To assess whether age independently predicts renal function in Takayasu arteritis (TA) patients with abdominal aortic involvemen. This retrospective study included 149 TA patients. Renal function was assessed by estimated glomerular filtration rate (eGFR). Vascular features (severe RAS, aortic plaques) were evaluated via integrated ultrasound and CT angiography. Univariate and multivariate regression analyses identified determinants of eGFR and clinical renal impairment (eGFR < 90 mL/min/1.73m²). Mean age was 33.85 years. Age showed the strongest inverse correlation with eGFR (r = -0.538, p < 0.001). In multivariate analysis, age remained the most robust independent predictor of lower eGFR (standardized β = -0.500, p < 0.001), exceeding the effect of severe RAS (β = -0.143, p = 0.043). The association of aortic plaques with eGFR lost significance after age adjustment. Logistic regression confirmed age as an independent risk factor for renal impairment (adjusted OR = 1.078 per year, 95% CI: 1.036–1.122, p < 0.001). In TA, chronological age is the strongest independent predictor of renal function, surpassing severe RAS. These findings highlight the necessity of incorporating an age-aware perspective into the clinical assessment of renal health in TA, particularly given its typical onset in young adulthood.

Competency-based training in clinical ultrasonography requires a clear understanding of skill acquisition trajectories. However, objective data on how residents actually learn in real-time clinical environments remain scarce. This study aims to map the learning pathway of ultrasound residents by analyzing real-time consultation patterns and introducing a novel metric—the skill acquisition half-life—to quantify the rate of skill mastery. We conducted a single-center retrospective observational study in a high-volume outpatient ultrasound department. Over an eight-week period, real-time consultation requests initiated by 45 residents across three postgraduate years (PGY-1 to PGY-3) were logged. Consultations were categorized by examination type (Standard vs. Advanced assignments). Adjusted consultation rates were calculated per clinical session. A negative exponential learning curve model was fitted to derive the skill acquisition half-life (T₁/₂), defined as the time required for the consultation rate to decrease by half. A total of 529 consultations were recorded, with PGY-1 residents accounting for 88.5

This study evaluates the performance of subharmonic-aided pressure estimation (SHAPE) with ultrasound contrast agents using data obtained from calibration procedures. A commercial scanner of ultrasonography (GE Healthcare Logiq E20, Wuxi, China) was used to perform SHAPE on a flowing contrast agent (Sonazoid) in a phantom setup under controlled microbubble stability and flow velocity conditions. Subharmonic time-intensity curves were collected during the SHAPE calibration procedure for analysis. Subharmonic amplitude of diluted contrast agents exhibited a time-dependent decline but was not affected by velocity. SHAPE sensitivity was measured through reciprocal pressurizing and depressurizing sequences to mitigate the effect of subharmonic decline over time. A wide range of mechanical index (MI) levels within the steady growth phase of the calibration curve showed higher SHAPE sensitivity compared to the traditionally recommended “optimal” MI at the maximum slope. The approximate maximum SHAPE sensitivity was −0.04 dB/mm Hg. Subharmonic amplitude was linearly correlated with pressure at a range of MI levels (R2 > 0.9, p < 0.05) but showed significant variations (approximately 2 dB standard deviation) in the time series. The lowered sensitivity compared to previous reports, combined with the substantial variation in subharmonic amplitude, raises concerns about the accuracy and consistency of SHAPE in clinical applications.

