Objective To explore the clinical value of shear wave elastic imaging(SWE)for renal cortical elasticity in patients with hypertension.Methods According to the diagnostic criteria of 2020 International Society of Hypertension(ISH)Global Hypertension Practice Guidelines,44 patients with simple hypertension admitted to the Department of Cardiology of our hospital were selected and 46 healthy controls were selected for the same period.The general data and and renal function indicators of blood biochemical were recorded.All subjects were examined by two-dimensional ultrasound and SWE elasticity to obtain the conventional ultrasound parameters and the Young's modulus(YM)value of the right.The above parameters between the two groups were compared.The influence factors were analyzed by multiple linear regression among the YM value of the right renal cortex,the general data,conventional ultrasound indicators and renal function indicators in the simple hypertension group.Results The course,systolic blood pressure(SBP)and diastolic blood pressure(DBP)in the simple hypertension group was higher than those in the control group,and the difference was statistically significant(P＜0.05).The YM value of the right renal cortex in the simple hypertension group was higher than that in the control group,and the difference was statistically significant(P＜0.05).The correlation analysis showed that the YM value of the right renal cortex was positively correlated with the duration of hypertension(P＜0.05),but not with age,blood pressure,right renal volume,right renal cortex thickness,right renal artery trunk peak systolic flow velocity(PSV),right renal artery trunk resistance index(RI),blood urea nitrogen,blood creatinine,or uric acid(P＞0.05).Further simple linear regression analysis showed that the duration of hypertension was an independent factor affecting the YM value of the right renal cortex.Conclusion SWE may be used to find the variation in elasticity of renal cortex in patients with simple hypertension.

Objective To compare the distribution of femoral osseous tunnels between using the em-pirical and fluoroscopic methods during anatomical reconstruction surgery for anterior cruciate ligament(ACL)rupture.Methods Between July 2019 and June 2022,46 patients who underwent arthroscopic ACL single-bundle anatomical reconstruction in our department were enrolled,including 34 males and 12 females,with 27 left and 19 right affected knees and a mean age of 31.8±4.9 years.The initial positioning of the femoral tunnel was based on the operator's experience,and later adjusted using the fluoroscopy.A rectangular box was drawn on the lateral view of the femoral tunnel,and the position of the tunnel was determined according to the proportion of the center of the tunnel in the deep-shal-low and the high-low directions.Then,the distribution of the femoral tunnel position in each direction and the degree of good positioning were compared between the initial and fluoroscopic localizations.Re-sults In the initial localization,in the x-axis direction,7 were too left,29 were correct and 10 were too right,with the corresponding number being 4,36 and 6 using the fluoroscopic localization.More-over,in the y-axis direction,30 and 3 cases were too high or too lower,with 14 norms using em-pirical method,while the numbers were 19,0 and 27 using the fluoroscopic positioning.The femoral tunnel was well-positioned in 11 cases(24%)at the time of initial positioning,and in 25 cases(54%)after fluoroscopic positioning adjustment.Conclusion The use of intraoperative fluoroscopy helps to im-prove the dispersion of the femoral osseous tunnel position in ACL single-bundle anatomical reconstruc-tion surgery.

Objective To observe the distribution of bone tunnel positions in anterior cruciate liga-ment(ACL) anatomic reconstruction surgery using the bony landmark method and the measuring meth-od for femoral positioning,respectively,so as to explore better positioning methods for ACL on the femoral side.Methods The data of 90 patients who underwent arthroscopic ACL single-bundle anatomi-cal reconstruction surgery in our department between October 2016 and July 2021 were analyzed retro-spectively.Patients with the femoral tunnel localized according to the resident's ridge and the bifur-cate ridge were selected into the bony landmark group(n=34),including 26 males and 8 females(19 left knees,15 right knees,and aged 30.8±4.6 years) while those with the femoral tunnel localized using ruler measurements were chosen into the measuring method group(n=56),consisting of 42 males and 14 females(32 left knees and 24 right knees,aged 31.7±5.3).A rectangular frame was drawn on the three-dimensional CT lateral view of the femur,and the bone canal position was located accord-ing to the proportion of the bone canal center point in the deep-shallow direction and the high-low di-rection of the rectangle frame.The distribution of the position in each direction and the degree of the tunnel position were compared between the two groups.Results In the deep-shallow direction in femo-ral epicondyle,4,23 and 7 of the bony landmark method group were of the posterior,normal and an-terior position,showing significant differences from those of the measuring method group(7,47 and 2).Moreover,significant differences were also observed in the number of patients with high/normal/low positions in the high-low direction,which was 22/11/1 in the bony landmark method group and 6/48/2 in the measuring method group(P<0.01).Meanwhile,the percentage of good bone tunnel positioning in the bony landmark method group was 26.5％,significantly lower than the measuring method group of 80.4％(P<0.01).Conclusion In anatomical reconstruction of the ACL,the measuring method is superi-or to the bony landmark method in the femoral tunnel positioning.

