Gestational diabetes mellitus(GDM)is a pregnancy-related complication characterized by abnormal glucose metabolism in pregnant women and has an important impact on fetal development.As a bridge between the mother and ...Gestational diabetes mellitus(GDM)is a pregnancy-related complication characterized by abnormal glucose metabolism in pregnant women and has an important impact on fetal development.As a bridge between the mother and the fetus,the placenta has nutrient transport functions,endocrine functions,etc.,and can regulate placental nutrient transport and fetal growth and development according to maternal metabolic status.Only by means of placental transmission can changes in maternal hyperglycemia affect the fetus.There are many reports on the placental pathophysiological changes associated with GDM,the impacts of GDM on the growth and development of offspring,and the prevalence of GDM in offspring after birth.Placental epigenetic changes in GDM are involved in the programming of fetal development and are involved in the pathogenesis of later chronic diseases.This paper summarizes the effects of changes in placental nutrient transport function and hormone secretion levels due to maternal hyperglycemia and hyperinsulinemia on the development of offspring as well as the participation of changes in placental epigenetic modifications due to maternal hyperglycemia in intrauterine fetal programming to promote a comprehensive understanding of the impacts of placental epigenetic modifications on the development of offspring from patients with GDM.展开更多
AIM:To quantitatively assess the ability of double contrast-enhanced ultrasound(DCUS) to detect tumor early response to pre-operative chemotherapy.METHODS:Forty-three patients with gastric cancer treated with neoadjuv...AIM:To quantitatively assess the ability of double contrast-enhanced ultrasound(DCUS) to detect tumor early response to pre-operative chemotherapy.METHODS:Forty-three patients with gastric cancer treated with neoadjuvant chemotherapy followed by curative resection between September 2011 and February 2012 were analyzed.Pre-operative chemotherapy regimens of fluorouracil + oxaliplatin or S-1 + oxaliplatin were administered in 2-4 cycles over 6-12 wk periods.All patients underwent contrast-enhanced computed tomography(CT) scan and DCUS before and after two courses of pre-operative chemotherapy.The therapeutic response was assessed by CT using the response evaluation criteria in solid tumors(RECIST 1.1) criteria.Tumor area was assessed by DCUS as enhanced appearance of gastric carcinoma due to tumor vascularity during the contrast phase as compared to the normal gastric wall.Histopathologic analysis was carried out according to the Mandard tumor regression grade criteria and used as the reference standard.Receiver operating characteristic(ROC) analysis was used to evaluate the efficacy of DCUS parameters in differentiating histopathological responders from non-responders.RESULTS:The study population consisted of 32 men and 11 women,with mean age of 59.7 ± 11.4 years.Neither age,sex,histologic type,tumor site,T stage,nor N stage was associated with pathological response.The responders had significantly smaller mean tumor size than the non-responders(15.7 ± 7.4 cm vs 33.3 ± 14.1 cm,P < 0.01).According to Mandard's criteria,27 patients were classified as responders,with 11(40.7%) showing decreased tumor size by DCUS.In contrast,only three(18.8%) of the 16 non-responders showed decreased tumor size by DCUS(P < 0.01).The area under the ROC curve was 0.64,with a 95%CI of 0.46-0.81.The effects of several cut-off points on diagnostic parameters were calculated in the ROC curve analysis.By maximizing Youden's index(sensitivity + specificity-1),the best cut-off point for distinguishing responders from non-responders was determined,which had optimal sensitivity of 62.9% and specificity of 56.3%.Using this cut-off point,the positive and negative predictive values of DCUS for distinguishing responders from non-responders were 70.8% and 47.4%,respectively.The overall accuracy of DCUS for therapeutic response assessment was 60.5%,slightly higher than the 53.5% for CT response assessment with RECIST criteria(P = 0.663).Although the advantage was not statistically significant,likely due to the small number of cases assessed.DCUS was able to identify decreased perfusion in responders who showed no morphological change by CT imaging,which can be occluded by such treatment effects as fibrosis and edema.CONCLUSION:DCUS may represent an innovative tool for more accurately predicting histopathological response to neoadjuvant chemotherapy before surgical resection in patients with locally-advanced gastric cancer.展开更多
This study was aimed to evaluate the relationship between carotid atherosclerotic plaque stability and the clinical symptoms in patients with carotid atherosclerotic plaques by using contrast-enhanced ultrasonography....This study was aimed to evaluate the relationship between carotid atherosclerotic plaque stability and the clinical symptoms in patients with carotid atherosclerotic plaques by using contrast-enhanced ultrasonography. Fifty patients with carotid atherosclerotic plaques were enrolled and examined with contrast-enhanced ultrasonography. The correlation of contrast agent enhancement of the carotid atherosclerotic plaques and the clinical symptoms was analyzed. The results showed that among the 50 patients, plaques were enhanced in the 23 patients with obvious clinical symptoms. In 27 patients without apparent clinical symptoms, plaques were enhanced sparsely in 15 patients and not enhanced in 12 patients. It was suggested that contrast-enhanced ultrasonography could be used for the examination of the microcirculation in carotid atherosclerotic plaques on real-time basis and serve as a new noninvasive approach for the assessment of stability of carotid atherosclerotic plaques.展开更多
Herein we reported 5 patients of mass-type intrahepatic cholangiocarcinoma(ICC)misdiagnosed as liver abscess by contrast-enhanced CT,the diagnosis was confirmed through contrast-enhanced ultrasound(CEUS)imaging and pa...Herein we reported 5 patients of mass-type intrahepatic cholangiocarcinoma(ICC)misdiagnosed as liver abscess by contrast-enhanced CT,the diagnosis was confirmed through contrast-enhanced ultrasound(CEUS)imaging and pathology.From January 2015 to January 2018,five patients(1 male and 4 females)were confirmed as ICC by surgical resection or biopsy in Tongde Hospital of Zhejiang Province,with average age of(74.2±5.6)years.These 5 ICC patients were misdiagnosed as liver abscess by contrast-enhanced CT and later on。展开更多
BACKGROUND As ultrasound-guided percutaneous liver biopsy(PLB)has become a standard and important method in the management of liver disease in our country,a periodical audit of the major complications is needed.AIM To...BACKGROUND As ultrasound-guided percutaneous liver biopsy(PLB)has become a standard and important method in the management of liver disease in our country,a periodical audit of the major complications is needed.AIM To determine the annual incidence of major complications following ultrasoundguided PLB and to identify variables that are significantly associated with an increased risk of major complications.METHODS A total of 1857 consecutive cases of PLB were included in our hospital from January 2021 to December 2021.The major complication rate and all-cause 30-d mortality rate were determined.Multivariate analyses were performed by logistic regression to investigate the risk factors associated with major complications and all-cause 30-d mortality following ultrasound-guided PLB.RESULTS In this audit of 1857 liver biopsies,10 cases(0.53%)of major complications occurred following ultrasound-guided PLB.The overall all-cause mortality rate at 30 d after PLB was 0.27%(5 cases).Two cases(0.11%)were attributed to major hemorrhage within 7 d after liver biopsy.Fibrinogen less than 2 g/L[odds ratio(OR):17.226;95%confidence interval(CI):2.647-112.102;P=0.003],post-biopsy hemoglobin level(OR:0.963;95%CI:0.942-0.985;P=0.001),obstructive jaundice(OR:6.698;95%CI:1.133-39.596;P=0.036),application of anticoagulants/antiplatelet medications(OR:24.078;95%CI:1.678-345.495;P=0.019)and age(OR:1.096;95%CI:1.012-1.187;P=0.025)were statistically associated with the incidence of major complications after PLB.CONCLUSION In conclusion,the results of this annual audit confirmed that ultrasound-guided PLB can be performed safely,with a major complication rate within the accepted range.Strict patient selection and peri-biopsy laboratory assessment are more important than procedural factors for optimizing the safety outcomes of this procedure.展开更多
