OBJECTIVE:The Focused Assessment with Sonography for Trauma (FAST) enables rapid detection of free intraperitoneal fluid, facilitating timely management of internal hemorrhage. This study aims to develop a Transformer-based model for automated detection on FAST images and evaluate its feasibility in assisting non-specialist operators. METHODS:Between June 2019 and June 2024, 1829 FAST-positive images demonstrating free intraperitoneal fluid and 303 FAST-negative images without fluid were retrospectively collected from Zhejiang Provincial People's Hospital. A Transformer-based model integrating segmentation and classification modules was developed and internally validated using five-fold cross-validation. External validation was performed on 848 images (424 positive/424 negative) from Hubei Provincial People's Hospital. Three operators with varying expertise-a junior sonographer, a clinician, and a non-clinical operator-evaluated all external images before and after model assistance to compare segmentation performance. RESULTS:Five-fold cross-validation yielded the following segmentation metrics: mean intersection over union (IoU) 0.671 ± 0.009, Dice coefficient 0.799 ± 0.013, and pixel accuracy (PA) 0.809 ± 0.010. Classification performance showed a mean accuracy of 0.922 ± 0.013, sensitivity of 0.938 ± 0.015, and specificity of 0.905 ± 0.015. External validation demonstrated accuracy 0.883, sensitivity 0.901, specificity 0.837, AUC 0.871, with segmentation IoU 0.683, Dice coefficient 0.812, and PA 0.781. The model performed comparably to junior Sonographer and outperformed non-specialists. After model assistance, all groups improved and inter-group differences disappeared (all p > 0.05). CONCLUSION:The Transformer model delivers diagnostic performance comparable to junior Sonographer for automated free intraperitoneal-fluid detection in FAST examinations and significantly improves detection accuracy among non-specialist operators.

Objective:To develop and validate a CT-based habitat imaging model incorporating intratumoral microenvironment heterogeneity analysis for noninvasive preoperative prediction of microvascular invasion (MVI) in hepatocellular carcinoma (HCC), addressing limitations of conventional radiomics in characterizing intra-tumor heterogeneity. Methods:This retrospective study included 216 patients with pathologically confirmed HCC undergoing resection. Preoperative portal venous phase contrast-enhanced CT and corresponding postoperative histopathologic MVI status were collected. Habitat (functional heterogeneous subregion) and conventional radiomic features were extracted. A habitat risk score and radiomic score were calculated. Clinical-pathologic factors (Edmondson grade, p53/CD10 expression, tumor diameter) identified via univariate/multivariate analyzes were integrated into a predictive model visualized as a nomogram. Performance was assessed by AUC, calibration curves, and decision curve analysis (DCA). DeLong's test compared ROC curves. Results:In the training set, the combined model achieved an AUC of 0.862 (95% CI: 0.797-0.926); in the validation set, AUC was 0.814 (95% CI: 0.710-0.918), both significantly outperforming individual models (all P < 0.05). Calibration curves showed good agreement (Hosmer-Lemeshow P = 0.60). DCA indicated net benefit at thresholds of 15%-65%. DeLong's test confirmed the combined model had higher AUC than the clinical model (Z = -3.21, P < .05) and radiomics-only model (Z = -2.05, P < .05). Conclusion:The CT-based habitat imaging model quantified intratumoral heterogeneity and, combined with clinicopathologic data, provided a reliable noninvasive tool for preoperative MVI risk stratification in HCC, with strong clinical potential.

