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.

Humans ; Synovial Fluid ; MicroRNAs/genetics* ; Exosomes/genetics* ; Osteoarthritis/genetics* ; Synovial Membrane

Objective:To investigate the clinical efficacy and prognostic influencing factors of open abdomen technique for acute pancreatitis with abdominal compartment syndrome (ACS).Methods:The retrospective cohort study was conducted. The clinical data of 186 patients of acute pancreatitis with ACS who were admitted to 6 hospitals, including 65 cases in the 910th Hospital of Joint Logistics Support Force of Chinese People′s Liberation Army, 46 cases in the First Affiliated Hospital of Wenzhou Medical University, 33 cases in the Fujian Provincial Hospital, 31 cases in the Second Affiliated Hospital of Fujian Medical University, 7 cases in the People′s Hospital Affiliated to Quanzhou Medical College, 4 cases in the Shishi General Hospital, from January 2013 to December 2020 were collected. There were 142 males and 44 females, aged (43±8)years. Observation indica-tors: (1) patients conditions after being treatment with open abdomen technique; (2) analysis of clinical characteristics in patients with different treatment outcomes; (3) changing trend of the volume of urine output, levels of lactic acid, levels of enteral nutrient intake and the sequential organ failure score in patients with different treatment outcomes; (4) influencing factors for prognosis of patients. Measurement data with normal distribution were represented as Mean± SD, and compari-son between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test or the continuity correction chi-square test. Repeated measurement data were analyzed using the repeated ANOVA. Spearman correlation analysis was used for correlation analyses. The COX regression model was used for univariate analysis and COX regression model with forward regression was used for multivariate analysis. Results:(1) Patients conditions after being treatment with open abdomen technique. Intra-abdominal pressure, oxygena-tion index, levels of lactic acid and sequential organ failure score of the 186 patients were (23.3±1.9)mmHg (1 mmHg=0.133 kPa), (121±24)mmHg, (5.0±3.4)mmol/L and 10.4±3.6 before the treatment with open abdomen technique and (11.2±2.9)mmHg, (222±38)mmHg, (3.2±2.1)mmol/L and 4.4±2.3 at postoperative 168 hours, showing significant differences in time effects before and after the treatment ( Ftime=855.26,208.50, 174.91,208.47, P<0.05). (2) Analysis of clinical characteristics in patients with different treatment outcomes. Of the 186 patients, 166 cases survived and were discharged, and 20 cases died during hospitalization. Age, sequential organ failure score, duration of ACS and levels of lactic acid during hospitalization before the treatment with open abdomen technique were (41±7)years, 9.4±3.4, 13(10,21)hours and (4.2±0.6)mmol/L in surviving patients, versus (45±6)years, 11.5±2.4, 65(39,84)hours and (5.2±0.5)mmol/L in dead patients, respectively, showing significant differences between them ( t=-2.10, -2.71, Z=-5.36, t=-7.16, P<0.05). Duration of postoperative acute gastro-intestinal injury, duration of continuous renal replacement therapy, time to liberation from mech-anical ventilation, duration of vasoactive drugs therapy, cases undergoing early abdominal closure, cases without intestinal fistula or with postoperative high-order intestinal fistula and low-order intestinal fistula during hospitalization after the treatment with open abdomen technique were 4(2,6)days, 4(3,7)days, 34(21,41)days, 3(2,6)days, 126, 131, 23, 12 in surviving patients, versus 13(10,17)days, 10(8,18)days, 0(0,3)days, 8(6,12)days, 1, 2, 15, 3 in dead patients, respectively, showing significant differences between them ( Z=-5.60, -3.75, -3.64, -3.06, χ2=41.43, 45.86, P<0.05). (3) Changing trend of the volume of urine output, levels of lactic acid, levels of enteral nutrient intake and the sequential organ failure score in patients with different treatment outcomes. The volume of urine output, levels of lactic acid, levels of enteral nutrient intake and the sequential organ failure score in surviving patients during hospitalization were (0.29±0.10)mL/(kg·h), (4.2±0.6)mmol/L, 0.0 kcal/(kg·d) and 9.4±3.4 before the treatment with open abdomen technique and (2.22±0.15)mL/(kg·h), (1.9±0.7)mmol/L, (20.7±2.9)kcal/(kg·d) and 3.7±2.2 at postoperative 168 hours. The above indicators in dead patients during hospitalization were (0.28±0.08)mL/(kg·h), (5.2±0.5)mmol/L, 0.0kcal/(kg·d) and 11.5±2.4 before the treatment with open abdomen technique and (0.28±0.09)mL/(kg·h), (7.7±0.8)mmol/L, (4.6±1.8)kcal/(kg·d) and 12.4±2.1 at postoperative 168 hours. There were significant differences in time effects in the above indicators in surviving patients and dead patients before and after the treatment with open abdomen technique ( Ftime=425.57, 188.59, 394.84, 37.52, P<0.05). There were interactive effects between the above indicators and the treatment outcome at different time points ( Finteraction=383.14, 233.04, 169.83, 36.61, P<0.05). There were signifi-cant differences in the change trends of the above indicators between the surviving patients and the dead patients during hospitalization ( Fgouprs=2 739.56, 877.98, 542.05, 240.85, P<0.05). (4) Influen-cing factors for prognosis of patients. Results of univariate analysis showed that age, sequential organ failure score, duration of ACS before surgery, procalcitonin, lactic acid, postoperative high-order intestinal fistula, abdominal hemorrhage, duration of postoperative acute gastrointestinal injury, duration of continuous renal replacement therapy, duration of vasoactive drugs therapy, early abdominal closure were related factors influencing prognosis of patients under-going treatment with open abdomen technique ( hazard ratio=1.07, 1.18, 1.39, 1.16, 8.25, 12.26, 2.83, 1.29, 1.56, 1.41, 0.02, 95% confidence interval as 1.00-1.15, 1.45-2.27, 1.22-1.57, 1.02-1.32, 1.75-38.90, 7.37-41.23, 1.16-6.93, 1.22-1.37, 1.23-1.99, 1.08-1.84, 0.00-0.16, P<0.05). Results of multivariate analysis showed that extended duration of ACS before surgery, postoperative high-order intestinal fistula and extended duration of postoperative acute gastrointestinal injury were independent risk factors influencing prognosis of patients undergoing treatment with open abdomen technique ( hazard ratio=1.05, 7.95, 1.17, 95% confidence interval as 1.01-1.32, 2.05-30.87, 1.13-1.95, P<0.05) and early abdominal closure was an independent protective factor ( hazard ratio=0.10, 95% confidence interval as 0.01-0.89, P<0.05). Results of Spearman correlation analysis showed that duration of ACS was positively correlated with sequential organ failure score before surgery ( r=0.71, P<0.05). Conclusions:Open abdomen technique is effective for acute pancreatitis with ACS. Extended duration of ACS before surgery, postoperative high-order intestinal fistula and extended duration of postoperative acute gastrointestinal injury are independent risk factors for prognosis of patients during hospitalization and early abdominal closure is an independent protective factor.

