Objective To investigate the protective effect of antihypertensive drug NO.1 on brain cortical tissue in spontaneously hypertensive rats.Methods A total of 60 spontaneously hypertensive rats (SHR,30 males and 30 females) and 12 healthy Wistar rats (6 males and 6 females) weighed (200 20) g,were randomly divided into 6 groups.Model group (SHR,n=12) and control group (healthy Wistar rats,n=12) were given the same dose of placebo.Captopril group (SHR,n=12) were given captopril 5 mg · kg-1 · d-1.The low-,median-and high-dose groups of antihypertensive drug NO.1 were given 0.25,0.5 and 1 g · kg 1 · d-1 respectively.After 4 weeks of treatment,carotid artery blood pressure was detected.All rats were sacrificed,and brain tissue samples were taken.The expressions of Bcl-2,Bax,necrosis factor NF-κB P65,chloride channel 2 and 3 (CLC-2 and CLC-3) were determined by RT-PCR and Western blotting.Results After 4 weeks of antihypertensive NO.1 treatment,SHR carotid artery blood pressure was (182.8 ± 7.3)mmHg in low dose group,(170.3±9.4) mmHg in medium dose group,and (163.9±10.6) mmHg in high dose group; and (205.4 ± 11.3)mmHg in the model group.Antihypertensive drug NO.1 significantly reduced blood pressure in spontaneously hypertensive rats,and had a concentrationresponse relationship (P＜0.05).Antihypertensive drug NO.1 decreased the expressions of Bax,CLC-2 and CLC-3,and increased the expressions of Bcl-2 and NF-κB P65.Conclusions Antihypertensive drug NO.1 plays a protective role in hypertension-induced cell injury by changing the metabolic enhancement in hypertension-induced cell volume decrease.

Objective: To introduce our experience on treatment of melanoma metastasis to lymph nodes by percutaneous radiofrequency ablation combined with microwave coagulation therapy under contrast-enhanced ultrasound guidance and to assess the subsequent clinical efficacy. Methods: The 64 years old male patient with right sole melanoma had an enlarged right inguinal lymph node and received surgical resection twice within 9 months. During the following 2-7 months, more than 20 enlarged lymph nodes appeared along the right iliac artery and right lower limb, complicated with lower limb swelling. Surgical resection was ruled out due to the involvement of the iliac artery and the great number of the enlargements. Chemotherapy and Chinese herb medication were proven to be less effective, then a combined thermotherapy by radio frequency ablation (CelonLab-ENT, Germany) and microwave coagulation (YWY-2T, China) was employed percutaneously under the guidance of contrast-enhanced ultrasound for the treatment. The patient was followed up for 6 months. Results: Intra- and post-operation contras-enhanced ultrasound scanning and biopsy pathology showed avascularity, necrosis, and atrophy in all the treated lymph nodes, with no obvious complications. The general condition of the patient was good and there was no new lesion found in other sites, except a few ones still receiving ablation in the right lower limb. Conclusion: Percutaneous radiofrequency ablation combined with microwave coagulation therapy under the guidance of contrast-enhanced ultrasound shows a stable killing effect for melanoma metastasis to lymph nodes in this patient, without obvious complications, and should be considered for more clinical applications.