Objective To observe the distribution of bone tunnel positions in anterior cruciate liga-ment(ACL) anatomic reconstruction surgery using the bony landmark method and the measuring meth-od for femoral positioning,respectively,so as to explore better positioning methods for ACL on the femoral side.Methods The data of 90 patients who underwent arthroscopic ACL single-bundle anatomi-cal reconstruction surgery in our department between October 2016 and July 2021 were analyzed retro-spectively.Patients with the femoral tunnel localized according to the resident's ridge and the bifur-cate ridge were selected into the bony landmark group(n=34),including 26 males and 8 females(19 left knees,15 right knees,and aged 30.8±4.6 years) while those with the femoral tunnel localized using ruler measurements were chosen into the measuring method group(n=56),consisting of 42 males and 14 females(32 left knees and 24 right knees,aged 31.7±5.3).A rectangular frame was drawn on the three-dimensional CT lateral view of the femur,and the bone canal position was located accord-ing to the proportion of the bone canal center point in the deep-shallow direction and the high-low di-rection of the rectangle frame.The distribution of the position in each direction and the degree of the tunnel position were compared between the two groups.Results In the deep-shallow direction in femo-ral epicondyle,4,23 and 7 of the bony landmark method group were of the posterior,normal and an-terior position,showing significant differences from those of the measuring method group(7,47 and 2).Moreover,significant differences were also observed in the number of patients with high/normal/low positions in the high-low direction,which was 22/11/1 in the bony landmark method group and 6/48/2 in the measuring method group(P<0.01).Meanwhile,the percentage of good bone tunnel positioning in the bony landmark method group was 26.5％,significantly lower than the measuring method group of 80.4％(P<0.01).Conclusion In anatomical reconstruction of the ACL,the measuring method is superi-or to the bony landmark method in the femoral tunnel positioning.

Objective:To investigate the clinical efficacy of three-dimensional speckle tracking imaging in the dynamic evaluation of left ventricular systolic function in patients with pregnancy-induced hypertension.Methods:50 patients with pregnancy-induced hypertension, who received prenatal examination in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from July 2019 to June 2020 and finally gave birth, were included in the observation group. An additional 50 healthy pregnant women who concurrently received prenatal examination were included as controls. All participants underwent routine echocardiography and three-dimensional speckle tracking imaging examinations. Parameters related to left ventricular systolic function were recorded. Routine echocardiography parameters and three-dimensional speckle tracking imaging parameters were compared between the observation and control groups.Results:There were no significant differences in routine echocardiography parameters (including heart rate, left ventricular end-diastolic diameter, interventricular septum thickness in end-diastole, left ventricular posterior wall thickness in diastole, and left ventricular ejection fraction) between before treatment, after treatment, and 3 months after delivery in the observation group, and between observation and control groups before treatment (all P > 0.05). The absolute values of left ventricular global longitudinal strain (LVGLS) [(-18.41 ± 2.23)% vs. (-26.03 ± 2.79)%], left ventricular global circumferential strain (LVGCS) [(31.29 ± 3.09)% vs. (37.45 ± 3.68)%], left ventricular global radial strain (LVGRS) [(-19.37 ± 2.19)% vs. (-24.59 ± 2.74)%], and left ventricular global area peak systolic strain (LVGAS) [(-26.61 ± 3.18)% vs. (-39.23 ± 3.96)%] measured before treatment were significantly lower in the observation group than in the control group ( t = 6.31 -14.87, all P < 0.05). The absolute values of LVGLS, LVGCS, LVGRS, and LVGAS in the observation group were significantly higher after treatment [(-24.79 ± 2.68)%, (35.94 ± 3.25)%, (-22.48 ± 2.41)%, (-37.54 ± 3.38)%] and 3 months after delivery [(-25.64 ± 2.72)%, (36.63 ± 3.47)%, (-23.91 ± 2.69)%, (-38.49 ± 3.64)%] than before treatment ( t = 4.08 - 10.59, P < 0.05). There were no significant differences in LVGLS, LVGCS, LVGRS, and LVGAS between observation group and control groups at each time point studied ( t = 0.47 - 1.19, P = 0.182 - 0.652 > 0.05). The absolute svalues of LVGLS, LVGCS, LVGRS and LVGAS in patients with pregnancy-induced hypertension were positively correlated with left ventricular ejection fraction values ( r = 0.638 - 0.775, P = 0.009 - 0.041 < 0.05). Conclusion:Three-dimensional speckle tracking imaging can be used to dynamically evaluate the impairment of left ventricular systolic function in patients with pregnancy-induced hypertension. This technique helps guide early intervention and prognosis evaluation and has a high clinical application value.

