MHz Probe Research Articles

Ultrasound-guided Tenotomy and Osteectomy for the Treatment of Iliopsoas Impingement Post-total Hip Replacement

Ultrasound-guided Tenotomy and Osteectomy for the Treatment of Iliopsoas Impingement Post-total Hip Replacement

Limitations of Muscle Ultrasound Shear Wave Elastography for Clinical Routine-Positioning and Muscle Selection.

Shear wave elastography (SWE) is a clinical ultrasound imaging modality that enables non-invasive estimation of tissue elasticity. However, various methodological factors—such as vendor-specific implementations of SWE, mechanical anisotropy of tissue, varying anatomical position of muscle and changes in elasticity due to passive muscle stretch—can confound muscle SWE measurements and increase their variability. A measurement protocol with a low variability of reference measurements in healthy subjects is desirable to facilitate diagnostic conclusions on an individual-patient level. Here, we present data from 52 healthy volunteers in the areas of: (1) Characterizing different limb and truncal muscles in terms of inter-subject variability of SWE measurements. Superficial muscles with little pennation, such as biceps brachii, exhibit the lowest variability whereas paravertebral muscles show the highest. (2) Comparing two protocols with different limb positioning in a trade-off between examination convenience and SWE measurement variability. Repositioning to achieve low passive extension of each muscle results in the lowest SWE variability. (3) Providing SWE shear wave velocity (SWV) reference values for a specific ultrasound machine/transducer setup (Canon Aplio i800, 18 MHz probe) for a number of muscles and two positioning protocols. We argue that methodological issues limit the current clinical applicability of muscle SWE.

ЭХОГРАФИЧЕСКАЯ ХАРАКТЕРИСТИКА ОБОДОЧНОЙ КИШКИ У ПАЦИЕНТОВ С ПСЕВДОМЕМБРАНОЗНЫМ КОЛИТОМ ПРИ COVID-19

Objectives. To analyze the colon echographic images of patients suffering from pseudomembranous colitis (PMC) with COVID-19. Material and methods. 24 patients with PMC and COVID-19 (group 1), 24 patients with COVID-19 infection without diarrhea (group 2) and 24 practically healthy subjects (group 3, the control one) were examined. The diagnosis of coronavirus infection was verified by isolating SARS-CoV-2 RNA by polymerase chain reaction from the mucous membrane of the upper respiratory tract. Clostridioides difficile infection was detected by means of an immunochromatographic test with the determination of microbial toxins in the feces of patients. Ultrasound investigation (US) was performed using convex 3.5-4.0 MHz and linear 9.0-10.0 MHz probes without special preparation of patients for the examination. Results. All patients of group 1 had a thickened colon wall from 3.5 up to 11.2 mm. Among the patients of the 2nd group, the thickness of the intestinal wall in 25% of cases was up to 2 mm inclusively, in 75% - 2.1 mm or more, of which in every fourth case it exceeded 3 mm. The thickness of the bowel wall between the 1st and the 2nd groups of patients, as well as the 1st and the 3rd groups of patients, had statistically significant differences, no such pattern was found between the 2nd and the 3rd groups. The progression of ultrasound signs of colon lesions in patients suffering from PMC with COVID-19 was accompanied by a worsening of their clinical condition and the aggravation of characteristic laboratory changes. With a positive response to PMC therapy regression of ultrasound changes in the intestinal wall occurs, but there is some delay in the normalization of structural changes recorded by ultrasound. In all cases of PMC with COVID-19, a loss or weakening of the stratification of the bowel wall is observed. Tocompletion of PMC treatment when the intestinal wall thickness exceeds 4.5 mm is accompanied by the occurrence of relapses. Conclusions. Ultrasound of the intestine in patients having PMC with COVID-19 makes it possible to objectify the condition of the bowel wall and to adjust the management of patients.

