Shear Wave Research Articles

Novel subharmonic-aided pressure estimation for identifying high-risk esophagogastric varices.

Subharmonic-aided pressure estimation (SHAPE) is a technique for determining changes in ambient pressure. We aimed to analyze a novel SHAPE integrated into ultrasound diagnostic equipment to predict patients with liver cirrhosis at high risk of esophagogastric varices (EV). This prospective study included 111 patients with liver cirrhosis diagnosed between 2020 and 2023. We obtained liver stiffness measurements (LSM) and spleen stiffness measurements (SSM) using shear wave elastography and hepatic vein-portal vein (HV-PV) gradient using the SHAPE method. The EV risk was determined either as null, low, or high by esophagoscopy and Child-Pugh stage. HV-PV gradient increased concordantly with the increase in EV risk (-7.0dB in null-risk, -4.4dB in low-risk, and -2.0dB in high-risk) with statistically significant difference among any two groups. The most appropriate cut-off value of the HV-PV gradient was -3.5dB, and sensitivity, specificity, and positive and negative predictive values were 80.0%, 89.0%, 80.0%, and 88.0%, respectively. The areas under the curve values for predicting the high-risk EV were 0.920, 0.843, and 0.824 for the HV-PV gradient, LSM, and SSM, respectively. The novel SHAPE system demonstrated high accuracy in identifying patients with liver cirrhosis at a high risk of EV.

Fisher discriminant analysis of multimodal ultrasound in diagnosis of cervical metastatic lymph nodes in papillary thyroid cancer.

The purpose of this study was to develop a diagnostic model utilizing multimodal ultrasound parameters to aid in the detection of cervical lymph node metastasis in papillary thyroid cancer (PTC) patients. The study included 84 suspicious lymph nodes from 69 PTC patients, all of whom underwent fine needle aspiration with pathological results. Data from conventional grayscale ultrasound, shear wave elastography (SWE), and superb microvascular imaging were analyzed. Key ultrasound features were compared between benign and metastatic groups to create a diagnostic model using Fisher's stepwise discriminant analysis. The model's effectiveness was assessed with self-testing, cross-validation, and receiver operating characteristic curve analysis. Four features, namely lymphatic hilum (X1), cortical hyperechogenicity (X2), vascular pattern (X4), and SWEmean (X7), were integral to the discriminant analysis, resulting in the equation: Y1 = -3.461 + 2.423X1 + 0.321X2 + 1.620X4 + 0.109X7, Y2 = -8.053 + 0.414X1 + 2.600X2 + 2.504X4 + 0.192X7. If Y1 < Y2, the LN would be diagnosed as metastatic lymph nodes. The model demonstrated an area under the curve of 0.833, with a sensitivity of 83.33% and specificity of 83.33%. The multimodal ultrasound diagnostic model, established through Fisher's stepwise discriminant analysis, proved effective in identifying metastatic lymph nodes in PTC patients.

The Value of Elastography in the Detection of Prostate Cancer – Clinical Experience

The aim of this study was to evaluate the efficacy of real-time shear wave elastography (SWE) in prostate cancer diagnosis in patients with elevated prostate-specific antigen values and abnormal results on digital rectal examination. This study included 74 patients (mean age 68.3 years) with suspected prostate cancer – prostate-specific antigen&gt;4 ng/mL and abnormal digital rectal examination. All patients scheduled for transrectal ultrasound biopsy of the prostate underwent standard transrectal ultrasonography and SWE. The reported sensitivity and specificity of SWE in the various studies varied widely, from 43–96% and 33–96%, respectively. This study showed that patients with elevated levels of prostate-specific antigen, abnormal digital rectal examination, and negative SWE may not require a biopsy which could significantly reduce the number of biopsies performed.

