Time-averaged Maximum Velocity Research Articles

Splenic Artery Doppler Waveforms in Gestational Diabetes and Association with Fetal Pancreas: A Prospective Case-Control Study.

This study evaluated fetal pancreas size and echogenicity, and splenic artery (SA) waveforms in pregnant women with gestational diabetes mellitus (GDM). This prospective case-control study was performed from October 2022 to November 2023 and included 124 pregnant women (62 with GDM and 62 controls). Pancreatic circumference, pancreatic echogenicity, umbilical artery Doppler measurements (systolic/diastolic ratio [S/D] and pulsatility index [PI]), SA Doppler measurements (S/D, PI, peak systolic velocity [PSV], time-averaged maximum velocity, and pressure gradient [PG] mean and maximum) values were compared between the GDM and control groups. The mean pancreatic circumference was higher and grade 2/3 echogenicity was more common in the GDM group, while grade 1 echogenicity was more common in the control group (p < 0.001 and p < 0.001, respectively). SA S/D and PI measurements were significantly higher in the GDM group than in the control group (p < 0.001 and p = 0.001, respectively). Moreover, PGmax was significantly higher in the GDM group than in the control group (p = 0.038). Pancreatic circumference was positively correlated with SA PSV (p = 0.004). Additionally, pancreatic circumference was positively correlated with PGmean and PGmax (p = 0.010 and p = 0.016, respectively). The increase in pancreas echogenicity was positively correlated with SA S/D and PI measurements (p = 0.007 and p = 0.002, respectively). PGmax was also positively correlated with increased pancreas echogenicity (p = 0.023). This study showed that fetal pancreas size and echogenicity were significantly higher in pregnant women with GDM than in controls. SA Doppler waveforms were consistent with an increase in vascular resistance associated with elevations of both S/D and PI in the GDM group.

Clinical study on improving the function of female bladder in controlling urine by acupuncture Zhibian (BL54) under ultrasound guidance

ObjectiveTo observe the effect of acupuncture Zhibian (BL54) on the function of the bladder in controlling urine in women under ultrasound.Method74 healthy subjects were randomly divided into deep acupuncture group of 37 cases and shallow acupuncture group of 37 cases. Under the guidance of ultrasound, the two groups of subjects were acupunctured at bilateral BL54. The deep acupuncture group was acupunctured to the pudendal nerve, and the shallow acupuncture group was acupunctured to the superficial fascia. Ultrasound was used to observe the peak systolic velocity (PSV), time average maximum velocity (TAMX), end diastolic velocity (EDV), pulsation index (PI), resistance index (RI) of the pudendal arteries, and bladder volume of two groups of subjects before and after acupuncture. The anatomical hierarchical structure of bilateral BL54 and score of Chinese version of the Massachusetts General Hospital Acupuncture Sensation Scale (C-MASS) of all subjects was measured.ResultAfter acupuncture, the PSV, TMAX of the pudendal artery, bladder volume, and the Score of C-MASS Scale in the deep acupuncture group were higher than in the shallow acupuncture group (P < 0.05). The RI of the pudendal arteries in the shallow acupuncture group decreased compared to before acupuncture (P < 0.05).ConclusionAcupuncture at the BL54 can increase the blood flow velocity of the pudendal artery, improve the function of the bladder in controlling urine in women, and different depths of acupuncture will have different therapeutic effects.

Cerebral blood flow in type II diabetes mellitus patients with impaired awareness of hypoglycemia: a cross-sectional study

Cerebral blood flow is maintained and regulated through various homeostatic mechanisms. It is maintained even during hypoglycemia in patients with type 1 diabetes mellitus, but appears to increase in those with impaired awareness of hypoglycemia. However, experiments are lacking to clarify these findings. Thus, this study was conducted to investigate whether cerebral blood flow increases in type 2 diabetes mellitus patients with impaired awareness of hypoglycemia by using Doppler sonography. This was a cross-sectional study conducted from July 2021 to June 2022 in the emergency department (ED) of Inje University Busan Paik Hospital, Busan, South Korea. Patients with type 2 diabetes with complaints of various symptoms of hypoglycemia (defined as blood glucose level &lt;60 mg/dL) were evaluated for this study after obtaining their informed consent. First, we assessed each patient’s awareness of hypoglycemia using the Gold method. Cerebral blood flow was then measured on Doppler sonography. The primary outcome was blood flow in both internal carotid arteries, and secondary outcomes included the diameter and time-averaged maximum velocity of both internal carotid arteries. A total of 132 patients were enrolled in the study, but 11 patients were excluded from analysis. Hypoglycemia was associated with increased cerebral blood flow in those with impaired awareness of hypoglycemia, but this association was not observed in other groups. The blood flow in the left internal carotid artery was significantly higher compared to the right side, perhaps due to the anatomical differences between the two arteries. The increased cerebral blood flow could be due to an adaptive response to hypoglycemia to enhance nutrient supply to the brain. However, given that this was a cross-sectional study, causality could not be determined. Thus, as in type 1 diabetes mellitus, hypoglycemia is associated with an increased cerebral blood flow in type 2 diabetes mellitus as well.

