Ultrasound-guided local ablation therapy for liver tumors has extensive clinical application because of its minimal invasiveness, proven effectiveness, low complication rates, and suitability for repeat treatments. Ultrasound-guided interventional therapy has continuously evolved in terms of the following: technological advancements, from the initial utilization of percutaneous ethanol injection to thermal ablation therapies exemplified by radiofrequency ablation and microwave ablation and presently advancing toward emerging techniques such as irreversible electroporation; imaging methods, from conventional ultrasound guidance to contrast-enhanced ultrasound and fusion imaging for precise guidance and assessment; supplementary strategies, from monotherapy to auxiliary method and synergistic therapy; and innovative treatment concepts, from early-stage small hepatocellular carcinoma to intermediate and even large liver cancers. The development of ultrasound-guided local ablation of liver cancers has progressed from an initial phase of rapid advancement to a mature stage characterized by further enhancements. This article provides a comprehensive overview of the status of technical equipment, treatment processes, efficacy, complications, and challenges encountered in ultrasound-guided local ablation for liver tumors, with the objective of offering valuable insights for interventional ultrasound physicians.

Objective:To establish a prediction method of diopter based on sequence of ocular biological parameters.Methods:A stratified random cluster sampling method was used to extract the dataset. The dataset consisted of data collected from January 2022 to January 2023 by the Eye & ENT Hospital, Fudan University, from children aged 5 to 13 years in 2 key schools and 2 general schools of Yangpu District, Shanghai. Children’s ocular biological parameters, including sex, age, diopter, axial length, corneal curvature, and anterior chamber depth were collected. The slope of the optimally fitted straight line was calculated using the least squares method. The least square-back propagation (BP) neural network model was established by combining baseline data and the pre-processed rate of the change of ocular biological parameters. The dataset was divided into the training set and the validation set according to the ratio of 8:2 for five-fold cross-validation. The model performance was evaluated by using the mean absolute error (MAE), mean squared error (MSE), root mean square error (RMSE), correlation coefficient R, and coefficient of determination R2. Results:The optimal performances of R2, R, RMSE, MAE, and MSE of the least square-BP neural network model were 0.96, 0.981 9, 0.214 2, 0.139 9 D, 0.045 9, respectively. The regression equation between the predicted value and the true value of the diopter was y=0.97 x+ 0.014 8, R2=0.97, with good correlation. In the internal verification, MAE values of the diopter at three, six, nine, and twelve months of follow-up were 0.110 1, 0.136 0, 0.153 7, and 0.184 8 D, respectively, which achieved clinically acceptable performance (less than 0.25 D). In the external validation, the errors were less than 0.25 D at all ages. Conclusions:A prediction method of diopter based on sequence of ocular biological parameters was successfully developed.

  Objective  To understand the current status of surgical treatment for hemophilia osteoarthropathy (HO) in China.  Methods  Using an online questionnaire, select domestic hospitals that partici-pated in the compilation of the 'Guideline for perioperative management of hemophilia patients undergoing orthopaedic surgery in China ', in addition to members of the National Joint Surgery Group, and the Orthopedic Branch of the Chinese Medical Association for targeted investigation and analysis.  Results  A total of 17 domestic hospitals were included, all of which were general hospitals. Hospitals that started HO surgery treatment before 2000 accounted for 35.29%. A total of 3057 surgical cases of HO were reported by those hospitals. The most commonly performed surgical procedures were hip and knee joint replacement. The most commonly used coagulation factor replacement regimen was recombinant coagulation factor preparation. Ten hospitals reported finding patients with transfusion-related infectious diseases. Bleeding and hematoma formation were the most frequently reported surgical complications. Excessive length of hospital stay and high economic costs were the most frequently reported problems.  Conclusions  Surgical treatment for HO in 17 hospitals is mainly carried out in some large comprehensive medical centers in the eastern region. Compared with the patient base, the popularity and number of surgeries are still relatively insufficient. It is necessary to further standardize the treatment system by standardizing factor replacement and strengthening rehabilitation to improve surgical treatment outcomes.

