Three-dimensional printing for preoperative rehearsal and intraoperative navigation during laparoscopic rectal cancer surgery with left colic artery preservation

BACKGROUND Prior studies have shown that preserving the left colic artery(LCA)during laparo-scopic radical resection for rectal cancer(RC)can reduce the occurrence of anasto-motic leakage(AL),without compromising oncological outcomes.However,anatomical variations in the branches of the inferior mesenteric artery(IMA)and LCA present significant surgical challenges.In this study,we present our novel three dimensional(3D)printed IMA model designed to facilitate preoperative rehearsal and intraoperative navigation to analyze its impact on surgical safety.AIM To investigate the effect of 3D IMA models on preserving the LCA during RC surgery.METHODS We retrospectively collected clinical dates from patients with RC who underwent laparoscopic radical resection from January 2022 to May 2024 at Fuyang People’s Hospital.Patients were divided into the 3D printing and control groups for sta-tistical analysis of perioperative characteristics.RESULTS The 3D printing observation group comprised of 72 patients,while the control group comprised 68 patients.The operation time(174.5±38.2 minutes vs 198.5±49.6 minutes,P=0.002),intraoperative blood loss(43.9±31.3 mL vs 58.2±30.8 mL,P=0.005),duration of hospitalization(13.1±3.1 days vs 15.9±5.6 days,P<0.001),postoperative recovery time(8.6±2.6 days vs 10.5±4.9 days,P=0.007),and the postoperative complication rate(P<0.05)were all significantly lower in the observation group.CONCLUSION Utilization of a 3D-printed IMA model in laparoscopic radical resection of RC can assist surgeons in understanding the LCA anatomy preoperatively,thereby reducing intraoperative bleeding and shortening operating time,demonstrating better clinical application potential.

Endoscopic ultrasound features of rectal melanoma:A case report and review of literature

BACKGROUND Rectal mucosal melanoma is a rare and highly aggressive disease.Common symptoms include anal pain,an anal mass,or bleeding.As such,the disease is usually detected on rectal examination of patients with other suspected anorectal diseases.However,due to its rarity and nonspecific symptoms,melanoma of the rectal mucosa is easily misdiagnosed.CASE SUMMARY This report describes the case of a 58-year-old female patient who presented with a history of blood in her stool for the prior one or two months,without any identifiable cause.During colonoscopy,a bulge of approximately 2.2 cm×2.0 cm was identified.Subsequently,the patient underwent endoscopic ultrasound(EUS)to characterize the depth of invasion of the lesions.EUS suggested a hypoechoic mucosal mass with involvement of the submucosal layer and heterogeneity of the internal echoes.Following surgical intervention,the excised tissue samples were examined and confirmed to be rectal malignant melanoma.The patient recovered well with no evidence of recurrence during follow-up.CONCLUSION This case shows that colonoscopy with EUS and pathological examination can accurately diagnose rare cases of rectal mucosal melanoma.

Diagnostic Value of Endoscopic Ultrasound in Staging Rectal Cancer

Objective:To explore the diagnostic value of endoscopic ultrasound(EUS)in the staging of rectal cancer.Methods:Fifty patients with rectal cancer,treated at the Department of Endoscopy,Cancer Hospital Affiliated to Fudan University,from March 2023 to June 2024,were selected.All patients underwent EUS and computed tomography(CT)examination within two weeks before surgery.The postoperative pathological staging was used as the standard to compare the accuracy of tumor TN staging using EUS and/or CT.Results:The accuracy rates of T and N staging by abdominal spiral CT were 72.00%and 76.00%,respectively,while those by EUS were 88.00%and 74%,respectively.There was a significant difference in the accuracy of T staging between the two methods(both P<0.05).Conclusion:EUS has high diagnostic value in the staging of rectal cancer,providing important reference information for clinicians,aiding in the development of personalized treatment plans,and assessing patient prognosis.

