Objective:To evaluate the blood flow patterns of peripulmonary lesions by color Doppler ultrasound and compare the differences of blood flow patterns between benign and malignant lesions.Methods:From June 2020 to July 2021, a total of 87 inpatients with peripulmonary lesions diagnosed by CT imaging examination were enrolled at Xi'an Chest Hospital, and all patients were confirmed by pathological diagnosis. The blood flow patterns of peripulmonary lesions were detected and classified using Colour Doppler ultrasound, which were divided into four types: type A, the presence of both intercostal artery blood supply patterns and dendritic reflux patterns of intrapulmonary veins in peripulmonary lesions; type B, the presence of intercostal artery blood supply pattern of peripulmonary lesions, but the absence of dendritic reflux of intrapulmonary veins; type C, the absence of intercostal artery blood supply pattern of lesions, but the presence of dendritic reflux pattern of intrapulmonary veins; type D, the absence of both intercostal artery blood supply pattern and dendritic reflux pattern of intrapulmonary veins in peripulmonary lesions. The differences of blood flow patterns between benign and malignant lesions were compared, and the value of blood flow patterns in distinguishing benign and malignant lesions was assessed by ROC curve analysis.Results:The blood flow patterns of 87 peripulmonary lesions were: type A in 19 cases, type B in 6, type C in 42, and type D in 20, of which 65 were benign (74.7%) and 22 were malignant (25.3%). By comparing the blood flow patterns of benign and malignant lesions, it was found that the dendritic reflux of intrapulmonary veins was the benign feature of peripulmonary lesions, and its constituent ratio was higher in the benign group than in the malignant group (90.8% vs 19.1%, χ2=53.332, P＜0.001); the sensitivity, specificity, and area under the curve of this pattern were 90.8%, 97.9%, and 0.908 (95% CI: 0.837-0.979, P＜0.001), respectively. Intraoperative bleeding volume [510.0 (477.5730.0) ml] was significantly increased in patients with intercostal artery supply to the malignant lesion [400.0 (350.0, 450.0) ml] than patients without (Z=2.627, P=0.009).Conclusion:There are differences in blood flow patterns between benign and malignant peripulmonary lesions. The dendritic reflux pattern of intrapulmonary veins is a benign feature of peripulmonary lesions. The blood supply pattern of intercostal arteries in patients with malignant lesions increases the risk of intraoperative bleeding, which requires close clinical attention.

Objective:To explore the clinical value of bedside lung ultrasound in emergency-plus (BLUE-plus) for assessing pulmonary lesions of patients with coronavirus disease 2019 (COVID-19) based on chest CT imaging.Methods:Total of 22 patients with COVID-19 admitted to Xi’an Chest Hospital (COVID-19 designated hospital in Xi’an) from January to February 2020 were dynamically examined by BLUE-plus, and compared with chest CT examination, the consistency and diagnostic accuracy were analyzed by Kappa test and ROC curve, respectively.Results:Among the 22 confirmed cases with COVID-19 according to BLUE-plus, the lesions were mostly distributed in the intersection of the posterior and lower blue dots and the ipsilateral posterior axillary line, which were named as posterolateral alveolar and/or pleural syndrome (PLAPS) point, and the consistent Kappa value between BLUE-plus and chest CT was 0.73 (95%CI: 0.442-1.018, P < 0.001). The sensitivity, specificity and accuracy of BLUE-plus on lung lesions were 94.7%, 83.3% and 93.2%. During the progressive period, the ultrasound image characteristics of patients with COVID-19 gradually changed from B ray to small patchy pulmonary consolidation, gradually aggravated to large sheet consolidation, and the bronchial inflation sign in the consolidation lesion was gradually reduced. The features of ultrasound image in recovery period of COVID-19 were opposite to the progressive period.Conclusions:BLUE-plus could be used to evaluate lung lesions and dynamic changes of patients with COVID-19. The application of ultrasound in these patients could provide dynamic imaging evidence in the evaluation of disease courses and therapeutic efficacy.

