Ultrasound Examination Research Articles

COMPARISON OF PLGF LEVELS, AMONG SMALL FOR GESTATIONAL AGE AND APPROPRIATE FOR GESTATIONAL AGE MOTHERS

Objective. Early detection of small for gestational age fetuses can prevent infant morbidity and mortality. The objective of this study was to compare the levels of Placental Growth Factor among small for gestational age with appropriate for gestational age mothers and to identify the predictive value of PlGF in detecting pregnancies with Intra uterine growth retardation in local population. Design. Quasi experimental (comparative cross-sectional) study. Place & duration of study. Gynecological department of Ayub Medical complex, Abbottabad from August 2021 to January 2022. Methodology. The studied population included total 68 mothers in last trimester with 34 in each group, i.e. appropriate for gestational age and small for gestational age. Fetal size was estimated either by clinical examination (symphysis fundal height) or estimated fetal weight by ultrasound examination. Sociodemographic along with reproductive history were recorded and blood samples analyzed for PlGF difference in both groups. Results. The median age of mothers was 32.5 years. The PlGF in small for gestational age was observed in the below normal concentration (mean value = 126.7 pg/mL) while it was observed in normal ranges in appropriate for gestational age mothers (mean value = 24.2 pg/ml) with P-value (<0.001). Conclusion. Mothers with small for gestational age were having significantly lower placental growth factor levels compared to mothers with appropriate for gestational age.

Adenomatoid Tumor Mimicking Peritoneal Carcinomatosis: A Case Report.

An adenomatoid tumor (AT) is a benign lesion, which is commonly located in the genital tract of both sexes. We present a case of a 66-yr-old woman with the unusual characteristics of an AT mimicking peritoneal carcinomatosis. The tumor was detected incidentally by ultrasound examination, and an ensuing imaging study raised suspicion of ovarian cancer with peritoneal carcinomatosis. From the pathologic diagnosis of frozen specimens, clear cell carcinoma was noted and the patient subsequently underwent cytoreductive surgery. An 8.5-cm-sized mass was observed on the uterine serosa, extending into the myometrium. In addition, multi-cystic nodular lesions were identified in the omentum, appendiceal and small bowel serosa, and the peritoneum. After histologic and extensive immunohistochemical examinations, the final diagnosis was AT. Recognition of the diverse presentations of AT is crucial for accurate diagnosis and appropriate treatment, as these tumors can involve multiple sites and mimic peritoneal carcinomatosis, potentially leading to a misdiagnosis of malignancy.

Determining the degree of proximal nerve fascicle rotation in healthy controls using ultrahigh-frequency neuromuscular ultrasound: A pilot study.

Ultrahigh-frequency ultrasound (UHFUS) allows improved visualization and higher resolution images of nerve fascicles than standard high-frequency ultrasound. Dynamic UHFUS may detect the presence of fascicular entwinement, the recently described sonographic phenomenon of pathologic fascicular rotation seen in neuralgic amyotrophy. This pilot study aims to establish normative reference values and degrees of fascicular rotation for the proximal portions of commonly involved upper limb nerves in healthy controls using UHFUS. Twenty healthy participants underwent sonographic examination of the median, musculocutaneous, and radial nerves on both upper limbs using UHFUS with a 48 MHz linear transducer. A single rater assessed the degree of fascicular rotation in each peripheral nerve. Fascicular rotation appears to occur in the proximal portion of each of these nerves. The mean degree of fascicular rotation for each of the measured nerves was median 94.5°, musculocutaneous 97.9°, and radial 50.9°. The maximum observed fascicular rotation in each nerve was 180°. Age, sex, height, weight, body mass index, and race did not predict degree of fascicular rotation (all p > .103). A single-factor ANOVA test showed the degree of fascicular rotation differed in median, musculocutaneous, and radial nerves (F = 4.748, p = .011). UHFUS allows quantification of fascicular rotation in healthy controls in the median, musculocutaneous, and radial nerves, and provides normative data. The data from this pilot study may serve as control data for future comparative studies in conditions where fascicular rotation occurs, such as neuralgic amyotrophy.

