Doppler Signal Research Articles

Analysis of oscillatory processes in the cardiovascular system in response to local heating in patients with type 2 diabetes mellitus

A comprehensive spectral analysis was used to assess heart rate variability and skin perfusion pattern of limbs in patients with type 2 diabetes mellitus in response to local heating and to identify significant predictors of physiological and pathological changes in the cardiovascular system. An electrocardiogram and skin perfusion on the forearm and foot were measured using Laser Doppler flowmetry at rest and during local heating in both healthy volunteers and patients with type 2 diabetes. The wavelet analysis was applied to Laser Doppler signals and heart rate variability (based on electrocardiogram signals). ROC analysis was used to evaluate significant predictors. The analysis results of patients with type 2 diabetes were compared with healthy controls. The following changes were observed in patients 1) impairment of skin blood flow reserve on the foot during heating, 2) lower amplitude oscillations in heart rate at rest and during heating, 3) an increase in amplitude of oscillations in the skin blood flow from the forearm in intervals related to respiration and heart activity at rest and during heating, 4) a decrease in amplitude of oscillations in the skin blood flow on the foot in the interval related to myogenic activity at rest and in cardiointerval during heating. The parameters of cardiovascular system (energies of heart rate variability at low-frequencies recorded by laser Doppler flowmetry on forearm in intervals related to respiration activity) with high discriminative power were revealed to distinguish patients from healthy subjects in response to local heating; these parameters can be used as markers for early diagnosis of microvascular disorders.

Perfusion Changes in Acute Septic Arthritis of the Hip Joint During Infancy Using Doppler USG.

To quantitatively assess vascularity changes of acute septic hips in infants using Doppler ultrasonography. To compare these findings with asymptomatic hips, and establish a correlation for accurate diagnosis between these findings. In this prospective case-control study, we included all children under 1year of age with a diagnosis of acute septic arthritis of the hip in the case group. For the control group, we enrolled apparently healthy, full-term neonates and infants not affected with any hip pathology. Doppler ultrasound of the medial femoral circumflex artery of the hip joint was done using a single Phillips HDI 5000 sonography machine. Following parameters were studied: peak systolic velocity (PSV), resistive index (RI), pulsatility index (PI), and systolic to diastolic ratio (SD ratio). Doppler signals and spectral waveforms were obtainable in 100% of hips in both groups. A statistically significant difference was found between the cases and controls with respect to their PSVs, RIs, PIs and SD ratios. The most striking difference was found between the PSVs of the two groups, whose mean was 6.18 in the control group and 11.8 in the case group. No significant correlation between age/gender and any of the 4 parameters was found. Doppler parameters are useful in raising suspicion of onset in the diagnosis of septic arthritis. No correlation was found between age or gender and any parameter in control group. These baseline values can be held valid for all children below the age of 7months.

A rotary trans-osseous ultrasound blood flow detection method for endoscopic application

Due to the small size and proximity to the spinal cord and vertebral artery, the cervical pedicle screw fixation procedure remains to be challenging in clinical practice. The screw misplacement has a high probability of occurrence of severe complications. How to prevent direct injury to the vertebral artery is a vital study focus in cervical spine surgery. In this work, a trans-osseous ultrasound Doppler method is proposed to explore the possibility of detecting blood flow through thin cortical bone. A miniature single-element prototype probe with a center frequency of 2.5 MHz is prepared. With the classical pulse-echo acquisition, a Spectral Power Index (SPI) algorithm based on Spectral Doppler and sliding window traversal is designed to enhance the Doppler signal intensity. In vitro and in vivo experiments were conducted to investigate the feasibility of this method. The results of in vitro experiments suggest that the anticoagulated bovine blood flowing at a mean velocity of 15 cm/s to 80 cm/s is detectable when the thickness of cortical bone is 0.7 ± 0.1 mm. The in vivo experiment showed that the large blood vessel with a diameter of about 3 mm (radial artery) can be detected through thin cortical bone (thickness of 0.7 ± 0.1 mm). The proposed trans-osseous Doppler method achieves artery detection through thin cortical bone, which has demonstrated the possibility of intraoperative vessel pre-warning. The present study poses a promising strategy to reduce the risk of vertebral artery injury and misalignment rate in the cervical pedicle screw insertion procedure.