Predictive value of the trans-perineal three-dimensional ultrasound measurement of the pubic arch angle for vaginal delivery

BACKGROUND Numerous variables are linked to the success of vaginal delivery,including the subpubic arch angle(SPAA)during labor,the importance of which has not yet been fully elucidated.AIM To examine the SPAA distributional characteristics and to ascertain SPAA’s ability to predict the type and duration of labor.METHODS We determined the SPAA and analyzed the corresponding data.We also evaluated the relationship between the SPAA and the mode of delivery and the duration of labor by regression.The present study comprised a total of 301 pregnant women who had given birth at Beijing Tiantan Hospital of the Capital Medical University between January and December of 2021.RESULTS Our analysis of 301 pregnant women revealed that the SPAA measured using three-dimensional trans-perineal ultrasound had a minimum angle of 81°and a maximum angle of 122.2°.The angle in the normal vaginal delivery group was greater than that in the labor cesarean group(P=0.000).The SPAA was a highly significant positive predictor of normal vaginal delivery(P=0.000)with an area under the curve of 0.782(P=0.000;95%CI:0.717-0.848).We found the length of the second stage of labor to be positively influenced by the SPAA using linear regression analysis(P=0.045).CONCLUSION The SPAA was a highly significant positive predictor of normal vaginal delivery.The length of the second stage of labor and normal vaginal birth were predicted by SPAA.

Role of three-dimensional endoanal ultrasound in assessing the anal sphincter morphology of female patients with chronic proctalgia

AIM To assess the role of three-dimensional endoanal ultrasound (3D-EAUS) for morphological assessment of the anal sphincter of female patients with chronic proctalgia (CP). METHODS In this unmatched case control study, 30 consecutive female patients with CP and 25 normal women (control group) were enrolled. 3D-EAUS was performed in all subjects. Thickness and length of internal anal sphincter (IAS), thickness of puborectalis muscle (PR), length of the external anal sphincter (EAS) plus PR, and puborectalis angle were measured and compared between the two groups. RESULTS Patients with CP had significantly shorter IAS length and greater PR thickness, as compared to those in normal individuals (26.28 +/- 3.59 mm vs 28.87 +/- 4.84 mm, P < 0.05 and 9.67 +/- 1.57 mm vs 8.85 +/- 0.97 mm, P < 0.05, respectively). No significant between-group differences were observed with respect to IAS thickness and the EAS plus PR length (P > 0.05). Puborectalis angle in the CP group was significantly decreased, both in resting (88.23 degrees +/- 1.81 degrees vs 89.94 degrees +/- 2.07 degrees in control group, P < 0.05) and straining (88.47 degrees +/- 3.32 degrees vs 90.72 degrees +/- 1.87 degrees in control group, P < 0.05) phases, which suggest the presence of paradoxical contraction of PR in patients with CP. In the CP group, no significant difference in puborectalis angle was observed between the resting and straining phases (88.23 degrees +/- 1.81 degrees vs 88.47 degrees +/- 3.32 degrees respectively, P > 0.05). CONCLUSION The association of greater PR thickness and paradoxical contraction of PR with CP suggest their potential value as markers of CP.

Detection of Congenital Uterine Malformation by Using Transvaginal Three-dimensional Ultrasound

This study assessed the clinical application of transvaginal three-dimensional ultrasound （3D TVUS） in the diagnosis of congenital uterine malformation. A retrospective study was performed on 62 patients with congenital uterine malformation confirmed hysteroscopically and/or laparoscopically. The patients were subjected to transvaginal two-dimensional ultrasound （2D TVUS） and 3D TVUS. The accuracy rate was compared between the two methods. The accuracy rate of 3D TVUS was （98.38%, 61/62）, higher than that of 2D TVUS （80.65%, 50/62）. 3D TVUS coronal plane imaging could demon- strate the internal shape of the endometrial cavity and the external contour of the uterine fundus. It al- lowed accurate measurement on the coronary plane, and could three-dimensionally show the image of cervical tube, thereby providing information for the diagnosis of some complex uterine malformation. 3D TVUS imaging can obtain comprehensive information of the uterus malformation, and it is superior to 2D TVUS for the diagnosis of congenital uterine malformations, especially complex uterine anomaly.

Sequential transcatheter arterial chemoembolization,three-dimensional conformal radiotherapy,and high-intensity focused ultrasound treatment for unresectable hepatocellular carcinoma patients

