Nuevas perspectivas en el tratamiento del cáncer de tiroides de bajo riesgo. Experiencia con la lobectomía tiroidea en una cohorte de 114 pacientes / New perspectives in the management of low-risk thyroid cancer. Experience with thyroid lobectomy in a cohort of 114 patients

RESUMEN Antecedentes: el tratamiento del carcinoma diferenciado de tiroides (CDT) de bajo riesgo es aún motivo de discusión. En las últimas décadas se observó una migración hacia tratamientos personalizados acordes con las características de cada paciente y de cada tumor. Las guías de práctica vigentes habilitan la lobectomía en pacientes seleccionados, con bajo riesgo de recurrencia. Objetivo: describir los resultados en una cohorte de pacientes con CDT de bajo riesgo de recurrencia tratados con lobectomía tiroidea. Material y métodos: estudio observacional descriptivo de una revisión retrospectiva de historias clínicas de 114 pacientes con CDT tratados con lobectomía tiroidea entre enero de 2015 y abril de 2023. Resultados: fueron operados 114 pacientes, con media de edad de 44 años ± 12; 90 (79%) fueron mujeres. La mediana del tamaño tumoral fue de 9,4 mm, RIC (rango intercuartílico 25-75% 7-13 mm), y 103 de los nódulos (90%) fueron ecográficamente sólidos. Solo 2 pacientes con invasión vascular mayor de 4 vasos requirieron completar la tiroidectomía total. No se registraron complicaciones de importancia, salvo una parálisis recurrencial transitoria. Con un seguimiento promedio de 33,4 meses, no se observaron recurrencias locorregionales ni a distancia en la población analizada. Conclusión: la lobectomía tiroidea en el tratamiento del CDT de bajo riesgo tuvo una baja morbilidad sin recurrencias en la serie presentada. La selección rigurosa de los pacientes y la interacción de un equipo multidisciplinario se consideran esenciales para la implementación exitosa de esta metodología terapéutica.

ABSTRACT Background: The treatment of low-risk differentiated thyroid cancer (DTC) is still a matter of debate. Over the past few decades, there has been a shift towards a more personalized approach, tailored to the individual risks of each patient and tumor. The current practice guidelines recommend lobectomy in selected patients, with low risk of recurrence. Objective: To describe the results of thyroid lobectomy in a cohort of patients with DTC with low risk of recurrence. Material and methods: We conducted a descriptive and observational study. The medical records of patients with DTC who underwent thyroid lobectomy between January 2015 and April 2023 were retrospectively reviewed. Results: A total of 114 patients were operated on; mean age was 44 ± 12 years and 90 (79%) were women. The median tumor size was 9.4 mm (IQR 25-75% 7-13 mm), and 103 nodules (90%) were solid on ultrasound. Only 2 patients with vascular invasion involving > 4 vessels required completion thyroidectomy. There were no major complications and only one patient developed temporary recurrent laryngeal palsy. There were no locoregional or distant recurrences during mean follow-up of 33.4 months. Conclusion: Thyroid lobectomy for low-risk DTC had low morbidity and no recurrences in the series presented. The rigorous selection of patients and the interaction of a multidisciplinary team are considered essential for the successful implementation of this therapeutic approach.

Development of a grading diagnostic model for schistosomiasis-induced liver fibrosis based on radiomics and clinical laboratory indicators / 中国血吸虫病防治杂志