Ultrasonography Enthesitis and Synovitis Screening in Psoriatic Patients: A Case Control Study.

The clinical screening of enthesitis and synovitis in patients with psoriasis lacks specificity and sensitivity during the preclinical phase. to assess US subclinical synovitis and enthesitis in psoriatic patients compared with healthy controls. A cross-sectional study on 40 psoriatic patients and 40 healthy sex- and age-matched controls. US examination of 18 joints was performed along with 22 entheseal sites on the upper and lower limbs. US subscores were established according to the US abnormalities: inflammatory score (tendon thickening, hypoechogenicity, bursitis, Doppler signal), damage score (calcification, enthesophytes, bone erosion) and total score (the sum of inflammatory and damage scores). US synovitis were more frequent in psoriatic patients (0.68%) than in controls (0.29%), but the difference was not significant. Patients with psoriasis had more US enthesitis (92,5%) compared to controls (40%)(p<0.001). The total number of enthesitis was higher in the psoriatic group (20.90%) compared to controls (4,78%)(p<0.001). There were more US abnormalities in the psoriatic group compared to controls for calcaneal tendon enthesis(p<0.001), distal patellar tendon enthesis(p<0.001) and deep flexor tendons of the finger enthesis(p<0.001). Compared to controls, psoriatic patients had a significantly higher inflammatory score (Mean±SD) (2.85±3.34 versus 0.58±1.17), damage score (3±2.57 versus 0.60±1.41), and total score (5.85±5.20 versus 1.18±2.07) (p < 0.001 each). Patients with scalp psoriasis had more US enthesitis (p=0.020). Our results indicate that US enthesitis and synovitis are more frequent in patients with psoriasis. Prospective studies with larger sample size are needed to define the contribution of US in predicting the clinical onset of PsA.

Gut-joint axis in knee synovitis: gut fungal dysbiosis and altered fungi–bacteria correlation network identified in a community-based study

ObjectivesKnee synovitis is a highly prevalent and potentially curable condition for knee pain; however, its pathogenesis remains unclear. We sought to assess the associations of the gut fungal microbiota and...

Exploration of Neurofilament Light Chain and Nerve Ultrasound in Leprotic Neuropathy.

To explore neurofilament light chain (NfL) levels in leprotic neuropathy compared to controls, and to determine if the changes correlate with ultrasonographic nerve findings. Individuals with leprosy with signs or symptoms suggestive of peripheral nerve involvement were recruited. They were evaluated by clinical examination, functional scores, laboratory assessments (including NfL), nerve conduction studies (NCS), and ultrasound. Ultrasound was conducted in bilateral median, ulnar, tibial, fibular, sural, and vagus nerves as well as cervical roots 5 and 6. Results were compared to age, sex, and body mass index matched healthy controls. A total of 320 nerves from 20 patients and 480 nerves from 30 controls were evaluated. NfL was significantly elevated in those with leprosy with a mean and standard deviation of 7.50 + 2.83 compared with 3.42 + 1.18 in controls (P < .001). Ultrasound showed focal enlargement of the nerves, particularly at entrapment sites. Additionally, there were noticeable changes in neural Doppler signal, echogenicity, and epineural thickness among the measured nerve sites. NfL levels in those with leprosy correlated closely with nerve cross-sectional area at all sites (P < .05). Functional and clinical assessment scores correlated with NfL and sonographic cross-sectional area as well (P ≤ .05). NfL is elevated in leprotic neuropathy. Ultrasound showed specific morphological changes in individuals with leprosy, and nerve enlargement correlated with NfL levels. Thus, both modalities may be useful for the diagnosis, prognosis, and disease monitoring in those with leprotic neuropathy, and further investigations are warranted.

EUS coil and glue for gastric varices-prevent, treat and rescue, one therapy to rule them all?