Background: Subharmonic aided pressure estimation (SHAPE) is an innovative non-invasive technique that leverages ultrasound subharmonic imaging to estimate pressure. This method exploits the "negative correlation between subharmonic amplitude and ambient pressure" observed in experimental settings. Despite extensive experimental validation and some promising results in clinical studies, the underlying mechanism of SHAPE remains incompletely understood. Although some studies have attempted to provide theoretical explanations, definitive conclusions have yet to be reached. In addition, theoretical investigations have mainly focused on the steady oscillation of bubbles under long pulse excitation, which contrasts with the short pulse excitation required for clinical SHAPE applications. An understanding of the SHAPE principle under short pulse excitation is needed. Methods: The exponential elasticity model (EEM) was used to simulate Sonazoid bubbles, and a probe-to-probe acoustic propagation model was introduced to mimic a practical SHAPE scenario. The simulated acoustic signals in response to three-cycle sinusoidal pulse excitations were analyzed for spectral composition. The relationship between microbubble oscillation patterns and subharmonic characteristics was identified through detailed investigation. Results: For the excitation pulse of 2.5 MHz frequency and 350 kPa magnitude, bubbles larger than the resonance radius (2.29 mu m) exhibited significant subharmonics in the magnitude spectrum, while bubbles smaller than the subharmonic resonance radius (3.85 mu m) showed the activity of scattering subharmonic energy and the sensitivity to ambient pressure. The emergence of subharmonics when increasing excitation power was related to the increasing amplification of the bubble self-oscillation and the period-doubling features in the acoustically forced oscillation. The negative correlation between subharmonic amplitude and ambient pressure was attributed to the reduced self-oscillation caused by increasing ambient pressure and hence bubble size reduction. Microbubbles falling between 2 and 3 mu m showed the desired subharmonic sensitivity to ambient pressure under the specified excitation conditions. Conclusion: The transient oscillatory behavior of microbubbles in response to short pulse excitation, characterized by a ringing down self-oscillation after the acoustic forcing effect has ceased, is crucial for understanding the subharmonic emergence and the observed negative correlation between subharmonic amplitude and ambient pressure. The proposed concepts of subharmonic resonance radius, subharmonic-significant bubbles, and subharmonic-active bubbles provide valuable insights into the diverse subharmonic behavior of microbubbles. The theoretical explanation of this negative correlation highlights the importance of using subharmonicsignificant-and-active bubbles for SHAPE applications.

Takayasu's arteritis (TAK) is a chronic inflammatory disease that often leads to stenosis or occlusion of the common carotid artery (CCA), posing significant risks such as stroke and cognitive impairment. Despite the widespread use of ultrasound in diagnosing and monitoring TAK, the lack of standardized criteria for assessing CCA stenosis has resulted in inconsistent evaluations. This study aims to establish standardized ultrasound diagnostic criteria for CCA stenosis in TAK, focusing on residual inner diameter and wall thickness. A total of 68 TAK patients with 120 CCAs and 120 healthy CCAs controls were included. Ultrasound examinations were performed using the iU22 Philips Healthcare system, with measurements of arterial wall thickness, inner and outer diameters, and carotid blood flow velocity. Head and neck computed tomography angiography (CTA) served as the gold standard for stenosis assessment. Statistical analyses were conducted to evaluate the diagnostic performance of various ultrasound parameters. The study found that the residual inner diameter was the most reliable parameter for assessing CCA stenosis, with high diagnostic accuracy across all stenosis categories (ROC values of 0.901 for ≥ 50

This study investigated the therapeutic mechanism of Baojing Tablets(BJT) in the treatment of chronic prostatitis through the signal transducer and activator of transcription 3(STAT3)/hypoxia-inducible factor 1α(HIF-1α)/glycolysis axis. A rat model of experimental autoimmune prostatitis was established to evaluate the efficacy of Baojing Tablets. Male Wistar rats were randomly divided into six groups(7 per group): control group, model group, low-, medium-, and high-dose Baojing Tablets groups(197.2, 591.5, 1 774.4 mg·kg~(-1), respectively), and a positive control group(Pusitai, 34.2 mg·kg~(-1)). After model induction, all treatments were administered continuously for four weeks. Hematoxylin and eosin(HE) staining was used to observe inflammatory infiltration and glandular damage in the prostate. Serum levels of interleukin-8(IL-8), interleukin-1β(IL-1β), and immunoglobulin G(IgG) were measured by enzyme-linked immunosorbent assay(ELISA). The expression levels of phosphorylated STAT3(p-STAT3), HIF-1α, multiple inositol polyphosphate phosphatase 1(MINPP1), and hexokinase(HK) in prostate tissues were detected by Western blot and immunohistochemistry. Untargeted metabolomics was employed to screen differential metabolites and analyze relevant metabolic pathways, thereby investigating the potential mechanism of Baojing Tablets in treating chronic prostatitis. HE staining results revealed that Baojing Tablets significantly ameliorated pathological damage to the prostate. ELISA results demonstrated that Baojing Tablets reduced serum levels of IL-8, IL-1β, and IgG. Western blot and immunohistochemistry analyses revealed that Baojing Tablets downregulated the expression levels of p-STAT3, HK, and HIF-1α in prostate tissues, while upregulating MINPP1 expression. Metabolomics results suggested that Baojing Tablets may exert its therapeutic effect by modulating 96 differential metabolites and participating in metabolic pathways such as glycolysis and arachidonic acid metabolism. In conclusion, Baojing Tablets may alleviate inflammation and inhibit the progression of chronic prostatitis by targeting STAT3 and suppressing the HIF-1 signaling pathway, thereby modulating glycolytic metabolism.