BACKGROUND Impaired interstitial cells of Cajal(ICCs)are central to the pathophysiology of acute cholecystitis(AC).Common bile duct ligation is a common model of AC,producing acute inflammatory changes and decrease in...BACKGROUND Impaired interstitial cells of Cajal(ICCs)are central to the pathophysiology of acute cholecystitis(AC).Common bile duct ligation is a common model of AC,producing acute inflammatory changes and decrease in gallbladder contractility.AIM To investigate the origin of slow wave(SW)in the gallbladder and the effect of ICCs on gallbladder contractions during the process of AC.METHODS Methylene blue(MB)with light was used to establish selective impaired ICCs gallbladder tissue.Gallbladder motility was assessed using the frequency of SW and gallbladder muscle contractility in vitro in normal control(NC),AC12h,AC24h,and AC48h groups of guinea pigs.Hematoxylin and eosin and Massonstained gallbladder tissues were scored for inflammatory changes.ICCs pathological changes alterations were estimated using immunohistochemistry and transmission electron microscopy.The alterations of c-Kit,α-SMA,cholecystokinin A receptor(CCKAR),and connexin 43(CX43)were assessed using Western blot.RESULTS Impaired ICCs muscle strips resulted in the decrease in gallbladder SW frequency and contractility.The frequency of SW and gallbladder contractility were significantly lower in the AC12h group.Compared with the NC group,the density and ultrastructure of ICCs were remarkably impaired in the AC groups,especially in the AC12h group.The protein expression levels of c-Kit were significantly decreased in the AC12h group,while CCKAR and CX43 protein expression levels were significantly decreased in the AC48h group.CONCLUSION Loss ICCs could lead to a decrease in gallbladder SW frequency and contractility.The density and ultrastructure of ICCs were clearly impaired in the early stage of AC,while CCKAR and CX43 were significantly reduced at end stage.展开更多
Objective: To investigate the correlation of small hepatocellular carcinoma ultrasonography parameters with the expression of oncogenes and angiogenesis genes. Methods: A total of 61 patients with small hepatocellular...Objective: To investigate the correlation of small hepatocellular carcinoma ultrasonography parameters with the expression of oncogenes and angiogenesis genes. Methods: A total of 61 patients with small hepatocellular carcinoma who were diagnosed in this hospital between July 2015 and May 2017 were selected as small hepatocellular carcinoma group, and 48 patients with hepatolithiasis were selected as hepatolithiasis group. The ultrasonography parameters of the two groups were recorded and the expression levels of oncogenes and angiogenesis genes in the surgical lesion tissues were detected. Pearson test was used to evaluate the correlation of ultrasonography parameters with the expression of oncogenes and angiogenesis genes. Results: IMAX level in small hepatocellular carcinoma group was higher than that in hepatolithiasis group while TTP and mTT levels were lower than those in hepatolithiasis group;oncogenes C-myc, N-ras, PIK3CA, RMP, Bmil and pim-3 mRNA expression in lesion tissues were higher than those of hepatolithiasis group;angiogenesis genes VEGF, Ang-1, Tie-2 and MACC1 mRNA expression in lesion tissues were higher than those of hepatolithiasis group while ARH1 mRNA expression was lower than that of hepatolithiasis group. Pearson test showed that the ultrasonography parameters IMAX, TTP and mTT levels in patients with small hepatocellular carcinoma were directly correlated to the expression of oncogenes and angiogenesis genes in lesions. Conclusion: The ultrasonography parameters of patients with small hepatocellular carcinoma are significantly different from those of patients with benign diseases, and the specific parameter levels are directly correlated with the malignancy of cancer cells.展开更多
Objective To explore the optimal administration route of tranexamic acid(TXA)in shoulder arthroscopic surgery.Methods Patients undergoing arthroscopic rotator cuff repair were randomly divided into four groups:control...Objective To explore the optimal administration route of tranexamic acid(TXA)in shoulder arthroscopic surgery.Methods Patients undergoing arthroscopic rotator cuff repair were randomly divided into four groups:control group(without TXA treatment),intravenous group(TXA was intravenously administered 10 minutes before surgery),irrigation group(TXA was added to the irrigation fluid during subacromial decompression and acromioplasty),and intravenous plus irrigation group(TXA was applied both intravenously and via intra-articular irrigation).The primary outcome was visual clarity assessed with visual analog scale(VAS)score,and the secondary outcomes included irrigation fluid consumption and time to subacromial decompression and acromioplasty procedure.Results There were 134 patients enrolled in the study,including 33 in the control group,35 in the intravenous group,32 in the irrigation group,and 34 in the intravenous plus irrigation group.The median and interquartile range of VAS scores for the intravenous,irrigation,and intravenous plus irrigation groups were 2.70(2.50,2.86)(Z=-3.677,P=0.002),2.67(2.50,2.77)(Z=-3.058,P<0.001),and 2.91(2.75,3.00)(Z=-6.634,P<0.001),respectively,significantly higher than that of the control group[2.44(2.37,2.53)].Moreover,the control group consumed more irrigation fluid than the intravenous group,irrigation group,and intravenous plus irrigation group(all P<0.05).The intravenous plus irrigation group consumed less irrigation fluid than either the intravenous group or the irrigation group(both P<0.001).There was no difference in subacromial decompression and acromioplasty operative time among the four groups.Conclusion TXA applied both topically and systematically can improve intraoperative visual clarity,and the combined application is more effective.展开更多
BACKGROUND Ochronosis,also known as alkaptonuria,is a rare autosomal recessive selfmetabolic disease arising from deficiency of homogentisate 1,2 dioxygenase enzyme.It affects several organs and muscoskeletal structur...BACKGROUND Ochronosis,also known as alkaptonuria,is a rare autosomal recessive selfmetabolic disease arising from deficiency of homogentisate 1,2 dioxygenase enzyme.It affects several organs and muscoskeletal structures.We herein report a case of a patient who presented with severe hip arthropathy complicated with late stage ochronosis.CASE SUMMARY A 56-year-old male patient was admitted in our department in 2019 with complaints of chronic low backache and left hip pain.After the required investigations were done,lumbar disc herniation and severe hip arthritis were the initial diagnosis.A total left hip arthroplasty was performed.Ochronotic osteoarthritis was only obtained post-surgery as confirmatory diagnosis.He was again admitted mid 2022 with the same complaints on the right hip.Subsequently,he underwent a total right hip arthroplasty.Post-operative recovery and follow-ups were deemed very satisfactory.CONCLUSION Ochronosis is an unusual diagnosis for a patient who presents with typical hip arthritis.Thus,unless meticulous history taking and advanced laboratory tests,the diagnosis can easily be missed by surgeons.展开更多
Backgrounds:Percutaneous ultrasound(US)and endoscopic ultrasound(EUS)-guided pancreatic biopsies are widely accepted in the diagnosis of pancreatic diseases.Studies comparing the diagnostic performance of US-and EUS-g...Backgrounds:Percutaneous ultrasound(US)and endoscopic ultrasound(EUS)-guided pancreatic biopsies are widely accepted in the diagnosis of pancreatic diseases.Studies comparing the diagnostic performance of US-and EUS-guided pancreatic biopsies are lacking.This study aimed to evaluate and compare the diagnostic yields of US-and EUS-guided pancreatic biopsies and identify the risk factors for inconclusive biopsies.Methods:Of the 1074 solid pancreatic lesions diagnosed from January 2017 to February 2021 in our center,275 underwent EUS-guided fine needle aspiration(EUS-FNA),and 799 underwent US-guided core needle biopsy(US-CNB/FNA).The outcomes were inconclusive pathological biopsy,diagnostic accuracy and the need for repeat biopsy.All of the included factors and diagnostic performances of both USCNB/FNA and EUS-FNA were compared,and the independent predictors for the study outcomes were identified.Results:The diagnostic accuracy was 89.8%for EUS-FNA and 95.2%for US-CNB/FNA(P=0.001).Biopsy under EUS guidance[odds ratio(OR)=1.808,95%confidence interval(CI):1.083-3.019;P=0.024],lesion size<2 cm(OR=2.069,95%CI:1.145-3.737;P=0.016),hypoechoic appearance(OR=0.274,95%CI:0.097-0.775;P=0.015)and non-pancreatic ductal adenocarcinoma carcinoma(PDAC)diagnosis(OR=2.637,95%CI:1.563-4.449;P<0.001)were identified as factors associated with inconclusive pathological biopsy.Hypoechoic appearance(OR=0.236,95%CI:0.064-0.869;P=0.030),lesions in the uncinate process of the pancreas(OR=3.506,95%CI:1.831-6.713;P<0.001)and non-PDAC diagnosis(OR=2.622,95%CI:1.278-5.377;P=0.009)were independent predictors for repeat biopsy.Biopsy under EUS guidance(OR=2.024,95%CI:1.195-3.429;P=0.009),lesions in the uncinate process of the pancreas(OR=1.776,95%CI:1.014-3.108;P=0.044)and hypoechoic appearance(OR=0.127,95%CI:0.047-0.347;P<0.001)were associated with diagnostic accuracy.Conclusions:In conclusion,both percutaneous US-and EUS-guided biopsies of solid pancreatic lesions are safe and effective;though the diagnostic accuracy of EUS-FNA is inferior to US-CNB/FNA.A tailored pancreatic biopsy should be considered a part of the management algorithm for the diagnosis of solid pancreatic disease.展开更多
