This report presents a case involving a 21-year-old male patient with acute promyelocytic leukemia, where the peripherally inserted central catheter (PICC) tip location was diagnosed differently using ultrasound and computed tomography. The PICC was inserted into the left upper arm via the basilic vein. Echocardiography performed in the left lateral recumbent position suggested the PICC tip to be in the right atrium, deepest at the level of the tricuspid annulus. However, trans-catheter contrast-enhanced echocardiography, performed with a different posture involving left shoulder abduction and slight external rotation, revealed the tip to be at the cavo-atrial junction. Additionally, chest computed tomography, conducted in the supine position with raised arms, indicated the tip to be located at the upper one-third of the superior vena cava. These contradictory diagnoses can be attributed to the use of different body postures during the assessments. Considering the clinical efficacy and safety, it is crucial to fully consider the influence of multiple postures on PICC tip location during placement and determination. We recommend incorporating at least two opposite extreme daily postures to assess the nearest and farthest positions of the tip, ensuring effective and safe PICC placement and reducing the risk of complications.

[This corrects the article DOI: 10.1016/j.apjon.2023.100238.].

目的 应用声辐射力脉冲(ARFI)技术检测移植肝组织剪切波速度,探讨移植肝组织硬度与肝功能的关系.方法 回顾性分析146例肝移植术后患者临床资料,肝移植受者均进行了 ARFI检查,测量移植肝组织的剪切波值,并进行分组分析.结果 ①酶学正常组和酶学增高组以及胆红素正常组和增高组的剪切波值分别为(1.23±0.30)m/s和(1.41±0.43)m/s,(1.25±0.32)m/s和(1.48±0.47)m/s,差异均具有统计学意义.②各酶学指标及胆红素指标分别与移植肝剪切波值呈正相关,相关系数为0.621、0.404、0.482、0.570和0.573,P＜0.05.③肝移植术后1年以上和1年以内组的剪切波值分别为(1.24±0.37)m/s和(1.59±0.53)m/s,差异具有统计学意义;肝移植术后≤7d组的剪切波值为(1.95±0.69)m/s,明显高于其他时间段组的剪切波值.结论 移植肝组织硬度升高与肝脏肝功能异常相关,剪切波速度在评估移植肝功能时具有重要临床价值.

目的 观察5G远程机器人超声诊断急腹症的价值.方法 回顾性分析44例于永兴岛接受5G远程机器人超声检查的急腹症患者,以专家复诊结果、其他影像学检查(X线、CT、MRI等)及随访结果作为参考诊断标准,评估5G远程机器人超声诊断的准确性,分析医师5G远程机器人超声操作经验对检查时长的影响,观察其诊断效能.结果 每例患者远程超声检查时间为10～27 min,平均(17.91±3.99)min.根据参考标准,44例中,阳性39例、阴性5例;5G远程机器人超声检出阳性34例、阴性10例;正确诊断39例,漏诊5例,包括3例输尿管中下段结石和2例胆囊颈部结石,其诊断急腹症的准确率为88.64％(39/44),敏感度为87.18％(34/39)、特异度为100％(5/5),漏诊率为12.82％(5/39).44例检查均由同一名医师于其具有初、中及高级操作经验时进行,分别检查18、12及14例,漏诊3、1及1例,检查时长分别为(20.83±3.38)、(17.25±2.70)及(14.71±2.87)min,三者总体比较及两两比较差异均有统计学意义(P均＜0.05).结论 5G远程机器人超声检查可在医疗资源匮乏等特殊情况下快速、实时诊断急腹症,且效能较佳.

目的 对比研究脑死亡(brain death,BD)供肝与健康成人肝脏剪切波速度(shear wave velocity,SWV)差异,探讨剪切波弹性成像在BD供肝质量评估中的应用价值.方法 回顾性分析我院器官移植中心2018年3月—2018年6月脑死亡器官捐献供肝50例作为脑死亡组,50例年龄相匹配的正常人作为对照组.应用西门子公司ACUSON S2000/S3000超声仪,配备声辐射力脉冲(acoustic radiation force impulse,ARFI)成像技术,测量BD供肝组和对照组的肝脏SWV值,同时对BD供肝进行肝功能和病理检查,并进行统计分析.结果 BD供肝组与对照组的SWV值分别为(1.53±0.37)m/s、(1.14±0.06)m/s,两组比较差异有统计学意义(P=0.000).50例BD供肝,其中39例(39/50,78％)出现一项或多项肝功能指标异常,37例(37/50,74％)供肝病理有轻微异常.BD供肝受者术后早期肝功能恢复延迟11例(11/50,22％),早期肝功能恢复正常39例(39/50,78％).结论 剪切波弹性成像技术可以量化供肝硬度值,在BD供肝质量评估中具有一定的应用价值,可以作为辅助评估BD供肝质量的超声新技术.

