Doppler Imaging Research Articles

Comparing artificial intelligence guided image assessment to current methods of burn assessment.

Appropriate identification of burn depth and size is paramount. Despite the development of burn depth assessment aids [e.g., laser doppler imaging (LDI)], clinical assessment, which assesses partial thickness burn depth with 67% accuracy, currently remains the most consistent standard of practice. We sought to develop an image-based artificial intelligence system that predicts burn severity and wound margins for use as a triaging tool in thermal injury management. Modified EfficientNet architecture trained by 1684 mobile-device-captured images of different burn depths were previously utilized to create a convoluted neural network (CNN). The CNN was modified to a novel Boundary-Attention Mapping (BAM) algorithm using elements of saliency mapping, which was utilized to recognize the boundaries of burns. For validation, 144 patient charts that included clinical assessment, burn location, total body surface area, and LDI assessment were retrieved for a retrospective study. The clinical images underwent CNN-BAM assessment and were directly compared with the LDI assessment. CNN using a four-level burn severity classification achieved an accuracy of 85% (micro/macro-averaged ROC scores). The CNN-BAM system can successfully highlight burns from surrounding tissue with high confidence. CNN-BAM burn area segmentations attained a 91.6% accuracy, 78.2% sensitivity, and 93.4% specificity, when compared to LDI methodology. Results comparing the CNN-BAM outputs to clinical and LDI assessments have shown a high degree of correlation between the CNN-BAM burn severity predictions to those extrapolated from LDI healing potential (66% agreement). CNN-BAM algorithm gives equivalent burn-depth detection accuracy as LDI with a more economical and accessible application when embedded in a mobile device.

Doppler Sonography Evaluation of Median Nerve Intraneural Blood Flow: A Systematic Review

Objective: This systematic review aims to determine the extent, scope, and nature of research using the sonographic measurement of intraneural blood flow within the median nerve and to identify, characterize, and compare image acquisition and analysis protocols that have been reported as potential candidate techniques for standardizing research and clinical applications. Materials and Methods: This systematic review summarizes image acquisition protocols and analysis methodologies from 52 current research studies using Doppler ultrasound to examine median nerve intraneural blood flow. Results: Four types of Doppler technologies were identified: power Doppler, color Doppler, spectral Doppler, and Superb Microvascular Imaging, but there were inconsistencies in how images were acquired and analyzed. Intraneural blood flow measurements were categorized into four types based on a combination of measurement level (e.g., binary, ordinal, continuous) and type of flow indicator (e.g., pixel count, intensity, velocity). Conclusion: Standardized imaging protocols and reporting guidelines are needed to improve consistency. Future studies should evaluate the accuracy and reliability of different image acquisition methods and analysis measurements.

LncRNA H19/miR-107 regulates endothelial progenitor cell pyroptosis and promotes flow recovery of lower extremity ischemia through targeting FADD

BackgroundPeripheral artery disease (PAD) is an ischemic disease with a rising incidence worldwide. The lncRNA H19 (H19) is enriched in endothelial progenitor cells (EPCs), and transplantation of pyroptosis-resistant H19-overexpressed EPCs (oe-H19-EPCs) may promote vasculogenesis and blood flow recovery in PAD, especially with critical limb ischemia (CLI). MethodsEPCs isolated from human peripheral blood was characterized using immunofluorescence and flow cytometry. Cell proliferation was determined with CCK8 and EdU assays. Cell migration was assessed by Transwell and wound healing assays. The angiogenic potential was evaluated using tube formation assay. The pyroptosis pathway-related protein in EPCs was detected by western blot. The binding sites of H19 and FADD on miR-107 were analyzed using Luciferase assays. In vivo, oe-H19-EPCs were transplanted into a mouse ischemic limb model, and blood flow was detected by laser Doppler imaging. The transcriptional landscape behind the therapeutic effects of oe-H19-EPCs on ischemic limbs were examined with whole transcriptome sequencing. ResultsOverexpression of H19 in EPCs led to an increase in proliferation, migration, and tube formation abilities. These effects were mediated through pyroptosis pathway, which is regulated by the H19/miR-107/FADD axis. Transplantation of oe-H19-EPCs in a mouse ischemic limb model promoted vasculogenesis and blood flow recovery. Whole transcriptome sequencing indicated significant activation of vasculogenesis pathway in the ischemic limbs following treatment with oe-H19-EPCs. ConclusionsOverexpression of H19 increases FADD level by competitively binding to miR-107, leading to enhanced proliferation, migration, vasculogenesis, and inhibition of pyroptosis in EPCs. These effects ultimately promote the recovery of blood flow in CLI.