Objective:To assess the clinical value of double-plane transrectal ultrasonography (DPTRUS) in the diagnosis and treatment of pelvic diseases.Methods:A retrospective analysis was performed on patients with pelvic diseases treated at Zhejiang Provincial People's Hospital from August 2022 to March 2023. The pelvic diseases were diagnosed by routine ultrasound (RUS), contrast-enhanced ultrasound (CEUS), and high-frequency ultrasound guided puncture biopsy or catheter drainage using a bi-planar transrectal probe (convex and linear array), including ultrasonic diagnosis and puncture biopsy of 173 cases of prostate disease, 4 cases of pararectal mass, and 1 case of cervical cancer, and ultrasonic diagnosis and catheter drainage of 1 case of encapsulated effusion in the uterine rectal fossa and 1 case of prostatic abscess. The accuracy, sensitivity, and specificity of RUS and CEUS in DPTRUS for the diagnosis of prostate cancer and other pelvic diseases were calculated using pathological examination results or CT enhancement results as gold standard, and the paired chi-square test was used to determine the difference between RUS and CEUS in the diagnosis of prostate cancer.Results:The accuracy, sensitivity, and specificity of RUS and CEUS in DPTRUS in the diagnosis of prostate cancer were 79.2%, 66.3%, and 93.8%, and 75.0%, 54.1%, and 95.8%, and there was no significant difference between them (χ2=3.20, P=0.063). The accuracy of ultrasonic diagnosis for other pelvic diseases was 100%, and all cases successfully underwent perineal ultrasound intervention.Conclusion:DPTRUS can correctly diagnose pelvic diseases and perform puncture biopsy for pathological diagnosis and puncture drainage treatment under the guidance of high-frequency ultrasound, thus achieving simultaneous diagnosis and treatment.

目的 研究射频消融技术对甲状旁腺功能亢进患者甲状旁腺激素(PTH)和血钙(Ca)的短期影响.方法 对47例病例进行回顾性分析,术前按照是否有基础疾病如糖尿病肾病、尿毒症等分为PHPT组和SHPT组.常规超声检查和核素扫描均可发现患者一侧或两侧均有1～4枚大小及数目不等的结节.检查并记录患者治疗前及治疗后短期内(消融后1 d)的PTH、血Ca的变化.结果 PHPT组25例患者消融前后的PTH值分别为186.0(117.3,244.0)和11.6(6.8,40.0)pg/mL,血Ca分别为(2.66±0.26)和(2.32±0.22)mmol/L,差异均有统计学意义(P<0.05).SHPT组22例患者消融前后的PTH值分别为1223.5(783.0,1559.0)和251.0(65.0,338.0)pg/mL,血Ca分别为(2.34±0.33)和(2.05±0.33)mmol/L,差异均有统计学意义(P<0.05).PHPT和SHPT组间比较,PHPT组消融前后PTH差值远少于SHPT组消融前后差值,差异有统计学意义(P<0.05).PHPT组消融前后血Ca差值大于SHPT组消融前后差值,但差异无统计学意义(P>0.05).结论 射频消融技术无论是对于原发性甲状旁腺功能亢进还是继发性甲状旁腺功能亢进都能够在短期内降低PTH和血Ca,且继发性甲状旁腺功能亢进PTH降低较原发性甲状旁腺功能亢进更明显.

Background: Rural general practitioners (GPs) have insufficient diagnostic information to deal with complex clinical scenarios due to the inequality in medical imaging resources in rural and remote communities. The objective of this study is to explore the value of a tele-mentored handheld ultrasound (tele-HHUS) system, allowing GPs to provide ultrasound (US) services in rural and remote communities. Methods: Overall, 708 patients underwent tele-HHUS examination between March and October 2021 and March and April 2022 across thirteen primary hospitals and two tertiary-care general hospitals. All US examinations were guided and supervised remotely in real time by US experts more than 300 km away using the tele-HHUS system. The following details were recorded: location of tele-HHUS scanning, primary complaints, clinical diagnosis, and US findings. The recommendations (referral or follow-up) based on clinical experience alone were compared with those based on clinical experience with tele-HHUS information. Results: Tele-HHUS examinations were performed both in hospital settings (90.6%, 642/708) and out of hospital settings (9.4%, 66/708). Leaving aside routine physical examinations, flank pain (14.2%, 91/642) was the most common complaint in inpatients, while chest distress (12.1%, 8/66) and flank discomfort (12.1%, 8/66) were the most common complaints in out-of-hospital settings. Additionally, the referral rate increased from 5.9% to 8.3% (kappa = 0.202; p = 0.000). Conclusions: The tele-HHUS system can help rural GPs perform HHUS successfully in remote and rural communities. This novel mobile telemedicine model is valuable in resource-limited areas.