目的 探讨在基层卫生单位进行常见创伤超声快速诊断技术教学培训的可行性和有效性.方法 培训对象来自基层卫生单位的89名学员,其中超声医学零基础学员81名,占91.0％;理论授课老师为副高级以上超声专家,技能培训老师为熟练掌握超声快速诊断技术的超声医师;培训周期为4 d(32学时);培训内容为基层卫生单位的常见急症和外伤超声快速诊断技能的理论授课和实际操作手把手教学.培训后全部学员参加理论知识笔试(百分制)和技能实际操作考核,并分析考核结果.结果 89名学员对培训的参与度为100％.培训后,81名超声零基础的学员理论平均成绩(93.7±5.0)分,8名有超声基础的学员理论平均成绩(95.5±3.0)分,二者比较,差异无统计学意义(P>0.05),表明通过培训,即使是超声零基础的学员,对创伤超声快速诊断理论知识的掌握与有超声基础者无差别.技能实际操作成绩,81名零基础的学员中,优秀率76.5％(62名/81名)、良好率23.5％(19名/81名),8名有超声基础的学员中,优秀率75.0％(6名/8名)、良好率25.0％(2名/8名)二者比较,差异无统计学意义(P>0.05).结论 通过培训,基层卫生单位的受训者能够迅速掌握常见创伤的超声快速诊断技术的理论知识,掌握实际操作技能.

目的 探讨基层医疗单元急诊超声诊断技能的培训技巧.方法 对象是来自于基层医疗单元培训班学员89名,其中81名为超声零基础,8名为兼职超声专业,但完成超声数量不足100例/年;培训时间4d;89名培训班学员接受培训后考核,并提供对培训的反馈信息.对培训后理论知识、技能操作的掌握情况进行分析.结果 通过培训,89名学员培训的参与度为100％.培训后理论考核成绩为(93.82±4.90)分,81名零基础的学员平均成绩为(93.58 ±5.02)分,8名有超声基础的学员平均成绩为(96.25 ±2.71)分.技能操作优秀62名,占69.66％(62/89);良好27名,占30.34％(27/89).其中81名零基础的学员中,优秀56名,占69.14％(56/81);良好25名,占30.86％(25/81).8名有超声基础的学员中,优秀6名,占6/8;良好2名,占2/8.两种学员各项考核比较差异均无统计学意义(P＞0.05)结论通过培训,受训者能够基本掌握急诊超声诊断技能的理论知识,完成基本的技能操作.

Objective To assess the clinical efficacy of ultrasound-guided autologous platelet-rich plasma (PRP) injection into injured tendons caused by military training. Methods Between March 2018 and June 2019, 41 patients with tendinopathy caused by military training were enrolled at Hainan Hospital of PLA General Hospital. Conventional ultrasound was used to evaluate the injuried tendons. Under the guidance of ultrasound, the 21G PTC needle was used to percutaneously puncture into the injury site, and autologous PRP was then injected into the lesions in amulti-point manner. Conventional ultrasound, limb mobility score, and pain score were used to evaluate the clinical efficacy. The results were compared between pre-treatment and 2 weeks or 1 month after treatment. Results The injection dose of PRP was (2.85±0.49) ml in the 41 patients. After treatment, ultrasound showed that the tendon became thinning, the morphological structure was improved, and the proliferation of peripheral blood vessels was lessened. The pain was alleviated gradually, and the movement range of all affected limbs was expanded. Pain score was significantly decreased at 1 month (2.71±1.39) and 2 weeks (4.66±2.43) after treatment compared with pre-treatment score (6.53±2.78) (P=0.006 and P=0.008, respectively). Limb mobility score was significantly increased at 1 month (79.70±5.09) and 2 weeks (72.33±3.34) after treatment compared with pre-treatment score (61.84±9.98) (P=0.004 and P=0.006, respectively). Conclusion Ultrasound-guided autologous PRP therapy is safe and effective in the treatment of tendinopathy caused by military training. Key words: Platelet-rich plasma; Ultrasonography, interventional; Tendinopathy; Military training

Early diagnosis is critical for the prevention and control of the coronavirus disease 2019 (COVID-19). We attempted to apply a protocol using teleultrasound, which is supported by the 5G network, to explore the feasibility of solving the problem of early imaging assessment of COVID-19. Four male patients with confirmed or suspected COVID-19 were hospitalized in isolation wards in two different cities. Ultrasound specialists, located in two other different cities, carried out the robot-assisted teleultrasound and remote consultation in order to settle the problem of early cardiopulmonary evaluation. Lung ultrasound, brief echocardiography, and blood volume assessment were performed. Whenever difficulties of remote manipulation and diagnosis occurred, the alternative examination was repeated by a specialist from another city, and in sequence, remote consultation was conducted immediately to meet the consensus. The ultrasound specialists successfully completed the telerobotic ultrasound. Lung ultrasound indicated signs of pneumonia with varying degrees in all cases and mild pleural effusion in one case. No abnormalities of cardiac structure and function and blood volume were detected. Remote consultation on the issue of manipulation practice, and the diagnosis in one case was conducted. The cardiopulmonary information was delivered to the frontline clinicians immediately for further treatment. The practice of teleultrasound protocol makes early diagnosis and repeated assessment available in the isolation ward. Ultrasound specialists can be protected from infection, and personal protective equipment can be spared. Quality control can be ensured by remote consultations among doctors. This protocol is worth consideration as a feasible strategy for early imaging assessment in the COVID-19 pandemic.