Aortic Steal Correlates with Acute Organ Dysfunction and Short-Term Outcomes in Neonates with Vein of Galen Malformation

Plain Language SummaryVein of Galen malformation is a rare, congenital intracerebral arteriovenous malformation with high morbidity and mortality in neonatal manifestation despite modern interdisciplinary strategies. Currently, there is no valid, noninvasive parameter for early prediction of clinical progression at the bedside. A typical finding of hemodynamically relevant vein of Galen malformation is flow reversal in the descending aorta (aortic steal). Therefore, we developed a new ultrasound method to quantify the percentage of reflux in the preductal aortic isthmus and integrated the measurement method into routine clinical practice. In this study, we retrospectively investigated the association between percentage of aortic steal, organ dysfunction parameters, mortality, and brain injury on magnetic resonance imaging (MRI) at baseline and follow-up in 12 neonates with vein of Galen malformation admitted between January 2021 and June 2022. Statistical analyses showed that the severity of organ dysfunction, mortality, and brain damage on MRI increased with increasing percentage of aortic steal. These correlations and associations showed a linear relationship between percentage reflux in the aortic isthmus and all outcome parameters. The potential of sonographically determined aortic steal to predict clinical progression and short- and long-term outcomes needs to be investigated in larger, prospective cohorts. If this marker proves as promising as the data from this study suggest, it could become an important diagnostic component for management and decision-making in critically ill neonates with vein of Galen malformation.

Ultrasonographic Screening of Dairy Cows with Normal Uterine Involution or Developing Postpartum Uterine Disease Using B-Mode, Color, and Spectral Doppler.

Uterine involution, ovarian activity, and incidence of postpartum uterine disease (PUD) were assessed in forty-eight dairy cows from calving until the 10th postpartum week. Postpartum follow-up included evaluation of uterine involution and ovarian structures by B-mode, Doppler color, and Doppler spectral ultrasound of the right uterine artery in cows with no calving or postpartum uterine problems (healthy cows). Data from cows that developed PUD (PUD cows) were compared with healthy cows matched by herd and days in milk (DIM). Data were analyzed by descriptive statistics, simple regression, one-way ANOVA, or repeated ANOVA measures, and in data analysis of healthy cows, uterine horn diameter assessed by B-mode ultrasound ranged from 22.9 ± 2.4 to 19.4 ± 1.4 mm and 19.9 ± 2.2 to 20.5 ± 2.3 mm from the fourth to the seventh postpartum week in the left and right uterine horns, respectively (P > 0.05). During the study, 15 and 7 cows had corpus luteum in the left and right ovaries, respectively. The mean time for the first postpartum CL was 30.1 ± 3.2 DIM (min 8, max 67 DIM). In data analysis of PUD cows, uterine blood flow assessed by color Doppler ranged from 7.4 ± 4.0 to 43.75 ± 10.3% in cows that developed PUD compared to 16.7 ± 11.0% in healthy cows (P > 0.05). No statistically significant changes were found in resistance index, pulsatility index, time-averaged maximum velocity, time-averaged mean velocity, or diastole/systole ratio (D/S) in cows that developed PUD compared to healthy cows (P > 0.05). Finally, no correlation was found between Doppler spectral parameters and uterine involution (P > 0.05). Our data suggest that cows receiving transition diets and exhibiting normal calving undergo a rapid macroscopic uterine involution and ovarian follicular dynamics resumption. Complete ultrasound evaluation provides valuable data for assessing uterine involution in postpartum dairy cows.

Influence of the channel bed slope on Shannon, Tsallis, and Renyi entropy parameters

Abstract Velocity distribution plays a fundamental role in understanding the hydrodynamics of open-channel flow. Among a multitude of approaches, the entropy-based approach holds great promise in achieving a reasonable characterisation of the velocity distribution. In entropy-based methods, the distribution depends on a key parameter, known as the entropy parameter (a function of the time-averaged mean velocity and maximum velocity), that relates to channel characteristics, such as channel roughness and channel bed slopes. The entropy parameter was regarded as constant for lack of experimental evidence, which would otherwise demonstrate if it had any correlation with channel properties. A series of experiments were conducted to collect velocity data in the laboratory flume for seven different values of the channel bed slope. The experimental data analysis revealed dissimilar fluctuations in entropy parameter values with varying bed slopes, with the lowest coefficient of variation in Renyi's (∼0.5%) and the highest in Shannon's case (∼10%). Performance evaluation of the predicted results substantiated good accuracy for all three entropies with the best results of Renyi entropy and lent strong support for using a constant (overall average) value of the entropy parameter for a specific channel cross-section rather than separate values for each channel bed slope.

