Ultrasound Guidance Research Articles

Distal radial artery palpability and successful arterial access for coronary angiography: A post-hoc analysis from two randomized trials.

Distal radial artery access (DRA) has been emerged as an alternative for conventional transradial arterial access. While palpation of radial artery is mandatory prior coronary angiography, it remains unknown the clinical impact of palpation in DRA success. Aim of our study is to explore whether the palpability of distal radial artery is linked with higher rates of successful arterial access. We conducted a post-hoc analysis using data from two randomized-controlled trials on DRA. All patients with available data on distal radial artery palpability and cannulation's success were included in our analysis. No procedure was performed with ultrasound guidance. Data on the palpability of the distal radial artery and the DRA success were available for 435 patients. Successful distal radial artery cannulation was attempted in 255 and 98 of patients with and without palpable distal radial artery, respectively. No significant difference between the two groups was observed (81.5% vs 80.3%, p = 0.786). Univariate analysis revealed statistically significant difference in gender, height, known CAD, valvular disease as indication for angiography and number of skin punctures. Multivariate analysis included these variables, as well as palpability of the distal radial artery and found that number of skin punctures and valvular disease as indication are significantly associated with DRA success. According our post-hoc analysis, the palpability of the distal radial artery is not associated with higher rates of DRA success. Further studies are required for the validation of these results.

Placental nanoparticle-mediated IGF1 gene therapy corrects fetal growth restriction in a guinea pig model.

Fetal growth restriction (FGR) caused by placental insufficiency is a major contributor to neonatal morbidity and mortality. There is currently no in utero treatment for placental insufficiency or FGR. The placenta serves as the vital communication, supply, exchange, and defense organ for the developing fetus and offers an excellent opportunity for therapeutic interventions. Here we show efficacy of repeated treatments of trophoblast-specific human insulin-like 1 growth factor (IGF1) gene therapy delivered in a non-viral, polymer nanoparticle to the placenta for the treatment of FGR. Using a guinea pig maternal nutrient restriction model (70% food intake) of FGR, nanoparticle-mediated IGF1 treatment was delivered to the placenta via ultrasound guidance across the second half of pregnancy, after establishment of FGR. This treatment resulted in correction of fetal weight in MNR + IGF1 animals compared to sham treated controls on an ad libitum diet, increased fetal blood glucose and decreased fetal blood cortisol levels compared to sham treated MNR, and showed no negative maternal side-effects. Overall, we show a therapy capable of positively impacting the entire pregnancy environment: maternal, placental, and fetal. This combined with our previous studies using this therapy at mid pregnancy in the guinea pig and in two different mouse model and three different human in vitro/ex vivo models, demonstrate the plausibility of this therapy for future human translation. Our overall goal is to improve health outcomes of neonates and decrease numerous morbidities associated with the developmental origins of disease.

Ultrasound-guided bilateral erector spinae plane block in the management of postoperative analgesia in living liver donors: a randomized, prospective study.

Living donor hepatectomy is a procedure associated with notable postoperative pain, impacting patient recovery and satisfaction. Addressing this challenge, we aimed to examine the effect of ultrasound-guided bilateral erector spinae plane block (ESPB) in postoperative analgesia management of patients undergoing living donor hepatectomy for liver transplantation. A single-center prospective, randomized, controlled study was conducted on ASA I-II patients aged 18-65 who underwent elective living donor hepatectomy. Participants were randomized into ESPB (N.=20) and control (N.=21) groups. ESPB was performed under ultrasound guidance with 0.25% bupivacaine (20 mL bilaterally) at T7-T9 levels. The control group received no block. Postoperative analgesia included IV acetaminophen, opioids, alongside fentanyl patient-controlled analgesia. Pain intensity was assessed using Numeric Rating Scale (NRS) at various time intervals. Primary outcome was to compare postoperative opioid consumption levels and secondary outcomes were to evaluate postoperative pain scores, requirement of rescue analgesia, and opioid-related side effects. Patients in ESBP group exhibited lower total fentanyl consumption (P=0.023) and lower meperidine use for rescue analgesia (P=0.001) compared to controls. While static pain scores showed no significant difference, Group ESPB reported lower dynamic pain scores in the immediate postoperative period (P=0.047). The incidence of nausea was lower in Group ESPB (6 vs. 17, P=0.002) with no observed complications. ESPB displayed promise in effectively managing post-living donor hepatectomy pain, resulting in decreased opioid consumption, improved pain relief, and reduced rescue analgesia requirements. This technique holds potential to enhance recovery and patient satisfaction following donor hepatectomy.