The stem and progenitor cells and the functional activity of liver from age-different Wistar rats

The liver has a big potential for self-healing, but the activity of regeneration decreases with age. Changes are occurring, including in the functional activity of various liver cell populations, the study of the characteristics of which can become the basis for the development of new therapeutic approaches to the liver diseases treatment at older people. The aim of this research was to study the level of stem and progenitor cells and the functional activity of the healthy liver from age- different rats. Material and methods. Experiments were carried out on Wistar rats aged 6 and 12 months. Ultrasound and histological examination of the liver from rats was used to assess morphological changes. The lipid profile of blood serum was evaluated by biochemical methods. Cytometric methods were used to study the surface and intracellular antigens of stem and progenitor cells isolated from the bone marrow, arterial blood and liver of rats. Results and discussion. In 12-month-old male Wistar rats, compared with 6-month-old rats, excessive formation of extracellular matrix components, disruption of tissue architecture, development of portal hypertension, as well as an increase in the concentration of cholesterol, triglycerides, high- and low-density lipoproteins were revealed. We identified age- related differences in the content of hematopoietic and mesenchymal stem cells, epithelial cells (CD45–CD326+) in the bone marrow, blood and liver of rats. In the liver parenchyma, the populations of hepatocyte precursors (CD45– CD326+CD133+), oval cells (CD45–CD326+CD133+CD90+). At the same time, the level of all cell populations in the liver parenchyma of rats expressing the intracellular marker Sox9 was higher in one-year-old animals compared to younger ones, regardless of the cell phenotype. Conclusions. In the liver of 12-month-old rats, compared to 6-month-old rats, the number of cells expressing Sox9, lymphocytes with an inflammatory phenotype increases, the number of stem cells and various populations of epithelial and endothelial cells decreases, which leads to a decrease in the regenerative capacity of the liver, disruption of the tissue architecture of the organ and changes in lipid metabolism. These changes largely determine the increased susceptibility with age to the development of chronic liver diseases.

Preoperative identification from occult leiomyosarcomas in laparoscopic hysterectomy and laparoscopic myomectomy: accuracy of the ultrasound scoring system (PRESS-US).

To assess the diagnostic performance and inter-observer agreement of a PREoperative sarcoma scoring based on ultrasound (PRESS-US) in differentiating uterine leiomyosarcoma (uLMS) from leiomyoma (LM). We conducted a retrospective evaluation of patients who underwent surgery and received standardized ultrasound examinations due to the presence of uterine myoma-like masses. Histological diagnosis was used as the reference standard. The masses were analyzed using morphological uterus sonographic assessment criteria, and the diagnostic accuracy of PRESS-US was evaluated using ROC curve analysis. Kappa (κ) statistics were used to assess the inter-observer agreement between a less experienced and an expert radiologist. Among the 646 patients, 632 (97.8%) were diagnosed with LM, and 14 (2.2%) had uLMS. The malignancy rates for low-risk and high-risk patients were 0.35% and 13.48%, respectively. The optimal PRESS-US cutoff was 17.5, resulting in an AUC of 89.7% (95% CI, 0.79-1.00), with a sensitivity of 85.7% and a specificity of 87.8%. The inter-observer agreement between a less experienced and an expert radiologist was excellent (κ = 0.811, P < 0.001). PRESS-US provides effective risk stratification for uLMS for radiologists with different levels of experience, with high reliability. Subgrouping high-risk patients helps in better risk stratification.

016. Case Report: Torsion of the Testicular Appendix in Pediatric

Background: The testicular appendix or hydatidosa sessile Morgagni is a congenital disorder consisting of residual vestigial tissue of the mesonephric and Müllerian ducts1. Commonly it is attached to the testis and caput epididymis. Its presence can lead to twist around their own axis, causing acute scrotal pain. Case: A 8-year-old boy presented with gradual onset of left scrotal pain that worsened with movement and improved with rest. Other symptoms included scrotal swelling and redness/hyperemis. The ultrasonography examination revealed torsion of the testicular sinistra with mild hydrocele. During surgical intervention, testicular of the appendix torsion was found and appendiceal excision was performed. Conclusion: Torsion of thetesticulsr appendix is a benign condition that commonly affects prepubertal males. Its atypical symptoms of acute scrotal pain can lead to misdiagnosis as testicular torsion.

