Standard Ultrasound Examination Research Articles

Bacterial Vaginosis and Prospective Ultrasound Measures of Uterine Fibroid Incidence and Growth.

Uterine fibroids often cause intolerable symptoms leading to invasive treatments, most commonly hysterectomy. Reproductive tract infections are hypothesized to influence uterine fibroid development, but few studies exist, especially for the highly prevalent condition bacterial vaginosis (BV). Both fibroids and BV have documented racial-ethnic disparities, with higher burden in Blacks. With prospective data from a community-based study (four standardized ultrasound examinations over 5 years) in young Black women, we examined baseline BV associations with fibroid incidence and growth. We computed adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for incidence comparing BV and no BV (Nugent score ≥7 vs. <7) using Cox proportional hazards models among 1027 women fibroid-free at baseline. Fibroid growth associations were based on linear mixed models estimating volume change between ultrasounds indexed to 18 months. We then expressed BV association as estimated percent difference in growth per 18 months, comparing exposed and unexposed. There were n = 247 incident fibroids and 1181 growth measures; average fibroid growth per 18 months was a 78% (95% CI: 69 to 87) increase in volume. BV prevalence was 51% and not associated with fibroid incidence (aHR: 1.0, 95% CI: 0.80 to 1.4) or growth (estimated % difference in growth, -3% (95% CI: -12 to 6). In this first study (to our knowledge) of ultrasound-monitored fibroid development and Nugent-assessed BV, we found no evidence to support the hypothesis that BV increased risk of fibroid incidence or growth or BV's role in the high burden of fibroids in Black women.

SMFM Fetal Anomalies Consult Series #4: Genitourinary anomalies

The fetal genitourinary system includes the fetal kidneys, ureters, and bladder and internal and external genitalia. The standard ultrasound examination of the fetal genitourinary system after the first trimester of pregnancy includes visualization of the fetal kidneys and bladder (Figures 1, A and B and 2). The renal pelvis should be assessed for dilation in an axial view of the anteroposterior diameter in the second and third trimesters of pregnancy (Figure 1, C). The fetal genitalia should be examined in multiple gestations, as this can aid in determination of chorionicity, or when medically indicated as when a patient is at risk of an X-linked genetic disorder (Figure 3). In addition, measurement of the amniotic fluid volume should be performed (Figure 4), as it provides a functional assessment of the fetal kidneys, which produce amniotic fluid after 16 to 17 weeks of gestation. Renal pathology can therefore result in both increased and decreased amniotic fluid volume.Figure 2Fetal bladderShow full captionFetal bladder in the (A) first and (B) second trimesters of pregnancy.Society for Maternal-Fetal Medicine. SMFM Fetal Anomalies Consult Series #4. Am J Obstet Gynecol 2021.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3Female and male genitalia in the second trimester of pregnancyShow full captionA, Female genitalia in the second trimester of pregnancy. B, Male genitalia in the second trimester of pregnancy.Society for Maternal-Fetal Medicine. SMFM Fetal Anomalies Consult Series #4. Am J Obstet Gynecol 2021.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 4Amniotic fluid assessmentShow full captionSociety for Maternal-Fetal Medicine. SMFM Fetal Anomalies Consult Series #4. Am J Obstet Gynecol 2021.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Fetal bladder in the (A) first and (B) second trimesters of pregnancy. Society for Maternal-Fetal Medicine. SMFM Fetal Anomalies Consult Series #4. Am J Obstet Gynecol 2021. A, Female genitalia in the second trimester of pregnancy. B, Male genitalia in the second trimester of pregnancy. Society for Maternal-Fetal Medicine. SMFM Fetal Anomalies Consult Series #4. Am J Obstet Gynecol 2021. Society for Maternal-Fetal Medicine. SMFM Fetal Anomalies Consult Series #4. Am J Obstet Gynecol 2021. When indicated, a detailed ultrasound examination (76811) may include an examination of the adrenal glands and interrogation of the renal arteries (Figure 5). Examination of the fetal genitalia is also included.1AIUM practice parameter for the performance of detailed second- and third-trimester diagnostic obstetric ultrasound examinations.J Ultrasound Med. 2019; 38: 3093-3100Crossref PubMed Scopus (31) Google Scholar Abnormalities of the genitourinary system are among the most common fetal structural malformations. Such anomalies range from mild (eg, mild urinary tract dilation) to severe life-threatening anomalies (eg, bilateral renal agenesis). Because the kidneys are responsible for the production of amniotic fluid, serious renal abnormalities that impair the production or excretion of urine (eg, urinary tract obstruction) can result in severe oligohydramnios, which can lead to pulmonary hypoplasia and can be life-threatening. The fetal bladder and renal pelvis are relatively easily visualized, and therefore, renal abnormalities are usually readily detected. Those abnormalities that are more difficult to identify, such as unilateral renal agenesis or a pelvic kidney, are less likely to be life-threatening or harmful to the fetus. Most renal anomalies are isolated, and as a general rule, the risk of underlying aneuploidy or genetic syndromes is low. The exception is polycystic kidneys, which can be associated with autosomal recessive or dominant disorders. Other genetic syndromes can be characterized by various forms of multicystic or polycystic kidneys. Therefore, cystic kidney disease should prompt careful assessment to look for other anomalies and inherited diseases. This Consult reviews the ultrasonographic diagnosis, genetic evaluation, and potential treatment and outcome of the following genitourinary abnormalities:•Adrenal neuroblastoma•Autosomal recessive polycystic kidney disease•Bladder outlet obstruction•Duplicated collecting system•Ectopic ureterocele•Hydroureter•Hypospadias•Multicystic dysplastic kidney•Ovarian cyst•Pelvic kidney•Renal agenesis•Renal pelvic dilation•Urinoma When coding for fetal genitourinary anomalies, the Society for Maternal-Fetal Medicine Coding Committee recommends utilizing the International Classification of Diseases, Tenth Revision, code series O35.8XX. The authors wish to acknowledge Mary E. Norton, MD; Jeffrey A. Kuller, MD; and Angie C. Jelin, MD, for providing a review of the genetics content and Joseph Wax, MD, for providing a general review of this Consult.

