Rupture of atherosclerotic plaques constitutes the major cause of thrombosis and acute ischemic coronary syndrome. Bone marrow‐derived mesenchymal stem cells microvesicles (BMSCs‐MVs) are reported to promote angiogenesis. This study investigated the role of BMSCs‐MVs in stabilizing atherosclerotic plaques. BMSCs‐MVs in mice were isolated and identified. The mouse model of atherosclerosis was established, and mice were injected with BMSCs‐MVs via the tail vein. The macrophage model with high glucose and oxidative damage was established and then incubated with BMSCs‐MVs. Nod‐like receptor protein 3 (NLRP3) expression, pyroptosis‐related proteins, and inflammatory factors were detected. Actinomycin D was used to inhibit the secretion of BMSCs‐MVs to verify the source of microRNA‐223 (miR‐223). The binding relationship between miR‐223 and NLRP3 was predicted and verified. BMSCs‐MVs with knockdown of miR‐223 were cocultured with bone marrow‐derived macrophages with knockdown of NLRP3, and then levels of miR‐223, NLRP3, pyroptosis‐related proteins, and inflammatory factors were detected. BMSCs‐MVs could reduce the vulnerability index of atherosclerotic plaques and intima‐media thickness in mice, and inhibit pyroptosis and inflammation. BMSCs‐MVs inhibited pyroptosis and inflammatory factors in macrophages. BMSCs‐MVs carried miR‐223 to inhibit NLRP3 expression and reduce macrophage pyroptosis, thereby stabilizing the atherosclerotic plaques.

Objective:To investigate the clinical application value of ultrasound in the diagnosis and differential diagnosis of Takayasu arteritis (TA ). Methods: A total of 39 suspected TA patients were examined by ultrasonography,erythrocyte sedimentation rate (ESR),C reactive protein (CRP)and CT angiography (CTA), and the ultrasound examination results were compared and analyzed with the final chinical diagnosis results. Results:Of the 39 cases of suspected TA patients which had been examined by ultrasound,33 cases were diagnosed as TA,2 cases were diagnosed as atherosclerosis (AS),2 cases were diagnosed as fibromuscular dysplasia (FMD) and 2 cases were diagnosed as thromboangiitis obliterans (TAO).Compared with final chinical diagnosis results, 1 FMD patient was misdiagnosed as TA,and the rest of the diagnostic results were consistent with the final chinical diagnosis results.Conclusion:Ultrasound examination can provide objective and accurate basis for the diagnosis and differential diagnosis of TA,and it is an effective method of imaging examination.

Objective To compare the effects of ultrasound guided with different dose of ropivacaine interscalene brachial plexus block.Methods By a prospective study method,from August 2012 to February 2016,92 patients with upper extremity surgery in our hospital were selected,Patients in two groups were given ropivacaine muscle interscalene brachial plexus block guided by ultrasound,and those in the observation group and control group were given 0.3％ and 0.4％ ropivacaine 20ml.Block effect and complications of two groups were recorded.Results The radial nerve,ulnar nerve and median nerve and musculocutaneous nerve sensory block onset times in the observation group were 9.11 ± 1.23,7.20 ± 1.33,8.20 ± 1.33 and 6.92 ± 1.00min that were obviously less than those of the control group of 11.34 ± 2.91,9.67 ± 2.01,9.98 ± 1.12 and 792 ± 1.94min (P ＜ 0.05).In observation group,anesthesia effect good rate was 97.8％,and in the control group,itwas 82.6％.Anesthesia effect of the observation group was significantly higher than that of the control group (x2 =3.204,P ＜ 0.05).In the observation group,the incidence of nausea and vomiting,irritability,drowsiness,respiratory depression and other complications after operation were 10.9％,the control group was 37.0％.The observation group was significantly less than the control group (P ＜ 0.05).The pain scores of 4h,12h and 24h after peration in the observation group were significantly lower than those in the control group (P ＜ 0.05).Conclusion Ultrasound guided ropivacaine interscalene brachial plexus blockcan achieve the ideal of the brachial plexus block effect,and the application of low dose ropivacaine can accelerate the onset time of sensory block in nerve,reduce the incidence of postoperative complications.It has better exert analgesic effect that is worth clinical use.

