微信平台结合病例教学模式在超声专业住院医师规范化培训中的应用探索

超声专业的住院医师培训既需要重视理论教学，更讲究“看图说话”，即以大量的超声病例为基础，训练住院医师从超声图像中寻找、发现并判别病变，从而形成敏锐的识别诊断能力。本研究利用即时通讯工具微信建立虚拟学习平台，通过该平台实施以病例教学模式，可以避免时间和场地的限制，使得师生之间交流更快捷。根据问卷调查，住院医师普遍认为该培训模式可有效提高学习效率、提升专业能力，希望在传统教学模式基础上加入该培训模式。住院医师的病例分析结果显示培训过程中住院医师的诊断准确率逐步提升。微信平台结合病例教学的模式可以为超声专业住院医师规范化培训提供新的思路和方法。     

MiR-125b在甲状腺癌患者中的表达及其意义

目的探讨miR-125b在甲状腺癌患者中的表达及其意义。方法选取甲状腺乳头状癌组织及其配对的癌旁组织各20例,所有患者均经超声及病理确诊。实时荧光定量PCR检测miR-125b mRNA的表达,Western Blot检测Foxp3、LC 3Ⅰ和LC 3Ⅱ蛋白的表达。将人甲状腺乳头状癌细胞系MDA-T32随机分为3组:对照组(不处理)、阴性对照组(转染无义序列)和miR-125b组(转染miR-125b mimics),实时荧光定量PCR检测miR-125b mRNA的表达,MTT法检测癌细胞对顺铂的敏感性,Western Blot检测Foxp3、LC 3Ⅰ和LC 3Ⅱ蛋白的表达。结果与癌旁组织对比,甲状腺癌组织中MiR-125b mRNA的表达显著降低(P <0.05),Foxp3蛋白表达显著增加(P <0.05)。与对照组相比,miR-125b组细胞中MiR-125b mRNA的表达显著增加(P <0.05),Foxp3蛋白的表达显著降低(P <0.05)。与对照组相比,在顺铂浓度为30μg/ml时,miR-125b组细胞活性显著降低(P <0.05)。在顺铂浓度为0、15、60、120μg/ml时,各组间细胞活性的对比无显著差异(P> 0.05)。与癌旁组织对比,甲状腺癌组织中LC 3Ⅱ蛋白的表达显著增加(P <0.05)。与对照组相比,miR-125b组细胞中LC 3Ⅱ蛋白的表达显著降低(P <0.05)。LC 3Ⅰ蛋白的表达在各组间对比无显著变化(P> 0.05)。结论miR-125b在甲状腺癌中下调,miR-125b介导的Foxp3下调可抑制自噬,并增强甲状腺癌细胞对顺铂的敏感性。     

Ultrasound-guided Brachytherapy for Cervix Cancer

Radiotherapy and brachytherapy are the definitive treatments for locally advanced cervix cancer. The use of soft-tissue imaging, particularly magnetic resonance imaging, has enhanced their effectiveness and improved clinical outcomes. However, the use of magnetic resonance imaging is largely restricted to well-resourced centres in both the first and developing world and remains elusive to many less advantaged centres, particularly those in areas with a high burden of cervix cancer. Ultrasound is an accessible, affordable and accurate imaging modality that can be used throughout the brachytherapy procedure. Ultrasound is primarily used to ensure safe insertion of the applicator but can also be used to guide planning. The methods used to utilise ultrasound images for planning are described. Ultrasound is particularly useful as a verification aid to confirm applicator placement after patients are moved and transferred around the radiotherapy department. It can also be used to verify the dimensions of treatment volumes over the course of brachytherapy. There is a crucial unmet need for an accessible economical soft-tissue imaging modality in cervical brachytherapy. Ultrasound has the potential to meet this need.     

Ultrasound Quantification of Acetabular Rounding in Hip Dysplasia: Reliability and Correlation to Treatment Decisions in a Retrospective Study

Currently, acetabular rounding is only subjectively assessed on ultrasound for developmental dysplasia of the hip. We tested whether acetabular rounding can be quantified reliably and can distinguish between hips requiring and not requiring treatment. Consecutive infants (n = 90) suspected of having dysplasia of the hip, seen at a pediatric orthopedic clinic, were separated into four diagnostic categories (normal, borderline but resolved, treated by brace, treated surgically). Acetabular rounding was assessed by semi-quantitative grade (0 = nil, 1 = mild, 2 = moderate, 3 = severe) by three observers and by direct measurement of acetabular radius of curvature (AROC) by two observers. Inter-observer reliability of rounding grade was poor (κ = 0.30–0.37). AROC had an inter-observer intra-class correlation coefficient of 0.84 and coefficient of variation of 29%–34%. Mean AROC was significantly higher for hips requiring treatment than for those not requiring treatment (3.3 mm vs. 1.6 mm, p = 0.007). AROC reliably quantifies an observation currently being made subjectively by radiologists and surgeons, and may be useful as a supplementary ultrasound index of dysplasia of the hip in future prospective studies.     

Ultrasound Fetal Weight Estimation: How Accurate Are We Now Under Emergency Conditions?

