Short Examination Time Research Articles

The Application Progress of Intravenous Anesthesia in the Concept of Comfort Medical Care

From 1 January 2022 to 25 March 2023, 2465 bronchoscopies, 315 general bronchoscopies (12.7%) and 2150 anaesthetics (87.3%) were performed, comparing patient comfort, medical compliance and physician experience. It was found that general intravenous anaesthesia can fully meet the requirements of bronchoscopy, with smooth circulation, low airway resistance, low incidence of tract spasm, short examination time and excellent examination results, and high patient acceptance. It is worthy of clinical promotion.

T1 Mapping of the Prostate Using Single-Shot T1FLASH: A Clinical Feasibility Study to Optimize Prostate Cancer Assessment.

The aim of this study was to assess the clinical feasibility of magnetic resonance imaging (MRI) T1 mapping using T1FLASH for assessment of prostate lesions. Participants with clinical suspicion for prostate cancer (PCa) were prospectively enrolled between October 2021 and April 2022 with multiparametric prostate MRI (mpMRI) acquired on a 3 T scanner. In addition, T1 mapping was accomplished using a single-shot T1FLASH technique with inversion recovery, radial undersampling, and iterative reconstruction. Regions of interest (ROIs) were manually placed on radiologically identified prostate lesions and representative reference regions of the transitional zone (TZ), benign prostate hyperplasia nodules, and peripheral zone (PZ). Mean T1 relaxation times and apparent diffusion coefficient (ADC) values (b = 50/b = 1400 s/mm 2 ) were measured for each ROI. Participants were included in the study if they underwent ultrasound/MRI fusion-guided prostate biopsy for radiologically or clinically suspected PCa. Histological evaluation of biopsy cores served as reference standard, with grading of PCa according to the International Society of Urological Pathology (ISUP). ISUP grades 2 and above were considered clinically significant PCa for the scope of this study. Histological results of prostate biopsy cores were anatomically mapped to corresponding mpMRI ROIs using biopsy plans. T1 relaxation times and ADC values were compared across prostate regions and ISUP groups. Across different strata, T1 relaxation time, ADC values, and diagnostic accuracy (area under the curve [AUC]) were compared using statistical methods accounting for clustered data. Of 67 eligible participants, a total of 40 participants undergoing ultrasound/MRI fusion-guided prostate biopsy were included. Multislice T1 mapping was successfully performed in all participants at a median acquisition time of 2:10 minutes without evident image artifacts. A total of 71 prostate lesions was radiologically identified (TZ 49; PZ 22). Among those, 22 were histologically diagnosed with PCa (ISUP groups 1/2/3/4 in n = 3/15/3/1 cases, respectively). In the TZ, T1 relaxation time was statistically significantly lower for PCa compared with reference regions ( P = 0.029) and benign prostate hyperplasia nodules ( P < 0.001). Similarly, in the PZ, PCa demonstrated shorter T1 relaxation times versus reference regions ( P < 0.001). PCa also showed a trend toward shorter T1 relaxation times (median, 1.40 seconds) compared with radiologically suspicious lesions with benign histology (median, 1.47 seconds), although statistical significance was not reached ( P = 0.066). For discrimination of PCa from reference regions and benign prostate lesions, T1 relaxation times and ADC values demonstrated AUC = 0.80 and AUC = 0.83, respectively ( P = 0.519). Discriminating PCa from radiologically suspicious lesions with benign histology, T1 relaxation times and ADC values showed AUC = 0.69 and AUC = 0.62, respectively ( P = 0.446). T1FLASH-based T1 mapping yields robust results for quantification of prostate T1 relaxation time at a short examination time of 2:10 minutes without evident image artifacts. Associated T1 relaxation times could aid in discrimination of significant and nonsignificant PCa. Further studies are warranted to confirm these results in a larger patient cohort, to assess the additional benefit of T1FLASH maps in conjunction with mpMRI sequences in the setting of deep learning, and to evaluate the robustness of T1FLASH maps compared with potentially artifact-prone diffusion-weighted imaging sequences.

