Abnormal Ultrasonographic Findings Research Articles

Effects of customized insoles with medial wedges on lower extremity kinematics and ultrasonographic findings in plantar fasciitis persons

The customized insole is widely recommended as an effective intervention for pain reduction and foot function improvement in plantar fasciitis persons. However, it is unclear whether the additional correction of medial wedges could change the kinematics from the only insole. The objectives of this study were thus to compare customized insoles with and without medial wedges on lower extremity kinematics during gait and to determine the short-term effects of the customized insole with medial wedges on pain intensity, foot function, and ultrasonographic findings in plantar fasciitis persons. A within-subject, randomized, crossover design within motion analysis research laboratory was conducted among 35 persons with plantar fasciitis. Main outcome measures included joint motions of the lower extremity and multi-segment foot, pain intensity, foot function, and ultrasonographic findings. The customized insole with medial wedges produced less knee motion in the transverse plane and hallux motion in all planes during the propulsive phase than that without medial wedges (all p < 0.05). After the 3-month follow-up, the insoles with medial wedges decreased pain intensity and increased foot function. Abnormal ultrasonographic findings also decreased significantly after the 3-month treatment of insoles with medial wedges. Customized insoles with medial wedges seem superior to those without medial wedges on both multi-segment foot motion and knee motion during propulsion. Positive outcomes from this study supported the use of customized insoles with medial wedges as an effective conservative treatment in patients with plantar fasciitis.Trial registration: TCTR20210928006 (28/09/2021).

Noninvasive prenatal testing, ultrasonographic findings and poor prenatal diagnosis rates for twin pregnancies: a retrospective study

BackgroundNoninvasive prenatal testing (NIPT) is increasingly used in the clinical prenatal screening of twin pregnancies, and its screening performance for chromosomal abnormalities requires further evaluation. For twin pregnancies with indications for prenatal diagnosis, there is a lack of clinical data to assess the prenatal diagnosis rate (PDR). The aim of this study was to evaluate the screening performance of NIPT for foetal chromosomal abnormalities in twin pregnancies and the PDR in the second and third trimesters.MethodsUltrasound scans were carried out for all twin pregnancies between 11 and 13+ 6 gestational weeks. For twin pregnancies with nuchal translucency thickness˂3.0 mm and no foetal structural malformations, NIPT was performed after blood sampling, followed by routine ultrasound monitoring. Women with twin pregnancies who underwent NIPT at the prenatal diagnostic centre of Xiangya Hospital from January 2018 to May 2022 were included in the study. Genetic counselling was offered to each pregnant woman when the NIPT result indicated a high risk of abnormalities or abnormal ultrasonographic (USG) findings were detected. We followed up twin pregnancies for NIPT results, USG findings, prenatal diagnosis results and pregnancy outcomes.ResultsIn 1754 twin pregnancies, the sensitivity, specificity and positive predictive value of NIPT for trisomy 21 were 100%, 99.9% and 75%, and the corresponding values for sex chromosome aneuploidy (SCA) were 100%, 99.9% and 50%, respectively. For the 14 twin pregnancies for which the NIPT results indicated a high risk of abnormalities, the PDR was 78.6% (11/14). For the 492 twin pregnancies for which the NIPT results indicated a low risk of abnormalities, the rate of USG findings in the second and third trimesters was 39.4% (194/492); of these pregnancies, prenatal diagnosis was recommended for 16.7% (82/492), but it was actually performed in only 8.3% (41/492), and the PDR was 50% (41/82). There was no significant difference in the PDR between the NIPT high-risk and low-risk groups.ConclusionsThe screening performance of NIPT for SCA in twin pregnancies needs to be further evaluated. When abnormal NIPT results or USG findings are used as the main prenatal diagnostic indicator in the second and third trimesters, the PDR is poor.

