Localization of Ectopic Hyperparathyroidism: Ultrasound Versus 99mTc-sestamibi, 4-Dimensional Computed Tomography, and 11C-choline Positron Emission Tomography/Computed Tomography.

OBJECTIVE: To investigate the usefulness of ultrasound (US) for the localization of ectopic hyperparathyroidism and compare it with 99mTc-sestamibi (99mTc-MIBI), 4-dimensional computed tomography (4D-CT), and 11C-choline positron emission tomography/ computed tomography (PET/CT). METHODS: Of the 527 patients with surgically confirmed primary hyperparathyroidism, 79 patients with ectopic hyperparathyroidism were enrolled. The diagnostic performance of US, 99mTc-MIBI, US + MIBI, 4D-CT, and 11C-choline PET/CT was calculated, and the factors affecting the sensitivity of US and 99mTc-MIBI were analyzed. RESULTS: Eighty-three ectopic parathyroid lesions were found in 79 patients. The sensitivity was 75.9%, 81.7%, 95.1%, 83.3%, and 100% for US, 99mTc-MIBI, US + MIBI, 4D-CT, and 11C-choline PET/CT, respectively. The difference in sensitivity among these different modalities did not achieve statistical significance (P > .05). The US sensitivity was significantly higher for ectopic lesions in the neck region than for those in the anterior mediastinum/chest wall (85.9% vs. 42.1%, P < .001). The 99mTc-MIBI and 4D-CT sensitivity was not significantly different between these two groups (84.1% vs. 94.6%, P = .193 and 81.3% vs. 85.7%, P = 1). The 11C-choline PET/CT sensitivity was 100% in both groups. CONCLUSIONS: US is a valuable tool for the localization of ectopic hyperparathyroidism, especially for ectopic lesions in the neck region.

Programmable Morphing Hydrogels for Soft Actuators and Robots: From Structure Designs to Active Functions.

Nature provides abundant inspiration and elegant paradigms for the development of smart materials that can actuate, morph, and move on demand. One remarkable capacity of living organisms is to adapt their shapes or positions in response to stimuli. Programmed deformations or movements in plant organs are mainly driven by water absorption/dehydration of cells, while versatile motions of mollusks are based on contraction/extension of muscles. Understanding the general principles of these morphing and motion behaviors can give rise to disruptive technologies for soft robotics, flexible electronics, biomedical devices, etc. As one kind of intelligent material, hydrogels with high similarity to soft biotissues and diverse responses to external stimuli are an ideal candidate to construct soft actuators and robots.The objective of this Account is to give an overview of the fundamental principles for controllable deformations and motions of hydrogels, with a focus on the structure designs and responsive functions of the corresponding soft actuators and robots. This field has been rapidly developed in recent years with a growing understanding of working principles in natural organisms and a substantial revolution of manufacturing technologies to devise bioinspired hydrogel systems with desired structures. Diverse morphing hydrogels and soft actuators/robots have been developed on the basis of several pioneering works, ranging from bending and folding deformations of bilayer hydrogels to self-shaping of non-Euclidean hydrogel surfaces, and from thermoactuated bilayer gel "hands" to electrodriven polyelectrolyte gel "worms". These morphing hydrogels have demonstrated active functions and versatile applications in biomedical and engineering fields.In this Account, we discuss recent progress in morphing hydrogels and highlight the design principles and relevant applications. First, we introduce the fundamentals of basic deformation modes, together with generic structure features, actuation strategies, and morphing mechanisms. The advantages of in-plane gradient structures are highlighted for programmable deformations by harnessing the out-of-plane buckling with bistability nature to obtain sophisticated three-dimensional configurations. Next, we give an overview of soft actuators and robots based on morphing hydrogels and focus on the working principles of the active systems with different structure designs. We discuss the advancements of hydrogel-based soft robots capable of swift locomotion with different gaits and emphasize the significances of structure control and dynamic actuation. Then we summarize versatile applications of hydrogel-based actuators and robots in biomedicines, cargo delivery, soft electronics, information encryption, and so forth. Some hydrogel robots with a built-in feedback loop and self-sensing system exhibit collaborative functions and advanced intelligence that are informative for the design of next-generation hydrogel machines. Finally, concluding remarks are given to discuss future opportunities and remaining challenges in this field. For example, miniature hydrogel-based actuators/robots with therapeutic or diagnostic functions are highly desired for biomedical applications. The morphing mechanisms summarized in this Account should be applicable to other responsive materials. We hope that this Account will inspire more scientists to be involved in this emerging area and make contributions to reveal novel working principles, design multifunctional soft machines, and explore applications in diverse fields.

Toughening Hydrogels by Forming Robust Hydrazide-Transition Metal Coordination Complexes.