PENGARUH TRADE-OFF NILAI TIME INVERSION TERHADAP OPTIMALISASI KUALITAS CITRA MRI LUMBOSACRAL SEKUEN STIR- SENSE CORONAL

ABSTRAK&#x0D; Background :STIR is a fat suppression technique used in spinal MRI. The TI setting determines how much fat signaling will be suppressed. SENSE is a technique to reduce length of STIR examination time. According to Westbrook, the TI values for a 1.5 Tesla MRI 100 – 175 ms. To find the optimal TI for Lumbosacral MRI need to do a trade-off and research.&#x0D; Method :This research is quantitative with an experimental approach. The study used 15 samples were scanned 3 times on the STIR-SENSE Coronal sequence with TI variations 140, 150 and 160 ms. The data obtained then ROI and SNR is calculated using SPSS. Recorded the scan time.&#x0D; Results : Normality test, p value &gt; 0.05 so the data distribution is normal. In the Test Of Within Subject Effect and the Test Of Between Subject Effect the value of Sig. &lt;0.05 means there is an effect between variables. In the Pairwise Comparison test SNR significance value obtained on all data &lt;0.05, it can be concluded there is a significant difference between the sequences. Scan time on trade-off TI of 140 and 150 ms is 2 minutes 36 seconds and on TI 160 ms 3 minutes 54 seconds.&#x0D; Conclusion :There is effect trade-of f TI value for optimizing the image quality of MRI Lumbosacral STIR-SENSE Coronal Sequence at Bali Mandara Hospital. The most optimal image quality ontime inversion trade-off 150 ms with mean 391.607 and a short examination time of 2 minutes 36 seconds.

Validating the use of 3D biplanar radiography versus CT when measuring femoral anteversion after total hip arthroplasty : a comparative study.

Although CT is considered the benchmark to measure femoral version, 3D biplanar radiography (hipEOS) has recently emerged as a possible alternative with reduced exposure to ionizing radiation and shorter examination time. The aim of our study was to evaluate femoral stem version in postoperative total hip arthroplasty (THA) patients and compare the accuracy of hipEOS to CT. We hypothesize that there will be no significant difference in calculated femoral stem version measurements between the two imaging methods. In this study, 45 patients who underwent THA between February 2016 and February 2020 and had both a postoperative CT and EOS scan were included for evaluation. A fellowship-trained musculoskeletal radiologist and radiological technician measured femoral version for CT and 3D EOS, respectively. Comparison of values for each imaging modality were assessed for statistical significance. Comparison of the mean postoperative femoral stem version measurements between CT and 3D hipEOS showed no significant difference (p = 0.862). In addition, the two version measurements were strongly correlated (r = 0.95; p < 0.001), and the mean paired difference in postoperative femoral version for CT scan and 3D biplanar radiography was -0.09° (95% confidence interval -1.09 to 0.91). Only three stem measurements (6.7%) were considered outliers with a > 5° difference. Our study supports the use of low-dose biplanar radiography for the postoperative assessment of femoral stem version after THA, demonstrating high correlation with CT. We found no significant difference for postoperative femoral version when comparing CT to 3D EOS. We believe 3D EOS is a reliable option to measure postoperative femoral version given its advantages of lower radiation dosage and shorter examination time.Cite this article: Bone Joint J2022;104-B(11):1196-1201.

Diagnostic Value of Hysterosalpingography

Objective: Hysterosalpingography (HSG) is a contrast-enhanced, radiographic examination method of the internal female reproductive organs, which is used in the context of infertility diagnostics for the clarification of uterine malformations. The aim of this study was to investigate the significance of HSG as a diagnostic method in reproductive medicine. Methods: The results of HSG examinations from the Clinic for Reproductive Medicine and Andrology of the University Hospital Halle (Saale) between 2006 and 2020 were retrospectively examined. Results: Normal uterine findings were diagnosed by HSG in 151(51.01%) patients. The most common uterine malformation was uterus arcuatus, which was found in 46 patients (15.54%); 30(10.14%) patients had uterus bicornis unicollis. Uterus bicornis, unicornis, and subseptus were present in 5(1.69%) patients each. A duplex uterus was detected in 3(1.01%) patients, and malformations of a uterus arcuatum unicollis, uterus septus, bicornis subseptus, and uterus corpora in case of sectio bicornis were detected in 1(0.34%) patient each. A comparison of HSG findings with those from initial baseline diagnostics (gynecologic manual examination, sonography, etc.) revealed a correlation of findings in 105 cases (35.84%) and divergence of findings in 79 cases (26.96%). With the assistance of the HSG findings, further specification of the previously collected findings was achieved in 27 cases (9.22%). The diagnostic significance of HSG in reproductive medicine was demonstrated by the fact that findings were obtained and could not be detected in the preliminary examinations. In addition, basic diagnostic findings were confirmed by HSG, and conversely, previously collected findings could be further specified. HSG is a less invasive diagnostic imaging procedure with a short examination time. The fluoroscopy time is usually only a few seconds. Therefore, the radiation exposure is negligible. Conclusion: HSG is a method of radiologic examination that can be used to diagnose and specify uterine malformations. The diagnosis by HSG often opens up new therapeutic options to correct uterine malformations.

