Ultrasound in Ti-Rads Classification of Thyroid Nodules at the Marie Curie Medical Clinic

Introduction: A thyroid nodule is a localized hypertrophy within the thyroid parenchyma. The aim of our study was to study the benefit of ultrasound in the Ti-rads classification of thyroid nodules. Methodology: This was a prospective study with a descriptive aim, with prospective collection, which took place over a period of 17 months at the “Marie Curie” medical clinic. The ultrasound machine used was a Voluson E8 from 2011 and the examinations were carried out by two radiologists and two experienced sonographers. The parameters studied were sociodemographic data;clinical data and ultrasound aspects of the Ti-rads classification in the management of nodules. Results: We collected 235 patients out of 738 patients referred to the service for a cervical ultrasound, i.e. a frequency of 31.84% of cases. There was a female predominance with 95.7% of cases and a sex ratio of 0.04. The average age of our patients was 50 years. We found on cervical ultrasound: Isthmo-lobar glandular hyperplasia in 99 patients, i.e. a frequency of 42.1%. The Ti-rads 3 classification was the most represented in 69.4% of cases. The benignity criterion represented 85.6% of cases in our patients and the malignancy criterion represented 14.4% of cases. Conclusion: The precise description of a thyroid nodule provided by ultrasound (Ti-rads) is essential in the management of nodules.

Assessment of Radiofrequency in Otorhinolaryngology at the Military Hospital of Ouakam (MHO)

Introduction: Coblation® is a low temperature-controlled tissue ablation technique widely used in human surgery. Its development in otorhinolaryngology has allowed a spectacular advance in the management of diseases of the nasal and oral cavities. The objective of our work was to study the indications for radiofrequency in ENT, to describe the technical aspects and to evaluate the results of his practice at the HMO. Patients and Methods: This is a retrospective study carried out in the ENT and Head and Neck Surgery department of the Ouakam Military Hospital (MHO) over a period of 3 years (from January 2015 to the end of December 2017), involving 37 patients who received radiofrequency treatment in the ENT sphere. Results: The study was carried out on 37 patients. The sex ratio of 0.19. The mean age of the patients was 33.3 years. The indications were dominated by chronic caseous cryptic tonsillitis with or without halitosis with 24 cases (64.9%) followed by recurrent tonsillitis in 5 cases (13.5%) then we have obstructive hypertrophy of the palatal tonsils with syndrome sleep apnea (OSAS) in 4 cases (10.8%) followed by nasal obstruction (hypertrophy of the inferior turbinates) and hypertrophy of the soft palate and uvula in 2 cases (5.4%). The complication rate was 8.1% and dominated by transient dysgeusia in 1 case or 2.7%, uvula edema in 1 case or 2.7% and bleeding in 1 case or 2.7%. The postoperative follow-up was done one week, 1 month, 3 months, 6 months and 12 months after radiofrequency. Volumetric reduction begins to set in from 1 month (62.5%) and becomes maximum in 3 months (74.3%). Conclusion: Coblation® is a controlled tissue ablation technique at low temperature, patented by ArthroCare® Corporation in 1997. Very widespread in human surgery. Its development in otorhinolaryngology was later, but allowed a spectacular advance in the management of diseases of the nasal and oral cavities.

Immobilization of RGD Peptide onto the Surface of Apatite-Wollastonite Ceramic for Enhanced Osteoblast Adhesion and Bone Regeneration

The arginine-glycine-aspartic （RGD） acid peptide was grafted to the surface of apatitewollastonite （AW） ceramic in an effort to improve its cell adhesion, proliferation and osteoinduction. RGD peptide was covalently immobilized onto the surface of AW ceramic via the synthetic cross linker AA.PTS-E and 1-ethyl-3-（3-dimethylaminopropyl）carbodiimide （EDC）. The modified surfaces were characterized by attenuated total reflectance Fourier transform infrared spectroscopy （ATR-FTIR） and X-ray photoelectron spectroscopy （XPS）. The chemical analysis indicated that RGD peptide had been immobilized onto the AW surface successfully. The growth of osteoblast-like cells （MG63） showed that modifying the AW surface with RGD peptide enhanced the cell adhesion and proliferation. And the histological evaluation of RGD-AW showed that the bone regeneration and remodeling process were significantly enhanced compared to the original AW ceramics after 2, 4 and 8 weeks implantation in rabbit＇s femoral condyles.