Minilaparotomy choledocholithotomy in patients with metabolic syndrome

Aim. To evaluate the outcomes of mini-laparotomy choledocholithotomy in patients with choledocholithiasis and metabolic syndrome using “Mini-Assistant” instruments.Materials and Methods. This study is based on the outcomes of surgical interventions performed on 54 patients diagnosed with choledocholithiasis accompanied by metabolic syndrome, conducted between 2009 and 2022. A minimally invasive laparoscopic approach was utilized, employing “Mini-Assistant” instruments. Preoperative assessments included laboratory tests, ultrasound examination, electrocardiography, echocardiography, respiratory function testing, chest radiography, esophagogastroduodenoscopy, and magnetic resonance cholangiopancreatography (MRCP). The miniaccess operation was performed using a transrectal incision, 6-7 cm in length. The technical steps of the operation were similar to traditional cholecystectomy and choledocholithotomy.Results. The average duration of the procedure was 68 ± 9.3 minutes. The patients’ condition before and after surgery was satisfactory, with stable hemodynamics. No hypertensive crises or tachycardia were observed. No mortality was reported. Postoperative complications were observed in three patients, including accumulation of serous fluid in the subcutaneous tissue (2 cases) and postoperative pancreatitis (1 case). The average length of hospital stay after choledocholithotomy via mini-access was 6 ± 1.6 days.Conclusion. Mini-laparotomy choledocholithotomy using the “Mini-Assistant” instrument set allows for avoiding conventional, more invasive techniques, facilitating effective surgical intervention even in cases where laparoscopic procedures are not feasible.

Novel TBC1D8B variant causes neonatal nephrotic syndrome combined with acute kidney injury

BackgroundNephrotic syndrome (NPHS), characterized by proteinuria, hypoalbuminemia, and edema, can be caused by genetic variations. TBC1D8B was recently discovered as a novel disease-causing gene for X-linked NPHS. With only a few reported cases, the clinical manifestations associated with variants of this gene need to be further examined.MethodsWe recruited a newborn with NPHS complicated by acute kidney injury (AKI) and his parents and tested the potential genetic cause of the disease through trio-whole exome sequencing and Sanger sequencing. Western blotting (WB) was performed using a mutant plasmid to evaluate mutant protein expression levels. Since the TBC1D8B protein interacts with RAB proteins to catalyze the GTPase hydrolysis process, immunofluorescence (IF) can be used to verify the interaction between the TBC1D8B mutant protein and RAB11A/RAB11B, and thus to confirm its effect on the endocytosis and vesicle recycling functions of RAB proteins within the cell.ResultsThe child, at 1 month, showed severe edema and proteinuria and unexplained coma with epilepsy. Ultrasound examination revealed multiple organ enlargement, and MRI showed nonspecific high diffusion-weighted imaging signal characteristics in the splenium of the corpus callosum. Hematoxylin and eosin staining showed diffuse inflammatory cell infiltration in the renal interstitium and multifocal renal tubule lumen expansion. Diffuse fusion of podocyte foot processes was observed under electron microscopy, indicating glomerular podocyte lesions. Genetic testing revealed a maternally inherited novel hemizygous variant, NM_017752: c.628 A > T, p.Lys210Ter, in TBC1D8B. In vitro functional experiments showed that this variant may lead to TBC1D8B protein degradation. IF results showed disrupted interaction with RAB11A/RAB11B, that then affects the biological function of RAB proteins in the process of cell intimal vesicle formation and intracellular transport.ConclusionThis study will enrich the mutational and phenotypic spectra of TBC1D8B and demonstrate the potential of this gene variants to cause early-onset NPHS leading to severe kidney disease.

TAPSE/sPAP by echocardiography to detect elevated pulmonary vascular resistance&amp;gt; 4 WU in postcapillary pulmonary hypertension patients: insights from the French PH HF registry

