Given that platinum-based drugs are widely used clinically as chemotherapeutic agents,their severe toxic side effects have attracted significant attention.Consequently,the development of novel nanoprodrugs based on lo...Given that platinum-based drugs are widely used clinically as chemotherapeutic agents,their severe toxic side effects have attracted significant attention.Consequently,the development of novel nanoprodrugs based on low-toxicity tetravalent platinum(Pt(Ⅳ))com plexes holds substantial research value.Herein,we discovered that coumarin derivatives exhibit inherent antitumor efficacy and significantly enhance superoxide anion radicals(·O_(2)^(-))generation in aqueous solutions under ultrasound(US)irradiation.Given that·O_(2)^(-)is known to mediate the reduction of Pt(Ⅳ)to divalent platinum(Pt(Ⅱ)),we engineered an US-responsive dual-drug nanoprodrug(P-cisPt(Ⅳ)@5-MOP).This nanoprodrug was prepared by covalently conjugating Pt(Ⅳ)and methoxy polyethylene glycol hydroxyl(m PEG-OH)to a poly(_(L)-glutamic acid)(PLG)carrier,followed by encapsulating coumarin derivatives.Under low-intensity US irradiation(1.5 W/cm^(2),1 MHz,10 min),P-cisPt(Ⅳ)@5-MOP achieved a Pt(Ⅳ)reduction rate of 91.4%.Furthermore,upon US exposure,its half-maximal inhibitory concentration(IC_(50))against 4T1 breast cancer cells decreased dramatically from 25.7μmol/L to 0.1μmol/L.Remarkably,this system combined with US therapy yielded a tumor inhibition rate of 90.9%,with 40%of tumor-bea ring mice achieving com plete eradication of tumors,while exhibiting low systemic toxicity.Collectively,this work not only identifies a novel sonosensitizer capable of generating·O_(2)^(-)but also develops a new class of ultrasound-activatable Pt(Ⅳ)nanoprodrug.展开更多
Neurodegenerative diseases,which are characterized by progressive neuronal loss and the lack of disease-modifying therapies,are becoming a major global health challenge.The existing neuromodulation techniques,such as ...Neurodegenerative diseases,which are characterized by progressive neuronal loss and the lack of disease-modifying therapies,are becoming a major global health challenge.The existing neuromodulation techniques,such as deep brain stimulation and transcranial magnetic stimulation,show limitations such as invasiveness,restricted cortical targeting,and irreversible tissue effects.In this context,low-intensity transcranial ultrasound has emerged as a promising noninvasive alternative that can penetrate deep into the brain and modulate neuroplasticity.This review comprehensively assesses the therapeutic mechanisms,efficacy,and translational potential of low-intensity transcranial ultrasound in treating neurodegenerative diseases,with emphasis on its role in promoting neuronal regeneration,modulating neuroinflammation,and enhancing functional recovery.We summarize the findings of previous studies and systematically illustrate the potential of low-intensity transcranial ultrasound in regulating cell death mechanisms,enhancing neural repair and regeneration,and alleviating symptoms associated with neurodegenerative diseases.Preclinical findings indicate that low-intensity transcranial ultrasound can enhance the release of neurotrophic factors(e.g.,brain-derived neurotrophic factor),promote autophagy to clear protein aggregates,modulate microglial activation,and temporarily open the blood-brain barrier to facilitate targeted drug delivery.Existing clinical trial data show that low-intensity transcranial ultrasound can reduce amyloid-βplaques,improve motor and cognitive deficits,and promote remyelination in various disease models.Early clinical trials suggest that low-intensity transcranial ultrasound may enhance cognitive scores in Alzheimer’s disease and alleviate motor symptoms in Parkinson’s disease,all while demonstrating a favorable safety profile.Past studies support the notion that by integrating safety,precision,and reversibility,low-intensity transcranial ultrasound can transform the treatment landscape for neurodegenerative disease.However,more advancements are necessary for future clinical application of low-intensity transcranial ultrasound,including optimizing parameters such as frequency,intensity,and duty cycle;considering individual anatomical differences;and confirming long-term efficacy.We believe establishing standardized protocols,conducting larger trials,and investigating the underlying mechanisms to clarify dose-response relationships and refine personalized application strategies are essential in this regard.Future research should focus on translating preclinical findings into clinical practice,addressing technical challenges,and exploring combination therapies with pharmacological or gene interventions.展开更多
Alzheimer’s disease is a common neurodegenerative disorder defined by decreased reasoning abilities,memory loss,and cognitive deterioration.The presence of the blood-brain barrier presents a major obstacle to the dev...Alzheimer’s disease is a common neurodegenerative disorder defined by decreased reasoning abilities,memory loss,and cognitive deterioration.The presence of the blood-brain barrier presents a major obstacle to the development of effective drug therapies for Alzheimer’s disease.The use of ultrasound as a novel physical modulation approach has garnered widespread attention in recent years.As a safe and feasible therapeutic and drug-delivery method,ultrasound has shown promise in improving cognitive deficits.This article provides a summary of the application of ultrasound technology for treating Alzheimer’s disease over the past 5 years,including standalone ultrasound treatment,ultrasound combined with microbubbles or drug therapy,and magnetic resonance imaging-guided focused ultrasound therapy.Emphasis is placed on the benefits of introducing these treatment methods and their potential mechanisms.We found that several ultrasound methods can open the blood-brain barrier and effectively alleviate amyloid-βplaque deposition.We believe that ultrasound is an effective therapy for Alzheimer’s disease,and this review provides a theoretical basis for future ultrasound treatment methods.展开更多
Background:The bacterial biofilm poses a significant challenge to traditional antibiotic therapy.There is a great need to develop novel antibiofilm agents combined with biofilm disrupting and bacteria-killing without ...Background:The bacterial biofilm poses a significant challenge to traditional antibiotic therapy.There is a great need to develop novel antibiofilm agents combined with biofilm disrupting and bacteria-killing without the dependence of antibiotic.Methods:Herein,we prepared ultrasound/magnetic field-responsive ferroferric oxide nanoparticles(Fe_(3)O_(4))/glucose oxidase microbubbles(FGMB)to form a cascade catalytic system for effective removing methicillin-resistant Staphylococcus aureus biofilms.FGMB were prepared through interfacial self-assembly of Fe_(3)O_(4) nanoparticles(NPs)and glucose oxidase(GOx)at the gas-liquid interface stabilized by surfactants.Under ultrasound/magnetic field stimulation,FGMB disrupted biofilm architecture through microbubble collapse-induced microjets and magnetically driven displacement.Simultaneously,ultrasound-triggered rupture of FGMB released GOx and Fe_(3)O_(4) NPs.Glucose can be oxidized by GOx to generate gluconic acid and hydrogen peroxide which was subsequently catalyzed into hydroxyl radicals by Fe_(3)O_(4) NPs,enabling chemical eradication of biofilm-embedded bacteria.Results:Optical microscopy images demonstrated that FGMB have spherical structure with average size of approximately 17μm.FGMB showed a 65.4%decrease in methicillin-resistant Staphylococcus aureus biofilm biomass and 1.1 log bacterial inactivation efficiency(91.2%),suggesting effective biofilm elimination.In vitro experimental results also indicate that FGMB have good biocompatibility.Conclusion:This antibiofilm strategy integrated dual modes of physical biofilm disruption with chemical bacteria-killing shows great potential as a versatile,non-resistant strategy for bacterial biofilm elimination.展开更多
