Objective: To prospectively evaluate the outcomes of ultrasound (US)-guided radiofrequency ablation (RFA) in tertiary hyperparathyroidism (THPT). Materials and Methods: Patients with THPT underwent RFA between September 2017 and January 2022. Laboratory parameters, including serum intact parathyroid hormone (iPTH) levels, were monitored for 48 months after RFA and compared with the levels at baseline. Complications related to RFA and changes in hyperparathyroidism-related clinical symptoms were recorded before and after RFA. Results: A total of 42 patients with THPT were recruited for this study. Ultimately, 36 patients with renal failure and 2 patients who underwent successful renal transplantation (male:female, 17:21; median age, 54.5 years) were enrolled. The follow-up time was 21.5 ± 19.0 months in the 36 patients with renal failure. In these 36 patients, iPTH levels were significantly decreased to 261.1 pg/mL at 48 months compared with the baseline value of 1284.9 pg/mL (P = 0.012). Persistent hyperparathyroidism, defined as iPTH levels maintained at > 585.0 pg/mL for 6 months after treatment, occurred in 4.0% of patients (1/25). Recurrent hyperparathyroidism, defined as iPTH levels > 585.0 pg/mL after 6 months, were 4.0% (1/25) and 0.0% (0/9) at 6 months and 4 years after treatment, respectively. In two patients with THPT after successful renal transplantation, iPTH decreased from the baseline value of 242.5 and 115.9 pg/mL to 171.0 and 62.0 pg/mL at 6 months after treatment. All complications resolved within 6 months of ablation without medical intervention, except in 10.5% (4/38) patients with permanent hypocalcemia. The overall symptom recovery rate was 58.8% (10/17). The severity scores for bone pain, arthralgia, and itchy skin associated with hyperparathyroidism improved after treatment (P < 0.05). Conclusion US-guided RFA is an effective and safe alternative to surgery in the treatment of patients with TPTH and improves hyperparathyroidism-related clinical symptoms.Keywords: Ultrasound; Radiofrequency ablation; Te

Objective:To evaluate the performance of two-dimensional fundamental sonosalpingography combined with saline infusion pelvic sonosalpingography(abbreviated as "2DFS+ SIPS" in this article) for assessing fimbrial part′s morphology and function of fallopian tubes.Methods:A total of 246 infertile women were collected from Zhejiang Provincial People′s Hospital from May 2018 to December 2019. They underwent dynamic three-dimensional harmonic sonosalpingography(abbreviated as "4DHS" in this article) first. Cases which were diagnosed as bilaterally tubal obstruction would be excluded. 2DFS+ SIPS was performed in 230 patients. Among them, 21 underwent laparoscopy and dye test(LDT) within 6 months and the results were regarded as golden standard.Results:①Tubes which were diagnosed as complete obstruction would be excluded. The total display rate of remaining fimbrial parts by using 2DFS+ SIPS and 4DHS were 77.4% and 24.0% respectively, which had statistically difference( P<0.001). ②According to 2DFS+ SIPS, fimbrial parts were classified into 3 types: normal, suspected abnormal and abnormal.Normal fimbrial parts accounted for 86.4% while suspected abnormal ones accounted for 13.6% under the condition of patency; abnormal fimbrial parts accounted for 81.2% while suspected abnormal ones accounted for 18.8% under the condition of partial obstruction. The difference in the proportion of normal and abnormal fimbrial parts according to different tubal patency was statistically significant( P<0.001). ③Fimbrial parts were classified into normal (normal fimbrial parts) and abnormal (suspected abnormal and abnormal fimbrial parts) further according to 2DFS+ SIPS, the results were compared with LDT. Accuracy, sensitivity, specificity, positive predictive value, negative predictive value and Youden′s index were 92.0%, 100%, 88.2%, 80.0%, 100%, 0.88, respectively. The consistency analysis showed the results of 2DFS+ SIPS and LDT were highly consistent (Kappa=0.828). ④All the side effects occured during the procedure or within 30 minutes after the procedure were self-limited.No serious complications were observed. Conclusions:2DFS+ SIPS is a preferred method for assessment of fimbrial part′s morphology and function, with its advantages of non-invasiveness, intuition, and accuracy. This combination could provide objective imaging basis for choosing clinical treatment strategies and predicting prognosis.

