Objective:To evaluate the effect of different blood pressure control levels on myocardial work by left ventricular pressure-strain loop (LVPSL) in elderly hypertensive patients.Methods:Retrospectively, 158 elderly patients with hypertension in Shanxi Bethune Hospital from January to June 2017 were randomly divided into standard anti-hypertensive group ( n=75) and intensive anti-hypertensive group ( n=83). Another 48 cases of age and sex matched elderly without cardiovascular and cerebrovascular diseases and other diseases affecting cardiac function were selected as control group. All patients with hypertension underwent echocardiography at baseline, 12 and 24 months after antihypertensive treatment. The parameters of myocardial work, including global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE), were obtained by LVPSL. The changes of myocardial work parameters were compared between the standard group and the intensive group after 12 and 24 months of antihypertensive treatment. Results:①At baseline, GWI, GCW, GWW of the standard group and the intensive group were significantly higher than those of the control group (all P<0.05). ②After 12 and 24 months of antihypertensive treatment, GWI, GCW and GWW in standard and intensive antihypertensive groups decreased continuously ( P<0.05). ③The GWI, GCW and GWW of the intensive antihypertensive group were lower than those of the standard antihypertensive group at 12 and 24 months after antihypertensive treatment ( P<0.05). ④After 12 months of antihypertensive treatment, the reductions of GWI, GCW and GWW in standard and intensive antihypertensive groups were greater than those in 24 and 12 months of antihypertensive treatment (all P<0.05), and the reductions of GWI, GCW and GWW in intensive antihypertensive group were greater than those in standard antihypertensive group (all P<0.05). Conclusions:Left ventricular systolic function decreases and myocardial work increases in elderly hypertensive patients. Left ventricular systolic function improves after antihypertensive treatment, and the improvement of intensive antihypertensive is more obvious than that of standard antihypertensive treatment.

OBJECTIVE：To overview and analyze the current evidence of systematic reviews of drug treatment for children with tic disorder （TD），and to provide evidence-based reference for clinical practice. METHODS ：Retrieved from Medline ，Embase， CBM，CNKI，VIP and Wanfang database ，and so on ，systematic reviews about the efficacy and safety of drug treatment for TD were collected. AMSTAR- 2 tools were used to evaluate the quality of included studies ；the intervention measures ，diagnosis standard，outcome index ，the types of included studies ，main conclusion ，control measures ，effect sizes of different drug treatment were also extracted and analyzed descriptively. RESULTS ：A total of 27 systematic reviews were included ，of which 5 were medium-quality，8 low-quality and 14 very-low-quality. Meta-analysis showed that although typical psychiatric drugs could control tic symptoms ，ADR were prominent and the safety was not good ；risperidone and aripiprazole as atypical psychiatric drugs had good efficacy and safety ，and the research evidence was relatively sufficient. Clonidine as α2 adrenergic agonist could effectively control tic symptoms with fewer ADR ，especially for patients with affention deficit and hyperactivity disorder （ADHD），and research evidence was sufficient. Tiapride could effectively improve tic symptoms ，and the overall tolerance was better. Tomoxetine and methylphenidate could significantly improve the tic symptoms of tic patients with ADHD. CONCLUSIONS ：In the clinical treatment of TD in children ，ADR induced by typical antipsychotics are prominent and the safety is not good ；risperidone， aripiprazole，clonidine and tiapride have good efficacy and safety. Clonidine ，tomoxetine and methylphenidate could significantly improve tic symptoms of TD patients with ADHD. But the quality of systematic review methodology for tomoxetine and methylp- henidate is not good and further improvement is needed.

