BACKGROUND:Definitive chemoradiotherapy is recommended as the primary treatment for cervical esophageal carcinoma (CEC). However, local control rates remain unsatisfactory for some patients. Therefore, in this study, we introduced a new treatment paradigm for individuals with CEC, customizing the choice between subsequent local treatments based on their response to induction chemotherapy and immunotherapy. PATIENTS AND METHODS:Induction treatment comprised two to four cycles of chemotherapy combined with programmed cell death protein 1 (PD-1) inhibitors. Patients achieving complete response (CR) or near CR after induction treatment underwent definitive chemoradiotherapy (dCRT), while those not achieving CR or near CR underwent surgical resection. RESULTS:Among the 40 eligible patients, 14 (35.0%) achieved a CR or near CR after induction treatment. Of the ten patients achieving a CR or near CR, one developed an esophageal fistula after dCRT (10.0%). Among the eight non-CR or non-near CR patients receiving chemoradiotherapy, six developed esophageal fistula (75.0%). Among the 26 patients who did not achieve CR or near CR after induction treatment, the 1-year cancer specific survival (CSS) rates were 93.3% [95% confidence interval (CI) 0.815-1%] for the 18 patients in the surgery group, and 71.4% (95% CI 0.447-1%) for the 8 patients in the chemoradiotherapy group (p = 0.027). The overall laryngeal preservation rate was 85.0% (34/40), with a functional laryngeal preservation rate of 77.5% (31/40). CONCLUSION:The approach consisting of combined immunotherapy and chemotherapy successfully identified patients who were responding well to induction treatment and who were sensitive to radiotherapy, for chemoradiotherapy; thus, improving laryngeal preservation rates. In addition, it also identified patients with poor responses to induction treatment and radiotherapy, for timely surgery; hence, reducing radiotherapy complications and enhancing survival.

目的 对比超声引导下 16G与 14G活检针穿刺对乳腺病变诊断的准确度,并分析影响因素.方法 回顾性分析 978 例使用 16G与 14G活检针行超声引导下乳腺病变穿刺活检的患者,对比两组穿刺病理的假阴性率、高风险病变被低估率、导管原位癌(DCIS)被低估率及一致率,并分析影响诊断效能的相关特征.结果 684 例使用 16G活检针,294 例使用 14G活检针.16G活检针假阴性率、高风险病变被低估率、DCIS被低估率及一致率依次为 2.7%、17.4%、31.0%、48.9%,14G活检针对应的概率依次为 3.3%、18.1%、31.6%、47.0%,两组间无统计学意义.16G活检针组病理结果一致性受年龄和乳腺影像报告和数据系统(BI-RADS)分类的影响,年龄越大、评分越高,高风险病变及DCIS被低估的可能性越大.结论 14G和 16G活检针进行超声引导下乳腺穿刺活检的诊断准确度没有统计学意义.年龄较大或者 BI-RADS分类较高的病变,可选择不受该因素影响的 14G活检针,有利于提高诊断的准确度.

Background:The varying experience of surgeons and ultrasound physicians, and their collaboration with physicians, may affect operation time and efficiency. We evaluated the learning curve of ultrasound-guided vacuum-assisted excision (VAE) of breast lesion with collaboration between different physicians, and assessed characteristics associated with operation time.Methods:The sample population of this retrospective study was divided into two groups: 49 consecutive patient surgeries completed by skilled surgeons and novice ultrasound physicians (U group); and 30 consecutive patient surgeries completed by skilled ultrasound physicians and novice surgeons (S group). Cumulative summation graphs were used to evaluate operation time and calculate the turning point of the learning curve. Patients in the U and S groups were divided into exploration stage and proficiency stage according to the turning point, and the differences in influencing factors were compared. A total of 548 patients who underwent vacuum-assisted breast excision performed by a combination of skilled surgeons and skilled ultrasound physicians were selected as the reference group (R group). The differences among the three groups were compared. The relationship between the operation time and other factors in the different groups was analyzed using linear regression.Results:The best learning curve of the sample population was the quadratic fitting equation, and the turning point was the 19th case in the U group and the 14th case in the S group. The total operation times in the proficiency stage were significantly shorter than those in the exploration stage in the U and S groups (P=0.012 and P=0.003, separately). Patient age, long diameter, short diameter, and depth of masses related to the operation time.Conclusions:Our data suggest the existence of different learning curves in ultrasound-guided vacuum-assisted excision for the collaborations of different stages surgeons and ultrasound physicians. Through the accumulation of experience, it is feasible to safely perform ultrasound-guided VAE of breast lesions.