Firn seismic anisotropy in the Northeast Greenland Ice Stream from ambient-noise surface waves

Abstract. We analyse ambient-noise seismic data from 23 three-component seismic nodes to study firn velocity structure and seismic anisotropy near the EastGRIP camp along the Northeast Greenland Ice Stream (NEGIS). Using nine-component correlation tensors, we derive dispersion curves of Rayleigh and Love wave group velocities from 3 to 40 Hz. These velocity distributions exhibit anisotropy along and across the flow. To assess these variations, we invert dispersion curves for shear wave velocities (Vsh and Vsv) in the top 150 m of the NEGIS using a Markov chain Monte Carlo approach. The reconstructed 1-D shear velocity model reveals radial anisotropy in the firn, with Vsh 12 %–15 % greater than Vsv, peaking at the critical density (550 kg m−3). We combine density data from firn cores drilled in 2016 and 2018 to create a new density parameterisation for the NEGIS, serving as a reference for our results. We link seismic anisotropy in the NEGIS to effective and intrinsic causes. Seasonal densification, wind crusts, and melt layers induce effective anisotropy, leading to faster Vsh waves. Changes in firn recrystallisation cause intrinsic anisotropy, altering the Vsv / Vsh ratio. We observe a shallower firn–ice transition across the flow (≈ 50 m) compared with along the flow (≈ 60 m), suggesting increased firn compaction due to the predominant wind direction and increased deformation towards the shear margin. We demonstrate that short-duration (9 d minimum), passive, seismic deployments and noise-based analysis can determine seismic anisotropy in firn, and we reveal 2-D firn structure and variability.

Significant spatial variation of upper crustal anisotropy in Southern Sichuan Basin, China: constraints from local shear wave splitting analysis

Summary The recent upsurge in seismic activity within the southern Sichuan Basin has garnered considerable public attention and simultaneously offers a valuable opportunity for investigating upper crustal anisotropy. Such investigations can provide critical insights into the stress field and crustal deformation in the region. We obtained a total of 1 845 high-quality local shear wave splitting measurements at 15 stations and 2 027 null measurements at 19 stations. These results indicate the presence of a single layer of anisotropy with a horizontal axis of symmetry at a depth of 3 to 7 km. The fast polarization directions display discernible spatial variations that are primarily influenced by the geographical location of earthquakes rather than changes over time. In the vicinity of the Baimazhen Syncline, the fast polarization directions coincide with the strike of the stratum, forming a circular pattern around the core of the syncline, suggesting that the observed anisotropy is structure-controlled. In contrast, stations situated in the southern Weiyuan Anticline and western Baimazhen Syncline display fast directions trending N171.7° E and N45.9° E, respectively. These directions are consistent with the P-axes of the focal mechanism of earthquakes, signifying that the anisotropy in these areas is governed by the regional stress field. The findings of this study not only deepen our understanding of the intricate geological structures in the southern Sichuan Basin but also indicate the need for greater caution when interpreting potential temporal changes in anisotropy in future research.

Evaluating the performance of automatic wave speed estimators of natural shear waves to assess myocardial stiffness

