BACKGROUND:Point-of-care ultrasound(POCUS)has become increasingly integrated into the practice of emergency medicine.A common application is the extended focused assessment with sonography in trauma(eFAST)exam.The Ame...BACKGROUND:Point-of-care ultrasound(POCUS)has become increasingly integrated into the practice of emergency medicine.A common application is the extended focused assessment with sonography in trauma(eFAST)exam.The American College of Emergency Physicians has guidelines regarding the scope of ultrasound in the emergency department and the appropriate documentation.The objective of this study was to conduct a review of performed,documented and billed eFAST ultrasounds on trauma activation patients.METHODS:This was a retrospective review of all trauma activation patients during a 10-month period at an academic level-one trauma center.A list comparing all trauma activations was crossreferenced with a list of all billed eFAST scans.Medical records were reviewed to determine whether an eFAST was indicated,performed,and appropriately documented.RESULTS:We found that 1,507 of 1,597 trauma patients had indications for eFAST,but 396(27%)of these patients did not have a billed eFAST.Of these 396 patients,87(22%)had documentation in the provider note that an eFAST was performed but there was no separate procedure note.The remaining 309(78%)did not have any documentation of the eFAST in the patient’s chart although an eFAST was recorded and reviewed during ultrasound quality assurance.CONCLUSION:A significant proportion of trauma patients had eFAST exams performed but were not documented or billed.Lack of documentation was multifactorial.Emergency ultrasound programs require appropriate reimbursement to support training,credentialing,equipment,quality assurance,and device maintenance.Our study demonstrates a significant absence of adequate documentation leading to potential revenue loss for an emergency ultrasound program.展开更多
Blood-brain barrier disruption and the neuroinflammatory response are significant pathological features that critically influence disease progression and treatment outcomes.This review systematically analyzes the curr...Blood-brain barrier disruption and the neuroinflammatory response are significant pathological features that critically influence disease progression and treatment outcomes.This review systematically analyzes the current understanding of the bidirectional relationship between blood-brain barrier disruption and neuroinflammation in traumatic brain injury,along with emerging combination therapeutic strategies.Literature review indicates that blood-brain barrier disruption and neuroinflammatory responses are key pathological features following traumatic brain injury.In the acute phase after traumatic brain injury,the pathological characteristics include primary blood-brain barrier disruption and the activation of inflammatory cascades.In the subacute phase,the pathological features are characterized by repair mechanisms and inflammatory modulation.In the chronic phase,the pathological features show persistent low-grade inflammation and incomplete recovery of the blood-brain barrier.Various physiological changes,such as structural alterations of the blood-brain barrier,inflammatory cascades,and extracellular matrix remodeling,interact with each other and are influenced by genetic,age,sex,and environmental factors.The dynamic balance between blood-brain barrier permeability and neuroinflammation is regulated by hormones,particularly sex hormones and stress-related hormones.Additionally,the role of gastrointestinal hormones is receiving increasing attention.Current treatment strategies for traumatic brain injury include various methods such as conventional drug combinations,multimodality neuromonitoring,hyperbaric oxygen therapy,and non-invasive brain stimulation.Artificial intelligence also shows potential in treatment decision-making and personalized therapy.Emerging sequential combination strategies and precision medicine approaches can help improve treatment outcomes;however,challenges remain,such as inadequate research on the mechanisms of the chronic phase traumatic brain injury and difficulties with technology integration.Future research on traumatic brain injury should focus on personalized treatment strategies,the standardization of techniques,costeffectiveness evaluations,and addressing the needs of patients with comorbidities.A multidisciplinary approach should be used to enhance treatment and improve patient outcomes.展开更多
Rectal neuroendocrine tumors(NETs)are increasingly detected and are the most common gastrointestinal NET sites.Often discovered incidentally during endoscopy,most are small,well differentiated,and have an excellent pr...Rectal neuroendocrine tumors(NETs)are increasingly detected and are the most common gastrointestinal NET sites.Often discovered incidentally during endoscopy,most are small,well differentiated,and have an excellent prognosis.Local resection is typically considered curative.Several guidelines,namely the European Neuroendocrine Tumor Society guidelines 2023,National Comprehensive Cancer network 2025,and the Polish Network of Neuroendocrine Tumors(2017)emphasize the use of endoscopic and endoscopic ultrasound staging to select the appropriate therapy,ranging from resection to advanced techniques for larger or metastatic diseases,highlighting the need for an accurate initial assessment.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
