超声造影评价颈动脉斑块内新生血管的研究进展

动脉粥样硬化斑块与心脑血管事件的发生密切相关,早期评估动脉粥样硬化斑块的稳定性对于预防心脑血管事件发生及制定治疗方案十分重要。大量研究证实斑块内新生血管与斑块的稳定性有关,超声造影可显示和评估颈动脉斑块内新生血管,是近年来斑块稳定性研究的热点技术之一。     

内镜超声诊断肠道子宫内膜异位症二例

子宫内膜异位症是指具有生长活力的子宫内膜组织在子宫腔以外部位的异常生长。肠壁异位内膜组织受卵巢激素周期性刺激而发生增生、出血、脱落,临床可有不同程度的肠道刺激症状。本文报道了2例因腹部非特异性症状就诊,肠镜下不典型,后经内镜超声、病灶活检确诊的肠道子宫内膜异位症的患者诊治情况。     

颈动脉斑块内钙化分布特征对斑块稳定性的影响

目的探讨颈动脉斑块内钙化分布特征对斑块稳定性的影响。方法选择行颈动脉内膜剥脱术患者49例,且术前通过二维超声及超声造影观察颈动脉斑块回声类型及斑块内造影剂分布情况,记录斑块回声类型、钙化部位、形态、数量及钙化旁有无新生血管,并进行分组,以术后病理结果为金标准,比较各组内不同钙化特征对斑块稳定性的影响。结果不同部位各钙化组、不同形态各钙化组及钙化旁有无新生血管的斑块稳定性比较,差异无统计学意义(χ~2=0. 415,P=0. 813;χ~2=2. 164,P=0. 339;χ~2=3. 352,P=0. 095);不同数量各钙化组的斑块稳定性比较,差异有统计学意义(χ~2=5. 555,P=0. 029)。结论钙化数量对颈动脉斑块稳定性有一定影响,多发钙化可导致斑块不稳定。     

糖尿病患者血清Nε-羧甲基赖氨酸水平与颈动脉钙化关系的临床研究

目的探究血清Nε-羧甲基赖氨酸(CML)对1型糖尿病和2型糖尿病患者不同程度颈动脉钙化的影响。方法选取2016年1月至2017年6月在江苏大学附属医院就诊患者506例,其中1型糖尿病148例,2型糖尿病191例,无糖尿病者167例,所有患者均行彩色多普勒超声检测双侧颈动脉。将颈动脉钙化严重程度按照0~8分予以评估,以1~4分为低钙化组,5~8分为高钙化组。记录患者一般临床资料、体格检查结果、实验室检查结果,并通过酶联免疫吸附实验测量血清CML水平。进行多因素Logistic回归分析,以确定1型糖尿病、2型糖尿病患者不同程度颈动脉钙化的独立预测因子。随访复测CML并追踪主要不良心脑血管事件(MACCE);分析CML变化与MACCE的关系。结果在颈动脉高钙化组和低钙化组,糖尿病患者的CML、颈动脉内膜中膜厚度和低密度脂蛋白胆固醇水平均高于无糖尿病者(P<0.05),且2型糖尿病患者高于1型糖尿病患者(P<0.05)。多因素Logistic回归分析显示,CML是1型糖尿病患者颈动脉钙化程度的独立预测因子(OR 2.025,95%CI 1.368~2.996,P<0.05),也是2型糖尿病患者颈动脉钙化程度的独立预测因子(OR 2.485,95%CI 1.481~4.171,P<0.05)。随访期CML水平明显升高与MACCE相关。结论CML是1型和2型糖尿病患者不同程度颈动脉钙化的独立预测因子,并在一定程度上预测糖尿病性心脑血管事件的发生。     

Clinical utility of treatment method conversion during single-session endoscopic ultrasound-guided biliary drainage

