Study of the Interior Design Based on Elderly People’s Psychological Behaviors and Requirements

Nowadays,the elderly have become an increasingly large group of people in China,but still many problems exist in their living space.This paper explores the physiological and psychological behavioral changes of the elderly,studies their living space requirements,and tries to put forward targeted design strategies in response.Therefore,making a better and more reasonable living space for the elderly as well as improving their living quality,finally helping the development of elderly-friendly design in China.

Application of ultrasound in aggressive angiomyxoma: Eight case reports and review of literature

Aggressive angiomyxoma （AAM） is a rare tumour that often occurs in soft tissues of the female genital tract. Eight cases of AAM are reported in this article, and the clinical features and ultrasound and magnetic resonance imaging （MRI） results of the eight cases are reviewed and summarized. The main complaints of all the patients were palpable and painless masses in the vulva or scrotum. The lesions were mainly located in the vulva, pelvis, and perineal region, with a large scope of involvement. The sonographic features of AAM were characteristic. On sonography, all of the masses were of irregular shape and showed hypoechogenicity, with a heterogeneous inner echotexture. Intratumoural and peritumoural blood fows were detected by colour Doppler imaging. On real-time ultrasonic imaging, prominent deformation of the lesions was observed bycompressing the masses with the probe. Some special imaging features were also revealed, including a la-minated or swirled appearance of inner echogenicity, and a fnger-like or tongue-like growth pattern. On MRI imaging, the lesions showed intermediate-intensity signals and intermediate to high-intensity signals on TI-weighted and T2-weighted sequences. A rapid and uneven enhancement pattern was demonstrated. After the comparison of sonographic features with MRIand pathological findings, we found the relevance of the ultrasonographic characteristics with MRI and his-tological features of AAM. Ultrasound can be a valuable imaging method for the preoperative diagnosis, eva-luation of scope, and follow-up of AAM.

Application of superb microvascular imaging in focal liver lesions

AIM To explore the ability of superb microvascular imaging(SMI) in differential diagnosis of focal liver lesions(FLLs) and to compare SMI morphology findings to those of color Doppler ultrasound and enhanced imaging.METHODS Twenty-four patients with 31 FLLs were included in our study,with diagnoses of hemangioma(HE)(n = 17),hepatocellular carcinoma(HCC)(n = 5),metastatic lesions(n = 5),primary hepatic lymphoma(n = 1),focal nodular hyperplasia(FNH)(n = 2),and adenoma(n = 1). Nine lesions were pathologically diagnosed,and 22 lesions were radiologically confirmed,all of which were evaluated by at least two types of enhanced imaging techniques. All patients had undergone SMI. Patients were divided into subgroups based on pathological and radiological diagnoses to analyze SMI manifestations. We also compared the SMI manifestations of the most common malignant FLLs(HCCs and metastatic lesions) with those of the most common benign FLLs(HEs).RESULTS HEs were classified into three SMI subgroups: diffuse dot-like type(n = 6),strip rim type(n = 8),and nodular rim type(n = 3). The sizes of the three types of HEs were significantly different(P = 0.00,< 0.05). HCCs were classified into two subgroups: diffuse honeycomb type(n = 2) and non-specific type(n = 3). Four of the metastatic lesions were the strip rim type,and the other metastatic lesion was the thick rim type,which is the same as that of lymphoma. FNH was described as a spoke-wheel type,and adenoma as a diffuse honeycomb type. The SMI types of HCCs and metastatic lesions were significantly different from those of HEs(P = 0.048,< 0.05).CONCLUSION SMI technology enables microvascular evaluation of FLLs without using any contrast agent. For HEs,lesion size may affect SMI performance. SMI is able to provide useful information for differential diagnosis of HCCs and metastatic lesions from HEs.

COLOR DOPPLER ULTRASONOGRAPHY APPEARANCES OF RENAL VEIN THROMBOSIS AND ITS DIAGNOSTIC VALUE

Objective To evaluate color Doppler ultrasonography (CDU) appearances of renal vein thrombosis (RVT) and its diagnostic value.Methods Ten patients with RVT were analyzed retrospectively. Renal structure, distributions of intrarenal flow signals, echogenicity, and flow fullness in main renal veins were observed with CDU. Resistance index (RI) was recorded from the waveforms of segmental or interlobar renal artery.Results Ten kidneys in nine patients were confirmed to have thrombus within the main renal veins, and one patient was confirmed to have thrombus within the small intrarenal veins. The appearances of the main renal vein thrombosis included full of solid echogenicity or strip echogenicity and complete or partial filling defect within the main renal veins, and absent or a few intrarenal venous flow signals in 70% of kidneys involved. The appearances of intrarenal vein thrombosis included obscure renal structure and no venous flow signal within the involved part of the kidneys. Reverse diastolic flow in the intrarenal artery had only a sensitivity of 36% (4/11); in other 7 kidneys without intrarenal arterial reverse diastolic flow, increased RI (mean, 0.84; range, 0.74-0.96) was found.Conclusion CDU is helpful for rapid clinical diagnosis and follow-up of RVT, and therefore can be the first imaging modality of choice for RVT.

