Real-time Ultrasonography Research Articles

Autonomous Robotic Screening of Tubular Structures Based Only on Real-Time Ultrasound Imaging Feedback

Ultrasound (US) imaging is widely employed for diagnosis and staging of vascular diseases, mainly due to its high availability and the fact it does not emit ionizing radiation. However, high interoperator variability limits the repeatability of US image acquisition. To address this challenge, we propose an end-to-end workflow for automatic robotic US screening of tubular structures using only real-time US imaging feedback. First, a U-Net was trained for real-time segmentation of vascular structure from cross-sectional US images. Then, we represented the detected vascular structure as a 3-D point cloud, which was used to estimate the centerline of the target structure and its local radius by solving a constrained nonlinear optimization problem. Iterating the previous processes, the US probe was automatically aligned to the normal direction of the target structure, while the object was constantly maintained in the center of the US view. The real-time segmentation result was evaluated both on a phantom and <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">in vivo</i> on brachial arteries of volunteers. In addition, the whole process was validated using both simulation and physical phantoms. The mean absolute orientation, centering, and radius error ( <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"><tex-math notation="LaTeX">$\pm$</tex-math></inline-formula> SD) on a gel phantom were <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"><tex-math notation="LaTeX">$\text{3.7}\pm \text{1.6}^{\circ }$</tex-math></inline-formula> , <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"><tex-math notation="LaTeX">$0.2\pm \text{0.2}\,\text{mm}$</tex-math></inline-formula> and <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"><tex-math notation="LaTeX">$0.8\pm \text{0.4}\,\text{mm}$</tex-math></inline-formula> , respectively. The results indicate that the method can automatically screen tubular structures with an optimal probe orientation (i.e., normal to the vessel) and accurately estimate the radius of the target structure.

Ultrasound Speckle Reduction Using Wavelet-Based Generative Adversarial Network.

The visual quality of ultrasound (US) images is crucial for clinical diagnosis and treatment. The main source of image quality degradation is the inherent speckle noise generated during US image acquisition. Current deep learning-based methods cannot preserve the maximum boundary contrast when removing noise and speckle. In this paper, we address the issue by proposing a novel wavelet-based generative adversarial network (GAN) for real-time high-quality US image reconstruction, viz. WGAN-DUS. First, we propose a batch normalization module (BNM) to balance the importance of each sub-band image and fuse sub-band features simultaneously. Then, a wavelet reconstruction module (WRM) integrated with a cascade of wavelet residual channel attention block (WRCAB) is proposed to extract distinctive sub-band features used to reconstruct denoised images. A gradual tuning strategy is proposed to fine-tune our generator for better despeckling performance. We further propose a wavelet-based discriminator and a comprehensive loss function to effectively suppress speckle noise and preserve the image features. Besides, we have designed an algorithm to estimate the noise levels during despeckling of real US images. The performance of our network was then evaluated on natural, synthetic, simulated and clinical US images and compared against various despeckling methods. To verify the feasibility of WGAN-DUS, we further extend our work to uterine fibroid segmentation with the denoised US image of the proposed approach. Experimental result demonstrates that our proposed method is feasible and can be generalized to clinical applications for despeckling of US images in real-time without losing its fine details.

Clinical Evaluation of Weight Loss Diet on Adiposity Markers and Subcutaneous Fat in Obese Dogs

Background: This clinical study was conducted in thirteen apparently healthy overweight/obese dogs during the period 2018-19. The study involved nutritional interventions such as feeding of high protein and low fat diet and increased physical activity for these dogs, so as to assess effect of these interventions on adiposity markers and subcutaneous fat in obese dogs. Methods: The prescribed weight loss diet consisted of high crude protein (%), crude fibre (%) and reduced fat (%) compared to the mean values of pre-weight loss diets. The study was conducted over a span of 12 weeks and various hemato-biochemical parameters, adiposity markers and subcutaneous fat thickness were measured on 0, 30, 60 and 90 days. Result: Dogs included in this study showed reduction of an average of 9% of their body weight. Significant (P less than 0.05) difference was observed in mean values of Body Condition Score at day 60, from day 30 and this difference persisted until day 90, when compared with day 0 of treatment. Serum cholesterol and leptin concentrations were markedly reduced at the end of weight loss period. Decreased thickness of subcutaneous fat by real time ultrasonography was observed from day 0 to day 90 in five anatomical locations i.e. abdomen, mid abdomen, 9 Inter Costal Space, thigh and lumbar.