Objective To investigate the feasibility of developing a grading diagnostic model for schistosomiasis-induced liver fibrosis based on B-mode ultrasonographic images and clinical laboratory indicators. Methods Ultrasound images and clinical laboratory testing data were captured from schistosomiasis patients admitted to the Second People’s Hospital of Duchang County, Jiangxi Province from 2018 to 2022. Patients with grade I schistosomiasis-induced liver fibrosis were enrolled in Group 1, and patients with grade II and III schistosomiasis-induced liver fibrosis were enrolled in Group 2. The machine learning binary classification tasks were created based on patients’radiomics and clinical laboratory data from 2018 to 2021 as the training set, and patients’radiomics and clinical laboratory data in 2022 as the validation set. The features of ultrasonographic images were labeled with the ITK-SNAP software, and the features of ultrasonographic images were extracted using the Python 3.7 package and PyRadiomics toolkit. The difference in the features of ultrasonographic images was compared between groups with t test or Mann-Whitney U test, and the key imaging features were selected with the least absolute shrinkage and selection operator (LASSO) regression algorithm. Four machine learning models were created using the Scikit-learn repository, including the support vector machine (SVM), random forest (RF), linear regression (LR) and extreme gradient boosting (XGBoost). The optimal machine learning model was screened with the receiver operating characteristic curve (ROC), and features with the greatest contributions to the differentiation features of ultrasound images in machine learning models with the SHapley Additive exPlanations (SHAP) method. Results The ultrasonographic imaging data and clinical laboratory testing data from 491 schistosomiasis patients from 2019 to 2022 were included in the study, and a total of 851 radiomics features and 54 clinical laboratory indicators were captured. Following statistical tests (t = −5.98 to 4.80, U = 6 550 to 20 994, all P values < 0.05) and screening of key features with LASSO regression, 44 features or indicators were included for the subsequent modeling. The areas under ROC curve (AUCs) were 0.763 and 0.611 for the training and validation sets of the SVM model based on clinical laboratory indicators, 0.951 and 0.892 for the training and validation sets of the SVM model based on radiomics, and 0.960 and 0.913 for the training and validation sets of the multimodal SVM model. The 10 greatest contributing features or indicators in machine learning models included 2 clinical laboratory indicators and 8 radiomics features. Conclusions The multimodal machine learning models created based on ultrasound-based radiomics and clinical laboratory indicators are feasible for intelligent identification of schistosomiasis-induced liver fibrosis, and are effective to improve the classification effect of one-class data models.

Accuracy of Medial Tibiofemoral Joint Space Palpation Among Second-Year Doctor of Physical Therapy Students Using Ultrasound Verification: An Observational Study

Background: Palpation skills are universally taught in physical therapy education programs worldwide. Accurate palpation is necessary for diagnosis and to guide interventional approaches. The primary purpose of this investigation was to measure ultrasonographic-confirmed palpation accuracy of the medial tibiofemoral joint space among second-year Doctor of Physical Therapy students examining participants with characteristics representative of patients seen in clinical practice.Methods: Five second-year Doctor of Physical Therapy students served as examiners. Thirty-six participants contributed 67 knees for examination. The primary outcome was ultrasonographic-confirmed palpation accuracy, and the secondary outcomes evaluated the association between palpation accuracy and participant characteristics. Results: Pooled examiner accuracy was 39%. Chi-Square analyses revealed no association between pooled examiner palpation accuracy and BMI category (x2=1.46, p=0.48), age category (x2=0.21, p=0.65), sex (x2=1.47, p=0.23), skin tone (x2=0.06, p=0.81), or side of the examined knee (x2=0.27, p=0.61). Individual examiner palpation accuracy ranged from 14% to 75%, revealing a significant difference across examiners (x2=15.0, p=0.005). Two examiners had a combined accuracy of 64%, while the remaining 3 had a combined accuracy of 24%. Chi-Square analyses revealed no association between "successful" vs "unsuccessful" examiners and BMI category (x2=3.54, p=0.17), age category (x2=1.39, p=0.24), sex (x2=4.22, p=0.04), skin tone (x2=0.001, p=0.97), or side of the examined knee (x2=0.08, p=0.77). Conclusion: This investigation provides original data of ultrasonographic-confirmed palpation accuracy among second-year Doctor of Physical Therapy students examining participants with characteristics representative of patients seen in clinical practice. Results may help inform instructional approaches and curricular design in physical therapy education.

