BACKGROUND AND AIM:Phyllodes tumors of the breast are rare fibroepithelial neoplasms whose pathological classification remains challenging due to marked histological heterogeneity, often complicating clinical management decisions. This study investigated whether preoperative ultrasound features correlate with pathological grade in phyllodes tumors and can serve as adjunctive information to guide diagnosis and management. METHODS:This retrospective study included 78 patients with pathologically confirmed phyllodes tumors (55 benign, 22 borderline, 1 malignant) who underwent preoperative ultrasound. Two blinded breast radiologists assessed tumor characteristics using the BI-RADS lexicon. Histopathological grading followed the 2019 WHO criteria. Statistical analysis included chi-square tests, receiver operating characteristic (ROC) curve analysis, and interobserver agreement assessment. Minimum follow-up was 12 months (median, 28 months; range, 12-48 months). RESULTS:Significant differences between benign and borderline tumors were observed for maximum diameter (median, 2.7 vs. 5.0 cm; p < 0.001), irregular shape (21.8% vs. 72.7%; p < 0.001), wavy margins (18.2% vs. 72.7%; p < 0.001), calcification (16.4% vs. 50.0%; p = 0.004), and internal anechoic/hypoechoic areas (1.8% vs. 77.3%; p < 0.001). Boundary characteristics, aspect ratio, orientation, and color Doppler flow were not discriminatory (p > 0.05). The optimal size cutoff was 3.55 cm (AUC: 0.881; sensitivity: 82.6%; specificity: 83.6%; p < 0.001), while a combined model incorporating all five features achieved superior performance (AUC: 0.924; sensitivity: 90.9%; specificity: 85.5%). The single malignant tumor measured 18 cm and demonstrated all high-risk features. Local recurrence occurred in 9.1% of borderline tumors (2/22), and no benign tumors recurred during follow-up. Interobserver agreement ranged from moderate to almost perfect (κ = 0.58-0.89). CONCLUSION:Specific ultrasound features, particularly size > 3.55 cm, irregular shape, wavy margins, calcification, and internal cystic areas, correlate significantly with borderline grade in phyllodes tumors. These findings can guide clinical suspicion, prompt consideration of wider excision when wavy margins are present, and help pathologists target solid components adjacent to cystic areas, potentially improving diagnostic accuracy and reducing recurrence.

Sjögren disease (SjD) is characterized by autoimmune lymphocytic infiltration of lacrimal and salivary glands, leading to dry eye and dry mouth. This study aimed to investigate the features and diagnostic value of lacrimal gland ultrasonography (LGUS) for distinguishing SjD from undifferentiated connective tissue diseases (UCTDs). This prospective cohort study enrolled 80 patients, including 46 with SjD and 34 with non-SjD UCTDs. All participants underwent LGUS, scored according to the OMERACT guidelines for greyscale and color Doppler systems, alongside salivary gland ultrasonography (SGUS) and objective dry eye tests. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis. The ocular surface evaluation including tear break-up time (BUT), Schirmer test (ST), ocular staining score (OSS), and LGUS greyscale score of patients with SjD showed significant differences as compared with non-SjD patients, while no difference was found in morphology and color Doppler ultrasound score between the two groups. The ROC of LGUS has an AUC of 0.70 (95

Diabetic wound (DW) is a diabetes complication characterized by high morbidity and disability rates. Previous therapeutic systems focused on macrophages while neglecting the upstream regulatory factor of neuropeptide-mediated neuroimmune communication. In addition, precise delivery is directly important for the treatment of DW. This study constructed an amphiphilic prodrug molecule MC by covalently conjugating calcitonin gene-related peptide (CGRP) with manganese porphyrin (MnP). MC was then co-assembled with DSPE-PEG-folic acid to form targeted nanoparticles MCF. Subsequently, MCF was loaded into an ultrasound-responsive hydrogel to obtain the MCF@CA system, integrating neuroimmune modulation and reactive oxygen species (ROS) scavenging functions. Upon local administration, ultrasound triggering enables the on-demand release of the nanodrug MCF from MCF@CA. Subsequently, FA targets M1 macrophages, prolonging wound retention time. MnP scavenges ROS, improving fibroblast function and promoting macrophage polarization towards an anti-inflammatory phenotype. This study presents an ultrasound-responsive hydrogel MCF@CA delivering targeted nanoparticles where CGRP regulates the regenerative transition of the immune microenvironment. Animal experiments confirmed that MCF@CA combined with ultrasound significantly promotes DW healing by enhancing collagen deposition, immune modulation, and improving blood supply. Therefore, this study provides an on-demand controlled delivery platform with clear translational potential for diabetic wound therapy.