The primary aim of this study was to evaluate the accuracy of sonographic estimation of fetal weight when performed at due date by first-line sonographers. This was a prospective study including 500 singleton pregnancies. Ultrasound examinations were performed by residents on delivery day. Estimated fetal weights (EFWs) were calculated and compared with the corresponding birth weights. The median absolute difference between EFW and birth weight was 200 g (100–330). This difference was within ±10% in 75.2% of the cases. The median absolute percentage error was 5.53% (2.70%–10.03%). Linear regression analysis revealed a good correlation between EFW and birth weight (r = 0.79, p < 0.0001). According to Bland–Altman analysis, bias was −85.06 g (95% limits of agreement: −663.33 to 494.21). In conclusion, EFWs calculated by residents were as accurate as those calculated by experienced sonographers. Nevertheless, predictive performance remains limited, with a low sensitivity in the diagnosis of macrosomia.     

The Effect of Short Duration Ultrasound Pulses on the Interaction Between Individual Microbubbles and Fibrin Clots

In previous work, we examined microscale interactions between microbubbles and fibrin clots under exposure to 1 ms ultrasound pulses. This provided direct evidence that microbubbles were capable of deforming clot boundaries and penetrating into clots, while also affecting fluid uptake and inducing fibrin network damage. Here, we investigate the effect of short duration (15 μs) pulses on microscale bubble-clot interactions as function of bubble diameter (3–9 μm) and pressure. Individual microbubbles (n = 45) were placed at the clot boundary with optical tweezers and exposed to 1 MHz ultrasound. High-speed (10 kfps) imaging and 2-photon microscopy were performed during and after exposure, respectively. While broadly similar phenomena were observed as in the 1 ms pulse case (i.e., bubble penetration, network damage and fluid uptake), substantial quantitative differences were present. The pressure threshold for bubble penetration was increased from 0.39 MPa to 0.6 MPa, and those bubbles that did enter clots had reduced penetration depths and were associated with less fibrin network damage and nanobead uptake. This appeared to be due in large part to increased bubble shrinkage relative to the 1 ms pulse case. Stroboscopic imaging was performed on a subset of bubbles (n = 11) and indicated that complex bubble oscillations can occur during this process.     

A systematic review on the utility of ultrasonography in the diagnosis of testicular torsion in acute scrotum patients

IntroductionUltrasound is a valuable tool in establishing the cause of acute scrotum pain. However, its role in testicular torsion (TT) detection remains controversial. This review aims integrate pre-existing data to assess the value of B-mode and colour Doppler ultrasound (CDS) features combined in the detection of TT in acute scrotum pain patients of all ages.MethodsA search through electronic databases, grey literature and hand searching using specific search terms was conducted to identify relevant literature. Search results were subjected to a three-step selection process to ensure the inclusion criteria of this review were met. Statistical data pertaining to the accuracy, sensitivity, and specificity of the B-mode, CDS and combined B-mode CDS features were extracted. These results subsequently underwent a narrative analysis.ResultsFive studies met the inclusion criteria. A variety of B-mode features were identified. Most studies showed that reliance on CDS alone can be prone to false-negative results. The combination of B-mode and CDS features were found to increase the overall sensitivity of ultrasound towards TT (up to 100% in 3 studies). All studies recommended correlation with clinical examination findings. Several limitations in methodology of the included studies were noted: small sample populations and lack of information on the experience of ultrasound practitioners. This highlighted the need for a primary study with a larger sample population to validate the findings of this review.ConclusionThe combination of B-mode and CDS ultrasound is a useful and reliable triage tool in the detection of TT, particularly in equivocal or low suspicion cases but its findings should always be adjunct with clinical examination. Nevertheless, it is noted that appropriate service level agreements, pathways, and training are key factors in ensuring effectiveness of the process.Implications for practiceDedicated training and appropriate departmental protocol are key in ensuring accurate diagnosis across all levels of practice.     

Heel fat pad syndrome beyond acute plantar fascitis

Heel pain is a frequent cause of pain and disability in adult active population. In patients with this clinical presentation, several causes must be ruled out, among them plantar fasciitis the most common. Other etiologies of plantar heel pain are the entrapment of muscular branch of the lateral plantar nerve (Baxter nerve) or fat pad atrophy, being the last one the second cause of heel pain after plantar fasciitis.A case series of patients with pathological findings of the heel fat pad area using MRI and US to provide a differential diagnosis of heel pain.Observational case series study. Nine patients visited presented with pain in the plantar aspect of the heel.The plantar aspect of the heel was evaluated in detail with US and MRI. Main inclusion criteria were to present acute or chronic pain on the plantar aspect.In five cases the right heel was affected, in three cases the left heel. One case presented bilateral complaints. All patients presented mechanical pain. Specifically, four of them also described a constant clunk during footstep. Heel fat pad lesion was confirmed with MRI and US in the medial aspect, observed in five patients. In four patients, the heel fat pad was globally affected respectively.This case series tries to put some light on other heel conflicts beside plantar fasciitis that should be ruled out, being one of those, heel fat pad atrophy. Our presentation highlight the role that bed side ultrasound can play in the definition of a specific pattern confirmed with MRI after the US.