BACKGROUND The treatment technology of liver cancer is progressing.In addition to traditional surgical resection,combined therapies of immunotherapy based on immune checkpoint inhibitors,chemotherapy,and transcatheter...BACKGROUND The treatment technology of liver cancer is progressing.In addition to traditional surgical resection,combined therapies of immunotherapy based on immune checkpoint inhibitors,chemotherapy,and transcatheter arterial chemoembolization for hepatocellular carcinoma are more and more widely used.Accurate preoperative diagnosis of liver cancer will provide important information for comprehensive treatment and prognosis evaluation of liver cancer.Sonazoidcontrast-enhanced ultrasound is not only helpful for the qualitative diagnosis of liver lesions,but also has great potential in the diagnosis of histological differentiation of liver cancer.AIM To assess the differentiation of hepatocellular carcinoma(HCC)by utilizing the parameters and imaging features of Sonazoid-contrast-enhanced ultrasound(CEUS).METHODS A retrospective analysis was conducted on the CEUS data of 239 lesions through case-control study.These patients received Sonazoid-CEUS within one week before surgery and were confirmed as HCC by postoperative pathology.Within the cases,patients were further categorized into well-differentiated and poorlydifferentiated group.Time-intensity curves of the region of interest in both arterial and Kupffer phases were generated,allowing for the acquisition of quantitative parameters to assess the diagnostic efficacy in distinguishing lesions between these two groups and determining an appropriate cut-off value.RESULTS Univariate analysis showed that the absolute value of enhancement intensity(EIAV),intensity ratio(IR)and intensity difference(ID)in Kupffer phase were statistically different between the groups with different degree(P=0.015,P=0.000,P=0.000).The sensitivity and specificity were 40.2%,82.4%,80.4% and 78.1%,86.9% and 74.5%,respectively,for differentiating HCC lesions with EIAV≥56.384 dB,IR≥1.215 and ID≥9.184 dB.The area under the receiver operating characteristic curve were 0.590,0.877,0.815.There was no significant difference in the parameters of arterial phase,including peak time,initial growth time,rise time and the absolute value of peak intensity of lesions between the two groups(P>0.05).Multivariate analysis showed that the level of alphafetoprotein(AFP)and IR were risk factors for poor differentiation(P=0.001).CONCLUSION Among the parameters of Sonazoid-CEUS,IR in Kupffer phase exhibits superior diagnostic efficacy with high sensitivity and specificity in the diagnose of pathological differentiation of HCC.Combined with preoperative AFP level,a more accurate diagnosis will be obtained.Compared with portal vein phase,Kupffer phase showed the ability to identify HCC lesions more sensitive.These findings hold significant guiding implications and reference value for clinical practice.展开更多
Wearable ultrasound devices represent a transformative advancement in therapeutic applications,offering noninvasive,continuous,and targeted treatment for deep tissues.These systems leverage flexible materials(e.g.,pie...Wearable ultrasound devices represent a transformative advancement in therapeutic applications,offering noninvasive,continuous,and targeted treatment for deep tissues.These systems leverage flexible materials(e.g.,piezoelectric composites,biodegradable polymers)and conformable designs to enable stable integration with dynamic anatomical surfaces.Key innovations include ultrasound-enhanced drug delivery through cavitation-mediated transdermal penetration,accelerated tissue regeneration via mechanical and electrical stimulation,and precise neuromodulation using focused acoustic waves.Recent developments demonstrate wireless operation,real-time monitoring,and closed-loop therapy,facilitated by energy-efficient transducers and AI-driven adaptive control.Despite progress,challenges persist in material durability,clinical validation,and scalable manufacturing.Future directions highlight the integration of nanomaterials,3D-printed architectures,and multimodal sensing for personalized medicine.This technology holds significant potential to redefine chronic disease management,postoperative recovery,and neurorehabilitation,bridging the gap between clinical and home-based care.展开更多
In complex geological environments,the analysis of drill cores to determine rock strength can be challenging due to the wide variability in the degree of fracturing,leading to subjectivity in the collection of represe...In complex geological environments,the analysis of drill cores to determine rock strength can be challenging due to the wide variability in the degree of fracturing,leading to subjectivity in the collection of representative samples for uniaxial compressive strength testing.This study evaluates non-destructive techniques on calcareous rocks with different tectonic deformations,including Equotip hardness,ultrasound P-wave velocity,thin section analysis,and calcimetry,integrated with photogrammetric fracture analysis.The investigated carbonate rock samples are sourced from drill cores derived from the Umbria-Marche fold and thrust belt(northern Apennines,Italy),including a gently dipping limb of an anticline,a hinge zone of an anticline,and a fault zone associated with a thrust.Fracture intensity,quantified by the P21 parameter using photogrammetric techniques on pre-loading rock samples,is assessed alongside macroscopic identification of discontinuities(such as stylolites,veins,and joints)using marker colours to monitor failures during uniaxial compression testing.Empirical correlations depicted by single and multi-linear relationships indicate a strong dependence between the mechanical and physical properties of limestones.Both Equotip and P-wave velocity are influenced by fracture intensity,but P-wave velocity varies significantly with discontinuity orientation,especially at 45°-90°.To refine uniaxial compressive strength predictions and mitigate multicollinearity,statistical approaches,including linear and multilinear regression,Principal Component Analysis and Gaussian Process Regression,were tested.Findings improve the reliability of non-destructive techniques for assessing rock strength in structurally complex settings,with implications for geotechnical applications.展开更多
AIM:To investigate age-related differences in the irislens angle(ILA)among patients with age-related cortical cataracts and elucidate the impact of age on lens stability.METHODS:A prospective observational study was c...AIM:To investigate age-related differences in the irislens angle(ILA)among patients with age-related cortical cataracts and elucidate the impact of age on lens stability.METHODS:A prospective observational study was conducted on patients with age-related cortical cataracts scheduled for phacoemulsification surgery.Preoperative ultrasound biomicroscopy(UBM)images were collected and analyzed.Initially,patients were stratified into two age groups:<60y and≥60y,with no significant intergroup differences in sex or eye laterality.For further analysis,participants were subdivided into three age strata:<60y,60-75y,and>75y.The ILA was measured in four quadrants(superior,inferior,nasal,and temporal).Intergroup differences in ILA were compared,and correlations between age and ILA parameters were analyzed using statistical methods.RESULTS:The sample data were categorized into three groups according to age,<60y(113 patients;55.8%female),60–75y(245 patients;61.0%female),and>75y(70 patients;50.2%female).The superior quadrant ILA increased progressively with age stratification(P=0.02),and the maximum ILA difference(ΔILA)was significantly higher in patients over 75y(P<0.01).Simple linear regression analysis demonstrated a positive correlation between age and ILA in the superior(Y=7.487+0.096X,R=0.191,P<0.001)and temporal(Y=10.254+0.052X,R=0.104,P=0.032)quadrants.Additionally,the mean ILA across all quadrants(ILAmean)andΔILA were positively correlated with age(ILAmean:Y=9.721+0.055X,R=0.138,P=0.004;ΔILA:Y=3.267+0.044X,R=0.006,P<0.05).CONCLUSION:In patients with age-related cortical cataracts,ILA increases with age,particularly in the superior and temporal quadrants,suggesting that advanced age is associated with greater lens deviation and decreased lens stability.UBM imaging can effectively evaluate the status of the zonule and lens stability,providing crucial evidence for personalized surgical planning based on patients’age.展开更多
The occurrence of difficult arteriovenous fistulas makes the use of vascular access in hemodialysis patients face great challenges.With the widespread application of point-of-care ultrasound,POCUS technology,it provid...The occurrence of difficult arteriovenous fistulas makes the use of vascular access in hemodialysis patients face great challenges.With the widespread application of point-of-care ultrasound,POCUS technology,it provides a new solution for clinical practice.This article reviews the principle,basic process,application status,current clinical challenges and development direction of difficult arteriovenous fistulas cannulation guided by POCUS technology,in order to provide reference for the standardized clinical application and future research direction of this technology.展开更多
