Objective:To assess the feasibility of shear wave elastography (SWE) in differentiating inflammatory and fibrotic strictures in Crohn's disease (CD) .Methods:A cross-sectional survey study was conducted. The patients with stricture-type CD who underwent SWE examination at the First Affiliated Hospital of Sun Yat-sen University from January 2020 to June 2023 were continuously collected. The general data, laboratory examination indicators, and ultrasound examination indicators were collected. Laboratory examination indicators included C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Ultrasound examination indicators included intestinal wall thickness, proximal bowel dilation, intestinal wall layer structure, Limberg grading, and the elasticity indicator SWE value. Patients were divided into inflammatory stricture group and fibrotic stricture group by using a modified fibrosis score of the narrowed intestine. Statistical analysis was performed to compare the differences in clinical data between the two groups, and Spearman correlation analysis was used to evaluate the correlation between ultrasound indicators and fibrosis score. Receiver operating characteristic (ROC) curves were plotted, and the diagnostic efficacy of SWE for inflammatory stricture and fibrotic stricture was calculated.Results:A total of 60 CD patients [44 men, 16 women; mean age, 34.3 ± 11.1 years; mean disease duration 60 (24, 117) months] were included. There were 43 patients in the inflammatory stricture group and 17 in the fibrotic stricture group. The differences in CRP ( P = 0.049), intestinal wall thickness ( P = 0.020), intestinal wall layer structure ( P = 0.001), and SWE value ( P < 0.001) between the two groups were statistically significant, but the differences in other indicators were not statistically significant (all P > 0.05). Intestinal wall thickness, intestinal wall layer structure, and SWE value were all positively correlated with fibrosis scores (all r s >0.3). In distinguishing inflammatory stricture from fibrotic stricture, a cut-off value of 15.9 kPa for SWE value yielded a sensitivity of 0.824, a specificity of 0.791, and the area under curve was 0.850 (95% CI: 0.740~0.952, P<0.001) . Conclusion:SWE examination can be used for the differential diagnosis of inflammatory and fibrotic strictures in CD, providing more diagnostic evidence for patients with stricture-type CD.

Objective:To explore a better measurement mode of shear wave elastography (SWE) in the skin of lymphedema limbs, and to test its diagnostic efficacy in lymphedema.Methods:Between 1st and 10th August, 2023, 22 healthy volunteers were recruited in the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ulrasound, the First Afiliaed Hospital of Sun Yat-Sen University to measure the Young's modulus (E-value) of limb skin by SWE using a gel pad (GP group) and the thick-layer coupling gel (CG group) respectively. Then between 15th August and 28th September, 2023, 11 patients with 13 lower limb lymphedema, who were treated in the Department of Microsurgery, Orhopaedic Trauma and Hand Surgery, the First Affiliaed Hospital of Sun Yat-Sen University, were consecutively enrolled to find out the E-value of skin in oedematous limbs. The receiver operating characteristic curve (ROC) was constructed and the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated to evaluate the diagnostic efficiency. SPSS 26.0, R studio and GraphPad Prism 8 software were used for statistical analysis. Paired sample non-parametric test (Wilcoxon signed rank test) was used to compare the difference in E-value between the 2 groups. P<0.01 was considered statistically significant. Spearman correlation test was used to analyse the correlation of E-value values between the GP group and CG group. Results:Overall, it was found from the healthy volunteers that E-value of skin in distal limbs were higher than that in proximal limbs, especially in lower extremities. E-value of all scanned location in GP group were found higher than those of CG group with statistically significant difference ( P<0.01), and the values of interclass correlation coefficient (ICC) showed a good repeatability. The 11 patients with lymphedema in 13 lower extremities were examined with the thick-layer coupling gel. The skin E-value in calf of patients with lymphedema were significantly higher than that of the healthy volunteers ( P<0.01), except the skin of thighs ( P>0.01). A lymphedema was diagnosed while either a skin E-value was 27.6 kPa calculated by Youden index or with the thickness of skin was 2.3 mm. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy in the diagnosis of a lymphedema were found at 92.3%, 100%, 100%, 95.7% and 97.1%, respectively. The area under curve (AUC) of ROC was 0.962. The correlation coefficients (R) of E-value in arm, forearm, thigh and lower leg in the GP group and CP group were 0.665, 0.882, 0.850 and 0.815, respectively, which were all significantly correlated. Conclusion:Application of thick layer coupler in ultrasound skin SWE is highly feasible, and the combination of ultrasound skin SWE and skin thickness has higher diagnostic efficiency in the diagnosis of lower extremities lymphedema. It allows more accurate ultrasonic image technical support for early monitoring and diagnosis of lymphedema, microsurgical treatment and a quantitatively perioperative evaluation.