Objective: To investigate the safety and efficacy of percutaneous microwave ablation (PMWA) for huge liver cavernous hemangiomas(LCHs), and to assess the potential advantages of extracting blood from the hemangioma during the ablation procedures. Methods: A water-cooled microwave antenna named KY-2100 compatible with a frequency of 2,450 MHz generator was used to perform heating ablation in 19 patients for their LCHs guided by contrast-enhanced ultrasound under general anesthesia; the patients had multiple LCHs, at least with one having a diameter longer than 6 cm. Twenty lesions matched in their maximal size in 10 patients were ablated assisted with or without extracting blood from the hemangiomas. The relevant factors for the safety and ablation duration, thoroughness of ablation, and complications were comprehensively assessed. Results: The ablation durations varied from 39 to 163 min in the 19 patients, with an average of (93±39.85) min. For those maximum-length matched lesions, blood extraction significantly shortened the ablation duration compared to non-blood extraction group ([29.61±14.07] min vs [41.57±14.93] min, P<0.05). Except for slight elevation of serum ALT level ([133.58±46. 29] U/L) in 75% patients, there were no other complications such as intra-peritoneal bleeding, bile leakage, or hemoglobinemia. The average hospital stay was (4±0.95) days. All the ablated LCHs shrank markedly, with the maximal diameter decreased by 82.54%. The hemangioma-induced symptoms were relieved in all patients. Conclusion: PMWA is technically feasible, safe and effective for treating LCHs. It can be an attractive alternative for surgical resection of hemangiomas at high-risk locations. And prompt extraction of focal blood can reduce the bleeding risk and shorten ablation duration.

Objective: To assess the diagnostic value of oral SonoVue in contrast-enhanced ultrasound examination of stomach, so as to pave a way for future clinical research and application. Methods: Four patients with pathologically-confirmed advanced gastric cancer underwent contrast-enhanced ultrasound examination of stomach using the following 3 contrast strategies: oral intake of Chinese herb solution, oral intake of SonoVue solution and intravenous injection of SonoVue. The 3 sonograms of each patient were reviewed, in a blind manner, by 9 ultrasound specialists taking into consideration of the following 6 indications: the clearness of tumor on the gastric internal surface, the appearance of tumor ulceration, the appearance of tumor intrusion, width of tumor infiltration, depth of tumor infiltration, and gastric obstruction severity. The findings were statistically analyzed and the diagnostic value of oral SonoVue for gastric diseases was assessed. Results: Oral intake of SonoVue solution obtained the best sonogram among the 3 contrast strategies. The inter-observers variability was minimal for sonograms of patients in oral SonoVue group considering the first 3 and the last indications mentioned above; the variability was minimal for sonograms of patients who received intravenous injection of SonoVue considering metastasis degree and infiltration depth. Conclusion: Oral gastric contrast-enhanced ultrasound examination using oral SonoVue is stable in demonstrating gastric cancer. The quality of sonograms using oral SonoVue is better than that using oral Chinese herbs.

Objective: To summarize the ultrasound features of renal arteriovenous fistula (RAVF) under various ultrasound imaging modes, so as to avoid missed diagnosis of RAVF on initial ultrasound examination. Methods: The clinical data of 6 patients with RAVF, including the ultrasound evidence, the timing of ultrasound diagnosis, the modes of ultrasound diagnosis, and the agreement between ultrasound diagnosis and selective renal arterial angiography, were retrospectively analyzed. Results: 2D ultrasound had 1 case of correct diagnosis, 1 case of misdiagnosis and 4 cases of missed diagnosis. Color Doppler and spectral Doppler both had all the 6 cases correctly diagnosed. Ultrasound angiography in 3 cases demonstrated that the contrast agent reached the renal veins earlier than reached the renal parenchyma; large fistula lumen was associated with ischemia of downstream areas. 3D ultrasound vividly reflected the structure of fistula lumen volume, and provided us with the profiles of blood signal in fistula at different planes and angles, improving our knowledge of blood flow on the fistula. Conclusion: Ultrasound is the first line screening method for RAVF. Color Doppler plays a decisive role in the diagnosis of RAVF and pulsed spectral Doppler plays a synergetic role and contributes to differential diagnosis. Contrast-enhanced ultrasound may help to discover the abnormality of venous circulation and the ischemic parenchyma area due to shunting. 2D ultrasound has a poor diagnostic value and is liable to lead to misdiagnosis and missed diagnosis.