Pathology Verified Concomitant Papillary Thyroid Carcinoma in the Sonographically Suspected Thyroid Lymphoma:A Case Report

PAPILLARY thyroid carcinoma （PTC） is the most common thyroid cancer and consists of nearly 80% of all cases of thyroid cancer.1 It is asso- ciated with the lowest level of malignancy and an excellent prognosis. Primary thyroid lymphoma （PTL） is a lymphomatous process which develops in the thyroid without involvement of primary lymphoid organs or distant metastases at diagnosis.2 It is a rare malignancy that accounts for 1%-5% of all thyroid malignancies and less than 2% of all extranodal lymphomas. The incidence of PTL is one or two cases per million.2＇ 3 It occurs frequently in elder woman, with a peak incidence in the sixth decade of life.

Role of Contrast-enhanced Ultrasound in the Evaluation of Inflammatory Arthritis

Objective：Contrast-enhanced ultrasound （CEUS） is a well-established imaging modality which has been put into clinical use in recent years with the development of second-generation contrast agent and imaging devices,and its applications in the assessment of inflammatory arthritis,such as rheumatoid arthritis,psoriatic arthritis,and ankylosing spondylitis,have provoked abundant discussion and researches among radiologists and rheumatologists.To summarize the achievements of clinical studies on CEUS in the application of arthritis,and to keep up with the latest progresses of the imaging technique,we reviewed the literature in recent years,hoping to establish the role of CEUS in joint diseases.Data Sources：PubMed and EMBASE.Study Selection：We searched the database with the conditions ＂contrast-enhanced ultrasound AND arthritis＂ with the time limitation of recent 10 years.Clinical studies applying CEUS in inflammatory arthritis and review articles about development of CEUS in joint diseases in English were selected.Results：As it is proved by most studies in recent years,by delineating microvasculature within the inflamed joints,CEUS can indicate early arthritis with high sensitivity and specificity.Moreover,the imaging of CEUS has been proved to be consistent with histopathological changes of inflammatory arthritis.Quantitative analysis of CEUS permits further evaluation of disease activity.CEUS also plays a significant role in the therapeutic monitoring of the disease,which has been backed up by a number of studies.Conclusions：CEUS may be a new choice for the rheumatologists to evaluate inflammatory arthritis,because of its low price,ability to provide dynamic pictures,and high sensitivity to angiogenesis.It can also be applied in disease classification and therapeutic monitoring.More studies about CEUS need to be done to set up the diagnostic standards.

＂Onion Skin-liked Sign＂ in Thyroid Ultrasonography： A Characteristic Feature of Benign Thyroid Nodules

Background： Some ultrasonographic （US） signs overlap between benign and malignant nodules. The purpose of this study was to raise a special US sign of benign thyroid nodules, termed the ＂onion skin-liked sign.＂ Methods： Twenty-seven patients with 27 nodules who shrank naturally and the ＂onion skin-liked sign＂ appeared on the final US images were enrolled in the study. The ultrasound characters and risk stratifications at the start and end of observation were compared. Then, thirty goiters with fibrosis and thirty papillary thyroid carcinomas （PTC） were randomly selected from the database of our hospital, matched the sizes of 27 nodules at the end point of observation. The differences of ＂onion skin-liked sign＂ between the two groups were analyzed. Results： The average duration of follow-up of 27 nodules was 24.0 ± 12.2 months （range, 12-65 months）. At the end of the follow-up, the size of the nodules decreased on average by 1.26 ± 0.82 cm （range, 0.3-3.4 cm） and calcification was found in 21 nodules, compared with only 2 nodules with calcification at the start of the follow-up. In addition, only negligible or no blood flow signal could be detected at the periphery of all the nodules and 100% （27/27） were high suspicion at the end of observation. In matched groups, all PTC showed high suspicion of malignancy, 18/30 （60%） goiters with fibrosis were high suspicion and 11/30 （37%） were intermediate suspicion. Twenty-two patients in the group of nodular fibrosis presented ＂onion skin-liked sign,＂ which was not shown in any patient of PTC group. The sensitivity, specificity, positive predictive value, and negative predictive value of ＂onion skin-liked sign＂ in predicting nodular goiter with fibrosis were 73.3%, 100%, 100%, and 78.9%, respectively. Conclusions： The ＂onion skin-liked sign＂ was a characteristic US feature of benign thyroid nodules detected in the follow-up of thyroid nodules. It is useful to differentiate PTCs and nodular goiters with fibrosis.

