Nianan He

OBJECTIVE: The purpose of this study was to evaluate the usefulness of a contrast-enhanced contrast-specific ultrasonographic technique with a low mechanical index for characterization of focal liver lesions. METHODS: Contrast-specific ultrasonography was used to assess 144 patients with 147 focal liver lesions: 87 primary liver carcinomas, 27 hemangiomas, 16 focal nodular hyperplasias, 5 hepatic abscesses, 3 inflammatory pseudotumors of the liver, and 9 metastases. A sulfur hexafluoride gas-based contrast agent was used with a mechanical index of 0.08 to 0.11. RESULTS: On contrast-enhanced ultrasonography, the typical hemodynamic pattern of primary liver carcinoma was the whole-lesion enhancement or mosaic enhancement in the arterial phase with an enhancement defect in the late phase (sensitivity, 92.0%; specificity, 86.7%). The most common enhancement pattern of hemangioma was that enhancement appeared in the periphery first and progressively filled into the lesion center (sensitivity, 96.3%; specificity, 97.5%). The enhancement pattern of focal nodular hyperplasia was that the whole lesion enhanced early and rapidly in the arterial phase with a centrifugal radiating configuration and appeared isoechoic or hyperechoic until the late phase (sensitivity, 87.6%; specificity, 94.5%). The central scar was detected in 31.3% of cases in the late phase. The specific enhancement of a hepatic abscess was the honeycomblike enhancement in all phases (sensitivity, 80.0%; specificity, 100%). No enhancement of a lesion in all phases was specific for an inflammatory pseudotumor of the liver. CONCLUSIONS: Contrast-enhanced real-time ultrasonography is a promising approach in the noninvasive characterization of focal liver lesions and can be useful as a first-line imaging technique clinically when a focal liver lesion is detectable on ultrasonography.

Treating biofilm infections on implanted medical devices is formidable, even with extensive antibiotic therapy. The aim of this study was to investigate whether ultrasound (US)-targeted microbubble (MB) destruction (UTMD) could enhance vancomycin activity against Staphylococcus epidermidis RP62A biofilms. Twelve-hour biofilms were treated with vancomycin combined with UTMD. The vancomycin and MB (SonoVue) were used at concentrations of 100 μg/ml and 30% (vol/vol), respectively, in studies in vitro. After US exposure (0.08 MHz, 1.0 W/cm(2), 50% duty cycle, and 10-min duration), the biofilms were cultured at 37 °C for another 12 h. The results showed that many micropores were found in biofilms treated with vancomycin combined with UTMD. Biofilm densities (A(570) values) and the viable counts of S. epidermidis recovered from the biofilm were significantly decreased compared with those of any other groups. Furthermore, the highest percentage of dead cells was found, using confocal laser scanning microscopy, in the biofilm treated with vancomycin combined with UTMD. The viable counts of bacteria in biofilms in an in vivo rabbit model also confirmed the enhanced effect of vancomycin combined with UTMD. UTMD may have great potential for improving antibiotic activity against biofilm infections.

OBJECTIVES: The aim of this study was to explore the risk factors associated with failed sonographically guided saline hydrostatic intussusception reduction in children. METHODS: We retrospectively reviewed the medical records and sonograms of 288 cases of intussusception over a 3-year period. Logistic regression was used for the analysis of the clinical data (sex, age, duration of symptoms, and presence or absence of emesis or bloody stool) and sonographic features (initial location and intussusception length, presence or absence of free peritoneal fluid, and trapped fluid in the intussusception). RESULTS: The sex, age, and duration of symptoms showed no significant impact on the hydrostatic reducibility. The success rate became significantly lower for the intussusception cases with the presence of bloody stool, free peritoneal fluid, and trapped fluid in the intussusception (P < .05). The success rate was also lower when the intussusceptions were located in the left side of the abdomen (P < .05). For the above risk factors, the odds ratios from multivariate logistic regression analysis were 174.68 for initial intussusception location in the descending colon/rectum, 36.06 for the presence of peritoneal fluid, 13.22 for trapped fluid in the intussusception, and 9.27 for the presence of bloody stool. CONCLUSIONS: An initial intussusception location in the descending colon/rectum, the presence of peritoneal fluid, trapped fluid in the intussusception, and bloody stool are the most important risk factors for failure of sonographically guided saline hydrostatic intussusception reduction.