Acta Academiae Medicinae Sinica

ABSTRACT: Microbubble contrast agents for ultrasound (US) have been developed and clinically applied in recent years. Contrast-enhanced ultrasound (CEUS) has been widely used in the imaging of liver and other organs such as kidney， pancreases， spleen， prostate， ovarian， uterus as well as abdominal trauma, showing promising values in the diagnosis and differential diagnosis of various diseases. This article reviews the recent development and future protential clinical applications of CEUS.

ABSTRACT:Objective To explore the feasibility of therapeutic angiogenesis in myocardial infarction induced by hepatocyte growth factor (HGF) mediated by ultrasound-targeted microbubble destruction. Methods Forty Wistar rats were divided into 4 groups after the models of myocardial infarction were established: HGF+ultrasound+microbubble (HGF+US/MB) groups, HGF and ultrasound (HGF+US) group, HGF and microbubble (HGF+MB) group, and surgery alone (SA) group. Ultrasound-targeted destruction microbubble loaded with HGF gene with ECG trigger was performed in HGF+US/MB group, and HGF gene with ECG trigger was performed in HGF+US group. Microbubble loaded with HGF gene was infused intravenously in HGF+MB group, and normal saline were infused in SA group. All rats were killed 14 days after transfection. The CD34 expression was detected by immunohistochemistry(IHC), and microvessel density（MVD） was counted in high power field. The HGF expression on myocardium was detected by ELISA, and the correlation between the contents of HGF and MVD in myocardium was analyzed. Results IHC results showed that CD34 expressions, shown as brown granules, were located on the membrane and endochylema of vascular endothelial cells. The MVD in HGF+US/MB group [(266.9±39.8)/HPF] were highest among all the groups. The contents of HGF in myocardium were highest in HGF+US/MB group [(5.54±0.81) ng/g], and the contents of HGF in anterior wall were significantly higher than those in posterior wall (P<0.05); the difference was also significant when compared with others groups (P<0.01). The correlation analysis showed the contents of HGF was positively correlated with MVD in myocardium. Conclusion Ultrasound-targeted microbubble destruction can effectively deliver HGF into the infracted myocardium and facilitate angiogenesis, which provides a novel way in the gene therapy of myocardial infarction.

ABSTRACT:Objective To prepare polyelectrolyte multilayer film-coated microbubble ultrasound contrast agent (UCA) and evaluate its effects in contrast imaging on normal rabbit’s liver parenchyma. Methods Perfluorocarbon (PFC)-containing microbubble UCA (ST68-PFC) were prepared by sonication-based on surfactants (Span 60 and Tween 80). Subsequently, the resulting ST68-PFC microbubbles were coated using oppositely charged polylysine (PLL) and alginate (Alg) by microbubble-templated layer-by-layer self-assembly technique via electrostatic interaction. The enhancement effects in contrast imaging on normal rabbit’s liver parenchyma were assessed. Results The obtained microbubble UCA exhibited a narrow size distribution. The polyelectrolytes were successfully assembled onto the surface of ST68-PFC microbubbles. In vivo experiment showed that polyelectrolyte multilayer film-coated UCA effectively enhanced the imaging of rabbit’s liver parenchyma. Conclusions The novel microbubble UCA obtained via layer-by-layer self-assembly, when enabling more functions, has no obvious difference in enhancement effects compared with the premodified microbubbles. The polymers with chemically active groups (such as amino group and carboxyl group) can be used as the outermost layer for the attachment of targeting ligands to microbubbles, which allows the selective targeting of the microbubbles to desired sites.