Myocardial performance imaging for the early identification of cardiac dysfunction in neonates with sepsis

PurposeThe assessment of cardiac performance in septic new-borns is crucial for detecting hemodynamic instability and predicting outcome. The aim of the study is to assess myocardial performance in neonates with sepsis for the early identification of cardiac dysfunction.Patients and methodsA case control study was carried out from September 2022 to May 2023 at the Neonatal Intensive care unit, Kasturba Medical College, Manipal. A total of 68 neonates were included in the study, with 33 females and 35 males. The study population was further subdivided into 3 groups namely preterm septic neonates (n = 21), term septic neonates (n = 10) and non-septic healthy controls (n = 37). The cardiac structure and function were assessed using conventional method, Tissue Doppler imaging (Sm) and speckle tracking echocardiography (GLS). The study was approved by the Institutional Ethics Committee at Kasturba Medical College, Manipal (approval number IEC: 90/2022). The CTRI registration number for the study is CTRI/2022/09/045437 and was approved on September 12, 2022. Prior to the neonate’s enrolment, informed consent was obtained from their mothers or legal guardians.ResultsOut of the total 68 neonates, 31 were cases and 37 were controls which included 33 females and 35 males. LV systolic function was not statistically significant between cases and controls. E/A ratio of the mitral valve was significantly lower in septic newborns than in healthy neonates. (1.01 ± 0.35 vs 1.18 ± 0.31, p < 0.05) preterm neonates showed significantly lower Lateral E’ and RV E’ velocities than term neonates. TAPSE was significantly lower in septic preterm neonates. (8.61 ± 1.28 vs. 10.7 ± 2.11, p < 0.05) No significant difference was noted in the Myocardial Performance Index between septic neonates and healthy neonates. LV Global Longitudinal Strain was slightly lower in preterm septic neonates than in term neonates with sepsis.ConclusionSeptic newborns are associated with LV diastolic dysfunction, RV systolic dysfunction and substantially higher pulmonary systolic pressures.

Gerbode defect resulting from Group B Streptococcus infective endocarditis: a case report

BackgroundGerbode defect is an unusual abnormal communication between the left ventricle and the right atrium and is a serious complication of aortic infective endocarditis. Group B Streptococcus is an uncommon cause of infective endocarditis and has a markedly destructive effect on valvular tissue. Acute fistulation between the left ventricle and the right atrium associated with this form of infective endocarditis is a life-threatening, aggressive complication that often requires urgent surgical intervention. However, the identification of actual communication is often extremely difficult. Herein, we describe an unusual case of Gerbode defect resulting from Group B Streptococcus infective endocarditis and discuss the issues surrounding such a rare cardiac defect and such an infection.Case presentationA 60-year-old man with underlying uncontrolled diabetes mellitus underwent endoscopic retrograde biliary drainage for acute cholangitis. On the 10th postoperative day, the patient developed multiple acute cerebral embolisms. Transthoracic echocardiography demonstrated severe aortic regurgitation and a large mobile vegetation near the tricuspid annulus. No obvious fistula between the left ventricle and the right atrium could be demonstrated. The blood culture examination was positive for Group B Streptococcus. The patient was diagnosed with Group B Streptococcus infective endocarditis, and antibiotic therapy was initiated. Transesophageal echocardiogram performed after referral to our hospital confirmed detachment of the right coronary cusp of the aortic valve from the annulus and an abnormal cavity immediately below the right coronary cusp. Color Doppler imaging finally revealed systolic blood flows from the left ventricle into the right atrium through the cavity. Therefore, we diagnosed the patient with Gerbode defect resulting from Group B Streptococcus infective endocarditis. In addition to aortic valve replacement, defect closure and left ventricular outflow tract repair were successfully performed urgently for severely complicated and uncommon infective endocarditis. The patient was uneventfully discharged without any complications.ConclusionsWe reported successful surgical treatment of unusual active IE and Gerbode defect caused by GBS. Careful preoperative echocardiographic work-up is imperative for accurate early diagnosis and successful repair.