Abstract Background Post-capillary pulmonary hypertension (pcPH) lacks effective treatment options. Patients with a PVR &amp;gt; 4 WU, known as combined pcPH (cpcPH), may benefit from investigational drugs like sotatercept. Identifying cpcPH patients suitable for vasodilation therapy in echocardiography labs is critical. Purpose To pinpoint an echocardiographic parameter capable of detecting cpcPH patients with a PVR above 4WU, addressing a common challenge in clinical practice. Methods In this study, 225 participants from the French PH-HF registry, all diagnosed with heart failure and a preserved ejection fraction, were examined. These patients underwent right heart catheterization and got ultrasound examinations within a 24-hour timeframe. The pulmonary vascular resistance were calculated using previously established methods, and data from standard echocardiography, including assessments of diastolic function, were gathered. Results 69 patients exhibited a pulmonary vascular resistance (PVR) greater than 4 WU, while 156 patients had a PVR ≤ 4 WU. Age averaged 69±12 years. Mean pulmonary artery pressure, wedge pressure, cardiac output, and pulmonary vascular resistance were 39±9 mm Hg, 22±4 mm Hg, 5.1±1.7 l/min, and 3.5±2.0 WU, respectively. Comparative analysis between patients with PVR ≤ 4 WU and those with PVR &amp;gt; 4 WU revealed similar ejection fraction (EF), left atrial volume index, and E/A ratio by echocardiography (p=0.97, p=0.69, p=0.43, respectively). However, patients with PVR &amp;gt; 4 WU showed elevated E/e’ (p=0.008), higher systolic pulmonary artery pressure (sPAP, p=0.001), but reduced myocardial S and e’ tissue Doppler velocities (p=0.001) and tricuspid annular plane systolic excursion (TAPSE) (p=10^-5). Notably, the relationship between TAPSE/sPAP and PVR &amp;gt; 4 was curvilinear and strong (p=0.001, FIG 1). Using ROC curve analysis, patients with TAPSE/sPAP &amp;lt; 0.38 mm/mmHg were identified to have PVR &amp;gt; 4 WU with a sensitivity and specificity of 68%. Conclusion Within the scope of postcapillary pulmonary hypertension, right ventricular arterial coupling is a simple ultrasound parameter potentially effective in identifying individuals exhbiting PVR &amp;gt; 4 WU with a good sensitivityFigure 1:PRV and coupling plotFigure 2:RV coupling ROC

Predictors for mitral regurgitation improvement in patients with pure severe aortic regurgitation undergoing transcatheter aortic valve replacement: when can kill two birds with one stone?

Abstract Objective Transcatheter aortic valve replacement (TAVR) has been recognized as a significant treatment for pure severe aortic regurgitation (PSAR). Part of patients with PSAR concurrently suffer from functional mitral regurgitation (FMR). Whether TAVR could improve FMR in patients with PSAR and the predictors have not yet been clarified. This study aims to explore predictors of FMR improvement in patients with PSAR undergoing TAVR and subsequently provide evidence for further clinical therapy. Method Patients with PSAR and FMR who underwent TAVR at Zhongshan Hospital Affiliated with Fudan University were enrolled from June 2021 to August 2023. Depending on whether FMR improved one month post-TAVR, they were divided into groups with or without FMR improvement. The baseline data, imaging results, and follow-up data of the patients were collected. Result This study included 75 patients, among whom 38 patients had improved FMR and 37 patients did not. Compared to patients without FMR improvement, more patients in the FMR-improved group were diagnosed with renal insufficiency (10.8% vs. 0%, p=0.018), left bundle branch block (8.1% vs. 0%, p= 0.037), and less right bundle branch block (0% vs. 10.5%, p=0.017). The transthoracic ultrasound examination showed that patients with FMR improvement were prone to have lower left ventricular ejection fraction (LVEF) and larger left ventricle end dimension diastole (LVEDd). A higher proportion of patients in the FMR-improved group were found to have had more moderate to severe FMR (28.9% vs. 2.7%, P=0.029). In both groups, the degree of aortic regurgitation was significantly improved during the 1-day and 1-month follow-ups post-TAVR (p&amp;lt;0.001). No significant differences were found in the incidence of postoperative adverse events between the two groups during the short-term follow-up. Conclusion FMR improvement is observed in approximately half of PSAR patients undergoing TAVR. A higher FMR degree, lower LVEF, and hypertension before TAVR are independent predictors of FMR improvement.Figure 1 AR and MR post TAVRTable 1 Logistic regression

Comparison of ultrasound scanning and clinical examination for detecting insulin injection related Lipohypertrophy and construction of Lipohypertrophy classification table.