Transient perivascular inflammation of the carotid artery (TIPIC) syndrome is a relatively rare disease, and ultrasound is the first screening method for initial diagnosis of the disease. Contrast-enhanced ultrasound (CEUS) has unique advantages in the follow-up of patients with TIPIC syndrome. This paper reports a patient with TIPIC syndrome who was treated with acute left neck pain. The inflammation was significantly relieved and subsided after treatment with non-steroidal anti-inflammatory drugs. The ultrasound changes of carotid artery lesions in this patient during follow-up were analyzed, and the application value of CEUS in the follow-up diagnosis of this disease was summarized, in the hope of providing clinical reference.

OBJECTIVES:Study the efficacy and safety of mycophenolate mofetil (MMF) combined with methotrexate (MTX) compared to cyclophosphamide (CYC) followed by azathioprine (AZA) to treat active Takayasu arteritis (TAK). METHODS:Adults with active TAK were randomised in a 2:1 ratio to receive oral MMF plus MTX or intravenous CYC followed by oral AZA. All subjects also received high-dose oral glucocorticoids with a predefined taper. The primary endpoint was overall response rate at week 52, defined as achieving a complete response (CR) or partial response (PR). Secondary endpoints included rates of CR and PR at weeks 28 and 52. RESULTS:A total of 111 patients with TAK were enrolled: 74 in the MMF+MTX group and 37 in the CYC/AZA group, with comparable baseline demographic and clinical features. The overall response rates at 28 and 52 weeks were 58.1% and 55.4% in the MMF+MTX group, respectively, higher than 32.4% at both time points in the CYC/AZA group (P = .011 and .022). CR and PR rates at 28 and 52 weeks were also higher in the MMF+MTX group. Relapse occurred in 4 patients in the MMF+MTX group and 2 in the CYC/AZA group. One serious adverse event, neutropenia with fever, occurred in 1 patient in the CYC/AZA group. CONCLUSIONS:Treatment of active TAK with MMF+MTX has more favourable efficacy compared to CYC/AZA. These findings provide evidence to use the combination of MTX and MMF, 2 generally well-tolerated and inexpensive therapies, to treat TAK.

This study examines the reliability of subharmonic-aided pressure estimation (SHAPE) using polydisperse microbubbles. SHAPE utilizes the subharmonic response of ultrasound contrast agent microbubbles to estimate pressure non-invasively. Despite its potential, gaps in theoretical understanding and experimental inconsistencies with polydisperse microbubbles necessitate further investigation. This research explores the impact of microbubble distribution, excitation parameters, and contrast-enhanced ultrasound imaging modes on SHAPE's signal consistency, measurement linearity, and sensitivity. A one-dimensional microbubble population model was developed to simulate microbubble behavior and the Hilbert transform demodulation technique was applied for subharmonic analyses. Variability in SHAPE was further assessed through flow phantom experiments using Sonazoid agents and a commercial SHAPE scanner. Findings indicate that bubble distribution in both size and location, microbubble interactions, and CEUS imaging modes significantly influence subharmonic responses. An excitation frequency of 3.5 MHz is recommended for robust SHAPE. Monte Carlo simulations confirmed the inherent variability of subharmonic amplitude signals due to dynamic bubble distributions. Using monodisperse microbubbles enhanced SHAPE sensitivity and consistency, without markedly reducing signal variability. These results underscore the necessity of further research to optimize SHAPE for clinical applications, focusing on microbubble characteristics and excitation conditions to enhance consistency and reliability.