Transabdominal ultrasound evaluation of vascularity of gallbladder lesions: particularly those with wall thickening.

Gallbladder wall thickening is relatively common in clinical settings, and for appropriate diagnosis, the size, shape, internal structure, surface contour, and vascularity of the gallbladder wall must be evaluated. Morphological evaluation is the most important; however, some gallbladder lesions resemble gallbladder cancer in imaging studies, making differential diagnosis challenging. Vascular evaluation is indispensable for a precise diagnosis in these cases. In this review, we present the current status of vascular evaluation using US and diagnosis using vascular imaging for gallbladder lesions, including those presenting with wall thickening. To date, several ultrasound imaging techniques have been developed to assess vascularity, including Doppler imaging with high sensitivity, use of contrast agents, and microvascular imaging using a novel filter for Doppler imaging. Although conventional color Doppler imaging is rarely used for the diagnosis of gallbladder lesions, the efficacy of contrast-enhanced ultrasound in assessing the vascularity, enhancement pattern, or timing of enhancement/washout has been reported. Presence of multiple irregular microvessels has been speculated to indicate malignancy. However, few reports on microvessels have been published, and further studies are required for the precise diagnosis of gallbladder lesions with microvascular evaluation.

Association of high-sensitivity troponin T with left ventricular dysfunction in prediabetes

Background Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) are an increasingly serious problem worldwide. Tissue Doppler imaging (TDI), a non-invasive technique, may evaluate both systolic and diastolic function during the first phases of cardiovascular disease (CVD). High-sensitivity cardiac troponin T (hs-cTnT) can detect subclinical myocardial injury in asymptomatic prediabetic patients. Aim We aimed to investigate the relationship between left ventricular (LV) function and hs-cTnT in prediabetic patients. Methods Between 1 October 2021 and 1 October 2022, we recruited 96 prediabetic and an equal number of age- and gender-matched healthy volunteers prospectively. TDI was used to evaluate both systolic and diastolic functions. Hs-cTnT levels were obtained and compared between groups. Results It was found that the values for mitral annular plane systolic excursion (MAPSE), E, the rapid filling wave, E/Em, and the peak annular velocities of systolic excursion in the ejection period (Sm) were all significantly higher in these patients compared to healthy individuals (p < .001). Hs-cTnT was an independent predictor of left ventricular diastolic dysfunction (LVDD) and left ventricular systolic dysfunction (LVSD) (odds ratio [OR] = 2.625, 95% confidence interval [CI] = 1.324–4.308, p < .001, and OR = 1.922, 95% CI = 0.454–3.206, p = .004). Conclusions Prediabetics had higher hs-cTnT levels than controls. We showed that LVSD and LVDD functions were negatively affected in prediabetic patients. Our results proved that hs-cTnT levels may be associated with subclinical LV dysfunction in prediabetes.

Required volume for color flow injection test to confirm the intravascular placement of a peripheral venous catheter

Background: Confirmation of adequate peripheral intravenous catheter placement is essential before using venous catheters. The color flow injection test has been reported as a method with high sensitivity and specificity for this purpose. The technique involves administrating saline through the peripheral venous route to observe changes in the color flow pattern around the same vein at a more central location. However, the required volume of saline remains uncertain. This study aims to determine the appropriate dosage for conducting the test in pediatric patients and explore any potential correlations between dosage and patient characteristics. Methods: A prospective study was conducted in children under 6 years of age with American Society of Anesthesiologists Physical Status 1–2 presenting for general anesthesia. After an intravenous cannula was placed in the forearm under general anesthesia, normal saline was injected at a speed of approximately 1 mL/s while the axillary artery and vein were observed with color flow Doppler imaging. The volume of normal saline required to induce a change in the color flow pattern around the vessels was measured. Measurements were performed twice and averaged for comparison with patient characteristics and other factors. Results: The study cohort included 30 patients aged from 0.3 to 5.5 (2.6 ± 1.6) years. The change in color flow Doppler imaging was noted in all the patients, and the average volume was 1.40 ± 0.36 mL (95% confidence interval (CI), 1.27–1.54; p &lt; 0.001), which was significantly correlated with age, with a correlation coefficient of 0.435 (95% CI, 0.09–0.69; p = 0.02). Conclusions: The required volume for the color flow injection test is small; therefore, the test is easy to perform and minimally invasive in pediatric patients.