In portal hypertension, gastric varix-associated bleeding is known to have higher transfusion requirements, uncontrolled bleeding, rebleeding, intensive care unit requirements, and death. EUS-guided coil insertion is now an acceptable modality for endoscopic management in cases of gastric varices. With this study, we discuss our large single-center experience in the use of EUS for coil and glue injection in gastric varices. We also look into adverse events associated with and possibilities of using this modality as both primary prophylaxis and a rescue therapy. The study was conducted in a tertiary care center in India. A total of 86 patients were included in the study. The indication for EUS-guided coil and glue was divided into 3 clinical situations, namely, rebleed, rescue, and primary. The technical success and clinical success, that is, control of bleed in patients, were confirmed by absence of Doppler signal on EUS, endoscopic view, and stabilized hemoglobin with no need of blood product transfusion to maintain hemoglobin. The mean Child-Turcotte-Pugh score and Model for End-Stage Liver Disease-Na score were 9.2 and 14.6, respectively. The mean size of the gastric varices was 18.9 mm. The mean number of coils used was 2.9, and the average quantity of glue required was 1.6 mL. The technical success was 100% across the patient group. Clinical success was seen in 90% of the patient group. Mean follow-up was seen for 175.2 days. EUS-guided coil and glue therapy has a role in different clinical settings, as primary therapy, rebleed, and rescue therapy. It has significant technical and clinical success. Its role in treatment algorithms needs to be further studied in prospective studies. It may offer a cost advantage in comparison to interventional radiology-led interventions.

Early Intestinal Ultrasound Predicts Clinical and Endoscopic Treatment Response and Demonstrates Drug-Specific Kinetics in Moderate-to-Severe Ulcerative Colitis.

Intestinal ultrasound (IUS) is an emerging modality in monitoring disease activity in ulcerative colitis (UC). Here, we aimed to identify early IUS predictors of treatment response as evaluated by endoscopy and assessed the kinetics of IUS changes. This prospective, longitudinal study included UC patients with endoscopic disease activity (endoscopic Mayo score [EMS] ≥2) starting anti-inflammatory treatment. Clinical scores, biochemical parameters and IUS were assessed at baseline (W0), at week 2 (W2), at W6(W6), and at the time of second endoscopy (W8-W26). Per colonic segment, endoscopic remission (EMS = 0), improvement (EMS ≤1), response (decrease in EMS ≥1), and clinical remission (Lichtiger score ≤3) were assessed and correlated with common IUS parameters. Additionally, drug-specific responsiveness of bowel wall thickness (BWT) was assessed. A total of 51 patients were included and followed, and 33 patients underwent second endoscopy. BWT was lower from W6 onward for patients reaching endoscopic improvement (3.0 ± 1.2 mm vs 4.1 ± 1.3 mm; P = .026), remission (2.5 ± 1.2 mm vs 4.1 ± 1.1 mm; P = .002), and clinical remission (3.01 ± 1.34 mm vs 3.85 ± 1.20 mm; P = .035). Decrease in BWT was more pronounced in endoscopic responders (-40 ± 25% vs -4 ± 28%; P = .001) at W8 to W26. At W6, BWT ≤3.0 mm (odds ratio [OR], 25.13; 95% confidence interval, 2.01-3.14; P = .012) and color Doppler signal (OR, 0.35; 95% confidence interval, 0.14-0.88; P = .026) predicted endoscopic remission and improvement, respectively. Submucosal layer thickness at W6 predicted endoscopic remission (OR, 0.09; P = .018) and improvement (OR, 0.14; P = .02). Furthermore, BWT decreased significantly at W2 for infliximab and tofacitinib and at W6 for vedolizumab. BWT and color Doppler signal predicted endoscopic targets already after 6 weeks of treatment and response was drug specific. IUS allows close monitoring of treatment in UC and is a surrogate marker of endoscopy.

