Application progresses of ultrasound for snakebites and relative complications

Snakebite has become a serious public health problem with high mortality and disability rates.Ultrasound can provide imaging basis for diagnosis and treatment of snakebites and relative complications.The application progresses of ultrasound in snakebites and complications were reviewed in this article.

Lung ultrasound score evaluation of the effect of pressure-controlled ventilation volume-guaranteed on patients undergoing laparoscopicassisted radical gastrectomy

BACKGROUND Laparoscopic-assisted radical gastrectomy(LARG)is the standard treatment for early-stage gastric carcinoma(GC).However,the negative impact of this proce-dure on respiratory function requires the optimized intraoperative management of patients in terms of ventilation.AIM To investigate the influence of pressure-controlled ventilation volume-guaranteed(PCV-VG)and volume-controlled ventilation(VCV)on blood gas analysis and pulmonary ventilation in patients undergoing LARG for GC based on the lung ultrasound score(LUS).METHODS The study included 103 patients with GC undergoing LARG from May 2020 to May 2023,with 52 cases undergoing PCV-VG(research group)and 51 cases undergoing VCV(control group).LUS were recorded at the time of entering the operating room(T0),20 minutes after anesthesia with endotracheal intubation(T1),30 minutes after artificial pneumoperitoneum(PP)establishment(T2),and 15 minutes after endotracheal tube removal(T5).For blood gas analysis,arterial partial pressure of oxygen(PaO_(2))and partial pressure of carbon dioxide(PaCO_(2))were observed.Peak airway pressure(P_(peak)),plateau pressure(Pplat),mean airway pressure(P_(mean)),and dynamic pulmonary compliance(C_(dyn))were recorded at T1 and T2,1 hour after PP establishment(T3),and at the end of the operation(T4).Postoperative pulmonary complications(PPCs)were recorded.Pre-and postoperative serum interleukin(IL)-1β,IL-6,and tumor necrosis factor-α(TNF-α)were measured by enzyme-linked immunosorbent assay.RESULTS Compared with those at T0,the whole,anterior,lateral,posterior,upper,lower,left,and right lung LUS of the research group were significantly reduced at T1,T2,and T5;in the control group,the LUS of the whole and partial lung regions(posterior,lower,and right lung)decreased significantly at T2,while at T5,the LUS of the whole and some regions(lateral,lower,and left lung)increased significantly.In comparison with the control group,the whole and regional LUS of the research group were reduced at T1,T2,and T5,with an increase in PaO_(2),decrease in PaCO_(2),reduction in P_(peak) at T1 to T4,increase in P_(mean) and C_(dyn),and decrease in Pplat at T4,all significant.The research group showed a significantly lower incidence of PPCs than the control group within 3 days postoperatively.Postoperative IL-1β,IL-6,and TNF-αsignificantly increased in both groups,with even higher levels in the control group.CONCLUSION LUS can indicate intraoperative non-uniformity and postural changes in pulmonary ventilation under PCV-VG and VCV.Under the lung protective ventilation strategy,the PCV-VG mode more significantly improved intraop-erative lung ventilation in patients undergoing LARG for GC and reduced lung injury-related cytokine production,thereby alleviating lung injury.

Ovarian-adnexal reporting and data system ultrasound evaluation and pathological characteristics of ovarian collision tumor

