Objective:To observe the ability of abdominal ultrasonography (hereinafter referred to as water-injection ultrasonography) after injection of 0.9% sodium chloride solution via endoscopic nasobiliary drainage tube in the detection of residual stones in bile duct after stone extraction by endoscopic retrograde cholangiopancreatography (ERCP).Methods:From January 2015 to June 2023, at the Second Department of General Surgery, Shengjing Hospital, China Medical University, 342 patients, who were diagnosed with choledochal stones and received stone extraction by ERCP and at the same time placed endoscopic nasobiliary drainage tube, were enrolled.After stone extraction by ERCP, all the patients underwent cholangiography, conventional abdominal ultrasound, and water-injection ultrasonography. The patients with stones removed by the secondary ERCP were positive. The ability to detect residual stones in bile duct by cholangiography, conventional abdominal ultrasound and water-injection ultrasonography were compared. Chi-square test was performed for statistical analysis.Results:The results of cholangiography showed that 35 patients were suspected with residual stones in bile duct, among them 28 were confirmed to be true-positive, the sensitivity was 50.9% and specificity was 97.6%; the results of conventional abdominal ultrasound showed that 15 patients were suspected with residual stones in bile duct, among them 13 were confirmed to be true positive with a sensitivity of 23.6% and a specificity of 99.3%; and the results of water-injection ultrasonography showed that 56 patients were suspected with residual stones in bile duct, among them 50 were confirmed as true positive, with a sensitivity of 90.9% and a specificity of 97.9%. The number of true-positive patients detected by water-injection ultrasonography was greater than those determined by cholangiography and conventional abdominal ultrasonography, and the sensitivity was higher than that of cholangiography and conventional abdominal ultrasonography, and the differences were statistically significant ( χ2=21.33, 50.85, 38.77 and 92.53, all P<0.001). There was no statistically significant difference in the specificity among water-injection ultrasonography, cholangiography and conventional abdominal ultrasonography (both P>0.05). Conclusion:Water-injection ultrasonography can effectively improve the detection rate of residual stones in bile duct after ERCP.

Purpose To explore the value of contrast-enhanced ultrasound(CEUS)in the differential diagnosis of gallbladder polypoid lesions(GPLs)(diameter≥10 mm).Materials and Methods A prospective enrollment of 229 patients with GPLs who underwent cholecystectomy in 17 hospitals from December 1 2021 to June 30 2024 was conducted to analyze the relationship between general data,conventional ultrasound,CEUS characteristics and the nature of GPLs.Multivariate Logistic regression was employed to identify independent risk factors for neoplastic polyps,the differential diagnostic value of different indicators was compared.Results Among 229 patients with GPLs,there were 108 cases of cholesterol polyps,102 cases of adenoma and 19 cases of gallbladder cancer.Age(Z=-4.476,P<0.001),polyp number(χ2=15.561,P<0.001),diameter(Z=-8.149,P<0.001),echogenicity(χ2=9.241,P=0.010),vascularity(χ2=23.107,P<0.001),enhancement intensity(χ2=47.610,P<0.001),enhancement pattern(χ2=6.468,P=0.011),vascular type(χ2=84.470,P<0.001),integrity of gallbladder wall(χ2=7.662,P=0.006)and stalk width(Z=-9.831,P<0.001)between cholesterol polyps and neoplastic polyps were statistically significant.Age,location,diameter,echogenicity,enhancement pattern,vascular type and stalk width between adenoma and gallbladder cancer were statistically significant(Z=-4.333,-3.902,-5.042,all P<0.05).Multivariate Logistic regression analysis showed that hyper-enhancement,branched vascular type and stalk width were independent risk factors for neoplastic polyps(OR=4.563,5.770,3.075,all P<0.001).The combination of independent risk factors was better than single factor and diameter in the differential diagnosis of cholesterol polyps and neoplastic polyps(all P<0.01).Conclusion CEUS can effectively identify the nature of GPLs and provide a valuable imaging reference for the selection of treatment methods.

