Screening Ultrasound Examination Research Articles

Prevalence of negative sliding sign representing pouch of Douglas obliteration during pelvic transvaginal ultrasound for any indication

Pouch of Douglas (POD) obliteration can be predicted with a high degree of certainty and reproducibility using the dynamic transvaginal ultrasound (TVS) sliding-sign technique. So far, studies on POD obliteration prediction have focused on tertiary-care populations with high prevalence of endometriosis; however, POD obliteration may exist in individuals with asymptomatic endometriosis or other conditions. Our primary aim was to determine the prevalence of a negative sliding sign, representing POD obliteration, in a cohort of patients undergoing TVS for any gynecological indication. This was a prospective observational study of consecutive women with an indication for gynecological TVS, conducted at a high-volume ultrasound practice between July and August 2018. Clinical and surgical history, indication for TVS and TVS findings were documented. The prevalence of TVS-confirmed POD obliteration, determined by interpretation of the sliding sign, was calculated for the entire cohort and for the subgroups of women with and without risk factors for endometriosis. High risk for endometriosis was defined as having (1) a TVS referral for endometriosis-like pelvic pain or endometriosis specifically and/or (2) clinical symptoms or signs suggestive of endometriosis. Low risk was defined as the absence of these characteristics. During the study period, 1043 consecutive women underwent TVS. After excluding those who underwent transabdominal ultrasound, had a history of hysterectomy or with missing data, 909 women were analyzed. The prevalence of a negative sliding sign in the entire cohort was 47/909 (5.2%). A negative sliding sign was observed in 22/639 (3.4%) women with a low risk for endometriosis and 25/243 (10.3%) of those with a high risk for endometriosis (difference in proportions, 6.9% (95% CI 2.8-10.9%); P < 0.001). We have demonstrated an overall prevalence of a negative sliding sign, suggesting POD obliteration, of 5.2% (or 1/20) in women seeking TVS for a gynecological indication. The prevalence of negative sliding sign in low-risk women is not negligible (3.4% or 1/29 women). These women are most likely to have asymptomatic endometriosis or another important etiology of POD obliteration. The prevalence of a negative sliding sign is approximately three-times higher in women with signs and/or symptoms of endometriosis (10.3% vs 3.4%). Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

Порушення репродуктивного здоров’я у пацієнток з аномаліями розвитку статевих органів

Female genital tract malformations are often a challenge not only for obstetricians and gynecologists, but also for doctors of other specialties. This pathology often leads to negative obstetric and perinatal consequences, the emergence of gynecological complications that significantly impair the quality of life of patients at different ages. The incidence of female genital abnormalities in the general female population ranges from 5.5 to 6.7% and is on average three times higher among patients with reproductive health disorders. The objective: to assess the frequency of reproductive disorders and determine the sequence of use of clinical and instrumental methods of examination in patients with female genital tract malformations. Materials and methods. We conducted a retrospective assessment of the relationship between menstrual disorders and the presence of female genital tract malformations. We observed 124 patients with a confirmed diagnosis of female genital tract malformations. The age of women ranged from 22 to 42 years. The diagnosis was based on complaints, medical history and life, as well as data from clinical, laboratory and instrumental examinations. Results. The mean age of patients was 29.2±3.8 years. From the moment of the patient’s first visit to the gynecologist until the final verification of the diagnosis took from 6 months to 7 years. Dysmenorrhea occurred in 70.2% of patients with abnormalities in the development of the female genital organs, late menarche – in 12.1%, primary / secondary amenorrhea – in 11.3%, irregular menstrual cycle – in 9.7%, violation of the menstrual cycle – at 28.2%. The combination of female genital tract malformations with various defects of the urinary system occurred in 24 (19.4%) women. Conclusion. In 81.2% of patients from adolescence there were clinical manifestations associated with female genital tract malformations. Screening ultrasound examination of the pelvic organs and gynecological examination is shown to all girls aged 15 years. It is advisable to determine the karyotype in patients with primary / secondary amenorrhea. Renal ultrasound should be performed in all patients with suspected female genital tract malformations. In case of suspicion of ultrasound examination for abnormal development of the female genitals, patients before sexual intercourse are recommended to perform MRI examination; in the presence of sexual life with a preserved menstrual cycle, it is advisable in the second phase of the cycle to conduct transvaginal 3D ultrasound, which can be supplemented by MRI. Keywords: genital abnormalities, dysmenorrhea, menstrual function.