BACKGROUND Collision tumor are neoplasms,including two histologically distinct tumors that coexist in the same mass without histological admixture.The incidence of collision tumor is low and is rare clinically.AIM To investigate ultrasound images and application of ovarian-adnexal reporting and data system(O-RADS)to evaluate the risk and pathological characteristics of ovarian collision tumor.METHODS This study retrospectively analyzed 17 cases of ovarian collision tumor diagnosed pathologically from January 2020 to December 2023.All clinical features,ultrasound images and histopathological features were collected and analyzed.The O-RADS score was used for classification.The O-RADS score was determined by two senior doctors in the gynecological ultrasound group.Lesions with O-RADS score of 1-3 were classified as benign tumors,and lesions with O-RADS score of 4 or 5 were classified as malignant tumors.RESULTS There were 17 collision tumors detected in 16 of 6274 patients who underwent gynecological surgery.The average age of 17 women with ovarian collision tumor was 36.7 years(range 20-68 years),in whom,one occurred bilaterally and the rest occurred unilaterally.The average tumor diameter was 10 cm,of which three were 2-5 cm,11 were 5-10 cm,and three were>10 cm.Five(29.4%)tumors with O-RADS score 3 were endometriotic cysts with fibroma/serous cystadenoma,and unilocular or multilocular cysts contained a small number of parenchymal components.Eleven(64.7%)tumors had an O-RADS score of 4,including two in category 4A,six in category 4B,and three in category 4C;all of which were multilocular cystic tumors with solid components or multiple papillary components.One(5.9%)tumor had an O-RADS score of 5.This case was a solid mass,and a small amount of pelvic effusion was detected under ultrasound.The pathology was high-grade serous cystic cancer combined with cystic mature teratoma.There were nine(52.9%)tumors with elevated serum carbohydrate antigen(CA)125 and two(11.8%)with elevated serum CA19-9.Histological and pathological results showed that epithelial-cell-derived tumors combined with other tumors were the most common,which was different from previous results.CONCLUSION The ultrasound images of ovarian collision tumor have certain specificity,but diagnosis by preoperative ultrasound is difficult.The combination of epithelial and mesenchymal cell tumors is one of the most common types of ovarian collision tumor.The O-RADS score of ovarian collision tumor is mostly≥4,which can sensitively detect malignant tumors.

Assessment of perianal fistulizing Crohn’s disease activity with endoanal ultrasound: A retrospective cohort study

BACKGROUND Perianal fistulas pose dual challenges to Crohn's disease(CD)patients.Low patient compliance due to the complexity of existing examination methods plagues the treatment and follow-up management of perianal CD.AIM To determine the accuracy of endoanal ultrasound(EUS)and shear wave elastography(SWE)for evaluating perianal fistulizing CD(PFCD)activity.METHODS This was a retrospective cohort study.A total of 67 patients from August 2022 to December 2023 diagnosed with CD were divided into three groups:Non-anal fistula group(n=23),low-activity perianal fistulas[n=19,perianal disease activity index(PDAI)≤4],high-activity perianal fistulas(n=25,PDAI>4)based on the PDAI.All patients underwent assessments including EUS+SWE,pelvic magnetic resonance[pelvic magnetic resonance imaging(MRI)],C-reactive protein,fecal calprotectin,CD activity index,PDAI.RESULTS The percentage of fistulas indicated by pelvic MRI and EUS was consistent at 82%,and there was good consistency in the classification of perianal fistulas(Kappa=0.752,P<0.001).Significant differences were observed in the blood flow Limberg score(χ^(2)=8.903,P<0.05)and shear wave velocity(t=2.467,P<0.05)between group 2 and 3.Shear wave velocity showed a strong negative correlation with magnetic resonance novel index for fistula imaging in CD(Magnifi-CD)score(r=-0.676,P<0.001),a weak negative correlation with the PDAI score(r=-0.386,P<0.05),and a weak correlation between the Limberg score and the PDAI score(r=0.368,P<0.05).CONCLUSION EUS combined with SWE offers a superior method for detecting and quantitating the activity of perianal fistulas in CD patients.It may be the ideal tool to assess PFCD activity objectively for management strategies.

Overview of the immunological mechanisms in hepatitis B virus reactivation:Implications for disease progression and management strategies

Hepatitis B virus(HBV)reactivation is a clinically significant challenge in disease management.This review explores the immunological mechanisms underlying HBV reactivation,emphasizing disease progression and management.It delves into host immune responses and reactivation’s delicate balance,spanning innate and adaptive immunity.Viral factors’disruption of this balance,as are interac-tions between viral antigens,immune cells,cytokine networks,and immune checkpoint pathways,are examined.Notably,the roles of T cells,natural killer cells,and antigen-presenting cells are discussed,highlighting their influence on disease progression.HBV reactivation’s impact on disease severity,hepatic flares,liver fibrosis progression,and hepatocellular carcinoma is detailed.Management strategies,including anti-viral and immunomodulatory approaches,are critically analyzed.The role of prophylactic anti-viral therapy during immunosuppressive treatments is explored alongside novel immunotherapeutic interventions to restore immune control and prevent reactivation.In conclusion,this compre-hensive review furnishes a holistic view of the immunological mechanisms that propel HBV reactivation.With a dedicated focus on understanding its implic-ations for disease progression and the prospects of efficient management stra-tegies,this article contributes significantly to the knowledge base.The more profound insights into the intricate interactions between viral elements and the immune system will inform evidence-based approaches,ultimately enhancing disease management and elevating patient outcomes.The dynamic landscape of management strategies is critically scrutinized,spanning anti-viral and immunomodulatory approaches.The role of prophylactic anti-viral therapy in preventing reactivation during immunosuppressive treatments and the potential of innovative immunotherapeutic interventions to restore immune control and proactively deter reactivation.