Contrast-enhanced Ultrasound in Detecting Endoleaks with Failed Computed Tomography Angiography Diagnosis after Endovascular Abdominal Aortic Aneurysm Repair

Background： Endovascular aneurysnl repair （EVAR） is one of the first-line therapies of abdominal aortic aneurysms. Postoperative endoleak is the most common complication of EVAR. Computed tomography angiography （CTA）, which is routine for follow-up, has side effects （e.g., radiation） and also has a certain percentage of missed diagnosis. Preliminary studies on contrast-enhanced ultrasound （CEUS） have shown that the sensitivity of CEUS for detecting endoleak is no lower than that of CTA. To investigate the advantages of CEUS, we conducted CEUS examinations of post-EVAR cases in which CTA failed to detect endoleak or could not verify the type of endoleak. Methods： Post-EVAR patients, who were clinically considered to have endoleak and met the inclusion criteria were enrolled between March 2013 and November 2014. All of the patients underwent color Doppler flow imaging （CDFI） and a CEUS examination. Size, location, microbubble dispersion, and hemodynamic characteristics of leaks were recorded. Comparison between the diagnosis of CEUS and CDF1 was conducted using Fisher＇s exact test and clinical outcomes of all patients were followed up. Results： Sixteen patients were enrolled, and 12 （75%） had endoleaks with verified types by CEUS. Among 12 cases of endoleaks were positive by CEUS, 10 were CDFl-positive, and the four CEUS-negative cases were all negative by CDFI. The diagnostic values of CEUS and CDFI were statistically difl＇erent （P = 0,008）. Six patients with high-pressure endoleaks received endovascular re-intervention guided by CEUS results. One patient with type Ⅲ endoleak had open surgery when endovascular repair failed. Conclusions： C EUS is a new, safe, and effective means for detection ofendoleaks post-EVAR. This technique can be used as a supplement for routine CTA follow-up to provide more detailed information on endoleak and its category.

In vivo longitudinal and multimodal imaging of hypoxia-inducible factor 1a and angiogenesis in breast cancer

Background:Angiogenesis and hypoxia-inducible factor 1a(HIF-1a)play major roles in solid tumors.This study aimed to establish a longitudinal and multimodal imaging model for in vivo evaluation of HIF1a and angiogenesis in breast cancer.Methods:By transfection of a 5 hypoxia-responsive element(HRE)/green fluorescent protein(GFP)plasmid,the cell line Ca761-hregfp was established,which emitted green fluorescence triggered by HIF-1a under hypoxia.The cells were subjected to CoCl2-simulated hypoxia to confirm the imaging strategy.We grew Ca761-hre-gfp cells in the left rear flanks of twelve 615 mice.Experiments were conducted on days 4,9,15,and 19.For in vivo analysis,Ca761-hre-gfp subcutaneous allografted tumors were imaged in vivo using contrast-enhanced ultrasound(CEUS)and fluorescence imaging(FLI)during tumor development.The tumor size,CEUS peak intensity,and FLI photons were measured to evaluate tumor growth,angiogenesis,and HIF-1a activity,respectively.After each experiment,three mice were randomly sacrificed and tumor specimens were collected to examine HIF-1a activity and the microvessel density(MVD).Results:In vitro,both green fluorescence and HIF-1a expression were detected in Ca761-hre-gfp cells treated with CoCl2,indicating the suitability of the cells to detect HIF-1a activity.In vivo,HIF-1a activity first increased and then decreased,which was significantly correlated with angiogenic changes(r=0.803,P=0.005).These changes were confirmed by immunohistochemical staining of HIF-1a and MVD.Conclusions:The findings validated the Ca761-hre-gfp murine allograft model for reliable evaluation of HIF-1a activity and angiogenesis longitudinally using both molecular and pre-clinical non-invasive imaging modalities.The cell line may be useful for studies of anti-HIF pathway therapies.

Comparison of Clinical and Ultrasonographic Features of Poorly Differentiated Thyroid Carcinoma and Papillary Thyroid Carcinoma

Background： The clinical behavior and management of poorly differentiated thyroid carcinoma （PDTC） are very different from papillary thyroid carcinoma （PTC）. By comparing the clinical and ultrasonographic features between the two tumors, we proposed to provide more possibilities for recognizing PDTC before treatment. Methods： The data of 13 PDTCs and 39 ageand gender-matched PTCs in Peking Union Medical College Hospital between December 2003 and September 2013 were retrospectively reviewed. The clinical and ultrasonic features between the two groups were compared. Results： The frequencies of family history of carcinoma, complication with other thyroid lesions, lymph node metastases, recurrent laryngeal nerve injuries, and distant metastases were higher in PDTCs （30.8%, 61.6%, 69.2%, 23.1%, and 46.2%, respectively） than those in PTCs （2.6%, 23.1%, 25.6%, 2.6%, and 2.6%, respectively） （P 〈 0.05）. The mortality rate of PDTCs was greatly higher than PTCs （P 〈 0.01）. Conventional ultrasound showed that the size of PDTCs was larger than that of PTCs （3.1±1.9 cm vs. 1.7± 1.0 cm）. Clear margins and rich and/or irregular blood flow were found in 92.3% of PDTCs, which differed substantially from PTCs （51.7% and 53.8%, respectively） （P 〈 0.05）. Conclusions： PDTC is more aggressive and its mortality rate is higher than PTCs. Accordingly, more attention should be given to suspicious thyroid cancer nodules that show large size, regular shape, and rich blood flow signals on ultrasound to exclude the possibility of PDTCs.