Objective To investigate the enhancing effect of ultrasound microbubbles on transfection of recombinant adenoassociated virus (rAAV) mediated green fluorecent protein (EGFP) gene into retinal ganglion cells (RGC) in vivo.Methods A total of 40 adult Sprague-Dawley (SD) rats were divided into four groups randomly (group A,B,C,D) with 10 rats in each. Group A was the normal control, in which the rats underwent intravitreal injection with 5 mu;l phosphate buffered solution. The rats in group B underwent intravitreal injection with 5 mu;l recombinant adenoassociated virus encoding EGFP gene (rAAV2-EGFP). The rats in group C underwent ultrasound irradiation on eyes right after intravitreal injection with 5 mu;l rAAV2-EGFP; The ultrasound irradiation was performed on the rats in group D right after intravitreal injection with the mixture solution of microbubbles and rAAV2-EGFP ultrasound. After 21 days, RGC were labeled retogradely with fluogold. Seven days after labeling, the retinal flatmounts and frozen sections were made from five rats in each group. Expression of EGFP reporter gene was observed by laser scanning confocal microscope and evaluated via average optical intensity (AOD) and RGC transfection rate. Labeled RGC were counted to evaluate the adverse effects.Results Green fluorescence can be observed exactly in labeled RGC in B，C，and D groups. The AOD and transfection rate in group D was （95.02plusmn;7.25）% and（20.10plusmn;0.74）% , respectively; which were higher than those in group B and C (F=25.970，25.799；P＜0.01). The difference of the number of RGC among the four groups was not significant(F=0.877,P＞0.05). Conclusion Under the condition of low frequency and with certain energy, ultrasoundmediated microbubble destruction can effectively and safely enhance rAAV delivery to RGC in rats.
Objective To investigate the value of a new double action MR contrast agent——Gd-BOPTA in the diagnosis of focal nodular hyperplasia (FNH) of the liver with correlation of pathology. Methods Dedicated MRI scans were performed for 5 patients suspected to have liver FNH on clinical and imaging basis (six lesions). The MR imaging protocol included axial T1W and T2W plain scan, coronal T2 weighted imaging, 3D MRCP, Gd-BOPTA enhanced LAVA dynamic tri-phasic acquisitions (scanning at 15 s, 55 s and 90 s respectively), enhanced 2D T1W scan, enhanced LAVA in delay phase (at 5 and 10 min) and in the hepatobiliary phase (at 40 and 80 min). The imaging features on each MR sequence were compared with surgical and pathological findings. Results Six lesions in 5 FNH patients were all correctly diagnosed (5 conformed by surgery and 1 by needle biopsy). ①The hemodynamic phase: The parenchyma of 5 lesions were markedly enhanced in the arterial phase, being isointense or slight hypointense in both the portal venous and delay phases, while 1 lesion was isointense in all phases except being slight hyperintense in the arterial phase; The central scar of 5 lesions were not enhanced in the dynamic phase, but showed delayed enhancement. ②The hepatobiliary (excretory) phase: The parenchyma of all 6 lesions were slight hyperintense or isointense, and tree-like bile ducts with hyperintensity were seen within one lesion. The scar showed no enhancement. ③Pathology: The parenchyma was consisted of disarranged normal hepatocytes but with cytoedema, lack of portal tracts and cholestatic change. The central scar showed rich fibrous tissue, a very thick-walled arteriole, proliferative bile ducts, infiltration of inflammatory cells and myxomatous changes. Conclusion As a dual-phase MR contrast agent capable of depicting both the hemodynamic attributes and hepatobiliary excretion, Gd-BOPTA enhanced MRI can reflect the pathological features of FNH and reach a high diagnostic accuracy.
ObjectiveTo observe the changes of macular visual function after myopic foveoschisis (MF) and pars plana vitrectomy (PPV) combined with internal limiting membrane peeling and air filling. MethodsA single-center, retrospective study. From October 2018 to October 2019, 29 MF inpatients (32 eyes) in Tianjin Eye Hospital were included in this study. There were 3 males (4 eyes) and 26 females (28 eyes). The age was 63.00±3.45 years old. Equivalent spherical lens degree was －14.16±2.54 D, and axial length was 29.14±1.04 mm. Among them, 3 patients (3 eyes) had lamellar macular holes. All eyes underwent standard pars plana three-channel 25G PPV combined with internal limiting membrane peeling and air filling. Before surgery and at 1, 3, and 6 months after surgery, macular microperimetry was performed with a macular integrity assessment instrument, and the mean retinal sensitivitie (MS) within 10° of the macula, fovea 2° and 4° fixation rates (P1, P2), 63% and 95% bivariate contour ellipse area (BCEA) were recorded. The comparison of MS, P1, P2, 63%BCEA and 95%BCEA at different times before and after surgery was performed by paired t test; the comparison of fixation stability rate was performed by χ2 test. ResultsCompared with before surgery, there were significant differences in the improvement of MS in affected eyes at 1, 3 and 6 months after surgery (t=－2.208, －3.435,－4.919; P=0.038, 0.002, 0.000). In the pairwise comparison at different times after surgery, only 6 months after surgery and 1 month after surgery were significantly different (P=0.036). Compared with the preoperative P1, P2, 63%BCEA and 95%BCEA, the P1 and P2 of the eyes gradually increased after surgery, while the 63%BCEA and 95%BCEA gradually decreased, however, the difference was not statistically significant (P1: t=－1.595,－1.698,－1.966; P=0.125, 0.104, 0.062. P2: t=－1.622,－1.654,－1.707; P=0.119, 0.112, 0.102. 63%BCEA: t=1.410, 1.409, 1.553; P=0.172, 0.173, 0.135. 95%BCEA: t=1.412, 1.408, 1.564; P=0.172, 0.173, 0.132). Six months after surgery, all the eyes underwent anatomical repositioning of the macular area, and no serious complications such as full-thickness macular hole and macular hole retinal detachment were found. ConclusionsPPV with internal limiting membrane peeling and air filling is an effective and safe method for MF, and the macular function improved significantly within 6 months postoperatively.
