Ultrasound Index Research Articles

Using ultrasound reflection coefficient index and other clinical parameters to predict the risk of progression in adolescents with idiopathic scoliosis (AIS)- a pilot study.

To determine the association of the ultrasound reflection coefficient index and other clinical parameters to predict curve progression in children with AIS. Sixty-six females (13.9 ± 1.5 years old) under observation with baseline Cobb angle (24.4 ± 10.4°) consented and participated. Besides the standard clinical procedures, all participants were scanned by an ultrasound (US) imager in a standing position. All participants had been followed, and the average follow-up visit was 7.5 ± 3.1 months. Five parameters were investigated, including the Cobb angle and the Risser sign measured from the radiographs, and the kyphotic angle (KA), the axial vertebral rotation (AVR), and the reflection coefficient (RC) index measured from the ultrasonographs. The curve was considered progressed when the Cobb angle measured on two consecutive radiographs was increased by more than 5°. Among the 5 parameters, the KA, RC index, and Risser sign were found to be significantly associated with progression (p < 0.05). Children who had KA ≤ 38° and RC ≤ 0.06 showed higher chances of progression (62%) versus children with KA > 38° and RC > 0.06. This pilot study showed that curve progression is associated with the Risser sign, KA, and RC index. Other parameters and a more extensive clinical study should be combined to develop a higher-accuracy prediction model.

P0392 Prospective endoscopy of pan-enteric mucosal, transmural and biochemical dynamics in the first year of biological treatment in Crohn’s disease - a prospective MILESTONE study

Abstract Background Crohn’s disease (CD) complications affect 25% of patients at diagnosis and may progress to over 70% within ten years, often evolving into more complex forms. Controlling inflammation is essential to prevent disease progression, with biologics playing a central role. Video capsule endoscopy (VCE) and intestinal ultrasound (IUS) have proven effective in monitoring CD and predicting future complications. However, prospective data on pan-enteric mucosal inflammation and transmural healing in CD remain limited. Methods This prospective observational study included patients with CD who started on first-line biologics. Patients were followed at baseline, 14 weeks, and 52 weeks with assessments including CD Activity Index (CDAI), C-reactive protein (CRP), fecal calprotectin (FCP), pan-enteric VCE after confirming small-bowel patency via patency capsule (PC) ingestion, and IUS. The primary outcome was the continuation of biologic therapy after one year. Biochemical, endoscopic, and ultrasonographic remission were defined as follows: FCP&amp;lt;150 µg/g, Lewis score (LS)&amp;lt;135 or Eliakim score (ES)&amp;lt;4, and terminal ileum-bowel wall thickness (TI-BWT)&amp;lt;3 mm. Results Seventy-eight patients were screened, with 59 enrolled (median age: 30 [23-43] years; male: 31/59 [52%]; B2/3 disease phenotype: 12/59 [20.3%]), and 19 excluded (Figure, A). The patients started vedolizumab (21/59, 35%), infliximab (11/59, 19%), adalimumab (24/59, 41%) and ustekinumab (3/59, 5%). Eight patients were dropped out before the 14-week time point (Figure, A). At 52 weeks, 34/59 (58%) patients continued their biologics. Among patients with abnormal baseline biochemical, endoscopic, and ultrasonographic measures, 11/42 (26.2%) achieved biochemical normalization, 7/52 (13.5%) achieved small-bowel mucosal healing (MH), 6/38 (15.8%) achieved pan-enteric MH, and 8/28 (28.6%) achieved transmural healing at 14 weeks (Figure, B). Seventeen patients discontinued the study between the 14-week and 52-week time points (Figure, A). At 52 weeks, 17/42 (40.5%) of patients achieved biochemical normalization, 9/52 (17.3%) achieved small-bowel MH, 12/38 (31.6%) achieved pan-enteric MH, and 10/28 (35.7%) achieved transmural healing (Figure, B).All median study indices significantly improved during follow-up: CDAI: 103→64→63 (p=0.08); CRP (mg/dL): 6.6→5.0→4.1 (p=0.016); FCP (μg/g): 678→190→101 (p=0.009); LS: 750→225→225 (p&amp;lt;0.001); ES: 11→4→2 (p&amp;lt;0.001); TI-BWT (mm): 3.8→ 3.3→2.3 (p&amp;lt;0.001) (Figure, C). Conclusion First-line biologics significantly improve pan-enteric MH rates, along with clinical, biochemical, and ultrasonographic indices, in patients with CD over one year, with more than half of patients remaining on therapy during this period.

