Ultrasound Assessment Research Articles

Ultrasound assessment of the frequency and variation of arteries in the interscalene region.

Given the abundance of arteries in the neck, a significant risk of puncturing arteries exists when performing a brachial plexus block. Therefore, it is important to confirm the presence of arteries when performing a brachial plexus block via the interscalene approach. This study aimed to investigate the frequency and variations of arteries in the interscalene region in healthy Japanese adults using ultrasonography. This is an observational study at a university hospital. We analyzed videos of the brachial plexus recorded in another study using an ultrasound device and then investigated the frequency of the presence of arteries and the location of arteries in the interscalene region. Among 68 cases, 48 (70.6%) had one or more arteries in the interscalene region (63 arteries in total). The artery frequency on the ventral side of the 5th cervical nerve (C5), between C5 and the 6th cervical nerve (C6), between C6 and the 7th cervical nerve (C7), between C7 and the 8th cervical nerve (C8), and on the dorsal side of C8 was 19.1%, 1.5%, 35.3%, 29.4%, and 7.4%, respectively. The artery frequencies between C6 and C7 and between C7 and C8 were higher than those between C5 and C6 and on the dorsal side of C8. Interscalene observations using ultrasound devices revealed a high artery frequency, with numerous topographic variations.

Retromuscular, periprosthetic drainage after hernioplasty with sublay mesh reinforcement in ventral hernias results in less retromuscular fluid collections but longer hospital stay and analgetic use with unclear effect on clinical outcome - a randomized controlled trial

PurposeTo determine whether periprosthetic drain insertion for hernioplasty using sublay mesh augmentation influences retromuscular fluid collections (RFC) and the clinical course.MethodsForty-two patients with open repair of midline hernias (M2-4, W1, European Hernia Society classification) were allocated to groups with or without retromuscular drains. Subcutaneous drainages were used in both groups to avoid confounding from surgical site occurrences due to superficial, subcutaneous fluid collections. The participants underwent clinical and ultrasound assessments on postoperative days (POD) 14 and 30 to detect RFC, subcutaneous seromas, and wound complications. The sample size was estimated using the RFC of a test cohort with drainage; the assumed relevant volume (5 ml) was calculated comprising 84% (mean + 1 SD) of these patients.ResultsIn the retromuscular drainage group, the RFC median volume was reduced by 75.2% on POD 14, and by POD 30, no RFC were found [0.2 vs. 25.8 (p < 0.001) and 0 vs. 4.0 (p = 0.02) on PODs 14 and 30, respectively]. The number of patients with RFC ≥ 5 mL was also significantly lower in the drainage group [4 vs. 12 (p = 0.02) and 1 vs. 8 (p = 0.02) on PODs 14 and 30, respectively]. No surgical site infections occurred in either group, but retromuscular hematoseroma led to one revision surgery and one needle aspiration in the group without drainage. In the drainage group, a significantly longer hospital stay (6.5 days vs. 4 days; p = 0.01) and longer regular analgetic intake (6 vs. 3 days; p = 0.03) were observed. Multivariable regression revealed that retromuscular drainage usage was the only independent predictor of the RFC volume.ConclusionWe found that the use of retromuscular drains after hernioplasty with sublay hernia repair reduced periprosthetic fluid collections in our population but prolonged hospital stay. Whether the reduction of RFC can prevent SSO or revision surgery cannot be determined from our data, the relevance is therefore not assessable. Hence, further larger studies are required to determine the clinical relevance of drains.

Ultrasound assessment of the pelvic sidewall: methodological consensus opinion.

