Background:Parkinson's disease (PD), a common neurodegenerative disorder, severely affects patients' quality of life. This study aims to update the assessment of PD's prevalence, incidence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021. Analyses were conducted at Socio-demographic Index (SDI), global, regional, and national levels, stratified by gender and age. Methods:PD data from the Global Burden of Disease (GBD) 2021 database was extracted. Trends in age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) of PD were assessed, and estimated annual percentage change (EAPC) was calculated during the study period. Analyses were done by gender, age, GBD region, and SDI quintiles, using R statistical software for analyses and mapping. Results:In 2021, the global burden of PD remained substantial. The number of prevalent PD cases grew from 3,148,394.56 in 1990 to 11,767,271.97 in 2021 (a 2.74-fold increase). Incident cases rose from 417,134.69 to 1,335,142.12 (a 2.20-fold increase). Males exhibited higher prevalence, incidence, and mortality rates than females across almost all age groups. High-SDI regions had higher ASPR, ASIR, and ASDR values than low-SDI regions. Countries and regions in Asia, particularly China and Japan, exhibited among the highest ASPR and ASIR globally. Projections indicate global ASPR and ASIR will continue to rise substantially over the next three decades (to 2050), with males exhibiting a faster rate of increase than females, while the ASMR is predicted to remain essentially stable. Conclusion:This study systematically delineates the epidemiological landscape, temporal trends, and burden profiles of Parkinson's disease across global, regional, gender-stratified, and age-specific populations, providing an evidence-based framework to guide precision prevention strategies and optimize healthcare resource prioritization.

Occult cervical lymph node metastasis (CLNM) remains a clinically relevant issue in clinically node-negative (cN0) papillary thyroid carcinoma (PTC), while its preoperative prediction remains challenging. This study aimed to develop and internally validate a multimodal ultrasound-based nomogram for individualized prediction of occult CLNM in patients with cN0 PTC. This retrospective study included 204 patients with pathologically confirmed cN0 PTC who underwent preoperative conventional ultrasonography (US), superb microvascular imaging (SMI), shear wave elastography (SWE), and contrast-enhanced ultrasound (CEUS) between January 2020 and April 2022. Patients were randomly assigned to training (n = 143) and validation (n = 61) cohorts. Clinical characteristics and multimodal ultrasound features were analyzed. Candidate predictors were screened using univariate logistic regression and least absolute shrinkage and selection operator (LASSO) regression. Conventional ultrasound and multimodal ultrasound nomograms were constructed and evaluated using receiver operating characteristic analysis, calibration curves, decision curve analysis (DCA), interobserver agreement analysis, and bootstrap internal validation. The multimodal ultrasound nomogram incorporated 12 predictors derived from conventional US, SWE, and CEUS features. The model achieved bootstrap-corrected AUCs of 0.849 (95

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.

OBJECTIVE:This study aims to investigate the correlation between the triglyceride-glucose (TyG) index and intraplaque neovascularization (IPN), evaluate the predictive efficacy of the TyG index for massive IPN, and provide novel serological markers for the early clinical identification of vulnerable plaques. METHODS:A total of 308 patients enrolled between May 2019 and December 2024 were included. IPN (0-3) was graded by Contrast-enhanced ultrasound (CEUS) and dichotomized (Grade I: none/minimal neovascularization, Grade II: extensive neovascularization). The association between the TyG and Grade II and its predictive performance were evaluated. RESULTS:The proportion of IPN Grade II significantly increased with ascending TyG quartiles (Q1: 37.66% vs. Q4: 85.71%, P < 0.001). After adjusting for confounders, the risk of Grade II in the Q4 group was 7.32 times higher than in the Q1 group (95% CI: 2.81-19.05). Restricted cubic spline analysis revealed an exponential increase in risk when TyG > 8.28. Subgroup analysis demonstrated a stronger association between TyG and IPN Grade II in hypertensive populations. Furthermore, the TyG index yielded an area under the curve of 0.72, with a sensitivity of 81% and specificity of 60% at the optimal cutoff value of 8.645. CONCLUSION:This study demonstrates that the TyG index is significantly and independently associated with extensive IPN in carotid plaques. This finding suggests the TyG index has potential as a supplementary serological marker in the assessment of plaque vulnerability.