A STUDY ON ASSESSMENT OF RIGHT VENTRICULAR FUNCTION BY RIGHT VENTRICULAR OUTFLOW TRACT SYSTOLIC EXCURSION IN ADULT POPULATION ATTENDING A TERTIARY CARE HOSPITAL IN EASTERN INDIA

Objectives: The objectives of the study are as follows: (1) to assess the right ventricular function (RVF) by right ventricle outflow tract systolic excursion through M-mode echocardiography and (2) to correlate the right ventricle outflow tract systolic excursion value with other 2D echocardiographic methods of RVF assessment. Methods: The present observational prospective study was conducted in the department of cardiology, Apollo Multispeciality Hospital, Kolkata, among patients visiting the cardiology outpatient department and inpatient department from August 2021 to August 2022 to assess the RVF by right ventricle outflow tract systolic excursion through M-mode echocardiography and correlate the results with other methods (tricuspid annulus plane systolic excursion, tissue Doppler imaging, pulmonary artery pressure, fractional area change [FAC]) of RVF assessment. Results: Majority of the patients in both groups belong to the age group of 51–60 years (45.5%), followed by 61–70 years (29.5%) and 41–50 years (20.5%). Patients with right ventricular (RV) dysfunction were more aged as compared to normal RVF. The mean body mass index (BMI) was significantly higher and mean hemoglobin level was significantly lower in patients with RV dysfunction as compared to the control group (p&lt;0.05). Both systolic and diastolic blood pressures were significantly higher among the patient group than in the control group (p&lt;0.05). We found that right ventricular outflow tract systolic excursion (RVOT-SE), tricuspid annular plane systolic excursion (TAPSE), tissue Doppler myocardial performance index, left ventricular (LV) ejection fraction (%), and FAC were significantly lower among patient group than control group (p&lt;0.01). TAPSE ≤17 mm was the best cutoff value that differentiates patients with RV systolic dysfunction from healthy individuals with normal RV systolic function. There were 67% of patients with ≤17 mm and 33% had &gt;17 mm TAPSE. Conclusion: Our study concludes that RVOT-SE is a highly sensitive and specific method for diagnosing reduced RV systolic function patients. RVOT SE is not accurate as a sole parameter, but its high values can be used as an indicator for normal RV systolic function. It is simple to get, requiring one easy and reproducible M-Mode measurement from the parasternal short-axis view.

SPIRou spectropolarimetry of the T Tauri star TW Hydrae: magnetic fields, accretion, and planets

ABSTRACT In this paper, we report near-infrared observations of the classical T Tauri star TW Hya with the SPIRou high-resolution spectropolarimeter and velocimeter at the 3.6-m Canada–France–Hawaii Telescope in 2019, 2020, 2021, and 2022. By applying Least-Squares Deconvolution (LSD) to our circularly polarized spectra, we derived longitudinal fields that vary from year to year from –200 to +100 G, and exhibit low-level modulation on the 3.6 d rotation period of TW Hya, despite the star being viewed almost pole-on. We then used Zeeman–Doppler Imaging to invert our sets of unpolarized and circularly polarized LSD profiles into brightness and magnetic maps of TW Hya in all four seasons, and obtain that the large-scale field of this T Tauri star mainly consists of a 1.0–1.2 kG dipole tilted at about 20° to the rotation axis, whereas the small-scale field reaches strengths of up to 3–4 kG. We find that the large-scale field is strong enough to allow TW Hya to accrete material from the disc on the polar regions at the stellar surface in a more or less geometrically stable accretion pattern, but not to succeed in spinning down the star. We also report the discovery of a radial velocity signal of semi-amplitude $11.1^{+3.3}_{-2.6}$ m s−1 (detected at 4.3σ) at a period of 8.3 d in the spectrum of TW Hya, whose origin may be attributed to either a non-axisymmetric density structure in the inner accretion disc, or to a $0.55^{+0.17}_{-0.13}$MꝜ candidate close-in planet (if orbiting in the disc plane), at an orbital distance of 0.075 ± 0.001 au.

