Objective:To investigate the application value of shear wave elastography (SWE) in the evaluation of T re-staging after neoadjuvant chemoradiotherapy (nCRT) for locally advanced rectal cancer.Methods:Clinical, endorectal ultrasound (ERUS) and SWE data of 271 patients with locally advanced rectal cancer who underwent nCRT and total mesorectal excision in Fujian Medical University Union Hospital from October 2021 to March 2023 were prospectively collected. The independent predictors for low T staging were analyzed and screened, and the Logistic regression model was constructed. An independent test set was used to validate the prediction performance of the models and compare them with the diagnostic results of sonographers.Results:Binary multivariate Logistic regression analysis showed that Emean of the mesentery around the lesion, thickness, and enlarged lymph nodes around the rectum were the independent predictors for low T staging, and the odds ratios were 1.089, 1.214, 0.183, respectively. The Logistic regression model A established by Emean, thickness and enlarged lymph nodes around the lesion and the Logistic regression model B established by Emean around the lesion had high diagnostic efficiencies (area under the ROC curve were 0.931, 0.918, respectively, the accuracy were 0.888 and 0.887, respectively). There was no significant difference in diagnostic accuracy between the two models ( P=1.000), and both models were significantly higher than that of sonographers (all P<0.001). Conclusions:SWE can effectively predict whether the tumor is of low T staging after nCRT in locally advanced rectal cancer, and can be used as an important supplement to ERUS in evaluating the T re-staging of rectal cancer after nCRT.

Respiratory diseases are common， frequently-occurring clinical diseases. As the prevalence rate is increasing year by year， they have become a problem that seriously affects public health. The diseases are mainly located in the lung by traditional Chinese medicine （TCM） syndrome differentiation. Lung governs Qi and controls breathing and is also an organ for the storage of phlegm. Clinically， phlegm and Qi are often used for the treatment. Banxia Houputang （BHT）， originated from Synopsis of the Golden Chamber （《金匮要略》）， was used to treat plum-stone Ai （globus hystericus） at first. It is composed of Rhizoma Pinelliae， Cortex Magnoliae Offcinalis， Poria， Rhizoma Zingiberis Recens， and Folium Perillae， and treats diseases with the core pathogensis of mutual obstruction of phlegm and Qi. BHT has the effects of moving Qi， dissipating mass， descending adverse Qi， and resolving phlegm， which basically correspond to the pathological characteristics of the lungs. Clinical studies have confirmed that modified BHT can be used either alone or in combination with western medicine to treat chronic pharyngitis， asthma， chronic obstructive pulmonary disease， pneumonia， obstructive sleep apnea， upper airway cough syndrome and other respiratory diseases， with significant effects. It effectively improves the symptoms and signs of the diseases and reduces the recurrence rate. Basic research has shown that BHT plays anti-inflammatory， anti-oxidative stress， anti-apoptotic， autophagy-regulating， and iron overload-regulating roles by regulating the targets in multiple pathways. This paper， by combing the relevant literature in recent years， conducted a systematic review on BHT from the three aspects of syndrome analysis， clinical treatment research and mechanism research， with a view to providing theoretical basis and reference for the mechanism research of BHT in treating respiratory diseases and for expanding its clinical application.

ObjectiveTo investigate the intervention effect of Buzhong Yiqitang （BZYQT） on pulmonary inflammation in mice induced by chronic intermittent hypoxia （CIH） and preliminarily elucidate its mechanism. MethodForty healthy male C57BL/6 mice aged 6-8 weeks were randomly divided into the following groups： normoxia group， model group （exposed to CIH）， and low-， medium-， and high-dose BZYQT groups. The normoxia group was exposed to a normoxic environment， while the model group and the low-， medium-， and high-dose BZYQT groups were exposed to intermittent hypoxia. In the BZYQT groups， the BZYQT （8.1， 16.2， 32.4 g·kg^-1·d^-1） was administered orally 30 min before placing the mice in the hypoxic chamber， while the model group and the normoxia group received an equivalent volume of normal saline. After five weeks of modeling， pulmonary function of the mice was measured using an EMKA animal lung function analyzer， and lung tissue samples were collected after the pulmonary function tests. Hematoxylin-eosin （HE） staining was performed to observe the histopathological changes in the lung tissue of each group. Enzyme-linked immunosorbent assay （ELISA） was used to measure the levels of interleukin-6 （IL-6）， interleukin-8 （IL-8）， tumor necrosis factor-α （TNF-α） in the serum， as well as angiotensin Ⅱ （Ang Ⅱ） and angiotensin-（1-7） ［Ang（1-7）］ in lung tissue. Western blot and immunohistochemistry were used to detect the protein expression of IL-6， IL-8， TNF-α， angiotensin-converting enzyme 2 （ACE2）， and mitochondrial assembly receptor （Mas）. ResultCompared with the normoxia group， the model group showed significant abnormalities in lung function （P<0.05， P<0.01）， lung tissue changes， such as thickening of alveolar walls and inflammatory cell infiltration， increased levels of IL-6， IL-8， TNF-α in the serum and Ang Ⅱ in lung tissue （P<0.01）， decreased level of Ang（1-7） （P<0.01）， increased protein expression of IL-6， IL-8， and TNF-α， and decreased protein expression of ACE2 and Mas （P<0.05， P<0.01）. Compared with the model group， the BZYQT groups showed improvement in lung function （P<0.05， P<0.01）， and HE staining of lung tissue showed approximately normal alveolar wall thickness and reduced inflammatory cell infiltration. Immunohistochemistry and Western blot analysis showed a significant decrease in the expression of inflammatory-related proteins （P<0.05， P<0.01）， and a significant increase in ACE2 and Mas protein expression （P<0.05， P<0.01）. ConclusionBZYQT can improve lung injury in mice exposed to CIH by regulating the ACE2-Ang（1-7）-Mas axis to inhibit inflammatory responses.

