Ultrasound Grading Research Articles

Association between serum interleukin (IL)-12 level and severity of non-alcoholic fatty liver disease (NAFLD).

What is new? Serum IL-12 level is associated with NAFLD severity. Elevation in serum IL-12 level is in line with more severe NAFLD based on BARD score and NAFLD fibrosis score. Positive correlation is observed between serum IL-12 level and BARD score.Introduction. Non-alcoholic fatty liver disease (NAFLD) is one of the most common liver diseases worldwide. Lipid accumulation in the liver triggers inflammation and leads to NAFLD. Prolonged inflammation will worsen the disease progression. Pro-inflammatory cytokines, including interleukin (IL)-12, plays a role in the inflammatory process. This study aimed to determine the association between IL-12 and NAFLD severity.Methods. A cross-sectional study was conducted between January and July 2019 in Haji Adam Malik Hospital Medan, Indonesia. Subjects were patients aged 18 years or older diagnosed with NAFLD based on ultrasound. Exclusion criteria were excessive alcohol consumption, other primary liver diseases, malignancies, and cardio-metabolic disturbances. Serum IL-12 level was determined using an enzyme-linked immunosorbent assay method. The severity of NAFLD was assessed using the BARD score and NAFLD fibrosis score.Results. A total of 100 subjects were enrolled with male predominant. The mean age of subjects was 54.97 ± 8.85 years, and the most frequent comorbidity was obesity. Most subjects had mild to moderate disease progression. Serum IL-12 level was higher in more severe NAFLD based on ultrasound grading (P < 0.001), BARD score (P = 0.003), and NAFLD fibrosis score (P = 0.005). A positive correlation was observed between serum IL-12 level and BARD score (P < 0.001) with sufficient accuracy (AUC = 0.691, P = 0.014).Conclusion. Serum IL-12 level was associated with the severity of NAFLD. Higher serum IL-12 level was observed in more severe NAFLD progression.

STUDY ON EFFICACY OF ULTRASOUND AND FOB IN CONFIRMING THE PLACEMENT OF LARYNGEAL MASK AIRWAY

Ultrasound is a safe and non invasive technique for assessing the airway . In this observational study, 60 patients belonging to ASAClasses I and II scheduled for elective general surgery without any airway abnormality were included. Squared wave of capnogramTransverse neck ultrasound was performed using linear probe (8- 13Hz) started from hyoid bone (hyperechoic supercial inverted Ushaped linear structure)probe moved caudally with slight cephalad angle visualization of vocal cord &amp; arytenoids. The Ultrasound arytenoid grade had a signicant correlation with LMA rotation grade.The incidence of LMAMalposition by ultrasound was found to be 80% .With regard to the test performance ,US was found to have a sensitivity of 92%,with a positive predictive value of 94% to detect the LMA rotation of any number of degrees. The specicity was 62% with a negative predictive value of 55%. FOB Examination is the gold standard tool for conrmation of the correct placement of LMA. ,we evaluated USG as a tool to conrm the placement comparing with the FOB examinationThe FOB examination is invasive &amp; interrupts the ventilation during procedure. It cannot be done frequently intra-operatively compromising ventilation. These problems can be overcome by using ultrasound.USG detects the rotation of LMAeven if it is positioned at optimal depth thereby predicting the chance of dislodgement during the course of surgery.

Role of Diffusion-Weighted Magnetic Resonance Imaging in the Diagnosis and Grading of Hepatic Steatosis in Patients With Non-alcoholic Fatty Liver Disease: Comparison With Ultrasonography and Magnetic Resonance Spectroscopy

Nonalcoholic fatty liver disease (NAFLD) is becoming the most common cause of cirrhosis. Although magnetic resonance spectroscopy (MRS) is considered the gold standard, it has a few limitations. The role of diffusion-weighted imaging (DWI), which is a simpler sequence, in the diagnosis and grading of fatty liver is not well studied. The aim of the study was to investigate the value of DWI in the diagnosis and grading of hepatic steatosis in patients with NAFLD. Fifty-one adults (mean age: 38 years; 28 men, 23 women) with NAFLD, diagnosed clinically and by ultrasonography (USG), were included in the study after obtaining informed consent and approval from the institute ethics committee. USG was performed for grading of hepatic steatosis in all patients, followed by magnetic resonance imagingwith DWI and MRS, on a 1.5T scanner. The mean apparent diffusion coefficient (ADC) values and proton density fat fraction (PDFF) were calculated, and MRS was used as the gold standard. The mean ADC values were compared with the PDFF and USG grades. There was a weak correlation between ADC values and PDFF (r= -0.36; P < 0.05). In addition, there was a weak correlation between the ADC values of the liver and USG grade (r= -0.34; P < 0.05). However, an overall increase in USG grades and PDFF was associated with decrease in the mean ADC value (P < 0.001). DWI is not accurate in the diagnosis and grading of hepatic steatosis in patients with NAFLD. However, a significant increase in fat deposition in the liver lowers the ADC values.