ABSTRACT:Objective To evaluate the effectiveness of a tailored approach to radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC). Methods Ultrasound-guided percutaneous RFA was performed in 274 tumors of 228 patients located at liver periphery, including 59 near the bowel, 115 near the diaphragm, 54 near the gallbladder, and 46 near the liver surface. The tumor sizes ranged 1.2-7.0 cm ［mean (3.7±1.2) cm］. A tailored treatment strategy was established for tumors in different locations. Contrast-enhanced CT was performed one month later to evaluate the early necrosis rate of the treated tumors. Results Early tumor necrosis rate was 91.6% of the peripherally located HCC, including 91.5% of the tumors near the bowel, 90.4% near the diaphragm, 92.6% near the gallbladder, and 93.5% near the liver surface. Local tumor recurrence rates were 8.5%, 9.6%, 7.4% , and 6.5% for tumors near the bowel, diaphragm, gallbladder, and liver surface, respectively. The 1-, 2-, and 3-year survival rate of this group were 82.3%, 62.9%, and 53.7%, respectively. Major complications occurred in 3.3% of the treatment sessions, including haemorrhage (n=2), nearby structure injury (n=6), and needle tract seeding (n=4). Conclusion The tailored approach to RFA provides a promising treatment option for refractory peripherally located HCC with satisfactory tumor necrosis rate and low complication rate.

ABSTRACT:Objective To explore the value of contrast-enhanced ultrasound (CEUS) in the diagnosis of renal cystic lesion. Methods Totally 88 patients with 97 atypical cystic lesions of kidneys were examined by conventional ultrasound (color Doppler flow imaging and power Doppler flow imaging), CEUS, and contrast-enhanced computed tomography (CECT), respectively. The results from the three imaging approaches were classified by Bosniak classification system and compared with each other. In patients who underwent surgeries, the pathological results were used to validate the imaging results. Results The results of CEUS and CECT on atypical cystic lesions were not significantly different（P>0.05). The results gained by conventional ultrasound were significantly different from those of CEUS and CECT（P<0.05). Compared with the pathological results of 32 patients who underwent surgery, the sensitivities of CEUS in the diagnosis of benign, doubtfully malignant, and malignant cystic tumors of kidney were 63.2%, 95.0%， and 94.7%, respectively, the specificities were 92.9%, 76.9%, and 85.7%, respectively, and the accuracies were 75.8%, 87.9%, and 90.0%, respectively. Conclusions The classification of atypical cystic lesions using CEUS is highly consistent with CECT. CEUS is valuable in the diagnosis of benign and malignant renal cystic lesions.

ABSTRACT:Objective To study the role of contrast-enhanced ultrasound （CEUS）in the management of splenic trauma. Methods Forty patients with splenic trauma underwent CEUS examination and then different management were provided according to the examination results and the general status of patients: conservative treatment (group Ⅰ， n=19); CEUS-guided injective therapy (group Ⅱ， n=6); and surgery （group Ⅲ， n=15). Results Eighteen patients were cured in group Ⅰ and one patient experienced rehaemorrhagia. The haemostatic effect of CEUS-guided injective therapy was obvious in all six patients in group Ⅱ. Among them, one patient experienced arteriovenous fistula, which was resolved after one week of injective therapy. Fifteen patients in Group Ⅲ underwent surgery and were cured. Conclusion CEUS can provide reliable information for therapy mode selection in patients with splenic trauma and can be used to guide injective therapy.

ABSTRACT:Objective To investigate the value of real-time harmonic contrast-enhanced ultrasound (CEUS) in the diagnosis of atypical liver abscesses. Methods We used Technos DU8 system with CEUS technique to examine 32 patients with suspected liver masses. Mechanical index was set at 0.08- 0.11. The contrast agent SonoVue was injected as a bolus (2.4 ml, <5s) in the antecubital vein. Results A total of 36 lesions were studied in 32 patients, including 30 patients with single nodule and 2 patients with multiple nodules. All lesions with liver abscess were confirmed by biopsy. The whole-enhanced pattern in all lesions was clearly displayed in the arterial phase after the administration of SonoVue. The mean time of the beginning enhancement was (14.48±3.62) s, the mean peak enhancement time was (22.92±4.35)s, and the mean time of hypoechoic appearance of lesion was (80.30±35.30)s. The lesions with hypoechoic pattern (37.5%, 12/32) and isoechoic pattern (62.5 %, 20/32) in the portal phase were detected by CEUS. The characteristic sign with honeycomb pattern on CEUS was shown in 30 (93.8%) liver abscess lesions. Conclusion CEUS is valuable in the diagnosis of atypical liver abscesses.