A Novel Murine Model of Early Abdominal Aortic Aneurysm Reflects Immunopathology in Human Abdominal Aortic Aneurysms

The pathogenesis of abdominal aortic aneurysm (AAA) remains poorly understood but there is mounting evidence that AAA may be an immune mediated condition. Current mouse models of AAA were developed primarily to reproduce mature aneurysms and may poorly reflect the pathology found in early AAA. We propose a novel murine model of AAA incorporating sensitization to aortic antigens, which Results in more robust AAA and duplicates the proposed autoimmune mechanisms in humans. C57B/L6 mice were randomized to sensitization to fragmented elastin (fELA) or control. One week later AAA was induced in all mice with the topical elastase method. Prior to sacrifice, development of a delayed-type hypersensitivity (DTH) reaction was assessed by cutaneous challenge in the ear pinna with fELA. Blood and periaortic lymph nodes (LN) were collected for quantification of type 1 regulatory T-cells (Tr1) and T-helper 17 (Th17) cells by flow cytometry. The mice were perfused with a silicone injection compound to fill and opacify their vasculature and microcomputed tomography scans were obtained for three-dimensional reconstruction of the infrarenal aorta (Fig 1) to evaluate volume and surface area of the aneurysms. Mice sensitized to fELA had larger aneurysms: volume 5.31 mm3 versus 4.16 mm3 (P = .034) and surface area 34.55 mm2 versus 30.87 mm2 (P = .038). They had positive DTH reactions to fELA represented by a greater weight difference between challenged and unchallenged ears: 4.13 mg vs 0.21 mg (P = .0004). The degree of DTH response was found to positively correlate with both volume (Fig 2) (R = 0.79; P = .00025) and surface area of aneurysm (R = 0.71; P = .0019). Flow cytometry Results were noTable for a significantly decreased Tr1/Th17 ratio in the sensitized group both in the blood (P = .0005) and LNs (P = .031) and in periaortic LNs this Tr1/Th17 ratio negatively correlated with AAA volume (R = –0.52; P = .021) with a trend toward a similar correlation in the blood (R = –0.49; P = .056). The addition of sensitization to fELA to a surgical topical elastase model of AAA Results in the development of larger aneurysms whose size correlates both with the DTH response to the antigen and with a decreasing Tr1/Th17 ratio in blood and periaortic LNs. The decreased Tr1/Th17 ratio is of particular interest as this was noted to be highly predictive of the presence of AAA in a study of Veterans Affairs patients presenting for screening ultrasound examination (0.5287 in AAA vs 2.6570 in non-AAA; P < .00001; receiver operating characteristic curve with an area under the curve of 0.925; 58 patients).Fig 2The strength of the delayed type-hypersensitivity (DTH) reaction to cutaneous challenge with elastin fragments correlates with aneurysm volume as calculated from three-dimensional reconstructions of the infrarenal aorta on microcomputed tomography scans (MicroCT). Cutaneous challenge was performed on the pinna of the ear and reaction quantified by weight difference compared to contralateral ear which was injected with vehicle.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Ultrosound assessment of the thoracic and abdominal aorta in civil aviation pilots of senior age group

Introduction. Early detection of subclinical atherosclerosis in different arterial vessels, including the main vessel aorta, is important for clinical practice and aeromedical assessment, especially in senior age people. Objective: to evaluate condition of the thoracic and abdominal aorta in civil aviation pilots of senior age group according to ultrasonography. Material. 1189 civil aviation pilots aged 54-68 yrs who underwent routine in-patient examination at the Central Clinical Hospital of Civil Aviation on a regular basis were examined. The average age - 56,75 ± 0,07 years. Methods: ultrasound screening examination was performed for early diagnosis of aortic atherosclerosis. Results. Only 4,7% of civil aviation senior age pilots have not changes in the abdominal and thoracic aorta. The majority of the examined have atherosclerotic lesions of the aortic wall, which was more often in thoracic (93,8%), then in abdominal (22,1%) aorta. However, changes in the abdominal aorta were more significant for the clinical and medical assessment. There were signs of unstable atherosclerotic plaque in the abdominal aorta in two cases (0,2%). Abdominal aortic aneurysm was first diagnosed in two pilots (0,2%). Atherosclerotic aortic defect (stenosis and insufficiency) was identified in one 59-year-old pilot (0,1%). Conclusion. Five pilots were unfit (0,5%) and 44 pilots were needed in thorough further follow-up observation due to identified changes (dilatation of the thoracic aorta - 31 pilots and abdominal aorta - two pilots, atherosclerotic plaques in the abdominal aorta - 11 pilots). According this data screening evaluation for detection of atherosclerosis as in the thoracic aorta, as in the abdominal aorta is useful for pilots of senior age group.