目的 回顾性分析低年资超声医师与熟练临床医师组合行超声引导下真空辅助乳腺旋切术是否存在学习曲线,计算曲线转折点,分析影响学习曲线的其他因素.方法 低年资超声医师与熟练临床医师组合行超声引导下真空辅助乳腺旋切术的患者49例为研究组,以累积和分析法绘制学习曲线,计算转折点,将研究组数据分为学习探索阶段和熟练掌握阶段,比较两组数据各指标差异有无统计学意义;选择同一时期熟练超声医师与熟练临床医师组合行超声引导下真空辅助乳腺旋切术的患者548例为基准组,比较研究组与基准组各指标差异是否有统计学意义;利用线性回归法分别对研究组及基准组中手术时间与其他各指标间的关系进行分析.结果 研究组最佳学习曲线为二次拟合方程,学习曲线转折点为第19例;学习探索阶段和熟练掌握阶段手术时间及BI-RADS 分类组间比较差异有统计学意义,其他指标无统计学意义;研究组与基准组手术时间组间比较差异有统计学意义,其他指标无统计学意义;研究组手术时间与结节厚径呈正相关;基准组手术时间与结节长径、厚径及深度呈正相关,与患者年龄呈负相关.结论 低年资超声医师与熟练临床医师组合行超声引导下真空辅助乳腺旋切术存在学习曲线,曲线转折点最佳为第19例,患者年龄、结节长径、厚径及距表皮的深度可能是影响学习曲线的其他因素.

Objective:To compare the gray-scale and contrast-enhanced ultrasound features between focal organizing pneumonia (FOP) and subpleural focal chronic nonspecific inflammation.Methods:Twenty-four patients with FOP and 40 patients with focal chronic nonspecific inflammation pathologically diagnosed at Peking University Third Hospital from January 2017 to April 2022 were analyzed retrospectively. The conventional ultrasonic features of the two groups, as well as the arrival time of contrast agent, the phase of enhancement, the enhance mode, the degree of enhancement, the degree of uniformity of enhancement, and the presence or absence of non-enhanced areas were compared between the two groups.Results:On ultrasound images, the proportion of patients with air bronchogram sign (62.5%, 15/24) was significantly higher in the FOP group than in the focal chronic nonspecific inflammation group (14/40, 35%, P=0.032). The results of contrast-enhanced ultrasound showed that the two groups were supplied by the pulmonary artery. Compared with the focal chronic nonspecific inflammation group, FOP was mainly uniformly enhanced (20/24, 83.3%), while 55% of cases in the focal chronic nonspecific inflammation group was unevenly enhanced (22/40, 55.0%); the difference between the two groups was statistically different (P=0.003). Non-enhanced areas within the lesions were more common in the chronic nonspecific inflammation group (15/40, 37.5% vs 2/24, 8.3%, P=0.011).Conclusion:FOP is more common with air bronchogram sign. Contrast-enhanced ultrasound shows homogeneous and diffuse enhancement, and few perfusion defects. These features may be helpful to the differential diagnosis of FOP and focal chronic nonspecific inflammation.

