Origami-Inspired Soft Twisting Actuator.

Soft actuators have shown great advantages in compliance and morphology matched for manipulation of delicate objects and inspection in a confined space. There is an unmet need for a soft actuator that can provide torsional motion to, for example, enlarge working space and increase degrees of freedom. Toward this goal, we present origami-inspired soft pneumatic actuators (OSPAs) made from silicone. The prototype can output a rotation of more than one revolution (up to 435°), more significant than its counterparts. Its rotation ratio ( = rotation angle/aspect ratio) is more than 136°, about twice the largest one in other literature. We describe the design and fabrication method, build the analytical model and simulation model, and analyze and optimize the parameters. Finally, we demonstrate the potentially extensive utility of the OSPAs through their integration into a gripper capable of simultaneously grasping and lifting fragile or flat objects, a versatile robot arm capable of picking and placing items at the right angle with the twisting actuators, and a soft snake robot capable of changing attitude and directions by torsion of the twisting actuators.

Sonographic imaging features of alveolar soft part sarcoma: Case series and literature review.

BACKGROUND: Alveolar soft part sarcoma (ASPS) is a rare tumor but potentially fatal condition. Understanding the imaging and clinical features of ASPS is of certain value for preoperative qualitative diagnosis and clinical treatment of tumors. Nevertheless, there have been only 11 documented case reports describing the sonographic features in the English literature. METHODS: Three patients with confirmed ASPS occurring primarily in the limbs were enrolled in this study. Complete surgical excision was performed with conservative limb function. We pay particular attention to the ultrasonographic features and performed a literature review of ASPS cases. RESULTS: With regular surveillance, one patient had no symptom recurrence and two developed lung and/or breast metastasis later. The specific sonographic findings were heterogeneous hypoechoic, well-circumscribed, and lobulated or round contours on grayscale images, abundant flow signals of intratumoral and extratumoral tubular structures on color Doppler images. CONCLUSION SUBSECTIONS: Its low incidence rate and lack of characteristic clinical manifestations often result in misdiagnosis of ASPS. The specific sonographic findings may add useful diagnostic information.

Viscoelasticity assessment for in vivo quantification of muscle contusion injury in rats using shear wave elastography.

The aim of the study described here was to investigate the role of viscoelasticity in assessing muscle fibrosis and inflammation in a rat model of contusion using quantitative shear wave elastography (SWE). Unilateral gastrocnemius muscle contusion was induced in 32 male rats using an impactor apparatus. The contralateral muscles served as the control group. SWE was applied to the control group and rats 1, 3, 14 and 21 d after successful modeling (each time point group, n = 8). Histologic features were used as reference standards. The degree of fibrosis was moderately correlated with shear wave speed (r = 0.53), whereas the degree of inflammation was well correlated with shear wave dispersion (SWD) slope (r = 0.74). The area under the receiver operating characteristic curve (AUC) for the dispersion slope for muscle inflammation and fibrosis assessment was 0.87 (95% confidence interval: 0.705-0.963), which exceeded that of the shear wave speed (0.68, 95% confidence interval: 0.494-0.834). The larger decline in dispersion slope in the fibrotic stage than in the inflammation stage (1-d group vs. 14-d group or 21-d group, p < 0.05) indicated better predictive performance than the shear wave speed.

Quantification of Nerve Viscosity Using Shear Wave Dispersion Imaging in Diabetic Rats: A Novel Technique for Evaluating Diabetic Neuropathy.