Abstract 2469: Image-guided focused ultrasound-mediated drug delivery for improved cancer treatment

Abstract Introduction: The first option for cancer treatment is often chemotherapy. However, studies have shown that only 1% of the injected dose reaches the target cancer as the tumor microenvironment presents a physical barrier for optimal drug delivery. Focused ultrasound (FUS) in combination with microbubble (MB) contrast agents is an emerging therapy to improve drug delivery by temporarily increasing microvascular permeability. This research details the development and testing of a novel ultrasound (US) image-guided FUS system and method for enhancing drug delivery to tumor tissue and volume space with comparison to a 2-dimensional (2-D) US therapeutic technology. Methods: Real-time US therapy was implemented on a programmable US system (Vantage 256, Verasonics Inc) equipped with a dual US transducer configuration for interleaved anatomical imaging and volumetric treatment delivery (HIFU-Plex, Sonic Concepts Inc). Both US imaging and therapeutic transducers are co-registered 128 element arrays with center frequencies of 3.5 and 2.0 MHz, respectively. The latter is a concentric array that enables beam steering in 3-dimensional (3-D) space. US treatment was performed at a peak negative pressure of 0.7 MPa (mechanical index, MI of 0.45), pulse repetition frequency of 10 Hz, and duty cycle of 10%. BALB/c mice (N = 22, Charles River Laboratory) were implanted with 2.0 × 105 breast cancer cells (4T1, ATCC). Once tumors reached 0.6 cm in size, mice were randomly divided into a 3-D or 2-D US therapy group or sham control. US therapy was performed following an intravascular injection of microbubbles (Definity, Lantheus Medical Imaging) and IR-780 dye. Note microbubbles function as a therapeutic mediator whereas the fluorescent dye represents a surrogate small molecule drug. Live animal fluorescent imaging was performed at baseline before US therapy (0 h) and again at 1, 24, and 48 h. Following the 48 h timepoint, animals were euthanized and tumors surgically excised for ex vivo analysis. Results: 3-D US-mediated therapy improved molecular delivery to tumor tissue by 150 and 180% at 24 and 48 h, respectively, when compared to our previously established 2-D US therapeutic approach (p = 0.22) or sham therapy (p = 0.07). A similar trend was observed during ex vivo imaging of excised tumor samples treated with 3-D US therapy as compared to the 2-D US therapeutic approach (p = 0.41) or sham therapy (p = 0.04). Dye extraction further confirmed these observations (p &amp;gt; 0.12). Conclusions: 3-D US therapy improved molecular delivery to the tumor volume compared to our previously established 2-D US-based method as confirmed by a series of optical imaging studies. Citation Format: Ryan Margolis, Junjie Li, Lokesh Basavarajappa, Kenneth Hoyt. Image-guided focused ultrasound-mediated drug delivery for improved cancer treatment [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2469.

Evaluation of Ultrasound Measurement of Subcutaneous Fat Thickness in Dairy Jennies during the Periparturient Period.

Simple SummaryUltrasonography is an accurate method to objectively measure subcutaneous fat (SF) thickness and to routinely predict body fat reserves in cows, horses, and donkeys. The aim of the present study was to describe ultrasonographic SF thickness in periparturient jennies. The SF was evaluated in 6 different truncal location in 6 dairy jennies prior and post parturition. Measurement values were reported and each site were compared through time. No statistically significant differences were found between sites and time. The mean values of SF measurements were above those reported by others. A good and reliable association was detected between body condition score (BCS) and sites during the whole study period. Our study gives a preliminary description of different body locations fat reserves evaluated by ultrasonography, showing no significative variations, in pregnant and lactating jennies.The body condition score (BCS) represents a practical but subjective method for assessing body fat reserves. Real time ultrasonography (RTU) has been proposed as an accurate method to objectively measure subcutaneous fat (SF) thickness and predict body fat reserves in cows, horses and donkeys. The aim of the present study was to describe RTU measures of SF thickness during periparturient period in jennies. The present prospective cohort study evaluated six dairy jennies. SF RTU were performed at 15 and 7 days before the presumptive delivery, and 2, 15 and 30 days after delivery. A portable ultrasound machine and multifrequency linear transducer (5–7.5 MHz) was used. RTU images were obtained in six sites (S1–S6). Results at each time point were reported as mean ± standard deviation and compared through time. A total of 180 images were evaluated. RTU technique was easy to perform and well tolerated. No statistically significant differences were found of each site during time, except for S2 and S6a: S2 at T2 and S6a at T1 were significatively different to values obtained at T5. The RTU mean values were above those reported by others, suggesting major physio-logical challenges related to energy balance and fat mobilization in pregnant jennies bred for milking production. BCS and sites through observational time have shown a good and reliable association. Our study could give preliminary indications on fat reserves in different body locations evaluated thanks to RTU and it show no significative variation of SF thickness, in pregnant and lactating jennies.

Microwave focal therapy of prostate cancer: a non-clinical study and exploratory clinical trial.