BACKGROUND Ultrasound is a vital tool for the diagnosis and management of colorectal cancer(CRC).Contrast-enhanced ultrasound(CEUS)is a non-invasive,safe,and cost-effective method for evaluating tumour blood vessels,t...BACKGROUND Ultrasound is a vital tool for the diagnosis and management of colorectal cancer(CRC).Contrast-enhanced ultrasound(CEUS)is a non-invasive,safe,and cost-effective method for evaluating tumour blood vessels,that play a crucial role in tumour growth and progression.AIM To explore CEUS’s role in the quantitative evaluation of CRC blood vessels and their correlation with angiogenesis markers and prognosis.METHODS This study prospectively enrolled 100 patients with CRC confirmed by histo-pathology.All patients received preoperative CEUS examinations.Quantitative parameters,such as peak intensity(PI),time to peak(TTP),and area under the curve(AUC),were derived from time-intensity curve(TIC)analysis.Tumour tissue samples were obtained during surgery and examined immunohistochem-ically to assess the expression of angiogenesis markers,including vascular endo-thelial growth factor(VEGF)and microvessel density(MVD).The correlation between CEUS parameters,angiogenesis markers,and clinicopathological features was evaluated using appropriate statistical tests.RESULTS Quantitative CEUS parameters(PI,TTP,and AUC)showed significant correlations with VEGF expression(P<0.001)and MVD(P<0.001),indicating a strong link between tumour blood vessels and angiogenesis.Increased PI,reduced TTP,and expanded AUC values were significantly related to higher tumour stage(P<0.001),lymph node metastasis(P<0.001),and distant metastasis(P<0.001).Furthermore,these parameters were recognized as independent predictors of overall survival and disease-free survival in multivariate analysis(P<0.001).CONCLUSION CEUS has a high potential in guiding treatment planning and predicting patient outcomes.However,more com-prehensive,multicentre studies are required to validate the clinical utility of CEUS in CRC management.展开更多
AIM:To investigate the prevalence and risk factors of polypoid lesions of the gallbladder (PLGs) in petrochemical employees in Ningbo, Zhejiang Province, China. METHODS:All active and retired employees aged 20-90 year...AIM:To investigate the prevalence and risk factors of polypoid lesions of the gallbladder (PLGs) in petrochemical employees in Ningbo, Zhejiang Province, China. METHODS:All active and retired employees aged 20-90 years (n = 11098) of a refinery and chemical plant in eastern China were requested to participate in a health survey. The participants were subjected to interview, physical examination, laboratory assessments and ultrasonography. All the participants were invitedto have a physical examination after a face-to-face interview. Fasting blood samples were obtained from the antecubital vein, and the samples were used for the analysis of biochemical values. Abdominal ultrasonography was conducted. RESULTS:A total of 10461 (7331 men and 3130 women) current and former petrochemical employees attended for screening. The overall prevalence of postcholecystectomy, gallstones and PLGs was 0.9%, 5.2% and 7.4%, respectively. Compared with the increased prevalence of either gallstones or post-cholecystectomy in older persons, PLGs were more common in the middle-aged, peaking in those aged 40-59 years. Excluding the patients with gallstones, gallstones mixed with PLGs, or those who had undergone cholecystectomy, in the remaining 9828 participants, the prevalence of PLGs in men (8.9%) was significantly higher than that in women (5.5%, P < 0.001). The analyzed risk factors with increased OR for the development of PLGs were male gender (OR = 1.799, P < 0.001), age ≥ 30 years (OR = 2.699, P < 0.001) and hepatitis B surface antigen (HBsAg) positivity (OR = 1.374, P = 0.006). CONCLUSION:PLGs are not rare among Chinese petrochemical employees. Male gender, HBsAg positivity, and middle age are risk factors for developing PLGs.展开更多
AIM: To investigate the prevalence and risk factors of polypoid lesions of gallbladder (PLG) among the health examinees in the Shanghai region, China. METHODS: A total of 11 816 subjects who underwent health examinati...AIM: To investigate the prevalence and risk factors of polypoid lesions of gallbladder (PLG) among the health examinees in the Shanghai region, China. METHODS: A total of 11 816 subjects who underwent health examinations in our hospital between August 2010 and February 2011 were analyzed retrospectively. Among them, there were 7174 men and 4642 women. PLG was diagnosed by the real-time ultrasonography. Those with the body mass index (BMI) ≥ 28 were considered to be obese. Blood biochemical indices were detected with the fully automatic biochemical analyzer and hepatitis B surface antigen (HBsAg) was tested by the automated enzyme immunoassay. The correlations between the prevalence of PLG and age, sex, BMI, serum cholesterol (T-Cho), triglycerides (TG),blood sugar, HBsAg, high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), gallstone and fatty liver were investigated. After univariate analysis of 11 variables, stepwise logistic regression analysis was performed to explore the risk factors of PLG. RESULTS: There was a significant difference in sex, T-Cho, HBsAg, HDL-C, LDL-C and fatty liver between the PLG-positive group and the PLG-negative group (332/163 vs 6842/4479, P = 0.003; 22/473 vs 295/11 026, P =0.013; 92/403 vs 993/10 328, P = 0.001; 47/448 vs 332/10 989, P = 0.001; 32/463 vs 381/10 940, P = 0.001; 83/412 vs 3260/8061, P = 0.001). No significant difference was found in the age, BMI, TG, blood sugar and gallstone between the two groups (47.3 ± 26 vs 45.1 ± 33, P = 0.173; 59/436 vs 1097/10 224, P = 0.102; 52/443 vs 982/10 339, P = 0.158; 17/478 vs 295/11 026, P = 0.26; 24/471 vs 395/10 926, P = 0.109). Logistic regression analysis showed that the sex, HBsAg and HDL-C were independent risk factors for the development of PLG in a descending order of HDL-C > HBsAg > sex. CONCLUSION: In healthy people, the male gender, positive HBsAg, and low HDL-C confer higher risks of PLG development.展开更多
AIM:To investigate the prevalence of fatty liver discovered upon physical examination of Chinese patients and determine the associated clinical characteristics.METHODS:A total of 3433 consecutive patients who received...AIM:To investigate the prevalence of fatty liver discovered upon physical examination of Chinese patients and determine the associated clinical characteristics.METHODS:A total of 3433 consecutive patients who received physical examinations at the Huangpu Division of the First Affiliated Hospital at Sun Yat-sen University in Guangzhou,China from June 2010 to December2010 were retrospectively enrolled in the study.Results of biochemical tests,abdominal ultrasound,electrocardiography,and chest X-ray were collected.The diagnosis of fatty liver was made if a patient met any two of the three following ultrasonic criteria:(1)liver and kidney echo discrepancy and presence of an increased liver echogenicity(bright);(2)unclear intrahepatic duct structure;and(3)liver far field echo decay.RESULTS:The study population consisted of 2201males and 1232 females,with a mean age of 37.4±12.8 years.When all 3433 patients were considered,the overall prevalence of hyperlipidemia was 38.1%,of fatty liver was 26.0%,of increased alanine aminotransferase(ALT)and/or aspartate aminotransferase(AST)levels was 11.9%,of gallstone was 11.4%,of hyperglycemia was 7.3%,of hypertension was 7.1%,and of hyperuricemia was 6.2%.Of the 2605 patients who completed the abdominal ultrasonography exam,677(26.0%)were diagnosed with fatty liver and the prevalence was higher in males(32.5%vs females:15.3%,P<0.001).The overall prevalence of fatty liver increased with age,with the peak prevalence(39.5%)found in the 60 to 70-year-old age group.Among patients between the ages of 18 to 50-year-old,the prevalence of fatty liver was significantly higher in males(20.2%vs females:8.7%,P<0.001);the difference in prevalence between the two sexes in patients>50-year-old did not reach statistical significance.Only 430 of the patients diagnosed with fatty liver had complete information;among those,increased ALT and/or AST levels were detected in only 30%,with all disturbances being mild or moderate.In these 430 patients,the overall prevalence of hypertriglyceridemia was 31.4%,of mixed type hyperlipidemia was 20.9%,of hypercholesterolemia was 12.3%,of hyperglycemia was 17.6%,of hypertension was 16.0%,of hyperuricemia was 15.3%,and of gallstone was 14.4%.Again,the prevalences of hypertriglyceridemia and hyperuricemia were higher in males(hypertriglyceridemia,36.0%vs females:12.0%,P<0.05;hyperuricemia,17.3%vs females:7.2%,P<0.05);in contrast,however,the prevalences of mixed type hyperlipidemia and hypercholesterolemia was higher in females(mixed type hyperlipidemia,18.7% vs females:30.1%,P<0.05,hypercholesterolemia,9.5%vs females:24.1%,P<0.05).Finally,comparison of the fatty liver group to the non-fatty liver group showed that prevalences of hyperlipidemia,hyperglycemia,hypertension,and hyperuricemia were higher in the former(all P<0.01).CONCLUSION:A high prevalence of fatty liver is detected upon physical examination in Guangzhou,and the primary associated clinical findings are hyperlipidemia,hyperglycemia,hypertension,and hyperuricemia.展开更多
Left ventricular remodeling index (LVRI) was assessed in patients with hypertensive heart disease (HHD) and coronary artery disease (CAD) by real-time three-dimensional echocardi-ography (RT3DE). RT3DE data of 18 pati...Left ventricular remodeling index (LVRI) was assessed in patients with hypertensive heart disease (HHD) and coronary artery disease (CAD) by real-time three-dimensional echocardi-ography (RT3DE). RT3DE data of 18 patients with HHD, 20 patients with CAD and 22 normal con-trols (NC) were acquired. Left ventricular end-diastolic volume (EDV) and left ventricular end-diastolic epicardial volume (EDVepi ) were detected by RT3DE and two-dimensional echocar-diography Simpson biplane method (2DE). LVRI (left ventricular mass /EDV) was calculated and compared. The results showed that LVRI measurements detected by RT3DE and 2DE showed sig-nificant differences inter-groups (P<0.01). There was no significant difference in NC group (P>0.05), but significant difference in HHD and CAD intra-group (P<0.05). There was good positive correla-tions between LVRI detected by RT3DE and 2DE in NC and HHD groups (r=0.69, P<0.01; r=0.68, P<0.01), but no significant correlation in CAD group (r=0.30, P>0.05). It was concluded that LVRI derived from RT3DE as a new index for evaluating left ventricular remodeling can provide more su-periority to LVRI derived from 2DE.展开更多
