Ultrasonographic Parameters Research Articles

SDMS CME Credit – Can Multi-organ Sonographic Parameters Predict Mortality in Patients with Acute Kidney Injury?

SDMS CME Credit – Can Multi-organ Sonographic Parameters Predict Mortality in Patients with Acute Kidney Injury?

Influence of serum uric acid on bone and fracture risk in postmenopausal women

AimsUric acid has been associated with several metabolic conditions, including bone diseases. Our objective here was to consider the relationship between serum uric acid levels and various bone parameters (bone mineral density, ultrasonographic parameters, vitamin D, PTH and serum calcium), as well as the prevalence and risk of fragility fracture.MethodsAn observational and cross-sectional study carried out on 679 postmenopausal women, classified into 3 groups according to their serum uric acid levels, in whom bone densitometry, calcaneus ultrasounds, PTH, vitamin D and serum calcium analysis were done. Bone fractures were collected through the clinical history and lateral spinal X-ray.ResultsHigher uric acid levels were found in women with older age, high BMI, diabetes, and high blood pressure. Higher levels of PTH and serum calcium were also observed, but did not effect on vitamin D. Serum uric acid was positively related to densitometric and ultrasonic parameters and negatively associated with vertebral fractures.ConclusionsIn the population of postmenopausal women studied, sUA levels were correlated with BMD, BUA, and QUI-Stiffness, and this correlation was independent of age and BMI. In addition, sUA was associated with a decrease in vertebral fractures. These results imply a beneficial influence of sUA on bone metabolism, with both a quantitative and qualitative positive effect, reflected in the lower prevalence of vertebral fractures.

Maternal Placental Growth Factor (PlGF) levels, sonographic placental parameters, and outcomes of IVF pregnancies with and without embryo trophectoderm biopsy.

In vitro fertilization (IVF) is associated with abnormal trophoblast invasion and resultant decreased levels of circulating placental biomarkers such as placental growth factor (PlGF).Our objective was to evaluate maternal serum levels of second/third trimester PlGF, sonographic placental parameters, and clinical outcomes among IVF frozen embryo transfer (FET) pregnancies with and without embryo trophectoderm biopsy. This was a retrospective study of pregnant patients who conceived using a single frozen embryo transfer (FET) and gave birth between 30 January 2018 and 31 May 2021. We compared PlGF levels, sonographic placental parameters, and clinical outcomes between FET with biopsy and FET without biopsy groups. The median PlGF level was 614.5 pg/mL (IQR 406-1020) for FET pregnancies with biopsy, and 717.0 pg/mL (IQR 552-1215) for FET pregnancies without biopsy. The adjusted mean difference was 190.9 pg/mL lower in the FET biopsy group (95% CI, -410.6, 28.8; p = 0.088). There were no statistically significant differences in placental parameters or clinical pregnancy outcomes. This exploratory study demonstrated a possible trend toward lower maternal serum PlGF in the pregnancies conceived with FET using a biopsied embryo. Further investigation is warranted into the potential placental health effects of trophectoderm biopsy.

Evaluation of the effect of SARS-COV-2 infection on Doppler ultrasound and placental findings of pregnant women: a systematic review and meta-analysis.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can infect the human placenta and has been shown to have an adverse effect on Doppler ultrasound parameters and placental features. However, the specific effects of the SAS-CoV-2 infection on the fetal-placental unit in pregnant women remain unclear. The aim of this systematic review and meta-analysis was to evaluate the impact of SARS-CoV-2 infection on Doppler ultrasound and placental findings in pregnant women. A systematic search was conducted using four electronic databases (PubMed, Embase, Scopus, and Cochrane Library) to select publications published in peer-reviewed journals written in English. Odds ratios (ORs) were calculated, along with their 95% confidence intervals (CIs). Heterogeneity was assessed using Cochrane Q and I<sup>2</sup> statistics and the appropriate P-value. The analysis used RevMan 5.3. This meta-analysis included 1,210 pregnant women from 10 case-control studies. SARS-CoV-2-infected pregnant women exhibited higher likelihoods of placental abnormalities (OR, 2.62; 95% CI, 1.66 to 4.13), aberrant Doppler values (OR, 1.95; 95% CI, 1.16 to 3.27), an abnormal cerebroplacental ratio (OR, 2.68; 95% CI, 1.52 to 4.75), altered fetoplacental circulation (OR, 1.56; 95% CI, 1.07 to 2.28), and increased placental thickness and placental venous lakes (OR, 1.85; 95% CI, 1.25 to 2.72). According to this meta-analysis, pregnant women infected with SARS-CoV-2 are more likely to experience altered Doppler ultrasonography parameters and placental abnormalities, including increased placental thickness, placental venous lakes, altered fetoplacental circulation, and cerebroplacental ratio. However, the limited number of case-control studies requires larger sample sizes to validate and enhance the evidence.

