Sentinel lymph node metastasis (SLNM) is a crucial predictor for breast cancer treatment and survival. This study was designed to propose deep learning (DL) models based on grayscale ultrasound, color Doppler flow imaging (CDFI), and elastography images, and to evaluate how DL radiomics can be used to classify SLNM in breast cancer. Clinical and ultrasound data of 317 patients diagnosed with breast cancer at the Second Affiliated Hospital of Nanchang University were collected from January 2018 to December 2021 and randomly divided into training and internal validation cohorts at a ratio of 7:3. An external validation cohort comprising data from Nanchang Third Hospital with 42 patients collected. Three DL models, namely DL-grayscale, DL-CDFI, and DL-elastography, were proposed to predict SLNM by analyzing grayscale ultrasound, CDFI, and elastography images. Three DL models were compared and evaluated to assess diagnostic performance based on the area under the curve (AUC). The AUCs of the DL-grayscale were 0.855 and 0.788 in the internal and external validation cohorts, respectively. For the DL-CDFI model, the AUCs were 0.761 and 0.728, respectively. The diagnostic performance of DL-elastography was superior to that of the DL-grayscale and DL-CDFI. The AUC of the DL-elastography model was 0.879 in the internal validation cohort, with a classification accuracy of 86.13%, sensitivity of 91.60%, and specificity of 82.79%. The generalization capability of DL-elastography remained high in the external cohort, with an AUC of 0.876, and an accuracy of 85.00%. DL radiomics can be used to classify SLNM in breast cancer using ultrasound images. The proposed DL-elastography model based on elastography images achieved the best diagnostic performance and holds good potential for the management of patients with SLNM.

This study aimed to detect early changes in left ventricular systolic function in Beagle dogs after radiotherapy using two-dimensional speckle tracking echocardiography and to explore its potential value in evaluating radiation-induced heart disease. Thirty-six Beagle dogs were randomized into a control group (n = 18) and an irradiation group (n = 18). The irradiation group received a single dose of 20 Gy to the left ventricular anterior wall, while controls underwent sham irradiation. Conventional echocardiography and 2D speckle tracking echocardiography were performed at baseline and 3, 6, and 12 months post-procedure. Additionally, six dogs were randomly selected from each group and euthanized at 3-, 6-, and 12-month post-irradiation, and their hearts were collected for histopathological testing. In the irradiation group, the global longitudinal strain of the left ventricle and regional strain in the irradiated area were significantly reduced versus baseline and controls by 3 months, with progressive decline at 6 and 12 months. Strain reduction correlated spatially with pathological injury. Conversely, there were no substantial differences in conventional echocardiographic parameters between the groups after 3 months. Conventional parameters (e.g., LVEF) showed differences only at later timepoints. Histopathology revealed progressive cardiomyocyte damage, fibrosis, and microvascular injury in irradiated regions, extending to the posterior wall by 12 months. Two-dimensional speckle tracking echocardiography-derived strain parameters spatially correlate with radiation-induced pathological changes and detect subtle systolic dysfunction prior to irreversible remodeling. Speckle tracking may localize regions of peak radiation dose delivery.

Background: Metabolic dysfunction-associated fatty liver disease (MAFLD) is highly prevalent in type 2 diabetes mellitus (T2DM) and may contribute to early myocardial dysfunction. The Fibrosis-4 (Fib-4) index is a reliable marker of hepatic fibrosis, and the triglyceride-glucose (TyG) index is an effective indicator of insulin resistance (IR). Both are linked to various cardiovascular diseases (CVDs).However, their combined impact on subclinical left ventricular dysfunction (SLVD) remains unclear. This study aimed to explore the associations between hepatic fibrosis, IR, and SLVD in T2DM patients. Methods: We enrolled 270 T2DM patients between September 2024 and April 2025.MAFLD was diagnosed by ultrasonography, hepatic fibrosis was assessed using the Fib-4 index, and insulin resistance was estimated using the TyG index formula. Left Ventricular Global Longitudinal Strain (LV GLS) was measured by speckle-tracking echocardiography, with SLVD defined as absolute value of LV GLS <18%. T2DM patients were divided into three groups based on the presence of MAFLD and Fib-4 <1.3 or ≥1.3: non-MAFLD, MAFLD+Fib-4<1.3, and MAFLD+Fib-4≥1.3, and further stratified by the TyG median. Multivariable logistic regression models were used to evaluate the independent and interactive associations of Fib-4 index and TyG index with SLVD. Results: Compared to non-MAFLD patients, T2DM patients with MAFLD were younger, had a shorter duration of diabetes, and exhibited worsened lipid profile, with higher TyG values and lower LV GLS. MAFLD independently predicted SLVD (adjusted OR = 3.21, 95% CI: 1.64–6.29). Even in patients with Fib-4 <1.3, MAFLD was associated with higher SLVD risk (OR = 2.94), while advanced fibrosis further increased SLVD risk (OR = 3.68). TyG independently predicted SLVD (adjusted OR = 2.73, 95% CI: 1.48–5.03). Importantly, patients with both high Fib-4 (≥1.3) and high TyG (≥9.03) had the greatest SLVD risk (OR = 7.58), whereas advanced fibrosis alone was not significant. Conclusions: Fib-4 index and TyG index are independent predictors of SLVD in T2DM, and their coexistence exerts a synergistic effect. Combined assessment provides a simple, non-invasive tool for early risk stratification, highlighting the clinical importance of the liver–heart axis in identifying SLVD.