The purpose of this study was to evaluate the outcome of patients with unresectable hepatocellular carcinoma（HCC） treated by sequential therapy of transcatheter arterial chemoembolization（TACE）,three-dimensional conformal radiotherapy（3-DCRT） and high-intensity focused ultrasound（HIFU）.From October,2005 to September,2010,120 patients with unresectable HCC received the sequential treatments of several courses of TACE followed in 2-4 weeks by 3-DCRT and then a single session of HIFU with a curative intent.The median tumor irradiation dose was 40 Gy.Tumor response,toxicity and overall survival rate were analyzed.Clinicopathologic factors affecting the primary technique effectiveness and overall survival rates were investigated by univariate analysis or multivariate analysis.All 120 HCC patients were followed up by the last follow-up time.Among these patients,hepatic toxicities due to treatment were notable in 9 cases.Gastrointestinal bleeding after the overall treatment occurred in 2 cases,leukopenia of grade III was detected in 1 case,radiation-induced liver disease（RILD） was observed in 2 patients,and first-and second-degree skin burn around the HIFU treatment zone were observed in 2 patients and 1 patient,respectively.Among 120 patients,23,83 and 14 cases achieved partial response,stable disease and progressive disease,respectively.The overall survival rates at 1 year,3 years and 5 years were 70%,35% and 15%,respectively,with a median survival time of 26 months.Both Child-Pugh liver function grading and radiation dose were determined to be independent predictors for overall survival revealed by the multivariate analysis.It is concluded that the sequential therapy of TACE,3-DCRT and HIFU is a promising therapeutic regimen for unresectable HCC.

Current and future role of three-dimensional modelling technology in rectal cancer surgery:A systematic review

BACKGROUND Three-dimensional(3D)modelling technology translates the patient-specific anatomical information derived from two-dimensional radiological images into virtual or physical 3D models,which more closely resemble the complex environment encountered during surgery.It has been successfully applied to surgical planning and navigation,as well as surgical training and patient education in several surgical specialties,but its uptake lags behind in colorectal surgery.Rectal cancer surgery poses specific challenges due to the complex anatomy of the pelvis,which is difficult to comprehend and visualise.AIM To review the current and emerging applications of the 3D models,both virtual and physical,in rectal cancer surgery。METHODS Medline/PubMed,Embase and Scopus databases were searched using the keywords“rectal surgery”,“colorectal surgery”,“three-dimensional”,“3D”,“modelling”,“3D printing”,“surgical planning”,“surgical navigation”,“surgical education”,“patient education”to identify the eligible full-text studies published in English between 2001 and 2020.Reference list from each article was manually reviewed to identify additional relevant papers.The conference abstracts,animal and cadaveric studies and studies describing 3D pelvimetry or radiotherapy planning were excluded.Data were extracted from the retrieved manuscripts and summarised in a descriptive way.The manuscript was prepared and revised in accordance with PRISMA 2009 checklist.RESULTS Sixteen studies,including 9 feasibility studies,were included in the systematic review.The studies were classified into four categories:feasibility of the use of 3D modelling technology in rectal cancer surgery,preoperative planning and intraoperative navigation,surgical education and surgical device design.Thirteen studies used virtual models,one 3D printed model and 2 both types of models.The construction of virtual and physical models depicting the normal pelvic anatomy and rectal cancer,was shown to be feasible.Within the clinical context,3D models were used to identify vascular anomalies,for surgical planning and navigation in lateral pelvic wall lymph node dissection and in management of recurrent rectal cancer.Both physical and virtual 3D models were found to be valuable in surgical education,with a preference for 3D printed models.The main limitations of the current technology identified in the studies were related to the restrictions of the segmentation process and the lack of 3D printing materials that could mimic the soft and deformable tissues.CONCLUSION 3D modelling technology has potential to be utilised in multiple aspects of rectal cancer surgery,however,it is still at the experimental stage of application in this setting.

Prenatal Diagnosis of Sirenomelia by Two-Dimensional and Three-Dimensional Skeletal Imaging Ultrasound

Summary： This study sought to evaluate the contribution of two-dimensional ultrasound （2D-US） and three-dimensional skeletal imaging ultrasound （3D-SUIS） in the prenatal diagnosis of sirenomelia. Be- tween September 2010 and April 2014, a prospective study was conducted in a single referral center using 3D-SU1S performed after 2D-US in 10 cases of sirenomelia. Diagnostic accuracy and detailed findings were compared with postnatal three-dimensional helical computed tomography （3D-HCT）, radiological findings and autopsy. Pregnancy was terminated in all 10 sirenomelia cases, including 9 singletons and I conjoined twin pregnancy, for a total of 5 males and 5 females. These cases of sirenomelia were deter- mined by autopsy and/or chromosomal examination. Initial 2D-US showed that there were 10 cases of oligohydranmios, bilateral renal agenesis, bladder agenesis, single umbilical artery, fusion of the lower limbs and spinal abnormalities; 8 cases of dipus or monopus; 2 cases of apus; and 8 cases of cardiac abnormalities. Subsequent 3D-SUIS showed that there were 9 cases of scoliosis, l0 cases of sacrococ- cygeal vertebra dysplasia, 3 cases of hemivertebra, 1 case of vertebral fusion, 3 cases of spina bifida, and 5 cases of rib abnormalities. 3D-SUIS identified significantly more skeletal abnormalities than did 2D-US, and its accuracy was 79.5% （70/88） compared with 3D-HCT and radiography. 3D-SUIS seems to be a useful complementary method to 2D-US and may improve the accuracy of identifying prenatal skeletal abnormalities related to sirenomelia.

