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.

Objective To investigate the value of virtual touch tissue imaging (VTI) in the differential diagnosis of small solid thyroid nodules.Methods 35 patients with 41 small thyroid nodules were examined by conventional ultrasound and VTI examination.The stiffness of the nodules in VTI images was scored.Area ratios of VTI and gray scale images of nodules were calculated.The pathological diagnosis was used as the gold standard.The ROC curve was drawn to determine the cut off point of area ratio to predict thyroid cancer.Results 41 small thyroid nodules were confirmed by pathological diagnosis,including 23 benign and 18 malignant nodules.Compared with benign nodules,the ratio of VTI hardness score ≥4 was significantly higher in the malignant nodules (88.9％ vs 8.7％,P ＜0.01).Compared with benign nodules,the area ratios of malignant nodules were higher (1.67 ± 0.16 vs 1.23 ± 0.12,P ＜0.01).When 1.46 was set as the cut off point of areas ratio,the sensitivity and specificity of diagnosing thyroid cancer were 88.9％ and 95.7％,respectively.Conclusions VTI can provide information about thyroid nodules hardness.It has high value in the differential diagnosis of small solid thyroid nodules.

Objective To explore the value of vascular enhancement technology (VET) in the evaluation of therapeutic efficacy of stenting for Budd-Chiari syndrome (BCS).Methods Two-dimensional ultrasound,color Doppler and VET were performed on 39 BCS patients with 41 stents,the static and dynamic images of stents and vessels with stents were stored.VET and two-dimensional ultrasound imaging quality of intravascular stent were compared.Patients with stent stenosis found by ultrasound were examined by digital subtraction angiography(DSA).The ranges of stent thrombosis were measured by DSA and VET and the difference was compared.Results VET image quality scores of endovascular stent were higher than those of the two-dimensional ultrasound,the difference was statistically significant.The ranges of stent thrombosis measured by VET were similar to DSA.Conclusions VET can improve the clarity of intravascular stents.VET and color Doppler can enhance the clinical value of ultrasound in the evaluation of therapeutic efficacy of stenting for BCS.

Objective:To display human CD137 extra-cellular domain on phage using phage display technique and detect its antigenicity and bioactivity.Methods:CD137 extra-cellular gene was amplified from CIS plasmid using PCR and then clone it into pComb3HSS.The recombinant pComb3H-CD137 was transfected into competent bacteria XL1-Blue, then the transfected bacteria was co-infected with help phage VCSM13 and CD137 extra-cellular domain was displayed on the phage surface. The antigenicity and bioactivity of CD137 displayed on phage was detected by ELISA and inhibition assay of lymphocyte proliferation(MTT).Results:CD137 PCR products was 525 bp, the recombined plasmid was named pComb3H-CD137, CD137 was displayed on phage. ELISA detection showed that phage displayed CD137 possesses antigenicity of human CD137. MTT inhibition assay showed that lymphocytes proliferation stimulated by PHA and CD137 could be inhibited by phage displayed CD137, indicating that it has bioactivity of nature CD137.Conclusion:The studies demonstrate that phage display system can display human CD137 extra-cellular domain homodimer with antigenicity and bioactivity.

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.

ObjectiveTo explore the application value of acoustic radiation force impulse(ARFI) in the differential diagnosis of breast lesions.Methods Eighty six patients with 107 lesions were performed ARFI elastography.The stiffness of the masses in virtual touch tissue image(VTI) were scored.The pathological diagnosis as the gold standard,drawed the ROC curve to find the cut off point of area ratio to predict breast cancer.Shear wave velocity(SWV) within the breast masses were measured using virtual touch tissue quantification(VTQ) technique.ResultsThe elastography hardness score higher than grade 4 was mainly distributed in the malignancies compared to benign lesions( P ＜0.01).1.53 as the cut-off point of area ratio,sensitivity and specificity of diagnosing breast cancer were 95.7 ％,92.5 ％.SWV of malignant group higher than benign group,the difference was statistically significant (P ＜ 0.001 ).Conclusions Hardness score in VTI imaging,area ratio of benign and malignant lesions,SWV within the breast masses can help the differential diagnosis of breast lesions.

