Combination Of Ultrasonography Research Articles

Assessment of Vitamin D Status in Primary Hyperparathyroidism Patients: A Retrospective Study.

Primary hyperparathyroidism (PHPT), a condition that manifests in various clinical forms, is a significant health concern. Normocalcemic primary hyperparathyroidism (NPHPT) is characterized by normal calcemia despite elevated parathyroid hormone (PTH) levels. Vitamin D deficiency can contribute to the clinical spectrum and complexity of NPHPT. Low vitamin D levels can elevate PTH, making it difficult to distinguish between NPHPT and secondary hyperparathyroidism. Additionally, it might mask hypercalcemia, leading to an underestimation of the disease severity.Our study aims to shed light on these complexities by investigating normocalcemic and hypercalcemic PHPT patient's clinical, hormonal, and biochemical patterns, including their vitamin D status. Materials: In this retrospective study, we enrolled 60 PHPT patients with autonomous parathyroid function confirmed using a combination of ultrasonography, radionuclide scan, and parathyroid function index calculation. We evaluated the albumin-corrected calcemia, calciuria, PTH, 25(OH)D level, serum phosphate, bone mineral density, and major clinical symptoms (fracture, nephrolithiasis). A comparative analysis and a correlation study were performed between normo- and hypercalcemic and vitamin D-deficient and vitamin D-non-deficient groups. The median age was 62 years, 51.66% (31/60) being normocalcemic and 46.66% (29/60) presenting a deficient 25(OH)D level. In the group with 25(OH)D below 20 ng/mL, we observed a reduced level of albumin-corrected calcemia, without a significant increase of PTH compared to the adequate 25(OH)D level group. The frequency of the NPHPT and the risk of fracture were significantly higher in the deficient 25(OH)D group (20/60, 33.33%and8/60, 13.33%) than in the adequate one (11/60, 18.33% and 1/60, 1.66%) with OR=4.7 (p<0.004) and OR=9.7 (p<0.027), respectively. We also found a positive correlation between PTH and adenoma size, the parathyroid function index and adenoma size, as well as PTH and phosphate levels. However, the correlation between 25(OH)D and phosphate levels was negative and moderate (rho=-0.504, p<0.001), adding a new layer of complexity to our understanding of these relationships. Our study provided significant insight into the link between vitamin D status and normocalcemic PHPT. We found that vitamin D-deficient patients with normocalcemic PHPT have an increased fracture risk, which requires meticulous monitoring and possible supplementation with vitamin D. This should be done carefully to avoid exacerbating hypercalcemia or hypercalciuria. Further research is needed to refine these management strategies and deepen our understanding of the complex relationships between the analyzed parameters.

Ultrasound Diagnosis and Near-Infrared Spectroscopy in the Study of Encephalopathy in Neonates Born under Asphyxia: Narrative Review.

Brain injury resulting from adverse events during pregnancy and delivery is the leading cause of neonatal morbidity and disability. Surviving neonates often suffer long-term motor, sensory, and cognitive impairments. Birth asphyxia is among the most common causes of neonatal encephalopathy. The integration of ultrasound, including Doppler ultrasound, and near-infrared spectroscopy (NIRS) offers a promising approach to understanding the pathology and diagnosis of encephalopathy in this special patient population. Ultrasound diagnosis can be very helpful for the assessment of structural abnormalities associated with neonatal encephalopathy such as alterations in brain structures (intraventricular hemorrhage, infarcts, hydrocephalus, white matter injury) and evaluation of morphologic changes. Doppler sonography is the most valuable method as it provides information about blood flow patterns and outcome prediction. NIRS provides valuable insight into the functional aspects of brain activity by measuring tissue oxygenation and blood flow. The combination of ultrasonography and NIRS may produce complementary information on structural and functional aspects of the brain. This review summarizes the current state of research, discusses advantages and limitations, and explores future directions to improve applicability and efficacy.

The model for predicting the central lymph node metastasis in cN0 papillary thyroid microcarcinoma with Hashimoto's thyroiditis.