Isolated myeloid sarcoma in the pancreas and orbit:A case report and review of literature

Myeloid sarcoma(MS) is a type of extramedullary solid haematological tumour. Myeloid sarcoma is classified into two types based on whether onset of the disease is complicated by haematologic diseases: extramedullary infiltration of leukaemia(leukaemic MS) and isolated myeloid sarcoma. The incidence of isolated myeloid sarcoma is low. In particular, isolated myeloid sarcoma involving the pancreas is extremely rare and prone to misdiagnosis. This case report describes the long and eventful diagnostic process of a case of myeloid sarcoma involving the pancreas and orbit. Due to a lack of typical clinical manifestations and imaging characteristics, the patient underwent several rounds of treatment without a confirmed diagnosis. Eventually, the final diagnosis was pathologically confirmed using several types of biopsies and immunohistochemical detection. To date, this type of disease has not been reported in the literature. This case report describes the detailed diagnostic process and discusses the strategies used for diagnosis, which will facilitate the diagnosis of such diseases in the future.

Multicenter case-control study of the risk factors for ulcerative colitis in China

AIM:To evaluate potential risk factors in the development of ulcerative colitis(UC) in China.METHODS:A total of 1308 patients with UC and 1308 age-matched and sex-matched controls were prospectively studied in China.The UC cases were collected from 17 hospitals in China from April 2007 to April 2010.Uniform questionnaires were designed to investigate risk factors including smoking,appendectomy,stress,socio-economic conditions,nonsteroidal antiinflammatory drugs(NSAIDs),oral contraceptives,diet,breastfeeding,infections and family sanitary conditions.Group comparisons by each factor were done using simple logistic regression analysis.Conditional logistic regression was used for multivariate analysis.RESULTS:By univariate analysis,the variables predictive of UC included feeling stress,light and heavy alcoholic drinking,spicy food,sugar consumption and infectious diarrhea,while heavy tea intake and tap water consumption were protective against UC.On multivariate analysis,the protective factor for UC was tap water consumption [odds ratios(OR) = 0.424,95%CI:0.302-0.594,P < 0.001];while the potential risk factors for UC were heavy sugar consumption(OR = 1.632,95%CI:1.156-2.305,P < 0.001),spicy food(light intake:OR = 3.329,95%CI:2.282-4.857,P < 0.001;heavy intake:OR = 3.979,95%CI:2.700-5.863,P < 0.001),and often feeling stress(OR = 1.981,95%CI:1.447-2.711,P < 0.001).Other factors,such as smoking habit,appendectomy,breastfeeding,a history of measles,rural or urban residence,education,oral contraceptives,and NSAID use have not been found to have a significant association with the development of UC in the present study.CONCLUSION:Our study showed tap water consumption was a protective factor for UC,while spicy food,heavy sugar consumption and often feeling stress were risk factors for UC in this Chinese population.

Antagomir Dependent MicroRNA-205 Reduction Enhances Adhesion Ability of Human Corneal Epithelial Keratinocytes

Objective To investigate the effect of microRNA-205 reduction by antagomirs on adhesion ability of normal human corneal epithelial keratinocytes(NHCEKs).Methods Antagomir-205,complementary and inhibitory to microRNA-205,was used to suppress endogenous microRNA-205 in NHCEKs.The adhesion ability of treated NHCEKs was then assessed by cell adhesion assay.Immunoblot and immunohistochemistry were conducted to determine the level of two focal adhesion-related proteins,focal adhesion kinase(FAK) and paxillin(Pax).Phalloidin staining was performed to measure the level of filamentous actin in antagomir-treated NHCEKs.Results Antagomir-205 markedly reduced the level of microRNA-205 in NHCEKs and significantly enhanced adhesion ability of NHCEKs(P<0.01).Further protein analysis validated that inhibition of mi-croRNA-205 increased the number of phosphorylated FAK and phosphorylated Pax,and decreased filamen-tous actin.Conclusion Our findings suggest that microRNA-205 has down-regulating effect on cell motility in NHCEKs.