Renal Ultrasonography Findings in Cats with Feline Infectious Peritonitis

Feline infectious peritonitis (FIP) is a fatal disease caused by a mutated feline enteric coronavirus (FECV) that causes a wide diversity of clinical findings. Antemortem diagnosis may be challenging as the non-effusive form causes pyogranulomatous inflammation in various organs including the eye, brain, omentum, liver and kidney compared to the effusive form. Since it has been discussed that the kidney is the organ most susceptible to FIP-related lesion development, this study aimed to evaluate the renal ultrasonography findings in cats with naturally developed non-effusive FIP. Clinical and renal ultrasonographic examinations of 17 cats with compatible clinical findings that would suggest the presence of non-effusive FIP were performed with the appropriate protocol. Both cats’ kidneys were evaluated for echogenicity, size (longitudinal length), shape, presence of free fluid, if any, and echogenicity of this fluid. As a result of renal ultrasonography, it was observed that the most prominent abnormal ultrasonographic findings were cortical hyperechogenicity (11 out of 17 cats), medullary rim sign (11 out of 17 cats), renomegaly (10 out of 17 cats), pyelectasis (5 out of 17 cats), loss of corticomedullary differentiation (4 out of 17 cats) and distortion of internal architecture (4 out of 17 cats). In conclusion, it was observed that morphological and parenchymal alterations occur in the renal ultrasonographic evaluation in cats with non-effusive FIP, and renal ultrasonography could provide useful clinical information in evaluating the clinical reflection of vasculitis due to FIP. Although these abnormal renal ultrasonography findings were not specific for FIP, it was concluded that the combination of the observed ultrasonographic findings and other compatible clinical findings and their evaluation together can be used to increase the index of suspicion for antemortem FIP infection.

The diagnostic efficiency of whole-body bedside ultrasonography protocol for syncope patients in the emergency department

BackgroundThe emergency physician should diagnose and treat the critical illnesses that cause syncope/presyncope in patients presenting to the emergency department (ED). Whole-body ultrasonography can detect the critical etiology of syncope with high diagnostic sensitivity. We aimed to reveal whether whole-body ultrasonography for syncope (WHOBUS-Syncope) protocol recognizes high-risk syncope patients and the effect of WHOBUS-Syncope protocol on the management of patients. MethodThis is a prospective, cross-sectional study. Patients over the age of 18 years who presented to the ED with syncope or near syncope were included consecutively. Carotid, lung, cardiac, collapsibility of inferior vena cava, abdominal and compression ultrasonography of the lower extremity veins was performed among the WHOBUS-Syncope protocol. Frequency of abnormal sonographic findings associated with syncope/presyncope and requirement of critical intervention for abnormal sonographic findings were assessed. Results152 patients were included in the study. The median age of the patients was 61.5 years (IQR: 41–71.8) and 52.6% were female. The most common (64.3%) abnormal sonographic finding was >50% collapse of vena cava inferior during inspiration. In addition, abnormal sonographic findings thought to cause syncope/presyncope were detected in 35.5% of the patients. Bolus fluid resuscitation were given in in 62 patients (40.8%) with increased inferior vena cava collapse. Critical interventions other than fluid resuscitation were performed for abnormal sonographic findings in 35 (23%) of the patients. Advanced age, increased heart rate and the presence of high-risk criteria in the ‘European Society of Cardiology Guidelines for Syncope’ were independent risk factors for detection of abnormal ultrasonographic findings related to syncope/presyncope. ConclusionWHOBUS-Syncope protocol can be included in emergency practice as part of the standard evaluation in patients with syncope or presyncope presenting to the ED.

Prevalence of Abnormal Ultrasonographic Findings in Asymptomatic Peroneal Tendons

