Background:Congenital hepatic hemangioma(CHH)is a rare benign vascular tumor that occurs prenatally.However,only a few cases have been summarized and evaluated for the prenatal and postnatal imaging features of CHH,an...Background:Congenital hepatic hemangioma(CHH)is a rare benign vascular tumor that occurs prenatally.However,only a few cases have been summarized and evaluated for the prenatal and postnatal imaging features of CHH,and no studies have conducted long-term follow-up on it.This study aimed to explore the ultrasound and magnetic resonance features,growth patterns,and clinical outcomes of CHH.Methods:Thirty-six pregnancies with a prenatal fetal diagnosis and postnatal diagnosis of CHH were studied.CHHs were grouped into those with a diameter≥4 cm and those with a diameter<4 cm according to the largest diameter.Fisher's exact test was used to compare the imaging characteristics between the groups.The volume of CHHs was measured at each follow-up visit to plot the growth pattern of the tumors,and the volume of CHHs was compared before and after birth using a rank sum test analysis.Results:Thirty-three cases of CHHs were confirmed by postnatal imaging,and three were confirmed by a biopsy.Mixed echoes were more common in the diameter≥4 cm group than in the diameter<4 cm group(p=0.026).Complications were more likely to occur in the large-diameter group.Eighteen(54.5%)cases were classified as rapidly involuting congenital hemangioma,nine(27.3%)as partially involuting congenital hemangioma,and two(6.1%)as noninvoluting congenital hemangioma.A new type of CHH was identified in which four(12.1%)cases continued to proliferate after birth and spontaneously subsided in subsequent months.The CHH volume decreased with age and was significantly decreased at 9 months postnatal compared to birth(p=0.001).Conclusion:This study showed the imaging features of CHH were associated with the lesion size.Based on postnatal follow-up,a new type of CHH was identified.If there are no complications at birth in CHH cases,a good prognosis is indicated.展开更多
BACKGROUND Congenital cytomegalovirus(CMV)infection represents a significant public health concern as the most prevalent viral infection in newborns,potentially leading to severe neurological and developmental complic...BACKGROUND Congenital cytomegalovirus(CMV)infection represents a significant public health concern as the most prevalent viral infection in newborns,potentially leading to severe neurological and developmental complications.The majority of cases are asymptomatic and remain undetected during pregnancy due to the absence of effective screening methods.CASE SUMMARY A 27-year-old primigravida presented for early pregnancy ultrasound,which revealed an atypical finding:A normal anechoic thalamus appearing hyperechoic on the mid-sagittal view of the fetal head.Subsequent ultrasound examinations during mid and late gestation demonstrated classic intracranial features sug-gestive of congenital CMV infection.Chromosomal karyotyping and microarray analysis of the fetus yielded no significant abnormalities.Following compre-hensive prenatal counseling regarding potential adverse fetal outcomes,the patient elected to continue her pregnancy.She ultimately underwent cesarean delivery at 42 weeks gestation at another facility,resulting in the birth of a female neonate.At five months of age,the infant presented with epilepsy and significant growth and developmental delays.CONCLUSION Congenital CMV infection occurs during the first trimester may manifest as hyperechoic thalamus which can be revealed by ultrasound in the mid-saggital view of the fetal head.Future research should investigate the correlation between echogenic thalamus and developmental outcomes,as well as explore early sc-reening techniques for suspected congenital CMV infection cases.展开更多
BACKGROUND Crohn's disease(CD)-related small bowel adenocarcinoma(SBA)is a rare adenocarcinoma that is difficult to detect and diagnose in its early stages and is associated with long-standing inflammation,which m...BACKGROUND Crohn's disease(CD)-related small bowel adenocarcinoma(SBA)is a rare adenocarcinoma that is difficult to detect and diagnose in its early stages and is associated with long-standing inflammation,which may predispose patients with CD to SBA.This case report describes a patient with CD who was diagnosed with SBA using intestinal ultrasonography(IUS).CASE SUMMARY A 38-year-old male diagnosed with CD since 23 years of age was maintained in remission with mesalamine,although he did not take his medication regularly.The patient presented with recurrent dull abdominal pain,bloating,and a threemonth history of diarrhea(3 times per day)with unformed stools.Abdominal examination revealed mildly diffuse tenderness.IUS revealed eccentric thickening(23 mm)in the terminal ileum.The hierarchical structure of the intestinal wall disappeared,revealing the“pseudo-kidney”sign.A stricture was identified in the terminal ileum with dilation of the proximal intestinal tract.Color Doppler flow imaging revealed linear blood flow.Contrast-enhanced ultrasound revealed highly heterogeneous enhancement with rapid washout in ileocecal junction,suggesting malignant transformation of CD with intestinal obstruction.Pathological examination revealed poorly differentiated adenocarcinoma of the ileocecal junction.CONCLUSION Active surveillance for SBA using IUS is prudent,given its advantages of realtime dynamic imaging,high-detail resolution,and low cost.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is a major global contributor to cancer-related mortality,with advanced stages presenting substantial therapeutic challenges.Although targeted immunotherapy shows potential,many...BACKGROUND Hepatocellular carcinoma(HCC)is a major global contributor to cancer-related mortality,with advanced stages presenting substantial therapeutic challenges.Although targeted immunotherapy shows potential,many patients exhibit poor responses,underscoring the need for predictive tools to optimize treatment strategies.Emerging data indicate that ultrasound features(e.g.,tumor stiffness)and serum biomarkers may serve as predictors of treatment outcomes.However,an integrated model for these predictors remains unavailable.This paper introduces a machine learning-based approach that combines ultrasound and serological data to forecast immunotherapy efficacy in patients with advanced HCC.AIM To develop a non-invasive predictive model for targeted immunotherapy in advanced HCC,incorporating both internal and external validation.METHODS Patients with advanced HCC who received targeted immunotherapy at two medical centers were enrolled and divided into internal training,internal validation,and external validation cohorts.Comprehensive clinical data were gathered.Initially,13 machine learning algorithms were tested using the internal training cohort.The algorithm yielding the highest area under the curve(AUC)in the internal validation cohort was selected to construct a predictive model,termed the Target Immunotherapy Predictive Model(TIPM).TIPM performance was then compared with that of traditional tumor staging systems(tumor-node-metastasis,Barcelona Clinic Liver Cancer,China Liver Cancer,Hong Kong Liver Cancer,and C-reactive protein and alpha-fetoprotein in immunotherapy).RESULTS A total of 306 patients participated in the study,with 143 in the internal training cohort,62 in the internal validation cohort,and 101 in the external validation cohort.In the internal validation cohort,the random forest model achieved the highest AUC(0.975,95%confidence interval:0.924-0.998).The key predictors for TIPM were tumor size,platelet count,tumor stiffness change,and white blood cell count.During external validation,TIPM outperformed conventional models,reaching an AUC of 0.899(95%confidence interval:0.840-0.957).Calibration curves demonstrated strong concordance with observed outcomes,while decision curve analysis confirmed TIPM’s enhanced clinical value.Additional metrics,such as the net reclassification index and integrated discrimination improvement,further supported TIPM’s superior predictive accuracy.CONCLUSION TIPM provides a robust tool for predicting targeted immunotherapy efficacy in advanced HCC,facilitating personalized treatment planning.展开更多
BACKGROUND Childhood intestinal lymphoma is characterized by its insidious onset and the absence of specific clinical symptoms.The thinner abdominal wall in children significantly aids in the ultrasound visualization ...BACKGROUND Childhood intestinal lymphoma is characterized by its insidious onset and the absence of specific clinical symptoms.The thinner abdominal wall in children significantly aids in the ultrasound visualization of the abdominal cavity and intestines.Although many typical cases of intestinal lymphoma can be diagnosed through ultrasound,physicians often either overlook these values or assume that ultrasound has limited diagnostic value for intestinal lymphoma.AIM To clarify the diagnosis of intestinal lymphoma and classify its severity using ultrasound,as well as to correlate this with prognosis.METHODS The correlation between ultrasound diagnostic outcomes,laboratory indicators,and clinical prognosis was analyzed to demonstrate the effectiveness of ultrasound in assessing the severity of intestinal lymphoma and to provide new evidence for the diagnosis and treatment of the disease in children.A retro-spective analysis was conducted on the sonographic images and case data of 28 children diagnosed with intestinal lymphoma and confirmed by surgical pathology.Additionally,we sought to determine the correlation between ultrasonic classification of lymphoma,lactate dehydrogenase(LDH)values,pathological classification,and prognosis.RESULTS Ultrasound was utilized to categorize 28 cases of intestinal lymphoma into focal segmental(15 cases)and extensive(13 cases)types.Ultrasound classification and LDH levels were significantly correlated with prognosis(P<0.05),while pathological type,age,gender,and treatment modality showed no significant correlation(P>0.05).Among ultrasound manifestations,there was a significant difference in LDH levels between the segmental and extensive groups(P<0.05).The prognosis for children with extensive intestinal lymphoma was poorer than that for children with localized segmental intestinal lymphoma(P<0.05).CONCLUSION Ultrasound can be used in the diagnosis and classification of intestinal lymphoma in children.Extensive intestinal lymphoma is associated with significantly elevated LDH and poor prognosis.展开更多