癌症是困扰人类健康的一大难题.由于肿瘤细胞存在免疫逃逸现象,给癌症的治疗带来了诸多困难.铁死亡作为一种新型细胞死亡方式,存在于肿瘤发生、发展的各个过程.临床可通过促进肿瘤细胞内的芬顿反应、抑制肿瘤细胞中谷胱甘肽过氧化物酶4的表达、外源性调节肿瘤细胞的脂质过氧化等途径诱导铁死亡的发生,实现对癌症的治疗.构建纳米给药系统可以改善药物作用,实现靶向治疗,但其安全性还有待提高.因此,未来探究铁死亡的调控机制、改进纳米给药系统、实现基于铁死亡的癌症纳米疗法,可以为癌症的治疗开辟新途径.

患者男,39岁.8年前确诊急性非淋巴细胞白血病-M7型,行亲缘性异基因外周血干细胞移植术,术后5年病情稳定.1年前腹部超声显示,肝脏、脾脏及双肾实质内弥漫性分布的异常回声(中央呈稍强回声区,周边呈低回声区),边界清晰,形态规则(图1);遂行超声引导下肝脏穿刺活检,病理诊断:真菌感染引发慢性肉芽肿性炎伴坏死(图2).

Objective To observe the effect of intrathoracic injection of urokinase on the separation of fibrous septa in the pleural effusion of patients with tuberculous pleurisy treated by ultrasound, and to explore the time rule and optimal drainage time node of fibrin strip separation in urokinase-dissolved pleural effusion. Methods A total of 147 patients with tuberculous pleurisy and pleural effusion with fiber strips influencing the drainage were selected. According to the full drainage volume on the day, 48 cases were divided into group A (fully diverted flow≤500 ml), 63 cases in group B (fully diverted flow 500~800 ml), and 36 cases in group C (fully diverted flow≥800 ml). All of them were injected with 200,000 units of urokinase. Then we analyzed the images under the guidance of ultrasound at the time points of before injection, and 0.5 h, 1.0 h, 1.5 h, 2.0 h, 2.5 h and 3.0 h after injection. The changes of the number of fibrous septa in pleural effusion at different time points were analyzed. Results After drug injection, the number of pleural effusion fibers in the 147 patients was compared at different time points, and there was a statistically difference (F=34.989, P=0.000). There was a statistical difference between before injection and 1.0 h after injection (t=6.274, P=0.000). There was a statistical difference between 0.5 h and 1.0 h after injection (t=3.300, P=0.001). There was no statistical difference between 1.0 h and 1.5 h, 2.0 h, 2.5 h, 3.0 h after injection (P>0.05). There were statistical differences between 1.0 h after injection in group A, B and C, and 0.5 h before injection and 0.5 h after injection (pre-drug comparison: t=-6.020, -4.331, 8.554; compared with 0.5 h after injection: t=-3.338, 2.613, 5.216; all P 0.05). Conclusion After injection of 200,000 units of urokinase, the fastest dissolution rate of fibrous septa in pleural effusion achieved with the first hour, and the dissolution effect was not obvious at 1.5 h after injection. Ultrasound is an effective method to observe the changes of fibrous septa dissolution in thoracic cavity in real time, and is worthy of clinical application. Key words: Ultrasonography; Tuberculous pleurisy; Septate fiber; Urokinase; Pleural effusion

乡镇卫生院是我国广大基层百姓生命健康的保护伞,是农村三级医疗卫生服务体系的枢纽,为广大基层百姓提供疾病的初级诊断治疗,急症、外伤的初步处理,重症分诊,健康扶贫,基层百姓健康查体,慢性病的治疗等多项工作,是保证卫生服务诸多功能在农村基层落实的关键环节.超声诊断学作为普遍应用的辅助检查,已成为乡镇卫生院必不可少的确定诊断的检查方式.但乡镇卫生院超声医师普遍存在继续教育机会少,多数教学停留在县级医院层面,缺乏实践及持久帮带,教学内容针对性差,继续教育时间短等诸多问题.针对这些问题,我们继续教育中心就如何加强乡镇卫生院超声人才培养,制定了完善的规范化体系,针对乡镇卫生院超声人才继续教育制定专项方案,确保教学的实效性、针对性和体系的完善性.