Objective:To compare the application of SonoVue and Sonazoid in the localization of sentinel lymph nodes (SLN) in early breast cancer patients.Methods:A total of 204 patients with T1-2 breast cancer diagnosed at Peking University Third Hospital from January 1, 2018 to January 30, 2020 were included. All patients underwent axillary lymph node dissection or sentinel lymph node biopsy to obtain the pathological results, and all patients underwent contrast-enhanced ultrasound examination before operation. According to the type of contrast agent used, the patients were divided into either a SonoVue group (135 cases, including 1 male case) or a Sonazoid group (69 cases). The number and time of enhancement of SLN in the two groups were observed, and the two contrast agents were then compared with methylene blue staining.Results:Among the 135 patients in the SonoVue group, 210 SLNs were detected by CEUS and 297 by methylene blue staining, and the difference was statistically significant (t=6.964, P=0.000); among 69 patients in the Sonazoid group, 102 SLNs were detected by CEUS and 139 by methylene blue staining, and the difference was also statistically significant (t=3.763, P=0.000). Among the 135 patients in the SonoVue group, 1 failed in angiography localization, and 4 failed in methylene blue staining localization; all the 68 patients in the Sonazoid group all succeeded in localization, but 3 cases failed in methylene blue staining localization, with no significant difference (P=0.370, 0.244).The success rate of enhancement between in the SonoVue and Sonazoid groups was 99.3% vs 100%, and the difference was not statistically significant (P＞0.05).There was no SLN enhancement in the SonoVue group at 60 and 120 min after injection of the contrast medium. The blue stained lymph nodes in the Sonazoid group had continued enhancement in saline.Conclusion:The diagnostic value of Sonazoid in sentinel lymph nodes in early breast cancer patients is not lower than that of SonoVue,and its ability of continuous enhancement of SLN is expected to be used for intraoperative confirmation of the accuracy and completeness of SLN removal.

Objective To explore the application of online teaching of ultrasonic theory during the COVID-19 pandemic. Methods The standardized training of undergraduates, graduates and refresher doctors who have participated in the online theoretical teaching of ultrasound in the Peking University Third Hospital. Compared with the assessment results in previous years as the Objective index, the questionnaire was used as the subjective evaluation index. Results There was no significant difference between the experimental group and the control group. It is shown that 78.3% of learners belives that the online teaching method got better than the conventional offline teaching method. Conclusions The quality of online teaching is similar to that of conventional teaching mode but both trainers and trainees prefer the online teaching.

Objectives To assess the efficacy of percutaneous Sonazoid-enhanced ultrasound and in vitro verification for identification sentinel lymph nodes (SLNs) and diagnosis of metastatic SLNs in patients with early breast cancer (BC). Methods Sixty-eight patients with early BC were enrolled finally. After the induction of general anesthesia, 0.4 ml of Sonazoid (SNZ), a new second-generation tissue-specific ultrasound contrast agent (UCA), mixed with 0.6 ml of methylene blue, was injected intradermally. The lymphatic vessels and connected SLNs were immediately observed and marked. After being resected, these SLNs were soaked in saline water and examined still in the mode of contrast-enhanced ultrasound (CEUS) in vitro. This procedure could ensure that all the enhanced nodes had been removed as much as possible. The numbers of SLNs detected by UCA and blue dye were recorded. The enhancement patterns of SLNs were compared with the final pathological results. Results SLNs detection rate by SNZ-CEUS was 100%, which was higher than that by blue dye (95.59%). CEUS identified a median of 1.5 nodes, while blue dye identified a median of 1.9 nodes per case ( p = 0.0012). When homogeneous high perfusion and complete annular high perfusion were regarded as negative nodes, the sensitivity and negative predictive value were 92.31% and 96.79% respectively, while the specificity was 84.21%. Conclusions Percutaneous SNZ-enhanced ultrasonography combined with in vitro verification is a feasible and reliable method for SLNs identification intraoperatively. Enhancement patterns can be helpful in determining the status of SLNs. Key Points • CEUS with percutaneous injection of Sonazoid can successfully identify SLNs with the rate of 100% in early breast cancer patients, higher than 95.59% of blue dye. • Sonazoid, with high affinity with reticuloendothelial cells, increases the imaging time of SLNs and facilitates biopsy intraoperatively better than Sonovue as a lymphatic tracer. • Homogenous high and complete annular high perfusions have a sensitivity of 92.31% and a negative predictive value of 96.79% in the prediction of uninvolved SLNs.