Objective:To evaluate the effects of different blood pressure control levels on left ventricular myocardial mechanics in patients with primary elderly hypertension by using two-dimensional speckle tracking imaging (2D-STI).Methods:A total of 315 elderly patients with essential hypertension diagnosed in Bethune Hospital Affiliated to Shanxi Medical University from January to June 2017 were collected and randomly divided into standard antihypertensive group and intensive antihypertensive group. The patients who were receiving antihypertensive drugs were treated with antihypertensive drugs more or less, and the patients who had not yet been treated started antihypertensive drugs therapy. The blood pressure was adjusted to the target value within 3 months (blood pressure in standard antihypertensive group was controlled at 130-150/<90 mmHg, intensive antihypertensive group was controlled at 110-130/<80 mmHg). All patients were followed up for 24 months. After 24 months of antihypertensive drugs treatment, 26 cases of lost follow-up, substandard blood pressure or poor image quality were excluded, and 289 patients were included, standard antihypertensive group ( n=148), intensive antihypertensive group ( n=141) . During the same period, 71 age-matched people without essential hypertension were selected as control group. Comprehensive echocardiography were performed in all subjects at baseline and 24 months. The longitudinal strain of the inner, middle and outer layers (GLS-endo, GLS-mid, GLS-epi) of the whole left ventricle were obtained by two-dimensional speckle tracking technique. The routine echocardiographic and left ventricular strain parameters were compared at baseline and 24 months. Results:①At baseline, the end-diastolic thickness of interventricular septum (IVSD), the end-diastolic thickness of left ventricular posterior wall (LVPWD), the end-diastolic diameter of left ventricle (LVEDD), the left ventricular mass index (LVMI), the relative wall thickness (RWT) and the ratio of early diastolic mitral flow velocity to early diastolic mitral annulus velocity(E/e′) in two antihypertensive groups were higher than those in the control group, and the levels of GLS-endo, GLS-mid and GLS-epi were lower than those in the control group(all P<0.05). There were no significant differences in routine echocardiographic parameters and strain parameters between standard antihypertensive group and intensive antihypertensive group (all P>0.05). ②After 24 months of antihypertensive drugs treatment, LVEDD and E/e′ in standard antihypertensive group and IVSD, LVPWD, LVEDD, LVMI, RWT, E/e′in intensive antihypertensive group were lower than those at baseline, and IVSD, LVMI and RWT in intensive antihypertensive group were lower than those in standard antihypertensive group (all P<0.05). ③After 24 months of antihypertensive drugs treatment, GLS-endo, GLS-mid and GLS-epi in two antihypertensive groups were higher than those at baseline, and GLS-endo, GLS-mid, GLS-epi in intensive antihypertensive group were higher than those in standard antihypertensive group(all P<0.05). Conclusions:①The left ventricular myocardial mechanics is damaged and the systolic function is decreased in elderly patients with essential hypertension; ②The myocardial mechanics is significantly improved after antihypertensive treatment, with more improvement in intensive antihypertensive treatment patients.

Objective: To analyze the image features of shear wave elastrography (SWE) in breast masses, and to evaluate their values in the differentiation of benign and malignant breast lesions. Methods: A total of 361 patients with 403 breast lesions who simultaneously underwent conventional ultrasound and SWE examination from February 2015 to January 2018 were selected. Diagnosis in all patients was confirmed by aspiration biopsy or operative pathology. The SWE images were collected and the elastic images were divided into 5 types. The SWE image features of different breast pathological types were summarized, and their values in benign and malignant breast lesion diagnoses were evaluated. Results: The main features of benign breast lesion were type Ⅰ and Ⅱ, the main features of the malignant lesion were type Ⅳ and Ⅴ, and the proportion of which were 43.6% (71/163), 37.4% (61/163), 22.1% (53/240) and 57.9% (139/240), respectively. Type Ⅲ accounted for a certain proportion in both benign and malignant lesions. The SWE image features of benign and malignant lesions were compared and a significant difference was observed (P<0.001). The type Ⅴ features were mainly observed in invasive ductal carcinoma, invasive lobular carcinoma and other types of invasive carcinoma, while the type Ⅳ features were mostly presented in ductal carcinoma in situ and mucinous carcinoma. Fibroadenoma, fibroadenosis accompanied with fibroadenoma, and fibroadenosis were featured with type Ⅰ. Both intraductal papilloma and benign phyllodes tumor were mostly type Ⅱ, while type Ⅲ and Ⅴ were more common in chronic granulomatous mastitis. When type Ⅰ and typeⅡof breast lesions were classified as benign features while type Ⅳ and Ⅴ were malignant features, the sensitivity and specificity of breast malignant lesion diagnosis were 91.2% and 84.7% by application of SWE combined with breast imaging reporting and data system (BI-RADS). The sensitivity of combined diagnosis was slightly lower than that of conventional ultrasound (P>0.05), but the specificity was significantly higher than conventional ultrasound (P<0.01). Conclusion The SWE is a simple and effective method. Combination of SWE with conventional ultrasound may improve the diagnostic differentiation of benign and malignant breast lesions.