A standardized methodology for the ultrasound evaluation of the pelvic sidewall has not been proposed to date. Herein, a collaborative group of gynecologists and gynecological oncologists with extensive ultrasound experience presents a systematic methodology for the ultrasonographic evaluation of structures within the pelvic sidewall. Five categories of anatomical structures are described (muscles, vessels, lymph nodes, nerves and ureters). A step-by-step transvaginal ultrasound (or, when this is not feasible, transrectal ultrasound) approach is outlined for the evaluation of each anatomical landmark within these categories. Accurate assessment of the pelvic sidewall using a standardized approach improves the detection and diagnosis of non-gynecological pathologies that may mimic gynecological tumors, reducing the risk of unnecessary and even harmful intervention. Furthermore, it plays an important role in completing the staging of malignant gynecological conditions. Transvaginal or transrectal ultrasound therefore represents a viable alternative to magnetic resonance imaging in the preoperative evaluation of lesions affecting the pelvic sidewall, if performed by an expert sonographer. A series of videoclips showing normal and abnormal findings within each respective category illustrates how establishing a universally applicable approach for evaluating this crucial region will be helpful for assessing both benign and malignant conditions affecting the pelvic sidewall. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Fetal growth ultrasound in obese patients for the detection of growth abnormalities.

To examine the impact of maternal obesity on fetal growth abnormalities including fetal growth restriction (FGR) and large for gestational age (LGA) fetuses. Secondary analysis from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b). The study excluded individuals with pregestational or gestational diabetes, chronic hypertension, and other major maternal medical conditions. Ultrasound assessments were performed at 16 - 21 and 22 - 29 weeks of gestation. Our exposure was the presence of pre-pregnancy obesity. Our primary outcome was rates of fetal growth abnormalities identified by ultrasound, defined as FGR (estimated fetal weight [EFW] or abdominal circumference < 10th percentile) or LGA (EFW > 90 th percentile) among obese compared to non-obese women. A secondary analysis was performed after limiting ultrasound performed from 28-29 weeks. To estimate adjusted relative risks (aRR) with 95% confidence intervals (95%CIs), we used generalized linear models with Poisson distribution and log link using robust error variance, adjusting for the predefined covariates. Of 7,354 participants, 1,443 (19.6%) had pre-pregnancy obesity while 5,911 (80.4%) did not. Pre-pregnancy obesity compared with normal weight was associated with an increased risk of fetal growth abnormalities both at 16-21 weeks (16.0% vs. 13.2%; aRR 1.23; 95%CI 1.06-1.42) and 22-29 weeks (16.0% vs. 12.1%; aRR 1.33; 95%CI 1.14-1.54). Furthermore, pre-pregnancy obesity compared with normal weight was associated with an increased risk of LGA both at 16-21 weeks (12.5% vs. 10.3%; aRR 1.24; 95%CI 1.05-1.47) and 22-29 weeks (10.6% vs. 6.9%; aRR 1.66; 95%CI 1.38-2.01). In a secondary analysis limited to the ultrasound 28-29 weeks, both fetal growth abnormalities and LGA were associated with the presence of obesity. In any of the analyses, pre-pregnancy obesity was not associated with FGR compared to normal weight. Maternal obesity is associated with an increased risk of fetal growth abnormalities and LGA fetuses.

Telemedicine ultrasound assessment for placenta accreta spectrum: Utility and interobserver reliability of asynchronous remote imaging review.

Management of patients with placenta accreta spectrum (PAS) by trained multidisciplinary teams is associated with improved outcomes. Ultrasound can predict intraoperative risks, but expert ultrasound imaging of PAS is often limited. Telemedicine is used increasingly in obstetrics, permitting expert consultation when essential resources are not available locally. Our objective was to evaluate the feasibility of teleconsultation using standardized ultrasound image acquisition and reporting, and to correlate prognosis with intraoperative findings in patients at risk for PAS. A total of 12 PAS imaging experts (teleconsultants) were selected to asynchronously review deidentified standardized grayscale and color Doppler ultrasound images for five patients who had completed treatment for PAS, resulting in 60 individual teleconsultations. All patients were managed at a center using standardized imaging acquisition and intraoperative topographic classification to individualize surgical management. Teleconsultants reported the predicted topographic classification and recommended a surgical approach based on the topographic classification algorithm. Prognoses were compared with that reported by the local sonologist and with intraoperative findings. In all five patients, local sonologist prognosis and antenatal topographic classification was confirmed during surgery and the final surgical approach matched that which was recommended preoperatively. Teleconsultant antenatal evaluation and management plans matched those of the local team in 71.7% of the cases. When reports differed, PAS severity was overestimated in nine reviews (16.9%) and was underestimated in six reviews (11.3%). Remote imaging teleconsultation provides accurate prenatal staging in most patients at risk for PAS. Teleconsultation is a feasible strategy to improve prenatal imaging, management planning, and guidance for local teams in settings with limited healthcare resources.