Use of B–mode and Power Doppler ultrasonography of the uterus and preovulatory follicle to predict ovulation time in Holstein cows after heat synchronization

Aim of study: To evaluate the utility of B-mode and Power Doppler ultrasonography to predict ovulation time in Holstein cows by assessment of uterine and follicle measurements. Area of study: Galicia, NW Spain Material and methods: 33 Holstein cows were examined every 12 h until ovulation. Measurements for the ratio endometrium/myometrium (END/MYO), uterine lumen (UL), diameter of the dominant follicle (DF), and Power Doppler of the dominant follicle and corpus luteum were recorded. The times of onset of heat, maximum heat (MHA) and heat finalization were obtained from the database of monitoring devices. Blood samples were taken at each examination for progesterone (P4) determination. Data were analyzed using one-way ANOVA and Pearson’s χ2 tests. Main results: For UL, time -6 (1.53 mm) with respect to ovulation (time 0) significantly differed from time -42 (5.70 mm). Concerning DF, significant differences were observed between time -6 (20.48 mm) and time -54 (16.60 mm). As for P4, significant differences were found between time -6 (0.34 ng/mL) and time -54 (1.03 ng/mL). Considering MHA, significant differences were observed for the UL between after and before/during groups; for DF, significant differences were found before and after MHA. As for heat, the UL significantly differed between after and before/during groups. Significant differences were found for the percentage of cows with Doppler signal in the ovulatory follicle and corpus luteum concerning MHA and heat factors. Research highlights: The use of Power Doppler to predict ovulation time needs to be refined. The END/MYO and UL measurements could be useful to identify cows in heat, but inaccurate to determine ovulation.

Parametric Doppler correction for wayside array acoustic signal via short-time reconstruction

The trackside acoustic detection system (TADS) plays a vital role in vehicle bearings condition monitoring. However, the inevitable Doppler distortion embedded in collected data will bring considerable difficulties to defect inspection and diagnosis in the system. The distortion elimination approaches mainly achieve spectrum recovery based on time-domain interpolation resampling (TIR) in a data-driven way. These will be further limited by the requirement to signal to noise ratio (SNR) or calculation speed. Considering the principle of wayside acoustic physical model and the benefits of array acoustic in practice, this study proposes an adaptive parametric Doppler correction (PDC) scheme based on short-time reconstruction (STR), including perception modeling, inverse perception optimization and Doppler correction. Firstly, mathematical modeling with multiple perception operators, including acoustic amplitude modulation operator, frequency modulation operator and array time delay operator, a wayside acoustic physical model based on array sensing is established. Secondly, through the corresponding inverse multiple perception operators, a transition signal with frequency-domain energy concentrated is obtained for the optimal moving parameters searching. Thirdly, within short-time sequence segments of the sound source, the real-time position recovery is realized via the proposed STR with formulaic propagation delay compensation. Theoretically, it can be seen that the proposed PDC scheme can simultaneously recover the amplitude, frequency distribution and phase of the Doppler signal, which can be applicable to all wayside acoustic diagnosis scenarios. With the correction analysis of simulation and experimental array defect signals, it can be confirmed that the proposed STR-based PDC scheme is effective for Doppler signal recovery in high fidelity, and has great potential to the real-time diagnosis of TADS.

Unsupervised cluster analysis of clinical and ultrasound features reveals unique gout subtypes: Results from the Egyptian College of Rheumatology (ECR)

BackgroundGout comprises a heterogeneous group of disorders; however, comorbidities have been the focus of most efforts to classify disease subgroups. ObjectivesWe applied cluster analysis using musculoskeletal ultrasound (MSUS) combined with clinical and laboratory findings in patients with gout to identify disease phenotypes, and differences across clusters were investigated. Patients and methodsPatients with gout who complied with the ACR/EULAR classification criteria were enrolled in the Egyptian College of Rheumatology (ECR)-MSUS Study Group, a multicenter study. Selected variables included demographic, clinical, and laboratory findings. MSUS scans assessed the bilateral knee and first metatarsophalangeal joints. We performed a K-mean cluster analysis and compared the features of each cluster. Results: 425 patients, 267 (62.8 %) males, mean age 54.2 ± 10.3 years were included. Three distinct clusters were identified. Cluster 1 (n = 138, 32.5 %) has the lowest burden of the disease and a lower frequency of MSUS characteristics than the other clusters. Cluster 2 (n = 140, 32.9 %) was mostly women, with a low rate of urate-lowering treatment (ULT). Cluster 3 (n = 147, 34.6 %) has the highest disease burden and the greatest proportion of comorbidities. Significant MSUS variations were found between clusters 2 and 3: joint effusion (p < 0.0001; highest: cluster 3), power Doppler signal (p < 0.0001; highest: clusters 2), and aggregates of crystal deposition (p < 0.0001; highest: cluster 3). ConclusionCluster analysis using MSUS findings identified three gout subgroups. People with more MSUS features were more likely to receive ULT. Treatment should be tailored according to the cluster and MSUS features.