Three-Dimensional Conformal Radiotherapy for Rectal Cancer and the Changes in Cancer Multi-biomarkers

OBJECTIVE To investigate the clinical efficacy of three-dimensional conformal radiotherapy （3D-CRT） for locally advanced or postoperatively relapsed rectal cancer, and to examine the changes in cancer multi-biomarkers. METHODS Sixty patients with locally advanced or postoperatively relapsed rectal cancer were randomly divided into two groups after 40 Gy external radiation, namely a late-course 3D-CRT group and a conventional radiotherapy group that served as the control. There were 30 patients in each group. For patients in the 3D-CRT group, multi-biomarkers were measured before and after radiotherapy and after relapse. RESULTS Response rates in the 3D-CRT and the control groups were 86.7% （26/30） and 70% （21/30） respectively, without a significant difference （P〉0.05）. The 1-, 2- and 3-year survival rates were 80%, 53.3% and 36.7% in the 3D-CRT group; in the control group the rates were 56.7%, 40% and 13.3% respectively, with a significant difference （P=0.0213）. CEA, CA19-9, CA242 and FER decreased after radiotherapy in the 3D-CRT group, P〈0.01, indicating a significant difference. The values after relapse were higher than those without relapse, P〈0.01, indicating a significant difference. CONCLUSION Conventional radiotherapy with a 3D-CRT boost gives better therapeutic effect to patients with locally advanced or postoperatively locally relapsed rectal cancer. A multi-biomarker protein chip diagnosis system can be utilized as an effective tool to determine the therapeutic effect and prognosis.

Anorectal dysfunction in patients with mid-low rectal cancer after surgery: A pilot study with three-dimensional high-resolution manometry

BACKGROUND The quality of life in patients who develop low anterior resection syndrome(LARS)after surgery for mid-low rectal cancer is seriously impaired.The underlying pathophysiological mechanism of LARS has not been fully investigated.AIM To assess anorectal function of mid-low rectal cancer patients developing LARS perioperatively.METHODS Patients diagnosed with mid-low rectal cancer were included.The LARS score was used to evaluate defecation symptoms 3 and 6 mo after anterior resection or a stoma reversal procedure.Anorectal functions were assessed by threedimensional high resolution anorectal manometry preoperatively and 3-6 mo after surgery.RESULTS The study population consisted of 24 patients.The total LARS score was decreased at 6 mo compared with 3 mo after surgery(P<0.05),but 58.3%(14/24)lasted as major LARS at 6 mo after surgery.The length of the high-pressure zone of the anal sphincter was significantly shorter,the mean resting pressure and maximal squeeze pressure of the anus were significantly lower than those before surgery in allpatients (P < 0.05), especially in the neoadjuvant therapy group after surgery (n = 18). The focalpressure defects of the anal canal were detected in 70.8% of patients, and those patients had higherLARS scores at 3 mo postoperatively than those without focal pressure defects (P < 0.05). Spasticperistaltic contractions from the new rectum to anus were detected in 45.8% of patients, whichwere associated with a higher LARS score at 3 mo postoperatively (P < 0.05).CONCLUSIONThe LARS score decreases over time after surgery in the majority of patients with mid-low rectalcancer. Anorectal dysfunctions, especially focal pressure defects of the anal canal and spasticperistaltic contractions from the new rectum to anus postoperatively, might be the majorpathophysiological mechanisms of LARS.