To the Editor: Continuous monitoring of hemodynamic status can be used to detect early abnormal circulation and is very helpful for the management of the critically ill. Today, different minimally invasive and non-invasive monitoring systems can measure functional hemodynamic parameters to guide treatment planning and improve patient care. Among them, the thoracic electrical bio-impedance (TEB) technique is widely available and is accurate for most patients, especially after open-heart surgery. However, there are ethnicity-related differences among hemodynamic characteristics and the hemodynamic response to the same cardiovascular disease differs among racial groups. Currently, no nationwide hemodynamic parameter reference ranges can be used for healthy Chinese Han adults. A large-scale, forward-looking research investigation of the hemodynamic state markers in China has not been wholly reported. Therefore, it is necessary to establish ethnicity-speci fi c hemodynamic reference ranges for the Chinese Han population and evaluate the relationship between these parameters and age/sex, in order to promote ef fi cient and accurate judgment in clinical practice. From July 2012 to September 2017, a prospective, nationwide study led by the Ministry of Science and Technology of the People ’ s Republic of China was designed, organized, and performed to establish normal reference ranges of hemodynamic parameters for the Chinese Han population and to con fi rm the impacts of age and sex on these parameters.

目的 通过对不同类型脑卒中合并孤立性比目鱼肌间静脉血栓患者的超声随访结果进行回顾性分析,探讨孤立性小腿比目鱼肌间静脉血栓的管理方法.方法 回顾性分析我院神经内科脑卒中患者下肢静脉超声检查结果,选取合并孤立性小腿比目鱼肌肌间静脉血栓且进行两次及以上超声检查患者共123例,其中出血性脑卒中属于抗凝绝对禁忌证为非抗凝组44例,缺血性脑卒中属于抗凝绝对适应证为抗凝组79例,通过卡方检验分析两组患者下肢静脉血栓超声检查变化是否有统计学差异.结果 (1)肺栓塞:两组中均无患者发生.(2)血栓延伸到腘静脉:抗凝组1例,非抗凝组2例,P=0.278.(3)血栓再通或部分再通:抗凝组16例,非抗凝组11例,P=0.542.结论 孤立性小腿比目鱼肌间静脉血栓患者应以定期复查为主,延伸到腘静脉再进行治疗.

目的 探讨术前超声造影定位前哨淋巴结和术前超声造影+术中美蓝显影联合法检测T1～T2期乳腺癌前哨淋巴结的效果.方法 选取我院就诊乳腺癌患者46例,术前进行超声造影观察前哨淋巴结,术中进行美蓝显影探查淋巴结并切除送病理检查,比较两种方法及联合应用对早期乳腺癌前哨淋巴结的成功率及检出个数.结果 美蓝显影结果符合术后结果的为40例(86.95％),超声造影结果符合术后结果的为39例(84.79％),两者联合诊断符合的为43例(93.48％),造影组与美蓝组、造影与联合诊断两两组间比较,差异均没有统计学意义.结论 超声造影术前检查前哨淋巴结与术中美蓝显影结果无明显差别,联合两者进行可以优化早期乳腺癌前哨淋巴结检出率.

The ideal method to diagnose prostate cancer (PCa) should be minimally invasive with few complications, and must provide a higher sensitivity for diagnosing clinically significant PCa than clinically insignificant PCa ( Kasivisvanathan et al., 2018 Kasivisvanathan V Rannikko AS Borghi M Panebianco V Mynderse LA Vaarala MH Briganti A Budaus L Hellawell G Hindley RG Roobol MJ Eggener S Ghei M Villers A Bladou F Villeirs GM Virdi J Boxler S Robert G Singh PB Venderink W Hadaschik BA Ruffion A Hu JC Margolis D Crouzet S Klotz L Taneja SS Pinto P Gill I Allen C Giganti F Freeman A Morris S Punwani S Williams NR Brew-Graves C Deeks J Takwoingi Y Emberton M Moore CM MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med. 2018; 19: 1767-1777 Crossref Scopus (1012) Google Scholar ). Previous studies have shown that targeted biopsy (TBx) and 12-core system biopsy (12-SBx) are often performed simultaneously to avoid missing a diagnosis of clinically significant PCa; consequently, more biopsy cores are obtained when performing multiparametric magnetic resonance imaging (MRI)/Transrectal Ultrasound (TRUS) fusion biopsy ( Ahmed et al., 2017 Ahmed HU El-Shater BA Brown LC Gabe R Kaplan R Parmar MK Collaco-Moraes Y Ward K Hindley RG Freeman A Kirkham AP Oldroyd R Parker C Emberton M Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): A paired validating confirmatory study. Lancet. 2017; 389: 815-822 Abstract Full Text Full Text PDF PubMed Scopus (1279) Google Scholar ). The aim of our research was to develop an alternative sampling scheme that utilizes fewer biopsy cores while maintaining a diagnostic efficiency for PCa equivalent to that of TBx + 12-SBx.