Bacterial Vaginosis-Associated Bacteria and Uterine Fibroids: A Nested Case-Control Study.

Reproductive tract infections are hypothesized to influence uterine fibroid development, yet few studies have investigated the common condition of bacterial vaginosis (BV). The literature is currently limited to data using self-report of BV. We conducted a nested case-control study of 200 women (100 cases and 100 controls) from a large study of 23- to 35-year-old African American women, 1310 of whom were fibroid-free and prospectively followed up for 5 years to identify incident fibroids with standardized ultrasound examinations. We used quantitative polymerase chain reaction, an objective molecular method, to assess 9 BV-associated and 4 Lactobacillus species from vaginal swab specimens. We used hierarchical logistic regression to compute odds ratios and 95% confidence intervals to examine associations between bacterial species (both individually and grouped as (1) "optimal" Lactobacillus and (2) BV-associated species) with fibroid incidence and number. We also examined vaginal imbalance (quantitatively more BV-associated bacteria than optimal Lactobacilli). Contrary to our hypothesis, we found no increase in fibroid incidence or number among women with more BV-associated bacteria. High imbalance (only BV-associated bacteria, no optimal Lactobacillus bacteria) was actually inversely associated with fibroid incidence (odds ratio, 0.38; 95% confidence interval, 0.17-0.81). This is the first study of ultrasound-detected incident fibroids and molecular vaginal bacterial assessment. We found no evidence that BV-associated bacteria increase the risk of fibroid incidence or number.

BODY TYPES AND ANATOMICAL VARIABILITY OF THE THYROID GLAND IN WOMEN

One of the tasks of science of the constitution, along with the definition of a human's somatotype, is to identify the characteristic typological features of a body region, morphological and functional system or an individual organ, which, in combination with new morphological and clinical research methods, is of great scientific and practical importance. Interest in morphological and functional studies of the thyroid gland has been steadily growing over the past thirty years, which is associated with an increase in oncological diseases of this organ in young women and is caused by the deterioration of the environment and radiation pollution of the environment as a result of technological disasters. In addition, the development of iodine-deficient conditions increases, which affect the function of the thyroid gland. The purpose of the review is a descriptive meta-analysis of modern scientific data on the structure of the thyroid gland depending on the parameters of the neck and constitutional and typological characteristics of women. It was found that despite the large number of publications devoted to the morphology of the thyroid gland, most of the parameters of this organ were obtained only by standard ultrasound examination; insufficiently studied tissue organization of the gland at the macro-microscopic level; there is no unified classification of forms of the thyroid gland and data on the distribution of their frequency in persons of different sex; the relationship of the anatomical characteristics of this organ with the size of the neck, as well as with the somatotype, has not been sufficiently studied. It is noted that the majority of authors who carry out somatotyping prefer one scheme of constitutional diagnostics and rarely use a set of methods. Obviously, due to the increase in the incidence of the thyroid gland in young people, the objects of research should be people of young age. The increase in the frequency of oncological diseases of the thyroid gland and the success of endocrine surgery require a new approach to patients and dictate the need for a comprehensive study of this organ, taking into account the local and general constitution in women of a mature age period. Until now, researchers do not have an exact answer to the question of what constitutionally determined features can be identified in the neck area and whether there is a connection between the main morphological parameters of the thyroid gland with the somatotype and physical development of a person. Comprehensive studies of the thyroid gland, taking into account the parameters of the neck and constitutional variability of a person, may have new theoretical and practical significance.

