Pingyang Zhang

Background/Objectives: The accurate preoperative risk stratification of adnexal masses is clinically important. This study compared the diagnostic performance of the International Ovarian Tumor Analysis (IOTA) Simple Rules (SR), the Assessment of Different NEoplasias in the adneXa (ADNEX) model, and the American College of Radiology Ovarian-Adnexal Reporting and Data System (ACR O-RADS). Methods: This retrospective comparative study analyzed 429 women from a selected surgical dataset with pathology restrictions at a tertiary hospital in Nanjing, China, between January 2022 and October 2024. Two experienced gynecologic ultrasonographers independently applied SR, ADNEX (test-positive at a malignancy risk ≥ 10%), and O-RADS (test-positive at categories 4–5). Surgical histopathology served as the reference standard. Diagnostic performance was evaluated using exact binomial 95% confidence intervals (CIs), paired comparisons, receiver operating characteristic (ROC) analysis, ADNEX calibration, observed malignancy proportions across O-RADS categories, and interobserver agreement. Results: Among the 429 selected index adnexal masses, 114 (26.6%) were malignant. SR produced inconclusive classifications for 81 masses (18.9%). When SR-malignant and SR-inconclusive classifications were both regarded as positive indications for referral, SR achieved a sensitivity of 83.3% (95% CI, 75.2–89.7%) and a specificity of 84.1% (95% CI, 79.6–88.0%). ADNEX achieved a sensitivity of 86.0% (95% CI, 78.2–91.8%) and a specificity of 81.9% (95% CI, 77.2–86.0%), whereas O-RADS achieved a sensitivity of 89.5% (95% CI, 82.3–94.4%) and a specificity of 83.5% (95% CI, 78.9–87.4%). The AUCs for ADNEX and O-RADS were 0.92 and 0.90, respectively, with no statistically significant difference identified by paired DeLong analysis (p = 0.16). After Holm adjustment, none of the pairwise comparisons of sensitivity or specificity reached statistical significance. ADNEX exhibited apparent overall underprediction (calibration intercept, 0.865; calibration slope, 1.022; Brier score, 0.096). For O-RADS categories 2 and 4, the point estimates of observed malignancy proportions fell outside the corresponding predefined risk ranges. Interobserver agreement was almost perfect for O-RADS (κ = 0.89) and substantial for ADNEX (κ = 0.79) and SR (κ = 0.68). Conclusions: Within this selected surgical dataset subject to pathology-based restrictions, SR, ADNEX, and O-RADS demonstrated distinct diagnostic performance profiles. Following Holm adjustment, no statistically significant differences in sensitivity or specificity were detected among the three systems. Analyses of masses receiving an inconclusive SR classification were exploratory and therefore do not establish the validity of a sequential diagnostic pathway. Prospective multicenter investigations involving unselected populations are warranted before these findings can be generalized to broader clinical populations.

Background: Ventricular pre-excitation can cause left ventricular (LV) mechanical dyssynchrony and dysfunction. However, the specific impact of accessory pathway (AP) location on LV mechanics remains incompletely characterized. This study utilized two-dimensional speckle-tracking echocardiography (2D-STE) to quantify and compare LV deformation and synchrony across these anatomical subgroups. Methods: We retrospectively analyzed 91 patients with Wolff-Parkinson-White (WPW) syndrome (age 38.2±1.4 years) and 56 matched controls using 2D-STE. Global and regional LV deformation and synchrony were compared across AP-location groups: septal (n=34), right (n=38), and left (n=19). LV deformation parameters included circumferential strain (CS), longitudinal strain (LS), and radial strain (RS). LV synchrony was assessed by peak strain dispersion (PSD) of LV segments for each strain direction. Results: All patient groups (septal: −19.0%±0.7%, right: −19.3%±0.6%, and left AP: −19.2%±0.8%) had lower global CS (GCS) compared with controls (−23.1%±0.4%, all Pvs. controls (65.0%±0.3%; PConclusions: LV mechanical dysfunction in WPW syndrome varies by AP location. Septal and right APs lead to widespread strain impairment, dyssynchrony, and lower LVEF, whereas left APs mainly reduce CS. Reduced LVEF is closely associated with impaired LV mechanics and dyssynchrony.