Dosimetric study of five-field intensity-modulated radiotherapy compared with conventional three-dimensional conformal radiotherapy for rectal cancer

Objective： The aim of the study was to compare the difference of dose distribution in clinical target volume and organ at risk （OAR） between five-field intensity-modulated radiotherapy （IMRT） and conventional three-dimensional conformal radiotherapy （3DCRT） in the radiotherapy of rectal cancer. Methods： Fifteen patients with rectal cancer treated with radio- therapy （RT） were retrospectively analyzed. Among the patients, seven received RT preoperatively and 8 postoperatively. The target volume and the OARs such as the small bowel, bladder and femoral heads were contoured for each patient. 3DCRT-plan and IMRT-plan were performed for each patient respectively, with the prescribed dose covering at least 95% of the planning target volume （PTV）. The conformity index （CI） and homogeneity index （HI） were used for evaluation of the dose distribution in the target volume, and the Dx% （the lowest dose to the x% volume of the OARs that received the highest dose of irradiation） and the mean dose were used for evaluation of the dose to OARs. Paired-T test was used for companson of the difference between the two plans. Results： In the IMRT-plan and 3DCRT-plan, the CI were 0.94 and 0.87 （P = 0.000） and the HI were 1.13 and 1.17, respectively （P = 0.001）. For small bowel, the D30%, D50% and the mean dose were 19.67 Gy, 15.13 Gy and 18.81 Gy in the IMRT-plan and 25.20 Gy, 22.20 Gy and 22.89 Gy in the 3DCRT-plan, respectively （P 〈 0.001 for all pairs of parameters）. For bladder, the D30%, D50%, and the mean dose were 24.80 Gy, 34.20 Gy and 28.70 Gy in the IMRT- plan, and 35.07 Gy, 44.67 Gy and 35.68 Gy in the 3DCRT-plan, respectively （P 〈 0.001 for all pairs of parameters）. For femoral heads, the D5% in the IMRT-plan and 3DCRT-plan were 40.6 Gy and 40.47 Gy, respectively （P = 0.936）, and the mean dose were 30.14 Gy and 25.57 Gy, respectively （P = 0.001）. Conclusion： Five-field IMRT-plan is better than 3DCRT-plan in the conformity and the dose homogeneity within target volume and also better in sparing the small bowel and bladder.

Study on sex differences and potential clinical value of threedimensional computerized tomography pelvimetry in rectal cancer patients

BACKGROUND Laparoscopic rectal cancer radical surgery is a complex procedure affected by various factors.However,the existing literature lacks standardized parameters for the pelvic region and soft tissues,which hampers the establishment of consistent conclusions.AIM To comprehensively assess 16 pelvic and 7 soft tissue parameters through computerized tomography(CT)-based three-dimensional(3D)reconstruction,providing a strong theoretical basis to address challenges in laparoscopic rectal cancer radical surgery.METHODS We analyzed data from 218 patients who underwent radical laparoscopic surgery for rectal cancer,and utilized CT data for 3D pelvic reconstruction.Specific anatomical points were carefully marked and measured using advanced 3D modeling software.To analyze the pelvic and soft tissue parameters,we emp-loyed statistical methods including paired sample t-tests,Wilcoxon rank-sum tests,and correlation analysis.RESULTS The investigation highlighted significant sex disparities in 14 pelvic bone parameters and 3 soft tissue parameters.Males demonstrated larger measurements in pelvic depth and overall curvature,smaller measurements in pelvic width,a larger mesorectal fat area,and a larger anterior-posterior abdominal diameter.By contrast,females exhibited wider pelvises,shallower depth,smaller overall curvature,and an increased amount of subcutaneous fat tissue.However,there were no significant sex differences observed in certain parameters such as sacral curvature height,superior pubococcygeal diameter,rectal area,visceral fat area,waist circumference,and transverse abdominal diameter.CONCLUSION The reconstruction of 3D CT data enabled accurate pelvic measurements,revealing significant sex differences in both pelvic and soft tissue parameters.This study design offer potential in predicting surgical difficulties and creating personalized surgical plans for male rectal cancer patients with a potentially“difficult pelvis”,ultimately improving surgical outcomes.Further research and utilization of these parameters could lead to enhanced surgical methods and patient care in laparoscopic rectal cancer radical surgery.

