Objective:To investigate the myocardial protective effect of extracorporeal cardiac shock wave therapy (CSWT) combined with sulfur hexafluoride microbubble post-conditioning on myocardial ischemia-reperfusion injury (MI/RI) in rats, and to provide theoretical support for clinical treatment of MI/RI.Methods:A total of 32 male SD rats were randomly divided into 4 groups: sham operation group (Sham group), MI/RI group (IR group), CSWT group (IR+ SW group), and CSWT combined with sulfur hexafluoride microbubble treatment group (IR+ SW+ MB group), with 8 rats in each group. Therapeutic intervention was performed in IR+ SW group and IR+ SW+ MB group on the 1st, 3rd and 5th day after modeling. The left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) of the rats were measured by echocardiography before and after treatment. On the 7th day, myocardial fibrosis was assessed by Masson staining, and cardiomyocyte apoptosis was observed by TUNEL staining. The myocardial apoptotic proteins Bcl-2, BAX, Cleaved-Caspase-3 and Cleaved-Caspase-9 in the infarct boundary area were detected by Western blot. The differences of the above indexes among different groups were compared.Results:①There was no significant change in heart rhythm and heart rate among the groups before and after treatment, and there was no significant difference in heart rate ( P>0.05). ②The echocardiographic results after treatment showed that, compared with IR group, LVEDD and LVESD in IR+ SW group and IR+ SW+ MB group decreased in turn, while LVEF and LVFS increased in turn with significant differences between each two groups (all P<0.05). ③Compared with IR group, the degrees of myocardial fibrosis and apoptosis in IR+ SW group and IR+ SW+ MB group were alleviated in turn, and the relief in IR+ SW+ MB group was the most obvious. Quantitative analysis showed that compared with IR group, the proportions of cardiomyocyte apoptosis in IR+ SW group and IR+ SW+ MB group decreased in turn, and there were significant differences between each two groups (all P<0.05). ④The results of Western blot detection showed that compared with IR group, the levels of Bcl-2 in IR+ SW group and IR+ SW+ MB group increased in turn, while the levels of BAX and the activation level of Caspase-3 and Caspase-9 protein decreased in turn. These differences were all statistically significant between each two groups (all P<0.05) except for the activation level of Caspase-3 protein between IR+ SW group and IR+ SW+ MB group ( P>0.05). Conclusions:CSWT combined with sulfur hexafluoride microbubble therapy can improve left ventricular remodeling and left ventricular systolic function by inhibiting cardiomyocyte apoptosis.

Objective:To assess the prognostic potential of post systolic shortening (PSS) on cardiac injury in the breast cancer patients after chemotherapy.Methods:This was a prospective cohort study in breast cancer patients after chemotherapy who were followed up to observe the risk of cardiac injury. A total of 69 female patients with HER-2 negative breast cancer were selected in the Fourth Hospital of Hebei Medical University from February to August 2019. The post-systolic strain index (PSI) of each segment of left ventricular myocardium after chemotherapy was obtained by two-dimensional speckle tracking echocardiography. PSI (%) was defined as follows: [(peak strain in cardiac cycle-peak strain in systole)/peak strain in cardiac cycle]×100%. PSS was regarded as meaningful if PSI >20%. End point was cardiac injury, which could be manifested as cardiotoxicity, cardiogenic death, myocardial infarction, unstable angina pectoris, and severe arrhythmias. Occurence of any above mentioned cardiac injuries was considered as end point event. According to the number of myocardial walls with PSS, the patients were divided into three groups: group A (no walls), group B (1 wall), and group C (≥2 walls). Additionally, the patients were also stratified according to tertiles of PSI: layer A (the first tertile), layer B (the second tertile), and layer C (the third tertile).Results:During a median follow-up of 18 months (Q 1=17 months, Q 3=18 months), 17 patients (24.64%) were diagnosed as having end point events. The risk of end point increased with the increase in the number of myocardial walls with PSS and the increase in PSI stratification.After adjusting for age, hypertension, systolic blood pressure, global longitudinal strain, and E peak of mitral early diastolic inflow velocity/average peak early diastolic mitral annular velocity e′ (E/e′), the association remained significant, (Per 1 increase in number of walls with PSS, hazard ratio, 1.96, P=0.007. Per 1% increase in PSI, hazard ratio, 1.44, P<0.001). In terms of predictive ability, the Harrell′s C index of PSS and of PSI was 0.70 and 0.73, respectively, both P<0.01, which indicated moderate accuracy. Conclusions:The presence of PSS in breast cancer patients after chemotherapy can provide independent prognostic information for the future occurrence of cardiac injury.