5 Early diagnosis of coronary artery disease in postmenopausal women by arterial stiffness assessment

Abstract Aims Arterial stiffness is a marker of cardiovascular disease useful to identify, at an early stage, subjects with increased risk of cardiovascular artery diseases (CADs). Nevertheless, studies on gender-specific interactions of PWV and CAD are lacking. Therefore, the aim of this study is to investigate, in a population of postmenopausal women, the role of PWV in relation to CAD. The goal of our study was to assess the prevalence of CAD, among postmenopausal women affected by increased arterial stiffness, assessed by global pulse wave velocity (gPWV), and with diabetes and/or hypertension on target, distinguishing the different phenotypes. Methods and results We enrolled 632 consecutive women with an increased gPWV, 300 consecutive postmenopausal women with normal gPWV were included as control group (CG). We assessed arterial stiffness by gPWV, performed by pulsed Doppler (3.5 MHz probe) using two-dimensional guidance and ECG trigger. Philips Epiq 7 was used which is an echo-Doppler system equipped with a multifrequency transducer. The gPWV was assessed as normal for a velocity equal or lower than 7.1 m/s. CAD diagnosis was accepted when confirmed by exercise or nuclear stress test, cardiac catheterization, and angiogram or cardiac CT scan. All women were on therapy, with blood pressure < 130/80 mmHg and HbA1c < 7%. 55 (8.8%) women were affected by CAD among 632 with increased gPMW, and 15 (5%) among 300 women of CG, P < 0.04. There was no difference for mean age between the two groups: 58 ± 11 and 56 ± 8, respectively, P = 0.2. 29 (4.5%) women were affected by CAD and hypertensive cardiomyopathy among 632 with increased gPMW, and 6 (2%) among 300 women of CG, P < 0.05. 16 (2.6%) women were affected by CAD and metabolic cardiomyopathy among 632 with increased gPMW, and 2 (0.7%) among 300 women of CG, P < 0.05. Seventeen (2.7%) women were affected by CAD alone among 632 with increased gPMW, and 2 (0.7%) among 300 women of CG, P < 0.04. Conclusions We found a higher prevalence of CAD among postmenopausal women with increased gPWV when affected by hypertension and/or diabetes, also if on target therapy; the statistically significant correlation is confirmed also when women are affected by hypertensive or metabolic cardiomyopathy. We conclude that early detection increased gPWV may identify women with higher risk to develop CAD also before they become symptomatic.

THE CORRELATION BETWEEN FEMORAL INTIMA-MEDIA THICKNESS (F.IMT) AND THE SEVERITY OF CORONARY ARTERY DAMAGE IN PATIENTS WITH CORONARY ARTERY DISEASE

A pre-clinical sign of atherosclerisis is hypertrophy of arterial wall. Femoral intima-media thickness is noninvasive marker of arterial wall alteration, which can easily be assessed by high resolusion B mode ultrasound. Aims: To investigate the correlation between femoral intima-media thickness and the severity of coronary artery diseases. Methods: 111 consecutive patients with coronary artery diseases were enrolled. Femoral intima-media thickness was assessed by B mode ultrasound with 7.5 - 10 MHz probe about 10 - 15 mm before bifurcation to profond and superfacial femoral arteries. The femoral intima-media thickness < 1.0 mm is named as “normal”, ≥ 1.0 mm is “thick” and ≥ 1.5 mm is defined as “atherosclerosic femoral plaque”. The severity of coronary artery diseases was calculated by Gensini Score. Results: Mean femoral intima-media thickness was 1.57 ± 1.23 mm, 55% patients with abnormal femoral intima-media thickness (male 57.0% vs female 50.0%), 36.9% of patients with coronary artery diseases had atherosclerosic femoral plaque. There was a good correlation between femoral intima-media thickness and severity of coronary artery diseases by Gensini score and its risk factors (age, plasma glucose, smoking, hypertension…). Conclusion: Patients with coronary artery diseases are likely to have concomittant peripheral artery disease with high frequency of femoral artery wall changes. Femoral intima-media thickness could be a helpful diagnostic marker and therapeutic points. Key words: atherosclerisis, Femoral intima-media thickness, coronary artery diseases, femoral intimamedia thickness (F.IMT).

Ultrasound Assessment for Thyroid Examination in Patients with Hypothyroidism

Patients with overt hypothyroidism show decreased echogenicity of the thyroid at ultrasonography . The purpose of the present study was to evaluate the effectiveness of ultrasonography for diagnosing the most common hypothyroidism and to guide patients to appropriate treatment show decreased echogenicity of the thyroid by ultrasonography. This study have been conducted on 80Patients, the age group between 20-70 years, in the period of January 2020 to October 2021. Thyroid ultrasonography was carried out by the type of ultrasound (US) machine used in the study is a sameness -X300 ultrasound device with 7.5MHz probe. The volume of the thyroid lobe noticed calculations according to the formula of the: width x length x thickness. The assessment of the 80 patients with hypothyroidism who were included in our study, (57) patients with decreased echogenicity, 23 patients had been with normal echogenicity, the lowest was found in patients homogenous enhancement 42.5%, non- homogenous 57.5%, thyroid the gland has a medium gray scale homogeneous echo pattern and the level of echogenicity is higher than Size of thyroid, The higher percentage of nodules (51.3%) of the size of the thyroid was normal. But the higher percentage of nodules type (40.0%) for the study group was solid compared to the lower percentage (2.5%) was solid and cystic. Ultrasound had high specificity and more accuracy to assess patients with hypothyroidism. An association between hypo echogenicity at thyroid US and high level of thyroid stimulation hormone (TSH suggesting decreased echogenicity at the ultrasonography diagnostic.