Relationship between intracranial pressure and neurocognitive function among older adults after radical resection of rectal cancer

BACKGROUND Older patients are prone to postoperative cognitive decline after laparoscopic rectal cancer surgery,which may be associated with increased intraoperative intracranial pressure(ICP).This study investigated the correlation between intra-operative ICP changes,as indicated by measurements of the optic nerve sheath diameter(ONSD)using ultrasonography,and subsequent cognitive function to provide better patient care.AIM To evaluate changes in ICP and associated postoperative neurocognition in older adults after laparoscopic radical resection for rectal cancer.METHODS We included 140 patients who visited the Mianyang Central Hospital for malig-nant rectal tumors,measured their ONSDs before surgery and 30 and 60 minutes after the Trendelenburg position during surgery,and evaluated the patients’cog-nitive function 1 day before surgery and 1,4,and 7 days after surgery.The Mini-Mental State Examination(MMSE)and confusion assessment method(CAM)scores of the patients with different ONSDs were compared at different times after surgery.RESULTS In patients with an ONSD greater than 5.00 mm(group A1),the MMSE scores at 1 day and 4 days after surgery were significantly lower than those of patients with an ONSD less than or equal to 4.00 mm(group A2)(P<0.05).The CAM scores of group A1 were significantly higher than those of group A2(P<0.05).The MMSE scores of group A1 on days 1 and 4 after surgery were significantly lower than those 1 day before and 7 days after surgery(P<0.05),while the CAM scores 1 day and 4 days after surgery were significantly higher than those 1 day before and 7 days after surgery.CONCLUSION Decline in cognitive function among older adults after the procedure may be related to intracranial hypertension during surgery.

Three-dimensional psychological guidance combined with evidencebased health intervention in patients with liver abscess treated with ultrasound

BACKGROUND Liver abscess is a common clinical liver disease mainly caused by suppurative bacteria or amoebae,with early clinical signs of chills,high fever,jaundice,and other symptoms.Establishing its early diagnosis is difficult,which may lead to misdiagnosis.AIM To observe the effects of psychological guidance combined with evidence-based health intervention in patients with liver abscess treated with ultrasound.METHODS A total of 120 patients with bacterial liver abscess admitted to our hospital from May 2018 to February 2021 were selected and divided into groups according to their intervention plan.RESULTS After the intervention,Self-Rating Depression Scale,Self-Rating Anxiety Scale,Self-Perceived Burden Scale(SPBS),and quality of life scores(physical functioning,role physical,bodily pain,general health,vitality,social functioning,role emotional,mental health)were lower than before the intervention in the two groups.The observation group had lower negative sentiment,SPBS,and quality of life scores than the control group.In the observation group,31 and 24 patients had good and general compliance,respectively,with a compliance rate of 91.67%,which was significantly higher than that in the control group.The observation group had significantly lower total incidence of incision infection,abdominal abscess,hemorrhage,and severe abdominal pain than the control group.CONCLUSION Three-dimensional psychological guidance combined with evidence-based health intervention in treating liver abscess can reduce patients’burden and negative emotions,improve patient compliance and quality of life,and reduce complications.

Changes in three-dimensional power Doppler ultrasound features before and after neoadjuvant chemotherapy for cervical cancer and their relationship with malignant molecule expression

Objective:To study the changes in three-dimensional power Doppler ultrasound features before and after neoadjuvant chemotherapy for cervical cancer and their relationship with malignant molecule expression.Methods: The patients who were diagnosed with cervical cancer and received neoadjuvant chemotherapy in Wuhan Red Cross Hospital between March 2015 and October 2017 were selected as the cervical cancer group, and the patients who received cervical biopsy and were diagnosed with stage I cervical intraepithelial neoplasia by pathological findings during the same period were selected as the control group. Before biopsy, three-dimensional power Doppler ultrasonography was performed to measure VI, FI and VFI;the tissues of cervical cancer group before and after chemotherapy as well as the biopsy tissues of control group were collected to measure the expression of proliferation genes, invasion genes and angiogenesis genes.Results: The VI, FI and VFI levels as well as the Piwil2 gene (Piwil2), CyclinD1, N-Myc downstream regulated gene 3 (NDRG3), CXC chemokine ligand 5 (CXCL5), cathepsin-L (CAT-L), EGF-containing fibulin-like extracellular matrix protein 1 (EFEMP1), angiotensin (Ang)1, Ang2 and angiopoietin-like protein 4 (ANGPTL4) mRNA expression levels in the tissues of cervical cancer group before and after chemotherapy were all significantly higher than those of control group whereas the thrombospondin 2 (THBS2), Smac gene (Smac), large tumor suppressor kinase 1 (LATS1), reversion-inducing-cysteine-rich protein with kazal motifs (RECK) and plas minogen activator inhibitor 1 (PAI-1) mRNA expression levels in the tissues were all significantly lower than those of control group, and the VI, FI and VFI levels as well as the Piwil2, CyclinD1, NDRG3, CXCL5, CAT-L, EFEMP1, Ang1, Ang2 and ANGPTL4 mRNA expression levels in the tissues of cervical cancer group after chemotherapy were all significantly lower than those before chemotherapy whereas the THBS2, Smac, LATS1, RECK and PAI-1 mRNA expression levels were all significantly higher than those before chemotherapy;the VI, FI and VFI levels in cervical cancer tissues were positively correlated with the Piwil2, CyclinD1, NDRG3, CXCL5, CAT-L, EFEMP1, Ang1, Ang2 and ANGPTL4 mRNA expression levels, and negatively correlated with the THBS2, Smac, LATS1, RECK and PAI-1 mRNA expression levels.Conclusion: The changes in the three-dimensional power Doppler ultrasound parameters before and after neoadjuvant chemotherapy for cervical cancer can reflect the changes in proliferation, invasion and angiogenesis gene expression in the lesions.