Bilateral versus unilateral erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a randomized controlled study

Abstract Introduction Laparoscopic cholecystectomy (LC) is the common surgical intervention for benign biliary diseases. Postoperative pain after LC remains as an important problem, with two components: somatic and visceral. Trocar entry incisions lead to somatic pain, while peritoneal distension with diaphragm irritation leads to visceral pain. Following its description by Forero et al., the erector spinae plane (ESP) block acquired considerable popularity among clinicians. This led to the use of ESP block for postoperative pain management for various operations. Materials and methods This study was conducted between January and June 2019. Patients aged between 18 and 65 years with an American Society of Anesthesiologists (ASA) physical status I-II, scheduled for elective laparoscopic cholecystectomy were included in the study. All the patients received bilateral or unilateral ESP block at the T8 level preoperatively according to their groups. Results There was no significant difference between the groups in terms NRS scores either at rest or while coughing at any time interval except for postoperative 6th hour (p = 0.023). Morphine consumption was similar between the groups but was significantly lower in group B at 12 and 24 hours (p = 0.044 and p = 0.022, respectively). Twelve patients in group A and three patients in group B had shoulder pain and this difference was statistically significant (p = 0.011). Discussion In conclusion, bilateral ESP block provided more effective analgesia than unilateral ESP block in patients undergoing elective LC. Bilateral ESP block reduced the amount of opioid consumption and the incidence of postoperative shoulder pain.

Advances in Molecular Targeted Ultrasound Contrast Agents / 中国医学科学院学报

In real-time ultrasound,molecular targeted contrast agent is introduced into the blood circulation through peripheral intravenous injection to enhance the imaging signal of target lesions after binding to the corresponding intravascular receptors,which can realize early diagnosis,staging of diseases,assessment of treatment response,and targeted treatment.In addition,molecular targeted ultrasound contrast agents provide a platform for the delivery of drugs and genes via microbubbles,and nanoscale contrast agents can be infiltrated through vascular endothelium into the interstitial space of the lesion for imaging or treatment.The available studies of molecular targeted ultrasound contrast agents mainly focus on the preclinical trials.Some clinical trials have been conducted in humans and preliminarily confirm the safety and feasibility of targeted ultrasound contrast agents.The molecular targeted ultrasound contrast agents enjoy a broad prospect in clinical application.

Evaluation of Extrathyroidal Extension of Papillary Thyroid Microcarcinoma With Three-Dimensional Tomographic Ultrasound Imaging / 中国医学科学院学报

Objective To evaluate extrathyroidal extension (ETE) in papillary thyroid microcarcinoma (PTMC) with three-dimensional tomographic ultrasound imaging (3D-TUI). Methods A total of 97 thyroid nodules of 79 patients with PTMC treated in PUMC Hospital from February 2016 to January 2018 were included in this study.Two ultrasound experts performed independent blinded assessment of the relationship between thyroid nodules and thyroid capsule by two-dimensional ultrasound (2D-US) and 3D-TUI.The results of 2D-US and 3D-TUI in evaluating ETE were compared with intraoperative findings and postoperative histological and pathological results. Results Among the 97 nodules,54 (55.7%) nodules had ETE.The diagnostic sensitivity (68.5% vs.37.0%;χ2=10.737,P=0.002),accuracy (74.5% vs.56.7%;χ2=6.686,P=0.015),and area under the receiver operating characteristic curve[0.761 (95%CI=0.677-0.845) vs.0.592 (95%CI=0.504-0.680);Z=3.500,P<0.001] of 3D-TUI were higher than those of 2D-US.However,3D-TUI and 2D-US showed no significant difference in the specificity (84.1% vs.81.4%;χ2=0.081,P=0.776),negative predictive value (67.9% vs.50.7%;χ2=3.645,P=0.066),or positive predictive value (84.1% vs.71.4%;χ2=1.663,P=0.240). Conclusion Compared with 2D-US,3D-TUI demonstrates increased diagnostic efficiency for ETE of PTMC.

Analysis on the diagnostic value of ABUS combined with DBT in dense type of intra-mammary breast cancer / 中国医学装备