High frequency ultrasonic scattering from cracks in orthotropic silicon wafers

Silicon wafers, commonly used in the photovoltaic industry, are susceptible to cracking during manufacturing and processing that may impact their performance. These microscale cracks are difficult to detect ultrasonically due to the anisotropic nature of silicon and the high frequencies necessary for inspection. For instance, phased array (PA) approaches commonly used to detect and size cracks are unsuitable for this application due to the frequency constraints of commercial PA systems. Therefore, crack scattering in anisotropic media has mostly been studied from a theoretical perspective and little work has been done from an experimental lens. In this presentation, we experimentally evaluate ultrasonic scattering from cracks in submillimeter silicon wafers using single-element 100 MHz probes. We use an oblique-incidence, pulse-echo configuration to spatially map shear scattering from cracks at different orientations in orthotropic silicon samples. Our results illustrate the strong scattering dependence on crystal orientation and elucidate the complexities in the response as a function of the planes of symmetry. These results will enable more in-depth sensitivity analysis for crack detection and characterization in anisotropic samples.

High-Frequency Ultrasound Assessment of Skin and Oral Mucosa in Metabolic Syndrome Patients—A Cross-Sectional Study

Background: Exogenous factors (such as sun exposure, smoking habits, and diet) and endogenous (inflammatory status, general diseases) have a direct influence on skin and soft tissue characteristics. The study’s objective was to assess the impact of metabolic syndrome (MS) on characteristics of skin layers in sun-exposed and non-exposed maxillofacial tissues evaluated by high-frequency ultrasound (HFU), as a potential diagnosis and monitoring tool for the aging process. Material and methods: The present study included 102 subjects (24 with MS; 78 without MS). Anthropometric parameters and disease history were recorded, and blood samples were harvested in order to assess biochemical parameters of MS. Sun-exposed skin (zygomatic region) and non-exposed oral mucosa of the lower lip were assessed using HFU (DUB® cutis, Taberna Pro Medicum) with a 22 MHz probe. Results: Patients with cardiac disease had significantly lower values for epidermis density (p = 0.002). Gender was independently linked to the aged dermis depth (p < 0.001), aged dermis no. of px (pixels) (p < 0.001), dermis depth (p < 0.001), dermis no. of px (p < 0.001), and subcutaneous tissue density (p < 0.001). Patients with MS had thinner epidermis (p = 0.008) and thinner aged dermis (p = 0.037) when compared to non-MS subjects. Conclusion: Patients with MS had thinner epidermis and a lower epidermis number of pixels in sun-exposed skin. Women had lower epidermis density and thicker dermis in sun-exposed skin. Our study showed that HFU, as a non-invasive investigation approach, is useful to diagnose and monitor the aging process in skin and oral mucosa, correlated with skin phenotype pathological conditions.

Timed Average Mean Maximum Velocity (TAMMV) of Cerebral Blood Flow of Children and Adolescents with Sickle cell Disease: correlation with clinical and hematological profiles in country.

Detection of abnormal TAMMV with transcranial Doppler is fundamental in primary stroke prevention in children with sickle cell disease (SCD). The study aimed at evaluating TAMMV and correlating it with clinical and hematological profiles of children and adolescent with SCD. Transcranial Doppler was performed on subjects aged 2-16 years, using a 2 MHz probe placed over the transtemporal windows. Pulse oximetry was used to determine the peripheral oxygen saturation while clinical and hematological profiles were retrieved from their medical records. One hundred and thirty five patients were recruited. The mean TAMMV was 125cm/s. Patients with HbSS had a significantly higher TAMMV (131cm/s) than those with HbSC (107cm/s). Only one (0.74%) patient had abnormal TAMMV. TAMMV correlated inversely with oxygen saturation, Hct and patient's age, and positively with white cell and platelet counts. Previous history of acute chest syndrome (ACS) and recurrent painful crises increased the risk of development of abnormal and conditional velocity. Frequency of abnormal TAMMV in this study was low. Younger children and those with HbSS had higher TAMMV. Age, oxygen saturation and haematocrit correlated negatively while white cell and platelet counts correlated positively with TAMMV. Previous history of ACS and recurrent bone pain were associated with increased risk of having abnormal and conditional TAMMV.