1临床资料患者男,20岁,以外伤后左下肢痛,呼吸困难6天,右小腿痛1天入院。体征:患者一般状态差,大剂量升压药物血压维持致120/80mmHg,意识清,气管切开、呼吸机辅助呼吸,20次/分,压力支持模式,血氧96%;心脏听诊:心率120次/分,律齐,心音弱。左下肢明显触痛,以小腿为著,皮肤青紫、皮温低,未触及动脉搏动,无深、浅感觉,肌力0级,右下肢足踝部皮肤青紫,活动尚可,肌力Ⅳ级,轻度触痛,未见明显浮肿,病理反射未引出。右上肢前臂皮

目的:探讨连翘苷对动脉粥样硬化(atherosclerosis,AS)模型大鼠的治疗作用及其机制.方法:将48只清洁级SD大鼠随机分为6组:正常组、模型组、洛伐他汀6mg/kg组、连翘苷50mg/kg组、连翘苷100mg/kg组、连翘苷150mg/kg组,每组8只.实验采用高脂喂饲+右侧颈总动脉球囊损伤+腹腔注射维生素D3的方法复制AS大鼠模型.4周后正常组用等量生理盐水ig,ig洛伐他汀6mg/kg,ig连翘苷50、100、150mg/kg,1次/d,10周后超声下观察右侧颈总动脉形态并计算AS斑块面积;肉眼及光镜下观察右侧颈总动脉形态;检测右侧颈总动脉血管舒缩功能;检测血管组织中AS相关炎性因子和氧化性指标;免疫组化和Western技术检测钠氢交换蛋白1 (Sodium hydrogen exchange protein 1,NHE-1)的蛋白表达水平;PCR技术检测NHE-1的基因达水平.结果:150mg/kg连翘苷可以减小AS斑块面积;提高动脉舒缩功能;降低血管组织细胞间粘附因子-1(IACM-1)、血管细胞间粘附因子-1(VACM-1)、白细胞介素-1(IL-1)和白细胞介素-6(IL-6)含量,增加大鼠组织中NO、SOD含量并减少MDA含量;降低血管组织NHE-1的蛋白表达水平和基因表达水平.结论:150mg/kg连翘苷有可能通过降低NHE-1的基因和蛋白表达减少机体氧化应激,进一步降低AS相关炎性因子,起到治疗AS的作用.

目的:探讨正常甲状腺与甲状腺功能亢进症(Graves病)患者甲状腺腺体内血流和血管变化情况,阐明三维彩色多普勒超声定量诊断Graves病患者甲状腺血流的价值.方法:选取55例Graves病患者作为病例组,38例健康志愿者作为对照组,全部受检者行甲状腺三维超声检查.使用QLAB软件系统对存储的图像进行三维重建,获得血管指数(VI)、血流指数(FI)和血管血流指数(VFI)参数.Pearson相关分析法分析病例组患者甲状腺VI、FI、VFI与甲状腺功能指标游离三碘甲状腺原氨酸(FT3)、血清游离甲状腺素(FT4)、促甲状腺激素(TSH)及24小时吸碘率最高值的相关性.结果:病例组患者甲状腺两侧叶对应同部位VI、FI和VFI比较差异无统计学意义(P＞0.05);病例组患者甲状腺同侧叶腺体对应部位VI、FI和VFI比较差异无统计学意义(P＞0.05),病例组患者同侧叶甲状腺腺体VI、FI和VFI高于对照组(P＜0.01);病例组患者左叶甲状腺VI、FI、VFI与FT3呈正相关关系(r=0.65,r=0.34,r=0.65,P＜0.05或P＜0.01);病例组患者左叶甲状腺VI、FI、VFI与FT4呈正相关关系(r=0.45,r=0.47,r=0.46,P＜0.05);病例组患者左叶甲状腺VI、VFI与TSH呈负相关关系(r=-0.51、r=-0.54,P＜0.05),FI与TSH无相关关系(r=-0.31,P＞0.05);病例组患者左叶甲状腺VI、FI、VFI与24小时吸碘率最高值呈正相关关系(r=0.67,r=0.68,r=0.69,P＜0.05).结论:三维彩色多普勒超声可直观、立体和定量地评价Graves病患者甲状腺血流变化情况,Graves病患者甲状腺腺体内血流弥漫性增多.