ObjectiveTo compare the investigation results of compliance and accuracy of hand hygiene in medical staff achieved by Hospital Infection Management Department and Department Infection Management Teams, and analyze the reasons for differences of the results and take measures to improve the investigation ability of hand hygiene in hospitals. MethodsWe statistically analyzed the results of compliance and accuracy of hand hygiene from January to December 2013 investigated by the infection management department and 25 infection management teams. Both the hospital and departments used "WHO Standard Observation Form". Single-blind method was used to observe the implementation of hand hygiene in medical staff. ResultsThe hospital infection management department investigation showed that hand hygiene compliance and accuracy were 64.97% and 87.78%, respectively, while the investigation by infection management teams showed that hand hygiene compliance and accuracy were 90.54% and 93.37%, respectively. The differences between the investigation results of two-level organizations were statistically significant (χ2=286.2, P<0.001; χ2=532.6, P<0.001). ConclusionWe should take measures to enforce the training of hand hygiene implementation and the observation method, and improve the guidance and assessment, promote investigators' working responsibility and observation ability, so that the survey data can accurately reflect the actual situation to urge medical staff to form good hand hygiene habits.
Objective To observe the protective effect of ultrasound microbubble contrast agentmediated transfection of brain-derived neurotrophic factor(BDNF) into the retina and visual cortex on retinal ganglion cells (RGC) after optic nerve injury. Methods A total of 88 male Sprague-Dawley (SD) rats were randomly divided into normal group (group A, eight rats), sham operation group (group B, 16 rats), control group (group C, 16 rats), eyes transfection group (group D, 16 rats), brain transfection group (group E, 16 rats), combined transfection group (group F, 16 rats). The optic nerve crush injury was induced, and then the groups B to F were divided into one-week and two-week after optic nerve injury subgroup with eight rats each, respectively. The rats in group B and C underwent intravitreal and visual cortex injection with phosphate buffered solution respectively. The rats in group D and E underwent intravitreal and visual cortex injection with the mixture solution of microbubbles and BDNF plasmids respectively. The rats in group F underwent both intravitreal and visual cortex injection with the mixture solution of microbubbles and BDNF plasmids at the same time. The ultrasound exposure was performed on the rats in group D to F after injection with the mixture solution of microbubbles and BDNF plasmids. One and two weeks after optic nerve injury, RGC were retrogradely labeled with Fluorogold; active caspase-3 protein was observed by immunohistochemistry and the N95 amplitude was detected by pattern electroretinogram (PERG). Results Golden fluorescence can be observed exactly in labeled RGC in all groups，the difference of the number of RGC between the six groups and ten subgroups were significant（F=256.30，65.18；P＜0.01）. Active caspase-3 in ganglion cell layer was detected in group C to F, but not in group A and B. The difference of the N95 amplitude between the six groups and ten subgroups were significant（F=121.56，82.38；P＜0.01）.Conclusion Ultrasound microbubble contrast agent-mediated BDNF transfection to the rat retina and visual cortex can inhibit the RGC apoptosis after optic nerve injury and protect the visual function.