将食管裂孔疝病例组和阴性对照组患者超声混合造影观察结果与术中结果进行对比分析，以评价超声混合造影在食管裂孔疝手术患者评估中的可行性和实用性。结果表明，超声混合造影测量结果与术中测得的食管裂孔疝内径呈正相关（ P<0.05），同时对食管裂孔疝的诊断具有较高的诊断效能。

超声检查因便携、经济、安全无辐射等优势,在新型冠状病毒肺炎(简称新冠肺炎)肺部病情进展、循环容量变化、基础疾病评估等方面展现出重要的临床价值,是新冠肺炎患者必备的影像学检查方法之一[1-5].与X线、CT检查相比,超声检查的一个显著特点是集技术与诊断于一体,需要医师在患者身旁进行实时检查并同时完成疾病的诊断,对医师的个人经验依赖程度高,其准确性常受制于超声医师的实际操作手法与临床经验,因此其评估病情的价值受到了一定的限制,同时也让医师直接暴露于患者环境中,增加了医师被感染的风险.

Objective: To assess the efficacy and safety of ultrasound (US)-guided radiofrequency ablation (RFA) in patients with primary hyperparathyroidism (PHPT). Materials and Methods: This prospective study enrolled 39 participants (14 male, 25 female; mean age, 59.5 +/- 15.3 [range, 18-87] years) between September 1, 2018, and January 31, 2021. All participants had parathyroid lesions causing PHPT, proven biochemically and through imaging. The imaging features of the PHPT nodules, including the shape, margin, size, composition, and location, were evaluated before treatment. Serum intact parathyroid hormone, calcium, and phosphorus levels; parathyroid nodule volume; and PHPT-related symptoms were recorded before and after treatment. We calculated the technical success, biochemical cure, and clinical cure rates for these patients. Complications were evaluated during and after the ablation. Results: Complete ablation was achieved in 38 of the 39 nodules in the 39 enrolled participants. All the patients were treated in one session. The technical success rate was 97.4% (38/39). The mean follow-up duration was 13.2 +/- 4.6 (range, 6.0-24.9) months. At 6 and 12 months post-RFA, the biochemical cure rates were 82.1% (32/39) and 84.4% (27/32), respectively, and the clinical cure rates were 100% (39/39) and 96.9% (31/32), respectively. Only 2.6% (1/39) of the patients had recurrent PHPT. At 1, 3, 6, and 12 months after technically successful RFA, 44.7% (17/38), 34.3% (12/35), 15.8% (6/38), and 12.5% (4/32) of participants, respectively, had elevated eucalcemic parathyroid hormone levels. Recurrent laryngeal nerve paralysis occurred in 5.1% (2/39) of the patients, who recovered spontaneously within 1-3 months. Conclusion: US-guided RFA was effective and safe for PHPT patients. RFA may be an alternative treatment tool for patients who cannot tolerate or refuse to undergo surgery.

BackgroundDisability has become a global population health challenge. Due to difficulties in self-care or independent living, patients with disability mainly live in community-based care centers or institutions for long-term care. Nonetheless, these settings often lack basic medical resources, such as ultrasonography. Thus, remote ultrasonic robot technology for clinical applications across wide regions is imperative. To date, few experiences of remote diagnostic systems in rural care centers have been reported.ObjectiveTo assess the feasibility of a fifth-generation cellular technology (5G)-based robot-assisted remote ultrasound system in a care center for disabled patients in rural China.MethodsPatients underwent remote robot-assisted and bedside ultrasound examinations of the liver, gallbladder, spleen, and kidneys. We compared the diagnostic consistency and differences between the two modalities and evaluated the examination duration, image quality, and safety.ResultsForty-nine patients were included (21 men; mean age: 61.0 ± 19.0 [range: 19–91] years). Thirty-nine and ten had positive and negative results, respectively; 67 lesions were detected. Comparing the methods, 41 and 8 patients had consistent and inconsistent diagnoses, respectively. The McNemar and kappa values were 0.727 and 0.601, respectively. The mean duration of remote and bedside examinations was 12.2 ± 4.5 (range: 5–26) min and 7.5 ± 1.8 (range: 5–13) min (p < 0.001), respectively. The median image score for original images on the patient side and transmitted images on the doctor side was 5 points (interquartile range: [IQR]: 4.7–5.0) and 4.7 points (IQR: 4.5–5.0) (p = 0.176), respectively. No obvious complications from the examination were reported.ConclusionsA 5G-based robot-assisted remote ultrasound system is feasible and has comparable diagnostic efficiency to traditional bedside ultrasound. This system may provide a unique solution for basic ultrasound diagnostic services in primary healthcare settings.