The effect of 50 GR oral glucose tolerance test on fetal celiac artery and superior mesenteric artery doppler parameters in healthy pregnancies.

To understand the effect of 50-g oral glucose tolerance test (OGTT) on fetal celiac artery and superior mesenteric artery (SMA) doppler parameters. A total of 43 healthy pregnant women followed inour hospital were included in the study. All doppler parameters of the celiac artery and SMA (PSV:Peak systolicvelocity; PI:Pulsatility index; RI:Resistance index, S/D:Systolic/diastolic ratio; TAMAX:Time average maximum velocity) were obtained by ultrasonography before and 1 h after OGTT. The mean PSV value of the celiac artery decreased statistically significantly after OGTT (37.29±11.96 cm/s; 29.51±10.07 cm/s; p=0.002). While the mean of the PI was 2.09±0.57 before the test, it was found to be 1.84±0.64 afterthe test (p=0.027). Mean PSV (39.82±13.07 cm/s; 35.19±15.27 cm/s; p=0.104) and PI (2.21±0.65; 2.11±0.80; p=0.375) values of SMA were also found to be decreased without statistically significancy. The data obtained from our study reveals that the PSV and PI values of celiac artery and SMA slightly decrease after OGTT.

Administration of Estradiol Benzoate Enhances Ovarian and Uterine Hemodynamics in Postpartum Dairy Buffaloes.

The postpartum (PP) period is a crucial stage for the resumption of reproductive performance and ovarian cyclicity in dairy buffaloes. The present study aimed, for the first time, to assess the effect of the administration of estradiol benzoate (EB) on ovarian and uterine hemodynamics in PP dairy buffaloes. Eight pluriparous acyclic domestic buffaloes were enrolled in the present experiment and received a dose of 10 mg of estradiol benzoate (EB) intramuscularly 4 weeks after parturition. All animals were examined two times before EB administration (days -3, and -1) and on the day of EB administration (day 0), followed by examinations on days 1, 3, 5, 7, and 9 post-EB administration. The middle uterine artery (MUA) and ovarian artery (OA) blood flow patterns were assessed using a color Doppler ultrasound device. The reproductive parameters were (1) the cross-sectional diameters (cm) of the OA and MUA, (2) cranial uterine horn thickness (UHT; cm), and (3) hemodynamic changes within the MUA on both the ipsi- and contra-lateral sides of the previous pregnant horn and within the OA corresponding to the ovarian tissues. The examined blood flow parameters were the pulsatility index (PI), resistance index (RI), peak systolic/end-diastolic ratio (S/D), time-averaged maximum velocity (TAV; cm/s), uterine blood flow rate (BFR; bpm), and uterine blood flow volume (BFV; mL/min). Concomitantly, blood samples were collected from the coccygeal vein, and the sera were stored at -18 °C for use in estradiol (E2-17β) and nitric oxide (NO) assays. The results revealed increases in both OA and MUA cross-sectional diameter (cm) on the ipsi-lateral and contra-lateral (p < 0.05) sides within 24 h until day 9 post-treatment. The values of the RI and PI of blood flow within the OA and MUA on the ipsi-lateral and contra-lateral sides of the previous pregnancy were obviously lower (p < 0.05) at 24 h after the administration of EB, and then, started to gradually elevate, reaching the pre-treatment values on day 9 after EB administration. Both the BFR and BFV in the OA and MUA significantly increased from 24 h to 72 h after EB administration on both the ipsi-lateral and contra-lateral sides (p < 0.05); then, their values started to decrease to reach the pretreatment value on day 9 after EB administration. Both E2 and NO concentrations significantly increased (p < 0.05) from 24 h until day 3 after EB injection and then started to decline after that, reaching the pre-treatment value on day 9. In conclusion, the administration of EB enhances the ovarian and uterine blood flow concomitantly with increased levels of NO in PP dairy buffaloes.