Standardized Ultrasound Evaluation for Active Surveillance of Low-Risk Thyroid Microcarcinoma in Adults: 2024 Korean Society of Thyroid Radiology Consensus Statement.

Active surveillance (AS) has been widely adopted as an alternative to immediate surgery owing to the indolent nature and favorable outcomes of papillary thyroid microcarcinoma (PTMC). AS is generally recommended for tumors measuring ≤1 cm without aggressive cytological subtypes, risk of gross extrathyroidal extension (ETE), lymph node metastasis (LNM), or distant metastasis. AS requires careful patient selection based on various patient and tumor characteristics, and ultrasound (US) findings. Moreover, during AS, regular US is performed to monitor any signs of tumor progression, including tumor growth, new US features of potential gross ETE, and LNM. Therefore, appropriate imaging-based assessment plays a crucial role in determining whether AS or surgery should be pursued. However, detailed recommendations concerning US evaluation are currently insufficient, necessitating the formulation of this guideline. The Korean Society of Thyroid Radiology has developed a consensus statement for low-risk PTMC, covering US assessment methods when considering AS as a management option and conducting follow-up imaging tests during AS. This guideline aims to provide optimal scientific evidence and expert opinion consensus regarding a standardized US-based assessment protocol for low-risk PTMC.

Neovascularization as a Leading Mechanism of Intraplaque Hemorrhage and Carotid Plaque Destabilization: A Narrative Review.

Intraplaque neovascularization (IPN) is considered a leading mechanism causing carotid plaque destabilization. We provide an objective and comprehensive summary of the biology, imaging techniques, and treatment options related to carotid IPN. Plaque neovascularization has been reported to originate mainly from the adventitial vasa vasorum as a response to hypoxia. The leakage and rupture of neovessels lead to the formation of extravasations and foci of inflammation that destabilize the plaque. Vascular endothelial growth factor and its receptors are key regulators of neoangiogenesis. Neovascularization can be analyzed by advanced computed tomography and magnetic resonance imaging. The basic tools for the ultrasound assessment of IPN are contrast-enhanced ultrasound, superb microvascular imaging, and ultrasound molecular imaging. A promising direction of research seems to be the identification of patients with advanced plaque neovascularization. A simple test assessing low-velocity flow in the IPN can detect patients at risk of stroke before they experience rupture of defective neovessels and intracerebral embolism. In addition to surgical treatment, the stabilization of carotid atherosclerotic plaque can be supported pharmacologically. Statins have the best-documented role in this respect. The ideal moment of intensified therapeutic intervention in patients with previously stable carotid plaque is its increased neovascularization. However, the time frame in which intracerebral embolization may occur is unknown, and therapeutic intervention may be too late. The formation of deficient neovessels can currently be non-invasively evaluated with ultrasound. Superb microvascular imaging may change the clinical approach for asymptomatic patients at risk of cerebral ischemia.

Improved vascular health linked to increased physical activity levels and reduced sedentary behavior in rheumatoid arthritis.

