Degeneration of dopaminergic neurons in substantia nigra and neuroinflammation caused by microglia is one of the basic pathological features of Parkinson's disease (PD). Currently, therapeutic strategies that enhance dopaminergic neuronal function while simultaneously mitigating neuroinflammation hold great promise but face significant challenges in clinical application. To address these challenges, we developed a neuron-derived exosome biomimetic multifunctional nanoregulator codelivered tyrosine hydroxylase (TH) mRNA and stimulator of interferon genes (STING) antagonist. This nanoregulator system simultaneously delivers TH mRNA to enhance dopaminergic neuronal function and activity while incorporating the STING antagonist H-151 to promote microglial polarization from the pro-inflammatory M1 phenotype to the anti-inflammatory M2 phenotype, effectively suppressing neuroinflammation. Both in vitro and in vivo studies demonstrate that via mRNA therapy can precisely target and regulate dopamine (DA) synthesis, and that combined anti-inflammatory treatment effectively enhances this effect, significantly alleviating motor dysfunction in PD mice. Our findings present an effective approach for the development of PD medications and the advanced delivery of mRNA nanomedicines. This innovative nanoregulator represents a promising therapeutic strategy for managing neuroinflammation and improving dopaminergic neuronal function in PD by merging mRNA-based gene therapy with neuroinflammation modulation, addressing DA deficiency at its root and overcoming the current treatment obstacles in PD.

OBJECTIVES:To investigate the value of intraoperative conventional and contrast-enhanced ultrasound in the surgical resection of brain metastases (BMs). METHODS:A total of 46 patients with solitary tumors were enrolled. Intraoperative conventional ultrasound was performed to locate the tumors and observe the size, echo characteristics, position, depth, and degree of peritumoral edema of BMs and compare them with the findings from preoperative magnetic resonance imaging (MRI). Contrast-enhanced ultrasound was performed on 7 BMs with unclear borders to observe the borders and perfusion pattern. Completeness of tumor resection was assessed by ultrasound and compared with the assessment from postoperative MRI. RESULTS:All BMs were detected by intraoperative conventional ultrasound. Although BMs had various ultrasonic manifestations, most of them had clear boundaries (32/46, 69.6%), severe peritumoral edema (33/46, 71.7%), and a rich blood supply (35/46, 76.1%). There was no significant difference in assessing tumor size and peritumoral edema between intraoperative conventional ultrasound and preoperative MRI (P = .121 and 1.000, respectively). BMs exhibited a rapidly inhomogeneous high enhancement and a delayed wash-out in enhancement compared with surrounding tissues on contrast-enhanced ultrasound. All the BMs had complete resection as assessed by intraoperative conventional ultrasound, which was confirmed by the postoperative MRI. CONCLUSIONS:BMs have some certain characteristics on both conventional and contrast-enhanced ultrasound. Intraoperative conventional ultrasound plays a useful role in real-time navigation and assessing the completeness of tumor resection for neurosurgeons. In addition, contrast-enhanced ultrasound is helpful in recognizing the tumor borders when the distinction between BMs and surrounding tissues is unclear.

Objective: Glioma constitutes the most common primary malignant tumor in the central nervous system. In recent years, microwave ablation (MWA) was expected to be applied in the minimally invasive treatment of brain tumors. This study aims to evaluate the feasibility and accuracy of microwave ablation in ex vivo brain tissue by Shear Wave Elastography (SWE) to explore the application value of real-time SWE in monitoring the process of MWA of brain tissue.Methods: Thirty ex vivo brain tissues were treated with different microwave power and ablation duration. The morphologic and microscopic changes of MWA tissues were observed, and the diameter of the ablation areas was measured. In this experiment, SWE is used to quantitatively evaluate brain tissue's degree of thermal injury immediately after ablation.Results: This study It is found that the ablation range measured by SWE after ablation is in good consistency with the pathological range [ICCSWEL1-L1 = 0.975(95% CI:0.959 - 0.985), ICCSWEL2-L2 = 0.887(95% CI:0.779 - 0.938)]. At the same time, the SWE value after ablation is significantly higher than before (mean +/- SD,9.88 +/- 2.64 kPa vs.23.6 +/- 13.75 kPa; p < 0.001). In this study, the SWE value of tissues in different pathological states was further analyzed by the ROC curve (AUC = 0.86), and the threshold for distinguishing normal tissue from tissue after ablation was 13.7 kPa. The accuracy of evaluating ablation tissue using SWE can reach 84.72%, providing data support for real-time quantitative observation of the ablation range.Conclusion: In conclusion the accurate visualization and real-time evaluation of the organizational change range of the MWA process can be realized by real-time SWE.