Reliability and validity of a standardised ultrasound examination protocol to quantify vastus lateralis muscle.

ObjectiveTo evaluate the reliability and validity of a standardized ultrasound examination protocol for measuring vastus lateralis muscle size.DesignProspective cohort study.SubjectsSixteen staff members of the university hospital of Heidelberg.MethodsMuscle thickness, cross-sectional area and subcutaneous adipose tissue thickness were measurxsed at 3 standardized sites on the right and left vastus lateralis muscle. Ultrasound measurements were collected by 2 independent investigators on 2 different days and compared with magnetic resonance imaging measurements.ResultsIntraclass correlation coefficients (ICC) for intra- and inter-rater reliability showed very good closeness of agreement for all parameters (ICC = 0.929–0.994, p < 0.001). Muscle thickness and subcutaneous adipose tissue thickness ultrasound and magnetic resonance imaging measurements revealed good to very good closeness of agreement (ICC = 0.835–0.969, p < 0.001), whereas cross-sectional area showed only average closeness of agreement (ICC = 0.727, p < 0.001). A strong predictive positive correlation for ultrasound and magnetic resonance imaging-based measurements of cross-sectional area was found (R² = 0.793, p < 0.001).ConclusionBy standardization of an examination protocol, quantitative vastus lateralis muscle ultrasound proved to be a reliable method for assessing vastus lateralis muscle size. Furthermore, this protocol is valid for measuring muscle thickness and subcutaneous adipose tissue thickness, although there seems to be a systematic underestimation of cross-sectional area depending on subcutaneous adipose tissue thickness.LAY ABSTRACTThe quantification of muscle mass is crucial for diagnosis and monitoring of muscle atrophy caused by inactivity or in the context of diseases, and could also be used for monitoring the development of muscle hypertrophy during resistance training. Application of a standardized examination protocol for quantitative vastus lateralis muscle ultrasound proved to be a reliable method for assessing vastus lateralis muscle size in people with varying body weight and body composition, respectively. In this regard, it could be considered an alternative examination tool to time- and cost-consuming gold-standard magnetic resonance imaging (MRI), which is seldom readily available in clinical practice. However, compared with MRI measurements, muscle cross-sectional area measured using ultrasound seems to be systematically underestimated, depending on subcutaneous adipose tissue thickness.

Accuracy of the SpineNav3DTM Ultrasound Technology in Estimating the Epidural Space Depth for Epidural and Spinal Insertion in Pregnant Obese Patients

Introduction: Ultrasound facilitates neuraxial puncture in obese parturients. Unfortunately, the widespread adoption of neuraxial ultrasound may be limited by the lack of technical expertise or the limited availability of the equipment. A wireless portable ultrasound device (Accuro, Rivanna Medical, Charlottesville, VA) with automated pattern recognition software (SpineNav3DTM technology) has been introduced to obtain the automated real-time identification of interspaces and epidural depth. The primary objective of this study was to assess the accuracy of the SpineNav3DTM ultrasound technology (Accuro) in estimating the epidural space depth compared to the standard ultrasound examination in pregnant obese patients. The secondary aim was to compare the ultrasound measurements with the measured needle depth during epidural and spinal insertion. Methods: The study was conducted at S Gerardo Hospital, Monza, Italy from March 2021 to April 2021. Obese laboring women requesting epidural analgesia or undergoing elective cesarean delivery under spinal anesthesia were recruited. All the subjects had their lumbar area scanned for the measurements of the depth of the epidural space by the SpineNav3DTM ultrasound technology and by the standard US and then both compared with the needle insertion depth in a double-blind fashion. Results: Forty-eight women were enrolled in the study. There was agreement (±0.25 cm) between the epidural depth (in cm) measured with the Accuro, versus the standard ultrasound. There was a significant difference between the mean depth of epidural space s measured by Accuro or Standard US and needle insertion depth (P Conclusions: The handheld ultrasound system with 3D spine navigation technology can automatically identify and measure the epidural depth with the same accuracy as the standard ultrasounds in obese pregnant women.