To investigate the heterogeneity of azygos-hemiazygos venous pathway (AVP) in renal cell carcinoma (RCC) with venous obstruction caused by tumor thrombus (VTT), and evaluate its relation to intraoperative hemorrhage and surgical complexity. Patients with RCC and VTT who underwent radical nephrectomy and tumor thrombectomy(RNTE) from January 2014 to March 2022 were included continuously in this retrospective study. The AVP was measured by maximum venous width at aortic hiatus level (MVW at AH level), and compared across various levels of venous obstruction. The correlation to intraoperative hemorrhage was assessed using Spearman’s rank correlation. Receiver Operating Characteristic curve analysis was conducted to evaluate the ‌associative‌ performance and patients with compensated AVP were defined according to the optimal threshold.Surgical and other clinical features were compared between patients with and without compensated AVP. Three hundred thirty-three patients were included. The heterogeneity of AVP was apparent, with MVW at AH level ranging from 0.9 to 19.1 mm, and correlated to venous obstruction(p < 0.01). Increased MVW at the AH level was strongly associated with more intraoperative hemorrhage (p < 0.001). The AUC value for the risk assessment of massive hemorrhage was approximately 0.82, with an optimal cutoff identified at 7 mm.106 patients were defined with compensated AVP, they had higher hemorrhage volume (p < 0.001), longer surgery time (p < 0.001), higher rates of conversion to open surgery and postoperative complications (p = 0.012, p < 0.001). AVP exhibits notable heterogeneity among patients with RCC and VTT, and may represent a promising potential indicator for surgical planning. RNTE carry a significant tendency of intraoperative bleeding, preoperative identification of patients at risk of massive hemorrhage aids the deployment of surgical strategy. Measuring the AVP with MVW at the AH level appears to be associated with the risk of massive hemorrhage (> 2000 ml), and the AUC for this cohort was found to be approximately 0.82.

To retrospectively analyze the clinical and imaging characteristics of classic angiomyolipoma (CAML) with venous tumor thrombus (VTT) and compare them with those of clear cell renal cell carcinoma (ccRCC). Clinical data from six patients with renal CAML complicated by VTT and 18 with ccRCC complicated by VTT, treated at Peking University Third Hospital from April 2018 and June 2022, were retrospectively analyzed. All patients underwent preoperative ultrasound and contrast-enhanced CT. Clinical manifestations, imaging characteristics, surgical findings, and pathological data were collected, and patients were followed up. Enhanced CT showed renal sinus involvement in all CAML cases versus four ccRCC cases (p = 0.002). All primary CAML tumors had fatty components, compared to one ccRCC case (p < 0.001). Enhanced CT also revealed 7 VTTs with fatty components (6 in the CAML group) (p < 0.001). Thrombus lengths in the inferior vena cava (IVC) were 8.05 ± 2.22 cm for CAML and 5.29 ± 2.38 cm for ccRCC, with no significant difference (p = 0.610). The maximum/minimum anteroposterior VTT diameter ratios were 3.98 and 1.09, respectively (p < 0.001); coronal diameter ratios were 4.00 and 1.12, respectively (p < 0.001). Ultrasound revealed that, except for one Mayo Level 0 case, the involved IVC in the CAML group had continuous, intact walls with blood flow signals in the residual lumen, while in the ccRCC group, most VTTs had unclear boundaries and only one case showed blood flow signals in the residual lumen (p = 0.001). Intraoperative blood loss was significantly lower in CAML cases (p = 0.017). No CAML patient had VTT invading the venous wall, unlike 8 ccRCC patients (p = 0.016). All patients were followed for 21–74 months (median: 34.5 months, mean: 36.6 months). All were alive with normal renal function, and no tumor recurrence or metastasis was observed. Renal CAML with VTT is characterized by three imaging features: the presence of fatty components, a unique geometric growth pattern, and the absence of venous wall invasion, potentially serving as valuable indicators for differentiating CAML from ccRCC lesions.