Percutaneous Ultrasound Guided Celiac Plexus Approach: Results in a Pig Cadaveric Model

Celiac plexus (CP) block (CPB) and neurolysis (CPN) are interventional techniques employed in human analgesia to control visceral pain originating from the upper abdomen. Visceral pain is common in animals and its treatment is challenging. A percutaneous ultrasound (US)-guided approach to the CP has been reported in people but not in veterinary species. The objective of this study is to describe a US-guided percutaneous approach to the CP in a porcine cadaveric model. Cadavers were positioned in right lateral recumbency. The vertebral body of the last thoracic vertebra (T15) was identified (in transverse view) with a left cranial abdominal US scan. Under US guidance, an 18 G Tuohy needle was inserted parallel and ventral to the transverse process of T15. The transducer was gently slid and tilted to have an in-plane view while introducing the needle through the epaxial muscle layer. Once the T15 body was contacted, the needle was advanced towards the ventral surface of the vertebra, and if loss of resistance was present, 2 mL of dye (China Ink) was injected. A laparotomy was performed, and the dyed tissue dissected for histological preparation from 14 cadavers. In all samples submitted for histological study, tissue belonging to the CP was found. The percutaneous ultrasound-guided approach to the CP was effective in localizing the CP in all subjects. Future studies are warranted to identify the clinical utility of this technique in veterinary species.

In Patients With Painful Hip Osteoarthritis, Is It More Beneficial to Offer Them an Ultrasound-Guided or a Fluoroscopic-Guided Intra-Articular Corticosteroid Injection to Relieve Their Symptoms? A Systematic Review and Network Meta-Analysis.

Hip osteoarthritis (OA) is a common disabling musculoskeletal condition. Clinical guidelines recommend intra-articular corticosteroid injections (IACSI) as a pharmacological adjunct to help manage pain. IACSI are typically image-guided either by ultrasound guidance (USG) or fluoroscopic guidance (FG) with no clear evidence towards the more efficacious guidance technique. This study aims to systematically review the scientific literature to determine the clinical effectiveness of USG compared with FG-IACSIs for people with pain-related hip OA. A systematic review of major bibliographic databases from inception to 24 August 2023 was conducted. Randomised controlled trials of USG- and FG-IACSIs for patients with hip OA were included. The primary outcome measure was pain. Hedges' g calculated effect size and meta-analysis using the random-effects model-estimated pooled effect sizes. τ2, I2 and Cochran's Q calculated heterogeneity. Network meta-analysis was completed to indirectly compare effect sizes. Quality was assessed using the Cochrane risk-of-bias tool (RoB2). A total of 1464 citations were identified; eight studies were included in the review. No studies directly compared imaging modalities. Two network meta-analyses indirectly comparing USG- to FG-IACSI via an image-guided comparator hip injection ([any comparator], [local anaesthetic or saline]) established effect sizes (g) of 2.61 and 2.46, respectively, both in favour of FG-IACSI. Heterogeneity was low in the USG studies and high in the FG studies. Evidence suggests that both USG and FG-IACSI are effective at reducing pain at 1 month in patients with painful hip OA. Although network meta-analyses favoured FG-IACSI, further high-quality trials are needed to determine the preferred guidance technique.

Fate of nondiagnostic thyroid fine needle aspirations.