ХОЗЛ и почки: две стороны одной проблемы

The problems of diagnosis, treatment, prevention of chronic obstructive pulmonary disease remain relevant due to the increase in morbidity, disability and mortality of patients. Recently, the level of renal dysfunction in the progression of chronic obstructive pulmonary disease has increased. The purpose of research was to study the indicators of renal dysfunction in chronic obstructive pulmonary disease, depending on the severity and frequency of chronic obstructive pulmonary disease exacerbations, comorbidity, respiratory function, morphological and functional state of the myocardium to optimize the diagnosis and prognosis of chronic obstructive pulmonary disease. Material and methods. The article presents the results of examination of 81 patients in different groups of chronic obstructive pulmonary disease (BCD) with comorbidity (arterial hypertension in 49 patients, diabetes mellitus type 2 – in 16, postinfarction cardiosclerosis – in 6, diffuse cardiosclerosis – in 53, angina pectoris – in 5 patients). The external respiration function was made by using a computer spirograph. The morphological and functional state of the myocardium was studied by the standard ultrasound examination. Glomerular filtration rate was estimated by using the Cockcroft-Gault formula. The A/C ratio, microalbuminuria in the morning urine portion, and the level of C-reactive protein were also studied. The results of the studies were analyzed by methods of nonparametric statistics with an assessment of differences between groups of patients using the Mann-Whitney U-test; to assess the parameters of the relationship between indicators, the method of pair rank correlation by Spearman was used. Results and discussion. Signs of renal dysfunction, hypoxia (SpO2), systemic inflammation of low intensity C-reactive protein were found only in group D of patients with chronic obstructive pulmonary disease. In the same group, the greatest number of correlations of indicators of renal dysfunction and SpO2 with various indicators of the morphofunctional state of the myocardium according to echocardiography, the frequency of exacerbations, and comorbidity with hypertension, diffuse and postinfarction cardiosclerosis was revealed. In group B and C, no correlations of indicators of renal dysfunction with other indicators were found. In the group of patients with GFR less than 90 ml/min/1.73m2, there were correlations of the A/C ratio with the frequency of exacerbations, C-reactive protein, correlations between microalbuminuria and dyspnea, daily proteinuria, and SPPA. Conclusion. In the future, it is necessary to continue the search for early specific available biomarkers of renal dysfunction that can be used for early prescription of pleiotropic therapy, and timely initiation of nephroprotection from the standpoint of network medicine

Role of ultrasound in Evaluation of Fever of Unknown Origin

Background: Abdominal ultrasonography is a valuable tool for evaluating patients with FUO. A skilled ultrasonographer can examine most abdominal organs and often detect lesions that are not demonstrated by radiography. Aim of the work: The aim of this study is to demonstrate the diagnostic value of a complete standardized ultrasound examination of patients with fever of unknown origin. Patient and methods: We evaluate 60 patients by (ultrasound and colour Doppler) with infection in 32 patients and non-infection in 28 patients. The ultrasound and color Doppler diagnosis was confirmed by histological examination and others images. Results: In this study the US diagnosis were correlated with the final diagnosis based on laboratory examination in 44(73.3%) of the cases, US diagnosis did not correlate with final diagnosis in 16(26.7%) of the cases. Conclusion: Ultrasound is a valuable non-invasive tool in diagnosis of fever of unknown origin patients.

A Method of Improving Representation of Endometriosis Ultrasound Data By Using Local Phase Tissue Signatures

