Objective To explore the methods and clinical value of transrectal ultrasound (TRUS) in detecting rectal gastrointestinal stromal tumor(GIST) with head scanning probe.Methods A total of 12 patients had the ultrasonic examination through the rectum with the head scanning probe.Preoperative ultrasonic findings were compared with the pathological results.Results Of the 12 patients,the patients were divided into three groups,including 3 cases with low-degree severity,6 cases with moderate-degree severity and 6 cases with high-degree severity.The lymph node metastasis was not found near intestines.Rectal GIST appeared as a hypoechoic mass with clear limit、regular form and expanded growth under TRUS.The CDFI showed abundant flow in the tumor and TRUS had an overall accuracy rate of 75.0%(9/12)in the diagnosis of rectal GIST.The accuracy of TRUS in the staging diagnosis of rectal GIST was 83.3%(10/12).Conclusion The TRUS with the head scanning probe is of great value for pre-operative diagnosis and staging of rectal GIST.Rectal water window and felicitous check-up technique can enhance the accuracy of TRUS.

OBJECTIVETo explore the feasibility of evaluating complete ischemia-reperfusion injury (IRI) of the testis by contrast-enhanced ultrasonography with microbubbles (MB) targeted to P-selectin (MBp) in rabbits.

METHODSWe randomly divided 30 healthy adult rabbits into five groups of equal number (control, 0.5 h IRI, 1 h IRI, 2 h IRI, and 4 h IRI), prepared phospholipid MB and MBp, and performed contrast-enhanced ultrasonography of the bilateral testes with MB or MBp at an interval of 20 min at different times after IRI. When MB or MBp disappeared completely in the healthy testis at 4 to 5 min after intravenous injection, we recorded the power of the first frame (F-P) in the IRI testes followed by immunohistochemical staining of the testis tissue.

RESULTSCEU with MBp achieved a significantly higher F-P than that with MB in all the IRI groups (P < 0.05), which was (8.34 +/- 1.20) versus (1.87 +/- 0.25) 10(-5) AU at 2 hours, but there was no significant difference between MB and MBp in the control rabbits (0 AU, P > 0.05). Immunohistochemistry showed a significantly time-dependent increase in the expression of P-selectin in the vascular endothelial cells of the IRI testes, but not in those of the control.

CONCLUSIONContrast-enhanced ultrasonography with MBp can be used to evaluate the inflammatory reaction of testicular ischemia-reperfusion injury.

Animals ; Antibodies ; Disease Models, Animal ; Male ; Microbubbles ; P-Selectin ; immunology ; Rabbits ; Reperfusion Injury ; diagnostic imaging ; Testis ; blood supply ; Ultrasonography

AIM: To explore the predisposing factors, population characteristics and clinical features of severe fungal keratitis.
METHODS:The data of 233 cases 233 eyes of severe fungal keratitis in my hospital from January, 2008 to November, 2013 was retrospectively reviewed. The predisposing factors, population characteristics and clinical features were analyzed.
RESULTS: In 233 cases of severe fungal keratitis, the number of male patients was 153 ( 65. 7%) and the number ratio of male to female was 1. 9:1. The average age of them was (52. 7±11. 3), and most of them were middle-aged and elderly people living in the rural area (78. 1%) and were farmers ( 66. 1%) with low literacy (59. 7%). In 233 cases, 188 cases (80. 7%) possessed a clear history of ocular trauma, mainly caused by plant-based trauma (60. 9%). 90 cases (57. 3%) were infected with Fusarium, and 47 cases ( 29. 9%) by Aspergillus. The main treatment of severe fungal keratitis was surgery (87. 9%). 83 cases ( 52. 9%) were treated with penetrating keratoplasty, and in Fusarium and Aspergillus infected patients with severe fungal keratitis, 58. 4% ( 80/137 ) were performed with penetrating keratoplasty. In addition, patients treated with eye enucleation or evisceration, 68. 4% (13/19) were infected with Fusarium species.
CONCLUSION: Patients with severe fungalkeratitis in our hospital are mainly elderly male farmers living in rural, because of low economic condition and poor diagnosis consciousness. The main pathogens are Fusarium and Aspergillus species, and the major treatment is penetrating keratoplasty. Most of patients with poor clinical outcomes are infected with Fusarium species.