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.

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.

BACKGROUND:Stroke is closely related to carotid atherosclerotic plaques, which tend to occur in specific parts of the arteries, especially at the bifurcations, and are considered to be caused by biomechanical factors. Quantitative analysis of hemodynamic stress characteristics of the carotid sinus in vivo provides a mechanical basis for the development of atherosclerotic plaque in the carotid sinus. Previous studies found that ultrasound (US) contrast agent microbubbles would vibrate nonlinearly under the excitation of sound pressure, generating subharmonics (transmission fundamental frequency, i.e., f0 and subharmonic frequency at f0 /2), which have the highest sensitivity to pressure changes and exhibit an inverse linear relationship with environmental pressure.PURPOSE:This study employed subharmonic aided pressure estimation (SHAPE) technology to reflect carotid artery hydrodynamic characteristics in the carotid lumen.METHODS:From May 2021 to December 2021, this prospective study reviewed a total of 26 normal carotid arteries of 13 participants, all of whom received bilateral carotid artery routine US and SHAPE US examinations. During this study, the lumen of the bilateral distal segment of the common carotid artery (Distal-CCA), carotid artery bifurcation (CAB), and carotid bulb (CB) were scanned section by section from bottom to top in longitudinal and transverse sections. Subsequently, the subharmonic amplitudes in the lumen of normal carotid arteries were collected and analyzed.RESULTS:This study found that the amplitude of subharmonic amplitude in the carotid was distributed unevenly, with the amplitudes of subharmonic at the CAB being higher. Specifically, the subharmonic gradient of the carotid artery bifurcation apex plane was maximum (9.72 ± 4.31 dB), while the average subharmonic amplitude of the outer lateral layer of the carotid artery was higher (-56.40 ± 6.31 dB) (p < 0.001).CONCLUSION:The SHAPE technique is capable of indirectly reflecting the pressure changes of vascular system tissues, which may provide a new monitoring method for evaluating mechanical characteristics obviating invasion.

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.

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。

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.

Background: Prophylactic central neck dissection (pCND) in patients with well-differentiated primary papillary thyroid carcinoma (PTC) has become controversial. Several attempts have been made to predict central compartment lymph node metastasis (CLNM) based on clinical and conventional ultrasonic parameters. This study aimed to develop a decision tree (DT) model for predicting the risk of CLNM in patients with PTC based on clinical and preoperative multimodal ultrasound (US) characteristics. Methods: A total of 148 PTC nodules confirmed by surgical pathology at Beijing Tiantan Hospital were retrospectively analyzed. All nodules underwent multimodal US examinations preoperatively from January 2020 to September 2021. Correlation analysis of CLNM with clinical characteristics as well as multimodal US parameters of PTC lesions based on gray-scale US, color Doppler flow imaging (CDFI), superb microvascular imaging (SMI), contrast-enhanced ultrasound (CEUS), and shear wave elastography (SWE) technology was carried out. Finally, the chi-squared automatic interaction detector (CHAID) with a 10-fold cross-validation was used to establish DTs for CLNM prediction. The area under the curve was calculated to compare the predictive performance.Results: Univariate analysis indicated that CLNM was positively correlated with thyroglobulin level, maximum size, taller-than-wide, the number of microcalcifications greater than or equal to 5, contact capsule, abnormal cervical lymph node on conventional US, noncentripetal perfusion, delayed clearance, the average shear wave velocity (SWV mean), and the SWV ratio (P<0.05). The multimodal US DT based on taller than-wide, contact capsule, abnormal cervical lymph node on conventional US, and centripetal enhancement as independent variables showed good discrimination: the sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve were 80.0%, 76.7%, 78.4%, and 0.837 [95% confidence interval (CI): 0.771-0.902]. There was a significant difference between the multimodal and conventional US DTs (P=0.009).Conclusions: Our results indicated that the DT based on the preoperative multimodal US characteristics of PTCs has a reasonable predictive ability for CLNM and can be conveniently used for clinical decision making of individualized treatment in patients with well-differentiated PTC.