P0751 The effects of high and low emulsifier diets in active Crohn’s disease: A pilot double-blinded randomised feeding trial

Abstract Background Preclinical studies implicate dietary emulsifiers as detrimental to patients with Crohn’s disease. We aimed to examine the effect of high- and low-emulsifiers diets on intestinal inflammation in adults with ileal Crohn’s disease. Methods In a pilot double-blinded, randomized, controlled feeding study, patients with symptomatic and sonographically active Crohn’s disease with ileal involvement on stable medical therapy were randomized to received four weeks of an isocaloric high (HED) or low (LED) emulsifier diet modelled on Australian healthy eating guidelines. Evaluation of objective markers (faecal calprotectin, C-reactive protein, sonographic indices), clinical disease activity (Harvey Bradshaw Index), body composition (waist circumference, visceral adipose tissue via bioimpedance and quantitative muscle ultrasound) and quality of life were measured at baseline and at study completion. Results Of 116 patients screened, 24, mean age 37 (95% CI 32, 41) years, 12 male, were randomized. Five participants (2 HED, 3 LED) withdrew due to increased gastrointestinal symptoms. Dietary adherence was excellent. On ultrasound, IBUS-SAS fell from 51 (35, 68) to 33 (15, 51) on HED (p=0.014) and from 57 (38, 76) to 44 (29, 59) on LED (p=0.010) with no difference between diets (p=0.28). C-reactive protein and faecal calprotectin did not change overall. 9/12 on HED and 7/12 on LED entered clinical remission (Harvey Bradshaw Index ≤4). Quality of life improved on both diets (both p&amp;lt;0.003) as did fatigue (both p≤0.050). The HED and LED reduced weight by 2.2 [1.3,3.2] kg (p=0.009), waist circumference by 4% (p&amp;lt;0.001) and visceral adipose tissue by 16% (p&amp;lt;0.001) without a change of quantitative muscle ultrasound (p=0.78).There was no difference in any outcomes between the diets. Conclusion Emulsifiers in the food supply have no effect on intestinal inflammation in patients with active ileal Crohn’s disease, but a diet that follows healthy eating principles was associated with reduction of intestinal inflammation, clinical remission, improved quality of life and fatigue scores with reduction of visceral adipose tissue whilst maintaining lean muscle mass. Australian New Zealand Clinical Trials Registry (ACTRN12619000980134).

Evaluating protein SUPPLEMENTation in Ulcerative Colitis (SUPPLEMENT-UC)

Abstract Background and aims A higher dietary protein intake has overall health and body composition benefits but also has the propensity to drive inflammation in ulcerative colitis (UC). This study aims to investigate whether recreational animal-based protein supplementation affects ability to maintain remission in adults with clinically quiescent UC. Methods Twenty-four adults with quiescent UC (Simple Clinical Colitis Activity Index (SCCAI) ≤2) on stable therapy will be randomised to a 24-week double blind, parallel, placebo-controlled protein supplement intervention in addition to habitual diet. The primary outcome is maintenance of remission (defined as SCCAI ≤2) at 24 weeks, relapse being defined as an increase in SCCAI ≥2 points and/or escalation of medical therapy. Disease activity will be assessed using clinical, biochemical and sonographic indices. Adherence, tolerability and safety will be measured using pre-defined categories and 100-mm visual analogue scales. Dietary intake and change in body composition will be measured along with biomarkers and metabolites of fermentation in faecal, blood and urine specimens. Anticipated impact This trial addresses one of the top three international IBD research priorities - the role of diet to induce/maintain remission in UC. It will be the first ever study to investigate whether animal-based protein supplements influence the ability of adults with quiescent UC to maintain remission, and to explore the mechanistic basis and relationship between dietary substrate, gut microbiota, and disease activity. The trial results are anticipated to inform UC treatment paradigms by demonstrating dietary factors influence disease activity and dietary advice can be readily incorporated into current UC treatment paradigms as a cost neutral, adjunctive therapy to optimise response to existing therapies. The ultimate goal is to optimise therapeutic outcomes and improve quality of life for people with UC.

P0284 A Comparison of the Milan Ultrasound Criteria with the Ulcerative Colitis Intestinal Ultrasound Index to Assess Disease Activity in Patients with Ulcerative Colitis