Energy dissipation based on dynamic fracture of metal ligands is an effective way to toughen hydrogels for specific applications in biomedical and engineering fields. Exploration of new kinds of metal-ligand coordinates with robust bonding strength is crucial for the facile synthesis of tough gels. Here a hydrogel toughening strategy based on the formation of robust coordination complexes between the hydrazide ligands and zinc ions is reported. The resultant hydrogels exhibit high strength and toughness at room temperature. Their mechanical properties show temperature dependence due to the dynamic nature of coordination bonds. In addition, the amine group of hydrazides in the gel matrix provides a reactive site for Schiff's base reaction, enabling surface modification without influence on overall mechanical performances of the gel. The hydrazide ligands are easy to synthesize and can coordinate very well with several transition metals. Such a metal-ligand coordination should be suitable to develop tough soft materials with versatile applications.

High-frequency ultrasound features in vulvar lichen sclerosus and correlation with histopathology.

BACKGROUND: Vulvar lichen sclerosus (VLS) is a chronic inflammatory disease initially involving anogenital areas. Noninvasive assessment is essential for precise management in VLS. We aim to analyze high-frequency ultrasound (HFUS) features and correlate HFUS with histopathological changes. MATERIALS AND METHODS: Forty patients with histopathologically confirmed VLS lesions were retrospectively identified from August 2020 to September 2021. The clinical manifestations, dermoscopic images as well as both 20 and 50 MHz HFUS images were assessed. HFUS assessment included epidermal morphology, hypoechoic dermal band thickness, and hypoechoic dermal band internal echo. We compared HFUS images with histopathology, and Pearson's correlation coefficient was used to assess the relationship between hypoechoic dermal band thickness and histopathological depth. RESULTS: Hypoechoic dermal band was present in 100% (40/40) VLS lesions. There was a significant linear positive correlation between the histopathological depth and corresponding hypoechoic dermal band thickness, with a Pearson correlation coefficient of 0.685 (p < 0.001). Besides, 95% (38/40) lesions revealed smooth epidermis, and the internal echo of hypoechoic dermal band was assessed as homogeneous in 60% (24/40) and inhomogeneous in 40% (16/40) lesions. CONCLUSION: HFUS characteristics, as well as measurable hypoechoic dermal band thickness, may provide valuable information in the precise diagnosis and the treatment monitoring of VLS.

A comparative study of melanocytic nevi classification with dermoscopy and high-frequency ultrasound.

BACKGROUND: Melanocytic nevi (MN) can be classified into three subtypes according to the depth of the nests of nevus cells which is important for management. High-frequency ultrasound (HF-US) can clearly reveal the lesion size, contour, depth, and internal structures. However, the HF-US studies of MN according to subtypes are limited. We aimed to describe the HF-US features of MN and explore its value in accurate classification. MATERIALS AND METHODS: This retrospective study was conducted from January 2018 to November 2019. Eighty-five patients with MN were included and examined by 50 and 20 MHz HF-US. The HF-US features were recorded including morphological flatness, depth, shape, boundary, internal echogenicity, hyperechoic spots, lateral acoustic shadow, posterior echoic patterns, mushroom signs, and straw-hat signs. Each image was evaluated by two physicians independently, and the consistency was tested. RESULTS: Eleven lesions could not be detected by HF-US. The rest 74 lesions underwent ultrasonic analysis. MN appeared as strip-shaped or oval, hypoechoic areas localized in the epidermis and dermis under ultrasonography. A strong consistency between HF-US and dermoscopy of determining the lesion depth was achieved (κ = 0.935, p < 0.001). The hyperechoic spots were found in 57.6% intradermal nevi. The mushroom signs were seen in 34.8% intradermal nevi, and the straw-hat signs were seen in all the compound nevi. CONCLUSION: MN can be correctly classified using HF-US, and it had a strong correlation with dermoscopic and clinical classification. HF-US could further reveal the internal morphological features of MN, which may support more precise classification and management.

[Imaging in the Diagnosis of Breast Cancer in Elderly Women].

The breast cancer diagnosed in the women at or above age 70 is defined as breast cancer in the elderly.As the population keeps aging,breast cancer in the elderly presents increasing incidence and high mortality.Early detection,early diagnosis,and early treatment might improve the prognosis of these patients. Comprehensively evaluating the functional age of elderly patients is essential for the individualized treatment. Medical imaging plays a key role in the screening,early diagnosis,therapy selection,evaluation of neoadjuvant therapy efficacy,and postoperative follow-up.We reviewed the current literature and focused on the role of medical imaging in the diagnosis and treatment recommendations for breast cancer in the elderly.

Magneto-Orientation of Magnetic Double Stacks for Patterned Anisotropic Hydrogels with Multiple Responses and Modulable Motions.

