ (29/40,Kappa =0.396,P =0.009).Conclusions Transrectal elastography and contrast-enhanced ultrasound can reflect the pathological changes and perfusion characteristics of lesions in a certain extent and have high value in clinical therapy.

Objective To measure cerebral circulation time(CCT) of a group of normal adults by contrast-enhanced ultrasound. Methods Forty-seven cases of healthy volunteers without any cardio-cerebral disease history were enrolled in the study. Internal carotid artery and vertebral artery were observed and the blood flow was measured with high frequency probe. Contrast-enhanced agent SonoVue was injected bolus into median cubital vein. CCT was measured and calculated according to the contrast curve analysis. Contralateral CCT measurement was repeated when the blood flow signal resume to the baseline intensity. Cerebral blood volume was then calculated according to CCT and cerebral blood flow. Results All the imaging of carotid vessels was presented clearly in all objects. Cerebral blood flow was 603 ～ 990 ml/min with an average (778 ± 171)ml/min. Bi-lateral CCT was measured successfully,the value ranged 4. 1 ～ 10.2 s with average (6.22 ± 1.47) s. There were no significant differences both in contrast of left and right side of the carotid vessels and in contrast of three dosage groups ( P ＞0.05). The cerebral blood volume was 54～96ml with average (76 ± 27)ml. Conclusions Contrast-enhanced ultrasound can be useful in measurement and calculation of CCT and cerebral blood volume.

Objective To investigate the effect of spleen spontaneous shunt on portal vein hemodynamics in patients with liver cirrhosis with Doppler ultrasound. Methods Eighty-seven patients were divided into chronic hepatitis group, liver cirrhosis group and control group. Liver function of cirrhosis patients was classified into Child A and Child B/C according to Child-Pugh categorization criteria. Hemodynamic parameters of hepatic artery, portal vein, superior mesenteric artery/vein and spleen artery/vein were examined on resting condition. Then the blood shunt ratio of spleen vein and superior mesenteric vein with portal vein, as well as hepatic circulation index (HCI) were calculated. The relationship between spleen blood shunt and HCI was analyzed. Results Portal vein blood flow was not significantly different among groups. Spleen vein blood flow increased in cirrhosis group, which was significantly different to that of control group and chronic hepatitis group. The spleen shunt ratio of cirrhosis group was greater than that of control group and chronic hepatitis group, as well as the Child B/C and Child A in cirrhosis group;the ratio of spleen vein flow to portal vein flow and spleen vein flow to superior mesenteric vein flow increased, but the ratio of superior mesenteric vein flow to portal vein flow decreased with the liver function decreased in cirrhosis group. There was non-linear negative correlation between HCI and the spleen shunt ratio. Conclusion Spleen spontaneous shunt and splenic hyperdynamic circulation play an important role in liver perfusion. Detecting Vspv/Vpv ratio with Doppler ultrasound in patients with liver cirrhosis is helpful in assessing liver function reserve.

Objective To propose an accurate method of noninvasive determination of central venous pressure(CVP ) by locating the central point of right atrium (RA ) using echocardiography .Methods Through the 3D reconstruction ,the accurate positions of RA of 30 patients who had been examined by multislice 3‐dimensional computed tomography for chest imaging were recorded .Based on solid geometric principles ,the central point in RA was located by echocardiography and then compared with CT‐location point .The accuracy and feasibility were assessed by absolute distance (Da) ,vertical distance (Dv) and the whole time of location (T) between the two points .Results Mean Da ,Dv and T of the whole subjects were 07.6cm(95% CI:06.2to08.1cm),01.6cm(95% CI:-00.2to03.4cm),and438.0s(95% CI:400.1to 47 4.0 s) ,respectively .Conclusions The echocardiographic method on the basis of solid geometry proposed in this study could be used to locate the central point in RA accurately and simply .Thus it would be helpful to improve the accuracy of noninvasive determination of central venous pressure .

