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 study feasibility of combined haemostatic percutaneous injection therapy guided by contrast-enhanced ultrasonography (CEUS) in treatment of renal injuries. Methods Eighteen New Zealand rabbits were inflicted with kidney injury imitating grades Ⅲ-Ⅳ blunt injuries. The animals were randomly and equally divided into three groups, Group A ( treated with hemocoagulase),Group B ( treated with hemocoagulase and Alpha-cyanoacrylate) and Group C ( control group, given normal saline). The hemostatic time, hemostatic effect, and perirenal hematoma were observed. Results A perirenal hematoma was observed one hour after treatment. The perirenal fluid thickness was (0.200 ±0.012) cm in Group A, (0.050 ±0.002) cm in Group B and (0.400 ±0.009) cm in Group C, with statistical significance between two test groups and Group C (P ＜ 0.05 ). At days 7 and 14 following treatment, lesion length and cross section was ( 1. 107 ±0. 143) cm and (0.433 ±0. 163) cm in Group A, (0.567 ±0.082) cm and (0. 160 ±0. 078) cm in Group B, and (0.980 ±0. 203) cm and (0.686 ± 0. 157) cm in Group C. There was statistical significance between the test groups (Groups A and B) and Group C (P＜0. 01) at day 14. The lesion size in Group A was lager than that in Group B (P ＜ 0.01 ). One month after treatment, a slight nephrohydrosis occurred in Group B. Conclusions Either injection of simple hemocoagulase or combined use of hemocoagulase and Alpha-cyanoacrylate guided by CEUS can attain positive hemostatic effect, but the latter one is more rapid and reliable.

Objective To approach the diagnostic value of contrast-enhanced ultrasonography(CEUS)for the detection of traumatic laceration of pancreas. Methods Sixty cases of pancreatic traumatic model were made in twelve healthy swines after the animals were anesthetized and laparotomized. Then the conventional ultrasonography(US) and CEUS were performed in each case to diagnose the traumatic region,immediately. The results were compared with surgical findings. Results Among sixty injuries,the detection rate of conventional ultrasonography was 66. 7%,the detection rate of CEUS was 88.3%. Conclusions CEUS shows higher detection rate than conventional US in diagnosing pancreatic laceration,and it also can improve the diagnostic value of ultrasound for the detection of pancreatic laceration.

Objective To study haemostatic percutaneous injection therapy for the management of vascular damage in patients with renal injuries guided by contrast-enhanced ultrasonography(CEUS).Methods Which of 56 patients with renal trauma were diagnosis by CEUS,37 cases with grades Ⅱ-Ⅳ renal injuries were brought into our study.According to wound degree and accompanying active bleeding,they were divided into experiment group (percutaneous injection hemostatic treatment)and control group(conservative treatment).Results Thirty-seven renal trauma manifest low perfusion in lesions by CEUS,and the contrast agent could be seen overflow to renal pelvi and the location of capsule in 13 patients.The patients were divided into experiment group(17 cases)and control group(20 cases).The color of hematuria of 9 patients in experiment group became gradually light at 30 mins after treatment.and the color of 7 cases become normal,and hematuria of the only one was iterative appear.The color of hematuria of 9 patients in control group became gradually light in 24-72 hours,others' hematuria became gradually light in 5-14 days.The time of color of hematuria become light of the former was shorter than those of the latter(P<0.05).Reexamination by ultrasound and renal function and urine routine at 1,3 and 6 months after treatment,the results of all patients indicated normal.Conclusions Haemostatic percutaneous injection therapy for renal trauma guided by contrast-enhanced ultrasonography has very obvious hemostatic efficacy.Its advantages included may be used for effective,minimally invasive control of renal injuries(grades Ⅱ-Ⅳ),and can be a feasible management of active bleeding at bedside.