A kind of focal lesions called focal nodular hyperplasia-like nodules (FNH-LNs) was found in liver cirrhosis, especially in alcoholic cirrhosis, which is similar to focal nodular hyperplasia in histology. The imaging features of FNH-LNs show hyperenhancement in arterial phase, hypoenhancement in portal venous phase or delayed phase. FNH-LNs are easily misdiagnosed as hepatocellular carcinoma (HCC). With reviewing the relating articles in China and abroad, this article summarizes the etiology, clinicopathological features and imaging manifestations of FNH-LNs, so as to distinguish FNH-LNs and HCC in cirrhosis and guide selection of treatment.

Clinically, there are still substantial differences between hepatocellular carcinoma (HCC) and non-HCC liver malignancies in terms of risk factors, pathogenesis, biological behaviors, treatment selections, prognosis, and prevention measurement. The liver imaging reporting and data system (LI-RADS) M (LR-M) classification criteria in the contrast-enhanced ultrasound LI-RADS (CEUS LI-RADS) can help differentiate HCC from non-HCC malignancies. This review discussed and summarized recent advancements in differential diagnosis of HCC from non-HCC using the LR-M criteria and speculated future directions in the field, i.e., how CEUS LI-RADS distinguish HCC from intrahepatic cholangiocarcinoma, mixed hepatocellular carcinoma cholangiocarcinoma, and liver metastasized and benign tumors. It also discussed differences between CEUS LI-RADS and CT/MRI LI-RADS in diagnosis of liver neoplasms and Sonazoid Ⓡ modified CEUS LI-RADS in differential diagnosis of HCC from non-HCC.

OBJECTIVE: To understand the oral health status of children aged 3-12 in Shaoshan area of Hunan province and to evaluate the role of oral health educations based on community such as fluoride varnish, oral hygiene introduction in improving the oral health of children in the area so as to gain expe-rience. METHODS: The study used cluster sampling to select 3 kindergartens and 2 primary schools in different economic development areas of Shaoshan. Oral health status survey and interventions were conducted in December 2014 and September 2016, respectively. The average debris index, decayed missing filled teeth (deciduous teeth: dmft; permanent teeth: DMFT), and caries prevalence rate of children aged 3-6 years and 6-12 years were compared. At the same time, children aged 5 and 12 were used as representative populations to compare the indices as listed before and the caries prevalence rate of the first permanent molar in 12-year-old children was compared as well. Finally, health economic analysis was carried out based on the 2 years' result. RESULTS: In this study, 992 children and 896 children in 2014 and 2016 were included respectively. As for children aged 3-6 years, the average debris index and dmft in 2016 were significantly less than that in 2014 (P < 0.001, P < 0.001), and the difference of DMFT was not significant (P=0.419). Children aged 6-12 years showed the same result, the average debris index and dmft in 2016 were significantly less than those in 2014 (P < 0.001, P=0.013), and the difference in DMFT was not significant (P=0.674). 173 and 179 5-year-old children were included in 2014 and 2016 respectively, and the dmft showed significant difference (P=0.038); the caries prevalence rate was 75.7% and 71.5%, respectively, which was also not significant (P=0.370). With respect to the 12-year-old children, 65 and 104 children were included and the differences in dmft and DMFT were not significant (P=0.133, P=0.171). The caries prevalence of the first permanent molar in the 12-year-old children was 36.9% and 26.9%, whose difference was not significant (P=0.171). CONCLUSION The application of fluoride varnish and oral health education can significantly reduce the dmft of children aged 3-12 years in Shaoshan area and significantly improve the oral hygiene status. DMFT, the caries prevalence rate of 5-year-old children's deciduous teeth and 12-year-old children's first permanent molar showed a decline.
Child ; Child, Preschool ; DMF Index ; Fluorides ; Humans ; Molar ; Oral Health ; Prevalence

Objective To investigate the ultrasound features of hepatic inflammatory myofibroblastic tumor (HIMT).Methods A retrospective analysis was performed for the ultrasound features of 4 patients who visit Shengjing Hospital from February 2007 to July 2017 with pathologically confirmed HIMT,including the location,size,boundary,morphology,internal echo,and blood flow of lesions.Results The patients were aged 2-69 years and there were 2 male and 2 female patients.All 4 patients had single tumor with a maximum diameter of 3.4 -21.2 cm.Two patients had clear boundaries and two had unclear boundaries.Two patients had solid tumor with inhomogeneous low echo and 2 had mixed cystic and solid type;color Doppler flow imaging found blood flow signal in tumor in all patients.Conclusion Ultrasound can clearly reveal the size,internal echo,and blood flow of HIMT,but the ultrasound images of HIMT lack specificity.Pathological examination is still needed for a confirmed diagnosis.