OBJECTIVE: Viscoelasticity is an essential feature of nerves, although little is known about their viscous properties. The discovery of shear wave dispersion (SWD) imaging has presented a new approach for the non-invasive evaluation of tissue viscosity. The present study investigated the feasibility of using SWD imaging to evaluate diabetic neuropathy using the sciatic nerve in a diabetic rat model. MATERIALS AND METHODS: This study included 11 diabetic rats in the diabetic group and 12 healthy rats in the control group. Bilateral sciatic nerves were evaluated 3 months after treatment with streptozotocin. We measured the nerve cross-sectional area (CSA), nerve stiffness using shear wave elastography (SWE), and nerve viscosity using SWD imaging. The motor nerve conduction velocity (MNCV) was also measured. These four indicators and the histology of the sciatic nerves were then compared between the two groups. The performance of CSA, SWE, and SWD imaging in distinguishing the two groups was assessed using receiver operating characteristic (ROC) analysis. RESULTS: Nerve CSA, stiffness, and viscosity in the diabetic group was significantly higher than those in the control group (all p < 0.05). The results also revealed a significantly lower MNCV in the diabetic group (p = 0.005). Additionally, the density of myelinated fibers was significantly lower in the diabetic group (p = 0.004). The average thickness of the myelin sheath was also lower in the diabetic group (p = 0.012). The area under the ROC curve for distinguishing the diabetic neuropathy group from the control group was 0.876 for SWD imaging, which was significantly greater than 0.677 for CSA (p = 0.030) and 0.705 for SWE (p = 0.035). CONCLUSION: Sciatic nerve viscosity measured using SWD imaging was significantly higher in diabetic rats. The viscosity measured using SWD imaging performed well in distinguishing the diabetic neuropathy group from the control group. Therefore, SWD imaging may be a promising method for the evaluation of diabetic neuropathy.

Value of Ultrasound-Guided Biopsy in Evaluating Internal Mammary Lymph Node Metastases in Breast Cancer.

OBJECTIVES: This retrospective study aimed to assess the value of a real-time, ultrasound-guided biopsy in evaluating internal mammary lymph nodes (IMLNs) in breast cancer. METHODS: Patients who were diagnosed with breast cancer and underwent real-time, ultrasound-guided core-needle biopsy (CNB) or fine-needle aspiration (FNA) in suspected IMLN metastasis were retrospectively analyzed. Patient information and ultrasonographic images were reviewed and correlated with pathology results. RESULTS: Of the 164 IMLNs that were subjected to CNB, 131 were positive for metastasis by histopathologic confirmation, 8 were negative, and 25 were insufficient. By FNA, 84 IMLNs were regarded as positive for metastasis, 4 were negative, and 4 were insufficient. In total, there were 215 (83.98%) metastatic IMLNs, 12 benign IMLNs, and 29 unconfirmed by histopathology. There were statistically significant differences in the success of puncture sampling and detection of IMLN metastasis between the CNB and FNA groups (P < .05). There were no significant complications reported after FNA or CNB, including bleeding, nerve injury, infection, pneumothorax, or hemothorax. CONCLUSIONS: Our study showed that ultrasonography accurately detected nodes that were likely to be malignant IMLNs, and that real-time, ultrasound-guided CNB and FNA are accurate and valuable techniques for the determination of status in breast cancer patients. Moreover, performing ultrasound-guided CNB and FNA on suspicious IMLN metastasis does not have additional severe complications.

Differential diagnosis between small breast phyllodes tumors and fibroadenomas using artificial intelligence and ultrasound data.

BACKGROUND: It is challenging to differentiate between phyllodes tumors (PTs) and fibroadenomas (FAs). Artificial intelligence (AI) can provide quantitative information regarding the morphology and textural features of lesions. This study attempted to use AI to evaluate the ultrasonic images of PTs and FAs and to explore the diagnostic performance of AI features in the differential diagnosis of PTs and FAs. METHODS: A total of 40 PTs and 290 FAs <5 cm in maximum diameter found in female patients were retrospectively analyzed. All tumors were segmented by doctors, and the features of the lesions were collated, including circularity, height-to-width ratio, margin spicules, margin coarseness (MC), margin indistinctness, margin lobulation (ML), internal calcification, angle between the long axis of the lesion and skin, energy, grey entropy, and grey mean. The differences between PTs and FAs were analyzed, and the diagnostic performance of AI features in the differential diagnosis of PTs and FAs was evaluated. RESULTS: Statistically significant differences (P<0.05) were found in the height-to-width ratio, ML, energy, and grey entropy between the PTs and FAs. Receiver operating characteristic (ROC) curve analysis of single features showed that the area under the curve [(AUC) 0.759] of grey entropy was the largest among the four features with statistically significant differences, and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 0.925, 0.459, 0.978, and 0.190, respectively. When considering the combinations of the features, the combination of height-to-width ratio, margin indistinctness, ML, energy, grey entropy, and internal calcification was the most optimal of the combinations of features with an AUC of 0.868, and a sensitivity, specificity, PPV, and NPV of 0.734, 0.900, 0.982, and 0.316, respectively. CONCLUSIONS: Quantitative analysis of AI can identify subtle differences in the morphology and textural features between small PTs and FAs. Comprehensive consideration of multiple features is important for the differential diagnosis of PTs and FAs.