BACKGROUND Although several techniques for endoscopic ultrasound-guided biliary drainage(EUS-BD)are available at present,an optimal treatment algorithm of EUS-BD has not yet been established.AIM To evaluate the clinical utility of treatment method conversion during single endoscopic sessions for difficult cases in initially planned EUS-BD.METHODS This was a single-center retrospective analysis using a prospectively accumulated database.Patients with biliary obstruction undergoing EUS-BD between May 2008 and April 2016 were included.The primary outcome was to evaluate the improvement in EUS-BD success rates by converting the treatment methods during a single endoscopic session.Secondary outcomes were clarification of the factors leading to the conversion from the initial EUS-BD and the assessment of efficacy and safety of the conversion as judged by technical success,clinical success,and adverse events(AEs).RESULTS A total of 208 patients underwent EUS-BD during the study period.For 18.8%(39/208)of the patients,the treatment methods were converted to another EUSBD technique from the initial plan.Biliary obstruction was caused by pancreatobiliary malignancies,other malignant lesions,biliary stones,and other benign lesions in 22,11,4,and 2 patients,respectively.The reasons for the difficulty with the initial EUS-BD were classified into the following 3 procedures:Target puncture(n=13),guidewire manipulation(n=18),and puncture tract dilation(n=8).Technical success was achieved in 97.4%(38/39)of the cases and clinical success was achieved in 89.5%of patients(34/38).AEs occurred in 10.3%of patients,including bile leakage(n=2),bleeding(n=1),and cholecystitis(n=1).The puncture target and drainage technique were altered in subsequent EUSBD procedures in 25 and 14 patients,respectively.The final technical success rate with 95%CI for all 208 cases was 97.1%(95%CI:93.8%-98.9%),while that of the initially planned EUS-BD was 78.8%(95%CI:72.6%-84.2%).CONCLUSION Among multi-step procedures in EUS-BD,guidewire manipulation appeared to be the most technically challenging.When initially planned EUS-BD is technically difficult,treatment method conversion in a single endoscopic session may result in successful EUS-BD without leading to severe AEs.     

Value of shear wave elastography with maximal elasticity in differentiating benign and malignant solid focal liver lesions

BACKGROUNDIt is important to differentiate benign and malignant focal liver lesions (FLLs) accurately. Despite the wide use and acceptance of shear wave elastography (SWE), its value for assessing the elasticity of FLLs and differentiating benign and malignant FLLs is still investigational. Previous studies of SWE for FLLs used mean elasticity as the parameter to reflect the stiffness of FLLs. Considering the inhomogeneity of tumor stiffness, maximal elasticity (Emax) might be the suitable parameter to reflect the stiffness of FLLs and to differentiate malignant FLLs from benign ones.AIMTo explore the value of SWE with Emax in differential diagnosis of solid FLLs.METHODSWe included 104 solid FLLs in 95 patients and 50 healthy volunteers. All the subjects were examined using conventional ultrasound (US) and virtual touch tissue quantification(VTQ) imaging. A diagnosis of benign or malignant FLL was made using conventional US. Ten VTQ values were acquired after 10 consecutive measurements for each FLL and each normal liver, and the largest value was recorded as Emax.RESULTSThere were 56 cases of malignant FLLs and 48 cases of benign FLLs in this study. Emax of malignant FLLs (3.29 ± 0.88 m/s) was significantly higher than that of benign FLLs (1.30 ± 0.46 m/s, P < 0.01) and that of livers in healthy volunteers (1.15 ± 0.17 m/s, P < 0.01). The cut-off point of Emax was 1.945, and the area under the curve was 0.978. The sensitivity and specificity of Emax were 92.9% and 91.7%, respectively, higher (but not significantly) than those of conventional US (80.4% for sensitivity and 81.3% for specificity). Combined diagnosis of conventional US and Emax using parallel testing improved the sensitivity to 100% with specificity of 75%.CONCLUSIONSWE is a convenient and easy method to obtain accurate stiffness information of solid FLLs. Emax is useful for differential diagnosis of FLLs, especially in combination with conventional US.     