ABSTRACT:Objective To investigate the value of contrast-enhanced ultrasound in the differential diagnosis of solid focal lesions of pancreas (s-FLPs). Methods We retrospectively analyzed the clinical data of 56 s-FLPs examined with contrast agent combined with low mechanical indicators contrast-enhanced ultrasound. Results The surrounding pancreas parenchyma enhancement time, lesion enhancement time, and peak enhancement time between different groups of s-FLPs had no significant differences（P>0.05）, while the beginning to peak enhancement time showed significant difference (P<0.05). When using the enhancement speed as a diagnostic indicator to differentiate pancreatic carcinoma from tumor-like pancreatitis, the sensitivity, specificity， and accuracy were 90.5%, 71.4%, and 85.7% for pancreatic carcinoma and 75.0%, 91.7%, and 89.3% for tumor-like pancreatitis. When using the enhancement pattern as a diagnosis indicator to differentiate pancreatic carcinoma from tumor-like pancreatitis, the sensitivity, specificity， and accuracy were 85.7%, 78.6%, and 83.9% for pancreatic carcinoma and 75.0%, 100%, and 94.6% for tumor-like pancreatitis. When different indicators were combined, enhancement pattern and enhancement speed showed the best diagnostic results; however, the Youden index was not improved. Conclusions Different s-FLPs show different enhancement findings on contrast-enhanced ultrasound. The enhancement pattern and enhancement speed are the most useful diagnostic indicators.

ABSTRACT:Objective To observe the performance of liver metastases with contrast-enhanced ultrasound (CEUS) and assess its clinical application. Methods Twenty-one patients with 21 untreated liver metastases underwent CEUS with low mechanical index imaging. The characteristic appearances of CEUS in different vascular phases were observed. Results Of 21 metastases, 19 (90.5%) were identified as fast-in and fast-out enhancement pattern. In the arterial phase, all the 21 lesions showed enhancement but with varied appearances: 12（57.1％）showed early diffuse enhancement, 8（38.1％） showed ring-like enhancement, and the remaining one lesion of large size showed slowly enhomogenous minor enhancement. In the late phase, sharp defects were found in 20 lesions (95.2%), and more lesions were detected in 3 patients（14.3％). Conclusion CEUS can show the characteristic appearance of liver metastases, and can be used for the screening and diagnosis of liver cancers.

ABSTRACT:Objective To evaluate the early diagnostic value of contrast-enhanced ultrasound (CEUS)in acute renal failure (ARF) of rabbit. Methods The rabbit model of ARF was established by intramuscular injection of 50 % glycerin (12 ml/ kg) into the hind legs of 18 New Zealand rabbits. CEUS was performed for both kidneys before injection and 6 hours after the injection. The slope rate of ascending curve（A）,the slope rate of descending curve（α）, area under curve (AUC) , derived peak intensity（DPI）, and time to peak（TTP）were measured in renal cortex of rabbits using Q-lab software package. Blood serum urea nitrogen (BUN) and serum creatinine (SCr) were measured. Results The values of A and α before the injection of glycerin were (3.07±1.83)dB/s and (0.19±0.15)/s, respectively, which were significantly higher than the values after injection [(2.76±1.31) dB/s and (0.09±0.02)/s, respectively] (P<0.05). The values of AUC and TTP before the injection of glycerin were (137.4±68.4) dB s and (6.33±3.71)s, which were significantly lower than the values after injection [(309.5±88.9) dB s and (8.61±3.97)s, respectively] (P<0.01). No significant change of DPI, BUN or SCr was found. Conclusions CEUS can precisely display the hemodynamic change of ARF model of rabbit in the early stage, with superior sensitivity than BUN and SCr. It may be a promising imaging method for the early diagnosis of ARF.

ABSTRACT:Objective To observe the patterns of benign and malignant breast lesions using real-time gray-scale contrast-enhanced ultrasound and assess its value in the differential diagnosis of begign and malignant breast tumors. Methods Totally 116 breast lesions (benignity n=63; malignancy n=53) underwent real-time gray-scale contrast-enhanced ultrasound. The patterns of their enhancement were assessed from 6 aspects： degree of enhancement, process of enhancement, completeness of enhancement, homogeneity of enhancement, boundary of the enhanced lesions, and exhistance of radial enhancement around the lesions. The results were compared with the pathologic findings. Results Contrast-enhanced sonographic patterns were significantly different between benign and malignant breast lesions. Most malignant lesions were non-centripetally, incompletely, and inhomogeneously enhanced. After having been injected with the microbubble contrast medium, the boundary of the lesions became unclear, and the radial enhancement around lesion were mainly seen in the malignant lesions. Conclusion The patterns of real-time gray-scale contrast-enhanced ultrasound are remarkably different between malignant and benign breast lesions, showing promising values for its clinical application.