Objective To explore the correlation between Galectin-3 ,c-Met , HBME-1 ,CK19 and lymph node metastasis of thyroid carcinoma ,and study the value of ultrasound combined with the markers in estimating prognosis . Methods From December 2015 to September 2016 ,46 patients with thyroid nodules (8 were benign and 38 were malignant) who undergone surgery in our hospital were screened out . Preoperative analysis of ultrasonic manifestations of cervical lymph nodes and the evaluation of lymph node had been done before surgery .Immunohistochemical test of Galectin-3 ,c-Met ,HBME-1 and CK19 by Maxvision one step method for postoperative paraffin wax block were performed . Pathology was the gold standard for the final determination of metastatic lymph nodes . Results Chi-square and prospective chi-square test results showed that ultrasound assessment of metastatic lymph nodes compared with the final pathological results were statistically significant ( P ＜ 0 .001) . The expressions of Galectin-3 and c-Met were statistically significant compared with the lymph node metastasis confirmed by pathology ( Galectin-3 :P ＝0 .005 ;c-Met : P ＜0 .001) . The expressions of HBME-1 and CK19 were not statistically significant ( HBME-1 : P ＝0 .162 ,CK19 : P ＝0 .154) . ROC curve results showed that the comparison of Galectin-3 and c-Met and ultrasound cut-off value had the highest diagnostic value ,the sensitivity was 92 .3% and the specificity was 80 .0% . Conclusions The expressions of Galectin-3 and c-Met are associated with lymph node metastasis of thyroid carcinoma ,but HBME-1 and CK19 are not . Ultrasound combined with the expression of the markers for lymph node metastasis is valuable in guiding the prognosis of patients .

Objective To invesigate the reproducibility of automated breast volume scanner ( ABVS) in detection of breast lesions . Methods Thirty‐five patients with breast lesions diagnosed by conventional hand‐hold ultrasound were involved in the study . Every patient underwent ABVS twice by two different doctors . The number ,location and size of findings were documented and analyzed . Intra‐class correlation coefficients were used to evaluate the reproducibility . Results The number of findings was 67 and 68 respectively ,and the cronbach′s ɑwas 0 .997 . The ɑ of distance from nipple ,distance from skin ,and clock face location were 0 .343 ,0 .883 ,and 0 .949 . The ɑ of length superior‐inferior ,medial‐lateral ,and anterior‐posterior were 0 .938 ,0 .936 ,and 0 .948 . Conclusions The reproducibility of ABVS in detection of breast lesions is perfectly high . ABVS may be a good modality in monitoring benign lesions and evaluating neoadjuvant chemotherapy in the future .

Objective To evaluate the application value of virtual touch tissue quantification(VTQ) in the differential diagnosis of small breast lesions.Methods Fifty-six patients with sixty-nine small breast lesions whose largest diameter were less than or equal to 1 cm were evaluated with VTQ.The shear wave velocity (SWV) of the lesions and normal breast tissue were measured to analyze the diversity of different pathological types lesions of SWV and to find the optimal cut-off points using ROC curve to predict small breast cancer.Resuits The mean SWV(Vm) and the ratio (mean of lesions and normal tissue) of SWV (Vm1/Vm2) in benign group was (2.93 ± 1.32)m/s,1.79 ± 0.63,respectively,and that in malignant group was (5.65 ± 2.63) m/s,3.61 ± 1.35,respectively,there were statistically significant differences between benign group and malignant group (t test,P ＜0.05).The cut-off point of Vm was determined as 4.43 m/ s,the sensitivity,specificity and accuracy of diagnosing breast cancer were 80.5％,89.3％,92.8％,respectively.The cut-off point of Vm1/Vm2 was determined as 2.37,the sensitivity,specificity and accuracy of diagnosing breast cancer were 76.9％,81.2％,89.9％,respectively.Conclusions VTQ technique can provide helpful information in the differential diagnosis of small breast lesions.

Objective To evaluate the applicative value of ultrasound elastography in diagnosis of focal lesions in the parotid and submandibular glands.Methods 30 patients(30 lesions) were scanned by real-time ultrasound elastography and were analyzed in elastography evaluated criteria (5 score method).All the results were compared with the pathological types.Results The elastographic grades of most benign nodules were 1 - 3,while most of malignancy were 4 - 5.The elastographic grades of benign and malignant lesions were of significant difference statistically( P ＜0.01 ).If elastographic grade 4 or 5 were diagnosed as malignancies,the sensitivity,specificity and accuracy for diagnosing malignant l(e)sions in the parotid and submandibular glands were 72.73 ％,84.21 ％,80.00 ％,respectively.Conclusions Ultrasound elastography is useful in the differential diagnosis of focal lesions in the parotid and submandibular glands.