Artificial intelligence(AI)is revolutionizing medical imaging,particularly in chronic liver diseases assessment.AI technologies,including machine learning and deep learning,are increasingly integrated with multiparame...Artificial intelligence(AI)is revolutionizing medical imaging,particularly in chronic liver diseases assessment.AI technologies,including machine learning and deep learning,are increasingly integrated with multiparametric ultrasound(US)techniques to provide more accurate,objective,and non-invasive evaluations of liver fibrosis and steatosis.Analyzing large datasets from US images,AI enhances diagnostic precision,enabling better quantification of liver stiffness and fat content,which are essential for diagnosing and staging liver fibrosis and steatosis.Combining advanced US modalities,such as elastography and doppler imaging with AI,has demonstrated improved sensitivity in identifying different stages of liver disease and distinguishing various degrees of steatotic liver.These advancements also contribute to greater reproducibility and reduced operator dependency,addressing some of the limitations of traditional methods.The clinical implications of AI in liver disease are vast,ranging from early detection to predicting disease progression and evaluating treatment response.Despite these promising developments,challenges such as the need for large-scale datasets,algorithm transparency,and clinical validation remain.The aim of this review is to explore the current applications and future potential of AI in liver fibrosis and steatosis assessment using multiparametric US,highlighting the technological advances and clinical relevance of this emerging field.展开更多
Although previous studies have demonstrated that transcranial focused ultrasound stimulation protects the ischemic brain,clear criteria for the stimulation time window and intensity are lacking.Electrical impedance to...Although previous studies have demonstrated that transcranial focused ultrasound stimulation protects the ischemic brain,clear criteria for the stimulation time window and intensity are lacking.Electrical impedance tomography enables real-time monitoring of changes in cerebral blood perfusion within the ischemic brain,but investigating the feasibility of using this method to assess post-stroke rehabilitation in vivo remains critical.In this study,ischemic stroke was induced in rats through middle cerebral artery occlusion surgery.Transcranial focused ultrasound stimulation was used to treat the rat model of ischemia,and electrical impedance tomography was used to measure impedance during both the acute stage of ischemia and the rehabilitation stage following the stimulation.Electrical impedance tomography results indicated that cerebral impedance increased after the onset of ischemia and decreased following transcranial focused ultrasound stimulation.Furthermore,the stimulation promoted motor function recovery,reduced cerebral infarction volume in the rat model of ischemic stroke,and induced the expression of brain-derived neurotrophic factor in the ischemic brain.Our results also revealed a significant correlation between the impedance of the ischemic brain post-intervention and improvements in behavioral scores and infarct volume.This study shows that daily administration of transcranial focused ultrasound stimulation for 20 minutes to the ischemic hemisphere 24 hours after cerebral ischemia enhanced motor recovery in a rat model of ischemia.Additionally,our findings indicate that electrical impedance tomography can serve as a valuable tool for quantitatively evaluating rehabilitation after ischemic stroke in vivo.These findings suggest the feasibility of using impedance data collected via electrical impedance tomography to clinically assess the effects of rehabilitatory interventions for patients with ischemic stroke.展开更多
Pancreatic adenocarcinoma is the fourth leading cause of cancer-related death in the United States. Due to the aggressive tumor biology and late manifestations of the disease, long-term survival is extremely uncommon ...Pancreatic adenocarcinoma is the fourth leading cause of cancer-related death in the United States. Due to the aggressive tumor biology and late manifestations of the disease, long-term survival is extremely uncommon and the current 5-year survival rate is 7%. Over the last two decades, endoscopic ultrasound(EUS) has evolved from a diagnostic modality to a minimally invasive therapeutic alternative to radiologic procedures and surgery for pancreatic diseases. EUSguided celiac plexus intervention is a useful adjunct to conventional analgesia for patients with pancreatic cancer. EUS-guided biliary drainage has emerged as a viable option in patients who have failed endoscopic retrograde cholangiopancreatography. Recently, the use of lumen-apposing metal stent to create gastrojejunal anastomosis under EUS and fluoroscopic guidance in patients with malignant gastric outlet obstruction has been reported. On the other hand, anti-tumor therapies delivered by EUS, such as the injection of anti-tumor agents, brachytherapy and ablations are still in the experimental stage without clear survival benefit. In this article, we provide updates on well-established EUS-guided interventions as well as novel techniques relevant to pancreatic cancer.展开更多
BACKGROUND Endometrial cancer(EC)is the most common gynecological malignancy in high-income countries,with incidence rates rising globally.Early and accurate diag-nosis is essential for improving outcomes.Transvaginal...BACKGROUND Endometrial cancer(EC)is the most common gynecological malignancy in high-income countries,with incidence rates rising globally.Early and accurate diag-nosis is essential for improving outcomes.Transvaginal ultrasound(TVUS)remains a cost-effective first-line tool,and emerging techniques such as three-dimensional(3D)ultrasound(US),contrast-enhanced US(CEUS),elastography,and artificial intelligence(AI)-enhanced imaging may further improve diagnostic performance.AIM To systematically review recent advances in US-based imaging techniques for the diagnosis and staging of EC,and to compare their performance with magnetic resonance imaging(MRI).METHODS A systematic search of PubMed,Scopus,Web of Science,and Google Scholar was performed to identify studies published between January 2010 and March 2025.Eligible studies evaluated TVUS,3D-US,CEUS,elastography,or AI-enhanced US in EC diagnosis and staging.Methodological quality was assessed using the QUADAS-2 tool.Sensitivity,specificity,and area under the curve(AUC)were extracted where available,with narrative synthesis due to heterogeneity.RESULTS Forty-one studies met the inclusion criteria.TVUS demonstrated high sensitivity(76%–96%)but moderate specificity(61%–86%),while MRI achieved higher spe-cificity(84%–95%)and superior staging accuracy.3D-US yielded accuracy com-parable to MRI in selected early-stage cases.CEUS and elastography enhanced tissue characterization,and AI-enhanced US achieved pooled AUCs up to 0.91 for risk prediction and lesion segmentation.Variability in per-formance was noted across modalities due to patient demographics,equipment differences,and operator experi-ence.CONCLUSION TVUS remains a highly sensitive initial screening tool,with MRI preferred for definitive staging.3D-US,CEUS,elastography,and AI-enhanced techniques show promise as complementary or alternative approaches,particularly in low-resource settings.Standardization,multicenter validation,and integration of multi-modal imaging are needed to optimize diagnostic pathways for EC.展开更多
Cardiorenal syndrome reflects a complex interplay between cardiac and renal dysfunction,often compounded by fragmented management between cardiology and nephrology.Traditional phrases such as“the heart likes it dry a...Cardiorenal syndrome reflects a complex interplay between cardiac and renal dysfunction,often compounded by fragmented management between cardiology and nephrology.Traditional phrases such as“the heart likes it dry and the kidneys like it wet”oversimplify care and perpetuate misconceptions about diuretic use and fluid management.Emerging evidence points to venous congestion rather than reduced cardiac output as a key driver of worsening renal function and adverse outcomes in heart failure.This article blends current evidence with the authors’perspective and clinical experience to explore the role of point-of-care ultrasound(POCUS)in the hemodynamic assessment of cardiorenal dysfunction,highlighting practical frameworks and tools.Conventional bedside assessment tools are limited,and static markers such as serum creatinine and physical signs can be misleading.POCUS provides a dynamic,physiology-based evaluation by integrating focused cardiac imaging,venous Doppler,lung ultrasound,and abdominal views.Frameworks such as“pump,pipes,and leaks”and scoring systems like venous excess ultrasound enable realtime visualization and quantification of congestion,shifting practice from assumption-based to data-driven care and fostering alignment between specialties.As training opportunities expand and supporting evidence grows,POCUS should be regarded as a core clinical skill in the management of cardiorenal dysfunction,with the potential to improve diagnostic precision and guide targeted therapy.展开更多