Thermosensitive liposomes have demonstrated great potential for tumor-specific chemotherapy. Near infrared (NIR) dyes loaded liposomes have also shown improved photothermal effect in cancer theranostics. However, the instability of liposomes often causes premature release of drugs or dyes, impeding their antitumor efficacy. Herein, we fabricated a highly stable thermo-responsive bubble-generating liposomal nanohybrid cerasome with a silicate framework, combined with a NIR dye to achieve NIR light stimulated, tumor-specific, chemo-photothermal synergistic therapy. Methods: In this system, NIR dye of 1,1'-Dioctadecyl-3,3,3',3'- Tetramethylindotricarbocyanine iodide (DiR) with long carbon chains was self-assembled with a cerasome-forming lipid (CFL) to encapsulate ammonium bicarbonate (ABC), which was further used for actively loading doxorubicin (DOX), affording a thermosensitive and photosensitive DOX-DiR@cerasome (ABC). Results: The resulting cerasome could disperse well in different media. Upon NIR light mediated thermal effect, ABC was decomposed to generate CO2 bubbles, resulting in a permeable channel in the cerasome bilayer that significantly enhanced DOX release. After intravenous injection into tumor-bearing mice, DOX-DiR@cerasome (ABC) could be efficiently accumulated at the tumor tissue, as monitored by DiR fluorescence, lasting for more than 5 days. NIR light irradiation was then performed at 36h to locally heat the tumors, resulting in immediate CO2 bubble generation, which could be clearly detected by ultrasound imaging, facilitating the monitoring process of controlled release of the drug. Significant antitumor efficacy could be obtained for the DOX-DiR@cerasome (ABC) + laser group, which was further confirmed by tumor tissue histological analysis.

患者男,50岁.因右侧面颊部包块就诊,无吸烟、无酗酒史、无疼痛.于我院行超声检查,超声示:右侧面颊部隆起处皮下可见一低回声结节(图1),边界清晰,周边可见小动脉伴行.提示为“右侧面颊部皮下结节,表皮样囊肿?”.病理结果:肌纤维母细胞瘤.

专科医师规范化培训是医学继续教育的重要组成部分,其建立在住院医师规范化培训基础上,在更高的要求上继续培养能够规范、独立地从事临床专科诊断和治疗工作的医师. 2006 年我国启动专科医师培训试点工作,近年来又发布了《关于开展专科医师规范化培训制度试点的指导意见》(国卫科教发〔2015〕97号) ,从而正式确立了"5 +3 +X"( 5年本科培训,3年住院医师规范化培训, X年专科医师规范化培训,目前北京大学医学部暂定为3 年)的专科医师培养模式[1～3]. 2017 年初,北京大学医学部发布专科医师培训细则,其中超声科成为试点科室. 我们对相关培训工作情况进行学习和讨论,初步形成了对超声专业专科医师规范化培训的认识,本文对此进行总结.