AbstractBackgroundCarotid vulnerable plaque is an important risk factor for stroke occurrence and recurrence. However, the relationship between risk parameters related to carotid vulnerable plaque (plaque size, echogenicity, intraplaque neovascularization, and plaque stiffness) and neurological outcome after ischemic stroke or TIA is unclear. This study investigates the value of multimodal ultrasound-based carotid plaque risk biomarkers to predict poor short-term functional outcome after ischemic stroke or TIA.MethodsThis study was a single-center, prospective, continuous, cohort study to observe the occurrence of adverse functional outcomes (mRS 2–6/3–6) 90 days after ischemic stroke or TIA in patients, where the exposure factors in this study were carotid plaque ultrasound risk biomarkers and the risk factors were sex, age, disease history, and medication history. Patients with ischemic stroke or TIA (mRS ≤3) whose ipsilateral internal carotid artery stenosis was ≥50% within 30 days were included. All patients underwent multimodal ultrasound at baseline, including conventional ultrasound, superb microvascular imaging (SMI), and shear wave elastography (SWE). Continuous variables were divided into four groups at interquartile spacing for inclusion in univariate and multifactorial analyses. After completion of a baseline ultrasound, all patients were followed up at 90 days after ultrasound, and patient modified neurological function scores (mRSs) were recorded. Multivariate Cox regression and ROC curves were used to assess the risk factors and predictive power for predicting poor neurological function.ResultsSMI revealed that 20 (30.8%) patients showed extensive neovascularization in the carotid plaque, and 45 (69.2%) patients showed limited neovascularization in the carotid plaque. SWE imaging showed that the mean carotid plaque stiffness was 51.49 ± 18.34 kPa (23.19–111.39 kPa). After a mean follow-up of 90 ± 14 days, a total of 21 (32.3%) patients had a mRS of 2–6, and a total of 10 (15.4%) patients had a mRS of 3–6. Cox regression analysis showed that the level of intraplaque neovascularization and plaque stiffness were independent risk factors for a mRS of 2–6, and the level of intraplaque neovascularization was an independent risk factor for a mRS of 3–6. After correcting for confounders, the HR of intraplaque neovascularization level and plaque stiffness predicting a mRS 2–6 was 3.06 (95% CI 1.05–12.59,P = 0.041) and 0.51 (95% CI 0.31–0.83,P = 0.007), respectively; the HR of intraplaque neovascularization level predicting a mRS 3–6 was 6.11 (95% CI 1.19–31.45,P = 0.031). For ROC curve analysis, the mRSs for intraplaque neovascularization level, plaque stiffness, and combined application to predict 90-day neurological outcome ranged from 2 to 6, with AUCs of 0.73 (95% CI 0.59–0.87), 0.76 (95% CI 0.64–0.89) and 0.85 (95% CI 0.76–0.95), respectively. The mRSs for the intraplaque neovascularization level to predict 90-day neurological outcome ranged from 3 to 6, with AUCs of 0.79 (95% CI 0.63–0.95).ConclusionIntraplaque neovascularization level and plaque stiffness may be associated with an increased risk of poor short-term functional outcome after stroke in patients with recent anterior circulation ischemic stroke due to carotid atherosclerosis. The combined application of multiple parameters has efficacy in predicting poor short-term functional outcome after stroke.