Objective To investigate diagnostic efficacy of transvaginal three-dimensional hysterosalpingo-contrast sonography(3D-Hy Co Sy) in assessing tubal patency with chromolaporoscopy. Methods A total of 157 infertile women...Objective To investigate diagnostic efficacy of transvaginal three-dimensional hysterosalpingo-contrast sonography(3D-Hy Co Sy) in assessing tubal patency with chromolaporoscopy. Methods A total of 157 infertile women underwent 3D-Hy Co Sy to evaluate tubal patency. Among these patients, 39 patients were also examined by chromolaporoscopy. The concordance of the two clinical assessment methods was analyzed by the Kappa coefficient test. Results Among the 306 oviducts examined by 3D-Hy Co Sy, 99(32.4%) were patent, 126(41.2%) partially obstructed, and 81(26.5%) completely obstructed. Diagnostic results with 3D-Hy Co Sy were not statistically different from those obtained in the 39 women(78 oviducts) who also underwent chromolaporoscopy, and the two methods showed a high concordance(κ=0.747, P=0.000). The 3D-Hy Co Sy procedure had a sensitivity of 84.8%(28/33), a specificity of 96.2%(25/26), and positive and negative predictive values of 93.3%(28/30) and 86.2%(25/29) respectively. Conclusion Transvaginal 3D-Hy Co Sy can accurately reveal the spatial path and morphology of the oviduct and is a safe and effective method to evaluate tubal patency.展开更多
AIM:To investigate the effects of carbon dioxide (CO2) and helium insufflation administered at different pressures on the growth and apoptosis of cultured human gastric cancer cells. METHODS:The gastric cancer cells M...AIM:To investigate the effects of carbon dioxide (CO2) and helium insufflation administered at different pressures on the growth and apoptosis of cultured human gastric cancer cells. METHODS:The gastric cancer cells MKN-45 were exposed to a CO2 and helium environment maintained at different pressures (0, 5, 10 and 15 mmHg). The cells were exposed to simulated pneumoperitoneum environment for 4 h, and pH of the culture media was measured after it was moved to normal conditions for 0, 2, 4, 6 and 8 h. Proliferation viability of MKN-45 was examined by 3-4,5Dimethylthiazol-2-yl,5-diphenyltetrazolium bromide or triazolyl blue (MTT) assay after it was moved to normal conditions. Apoptotic ratio was measured by Annexin V-FITC/PI double labelled staining. RESULTS:The pH of media was acid and recovered to normal after 4 h in the CO2 group while it was basic in the helium group. There was no difference between CO2 groups (under 10 mmHg ) and control group (P > 0.05) in the proliferative viability of the cells. The cultured cells exposed to 15 mmHg CO2 environment grew more slowly than control group from 4 to 7 d (P < 0.01 ) while there was no difference from 1 to 3 d (P > 0.05). The proliferative viability in helium group was not obviously different from the control group (P > 0.05). The apoptotic ratio of the cultured cells was markedly higher than that of the control group (P < 0.01) at 10 and 15 mmHg CO2 insufflation pressure. In helium group, the apoptotic ratio was not obviously different from the control group (P > 0.05). CONCLUSION:There is no obvious effect in the proliferation and apoptosis of MKN-45 cells under 10 mmHg CO2 insufflation pressure and helium in any pressure. Fifteen mmHg CO2 insufflation pressure can inhibit the proliferation of the cells and improve apoptosis.展开更多
AIM: To establish a kind of standardization of the clinical chemotherapeutic prototypes for unresectable hepatocellular carcinomas (HCC).METHODS: 10-Hydroxycamptothecin (HCPT) was applied through transcatheter arteria...AIM: To establish a kind of standardization of the clinical chemotherapeutic prototypes for unresectable hepatocellular carcinomas (HCC).METHODS: 10-Hydroxycamptothecin (HCPT) was applied through transcatheter arterial embolization (TAE) to HCC patients who were categorized into three groups: (1) test group: treatment with HCPT twice (HCPT d1 and 14) through TAE and portal venous embolization. (2) Control Ⅰ: treatment with anticancer drugs without HCPT. (3) Control Ⅱ: treatment with HCPT as a major component in anticancer drugs once (HCPT d1). A set of comparisons between test groups and control Ⅰ and Ⅱ groups were performed before and after the treatment to study the effectiveness of each treatment, in terms of tumor volumes, dynamic variations in serum alpha-fetoprotein (AFP), gamma-glutamyl transferase hepatoma-specific band (GGT-Ⅱ), patient survival and adverse events.RESULTS: The general effectiveness rate of the test group reached 62.1% (72/116), remarkably higher than that of control Ⅰ (32.1%, 40/124) and control Ⅱ (54.7%, 47/56),(P＜0.01 and P＜0.05, respectively). Especially, the reduction rate or disappearance of the portal vein tumor emboli was as high as 88.4% (61/69) in the test group, in contrast with 13.9% (10/72) in control Ⅰ and 35.9% (18/51) in control Ⅱ (P＜0.01 and P＜0.01, respectively). After treatment, AFP decreased or turned to negative levels at 52.3% (34/65)in control I, 67.3% (35/52) in control Ⅱ, and 96.8% (60/62)in the test group. Also GGT-Ⅱ declined or became negative at 37.8% (28/74) in control Ⅰ, 69.5% (57/82) in control Ⅱ,and 94.7% (89/94) in test group (P＜0.01 and P＜0.05,respectively).CONCLUSION: We have designed a good protocol (test group) to treat HCC with excellent advantages of high efficiency, low cost, low toxicity and low adverse events and easy application. It could be recommended as one of the standardizations for HCC treatment in clinical practice.展开更多
AIM: To establish a new model for predicting survival in acute-on-chronic liver failure(ACLF) patients treated with an artificial liver support system. METHODS: One hundred and eighty-one ACLF patients who were admitt...AIM: To establish a new model for predicting survival in acute-on-chronic liver failure(ACLF) patients treated with an artificial liver support system. METHODS: One hundred and eighty-one ACLF patients who were admitted to the hospital from January 1, 2012 to December 31, 2014 and were treated with an artificial liver support system were enrolled in this retrospective study, including a derivation cohort(n = 113) and a validation cohort(n = 68). Laboratory parameters at baseline were analyzed and correlatedwith clinical outcome. In addition to standard medical therapy, ACLF patients underwent plasma exchange(PE) or plasma bilirubin adsorption(PBA) combined with plasma exchange. For the derivation cohort, KaplanMeier methods were used to estimate survival curves, and Cox regression was used in survival analysis to generate a prognostic model. The performance of the new model was tested in the validation cohort using a receiver-operator curve.RESULTS: The mean overall survival for the derivation cohort was 441 d(95%CI: 379-504 d), and the 90- and 270-d survival probabilities were 70.3% and 58.3%, respectively. The mean survival times of patients treated with PBA plus PE and patients treated with PE were 531 d(95%CI: 455-605 d) and 343 d(95%CI: 254-432 d), respectively, which were significantly different(P = 0.012). When variables with bivariate significance were selected for inclusion into the multivariate Cox regression model, number of complications, age, scores of the model for end-stage liver disease(MELD) and type of artificial liver support system were defined as independent risk factors for survival in ACLF patients. This new prognostic model could accurately discriminate the outcome of patients with different scores in this cohort(P < 0.001). The model also had the ability to assign a predicted survival probability for individual patients. In the validation cohort, the new model remained better than the MELD.CONCLUSION: A novel model was constructed to predict prognosis and accurately discriminate survival in ACLF patients treated with an artificial liver support system.展开更多
文摘Gestational diabetes mellitus(GDM)is a pregnancy-related complication characterized by abnormal glucose metabolism in pregnant women and has an important impact on fetal development.As a bridge between the mother and the fetus,the placenta has nutrient transport functions,endocrine functions,etc.,and can regulate placental nutrient transport and fetal growth and development according to maternal metabolic status.Only by means of placental transmission can changes in maternal hyperglycemia affect the fetus.There are many reports on the placental pathophysiological changes associated with GDM,the impacts of GDM on the growth and development of offspring,and the prevalence of GDM in offspring after birth.Placental epigenetic changes in GDM are involved in the programming of fetal development and are involved in the pathogenesis of later chronic diseases.This paper summarizes the effects of changes in placental nutrient transport function and hormone secretion levels due to maternal hyperglycemia and hyperinsulinemia on the development of offspring as well as the participation of changes in placental epigenetic modifications due to maternal hyperglycemia in intrauterine fetal programming to promote a comprehensive understanding of the impacts of placental epigenetic modifications on the development of offspring from patients with GDM.