Objective To evaluate the changes of myocardial mechanics before and after percutaneous coronary intervention ( PCI ) in patients with acute myocardial infarction ( AM I ) by ultrasonic speckle tracking technique ,and investigate the recovery of left ventricular myocardium mechanics and the effects of common complications on the improvement of myocardial mechanics . Methods Sixty‐two patients with AM I were examined by echocardiography within 12 hours ,1 week and 3 months after PCI . According to the complications the patients were divided into simple AM I group ( 21 cases ) ,AM I with diabetes mellitus group ( 21 cases) ,and AM I with hypertension group ( 20 cases) . T hirty healthy volunteers were selected as control group . Conventional echocardiographic parameters and left ventricular strain parameters were evaluated in all subjects . Results ①Left ventricular end‐diastolic diameter ( LVEDD) ,left ventricular end‐systolic diameter ( LVESD) ,left ventricular end‐diastolic volume ( LVEDV ) ,and left ventricular end‐systolic volume ( LVESV ) in each AM I group before PCI were greater than the control group ( P ＜ 0 .05 ) ,left ventricular ejection fraction ( LVEF ) , global longitudinal and circumferential endocardial ( midcardial , epicardial) strain ,and left ventricular global radial strain were smaller than the control group ( P ＜0 .05) ;the global longitudinal and circumferential endocardial ( midcardial ,epicardial ) strain ,and left ventricular global radial strain in AM I with diabetes group were less than simple AM I group and AM I with hypertension group ( P ＜0 .05) ; the global longitudinal endocardial strain in AM I with hypertension group was less than simple AM I group ( P ＜0 .05) . ② The LVESV in the third month after PCI was less than that before and during 1 week after surgery ( P ＜ 0 .05 ) ,still greater than control group ( P ＜ 0 .05 ) . LVEF ,the left ventricular global longitudinal and circumferential endocardial( midcardial ,epicardial) strain , and left ventricular global radial strain were greater than those before and during 1 week after surgery ( P＜0 .05) ,still less than control group ( P＜0 .05) ; T here was no significant difference before PCI and during 1 week after PCI about routine and strain parameters ( P＞0 .05 ) . ③ T he degree of improvement of global longitudinal and circumferential endocardial strain in AM I with diabetes group were less than those in simple AM I group( P ＜0 .05) . T he degree of improvement of global longitudinal endocardial strain in AM I with hypertension group was less than that in simple AM I group ( P ＜0 .05) . Conclusions Patients with AMI have poor myocardial mechanics before PCI ,especially those with diabetes mellitus ; myocardial mechanics improves significantly 3 months after PCI ; diabetes mellitus or hypertension affectes the improvement of myocardial mechanics in patients with AM I after PCI .