Phantom-based evaluations of two binning algorithms for four-dimensional CT reconstruction in lung cancer radiation therapy

Objective: The purpose of this study was to evaluate the performance of the phase-binning algorithm and amplitude-binning algorithm for four-dimensional computed tomography(4DCT) reconstruction in lung cancer radiation therapy. Methods: Quasar phantom data were used for evaluation. A phantom of known geometry was mounted on a four-dimensional(4D) motion platform programmed with twelve respiratory waves(twelve lung patients trajectories) and scanned with a Philips Brilliance Big bore 16-slice CT simulator. The 4DCT images were reconstructed using both phase- and amplitude-binning algorithms. Internal target volumes(ITVs) of the phase- and amplitude-binned image sets were compared by evaluation of shape and volume distortions. Results: The phantom experiments illustrated that, as expected, maximum inhalation occurred at the 0% amplitude and maximum exhalation occurred at the 50% amplitude of the amplitude-binned 4DCT image sets. The amplitude-binned algorithm rendered smaller ITV than the phase-binning algorithm. Conclusion: The amplitude-binning algorithm for 4DCT reconstruction may have a potential advantage in reducing the margin and protecting normal lung tissue from unnecessary irradiation.

Association between Cardiac Changes and Stress, and the Effect of Peroxisome Proliferator-activated Receptor-γ on Stress-induced Myocardial Injury in Mice

This study was aimed to investigate the effect of stress induced by high-intensity exercises on the cardiovascular system. In the epidemiological investigation, 200 subjects（test group） engaged in special high-intensity exercises, and 97 who lived and worked in the same environment and conditions as those in the test group, but did not participate in the exercises served as controls. In the second part of the study, 50 mice were randomly divided into control group, exhaustive swimming group, white noise group, exhaustive swimming plus white noise group, and pioglitazone intervention group. The results showed that the plasma concentrations of the myocardial injury markers heart fatty acid-binding protein（H-FABP）, C-reactive protein（CRP）, β-endorphin（β-EP） and levels of psychological stress were significantly increased in test group as compared with control group; special high-intensity exercises resulted in a significant elevation of the incidence of cardiac arrhythmias. Animal experiments showed that the plasma levels of corticosterone（CORT） and troponin I（Tn I） were raised while the level of SOD was reduced in exhaustive swimming group, white noise group, and exhaustive swimming plus white noise group. The expression levels of PPARγ m RNA and protein were decreased in myocardial tissues in these groups as well. HE staining showed no remarkable change in myocardial tissues in all the groups. Treatment with pioglitazone significantly decreased the plasma levels of Tn I and CORT, while increased the level of SOD and the expression levels of PPARγ m RNA and protein. It was concluded that the high-intensity exercises may induce a heavy physical and psychological stress and predispose the subjects to accumulated fatigue and sleep deprivation; high-intensity exercises also increases the incidence of arrhythmias and myocardial injury. PPARγ may be involved in the physical and psychological changes induced by high-intensity exercises.

Bone marrow-sparing intensity-modulated radiotherapy for postoperative treatment of cervical cancer

Objective： The aim of this study was to compare bone marrow-sparing intensity-modulated radiotherapy （IMRT） with IMRT without entering pelvic bone marrow as a planning constraint in the treatment of cervical cancer after hysterectomy. Methods： For a cohort of 10 patients, bone marrow-sparing IMRT and routine IMRT planning were designed. The prescribed dose was 45 Gy/1.8 Gy/25f, 95% of the planning target volume received this dose. Doses were computed with a commercially available treatment planning system （TPS） using convolution/superimposition （CS） algorithm. Plans were compared according to dose-volume histogram （DVH） analysis in terms of planning target volume （PTV） homogeneity and conformity indices （HI and CI） as well as organs at risk （OARs） dose and volume parameters. Results： Bone marrow-sparing IMRT had an vantages over routine IMRT in terms of CI, but inferior to the latter for HI. Compared with routine IMRT, V5, Vl0, V20, V30, V40 of pelvic bone marrow of bone marrow-sparing IMRT reduced by 1.81%, 8.61%, 31.81%, 29.50%, 28.29%, respectively. No statistically significant differences were observed between bone marrow-sparing IMRT and routine IMRT in terms of small bowel, bladder and rectum. Conclusion： For patients with cervical cancer after hysterectomy, bone marrowsparing IMRT reduced the pelvic bone marrow volume irradiated at all dose levels and might be conducive to preventing the occurrence of acute bone marrow toxicity.

