BackgroundSuperb microvascular imaging (SMI) for depiction of microvascular flow in thyroid nodules was compared with color/power Doppler imaging (CDI/PDI) and contrast-enhanced ultrasonography (CEUS). In addition, the diagnostic performance of conventional ultrasound combined with SMI for differentiating benign and malignant thyroid nodules was evaluated.MethodsPreoperative conventional ultrasound consisting of gray-scale ultrasonography and CDI/PDI, followed by SMI and CEUS, was used to record 52 thyroid nodules. Two radiologists analyzed the gray-scale ultrasound signs and nodules’ microvascular flow patterns to differentiate between benign (n = 13) and malignant nodules (n = 39).ResultsSMI was significantly more effective in the detection of microvascular flow signals than CDI/PDI. In malignant nodules, SMI depicted the presence of incomplete surrounding periphery microvasculature and of disordered heterogeneous internal microvasculature. Benign nodules showed complete surrounding periphery microvasculature (ring sign) and homogeneity internal branching. The accuracies of conventional ultrasound combined with CDI/ PDI, SMI, or CEUS for predicting malignancy were 67.31, 86.54, and 92.31%, respectively. The accuracy of SMI differed significantly from CDI/PDI (P = 0.012), but not from CEUS (P = 0.339).ConclusionsMicrovascular flow and vessel branching in the peripheral and internal microvasculature of thyroid nodules is depicted with greater detail and clarity with SMI compared with conventional ultrasound. SMI offers a safe and low-cost alternative to CEUS for differentiating between benign and malignant thyroid nodules.

Acute lymphoblastic leukemia (ALL) with distinct fusion transcripts has unique clinical features. In this study, the incidence, clinical characteristics, early treatment response, and outcomes of 1,004 Chinese pediatric ALLs were analyzed. Patients with TEL‐AML1 and E2A‐PBX1 fusion genes or other B cell precursor ALLs (BCP‐ALL) had favorable clinical features, were sensitive to prednisone, had low minimal residual disease (MRD), and an excellent prognosis, with a 5‐year event‐free survival (EFS) of 84–92%. T‐ALL was associated with a high WBC, increased age, more central nervous system involvement, a poor prednisone response, and high MRD, with a 5‐year EFS of 68.4 ± 5.2%. Patients with BCR‐ABL and MLL rearrangements usually had adverse clinical presentations and treatment responses, and a dismal prognosis, with 5‐year EFS of 27.3 and 57.4%, respectively. We also showed that BCR‐ABL and MLL rearrangements, the prednisone response, and MRD were independent prognostic factors. Interestingly, the BCH‐2003 protocol resulted in a better outcome for E2A‐PBX1+ patients than the CCLG‐2008 protocol. Intermediate and late relapses were more common in TEL‐AML1+ patients and other BCP‐ALLs compared with other subgroups (P = 0.018). Therefore, this study suggests that a fusion gene‐specific chemotherapy regimen and/or targeted therapy should be developed to improve further the cure rate of pediatric ALL. Am. J. Hematol. 2012. © 2012 Wiley Periodicals, Inc.

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Objective: To explore the therapeutic effects of early enteral nutrition (EEN) on patients with sepsis on mechanical ventilation. Methods: Patients with sepsis on mechanical ventilation in the medical intensive care unit (ICU) from January 2013 to March 2016 were treated with enteral nutrition. Patients treated within 48 hours of initiation of mechanical ventilation were assigned to the EEN group, and the rest were assigned to the delayed enteral nutrition (DEN) group. Peripheral blood Th17 cells and Treg cells, endotoxin (ET) level, 28-day mortality, duration of mechanical ventilation, lengths of ICU stay and hospital stay, and incidence of ICU-acquired weakness (ICU-AW) were analyzed between the 2 groups. Results: The proportion of Th17 cells and ET levels in the EEN group were significantly lower than those in the DEN group, whereas the proportion of Treg cells in the EEN group was remarkably higher than that in the DEN group ( P < .05). The duration of mechanical ventilation, lengths of ICU stay and hospital stay, and incidence of ICU-AW were higher in the DEN group than in the EEN group ( P < .05), but there was no significant difference in the 28-day mortality between the 2 groups. Conclusion: Patients with sepsis mainly present with an increased proportion of Th17 cells in the early stage, manifesting as enhanced immune response. Early enteral nutrition can inhibit the excessive immune response, shorten the duration of mechanical ventilation, lengths of ICU stay and hospital stay, and reduce the incidence of ICU-AW, but it has no obvious effect on 28-day mortality.

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Highlights Standard procedures and appropriate assessment of exercise are proposed for the commonly used animal models related to chronic exercise (e.g., treadmill running, voluntary wheel running, swimming exercise, and resistance exercise) in cardiovascular research. Optimal design of animal exercise studies in cardiovascular research should consider the choice of exercise models, control of exercise protocols, exercise at different stages of disease, and other factors, such as age, sex, and genetic background. An optimal design for studying exercise-induced physiological cardiac growth and its related beneficial effects against cardiovascular diseases is presented.