Objective: To investigate the value of transrectal ultrasonography(TRUS) in the preoperative diagnosis and tumor T-staging of anorectal malignant melanoma(ARMM). Methods: The clinical and ultrasound data of 19 patients(22 lesions) with ARMM confirmed by pathology from February 2008 to Apirl 2019 in Fujian Medical University Affiliated Union Hospital were collected. TRUS was performed within one week before pathological examination. The sonographic features were summarized, ultrasonic typing was performed according to the lesion size and growth pattern, and the accuracies of preoperative ultrasound diagnosis and tumor staging were analyzed. Results: Among the 22 lesions, 63.64%(14/22) were with a distance of ≤3 cm between the anal verge and the lower margin of tumor, 68.18%(15/22) with regular shape, 81.82%(18/22) with clear boundary, and 63.64%(14/22) with Adler blood flow grading from Ⅱ to Ⅲ. The preoperative TRUS diagnostic coincidence rate was 73.68%(14/19), and the tumor T-staging accuracy was 75%(12/16), respectively. Conclusions TRUS exhibits certain sonographic characteristics, with high preoperative diagnosis rate and tumor T-staging accuracy in anorectal malignant melanoma, which is of great guiding significance for clinical diagnosis and treatment.

OBJECTIVE: To explore the effect of decoction (DGNTD) on cell apoptosis and TNF receptor super family 6 (Fas)/caspase-8 pathway in rheumatoid arthritis (RA) fibroblast-like synoviocytes (FLS). METHODS: FLS isolated from the synovial tissue of RA patients were cultured and identified using immunofluorescence staining. The cells were treated with 10% blank serum (blank control group), 10% sera containing low, moderate or high doses of DGNTD, or 20 μmol/mL KR-33493 (a Fas inhibitor) combined with 10% serum containing high-dose DGNTD. MTT assay was used to detect the proliferation of the cells after the treatments. Apoptosis of the cells was detected at 48 h in each group using Hoechst 33342 staining and flow cytometry with annexin V-FITC/PI staining. The mRNA and protein expressions of Fas, FADD, caspase-8 and caspase-3 in the cells at 48 h were detected using qPCR and Western blotting. RESULTS: Immunofluorescence staining identified the cultured cells as FLS. Treatment with DGNTD-containing sera significantly inhibited the proliferation of FLS, and the inhibitory effects were enhanced as the dose and intervention time increased ( < 0.05). Hoechst 33342 staining and flow cytometry showed that the sera containing different doses of DGNTD significantly promoted apoptosis of FLS ( < 0.05). The expression levels of Fas, FADD, caspase-8, and caspase-3 at both mRNA and protein levels were significantly increased in the cells after treatment with different doses of DGNTD-containing sera ( < 0.05). The application of KR-33493 obviously reversed the effects of DGNTD on the FLS ( < 0.05). CONCLUSIONS DGNTD can induce apoptosis of the FLS by activating Fas/caspase-8 signaling pathway.
Apoptosis ; Arthritis, Rheumatoid ; Caspase 8 ; Cell Proliferation ; Cells, Cultured ; Fibroblasts ; Synovial Membrane ; Synoviocytes