To explore the value of microflow patterns based on superb microvascular imaging (SMI) combined with greyscale ultrasound in thyroid nodule diagnosis and biopsy recommendation. Adult patients with thyroid nodules were recruited from May 2023 to February 2024. The greyscale features of nodules were evaluated according to the five ultrasound risk stratification systems (RSSs). The microflow patterns on SMI were used to adjust the category of nodules. The crab claw-like and the root hair-like patterns were malignant signs for upgrading, with the wheel-like and the arborescent patterns for downgrading. The diagnostic performance and biopsy recommendation of microflow patterns combined with greyscale ultrasound were analyzed. A total of 253 nodules (136 malignant, 117 benign) in 203 patients were included. Chinese Thyroid Imaging Reporting and Data System (C-TIRADS) owned the best diagnostic sensitivity and the largest AUC, with no significant improvement for the former (0.853 vs 0.904, p = 0.096) but an evident increase for the latter (0.834 vs 0.900, p < 0.001) when combined with SMI. American College of Radiology (ACR) TI-RADS had the highest specificity, which was further enhanced by SMI (0.803 vs 0.855, p = 0.041). The unnecessary biopsy rates of RSSs were reduced by 1.27–20.30

This study aims to reveal the correlation between the pharmacokinetics(PK) and pharmacodynamics(PD) of multiple components in Epimedii Folium-Chuanxiong Rhizoma and clarify the pharmacodynamic material basis and mechanism of this herb pair in treating osteoarthritis. The Hulth method was used to establish the rat model of osteoarthritis and plasma was collected at various time points after drug administration. The plasma concentrations of multiple components were measured. Enzyme-linked immunosorbent assay(ELISA) was used to measure the plasma concentrations of matrix metalloproteinase(MMP)-3, MMP-13, interleukin-1β(IL-1β), nitric oxide(NO), and tumor necrosis factor-α(TNF-α) as pharmacodynamic indicators. Self-defined weighting coefficients were used to calculate the PK and PD data, and a Sigmoid E_(max) fitting model was used to evaluate the synergistic effect of the compatibility of Epimedii Folium-Chuanxiong Rhizoma. The PK-PD models for Epimedii Folium, Chuanxiong Rhizoma, and Epimedii Folium-Chuanxiong Rhizoma were E=(1.926×C~(2.652))/(0.136 6~(2.652)+C~(2.652)), E=(1.618×C~(345.2))/(0.118 4~(345.2)+C~(345.2)), and E=(2.305×C~(2.786))/(0.240 3~(2.786)+C~(2.786)), respectively. The E_(max) of Epimedii Folium-Chuanxiong Rhizoma was larger than those of the two herbal medicines alone. The EC_(50) of the herb pair was lower than the sum of Epimedii Folium and Chuanxiong Rhizoma alone. The concentrations of MMP-3, MMP-13, IL-1β, NO, and TNF-α were correlated with mass concentrations of multiple components in Epimedii Folium and Chuanxiong Rhizoma, and the compatibility was better than single use. Epimedii Folium, Chuanxiong Rhizoma, and Epimedii Folium-Chuanxiong Rhizoma may play a role in the treatment of osteoarthritis by inhibiting MMP-3, MMP-13, IL-1β, NO, and TNF-α.

Venous ultrasound is the primary, widely accepted diagnostic tool to assess deep vein thrombosis (DVT) in the lower extremities. However, other focal lesions in the lower extremities can be identified on ultrasound. The sonographic appearance of these abnormalities may overlap the thrombosis, which included vascular tumors, Baker's cyst, hematoma, cancer thrombosis, and peripheral nerve tumors. This essay derives from cases diagnosed in our centers and published literature, with images available for illustrations, which may help to improve the clinical management of these findings.