Objective To study the adverse effect of mirror artifacts generated from the specular reflection of trachea wall on microwave ablation (MWA) treatment of thyroid nodules and the causes. Methods Perioperative ultrasound imaging data of 304 patients who received MWA of thyroid nodules in Shanghai International Medical Center from Jan. 2018 to Oct. 2018 were systemically studied. The occurrence rate, sources, acoustic characteristics of the mirror artifacts and the adverse effects of mirror artifacts on MWA were summarized. The factors contributing to specular reflection of trachea were analyzed. Results A total of 169 cases (55.59%) presented tracheal mirror reflection artifacts in this study. The sources of mirror artifacts included thyroid nodules (20 cases, 11.83%), injection needle (133 cases, 78.70%), ablation electrode (16 cases, 9.47%), hydro-dissection zone (137 cases, 81.07%), and remote ablated area of thyroid nodule (8 cases, 4.73%). We also found that 88.17% (149/169) of mirror artifacts were during the MWA operative period. Conclusion Mirror artifacts generated from the specular reflection of trachea wall are commonly seen in the perioperative period of thyroid nodule MWA. Lesion close to the trachea, flattened tracheal wall, and flat interface linearity larger than the real source dimension are the important causes of mirror artifacts. Direct compression on the tracheal wall caused by thyroid nodules, ablated areas and hydro-dissection zone are the main causes of flattened tracheal wall.

Objective:To summarize the ultrasound features of renal arteriovenous fistula(RAVF)under various ultrasound imaging modes,so as to avoid missed diagnosis of RAVF on initial ultrasound examination.Methods:The clinical data of 6 patients with RAVF,including the ultrasound evidence,the timing of ultrasound diagnosis,the modes of ultrasound diagnosis, and the agreement between ultrasound diagnosis and selective renal arterial angiography,were retrospectively analyzed.Results: 2D ultrasound had 1 case of correct diagnosis,1 case of misdiagnosis and 4 cases of missed diagnosis.Color Doppler and spectral Doppler both had all the 6 cases correctly diagnosed.Ultrasound angiography in 3 cases demonstrated that the contrast agent reached the renal veins earlier than reached the renal parenchyma;large fistula lumen was associated with ischemia of downstream areas.3D ultrasound vividly reflected the structure of fistula lumen volume,and provided us with the profiles of blood signal in fistula at different planes and angles,improving our knowledge of blood flow on the fistula.Conclusion: Ultrasound is the first line screening method for RAVF.Color Doppler plays a decisive role in the diagnosis of RAVF and pulsed spectral Doppler plays a synergetic role and contributes to differential diagnosis.Contrast-enhanced ultrasound may help to discover the abnormality of venous circulation and the ischemic parenehyma area due to shunting.2D ultrasound has a poor diagnostic value and is liable to lead to misdiagnosis and missed diagnosis.

Objective To explore in vitro effects and the mechanism for FLAG regimen compared with IA regimen in P-glycoprotein-positive and -negative acute myeloblastic leukemia(AML) cell lines. Methods The expression of P-glycoprotein in K562 and K562/A02 cells were analyzed by flow cytometry. The effects of FLAG and IA on the proliferation of K562 and K562/A02 cells were detected by MTT assay. The Ara-CTP and Ara-C levels in those cells were measured by HPLC,the gene expression of hENT1 in K562 and K562/A02 cells was detected by real-time PCR. Results The positive rates of P- glycoprotein were (1.32±0.24)% in K562 cell and (97.66±3.77)% in K562/A02 cell, respectively. The expression of P- glycoprotein had no change after treated with FLAG or IA. The cytotoxicity to K562 of IA was better than FLAG [(84.41±9.33) % v.s (73.17±13.20)%, P<0.05], and the cytotoxicity to K562/A02 of FLAG was better than IA [(70.55±11.32)% v.s (48.46±12.81)%, P<0.01]. Ara-C and Ara-CTP accumulation and hENT1 expression in AML cells treated with FLAG were higher than that treated with IA. Conclusion P-glycoprotein-positive AML cells are more sensitive to FLAG regimen than IA regimen. The biochemical modulation of Ara-CTP and Ara-C may be the major mechanism.

