Gastroparesis (GP) is a gastric motility disorder characterized by delayed gastric emptying in the absence of mechanical obstruction. This expert consensus covers aspects of GP etiology (diabetes, surgery, drug-induced, idiopathic, scleroderma, etc.), symptomatology, diagnosis (scintigraphic imaging, ultrasound contrast meal assessment, and radiopaque marker gastric motility testing), and treatment (pharmacological therapy, nutritional support, traditional Chinese medicine, and interventions targeting the pylorus, such as endoscopic surgery and surgical procedures). GP significantly impacts patients' psychological well-being and quality of life, potentially leading to psychological disorders such as anxiety and depression, and also imposes a heavy economic burden on patients and society. Therefore, this expert consensus advocates for the establishment of a multidisciplinary team diagnosis and treatment model, which will further standardize and optimize the diagnosis and treatment process of GP in our country and is crucial for improving patients' therapeutic outcomes and quality of life.
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Open Access
CONSENSUS AND GUIDELINES
Issue
Open Access
Case Report
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Primary squamous cell carcinoma of the thyroid (PSCCT) is a rare clinical disease characterized by rapid growth, high invasiveness, and a poor prognosis. A 66-year-old male patient was admitted due to throat pain and dysphagia. Ultrasound revealed a calcified hypoechoic mass in the right lobe of the thyroid gland, measuring approximately 35.3 ml. Ultrasound and PET-CT both indicated high suspicion of malignancy. The patient underwent contrast-enhanced US-guided biopsy, and the pathological results revealed poorly differentiated squamous cell carcinoma. CEUS was performed regularly during the Chemotherapy combined with pembrolizumab (PD-1) treatment courses. The vital area was significantly reduced with neither recurrence nor cervical lymph node metastasis. Surgical resection and chemotherapy combined with immunotherapy had a significant treatment effect in this case. CEUS is helpful for diagnosis confirmation, biopsy guidance and efficacy evaluation and has important clinical application value.
Open Access
Original Research
Issue
To compare the diagnostic sensitivity and consistency of ultrasound-guided attenuation parameter (UGAP) with B-mode ultrasound in nonalcoholic fatty liver disease (NAFLD) patients, and explored their correlation with clinical indicators.
Patients suspected of NAFLD from July to November 2021 were enrolled in this prospective study. After performing the B-mode ultrasound and UGAP examination, all patients were divided into four groups according to the grade of NAFLD obtained by two modalities, respectively. The diagnostic agreement of the two modalities were evaluated, and the diagnostic sensitivity was compared by the McNemar test. The correlation between clinical indicators and the attenuation coefficient (AC) of UGAP was analyzed by linear regression.
The intraclass correlation coefficient of UGAP was 0.958 (95%CI: 0.943, 0.970), while the kappa value of B-mode ultrasound grading was 0.799 (95%CI: 0.686, 0.912). The diagnostic sensitivity of UGAP was higher than that of B-mode ultrasound (99.0% vs. 32%, P < 0.001). BMI and TG can be distinguished in different grades of NAFLD diagnosed by B-mode ultrasound, while BMI, ALT, HDL, and Apo A can be distinguished in different grades of NAFLD diagnosed by UGAP. BMI (r = 0.502, P < 0.001), ALT (r = 0. 396, P < 0.001), TG (r = 0.418, P < 0.001), HDL (r = -0. 359, P < 0.001) and Apo A (r = -0.228, P = 0.020) were linearly correlated with the AC value of UGAP.
Compared with the B-mode ultrasound, UGAP had a higher sensitivity and consistency in diagnosing NAFLD, and correlated well with some laboratory indicators, which may be more valuable in screening and diagnosis of NAFLD.
Open Access
Review Article
Issue
To determine the efficacy of Doppler-based renal resistive index (RRI) in the prediction of acute kidney injury (AKI) in critically ill patients.
A systematic review and meta-analysis of cohort studies was conducted. Relevant studies were identified in PubMed, Embase and Cochrane Library from inception to November 1, 2020, and reference lists of identified primary studies. Prospective studies that examined the diagnostic accuracy of RRI in AKI were included.
Among the 126 articles identified, 18 were included, with a total of 1656 patients. Bivariate analysis yielded pooled sensitivity and specificity of 0.81 (95% CI 0.74–0.86) and 0.75 (95% CI 0.65–0.83), respectively. The summary positive likelihood ratio was 3.2 (95% CI 2.2–4.6), and negative likelihood ratio was 0.26 (95% CI 0.19–0.36).
Elevated RRI may be an early predictor of AKI in critically ill patients. Further large-scale prospective studies are needed to confirm the predictive efficacy and determine the performance and optimal cutoff value of RRI among the included studies.
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