Worse glycemic control is associated with an impaired arterial energy transfer pattern in elderly with diabetes

Abstract Background Worse glycaemic control is known to exacerbate endothelial insult, increasing macro- and microvascular complication risks in diabetes. Impaired intracranial haemodynamics have been frequently reported in patients with diabetes alongside with malperfusion causing structural abnormalities, and poor cognitive and cortical functionality (1-2).Assessment of the alterations in energy transfer characteristics derived from hemodynamic signals may provide novel mechanistic information about how worse glycaemic control may affect cerebrovascular perfusion. Wave reflection index(WRI) is a previously proposed measure of arterial energy transfer efficiency which reflects distal impedance mismatch(3-4). Purpose We aim to interrogate potential relationship between a worse glycaemic control and a less efficient arterial energy transfer, which could enhance our understanding of the cerebrovascular-cortical functional coupling on a mechanistic basis in elderly with diabetes. Methods Left middle cerebral artery wave intensity (WI) was computed with arterial blood pressure and flow velocity (transcranial Doppler) signal as previously described (WI = (dP/dt)*(dU/dt)) (Figure 1). Standard statistical tests were used to interrogate the relationship between glycated haemoglobin levels (HbA1c) and WI parameters. Results In 36 patients with diabetes mellitus type-2 (DM2) (mean age = 65.7 ± 8.8 years), backward compression wave intensity (BCWI) and wave reflection ratio (WRI= BCWI/FCWI) were significantly correlated with HbA1c levels before (rBCWI: 0.409 pBCWI:0.013; rWRI:0.345 pWRI:0.040) and after (rBCWI: 0.410 pBCWI:0.018, rWRI:0.351 pWRI:0.045) adjusting for age, sex and mean arterial pressure (Figure 2). Conclusion(s) In elderly patient with DM2, higher HbA1c values indicating worse glycaemic control are significantly correlated with altered cerebrovascular energy transfer characteristics as assessed by MCA wave intensity analysis. Continuous relationship between worse glycaemic control and higher wave reflection index (a measure of less efficient energy transfer in arterial system and distal impedance mismatch) may imply that the use of energy transfer related indices alongside with conventional hemodynamic indices may help providing a more comprehensive pathophysiological understanding about how cardiovascular risk factors interfere with perfusion.Computation of Wave IntensityMain Results

Abstract 17923: Acute Limb Ischemia Due to Dissection and Thrombosis of Anomalous Right Subclavian Artery: A Rare Complication of Trans-Radial PCI

Introduction: Right subclavian artery (RSA) normally originates from brachiocephalic artery, but in 0.4-1.8% of the general population it may arise directly from the aortic arch distal to the left subclavian artery. We present a case of acute limb ischemia due to dissection and thrombosis of anomalous right subclavian artery (ARSA) following transradial PCI. Case: A 60-year-old female presented with anterior STEMI. Coronary angiogram was performed via right transradial approach. During the procedure the aortic arch was noted to be exceedingly tortuous and coronary artery catheterization was difficult. Post-procedure, patient reported right arm pain. Her right hand was cold with bluish discoloration, nonpalpable right radial, ulnar and brachial artery pulses which prompted a CTA of the chest and right upper extremity. Imaging revealed ARSA with dissection and thrombosis of the RSA extending to mid-brachial artery and absent opacification of radial/ulnar arteries. The patient underwent right brachial artery cutdown, axillary artery thrombectomy and stenting of ARSA dissection. Post procedure, her pulses were palpable with triphasic doppler signals in the radial and ulnar artery. Four months later, surveillance CTA of chest showed patent stent without additional evidence of dissection (Figure 1). Discussion: ARSA is a rare anatomical variation of the origin of the RSA but also the most common abnormality of the aortic arch. ARSA anomaly is often asymptomatic, but approximately 10% is associated with tracheo-esophageal symptoms; the most frequent among them is dysphagia. Only 60% of coronary procedures using transradial approach are successful in the presence of ARSA. This congenital variant makes it difficult to approach the ascending aorta by the right transradial route, as it requires the catheter to curve back to reach the aortic root. Prompt recognition of this anomaly during the procedure and alternate access routes can avoid these severe complications.