Doppler ocular ultrasound in patients with type 2 diabetes mellitus

Purpose: To determine ocular blood flow parameters by Doppler ultrasound scanning in type 2 diabetic patients with different stages of diabetic retinopathy. Material and Methods: In this prospective study, forty-five patients (90 eyes) with type 2 diabetes mellitus were divided into three groups of 15 patients each: no diabetic retinopathy group (DR0), non-proliferative retinopathy (NPDR), and proliferative retinopathy (PDR) groups. Doppler indices such as systolic blood flow velocity (Vs), diastolic blood flow velocity (Vd), time-averaged maximum velocity (TAMXV), pulsatility index (PI) and resistivity index (RI) in the ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary arteries (SPCA) were determined. ANOVA was used for quantitative comparisons between the three groups. Results: There was a significant (р less 0.05) decrease in (a) the Vs from 71.1 +- 20.6 cm/s in the DR0 group to 59.9 +- 16.7 cm/s in the NPDR group and 47.4 +- 16.4 cm/s in the PDR group, (b) Vd from 22.1 +- 6.9 cm/s to 17.0 +- 6.6 cm/s and 12.3 +- 5.9 cm/s, respectively; and (c) TAMXV from 37.2 +- 11.3 cm/s to 31.9 +- 9.1 cm/s and 25.3 +- 9.7 cm/s, respectively, and an increase in the RI from 0.69 +- 0.06 cm/s to 0.71 +- 0.09 cm/s and 0.75 +- 0.08 cm/s, respectively, in the OA. In addition, there was a significant decrease in the Vd from 9.9 +- 5.4 cm/s in the DR0 group to 8.1 +- 3.8 cm/s in the NPDR group and 5.5 +- 3.1 cm/s in the PDR group, and an increase in the PI from 1.34 +- 0.16 cm/s to 1.46 +- 0.28 cm/s and 1.54 +- 0.24 cm/s, respectively, and in the RI from 0.71 +- 0.06 cm/s to 0.75 +- 0.07 cm/s and 0.80 +- 0.05 cm/s, respectively, in the CRA. Moreover, there was a significant decrease in the Vd from 4.3 +- 1.6 cm/s in the DR0 group to 3.2 +- 2.0 cm/s in the NPDR group and 3.1 +- 2.2 cm/s in the PDR group, and an increase in the PI from 1.32 +- 0.21 cm/s to 1.37 +- 0.24 cm/s and 1.54 +- 0.26 cm/s, respectively, and in the RI from 0.76 +- 0.04 cm/s to 0.82 +- 0.06 cm/s and 0.82 +- 0.06 cm/s, respectively, in the SPCA. Conclusion: We found that the arteries examined in patients with diabetic retinopathy tended to have decreased blood flow velocities and increased resistivity and pulsatility indices, with the greatest changes observed in patients with PDR. In addition, the difference in mean values of most Doppler indices between the PDR and NPDR groups was larger than that between the NPDR and DR0 groups.

The Fetal Liver Afferent Venous Flow Volumes in Fetuses With Appropriate for Gestational Age Birth Weight.

The present study aimed: 1) to simultaneously investigate the relationship between blood flow volumes of the two fetal liver afferent venous systems of normally appropriate for gestational age newborns. 2) to establish the normal reference range centiles values that will serve as a basis for future investigations. A cross-sectional, prospective study of singleton low obstetric risk pregnancies. Doppler examination included the measurement of the umbilical and the main portal vein vessels' diameters and time-averaged maximum velocity. The absolute and per kilogram of estimated fetal weight flow volumes and the ratio between the placental and portal blood volume flow were calculated from these data. Three hundred and sixty-three pregnant women were included in the study. The umbilical and portal flow volumes' capacity to provide blood flow per kilogram of fetal weight, in the period of maximum fetal growth, was diverse. The placental flow decreased continuously from a mean of 121.2 mL/min/kg at the 20th week of gestation to 64.1 mL/min/kg at the 38th week of gestation. Meanwhile, the portal flow volume per kilogram of fetal weight increased from 9.6 mL/min/kg at 32 weeks of gestation to 10.3 at the 38th week of gestation. This resulted in a decrease in the umbilical to portal flow volume ratio from 13.3 to 9.6 during this period. Our results indicate that in the period of maximum fetal growth, the placental/portal ratio diminishes emphasizing the portal flow's predominance with low oxygen and nutrient supply to the liver.

Effect of Acute Melatonin Injection on Metabolomic and Testicular Artery Hemodynamic Changes and Circulating Hormones in Shiba Goats under Sub-Tropical Environmental Conditions.

The beneficial effects of melatonin were investigated to mitigate various detrimental effects and toxicity on reproductive performance. The present study aimed, for the first time, to explore the effect of intravenous melatonin injection on testicular artery hemodynamics (TH) and metabolomic changes, reproductive hormones in heat-stressed bucks. Ten bucks were randomly split into two groups (five each): (1) the melatonin group, treated with a single intravenous dose of melatonin solution containing 10 mg melatonin each, and (2) the control group, which was treated with 10 mL of the vehicle without melatonin. Changes in the TH at the level of the supra testicular artery (STA) were assessed by triplex ultrasonography just before (0 h) and at 0.5, 2, 7, 24, and 168 h after melatonin or vehicle administration. Doppler velocity parameters of peak systolic velocity (PSV; cm/s), end-diastolic velocity (EDV; cm/s), and time average maximum velocity (TAMAX; cm/s) were measured. Doppler indices (resistive index; RI and pulsatility index; PI), systole/diastole (S/D) ratio and total arterial blood flow volume (TABFV; ml/minute) were measured. Peripheral concentrations of FSH, LH, inhibin, melatonin, testosterone (T), estradiol (E2), and cortisol were measured just before injection (0 h) and at 0.5, 2, 7, and 24 h and daily up to day 7 post administration in both groups. Results revealed reductions in the RI values and increases in the TABFV in the melatonin group compared to the control one, especially 2 h after administration. Significant increases in concentrations of FSH, T, E2, and melatonin and decreases in cortisol and inhibin in the melatonin group compared to the control one. Plasma metabolomic analysis at 2 h indicated the up-regulation of L-glutamine, L-arginine, sorbitol, D-glucose, ascorbic acid, and ornithine and the down-regulation of D-xylose, D-arabitol, ribitol, and oleic acid in the melatonin versus the control group. In conclusion, acute administration of melatonin (10 mg IV) enhanced testicular artery blood flow and plasma reproductive hormones in the Shiba goat under heat-stress circumstances.

