超声微血管成像技术的研究进展

超声微血管成像技术是在多普勒血流成像基础上发展起来的新型多普勒成像模式,对微细血管结构及深部血管的显示存在极大的优势。研究显示,超声微血管成像技术在乳腺、甲状腺、肝脏、颈动脉斑块、肌骨、肾脏以及淋巴结疾病中有较好的应用,在疾病活动分级及监测治疗反应中也显示出特殊的应用价值。本文将从以下三个方面对超声微血管成像技术展开综述：超声微血管成像技术的原理、超声微血管成像技术的临床应用以及超声微血管成像技术的现状和展望。     

肝移植拔除T管后胆漏的超声介入治疗

目的探讨超声引导下置管引流在肝移植拔除T管后胆漏中的价值,并与其他处理方法作比较。方法2001年8月至2005年3月肝移植行胆管端端吻合或胆肠吻合放置T管患者76例,拔除T管后发生胆漏9例,其中8例患者行超声引导下置管引流,男性7例,女性1例,年龄22-59岁,平均46.7岁。穿刺置管引流术方法为确定穿刺点,在超声引导下采用Seldinger法徒手操作,18G穿刺针穿入积液内,观察到针尖进入积液区后拔出针芯,见液体流出或抽出液体后放入导丝,退出穿刺针放置带内套针的7F直通管,导管进入积液内退出内套针和导丝,局部固定包敷引流管。结果8例患者拔除T管后分别出现剧烈腹痛、发烧、大汗淋漓等症状,超声检查发现均有盆腔积液,积液最大深度范围为3～7cm。8例超声引导下置管引流均一次成功,引流出淡黄色或金黄色胆汁,1d内症状均迅速改善或消失。5～10d后见管内无引流液后拔管,无并发症发生。结论超声引导下置管引流对肝移植拔除T管后胆漏的治疗是安全、有效的,具有重要价值。     

Addition of terlipressin to norepinephrine in septic shock and effect of renal perfusion: a pilot study

PurposeTerlipressin improves renal function in patients with septic shock. However, the mechanism remains unclear. Here, we aimed to evaluate the effects of terlipressin on renal perfusion in patients with septic shock.Materials and MethodsThis pilot study enrolled patients with septic shock in the intensive care unit of the tertiary hospital from September 2019 to May 2020. We randomly assigned patients to terlipressin and usual care groups using a 1:1 ratio. Terlipressin was intravenously pumped at a rate of 1.3 μg/kg/hour for 24 h. We monitored renal perfusion using renal contrast-enhanced ultrasound (CEUS). The primary outcome was peak sonographic signal intensity (a renal perfusion parameter monitored by CEUS) at 24 h after enrollment.Results22 patients were enrolled in this study with 10 in the terlipressin group and 12 in the usual care group. The baseline characteristics of patients between the two groups were comparable. The peak sonographic signal intensity at 24 h after enrollment in the terlipressin group (60.5 ± 8.6 dB) was significantly higher than that in the usual care group (52.4 ± 7.0 dB; mean difference, 7.1 dB; 95% CI, 0.4–13.9; adjusted p = .04). Patients in the terlipressin group had a lower time to peak, heart rates, norepinephrine dose, and a higher stroke volume at 24 h after enrollment. No significant difference in the urine output within 24 h and incidence of acute kidney injury within 28 days was found between the two groups.ConclusionsTerlipressin improves renal perfusion, increases stroke volume, and decreases norepinephrine dose and heart rates in patients with septic shock.     

Thyroid papillary carcinoma with the ‘snowstorm appearance’: a clinicopathological analysis of three cases

This current case report presents the detailed clinicopathological analysis of three patients with papillary thyroid carcinoma, each of which presented with the ‘snowstorm appearance’ on ultrasonography. Ultrasonography of this tumour typically shows a diffusely enlarged thyroid with hypoechoic and heterogeneous internal echoes, and diffusely scattered microcalcifications, which form the ‘snowstorm appearance’. Microscopically, case 1 had a large number of psammoma bodies, infiltration of lymphocytes, formation of lymphatic follicles and extensive squamous metaplasia, leading to the diagnosis of a diffuse sclerosing variant of papillary thyroid carcinoma (DSVPTC). Case 2 was diagnosed with follicular papillary thyroid carcinoma. Their tumour had numerous calcifications in the stroma and follicles. Case 3 was diagnosed with a multifocal papillary thyroid carcinoma in the background of Hashimoto''s thyroiditis. Their tumour showed calcification in the stroma and follicles, together with cervical lymph node metastasis. DSVPTC is a rare variant of thyroid papillary carcinoma. It has the ‘snowstorm appearance’ on ultrasound, but this can also be found in follicular papillary carcinoma and multifocal thyroid papillary carcinoma. Papillary thyroid carcinoma with the ‘snowstorm appearance’ has a large number of peripheral lymph nodes metastases, thus requiring radical surgery and postoperative adjuvant therapy.     