Abstract Introduction Cardiac Shear Wave Elastography is an emerging non-invasive technique using ultrafast echocardiographic imaging. Natural shear waves (SW) occur after mitral valve closure (MVC) and aortic valve closure (AVC), and their propagation velocities are directly related to myocardial stiffness. However, the current assessment of SW velocities lacks a gold standard method, and relies on manual measurements with their inherent variability. Purpose To explore new automated methods for shear wave velocity estimates, aiming to achieve greater accuracy, less variability, and high feasibility. Methods To visualize shear waves, anatomical M-modes were drawn (4±1 cm) along ventricular septum in parasternal long axis views (PLAX), acquired with high-frame-rate echocardiography (1055±159 Hz). M-modes were colour coded for tissue acceleration. SWs appear as tilted green bands after MVC &amp; AVC, the slope of which represents the SW propagation velocity. One hundred-twenty different slopes from healthy volunteers (n=67) and patients (n=53) were measured manually and with 9 different automatic methods. All automatic methods were initiated by indicating the approximate position of the shear wave in the M-mode with a mouse click of the user. Measurements were repeated three times to assess measurement reproducibility. (figure 1, A). In order to determine the influence of display settings, three different acceleration colour scales were tested (0.5, 1, 2 m/s²). (Figure 1, B). Failure of correctly identifying shear waves was counted to assess feasibility. Due to the lack of a gold standard, manual measurements of an experienced reader served as reference. Results Three of nine automatic methods: Radon Transformation (RT), Regression Segmentation Maximum value (RM), Regression Segmentation Weighted Maximum (RMW), revealed the least variability with repeated measurements (0.0±0.0 m/s for all) and colour scales (0.0±0.0, 0.1±0.2 and 0.1±0.2 m/s, resp.). Those three methods showed moderate to good agreement (r=0.66, ICC 0.77 [CI 0.64- 0.85]; r= 0.67, ICC 0.75 [CI 0.50 -0.86]; and r= 0.77, ICC 0.85 [CI 0.73-0.90], resp.) with manual measurements (r=0.96, ICC 0.98 [CI 0.97- 0.99] (figure 2). Conclusion RT, RM, and RMW showed a good reproducibility while RMW showed the best agreement with manual measurements. Our data suggest, that the RMW method could offer an objective alternative for SW velocity estimations. Further research is needed to explore their applicability in clinical scenarios.

Shear wave speed, dispersion slope and anisotropy evaluation using cardiac shear wave elastography in patients with Fabry disease

Abstract Background Cardiac shear wave imaging has been proposed to investigate left ventricular myocardial alterations non-invasively. Dispersion slope and anisotropy are fundamental properties that have not been studied in Fabry disease (FD) patients yet. Purpose The aim of this study was to determine and compare shear wave propagation speed, dispersion slope and fractional anisotropy in FD patients and healthy controls. Methods We prospectively included 20 FD patients and 20 healthy controls (HC). Shear wave speed, dispersion slope and fractional anisotropy were measured non-invasively in anteroseptal basal segment using an ultrasound for cardiac shear wave imaging. Echocardiography, electrocardiogram and laboratory evaluations were performed. Results Shear wave propagation speed was higher in FD patients than in HC group (1.46 ± 0.12 m/s and 1.36 ± 0.17 m/s, p = 0.03). No difference was found in dispersion slope (11.4 m/s/kHz in FD group and 11.3 m/s/kHz in HC group, p = 0.6). Fractional anisotropy was 0.05 ± 0.04 in FD group and 0.05 ± 0.04 in HC group, p = 0.4. Conclusion Shear wave speed was higher in FD patients compared to control group. Dispersion slope and fractional anisotropy in FD group did not reveal significant difference to the control group.

Can examining shear wave elastography predict elevated filling pressures? - A comparative evaluation against the current guideline algorithm

Abstract Background The clinical assessment of left ventricular diastolic function is complex, as there is no single non-invasive parameter that provides a direct measurement of myocardial relaxation, myocardial compliance, or–as a surrogate-LV filling pressure. The estimation of diastolic function involves therefore a combination of various parameters. Shear wave (SW) elastography (SWE) is a novel method based on high frame rate echocardiography. SWs are generated following mechanical excitation of the myocardium, such as after mitral valve closure (MVC), and their propagation velocity is directly linked to myocardial stiffness (MS) and is therefore a potential marker of diastolic function. Purpose The aim of this study was to investigate if the propagation velocities of natural shear waves are related to invasively measured mid-(LVMDP) and end-diastolic LV filling pressures (LVEDP) and, thus, could be used as echocardiographic estimate of left ventricular diastolic function. Methods We prospectively enrolled 95 patients with a wide range of diastolic function, scheduled for heart catheterization so that LVMDP and LVEDP could be invasively measured. Patients with myocardial pathology or dysfunction of the anteroseptal wall, as well as severe aortic stenosis, and a more than moderate mitral regurgitation were excluded. Echocardiography was performed immediately after catheterization. SW elastography in parasternal long axis views of the left ventricle (LV) was performed using an experimental scanner (HD-PULSE) at 1040±200 frames per second. An anatomical M-mode was extracted from the midline of the LV septum and color coded for tissue acceleration. The SW propagation velocity at MVC was measured as slope on the M-mode (A). Standard echocardiographic parameters were obtained with a high-end ultrasound machine (Vivid 95, GE Vingmed Ultrasound). The algorithm for evaluating diastolic dysfunction as recommended by the European Association of Cardiovascular Imaging expert consensus 2021 was applied to categorize LV filling pressure as normal or elevated. Results SW velocities correlated significantly with both, LVMDP (r=0.47; p&amp;lt;0,001) and LVEDP (r=0.71, p&amp;lt;0.001). They could excellently detect elevated LVEDP (AUC=0.95, Sensitivity=0.92, Specificity=0.94) and detected elevated LVMDP with AUC=0.79, Sensitivity=0.87, Specificity= 0.65, similar to the guideline approach (AUC=0.78, Sensitivity=0.62, Specificity=0.94). Conclusions SW velocities, measured by high frame rate echocardiography, show a strong correlation with the end-diastolic and a good correlation with mid-diastolic filling pressures. The method could excellently distinguish normal and elevated LVEDP and could–through a single measurement-differentiate normal and elevated LVMDP as good as the current guideline algorithm with its combination of four parameters in a decision tree. Our data suggest a potential clinical value of the new method for the non-invasive assessment of diastolic function.