High-intensity Focused Ultrasound-A New Choice to Conduct Pulmonary Artery Denervation.

This research aimed to explore whether high-intensity focused ultrasound (HIFU) could conduct pulmonary artery denervation (PADN).HIFU was performed in pulmonary arteries of 6 normotensive rabbits at dose of 250W, 6 times for each rabbit, and an additional 6 rabbits served as controls. Then ATEPH was induced in both groups by intravenous infusion of autogeneic thrombus. Hemodynamics and ultrasonography parameters were measured by right heart catheter and echocardiography pre- and post-establishment of ATEPH models in both groups. Histological analysis and immunohistochemistry of tyrosine hydroxylase (TH) were also performed. After PADN procedures, 5 rabbits were successfully conducted PADN, of which ablation zone was also observed in right auricle or right lung in 4 rabbits. Ablation zone was detected only in right lung in 1 rabbit. Compared with control group, milder right heart hemodynamic changes were found in PADN group, accompanied by improved ultrasound parameters in PADN group. HIFU can acutly damage SNs around pulmonary artery successfully, which may be a new choice to conduct PADN. However, the accuracy of HIFU with PADN needs to be improved.

Predictive Value of Sonographic Parameters on the Effects of Cranial Molding Helmet Therapy in Infants with Positional Plagiocephaly.

Positional plagiocephaly is a deformational cranial flattening frequently treated in pediatric neurosurgical practice. Positional maneuvers and orthotic helmet therapy are preferred therapeutic options for moderate-to-severe forms. Treatment response seems to be age-dependent. Nevertheless, predictive data are vague, and cost-efficiency might be a limiting factor for treatment. The purpose of this study was to investigate the early predictive value of sonographic parameters on the efficacy of orthotic helmet therapy through the assessment of changes in skull shape and correlation of the parameters with caliper cephalometry values and with age. A consecutive cohort of 49 patients < 10 months of age, undergoing orthotic helmet therapy for positional plagiocephaly, was recruited prospectively. The authors routinely assessed the patency of the lambdoid sutures by ultrasound and the following additional skull parameters were measured: suture width, adjacent full bone thickness, adjacent cortical bone thickness and occipital angle. Caliper cephalometric values, as well as demographic and clinical data were collected. Retrospective data analysis showed an inverse relation between both cortical and full skull bone thickness and early treatment efficacy, defined by a reduction in the occipital angle. The improvement of sonographic parameters correlated with the development of cranial caliper cephalometry values. In conclusion, the sonographic assessment of skull bone thickness is a safe and cost-effective tool to predict the early efficacy of orthotic helmet therapy in positional plagiocephaly and might, therefore, help the clinician to foresee the potential evolution of the deformity.