经阴道或直肠彩色多普勒超声在多囊卵巢综合征中的临床应用

目的:观察经阴道或直肠彩色多普勒超声在多囊卵巢综合征中的诊断价值。方法:经阴道或经直肠行彩色多普勒超声检查,显示双侧卵巢内部结构,记录最多切面卵泡数,测量最大切面卵巢径线,计算卵巢体积,选用面积测量软件包测量卵巢面积(TA)、髓质面积(SA),然后计算SA/TA,并记录。启动彩色多普勒和频谱多普勒测量卵巢间质动脉搏动指数(PI)、阻力指数(RI)值。所有数据均测量3次并取平均值。结果:多囊卵巢综合征组患者卵巢体积增大(>10mL),双侧卵巢呈多囊样改变,多见10个以上小囊,小囊直径约4～6mm。卵巢间质回声增强,面积增大,间质面积比例较对照组显著增大,P<0.05,卵巢间质血流较丰富,卵巢间质动脉血流RI、PI与对照组比较,差异有统计学意义。结论:经阴道或经直肠彩色多普勒超声,可更直观准确显示卵巢特征。最多切面卵巢小卵泡数目、间质面积比、卵巢间质动脉阻力指数相结合对诊断多囊卵巢综合征(PCOS)有很重要的临床价值。     

Cell-penetrating peptide-doxorubicin conjugate loaded NGR-modified nanobubbles for ultrasound triggered drug delivery

A new drug-targeting system for CD13⁺ tumors has been developed, based on ultrasound-sensitive nanobubbles (NBs) and cell-permeable peptides (CPPs). Here, the CPP-doxorubicin conjugate (CPP-DOX) was entrapped in the asparagine–glycine–arginine (NGR) peptide modified NB (CPP-DOX/NGR-NB) and the penetration of CPP-DOX was temporally masked; local ultrasound stimulation could trigger the CPP-DOX release from NB and activate its penetration. The CPP-DOX/NGR-NBs had particle sizes of about 200?nm and drug entrapment efficiency larger than 90%. In vitro release results showed that over 85% of the encapsulated DOX or CPP-DOX would release from NBs in the presence of ultrasound, while less than 1.5% of that (30?min) without ultrasound. Cell experiments showed the higher cellular CPP-DOX uptake of CPP-DOX/NGR-NB among the various NB formulations in Human fibrosarcoma cells (HT-1080, CD13⁺). The CPP-DOX/NGR-NB with ultrasound treatment exhibited an increased cytotoxic activity than the one without ultrasound. In nude mice xenograft of HT-1080 cells, CPP-DOX/NGR-NB with ultrasound showed a higher tumor inhibition effect (3.1% of T/C%, day 24), longer median survival time (50 days) and excellent body safety compared with the normal DOX injection group. These results indicate that the constructed vesicle would be a promising drug delivery system for specific cancer treatment.     

Characteristics and Sonophotocatalytic Activity of Natural Sphalerite under Ultrasonic (1.7 MHz) and UVA LED (365 nm) Irradiation

Naturally occurring sono- and photoactive minerals, which are abundant on Earth, represent an attractive alternative to the synthesized sonophotocatalysts as cost-effective materials for water and wastewater treatment. This study focuses on characterizing and evaluating the sonophotocatalytic activity of natural sphalerite (NatS) from Dovatka deposit (Siberia) under high-frequency ultrasonic (US, 1.7 MHz) and ultraviolet light-emitting diodes (UVA LED, 365 nm) irradiation towards degradation of 4-chlorophenol as a model organic pollutant. Since raw natural sphalerite did not exhibit a measurable photocatalytic activity, it was calcined at 500, 900 and 1200 °C. The natural sphalerite after calcination at 900 °C (NatS*) was found to be the most effective for sonophotocatalytic degradation of 4-chlorophenol, attaining the highest efficiency (55%, 1 h exposure) in the following row: UV < US ≈ UV/US ≈ US/NatS* < UV/NatS* < UV/US/NatS*. Addition of 1 mM H₂O₂ increased the removal to 74% by UV/US/NatS*/H₂O₂ process. An additive effect between UV/NatS* and US/NatS* processes was observed in the sonophotocatalytic system as well as in the H₂O₂-assisted system. We assume that the sonophotocatalytic hybrid process, which is based on the simultaneous use of high-frequency ultrasound, UVA light, calcined natural sphalerite and H₂O₂, could provide a basis of an environmentally safe and cost-effective method of elimination of organic pollutants from aqueous media.     

人工智能在乳腺超声中的应用与发展

人工智能是利用计算机模拟人类学习、思考及作出判断的技术和方法,在医学影像领域应用中为临床流程带来便利,也为疾病诊断、治疗和预后提供更多的信息。而超声技术与人工智能的结合为乳腺诊断带来革新,本文就人工智能在乳腺超声中的流程及方法、应用和发展作一综述。