Objective To study the relationship between the washout speed in the contrast-enhanced ultrasound (CEUS) and the differentiation grading in pathology in patients with hypervascular hepatocellular carcinoma (HCC).Methods Totally 271 patients who underwent complete resection for hypervascular HCC from April 2009 to December 2014 at Nanchong Central Hospital were included in this study.CEUS examinations were perfomred in all patients 2-3 days before liver resection.A timer on the ultrasound screen displayed the time elapsed since the saline flush was used to determine time to washout.The washout rate were categorized into four levels based on enhancement in portal venous phase and delayed phase.The differentiation grade and the washout speed were compared using Kruskal-Wallis test.Results All 271 (100％) lesions were arterially enhanced with different washout rate.Washout speed 1 was found in 19 patients (7.0％),while speed 2 in 157 patients (57.9％),speed 3 in 65 (24.0％),and speed 4 in 30,respectively.The washout speed had a significant correlation with the differentiation (x2=179.8238,P ＜ 0.001).The faster washout speed,the higher differentiated.Washout speed 1 could distinghuish well-differentiated from the poor and moderately differentiated tumor.The sensitivity and specificity of preoperative washout speed 1 to identify well histologic grade were 98.0％ and 77.8％,the positive predictive value and negative predictive value were 96.0％ and 48.8％,and the positive likelihood ratio and negative likelihood ratiowere were 1.9 and 0.01.Washout speed 4 could distinghuish poor differentiated from well and moderately differentiated tumor The sensitivity and specificity of preoperative washout speed 4 to identify poor histologic grade were 24.3％ and 97.0％,the positive predictive value and the negative predictive value were 65.3％ and 61.3％,and the positive likelihood ratio and negative likelihood ratiowere were 3.2 and 0.7.Conculsions Washout speed can reflect the degree of differentiation roughly.Washout speed can effectively diagnose the well-differentiated HCC,but it is difficult for moderate and poor differentiated HCC.

Objective To investigate the risk factors of postoperative severe hypocalcemia (SH) occur-rence in the patients with secondary hyperparathyroidism (SHPT) treated by ultrasound-guided radiofrequen-cy ablation (RFA).Methods A total of 41 patients with SHPT receiving RFA treatment in the Affiliated Nanchong Central Hospital of North Sichuan Medical College from May 2019 to March 2023 were selected as the study subjects.The retrospective analysis was adopted to collect the data such as the basic information,disease information,laboratory and imagiological examination.The patients were divided into the SH group and non-SH group according to whether or not the corrected serum calcium level being lower than 1.8 mmol/L on 1 d after RFA.The univariate and multivariate logistic regression models were used to analyze the related risk factors of SH occurrence after RFA.The receiver operating characteristic (ROC) curve was drawn to test the predictive efficiency of the related risk factors.Results There were 41 patients with SHPT,inclu-ding 19 males and 22 females,with an average age of (49.56±13.64)years old,and 22 cases developed SH on 1 d after RFA.The univariate analysis results showed that preoperative alkaline phosphatase (ALP),C-reac-tive protein (CRP),parathyroid hormone (PTH) and serum calcium levels had statistical differences between the two groups.The multivariate logistic regression analysis results showed that ALP was an independent risk factor for postoperative SH occurrence.The area under the curve (AUC) of adopting ALP for predicting SH occurrence after RFA in the patients with SHPT was 0.895,and the best predicted cut-off value was 323.34 U/L.Conclusion Paying attention to the level of ALP before operation and correcting it reasonably could be conducive to reduce the incidence rate of postoperative SH.