目的:探讨颈动脉和下肢动脉粥样硬化(AS)的超声检查结果及其危险因素,阐明各危险因素对不同部位AS的作用程度.方法:选择颈动脉及下肢动脉彩色多普勒超声检查的受检者366名,根据超声影像学结果将其分为健康组(n=133)、单纯颈动脉硬化组(CAD组,n=42)、单纯下肢动脉硬化组(PAD组,n=69)和颈动脉硬化并发下肢动脉硬化组(CAD+ PAD组,n=122).分析各组受检者的性别、年龄、吸烟史、饮酒史、高血压(HBP)、糖尿病(DM)史、高血脂和体质量指数(BMI)等危险因素,并对下肢动脉硬化斑块形成危险因素进行Logistic回归分析.结果:受检者中颈动脉斑块的检出率为44.8％ (164/366),下肢动脉硬化的检出率为52.1％ (191/366).与健康组比较,PAD组和CAD+ PAD组受检者的年龄、吸烟率、HBP检出率及高血糖的检出率升高(P＜0.05).与CAD组比较,PAD组和CAD+ PAD组受检者吸烟率及DM检出率均升高(P＜0.01).Logistic回归分析,男性、高龄(45～59、60～74、≥75岁)、吸烟和高血糖是下肢动脉硬化的危险因素(OR=2.520,OR=3.056,OR=6.895,OR=29.483,OR=4.136,OR=3.736,P＜0.001).结论:AS的形成是多重因素共同作用的结果,高龄、吸烟和高血糖是AS斑块形成的重要危险因素,其中吸烟和高血糖者下肢AS的发病率明显高于颈动脉.

下肢静脉解剖变异在下肢血管变异中较为常见,其中以浅静脉的变异最为多见,目前彩色多普勒超声对大隐静脉及小隐静脉变异的研究报道较多[1,2],对深静脉变异的研究相对较少。本文通过对股浅静脉进行彩色多普勒超声检查,观察其重复股浅静脉的发生情况,计算重复股浅静脉的发生率,探讨重复股浅静脉的变异在临床中的存在价值。1资料与方法1.1研究对象选取我院2013年1月至2013年7月门诊行下

Objective:To explore the quantitative evaluation of the normal thyroid blood flow of three dimensional ultrasound. Methods:38 cases of normal adults were used doppler ultrasonic to detect thyroid and given vascular energy diagram of three dimensional ultrasound.It used QLAB workstation for 3D imaging on thyroid color image,and obtaineed vascular index,blood flow index and vascularization flow index by using t test.Results:In the three dimensional energy diagram,whether left and right lobe thyroid,or male and female thyroid,in the unit volume condition,there were no significant differences between the vascular index, blood flow index and their product (P>0.05).Conclusion:Three dimensional ultrasound can measure vascular index,blood flow index of thyroid.It can be used to quantitatively evaluate thyroid blood vessels,more truly reflect the blood flow situation of thyroid parenchyma.

动脉粥样硬化（atherosclerosis,AS）是心脑血管疾病的主要病因之一。超声检查是一种无创、经济、快捷的方法。通过颈动脉超声检测颈动脉内膜中层厚度（intima-media thickness,IMT）及观察颈部斑块形态目前研究较多,但对动脉硬化与锁骨下动脉的关系研究较少。本研究对随机人群锁骨下动脉进行筛查,旨在探讨锁骨下动脉粥样硬化常累及的部位,同时探讨锁骨下动脉粥样硬化斑块发生的危险因素。

目的：探讨小乳腺癌的超声特点，旨在提高超声对小乳腺癌的诊断符合率，以达到早期诊断的目的。方法：应用二维、彩色多普勒血流成像回顾性研究分析45例乳腺癌患者60块病灶的超声图像特点，与病理结果对照。结果：本组60块病灶经手术病理证实均为乳腺癌，超声提示恶性的51块，符合率为85%，高频二维超声声像图及彩色多普勒血流显像均具有很好的阳性预告意义。结论：使用高频二维超声结合彩色多普勒超声可提高小乳腺癌的术前诊断准确率结论：二维声像图及彩色多普勒超声的特征性改变，在小乳腺癌早期诊断中具有重要的意义，但也有一定的局限。