Fundoscopy use in neurology departments and the utility of smartphone photography: a prospective prevalence and crossover diagnostic accuracy study amongst neurology inpatients.

Background and purposeAlthough fundoscopy is a crucial part of the neurological examination, it is challenging, under‐utilized and unreliably performed. The aim was to determine the prevalence of fundus pathology amongst neurology inpatients and the diagnostic accuracy of current fundoscopy practice compared with systematic screening with smartphone fundoscopy (SF) and portable non‐mydriatic fundus photography (NMFP).MethodsThis was a prospective cross‐sectional surveillance and diagnostic accuracy study on adult patients admitted under neurology in an Australian hospital. Inpatients were randomized to initial NMFP (RetinaVue 100, Welch Allyn) or SF (D‐EYE) followed by a crossover to the alternative modality. Images were graded by neurology doctors, using telemedicine consensus neuro‐ophthalmology NMFP grading as the reference standard. Feasibility parameters included ease, comfort and speed.ResultsOf 79 enrolled patients, 14.1% had neurologically relevant pathology (seven, disc pallor; one, hypertensive retinopathy; three, disc swelling). The neurology team performed direct ophthalmoscopy in 6.6% of cases and missed all abnormalities. SF had a sensitivity of 30%–40% compared with NMFP (45.5%); however, it had a lower rate of screening failure (1% vs. 13%, p < 0.001), a shorter examination time (1.10 vs. 2.25 min, p < 0.001) and a slightly higher patient comfort rating (9.2 vs. 8/10, p < 0.001).ConclusionOur study demonstrates a clinically significant prevalence of fundus pathology amongst neurology inpatients which was missed by current fundoscopy practices. Portable NMFP screening appears more accurate than SF, whilst both are diagnostically superior to routine fundoscopic practice, feasible and well tolerated by patients.

Evaluating the Quality of Optimal MRCP Image Using RT-2D-Compressed SENSE(CS)Turbo Spin Echo: Comparing Respiratory Triggering(RT)-2D-SENSE Turbo Spin Echo and Breath Hold-2D-Single-Shot Turbo Spin Echo.

This study aimed to select the pulse sequence providing the optimal MRCP image quality by applying various reduction and denoising level parameters—which could improve image quality and shorten examination time—to BH-2D-SSh TSE, RT- 2D-SENSE TSE, and RT-2D-Compressed SENSE(CS) TSE and then comparing and analyzing the obtained images. This study was carried out using 30 subjects (15 men and 15 women with a mean age of 53 ± 8.76 years) who underwent an MRCP test using 3.0T MRI equipment. These 30 subjects were composed of 20 patients (CHDD: 7; LC: 6; and IPMN: 7) and 10 volunteers without a disease. When the CS technique was used, five reduction values (1.1, 1.2, 1.3, 1.4, and 1.5) were used and four denoising levels (No, Weak, Medium, and Strong) were used. The existing SENSE method was based on a reduction value of 1, and other parameters were set the same. The image data of BH-2D-SSh TSE, RT-2D-SENSE TSE, and RT-CS-2D TSE used for the analysis were acquired in the coronal plane, and the acquired data underwent MIP post-processing for analysis. To compare these techniques, SNR and CNR were measured for six biliary duct images for the purpose of quantitative analysis, and qualitative analysis was performed on the sharpness of the duct, the overall quality of the image, and the motion artifact. The results of the quantitative and standard analyses showed that the RT-2D-CS TSE technique had the highest results for all IPMN, LC, and CHDD diseases (p < 0.05). Moreover, SNR and CNR were the highest when the reduction value was set to 1.3 and the denoising level was set to medium as the CS setting values (p < 0.05). Compared with the conventional RT-2D-SENSE TSE, the test time decreased by 20% and SNR and CNR increased by 14% on average. When conducting RT-2D-CS TSE, we found that it shortened the examination time and improved the image quality compared to the existing RT-2D-SENSE TSE. Unlike previous studies, this study using the RT technique shows that it is a useful MRI Pulse Sequence technique able to replace the BH-2D-SSh TSE and BH-3D-SENSE GRASE techniques, which require the patient to hold their breath during the test.

