Objective To compare the ultrasonographic manifestations of ligamenta patella and their entheses of healthy volunteers with those of professional athletes. Methods Sonography was performed using a GE Logiq 700 MR Expert Series ultrasound equipment and a 5-10 MHz multifrequency linear array transducer. Fifty-two healthy volunteers and 20 professional athletes underwent sonography on ligamentum patella of both sides. Results The normal ligamenta patella′s contour was regular and sharply defined, appearing as tightly packed echoic structures with fine parallel internal linear echoes with a synovial sheath to a thickness of 0.02 cm. The attaching bone surface was smooth and continuous. The ligamenta patella of male was longer than that of the female(P

Purpose To explore the effect of ultrasonic section,patient position and other factors on Young's modulus and shear wave velocity measurement of the muscle,and to study the consistency between Young's modulus and shear wave velocity on reflection of muscle hardness.Materials and Methods Shear wave elastography was used to detect 10 healthy young men and 10 women.Longitudinal and transverse detection of the Young's modulus and shear wave velocity of gastrocnemius and soleus were performed in natural ankle joint position,maximum plantar flexion and maximum dorsiflexion position.Results ① Comparison of the elasticity measurement between gastrocnemius and soleus.There were significant differences in the Young's modulus in the maximum plantar flexion and Young's modulus and shear wave velocity in maximum dorsiflexion position in longitudinal detection (P＜0.05) that gastrocnemius measurements were higher than soleus measurements.There were significant differences in Young's modulus and the shear wave velocity (P＜0.05) in natural position and maximum dorsiflexion position that soleus measurements were higher than gastrocnemius measurements.② In the positions of the ankle joints,the differences between longitudinal detection values and transverse detection values of gastrocnemius or soleus were statistically significant (P＜0.01) and longitudinal detection values were higher than transverse detection values.③ Comparison of the elasticity measurement of gastrocnemius and soleus muscle among different positions of the ankle joints.The measurement in natural position and in the maximum plantar flexion were evidently higher than that in the maximum dorsiflexion position (P＜0.01) in longitudinal detection.The maximum dorsiflexion position showed higher elasticity measurement.Only elasticity measurement in natural position and the maximum plantar flexion of the soleus was statistically different from that in the maximum dorsiflexion position (P＜0.01) that it was higher in the maximum dorsiflexion position.Conclusion The ultrasound elasticity measurements of gastrocnemius and soleus are related with the ultrasonic longitudinal or transverse section and the relative ankle positions.Moreover,there are some differences in elasticity measurements between these two muscles.should be given to all of these in quantitative evaluation of muscle hardness using shear wave ultrasound elastography.

Objective:To explore the influence of nephroblastoma over expressed gene (CCN3)on differentiation of bone marrow mesenchymal stem cells (BM-MSCs)into endothelial cells.Methods:BM-MSCs differentiation into endothelial cells induced by condition medium containing vascular endothelial growth factor (VEGF,50ng/ml)was regarded as positive control group.BM-MSCs differentiation into endothelial cells induced by condition medium con-taining recombined CCN3 protein (100 ng/ml)and VEGF (50 ng/ml)was regarded as CCN3 group,and BM-MSCs incubated in pure complete medium was regarded as negative control group.Immunofluorescence staining and semi-quantitative reverse transcription-polymerase chain reaction method (RT-PCR)were used to measure expression of von Willebrand factor (vWF)after 16d to evaluate endothelial cell differentiation,and semi-quantitative RT-PCR method was used to measured expression of Notch1 gene mRNA before and after induced BM-MSCs differentiation. Results:On 16d after induced BM-MSCs differentiation,some cells of positive vWF fluorescence staining were ob-served in positive control group,those of CCN3 group was significantly more than those of positive control group, and expression of vWF mRNA [ratio of optical density (OD): (0.550±0.090)]of CCN3group was significantly higher than that of positive control group (0.358±0.080),(P<0.01),and no vWF-positive cells were observed in negative control group;Besides,before induced differentiation,expression of Notch1 gene mRNA were low in three groups without significant difference between any two groups (P>0.05 all),on 16d after induced differentiation, expressions of Notch1 gene mRNA in positive control group (0.232±0.047)and CCN3 group (0.352±0.029)were significantly higher than that of negative control group (0.132±0.033),P<0.01 all,it of CCN3 group was signifi-cantly higher that of positive control group (P<0.01).Conclusion:CCN3 can enhance BM-BMCs differentiation into endothelial cells by activating Notch1 signal pathway.