ObjectiveTo investigate the value of advanced dynamic flow (ADF) versus color Doppler flow imaging (CDFI) in evaluating stent patency after transjugular intrahepatic portosystemic shunt (TIPS). MethodsA total of 60 post-TIPS patients who underwent ADF, CDFI, and contrast-enhanced ultrasound (CEUS) in Shengjing Hospital of China Medical University from September 2016 to May 2018 were enrolled. The grade of the patency of TIPS stent was evaluated according to the results of ADF, CDFI, and CEUS. With the results of CEUS as the gold standard, the Kappa test was used to examine the consistency between ADF and CEUS results, as well as between CDFI and CEUS results, the Z test was used as the hypothesis testing of kappa value. ResultsThere was extremely strong consistency between ADF and CEUS in evaluating stent patency after TIPS (Kappa=0.902, P＜0.05), while there was moderate consistency between CDFI and CEUS in evaluating stent patency after TIPS (Kappa=0423, P＜0.05). The Z test found that the difference was statistically significant (P＜0.05). ConclusionCompared with CDFI, ADF has a higher value in evaluating stent patency after TIPS and has certain clinical significance.

Objective To investigate the diagnostic value of splenic elasticity measured with real-time shear wave elastography (SWE) in liver cirrhosis patients with portal hypertension.Methods Totally 64 cirrhotic patients with portal hypertension (PH group) and 62 liver cirrhosis patients without portal hypertension (control group) were enrolled.The elasticity,the thickness and the length of the spleen of both groups were compared.The areas under the ROC curve (AUC) of the SWE elasticity,the thickness and the length of the spleen were compared with a DeLong test.The optimal cutoff value of SWE elasticity was obtained,and the sensitivity and specificity were calculated,respectively.Results The differences of the SWE elasticity,the thickness and the length of the spleen between the two groups were statistically significant (all P＜0.001).AUC of SWE elasticity,thickness and length of the spleen was 0.979 (95％ CI[0.944,0.989]),0.917 (95％CI [0.854,0.926] and 0.865 (95％CI [0.775,0.928]),respectively.The differences between each two parameters were statistically significant (all P＜0.05).The optimal cutoff value of the spleen SWE elasticity was 19.98 kPa,the sensitivity and the specificity was 95.78％ and 94.27％,respectively.Conclusion The diagnostic efficacy of spleen SWE elasticity was higher than that of spleen thickness and spleen length,therefore having better diagnostic value for liver cirrhosis patients with portal hypertension.

Objective To investigate the contrast-enhanced ultrasonography appearances characteristics of intrahepatic peripheral cholangiocarcinoma( ICC) and to improve the diagnosis level of ICC on contrast-enhanced ultrasonography . Methods Thirty cases with ICC confirmed by pathological examinations of surgeries were retrospectively analyzed for findings of ultrasonography , clinic and pathology ,to explore the typical contrast-enhanced ultrasonography appearances and the correlation with pathological differentiation . ResultsOn contrast-enhanced ultrasonography , 30 lesions showed enhancement on the arterial phase and appeared hypo-echoic enhancement on the portal phase ,which displayed fast-in and fast-out" enhancement pattern . During the hepatic arterial phase of contrast-enhanced ultrasonography ,10 lesions showed peripheral enhancement ,10 lesions showed relatively homogeneous hyper-enhancement ,6 lesions showed heterogeneous enhancement ,2 lesions showed iso-enhancement ,and 2 lesions showed hypo-enhancement . To the 30 lesions ,the average initial time of enhancement was ( 18 .81 ± 4 .66)s (12 －28 s) ,the average time of washing-out was (36 .00 ± 12 .30) s (18 －60 s) . There was no significant difference in time of washing-in and washing-out among different pathological differentiation groups ( P＞0 .05) . Conclusions ICC often shows fast-in and fast-out" enhancement pattern on contrast-enhanced ultrasonography ,and the time of washing-out is generally in late arterial phase or early portal phase ,but there is no significant difference in time of washing-in and washing-out among different pathological differentiation groups .