To examine the safety and efficacy of microwave tissue coagulation (MTC) for prostate cancer and assess its use in lesion-targeted focal therapy in a non-clinical study and a clinical phase II trial. In the non-clinical study using Microtaze® -AFM-712 (Alfresa Pharma Corporation, Osaka, Japan) with an MTC needle, MTC was performed using a transperineal approach to targeted canine prostatic tissue under real-time ultrasonography guidance. Using various MTC output and irradiation time combinations, the targeted and surrounding tissues (rectum, bladder and fat) were examined to confirm the extent of coagulative necrosis or potential cell death, and to compare intra-operative ultrasonography and pathology findings. The exploratory clinical trial was conducted to examine the safety and efficacy of MTC. Five selected patients underwent transperineal MTC to clinically single lesion magnetic resonance imaging (MRI)-visible lesions with Gleason score 3 + 4 or 4 + 4. Prostate-specific antigen (PSA), MRI and Expanded Prostate Cancer Index Composite questionnaire findings were compared before and 6 months after surgery. The region of coagulative necrosis was predictable by monitoring of ultrasonically visible vaporization; thus, by placing the MTC needle at a certain distance, we were able to perform a safe procedure without adverse events affecting the surrounding organs. Based on the non-clinical study, which used various combinations of output and irradiation time, MTC with 30-W output for 60-s irradiation was selected for the prostate. Based on the predictable necrosis, the therapeutic plan (where to place the MTC needle to achieve complete ablation of the target and how many sessions) was strictly determined per patient. There were no serious adverse events in any patient and only temporary urinary symptoms related to MTC therapy were observed. Furthermore, post-treatment satisfaction was very high. All preoperative MRI-visible lesions disappeared, and PSA decreased by 55% 6 months after surgery. Microwave tissue coagulation may be an option for lesion-targeted focal therapy for prostate cancer.

Diaphragmatic Mobility and Chest Expansion in Patients with Scapulocostal Syndrome: A Cross-Sectional Study.

Scapulocostal syndrome (SCS) is a subset of myofascial pain syndrome affecting the posterior shoulder and upper back area. Some of the affected muscles are attached to the rib cage, which may affect diaphragmatic mobility and chest expansion. The purpose of this study was to investigate the characteristics of diaphragmatic mobility and chest expansion in patients with SCS. Twenty-nine patients with SCS and twenty-nine healthy participants of a similar age, gender, weight, and height were included in the study. All participants were evaluated for diaphragmatic mobility (DM) by real-time ultrasound (RTUS) and for chest expansion (CE) using a cloth tape measure. An independent t-test was used to compare the outcome variables between groups. The DM value in the SCS group was 46.24 ± 7.26 mm, whereas in the healthy group it was 54.18 ± 9.74 mm. The DM value was lower in the SCS group compared to in healthy participants (p < 0.05). Chest expansion at the axilla, the fourth intercostal space (4th ICS), and the xiphoid level in the SCS group was 7.26 ± 1.13, 6.83 ± 0.94, and 6.86 ± 1.25, respectively, while chest expansion at the axilla, 4th ICS, and xiphoid level in the healthy group was 7.92 ± 1.39, 7.54 ± 1.43, and 8.13 ± 1.32, respectively. Chest expansion at the 4th ICS and the xiphoid level in the SCS group was significantly lower than in the healthy group (p < 0.05). Patients with SCS presented a decrease in diaphragmatic mobility and chest expansion. Therefore, SCS treatment programs ought to add breathing exercises to improve lung expansion.

A Randomized, Single-Blind Clinical Trial Comparing Robotic-Assisted Fluoroscopic-Guided with Ultrasound-Guided Renal Access for Percutaneous Nephrolithotomy.

We conducted a randomized, single-blind clinical trial comparing the surgical outcomes of robotic-assisted fluoroscopic-guided (RAF group) and ultrasound-guided (US group) renal access in mini-percutaneous nephrolithotomy (PCNL). We recruited patients who underwent mini-PCNL with ureteroscopic assistance for large renal stones between January 2020 and May 2021. Block randomization was performed using online software. Automated needle target with x-ray was used for fluoroscopic-guided renal access in the RAF group. PCNL was performed by residents using a pneumatic lithotripsy system with 16.5Fr/17.5Fr tracts. The primary outcome was single puncture success, and the secondary outcomes were stone-free rate, complication rate, parameters measured during renal access and fluoroscopy time. In total, 71 patients (35 in US group, 36 in RAF group) were enrolled. No difference was seen in the single puncture success rate between the US and RAF groups (34.3% and 50.0%, p=0.2). In 14.3% cases in the US group vs no cases in the RAF group, the resident was unable to obtain access due to difficult targeting (p=0.025). The mean number of needle punctures was significantly fewer, and the median duration of needle puncture was shorter in the RAF group (1.83 vs 2.51 times, p=0.025; 5.5 vs 8.0 minutes, p=0.049, respectively). The stone-free rate at 3 months after surgery was 83.3% and 70.6% in the RAF and US groups, respectively (p=0.26). Multivariate analysis revealed that RAF guidance reduced the mean number of needle punctures by 0.73 times (p=0.021). RAF renal access in mini-PCNL may have further potential applications in this field.