Real-time ultrasound-guided internal jugular vein cannulation by oblique-axis in-plane: Practice at the Fourth Hospital of Hebei Medical University.

OBJECTIVE: We aimed to evaluate oblique-axis in-plane (OA-IP) techniques for real-time ultrasound-guided internal jugular vein (IJV) cannulation. METHODS: We retrospectively analysed 1065 patients who underwent ultrasound (US)-guided IJV cannulation. We recorded demographic characteristics of patients, success rate, access time, cannulation time, number of attempts and the incidence of acute complications. RESULTS: The overall success rate of the procedure was 100% (n = 1605). In total, 1594 cases (99.3%) were successful at the first attempt, and 11 (0.7%) were successful at the second attempt; no patient required three or more attempts. The mean access time was 18.7 ± 19.3 seconds. The mean cannulation time was 349.0 ± 103.8 seconds. There were 54 (3.4%) acute complications out of the total 1605 cannulations: 23 cases of puncture site bleeding (1.4%), 20 cases allergic to dressing (1.3%), 10 cases of local cervical hematomas (0.6%), and one catheter misplacement (0.1%). There were no major complications 12 hours following the procedure. CONCLUSIONS: The results of our study suggest that OA-IP techniques can improve ultrasound-guided IJV cannulation with a high success rate and safety in clinical practice. Clinicians should consider adopting these methods.

Application of ultrasound artificial intelligence in the differential diagnosis between benign and malignant breast lesions of BI-RADS 4A.

BACKGROUND: The classification of Breast Imaging Reporting and Data System 4A (BI-RADS 4A) lesions is mostly based on the personal experience of doctors and lacks specific and clear classification standards. The development of artificial intelligence (AI) provides a new method for BI-RADS categorisation. We analysed the ultrasonic morphological and texture characteristics of BI-RADS 4A benign and malignant lesions using AI, and these ultrasonic characteristics of BI-RADS 4A benign and malignant lesions were compared to examine the value of AI in the differential diagnosis of BI-RADS 4A benign and malignant lesions. METHODS: A total of 206 lesions of BI-RADS 4A examined using ultrasonography were analysed retrospectively, including 174 benign lesions and 32 malignant lesions. All of the lesions were contoured manually, and the ultrasonic morphological and texture features of the lesions, such as circularity, height-to-width ratio, margin spicules, margin coarseness, margin indistinctness, margin lobulation, energy, entropy, grey mean, internal calcification and angle between the long axis of the lesion and skin, were calculated using grey level gradient co-occurrence matrix analysis. Differences between benign and malignant lesions of BI-RADS 4A were analysed. RESULTS: Significant differences in margin lobulation, entropy, internal calcification and ALS were noted between the benign group and malignant group (P = 0.013, 0.045, 0.045, and 0.002, respectively). The malignant group had more margin lobulations and lower entropy compared with the benign group, and the benign group had more internal calcifications and a greater angle between the long axis of the lesion and skin compared with the malignant group. No significant differences in circularity, height-to-width ratio, margin spicules, margin coarseness, margin indistinctness, energy, and grey mean were noted between benign and malignant lesions. CONCLUSIONS: Compared with the naked eye, AI can reveal more subtle differences between benign and malignant BI-RADS 4A lesions. These results remind us carefully observation of the margin and the internal echo is of great significance. With the help of morphological and texture information provided by AI, doctors can make a more accurate judgment on such atypical benign and malignant lesions.

A quantitative evaluation of sciatic nerve stiffness after compression by shear wave elastography in diabetic rats.