AIUM Practice Parameter for the Performance of an Ultrasound Examination of Solid-Organ Transplants.

AIUM Practice Parameter for the Performance of an Ultrasound Examination of Solid-Organ Transplants.

Updated DEGUM Quality Requirements for the Basic Prenatal Screening Ultrasound Examination (DEGUM Level I) between 18 + 0 and 21 + 6 weeks of gestation

A precondition for the early detection of fetal abnormalities is the high quality of prenatal basic ultrasound (screening examination). The objective of ultrasound screening is the recognition of abnormal fetal growth and fetal anatomical anomalies. The prenatal detection of fetal abnormalities enables detailed prenatal counselling of parents, improved care at birth and potentially a reduction in morbidity and mortality. In the guidelines for maternity care in Germany ("Mutterschaftsrichtlinien"), the performance of basic ultrasound in pregnancy is not clearly defined. The required image documentation includes a few biometric measurements only. Therefore, adherence to a standard technique and the possibility of audit are limited, thus not necessarily resulting in high screening quality. In this update of the DEGUM quality requirements for level I screening ultrasound examination between 18 + 0 and 21 + 6weeks of gestation, the required parameters, standard planes and required documentation are described in detail. The greater experience of gynecologists in the field of sonographic screening examinations and the use of a modern ultrasound technique allow improvement of the screening quality. This will improve the standard of basic ultrasound screening. Due to the enhanced standard of the DEGUM I examination, more pregnant women may benefit from a detailed ultrasound examination and specialized therapy in DEGUM level II and III centers. The required fetal structures are described in detail. This update of the requirements for level I DEGUM basic ultrasound examination between 18 + 0 and 21 + 6 weeks of gestation goes far beyond the guidelines for maternity care in Germany (the "Mutterschaftsrichtlinien") thereby elevating standards.

Prevention of reproductive disorders in women with female genital tract malformations

Summary. Reproductive health is a priority in today’s global health care system. Among the factors of reproductive health disorders are female genital tract malformations. This pathology is mostly diagnosed with the onset of reproductive disorders at different ages of women, negatively affecting not only the reproductive but also the sexual functions of women, absorbing the quality of her life. The objective: to develop measures for the prevention of reproductive disorders in patients with female genital tract malformations based on the assessment of clinical manifestations and the frequency of reproductive disorders. Materials and methods. A retrospective assessment of reproductive disorders in 84 patients with a verified diagnosis of abnormalities in the development of the female genital organs was performed. The diagnosis was based on complaints, anamnestic data, the results of objective examination, clinical, laboratory and instrumental methods. The control group consisted of 25 women without abnormalities in the development of the female genitalia. Results. The mean age of the surveyed women was 27.6 ± 3.8 years. The duration of verification of the diagnosis of female genital tract malformations from the moment of the first visit to the gynecologist took an average of 3.1 ± 1.3 years. Of all the abnormalities in the development of the female reproductive system, 14.3 % were so-called «obstructive» abnormalities associated with impaired menstrual blood flow. Therefore, their clinical manifestation was earlier and more pronounced than in other patients and was manifested primarily by severe dysmenorrhea. Deviations in the age of onset of menarche occurred in 25 % of patients (OR =8; 95 % CI 1,019 – 62,798). In 73.8 % of women, the first reproductive disorders began during puberty. Dys menorrhea of varying severity occurred in 69.1 % of patients (OR = 7,064; 95 % СІ 2,527 – 19,744), of whom 70.6 % used medical treatment. The share of infertility among the women with anomalies in the development of the reproductive system was 19.1 %, pregnancy loss – 40.5 %. It was found that the risk of miscarriage in patients with congenital pathology of the female genitalia increases significantly (OR = 3,570; 95 % CI 1,125 – 11,325). 34.5 % of patients were diagnosed with genital endometriosis (OR = 6,064; 95 % СI 1,335 – 27,540). In 21.4 % of cases, abnormalities in the development of the female genitals were combined with congenital kidney disease. Conclusions. Prevention and predictability of reproductive disorders in patients with female genital tract malformations should begin with the pubertal period of the girl. A separate risk group consists of girls with pathology of the kidneys diagnosed prenatally. The basis for the prevention of reproductive health disorders in women with female genital tract malformations is the timely verification of congenital pathology and the development of a personalized system of management. The results of our research and the literature suggest that verification of the diagnosis of female genital tract malformations in women usually begins when patients have lost pregnancy or are experiencing infertility, while dysmenorrhea, menstrual irregularities that may occur in adolescence, often do not alert and do not become the basis for exclusion of congenital anomalies. That is why we believe that screening ultrasound examination of the pelvic organs in the presence of these disorders, it is advisable to conduct girls during puberty, if necessary – using 3D ultrasound and/or MRI.