Air bronchogram integrated lung ultrasound score to monitor community-acquired pneumonia in a pilot pediatric population

AimsChest ultrasound is a non-invasive method for evaluating children with suspected community-acquired pneumonia (CAP). We evaluated the prognostic role of change of ultrasonographic (US) air bronchogram in management of CAP in terms of: rate of complicated CAP, change of empiric antibiotic therapy, relationship to defervescence time, and length of hospitalization.MethodsPatients with CAP and radiographic evidence of lung consolidation were prospectively enrolled. Chest US examinations were performed within 12 h from admission and after 48 h. A new grading system (USINCHILD score) based on presence and features of air bronchogram was adopted.ResultsThirty six patients were stratified into two groups according to the presence of an increase of at least 1 grade of US score (Δ US grade), expression of an improvement of lung consolidation. Δ US grade after 48 h ≥ 1 was associated with an increased risk of complicated CAP (p value 0.027) and a longer defervescence time (p value 0.036). Moreover, Δ US grade ≥ 1 was predictive of a short hospitalization (p value 0.008).ConclusionsUSINCHILD score could be an innovative biotechnology tool for the management of pediatric CAP.Trial registration number and date of registrationNCT03556488, June 14, 2018.Graphic abstract

The clinical utility of accurate NAFLD ultrasound grading: Results from a community-based, prospective cohort study

ObjectivesDespite its widespread use there is no consensus on ultrasound criteria to diagnose fatty liver. MethodIn an ongoing, cohort-study, participants were initially screened in 2007 and reassessed in 2014 by interview, anthropometric measurements, liver ultrasonography, and blood tests. We evaluated utility of increased hepatic echogenicity alone (intermediate) compared to using additional criteria which included signal attenuation and/or vascular blunting along with increase of hepatic echogenicity (moderate-severe), to diagnose fatty liver in NAFLD. We made a comparison of the two radiologically defined groups, in order to choose a classification method for NAFLD, which may better predict baseline adverse metabolic traits (MT), and adverse metabolic and cardiovascular events (CVE) after 7-year of follow-up. ResultsOf 2985 recruited in 2007, 940 (31.5 %) had moderate-severe NAFLD, 595 (19.9 %) intermediate NAFLD, and 957 (32.1 %) were controls (no fatty liver). 2148 (71.9 %) attended follow-up in 2014; they included 708 who had moderate-severe NAFLD, 446 intermediate NAFLD and 674 controls, at baseline (in 2007).At baseline, adverse anthropometric indices and MTs were significantly higher in both moderate-severe NAFLD and intermediate NAFLD compared to controls, except for low HDL. They were commoner in moderate-severe NAFLD than in intermediate NAFLD. After seven years, the odds of developing new-onset metabolic traits and CVEs were significantly higher compared to controls only in moderate-severe NAFLD. ConclusionsOnly moderate-severe NAFLD predicted risk of incident adverse MTs and CVEs. However, both moderate-severe and intermediate NAFLD were associated with higher prevalence of adverse anthropometric and metabolic traits, thereby identifying individuals who need medical intervention even among those with milder degrees of fatty liver. We therefore recommend using increased hepatic echogenicity, and not only the more stringent criteria (which include signal attenuation and/or vascular blunting), for the diagnosis of fatty liver in individuals with NAFLD.

