Immunotherapy is showing good potential for colorectal cancer therapy, however, low responsive rates and severe immune-related drug side effects still hamper its therapeutic effectiveness. Herein, a highly stable cerasomal nano-modulator (DMC@P-Cs) with ultrasound (US)-controlled drug delivery capability for selective sonodynamic-immunotherapy is fabricated. DMC@P-Cs' lipid bilayer is self-assembled from cerasome-forming lipid (CFL), pyrophaeophorbid conjugated lipid (PL), and phospholipids containing unsaturated chemical bonds (DOPC), resulting in US-responsive lipid shell. Demethylcantharidin (DMC) as an immunotherapy adjuvant is loaded in the hydrophilic core of DMC@P-Cs. With US irradiation, reactive oxygen species (ROS) can be effectively generated from DMC@P-Cs, which can not only kill tumor cells for inducing immunogenic cell death (ICD), but also oxidize unsaturated phospholipids-DOPC to change the permeability of the lipid bilayers and facilitate controlled release of DMC, thus resulting in down-regulation of regulatory T cells (Tregs) and amplification of anti-tumor immune responses. After intravenous injection, DMC@P-Cs can efficiently accumulate at the tumor site, and local US treatment resulted in 94.73% tumor inhibition rate. In addition, there is no detectable systemic toxicity. Therefore, this study provides a highly stable and US-controllable smart delivery system to achieve synergistical sonodynamic-immunotherapy for enhanced colorectal cancer therapy.

Inflammation is considered to be the main target of the development of new stroke therapies. There are three key issues in the treatment of stroke inflammation: the first one is how to overcome the blood-brain barrier (BBB) to achieve drug delivery, the second one is how to select drugs to treat stroke inflammation, and the third one is how to achieve targeted drug delivery. In this study, we constructed hydrocortisone-phosphatidylserine microbubbles and combined them with ultrasound (US)-targeted microbubble destruction technology to successfully open the BBB to achieve targeted drug delivery. Phosphatidylserine on the microbubbles was used for its "eat me" effect to increase the targeting of the microvesicles. In addition, we found that hydrocortisone can accelerate the closure of the BBB, achieving efficient drug delivery while reducing the entry of peripheral toxins into the brain. In the treatment of stroke inflammation, it was found that hydrocortisone itself has anti-inflammatory effects and can also change the polarization of microglia from the harmful pro-inflammatory M1 phenotype to the beneficial anti-inflammatory M2 phenotype, thus achieving dual anti-inflammatory effects and enhancing the anti-inflammatory effects in ischemic areas after stroke, well reducing the cerebellar infarction volume by inhibiting the inflammatory response after cerebral ischemia. A confocal microendoscope was used to directly observe the polarization of microglial cells in living animal models for dynamic microscopic visualization detection showing the advantage of being closer to clinical work. Taken together, this study constructed a multifunctional targeted US contrast agent with the function of "one-stone-two-birds", which can not only "on-off" the BBB but also have "two" anti-inflammatory functions, providing a new strategy of integrated anti-inflammatory targeted delivery and imaging monitoring for ischemic stroke treatment.

The ultrasound diagnosis imaging report reflects the sum of a radiologist's synthesis and judgement into a patient's condition. It is also an important product that is generated by radiologists to help the patients. In spite of the importance of clear and effective report writing, radiologists usually receive little or no formal reporting education. There are key principles when reporting the ultrasound findings, impression, and recommendations to promote report quality and reading experience. The findings should emphasize short and factual observations while avoiding redundancy. The impression is the thoughtful synthesis of findings leading to a diagnosis, a differential diagnosis and management recommendations. Improved report writing is achieved only after persistent learning, follow up and summaries.

Peyton's four-step teaching method is widely used in education of clinical skills. At the present study, this method was introduced into musculoskeletal ultrasound training, and the effect of this training strategy was evaluated. Problems which may occur in the process were also searched in order to improve this method. Compared to traditional method, students accepted Peyton's four-step teaching method, namely demonstration, deconstruction, comprehension and performance all achieved better scores in both theory and skill tests. Peyton's four-step teaching method also stimulated students′ learning interest and improved their teaching skill. However, one-to-one teaching is inefficient and few mutual discussion and inspiration among group members. The modified Peyton's four-step method with group teaching will be optimized and applied in future research and application.