Objecive To evaluate the effect of radiotherapy on breast cancer patients by using Doppler ultrasound before and after treatment.Methods Color Doppler ultrasound was used to evaluate the effect of radiotherapy on 25 breast cancer cases from July 2011 to August 2012 including blood vessel grading,distribution and resistance to blood flow before and after radiotherapy,the recurrence of lymph nodes underarms,thyroid,neck and complications observed 2 years after radiotherapy.Results Out of the 25 breast cancer cases16 cases were totally relieved,5 partial relieved and 3 without effect and 1 case failed.The average blood flow resistance index of patients before and after radiotherapy showed a significant difference(P<0.05).The recurrence rates of breast cancer cases 2 years after radiotherapy and without radiotherapy were.16% and 48%,respectively.More complications were notice in patients with radiotherapy than those without radiotherapy in the control group.Conclusions Doppler ultrasound can evaluate the effect of radiotherapy on breast cancer cases as it can disclose the changes of focal lesions in most of the cases,the vascular distribution and grading and the recurrence 2 years after radiotherapy.

Objective To determine the degree of volume reduction of major arteries of lower extremities with the three-dimensional ultrasound volume method and to compare the measuring results of clinical stage,ankle-brachial index(ABI)and transcutaneous oxygen pressure(TcPO2)of arterial ischemic disease,and to explore its clinical value.Methods 60patients(March 2011-February 2012,with ultrasound examination in our hospital,unilateral limb,total of 60arteries,without ipsilateral iliac artery stenosis or occlusion)with arterial sclerosis obstruction(ASO)were selected and the vascular volumes of the selected arteries segments were measured with GI3DQ technique,then the reduction degree of overall volume of narrow lower extremity arteries was calculated.According the results of the calculation,the patients were divided into the mild(the reduction of volume 30%49%),the moderate(the reduction of volume 50%-70%)and severe(the reduction of volume 70%)groups(n=20)and the volume reduction of major arteries of lower extremities was measured with the three-dimensional ultrasound volume method,and the statistical correlation analysis was performed with clinical stage,ABI and TcPO2.Results The patients showed reduced lower extremity arterial volume in varying degrees,the reduction extent and ASO clinical stage showed a moderate correlation(r=0.500,P0.01).The ABI of the patients in mild group was 0.72-0.90,in moderate group 0.44-0.69,in severe group 0.40.The TcPO2 in mild group was 42-50mmHg,in moderate group 24-41 mmHg,in severe group 22 mmHg.The results showed that the correlation coefficient(R2)of three-dimensional ultrasound volume and ABI,as well as the R2 of three-dimensional ultrasound volume and TcPO2 were 0.9987and 0.9957,and there was linear correlation between the two sets of comparative data.Conclusion The three-dimensional ultrasound measurement of lower extremity arterial volume to assess the degree of arterial ischemia can be used as a new,comprehensive non-invasive imaging method in the evaluation of lower limb ischemia.

目的:探讨利用三维超声容积法评价下肢动脉硬化闭塞症(ASO)动脉狭窄程度的价值.方法:已确诊下肢ASO患者30例,患肢47条,病变节段230段,以二维超声直径法确定狭窄程度(分别选出轻度狭窄30段,中度狭窄30段,重度狭窄30段),每段病变节段长度设定为5 cm；对同一病变节段分别采用二维超声面积法和三维超声容积法计算动脉狭窄程度.结果:二维超声面积法与二维超声直径法比较,轻度狭窄组、重度狭窄组差异无统计学意义(P＞0.05),中度狭窄组差异有统计学意义(P＜0.05)；三维超声容积法与二维超声直径法比较,3组狭窄动脉差异均无统计学意义(P＞0.05).三维超声容积法、二维超声面积法与二维超声直径法结果的一致性系数(Kappa值)分别为0.942和0.860.二维超声面积法、三维超声容积法与二维超声直径法测量结果的符合率范围为80％～100％.二维超声面积法和三维超声容积法测量3组狭窄动脉时,有18段较二维超声直径法诊断动脉狭窄程度偏高；二维超声面积法测量3组狭窄动脉时,有1段较二维超声直径法诊断动脉狭窄程度偏低.结论:三维超声容积法能够评价下肢ASO动脉狭窄程度,其与二维超声直径法结合,相互补充, 作为一种评价动脉狭窄程度的新方法,能够更准确地判定动脉狭窄程度.