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 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 observe therapeutic efficacy and safety of Rupi sanjie capsules in the treatment of mammary gland hyperplasia after minimally invasive rotation and surgical. METHODS:A total of 180 patients with mammary gland hyperplasia or mammary gland hyperplasia combined with mammary fibroma were selected retrospectively from general surgery department of the First Affiliated Hospital of Soochow University during May 2015 to May 2017. They were divided into control group(n＝90)and observation group (n＝90) according to medication methods. Both groups received minimally invasive rotation and surgical treatment. After operation,control group was given Tamoxifen citrate tablets 10 mg orally,twice a day. Observation group was given Rupi sanjie capsules 2.12 g orally,3 times a day. Two groups stopped taking medication during menstruation,and both groups were treated for 8 weeks. Clinical efficacies of 2 groups were observed,and the levels of VEGF,FGF and MVD,the occurrence of ADR were observed before and after treatment. RESULTS:The total response rate of observation group(95.56%) was significantly higher than that of control group(86.67%),with statistical significance(P＜0.05). Before treatment,there was no statistical significance in the levels of VEGF,FGF and MVD between 2 groups (P＞0.05). After treatment,the levels of VEGF,FGF and MVD in 2 groups were significantly lower than before treatment,and the observation group was significantly lower than the control group,with statistical significance(P＜0.05). No obvious ADR was found in 2 groups during treatment. CONCLUSIONS:After minimally invasive rotation and surgical,Rupi sanjie capsules shows significant therapeutic efficacy for mammary gland hyperplasia,can reduce the levels of VEGF,FGF and MVD with good safety.

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.