目的 评估实时超声引导下尺神经周围药物注射及去除病因治疗肘管综合征的临床价值.方法 回顾性分析行超声引导下单侧尺神经周围药物注射治疗肘管综合征的患者40例,其中男23例,女17例,年龄42～68岁,平均(56±10.5)岁.结合临床病史及超声检查,对其中12例类风湿性关节炎患者、5例肘管处腱鞘囊肿患者进行针对病因的治疗.采用门诊和电话方式随访,分别记录治疗前和治疗后的患者尺侧手指疼痛的疼痛视觉模拟评分(VAS),应用配对t检验比较治疗前和治疗后1周、1个月的VAS评分.结果 40例患者肘管处尺神经平均最大横截面积约9.2 mm2,其中12例类风湿患者可见肘关节滑膜增生挤压尺神经,5例患者可见肘管处腱鞘囊肿压迫尺神经.40例患者均成功进行超声引导下介入治疗.40例患者治疗前疼痛VAS评分(7.7±0.9)分,治疗后1周VAS评分(3.6±1.2)分,治疗后1个月VAS评分(3.1±1.1)分,与治疗前比较均明显降低并具有统计学意义(P＜0.05).结论 实时超声引导下尺神经周围药物注射及去除病因治疗肘管综合征是一种安全、有效的方法.

OBJECTIVE:We developed an intelligent assistance system for shoulder ultrasound imaging, incorporating deep-learning algorithms to facilitate standard plane recognition and automatic tissue segmentation of the rotator cuff and its surrounding structures. We evaluated the system's performance using a dedicated data set of rotator cuff ultrasound images to assess its feasibility in clinical practice.METHODS:To fulfill the system's primary functions, we designed a standard plane recognition module based on the ResNet50 network and an automatic tissue segmentation module using the Mask R-CNN model. The modules were trained on carefully curated data sets. The standard plane recognition module automatically identifies a specific standard plane based on the ultrasound image characteristics. The automatic tissue segmentation module effectively delineates and segments anatomical structures within the identified standard plane.RESULTS:With the use of 59,265 shoulder joint ultrasound images, the standard plane recognition model achieved an impressive recognition accuracy of 94.9% in the test set, with an average precision rate of 96.4%, recall rate of 95.4% and F1 score of 95.9%. The automatic tissue segmentation model, tested on 1886 images, exhibited a commendable average intersection over union value of 96.2%, indicating robustness and accuracy. The model achieved mean intersection over union values exceeding 90.0% for all standard planes, indicating its effectiveness in precisely delineating the anatomical structures.CONCLUSION:Our shoulder joint musculoskeletal intelligence system swiftly and accurately identifies standard planes and performs automatic tissue segmentation.

Background:The varying experience of surgeons and ultrasound physicians, and their collaboration with physicians, may affect operation time and efficiency. We evaluated the learning curve of ultrasound-guided vacuum-assisted excision (VAE) of breast lesion with collaboration between different physicians, and assessed characteristics associated with operation time.Methods:The sample population of this retrospective study was divided into two groups: 49 consecutive patient surgeries completed by skilled surgeons and novice ultrasound physicians (U group); and 30 consecutive patient surgeries completed by skilled ultrasound physicians and novice surgeons (S group). Cumulative summation graphs were used to evaluate operation time and calculate the turning point of the learning curve. Patients in the U and S groups were divided into exploration stage and proficiency stage according to the turning point, and the differences in influencing factors were compared. A total of 548 patients who underwent vacuum-assisted breast excision performed by a combination of skilled surgeons and skilled ultrasound physicians were selected as the reference group (R group). The differences among the three groups were compared. The relationship between the operation time and other factors in the different groups was analyzed using linear regression.Results:The best learning curve of the sample population was the quadratic fitting equation, and the turning point was the 19th case in the U group and the 14th case in the S group. The total operation times in the proficiency stage were significantly shorter than those in the exploration stage in the U and S groups (P=0.012 and P=0.003, separately). Patient age, long diameter, short diameter, and depth of masses related to the operation time.Conclusions:Our data suggest the existence of different learning curves in ultrasound-guided vacuum-assisted excision for the collaborations of different stages surgeons and ultrasound physicians. Through the accumulation of experience, it is feasible to safely perform ultrasound-guided VAE of breast lesions.