典型的小腿肌间静脉血栓和腘窝囊肿,在超声声像图上不难鉴别。但是当小腿肌间静脉血栓仅累及一条,有时与腘窝囊肿向下流注形成的条形低或无回声往往很难鉴别,容易误诊。正确的超声诊断对指导临床治疗有重要价值。本文通过对两种病变的超声表现进行回顾性分析,旨在探讨两者的共同点及不同点,以明确诊断。1资料与方法1.1一般资料本组选取临床及超声检查已确诊的一条小腿肌间静脉血栓患者37例;腘窝囊肿向下

超声检查目前在临床工作中起着越来越重要的作用,已渗透到临床的每个学科。合理、有计划的安排新留院医师在轮转到超声科过程中的实习内容,可使轮转医师在较短的时间内了解和掌握更多的超声检查在临床工作中的应用范围和意义,为轮转医师早日成为合格医师创造出优化成长的环境。

大动脉瘤的影像检查有超声、CTA、MRA、DSA等方法。由于MRA检查费用较高、检查时间长且要求患者严格制动,DSA检查费用高且属有创、并有一定的禁忌症,故临床对动脉瘤的诊断通常采用超声及CTA检查[1]。

小腿肌间静脉丛是下肢深静脉血栓的好发部位[1],通常起病隐匿,病变范围小,尤其是年轻患者常常临床症状较轻,有时仅表现为小腿局部疼痛,可能因为临床未发现而失去早期诊断和治疗的机会,血栓严重者可向大腿主干深静脉扩展或引起致命性肺栓塞[2]。彩色多普勒超声能够清晰地显示肌肉间扩张的静脉管壁、管腔回声及静脉与周围组织的关

目的:通过彩色多普勒超声(CDU)观察下肢动脉缺血性疾病侧支动脉建立情况,探讨病变动脉周围侧支动脉建立的特点,为其诊断、治疗及远期疗效评价提供有效指标.方法:采用CDU检测116例下肢动脉缺血性疾病患者116条病变动脉侧支动脉数量及分布,比较不同病种、不同病程及不同临床分期患者侧支动脉形成数量及分布特点.结果:不同病种间比较,硬化性动脉硬化闭塞症(ASO)组患者大腿段平均侧支动脉数量(3.11±1.47)多于糖尿病性ASO组(0.94±0.65)及血栓闭塞性脉管炎(TAO)组(1.05±0.47)(P<0.05);硬化性ASO组及TAO组小腿段平均侧支动脉数量(1.32±1.28,1.75±1.31)均多于糖尿病性ASO组(0.55±0.41)(P<0.05),但前两者间比较差异无统计学意义(P>0.05).不同病程间比较,10～15年组患者平均侧支动脉数量(4.22±2.31)多于10 d～3年、3～10年、15～20年及20年以上组(1.81±1.51,2.74±2.29,2.53±1.47,1.70±0.64)(P<0.05);3～10年及15～20年组患者多于10 d～3年及20年以上组(P<0.05),但前两者及后两者间比较差异均无统计学意义(P>0.05).不同临床分期间比较,临床一期组患者平均侧支动脉数量(3.65±2.58)多于临床二期及三期组(2.03±1.83,1.61±1.44)(P<0.05),临床二期组多于临床三期组(P<0.05).结论:硬化性ASO患者大腿段及小腿段侧支动脉均建立丰富;TAO患者大腿段侧支动脉建立较少,小腿段建立较多;糖尿病性ASO患者侧支动脉建立均较少.病程小于15年的患者侧支动脉建立数量逐渐增多,病程大于15年以后侧支动脉建立逐渐减少.临床分期越早,侧支动脉数量建立越多,反之减少.CDU评价下肢缺血性疾病侧支动脉建立可作为诊断、治疗及远期疗效评价的指标.

患者男,24岁.发现右侧阴囊间断性胀痛半年,时轻时重,尚能忍受.半月前发现"花生米"大小肿物.查体:右侧阴囊可触及径约1 cm肿物,不活动.超声检查:双侧睾丸大小正常,实质回声不均匀,可见散在点状强回声;右侧睾丸实质内见1个无回声为主的混合回声肿物,边界清晰,无回声区内可见条索状高回声,并可见细密点状低回声,CDFI:肿物周围血流信号丰富;左侧附睾头内可见3个无回声肿物,周边界限清晰,较大的大小0.49 cm×0.43 cm,右侧附睾头内可见1个无回声肿物,周边界限清晰,大小0.32 cm×0.24 cm,CDFI:内部未见明显血流信号.