Abstract Background Intestinal ultrasound (IUS) scoring systems have been developed to detect disease activity in patients with ulcerative colitis (UC). Nevertheless, further and comparing studies IUS scores to evaluate disease activity in UC patients are needed. We aimed to compare 2 existing validated scores, the Milan Ultrasound Criteria (MUC) and Ulcerative Colitis Intestinal Ultrasound (UC-IUS) index, for evaluating disease activity in patients with UC. Methods An observational cross-sectional study was performed in adult UC patients between November 2019 and June 2024. All UC patients underwent IUS before a day colonoscopy, and endoscopic Mayo score ≥2 was accepted as an active disease. Results Total 62 adult patients with UC (median age: 39 years) were included in the study, 39 (62.9%) patients were male, the median age was 39 years and the median duration of the disease was 6.32 (IQR, 2.63-12.32) years. Extensive location was the most prevalent extension 39 (62.9%) among all patients. The median MUC was 8.42 (IQR, 6.34-10.96) and the median UC-IUS index was 5 (IQR, 4-6.25) for all UC patients. In patients with endoscopically remission group (endoscopic Mayo score &amp;lt;2), which include 14 (22.6%) patients, the median MUC was 5.76 (IQR, 3.61-6.8) and the median UC-IUS index was 3 (IQR, 2-4). Nevertheless, in endoscopically active group, the median MUC was 9.14 (IQR, 7.6-11.63) and the median UC-IUS index was 6 (IQR, 4-7), MUC and UC-IUS index were higher in endoscopic active group than in remission group (p&amp;lt; 0.001). Furthermore, the clinically active group (partial Mayo score ≥5) had greater MUC and UC-IUS index than the clinically remission group (p&amp;lt; 0.005 and p&amp;lt; 0.001, respectively). The cut-off value for MUC to predict endoscopic activity (endoscopic Mayo score ≥2) was 7.46 (AUC: 0.906, 95% CI: 0.830-0.983, sensitivity: 81%, specificity: 86%, p &amp;lt; 0.001), and the cut-off value for UC-IUS index to expect endoscopic activity was 4.5 (AUC: 0.846, 95% CI: 0.739-0.953, sensitivity: 71%, specificity: 86%, p &amp;lt; 0.001). Conclusion In this study, we found that MUC and UC-IUS index demonstrates a strong correlation with the endoscopically active UC patients. The most accurate cut-off value for MUC was 7.6 and the most accurate cut-off value for UC-IUS index was 4.5 in UC patients with endoscopically active group.

Optic nerve sonographic parameters in idiopathic intracranial hypertension, case-control study

The most common diagnostic error of IIH is inaccurate funduscopic examination. Moreover, IIH could be diagnosed without papilledema. Trans orbital sonography could be used as a non-invasive and cheap tool for discovering increased ICP (intracranial Pressure). Aim of our study was discovering the changes in ultra-sonographic indices and which one could predict the increased ICP. Sixty-eight patients were diagnosed as definite IIH and 68 healthy volunteers are included in the study who had the same sex and age. ONSD, peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index (RI) were estimated by transorbital color Doppler. Multivariate linear regression was used to discover the predictors of increased ICP. ROC curve was plotted for the predictor. A statistically significant difference was found between IIH patients and controls regarding ONSD, EDV and RI. Multivariate linear regression revealed that ONSD is the only predictor of increased CSP pressure. Its cut-off value indicating high ICP was 5.7 mm on Rt and Lt eye (AUC: 0.916; 95% confidence interval 0.867–0.965; p < 0.001; 90% sensitivity, 80% specificity at Rt eye. AUC: 0.902; 95% confidence interval 0.845–0.958; p < 0.001; 91% sensitivity, 80% specificity at Lt eye).

Correlation between hepatic steatosis severity diagnosed by ultrasound and metabolic indexes in elderly patients with MAFLD.

To explore the connection between metabolic parameters and the severity of hepatic steatosis determined through ultrasound in elderly individuals with metabolic dysfunction-associated fatty liver disease (MAFLD). 4,663 senior individuals who were 65 years of age or older were included in this research. They were examined physically at the Ninghai Street Community Health Service Center in Yantai City between June 7, 2021, and October 15, 2021. There were two categories of individuals identified: the MAFLD group (n = 2,985) and the non-MAFLD group (n = 1,678). Based on liver ultrasonography results, individuals in the MAFLD group were further separated into three groups: mild (n = 2,104), moderate (n = 766), and severe (n = 115). To identify indicators of risk for the severity of hepatic steatosis, metabolic data was contrasted between the groups employing logistic regression. In comparison to the non-MAFLD group, the MAFLD group showed significantly elevated levels of body mass index (BMI), blood pressure, gender, age, lipid profile, alanine transaminase (ALT), and fasting blood glucose (FBG; p < 0.05). Among individuals with MAFLD, there was a positive correlation between BMI, FBG, ALT, and aspartate transaminase (AST) levels and the severity of hepatic steatosis (p < 0.05). Logistic regression analysis indicated that BMI, female gender, FBG, ALT, triglycerides (TG), and serum uric acid (SUA) constituted risk factors for increased severity of hepatic steatosis in MAFLD. The severity of hepatic steatosis in elderly MAFLD patients is significantly correlated with female gender, BMI, ALT, FBG, TG, and SUA.