Correlations of transcranial sonography of substantia nigra characteristics with MRI iron deposition on substantia nigra in patients with Parkinson disease

Objective To explore the correlations of transcranial sonography of substantia nigra(SN-TCS)characteristics with MRI iron deposition on substantia nigra in patients with Parkinson disease(PD).Methods Data of SN-TCS and craniocerebral MRI in 120 PD patients were retrospectively analyzed.The patients were divided into iron deposition positive group(positive group,n=46)and iron deposition negative group(negative group,n=74)according to quantitative susceptibility mapping(QSM)value.Then parameters of SN-TCS and MRI were compared between groups(both P<0.05),and correlation analysis were also performed.Results The proportion of high echo positive,strong echo area and QSM value of substantia nigra,as well as of hyper-substantia nigra area/midbrain area(S/M)in positive group were all higher than those in negative group(all P<0.001).No significant difference of midbrain area was found between groups(P>0.05).Strong echo area of substantia nigra and S/M based on SN-TCS were both low-medium positively correlated with substantia nigra QSM value showed on MRI(r=0.497,0.529,both P<0.001).Conclusion SN-TCS characteristics of PD patients were correlated with MRI iron deposition on substantia nigra,among which strong echo area and S/M were valuable for evaluating iron deposition on substantia nigra.

Hepatic cystic lesions mimicking liver abscess on imaging: A report oftwo cases

Hepatic cystic lesions include congenital dysplasia,inflammatory cystic lesions,neoplastic cystic lesions and parasitic cystic lesions.As different treatment modalities can be chosen for these lesions,differential diagnosis is particularly important[1].Clinical features or imaging findings of cystic lesions of the liver are typical;for instance,liver abscess often shows thick-walled enhancement on contrast-enhanced CT.

Clinical value of oral contrast-enhanced ultrasonography in diagnosis of gastric tumors

BACKGROUND The incidence of gastric cancer remains high,and it is the sixth most common cancer and the fourth leading cause of cancer deaths worldwide.Oral contrastenhanced ultrasonography is a simple,non-invasive,and painless method for the diagnosis of gastric tumors.AIM To explore the diagnostic value of oral contrast-enhanced ultrasonography for the detection of gastric tumors.METHODS The screening results based on oral contrast-enhanced ultrasonography and electronic gastroscopy were compared with those of the postoperative pathological examination.RESULTS Among 42 patients with gastric tumors enrolled in the study,the diagnostic accordance rate was 95.2%for oral contrast-enhanced ultrasonography(n=40)and 90.5%for electronic gastroscopy(n=38)compared with postoperative pathological examination.The Kappa value of consistency test with pathological findings was 0.812 for oral contrast-enhanced ultrasonography and 0.718 for electronic gastroscopy,and there was no significant difference between them(P=0.397).For the TNM staging of gastric tumors,the accuracy rate of oral contrast enhanced ultrasonography was 81.9%for the overall T staging and 50%,77.8%,100%,and 100%for T1,T2,T3,and T4 staging,respectively.The sensitivity and specificity were both 100%for stages T3 and T4.The diagnostic accuracy rate of oral contrast-enhanced ultrasonography was 93.8%,80%,100%,and 100%for stages N0,N1-N3,M0,and M1,respectively.CONCLUSION The accordance rate of qualitative diagnosis by oral contrast-enhanced ultrasonography is comparable to that of gastroscopy,and it could be used as the preferred method for the early screening of gastric tumors.