BACKGROUND The current study was to assess the application effects of conventional surgical techniques and ultrasound-guided precise localization technology for early gastric cancer(EGC),with an emphasis on long-term ...BACKGROUND The current study was to assess the application effects of conventional surgical techniques and ultrasound-guided precise localization technology for early gastric cancer(EGC),with an emphasis on long-term survival,postoperative complications,and surgical results.AIM To evaluate perioperative results,postoperative complications,and long-term survival in order to conduct a thorough comparison between conventional surgical techniques and ultrasound-guided precise localization technology for the treatment of EGC.METHODS Of 100 EGC patients were gathered,and they were subsequently divided into two groups based on the surgical technique used:The observation group(n=52)received surgery assisted by ultrasound-guided precise localization technology,whereas the control group(n=48)received traditional surgical treatment.The baseline characteristics were similar between the groups.Operation time,intraoperative hemorrhage,the number of lymph nodes removed,postoperative problems,survival rate,and other surgical and postoperative parameters were compared.RESULTS Compared with the control group,the observation group had significantly less intraoperative blood loss(80 mL vs 120 mL,P<0.05)and more dissected lymph nodes(28 vs 22,P<0.05).There were fewer postoperative complications in the observation group than in the routine group(8%vs 16%,P<0.05),hospitalization after surgery was shorter,and gastrointestinal function returned sooner.The long-term survival rates at 5 years and 3 years were significantly greater in the observation group than in the control group:82%and 88%vs 70%and 78%,respectively(P<0.05).CONCLUSION It is possible that ultrasound-guided accurate localization technology might be utilized more widely in clinical practice because it could significantly enhance the results of surgery for EGC,including reduced blood loss,better lymphadenectomy,lower complication rates,and improved survival rates.Further studies should aim to refine this technology and consider its utility in other types of oncologic surgery.展开更多
BACKGROUND Preoperative distinguishing between benign and malignant gastrointestinal stromal tumors(GISTs)poses a challenge.Ultrasound elastography has emerged as a promising diagnostic tool;however,further investigat...BACKGROUND Preoperative distinguishing between benign and malignant gastrointestinal stromal tumors(GISTs)poses a challenge.Ultrasound elastography has emerged as a promising diagnostic tool;however,further investigation is needed to assess its diagnostic accuracy in evaluating GISTs.AIM To evaluate the accuracy of ultrasound elastography for differentiating between benign and malignant GISTs.METHODS This prospective study included 110 patients with 103 histopathologically confirmed GISTs between January 2021 and December 2023.All tumors underwent conventional ultrasound examination,strain elastography(SE),and shearwave elastography(SWE)before surgical resection.The study evaluated elastographic parameters such as strain ratio,elastographic patterns,mean elastic modulus,and heterogeneity index.Diagnostic performance was evaluated using receiver operating characteristic curve analysis,with histopathological diagnosis as the reference standard.RESULTS Of the 103 GISTs,45(43.7%)were benign and 58(56.3%)were malignant based on modified National Institutes of Health criteria.Malignant GISTs exhibited significantly higher strain ratios(4.82±1.73 vs 2.31±0.89;P<0.001)and mean elastic modulus values(45.6±15.8 kPa vs 21.3±8.4 kPa;P<0.001)than benign tumors.The optimal cutoff values were 3.45 for the strain ratio(sensitivity:84.5%,specificity:86.7%)and 32.5 kPa for the mean elastic modulus(sensitivity:87.9%,specificity:88.9%).The areas under the curve were 0.892 and 0.918,respectively.Interobserver agreement was excellent for both SE[intraclass correlation coefficient(ICC)=0.88]and SWE(ICC range:0.85-0.93)measurements.CONCLUSION Ultrasound elastography shows high diagnostic accuracy in distinguishing between benign and malignant GISTs.Combining SE and SWE provides complementary parameters for preoperative risk stratification.展开更多
BACKGROUND Severe esophagogastric varices(EGVs)significantly affect prognosis of patients with hepatitis B because of the risk of life-threatening hemorrhage.Endoscopy is the gold standard for EGV detection but it is ...BACKGROUND Severe esophagogastric varices(EGVs)significantly affect prognosis of patients with hepatitis B because of the risk of life-threatening hemorrhage.Endoscopy is the gold standard for EGV detection but it is invasive,costly and carries risks.Noninvasive predictive models using ultrasound and serological markers are essential for identifying high-risk patients and optimizing endoscopy utilization.Machine learning(ML)offers a powerful approach to analyze complex clinical data and improve predictive accuracy.This study hypothesized that ML models,utilizing noninvasive ultrasound and serological markers,can accurately predict the risk of EGVs in hepatitis B patients,thereby improving clinical decisionmaking.AIM To construct and validate a noninvasive predictive model using ML for EGVs in hepatitis B patients.METHODS We retrospectively collected ultrasound and serological data from 310 eligible cases,randomly dividing them into training(80%)and validation(20%)groups.Eleven ML algorithms were used to build predictive models.The performance of the models was evaluated using the area under the curve and decision curve analysis.The best-performing model was further analyzed using SHapley Additive exPlanation to interpret feature importance.RESULTS Among the 310 patients,124 were identified as high-risk for EGVs.The extreme gradient boosting model demonstrated the best performance,achieving an area under the curve of 0.96 in the validation set.The model also exhibited high sensitivity(78%),specificity(94%),positive predictive value(84%),negative predictive value(88%),F1 score(83%),and overall accuracy(86%).The top four predictive variables were albumin,prothrombin time,portal vein flow velocity and spleen stiffness.A web-based version of the model was developed for clinical use,providing real-time predictions for high-risk patients.CONCLUSION We identified an efficient noninvasive predictive model using extreme gradient boosting for EGVs among hepatitis B patients.The model,presented as a web application,has potential for screening high-risk EGV patients and can aid clinicians in optimizing the use of endoscopy.展开更多
BACKGROUND Ultrasound classification can be used to determine the severity of adhesive intestinal obstruction and to guide the formulation of treatment plans.AIM To explore the value of ultrasound classification in di...BACKGROUND Ultrasound classification can be used to determine the severity of adhesive intestinal obstruction and to guide the formulation of treatment plans.AIM To explore the value of ultrasound classification in disease judgment and treatment plan formulation for patients with adhesive intestinal obstruction.METHODS The medical records of 120 patients with adhesive intestinal obstruction presenting at Taihe Hospital Affiliated with Hubei Medical College were retrospectively analyzed from January 2022 to January 2024 according to the severity of ultrasound images,divided into simple(mild),complex(moderate),and critical(severe),analyzing the imaging characteristics of patients with different ultrasound classifications,and developing the corresponding treatment plan according to the ultrasound typing results,that is,conservative treatment and surgical treatment,contrast the ultrasound signs of patients in the conservative vs surgical treatment groups,and the value of ultrasound classification in the treatment of adhesive ileus.RESULTS Among the 120 patients,P>0.05,compared with the general data(sex,age,body quality index,time to onset,and history of onset),the proportion of bowel distension and abdominal effusion(P>0.05),and the proportion of adhesion mass and cross-cross in the conservative treatment group,P<0.05.CONCLUSION Ultrasound typing can aid in the clinical evaluation of the severity of adhesive intestinal obstruction and provide an imaging reference for clinicians to develop targeted treatment plans.展开更多
Thyroid-associated ophthalmopathy(TAO),an autoimmune disorder closely associated with thyroid dysfunction,requires timely diagnosis and ongoing accurate evaluation to improve patient outcomes.With the global incidence...Thyroid-associated ophthalmopathy(TAO),an autoimmune disorder closely associated with thyroid dysfunction,requires timely diagnosis and ongoing accurate evaluation to improve patient outcomes.With the global incidence of TAO increasing and significantly affecting the quality of life of patients,there is an urgent need for effective diagnostic tools.As a noninvasive imaging technique,ultrasound plays a pivotal role in diagnosing and managing TAO,particularly in the early detection of and monitoring of disease progression.Despite its advantages,ultrasound faces challenges such as limited resolution for deep orbital structures and a lack of standardized protocols,which can lead to diagnostic inaccuracies.This paper reviews the current status of ultrasound applications in TAO,including diagnostic utility,recent technological advances,and key challenges.It proposes strategies for future research and improvement,emphasizing analysis of ultrasound imaging data to develop biomarker stratification models.We propose an integrated multimodal framework that combines ultrasound elastography with deep learning to improve diagnostic precision.展开更多
Background:Balloon catheter isolation is a promising auxiliary method for thermal ablation treatment of liver cancer. We aimed to explore the safety and effectiveness of balloon catheter isolation-assisted ultrasound-...Background:Balloon catheter isolation is a promising auxiliary method for thermal ablation treatment of liver cancer. We aimed to explore the safety and effectiveness of balloon catheter isolation-assisted ultrasound-guided percutaneous microwave ablation (MWA) in treating liver cancer in difficult anatomical locations.Methods:Data of 132 patients with 145 difficult-site liver cancer treated with ultrasound-guided percutaneous MWA were retrospectively analyzed. Participants were classified into the isolation (n=40)and non-isolation (n=92) groups based on whether the patients were treated using a balloon catheter prior to ablation. The major complication rates, local tumor residuals (LTR), and tumor follow-up for local tumor progression (LTP) at 6 and 12 months post-ablation were compared between the two groups.Results:The rates of major postoperative complications did not significantly differ between the isolation and non-isolation groups (2.5%vs. 4.3%, P=0.609). The postoperative LTR rates were significantly different between the isolation and non-isolation groups (4.8%vs. 17.5%, P=0.032). Balloon catheter isolation [odds ratio (OR)=0.225, 95%confidence interval (CI):0.085–0.595, P=0.009] and tumor diameter(OR=2.808, 95%CI:1.186–6.647, P=0.019) were identified as independent factors influencing LTR rate.The cumulative LTP rates at 6 and 12 months after ablation showed no significant differences between the isolation and non-isolation groups (2.6%vs. 7.9%, P=0.661;4.9%vs. 9.8%, P=0.676, respectively).Cox proportional hazards regression analysis showed that tumor diameter was an independent risk factor for cumulative LTP rate (OR=3.445, 95%CI:1.406–8.437, P=0.017).Conclusions:Balloon catheter isolation-assisted MWA was safe and effective in the treatment of difficultsite liver cancer. Additionally, tumor diameter significantly influenced LTR and LTP rates after ablation.展开更多