OBJECTIVE:To evaluate the feasibility of axillary nerve (AN) visualization in healthy volunteers and the diagnostic value of AN injury via high-resolution ultrasonography (HRUS).METHODS:AN was examined by HRUS on both sides of 48 healthy volunteers and oriented the transducer according to three anatomical landmarks: quadrilateral space, anterior to subscapular muscle, and posterior to axillary artery. The maximum short-axis diameter (SD) and cross-sectional area (CSA) of AN were measured at different levels, and AN visibility was graded by using a five-point scale. The patients suspected of having AN injury were assessed by HRUS, and the HRUS features of AN injury were observed.RESULTS:AN can be visualized on both sides in all volunteers. There was no significant difference in SD and CSA of AN at the three levels between the left and right sides or in SD between males and females. However, the CSA of males at different levels was slightly larger than those of females (P < .05). In most volunteers, AN visibility at different levels was excellent or good, and AN was best displayed anterior to subscapular muscle. Rank correlation analysis revealed that the degree of AN visibility had correlation with height, weight, and BMI. A total of 15 patients diagnosed with AN injury, 12 patients showed diffuse swelling or focal thickening in AN, and 3 patients showed AN discontinuity.CONCLUSION:HRUS is able to reliably visualize AN, and it could be considered as the first choice for diagnosing AN injury.

High-resolution CT (HRCT) imaging features of idiopathic interstitial pneumonia (IIP) patients are related to glucocorticoid sensitivity. This study aimed to develop an artificial intelligence model to assess glucocorticoid efficacy according to the HRCT imaging features of IIP. The medical records and chest HRCT images of 150 patients with IIP were analyzed retrospectively. The U-net framework was used to create a model for recognizing different imaging features, including ground glass opacities, reticulations, honeycombing, and consolidations. Then, the area ratio of those imaging features was calculated automatically. Forty-five patients were treated with glucocorticoids, and according to the drug efficacy, they were divided into a glucocorticoid-sensitive group and a glucocorticoid-insensitive group. Models assessing the correlation between imaging features and glucocorticoid sensitivity were established using the k-nearest neighbor (KNN) algorithm. The total accuracy (ACC) and mean intersection over union (mIoU) of the U-net model were 0.9755 and 0.4296, respectively. Out of the 45 patients treated with glucocorticoids, 34 and 11 were placed in the glucocorticoid-sensitive and glucocorticoid-insensitive groups, respectively. The KNN-based model had an accuracy of 0.82. An artificial intelligence model was successfully developed for recognizing different imaging features of IIP and a preliminary model for assessing the correlation between imaging features and glucocorticoid sensitivity in IIP patients was established.

目的 探讨超声在股直肌腱钙化性肌腱炎诊断中的应用价值.方法 回顾性分析35例因腹股沟区疼痛在我院行超声检查并诊断为股直肌钙化性肌腱炎的患者,观察股直肌腱的病变部位、厚度,内部回声、钙化灶形态、局部血流情况及有无其他并发症.结果 股直肌钙化性肌腱炎主要累及直头(91.4％),患侧股直肌腱较健侧多肿胀增厚(74.3％),腱体内结构紊乱(71.4％),回声减低(91.4％),局部血流信号增多(42.8％),腱体内钙化灶以Ⅱ型和Ⅲ型为主(65.7％),边缘不清(68.6％),在超声扫查过程中35例患者局部均有明显压痛.结论 超声能显示病变肌腱的形态和回声变化,动态观察钙化部位及其与周围组织的关系,可作为该病的理想影像检查方法.

