Chunsong Kang's research while affiliated with Tongji Hospital and other places

Cardiovascular disease is one of the leading causes of mortality in patients with obesity. Metabolically healthy obesity (MHO), in which people do not have metabolic disorders, is a transient state of obesity. However, over the long term, a proportion of individuals with MHO develop metabolic syndrome (MetS). We aimed to investigate the effect of substantial weight loss following bariatric surgery in MHO on carotid intima-media thickness (CIMT) and pulse-wave velocity (PWV), which are independent predictors of subclinical atherosclerosis. This prospective study included 38 patients (34 women, four men) undergoing bariatric surgery who had severe obesity but without comorbidities (hypertension, diabetes, and hyperlipidemia), and 28 control individuals who were matched for age and sex. CIMT and PWV of the left common carotid artery were measured. At 12-month follow-up after bariatric surgery, measurements were repeated in the 38 patients with obesity. Mean baseline body mass index (BMI) in the MHO group was 40.55 ± 3.59 kg/m2, which decreased by 33.1% after bariatric surgery. Compared with controls, CIMT and PWV were increased in MHO (543.53 ± 55.29 vs. 407.82 ± 53.09 μm, 6.70 ± 1.22 vs. 5.45 ± 0.74 m/s, respectively; all P < 0.001). At 12 months post-bariatric surgery, CIMT in MHO was lower than baseline (466.79 ± 53.74 vs. 543.53 ± 55.29 μm, P = 0.009), but PWV was not significantly different from baseline (6.27 ± 0.86 vs. 6.70 ± 1.22 m/s, P = 0.132). Multivariate regression showed that BMI was an independent predictor of CIMT (β = 0.531, P < 0.001). Carotid artery structure and function were impaired in MHO, and improved carotid artery structure was associated with weight loss in MHO after bariatric surgery.

Objectives Differential diagnosis of benign and malignant thyroid imaging reporting and data system (TIRADS) category 4a and 4b nodules can be difficult using conventional ultrasonography (US). The objective of this study was to evaluate the diagnostic efficacy of a combination of the Chinese-TIRADS (C-TIRADS) and shear wave elastography (SWE) in detecting malignant nodules among category 4a and 4b thyroid nodules. Methods Among 409 thyroid nodules in 332 patients that we included in this study, 106 thyroid nodules were diagnosed as category 4a and 4b using C-TIRADS. We used SWE to measure the maximum Young’s modulus (Emax) values of category 4a and 4b thyroid nodules. We calculated the diagnostic efficacy of only the C-TIRADS, only SWE, and a combination of C-TIRADS with SWE, and compared these, while taking the pathology results as the gold standard. Results The area under the ROC curve (AUC), sensitivity, and accuracy values of the combination of C-TIRADS and SWE (0.870, 83.3%, and 84.0%, respectively) were all higher when compared with the values of only the C-TIRADS (0.785, 68.5%, and 78.3%, respectively) or only SWE (0.775, 68.5%, and 77.4%, respectively) in the diagnosis of category 4a and 4b thyroid nodules. Conclusion In this study, we found that the combination of C-TIRADS and SWE significantly improved the diagnostic efficacy in detecting malignant nodules among category 4a and 4b thyroid nodules, and this could provide a reference for further use of this combination by clinicians for diagnosis and treatment.