To explore an cost-effective, convenient method for lipohypertrophy (LH) detection with a high detection rate, and to construct a classification table for LH, so as to provide reference for LH screening and management. From December 2021 to November 2022, 395 hospitalized patients with diabetes from a Tianjin tertiary hospital were enrolled. The LH was detected through ultrasound scanning (USS), structured visual palpation (SVP), and ordinary visual palpation (OVP), and the detection rates were compared. A classification table for LH (LH-LNT table) was constructed based on SVP characteristics. Under USS, SVP, and OVP, the detection of LH was 89.6%, 78.0%, and 66.6% respectively, with site detection at 92.3%, 71.2%, and 57.8% respectively, showcasing statistically significant differences among the three methods. SVP had a lower misdiagnosis rate than OVP, with upper arm and thighs being common misdiagnosed sites. LH was mostly found in the lower abdomen, flat, and soft on palpation. L1N2T1 (two soft LH on abdomen) was the main type, accounting for 35.4%. SVP is useful for detecting LH and deserves clinical promotion. The LH-LNT table constructed here effectively summarizes patient LH status, aiding doctor-nurse-patient communication.

The relationship between post-anastomosis brachial artery flow rate and brachiocephalic arteriovenous fistula access maturity in end-stage kidney disease patients with diabetes mellitus

Background: From previous studies, evaluation of post-anastomosis draining-vein volume flow rate with Doppler ultrasound can be a predictor for arteriovenous fistula maturation. Due to the high variation in measurements by the effect of probe pressure in draining vein, measuring volume flow rate based on post-anastomosis feeding-artery may be an early alternative predictor of arteriovenous fistula maturation. This study aims to investigate the correlation of post-creation brachial artery volume flow rate on maturity of brachiocephalic arteriovenous fistula access in patients with end-stage kidney disease with diabetes mellitus. Methods: A retrospective cohort study was conducted on end-stage kidney disease patients with diabetes mellitus who underwent brachiocephalic arteriovenous fistula creation at three hospitals from July 2019 to March 2020. Doppler ultrasound examination of the brachial artery and draining vein volume flow rate was conducted at pre-operative, post-creation, 2 weeks, and 6 weeks post-creation. Maturity was evaluated at 6 weeks post-anastomosis. Results: A total of 71 subjects met the inclusion and exclusion criteria, with 44 (62%) achieving maturation within 6 weeks. There was a correlation between post-anastomosis brachial artery (p &lt; 0.001) and draining vein volume flow rate (p &lt; 0.001) with arteriovenous fistula maturity after 6 weeks post-operatively. Brachial artery volume flow rate of ⩾350 mL/min can predict AVF maturity with a sensitivity of 95.45% (95% confidence interval = 84.86–98.74) and a specificity of 85.19% (95% confidence interval = 67.52–94.08). Conclusion: Post-anastomosis brachial artery flow volume can be a valuable parameter to predict brachiocephalic arteriovenous fistula maturity. It is a potential alternative to draining vein volume flow, which is technically a difficult examination.

Diagnosis of canine B-cell chronic lymphoid leukemia with a CD21 negative phenotype using the LT21 clone CD21 antibody in flow cytometry: a case report

BackgroundChronic lymphoid leukemia (CLL) is a hematological disorder characterized by the clonal expansion of small mature lymphocytes that accumulate in the blood and bone marrow. CLL can arise from B-, T-, or natural killer cell clones. The cytological evaluation of blood smears is often the simplest and least invasive method for diagnosing lymphoid leukemia. Immunophenotyping is used to further subclassify the type of lymphoid leukemia.Case presentationA 15-year-old, 4.4-kg spayed female Shih Tzu was presented to the veterinary medical teaching hospital of Kangwon National University. Despite having a normal appetite and activity level, cervical and inguinal lymph node enlargement was noted on physical examination. Complete blood count revealed severe leukocytosis, severe lymphocytosis, and monocytosis. Splenomegaly, hepatomegaly, and lymph node enlargement were detected on radiographic and ultrasonographic examination. Immunophenotyping was performed using peripheral blood mononuclear cells (PBMCs). The majority of lymphocytes exhibited the following profiles: CD3−CD79a− (97.5%), CD4−CD8− (98.6%), CD21−CD79a− (98.4%), CD34− (0.1%), CD45+ (99.6%), major histocompatibility complex class II+ (99.5%), and CD14− (0.5%). Based on the immunophenotyping results, possible differentials considered included the following: the majority of lymphocytes may be natural killer (NK) cell clones, plasma cell clones, or show aberrant expression or loss of CD21 marker due to the neoplastic nature of the cells. Further flow cytometry was performed using antibodies against CD3, CD5, CD94, and granzyme B. The combined results indicated that the predominant lymphocyte subset in the PBMCs was CD3−CD5−CD21−CD94−granzyme B−. To confirm monoclonality and exclude the aberrant loss of CD markers, a polymerase chain reaction for antigen receptor rearrangement (PARR) assay was conducted. The PARR assay, using DNA from blood and lymph node samples, showed B-cell monoclonality. Immunocytochemistry using PBMCs showed that the plasma cell marker Multiple Myeloma Oncogene 1 (MUM1) was not expressed. Therefore, the diagnosis was confirmed to be B-cell CLL.ConclusionImmunophenotyping can help subclassify the type of lymphoid leukemia; however, as tumor cells can show aberrant expression or loss of the CD21 marker, combining immunophenotyping with the PARR assay could yield a more accurate diagnosis.