Objective:To investigate the value of real-time shear wave elastography (SWE) in the diagnosis of acute testicular torsion.Methods:A total of 30 rabbits were randomly divided into 3 groups including control group (Group S), complete torsion group (Group C) and incomplete torsion group (Group U), and corresponding animal models were built. Rabbits in each group were examined by gray scale and color Doppler ultrasound, SWE and contrast-enhanced ultrasound(CEUS) before and after operation. Mean values of elasticity modulus (Emean) of testicular capsule area, parenehyma testis, spermatic cord torsion section, torsion lower section and contrast-enhanced ultrasound parameters were recorded and then pathological examinations were performed.Results:There was no significant difference for Emean values of each group in all parts before operation( P>0.05). There was no significant difference for Emean value of S group at each period after operation( P>0.05). Emean value of postoperative testicular capsule area in U group increased obviously and rapidly compared with C group, yellow or red "hard ring signs" appeared within four to six hours after operation, there was significant difference of Emean value difference at various periods after operation in group U and C, and at 1 h, 1.5 h, 2 h, 2.5 h, 3 h and 3.5 h postoperatively between group U and C( P<0.05). Postoperative Emean value of parenchyma testis in group C and U increased about 5 kPa, expression of SWE was consistent blue. Postoperative Emean value of spermatic cord torsion section in group C increased more obviously compared with U group, a large patch of red signals appeared within five to six hours after operation, there was significant difference of Emean value at various periods after operation in group C and U, and at each period except instant, 2 h, and 3 h postoperatively between group C and U( P<0.05). Postoperative Emean value in spermatic cord torsion lower section in group U and C increased slowly ( P<0.05), expression of SWE changed from blue to blue green and green from original blue. CEUS showed blood pefusion in testis was "in and out slowly " in group U, pathological feature showed the testicular spermatogenic cells were in disorder with interstitial edema, distinct expansion of microvascular lumen, hyperemia and congestion and lots of erythrocyte leakage. CEUS showed postoperative contrast agent was not filling in testicular in group C, pathological feature showed the testicular spermatogenic cells were in disorder with interstitial edema, slight expansion of microvascular lumen, congestion and part erythrocyte leakage. Conclusions:The image changes of SWE after acute testicular torsion are related with the degree and time of torsion, the changes of testicular capsule area and spermatic cord torsion section are most significant. The use of SWE helps to get accurate hardness information of focus with effective clinical value for the diagnosis testicular torsion.

Objective:To compare the expression levels of absent in melanoma 2 (AIM2) inflammasome pathways in rheumatoid arthritis (RA) and osteoarthritis (OA) synovial specimens.Methods:Synovial tissue samples were collected from 41 RA and 26 OA patients, respectively. Horseradish peroxidase immunohi stochemical staining was used to detect AIM2 inflammasome pathway-related proteins, including AIM2, apoptosis-associated speck-like protein containing a CARD(ASC), caspase-1, and interleukin-1 (IL-1β). A semi-quantitative score (H-score) was performed according to the degree of positiveness. Correlation analysis between H-score results and clinical indicators of erythrocyte sedimentation tate (ESR) and C-reactive protein (CRP) were performed. The H score between RA and OA was analyzed by t test and Spearman correlation analysis were utilized for correlation analysis between H score and ESR and CRP.Results:The H scores of AIM2 protein in RA synovial tissues was (132±7) and (54±8) in OA synovial tissues ( t=7.42, P<0.01). The H scores of ASC protein in RA synovial tissues was (107±9) and (74±6) in OA synovial tissues ( t=2.36, P<0.05). The H scores of caspase-1 protein in RA synovial tissues was (99±5) and (74±10) in OA synovial tissues ( t=2.15, P<0.05). The H scores of IL-1β protein in RA synovial tissues was (118±11) and (76±7) in OA synovial tissues ( t=3.30, P<0.05) . In the correlation analysis, AIM2 was positively correlated with ESR [ r=0.74, P<0.01, 95% CI(0.38, 0.9)], and ASC was positively correlated with ESR [ r=0.5, P<0.05, 95% CI(0.16, 0.74)], IL-1β was positively correlated with ESR [ r=0.62, P<0.05, 95% CI (0.31, 0.81)], and the difference was statistically significant ( P<0.05). At the same time, AIM2 was positively correlated with CRP [ r=0.65, P<0.05, 95% CI(0.25, 0.86)]; ACS was positively correlated with CRP [ r=0.42, P<0.05, 95% CI(0.05, 0.69)]. IL-1β was positively correlated with C-reactive Protein [ r=0.41, P<0.05, 95% CI(0.05, 0.67)] and positively correlated with C-reactive protein, and the difference was statistically significant ( P<0.05). Conclusion::The expression of AIM2 inflammasome pathway-related proteins in RA synovium, including AIM2, ASC, caspase-1, and IL-1β, is higher than that of OA and are positively correlated with disease activity. Activation of AIM2 inflammasome pathway may be associated with the pathogenesis of RA disease activity.