Objective:To investigate the treatment and prevention of biliary tract injury following absolute ethanol sclerotherapy for large liver cysts.Methods:From January 2009 to December 2020, 30 patients with large liver cysts (with a maximum cross-sectional length ≥10 cm) treated with ultrasound-guided percutaneous absolute ethanol sclerotherapy at Beijing Tiantan Hospital affiliated to Capital Medical University were included in this study, including one patient with polycystic liver disease. Absolute ethanol was used for the sclerotherapy of liver cysts via needle aspiration or catheter drainage. In patients treated with catheter drainage and sclerotherapy, the amount and color of cyst drainage fluid and the extubation time were recorded after treatment. The main complications and long-term efficacy of sclerotherapy for large liver cysts were analyzed.Results:Thirty patients with 30 large liver cysts were treated with ultrasound-guided percutaneous absolute ethanol sclerotherapy, of whom 3 patients underwent needle aspiration and sclerotherapy and 27 underwent catheter drainage and sclerotherapy. The maximum cross-sectional length of the 30 cysts was 10-18 cm, a total of 400 ml to 2500 ml of light yellow or clear fluid was extracted from each cyst, and 200ml to 300 ml of absolute ethanol was injected into each cyst cavity during one session of sclerotherapy, which was divided into 4-6 injections. Among 27 patients treated with catheter drainage and sclerotherapy, the indwelling time of the drainage tube was 3-5 days in 26 patients and 10 days in 1 patient. Two patients (6.7%) had excessive intracapsular hemorrhage during treatment, and the bleeding stopped spontaneously due to compression of the drainage tubes. Three patients (10.0%) developed biliary tract injury after sclerotherapy, who were treated with catheter drainage and the catheters were removed until bile leakage stopped; the extubation time was 3 days, 2 weeks and 3 months, respectively, and the three patients' cysts were completely or mostly absorbed without recurrence. Of the 30 patients included, 29 received one session of sclerotherapy and 1 received two sessions of sclerotherapy. With a median follow-up period of 15 (range 13-64) months in 30 patients, the total effective rate was 100% (30/30), and the cure and significant effective rate was 76.7% (23/30).Conclusion:There is an increased risk of biliary tract injury following absolute ethanol sclerotherapy for large liver cysts adjacent to primary or secondary bile ducts. Catheter drainage with sclerotherapy is helpful to prevent and detect early biliary tract injury. Bile containing cyst and biliary tract injury following sclerotherapy are likely to be cured by catheter drainage, which should be given sufficient observation time.

儿童卒中是临床常见的危急症,是儿童致残和死亡的主要原因之一,病因复杂多样,其中心源性卒中不容忽视.三尖瓣下移畸形是一种少见的先天性心脏病,主要累及三尖瓣和右心室,少数可合并房间隔缺损或卵圆孔未闭引起矛盾栓塞,导致心源性卒中发生.本文报道1例由三尖瓣下移畸形合并房间隔缺损引起儿童卒中的病例,超声心动图技术有助于该类疾病的明确诊断、严重度评估以及其他异常的识别.

dependent and miss a great deal of microscopic information. Recently, many radiomics models for carotid plaque that identify unstable plaques and predict cardiovascular outcomes have been proposed. This systematic review was aimed at assessing whether radiomics is a reliable and reproducible method for the clinical prediction of carotid plaque. A systematic search was conducted to identify studies published in PubMed and Cochrane library from January 1, 2001, to September 30, 2022. Both retrospective and prospective studies that developed and/or validated machine learning models based on radiomics data to classify or predict carotid plaques were included. The general characteristics of each included study were selected, and the methodological quality of radiomics reports and risk of bias were evaluated using the radiomics quality score (RQS) tool and Quality Assessment of Diagnostic Accuracy Studies-2, respectively. Two investigators independently reviewed each study, and the consensus data were used for analysis. A total of 2429 patients from 16 studies were included. The mean area under the curve of radiomics models for diagnostic or predictive performance of the included studies was 0.88 +/- 0.02, with a range of 0.741-0.989. The mean RQS was 9.25 (standard deviation: 6.04), representing 25.7% of the possible maximum value of 36, whereas the lowest point was -2, and the highest score was 22. Radiomics models have revealed additional information on patients with carotid plaque, but with respect to methodological quality, radiomics reports are still in their infancy, and many hurdles need to be overcome.