Thyroid nodules may be detected during the workup of thyroid hormone abnormalities and as incidental findings during unrelated imaging studies. The diagnosis of a thyroid nodule is mainly established by performing fine needle aspiration (FNA) under ultrasound guidance. Thyroid nodules are classified as nondiagnostic, defined in the Bethesda System for Reporting Thyroid Cytopathology as samples with excess blood, cyst fluid only, and lack of thyroid follicular cells. The current study evaluates a series of nondiagnostic FNAs to assess whether repeat sampling improves yield and what patient management, and outcomes are after a nondiagnostic FNA. Thyroid FNAs from 2016 to 2023 were retrieved from our institution archives. All cases were performed under ultrasound guidance and with rapid on-site evaluation. Cases were assigned the Bethesda System Category. Nondiagnostic FNAs were further reviewed for repeat FNA procedures, potential molecular testing, or diagnostic resections. In total 3104 thyroid FNAs were reviewed, with 153 (4.9%) being nondiagnostic. Of the 154 FNAs, there were 129 patients with an average age of 60 and a male-to-female ratio of 1:3.2. Of the 130 patients, there were 50 patients who underwent 55 repeat FNAs. Thirty-seven (67%) of the repeats were benign, 13 (24%) were nondiagnostic again, and 5 (9%) were atypia of undetermined significance (AUS). Molecular testing was performed on repeat FNAs diagnosed AUS. Four cases showed no mutations and had a high likelihood of being benign. One case did have an NRAS Q61R mutation, and resection revealed a noninvasive follicular thyroid neoplasm with papillary-like nuclear features. Seventeen (13% of all cases) with nondiagnostic FNA were resected. Twelve (71%) thyroidectomies showed benign adenomatous nodules. The remainder showed incidental papillary thyroid microcarcinoma (0.1 cm), an infarcted follicular adenoma, a noninvasive follicular thyroid neoplasm with papillary-like nuclear features, and metastatic renal cell carcinoma (2×). Thyroid nodules with nondiagnostic cytology are reassuring of being highly likely a benign nodule. Only 5 of the 55 (9%) repeat FNAs yielded abnormalities, with only one of those being truly a follicular neoplasm (confirmed by molecular testing and resection). No primary thyroid malignancies have been identified in follow-up (repeat FNA or surgery). Clinical and ultrasound follow-up may be more appropriate management for nondiagnostic thyroid FNAs.

Expression of the Hopeful Therapeutic Target CD15 in Women with Breast Cancer

Background: CD15 is emerging as a recent prognostic marker with potential as a future therapeutic target in human malignancies. Its biological role in human cancer involves facilitating tumor cell adhesion through interaction with E-, L-, and P-selectins. This interaction allows adhesion to endothelial cells, enhancing metastatic potential. Objective: to study CD15 expression and its relationship to some pathologic parameters to provide the first Iraqi data-driven analysis of this growing concept in women with breast cancer. Subjects and Methods: A retrospective study was carried out utilizing tissue samples obtained from 85 patients with invasive breast cancer. Materials included one formalin-fixed paraffin-embedded tissue block, one hematoxylin and eosin-stained histological section, and two immunohistochemical-stained ER and HER2/NEU sections for each patient. The samples were obtained through core needle biopsy under ultrasound guidance. Data review and immunohistochemical staining with CD15 were conducted, followed by statistical analysis using the chi-square test to explore correlations. Results: CD15 expression was observed in 55% of breast cancer samples. There was a highly significant statistical relationship between CD15 expression and the presence of axillary lymph node metastasis (proven by fine needle aspiration cytology). However, there was no significant statistical relationship between CD15 expression and the histological grade, ER receptor, HER2-NEU status, and tissue calcification. Conclusion: CD15 expression was detected in breast cancer cells, with a highly significant association observed between CD15 expression and axillary lymph node metastasis at presentation. CD15 could serve as a prognostic marker as association with axillary lymph nodes reflects negative impact on prognosis and at the same time a promising therapeutic target for patients with breast cancer as blockage of CD15 antigen’s function will result in reduction of the metastatic potential and it could be an immunotherapeutic target.