Fetal pulmonary artery Doppler blood flow velocity measures and early infant lung function. A prospective cohort study

Background Reduced lung function at birth has evident antenatal origins and is associated with an increased risk of wheezing and asthma later in life. Little is known about whether blood flow in the fetal pulmonary artery, may impact postnatal lung function. Objective Our primary aim was to investigate the potential associations between fetal Doppler blood flow velocity measures in the fetal branch pulmonary artery, and infant lung function by tidal flow-volume (TFV) loops at three months of age in a low-risk population. Our secondary aim was to explore the association between Doppler blood flow velocity measures in the umbilical and middle cerebral arteries, and the same lung function measures. Methods In 256 non-selected pregnancies from the birth cohort study Preventing Atopic Dermatitis and ALLergies in Children (PreventADALL) we performed fetal ultrasound examination with Doppler blood flow velocity measurements at 30 gestational weeks (GW). We recorded the pulsatility index, peak systolic velocity, time-averaged maximum velocity, acceleration time/ejection time ratio, and time velocity integral primarily in the proximal pulmonary artery close to the pulmonary bifurcation. The pulsatility index was measured in the umbilical and middle cerebral arteries and the peak systolic velocity in the middle cerebral artery. The cerebro-placental ratio (ratio between pulsatility index in the middle cerebral and umbilical arteries) was calculated. Infant lung function was assessed using TFV loops in awake, calmly breathing three months old infants. The outcome was the time to peak tidal expiratory flow to expiratory time ratio (t PTEF/t E), t PTEF/t E <25th percentile, and tidal volume per kg body weight (V T/kg). Potential associations between fetal Doppler blood flow velocity measures and infant lung function were assessed using linear and logistic regressions. Results The infants were born at median (min - max) 40.3 (35.6 − 42.4) GW, with a mean (SD) birth weight of 3.52 (0.46) kg, and 49.4% were females. The mean (SD) t PTEF/t E was 0.39 (0.1) and the 25th percentile was 0.33. Neither univariable nor multivariable regression models revealed any associations between fetal pulmonary blood flow velocity measures and t PTEF/t E, t PTEF/t E <25th percentile, or V T/kg at three months of age. Similarly, we did not observe associations between Doppler blood flow velocity measures in the umbilical and middle cerebral arteries and infant lung function measures. Conclusion In a cohort of 256 infants from the general population, fetal third-trimester Doppler blood flow velocity measures in the branch pulmonary, umbilical, and middle cerebral arteries were not associated with infant lung function measures at three months of age.

Impact of rigid cervical collars on the vital signs and cervical vasculature: Should we be on the alert for anything?

ObjectiveIn this study, it was aimed to reveal the effect of RCC application on vital signs and physiology of the neck vascular structures. MethodsThe study was designed as a prospective interventional study on 11 volunteers. The factors that would affect the hemodynamics of the volunteers were standardized before the measurements. The vital signs before and after RCC were measured and under the guidance of ultrasonography (USG), internal jugular vein cross-sectional area (CSA), diameter of the common carotid artery (CCAD), peak systolic velocity (PSV). end-diastolic velocity (EDV), time-averaged maximum velocity (TAMAX), Pulsatility Index, Resistivity Index, time averaged mean velocity (TAMEAN), Volume Flow (FV) measurements were made and compared with each other. ResultsAmong 11 volunteers, the study included 5 women (45.5%). 10 min of RCC application was associated with a reduction of the heart rate by 7.9 bpm (95% CI 4.84–10.98) (pre-collar 74.73 + −8.84, post-collar 66.82 + −9.05, p < 0.001). A corresponding 7.18 mmHg (95% CI 2.11–12.25) decrease in systolic blood pressure (pre-collar mean 115.82 mmHg + −12.55, post-collar mean 108.64 mmHg + −11.46, p = 0.01) and 108.55 mL/min reduction of mean common carotid artery blood volume (95% CI 22.28–194.82) (pre-collar 590.14 mL/min + −194.63, post-collar 481.59 mL/min + −279.36, p = 0.019) were noted. Internal jugular vein CSA has decreased for 0.17 cm2 (95% CI 0.05–0.29) (pre-collar CSA 0.53 + −0.29, post-collar CSA 0.36 + −0.17, p = 0.012). ConclusionIn healthy volunteers, RCC application lasting for ten minutes may reduce systolic blood pressure and heart rate, while decreasing blood volume in both the common carotid artery and the internal jugular vein. It has also been noted that the collapse is larger in the internal jugular vein than in the common carotid artery following the pressure applied by RCC.