Correlation of clinical parameters and objective assessment tools in active thyroid eye disease – Prospective analytical study

Primary objective of this study was to identify the disease in active phase, clinically assess it and start medical management. Secondary objective was to analyze whether the objective tools like B-scan and serum levels of IL-6 and HS-CRP aid in the diagnosis of activity in thyroid eye disease. : The aim wasto analyze the correlation of clinical parameters and significance of objective assessment tools in active thyroid eye disease. Clinically diagnosed cases of TED with lid signs, soft tissue changes, restrictive myopathy and bilateral axial proptosis were included in our study. Patients in chronic stable phase were excluded from study. This was a prospective analytical study, conducted from June 2010 till June 2012. Sample size was thirty patients in the age group of 20 to 60 years. Complete ophthalmology workup and objective disease assessment tools including B scan (OTI 1000 with 7.5-10 MHz) was used in our study. All patients underwent CT scan orbit-axial and coronal view. After assessing the severity and stage of the disease, each patient was managed accordingly using different modalities. : Identifying the disease activity early and aggressive management with systemic steroids in moderately active and severe stage has decreased the morbidity associated with the disease. A- scan with orbital B-scan helps in diagnosing the activity in thyroid eye disease. This procedure is very economical with relatively short examination time and no risk of radiation .Follow up of the patients can also be performed easily. IL-6 and HS-CRP was statistically significantly elevated in patients with severe disease when compared to control group. Hence can help in assessing disease activity in patients with severe disease.

Welfare Assessment on Healthy and Tumor-Bearing Mice after Repeated Ultrasound Imaging

Introduction: Ultrasound (US) imaging enables tissue visualization in high spatial resolution with short examination times. Thus, it is often applied in preclinical research. Diagnostic US, including contrast-enhanced US (CEUS), is considered to be well-tolerated by laboratory animals although no systematic study has been performed to confirm this claim. Therefore, the aim of this study was to screen for possible effects of US and CEUS examinations on welfare of healthy mice. Additionally, the potential influence of CEUS and molecular CEUS on well-being and therapy response to regorafenib was investigated in breast cancer-bearing mice. Material and Methods: Forty healthy Balb/c mice were randomly assigned for examination with US or CEUS (3×/week) for 4 weeks. Untreated healthy mice and mice receiving only isoflurane anesthesia served as controls (n = 10/group). Ninety-four 4T1 tumor-bearing Balb/c mice were allocated randomly to the following groups: no imaging, isoflurane anesthesia, CEUS, and molecular CEUS. They either received 10 mg/kg regorafenib or vehicle solution daily by oral gavage. Animals were examined three times within 2 weeks. CEUS measurements were performed using phospholipid microbubbles, and phospholipid microbubbles targeting the vascular endothelial growth factor receptor-2 were applied for molecular CEUS. Welfare evaluation was performed by daily observational score sheets, measuring the heart rate, Rotarod performance, and fecal corticosterone metabolites twice a week. On the last day, pathological changes in serum corticosterone concentrations, hemograms, and organ weights were obtained. Moreover, a potential influence of isoflurane anesthesia, CEUS, and molecular CEUS on regorafenib response in tumor-bearing mice was examined. Analysis of variance and Dunnett’s post hoc test were performed as statistical analyses. Results: Severity parameters were not altered after repeated US and CEUS examinations of healthy mice, but spleen sizes were significantly lower after isoflurane anesthesia. In tumor-bearing mice, no effect on animal welfare after repeated CEUS and molecular CEUS could be observed. However, leukocyte counts and spleen weights of tumor-bearing mice were significantly lower in animals examined with CEUS and molecular CEUS compared to the control groups. This effect was not visible in regorafenib-treated animals. Conclusions: Repeated US and (molecular) CEUS have no detectable impact on animal welfare in healthy and tumor-bearing mice. However, CEUS and molecular CEUS in combination with isoflurane anesthesia might attenuate immunological processes in tumor-bearing animals and may consequently affect responses to antitumor therapy.

Observation and Nursing of Adverse Reactions in Severe Patients with Enhanced MRI.

In order to explore the observation and nursing of adverse reactions in severe patients with enhanced magnetic resonance imaging, a family nursing service model was proposed in patients with enhanced magnetic resonance imaging. 150 patients who underwent enhanced magnetic resonance imaging in a hospital were selected as the research objects. The patients were divided into two groups by random number table method. 75 patients in the control group received routine nursing intervention and 75 patients in the observation group received family nursing service intervention. The anxiety score, depression score, examination time, one-time success rate, comfort score, incidence of adverse reactions, excellent image quality rate and nursing satisfaction were compared between the two groups. The results showed that the anxiety score and depression score of the observation group were lower than those of the control group (P < 0.05), the examination time of the observation group was significantly shorter than that of the control group (P < 0.05), and the comfort score and one-time success rate of the observation group were significantly higher than those of the control group (P < 0.05). The incidence of adverse reactions was significantly lower than that in the control group (P < 0.05), the excellent and good image quality rate (95.00%) and nursing satisfaction (97.22%) were significantly higher than those in the control group (83.00%, 86.56%). This shows that the application effect of family nursing service mode in magnetic resonance enhanced scanning is remarkable. Therefore, the use of family care mode in MRI patient examination can effectively reduce patients' anxiety and depression scores, shorten examination time, reduce adverse reactions, improve the success rate of one-time examination, improve patients' comfort during examination and patients' evaluation of nursing services. The effect is ideal and worthy of clinical research and promotion.