Circulatory and Metabolic Physiology Disorder in Different Organs of the Subtropical Scallop Species Chlamys nobilis Under Thermal and Hypoxia Stress, Revealed by Doppler Ultrasonography Technique

Extremely high temperature and hypoxia are mounting problems affecting the world’s coastal waters under the global warming environment, with severe consequences for marine life. Scallop is one of the most fragile species to hypoxia stress for their high respiration rate and lack of self-protection ability such as long-time shell closing. Circulatory physiology rhythm is sensitive to environmental stress and is an important means for shellfish to quickly respond to environmental stress. Therefore, monitoring the circulatory physiology indexes of Chlamys nobilis under hypoxia and high temperature stress is helpful to quickly diagnose its stress state and reveal the response process of circulatory system to the stress. In this study, using real-time Doppler ultrasonography technique, we continuously monitored the circulatory physiological indexes [heart rate (HR), blood flow volume (FV), blood velocity (PS and ED), resistance index (RI) and S/D ratio) of the scallop organs (gill, mantle and adductor muscle) under hypoxia (mild 4 mg/L DO, moderate 3 mg/L DO and severe 2 mg/L DO)] and fluctuating high temperature stress (29-31°C). Important metabolic function indexes [adenosine triphosphate (ATP), pyruvate kinase (PK) and cytochrome C oxidase (COX)] of various tissues were measured simultaneously. The results show that scallops are very sensitive to the changes of temperature and dissolved oxygen. Both high temperature and hypoxia will increase the HR, and severe hypoxia will bring greater load to the heart of the scallop. Hypoxia stress mainly caused the changes of PS, and the RI and S/D of the gill gradually increased. At 2mg/L DO level, the total blood flow of the mantle and adductor muscle decreased, but the blood flow supply in the gill was stable. The scallop is very sensitive to the change of high temperature and can make adjustments immediately. High temperature increased blood flow in various organs and preferentially supplied to the gill. The RI and S/D of branchial vessels under high temperature were lower than those under hypoxia. The ATP content of the mantle was continuous accumulated under high temperature and was significantly higher than that of the gill and adductor muscle, indicating the specificity of tissue metabolism. The overall circulatory physiological indexes of the gill showed a more positive response to the stress environment than the mantle and adductor muscle. All the results proved that the gill has the best resistance to the hypoxia and high temperature stress. Our study revealed the circulatory physiology regulation mechanism of the noble scallop C. nobilis under environmental stress, and provide effective data and technique supports for the timely diagnose of stress condition of the species, so as to formulate necessary handling strategies for the scallop farm.

Effects of oral contraceptive use on muscle strength, muscle thickness, and fiber size and composition in young women undergoing 12 weeks of strength training: a cohort study

BackgroundIt is suspected that hormonal fluctuations during menstruation may cause different responses to strength training in women who use oral contraceptives (OC) versus those who do not. However, previous studies that investigated the existence of such differences produced conflicting results. In this study, we hypothesized that OC use has no effect on muscle strength and hypertrophy among women undergoing strength training. Thus, we compared the differences in muscle strength and thickness among women who used OCs and those who did not.MethodsWe investigated the influence of OC use on muscle strength (Fmax), muscle thickness (Mtk), type 1-to-type 2 muscle fiber (NO) ratio, muscle fiber thickness (MFT), and nuclear-to-fiber (N/F) ratio. Seventy-four healthy young women (including 34 who used OCs and 40 who did not) underwent 12 weeks of submaximal strength training, after which Fmax was evaluated using a leg-press machine with a combined force and load cell, while Mtk was measured using real-time ultrasonography. Moreover, the NO ratio, MFT, and N/F ratio were evaluated using muscle needle biopsies.ResultsParticipants in the non-OC and OC groups experienced increases in Fmax (+ 23.30 ± 10.82 kg and + 28.02 ± 11.50 kg respectively, p = 0.073), Mtk (+ 0.48 ± 0.47 cm2 and + 0.50 ± 0.44 cm2 respectively, p = 0.888), Fmax/Mtk (+ 2.78 ± 1.93 kg/cm2 and + 3.32 ± 2.37 kg/cm2 respectively, p = 0.285), NO ratio (type 2 fibers: + 1.86 ± 6.49% and − 4.17 ± 9.48% respectively, p = 0.169), MFT (type 2 fibers: + 7.15 ± 7.50 µm and + 4.07 ± 9.30 µm respectively, p = 0.435), and N/F ratio (+ 0.61 ± 1.02 and + 0.15 ± 0.97 respectively, p = 0.866) after training. There were no significant differences between the non-OC and OC groups in any of these parameters (p > 0.05).ConclusionsThe effects of 12 weeks of strength training on Fmax, muscle thickness, muscle fiber size, and composition were similar in young women irrespective of their OC use.