Objective: This study aimed to investigate the impact of microbubble degradation and flow velocity on Sub-Harmonic Aided Pressure Estimation (SHAPE), and to explore the correlation between subharmonic amplitude and pressure as a single factor. Methods: We develop an open-loop vascular phantom platform system and utilize a commercial ultrasound machine and microbubbles for subharmonic imaging. Subharmonic amplitude was measured continuously at constant pressure and flow velocity to assess the impact of microbubble degradation. Flow velocity was varied within a range of 4-14 cm/s at constant pressure to investigate its relationship to subharmonic amplitude. Furthermore, pressure was varied within a range of 10-110 mm Hg at constant flow velocity to assess its isolated effect on subharmonic amplitude. Results: Under constant pressure and flow velocity, subharmonic amplitude exhibited a continuous decrease at an average rate of 0.221 dB/min, signifying ongoing microbubble degradation during the experimental procedures. Subharmonic amplitude demonstrated a positive correlation with flow velocity, with a variation ratio of 0.423 dB/(cm/s). Under controlled conditions of microbubble degradation and flow velocity, a strong negative linear correlation was observed between pressure and subharmonic amplitude across different Mechanical Index (MI) settings (all R-2 > 0.90). The sensitivity of SHAPE was determined to be 0.025 dB/mmHg at an MI of 0.04. Conclusion: The assessment of SHAPE sensitivity is affected by microbubble degradation and flow velocity. Excluding the aforementioned influencing factors, a strong linear negative correlation between pressure and subharmonic amplitude was still evident, albeit with a sensitivity coefficient lower than previously reported values.

Intravenous leiomyomatosis (IVL) is a rare gynecological-related tumor. It can invade and extend in the blood vessel and eventually involve the cardiac cavity or even the pulmonary artery. IVL generally does not adhere to the vein wall and infrequently leads to the manifestation of Budd-Chiari syndrome (BCS). In this case report, the presence of a sizable tumor obstructed the second hepatic portal, impeding the return flow of the hepatic veins, thereby precipitating the development of BCS. The presence of collateral veins and dilation of the accessory hepatic vein were identified through computed tomography venography and ultrasonography, thus supporting the diagnosis of BCS. The patient underwent a comprehensive surgical resection and was found to have a favorable prognosis.

OBJECTIVE:Tumor necrosis factor (TNF) alpha and interleukin-17 (IL-17) are thought to be involved in the pathogenesis of Takayasu arteritis (TAK), and TNF inhibitors (TNFi) are recommended for the treatment of TAK. The present study was undertaken to investigate the efficacy of secukinumab, an IL-17A monoclonal antibody, compared to treatment with TNFi.METHODS:This was a prospective, single-center, open-label cohort study. Patients with active TAK who did not respond to treatment with glucocorticoids combined with 2 immunosuppressive agents were treated with either secukinumab or TNFi as an add-on therapy without an increased dosage of glucocorticoids. A complete response was defined as complete resolution of signs and symptoms of active disease, normal values of inflammatory markers, no progression on imaging of involved arteries, and dose of glucocorticoid <15 mg/day. A partial response was similarly defined as a complete response except with an erythrocyte sedimentation rate <40 mm/hour and C-reactive protein level of <20 mg/liter.RESULTS:Nineteen patients in the secukinumab group and 34 patients in the TNFi group were enrolled. The demographic data and inflammatory markers of the 2 groups were comparable at baseline. Complete response and partial response for patients treated with secukinumab and TNFi were 31.6% and 58.8% (P = 0.057), respectively, at 3 months and 52.6% and 64.7%, respectively, at 6 months (P = 0.389).CONCLUSION:Our findings suggest that secukinumab and TNFi are effective for patients with TAK who do not respond to oral glucocorticoids and conventional immunosuppressive agents, with similar response rates at 3 and 6 months.

扩张型心肌病是引起心力衰竭、心律失常和猝死的常见疾病之一,扩张型心肌病的防治是抑制基础病因介导的心肌损害,有效控制心力衰竭和心律失常,预防猝死和栓塞,提高病人生活质量及生存率.王亚红教授临床治疗扩张型心肌病疗效显著,王亚红教授继承郭维琴教授益气泻肺汤基础上重视脾脏在治疗扩张型心肌病的作用,脾主身之肌肉,心肌亦为脾主,在益气泻肺汤基础上合四君子汤,可改善病人症状,提高生活质量和满意度.