Abstract: Objective To investigate the nutritional status of patients with pulmonary tuberculosis and its effects on conventional anti-tuberculosis treatment, so as to provide a basis for improving the efficacy of conventional treatment of pulmonary tuberculosis. Methods The relevant data of 168 patients with pulmonary tuberculosis admitted to Suining Central Hospital from April 2020 to April 2022 were retrospectively analyzed. Nutritional status of the patients before treatment was investigated using the Mini Nutritional Assessment (MNA) score, and the influencing factors of nutritional status before treatment were analyzed. Therapeutic effects of anti-tuberculosis drugs in the non-nutritional risk group and the nutritional risk group were comparatively analyzed. Results Among the 168 patients, 64 were assessed as having good nutritional status before treatment, 59 had the risk of malnutrition and 45 were malnourished according to the MNA score. Univariate analysis and linear regression analysis showed that age, underlying diseases, and clinical symptoms were factors affecting the MNA score before treatment (t=3.173, 3.718, 2.018, P all<0.05); whereas gender and education level were not factors affecting MNA score before treatment (t=0.065, 0.059, P all>0.05). According to the MNA score before treatment, the patients were dividedinto a non-nutritional risk group (MNA score > 23.5) and a nutritional risk group (MNA score ≤23.5). The negative conversion rate of sputum bacteria, effective rate of focal absorption in the non-nutritional risk group were 92.19% (59/64)and90.63% (58/64) , respectively, which were significantly higher than corresponding 79.85% (82/104)and76.92% (80/104) in the nutritional risk group. The drug resistance rate, adverse reaction rate, and average treatment cost of the no nutritional risk group and nutritional risk group were 7.81% (5/64) and 21.15% (12/104), 15.63% (10/64) and 31.73% (33/104), (0.62±0.13) million yuan and (0.89±0.26) million yuan, respectively, with significant differences (χ2=5.228, 5.071, 7.685, 5.396, 7.728, P all<0.05). Conclusions Patients with pulmonary tuberculosis exhibit poor nutritional status before treatment. The patients’nutritional status is easily affected by age, underlying diseases, and clinical symptoms, thereby affecting the effect of anti-tuberculosis treatment. Therefore, early nutritional intervention for tuberculosis patients should be recommended in order to prevent malnutrition and enhance the effectiveness of anti-tuberculosis treatment.

ObjectiveToexplore the appearance ofmusclecrushinjuryatquantitative ultrasonographic elastography by supersonic shear imaging (SSI).MethodsThe animal experiment was done using a special balloon cuff device to create left hind leg crush injury with a force of 18.6 kPa.Twentythree New Zealand rabbits had crush injury of extremity and survived for 72 hours.SSI quantitative elastography was performed in crushed and no-crushed regions of each rabbit hind leg.Quantitative lesion elasticity was measured in terms of the Young modulus (in kilopascals) at 30 min,2 h,6 h,24 h and 72 h after the release of the crushing pressure.A receiver operating characteristic (ROC) curve analysis was used to assess diagnostic performance.ResultsThe area of crushed region in left hind leg accounted for 2.6％ -3.0％ of body surface area in 23 rabbits.The crushed regions exhibited maximum elasticity values of (19.51 ± 6.74)kPa,(21.47 ± 5.54) Pa,(11.36 ± 5.35)kPa,(15.09 ± 3.31)kPa and (13.72 ± 3.74) kPa,and mean elasticity values of (12.44 ± 3.77)kPa,(13.20 ± 3.60)kPa,(6.80±2.86)kPa,(10.04 ± 2.95)kPa and (6.94 ± 0.97)kPa at 30 min,2 h,6 h,24 h and 72 h after the release of the crushing pressure.Comparing with those of no-crushed regions,they were higher obviously (P＜0.001).ROC curves showed that extremity crush injury was diagnosed by using elasticity value,and the greater the elasticity value,the greater the diagnostic value.Conclusions SSI provides quantitative elasticity measurements,thus adding complementary information that potentially could help in crush injury characterization with conventional ultrasonography.

Purpose:The aim of this study was to investigate the diagnostic value of color Doppler Ultrasound in Budd-Chiari Syndrome (BCS) with hepatic venous(HV) outflow obstruction.Materials and Methods:The features of ultrasonography in 138 patients of Budd-Chian Syndrome were analyzed and compared with that of angiography.Results:83 patients had membranous obstruction and 45 segmental occlusion of HV.10 patients had HV stenosis.The ultrasound was able to reveal stenosis,atresia,emboli,or membranous obstruction in hepatic venous outflow tract.Collateral branches could be seen between the hepatic veins with short hepatic vein expanded.Both HV and IVC were involved in 35 cases,with thrombus in IVC in 11 and HV in 7.There was two false positive cases and 3 false negative in ultrasound diagnosis.Conclusion: The position and type of occlusion in HV could be accurately detected by color Doppler ultrasound,and so was the existence and degree of collateral circulation,which were of aid for the operation and follow-up.