Objective To study the clinical value of color Doppler ultrasonography in typing tuberculous epididymitis.Methods The appearances of color Doppler ultrasound and the findings on operation were analysed in 33 patients with tuberculous epididymitis.Results Of the 33 patients,epididymis appeared as diffusely and heterogeneously enlarged lesions with increased flow in 2 cases,appeared as nodular lesions in 13 cases including nodi with echofree space in 3 cases, nodi with high-level echo patches in 3 cases, and low echo-level nodi in 7 cases. Multiple lesions in scrotum were detected in 17 cases, of whom epididymis up to 11 cases appeared as diffusely enlarged heterogeneous lesions with flow increased.The sonographic appearancs of tuberculous epididymitis could be divided into 3 types:diffusion type, nodus type and complicated type. Nodus type included 3 subtypes: purulence type, calcification type, and cheese type.The accuracy rate of ultrsound diagnosis was 87.9%.Conclusions Testis is easy to be involved when epididymitis appears as diffusion type, so surgical treatments should be early.Purulence type and complicated type need surgical treatments while calcification type does not. Antituberculous drug treatments can be tried before surgical treatments in cheese type.Sonography of urinary system is helpful for the diagnosis of asymptomatic tuberculosis in urinary system when tuberculous epididymitis is first suspected on sonography.

The purpose of this study was to investigate the existence and extent of cognitive impairment in adult diabetes mellitus (DM) patients with episodes of recurrent severe hypoglycemia,by using meta-analysis to synthesize data across studies.PubMed,EMBASE and Cochrane library search engines were used to identify studies on cognitive performance in DM patients with recurrent severe hypoglycemia.Random-effects meta-analysis was performed on seven eligible studies using an inverse-variance method.Effect sizes,which are the standardized differences between the experimental group and the control group,were calculated.Of the 853 studies,7 studies met the inclusion criteria.Compared with control subjects,the adult DM patients with episodes of recurrent severe hypoglycemia demonstrated a significantly lowered performance on memory in both types of DM patients,and poor performance of processing speed in type 2 DM patients.There was no significant difference between adult DM patients with and those without severe hypoglycemia in other cognitive domains such as general intelligence,executive function,processing speed and psychomotor efficiency.Our results seem to confirm the hypothesis that cognitive dysfunction is characterized by worse memory and processing speed in adult DM patients with a history of recurrent severe hypoglycemia,whereas general intelligence,executive function,and psychomotor efficiency are spared.

OBJECTIVETo compare the impact of unilateral acute testicular ischemia on the hemodynamics and histology of the contralateral testis of the rabbits under consistent anesthesia with that of the rabbits in the conscious state.

METHODSForty-two healthy male white rabbits were randomly divided into an anesthetic group (Group A) to receive injection of sodium pentobarbital (PS) and a non-anesthetic group (Group B), each including a control group of 5 animals (A0 and B0), an incomplete testicular ischemia group of 8 (A1 and B1), and a complete testicular ischemia group of 8 (A2 and B2). Testicular ischemia models were constructed by color Doppler ultrasonography. Contrast-enhanced ultrasound (CEUS) was used to observe the perfusion of the contralateral testes before and after ligating and loosening the unilateral spermatic cord in each experimental group. The control animals also underwent CEUS and measurement of the heart rate (HR) and blood pressure (BP) at the corresponding time. Histological structure changes in the contralateral testes of the rabbits were observed in both anesthetic and conscious states.

RESULTSPS anesthesia markedly suppressed the HR and BP of the rabbits. The parameters in Groups of A0, A1 and A2 showed no statistically significant changes after unilateral ligation of the spermatic cord, while Groups B1 and B2 displayed significantly decreased peak-base difference (PBD) and prolonged arrival time (AT) and half time of descending peak intensity (HT). Groups A1, B1 and B2 showed significantly increased PBD and prolonged HT shortly after loosening the spermatic cord. Focal pathological and ultrastructural changes were observed in the contralateral testes of the ischemic rabbits, but no significant difference was found in Johnson's score in comparison with the controls. The apoptotic cells were remarkably increased in Groups A1, B1 and B2.

