Pulsatility Index Levels Research Articles

Analysis of Ophthalmic Artery Doppler in Normotensive, Preeclamptic, and Eclamptic Pregnancies in Correlation With Clinical Parameters in a Tertiary Care Hospital in India.

Preeclampsia occurs in hypertensive pregnant women beyond 20 weeks of gestation and is accompanied by proteinuria. Hypertensive retinopathy is the most prevalent sign of preeclampsia, and eclampsia and it needs to be addressed at the earliest opportunity. This study was intended to gauge and assess the ophthalmic artery Doppler indices such as mean enveloped velocity, the pulsatility index (PI), and the resistivity index (RI) in normotensive, preeclamptic, and eclamptic pregnancies with their respective correlations. We also saw correlations with serum creatinine and platelets with the PI and RI. Methods A prospective case-control study was conducted among70 subjects in the Department of Radiodiagnosis of Sri Devaraj Urs Medical College, Tamaka, Karnataka, India. We carried out ultrasound and Doppler examinations of theright ophthalmic artery. Doppler indices including mean enveloped velocity, PI, and RI were assessed in normotensive as well as preeclamptic pregnancies. Results The mean ages of cases and controls were 28.26 and 26.74 years, respectively. The mean RIs in controls and cases were 0.86 and 0.69, respectively (preeclampsia and eclampsia were 0.73 and 0.65, respectively), whereas the mean PIs in controls and cases were 1.96 and 1.17, respectively (preeclampsia and eclampsia were 1.31 and 1.06, respectively). The mean enveloped velocities in preeclampsia and eclampsia were 28.82 cm/sec and 20.43 cm/sec, respectively. Conclusion We found a definite reduction in the PI, RI, and mean enveloped velocity flow levels in preeclampsia and eclampsia patients in comparison to that amongst normal subjects. Therefore, it is important to assess and manage such conditions at the earliest stage to achieve a better prognosis while providing adequate treatment to the patient.

Associations between the artificial intelligence scoring system and live birth outcomes in preimplantation genetic testing for aneuploidy cycles

BackgroundSeveral studies have demonstrated that iDAScore is more accurate in predicting pregnancy outcomes in cycles without preimplantation genetic testing for aneuploidy (PGT-A) compared to KIDScore and the Gardner criteria. However, the effectiveness of iDAScore in cycles with PGT-A has not been thoroughly investigated. Therefore, this study aims to assess the association between artificial intelligence (AI)-based iDAScore (version 1.0) and pregnancy outcomes in single-embryo transfer (SET) cycles with PGT-A.MethodsThis retrospective study was approved by the Institutional Review Board of Chung Sun Medical University, Taichung, Taiwan. Patients undergoing SET cycles (n = 482) following PGT-A at a single reproductive center between January 2017 and June 2021. The blastocyst morphology and morphokinetics of all embryos were evaluated using a time-lapse system. The blastocysts were ranked based on the scores generated by iDAScore, which were defined as AI scores, or by KIDScore D5 (version 3.2) following the manufacturer’s protocols. A single blastocyst without aneuploidy was transferred after examining the embryonic ploidy status using a next-generation sequencing-based PGT-A platform. Logistic regression analysis with generalized estimating equations was conducted to assess whether AI scores are associated with the probability of live birth (LB) while considering confounding factors.ResultsLogistic regression analysis revealed that AI score was significantly associated with LB probability (adjusted odds ratio [OR] = 2.037, 95% confidence interval [CI]: 1.632–2.542) when pulsatility index (PI) level and types of chromosomal abnormalities were controlled. Blastocysts were divided into quartiles in accordance with their AI score (group 1: 3.0–7.8; group 2: 7.9–8.6; group 3: 8.7–8.9; and group 4: 9.0–9.5). Group 1 had a lower LB rate (34.6% vs. 59.8–72.3%) and a higher rate of pregnancy loss (26% vs. 4.7–8.9%) compared with the other groups (p < 0.05). The receiver operating characteristic curve analysis verified that the iDAScore had a significant but limited ability to predict LB (area under the curve [AUC] = 0.64); this ability was significantly weaker than that of the combination of iDAScore, type of chromosomal abnormalities, and PI level (AUC = 0.67). In the comparison of the LB groups with the non-LB groups, the AI scores were significantly lower in the non-LB groups, both for euploid (median: 8.6 vs. 8.8) and mosaic (median: 8.0 vs. 8.6) SETs.ConclusionsAlthough its predictive ability can be further enhanced, the AI score was significantly associated with LB probability in SET cycles. Euploid or mosaic blastocysts with low AI scores (≤ 7.8) were associated with a lower LB rate, indicating the potential of this annotation-free AI system as a decision-support tool for deselecting embryos with poor pregnancy outcomes following PGT-A.