ULTRASONOGRAPHY IN THE INVESTIGATION OF TEMPOROMANDIBULAR JOINTS: PROBLEMS AND PROSPECTS

Ultrasonography (USG) can be considered as a useful method for rapid screening of patients with suspected temporomandibular disorders (TMDs). It is necessary to select USG parameters of the temporomandibular joint (TMJ) and the masticatory muscles (MM) with unambiguous interpretation and to standardize them (determine the norm and reference points of measurement). Purpose of the study. To review the ultrasonographic parameters of the TMJ and masticatory muscles MM with unambiguous interpretation. Materials and methods. An analysis of the literature was carried out by processing scientific and metric bases, from which 26 articles were selected. Results. During the USG examination of the TMJ and MM, various parameters are determined, which can be conditionally divided into parameters with an unambiguous interpretation, and those that cause controversy. Based on the analysis of the scientific and practical literature, as well as our own experience, USG parameters with an unambiguous interpretation were selected, namely, the width of the joint space, the amplitude of condylar translation, the thickness of the MM at rest and during compression, the percentage of thickening of MM, the position of the articular disc when closed and open mouth, movement of the condyle during opening and closing the mouth, clarity and uniformity of the width of the subchondral-cartilaginous complex of the condyle. Conclusions. The literature review indicates an urgent need to standardize the USG protocol for TMJ and masticatory muscle examination by unifying clinically important USG parameters, determining their norm and gender characteristics.

Pelvic ultrasound and pubertal attainment in girls with sexual precocity: the pivotal role of uterine volume in predicting the timing of menarche.

Among girls assessed for pubertal precocity, pelvic ultrasound (pUS) may represent a pivotal tool to predict the time expected to elapse between sonographic assessment and the onset of menarche (TUS-M). Accordingly, the present analysis is meant to define the statistical relationship between sonographic parameters and TUS-M, in order to identify the most reliable predictor of the timing of menarche. Retrospective, multicenter analysis. Girls assessed for sexual precocity and showing sonographic and clinical findings consistent with pubertal onset upon referral were considered eligible. Patients treated with GnRH analogues were excluded and only those who had subsequently achieved complete and spontaneous pubertal attainment and for whom the exact date of menarche was available were included. Overall, we enrolled 184 girls from five tertiary care Italian Centers. The time elapsed (months) between baseline endocrine assessment and spontaneous achievement of menarche showed a negative statistically significant correlation (p<0.0001) with LH (r:-0.61), FSH (r:-0.59), estradiol (r:-0.52) and stimulated LH values (r:-0.58). Among pUS parameters, ovarian volume (r:-0.17 left, -0.30 right) and uterine body-to-cervix ratio (r:-0.18) poorly correlated with TUS-M, while uterine diameters (r:-0.61 longitudinal, -0.64 anteroposterior) and volume (r:-0.70) achieved a highly statistical significance (p<0.0001). Uterine volume (UV) showed a negative logarithmic relationship with TUS-M and represented the most reliable predictor of the timing of menarche in uni- and multivariable analyses (p <0.001). ROC analyses identified the UV thresholds that best predict the onset of menarche within 18, 12 and 6 months, respectively: 3.76, 6.02 and 8.80 ml. The logarithm of UV shows the best statistical performance in predicting the timing of menarche in girls assessed for pubertal precocity. Accordingly, we developed a user-friendly online application that provides clinicians with an estimation of the months expected to elapse before menarche, based on the UV recorded upon pUS.

The Diagnostic Accuracy of Sonographic Parameters for Renal Artery Stenosis in Adults: A Rapid Literature Review Based on a Statistical Approach

Objective: The aim of this study was to determine the 95% confidence interval (CI) cutoff for sonographic renal artery stenosis (RAS) parameters. A secondary objective was to determine the diagnostic accuracy parameters of peak systolic velocity (PSV), renal aortic ratio (RAR), acceleration index (AI), and acceleration time (AT) for diagnosing RAS. Materials and Methods: Diagnostic test accuracy (DTA) parameters and 95% CIs were evaluated for the sonographic cutoff values. A total of 31 articles were extracted and subjected to statistical analysis. Results: The mean 95% CI cutoff for PSV, RAR, AI, and AT were 192.50 (175.16, 209.84), 3.10 (2.83, 3.38), 3.39 (2.51, 4.27), and 80.78 (68.56, 93.01), respectively. The pooled mean 95% CI sensitivity of PSV, RAR, AI, and AT were 85.90% (79.84, 91.97), 82.34% (77.58, 87.11), 74.92% (64.53, 85.33), and 73.57% (63.01, 84.13), respectively, whereas the pooled mean specificity of the same parameters was 82.52% (75.78, 89.25), 86.97% (83.12, 90.82), 78.93% (66.34, 91.52), and 82.57% (70.70, 94.44), respectively. Conclusion: The pooled mean 95% CI for sensitivity and specificity of the sonographic parameters was concordant with the literature. Based on this higher level of evidence, except RAR, the mean 95% CI cutoff for PSV, AI, and AT were consistent with the cutoff values encountered in the published literature.