Doppler Ultrasound in Prostate Cancer: It’s Utility for the Diagnosis of High-Grade Tumors

Purpose: The aim of the present study was to evaluate the association between prostate vascularization seen in Doppler ultrasound and histopathological grade (Gleason score) in patients with a diagnosis of prostate cancer. Methods: A Gleason score &gt;7 was the dependent variable and Doppler ultrasound findings (vascular analysis, presence of nodule and prostate weight) were the independent variables. Univariate analysis was performed considering advanced tumors (Gleason &gt;7) as the dependent variable and area of hypervascularization, age and PSA as the independent variables. Multivariate analysis was performed using a binary regression model with the occurrence of advanced tumors (Gleason &gt;7) as the dependent variable. Results: In the univariate analysis, samples with Gleason ≤7 had a lower chance of being hypervascularized (OR: 0.44, 95% CI: 0.29-0.69), whereas those with Gleason scores &gt;7 had a fourfold greater chance of being hypervascularized (OR: 4.136, 95% CI: 2.598-6.554, p&lt;0.001). Moreover, hypervascularized tumors had a 7.4-fold greater chance of having a score &gt;7. Conclusion: The present study reveals an association between tumor hypervascularization detected using Doppler ultrasound and higher Gleason scores (more aggressive tumors), enabling an indirect inference of a worse prognosis for hypervascularized prostatic tumors. These findings should be confirmed in longitudinal studies.

Effect of Vildagliptin versus Vildagliptin plus Metformin on Nonalcoholic Fatty Liver Disease Patients with Type 2 Diabetes Mellitus

Background/Aims: Nonalcoholic fatty liver disease (NAFLD) is believed to be the most common chronic liver disease. The present study aimed to evaluate the efficacy of the vildagliptin versus vildagliptin / metformin combination in the treatment of nonalcoholic fatty liver disease patients with type 2 diabetes mellitus (T 2DM). Methods: One hundred twenty patients, who were newly diagnosed with T 2DM, and proof of diagnosis of NAFLD, were enrolled in a twelve-month open label prospective parallel study. The patients were divided into two groups; Group 1 received vildagliptin in a dose of 50 mg twice daily and Group 2 received vildagliptin/metformin in a dose of 50 mg/ 1000 mg twice daily. Body mass index and fatty liver ultrasound grading were evaluated with the assay of HbA1c and serum levels of fasting and postprandial glucose, lipid profile, liver enzymes, fasting insulin, adiponectin, ferritin, and creatinine and blood urea with calculation of HOMA-IR before and after treatment. Results: There was a significant improvement in fatty liver ultrasound grading in both groups (p=0.001). Univariate and multivariate analysis showed that the improvement in NAFLD grading in both groups was affected by change in BMI, HbA1c, fasting insulin, HOMA-IR, triglycerides and adiponectin. After twelve months both groups showed significant decrease in BMI (p=0.001), fasting serum insulin (p<0.05 and p=0.001, respectively), HOMA-IR, HbA1c and triglycerides (p=0.001). However, adiponectin level increased significantly in both groups (p=0.001). Conclusion: Both vildagliptin or vildagliptin/metformin combination can improve fatty liver disease through their effect on BMI, serum levels of insulin, triglycerides, adiponectin and HOMA-IR.

Ultrasonic evaluation of thelarche grading in 2-8-year-old obese girls suspected of precocious pubert.

The prevalence of obesity in children is increasing. In obese children, clinical examination alone is not sufficient to differentiate lipomastia from thelarche. The aim of this study was to investigate the frequency of true thelarche in obese girls suspected of precocious puberty. In a cross-sectional study, 100 obese girls between the ages of 2 and 8 years were screened. Maturity stages were determined based on the Tanner scale in the questionnaire. Breast ultrasound was performed for all cases. Other uterine and ovarian laboratory tests, including blood tests to determine plasma levels of LH, FSH, oestradiol, and bone age, were also performed. In ultrasonography examination of 80 children (80%), one breast was pubertal and in 72 people both breasts were pubertal in which ultrasonography of 78 children showed puberty of right breast and 74 children showed puberty of left breast. Twenty children showed bilateral lipomastia. In clinical examination, breasts of 18.9% children seemed lipoid, 35.8% children were seriously suspicious, and 45.3% children seemed pubescent. In pelvic ultrasound, the relationship between ovarian volume and breast ultrasound grade was significant, but uterine volume was not significantly related to breast ultrasound grade. Also, uterine volume with age at ultrasonography, bone age, birth height, left ovarian volume, right ovarian volume, right breast bud diameter, and left breast bud diameter were correlated. Ultrasound can help obese or overweight children to differentiate between true thelarche and lipomastia. The study also found that most suspected children had true thelarche.

Analysis of bleb morphology after CLASS with ultrasound biomicroscopy and clinical grading scale.

