OBJECTIVE: To optimize the microwave-assisted extraction of total organic acids from Isatis indigotica. METHODS: With the dissolution rate of total organic acids as indexes, the content of total organic acids was determiend by acid-base titration and the three main factors including volume of solvent, microwave power and extraction time in the extraction process were optimized by orthogonal test. RESULTS: The optimal extraction process is to add 15 times amount of water and extract at a microwave power of 522 W for 20 minutes. Under the above condition, the extraction rate was 4.83%, close to the extraction yield achieved by water decoction for 2 h. CONCLUSION: The microwave-assisted extraction of total organic acids from Radix Isatidis is characterized by rapid, simple, efficient and energy-saving etc, thus deserving to be be popularized.

Objective To compare contrast-enhanced ultrasonography (CEUS) features of clear cell renal cell carcinoma (CCRCC) and angiomyolipoma (AML), and to explore the value of CEUS for differential diagnosis. Methods CEUS appearance of 106 CCRCCs and 25 AMLs confirmed pathologically were analyzed retrospectively. For each lesion, the enhancement degree, the homogeneity of enhancement, the presence of perilesional enhancement, the washing-in and washing-out pattern and the process of enhancement (i.e. diffuse, centrifugal or centripetal enhancement) were evaluated. The results were compared with the pathologic findings. Results There was no statistically significance in the degree of enhancement and the washing-in and washing-out pattern between CCRCC and AML (P>0.05). However, significantly different was found in the homogeneity of enhancement, the presence of perilesional enhancement and the process of enhancement between CCRCC and AML (P<0.01). Heterogeneous enhancement, perilesional enhancement and diffuse enhancement were mainly seen in CCRCC, and the positive predictive value for CCRCC was 97.26%, 100% and 94.74%, respectively. When all the three CEUS findings combined were used as criterion for differentiating CCRCC from AML, the positive and negative predictive values was 100% and 95.00%, respectively. Conclusion CEUS characteristics of CCRCC is different from that of AML. CEUS is useful for the differential diagnosis of CCRCC and AML.

Objective To investigate the feasibility of contrast-enhanced ultrasonography (CEUS) combined with Bosniak classification in diagnosis of cystic renal cell carcinoma (CRCC). Methods Routine and contrast-enhanced ultrasonic manifestations of 24 patients (24 lesions) of CRCC confirmed with operation and pathology were retrospectively analyzed. The number of septa, thickness of wall and septa, with or without solid nodules and blood supply were evaluated. Each tumor was categorized on CEUS images using the Bosniak classification system, and the diagnostic coincidence rate was calculated. Results On routine ultrasonographic images, there were 2 lesions without septa, 8 with a few septa and 14 with multiple septa, 5 lesions with septa and (or) wall thickness ≤1 mm and 19 lesions thickness ＞1 mm; solid nodules were shown in 7 lesions and the color flow was shown in 11 lesions. On CEUS images, there were 8 lesions with a few septa and 16 with multiple septa, 1 lesion with septa and (or) wall thickness ≤1 mm and 23 lesions thickness ＞1 mm; solid nodules were shown in 9 lesions, and the enhancement could be demonstrated in all the lesions. According to Bosniak classification system, CEUS demonstrated 15 grade Ⅲ and 9 grade Ⅳ lesions. The diagnostic coincidence rate of CEUS combined with Bosniak classification was 100%. Conclusion The blood supply and sophisticated internal structures of CRCC can be shown better with CEUS than routine ultrasonography. CEUS combined with Bosniak classification can be used for the diagnosis of CRCC.

Objective To assess transrectal contrast enhanced ultrasound (CEUS ) targeted biopsy (TB) for detection prostate cancer (PCa) by comparing with systematic biopsy (SB) .Methods 151 consecutive patients scheduled for prostate biopsy were enrolled in this prospective study with a mean age of 68 8.± 8 0. (47-86) and prostate specific antigen (11 5.± 6 9.)μg/L (0 3.-39 8.μg/L) .CEUS was performed by a single experienced radiologist who was blinded to all clinical data with the Sequoia 512 ultrasonography system equipped with EV8C4 endfire probe .Hypoperfusion lesions ,hyperperfusion lesions and lesions with rapid wash‐in or wash‐out were suspicious for malignant ,and these lesions were sampled with 2-4 cores in addition with 10‐core SB .Results The overall PCa detection rate was 40 4.% (61/151) .Of 61 PCa patients , 11 (18 0.% ) had positive cores in TB ,18 (23 0.% ) had positive cores in SB and 36 (59 0.% ) had positive cores in both biopsy protocols .The PCa detection rate of TB and SB was 33 1.% and 31 1.% respectively (P=0 7.12) .A total of 1 755 cores were sampled including 1 510 SB cores and 245 TB cores .The positive rate for TB was significantly higher than SB (52 2.% vs 11 5.% ,P =0.000) .Of 61 PCa patients ,18 had low‐grade cancer (Gleason score<7) and 43 had high‐grade cancer (Gleason score≥7) .The sensitivity for high‐grade PCa was 86 0.% with TB ,which was significantly higher than low‐grade cancer (55 6.% ,P =0.018) . Conclusions The PCa detection rate of CEUS‐TB was equal with SB ,whereas the positive rate by core of CEUS‐TB was significant higher than SB .Furthermore ,CEUS‐TB was more sensitive in detection of high grade prostate cancer .