Pericapsular nerve group (PENG) block versus supra-inguinal fascia iliaca (SIFI) block for functional outcome in patients undergoing hip surgeries – A randomised controlled study

Background and Aims: In hip surgeries, the pericapsular nerve group (PENG) block and supra-inguinal fascia iliaca (SIFI) block are commonly employed perioperative regional analgesia techniques. This study aimed to compare functional outcomes regarding quadriceps muscle strength and weight-bearing capacity between PENG and SIFI blocks after hip surgery. Methods: In this single-centre, double-blinded, randomised trial, 60 patients undergoing hip surgeries under subarachnoid block were randomised into either Group P (PENG block) or Group S (SIFI block). Blocks were administered under ultrasound guidance with 30 mL of 0.2% ropivacaine and 4 mg dexamethasone. Functional mobility was assessed 24 and 48 h postoperatively by measuring quadriceps strength and maximum weight-bearing capacity. Analgesic efficacy was also evaluated by comparing visual analogue score (VAS) scores at 24 h, total opioid consumption over 24 h, and duration of analgesia. Statistical analysis included Student’s t-test, Chi-square, and Z-test as appropriate, with statistical significance set at P < 0.05. Results: Group P demonstrated significantly higher quadriceps-muscle strength at 24 h (P = 0.025) and 48 h (P = 0.002) post surgery. More patients in Group P achieved superior weight-bearing grades at 24 h (P = 0.002) post surgery compared to Group S. VAS scores were significantly lower in Group P at 24 h post surgery (P = 0.006). Group P also showed a prolonged duration of analgesia (P = 0.019) and lower mean opioid consumption (P = 0.001) compared to Group S. Conclusion: The PENG block may be superior to the SIFI block in terms of functional outcomes with better quadriceps strength, enhanced weight-bearing, and provision of more effective postoperative analgesia in hip surgery patients.

Impact of the COVID-19 pandemic on diagnostic breast biopsies: a retrospective comparative study

Aims: The purpose of this study is to evaluate and compare the quantity and pathological outcomes of diagnostic breast biopsy procedures performed in our interventional radiology unit before, during, and after the COVID-19 pandemic. This study aims to examine the influence of the COVID-19 pandemic on the quantity of biopsies performed and the rates of detecting malignancies during different time periods. Methods: This retrospective study examined 365 patients who underwent diagnostic breast biopsies between January 2019 and January 2023. The study was approved by the hospital's ethics committee. After excluding 19 patients with inconclusive pathology results, a total of 346 patients were analyzed. Biopsies were performed utilizing 14-18 G tru-cut needles with the assistance of ultrasound guidance. Patients were classified into the following periods: pre-pandemic, pandemic, and post-pandemic. The histopathological findings were categorized as either benign or malignant. Statistical comparisons were conducted using the SPSS software, and a significance level of p<0.05 was used. Results: The average age of the patients was 53.7 ± 15.7 years. Out of the total of 346 biopsies, 165 (47.7%) were determined to be malignant, while 177 (51.2%) were found to be benign. The distribution of biopsies was as follows: 76 (22.0%) were conducted before the pandemic, 13 (3.8%) were conducted during the pandemic, and 257 (74.3%) were conducted after the pandemic. There was a substantial decline in the number of biopsies during the pandemic compared to before the pandemic, and a significant rise in the post-pandemic period compared to both the pandemic and pre-pandemic periods (p=0.024 and p=0.041, respectively). The incidence of malignancies during the post-pandemic period was significantly greater compared to both the pre-pandemic period (p=0.045) and the pandemic period (p=0.027). Conclusion: The COVID-19 pandemic caused substantial disruptions in breast cancer diagnostics, as indicated by a decrease in the number of biopsies performed and delays in the detection of malignancies. Following the pandemic, there was a significant rise in the incidence of malignancies, which can be attributed to the delays in diagnosing and treating these conditions during the pandemic. These findings indicate the significance for stronger healthcare strategies to reduce the effects of future crises on cancer management.

Transaxillary access for PDA Stenting in Neonates with Duct-Dependent Cyanotic Congenital Heart: A Retrospective Study