Rheumatoid arthritis (RA) is characterized by deteriorated vascular health and increased cardiovascular risk. Physical activity (PA) is recommended for cardiovascular management in RA, but evidence on the associations between objectively-measured PA and vascular health markers in RA is limited. In this cross-sectional study, eighty-two post-menopausal women with RA (62±7 years) undertook ultrasound assessments of vascular function and structure, including brachial and superficial femoral artery (BA and SFA) flow-mediated dilation; baseline and post-hyperemia peak diameters; and carotid intima-media thickness. Participants also performed a 7-day accelerometer-based assessment of PA and sedentary behavior (SB). Fitted regression models controlled for age, body mass index and disease activity were conducted to examine associations between vascular and PA outcomes. Regression analyses revealed that prolonged SB (bouts>60min) and total sedentary time were inversely associated with both baseline and peak BA diameters, with each additional hour of SB resulting in decreases of 0.08-0.1mm in these diameters (p≤0.01). Total sedentary time also showed similar negative associations with peak SFA diameters (β=-0.14[-0.24-0.05], p<0.01). Conversely, light-intensity PA and stepping time were positively associated with both baseline and peak BA diameters, with each additional hour increasing these diameters by 0.10-0.24mm (p≤0.02). Finally, standing time was positively associated with SFA peak diameter (β=0.11[0.01-0.20], p=0.02). No associations were found between moderate-to-vigorous PA and vascular outcomes. In conclusion, in patients with RA, SB was negatively, while light PA was positively, associated with BA and SFA diameters. These findings suggest that reducing SB and increasing PA, even at light intensities, may improve vascular health in RA.

Rationale and Design of the DEFIANCE Study: A Randomized Controlled Trial of Mechanical Thrombectomy Versus Anticoagulation Alone for Iliofemoral Deep Vein Thrombosis

BackgroundDeep vein thrombosis (DVT) is a common medical condition that is associated with clinically significant sequelae, including postthrombotic syndrome (PTS). Anticoagulation alone remains the guideline-recommended treatment for many patients with iliofemoral DVT. Recent technological advances have led to an increase in the use of mechanical thrombectomy for DVT, but mechanical thrombectomy-based procedures have not yet been compared with standard-of-care anticoagulation therapy in randomized studies. MethodsThe DEFIANCE study (ClinicalTrials.gov: NCT05701917) is an international and actively enrolling randomized controlled trial (RCT) in lower extremity DVT assessing an interventional strategy that includes mechanical thrombectomy with the ClotTriever System (Inari Medical, Irvine, CA) versus anticoagulation alone. Approximately 300 patients with unilateral iliofemoral DVT and symptom duration ≤12 weeks will be randomized 1:1. Study conduct includes an independent core laboratory for duplex ultrasound assessment, an independent medical monitor for safety adjudication, and evaluation of PTS severity on the Villalta scale using best clinical practices. The primary endpoint is a composite outcome structured as a hierarchal win ratio of 1) the occurrence of treatment failure or therapy escalation as adjudicated by the medical monitor, with failure defined as amputation or gangrene of the target leg or venous thromboembolism-related mortality, and 2) the assessment of PTS severity at the 6-month follow-up visit. In addition to being a component of the primary endpoint, the severity of PTS at 6 months is also evaluated as a stand-alone secondary endpoint. An additional secondary endpoint is a composite of outcomes at the 10-day visit and is structured as a hierarchal win ratio of 1) vessel compressibility on duplex ultrasound, 2) patient-reported pain, and 3) improvement of edema. The safety endpoints are access site complications requiring endovascular or surgical repair and the occurrence through the 30-day visit of mortality, major bleeding, or new symptomatic pulmonary embolism. ConclusionsDEFIANCE will be the first RCT to evaluate a mechanical thrombectomy-based interventional approach versus anticoagulation therapy alone for DVT. The results will inform the treatment of patients with iliofemoral DVT and the prevention of PTS-associated morbidity. Trial RegistrationDEFIANCE: RCT of ClotTriever System Versus Anticoagulation In Deep Vein Thrombosis (DEFIANCE), ClinicalTrials.gov: NCT05701917, URL: https://clinicaltrials.gov/study/NCT05701917?cond=Deep%20Vein%20Thrombosis&term=defiance&rank=1