Differences in umbilical vein predict placental sharing and outcome in monochorionic twins with selective growth-restriction

To examine the association between umbilical venous diameters and flow with placental sharing and adverse outcomes in monochorionic twin pregnancies diagnosed with selective fetal growth restriction (sFGR). The venous placental territory determines the oxygenated blood flow to the fetuses. Unequal placental sharing is considered the main contributor but is not yet quantifiable during pregnancy. Prospective cohort study of monochorionic diamniotic twin pregnancies diagnosed with sFGR. The following ultrasound variables were measured: intra-abdominal and free loop diameter of the umbilical vein (UV), estimated fetal weight (EFW), and cord insertions. The time-averaged maximum velocity in the intra-abdominal UV was measured and used to calculate UV-flow. Ratios (larger/smaller twin) were used for analysis. Adverse outcome was defined as the occurrence of fetal demise or birth before 34 weeks. We included 102 consecutive sFGR pregnancies, of which 88 placentas (86%) underwent injection studies with barium sulfate. The overall survival was 89%: 7 cases with single fetal demise (7%), 5 with double demise (5%), and 5 neonatal deaths (5%) occurred. Univariable linear regression analysis showed a significant association for all of the variables with placental sharing. In multivariable analysis, the UV-variables and a discordant cord insertion remained significantly associated with placental sharing. EFW differences and a concordant or intermediate cord insertion were not significantly associated with placental sharing. Logistic regression and receiver operating characteristics curve analysis demonstrated that EFW discordance and the cord insertion site had a poor predictive accuracy for an unequally shared placenta or an adverse outcome. In contrast, the predictive accuracy of the UV-variables was fair. Differences in UV-diameter and flow between the twins at the time of sFGR diagnosis inform us of the placental sharing, more so than differences in EFW. Differences in UV-variables between the twins also seem to increase the risk of fetal demise and birth before 34 weeks.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Особливості мозкового кровотоку у пацієнтів з різними видами головного болю

Introduction. Currently, the most common types of neurological diseases presenting with headache are migraine (M), tension-type headache (TTH) and cervicogenic headache (CH). At the current level, the use of such a highly informative method as duplex scanning in the diagnosis of various types of headache is relevant. A large number of works are devoted to the study of cerebral hemodynamic disorders in patients with migraine with and without aura, in the period between attacks and during an attack. In patients with M, a change in the tone of the vessels of the arterial bed, an increase in interictal hypotension, a decrease in cerebral blood flow reserves, and the phenomenon of venous dysemia were determined. Paradoxical vascular reaction and disruption of autoregulation were noted in patients with TTH. Hemodynamic characteristics of TTH were signs of increased tone in extracranial arteries and decreased tone in intracranial vessels; decrease in cerebral blood flow reserves; signs of venous dyscirculation. In patients with CH the most pronounced changes in hemodynamics in the form of a decrease in speed and an increase in blood flow kinematic indices are observed in VA and BA. Also, in patients with CH, there is a correlation between the severity of vertebral dysfunction and cerebral dysgemia In the available works, hemodynamic patterns characteristic of certain types of headache were not determined. Nor was a comparison of hemodynamic characteristics in patients with M, TTH and CH. In connection with the above, the question of the role of vascular factors is relevant for the study of pathogenetic mechanisms of the development of various types of headache. The aim of the work was to study the features of blood circulation in extra- and intracerebral vessels in patients with migraine, tension type headache and cervicogenic headache. Materials and methods. 458 young patients (16-44 years old, men – 203, women – 255) with various types of headache were studied; including migraine – 124 patients, tension type headache – 186 patients, cervicogenic headache – 146 patients. The indicators of peak systolic blood flow velocity (Vs), time-averaged maximum blood flow velocity (TAMX), pulsatility (PI) and resistance (RI) indices in general (CCA), external (ECA), internal carotid (ICA), vertebral (VA) in segments V2 and V4, anterior (ACA), middle (MCA), posterior (PMA) cerebral, and basilar (BA) arteries were studied The results. In all clinical groups, there was a decrease in speed indicators and an increase in the values of the resistance index in VA. Changes in hemodynamics in the V2 segments are possibly due to extravasal compression and hypoplasia of the VA. In patients with M, the flow rate along the MCA was significantly increased. Patients with TTH showed excessive perfusion of BA. Pulsation index in MCA was increased in TTH and in M. PI values in patients with TTH were moderately increased in PMA and BA. In patients with M and TTH an increase in the PI index was observed in the MCA, the PI index was increased in the PMA in patients with CH and decreased in the groups with M and TTH. This index was increased in VA and BA in all clinical groups. In the group of patients with M, the peak-like variant of the spectrum in MCA prevailed. A characteristic feature of the group of patients with CH was the dominance of the peak-like spectrum in VA. Conclusions. Hemodynamic indicators in the extracranial segments of VA were reduced in all clinical groups, which is probably caused in most cases by vertebral impact and structural changes. Patterns of excessive perfusion in MCA were characteristic for patients with M and TTH, in PMA – for patients with M, in VA – for patients with CH, in BA – for patients with M and CH. In the group of patients with CH, the leading hemodynamic pattern was the presence of vasospastic reactions in the vertebral vessels. Pulsation indices increased in patients with TTH in MCA, as well as in patients with CH in PMA and BA. The predominance of the peak-like spectrum of the Doppler curve was noted in MCA in patients with M and in VA in patients with CH.