Objective:To investigate thromboprophylaxis of patients with COVID-19.Methods:Clinical data of 31 patients with COVID-19 in Zhongnan Hospital of Wuhan University was analyzed retrospectively, including basic information, clinical characteristics, examination results, therapy and Padua scores. 5G remote ultrasound diagnosis system was used in the ultrasonography of lower limb vein, inferior vena cava and the heart. According to the patient′s status, the thromboprophylaxis was established, and the incidence of venous thromboembolism (VTE) was observed.Results:There were 20 cases of general types and 11cases of severe types. All patients underwent dynamic assessment and thromboprophylaxis. Basic prevention was applied in 28 cases and mechanical prevention was used in 3 cases. There was no VTE event in all patients during hospitalization.Conclusions:Prevention and monitoring of VTE is an important part of the treatment of patients with COVID-19, which can effectively reduce the incidence of lower extremity deep vein thrombosis and fatal pulmonary embolism in isolation ward.

Objective To investigate the efficacy of ultrasound-guided cervical plexus block in radiofrequency ablation of thyroid and parathyroid benign lesions . Methods One hundred and twenty-five patients with thyroid nodules or hyperparathyroidism , who were undergone ultrasound guided radiofrequency ablation ,were randomly assigned to receive either ultrasound-guided cervical plexus block or local infiltration anesthesia ,and the pain grading was evaluated by numerical rating scale ( NRS ) . The anesthetic dosage and the effect of thermal ablation surgery of ultrasound-guided cervical plexus block anesthesia and local anesthesia were compared . Results The anesthetic dosage in ultrasound-guided cervical plexus block was lower than that in local infiltration anesthesia( t = 17 .681 , P < 0 .05) . The pain grading of ultrasound-guided cervical plexus block was lower than that of local infiltration anesthesia( χ2 = 33 .738 , P < 0 .05) . Conclusions Ultrasound-guided cervical plexus nerve block has lower anesthetic dosage and pain grading in the radiofrequency ablation of thyroid and parathyroid benign lesions ,which may be widely applied in clinical .

Objective: To evaluate the differential diagnosis of idiopathic granulomatous mastitis (IGM) and invasive ductal carcinoma. Methods: The ultrasonographic data of 37 IGM patients and 50 cases of IDC were analyzed retrospectively. The shape, growth direction, margin, internal echo, posterior echo, calcification, Adler blood flow classification, PSV(peak sestolic velocity), RI (resistance index)and elasticity scores were analyzed by χ² test and independent sample t test. The optimal cutoff values of age, PSV and RI were calculated by receiver operating characteristic (ROC) curve. Logistic regression analysis was used to calculate the odds ratio (OR) of ultrasonic variates in the diagnosis of both diseases. Results: There were no significant differences in the shape, margin, internal echo and blood flow grading between the two groups. The age, lesion growth direction, posterior echo, calcification, PSV, RI and elasticity were statistically different. The cut-of value of Age, PSV and RI were 38.5 years old, 13.20 cm/s, and 0.655. Logistic regression multi-variated analysis revealed that elastic score (OR=9.806) had the best value of the differential diagnosis, as well as calcification (OR=6.937), posterior echo decay (OR=4.613), RI (OR=3.257), lesion growth orientation (OR=3.198), and PSV (OR=1.202). Lesion shape, margin, internal echo, and Adler blood flow classification did not help in differential diagnosis. Conclusion Ultrasound multi-parameter analysis has high value in IGM and IDC differential diagnosis.

Objective To analyze the influencing factors of hematoma complicated from ultrasound-guided minimally invasive surgery for benign breast masses.Methods Retrospective analysis was performed in 412 patients with a total of 516 masses underwent the ultrasound-guided minimally invasive surgery for benign breast masses from January 2011 to December 2015 in Xiaoshan Hospital. Theχ2 test was used to univariately analyze risk factors of hematoma formation after ultrasound-guided minimally invasive surgery for benign breast masses. Logistic regression analysis was used to multivariately analyze risk factors of hematoma formation.Results All masses were resected completely, however, hematomas with long diameter≥1.0 cm were formed in 43 masses one week after surgery, and all hematomas were completely absorbed after six months. There were significant differences in the incidence of hematoma between the groups of different needle sizes, numbers of needle cutting, masses sizes, blood flow grades, depth, resection numbers and effective compression time of postoperative bandages (χ2=16.917, 14.548, 39.971, 23.333, 29.137, 36.819 and 39.864, respectively, allP<0.001). The needle sizes, the numbers of needle cutting, the masses sizes, blood flow grades, depth, resection numbers and the effective compression time constituted the risk factors of hematoma formation after the minimally invasive surgery.Conclusions The risk factors of the hematoma formation after ultrasound-guided minimally invasive surgery for benign breast masses included the different size of the needle, the number of different cutting needles, different size of the masses, the grade of blood flow, the number of resection and the different effective compression time of postoperative bandages. We could prevent the occurrence of hematoma in advance by screening patients and take corresponding measures.

