Objective:To analyze a series of ultrasonic follow-up data of breast at different stages after breast autologous fat injection, and explore the value of ultrasound as a means of postoperative imaging evaluation.Methods:The clinical and ultrasonic data of patients who underwent breast autologous fat transplantation in the Department of Plastic Surgery of Peking University Third Hospital from October 2015 to September 2021 were analyzed retrospectively. According to the images, whether the breast structures at different levels (skin layer, subcutaneous fat layer, glandular layer, posterior breast space and chest wall muscle layer) were clear and whether there were abnormal echoes were observed. The location, size, shape, calcification and blood flow signals of abnormal echoes were recorded.Results:A total of 61 female patients, aged 20-41 years, were included. The single fat injection volume of unilateral breast was 70-300 ml (including 251-300 ml, 15 cases; 200-250 ml, 36 cases; less than 200 ml, 10 cases). The ultrasonic images of postoperative patients were continuously obtained. The changes were mainly reflected in two aspects. One was the fat band formed in the posterior breast space, which showed a medium vocal cord in the initial stage and lacked a cord like texture. With the passage of time, more and clear strong echo intervals gradually formed in it. Second, focal fat necrosis can be identified in the subcutaneous fat layer, glandular layer and posterior breast space. At the initial stage, it is irregular and anechoic with unclear boundary. Over time, its edge echo increases, forming round or oval anechoic with clear boundary.Conclusions:Ultrasound can be used as an effective and necessary means of postoperative management of breast autologous fat transplantation, and can provide valuable information for clinicians to accurately judge the surgical effect.

Objective:To quantitatively evaluate diastasis recti abdominis in postpartum women by high frequency ultrasound, investigate the appropriate diagnostic threshold, and identify the factors related to diastasis recti abdominis.Methods:From April to July 2019, 51 women at 6-30 months after delivery at Third Hospital of Peking University were recruited. Age, height, weight, body mass index, postpartum time, mode of delivery, and delivery times were collected. Abdominal circumference was measured. Subcutaneous fat thickness and maximum rectus abdominis distance during relaxation and contraction were evaluated by ultrasound. Pearson correlation analysis was used to explore the relationship between rectus abdominis distance and age, postpartum time, height, and physique. Point biserial correlation analysis was used to explore the correlation between delivery mode or delivery times and rectus abdominis distance. Independent sample t test was used to compare the difference of rectus distance in relaxation or contraction state between cesarean section and natural delivery women.Results:The average maximum distance of the rectus abdominis was (2.88±1.04) cm in relaxation and (2.45±1.15) cm in contraction. When 75% of the rectus abdominis distance deviated from the normal population was set as the diagnostic cut-off value, the diagnostic cut-off values of diastasis recti abdominis during relaxation and contraction were 3.0 cm and 2.8 cm, respectively. There was a linear correlation between rectus abdominis distance during relaxation and contraction (r=0.899, P＜0.001). There was no significant correlation between the distance of the rectus abdominis and age, height, weight, body mass index, postpartum time, abdominal circumference, subcutaneous fat thickness, or delivery times. Only the mode of delivery had a weak correlation with the distance of the rectus abdominis during contraction (r=0.369, P=0.008). There was no significant difference in the distance of the rectus abdominis between the first and second births. The distance of the rectus abdominis in women with a caesarean section was significantly larger than that of women with a natural delivery [(3.16±1.31) cm vs (2.58±0.47) cm, t=-2.082, P=0.038; (2.85±1.35) cm vs (2.00±0.64) cm, t=-2.828, P=0.007].Conclusion:High frequency ultrasound can accurately and quantitatively evaluate diastasis recti abdominis, and the measurement of rectus abdominis distance in relaxation or contraction state has similar value. High frequency ultrasound can provide useful information for exploring the mechanism of diastasis recti abdominis and related influencing factors.

Case-oriented Workshop training mode is a professional training method which has been highly praised by anesthesiologists in recent years. It is of great significance to stimulate the participation of anesthesiologists and strengthen the application of the extended focused assessment with sonography for trauma (EFAST) in perioperative anesthesia management. The training of EFAST is divided into two stages: the first stage is about the relevant knowledge of EFAST and watching standardized operations on site, and the second stage is for each trainee to practice the operations under the guidance of the teacher until they can complete them independently. The EFAST adopts Workshop training mode, and the trainees can complete the target area scanning in about 90 seconds on average. It can maximize the training effectiveness and comprehensively improve the trainees' mastery of knowledge and skills in an all-round way. It is a training mode worthy of promotion in anesthesiology department.