Achieving Total Enteroscopy by Consecutive Bidirectional Double-balloon Enteroscopy Procedures.

To investigate the feasibility and safety of achieving total enteroscopy by consecutive bidirectional double-balloon enteroscopy (DBE) procedures. The demographic data, indication, initial insertion route, examination time for each insertion and the entire procedure, total enteroscopy rate, diagnostic yield and adverse events of patients who attempted to achieve total enteroscopy by consecutive bidirectional DBE procedures from January 2014 to December 2019 were retrospectively analyzed. A total of 189 patients were included, and the total enteroscopy rate was 87.3%. Initiating the DBE procedure via the retrograde approach as the initial insertion route achieved a higher total enterosocpy rate (90.9% vs. 78.9%, P=0.023), with shorter overall examination time (134.2±36.2 vs. 156.9±47.6 min, P=0.017) and shorter examination time for the opposite insertion route (23.8±19.9 vs. 53.1±27.6 min, P=0.000) compared with anteograde approach as the initial insertion route. The overall diagnostic yield was 37.6%. The diagnostic yield for successfully achieving total enteroscopy was higher, when compared to the yield for not successfully achieving total enteroscopy (39.4% vs. 25%, P=0.029). The overall rate of adverse events was 2.1% (4/189). There was no significant difference in adverse event rate between the overall examination time ≥2 h group and <2 h group (2.1% vs. 2.0%, P=0.593). Consecutive bidirectional DBE procedure is an effective and safe strategy for achieving total enteroscopy with a considerable success rate. This may be a promising option and alternative to traditional methods, and helpful to more promptly establish a definite diagnosis. The retrograde approach, as the initial insertion route, is preferred in clinical practice.

PEATE por estímulo chirp em recém-nascidos: uma revisão integrativa

ABSTRACT Purpose: to review the literature available on electrophysiological findings on ABR with chirp stimuli in newborns. Methods: articles were searched in PubMed, MEDLINE, Scopus, Web of Science, LILACS, and SciELO. Papers published in English and Portuguese between 2010 and 2020 were selected, including those that addressed ABR with air-conduction broadband chirp stimuli in newborns, that assessed ABR with a specific frequency, and that compared ABR results with chirp and click stimuli. Articles that assessed only bone-conduction results, duplicates, literature reviews, case reports, letters, and editorials were excluded. Literature review: the search strategy resulted in nine selected articles. Four studies (44.4%) analyzed ABR wave amplitude and latency with chirp stimuli, three studies (33.3%) compared the time of ABR procedures between chirp and click stimuli, two studies (22.2%) analyzed only amplitude, and two (22.2%), verified the specificity of ABR with chirp stimuli in neonatal hearing screening. Conclusion: chirp stimuli elicit responses with greater amplitudes, lower latencies, and shorter examination time than those with click stimuli in newborns.

Role of Sonoelastography for Differentiating Benign and Malignant Cervical Lymph Nodes: A Cross-sectional Study

Introduction: Cervical nodes form one of the major groups of Lymph Nodes (LN) that are frequently involved in inflammatory and neoplastic diseases. Metastasis causes the most apparent change in consistency of the node among the various nodal pathologies. Ultrasound elastography provides an estimate of tissue consistency by measuring the degree of distortion under the application of an external force. Aim: To estimate the diagnostic accuracy of sonoelastography in the differentiation of malignant and benign cervical LN with fine needle aspiration cytology/biopsy considered as a gold standard. Materials and Methods: A cross-sectional study was carried out from March 2020 to January 2021 in a tertiary care hospital in south India, a total of 50 patients with cervical lymphadenopathy underwent ultrasonography followed by elastography of superficial neck LN using high frequency linear transducer by freehand technique. The ultrasound characteristics of selected LN were determined and colour elastogram pattern was assessed using colour mapping elastography. The chi-square test was performed. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were obtained. The results were then compared to the fine needle aspiration cytology. Results: A total of 50 subjects(median age of 40.5±18.71 years ; 19 (38%) males and 31 (62%) females). The grayscale and colour Doppler features of cervical LN which helped predict malignancy were short axis ≥8 mm, S:L axis ratio ≥0.5, absence of normal central fatty hilum, abnormal echogenicity, lobulated border, presence of calcification and peripheral/mixed vascularity. With reference to the above variables of cervical LN characterisation on grayscale, colour doppler ultrasound and sonoelastography findings, elastography pattern was the most promising variable to differentiate malignant from benign cervical LN with 95.2% sensitivity, 75.0% specificity, 95.2% PPV, 75.0% NPV and 92.0% accuracy. Conclusion: Sonoelastography is useful in the assessment of elastic properties of cervical LN with short examination time required, real-time display, immediate interpretation and limited cost. Sonoelastography had higher diagnostic accuracy than gray scale and doppler ultrasound in differentiating benign from malignant cervical LN. Sonoelastography is an effective supplement to conventional gray scale and colour doppler ultrasound and that the combination is clinically recommended for a more accurate diagnosis of metastatic LN.