目的 回顾性分析低年资超声医师与熟练临床医师组合行超声引导下真空辅助乳腺旋切术是否存在学习曲线,计算曲线转折点,分析影响学习曲线的其他因素.方法 低年资超声医师与熟练临床医师组合行超声引导下真空辅助乳腺旋切术的患者49例为研究组,以累积和分析法绘制学习曲线,计算转折点,将研究组数据分为学习探索阶段和熟练掌握阶段,比较两组数据各指标差异有无统计学意义;选择同一时期熟练超声医师与熟练临床医师组合行超声引导下真空辅助乳腺旋切术的患者548例为基准组,比较研究组与基准组各指标差异是否有统计学意义;利用线性回归法分别对研究组及基准组中手术时间与其他各指标间的关系进行分析.结果 研究组最佳学习曲线为二次拟合方程,学习曲线转折点为第19例;学习探索阶段和熟练掌握阶段手术时间及BI-RADS 分类组间比较差异有统计学意义,其他指标无统计学意义;研究组与基准组手术时间组间比较差异有统计学意义,其他指标无统计学意义;研究组手术时间与结节厚径呈正相关;基准组手术时间与结节长径、厚径及深度呈正相关,与患者年龄呈负相关.结论 低年资超声医师与熟练临床医师组合行超声引导下真空辅助乳腺旋切术存在学习曲线,曲线转折点最佳为第19例,患者年龄、结节长径、厚径及距表皮的深度可能是影响学习曲线的其他因素.

Abstract Background Subspine impingement (SSI) does not have effective diagnostic criteria, especially in patients who also have femoroacetabular impingement (FAI). The classification of anterior inferior iliac spine (AIIS) morphology via three-dimensional CT is controversial. Purpose To propose a method for ultrasound-guided AIIS injection as a way to diagnose SSI and evaluate the accuracy of radiography methods, including 3-D CT and MRI, as well as intraoperative findings. Methods Patients diagnosed with FAI between September 2020 and December 2021 were evaluated in this prospective study. Those who met the criteria were included in the ultrasound-guided AIIS injection test. Whether the pain was relieved after injection was recorded in the radiology report. Patients who experienced significant relief of the anterior groin pain (more than 50%) after the AIIS injection were considered positive responders. Among these patients, radiography materials, including AIIS morphology as measured by 3-D CT as well as superior capsular oedema on MRI, were compared. The presence of congestion or bruising on the capsule side of the labrum corresponding to the AIIS during hip arthroscopy was recorded. Results A total of 73 patients with FAI underwent the ultrasound-guided AIIS injection test. Prevalence rates of 13.70% (10/73), 58.90% (43/73), 23.29% (17/73) and 4.11% (3/73) were recorded for Type I, Type IIA, Type IIB and Type III AIISs, respectively. Thirty-six patients had positive responses to injection, and 37 patients had negative responses to injection. None of the patients with Type I, 23 (53.49%) patients with Type IIA, 11 (64.71%) patients with Type IIB and 2 (66.7%) patients with Type III AIISs had positive responses to the injection. A total of 57.14% of patients with Type II or Type III AIIS had positive responses to the injection. The proportions of patients with superior capsular oedema on MRI in the Type I, Type IIA, Type IIB, and Type III AIIS groups was 0, 30.23, 29.41 and 0%, respectively. Among non-Type I AIIS patients, those who reported positive responses to the injection had a higher incidence of superior capsular oedema (38.89% vs. 14.81%, P = 0.036), but they had no significant differences in the proportion of congestion or bruising of the labrum (47.22% vs. 37.04%, P = 0.419). The results showed that no pairs of methods—ultrasound-guided injection, MRI, and intraoperative findings—achieved good consistency (κ = 0.222, κ = 0.098 and κ = − 0.116). Conclusions Radiographic methods including 3-D CT and MRI as well as the intraoperative findings of the labrum cannot be considered an accurate and reliable basis for the diagnosis and treatment of SSI in FAI patients. It is suggested that ultrasound-guided AIIS injections be combined with radiography to better diagnose SSI. Level of Evidence IV, case series.