Breast cancer imaging-clinical experience with two-dimensional-shear wave elastography: A retrospective study.

Breast cancer morbidity has been increasing worldwide, but treatments are improving. The therapeutic response depends on the stage at which the disease is diagnosed. Therefore, early diagnosis has never been more essential for successful treatment and a reduction in mortality rates. Radiology plays a pivotal role in cancer detection, and advances in ultrasound (US) palpation have shown promising results for breast cancer imaging. The addition of two-dimensional-shear wave elastography (2D-SWE) US in the routine breast imaging exam can increase early cancer detection and promote better surveillance. To evaluate the clinical applications of 2D-SWE US in breast cancer detection and its combination with other imaging modalities. The 200 consecutive female patients aged 50-80 were examined to evaluate palpable breast lesions. All patients underwent mammography, bright mode (B-mode) US, and 2D-SWE followed by US-guided biopsy in two consecutive sessions. Combining B-mode and shear wave US imaging with X-ray mammography revealed 100% of the suspicious lesions, resulting in greater sensitivity, specificity, and negative predictive value. The result improves compared to either B-mode or 2D-SWE alone (P = 0.02). Combining 2D-SWE with conventional US and X-ray techniques improves the chance of early cancer detection. Including 2D-SWE in regular breast imaging routines can reduce the need for biopsies and improve the chance of early cancer detection and survivability with the proper line of therapy.

Early detection of cardiac dysfunction using shear wave imaging: insights into reduced cardiorespiratory fitness in childhood cancer survivors