Objective:To explore the diagnostic value of automatic breast ultrasound imaging system(ABUS)combined with digital breast tomosynthesis(DBT)for dense type of intra-mammary breast cancer.Methods:A total of 96 patients with dense type of intra-mammary breast cancer who admitted to hospital were selected,and all patients completed ABUS and DBT examinations within 1 week before they underwent the invasive operations such as puncture and surgery.Taking pathological results as the gold standard,the diagnostic values of ABUS and DBT for dense type of intra-mammary breast cancer were analyzed.Results:A total of 96 lesions were detected out from 96 patients by pathological examination.Based on the pathological results as the gold standard,the sensitivity,specificity and area under curve(AUC)value of ROC of ABUS were respectively 77.32%,82.53%and 0.711(95%CI:0.635～0.792)in diagnosing dense type of intra-mammary breast cancer.The sensitivity,specificity and AUC value of DBT were respectively 81.59%,80.23%and 0.734(95%CI:0.612～0.776)in diagnosing that.The sensitivity,specificity and AUC of ABUS combined with DBT were respectively 89.38%,92.46%and 0.787(95%CI:0.659～0.824)in diagnosing that.Conclusion:ABUS combined with DBT is beneficial to improve the clinical detection rate of dense type of intra-mammary breast cancer,and reduce the missed diagnosis of tumor without company of calcification lesion.

Assessing muscle stiffness using shear wave elastography / 中华物理医学与康复杂志

Objective:To measure the change in Young′s modulus of the biceps brachii during passive stretching and to assess the potential of shear wave elastography (SWE) as an auxiliary quantitative technique for assessing muscle tone.Methods:Forty-nine stroke survivors and 30 healthy subjects were evaluated using the modified Ashworth scale (MAS). According to their MAS scores they were divided into a healthy group, a healthy elbow group, an MAS class-0 group, an MAS class-1 group, an MAS class-1 + group and an MAS class-2 group. During passive extension of the subjects′ elbows, shear wave elastography was used to image the biceps brachii. Six points of the elbow were selected to record the instantaneous Young′s modulus ( EX) and calculate its change during the movement (Δ E). Those data were correlated with the MAS scores and compared among the groups. Results:Persons with higher MAS scores tended to have a higher Young′s modulus of the biceps brachii, and the modulus was likely to increase more with increases in the angle of elbow extension. From half of the range of motion to full extension there were significant differences in EX and Δ E between MAS class-0 and class-1 groups, as well as between the class-0 and class-1 + groups. There were, however, no significant differences between MAS class-1 and MAS class-1 + . Conclusions:MAS scores can usefully predict biceps brachii stiffness during passive elbow flexion. Shear wave elastography can quantify that stiffness and also muscle tone.

Application of WeChat-based PBL teaching method combined with micro-classroom in the teaching of contrast-enhanced gastrointestinal ultrasound imaging / 中华医学教育探索杂志

Objective:To investigate the application value of WeChat-based problem-based learning teaching method combined with micro-classroom in the teaching of contrast-enhanced gastrointestinal ultrasound imaging for residents in standardized residency training.Methods:A total of 40 trainees who underwent the standardized residency training in the Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University from January 2019 to June 2021 were selected as the research objects. They were randomly divided into the experimental group (WeChat-based PBL teaching method combined with micro-classroom) and the control group (traditional teaching method). The teaching content was the diagnosis of gastrointestinal ultrasound imaging. After the theoretical learning and practice, assessments of contrast-enhanced gastrointestinal ultrasound imaging including theory and operating practice were performed to all students. SPSS 22.0 was used for t test and rank sum test.Results:After training, the theoretical test scores of the experimental group were higher than those of the control group [(93.09±2.31) vs. (90.63±2.26)], and the difference was statistically significant ( P<0.05). However, there was no significant difference between the two groups in the number distribution of students at all levels of operational practice ( P>0.05). Conclusion:The WeChat-based PBL teaching method combined with micro-classroom is beneficial to improve students' knowledge of contrast-enhanced gastrointestinal ultrasound imaging, and is worth being popularized and applied in clinical teaching.