Background and Objectives: Portal hypertension (PH), as the main consequence of cirrhosis, leads to the development of gastroesophageal varices (GEVs). Variceal hemorrhage (VH) caused by the rupture of GEVs is a life-threatening emergency. Thus, the prediction of VH risk is considerably important. Our pilot study aimed to identify the risk factors of variceal hemorrhage (VH) in cirrhosis. Materials and Methods: Cirrhotic patients were prospectively included and divided into two groups according to the presence or absence of VH. Conventional ultrasound and shear wave dispersion (SWD) imaging were conducted to detect the portal vein diameter, spleen diameter, ascites, liver stiffness (LS) and shear wave dispersion slope (SWDS). The laboratory tests were recorded, including platelets (PLT), alanine transaminase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL) and albumin (ALB). The risk factors of VH were screened using univariate analyses and identified using multivariate logistic regression. The ROC curves were used to assess diagnostic accuracy. Comparisons between AUCs were performed using the Delong method. Results: Sixty-five patients with 22 VHs were finally included. The SWDS, spleen diameter and ascites were identified as independent risk factors for VH. The SWDS showed good performance for diagnosing VH (AUC = 0.768, 95% CI: 0.647–0.864), and sensitively identified 95.5% (95% CI: 77.2%–99.9%) of patients with VH. Including the three risk factors in multivariate logistic regression, we obtained a formula for diagnosing VH: −20.749 + 0.804 × SWDS + 0.449 × spleen diameter + 1.803 × ascites (no ascites = 0, ascites = 1). Comparison of AUCs revealed that the formula (AUC = 0.900, 95% CI: 0.800–0.961) performed better than LS, SWDS, and spleen diameter in diagnosing VH (p < 0.001; p < 0.05; p < 0.05). Conclusions: SWDS is a sensitive parameter for assessing the risk of VH. Combining the SWDS, spleen diameter and ascites resulted in good diagnostic accuracy.

We investigated the diagnostic performance of qualitative and quantitative ultrasound criteria for anterosuperior acetabular labral tears (ALTs). In all, 118 people with ALTs (120 hips; case group) and 31 asymptomatic volunteers (42 hips; control group) at Peking University Third Hospital between August 2018 and November 2019 were consecutively included. The labral cleft, labral heterogeneous echogenicity, labral plump morphology, paralabral cyst and labral focal hyperechoic area were used as the qualitative criteria. The anterosuperior labral cross-section area (CSA) was measured as the quantitative criterion. The diagnostic utility of the quantitative and qualitative criteria were explored with magnetic resonance imaging as the diagnostic gold standard. Labral heterogeneous echogenicity was the most sensitive criterion for diagnosing ALTs (up to 80.00%), and the specificity of diagnosing ALTs with paralabral cysts, labral focal hyperechoic area and subcortical cysts of the femoral head and neck was as high as 90.48%-100%. The labral CSA in the case group was 0.27 cm2 (0.21-0.39 cm2), which was significantly larger compared with the control group (0.18 cm2 [0.14-0.23 cm2]; p < 0.001). The area under the receiver operating characteristic curve was 0.802 for diagnosing ALTs according to the labral CSA. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of the combined qualitative criteria for diagnosing ALTs were 90.00%, 71.43%, 90.00%, 71.43% and 85.19%, respectively. Labral heterogeneous echogenicity is a sensitive criterion for diagnosing ALTs, and paralabral cysts, labral focal hyperechoic, area and subcortical cysts of the femoral head and neck are specific criteria. The CSA of the anterosuperior acetabular labrum measured by ultrasound can be used as a quantitative criterion to diagnose ALTs. The combination of labral qualitative criteria provides higher sensitivity and accuracy in diagnosing ALTs.

The long head of the biceps tendon (LHBT) has been recognized as an important generator of anterior shoulder pain, causing a significant reduction in the shoulder flexion range. Various tendinous and ligamentous structures form the anchoring apparatus of the LHBT along its course to maintain its appropriate location during shoulder movements, including the coracohumeral ligament (CHL), superior glenohumeral ligament (SGHL), subscapularis (SSC) tendon and supraspinatus (SSP) tendon as well as the less recognized tendons of pectoralis major (PM), latissimus dorsi (LD) and teres major (TM). Lesions of this stabilizing apparatus may lead to an instability of the LHBT, resulting in pain at the anterior shoulder. Ultrasonography (US) has been increasingly used in the assessment of shoulder injuries, including the anchoring apparatus of the LHBT. An accurate diagnosis of these injuries is often challenging, given the complex anatomy and wide spectrum of pathologies. In this review article, US anatomy and common pathologic conditions that affect the anchoring apparatus of the LHBT are discussed, including biceps pulley lesions, adhesive capsulitis, chronic pathology of SSC and SSP tendons, tears in the PM tendon and injuries to the LD and TM. Knowledge of a normal anatomy, an appropriate scanning technique and US findings of common pathologic conditions are the keys to accurate diagnoses.