To explore the clinical application value of high‐frequency contrast‐enhanced ultrasound in guiding peripheral lung consolidation biopsy . Methods Clinical data of 33 patients with peripheral pulmonary w ho underwent high‐frequency contrast‐enhanced ultrasound biopsy were retrospectively analyzed . According to the pathological results as the gold standard ,the puncture path , needle tip display ,puncture complications and the diagnostic rate of pathological results were described . Results Among the 33 patients ,32 patients had pathological findings ,including 18 malignant lesions ,14 benign lesions ,and 1 non‐effective tissue . ①T he difference between lesion enhancement and peripheral lung tissue enhancement time within 2 .5 s were in 20 patients ( 12 benign ,8 malignant) ,12 patients ( 2 benign ,10 malignant) showed difference greater than 2 .5 s . T here were 19 cases with uniform enhancement ,including 9 benign cases ( 28 .1% ) ,10 malignancy cases ( 31 .3% ) ; 13 cases with uneven enhancement ,including 5 cases with benign ( 15 .6% ) ,8 cases with malignancy ( 25 .0% ) . T he rate of relatively uneven enhancement of malignant lesions was higher ,but the difference was not statistically significant ( P ＝0 .618 ) . ② High‐frequency contrast‐enhanced images were scored at 2 points or more in 28 cases ( 87 .5% ) ,and the high‐frequency contrast‐enhanced ultrasound images were satisfactory . ③Interventional puncture path score was 2 points or more in 29 cases ( 90 .6% ) . ④Puncture needle tip display were scored at 1 point or more in 28 cases ( 87 .5% ) . ⑤A total of 87 needles were punctured ,and 32 cases obtained pathological diagnosis of puncture ( 97 .0% ,32/33) . Conclusions Due to its high spatial resolution ,high‐frequency ultrasound can avoid adjacent tissues and blood vessels by showing the position of the needle tip in real time without the need of puncture frame and multi‐angle needle insertion during operation ,and accurately locate the target with good safety .

The training of residents majoring in ultrasound needs not only to pay attention to the teaching of speculative knowledge,but also to "look at pictures and talk",which is based on a large number of diagnostic ultrasound cases,training the residents to find,discover and discriminate the lesions from the ultrasonic images to finally form a sharp recognition and diagnosis ability.This study used the instant messaging tool WeChat to establish a virtual learning platform and implement a case based teaching process through this platform,which can avoid the limitations of time and space,and make the communication between teachers and students faster.According to the questionnaire survey,residents generally believed that the training mode can effectively improve learning efficiency and professional ability and hope to add this training mode to the basis of traditional teaching mode.The results of resident case analysis showed that the diagnostic accuracy of residents gradually increased during the training process.The model of WeChat platform combined with case teaching can provide new ideas and methods for standardized training of resident doctors in ultrasound specialty.

目的 探讨日常病例报告评价及反馈系统在超声住院医师规范化培训中的应用价值.方法 按照规范化操作、规范留图、体表标记、彩色血流、语言表达及报告书写等方面制定住院医师考核评分评估的方法;按照评分方法对培训后的住院医师的日常病例报告进行评分,并对病例进行定期点评反馈;以往届未经过培训的住院医师同时期的诊断报告为对照,在以上方面及常规定期考核成绩进行配对t检验,判断同期水平住院医师报告诊断水平有无差别.结果 经过日常病例报告评价及反馈系统培训后的住院医师临床报告各方面的评分(总分46.70)水平均较对照组的评分(总分40.70)有提高(P<0.05);住院医师在超声诊断及报告水平提高方面的自我评价结果满意率为90％.结论 日常病例报告评价与反馈系统在临床教学实践中具有较高的可行性,可以有效地提高医师培训的质量.

介入性超声是指在实时超声影像学监测和引导下,将特制的针具、导管导丝、消融电极等器械或造影剂引入人体,对病变进行诊断和治疗的过程,是超声与介入学融合而成的交叉学科. 1974年Pedersen等[1]在超声引导下进行第一例肾造瘘术,标志着介入性超声治疗的开始. 由于这种治疗方法能够实时监测诊断及治疗的全过程,不仅安全简便,而且定位精准,取材满意,并发症较少,目前已用于全身多系统组织器官的穿刺活检及射频消融治疗,而且建立了诊疗规范[2] ,部分应用已经写入治疗指南[3] ,成为介入治疗学的重要分支[4]. 但是囿于我国当前的临床教育水平及教学能力,介入性超声的发展仍然比较缓慢,而从业医师的学历、临床经验、技术水平也参差不齐,因此,探讨介入超声专科医师培训的模式,建立相应的培养体系和操作技术规范,对提高我国相关专业技术水平具有重要意义.