Objective To analyze the current situation of the quality of critical value management in ultrasound department,and to explore the application and effect of PDCA cycle method in critical value management.Methods The quality status of emergency data during the period from January 2015 to January 2019 after the PDCA cycle was adopted was analyzed.The PDCA cycle method was applied to improve the overall quality.The reporting rate,awareness rate,qualified rate of writing,and timely rate of clinical treatment were compared before and after the PDCA cycle was adopted to evaluate the effect of PDCA cycle method.Results From January 2015 to January 2019,the reporting rate was 96.4％,98.0％,94.5％,and 96.7％,the awareness rate of critical value was 63.2％,78.6％,84.8％,and 92.2％,the qualified rate of writing was 70.4％,77.2％,85.3％,and 94.0％,and the timely rate of clinical treatment was 50.9％,71.7％,81.1％,and 85.5％,respectively.The awareness rate,the qualified rate of writing,and the timely rate of clinical treatment were significantly improved (x2=12.464,38.184,52.926,all P ＜ 0.05).Conclusion PDCA cycle method can improve the quality of emergency management in ultrasound department.

To analyze the image features of shear wave elastrography (SWE) in breast masses, and to evaluate their values in the differentiation of benign and malignant breast lesions.Methods A total of 361 patients with 403 breast lesions who simultaneously underwent conventional ultrasound and SWE examination from February 2015 to January 2018 were selected. Diagnosis in all patients was confirmed by aspiration biopsy or operative pathology. The SWE images were collected and the elastic images were divided into 5 types. The SWE image features of different breast pathological types were summarized, and their values in benign and malignant breast lesion diagnoses were evaluated. Results The main features of benign breast lesion were type Ⅰ and Ⅱ, the main features of the malignant lesion were type Ⅳ and Ⅴ, and the proportion of which were 43.6%(71／163), 37.4%(61／163), 22.1%(53／240) and 57.9%(139／240), respectively. Type Ⅲ accounted for a certain proportion in both benign and malignant lesions. The SWE image features of benign and malignant lesions were compared and a significant difference was observed (P＜0.001). The typeⅤfeatures were mainly observed in invasive ductal carcinoma, invasive lobular carcinoma and other types of invasive carcinoma, while the typeⅣ features were mostly presented in ductal carcinoma in situ and mucinous carcinoma. Fibroadenoma, fibroadenosis accompanied with fibroadenoma, and fibroadenosis were featured with typeⅠ. Both intraductal papilloma and benign phyllodes tumor were mostly type Ⅱ, while typeⅢandⅤwere more common in chronic granulomatous mastitis. When typeⅠand typeⅡof breast lesions were classified as benign features while type Ⅳ and Ⅴ were malignant features, the sensitivity and specificity of breast malignant lesion diagnosis were 91.2% and 84.7% by application of SWE combined with breast imaging reporting and data system ( BI?RADS). The sensitivity of combined diagnosis was slightly lower than that of conventional ultrasound (P＞0.05), but the specificity was significantly higher than conventional ultrasound ( P＜0.01 ). Conclusion The SWE is a simple and effective method. Combination of SWE with conventional ultrasound may improve the diagnostic differentiation of benign and malignant breast lesions.

To analyze the image features of shear wave elastrography (SWE) in breast masses, and to evaluate their values in the differentiation of benign and malignant breast lesions.Methods A total of 361 patients with 403 breast lesions who simultaneously underwent conventional ultrasound and SWE examination from February 2015 to January 2018 were selected. Diagnosis in all patients was confirmed by aspiration biopsy or operative pathology. The SWE images were collected and the elastic images were divided into 5 types. The SWE image features of different breast pathological types were summarized, and their values in benign and malignant breast lesion diagnoses were evaluated. Results The main features of benign breast lesion were type Ⅰ and Ⅱ, the main features of the malignant lesion were type Ⅳ and Ⅴ, and the proportion of which were 43.6%(71／163), 37.4%(61／163), 22.1%(53／240) and 57.9%(139／240), respectively. Type Ⅲ accounted for a certain proportion in both benign and malignant lesions. The SWE image features of benign and malignant lesions were compared and a significant difference was observed (P＜0.001). The typeⅤfeatures were mainly observed in invasive ductal carcinoma, invasive lobular carcinoma and other types of invasive carcinoma, while the typeⅣ features were mostly presented in ductal carcinoma in situ and mucinous carcinoma. Fibroadenoma, fibroadenosis accompanied with fibroadenoma, and fibroadenosis were featured with typeⅠ. Both intraductal papilloma and benign phyllodes tumor were mostly type Ⅱ, while typeⅢandⅤwere more common in chronic granulomatous mastitis. When typeⅠand typeⅡof breast lesions were classified as benign features while type Ⅳ and Ⅴ were malignant features, the sensitivity and specificity of breast malignant lesion diagnosis were 91.2% and 84.7% by application of SWE combined with breast imaging reporting and data system ( BI?RADS). The sensitivity of combined diagnosis was slightly lower than that of conventional ultrasound (P＞0.05), but the specificity was significantly higher than conventional ultrasound ( P＜0.01 ). Conclusion The SWE is a simple and effective method. Combination of SWE with conventional ultrasound may improve the diagnostic differentiation of benign and malignant breast lesions.