To develop a tumor burden score (TBS)-based risk stratification system (RSS) for preoperative discrimination of lateral lymph node metastasis (LLNM) and compare it with conventional US and TBS-only models. This retrospective study included consecutive 404 adult patients diagnosed with PTC who underwent thyroid US and lateral lymph node dissection between January 2021 and October 2023. A prospective validation cohort was established with 174 patients enrolled from November 2023 to August 2024. Two novel tumor burden parameters, including D1/D2 and TBS score, were proposed. Logistic regression analyses were performed to assess associations between variables and LLNM in the training cohort. Features with p < 0.05 were incorporated into the LLNM RSS based on the Framingham risk score equation. Area under the receiver operating characteristic curve (AUC) was compared among the RSS, conventional US model, and TBS model in both cohorts. In both training and validation cohorts, the RSS showed improved performance for identifying LLNM compared with the TBS model (AUC, 0.809 vs. 0.703, p < 0.01 and AUC, 0.752 vs. 0.634, p = 0.03), and in the training cohort, the AUC of the RSS was superior compared with the conventional US model (AUC, 0.809 vs. 0.732, p < 0.01). Furthermore, we identified clustered punctate echogenic foci (PEF) distributed along the periphery of primary tumors as a robust independent predictor of LLNM (OR = 3.157, 95

Background and Objectives: In this study, we assessed the utility of ultrasonography in monitoring the chemotherapeutic effects on primary thyroid lymphoma (PTL). Materials and Methods: This retrospective analysis included 17 patients with PTL who received chemotherapy from 2012 to 2022. The sonographic features were examined pre- and post-treatment using ultrasound (US) to monitor the treatment response at the first to second, third to fourth, and end cycles of chemotherapy and follow-up, and progression-free survival (PFS) and overall survival (OS) were analyzed. Results: The sonographic findings for all the patients indicated diffuse or nodular infiltration with markedly hypoechoic masses, and “stripe-shaped” high echoes and posterior acoustic enhancement were observed. Following one to two cycles of chemotherapy, a US examination revealed varying tumor reduction degrees and diminished blood flow signals. After three to four cycles of chemotherapy, the US demonstrated an evaluation efficacy comparable to that of PET-CT in cases in which the lesion had entirely disappeared postchemotherapy; however, its ability to differentiate between treatment response and residual lesions was less effective compared to that of PET-CT. After the end cycle of chemotherapy, the lesion sizes had significantly decreased compared to those at the baseline (p < 0.05). Postchemotherapy, Adler’s blood flow grades decreased significantly, with 80% graded as 0–1. Among the 10 patients with cervical lymph node enlargement, 70% showed reduced lesion sizes and blood flow signals. The cumulative 5-year PFS and OS rates were both 80% for the diffuse type and 82.5% and 78.8% for the nodular type, respectively (p > 0.05). Conclusions: US can be utilized to monitor the therapeutic response following chemotherapy for PTL, especially for early assessment and repeated dynamic monitoring, and can serve as a complementary follow-up method to PET-CT.