Ultrasonographic analysis of palatal donor site healing accelerated with platelet-rich fibrin following subepithelial connective tissue harvesting.

Platelet-rich fibrin (PRF) contains a variety of growth factors and bioactive molecules that play crucial roles in wound healing and angiogenesis. We aimed to evaluate the effects of PRF on tissue thickness and vascularization of the palatal donor site by ultrasound (USG) following subepithelial connective tissue harvesting. A subepithelial connective tissue graft was harvested from the palatal region with a single incision for root coverage in 20 systemically healthy patients. In the test group (n = 10), the PRF membrane was placed at the donor site, whereas no material was applied in the control group (n=10). Palatal tissue thickness (PTT) and pulsatility index (PI) were evaluated by USG at baseline and on the 3rd, 7th, 14th, 30th, and 90th days after surgery. The early healing index (EHI) was used to evaluate donor site healing for 30 days. PTT was significantly higher in the PRF group on the 3rd and 14th days after surgery when compared to the controls. In the PRF-treated group, PI levels were significantly higher than in the controls, especially on the 14th day. PTT increased significantly 90 days after surgery compared to the test group baseline, but controls showed a significant decrease. The PRF group showed statistically significant improvements in EHI scores compared to controls on days 3, 7, and 14. This study found a negative correlation between PI values and EHI scores on postoperative days three and seven in the test group. USG is a non-invasive, objective method to radiographically evaluate the regenerative effects of PRF on palatal wound healing after soft tissue harvesting. To overcome graft inadequacy in reharvesting procedures, PRF application may enhance clinical success and reduce possible complications by increasing tissue thickness and revascularization in the donor area.

ROLE OF DOPPLER ULTRASOUND AT 13 WEEKS GESTATION IN PREDICTION OF PRE-ECLAMPSIA

Objective: The objective of this study was to assess the role of Doppler ultrasound (USG) at 13-week gestation in the prediction of pre-eclampsia (PE) and to assess the mean pulsatility index (PI) in uterine arteries at 13-week Doppler ultrasonography for the early prediction of PE. Methods: This was a observational prospective cohort study in which all the pregnant females at 12–14 weeks gestation were subjected to Doppler waveform analysis on color Doppler USG machines. Obstetric parameters of fetal biometry, mean PI (using the TVS method), and percentiles were calculated using fetal medicine foundation proforma. Reports were categorized as high risk or low risk for the development of PE. Routine USG follow-up scanning was done at 18–20 weeks (Anomaly scan) 24–28 weeks (Growth scan) and 34–36 weeks (Doppler scan) for the development of PE and intrauterine growth restriction. Development or absence of PE was noted. Results: Four hundred antenatal patients were included in the study. The maximum number of patients was in the age group 21–30 years (75.50%). No significant difference in the occurrence of PE in different age groups was found in our study. The incidence of PE was 3.33% (1 out of 30) in patients who developed PE at a later stage. Similar incidence of hypertension was 10% (three out of 30), smoking, and diabetes in 2 and 3 each. The mean uterine artery PI level at 12–14 weeks was 3.11±0.12 in patients who developed PE. In our study, 24 (80%) high-risk (&gt;1:150) and 10 (33.33%) low-risk (≤1:150) patients developed PE. Out of 30, 4 (13.33%) had Apgar 0–3, 6 (20%) had Apgar 4–6, and 20 (66.67%) had Apgar 7–10 in patients who developed PE. Conclusion: High mean uterine artery PI between 12 and 14 weeks gestation is a good predictor of PE and can be used as an effective screening tool. Diastolic notch in the uterine artery and combination of uterine artery Doppler parameters is better in the prediction of PE.

Оцінка показників комплексної стратифікації ризиків розвитку прееклампсії в пацієнток із ретрохоріальними гематомами