Preliminary study on the efficacy of ultrasound therapy in the rat model of sepsis

To investigate the possible mechanism of ultrasound therapy in the rat model of sepsis. Seventy-eight male Sprague-Dawley (SD) rats were randomly divided into Sham group (n = 12), septic model group (n = 22), ultrasound treatment group (n = 22), methyllycaconitine citrate (MLA) combined with ultrasound treatment group (n = 22). In the Sham group, only the abdomen was opened, the cecum was found to be free, without cecal ligation and puncture (CLP). In the septic model group, CLP was used to replicate the septic rat model. After operation, each group of rats were subcutaneously injected with preheated 37 centigrade normal saline. The rats in the ultrasound treatment group were treated with ultrasound [Philips IU22 L9-3 ultrasound instrument and 9 MHz probe were used to break the sequence in the spleen area once every 6 seconds, with 1 second for each time, the mechanical index (MI) was 0.72, and the treatment time was 10 minutes]. In the MLA combined with ultrasound treatment group, α7 nicotinic acetylcholine receptor (α7nAChR) specific blocker MLA 4 mg/kg was injected intraperitoneally 30 minutes before operation, and ultrasound treatment was performed 2 hours after operation. The levels of tumor necrosis factor-α (TNF-α) and interleukin (IL-1β, IL-6) in serum of each group were measured by enzyme-linked immunosorbent assay (ELISA) at 24 hours after operation. The 10-day survival rate of each group was recorded, and the symptoms of each group were evaluated by clinical disease score (CDS). The histopathological changes of lung and colon were observed under light microscope. Compared with the Sham group, the 10-day survival rate of rats in the septic model group was decreased significantly [40% (4/10) vs. 100% (6/6)], the CDS was (10.73±2.19 vs. 6.17±0.58) and the levels of TNF-α, IL-6, and IL-1β were increased significantly at 24 hours after operation [TNF-α (ng/L): 42.00±8.92 vs. 13.16±3.19, IL-6 (ng/L): 129.37±25.04 vs. 63.99±12.92, IL-1β (ng/L): 254.98±67.27 vs. 76.83±25.39, all P < 0.01]. Compared with the septic model group, the survival rate in the ultrasound treatment group was improved [70% (7/10) vs. 40% (4/10)], but there was no significant difference (P > 0.05). The CDS (7.64±2.68 vs. 10.73±2.19) and the expressions of TNF-α, IL-6, and IL-1β were significantly reduced at 24 hours after operation [TNF-α (ng/L): 16.93±6.02 vs. 42.00±8.92, IL-6 (ng/L): 73.65±24.38 vs. 129.37±25.04, IL-1β (ng/L): 111.86±14.08 vs. 254.98±67.27, all P < 0.01]. Compared with the ultrasound treatment group, the survival rate in the MLA combined with ultrasound treatment group was reduced [60% (6/10) vs. 70% (7/10)], but the difference was not statistically significant (P > 0.05). CDS was significantly increased (9.55±2.72 vs. 7.64±2.68), and the levels of TNF-α, IL-6 and IL-1β were significantly increased at 24 hours after operation [TNF-α (ng/L): 34.61±7.89 vs. 16.93±6.02, IL-6 (ng/L): 112.92±10.42 vs. 73.65±24.38, IL-1β (ng/L): 212.57±32.16 vs. 111.86±14.08, all P < 0.01]. Microscopically, in the septic model group, the alveolar septum was thickened, a large number of inflammatory cells infiltrated, normal pulmonary reticular structure disappeared, and pulmonary interstitium showed obvious hemorrhage and edema, meanwhile, the structure of colonic villi was obviously abnormal, with cells were edema and inflammatory cell infiltration, and the arrangement was disordered, so that the subepithelial space and the top of it fell off. After ultrasound treatment, the thickness of the alveolar interval in rats was similar to that in Sham group, without obvious inflammatory cell infiltration, and the pulmonary reticular structure was relatively intact. At the same time, the morphology of colonic villi was basically normal and orderly, the edema of cell was not obvious, and subcutaneous space and tip fall off were not obvious. After being antagonized by MLA, the rat lung tissue showed thickened alveolar septum, inflammatory cell infiltration, incomplete pulmonary network structure, hemorrhage and edema in the interstitium. The villi structure of the colon was faintly visible, with obvious cell edema and inflammatory cell infiltration, and the arrangement was abnormal. Ultrasound treatment improves the prognosis of septic rats, MLA can reverse the anti-inflammatory effect of ultrasound therapy by antagonizing α7nAChR, suggesting that the protective mechanism of ultrasound in sepsis may be related to activating the cholinergic anti-inflammatory pathway mediated by α7nAChR.

