Yukun Luo

Peripheral nerve regeneration requires coordinated structural, biochemical, and bioelectrical regulation, whereas conventional nerve guidance conduits (NGCs) provide static microenvironments that poorly accommodate the evolving requirements of nerve repair. Here, we developed a spatiotemporally programmed and mechanoelectrically active NGC by integrating a small intestinal submucosa-derived extracellular matrix (SIS-ECM) outer conduit with a longitudinally graded gelatin methacrylate (GelMA) intraluminal scaffold. GelMA networks with different degrees of methacrylation were spatially organized along the conduit, generating region-dependent pore architectures and degradation behaviors that enabled temporally staggered release of nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), and glial cell line-derived neurotrophic factor (GDNF). Meanwhile, incorporation of BaTiO3 (BT) nanoparticles endowed the GelMA scaffold with stable, tunable, and force-responsive electromechanical properties, allowing mechanical deformation to be converted into localized electrical signals. In vitro, ultrasound-activated mechanoelectrical stimulation significantly enhanced βIII-tubulin expression and neurite elongation in PC12 cells, while combined neurotrophic-factor treatment promoted neuronal differentiation. In a 10-mm rat sciatic nerve defect model, the GelMA/BT-AF conduit markedly improved locomotor recovery, plantar weight bearing, nerve conduction, and target muscle reinnervation, with several functional outcomes approaching those achieved by autologous nerve grafting. Histological analyses demonstrated enhanced axonal regeneration, Schwann cell-associated reconstruction, myelinated fiber maturation, and remyelination throughout the repaired nerve segment. This study established a biomimetic NGC in which scaffold degradation programs biochemical signaling while mechanical deformation activates electrical signaling, thereby creating a dynamic regenerative microenvironment that supports structural reconstruction and functional recovery after peripheral nerve injury.

Objectives: To develop a modified American College of Radiology (ACR) thyroid imaging, reporting and data system (TI‐RADS) incorporating contrast‐enhanced ultrasound (CEUS) features and nodule location to improve diagnostic performance and fine‐needle aspiration (FNA) recommendations for ACR TR4 or higher thyroid nodules. Methods: This prospective study enrolled patients who underwent ultrasound and CEUS at 3 hospitals between June 2024 and January 2026. CEUS and location features were analyzed using multivariable logistic regression to construct the modified system. Diagnostic performance and biopsy recommendation efficiency were compared with ACR TI‐RADS. Results: Four hundred and eight patients with 442 nodules were included. Independent predictors included enhancement intensity, enhancement direction, ring enhancement, enhancement area and nodule location. In the training set ( n = 334), the modified system achieved higher AUC and sensitivity than ACR TI‐RADS (AUC: 0.90 [95% CI: 0.86–0.93] versus 0.75 [95% CI: 0.71–0.79]; sensitivity: 88.5% versus 60.3%; p < .01), higher accuracy of malignant nodule biopsies (AMB: 67.1% versus 49.4%), lower unnecessary biopsy rate (UBR: 32.9% versus 50.6%), and lower biopsy rate of benign nodules (BRB: 20.8% versus 31.2%), with no unsafe downgrading. Similar results were observed in the temporal validation set ( n = 108): AUC 0.95 (95% CI: 0.90–0.99) versus 0.73 (95% CI: 0.66–0.79); sensitivity 87.0% versus 49.3%; AMB 83.3% versus 53.3%; UBR 16.7% versus 46.7%, and BRB 5.1% versus 17.9%. Conclusions: A modified ACR TI‐RADS integrating CEUS features and nodule location improved diagnostic performance and FNA recommendations for ACR TR4 or higher nodules. Pending external validation, this system may provide a practical approach for refining risk stratification and reducing unnecessary biopsies.

Background: The similar imaging characteristics of renal angiomyolipoma without visible fat (RAML.wvf) and clear cell renal cell carcinoma (ccRCC) are notable. Color Parameter Imaging (CPI) has emerged as an advanced contrast‐enhanced ultrasound (CEUS) analysis tool that quantifies temporal perfusion dynamics. Objective: Evaluate the diagnostic value of CPI in distinguishing AML.wovf from ccRCC. Methods: In this prospective study, 88 patients (35 with AML and 53 with ccRCC) underwent CEUS and CPI. Junior and senior radiologists independently analyzed the CEUS and CPI images. Three diagnostic approaches were compared: (1) CPI alone, (2) CEUS alone, and (3) CEUS combined with CPI. The diagnostic sensitivity, specificity, accuracy, and receiver operating characteristic (ROC) curves of resident and staff radiologists were analyzed. Results: The CPI features of ccRCC and AML.wovf analyzed by the junior and senior radiologist groups showed significant differences: the mosaic sign and the Cold sign (both p < 0.001) were more indicative of AML.wovf, whereas the Warm sign was more suggestive of ccRCC (both p < 0.05). The area under the curve (AUC) for the combined CEUS+CPI diagnosis in the junior radiologist group was higher than that for CEUS alone ( p = 0.012). Regarding diagnostic confidence between the two radiologist groups, the proportion of uncertain cases in the CPI group was significantly lower than in the CEUS group for both the senior radiologist group and the junior radiologist group (both p < 0.05). Conclusion: CPI technology can enhance the diagnostic performance of contrast‐enhanced ultrasound in differentiating ccRCC from AML.wovf, particularly offering an advantage in improving the diagnostic accuracy of junior radiologists.