ABSTRACT:Objective To evaluate the clinical value of color Doppler in monitoring graft flow in patients who underwent simultaneous pancreas-kidney （SPK）transplantation. Methods Totally 18 patients received color Doppler ultrasonography on day 1,3, and 7 after SPK. Volumes and arteriovenous velocities of the kidney and pancreas grafts were recorded, and resistance index (RI) was calculated. Results Color Doppler ultrasound clearly displayed the modality, size, and flow of the kidney and pancreas grafts. Compared with the single kidney grafts, the modality, volume ,and arteriovenous velocity of kidney grafts in SPK was not significantly different. Although the volume of pancreas graft was remarkably larger than the normal control pancreas early after transplantation, no difference in artery velocity was found between pancreas graft and normal pancreas. The spectrum of the portal vein in pancreas grafts showed the typical spectrum of iliac veins. Conclusion Color Doppler ultrasound is sensitive in monitoring the graft flow of SPK recipients and can be used to identify postoperative vascular complications and evaluate tissue perfusion.

ABSTRACT:Objective To assess the left ventricular rotation and twist in patients with hypertrophic cardiomyopathy (HCM) by 2-dimensional ultrasound speckle-tracking imaging (STI). Methods Two-dimensional images of left ventricule（LV） at basal and apical short-axis views were acquired in 20 patients with HCM and 20 healthy subjects to evaluate LV rotation. LV twist were defined as rate of apical LV rotation to the basal. Peak rotation (Prot) and the time to Prot in basal and apical short axis views were measured separately. Peak twist (Ptw), twist at aortic valve closure (AVCtw), twist at mitral valve opening (MVOtw), untwisting rate (Untw R), and half time of untwisting (HTU) were calculated. Results Compared with the control group, the value of Prot-MV, Prot-AP, Ptw, time to Ptw, AVCtw, MVOtw, and HTU significantly increased (all P<0.05) and the Untw R significantly decreased (P<0.05) in the HCM group. In the HCM group, time to Prot in apical view was significantly higher than that in basal view. Conclusion STI can noninvasively evaluate the characteristics of LV twist and rotation in patients with HCM.

ABSTRACT:Objective To demonstrate the abnormal intima rotation pattern of the carotid atherosclerosis plaque using velocity vector imaging, and to develop a new method for the clinical mechanical state assessment of the plaque intima. Methods The rotation movement and rotation angle on the serial dynamic ultrasonic short-axis gray scale views of 48 isolated atherosclerosis plaques (i.e., upstream, midstream, and downstream) and nearby reference segments of carotid artery in 46 patients were derived and analyzed using a dedicated velocity vector imaging workstation. The incidence of intima rotation movement and the rotation angle at different sections of the plaque and nearby reference segments before and after the standard grip stress test during systole and diastole respectively were counted and measured. Results Before and after the stress test, the intima rotation movement occurred at the majority of the short-axis sections of the plaque and the nearby reference segments during cardiac cycle. Before the stress test, the incidence of intima rotation movement at the upstream section of the plaque during systole was significantly higher than that of reference segment (P＝0.036). The reversal direction of the intima rotation at those sections and reference segment during systole and diastole was demonstrated. After the stress test, the incidence of intima rotation movement at the midstream section of the plaque during diastole was significantly lower than that of reference segment (P＝0.031). The incidence of the intima rotation movement changed at the sections of upstream, midstream, and downstream of the plaque before and after the stress test also were explored (i.e., increased in systole and decreased in diastole) except the reference segment intima. Conclusions The intima rotation movement occurs at the majority of the isolated plaque and nearby reference segment, and the incidences of the intima rotation movement at the plaque is different from that of the reference segment during systole and diastole respectively. The abnormal pattern of intima rotation movement may be used to indicate the unstable mechanical state of the isolated plaque intima.