Predicting Weaning Outcome of Mechanically Ventilated Patients Using Ultrasound Diaphragmatic Excursion-Based Shallow Breathing Index Compared to Traditional Shallow Breathing Index

Predicting Weaning Outcome of Mechanically Ventilated Patients Using Ultrasound Diaphragmatic Excursion-Based Shallow Breathing Index Compared to Traditional Shallow Breathing Index

Accuracy of three-dimensional ultrasound and power Doppler in prediction of endometrial carcinoma in women with postmenopausal bleeding

Background Transvaginal sonographies in two dimensions have traditionally been the primary method for evaluating the endometrium. However, three-dimensional (3D) ultrasonography (US) can save entire volumes. Aim The research aimed to evaluate the precision of 3D US and power Doppler indices in predicting the incidence of endometrial cancer in women experiencing postmenopausal bleeding. Additionally, the ultrasound results were compared with the histopathologic findings of endometrial biopsies. Patients and methods This research was conducted on a sample of 100 women aged 40–60 years old, with BMI ranging from 18.5 to 38 kg/m2. Participants were postmenopausal (having no menstruation for at least 1 year) and had a uterine hemorrhage and an endometrial thickness (ET) of more than 4 mm. Patients underwent assessment of two-dimensional and 3D transvaginal US as well as three-dimensional power Doppler imaging. Results The ET and endometrial volume (EV) were significantly higher in suspected malignant than benign groups (P&lt;0.001). ET and EV can predict the occurrence of endometrial cancer, respectively, at cut-off more than 14.2 mm (area under the curve=0.880 and P&lt;0.001) and more than 7.5 cm3 (area under the curve=0.902 and P&lt;0.001) with 80% sensitivity, 74.12%, 100%specificity, 35.3%, 100% positive predictive value, and 95.5%, 96.6% negative predictive value. The vascularization index was significantly higher in suspected malignant than benign (P&lt;0.001). Conclusion EV and Doppler of endometrial vascularization index together were good diagnostic tools for early prediction of subtle pathology of endometrial carcinoma. Histopathological examinations of endometrial biopsies were the gold standard for the final diagnosis of endometrial carcinoma.

Contribution and evolution of respiratory muscles function in weaning outcome of ventilator-dependent patients

BackgroundThe present study was designed to investigate the evolution and the impact of respiratory muscles function and limb muscles strength on weaning success in prolonged weaning of tracheotomized patients. The primary objective was to determine whether the change in respiratory muscles function and limb muscles strength over the time is or is not associated with weaning success.MethodsTracheotomized patients who were ventilator dependent upon admission at a weaning center were eligible. Diaphragm function was assessed with the phrenic nerve stimulation technique and with ultrasound to measure the diaphragm thickening fraction (TFdi) and diaphragm excursion (EXdi). Global respiratory muscle function was assessed with the maximal inspiratory pressure (MIP) and the forced vital capacity (FVC). Limb muscle strength was measured with the Medical Research Council Score (MRC). Measurements were made on a weekly basis. Patients were compared according to their outcome at discharge: complete weaning, partial weaning or death.ResultsAmong the 60 patients who were enrolled, 30 patients finally achieved complete weaning, 20 had partial weaning and 10 died. At 6 months, 6 patients were lost of follow-up, 33 achieved complete weaning, 10 had partial weaning and 11 died. In median, 2 (1–9) assessments were performed per patient. Diaphragm dysfunction was present in all patients with a median Ptr,stim of 5.5 cmH2O (3.0–7.5). Ptr,stim, MIP, TFdi and EXdi at admission were not different between patients who achieved complete weaning and their counterparts. At discharge of the weaning center, MIP, Ptr,stim and EXdi significantly increased in patients who achieved complete weaning. The MRC score significantly increased only in patients with complete weaning. At discharge, diaphragm dysfunction was highly prevalent even in patients with complete weaning (Ptr,stim < 11 cmH2O in n = 11 (37%)).ConclusionRespiratory muscle function and limb muscles strength are severely impaired in patients with prolonged weaning from mechanical ventilation. Significant improvement of diaphragm ultrasound indices was associated with successful weaning from mechanical ventilation and ICU-acquired weakness upon admission was significantly associated with good outcome suggesting that it was an amendable determinant of weaning failure in this population.

