Objective To investigate the application value of improved intermittent compression strain elastography in im-proving the image stability of breast elastography and the identification ability of benign and malignant nodules.Methods In all,113 patients(138 breast lesions)were recruited in this study,who accepted high frequency color Doppler ultrasound,im-proved intermittent compression strain elastography(IICSE)and nonintermittent compression strain elastography(NCSE)one week ahead of the surgery.By comparing the first three times of IICSE and NCSE,the same elastic result rate was obtained,and the receiver operating characteristic(ROC)curve of IICSE and NCSE elastic score was drawn to identify benign and malignant breast lesions,and the area under the curve(AUC)was calculated,and those with larger AUC area were selected to adjust the classification of BI-RADS.To compare the difference of diagnosis of benign and malignant breast lesions of different BI-RADS classification by high-frequency color ultrasound and high-frequency color ultrasound combined with IICSE,and the difference of the composition ratio of nodules classified by different BI-RADS.Results The consistency rate of elastic results obtained by IICSE was higher than that of NCSE(90.6％vs.34.8％,P＜0.05).ROC curve showed that the area under the curve(AUC)of IICSE was greater than that of NCSE(0.865 vs.0.636,P＜0.05).Comparing the results before and after high-frequency color ultrasound combined with IICSE,the number of BI-RADS type 3 and type 5 nodules increased significantly,while the number of BI-RADS type 4 nodules decreased(both P＜0.05).Conclusion IICSE improves low stability of conventional elastic ima-ging.At the same time,IICSE reduces the number of patients who need further examination,reducing overuse of medical re-sources.

Objective To summarize the sonographic characteristics of high frequency ultrasound and elastography of thyroid microcarcinoma(TMC),and to analyze the causes of misdiagnosis.Methods The preoperative ultrasonic data of 245 suspicious TMCs in 202 patients,as confirmed by operation pathology,were retrospectively analyzed.Results Preoperative ultrasonography accurately diagnosed 221 TMCs,the diagnosis rate was 90.2％,and the misdiagnosis rate was 9.8％.Among the missed diagnosed lesions,18 lesions were nodular goiter,others were 3 nodular goiter with focal papillary hyperplasia of follicular epithelium,2 nodular goiter with adenomatous hyperplasia,1 focal lymphocytic thyroiditis,respectively.The thyroid lesions≤0.5 cm in diameter were more easily to misdiagnose.According to the importance of the ultrasonographic features of TMC,the order were aspect ratio (A/T) ≥ 1,irregular-shape,microcalcifications,low or very-low echo.Based on the above corresponding characteristics and considering other features together,the diagnostic accuracy rate were 94.1 ％,93.9％,92.4％ and 90.5％,respectively.Less blood supply and ill-defined boundary were the secondary sonographic signs of TMC.The elastographic scores of TMC were most showed 4 to 5 points.Diagnosis of TMC relied on elastography alone is less effective,but when elastograph diagnosis based on high frequency ultrasound,the diagnostic accuracy is much higher,especially when there is no calcification in the lesions.Conclusions High-frequency ultrasound has a very important value in the diagnosis of TMC,while elastography has certain assistant value on the basis of high-frequency ultrasonic diagnosis.

Objective To induce the immune tolerance of heart grafts with infusion of isogeneic bone marrow mesenchymal stem cells (BMSCs) in heart transplant rats.Method Donor Wistar rats and recipient F344 rats were randomly divided into 4 groups:acute rejection group (group A),Wistar rats as the donors and F344 rats as the recipients for heart transplantation; low dose cyclosporin A(CsA) group (group B),recipient F344 rats given low dose CsA; BMSCs group (group C),recipient F344 rats given isogeneic BMSCs; BMSC and low dose CsA group (group D),the recipient F344 rats given isogeneic BMSCs and low dose CsA.The serum cytokine levels were determined,and the donor heart pathological changes and survival were observed postoperatively.The relative level of Foxp3 mRNA expression in the spleen of the recipient F344 rats was also observed.Result The blood levels of interleukin-2 (IL-2) and interferon-γ(INF-γ) were significantly reduced,but IL-4 and IL-10 levels were increased (P＜0.05),and the survival time of donor heart was significantly prolonged in group D as compared with groups A,B and C (P＜0.05 for all).Heart pathological examination revealed a mild acute rejection in group D,moderate acute rejection in groups B and C group,and severe acute rejection in group A respectively.The expression of Foxp3 mRNA was significantly lower in group A than in groups B,C and D (P＜0.05 for all),and that in group D was significantly higher than in groups B and C (P＜0.05 for both),but there was no significant difference between between groups B and C (P＞0.05).Conclusion Intravenous administration of BMSCs can alleviate immunorejection in heterotopic rat heart transplantation.Low-dose CsA acts synergistically with BMSCs to significantly inhibit acute rejection after heart transplantation.The partial mechanisms involve the suppressive effect of BMSCs on the expression of Foxp3 mRNA and modulation on cytokine.