Deep learning models semi-automatic training system for quality control of transthoracic echocardiography

Objective To explore the value of deep learning(DL)models semi-automatic training system for automatic optimization of clinical image quality control of transthoracic echocardiography(TTE).Methods Totally 1250 TTE videos from 402 patients were retrospectively collected,including 490 apical four chamber(A4C),310 parasternal long axis view of left ventricle(PLAX)and 450 parasternal short axis view of great vessel(PSAX GV).The videos were divided into development set(245 A4C,155 PLAX,225 PSAX GV),semi-automated training set(98 A4C,62 PLAX,90 PSAX GV)and test set(147 A4C,93 PLAX,135 PSAX GV)at the ratio of 5∶2∶3.Based on development set and semi-automatic training set,DL model of quality control was semi-automatically iteratively optimized,and a semi-automatic training system was constructed,then the efficacy of DL models for recognizing TTE views and assessing imaging quality of TTE were verified in test set.Results After optimization,the overall accuracy,precision,recall,and F1 score of DL models for recognizing TTE views in test set improved from 97.33%,97.26%,97.26%and 97.26%to 99.73%,99.65%,99.77%and 99.71%,respectively,while the overall accuracy for assessing A4C,PLAX and PSAX GV TTE as standard views in test set improved from 89.12%,83.87%and 90.37%to 93.20%,90.32%and 93.33%,respectively.Conclusion The developed DL models semi-automatic training system could improve the efficiency of clinical imaging quality control of TTE and increase iteration speed.

Exploring the therapeutic potential of Qi Teng Mai Ning recipe in ischemic stroke and vascular cognitive impairment

Background:This study aims to explore the therapeutic effects of the Qi Teng Mai Ning recipe on ischemic stroke and vascular cognitive impairment through its potential to modulate cellular autophagy,with a focus on identifying its active ingredients and their target proteins.Methods:The study began with the identification of active ingredients in the Qi Teng Mai Ning recipe.It proceeded to screen the gene expression omnibus database for ischemic stroke and vascular cognitive impairment-associated differentially expressed mRNAs and to identify cellular autophagy-related proteins via the Human Autophagy Database.These proteins were annotated with Gene Ontology and Kyoto Encyclopedia of Genes and Genomes functions and subjected to molecular docking with the recipe’s core active ingredients.In vitro cell experiments were conducted on hypoxic HT22 cells,involving CCK8 assay,lentiviral transfection to silence autophagy related 9B(ATG9B),immunofluorescence staining,and qPCR validation to investigate the effects of the recipe on autophagy.Results:The analysis identified 104 active ingredients targeting 408 proteins and forming a complex ingredient-target network.Intersecting 55 ischemic stroke-related and 909 vascular cognitive impairment-related differentially expressed mRNAs revealed 14 co-expressed mRNAs.Molecular docking showed quercetin,kaempferol,myrcene,and conferone as key ingredients targeting autophagy-related proteins.Cellular experiments indicated that the recipe significantly enhanced cell viability under hypoxic conditions,reduced apoptosis,and modulated the expression of autophagy-related factors,thereby decreasing apoptosis rates in HT22 cells.Conclusion:The Qi Teng Mai Ning recipe offers protective effects against ischemic stroke and vascular cognitive impairment by modulating autophagy-related proteins.Its efficacy highlights the potential of traditional Chinese medicine in treating these conditions,though further research is needed to fully understand its mechanisms and clinical applications.

Association of autoimmune thyroid disease with type 1 diabetes mellitus and its ultrasonic diagnosis and management

As a common hyperglycemic disease,type 1 diabetes mellitus(T1DM)is a complicated disorder that requires a lifelong insulin supply due to the immunemediated destruction of pancreaticβcells.Although it is an organ-specific autoimmune disorder,T1DM is often associated with multiple other autoimmune disorders.The most prevalent concomitant autoimmune disorder occurring in T1DM is autoimmune thyroid disease(AITD),which mainly exhibits two extremes of phenotypes:hyperthyroidism[Graves'disease(GD)]and hypothyroidism[Hashimoto's thyroiditis,(HT)].However,the presence of comorbid AITD may negatively affect metabolic management in T1DM patients and thereby may increase the risk for potential diabetes-related complications.Thus,routine screening of thyroid function has been recommended when T1DM is diagnosed.Here,first,we summarize current knowledge regarding the etiology and pathogenesis mechanisms of both diseases.Subsequently,an updated review of the association between T1DM and AITD is offered.Finally,we provide a relatively detailed review focusing on the application of thyroid ultrasonography in diagnosing and managing HT and GD,suggesting its critical role in the timely and accurate diagnosis of AITD in T1DM.

