ObjectiveTo determine the validity of transcranial sonography (TCS) in the differential diagnosis of Parkinson's disease (PD) and essential tremor (ET). MethodsTCS was performed in 100 patients with PD, 33 patients with ET and 100 normal controls in a blind manner. The echo signal intensity of the substantia nigra was classified into grade Ⅰ-Ⅴ for semi-quantitative analysis.When the echo intensity was gradeⅢ or more,it was deemed as abnormal and the area of the substantia nigra hyperechogenicity would be measured and its ratio to the area of the whole midbrain ( S/M ) would be calculated. Results ( 1 ) Semi-quantitative analysis: the ratio of the persons whose echo intensity of the substantia nigra was grade Ⅲ or more was greater (76. 00％ ,76/100) in PD than ET (9. 09％, 3/33) and normal controls ( 13.00％, 13/100; x2 = 130. 622, P ＜0. 01 ). However, there was no difference between ET and controls. (2) Quantitative analysis: the median and quartile range of the area of substantia nigra hyperechogenicity and S/M were greater in PD patients ( O. 54 ( 0. 57 ), 11.03 ( 9. 00 ) ) than ET ( 0. 00(0.04), 0.00(1.55),H= 42.39,42.19, both P＜0. 01, respectively) and normal controls (0.00(0. 00), 0. 00 (0. 00 ), H = 121.86,121.47, both P ＜ 0. 01, respectively), and there was no difference between ET and controls. (3) Using the area of hyperechogenicity ≥0. 20 cm2 or S/M ≥ 7％ as a cut off for predicting PD, the sensitivity, specificity and accuracy were 85.39％, 78. 38％ and 81.50％ or 86. 02％,81.31％ and 83.50％ ,respectively. But there was no significant difference for the accuracy (Z = 0. 683,P ＞ 0. 05). ConclusionTCS might find the specific hyperechogenicity of substantia nigra in PD patients,providing useful information to distinguish PD from ET.

Objective To analyze the values of anteroposterior diameter (APD) in fetal renal pelvis separation during different gestational weeks and in predicting the prognosis.Methods Totally 182 cases of fetal renal pelvis separation in the Second Affiliated Hospital of Soochow University were enrolled in this study between January 2013 and October 2015.All of them were followed up to 12 months after birth.The detecting gestational weeks of non-reversible renal hydronephrosis and values of fetal renal pelvis APD were analyzed.Results Among the 182 cases of fetal renal separation,46 cases were detected in the second trimester,136 cases were detected in the third trimester (bilateral renal pelvis separation occurred in 92 cases).During the follow-up,114 cases recovered in the fetal period and 52 cases recovered within 12 months after birth,finally,16 cases (8.8％,16/182) of them progressed to non-reversible renal hydronephrosis.Among the 16 fetus of non-reversible renal hydronephrosis,10 cases (62.5％,10/16) were detected in the second trimester,their values of APD were 7.4-11.5 mm and the average was (8.0± 1.5) mm;6 cases (37.5％,6/16) were detected in the third trimester,their values of APD were 13.6-14.8 mm and the average was (12.8±2.0) rmm.The values of APD in fetus who were detected in the second trimester were smaller than those in the fetus who detected in the third trimester and the prognosis in the fetus who were detected in the second trimester was worse than those in the fetus who were detected in the third trimester,the fetus (21.7％,10/46) who progressed to non-reversible renal hydronephrosis in the second trimester were more than the fetus (4.4％,6/136) who were detected in the third trimester.Conclusion Clinical following-up combined with the detecting gestational weeks of fetal renal pelvis separation and values of fetal renal plevis APD by prenatal ultrasound may be helpful in predicting their prognosis.