目的:研究网络直播手段在超声诊断与教学中的应用.方法:以教学医院为依托,以互联网为载体,借助现代化信息技术,使用某公司网络直播系统,上传现场画面及授课画面,采用“互联网+医疗”,为超声医生开展专业的学习、培训、继续再教育.结果:借助现代媒体网络,医学超声、互联网和远程培训的有机结合,听课人员达上万次,面向全国教学,突破了传统的限制,实现了良好的效果,满意度为100％.结论:结合公司和医院的自身优势,将超声检查和超声培训联合起来,为更多的基层医生提供优质的教学资源与技术,是未来影像学的主要手段和方法,让更多的医生与非专业人士受益.

Objective To clear the ultrasonographic features of tuberculin skin test (PPD) induration,clarify the application value of ultrasound in PPD induration judgment.Methods One hundred and fifty patients from in our hospital were examined by PPD,and the PPD induration were scored relatively by artificial interpretation (group A) and ultrasound interpretation (B group),analysis the ultrasonographic features of different induration the PPD.Results (negative,positive,positive) and detect the strong positive rate of A and B group.Results The ultrasonographic manifestations showed differences of PPD induration (negative,positive,positive).117 cases were definite tuberculosis in the 150 cases and 33 cases were not tuberculosis.The positive rate of B group (81.2％) than in A group (42.7％) was significantly increased (P＜ 0.05).Conclusions Ultrasonographic manifestations shows difference of different PPD induration reaction results,compared with the traditional manual interpretation of the decision PPD induration,it shows higher specificity and sensitivity,and is expected to be an efficient and reliable new method for the diagnosis of PPD induration.

A 32‐year‐old man was admitted to our hospital for repeated ab‐ dominal pain, diarrhea and symptoms of intestinal obstruction caused by invasive abdominal fibromatosis. The patient had been subjected to total colectomy for multiple polyps approximately 3 years previously. Two years later, he was pathologically diag‐ nosed as having abdominal fibromatosis. On December 13, 2016, tumor resection, pancreaticoduodenectomy and small bowel auto‐transplantation were successfully performed with 150 cm of segmental bowel autograft. Eight hours after the procedure, the patient complained of abdominal distention with an increased heart rate.

Objective:To discuss the value of the clinical data and hemodynamic indexes of uterine arteries in predicting adverse outcomes in patients with pregnancy-induced hypertension(PIH).Methods:Eighty-seven PIH patients in second-third trimester complicated with fully follow-up materials were chosen for this study.The general clinical data were recorded.A series of dynamics indexes of uterine artery were detected by conventional abdominal ultrasound.All the patients were followed-up through the whole pregnant period.Eclampsia,fetal distress in uterus and early pregnancy termination were recorded as the adverse outcomes.The patients were divided into benign group and adverse group based on the outcomes.Results:Sixty-three PIH patients (72.4％) presented adverse outcomes during the followed-up period.The proportion of severe preeclampsia in adverse group increased significantly compared with the benign group (58.7％ vs 20.8％,P=0.003).In adverse group,patients were more likely to have the early diastolic notch in both sides of uterine arteries compared to the patients in begin group (39.7％ vs 16.7％,P=0.042).The PI,RI and S/D values of uterine artery were increased significantly in PIH patients presented adverse outcomes in late pregnancy (P＜0.05).When the cut-off value of PI was 0.97,the sensitivity and specificity of predicting adverse outcomes were 50.8％ and 83.8％ respectively.When the cut-off value of RI was 0.51,the sensitivity and specificity of predicting adverse outcomes were 63.5％ and 70.8％ respectively;When the cut-off value of S/D was 2.1,the sensitivity and specificity of predicting adverse outcomes were 65.1％ and 70.8％ respectively.The multinomial logistic regression analysis showed that RI＞0.51 was the independent predictive factor of adverse outcomes of PIH patients (OR=4.224,P=0.006).Conclusions:PIH can cause multiple hemodynamic changes.Hemodynamic changes of the uterine arteries which could be assessed by ultrasound has certain significance for the prognosis of PIH,and our study suggests that the RI could be the independent predictive factor of adverse pregnancy outcomes.