Background: Early preoperative evaluation of cervical lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) is critical for further surgical treatment. However, insufficient accuracy in predicting LNM status for PTC based on ultrasound images is a problem that needs to be urgently resolved. This study aimed to clarify the role of convolutional neural networks (CNNs) in predicting LNM for PTC based on multimodality ultrasound. Methods: In this study, the data of 308 patients who were clinically diagnosed with PTC and had confirmed LNM status via postoperative pathology at Beijing Tiantan Hospital, Capital Medical University, from August 2018 to April 2022 were incorporated into CNN algorithm development and evaluation. Of these patients, 80% were randomly included into the training set and 20% into the test set. The ultrasound examination of cervical LNM was performed to assess possible metastasis. Residual network 50 (Resnet50) was employed for feature extraction from the B-mode and contrast-enhanced ultrasound (CEUS) images. For each case, all of features were extracted from B-mode ultrasound images and CEUS images separately, and the ultrasound examination data of cervical LNM information were concatenated together to produce a final multimodality LNM prediction. Sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC) were used to evaluate the performance of the predictive model. Heatmaps were further developed for visualizing the attention region of the images of the best-working model. Results: Of the 308 patients with PTC included in the analysis, 158 (51.3%) were diagnosed as LNM and 150 (48.7%) as non-LNM. In the test set, when a triple-modality method (i.e., B-mode image, CEUS image, and ultrasound examination of cervical LNM) was used, accuracy was maximized at 80.65% (AUC =0.831; sensitivity =80.65%; specificity =82.26%), which showed an expected increased performance over B-mode alone (accuracy =69.00%; AUC =0.720; sensitivity =70.00%; specificity =73.00%) and a dual-modality method (B-mode image plus CEUS image: accuracy =75.81%; AUC =0.742; sensitivity =74.19%; specificity =77.42%). The heatmaps of our triple-modality model demonstrated a possible focus area and revealed the model's flaws. Conclusions: The PTC lymph node prediction model based on the triple-modality features significantly outperformed all the other feature configurations. This deep learning model mimics the workflow of a human expert and leverages multimodal data from patients with PTC, thus further supporting clinical decision-making.

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 There is a recognized need for additional approaches to improve the accuracy of extrathyroidal extension (ETE) diagnosis in papillary thyroid carcinoma (PTC) before surgery. Up to now, multimodal ultrasound has been widely applied in disease diagnosis. We investigated the value of radiomic features extracted from multimodal ultrasound in the preoperative prediction of ETE. Methods We retrospectively pathologically confirmed PTC lesions in 235 patients from January 2019 to April 2022 in our hospital, including 45 ETE lesions and 205 non-ETE lesions. MaZda software was employed to obtain radiomics parameters in multimodal sonography. The most valuable radiomics features were selected by the Fisher coefficient, mutual information, probability of classification error and average correlation coefficient methods (F + MI + PA) in combination with the least absolute shrinkage and selection operator (LASSO) method. Finally, the multimodal model was developed by incorporating the clinical records and radiomics features through fivefold cross-validation with a linear support vector machine algorithm. The predictive performance was evaluated by sensitivity, specificity, accuracy, F1 scores and the area under the receiver operating characteristic curve (AUC) in the training and test sets. Results A total of 5972 radiomics features were extracted from multimodal sonography, and the 13 most valuable radiomics features were selected from the training set using the F + MI + PA method combined with LASSO regression. The multimodal prediction model yielded AUCs of 0.911 (95% CI 0.866–0.957) and 0.716 (95% CI 0.522–0.910) in the cross-validation and test sets, respectively. The multimodal model and radiomics model showed good discrimination between ETE and non-ETE lesions. Conclusion Radiomics features based on multimodal ultrasonography could play a promising role in detecting ETE before surgery.