Retrospective renal sonographic study: assessment of renal volume and resistance index

Background. Renal ultrasound is a convenient, safe, and affordable tool for visualization of the kidneys in the daily practice of nephrologists and doctors of other specialties. Kidney volume, which is calculated by the sonographic method, gives an idea about the state of the kidneys of the patient, but says almost nothing about their function. There are many studies of renal index of resistance (IR) as a marker of kidney function. IR values were compared with serum creatinine levels and/or histological data. And although conflicting research data limit the use of IR as a marker of kidney function, correct interpretation of IR helps restore it to the status of a candidate marker of kidney function. The purpose of the study: to conduct a retrospective analysis of the sonographic renal parameters in patients who sought outpatient medical care at the Brovary medical institution. Materials and methods. Retrospective randomized cohort study was conducted of sonograms of 66 outpatients who sought outpatient medical care at a private medical facility in Brovary from February 2022 to February 2024. They were divided into 2 groups: the first one (n = 31) — men and the second group (n = 35) — wo­men. Results. The results of multiple linear regression in the group 1 for right kidney (RK) showed that the independent variable in this model, RK thickness, is of low significance as a predictor for IR RK, and the following independent variables were not significant as predictors for IR RK: RK length, RK width, RK volume, age. Multiple linear regression results in the group 1 for left kidney (LK) indicate that the independent variable in this model, LK width, is moderately significant as a predictor for LK IR, and the following independent variables were not significant as predictors for LK IR: LK length, LK thickness, LK volume, age. Multiple linear regression results in the group 2 for RK showed that the independent variables in this model, RK width and age, are significant as predictors for IR RK, and the following independent variables were not significant as predictors for IR RK: RK length, RK thickness, RK volume. Multiple linear regression results in the group 2 for LK indicate that the independent variable in this model, LK width, is moderately significant as a predictor for LK IR, and the following independent variables were not significant as predictors for LK IR: LK length, LK thickness, LK volume, age. Conclusions. Renal ultrasound allows predicting the category of patients who will need a consultation with a nephrologist/urologist, identifying risk groups for chronic kidney disease.

Normal sonographic measurements for kidney dimensions in Saudi adult population: A cross-sectional prospective study.

The use of ultrasound-based measurements to determine renal size has proven valuable in the diagnosis of renal function and associated disorders. The dimensions of the abdominal organs are affected by an individual's body age, height, sex, and weight. The objective of this study was to establish the standard sonographic parameters for renal dimensions and to determine the correlation between body measurements and renal dimensions in a population of healthy adults residing in Jazan City, Saudi Arabia. The present study was a prospective study conducted at a single center located in Jazan City from February to August 2022. Ninety-five participants underwent abdominal ultrasonography. The process of measuring renal size through sonography entails the measurement of various dimensions of the kidney, such as renal length, width, and thickness. The demographic information of the participants, including their sex, age, height, and weight, was documented. All analyses were performed using Statistical Package for the Social Sciences v27 software. The dimensions of the right kidney, specifically the length, width, and thickness, had mean value of 9.79 centimeters (cm), 5.09 cm, and 4.10 cm, respectively. The left kidney had mean dimensions of 10.1 cm, 5.09 cm, and 4.10 cm for length, width, and thickness, respectively. The left kidney was larger than the right kidney. Furthermore, male participants exhibited larger kidney measurements than their female counterparts did. A noteworthy positive correlation was observed between the thickness of the left kidney and sex, whereas no significant correlations were found with age, weight, or height. The current study revealed that the kidney dimensions were observed to be larger in males as compared to females. The research findings indicate that there is no significant correlation between kidney dimensions and various demographic factors, such as age, height, weight, and sex. In addition, this study provides reference tables for further use.