Information Women Choose to Receive About Prenatal Chromosomal Microarray Analysis.

To examine the choices of women with both high-risk and low-risk pregnancies who are undergoing prenatal chromosomal microarray analysis in a clinical setting regarding three challenging types of findings: variants of uncertain clinical significance, susceptibility loci for neurodevelopmental disorders, and copy number variants associated with risks for adult-onset conditions. We assessed whether women's choices were associated with indications for testing or with one-on-one pretest genetic counseling. In this cross-sectional study, medical records of women who underwent invasive prenatal chromosomal microarray analysis testing (N=1,070) at Hadassah Medical Center between June 2017 and February 2018 were examined for testing indications, choices regarding chromosomal microarray analysis findings, and type of pretest genetic counseling. Multivariable analyses to assess associations with testing indication and prior genetic counseling were carried out using logistic regression models. In total, 56% of women (n=593) chose to be informed of all three types of findings and 20% (n=218) chose not to be informed of any of the findings beyond high-penetrance childhood-onset pathogenic findings. Variants of uncertain clinical significance as a single choice was the least-selected finding (2.5%, n=27). Low-risk pregnancies (ie, those with normal biochemical screening and fetal ultrasound examinations) were associated with increased interest in receiving genetic information about adult-onset conditions (adjusted odds ratio [aOR] 1.7; 95% CI 1.18-2.33) and susceptibility loci (aOR 1.5; 95% CI 1.08-2.10). Women with both high-risk and low-risk pregnancies were generally more likely to choose to receive additional genetic information, albeit differences in preferences depend on testing indication and type of pretest counseling.

Diagnostic Tactics in the Absence of Ultrasound Images of the Gallbladder

Objective: determine the optimal checklist of diagnostic procedures, whose application will make it possible to effectively identify and differentiate malformations of the biliary system of the fetus accompanied by the absence of ultrasound imaging of the gallbladder. Material . The fetuses in single-fetal pregnancy in the period of gestation of 16-37 weeks were examined. Results. The study has determined the optimal checklist of the diagnostic procedures, including dynamic sonography, biochemical amniotic fluid test, magnetic resonance imaging, which should be carried out in the absence of ultrasound imaging of the gallbladder during the screening ultrasound examination of pregnant women aimed at the identification of the congenital malformations of the fetus. The cases and conditions of the biochemical amniotic fluid testing have been identified. The standards of the percentile values of the total alkaline phosphatase and gamma-glutamyl transpeptidase concentrations in amniotic fluid have been developed. Conclusion. If the gall bladder of the fetus cannot be visualized by ultrasound, isolated agenesis of the gall bladder, atresia of the biliary tract, cystic fibrosis, aneuploidy, multiple congenital malformations should be suspected. In view of the extremely unfavorable prognosis in case of biliary atresia, the verification ultrasound examination should be repeated dynamically several times over the next week, and if the gallbladder is not detected, then for the differential diagnosis it is necessary to use additional methods such as MRI and biochemical amniotic fluid test in order to determine changes in their concentration of digestive enzymes in comparison with the normative values determined by the authors.

Optimization of Prenatal Screening for Developmental Lung Anomalies

Objective: to determine the list of ultrasound criteria for normal development of the fetal lung, the use of which will make it possible to identify lung malformations in the fetus effectively, as well as to predict the development of lung hypoplasia in the newborn. Material of the research. The fetuses of singleton pregnancy in 1570 female patients of Minsk during the gestation period of 20-37 weeks. Results. The minimum list of the ultrasound criteria for the features of the lung development, which should be used for screening ultrasound examinations of pregnant women aimed at the detection of congenital lung malformations of the fetus, has been determined. The work indicates cases which require additional measurement of the lung volume of the fetus, the most optimal method for which is to use the VOCAL software package during three-dimensional sonography or direct measurement by MRI. The measurement data for the percentile values of the fetal lung volume taking into account the regional biometric features, as well as the percentile measurement data for the quantity of amniotic fluid have been determined. Conclusion. The minimum list of the ultrasound criteria for adequate lung development, the use of which during the screening ultrasound examinations of pregnant women will make it possible to detect congenital lung malformations of the fetus with high sensitivity, includes such characteristics as parenchyma homogeneity, diaphragm position, fluid in the pleural cavity, and the presence of fluid movement through the airways. The prenatal prediction of the development of respiratory distress syndrome in newborns requires direct measurement of the lung volume by means of the volumetric calculation program of three-dimensional sonography or MRI, followed by the assessment of the results using the tables of the regional percentile values, developed by the authors. Also, in cases of oligohydramnios, to make such a prediction, it is necessary to assess the quantity of amniotic fluid using the tables of the regional percentile values, developed by the authors.