Filtration in the area subjected to CO2 laser-assisted sclerectomy surgery (CLASS) is described using ultrasound biomicroscopy (UBM) and the clinical grading scale to evaluate the mechanism of intraocular pressure (IOP) reduction. Twenty-eight patients with open-angle glaucoma underwent CLASS. The Indiana Bleb Appearance Grading Scale evaluation was performed 1 month after surgery to determine bleb height, extent, vascularity, and leakage. UBM was used to describe and measure the surgical area. Bleb morphology, the size of the scleral lake, scleral route, and trabeculodescemetic membrane (TDM) thickness were examined. One month after CLASS, IOP significantly decreased from 20.46 ± 3.92 mmHg to 12.71 ± 2.99 mmHg, and the anterior chamber depth significantly more shallow, from 2.75 ± 0.36 mm to 2.61 ± 0.33 mm(p < 0.05). Shallow uplift occurred in 71.43% of the blebs, and 64.29% of the blebs were within 1 to 2 h; 82.15% showed mild or moderate vascular hyperemia, and the Seidel test was negative. UBM showed that all eyes had an intact TDM, with a mean thickness of 99.3 ± 22.2 μm; 21 eyes (75%) had L-type (low reflective). The scleral lake anteroposterior length, height, and transversal length were 2.247 ± 1.831 mm, 0.520 ± 0.234 mm, and 3.312 ± 0.423 mm, respectively. The TDM thickness and postoperative IOP were positively correlated, and the size of the scleral lake was not correlated with IOP reduction. Four eyes (14.29%) exhibited cyclodialysis. UBM examination indicated the aqueous humor drainage route. In the early stage after CLASS, subconjunctival and choroidal drainage routes might be the major mechanism underlying IOP reduction. Mild and moderate congestion of bleb blood vessels warrant attention to avoid early bleb scarring.

Utility of quantitative ultrasound in community screening for hepatic steatosis

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease. Quantitative ultrasound facilitates clinical grading of hepatic steatosis (the early stage of NAFLD). However, the utility of quantitative ultrasound as a first-line method for community screening of hepatic steatosis remains unclear. Therefore, this study aimed to investigate the utility of quantitative ultrasound to screen for hepatic steatosis and for metabolic evaluation at the community level. In total, 278 participants enrolled from a community satisfied the study criteria. Each subject underwent anthropometric and biochemical examinations, and abdominal ultrasound imaging was performed to measure the controlled attenuation (CAP), integrated backscatter (IB), and information Shannon entropy (ISE). The assessment outcomes were compared with the fatty liver index (FLI), hepatic steatosis index (HSI), metabolic syndrome (MetS), and insulin resistance to evaluate the screening performance through the area under the receiver operating characteristic curve (AUROC) and Delong’s test. Ultrasound ISE, CAP, and IB were effective in screening hepatic steatosis, MetS, and insulin resistance. In screening for hepatic steatosis, the AUROCs of ISE, CAP, and IB were 0.85, 0.83, and 0.80 (the cutoff FLI = 60), respectively, and 0.84, 0.75, 0.77 (the cutoff HSI = 36), respectively, and those for the evaluation of MetS and insulin resistance were 0.79, 0.75, 0.79, respectively, and 0.83, 0.76, 0.78, respectively. Delong’s test revealed that ISE outperformed CAP and IB for the detection of hepatic steatosis and insulin resistance (P < .05). Based on the present results, ultrasound ISE is a potential imaging biomarker during first-line community screening of hepatic steatosis and insulin resistance.

Ultrasound grading of thyroid nodules using the BTA U-scoring guidelines - Is there evidence of intra-and interobserver variability?

U-score ultrasound classification (graded U1-U5) is widely used to grade thyroid nodules based on benign and malignant sonographic features. It is well established that ultrasound is an operator-dependent imaging modality and thus more susceptible to subjective variances between operators when using imaging-based scoring systems. We aimed to assess whether there is any intra- or interobserver variability when U-scoring thyroid nodules and whether previous thyroid ultrasound experience has an effect on this variability. A total of 14 ultrasound operators were identified (five experienced thyroid operators, five with intermediate experience and four with no experience) and were asked to U-score images from 20 thyroid cases shown as a single projection, with and without Doppler flow. The cases were subsequently rescored by the 14 operators after six weeks. The first and second round U-scores for the three operator groups were then analysed using Fleiss' kappa to assess interobserver variability and Cochran's Q test to determine any intraobserver variability. We found no significant interobserver variability on combined assessment of all operators with fair agreement in round 1 (Fleiss' kappa = 0.30, p <0.0001) and slight agreement in round 2 (Fleiss' kappa = 0.19, p < 0.0001). Cochran's Q test revealed no significant intraobserver variability in all 14 operators between round 1 and round 2 (all p>0.05). We found no statistically significant inter- or intraobserver variability in the U-scoring of thyroid nodules between all participants reinforcing the validity of this scoring method in clinical practice, allaying concerns regarding potential subjective biases in reporting.