The Diagnostic accuracy of Ultrasound and Color Doppler Imaging in predicting of Placenta Accreta Spectrum

The Diagnostic accuracy of Ultrasound and Color Doppler Imaging in predicting of Placenta Accreta Spectrum

Intelligent diagnosis of atrial septal defect in children using echocardiography with deep learning

BackgroundAtrial septal defect (ASD) is one of the most common congenital heart diseases. The diagnosis of ASD via transthoracic echocardiography is subjective and time-consuming. MethodsThe objective of this study was to evaluate the feasibility and accuracy of automatic detection of ASD in children based on color Doppler echocardiographic static images using end-to-end convolutional neural networks. The proposed depthwise separable convolution model identifies ASDs with static color Doppler images in a standard view. Among the standard views, we selected two echocardiographic views, i.e., the subcostal sagittal view of the atrium septum and the low parasternal four-chamber view. The developed ASD detection system was validated using a training set consisting of 396 echocardiographic images corresponding to 198 cases. Additionally, an independent test dataset of 112 images corresponding to 56 cases was used, including 101 cases with ASDs and 153 cases with normal hearts. ResultsThe average area under the receiver operating characteristic curve, recall, precision, specificity, F1-score, and accuracy of the proposed ASD detection model were 91.99, 80.00, 82.22, 87.50, 79.57, and 83.04, respectively. ConclusionsThe proposed model can accurately and automatically identify ASD, providing a strong foundation for the intelligent diagnosis of congenital heart diseases.

TOBE-Costas arrays for fast high-resolution 3D power Doppler imaging.

2D sparse arrays and row-column arrays are both alternatives to 2D fully-addressed arrays with lower channel counts. Row-column arrays have recently demonstrated fast 3D structural and flow imaging but commonly suffer from high grating lobes or require multiplexing to achieve better quality. 2D sparse arrays enable full-volume acquisitions for each to transmit event, but plane-wave transmissions with them usually lack quality in terms of uniformity of wavefronts. Here, we propose a novel architecture that combines both types of these arrays in one aperture, enabling imaging using row-column or sparse arrays alone or a hybrid imaging scheme where the row-column array is used in transmission and a 2D sparse array in reception. This hybrid imaging scheme can potentially solve the shortcomings of each of these approaches. The sparse array layout chosen is a Costas array, characterized by having only one element per row and column, facilitating its integration with row-column (TOBE) arrays. We simulate images acquired with TOBE-Costas arrays using the hybrid imaging scheme and compare them to row-column and sparse spiral arrays of equivalent aperture size (128λ×128λ at 7.5 MHz) in ultrafast plane-wave imaging of point targets and 3D power Doppler imaging of synthetic flow phantoms. Our simulation results show that TOBE-Costas arrays exhibit superior resolution and lower side lobe levels compared to plane-wave compounding with row-column arrays. Compared to density-tapered spiral arrays, they provide a larger field of view and finer resolution.

Targeting the histone methyltransferase SETD7 rescues diabetes-induced impairment of angiogenic response by transcriptional repression of semaphorin 3G