Standardized evaluation of diabetic retinopathy using artificial intelligence and its association with metabolic dysfunction-associated steatotic liver disease in Japan: A cross-sectional study.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is common in patients with obesity and diabetes and can lead to serious complications. This study aimed to evaluate fundus photographs using artificial intelligence to explore the relationships between diabetic retinopathy (DR), MASLD, and related factors. In this cross-sectional study, we included 1,736 patients with a history of diabetes treatment or glycated hemoglobin (HbA1c) levels of ≥6.5%. All participants were negative for hepatitis B surface antigen and hepatitis C virus antibody and were selected from 33,022 examinees at a health facility in Japan. Fundus photographs were analyzed using RetCAD software, and DR scores were quantified. The presence of DR was determined using two cutoffs: sensitivity (CO20) and specificity (CO50). Steatotic liver (SL) stages were assessed via ultrasound and fibrosis indices and classified into three groups: no SL (SL0), SL with low fibrosis (SL1), and SL with high fibrosis (SL2). Odds ratios (ORs) for the risk of DR associated with each SL stage were calculated using logistic regression, adjusted for age, sex, body mass index, HbA1c, C-reactive protein level, and alcohol consumption. The risk of DR was lower in the SL1 (OR: 0.63, 0.54) and SL2 (OR: 0.64, 0.77) groups compared to the SL0 group at CO20 for both the Fibrosis-4 Index (FIB-4) and the non-alcoholic fatty liver disease fibrosis score (NFS), respectively. Additionally, higher levels of cholinesterase were consistently associated with a reduced risk of DR (FIB-4: OR 0.52, NFS: OR 0.54) at CO50. This study demonstrates that MASLD was associated with a reduced risk of DR, with cholinesterase levels providing further protective effects, highlighting the need for further research into the protective mechanisms and refinement of DR evaluation techniques. The standardized AI evaluation method for DR offers a reliable approach for analyzing retinal changes.

Integrating carotid doppler, grey scale ultrasound, and aortic oscillometry to evaluate macroangiopathy in myositides: the MYOCARD cohort.

To evaluate the combination of novel colour Doppler ultrasound (CDUS), greyscale ultrasound (GSUS), and oscillometric indices of macroangiopathy in patients with idiopathic inflammatory myopathies (IIM). Second, to explore the associations between these imaging markers and both patient-related and disease-related characteristics, as well as traditional cardiovascular (CV) risk factors. We conducted CDUS to evaluate arterial compliance markers, specifically the resistance (RI) and pulsatility (PI) indices, both in the common (CCA) and internal carotid arteries (ICA) of patients with IIM and healthy controls. Additionally, we performed GSUS examinations to measure carotid intima-media thickness (cIMT), identify plaques, and quantify cumulative carotid calcification surface. Oscillometric assessments determined aortic stiffness using carotid-femoral pulse wave velocity (cfPWV). We recruited 82 IIM patients and 88 healthy controls. Patients showed significantly higher cIMT (padj=0.014), CCA-RI (padj=0.005), CCA-PI (padj=0.002), ICA-RI (padj=0.003), and ICA-PI (padj=0.024), compared with controls. RI and PI of CCA and ICA were higher in patients with lower lung function vital capacity, respectively (all; p< 0.05). cfPWV correlated positively with traditional CV-risk factors including age (rho = 0.546, p< 0.001), mean arterial pressure (rho = 0.331, p= 0.003), diabetes (p= 0.007), and hyperlipidemia (p= 0.032), and associated negatively with lung CO-diffusion (rho=-0.329, p= 0.031). In one of the largest CV surrogate marker studies in IIM, patients exhibited increased carotid pulsatility, resistance, and atherosclerosis compared with controls. Lower lung function parameters predicted aortic stiffness and Doppler indices, suggesting a possible link between lung involvement and increased CV risk. Angiopathy markers may reveal significant vascular abnormalities in IIM patients, enhancing CV screening and risk classification.

Homeopathic and biotherapeutic therapies improve chronic arthritis and production rates in dairy goats displaying small ruminant lentiviruses