The peroneus longus (PL) and peroneus brevis (PB) tendons comprise the lateral compartment of the leg and stabilize the foot during weightbearing. Peroneal tendinopathy can precipitate lateral ankle pain and induce functional disability. The progression of peroneal pathology to lateral ankle dysfunction is thought to stem from asymptomatic, subclinical peroneal tendinopathy. There may be clinical benefit to identifying asymptomatic patients with this condition before progression to disability. Various ultrasonographic characteristics have been observed in peroneal tendinopathy. The purpose of this study is to identify the frequency of subclinical tendinopathic characteristics in asymptomatic peroneal tendons. One hundred seventy participants underwent bilateral foot and ankle ultrasonographic examination. Images were assessed for abnormalities of the PL and PB tendons by a group of physicians who recorded frequencies of abnormalities. This team consisted of an orthopaedic surgeon specializing in foot and ankle surgery, a fifth-year orthopaedic surgery resident, and a family medicine physician with musculoskeletal sonographer certification. A total of 340 PL and 340 PB tendons were assessed. Sixty-eight (20%) PL and 41 (12.1%) PB tendons had abnormal traits. Twenty-four PLs and 22 PBs had circumferential fluid, 16 PLs and 9 PBs had noncircumferential fluid, 27 PLs and 6 PBs had thickening, 36 PLs and 12 PBs had heterogenicity, 10 PLs and 2 PBs had hyperemia, and 1 PL had calcification. In Caucasian participants, male gender was associated with increased frequency of abnormal findings, but there were no other significant differences based on age, body mass index, or ethnicity. In our studied population of 170 patients who had no complaints of associated symptoms, we found that 20% of PLs and 12% of PBs displayed ultrasonographic abnormalities. When we included all unusual findings within and around the tendons, prevalence rates of ultrasonographic abnormalities were 34% for PLs and 22% for PBs. Level II, prospective cohort study.

Placental Abruption with Subamniotic Hemorrhage: A Case Report

Background: Subamniotic hemorrhage is a rare lesion with abnormal ultrasonographic findings that is caused by placental abruption. We report the case of a patient with placental abruption who presented with antepartum bleeding in whom the ultrasound findings of subamniotic hemorrhage were detected. This resulted in early diagnosis, leading to a favorable clinical outcome in this patient. Case: A primigravid 35-year-old woman visited the emergency room due to vaginal bleeding at 36 + 4 weeks of gestation. Ultrasound examination revealed a subamniotic hemorrhage that had not been evident on previous antenatal ultrasonography. An emergent cesarean section was performed, and the diagnosis of placental abruption was confirmed. The patient and baby were discharged after an uneventful course in the hospital. Conclusions: Detection of subamniotic hemorrhage by ultrasound helped in achieving an early diagnosis that resulted in prompt intervention against acute placental abruption and ensured favorable clinical outcomes. A thorough ultrasound examination of the placenta should be performed when managing patients with antepartum bleeding.

Abnormal Ultrasonographic Findings in Patients with Chronic HCV: An Egyptian Experience

Abnormal Ultrasonographic Findings in Patients with Chronic HCV: An Egyptian Experience

Ultrasonographic assessment of dengue fever and its correlation with platelet count

&lt;p&gt;&lt;em&gt;Background:&lt;/em&gt; Dengue virus infections are a significant threat to human populations particularly in the tropical and subtropical regions. This is mainly transmitted by Aedes aegypti mosquito from humans to humans. The main pathological mechanisms associated include thrombocytopenia, haemorrhagic diathesis with haemoconcentration. Ultrasonography is used because of its ability to detect plasma leakage signs and prediction of disease severity.&lt;/p&gt; &lt;p&gt;&lt;em&gt;Objective:&lt;/em&gt; To evaluate the usefulness of ultrasonographic findings of dengue fever and its correlation with platelet count.&lt;/p&gt; &lt;p&gt;&lt;em&gt;Methods:&lt;/em&gt; It was a prospective observational study, carried out in Bangladesh Medical College Hospital, Dhaka from May 2019 to August 2019. A total of 213 patients of suspected dengue fever during the epidemic were included in this study. All the cases were serologically diagnosed and evaluated with ultrasonographic findings. Platelet counts were estimated in all the cases and compared with findings recorded on ultrasonographic findings.&lt;/p&gt; &lt;p&gt;&lt;em&gt;Results:&lt;/em&gt; The mean age of the study population was 28.7 years. The male female ratio was 1.7:1. The common features on ultrasonography were thickened and oedematous gall bladder wall, mild to moderate ascites, pleural effusion (unilateral and bilateral), and hepatosplenomegaly. Thickened and oedematous gall bladder wall were observed in 68.8%, mild to moderate ascites 65.3%, bilateral pleural effusion 58.2 %, unilateral pleural effusion 40.4%, hepatomegaly 34.3 % and splenomegaly 13.6 % Platelet counts were significantly lower in abnormal ultrasonographic findings (&lt;em&gt;p&lt;/em&gt;=0.001).&lt;/p&gt; &lt;p&gt;&lt;em&gt;Conclusion:&lt;/em&gt; In a febrile patient with thrombocytopenia and positive dengue serology, ultrasonography of the abdomen is a useful tool to evaluate the severity of illness. Ultrasound findings of gall bladder wall oedema, ascites, and pleural effusion were correlated with the severity of thrombocytopenia. In epidemic scenarios, Ultrasonographic features may help in roughly estimating the platelet count even before serology and platelet results are available. Thus, it helps in treatment planning without waiting for the laboratory results.&lt;/p&gt; Bangladesh Med Res Counc Bull 2021; 47(1): 23-28