This paper mainly analyzed two special troubleshooting cases of Philips EPIQ 7 color ultrasound diagnostic imaging system, and the maintenance method was discussed. Philips EPIQ 7 in the ultrasound department of our hospital had peculiar smell, this paper analyzed causes of the smell, found source of the trouble and repaired it. Results showed that bad contact of operating tabs on the instrument panel result in burning odor, and small amount of ash accumulation result in error report. This two fault cases analyzed in this paper are rare, so it need patience to find fault source. Regular maintenance can decrease faults occurrence rate, and ensure normal using of the machine.

目的:探讨超声引导下经皮穿刺活检术对于周围型肺肿块及胸膜病变诊断的临床应用价值及适应证的选择和并发症的处理.方法:对628例经CT检查确诊的肺周围型肿块或明确的胸膜病变,先经常规超声检查了解病灶二维图像及血流分布情况,筛选后在超声引导下穿刺活检并送检.结果:628例中,肺周围型肿块570例,胸膜病变58例;627例穿刺成功,穿刺成功率99.8％;穿刺结果与术后病理结果诊断符合率达93.5％(587/628);并发症发生率5.09％(32/628).结论:超声引导下肺胸膜病变穿刺活检术诊断准确率高、简便易行、创伤小、并发症少、可操作性强,临床应用价值较高.

快速、便捷的超声影像学检查为急腹症的诊断提供了直接手段.加强急腹症的超声诊断教学对超声专业学生提高急腹症诊断准确率有重要意义.结合影像学教学及临床实际应用,将PBL教学法引入急腹症超声诊断学教学中,探索一种以病案为引导,以声像图为核心,以疾病诊断为根本的网络式分析逆向教学新模式,加强教学互动,提高实践能力.

Objective To assess the value of transabdominal ultrasound-guided catheter drainage of postoperative lymphocysts in patients with pelvic malignancy. Methods 143 postoperative lymphocysts in 112 patients with pelvic malignancy were drained percutaneously using 8.5F Cook catheters under ultrasound guidance. Results The procedure was successful in all patients without complications. 142 lymphocysts were completely healed with cure rate of 99.3%. Only one recurred after three months. The duration of drainage ranged from 3 to 15 days (average:.5 days) totaling 270-3200 ml(average:.812 ml). Conclusion Transabdominal ultrasound-guided percutaneous drainage of pelvic lymphocysts is simple and safe with less pain , fewer complications , high cure rate , and low recurrence rate.

Objective To investigate the basis of ultrasound microbubble technology enhanced thermal ablation effect.Methods All 48 rabbits bearing hepatic tumors were averagely randomly divided into four groups:only laser group,sham,destruction + laser group,and blank group.The filling defect area changes of before and after treatment were observed and the differences between groups were compared.Results Pathology confirmed ablation of tumor tissue could produce coagulation necrosis for experiment group.The conventional ultrasound showed there was no significant variation in the maximum diameter and area in the pre and post treatment of experiment group and control group(P ＞0.05).There was no change for the control group.Ultrasound imaging showed an area of filling defect were:laser treatment alone group (0.83 ± 0.06) cm2,microbubbles false break combined with laser therapy group (0.65 ± 0.05) cm2,microbubbles break combined with laser therapy group (2.40 ± 0.16)cm2,blank control group (0.01 ± 0.01) cm2.The filling defect area of the treatment group,which was combined with ultrasound microbubble break technology and laser ablation was increased,there was significant variation in the each group (P ＜0.05).Conclusions Microbubble burst combined laser ablation could expand the single needle laser ablation area of rabbit VX2 liver tumor and increase the therapeutic effect.