Study Objective Endometriosis is a gynecological condition affecting 10-15% of women in their reproductive years. Early and accurate diagnosis requires the development of noninvasive, cost effective and safe imaging technology. Ultrasound could overcome some of the MRI challenges. However, noise, high inter- and intra-variability during ultrasound imaging reduces image quality and reproducible reading. Deep learning has increased its role in imaging analysis and has been applied to automatic ultrasound image analysis. The main objective is the investigation of how new computational methods, can improve the representation of endometriosis tissue in ultrasound data. Design We have developed computational method for processing B-mode ultrasound data. Our algorithms are based on the extraction of local phase tissue signatures, are intensity invariant. These features are not affected by the ultrasound transducer operating frequency, ultrasound machine settings, and the body mass index of the patient. Setting Clinical ultrasound sites. Patients or Participants The proposed computational methods will be validated on 3D ultrasound images obtained from the standard transvaginal ultrasound examinations. Interventions Both RF signals and B-mode data will be normalized to [-1, 1] and then rescaled to size (4096, 256, number of slices) using bilinear interpolation before inputting to our proposed networks. Training of the proposed CNNs will be achieved by investigating various methods based on gradient descent and variants such as adam, adagrad, adelta. Measurements and Main Results 100 B-mode US and RF US scans will be collected from each patient bringing the dataset size to 27,400 (B-mode and RF US). A sample size of 274 (137 healthy,137 diseased) subjects is sufficient to estimate a high Area Under the Curve. Conclusion New tissue signatures provide valuable information and improved representation of the endometriosis. Future work will involve the development of artificial intelligence, specifically methods based on deep learning, methods to derive models that yield individual-level accurate, early diagnosis in the context of endometriosis management.

THE ULTRASOUND DIAGNOSTICS POTENTIAL OF THE SMALL PELVIS TUMORS IN CHILDREN

Purpose of the study . To assess the potential of sonography in the diagnosis of pelvic tumors in children. Patients and methods. We retrospectively analyzed results of ultrasound examination of the small pelvis, abdominal cavity and retroperitoneal space in 110 children with pelvic cancer referred for examination and treatment to National Medical Research Centre for Oncology of the Ministry of Health of Russia, distinguishing the most significant ultrasound parameters regardless of the tumor histological structure. 69.1% of patients were diagnosed with germ cell tumors, including 72.4% with gonadal and 27.6% with extragonadal tumors, 85.8% with sacrococcygeal tumors, 9.5% — uterine and 4.7% — vaginal tumors. Rhabdomyosarcoma was detected in 25.4%, neuroblastoma in 4.5% and a primitive neuroectodermal tumor in 1%. Standard ultrasound examination was performed using scanners Philips IU22 (USA) and Logic 400 MD (GE, USA) with convex transducers (3.5–5.5 MHz) in grayscale, color Doppler and power Doppler modes. Results . The first stage of diagnostics showed that malignant pelvic tumors were characterized with an irregular shape registered in 97 (88.2%; p 0.05); tumor echodensity was reduced in 75 children (68.2%; р =0.001). Dopplerography in most patients — 100 (90.9%) — registered a hyperintense intratumoral blood flow, mainly of an arterial type, with maximum arterial velocities (MAV) ranging from 12.5 to 45 cm/s, average MAV = 30±2.7 cm/s. The specificity of the method was 86.3% ( p =0.001), sensitivity 85.2% ( p =0.011), accuracy 87.5% ( p =0.014). Ultrasound monitoring was performed during treatment after each polychemotherapy cycle; we assessed changes in the size of tumors, their structure and neovascularization, allowing evaluation of the antitumor treatment effectiveness. Conclusion . A complex sonography is an important method in the primary diagnostics of pelvic tumors in children, as well as a priority method in antitumor treatment monitoring, which allows detection of the tumor extent and helps to avoid multiple radiation exposure of the growing child’s body.

ANATOMIC-FUNCTIONAL STATE OF PELVIC ORGANS IN WOMEN WITH INFERTILITY AND OVARICOVARICOCELE

ANATOMIC-FUNCTIONAL STATE OF PELVIC ORGANS IN WOMEN WITH INFERTILITY AND OVARICOVARICOCELE

Surgical treatment of ovarian endometriomas using intraoperative ultrasound

Aim. To improve the results of the surgical treatment of patients with ovarian endometriomas using intraoperative echography.Materials and methods. The results of the surgical treatment of 138 patients with endometrioid ovarian cysts were prospectively and retrospectively analyzed. The main group consisted of 69 patients, who underwent standard ultrasound examination before and after surgery, as well as intraoperative laparoscopic ultrasound imaging. The control group (retrospectively) consisted of 69 patients with endometrioid ovarian cysts, who were not subject to laparoscopic ultrasound examination.Results. The use of intraoperative transvaginal and laparoscopic echography can reduce the time of surgical revision, reduce the number of intra- and postoperative complications, as well as the frequency of relapses in the postoperative period.Conclusion. According to the obtained results, intraoperative ultrasound echography has a high diagnostic accuracy of up to 99.2%. This method of intraoperative diagnosis allows the optimal volume and method of surgical intervention to be determined, and the safety and adequacy of surgical treatment to be ensured, thus maximizing the reproductive function.