Dynamic monitoring of carcinoembryonic antigen,CA19-9 and inflammation-based indices in patients with advanced colorectal cancer undergoing chemotherapy

BACKGROUND The roles of carcinoembryonic antigen(CEA)and carbohydrate antigen(CA19-9)in monitoring the patient response to chemotherapy for metastatic colorectal cancer(mCRC)are not clearly defined,and inflammatory indices,including the neutrophil-to-lymphocyte ratio(NLR),lymphocyte-to-monocyte ratio(LMR),platelet-to-lymphocyte ratio(PLR)and systemic immune-inflammation index(SII),have been sparsely investigated for this purpose.AIM To aim of this study was to evaluate the relationship between the kinetics of CEA,CA19-9,NLR,LMR,PLR and SII in serum and patient response to chemotherapy estimated by computed tomography(CT)in patients with unresectable mCRC.METHODS Patients with mCRC treated with a 1st-line and 2nd-line chemotherapy underwent at least 3 whole-body spiral CT scans during response monitoring according to the Response Evaluation Criteria in Solid Tumour 1.1(RECIST 1.1),and simultaneous determination of CEA,CA19-9,neutrophil,lymphocyte,platelet and monocyte levels was performed.The kinetics of changes in the tumour markers and inflammatory indices were calculated as the percentage change from baseline or nadir,while receiver operating characteristic curves were drawn to select the thresholds to define patients with progressive or responsive disease with the highest sensitivity(Se)and specificity(Sp).The correlation of tumour marker kinetics with inflammatory index changes and RECIST response was determined by univariate and multivariate logistic regression analysis and the clinical utility index(CUI).RESULTS A total of 102 patients with mCRC treated with chemotherapy were included.Progressive disease(PD),defined as a CEA increase of 25.52%,resulted in an Se of 80.3%,an Sp of 84%,a good CUI negative[CUI(Ve-)]value of 0.75 and a good fraction correct(FC)value of 81.2;at a CEA cut-off of-60.85%with an Se of 100%and an Sp of 35.7%for PD,CT could be avoided in 25.49%of patients.The 21.49%CA19-9 cut-off for PD had an Se of 66.5%,an Sp of 87.4%,an acceptable CUI(Ve-)value of 0.65 and an acceptable FC value of 75.An NLR increase of 11.5%for PD had an Se of 67%and an Sp of 66%;a PLR increase of 5.9%had an Se of 53%and an Sp of 69%;an SII increase above-6.04%had an Se of 72%and an Sp of 63%;and all had acceptable CUI(Ve-)values at 0.55.In the univariate logistic regression analysis,CEA(P<0.001),CA19-9(P<0.05),NLR(P<0.05),PLR(P<0.05)and SII(P<0.05)were important predictors of tumour progression,but in the multivariate logistic regression analysis,CEA was the only independent predictor of PD(P<0.05).CONCLUSION CEA is a useful marker for monitoring the chemotherapy response of patients with unresectable mCRC and could replace a quarter of CT examinations.CA19-9 has poorer diagnostic characteristics than CEA but could be useful in some clinical circumstances,particularly when CEA is not increased.Dynamic changes in the inflammatory indices NLR,PLR and SII could be promising for further investigation as markers of the chemotherapy response.

The effect of anti-CD28 on the CD3-AK proliferation and tumoricidal activity

Objective The aim of this study was to costimulate the CD3-AK cells with anti-CD28 monoclonal antibody (mAb), observe the effect of cell proliferation and cytotoxicity and explore the regulatory role of CD28 mAb on the CD3-AK tumoricidal activity.