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
Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy remains a challenging field in therapeutic endoscopy due to the complex anatomical reconstructions that limit access to t...Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy remains a challenging field in therapeutic endoscopy due to the complex anatomical reconstructions that limit access to the biliary tree.Over the past two decades,device-assisted enteroscopy(DAE),including singleballoon,double-balloon,and motorized spiral enteroscopy,has expanded the feasibility of ERCP in this population,with overall technical success rates generally reported between 70%and 90%.Nevertheless,these techniques are technically demanding,time-consuming,and frequently affected by limited reach and unstable positioning.More recently,interventional endoscopic ultrasound(EUS)-guided procedures have emerged as highly effective alternatives,significantly improving clinical outcomes in selected patients,particularly in those with long-limb Roux-en-Y reconstructions where conventional methods are less effective.Percutaneous transhepatic biliary drainage continues to represent a valuable salvage option when endoscopic approaches fail,though it is associated with a greater burden of reinterventions and adverse events.This minireview provides a comprehensive overview of the main endoscopic strategies for biliary drainage in altered anatomy,focusing on technical considerations,efficacy,and safety profiles of DAE-assisted ERCP,EUS-guided interventions,and motorized systems.The evolving landscape of biliary drainage in this setting highlights the need for tailored treatment strategies,multidisciplinary collaboration,referral to high-volume centers,and further prospective studies to refine patient selection and optimize clinical outcomes.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
Spontaneous recovery frequently proves maladaptive or insufficient because the plasticity of the injured adult mammalian central nervous system is limited.This limited plasticity serves as a primary barrier to functio...Spontaneous recovery frequently proves maladaptive or insufficient because the plasticity of the injured adult mammalian central nervous system is limited.This limited plasticity serves as a primary barrier to functional recovery after brain injury.Neuromodulation technologies represent one of the fastest-growing fields in medicine.These techniques utilize electricity,magnetism,sound,and light to restore or optimize brain functions by promoting reorganization or long-term changes that support functional recovery in patients with brain injury.Therefore,this review aims to provide a comprehensive overview of the effects and underlying mechanisms of neuromodulation technologies in supporting motor function recovery after brain injury.Many of these technologies are widely used in clinical practice and show significant improvements in motor function across various types of brain injury.However,studies report negative findings,potentially due to variations in stimulation protocols,differences in observation periods,and the severity of functional impairments among participants across different clinical trials.Additionally,we observed that different neuromodulation techniques share remarkably similar mechanisms,including promoting neuroplasticity,enhancing neurotrophic factor release,improving cerebral blood flow,suppressing neuroinflammation,and providing neuroprotection.Finally,considering the advantages and disadvantages of various neuromodulation techniques,we propose that future development should focus on closed-loop neural circuit stimulation,personalized treatment,interdisciplinary collaboration,and precision stimulation.展开更多
Pancreatic cysts are mostly incidental findings on computed tomography or magnetic resonance imaging scans,with few patients presenting with abdominal pain or other symptoms.The accurate diagnosis of cysts is importan...Pancreatic cysts are mostly incidental findings on computed tomography or magnetic resonance imaging scans,with few patients presenting with abdominal pain or other symptoms.The accurate diagnosis of cysts is important as management depends on the type(neoplastic or non-neoplastic).Cross-sectional imaging is fast being replaced with endoscopic ultrasound(EUS)and various techniques based on that such as EUS-guided fine needle aspiration,EUS-guided needle confocal laser endomicroscopy,EUS-through-the-needle biopsy,and contrast-enhanced EUS.Clinical studies have reported varying diagnostic and adverse event rates with these modalities.In addition,American,European,and Kyoto guidelines for the diagnosis and management of pancreatic cysts have provided different recommendations.In this editorial,we elaborate on the clinical guidelines,recent studies,and comparison of different endoscopic methods for the diagnosis of pancreatic cysts.展开更多