Experimental model standardizing polyvinyl alcohol hydrogel to simulate endoscopic ultrasound and endoscopic ultrasound-elastography

BACKGROUND Endoscopic ultrasound(EUS) and endoscopic ultrasound elastography(EUS-E) simulation lessens the learning curve; however, models lack realism, diminishing competitiveness.AIM To standardize the mechanical properties of polyvinyl alcohol(PVA) hydrogel for simulating organs and digestive lesions.METHODS PVA hydrogel(Sigma Aldrich, degree of hydrolysis 99%) for simulating EUS/EUS-E lesions was investigated in Unidad de Investigación y Desarrollo Tecnológico at Hospital General de México "Dr. Eduardo Liceaga", Mexico City. We evaluated physical, contrast, elasticity and deformation coefficient characteristics in lesions, applying Kappa's concordance and satisfaction questionnaire(Likert 4-points).RESULTS PVA hydrogel showed stable mechanical properties. Density depended on molecular weight(MW) and concentration(C). PVA bblocks with the greatest density showed lowest tensile strength(r =-0.8, P = 0.01). Lesions were EUSgraphically visible. Homogeneous and heterogeneous examples were created from PVA blocks or PVA phantoms, exceeding(MW_2 = 146000-186000, C_9 = 15% and C_(10) = 20%) with a density under(MW_1 = 85000-124000, C_1 = 7% and C_2 = 9%). We calculated elasticity and deformation parameters of solid(blue) areas, contrasting with the norm(Kappa = 0.8; high degree of satisfaction).CONCLUSION PVA hydrogels were appropriate for simulating organs and digestive lesions using EUS/EUS-E, facilitating practice and reducing risk. Repetition amplified skills, while reducing the learning curve.     

二维超声联合超微血管成像技术在宫颈癌 术前分期诊断中的价值

目的 探讨经阴道二维超声联合超微血管成像（SMI）在宫颈癌术前分期诊断中的应用价值。 方法 选取2018 年11 月—2019 年12 月广西壮族自治区人民医院收治的经病理检查确诊为宫颈癌拟手术治 疗的76 例患者。所有患者术前行阴道二维超声联合SMI 及磁共振成像（MRI）检查。以术后病理结果为金 标准,分析2 种检查方法对宫颈癌分期的准确率及敏感性。结果 76 例宫颈癌患者中,Ⅰ A 期3 例,Ⅰ B 期 57 例,Ⅱ期16 例。二维超声联合SMI 诊断宫颈癌分期总的准确率为77.6%（59/76）,MRI 为73.7%（56/76）, 差异无统计学意义（P >0.05）。二维超声联合SMI 诊断Ⅰ B1、Ⅰ B2 期的准确率均高于MRI（P <0.05）。肿瘤 直径<2 cm、2 ～ <4 cm 时,二维超声联合SMI 诊断敏感性为87.5% 和93.8%,优于MRI 的84.0% 和87.5%。 结论 二维超声联合SMI 在早期宫颈癌术前分期诊断上具有价格低廉、可反复操作、无创等优势,可为宫颈 癌治疗方案的制定提供重要依据。     

Carotid Intima-Media Thickness and Plaque in Cardiovascular Risk Assessment

Carotid intima-media thickness (CIMT) has been shown to predict cardiovascular (CV) risk in multiple large studies. Careful evaluation of CIMT studies reveals discrepancies in the comprehensiveness with which CIMT is assessed—the number of carotid segments evaluated (common carotid artery [CCA], internal carotid artery [ICA], or the carotid bulb), the type of measurements made (mean or maximum of single measurements, mean of the mean, or mean of the maximum for multiple measurements), the number of imaging angles used, whether plaques were included in the intima-media thickness (IMT) measurement, the report of adjusted or unadjusted models, risk association versus risk prediction, and the arbitrary cutoff points for CIMT and for plaque to predict risk. Measuring the far wall of the CCA was shown to be the least variable method for assessing IMT. However, meta-analyses suggest that CCA-IMT alone only minimally improves predictive power beyond traditional risk factors, whereas inclusion of the carotid bulb and ICA-IMT improves prediction of both cardiac risk and stroke risk. Carotid plaque appears to be a more powerful predictor of CV risk compared with CIMT alone. Quantitative measures of plaques such as plaque number, plaque thickness, plaque area, and 3-dimensional assessment of plaque volume appear to be progressively more sensitive in predicting CV risk than mere assessment of plaque presence. Limited data show that plaque characteristics including plaque vascularity may improve CV disease risk stratification further. IMT measurement at the CCA, carotid bulb, and ICA that allows inclusion of plaque in the IMT measurement or CCA-IMT measurement along with plaque assessment in all carotid segments is emerging as the focus of carotid artery ultrasound imaging for CV risk prediction.