Advancements in healthcare technology have improved mortality rates and extended lifespans,resulting in a population with multiple comorbidities that complicate patient care.Traditional assessments often fall short,un...Advancements in healthcare technology have improved mortality rates and extended lifespans,resulting in a population with multiple comorbidities that complicate patient care.Traditional assessments often fall short,underscoring the need for integrated care strategies.Among these,fluid management is particularly challenging due to the difficulty in directly assessing volume status especially in critically ill patients who frequently have peripheral oedema.Effective fluid ma-nagement is essential for optimal tissue oxygen delivery,which is crucial for cellular metabolism.Oxygen transport is dependent on arterial oxygen levels,haemoglobin concentration,and cardiac output,with the latter influenced by preload,afterload,and cardiac contractility.A delicate balance of these factors ensures that the cardiovascular system can respond adequately to varying ph-ysiological demands,thereby safeguarding tissue oxygenation and overall organ function during states of stress or illness.The Venous Excess Ultrasound(VExUS)Grading System is instrumental in evaluating fluid intolerance,providing detailed insights into venous congestion and fluid status.It was originally developed to assess the risk of acute kidney injury in postoperative cardiac patients,but its versatility has enabled broader applications in nephrology and critical care settings.This mini review explores VE×US’s application and its impact on fluid management and patient outcomes in critically ill patients.展开更多
The five-year survival rate of gastric cancer in China is close to those in European and North Americancountries but far lower than those in the Republic of Korea and Japan where national gastric cancerscreening syste...The five-year survival rate of gastric cancer in China is close to those in European and North Americancountries but far lower than those in the Republic of Korea and Japan where national gastric cancerscreening systems have been established.It is of great significance to build a high-quality gastric cancerscreening system adaptive to China's national conditions.Due to the large number of people at risk ofgastric cancer and the uneven distribution of medical resources,it is still difficult for China to carry out anationwide gastroscopy screening program for gastric cancer.Gastric oral contrast ultrasonography(OCUS)is a promising,non-invasive tool for initial gastric cancer screening,offering a painless,radiationfreealternative.Based on two 2020 OCUS consensuses,this document analyzes national gastric cancerscreening strategies and challenges to elaborate on the necessity,feasibility,and current problems ofpreliminary ultrasound screening in China.It details the key aspects of OCUS,including indications,contraindications,operator requirements,contrast agent standards,and essential scanning protocols.Italso introduces the standardized ultrasound sections and the Stomach Ultrasound Report and Data System(Su-RADS)and proposes the relevant consensus opinions.After several rounds of discussions and voting byexperts from multiple societies,a total of 17 consensus opinions have been formed on OCUS as a preliminary screening technique for gastric cancer,with the aim of standardizing the popularization ofOCUS.In addition,the consensus calls for conducting nationwide multicenter prospective studies toimprove the level of evidence and provide big data support for the construction of a preliminary gastriccancer ultrasound screening system that is in line with China's national conditions.展开更多
BACKGROUND Endoscopic ultrasound(EUS)is crucial for diagnosing solid pancreatic lesions,especially pancreatic ductal adenocarcinoma(PDAC),a highly aggressive cancer which represents the majority with a prevalence of a...BACKGROUND Endoscopic ultrasound(EUS)is crucial for diagnosing solid pancreatic lesions,especially pancreatic ductal adenocarcinoma(PDAC),a highly aggressive cancer which represents the majority with a prevalence of approximately 85%.AIM To identify EUS features that differentiate PDAC from other lesions such as neuroendocrine tumors(NETs)and helping in the differential diagnosis,by analyzing a large sample of solid pancreatic lesions.METHODS This observational,retrospective,multicenter study analyzed the endosonographic characteristics of 761 patients with a radiological diagnosis of solid pancreatic lesion,who underwent pancreatic EUS for typing and staging with needle biopsies between 2015 and 2023.General patient characteristics(age and sex)and solid lesion features were collected and described,such lesion size(Bmode),vessel involvement(compression or invasion),ductal dilation,lymphadenopathy,echogenicity,echopattern,margin regularity,multifocality,internal vascularization and elastography.Subsequently,a predictive analysis was performed through univariate and multivariate logistic regression to identify predictive features for PDAC or NET diagnoses.RESULTS Our study enrolled 761 patients,predominantly male with a mean age of 68.6.PDACs were generally larger(mean 33 mm×27 mm),often had irregular margins,and displayed significant upstream ductal dilation.Hypoechogenicity was common across malignant lesions.In contrast,NETs were smaller(mean 20 mm×17 mm)and typically had regular margins with multiple lesions.Vascular involvement,although predominant in PDAC,is a common feature of all malignant neoplasms.Multifocality,however,although a rare finding,is more typical of NETs and metastases,and practically absent in the remaining lesions.Predictive analyses showed that ductal dilation and irregular margins were the most significant predictors for PDAC[odds ratio(OR)=5.75 and 3.83],with hypoechogenicity,heterogeneous echopattern and lymphadenopathies also highly significant(OR=3.51,2.56 and 1.99).These features were inversely associated with NETs,with regular margins and absence of ductal involvement or lymphadenopathies(OR=0.24,0.86 and 0.45 respectively),as already shown by the descriptive analysis.Finally,age,despite achieving statistical significance,lacks clinical value given an OR trending towards 1.CONCLUSION This study provides a comprehensive overview of EUS features for solid pancreatic lesions,identifying distinct features like upstream ductal dilation and irregular margins for PDAC vs regular margins for NETs as strong diagnostic predictors.These findings enhance the understanding of pancreatic pathologies,offering valuable insights for improved differential diagnosis and clinical management,especially in complex cases.Further prospective studies could build on these results.展开更多
Artificial intelligence (AI)-based radiomics has attracted considerable research attention in the field of medical imaging, including ultrasound diagnosis. Ultrasound imaging has unique advantages such as high tempora...Artificial intelligence (AI)-based radiomics has attracted considerable research attention in the field of medical imaging, including ultrasound diagnosis. Ultrasound imaging has unique advantages such as high temporal resolution, low cost, and no radiation exposure. This renders it a preferred imaging modality for several clinical scenarios. This review includes a detailed introduction to imaging modalities, including Brightness-mode ultrasound, color Doppler flow imaging, ultrasound elastography, contrast-enhanced ultrasound, and multi-modal fusion analysis. It provides an overview of the current status and prospects of AI-based radiomics in ultrasound diagnosis, highlighting the application of AI-based radiomics to static ultrasound images, dynamic ultrasound videos, and multi-modal ultrasound fusion analysis.展开更多
Conventional echocardiography can sometimes pose a challenge to diagnosis due to sub-optimal images.Ultrasound contrast agents(UCAs)have been shown to drastically enhance imaging quality,particularly depicting the lef...Conventional echocardiography can sometimes pose a challenge to diagnosis due to sub-optimal images.Ultrasound contrast agents(UCAs)have been shown to drastically enhance imaging quality,particularly depicting the left ventricular endocardial borders.Their use during echocardiography has become a valuable tool in non-invasive diagnostics.UCAs provide higher-quality images that may ultimately reduce the length of hospital stays and improve patient care.The higher cost associated with UCAs in many situations has been an impediment to frequent use.However,when used as an initial diagnostic test,UCA during rest echocardiogram is more cost-effective than the traditional diagnostic approach,which frequently includes multiple tests and imaging studies to make an accurate diagnosis.They can be easily performed across multiple patient settings and provide optimal images that allow clinicians to make sound medical decisions.This consequently allows for better diagnostic accuracies and improvement in patient care.展开更多