Optimizing Lower Extremity Duplex Ultrasound Screening After Traumatic Injury

BackgroundThe risk assessment profile (RAP) score has been used to determine patients who would most benefit from lower extremity duplex ultrasound screening (LEDUS). We hypothesized that revising our LEDUS protocol to perform screening ultrasound examinations in patients with an RAP ≥8 within 48 h of admission would reduce the number of LEDUS performed without changing outcomes. MethodsA retrospective review was conducted on trauma patients admitted from July 1, 2014, to June 30, 2015, and July 1, 2016, to June 30, 2017. In 2014-2015, patients with an RAP score ≥5 underwent weekly LEDUS examinations starting on hospital day 4. In 2016-2017, the protocol was changed to start screening patients with an RAP score ≥8 by hospital day 2. Both protocols screened with weekly ultrasounds after the first examination. Demographic data, injury characteristics, LEDUS examination findings, chemoprophylaxis type, and venous thromboembolism incidence were collected. ResultsA total of 602 patients underwent LEDUS examination in 2014-2015, whereas only 412 underwent LEDUS in 2016-2017. No significant difference was seen in the number of patients diagnosed with deep vein thrombosis (DVT) or pulmonary embolism. DVTs were most often identified on the first LEDUS examination in both cohorts. Of patients diagnosed with a DVT on an LEDUS examination, a significantly higher RAP score (12 versus 10), and a shorter time to first duplex (1 versus 3 d), and DVT diagnosis (2 versus 4 d) were observed in the 2016-2017 cohort. In patients diagnosed with a pulmonary embolism, no significant differences were demonstrated between cohorts. ConclusionsRefinement of LEDUS protocols can decrease overutilization of hospital resources without compromising trauma patient outcomes.

Screening for breech presentation using universal late-pregnancy ultrasonography: A prospective cohort study and cost effectiveness analysis.

BackgroundDespite the relative ease with which breech presentation can be identified through ultrasound screening, the assessment of foetal presentation at term is often based on clinical examination only. Due to limitations in this approach, many women present in labour with an undiagnosed breech presentation, with increased risk of foetal morbidity and mortality. This study sought to determine the cost effectiveness of universal ultrasound scanning for breech presentation near term (36 weeks of gestational age [wkGA]) in nulliparous women.Methods and findingsThe Pregnancy Outcome Prediction (POP) study was a prospective cohort study between January 14, 2008 and July 31, 2012, including 3,879 nulliparous women who attended for a research screening ultrasound examination at 36 wkGA. Foetal presentation was assessed and compared for the groups with and without a clinically indicated ultrasound. Where breech presentation was detected, an external cephalic version (ECV) was routinely offered. If the ECV was unsuccessful or not performed, the women were offered either planned cesarean section at 39 weeks or attempted vaginal breech delivery. To compare the likelihood of different mode of deliveries and associated long-term health outcomes for universal ultrasound to current practice, a probabilistic economic simulation model was constructed. Parameter values were obtained from the POP study, and costs were mainly obtained from the English National Health Service (NHS). One hundred seventy-nine out of 3,879 women (4.6%) were diagnosed with breech presentation at 36 weeks. For most women (96), there had been no prior suspicion of noncephalic presentation. ECV was attempted for 84 (46.9%) women and was successful in 12 (success rate: 14.3%). Overall, 19 of the 179 women delivered vaginally (10.6%), 110 delivered by elective cesarean section (ELCS) (61.5%) and 50 delivered by emergency cesarean section (EMCS) (27.9%). There were no women with undiagnosed breech presentation in labour in the entire cohort. On average, 40 scans were needed per detection of a previously undiagnosed breech presentation. The economic analysis indicated that, compared to current practice, universal late-pregnancy ultrasound would identify around 14,826 otherwise undiagnosed breech presentations across England annually. It would also reduce EMCS and vaginal breech deliveries by 0.7 and 1.0 percentage points, respectively: around 4,196 and 6,061 deliveries across England annually. Universal ultrasound would also prevent 7.89 neonatal mortalities annually. The strategy would be cost effective if foetal presentation could be assessed for £19.80 or less per woman. Limitations to this study included that foetal presentation was revealed to all women and that the health economic analysis may be altered by parity.ConclusionsAccording to our estimates, universal late pregnancy ultrasound in nulliparous women (1) would virtually eliminate undiagnosed breech presentation, (2) would be expected to reduce foetal mortality in breech presentation, and (3) would be cost effective if foetal presentation could be assessed for less than £19.80 per woman.