Objective To explore the factors influencing the ultrasonic subharmonic-aided pressure estimation(SHAPE)technology.Methods An in vitro simulation of dynamic flow was constructed in a water tank.Three thousand and six hundred subharmonic amplitudes under different mechanical index(MI),sonazoid ultrasound contrast agent concentrations,and flow rates were obtained by SHAPE.The MI and subharmonic amplitude ranges during the pressure-related subharmonic rapid growth stage,the optimal ultrasound contrast agent concentration,and flow rate were quantified using a total fitting curve.Results The MI and sub-harmonic amplitude ranges were 0.04-0.38 and-61.94--12.82 dB,respectively.When the other parameters were constant,the maximum differences of the subharmonic amplitude under different concentrations,flow rates,and MIs were-10.0 dB,-12.84 dB,and 35.96 dB,respectively.The subharmonic amplitude and MI demonstrated the strongest correlation(r=0.973)when the contrast agent concentration and flow rate were 3.2 μL/100 mL and 8 μL/min,respectively.With MI difference of 0.04,the mean relative subharmonic amplitude was(3.18±1.55)dB(95%CI:2.80-3.56).Under the same concentration and flow rate,the increase of MI caused a gradual decrease in the subharmonic amplitude from 9 dB to 0.31 dB.Conclusion Identification and quantification of the influencing factors may improve the accuracy and effectiveness of SHAPE.

Ischemic stroke is the major cause of disability and death worldwide, but post-stroke neuronal death and related mechanisms remain unclear. Ferroptosis, a newly identified type of regulated cell death, has been shown to be associated with neurological disorders, yet the exact relationship between ferroptosis and ischemic stroke has not been elucidated. The purpose of this study is to investigate the effects of ferroptosis-specific inhibitor ferrostatin-1 (Fer-1) on neuronal injury after cerebral ischemia/reperfusion (I/R) and the underlying mechanism. In this study, we demonstrated that ferroptosis does occur in the stroke model. We found that Fer-1 reduced the levels of iron and malondialdehyde, and increased the content of glutathione and the expression of solute carrier family 7 member 11 and glutathione peroxidase 4 in cerebral I/R models. Additionally, Fer-1 significantly reduced the infarct volume and improved neurobehavioral outcomes. Moreover, we found that Fer-1 increased the levels of phosphorylated AKT and GSK3β following cerebral I/R. To further investigate the functional role of the AKT in the neuroprotective effects of Fer-1, MCAO models and oxygen-glucose deprivation-induced HT22 cells were pretreated with the AKT inhibitor MK-2206 before treatment with Fer-1 and the protective effects of Fer-1 were reversed. In conclusion, Fer-1 has protective effects on cerebral I/R injury by activating the AKT/GSK3β pathway, indicating that ferroptosis may become a novel target in the treatment of ischemic stroke.

Objective:To assess the value of S-Detect and contrast-enhanced ultrasound (CEUS) in the differential diagnosis of Breast Imaging Reporting and Data System(BI-RADS) 4 breast lesions.Methods:A total of 104 breast lesions in 100 patients diagnosed as BI-RADS category 4 by conventional ultrasound were prospectively enrolled, and all of them were received S-Detect and CEUS examination at the same time. Taking pathology as the gold standard, ROC curve was constructed to compare the diagnostic efficacy of conventional ultrasound, S-Detect, CEUS and their combination.Results:Among the 104 BI-RADS category 4 breast lesions, 63 were benign and 41 were malignant. The sensitivities of conventional ultrasound, S-Detect, CEUS and S-Detect combined with CEUS were 73.17%, 87.80%, 87.80%, 90.24%; the specificities were 57.14%, 60.32%, 68.25%, 77.78%; the positive predictive values were 52.63%, 59.02%, 64.29% and 72.55%; the negative predictive values were 76.60%, 88.37%, 89.59% and 92.45%; the accuracies were 63.46%, 71.15%, 75.96% and 82.69%; and the areas under the ROC curve (AUC) were 0.652, 0.741, 0.780 and 0.840. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of S-Detect and CEUS diagnosis were improved compared with conventional ultrasound. The AUC of combined diagnosis was higher than that of S-Detect, CEUS alone, and the differences were statistically significant(all P<0.05). The AUC of CEUS was higher than that of conventional ultrasound, and the difference was statistically significant ( P<0.05). There were no significant differences in AUC between any two of other groups (all P>0.05). Conclusions:The combined application of S-Detect and CEUS could achieve complementary advantages, which is of great significance for the differential diagnosis of benign and malignant in BI-RADS 4 breast lesions.