Background: Duct-dependent cyanotic congenital heart is a critical heart disease in infants. In neonates, patients with obstructing native ductus arteriosus may need palliative stenting to maintain adequate blood flow during the transition period. These babies are similar to ductal-dependent lesions but require patent ductus arteriosus (PDA) flow for their transition from fetal to neonatal circulation. PDA stenting is a well-recognized palliative for duct-dependent cyanotic congenital heart in neonates. Objectives: The study highlights the clinical utilities of transaxillary access for PDA stenting in neonates with duct-dependent cyanotic congenital heart Methods: The study aimed to evaluate the effectiveness of transaxillary access for direct stenting and stent placement in neonates with stable duct-dependent congenital heart disease and cyanosis due to non-obstructive arterial duct. The study involved a retrospective approach, using existing data and focusing on acute interventional procedure success with transaxillary access. Secondary endpoints included successful weaning from access to surgical conduit, cannula removal, antegrade flow reduction if connected to BDG, need and success rate of transaxillary plug insertion, and major and minor complications associated with AXA. The study design allowed for a comprehensive evaluation of the feasibility of this technique and its potential benefits and drawbacks. Data was collected from electronic medical records, Picture Archiving and Communication System, and the electronic database of the Intensive Care Unit of a hospital between 2016 and 2021. The study aimed to evaluate the risk-benefit of performing DDC in neonates through the AS in a new cohort of patients in the future. Results: This retrospective study examined the management of cyanotic congenital heart disease in 36 neonates, with eight cases involving elbow neoaortic utilization and 28 having a PDA diameter less than 1 mm. In seven cases, a 4-Fr angiographic pigtail was inserted retrograde to image the PDA, which was then accessed by navigating a 4-Fr JB1 catheter from the cannulation site. A portable X-ray unit was used exclusively to position these catheters and wires during the procedures under C-arm guidance. Diagnostic catheter removals were managed differently in this study, following the same principles used for sheath extractions in 29 retrospective and prospective presentations. The study reported on the procedural outcomes for transaxillary access and PDA stenting in neonates with duct-dependent cyanotic congenital heart disease. The study found no specific demographic or additional pre-procedural risk factors that would affect the results of the study. Conclusion: Transaxillary PDA stenting is a safe method for treating duct-dependent hypoxic congenital hearts in neonates, but has limitations like limited use, long transcatheter treatment periods, and anesthesia risks. It's recommended for developing countries with limited access to advanced care. The study improved palliative PDA stenting standard in CCTGA patients with complex congenital heart disease. Recommendations include insertion of a transaxillary sheath, support, and arterial access under ultrasound guidance.

Predicting and managing intra-abdominal collections by image guided percutaneous drainage after cytoreductive surgery and hyperthermic intra peritoneal chemotherapy: A five-year experience with 1313 patients

IntroductionIntraabdominal collections (IACs) are common following cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Inflammatory biomarkers and nutritional index (NI) may predict IACs. Management of IACs with image guided percutaneous drainage (IGPD) is an alternative to laparotomy. AimTo identify factors that predict IACs following CRS and HIPEC and to review outcomes following IGPD. MethodA retrospective review of prospectively collected data from a national referral centre including patients undergoing CRS and HIPEC who developed IACs treated with IGPD, between January 2018 and March 2022. Propensity score matched cases were compared to evaluate the prediction of IACs. The outcomes of IGPD were reviewed. ResultsIntraabdominal collections developed in 106 (8.0 %) of 1313 patients and 101/106 underwent IGPD, under Ultrasound or CT guidance. Laparotomy was required in 5/106.In those undergoing IGPD, pre- and postoperative CRP and neutrophils were significantly elevated while pre- and postoperative albumin and NI were significantly lower than propensity score matched controls. The postoperative CRP and neutrophil count, and pre and postoperative albumin and mGPS were identified as independent predictors in multivariable analysis.IGPD improved clinical condition in 94 %. In 15/106(14.8 %) the aetiology of the IAC was anastomotic leak with left subphrenic collections the most common (24/101, 24 %). There were 4 major complications, 2 perforations of bladder during IGPD insertion and 2 post drain removal bleeds. ConclusionIntraabdominal collections following CRS and HIPEC can be predicted by inflammatory markers and nutritional index. Prompt use of IGPD results in good outcomes avoiding the need for laparotomy.

Percutaneous radiofrequency ablation of hepatocellular carcinomas abutting the right posterior diaphragm: factors associated with tumor recurrence and overall survival.