Small ruminant lentiviruses (SRLV) are chronic and progressive diseases that compromise production, health and animal welfare. Due to the lack of cure, vaccines or any effective treatments against SRLV, homeopathy emerges as a low-cost and residue-free approach. This study sought to evaluate the effect of two homeopathic interventions following a triple-blind, placebo-controlled protocol to treat goats displaying SRLV. A total of 42 adult Saanen goats (4.6 ± 1.3 years old; 2.6 ± 0.2 body condition score [BCS]; 59.5 ± 8.7 kg) with chronic arthritis and weight loss were included in this study after infection confirmation by PCR and seropositivity by Western Blot to SRLV. The following experimental groups were organized: SRLV living nosode (Gnosode; n=14), Homeopathic (Ghomeopathic; n=14) and Placebo (Gplacebo; n=14). Treatments were administered daily, orally, for 90 days. Every month, all goats underwent a clinical examination, joint ultrasound and collection of production indices. There was a treatment effect (p≤0.05) for productive (BCS and live weight) and clinical indices (clinical articular index, crepitation and width indices). Gnosode and Ghomeopathic showed a greater BCS when compared to Gplacebo (2.7±0.3 = 2.8±0.4 ≠ 2.5±0.3). Ghomeopathic had a greater live weight compared to Gplacebo, even though equal to Gnosode (62.4±11.2 ≠ 57.2±9.5 = 60.4±9.8 kg). In clinical evaluations, Gnosode obtained lower carpal joint indices when compared to Gplacebo, even though equal to Ghomeopathic (8.2±1.7 ≠ 8.7±1.0 = 8.5±1.4 cm). There was also an improvement (p≤0.05) for joint ultrasound indices (sagittal and transverse section of the carpus, distance from the joint capsule to the subchondral space, area and lesion perimeter). Such indices obtained lower values in both treated groups (Gnosode and Ghomeopathic) when compared to Gplacebo as highlighted for the distance from the joint capsule to the subchondral space (6.9±3.3 = 7.6±3.4 ≠ 10.8±4.4 mm), area (137.5±84.4 = 157.9±89.1 ≠ 235.0±90.1 mm) and joint lesion perimeter (81.8±18.8 = 85.7±17.6 ≠ 101.5±15.9 mm). Comparing the joint lesion area from D0 to D90, there was a reduction by more than 50% in both treated groups with an increase of 37.2% in Gplacebo. In conclusion, Gnosode and Ghomeopathic demonstrated promising outcomes improving arthritic lesions and production rates. Therefore, both medicines, can be safely used in goats infected with SRLV displaying chronic arthritis and weight loss.

Volume status evaluation by IVC diameter and pleth variability index in spinal anesthesia.

We aimed to predict the risk of hypotension due to spinal anesthesia (HSA) by measuring the diameter and area of the inferior vena cava (IVC-D, IVC-A) through ultrasound and pleth variability index (PVI) in patients who underwent endovenous radiofrequency ablation under spinal anesthesia (SA). This cross-sectional, observational, and prospective study was completed with 64 patients. Before SA, PVI IVC-D, and IVC-A were measured. Patients were divided into two groups as hypotension group (Group 1) and patients who did not developed hypotension after SA (Group 2). Shapiro-Wilk normality test and student's t-test were used for statistical analysis. The mean PVI of Group 1 was higher than Group 2, whereas the mean IVC-D and IVC-A in Group 2 was significantly higher than Group 1 (p = 0.000, p = 0.000, p = 0.001). Cutoff values for hypotension PVI > 15% and IVC-A ≤ 2.98 mm2 (p = 0.001, p < 0.05). PVI and IVC-D and IVC-A measurements are effective and reliable methods that should be used to predict the risk of developing HSA in patients who will undergo surgery under SA.

The association between age at menopause and bone health in Southwest China women: mediation effect of body mass index

BackgroundPrevious studies have yielded inconsistent findings regarding the association between age at menopause and bone health, with limited exploration of potential mediating factors, particularly in the less-developed muti-ethnic regions of China. Our objective was to analyze the association between age at menopause and bone health among postmenopausal women in southwest China, while also examining the mediating effect of body mass index (BMI) and the moderating effect of years since menopause on this association.Methods and resultsThe analysis included a total of 15,352 naturally postmenopausal women obtained from the baseline data of the China Multi-Ethnic Cohort (CMEC) Study. Multiple linear regression was used for multivariate analysis. Mediation analysis was conducted to examine the mediating role of BMI in the association between age at menopause and bone health. A significant positive association was observed between age at menopause and bone health index (Quantitative ultrasound index, QUI). Specifically, with each year’s delay in age at menopause, there was an increase of 0.260 (95% confidence interval (CI): 0.152–0.368) in QUI. Notably, women with later menopause (menopausal age ≥ 53 years) exhibited a higher QUI (β: 2.684, 95%CI: 1.503–3.865). Additionally, BMI partially mediated the relationship between age at menopause and QUI, accounting for 9.0% of the total effect, with an indirect effect coefficient β(95%CI) was 0.023(0.014, 0.032). Besides, it is worth mentioning that years since menopause moderated the association between age at menopause and bone health as well as the mediating effect of BMI.ConclusionNaturally postmenopausal women with a later age at menopause demonstrate enhanced bone health. Maintaining a moderately high BMI, without progressing to overweight or obesity, may provide health benefits for postmenopausal women, especially for those with a longer duration since menopause.

An Association Between Fetal Subarachnoid Space and Various Pathologies Using MR Imaging.