Musculoskeletal ultrasound of the shoulder in systemic sclerosis.

To explore shoulder findings by ultrasonography and to find factors associated with shoulder ultrasonographic abnormalities in systemic sclerosis patients. A series of systemic sclerosis patients who attended the scleroderma clinic, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand, were prospectively evaluated for baseline characteristics, physical examination, and ultrasonography of both shoulders. Seventy-four systemic sclerosis patients were enrolled in this study. Diffuse cutaneous type of systemic sclerosis was the most common type (62.2%). The three common systemic sclerosis-associated symptoms were skin tightness (28.5%), salt-pepper appearance (20.9%), and telangiectasia (11.6%). The prevalence of shoulder pain in systemic sclerosis patients was 43.2% (32/74). Sixty-eight patients (92%) had abnormal ultrasonographic findings. The most common ultrasonographic abnormalities were unilateral calcification inside the glenohumeral joint (45.9%), bilateral calcification inside the glenohumeral joint (36.5%), and bilateral supraspinatus tendinosis (28.9%). Skin edematous was the only factor associated with abnormal shoulder ultrasonographic findings. No association between shoulder pain and abnormal shoulder ultrasonographic findings was detected. Ultrasonographic abnormalities in the shoulder were common in the systemic sclerosis patients. The most frequent ultrasonographic finding of shoulder joints in systemic sclerosis patients was calcification inside the glenohumeral joint. Moreover, asymptomatic shoulder ultrasonographic abnormalities were prevalent in individuals with systemic sclerosis.

Abnormal Ultrasonographic Findings of Acellular Dermal Matrix in Implant-Based Breast Reconstruction: Correlations with Histopathology.

Background: Acellular dermal matrix (ADM) in implant-based breast reconstruction can show various ultrasound (US) findings. However, there are limited reports on the US features of the ADM. The aims of this study were to evaluate US findings of the ADM in implant-based breast reconstruction and correlate them with histopathological findings. Methods: Between January 2015 and August 2020, 250 women who underwent implant-based breast reconstruction with ADM and a breast US examination at 6 months to 1 year after reconstruction were retrospectively analyzed. Abnormal US findings were classified as type 1 (focal thickening with decreased echogenicity), 2 (diffusely hyperechoic), or 3 (bright echogenic spots). ADM biopsy was performed in 33 patients who underwent second stage or revisional surgeries. Results: In total, 176 consecutive women with 207 US findings were analyzed. The US findings were normal in 52.2% of the women. The percentages of type 1, 2, and 3 patients were 13.5%, 11.1%, and 23. 2%, respectively. These patients had microscopic findings that showed patchy areas with chronic inflammatory infiltrates, dense collagen bundles without degenerative or inflammatory changes, and empty spaces or degenerated foci unaccompanied by inflammation. Conclusion: Knowing the various ADM presentations on US can help avoid unnecessary invasive procedures.