Evaluating transient phenomena by wavelet analysis: early recovery to exercise.

Wavelet analysis (WA) provides superior time-frequency decomposition of complex signals than conventional spectral analysis tools. To illustrate its usefulness in assessing transient phenomena, we applied a custom-developed WA algorithm to laser-Doppler (LD) signals of the cutaneous microcirculation measured at glabrous (finger pulp) and nonglabrous (forearm) sites during early recovery after dynamic exercise. This phase, importantly contributing to the establishment of thermal homeostasis after exercise cessation, has not been adequately explored because of its complex, transient form. Using WA, we decomposed the LD signals measured during the baseline and early recovery into power spectra of characteristic frequency intervals corresponding to endothelial nitric oxide (NO)-dependent, neurogenic, myogenic, respiratory, and cardiac physiological influence. Assessment of relative power (RP), defined as the ratio between the median power in the frequency interval and the median power of the total spectrum, revealed that endothelial NO-dependent (5.87 early recovery; 1.53 baseline; P = 0.005; Wilcoxon signed-rank test) and respiratory (0.71 early recovery; 0.40 baseline; P = 0.001) components were significantly increased, and myogenic component (1.35 early recovery; 1.83 baseline; P = 0.02) significantly decreased during early recovery in the finger pulp. In the forearm, only the RP of the endothelial NO-dependent (1.90 early recovery; 0.94 baseline; P = 0.009) component was significantly increased. WA presents an irreplaceable tool for the assessment of transient phenomena. The relative contribution of the physiological mechanisms controlling the microcirculatory response in the early recovery phase appears to differ in glabrous and nonglabrous skin when compared with baseline; moreover, the endothelial NO-dependent influence seems to play an important role.NEW & NOTEWORTHY We address the applicability of wavelet analysis (WA) in evaluating transient phenomena on a model of early recovery to exercise, which is the only exercise-associated phase characterized by a distinct transient shape and as such cannot be assessed using conventional tools. Our WA-based algorithm provided a reliable spectral decomposition of laser-Doppler (LD) signals in early recovery, enabling us to speculate roughly on the mechanisms involved in the regulation of skin microcirculation in this phase.

Wavelet Scattering Transform based Doppler signal classification

Normal blood supply to the human brain may be marred by the presence of a clot inside the blood vessels. This clot structure called emboli inhibits normal blood flow to the brain. It is considered as one of the main sources of stroke. Presence of emboli in human’s can be determined by the analysis of transcranial Doppler signal. Different signal processing and machine learning algorithms have been used for classifying the detected signal as an emboli, Doppler speckle, and an artifact. In this paper, we sought to make use of the wavelet transform based algorithm called Wavelet Scattering Transform, which is translation invariant and stable to deformations for classifying different Doppler signals. With its architectural resemblance to Convolutional Neural Network, Wavelet Scattering Transform works well on small datasets and subsequently was trained on a dataset consisting of 300 Doppler signals.To check the effectiveness of extracted Scattering transform based features for Doppler signal classification, learning algorithms that included multi-class Support vector machine, k-nearest neighbor and Naive Bayes algorithms were trained. Comparative analysis was done with respect to the handcrafted Continuous wavelet transform features extracted from samples and Wavelet scattering with Support vector machine achieved an accuracy of 98.89%. Also, with set of extracted scattering coefficients, Gaussian process regression was performed and a regression model was trained on three different sets of scattering coefficients with zero order scattering coefficients providing least prediction loss of 34.95%.