Preeclampsia prediction –First trimester screening markers

Preeclampsia is a multi-system disorder manifested primarily by hypertension and proteinuria during second half of pregnancy. It is a major cause of maternal morbidity and mortality worldwide. Despite decades of research into the condition, the ability of clinicians to predict preeclampsia prior to the onset of symptoms has not improved significantly. In this review we will look at potential biomarkers for early prediction and diagnosis of preeclampsia. To evaluate the efficacy of different biochemical and biophysical markers in the early weeks of gestation as screening tools for early prediction of preeclampsia. This hospital-based prospective observational study conducted on 52 pregnant women, at less than 13 weeks of gestation were recruited. Maternal urine microalbumin, urinary albumin to creatinine ratio, and USG uterine artery PI levels were analyzed among the pregnant women who subsequently developed PE and compare with those who did not develop PE. Methods used for the detection of markers are: immunoturbidimetric method for urine albumin, modified kinetic Jaffe reaction without deproteinization for Urine creatinine and Uterine artery Doppler velocimetry was done by PHILIPS HD11XE transabdominal ultrasound machine using a 4-6 MHz probe with the same sonographer. In the present study, spot urine microalbumin and spot urine albumin to creatinine ratio (UACR) at 11-13 were significantly higher in women who developed PE subsequently when compared to nonpreeclamptic women.(P&amp;#60;0.0001). The mean levels of 1st and 2nd-trimester uterine artery PI significantly high in women who subsequently developed PE when compared to those who did not develop preeclampsia (P&amp;#60;0.0001). Study results showed a strong association between gestational age at delivery and neonatal outcome (neonatal birth weight and APGAR) with preeclampsia. The maternal urine microalbumin, albumin to creatinine ratio, and uterine artery PI found to have good sensitivity and specificity for early prediction of PE. Study concluded that the women who are prone to develop PE subsequently, had high levels of MAP, UAPI, microalbuminuria and urine albumin to creatinine ratio than the normotensive women. In our setting, MAP, UAPI, microalbuminuria, and UACR markers appeared to be better screening modalities. The combination of biochemical markers with the biophysical markers, demographic characteristics, and other novel markers will establish the effective screening models for early prediction of PE. Early identification of high-risk cases will offer an opportunity for prophylactic therapy, such as Low- dose Aspirin in selected groups of high-risk women screened in the first trimester, thus improving the maternal and perinatal outcome.

Detection and identification of subcutaneous defects using ultrasonic waves in reflective test

Non-destructive ultrasonic evaluation is one of the methods used for inspection in mechanical engineering. This method has diverse applications in various fields, including industry and medicine. The main purpose of this research is to identify a subcutaneous defect with ultrasonic waves. This is done by sending ultrasonic waves into the skin tissue and receiving backward echoes, simulating them using a software, and calculating the time difference using the speed of sound. In this research, the behavior of longitudinal and transverse waves is investigated in collisions with a defect by describing the genesis and application history as well as the principles and definitions of ultrasonic waves. In the test, first, the method of identifying the subcutaneous defect is explained. Then, the dimensions and stiffness of the defect are determined by analyzing the information obtained from the location. Using the 3.5-MHz probe, the defect was detected at a distance of 1.8 mm, indicating a high level of reliability compared to the sonography imaging device. This was while the 10-MHz probe failed to detect the defect just near the skin surface. The results confirm the choice of this method as a suitable method for detecting the subcutaneous defect.

The correlation between the femoral artery intima-media thickness and the severity of coronary artery diseases

Background: A pre-clinical sign of atherosclerisis is hypertrophy of arterial wall. F.IMT (Femoral intima-media thickness) is non-invasive marker of arterial wall alteration, which can easily be assessed by high resolusion B mode ultrasound. We aim to investigate the correlation between femoral intima-media thickness (F.IMT) and the severity of coronary artery disease (CAD). Methods: 111 consecutive patients with coronary artery disease (CAD) were enrolled. Femoral IMT (F.IMT) was assessed by B mode ultrasound with 7.5 - 10 MHz probe about 10 -15 mm before bifurcation to profond and superficial femoral arteries. The F.IMT &lt; 1.0 mm is named as “normal”, F.IMT ≥ 1.0 mm and &lt; 1.5 mm is “thick” and ≥1.5 mm is defined as “atherosclerosic femoral plaque”. The severity of CADs was calculated by Gensini Score. Results: Mean F.IMT is 1.57 ± 1.23 mm, 55% patients with abnormal F.IMT (male 57.0% và female 50.0%), 36.9% of patients with CAD have atherosclerosic femoral plaque. There is a good correlation between F.IMT and severity of CAD by Gensini score and its risk factors (age, plasma glucose, smoking, hypertension…) Conclusion: Hospitalised patients with CAD are likely to have concomittant PAD with high frequency of femoral artery wall changes. F.IMT could be a helpful diagnostic marker and therapeutic points.