Time Tracking of Standard Ultrasound Examinations in Pediatric Hospitals and Pediatric Medical Practices - A Multicenter Study by the Pediatric Section of the German Society of Ultrasound in Medicine (DEGUM).

Ultrasonography is the primary imaging modality in pediatrics but still lacks sufficient reimbursement in Germany. In this multicenter study, national data for the duration of standard ultrasound in pediatrics were systematically documented in order to specify the actual time required. N = 10 hospitals (N = 5 university hospitals, N = 5 non-university hospitals) and N = 3 medical practices in Germany recorded the entire process of an ultrasound examination in a special protocol developed by the Pediatric Section of the DEGUM. The duration of each of seven single steps during ultrasonography (from data input to final discussion of the results) of different organ systems was logged. In total, N = 2118 examinations from different organ systems were recorded. N = 10 organ systems were examined frequently (> 30 times). The total duration of an ultrasound examination was statistically significantly longer in hospitals compared to medical practices (median (IQR) 27 min. (18-38) vs. 12 min. (9-17), p < 0.001). The "hands-on" patient time was approximately one half of the total required time in both settings (49.9 % vs. 48.9 %). Ultrasonography of the abdomen and brain lasted longer in university hospitals than in non-university hospitals (p < 0.001, and p = 0.04, respectively). Cooperation and age did not uniformly correlate with the total duration. This study provides novel comprehensive national data for the duration of standardized ultrasound examinations of children and adolescents in Germany. These data are essential for a further evaluation of the economic costs and should support better remuneration in the future.

Diagnostic accuracy and temporal impact of ultrasound in patients with dyspnea admitted to the emergency department.

ObjectiveFew studies have prospectively evaluated the diagnostic accuracy and temporal impact of ultrasound in the emergency department (ED) in a randomized manner. In this study, we aimed to perform a randomized, standard therapy controlled evaluation of the diagnostic accuracy and temporal impact of a standardized ultrasound strategy, versus standard care, in patients presenting to the ED with acute dyspnea.MethodsThe patients underwent a standardized ultrasound examination that was blinded to the team caring for the patient. Ultrasound results remained blinded in patients randomized to the treating team but were unblinded in the interventional cohort. Scans were performed by trained emergency physicians. The gold standard diagnosis (GSDx) was determined by two physicians blinded to the ultrasound results. The same two physicians reviewed all data >30 days after the index visit.ResultsFifty-nine randomized patients were enrolled. The mean±standard deviation age was 54.4±11 years, and 37 (62%) were male. The most common GSDx was acute heart failure with reduced ejection fraction in 13 (28.3%) patients and airway diseases such as acute exacerbation of asthma or chronic obstructive pulmonary disease in 10 (21.7%). ED diagnostic accuracy, as compared to the GSDx, was 76% in the ultrasound cohort and 79% in the standard care cohort (P=0.796). Compared with the standard care cohort, the final diagnosis was obtained much faster in the ultrasound cohort (mean±standard deviation: 12±3.2 minutes vs. 270 minutes, P<0.001).ConclusionA standardized ultrasound approach is equally accurate, but enables faster ED diagnosis of acute dyspnea than standard care.

Race–ethnic differences in the associations of maternal lipid trait genetic risk scores with longitudinal fetal growth

Fetal growth, an important predictor of cardiometabolic diseases in adults, is influenced by maternal and fetal genetic and environmental factors. We investigated the association between maternal lipid genetic risk score (GRS) and fetal growth among 4 US racial-ethnic populations (Whites, Blacks, Hispanics, and Asians). We extracted genotype data for 2008 pregnant women recruited in the National Institute of Child Health and Human Development Fetal Growth Studies-Singleton cohort with up to 6 standardized ultrasound examinations. GRS was calculated using 240 single-nucleotide polymorphisms previously associated with higher total cholesterol (GRSTChol), low-density lipoprotein cholesterol (GRSLDLc), and triglycerides (GRSTG) and lower high-density lipoprotein cholesterol (GRSHDLc). At 40 weeks' gestation, a unit increase in GRSTG was associated with 11.4g higher fetal weight (95% confidence interval [CI] 2.8-20.0g) among normal-weight Whites, 26.3g (95% CI 6.0-46.6g) among obese Blacks, and 30.8g (95% CI 6.3-55.3g) among obese Hispanics. Higher GRSHDLc was associated with increased fetal weight across 36 to 40weeks among normal-weight Whites and across 13 to 20weeks among normal-weight Asians, but with decreased fetal weight across 26 to 40weeks among normal-weight Hispanics. Higher GRSTChol was suggestively associated with increased fetal weight in males and decreased in females. Associations remained consistent after adjustment for serum lipids. Associations between fetal weight and maternal lipid GRS appear to vary by maternal race-ethnic group, obesity status, and offspring sex. Genetic susceptibility to unfavorable lipid profiles contributes to fetal growth differences even among normal-weight women suggesting a potential future application in predicting aberrant fetal growth.