Objective:To analyze the characteristics of laboratory test results and multimorbidities in elderly patients with rheumatoid arthritis(RA)and thus to provide a basis for the treatment of RA in the elderly.Methods:Retrospective analysis was performed on RA patients admitted to the Second Affiliated Hospital of Nanjing Medical University from March 2018 to December 2020.Patients were divided into an elderly RA(ERA)group(≥60 years)and a non-elderly RA(NERA)group(<60 years).The prevalences of multimorbidities and laboratory results were compared between the two groups, and influencing factors of multimorbidities in ERA patients were analyzed by using binary Logistic regression.Results:There were 215 patients in this cohort, of whom 156 patients were in the ERA group and 59 patients were in the NERA group.The prevalences of comorbid hypertension, diabetes mellitus, coronary heart disease(CHD)and interstitial lung disease in the ERA group were higher than those in the NERA group( χ2=19.890, 6.977, 5.964, 7.484, all P<0.05).The disease duration in the ERA group was longer than that in the NERA group[117.5(36.0, 240.0)months vs.72.0(10.5, 123.5)months, Z=3.142, P=0.002], and the levels of serum C-reactive protein(CRP), erythrocyte sedimentation rate(ESR), urea, creatinine and cystatin C were higher than those in NERA group[9.7(3.2, 24.8)mg/L vs.3.1(3.0, 8.3)mg/L, 31.0(13.0, 53.3)mm/h vs.17.0(11.0, 31.5)mm/h, (5.38±1.54)mmol/L vs.(4.75±1.46)mmol/L, (63.82±15.33)μmol/L vs.(57.31±11.38)μmol/L, (1.23±0.42)mg/L vs.(0.90±0.23)mg/L]( Z=4.275, 2.770, t=2.714, 2.966, 5.714, all P<0.05).The levels of serum magnesium, albumin and hemoglobin were lower than those in the NERA group[(0.84±0.08)mmol/L vs.(0.86±0.06)mmol/L, (37.46±5.32)g/L vs.(40.77±4.95)g/L, (114.52±18.06)g/L vs.(124.32±16.40)g/L]( t=2.653, 4.147, 3.648, all P<0.05).Correlation analysis showed that the level of serum CRP in the ERA group was negatively correlated with serum albumin and magnesium( r=-0.449, -0.329, all P<0.05).Uric acid was positively correlated with rheumatoid factor(RF), cystatin C, urea, age and disease duration( r=0.259, 0.416, 0.210, 0.232, 0.179, all P<0.05), but negatively correlated with hemoglobin and magnesium( r=-0.262, -0.207, all P<0.05).RF was positively correlated with uric acid, urea, total cholesterol, low density lipoprotein, the 28-joint Disease Activity Score(DAS28 score), age and disease duration( r=0.259, 0.177, 0.205, 0.234, 0.248, 0.225, 0.211, all P<0.05), but negatively correlated with albumin and hemoglobin( r=-0.301, -0.182, all P<0.05).Serum magnesium was negatively correlated with CRP, ESR, urea, uric acid and cystatin C( r=-0.273, -0.192, -0.175, -0.207, -0.315, all P<0.05).These correlations were not found in the NERA group.Multivariate Logistic regression analysis showed that factors affecting hypertension in ERA patients were age, RF and albumin.Influencing factors of CHD were age, disease duration, serum magnesium and triglycerides.Factors that affect interstitial lung disease were RF, DAS28 score and albumin. Conclusions:Compared with NERA patients, ERA patients show an elevated level of systemic inflammation and poorer nutrition assessed by relevant parameters.CRP, RF and uric acid have complex correlations with serum magnesium, hemoglobin, and albumin.ERA patients have higher prevalences of multimorbidities.Age, disease duration, RF, triglycerides, DAS28 score, serum magnesium and albumin affect the occurrence of multimorbidities in ERA patients.