POS0778 ULTRA HIGH-RESOLUTION ULTRASOUND (UHFUS) OF LABIAL GLANDS IS A STRONG PREDICTOR OF SALIVARY GLAND HISTOPATHOLOGY IN SJÖGREN’S SYNDROME (PSS)

Background:Last-generation ultra high-resolution ultrasound (UHFUS) transducers, producing frequencies up to 70 MHz and achieving tissue resolution up to 30 μm, are opening up new possibilities for the study of labial salivary glands (LSG) in patients clinically suspected with primary Sjögren’s syndrome (pSS).Objectives:To explore the value of LSG-UHFUS as a predictor of the intensity of the histological inflammation in LSG biopsy in an inception cohort of patients with sicca symptoms derived from daily clinical practice.Methods:Consecutive patients undergoing a LSG for clinically suspected pSS were included in this study from January 2018 to October 2020. UHFUS of LSG was performed by using VEVO MD, equipped with a 70 MHz probe, scanning first the central compartment of the inferior lip, and then both peripheral compartments. Parenchymal homogeneity was graded on a scale of 0 (normal) to 3 (evident). UHFUS imaging was used to locate the LSG for the US-guided biopsy. For each of the LSG specimens the area of the glandular tissue, the presence and number of foci and the focus score (FS) were assessed. Immunostaining for CD21 was performed to evaluate the presence of follicular dendritic cells (FDC) in foci.Results:We included a total of 171 patients with suspected pSS: out of them, 83 (48.5%) received a diagnosis of pSS (ACR 2016 criteria) and 88 (51.5 %) were diagnosed as no-SS sicca controls. Out of the 171 LSG biopsies, 73/171 (42.7%) were characterized by a nonspecific chronic sialadenitis (NSCS) whereas a focal lymphocytic sialadenitis (FLS) was described in the remaining 98/171 (57.3%). UHFUS-LSG scores were differently distributed in pSS patients with respect to no-SS sicca controls: a score 0 was detected in 16/88 no-SS sicca controls and in none of the 83 pSS patients, whereas a score 3 was detected in 12/83 pSS and in none of no-SS sicca controls. (p&lt;0.001). The higher was the UHFUS grading, the higher was the number of foci (from a mean (S.D) = 0.38 (0.72) in UHFUS-score 0 to 4.58 (3.11) in UHFUS-score 3, p&lt;0.001) and the focus score (from 0.17 (0.32) in UHFUS-score 0 to 1.88 (0.90) in UHFUS-score 3, p&lt;0.001) of the samples. Overall, out of the 16 no-SS controls with LSG-UHFUS score 0, only 4/16 showed histological features of focal lymphocytic infiltrate; however, the mean FS of those 4/16 samples was 0.17 (0.32). In fact, considering a FS≥1, negative UHFUS-LSG was highly predictive of a negative histology (100 %). By contrast, out of the 12 pSS patients with the highest score at LSG-UHFUS (score 3), 10/12 presented FDC networks in their biopsies, with a positive predictive value of 83% of the severity of the infiltrate.Conclusion:UHFUS of LSG appeared feasible and sensitive in pSS; due to its striking negative predictive value this novel tool can help to identify negative patients on subsequent lip biopsy, thus avoiding invasive procedures in selected cases. Besides its diagnostic role, considering the association with the presence of FDC networks, UHFUS-LGS may also have a role in patients prognostic stratification.Disclosure of Interests:None declared

Real-time visualisation of peripheral nerve trauma during subepineural injection in pig brachial plexus using micro-ultrasound