Proposal for a new classification of anorectal abscesses based on clinical characteristics and postoperative recurrence

BACKGROUND Current surgical procedures for anorectal abscesses,including incision and drainage alone or combined concurrent fistulotomy,remain controversial primarily due to the unpredictability of postoperative recurrence or the progression to anal fistula.AIM To evaluate factors that predict postoperative recurrence of anorectal abscesses and propose a new classification to guide surgical procedures.METHODS In this retrospective study,525 patients with anorectal abscesses treated by incision and drainage alone,at a tertiary general hospital from August 2012 to July 2022,were included.A new classification for anorectal abscesses based on their propensity to develop into fistulas,considering 18 other potential risk factors,was established.These factors,from electronic medical records,were screened for significance using theχ^(2)test and subsequently analyzed with multivariate logistic regression to evaluate their relationship with postoperative recurrence of anorectal abscesses.RESULTSOne year post-follow-up,the overall recurrence rate was 39%:81.0%and 23.5%for fistula-prone and non-fistulaproneabscesses,respectively.Univariateχ^(2)analysis showed significant differences in recurrence rates based onanatomical classifications and pus culture results(P<0.05).Fistula-prone abscess,≥7 days between symptomonset and surgery,chronic diarrhea,preoperative antibiotic use,and local anesthesia were risk factors for recurrence,while diabetes mellitus was protective(P<0.05).Moreover,fistula-prone abscess[odds ratio(OR)=7.651,95%CI:4.049–14.458,P<0.001],≥7 days from symptom onset to surgery(OR=2.137,95%CI:1.090–4.190,P=0.027),chronic diarrhea(OR=2.508,95%CI:1.216–5.173,P=0.013),and local anesthesia(OR=2.308,95%CI:1.313–4.059,P=0.004)were independent risk factors for postoperative anorectal abscess recurrence using multivariatelogistic regression.Body mass index≥28(OR=2.935,95%CI:1.203–7.165,P=0.018)was an independentrisk factor for postoperative recurrence of non-fistula-prone abscess.CONCLUSIONThe choice of surgical procedure for treating anorectal abscesses should follow this new classification.Prompt andthorough incision and drainage can significantly reduce postoperative recurrence.

Evaluating the Impact of Transcutaneous Electrical Nerve Stimulation on Patients Undergoing Inguinal Hernia Surgery: A Meta- Analysis of Randomized Controlled Trials

Objective:A comprehensive meta-analysis based on the latest randomized controlled trials(RCTs)was conducted to investigate the effects of transcutaneous electrical nerve stimulation(TENS)on patients undergoing treatment after inguinal hernia surgery.Methods:A detailed search of Embase,PubMed,Web of Science,and the Cochrane Library was performed for RCTs investigating the use of TENS during inguinal hernia surgery up to September 28,2021.The Cochrane tool was applied to assess the risk of bias in the included studies.Results:Seven eligible RCTs with a total of 379 cases were included.The meta-analysis showed a mean difference(MD)in VAS of-1.61[95%CI:-2.20-1.02,P<0.00001]at 2 hours post-operation,VAS MD=-1.33 at 4 hours post-operation[95%CI:-2.84-0.18,P=0.09],VAS MD=-2.36 at 8 hours post-operation[95%CI:-4.04-0.69,P=0.006],and VAS MD=-1.75 at 24 hours post-operation[95%CI:-2.64-0.85,P=0.0001].The cortisol level MD at 24 hours post-operation was-52.56[95%CI:-168.8-63.76,P=0.38].Conclusion:TENS significantly reduces postoperative pain following inguinal hernia surgery and promotes patient recovery.TENS is recommended for patients undergoing inguinal hernia surgery.However,further high-quality studies are needed to confirm additional effects.