Objective:To explore the inconsistent and consistent classifications for lesions ≤2 cm by contrast-enhanced ultrasound(CEUS) Liver Imaging Reporting and Data System(LI-RADS) v2017 and contrast-enhanced computed tomography/contrast-enhanced magnetic resonance imaging(CECT/MRI) LI-RADS v2018.Methods:The focal liver lesions ≤2 cm underwent CEUS and CECT/MRI within 1 month were enrolled in this retrospective study.Each nodule was categorized according to the CEUS LI-RADS v2017 and CECT/MRI LI-RADS v2018. Intermodality agreement between the CEUS LI-RADS and CECT/MRI LI-RADS for each lesion was assessed with Cohen′s Kappa. Lesions with inconsistent classification for CEUS LI-RADS and CECT/MRI were analyzed.Results:A total of 145 lesions with a size of (1.65±0.33)cm in 145 patients were included. The numbers of lesions in LR-3, 4, 5 and M were 16, 23, 90 and 16 on CEUS LI-RADS, 25, 31, 87 and 2 on CECT/MRI, respectively. And 73.1% lesions were classified as LR-5 or M on CEUS, while 61.4% lesions were classified as LR-5 or M on CECT/MRI ( P=0.033). The incidences of HCC in LR-3, 4 and 5 were 37.5%, 52.2% and 97.8% on CEUS LI-RADS, 56.0%, 64.5% and 96.6% on CECT/MRI LI-RADS respectively. Among the 145 lesions, 56 lesions had inconsistent classifications of CEUS and CECT/MRI LI-RADS. Twenty-eight lesions in CECT/MRI LR-3 and 4 were escalated to LR-4 and 5 by CEUS and 82.1% of them were found to be HCC. Fourteen lesions on CEUS LR-3 and 4 were escalated to LR-4 and 5 by CECT/MRI and 85.7% of them were found to be HCC. Conclusions:The LR-5 of the CEUS and CECT/EOB-MRI LI-RADS has a comparable incidence of HCC. However, the inter-modality agreement of the LI-RADS category between CEUS and CECT/EOB-MRI is poor. The proportion of lesions in CEUS LR-5 and M is much higher than that in CECT/MRI LR-5 and M, while the proportion of lesions in CECT/MRI LR-3 and 4 is high than that in CEUS LR-3 and 4.

Objective:To investigate the clinical and genetic characteristics of peroxisome D-bifunctional protein deficiency (PDBPD) associated with HSD17B4 mutation. Methods:The clinical and genetic characteristics of 2 cases of PDBPD in August 2020, at Children′s Hospital Affiliated to Nanjing Medical University caused by HSD17B4 gene mutation were retrospectively analyzed. Results:Male proband and his sister suffered from neonatal epilepsy, psychomotor development disorders, ataxia, myasthenia, hearing impairment, and foot deformity.The very long chain fatty acids in serum were normal, and brain magnetic resonance imaging (MRI) showed bilateral cerebellar hemisphere atrophy.Electromyography suggested changes in the myoelectricity of multiple peripheral neurogenic lesions.Auditory evoked potential displayed severe bilateral sensorineural hearing loss.Exome sequencing identified compound heterozygous mutations (c.1171G > C, c.686-2A>T) in HSD17B4.The clinical diagnosis was PDBPD, aged 8 and 14 years, respectively. Conclusions:Two cases of HSD17B4 mutation-induced PDBPD were first reported in Chinese mainland, which was in line with its typical clinical manifestations.The newly discovered c. 1171G> C and c. 686-2A>T mutations enriched the HSD17B4 mutation spectrum.

Model informed precision dosing (MIPD) is a new concept to guide precision dosing for individual patient by modeling and simulation based on the available information about the individual patient, medications and the disease. Compared to the empirical dosing, MIPD could improve the efficacy, safety, economics and adherence of the pharmacotherapy according to the individual's pathophysiology, genotyping and disease progression. This consensus report provides a brief account of the concept, methodology and implementation of MIPD as well as clinical decision supporting systems for MIPD. The status and future advancing of MIPD was also discussed to facilitate the appropriate application and development of MIPD in China.

Macular edema secondary to retinal vein occlusion (RVO) is the leading cause of visual impairment in patients with RVO.Intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents is the first-line treatment for RVO and most of patients can obtain improvements of macular morphology and visual function.Optical coherence tomography (OCT) can clearly characterize the macular microstructure.Qualitative or quantitative analysis of histological retinal layers of the macula, before and after anti-VEGF treatment, can guide the clinical treatment and predict visual outcome of patients with RVO.OCT predictors of visual prognosis in patients with RVO following anti-VEGF treatment, including central retinal thickness, disruption of external limiting membrane and ellipsoid zone, hyperreflective foci, disorganization of the retinal inner layers, serous retinal detachment or intraretinal cystoid spaces, subretinal hemorrhage, vitreomacular adhesion and retinal pigment epithelium (RPE) integrity are focused on in this review, aiming to enhance patient counseling and improve risk assessment and advance clinical management.