BackgroundNerve damage is consistently demonstrated after subepineural injection in animal studies, but not after purposeful injection in patients participating in clinical studies. There is a need to better visualise nerves in order to understand the structural changes that occur during subepineural injection. MethodsWe scanned the brachial plexuses of three anaesthetised pigs using micro-ultrasound imaging (55–22 MHz probe), inserted 21 gauge block needles into the radial, median, and axillary nerves, and injected two 0.5 ml boluses of saline into nerves at a rate of 12 ml min−1. Our objectives were to measure the area and diameter of nerves and fascicles, and to describe changes in nerve anatomy, comparing our findings with histology. ResultsImages were acquired at 42 sites across 18 nerves in three pigs and compared dimensions (geometric ratio; 95% confidence interval; P value). As expected, the nerve cross-sectional area was greater in the proximal brachial plexus compared with the mid-plexus (2.10; 1.07–4.11; P<0.001) and the distal plexus (2.64; 1.42–4.87; P<0.001). Nerve area expanded after 0.5 ml injection (2.13; 1.48–3.08; P<0.001). Using microultrasound, subepineural injection was characterised by nerve and fascicle rotation, uniform, or localised swelling and epineural rupture. Micro-ultrasound revealed a unique pattern suggestive of subperineural injection after a median nerve injection, and good face validity with histology. Histology showed epineural trauma and inflammation to the perineurium. ConclusionWe accurately identified fascicles and real-time structural changes to peripheral nerves using micro-ultrasound. This is the first study to visualise in vivo and in real-time the motion of nerves and fascicles in response to anaesthetic needle insertion and fluid injection.

The diagnosis of malignant breast lumps using fine needle aspiration cytology and ultrasonography versus histopathology

Background and objective: The most common cancer of women worldwide is breast cancer and usually presents as a breast lump. Fine needle aspiration cytology and ultrasonography are two investigational techniques used to differentiate malignant breast lump from benign one. This study aimed to find out and compare the specificity, sensitivity, and predictive values of ultrasonography versus fine needle aspiration cytology for the diagnosis of malignant breast lump. Methods: Patients who presented with clinically palpable breast lump at the department of Surgery, Rizgary Teaching Hospital, Erbil, from October 2014 to March 2016, were included. The age of the study participants ranged from 15 to 56 years. The highest rate (28.9%) was among the age group 35-45 years. Breast abscess, cystic breast lumps, and recurrent lumps have been excluded. The ultrasonographic evaluation was done by using 7.5 MHz probe for all patients at the department of radiology and fine needle aspiration cytology at the department of histopathology. All the patients underwent excision of the lumps, and histopathological examination was done for tissues. Specificity, sensitivity, and predictive values of ultrasonography and fine needle aspiration cytology were estimated, taking the histopathological result as the gold standard. A comparison of values was made. Results: Ninety patients with 93 breast lumps were included in this study. Fine needle aspiration cytology reported 28 lumps as malignant lumps and 63 as benign, and two cases were indeterminate. Ultrasonography reported 27 cases as malignant, 54 as benign, and nine as indeterminate, while three breast lumps were failed to be detected. Sensitivity, specificity, positive and negative predictive values of ultrasonography and fine needle aspiration cytology in diagnosing malignant breast lump were 94.74%, 100%, 100%, 97.22%, and 90.48%, 100%, 100%, 95.24%,respectively. Conclusion: Ultrasonography and fine needle aspiration cytology are 100% specific in diagnosing malignant breast lesions. Although ultrasonography appears more sensitive than fine needle aspiration cytology, it has a higher percentage of the indeterminate report. Keywords: Fine needle aspiration cytology; Ultrasonography; Breast lumps.

Utility of high-frequency ultrasound in assessing cutaneous edema in venous ulcer patients.

High-frequency ultrasound (HFUS) using a 20MHz probe is a non-invasive assessment tool. Its utility in dermatology for diagnosis of disease or for monitoring of treatment response in various dermatological conditions is still being explored. Edema secondary to venous hypertension is the main pathogenic factor in the development of venous leg ulcers. However, there is no objective method for assessment of degree of edema. In this study, we explore the utility of high-frequency ultrasound in assessing cutaneous edema and for monitoring its improvement with compression therapy among patients with venous ulcer. Twenty patients with venous ulcer were enrolled in the study. Measurement of cutaneous edema was done at baseline and after 2weeks of compression therapy in all patients. The 3 levels of measurement were dorsum of foot (low site, L1), 4cm proximal to the medial malleolus (middle site, L2), and the medial aspect of the calf between the medial malleolus and the knee (upper site, L3). Baseline subepidermal low echogenic band (SLEB) measurements were 2.46±0.69mm, 2.94±0.65mm, and 2.66±0.64mm at L1, L2, and L3, respectively. There was a significant reduction in SLEB measurement after compression therapy ( p values 0.008, 0.002, and 0.003 at L1, L2, and L3, respectively). The mean percentage reduction in SLEB at level of medial malleolus (mid level - 29.61±12.24) was higher than the other 2 sites (L1-22.45±15.83 and L3 were 27.57±12.34). Cutaneous ultrasound aids in accurate assessment of level and severity of edema. Hence, it can be utilized in trials to objectively assess the adequacy of treatment for patients with venous insufficiency.