Statin indication according to the 2019 World Health Organization cardiovascular disease risk charts and carotid ultrasound in Mexican mestizo rheumatoid arthritis patients

Abstract Background: We aimed to assess the concordance of recommendation for initiating statin therapy according to the 2019 World Health Organization (WHO) cardiovascular disease (CVD) risk charts and to the presence of carotid plaque (CP) identified with carotid ultrasound in Mexican mestizo rheumatoid arthritis (RA) patients, and to determine the proportion of patients reclassified to a high cardiovascular risk after the carotid ultrasound was performed. Methods: This was a cross-sectional study nested of a RA patients' cohort. A total of 157 Mexican mestizo RA patients were included. The cardiovascular evaluation was performed using the 2019 WHO CVD risk charts (laboratory-based model) for the Central Latin America region. A carotid ultrasound was performed in all patients. The indication to start statin therapy was considered if the patient was classified as high risk, moderate risk if > 40 years with total cholesterol (TC) > 200 mg/dl or LDL-C > 120 mg/dl, and low risk if > 40 years with TC > 300 mg/dl, according to the WHO CVD risk chart or if the patient had carotid plaque (CP). Cohen's kappa (k) coefficient was used to evaluate the concordance between statin therapy initiation. Results: Initiation of statin therapy was considered in 49 (31.2%) patients according to the 2019 WHO CVD risk charts and 49 (31.2%) patients by the presence of CP. Cardiovascular risk reclassification by the presence of CP was observed in 29 (18.9%) patients. A slight agreement (k = 0.140) was observed when comparing statin therapy recommendations between 2019 WHO CVD risk charts and the presence of CP. Conclusion: The WHO CVD risk charts failed to identify a large proportion of patients with subclinical atherosclerosis detected by the carotid ultrasound and the concordance between both methods was poor. Therefore, carotid ultra-sound should be considered in the cardiovascular evaluation of RA patients.

Comparison of Clinical Examination and Various Imaging Modalities in the Diagnosis of Head and Neck Cancer

Abstract Introduction Squamous cell Carcinoma of the Head and Neck (HNSCC) is the most common tumor entity of malignant processes in the head and neck area. Due to the metastasizing behavior of these tumors, the staging is indispensable for the treatment planning and requires imaging techniques, which are sensitive, specific, and as far as possible cost-effective, to benefit ultimately the patient and to ensure optimal care. Objectives The aim of the present study is to compare the clinical examination including palpation, ultrasound and computed tomography (CT)/magnetic resonance imaging (MRI) for the diagnosis of neck metastases to make the correct indication for a neck dissection. Methods Data from 286 patients with HNSCC were analyzed for neck metastases to determine which diagnostic tool is the best to answer the question if a neck dissection is necessary or not. Each study method was examined retrospectively by comparing sensitivity, specificity, the positive/negative predictive value, the positive likelihood ratio and the diagnostic accuracy. Results The ultrasound showed a sensitivity of 91.52%, a specificity of 61.67%, a positive/negative predictive value of 76.65%/84.09%, a positive likelihood ratio of 2.39 and a diagnostic accuracy of 78.95%. The clinical examination showed a sensitivity of 75.76%, a specificity of 66.12%, a positive/negative predictive value of 75.30%/66.67%, a positive likelihood ratio of 2.24 and a diagnostic accuracy of 71.68%. The CT/MRI showed a sensitivity of 78.66%, a specificity of 62.50%, a positive/negative predictive value of 74.14%/68.18%, a positive likelihood ratio of 2.10 and a diagnostic accuracy of 71.83%. Radiographically, ultrasound, as well as the clinical examination, could be judged to be free from radiation load and side effects from the contrast medium. The high dependence on the investigator when using ultrasound made reproducibility of the results difficult. Conclusions It could be shown that ultrasound was the diagnostic tool with the highest sensitivity, positive/negative predictive value, positive likelihood ratio and diagnostic accuracy by detecting and interpreting metastases in the head and neck region correctly. Whether a neck dissection should be performed depends to a large extent on the ultrasound findings.

Application of multiple empirical kernel mapping ensemble classifier based on self-paced learning in ultrasound-based computer-aided diagnosis for breast cancer / 生物医学工程学杂志