Disease characterization in cloned foals in Colombia, the effect of placental pathologies on the success and survival of cloned foalsfrom two different cell lines

Cloned foals born in the different cloning programs in the USA, Argentina, and recently in Colombia have experienced several pathological entities during their pregnancy and neonatal period. These entities include abortions, stillbirths, hypoxic-ischemic encephalopathy, large umbilical remanent, and angular deformity on the fore limb. The objectives of this study were to determine whether cloned foals suffer similar diseases and have the same mortality rate as noncloned ones and the differences between cloned foals from two different cell lines (fibroblastic and bone marrow cells) and, to establish whether mares carrying cloned foals from different cell lines have ultrasonographic, paraclinical, and hormonal profile parameters equal to traditional pregnancies and to determine whether there are differences between the cloned foals from the two different cell lines. In the analysis of the continuous variables, significant mean differences were established in the three groups of mares in PCV, hemoglobin, erythrocyte count, MCV, MCH, serum proteins and globulins, and in lymphocyte counts p&lt;0.05. A risk analysis was made for morbidity and mortality associated with the cell origin of the clone and its pregnancy using chi-square sequential tests and logistic regression, and it was considered statistically significant at p&lt; 0.05. A principal component analysis of the paraclinical findings of the mares with the outcome of the foal and the paraclinical parameters of the foals divided by the origin of gestation was performed to evaluate the components of the response variable and their dynamics. Thirty-four pregnancies of clones of fibroblastic origin, 26 of clones of bone marrow origin, and 32 of non-clones were studied. The presentation of placental diseases compatible with placentitis was significantly more frequent (p= 0.026) in mares with cloned foals from fibroblastic cell lines. Neonatal sepsis was determined to be the most frequent disease and was diagnosed more commonly in foals of fibroblastic cell origin—an increase in the risk (OR 37) (p=0.0006). The risk of death was positive and significant with the fibroblast cell line foals (OR: 9.1. P&lt;0.01) compared to the cloned foals of marrow cell origin and non-cloned foals. The risk of death can be predicted in the neonatal period, and some indicators found in this study, such as signs related to placentitis, are associated with increased neonatal mortality and are more frequent in foals of fibroblastic cell origin.

Clinical and diagnostic value of transrectal ultrasound in assessing the severity of ulcerative colitis

Background. Endoscopic and histological studies play a decisive role in the diagnosis of inflammatory bowel diseases, as they allow confirming the diagnosis, determining the degree of inflammatory activity, the extent of intestinal damage, and monitoring the course of disease and the effectiveness of therapy. Howe­ver, it is not possible to assess the state of all intestinal layers with colonoscopy. Modern non-invasive methods such as ultrasound, computed tomography, and magnetic resonance imaging cope best with this purpose. With their help, you can assess the state of the intestinal wall and obtain a cross-sectional image of the intestine, evaluate extraintestinal structures (lymph nodes, vessels, fatty tissue). It can be said that endoscopy and ultrasound search for the same type of information but look at different things. Deepening the knowledge about the role of ultrasound of the distal parts of the colon in ulcerative colitis (UC) will contribute to the improvement of diagnosis, development of methods for determining the activity of UC, control of therapy, which will allow optimizing the choice of adequate treatment measures. The goal of the work: to improve the diagnosis of ulcerative colitis based on the study of ultrasonographic parameters of the rectum. Materials and methods. Transrectal ultrasound was performed on an expert-class SonoScape S60 ultrasound scanner using a low-frequency convex probe of 3.5 MHz and a rectovaginal convex probe of 6 MHz. Transperineal and transrectal approaches were used. Results. Wall thickness and submucosal thickness differed significantly in moderate and severe UC. Analysis of transrectal ultrasound indicators depending on the endoscopic activity of the UC revealed no significant differences in the rectal wall thickness. But there was a tendency to increase in the thickness of the mucous layer and the coefficient of deformation with increasing endoscopic activity. Most patients had an increase in the degree of blood flow density, which depended on the disease severity. During the regression analysis, a relationship was found between the intestinal wall thickness (r = 0.44; p = 0.0121) and submucosal layer thickness (r = 0.86; p = 0.006) with the Mayo index. A correlation was revealed between the thickness of the colon wall and the frequency of bowel movements (r = 0.37; p = 0.018), leukocytosis (r = 0.38; p = 0.016) and erythrocyte sedimentation rate (r = 0.35; p = 0.027). The blood flow density in the intestinal wall positively correlated with the presence of edema (r = 0.32; р = 0.045), the severity of the vascular pattern (r = 0.42; р = 0.008), the presence of erosions (r = 0.4; р = 0.011) and bleeding of the mucous membrane (r = 0.50; p = 0.001). The coefficient of deformation positively correlated with the presence of flatulence (r = 0.35; р = 0.048). Conclusions. Endoscopic exa­mination in patients with UC should be supplemented with transrectal ultrasound. A correlation was found between the intestinal wall thickness and the thickness of the submucosal layer in patients with UC and the Mayo index. A tendency to increase in the thickness of the mucous layer and the coefficient of deformation with increasing endoscopic activity was determined. Relationships between endoscopic and ultrasound parameters can be used to assess disease activity.