Objective To explore the clinical application value of virtual touch tissue quantification (VTQ) technique in Hashimoto's thyroiditis(HT).Methods Fifty-three patients with HT and 46 health subjects were examed by conventional ultrasonography and VTQ, their shear were velocity (Vs) was measured.A receiver-operating characteristie(ROC) curve was drew according to Vs which can obtain the value of optimal operating point for diagnosing HT.Results The 2D ultrasonic appearance of 53 cases HT were classified into five species, but there was no significant difference in the Vs (F = 0.424, P = 0.790).The area under the ROC curve was 0.976,which showed a high statistical significances(P = 0.000).ROC curve displayed that Vs of 2.53 m/s could be used to diagnose HT,the sensitivity and specificity were 87％and 100％ ,respectively.Fifty-three patients with HT were classified into three groups according to thyroid function, 10 patients with hyperthyroidism, 25 patients with hypothyroidism and 18 patients with euthyroidism.The Vs of HT among the three groups were no significant difference(P = 0.884), but their Vs were all obviously higher than that of normal thyroid Vs(P = 0.000).Conclusions VTQ technique can evaluate the hardness of thyroid and has some help for differential diagnosis of HT.

Objective To explore the clinical value of tissue synchronization imaging(TSI) in assessment of the characteristics of myocardium asynchrony in patients with ischemic cardiomyopathy(ICM). Methods Thirty-eight patients with ICM were divided into two groups: 26 patients without left bundle branch block(LBBB) in group A, and 12 patients with LBBB in group B. The control group consisted of 26 normal healthy subjects. According to 2D color,the characteristics of myocardium motion in each group were compared by TSI. The time for reaching systolic velocity peak(Ts) and early diastole velicity peak(Te) were measured separately in 12 segments. Standard deviations of Ts(Ts-SD) and Te(Te-SD) as well as difference of Ts(Ts max-min) and Te(Te max-min) of all 12 segments were calculated. The myocardium synchronization were assessed in each group. Results ①91.8% segments in the control group showed normal, with only 8.2% segments were slightly prolonged. TSI of all the ICM patients showed an obvious uneven chroma distribution from green to yellow and then to red. There were far more yellow or red segments than in the control group. ②Ts-SD.Ts max-min of LV 12 segments were significantly prolonged in all ICM groups compared with that in the control group ( P <0. 05). Systolic asynchrony was more obvious in group B than in group A. ③Te-SD,Te max-min of LV 12 segments were significantly prolonged in ICM groups than in the control group ( P < 0. 05). Diastolic asynchrony was more obvious in group B than in group A( P < 0. 05). ④Compared with that in the control group, postsystolic shortening(PSS) was common in patients with ICM. 32. 4% segments of group A were detected PSS.and 56. 0% segments of group B were detected PSS. Conclusions Left ventricular systolic and diastolic mechanical asynchrony is obvious in patients with ICM and PSS is common among them. Systolic and diastolic mechanical asynchrony is more severe in ICM patients with LBBB. TSI is the optimal means to evaluate the characteristics of asynchronous myocardial contraction.

Objective To evaluate the variation of aortic distensibility and its relation with left ventricular concentric remodeling in patients with primary hypertension.Methods Using two-dimensional and Doppler echocardiography,aortic distensibility (AD) and relative wall thickness (RWT),a parameter of left ventricular concentric remodeling were measured in 23 normal subjects (control group) and 32 patients with primary hypertension (hypertensive group).Taking the mean- 1.645 s of control group as the normal cut off value of AD,the hypertensive group was divided into two subgroups: group I with AD value lower than normal and group II within the normal range.Related clinical variables and echo parameters were compared between the two groups and stepwise regression was made to determine the relationship between AD and RWT.Results AD of hypertensive group was lower than that of control group; Univariate analysis showed that AD was significantly related to RWT,age and systolic blood pressure in hypertensive group; Multivariate regression demonstrated that RWT,age and systolic blood pressure entered the regression equation.Conclusions Aortic distensibility decreased in patients with hypertension and its reduction showed close relations with concentric remodeling of left ventricle,aging and increased systolic blood pressure.

Objective To explore the value of integrate d backscatter technique (IBS) in quantitative evaluation of myocardial viability and left ventricular remodeling (LVRM) in patients with acute myocardial infarction(AMI). Methods In 18 healthy subjects (control group) and 36 patients with first onset AMI, IBS images were obtained at apical long axis, 2- and 4-chamber views within one week, at 1 and 3 months after percutaneous intracoronary stenting. The dynamic changes of IBS and its cyclic variation (CVIB) at middle segments of six different walls of left ventricle were compared with normal control, and the relations of these changes with the remodeling and the function of left ventricle were analyzed. Results Based on the existence of LVRM, the patients were divided into two groups: group A without LVRM and group B with LVRM. In group A, IBS of both infarct and non-infarct segments were not significantly different from control group within one week while CVIB of infarct segments decreased significantly than that of control group. CVIB improved gradually with the recovery of LV function whereas IBS showed no change. In group B, IBS of infarct segments increased significantly than that of control group and CVIB of both infarct and non-infarct segments decreased significantly. IBS of both infarct and non-infarct segments increased gradually while only CVIB of non-infarct segments recovered. Meanwhile, ventricular aneurysm appeared and LV enlarged gradually with LV function not improved. Conclusions The dynamic changes of IBS are different in patients with AMI from normal subjects and it may be clinically useful to evaluate myocardial viability quantitatively and predict LVRM and the recovery of LV function.