Reported here is a multi-response anisotropic poly(N-isopropylacrylamide) hydrogel developed by using a rotating magnetic field to align magnetic double stacks (MDSs) that are fixed by polymerization. The magneto-orientation of MDSs originates from the unique structure with γ-Fe2 O3 nanoparticles sandwiched by two silicate nanosheets. The resultant gels not only exhibit anisotropic optical and mechanical properties but also show anisotropic responses to temperature and light. Gels with complex ordered structures of MDSs are further devised by multi-step magnetic orientation and photolithographic polymerization. These gels show varied birefringence patterns with potentials as information materials, and can deform into specific configurations upon stimulations. Multi-gait motions are further realized in the patterned gel through dynamic deformation under spatiotemporal light and friction regulation by imposed magnetic force. The magneto-orientation assisted fabrication of hydrogels with anisotropic structures and additional functions should bring opportunities for gel materials in biomedical devices, soft actuators/robots, etc.

The value of contrast-enhanced ultrasound for sentinel lymph node identification and characterisation in pre-operative breast cancer patients: A prospective study.

OBJECTIVE: To explore the feasibility of sentinel lymph node (SLN) identification by contrast-enhanced ultrasound (CEUS) in pre-operative breast cancer patients and the value of enhancement patterns for diagnosing lymph node metastases and characterising axillary nodal burden. METHODS: 110 consecutive breast cancer patients were enrolled. Before the surgery, microbubbles were injected intradermally. The lymphatic drainage pathway was detected to identify the SLNs. Blue dye and indocyanine green (ICG) fluorescence were used to trace SLNs during the operation. The enhancement patterns of SLNs were recorded and compared with the final pathological diagnosis. RESULTS: SLN detection rate was 96.4 % of 110 patients, 134 SLNs were detected in total. The sensitivity, specificity, positive-predictive value, negative-predictive value and accuracy of predicting SLNs metastases by CEUS enhancement patterns were 100 %, 52.0 %, 43.4 %, 100 % and 64.9 %, respectively. No metastatic SLNs were presented as homogeneous enhancement. Low nodal burden with 0-2 SLN metastases in 92.5 % nodes presented as heterogeneous enhancement. No enhancement pattern was proved to be SLN metastases in 100 % patients. CONCLUSIONS: CEUS is a feasible approach for SLN identification. CEUS enhancement patterns can be helpful in recognising metastatic SLNs and nodal burden. KEY POINTS: • CEUS is a feasible approach for SLN identification and characterisation. • The enhancement patterns on CEUS can be helpful in recognising metastasised SLNs. • Homogeneous enhancement pattern has the highest negative-predictive value.

Value of Acoustic Radiation Force Impulse Imaging in the Diagnosis of Early Non-alcoholic Steatohepatitis.

Objective To evaluate the value of acoustic radiation force impulse(ARFI)imaging in the diagnosis of early non-alcoholic steatohepatitis(NASH).Methods Totally 32 SD rats were randomly divided into high-fat diet group(n=24)and normal-diet group(n=8)by using the random number table. At the end of the 4th,8th,12th,and 16th week,six rats from the high-diet group and two rats from the normal-diet group were selected blindly for weighting,blood biochemical test,conventional ultrasound,and ARFI imaing. HE staining was used for pathological observation. Results None of the 32 rats developed liver fibrosis. Based on the pathological results,these rats were divided into M1 [mild-to-moderate simple fatty liver(SS)],M2(severe SS),M3(severe SS with early NASH),and C groups(normal control). Early NASH was seen only in the severe hepatic steatosis groups,and its distribution had a significant difference(P=0.006). The diagnostic accuracy of conventional ultrasound based on histological results was 34.4%(11/32). The ARFI value of M3 group was significantly lower than that of M2 group [(1.16±0.04)m/s vs.(1.22±0.05)m/s;t=2.301,P=0.04),and the low-density lipoprotein of M3 group was significantly higher than M2 group [(1.53±0.07)mmol/L vs.(1.21±0.22)mmol/L;t=3.075,P=0.01),while other clinical indicators had no statistical difference between these two groups. Conclusions The development of early NASH is associated with the severity of hepatic steatosis. ARFI value can provide important information to identify early NASH in patients with severe hepatic steatosis.

Clinical Values of Combined Diffused Optical Tomography and PET-CT in the Diagnosis of Breast Cancer.

Objective To investigate the clinical values of combined diffused optical tomography (DOT) combined positron emission tomography-computed tomography (PET-CT) in the diagnosis of breast cancer. Methods We performed DOT and PET-CT examinations in 38 patients with 40 lesions and compared these images with the pathological results to analyze the sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of these two techniques and their combination.Results The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value in diagnosing breast cancer were 78.26%,76.47%,77.50%,72.22%,and 81.81% for DOT,86.96%,82.35%,85.00%,86.96%,and 82.35% for PET-CT,and 86.96%,94.12%,90.00%,95.23%,and 84.21% for the combination of PET-CT and DOT.Conclusions DOT and PET-CT are both effective diagnostic methods for breast cancer.Combined DOT and PET-CT can improve the diagnostic efficacy in terms of specificity,positive predictive value,and accuracy.