Objective To determine the central venous pressure (CVP) noninvasively based on hemodynamics principles using ultrasound location of the collapse point of the internal jugular vein.Methods Forty patients were enrolled in this study.The collapse point of the internal jugular vein was located and marked by a linear transducer,the body mark of right atrium was marked on the right lateral wall of the chest.The noninvasive CVP was calculated according to the vertical distance between those two points.The invasive CVP determination by central venous catheter was also carried out on all the patients.Correlation analysis was used to compare the invasive and noninvasive methods.With invasive determination of CVP as the gold standard,the ROC curve of the noninvasive ultrasound method was sketched to explore the optimal cut-off points.Results The correlation analysis reveal high positive correlation between CVPs determined by ultrasound imaging and central venous catheter (r =0.906,P ＜0.01).By the ROC curve test,fluid column height of 10.75 cm by ultrasound method was determined as the cut-off point,with the sensitivity and specificity of diagnosing elevation of CVP being 88.9％ and 93.5 ％ respectively.The corresponding area under the curve was 0.971.Conclusions Ultrasound imaging could be used to determine CVP noninvasively,which would be helpful in diagnosis of the circulating load of patients.

Objective:To study the value of ultrasound-guided endoscopic retrograde appendicitis therapy in children with uncomplicated appendicitis.Methods:This study was a single center, retrospective study, including all electronic cases of appendicitis diagnosed clinically in Department of Pediatrics, the Second Affiliated Hospital of Air Force Military Medical University from October 2018 to October 2020 and received ultrasound-guided endoscopic retrograde appendicitis therapy.The clinical features, treatment and prognosis of the children were retrospectively analyzed.Results:A total of 152 electronic cases were included, there were 77 males and 75 females, aged(6.84±3.09) years.All the 152 children were treated with ultrasound-guided endoscopic retrograde appendicitis therapy.Intubation success rate and clinical success rate was 98.03%(149/152 cases)and 97.99%(146/149 cases), respectively.The median time of endoscopic therapy was 42.50 (31.00, 56.00) minutes.Mean postoperative hospital stay was (2.81 ±1.41) days, and the mean total hospital stay was (4.19 ±1.71) days.A total of 139 patients were followed up with a median follow-up time of 5 (1, 26) months.During the follow-up, the recurrence rate was 7.19%(10/139 cases), and the median time of recurrence was 2 (1, 3) months.Conclusions:Ultrasound-guided endoscopic retrograde appendicitis therapy had high effective rate and low recurrence rate in children with uncomplicated appendicitis, preserved the physiological function of appendix and avoided radiation damage.It can be used as a safe and effective treatment for acute and chronic uncomplicated appendicitis in children.

Objective:To investigate the effect of self-made phase-change nanodroplets IR780/FA-Nds-DTX as molecular targeted ultrasound contrast agents for accurate diagnosis and combined targeted therapy of pancreatic cancer.Methods:Pancreatic cancer cell lines were cultured in vitro and 50 tumor bearing nude mouse models were established. The experimental group (IR780/ FA-NdS-DTX) and four control groups[ normal saline, Nds(FITC), FA-Nds (FITC) and IR-780] were divided to verify dual-mode targeted imaging. The imaging using the IVIS Imaging System verified the high-efficiency targeted detection ability and near-infrared fluorescence imaging of IR780/FA-Nds-DTX for tumors in vivo, phase transformation induced by low-intensity focused ultrasound and further contrast-enhanced ultrasound imaging verified the high-efficiency aggregation of IR780/FA-Nds-DTX in local tumors and accurate evaluation of tumor contour. The therapeutic effect was observed in the experimental group (IR780/FA-Nds-DTX) and four control groups (FA-Nds-IR780, FA-Nds-DTX, FA-Nds and normal saline). After low-intensity focused ultrasound irradiation for 30s induced microbubble blasting after phase transformation in each group, 808nm photothermal therapy apparatus was used to irradiate tumor area in each group. Two-dimensional ultrasound was used to monitor the changes in tumor volume in each group before and at 3 d, 9 d, 15 d after treatment, and the changes in tumor volume rate and inhibition in each group were statistically analyzed and compared.Results:The amount of IR780/ FA-Nds-DTX locally targeted aggregation was the largest, and the average fluorescence intensity of tumor in the experimental group was significantly higher than that of the control groups: IR780/ FA-Nds-DTX group compared with Nds(FITC) group[(5.12±0.69)×10 7 vs (1.06±0.23)×10 7, P<0.05], IR780/FA-Nds-DTX group compared with FA-Nds (FITC) group [(5.12±0.69)×10 7 vs (2.98±0.34)×10 7, P<0.05], IR780/FA-Nds-DTX group compared with IR-780 group [(5.12±0.69)×10 7 vs (1.54±0.42)×10 7, P<0.05], and there was no fluorescence in tumor area in saline group. Further contrast-enhanced ultrasound imaging after nanodroplet phase transformation could more accurately locate the tumor boundary. After 15 days of photothermal ablation combined with chemotherapy, the growth rate of tumor volume in the IR780/ FA-Nds-DTX treatment group was significantly lower than that in the control groups: IR780/FA-Nds-DTX group compared with FA-Nds-IR780 group[(0.105±0.075) vs (0.405±0.175), P<0.05], IR780/ FA-Nds-DTX group compared with FA-Nds-DTX group [(0.105±0.075) vs (1.385±0.035), P<0.05], IR780/ FA-Nds-DTX group compared with FA-Nds group [(0.105±0.075) vs (2.255±0.105), P<0.05], IR780/ FA-Nds-DTX group compared with normal saline group [(0.105±0.075) vs (2.185±0.155), P<0.05]. And the tumor inhibition rate increased significantly: IR780/ FA-Nds-DTX group compared with FA-Nds-IR780 group [(0.93±0.06) vs (0.48±0.17), P<0.05], IR780/ FA-Nds-DTX group compared with FA-Nds-DTX group [(0.93±0.06) vs (-0.51±0.105), P<0.05], IR780/ FA-Nds-DTX group compared with FA-Nds group [(0.93±0.06) vs (-1.63±0.115), P<0.05], IR780/ FA-Nds-DTX group compared with normal saline[(0.93±0.06) vs (-1.35±0.245), P<0.05]. Conclusions:The self-made phase-change ultrasound contrast agents IR780/FA-Nds-DTX have good potential clinical value in targeted detection and combined therapy of pancreatic cancer with small lesions or even metastases.