Inter-software reliability and agreement for follicular and luteal morphometric and echotextural ultrasonographic parameters in beef cattle

This study aimed to compare the inter-software and inter-observer reliability and agreement for the assessment of follicular and luteal morphometry and echotexture parameters in beef crossbreed females (3/8 Bos taurus indicus and 5/8 Bos taurus taurus). B-mode and color Doppler ultrasonographic ovarian images were obtained at specific time points of estradiol-progesterone-based protocols for timed artificial insemination (TAI). Sonograms were analyzed by two observers using a licensed (IASP1) and an open access (IASP2) software package. A total of 292 snap-shot sonograms were analyzed for morphometric parameters and 504 for echotexture parameters. inter-software reliability was judged moderate to excellent (ICC or CCC=0.73–0.98), whereas inter-observer reliability for morphometric parameters was deemed good to excellent (ICC or CCC=0.82–0.98). A small percentage (up to 10.95 %) of measured parameters fell outside the limits of inter-software and inter-observer agreement. For echotexture parameters, inter-software reliability varied widely (ICC or CCC=0.16–0.95) based on the size of regions of interest (ROI), while inter-observer reliability ranged from moderate to excellent (ICC or CCC= 0.71–0.97). The highest inter-software reliability for pixel value and heterogeneity value was observed for the corpus luteum (ICCs=0.81–0.95; P>0.05), followed by the peripheral follicular antrum (ICCs=0.75–0.78; P<0.05). However, lower reliability was determined for the follicular wall (ICCs=0.08–0.33; P<0.0001) and perifollicular stroma (ICCs=0.16–0.46; P<0.05). In conclusion, both software packages showed high reproducibility for morphometric measurements, while echotexture measurements were more challenging to replicate based on ROI sizes. Caution is advised when selecting ROI sizes for echotexture measurements in bovine ovaries.

CORRELATION BETWEEN FETAL BIOMETRY AND FETAL TRANSVERSE CEREBELLAR DIAMETER IN DETERMINATION OF GESTATIONAL AGE FROM THE 15TH WEEK OF GESTATION TO TERM IN HEALTHY WOMEN WITH UNCOMPLICATED PREGNANCY

Objectives: The present study was conducted as an attempt to determine a correlation between the transverse cerebellar diameter (TCD) and the gestational age (GA) as determined by the last menstrual period (LMP) and other sonographic parameters such as biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) in healthy women with uncomplicated pregnancy between the 15th week of gestation to term, to derive normogram for estimating the GA of the fetus from ultrasonographically measured transverse cerebellar diameter. Methods: This prospective study was conducted on 1040 healthy women with uncomplicated pregnancy between the 15th week of gestation to term. Correlation between the GA by LMP with GA by other ultrasound parameters was done using Karl Pearson’s correlation(r). Results: This study demonstrated that throughout 15–40 weeks, TCD showed a strong correlation with clinical GA with a correlation coefficient (r) of 0.967 and a statistically significant correlation. Correlation coefficients between TCD and BPD, TCD and HC, TCD and AC, and TCD and FL being 0.987, 0.987, 0.986, and 0.988, respectively, indicated statistically significant and very strong correlation. Normogram of TCD showed that there was a linear relationship between cerebellar growth and gestational age. Conclusion: TCD can be used as a reliable parameter for the determination of GA.

Assessment of volume status of pediatric hemodialysis patients.