Purpose - to assess the prognostic value of a comprehensive study of the influence of indicators of angiogenic/antiangiogenic profile in women with retrochorial hematoma (RCH) in the І trimester, uterine artery (UA) dopplerometry data in stratifying the risks of developing placental dysfunction in these women. Materials and methods. A prospective analysis of the course of pregnancy was carried out in 137 women with a threat of miscarriage aged 20 to 47 years, who made up two comparison groups: the Group I - 60 patients with RCH, the Group II - 77 patients with a threat of abortion without hematoma. Results. The average age of women of the Group I was 31.2±0.6 years, of the Group II - 32.2±0.6 years. The gestational age at enrollment was equal 6.1±0.55 weeks in the Group I and 7.2±0.61 weeks in the Group II. A direct, reliable correlation of weak strength was established in pairs: the presence of the human chorionic gonadotropin (hCG) and the pulsatility index (PI) in UA &gt;95 percentile, hCG and a higher level of hCG in the I and II trimesters of pregnancy. A reduced level of PAPP-A was significantly associated with cases of preeclampsia (PE) in the anamnesis, increased Body Mass Index, a high level of PI in UA, including with PI levels &gt;95 percentile, as well as with a reduced level of free estriol. Significant inverse correlations were established between the level of PLGF and indicators of PE in history, the level of PI in UA and the content of hCG. At the same time, the level of alpha-fetoprotein in the studied patients was directly associated with increased levels of PI in UA and hCG. It was established that the risk of early PE was more inherent for women with the presence of PCH in the І trimester of pregnancy, while the percentage of the development of late PE with and/or without fetal growth retardation was more often higher in women with a threat of termination of pregnancy in the І trimester trimesters without the formation of RHG. Conclusions. The occurrence of RHG at the stage of early placentation increases the risks of developing placental dysfunction and obstetric complications associated with it. PRISCA-1, PLGF, PI of UA, as well as the calculation of the risk of developing PE in the trimester І using the FMF calculator should be used to form a risk group for the development of placenta-associated complications. Indicators of PI of UA &gt;99 percentile in the І trimester of pregnancy in combination with a decrease in PAPP-A ˂0.45 MoM should be considered critical. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patients was obtained for conducting the studies. No conflict of interests was declared by the authors.

The S-100B level, intracranial pressure, body temperature, and transcranial blood flow velocities predict the outcome of the treatment of severe brain injury.

This study evaluates the applicability of S100B levels, mean maximum velocity (Vmean) over time, pulsatility index (PI), intracranial pressure (ICP), and body temperature (T) for the prediction of the treatment of patients with traumatic brain injury (TBI). Sixty patients defined by the Glasgow Coma Scale score ≤ 8 were stratified using the Glasgow Coma Scale into 2 groups: favorable (FG: Glasgow Outcome Scale ≥ 4) and unfavorable (UG: Glasgow Outcome Scale < 4). The S100B concentration was at the time of hospital admission. Vmean was measured using transcranial Doppler. PI was derived from a transcranial Doppler examination. T was measured in the temporal artery. The differences in mean between FG and UG were tested using a bootstrap test of 10,000 repetitions with replacement. Changes in S100B, Vmean, PI, ICP, and T levels stratified by the group were calculated using the one-way aligned rank transform for nonparametric factorial analysis of variance. The reference ranges for the levels of S100B, Vmean, and PI were 0.05 to 0.23 µg/L, 30.8 to 73.17 cm/s, and 0.62 to 1.13, respectively. Both groups were defined by an increase in Vmean, a decrease in S100B, PI, and ICP levels; and a virtually constant T. The unfavorable outcome is defined by significantly higher levels of all parameters, except T. A favorable outcome is defined by S100B < 3 mg/L, PI < 2.86, ICP > 25 mm Hg, and Vmean > 40 cm/s. The relationships provided may serve as indicators of the results of the TBI treatment.

Effects of Dydrogesterone Tablets Combined with Zishen Yutai Pills on Threatened Abortion in Early Pregnancy and Pregnancy Outcomes.

Objective To explore the effect of dydrogesterone tablets combined with Zishen Yutai pills on threatened abortion in early pregnancy and pregnancy outcomes. Methods This study retrospectively analyzed the clinical data of 100 patients with threatened abortion in early pregnancy who came to the Linhai Second People's Hospital/Taizhou Municipal Hospital from January 13, 2021, to January 13, 2022. According to different treatment methods, 48 patients treated with progesterone injection were assigned to the control group (CG), while 52 cases with the combined therapy of dydrogesterone tablets and Zishen Yutai pills were assigned to the observation group (OG). The two groups were compared in terms of the following parameters: treatment efficacy, whole blood high shear viscosity, hematocrit (HCT), plasma fibrinogen (FIB) level, spiral artery pulsatility index (PI), uterine spiral artery blood flow resistance index (RI), lumbar and abdominal pain relief time, hemostasis time, estrogen levels, pregnancy outcomes, neonatal adverse outcomes, and incidence of adverse reactions. Results Compared with CG, the therapeutic effect in OG was observed to be evidently better, and its pain relief time and hemostasis time in the waist and abdomen were markedly shorter. After treatment, the whole blood high shear viscosity, FIB, RI, PI, and estrogen levels of both groups improved statistically compared with those before treatment, with more significant improvements in OG compared with CG. OG was also superior to CG with markedly lower incidence of preterm birth, miscarriage, neonatal adverse outcomes, and adverse reactions and a drastically higher full-term pregnancy rate. Conclusion Zishen Yutai pill combined with dydrogesterone tablets is of remarkable therapeutic effect in treatment of early threatened abortion, which can significantly improve clinical symptoms and pregnancy outcomes of patients, with a high safety profile, which is worthy of clinical application.