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Swiss National Science Foundation (n. 310030_197557), the Swiss Heart Foundation (n. FF19045) Background Peripheral artery disease (PAD) is highly prevalent in patients with diabetes (DM) and associates with a poor prognosis (1). Revascularization strategies failed to improve outcome, highlighting the need to develop new strategies to promote blood vessel growth (2). Histone modifications have emerged as key modulators of gene expression (3), however their role in angiogenic response in DM remains poorly understood. The present study investigates the role of chromatin remodelling in DM-related impairment of angiogenic response. Methodology Primary human aortic endothelial cells (HAECs) were exposed to normal glucose (NG, 5 mM) or high glucose (HG, 25 mM) levels for 48 hours. Unbiased gene expression profiling was performed by RNA sequencing (RNA-seq). Cell migration and tube formation were employed to study angiogenic properties in HAECs. Levels of the histone methyltransferase SETD7 and its chromatin signature at histone 3 on lysine 4 (H3K4me1) were investigated by Western blot and chromatin immunoprecipitation (ChIP). Pharmacological blockade of SETD7 was achieved by using the selective inhibitor (R)-PFI-2 while the inactive enantiomer (S)-PFI-2 was used as a control. Mice with streptozotocin-induced DM were orally treated with (R)-PFI-2 or vehicle and underwent hindlimb ischemia by femoral artery ligation. Blood flow was analysed at 24 hours, 7 and 14 days by laser Doppler imaging. Our experimental findings were also translated in endothelial cells (ECs) and gastrocnemius muscle samples obtained from DM patients with PAD. Results RNA-seq in HG-treated HAECs unveiled the histone methyltransferase SETD7 as the top-ranking transcript. SETD7 upregulation was associated with increased H3K4me1 levels as well as with impaired HAECs migration and tube formation. Both SETD7 silencing and inhibition by (R)PFI-2 rescued hyperglycemia-induced impairment of HAECs migration and tube formation, while SETD7 overexpression blunted the angiogenic response. RNA-seq and ChIP assays showed that SETD7-induced H3K4me1 enables the transcription of the angiogenesis inhibitor semaphorin-3G (SEMA-3G) by increasing chromatin accessibility to PPARγ. Moreover, SEMA-3G overexpression mimicked the impairment of angiogenic response observed during hyperglycemia. In DM mice with hindlimb ischemia, (R)-PFI-2 improved limb perfusion by suppressing SEMA-3G. Finally, RNAseq in vascular specimens from DM patients with PAD confirmed the upregulation of SETD7/SEMA3G signalling, whereas SETD inhibition restored angiogenic properties in ECs from DM patients. Conclusion SETD7 is a novel epigenetic target to boost neovascularization in DM patients with PAD.

Evaluation of functional significance of intermediate coronary artery lesions noninvasively by tissue doppler echocardiography and single photon emission computed tomography versus invasively by IFR

Background: Myocardial perfusion imaging by single photon emission computed tomography (MPI–SPECT) is noninvasive test that can give an important information for the diagnosis of coronary artery disease (CAD), detect reversible ischemia, quantify defect sizes and help in clinical decisions of interventions as well as assessment of disease prognosis. Tissue Doppler imaging (TDI) emerged as a potential modality for assessing systolic and diastolic LV performance. Strain doppler echocardiography (SDE) is a new tool for measuring regional myocardial deformation excluding the effect of adjacent myocardial tissue. The development of Instantaneous wave-free Ratio (IFR) as a relatively new invasive method for physiological assessment of coronary lesions without the use of pharmacologic hyperemic agents is the golden standard test for assessment of intermediate coronary lesions and guiding the revascularization decision. Methods: This Cross-sectional study was done was conducted on 50 cases with intermediate coronary artery lesions admitted at the Cardiology departments in Benha University, Kobry Elkobba Military Hospital and Air Force Specialized Hospital. All groups were subjected to history and clinical examination, cardiac examination, 12 lead ECG, 2D echocardiography, routine laboratory investigations, coronary angiography with evaluation of intermediate lesion by IFR then TDI and SDE for evaluation the regional myocardial deformation of the segments supplied by the same coronary artery, after that 99mTc-sestamibi (MIBI) SPECT imaging was done to quantify defect size and finally correlation was done between results of IFR, TDI and SPECT to guide the revascularization decision. Results: Pearson’s correlation analysis showed that; Gated single-photon emission computed moderate and severe Ischemia, Sm-velocity, WMSI, DT, had a highly significant positive correlation with IFR value (p &lt; 0.001). E/A ratio, Mean E/e’ velocity ratio, FS, LVEF and LV GLS had a highly significant negative correlation with IFR value (p &lt; 0.001). Conclusions: Instantaneous wave-free Ratio (IFR) modality is a reliable measure to guide functional significance of the intermediate coronary artery lesions for decision making and guiding plan of management. But it is an expensive and invasive modality. On the other hand, SPECT and tissue doppler modalities showed high sensitivity and specificity in the same group of patients with less expensive, non-invasive and no contrast use advantages.