CORRELATION BETWEEN CAROTID INTIMA-MEDIA THICKNESS WITH URINE ALBUMIN CREATININE RATIO IN PATIENTS WITH TYPE 2 DABETES MELLITUS

Introduction: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality for individuals with diabetes. Common conditions coexisting with type 2 diabetes (e.g., hypertension and dyslipidemia) are clear risk factors for ASCVD, and diabetes itself confers independent risk. Large benets are seen when multiple cardiovascular risk factors are addressed simultaneously. Increased urinary albumin excretion (albuminuria) and reduced Glomerular Filtration Rate (GFR) are risk factors for progressive kidney failure and cardiovascular disease. It has been reported that microalbuminuria had a close association with cardiovascular diseases (CVD) as well. It was also reported that microalbuminuria or macroalbuminuria increased the mortality rate by 60 – 80% (1) . Albuminuria can be most easily performed by urinary albumin-to Creatinine ratio (ACR) in a random spot urine collection (2). Atherosclerosis is the main cause of cardiovascular diseases; measurement of IMT (Intima Media Thickness) enables the detection of atherosclerosis lesions of the arterial wall. CIMT (Carotid Intima Media Thickness) can be measured by high frequency B mode ultrasonography, which provides a high degree of accuracy in estimating the arterial wall thickness. B-mode gray scale sonography allows for imaging of atherosclerotic plaques and intima-media thickness of carotid arteries. Of these, continuous- wave Doppler and single-gate pulsed-wave Doppler sonography incorporated in duplex systems are reported to be highly accurate relative to angiography for the detection and classication of the degree of obstruction producing a narrowing of lumen more than 50%. In addition, the use of high-resolution B-mode real-time sonography makes it possible to identify small, non stenotic (&lt;50%) plaques and to describe the echo morphology of carotid arteries (3). The carotid IMT is signicantly higher in diabetic patients than that in non-diabetic patients (4), and the increased IMT can predict future events of silent brain infarction and coronary heart disease in the patients with T2DM (5). Carotid IMT is considered to reect an early stage of macroangiopathy in patients with diabetes. An increasing CIMT above normal level (&gt; 0.8 mm) is associated with increasingly severe coronary artery disease, an increased risk of myocardial infarction and also stroke. Urine ACR is an important marker for the progression of renal dysfunction and is currently recognized as predictive factors for CVD. However, association of IMT with both urinary ACR (Albumin Creatinine Ratio) in type 2 diabetic patients has been investigated in a few reports. Keeping them in mind, a hospital based cross sectional study was performed on the patients presenting with type 2 diabetes mellitus. The study was aimed to establish the role of urine ACR as a leading investigation in patients presenting with type 2 diabetes mellitus for cardiovascular risk assessment. It was intended to evaluate the Carotid IMT in these patients and also detection of atherosclerotic plaque which are clearly related to pathogenesis and aid in planning of management. Our objective is to nd out the correlation between urine ACR and carotid intima media thickness (CIMT) in type 2 diabetes patients and whether urine ACR can be used as a screening tool for risk stratication for future cardiovascular disease in Indian population.

Echocardiographic Determination of Percutaneous Central Venous Catheters in the Superior Vena Cava: A Prospective Cohort Study.

Malposition of percutaneous central venous catheters (PCVCs) in the superior vena cava (SVC) is common. We previously showed that real-time sonography was safer and faster than radiography in identifying PCVC tip location in the inferior vena cava (IVC). However, in preterm infants, determining PCVC tip location in the SVC is complicated by endotracheal or nasogastric tubes in situ and emphysematous lung conditions. We aimed to find an appropriate sonographic view by which to assess PCVC tip location in the SVC compared to the sonographic examination of PCVC in the IVC. Neonates (n = 50) with PCVCs in the SVC were enrolled and their data (gestational age, gender, birth weight, body weight at intervention, repositioning rate, and duration of tip assessment) were compared with retrospective data of 50 neonates with PCVCs in the IVC. The mean gestational age in the groups of IVC and SVC was 31.43 weeks and 32.16 weeks, respectively. The mean birth weight in the groups of IVC and SVC was 1642.18 g and 1792.00 g, respectively. Placement of an S12-4 ultrasound sector transducer to obtain clear parasternal views of the aorta allows visualization of PCVC tips in the SVC and near the cavoatrial junction. PCVC repositioning rates were not significantly different between the two groups (p = 0.092). Sonography examinations in the SVC had a longer duration than those in the IVC (p < 0.001). Sonography provides an accurate method for determining PCVC tip location in the SVC.