CONCLUSIONAcute testicular ischemia may induce injury to the contralateral testis to some degree, and a reflexive sympathetic response may cause hemodynamic changes in the non-anesthetic state. And the neural and vascular inhibitory effects of anesthesia could make insignificant changes of blood perfusion in the contralateral testis.

Animals ; Disease Models, Animal ; Ischemia ; diagnostic imaging ; pathology ; Male ; Rabbits ; Reperfusion Injury ; diagnostic imaging ; pathology ; Testicular Diseases ; diagnostic imaging ; pathology ; Testis ; blood supply ; diagnostic imaging ; pathology ; Ultrasonography

OBJECTIVETo discuss the correlation of ultrasonographic grading of varicocele (VC) with the changes of seminal parameters after varicocelectomy.

METHODSA total of 129 cases of VC were diagnosed by scrotal color Doppler ultrasonography (CDU) and graded into 3 groups: VC I, VC II and VC III, according to three different grading indexes: the regurgitant volume of pampiniform plexus veins (PPV), the maximum diameter of PPV and the combination of the regurgitant volume and the maximum diameter of PPV. All the patients underwent high ligation of the spermatic vein and semen analysis was performed before and after varicocelectomy according to the WHO guidelines.

RESULTSWith the maximum diameter of PPV as the grading index, there were statistically significant differences in the seminal parameters of VC III (P < 0.05) but not in those of VC I and VC II (P > 0.05) before and after varicocelectomy, while based on the regurgitant volume of PPV or the combination of the regurgitant volume and the maximum diameter of PPV, the differences were insignificant in VC I (P > 0.05), significant in VC II (P < 0.05) and extremely significant in VC III (P < 0.01). No significant differences were found in the rate of sperm abnormality among the 3 groups after varicocelectomy (P > 0.05).

CONCLUSIONDifferent grading indexes influence the changes of seminal parameters after varicocelectomy. The regurgitant volume of PPV and the combination of the regurgitant volume and the maximum diameter of PPV are more reasonable and reliable as the grading indexes of VC. Different grades of VC respond differently to varicocelectomy. Whether VC I necessitates varicocelectomy needs to be further investigated.

Adult ; Humans ; Male ; Semen ; cytology ; physiology ; Sperm Count ; Sperm Motility ; Ultrasonography, Doppler, Color ; methods ; Varicocele ; diagnostic imaging ; physiopathology ; surgery

OBJECTIVETo discuss the correlation between sonographic appearance of different degrees of acute unilateral testicular ischemia and histological changes of the testis after reperfusion.

METHODSThirty-two male rabbits were equally divided into a control (sham operation) group and 3 ischemia groups. Unilateral testicular ischemia models were established under the color Doppler ultrasound (CDU) observation and allocated according to different degrees of ischemia to Group A (with homogeneous echoes and slightly decreased flow signals), B (with heterogeneous echoes and obviously decreased flow signals) and C (with radial or small-shredded low echoes and absence of flow signals). Then contrast-enhanced ultrasonography (CEUS) was performed, followed by reperfusion of the ischemic testes. A month later, the histological changes of the testes were observed and the correlation of the histological changes with the sonographic and CEUS manifestations was analyzed.

RESULTSConcerning the CEUS parameters such as the arrival time (AT), reperfusion rate, time-to-peak (TTP), half descent time (DT/2) of the ischemic testes, Groups A and B showed significant differences from the control group (P < 0.05). The peak-base difference (PBD) was significant in Group B (P < 0.05) but not in A (P > 0.05), and no enhancement was seen in Group C. As for Johnson's scores obtained 1 month later, Group A exhibited no significant difference (8.70 +/- 0.39) (P > 0.05), Group B showed significant difference (6.01 +/- 0.88) (P < 0.05), and Group C extremely significant difference (3.16 +/- 1.05) (P< 0.001) from the control group (9.10 +/- 0.11).

CONCLUSIONCEUS is superior to CDU in evaluating the perfusion of testicular ischemia. Sonographic appearances of testicular ischemia are significantly correlated with histological changes of the testis after reperfusion. Ultrasonography helps to predict the spermatogenetic function of ischemic testes after reperfusion.