Objective To explore the rules of the compatible application of antagonistic combination Ginger and Radix Scutellariae in clinical.Methods The prescriptions included the compatibility application of Ginger and Radix Scutellariae were systematically retrieved in literature. Using Excellas a storage and analysis tool, the information about treatments, dosage, compatibility proportion, and dosage form were analyzed with the method of bibliometrics.Results The prescriptions included the compatibility application of “Ginger and Radix Scutellariae” were mainly used for the treatment of internal diseases (746 cases, 76%), followed by gynecological diseases (62 cases, 6%), ear-nose-throat diseases (43 cases, 4%), etc. The largest number of internal diseases was spleen-stomach diseases, which accounted for 26% (193 cases) of the total internal diseases. And the others were diseases of liver-gallbladder 189 cases (25%), and diseases of lung (185 cases, 25%). In the prescriptions, the dosages of Radix Scutellariae were primarily 10, 12, 9, 15 g, 69% (532/772) of which were in the dose range provided by Chinese Pharmacopoeia. The dosages of Ginger were mainly 10 g and 6 g, 84% (356/424) of which were in the dose range provided by Chinese Pharmacopoeia. The compatibility proportion of Ginger and Radix Scutellariae was mostly 1∶1, which accounted for 32%.Conclusion The antagonistic combination Ginger and Radix Scutellariae was widely used in a variety of interior, exterior, gynaecology, paediatrics and other syndromes. The two drugs were contrary in the property (one cold and the other hot) and the function (one warming lung and the other clearing away the lung-heat), but their compatibility application can achieve a satisfactory efficacy.

Objective To analyze the blood perfusion modes of retroperitoneal benign and malignant masses by real-time contrast-enhanced ultrasonography (CEUS). Methods Forty-five patients with retroperitoneal masses, including 18 benign and 27 malignant masses, were performed with CEUS. The perfusion of contrast agent, entering style and the vascular patterns of contrast agent were described. And the diagnosis value of perfusion characteristics was evaluated in retroperitoneal benign and malignant masses. Results The perfusion of CEUS showed significant differences in the entering style of contrast agent and the vascular patterns in malignant masses in comparison to benign masses. In the entering style of contrast agent, center enhancement of malignant masses was 70. 37% (19/27), periphery enhancement of benign masses was 72.22% (13/18) ,there was statistical significane in the result( P = 0.0069). To the vascular patterns level,there were 2 with level 0 and 11 with level 1 in benign group, 10 with level 2 and 9 with level 3 in malignant group, there was statistical significane between malignant group and benign group too( P=0.0206). Conclusions CEUS is benefit to improve the accuracy of diagnosis of retroperitonea malignant and benign masses.

Objective To assess the features of transcranial sonography (TCS) in Parkinson disease (PD) and Alzheimer disease (AD).Methods Totally 38 PD patients (PD group),28 AD patients (AD group) and 26 controls (control group)underwent TCS.The echogenicity of the substantia nigra,widths of third ventricle and parameters of middle cerebral artery among the three groups were analyzed.Results The ratio of hyperechogenicity of substantia nigra in PD group (31/38,81.58％) were higher than those in AD group (8/28,28.57％) and control group (3/26,11.54％;x2 =18.74,30.41,both P＜0.001),and there was no significant difference in hyperechogenicity of substantia nigra between AD group and control group (x2 =2.41,P=0.120).The widths of third ventricle in AD group ([0.82±0.14]cm) were wider than those in PD group ([0.63±±0.16]cm) and control group ([0.56±0.16]cm,both P＜0.001),and there was no significant difference in widths of third ventricle between PD group and control group (P=0.098).The mean velocities in bilateral middle cerebral artery in AD group were lower than that of in PD group and in control group (all P＜0.05).The pulsatility index in right middle cerebral artery in AD group were greater than that in PD group and control group (both P＜0.05).Conclusion According to the changes of echogenicity of substantia nigra,widths of third ventricle and parameters of middle cerebral artery,TCS may provide some useful information for diagnosis of PD and AD.