Both feature representation and classifier performance are important factors that determine the performance of computer-aided diagnosis (CAD) systems. In order to improve the performance of ultrasound-based CAD for breast cancers, a novel multiple empirical kernel mapping (MEKM) exclusivity regularized machine (ERM) ensemble classifier algorithm based on self-paced learning (SPL) is proposed, which simultaneously promotes the performance of both feature representation and the classifier. The proposed algorithm first generates multiple groups of features by MEKM to enhance the ability of feature representation, which also work as the kernel transform in multiple support vector machines embedded in ERM. The SPL strategy is then adopted to adaptively select samples from easy to hard so as to gradually train the ERM classifier model with improved performance. This algorithm is verified on a B-mode ultrasound dataset and an elastography ultrasound dataset, respectively. The results show that the classification accuracy, sensitivity and specificity on B-mode ultrasound are (86.36±6.45)%, (88.15±7.12)%, and (84.52±9.38)%, respectively, and the classification accuracy, sensitivity and specificity on elastography ultrasound are (85.97±3.75)%, (85.93±6.09)%, and (86.03±5.88)%, respectively. It indicates that the proposed algorithm can effectively improve the performance of ultrasound-based CAD for breast cancers with the potential for application.

The Enhancement of Ultrasonic Visibility and Technical Requirements of Needles and Catheters / 中国医疗器械杂志

Ultrasound guided needle biopsy or catheterization is a rising operation in clinical diagnosis and treatment. However, poor visualization under ultrasound is the main disadvantage of this technique. This paper summarized the basic methods used to solve such problem, as well as the corresponding product technical requirements.

Mechanism of Wenjingtang on Improving Endometriosis in Rats Based on Regulating HIF-1α Expression / 中国实验方剂学杂志

Objective:To observe the effect of Wenjingtang on the expression of hypoxia inducible factor-1α （HIF-1α） and ultrastructure of mitochondria in rats with endometriosis （EMs）， and to explore the mechanism of Wenjingtang in the treatment of EMs. Method:The EMs model rat was established by autogenous intimal transplantation， and the volume of ectopic lesions was measured by small animal ultrasound imaging system. According to the volume of ectopic lesions， rats successfully modeled were randomly divided into model group， low， middle ang high dose Wenjingtang group （4.85， 9.7， 19.4 g·kg-1） and gestrinone group （0.25 mg·kg-1）， 10 in each group， another 10 rats were recruited in a sham operation group. After 6 weeks of drug treatment， the volume of ectopic lesions was measured by ultrasound imaging system and caliper， the morphology of ectopic endometrium was observed by hematoxylin-eosin （HE） staining， the levels of interleukin-1β （IL-1β）， tumor necrosis factor-α （TNF-α） and transforming growth factor-β1 （TGF-β1） in peritoneal fluid were measured by enzyme linked immunosorbent assay （ELISA）， the mRNA and protein expression of HIF-1α in eutopic or ectopic endometrial tissues were detected by Real-time fluorescent quantitative polymerase chain reaction （Real-time PCR） and Western blot， and the ultrastructure of mitochondria in ectopic endometrium was observed by transmission electron microscope （TEM）. Result:Compared with sham operation group， ectopic lesions were found in model group， showing vesicular structure， and the typical endometrial tissue morphology was found in the lesions. The contents of IL-1β， TNF-α， TGF-β1 and the expression of HIF-1α mRNA and protein were significantly increased than those in the sham operation group （P<0.05，P<0.01）. TEM showed that the number of mitochondria in the cytoplasm of ectopic endometrium increased and the structure was intact. Compared with model group， the volume of ectopic focus was significantly decreased in all Wenjingtang groups （P<0.01）， and the results of ultrasonic examination were basically consistent with those of caliper measurement， HE staining showed that the columnar epithelial cells of ectopic endometrium were damaged or exfoliated and the interstitial cells were loose， the content of TNF-α in each dose group of Wenjingtang was significantly decreased， the content of IL-1β and TGF-β1 in the medium dose and high dose groups of Wenjingtang was significantly decreased （P<0.05，P<0.01）， the expression of HIF-1α mRNA and protein were significantly decreased in all Wenjingtang groups （P<0.05，P<0.01）. The mitochondria of ectopic endometrium were obviously swollen， the crest was broken or even disappeared， some of the mitochondria were vacuolar degeneration and the outer membrane was ruptured. Conclusion:Wenjingtang has a good therapeutic effect on experimental EMs in rats， and the mechanism is related to reducing the expression of HIF-1α， improving hypoxia in ectopic lesions and inducing mitochondrial damage in ectopic endometrium.