Ultrasound-Guided Rectus Sheath Block as the Single Anaesthetic Technique for Umbilical Hernia Repair: A Report of 3 Cases.

In this study, we report 3 cases of ultrasound-guided rectus sheath block used for anaesthetic management of simple periumbilical surgery. We selected 3 patients based on the American Society of Anaesthesiology I-II and defect sizes known to be smaller than 4 cm without peritoneal involvement. We applied a rectus sheath block with 10 mL of 0.5% bupivacaine and 5 mL of 2% lidocaine bilaterally deposited in the space between rectus abdominis and posterior rectus sheath under real-time ultrasonography. Two of our patients tolerated surgery well with minimal sedoanalgesia; however, one of our patients needed dissociative anaesthesia to be compatible because the surgeon found out that the defect was bigger and adjacent to the peritoneum. Rectus sheath block is an underused technique that has the potential to be used as a sole anaesthetic technique in selected cases. So it would be wise to improve and consider rectus sheath block as a valuable tool when there is no better.

Stiffness in breast masses with posterior acoustic shadowing: significance of ultrasound real time shear wave elastography

BackgroundTo assess the stiffness of benign breast masses in ultrasound images with posterior acoustic shadowing (PAS) and malignant lesions, and explore the significance of differential diagnosis using ultrasound real time shear wave elastography.Material and methodsAll 117 mammary masses (98 patients) with PAS were assessed by using routine ultrasound examination, and elastic modulus values were obtained with the real time shear wave elastography mode. All breast lesions were confirmed by surgery or biopsy. The significance of differences in ultrasound elastography values between breast benign and malignant masses with posterior acoustic shadowing was assessed, and the ROC curves of elasticity modulus values were analyzed.ResultsAmong the 117 masses, 72 were benign and 45 were malignant. The two types of breast masses showed significant differences in size, margin, internal echo, calcification, and blood flow characteristics (P < 0.05), although the difference in orientation was not significant (P > 0.05). Emean, Emax and Esd obtained with real time shear wave elastography showed statistically significant differences between benign masses with posterior acoustic shadowing and breast cancer (P < 0.05), while Emin showed no significant difference between them (P = 0.633). Ultrasound real time shear wave elastography showed higher sensitivity and specificity than conventional ultrasound.ConclusionsBenign and malignant breast masses with PAS show different ultrasound manifestations. Real time shear wave elastography can facilitate the differential diagnosis and treatment planning for these breast masses.

Serum levels of interleukin-34 and RANKL as multivariable predictors of bone erosion seen by ultrasonography in patients with ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic inflammatory arthritic disease, and sacroiliitis, enthesitis, and propensity for sacroiliac and spinal fusion are characteristic pathological features. Interleukin-34 (IL-34) plays a role in the induction and differentiation of osteoclasts. Other inflammatory factors are not directly involved in the induction and differentiation, but play an indirect role by modulating the level of receptor activator of nuclear factor-κB (RANKL) and other molecules during the process of inflammatory bone destruction in AS. However, to our knowledge, the relationship between enthesitis and bone erosion, and IL-34 and RANKL in AS has not yet been elucidated. To determine the correlation between serum IL-34, RANKL, and disease severity including enthesitis and bone erosion in patients with AS and develop multivariable predictive model. We conducted a cross-sectional study of 40 patients with AS, compared with 40 patients with osteoarthritis, and 40 healthy volunteers. Their serum levels of IL-34 and RANKL were measured using enzyme-linked immunosorbent assays (ELISAs). Enthesitis and bone erosion were assessed with real-time ultrasonography. Spearman rank correlation coefficients were determined to analyze the relationship between the variables. Multiple logistic regression was used to determine associations and receiver operating characteristic (ROC) curve analyses were conducted to determine the diagnostic performance of cytokine levels. In patients with AS, serum levels of IL-34 (878.9 ± 116.4 pg/mL) and RANKL (155.6 ± 13.8 pg/mL) were significantly (P < 0.01) higher than those in patients with osteoarthritis (626.6 ± 79.0 and 138.1 ± 15.3 pg/mL, respectively) or a healthy group (612.9 ± 61.1 and 104.9 ± 15.4 pg/mL, respectively). Serum levels of IL-34 were not significantly correlated with the levels of RANKL. In patients with AS, serum levels of IL-34 and RANKL adjusted for age and weight were significantly correlated with enthesitis (0.798, P < 0.01; 0.347, P < 0.05, respectively) and bone erosion (0.822, P < 0.01; 0.368, P < 0.05, respectively). The area under the ROC curve (AUC) for the serum levels of IL-34 was 0.995 between patients with AS and healthy individuals. When serum level of IL-34 was >697.1 pg/mL, the sensitivity (SE) was >99% and specificity (SP) was 95.0%. The AUC for IL-34 was 0.982 between patients with AS and patients with osteoarthritis. When serum IL-34 was >688.4 pg/mL, the SE was >99% and SP 85.0%. IL-34 correlation with the number of bone erosions of enthesis was rs = 0.795, P < 0.01. The AUC for serum RANKL was 0.993 between patients with AS and healthy individuals. When serum RANKL was >126.2 pg/mL, the SE was 97.5% and SP 97.5%. The AUC for serum RANKL was 0.798 between patients with AS and patients with osteoarthritis. When serum RANKL was >149.3 pg/mL, the SE was 70% and SP was 80.0%. In patients with AS, serum levels of IL-34 and RANKL may be useful indicators of enthesitis, especially for bone erosions. IL-34 is associated with AS-associated enthesis damage and is a potential biomarker for predicting subsequent progression in patients with AS.