Objective:To assess the feasibility of shear wave elastography (SWE) in differentiating inflammatory and fibrotic strictures in Crohn's disease (CD) .Methods:A cross-sectional survey study was conducted. The patients with stricture-type CD who underwent SWE examination at the First Affiliated Hospital of Sun Yat-sen University from January 2020 to June 2023 were continuously collected. The general data, laboratory examination indicators, and ultrasound examination indicators were collected. Laboratory examination indicators included C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Ultrasound examination indicators included intestinal wall thickness, proximal bowel dilation, intestinal wall layer structure, Limberg grading, and the elasticity indicator SWE value. Patients were divided into inflammatory stricture group and fibrotic stricture group by using a modified fibrosis score of the narrowed intestine. Statistical analysis was performed to compare the differences in clinical data between the two groups, and Spearman correlation analysis was used to evaluate the correlation between ultrasound indicators and fibrosis score. Receiver operating characteristic (ROC) curves were plotted, and the diagnostic efficacy of SWE for inflammatory stricture and fibrotic stricture was calculated.Results:A total of 60 CD patients [44 men, 16 women; mean age, 34.3 ± 11.1 years; mean disease duration 60 (24, 117) months] were included. There were 43 patients in the inflammatory stricture group and 17 in the fibrotic stricture group. The differences in CRP ( P = 0.049), intestinal wall thickness ( P = 0.020), intestinal wall layer structure ( P = 0.001), and SWE value ( P < 0.001) between the two groups were statistically significant, but the differences in other indicators were not statistically significant (all P > 0.05). Intestinal wall thickness, intestinal wall layer structure, and SWE value were all positively correlated with fibrosis scores (all r s >0.3). In distinguishing inflammatory stricture from fibrotic stricture, a cut-off value of 15.9 kPa for SWE value yielded a sensitivity of 0.824, a specificity of 0.791, and the area under curve was 0.850 (95% CI: 0.740~0.952, P<0.001) . Conclusion:SWE examination can be used for the differential diagnosis of inflammatory and fibrotic strictures in CD, providing more diagnostic evidence for patients with stricture-type CD.

Objective To investigate the effect of limitation in flow of people on medical care quality in emergency resuscitation room (ERR).Methods This study was retrospectively performed to compare emergency medical quality before and after (October to December,2015 vs.February to April,2016) limitation of flow of people in ERR.Variables included noise level,occupational exposure,adverse event,hospital-acquired infection,length of stay (LOS) in ERR,mortality rate,return of spontaneous circulation (ROSC) rate after cardiopulmonary resuscitation (CPR),the rate of unexpected return to ERR,door to drug and door to balloon time for patients with ST-segment elevated myocardial infarction (STEMI),patients' and emergency personnels' satisfaction level.The data were analyzed with t-test,chi-square test or Poisson Z test where appropriate.Results There were 5 031 and 5 097 patients respectively admitted in ERR before and after limitation of flow of people.Patients' main diagnoses and severity of illness between the two periods had no significantly difference (P＞0.05).After the limitation of flow of people,the noise level in ERR was lowered (P＜0.01),the numbers of occupational exposure events (14 cases vs.4 cases,Z=2.357,P=0.018) and adverse events (18 cases vs.5 cases,Z=2.711,P=0.007) were decreased,the rate of hospital-acquired infection was reduced (1.1％ vs.0.5％,x2=8.111,P=0.004),the LOS in ERR was shortened [(6.3±0.8) h vs.(4.6±0.6) h,t=121.083,P＜0.01],the door to balloon time for STEMI patients was also decreased [(91.2±12.8) min vs.(89.3±8.0) min,t=2.486,P=0.013].Moreover,patients' and emergency personnels' satisfaction level were elevated.No significant difference was observed in mortality rate,ROSC rate,rate of unexpected return to ERR and door to drug time for STEMI patients.Conclusions The limitation of flow of people in ERR can lower the noise level,reduce emergency personnels' working pressure,improve their working efficiency,avoid medical errors,elevate patients' and emergency personnels' satisfaction level.

Objective To evaluate the clinical value of echocardiography in the diagnosis of aorticoleft ventricular tunnel.Methods The echocardiographic and clinical characteristics were retrospectively analyzed in 6 patients with aortico-left ventricular tunnel we reported and 147 cases that documents reported.Results Six patients were confirmed by operation.The main echocardiographic characteristics of aortico-left ventricular tunnel were as follows:An abnormal communication began in the ascending aorta above the level of the coronary arteries,bypassed the aortic valve,and terminated in the left ventricle.The color Doppler flow imaging demonstrated to-and-fro flow,with or without aortic valve involvement.According Hovaguimian and his colleagues,2 cases were type Ⅰ,2 cases were type Ⅲ,1 case was type Ⅳ,1 case was type Ⅱ (showed as recanalization).Base on all of the 153 patients that we and documents reported,the accuracy rate of ultrasound diagnosis was 79.6％,the misdiagnosis rate was 17.1％,and missed diagnosis rate was 3.3 ％.Conclusions Echocardiography is the non-invasive and sensitive tool in the diagnosis of the type of aortico-left ventricular tunnel and structure of cardiac involvement,and is the preferred method for preoperative.