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Objective To investigate the value of predicting the vulnerability of atherosclerotic plaques in assessment of intraplaque neovascularization using carotid contrast-enhanced ultrasound. Methods A total of 24 cases diagnosed as moderate to severe carotid stenosis by digital subtraction angiography (DSA) underwent carotid endarterectomy (CEA) from September 2017 to October 2018. Preoperative carotid contrast-enhanced ultrasound and postoperative pathological examination were performed in the patients. Results Compared with postoperative pathological results, 22 cases were clearly diagnosed by preoperative carotid contrast-enhanced ultrasound, and 2 cases were missed. The precision rate of preoperative diagnosis was 91.67% (22/24). Meanwhile carotid plaques were divided into four grades (Grade Ⅰ-Ⅳ) according to the degree of enhancing extent of contrast-enhanced ultrasound. Each grade included 6 cases (25%). Pearson correlation analysis showed there was an evidently positive correlation between preoperative grade of carotid plaques and number of intraplaque CD34-positive neovessels (r = 0.871, P = 0.000). The value of area under the curve (AUC) was 0.927 (95% CI: 0.848-1.006, P = 0.000). Conclusions The grade of carotid plaques was positively related to intraplaque CD34-positive neovessels. Hence, carotid contrast-enhanced ultrasound plays an important role in predicting the vulnerability of atherosclerotic plaques and risk of ischemic stroke and judging optimal surgical time. DOI: 10.3969/j.issn.1672-6731.2019.03.009

Background: Breast pain is one of the most common breast disorders, affecting 41%–69% women in the clinical populations. Chinese herbal medicine (Rupi Sanjie, RPSJ) capsule has been recommended to be commonly used for breast pain in China. This review aimed to systematically collect latest evidence and critically evaluate the eff ;ectiveness and safety of RPSJ capsule for breast pain. Methods: We searched 6 databases from their inception to June 1, 2020 for randomized clinical trials (RCTs) comparing RPSJ capsule with conventional drug therapies, placebo or no treatment. Primary outcomes were breast pain relief, reduction of breast mass and clinical cure rate. Results: Seventeen RCTs were included in total, involving 2899 participants with breast pain. RPSJ capsule showed a significant effects in shortening duration of the breast pain (MD-6.51 days, 95%CI [-8.57, -4.45], n = 82, 1 trial), shortening the duration of breast mass (MD-5.17 days, 95%CI [-7.56, -2.78], n = 82, 1 trial), improving clinical cure rate (RR 1.55, 95% CI [1.21, 2.00], I² = 64%, n = 1398, 10 trials) and total effective rate (RR 1.08, 95% CI [1.03, 1.14], I² = 71%, n = 2170, 14 trials) compared to Tamoxifen (TAM). The meta-analysis showed that the incidence of total adverse events was higher in TAM group than the RPSJ capsule group (RR 0.30, 95%CI [0.21, 0.42], I² = 49%, n = 2122, 13 trials). Conclusions: RPSJ capsule appears to be a potentially effective in treating breast pain and seems generally safe for clinical application. However, this potential benefit is inconclusive due to generally weak evidence, and the findings should be further confirmed in large and rigorous trials.

BackgroundLactation mastitis (LM) affects approximately 3% to 33% of postpartum women and the risk factors of LM have been extensively studied. However, some results in the literature reports are still not conclusive due to the complexity of LM etiology and variation in the populations. To provide nationally representative evidence of the well-accepted risk factors for LM in China, this study was aimed to systematically summary the risk factors for LM among Chinese women and to determine the effect size of individual risk factor.Material and methodsSix major Chinses and English electronic literature databases (PubMed, Web of Science, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wan fang Database and China Science Technology Journal Database) were searched from their inception to December 5st, 2020. Two authors extracted data and assessed the quality of included trials, independently. The strength of the association was summarized using the odds ratio (OR) with 95% confidence intervals (CI). The population attributable risk (PAR) percent was calculated for significant risk factors.ResultsFourteen studies involving 8032 participants were included. A total of 18 potential risk factors were eventually evaluated. Significant risk factors for LM included improper milking method (OR 6.79, 95%CI 3.45-13.34; PAR 59.14%), repeated milk stasis (OR 6.23, 95%CI 4.17-9.30; PAR 49.75%), the first six months postpartum (OR 5.11, 95%CI 2.66-9.82; PAR 65.93%), postpartum rest time less than 3 months (OR 4.71, 95%CI 3.92-5.65; PAR 56.95%), abnormal nipple or crater nipple (OR 3.94, 95%CI 2.34-6.63; PAR 42.05%), breast trauma (OR 3.07, 95%CI 2.17-4.33; PAR 15.98%), improper breastfeeding posture (OR 2.47, 95%CI 2.09-2.92; PAR 26.52%), postpartum prone sleeping position (OR 2.46, 95%CI 1.58-3.84; PAR 17.42%), little or no nipple cleaning (OR 2.05, 95%CI 1.58-2.65; PAR 24.73%), primipara (OR 1.73, 95%CI 1.25-2.41; PAR 32.62%), low education level (OR 1.63, 95%CI 1.09-2.43; PAR 23.29%), cesarean section (OR 1.51, 95%CI 1.26-1.81; PAR 18.61%), breast massage experience of non-medical staff (OR 1.51, 95%CI 1.25-1.82; PAR 15.31%) and postpartum mood disorders (OR 1.47, 95%CI 1.06-2.02; PAR 21.27%).ConclusionsThis review specified several important risk factors for LM in China. In particular, the incidence of LM can be reduced by controlling some of the modifiable risk factors such as improper breastfeeding posture, improper milking method, repeated milk stasis, nipple cleaning, breast massage experience of non-medical staff and postpartum sleeping posture.

Objective To investigate the serum homocysteine (Hcy) level and intima-media thickness (IMT) of patients with carotid artery stenosis and the relation between the two. Methods A total of 126 patients diagnosed as carotid artery stenosis and performed by carotid endarterectomy (CEA) from January 2012 to April 2018 were selected in this study. The extent of carotid artery stenosis was evaluated by carotid Doppler color ultrasound and digital subtraction angiography (DSA). Serum Hcy levels were measured in all patients and 100 healthy controls. Results The average concentration of serum Hcy [(16.47 ± 6.53) μ mol/L vs. (10.53 ± 3.39) μ mol/L; t = 8.828, P = 0.000], the incidence rate of hyperhomocysteinemia [61 cases (48.41%) vs. 6 cases (6%); χ2 = 48.084, P = 0.000] and IMT of carotid artery [(1.33 ± 0.15) mm vs. (0.82 ± 0.11) mm; t = 28.462, P = 0.000] in carotid artery stenosis group were significantly higher than those in control group. According to the extent of carotid artery stenosis, the carotid artery stenosis group was further divided into moderate (N = 10) and severe (N = 116) carotid artery stenosis subgroups. The average concentration of serum Hcy in moderate stenosis group was significantly lower than that in severe stenosis group [(13.44 ± 2.83) μmol/L vs. (16.73 ± 6.69) μmol/L; t = -3.022, P = 0.007]. Nevertheless, the incidence rate of hyperhomocysteinemia [2 cases (2/10) vs. 59 cases (50.86%); adjusted χ2 = 2.384, P = 0.123] had no significant difference between 2 subgroups. Pearson correlation analysis demonstrated that the concentration of serum Hcy was positively related with IMT of carotid artery (r = 0.610, P = 0.032). Conclusions Patients with carotid artery stenosis present higher level of serum Hcy, which is positively associated with IMT. DOI: 10.3969/j.issn.1672-6731.2019.01.009