Fecal incontinence is a common condition that can significantly impact patients’quality of life.Obstetric anal sphincter injury and anorectal surgeries are common etiologies.Endoanal ultrasound and anorectal manometr...Fecal incontinence is a common condition that can significantly impact patients’quality of life.Obstetric anal sphincter injury and anorectal surgeries are common etiologies.Endoanal ultrasound and anorectal manometry are important diagnostic tools for evaluating patients.There are various treatment options,including diet,lifestyle modifications,drugs,biofeedback therapy,tibial and sacral nerve neuromodulation therapy,and surgery.In this editorial,we will discuss current controversies and novel approaches to fecal incontinence.Screening for asymptomatic anal sphincter defects after obstetric anal sphincter injury and in patients with inflammatory bowel disease is not generally recommended,but may be helpful in selected patients.The Garg incontinence score is a new score that includes the assessment of solid,liquid,flatus,mucous,stress and urge fecal incontinence.Novel tests such as translumbosacral anorectal magnetic stimulation and novel therapies such as translumbosacral neuromodulation therapy are promising diagnostic and treatment options,for both fecal incontinence and neuropathy.Home biofeedback therapy can overcome some limitations of the office-based therapy.Skeletal muscle-derived cell implantation of the external anal sphincter has been further studied as a possible treatment option.Sacral neuromodulation may be useful in scleroderma,congenital fecal incontinence and inflammatory bowel disease but merits further study.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
In recent decades,maternal–fetal medicine has undergone substantial advancements in the management of high-risk pregnancies.These include enhanced prenatal screening and diagnosis facilitated by innovations in ultras...In recent decades,maternal–fetal medicine has undergone substantial advancements in the management of high-risk pregnancies.These include enhanced prenatal screening and diagnosis facilitated by innovations in ultrasound imaging,as well as the advances in fetal medical and interventional therapies informed by the deeper understanding of pathophysiological mechanisms underlying fetal and maternal disease processes.展开更多
Pancreatic cancer is recognized as one of the leading causes of cancer mortality,representing the second most common source of cancer-related deaths within the gastrointestinal domain.Surgical resection is currently t...Pancreatic cancer is recognized as one of the leading causes of cancer mortality,representing the second most common source of cancer-related deaths within the gastrointestinal domain.Surgical resection is currently the only definitive treatment;however,the subtle emergence of symptoms often leads to a diagnosis at an advanced stage,with merely 10%-15%of patients being eligible for surgical intervention.The primary obstacle to achieving a potential radical resection is the presence of distant metastatic disease or invasion of adjacent major vascular structures.This review aims to highlight the critical role of endoscopic ultrasound in the diagnosis and staging of pancreatic tumors.We systematically searched PubMed,MEDLINE and Web of Science by using‘pancreatic cancer’and‘endoscopic ultrasonography’as keywords.Relevant studies were reviewed and analyzed.Endoscopic ultrasonography(EUS)is efficient in the diagnosis and staging of pancreatic cancer,past studies reported the accuracy of EUS is 63%to 94%for T-staging and 44%to 82%for N-staging but there are still limitations that need to be comprehensively applied with other diagnostic methods to evaluation of distant metastasis for surgical resectability.Our review aims to reveal the value for the staging of pancreatic cancer.展开更多
Perianal fistulising Crohn’s disease is a challenging complication that can affect up to 20%of patients with Crohn’s disease and is associated with significant morbidity.Despite advances in medical therapies,particu...Perianal fistulising Crohn’s disease is a challenging complication that can affect up to 20%of patients with Crohn’s disease and is associated with significant morbidity.Despite advances in medical therapies,particularly anti-tumor necrosis factor agents,the majority of patients still require surgical intervention.Accurate diagnosis and monitoring are essential to optimise outcomes and guide multidisciplinary management.Although clinical scoring systems such as the perianal disease activity index are widely used,their subjective application limits their reproducibility and reliability,underscoring the need for more objective methods of evaluating perianal fistulising Crohn’s disease activity.Imaging has thus become central to the objective assessment of perianal fistulising Crohn’s disease,with magnetic resonance imaging(MRI)recognised as the gold standard in view of its ability to provide clear,detailed images of the perianal region in a radiation-free manner.Guidelines also endorse the use of imaging modalities such as endoanal ultrasound and transperineal ultrasound as viable alternatives to MRI for the assessment of perianal fistulising Crohn’s disease in centres with appropriate expertise.This article aims to evaluate and compare the diagnostic accuracy and clinical utility of MRI,endoanal ultrasound,and transperineal ultrasound in the assessment of perianal fistulising Crohn’s disease,highlighting their respective strengths,limitations,and roles in clinical practice.展开更多