Objective To evaluate the diagnostic value of gray scale contrast-enhanced ultrasonography(CEUS) in the diagnosis of active hemorrhage of the kidney.Methods Forty-six active hemorrhage animal models were created within the kidney of 23 New Zealand rabbits heparinized under general anesthesia,rabbit kidneys were examined by routine two dimensional ultrasonography and CEUS.Results Routine ultrasonography showed 26 traumas with irregular and poorly defined margins.CEUS showed all active bleeding sites,contrast agents overflowed from injured blood vessel and formed irregular remarkable enhanced parts.After average 85s for contrast agent was injected,the intensity of the enhanced regions in the kidneys were significantly higher than those of normal renal parenchyma.Conclusions CEUS could clearly demonstrate the active hemorrhage in traumatic kidney and could significantly improve the diagnostic level of ultrasonography.

Objective To determine whether hemostatic agents directly injected into injury sites under the guidance of contrast-enhanced ultrasound(CEUS)can effectively control hemorrhage from hepatic or splenic trauma. Methods Healthy adult dogs were impacted by a impactor to create hepatic or splenic trauma. Among 32 dogs,28 had hepatic or splenic injury of grade Ⅲ～Ⅳ according to Injury Scale of the American Association for the Surgery of Trauma(AAST),which were divided into two groups,the treatment group and the control. In the treatment group,hemocoagulase and α-cyanoacrylate were injected respectively into the injury site and transected micro-vessel tinder the guidance of CEUS,while in the control group,normal saline was injected. Results All animals of the two groups survived after the injection. CEUS demonstrated that active hemorrhage disappeared in treatment group but still existed in the control group.In the treatment group,laparotomy showed that hepatic or splenic injury had been covered and adhered with clot and glue membrane of hemostatic agents and free intraperitoneal blood volume was significantly less than that in the control group(P=0.000),while in the control group injury bleeding did not stop after injection. Conclusions Hemostatic agents injected under the guidance of CEUS can effectively control hemorrhage from hepatic or splenic trauma of grade Ⅲ～Ⅳ. This therapy was simple,convenient and effective. It may be performed immediately after hepatic or splenic injury was diagnosed.

Objective To analyse the cost-effectiveness analysis of the focal injection treatment under the guidance of contrast enhanced ultrasound(CEUS) for the severe abdominal parenchymal organs trauma.Methods One hundred and twelve patients with severe abdominal parenchymal organs trauma,including 42 hepatic injuries,52 splenic injuries and 33 renal injuries,were rolled in this study. The cost-effectiveness of this group was compared with that of surgery group. Results Treatment duration of single organ trauma under the guidance of CEUS was 20 - 30 minutes. During the first 72 hours after the focal injection, blood pressure and heart rate were improved ( P ＜0.05). Free intraperitoneal liquid did not increase on immediate US image of post-therapy and then it disappeared gradually. Heart rate returned to normal level after injection treatment ( P ＜0. 001 ). Lengths of stay in hospital was 3 - 11 (5.4 ± 2.4)days, which was not different with 3 - 9(5.1± 1.9) of surgery group( P ＞0.05). Treatment cost was 0.32 - 0.43 (0.36 ±0. 14) ten thousand RMB, which was obviously less than 3. 1 - 4. 2 (3.6 ± 10.8) ten thousand RMB of surgery group ( P ＜ 0.01 ). Conclusions The efficacy of the focal injection treatment of the severe abdominal parenchymal organs trauma under the guidance of CEUS was consistent with that of the operative treatment, but its cost was less. Especially it benefited for reserving organs and less pain.

Objective To explore the value of percutaneous injection of hemostatic agents under the guidance of contrast-enhanced ultrasound(CEUS)for grade Ⅲ-Ⅳ hepatic trauma patients.Methods Eleven patients with severe hepatic trauma were treated using percutaneous focal injection of hemostatic agents.Five of these patients were hepatic injury of grade Ⅲ,and others were grade Ⅳ according to AAST.Results Out of all patients with severe hepatic trauma,9 patients were cured by once percutaneous injection of hemostatic agents under the guidance of CEUS,and 1 patient was cured by twice injection,and 1 patient was switched to surgery because of complicated pancreatic injury and the increase of free intraperitoneal fluid.Conclusions CEUS can display the site and severity of liver injury.Combining with interventional technology,injection of hemostatic agents under the guidance of CEUS can save life and avoid to resect organ,and it can win time for treating other compound injury.