The earliest timing of ultrasound in screening for developmental dysplasia of the hips.

PurposeThe current study aimed to evaluate the results of ultrasound screening for developmental dysplasia of the hips (DDH) done at various weeks of life, to determine the earliest time that ultrasound screening can be performed reliably.MethodsIn this 17-year cohort study, all neonates who underwent ultrasound screening prior to the 12th week of life with subsequent follow-up radiography done at 1 year of life were included. The ultrasound images were evaluated according to the Graf classification, Harcke’s dynamic ultrasound screening method, and Terjesen’s femoral head coverage method. The radiographic images were evaluated according to the acetabular index and the femoral head position. The accuracy and correlation between the ultrasound findings from various weeks of life with the radiographic findings at 1 year of life were evaluated.ResultsA total of 348 neonates were included in the study, of whom 92 had abnormal ultrasound findings and 42 had abnormal radiographic findings at 1 year. Significant differences were identified between the findings of ultrasound screening examinations performed prior to the fourth week of life (day 21 and before) and the radiographic findings at 1 year of life (P<0.05). In contrast, no significant differences were identified when ultrasound screening was performed between the fourth and 12th weeks of life (day 22 and beyond) (P>0.05). The accuracy of ultrasound screening was 79.2% or higher when performed during or after the fourth week of life (day 22 and beyond).ConclusionThe earliest that ultrasound screening for DDH can be performed reliably is during the fourth week of life (day 22 and beyond).

Histopathological analysis of papillary thyroid carcinoma detected during ultrasound screening examinations in Fukushima.

Thyroid ultrasound screening of young residents in Fukushima Prefecture, Japan, showed a high detection rate of papillary thyroid carcinoma (PTC). Detailed morphological analysis of these tumors was not presented to date. This study sets out to evaluate changes in histopathological and invasive characteristics of Fukushima PTC with time after the nuclear accident of March 2011 in all available cases and in different age subgroups. Histological specimens of 115 PTCs from patients aged 18 years or younger at the time of the Fukushima Dai‐ichi Nuclear Power Plant accident, who underwent surgical resection at Fukushima Medical University during 2012‐2016, were reviewed. Patients were divided into those treated during the first 4 years after the accident (n = 78, shorter‐onset) or later (n = 37, longer‐onset). The whole group and 3 age subgroups: children (aged less than 15 years), adolescents (aged from 15 to less than 19 years), and young adults (aged from 19 years) at surgery were analyzed. No statistically significant time‐related changes in tumor structure or invasiveness were found in the whole group or in age‐matched subgroups. Statistically significant age‐related downtrend was observed for intrathyroid spread in the whole group of patients. The absence of temporal changes in tumor morphological characteristics and tumor invasiveness strongly suggests common etiology of the shorter‐ and longer‐onset Fukushima PTCs, which are unlikely related to the effect of exposure to very low doses of radiation.

Evaluation of the structure and hemodynamics of internal jugular veins by ultrasound in normal population

Objective To investigate the structure and hemodyanmics characteristics of internal jugular veins (IJV) in normal population. Methods A total of 126 individuals for stroke screening and IJV ultrasound examination from Oct 2017 to May 2018 in our hospital were enrolled.The the level of IJV influx into innominate vein (J1), the level of superior thyroid vein influx into IJV (J2) and the level of the segment equal to from the bifurcation of common carotid artery to out of skull(J3) of IJV were evaluated by ultrasound. The parameters included the maximum diameters of the three segments during the smooth respiration period, cross section area (CSA), the maximum velocity (Vmax), mean flow volume (FVm) and the maximum pressure gradient (PGmax). The parameters of bilateral IJVs were compared. The effects of gender and age on these parameters were analyzed. Results The structures and hemodynamics parameters of left IJV were lower than those of right IJV (all P 0.05). With aging, the left/right ratio of Vmax and PGmax were decreased, especially at J1 segment (P<0.05). Conclusions Color Doppler flow imaging can evaluate the IJV structures and hemodynamics by assessing the diameter, CSA, Vmax, FVm and PGmax. Right IJV is the dominated outflow side in normal population. With aging, the drainage of left IJV is decreased. Key words: Ultrasonography; Jugular vein; Hemodynamics; Structure; Normal population

Association of advanced hepatic fibrosis and sonographic visualization score: a dual-center study using ACR US LI-RADS.