Spectrum of Neural Tube Defects Among the Fetal Autopsies in a Tertiary Care Hospital in Southern India

Background: Neural tube defects (NTDs) are congenital disorders with multifactorial etiology that increase the risk of death as well as disability in early neonatal period and infancy. Objective: The study was conducted in a tertiary care referral hospital to analyse the disease burden of neural tube defects and to study the associated anomalies in the affected fetuses. Materials and Methods: This study was conducted retrospectively from January 2011 to December 2020 on a total number of 402 fetal autopsies received after abnormal ultrasonographic findings and intrauterine deaths diagnosed prenatally. Results: Out of the total 402 cases of fetal autopsies, 42 neural tube defects were detected, 33(79 %) were open type and 9(21%) were closed type neural tube defects. Out of the open type, majority were meningomyeloceles with 18 (43% of NTDs) cases, 11(26% of NTDs) cases were of anencephaly. Arnold chiari malformation was associated in 4 cases and a rare case of craniorachischisis was encountered. Among the closed type, 6 (14%) were meningoceles and 3(7%) were encephaloceles. A case of Meckel Gruber syndrome with an associated encephalocele was diagnosed. Conclusion:The present study would contribute to the prevalent disease burden of neural tube defects in Southern India, proving to be useful in the design and implementation of appropriate comprehensive preventive strategies including nutritional fortification, swift antenatal diagnosis and prompt intervention to reduce the morbidity.

Abnormal Ultrasonographic Findings among Referred Patients with Pain Abdomen in the Radiology Department of a Tertiary Care Center: A Descriptive Cross-sectional Study.

Correct and prompt diagnosis is essential for the appropriate management of patients. Often, children and their caretakers cannot provide a reliable history to allow clinicians to determine the cause of the pain. This study's objective was to find out the prevalence of abnormal ultrasonographic findings among referred patients with pain abdomen in the radiology department of a tertiary care center of Nepal. A descriptive cross-sectional study was conducted among patients in the out-patient and emergency department with complaints of abdominal pain from 2021 April 5 to August 30 in a tertiary care hospital. Ethical clearance was taken from IRC (registration no: 423/2021). The convenience sampling method was used. Written informed consent was taken from each study participant. Collected data were entered and analyzed on Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Among 250 patients with pain abdomen referred to the department of radiology, 169 (67.6%) (61.80-73.40 at 95% Confidence Interval) had abnormal ultrasonographic findings. Mean age of the patients was 39.4±17.9 years. Initial clinical diagnosis was in agreement with the abdominal ultrasound diagnosis in 57 (22.8%) patients. For the remaining 193 patients, the diagnosis obtained from abdominal ultrasound differed from the initial clinical diagnosis. Most of the cases of pain abdomen showed abnormalities in ultrasound. Clinical evaluation should be used together with ultrasound abdomen in order to arrive at a correct diagnosis.

Ultrasonography Findings in the Proximal Sciatic Nerve and Deep Gluteal Muscles in 29 Dogs With Suspected Sciatic Neuritis.

The present study aimed to describe the ultrasonography technique and analyze the ultrasonographic findings of the proximal sciatic nerve and deep gluteal muscles in dogs with suspected sciatic neuritis. The records of 29 dogs that underwent musculoskeletal ultrasound of the sciatic nerve and deep gluteal muscles were retrospectively evaluated. Both right and left sides were evaluated. Abnormal findings were unilateral in 28/29 (97%) of the dogs. The muscles examined included the piriformis muscle, gemelli muscles, internal obturator muscle, and medial gluteal muscle. Data included signalment, purpose of the dog, orthopedic examination findings, lameness examination findings, other diagnostic imaging findings, and ultrasonography findings. Irregular margins of the sciatic nerve were recorded in 76% of the dogs. The diameter of the sciatic nerve on the affected limb was significantly larger than the nerve on the contralateral, unaffected side (p < 0.00001). The mean ± standard deviation (SD) of the sciatic nerve inner diameter between the unaffected and affected limbs was 15 ± 14.66%. The mean ± SD in sciatic nerve outer diameter was 12 ± 7.71%. Abnormal ultrasonographic findings in at least one of the examined muscles were found in 28/29 (97%) of the dogs and included changes in echogenicity in 28/29 (97%) of the dogs, loss of detail in muscle fiber pattern in 5/29 (17%) of the dogs, and impingement between the sciatic nerve and piriformis muscle in 6/29 (21%) of the dogs. The most common underlying diagnosis was lumbosacral stenosis in 9/29 (31%) of the dogs. The most common sport was agility for 21/29 (71%) of the dogs. Repetitive jumping may predispose to both lumbosacral disease, through dynamic compression, and changes within the piriformis muscle, due to overuse of the muscle leading to irritation to sciatic nerve. Ultrasonography is considered a safe and non-invasive diagnostic method to evaluate the sciatic nerve and deep gluteal muscles of dogs, and provides additional guidance for diagnostics and rehabilitation planning. This is the first study documenting ultrasonography findings in a case series of the sciatic nerve and deep gluteal muscles and their pathology in dogs.