Ultrasonography and X-ray micro-computed tomography characterization of the effects caused by carrageenin in the muscle of gilthead seabream (Sparus aurata)

The current work aimed to carry out an in vivo study of the λ-carrageenin-induced inflammation in the skin of gilthead seabream (Sparus aurata). The fish were injected intramuscularly with phosphate-buffered saline (PBS, as control) or λ-carrageenin (1% in PBS), and the injection zone was evaluated by real-time ultrasonography (Vevo Lab, VisualSonics) at 1.5, 3, 6, 12, and 24 h post-injection (p.i.). Results demonstrated that the skin thickness was increased in fish injected with λ-carrageenin and sampled at 1.5, 3, and 6 h p.i. However, the skin thickness of the injected area decreased to the normal values in those fish sampled at 12 and 24 h p.i. In addition, fish injected with λ-carrageenin and analysed at 1.5, 3, and 6 h p.i. showed, in the underlying muscle at the injection place, several hyperechoic small foci surrounded by an anechoic area which were not observed in control fish. Furthermore, the fish were analysed by X-ray micro-computed tomography (micro-CT). The analysis of the micro-CT acquisitions revealed also a dark area in the place of the injection with λ-carrageenin at 1.5, 3, and 6 h. These areas were smaller in fish analysed at longer times (12 h p.i.) and were almost disappeared in fish sampled at 24 h p.i. These areas had an average density of −850 to −115 HU, which did not correspond with any tissue density of the rest of the body. Furthermore, similar dark areas at the injection zones were never observed in control fish. Present results support the use of both non-invasive techniques to study the inflammatory process in fish of commercial interest such as gilthead seabream.

ASSESSMENT OF CARCASS TISSUE COMPOSITION IN GROWING RABBITS USING REAL TIME ULTRASONOGRAPHY

&lt;p&gt;&lt;strong&gt;Background. &lt;/strong&gt;Carcass yield varies depending on the relative proportions of muscle, fat and bone, therefore, the possibility of predicting its value would produce valuable information that will promote the viability and sustainability of rabbit meat production. &lt;strong&gt;Methodology.&lt;/strong&gt; Thirty-eight male growing rabbits (New Zealand White × Californian) with body weights (BW) of 1329 ± 291 g and from 60 to 100 days of age were used. Real time ultrasonography (RTU) measurements were taken 12 h before slaughtering. For that, rabbits were shaved between the 6&lt;sup&gt;th&lt;/sup&gt; and 7&lt;sup&gt;th&lt;/sup&gt; lumbar vertebrae. The &lt;em&gt;longissimus thoracis et lumborum&lt;/em&gt;&lt;em&gt; &lt;/em&gt;muscle (LM) area (LDA) and also the maximum LM width (LDW) and the maximum depth LM (LDD) were measured. Data recorded at slaughtering included carcass and non-carcass components. After chilling at 4° C for 24 hours, carcasses were split longitudinally to obtain left and right halves that were later weighed. Thereafter, the right half carcass was weighed and manually deboned for recording weights of muscle (TCM), and bone (TCB). &lt;strong&gt;Results.&lt;/strong&gt; The highest correlation (r = 0.84, &lt;em&gt;P&lt;/em&gt; &amp;lt;0.001) was observed between TCM and LDD, while the lower correlation (r = 0.4,&lt;em&gt; P&lt;/em&gt; &amp;lt;0.001) was observed between TCB and LDW. The BW were highly related to carcass characteristics (r&amp;gt;0.77≤0.97). &lt;em&gt;In vivo&lt;/em&gt; RTU measurements explained a low to moderate amount of variation in TCB and TCM with an r&lt;sup&gt;2 &lt;/sup&gt;of 0.36 to 0.77 (&lt;em&gt;P&lt;/em&gt; &amp;lt; 0.001) respectively. BW explained from 49 to 92% of variation in TCB and TCM, respectively. &lt;strong&gt;Implications.&lt;/strong&gt; The &lt;em&gt;in vivo&lt;/em&gt; ultrasound measurements it is a viable tool that allows predicting carcass value of rabbits.&lt;strong&gt; Conclusion. &lt;/strong&gt;Our results indicated that the use of RTU measurements could accurately predict muscle from growing rabbit's carcass.&lt;/p&gt;

