[Epidemiological investigation of tinnitus in Sichuan and Chongqing]

Objectives: To investigate the prevalence and associated risk factors of tinnitus in Sichuan and Chongqing. Methods: We designed a tinnitus epidemiological questionnaire. The multi-stage stratified cluster random sampling methods was applied to obtain study subjects in six areas (Nanchong, Jiangjin, Fengdu, Yunyang, Suining and Ya'an), which were selected for epidemiological investigation. Home visit completion of epidemiological questionnaires was conducted. The trained investigators guided the respondents to fill in the tinnitus epidemiological questionnaires, and the epidemiological status of six areas on prevalence and risk factor was investigated. SPSS 22.0 software was used for statistical analysis. Results: Sampling population were 10 289, in which 9 273 were valid questionnaires. There were 4 281 males and 4 992 females, with an average age of 47.3 years, among which 34.83% (3 230/9 273) had tinnitus. 3.99% (370/9 273) were diagnosed with bothersome tinnitus. In a multivariable logistic regression mod, the following factors were associated with onsetting of tinnitus: sleep disorder [Odds Ratio(OR)=3.74] and noise exposure(OR=1.99). The risk of disease was lowest in the age of 30-40 years old, while the risk of disease was higher for people under 30 and over 40. In another multivariable logistic regression mode, the following factors were associated with having bothersome tinnitus: older people were more likely to suffer from tinnitus, sleep disorders (OR=4.68) and noise exposure (OR=1.56). Conclusions: The prevalence of tinnitus in Sichuan and Chongqing is about 34.83%, but most of the tinnitus is short-lived and has low loudness, which will not affect the patients. Only a small number of patients with tinnitus (3.99%) persist and affect their health and need treatment. The occurrence and exacerbation of tinnitus may be related to sleep, age, and noise exposure.

Evaluation of thyroid hemangioma by conventional ultrasound combined with contrast-enhanced ultrasound: a case report and review of the literature

Primary thyroid hemangioma is an extremely rare clinical disease. Only 31 cases have been reported to date according to a PubMed search, and most were postoperatively diagnosed by pathologic examination. Ultrasonography is the first-line imaging modality for thyroid disease screening. However, preoperative ultrasonic diagnosis of thyroid hemangioma has been rarely reported. We herein describe a 24-year-old woman with a painless mass in the left thyroid lobe. Routine ultrasound (US) and contrast-enhanced US (CEUS) were performed. Routine US revealed an anechoic tumor with linear echogenic septal lines and compressibility. CEUS showed a characteristic “slow in and slow out” pattern of contrast filling and perfusion. Based on the combined findings of routine US and CEUS, the initial diagnosis was thyroid venous hemangioma. Postoperative pathological examination demonstrated multiple irregular dilated vessel lumens filled with red blood cells and multiple hemorrhagic zones. Immunohistochemical staining showed positivity for CD31 and smooth muscle actin.. Overall, this case showed US characteristics of a rare case of thyroid hemangioma, which is of importance for preoperative planning to avoid a large amount of blood loss during surgery. This case together with our literature review will help radiologists to bridge the knowledge gap of thyroid hemangioma, especially at the initial US screening.

Role of shear wave elastography in the evaluation of the treatment and prognosis of supraspinatus tendinitis

BACKGROUND

Supraspinatus tendinitis recurs easily after treatment. One of the main reasons is the lack of objective tools for the efficacy evaluation. Shear wave elastography (SWE) can quantitatively analyze the tissue elasticity of region of interest by measuring the Young’s modulus (YM) value.

AIM

To explore the role of SWE in the efficacy and prognostic evaluation of supraspinatus tendinitis.

METHODS

Eighty-seven patients with supraspinatus tendinitis treated in Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences were recruited. Another 30 healthy volunteers were enrolled as the control group. The visual analogue scale (VAS) and Constant-Murley Score (CMS) were recorded before treatment. All participants were scanned by SWE scan, and the YM value of the region of interest were recorded. Spearman correlation analysis was performed on YM values with VAS and CMS. Univariate repeated measures analysis of variance was used to calculate the changing trend of VAS, CMS and SWE under different treatment courses. After treatment, the patients were further grouped based on who achieved significantly effective and curative treatment. The patients in the continued treatment group continued to receive treatment according to the YM value, and the remaining patients who stopped receiving treatment were included in the stopped treatment group. All patients were followed up for 1 year, and the difference in recurrence rates between the continued treatment group and the stopped treatment group were compared.

RESULTS

The SWE images of supraspinatus muscle in healthy volunteers were mainly blue, while those of patients with supraspinatus tendinitis showed regional red and green areas. The average YM value of the supraspinatus muscle in healthy volunteers was 26.12 ± 4.03 kPa. The average YM value of patients with supraspinatus muscle was greater than that of healthy volunteers (average YM = 60.61 ± 11.53 kPa, t = 26.344, P < 0.001). The YM value was positively correlated with VAS (r = 0.564, P < 0.001) and negatively correlated with CMS (r = -0.411, P < 0.001). The changes of VAS and CMS were the most obvious in course 1 and then decreased gradually. The degree of change in YM values was similar in different courses. After a 1-year follow-up, the cumulative relapse-free rate in the continued treatment group was 91.43%, which was significantly higher than that in the stopped treatment group (64.71%, X² = 7.379, P = 0.007).