A Rare Case of the Bladder Endometriosis and Overview of the Literature

Endometriosis is a chronic, non-cancerous condition characterized by the growth of endometrial tissue outside the uterus. Isolated involvement of the bladder is rare and often part of a broader deep infiltrating pelvic endometriosis. Bladder endometriosis should be considered in cases of unexplained dysuria and urinary symptoms not clarified by imaging or pelvic examination. Magnetic resonance imaging can be used as a diagnostic aid. This case report presents two patients diagnosed with bladder endometriosis postoperatively. Conservative treatment with gestagen preparations was administered. After 3-6 months of follow-up, ultrasonography and symptom assessment showed no recurrence. Clinicians should be aware of bladder endometriosis as a potential cause of persistent urinary symptoms, given its rarity and often delayed diagnosis.

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.

Portable ultrasound devices for obstetric care in resource-constrained environments: mapping the landscape

Background The WHO’s recommendations on antenatal care underscore the need for ultrasound assessment during pregnancy. Given that maternal and perinatal mortality remains unacceptably high in underserved regions, these guidelines are imperative for achieving better outcomes. In recent years, portable ultrasound devices have become increasingly popular in resource-constrained environments due to their cost-effectiveness, useability, and adoptability in resource-constrained settings. This desk review presents the capabilities and costs of currently available portable ultrasound devices, and is meant to serve as a resource for clinicians and researchers in the imaging community. Methods A list of ideal technical features for portable ultrasound devices was developed in consultation with subject matter experts (SMEs). Features included image acquisition modes, cost, portability, compatibility, connectivity, data storage and security, and regulatory certification status. Information on each of the devices was collected from publicly available information, input from SMEs and/or discussions with company representatives. Results 14 devices were identified and included in this review. The output is meant to provide objective information on ideal technical features for available ultrasound systems to researchers and clinicians working in obstetric ultrasound in low-resource settings. No product endorsements are provided. Conclusions This desk review provides an overview of the landscape of low-cost portable ultrasound probes for use in obstetrics in resource-constrained environments, and provides a description of key capabilities and costs for each. Methods could be applied to mapping the landscape of portable ultrasound devices for other clinical applications, or may be extended to reviewing other types of healthcare technologies. Further studies are recommended to evaluate portable ultrasound devices for usability and durability in global field settings.

Intravascular Ultrasound Assessment of Distal Trans-Radial Access in Patients Undergoing Percutaneous Coronary Intervention.

Distal trans-radial access (dTRA) for percutaneous coronary interventions (PCI) is increasingly gaining attention due to its potential to mitigate radial artery occlusion (RAO). However, a comprehensive understanding of the mechanical impact of the devices on the radial artery (RA) wall remains limited. Using a complete intravascular ultrasound (IVUS) evaluation of the RA, including also the vascular access site, we aimed to evaluate all the consequences related to the catheterization on the RA wall, starting from the vascular access, comparing conventional sheath and sheathless approaches. This is an observational, prospective, multicenter study aimed to assess the entire RA wall immediately after IVUS-guided PCI via-dTRA. IVUS assessment included quantitative measurements (minimal lumen area [MLA], minimal vessel area [MVA]) and qualitative observations (dissections, vasospasm). Study objectives included delineating RA wall structure post-PCI and comparing findings between conventional and sheathless approaches. Fifty patients (21 [42%] with conventional sheath, 29 [58%] sheathless) were enrolled between March 2023 and February 2024. Female patients were more prevalent in the convention sheath group (38% vs. 7%, p < 0.001). Sheathless approach utilized 7-French guiding catheters more frequently (33% vs. 86%, p < 0.001). Post-procedural IVUS identified dissections in 12% of cases, with no significant difference between approaches. Arterial vasospasm was present in a quarter of patients, numerically higher in the conventional sheath group (29% vs. 21%, p = 0.5). MLA and MVA were comparable between groups, though MLA and MVA were lowest at the proximal segment of the RA only in the conventional sheath group (p < 0.001). No RAO was documented during the IVUS evaluation. The intravascular assessment of dTRA after coronary interventions, utilizing either conventional or sheathless approaches, including large-bore guiding catheters, demonstrated a relatively low incidence of access-related complications such as dissection and vasospasm, without affecting the flow and patency of the proximal RA.