基金Supported by National Science Foundation of China,No. 81101834Projects of the Health Bureau of Zhejiang Province, No.2009QN011 and 2011KYB037
文摘AIM:To quantitatively assess the ability of double contrast-enhanced ultrasound(DCUS) to detect tumor early response to pre-operative chemotherapy.METHODS:Forty-three patients with gastric cancer treated with neoadjuvant chemotherapy followed by curative resection between September 2011 and February 2012 were analyzed.Pre-operative chemotherapy regimens of fluorouracil + oxaliplatin or S-1 + oxaliplatin were administered in 2-4 cycles over 6-12 wk periods.All patients underwent contrast-enhanced computed tomography(CT) scan and DCUS before and after two courses of pre-operative chemotherapy.The therapeutic response was assessed by CT using the response evaluation criteria in solid tumors(RECIST 1.1) criteria.Tumor area was assessed by DCUS as enhanced appearance of gastric carcinoma due to tumor vascularity during the contrast phase as compared to the normal gastric wall.Histopathologic analysis was carried out according to the Mandard tumor regression grade criteria and used as the reference standard.Receiver operating characteristic(ROC) analysis was used to evaluate the efficacy of DCUS parameters in differentiating histopathological responders from non-responders.RESULTS:The study population consisted of 32 men and 11 women,with mean age of 59.7 ± 11.4 years.Neither age,sex,histologic type,tumor site,T stage,nor N stage was associated with pathological response.The responders had significantly smaller mean tumor size than the non-responders(15.7 ± 7.4 cm vs 33.3 ± 14.1 cm,P < 0.01).According to Mandard's criteria,27 patients were classified as responders,with 11(40.7%) showing decreased tumor size by DCUS.In contrast,only three(18.8%) of the 16 non-responders showed decreased tumor size by DCUS(P < 0.01).The area under the ROC curve was 0.64,with a 95%CI of 0.46-0.81.The effects of several cut-off points on diagnostic parameters were calculated in the ROC curve analysis.By maximizing Youden's index(sensitivity + specificity-1),the best cut-off point for distinguishing responders from non-responders was determined,which had optimal sensitivity of 62.9% and specificity of 56.3%.Using this cut-off point,the positive and negative predictive values of DCUS for distinguishing responders from non-responders were 70.8% and 47.4%,respectively.The overall accuracy of DCUS for therapeutic response assessment was 60.5%,slightly higher than the 53.5% for CT response assessment with RECIST criteria(P = 0.663).Although the advantage was not statistically significant,likely due to the small number of cases assessed.DCUS was able to identify decreased perfusion in responders who showed no morphological change by CT imaging,which can be occluded by such treatment effects as fibrosis and edema.CONCLUSION:DCUS may represent an innovative tool for more accurately predicting histopathological response to neoadjuvant chemotherapy before surgical resection in patients with locally-advanced gastric cancer.
文摘This study was aimed to evaluate the relationship between carotid atherosclerotic plaque stability and the clinical symptoms in patients with carotid atherosclerotic plaques by using contrast-enhanced ultrasonography. Fifty patients with carotid atherosclerotic plaques were enrolled and examined with contrast-enhanced ultrasonography. The correlation of contrast agent enhancement of the carotid atherosclerotic plaques and the clinical symptoms was analyzed. The results showed that among the 50 patients, plaques were enhanced in the 23 patients with obvious clinical symptoms. In 27 patients without apparent clinical symptoms, plaques were enhanced sparsely in 15 patients and not enhanced in 12 patients. It was suggested that contrast-enhanced ultrasonography could be used for the examination of the microcirculation in carotid atherosclerotic plaques on real-time basis and serve as a new noninvasive approach for the assessment of stability of carotid atherosclerotic plaques.
基金supported by a grant from the Major Research Project of Natural Science Foundation of Zhejiang Province(NO.LSD19H180001)。
文摘Herein we reported 5 patients of mass-type intrahepatic cholangiocarcinoma(ICC)misdiagnosed as liver abscess by contrast-enhanced CT,the diagnosis was confirmed through contrast-enhanced ultrasound(CEUS)imaging and pathology.From January 2015 to January 2018,five patients(1 male and 4 females)were confirmed as ICC by surgical resection or biopsy in Tongde Hospital of Zhejiang Province,with average age of(74.2±5.6)years.These 5 ICC patients were misdiagnosed as liver abscess by contrast-enhanced CT and later on。
文摘BACKGROUND As ultrasound-guided percutaneous liver biopsy(PLB)has become a standard and important method in the management of liver disease in our country,a periodical audit of the major complications is needed.AIM To determine the annual incidence of major complications following ultrasoundguided PLB and to identify variables that are significantly associated with an increased risk of major complications.METHODS A total of 1857 consecutive cases of PLB were included in our hospital from January 2021 to December 2021.The major complication rate and all-cause 30-d mortality rate were determined.Multivariate analyses were performed by logistic regression to investigate the risk factors associated with major complications and all-cause 30-d mortality following ultrasound-guided PLB.RESULTS In this audit of 1857 liver biopsies,10 cases(0.53%)of major complications occurred following ultrasound-guided PLB.The overall all-cause mortality rate at 30 d after PLB was 0.27%(5 cases).Two cases(0.11%)were attributed to major hemorrhage within 7 d after liver biopsy.Fibrinogen less than 2 g/L[odds ratio(OR):17.226;95%confidence interval(CI):2.647-112.102;P=0.003],post-biopsy hemoglobin level(OR:0.963;95%CI:0.942-0.985;P=0.001),obstructive jaundice(OR:6.698;95%CI:1.133-39.596;P=0.036),application of anticoagulants/antiplatelet medications(OR:24.078;95%CI:1.678-345.495;P=0.019)and age(OR:1.096;95%CI:1.012-1.187;P=0.025)were statistically associated with the incidence of major complications after PLB.CONCLUSION In conclusion,the results of this annual audit confirmed that ultrasound-guided PLB can be performed safely,with a major complication rate within the accepted range.Strict patient selection and peri-biopsy laboratory assessment are more important than procedural factors for optimizing the safety outcomes of this procedure.
基金Supported by the Pudong New Area Clinical Traditional Chinese Medicine of Top Discipline Project,No.PDZY-2018-0603 and the Featured Clinical Discipline Project of Shanghai Pudong,No.PWYts2021-06.