Background:This study evaluates the efficacy of gabexate mesylate thermosensitive in-situ gel(GMTI) in the treatment of beagle grade Ⅲ pancreatic trauma(PT) with the assistance of contrast-enhanced ultrasound(CEUS) a...Background:This study evaluates the efficacy of gabexate mesylate thermosensitive in-situ gel(GMTI) in the treatment of beagle grade Ⅲ pancreatic trauma(PT) with the assistance of contrast-enhanced ultrasound(CEUS) and investigates its mechanism of action.Methods:A grade Ⅲ PT model consisting of 15 beagle dogs with severed main pancreatic ducts was created and treated with cephalic vein injection of gabexate mesylate(GM)(1.54mL/10kg,TID) and peripancreatic injection of GMTI(4.63 mL/10 kg,QD) guided by CEUS within 24h post-surgery.Ascites and serum levels of amylase(AMY),lipase(LPS),C-reactive protein(CRP),interleukin(IL)-6,tumor necrosis factor(TNF)-α,and urinary trypsinogen activating peptide(TAP) were detected by ELISA.Histopathological changes in the canine pancreas were observed by Hematoxylin and Eosin staining.Results:CEUS accurately displayed pancreatic lesions and guided catheterisation.Compared to the control group,the ascites was significantly reduced after treatment(p<0.01).AMY and LPS ascites significantly decreased on post-operative 1st and 2nd day(p<0.01).The levels of AMY,LPS,CRP,IL-6,and TNF-α in serum were decreased(p<0.05 or p <0.01).Urinary TAP was decreased 1 and 2 days after treatment(p<0.05or p<0.01,respectively).In the control group,pancreatic tissue necrosis was evident in the wound area.Normal glandular cell structures and fibrous tissue hyperplasia were observed in the wound area after GMTI treatment.The GMTI group performed better than the GM group in improving pancreatic histology and reducing AMY levels in the early post-operative period.Conclusion:Guided by CEUS,daily peripancreatic injections of GMTI in Beagles effectively inhibit pancreatic enzyme activity and aid in the adjuvant treatment of pancreatic trauma.展开更多
In this article we comment on the paper by Xu et al describing retrospective data on endoscopic treatment outcome of esophageal gastrointestinal stromal tumors(GISTs).Esophageal GIST is a rare type of mesenchymal tumo...In this article we comment on the paper by Xu et al describing retrospective data on endoscopic treatment outcome of esophageal gastrointestinal stromal tumors(GISTs).Esophageal GIST is a rare type of mesenchymal tumor.GISTs originate from the interstitial cells of Cajal,which are pacemaker cells involved in gut motility.GISTs are most commonly found in the stomach and small intestine,but esophageal involvement is rare.Esophageal GISTs account for<1%of all GISTs.Endoscopic resection remains the mainstay for small,localized tumors with excellent outcomes.However,larger tumors may require multidisciplinary strategies to provide the best oncological outcomes.Here,we discuss the usefulness of endoscopic ultrasound(EUS)of subepithelial tumors of the upper gastrointestinal tract.EUS is a crucial tool in the diagnosis,staging,and management of subepithelial masses.Given the subepithelial nature of these tumors,standard endoscopy is not adequate,making EUS essential for a comprehensive assessment.EUS provides accurate tumor size assessment and enables fine needle aspirations guided biopsy,for treatment planning.展开更多
Background:Platinum can cause chemotherapy-related cognitive impairment.Low-intensity focused ultrasound(LIFUS)is a promising noninvasive physical stimulation method with a unique advantage in neurological rehabilitat...Background:Platinum can cause chemotherapy-related cognitive impairment.Low-intensity focused ultrasound(LIFUS)is a promising noninvasive physical stimulation method with a unique advantage in neurological rehabilitation.We aimed to investigate whether LIFUS can alleviate cisplatin-induced cognitive impairment in rats and explore the related neuropatho-logical mechanisms.Methods:After confirming the target position for LIFUS treatment in 18 rats,64 rats were randomly divided into four groups:control,model,sham,and LIFUS groups.Before and after LIFUS treatment,detailed biological behavioral assessments and magnetic resonance imaging were performed.Finally,the rats were euthanized,and relevant histopathological and molecular biological experiments were conducted and analyzed.Results:In the Morris water maze,the model group showed fewer platform crossings(1.250.93 vs.5.691.58),a longer escape latency(41.6536.55 s vs.6.382.11 s),and a lower novel object recognition index(29.7711.83 vs.83.695.67)than the control group.LIFUS treatment improved these metrics,with more platform crossings(3.130.34),a higher recognition index(65.588.71),and a shorter escape latency(6.452.27 s).Longitudinal analysis of the LIFUS group further confirmed these improvements.Neuroimaging revealed significant differences in diffusion tensor imaging metrics of specific brain regions pre-and post-LIFUS.Moreover,neuropathology showed higher dendritic spine density,less myelin loss,fewer apoptotic cells,more synapses,and less mitochondrial autophagy after LIFUS treatment.The neuroimaging indicators were correlated with behavioral improvements,highlighting the potential of LIFUS for alleviating cognitive impairment(as demonstrated through imaging and analysis).Our investigation of the molecular biological mechanisms revealed distinct protein expression patterns in the hippocampus and its subregions.In the model group,glial fibrillary acidic protein(GFAP)and ionized calcium-binding adaptor molecule 1(IBA1)expression levels were elevated across the hippocampus,whereas neuronal nuclei(NeuN)expression was reduced.Subregional analysis revealed higher GFAP and IBA1 and lower NeuN,especially in the dentate gyrus subregion.Moreover,positive cell areas were larger in the cornu ammonis(CA)1,CA2,CA3,and dentate gyrus regions.In the CA2 and CA3,significant differences among the groups were observed in GFAP-positive cell counts and areas,and there were variations in NeuN expression.Conclusions:Our results suggest that LIFUS can reverse cisplatin-induced cognitive impairments.The neuroimaging findings were consistent with the behavioral and histological results and suggest a neuropathological basis that supports further research into the clinical applications of LIFUS.Furthermore,LIFUS appeared to enhance the plasticity of neuronal synapses in the rat hippocampus and reduce hippocampal inflammation.These findings highlight the clinical potential of LIFUS as an effective,noninvasive therapeutic strategy and monitoring tool for chemotherapy-induced cognitive deficits.展开更多
