OBJECTIVE: To assess segmental liver stiffness (LS) with MRI before and after endovascular intervention in patients with Budd-Chiari syndrome (BCS). MATERIALS AND METHODS: Twenty-three patients (13 males and 10 females; mean age, 42.6 ± 12.6 years; age range, 31–56 years) with BCS as a primary liver disease were recruited for this study. Two consecutive magnetic resonance elastography (MRE) examinations were performed before the endovascular treatment. Fifteen patients who underwent endovascular intervention treatment also had follow-up MRE scans within three days after the procedure. LS was measured in three liver segments: the right posterior, right anterior, and left medial segments. Inter-reader and inter-exam repeatability were analyzed with intraclass correlation coefficients (ICCs) and Bland-Altman analysis. Segmental LS and clinical characteristics before and after the intervention were also compared. RESULTS: Within three days of the endovascular intervention, all three segmental LS values decreased: LS of the right posterior segment = 7.23 ± 0.88 kPa (before) vs. 4.94 ± 0.84 kPa (after), LS of the right anterior segment = 7.30 ± 1.06 kPa (before) vs. 4.77 ± 0.85 kPa (after), and LS of the left medial segment = 7.22 ± 0.87 kPa (before) vs. 4.87 ± 0.72 kPa (after) (all p = 0.001). There was a significant correlation between LS changes and venous pressure gradient changes before and after treatments (r = 0.651, p = 0.009). The clinical manifestations of all 15 patients significantly improved after therapy. The MRE repeatability was excellent, with insignificant variations (inter-reader, ICC = 0.839–0.943: inter-examination, ICC = 0.765–0.869). Bland-Altman analysis confirmed excellent agreement (limits of agreement, 13.4–19.4%). CONCLUSION: Segmental LS measured by MRE is a promising repeatable quantitative biomarker for monitoring the treatment response to minimally invasive endovascular intervention in patients with BCS.
Budd-Chiari Syndrome ; Elasticity Imaging Techniques ; Female ; Follow-Up Studies ; Humans ; Liver Diseases ; Liver ; Magnetic Resonance Imaging ; Male ; Venous Pressure

Objective:To explore the diagnostic value of ultrasonography for injuries of anterior talofibular ligament(ATFL)and anterior inferior tibiofibular ligament distal fascicle(ATiFL-DF)in patients with ankle fractures.Methods:Clinical data of 51 patients with ankle fractures who were clinically suspected of ligament injuries and underwent ankle ultrasonography examination and arthroscopy in Sir Run Run Shaw Hospital,Zhejiang University School of Medicine from April 2019 to March 2023 were retrospectively analyzed.Using arthroscopic results as the gold standard,the sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)of ultrasonography in diagnosing ATFL and ATiFL-DF injuries were evaluated,and Kappa consistency test was performed.Results:The sensitivity and specificity of ultrasonography in diagnosis of ATFL injury were 100.0%and 92.3%,with the PPV of 92.6%and NPV of 100.0%.Ultrasonography findings exhibited excellent concordance with arthroscopic results(kappa=0.849).The sensitivity and specificity of ultrasonography in diagnosis of ATiFL-DF injury was 86.7%and 33.3%,with the PPV of 90.7%and NPV of 25.0%.However,the consistency between ultrasonography and arthroscopic results was poor(kappa=0.168).Conclusions:Ultrasonography is reliable in assessing injuries of ATFL in patients with ankle fractures,but its specificity in diagnosing ATiFL-DF is poor.Therefore,ankle arthroscopy remains necessary for ankle fracture patients with negative findings of ATiFL-DF in ultrasonography.

Objective To investigate the effect of promoting natural delivery by implementing the systemic exercise and diet intervention for obstetric VIP primiparas during the middle and late pregnancy period . Methods From January 2011 to March 2012 , 97 primiparas were chosen as the intervention group in obstetric VIP clinic;at the same time, 274 cases of pregnant women were chosen as the control group from the general antenatal clinic of the hospital .Neither of the two groups of pregnant women had movement contraindication , and they all voluntarily made the decision for vaginal delivery .Pregnant women in the control group only accepted the general out-patient routine prenatal check-up and health guidance;while the pregnant women in the intervention group received the VIP systemic exercise and diet guidance in addition to the outpatient routine prenatal check-up and health guidance .The fetal presentation height before delivery , the degree of cervical dilation, the time of birth process, the amount of postpartum bleeding and the mode of delivery were compared within the two groups.Results The natural birth rate in the intervention group was 70.1%significantly higher than that of 35.8%in control group (χ2 =32.788, P<0.01).The descending level of fetal presentation in the intervention group was ( -0.65 ±1.15) cm, which was significantly lower than ( -1.12 ±1.10) cm in the control group (t=2.65, P<0.01).The total labor time and the first stage of labor time were (369.10 ± 166.82)min and (334.72 ±165.69) min, respectively, which were significantly shorter than (439.48 ± 177.93)min and (403.06 ±174.67)min in the control group (t=-2.57, -2.53;P<0.05).The weight of pregnant women before delivery and that of the neonates were (74.70 ±4.80) kg and (3 489.00 ±66.89) g, respectively, in the intervention group, and were (77.80 ±4.70)kg and (3 680.00 ±54.62)g, respectively, in the control group.The differences were significant (t=1.83, 1.12; P<0.05).Conclusions The VIP clinic provides the pregnant women with systemic exercise intervention and nutritional diet guidance , which result in decreasing the cesarean section rate , increasing the natural delivery rate , effectively shortening the time of labor process and reducing the amount of intrapartum bleeding .