文摘BACKGROUND Impaired interstitial cells of Cajal(ICCs)are central to the pathophysiology of acute cholecystitis(AC).Common bile duct ligation is a common model of AC,producing acute inflammatory changes and decrease in gallbladder contractility.AIM To investigate the origin of slow wave(SW)in the gallbladder and the effect of ICCs on gallbladder contractions during the process of AC.METHODS Methylene blue(MB)with light was used to establish selective impaired ICCs gallbladder tissue.Gallbladder motility was assessed using the frequency of SW and gallbladder muscle contractility in vitro in normal control(NC),AC12h,AC24h,and AC48h groups of guinea pigs.Hematoxylin and eosin and Massonstained gallbladder tissues were scored for inflammatory changes.ICCs pathological changes alterations were estimated using immunohistochemistry and transmission electron microscopy.The alterations of c-Kit,α-SMA,cholecystokinin A receptor(CCKAR),and connexin 43(CX43)were assessed using Western blot.RESULTS Impaired ICCs muscle strips resulted in the decrease in gallbladder SW frequency and contractility.The frequency of SW and gallbladder contractility were significantly lower in the AC12h group.Compared with the NC group,the density and ultrastructure of ICCs were remarkably impaired in the AC groups,especially in the AC12h group.The protein expression levels of c-Kit were significantly decreased in the AC12h group,while CCKAR and CX43 protein expression levels were significantly decreased in the AC48h group.CONCLUSION Loss ICCs could lead to a decrease in gallbladder SW frequency and contractility.The density and ultrastructure of ICCs were clearly impaired in the early stage of AC,while CCKAR and CX43 were significantly reduced at end stage.
文摘Objective: To investigate the correlation of small hepatocellular carcinoma ultrasonography parameters with the expression of oncogenes and angiogenesis genes. Methods: A total of 61 patients with small hepatocellular carcinoma who were diagnosed in this hospital between July 2015 and May 2017 were selected as small hepatocellular carcinoma group, and 48 patients with hepatolithiasis were selected as hepatolithiasis group. The ultrasonography parameters of the two groups were recorded and the expression levels of oncogenes and angiogenesis genes in the surgical lesion tissues were detected. Pearson test was used to evaluate the correlation of ultrasonography parameters with the expression of oncogenes and angiogenesis genes. Results: IMAX level in small hepatocellular carcinoma group was higher than that in hepatolithiasis group while TTP and mTT levels were lower than those in hepatolithiasis group;oncogenes C-myc, N-ras, PIK3CA, RMP, Bmil and pim-3 mRNA expression in lesion tissues were higher than those of hepatolithiasis group;angiogenesis genes VEGF, Ang-1, Tie-2 and MACC1 mRNA expression in lesion tissues were higher than those of hepatolithiasis group while ARH1 mRNA expression was lower than that of hepatolithiasis group. Pearson test showed that the ultrasonography parameters IMAX, TTP and mTT levels in patients with small hepatocellular carcinoma were directly correlated to the expression of oncogenes and angiogenesis genes in lesions. Conclusion: The ultrasonography parameters of patients with small hepatocellular carcinoma are significantly different from those of patients with benign diseases, and the specific parameter levels are directly correlated with the malignancy of cancer cells.
文摘Objective To explore the optimal administration route of tranexamic acid(TXA)in shoulder arthroscopic surgery.Methods Patients undergoing arthroscopic rotator cuff repair were randomly divided into four groups:control group(without TXA treatment),intravenous group(TXA was intravenously administered 10 minutes before surgery),irrigation group(TXA was added to the irrigation fluid during subacromial decompression and acromioplasty),and intravenous plus irrigation group(TXA was applied both intravenously and via intra-articular irrigation).The primary outcome was visual clarity assessed with visual analog scale(VAS)score,and the secondary outcomes included irrigation fluid consumption and time to subacromial decompression and acromioplasty procedure.Results There were 134 patients enrolled in the study,including 33 in the control group,35 in the intravenous group,32 in the irrigation group,and 34 in the intravenous plus irrigation group.The median and interquartile range of VAS scores for the intravenous,irrigation,and intravenous plus irrigation groups were 2.70(2.50,2.86)(Z=-3.677,P=0.002),2.67(2.50,2.77)(Z=-3.058,P<0.001),and 2.91(2.75,3.00)(Z=-6.634,P<0.001),respectively,significantly higher than that of the control group[2.44(2.37,2.53)].Moreover,the control group consumed more irrigation fluid than the intravenous group,irrigation group,and intravenous plus irrigation group(all P<0.05).The intravenous plus irrigation group consumed less irrigation fluid than either the intravenous group or the irrigation group(both P<0.001).There was no difference in subacromial decompression and acromioplasty operative time among the four groups.Conclusion TXA applied both topically and systematically can improve intraoperative visual clarity,and the combined application is more effective.
文摘BACKGROUND Ochronosis,also known as alkaptonuria,is a rare autosomal recessive selfmetabolic disease arising from deficiency of homogentisate 1,2 dioxygenase enzyme.It affects several organs and muscoskeletal structures.We herein report a case of a patient who presented with severe hip arthropathy complicated with late stage ochronosis.CASE SUMMARY A 56-year-old male patient was admitted in our department in 2019 with complaints of chronic low backache and left hip pain.After the required investigations were done,lumbar disc herniation and severe hip arthritis were the initial diagnosis.A total left hip arthroplasty was performed.Ochronotic osteoarthritis was only obtained post-surgery as confirmatory diagnosis.He was again admitted mid 2022 with the same complaints on the right hip.Subsequently,he underwent a total right hip arthroplasty.Post-operative recovery and follow-ups were deemed very satisfactory.CONCLUSION Ochronosis is an unusual diagnosis for a patient who presents with typical hip arthritis.Thus,unless meticulous history taking and advanced laboratory tests,the diagnosis can easily be missed by surgeons.
基金supported by grants from The Development Project of National Major Scientific Research Instrument(82027803)National Natural Science Foundation of China(81971623)Key Project of Natural Science Foundation of Zhejiang Province(LZ20H180001)。
文摘Backgrounds:Percutaneous ultrasound(US)and endoscopic ultrasound(EUS)-guided pancreatic biopsies are widely accepted in the diagnosis of pancreatic diseases.Studies comparing the diagnostic performance of US-and EUS-guided pancreatic biopsies are lacking.This study aimed to evaluate and compare the diagnostic yields of US-and EUS-guided pancreatic biopsies and identify the risk factors for inconclusive biopsies.Methods:Of the 1074 solid pancreatic lesions diagnosed from January 2017 to February 2021 in our center,275 underwent EUS-guided fine needle aspiration(EUS-FNA),and 799 underwent US-guided core needle biopsy(US-CNB/FNA).The outcomes were inconclusive pathological biopsy,diagnostic accuracy and the need for repeat biopsy.All of the included factors and diagnostic performances of both USCNB/FNA and EUS-FNA were compared,and the independent predictors for the study outcomes were identified.Results:The diagnostic accuracy was 89.8%for EUS-FNA and 95.2%for US-CNB/FNA(P=0.001).Biopsy under EUS guidance[odds ratio(OR)=1.808,95%confidence interval(CI):1.083-3.019;P=0.024],lesion size<2 cm(OR=2.069,95%CI:1.145-3.737;P=0.016),hypoechoic appearance(OR=0.274,95%CI:0.097-0.775;P=0.015)and non-pancreatic ductal adenocarcinoma carcinoma(PDAC)diagnosis(OR=2.637,95%CI:1.563-4.449;P<0.001)were identified as factors associated with inconclusive pathological biopsy.Hypoechoic appearance(OR=0.236,95%CI:0.064-0.869;P=0.030),lesions in the uncinate process of the pancreas(OR=3.506,95%CI:1.831-6.713;P<0.001)and non-PDAC diagnosis(OR=2.622,95%CI:1.278-5.377;P=0.009)were independent predictors for repeat biopsy.Biopsy under EUS guidance(OR=2.024,95%CI:1.195-3.429;P=0.009),lesions in the uncinate process of the pancreas(OR=1.776,95%CI:1.014-3.108;P=0.044)and hypoechoic appearance(OR=0.127,95%CI:0.047-0.347;P<0.001)were associated with diagnostic accuracy.Conclusions:In conclusion,both percutaneous US-and EUS-guided biopsies of solid pancreatic lesions are safe and effective;though the diagnostic accuracy of EUS-FNA is inferior to US-CNB/FNA.A tailored pancreatic biopsy should be considered a part of the management algorithm for the diagnosis of solid pancreatic disease.