Despite advancements in drug-eluting stent technology, the incidence of in-stent restenosis (ISR) remains around 5–10%. The complex mechanisms of ISR are primarily based on the proliferation and migration of vascular smooth muscle cells (VSMCs). The dishevelled gene (DVL2), a component of the WNT signaling pathway, is involved in tumorigenesis. However, the role of DVL2 in ISR remains unknown. In this study, we used the rat carotid balloon injury model in vivo and PDGF-BB-treated VSMCs in vitro. Intimal hyperplasia was assessed by Hematoxylin and eosin staining. VSMCs proliferation was measured using EdU and CCK-8 assays, and migration was evaluated via transwell and Wound-healing assays. DVL2 expression was significantly increased in both balloon-injured carotid arteries and PDGF-BB-stimulated VSMCs. Knockdown of DVL2 using adeno-associated virus (AAV) effectively reduced intimal hyperplasia after balloon injury. Similarly, siRNA-mediated DVL2 silencing suppressed PDGF-BB-induced VSMCs proliferation and migration, whereas plasmid-driven DVL2 overexpression enhanced these effects. Additionally, DVL2 knockdown in PDGF-BB-stimulated VSMCs markedly upregulated the contractile markers α-smooth muscle actin and calponin. Mechanistically, DVL2 silencing inhibited β-catenin activation in PDGF-BB-treated VSMCs. Collectively, these findings demonstrated that DVL2 promoted VSMCs proliferation and migration by activating β-catenin signaling, highlighting its potential as a candidate therapeutic target for ISR.

Objective: To compare the diagnostic performance of contrast-enhanced transcranial Doppler (c-TCD) and contrast-enhanced transthoracic echocardiography (c-TTE) under resting and Valsalva conditions for detecting patent foramen ovale (PFO), and to evaluate the clinical utility of an integrated diagnostic model combining both modalities. Materials and methods: In this retrospective study, a total of 146 patients with suspected PFO underwent both c-TCD and c-TTE at rest and during the Valsalva maneuver. Among them, 40 patients also received contrast-enhanced transesophageal echocardiography (c-TEE), which served as the reference standard. Detection rates, shunt grading, and inter-modality agreement were analyzed. A logistic regression model integrating c-TCD and c-TTE findings was developed and assessed using receiver operating characteristic (ROC) curves and decision curve analysis (DCA). Results: The Valsalva maneuver significantly increased the detection rates of right-to-left shunt (c-TCD: from 41.4% to 76.7%; c-TTE: from 45.2% to 80.1%) and the proportion of Grade 3 shunts ( P < 0.0001). At rest, c-TCD detected more high-grade shunts than c-TTE ( P = 0.030), supporting its use as a sensitive initial screening tool. Inter-modality agreement improved markedly during Valsalva (weighted Kappa = 0.782). The combined model achieved 100% sensitivity and negative predictive value in the TEE subgroup, with an area under the ROC curve of 0.97 and no false negatives. DCA confirmed the superior net clinical benefit of the integrated approach across a broad range of decision thresholds. Conclusion: Valsalva maneuver significantly enhances the diagnostic yield of both c-TCD and c-TTE. While c-TCD may serve as an effective first-line screening tool, its combination with c-TTE ensures improved diagnostic accuracy and clinical decision-making value. The integrated model demonstrates strong potential for clinical implementation as a noninvasive, efficient strategy to reduce unnecessary c-TEE procedures.

(1) Background: Our aim was to evaluate left atrial (LA) volumes and function in patients with newly diagnosed, treatment-naive type 2 diabetes mellitus (T2DM) using Four-Dimensional Automated Left Atrial Quantificative (four-dimensional auto LAQ) analysis and to explore the independent factors influencing left atrial function in diabetic patients. (2) Method: A total of 62 treatment-naive, newly diagnosed T2DM patients without hypertension or obesity and 50 healthy controls were prospectively enrolled in the study. All participants underwent laboratory analyses, routine echocardiography and 4D LAQ assessment. The parameters were compared between the two groups, and independent factors influencing left atrial function in diabetic patients were investigated through univariate and multivariate linear regression analyses. (3) Results: Despite no significant difference in LA end-systolic anteroposterior diameter between groups, LA volume parameters (LAVmax, LAVmin, LAVpreA, and LAVmaxI) were significantly increased in T2DM patients (all p < 0.05). Regarding LA strain, reservoir and conduit function were significantly impaired in T2DM patients, as reflected by lower LASr, LAScd, LASr-c, and LAScd-c (all p < 0.05). Conversely, circumferential contractile strain (LASct-c) was significantly higher in the T2DM group (p = 0.029), while longitudinal contractile strain (LASct) did not differ significantly between groups (p = 0.146). Multivariate analysis revealed that HbA1c and E/e’ ratio were independently associated with multiple LA strain parameters (all p < 0.05). (4) Conclusion: Newly diagnosed, treatment-naive patients with T2DM exhibited increased LA volumes, decreased left atrial ejection fraction (LAEF), and impaired reservoir and conduit functions, accompanied by a compensatory increase in contractile function. Furthermore, HbA1c and E/e’ demonstrated an independent correlation with 4D strain parameters. 4D Auto LAQ echocardiography may serve as a sensitive tool for early detection of diabetic atrial myopathy.