Objective To compare the predictive value of different ratio measurement in predicting the risk of malignant thyroid nodules and to determine the best value of ratio in diagnosing thyroid nodules.Methods The clinical data of 342 thyroid nodules diagnosed by ultrasonography and confirmed by histology in our hospital from January 2018 to August 2018 were analyzed.The ratio of nodules in different sections,including longitudinal plane ratio(A/TL)and transverse plane ratio(A/TC),was obtained through the maximum head-foot diameter(TL),the maximum left-right diameter(TC),and the anterior-posterior diameter(A)of transverse section measured by ultrasonography.The correlation of histological diagnosis of benign or malignant nodule with longitudinal ratio and transverse ratio were analyzed.Results The A/TC and A/TL of malignant nodules were 1.00(0.83,1.17)and 0.81(0.65,1.00),respectively,which were significantly higher than those of benign nodules [0.81(0.67,0.93)(Z=-6.567,P=0.000)and 0.63(0.52,0.75)(Z=-7.239,P=0.000)].The area under the ROC curve of A/TC and A/TL was 0.734 and 0.712,respectively,showing no significant difference(area difference:0.0210,standard error:0.0213,95% CI:-0.0207-0.0627,Z=0.987,P=0.3235).The threshold values of A/TC and A/TL for predicting malignant nodules were 0.784 161 5 and 0.985 714 5,respectively.Conclusions Both A/TL and A/TC has similar diagnostic value in predicting the risk of malignant nodules.The best cutoff value of the above two ratios are 0.78 and 0.99 respectively.

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.

OBJECTIVE:To summarize and evaluate the value of applying the thyroid imaging reporting and data system (TI-RADS) released by American College of Radiology (ACR) in 2017 of the thyroid classification, and to propose an optimized classification method based on the result to facilitate more accurate and precise risk stratification of thyroid nodules.METHODS:In the study, 342 thyroid nodules assessed by 2017 ACR TI-RADS were retrospectively analyzed. Each nodule had a score, and all the scores of nodules were compared with the pathological results. The proportion of malignant nodules in different scoring ranges was obtained. The diagnostic efficacy of all nodules, nodules above 1 cm and less than or equal to 1 cm was evaluated by ROC curve, respectively.RESULTS:The AUC of all nodules, nodules above 1 cm and less than or equal to 1 cm were 0.907, 0.936 and 0.717, respectively. With the increase of the scores, the proportion of benign nodules decreased gradually, and the proportion of malignant nodules increased, especially nodules of 4-6 scores increased significantly. Based on the proportion of malignant nodules with 3 scores, the proportion of malignant nodules with 4, 5 and 6 scores increased 1.6, 3.8 and 5.3 times, respectively. The proportion of malignant nodules with 6-8 scores was 81%-84%, while the proportion of malignant nodules with 9 scores or more was 93%-94%. According to the distribution characteristics of malignant nodules, the classification of TI-RADS was adjusted. TI-RADS 4 was divided into TI-RADS 4a, TI-RADS 4b and TI-RADS 4c, corresponding to 4, 5 and 6-8 scores respectively, while the nodules with 9 scores or more were divided into TI-RADS 5.CONCLUSION:2017 ACR TI-RADS has high diagnostic value for thyroid nodules above 1 cm, but it is not so effective for the nodules less than or equal to 1 cm. According to the proportion distribution of malignant nodules in different scoring ranges, appropriate adjustment of classification will be more accurate and precisely predict the malignant risk of nodules.