ABSTRACT:Objective To study the value of prenatal ultrasound in the diagnosis of fetal malformations. Methods We retrospectively analyzed the clinical data of 993 cases of neonates and induced babies with malformations who were labored in our hospital from January 1999 to October 2006. Results The incidence rate of fetal malformation was 22.5‰ in our study group. The detection rate of prenatal ultrasound was 79.02%(1 062/1 344), among which the detection rate of the severe malformations (87.58%,860/982) were significantly higher than that of the minor malformations (55.80%,202/362)（P<0.005). The false negative rate was high for the extremity malformations (39.46%) and facial malformations (31.91%), especially the acrosclerodermas, simple cleft palates, and ear deformities. Conclusion Prenatal ultrasound is sensitive for fetal severe malformations, while the detection rate is low for fetal minor malformations.

ABSTRACT:Objective To explore the clinical application of real-time three-dimensional ultrasonography in the routine scanning of normal fetal heart. Methods A total of 110 volume datasets of normal fetal hearts in the second trimester were acquired by spatio-temporal image correlation (STIC). An off-line analysis of acquired volume datasets was performed to examine each segment of fetal heart with tomographic ultrasound imaging（TUI） and dynamic multi-planar mode (MP). The re-slice images of four-chamber view, ventricular outflow tract views, and the three vessels plane were viewed with TUI. The quality of images obtained from TUI was compared with the conventional 2D imaging mode. The volume datasets were displayed interactively with MP as a series of three-orthogonal planes. The dynamic loops of one cardiac cycle were preformed by navigating the pivot point and rotational axis and shifting each re-slice image plane inside the volume datasets. Results Satisfactory gray-scale volume acquisitions were accomplished in 110 cases . The average STIC scanning time of fetal heart was （55±15）s. An offline analysis showed that four standard planes of 2D routine screening for fetal hearts were easily obtained by TUI. The quality of the images derived from volume datasets were comparable to that directly obtained from 2D echocardiography. The visualization rate had no significant difference between TUI and routine 2D screening（P>0.05). In MP mode, 39 cases with the starting plan of apical four-chamber view were obtained. Each segment of fetal heart was almost visualized off line, both in a frozen state and with heart in motion to fulfill sequential segmental analysis in fetal cardiac anatomy. The 72%- 100% main features of atria, ventricles, aorta, and the junction segments were viewed with MP by adjusting the three dimensional volume datasets, whose quality and contents met the expectations of off-line segmental analysis of normal fetal heart. A sagittal section of ventricular septum was obtained in the offline analysis, which was an unconventional view in 2D echocardiography. Conclusion Real-time three-dimensional ultrasonography can be applied for off-line segmental analysis of normal fetal hearts in the second trimester.

ABSTRACT:Objective To evaluate the third plane image of the three-dimensional sonography (3D US) for the quantitative analysis of the cerebellar vermis in normal and Dandy-Walker syndrome (DWS) fetuses. Methods The cerebellar vermis was scanned with trans-abdominal 3D US in the second and third trimesters in 571 normal fetuses and 39 fetuses with Dandy-Walker syndrome. The surface area of the vermis in the mid-sagittal view was measured and calculated. The correlation between the vermian area and the pregnant week was analyzed. The data of vermian area between normal and DWS fetuses was compared. Results The vermian area was measured in 529 normal fetuses in the third plane of 3D US. The vermis grew in a linear fashion throughout pregnancy and the growth pattern positively correlated with the gestational age（r2＝0.854， P＜0.05). In 39 fetuses with DWS, including 14 with Dandy-Walker malformation (DWM) and 25 with Dandy-Walker variant (DWV), no vermian structure was showed in the mid-sagittal plane in 12 fetuses with DWM and 2 fetuses with DWV, whereas a small vermis appeared in other DWSs. Conclusions The third plane image obtained by 3D US is valuable in studying the fetal cerebellar vermis during the middle and late pregnancy. Knowledge of normal and abnormal vermian appearance may help identify developmental anomalies. Measurement of vermian area in the third plane with 3D US provide a quantitative indicator for prenatal diagnosis of DWS.