SmartAmp method can rapidly detect SARS-CoV-2 in dead bodies

Rapid and accurate detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in dead bodies is essential to prevent infection among those working with dead bodies. This study focused on the Smart Amplification (SmartAmp) method, which has a short examination time (approximately an hour), is simple to perform, and demonstrates high specificity and sensitivity. This method has already been used for clinical specimens; however, its effectiveness in dead bodies has not been reported. This study examined the SmartAmp method using 11 autopsies or postmortem needle biopsies performed from January to May, 2021 (of these, five cases tested positive for SARS-CoV-2 by quantitative real-time polymerase chain reaction (qRT-PCR) and six cases tested negative). Swab samples were collected from the nasopharynx, oropharynx, or anus and the SmartAmp and qRT-PCR results were compared. For the nasopharynx and oropharynx samples, the same results were obtained for both methods in all cases; however, for the anal swabs, there was one case that was positive according to qRT-PCR but negative according to the SmartAmp method. The SmartAmp method may therefore be less sensitive than qRT-PCR and results may differ in specimens with a low viral load, such as anal swabs. However, in the nasopharynx and oropharynx specimens, which are normally used for testing, the results were the same using each method, suggesting that the SmartAmp method is useful in dead bodies. In the future, the SmartAmp method may be applied not only during autopsies, but also in various situations where dead bodies are handled.

Prediction of Judkins Left Catheter Size during Left Transradial Coronary Angiography by Simple Chest Radiographic and Echocardiographic Index.

Background and Objectives: Appropriate catheter selection when conducting transradial coronary angiography (CAG) helps shorten examination time, preventing vascular complications and lowering medical expense. However, catheter selection is made based on the practitioner’s experience in almost all cases. Therefore, we undertook this study to define radiologic and echocardiographic indices that would enable physicians to anticipate appropriate catheter selection. Materials and Methods: This is a retrospective study of 244 undergoing transradial diagnostic CAG at an established center from February 2006 to April 2014. Patients who successfully underwent angiography with a JL3.5 catheter were defined as the control group, and patients who successfully underwent angiography after the catheter was replaced with a JL4.0 or higher were defined as the switched group. To identify predictors for appropriate catheter selection, radiologic and echocardiographic indices were analyzed. Results: A total of 122 patients in the switched group and 122 patients in the control group were analyzed in this study. Average age was 64.65 ± 8.6 years. In the radiographic index, the switched group exhibited a significantly higher mediastinal-thoracic ratio (0.27 ± 0.05 vs. 0.23 ± 0.03, p < 0.001. Additionally, the mediastinal-cardiac ratio was significantly greater in the switched group (0.50 ± 0.08 vs. 0.45 ± 0.05, p < 0.001). Aortic root diameter, which is used here as the echocardiographic index, was significantly larger in the switched group compared to the control group (34.94 ± 4.18 mm vs. 32.66 ± 3.99 mm, p < 0.001). In the multivariable logistic regression model, mediastinal-cardiac ratio (OR 5.197, 95% CI 2.608–10.355, p < 0.001) and increased aortic root (OR 2.115, 95% CI 1.144–3.912, p = 0.017) were significantly associated with catheter change. Conclusions: Mediastinal-cardiac ratio and aortic root diameter provide helpful and effective indices for appropriate catheter selection during transradial coronary angiography.

Safety and efficacy of dexmedetomidine hydrochloride combined with midazolam in fiberoptic bronchoscopy in children: a prospective randomized controlled study.