Objective:To explore the clinical value of Liver Imaging Reporting and Data System (LI-RADS) version 2017 with contrast-enhanced ultrasound (CEUS) for the risk prediction of hepatocellular carcinoma (HCC).Methods:Five hundred and seventy-one patients with HCC risk factors had received CEUS examination in Tianjin Third Central Hospital, 270 patients with 295 nodules were enrolled in this study according to the inclusion criteria. The final diagnostic reference standard was decided by surgical pathology or ultrasound-guided biopsy pathology. Each nodule was classified according to CEUS LI-RADS v2017. The diagnostic accuracy of CEUS LI-RADS v2017 for the prediction of HCC was analyzed retrospectively.Results:Of all 295 nodules, 95 nodules were diagnosed by surgical pathology and 200 nodules by ultrasoud-guided biopsy pathology, among which with 245 HCC, 13 intrahepatic cholangiocarcinoma (ICC), 8 combined hepatocellular cholangiocarcinoma(CHC), 2 metastatic neoplasm of other cellular origin and 27 benign nodules.The numbers of LR-3, LR-4, LR-5 and LR-M categories were 16(5.4%), 28(9.5%), 183(62.0%), 68(23.1%) and the positive predictive value (PPV) of LR-3, LR-4 and LR-5 were 43.8%, 60.7%, 98.4% for HCC, respectively. The sensitivity, specificity and positive predictive value of LR-5 category for HCC were 73.5%, 94.0%, 98.4%, respectively. 60.3%(41/68) LR-M category nodules were pathologically confirmed to be HCC.Conclusions:CEUS LI-RADS v2017 classification standard has reliable risk prediction value for patients with high risk factors of HCC, of which the LR-5 category has higher PPV for HCC. However, the differential diagnosis between HCC and other non-HCC malignancies still remains to be further studied for LR-M observations.

Objective:To compare enhancement patterns of combined hepatocellular-cholangiocarcinoma (CHC) in CEUS and CECT/MRI and to explore the role of imaging, the discordance of imaging findings and tumor markers, differences in tumor markers in the diagnosis of CHC.Methods:Thirty-five CHCs from July 2011 to August 2019 in Third Central Hospital of Tianjin confirmed by pathological diagnosis were retrospectively reviewed. The enhancement patterns of CHCs on CEUS and CECT/MRI were compared. A combination of the discordance of CEUS and CECT/MRI, the discordance of elevated tumor markers and imaging findings and the discordance of tumor markers was applied to diagnose CHC.Results:About 62.9% and 37.1% lesions showed the HCC and ICC enhancement patterns on CEUS, while 48.6%, 31.4% and 20% lesions showed the HCC, ICC and CHC enhancement patterns, on CECT/MRI, respectively. For 12 lesions with a diameter≤3.0 cm, all of which presented HCC enhancement patterns on CEUS, and 91.7% lesions showed HCC enhancement pattern and 9.3% lesions showed ICC enhancement pattern on CECT/MRI, respectively. For 23 lesions with a size >3.0 cm, 43.5% and 56.5% of which showed the HCC and ICC enhancement patterns on CEUS, respectively. And 26.1%, 43.5% and 30.4% of the lesions showed the HCC, ICC and CHC enhancement patterns on CECT/MRI, respectively. If the discordance of CEUS and CECT/MRI, the discordance of image features and tumor markers, or simultaneous elevation of AFP and CA19-9, were used as diagnostic information, 78.6% of the lesions met at least one of the three criteria.Conclusions:CHCs show different enhancement patterns on CEUS and CECT/MRI. With the increase of size of tumors, the enhancement patterns of CHCs have changed from HCC-like to ICC-like or CHC-like. Combination of the discordance of CEUS and CECT/MRI, the discordance of imaging findings and tumor markers and differences in tumor markers can improve the detection rate of CHCs.