Objective:To systematically evaluate global research trends on contrast-enhanced ultrasound(CEUS)in tumor diagnosis using bibliometric methods.Methods:Publications from January 2000 to June 2025 were retrieved from th...Objective:To systematically evaluate global research trends on contrast-enhanced ultrasound(CEUS)in tumor diagnosis using bibliometric methods.Methods:Publications from January 2000 to June 2025 were retrieved from the Web of Science Core Collection(SCI-EXPANDED).Only English-language articles and reviews were included.A total of 3,493 records were analyzed.VOSviewer 1.6.20 were used for bibliometric and visualization analyses,covering annual output,countries and institutions,authors,journals,keyword co-occurrence,collaboration networks,and co-citation patterns.Results:The number of publications demonstrated steady growth with acceleration after 2018,peaking in 2021 and 2023(>350 papers/year).Dietrich Christoph F.was the most productive and influential author,while Chinese scholars(e.g.,Dong Yi,Wang Wen-Ping)and institutions such as Sun Yat-sen University and Fudan University emerged as leading contributors.European journals,particularly Ultrasound in Medicine and Biology and European Radiology,showed high academic influence.Keyword analysis revealed liver cancer,especially hepatocellular carcinoma,as the dominant research theme,with expanding applications in breast,renal,and prostate tumors.Collaboration networks highlighted strong partnerships between China and Europe,whereas North American participation remained limited.Co-citation analysis indicated that a small number of highly cited studies shaped the intellectual foundation of the field.Conclusion:CEUS research in tumor diagnosis has expanded rapidly,characterized by concentrated leadership,thematic diversification,and strengthening international collaboration.With advances in artificial intelligence,super-resolution imaging,and novel contrast agents,CEUS is expected to evolve from a diagnostic tool into an integrated platform for tumor detection,treatment monitoring,and personalized cancer care.展开更多
BACKGROUND Dry eye disease(DED)is a multifactorial ocular surface disorder with rising prevalence.It is closely related to systemic health and psychological factors,such as sleep and mood disorders,which significantly...BACKGROUND Dry eye disease(DED)is a multifactorial ocular surface disorder with rising prevalence.It is closely related to systemic health and psychological factors,such as sleep and mood disorders,which significantly impact the quality of life of patients.AIM To explore the correlations between ocular surface function,sleep quality,and anxiety/depression in patients with DED.METHODS This was a cross-sectional investigative study that included 358 patients with DED between January 2022 and January 2025.Ocular surface was assessed using the ocular surface disease index(OSDI),tear film break-up time,fluorescein staining score,and Schirmer I test.The Pittsburgh Sleep Quality Index(PSQI),Self-Rating Anxiety Scale(SAS),and Self-Rating Depression Scale(SDS)were used to evaluate sleep quality and anxiety/depression levels.Correlation and linear regression analyses were used to explore the relationships.RESULTS The mean PSQI score of the patients was 9.94±2.18;the mean SAS score was 47.30±4.90,and the mean SDS score was 50.08±5.52.These suggested a prevalence of sleep and psychological abnormalities.There was a significant correlation between the indicators of ocular surface function(OSDI,tear film break-up time,fluorescein staining,and Schirmer I test)and PSQI,SAS,and SDS scores(P<0.05).Moreover,multiple regression revealed that age≥50 years(β=1.55,P=0.029),PSQI scores(β=0.58,P<0.001),SAS scores(β=0.17,P=0.017),and SDS scores(β=0.15,P=0.019)were independent predictors of the OSDI scores.CONCLUSION Ocular surface function in patients with DED is closely related to sleep quality and anxiety/depression,emphasizing the need for holistic clinical management.展开更多
BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis ...BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis and heart failure has rarely been observed in cases of pediatric patients with CH pathology.Here,we explored the etiological relationship between CH,heart failure,and refractory lactic acidosis to reflect the importance of thyroid function screening in neonates with heart disease.CASE SUMMARY A 33-day-old extremely premature female infant presented with tachypnea,respiratory distress,recurrent infections,and abdominal distension postnatal.On admission to our facility,she had cardiomegaly,hepatomegaly,and lactic acidosis(revealed on blood gas analysis),with lactate progressively rising to 25 mmol/L.Chest radiographs showed pulmonary congestion,while echocardiography revealed cardiac enlargement,left ventricular wall thickening,and pericardial effusion.Initial management aimed at correcting acidosis and treating heart failure proved ineffective.After reassessment,thyroid function tests showed significantly decreased triiodothyronine,free triiodothyronine,thyroxine,and free thyroxine levels,with a significantly increased thyroidstimulating hormone level,confirming a CH diagnosis.Levothyroxine was administered,resulting in rapid correction of lactic acidosis and gradual improvement of thyroid function and systemic symptoms,culminating in full recovery and discharge.We also reviewed the relevant literature on thyroid and cardiac dysfunctions in order to explore their deeper association.CONCLUSION This case links CH-induced heart failure with refractory lactic acidosis,urging prompt thyroid screening in affected neonates to reduce mortality.展开更多
Vitamin D deficiency(VDD)represents a significant nutritional concern among children and adolescents.The estimated prevalence of VDD in China is 46.8%in this population^([1]).VDD during childhood and adolescence has b...Vitamin D deficiency(VDD)represents a significant nutritional concern among children and adolescents.The estimated prevalence of VDD in China is 46.8%in this population^([1]).VDD during childhood and adolescence has been associated with the onset of various conditions,including acute respiratory infections,asthma,atopic dermatitis,and food allergies^([2]).Multiple factors,including age,sun exposure,adiposity,and genetics,influence vitamin D levels^([2,3]).Increasing attention has been directed toward understanding the environmental determinants that may influence vitamin D status.Given the potential of metallic pollutants to disrupt endocrine function and their ubiquity in the environment,investigating the effects of metal exposure on human vitamin D status,particularly in vulnerable populations,is imperative.展开更多
AIM To describe contrast-enhanced ultrasound(CEUS) features and evaluate differential diagnosis value of CEUS and conventional ultrasound for patients with benign and malignant gallbladder lesions. METHODS This study ...AIM To describe contrast-enhanced ultrasound(CEUS) features and evaluate differential diagnosis value of CEUS and conventional ultrasound for patients with benign and malignant gallbladder lesions. METHODS This study included 105 gallbladder lesions. Before surgical resection and pathological examination, conventional ultrasound and CEUS were performed to examine for lesions. Then, all the lesions were diagnosed as(1) benign,(2) probably benign,(3) probably malignant or(4) malignant using both conventional ultrasound and CEUS. The CEUS features of these gallbladder lesions were analyzed and diagnostic efficiency between conventional ultrasound and CEUS was compared.RESULTS There were total 17 cases of gallbladder cancer and 88 cases of benign lesion. Some gallbladder lesions had typical characteristics on CEUS(e.g., gallbladder adenomyomatosis had typical characteristics of small nonenhanced areas on CEUS). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CEUS were 94.1%, 95.5%, 80.0%, 98.8%and 95.2%, respectively. These were significantly higher than conventional ultrasound(82.4%, 89.8%, 60.9%, 96.3% and 88.6%, respectively). CEUS had an accuracy of 100% for gallbladder sludge and CEUS helped in differential diagnosis among gallbladder polyps, gallbladder adenoma and gallbladder cancer.CONCLUSION CEUS may provide more useful information and improve the diagnosis efficiency for the diagnosis of gallbladder lesions than conventional ultrasound.展开更多
AIM To establish a modified B-ultrasound method of measuring the antral section only to assess gastric motility in healthy people,and evaluate its application in guiding enteral nutrition(EN) in critically ill patient...AIM To establish a modified B-ultrasound method of measuring the antral section only to assess gastric motility in healthy people,and evaluate its application in guiding enteral nutrition(EN) in critically ill patients. METHODS First,30 healthy volunteers were selected. The modified B-ultrasound method and the traditional B-ultrasound method were applied to assess gastric function. The correlation of indices of gastric function between the two groups was analyzed statistically. In addition,64 critically ill patients were selected,and the modified B-ultrasound method and the gastric juice withdrawal method were applied to guide the implementation of EN. Daily caloric value,the time required to achieve complete EN,ICU stay,hospitalization time,and serum prealbumin and albumin levels were recorded and compared between the two groups. Kaplan-Meier survival curve was used to compare the complications of EN between the two groups. RESULTS In healthy subjects,there was a good correlation among gastric emptying time,antral contraction frequency andantral motility index between the two groups(r = 0.57,0.61 and 0.54,respectively). The study on critically ill patients also revealed that a better effect of EN was achieved in the modified B-ultrasound method group,in which patients had shorter ICU stay and hospitalization time and higher levels of serum prealbumin and albumin. The Kaplan-Meier survival analysis revealed that the improved B-ultrasound method was associated with significantly fewer EN complications(P = 0.031).CONCLUSION The modified B-ultrasound method can provide a good real-time assessment of gastric function and has a better effect than the traditional method in guiding EN in critically ill patients.展开更多