文摘BACKGROUND Ultrasound is a vital tool for the diagnosis and management of colorectal cancer(CRC).Contrast-enhanced ultrasound(CEUS)is a non-invasive,safe,and cost-effective method for evaluating tumour blood vessels,that play a crucial role in tumour growth and progression.AIM To explore CEUS’s role in the quantitative evaluation of CRC blood vessels and their correlation with angiogenesis markers and prognosis.METHODS This study prospectively enrolled 100 patients with CRC confirmed by histo-pathology.All patients received preoperative CEUS examinations.Quantitative parameters,such as peak intensity(PI),time to peak(TTP),and area under the curve(AUC),were derived from time-intensity curve(TIC)analysis.Tumour tissue samples were obtained during surgery and examined immunohistochem-ically to assess the expression of angiogenesis markers,including vascular endo-thelial growth factor(VEGF)and microvessel density(MVD).The correlation between CEUS parameters,angiogenesis markers,and clinicopathological features was evaluated using appropriate statistical tests.RESULTS Quantitative CEUS parameters(PI,TTP,and AUC)showed significant correlations with VEGF expression(P<0.001)and MVD(P<0.001),indicating a strong link between tumour blood vessels and angiogenesis.Increased PI,reduced TTP,and expanded AUC values were significantly related to higher tumour stage(P<0.001),lymph node metastasis(P<0.001),and distant metastasis(P<0.001).Furthermore,these parameters were recognized as independent predictors of overall survival and disease-free survival in multivariate analysis(P<0.001).CONCLUSION CEUS has a high potential in guiding treatment planning and predicting patient outcomes.However,more com-prehensive,multicentre studies are required to validate the clinical utility of CEUS in CRC management.
基金Supported by Ningbo Social Development and Technology Support Plan Project of China, No. 2011C50021Ningbo Natural Science Foundation of China, No. 2012A610187+1 种基金Clinical Research Foundation of Zhejiang Medical Association, No. 2010ZYC-B07Zhenhai Social Development and Technology Support Plan Project of Ningbo, No. 2011A2062
文摘AIM:To investigate the prevalence and risk factors of polypoid lesions of the gallbladder (PLGs) in petrochemical employees in Ningbo, Zhejiang Province, China. METHODS:All active and retired employees aged 20-90 years (n = 11098) of a refinery and chemical plant in eastern China were requested to participate in a health survey. The participants were subjected to interview, physical examination, laboratory assessments and ultrasonography. All the participants were invitedto have a physical examination after a face-to-face interview. Fasting blood samples were obtained from the antecubital vein, and the samples were used for the analysis of biochemical values. Abdominal ultrasonography was conducted. RESULTS:A total of 10461 (7331 men and 3130 women) current and former petrochemical employees attended for screening. The overall prevalence of postcholecystectomy, gallstones and PLGs was 0.9%, 5.2% and 7.4%, respectively. Compared with the increased prevalence of either gallstones or post-cholecystectomy in older persons, PLGs were more common in the middle-aged, peaking in those aged 40-59 years. Excluding the patients with gallstones, gallstones mixed with PLGs, or those who had undergone cholecystectomy, in the remaining 9828 participants, the prevalence of PLGs in men (8.9%) was significantly higher than that in women (5.5%, P < 0.001). The analyzed risk factors with increased OR for the development of PLGs were male gender (OR = 1.799, P < 0.001), age ≥ 30 years (OR = 2.699, P < 0.001) and hepatitis B surface antigen (HBsAg) positivity (OR = 1.374, P = 0.006). CONCLUSION:PLGs are not rare among Chinese petrochemical employees. Male gender, HBsAg positivity, and middle age are risk factors for developing PLGs.
文摘AIM: To investigate the prevalence and risk factors of polypoid lesions of gallbladder (PLG) among the health examinees in the Shanghai region, China. METHODS: A total of 11 816 subjects who underwent health examinations in our hospital between August 2010 and February 2011 were analyzed retrospectively. Among them, there were 7174 men and 4642 women. PLG was diagnosed by the real-time ultrasonography. Those with the body mass index (BMI) ≥ 28 were considered to be obese. Blood biochemical indices were detected with the fully automatic biochemical analyzer and hepatitis B surface antigen (HBsAg) was tested by the automated enzyme immunoassay. The correlations between the prevalence of PLG and age, sex, BMI, serum cholesterol (T-Cho), triglycerides (TG),blood sugar, HBsAg, high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), gallstone and fatty liver were investigated. After univariate analysis of 11 variables, stepwise logistic regression analysis was performed to explore the risk factors of PLG. RESULTS: There was a significant difference in sex, T-Cho, HBsAg, HDL-C, LDL-C and fatty liver between the PLG-positive group and the PLG-negative group (332/163 vs 6842/4479, P = 0.003; 22/473 vs 295/11 026, P =0.013; 92/403 vs 993/10 328, P = 0.001; 47/448 vs 332/10 989, P = 0.001; 32/463 vs 381/10 940, P = 0.001; 83/412 vs 3260/8061, P = 0.001). No significant difference was found in the age, BMI, TG, blood sugar and gallstone between the two groups (47.3 ± 26 vs 45.1 ± 33, P = 0.173; 59/436 vs 1097/10 224, P = 0.102; 52/443 vs 982/10 339, P = 0.158; 17/478 vs 295/11 026, P = 0.26; 24/471 vs 395/10 926, P = 0.109). Logistic regression analysis showed that the sex, HBsAg and HDL-C were independent risk factors for the development of PLG in a descending order of HDL-C > HBsAg > sex. CONCLUSION: In healthy people, the male gender, positive HBsAg, and low HDL-C confer higher risks of PLG development.
基金Supported by The Science and Technology Project of Guangdong ProvinceChina+3 种基金No.2010B031600047Shenzhen Jian An Pharmaceutical Company Limited for their support
文摘AIM:To investigate the prevalence of fatty liver discovered upon physical examination of Chinese patients and determine the associated clinical characteristics.METHODS:A total of 3433 consecutive patients who received physical examinations at the Huangpu Division of the First Affiliated Hospital at Sun Yat-sen University in Guangzhou,China from June 2010 to December2010 were retrospectively enrolled in the study.Results of biochemical tests,abdominal ultrasound,electrocardiography,and chest X-ray were collected.The diagnosis of fatty liver was made if a patient met any two of the three following ultrasonic criteria:(1)liver and kidney echo discrepancy and presence of an increased liver echogenicity(bright);(2)unclear intrahepatic duct structure;and(3)liver far field echo decay.RESULTS:The study population consisted of 2201males and 1232 females,with a mean age of 37.4±12.8 years.When all 3433 patients were considered,the overall prevalence of hyperlipidemia was 38.1%,of fatty liver was 26.0%,of increased alanine aminotransferase(ALT)and/or aspartate aminotransferase(AST)levels was 11.9%,of gallstone was 11.4%,of hyperglycemia was 7.3%,of hypertension was 7.1%,and of hyperuricemia was 6.2%.Of the 2605 patients who completed the abdominal ultrasonography exam,677(26.0%)were diagnosed with fatty liver and the prevalence was higher in males(32.5%vs females:15.3%,P<0.001).The overall prevalence of fatty liver increased with age,with the peak prevalence(39.5%)found in the 60 to 70-year-old age group.Among patients between the ages of 18 to 50-year-old,the prevalence of fatty liver was significantly higher in males(20.2%vs females:8.7%,P<0.001);the difference in prevalence between the two sexes in patients>50-year-old did not reach statistical significance.Only 430 of the patients diagnosed with fatty liver had complete information;among those,increased ALT and/or AST levels were detected in only 30%,with all disturbances being mild or moderate.In these 430 patients,the overall prevalence of hypertriglyceridemia was 31.4%,of mixed type hyperlipidemia was 20.9%,of hypercholesterolemia was 12.3%,of hyperglycemia was 17.6%,of hypertension was 16.0%,of hyperuricemia was 15.3%,and of gallstone was 14.4%.Again,the prevalences of hypertriglyceridemia and hyperuricemia were higher in males(hypertriglyceridemia,36.0%vs females:12.0%,P<0.05;hyperuricemia,17.3%vs females:7.2%,P<0.05);in contrast,however,the prevalences of mixed type hyperlipidemia and hypercholesterolemia was higher in females(mixed type hyperlipidemia,18.7% vs females:30.1%,P<0.05,hypercholesterolemia,9.5%vs females:24.1%,P<0.05).Finally,comparison of the fatty liver group to the non-fatty liver group showed that prevalences of hyperlipidemia,hyperglycemia,hypertension,and hyperuricemia were higher in the former(all P<0.01).CONCLUSION:A high prevalence of fatty liver is detected upon physical examination in Guangzhou,and the primary associated clinical findings are hyperlipidemia,hyperglycemia,hypertension,and hyperuricemia.