Objective:Based on the research results of the national continuing medical education project "musculoskeletal ultrasound and new technology quality class" held by the Department of Ultrasound Diagnosis of Peking University Third Hospital, to explore and analyze the effect of basic and applied teaching method based on musculoskeletal ultrasound.Methods:Totally 109 participants attending the classes held on April 14-18, 2019 and on September 9-13, 2019 were selected as study objects, and the training effects of quality private classes were evaluated by questionnaires, operational tests and theoretical tests. SPSS 21.0 was used for t test. Results:The results showed that more than 80% of students were satisfied with the teaching content, teaching plan and teaching materials. Through the class training, the greatest gains of the students were that the operation ability [67 cases (30.7%)] and the theoretical level [53 cases (24.3%)] had been significantly improved. All 109 students passed the operation test. There were no statistical differences in the average scores of theoretical tests among the students with different professional titles, academic qualifications and whether they were from primary hospitals (75-80 points, P>0.05) . Conclusion:The musculoskeletal ultrasound quality private class can improve the students' operating ability and theoretical level in the musculoskeletal system. The class model can guarantee the teaching quality and provide a new direction for continuing medical education.

Objective To explore the application effect of diversified teaching mode in ultrasound-guided interventional procedures for treatment of pain. Methods Thirty learners who studied in the Department of Pain, Peking University Third Hospital from January 2018 to December 2020 were enrolled as participants, and were divided into control group and observation group. The control group adopted conventional teaching mode, while the observation group adopted diversified teaching mode. The clinical skill assessments, teaching quality and satisfaction scores of the two groups were compared. Results The excellent and good rate of clinical skill assessments in the observation group was 93.3%, which was higher than that in the control group, which was 73.3%(P＜0.05). Scores of mastering basic theoretical knowledge, improving clinical thinking ability, motivating learning interests and improving disease diagnosis and treatment ability in observation group were higher than those in control group (P＜0.01). Conclusions Diversified teaching mode improves ultrasound-guided interventional pain management skills, and supports the capacity building of clinical treatment.The method may function as a innovative clinical training pathway for other medical schools and healthcare institutions.

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.

Objective To compare the learning outcomes of “interactive anatomical teaching” combined with “peer education” with traditional teaching in shoulder joint ultrasound training. Methods Two groups of refresher doctors were given shoulder joint ultrasound training, using “interactive anatomical teaching” combined with “peer education” (combined teaching group) and traditional teaching (traditional teaching group)respectively. Before and after the training, selected-response examination, practical operation and film reading ability were evaluated. After the training, a questionnaire survey was conducted to refresher doctors, including comprehensive course evaluation and satisfaction with personal capacity building. Results After the training, there was no statistically significant difference in Objective examination questions between the two groups. The score of combined teaching group was significantly higher than that of traditional teaching group on practical operation and film reading ability (P＜0.05). The comprehensive course evaluation and satisfaction with personal ability improvement in combined teaching group was significantly higher than that of traditional teaching group(P＜0.05). Conclusions The“interactive anatomical teaching” combined with “peer education” enable the refresher doctors to master the theoretical knowledge, operation skills and diagnosis of shoulder joint ultrasound tecnhology, which is believed to be a better teaching and training method than traditional approaches.

>A chronic autoimmune disease named rheumatoid arthritis(RA) is characterized mainly by synovitis, which has high morbidity, disability and mortality rates. In addition, the aetiology and pathogenesis of RA have not been fully determined. RA is usually accompanied by persistent arthritic pain, swelling, stiffness, and functional disorders; in severe cases, it may result in cardiovascular, pulmonary, psychological and skeletal diseases(Scott et al.,2010).