To evaluate the association between imaging and clinical features and visualization scores, as specified by American College of Radiology (ACR) Ultrasound Liver Imaging Reporting and Data System (LI-RADS), on hepatocellular carcinoma (HCC) screening ultrasound examinations. In this dual-center retrospective study, HCC screening ultrasound reports containing ultrasound elastography measurements (January to September, 2017) were reviewed. Ultrasound point shear wave elastography and 2-dimensional shear wave elastography were used to assess liver stiffness; median shear wave velocity was translated to METAVIR fibrosis scoring, per previously published data. Reports were analyzed for subject age, sex, reason for HCC screening, spleen size, fibrosis scores, and assigned ultrasound visualization scores. Jonckheere-Terpstra trend and Kendall's tau-b coefficient analyses were performed. 714 subjects (mean age 55; 51% male, 49% female) were included. 308 (43%) subjects had clinically declared cirrhosis; 406 (57%) did not. Majority (535, 75%) of exams were adequate (Visualization Score A), 156 (22%) moderately limited (Visualization Score B), and 23 (3%) severely limited (Visualization Score C). Increasing spleen size and patient age were associated with worsening visualization scores (p < 0.001). Suboptimal visualization was also associated with clinically significant fibrosis (≥ F2) by elastography (Kendall's tau-b = 0.181, p < 0.001) and clinically declared cirrhosis (Kendall's tau-b = 0.433, p < 0.001). There was no association with patient sex. Using ACR Ultrasound LI-RADS visualization score assessment, majority (75%) of HCC screening exams were diagnostically adequate, and only 3% were severely limited. Sonoelastographic diagnosis of clinically significant fibrosis, as well as clinical cirrhosis, increased patient age, and spleen size, were associated with greater diagnostic limitations.

Screening BRCA1 and BRCA2 Mutation Carriers for Breast Cancer

Women with BRCA mutations, who choose to decline or defer risk-reducing mastectomy, require a highly sensitive breast screening regimen they can begin by age 25 or 30. Meta-analysis of multiple observational studies, in which both mammography and magnetic resonance imaging (MRI) were performed annually, demonstrated a combined sensitivity of 94% for MRI plus mammography compared to 39% for mammography alone. There was negligible benefit from adding screening ultrasound or clinical breast examination to the other two modalities. The great majority of cancers detected were non-invasive or stage I. While the addition of MRI to mammography lowered the specificity from 95% to 77%, the specificity improved significantly after the first round of screening. The median follow-up of women with screen-detected breast cancer in the above observational studies now exceeds 10 years, and the long-term breast cancer-free survival in most of these studies is 90% to 95%. However, ongoing follow-up of these study patients, as well of women screened and treated more recently, is necessary. Advances in imaging technology will make highly sensitive screening accessible to a greater number of high-risk women.

Association of Conventional Cardiovascular Risk Factors with Carotid Atherosclerosis Prevalence in General Population

Material and methods. In the cross-sectional population-based study of general unorganized population of Tomsk aged 25-64 years ultrasound screening examination of the carotid arteries was done for detection of atherosclerotic plaques (plaque). As potential plaque determinants the following factors were studied: age, gender, smoking, low and high density lipoproteins (LDL-C and HDL-C), triglycerides, arterial hypertension, body mass index (BMI), low educational status (LES), high-sensitive C-reactive protein, glucose, diabetes mellitus, antihypertensive and hypolipidemic therapy. Study of relationships was carried out with logistic regression analysis. The error probability of less than 5% was considered statistically significant.Results. In the crude analysis most of the determinants under study showed statistically significant relationship with plaque presence. After adjustment for age and sex, LDL-C, smoking and LES were associated with CAS prevalence. In multivariable regression analysis 9 risk factors appeared to be independently associated with plaque presence, wherein age, male sex, LDL-C, BMI and HDL-C were the most significant. In the participants of 50 years and older the smoking effect was the next in significance after LDL-C.Conclusion. The results obtained focus attention on the comparative value of the major atherogenic risk factors and suggest that currently effective and timely control of LDL-C is of primary importance for prevention of carotid atherosclerosis in the general working-age population. As well the findings of the study evidence that at the population level smoking is still one of the leading atherogenic risk factors.

Comparing Internet-Based Cognitive Behavioral Therapy With Standard Care for Women With Fear of Birth: Randomized Controlled Trial.