Purpose Hepatocirrhotic nephropathy progresses rapidly and has a poor prognosis, and early detection of renal changes in patients with cirrhosis is particularly important for its prevention and treatment. The objective of this study was to evaluate the value of shear wave elastography (SWE) in the early diagnosis of hepatocirrhotic nephropathy. Methods 206 hepatic cirrhosis patients with normal conventional renal function were enrolled and divided into Child–Pugh grade A (Group A), Child–Pugh grade B (Group B), and Child–Pugh grade C (Group C) according to the Child–Pugh grading method. Meanwhile, 60 healthy volunteers matched in age and sex were selected as the control group. The maximum Young’s modulus (Emax), average Young’s modulus (Emean), and minimum Young’s modulus (Emin) of the left renal parenchyma were measured by SWE in all subjects. The Emax, Emean, and Emin values of the left renal parenchyma were compared between the cirrhosis and control groups. Results The Emax, Emean, and Emin values of left renal parenchyma in cirrhosis group were higher than those in control group (p = 0.00, 0.00, 0.00). The Emax, Emean, and Emin values of left renal parenchyma in cirrhosis group B and group C were higher than those in control group (p = 0.00, 0.00, 0.00; p = 0.00, 0.00, 0.00), but these values in cirrhosis group A were not significantly different from control group(p = 0.48, 0.52, 0.92). Comparison of the Emax, Emean, and Emin values in left renal parenchyma of three cirrhosis groups, the values of Group B and Group C were higher than those of Group A (p = 0.00, 0.00, 0.00; p = 0.00, 0.00, 0.00), and there was no significant difference between Group B and Group C (p = 0.71, 0.18, 0.39). Conclusion SWE can detect renal tissue damage in patients with liver cirrhosis earlier than changes identified during routine laboratory examination by quantitatively measuring the elastic parameters of renal parenchyma and may become a new method for early diagnosis of hepatorenal syndrome. Graphical Abstract

Objective This study aimed to evaluate the impact of different left ventricular geometric patterns on right ventricular deformation and function in the elderly with essential hypertension via two-dimensional speckle tracking and three-dimensional echocardiography. Methods A total of 248 elderly people with essential hypertension were divided into four groups based on the left ventricular mass index (LVMI) and relative wall thickness (RWT): the normal geometric, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy groups. Moreover, 71 participants were recruited as the control group. These participants were examined by two-dimensional speckle tracking and three-dimensional echocardiography to obtain the right ventricular strain parameters, three-dimensional volume, and function parameters. Results The right ventricular strain parameters decreased gradually from the normal geometric group to the concentric hypertrophy group ( P < 0.05), and the strain parameters in the concentric remodeling, eccentric hypertrophy, and concentric hypertrophy groups were lower than those in the control and normal geometric groups ( P < 0.05). The right ventricular three-dimensional echocardiographic parameters only changed in the eccentric hypertrophy group ( P < 0.05) and the concentric hypertrophy group ( P < 0.05) in the form of an increase in volume and a decrease in function. Multivariate linear regression analysis showed that the right ventricular free wall longitudinal strain was independently associated with the systolic blood pressure (SBP), LVMI, and RWT ( P < 0.05) and was primarily affected by the LVMI (normalized β = 0.637, P < 0.05). Conclusion The systolic function of the right ventricular myocardium declined in the elderly with essential hypertension due to impaired myocardial mechanics. The right ventricular strain parameters could indicate mechanical damage in the concentric remodeling group earlier than the right ventricular three-dimensional volume and function parameters. The right ventricular free wall longitudinal strain was primarily subject to the LVMI.

In shear wave elastography (SWE) studies, the optimal cutoff value of Young’s modulus for the diagnosis of benign and malignant thyroid nodules varies greatly, which affects the clinical application of the method. The objective of this study was to evaluate the influence of thyroid nodule size on the clinical diagnostic efficacy of SWE. A total of 356 thyroid nodules of 280 patients were divided into three groups according to size (Group A: ≤ 1 cm; Group B: 1–2 cm; Group C: ≥ 2 cm). SWE was used to measure the maximum Young's modulus (Emax) values of all thyroid nodules. Receiver operating characteristic (ROC) curves were drawn with pathological results as the gold standard. For all nodules, the optimal cutoff value of Emax in SWE for diagnosing malignant thyroid nodules was 36.2 kPa. The sensitivity and specificity were 76.5% and 78.4%, respectively. Groups A, B, and C had different optimal Emax cutoff values of 33.7 kPa, 37.7 kPa, and 55.1 kPa, respectively. The area under the ROC curve (AUC) values of Groups A, B, and C (0.844, 0.886, and 0.935, respectively) were all greater than the values for all lesions (0.830). The specificity values of Groups A, B, and C (86.4%, 82.6%, and 88.2%, respectively) were all increased, and the sensitivity values of Groups B and C (89.7% and 96.4%, respectively) were also increased compared with the values for all lesions. Thyroid nodule size affects the optimal Emax cutoff value of SWE. We suggest that different cutoff values be used to diagnose benign and malignant thyroid nodules according to lesion size.