Predictive value of quantitative contrast-enhanced ultrasound in hepatocellular carcinoma recurrence after ablation

AIM: To investigate the relationship between contrastenhanced ultrasound(CEUS),basic fibroblast growth factor(b FGF),endothelin-1(ET-1),and hepatocellular carcinoma(HCC) recurrence after ablation. METHODS: A total of 51 HCC patients(38 males and 13 females) who received radiofrequency ablation in our hospital from June 2012 to July 2014 were enrolled in this study. The patients were divided into two groups: recurrence group and non-recurrence group. Routine abdominal examination was first performed in the horizontal position. Then the patients underwent CEUS and immunohistochemical staining before receiving radiofrequency ablation. All patients were followed-up every three months for one year.The results of CEUS and serum tumor marker levels were evaluated and combined together to estimate HCC recurrence and metastasis. Patients were divided into two groups: recurrence group and non-recurrence group. Quantitative parameters of CEUS and tumor expression levels of b FGF and ET-1 were compared between the two groups,respectively. Binary logistic regression analysis was used to analyze the relationship between CEUS quantitative parameters,expression levels of ET-1 and b FGF,and HCC recurrence after ablation. RESULTS: Based on the quantitative parameters of CEUS before patients received radiofrequency ablation,the levels of tumor rise time(t RT),tumor time to peak(t TTP),tumor peak intensity(t PI) and tumorparenchymal peak intensity(t-p PI) in the recurrence group were significantly lower than those in the nonrecurrence group(16.6 ± 6.1 vs 23.2 ± 7.0,P = 0.000; 41.2 ± 10.2 vs 59.6 ± 14.2,P = 0.000; 23.8 ± 6.7 vs 31.4 ± 6.4,P = 0.000; 7.1 ± 3.4 vs 14.6 ± 7.4,P = 0.000; respectively). The expression levels of b FGF in the recurrence group were significantly higher than those in the non-recurrence group(P < 0.05). Levels of t TTP showed a significant inverse correlation with the level of b FGF in tumors(r =-0.312,P = 0.037). The Binary logistic regression analysis results revealed that the levels of t RT,t TTP,t PI and the level of b FGF were associated with HCC recurrence after radiofrequency ablation(P < 0.05). CONCLUSION: CEUS is a noninvasive and effective method for evaluating the angiogenesis of HCC,and predicting its recurrence and prognosis.

Evaluation of short-and medium-term efficacy and complications of ultrasound-guided ablation for small liver cancer

BACKGROUND To ensure clinical efficacy and prolong patient survival,treatments such as surgery and microwave ablation(MWA)are used for early liver cancer.MWA is preferred because it effectively preserves the normal liver tissue and causes transient coagulation necrosis of local liver tumor cells.However,due to technical limitations,the cancerous liver tissue cannot be completely ablated;therefore,the probability of local tumor recurrence is high.AIM To investigate the clinical efficacy and safety of ultrasound-guided percutaneous MWA in the treatment of small liver cancer.METHODS A total of 118 patients treated for small liver cancer in The Central Hospital of Yongzhou from January 2018 to April 2019 were selected.Sixty-six patients received ultrasound-guided percutaneous MWA(MWA group)and 52 received laparoscopic surgery(laparoscope group).The operation time,blood loss,hospital stay,and medical expenses of both groups were statistically analyzed.Serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),albumin(ALB),alpha fetal protein(AFP),carcinoembryonic antigen(CEA),and peripheral blood regulatory T lymphocytes(Treg)levels were evaluated pre-and post-operatively.The cross-sectional area of tumors measured before and after ablation was analyzed statistically;the therapeutic effect was compared between both groups in terms of surgical complications,2-year progression-free survival rate,and overall survival rate.RESULTS The operation time,blood loss,hospital stay,and medical expenses in the MWA group were lower than those of the laparoscope group,and the differences were significant(P<0.05);these parameters,and ALT,AST,TBIL,and ALB levels were compared preoperatively between both groups,and there was no significance(P>0.05).The operation time,blood loss,hospital stay,and medical expenses for 2 d and 1 wk after surgery,the ALT and AST of the MWA group were lower than those of the laparoscope group,and the difference was significant(P<0.05).The operation time,blood loss,hospital stay,and medical expenses,and serum AFP,CEA,and Treg levels were measured preoperatively and 4 and 8 wk postoperatively,and there were no significant differences between the two groups(P>0.05).Compared with preoperative levels,serum AFP,CEA,and Treg levels in both groups were decreased(P<0.05).The lesion in the MWA group had a maximum area of 4.86±0.90 cm2,1.24±0.57 cm2,and 0.31±0.11 cm2 preoperatively,1 and 3 mo postoperatively,respectively.Fifty-eight of them achieved complete response and eight achieved a partial response.After 2 years of followup,the progression-free and overall survival rates in the MWA group were 37.88%and 66.67%,respectively,compared with 44.23%and 76.92%in the laparoscope group,with no significant difference(P>0.05).CONCLUSION The effects of ultrasound-guided percutaneous MWA in the treatment of small liver cancer are similar to those of laparoscopic surgery.However,ablation causes less trauma and liver dysfunction.