BACKGROUND Cervical lymph node metastasis in papillary thyroid carcinoma(PTC) affects the treatment and prognosis of patients. Ultrasound is a common imaging method for detecting cervical lymph nodes in PTC patients; ...BACKGROUND Cervical lymph node metastasis in papillary thyroid carcinoma(PTC) affects the treatment and prognosis of patients. Ultrasound is a common imaging method for detecting cervical lymph nodes in PTC patients; however, it is not accurate in determining lymph node metastasis.AIM To evaluate the value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in PTC.METHODS A total of 94 patients with PTC were recruited. According to pathological results,lymph nodes were divided into two groups: metastatic group(n = 50) and reactive group(n = 63). The routine ultrasound findings, contrast-enhanced ultrasound and elastography data were recorded and compared. Logistic regression was used to generate predictive probability distributions for the diagnosis of lymph node metastasis with different indicators. Receiver operating characteristic curve analysis was used to test the efficacy of contrast-enhanced ultrasound combined with elastography based on routine ultrasound in evaluating PTC cervical lymph node metastasis.RESULTS The ratio of long diameter/short diameter(L/S) ≤ 2, irregular marginal morphology, missing lymphatic portal, peripheral or mixed blood flow distribution, peak intensity(PI), non-uniform contrast distribution and elasticity score in the metastatic group were significantly higher than those in the reactive group(P < 0.05). L/S ratio, missing lymphatic portal, PI and elasticity score had a significant influence on the occurrence of PTC cervical lymph node metastasis(P< 0.05). Furthermore, the area under the curve(AUC) for lymph node metastasis diagnosed using the combination of PI ratio, elasticity score, missing lymphatic portal and LS was 0.936, which was significantly higher than the AUC for PI ratio alone. The difference was statistically significant(P < 0.05). The fitting equation for the combined diagnosis was logit(P) =-12.341 + 1.482 × L/S ratio + 3.529 ×missing lymphatic portal + 0.392 × PI + 3.288 × elasticity score.CONCLUSION Based on the gray-scale ultrasound, the combination of contrast-enhanced ultrasound and elastography can accurately assess PTC cervical lymph node metastasis.展开更多
Nerve growth factor(NGF)plays an important role in promoting neuroregeneration after peripheral nerve injury.However,its effects are limited by its short half-life;it is therefore important to identify an effective mo...Nerve growth factor(NGF)plays an important role in promoting neuroregeneration after peripheral nerve injury.However,its effects are limited by its short half-life;it is therefore important to identify an effective mode of administration.High-frequency ultrasound(HFU)is increasingly used in the clinic for high-resolution visualization of tissues,and has been proposed as a method for identifying and evaluating peripheral nerve damage after injury.In addition,HFU is widely used for guiding needle placement when administering drugs to a specific site.We hypothesized that HFU guiding would optimize the neuroprotective effects of NGF on sciatic nerve injury in the rabbit.We performed behavioral,ultrasound,electrophysiological,histological,and immunohistochemical evaluation of HFU-guided NGF injections administered immediately after injury,or 14 days later,and compared this mode of administration with intramuscular NGF injections.Across all assessments,HFU-guided NGF injections gave consistently better outcomes than intramuscular NGF injections administered immediately or 14 days after injury,with immediate treatment also yielding better structural and functional results than when the treatment was delayed by 14 days.Our findings indicate that NGF should be administered as early as possible after peripheral nerve injury,and highlight the striking neuroprotective effects of HFU-guided NGF injections on peripheral nerve injury compared with intramuscular administration.展开更多
AIM： To study the portal hemodynamics and their relationship with the size of esophageal varices seen at endoscopy and to evaluate whether these Doppler ultrasound parameters might predict variceal bleeding in patien...AIM： To study the portal hemodynamics and their relationship with the size of esophageal varices seen at endoscopy and to evaluate whether these Doppler ultrasound parameters might predict variceal bleeding in patients with liver cirrhosis and portal hypertension. METHODS： One hundred and twenty cirrhotic patients with esophageal varices but without any previous bleeding were enrolled in the prospective study. During a 2-year observation period, 52 patients who had at least one episode of acute esophageal variceal hemorrhage constituted the bleeding group, and the remaining 68 patients without any previous hemorrhage constituted the non-bleeding group. All patients underwent endoscopy before or after color Doppler-ultrasonic examination, and images were interpreted independently by two endoscopists. The control group consisted of 30 healthy subjects, matched to the patient group in age and gender. Measurements of diameter, flow direction and flow velocity in the left gastric vein （LGV） and the portal vein （PV） were done in all patients and controls using color Doppler unit. After baseline measurements, 30 min after oral administration of 75 g glucose in 225 mL, changes of the diameter, flow velocity and direction in the PV and LGV were examined in 60 patients with esophageal varices and 15 healthy controls. RESULTS： The PV and LGV were detected successfully in 115 （96%） and 105 （88%） of 120 cirrhotic patients, respectively, and in 27 （90%） and 21 （70%） of 30 healthy controls, respectively. Among the 120 cirrhotic patients, 37 had F1, 59 had F2, and 24 had F3 grade varices. Compared with the healthy controls, cirrhotic group had a significantly lower velocity in the PV, a significantly greater diameter of the PV and LGV, and a higher velocity in the LGV. In the cirrhotic group, no difference in portal flow velocity and diameter were observed between patients with or without esophageal variceal bleeding （EVB）. However, the diameter and blood flow velocity of the LGV were significantly higher for EVB （＋） group compared with EVB （-） group （P〈0.01）. Diameter of the LGV increased with enlarged size of varices. There were differences between F1 and F2, F1 and F3 varices, but no differences between F2 and F3 varices （P = 0.125）. However, variceal bleeding was more frequent in patients with a diameter of LGV 〉6 mm. The flow velocity in the LGV of healthy controls was 8.70＋1.91 cm/s （n = 21）. In patients with liver cirrhosis, it was 10.3＋2.1 cm/s （n = 12） when the flow was hepatopetal and 13.5＋2.3 cm/s （n = 87） when it was hepatofugal. As the size of varices enlarged, hepatofugal flow velocity increased （P〈0.01） and was significantly different between patients with F1 and F2 varices and between patients with F2 and F3 varices. Variceal bleeding was more frequent in patients with a hepatofugal flow velocity 〉15 cm/s （32 of 52 patients, 61.5%）. Within the bleeding group, the mean LGV blood flow velocity was 16.6＋2.62 cm/s. No correlation was observed between the portal blood flow velocity and EVB. In all healthy controls, the flow direction in the LGV was hepatopetal, toward the PV. In patients with F1 varices, flow direction was hepatopetal in 10 patients, to-and-fro state in 3 patients, and hepatofugal in the remaining 18. The flow was hepatofugal in 91% patients with F2 and all F3 varices. Changes in diameter of the PV and LGV were not significant before and after ingestion of glucose （PV： 1.41＋1.5 cm before and 1.46＋1.6 cm after; LGV： 0.57＋1.7 cm before and 0.60＋1.5 cm after）. Flow direction in the LGV was hepatopetal and to-and-fro in 16 patients and hepatofugal in 44 patients before ingestion of glucose. Flow direction changed to hepatofugal in 9 of 16 patients with hepatopetal and to-and-fro blood flow after ingestion of glucose. In 44 patients with hepatofugal blood flow in the LGV, a significant increase in hepatofugal flow velocity was observed in 38 of 44 patients （86%） with esophageal varices. There was a relationship between the percentage changes in flow velocity and the size of varices. Patients who responded excessively to food ingestion might have a high risk for bleeding. The changes of blood flow velocity in the LGV were greater than those in the PV （LGV： 28.3＋26.1%, PV： 7.2＋13.2%, P〈0.01）, whereas no significant changes in the LGV occurred before and after ingestion of glucose in the control subjects. CONCLUSION： Hemodynamics of the PV is unrelated to the degree of endoscopic abnormalities in patients with liver cirrhosis. The most important combinations are endoscopic findings followed by the LGV hemodynamics. Duplex-Doppler ultrasonography has no value in the identification of patients with cirrhosis at risk of variceal bleeding. Hemodynamics of the LGV appears to be superior to those of the PV in predicting bleeding.展开更多
文摘Background:Congenital hepatic hemangioma(CHH)is a rare benign vascular tumor that occurs prenatally.However,only a few cases have been summarized and evaluated for the prenatal and postnatal imaging features of CHH,and no studies have conducted long-term follow-up on it.This study aimed to explore the ultrasound and magnetic resonance features,growth patterns,and clinical outcomes of CHH.Methods:Thirty-six pregnancies with a prenatal fetal diagnosis and postnatal diagnosis of CHH were studied.CHHs were grouped into those with a diameter≥4 cm and those with a diameter<4 cm according to the largest diameter.Fisher's exact test was used to compare the imaging characteristics between the groups.The volume of CHHs was measured at each follow-up visit to plot the growth pattern of the tumors,and the volume of CHHs was compared before and after birth using a rank sum test analysis.Results:Thirty-three cases of CHHs were confirmed by postnatal imaging,and three were confirmed by a biopsy.Mixed echoes were more common in the diameter≥4 cm group than in the diameter<4 cm group(p=0.026).Complications were more likely to occur in the large-diameter group.Eighteen(54.5%)cases were classified as rapidly involuting congenital hemangioma,nine(27.3%)as partially involuting congenital hemangioma,and two(6.1%)as noninvoluting congenital hemangioma.A new type of CHH was identified in which four(12.1%)cases continued to proliferate after birth and spontaneously subsided in subsequent months.The CHH volume decreased with age and was significantly decreased at 9 months postnatal compared to birth(p=0.001).Conclusion:This study showed the imaging features of CHH were associated with the lesion size.Based on postnatal follow-up,a new type of CHH was identified.If there are no complications at birth in CHH cases,a good prognosis is indicated.