探讨超声次谐波辅助压力估测（subharmonic-aided pressure estimation，SHAPE)技术的影响因素。方法 在水槽内构建一个动态流量的体外模拟实验。通过SHAPE技术采集不同机械指数 (mechanical index，MI)、超声造影剂浓度及流速下的次谐波幅度值共3 600个，绘制总拟合曲线，量化与压力相关的次谐波幅度快速增长阶段的MI范围及次谐波幅度范围、最佳超声造影剂浓度及流速，明确SHAPE技术应用中的影响因素。结果 ①与压力相关的次谐波快速增长阶段：MI范围为0.04~0.38，次谐波幅度范围－61.94~－12.82 dB； ②〖JP+1〗快速增长阶段，不同浓度及流速下，次谐波幅度差异有统计学意义（P<0.05);在其他参数一定的情况下，不同浓度、流速和MI下的次谐波幅值最大差异分别为－10.0 dB、－12.84 dB和35.96 dB；③造影剂浓度为3.2 μL/100 mL，流速为8 μL/min时，次谐波幅度与MI的相关系数最高（r=0.973); ④ 增加相同的MI，不同浓度及流速间次谐波幅度变化的相对值进行比较，均无统计学意义（P>0.05)，其中MI相差0.04，次谐波幅度相对值均值约(3.18±1.55)dB，95%可信区间：2.80~3.56 dB；⑤MI的增加导致次谐波幅增加值从9 dB逐渐减小到0.31 dB。结论 与声压相关的MI范围及次谐波幅度范围，超声造影剂浓度及流速对SHAPE技术有影响，明确及量化这些影响因素，提高了SHAPE测压的准确性和有效性。

目的 观察术中超声用于辅助胚胎发育不良性神经上皮瘤(DNET)切除术的价值.方法 纳入32例接受术中超声辅助下脑肿瘤切除术并经术后病理证实的DNET患者,依照术前MRI所见将病灶分为Ⅰ型(n=12)、Ⅱ型(n=11)及Ⅲ型(n=9);比较各型病灶术中超声表现,观察以之判断DNET病灶MRI类型及术中超声辅助切除DNET的价值.结果 不同MRI类型DNET病灶之间,术中超声呈"脑沟样"回声、后方回声增强及边界清晰占比差异均有统计学意义(P均＜0.05).根据病灶后方回声增强判断MRI Ⅰ型DNET的敏感度和特异度分别为75.00％和95.00％,以病灶内"脑沟样"回声判断MRI Ⅲ型DNET的敏感度和特异度分别为77.78％和78.26％,以病灶边界不清判断MRI Ⅲ型DNET的敏感度和特异度分别为66.67％和91.30％.32例均在术中超声辅助下准确定位DNET,30例(30/32,93.75％)完全切除病灶.结论 术中超声可清晰显示DNET并辅助术者判断其类型,进而选择切除方式及范围.

Stroke is closely associated with carotid plaques. The assessment of carotid plaque is still the key issue of stroke prevention in clinical practice. This prospective cross-sectional study included patients with carotid plaque evaluated by ultrasonography (US). The intima-media thickness (IMT), lumen stenosis severity, thickness, and length of carotid plaque were measured by the routine US, and the amplitudes of subharmonics in the upstream shoulder, top, and downstream shoulder of all plaques and corresponding lumens were observed by Subharmonic Aided Pressure Estimation (SHAPE) US examination from the US contrast agent perflubutane microbubbles (Sonazoid), which analyzed the clinical parameters of patients, the subharmonic amplitude characteristics of all plaques and lumens, and the parameter differences between the ischemic stroke (IS) group and control group. From May 2021 to February 2022, 46 carotid plaques of 23 patients were included. For plaques, the subharmonic amplitude in the plaque (-60.52 +/- 4.46) was lower than that in the opposing level lumen (-56.82 +/- 5.68 dB), the subharmonic gradient across the plaque cap was negatively correlated with plaque thickness (r = -0.51, p < 0.001), and with the lumen stenosis severity (r = -0.42, p = 0.003). The median IMT of the IS group was thicker than the control group. The subharmonic gradient of the intraplaque of the IS group was larger than the control group (p = 0.004). In this analysis, we use the receiver operating characteristic (ROC) curve to establish the cutoff value of the difference to predict a new monitoring method for plaque without invasion to predict IS. It still needs a large-scale study with long-term follow-up to validate these findings.