Objective To investigate the clinical value of contrast?enhanced ultrasonography ( CEUS ) in assessing the high?risk population of hepatic malignant tumor ( HMT ) . Methods Three hundred patients with high?risk of HMT were enrolled and examined by CEUS. The clinical data of these patients were collected. A comparative analysis was performed to assess the ability of CEUS for detecting and characterizing lesions in the liver. Kappa test was used for assessing the intra?and inter?observer reliability of CEUS. Results In 87 enrolled patients with 119 malignant lesions detected by contrast?enhanced MRI, 112 lesions were detected by CEUS and 95 lesions were detected by unenhanced ultrasonography ( US ) . The detection rate of CEUS for HMT was significant higher than that of US (94.1% vs. 79.8%;P<0.01). More HMT lesions were detected by CEUS than by US in 17.2% patients. One hundred and seventy?seven patients with 215 lesions were confirmed by pathological diagnosis or long?time follow?up. There were 118 malignant and 97 benign lesions. The accuracy of CEUS for differential diagnosis of the liver lesions was 91.6% (197/215), significantly higher than that by US (59.1%, 127/215) (P<0.01). CEUS improved the accuracy for 35.0% ( 62/177) patients. For 96 patients with 105 lesions detected for the first time, the agreement of diagnosis by CEUS was 92.4% (97/105). The reliability of CEUS was high (Kappainter=0.866; Kappaintra=0.934) . Conclusions CEUS improves the detection rate and diagnostic accuracy rate of the HMT high?risk population, with a high agreement for diagnosing the new lesions. CEUS may be considered as a first?line method to assess the high?risk population of HMT conveniently, accurately and reliably.

Objective To investigate the clinical value of contrast?enhanced ultrasonography ( CEUS ) in assessing the high?risk population of hepatic malignant tumor ( HMT ) . Methods Three hundred patients with high?risk of HMT were enrolled and examined by CEUS. The clinical data of these patients were collected. A comparative analysis was performed to assess the ability of CEUS for detecting and characterizing lesions in the liver. Kappa test was used for assessing the intra?and inter?observer reliability of CEUS. Results In 87 enrolled patients with 119 malignant lesions detected by contrast?enhanced MRI, 112 lesions were detected by CEUS and 95 lesions were detected by unenhanced ultrasonography ( US ) . The detection rate of CEUS for HMT was significant higher than that of US (94.1% vs. 79.8%;P<0.01). More HMT lesions were detected by CEUS than by US in 17.2% patients. One hundred and seventy?seven patients with 215 lesions were confirmed by pathological diagnosis or long?time follow?up. There were 118 malignant and 97 benign lesions. The accuracy of CEUS for differential diagnosis of the liver lesions was 91.6% (197/215), significantly higher than that by US (59.1%, 127/215) (P<0.01). CEUS improved the accuracy for 35.0% ( 62/177) patients. For 96 patients with 105 lesions detected for the first time, the agreement of diagnosis by CEUS was 92.4% (97/105). The reliability of CEUS was high (Kappainter=0.866; Kappaintra=0.934) . Conclusions CEUS improves the detection rate and diagnostic accuracy rate of the HMT high?risk population, with a high agreement for diagnosing the new lesions. CEUS may be considered as a first?line method to assess the high?risk population of HMT conveniently, accurately and reliably.

OBJECTIVETo construct an eukaryotic expression plasmid for AY358935 gene and explore its function.

METHODScDNA of the AY358935 gene was amplified by reverse transcription-PCR and cloned into pGEM-Teasy. The pGEM-T-AY was validated by sequencing and served as a template for the construction of eukaryotic expression plasmid. The pcDNA3.1-AY recombinant was validated by double enzyme digestion and used for transient transfection of M14 cells. Expression of the AY358935 protein and proliferation of the M14 cells were determined respectively by Western blotting and 3-(4,5)-dimethylthiahiazo(-z-y1)-3,5-di-phenytetrazoliumromide (MTT) colorimetry.