BACKGROUND: Our study investigates the feasibility of using quantitative evaluation for nerve entrapment visualization by shear wave elastography (SWE) in diabetic rats. METHODS: A total of 24 male Sprague-Dawley (SD) rats were included in this study. Before injection of streptozotocin (STZ), the experimental groups were assigned as the diabetic nerve compression (DNC) group (DNC, n=18) and the control group (CON, n=6). The DNC model was created by wrapping a silicone tube around the nerve, and then the DNC group was divided into the DNC 2-week (DNC2W, n=6), 4-week (DNC4W, n=6), and 8-week (DNC8W, n=6) groups according to the different duration time of sciatic nerve compression. The nerve stiffness was detected by SWE. Meanwhile, motor nerve conduction velocity (MNCV) was detected. These 2 indicators and histology of sciatic nerves were compared across the different groups. RESULTS: The stiffness of the nerve depicted by SWE at the compression site increased markedly along with the duration time of compression (P<0.01). The MNCV decreased along with the duration time of nerve compression (P<0.05). The nerve stiffness depicted by SWE was negatively correlated with MNCV (r=-0.926; P<0.01). Myelinated fiber density significantly decreased as the duration time of nerve compression increased (P<0.01). Some differences were found between DNC4W and DNC8W groups, and CON and DNC2W groups (P<0.05) in average axon diameter, myelin sheath thickness, and g ratio. CONCLUSIONS: The increased values of SWE, along with the increased duration of nerve compression, could reflect the severity of nerve entrapment in diabetic rats. Therefore, SWE may be used as a noninvasive and effective method to quantitatively evaluate the severity of diabetic nerve entrapment.

The value of contrast-enhanced ultrasonography to detect the sacroiliac joint for predicting relapse after discontinuation of anti-tumor necrosis factor therapy in patients with ankylosing spondylitis.

BACKGROUND: Ankylosing spondylitis (AS) is a chronic inflammatory disease characterized by high relapse. Therefore, the present study aimed to investigate the ultrasonographic features of contrast-enhanced ultrasonography (CEUS) in the sacroiliac joint (SIJ) in patients with AS in remission after discontinuation of anti-tumor necrosis factor (TNF) therapy, and also examined the role of CEUS in predicting relapse. METHODS: In this prospective observational study, 130 SIJs in 65 patients with AS (according to modified New York criteria) satisfying Ankylosing Spondylitis Disease Activity Score (ASDAS) inactive disease after discontinuation of anti-TNF therapy were investigated on color Doppler ultrasonography (CDUS) and CEUS. Vascularization and the resistive index (RI) of the SIJ were observed and measured. We defined no blood flow, high RI of arterial blood flow (RI ≥0.7), the reversed phase in the diastolic phase or venous blood flow in the bilateral SIJs, as negative CDUS/CEUS; meanwhile, low RI of arterial blood flow (RI <0.7) in the unilateral or bilateral SIJs was defined as positive CDUS/CEUS. All the patients were followed up for 52 weeks until relapse. Relapse was defined as an increase of two or more items in comparison with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) at the time of anti-TNF withdrawal. RESULTS: After 52 weeks, 46 of the 65 patients (70.8%) had relapse. The mean time to relapse was 31.4 weeks (±8.4 weeks, range 20 to 52). After discontinuation of anti-TNF therapy, positive CEUS accounted for 61.5%; this was significantly more than positive CDUS (13.8%). The vascularization detected by CEUS for patients of relapse was significantly different from that of patients with remission (P<0.05). In addition, patients with negative CEUS had a longer duration of remission than the patients with positive CEUS (P=0.005). A Cox proportional hazards regression analysis found that the disease duration could also be regarded as a factor predictive of relapse in patients with AS. CONCLUSIONS: The use of CEUS distinctly improved the detection of vascularization in the SIJ in patients with AS in remission after anti-TNF withdrawal. The presence of vascularization in the SIJ detected by CEUS at the time of anti-TNF withdrawal could yield a valuable predictor of relapse in patients with AS. A significant limit of this study is the lack of magnetic resonance imaging (MRI) as the standard reference.

Establishment of the U.L.T.R.A. measurement rating system for anterior urethral stricture.