Usability of the Level of the S100B Protein, the Gosling Pulsatility Index, and the Jugular Venous Oxygen Saturation for the Prediction of Mortality and Morbidity in Patients with Severe Traumatic Brain Injury.

The high frequency of traumatic brain injury imposes severe economic stress on health and insurance services. The objective of this study was to analyze the association between the serum S100B protein, the Gosling pulsatility index (PI), and the level of oxygen saturation at the tip of the internal jugular vein (SjVO2%) in patients diagnosed with severe TBI. The severity of TBI was assessed by a GCS score ≤ 8 stratified by Glasgow outcome scale (GOS) measured on the day of discharge from the hospital. Two groups were included: GOS < 4 (unfavorable group (UG)) and GOS ≥ 4 (favorable group (UG)). S100B levels were higher in the UG than in the FG. PI levels in the UG were also substantially higher than in the FG. There were similar levels of SjVO2 in the two groups. This study confirmed that serum S100B levels were higher in patients with unfavorable outcomes than in those with favorable outcomes. Moreover, a clear demarcation in PI between unfavorable and FGs was observed. This report shows that mortality and morbidity rates in patients with traumatic brain injury can be assessed within the first 4 days of hospitalization using the S100B protein, PI values, and SjVO2.

Vascular Function in Continuous‐Flow Left Ventricular Assist Device Recipients: Effect of a 6‐Week Pulsatility Treatment Regimen.

Vascular function is further diminished in chronic heart failure patients implanted with a continuous‐flow left ventricular assist device (LVAD), which contributes to vascular‐related adverse events. A single pulsatility treatment has been documented to recover vascular function, however, the impact of a chronic treatment regimen is unknown.MethodsEleven LVAD recipients and ten well‐matched controls, received unilateral, 45‐minute, arm pulsatility treatment, created by intermittent cuff inflation and deflation (2‐second duty cycle), distal to the elbow, three days a week for 6 weeks. Vascular function was assessed by percent brachial artery flow mediated dilation (%FMD) (Doppler ultrasound).ResultsAt baseline, %FMD was not different between LVAD recipients (4.2±0.3%) and controls (4.4±0.4 %), while LVAD recipients exhibited an attenuated %FMD/Shear (LVAD: 0.09±0.01; Controls: 0.14±0.01 %/s−1, p&lt;0.05) and a longer time‐to‐peak dilation (LVAD: 85±6; Controls: 51±5 s, p&lt;0.05). Pulsatility index (PI) was lower in the LVAD recipients compared to controls (LVAD: 2±1; Controls: 13±2 AU, p&lt;0.05). Importantly, during the pulsatility treatment, the PI level was not different between groups (LVAD: 28±5; Controls: 34±5 AU). Although time‐to‐peak dilation was not altered by 6‐weeks of pulsatility treatment, %FMD (LVAD: 7.9±0.5; Controls: 7.3±0.7 %) and %FMD/Shear (LVAD: 0.16±0.02; Controls: 0.26±0.03 %/s−1) improved significantly. Notably, %FMD/Shear in the LVAD recipients recovered to the baseline level of controls. All measures returned to baseline levels after a 6‐week washout period.ConclusionsA 6‐week pulsatility treatment regimen restored vascular function in LVAD recipients, demonstrating the efficacy of a pulsatility targeted intervention to potentially mitigate vascular related adverse events in this population.Support or Funding InformationCOI: Dr. Stavros G. Drakos serves on the Steering Committee of the Abbott‐sponsored INTELLECT‐2 LVAD. Funding: This research was supported by the National Institutes of Health (1T322HL13945, R01HL118313) and the U.S. Veteran’s Administration (E6910‐R, E1697‐R, E1433‐P, E9275‐L, E1572‐P, and I01RX001311).

From first-trimester screening to risk stratification of evolving pre-eclampsia in second and third trimesters of pregnancy: comprehensive approach.