This study aims to create composite carriers by combining cyclodextrin metal organic frameworks (CD-MOFs) with soybean hull polysaccharide (SHP) polymers for enhanced performance. A cubic structured composite carrier was successfully synthesized, exhibiting potential for delivering functional factors. Interaction between cyclodextrin (CD) and SHP was predominantly driven by hydrogen bonding forces, as evidenced by Fourier transform infrared spectroscope (FTIR), Raman spectroscopy. Characterization methods such as Powder X-ray diffraction (XRD), Differential scanning calorimetry (DSC), and FTIR confirmed successful encapsulation of Curcumin (Cur) within gamma-CD-MOF@SHP. At 35 degrees C, with a Cur to carrier mass ratio of 1:3, loading efficiency improved after 24 h of immersion. SHP demonstrated a protective effect on Cur, reducing release in the stomach while maximizing release in the intestine, thus enhancing Cur utilization. Additionally, gamma-CD-MOF composites were shown to stabilize functional factors and regulate their release. Overall, the combination of MOFs and polymers holds promise for functional factor delivery.

AbstractBackgroundBlood-brain barrier (BBB) dysfunction caused by endothelial cell injury is one of the widely accepted pathogenesis of small cerebral vessel disease (CSVD). However, the early microcirculation studies were notably deficient in providing compelling imaging evidence, which has hampered a comprehensive understanding of the pathophysiological processes underlying BBB dysfunction in CSVD. The onset of CSVD is insidious and the clinical manifestations are diverse, diagnosis of CSVD relies primarily on neuroimaging information currently. These MRI imaging features mainly represent the end-stage brain parenchyma injury, rather than the vascular lesion itself. Therefore, clarifying the pathophysiological processes related to cerebral microcirculation in CSVD is of great significance for early treatment intervention of CSVD.MethodsTwenty rats were used to prepare CSVD animal model by ultrasound combined with ultrasonic microbubble contrast agent. MRI, functional ultrasound (fUS) imaging and ultrasound localization microscopy (ULM) were used to evaluate microcirculation changes in acute and chronic models.ResultsCurrently, our research has successfully validated that the imaging characteristics of this model align with the four established criteria outlined in the STRIVE-2 classification. FUS shows increased microflow velocity in the molding area, which can be used for initial evaluation of CSVD models in the acute phase. ULM has revealed a progressive reduction in the density of both the short cortical arteries and the long medullary arteries, along with their respective branches, over time. Concurrently, there has been a noted deviation in blood flow velocity.ConclusionThis model offers compelling evidence at the microvascular level, suggesting that blood-brain barrier (BBB) dysfunction is a central pathophysiological mechanism in the etiology of CSVD. Then it provides a straightforward, efficient, and widely applicable tool and continuous monitoring method for the further investigation of CSVD from the macroscopic to the microscopic circulation level, with significant long-term implications for CSVD diagnosis and treatment.

Background: Blood-brain barrier (BBB) dysfunction caused by endothelial cell injury is one of the widely accepted pathogenesis of small cerebral vessel disease (CSVD). However, the early microcirculation studies were notably deficient in providing compelling imaging evidence, which has hampered a comprehensive understanding of the pathophysiological processes underlying BBB dysfunction in CSVD. The onset of CSVD is insidious and the clinical manifestations are diverse, diagnosis of CSVD relies primarily on neuroimaging information currently. These MRI imaging features mainly represent the end-stage brain parenchyma injury, rather than the vascular lesion itself. Therefore, clarifying the pathophysiological processes related to cerebral microcirculation in CSVD is of great significance for early treatment intervention of CSVD. Methods: Twenty rats were used to prepare CSVD animal model by ultrasound combined with ultrasonic microbubble contrast agent. MRI, functional ultrasound (fUS) imaging and ultrasound localization microscopy (ULM) were used to evaluate microcirculation changes in acute and chronic models. Results: Currently, our research has successfully validated that the imaging characteristics of this model align with the four established criteria outlined in the STRIVE-2 classification. FUS shows increased microflow velocity in the molding area, which can be used for initial evaluation of CSVD models in the acute phase. ULM has revealed a progressive reduction in the density of both the short cortical arteries and the long medullary arteries, along with their respective branches, over time. Concurrently, there has been a noted deviation in blood flow velocity. Conclusion: This model offers compelling evidence at the microvascular level, suggesting that blood-brain barrier (BBB) dysfunction is a central pathophysiological mechanism in the etiology of CSVD. Then it provides a straightforward, efficient, and widely applicable tool and continuous monitoring method for the further investigation of CSVD from the macroscopic to the microscopic circulation level, with significant long-term implications for CSVD diagnosis and treatment. ### Competing Interest Statement The authors have declared no competing interest.