Point-of-care ultrasound(POCUS) is recognized as a valuable diagnostic tool,especially in resourcelimited settings(RLS).POCUS provides rapid diagnostic information that enables health professionals to make critical de...Point-of-care ultrasound(POCUS) is recognized as a valuable diagnostic tool,especially in resourcelimited settings(RLS).POCUS provides rapid diagnostic information that enables health professionals to make critical decisions at the bedside.^([1]) Despite the welldocumented benefits of POCUS,access to longitudinal,comprehensive training programs and a lack of trainee feedback are barriers to the widespread use of this technology in such settings.^([2])展开更多
基金financially supported by the National Natural Science Foundation of China(Nos.52533015,52495013,52403211,52573183,52273157,52073279 and 52025035)Jilin Province,China(Nos.20250601009RC and 20230508102RC)Youth Innovation Promotion Association of the Chinese Academy of Sciences(No.2022224)。
文摘Given that platinum-based drugs are widely used clinically as chemotherapeutic agents,their severe toxic side effects have attracted significant attention.Consequently,the development of novel nanoprodrugs based on low-toxicity tetravalent platinum(Pt(Ⅳ))com plexes holds substantial research value.Herein,we discovered that coumarin derivatives exhibit inherent antitumor efficacy and significantly enhance superoxide anion radicals(·O_(2)^(-))generation in aqueous solutions under ultrasound(US)irradiation.Given that·O_(2)^(-)is known to mediate the reduction of Pt(Ⅳ)to divalent platinum(Pt(Ⅱ)),we engineered an US-responsive dual-drug nanoprodrug(P-cisPt(Ⅳ)@5-MOP).This nanoprodrug was prepared by covalently conjugating Pt(Ⅳ)and methoxy polyethylene glycol hydroxyl(m PEG-OH)to a poly(_(L)-glutamic acid)(PLG)carrier,followed by encapsulating coumarin derivatives.Under low-intensity US irradiation(1.5 W/cm^(2),1 MHz,10 min),P-cisPt(Ⅳ)@5-MOP achieved a Pt(Ⅳ)reduction rate of 91.4%.Furthermore,upon US exposure,its half-maximal inhibitory concentration(IC_(50))against 4T1 breast cancer cells decreased dramatically from 25.7μmol/L to 0.1μmol/L.Remarkably,this system combined with US therapy yielded a tumor inhibition rate of 90.9%,with 40%of tumor-bea ring mice achieving com plete eradication of tumors,while exhibiting low systemic toxicity.Collectively,this work not only identifies a novel sonosensitizer capable of generating·O_(2)^(-)but also develops a new class of ultrasound-activatable Pt(Ⅳ)nanoprodrug.
基金supported by STI2030-Major Project,No,2021ZD0204200(to LX).
文摘Neurodegenerative diseases,which are characterized by progressive neuronal loss and the lack of disease-modifying therapies,are becoming a major global health challenge.The existing neuromodulation techniques,such as deep brain stimulation and transcranial magnetic stimulation,show limitations such as invasiveness,restricted cortical targeting,and irreversible tissue effects.In this context,low-intensity transcranial ultrasound has emerged as a promising noninvasive alternative that can penetrate deep into the brain and modulate neuroplasticity.This review comprehensively assesses the therapeutic mechanisms,efficacy,and translational potential of low-intensity transcranial ultrasound in treating neurodegenerative diseases,with emphasis on its role in promoting neuronal regeneration,modulating neuroinflammation,and enhancing functional recovery.We summarize the findings of previous studies and systematically illustrate the potential of low-intensity transcranial ultrasound in regulating cell death mechanisms,enhancing neural repair and regeneration,and alleviating symptoms associated with neurodegenerative diseases.Preclinical findings indicate that low-intensity transcranial ultrasound can enhance the release of neurotrophic factors(e.g.,brain-derived neurotrophic factor),promote autophagy to clear protein aggregates,modulate microglial activation,and temporarily open the blood-brain barrier to facilitate targeted drug delivery.Existing clinical trial data show that low-intensity transcranial ultrasound can reduce amyloid-βplaques,improve motor and cognitive deficits,and promote remyelination in various disease models.Early clinical trials suggest that low-intensity transcranial ultrasound may enhance cognitive scores in Alzheimer’s disease and alleviate motor symptoms in Parkinson’s disease,all while demonstrating a favorable safety profile.Past studies support the notion that by integrating safety,precision,and reversibility,low-intensity transcranial ultrasound can transform the treatment landscape for neurodegenerative disease.However,more advancements are necessary for future clinical application of low-intensity transcranial ultrasound,including optimizing parameters such as frequency,intensity,and duty cycle;considering individual anatomical differences;and confirming long-term efficacy.We believe establishing standardized protocols,conducting larger trials,and investigating the underlying mechanisms to clarify dose-response relationships and refine personalized application strategies are essential in this regard.Future research should focus on translating preclinical findings into clinical practice,addressing technical challenges,and exploring combination therapies with pharmacological or gene interventions.
基金supported by the National Natural Science Foundation of China,Nos.82371886(to JY),81925020(to DM),82202797(to LW),and 82271218(to CZ).
文摘Alzheimer’s disease is a common neurodegenerative disorder defined by decreased reasoning abilities,memory loss,and cognitive deterioration.The presence of the blood-brain barrier presents a major obstacle to the development of effective drug therapies for Alzheimer’s disease.The use of ultrasound as a novel physical modulation approach has garnered widespread attention in recent years.As a safe and feasible therapeutic and drug-delivery method,ultrasound has shown promise in improving cognitive deficits.This article provides a summary of the application of ultrasound technology for treating Alzheimer’s disease over the past 5 years,including standalone ultrasound treatment,ultrasound combined with microbubbles or drug therapy,and magnetic resonance imaging-guided focused ultrasound therapy.Emphasis is placed on the benefits of introducing these treatment methods and their potential mechanisms.We found that several ultrasound methods can open the blood-brain barrier and effectively alleviate amyloid-βplaque deposition.We believe that ultrasound is an effective therapy for Alzheimer’s disease,and this review provides a theoretical basis for future ultrasound treatment methods.
基金supported by the National Natural Science Foundation of China(22375101)the Natural Science of Colleges and Universities in Jiangsu Province(24KJB430027).
文摘Background:The bacterial biofilm poses a significant challenge to traditional antibiotic therapy.There is a great need to develop novel antibiofilm agents combined with biofilm disrupting and bacteria-killing without the dependence of antibiotic.Methods:Herein,we prepared ultrasound/magnetic field-responsive ferroferric oxide nanoparticles(Fe_(3)O_(4))/glucose oxidase microbubbles(FGMB)to form a cascade catalytic system for effective removing methicillin-resistant Staphylococcus aureus biofilms.FGMB were prepared through interfacial self-assembly of Fe_(3)O_(4) nanoparticles(NPs)and glucose oxidase(GOx)at the gas-liquid interface stabilized by surfactants.Under ultrasound/magnetic field stimulation,FGMB disrupted biofilm architecture through microbubble collapse-induced microjets and magnetically driven displacement.Simultaneously,ultrasound-triggered rupture of FGMB released GOx and Fe_(3)O_(4) NPs.Glucose can be oxidized by GOx to generate gluconic acid and hydrogen peroxide which was subsequently catalyzed into hydroxyl radicals by Fe_(3)O_(4) NPs,enabling chemical eradication of biofilm-embedded bacteria.Results:Optical microscopy images demonstrated that FGMB have spherical structure with average size of approximately 17μm.FGMB showed a 65.4%decrease in methicillin-resistant Staphylococcus aureus biofilm biomass and 1.1 log bacterial inactivation efficiency(91.2%),suggesting effective biofilm elimination.In vitro experimental results also indicate that FGMB have good biocompatibility.Conclusion:This antibiofilm strategy integrated dual modes of physical biofilm disruption with chemical bacteria-killing shows great potential as a versatile,non-resistant strategy for bacterial biofilm elimination.