Radiofrequency ablation (RFA) of subphrenic hepatocellular carcinomas (HCCs) using ultrasound (US) guidance presents a challenge. To evaluate local tumor progression (LTP) and overall survival (OS) after RFA of right posterior subphrenic HCCs, and to identify the risk factors for LTP and OS after RFA. We screened patients who underwent US-guided RFA for a single HCC <3 cm in the right posterior subphrenic area. Cumulative rates of LTP and OS were compared between multiple- and single-electrode treatments and artificial pleural effusion versus no-effusion groups using Kaplan-Meier curves and the log-rank test. The risk factors for LTP and OS were assessed. A total of 36 patients were included. The cumulative 5-year and 10-year LTP rates were 32.9% and 39.6%, respectively, and the corresponding OS rates were 72.2% and 48.7%, respectively. The multiple-electrode group had significantly lower cumulative LTP rates compared to the single-electrode group (P < 0.001). The group receiving artificial pleural effusion showed a trend towards lower LTP rates than the no-effusion group (P = 0.076). The albumin-bilirubin (ALBI) grade was the only risk factor for LTP (hazard ratio [HR] = 4.17, 95% confidence interval [CI] = 1.26-14.55; P = 0.020). A lower albumin level was a risk factor for mortality (HR = 0.24, 95% CI = 0.07-0.79; P = 0.020). US-guided RFA with multiple electrodes and artificial pleural effusion tends to be linked with lower LTP rates. The ALBI grade and serum albumin level are risk factors for LTP and OS, respectively.

How does ultrasound-guided (UG) injection of corticosteroid and local anesthetic compare with non-ultrasound-guided (NUG) injection for adults with Morton's neuroma?

How does ultrasound-guided (UG) injection of corticosteroid and local anesthetic compare with non-ultrasound-guided (NUG) injection for adults with Morton's neuroma?

Relationship between Body Mass Index and Prostate Specific Antigen among Community Men in Port Harcourt, Nigeria

Background: The prevalence of prostate cancer is increasing at a high rate in the Niger Delta region of Nigeria. The role of androgens, age and genetics are established worldwide. Among others, obesity, a consequence of Improvement in quality of life in the oil rich region, which has also been implicated in several conditions like diabetes, hypertension, depression, osteoarthritis and several other malignancies, could be a risk factor. Our aim in this study is to establish a relationship between BMI, an index of obesity and Prostate Specific Antigen (PSA), a marker for prostate cancer. Materials and Methods: We carried out a community-based observational study in Port Harcourt, Rivers State. The demographic, anthropometric and medical history of men, forty years and above who have lived in the Niger Delta area of Nigeria for over 15 years and who had no prior history of prostate cancer was taken. The BMI and the quantitative PSA of the participants were determined. The corelation of BMI and PSA was established. Results: A total of 583 respondents participated in the study. Mean age was 60.53 ±7.82. Mean BMI was 24.49 ±3.75. 18% of respondents were underweight, 53.3% were of normal weight, 35.3% were overweight and 7% were obese. The mean PSA was 4.12ng/ml, 84.5% had normal PSA, 15.5% had PSA greater than 4. There was a weak negative correlation between BMI and serum PSA with Pearson correlation of -0.010. Conclusion: This study shows a negative correlation between BMI and prostate cancer. In view of this inverse relationship between PSA and BMI it may be necessary to reduce the threshold for further evaluations like prostate biopsies in patients with high BMI. Additionally more specific diagnostic tools like ultrasound guidance during prostate biopsy may be helpful.

Dermal Filler-Induced Alopecia: A Case Report and Literature Review.

Dermal filler-induced alopecia is a rare yet significant complication of aesthetic procedures primarily associated with vascular occlusion and subsequent tissue ischemia. Hyaluronic acid (HA) fillers, though widely used for facial rejuvenation, can lead to adverse outcomes such as skin necrosis and hair loss, particularly in high-risk areas like the temples and glabella. This case report aims to highlight the clinical presentation, diagnostic approach, and multidisciplinary management of filler-induced alopecia, contributing to the existing literature with a comprehensive review of previously reported cases. A 21-year-old female presented with localized skin necrosis and alopecia four days after receiving 7 mL of HA filler injections in the temples, tear trough, and eyebrow glabella regions. Trichoscopy revealed follicular dropout and white dots, consistent with ischemic hair loss. Treatment included hyaluronidase injections (1500 units), intralesional corticosteroids, topical minoxidil, and CO2 laser therapy. Over 1 year of follow-up, the patient achieved complete hair regrowth and resolution of facial scarring. Only 16 cases of filler-induced alopecia have been documented, predominantly involving HA fillers. This case underscores the importance of early recognition and intervention with hyaluronidase to mitigate ischemic damage. The multidisciplinary management approach employed here demonstrates the potential for full cosmetic recovery. Filler-induced alopecia, though rare, necessitates heightened awareness among dermatologists and aesthetic practitioners. Adhering to recommended injection techniques and dosages, alongside the judicious use of ultrasound guidance, can minimize risks and improve patient safety.