Value of the 'clicky hip' in selective screening for developmental dysplasia of the hip.

The aim of this study was to review the value of accepting referrals for children with 'clicky hips' in a selective screening programme for hip dysplasia. A single-centre prospective database of all referrals to the hip clinic was examined to identify indication for referrals, diagnosis, and treatment. All patients referred received a standardized ultrasound scan and clinical examination by an orthopaedic consultant. There were 5716 children referred to the orthopaedic hip clinic between 1 June 2014 and 26 September 2018. In all, 1754 children (30.1%) were referred due to 'clicky hip' with no additional risk factors or indications for ultrasound scan. A total of 123 children (7.1%) referred with 'clicky hip' and no additional risk factors or examination findings had an abnormal initial hip ultrasound, including 16 children (0.9%) with dysplastic hips. Of the 141 children who required treatment in a Pavlik harness during the study period, 23 (16%) had been referred with a 'clicky hip' and no additional risk factors or examination findings, including six children with Graf 3 or 4 hips. There is significant value in reviewing children with an isolated 'clicky hip'. Many children who require treatment are referred to the orthopaedic service as 'clicky hip' with no additional risk factors. In a pragmatic pathway with a diverse population of clinicians performing baby checks, 'clicky hip' is an important indication for referral and should not be discarded. Cite this article: Bone Joint J 2019;101-B:635-638.

Relationship between vascular damage and left ventricular concentric geometry in patients undergoing coronary angiography: a multicenter prospective study.

Vascular structural (intima-media thickness) and functional (carotid pulse wave velocity, cPWV) alterations are related to different patterns of left ventricular (LV) geometry in general population samples and in hypertensive patients. The relationship between vascular damage, evaluated by both echotracking ultrasound and coronary angiography, and LV geometry has not been prospectively analyzed. In eight Italian centers, 399 consecutive patients, without history of prior coronary artery disease and with clinical indication to coronary angiography, prospectively underwent cardiac standard ultrasound examination for the evaluation of LV mass, indexed by height to 2.7 power (LVMi g/m) and relative wall thickness (RWT), the measurement of Doppler flow in the left anterior descending artery (LAD) and the echocardiographic calcium score (eCS). In all patients measurement of common carotid intima-media thickness (cIMT) and cPWV by carotid ultrasound, with the realtime echotracking system was performed. The noninvasive evaluations were performed blindly to clinical information, before coronary angiography. cIMT and cPWV were higher in patients with concentric LV hypertrophy (LVH) (LVMi ≥ 49 g/m in men and ≥47 g/m in women and RWT ≥ 0.42) as compared with those with normal LVMi and geometry (N: LVMi < 49 g/m in men and <47 g/m in women and RWT < 0.42) and to those with concentric remodeling (normal LVMi and RWT ≥ 0.42). Distal LAD velocity and eCS were greater in patients with concentric LVH than in others groups. At coronary angiography the prevalence of coronary stenosis (>50%) was greater in patients with concentric LVH and concentric remodeling, as compared with N. Patients with both concentric LVH and concentric remodeling showed higher values of cIMT and cPWV and distal LAD velocity and a greater prevalence of coronary stenosis (>50%) than patients with RWT less than 0.42. Our results further reinforced the observation that in patients undergoing elective coronary angiography, concentric geometry is associated with structural and functional carotid alterations, with higher distal LAD flow velocity and eCS. In this large group of patients, concentric geometry is associated with a greater prevalence of coronary stenosis, as assessed by coronary angiography. These results might contribute to explain the greater cardiovascular risk associated with concentric remodeling and LVH.