The relationship between Hashimoto's thyroiditis (HT) and papillary thyroid microcarcinoma (PTMC) is controversial. These include central lymph node metastasis (CLNM), which affects the prognosis of PTMC patients. This study aimed to establish a predictive model combining ultrasonography and clinicopathological features to accurately evaluate latent CLNM in PTMC patients with HT at the clinical lymph node-negative (cN0) stage. In this study, 1102 PTMC patients who received thyroidectomy and central cervical lymph node dissection (CLND) from the First Affiliated Hospital of Shandong First Medical University from January 2021 to December 2022 and the 960th Hospital of PLA from January 2021 to December 2022 were jointly collected. The clinical differences between PTMCs with HT and those without HT were compared. A total of 373 PTMCs with HT in cN0 were randomly divided into a training cohort and a validation cohort. By analyzing and screening the risk factors of CLNM, a nomogram model was established and verified. The predictive performance was measured by the receiver operating characteristic (ROC) curve, calibration curve, and clinical decision curve analysis (DCA). The ratio of central lymph node metastasis (CLNMR) in PTMCs with HT was 0.0% (0.0%, 15.0%) and 7.7% (0.0%, 40.0%) in the non-HT group (P<0.001). Multivariate logistic regression analysis showed that age, gender, calcification, adjacent to trachea or capsule, and TPOAB were predictors of CLNM in PTMCs with HT. The areas under the curve (AUC) of the prediction models in the training cohort and the validation cohort were 0.835 and 0.825, respectively, which showed good differentiation ability. DCA indicates that the prediction model also has high net benefit and clinical practical value. This study found that CLN involvement was significantly reduced in PTMC patients with HT, suggesting that different methods should be used to predict CLNM in PTMC patients with HT and without HT, to more accurately assist preoperative clinical evaluation. The actual CLNM situation of PTMCs with HT in cN0 can be accurately predicted by the combination of ultrasonography and clinicopathological features.

Radiomic nomogram for discriminating parotid pleomorphic adenoma from parotid adenolymphoma based on grayscale ultrasonography.

To differentiate parotid pleomorphic adenoma (PA) from adenolymphoma (AL) using radiomics of grayscale ultrasonography in combination with clinical features. This retrospective study aimed to analyze the clinical and radiographic characteristics of 162 cases from December 2019 to March 2023. The study population consisted of a training cohort of 113 patients and a validation cohort of 49 patients. Grayscale ultrasonography was processed using ITP-Snap software and Python to delineate regions of interest (ROIs) and extract radiomic features. Univariate analysis, Spearman's correlation, greedy recursive elimination strategy, and least absolute shrinkage and selection operator (LASSO) correlation were employed to select relevant radiographic features. Subsequently, eight machine learning methods (LR, SVM, KNN, RandomForest, ExtraTrees, XGBoost, LightGBM, and MLP) were employed to build a quantitative radiomic model using the selected features. A radiomic nomogram was developed through the utilization of multivariate logistic regression analysis, integrating both clinical and radiomic data. The accuracy of the nomogram was assessed using receiver operating characteristic (ROC) curve analysis, calibration, decision curve analysis (DCA), and the Hosmer-Lemeshow test. To differentiate PA from AL, the radiomic model using SVM showed optimal discriminatory ability (accuracy = 0.929 and 0.857, sensitivity = 0.946 and 0.800, specificity = 0.921 and 0.897, positive predictive value = 0.854 and 0.842, and negative predictive value = 0.972 and 0.867 in the training and validation cohorts, respectively). A nomogram incorporating rad-Signature and clinical features achieved an area under the ROC curve (AUC) of 0.983 (95% confidence interval [CI]: 0.965-1) and 0.910 (95% CI: 0.830-0.990) in the training and validation cohorts, respectively. Decision curve analysis showed that the nomogram and radiomic model outperformed the clinical-factor model in terms of clinical usefulness. A nomogram based on grayscale ultrasonic radiomics and clinical features served as a non-invasive tool capable of differentiating PA and AL.

Usefulness of combined ultrasonography and MRI to distinguish the diagnosis of Adenoid Cystic Carcinoma of the floor of the mouth