Surgical site characteristics after CLASS followed by ultrasound biomicroscopy and clinical grading scale: a 2-year follow-up.

This study describes the imaging of the filtering area in CO2 laser-assisted sclerectomy surgery (CLASS) using ultrasound biomicroscopy (UBM) combined with the Indiana Bleb Appearance Grading Scale (IBAGS) and evaluates the mechanism by which CLASS lowers the intraocular pressure (IOP). Twenty-eight cases (28 eyes) of primary open-angle glaucoma that could not be controlled by drugs underwent CLASS. At 1, 3, 6, 12, 18, and 24 months after surgery, IBAGS was used to evaluate the external morphology of the filtering blebs, and UBM was used to describe and measure their internal structure. During the early period after CLASS, most cases showed diffuse filtering blebs with a serious degree of congestion. At the end of follow-up, most cases did not present filtering blebs. All patients showed an intact and thin trabeculodescemetic membrane (TDM) with an average thickness of 0.094 ± 0.017 mm. The scleral reservoir size gradually decreased over time and tended to stabilize after 18 months. At 3 and 6 months after surgery, 53.57% of the patients had abnormalities in the TDM area, and after laser goniopuncture treatment, the scleral reservoir became slightly larger and the IOP decreased. The TDM thickness was not correlated with postoperative IOP, and the scleral reservoir size was negatively correlated with IOP. During the early phase after CLASS, the subconjunctival and suprachoroidal pathways may be the main mechanisms lowering IOP; over time, internal drainage pathways such as the intrascleral, trabecular-meshwork, and suprachoroidal pathways play greater roles in lowering IOP.

OC08.01: Placenta accreta spectrum prenatal ultrasound grade and association with clinical outcomes

OC08.01: Placenta accreta spectrum prenatal ultrasound grade and association with clinical outcomes

Radio Pathological Correlation of Thyroid Nodules Using Tirads Based Ultrasound Classification and Bethesda Classification for FNAC: a Prospective Study

Background: Thyroid gland is afflicted by various pathologies amongst which nodules are the cause of maximum concern because of their malignant potential. With the introduction of high resolution ultrasound and use of Thyroid imaging reporting and data system (TIRADS) classifi cation as a widely used universal grading system, there has been reduced inter-observer variability and increased inter-departmental communication. In this study, we studied the TIRADS ultrasound grading as a screening tool and compared it with the BETHESDA grading on FNAC. Material and methods: 200 patients with thyroid nodules were subjected to ultrasound and USG guided FNAC. Each was assigned a TIRADS and Bethesda grade. Findings were compared to assess the sensitivity, specifi city, PPV (positive predictive value) and NPV (negative predictive value) of ultrasound in differentiating benign from malignant nodules. RESULT: Out of 200 nodules examined, 116 nodules belonged to TIRADS 2 while 44, 13 and 27 belonged to TIRADS 3, 4 and 5 respectively. On FNAC, 162 patients belonged Bethesda 2 &amp; 12, 7, 15 and 4 to Bethesda 3, 4, 5 and 6 respectively. The sensitivity, specifi city, PPV and NPV of ultrasound were found to be 92.3, 90.8, 60 and 98.75 % respectively. Conclusion: TIRADS is an effective risk stratifi cation system which should be routinely used in our clinical practice as it can predict the possibility of a particular nodule for being malignant to a great extent. Especially keeping in mind its high negative predictive value, FNAC can be deferred in TIRADS 2 patients which form a majority of cases reporting to pathology department for thyroid FNAC.

Clinical Value of Information Entropy Compared with Deep Learning for Ultrasound Grading of Hepatic Steatosis.