Prenatal diagnosis of 7 cases with uniparental disomy by utilization of single nucleotide polymorphism array

BackgroundThe phenotypes of uniparental disomy (UPD) are variable, which may either have no clinical impact, lead to clinical signs and symptoms. Molecular analysis is essential for making a correct diagnosis. This study involved a retrospective analysis of 4512 prenatal diagnosis samples and explored the molecular characteristics and prenatal phenotypes of UPD using a single nucleotide polymorphism (SNP) array.ResultsOut of the 4512 samples, a total of seven cases of UPD were detected with an overall frequency of 0.16%. Among the seven cases of UPD, two cases are associated with chromosomal aberrations (2/7), four cases (4/7) had abnormal ultrasonographic findings. One case presented with iso-UPD (14), and two case presented with mixed hetero/iso-UPD (15), which were confirmed by Methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) as maternal UPD (15) associated with Prader-Willi syndrome (PWS). Four cases had iso-UPD for chromosome 1, 3, 14, and 16, respectively; this is consistent with the monosomy rescue mechanism. Another three cases presented with mixed hetero/isodisomy were consistent with a trisomy rescue mechanism.ConclusionThe prenatal phenotypes of UPD are variable and molecular analysis is essential for making a correct diagnosis and genetic counselling of UPD. The SNP array is a useful genetic test in prenatal diagnosis cases with UPD.

Types of Parenchymal Changes Diagnosed on DMSA Scans of Kidneys Affected by Different Grades of Vesicoureteral Reflux.

BackgroundRenal parenchymal damage and scarring usually is associated with urinary tract infection (UTI), whereas the impact of vesicoureteral reflux (VUR) on the kidneys is unclear. We aimed to compare kidneys with all grades of VUR (grades Io-V) and those without VUR by using direct radionuclide cystography, voiding cystourethrography, and findings from 99mTc-DMSA scintigraphy (DMSA scan).Material/MethodsThe present analysis included 253 renal ureteral units (RUU) from 129 children with VUR and recurrent UTI and children with a single febrile UTI associated with abnormal ultrasonographic findings. The 6 grades of VUR (Io, I, II, III, IV, and V) and 35 RUUs without VUR were divided into 4 groups: 1. Non-dilated VUR (grades Io-II); 2. Mildly dilated VUR (grade III); 3. Dilated VUR (grades IV–V); and 4. The control group.ResultsDMSA scanning showed significant differences between the groups with non-dilated VUR, grade III VUR, grades IV–V VUR, and the control group in kidney width (χ2=30.5; P<0.001); position and shape (χ2=30.6; P<0.001); intensity of activity (χ2=38.1; P<0.001); distribution of activity (χ2=34.5; P<0.001); and existence of scars (χ2=16; P<0.001). The probability of abnormalities on DMSA scans increased with the VUR grade. However, inside the groups of dilated and non-dilated VUR we found no significant statistical differences between those characteristics.ConclusionsOur results indicate that kidneys without VUR or with non-dilated lateral VUR and dilated VUR on the contralateral side represent 2 different categories of parenchymal changes.