Expression of MEK1 in the colorectal cancer and its clinical implication

Objective:The aim of this study was to investigate the relationship between expression of MEK1 protein in the mitogen-activated protein kinase (MAPK) signaling pathway and liver as well as lymph node metastasis in colorectal cancer patients.Methods:Immunohistochemistry was performed to detect the expression of MEK1 protein in primary cancer,normal colonic mucosa,lymph nodes and liver metastatic foci from 86 colorectal cancer patients.Life table analysis was employed to evaluate the association between MEK1 expression and patients' survival.Results:The positive rate of MEK1 expression in the primary cancer,normal colonic mucosa,metastatic lymph nodes and liver metastatic foci was 52.3%,32.6%,71.4% and 78.3%,respectively.The positive rate of MEK1 expression in the primary cancer,metastatic lymph nodes and liver metastatic foci was significantly higher than that in the normal colonic mucosa (P < 0.01).Furthermore,the positive rate of MEK1 expression in stage III and IV colorectal cancer patients was dramatically higher than that in stage I and II colorectal cancer patients (P < 0.01).The positive rate of MEK1 expression in patients with poorly differentiated adenocarcinoma and mucinous adenocarcinoma was significantly higher than patients with well or moderately differentiated adenocarcinoma (P < 0.01).The 3-year disease-free survival rate was 41.3% in MEK1 positive patients and 73.1% in MEK1 negative patients.The survival rate of MEK1 positive patients was significantly lower than that of MEK1 negative patients (P < 0.05).Conclusion:The increased expression of MEK1 was associated with lymph node metastasis and liver metastasis of colorectal cancer.Therefore,detection of MEK1 expression may have important significance in the evaluation of patients' prognosis.

Comparison of the dose to lung volume between supine and prone position during treatment planning

Objective The aim of the study was to compare the dose to lung volume in the supine and prone posi- tion while designing CyberKnife treatment plans to treat metastatic tumors in the spinous processes of the thoracic vertebrae, and offer a reference for reducing damage to normal tissues. Methods Nine cases of metastatic tumors in the spinous processes of the thoracic vertebrae were selected, and then we designed treatment plans based on the supine and prone positions and compared the results. Results In contrast with the treatment plan based on the prone position, the one for the supine position required 14862-36337 MU more; the lung D5% was 5.20-7.90 Gy higher; and the lung D20% was 2.61-5.73 Gy higher. The difference of dose to spine volume between the two plans was -2.21-2.67 Gy; to the skin volume was -3.93-7.85 Gy; and to the esophagus was 0.28-6.39 Gy. Conclusion The treatment plan based on the prone position of patients can better protect lung tissues than the one based on the supine position, and can also improve the avaUabilitv of beams.

Dosimetric comparison of different multileaf collimators in volumetric modulated arc therapy for malignant pleural mesothelioma

Objective The aiom of the study was to compare the impacts of two types of multileaf collimators （MLC） [standard MLC with a width of 10 mm （sMLC） and micro-MLC with a width of 5 mm （mMLC）] on volumetric modulated arc therapy （VMAT） planning for malignant pleural mesothelioma. Methods VMAT for ten patients with inoperable malignant pleural mesotheliomas was retrospectively planned with the sMLC and mMLC. Histogram-based dose-volume parameters of the planning target vol- ume （PTV） [conformity index （CI） and homogeneous index （HI）] and organs-at-risk were compared for VMAT plans with sMLC （sMLC-VMAT） and mMLC （mMLC-VMAT）. Results The mMLC-VMAT plans were more efficient （average delivery time： 2.67±1.49 min） than the sMLC-VMAT plans （average delivery time： 4.21 ± 2.03 min; P 〈 0.05）. Moreover, compared to the sMLC plans, the mMLC plans demonstrated advantages in the dose coverage of the PTV （CI 0.75 ± 0.08 vs 0.73± 0.09; HI 1.09 ±0.02 vs 1.10± 0.02）, although the difference was not statistically significant （P 〉 0.05）. In addition, significant dose sparing in the fraction of the ipsilateral lung volume receiving 〉 20 Gy （V20; 54.72± 27.08 vs 58.52 ± 29.30） and 〉 30 Gy （V30; 42.74 ± 27.86 vs 46.86± 31.49） radiation, respectively, was observed for the mMLC plans （P 〈 0.05）. Conclusion Comparing sMLC-VMAT and mMLC-VMAT not only demonstrated the higher efficiency and better optimal target coverage of mMLC-VMAT, but also considerably improved the dose sparing of the ipsilateral lung in the VMAT plans for mali qnant pleural mesothelioma.