An improved wavelet threshold denoising approach for surface electromyography signal

BackgroundThe surface electromyography (sEMG) signal presents significant challenges for the dynamic analysis and subsequent examination of muscle movements due to its low signal energy, broad frequency distribution, and inherent noise interference. However, the conventional wavelet threshold filtering techniques for sEMG signals are plagued by the Gibbs-like phenomenon and an overall decrease in signal amplitude, leading to signal distortion.PurposeThis article aims to establish an improved wavelet thresholding method that can filter various types of signals, with a particular emphasis on sEMG signals, by adjusting two independent factors. Hence, it generates the filtered signal with a higher signal-to-noise ratio (SNR), a lower mean square error (MSE), and better signal quality.ResultsAfter denoising Doppler and Heavysine signals, the filtered signal exhibits a higher SNR and lower MSE than the signal generated from traditional filtering algorithms. The filtered sEMG signal has a lower noise baseline while retaining the peak sEMG signal strength.ConclusionThe empirical evaluation results show that the quality of the signal processed by the new noise reduction algorithm is better than the traditional hard thresholding, soft thresholding, and Garrote thresholding methods. Moreover, the filtering performance on the sEMG signal is improved significantly, which enhances the accuracy and reliability of subsequent experimental analyses.

Supercharging DIEP Flaps Using Contralateral Superficial Inferior Epigastric Vein Grafts

Introduction: Venous congestion, even with a patent deep venous anastomosis, can afflict some DIEP (Deep Inferior Epigastric Perforator) flaps and various techniques of superficial venous supercharging have been described, although the indications for its use are not consensual. The main goal of this study is to confirm that superficial venous supercharge of DIEP flaps, utilizing the contralateral Superficial Inferior Epigastric Vein (SIEV) as an interposition vein graft, is feasible and functional. Materials and Methods: We retrospectively reviewed all DIEP flap breast reconstruction patients treated at our institution between June 2016 and December 2017 and that met all the inclusion criteria: Unilateral breast reconstruction with a DIEP flap; flap weighing more than 750 gm; supercharging of the ipsilateral superficial venous system; contralateral SIEV interposition graft; implantable doppler probe in the superficial system for at least 5 days. In the technique described here, the contralateral SIEV graft was harvested and anastomosed to the ipsilateral SIEV, obtaining this way a long vein that easily reaches the recipient vein (distal end of the Internal Mammary Vein - IMV). A Doppler probe was implanted in the superficial system, for at least 5 postoperative days, to monitor the function of this supercharging. We also analyzed the patient’s history, flaps weight, number and perforator rows, recipient vessels, SIEV graft length and diameter and all perioperative complications. Results: Ten patients met all inclusion criteria. They were treated using this technique and analyzed. Two patients had some type of alteration of the Doppler signal and clinical signs of venous congestion. They were surgically revised with success and were analyzed in detail. No total or partial flap failures were found. Clinical fat necrosis was also absent. Conclusion: This technique seems to be feasible, functional and adds an extra length to ipsilateral SIEV to reach a recipient vein. This way, the flap inset is not compromised by a short SIEV. No further significant morbidity is added for SIEV harvest that is in the same operative field, unlike the saphenous or cephalic veins. In selected patients, it could be an alternative supercharging technique.

FRI461 Two-years Course Of Subacute Thyroiditis After COVID-19 Vaccination: A Case Report

Abstract Disclosure: S. Yoshida: None. COVID-19 has been reported to cause subacute thyroiditis. Furthermore, the literature includes cases of COVID-19 vaccine-related subacute thyroiditis, but few reports describe the long-term course of vaccine-induced subacute thyroiditis. Herein, we report the case of a 47-year-old woman with no medical history who developed subacute thyroiditis after mRNA COVID-19 vaccination and was followed up for 2 years. Her fever persisted after the second dose of the COVID-19 vaccine, and she became aware of left anterior neck pain 8 days later. There were no infectious disease symptoms or signs in the patient’s history or at a recent physical examination. All thyroid autoantibodies were negative. On ultrasound, the thyroid gland was diffusely enlarged, and internal echogenicity was diffusely hypoechoic, coarse, and color Doppler blood flow signals were decreased without confinement to the pain area. She was diagnosed with subacute thyroiditis with tender thyroid swelling, thyrotoxicosis, and an inflammatory reaction. It was suspected that there was a causal link between the onset of subacute thyroiditis and COVID-19 mRNA vaccination because it developed immediately after vaccination and there were no other obvious causes. She was started on prednisolone, and her symptoms improved rapidly, leading to hypothyroidism 1 month later. The swelling of the thyroid gland improved rapidly, and it became atrophic several months after the onset of subacute thyroiditis. She never received any additional vaccinations. Two years after the onset, there was no recurrence of subacute thyroiditis, thyroid atrophy persisted, and the patient required levothyroxine supplementation (100 µg/day). Subacute thyroiditis generally has a good prognosis and rarely leads to permanent hypothyroidism. Subacute thyroiditis due to vaccination may follow a different course than that due to typical viral infection, and we need to examine its long-term prognosis. Presentation: Friday, June 16, 2023