Background Only a small percentage of patients with hepatocellular carcinoma (HCC) may benefit out of surgical resection. Thus, lots of these patients are in need of local control, such as percutaneous ethanol injection (PEI), percutaneous laser ablation (PLA), or radiofrequency thermal ablation (RF). Purpose To investigate the effects of ultrasound-guided PLA combined with PEI on rabbit VX2 liver tumors, using conventional gray-scale ultrasonography (US), color/power Doppler (CD/PD)US, contrast-enhanced (CE) US, and histologic examination. Material and Methods VX2 tumors were implanted in the livers of 80 rabbits. Fourteen days after implantation, animals were randomly separated into four groups of 20 rabbits. Treatment of the four groups was with: (i) PLA; (ii) PEI; (iii) combined therapy of PLA immediately followed by PEI; and (iv) combined therapy of PEI immediately followed by PLA. Conventional gray-scale US, CD US, PD US, and CE US were performed before and after ablation. The effects on ablated areas were assessed by histologic examination. Results Conventional gray-scale US showed a clear boundary around the ablated area in groups 1, 3, and 4. An isoechoic treated region with an irregular boundary was seen in group 2. On CE US, coagulated areas demonstrated a perfusion defect. Both conventional gray-scale US and CE US showed that the ablated volume in group 4 was larger than that in groups 1, 2, and 3. CD US and PD US demonstrated residual tumor in the periphery of ablated areas in groups 1 and 2, but not in groups 3 and 4. CE US demonstrated no residual tumor in group 4, unlike in groups 1, 2, and 3. Examination of treated tumors demonstrated necrosis in the ablated zones and increasing surrounding fibrous bands in the four treatment groups. Residual viable tissue in group 4 was less than that in groups 1, 2, and 3. Conclusion Combined therapy of PEI immediately followed by PLA can coagulate significantly larger volumes of tumor and reduce residual tumor.

Objective To investigate the long-term effect of triple organ transplantation (liver,kidney,and pancreas) in a patient with end-stage liver disease secondary to chronic hepatitis B and cirrhosis combined with chronic renal failure and insulin-dependent diabetes,and explore the optimal surgical procedure.Methods A 43-year-old male patient presented with progressive ematiation and hypourocrinia for 2 months.Blood test showed ALT 117 U/L,AST 113 U/L,ALB 26.9 g/L,TBIL 102 μmol/L,BUN 23.6mmol/L,CRE 664 μmol/L.The fasting and postprandial plasma glucose were 10.8 mmol/L and 18.4mmol/L,respectively.Ultrasound and CT scan showed hepatic cirrhosis,hydroperitoneum,splenomegaly,enlarged caput pancreatic duct,expanded main pancreatic duct and renal atrophy.Nephorgram showed both kidneys were impaired severely.The eaminations indicated exocrine pancreatic insufficiency and insulin-dependent diabetes related to chronic pancreatitis (CP) after developing end-stage hepatic and renal failure.Simultaneous piggyback orthotopic liver and heterotopic pancreas-duodenum and renal transplantation was performed on 17-01-2005.Pancreatic exocrine secretions were drained enterically to the jejunum and the donor kidney was placed in left iliac fossa.Patient was prescribed prednisone,tacrolimus,mycophenolate mofetil,ATG (Rabbit Anti-human Thymocyte Immunoglobulin) and simulect for immunosuppression.Results Satisfied hepatic and pancreatic function was achieved within 7 days after surgery.The kidney did not function and CRRT (Continuous Renal Replacement Therapy) was used.Subsequently,the donor kidney was removcd at day 16 after surgery due to acute rejection.The second renal transplantation at the same position was perfromed and the new graft kidney functioned 3 days later.The patient had no rejection reaction or other complications such as pancreatitis,thrombosis,or local infections during the following 8 years.The patient has become insulin independent with normal liver and renal functions.The immunosuppressive drugs FKS06+Pred was used and the tacrolimus level maintained 3.0-4.5 μmol/L,Lamivudine was long-term used to inhibition HBV virus duplication.Conclusions Simultaneous piggyback orthotopic liver combined with heterotopic pancreas-duodenum and renal transplantations is a good therapeutic option for patients with exocrine pancreatic insufficiency and insulin-dependent diabetes combined with hepatic and renal failure.