Objectives: As a noninvasive method, diagnostic rate of PFO by CTTE is controversial because of its subjectivity and the examiner's dependence about the bubbles identification. In order to improve the diagnostic accuracy, a machine learning algorithm diagnostic method for PFO based on CTTE images (AI-CTTE) was established in our primary study. This study aimed to investigate the efficiency of the AI method in PFO detect,and to clarify the clinical value of AI in identifying PFO.Methods: From August 2019 to June 2021, 200 patients with suspected PFO in six hospitals were eventually enrolled, and all the patients underwent CTEE and CTTE examinations respectively. Each case contained ul-trasound videos of 5 cardiac cycles before and after injecting agitated saline with Valsalva maneuver from apical four-chamber (A4C) view. The patients with or without PFO were identified by the machine learning algorithm and other non-operating physicians (including experts and junior physicians). Results: A total of 144 out of 200 (72%) patients were confirmed PFO by CTEE. CTEE was used as a gold standard to assess the model's diagnostic valve.The sensitivity and specificity of the AI-CTTE for PFO detection were 78% and 75% respectively. In comparison, the sensitivity and specificity of the ultrasonic experts group were 86% and 89%, while those of the ultrasound residents group were 62% and 82%. The diagnostic efficiency of the AI-CTTE was similar with the ultrasonic experts group, but significantly higher than the ultrasound residents group.Conclusions: As a non-invasive method, AI can provide diagnostic help for junior physicians, it creates a new way for PFO recognition.

BACKGROUND:Benign breast lesions are often associated with hard nodule formation after microwave ablation (MWA), which persists for a long time and causes problems in patients. The aim of this study was to evaluate the efficacy of decorin in the treatment of hard nodule formation and its potential mechanism of action. METHODS:Using a Bama miniature pig model of mammary gland hyperplasia, immunohistochemistry, Masson's trichrome and western blotting were firstly applied to compare the extent of fibrosis and activation of key members of the TGF-β1/SMAD and MAPK signaling pathways of hard nodule in the control and MWA groups, and then the extent of fibrosis and expression of signaling pathways in hard nodule were examined after application of decorin. RESULTS:The results showed that the MWA group had increased levels of TGF-β1, p-SMAD2/3, p-ERK1/2, and collagen I proteins and increased fibrosis at 2 weeks, 4 weeks, and 3 months after MWA. After decorin treatment, the expression levels of each protein were significantly downregulated, and the degree of fibrosis was reduced at 2 weeks, 4 weeks, and 3 months after MWA compared with the MWA group. CONCLUSION:In conclusion, these results suggest that activation of TGF-β1 may play an important role in hard nodule formation and that decorin may reduce hard nodule formation after MWA in a model of mammary gland hyperplasia by inhibiting the TGF-β1/SMAD and MAPK signaling pathways.

Background:To analyze the characteristics of images from intraoperative ultrasound (IoUS) and preoperative magnetic resonance imaging (MRI) and their relationship with pathological components of dysembryoplastic neuroepithelial tumor (DNT) and to discuss the role of IoUS in detecting tumor residues.Methods:The clinical and image data of 24 patients with postoperative pathology-confirmed DNT were analyzed retrospectively. Baseline characteristics, imaging features, and intraoperative residues were recorded for further analysis. Cohen's kappa consistency evaluation was performed on the echo and signal characteristics of the lesions.Results:Cohen's kappa coefficient between the echo and signal of the lesion was 0.832. The characteristics of IoUS were gyrus or mass hyperechoic solid nodules located under the cortex, insufficient blood flow signals, and clear boundaries, in addition to mixed cystic and solid echo nodules. The solid part of the lesion consisted of pathologically nodular specific glioneuronal element (SGE) or was combined with glial nodules and focal cortical dysplasia (FCD), which was characterized by a high echo or long T1 long T2 signal and uniform or uneven distribution. The cystic part consisted of a mucinous matrix, showing echoless or long T1 long T2 on fluid attenuated inversion recovery (FLAIR), which was higher than that in cerebrospinal fluid but lower than that in the cerebral cortex. The residual lesion discovered using IoUS was confirmed with postoperative MRI.Conclusions:The IoUS characteristics of DNT are strongly consistent with MRI, and its imaging features are related to pathological components. IoUS can assist the operator to judge the mode and scope of tumor resection, detect residual tumor, and improve the rate of total tumor resection.