OBJECTIVETo investigate the correlation between viral factors and liver histological changes of HBeAg-negative chronic hepatitis B patients with persistently normal serum ALT levels (PNAL).

METHODSHBV DNA level, HBV genotype, basal core promoter (BCP) and precore mutation were examined in 52 HBeAg-negative chronic hepatitis B patients with PNAL (defined as normal ALT measured on at least 3 occasions in the intervals of about two months over a period of 12 months or more prior to the biopsy).

RESULTSSubjects with both BCP and precore mutations had significantly higher HBV DNA levels than those without mutations [(4.9+/-1.4) vs (4.1+/-1.1) log(10)copies/ml, t = 2.308, P < 0.05]. A higher proportion of patients with histological activity index (HAI) > or = to 4 was found in patients with both mutations (32.1% vs 16.7%) than in patients without mutation, however, the proportion of patients with histological activity index (HAI) > or = to 3 in patients with mutations was not significantly different from that in patients without mutations (14.3% vs. 12.5%, x(2)=0.000, P > 0.05). In patients without precore or BCP mutations, there was a strong positive correlation between viral load and liver inflammation as well as fibrosis (precore: r=0.626, 0.592, P < 0.01; BCP: r=0.730, 0.641, P < 0.01). In patients without both mutations, HBV DNA has shown a high accuracy for predecting fibrosis (F > or = 3) (AUC = 0.905, 95% CI: 0.771-1.039, P < 0.05) with the cutoff value of 4.5 log(10) copies/ml (sensitivity = 1.000, specificity = 0.778, PPV = 42.9%, NPV = 100.0%). Results of both genotypes and mutations were successfully obtained in 40 samples with HBV DNA is > or = to 10(4) copies/ml. The higher viral load was observed in the patients with genotype B than genotype C (5.1 vs 4.3 log(10)copies/ml, t = 2.059, P < 0.05), but no difference was seen of liver pathologic changes between these two genotypes.

CONCLUSIONSVirus harboring both BCP and precore mutants has the higher replication level than wild type virus. 32.1% and 14.3% of the patients with both mutations have moderate or severe inflammation and fibrosis. There was a strong positive correlation between viral load and liver histological changes in patients without precore or BCP mutations, and viral load shows a high accuracy for predecting significant fibrosis (F > or = 3).

Adult ; Alanine Transaminase ; blood ; Base Sequence ; Carrier State ; pathology ; virology ; DNA, Viral ; blood ; genetics ; Female ; Genotype ; Hepatitis B e Antigens ; blood ; Hepatitis B virus ; genetics ; Hepatitis C, Chronic ; blood ; pathology ; virology ; Humans ; Liver ; pathology ; virology ; Male ; Middle Aged ; Mutation ; Promoter Regions, Genetic ; genetics ; Viral Load