Preeclampsia and associated hypertensive disorders of pregnancy represent a leading cause of global maternal and neonatal morbidity and mortality. Identification of women at high risk for developing preterm-preeclampsia and prophylaxis with low-dose aspirin has the potential to significantly reduce the rate of preterm-preeclampsia. In addition, risk assessment and monitoring of women in the second and third trimester of pregnancy, to aid in early detection of evolving disease, timely referral to specialist care, and active monitoring of women with confirmed or suspected preeclampsia is essential for improving maternal and neonatal outcomes. The angiogenesis-related biomarkers sFlt-1 and PlGF have been shown to have clinical value to aid in the prediction, diagnosis, and risk stratification of preeclampsia when used either alone or in combination with other risk factors. However, currently there is no consensus on the optimum strategy to link first trimester screening for preterm-preeclampsia with appropriate second and third trimester risk assessment strategies. This opinion paper will outline the current evidence for first trimester preeclampsia screening and prevention, as well as the evidence for various risk stratification approaches for detection of evolving preeclampsia through the second and third trimesters of pregnancy, and proposes a potential model integrating these tools. This article is protected by copyright. All rights reserved.

Ultrasound Probe Pressure on the Maternal Abdominal Wall and the Effect on Fetal Middle Cerebral Artery Doppler Indices.

Background and Objectives: Doppler ultrasound of umbilical and fetal vessels is useful for monitoring fetal well-being, fetal anemia, intrauterine growth retardation, and other perinatal outcomes. The adverse perinatal outcome and circulatory changes can be reflected in fetal Doppler studies. The aim of this study was to evaluate the effect of increased pressure exerted on the maternal abdominal wall during routine ultrasound on the middle cerebral artery (MCA), resistance index (RI), pulsatility index (PI), and peak systolic velocity (PSV). Materials and Methods: A prospective study was conducted, in which we included 40 pregnant women between 24 + 0 and 41 + 3 gestational weeks (GW), with singleton pregnancies, without any associated pathologies, undergoing routine US examination. We recorded the flow velocity waveforms in the MCA, and we measured the RI, PI, PSV, and the applied pressure on to the maternal abdominal wall—needed for a proper evaluation of MCA. We then repeated the same measurements at two different higher pressure levels, at the same time having a proper image of the targeted vessel. Results: We found significant differences for the PI and RI levels with an increase in abdominal pressure (median PI 1.46, 1.58, and 1.92, respectively; median RI 0.74, 0.78, and 0.85, respectively; p < 0.05), for both PI and RI. At the same time, we found no significant differences for PSV in the studied group in relationship with increase in abdominal pressure (median PSV 39.56, 40.10, and 39.70, respectively; p > 0.05). Conclusions: The applied abdominal pressure by the examiner’s hand, during routine US scan in pregnancy, can modify the MCA parameters of blood flow resistance (PI and RI) when measured by Doppler US, thus influencing the diagnostic accuracy in a series of pregnancy associated pathologies, such as chronic fetal distress (CFD) or intrauterine growth restriction (IUGR).

Renal Doppler Resistance Indices in Kidney Transplant Recipients With Proteinuria

BackgroundThe onset of proteinuria in renal transplant recipients may be associated with an increased risk of allograft failure. Little is known about the relationships between factors influencing proteinuria and the Doppler ultrasound (DU) intrarenal resistive index (RI) and pulsatility index (PI) among donor recipients with proteinuria <1000 mg/24 h. MethodsWe assessed correlations between the DU RI and PI and protein content in 93 selected renal transplant recipients: 62 patients with proteinuria 100 to 299 mg/24 h, 16 patients with proteinuria 300 to 499 mg/24 h, and 15 patients with proteinuria 500 to 999 mg/24 h. All patients underwent transplantation in a single center and were monitored by DU for at least 28 months post-transplantation. ResultsThe DU RI values of the proteinuria 100 to 299 mg/24 h, 300 to 499 mg/24 h, and 500 to 999 mg/24 h groups were 0.67 ± 0.05; 0.65 ± 0.04, and 0.64 ± 0.07, respectively, and the PI values were 1.21 ± 0.20, 1.10 ± 0.14, and 1.15 ± 0.22, respectively. Multivariate logistic regression analysis revealed a correlation between group 100 to 299 mg/24 h and RI values, serum creatinine, living donor (R2 = 19.6%, P = .05); group 300 to 499 mg/24 h and the RI, PI values, cadaver donor (R2 = 17.5%, P = .001); and group 500 to 999 mg/24 h and the RI, PI values, serum creatinine, graft survival (R2 = 15.4%, P = .005). ConclusionsAmong donor recipients with proteinuria <1000 mg/24 h, DU RI values were <0.72 and PI values were <1.41 and correlations were revealed between the incidence of proteinuria and factors such as the RI, PI, and serum creatinine level.