Objective:To investigate the value of abdominal ultrasound in the diagnosis of postpartum diastasis of the rectus abdominis muscle (DRA).Methods:A total of 300 pregnant women who received prenatal examination and finally gave birth in Wenzhou Hospital of Integrated traditional Chinese and Western Medicine between October 2018 and October 2020 were included in this study. All of them underwent finger test and high-frequency ultrasound to determine the degree of DRA. The occurrence of DRA was recorded. The efficacy of abdominal high-frequency ultrasound versus finger test in the diagnosis of DRA was analyzed. The high-frequency ultrasound outcomes regarding DRA distance at different positions and at different phases were compared between women with DRA and those without DRA. Results:The overall incidence of DRA among all women included in this study was 57.67% (173/300). The incidence of DRA in multiparae was significantly higher than that in primipara [73.38% (102/139) vs. 44.10% (71/160), χ2 = 26.20, P = 0.001). The incidence of DRA in women subjected to cesarean section was significantly higher than that in women subjected to vaginal delivery [68.52% (74/108) vs. 51.56% (99/192), χ2 = 8.14, P = 0.004). The sensitivity, specificity and accuracy of abdominal ultrasound in the diagnosis of DRA were 99.42%, 98.42% and 99.00%, respectively, which were significantly higher than those of finger test [80.35%,85.04%, 82.33%, χ2 = 34.61, 15.00, 49.23, all P < 0.01]. The DRA distances at different positions measured at 36 weeks of gestation and 2 weeks postpartum were significantly shorter in women with DRA than those without DRA ( t = 5.17-7.46, P < 0.001). Conclusion:Abdominal ultrasound is of high clinical application value in the early diagnosis and rehabilitation treatment of postpartum DRA.

Lateral epicondylitis is a common clinical disease with characteristics of lateral elbow pain, insidious onset and easy recurrence, which can cause forearm pain and decreased wrist strength, seriously affecting patients′ daily life and work. Although there are various treatment methods for lateral epicondylitis with different effects, standard treatments are still lacking nowadays. Platelet-rich plasma (PRP) has good effects on bone and tendon repair, and is now widely used in the treatment of lateral epicondylitis. However, there is a lack of a unified understanding of the technology and specifications of PRP in the treatment of lateral epicondylitis. Therefore, the Sports Medicine Branch of the Chinese Medical Association and Physical Medicine and Rehabilitation Branch of the Chinese Medical Association organized experts in the fields of sports medicine and rehabilitation medicine in China to formulate the "clinical expert consensus on platelet-rich plasma treatment for lateral epicondylitis (2022 version)", and proposed suggestions based on evidence-based medicine mainly from the concept, epidemiology and pathophysiology of lateral epicondylitis, symptoms, signs and imaging manifestations of lateral epicondylitis, PRP concept and application component requirements, quality control of PRP preparation technology, indications and contraindications of PRP in the treatment of lateral epicondylitis, PRP injection in the treatment of lateral epicondylitis, application of PRP in the operation of lateral epicondylitis, related problems after PRP treatment of lateral epicondylitis, evaluation of the results after PRP treatment of lateral epicondylitis, and health and economic evaluation of PRP treatment of lateral epicondylitis, so as to provide guidance for clinical diagnosis and treatment.

