Delamination of rotator cuff tears: Real-time dynamic ultrasound findings.

PURPOSE: The purpose of this study was to evaluate the value of diagnosing delaminated tears and ultrasonic characteristics on real-time dynamic ultrasound. MATERIALS AND METHODS: We enrolled 143 consecutive patients who underwent arthroscopic rotator cuff repair between April 2020 and January 2021. All patients were examined using real-time dynamic ultrasound of the shoulder within 2 weeks before arthroscopy. In our study, delaminated tears were defined as intratendinous horizontal splitting with or without the retraction of the articular or bursal layer of tendon. Delaminated tears were classified into three types on the basis of their shape: greater retraction of the articular layer (type I), greater retraction of the bursal layer (type II), and equal retraction of both layers (type III). The sensitivity and specificity of real-time dynamic ultrasound for evaluation of delaminated tears were calculated using arthroscopy findings as the gold standard. Ultrasonic imaging appearances of delaminated rotator cuff tears were further described. RESULTS: Of the 143 patients, 47 (32.9%) had delaminated tears as confirmed by arthroscopy; 35 of these tears involved the supraspinatus tendon and 12 involved both supraspinatus and infraspinatus tendons. Real-time dynamic ultrasound correctly diagnosed 36 of 47 delaminated tears with sensitivity 72.0% (57.2%-83.3%) and specificity 96.7% (90.2%-99.2%). Moreover, type I tear (n = 32) was more common than type II (n = 11) and type III tears (n = 4). Real-time dynamic ultrasound evaluated shape of type I, type II, and type III with a sensitivity and specificity of 56% and 80%, 72% and 83%, and 100% and 98%, respectively. Anechoic horizontal linear splitting of tendon, unequal retraction of the bursal and articular layers, and thinning of the suffering tendon were the three signs observed during real-time dynamic ultrasound examination. These three signs were indicative of a diagnosis of delaminated rotator cuff tears with high specificities (100.0%, 100.0%, and 97.9%, respectively) but relatively low sensitivities (25.5%, 25.5%, and 36.2%, respectively). CONCLUSION: Real-time dynamic ultrasound can be practically used for diagnosing delamination of rotator cuff tears with medium sensitivity and high specificity. Anechoic horizontal linear splitting of tendon, unequal retraction of the bursal and articular layers, and thinning of the involved tendon are the three important ultrasonic signs for diagnosis of delaminated rotator cuff tears.

Ultrasmall MoS2 nanodots-wrapped perfluorohexane nanodroplets for dual-modal imaging and enhanced photothermal therapy.

Development of a multifunctional nanotherapeutic agent with high contrast-enhanced dual-modal imaging and photothermal therapy (PTT) efficacy is of great interest. Combination of ultrasound (US) and computed tomography (CT) imaging offers high spatial resolution images, showing great potential in medical imaging. Herein, the semiconducting perfluorohexane (PFH) nanodroplets, MoS2-PFH-PLLAs, are developed by stabilizing PFH droplets with the coating shell of poly (lactic-co-glycolic acid) (PLLA) and encapsulating the droplets with photoabsorbers of ultrasmall molybdenum disulfide (MoS2) nanodots. Upon near-infrared (NIR) irradiation, the MoS2-PFH-PLLAs can absorb the NIR light and convert it into heat, which not only promotes liquid-to-gas phase transition of PFH but also triggers photothermal heating, resulting in contrast-enhanced US/CT imaging and photothermal killing effect in vitro. Furthermore, the production of microbubbles can serve as the blasting agents to collaboratively enhance PTT efficacy after NIR irradiation. When intravenously injected into tumor-bearing mice, the MoS2-PFH-PLLAs exhibit a dual-modal US/CT imaging-guided synergistically therapeutic efficacy under NIR irradiation, resulting in tumor ablation. These nanotherapeutic agents demonstrate good biocompatibility, highly contrast-enhanced US/CT imaging, and combinational enhanced PTT efficacy.

The molecular effects of ultrasound on the expression of cellular proteome.

High frequency and low intensity, diagnostic ultrasound methods are recognized to be safe in epidemiology and pathology but the bioeffects of these methods on molecular and proteomic levels are unknown. As a representative organism that can directly reflect the molecular response to stresses, Escherichia coli was selected for exposure to ultrasound probes C1-5, M5s and 9 L for 10 min and 20 min. ITRAQ was used to measure the expression of the cellular proteome. The results showed that both the frequency and time of exposure to ultrasound affected the proteome expression. Fifty biological processes were affected and nineteen metabolic processes, including carbohydrate metabolism, asparagine metabolism and phosphate import were differentially regulated. Lower frequency ultrasound caused copper export and iron­sulfur cluster biosynthesis upregulation. Nine proteins (GlpD, AsnB, TdcB, CopA, IscR, IscU, IscS, IscA, RecA) were key for the adaption to ultrasound. Accordingly, the results of the potential risks based on the calculation of the orthologous genome clarified that relevant pathways and potentially sensitive individuals were worthy of further study. These findings offer insights into reveal the bioeffects of ultrasound at the metabolic network and proteomic levels.

Phase-shifted pentafluorobutane nanoparticles for ultrasound imaging and ultrasound-mediated hypoxia modulation.

The integration of ultrasound (US) contrast enhancement with oxygen-loading nanoagents provide the synergistic strategy for simultaneously US imaging and hypoxic microenvironment modulation. Herein, we synthesize pentafluorobutane (PFB)-loading methoxy poly(ethylene glycol)-b-poly(l-lactide) (PLLA) nanoparticle as the novel US-contrast-enhanced agent and demonstrate that PFB@PLLA effectively loads oxygen. We characterize the nanosize, phase-transformation property and oxygen-loading amount of PFB@PLLA and investigate the effectiveness of these nanoagents in US-contrast-enhanced imaging. The PFB@PLLA displays a perfect temperature-responsive phase-transition property and its liquid-to-gas phase transition temperature is 45°C, which produces microbubbles in the targeted regions. Moreover, PFB@PLLA loads high amount of oxygen and US-triggering PFB@PLLA reoxygenation effectively inhibits the expression of hypoxia-related proteins (HIF-1α and CAIX), reduces lactate secretion and glycolysis, which modulates hypoxic microenvironment and inhibits cancer cell migration and invasion in vitro. This study demonstrates that the US contrast-enhanced activity of PFB@PLLAs and the promising utility of oxygen-loading nanoagents to improve hypoxic microenvironment.

Vertebral Artery Dissection Probably Caused by Massage: A Case Report.

MASSAGE has been recommended to more people as an adjunct to health care. We illustrate a case of vertebral artery dissection (VAD) probably caused by massage that almost resulted in the patient's death. The patient experienced sudden cardiac arrest and paralysis. After treatment with anticoagulation and antiplatelet, he finally discharged without any sequelae.