Altered Right Portal and Umbilical Vein Doppler Parameters in Fetal Macrosomia Resulting from Pregestational andGestational Diabetic Mothers: A Prospective Case-Control Study

Objective: To evaluate the blood flow of the umbilical vein and right portal vein in macrosomic fetuses of diabetic mothers and investigate the effect of maternal insulin treatment on these blood flows. Material and Methods: This prospective case-control study was conducted between March 2019 and December 2019. Fetuses of the 49 pregestational and gestational diabetic mothers who had an abdominal circumference percentile above 97% were evaluated as macrosomic and formed the study group. The study group was divided into two subgroups: patients treated with insulin and those who did not. In the control group, 48 non-diabetic pregnant women with matched gestational weeks whose fetuses are at the 10-90% percentile were included. Time-averaged maximum blood velocity (TAMXV) values of the right portal vein and the free loop of the umbilical vein were measured. Results: The median right portal vein TAMXV value and umbilical vein TAMXV value were found to be significantly higher in diabetic pregnancies (16.25 cm/s, and 15.28 cm/s, respectively) than in the control group (12.76 cm/s, and 13.38 cm/s, respectively, p<0.001). Umbilical and right portal vein flows were similar in macrosomic fetuses of diabetic mothers who were treated with insulin or those who did not. While umbilical vein flow in macrosomic fetuses increased as the gestational age progressed (p=0.028), it was observed steadily in normally growing fetuses. Conclusion: The umbilical and right portal vein flows are higher in macrosomic fetuses of diabetic mothers than in appropriately grown fetuses. Maternal insulin treatment does not affect fetal umbilical vein and right portal vein blood flow in macrosomic fetuses.

Does umbilical venous diameter or time-averaged maximum velocity correlate better with fetal outcome in growth-restriction?

Does umbilical venous diameter or time-averaged maximum velocity correlate better with fetal outcome in growth-restriction?

Correction of fetal umbilical vein flow imbalance following laser surgery for twin-twin transfusion syndrome.

Twin-twin transfusion syndrome (TTTS) is characterized by unequal hemodynamics between the twins. We aimed to assess preoperatively the difference in umbilical vein flow (UVF) between the recipient and donor monochorionic diamniotic twins and evaluate the change in UVF following laser surgery in both twins. This was a retrospective cohort study of differences in UVF that occurred following laser surgical treatment of TTTS. Sonographic assessment of the umbilical vein before and 24 h after fetoscopic laser surgery for TTTS was performed. Umbilical vein diameter and time-averaged maximum velocity were measured, and UVF per kg (UVF/kg) was converted into a Z-score by a calculator created using gestational age as an independent variable. Z-score values were converted into centiles, which were evaluated statistically. Median differences in UVF/kg centile values were adjusted for TTTS stage and presence of arterioarterial anastomoses. The study population consisted of 363 TTTS patients. The adjusted preoperative median difference in UVF/kg centile between the recipient vs donor twin was 17.9% (-17.1% to 57.6%), P < 0.0001. The adjusted median difference in UVF/kg centile between the postoperative vs preoperative period among recipients was 2.2% (-10.8% to 13.8%), P < 0.0001, while the adjusted median difference among donors was 27.3% (8.2%-34.6%), P < 0.0001. The preoperative difference in UVF between the recipient and donor twins confirms the pathophysiology of TTTS. Postoperatively, the substantial increase in UVF of the donor twin and the relatively small increase in UVF of the recipient twin confirm that ablation of the vascular communications resulted in rapid improvement in perfusion of the donor twin. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Classification of Vascular Hotspots and Micro-Vessel Flow Velocity Waveforms in Low-Grade Squamous Intraepithelial Lesions and HPV Condyloma of the Cervix.