Objective: To investigate the correlation between the maximum elastic modulus(Emax) of breast cancer obtained by shear-wave elastography (SWE) and immunohistochemical profiles. Methods: One hundred and sixty patients with 171 pathologically proven breast lesions were included in this study. All of them underwent conventional ultrasound and SWE examination before surgery. The Emax and maximum diameter were obtained. Histologic grade, immunohistochemical profiles ER, PR, HER-2, Ki-67 and molecular subtypes were recorded according to pathological results after surgery. The correlation between Emax and tumor size, histological grade, ER, PR, HER-2, Ki-67 and molecular subtypes were analyzed. Results: ①There was a positive correlation between the tumor size with Emax(r=0.510, P<0.05); ②The Emax of tumors with HER-2 positive expression were higher than that with HER-2 negative expression(P<0.05), the Emax of tumors with Ki67 high expression were higher than that with Ki67 low expression (P<0.05); ③There were significant differences in Emax between different molecular subtypes(P<0.05), the Emax of HER-2 positive tumor was the highest, followed by those of Luminal B tumor, triple-negative and Luminal A tumor; ④Multiple linear regression indicated that tumor size was the strongest pathologic determinate of Emax value(P<0.05), its standardized partial regression coefficient was 0.500, and HER-2 also had significant influence on Emax value of tumor(P<0.05), the standardized partial regression coefficient was 0.237. Conclusions Some prognosis immunohistochemical feature of breast cancer showed association with the Emax. Breast cancers with higher Emax at shear-wave elastography had poor prognostic features. To some extend, the value of Emax can reflect the biological characteristics of breast cancer, SWE may provide a certain imaging basis for the prognosis of breast cancer and the choice of treatment plan.

Objective: To investigate the value of shear wave elastography (SWE) in the early diagnosis of hepatic cirrhosis nephropathy. Methods: Seventy-three hepatic cirrhosis patients with normal conventional renal function were enrolled in the study, and were subdivided into Child-Pugh A group, Child-Pugh B group and Child-Pugh C group. Forty healthy volunteers were served as the control group. All the subjects underwent SWE to obtain the Young′s modulus value of left renal cortex, medulla and parenchyma which included Emax, Emin, Emean. The Young′s modulus value were compared among different groups. Results: Compared to the control group, the Emax, Emean of left renal cortex, modulus and parenchyma in hepatic cirrhosis group were higher(P<0.05). Compared to the control group, there was no significant difference in Emax, Emin and Emean of left renal cortex, medulla and parenchyma in group A(P>0.05). The Emax and Emean of left renal cortex, medulla and parenchyma were higher both in group B and group C than those in control group(P<0.05). Comparison of liver cirrhosis among groups, the Emax and Emean of left renal cortex, medulla and parenchyma in group B and group C were higher than those of group A(P<0.05), there was no significant difference between group B and group C(P>0.05). Conclusions SWE can quantitatively determine the elastic parameters of renal tissue in patients with different degrees of cirrhosis, the change of renal tissue elasticity is earlier than that of routine laboratory examination, SWE can early detect renal tissue damage in patients with liver cirrhosis.