Objective To investigate the substantia nigra (SN) and brainstem raphe (BR) echogenic features of Parkinson's disease (PD) patients with musculoskeletal pain.Methods A total of 115 PD patients recruited in the Second Affiliated Hospital of Soochow University from October 2014 to May 2016 were assessed with the following rating scales:Unified Parkinson's Disease Rating Scale (UPDRS),Hoehn and Yahr Staging Scale (H/Y),Hamilton Rating Scale for Depression (HRSD),Beck Depression Inventory Ⅱ (BDI-Ⅱ) and Visual Analogue Scale (VAS).All the subjects underwent transcranial sonography during the clinical evaluation.And the patients were divided into PD with musculoskeletal pain (n =54) and PD without musculoskeletal pain (n =61) groups,or PD with depression(n =74) and PD without depression(n =41) groups.Results Compared with PD patients without pain,PD patients with musculoskeletal pain had higher scores of UPDRS-Ⅱ,-Ⅲ,HRSD,BDI,NMSQ and H/Y (UPDRS-Ⅱ score:12.56 ±6.01 vs 8.79 ±4.38,t =-3.801,P ＜0.01;UPDRS-Ⅲ score:24.43 ± 12.43 vs 20.07 ± 11.12,t=-1.986,P=0.049;HRSD score:11.65-±6.94 vs 8.38-±5.36,t=-2.844,P=0.005;BDI score:14.09 ±6.20 vs 9.74 ±6.00,t =-3.826,P ＜0.01;NMSQ score:8.57 ± 4.06 vs 5.60 ± 3.38,t=4.193,P＜0.01;H/Y:2.0(1.5,2.6) vs 1.5(1.0,2.0),Z=-3.011,P=0.003).Positive BR was more frequent in depressed than in non-depressed PD patients without pain (63.6％ vs 14.3％;x2 =15.25,P ＜0.01).Positive BR was positively associated with sex(r =0.228,P =0.014),age(r =0.184,P =0.049),disease duration (r =0.196,P =0.035),and depression (r =0.396,P ＜ 0.01).However,positive BR did not correlate with musculoskeletal pain.No correlation was found between positive SN and clinical characteristics of PD patients.Conclusions PD patients with musculoskeletal pain have worse activity of daily living,more severe motor symptoms,more non-motor symptoms,and are more depressed.SN and BR echogenecity do not correlate with musculoskeletal pain,however,hypoechogenic or interrupted BR is associated with depression in PD patients.

Objective To discuss the neuroimaging characteristics of transcranial ultrasound in Parkinson's disease (PD) patients with or without depression.Methods Transcranial sonography (TCS) was performed in PD patients with depression (PDD +,n =50),PD patients without depression (PDD-,n =50),depression patients (D,n =50) and healthy controls (n =50),who were enrolled in the Second Affiliated Hospital of Soochow University from September 2010 to July 2016.The differences of the neuroimaging characteristics of TCS in brainstem raphe (BR) and substantia nigra (SN) in four groups were analyzed.According to the degree of depression,PDD + and D groups were divided into three subgroups:mild,moderate and severe depression,and the differences of echo characteristics in BR were analyzed among the subgroups.Results The rate of abnormal BR echogenicity was significantly higher in PDD + (78.0％,39/50) and D (82.0％,41/50) groups than that in PDD-(18.0％,9/50) and healthy control (10.0％,5/50) groups (x2 =87.80,P ＜0.01),and there was no statistically significant difference among the subgroups (PDD + group,P =0.98;D group,P =0.57).The rate of SN hyperechogenicity was significantly higher in PDD + (80.0％,40/50) and PDD-(86.0％,43/50) groups than that in D (8.0％,4/50) and healthy control (10.0％,5/50) groups (x2 =110.07,P＜ 0.01).Conclusion The echogenicity changes of BR and SN on TCS could provide some useful neuroimaging information for the diagnosis and differential diagnosis of PDD-from PDD +.

Objective To analyze the blood perfusion characteristics of retroperitoneal benign and malignant tumors by real-time contrast enhanced ultrasonography and discuss its value in the differential diagnosis.Methods The study involved 42 patients with pathological evidence through surgery or needle biopsy,including 12 patients with benign retroperitoneal tumors and 30 patients with malignant retroperitoneal tumors.The blood perfusion characteristics of two groups were observed under low mechanical index after the injection of contrast ultrasound agent(SonoVue),and the changes of twodimensional ultrasonography and the time-intensity curve(TIC)were analyzed. Results During real time contrast enhancement,the different characteristics of retroperitoneal benign and malignant tumors were observed.Malignant tumors in retro peritoneum presented the pattern of ultrasound contrast agent(UCA) enhancement from center to periphery and enhanced overall uneven mainly,begin tumors presented peripheral enhancement pattern or uniformity and overall strengthening of the main.TIC curve between benign and malignant tumors displayed that contrast enhanced intensity of region of interest(P＜0.00 1),ascending slop and halftime of descending were statistically significant(P＜0.05).Conclusions Real-time contrast-enhanced ultrasonography is a valued method to provide information for the differential diagnosis in retroperitoneal benign and malignant tumors.