ObjectiveTo investigate the value of contrastenhanced ultrasonography in differential diagnosis between benign and malignant breast mass. MethodsTotally 65 patients with 70 breast masses were evaluated by general ultrasonography and contrastenhanced ultrasonography with contrast agent SonoVue. The related indexes, such as the degree and mode of contrast enhancement, the lesion boundaries and dissipation mode, were used to describe the difference between benign and malignant mass, which was also compared with pathological results. ResultsHistopathological examination revealed that benign mass was in 37 cases and malignant in 28 cases. The sensitivity, accuracy, positive predictive value, and negative predictive value of contrastenhanced ultrasonography with contrast agent SonoVue were significantly higher than that of general ultrasonography (Plt;0.05), while no significant difference in diagnostic specificity and misdiagnosis rate was observed between them (Pgt;0.05). All tumors showed contrast enhancement in various degrees. Of 28 patients with enhanced mass, hyperenhancement in 22 cases and nodular inhomogeneous enhancement in 21 cases were observed and the boundaries of malignant tumor were irregular with ill-defined and radial enhancement. Most of benign tumors were represented by weak, homogeneous enhancement, and the shape was regular with smooth and tidy boundary and intact capsule except seven cases with unclear boundary. These imaging characteristics of benign and malignant tumors were obviously different (P=0.000). In the resolution phase, both benign and malignant mass showed heterogeneous or homogeneous dissipation, which was not significantly different (P=0.791). ConclusionCompared with general ultrasonography, contrast enhanced ultrasonography may be more helpful for the differential diagnosis of benign and malignant breast tumors.
ObjectiveTo analyze systematic reviews (SRs) and meta-analyses on the efficacy of pharmacological interventions in the prevention of contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI). MethodsWe searched the PubMed, The Cochrane Library, EMbase, CNKI, CBM, WanFang Data, and VIP databases to identify SRs and meta-analyses on the pharmacological interventions aimed at preventing CI-AKI after PCI from inception of the databases to February 2022. Two researchers independently screened the literature and extracted data. The PRISMA statement, AMSTAR 2 tool, and GRADE system were adopted to evaluate the reporting quality, methodological quality, and evidence quality of the findings of the included SRs and meta-analyses. ResultsA total of 14 SRs and meta-analyses were identified. Among the drugs used were statins, N-acetylcysteine, sodium bicarbonate, Dan-hong injection, vitamins, salvianolate, adenosine antagonists, nicorandil, allopurinol, alprostadil, furosemide, trimetazidine, probucol, and brain natriuretic peptide. Most of the studies had relatively comprehensive coverage of the items, with the PRISMA scores ranging from 18 to 24.5. The main issues of reporting quality were protocol and registration, search, and funding. The methodological quality of the SRs and meta-analyses was generally low. Items 2 and 7 were the key items with poor scores, and the non-critical items with poor scores were items 3, 10, and 16. All drugs, except furosemide, decreased the incidence of CI-AKI. The quality of evidence ranged from medium to very low according to GRADE. Conclusion Most of the single drugs or drugs combined with hydration show the potential to prevent CI-AKI, however, the overall methodological quality of the included studies is relatively low, and the strength of evidence is generally low.
ObjectiveTo explore the safety and feasibility of contrast enhanced intraoperative ultrasonographyguided percutaneous radiofrequency ablation with artificial hydrothorax to hepatocellular carcinoma in the hepatic dome. MethodsThe clinical data of nine patients with hepatocellular carcinoma in the hepatic dome underwent ultrasonographyguided percutaneous radiofrequnecy ablation with artificial hydrothorax from January 2008 to June 2009 at Department of Hepatobiliopancreatic Surgery of West China Hospital were retrospectively analyzed. The perioperative results and recurrence of tumor were also analyzed. ResultsAll of nine patients with twelve tumors received successfully radiofrequency ablation with artificial hydrothorax of (2 444±464) ml (2 000-3 000 ml). The ablation time was 12-24 min (median 12 min), with an average of (15±5) min for each tumor. No hemothorax, pneumothorax, and death occurred during operation. One patient had ascites of 2 000 ml after ablation due to hypoalbuminenia, and ascites disappeared by infusion of abumin on 4 d after operation. The total volume of pleural drainage was 250-1 420 ml, with an average of (717±372) ml for each patient, and the drainage tube was withdrawn on 3-5 d after operation. The followup time was 7-23 months (mean 15 months). Tumor recurrence was found in three patients on 5, 6, and 7 months after operation, respectively. Of them, two patients were in stable disease stage after interventional and conservative therapy, respectively, and one case recurred at six months after operation and died of hypertensive heart disease and hepatic function deterioration at sixteen months after operation. The rest patients survived and no recurrence and metastasis was observed during the follow-up period.ConclusionThe technique of percutaneous radiofrequency ablation with artificial hydrothorax increases the feasibility of the minimal invasive treatment for hepatoma, which can be applied to hepatocellular carcinoma in the hepatic dome with high safety and clinical application value.
Sample size calculation is an important factor to evaluate the reliability of the diagnostic test. In this paper, a case study of the clinical diagnostic test of artificial intelligence for identification of liver contrast-enhanced ultrasound was performed to conduct two-category and multi-categories studies. Based on sensitivity and specificity, the sample size was then estimated in combination with the statistical characteristics of disease incidence, test level and one/two-sided test. Eventually, the sample size was corrected by integrating the factors of the proportion of training/test dataset and the dropout rate of cases in the medical image recognition system. Moreover, the application of Sample Size Calculator, MedCalc, PASS, and other software can accelerate sample size calculation and reduce the amount of labor.