Background: Radical surgery can achieve remarkable improvements in the survival of patients with renal cell carcinoma (RCC) and inferior vena cava tumor thrombus (IVCTT); however, not all patients can obtain the desired results. Therefore, identifying patients with poor survival after surgery is crucial for guiding follow-up adjuvant therapies and patient counseling. Objective: To evaluate the impact of primary tumor score based on tumor necrosis and tumor thrombus morphology on overall survival (OS), and create a postoperative prognostic model for patients with RCC and IVCTT. Methods: This retrospective study included 182 patients with RCC and IVCTT who underwent radical nephrectomy and thrombectomy (RNTE). Preoperative contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), ultrasound imaging, and clinical records were collected. Kaplan-Meier analysis was used to evaluate the overall survival (OS). Prognostic factors for OS were identified by univariate and multivariate analyses using the Cox proportional hazards regression model. A nomogram was developed and internally calibrated using the bootstrap resampling method. Results: The mean follow-up time was 24.1 months (1-84.5 months), and 34.1% (62 of 182) of the patients died of all causes. The primary tumor score possesses a superior prognostic value for the primary tumor compared with the level of IVCTT and tumor size. Multivariate Cox regression analysis showed that primary tumor score, distant metastasis, nonclear cell subtype, sarcomatoid degeneration, preoperative anemia grade, and ASA level were independent prognostic factors. Based on these factors, a nomogram was built; the concordance index was 0.77, and the AUC for predicting 1-3 years OS were 0.80, 0.81, and 0.78, respectively. Conclusions: Primary tumor score is a independent prognostic factors for patients with RCC and IVCTT. Combined with 5 easily acquired prognostic factors, a postoperative nomogram was developed and internally validated, and can be used to select patients who may benefit from adjuvant therapy or aggressive surveillance regimens. (c) 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Background Primary Sjögren's syndrome(pSS) is characterized as an autoimmune disorder mostly involving exocrine glands and pSS related dry eye (SSDE) contributes to a severe subtype of dry eye disease (DED). Emerging imaging tools such as lacrimal gland ultrasonography (LGUS) and in vivo confocal microscopy (IVCM) remain underutilized in diagnosing the disease. This study aims to investigate LGUS-IVCM correlations to map structural-functional relationships in SSDE patients. Methods This prospective cross-sectional study enrolled 27 SSDE patients and 12 non-pSS related dry eye (NSSDE) controls, utilizing IVCM and LGUS to assess corneal nerve morphology, immune cell activity, and glandular structural parameters. Results SSDE patients exhibited greater nerve tortuosity (p = 0.003), dendritic cell density (p < 0.001), and parenchymal echogenicity alterations (p = 0.013) versus NSSDE. For dry eye patients, subbasal nerve density inversely correlated with lacrimal gland area (r=-0.352, p < 0.05), logistic regression confirmed lacrimal gland area as an independent risk factor of nerve depletion. Meanwhile, ROC curve of dendritic cell density and activation strongly predicted SSDE with an AUC of 0.838 and 0.827. Conclusion SSDE patients suffer from more severe dry eye symptoms, while lacrimal gland changes with the disease development play a role in nerve depletion. Multimodal ophthalmic imaging reveals interconnected lacrimal gland-corneal neuroimmune dysfunction in SSDE, providing diagnostic biomarkers and treatment insights to explore in the future.