RESULTSThe amplicons of RT-PCR were confirmed to have similar size with the cDNA fragment of the AY358935 gene as well as cloned region of pcDNA3.1-AY. The cloned region of pGEM-T-AY was sequenced to be identical with cDNA sequence of the AY358935 gene. M14 cells were transfected by the AY358935 gene, pcDNA3.1 and liposomes, respectively. After 48 h, expression of the AY358935 protein in M14 cells transfected with the AY358935 gene was significantly higher than other two groups. They also had a significantly higher absorbance value (A=0.74) than other two groups (A=0.39 and 0.46, respectively; P<0.05).

CONCLUSIONAn eukaryotic expression plasmid of the AY358935 gene was successfully constructed. Product of the AY358935 gene may promote the proliferation of M14 cells.

Objective To explore the value of pelvic CT angiography(CTA)digital three-dimensional reconstruction model(abbreviated as"three-dimensional model")in the diagnosis of female pelvic mass.Methods A total of 98 patients with pelvic mass who were hospitalized and operated in Xi'an People's Hos-pital(Xi'an Fourth Hospital)from January 2021 to April 2023 were selected.All patients underwent B-ultra-sound and CTA examination before operation,and the original data of CTA were collected.The digital three-dimensional model of pelvic mass was established by three-dimensional reconstruction software,and the source of pelvic mass was judged according to the blood supply of pelvic mass.Taking postoperative pathological di-agnosis as the gold standard,the coincidence rate between different preoperative diagnosis methods(B-ultra-sound,CTA examination and three-dimensional model)was compared.The receiver operating characteristic(ROC)curve was plotted to evaluate the efficacy of different preoperative diagnostic methods in judging the ovarian origin of pelvic tumors.Results A total of 130 pelvic masses were included in 98 patients,and the average maximum diameter of the mass was(71.61±3.03)mm,including 83 ovarian masses and 47 non-ovarian masses.Taking postoperative pathological diagnosis as the gold standard,the diagnostic coincidence rate of the preoperative three-dimensional model was 72.31％,which was higher than that of B-ultrasound(58.46％)and CTA(52.31％),and the differences were statistically significant(P＜0.001).The sensitivity,specificity,positive predictive value,negative predictive value,accuracy,Kappa value,and area under the ROC curve were 79.51％,91.49％,94.29％,71.67％,83.85％,0.67 and 0.855,respectively,when the three-dimensional model showed that the blood supply of the mass originated from ovarian artery or uterine artery-ovarian branch.Conclusion The three-dimensional model of pelvic CTA can directly display the blood supply source,characteristics of mass,and the relationship between mass and adjacent organs,which can guide the clinical treatment.It has certain clinical value to judge the ovarian origin of pelvic mass by using ovarian artery and uterine artery-ovarian branch.

Objective:To investigate the effects of low-frequency and high frequency repetitive transcranial magnetic stimulation (rTMS) combined with levodopa and benserazide hydrochloride on mild cognitive impairment in patients with Parkinson disease (PD).Methods:Totally 90 PD patients with mild cognitive impairment who visited from January 2020 to June 2022 were included , and they were divided into a simple drug group ( n=30), drug+ low-frequency group ( n=30), and drug+ high-frequency group ( n=30) according to the order of admission.The patients in the simple drug group were treated with oral levodopa and benserazide hydrochloride, while the patients in drug+ low-frequency and drug+ high-frequency groups were treated with low-frequency or high-frequency rTMS on the basis of oral levodopa and benserazide hydrochloride.Montreal cognitive assessment(MoCA), digital span (DS), Chinese auditory learning test (CALT), the judgment of line orientation test (JLOT) and verbal fluency test (VFT) were used to evaluate the cognitive function of patients before and after 4 weeks of treatment.SPSS 26.0 was used for statistical analysis.The paired t-test was used for intra-group comparison before and after treatment, while one-way ANOVA was used for inter-group comparison. Results:There were no significant differences in MoCA, DS anterograde, DS backward, CALT immediate recall, CALT delayed recall, JLOT, and VFT scores among patients in the simple drug group before and after 4 weeks of treatment( t=-1.157, -0.648, -0.215, -0.290, -0.154, -0.782, -0.960, all P>0.05). After 4 weeks of treatment, MoCA, DS anterograde, DS backward, CALT immediate recall, CALT delayed recall, JLOT and VFT scores in drug+ low-frequency group and drug+ high-frequency group were higher than before treatment (drug+ low frequency group: t=-16.357, -11.379, -7.999, -11.805, -16.624, -15.996, -17.241, all P<0.05; drug+ high-frequency group: t=-25.198, -13.971, -13.904, -25.831, -26.382, -20.108, -15.643, all P<0.05). There were no statistically significant differences in the scores of MoCA, DS anterograde, DS backward, CALT immediate recall, CALT delayed recall, JLOT and VFT among the three groups before treatment (all P>0.05). After treatment, there were statistically significant differences in the scores of MoCA, DS anterograde, DS backward, CALT immediate recall, CALT delayed recall, JLOT and VFT among the three groups (simple drug group : (20.37±1.96), (4.37±1.19), (2.80±0.55), (6.93±1.70), (5.17±1.09), (15.50±2.69), (10.73±1.55); drug+ low-frequency group: (23.83±2.32), (5.87±0.94), (3.87±0.73), (9.17±1.74), (8.13±1.50), (20.77±2.19), (13.30±1.73); drug+ high-frequency group: (27.17±1.64), (6.73±1.01), (4.80±0.81), (11.20±2.06), (10.03±1.54), (25.17±3.14), (15.87±2.05)) (all P<0.05). Further analysis showed that both the drug+ low-frequency and drug+ high-frequency groups had higher scores than the simple drug group, and the drug+ high-frequency group had higher scores than the drug+ low-frequency group(all P<0.05). Conclusion:The combination of drug+ low-frequency or drug+ high-frequency rTMS and drug therapy can help improve cognitive function in patients with PD, and the efficacy of drug+ high-frequency rTMS may be more significant, which provides a new therapeutic idea for clinical treatment of patients with PD.