Objective To investigate the evaluation of virtual touch tissue quantification(VTQ)in differential diagnosis of thyroid benign and malignant nodules and its influence factors.Methods 127 patients with thyroid lesions and its adjacent normal thyroid tissue at the same depth were examined with VTQ.Test results were performed by shear wave velocity value (SWV) on the long axis dimension of the nodules.The maximum(Vmax),minimum(Vmin) value of SWV of thyroid lesions and the SWV(Vn) value of surrounding normal tissue were recorded.The mean value of SWV (Vm) and the ratio of Vm and Vn (Vm/n) were calculated.SWV value of benign and malignant nodules and different pathological types of nodules were analyzed.Receiver-operating characteristic curve(ROC) was drawn to assess the diagnostic efficiency.Results The Vmax,Vmin,Vm,Vm/n of malignant lesions [(4.61 ± 2.65) m/s,(2.74 ± 2.23) m/s,(2.99 ± 0.82)m/s,(1.69 ± 1.07)m/s,respectively] were obviously higher than that of benign nodules [(2.78 ± 0.96)m/s,(1.75 ± 0.60)m/s,(2.31 ± 0.38)m/s,(0.94 ± 0.23)m/s,respectively,P ＜0.01].The SWV value of thyroid papillary carcinoma was higher than that of nodular goiter,thyroid adenoma and Hashimoto's thyroiditis(P ＜0.05).The SWV value of Hashimoto's thyroiditis was higher than that of thyroid adenoma and nodular goiter (P ＜ 0.05).No significant differences of SWV value were found between thyroid adenoma and nodular goiter (P ＞ 0.05).Contrast the area under the receiver-operating curves above four groups of different SWV values,the results showed that Vm had the highest diagnostic value in diagnosis of benign and malignant thyroid nodules.When the best cut-off point of Vm was 2.48 m/s,the diagnostic value was highest and the sensitivity and specificity were 97％ and 81 ％.Conclusions VTQ could be used to quantify and evaluate the hardness of thyroid nodules and provided important value for the differential diagnosis of benign and malignant thyroid nodules.

Objective To investigate the differential diagnostic signiifcance of different calciifcation types in thyroid benign and malignant nodules with high-frequency ultrasound. Methods Totally 195 patients with thyroid lesions were examined on conventional high-frequency ultrasound pre-operatively. The evaluation was foucsed on the number and echo of thyroid nodules and the size, shape and distribution of calciifcation inside. Different calciifcation patterns were divided into 3 types:type 1 micro-calciifcation, type 2 coarse calciifcation, type 3 peripheral calciifcation. Results The calciifcation rate of thyroid malignant nodules 68.6%(81/118) was signiifcantly higher than that of benign nodules 40.0%(56/140) (χ2=21.096, P<0.01). The ratio of type 1 calciifcation in malignant nodules 72.8%(59/81) was obviously higher than that of benign nodules 41.1%(23/56) (χ2=13.906, P<0.01). There was no signiifcant difference of type 2 calciifcation between malignant and benign nodules (χ2=3.159, P>0.05). The incidence of type 3 calcification in malignant lesions 3.7%(3/81) was lower than that of benign nodules 21.4%(12/56) (χ2=10.669, P<0.05). The malignancy incidence of solitary thyroid nodule 85.3%(58/68) and extremely low echo nodules with calciifcation 76.2%(48/63) was higher than that of multiple thyroid nodules 33.3%(23/69) and other echo nodules 44.6%(33/74) (χ2=38.261, 14.057, both P<0.01). Conclusions There was potential risk of malignancy in each calciifcation of thyroid nodules. Different calciifcation types had important value for differential diagnosis of benign and malignant thyroid nodules.