文摘BACKGROUND The treatment technology of liver cancer is progressing.In addition to traditional surgical resection,combined therapies of immunotherapy based on immune checkpoint inhibitors,chemotherapy,and transcatheter arterial chemoembolization for hepatocellular carcinoma are more and more widely used.Accurate preoperative diagnosis of liver cancer will provide important information for comprehensive treatment and prognosis evaluation of liver cancer.Sonazoidcontrast-enhanced ultrasound is not only helpful for the qualitative diagnosis of liver lesions,but also has great potential in the diagnosis of histological differentiation of liver cancer.AIM To assess the differentiation of hepatocellular carcinoma(HCC)by utilizing the parameters and imaging features of Sonazoid-contrast-enhanced ultrasound(CEUS).METHODS A retrospective analysis was conducted on the CEUS data of 239 lesions through case-control study.These patients received Sonazoid-CEUS within one week before surgery and were confirmed as HCC by postoperative pathology.Within the cases,patients were further categorized into well-differentiated and poorlydifferentiated group.Time-intensity curves of the region of interest in both arterial and Kupffer phases were generated,allowing for the acquisition of quantitative parameters to assess the diagnostic efficacy in distinguishing lesions between these two groups and determining an appropriate cut-off value.RESULTS Univariate analysis showed that the absolute value of enhancement intensity(EIAV),intensity ratio(IR)and intensity difference(ID)in Kupffer phase were statistically different between the groups with different degree(P=0.015,P=0.000,P=0.000).The sensitivity and specificity were 40.2%,82.4%,80.4% and 78.1%,86.9% and 74.5%,respectively,for differentiating HCC lesions with EIAV≥56.384 dB,IR≥1.215 and ID≥9.184 dB.The area under the receiver operating characteristic curve were 0.590,0.877,0.815.There was no significant difference in the parameters of arterial phase,including peak time,initial growth time,rise time and the absolute value of peak intensity of lesions between the two groups(P>0.05).Multivariate analysis showed that the level of alphafetoprotein(AFP)and IR were risk factors for poor differentiation(P=0.001).CONCLUSION Among the parameters of Sonazoid-CEUS,IR in Kupffer phase exhibits superior diagnostic efficacy with high sensitivity and specificity in the diagnose of pathological differentiation of HCC.Combined with preoperative AFP level,a more accurate diagnosis will be obtained.Compared with portal vein phase,Kupffer phase showed the ability to identify HCC lesions more sensitive.These findings hold significant guiding implications and reference value for clinical practice.
基金the support from the start-up of the University of Missouri-Columbia。
文摘Wearable ultrasound devices represent a transformative advancement in therapeutic applications,offering noninvasive,continuous,and targeted treatment for deep tissues.These systems leverage flexible materials(e.g.,piezoelectric composites,biodegradable polymers)and conformable designs to enable stable integration with dynamic anatomical surfaces.Key innovations include ultrasound-enhanced drug delivery through cavitation-mediated transdermal penetration,accelerated tissue regeneration via mechanical and electrical stimulation,and precise neuromodulation using focused acoustic waves.Recent developments demonstrate wireless operation,real-time monitoring,and closed-loop therapy,facilitated by energy-efficient transducers and AI-driven adaptive control.Despite progress,challenges persist in material durability,clinical validation,and scalable manufacturing.Future directions highlight the integration of nanomaterials,3D-printed architectures,and multimodal sensing for personalized medicine.This technology holds significant potential to redefine chronic disease management,postoperative recovery,and neurorehabilitation,bridging the gap between clinical and home-based care.
文摘In complex geological environments,the analysis of drill cores to determine rock strength can be challenging due to the wide variability in the degree of fracturing,leading to subjectivity in the collection of representative samples for uniaxial compressive strength testing.This study evaluates non-destructive techniques on calcareous rocks with different tectonic deformations,including Equotip hardness,ultrasound P-wave velocity,thin section analysis,and calcimetry,integrated with photogrammetric fracture analysis.The investigated carbonate rock samples are sourced from drill cores derived from the Umbria-Marche fold and thrust belt(northern Apennines,Italy),including a gently dipping limb of an anticline,a hinge zone of an anticline,and a fault zone associated with a thrust.Fracture intensity,quantified by the P21 parameter using photogrammetric techniques on pre-loading rock samples,is assessed alongside macroscopic identification of discontinuities(such as stylolites,veins,and joints)using marker colours to monitor failures during uniaxial compression testing.Empirical correlations depicted by single and multi-linear relationships indicate a strong dependence between the mechanical and physical properties of limestones.Both Equotip and P-wave velocity are influenced by fracture intensity,but P-wave velocity varies significantly with discontinuity orientation,especially at 45°-90°.To refine uniaxial compressive strength predictions and mitigate multicollinearity,statistical approaches,including linear and multilinear regression,Principal Component Analysis and Gaussian Process Regression,were tested.Findings improve the reliability of non-destructive techniques for assessing rock strength in structurally complex settings,with implications for geotechnical applications.
文摘AIM:To investigate age-related differences in the irislens angle(ILA)among patients with age-related cortical cataracts and elucidate the impact of age on lens stability.METHODS:A prospective observational study was conducted on patients with age-related cortical cataracts scheduled for phacoemulsification surgery.Preoperative ultrasound biomicroscopy(UBM)images were collected and analyzed.Initially,patients were stratified into two age groups:<60y and≥60y,with no significant intergroup differences in sex or eye laterality.For further analysis,participants were subdivided into three age strata:<60y,60-75y,and>75y.The ILA was measured in four quadrants(superior,inferior,nasal,and temporal).Intergroup differences in ILA were compared,and correlations between age and ILA parameters were analyzed using statistical methods.RESULTS:The sample data were categorized into three groups according to age,<60y(113 patients;55.8%female),60–75y(245 patients;61.0%female),and>75y(70 patients;50.2%female).The superior quadrant ILA increased progressively with age stratification(P=0.02),and the maximum ILA difference(ΔILA)was significantly higher in patients over 75y(P<0.01).Simple linear regression analysis demonstrated a positive correlation between age and ILA in the superior(Y=7.487+0.096X,R=0.191,P<0.001)and temporal(Y=10.254+0.052X,R=0.104,P=0.032)quadrants.Additionally,the mean ILA across all quadrants(ILAmean)andΔILA were positively correlated with age(ILAmean:Y=9.721+0.055X,R=0.138,P=0.004;ΔILA:Y=3.267+0.044X,R=0.006,P<0.05).CONCLUSION:In patients with age-related cortical cataracts,ILA increases with age,particularly in the superior and temporal quadrants,suggesting that advanced age is associated with greater lens deviation and decreased lens stability.UBM imaging can effectively evaluate the status of the zonule and lens stability,providing crucial evidence for personalized surgical planning based on patients’age.
文摘The occurrence of difficult arteriovenous fistulas makes the use of vascular access in hemodialysis patients face great challenges.With the widespread application of point-of-care ultrasound,POCUS technology,it provides a new solution for clinical practice.This article reviews the principle,basic process,application status,current clinical challenges and development direction of difficult arteriovenous fistulas cannulation guided by POCUS technology,in order to provide reference for the standardized clinical application and future research direction of this technology.