Objective To evaluate the application value of virtual touch tissue quantification (VTQ)for evaluating small focal liver lesions.Methods Seventy-seven patients with 89 small focal liver lesions,whose largest diameter were less than or equal to 3 cm were evaluated with VTQ.The shcar wave velocity (SWV) of the tumor and background liver parenchyma were calculated,and their results were compared with those of 40 healthy subjects.Statistical analysis was performed on the SWV for the differentiation of normal liver,background liver parenchyma and lesions.The cut-off point for SWV was obtained by using ROC curve analysis which was used to predict malignancy lesions.Results The SWV of malignant lesions was significantly higher than that of benign ones [(2.56-± 0.67) m/s vs (1.70 ± 0.55) m/s,P =0.000].The SWV of metastatic liver carcinoma which came from lung cancer and breast cancer were higher than that of gastrointestinal tract cancer transfers (P =0.000).Based on 1.93 m/s as the cut-off point of SWV value,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value for diagnosing malignancies were 82.0 ％,84.6％,83.15 ％,87.23 ％ and 78.57 ％ respectively.Conclusions VTQ technique can help the differential diagnosis of small focal liver lesions.

Objective To investigate the applicative value of acoustic radiation force impulse imaging (ARFI) in the differential diagnosis of small hypoechoic thyroid nodules.Methods 31 patients were pathologically confirmed as having a total of 44 small hypoechoic thyroid nodules ≤ 1 cm in diameter,followed by analyses of the characteristics of their ARFI images,including virtual touch tissue imaging (VTI) and virtual touch tissue quantification (VTQ).Based on VTI images of the nodules,the hardness of small hypoechoic thyroid nodules was respectively scored,and the ratios of VTI images to gray scale image areas were calculated.With pathological diagnosis as the gold standard,VTI scores,area ratios and VTQ values of the ROC curve in diagnosis of thyroid malignant nodules were sketched so as to explore the optimal cut-off points in VTI scores,area ratios and VTQ values in the diagnosis of malignant nodules.Results By the ROC curve test,VTI score of 3 was determined as the cut-off point of areas ratio,with the sensitivity and specificity of diagnosing thyroid cancer being 96.0 ％ and 94.7％,respectively.There were 34 nodules with VTI score greater than 3 (including 9 benign nodules and 25 malignant nodules) and 10 nodules with VTI score of 3 or less (all benign nodules).Malignant thyroid nodules had higher ratio of VTI images to gray scale image area than that of the benign nodules (1.58 ± 0.18 vs 1.30 ± 0.10,P ＜0.05).When 1.47 was set as the cut-off point of areas ratio,the sensitivity and specificity of diagnosing thyroid cancer were 80.0％ and 94.7％,respectively.The VTQ value of 2.76 m/s in diagnosis of thyroid malignant nodules was designated as the cut-off point,with a sensitivity of 88.0 ％,specificity of 94.7 ％.Conclusions The ARFI technique is able to provide information of thyroid nodule hardness,which guarantees its high applicative value in the differential diagnosis of small hypoechoic thyroid nodules.

Objective To investigate the influence of age on perioperative clinical parameters, tumor resection effects and complications of patients with early stage gastric cancer for single lesion treated by ESD.Methods 60 patients with early stage gastric cancer for single lesion treated by ESD were chosen from January 2013 to July 2014 and divided into 2 groups including A group (35 patients) with < 60 years old and B group (25 patients) with ≥ 60 years old; and the operation time, intraoperative blood loss, hospital staying time, tumor curative resection and completed rate, the recurrence rate with follow-up and complications incidence of 2 groups were compared.Results All the patients were successfully performed the operation and no bleeding cases. There was no significant difference in the operation time, intraoperative blood loss, hospital staying time between 2 groups (P < 0.05). There was no significant difference in the tumor curative resection and completed rate between the 2 groups (P < 0.05). There was no significant difference in the recurrence rate with follow-up between 2 groups (P < 0.05). There was no signiifcant difference in the complications incidence between 2 groups (P < 0.05).Conclusion ESD is safe and feasible in the treatment of elderly patients with early stage gastric cancer for single lesion, and it is equivalent to short- and long-term efifcacy in non-elderly patients and not increase the operation time, the trauma degree and complications risk.