RETRACTED ARTICLE: Assessment of fetal intraventricular diastolic fluid dynamics using ultrasound vector flow mapping

ObjectiveThe purpose of this study was to investigate the feasibility of visualizing and quantifying the normal pattern of vortex formation in the left ventricle (LV) and right ventricle (RV) of the fetal heart during diastole using vector flow mapping (VFM).MethodsA total of 36 healthy fetuses in the second trimester (mean gestational age: 23 weeks, 2 days; range: 22–24 weeks) were enrolled in the study. Color Doppler signals were recorded in the four-chamber view to observe the phase of the diastolic vortices in the LV and RV. The vortex area and circulation were measured, and parameters such as intraventricular pressure difference (IVPD), intraventricular pressure gradient (IVPG), and average energy loss (EL_AVG) were evaluated at different diastolic phases, including isovolumic relaxation (D1), early diastole (D2), and late diastole (D3).ResultsHealthy second-trimester fetal vortex formations were observed in both the LV and RV at the end of diastole, with the vortices rotating in a clockwise direction towards the outflow tract. There were no significant differences in vortex area and circulation between the two ventricles (p > 0.05). However, significant differences were found in IVPD, IVPG, and EL_AVG among the diastolic phases (D1, D2, and D3) (p < 0.05). Trends in IVPD, IVPG, and EL_AVG during diastole (D1-D2-D3) revealed increasing IVPD and EL_AVG values, as well as decreasing IVPG values. Furthermore, during D3, the RV exhibited significantly higher IVPD, IVPG, and EL_AVG compared to the LV (p > 0.05).ConclusionVFM is a valuable technique for analyzing the formation of vortices in the left and right ventricles during fetal diastole. The application of VFM technology has the potential to enhance the assessment of fetal cardiac parameters.

Abscess pulsatility: a sonographic sign of osteomyelitis

IntroductionEarly diagnosis and aggressive treatment of acute osteomyelitis may improve prognosis and prevent further complications. Sonography is useful in the evaluation of osteomyelitis. It can demonstrate early signs of inflammation, such as soft tissue changes near the affected bone, periosteal thickening, periosteal elevation, and subperiosteal abscess.Case presentationA 68-year-old female presented to the emergency department with 3 weeks of worsening left lower extremity pain. She was initially seen by urgent care for left shin erythema and swelling and treated for cellulitis with intramuscular ceftriaxone without improvement. On presentation, she was afebrile and hemodynamically stable with erythema, swelling, and tenderness of the left pretibial soft tissues. Her labs revealed leukocytosis and elevated inflammatory markers. Point-of-care ultrasound demonstrated a bidirectional flow of fluid through a disruption in the bone cortex visualized on greyscale imaging and confirmed with color and spectral Doppler. The patient was diagnosed with osteomyelitis and treated with antibiotics and incision and drainage by orthopedic surgery.DiscussionThe unique sonographic finding of pulsatile flow of fluid within an abscess near bone has not been previously described in the literature. The presence of Doppler signal in any fluid other than blood is known as pseudoflow. The presence of pulsatility in this case, which could represent either blood or pseudoflow, drew the ultrasound operator's eye to the cortical defect and lead to the diagnosis of osteomyelitis.ConclusionsThe sonographic finding of pulsatility in an abscess near bone should raise the concern for communication with the medullary cavity.