BACKGROUND:The incidence rate of stroke or cerebrovascular accidents ranks first in China. More than 85% of stroke patients have residual upper limb motor dysfunction, especially hand dysfunction. Normalizing the rehabilitation evaluation process and standard quantitative evaluation method is a complex and key point in rehabilitation therapy. The study aimed to establish a function model based on the Bayes discriminant by measuring the thenar stiffness with shear wave elastography (SWE) to quantitatively evaluate the hand motor function of hemiplegic patients after stroke.METHODS:This study collected 60 patients diagnosed with hemiplegia after stroke from October 2021 to October 2022. Therapists used the Brunnstrom assessment (BA)scale to divide the patients into the stage. All the patients underwent the measurement of SWE examination of abductor pollicis brevis (APB), opponens pollicis (OP), flexor pollicis long tendon (FPLT), and flexor pollicis brevis (FPB) by two sonographers. The SWE change rate of four parts of the thenar area was calculated prospectively with the non-hemiplegic side as the reference, the function equation was established by the Bayes discriminant method, and the evaluation model was fitted according to the acquired training set data. Lastly, the model was verified by self-validation, cross-validation, and external data validation methods. The classification performance was evaluated regarding the area under the ROC curve (AUC), sensitivity, and specificity.RESULTS:The median SWE values of the hemiplegic side of patients were lower than those of the non-hemiplegic side. According to the BA stage and SWER of APB, OP, FPLT, and FPB, our study established the Bayes discriminative model and validated it via self-validation and cross-validation methods. Then, the discriminant equation was used to validate 18 patients prospectively, the diagnostic coincidence rate was about 78.8%, and the misjudgment rate was approximately 21.2%. The AUC of the discriminant model for diagnosing BA stage I-VI was 0.928(95% CI: 0.839-1.0),0.858(95% CI: 0.748-0.969),1.0(95% CI: 1.0-1.0), 0.777(95% CI: 0.599-0.954),0.785(95% CI: 0.593-0.977) and 0.985(95% CI: 0.959-1.0), respectively.CONCLUSION:This Bayes discriminant model built by measuring thenar stiffness was of diagnostic value and can provide an objective basis for evaluating clinical rehabilitation.

BACKGROUND Intracranial hypertension is a common clinicopathological syndrome in neurosurgery, and a timely understanding of the intracranial pressure (ICP) may help guide clinical treatment. We aimed to investigate the correlation between subharmonic contrast-enhanced ultrasound (SHCEUS) parameters and ICP in experimental canines. METHODS A dynamic model of ICP change from 11 mm Hg to 50 mm Hg was established in experimental canines by placing a latex balloon into the epidural space and injecting saline into the balloon. In addition, a pressure sensor was placed in the brain parenchyma to record the changes in ICP. When the ICP stabilized after each increase, subharmonic-aided pressure estimation (SHAPE) technology was performed to obtain the SHCEUS parameters, including the basal venous and adjacent intracranial arterial subharmonic amplitude and SHAPE gradient (subharmonic amplitude in the intracranial artery minus that in the basal vein). The correlation between these parameters and ICP was analyzed. RESULTS The subharmonic amplitude of the basal vein was negatively correlated with the ICP (r = -0.798), and the SHAPE gradient was positively correlated with the ICP (r = 0.628). According to the guidelines for ICP monitoring in patients with traumatic brain injury, we defined 20 mm Hg, 25 mm Hg, and 30 mm Hg as the cutoff ICP levels. The area under the receiver operating characteristic curve of the basal venous subharmonic amplitude for diagnosing intracranial hypertension >= 20 mm Hg, >= 25 mm Hg, and >= 30 mm Hg was 0.867 (95% confidence interval [CI], 0.750-0.943), 0.884 (95% CI, 0.770-0.954), and 0.875 (95% CI, 0.759-0.948), respectively. The area under the receiver operating characteristic curve of the SHAPE gradient for diagnosing intracranial hypertension >= 20 mm Hg, >= 25 mm Hg, and >= 30 mm Hg was 0.839 (95% CI, 0.716-0.924), 0.842 (95% CI, 0.720-0.926), and 0.794 (95% CI, 0.665-0.890), respectively. CONCLUSION SHCEUS parameters are correlated with ICP. The SHAPE technique can assist in evaluating ICP changes in canines, which provides a new idea and method for evaluating ICP.

