Objectives-Skeletal muscle dysfunction is one of the most common comorbidities in chronic obstructive pulmonary disease (COPD). The occurrence of respiratory failure in COPD is common and leads to the patient's death. The diaphragm is the most important muscle in the respiratory system and plays a key role in the onset of respiratory failure. This study explores the feasibility of ultrasound shear wave elastography (SWE) to measure diaphragmatic stiffness and evaluates its changes in COPD patients.Methods-In total, 77 participants (43 patients with stable COPD and 34 healthy controls) were enrolled. All subjects underwent complete diaphragmatic ultrasound SWE measurements and pulmonary function tests. The diaphragmatic stiffness was indicated via diaphragmatic shear wave velocity (SWV) at functional residual capacity (FRC). A trained operator performed the ultrasound SWE examinations of the first 15 healthy controls thrice to assess the reliability of diaphragmatic SWE.Results-A good to excellent reliability was found in diaphragmatic SWV at FRC (ICC = 0.93, 95%CI 0.82-0.98). As compared to the control group, the diaphragmatic SWV at FRC was considerably high in the COPD group (median 2.5 m/s versus 2.1 m/s, P = .008). Diaphragmatic SWV at FRC was linked to forced expiratory volume in one second (r = −0.30, P = .009), forced vital capacity (r = −0.33, P = .003), modified Medical Research Council score (r = 0.30, P = .001), and COPD assessment test score (r = 0.48, P < .001).Conclusions-Ultrasound SWE may be employed as an effective tool for quantitative evaluation of diaphragm stiffness and can help in personalized management of COPD, such as treatment guidance and follow-up monitoring.

Surgical resection remains the preferred approach for some patients with glioblastoma (GBM), and eradication of the residual tumour niche after surgical resection is very helpful for prolonging patient survival. However, complete surgical resection of invasive GBM is difficult because of its ambiguous boundary. Herein, a novel targeting material, c(RGDyk)-poloxamer-188, was synthesized by modifying carboxyl-terminated poloxamer-188 with a glioma-targeting cyclopeptide, c(RGDyk). Quantum dots (QDs) as fluorescent probe were encapsulated into the self-assembled c(RGDyk)-poloxamer-188 polymer nanoparticles (NPs) to construct glioma-targeted QDs-c(RGDyk)NP for imaging-guided surgical resection of GBM. QDs-c(RGDyk)NP exhibited a moderate hydrodynamic diameter of 212.4 nm, a negative zeta potential of-10.1 mV and good stability. QDs-c(RGDyk)NP exhibited significantly lower toxicity against PC12 and C6 cells and HUVECs than free QDs. Moreover, in vitro cellular uptake experiments demonstrated that QDs-c(RGDyk)NP specifically targeted C6 cells, making them display strong fluorescence. Combined with ultrasound-targeted microbubble destruction (UTMD), QDs-c(RGDyk)NP specifically accumulated in glioma tissue in orthotropic tumour rats after intravenous administration, evidenced by ex vivo NIR fluorescence imaging of bulk brain and glioma tissue sections. Furthermore, fluorescence imaging with QDs-c(RGDyk)NP guided accurate surgical resection of glioma. Finally, the safety of QDs-c(RGDyk)NP was verified using pathological HE staining. In conclusion, QDs-c(RGDyk)NP may be a potential imaging probe for imaging-guided surgery.

In this study, the utility of point-of-care lung ultrasound for the clinical classification of coronavirus disease (COVID-19) was prospectively assessed. Twenty-seven adult patients with COVID-19 underwent bedside lung ultrasonography (LUS) examinations three times within the first two weeks of admission to the isolation ward. We divided the 81 exams into three groups (i.e., moderate group, severe group, and critically ill group). Lung scores were calculated as the sum of points. A rank sum test and bivariate correlation analysis were carried out to determine the correlation between LUS on admission and the clinical classification of COVID-19. There were dramatic differences in LUS (p<0.001) among the three groups, and LUS scores (r=0.754) correlated positively with clinical severity (p<0.01). In addition, moderate, severe, and critically ill patients were more likely to have low (≤9), medium (9-15), and high scores (≥15), respectively. This study provides stratification criteria of LUS scores to assist in quantitatively evaluating COVID-19 patients.

Both two-dimensional (2D) and three-dimensional (3D) echocardiography can be used in the early diagnosis of myocardial toxicity in patients with anthracycline chemotherapy. However, there are few studies on the detection of early myocardial damage in specific regions. This study compared the role and significance of 2D strain and 3D strain in discovering early segmental dysfunction. We prospectively studied 56 breast cancer patients who received anthracycline therapy. The mean age of patients was 47.6 ± 8.1 years. They all received 4-6 cycles of chemotherapy. Before chemotherapy and after every two cycles, patients underwent standard echo, 2D and 3D speckle-tracking echocardiography (STE) and real-time three-dimensional echocardiography (RT-3DE). Compared with the baseline value (T0), 3D GLS was significantly reduced after two cycles (T2) (P<0.05), after four cycles (T4) 3D GCS was significantly reduced (P<0.05), after six cycles (T6) 2D derived EF, 2D GLS, E/e' ratio, Fractional shortening (FS), 3D derived EF, 3D GAS, GRS were considerably decreased (P<0.05). The area supplying blood from the anterior descending branch of the left coronary artery was the most susceptible to chemotherapy, and 3D GLS was found earlier than 2D GLS which was decreased considerably after two cycles (P<0.05). In anthracycline chemotherapy patients, some regions of early myocardial dysfunction may be more easily involved, through the evaluation of 2D and 3D echocardiography, 3D speckle tracking echocardiography may be more able to identify the involved segments of myocardium early. Moreover, the apical segments of the left ventricle seem to be more susceptible to cardiotoxicity.