Clinical Study on Transperineal Real-time 3D Ultrasound in Diagnosis of Constipation Caused by Female Posterior Pelvic Dysfunction

Clinical Study on Transperineal Real-time 3D Ultrasound in Diagnosis of Constipation Caused by Female Posterior Pelvic Dysfunction

Feasibility and efficiency of contrast enhanced ultrasound real time guided fine needle aspiration for sentinel lymph node of breast cancer.

To assess the feasibility and efficiency of contrast-enhanced ultrasound (CEUS) real-time guided fine needle aspiration (FNA) for sentinel lymph node (SLN) of breast cancer. This retrospective study reviewed 21 breast cancer patients who scheduled for surgical resection performed CEUS real-time guided SLN-FNA and intraoperative SLN biopsy (SLNB). The success rate of CEUS real-time guided SLN-FNA was analyzed. The FNA diagnostic efficiency of SLN metastasis was analyzed compared to SLNB. Twenty-six SLNs were detected by intradermal CEUS whereas 130 SLNs were detected by SLNB. The median SLNs detected by intradermal CEUS (n = 1) and by SLNB (n = 5) was significantly difference (p < 0.001). All 26 CE-SLNs of 21 patients were successfully performed intradermal CEUS dual image real-time guided SLN-FNA including 5 SLNs of 4 patients which were difficult to distinguish in conventional ultrasound. Compared to SLNB, FNA found 2 of 5 cases of SLN metastasis, the diagnosis sensitivity, specificity, positive predictive value, negative predictive value, false negative rate, false positive rate and Yoden index were 40%, 100%, 100%, 84.2%, 60%, 0%and 40%, respectively. SLN-FNA real-time guided by dual CEUS image mode was technically feasible. Patients with a positive SLN-FNA should be advised to ALND without intraoperative SLNB according to Chinese surgeon and patients' conservatism attitude. But a negative SLN-FNA did not obviate the need of conventional SLNB because of the high false negative rate.

7: Comparison of real-time cervical oesophageal ultrasonography and gastric antral ultrasonography to detect gastric insufflation during face-mask ventilation under general anaesthesia-Aprospective observational study.

Background and Aims:Face mask ventilation (FMV) is live saving. It is paramount to maintain oxygenation and ventilation. But FMV is avoided in rapid sequence induction( RSI), for fear of gastric insufflation. Gastric insufflation predisposes the patient to pulmonary aspiration. But the current methods available to detect gastric insufflation are not reliable markers. These include epigastric auscultation for insufflated gases, insertion of nasogastric tube to aspirate and measure the gases, and gastric antral cross-sectional area (CSA) measurement. Each of the above have their own limitations. So, reliable markers denoting gastric insufflation can prevent pulmonary aspiration and can enable “safe” FMV. Real-time transcutaneous ultrasonography(USG) of cervical oesophagus during FMV was done to look for comet-tail artefacts (acoustic shadows created by entrainment of gases into digestive tract)The aim of this study was to compare real-time upper cervical USG with gastric antral USG to detect gastric insufflation during FMV under general anaesthesia.Methods:Results:Ninety patients were recruited. One case of accidental intubation was withdrawn. Remaining 89 patients were analysed. There was an increased incidence of comet-tail artefacts in the oesophagus when compared to gastric antrum. This difference was statistically significant as analysed by Mcnemar test. The lowest peak airway pressure at which comet-tail artefacts appeared in oesophagus was 21.47 (SD-2.86) cm H20.Conclusion:Cervical oesophageal USG is better than gastric antral USG in identifying insufflation of gas into digestive tract. Limiting the airway pressures to < 20 cm H2O would be safer in providing safe FMV without cricoid pressure. Real-time USG monitoring of oesophagus in the neck for comet-tail artefacts is useful in early identification of early gastrooesophageal insufflation.