The Professional Profile and the Physical Therapy Service in the Emergency Units in the State of São Paulo

The emergency room is the entrance door of hospitals for patients who are in risk of life, and the role of the physiotherapist in this area is recognized as a qualified member of the team, helping to reduce the rate and time of orotracheal intubation, judicious use of invasive mechanical ventilation (MV) and non-invasive ventilation (NIV). The objective was to know the profile and performance of physical therapists in the emergency departments of hospitals in the state of São Paulo. Conducted through a semi-structured questionnaire covering personal and professional aspects, and analyzed and described in percentage form. Thirty-six questionnaires were analyzed, and it was observed that 92% provide emergency care, but only 25% work exclusively. Among the main reasons for admission to this sector are: acute respiratory failure (44%) and decreased level of consciousness (36.1%). Regarding the physiotherapeutic resources used in the emergency department, 97.2% make use of NIV, followed by monitoring of MV parameters (94.4%) and modification of parameters (94.4%). We also found that the average time of MV in this sector is 3 to 21 days (50%), and that 33% believe there is delay between indication and installation of NIV. The physiotherapist has much to contribute in emergency units, however, he must be trained through the search for technical and scientific knowledge, thus contributing to the consolidation of this area of expertise.

Neoadjuvant treatment of pancreatic ductal adenocarcinoma:Whom,when and how

Pancreatic ductal adenocarcinoma(PDAC),which is notorious for its aggressiveness and poor prognosis,remains an area of great unmet medical need,with a 5-year survival rate of 10%-the lowest of all solid tumours.At diagnosis,only 20%of patients have resectable pancreatic cancer(RPC)or borderline RPC(BRPC)disease,while 80%of patients have unresectable tumours that are locally advanced pancreatic cancer(LAPC)or have distant metastases.Nearly 60%of patients who undergo upfront surgery for RPC are unable to receive adequate adjuvant chemotherapy(CHT)because of postoperative complications and early cancer recurrence.An important paradigm shift to achieve better outcomes has been the sequence of therapy,with neoadjuvant CHT preceding surgery.Three surgical stages have emerged for the preoperative assessment of nonmetastatic pancreatic cancers:RPC,BRPC,and LAPC.The main goal of neoadjuvant treatment(NAT)is to improve postoperative outcomes through enhanced selection of candidates for curative-intent surgery by identifying patients with aggressive or metastatic disease during initial CHT,reducing tumour volume before surgery to improve the rate of margin-negative resection(R0 resection,a microscopic margin-negative resection),reducing the rate of positive lymph node occurrence at surgery,providing early treatment of occult micrometastatic disease,and assessing tumour chemosensitivity and tolerance to treatment as potential surgical criteria.In this editorial,we summarize evidence concerning NAT of PDAC,providing insights into future practice and study design.Future research is needed to establish predictive biomarkers,measures of therapeutic response,and multidisciplinary stra tegies to improve patient-centered outcomes.

Intra-Sellary Arachniodocele: About a Case at the Medical Clinic “The Stars” of Bamako

Intrasellar arachnoidocele is a herniation of the optochiasmatic cistern through a dehiscence of the sellar diaphragm producing an empty sella turcica, hence its name empty sella turcica syndrome. It is an extremely rare benign malformative pathology. We report a case of intra-sellar arachnoidocele in a 34-year-old woman revealed during an annual control of a sellar mass under dossinex by cerebral magnetic resonance imaging (MRI) which found the cystic formation of liquid signal identical to that of the LCS in hypo signal T1 and hyper signal T2 without enhancement after injection of Gadolinium. The epidemiological, clinical and radiological aspects of arachnoidocele were analyzed. The purpose of this work is to bring the interest of MRI in the management of this pathology.

Rare Antenatal Fetal Malformations of the Anterior Abdominal Wall in Mali: About a Case

Abdominal wall malformations correspond to a wide spectrum of congenital anomalies that are due to a defect in the closure of the anterior abdominal wall and can be fatal. We report the case of laparoschisis associated with a poly malformation syndrome in the same fetus at the reference health center of commune III of the district of Bamako. The objective is to clarify the interest of antenatal ultrasound in the diagnosis and prognosis of these malformations. It was a 19-year-old prim gravid woman received as part of the prenatal check-up. Antenatal ultrasound had allowed the diagnosis of malformation of the anterior abdominal wall of the gastroschisis type associated with abnormalities of the neural tube, the urogenital system and the bone skeleton. The antenatal diagnosis of the malformations had motivated the realization of a therapeutic termination of pregnancy at 19 weeks of amenorrhea and 3 days by triggering and vaginal delivery, allowing the confirmation of the diagnosis of gastroschisis and the poly malformation syndrome which is extremely rare. Antenatal ultrasound remains an ideal means of imaging for monitoring pregnancy and had made it possible to make the prognosis and antenatal diagnosis of multiple malformations in association, and to indicate better therapeutic decision-making.