Background: Non-invasive identification of coronary stenosis in stable coronary artery disease (CAD) patients lacking regional wall motion abnormalities (RWMA) remains challenging. This study aimed to develop and validate a myocardial work-derived nomogram for predicting significant coronary stenosis in these patients. Methods: In this retrospective study, 181 consecutive patients with angiographically confirmed CAD, preserved LVEF (≥55%), and no resting wall motion abnormalities were enrolled. Global myocardial work efficiency (GWE) was assessed using echocardiographic pressure–strain loop analysis. A multivariable-derived nomogram incorporating GWE and clinical biomarkers was developed and externally validated for predicting severe coronary stenosis. Results: The nomogram incorporating GWE, lipoprotein-associated phospholipase A2 (LP-PLA2), N-terminal pro brain natriuretic peptide (NT-proBNP), and serum creatinine (Scr) demonstrated favorable discrimination in both the training set (AUC 0.916, 95% CI 0.866–0.952) and validation set (AUC 0.911, 95% CI 0.853–0.951), with good calibration (mean absolute error: 1.9% vs 3.2% in training vs validation, respectively). Decision curve analysis confirmed clinical utility across all probability thresholds. Conclusions: Our nomogram provides a non-invasive tool for preoperative risk stratification and optimizes the use of invasive diagnostics in stable CAD patients without RWMA.

Background: Left atrial (LA) dysfunction is common in patients with heart failure with preserved ejection fraction (HFpEF). However, there are few reports on LA circumferential strain in this patient population. In this study, we investigated the clinical utility of four-dimensional automatic left atrial quantification (4D LAQ) technology in evaluating LA volume, function, and strain in patients with HFpEF. Methods: A total of 184 patients with suspected HFpEF and 68 healthy volunteers were recruited. According to the Heavy, Hypertensive, Atrial Fibrillation, Pulmonary Hypertension, Elder, and Filling Pressure (H₂FPEF) scale, patients were assigned to the HFpEF or non-HFpEF groups. Age- and sex-matched volunteers served as the control group. Results: Compared with the healthy controls, patients with HFpEF had a significantly higher LA minimum volume (LAVmin), LA maximum volume (LAVmax), LA presystolic volume (LAVpreA), and maximum volume index (LAVImax) (PConclusions: 4D LAQ technology can provide a noninvasive and quantitative assessment of LA volume and myocardial strain in patients with HFpEF. Among the assessed parameters, LASct-c demonstrated superior performance for assessing LA function in patients with HFpEF.

This study aimed to explore whether superficial invasive lymphomas and indolent lymphomas could be identified by Ultrasonographic vascular imaging. A retrospective study enrolled 82 lymphoma patients. According to proliferation rates and clinical course, the lymph nodes were classified as invasive and indolent lymphomatous lymph nodes. All patients underwent ultrasound (US) with three established techniques: color Doppler flow imaging (CDFI), angio plus ultrasound imaging (AngioPLUS™), and contrast-enhanced ultrasound (CEUS). Qualitative and quantitative parameters from the two groups were compared. Finally, the area under the receiver-operating characteristic (ROC) and regression analysis were used to compare the differences between the two groups and determine the diagnostic efficiency of the three techniques for differentiating invasive lymphoma from indolent lymphoma. The types of blood flow distribution between invasive and indolent lymphomatous lymph nodes were statistically different in all three Ultrasound techniques. In CDFI, invasive or indolent lymphomatous lymph nodes were determined by resistance index (RI) (p < 0.001). AngioPLUSTM offered better blood flow performance and diagnostic sensitivity than CDFI. In CEUS, the differences between the two groups in necrosis and arrival time (ATM) (p = 0.026, 0.043) were statistically significant. Finally, CDFI combined with CEUS had the highest diagnostic sensitivity of 98.1%. Interobserver agreements for qualitative parameters were all excellent. Ultrasonographic Vascular imaging is useful in identifying invasive and indolent lymphomatous lymph nodes, and CDFI combined with CEUS had the highest diagnostic sensitivity, which can guide clinicians to make more accurate diagnosis and better treatment for patients.