Abstract Background Diastolic dysfunction is thought to be the earliest cardiotoxic sequel after cancer therapy among childhood cancer survivors. Despite many survivors do exhibit reduced cardiorespiratory fitness (CRF) potentially due to cardiotoxicity, current echocardiographic parameters fail to detect hidden diastolic dysfunction early after therapy (1). High frame rate (HFR) shear wave imaging (SWI) is a novel tool that could give insights about myocardial stiffness, which is a key determining factor of diastolic function. Purpose We aimed at testing the ability of SWI to detect early alterations in myocardial stiffness among childhood cancer survivors and its relation with the reduced CRF. Methods Fifty childhood cancer survivors (mean 20 ±3 years) who received chemo-and/or- radiotherapy (mean time after treatment: 4 ±3 years) and thirty-two matched healthy volunteers (HV) were recruited. Conventional as well as HFR echocardiographic images (ca. 1200 frames/second) were acquired at rest using a modified commercial echocardiography machine. All participants underwent an incremental, symptom-limited cardiopulmonary exercise test on a treadmill measuring peak oxygen consumption (VO2 peak). HFR data were analysed offline. An anatomical M mode was drawn along the ventricular septum, and tissue Doppler acceleration maps were extracted to measure SW velocities after mitral valve closure (MVC) (Figure 1). Results Among cancer survivors, left ventricular ejection fraction (LVEF) and global longitudinal strain were significantly lower compared to HV (56 % ±4 vs 59 % ±4, and 17.6 % ±1.6 vs 19.1 % ±1.2, respectively; p &amp;lt;0.001). However, both LVEF and GLS were within the normal range and none of them correlated with the peak VO2 (Figure 2A&amp;B). None of the echocardiographic diastolic parameters (e.g. mitral E, E/e’, left atrial volume or TR jet velocity) showed significant difference between both groups (P &amp;gt; 0.05). The mean SW velocities were significantly higher in cancer survivors compared to HV (3.9 ±0.6 m/s vs 3.2 ±0.3 m/s respectively; p &amp;lt;0.001). Interestingly, SW velocities among cancer survivors showed moderate significant negative correlation with the VO2 peak (r= -0.590, p &amp;lt;0.001) indicating increasing myocardial stiffness as the cardiorespiratory fitness declined (Figure 2C). Conclusions Our data indicate that myocardial stiffness in cancer survivors is significantly increased. We hypothesize that this increased stiffness may at least in part explain the significantly reduced cardiorespiratory fitness in this population. Echocardiographic shear wave elastography appears as a promising non-invasive tool for early detection of diastolic dysfunction in follow-up of childhood cancer survivors.Figure 1.Figure 2.

Interaction between right atrial function reserve and liver stiffness after complete repair of tetralogy of fallot: a pilot study

Abstract Background Impaired right atrial mechanics is reported in patients with repaired tetralogy of Fallot (TOF) and is associated with liver stiffness. However, whether right atrial functional reserve correlates with liver stiffness is unknown. Purpose This study tested the hypothesis that right atrial reserve capacity is limited in patients with repaired TOF and explore its relationships with right ventricular function and liver stiffness. Methods 10 patients (45% male) aged 19.04 ± 3.76 at 16.70 ± 4.30 years after repair and 15 controls (60% male, aged 20.31 ± 1.25 years) were studied. RA mechanics was assessed by speckle-tracking echocardiography (STE) at rest and during bicycle exercise, with quantification of positive, negative, and total strain, and strain rates at ventricular systole (aSRs), early diastole (aSRed), and atrial contraction (aSRac). Right atrial function reserve (RAFR) is calculated as (∆RA total strain x [1-1/ RA total strain at baseline]). RV systolic and diastolic function was quantified using Doppler interrogation and STE. Hepatic shear wave velocity (c) and tissue elasticity (E) were measured using two-dimensional shear wave elastography. Results At rest, patients had significantly lower RA positive, negative and total strain, aSRs and aSRed than control subjects (all P&amp;lt;0.02). Shear wave velocity and hepatic E value were significantly higher in patients than controls (both P&amp;lt;0.02). Compared with controls, patients had significantly lower RA positive, negative and total strain, aSRs, aSRed, and aSRac at exercise (all P&amp;lt;0.05). No significant difference in hepatic shear wave velocity and tissue elasticity were found between patients and control subjects at exercise (all P&amp;gt;0.05). Both baseline liver stiffness indices correlated negatively with RAFR, RA positive and total strain and aSRed at exercise (p&amp;lt;0.05 for all). RV function parameters, including baseline trans-tricuspid early and late diastolic inflow velocity (E, A), systolic, early and late diastolic tricuspid annular velocity (s, e, a), isovolumetric acceleration (IVA), RV systolic and diastolic reserve correlated significantly with RA positive and total strain at exercise (P&amp;lt;0.05 for all). Conclusions In young adults with repaired TOF, right atrial function reserve is impaired, and is associated with increased liver stiffness and RV dysfunction.RA mechanics from rest to exerciseStress RA mechanics and liver stiffness

Transverse Vibration Response and Time-Varying Analysis of Axially Moving Beams Based on Choi–Williams Distribution