文摘BACKGROUND:Point-of-care ultrasound(POCUS)has become increasingly integrated into the practice of emergency medicine.A common application is the extended focused assessment with sonography in trauma(eFAST)exam.The American College of Emergency Physicians has guidelines regarding the scope of ultrasound in the emergency department and the appropriate documentation.The objective of this study was to conduct a review of performed,documented and billed eFAST ultrasounds on trauma activation patients.METHODS:This was a retrospective review of all trauma activation patients during a 10-month period at an academic level-one trauma center.A list comparing all trauma activations was crossreferenced with a list of all billed eFAST scans.Medical records were reviewed to determine whether an eFAST was indicated,performed,and appropriately documented.RESULTS:We found that 1,507 of 1,597 trauma patients had indications for eFAST,but 396(27%)of these patients did not have a billed eFAST.Of these 396 patients,87(22%)had documentation in the provider note that an eFAST was performed but there was no separate procedure note.The remaining 309(78%)did not have any documentation of the eFAST in the patient’s chart although an eFAST was recorded and reviewed during ultrasound quality assurance.CONCLUSION:A significant proportion of trauma patients had eFAST exams performed but were not documented or billed.Lack of documentation was multifactorial.Emergency ultrasound programs require appropriate reimbursement to support training,credentialing,equipment,quality assurance,and device maintenance.Our study demonstrates a significant absence of adequate documentation leading to potential revenue loss for an emergency ultrasound program.
基金supported by Open Scientific Research Program of Military Logistics,No.BLB20J009(to YZhao).
文摘Blood-brain barrier disruption and the neuroinflammatory response are significant pathological features that critically influence disease progression and treatment outcomes.This review systematically analyzes the current understanding of the bidirectional relationship between blood-brain barrier disruption and neuroinflammation in traumatic brain injury,along with emerging combination therapeutic strategies.Literature review indicates that blood-brain barrier disruption and neuroinflammatory responses are key pathological features following traumatic brain injury.In the acute phase after traumatic brain injury,the pathological characteristics include primary blood-brain barrier disruption and the activation of inflammatory cascades.In the subacute phase,the pathological features are characterized by repair mechanisms and inflammatory modulation.In the chronic phase,the pathological features show persistent low-grade inflammation and incomplete recovery of the blood-brain barrier.Various physiological changes,such as structural alterations of the blood-brain barrier,inflammatory cascades,and extracellular matrix remodeling,interact with each other and are influenced by genetic,age,sex,and environmental factors.The dynamic balance between blood-brain barrier permeability and neuroinflammation is regulated by hormones,particularly sex hormones and stress-related hormones.Additionally,the role of gastrointestinal hormones is receiving increasing attention.Current treatment strategies for traumatic brain injury include various methods such as conventional drug combinations,multimodality neuromonitoring,hyperbaric oxygen therapy,and non-invasive brain stimulation.Artificial intelligence also shows potential in treatment decision-making and personalized therapy.Emerging sequential combination strategies and precision medicine approaches can help improve treatment outcomes;however,challenges remain,such as inadequate research on the mechanisms of the chronic phase traumatic brain injury and difficulties with technology integration.Future research on traumatic brain injury should focus on personalized treatment strategies,the standardization of techniques,costeffectiveness evaluations,and addressing the needs of patients with comorbidities.A multidisciplinary approach should be used to enhance treatment and improve patient outcomes.
文摘Rectal neuroendocrine tumors(NETs)are increasingly detected and are the most common gastrointestinal NET sites.Often discovered incidentally during endoscopy,most are small,well differentiated,and have an excellent prognosis.Local resection is typically considered curative.Several guidelines,namely the European Neuroendocrine Tumor Society guidelines 2023,National Comprehensive Cancer network 2025,and the Polish Network of Neuroendocrine Tumors(2017)emphasize the use of endoscopic and endoscopic ultrasound staging to select the appropriate therapy,ranging from resection to advanced techniques for larger or metastatic diseases,highlighting the need for an accurate initial assessment.