Our study aimed to elucidate the impact of sodium-glucose cotransporter-2 inhibitor on left ventricular systolic function using global longitudinal strain in type 2 diabetes mellitus patients and to assess its protective effect depending on disease duration. Type 2 diabetes mellitus patients treated at our institute were included. According to whether sodium-glucose cotransporter-2 inhibitor was used in drug treatment, the patients were divided into SGLT2i group and control group, and propensity score matching was performed. For subgroup analysis, patients were further classified based on disease duration (1–5 years, 5–10 years, and 10–20 years). A total of 256 patients with type 2 diabetes mellitus were enrolled. Significantly better global longitudinal strain results were observed at the 6-month follow-up in the SGLT2i group than those of the control group and its baseline (p < 0.001). A significantly lower proportion of subclinical cardiac dysfunction was observed in the SGLT2i group (p < 0.001). Significantly greater global longitudinal strains were observed in the SGLT2i subgroups compared with control subgroups (p all < 0.05). Furthermore, sodium-glucose cotransporter-2 inhibitor use and epicardial adipose tissue thickness change were independently associated with global longitudinal strain change according to multivariate analysis. Sodium-glucose cotransporter-2 inhibitor significantly improved left ventricular function in type 2 diabetes mellitus patients without cardiovascular complications, regardless of disease duration, with more prominent outcomes observed in patients with early-stage disease.

Purpose: The established association between endothelial dysfunction and the pathogenesis of cardiovascular disease in diabetic individuals has been well-documented. Interleukin-35 (IL-35) can suppress inflammatory processes and ameliorate endothelial dysfunction. This study aimed to evaluate the effect of IL-35 treatment on diabetic mice with diabetes-induced cardiac injury using layer-specific strain analysis. Patients and Methods: Twenty-six mice were allocated into three groups: the control group (CON, n=10), the diabetic group (DM, n=10), and the diabetic group treated with IL-35 (DMIL, n=6). The DM and DMIL groups were subjected to a high-fat diet and streptozotocin to induce diabetes, with the DMIL group receiving an additional 6 weeks of IL-35 treatment. Measurements of body weight, blood glucose levels, routine echocardiographic parameters, and layer-specific strain were conducted at baseline, post-diabetes induction, and post-treatment. Morphological changes in cardiomyocytes were examined in pathological heart sections, and cardiac inflammation was detected by protein immunoblotting. Results: After inducing diabetes, diabetic mice exhibited notable systolic and diastolic dysfunction. IL-35 treatment significantly reduced myocardial inflammatory infiltration and improved myocardial fibrosis in the DMIL group in comparison to the DM group. Only diastolic function E/e’ showed a significant improvement when comparing conventional echocardiograms between the DMIL and DM groups. In the context of layered strain analysis, the DMIL group exhibited a notable enhancement in middle and epicardial global longitudinal strain and global radial strain when compared to the DM group. Conclusion: IL-35 can enhance myocardial function in diabetic mice. Layer-specific strain could serve as a valuable tool for evaluating interventions in diabetes.

Background: Adverse cardiovascular events due to radiation-induced heart disease (RIHD) have become the leading cause of death in cancer survivors, and early screening for RIHD has become an important clinical issue. Our objective was to determine the utility of three-dimensional speckle tracking echocardiography (3D-STE) for detecting RIHD. Methods: According to inclusion and exclusion criteria, patients with lung cancer who received radiotherapy in our hospital for the first time were recruited as subjects. All subjects underwent the conventional echocardiography and 3D-STE examination at six time points (1 day before radiotherapy, 2.5–3 and 5–6 weeks after beginning radiotherapy, and 3-, 6- and 12-month after ending radiotherapy). Routine electrocardiogram, serum cardiac troponin I (cTnI) and clinical data were detected simultaneously. Results: A total of 105 patients with lung cancer were included in the study. Conventional echocardiography found a small amount of pericardial effusion occurred in 8 subjects at 5–6 weeks after beginning radiotherapy. 3D-STE showed that, compared with before radiotherapy, the absolute values of global longitudinal strain (GLS) and global strain (GS) were significantly decreased at 5–6 weeks after beginning radiotherapy (P_GLS<0.001, P_GS=0.002), and the absolute values of GLS, global radial strain, global circumferential strain, GS were gradually decreased further at 3-, 6- and 12-month after ending radiotherapy (P<0.001). Electrocardiograph showed that 32 subjects had electrocardiograph abnormalities during radiotherapy and 3 had electrocardiograph abnormalities at 3-month after ending radiotherapy, and most returned to normal within 6 months after ending radiotherapy. Conclusions: Patients with lung cancer undergoing radiation therapy have shown a decrease in the function of the left ventricle of the heart while receiving treatment. Combining the assessment of cTnI with GLS can enhance the early detection of radiation-induced heart damage.