ABSTRACT:Objective To investigate the therapeutic effectiveness of intracoronary transplantation of autologous bone marrow mononuclear cells (BM-MNC) on myocardial ischemia reperfusion injury in mini-swine model. Methods Myocardial ischemia reperfusion injury model was established by ligating in 16 mini-swines, which were further randomized into two groups: (3.54±0.90) ×108 BM-MNC was intracoronarily transplanted in BM-MNC group (n=9), and phosphate buffer saline was intracoronarily applied in the control group (n=7). Ultrasonic cardiograhpy, hemodynamics， neovascular density, and myocardium infarction size were evaluated before and 4 weeks after transplantation. Results In BM-MNC group, left ventricular ejection fraction (LVEF), intra-ventricular septa, lateral wall and anterior wall, cardiac output (CO) and +dp/dtmax had no significant differences before and 4 weeks after transplantation (P>0.05). In the control group, LVEF, intra-ventricular septa, lateral wall and anterior wall, CO, and +dp/dtmax significantly decreased 4 weeks after transplantation (P<0.05). Left ventricular end-diastolic pressure and- dp/dtmax had no significant differences before and after cell transplantation. Capillary density was significantly larger in the BM-MNC group than in the control group [(13.39±6.96)/HP vs. (3.50±1.90)/HP]. The percentage and size of myocardial infarction was significantly lower in the BM-MNC group than in the control group. Conclusion Transplantation of BM-MNC into the myocardial ischemic reperfusion-injury area can increase capillary density and decrease infarction area, and thus remarkably improve cardiac systolic function.

ABSTRACT:Objective To observe the effects of angiostatin gene combined with chemotherapy on implanted human ovarian carcinoma of nude mouse. Methods The mice were randomly divided into four groups after 7 days of the intraperitoneal injection of tumor cells (4×106) ， and injected respectively with empty plasmid pcDNA3.0, angiostatin plasmid, cisplatin, and angiostatin plasmid + cisplatin. For combinational treatment， reagents were delivered in a timed fashion， where angiostatin plasmid was injected first， followed by cisplatin 24h later.The tumor samples were prepared to be used in the examinations of the expression of angiostatin with immunohistochemistry， of MVD in the tumor with immunohistochemistry， and of cell apoptosis with TUNEL staining. Results Tumor growth and ascites formation were inhibited in all 3 groups except for the control group. The therapeutic effectiveness in the combined group was more significant than in the other two groups.In this group， MVD（32.5±4.3） was the lowest and apoptosis index（5.12 ± 0.63） was the highest（P＜0.01）. Conclusions Angiostatin gene therapy combined with chemotherapy has a synergistic effect on the inhibition of ovarian cancer angiogenesis and ascites formation. Combining multiple therapies to treat ovarian cancer is an effective strategy.

ABSTRACT:Objective To investigate the relationship between CCR5△32 gene polymorphism and condyloma acuminata. Methods We used polymerase chain reaction to amplify the CCR5 gene fragments in 60 patients with condyloma acuminata and 50 age- and sampling date-matched controls， and compared the difference of genotypes between these two groups. Results No genotype difference was found between these two groups. Conclusion Condyloma acuminata are not associated with genetic polymorphism of CCR5△32 gene.

ABSTRACT:Objective To investigate the clinical value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in assessing pathologic responses in breast cancer treated with neoadjuvant chemotherapy. Methods Forty-five patients with pathologically confirmed breast carcinoma who finished last course of neoadjuvant chemotherapy underwent preoperative breast MRI. All the specimen slices were blindly reviewed by one pathologist. Pathologic response was assessed according Miller & Payne five-point classification, of which grade 5 defined as pathological complete response(pCR), and grade 5 or 4 defined as major histological response(MHR). DCE-MRI images were blindly reviewed by two radiologists retrospectively on workstation with Functool software. Any non-vessel enhancement in previous tumor bed in any phase of postcontrast acquisition was defined as residual disease. The diagnostic results of two radiologists were correlated to pathological gold standard. Inter-observer consistency was analyzed by Kappa statistics. Results DCE-MRI for pathological invasive (pINV) residual disease detection in two radiologists had sensitivities of 94.7% and 97.4%, specificities of 42.8% and 57.1%, and accuracy of 86.6% and 91.1%, respectively, while MHR evaluation had sensitivities of 95.5% and 81.8%, specificities of 73.9% and 82.6%, and accuracies of 84.4% and 82.2%, respectively. K values in determine pINV and MHR were 0.728 and 0.778, respectively, showing good inter-observer consistency. Conclusion DCE-MRI is sensitive in detecting residual breast cancer after neoadjuvant chemotherapy, and can be used to predict the postoperative pathologic response.