You-Gui-Wan is a widely used traditional Chinese medicine preparation for the treatment of osteoporosis with kidney-yang deficiency, and is composed of both yang-invigorating and kidney-tonifying herbs, and yin-nourishing and kidney essence-replenishing herbs. Considering that the pharmacokinetics of drugs might differ in different pathological conditions, it is necessary to study the pharmacokinetic characteristics of You-Gui-Wan under different osteoporotic conditions. In this study, the pharmacokinetic behaviors of You-Gui-Wan in osteoporosis rats with kidney-yin and kidney-yang deficiency were compared. The results showed that the absorption, metabolism, and disposition of You-Gui-Wan varied widely in animals with different types of osteoporosis. The active components belonging to the yang-invigorating herbs, such as aconitine, hypaconitine, mesaconitine, benzoylaconine, benzoylhypacoitine, benzoylmesaconine, chlorogenic acid and pinoresinol diglucoside, had a higher uptake and slower elimination in osteoporosis rats with kidney-yang deficiency, which corresponds to the opinion that You-Gui-Wan is used to treat kidney-yang deficiency syndrome, and indicates the scientific nature of Bian-Zheng-Lun-Zhi.

目的 观察加味黑布膏对Wistar大鼠耳廓复合痤疮模型皮损程度及外周血清白细胞介素-1α(IL-1α)、白细胞介素-4(IL-4)水平的影响.方法 将62只雌雄各半的Wistar大鼠随机分为空白组、模型组及4个药物组(选取2只大鼠判断耳廓复合痤疮模型形成),空白组、模型组不使用药物干预,其余四组予相应药物涂抹,其中阳性对照组外用维A酸乳膏,加味黑布膏低、中、高剂量组外用不等剂量的加味黑布膏.4周后肉眼观察各组鼠耳皮损程度;比较各组大鼠血清IL-1α、IL-4水平.结果 涂药4周后,与模型组比较,药物组鼠耳皮损均有不同程度地改善,其中阳性对照组、高剂量组皮损症状基本消退.阳性对照组、加味黑布膏各剂量组的IL-1α、IL-4水平显著低于模型组(P<0.05);高剂量组的IL-1α、IL-4水平显著低于中、低剂量组(P<0.05).结论 加味黑布膏可明显改善Wistar大鼠耳廓复合痤疮模型处皮损症状,可能与降低外周血清IL-1α、IL-4水平有关.

Objective:Intravenous leiomyomatosis (IVL) is a rare and aggressive tumor type that has the potential to extend into the inferior vena cava (IVC) and is susceptible to be misdiagnosed and neglected. Despite its clinical significance, there is a paucity of research that has focused on the specific manifestations of IVL on ultrasonography. Therefore, this study aims to systematically analyze the specific ultrasound features of IVL and augment its diagnostic accuracy. Materials and method:Prospective inclusion was granted to patients admitted to our hospital between December 2016 and March 2021 for an IVC-occupying lesion. Multi-modal ultrasonography, encompassing gray-scale and color Doppler, was conducted. Lesions were categorized as IVL or non-IVL based on pathological or follow-up data. Two ultrasound sonographers with over 5 years of experience read and recorded ultrasound data for all lesions, which were subsequently comparatively analyzed to identify specific signs of IVL. Results:A total of 284 patients diagnosed with IVC-occupying lesions were included in the study. The lesion types comprised of IVL (n=67, 23.6%), IVC thrombus (n=135, 47.5%), tumor thrombus of renal carcinoma involving the IVC (n=35, 12.4%), tumor thrombus of liver carcinoma involving the IVC (n=24, 8.5%), leiomyosarcoma of the IVC (n=14, 4.9%), and tumor thrombus of adrenocortical adenocarcinoma (n=9, 4.1%). The presence of "sieve hole" and "multi-track" signs was observed in 20 IVL lesions under the grey-scale modality, while both signs were absent in the non-IVL group (P<0.01). The study found no statistically significant differences in the presentation of "sieve hole" and "multi-track" signs under the grey-scale and color Doppler modalities in cases of intravascular lithotripsy (IVL) (P>0.05). Using these two signs as diagnostic criteria for IVL, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), miss rate, misdiagnosis rate, and accuracy were determined to be 29.9%, 100%, 100%, 82.2%, 70.1%, 0, and 83.5%, respectively (AUC ROC=0.649; 95%CI: 0.537-0.761). Conclusion:IVL exhibits distinct ultrasound presentations, including "sieve hole" and "multi-track" signs, which demonstrate high specificity and accuracy as diagnostic indicators. Furthermore, these signs are corroborated by pathological evidence and effectively distinguish IVL from other lesions occupying the IVC.