Objective To evaluate the effect of continuous transversus abdominis plane (TAP) block on postoperative systemic inflammatory responses of patients undergoing laparoscopic radical surgery for colorectal cancer.Methods Ninety-eight patients,aged 45-64 yr,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,weighing 50-75 kg,scheduled for elective laparoscopic radical surgery for colorectal cancer under general anesthesia,were divided into continuous patient-controlled epidural analgesia (PCEA) group (group PCEA) and continuous TAP block group (group TAPB) using a random number table,with 49 patients in each group.An epidural catheter was placed at L1,2 interspace,a test dose of 3 ml of 2％ lidocaine was given,and morphine 2 mg (in 10 ml of normal saline) was injected into the epidural space at the end of surgery in group PCEA.PCEA solution contained 0.15％ ropivacaine and sufentanil 2 μg/ml (diluted to 300 ml in normal saline).PCA pump was set up with a 2 ml bolus dose,a 20 min lockout interval and background infusion at a rate of 4 ml/h.Catheterization of bilateral transversus abdominis plane was accomplished under ultrasound guidance,and 0.3％ ropivacaine 20 ml was injected in group TAPB.TAP block solution contained 0.15％ ropivacaine (diluted to 300 ml in normal saline).PCA pump was set up with a 6 ml bolus dose,a 30 min lockout interval and background infusion at a rate of 6 ml/h.Analgesia lasted until 48 h after surgery,and visual analogue scale score was maintained less than or equal to 3 in both groups.Parecoxib sodium 40 mg was intravenously injected as a rescue analgesic when visual analogue scale score was more than 3.Blood samples were collected from the right internal jugular vein at 24 h before operation (T0) and 48 h after operation (T1) for determination of the expression of CXCL8 mRNA in serum (by real-time polymerase chain reaction) and expression of CXCL8 and STAT3 in serum (by Western blot).The development of requirement for rescue analgesia,sensory motor dysfunction of lower extremities and nausea and vomiting after surgery was recorded.Results Compared with the baseline at T0,the expression of serum CXCL8 mRNA,CXCL8 and STAT3 was significantly up-regulated at T1 in the two groups (P＜ 0.05).Compared with group PCEA,the expression of serum CXCL8 mRNA and STAT3 was significantly down-regulated at T1,the incidence of sensory motor dysfunction of lower extremities was decreased (P＜0.05),and no significant change was found in the expression of serum CXCL8,requirement for rescue analgesia or incidence of nausea and vomiting in group TAPB (P＞0.05).Conclusion Continuous TAP block can reduce postoperative systemic inflammatory responses of patients undergoing laparoscopic radical surgery for colorectal cancer.

Objective: To explore an effective long non-coding RNA (lncRNA) signature in predicting the prognosis of hepatocellular carcinoma through the analysis on RNA sequencing data of hepatocellular carcinoma patients and peritumoral tissues in the Cancer Genome Atlas (TCGA) database. Methods: The clinical characteristics and RNA sequencing data of 377 hepatocellular carcinoma patients were obtained from TCGA database by the end of February 2018. Then, differentially expressed lncRNAs between 50 pairs of tumor and peritumoral tissues were explored using student’s t-test. Next, a lncRNA signature was established through LASSO Cox regression analysis. All the patients were divided into four groups (<P₂₅, P₂₅-, P₅₀-, ≥P₇₅) based on the cut-off quartiles signature. Finally, compared with the control group (<P₂₅), the hazard ratios (HRs) of three groups (P₂₅-, P₅₀-, ≥P₇₅) were calculated by using Cox regression. The survival outcomes of patients in the four groups were compared to evaluate the capacity of the lncRNA signature model. Results: A total of 951 differentially expressed lncRNAs were identified between tumor and peritumoral tissues. A three-lncRNA signature, including LNCSRLR, MKLN1-AS and ZFPM2-AS1, was established to predict the prognosis of hepatocellular carcinoma patients. The outcome suggested that the death risk of the ≥P₇₅ group was 1.57 times larger than that of the <P₂₅ group (95%CI: 1.06-2.31, P<0.05). Conclusion The three-lncRNA signature, which established by LNCSRLR, MKLN1-AS and ZFPM2-AS1, was significantly associated with the prognosis of hepatocellular carcinoma patients based on TCGA database data.