MANAGEMENT OF LATERAL HUMERAL CONDYLAR FRACTURE IN CHILDREN

Analysis of literature related to treatment of children with humeral condyle fracture (HCF) showed that in 15–51% of cases the outcomes were unsatisfactory. Material and methods. Treatment experience of 486 children with acute HCF fractures aged 1 to 16 years is presented. The diagnostic uses additional oblique projections and computed tomography to detect the degree of dislocation and fragment mobility alongside with standard ultrasound examinations. Patients were distributed as follows considering the degree of HCF bone fragment dislocation: 170 (35%) patients with 1 degree of dislocation and 117 (24%) patients with 2 degree of dislocation, whereas 199 (41%) patients had 3 degree dislocation. Results. The patients were operated using the developed tactical scheme based on the suggested classification. It took into account both the degree of dislocation and fragment mobility in 1 degree fractures. Remote results were examined in 321 (66%) patients within 1–15 years after the trauma: the results were excellent in 278 (87%) cases, good in 29 (%) cases and satisfactory in 13 (4%) cases. Conclusions. Treatment of children with humeral condyle fractures was based on the differentiated approach to selection of treatment method depending on dislocation degree and mobility of a distal bone fragment.

Ultrasonographic evaluation of fetal kidney length as a reliable parameter for estimation of gestation age in 2nd &amp; 3rd trimester

The fetal Kidney length can be used in estimation of gestational age. In late 2nd and 3rd trimester both kidneys can be visualized easily and can be measured accurately. In late 2nd and 3rd trimester the fetal kidney length can be used as an investigational tool alone or may be in addition of other parameter in estimation of gestational age. The most commonly used parameters used by sonologist can predict gestational age in 1st and 2nd trimester. But as pregnancy advances, the accuracy of these parameters decreased. The length of fetal kidneys in mm collaborates very nicely with gestational age in weeks&#x0D; Objective: To evaluate that fetal kidney length is a reliable parameter for gestational age estimation in 2nd and in 3rd trimester of pregnancy.&#x0D; Methods: 371 healthy, pregnant females with a normal fetus were included in this study. A standard 2nd and 3rd trimester ultrasound examination was done. In addition to the standard biometric parameters, both fetal kidneys length were also measured. The collected data was subjected to statistical analysis.&#x0D; Results: This study finding confirmed that fetal kidney length can be used as standard parameters alone or in addition with other routine parameters for estimation of gestational age in late 2nd and 3rd trimester. The Pearson correlation coefficient r=0.988 which showed a strong correlation with kidney length and gestational age and p value is (0.00)&#x0D; Conclusion: Fetal kidney length estimates gestational age as accurate as other standard traditional parameters. It is more accurate in late 2nd &amp; 3rd trimesters of pregnancy when other parameters are not much reliable. It is easy to detect and measure.&#x0D; Int. J. Appl. Sci. Biotechnol. Vol 7(1): 108-113

Is neutrophil-lymphocyte ratio a novel biomarker for macrovascular and microvascular complications of type 2 diabetes?

Background/aimThe neutrophil-to-lymphocyte (N/L) ratio is a biomarker of inflammation. We aimed to test the hypothesis that macrovascular and microvascular complications of type 2 diabetes mellitus (DM) involve an inflammatory process.Patients and methodsThis is a cross-sectional study conducted on patients with type 2 DM. Demographic and clinical examination data of eligible patients were recorded. The blood samples for laboratory variables were collected and measured by the standard methods. A standard ultrasound examination was done to measure both carotid artery intima-media thickness (cIMT), and the averages of three results of each side were recorded.ResultsThe current study showed that N/L ratio was an independent predictor of cIMT in patients with type 2 DM (B=0.003, t=8.325, P=0.000), in addition to other conventional cardiovascular risk factors including age, male sex, smoking index, duration of diabetes, estimated glomerular filtration rate, low-density lipoprotein-cholesterol, urinary albumin creatinine ratio, and HBA1c. Moreover, N/L ratio was an independent predictor of albuminuria in patients with type 2 DM (B=0.110, t=3.638, P=0.006), in addition to duration of diabetes, HBA1c, SBP, BMI, and estimated glomerular filtration rate.ConclusionN/L ratio was an independent predictor of cIMT and albuminuria. This supports the hypothesis that diabetic macrovascular and microvascular complications involve an inflammatory process. Therefore, NLR may serve as a cost-effective and readily accessible marker of diabetic vascular complications.