To investigate the effectiveness of shear-wave elastography (SWE) based on e-health in diagnosing liver fibrosis in patients infected with hepatitis B virus (HBV) and provide theoretical basis for early diagnosis and treatment of patients with chronic HBV infection, in this study, 73 patients with chronic HBV infection who underwent e-health SWE examination were divided into chronic hepatitis B group (51 cases) and hepatitis B cirrhosis group (22 cases), and another 20 healthy volunteers were introduced as control. The contents of second liver two half-and-half, hyaluronic acid (HA) of liver fibrosis, laminin (LN), pAUVollagen III N terminal peptide (PIII NP), collage type IV (CIV), and HBV-DNA were detected. SWE was used to measure the elastic modulus in the S2 and S3 segments of the left outer lobe of the liver, S4 segment of the left inner lobe of the liver, S5 and S8 segments of the right anterior lobe of the liver, and S6 and S7 segments of the right posterior lobe of the liver. Finally, the correlations between the four examination results of liver fibrosis and the elastic modulus values were compared, and the receiver operator characteristic curve (ROC) for SWE technical diagnosis was drawn. The results showed that there was no significant difference in HBV-DNA content between the two groups (P>0.05); the contents of alanine transaminase (ALT) and aspartate aminotransferase (AST) in the blood of chronic hepatitis B group were significantly higher than those in the liver cirrhosis group (P

Objective To investigate the relationship between shear wave elastography (SWE) elasticity indices of papillary thyroid carcinoma (PTC) and central lymph node metastasis (CLNM) and to evaluate the value of SWE combined with gray-scale ultrasound (US) for predicting preoperative CLNM. Method This study included 172 patients with a pathology diagnosis of PTC who underwent preoperative gray-scale US and SWE evaluation. Patients were divided into CLNM-positive and CLNM-negative groups. We analyzed the association between SWE elasticity indices (Emax, Emean and Emin) and CLNM, compared the diagnostic efficacy of gray-scale US alone versus SWE combined with gray-scale US for predicting CLNM, and analyzed the influence of Hashimoto's thyroiditis (HT) on the diagnostic efficacy of CLNM. Results SWE elasticity values Emax, Emean and Emin were significantly higher in CLNM-positive patients (P=0.000, 0.000 and 0.003, respectively). The AUC of Emax was higher than that of other SWE indices for predicting CLNM (AUC = 0.749; 95% CI = 0.676–0.822). In multivariate analysis, microcalcification (OR = 5.254; 95% CI = 2.496–11.061), extrathyroidal extension (OR = 4.210; 95% CI = 1.423–12.456), multifocality (OR = 3.084; 95% CI = 1.190–7.991) and Emax >59.0 kpa (OR = 4.934; 95% CI = 2.318–10.500) were independent risk factors for predicting CLNM. The AUC of SWE combined with gray-scale US for predicting CLNM (AUC = 0.825; 95% CI = 0.760–0.879) was significantly higher (P = 0.011) than that for gray-scale US alone (AUC = 0.774; 95% CI = 0.704–0.834). There was no significant difference in AUC between the HT and non-HT subgroups in predicting CLNM (0.798 vs. 0.833, P = 0.640). Conclusions SWE can be used to predict CLNM in PTC patients. SWE combined with gray-scale US can improve the prediction of CLNM.