Accurate volume status assessment and dry weight achievement are the most challenging goals for a nephrologist. We aimed to evaluate the role of ultrasonographic parameters including lung ultrasound and inferior vena cava (IVC) measurements as practical methods of volume status assessment in children on hemodialysis by comparing them with established techniques, such as clinical evaluation and bioimpedance spectroscopy. A prospective cross-sectional study compared pre- and post-dialysis volume status using bioimpedance spectroscopy (BIS) parameters and clinical data with ultrasonographic lung B-lines and IVC parameters in children on regular hemodialysis. A total 60 children (mean age 9.4 ± 2.8years) were enrolled. Twenty patients (33.3%) were clinically overloaded to varying degrees (17 patients had mild to moderate signs of fluid overload and 3 patients had moderate to severe signs of fluid overload). All other patients (66.7%) were clinically euvolemic. Sonographic parameters were significantly lower post-dialysis than pre-dialysis, including lung B-line count and IVC diameter. IVC collapsibility index mean was significantly higher post-dialysis than pre-dialysis. There was a significant correlation between the lung B-line count, IVC parameters, and BIS-measured overhydration both before and after hemodialysis. Nine patients had ≥ 8 B-lines post-dialysis, only three of them were hypertensive. Clinical criteria alone are not specific for determining accurate fluid status in pediatric hemodialysis patients. Lung B-line score, IVC parameters, and BIS may be complementary to each other and to clinical data. Lung B-lines outperform IVC measurements and BIS in subclinical volume overload detection in pediatric hemodialysis patients.

Intraoperative Spinal Accessory Nerve Monitoring During Neck Dissection Surgery as a Predictor for Shoulder Dysfunction.

Shoulder dysfunction is one of the most common complications seen in patients who have undergone neck dissection surgery. The prevalence of shoulder dysfunction increases depending on the type and extent of neck dissection surgery. We aim to study the relationship between changes in intraoperative neuromonitoring (IONM) threshold during SAN stimulation, ultrasonographic measurement of muscle size and shear wave elastography with shoulder dysfunction. This is a prospective study. All patients who have undergone neck dissection in our centre have been recruited. Analysis of demographic data, IONM threshold during exposure and pre-closure, shoulder function score, neck disability index score (NDII) and ultrasonographic parameters pre-op and during follow up was done. The cohort was divided into patients who suffered from shoulder dysfunction post op (Group A) and patients with normal shoulder function post op (Group B). Statistical significance were seen in IONM threshold during SAN stimulation and Constant shoulder score for 6 months follow up in Group A. IONM threshold difference during exposure and pre-closure could effectively prognosticate shoulder dysfunction post op. A return of shoulder function could be seen in patients who suffered from shoulder dysfunction if early physiotherapy could be commenced.

Nomogram model of serum thymidine kinase 1 combined with ultrasonography for prediction of central lymph node metastasis risk in patients with papillary thyroid carcinoma pre-surgery.

The aim of this study was to develop a nomogram, using serum thymidine kinase 1 protein (STK1p) combined with ultrasonography parameters, to early predict central lymph node metastasis (CLNM) in patients with papillary thyroid carcinoma (PTC) pre-surgery. Patients with PTC pre-surgery in January 2021 to February 2023 were divided into three cohorts: the observation cohort (CLNM, n = 140), the control cohort (NCLNM, n = 128), and the external verification cohort (CLNM, n = 50; NCLNM, n = 50). STK1p was detected by an enzyme immunodot-blot chemiluminescence analyzer and clinical parameters were evaluated by ultrasonography. A suitable risk threshold value for STK1p of 1.7 pmol/L was selected for predicting CLNM risk by receiver operating characteristic (ROC) curve analysis. Multivariate analysis identified the following six independent risk factors for CLNM: maximum tumor size >1 cm [odds ratio (OR) = 2.406, 95% confidence interval (CI) (1.279-4.526), p = 0.006]; capsule invasion [OR = 2.664, 95% CI (1.324-5.360), p = 0.006]; irregular margin [OR = 2.922; 95% CI (1.397-6.111), p=0.004]; CLN flow signal [OR = 3.618, 95% CI (1.631-8.027), p = 0.002]; tumor-foci number ≥2 [OR = 4.064, 95% CI (2.102-7.859), p < 0.001]; and STK1p≥1.7 pmol/L [OR = 7.514, 95% CI (3.852-14.660), p < 0.001]. The constructed nomogram showed that the area under the ROC curve for the main dataset was 0.867 and that for the validation dataset was 0.830, exhibiting effectivity, and was recalculated to a total score of approximately 383. Through monitoring the response post-surgery, all patients were assessed as tumor-free at 12 months post-surgery, which was significantly associated with a reduction in STK1p to disease-free levels. We demonstrate for the first time that a novel nomogram including STK1p combined with ultrasonography can assist in the clinical prevention of CLNM, by facilitating timely, individualized prophylactic CLNM dissection, thereby reducing the risk of secondary surgery and the probability of recurrence.