Objective To explore novel lipid microbubbles with matrix metalloproteinase-9(TMB-9) targeting in the radiography evaluation of the protective effects of doxycycline on testicular ischemia-reperfusion injury by contrast-enhanced ultrasound(CEUS). Methods Thirty-six rabbits were randomly divided into control groups (group S1 and group S2),ischemia reperfusion groups (group R1 and group R2) and doxy intervention groups (group D1 and group D2).In the control groups,threading without ligation was performed after the exposure of the spermatic cord.The establishment of ischemia-reperfusion model was performed in ischemia reperfusion groups and doxy intervention groups,followed by 1-day feeding for group R1 and D1 as well as 4-day feeding for group R2 and D2.Group D1,group D2 and group S1 were given intraperitoneal injection of doxy 20 mg· kg -1· d-1.Group R1,group R2 and group S2 were given intraperitoneal injection of equivalent normal saline.MB and TMB-9 CEUS were undertook preoperative and postoperative respectively in each group.And the changes of the contrast parameters were analyzed, including PI,TP,Slope,MTT,DT/2 and AUC.The testes were taken for pathological examination after operation.Results TMB-9 contrast parameters of the group D1 including PI and AUC were significantly decreased,MTT and DT/2 decreased( P < 0.05),compared with Group R1.While compared with MB, TMB-9 contrast parameters of group D1 including PI and AUC were increased,MTT and DT/2 prolonged (P<0.05).TMB-9 contrast parameters of Group D2 including PI and AUC were significantly decreased, MTT and DT/2 decreased( P <0.01),compared with Group R2.TMB-9 contrast parameters of Group D2 only PI increased( P <0.01),while compared with MB.Compared with the ischemia reperfusion group,the expression of MMP-9 in the vascular basement membrane of doxy intervention groups was significantly decreased ( P < 0.01).Conclusions TMB-9 can sensitively and objectively evaluate testicular ischemia-reperfusion injury of testicular microvasculature at different reperfusion times before and after doxy intervention.

OBJECTIVEThis study aims to assess the effects of desensitizing toothpaste containing stannous fluoride on dentine hypersensitivity by performing Meta-analysis of randomized controlled trials (RCT) involving the treatment of dentine hypersensitivity with stannous fluoride-containing toothpaste.

METHODSThe study was developed based on the Cochrane handbook for systematic reviews of interventions (Version 5.1.0) and included the following: search strategy, selection criteria, data extraction, and risk of bias assessment. We searched electronic databases such as CNKI, CBM, PubMed, Embase, and Cochrane Library up to January 2015. RCT of treating dentine hypersensitivity with stannous fluoride-containing toothpaste were included. Data extraction and domain-based risk of bias assessment were independently performed by two reviewers. Meta-analysis was performed with RevMan 5.3 software.

RESULTSSix RCT with 494 patients (247 in the experimental group and 247 in the control group) were included. The results of Meta-analysis showed that the desensitizing effect of stannous fluoride-containing toothpaste was significantly better than that of control in tactile sensitivity test (SMD=1.41, 95% confidence interval 0.74-2.09, P<0.00001) and air blast test (SMD = -1.16, 95% confidence interval -1.84--0.48, P<0.000 01).

CONCLUSIONCurrent evidence shows that stannous fluoride-containing toothpaste is effective in treating dentine hypersensitivity in clinic. However, due to limited sample size and lower quality of the included studies, more high quality and large-sample RCT are needed to further verify the evidence.

Dentin Desensitizing Agents ; therapeutic use ; Dentin Sensitivity ; drug therapy ; Humans ; Randomized Controlled Trials as Topic ; Sodium Fluoride ; Tin Fluorides ; therapeutic use ; Toothpastes ; therapeutic use ; Treatment Outcome

OBJECTIVE:To provide reference for rational drug use and strengthen the management of adjuvant medication man-agement in the hospital. METHODS:1 080 and 860 discharged medical records of 12 Vitamins for injection were selected from our hospital during Jun.-Nov. 2014 (pre-special comment group,i.e. group A) and Jun.-Nov. 2015 (post-special comment group,i.e. group B),respectively. The application of 12 Vitamins for injection,hospitalization stay,drug cost and the incidence of ADR were compared before and after adjuvant medication special comment. RESULTS:After adjuvant medication special comments,the propor-tion of drug use of no indication,unsuitable solvent selection,irrational drug dosage,drug use of drug interaction and contraindica-tion,drug cost and the incidence of ADR in group B were all lower than in group A,with statistical significance(P<0.05). There was no statistical significance in hospitalization stay between 2 groups(P>0.05). CONCLUSIONS:Clinical pharmacists adopt adju-vant medication special comments to effectively standardize clinical application of 12 Vitamins for injection in our hospital.