BackgroundAlthough many pregnant women report fear related to the approaching birth, no consensus exists on how fear of birth should be handled in clinical care.ObjectiveThis randomized controlled trial aimed to compare the efficacy of a guided internet-based self-help program based on cognitive behavioral therapy (guided ICBT) with standard care on the levels of fear of birth in a sample of pregnant women reporting fear of birth.MethodsThis nonblinded, multicenter randomized controlled trial with a parallel design was conducted at three study centers (hospitals) in Sweden. Recruitment commenced at the ultrasound screening examination during gestational weeks 17-20. The therapist-guided ICBT intervention was inspired by the Unified protocol for transdiagnostic treatment of emotional disorders and consisted of 8 treatment modules and 1 module for postpartum follow-up. The aim was to help participants observe and understand their fear of birth and find new ways of coping with difficult thoughts and emotions. Standard care was offered in the three different study regions. The primary outcome was self-assessed levels of fear of birth, measured using the Fear of Birth Scale.ResultsWe included 258 pregnant women reporting clinically significant levels of fear of birth (guided ICBT group, 127; standard care group, 131). Of the 127 women randomized to the guided ICBT group, 103 (81%) commenced treatment, 60 (47%) moved on to the second module, and only 13 (10%) finished ≥4 modules. The levels of fear of birth did not differ between the intervention groups postintervention. At 1-year postpartum follow-up, participants in the guided ICBT group exhibited significantly lower levels of fear of birth (U=3674.00, z=−1.97, P=.049, Cohen d=0.28, 95% CI –0.01 to 0.57). Using the linear mixed models analysis, an overall decrease in the levels of fear of birth over time was found (P≤ .001), along with a significant interaction between time and intervention, showing a larger reduction in fear of birth in the guided ICBT group over time (F1,192.538=4.96, P=.03).ConclusionsFear of birth decreased over time in both intervention groups; while the decrease was slightly larger in the guided ICBT group, the main effect of time alone, regardless of treatment allocation, was most evident. Poor treatment adherence to guided ICBT implies low feasibility and acceptance of this treatment.Trial RegistrationClinicalTrials.gov NCT02306434; https://clinicaltrials.gov/ct2/show/NCT02306434 (Archived by WebCite at http://www.webcitation.org/70sj83qat)

HYDRONEPHROSIS IN CHILDREN (LOOK THROUGH THE PRISM OF TIME)

Introduction. The introduction of ultrasonic research into everyday perinatal practice in 1980s, the use of radioisotope and radiotherapeutic techniques, as well as minimally invasive methods of surgical correction of hydronephrosis, significantly changed our view of this malformation in a number of ways. The causes of dilatation of the collection system in the fetus and newborn can be both obstructive and non-obstructive in character. Material and methods. A work analyzes modern methods of diagnosis and treatment of hydronephrosis in children. The attitude to radiopaque methods of research (excretory urography, cystography, CT) in newborns and infants is emphasized to have changed also. In this regard, the emphasis was shifted to ultrasound, radioisotope methods of diagnosis and MRI. The antenatal detection of hydronephrosis transformation was noted to contribute also to the early implementation of the surgical correction of the defect. At the same time, there is considered the need for a well-structured approach to the surgical treatment, taking into account a number of factors in children with pyelectasis, visualized in a screening ultrasound examination in pre- and postnatal periods. The modern algorithm of diagnostics and tactics of the management of patients is considered. There is discussed a number of such issues relevant to the children’s urologist as: how probable is spontaneous resolution of obstruction of the ureteropelvic segment? What criteria indicate to the non-obstructive nature of the expansion of the collection system? The prospects of using technique of robotic pyeloplasty in children are analyzed. Is surgery necessary and at what age? What kind of the access and method of prompt correction should be preferred? Will the kidney function be restored after the operation? There are considered questions of laparoscopic and retroperitoneoscopic way of the elimination of hydronephrosis, indications and contraindications to the performance of each type of access. Based on the own experience the necessity and methods of drainage of the collection system of the kidney after the operation are discussed. The prospects of using robotics pyeloplasty in children are analyzed. Conclusion. Obstruction in the region of the ureteropelvic segment will continue to cause discussions in terms of the appropriateness of selection patients which can be observed in dynamics until the main process will be resolved naturally. Laparoscopic pyeloplasty in hydronephrosis is the “gold standard” in the world and its successful implementation in children with the use of endovideosurgical technologies largely depends on the manual skills of the operator, the experience of performing similar operations, teamwork in the person of an assistant, anesthesiologist and operating nurse.