A probe into effect of Shoutai pill on endometrial receptivity.

The effect of Shoutai pill on endometrial receptivity was analyzed. A total of 160 patients with spontaneous abortion were enrolled in this study. They were treated in the Fifth People's Hospital of Jinan (Shandong, China) from February 2014 to June 2016. The following treatment regimen was performed for the patients: after menstruation, Shoutai pill was taken as continuous medication for more than 5 menstrual cycles, the pill was taken 20 days per month, medication was stopped during menstruation, and contraceptive measures were taken during this period. Statistics were recorded of endometrial thickness and morphology, hemodynamic parameters of uterine spiral artery, including pulsatility index (PI) and resistance index (RI), endometrial LIF levels before and after treatment, and follicular development and ovulation were strictly monitored, and statistics of pregnancy were recorded. The endometrial thickness, type A endometrium and endometrial spiral arterial PI and RI levels, endometrial LIF levels were significantly improved after treatment (P<0.05); at the same time, pregnancy rate was 85%; during this treatment, patients had no significant side effects. In conclusion, improvement of endometrial acceptability with Shoutai pills can receive good effect, significantly promote embryo implantation and enhance pregnancy rate.

Combination of serum histidine-rich glycoprotein and uterine artery Doppler to predict preeclampsia.

The primary aim of this study is to determine the value of using a combination of serum histidine-rich glycoprotein (HRG) level and uterine artery pulsatility index (PI) in pregnant women at 11-13+6 weeks' gestation to predict preeclampsia. The secondary aim is to determine the association between other pregnancy complications with the use of these combined tests. Transabdominal uterine artery PI and serum HRG level were measured at the time of first-trimester aneuploidy screening at 11-13+6 weeks' gestation in 327 pregnant women. The primary outcome was preeclampsia. The predictive values of this combination test were calculated. Eighteen cases developed preeclampsia (5.5%) and four of these preeclamptic cases were early-onset preeclampsia (1.2%). The sensitivity, specificity, positive predictive value, and negative predictive value of uterine artery PI combined with serum HRG level to predict preeclampsia were 11.1%, 96.8%, 16.7%, and 94.9%, respectively. For the prediction of early-onset preeclampsia, the sensitivity, specificity, positive predictive value, and negative predictive value were 25%, 97.1%, 10%, and 99%, respectively. An abnormal uterine artery PI and abnormal serum HRG level were associated with preterm delivery and intrauterine growth restriction. Our findings reveal that the combination of uterine artery PI and serum HRG level at 11-13+6 weeks of gestation is not an effective method for predicting preeclampsia at the time of first-trimester screening.

Pulsatility Index as a Novel Parameter for Perfusion in Mouse Model of Hindlimb Ischemia

Background/Aims: In clinical settings, the pulsatility index (PI) has become a widely used tool for monitoring obstetrics or other vascular diseases. It is based on the maximum Doppler shift waveform derived from ultrasonography. However, it remains unclear whether the PI levels are correctly predicted from the perfusion in mouse model of hindlimb ischemia. Methods: To explore the relationship between PI and perfusion, we generated a unilateral hindlimb ischemia model in 8-week-old C57BL/6 male mice by ligation of the right common iliac artery and femoral artery. These mice were monitored with laser Doppler perfusion imaging (LDPI) and an ultrasound system (Vevo2100). Vessel densities in ischemic skeletal muscles were measured with vWF staining, which functions as a marker for endothelial cells. In order to further verify PI evaluation in other conditions, we performed therapeutic experiments using hindlimb ischemic mouse with PBS or FGF2 treatment. Results: In the mouse model of hindlimb ischemia, the PI levels were continuously elevated and were accompanied by an increased ratio of perfusion to blood flow. 1 and 4 weeks after ischemia, the densities of vWF staining were correlated with PI values. Moreover, the PI index exactly reflected the perfusion in hindlimb ischemic mice after FGF2 treatment, while it indicated the condition of angiogenesis after therapeutic treatment based on the association between PI values and the number of vWF-positive stained cells in muscles. Conclusion: This study confirms the utility of a noninvasive and reproducible ultrasound index for a rapid evaluation of perfusion and blood recovery after hindlimb ischemia in vivo. PI, as one stable and comparable parameter, is correlated with angiogenesis in hindlimb ischemic mouse. Moreover, PI can exactly reflect perfusion and angiogenesis in therapeutic hindlimb ischemic mouse models. This study suggested that PI can serve as a novel index for relatively reproducible and repeatable blood flow recovery in the evaluation of emerging ischemic therapies and disease development in mouse models of hindlimb ischemia.