Multi-Section Magnetic Soft Robot with Multirobot Navigation System for Vasculature Intervention.

Magnetic soft robots have recently become a promising technology that has been applied to minimally invasive cardiovascular surgery. This paper presents the analytical modeling of a novel multi-section magnetic soft robot (MS-MSR) with multi-curvature bending, which is maneuvered by an associated collaborative multirobot navigation system (CMNS) with magnetic actuation and ultrasound guidance targeted for intravascular intervention. The kinematic and dynamic analysis of the MS-MSR's telescopic motion is performed using the optimized Cosserat rod model by considering the effect of an external heterogeneous magnetic field, which is generated by a mobile magnetic actuation manipulator to adapt to complex steering scenarios. Meanwhile, an extracorporeal mobile ultrasound navigation manipulator is exploited to track the magnetic soft robot's distal tip motion to realize a closed-loop control. We also conduct a quadratic programming-based optimization scheme to synchronize the multi-objective task-space motion of CMNS with null-space projection. It allows the formulation of a comprehensive controller with motion priority for multirobot collaboration. Experimental results demonstrate that the proposed magnetic soft robot can be successfully navigated within the multi-bifurcation intravascular environment with a shape modeling error and a tip error of under the actuation of a CMNS through invitro ultrasound-guided vasculature interventional tests.

Central venous catheter-related infections: a systematic review, meta-analysis, trial sequential analysis and meta-regression comparing ultrasound guidance and landmark technique for insertion

BackgroundDuring central venous catheterization (CVC), ultrasound (US) guidance has been shown to reduce mechanical complications and increase success rates compared to the anatomical landmark (AL) technique. However, the impact of US guidance on catheter-related infections remains controversial. This systematic review and meta-analysis aimed to compare the risk of catheter-related infection with US-guided CVC versus AL technique.MethodsA systematic search on MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases was conducted until July 31, 2024. Randomized controlled trials (RCTs) and non-randomized studies of intervention (NRSI) comparing US-guided versus AL-guided CVC placement were included. The primary outcome was a composite outcome including all types of catheter-related infection: catheter-related bloodstream infections (CRBSIs), central line-associated bloodstream infections (CLABSIs), catheter colonization, or any other type of reported infection. The secondary outcomes included individual infection types and mortality at day-28. Subgroup analyses based on study type and operator experience were also performed.ResultsPooling twelve studies (8 RCTs and 4 NRSI), with a total of 5,092 CVC procedures (2072 US-guided and 3020 AL-guided), US-guided CVC was associated with a significant reduction in catheter-related infections compared with the AL technique (risk ratio (RR) = 0.68, 95% confidence interval (CI) 0.53–0.88). In the RCT subgroup, the pooled RR was 0.65 (95% CI 0.49–0.87). This effect was more pronounced in procedures performed by experienced operators (RR = 0.60, 95% CI 0.41–0.89). In inexperienced operators, the infection risk reduction was not statistically significant. The pooled analysis of CRBSIs and CLABSIs also favored US guidance (RR = 0.65, 95% CI 0.48–0.87).ConclusionUS-guided CVC placement significantly reduces the risk of catheter-related infections compared to the AL technique, particularly when performed by experienced operators.Trial registration PROSPERO CRD42022350884. Registered 13 August 2022.

Allium covered metal stent for treatment of malignant ureteral obstruction.