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Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy remains a challenging field in therapeutic endoscopy due to the complex anatomical reconstructions that limit access to the biliary tree.Over the past two decades,device-assisted enteroscopy(DAE),including singleballoon,double-balloon,and motorized spiral enteroscopy,has expanded the feasibility of ERCP in this population,with overall technical success rates generally reported between 70%and 90%.Nevertheless,these techniques are technically demanding,time-consuming,and frequently affected by limited reach and unstable positioning.More recently,interventional endoscopic ultrasound(EUS)-guided procedures have emerged as highly effective alternatives,significantly improving clinical outcomes in selected patients,particularly in those with long-limb Roux-en-Y reconstructions where conventional methods are less effective.Percutaneous transhepatic biliary drainage continues to represent a valuable salvage option when endoscopic approaches fail,though it is associated with a greater burden of reinterventions and adverse events.This minireview provides a comprehensive overview of the main endoscopic strategies for biliary drainage in altered anatomy,focusing on technical considerations,efficacy,and safety profiles of DAE-assisted ERCP,EUS-guided interventions,and motorized systems.The evolving landscape of biliary drainage in this setting highlights the need for tailored treatment strategies,multidisciplinary collaboration,referral to high-volume centers,and further prospective studies to refine patient selection and optimize clinical outcomes.
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.
基金supported by the National Natural Science Foundation of China,No.82371399(to YY)the Natural Science Foundation of Jiangsu Province,No.BK20221206(to YY)+1 种基金the Young Elite Scientists Sponsorship Program of Jiangsu Province,No.TJ-2022-028(to YY)the Scientific Research Program of Wuxi Health Commission,No.Z202302(to LY)。
文摘Spontaneous recovery frequently proves maladaptive or insufficient because the plasticity of the injured adult mammalian central nervous system is limited.This limited plasticity serves as a primary barrier to functional recovery after brain injury.Neuromodulation technologies represent one of the fastest-growing fields in medicine.These techniques utilize electricity,magnetism,sound,and light to restore or optimize brain functions by promoting reorganization or long-term changes that support functional recovery in patients with brain injury.Therefore,this review aims to provide a comprehensive overview of the effects and underlying mechanisms of neuromodulation technologies in supporting motor function recovery after brain injury.Many of these technologies are widely used in clinical practice and show significant improvements in motor function across various types of brain injury.However,studies report negative findings,potentially due to variations in stimulation protocols,differences in observation periods,and the severity of functional impairments among participants across different clinical trials.Additionally,we observed that different neuromodulation techniques share remarkably similar mechanisms,including promoting neuroplasticity,enhancing neurotrophic factor release,improving cerebral blood flow,suppressing neuroinflammation,and providing neuroprotection.Finally,considering the advantages and disadvantages of various neuromodulation techniques,we propose that future development should focus on closed-loop neural circuit stimulation,personalized treatment,interdisciplinary collaboration,and precision stimulation.
文摘Pancreatic cysts are mostly incidental findings on computed tomography or magnetic resonance imaging scans,with few patients presenting with abdominal pain or other symptoms.The accurate diagnosis of cysts is important as management depends on the type(neoplastic or non-neoplastic).Cross-sectional imaging is fast being replaced with endoscopic ultrasound(EUS)and various techniques based on that such as EUS-guided fine needle aspiration,EUS-guided needle confocal laser endomicroscopy,EUS-through-the-needle biopsy,and contrast-enhanced EUS.Clinical studies have reported varying diagnostic and adverse event rates with these modalities.In addition,American,European,and Kyoto guidelines for the diagnosis and management of pancreatic cysts have provided different recommendations.In this editorial,we elaborate on the clinical guidelines,recent studies,and comparison of different endoscopic methods for the diagnosis of pancreatic cysts.
文摘Fecal incontinence is a common condition that can significantly impact patients’quality of life.Obstetric anal sphincter injury and anorectal surgeries are common etiologies.Endoanal ultrasound and anorectal manometry are important diagnostic tools for evaluating patients.There are various treatment options,including diet,lifestyle modifications,drugs,biofeedback therapy,tibial and sacral nerve neuromodulation therapy,and surgery.In this editorial,we will discuss current controversies and novel approaches to fecal incontinence.Screening for asymptomatic anal sphincter defects after obstetric anal sphincter injury and in patients with inflammatory bowel disease is not generally recommended,but may be helpful in selected patients.The Garg incontinence score is a new score that includes the assessment of solid,liquid,flatus,mucous,stress and urge fecal incontinence.Novel tests such as translumbosacral anorectal magnetic stimulation and novel therapies such as translumbosacral neuromodulation therapy are promising diagnostic and treatment options,for both fecal incontinence and neuropathy.Home biofeedback therapy can overcome some limitations of the office-based therapy.Skeletal muscle-derived cell implantation of the external anal sphincter has been further studied as a possible treatment option.Sacral neuromodulation may be useful in scleroderma,congenital fecal incontinence and inflammatory bowel disease but merits further study.