Imaging modalities for atraumatic shoulder hypermobility: a scoping review.

Objective measures from imaging studies have the potential to assist in timely diagnosis of atraumatic shoulder hypermobility to better guide management. The aim of this scoping review is to examine imaging modalities and techniques used to characterize atraumatic shoulder hypermobility. MEDLINE, EMBASE, SPORTDiscus, Cochrane Library, and Web of Science were searched up to May 2024 for any primary study investigating imaging findings seen in atraumatic shoulder hypermobility. Patients with unilateral instability were excluded given its frequent association with traumatic origin. Eighteen observational studies met inclusion criteria. Results were divided into outcomes relating to capsular redundancy, glenohumeral anatomy, and muscle activation. Five studies using magnetic resonance arthrography (MRA) demonstrated statistically significant increases in capsular cross-sectional area (CSA), while a significant superior capsular elongation was reported by two studies in patients with multidirectional instability (MDI). Labrocapsular distance, glenocapsular ratio, and the presence of a combined sail and triangle sign on MRA were highly sensitive and specific parameters for identifying MDI. There were inconsistent findings for alterations of glenohumeral anatomy. Ultrasound assessments of acromiohumeral distance (AHD) were significantly increased in patients with MDI, but not in shoulders with hypermobility alone. Similarly, muscle activity measured by electromyography or glenohumeral translations differed significantly in patients with MDI, but not in those with hypermobility alone. Radiographic markers of capsular redundancy (e.g., CSA, labrocapsular distance, glenocapsular ratio), AHD, and muscular activity are useful in the diagnosis of MDI. However, there are no definitive imaging markers for diagnosing atraumatic shoulder hypermobility without MDI.

Ultrasound assessment of endothelial dysfunction in Egyptian migraine patients

BackgroundIt becomes clearer that migraine is associated with vascular risks; however, preclinical vascular involvement is not sufficiently addressed. Evidences point that migraine attacks affect vascular endothelium. The aim of this study was to investigate endothelial dysfunction in migraineurs through assessment of carotid intima-media thickness (CIMT) and flow-mediated dilatation (FMD) of the brachial artery and their correlation with clinical characteristics of migraine, headache severity, and brain magnetic resonance imaging (MRI) findings.ResultsA statistically significant difference was found between migraineurs and controls where carotid IMT was significantly higher and FMD of the brachial artery was significantly lower in migraineurs compared to controls. Carotid IMT was significantly higher and FMD was significantly lower in chronic migraine compared to episodic migraine patients. Mean IMT values were significantly higher in patients receiving ergots and in patients with subcortical white matter lesions in brain MRI. Mean FMD values were significantly lower in patients receiving ergots. There was a significant negative correlation between FMD and carotid IMT, age of the patients, disease duration, duration of headache attacks, headache frequency, and migraine disability assessment questionnaire (MIDAS) score. There were significant positive correlations between carotid IMT and age of patients, disease duration, headache frequency, MIDAS score, and number of MRI white matter lesions. For diagnosing endothelial dysfunction in migraineurs, the sensitivity and specificity of IMT were 72.5 and 70%, respectively, with a cut-off value of 0.575 mm and that of FMD were 82.5 and 90%, respectively, with a cut-off value of 20.55%.ConclusionMigraine coincides with endothelial dysfunction which promotes atherogenesis and increased risk of cerebral ischemia. FMD could be used as a potential biomarker for endothelial dysfunction in migraine. The affection of IMT and FMD is more in patients receiving ergots which may influence the selection of treatment in migraineurs in the future.