To investigate the clinical value of Doppler ultrasound in the rapid evaluation of therapeutic efficacy of angioplasty and prediction of recurrence in patients with Budd-Chiari syndrome (BCS). A retrospective study was conducted on BCS patients who underwent angioplasty at our hospital between January 2015 and December 2024. Ultrasound examinations were performed preoperatively and within 7 days postoperatively to compare changes in ultrasound parameters. Follow-up ultrasounds were conducted postoperatively. Differences in ultrasound parameters between recurrence and non-recurrence groups were analyzed to identify indicators for the rapid evaluation of recurrence. Cox regression analysis was used to identify independent risk factors for recurrence. A total of 99 patients (51 males, 48 females; mean age 39.38 ± 12.20 years) were included. Postoperative ultrasound showed significant increases in portal vein (PV) diameter (p = 0.019) and velocity (p < 0.001), while caudate lobe thickness (p = 0.016), spleen length (p = 0.004), spleen thickness (p = 0.012), and ascites depth (p < 0.001) decreased. During follow-up, PV velocity slightly decreased in the non-recurrence group (25.1 cm/s vs 28.3 cm/s, p = 0.018), while it significantly declined in the recurrence group (21.4 cm/s vs 30.2 cm/s, p < 0.001). The median velocity decline was greater in the recurrence group (-7 cm/s vs -1 cm/s, p = 0.003). Multivariate Cox regression identified postoperative paraumbilical vein dilation (HR: 2.970, 95% CI: 1.232-7.156, p = 0.015) and preoperative high D-dimer levels (HR: 1.258, 95% CI: 1.079-1.466, p = 0.003) as independent risk factors for recurrence. Doppler ultrasound is a valuable tool for the rapid evaluation of hepatic drainage during follow-up, particularly through monitoring PV velocity. Postoperative paraumbilical vein dilation may serve as a predictive marker for future recurrence. Question Evaluating angioplasty efficacy in BCS is complex and time-consuming, while predicting recurrence with Doppler ultrasound is challenging. Findings During follow-up, ultrasound monitoring of portal vein flow velocity reflects hepatic drainage, while postoperative paraumbilical vein dilation was an independent risk factor for recurrence. Clinical relevance Doppler ultrasound allowed for rapid evaluation of postoperative hepatic drainage in BCS patients during follow-up, optimizes examination protocols, predicts future vascular recurrence, and establishes a foundation for individualized follow-up and treatment.

To evaluate the clinical outcomes of thermal ablation (TA) for subcapsular papillary thyroid microcarcinoma (PTMC) and compared them with those of intraparenchymal PTMC. Patients with unifocal, clinical node-negative PTMC who underwent TA at three institutions between July 2015 and December 2021 were enrolled. Patients were divided into the subcapsular group (PTMC ≤ 2 mm from the capsule) and the intraparenchymal group (PTMC > 2 mm from the capsule). Propensity score matching (PSM) was used to balance between-group confounders. Primary outcomes were disease progression and disease-free survival (DFS); secondary outcomes included post-ablation lesion volume, volume reduction rate (VRR), cumulative tumor disappearance rate, and complications. A total of 209 and 288 patients were included in the subcapsular and intraparenchymal groups, respectively. During a mean follow-up of 48.4 months, the overall disease progression was 3.4%. Multivariate Cox regression analysis showed no association between subcapsular location and disease progression after adjusting for tumor volume, thyroid-stimulating hormone level, and ablation modality (HR = 1.3 [0.5, 3.5], p = 0.59). After 1:1 PSM, no significant differences between the subcapsular and intraparenchymal groups were observed in primary outcomes (disease progression: 4.3% vs. 3.8%; 5-year DFS rate: 93.2% vs. 93.9%, p = 0.82) or secondary outcomes (complication rate: 1.6% vs. 1.1%; latest volume: 0 mm³ vs. 0 mm³; latest VRR: 99.8% vs. 99.9%; cumulative tumor disappearance rate: 98.9% vs. 99.5%) (all p > 0.05). For eligible subcapsular PTMC patients, TA achieves 4-year clinical outcomes comparable to those of intraparenchymal PTMC cases, warranting further prospective investigations.

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.