文摘Artificial intelligence(AI)is revolutionizing medical imaging,particularly in chronic liver diseases assessment.AI technologies,including machine learning and deep learning,are increasingly integrated with multiparametric ultrasound(US)techniques to provide more accurate,objective,and non-invasive evaluations of liver fibrosis and steatosis.Analyzing large datasets from US images,AI enhances diagnostic precision,enabling better quantification of liver stiffness and fat content,which are essential for diagnosing and staging liver fibrosis and steatosis.Combining advanced US modalities,such as elastography and doppler imaging with AI,has demonstrated improved sensitivity in identifying different stages of liver disease and distinguishing various degrees of steatotic liver.These advancements also contribute to greater reproducibility and reduced operator dependency,addressing some of the limitations of traditional methods.The clinical implications of AI in liver disease are vast,ranging from early detection to predicting disease progression and evaluating treatment response.Despite these promising developments,challenges such as the need for large-scale datasets,algorithm transparency,and clinical validation remain.The aim of this review is to explore the current applications and future potential of AI in liver fibrosis and steatosis assessment using multiparametric US,highlighting the technological advances and clinical relevance of this emerging field.
基金supported by the Fundamental Research Funds for the Central Universities,Nos.G2021KY05107,G2021KY05101the National Natural Science Foundation of China,Nos.32071316,32211530049+1 种基金the Natural Science Foundation of Shaanxi Province,No.2022-JM482the Education and Teaching Reform Funds for the Central Universities,No.23GZ230102(all to LL and HH).
文摘Although previous studies have demonstrated that transcranial focused ultrasound stimulation protects the ischemic brain,clear criteria for the stimulation time window and intensity are lacking.Electrical impedance tomography enables real-time monitoring of changes in cerebral blood perfusion within the ischemic brain,but investigating the feasibility of using this method to assess post-stroke rehabilitation in vivo remains critical.In this study,ischemic stroke was induced in rats through middle cerebral artery occlusion surgery.Transcranial focused ultrasound stimulation was used to treat the rat model of ischemia,and electrical impedance tomography was used to measure impedance during both the acute stage of ischemia and the rehabilitation stage following the stimulation.Electrical impedance tomography results indicated that cerebral impedance increased after the onset of ischemia and decreased following transcranial focused ultrasound stimulation.Furthermore,the stimulation promoted motor function recovery,reduced cerebral infarction volume in the rat model of ischemic stroke,and induced the expression of brain-derived neurotrophic factor in the ischemic brain.Our results also revealed a significant correlation between the impedance of the ischemic brain post-intervention and improvements in behavioral scores and infarct volume.This study shows that daily administration of transcranial focused ultrasound stimulation for 20 minutes to the ischemic hemisphere 24 hours after cerebral ischemia enhanced motor recovery in a rat model of ischemia.Additionally,our findings indicate that electrical impedance tomography can serve as a valuable tool for quantitatively evaluating rehabilitation after ischemic stroke in vivo.These findings suggest the feasibility of using impedance data collected via electrical impedance tomography to clinically assess the effects of rehabilitatory interventions for patients with ischemic stroke.
文摘Pancreatic adenocarcinoma is the fourth leading cause of cancer-related death in the United States. Due to the aggressive tumor biology and late manifestations of the disease, long-term survival is extremely uncommon and the current 5-year survival rate is 7%. Over the last two decades, endoscopic ultrasound(EUS) has evolved from a diagnostic modality to a minimally invasive therapeutic alternative to radiologic procedures and surgery for pancreatic diseases. EUSguided celiac plexus intervention is a useful adjunct to conventional analgesia for patients with pancreatic cancer. EUS-guided biliary drainage has emerged as a viable option in patients who have failed endoscopic retrograde cholangiopancreatography. Recently, the use of lumen-apposing metal stent to create gastrojejunal anastomosis under EUS and fluoroscopic guidance in patients with malignant gastric outlet obstruction has been reported. On the other hand, anti-tumor therapies delivered by EUS, such as the injection of anti-tumor agents, brachytherapy and ablations are still in the experimental stage without clear survival benefit. In this article, we provide updates on well-established EUS-guided interventions as well as novel techniques relevant to pancreatic cancer.
文摘BACKGROUND Endometrial cancer(EC)is the most common gynecological malignancy in high-income countries,with incidence rates rising globally.Early and accurate diag-nosis is essential for improving outcomes.Transvaginal ultrasound(TVUS)remains a cost-effective first-line tool,and emerging techniques such as three-dimensional(3D)ultrasound(US),contrast-enhanced US(CEUS),elastography,and artificial intelligence(AI)-enhanced imaging may further improve diagnostic performance.AIM To systematically review recent advances in US-based imaging techniques for the diagnosis and staging of EC,and to compare their performance with magnetic resonance imaging(MRI).METHODS A systematic search of PubMed,Scopus,Web of Science,and Google Scholar was performed to identify studies published between January 2010 and March 2025.Eligible studies evaluated TVUS,3D-US,CEUS,elastography,or AI-enhanced US in EC diagnosis and staging.Methodological quality was assessed using the QUADAS-2 tool.Sensitivity,specificity,and area under the curve(AUC)were extracted where available,with narrative synthesis due to heterogeneity.RESULTS Forty-one studies met the inclusion criteria.TVUS demonstrated high sensitivity(76%–96%)but moderate specificity(61%–86%),while MRI achieved higher spe-cificity(84%–95%)and superior staging accuracy.3D-US yielded accuracy com-parable to MRI in selected early-stage cases.CEUS and elastography enhanced tissue characterization,and AI-enhanced US achieved pooled AUCs up to 0.91 for risk prediction and lesion segmentation.Variability in per-formance was noted across modalities due to patient demographics,equipment differences,and operator experi-ence.CONCLUSION TVUS remains a highly sensitive initial screening tool,with MRI preferred for definitive staging.3D-US,CEUS,elastography,and AI-enhanced techniques show promise as complementary or alternative approaches,particularly in low-resource settings.Standardization,multicenter validation,and integration of multi-modal imaging are needed to optimize diagnostic pathways for EC.
文摘Cardiorenal syndrome reflects a complex interplay between cardiac and renal dysfunction,often compounded by fragmented management between cardiology and nephrology.Traditional phrases such as“the heart likes it dry and the kidneys like it wet”oversimplify care and perpetuate misconceptions about diuretic use and fluid management.Emerging evidence points to venous congestion rather than reduced cardiac output as a key driver of worsening renal function and adverse outcomes in heart failure.This article blends current evidence with the authors’perspective and clinical experience to explore the role of point-of-care ultrasound(POCUS)in the hemodynamic assessment of cardiorenal dysfunction,highlighting practical frameworks and tools.Conventional bedside assessment tools are limited,and static markers such as serum creatinine and physical signs can be misleading.POCUS provides a dynamic,physiology-based evaluation by integrating focused cardiac imaging,venous Doppler,lung ultrasound,and abdominal views.Frameworks such as“pump,pipes,and leaks”and scoring systems like venous excess ultrasound enable realtime visualization and quantification of congestion,shifting practice from assumption-based to data-driven care and fostering alignment between specialties.As training opportunities expand and supporting evidence grows,POCUS should be regarded as a core clinical skill in the management of cardiorenal dysfunction,with the potential to improve diagnostic precision and guide targeted therapy.