Research progress of gut flora in improving human wellness

Human wellness is the ultimate goal of our efforts in improving the human life.Special foods are undoubtedly important in achieving human wellness.However,overeating significantly leads to obesity and diabetes.These chronic diseases will in turn affect the human wellness.Therefore,“dietary restriction and proper exercise”were introduced in the human daily life.Different foods cause various effects on the human health.The diversification of diet is a priority for nutritionists to keep our body healthy.To avoid diabetes mellitus,special foods for ketogenic diet,low-carbon diet,and low-calorie intake are also gradually attracting attention.In addition,the hypothesis that“hunger sensation comes from gut flora”brings new light to the research on the biological motivation for humans to eat food.This hypothesis has been gradually demonstrated using the flexible fasting technology by providing special foods,such as plant polysaccharides and dietary fibers.The response to food-needing signals from the gut flora to these foods demonstrates the importance of the gut flora in improving human wellness.The gut flora is probably an essential factor for translating the food-eating signals and converting the nutrition to our body.Therefore,“gut flora priority principle”is developed to guarantee human wellness.The 16S rRNA sequencing and mass spectrometric techniques can be used to identify the gut flora,which may guide us to a new era of human wellness based on gut flora wellness.

Glycemic and blood pressure control in older patients with hypertension and diabetes： association with carotid atherosclerosis

Backgroud Numerous studies have confirmed the effectiveness of slowing the progression of atherosclerosis by blood pressure （Bp） control in patients with hypertension and several studies also showed the efficacy of intensive glycemic control in decreasing progression of carotid intima-media thickness （CIMT） in patients with type 1 and type 2 diabetes. However, few studies have compared the relative importance of glycemic w＇. Bp control in patients with diabetes and hypertension. We aimed to investigate the association between Bp and glycemic control and subclinical carotid atherosclerosis in older patients with hypertension and type 2 diabetes. Methods In a cross-sectional study, B-mode high-resolution ultrasonography of the carotid artery was performed in 670 subjects （508 males and 162 females） aged 60 years or over who had self-reported hypertension and diabetes but no history of coronary heart disease or stroke. Subjects were categorized by their systolic blood pressure： tight control, 〈 130 mmHg; usual control, 130-139 mmHg; or uncontrolled, 〉 140 mmHg, and by their hemoglobin Alc （HbAlc） level： tight control, 〈 6.5%; usual control, 6.5%-7.5%; or uncontrolled, 〉 7.5%, respectively. Results The mean CIMT was 8.20 ±0.11 mm, and carotid plaque was found in 52.5% （352/670） subjects. Overall, 62.1% of the subjects had subclinical carotid atherosclerosis, defined as having either carotid plaque or elevated CIMT （≥ 1.1 ram）. The mean CIMT was significantly different between Bp control categories （7.60 ± 0.09 mm, 7.90 ±0.08 mm, and 8.60 ± 0.12 mm, respectively, P = 0.03） but not between glycemic control categories （8.20± 0.10 mm, 8.1 ±0.08 mm, and 8.40 ± 0.14 ram, respectively, P = 0.13） using ANCOVA analysis. Multivariable logistic regression adjusting for potential confounding factors showed that usual or uncontrolled Bp control were associated with having carotid plaque （OR = 1.08 and OR=1.42, respectively）, or elevated CIMT [Odd ratio （OR） = 1.17, 95% confidence interval （CI） 1.04-2.24, and OR = 1.54, 95% CI 1.36-2.96, respectively compared to tight Bp control; but did not show glycemic control as independent predictor of either having carotid plaque or elevated CIMT. Conclusions In older patients with hypertension and diabetes, blood pressure control, but not glycemic control is associated with subclinical carotid atherosclerosis.