Objective To systematically assess the relationship between oral administration of aspirin and survival benefit for patients with colorec?tal cancer(CRC)by meta?analysis. Methods Relevant studies were identified through searching PubMed and EMBASE. Random?effects model was derived to composite the pooled hazard ratio for overall mortality and CRC?specific mortality. The subgroup analysis was conducted for included data,and the bias analysis was reported. Results Thirteen studies on aspirin therapy were finally included in this meta?analysis. The overall surviv?al benefit associated with oral administration of aspirin represented an HR of 0.83(95%CI:0.71?0.96). Oral administration of aspirin was also asso?ciated with CRC?specific survival(HR=0.77,95%CI:0.64?0.93). No evidence was observed of an association between prediagnostic aspirin use and CRC overall survival(HR=1.00,95%CI:0.85?1.18)or CRC?specific survival(HR=0.97,95%CI:0.83?1.13). Conclusion These findings provide further indication that post?diagnostic aspirin therapy can improve CRC prognosis.

Objective To investigate the role of double contrast-enhanced ultrasonography (DCUS) in the diagnosis of rectal gastrointestinal stromal tumors (GISTs). Methods In eleven patients with rectal GISTs before surgery, gastrointestinal ultrasound contrast agent were injected into rectal lumen and tumor’s two dimensional ultrasound features were analyzed. Microbubbles were injected into the vein to investigate the feature of lesion microcirculation perfusion. After the surgery, according to the tumor diameter and mitotic count, rectal GISTs were classified as very low-risk, low-risk, intermediated-risk and high-risk tumors. The very low-risk and low-risk tumors were grouped together as one group while the intermediated-risk and high-risk tumors were grouped together as another group. According to ultrasound performance and pathological type, ultrasonic features of rectal GISTs with different risk levels were estimated. Results Among all rectal GISTs cases, 63.6%(7/11) were low-risk. Under DCUS, the tumor diameter was less than 5 cm, with regular round, hypoechogenicity, uniform low enhancement and less internal liquefaction necrosis. For the 36.4%(4/11) high-risk cases, under DCUS, the tumor diameter was≥5 cm, with irregular round or lobulation, mixed hyperechogenicity and hypoechogenicity, nonuniform high enhancement, large blood vessel and common liquefied necrosis region. The biological behavior of rectal GISTs was relevant to lesion size, liquefaction necrosis and enhancement mode of ultrasound contrast and irrelevant to the bound and shape of lesion. The accuracy of DCUS and contrast-enhanced ultrasonography were 90.9%(10/11) and 72.7%(8/11) respectively. Conclusions DCUS is considered as an effective tool in diagnosingrectal GISTs and can get useful information of the biological characteristics. It has great value for the diagnosis and treatment of rectal GISTs.

Objective To evaluate the preoperative T staging value of rectal carcinoma by using double contrast-enhanced ultrasonography (DCUS).Methods 71 patients with rectal carcinoma were examined by ultrasound after infusing contrast agent and bolus injection of SonoVue preoperatively.The border,shape and perfusion patterns of the tumor were observed.After surgery,the T staging made by DCUS and perfused contrast-enhanced ultrasonography (PCUS) was compared with final pathologic results respectively.Results The accuracy of PCUS and DCUS in determining the T stage of rectal carcinoma were 71.8％(T1 72.7％％,T250.0％,T374.4％,T476.9％) and 85.9％(T190.9％,T275.0％,T387.1％,T484.6％) respectively.The difference between these two methods was statistically significant (P ＜0.05).Conclusions DCUS is a new valuable method for T staging of rectal carcinoma with its high accuracy preoperatively.

Objective To investigate the utility of serum prostate specific antigen(PSA) density (PSAD),prostate antigen transition zone density(PSAT) and the ratio of free/total PSA with PSAD [(F/T)/PSAD] in the diagnosis of prostatic carcinoma (PCa) by three-dimensional ultrasonography.Methods Seventy-eight patients (serum prostate-specific antigen between 4-20 μg/L ) were involved.The prostatic volume and its transition zone volume were measured by three-dimensional ultrasonography.Then the relative parameters of PSA [PSAD,PSAT and (F/T)/PSAD] were calculated.Pathologic types were determined by using needle biopsy of prostate.Results Among them,27 patients were suffering from PCa,while the other 51 benign prostate hypertrophy (BPH).The difference of PSAD,PSAT and (F/T)/PSAD between PCa and BPH had arrived statistical significance (P<0.05).Proportions under the PCa curves were 0.736,0.760,0.800 respectively.Considering both sensitivity and specificity,a cutoff was recommanded:PSAD>0.20,PSAT>0.33,(F/T)/PSAD<0.8.Conclusions When the serum PSA level is between 4 μg/L and 20 μg/L,PSAD,PSAT and (F/T)/PSAD are of significant value to differentiate PCa from benign prostatic hyperplasia patients.The data are more reliable if prostatic volume are calculated by three-dimensional transrectal ultrasonography.