乳腺脓肿是多发生在产后哺乳的妇女,尤以初产妇更为多见,往往发生在产后3～4周.病因主要有两个:一是乳汁淤积,二是细菌入侵.临床表现为乳房疼痛、局部红肿、发热.脓肿可以是单房或多房性.感染严重者,可并发脓毒症.传统的外科治疗措施是及时作脓肿切开引流.但是创伤大,病情易反复,愈合后常遗留明显的手术瘢痕,导致乳房变形,而乳腺脓肿的患者多为哺乳期年轻女性,严重影响患者形体美观以及患者心理,难以被患者接受.

Objective To test the feasibility of using microwave to produce rapid hemostasis of liver active bleeding. Methods Twelve new Zealand white rabbits were anesthetized, and their livers were exposed. After heparinized, the animals were randomly divided into 80 W group, 60 W group and control group. Guided by color Doppler ultrasonography, an 18 G semi-automatic biopsy needle was inserted into the hepatic parenchyma, injuring the hepatic parenchyma and small blood vessel to create active bleeding. There were about 3-5 hepatic active bleeding sites created in one animal. Paired comparisons were performed among three groups. The microwave antenna was posed to the bleeding site worked with 80 W or 60 W. A corresponding site of active bleeding in another animal without application of microwave served as a control. Significant differences of blood loss, hemostasis time and carbonization rate were tested. Results 80 W and 60 W groups showed significantly less mean blood loss than control group [(0.09±0.12)g vs (1.83±0.52)g, χ 2=25.00, P0.05;(0.10±0.10)g vs (1.83±0.52)g, χ 2=23.00, P 0.050]. There was no significant difference of blood loss between 80 W group and 60 W group (χ 2=2.00, P0.05). 80 W group had less hemostasis time than 60 W group [(13.1±4.2)s vs (18.3±7.9)s, T+=4.5000, T-=115.5000, P=0.000], but had higher carbonization rate than 60 W group (13/16 vs 5/16, χ 2=8.127, P=0.004). Conclusions Coagulation with microwave is a rapid and effective method to arrest hepatic active bleeding. Sixty W can effectively induce hemostasis without significant carbonization, and the time of duration is 10 s to 40 s.

Objective To evaluate the value of contrast-enhanced ultrasound(CEUS) in differential diagnosis of hepatic hematoma and hepatic hemotoma with active bleeding.Methods New Zealand white rabbits(male,body weight 2.5-3.5 kg,n = 15) were heparinized and subsequently impacted with a self-made impactor to create hepatic blunt injury model.An 18 G semi-automatic biopsy needle was used to create hepatic active bleeding in 10 rabbits by injuring hepatic artery.Both unenhanced and contrast enhanced scanning were performed to evaluate the hepatic injury and search for hematomas and active bleeding sites.After that,the abdomen was opened to check if the injury of liver was identical with the results of sonographic studies.Results A total of 15 liver injury animal models were created,which included 5 cases of liver hematoma and 10 cases of liver hematoma with active bleeding.The 2-dimensional ultrasound imaging confirmed 9 cases of hematomas(9/15) but failed to suggest the presence of active bleeding(0/10),while contrast-enhanced imaging confirmed 15 hematomas(15/15) and identified 10 active bleeding(10/10).Active bleeding from contrast-enhanced imaging was displayed in the form that the contrast agent was extravasated from the injured liver parenchyma.The results of pathological examinations were basically matched with the results of sonographic studies.Conclusion It is demonstrated that CEUS is a rapid and effective diagnostic approach for differential diagnosis of hepatic hematoma and hepatic hematoma with active bleeding,wherein the existence of contrast agent active spillover is the main identification point.