Conduction system pacing preserves both electrical and mechanical interventricular synchrony, a UHF ECG validation study

Abstract Background Interventricular mechanical delay (IVMD) is an established echocardiographic risk factor for pacing-induced cardiomyopathy development. Ultra-high-frequency ECG (UHF-ECG) is a non-invasive tool visualizing the ventricular activation sequence. Purpose To compare UHF-ECG interventricular dyssynchrony with echocardiography and to establish interventricular dyssynchrony related to conductive system pacing (CSP) and right ventricular myocardial pacing (RVP). Methods 53 patients with advanced AV conduction disease, without organic heart disease, and preserved LV systolic function were prospectively included. Thirty-two had RVP, and twenty-one had CSP. CSP included both His bundle pacing (n=5) and left bundle branch area pacing (n=16). UHF-ECG and echocardiography were obtained at the baseline (during spontaneous rhythm) and after 1 year (during pacing). IVMD was manually calculated as a difference between the time from a distinct point of the QRS until the onset of the flow through LV and RV outflow tract using pulsed wave doppler imaging. Analysis was performed by two experienced and blinded cardiologists. Interventricular e-DYS was calculated automatically by a software as a time difference between activation in V8 (LV free wall) and V1 electrode (RV free wall). Results The average age of all included patients was 76 ± 6 years old and patients in both RVP and CSP group had similar clinical characteristics. The values of IVMD and interventricular e-DYS were similar in the whole study population both before the pacemaker implantation (-2 ± 21 ms for IVMD vs. 0 ± 20 ms for interventricular e-DYS; p=0.31) and after one year (14 ± 23 ms for IVMD vs. 14 ± 24 ms for UHF; p = 0.7). There were no significant differences in the baseline IVMD and interventricular e-DYS between those receiving CSP vs. RVP (IVMD -6 ± 22 ms for CSP vs 2 ± 20 ms for RVP, p=0.22) and interventricular e-DYS (e-DYS -5 ± 20 ms for CSP vs. 3 ± 20 ms for RVP, p=0.34). After one year of pacing, the patients with CSP preserved similar levels of both IVMD (mean change -2 ± 5 ms, p=0.74) and interventricular e-DYS V8-V1 (mean change 0 ± 4 ms, p = 0.95) – Figure 1. There was no difference between IVMD and interventricular e-DYS in CSP patients after one year (p=0.92). On the contrary, in the RVP group IVMD increased for 27 ± 5 ms (p &amp;lt;0.0001) and interventricular e-DYS for 24 ± 5 ms (p &amp;lt;0.0001) compared to the baseline - Figure 1. There was no difference between IVMD and interventricular e-DYS in RVP patients after one year (p=0.75). There was a moderate overall correlation between IVMD and e-DYS V8-V1 in all studied ventricular rhythms (R=0.73, p&amp;lt;0.0001) – Figure 2. Conclusions UHF-ECG expresses the interventricular dyssynchrony noninvasively by measuring the activation difference between V8-V1 chest leads. RV myocardial pacing increases interventricular dyssynchrony, while CSP preserves synchronous ventricular activation.CSP vs RVPcorrelation of dyssynchrony

Ultrasonographic Insights into Peripheral Psoriatic Arthritis: Updates in Diagnosis and Monitoring.

Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with psoriasis, characterized by heterogeneous clinical manifestations and variable disease progression. Ultrasonography has emerged as a valuable tool in the diagnosis and monitoring of PsA, providing real-time visualization of joint and soft tissue abnormalities. This review highlights recent advancements in ultrasonographic techniques for the assessment of PsA, including the identification of typical features, the role of power Doppler imaging in detecting active inflammation, and the potential of ultrasound for guiding treatment decisions. Additionally, we discuss the utility of ultrasound in assessing treatment response and monitoring disease progression in patients with PsA, with a focus on novel imaging modalities. By elucidating the evolving role of ultrasonography in PsA management, this article aims to enhance clinicians' understanding of its utility in facilitating early diagnosis, optimizing treatment strategies, and improving patient outcomes.

Comparison of Doppler Imaging and Microvascular Imaging in Cervical Lymph Node Blood Flow Analysis.