ABSTRACT:Objective To analyze the maltose clearance in plasma and urine of healthy volunteers with high-performance liquid chromatography. Methods Maltose solution was infused to 12 healthy volunteers during a 4-hour period at an infusion rate of 0.2, 0.3, and 0.5 g/(kg&#8226;h), Plasma and urine specimens were collected at different time points before and after infusion, and then analyzed with high-performance liquid chromatography. Results The coefficients of variation of the precision and accuracy of the analysis method ranged 3.68%-4.58% and 0.44%-4.83% for plasma, respectively, and 2.91%-7.62% and 0.95%-8.27% for urine, respectively. The plasma maltose concentration increased in a dose-dependent manner (r>0.99). The plasma maltose concentrations returned to the baseline levels 12 hours later. Two hours after injection, the urinary excretion of maltose increased, reached the peak value within 2-4 hours, began to decrease 6 hours later, and became zero 24 hours later. Conclusions An infusion rate of 0.2-0.5 g/(kg&#8226;h) of maltose will not remarkably increase the blood glucose level in healthy people. The routine infusion rate should below 0.3 g/(kg&#8226;h), unless an emergency exists.

ABSTRACT:Objective To investigate the feasibility of perioperative glycemic control with insulin glargine in type 2 diabetic patients. Methods We retrospectively analyzed the clinical data of 16 type 2 diabetic inpatients treated with insulin glargine (research group) and 16 type 2 diabetic inpatients treated with the traditional intensified insulin therapy (control group) for perioperative glycemic control. Results The fasting blood glucose values of the diabetic patients in the research group on the day of surgery and the first 3 postoperative days were (7.5±1.8), (8.2±1.8), (7.6±1.6), and (7.2±1.1) mmol/L, respectively, and were (9.0±2.8), (10.4±2.4), (8.8±2.7), (9.0±2.0) mmol/L in the control group, respectively. The fasting blood glucose values in the research group were significantly lower than the control group on the first and third postoperative day (P=0.02 and 0.01, respectively). No hypoglycemic events were observed and all wounds were healed well in both groups. Conclusion With satisfied fasting blood glucose level and fewer episode of hypoglycemia, perioperative glycemic control by insulin glargine in type 2 diabetic patients is safe, effective, and convenient.

ABSTRACT:Ultrasonic elastography (UE) is a new technique used in diagnosis of breast tumors. Approaches to determine the potential influential factors and to increase the diagnostic accuracy of UE include: understanding the principles of UE and mastering the correct examination methods; further research on the relevant pathologic changes of breast tumors under UE; establishment of the Logistic model of malignant breast tumors based on the ultrasound characteristics. Biopsy remains an option for the atypical lesions.

ABSTRACT:Cardiac resynchronization therapy (CRT) has became an alternative treatment in patients with severe medically refractory heart failure in recent years. Several large studies have demonstrated the effectiveness of CRT, which can improve the atrioventricular, interventricular, and intraventricular dyssynchronies. Echocardiography can be used to evaluate cardiac mechanical synchrony by means of M-mode, pulse Doppler, tissue Doppler, 3D, and other techniques, and can therefore be used to screen patients, select lead location, optimize pacemaker parameters, and follow up patients who have undergone CRT. This article reviews the strength and shortcomings of some commonly used echocardiographic techniques when they are applied in patients with heart failure.

ABSTRACT:Miniaturization of the sonographic transducer is clinically valuable for the diagnosis and treatment in obstetrics and gynecology, and transvaginal ultrasound has been widely used in gynecological examination. The application of laparoscopic and surgical ultrasound detectors can reduce complications or injuries. The application of three-dimensional ultrasound can clearly show fetal anatomic structures, providing a new way for prenatal diagnosis.