文摘Advancements in healthcare technology have improved mortality rates and extended lifespans,resulting in a population with multiple comorbidities that complicate patient care.Traditional assessments often fall short,underscoring the need for integrated care strategies.Among these,fluid management is particularly challenging due to the difficulty in directly assessing volume status especially in critically ill patients who frequently have peripheral oedema.Effective fluid ma-nagement is essential for optimal tissue oxygen delivery,which is crucial for cellular metabolism.Oxygen transport is dependent on arterial oxygen levels,haemoglobin concentration,and cardiac output,with the latter influenced by preload,afterload,and cardiac contractility.A delicate balance of these factors ensures that the cardiovascular system can respond adequately to varying ph-ysiological demands,thereby safeguarding tissue oxygenation and overall organ function during states of stress or illness.The Venous Excess Ultrasound(VExUS)Grading System is instrumental in evaluating fluid intolerance,providing detailed insights into venous congestion and fluid status.It was originally developed to assess the risk of acute kidney injury in postoperative cardiac patients,but its versatility has enabled broader applications in nephrology and critical care settings.This mini review explores VE×US’s application and its impact on fluid management and patient outcomes in critically ill patients.
基金supported by the CAMS Innovation Fund for Medical Sciences(2023-I2M-C&T-B-016)lthe National High Level Hospital Clinical Research Funding(2022-PUMCH-C-048)l the Noncommunicable Chronic Diseases-National Science and Technology Major Project(2024ZD0520600).
文摘The five-year survival rate of gastric cancer in China is close to those in European and North Americancountries but far lower than those in the Republic of Korea and Japan where national gastric cancerscreening systems have been established.It is of great significance to build a high-quality gastric cancerscreening system adaptive to China's national conditions.Due to the large number of people at risk ofgastric cancer and the uneven distribution of medical resources,it is still difficult for China to carry out anationwide gastroscopy screening program for gastric cancer.Gastric oral contrast ultrasonography(OCUS)is a promising,non-invasive tool for initial gastric cancer screening,offering a painless,radiationfreealternative.Based on two 2020 OCUS consensuses,this document analyzes national gastric cancerscreening strategies and challenges to elaborate on the necessity,feasibility,and current problems ofpreliminary ultrasound screening in China.It details the key aspects of OCUS,including indications,contraindications,operator requirements,contrast agent standards,and essential scanning protocols.Italso introduces the standardized ultrasound sections and the Stomach Ultrasound Report and Data System(Su-RADS)and proposes the relevant consensus opinions.After several rounds of discussions and voting byexperts from multiple societies,a total of 17 consensus opinions have been formed on OCUS as a preliminary screening technique for gastric cancer,with the aim of standardizing the popularization ofOCUS.In addition,the consensus calls for conducting nationwide multicenter prospective studies toimprove the level of evidence and provide big data support for the construction of a preliminary gastriccancer ultrasound screening system that is in line with China's national conditions.
基金Supported by the Italian Ministry of Health-Current research IRCCS(Funds Dedicated to the Research of the Gastroenterology and Digestive Endoscopy Unit,Fondazione IRCCS Ca’Granda,Ospedale Maggiore Policlinico,Milano).
文摘BACKGROUND Endoscopic ultrasound(EUS)is crucial for diagnosing solid pancreatic lesions,especially pancreatic ductal adenocarcinoma(PDAC),a highly aggressive cancer which represents the majority with a prevalence of approximately 85%.AIM To identify EUS features that differentiate PDAC from other lesions such as neuroendocrine tumors(NETs)and helping in the differential diagnosis,by analyzing a large sample of solid pancreatic lesions.METHODS This observational,retrospective,multicenter study analyzed the endosonographic characteristics of 761 patients with a radiological diagnosis of solid pancreatic lesion,who underwent pancreatic EUS for typing and staging with needle biopsies between 2015 and 2023.General patient characteristics(age and sex)and solid lesion features were collected and described,such lesion size(Bmode),vessel involvement(compression or invasion),ductal dilation,lymphadenopathy,echogenicity,echopattern,margin regularity,multifocality,internal vascularization and elastography.Subsequently,a predictive analysis was performed through univariate and multivariate logistic regression to identify predictive features for PDAC or NET diagnoses.RESULTS Our study enrolled 761 patients,predominantly male with a mean age of 68.6.PDACs were generally larger(mean 33 mm×27 mm),often had irregular margins,and displayed significant upstream ductal dilation.Hypoechogenicity was common across malignant lesions.In contrast,NETs were smaller(mean 20 mm×17 mm)and typically had regular margins with multiple lesions.Vascular involvement,although predominant in PDAC,is a common feature of all malignant neoplasms.Multifocality,however,although a rare finding,is more typical of NETs and metastases,and practically absent in the remaining lesions.Predictive analyses showed that ductal dilation and irregular margins were the most significant predictors for PDAC[odds ratio(OR)=5.75 and 3.83],with hypoechogenicity,heterogeneous echopattern and lymphadenopathies also highly significant(OR=3.51,2.56 and 1.99).These features were inversely associated with NETs,with regular margins and absence of ductal involvement or lymphadenopathies(OR=0.24,0.86 and 0.45 respectively),as already shown by the descriptive analysis.Finally,age,despite achieving statistical significance,lacks clinical value given an OR trending towards 1.CONCLUSION This study provides a comprehensive overview of EUS features for solid pancreatic lesions,identifying distinct features like upstream ductal dilation and irregular margins for PDAC vs regular margins for NETs as strong diagnostic predictors.These findings enhance the understanding of pancreatic pathologies,offering valuable insights for improved differential diagnosis and clinical management,especially in complex cases.Further prospective studies could build on these results.
基金the National Natural Science Foundation of China,Nos.92159305,92259303,62027901,81930053,and 82272029Beijing Science Fund for Distinguished Young Scholars,No.JQ22013and Excellent Member Project of the Youth Innovation Promotion Association CAS,No.2016124.
文摘Artificial intelligence (AI)-based radiomics has attracted considerable research attention in the field of medical imaging, including ultrasound diagnosis. Ultrasound imaging has unique advantages such as high temporal resolution, low cost, and no radiation exposure. This renders it a preferred imaging modality for several clinical scenarios. This review includes a detailed introduction to imaging modalities, including Brightness-mode ultrasound, color Doppler flow imaging, ultrasound elastography, contrast-enhanced ultrasound, and multi-modal fusion analysis. It provides an overview of the current status and prospects of AI-based radiomics in ultrasound diagnosis, highlighting the application of AI-based radiomics to static ultrasound images, dynamic ultrasound videos, and multi-modal ultrasound fusion analysis.
文摘Conventional echocardiography can sometimes pose a challenge to diagnosis due to sub-optimal images.Ultrasound contrast agents(UCAs)have been shown to drastically enhance imaging quality,particularly depicting the left ventricular endocardial borders.Their use during echocardiography has become a valuable tool in non-invasive diagnostics.UCAs provide higher-quality images that may ultimately reduce the length of hospital stays and improve patient care.The higher cost associated with UCAs in many situations has been an impediment to frequent use.However,when used as an initial diagnostic test,UCA during rest echocardiogram is more cost-effective than the traditional diagnostic approach,which frequently includes multiple tests and imaging studies to make an accurate diagnosis.They can be easily performed across multiple patient settings and provide optimal images that allow clinicians to make sound medical decisions.This consequently allows for better diagnostic accuracies and improvement in patient care.
文摘Point-of-care ultrasound(POCUS) is recognized as a valuable diagnostic tool,especially in resourcelimited settings(RLS).POCUS provides rapid diagnostic information that enables health professionals to make critical decisions at the bedside.^([1]) Despite the welldocumented benefits of POCUS,access to longitudinal,comprehensive training programs and a lack of trainee feedback are barriers to the widespread use of this technology in such settings.^([2])