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.

Objective:To explore the clinical application value of deep learning based ultrasonic thyroid nodule segmentation.Methods:We selected 1044 ultrasound images of 166 thyroid patients collected from Beijing Tiantan Hospital Affiliated to Capital Medical University from August 2018 to October 2020. The segmentation effect of Unet with improved self-attention mechanism and control Unet-based method was assessed using test datasets. Whether the segmentation result is close to the manual annotation by a sonographer with many years of clinical experience was used as a reference standard, and the Unet and Unet-based methods with improved self-attention mechanism were compared for the segmentation effect of thyroid nodules, using IoU (intersection and union ratio), Dice (Dice similarity coefficient), and the degree of closeness to the manual outline of thyroid nodules by the sonographer to evaluate the performance and clinical value of the deep learning model for thyroid nodule segmentation.Results:The IoU and Dice coefficients of thyroid nodule segmentation by Unet with improved self-attention mechanism were 0.815 and 0.839, respectively, which were higher than those of Unet (IoU=0.788, Dice=0.817). It can also be seen from the segmented images that the Unet based on the improved self-attention mechanism had a better segmentation effect on the overall and edge details of thyroid nodules than the Unet-based method, and was closer to the manual outline results of the sonographer.Conclusion:Unet based on self-attention mechanism has good performance in thyroid nodule segmentation, which can improve the diagnostic efficiency, the method also has clinical application value.

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.

Objectives The aim of this study was to evaluate the performance of deep learning-based detection and classification of carotid plaque (DL-DCCP) in carotid plaque contrast-enhanced ultrasound (CEUS). Methods and analysis A prospective multicentre study was conducted to assess vulnerability in patients with carotid plaque. Data from 547 potentially eligible patients were prospectively enrolled from 10 hospitals, and 205 patients with CEUS video were finally enrolled for analysis. The area under the receiver operating characteristic curve (AUC) was used to evaluate the effectiveness of DL-DCCP and two experienced radiologists who manually examined the CEUS video (RA-CEUS) in diagnosing and classifying carotid plaque vulnerability. To evaluate the influence of dynamic video input on the performance of the algorithm, a state-of-the-art deep convolutional neural network (CNN) model for static images (Xception) was compared with DL-DCCP for both training and holdout validation cohorts. Results The AUCs of DL-DCCP were significantly better than those of the experienced radiologists for both the training and holdout validation cohorts (training, DL-DCCP vs RA-CEUS, AUC: 0.85 vs 0.69, p<0.01; holdout validation, DL-DCCP vs RA-CEUS, AUC: 0.87 vs 0.66, p<0.01), that is, also better than the best deep CNN model Xception we had performed, for both the training and holdout validation cohorts (training, DL-DCCP vs Xception, AUC:0.85 vs 0.82, p<0.01; holdout validation, DL-DCCP vs Xception, AUC: 0.87 vs 0.77, p<0.01). Conclusion DL-DCCP shows better overall performance in assessing the vulnerability of carotid atherosclerotic plaques than RA-CEUS. Moreover, with a more powerful network structure and better utilisation of video information, DL-DCCP provided greater diagnostic accuracy than a state-of-the-art static CNN model. Trial registration number ChiCTR1900021846,