Relationship Between Subclavian Artery Stenosis Lesions and Posterior Circulation Infarction: A Preliminary Study

To investigate the correlation between subclavian steal syndrome and posterior circulation infarction using magnetic resonance imaging. A total of 294 patients diagnosed with subclavian steal syndrome using carotid Doppler ultrasonography were retrospectively included. According to the magnetic resonance imaging results, they were divided into posterior circulation infarction group and nonposterior circulation infarction group. Clinical indicators and carotid Doppler ultrasound parameters of patients were collected, and they were screened to establish a multiple logistic regression model. Receiver operating characteristic curve analysis of the established multiple logistic regression model was performed, and the area under the curve was calculated to evaluate the predictive efficiency of the model. After statistical analysis of all parameters of the 2 groups of patients, a total of 10 parameters were included in multiple logistic regression to establish a model. The results showed a correlation between posterior circulation infarction and subclavian artery occlusion, grade III subclavian steal syndrome, gender, vulnerable plaques, National Institutes of Health Stroke Scale score, and age. After the receiver operating characteristic curve analysis of the model, the area under the curve for the multiple logistic regression model was 0.773. The multiparameter composite model based on clinical baseline data and carotid Doppler ultrasonography parameters can effectively predict posterior circulation infarction and offer novel insight for clinical diagnosis.

A non-invasive preoperative prediction model for predicting axillary lymph node metastasis in breast cancer based on a machine learning approach: combining ultrasonographic parameters and breast gamma specific imaging features.

The most common route of breast cancer metastasis is through the mammary lymphatic network. An accurate assessment of the axillary lymph node (ALN) burden before surgery can avoid unnecessary axillary surgery, consequently preventing surgical complications. In this study, we aimed to develop a non-invasive prediction model incorporating breast specific gamma image (BSGI) features and ultrasonographic parameters to assess axillary lymph node status. Cohorts of breast cancer patients who underwent surgery between 2012 and 2021 were created (The training set included 1104 ultrasound images and 940 BSGI images from 235 patients, the test set included 568 ultrasound images and 296 BSGI images from 99 patients) for the development of the prediction model. six machine learning (ML) methods and recursive feature elimination were trained in the training set to create a strong prediction model. Based on the best-performing model, we created an online calculator that can make a linear predictor in patients easily accessible to clinicians. The receiver operating characteristic (ROC) and calibration curve are used to verify the model performance respectively and evaluate the clinical effectiveness of the model. Six ultrasonographic parameters (transverse diameter of tumour, longitudinal diameter of tumour, lymphatic echogenicity, transverse diameter of lymph nodes, longitudinal diameter of lymph nodes, lymphatic color Doppler flow imaging grade) and one BSGI features (axillary mass status) were selected based on the best-performing model. In the test set, the support vector machines' model showed the best predictive ability (AUC = 0.794, sensitivity = 0.641, specificity = 0.8, PPV = 0.676, NPV = 0.774 and accuracy = 0.737). An online calculator was established for clinicians to predict patients' risk of ALN metastasis ( https://wuqian.shinyapps.io/shinybsgi/ ). The result in ROC showed the model could benefit from incorporating BSGI feature. This study developed a non-invasive prediction model that incorporates variables using ML method and serves to clinically predict ALN metastasis and help in selection of the appropriate treatment option.