Objective To investigate the clinical value of acoustic radiation force impulse (ARFI) imaging in the evaluation of liver functional reserve in patients with hepatic focal lesions. Methods Eighty-six patients with hepatic focal lesions in General Hospital of the People′s Liberation Army from September 2011 to August 2012 were studied. According to Child-Pugh score, 54 of them were classified as grade A, 18 patients were classiifed as grade B, and 14 patients were classiifed as grade C. Seventy patients underwent surgery and 16 patients underwent non-surgical treatment. Shear wave velocity (SWV) values were measured using ARFI technique, and indocyanine green (ICG) clearance tests were also performed to achieve ICG clearance rate constant (ICGK) and ICG retention rate at 15 minutes (ICG15). Correlation between SWV and ICGK, SWV and ICG15 were studied using Pearson correlation, and correlation between SWV and Child-Pugh score were analyzed using Spearman rank correlation. Difference between SWV values of patients underwent surgery and those of patients underwent non-surgical treatment was compared using t-test for independent samples. Analyses of receiver operating characteristic (ROC) curve were performed to investigate the value of ARFI in the evaluation of surgical feasibility for patients with hepatic focal lesion, with the clinical decisions serving as the golden standard. Results There was correlations between SWV and ICGR15, SWV and ICGK, and SWV and Child-Pugh scores (r=0.764,P <0.001;r=-0.686,P=0.000;r=0.864,P=0.000). The SWV of patients who underwent surgery was (2.46±0.45) m/s, and the SWV of patients who underwent non-surgical treatment was (1.54±0.36) m/s, with a signiifcant difference (t=-0.80, P=0.000). The ROC curve analysis demonstrated a highest Youden′s index of 0.775 when the cut-off was 2.06m/s. The corresponding sensitivity was 87.5% and the specificity was 90.0% for ARFI in the diagnosis liver functional reserve deficiency. Conclusion ARFI can effectively evaluate the liver functional reserve in patients with hepatic focal lesions and thus could be beneifcial in the decision of clinical treatment.

Objective To study the clinical value of acoustic radiation force impulse imaging (ARFI) in patients with ischemic type biliary lesion (ITBL) after orthotopic liver transplantation. Methods Between July 2012 to January 2013, forty-one patients in General Hospital of the People′s Liberation Army were enrolled in this study who were admitted for post-transplantation follow-up. Among them, 15 patients were diagnosed as ITBL by ultrasonography. Besides conventional ultrasonography, ARFI was used to detect the shear wave velocity (SWV) of liver tissue at depth of 4 cm and 5 cm respectively. Simultaneously liver function test was performed. Independent-samples t test was performed to compare the difference of SWV between ITBL and non-ITBL group at the same depth. Paired-sample t test was performed to compare the difference of SWV for the same ITBL patient. Pearson correlation analysis was used in analyzing the relation between SWV and liver function. Results The average SWV in depth of 4 cm was (1.561±0.425) m/s and (1.121±0.160) m/s in ITBL and non-ITBL group, respectively. Signiifcant differences were found among the ITBL and non-ITBL groups (t=-3.173, P=0.01). The average SWV in depth of 5 cm was (1.608±0.545) m/s and (1.175±0.173) m/s in ITBL and non-ITBL group, respectively. Signiifcant differences were found among the ITBL and non-ITBL groups (t=-2.454, P=0.034). There was no signiifcant difference between SWV measurements at different depth for the same ITBL patient. For all patients, SWV at different depths were both strongly correlated with alkaline phosphatase (r=0.656, 0.667, respectively;both P=0.000) andγ-glutamyl transpeptidase (r=0.482, P=0.007;r=0.508, P=0.004). Conclusion The liver stiffness measurement is valuable for the clinical evaluation of post-transplantation ITBL.

Objective To evaluate the correlation between enhancement vascular mode and gallbladder polyp nature and size with contrast-enhance ultrasound (CEUS).Methods From December 2014 to May 2016,patients with gallbladder polyp lesions (GPL) larger than 1.0 cm were enrolled in this study.Before cholecystectomy,every patient underwent ultrasound (US) and CEUS examination.All features of US and CEUS were analyzed by two doctors who were blind to the patient clinical data.According to the pathological findings,GPL were divided into cholesterol polyp group and gallbladder adenoma group.The US features and enhancement vascular mode were analyzed statistically by t test and x2 test.The independent risk factors were analyzed by Logistic regression.The relationship between enhancement vascular mod and size of GPL were determined by bivariate correlation analysis.Results There were 103 patients with GPL larger than 1.0 cm.Eighty-two cases were cholesterol polyp and 21 cases were gallbladder adenoma.There were differences in size and color Doppler blood flow between two groups (t=-5.97 and 7.94,P ＜ 0.05).Dotted,branched vascular mod and irregular vascular mode were statistical different between two groups (x2=10.09 and 8.43,P ＜ 0.05).Regression analysis data proved that the size and branch vascular mod were the independent risk factors related with adenoma (P ＜ 0.05).In both cholesterol polyp group and adenoma group,there were weak positive correlation between enhancement vascular mode and size of GPL (r=0.188,0.397,P ＜ 0.05).Conclusions Branch vascular mod and size of GPL were help to distinguish gallbladder adenoma from cholesterol polyp.Comprehensive analysis of GPL's size and vascular mode could offer important guidance for differentiation diagnosis.