Microscopic study of ultrasound-mediated microbubble destruction effects on vascular smooth muscle cells

Objective:To observe vascular smooth muscle cell morphological changes induced by ultrasound combined with microbubbles by Atomic Force Acoustic Microscopy(AFAM).Methods:A7r5 rat aortic smooth muscle cells were divided into groups:control group(without ultrasonic irradiation,no micro bubbles)and US+MB group(45 kHz、0.4 W/cm^2 ultrasound irradiate for 20 seconds with a SonoVuc^(TM)concentration of[(56-140)×10~5/mL].Cell micromorphological changes(such as topographic and acoustic prognosis)were detected,before and after ultrasound destruction by AFAM.Results:In cell morphology,smooth muscle cells were spread o and connected to each another by fibers.At the center of the cell,the nuclear area had a rough surface and was significantly elevated from its surroundings.The cytoskeletal structure of the reticular nucleus and cytoplasm in the morphology of A7r5 cells(20μm×20μm)were clear before microbubble intervention.After acoustic exciting,the cell structure details of the acoustic image were improved with better resolution,showing the elasticity of different tissues.In the acoustic image,the nucleus was harder,more flexible and uneven compared with the cytoplasm.Many strong various-sized echo particles were stuck on the rough nuclear membrane's substrate surface.The nuclear membrane did not have a continuous smooth surface;there were many obstructions(pores).After ultrasound-intervention was combined with microbubbles,the dark areas of the A7r5 cell images was increased in various sizes and degrees.The dark areas showed the depth or low altitudes of the lower regions,suggesting regional depressions.However,the location and scope of the acoustic image dark areas were not similar to those found in the topographic images.Therefore,it was likely that the dark areas,both from the topographic and acoustic images,were sound-holes.In addition,some cell nuclei become round in different degrees after irradiation.Conclusions:Atomic force microscopy and acoustic excitation method can noninvasively and completely display a cell's structure,connections and elastic properties at a nano scale in just several minutes.The dark areas,both from the topographic and acoustic images,may be sound-holes;therefore,it would be helpful if these sound-holes were found.These findings provide a relationship between cell apoptosis after ultrasound and microbubble ultrasound irradiation,and the sound-hole effect.

Effect of CXCR4 pretreated with ultrasound-exposed microbubbles on accelerating homing of bone marrow mesenchymal stem cells to ischemic myocardium in AMI rats