Background/Objectives: This study aimed to explore a relationship between the fetal subarachnoid space (SAS) width and various fetal pathologies, employing fetal brain MRI scans. Methods: A retrospective collection of fetal brain MRI scans of 78 fetuses was performed with sonographic indications of microcephaly, macrocephaly, or fetal growth restriction (FGR), during a 7-year period at a single tertiary center. The SAS width (named the SAS index) was manually measured in millimeters in ten specific anatomical locations (four in the axial plane and six in the coronal plane), and then converted to centiles by comparing it to (previously collected) data of apparently healthy fetuses. We evaluated the median SAS centiles using the Kruskal-Wallis and Mann-Whitney U tests for statistical comparison. Results: Seventy-eight subjects (mean gestational age of MRI scan 34.2 ± 2.2 weeks) were evaluated. The median SAS centiles were consistently higher in the macrocephaly group compared to the microcephaly group in all ten anatomical locations (statistically significant except coronal left inferior temporal gyri). Most pronounced difference was displayed in the insula gyri (axial and coronal). The median SAS centiles were higher in the microcephaly group when compared with FGR across all ten anatomical locations (all were statistically significant except for coronal frontal and insula gyri), and the maximal difference was found in the frontal gyri of both planes. The median SAS indexes (IQR) of the three groups in millimeters: macrocephaly 91.55 (86.35-101.05), microcephaly 59.46 (50.00-66.91), and FGR 53.21 (49.71-59.10), p < 0.001. Conclusions: We found a statistically significant association between the fetal subarachnoid space and various fetal pathologies: macrocephaly, microcephaly, and FGR.

Determination of optimal cutoff value of ulcerative colitis intestinal ultrasound index to estimate endoscopic improvement in ulcerative colitis.

The ulcerative colitis intestinal ultrasound (UC-IUS) index (UII) has been reported as a sonographic scoring system correlating with the Mayo endoscopic subscore (MES). Endoscopic improvement (EI) of UC (MES ≤ 1) is a crucial therapeutic target in clinical practice. However, the cutoff value for estimating EI using the UII has not been established. We established test and validation cohorts comprising patients with UC undergoing IUS and endoscopy within a 15-day interval at our institution. IUS findings (bowel wall thickness, bowel blood flow, bowel wall structure, haustrations, and inflammatory fat) and endoscopic activity (MES) of each colon segment (ascending, transverse, descending, and sigmoid colon) were assessed. In the test cohort (74 segments), UII was correlated with MES (r = 0.645, p < 0.0001). The median UII was 1.0 and 6.0 among participants with MES ≤ 1 and MES ≥ 2, respectively. A UII of 2 was identified as the threshold for estimating MES ≤ 1 with receiver operating characteristic analysis. In the validation cohort (122 segments), UII was correlated with MES (r = 0.675, p < 0.0001) and the estimation ability of UII ≤ 2 for EI had a positive predictive value of 85.4% and negative predictive value of 79.0%. This estimation ability of UII for EI was numerically lower but not statistically different from the previously reported Milan Ultrasound Criteria and Kyorin Ultrasound Criterion for UC. UII ≤ 2 can be a simple, feasible criterion for estimating EI. Correlation with MES is an advantage of the UII compared with other criteria. Proper use of various sonographic criteria is important.

Alterations in maternal–fetal gut and amniotic fluid microbiota associated with fetal growth restriction

BackgroundFetal growth restriction (FGR) is typically characterised as the fetus’ inability to reach its inherent growth potential. A growing body of evidence points to the important role of the maternal gut microbiota in FGR development. However, comprehensive research on changes in maternal–fetal gut and intrauterine microbiota related to FGR is lacking.MethodsIn this case–control study, we sequenced bacterial 16S rRNA from 35 maternal faecal, 35 meconium, and 31 amniotic fluid samples collected from 19 pregnant women diagnosed with FGR and 16 healthy controls. We identified putative bacterial taxonomic and functional characteristics associated with FGR by comparing these to control samples.ResultsWe identified 34 differential operational taxonomic units (OTUs) in amniotic fluid, seven differential OTUs in maternal faecal matter, and two differential OTUs in meconium. Compared to controls, FGR subjects exhibited enriched bacterial OTUs of the genus Bacteroides in the maternal gut. They also had depleted OTUs of the order Enterobacterales and genus Pseudomonas in the amniotic fluid and genus Stenotrophomonas in the fetal gut. These altered bacterial OTUs showed a significant correlation with neonatal weight and fetal ultrasonographic indexes. Additionally, we identified differential microbial functional pathways related to glycan and lipid metabolism in the maternal gut. We developed diagnostic biomarkers for FGR based on the maternal–fetal gut and amniotic fluid microbiota.ConclusionsThis study offers a comprehensive overview of the shifts in microbial composition and functional pathways in the maternal–fetal gut and amniotic fluid microbiota related to FGR, and present novel insights into the development and screening of FGR. However, the assessment of contamination’s impact on meconium and amniotic fluid remains inconclusive, necessitating further rigorous experimentation to address this scientific inquiry in future studies.