Early coronary artery atherosclerosis in humans is associated with attenuated coronary retention of klotho

Abstract Background Vascular aging is a key feature of cardiovascular disease. α-klotho (klotho) is a protein inversely associated with aging and may contribute to vascular repair. Lower levels of systemic klotho have been identified in humans with features of early and advanced coronary atherosclerosis. It remains unknown if circulating klotho is present within human coronary circulation and whether cardiovascular klotho retention correlates with atherosclerosis. Purpose The current study aimed to assess the presence of klotho within coronary circulation compared to systemic circulation and hypothesized that net coronary klotho retention is attenuated in patients with early age-related features of coronary artery disease (CAD). Methods A total of 42 patients that underwent clinically indicated coronary angiogram for chest pain that had no obstructive CAD underwent intravascular ultrasound (IVUS) assessment were retrospectively examined. Virtual histology assessed coronary plaque characteristics. Blood samples simultaneously collected from the proximal aorta and coronary sinus were used for klotho detection using enzyme-linked immunosorbent assay. The net gradient of klotho across cardiovascular circulation was calculated by multiplying the arteriovenous klotho gradient by basal coronary blood flow. A net positive gradient indicated less cardiovascular klotho retention; a net negative gradient indicated greater cardiovascular klotho retention. Results Overall, participants were age 54±10 years old and 76% were female. There were overall higher levels of klotho within the coronary sinus (median 0.49 ng/mL [0.15; 1.69]) compared to systemic circulation (median 0.30 ng/mL [0.16; 1.14]). Participant groups were determined by those with positive (n = 20) or negative (n = 22) cardiovascular retention of klotho. Both groups were similar in age (56 ±2 vs. 51 ±2 years old, p = 0.080), gender (72% vs. 80% female, p = 0.580), and had similar occurrences of traditional cardiovascular comorbidities. Those with less cardiovascular klotho retention in the coronary vascular bed had significantly greater degree of non-obstructive coronary artery plaque (Gensini score 3.5 vs. 0, p &amp;lt; 0.001) and had higher percent plaque burden (46% [35; 53] vs. 34% [28; 46], p = 0.044) than those with greater cardiovascular klotho retention. Conclusions Patients with early coronary atherosclerosis may be characterized by attenuated retention of klotho within coronary circulation. Moreover, humans appear to have higher circulating klotho in coronary circulation than in systemic circulation. The current study may support a role for mechanism or potential therapeutic target for klotho in coronary atherosclerosis in humans.

Sonographic Assessment of Splenic Manifestations in Sickle Cell Disease Patients and Its Relation to Hematological Parameters: A Cross-Sectional Study in Basra, Iraq

Sonographic Assessment of Splenic Manifestations in Sickle Cell Disease Patients and Its Relation to Hematological Parameters: A Cross-Sectional Study in Basra, Iraq

Kinematic Measurements of Swallowing by Ultrasound: A Scoping Review.

Ultrasound (US) is a non-invasive method used to study the kinematics of the swallowing function. Kinematic measurements are reported in studies evaluating swallowing using US, but there is no standardization. The aim of this scoping review was to identify and characterize the kinematic measurements of swallowing obtained by ultrasound. We followed the methodological recommendations of the Joanna Briggs Institute (JBI) and the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-extension for scoping reviews (PRISMA-ScR). The research question followed the acronym PCC (population, concept, and context). Seven databases and gray literature were searched. Studies were selected using a blind, paired, and independent method. Data were extracted using a standardized tool. There were 2591 studies and 42 were eligible. Most studies had samples of less than 30 participants and mostly included healthy young adults and older people. The swallowing tasks during the assessments were not standardized. The most commonly studied measures were hyoid displacement and tongue movement during swallowing. However, there is no consensus between studies on the definition of the measures and the procedures for ultrasound assessment, including image acquisition and analysis.