Objective: To explore the sonographic features of primary testicular lymphoma(PLT). Methods: The sonographic features of 16 PLT patients confirmed by surgery and pathology were retrospectively analyzed. Results: Sixteen PLT patients were typed into 3 ultrasonic patterns: ①The diffuse homogeneous echo type: 2 cases, the ultrasonic features were homogeneous sieve-like hypoechoic echo, the blood flow signal was rich and radially distributed, with interstisial fibrosis inapparently under-microscope. ②The diffuse uneven homogeneous echo type: 9 cases, the ultrasonic features lobulated or map-like heterogeneous hypoechoic features, the blood flow signal was rich in linear distribution, and interstisial fibrosis proliferated to form fibrous septa under-microscope. ③The focal nodular pattern echo type: 5 cases, the ultrasonic features were homogeneous hypoechoic nodules, the blood flow signal was few, interstisial fibrosis hyperplasia surrounding the tumor under-microscope. Conclusions Ultrasonic appearances of primary testicular lymphoma are closely related to its pathologic characteristics, the recognization of their relations contributes to improve the diagnostic value of ultrasound.

Objective To investigate the value of high frequency ultrasound combined with color Doppler flow imaging in diagnosis and classification of trauma of penis on the clinical treatment . Methods T he sonographic features of 48 cases with penile trauma were analyzed and compared with treatment outcomes . Results T he ultrasonic findings of penile trauma ranged from penis contusion to penis fracture . According to the sonographic features ,the trauma of penis was grouped as follow s :Type 1 ,penis bruise ( 7 cases) presented with images of continuous penis skin and tunica albuginea ,inhomogeneous echoes of subcutaneous tissue . Type 2 ,corpora cavernosa bruise ( 4 cases ) showed images of continuous tunica albuginea ,inhomogeneous internal echoes of corpora cavernosa without abnormal flow signal . T he corpora cavernosa swelling into honeycomb‐like ,anechoic area of cavernosa with high‐speed artery Doppler signals w hen accompanied by cavernous artery injury . Four cases were treated conservatively . Type 3 ,the skin and subcutaneous tissue contusion ( 6 cases) manifested images of incontinuous and inhomogeneous echoes of skin and subcutaneous tissue but homogeneous echoes of corpora cavernosa and tunica albuginea . Six cases of patients underwent debridement and sutured by local anesthesia . Type 4 ,rupture of tunica albuginea( 26 cases) revealed images of incontinuous and irregular local tunica albuginea ,a hematoma seen between the tunica albuginea and subcutaneous tissue . Type 5 , penile fracture ( 5 cases ) revealed mostly or fully disconnected skin and corpora cavernosa ,tearing of blood vessels . T he patients of type 4 and 5 were all treated surgically . Conclusions Color Doppler ultrasonography could provide accurate assessment and classification for trauma of penis ,w hich is helpful to offer a reliable basis for clinical treatment scheme .

Objective To explore the relationship between ultrasonic appearances of epididymal spermatic granuloma and its pathologic characteristics. Methods The sonographic features of 32 cases of epididymal spermatic granuloma confirmed by pathology were retrospectively analyzed. Results A total of 34 epididymal spermatic granuloma nodules in 32 cases included 4 located in caput epididymidis and 30 located in cauda epididymidis,and maximum diameter of nodules were about 0.5-2.3 cm.Sonographic and pathologic appearances of nodules were: ① mostly low echo type,21 nodules mostly showed the obscure boundary and quite abundant blood flow signals,early granulomas formed with interstitial fibrosis inapparently under-microscope; ② inhomogeneous echo type,12 nodules mostly showed the barely clear boundary and blood flow signals from small amount to abundant amount,granulomas of different maturites distributed dispersedly with interstitial fibrosis of varying degrees under-microscope or single giant lesions formed;③mostly high echo type,1 nodule showed the obscure boundary and inapparent blood flow signals, center of the nodules distributed by a large amount of dense fibrous tissue under-microscope. Anechoic ethmoid sinus seen in 29 nodules was section of dilated epididymal ductus.Dotted strong echoes seen in 6 nodules were calcification of sperms in dilated epididymal ductus and necrotic tissue. Conclusions Ultrasonic appearances of epididymal spermatic granuloma are closely related to its pathologic characteristics.To recognize both relations contributes to improve the diagnostic value of ultrasound.