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.
文摘In recent decades,maternal–fetal medicine has undergone substantial advancements in the management of high-risk pregnancies.These include enhanced prenatal screening and diagnosis facilitated by innovations in ultrasound imaging,as well as the advances in fetal medical and interventional therapies informed by the deeper understanding of pathophysiological mechanisms underlying fetal and maternal disease processes.
文摘Pancreatic cancer is recognized as one of the leading causes of cancer mortality,representing the second most common source of cancer-related deaths within the gastrointestinal domain.Surgical resection is currently the only definitive treatment;however,the subtle emergence of symptoms often leads to a diagnosis at an advanced stage,with merely 10%-15%of patients being eligible for surgical intervention.The primary obstacle to achieving a potential radical resection is the presence of distant metastatic disease or invasion of adjacent major vascular structures.This review aims to highlight the critical role of endoscopic ultrasound in the diagnosis and staging of pancreatic tumors.We systematically searched PubMed,MEDLINE and Web of Science by using‘pancreatic cancer’and‘endoscopic ultrasonography’as keywords.Relevant studies were reviewed and analyzed.Endoscopic ultrasonography(EUS)is efficient in the diagnosis and staging of pancreatic cancer,past studies reported the accuracy of EUS is 63%to 94%for T-staging and 44%to 82%for N-staging but there are still limitations that need to be comprehensively applied with other diagnostic methods to evaluation of distant metastasis for surgical resectability.Our review aims to reveal the value for the staging of pancreatic cancer.
文摘Perianal fistulising Crohn’s disease is a challenging complication that can affect up to 20%of patients with Crohn’s disease and is associated with significant morbidity.Despite advances in medical therapies,particularly anti-tumor necrosis factor agents,the majority of patients still require surgical intervention.Accurate diagnosis and monitoring are essential to optimise outcomes and guide multidisciplinary management.Although clinical scoring systems such as the perianal disease activity index are widely used,their subjective application limits their reproducibility and reliability,underscoring the need for more objective methods of evaluating perianal fistulising Crohn’s disease activity.Imaging has thus become central to the objective assessment of perianal fistulising Crohn’s disease,with magnetic resonance imaging(MRI)recognised as the gold standard in view of its ability to provide clear,detailed images of the perianal region in a radiation-free manner.Guidelines also endorse the use of imaging modalities such as endoanal ultrasound and transperineal ultrasound as viable alternatives to MRI for the assessment of perianal fistulising Crohn’s disease in centres with appropriate expertise.This article aims to evaluate and compare the diagnostic accuracy and clinical utility of MRI,endoanal ultrasound,and transperineal ultrasound in the assessment of perianal fistulising Crohn’s disease,highlighting their respective strengths,limitations,and roles in clinical practice.
文摘Background:This study evaluates the efficacy of gabexate mesylate thermosensitive in-situ gel(GMTI) in the treatment of beagle grade Ⅲ pancreatic trauma(PT) with the assistance of contrast-enhanced ultrasound(CEUS) and investigates its mechanism of action.Methods:A grade Ⅲ PT model consisting of 15 beagle dogs with severed main pancreatic ducts was created and treated with cephalic vein injection of gabexate mesylate(GM)(1.54mL/10kg,TID) and peripancreatic injection of GMTI(4.63 mL/10 kg,QD) guided by CEUS within 24h post-surgery.Ascites and serum levels of amylase(AMY),lipase(LPS),C-reactive protein(CRP),interleukin(IL)-6,tumor necrosis factor(TNF)-α,and urinary trypsinogen activating peptide(TAP) were detected by ELISA.Histopathological changes in the canine pancreas were observed by Hematoxylin and Eosin staining.Results:CEUS accurately displayed pancreatic lesions and guided catheterisation.Compared to the control group,the ascites was significantly reduced after treatment(p<0.01).AMY and LPS ascites significantly decreased on post-operative 1st and 2nd day(p<0.01).The levels of AMY,LPS,CRP,IL-6,and TNF-α in serum were decreased(p<0.05 or p <0.01).Urinary TAP was decreased 1 and 2 days after treatment(p<0.05or p<0.01,respectively).In the control group,pancreatic tissue necrosis was evident in the wound area.Normal glandular cell structures and fibrous tissue hyperplasia were observed in the wound area after GMTI treatment.The GMTI group performed better than the GM group in improving pancreatic histology and reducing AMY levels in the early post-operative period.Conclusion:Guided by CEUS,daily peripancreatic injections of GMTI in Beagles effectively inhibit pancreatic enzyme activity and aid in the adjuvant treatment of pancreatic trauma.