CystNet: An AI driven model for PCOS detection using multilevel thresholding of ultrasound images

Polycystic Ovary Syndrome (PCOS) is a widespread endocrinological dysfunction impacting women of reproductive age, categorized by excess androgens and a variety of associated syndromes, consisting of acne, alopecia, and hirsutism. It involves the presence of multiple immature follicles in the ovaries, which can disrupt normal ovulation and lead to hormonal imbalances and associated health complications. Routine diagnostic methods rely on manual interpretation of ultrasound (US) images and clinical assessments, which are time-consuming and prone to errors. Therefore, implementing an automated system is essential for streamlining the diagnostic process and enhancing accuracy. By automatically analyzing follicle characteristics and other relevant features, this research aims to facilitate timely intervention and reduce the burden on healthcare professionals. The present study proposes an advanced automated system for detecting and classifying PCOS from ultrasound images. Leveraging Artificial Intelligence (AI) based techniques, the system examines affected and unaffected cases to enhance diagnostic accuracy. The pre-processing of input images incorporates techniques such as image resizing, normalization, augmentation, Watershed technique, multilevel thresholding, etc. approaches for precise image segmentation. Feature extraction is facilitated by the proposed CystNet technique, followed by PCOS classification utilizing both fully connected layers with 5-fold cross-validation and traditional machine learning classifiers. The performance of the model is rigorously evaluated using a comprehensive range of metrics, incorporating AUC score, accuracy, specificity, precision, F1-score, recall, and loss, along with a detailed confusion matrix analysis. The model demonstrated a commendable accuracy of \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$96.54\\%$$\\end{document} when utilizing a fully connected classification layer, as determined by a thorough 5-fold cross-validation process. Additionally, it has achieved an accuracy of \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$97.75\\%$$\\end{document} when employing an ensemble ML classifier. This proposed approach could be suggested for predicting PCOS or similar diseases using datasets that exhibit multimodal characteristics.

Administration of melatonin nanoparticles improves testicular blood flow, echotexture of testicular parenchyma, scrotal circumference, and levels of estradiol and nitric oxide in prepubertal ossimi rams under summer heat stress.

Environmental heat stress (HS) impairs reproductive efficiency in farm animals. This study investigated, for the first time, how the melatonin and melatonin nanoparticles treatment affected the testicular hemodynamics, testicular volume, echotexture [Pixel intensity (PIX) and integrated density (IND)], scrotal circumference, serum concentration of testosterone (T), estradiol (E2), nitric oxide (NO), and total antioxidant capacity (TAC) in prepubertal Ossimi ram lambs in hot climatic conditions. The lambs undergoing examination had a temperature humidity index (THI) of 87.05 ± 1.70, indicating severe HS condition. Fifteen prepubertal Ossimi ram lambs were exposed to a single s.c injection of either nano melatonin (nano melatonin group; 20mg/ram; n = 5) or melatonin suspended in two ml of corn oil (melatonin group; 40mg/ram; n = 5) or two ml of corn oil (control group; n = 5). Blood collection and ultrasonographic assessment of the testes and supratesticular arteries (STAs) were conducted immediately before treatment (W0) and once weekly for six successive weeks after nano melatonin and melatonin injection (W1-W6). Results revealed decreases (P < 0.05) in the Doppler indices (resistive index; RI and pulsatility index; PI) of the testicular arteries at most time points of the study in the nano melatonin and melatonin groups. PIX of testicular parenchyma was significantly increased (P ˂ 0.05) in the treated groups compared to the control one. IND of testicular parenchyma increased significantly in the nano melatonin group compared to the melatonin and control groups. Testicular volume and scrotal circumference significantly increased (P < 0.05) in nano melatonin and melatonin groups compared to the control one. T concentration did not significantly (P > 0.05) change in the treated groups compared to the control group. E2, NO, and TAC concentrations increased (P < 0.05) in the treated groups compared to the control one. In conclusion, this study extrapolated that administrations of melatonin or nano melatonin can ameliorate the effects of environmental HS in prepubertal Ossimi ram lambs with a more protective effect and lower dose of nano melatonin.