CONCLUSION

SWE can objectively indicate the severity of supraspinatus tendinitis. Using the YM value as a criterion for curative effect may reduce the recurrence rate.

Studies of Superb Microvascular Imaging and Contrast-Enhanced Ultrasonography in the Evaluation of Vascularization in Early Bone Regeneration

OBJECTIVE

The aim of this study was to investigate value of superb microvascular imaging (SMI) and contrast-enhanced ultrasonography (CEUS) in evaluating the neovascularization of early bone regeneration.

METHODS

Twenty-five Sprague-Dawley male rats were implanted with recombinant human bone morphogenetic protein-2/calcium phosphate cement (rhBMP-2/) in the muscle space of the left hind limb near the femoral head to establish the rat model of intramuscular ectopic osteogenesis. Ultrasonography and pathologic analysis were performed on the 3rd, 7th, 14th, 21st, and 28th days after modeling. Two-dimensional ultrasonography, SMI, and CEUS were used to assess neovascularization and bone formation.

RESULTS

Pathologic examination showed that different levels of neovascularization were observed in the graft bone over time after modeling, which increased significantly from the 3rd to 14th day, and then gradually decreased. CEUS and SMI showed no obvious microvessels inside the graft bone on the 3rd day. On the 7th day after modeling, a small number of neovascular vessels were observed around the graft bone. On the 14th day, neovascularization was observed in both the peripheral and inner parts of the graft bone. The number of neovascular vessels inside the graft bone had decreased gradually by the 21st and 28th days. The results of SMI and CEUS indexes showed that the vascular index, peak intensity, enhancement intensity, and enhancement rate first increased and then decreased with time. Their peak points were found on the 14th day. Arrival time, time to peak, and enhancement time decreased gradually over time (P < .05).

CONCLUSION

The combined application of SMI and CEUS may be useful in evaluating the neovascularization of early osteoanagenesis.

Value of superb micro-vascular imaging in predicting ischemic stroke in patients with carotid atherosclerotic plaques

BACKGROUND

Unstable carotid atherosclerotic plaques are prone to cause ischemic stroke. Contrast-enhanced ultrasound (CEUS) is the primary method of assessing plaque stability, but CEUS cannot be a method for screening for unstable plaque. The emergence of superb micro-vascular imaging (SMI) offers the possibility of clinically screening for unstable plaque

AIM

To investigate the value of SMI in predicting ischemic stroke in patients with carotid atherosclerotic plaques.

METHODS

Patients with carotid atherosclerotic plaques (luminal stenosis of 50%-70%) were enrolled into the present study. All patients received conservative medication. The patient's clinical baseline data, serological data, CEUS and SMI data were analyzed. All patients underwent a 3-year follow-up. The follow-up endpoint was the occurrence of ischemic stroke and patients were divided into stroke group and non-stroke group according to whether the prognosis occurred or not. Subsequently, the difference in clinical data was compared, the correlation of SMI and CEUS was analyzed, and multiple Cox regression and receiver operating characteristic curve were applied to investigate the value of SMI and CEUS in predicting cerebral arterial thrombosis in three years.

RESULTS

In this study, 43 patients were enrolled in the stroke group and 82 patients were enrolled in the non-stroke group. Cox regression revealed that SMI level (P = 0.013) and enhancement intensity (P = 0.032) were the independent factors influencing ischemic stroke. There was a positive correlation between SMI level and enhancement intensity (r = 0.737, P = 0.000). The area under curve of SMI level predicting ischemic stroke was 0.878. The best diagnostic point was ≥ level II, and its sensitivity and specificity was 86.05% and 79.27%. The area under curve of enhancement intensity predicting ischemic stroke was 0.890. The best diagnostic point was 9.92 db, and its sensitivity and specificity was 88.37% and 89.02%. As the SMI level gradually increased, the incidence of ischemic stroke increased gradually (X² = 108.931, P = 0.000).

CONCLUSION

SMI can be used as a non-invasive method of screening for unstable plaques and may help prevent ischemic stroke.

[Evaluation on preparation process of brevisapin colon-specific tables and its in vitro release]

OBJECTIVE

To prepare the new traditional Chinese medicine preparation--pH-dependent brevisapin colon-specific tablets, and investigate its in vitro release, in order to discuss the feasibility of preparing colon-targeted traditional Chinese medicines.

METHOD

With scutellarin, the active ingredient in brevisapin, as the evaluation index, coating prescriptions of the preparation was screened. The in vitro release determination method was adopted to detect the in vitro release performance of the preparation.