Cantilever beams with axial extension and contraction functions as time-varying parameter systems have attracted extensive research due to their prevalence in engineering structures. In this paper, the dynamic characteristics of the flat-push bridge mechanism are investigated from the theoretical aspect, firstly, it is simplified into a cantilever beam model with axial motion, and the transverse vibration equations of the cantilever beam are established based on the Euler–Bernoulli beam theory and D’Alembert’s principle, and the transverse displacements of the beam are discretized using the Galerkin truncation method and solved numerically by using the Newmark-[Formula: see text] method for the second-order vibration differential equations with variable coefficients; second-order vibration differential equations were solved numerically by the Newmark-[Formula: see text] method; then the structural examples in the existing literature are verified numerically, and the calculation results are consistent with the literature results, indicating that the transverse vibration equations derived in this paper are solved effectively; then a parametric analysis of the speed of the cantilever beam during axial extension/contraction was done, which showed that the faster the speed of axial motion, the faster the rate of change of the dynamic characteristics of the beam and the more pronounced the vibration; finally, the power signal is decomposed in the time-frequency domain by using the Choi–Williams Distribution (CWD), and the time-frequency characteristics of the system under different speeds are analyzed, and the results show that the use of CWD technique can accurately reflect the system’s transient vibration frequency and vibration energy with the change rule of time and speed, and the axial motion speed of ±0.05[Formula: see text]m/s, the transient frequency of the theoretical prediction and the average relative deviation between the finite element modal frequencies are kept within 5% and the recognition accuracy is high. This analysis provides flexible technical guidance for vibration control in engineering structures.

Geoacoustic Digital Model for the Sea of Japan Shelf (Peter the Great Bay)

In this paper, the authors present and analyze the geoacoustic digital seabed model they developed, which is a digital description of the water column characteristics, seabed topography, and information about sediments and rocks (their composition and elastic properties) for Peter the Great Bay, the Sea of Japan. The model consists of four relief layers, a foundation and three layers of bottom sediments, and also contains the velocities of longitudinal waves in rocks and statistical characteristics of the sound velocity distribution in the water layer for three seasons. Acoustic characteristics of geological structures are based on seismoacoustic studies, sediment lithology, and laboratory measurements of rock samples collected onshore. The velocities of longitudinal and transversal waves and also the density of the sediments were calculated from their empirical dependencies on the granulometric composition of bottom sediment samples over an area of about 800 km2. In a limited area of the shelf (approximately 130 km2), high-frequency acoustic studies were carried out using echo sounders, and the longitudinal wave velocities of the top sedimentary layer were determined. Porosity, density, longitudinal, and transverse wave velocities in bottom sediments were calculated using empirical models with a normal coefficient of reflection from the seabed. A comparison was made of the results of calculating the elastic properties of the seabed using various methods.

Metabarriers for mitigating traffic-induced surface waves: Mechanism dependence on buried arrangements

Locally resonant metamaterials provide exceptional wave manipulation capabilities in the low-frequency regime. This study introduces a buried metabarrier, which can simultaneously harness both resonant and geometric scatterings, to attenuate surface Rayleigh waves at both low and high frequencies induced by traffic. In particular, how the buried arrangements of metabarriers influence their resonant- and geometric-scattering mechanisms is investigated by considering the metabarrier units buried vertically and horizontally in the ground. To this purpose, a numerical finite element model, which is verified through comparisons with existing studies, is developed to analyze the attenuation performance of the metabarrier. Using this model, we perform parametric studies to examine the effects of the material properties and dimensions of the metabarriers on their attenuation behavior. Due to resonant scattering, low-frequency Rayleigh waves are mainly reflected by the vertical metabarriers; in contrast, they are predominantly converted into refracted bulk waves by the horizontal metabarriers. Additionally, the geometric scattering of horizontal metabarriers yields Bragg effects, which can reflect more high-frequency Rayleigh waves and induce a partial mode conversion to transverse bulk waves. Our systematic investigations will, to some extent, facilitate the future design of a well-performing metabarrier attenuating broadband Rayleigh waves.