PURPOSE: Anterior urethral stricture treatments are various, and comprehensive consideration should be given in selecting individualized treatment programs, which must be combined with the patient's stricture, length, complexity, and other factors. At present, there is no standard for the clinical description of the anterior urethral stricture for the selection of the characteristic index, and most of the indicators are qualitative information. In order to achieve consistent decisions and effective comparisons, it is imperative to establish a standardized description system. We used ultrasound contrast technology in the diagnosis of urethral stricture to establish a reliable measurement scoring system, for the refinement grading of the treatment, so as to objectively guide the establishment of treatment decisions. MATERIALS AND METHODS: A retrospective search of PubMed English literatures on anterior urethral stricture (January 1975-September 2016) was conducted, combined with a large number of clinical practice experience. We screened the five most closely related and highly repeatable anatomical characteristic indicators of anterior urethral stricture as a base of establishing the U.L.T.R.A. measurement scoring system. With the evaluation system, individualized cases can be made according to the severity of the stenosis preoperative pathological state from the five aspects of refinement grading, and estimated results of the success rate and prognosis of different surgical treatments for patients according to the score. RESULTS: The evaluation system consists of five indicators: (U) urethral stricture site, (L) length, (T) urethral stricture scar thickness, (R) stricture and stricture with a 10-mm proximal urethral dilatation ratio (stricture diameter ratio for short), and (A) alone urethral stricture or multiple urethral stricture; as well as other characteristics. Suffix (l) refers specifically to anterior urethral stricture due to the lichen sclerosus. CONCLUSION: The U.L.T.R.A. measurement scoring system proposed through urethral ultrasonography is a standardized system, which is a repeatable disease assessment tool. The five characteristic factors that were most associated with anterior urethral stricture were summarized. Through this, we can more accurately describe the degree of the disease and refinement grade the complexity of the treatment, and enable imaging technologists and surgeons to establish effective communication channels.

Role of real-time elastography in assessing the stage of thrombus.

BACKGROUND: Due to major complication that acute thrombosis can occur, we aim to observe the value of real-time tissue elastography (RTE) in assessing the stage of thrombi. METHODS: We prospectively analyzed 132 patients with deep venous thrombosis confirmed by clinical symptoms and conventional ultrasound examination. RTE imaging of thrombosis were estimated according Itoh's 5-point scale and we also calculated the strain ratio (reference/clot ratio). RESULTS: Differences in thrombus displacement have been presented as different color maps. In the group of acute thrombosis, 70.9% (39/55) showed red color. In the group of subacute thrombosis, 62.8% (27/43) showed green color. In the group of chronic thrombosis, 67.6% (23/34) showed blue color. The strain ratio of the chronic thrombosis group and the subacute thrombosis group were higher than that of the acute thrombosis group (P<0.001, P<0.05). The strain ratio of the chronic thrombosis group was higher than that of the acute and subacute thrombosis group (P<0.05). CONCLUSIONS: RTE has good diagnostic value for assessing the stage of thrombi.

A magnetic nanoparticle stabilized gas containing emulsion for multimodal imaging and triggered drug release.

PURPOSE: To develop a multimodal imaging guided and triggered drug delivery system based on a novel emulsion formulation composed of iron oxide nanoparticles, nanoscopic bubbles, and oil containing drugs. METHODS: Iron oxide paramagnetic nanoparticles were synthesized and modified with surface conjugation of polyethylenimide (PEI) or Bovine Serum Albumin (BSA). Both particles were used to disperse and stabilize oil in water emulsions containing coumarin-6 as the model drug. Sulfur hexafluoride was introduced into the oil phase to form nanoscopic bubbles inside the emulsions. The resulted gas containing emulsions were evaluated for their magnetic resonance (MR) and ultrasound (US) imaging properties. The drug release profile triggered by ultrasound was also examined. RESULTS: We have successfully prepared the highly integrated multi-component emulsion system using the surface modified iron oxide nanoparticles to stabilize the interfaces. The resulted structure had distinctive MR and US imaging properties. Upon application of ultrasound waves, the gas containing emulsion would burst and encapsulated drug could be released. CONCLUSION: The integrated emulsion formulation was multifunctional with paramagnetic, sono-responsive and drug-carrying characteristics, which may have potential applications for disease diagnosis and imaging guided drug release.

Relationship between serum osteocalcin levels and carotid intima-media thickness in Chinese postmenopausal women.