文摘BACKGROUND Congenital cytomegalovirus(CMV)infection represents a significant public health concern as the most prevalent viral infection in newborns,potentially leading to severe neurological and developmental complications.The majority of cases are asymptomatic and remain undetected during pregnancy due to the absence of effective screening methods.CASE SUMMARY A 27-year-old primigravida presented for early pregnancy ultrasound,which revealed an atypical finding:A normal anechoic thalamus appearing hyperechoic on the mid-sagittal view of the fetal head.Subsequent ultrasound examinations during mid and late gestation demonstrated classic intracranial features sug-gestive of congenital CMV infection.Chromosomal karyotyping and microarray analysis of the fetus yielded no significant abnormalities.Following compre-hensive prenatal counseling regarding potential adverse fetal outcomes,the patient elected to continue her pregnancy.She ultimately underwent cesarean delivery at 42 weeks gestation at another facility,resulting in the birth of a female neonate.At five months of age,the infant presented with epilepsy and significant growth and developmental delays.CONCLUSION Congenital CMV infection occurs during the first trimester may manifest as hyperechoic thalamus which can be revealed by ultrasound in the mid-saggital view of the fetal head.Future research should investigate the correlation between echogenic thalamus and developmental outcomes,as well as explore early sc-reening techniques for suspected congenital CMV infection cases.
基金Supported by Basic and Applied Basic Research Foundation of Guangdong Province,No.2023A1515220135Guangdong Provincial Medical Science and Technology Project Fund,No.A2023502.
文摘BACKGROUND Crohn's disease(CD)-related small bowel adenocarcinoma(SBA)is a rare adenocarcinoma that is difficult to detect and diagnose in its early stages and is associated with long-standing inflammation,which may predispose patients with CD to SBA.This case report describes a patient with CD who was diagnosed with SBA using intestinal ultrasonography(IUS).CASE SUMMARY A 38-year-old male diagnosed with CD since 23 years of age was maintained in remission with mesalamine,although he did not take his medication regularly.The patient presented with recurrent dull abdominal pain,bloating,and a threemonth history of diarrhea(3 times per day)with unformed stools.Abdominal examination revealed mildly diffuse tenderness.IUS revealed eccentric thickening(23 mm)in the terminal ileum.The hierarchical structure of the intestinal wall disappeared,revealing the“pseudo-kidney”sign.A stricture was identified in the terminal ileum with dilation of the proximal intestinal tract.Color Doppler flow imaging revealed linear blood flow.Contrast-enhanced ultrasound revealed highly heterogeneous enhancement with rapid washout in ileocecal junction,suggesting malignant transformation of CD with intestinal obstruction.Pathological examination revealed poorly differentiated adenocarcinoma of the ileocecal junction.CONCLUSION Active surveillance for SBA using IUS is prudent,given its advantages of realtime dynamic imaging,high-detail resolution,and low cost.
基金Supported by Natural Science Foundation of Fujian Province,No.2022J011285 and No.2023J011480Fuzhou Municipal Bureau of Science and Technology Program Fund,No.2021-S-109+1 种基金Provincial Subsidy Fund for Health and Wellness from Fujian Provincial Department of Finance,No.BPB-2022YXJFujian Provincial Health Technology Project,No.2020GGB032。
文摘BACKGROUND Hepatocellular carcinoma(HCC)is a major global contributor to cancer-related mortality,with advanced stages presenting substantial therapeutic challenges.Although targeted immunotherapy shows potential,many patients exhibit poor responses,underscoring the need for predictive tools to optimize treatment strategies.Emerging data indicate that ultrasound features(e.g.,tumor stiffness)and serum biomarkers may serve as predictors of treatment outcomes.However,an integrated model for these predictors remains unavailable.This paper introduces a machine learning-based approach that combines ultrasound and serological data to forecast immunotherapy efficacy in patients with advanced HCC.AIM To develop a non-invasive predictive model for targeted immunotherapy in advanced HCC,incorporating both internal and external validation.METHODS Patients with advanced HCC who received targeted immunotherapy at two medical centers were enrolled and divided into internal training,internal validation,and external validation cohorts.Comprehensive clinical data were gathered.Initially,13 machine learning algorithms were tested using the internal training cohort.The algorithm yielding the highest area under the curve(AUC)in the internal validation cohort was selected to construct a predictive model,termed the Target Immunotherapy Predictive Model(TIPM).TIPM performance was then compared with that of traditional tumor staging systems(tumor-node-metastasis,Barcelona Clinic Liver Cancer,China Liver Cancer,Hong Kong Liver Cancer,and C-reactive protein and alpha-fetoprotein in immunotherapy).RESULTS A total of 306 patients participated in the study,with 143 in the internal training cohort,62 in the internal validation cohort,and 101 in the external validation cohort.In the internal validation cohort,the random forest model achieved the highest AUC(0.975,95%confidence interval:0.924-0.998).The key predictors for TIPM were tumor size,platelet count,tumor stiffness change,and white blood cell count.During external validation,TIPM outperformed conventional models,reaching an AUC of 0.899(95%confidence interval:0.840-0.957).Calibration curves demonstrated strong concordance with observed outcomes,while decision curve analysis confirmed TIPM’s enhanced clinical value.Additional metrics,such as the net reclassification index and integrated discrimination improvement,further supported TIPM’s superior predictive accuracy.CONCLUSION TIPM provides a robust tool for predicting targeted immunotherapy efficacy in advanced HCC,facilitating personalized treatment planning.