Background/Aim: Adenoid cystic carcinoma (ACC) is a rare type of cancer that most often occurs in the salivary glands. The aim of this report was to describe a very rare case of ACC in the floor of the mouth referring to the usefulness of combined imaging methodology for the detection of the exact origin and extension of the tumor. Case Report: A 70-year-old female patient was referred to the private practice of one of the authors (D.A., Thessaloniki, Greece). Before the examination, the patient provided written informed consent in accordance with the Helsinki Declaration for research and patient's ethics. Subsequently, the patient was examined thoroughly. She exhibited a swelling on the floor of the mouth (left side). The swelling was painless, firm-solid upon palpation, non-movable and attached to adjacent tissues with normal covering oral mucosa. The patient was referred for an ultrasonography and MRI examination and afterwards an incisional biopsy was performed. The surgical removal of ACC and the involved sublingual but also the adjacent submandibular (for safety reasons) salivary glands were performed under general nasopharyngeal anesthesia with bilateral, both external and intraoral access. In addition, post-surgical radiotherapy was performed. Conclusions: Due to the aggressiveness of the lesion and the fact that in most cases adjacent tissues are affected, surgeons tend to be rather aggressive in their interventions. The imaging techniques may vary in their interpretation of the lesions. Ultrasonography and MRI examinations may assist the surgeon by depicting borders of the lesion under investigation, much more accurately, supporting the establishment of the diagnosis and avoiding the unnecessary loss of healthy neighboring tissue.

Persistent urinary incontinence in female Golden Retrievers following laser ablation of intramural ectopic ureters may be associated with the presence of historical urinary tract infection.

To identify predictive factors for postoperative continence in female Golden Retrievers following cystoscopic-guided laser ablation of intramural ectopic ureters (CLA-EU). 41 client-owned female entire Golden Retrievers with uni- or bilateral intramural ectopic ureter(s) were retrospectively enrolled. Patients were diagnosed with ectopic ureters with a combination of ultrasonography and cystoscopy. CLA-EU was performed for all dogs so that each ureteral opening was considered to be in an appropriate position by a single operator. All dogs had short-term follow-up 4 weeks and long-term follow up > 10 weeks after the procedure via telephone, which included urinary continence scoring. Clinical factors and ultrasonographic and cystoscopic findings from initial presentation were evaluated to identify predictive factors for postoperative continence. Short-term urinary continence was achieved in 46.3% of dogs with no additional medical therapies. Presence of historical urinary tract infections prior to CLA-EU (OR, 0.130; 95% CI, 0.020 to 0.621; P = .018) was negatively correlated and ureteral dilatation (OR, 34.260; 95% CI, 1.813 to 2,143; P = .043) was positively correlated with likelihood of urinary continence. Long-term urinary continence was achieved in 63.4% of dogs, and presence of historical urinary tract infections was negatively prognostic (OR, 0.173; 95% CI, 0.023 to 0.856; P = .048). Female Golden Retrievers undergoing CLA-EU have similar outcomes to those reported for other mixed-breed cohorts with > 30% of dogs failing to regain urinary continence. Historical urinary tract infections were significantly associated with both short- and long-term urinary continence in our population.

Cost-Utility Analysis of Non-Contrast Abbreviated Magnetic Resonance Imaging for Hepatocellular Carcinoma Surveillance in Cirrhosis.

Ultrasonography has a low sensitivity for detecting early-stage hepatocellular carcinoma (HCC) in cirrhotic patients. Non-contrast abbreviated magnetic resonance imaging (aMRI) demonstrated a comparable performance to that of magnetic resonance imaging without the risk of contrast media exposure and at a lower cost than that of full diagnostic MRI. We aimed to investigate the cost-effectiveness of non-contrast aMRI for HCC surveillance in cirrhotic patients, using ultrasonography with alpha-fetoprotein (AFP) as a reference. Cost-utility analysis was performed using a Markov model in Thailand and the United States. Incremental cost-effectiveness ratios were calculated using the total costs and quality-adjusted life years (QALYs) gained in each strategy. Surveillance protocols were considered cost-effective based on a willingness-to-pay value of $4,665 (160,000 Thai Baht) in Thailand and $50,000 in the United States. aMRI was cost-effective in both countries with incremental cost-effectiveness ratios of $3,667/QALY in Thailand and $37,062/QALY in the United States. Patient-level microsimulations showed consistent findings that aMRI was cost-effective in both countries. By probabilistic sensitivity analysis, aMRI was found to be more cost-effective than combined ultrasonography and AFP with a probability of 0.77 in Thailand and 0.98 in the United States. By sensitivity analyses, annual HCC incidence was revealed as the most influential factor affecting cost-effectiveness. The cost-effectiveness of aMRI increased in settings with a higher HCC incidence. At a higher HCC incidence, aMRI would remain cost-effective at a higher aMRI-to-ultrasonography with AFP cost ratio. Compared to ultrasonography with AFP, non-contrast aMRI is a cost-effective strategy for HCC surveillance and may be useful for such surveillance in cirrhotic patients, especially in those with high HCC risks.

Change in client choice under multiple prenatal genetic testing options including noninvasive prenatal testing (NIPT) after genetic counseling in a Japanese maternity hospital.