Value of myocardial function in children with Kawasaki disease by two-dimensional and three-dimensional ultrasound speckle tracking

Objective:To investigate the value of two-dimensional ultrasound speckle tracking(2D-STI)and three-dimensional ultrasound speckle tracking(3D-STI)in evaluating myocardial function in children with Kawasaki disease.Methods 92 children with Kawasaki disease admitted to our hospital from February 2017 to February 2019 were retrospectively analyzed.50 children who underwent 3D-STI examination were taken as observation group and 42 children who underwent 2D-STI examination were taken as control group.The left ventricular systolic function index,storage time and analysis time of the image,the diameter of coronary artery,the strain difference of left ventricular basal segment,middle segment,apical segment and whole segment were observed.Results The levels of left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular myocardial mass(LVMI)in the observation group were higher than those in the control group(P<0.05),but there was no statistical difference in left ventricular ejection fraction(LVEF)between the two groups(P>0.05).The storage time and analysis time of the image in the observation group were significantly lower than those in the control group(P<0.05).The left coronary artery(LCA)and right coronary artery(RCA)in the observation group were higher than those in the control group(P<0.05).There was no statistical difference between left anterior descending(LAD)in the two groups(P>0.05).The longitudinal peak systolic strain(LS),circumferential peak systolic strain(CS)and radial peak systolic strain(RS)in the observation group were higher than those in the control group(P<0.05).The global longitudinal peak strain(GLS),global circumferential peak strain(GCS)and global radial peak strain(GRS)in the observation group were higher than those in the control group(P<0.05).LS and CS in the middle segment of the observation group were higher than those in the control group(P<0.05).Conclusions Compared with 2D-STI,3D-STI can objectively and accurately reflect the myocardial function of children with Kawasaki disease.

Correlation analysis of real-time three-dimensional ultrasound in diagnosis of left ventricular function, portal hemodynamics and severity of liver function in patients with liver cirrhosis

Objective:To analyze the correlation between real-time three-dimensional ultrasound in diagnosis of left ventricular function, portal hemodynamics and severity of liver function in patients with liver cirrhosis.Methods: 90 patients with cirrhosis admitted to our hospital from January 2017 to December 2018 were enrolled in the cirrhosis group, and the cirrhosis components were group A, B and C according to the Child-Pauh classification criteria. During the same period, 90 healthy subjects who underwent physical examination were selected as the control group;real-time three-dimensional ultrasonography was performed to examine left ventricular function and portal hemodynamic parameters;Pearson correlation was used to analyze left ventricular function, portal hemodynamics and liver. Functional severity relationship.Results: The left heart E and E/A levels in the cirrhosis group were significantly lower than those in the control group (P<0.05), and the A level was significantly higher than the control group (P<0.05). The Dpv and Q levels in the cirrhosis group were significantly higher than those in the healthy control group. The difference was statistically significant (P<0.05), and the level of Vpv was significantly lower than that of healthy controls (P<0.05). There were significant differences in E, A and E/A levels between different Child-Paugh patients (P<0.05). There were significant differences in portal hemodynamics Dpv, Vpv and Q between the different Child-Paugh grades, and the difference was statistically significant (P<0.05);left heart function E and E/A and liver function severity There was a significant negative correlation (P<0.05). There was a significant positive correlation between left cardiac function A and liver function severity (P<0.05). Portal vein hemodynamics Dpv, Vpv and QE were significantly associated with liver function severity. Positive correlation (P<0.05). Conclusion: Real-time three-dimensional ultrasound can effectively detect left ventricular function and portal hemodynamics changes in patients with cirrhosis, and left heart function, portal hemodynamics and liver function severity are significantly correlated.