BACKGROUND:Distinguishing benign from malignant cervical lymph nodes is critical yet challenging. This study evaluates the postvascular phase of contrast-enhanced ultrasound (CEUS) and develops a user-friendly nomogram integrating demographic, conventional ultrasound, and CEUS features for accurate differentiation. METHODS:We retrospectively analyzed 395 cervical lymph nodes from 395 patients between January 2020 and December 2022. The cohort was divided into training and validation sets using stratified random sampling. A predictive model, based on demographic, ultrasound, and CEUS features, was created and internally validated. RESULTS:The training set included 280 patients (130 benign, 150 malignant nodes) and the validation set 115 patients (46 benign, 69 malignant). Relative hypoenhancement in the postvascular phase emerged as a promising indicator for MLN, with sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 96.7 %,52.3 %, 70.0 %, 93.2 %, and 76.1 %, respectively in the training set and 95.7 %, 52.2 %, 75.0 %, 88.9 %, and 74.8 % in the validation set. Age over 50 years, history of malignancy, short-axis diameter greater than 1.00 cm, focal hyperechogenicity, ill-defined borders, and centripetal perfusion were also identified as independent MLN indicators. The nomogram prediction model showed outstanding accuracy, with an area under the curve (AUC) of 0.922 (95 % CI: 0.892-0.953) in the training set and 0.914 (95 % CI: 0.864-0.963) in the validation set. CONCLUSION:Relative hypoenhancement in the postvascular phase of CEUS, combined with demographics and ultrasound features, is effective for identifying MLNs. The developed prediction model, with a user-friendly nomogram, can facilitate clinical decision-making.

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 past few decades have witnessed explosive development in drug delivery systems. However, in vivo delivery suffers from non-specific distribution in non-targeted organs or tissues, which may cause undesired side effects and even genotoxicity. Here, a general strategy that enables tuning the tropism of polymersomes for liver- and spleen-selective delivery is reported. By using a library screening approach, spleen-targeted polymersome PH9-Aln-8020 and liver-targeted polymersome PA9-ZP3-5050 are identified accordingly. Meanwhile, the second near-infrared (NIR-II) fluorescence imaging allows for in vivo dynamic evaluation of their spatial and temporal accumulation in specific tissues. O ur findings indicate that both polymer composition and protein corona on the surface are essential to determine the in vivo fate of polymersomes and tendency for specific organs. Importantly, PH9-Aln-8020 is employed as a systemic nanocarrier to co-deliver the antigen and adjuvant, which remarkably boost splenic immune responses in acute myeloid leukemia, melanoma, and melanoma lung metastasis mouse models. This study may open a new frontier for polymersomes in organ-selective delivery and other biomedical applications.

Purpose To explore modified parameters for The ACR Thyroid Imaging Reporting and Data System (TI-RADS) of contralateral nodules based on preoperative ultrasound features of suspected-lobe papillary thyroid carcinoma (PTC), to assist managing bilateral PTC. Methods 389 consecutive PTC patients (272 in training set and 117 in validation set) who underwent total thyroidectomy in our center were retrospectively analyzed from March 2020 to March 2022. According to postoperative pathological data, the patients were divided into unilateral and bilateral PTC group. The clinicopathological features and sonographic characteristics of suspected nodules were compared between the two groups and further ultrasonic characteristics of underestimated nodules were analyzed. Results Patients with BMI ≥ 25 kg/m2, multifocality in suspected-lobe, isthmus nodule with TI-RADS classification > 3 tended to have bilateral PTC (P < 0.001, P < 0.001, and P = 0.03, respectively). After modifying ACR TI-RADS classification of contralateral nodules using the above three parameters, AUC for diagnosing contralateral lesions increased from 0.79 (95%CI: 0.74–0.84) to 0.83 (0.78–0.87) in training set. Missed-diagnosis rate of contralateral PTCs were both decreased in training set [21.1% (28/133) to 4.5% (6/133)] and validation set [11.4% (8/70) to 2.9% (2/70)]. In addition, the presence of cystic components and halo sign in contralateral nodules tend to be underestimated by ultrasound preoperatively, with underestimation rates of 100% (6/6) and 73.3% (11/15), respectively. Conclusion The modified ACR TI-RADS classification based on suspected-lobe may be an effective method for preoperative malignant risk stratification of contralateral nodules in patients with bilateral PTCs, which can avoid inadequate surgical extent.