目的 探讨肾脏实性肿瘤的常规超声表现及造影表现,提高超声诊断准确率.方法 回顾性分析86例经手术病理证实的肾脏实性肿瘤的超声表现及造影表现特点.结果 86例肾脏实性肿瘤中恶性病变63例:透明细胞型肾癌(CCRCC)43例,乳头状肾细胞癌(PRCC)9例,嫌色细胞型肾癌(CHRCC)11例;23例为良性病变:肾血管平滑肌脂肪瘤(AML)10例及肾嗜酸细胞腺瘤(RO)13例.不同病理类型肾肿瘤在CEUS灌注期表现差异有统计学意义;环状高增强在恶性肾肿瘤中具有一定的特异性.结论 超声造影对肾脏实性肿瘤诊断及鉴别诊断具有一定的临床价值.

Purpose To assess the feasibility of ultrasound-guided (US-guided) radiofrequency ablation (RFA) for primary hyperparathyroidism (PHPT) and determine predictive factors for hypocalcemia and elevated serum intact parathyroid hormone(ePTH) with normocalcemia after ablation. Materials and Methods Between January 2015 and January 2021, data from 44 patients with PHPT who were treated with US-guided RFA were retrospectively evaluated. Serum intact parathyroid hormone(iPTH), total calcium (Ca), phosphorus, alkaline phosphatase (ALP), and 25-hydroxyvitamin D 3 (25(OH)D 3 ) levels and the volume of the abnormal enlarged parathyroid glands were recorded before RFA. Changes in iPTH and Ca levels at 1 and 3 days, and, 1, 3, and 6 months after ablation were recorded. Results Overall, thirteen patients developed hypocalcemia 1–3 days after RFA. ePTH with normocalcemia developed in 17 patients 1 month after RFA. Thirty-two patients were followed up for more than 6 months, and 27 of these patients had sustained normalized values for both serum iPTH and Ca levels more than 6 months after RFA. There were significantly more patients who developed hypocalcaemia, when the baseline ALP was greater than 261.5 U/L (sensitivity 61.5%, specificity 100.0%). The risk of ePTH decreased by 21.7% for every 1 ng/mL increase in 25 (OH) D 3 . The risk of ePTH was increased when a patient's serum iPTH was higher than 172.4 pg/mL (sensitivity 88.2%, specificity 76.2%). Conclusions US-guided RFA is feasible for clinical management of PHPT patients. Hypocalcaemia following RFA was associated with higher pre-RFA serum ALP levels. Elevated iPTH levels with normocalcemia at 1 month after RFA were associated with pre-RFA vitamin D deficiency and higher baseline iPTH levels. Patients with higher serum ALP and iPTH and lower 25 (OH) D 3 levels before RFA need to be managed carefully and monitored closely after RFA of PHPT.