Features of Vascularization of the Transitional Zone of the Uterus in Patients with Chronic Nonspecific Endometritis

Aim. Тo study the peculiarities of blood supply to the transitional zone of the uterus in patients with chronic nonspecific endometritis (ChE).Materials and methods. 106 women aged 22–45 years were examined. The main group included 72 patients with morphologically verified chronic endometritis. We distinguished subgroup I (n = 39.37%) of HE with an autoimmune component, subgroup II (n = 33.31%) with HE without an autoimmune component, as well as a control group consisting of 34 patients with a normal result of morphological examination. Transabdominal and transvaginal ultrasound examination (ultrasound) of the uterus and appendages was performed on the 18th–23rd day of the cycle, with the calculation of the parameter proposed by US — the coefficient of vascularization of the transitional zone of the uterus (k).Outcomes. In the control group, the average k value was 32 ± 2.6%, in the subgroup of patients with an autoimmune component (subgroup I) — 17.0 ± 4.0%, in the subgroup with a nonimmune component (subgroup II) — 23.0 ± 3.4%.Statistically significant differences in the k value were obtained between subgroup I and all the others, but there were no differences between subgroup II and the control group.Autoimmune nonspecific HE was predicted when the vascularization coefficient was below 20.9%. In nonimmune nonspecific HE, the resulting model was not statistically significant. Nonimmune nonspecific HE was predicted when the vascularization coefficient was equal to or higher than 18.6%.Under normal conditions, the resulting model was statistically significant. The norm was predicted when the vascularization coefficient was equal to or higher than 27.6%.Conclusion. The proposed coefficient of vascularization of the transitional zone of the uterus (k) showed high diagnostic value in patients with nonspecific СhE and it can be recommended for inclusion in the ultrasound examination protocol at the stage of pre-gravidar preparation.

Evaluation of Adipose Tissue Hormones and Tumor Necrosis factor in Patients with Endometriosis

Objective: To evaluate levels of physiological parameters (Testosterone, follicle stimulating hormone FSH, luteinizing hormone LH, leptin and tumor necrosis factor TNF-α, Adipsin and Ghrelin), Total antioxidant capacity-TAC, Glutathione S transfers -GST in sera of patients with endometriosis. Method: This study involved (85) women within reproductive age (25-40) years, who were distributed into two groups: patientsʹ group (55) women diagnosed with endometriosis, and (30) healthy control women. The study was carried out at Al-Karkh Maternity Hospital/ Baghdad and extended from 20/4/2024 to 20/5/2024. The pathological cases of patients were diagnosed by clinical examinations and confirmed by specialist physician with ultrasound examination. Blood samples were taken from both groups, serum was separated for each individual by a centrifuge. Results: a significant rise in the (FSH, Leptin, TNF -α, Adipisin) while a significant decrease in levels of (Testosterone , LH, GST, TAC, Ghrelin) concentration were found in the sera of patients compered to healthy women , with a probability of P ≤ 0.05. According to Receiver operating characteristic (ROC) statistical analysis, Area under curve (AUC ) for LH, leptin, TNF -α, adipsin, ghrelin, GST, TAC were closely or equal to (1) for patients . Conclusion: serum levels of LH, Leptin, Adipisin, Gherlin, TNF-α and GST can be dependable as prognostic indicator markers that reflect the degree of oxidative stress accompanying endometriosis.