目的 观察清咽利膈汤或解毒利咽方联合抗生素治疗急性扁桃体炎肺胃热盛证患儿的临床疗效.方法 纳入2020年11月—2021年11月在上海中医药大学附属龙华医院治疗的急性扁桃体炎肺胃热盛证患儿90例,采用双盲、随机对照方法将患儿分为对照组、治疗1组、治疗2组,每组30例.3组均给予抗生素治疗(首选阿莫西林,青霉素过敏者改用阿奇霉素),在此基础上对照组给予中药安慰剂颗粒口服,治疗1组给予清咽利膈汤颗粒口服,治疗2组给予解毒利咽方颗粒口服,3组疗程均为5 d.观察3组退热时间及治疗前后中医症状积分、外周血白细胞计数、中性粒细胞百分比、C反应蛋白水平和临床疗效、中医证候疗效.结果 治疗2组退热时间明显快于治疗1组和对照组(P均<0.05),治疗1组明显快于对照组(P<0.05).3组主症和次症积分均随治疗时间延长逐渐降低(对照组大便干积分无明显变化),且治疗1组和治疗2组治疗1,3,5 d后各项积分均明显低于对照组(P均<0.05);治疗2组治疗3 d后咽痛、咽黏膜充血、扁桃体肿大积分和治疗5 d后扁桃体肿大积分均明显低于同期治疗1组(P均<0.05),治疗1组治疗3 d后分泌物渗出积分和治疗5 d后咳嗽、大便干积分均明显低于同期治疗2组(P均<0.05).治疗5 d后,3组外周血白细胞计数、中性粒细胞百分比、C反应蛋白水平比较差异均无统计学意义(P均>0.05);对照组、治疗1组、治疗2组的临床总有效率分别为73.3％(22/30)、93.3％(28/30)和96.7％(29/30),中医证候总有效率分别为73.3％(22/30)、96.7％(29/30)和96.7％(29/30),治疗1组和治疗2组均明显高于对照组(P均<0.05),治疗1组和治疗2组比较差异均无统计学意义(P均>0.05).结论 清咽利膈汤与解毒利咽方治疗儿童急性扁桃体炎肺胃热盛证可有效改善患儿临床症状,疗效显著优于单纯使用抗生素.

The use of technology and international law in marine policy is becoming increasingly vital as we seek to address the challenges facing our oceans. Technology has revolutionized our ability to monitor, understand, and manage marine ecosystems, providing valuable tools for data collection, analysis, and decision-making. International law, ocean governance ensuring marine environment represented by the frameworks such as the United Nations Convention on the Law of the Sea (UNCLOS), plays a crucial role in governing the use of technology and establishing guidelines for the sustainable management of marine resources. This paper explores the intersection of technology and international law in marine policy, highlighting the transformative impact of technology on our understanding of the oceans and the legal frameworks that shape our approach to marine conservation. It examines the benefits of technology in enabling evidence-based decision-making and fostering international collaboration, while also addressing the legal and regulatory complexities that arise. The paper emphasizes the need for ongoing dialogue and the development of international legal frameworks to adapt to emerging technologies and discourse ethical considerations, and by harnessing the power of technology and international law, we can work towards effective marine policies that ensure the conservation and sustainable use of our oceans for future generations.

The aim of this study was to develop an efficient cell-free protein expression system derived from mammalian cells. We established a HeLa cell-based in vitro coupled transcription/translation system with T7 RNA polymerase and a plasmid that harbored a T7 promoter/terminator unit. To enhance protein synthesis in the coupled system, we placed the encephalomyocarditis virus (EMCV) internal ribosome entry site (IRES) or the hepatitis C virus (HCV) IRES between the T7 promoter and the coding region of the plasmid. Remarkably, we found that these IRES-dependent systems were able to produce large proteins including GCN2 (160kD), Dicer (200kD) and mTOR (260kD) to levels detectable on SDS–PAGE by Comassie Brilliant Blue-staining. We purified the synthesized proteins to near homogeneity, and validated their functionalities in the appropriate biochemical assays. In conclusion, the HeLa cell-based in vitro coupled transcription/translation system using the EMCV or HCV IRES is a convenient tool, particularly for the production of large recombinant proteins.