Objective To retrospectively analyze the clinical management and follow-up of 13 recipients with survival of over ten years after cardiac transplantation. Methods Thirteen male recipients underwent orthotopic heart transplantation between August 1995 and June 2001 in our center and received standard immunosuppressive therapy protocols (8 cases) or induction therapy protocols (5 cases). Cyclosporine, azathioprine or mycophenolate mofetil, and prednisolone were applied as maintenance immunosuppressive regimens. Six recipients switched from azathioprine to mycophenolate mofetil when mycophenolate mofetil was available. Perioperative complications were prevented and treated. After operation, the recipients were followed up regularly to set up personnel long-term follow-up files. The incidence of acute rejection (AR) and (cardiac allograft vasculopathy (CAV) was monitored. Results The 13 survived recipients accounted for 48. 1 % of the total number in the corresponding period (13/27). All survivals recovered well and had a good quality of life. The recent (1 year) complications included acute allograft rejection (3 cases), infection (4 cases), renal insufficiency (3 cases), allograft right ventricular dysfunction (5 cases), post-transplant diabetes (2 cases) and liver dysfunction (5 cases). The long-term (1 year later) complications included acute allograft rejection (2 cases), CAV (2 cases), hypercholesterolemia (5 cases), hypertension (4 cases), hyperuricemia (10 cases) and chronic renal impairment (3 cases). One hepatitis B virus carrier died of liver cancer 13 years after transplantation. Conclusion The long-term survival of cardiac allograft recipients is closely associated with psychological state, financial condition, compliance and follow-up medical system, while the sociological and environmental factors may play important roles.

Objective To investigate living quality of patients after orthotopic cardiac transplantation and to provide scientific evidence for specific strategy of therapy and improvement of living quality of patients with cardiac transplantation. Methods SF-36 and the social support questionnaire were used to analyze living quality of 79 patients who received orthotopic cardiac transplantation in the Department of Cardiovascular surgery of Affiliated Union Hospital of Fujian Medical University. The mode of SF-36 was from the investigative numerical value of residents in Sichuan province. Description, t-test and Spearman correlation analysis were used to study the related factors. Results Compared with a reference general population, the heart transplant recipients showed a significantly worse living quality score on all domains of the SF-36 scales (P＜0. 05), except the domain of somatic pain. Among the patients after cardiac transplantation, living quality was more significantly improved in ＞2-year survival group than that in ＜one-year survival group (P＜0. 05),except the domain of somatic pain. The relationships between the social support and living quality were analyzed,and it was found that as compared with a reference general population, the heart transplant recipients showed significantly lower scores on all domains of the social support questionnaire (P＜0. 01 ). The total social support scores were positively related to mental health related living quality (P＜0.05, r = 0.223 - 0.710), except the domain of somatic pain. Conclusion Compared with a general population, heart transplant recipients demonstrated a significantly worsened living quality. But evidence showed the living quality can be improved gradually with the prolongation of the survival time after heart transplantation. Social support was related to the living quality of heart transplantation patients. Improvement of availability on social support will probably improve living quality.

Objective To investigate the value of contrast enhanced ultrasound (CEUS) in diagnosing poor differentiated cholangiocarcinoma. Methods Sonograms of 11 patients with pathologically confirmed poor differentiated cholangiocarcinoma were retrospectively analyzed. The size, boundary, shape, echo, blood distribution and characteristics of the enhancement duration were observed. Results All lesions presented irregular shape (100%), most (9/11, 81.82%) with indefinite boundary, some (6/11, 54.55%) with low echo. No blood flow signal was found in the interior of masses, while grade 1 blood flow signal was detected in periphery of the lesions. Resistance index (RI) was ≥0.6 in spectral Doppler in 7 (63.64%) lesions. Marginal rim-like hyperechoic enhancement in the arterial phase was found without centripetal filling in all 11 patients, marginal rim-like hypoechoic enhancement was observed, but being hyperecho compared with interior part without medium in delayed phase. Conclusion The contrast-enhancement modality of poor differentiated cholangiocarcinoma is characteristic. Combined with two-dimensional ultrasonography and color Doppler ultrasound, the diagnostic rate will be improved.