Non-invasive Assessment of Liver Fibrosis Using Shear Wave Elastography in Patients With Type 2 Diabetes Mellitus Having Non-alcoholic Fatty Liver Disease

Non-invasive Assessment of Liver Fibrosis Using Shear Wave Elastography in Patients With Type 2 Diabetes Mellitus Having Non-alcoholic Fatty Liver Disease

New intensity prediction equation in Western China considering site equivalent shear wave velocity

New intensity prediction equation in Western China considering site equivalent shear wave velocity

A new approach to the diagnosis and surgical treatment of uterine scar defect after cesarean section

Introduction. An increase in the number of cesarean sections in the world leads to an increase in cases of formation of scar defects on the uterus, which requires attention and the use of new diagnostic and treatment methods. Studying the healing processes of the myometrium is key to preventing the formation of a uterine scar defect, and improvements in diagnostic methods and surgical techniques can reduce the risk of recurrence of a uterine scar defect.Purpose of the study. To develop an effective algorithm for the management of women with a uterine scar defect at the stage of preparation for pregnancy.Materials and methods. A prospective randomized cohort study was conducted using a random number generator method with the participation of 100 women with a uterine scar defect after cesarean section. The participants were divided into two groups: in the first group (35 women), surgical treatment was performed using an anchor thread and a collagen-based hemostatic matrix, while in the second group (65 women), surgical treatment was carried out in the traditional way (laparoscopic metroplasty without the use of additional techniques).Results. A mathematical model has been developed for predicting the risk of recurrence of a uterine scar defect. Using the method of step-by-step discriminant analysis, the most informative predictors of the formation of a recurrent uterine scar defect were identified: shear wave magnitude indicators according to ultrasound elastography, the presence of a cyst in the uterine scar area, the expression of receptors for progesterone and estradiol in the endometrial glands, the expression of CD20 cells and CD138 cells. plasma cells according to an immunohistochemical study of the endometrium.Conclusion. Understanding the main reasons for the formation of a scar defect and the risk factors for its recurrence will make it possible to more accurately predict the outcomes of laparoscopic metroplasty and choose the most appropriate treatment tactics for each specific patient, which, in turn, can improve the overall treatment results and the quality of life of women

Reproducibility of Cardiac Multifrequency MR Elastography in Assessing Left Ventricular Stiffness and Viscosity.

Cardiac magnetic resonance elastography (MRE) shows promise in assessing the mechanofunctional properties of the heart but faces clinical challenges, mainly synchronization with cardiac cycle, breathing, and external harmonic stimulation. To determine the reproducibility of in vivo cardiac multifrequency MRE (MMRE) for assessing diastolic left ventricular (LV) stiffness and viscosity. Prospective. This single-center study included a total of 28 participants (mean age, 56.6 ± 23.0 years; 16 male) consisting of randomly selected healthy participants (mean age, 44.6 ± 20.1 years; 9 male) and patients with aortic stenosis (mean age, 78.3 ± 3.8 years; 7 male). 3 T, 3D multifrequency MRE with a single-shot spin-echo planar imaging sequence. Each participant underwent two cardiac MMRE examinations on the same day. Full 3D wave fields were acquired in diastole at frequencies of 80, 90, and 100 Hz during a total of three breath-holds. Shear wave speed (SWS) and penetration rate (PR) were reconstructed as a surrogate for tissue stiffness and inverse viscous loss. Epicardial and endocardial ROIs were manually drawn by two independent readers to segment the LV myocardium. Shapiro-Wilk test, Bland-Altman analysis and intraclass correlation coefficient (ICC). P-value <0.05 were considered statistically significant. Bland-Altman analyses and intraclass correlation coefficients (ICC = 0.96 for myocardial stiffness and ICC = 0.93 for viscosity) indicated near-perfect test-retest repeatability among examinations on the same day. The mean SWS for scan and re-scan diastolic LV myocardium were 2.42 ± 0.24 m/s and 2.39 ± 0.23 m/s; the mean PR were 1.24 ± 0.17 m/s and 1.22 ± 0.14 m/s. Inter-reader variability showed good to excellent agreement for myocardial stiffness (ICC = 0.92) and viscosity (ICC = 0.85). Cardiac MMRE is a promising and reproducible method for noninvasive assessment of diastolic LV stiffness and viscosity. 2 TECHNICAL EFFICACY: 1.