An analysis of urinary tract infections in children up to 24 months of age: a 7-year single-centre follow-up

Introduction: Urinary tract infections are the second most common type of bacterial infection in children. Atypical infections may be associated with a higher future risk of chronic kidney disease. The current range of diagnostic tests in children with a history of urinary tract infections is still a subject of discussions. Aim of the study: We attempted to determine the indications for renal scintigraphy and develop a nephrological care model for children aged ≤24 months based on the analysis of urinary tract infections in this group of patients. Materials and methods: We included 61 children aged ≤24 months [42 (68%) girls and 19 (32%) boys], hospitalised in the Department of Paediatrics, Paediatric Nephrology and Allergology, Military Institute of Medicine in Warsaw from 2008 to 2015 due to their first episode of urinary tract infection, in our retrospective analysis. Depending on the result of DMSA static renal scintigraphy performed 6 months after completed treatment of urinary tract infection, patients were classified into 3 groups: normal scintigraphy (group I), irregular tracer uptake indicating a suspicion of post-inflammatory renal pole lesions (group II), and signs of hypodysplasia (group III). The following variables were compared: age at first infection, gender, fever, inflammatory markers, aetiology, ultrasonographic findings, and the results of voiding cystourethrography for vesicoureteral reflux. Results: The median age at the time of first infection was 5.5 months in group I, 7 months in group II, and 7.5 months in group III. Febrile urinary infection was reported in 6/21 patients in group I, 4/19 patients in group II, and 6/21 patients in group III. Increased C-reactive protein was observed in 7/21 patients in group I, 6/19 patients in group II, and 6/21 patients in group III. Recurrent infections were reported for 5/21 children in group I, 8/19 in group II, and 12/21 children in group III. Atypical aetiology of urinary infection was reported for 3/21 patients in group I, 2/19 in group II, and 2/21 in group III. Abnormal ultrasonographic findings were observed in 4/21 patients in group I, 1/19 patients in group II, and 4/21 patients in group III. Vesicoureteral reflux in voiding cystourethrography was reported in 5/21 patients in group I, 8/19 patients in group II, and 10/21 patients in group III. The analysis of all the investigated parameters showed no statistically significant differences between the groups. Conclusions: Renal scintigraphy should be performed in the youngest children with a history of urinary tract infection as it was not possible to identify patients with post-inflammatory renal scarring secondary to urinary tract infection based on the course of infection, its aetiology, ultrasound findings and the presence of vesicoureteral reflux. Ultrasonography was not sensitive enough to diagnose renal hypodysplasia in our group of children.

Identification of a critical region on chromosome 4p16.3 for Wolf-Hirschhorn syndrome-associated fetal growth retardation

To analyze ultrasonographic finding in fetuses with Wolf-Hirschhorn syndrome (WHS) and refine the critical region on chromosome 4p16.3 for WHS-associated fetal growth retardation (FGR). In total 2262 fetuses with abnormal ultrasonographic findings who underwent prenatal karyotyping and chromosomal microarray analysis were reviewed. WHS-associated 4p deletions detected in these fetuses were compared, and prenatal ultrasound findings in such fetuses were summarized. Meanwhile, WHS cases with prenatal ultrasound findings and isolated 4p deletions in previous studies were included for further analysis. An analysis of smallest region of overlap (SRO) among discrepant 4p deletions in these cases above was performed to define a critical region for FGR. 4p deletions were detected in 10 of the 2262 fetuses and 5.0% of the 202 fetuses with FGR. Combined with 80 WHS cases from previous studies, the most common prenatal ultrasound finding was FGR, which yielded a frequency of 76.7%. In addition, a SRO spanning approximately 419 kb (genomic position: 1.32-1.74 Mb) on chromosome 4p16.3 was discovered by comparing the unusual 4p deletions among the 10 fetuses. The region contained seven protein-coding genes, including TACC3, SLBP, TMEM129, FAM53A, MAEA, UVSSA and CRIPAK. For fetuses with WHS, the most common prenatal ultrasound phenotype was FGR. A region between 1.32 Mb to 1.74 Mb from the telomere on chromosome 4p16.3 is critical for WHS-associated FGR, for which TACC3 and SLBP are the candidate genes.

Performance of non-invasive prenatal screening for sex chromosome aneuploidies and parental decision-making.

Performance of non-invasive prenatal screening for sex chromosome aneuploidies and parental decision-making.