To study the safety and efficacy of dexmedetomidine hydrochloride combined with midazolam in fiberoptic bronchoscopy in children. A total of 118 children who planned to undergo fiberoptic bronchoscopy from September 2018 to February 2021 were enrolled. They were divided into a control group (n=60) and an observation group (n=58) using a random number table. The observation group received intravenous pumping of dexmedetomidine hydrochloride (2 μg/mL) at 1 μg/kg and then intravenous injection of midazolam at 0.05 mg/kg, followed by dexmedetomidine hydrochloride pumped intravenously at 0.5-0.7 μg/(kg·h) 10 minutes later to maintain anesthesia. The control group was given intravenous pumping of propofol at 2 mg/kg and then intravenous injection of midazolam at 0.05 mg/kg, followed by propofol pumped intravenously at 4-6 mg/(kg·h) 10 minutes later to maintain anesthesia. Fiberoptic bronchoscopy was performed after the children were unconscious. Heart rate (HR), respiratory rate, blood oxygen saturation, and mean arterial pressure (MAP) were recorded before inserting the bronchoscope (T0), at the time of inserting the bronchoscope (T1), when the bronchoscope reached the glottis (T2), when the bronchoscope reached the carina (T3), and when the bronchoscope entered the bronchus (T4). The intraoperative peak airway pressure (Ppeak), examination time, degree of sedation, extent of amnesia, incidence of adverse reactions, postoperative awakening time, and postoperative agitation score were also recorded. Compared with the control group, the observation group had significantly decreased MAP at T1 to T4 and HR at T1 to T3 (P<0.05). Compared with that at T0, MAP was significantly increased at T1 to T4 in the control group and at T3 in the observation group (P<0.05). HR was significantly higher at T1 to T3 than at T0 (P<0.05). Compared with the control group, the observation group showed significantly lower intraoperative Ppeak value, incidence of intraoperative adverse reactions, and postoperative agitation score, significantly shorter examination time, and better effects of amnesia and anesthesia (P<0.05). There was no significant difference in the degree of intraoperative sedation and postoperative awakening time between the two groups (P>0.05). Dexmedetomidine hydrochloride combined with midazolam is a safe and effective way to administer general anesthesia for fiberoptic bronchoscopy in children, which can ensure stable vital signs during examination, reduce intraoperative adverse reactions and postoperative agitation, shorten examination time, and increase amnesic effect.

Noninvasive Detection of Intracranial Hypertension by Novel Ultrasound Time-Harmonic Elastography.

A method for measuring intracranial pressure (ICP) noninvasively has long been sought after in neurology and neurosurgery. Treatment failure in individuals presenting with unspecific symptoms such as headache, gait disturbance, or visual impairment occurring in response to increased ICP can lead to irreversible brain injury, progressive disability, and death. Guidelines for diagnostic ICP measurement recommend intracranial placement of pressure tip catheters or lumbar puncture (LP) despite their invasiveness and possible complications. As ICP fluctuations are closely associated with changes in brain stiffness, ultrasound elastography could be a valid method to detect ICP noninvasively and with short examination times. In this pilot study, we have investigated the use of time-harmonic shear waves, introduced into the brain by an external shaker, and measured in real-time by transtemporal ultrasound, for deducing a noninvasive imaging marker sensitive to elevated ICP. To this end, we developed cerebral ultrasound time-harmonic elastography for the noninvasive quantification of shear wave speed (SWS) as a surrogate marker of cerebral stiffness in a short examination time of a few minutes. We found that SWS in patients enrolled for LP with confirmed intracranial hypertension was 1.81 ± 0.10 m/s, distinguishing them from healthy volunteers with excellent diagnostic accuracy (1.55 ± 0.08 m/s; P < 0.001; area under the curve, 0.99). Interestingly, values in symptomatic patients decreased to normal stiffness immediately after LP (1.56 ± 0.06 m/s, P < 0.001). Moreover, invasively measured opening pressure correlated with SWS measured before LP and liquid volume drained through the spinal tap with the SWS difference between the 2 measurements. Collectively, our results suggest a tight link between cerebral stiffness and ICP and demonstrate that intracranial hypertension can be detected noninvasively within short examination times, opening avenues for diagnostic applications of cerebral ultrasound time-harmonic elastography in neurology and emergency medicine.