Advances in the clinical application of imaging detection for caries / 口腔疾病防治

@#Dental caries detector is a kind of diagnostic tool specifically designed for dental professionals to detect and monitor the early occurrence and development of dental caries. They are widely used in the clinic because of their advantages of rapid detection, flexible applications, ease of carrying, intuitive detection results and lack of pain for the patient. However, due to the different types and principles of the instruments produced by various instrument manufacturers, the clinical application range, sensitivity and specificity of test results also show significant differences. In terms of the current clinical application effects, although the DIAGNOdent caries detector has the widest range of clinical use, the accuracy of its detection results needs to be improved because it is affected by factors such as pigments and dental materials. The Canary System caries detector can effectively avoid the interference of the above factors, but its classification of the degree of caries is not clear. The DIAGNOcam caries detector can effectively detect early caries, but it has low reliability for occlusal caries detection. The existing dental caries detectors on the market can be used only as clinical auxiliary tools, and the accuracy of the detection results and comprehensiveness of the detection range need further improvement. With the application of the new multispectral near-infrared scanning fiber endoscope (NIR-SFE) and high-frequency ultrasound imaging (HFUS) in the detection of dental caries, a more efficient and accurate diagnosis of dental caries is possible in the future. To this end, we still need to continue exploring new technology to help clinicians complete the early diagnosis and treatment of dental caries to improve the quality of life of their patients.

The value of MRI，EAS-EMG and TCS in identifying multi-system atrophy of P-type and Parkinson’s disease / 中风与神经疾病杂志

@#Objective　To explore the three auxiliary examinations of magnetic resonance imaging（MRI），anal sphincter electromyography（EAS-EMG） and transcranial ultrasound imaging（TCS） for multi-system atrophy of P-type（MSA-P） and Parkinson’s disease（PD） differential diagnostic value. Methods　Twenty-one patients with clinically diagnosed MSA-P and 33 patients with PD were enrolled. All of the patients underwent MRI，EAS-EMG，and TCS，and the medical records were comprehensive and preserved. The MRI，EAS-EMG and TCS results were compared and analyzed by the receiver operating characteristic（ROC） curves. Results　Slit-like hyperintensity in the posterolateral margin of the putamen，MUP mean time，mean amplitude，percentage of polyphase wave，incidence of spontaneous generation and satellite potential were higher in the MSA-P group than in the PD group. However，the high echogenic area of the substantia nigra，the ratio of the total area of the substantia nigra and the total area of the midbrain were lower than those of the PD group（both P<0.01）. The ROC curve showed that the slit-like hyperintensity in the posterolateral margin of the putamen had the highest specificity（97.0%） for the differential diagnosis of the two，the highest sensitivity of the hyperechoic area of the substantia nigra（81.0%），and the highest AUC of the MUP mean time（0.781）. The sensitivity of the three indicators combined to the differential diagnosis was 95.2%，and the AUC was 0.939.The differential diagnosis value was extremely high. Conclusion　The diagnostic value of MRI，EAS-EMG and TCS in MSA-P and PD is different and complement each other，and the combination of the three indicators has good diagnostic value.

Prenatal diagnosis of aortic arch malformation using tomographic ultrasound imaging / 中国医学影像技术

Objective: To explore the value of spatio-temporal image correlation (STIC) with tomographic ultrasound imaging (TUI) technique in diagnosis of fetal aortic arch malformation. Methods: Ultrasonic data of 45 fetuses diagnosed as aortic arch malformation were reviewed retrospectively. Three-vessel and trachea view of 2D echocardiography (2DE) were used to analyze the aortic arch position in relation to the trachea, and to find the aberrant brachiocephalic arteries. Volume data were obtained, and TUI reconstruction was used to form transverse and coronal TUI slices to observe the arch position, the aberrant left or right subclavian arteries, the origin and convergence of bilateral aortic arches. Results: Totally 5 fetuses of double aortic arch, 9 fetuses of left aortic arch with aberrant right subclavian arteries and 31 fetuses of right aortic arch were included. The accuracy rate of STIC-TUI in diagnosis of fetal aortic arch anomalies was significantly higher than that of 2DE (97.78% [44/45] vs 71.11% [32/45]; P<0.01). Conclusion: Fetal aortic arch malformation can be accurately diagnosed using STIC-TUI, which can be widely used with standardized post-analysis in the future.