Entropy is a quantitative measure of signal uncertainty and has been widely applied to ultrasound tissue characterization. Ultrasound assessment of hepatic steatosis typically involves a backscattered statistical analysis of signals based on information entropy. Deep learning extracts features for classification without any physical assumptions or considerations in acoustics. In this study, we assessed clinical values of information entropy and deep learning in the grading of hepatic steatosis. A total of 205 participants underwent ultrasound examinations. The image raw data were used for Shannon entropy imaging and for training and testing by the pretrained VGG-16 model, which has been employed for medical data analysis. The entropy imaging and VGG-16 model predictions were compared with histological examinations. The diagnostic performances in grading hepatic steatosis were evaluated using receiver operating characteristic (ROC) curve analysis and the DeLong test. The areas under the ROC curves when using the VGG-16 model to grade mild, moderate, and severe hepatic steatosis were 0.71, 0.75, and 0.88, respectively; those for entropy imaging were 0.68, 0.85, and 0.9, respectively. Ultrasound entropy, which varies with fatty infiltration in the liver, outperformed VGG-16 in identifying participants with moderate or severe hepatic steatosis (p < 0.05). The results indicated that physics-based information entropy for backscattering statistics analysis can be recommended for ultrasound diagnosis of hepatic steatosis, providing not only improved performance in grading but also clinical interpretations of hepatic steatosis.

Can the American Thyroid Association, K-Tirads, and Acr-Tirads Ultrasound Classification Systems Be Used to Predict Malignancy in Bethesda Category IV Nodules?

Objective: Management of thyroid nodules with Bethesda category III and IV cytology on fine needle aspiration (FNA) is challenging as they cannot be adequately classified as benign or malignant. Ultrasound (US) patterns have demonstrated the utility in evaluating the risk of malignancy (ROM) of Bethesda category III nodules. This study aims to evaluate the value of 3 well-established US grading systems (American Thyroid Association [ATA], Korean Thyroid Imaging Reporting and Data System [Korean-TIRADS], and The American College of Radiology Thyroid Imaging Reporting and Data System [ACR-TIRADS]) in determining ROM in Bethesda category IV nodules.Methods: Ninety-two patients with 92 surgically resected thyroid nodules who had Bethesda category IV cytology on FNA were identified. Nodule images were retrospectively graded using the 3 systems in a blinded manner. Associations between US risk category and malignant pathology for each system were analyzed.Results: Of the 92 nodules, 56 (61%) were benign and 36 (39%) were malignant. Forty-seven per cent of ATA high risk nodules, 53% of K-TIRADS category 5 nodules, and 50% of ACR-TIRADS category 5 nodules were malignant. The ATA high-risk category had 25% sensitivity, 82% specificity, 47% positive predictive value (PPV) for malignancy. K-TIRADS category 5 had 25% sensitivity, 85% specificity, 53% PPV for malignancy. ACR-TIRADS category 5 had 25% sensitivity, 84% specificity, 50% PPV for malignancy. None of the 3 grading systems yielded a statistically significant correlation between US risk category and the ROM (P = .30, .72, .28).Conclusion: The ATA, Korean-TIRADS, and ACR-TIRADS classification systems are not helpful in stratifying ROM in patients with Bethesda category IV nodules. Clinicians should be cautious of using ultra-sound alone when deciding between therapeutic options for patients with Bethesda category IV thyroid nodules.

ROLE OF PLATELET RICH PLASMA THERAPY ON ROTATOR CUFF DISEASE

Background: There is lack of evidence from randomized clinical trials that had assisted the efficacy of PRP in treating of rotator cuff diseases (RCD).Aim of the work: To study the effect of PRP injection on functional improvement on RCD, and to study the role of proinflammatory and angiogenesis-related cytokines as a pathogenic factor in RCD.Patients and methods:The study was conducted on 40 patients with RCD. All patients subjected to: clinical shoulder examination, clinical scoring including; (VAS and Los Angeles Shoulder score), cytokine assay of vascular endothelial growth factor (VEGF) and interleukin one beta (IL-1β), and diagnostic musculoskeletal ultrasound examination (MSU). All patients underwent two doses of ultrasound guided PRP injection with 4 weeks in-between. Re-evaluation after 4 weeks from first injection was done using clinical scoring, cytokine assay and MSU. Third assessment was done 3 months from first injection using clinical scoring and MSU.Results: There was a statistically high significant decrease in pain, improvement of range of motion (ROM), power and functional state in all participants after 2 doses of PRP injection and rehabilitation program. In addition, there was a highly statistical significant decrease of cytokines serum levels after 4 weeks. There was a highly significant improvement regarding MSU grading. There was positive correlation between the serum levels of cytokines and VAS and negative correlation between the serum levels of cytokines and other clinical scores. There was positive correlation between the serum levels of VEGF and MSU grading. Conclusion:PRP therapy is an effective treatment for RCD and lead to functional improvement. There is a strong correlation between levels of cytokines (IL-1β and VEGF) and clinical scores before injection and 4 weeks following first injection. There is strong correlation between level of VEGF and ultrasound grading of RCD.