Implementation of machine learning algorithms to screen for advanced liver fibrosis in metabolic dysfunction-associated steatotic liver disease (MASLD): an in-depth explanatory analysis.

Background This study aimed to train machine learning algorithms(MLAs) to detect advanced fibrosis(AF) in MASLD patients at the level of primary care setting and to explain the predictions to ensure responsible use by clinicians. Methods Readily available features of 618 MASLD patients followed up at a tertiary center were used to train five MLAs. AF was defined as liver stiffness≥9.3 kPa, measured via 2-dimension shear wave elastography(n=495) or liver biopsy≥F3(n=123). MLAs were compared to Fibrosis-4 index(FIB-4) and NAFLD fibrosis score(NFS) on 540 MASLD patients from the primary care setting as validation. Feature importance, partial dependence, and shapely additive explanations(SHAP) were utilized for explanation. Results Extreme gradient boosting(XGBoost) achieved an AUC=0.91,outperforming FIB-4(AUC=0.78) and NFS(AUC=0.81, both p&lt;0.05) with specificity=76% vs. 59% and 48% for FIB-4≥1.3 and NFS≥-1.45, respectively(p&lt;0.05). Its sensitivity(91%) was superior to FIB-4(79%). XGBoost confidently excluded AF (negative predictive value=99%) with the highest positive predictive value (31%), superior to FIB-4 and NFS (all p&lt;0.05). The most important features were HbA1c and GGT with a steep increase in AF probability at HbA1c&gt;6.5%. The strongest interaction was between AST and age. XGBoost, but not logistic regression, extracted informative patterns from ALT, LDL-c,and ALP(p&lt;0.001). One quarter of the false positives (FP) were correctly reclassified with only one additional false negative based on the SHAP values of GGT, platelets, and ALT which were found to be associated with a FP classification. Conclusions: An explainable XGBoost algorithm was demonstrated superior to FIB-4 and NFS for screening of AF in MASLD patients at the primary care setting. The algorithm also proved safe for use as clinicians can understand the predictions and flag FP classifications.

Using Panel Management to Identify Adult Patients With High-Risk Metabolic Dysfunction-Associated Steatotic Liver Disease/Metabolic Dysfunction-Associated Steatohepatitis Fibrosis in a Primary Care Clinic: A Pilot Study.

As rates of metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) rise, national organizations have released new guidance for primary care-driven detection of patients with advanced fibrosis who are most likely to have clinically relevant morbidity. Yet time constraints, workflow, and practitioner awareness limit integration of risk identification into clinical care. At the authors' primary care clinic, they implemented a panel management strategy that utilized the electronic health record to identify patients older than 35 years of age at risk for MASLD fibrosis with abnormal Fibrosis-4 (Fib-4) scores. Using a proactive model, these patients were offered elastography-based screening and follow-up appointments focused on metabolic health, with referrals to subspecialty care when indicated. Of 855 patients older than 35 years of age, 384 were identified as having risk factors for MASLD/MASH. Of these, 53 had abnormal Fib-4 scores with no prior work-up; 29 patients consented to a shear wave elastography; 16 underwent shear wave elastography; and 6 had moderate or high results concerning for at-risk fibrosis. Twenty patients attended MASLD-focused appointments. Reluctance to pursue testing was driven by skepticism surrounding preventative medicine, perceived cost, and desire to focus on other medical problems, some of which were life-limiting. Panel management represents a scalable strategy to quickly identify patients in primary care most likely to experience complications from MASLD/MASH and provides a targeted intervention to direct further management. Limitations include access to care, medical complexity, and patient acceptance.