文摘In this article we comment on the paper by Xu et al describing retrospective data on endoscopic treatment outcome of esophageal gastrointestinal stromal tumors(GISTs).Esophageal GIST is a rare type of mesenchymal tumor.GISTs originate from the interstitial cells of Cajal,which are pacemaker cells involved in gut motility.GISTs are most commonly found in the stomach and small intestine,but esophageal involvement is rare.Esophageal GISTs account for<1%of all GISTs.Endoscopic resection remains the mainstay for small,localized tumors with excellent outcomes.However,larger tumors may require multidisciplinary strategies to provide the best oncological outcomes.Here,we discuss the usefulness of endoscopic ultrasound(EUS)of subepithelial tumors of the upper gastrointestinal tract.EUS is a crucial tool in the diagnosis,staging,and management of subepithelial masses.Given the subepithelial nature of these tumors,standard endoscopy is not adequate,making EUS essential for a comprehensive assessment.EUS provides accurate tumor size assessment and enables fine needle aspirations guided biopsy,for treatment planning.
基金supported by the National Natural Science Foundation of China(82171908 and 82102015)the General Project of the Nanjing Medical Science and Technology Development Program(YKK21075)the Guangdong Basic and Applied Basic Research Foundation(No.2023A1515140030).
文摘Background:Platinum can cause chemotherapy-related cognitive impairment.Low-intensity focused ultrasound(LIFUS)is a promising noninvasive physical stimulation method with a unique advantage in neurological rehabilitation.We aimed to investigate whether LIFUS can alleviate cisplatin-induced cognitive impairment in rats and explore the related neuropatho-logical mechanisms.Methods:After confirming the target position for LIFUS treatment in 18 rats,64 rats were randomly divided into four groups:control,model,sham,and LIFUS groups.Before and after LIFUS treatment,detailed biological behavioral assessments and magnetic resonance imaging were performed.Finally,the rats were euthanized,and relevant histopathological and molecular biological experiments were conducted and analyzed.Results:In the Morris water maze,the model group showed fewer platform crossings(1.250.93 vs.5.691.58),a longer escape latency(41.6536.55 s vs.6.382.11 s),and a lower novel object recognition index(29.7711.83 vs.83.695.67)than the control group.LIFUS treatment improved these metrics,with more platform crossings(3.130.34),a higher recognition index(65.588.71),and a shorter escape latency(6.452.27 s).Longitudinal analysis of the LIFUS group further confirmed these improvements.Neuroimaging revealed significant differences in diffusion tensor imaging metrics of specific brain regions pre-and post-LIFUS.Moreover,neuropathology showed higher dendritic spine density,less myelin loss,fewer apoptotic cells,more synapses,and less mitochondrial autophagy after LIFUS treatment.The neuroimaging indicators were correlated with behavioral improvements,highlighting the potential of LIFUS for alleviating cognitive impairment(as demonstrated through imaging and analysis).Our investigation of the molecular biological mechanisms revealed distinct protein expression patterns in the hippocampus and its subregions.In the model group,glial fibrillary acidic protein(GFAP)and ionized calcium-binding adaptor molecule 1(IBA1)expression levels were elevated across the hippocampus,whereas neuronal nuclei(NeuN)expression was reduced.Subregional analysis revealed higher GFAP and IBA1 and lower NeuN,especially in the dentate gyrus subregion.Moreover,positive cell areas were larger in the cornu ammonis(CA)1,CA2,CA3,and dentate gyrus regions.In the CA2 and CA3,significant differences among the groups were observed in GFAP-positive cell counts and areas,and there were variations in NeuN expression.Conclusions:Our results suggest that LIFUS can reverse cisplatin-induced cognitive impairments.The neuroimaging findings were consistent with the behavioral and histological results and suggest a neuropathological basis that supports further research into the clinical applications of LIFUS.Furthermore,LIFUS appeared to enhance the plasticity of neuronal synapses in the rat hippocampus and reduce hippocampal inflammation.These findings highlight the clinical potential of LIFUS as an effective,noninvasive therapeutic strategy and monitoring tool for chemotherapy-induced cognitive deficits.