RESULT

The in vitro release determination results showed no brevisapin in artificial pH 1. 2 dilute hydrochloric acid solution for 2 h, an accumulated dissolution rate of less than 5% in pH 6. 8 phosphate buffer solution for 4 h, but an accumulated dissolution rate exceeding 90% in pH 7. 6 phosphate buffer solution for 1 h.

CONCLUSION

Brevisapin colon-specific tablets prepared can realize colon-specific release.

[Simultaneous determination of ephedrine hydrochloride, D-pseudoephedrine and amygdalin in xiao'er pingchuan qutan granule by HPLC]

OBJECTIVE

To establish an HPLC method for the determination of ephedrine hydrochloride, D-pseudo-ephedrine and amygdalin in Xiao'er Pingchuan Qutan granule.

METHOD

Pheny ether chromatographic column (4.6 mm x 250 mm, 5 microm) was adopted, with acetonitrile-0.1% phosphoric acid (containing 0.1% three ethylamine) (3:97) as the mobile phase. The UV detection wavelength was at 210 nm, with the flow rate of 1 mL x min(-1), and column temperature was at 35 degrees C.

RESULT

The linearity of ephedrine hydrochloride, D-pseudo-ephedrine and amygdalin ranged between 0.078 60-3.144 microg (r = 1.000 0), 0.103 4-2.068 microg (r = 0.999 7) and 0.430 5-3.157 microg (r = 0.999 8), respectively. Their average recoveries were 98.46% (RSD 1.1%), 103.0% (RSD 1.5%) and 97.15% (RSD 2.1%), respectively.

CONCLUSION

The method is simple, stable and reliable that it can be used to determine the content of ephedrine hydrochloride, D-pseudo-ephedrine and amygdalin in Xiao'er Pingchuan Qutan granule.

Technical refinements of infracture for the zygomatic body and arch reduction

Nowadays the infracture technique for the zygomatic body and arch has been popularized in Oriental countries for the reduction of zygoma. We can obtain sufficient operative field to handle the zygoma through the intraoral and temporopreauricular incision and control the amount of shaving and infracturing zygomatic prominence. We developed three types of infracture technique for the reduction of the zygomatic body and arch according to the degree of severity of the zygomatic prominence and the shape of the face: Type A, infracturing with bone-to-bone contact for mild prominence with/without a long face; Type B, infracturing beyond bone-to-bone contact for moderate prominence; and Type C, infracturing far beyond bone-to-bone contact and microplate fixation for severe prominence with/without a broad and short face. By applying the criteria described above, we can obtain aesthetically acceptable results in zygoma reduction.

Unfavorable results and their resolution in mandibular contouring surgery

Since the development of mandibular contouring surgery, there have been many unfavorable results due to technical reasons. Those results include asymmetry, undercorrection, overcorrection, and an incorrect contour line. Over three years the authors have analyzed 19 cases of unfavorable results and found the following: (1) There have been 7 cases of undercorrection, 5 cases of asymmetry, 5 cases of incorrect contour line, and 2 cases of overcorrection. (2) The main technical errors that cause unfavorable results seem to be the simple straight cutting of mandible angles instead of curved cutting using multistaged curved ostectomy. (3) We suggest that the basic way to prevent unfavorable results in mandibular contouring surgery is to contour the mandible, including angle, body, and symphysis, as a whole by way of multistaged curved ostectomy.

Infracture technique for the zygomatic body and arch reduction

In the Orient, prominent malar regions are considered unaesthetic and the majority of women with a prominent malar want to reduce the zygoma. Various operative procedures such as shaving or chiseling the zygomatic body or the zygomatic arch have been used for reducing malar eminence, but the zygomatic arch cannot be reduced sufficiently by these methods. By combining intraoral shaving of the zygomatic body and a new effect arch infracture technique through a temporopreauricular incision, we have obtained very satisfactory results in 19 cases and notable minimal complications over the last three years.

Mandibular contouring surgery for purely aesthetic reasons

The mandible's contour determines the shape of the lower part of the face and thus influences the appearance of the face and neck. There are two types of operative procedures that can be used on mandibular contour and they do not require orthodontic treatment: mandible angle reduction and genioplasty. We divided the mandible angle reduction group into Types A, B, and C according to the grade of angle protrusion. Type A needs just an angle resection, Type B needs an angle resection and resection of part of the body, and Type C needs resection of the angle, the body, and part of the symphysis. We have performed 258 mandibular contouring procedures. In genioplasty, shaving, advancement, shortening, and lengthening generally can be employed. Furthermore, when vertical lengthening is used, ostectomized mandible angle bone is carved and then grafted between the horizontal osteotomy site. Of the mandible angle reduction cases, 21 were Type A, 186 were Type B, and 28 were Type C. The curved ostectomy is most important in mandible angle reduction cases in order to achieve a more natural curve of the mandible's lower border. A total of 71 patients were very pleased with the results of the combined procedures of genioplasty and angle reduction.