Objective: To investigate the role and potential mechanism of CXCR4 in promoting targeted homing of bone marrow mesenchymal stem cells(BMSCs) with ultrasound-exposed microbubbles(UM) pretreatment. Methods: Third generation BMSCs were divided into four groups control group, ultrasound(US) group, UM group and ultrasound-exposed microbubbles plus catalase group. RT-PCR and western blot were performed to determine the levels of CXCR4 m RNA transcription and protein expression, respectively. Third generation BMSCs were labeled with Fluo-α/AM and divided into three groups: control group, US group and UM group, and flurorescence intensities in the cells were observed immediately, 5 min and 15 min after intervention underflurorescence microscope. The calcium iron levels in the cells were analyzed. BMSCs were divided into i ve group: group A without calcium in the medium, group B, group C, group D and group E containing calcium chloride with concentration of l mol, 2 mol, 4mol, anti-calciurn-sensing receptor antibody, respectively. RT-PCR and western blot were performed to determine the levels of CXCR4 m RNA transcription and proteins expression of the third generation BMSCs of each group, respectively. Results: The levels of CXCR4 m RNA transcription and protein expression between US group and control group had no statistically signii cant dif erence(P>0.05) shown by RT-PCR and western blot; the transcription level in the UM group was signii cantly higher than that in US group and control group(P<0.05); and in the ultrasound-exposed microbubbles plus catalase group, the transcription level was much lower than that in UM group. Fluorescence intensify in the cells of US group had no signii cant dif erence compared with that in the cells of the control group(P>0.05), which in the cells of UM group was signii cantly higher than that in the cells of both US group and control group(P<0.05). Compared to group A, expressions of CXCR4 of group B to D were signii cantly increased in concentration-dependent manner showed by RT-PCR and western blot(P< 0.05). Compared to group C, expressions of CXCR4 of group E were signii cantly decreased(P< 0.05). Conclusions: UM can promote the inl ux of calcium in BMSCs and increase m RNA transcription and protein expression of CXCR4. The latter may partly be caused by influx of calcium.

Chinese clinical practice guidelines for ultrasound-guided irreversible electroporation of liver cancer(version 2022)

Introduction Liver cancer remains a global health challenge,and its incidence is increasing worldwide.It is estimated that by 2025,more than one million individuals will be affected by liver cancer annually[1,2].In recent years,ablation has become a widely accepted treatment option for patients with primary and secondary liver malignancies[3].The commonly used ablation method for liver cancer is thermal ablation,including radiofrequency ablation.

Early ultrasound diagnosis of conjoined twins at eight weeks of pregnancy: A case report

BACKGROUND Conjoined twins are a rare occurrence,and the majority of these malformations are detected during second trimester screening.CASE SUMMARY Herein we report a case of conjoined twins,which was diagnosed by ultrasound at 8 wk gestation and was normal at 7 wk gestation.The two fetuses shared one heart and were diagnosed as thoracopagus twins.This is the first report of conjoined twins diagnosed at 8 wk gestation.The pregnancy was terminated electively at 9 wk gestation.Because some congenital malformations can be diagnosed earlier,a prenatal ultrasound examination at an early gestational stage cannot be dismissed.CONCLUSION This case demonstrates that a 7-8 wk gestation might be the earliest period when conjoined twins can be diagnosed by ultrasound.

Value of myocardial function in children with Kawasaki disease by two-dimensional and three-dimensional ultrasound speckle tracking

Objective:To investigate the value of two-dimensional ultrasound speckle tracking(2D-STI)and three-dimensional ultrasound speckle tracking(3D-STI)in evaluating myocardial function in children with Kawasaki disease.Methods 92 children with Kawasaki disease admitted to our hospital from February 2017 to February 2019 were retrospectively analyzed.50 children who underwent 3D-STI examination were taken as observation group and 42 children who underwent 2D-STI examination were taken as control group.The left ventricular systolic function index,storage time and analysis time of the image,the diameter of coronary artery,the strain difference of left ventricular basal segment,middle segment,apical segment and whole segment were observed.Results The levels of left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular myocardial mass(LVMI)in the observation group were higher than those in the control group(P<0.05),but there was no statistical difference in left ventricular ejection fraction(LVEF)between the two groups(P>0.05).The storage time and analysis time of the image in the observation group were significantly lower than those in the control group(P<0.05).The left coronary artery(LCA)and right coronary artery(RCA)in the observation group were higher than those in the control group(P<0.05).There was no statistical difference between left anterior descending(LAD)in the two groups(P>0.05).The longitudinal peak systolic strain(LS),circumferential peak systolic strain(CS)and radial peak systolic strain(RS)in the observation group were higher than those in the control group(P<0.05).The global longitudinal peak strain(GLS),global circumferential peak strain(GCS)and global radial peak strain(GRS)in the observation group were higher than those in the control group(P<0.05).LS and CS in the middle segment of the observation group were higher than those in the control group(P<0.05).Conclusions Compared with 2D-STI,3D-STI can objectively and accurately reflect the myocardial function of children with Kawasaki disease.