To assess hotspot micro-vessel flow velocity waveforms in human papillomavirus (HPV) cervical infections using transvaginal power Doppler ultrasound (TV-PDU) and to explore the associations of these sonographic parameters with HPV condyloma and low-grade squamous intraepithelial lesions (LSIL) of the cervix. A total of 39 patients with cervical HPV infections with abnormal cytology and colposcopy results (26 cases of LSIL; 13 cases of HPV condyloma) were enrolled to assess the vascular classification of the cervix and micro-vessel flow velocity using TV-PDU before treatment; 40 individuals with a pathologically normal cervix were used as the control group; seven parameters were measured, including vascular grading classification (Class I, Class II, and Class III), lowest pulsatility index (PI), resistance index (RI), peak systolic velocity (PS), end-diastolic velocity (ED), time average maximum velocity (TAMV), and the vascular index (VI = PS/ED). According to vascular classification, most LSILs were class I (69.2%, 18/26), followed by class II (26.9%, 7/26) and class III (3.8%, 1/26). Most HPV condylomas were class I (92.3%, 12/13), and one was class II (7.7%, 1/13). PI, RI, VI (p < 0.0001), and the PSs (p < 0.05) were significantly lower in these cases than in the controls. The ED and TAMV were not significantly different between the patients and controls (p = 0.4985 and p = 0.1564). No sonographic parameter was significantly different between LSIL and HPV condyloma. The mean PI, RI, and VI were significantly lower in LSIL than in the controls. For HPV condyloma, a PI of 1.07 had an 84.6% sensitivity, 85.0% specificity, and an AUC of 88.8%; for LSIL, a PI of 1.08 had a 100% sensitivity, 85% specificity, and an AUC of 94.2%; for HPV infection (HPV condyloma + LSIL), a PI of 1.08 had a 94.9% sensitivity, 85% specificity, and an AUC of 92.4%. Hotspot vascular classification and micro-vessel flow velocity waveforms may provide a potential practical method for the auxiliary diagnosis of cervical HPV infection. The PI may represent a valuable index for distinguishing the micro-vessel flow velocity waveforms in LSIL and HPV condyloma. Since the case numbers were limited in the current study, further validation is needed.

Umbilical venous diameter and flow in monochorionic diamniotic twin pregnancy: association with placental sharing and fetal demise.

To examine the association of umbilical venous diameter and flow in monochorionic diamniotic twin pregnancy with placental sharing and fetal demise. This was a prospective longitudinal cohort study of a consecutive series of monochorionic diamniotic twin pregnancies that underwent ultrasound assessments at 12, 16, 20 and 28 weeks' gestation. Fetal biometry (crown-rump length at 12 weeks or estimated fetal weight (EFW) thereafter) and cord insertion sites were recorded at each visit, as well as the diameter of the umbilical vein (UV) in both the intra-abdominal part and a free loop of the umbilical cord. Time-averaged maximum velocity in the intra-abdominal part of the UV was measured to calculate UV-flow. Univariate and multivariate linear regression analyses were performed to assess the relationship between intertwin ratios of these variables and placental sharing at 12, 16, 20 and 28 weeks' gestation. Placental sharing was calculated by dividing the larger by the smaller placental share, as measured on placental injection studies after birth. Additionally, the Mann-Whitney U-test and receiver-operating-characteristics-curve analysis were used to explore the relationship between the occurrence of fetal demise and intertwin differences in fetal biometry, cord insertion sites, UV diameters and flow at 12, 16, 20 and 28 weeks. Of 200 consecutive monochorionic twin pregnancies enrolled, injection studies were performed in 165 (82.5%) placentas. On univariate analysis, intertwin differences in fetal biometry, cord insertions and UV variables were associated significantly with placental sharing at 12, 16, 20 and 28 weeks' gestation. On multivariate analysis, intertwin differences in fetal biometry, cord insertions and all three UV variables remained associated significantly with placental sharing at 12 and 16 weeks. However, at 20 and 28 weeks, only the intertwin EFW ratio was associated consistently with placental sharing. Fetal demise of one or both twins complicated 26 (13.0%) pregnancies. Differences in EFW and cord insertion sites were not associated significantly with fetal demise, while at 16 weeks, differences in intra-abdominal UV diameter and flow were associated with an increased risk of subsequent fetal demise. At 12 and 16 weeks' gestation, intertwin differences in UV diameter and flow reflect placental sharing more accurately than do differences in fetal growth and cord insertion sites. At 16 weeks, discordance in intra-abdominal UV diameter and flow is also associated with an increased risk of fetal demise. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.