EFFECT OF INTRA LUMINAL SHUNTS IN OFF PUMP CORONARY BY PASS GRAFTING ON LONG TERM GRAFT PATENCY

The intraluminal coronary shunts (ILS) in OPCAB allow easier, safer, more accurate anastomosisand better myocardial protection by maintaining distal coronary perfusion during beatingheart coronary revascularization. This was retrospectively study on sixty patients at MaadiMilitary Medical Campus who had OPCAB using ILS; Multislice CT and coronary angiographywere performed after one year of surgery to assess the graft patency. The total numberof grafts was 118, 60 were LIMA (50.8%) and 58 were SVG (49.2%). Post operatively sevenpatients (11.7%) had MI, two patients (3.3%) had wound infection, one patient (1.7%) hadprolonged ventilation>24hours, and one patient (1.7) had perioperative intra- aortic balloonpump.By coronary angiography; 102/118 grafts (86.4%) were patent, 6 had significant stenosis(>50%) and 10 grafts (8.5%) were totally occluded. BY CT angiography; 101-grafts (85.6%)were patent, 7-grafts (5.9%) had significant stenosis and 10-grafts (8.5%) were totally occluded,but without significant difference between results of coronary angiography, and CT angiography(p>0.05).The results by using ILS during OPCAB was safe and showed very much accepted graft patencyone year after OPCAB compared to the studies looked for graft patency after OPCABbut using different methods to achieve bloodless field during anastomosis like snaring andbulldogs, CT angiography is a good modality in terms of follow up after CABG it was a noninvasivetechnique needs no hospital admission, short examination time and it has high sensitivityand specificity.

P-NU002. Muscle ultrasound is a highly sensitive non-invasive tool to detect fasciculations in limbs, tongue and paraspinal muscles in amyotrophic lateral sclerosis

Introduction . Fasciculations are characteristic feature of Amyotrophic Lateral Sclerosis (ALS) and their identification by Muscle Ultrasound (MUS) is an important non-invasive tool and allows studying the major bulk and more inaccessible muscles. This could potentially replace painful Electromyography (EMG) procedure to identify fasciculations. Our aim is to utilize MUS to identify and also detect fasciculations in unaffected muscles in early stages of ALS and correlate with EMG findings. Methods . In 30 cases (7 bulbar and 23 limb onset) with suspected ALS, we performed EMG in 3 muscles (biceps brachii, quadriceps and thoracic paraspinal) and MUS in 9 muscles (biceps, triceps, deltoid, abductor digiti minimi, quadriceps, hamstrings, tibialis anterior, thoracic paraspinal and tongue). MUS was performed using linear transducer (3-13 MHz, Esaote Mylab Gamma Scanner). Fasciculations were observed in each muscle for one minute. Frequency of fasciculations detected by MUS was compared with EMG findings in same muscles. Results . The M:F ratio was 4:1, age of onset was 50.1±12.8 years, age of presentation was 50.9±12.9 years. Duration of illness was 1.21±1.08 years. Of the total muscles studied, 176 muscles showed wasting while 334 were normal. Out of 284 muscles without clinical fasciculations, 206 (72.5%) showed fasciculations on MUS. Of 90 muscles examined by EMG, 20 (40.8%) of 49 muscles without clinical fasciculations showed fasciculations. Out of 23 pure limb onset cases, 16 cases showed extrinsic tongue muscle fasciculations on MUS. Fasciculations as detected by MUS vs. EMG: biceps brachii (90% vs 76.6%), quadriceps (80% vs 50%) and thoracic paraspinal (66.6% vs 40%) Conclusion . MUS is a promising tool in diagnosis of ALS. MUS is more sensitive in detecting fasciculations compared to EMG, can substitute it as it is noninvasive, safer, easily accessible, can access larger muscle areas in shorter examination time. Further, the test can be repeated for any longitudinal/sequential assessments.

Ventilatory response to CO2 with Read's rebreathing method in normal infants.

Methods of evaluating the ventilatory response to CO2 (VRCO2 ) of the respiratory center include the steady-state and the rebreathing method. Although the rebreathing method can evaluate the ventilatory response continuously to gradually increasing CO2 , the rebreathing method has been rarely performed in infants. The aim of this study was to investigate whether we could perform the VRCO2 with the rebreathing method in normal infants. The subjects were 80 normal infants. The gestational age was 39.9 (39.3-40.3) weeks, and the birth body weight was 3142 (2851-3451) grams. We performed the VRCO2 with Read's rebreathing method, measuring the increase in minute volume (MV) in response to the increase in EtCO2 by rebreathing a closed circuit. The value of VRCO2 was calculated as follow: VRCO2 (ml/min/mmHg/kg) = ΔMV/ΔEtCO2 /body weight. We performed the examination without adverse events. The age in days at examination was 3 (2-4), and the examination time was 150 ± 38 s. The maximum EtCO2 was 51.1 (50.5-51.9) mmHg. The value of VRCO2 was 34.6 (29.3-42.8). The intraclass correlation coefficient of the VRCO2 of cases with multiple measurements was 0.79. This study suggests that the rebreathing method can evaluate the ventilatory response to high blood CO2 in a short examination time. We conclude that the rebreathing method is useful even in infants. In the future, we plan to measure the VRCO2 of preterm infants, and evaluate the respiratory center of infants in more detail.