Serum biomarkers combined with uterine artery Doppler in prediction of preeclampsia.

First-trimester screening may be a major advantage over a second-trimester approach since it opens prospects for early and more efficient interventions. The aim of the current study was to evaluate whether the measurement of maternal serum inhibin A, activin A and placental growth factor (PlGF) at three to four months gestation with the second-trimester uterine artery pulsatility index (PI) are useful in predicting preeclampsia in a group of nulliparous women. All the patients also underwent uterine artery Doppler examination to measure the PI at 22–24 weeks gestation. Inhibin A, activin A and PlGF were measured using an ELISA by an examiner who was blinded to the pregnancy outcome. Thirty-eight cases with preeclampsia and 100 controls were analyzed. Second-trimester uterine artery PI and marker levels were expressed as multiples of the median (MoM). The uterine artery PI was increased in pregnancies with preeclampsia compared with controls. In pregnancies that developed preeclampsia, the uterine artery PI was increased (1.61±0.047 vs. 1.02±0.049, P<0.001), as was the level of inhibin A (1.72±0.023 vs. 1.03±0.063, P<0.001) and the level of activin A (1.68±0.38 vs. 1.06±0.42, P<0.001) compared with the controls. In contrast, the level of PlGF was decreased in pregnancies that developed preeclampsia compared with the controls (0.69±0.23 vs. 1.00±0.26, P<0.001). A combination of activin A, PlGF and uterine artery PI gave an AUC of 0.915 (95% CI, 0.812–0.928; P<0.001) with a sensitivity of 91% at a specificity of 82%. In our study, we demonstrated that both serum inhibin A and activin A levels were increased, while the PlGF level was decreased in the early second-trimester in women who developed preeclampsia.

The utility of first trimester uterine artery Doppler, placental volume and PAPP-A levels alone and in combination to predict preeclampsia.

In this study, we aimed to evaluate the detection of pre-eclampsia (PE) by integrating uterine artery Doppler, placental volume, and pregnancy-associated plasma protein A (PAPP-A) levels in the first trimester. We prospectively recruited 602 women that underwent 11-13weeks' aneuploidy screening. The mean pulsatility index (PI) of the uterine arteries and the placental volume were measured by ultrasonography. Measurement of PAPP-A levels has been performed at the same day of ultrasonographic examinations. The 90th percentile of uterine artery PI and the 10th percentile of placental volume and PAPP-A levels were used as cut-offs. Uterine artery PI, placental volume, and PAPP-A levels had similar sensitivities in predicting PE (53.66%, 63.41%, and 70.73%, respectively). Use of the parameters in combination had better sensitivity. If one parameter was positive, the sensitivity was 92.68% with 85.20% specificity. If at least two parameters were positive, the sensitivity was 85.37% with 98.89% specificity. In conclusion, the combination of increased PI of uterine artery with low placental volume and low PAPP-A levels in the first trimester achieved better results than either test alone in the prediction of PE.

Predictive value of angiogenic factors, clinical risk factors and uterine artery Doppler for pre-eclampsia and fetal growth restriction in second and third trimester pregnancies in an Ecuadorian population

Objective: To evaluate the performance of angiogenic factors, maternal risks and uterine artery Doppler (UAD) in the prediction of pre-eclampsia (PE) and fetal growth restriction (FGR) in a high-risk Ecuadorian population. Methods: Patients with singleton pregnancies (n = 346) were investigated at two clinical visits (18–25 weeks and 28–32 weeks). Mean uterine artery (UA), pulsatility index (PI) and maternal biomarkers (soluble fms-like tyrosine kinase-1, placental growth factor, sFlt-1/PLGF ratio) were obtained. The main endpoints were PE and FGR. UA PI and angiogenic factor levels were compared for the groups with PE (n = 34), FGR (n = 26), PE & FGR (n = 14) and controls (n = 272). Multivariable stepwise logistic regression was used to construct prediction models. Results: Pregnancies with either FGR or PE & FGR exhibited in the second trimester a significantly higher mean UA PI and sFlt-1/PLGF ratio and lower PLGF values compared to controls. In the third trimester, all groups with adverse outcome demonstrated significantly lower PLGF levels and a higher sFlt-1/PLGF ratio compared to normal pregnancies. Differences were most pronounced for pregnancies that developed PE and FGR for both time intervals. The combination of UAD and sFlt-1/PLGF ratio improved the predictive capacity for PE and FGR compared to each parameter alone. The best performance was obtained by integrating anamnestic risk factors, resulting in an area under the receiver operating curve for PE of 0.85 and 0.89 and for FGR of 0.79 and 0.77 in the second and third trimester, respectively. Conclusion: In a high-altitude Ecuadorian population, angiogenic factors and UA PI were useful tools in the prediction of PE and/or FGR. The highest performance was achieved by the combination of these factors, including obstetric and medical history.