Cervical lymph node metastasis is an important determinant of cancer stage and the selection of an appropriate treatment plan for patients with head and neck cancer. Therefore, metastatic cervical lymph nodes should be effectively differentiated from lymphoma, tuberculous lymphadenitis, and other benign lymphadenopathies. The aim of this work is to describe the performance of Doppler ultrasound and superb microvascular imaging (SMI) in evaluating blood flow information of cervical lymph nodes. In addition, the features of flow imaging in metastatic lymph nodes, lymphoma, and tuberculous lymphadenitis were described. Compared with Doppler ultrasound, SMI, the latest blood flow imaging technology, could detect more blood flow signals because the sensitivity, specificity, and accuracy of SMI in the diagnosis of cervical lymph node disease were higher. This article summarizes the value of Doppler ultrasound and SMI in evaluating cervical lymph node diseases and focuses on the diagnostic performance of SMI.

Endothelial Dysfunction Linked to Ventricular Dysfunction in Children With Sickle Cell Disease, a 3D Speckle Tracking Study.

Sickle Cell Disease (SCD) is not a hematologic disease that occurs in isolation; it results in multi-organ complications. There is growing evidence of vascular stiffness as its underlying cause. This study aimed to investigate the relationship between endothelial stiffness and LV dysfunction in SCD patients and to explore its pathophysiology, particularly regarding the depletion of vasodilators such as Nitric Oxide (NO). 32 patients with established criteria for SCD and 40 healthy control subjects were selected for this case-control study. Comprehensive clinical assessment and assessment of endothelial function using Brachial Flow-mediated dilation (FMD) were performed, along with serum NO measurement, which was followed by diagnosis and echocardiographic assessment using 3D speckle tracking echocardiography (STE) and tissue Doppler imaging (TDI). Collected SCD cases showed echocardiographic features of Systo-diastolic dysfunction with reduced FMD compared to controls, denoting endothelial dysfunction in those patients. LDH showed a marked elevation, while serum NO showed a significant reduction in cases compared with controls. We also noted a positive correlation between FMD on the one hand and measures of ventricular dysfunction and level of serum NO on the other hand, the latter proving that reduction of NO is responsible for reduced endothelial function. We present the first report to date to outline the role of vascular stiffness as measured by brachial FMD in the induction of left ventricular dysfunction in SCD. We recommend that more research be conducted regarding possible strategies to replenish serum NO stores to delay microvascular injury and, in turn, ventricular dysfunction in SCD.

Nitric oxide releasing nanofiber stimulates revascularization in response to ischemia via cGMP-dependent protein kinase.

Nitric oxide (NO) promotes angiogenesis via various mechanisms; however, the effective transmission of NO in ischemic diseases is unclear. Herein, we tested whether NO-releasing nanofibers modulate therapeutic angiogenesis in an animal hindlimb ischemia model. Male wild-type C57BL/6 mice with surgically-induced hindlimb ischemia were treated with NO-releasing 3-methylaminopropyltrimethoxysilane (MAP3)-derived or control (i.e., non-NO-releasing) nanofibers, by applying them to the wound for 20 min, three times every two days. The amount of NO from the nanofiber into tissues was assessed by NO fluorometric assay. The activity of cGMP-dependent protein kinase (PKG) was determined by western blot analysis. Perfusion ratios were measured 2, 4, and 14 days after inducing ischemia using laser doppler imaging. On day 4, Immunohistochemistry (IHC) with F4/80 and gelatin zymography were performed. IHC with CD31 was performed on day 14. To determine the angiogenic potential of NO-releasing nanofibers, aorta-ring explants were treated with MAP3 or control fiber for 20 min, and the sprout lengths were examined after 6 days. As per either LDPI (Laser doppler perfusion image) ratio or CD31 capillary density measurement, angiogenesis in the ischemic hindlimb was improved in the MAP3 nanofiber group; further, the total nitrate/nitrite concentration in the adduct muscle increased. The number of macrophage infiltrations and matrix metalloproteinase-9 (MMP-9) activity decreased. Vasodilator-stimulated phosphoprotein (VASP), one of the major substrates for PKG, increased phosphorylation in the MAP3 group. MAP3 nanofiber or NO donor SNAP (s-nitroso-n-acetyl penicillamine)-treated aortic explants showed enhanced sprouting in an ex vivo aortic ring assay, which was partially abrogated by KT5823, a potent inhibitor of PKG. These findings suggest that the novel NO-releasing nanofiber, MAP3 activates PKG and promotes therapeutic angiogenesis in response to hindlimb ischemia.