基金Supported by the Fujian Province Science and Technology Innovation Joint Fund Project,No.2021Y9188。
文摘BACKGROUND Childhood intestinal lymphoma is characterized by its insidious onset and the absence of specific clinical symptoms.The thinner abdominal wall in children significantly aids in the ultrasound visualization of the abdominal cavity and intestines.Although many typical cases of intestinal lymphoma can be diagnosed through ultrasound,physicians often either overlook these values or assume that ultrasound has limited diagnostic value for intestinal lymphoma.AIM To clarify the diagnosis of intestinal lymphoma and classify its severity using ultrasound,as well as to correlate this with prognosis.METHODS The correlation between ultrasound diagnostic outcomes,laboratory indicators,and clinical prognosis was analyzed to demonstrate the effectiveness of ultrasound in assessing the severity of intestinal lymphoma and to provide new evidence for the diagnosis and treatment of the disease in children.A retro-spective analysis was conducted on the sonographic images and case data of 28 children diagnosed with intestinal lymphoma and confirmed by surgical pathology.Additionally,we sought to determine the correlation between ultrasonic classification of lymphoma,lactate dehydrogenase(LDH)values,pathological classification,and prognosis.RESULTS Ultrasound was utilized to categorize 28 cases of intestinal lymphoma into focal segmental(15 cases)and extensive(13 cases)types.Ultrasound classification and LDH levels were significantly correlated with prognosis(P<0.05),while pathological type,age,gender,and treatment modality showed no significant correlation(P>0.05).Among ultrasound manifestations,there was a significant difference in LDH levels between the segmental and extensive groups(P<0.05).The prognosis for children with extensive intestinal lymphoma was poorer than that for children with localized segmental intestinal lymphoma(P<0.05).CONCLUSION Ultrasound can be used in the diagnosis and classification of intestinal lymphoma in children.Extensive intestinal lymphoma is associated with significantly elevated LDH and poor prognosis.
基金Supported by Wenzhou Science and Technology Bureau,No.Y20240363.
文摘BACKGROUND The current study was to assess the application effects of conventional surgical techniques and ultrasound-guided precise localization technology for early gastric cancer(EGC),with an emphasis on long-term survival,postoperative complications,and surgical results.AIM To evaluate perioperative results,postoperative complications,and long-term survival in order to conduct a thorough comparison between conventional surgical techniques and ultrasound-guided precise localization technology for the treatment of EGC.METHODS Of 100 EGC patients were gathered,and they were subsequently divided into two groups based on the surgical technique used:The observation group(n=52)received surgery assisted by ultrasound-guided precise localization technology,whereas the control group(n=48)received traditional surgical treatment.The baseline characteristics were similar between the groups.Operation time,intraoperative hemorrhage,the number of lymph nodes removed,postoperative problems,survival rate,and other surgical and postoperative parameters were compared.RESULTS Compared with the control group,the observation group had significantly less intraoperative blood loss(80 mL vs 120 mL,P<0.05)and more dissected lymph nodes(28 vs 22,P<0.05).There were fewer postoperative complications in the observation group than in the routine group(8%vs 16%,P<0.05),hospitalization after surgery was shorter,and gastrointestinal function returned sooner.The long-term survival rates at 5 years and 3 years were significantly greater in the observation group than in the control group:82%and 88%vs 70%and 78%,respectively(P<0.05).CONCLUSION It is possible that ultrasound-guided accurate localization technology might be utilized more widely in clinical practice because it could significantly enhance the results of surgery for EGC,including reduced blood loss,better lymphadenectomy,lower complication rates,and improved survival rates.Further studies should aim to refine this technology and consider its utility in other types of oncologic surgery.
文摘BACKGROUND Preoperative distinguishing between benign and malignant gastrointestinal stromal tumors(GISTs)poses a challenge.Ultrasound elastography has emerged as a promising diagnostic tool;however,further investigation is needed to assess its diagnostic accuracy in evaluating GISTs.AIM To evaluate the accuracy of ultrasound elastography for differentiating between benign and malignant GISTs.METHODS This prospective study included 110 patients with 103 histopathologically confirmed GISTs between January 2021 and December 2023.All tumors underwent conventional ultrasound examination,strain elastography(SE),and shearwave elastography(SWE)before surgical resection.The study evaluated elastographic parameters such as strain ratio,elastographic patterns,mean elastic modulus,and heterogeneity index.Diagnostic performance was evaluated using receiver operating characteristic curve analysis,with histopathological diagnosis as the reference standard.RESULTS Of the 103 GISTs,45(43.7%)were benign and 58(56.3%)were malignant based on modified National Institutes of Health criteria.Malignant GISTs exhibited significantly higher strain ratios(4.82±1.73 vs 2.31±0.89;P<0.001)and mean elastic modulus values(45.6±15.8 kPa vs 21.3±8.4 kPa;P<0.001)than benign tumors.The optimal cutoff values were 3.45 for the strain ratio(sensitivity:84.5%,specificity:86.7%)and 32.5 kPa for the mean elastic modulus(sensitivity:87.9%,specificity:88.9%).The areas under the curve were 0.892 and 0.918,respectively.Interobserver agreement was excellent for both SE[intraclass correlation coefficient(ICC)=0.88]and SWE(ICC range:0.85-0.93)measurements.CONCLUSION Ultrasound elastography shows high diagnostic accuracy in distinguishing between benign and malignant GISTs.Combining SE and SWE provides complementary parameters for preoperative risk stratification.
基金Supported by the Agency Natural Science Foundation of Fujian Province,China,No.2022J011285 and No.2023J011480.
文摘BACKGROUND Severe esophagogastric varices(EGVs)significantly affect prognosis of patients with hepatitis B because of the risk of life-threatening hemorrhage.Endoscopy is the gold standard for EGV detection but it is invasive,costly and carries risks.Noninvasive predictive models using ultrasound and serological markers are essential for identifying high-risk patients and optimizing endoscopy utilization.Machine learning(ML)offers a powerful approach to analyze complex clinical data and improve predictive accuracy.This study hypothesized that ML models,utilizing noninvasive ultrasound and serological markers,can accurately predict the risk of EGVs in hepatitis B patients,thereby improving clinical decisionmaking.AIM To construct and validate a noninvasive predictive model using ML for EGVs in hepatitis B patients.METHODS We retrospectively collected ultrasound and serological data from 310 eligible cases,randomly dividing them into training(80%)and validation(20%)groups.Eleven ML algorithms were used to build predictive models.The performance of the models was evaluated using the area under the curve and decision curve analysis.The best-performing model was further analyzed using SHapley Additive exPlanation to interpret feature importance.RESULTS Among the 310 patients,124 were identified as high-risk for EGVs.The extreme gradient boosting model demonstrated the best performance,achieving an area under the curve of 0.96 in the validation set.The model also exhibited high sensitivity(78%),specificity(94%),positive predictive value(84%),negative predictive value(88%),F1 score(83%),and overall accuracy(86%).The top four predictive variables were albumin,prothrombin time,portal vein flow velocity and spleen stiffness.A web-based version of the model was developed for clinical use,providing real-time predictions for high-risk patients.CONCLUSION We identified an efficient noninvasive predictive model using extreme gradient boosting for EGVs among hepatitis B patients.The model,presented as a web application,has potential for screening high-risk EGV patients and can aid clinicians in optimizing the use of endoscopy.
文摘BACKGROUND Ultrasound classification can be used to determine the severity of adhesive intestinal obstruction and to guide the formulation of treatment plans.AIM To explore the value of ultrasound classification in disease judgment and treatment plan formulation for patients with adhesive intestinal obstruction.METHODS The medical records of 120 patients with adhesive intestinal obstruction presenting at Taihe Hospital Affiliated with Hubei Medical College were retrospectively analyzed from January 2022 to January 2024 according to the severity of ultrasound images,divided into simple(mild),complex(moderate),and critical(severe),analyzing the imaging characteristics of patients with different ultrasound classifications,and developing the corresponding treatment plan according to the ultrasound typing results,that is,conservative treatment and surgical treatment,contrast the ultrasound signs of patients in the conservative vs surgical treatment groups,and the value of ultrasound classification in the treatment of adhesive ileus.RESULTS Among the 120 patients,P>0.05,compared with the general data(sex,age,body quality index,time to onset,and history of onset),the proportion of bowel distension and abdominal effusion(P>0.05),and the proportion of adhesion mass and cross-cross in the conservative treatment group,P<0.05.CONCLUSION Ultrasound typing can aid in the clinical evaluation of the severity of adhesive intestinal obstruction and provide an imaging reference for clinicians to develop targeted treatment plans.
基金Supported by National Natural Science Foundation of China,No.82170858 and No.82470935.
文摘Thyroid-associated ophthalmopathy(TAO),an autoimmune disorder closely associated with thyroid dysfunction,requires timely diagnosis and ongoing accurate evaluation to improve patient outcomes.With the global incidence of TAO increasing and significantly affecting the quality of life of patients,there is an urgent need for effective diagnostic tools.As a noninvasive imaging technique,ultrasound plays a pivotal role in diagnosing and managing TAO,particularly in the early detection of and monitoring of disease progression.Despite its advantages,ultrasound faces challenges such as limited resolution for deep orbital structures and a lack of standardized protocols,which can lead to diagnostic inaccuracies.This paper reviews the current status of ultrasound applications in TAO,including diagnostic utility,recent technological advances,and key challenges.It proposes strategies for future research and improvement,emphasizing analysis of ultrasound imaging data to develop biomarker stratification models.We propose an integrated multimodal framework that combines ultrasound elastography with deep learning to improve diagnostic precision.