Experiences of localization and removal of non-palpable subdermal contraceptive implants with ultrasound

OBJECTIVE: The aim of this study was to present experiences in localization and removal of non-palpable subdermal contraceptive implants with ultrasonography. METHODS: Medical records from January 1, 2016, to April 30, 2018, were retrospectively reviewed for 21 patients who were referred to a single institution and had an impalpable implant despite following the removal instruction. In all the cases, more than one attempt was made to remove the implant before referral. The rod was detected using radiography and ultrasonography. In all the cases, localization of the single implant was achieved with ultrasonography. The distal depth of the rod was measured, and skin marking was made following the echogenicity. The implants were subsequently removed under anesthesia. RESULTS: In 18 cases, the rods were localized using ultrasonography and successfully removed under local anesthesia. In the other three cases, removal with local anesthesia failed. Although the rod was detected successful with ultrasonography, the implants were removed under general anesthesia in the operating room. The depth from skin to rod, measured with ultrasonography, was >12.0 mm in all the cases and located deep in the muscular layer in the failure cases. The depth of the implants positively correlated with the time spent for removal (r=0.525; P=0.015). CONCLUSION: High frequency ultrasonography is a highly accurate tool for localization and measurement of the skin-to-rod depth. It is also useful for removing non-palpable implants. If the depth of the implant is >12.0 mm, removal of the implant in the operating room under general anesthesia is recommended.

An study of ultrasonic monitoring imaging of microwave ablation based on Nakagami statistic parameter / 生物医学工程学杂志

This paper explored the feasibility of using ultrasonic Nakagami statistic parameter imaging to evaluate the thermal lesion induced by microwave ablation (MWA) in porcine models. In this paper, thermal lesions were induced in livers and kidneys in 5 swines using a clinical MWA system. During this treatment progress, ultrasonic radiofrequency (RF) data were collected. The dynamic changes of Nakagami parameter in the thermal lesion were calculated, and the ultrasonic B-mode images and Nakagami images were reconstructed simultaneously. The contrast-to-noise ratio (CNR) between the thermal lesion and the surrounding normal tissue was calculated over the MWA procedure. After MWA, a bright hyperechoic region appeared in the ultrasonic Nakagami image as an indicator of the thermal lesion and this bright spot enlarged with lesion development during MWA exposure. The mean value of Nakagami parameter in the liver and kidney increased from 0.78 and 0.79 before treatment to 0.91 and 0.92 after treatment, respectively. During MWA exposure, the mean values of CNR calculated from the Nakagami parameter increased from 0.49 to 1.13 in the porcine liver and increased from 0.51 to 0.85 in the kidney, which were both higher than those calculated from the B-mode images. This study on porcine models suggested that the ultrasonic Nakagami imaging may provide an alternative modality for monitoring MWA treatment.

Multimodal Composite Iron Oxide Nanoparticles for Biomedical Applications

BACKGROUND: Iron oxide nanoparticles (IONPs) are excellent candidates for biomedical imaging because of unique characteristics like enhanced colloidal stability and excellent in vivo biocompatibility. Over the last decade, material scientists have developed IONPs with better imaging and enhanced optical absorbance properties by tuning their sizes, shape, phases, and surface characterizations. Since IONPs could be detected with magnetic resonance imaging, various attempts have been made to combine other imaging modalities, thereby creating a high-resolution imaging platform. Composite IONPs (CIONPs) comprising IONP cores with polymeric or inorganic coatings have recently been documented as a promising modality for therapeutic applications. METHODS: In this review, we provide an overview of the recent advances in CIONPs for multimodal imaging and focus on the therapeutic applications of CIONPs. RESULTS: CIONPs with phototherapeutics, IONP-based nanoparticles are used for theranostic application via imaging guided photothermal therapy. CONCLUSION: CIONP-based nanoparticles are known for theranostic application, longstanding effects of composite NPs in in vivo systems should also be studied. Once such issues are fixed, multifunctional CIONP-based applications can be extended for theranostics of diverse medical diseases in the future.