Grading Bleomycin-Induced Pulmonary Fibrosis in ex vivo Mouse Lungs Using Ultrasound Image Analysis.

The aim of this study was to assess bleomycin-induced pulmonary fibrosis on ex vivo mouse lungs using ultrasound image grading and texture analysis. Excised mouse lungs were divided into 3 groups: control, mild fibrosis, and severe fibrosis based on the monitored indicators of health. B-mode ultrasound images were obtained via scanning the mouse lungs ex vivo. The surface smoothness, echo density, and angle of lesions or the lung margin were graded, and the imaging contrast, correlation, homogeneity, and entropy were assessed via texture analysis. The grades of surface smoothness, echo density, and angle were statistically higher for the severe fibrosis group compared with those of the control and mild fibrosis groups (P < .05). In addition, statistically significant differences in the contrast, correlation, and homogeneity between mild and severe fibrosis groups were observed (P < .05). The results obtained in this study suggest that ultrasound image grading and texture analysis are valuable and meaningful methods for assessing pulmonary fibrosis in a bleomycin mouse model.

Importance of thyroid-stimulating hormone levels in liver disease.

Objectives Recently, several studies have reported the association between elevation of thyroid-stimulating hormone (TSH) levels and liver disease, especially, non-alcoholic fatty liver disease (NAFLD). We aimed to evaluate the incidence and risk factors of TSH elevation in patients with liver disease. Methods We retrospectively reviewed the data of patients aged <18 years who were diagnosed with liver disease between January 2015 and March 2019. Results Among the 77 patients, 17 (22.1%) had subclinical hypothyroidism and 3 (17.6%) progressed to overt hypothyroidism. A total of 26 (33.8%) patients had NAFLD, and 6 (23.1%) had subclinical hypothyroidism. The ultrasound grade of liver steatosis was not related to the elevation of TSH levels. The median age was significantly younger in patients with TSH elevation (5 vs. 9 years, p = 0.017). Albumin levels were significantly decreased (3.9 vs. 4.3g/dL, p = 0.007), and total bilirubin levels were elevated (2.2 vs. 0.6mg/dL, p = 0.001) in patients with subclinical hypothyroidism. Conclusions TSH elevation commonly occurs in patients with liver disease, especially those with younger age. The cause of liver disease was not a risk factor for TSH elevation.

Scrotoscopy and traditional open surgery shows a high degree of consistency in the diagnosis of testicular torsion: An initial report.

Traditional open surgery (OS) is usually necessary when testicular torsion (TT) cannot be excluded by scrotal ultrasound. Scrotoscopy has been used as a minimally invasive technique to diagnose or treat scrotal diseases, and it may also play a role in diagnosing TT.A retrospective analysis was performed for patients with TT to evaluate the consistency of scrotoscopy and OS in the diagnosis of TT. In the cases where preoperational Color Doppler ultrasonography was performed, scrotoscopy, open surgery, and confirmed TT were included for future analysis.A total of 43 patients were studied. Twisted testes were retained in 11 cases (25.59%), and the remaining 32 patients (74.41%) underwent orchiectomy. There were significant differences in the diagnostic value between the grading of scrotoscopy and ultrasound, as well as between ultrasound grading and blood supply grading (BSG) (both P < .05). However, no significant difference was observed between the grading of scrotoscopy and BSG in traditional OS (P > .05), but a high degree of consistency existed between scrotoscopy grading and BSG in traditional OS (Kappa = 0.733, P ≤ .001).Our limited data indicate that the diagnosis of testicular torsion by scrotoscopy is highly consistent with that of traditional surgical exploration. Therefore, further studies are necessary to confirm its application value in the future. Scrotoscopy may have potential application value for the patients whom testicular torsion are insufficiently diagnosed but cannot be excluded.