基金supported by a grant from the National Natural Science Foundation of China (82171937)。
文摘Background:Balloon catheter isolation is a promising auxiliary method for thermal ablation treatment of liver cancer. We aimed to explore the safety and effectiveness of balloon catheter isolation-assisted ultrasound-guided percutaneous microwave ablation (MWA) in treating liver cancer in difficult anatomical locations.Methods:Data of 132 patients with 145 difficult-site liver cancer treated with ultrasound-guided percutaneous MWA were retrospectively analyzed. Participants were classified into the isolation (n=40)and non-isolation (n=92) groups based on whether the patients were treated using a balloon catheter prior to ablation. The major complication rates, local tumor residuals (LTR), and tumor follow-up for local tumor progression (LTP) at 6 and 12 months post-ablation were compared between the two groups.Results:The rates of major postoperative complications did not significantly differ between the isolation and non-isolation groups (2.5%vs. 4.3%, P=0.609). The postoperative LTR rates were significantly different between the isolation and non-isolation groups (4.8%vs. 17.5%, P=0.032). Balloon catheter isolation [odds ratio (OR)=0.225, 95%confidence interval (CI):0.085–0.595, P=0.009] and tumor diameter(OR=2.808, 95%CI:1.186–6.647, P=0.019) were identified as independent factors influencing LTR rate.The cumulative LTP rates at 6 and 12 months after ablation showed no significant differences between the isolation and non-isolation groups (2.6%vs. 7.9%, P=0.661;4.9%vs. 9.8%, P=0.676, respectively).Cox proportional hazards regression analysis showed that tumor diameter was an independent risk factor for cumulative LTP rate (OR=3.445, 95%CI:1.406–8.437, P=0.017).Conclusions:Balloon catheter isolation-assisted MWA was safe and effective in the treatment of difficultsite liver cancer. Additionally, tumor diameter significantly influenced LTR and LTP rates after ablation.
文摘Objective:To systematically evaluate global research trends on contrast-enhanced ultrasound(CEUS)in tumor diagnosis using bibliometric methods.Methods:Publications from January 2000 to June 2025 were retrieved from the Web of Science Core Collection(SCI-EXPANDED).Only English-language articles and reviews were included.A total of 3,493 records were analyzed.VOSviewer 1.6.20 were used for bibliometric and visualization analyses,covering annual output,countries and institutions,authors,journals,keyword co-occurrence,collaboration networks,and co-citation patterns.Results:The number of publications demonstrated steady growth with acceleration after 2018,peaking in 2021 and 2023(>350 papers/year).Dietrich Christoph F.was the most productive and influential author,while Chinese scholars(e.g.,Dong Yi,Wang Wen-Ping)and institutions such as Sun Yat-sen University and Fudan University emerged as leading contributors.European journals,particularly Ultrasound in Medicine and Biology and European Radiology,showed high academic influence.Keyword analysis revealed liver cancer,especially hepatocellular carcinoma,as the dominant research theme,with expanding applications in breast,renal,and prostate tumors.Collaboration networks highlighted strong partnerships between China and Europe,whereas North American participation remained limited.Co-citation analysis indicated that a small number of highly cited studies shaped the intellectual foundation of the field.Conclusion:CEUS research in tumor diagnosis has expanded rapidly,characterized by concentrated leadership,thematic diversification,and strengthening international collaboration.With advances in artificial intelligence,super-resolution imaging,and novel contrast agents,CEUS is expected to evolve from a diagnostic tool into an integrated platform for tumor detection,treatment monitoring,and personalized cancer care.
文摘BACKGROUND Dry eye disease(DED)is a multifactorial ocular surface disorder with rising prevalence.It is closely related to systemic health and psychological factors,such as sleep and mood disorders,which significantly impact the quality of life of patients.AIM To explore the correlations between ocular surface function,sleep quality,and anxiety/depression in patients with DED.METHODS This was a cross-sectional investigative study that included 358 patients with DED between January 2022 and January 2025.Ocular surface was assessed using the ocular surface disease index(OSDI),tear film break-up time,fluorescein staining score,and Schirmer I test.The Pittsburgh Sleep Quality Index(PSQI),Self-Rating Anxiety Scale(SAS),and Self-Rating Depression Scale(SDS)were used to evaluate sleep quality and anxiety/depression levels.Correlation and linear regression analyses were used to explore the relationships.RESULTS The mean PSQI score of the patients was 9.94±2.18;the mean SAS score was 47.30±4.90,and the mean SDS score was 50.08±5.52.These suggested a prevalence of sleep and psychological abnormalities.There was a significant correlation between the indicators of ocular surface function(OSDI,tear film break-up time,fluorescein staining,and Schirmer I test)and PSQI,SAS,and SDS scores(P<0.05).Moreover,multiple regression revealed that age≥50 years(β=1.55,P=0.029),PSQI scores(β=0.58,P<0.001),SAS scores(β=0.17,P=0.017),and SDS scores(β=0.15,P=0.019)were independent predictors of the OSDI scores.CONCLUSION Ocular surface function in patients with DED is closely related to sleep quality and anxiety/depression,emphasizing the need for holistic clinical management.
文摘BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis and heart failure has rarely been observed in cases of pediatric patients with CH pathology.Here,we explored the etiological relationship between CH,heart failure,and refractory lactic acidosis to reflect the importance of thyroid function screening in neonates with heart disease.CASE SUMMARY A 33-day-old extremely premature female infant presented with tachypnea,respiratory distress,recurrent infections,and abdominal distension postnatal.On admission to our facility,she had cardiomegaly,hepatomegaly,and lactic acidosis(revealed on blood gas analysis),with lactate progressively rising to 25 mmol/L.Chest radiographs showed pulmonary congestion,while echocardiography revealed cardiac enlargement,left ventricular wall thickening,and pericardial effusion.Initial management aimed at correcting acidosis and treating heart failure proved ineffective.After reassessment,thyroid function tests showed significantly decreased triiodothyronine,free triiodothyronine,thyroxine,and free thyroxine levels,with a significantly increased thyroidstimulating hormone level,confirming a CH diagnosis.Levothyroxine was administered,resulting in rapid correction of lactic acidosis and gradual improvement of thyroid function and systemic symptoms,culminating in full recovery and discharge.We also reviewed the relevant literature on thyroid and cardiac dysfunctions in order to explore their deeper association.CONCLUSION This case links CH-induced heart failure with refractory lactic acidosis,urging prompt thyroid screening in affected neonates to reduce mortality.
基金supported by grants from the National Natural Science Foundation of China(G.F.Wang,grant number 82204071)(P.Y.Su,grant numbers 81874268 and 82473655)the Research Funds of the Center for Big Data and Population Health of IHM(P.Y.Su,No.JKS2023016)Anhui Provincial Health Commission Scientific Research Project(Y.Zhou,No.AHWJ2023A30027)。
文摘Vitamin D deficiency(VDD)represents a significant nutritional concern among children and adolescents.The estimated prevalence of VDD in China is 46.8%in this population^([1]).VDD during childhood and adolescence has been associated with the onset of various conditions,including acute respiratory infections,asthma,atopic dermatitis,and food allergies^([2]).Multiple factors,including age,sun exposure,adiposity,and genetics,influence vitamin D levels^([2,3]).Increasing attention has been directed toward understanding the environmental determinants that may influence vitamin D status.Given the potential of metallic pollutants to disrupt endocrine function and their ubiquity in the environment,investigating the effects of metal exposure on human vitamin D status,particularly in vulnerable populations,is imperative.
基金Supported by the National Natural Science Foundation of China,No.81301232
文摘AIM To describe contrast-enhanced ultrasound(CEUS) features and evaluate differential diagnosis value of CEUS and conventional ultrasound for patients with benign and malignant gallbladder lesions. METHODS This study included 105 gallbladder lesions. Before surgical resection and pathological examination, conventional ultrasound and CEUS were performed to examine for lesions. Then, all the lesions were diagnosed as(1) benign,(2) probably benign,(3) probably malignant or(4) malignant using both conventional ultrasound and CEUS. The CEUS features of these gallbladder lesions were analyzed and diagnostic efficiency between conventional ultrasound and CEUS was compared.RESULTS There were total 17 cases of gallbladder cancer and 88 cases of benign lesion. Some gallbladder lesions had typical characteristics on CEUS(e.g., gallbladder adenomyomatosis had typical characteristics of small nonenhanced areas on CEUS). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CEUS were 94.1%, 95.5%, 80.0%, 98.8%and 95.2%, respectively. These were significantly higher than conventional ultrasound(82.4%, 89.8%, 60.9%, 96.3% and 88.6%, respectively). CEUS had an accuracy of 100% for gallbladder sludge and CEUS helped in differential diagnosis among gallbladder polyps, gallbladder adenoma and gallbladder cancer.CONCLUSION CEUS may provide more useful information and improve the diagnosis efficiency for the diagnosis of gallbladder lesions than conventional ultrasound.