Objective To explore the effects of P85,microbubbles and ultrasound on plasmid DNA skeletal muscle gene transduction of mice in vivo. Methods Plasmid encoding green fluorescent protein (GFP) ,which conjugated with 0.05% P85 and/or microbubbles, 10% Optison,was injected into the tibialis anterior(TA) muscle of mice with or without ultrasound irradiation (1 MHz, 1 W/cm2 2 min,20% duty cycle). Mice were killed 1 week after injection. The TA muscles were removed and snap-frozen immediately in isopentane cooled by liquid nitrogen and sections 7 μm thick were cut at intervals. One set of sections mounted with DAPI were used to assess the transfection efficiency by counting the number of GFP-positive fibers under fluorescence microscopy,and the other set of sections were stained with haematoxylin and eosin to assess the tissue damage area. Results The P85 and Optison significantly enhanced the plasmid DNA skeletal muscle gene delivery in vivo separately (P<0.01, P<0.05).Ultrasound exposure could significantly enhance the efficiency of P85 induced gene delivery(P<0.01) but not of Option(P>0.05).The gene delivery efficiency induced by P85 was higher than that by Optison no matter with or without ultrasound irradiation(P<0.01). When the P85 conjugated with Optison, they could further significantly enhance gene delivery efficiency with ultrasound exposure (P<0.01). Meanwhile, ultrasound exposure could increase the muscle damage areas in the groups with microbubbles (P<0.01). Conclusions The P85,microbubbles and ultrasound exposure display synergistic effect to enhance plasmid DNA transduction in skeletal muscle of mice in vivo.

The value of color Doppler flow imaging (CDFI) and intravenous contrast-enhanced ultrasound (CEUS) for assessing the transplanted liver and early diagnosing complications by examining hemodynamic changes was discussed. Seventy-five patients with orthotopic liver transplantation (OLT) underwent CDFI. The following parameters were measured: peak systolic velocity (PS), resistance index (RI) and Doppler perfusion index (DPI) of the hepatic artery (HA), time average velocity (TAV) of portal vein (PV) and velocity of hepatic vein (HV) in different stages postoperation. And 11 patients of them received CEUS. Thirty healthy subjects were enrolled as controls. The results showed that: (1) In 23 patients without obvious complications, TAV of PV within 15 days post-operation was significantly higher than in controls (P<0.05), PS and DPI of HA within 7 days postoperation were lower, but RI was higher than in controls (P<0.05); (2) When the hepatic artery thrombosis (HAT) occurred, PS and DPI of HA were obviously decreased, but TAV of PV significantly increased like a high saw-tooth wave; (3) While rejection occurred, both TAV of PV and PS of HA were decreased with the increase in RI of HA, and the triphasic wave of HV disappeared and displayed as saw-tooth wave; (4) The incidence of biliary complications in liver transplantation was increased when DPI was reduced; (5) Seven cases of hepatic carcinoma relapse after OLT demonstrated hyperecho in the arterial phase and hypoecho in the portal and later phase on CEUS; (6) In 2 cases of HA thrombus, there was no visualized enhancement in arterial phase of CEUS, but enhancement during the portal vein and parenchymal phase. It was concluded that the hemodynamic changes of PV, HA and HV in the transplanted liver are valuable for assessing the transplanted liver and early diagnosing complications on CDFI and CEUS.
Bile Ducts/pathology ; Contrast Media/*administration & dosage ; Hemodynamics ; Hepatic Artery/pathology ; Infusions, Intravenous/*methods ; Liver Transplantation/*adverse effects ; Liver Transplantation/*methods ; Liver Transplantation/ultrasonography ; Perfusion ; Postoperative Complications ; Ultrasonography/*methods ; Ultrasonography, Doppler/*methods