Primary mucinous tumors of the testis and paratestis are very rare, with only 29 reported cases detected in a PubMed search. The histopathological characteristics of primary testicular mucinous tumors are similar to their ovarian counterparts, and the diagnosis and naming criteria refer to the criteria for female ovarian mucinous tumors. However, the clinical and imaging features of primary testicular mucinous tumors are poorly understood, and they are thus frequently undiagnosed or misdiagnosed. We present the case of a patient with a primary testicular mucinous tumor. A 52-year-old man presented with a 1-year history of painless enlargement of the left scrotum. Ultrasound examination revealed a cystic mass in the left testis, with viscous fluid areas and calcified spots, irregular solid bulges on the cyst wall, and a small blood supply. Serum alpha-fetoprotein, β-human chorionic gonadotropin, lactate dehydrogenase, renal function, inflammatory markers, and routine urine and blood examinations were all normal. The patient underwent radical resection of the left testis. Postoperative pathology showed a multilocular cystic mass, with the inner wall of the sac lined with mucous columnar epithelial cells, some with mild nuclear atypia, and no interstitial infiltration. The pathological diagnosis was testicular mucinous tumor. Postoperative abdominal and pelvic computed tomography, colonoscopy, and gastroscopy showed no suspicious lesions. The final diagnosis was primary testicular borderline mucinous tumor. The patient underwent postoperative follow-up examinations once a year for 4 years. Serum tumor markers, scrotal ultrasound, abdominal and pelvic computed tomography scans, and colonoscopy and gastroscopy revealed no evidence of metastases or other primary adenocarcinoma. This case highlights the clinical and imaging characteristics of primary testicular mucinous tumors, which might aid their differential diagnosis.

Background/aim: This study aimed to investigate the impact of blood pressure and sex on heart-vessel coupling in patients with essential hypertension via ultrasound. Materials and methods: We studied 76 patients with essential hypertension (48 males and 28 females) and 65 healthy controls (33 males and 32 females). Coupling parameters were obtained using ultrasound technology combined with brachial artery blood pressure measurement. Results: The Ea and Ees were higher in the hypertension group than in the control group (P < 0.01), with no statistically significant difference in Ea/Ees between the two groups (P >0.05). After subjects were classified by sex, the Ea and Ees of males and females in the hypertension group were higher than those in the control group (P < 0.05 or P < 0.01), while the Ea/Ees was lower in hypertensive females than in control females (P < 0.05). Conclusion: In female patients with essential hypertension, heart-vessel coupling was easily damaged, and systolic blood pressure was associated with heart-vessel coupling damage to some extent.

Background: The purpose of this study is to evaluate the intima-media thickness (IMT) and arterial elasticity of the common carotid artery (CCA) in patients with cerebral small vessel disease (SVD) by applying radiofrequency (RF) ultrasound technology. Methods: Fifty SVD subjects (SVD group) and fifty-three matched controls (Control group) were enrolled in the study. Structural and functional changes in the common carotid arterial wall were investigated by quality intima-media thickness (QIMT) and quanlity arterial stiffness (QAS) with a Mylab Twice ultrasound instrument. The vessel related variables between these two groups were analyzed. Results: There was a significant higher value of CCA-IMT in SVD group than that in control group (P<0.01). Pulse wave velocity (PWV), stiffness coefficient (α) and stiffness index (β) were remarkably greater (P<0.01) while compliance coefficient (CC) decreased significantly (P<0.01) in the SVD group than control group. Furthermore, significant difference was found on IMT between left and right CCA in SVD (P<0.01) and control group (P<0.01) while no significant difference was found on CC, α, β and PWV between left and right CCA in SVD (P>0.05) and control group (P>0.05). Conclusions: Decreased arterial elasticity of the CCA in patients with SVD compared with normal subjects. Ultrasound RF technology can be used to non-invasively and quantitatively detect the change in the structure and function of the CCA in SVD subjects for evaluating preclinical atherosclerosis.