BACKGROUND . Traditional methods for cardiopulmonary assessment of patients with coronavirus disease 2019 (COVID-19) pose risks to both patients and examiners. This necessitates a remote examination of such patients without sacrificing information quality. RESEARCH QUESTION: The goal of this study was to assess the feasibility of a 5G-based robotassisted remote ultrasound system in examining patients with COVID-19 and to establish an examination protocol for telerobotic ultrasound scanning. STUDY DESIGN AND METHOD. Twenty-three patients with COVID-19 were included and divided into two groups. Twelve were nonsevere cases, and 11 were severe cases. All patients underwent a 5G-based robot-assisted remote ultrasound system examination of the lungs and heart following an established protocol. Distribution characteristics and morphology of the lung and surrounding tissue lesions, left ventricular ejection fraction, ventricular area ratio, pericardial effusion, and examination-related complications were recorded. Bilateral lung lesions were evaluated by using a lung ultrasound score. RESULT The remote ultrasound system successfully and safely performed cardiopulmonary examinations of all patients. Peripheral lung lesions were clearly evaluated. Severe cases of COVID-19 had significantly more diseased regions (median [interquartile range], 6.0 [2.0-11.0] vs 1.0 [0.0-2.8]) and higher lung ultrasound scores (12.0 [4.0-24.0] vs 2.0 [0.0-4.0]) than non-severe cases of COVID-19 (both, P < .05). One nonsevere case (8.3%; 95% CI, 1.5-35.4) and three severe cases (27.3%; 95% CI, 9.7-56.6) were complicated by pleural effusions. Four severe cases (36.4%; 95% CI, 15.2-64.6) were complicated by pericardial effusions (vs 0% of nonsevere cases, P < .05). No patients had significant examination-related complications. INTERPRETATION Use of the 5G-based robot-assisted remote ultrasound system is feasible and effectively obtains ultrasound characteristics for cardiopulmonary assessment of patients with COVID-19. By following established protocols and considering medical history, clinical manifestations, and laboratory markers, this system might help to evaluate the severity of COVID-19 remotely.

患者,老年男性,75岁,因"发热伴咳嗽4 d"于2020年1月30日到浙江省桐乡市第一人民医院就诊.患者4 d前无明显诱因出现发热伴咳嗽,无鼻塞、流涕,无胸痛,无明显咳痰.起初为低热,未予重视,自服感冒药治疗.因4d来持续低热,咳嗽呈进行性加重并感全身乏力伴食欲下降而来院就诊.

目的:探讨胃幽门超声短轴切面内鼻肠管截面计数应用于定位重症病人留置鼻肠管的价值.方法:选择2019年5月1日至2020年7月1日浙江省人民医院重症医学科符合鼻肠管置管指征的重症病人157例,行盲插置管术.置管完成后,通过超声检查,获得胃幽门部的短轴标准切面,观察其内特征性的鼻肠管短轴截面声像并计数,必要时向管腔内注水或注气进行增强显像.将计数结果进行分组(奇数组,偶数组),分别进行定位效能分析,并记录超声检查时间及相关并发症.以腹部X线作为鼻肠管定位金标准.定位结果一致表示超声定位成功.结果:154例(98.1％)通过超声检查可快速显示胃幽门超声短轴切面及鼻肠管截面,中位检查时间为5(5～10)秒.139例(139/154,90.3％)在胃幽门超声短轴切面中发现的鼻肠管截面数为奇数(1或3),其中132例(95.0％)确定为幽门后置管,其定位幽门后置管的敏感度,特异度,阳性预测值,阴性预测值和准确性分别为97.8％,75.0％,99.2％,50.0％和97.1％.15例(15/154,9.7％)在胃幽门超声短轴切面中发现的鼻肠管截面数为偶数(0或2),其中13例(86.7％)为幽门前置管,其定位幽门前置管的敏感度,特异度,阳性预测值,阴性预测值和准确性分别为92.9％,0.0％,92.9％,0.0％,和86.7％.结论:胃幽门部及鼻肠管短轴截面通过超声检查易于探及;胃幽门超声短轴切面内鼻肠管截面计数法应用于鼻肠管定位具有较高的效能,有助于构建系统化、标准化鼻肠管超声定位流程.

To date, coronavirus disease 2019 (COVID-19) has infected millions of people worldwide. Ultrasound plays an indispensable role in the diagnosis, monitoring, and follow-up of patients with COVID-19. In this study, we used a robotic tele-echography system based on a 5G communication network for remote diagnosis. The system has great potential for lung, heart, and vasculature information, medical staff protection, and resource sharing, can be a valuable tool for treating patients during the pandemic, and can be expected to expand to more specialized fields.