Endoscopic mucosal resection for rectal carcinoids under micro-probe ultrasound guidance

AIM: To assess the therapeutic value of endoscopic mucosal resection (EMR) under micro-probe ultrasound guidance for rectal carcinoids less than 1 cm in diameter. METHODS: Twenty-one patients pathologically diagnosed with rectal carcinoids following colonoscopy in our hospital from January 2007 to November 2012 were included in this study. The patients consisted of 14 men and 7 women, with a mean age of 52.3 ± 12.2 years (range: 36-72 years). The patients with submucosal tumors less than 1 cm in diameter arising from the rectal and muscularis mucosa detected by micro-probe ultrasound were treated with EMR and followed up with conventional endoscopy and micro-probe ultrasound. RESULTS: All of the 21 tumors were confirmed by micro-probe ultrasound as uniform hypoechoic masses originating from the rectal and muscularis mucosa, without invasion of muscularis propria and vessels, and less than 1 cm in diameter. EMR was successfully completed without bleeding, perforation or other complications. The resected specimens were immunohistochemically confirmed to be carcinoids. Patients were followed up for one to two years, and no tumor recurrence was reported. CONCLUSION: EMR is a safe and effective treatment for rectal carcinoids less than 1 cm in diameter.

Transrectal ultrasound and magnetic resonance imaging measurement of extramural tumor spread in rectal cancer

AIM： To evaluate the agreement between transrectal ultrasound （TRUS） and magnetic resonance imaging （MRI） in classification of ≥ T3 rectal tumors. METHODS： From January 2010 to January 2012, 86 consecutive patients with ≥ T3 tumors were included in this study. The mean age of the patients was 66.4 years （range： 26-91 years）. The tumors were all ≥ T3 on TRUS. The sub-classification was defined by the penetration of the rectal wall： a： 0 to 1 mm; b： 1-5 mm, c： 6-15; d： 〉 15 mm. Early tumors as ab （≤ 5 ram） and advanced tumors as cd （〉 5 mm）. All patients underwent TRUS using a 6.5 MHz transrectal transducer. The MRI was performed with a 1.5 T Phil- ips unit. The TRUS findings were blinded to the radiol- ogist performing the interpretation of the MRI images and measuring the depth of extramural tumor spread RESULTS： TRUS found 51 patients to have an early ≥ T3 tumors and 35 to have an advanced tumor, where- as MRI categorized 48 as early ≥ T3 tumors and 38 as advanced tumors. No patients with tumors classified as advanced by TRUS were found to be early on MRI. The kappa value in classifying early versus advanced T3 rectal tumors was 0.93 （95% CI： 0.85-1.00）. We found a kappa value of 0.74 （95% CI： 0.63-0.86） for the total sub-classification between the two methods. The mean maximal tumor outgrowth measured by TRUS, 5.5 mm ± 5.63 mm and on MRI, 6.3 mm ±6.18 mm, P = 0.004. In 19 of the 86 patients the following CT scan or surgery revealed distant metastases; of the 51 patients in the ultrasound ab group three （5.9%） had metastases, whereas 16 （45.7%） of 35 in the cd group harbored distant metastases, P = 0.00002. The odds ratio of having distant metastases in the ultra- sound cd group compared to the ab group was 13.5 （95% CI： 3.5-51.6）, P = 0.00002. The mean maximal ultrasound measured outgrowth was 4.3 mm （95% CI： 3.2-5.5 mm） in patients without distant metastases, while the mean maximal outgrowth was 9.5 mm （95% CI： 6.2-12.8 ram） in the patients with metastases, P = 0.00004. Using the MRI classification three （6.3%） of 48 in the MRI ab group had distant metastases, while 16 （42.1%） of the 38 in the MRI cd group, P = 0.00004. The MRI odds ratio was 10.9 （95% CI： 2.9-41.4）, P = 0.00008. The mean maximal MRI measured out- growth was 4.9 mm （95% CI： 3.7-6.1 turn） in patients without distant metastases, while the mean maximal outgrowth was 11.5 mm （95% CI： 7.8-15.2 mm） in the patients with metastases, P = 0.000006. CONCLUSION： There is good agreement between TRUS and MRI in the pretreatment sub-classification of ≥ T3 tumors. Distant metastases are more frequent in the advanced group.