OBJECTIVE: Serum osteocalcin has been shown to be closely related to metabolic risk factors. Therefore, the aim of our study was to evaluate the association between serum osteocalcin levels and subclinical atherosclerosis in Chinese postmenopausal women. METHODS: A total of 1,319 postmenopausal women (age range, 41-78 y) without any history of cardiovascular disease or carotid plaque were analyzed. Electrochemiluminescence immunoassay was used to measure total serum osteocalcin levels. B-mode ultrasound measurement of carotid intima-media thickness (C-IMT) was used to evaluate subclinical atherosclerosis. Participants within the upper quartile of C-IMT measurements (≥0.65 mm) were classified as having increased C-IMT in the present study. C-IMT association with metabolic parameters was assessed by Spearman correlation analysis, whereas that with serum osteocalcin was assessed by multiple stepwise regression adjusted for potential confounders. RESULTS: The overall median (interquartile range) level of osteocalcin was 20.51 (16.71-24.98) ng/mL, and that of C-IMT was 0.60 (0.55-0.65) mm. Four hundred sixteen (31.5%) participants had increased C-IMT. Participants with increased C-IMT had significantly lower serum osteocalcin levels than those who had C-IMT lower than 0.65 mm (19.77 [16.17-24.52] vs 20.84 [16.92-25.39] ng/mL, P = 0.01). Serum osteocalcin level was significantly and negatively correlated with C-IMT (r = -0.107, P < 0.01) and was identified as an independent factor that significantly influenced C-IMT (standardized ß = -0.117, P < 0.01). CONCLUSIONS: Serum osteocalcin level is negatively associated with subclinical atherosclerosis in Chinese postmenopausal women.

An ultrasound study of anatomic variants of the sural nerve.

INTRODUCTION: There are anatomic variations of the sural nerve (SN). Knowledge of these morphological types and the length of the SN are important for planning surgical reconstruction of peripheral nerves. Our purpose was to classify the morphological types of the SN by using ultrasound. METHODS: Two-hundred SNs in 100 normal subjects were examined by ultrasound with 13-MHz linear-array transducers. Classification of the SN was evaluated by its formation. The distance between the union and the distal point of the lateral malleolus was measured. RESULTS: SN variants could be classified into three types: type I (81%); type II (18%); and type III (1%). In type I, the average length of the SN was 15.8 ± 5.7 cm. CONCLUSIONS: The morphological types of the SN can be determined using ultrasound. Ultrasound classification of the SN is useful with regard to donor nerve surgical reconstruction of peripheral nerves.

Preliminary study of the types of traumatic peripheral nerve injuries by ultrasound.

OBJECTIVES: To investigate the types of traumatic peripheral nerve injuries by ultrasound (US). To demonstrate the efficacy of US in case of peripheral nerve injuries and, in particular, its importance of demonstrating and monitoring the appearances of the nerve itself. METHODS: Two hundred and two patients, of which 117 subsequently underwent operative treatment, were prospectively examined by US in such a way that the transducer was moved to the nerve damaged region from the normal nerve located near a known anatomical landmark. The ultrasound features of the traumatic peripheral nerve injuries were classified according to abnormal fascicle, perineurium, epineurium, and peripheral tissues of peripheral nerve. RESULTS: The ultrasound features of the traumatic peripheral nerve injuries were classified into 7 types. In the 117 cases that underwent operative treatment, the accuracy of classification by using US was 93.2%. CONCLUSIONS: Ultrasound seems to be a valuable investigation for evaluating the type of traumatic peripheral nerve injury.

Can scavenger receptor Class B Type I loaded ultrasound contrast agent be a new method for treating atherosclerosis?

Nowadays, Ultrasound contrast agent (UCA) is not only a good contrast agent for ultrasonic imaging, but also an important tool for drug delivery. As a kind of UCA, lipofectamine has the shell with positive charge. It can encapsulate genes and also be adhered to cells because genes and cells are all with negative charge. With this feature, it plays an important role in transfection. Scavenger Receptor Class B Type I(SR-BI) is a HDL receptor thought to be the first step in the progress of cholesterol transport. In this way, SR-BI loaded UCA has great possibility to cure atherosclerosis plaque.

Low-frequency and high-intensity ultrasonic may play a better role in Ultrasound Contrast Agent drug delivery system in vivo.

For the ability to carry drugs and release them at target areas, Ultrasound Contrast Agent (UCA) can be a new vector for drug delivery. Ultrasound makes UCA ruptured so that the drugs it carried can be released. The intensity of medical ultrasound varies wildly. Although low-intensity ultrasound is often used in vitro studies, we think in vivo, the application of high-intensity ultrasound will have better future prospects for drug delivery than low-intensity ultrasonic.