Risk-stratified CA125 screening integrating CA125 trajectories, trajectory-specific progression and transvaginal ultrasound for ovarian cancer

BackgroundsCancer antigen 125 (CA125) is widely used for screening ovarian cancer (OC), yet its effectiveness remains debated. Potential factors may include ineffective cut-off value for CA125 in screening, as well as a lack of consideration for CA125 trajectories and trajectory-specific progression.MethodsBased on data from multiple rounds of CA125 tests and transvaginal ultrasound (TVU) examinations conducted on 28,456 women in the PLCO Trial, time-dependent receiver-operating-characteristic curves (ROCs) and area-under-the-curves (tdAUCs) analyses were employed to identify the optimal CA125 cut-off values for OC screening. Participants were categorized into four CA125 trajectories: stable negative CA125 (CA125SN), loss of positive CA125 (CA125LP), stable positive CA125 (CA125SP), and gain of positive CA125 (CA125GP). The associations between different CA125 trajectories, trajectory-specific progression indicators, and OC risk were explored. The effectiveness of risk-stratified CA125 screening, incorporating CA125 trajectories, trajectory-specific progression, and TVU, was evaluated using hazard ratio and 95% confidence intervals [HR (95%CIs)], with adjustments for potential confounders.ResultsAfter a median follow-up of 14.8 years for OC incidence and 23.8 years for OC mortality, 250 OC cases and 218 OC deaths were identified. The tdAUC for 10-year OC incidence with CA125 was 0.663, with an optimal cut-off value of 13.00 U/ml. Trajectory analyses showed that both CA125SP and CA125GP were significantly associated with increased risks of OC incidence [HRs (95%CIs): 2.00(1.47–2.73) and 3.06(2.25–4.16)] and mortality [HRs (95%CIs):1.58(1.13–2.21) and 2.60(1.87–3.62)] compared to CA125SN. Trajectory-specific progression analyses identified relative velocity as the optimal progression indicators for both CA125SP and CA125GP (tdAUCs: 0.712 and 0.767), with optimal cut-off values of 9% and 32% per year, respectively. Positive progression was associated with significantly increased risks of OC incidence [HRs (95%CI): 7.26(4.00-13.17) and 3.83(1.96–7.51) CA125GP and CA125SP] and mortality [HRs (95%CI): 8.03(4.15–15.56) and 6.04(2.78–13.14)] compared to negative progression. Optimized risk-stratified CA125 screening, which integrated CA125 trajectories, trajectory-specific progression, and TVU, reduced missed OC by 3.6% and improved accuracy compared to traditional screening methods.ConclusionsIncorporating CA125 trajectories and trajectory-specific progression into screening protocols enhances the identification of the population at high-risk of OC. An optimized screening strategy, which includes these factors along with TVU, is recommended to improve the effectiveness of OC screening.

Cesarean scar pregnancy: should surgery be the preferred treatment approach?

To compare the characteristics and outcomes of non-surgical and surgical treatments for Cesarean scar pregnancy (CSP). A retrospective study conducted at a tertiary university affiliated medical center, including all women diagnosed with Cesarean scar pregnancy between 2019 and 2023. Women treated non-surgically (including: methotrexate, uterine artery embolization and balloon catheter) were compared to women treated surgically (including: hysterectomy, hysteroscopy and excision of the pregnancy with or without uterine niche repair). Demographic information, medical history, obstetric and gynecological characteristics, presenting symptoms, imaging findings, management details, surgical characteristics, and follow-up data were collected from the women's electronic medical records. Primary outcome was defined as the β-hCG levels on follow-up visit at 2weeks following treatment. 42 women were diagnosed with Cesarean scar pregnancy during the study period, of them 9 (21%) were treated non-surgically and 33 (79%) were treated surgically. Median age was 33 (30-36) year old and median BMI was 31 (27-35) kg/m2, with no statistical differences in-between the groups. Most of the women had previous two Cesarean sections (n = 12, 28%). 63% of the women were asymptomatic at the time of diagnosis. On transvaginal ultrasound examination, embryo was demonstrated in 66.7% and cardiac activity was observed in 75%. The median gestational age at diagnosis and β-hCG levels were comparable between the non-surgical and surgical treatment groups (p = 0.22, p = 0.61, respectively). In the surgical arm, the most common surgical procedure was excision of the pregnancy with uterine niche repair, that was performed in 14/42 (33%) of the women. Median hospitalization length was 3 (1-4) and 2 (1-3) days, for the non-surgical and surgical treatment groups, respectively (p = 0.51). The hemoglobin level before discharge was similar between the groups (p = 0.20). Only one woman in each group visited the emergency room before the follow-up visit (p = 0.31). β-hCG levels on follow-up were significantly lower in the surgical group compared to the non-surgical (p = 0.02). Cesarean scar pregnancy can be asymptomatic and should be suspected to enable early diagnosis. Both non-surgical and surgical treatments are viable options, with comparable hospitalization lengths; however, the surgical intervention group is expected to show a significantly faster decrease in β-hCG levels.