Objective: To evaluate the perfusion defect of superficial lesions by high-frequency contrast-enhanced ultrasound through comparing the results of low-frequency and high-frequency contrast-enhanced ultrasound, and to put forward the preliminary countermeasures. Methods: Twenty-three patients (9 male and 14 female, aged 45.87 ± 9.32 years, ranging 34-73 years) with 6 sorts of superficial lesions, including 1 parotid pleomorphic adenoma, 3 thyroid adenomas, 5 thyroid adenocarcinomas, 5 cervical metastases, 7 breast carcinomas and 2 of testicular seminomas, were examined by both low-frequency and high-frequency contrast-enhanced ultrasounds. CEUS with SonoVue under CPS-Cadence mode was performed for each lesion using abdominal probe (low-frequency probe) 5 min before small parts probe (high-frequency probe). ACQ software was used to determine the peak intensity (PI) and the results were analyzed by Student's t test in pairs. Results: The PI values of all the 6 types of lesions were significantly lower in high-frequency contrast-enhanced ultrasound images than those in the low-frequency contrast-enhanced ultrasound images (P<0.001). Conclusion: The micro-vascular enhancement of superficial lesions by high-frequency CEUS might be lower than the real enhancement intensity. Abdominal low-frequency probe should be recommended for revealing the perfusion status of superficial lesions after high-frequency probe, which is used for observing the morphology and internal structures of superficial lesions.

OBJECTIVETo study the effects of transcutaneous electrical nerve stimulation on multimodal analgesia after total knee arthroplasty.

METHODSSixty patients diagnosed as knee osteoarthritis and suffered unilateral total knee arthroplasty in the department of orthopedics, Zhejiang Traditional Chinese Medicine Hospital from March 2009 to May 2012 were randomly divided into control group and test group, 30 cases in each group. All the patients received celecoxib preoperatively, knee periarticular injection with the drug mixture intraoperatively, and celecoxib and morphine sulfate controlled-release tablets postoperatively. The patients in the test group were also treated with transcutaneous electrical nerve stimulation each day after operation. All the patients started doing functional exercises at 24 h after operation. Postoperative visual analogue scales(VAS), passive and active range of motion of knee joint,and complications were recorded.

RESULTSThe VAS scores of test group during postoperative 24 h to 1 week were 3.39 +/- 0.69, 2.79 +/- 0.51, 2.16 +/- 0.52, and 1.07 +/- 0.57 separately,which were lower than 3.80 +/- 0.86, 3.22 +/- 0.58, 2.53 +/- 0.54 and 1.38 +/- 0.52 in the control group. The passive and active range of knee joint motion in the test group during postoperative 24 h to 2 weeks were (30.67 +/- 3.65) degrees, (39.17 +/- 3.96) degrees, (47.83 +/- 4.86) degrees, (93.67 +/- 7.30) degrees, (107.67 +/- 7.51) degrees and (29.83 +/- 5.33) degrees, (78.33 +/- 8.24) degrees, (95.17 +/- 5.94) degrees respectively,which were higher than (28.67 +/- 3.92) degrees, (36.83 +/- 4.25) degrees, (45.17 +/- 5.17) degrees, (89.83 +/- 7.25) degrees, (103.17 +/- 7.37) degrees and (24.17 +/- 10.26) degrees, (73.83 +/- 9.07) degrees, (91.33 +/- 7.42) degrees in the control group. In the test group, 19 patients had ring-shaped haemostasis impression to some extent in the skin of knee joint to different degree, and 5 patients had blister formation.

CONCLUSIONIt is meaningful to apply transcutaneous electrical nerve stimulation for treating multimodal analgesia after total knee arthroplasty,which can not only relieve patients' postoperative pain, and also promote the rehabilitation of knee function as far as possible.

Aged ; Aged, 80 and over ; Analgesia ; Arthroplasty, Replacement, Knee ; adverse effects ; Female ; Humans ; Knee Joint ; surgery ; Male ; Middle Aged ; Pain, Postoperative ; etiology ; therapy ; Transcutaneous Electric Nerve Stimulation ; Treatment Outcome