Point-of-Care Chest Ultrasonography as a Diagnostic Resource for COVID-19 Outbreak in Nursing Homes

ObjectiveBedside chest ultrasonography, when integrated with clinical data, is an accurate tool for improving the diagnostic process of many respiratory diseases. This study aims to evaluate the feasibility of a chest ultrasonographic screening program in nursing homes for detecting coronavirus disease-19 (COVID-19)–related pneumonia and improving the appropriateness of hospital referral of residents. DesignPragmatic, descriptive, feasibility study from April 2 to April 9, 2020. Setting and ParticipantsA total of 83 older residents (age 85 ± 8) presenting mild to moderate respiratory symptoms and not previously tested for COVID-19, residing in 5 nursing homes in Northern Italy. MethodsChest ultrasonography was performed at the bedside by a team of hospital specialists with certified expertise in thoracic ultrasonography, following a systematic approach exploring 4 different areas for each hemithorax, from the anterior and posterior side. Presence of ultrasonographic signs of interstitial pneumonia, including comet-tail artifacts (B-lines) with focal or diffuse distribution, subpleural consolidations, and pleural line indentation, was detected. The specialist team integrated ultrasonography data with clinical and anamnestic information, and gave personalized therapeutic advice for each patient, including hospital referral when needed. ResultsThe most frequent reasons for ultrasonographic evaluation were fever (63% of participants) and mild dyspnea (40%). Fifty-six patients (67%) had abnormal ultrasonographic findings. The most common patterns were presence of multiple subpleural consolidations (32 patients) and diffuse B-lines (24 patients), with bilateral involvement. A diagnosis of suspect COVID-19 pneumonia was made in 44 patients, and 6 of them required hospitalization. Twelve patients had ultrasonographic patterns suggesting other respiratory diseases, and 2 patients with normal ultrasonographic findings were diagnosed with COPD exacerbation. Conclusions and ImplicationsIn nursing home residents, screening of COVID-19 pneumonia with bedside chest ultrasonography is feasible and may represent a valid diagnostic aid for an early detection of COVID-19 outbreaks and adequate patient management.

First-trimester chorionic villus sampling: genetic analysis of 985 cases

Objective To investigate the value and safety of first-trimester chorionic villus sampling (CVS) in prenatal diagnosis. Methods This study retrospectively analyzed the clinical data of 985 cases undergoing CVS and prenatal diagnosis with karyotyping and fluorescence in situ hybridization (FISH) in the Department of Obstetrics and Gynecology of Peking University First Hospital from January 2012 to December 2017. The success rate of cell culture, indications for prenatal diagnosis, karyotyping results, and complications of CVS were described. Results Among the 985 cases, 970 (98.48%) underwent FISH and 893 (90.66%) received karyotyping, and 878 (89.14%) accepted both. After CVS, the success rate of cell culture was 96.64% (863/893). Abnormal ultrasonographic findings (42.64%, 420/985) were the most common indications for prenatal diagnosis. In this study, 181 cases of chromosomal abnormalities were detected, including numerical and structural abnormalities, accounting for 18.38% of all 985 cases. Those cases with abnormal ultrasonographic images had the highest detection rate of chromosomal abnormalities (31.90%, 134/420), followed by those with adverse pregnant history (11.83%, 20/169) and advanced maternal age (8.21%, 11/134). In addition, there was a discrepancy between karyotyping and FISH results, which might due to 16 cases of placental mosaicism and 13 cases of maternal cell contamination (MCC). Embryonic demises were reported in six cases (0.61%, 6/985), including four with chromosomal numerical abnormalities within four weeks after CVS. No other short- or long-term postoperative complications were found in the rest 979 cases (99.39%). Conclusions CVS in the first trimester is a safe and reliable invasive method for prenatal diagnosis, which can help to obtain an earlier diagnosis in a certain population such as those with abnormal ultrasonographic findings, thus improve the pertinence and efficiency of prenatal diagnosis. However, the potential influences of placental mosaicism and MCC on the diagnostic results should not be ignored. Key words: Chorionic villi sampling; Prenatal diagnosis; Chromosome aberrations; Pregnancy trimester, first