基金Supported by Cangzhou Science and Technology Project,No.131302097
文摘AIM To establish a modified B-ultrasound method of measuring the antral section only to assess gastric motility in healthy people,and evaluate its application in guiding enteral nutrition(EN) in critically ill patients. METHODS First,30 healthy volunteers were selected. The modified B-ultrasound method and the traditional B-ultrasound method were applied to assess gastric function. The correlation of indices of gastric function between the two groups was analyzed statistically. In addition,64 critically ill patients were selected,and the modified B-ultrasound method and the gastric juice withdrawal method were applied to guide the implementation of EN. Daily caloric value,the time required to achieve complete EN,ICU stay,hospitalization time,and serum prealbumin and albumin levels were recorded and compared between the two groups. Kaplan-Meier survival curve was used to compare the complications of EN between the two groups. RESULTS In healthy subjects,there was a good correlation among gastric emptying time,antral contraction frequency andantral motility index between the two groups(r = 0.57,0.61 and 0.54,respectively). The study on critically ill patients also revealed that a better effect of EN was achieved in the modified B-ultrasound method group,in which patients had shorter ICU stay and hospitalization time and higher levels of serum prealbumin and albumin. The Kaplan-Meier survival analysis revealed that the improved B-ultrasound method was associated with significantly fewer EN complications(P = 0.031).CONCLUSION The modified B-ultrasound method can provide a good real-time assessment of gastric function and has a better effect than the traditional method in guiding EN in critically ill patients.
基金Supported by Shenzhen Science and Technology Plan Funding Project,No.201102125
文摘BACKGROUND Cervical lymph node metastasis in papillary thyroid carcinoma(PTC) affects the treatment and prognosis of patients. Ultrasound is a common imaging method for detecting cervical lymph nodes in PTC patients; however, it is not accurate in determining lymph node metastasis.AIM To evaluate the value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in PTC.METHODS A total of 94 patients with PTC were recruited. According to pathological results,lymph nodes were divided into two groups: metastatic group(n = 50) and reactive group(n = 63). The routine ultrasound findings, contrast-enhanced ultrasound and elastography data were recorded and compared. Logistic regression was used to generate predictive probability distributions for the diagnosis of lymph node metastasis with different indicators. Receiver operating characteristic curve analysis was used to test the efficacy of contrast-enhanced ultrasound combined with elastography based on routine ultrasound in evaluating PTC cervical lymph node metastasis.RESULTS The ratio of long diameter/short diameter(L/S) ≤ 2, irregular marginal morphology, missing lymphatic portal, peripheral or mixed blood flow distribution, peak intensity(PI), non-uniform contrast distribution and elasticity score in the metastatic group were significantly higher than those in the reactive group(P < 0.05). L/S ratio, missing lymphatic portal, PI and elasticity score had a significant influence on the occurrence of PTC cervical lymph node metastasis(P< 0.05). Furthermore, the area under the curve(AUC) for lymph node metastasis diagnosed using the combination of PI ratio, elasticity score, missing lymphatic portal and LS was 0.936, which was significantly higher than the AUC for PI ratio alone. The difference was statistically significant(P < 0.05). The fitting equation for the combined diagnosis was logit(P) =-12.341 + 1.482 × L/S ratio + 3.529 ×missing lymphatic portal + 0.392 × PI + 3.288 × elasticity score.CONCLUSION Based on the gray-scale ultrasound, the combination of contrast-enhanced ultrasound and elastography can accurately assess PTC cervical lymph node metastasis.
基金supported by the National Natural Science Foundation of China,No.81100922
文摘Nerve growth factor(NGF)plays an important role in promoting neuroregeneration after peripheral nerve injury.However,its effects are limited by its short half-life;it is therefore important to identify an effective mode of administration.High-frequency ultrasound(HFU)is increasingly used in the clinic for high-resolution visualization of tissues,and has been proposed as a method for identifying and evaluating peripheral nerve damage after injury.In addition,HFU is widely used for guiding needle placement when administering drugs to a specific site.We hypothesized that HFU guiding would optimize the neuroprotective effects of NGF on sciatic nerve injury in the rabbit.We performed behavioral,ultrasound,electrophysiological,histological,and immunohistochemical evaluation of HFU-guided NGF injections administered immediately after injury,or 14 days later,and compared this mode of administration with intramuscular NGF injections.Across all assessments,HFU-guided NGF injections gave consistently better outcomes than intramuscular NGF injections administered immediately or 14 days after injury,with immediate treatment also yielding better structural and functional results than when the treatment was delayed by 14 days.Our findings indicate that NGF should be administered as early as possible after peripheral nerve injury,and highlight the striking neuroprotective effects of HFU-guided NGF injections on peripheral nerve injury compared with intramuscular administration.
基金Supported by the Natural Science Foundation of Shanghai, No. 034119921
文摘AIM： To study the portal hemodynamics and their relationship with the size of esophageal varices seen at endoscopy and to evaluate whether these Doppler ultrasound parameters might predict variceal bleeding in patients with liver cirrhosis and portal hypertension. METHODS： One hundred and twenty cirrhotic patients with esophageal varices but without any previous bleeding were enrolled in the prospective study. During a 2-year observation period, 52 patients who had at least one episode of acute esophageal variceal hemorrhage constituted the bleeding group, and the remaining 68 patients without any previous hemorrhage constituted the non-bleeding group. All patients underwent endoscopy before or after color Doppler-ultrasonic examination, and images were interpreted independently by two endoscopists. The control group consisted of 30 healthy subjects, matched to the patient group in age and gender. Measurements of diameter, flow direction and flow velocity in the left gastric vein （LGV） and the portal vein （PV） were done in all patients and controls using color Doppler unit. After baseline measurements, 30 min after oral administration of 75 g glucose in 225 mL, changes of the diameter, flow velocity and direction in the PV and LGV were examined in 60 patients with esophageal varices and 15 healthy controls. RESULTS： The PV and LGV were detected successfully in 115 （96%） and 105 （88%） of 120 cirrhotic patients, respectively, and in 27 （90%） and 21 （70%） of 30 healthy controls, respectively. Among the 120 cirrhotic patients, 37 had F1, 59 had F2, and 24 had F3 grade varices. Compared with the healthy controls, cirrhotic group had a significantly lower velocity in the PV, a significantly greater diameter of the PV and LGV, and a higher velocity in the LGV. In the cirrhotic group, no difference in portal flow velocity and diameter were observed between patients with or without esophageal variceal bleeding （EVB）. However, the diameter and blood flow velocity of the LGV were significantly higher for EVB （＋） group compared with EVB （-） group （P〈0.01）. Diameter of the LGV increased with enlarged size of varices. There were differences between F1 and F2, F1 and F3 varices, but no differences between F2 and F3 varices （P = 0.125）. However, variceal bleeding was more frequent in patients with a diameter of LGV 〉6 mm. The flow velocity in the LGV of healthy controls was 8.70＋1.91 cm/s （n = 21）. In patients with liver cirrhosis, it was 10.3＋2.1 cm/s （n = 12） when the flow was hepatopetal and 13.5＋2.3 cm/s （n = 87） when it was hepatofugal. As the size of varices enlarged, hepatofugal flow velocity increased （P〈0.01） and was significantly different between patients with F1 and F2 varices and between patients with F2 and F3 varices. Variceal bleeding was more frequent in patients with a hepatofugal flow velocity 〉15 cm/s （32 of 52 patients, 61.5%）. Within the bleeding group, the mean LGV blood flow velocity was 16.6＋2.62 cm/s. No correlation was observed between the portal blood flow velocity and EVB. In all healthy controls, the flow direction in the LGV was hepatopetal, toward the PV. In patients with F1 varices, flow direction was hepatopetal in 10 patients, to-and-fro state in 3 patients, and hepatofugal in the remaining 18. The flow was hepatofugal in 91% patients with F2 and all F3 varices. Changes in diameter of the PV and LGV were not significant before and after ingestion of glucose （PV： 1.41＋1.5 cm before and 1.46＋1.6 cm after; LGV： 0.57＋1.7 cm before and 0.60＋1.5 cm after）. Flow direction in the LGV was hepatopetal and to-and-fro in 16 patients and hepatofugal in 44 patients before ingestion of glucose. Flow direction changed to hepatofugal in 9 of 16 patients with hepatopetal and to-and-fro blood flow after ingestion of glucose. In 44 patients with hepatofugal blood flow in the LGV, a significant increase in hepatofugal flow velocity was observed in 38 of 44 patients （86%） with esophageal varices. There was a relationship between the percentage changes in flow velocity and the size of varices. Patients who responded excessively to food ingestion might have a high risk for bleeding. The changes of blood flow velocity in the LGV were greater than those in the PV （LGV： 28.3＋26.1%, PV： 7.2＋13.2%, P〈0.01）, whereas no significant changes in the LGV occurred before and after ingestion of glucose in the control subjects. CONCLUSION： Hemodynamics of the PV is unrelated to the degree of endoscopic abnormalities in patients with liver cirrhosis. The most important combinations are endoscopic findings followed by the LGV hemodynamics. Duplex-Doppler ultrasonography has no value in the identification of patients with cirrhosis at risk of variceal bleeding. Hemodynamics of the LGV appears to be superior to those of the PV in predicting bleeding.
