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Objective:To analyse the changes in color Doppler and contrast-enhanced ultrasound (CEUS) blood flow parameters in patients with septic acute kidney injury (AKI) from the perspective of macroscopic circulation and microscopic circulation perfusion, in order to explore the value of clinical application of ultrasound in this disease.Methods:A total of 53 ICU-admitted patients diagnosed with septic AKI at the Second Affiliated Hospital of Soochow University from January 2021 to May 2022 were selected.Patients with septic AKI were classified into stages 1-3 according to the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) AKI diagnostic criteria, with stage 1 being the mild group(17 cases), stages 2 and 3 being the severe group(21 cases), and septic patients without AKI in the same period being the control group(15 cases). The ultrasound parameters such as the relative blood flow(RBF) and time-averaged velocity(TAV) of the renal artery as well as the cardiac output (CO) and cardiac index (CI) in the macroscopic circulation were measured, and the time-intensity curve was analysed by the CEUS analysis software to calculate the microscopic parameters such as time to peak(TTP), rise time(RT), fall half time(FHT) and mean transit time(MTT), and the cardiac output and cardiac index were also measured. The differences in ultrasound Doppler and CEUS parameters among the various groups were compared. The diagnostic effectiveness of each parameter for severe AKI was assessed using ROC curve analysis.Results:①In macrocirculation, the renal blood flow (RBF) and time-averaged velocity (TAV) gradually decreased ( P=0.004, P<0.001) as the disease progressed in AKI patients. But the difference of CO and CI among the three groups were not statistically significant in each group ( P=0.17, 0.12). ②In microcirculation, the renal interlobar artery Doppler parameters pulsatility index (PI), resistance index (RI), and systolic/diastolic flow ratio (S/D) gradually increase in patients with septic AKI ( P<0.05) and the CEUS parameters TTP, RT, FHT and MTT were prolonged ( P<0.001, P=0.003, P=0.004, P=0.009). ③The combined diagnosis of RI and TTP was more beneficial in diagnosing septic AKI in critically ill patients [AUC=0.93(0.85-1.00)]. Conclusions:Color Doppler ultrasound combined with CEUS can detect reduced macroscopic and microscopic circulation in patients with septic AKI, especially in those with severe AKI, and this is independent of changes in CO or CI.
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A 77-years-old female patient presented gross hematuria for one week, and CT showed a mass in the left kidney. Ureteroscopy detected a left renal mass. Laparoscopic nephroureterectomy was performed and pathology showed the tumor was mainly located in the renal parenchyma, with glomeruli around the tumor cells. Urothelium showed no obvious dysplasia or clear migration of tumor cells. Considering both the clinical symptoms, and squamous cell carcinoma not detecting in other locations of the patient, primary renal parenchyma was confirmed. Three months after surgery, CT detected recurrence in the operating area, with metastasis to the adjacent abdominal cavity and aorta lymph node.
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[Objective]To assess the efficacy and safety of low intensity pulsed ultrasonography for fractures.[Methods]According to Cochrane Systematic Review,Medline,EMBASE,Cochrane Library,CNKI and CBM were searched for RCTs,and gray literature were also searched.Furthermore,the bibliographies of retrieved papers and content experts were consulted for additional references.The quality of included studies was critically evaluated.Data analyses were performed with the Cochrane Collaboration's RevMan 5.0 software.[Results]Ten randomized controlled trials with total of 452 patients met the included criteria.The meta-analysis showed treatment with a low-intensity pulsed ultrasound signal can reduce healing time compared with the placebo group(RR=1.43,95% CI[1.15,1.79]P=0.001).[Conclusion]Treatment with a low-intensity pulsed ultrasound signal can reduce healing time.Some trials included in the review were of poor quality.Multi-center,large-scale randomized controlled trials of higher quality are needed to support our results.