文摘Left ventricular remodeling index (LVRI) was assessed in patients with hypertensive heart disease (HHD) and coronary artery disease (CAD) by real-time three-dimensional echocardi-ography (RT3DE). RT3DE data of 18 patients with HHD, 20 patients with CAD and 22 normal con-trols (NC) were acquired. Left ventricular end-diastolic volume (EDV) and left ventricular end-diastolic epicardial volume (EDVepi ) were detected by RT3DE and two-dimensional echocar-diography Simpson biplane method (2DE). LVRI (left ventricular mass /EDV) was calculated and compared. The results showed that LVRI measurements detected by RT3DE and 2DE showed sig-nificant differences inter-groups (P<0.01). There was no significant difference in NC group (P>0.05), but significant difference in HHD and CAD intra-group (P<0.05). There was good positive correla-tions between LVRI detected by RT3DE and 2DE in NC and HHD groups (r=0.69, P<0.01; r=0.68, P<0.01), but no significant correlation in CAD group (r=0.30, P>0.05). It was concluded that LVRI derived from RT3DE as a new index for evaluating left ventricular remodeling can provide more su-periority to LVRI derived from 2DE.
基金Supported by the Health Department of Guangdong Province(B2011259)
文摘Objective To investigate diagnostic efficacy of transvaginal three-dimensional hysterosalpingo-contrast sonography(3D-Hy Co Sy) in assessing tubal patency with chromolaporoscopy. Methods A total of 157 infertile women underwent 3D-Hy Co Sy to evaluate tubal patency. Among these patients, 39 patients were also examined by chromolaporoscopy. The concordance of the two clinical assessment methods was analyzed by the Kappa coefficient test. Results Among the 306 oviducts examined by 3D-Hy Co Sy, 99(32.4%) were patent, 126(41.2%) partially obstructed, and 81(26.5%) completely obstructed. Diagnostic results with 3D-Hy Co Sy were not statistically different from those obtained in the 39 women(78 oviducts) who also underwent chromolaporoscopy, and the two methods showed a high concordance(κ=0.747, P=0.000). The 3D-Hy Co Sy procedure had a sensitivity of 84.8%(28/33), a specificity of 96.2%(25/26), and positive and negative predictive values of 93.3%(28/30) and 86.2%(25/29) respectively. Conclusion Transvaginal 3D-Hy Co Sy can accurately reveal the spatial path and morphology of the oviduct and is a safe and effective method to evaluate tubal patency.
基金The "11th Five-Year" Program of People’s Liberation Army of China (PLA), No. 06MB240
文摘AIM:To investigate the effects of carbon dioxide (CO2) and helium insufflation administered at different pressures on the growth and apoptosis of cultured human gastric cancer cells. METHODS:The gastric cancer cells MKN-45 were exposed to a CO2 and helium environment maintained at different pressures (0, 5, 10 and 15 mmHg). The cells were exposed to simulated pneumoperitoneum environment for 4 h, and pH of the culture media was measured after it was moved to normal conditions for 0, 2, 4, 6 and 8 h. Proliferation viability of MKN-45 was examined by 3-4,5Dimethylthiazol-2-yl,5-diphenyltetrazolium bromide or triazolyl blue (MTT) assay after it was moved to normal conditions. Apoptotic ratio was measured by Annexin V-FITC/PI double labelled staining. RESULTS:The pH of media was acid and recovered to normal after 4 h in the CO2 group while it was basic in the helium group. There was no difference between CO2 groups (under 10 mmHg ) and control group (P > 0.05) in the proliferative viability of the cells. The cultured cells exposed to 15 mmHg CO2 environment grew more slowly than control group from 4 to 7 d (P < 0.01 ) while there was no difference from 1 to 3 d (P > 0.05). The proliferative viability in helium group was not obviously different from the control group (P > 0.05). The apoptotic ratio of the cultured cells was markedly higher than that of the control group (P < 0.01) at 10 and 15 mmHg CO2 insufflation pressure. In helium group, the apoptotic ratio was not obviously different from the control group (P > 0.05). CONCLUSION:There is no obvious effect in the proliferation and apoptosis of MKN-45 cells under 10 mmHg CO2 insufflation pressure and helium in any pressure. Fifteen mmHg CO2 insufflation pressure can inhibit the proliferation of the cells and improve apoptosis.
文摘AIM: To establish a kind of standardization of the clinical chemotherapeutic prototypes for unresectable hepatocellular carcinomas (HCC).METHODS: 10-Hydroxycamptothecin (HCPT) was applied through transcatheter arterial embolization (TAE) to HCC patients who were categorized into three groups: (1) test group: treatment with HCPT twice (HCPT d1 and 14) through TAE and portal venous embolization. (2) Control Ⅰ: treatment with anticancer drugs without HCPT. (3) Control Ⅱ: treatment with HCPT as a major component in anticancer drugs once (HCPT d1). A set of comparisons between test groups and control Ⅰ and Ⅱ groups were performed before and after the treatment to study the effectiveness of each treatment, in terms of tumor volumes, dynamic variations in serum alpha-fetoprotein (AFP), gamma-glutamyl transferase hepatoma-specific band (GGT-Ⅱ), patient survival and adverse events.RESULTS: The general effectiveness rate of the test group reached 62.1% (72/116), remarkably higher than that of control Ⅰ (32.1%, 40/124) and control Ⅱ (54.7%, 47/56),(P＜0.01 and P＜0.05, respectively). Especially, the reduction rate or disappearance of the portal vein tumor emboli was as high as 88.4% (61/69) in the test group, in contrast with 13.9% (10/72) in control Ⅰ and 35.9% (18/51) in control Ⅱ (P＜0.01 and P＜0.01, respectively). After treatment, AFP decreased or turned to negative levels at 52.3% (34/65)in control I, 67.3% (35/52) in control Ⅱ, and 96.8% (60/62)in the test group. Also GGT-Ⅱ declined or became negative at 37.8% (28/74) in control Ⅰ, 69.5% (57/82) in control Ⅱ,and 94.7% (89/94) in test group (P＜0.01 and P＜0.05,respectively).CONCLUSION: We have designed a good protocol (test group) to treat HCC with excellent advantages of high efficiency, low cost, low toxicity and low adverse events and easy application. It could be recommended as one of the standardizations for HCC treatment in clinical practice.
基金Supported by National Natural Science Foundation of China,No.81201107Natural Science Foundation of Hubei Province of China,No.2014CFB409
文摘AIM: To establish a new model for predicting survival in acute-on-chronic liver failure(ACLF) patients treated with an artificial liver support system. METHODS: One hundred and eighty-one ACLF patients who were admitted to the hospital from January 1, 2012 to December 31, 2014 and were treated with an artificial liver support system were enrolled in this retrospective study, including a derivation cohort(n = 113) and a validation cohort(n = 68). Laboratory parameters at baseline were analyzed and correlatedwith clinical outcome. In addition to standard medical therapy, ACLF patients underwent plasma exchange(PE) or plasma bilirubin adsorption(PBA) combined with plasma exchange. For the derivation cohort, KaplanMeier methods were used to estimate survival curves, and Cox regression was used in survival analysis to generate a prognostic model. The performance of the new model was tested in the validation cohort using a receiver-operator curve.RESULTS: The mean overall survival for the derivation cohort was 441 d(95%CI: 379-504 d), and the 90- and 270-d survival probabilities were 70.3% and 58.3%, respectively. The mean survival times of patients treated with PBA plus PE and patients treated with PE were 531 d(95%CI: 455-605 d) and 343 d(95%CI: 254-432 d), respectively, which were significantly different(P = 0.012). When variables with bivariate significance were selected for inclusion into the multivariate Cox regression model, number of complications, age, scores of the model for end-stage liver disease(MELD) and type of artificial liver support system were defined as independent risk factors for survival in ACLF patients. This new prognostic model could accurately discriminate the outcome of patients with different scores in this cohort(P < 0.001). The model also had the ability to assign a predicted survival probability for individual patients. In the validation cohort, the new model remained better than the MELD.CONCLUSION: A novel model was constructed to predict prognosis and accurately discriminate survival in ACLF patients treated with an artificial liver support system.