Changes of Hemodynamic Parameters at the Preparatory Stage of Periodization Training among the Male and Female Athletes Involved in Different Running Events

The present study was conducted to determine the changes occurs in hemodynamic variables of (HR, LVSD,LVESD, Stroke volume, Cardiac output) at different training phases of periodization in athletic events suchas, middle distance and long-distance running between the male and female novice athletes in athletictraining center at maychew, Ethiopia.Materials and Method: In this qazi-experimental study, 18 athletes selected from different phases of trainingat maychew athletic training center in Ethiopia. The novice athletes of male and female were selected by theirperformance in the regional wise, as they are novice athletes in the training center they used to go for morethan a year training however the researcher wanted to know the hemodynamic parameters changes occursbefore the athletes used to engage in specific period of training. To analyze the hemodynamic parameterthe subjects were taken to the comprehensive specialized regional hospital then, "Echocardiography was performed by VIVID E-19(General Electric) undertaken using a 2.5MHz probe "are used to calculate several hemodynamic parameters the values of hemodynamic parameters were recorded at intervals. The recorded data were analyzed by SPSS 21 software, using independent t-test, it is concluded that while comparing the male and female novice athletes male athletes are dominating in longdistance then female athletes are dominating in middle distance running events.

Cardiac Morphology Changes Occur at the Preparatory Stage of Periodization Training among the Male and Female Athletes Involved in Different Running Events

This research aimed to determine the influence of certain cardiac morphological variables in novice trainingathletes on the volume and intensity at the Preparatory stage of the training period. present study wasconducted to determine the changes occurs in cardiac variables of (LVEDD, LVPWD, LVEF, LVEDV,LVESV) at Preparatory stage of periodization training in different athletic events such as middle distanceand long-distance running from the male and female novice athletes in athletic training center at maychew,Tigray region, EthiopiaMaterials and Method: In this qazi-experimental study, 18 athletes selected from different phases oftraining at maychew athletic training center in Ethiopia. The novice athletes of male and female wereselected by their performance in the regional wise, as they are novice athletes in the training center they usedto go for more than a year training however the researcher wanted to know the cardiac parameters changesoccurs before the athletes used to engage in a specific period of training. To analyze the cardiac parameterthe subjects were taken to the comprehensive specialized regional hospital then, Echocardiography was performed by VIVID E-19 (General Electric) undertaken using a 2.5MHz probe are used to calculate several cardiac-related parameters the values of cardiac parameters were recorded at intervals. The recorded data were analyzed by SPSS 21 software, using independent t-test, Inconclusion, while comparing the male and female novice athletes male athletes are dominating in and longdistance then female athletes were as female athletes are dominating only in middle distance running eventsas cardiac morphology variables concerns.

Usefulness of high-frequency ultrasound in differentiating basal cell carcinoma from common benign pigmented skin tumors.

Basal cell carcinoma (BCC) is the most common cutaneous malignancy. Occasionally, it may have an appearance similar to that of some benign pigmented skin lesions. Therefore, additional information is needed to differentiate these lesions. A diagnostic accuracy study was performed from February 2018 to April 2019. All lesions underwent ultrasound examination with 50 and 20MHz probes. The high-frequency ultrasound (HFUS) images were evaluated independently by 2 experienced doctors for the presence of predefined features, including the depth, shape, margin, anechoic area, hyperechoic spots, epidermal interrupted echo, mushroom sign, flat-bottom sign, and superficial hyperechoic focus (SHEF). A total of 54 BCCs, 51 melanocytic nevi and 55 seborrheic keratoses (SK), were included. BCCs often involved the subcutaneous tissue (11/54, 20.4%; P<.001) and had an irregular shape (26/54, 48.1%; P<.001) and ill-defined borders (26/54, 48.1%; P<.001), while most benign pigmented lesions had a regular shape (101/106, 95.3%; P<.001) and well-defined borders (95/106, 89.6%; P<.001). BCCs occasionally showed anechoic areas (10/54, 18.5%; P<.001) and epidermal interrupted echo (18/54, 33.3%; P<.001). Moreover, hyperechoic spots could be found in BCCs (43/54, 79.6%), nevi (27/51, 52.9%), and SK (30, 54.5%) (P=.001), with mean number of 7.3, 5.5, and 8.0, respectively. The mushroom signs were all present in melanocytic nevi (18/51, 35.3%), while the flat-bottom sign (43/55, 78.2%; P<.001) and SHEF (40/55, 72.7%; P<.001) presented mainly in SKs. Based on the typical features, HFUS could improve the accuracy of BCC identification and should be considered when dermatologists are unsure about the lesion type.