Objective To analyze the enhancement degree of prostate cancer on contrast-enhanced transrectal ultrasonography (CETRUS) in relation to tumor location.Methods 150 patients suspected of prostate cancer were evaluated with CETRUS.The degree of enhancement of the lesions was objectively measured using peak intensity (PI) with time-intensity curve analysis software.The peak intensity of the lesions located in the medial peripheral zone,the lateral peripheral zone and the transition zone was compared and analyzed.Results Prostate cancer was detected in 96 of 150 patients.The mean PI value of the prostate cancer was significantly higher than that of the benign prostate hyperplasia lesions [(9.88 ± 3.76)dB vs (8.74±4.52)dB,P ＜0.01].The PI value of the cancer foci located in the medial peripheral zone,the lateral peripheral zone and the transition zone increased gradually [(6.55 ± 2.90)dB vs (10.57±2.52)dB vs (13.64±2.38)dB,P ＜0.001].The Spearman correlation coefficient between the tumor location and the PI value was 0.718 (P ＜0.001).The partial correlation coefficient was 0.720 when the Gleason score was used as a covariate (P ＜0.001).Conclusions There was significant difference in enhancement degree between prostate cancer lesions with different location.Being aware of this might be valuable for improving the sensitivity and specificity of CEUS in diagnosis of the prostate cancer.

Objective To determine whether cadence contrast pulse sequencing (CPS) harmonic ultrasonography can be used to predict aggressiveness of peripheral zone prostate cancer.Methods CPS harmonic ultrasonography was performed in 62 biopsy-proved prostate cancer patients.Time intensity curves were reconstructed for biopsy-proved or radical prostatectomy histopathology proved prostate cancer lesions.The characteristics of the curves were described using hemodynamic parameters including arrival time (AT),time-to peak (TTP) and peak intensity (PI).The differences of hemodynamic parameters between different Gleason score and pathologic stage were analyzed.Results Prostate biopsy revealed 156 peripheral zone prostate cancer lesions among 62 patients,including 40 low grade lesions and 116 high grade lesions.In comparison with low-grade lesions,the contrast agents arrived and distributed earlier in highgrade lesions (P =0.005,0.023).In addition to lower AT and TTP,high-grade tumors had higher PI than low-grade tumors (P =0.008).Among 21 patients underwent radical prostatectomy,histopathology documented 14 low grade tumors and 17 high grade tumors,significant differences of hemodynamic parameters were found between these two groups (P ＜0.05).Furthermore,prostate cancer lesions with extra capsular extension also had high PI than those confined in the gland (P =0.000).Conclusions Contrast-enhanced ultrasound and hemodynamic parameters might be helpful in predicting aggressiveness of prostate cancer.

Objective To determine the utility of elastography guided biopsies in men undergoing transrectal ultrasound-guided transperineal prostate biopsies.Methods A total of 108 consecutive patients suspicious for prostate cancer due to elevated serum prostate specific antigen level or abnormal digital rectal examination were enrolled in this prospective study.All patients underwent combined elastography-targeted and 10 core-systematic transperineal biopsy.The impact of elastography-targeted biopsies on the prostate cancer detection rate was analyzed in comparison with prostate biopsy pathology.Results The overall prostate cancer detection rate was 49.1％ (53/108).The prostate cancer detection rate of systematic biopsy was 35.2％(38/108).The increase in cancer detection rate by elastography-targeted biopsies was 13.9％(15/108,P =0.039).A total of 1296 cores were sampled among 108 patients,including 1080 systematic biopsy cores and 216 targeted biopsy cores.The positive rate of targeted biopsy was significantly higher than systematic biopsy (50.9％ vs 14.1％,P ＜0.0001).Conclusions Prostate cancer detection rate could be significantly improved by elastography targeted transperineal biopsy.