Efficacy of Uterine Artery Doppler Changes, Platelet Indices and Combination of Both in Prediction of Preeclampsia in Pregnant Women: A Prospective Observational Study

Introduction: Preeclampsia is a pregnancy-specific medical disorder characterised by an abnormal vascular response to placentation. Uterine artery Doppler ultrasound has emerged as a predictive tool in preeclampsia. Abnormal Doppler waveforms have been associated with impaired placental perfusion and an increased risk of developing preeclampsia. Preeclampsia is associated with alterations in platelet function and activation. The estimation of platelet indices is an easy and economical method for screening preeclampsia. Abnormal uterine artery Doppler findings and abnormal platelet indices are both related to the etiological pathways of preeclampsia. Aim: To compare the efficacy of uterine artery Doppler changes, platelet indices alone and their combination in predicting preeclampsia among pregnant women. Materials and Methods: This was a prospective observational study conducted Department of Obstetrics and Gynaecology, Gandhi Hospital in Secunderabad, Telangana, India, over 18 months, including 160 pregnant women aged 18-35 years with singleton pregnancies between 20-24 weeks of gestational age. Doppler ultrasound and platelet indices were measured and patients were followed-up until delivery for the development of preeclampsia. Receiver Operating Characteristic (ROC) curves were constructed and sensitivity, specificity and accuracy were determined to predict preeclampsia. Results: The mean age of the study population was 25.9±4.04 years. The sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy of platelet indices in predicting preeclampsia alone were 67.71%, 59.38%, 71.43%, 55.07% and 64.38%, respectively. The sensitivity, specificity, PPV, NPV and accuracy of the uterine artery Doppler indices in predicting preeclampsia alone were 77.08%, 68.75%, 78.72%, 66.67% and 73.75%. The combined assessment of uterine artery Doppler study and platelet indices in the prognostication of preeclampsia had a sensitivity of 85.42%, specificity of 82.81%, PPV of 88.17% and NPV of 79.10%, with improved accuracy of 84.38%. Conclusion: A combination of uterine artery Doppler ultrasound with platelet indices is easy to use, affordable, readily available in clinical settings and more effective in predicting preeclampsia than when used individually.

Elevation of circulating FGF23 in chronic kidney disease promotes atrial fibrosis through the AKT pathway

Abstract Background The relationship between chronic kidney disease (CKD) and atrial fibrillation (AF) remains unclear. Elevated level of fibroblast growth factor 23 (FGF23) is highly associated with increased cardiovascular disease and mortality in patients suffering from CKD. In recent years, studies have shown that FGF23 promotes cardiac hypertrophy through FGFR4, suggesting that FGF23 may be an important bridge between the heart and kidney. Purpose In this study, we sought to use a well-established rat model of CKD to further characterize the effects of CKD on AF and to identify potential drivers of CKD-induced AF. Methods 14 SD rats were randomly selected to undergo 5/6 nephrectomy and fed for 15 weeks to establish a CKD model, while the SHAM group (8 rats) underwent the same surgery without removing kidney tissue. Body weight, blood pressure, renal function, cardiac ultrasound, epicardial electrocardiography, and pathological indices were monitored in both groups. Gene sequencing was performed on the left atria to search for differentially expressed genes. Rat atrial fibroblasts were selected for further mechanism exploration. We chose TGF-β to stimulate fibroblasts to mimic the process of fibrosis in vivo, and then administered FGFR inhibitors to explore the downstream molecular mechanisms. Results Systolic blood pressure and creatinine were elevated in the CKD group. Compared with the SHAM group, the incidence of AF was significantly higher, left atrial diameter was significantly larger, and epicardial electrical markers showed that left atrial electrical conduction velocity was significantly slower and conduction heterogeneity was significantly increased in the CKD group. Pathologic staining of the left atrium showed significant fibrosis in the CKD group. Consistent with previous findings, FGF23 was significantly elevated in CKD rats. Transcriptomic sequencing revealed that FGFR4 expression was significantly upregulated in the left atrium of CKD rats, The results in rat atrial fibroblasts showed that blocking FGFR4 expression inhibited TGF-β-induced fibrosis and was mediated by the AKT pathway. Conclusions The mechanism of CKD-induced AF is that CKD promotes both structural and electrical remodeling of the atria. Further investigation of its possible downstream molecules revealed that elevated FGF23 in the CKD circulation promotes the development of atrial fibrosis by binding to FGFR4 through the AKT pathway.