【Objective】 To retrospectively analyze the detection results of blood donors with HBsAg reactivity to single reagent detected by enzyme-linked immunosorbent assay (ELISA) in our center, so as to provide basis for further consolidating the blood donor team. 【Methods】 Samples of blood donors who had been deferred for at least 6 months due to HBsAg reactivity to sole ELISA assay were collected, and HBsAg ELISA and NAT were further performed. Meanwhile, HBsAg/HBsAb/HBeAg/HBeAb/HBcAb were detected by Roche electrochemiluminescence immunoassay, and the results were statistically analyzed. 【Results】 Among these 51 selected samples, 45 were negative to two assays, 6 were reactive to sole assay, with reactivity-yield rate at 11.76% (6/51). The results of NAT/ECLIA were all negative. For five indicators of hepatitis B virus infection, 23 samples were all negative and 28 were partially positive, mainly anti-HBs, anti-HBc and anti-HBe. 【Conclusion】 The follow-up detection of HBsAg ELISA sole-reagent reactive samples, supplemented with the detection of HBV serological markers, can reduce the number of deferred blood donors, increase the willingness to donate blood again, and protect the rights and interests of blood donors.

OBJECTIVE: To assess the application of probe-based confocal laser endomicroscopy (pCLE) in diagnosis of gastric carcinoma and precancerous lesions. METHODS: Patients underwent pCLE in the First Affiliated Hospital of Zhejiang University School of Medicine during December 2013 and November 2014 and in the First Affiliated Hospital of Zhejiang Chinese Medical University during January 2014 and December 2017 were enrolled. The consistency between pCLE diagnosis and pathological diagnosis of gastric lesions, including atrophic gastritis, gastric intestinal metaplasia, low-grade intraepithelial neoplasia and high-grade intraepithelial neoplasia (including gastric carcinoma) was analyzed. RESULTS: Totally 154 gastric lesions from 119 patients were detected by pCLE. Using pathological diagnosis as gold standard, the sensitivity, specificity, coincidence rate and κ value of pCLE diagnosis for atrophic gastritis were 94.34%, 91.09%, 92.21%and 0.83; those indicators for gastric intestinal metaplasia were 84.47%, 92.16%, 87.01% and 0.72. The coincidence rate and κ value of pCLE diagnosis of complete gastric intestinal metaplasia were 0.75 and 0.49; for incomplete gastric intestinal metaplasia were 0.79 and 0.48, respectively. The sensitivity, specificity, coincidence rate and κ value of pCLE diagnosis for low-grade intraepithelial neoplasia were 85.29%, 87.50%, 87.01%and 0.66; those for high-grade intraepithelial neoplasia (including gastric carcinoma) were 95.83%, 97.17%, 96.75%and 0.92. CONCLUSIONS pCLE can be used for diagnosis of gastric carcinoma and pericancerous lesions and also for typing of gastric intestinal metaplasia.
Carcinoma ; diagnostic imaging ; Endoscopy, Gastrointestinal ; Humans ; Metaplasia ; Microscopy, Confocal ; Precancerous Conditions ; diagnostic imaging ; Sensitivity and Specificity ; Stomach ; diagnostic imaging ; pathology ; Stomach Neoplasms ; diagnostic imaging