Background In the treatment of ischemic cerebral stroke (ICS), most conventional treatments, including carotid endarterectomy and carotid artery stenting, may cause cerebral ischemia-reperfusion injury (CIRI). For treated ICS patients, changes in cerebral blood flow are directly related to brain function. At present, computed tomography perfusion, dynamic susceptibility contrast-enhanced perfusion weighted imaging and magnetic resonance arterial spin labeling perfusion imaging are used to monitor cerebral blood flow, but they still have some limitations. Our study aimed to monitor the changes in cerebral cortical blood flow by laser speckle contrast imaging (LSCI) in CIRI model mice and to propose a new method for predicting outcomes after CIRI. C57BL/6 N mice were used to establish a mouse CIRI model based on a modified thread-occlusion method and divided into a good outcome group and a poor outcome group according to survival within 7 days. The cerebral cortical blood flow of the area supplied by the left middle cerebral artery was monitored by LSCI at baseline (before modeling), 1 h after ischemia, immediately after reperfusion and 24 h after reperfusion. Then, the brains of the mice were removed immediately and stained with hematoxylin and eosin to observe the pathological changes in brain neurons. Results The cerebral cortical blood flow in the poor outcome group was obviously reduced compared with that less in the good outcome group at 24 h after reperfusion (180.8 ± 20.9 vs. 113.9 ± 6.4, p = 0.001), and at 24 h after reperfusion, the cerebral cortical blood flow was negatively correlated with the severity of brain tissue injury (p = − 0.710, p = 0.010). Conclusions LSCI can monitor the changes in cerebral cortical blood flow during CIRI in mice and could be used as a feasible method for predicting outcomes after CIRI in mice.

Background The aim of this study is to propose a new TI-RADS and compare it with the American College of Radiology (2017 ACR)-TI-RADS and the 2020 Chinese (2020 C)-TI-RADS. Methods A retrospective analysis of 749 thyroid nodules was performed. Based on the calculated odds ratio of ultrasonic signs between benign and malignant nodules, a new thyroid nodule score and malignancy rate were calculated. A receiver operating characteristic curve was drawn to analyze the new system's effectiveness in the differential diagnosis of benign and malignant thyroid nodules and was compared with the 2020 C-TI-RADS and 2017 ACR-TI-RADS. Five ultrasound physicians with different qualifications graded another 123 thyroid nodules according to the 2017ACR-TI-RADS, 2020 C-TI-RADS, and the newly proposed TI-RADS. Intergroup and intragroup consistency was evaluated using the Kappa test and intraclass correlation coefficient (ICC) test. Results 1) The new thyroid nodule score was divided into 0, 1, 2, 3, 4, and 5 points, with malignancy rates of 1.52%, 7.69%, 38.24%, 76.00%, 90.75%, and 93.75%, respectively. Using 3 points as the cutoff value to diagnose benign and malignant thyroid nodules, the sensitivity and specificity were 94.03% and 67.39%, respectively, which were higher than those of the 2017 ACR-TI-RADS and 2020 C-TI-RADS. The simplified TI-RADS, namely, sTI-RADS, was established as follows: sTI-RADS 3 (0 points), malignancy rate < 2%; sTI-RADS 4a (1 point), malignancy rate 2-10%; sTI-RADS 4b (2 points), malignancy rate 10-50%; sTI-RADS 4 (3 points), malignancy rate 50-90%; and sTI-RADS 5 (4 and 5 points), malignancy rate > 90%. 2) Five ultrasound doctors graded thyroid nodules by the 2017 ACR-TI-RADS, 2020C-TI-RADS and sTI-RADS. Intragroup consistency was good among all tests; ICC were 0.86 (0.82-0.90), 0.84 (0.78-0.88), and 0.88 (0.84-0.91), respectively, while only sTI-RADS had good intergroup consistency. Conclusion In summary, we proposed a new TI-RADS, namely, sTI-RADS, which was obtained using a simple assignment method with higher specificity, accuracy, positive predictive value, and Youden index than the 2017 ACR-TI-RADS and 2020 C-TI-RADS.