Inhibin A, activin A, placental growth factor and uterine artery Doppler pulsatility index in the prediction of pre‐eclampsia

To evaluate whether the measurement of maternal serum inhibin A, activin A and placental growth factor (PlGF) at 12 + 0 to 16 + 0 weeks of gestation alone or in combination with second-trimester uterine artery Doppler pulsatility index (PI) is useful in predicting pre-eclampsia. This was a case-control study of pre-eclampsia. From pregnant women attending their first antenatal examination at 12-16 weeks we collected serum samples and stored them at - 80 °C. All patients also underwent uterine artery Doppler examination to measure the PI at 22-24 weeks' gestation. We retrieved for analysis frozen samples from women who then developed pre-eclampsia, as well as three control samples per woman, matched for gestational age and storage time. Inhibin A, activin A and PlGF were measured using an enzyme-linked immunosorbent assay (ELISA) by an examiner who was blinded to the pregnancy outcome. There were 31 cases with pre-eclampsia and 93 controls. Second-trimester uterine artery PI and marker levels were expressed as multiples of the median (MoM). The uterine artery PI was increased in pregnancies with pre-eclampsia compared with controls (mean ± SD, 1.45 ± 0.31 MoM vs. 1.02 ± 0.25 MoM, P < 0.001), as were the level of inhibin A (mean ± SD, 1.57 ± 0.34 MoM vs. 1.08 ± 0.43 MoM, P < 0.001) and the level of activin A (mean ± SD, 1.68 ± 0.38 MoM vs. 1.06 ± 0.42 MoM, P < 0.001). The level of PlGF was decreased in pre-eclampsia compared with controls (mean ± SD, 0.69 ± 0.23 MoM vs. 1.00 ± 0.26 MoM, P < 0.001). Receiver-operating characteristics curves were analyzed for controls and cases and areas under the curve (AUC) were 0.796 (95% CI, 0.712-0.880, P < 0.001) for inhibin A, 0.823 (95% CI, 0.746-0.899, P < 0.001) for activin A, 0.831 (95% CI, 0.752-0.910, P < 0.001) for PlGF and 0.851 (95% CI, 0.783-0.920, P < 0.001) for uterine artery PI. The combination of activin A, inhibin A and PI using logistic regression analysis yielded an AUC of 0.907 (95% CI, 0.830-0.938, P < 0.001) with a sensitivity of 87% and a specificity of 80%. The combination of activin A, PlGF and PI gave an AUC of 0.925 (95% CI, 0.852-0.978, P < 0.001) with a sensitivity of 90% and a specificity of 80%. Combining all four markers gave an AUC of 0.941 (95% CI, 0.891-0.990, P < 0.001) with a sensitivity of 93% and a specificity of 80%. Early second-trimester serum inhibin A, activin A, PlGF and second-trimester uterine artery Doppler PI may add further information for the prediction of pre-eclampsia. The combination of the three serum markers and uterine artery Doppler PI has the highest prediction value for pre-eclampsia.

Role of uterine artery Doppler velocimetry indices and plasma adrenomedullin level in women with unexplained recurrent pregnancy loss

To evaluate uterine artery Doppler flow resistance and plasma adrenomedullin levels in women with unexplained recurrent pregnancy loss (RPL) compared to controls. Eighty-three women, who attend the department of Obstetrics and Gynecology, Benha University, Egypt, participated in this study (RPL group: n=40, and control group: n=43). Uterine artery Doppler and plasma adrenomedullin (AM) (pg/mL) levels were measured for all women in the mid-luteal phase of a non-pregnant cycle. Both uterine artery pulsatility index (PI) and AM levels were significantly higher in RPL group compared to controls (2.71 ± 0.259 vs 2.06 ± 0.194 for PI and 287.5 ± 80.4 pg/mL vs 156.1 ± 39.8 pg/mL for AM, P<0.01). Uterine artery PI had a significant positive correlation with plasma AM levels both in the RPL group (r=0.645, P<0.001) and in the control group (r=0.384, P=0.011). Number of previous miscarriages in RPL group was significantly correlated with both uterine artery PI (r=0.838, P=0.015) and plasma AM levels (r=0.509, P=0.001). Uterine artery PI may be useful in identifying women with unexplained RPL who have impaired uterine circulation. Plasma AM may serve as a biochemical marker for RPL caused by impaired uterine perfusion.