Animals ; Disease Models, Animal ; Ischemia ; diagnostic imaging ; pathology ; Ischemic Preconditioning ; Male ; Rabbits ; Reperfusion Injury ; diagnostic imaging ; pathology ; Testicular Diseases ; diagnostic imaging ; pathology ; Testis ; diagnostic imaging ; pathology ; Ultrasonography, Doppler, Color

OBJECTIVETo discuss the diagnostic value of an ultrasonic assessing system for detecting the severity of hepatic fibrosis in patients with chronic hepatitis B (CHB).

METHODSUltrasonographic variables were analyzed in 110 CHB patients. An ultrasonic semi-quantitative scoring system using seven ultrasonic morphologic parameters, a Fisher discriminating function and three quantitative ultrasonic parameters was developed. The performance of these methods was also studied and compared.

RESULTSThe areas under the curve of the scoring system for different liver fibrosis stages were >or= S2: 0.946, >or= S3: 0.914, and S4: 0.915. The total score was well correlated with the histological stage of fibrosis (r=0.824, P < 0.001). There was a significant difference between the stages of fibrosis. The accuracy of the Fisher discriminating function for identifying three study endpoints was 76.5%, 78.2% and 67.3%. Combining the ultrasonic scoring system and the discriminating function, the specificity was 85%-90% and the accuracy was 77%-84%.

CONCLUSIONOur ultrasonic semi-quantitative scoring system is a noninvasive method for quantitating liver fibrosis. If it is used together with a discriminating function, the accuracy of diagnosing liver fibrosis can be significantly increased.

Adolescent ; Adult ; Aged ; Female ; Hepatitis B, Chronic ; diagnostic imaging ; Humans ; Liver Cirrhosis ; diagnostic imaging ; pathology ; Male ; Middle Aged ; Ultrasonography, Doppler, Color ; Young Adult

OBJECTIVETo compare the effects of close reduction combined with minimally invasive percutaneous plate osteosynthesis for distal fracture of tibial shaft.

METHODSFrom March 2009 to May 2013, there were 124 patients (89 males and 35 females, 30 of them were injured in a traffic accident and 94 were falling down in daily life, the ages ranging from 21 to 81 years old) who suffered from distal fracture of tibial shaft. Sixty-six patients (48 males and 18 females, 45 cases of type A, 12 cases of type B and 9 cases of type C) were treated with close manipulative reduction combined with minimally invasive percutaneous plate fixation. After close reduction, a minimal incision was made and a anatomic plate was inserted just along the medial tibia periostea, and then the fracture was fixed without fracture exposure. The other 58 patients (41 males and 17 females, 41 cases of type A, 10 cases of type B and 7 cases of type C) were treated with conventional open reduction and internal fixation. Length of the incision, operating time, early postoperative pain (recorded using the Visual Analog Scale score) and the outcome results (recorded using the evaluation standard of Johner-Wruhs) were compared.

RESULTSThe length of incision was meanly (7.34 ± 1.42) cm in MIPPO group and (21.82 ± 2.35) cm in ORIF group; operation time was (44.48 ± 10.00) min in MIPPO group and (59.42 ± 11.84) min in ORIF group. The postoperative radiographs verified good position of all screws and satisfactory bone fracture reduction in both groups. All the patients were followed up, and the duration ranged from 10 to 24 months (mean 15.2 months) in both groups. In MIPPO group,only one patient had delayed union and got union after Chinese herb therapy. The other 65 patients got bony union during 15 to 20 weeks. While in ORIF group, 3 patients suffered from nonunion and received reoperation with bone grafting, and 4 patients got bone infection.

CONCLUSIONTreatment of distal fracture of tibial shaft, combined with close reduction and MIPPO technique, has the advantages such as less invasion, less damage of blood supply, simplified procedure of operation and higher union rate, which is an ideal methods and is accordant to the biological demand.

Adult ; Aged ; Aged, 80 and over ; Bone Plates ; Case-Control Studies ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Manipulation, Orthopedic ; methods ; Middle Aged ; Tibial Fractures ; therapy