Objective:To analyze the usage intention and key issues of medical staff to use telemedicine, for improving telemedicine service system in China.Methods:From October to November 2019, medical workers of both the inviting party and invited party who experienced telemedicine in seven provinces of Fujian, Hainan, Henan, Hunan, Guizhou, Sichuan and Qinghai were selected for an online questionnaire survey. Areas covered included their usage intention, satisfaction and cognitive appraisal of telemedicine. Descriptive statistical analysis and non-parametric test were used to discuss the intention of further use, satisfaction and challenges of medical workers in various provinces and regions.Results:1 084 valid questionnaires were recovered. The data found the overall satisfaction was 98.62%, and the proportion of their intention of further use was 98.25%, and those from the eastern and western provinces presented higher intention of usage. The top challenges as reflected by these medical workers were named as follows: timeliness of consultation progress and information feedback; long latency time; low Internet speed, poor and interrupted Internet signal; inadequate system equipments and inconvenient operation; difficulties in remote physical checkup and overall understanding of patient conditions; as well as substandard, incomplete and poor medical records.Conclusions:These medical workers are satisfied with the telemedicine services and willing to continue to use telemedicine.For those existing problems, it is suggested to strengthen the infrastructure and optimize the process of telemedicine services, so as to encourage them in greater use of telemedicine.

Objective:To analyze the actual and expected incentives and key issues of telemedicine providers in China and to provide important references for optimizing telemedicine incentive policies.Methods:The sample data came from a questionnaire survey of 1 084 providers in 7 provinces of Fujian, Hainan, Henan, Hunan, Guizhou, Sichuan and Qinghai in October and November 2019 and a semi-structured interview data at 6 hospitals in Henan province in January 2020. Descriptive analysis was used to sort such data into text data for classified summation.Results:The greatest gaps were found between actual incentives and expected ones in expense subsidies, title promotion and excellence awards, with such gaps as high as 18.65, 28.26, 29.28 percentages among providers of junior, deputy senior and senior academic titles respectively. Hospitals fall short in providing adequate incentives for telemedicine providers, not to mention lack of differentiation and diversification in personnel incentives, and poor implementation of incentive policies.Conclusions:It is suggested to strengthen incentive demand analysis, break the homogenization bottleneck of incentive policies, and consolidate internal publicity and implementation of incentive policies.

OBJECTIVE: To determine whether contrast-enhanced harmonic ultrasonography can be used to predict the aggressiveness of prostate cancer. MATERIALS AND METHODS: Contrast-enhanced harmonic ultrasonography was performed in 103 patients suspected of prostate cancer before biopsy. Time intensity curves were reconstructed for systematic biopsy sites and sonographic abnormalities. The characteristics of the curves were described using hemodynamic indices including arrival time (AT), time-to-peak (TTP), and peak intensity (PI). The differences of hemodynamic indices between high-grade and low-grade cancer were analyzed and the correlations between the hemodynamic indices and biopsy Gleason score were studied. RESULTS: Prostate cancer was detected in 41 of 103 patients and there were significant differences in the hemodynamic indices between the biopsy sites of the non-malignant patients and prostate cancer lesions (p < 0.05). The prostate biopsies revealed 154 prostate cancer lesions, including 31 low-grade lesions and 123 high-grade lesions. The hemodynamic indices AT and TTP of high-grade tumors were significantly shorter than those of low-grade tumors (p = 0.001, 0.002). In addition, high-grade peripheral zone (PZ) tumors had higher PI than low-grade PZ tumors (p = 0.009). The PZ prostate cancer Gleason score correlated with PI, AT and TTP, with Spearman correlation coefficients of 0.223, -0.335, and -0.351, respectively (p = 0.013, < 0.001 and < 0.001). CONCLUSION: Contrast-enhanced ultrasound measurements of hemodynamic indices correlate with the prostate cancer Gleason score.
Aged ; Aged, 80 and over ; Biopsy, Needle ; *Contrast Media ; Hemodynamics ; Humans ; Male ; Middle Aged ; Phospholipids/*diagnostic use ; Prostate/pathology ; Prostatic Neoplasms/blood supply/diagnosis/*ultrasonography ; Sulfur Hexafluoride/*diagnostic use ; Ultrasonography, Doppler ; Ultrasonography, Interventional