Triple-negative breast cancer (TNBC), which is a kind of aggressive breast cancer, has a much higher recurrence rate and a shorter overall survival rate than other breast cancer subtypes owing to its lack of expression of the progesterone receptor (PR), estrogen receptor (ER) and HER2. For improving the therapeutic efficacy of TNBC, we developed a new kind of multifunctional cationic porphyrin-grafted lipid (CPGL) microbubble loaded with HIF 1α siRNA (siHIF@CpMB). Owing to the amphiphilic structure of CPGL, it can be self-assembled into microbubbles (MBs) with conventional lipids and the porphyrin group could be used as a photosensitizer for photodynamic therapy (PDT), while the amino group could adsorb HIF 1α siRNA (siHIF) through electrostatic adsorption. Such MBs possess a remarkably high drug loading content and less premature drug release. Distribution of MBs could be easily monitored by real-time US imaging (3-12 MHz). Furthermore, with the assistance of ultrasound targeted microbubble destruction (UTMD), siHIF@CpMBs could be efficiently converted into nanoparticles in situ, facilitating the accumulation of porphyrin and siRNA at the tumor site through the cavitation effect. HIF 1α siRNA down-regulated the HIF 1α level, which was induced by the common hypoxic tumor environment or the ROS (generated by PDT), enhanced the PDT efficacy and partly inhibited the tumor progression. Therefore, UTMD assisted combination of PDT and gene therapy was believed to be an effective therapeutic strategy for TNBC.

Objective To retrospectively evaluate interobserver variability between radiologists by using lexicon of the Thyroid Imaging Reporting and Data System ( TI-RADS ) to classify lesions on ultrasonography and retrospectively determine the positive predictive value ( PPV) of each TI-RADS level. Methods Five radiologists retrospectively reviewed 188 consecutive thyroid nodules with known pathologic diagnosis of 172 patients from June,2016 to November,2016. Each observer described each lesion with TI-RADS terminology and final TI-RADS level were assigned by adding the points from all categories. Cohen κ statistic was used to assessed the interobserver variability for each ultrasonographic ( US ) descriptors and final TI-RADS level. PPV for all TI-RADS levels were determined for all readers combined. Results For each US descriptor,composition,echogenicity,shape,margin,echogenic foci,their κ were 0.743 (0.713－0.772),0.418 (0.319－0.517),0.468 (0.389－0.547),0.397 (0.291－0.503) and 0.566 (0.514－0.617) respectively ( data in parentheses are 95% confidential intervals). The κ for TI-RADS level was 0.782 (0.749 －0.81). PPV for TI-RADS level 1 to 5 were 0(0/8),0(0/23),14.3% (4/28),29.7%(11/37) and 85.7% (78/91). Conclusions Interobserver agreement with the TI-RADS terminology is substantial for composition, moderate for echogenicity, shape and echogenic foci, fair for margin. Interobserver agreement is substantial for TI-RADS level. Consequently different understanding in US images has little influence in patient management,justifying the use of ACR-TIRADS in clinical practice.

目的 探讨膝关节外侧副韧带的超声检查技巧,以及高频超声在其损伤诊断中的应用价值.方法 对42例健康志愿者及6例临床单侧膝关节外侧副韧带损伤的患者进行高频超声检查,总结该韧带的超声扫查技巧及损伤时的声像图特点.膝关节外侧副韧带损伤程度以MRI为金标准.结果 以腓骨小头为声像图标志可以迅速、准确地寻找和显示膝关节外侧副韧带,俯卧位扫查法更方便.膝关节外侧副韧带损伤超声表现为韧带肿胀,回声减低,以腓骨小头附着处为明显,但仅凭声像图表现无法确定局部撕裂程度.结论 采用俯卧位扫查法,高频超声可清晰显示外侧副韧带并对其损伤做出初步判断.

目的 探索声像图征象评分方法对甲状腺结节进行危险性分层评价,为临床诊治提供参考价值.方法 回顾性分析572例甲状腺结节(良性306例、恶性266例)的病理结果和术前超声征像,比较良、恶性结节二维及彩色多普勒超声的声像图表现,利用Logistic回归分析建立评分系统,对结节的危险性进行分层评价.结果 甲状腺良、恶性结节的声像图特点存在差异,按与恶性的相关性大小(OR值)排列如下:细小钙化(12.147)＞形态不规则(6.927)＞纯实性(3.331)＞单发结节(1.839)＞低回声(1.803).根据这些特点获得评分方程,对每个甲状腺结节进行再评估,得到提示结节危险性的评分值,其ROC曲线下面积达到0.927,说明评分值用于判断结节良恶性有显著性意义(P=0.000).结论 甲状腺结节的声像图特点对提示结节的恶性风险具有不同程度的价值,利用综合分析的评分方法将结节分为不同的危险等级,可为临床医师处理该病提供依据.