OBJECTIVE: To study the correlation between DNA methylation patterns and gene expression in Down syndrome (DS). METHODS: Induced pluripotent stem cells (iPSCs) derived from normal controls and DS patients were subjected to whole genome bisulfite sequencing and differentially methylated region (DMR) screening. Statistical analysis for chromosomal and gene element distribution were carried out for DMR. Gene ontology (GO) and enrichment-based cluster analysis were used to explore the molecular function of differentially expressed genes. RESULTS: A total of 1569 DMR were identified in iPSCs derived from DS patients, for which the proportion of hypermethylation in promoter regions was significantly greater than that of the genebody. No DMR enrichment was noted on chromosome 21. Hypermethylation of the promoter and genebody was predicted to be inhibitory for gene expression. Functional clustering revealed the pathways related to neurodevelopmental, stem cell pluripotency and organ size regulation to be significantly correlated with differentially methylated genes. CONCLUSION Extensive and stochastic anomalies of genome-wide DNA methylation has been discovered in iPSCs derived from DS patients, for which the pattern and molecular regulation of methylation were significantly different from those of normal controls. Above findings suggested that DNA methylation pattern may play a vital role in both the pathogenesis of neurodevelopmental disorders and other phenotypic abnormalities during early embryonic development.
DNA Methylation ; Down Syndrome/genetics* ; Female ; Humans ; Induced Pluripotent Stem Cells ; Pregnancy ; Promoter Regions, Genetic ; Whole Genome Sequencing

Genetic diseases that have shown clinical symptoms in neonatal period are often characterized with atypical symptoms and serious condition, which contributes to difficulties in diagnosis and treatment.With the progress of sequencing technology, the next-generation sequencing technology is gradually applied to the clinical field with its advantages of high throughput, low cost and rapid detection.As one of next-generation sequencing technologies, the whole exome sequencing technology(WES)captures, enriches and sequences the genomic exon regions, and then the large amount of WES data is analyzed by bioinformatics methods and screened to find variant site in gene that causes genetic disease.WES technology has gradually become an important means of diagnosis in neonatal genetic diseases because of its advantages of comprehensive results and short reporting period.

Objective:To observe the clinical effect of two-dimensional speckle tracking technique in diagnosis and prognosis evaluation of heart failure with left ventricular ejection fraction preservation.Methods:A total of 64 heart failure patients with reduced left ventricular ejection fraction (HFNEF) and 64 healthy volunteers in the Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou were selected from July 2016 to July 2018.Conventional echocardiography and two-dimensional speckle tracking were performed in all subjects.The hemodynamic parameters and strain parameters of two-dimensional speckle tracking were recorded.The differences of conventional echocardiographic parameters and two-dimensional speckle tracking strain parameters in different subjects were analyzed.Results:The E/A (0.79±0.24) and E/E' value (18.93±3.41) in HFNEF patients had statistically significant differences compared with healthy subjects [(1.28±0.35) and (6.84±1.37)] ( t=9.507, 23.294; P=0.000, 0.000). There were no statistically significant differences in HR, LAD, LVD, LVSD, LVPWD, LVEF and LVFS between HFNEF patients [(71.37±5.93)times/min, (35.32±4.37)mm, (47.13±5.01)mm, (9.24±1.76)mm, (9.35±1.82)mm, (63.98±5.37)%, (35.49±4.46)%] and healthy subjects [(70.14±5.28)times/min, (37.64±4.69)mm, (49.26±5.54)mm, (9.39±1.82)mm, (9.48±1.90)mm, (66.35±5.41)%, (34.02±4.17)%] ( t=0.384-1.628; P=0.102-0.564). In HFNEF patients, the anterior septum, anterior wall, posterior wall, inferior wall and posterior wall of apical segment of left ventricle, the inferior wall and posterior wall of papillary muscle and the posterior wall, inferior wall and posterior wall of basal segment, SRs and ROT of left ventricle were significantly lower than those of healthy subjects, while GLS (-13.52±4.18) and GCS (-10.43±3.85) of left ventricle in HFNEF patients were significantly higher than those of healthy subjects [(-19.89±4.61) and (-15.67±4.24)] ( t=8.947~14.063; P=0.000-0.000<0.05). After treatment, the clinical symptoms of HFNEF patients improved significantly in the whole apical segment of left ventricle, inferior and posterior wall of papillary muscle segment, posterior lateral wall, inferior wall, posterior wall SRs and left ventricular GLS, GCS and ROT ( t=7.258-13.193; P=0.000-0.000<0.05). Two-dimensional strain GLS and GC values in HFNEF patients were negatively correlated with E/A values and positively correlated with E/E' value ( r=-0.817, -0.763; P=0.004, 0.012<0.05), while two-dimensional strain ROT results were positively correlated with E/A values and negatively correlated with E/E' values ( r=-0.805, -0.759; P=0.006, 0.014<0.05). Conclusion:Left ventricular systolic function damage has occurred in HFNEF patients.Two-dimensional speckle tracking technique is highly sensitive to the changes of myocardial systolic function for HFNEF patients.It has high clinical value in the diagnosis and prognosis evaluation of HFNEF.Relevant clinical workers should pay attention to it.