High-frequency ultrasound for assessing the renal characteristics of spontaneous type 2 diabetes mellitus db/db mice.

There are few ultrasonographic studies on the spontaneous T2DM db/db mouse. Our objective was to dynamically investigate and assess renal morphological and hemodynamic changes in spontaneous type 2 diabetes mellitus db/db mice through high-frequency ultrasound. Eighteen male db/db mice (the model group) and twelve male db/+ mice (the control group) were included. Body weight and fasting blood glucose were measured at the ages of 8, 16 and 32 weeks. High-frequency ultrasound examinations were conducted at the same ages. Compared with those in the control group, H&E and Masson staining revealed pathological changes in the renal tissue of the db/db mice at 16 weeks of age, and the lesions were significantly aggravated at 32 weeks of age. The body mass of the mice in the model group increased significantly at 8, 16 and 32 weeks of age, and the kidney volume measured by ultrasound also increased with age. Compared with those of the control group, the blood flow scores determined via power Doppler were significantly different. The peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) of the renal artery and the PSV, EDV, and RI of the segmental artery were significantly different at the 16th week compared with those that at the eighth week. The results of high-frequency ultrasound revealed that the renal hemodynamics of db/db mice changed at the sixteen weeks.

A novel technique for snuffbox fistula creation.

In this pilot study, we describe a novel technique for creating a snuffbox fistula (SBF) and present the preliminary outcomes after 4-6 weeks of follow-up. The study included eight male patients with a mean age of 50 years (range 36-66 years). All patients received an SBF using the modified no-touch technique (MNTT) and piggyback straight-line on-lay technique (pSLOT). Immediate patency was obtained for all patients. In one case, a thrombosis developed at the juxta anastomosis. The remaining seven SBFs met the clinical arteriovenous fistula maturity criteria at the physical examination performed 4-6 weeks after surgery, showing an easily palpable vein, a straight superficial segment >10 cm in length and a sufficient diameter, and good palpable thrill. In addition, an ultrasound examination showed that the diameter of the drainage vein was 4-6 mm, and the brachial blood flow was ⩾500 mL/min. The combination of MNTT and pSLOT was used to successfully establish SBFs, and the success rate of surgery and access maturity were high.

Relationship between parameters of the urethrovesical segment and quality of life in women with stress urinary incontinence

Aim of the study. To determine the relationship between ultrasound parameters of the urethro-vesical segment and the quality of life of women with stress urinary incontinence before and after surgical treatment. Materials and methods. We studied the quality of life and the severity of symptoms according to the UDI-6, I-Qol, IIQ-7, ICIQ-SF questionnaires, as well as ultrasound examination of the urethro-vesical segment in 40 women with stress urinary incontinence before and after surgery for the period 2023-2024. Correlation analysis among the listed indicators was performed. The mean age in the analyzed group was 49.7±9.7 years. Results and discussion. There was a significant improvement in postoperative quality of life scores for all the questionnaires used. There was a direct correlation between UDI-6 and urethral diameter in the Valsalva test, between IIQ-7 and the distance between the pubic symphysis and the bladder neck in the Valsalva test, the severity of symptoms according to the ICIQ-SF scale and the size of the posterior urethro-vesical angle at rest before surgery. After surgery, an inverse correlation was found between the distance from the pubic symphysis to the bladder neck in the Valsalva test and the data of the I-Qol questionnaire, as well as I-Qol and the values of the posterior urethro-vesical (β) angle in the Valsalva test. A direct correlation was found between the distance from the pubic symphysis to the bladder neck in the Valsalva test and the results of the IIQ-7 questionnaire, as well as between the β-angle value and the severity of symptoms according to the ICIQ-SF questionnaire. Conclusions. The results of the analysis confirmed the researchers' hypothesis that ultrasound parameters of the urethro-vesical segment correlate with the severity of symptoms and the level of quality of life in patients with stress urinary incontinence before and after surgical treatment.