Malignant ureteral obstruction (MUO) has the potential to result in a range of outcomes, including varying degrees of hydronephrosis and renal impairment. Allium covered metal stents have provided a new, highly effective treatment option for MUO. Our objective was to evaluate the safety and efficacy of the Allium covered metallic stent for the treatment of malignant ureteral obstruction. Clinical data of 29 patients who underwent endoscopic insertion of an Allium ureteral stent between October 2019 and August 2021 at Yongchuan Hospital, affiliated with Chongqing Medical University, were analyzed retrospectively. At one, three, six and 12 months after insertion, serum creatinine was measured, the width of the renal pelvis was rechecked under ultrasound guidance, and the position and shape of the stent were checked by abdominal x-ray. Data on long-term stent patency, incidence of complications, changes in renal function and hydronephrosis grade were collected and analyzed. Ureteral stent symptom questionnaire (USSQ) was administered preoperatively and after six months in 22 patients with previous stent history. Allium covered metal stents (n = 33) were implanted successfully in 29 patients who were followed for three to 22 months, with 32/33 stents remaining patent. Serum creatinine levels decreased in 17 patients (p < 0.001), and hydronephrosis decreased in 24 patients. Clavien-Dindo grade I complications were observed in seven patients, Clavien-Dindo II in one patient, whereas stent displacement and stent encrustation occurred in one patient each (Clavien-Dindo III-IV). USSQ scores had significantly improved six months after stent insertion (p < 0.001). Allium ureteral stents are a safe and effective treatment option for malignant ureteral obstruction, with good long-term patency, helping to preserve renal function and improve quality of life.

Percutaneous ultrasound-guided A1 pulley release utilizing a modified 20-gauge spinal needle.

Trigger finger is a common cause of hand pain. Though multiple techniques for percutaneous A1 pulley release have been described in the literature, there is a continued need for safe and effective techniques using inexpensive, familiar, and commonly found instruments. This study evaluated outcomes of percutaneous A1 pulley release performed using a novel technique with a modified 20-gauge spinal needle and ultrasound guidance, with follow-up outcomes at least 6 months after the procedure. To evaluate the efficacy and safety of a novel percutaneous A1-pulley release technique in individuals with trigger finger. Retrospective observational study. Private practice outpatient orthopedics clinic. Forty digits from 30 unique patients with trigger finger who underwent percutaneous A1 pulley release. Percutaneous ultrasound-guided A1 pulley release performed with a modified 20-gauge spinal needle. The primary outcome measure was cessation of triggering. Secondary measures examined intraoperative and postoperative pain, postprocedural duration of activity limiting pain, and time to perform the procedure. Immediate cessation of triggering was achieved in all 40 digits following the procedure, with no recurrence reported at any time at an average follow-up of 11 months (range 6-32). Patients reported returning to normal activity in 2.75 days. Only one minor complication was reported, tenosynovitis, which resolved with a corticosteroid injection. Percutaneous, ultrasound-guided A1 pulley release performed with a modified 20-gauge spinal needle can be safely performed with good outcomes and a rapid return to normal activity.

Ultrasound-Guided Venous Catheter Placement in Prone Position.

The prone position is often used for patients with adult respiratory distress syndrome and specific surgical postures. When performing venous cannulation in this position, it is important to have a structured review to introduce the available major veins and ultrasound-guided procedure. In this review, we discuss the techniques of ultrasound-guided cannulation and provide insights into various aspects, including the anatomical locations of veins, vein sizes, placement techniques, surrounding structures at risk, and reported experiences with catheter placements. Eight major veins can be accessed in the prone position: the internal jugular vein, external jugular vein, brachiocephalic vein, basilic vein, mid-thigh femoral vein, popliteal vein, posterior tibial vein, and small saphenous vein. To minimize the risk of venous thromboembolism, the ratio of catheter diameter to vessel diameter should be less than 0.67. The review also presents the minimal requirement of venous diameter for different catheters in a tabulated form. For larger veins, real-time ultrasound guidance with the long-axis view/in-plane technique is suggested, while for smaller vessels, the short-axis view/out-of-plane technique is recommended. The review includes sonographic illustrations of the two techniques and surrounding arteries and nerves for the eight major veins. The aim of this review is to help clinicians assess the eight major veins and safely insert various types of catheters for patients in the prone position.