Objective To evaluate clinical application of measuring the sizes in different directions and stalk width of gallbladder polyp lesions (GPL) ≥1.0 cm for differentiation diagnosis between cholesterol polyp and adenoma by both gray scale ultrasound (US) and contrast-enhanced ultrasound (CEUS). Methods From January to September 2016, a total of 81 patients with GPL ≥ 1.0 cm received cholecystectomy in our hospital were enrolled in this study. All participations underwent US and CEUS scanning before cholecystecomy. Patient′s clinical data, sizes in different directions, stalk width and features of US images were recorded. According to pathological findings, patients were divided into cholesterol polyp group and adenoma group. All of the clinical data, sizes, stalk width and features of US images were statistically analyzed. Patient′s age, size in vertical and parallel sizes, stalk width of GPL, ratio of vertical size to stalk width, ratio of parallel size to stalk width and ratio of vertical size to parallel size were compared with t-test. Genda, number and location of GPL, echoic level and blood flow signal were compared with the χ2test.Bivariate was used for relation analysis.Results There were difference in patient′s age,vasularity of GPL, size in vertical direction, size in parallel direction, stalk width, ratio of vertical size to stalk width, ratio of parallel size to stalk width[9(15.8%)vs 9(37.5%),(37.02±10.14)years old vs(52.25±13.85)years old, (0.94±0.33)cm vs(1.27±0.79)cm,1.10±0.37 vs 1.71±0.50,(0.26±0.10)cm vs(0.58±0.51)cm,3.82±1.87 vs 2.92±1.61],the differences were statistically significant(χ2=2.675,t=5.303,2.675,5.855,4.566,-2.536, all P<0.05), but no difference in ration of vertical size to parallel size between two groups (all P>0.05). Bivariate realtion analysis proved that size in vertical direction, size in parallel direction, stalk width and ratio of vertical size to stalk width were related with the nature of GPL≥1.0 cm (r=0.375, 0.571, 0.586, -0.342, all P<0.05). Conclusion Sizes in different directions and stalk width were important factors for predicting the nature of GPL ≥1.0 cm.

Diabetic lower extremity vascular disease is one of the common chronic complications of diabetes,which has a strong disabling effect,clinically,it is of great significance to actively and effectively control the progression of the disease and improve the quality of life of patients.In Sanxiao Lun,LIU Wansu put forward the theory of"dryness-heat and stagnation"according to the pathogenesis of consumptive thirst,and thought that the dryness-heat and stagnation in the stomach and intestines of sanjiao were too severe,the xuanfu was blocked,and the qi and liquid failed to diffuse,which caused diabetes.Vascular endothelial injury and inflammatory reaction are important factors in the development of vascular disease,the pathogenesis evolution of"dryness-heat and stagnation"conforms to the pathological characteristics of inflammatory reaction in western medicine,and the dryness-heat runs through the diabetic lower extremity vascular disease throughout.In this paper,it is believed that diabetic lower extremity vascular disease belongs to the category of"flaccidity and paralysis"in traditional Chinese medicine,and lung scorched by heat is the cause of flaccidity."Dryness-heat and stagnation"is the source of invading heat(dryness-heat),lung scorched by heat,pulse failure and vein stasis occurred,which causes diabetic lower extremity vascular disease.Treatment should be based on flaccidity,combined with the viewpoint of LIU Wansu's Sanxiao Lun,taking yangming as the top priority,regulating the triple diabetes,solving the problem of dryness-heat and stagnation,combined with the method of purging the south and supplementing the north,so that the invading heat is cleared,lung heat is diminished,and flaccidity disease cannot occur,in order to provide new ideas for the clinical prevention and treatment of diabetic lower extremity vascular disease.

Objective: To study the correlation of lifestyle characteristics with thyroid nodules in a population-based sample of centenarians in Hainan. Methods: The study was based on China Hainan Centenarian Cohort Study (CHCCS) conducted in 18 cities and counties in Hainan province from 2014 to 2016. A group of multidisciplinary team interviewed and examined local centenarians with structured questionnaires and ultrasonography procedures. A total of 918 centenarians were analyzed after excluding those who refused ultrasonographic examinations or had relevant missing data. Thyroids of centenarians were examined by 3-year experienced sonographer, details on lifestyle characteristics and dietary habits were collected by standard procedure. Results: Of the 918 centenarians, 683 (74.4%) had thyroid nodules under the ultrasonography procedures. The prevalence of thyroid nodules in different group of areca nut consumption varied significantly (P<0.05). In multivariate logistic regression model, the results showed female and areca nut intake were independently associated with thyroid nodules in centenarians (P<0.05). Conclusions The modifiable variables including areca nut intake as well as non-modifiable such as gender are independent determinants of thyroid nodules in centenarians. Further studies are warranted to explore and verify these associations in populations with different ranges of age.