Objective:To investigate the predictive value of multimodal ultrasound consisting of conventional ultrasound, contrast-enhanced ultrasound, and superb microvascular imaging (SMI) in cervical lymph node metastasis (CLNM) of papillary thyroid microcarcinoma (PTMC).Methods:A retrospective analysis was performed on 99 patients with pathologically confirmed PTMC at Beijing Tiantan Hospital, Capital Medical University from October 2018 to April 2021. Conventional ultrasound, contrast-enhanced ultrasound, and SMI were all performed preoperatively. According to pathologic results, the patients were divided into either a non-metastatic cervical lymph node group (n=60) or a metastatic cervical lymph node group (n=39). Features of multimodal ultrasound and clinical data of PTMC were observed and recorded. Independent-sample t test, Chi-square test, and Fisher exact test were used to compare the differences in all features between the two groups, and the statistically significant factors were included in multivariate Logistic regression analysis to identify the independent risk factors for PTMC with CLNM.Results:Univariate analysis showed that compared with the patients with CLNM, the patients without CLNM were older [(47.50±11.48) years vs (39.67±9.95) years], had smaller PTMC [(0.66±0.02) cm vs (0.77±0.02) cm], were less likely to have the maximum diameter of single carcinoma or the sum of the maximum diameter of multiple carcinoma＞1.0 cm (13/60 vs 17/39), had less microcalcifications (none, ≤5 but not none, and＞5∶23, 23, and 14 vs 10, 10, and 19, respectively), were less likely to have PTMC with equal or high density enhancement (9/60 vs 13/39), and were less likely to have interruption of capsule continuity in early stage of contrast-enhanced ultrasound (14/60 vs 17/39) (t=3.491, P=0.001; t=3.376, P=0.001; χ2=5.379, P=0.020; χ2=6.854, P=0.032; χ2=4.596, P=0.032; and χ2=4.509, P=0.034, respectively). Multivariate analysis showed that younger age (odds ratio [OR]=0.933, P =0.004), larger PTMC (OR=30.567,P=0.046), and interruption of capsule continuity in early stage of contrast-enhanced ultrasound (OR=0.296, P=0.032) independently increased the risk of CLNM in PTMC.Conclusion:Younger age, larger PTMC, and interruption of capsule continuity in early stage of contrast-enhanced ultrasound are independent risk factors for predicting CLNM of PTMC. The features of preoperative multimodal ultrasound have appreciated predictive value for CLNM in patients with PTMC.

Background Thyroid cancer is the most common malignancy of the endocrine system worldwide. Papillary thyroid cancer (PTC) is the most common pathologic type. The preoperative diagnosis of PTC and central lymph node metastasis (CLNM) or metastatic tendency is of great clinical significance to the diagnosis, treatment and prognosis of these patients. This study was conducted to investigate the correlation between ultrasound features and central CLNM of PTC. Methods This study retrospectively analyzed patients who underwent PTC surgery and central lymph node dissection in the Department of Surgery, Beijing Tiantan Hospital, from January 2019 to February 2020. According to the inclusion and exclusion criteria, data from 136 patients were ultimately included, and the clinical and ultrasonic data of the patients were analyzed by multivariate regression to evaluate the correlation among grayscale ultrasound (US), superb microvascular imaging (SMI) and contrast-enhanced ultrasound (CEUS) features of thyroid nodules and CLNM of PTCs. Results The multivariate analysis showed that tumor size, multifocality, microcalcification characteristics, SMI vascularization, and CEUS evaluation of contact with the adjacent capsule were correlated with PTC metastasis (P=0.008, P=0.001, P=0.028, P=0.041, and P< 0.001, respectively). Comparisons of the area under the ROC curves revealed that the area under the ROC curve of the degree of nodular invasion into the thyroid capsule was the largest (AUC: 0.754). The sensitivity and specificity for evaluating CLNM of PTC were 67.7% and 83.1%, respectively. Conclusions Ultrasound characteristics of the following features are associated with a high risk of lymph node metastasis in PTCs: maximum diameter of nodules ≥1 cm, multifocality, ≥5 microcalcifications, abundant blood flow of SMI in nodules and nodule contact with the thyroid capsule ≥25% under CEUS. Ultrasound has clinical value in the preoperative evaluation of CLNM of PTCs.