This study examined how clients' selection and preference for noninvasive prenatal testing (NIPT) for aneuploidy changed with genetic counseling (GC) performed by certified geneticists at a primary hospital specializing in obstetrics, where other multiple prenatal genetic tests options were available. A total of 334 couples who underwent GC between 2017 and 2019 were included in the study. The average age of the pregnant women who underwent GC was 35.1 years. Among the 95 couples (28.4%) who wanted NIPT at the start of GC, 10 (10.5%) switched to other tests, and 4 (4.2%) chose not to undergo any test. Among the 106 (31.7%) couples who wanted the combination of ultrasonography and the serum marker test, 12 (11.3%) chose not to undergo the test. Among the 92 (27.5%) couples who were undecided before GC, 21 (22.8%) wanted NIPT, 31 (33.7%) selected combined tests, and 18 (19.6%) did not undergo any test. We have demonstrated the significance of GC before prenatal genetic testing under widespread use of NIPT. Ideally, obstetric facilities should provide GC, or at least, pre-counseling at their own facilities, and offer multiple prenatal genetic testing options or refer to other facilities for the same.

Prediction of the invasiveness of PTMC by a combination of ultrasound and the WNT10A gene.

The purpose of this study was to predict the invasiveness of papillary thyroid microcarcinoma (PTMC) via ultrasonography in combination with the Wnt family member 10A (WNT10A) gene to provide a reference basis for evaluating the invasive capability of PTMC. Cancer tissue were collected from 182 patients with unifocal PTMC, and the patients were divided into the invasive group and the non-invasive group based on whether the lesions invaded the thyroid capsules or whether lymph node metastasis occurred. The expression of WNT10A protein was examined. Age, sex, maximum nodule diameter, color Doppler flow imaging (CDFI), nodule echo, microcalcification, aspect ratio, morphology (boundary), nodule location, internal structure, ultrasound-suspected lymph node metastasis (US-LNM), and WNT10A expression were compared between the invasive group and the non-invasive group. Univariate analysis and multivariate logistic regression analysis were performed, and a p value of less than 0.05 indicated that the difference was statistically significant. (1) 36 patients in the non-invasive group showed high expression and 66 patients showed low or no expression, while 54 patients in the invasive group showed high expression and 26 patients showed low or no expression, suggesting that the expression level of WNT10A was higher in the invasive group than in the non-invasive group, with a statistically significant difference between the two groups (P<0.01). (2) Univariate analysis showed that there were statistically significant differences between the invasive PTMC group and the non-invasive group in age, sex, maximum nodule diameter, microcalcification, US-LNM and high WNT10A expression. (3) Multivariate analysis showed that the risk factors for invasiveness in patients with PTMC included age < 45 years, maximum nodule diameter > 7 mm, microcalcification, US-LNM and high WNT10A expression. The risk factors for PTMC invasiveness included age < 45 years, maximum nodule diameter >7 mm, microcalcification, US-LNM and high WNT10A expression. A combination of ultrasonography and WNT10A gene analysis could provide a reference basis for evaluating the invasive capability of PTMC.

Cowper's Syringocele: A Literature Review.

Cowper's syringocele is a rare but underdiagnosed cystic dilatation of the main ducts of Cowper's gland. It is becoming more widely known in the adult population. Recent research proposes that syringoceles should be categorized according to the intraductal pressures causing ductal dilatation from mild to gross ultimately involving the gland itself. Although there may be some overlap in the clinical manifestations of different syringoceles, mildly dilated ducts are frequently asymptomatic. Moreover, moderate to gross duct dilatations can manifest as lower urinary tract symptoms(LUTS) or obstructive symptoms. A valid differential diagnosis is essential because these symptoms can be found in a wide range of severe illnesses. Syringocele can be diagnosed by ultrasonography in combination with voiding retrograde/antegrade cystourethrogram (VCUG), nevertheless, other procedures like cystourethroscopy, CT scan, and MRI scans can be helpful. Initially, conservative surveillance is advised, but if necessary, endoscopic marsupialization or surgical excision is the preferred treatment modality to address persistent problems.

Combined ultrasonography and CT for prognosis and predicting clinical outcomes of patients with pseudomyxoma peritonei

ObjectivesThis study aimed to identify the diagnostic accuracy of combined ultrasonography (US) and computed tomography (CT) in evaluating the tumor burden of pseudomyxoma peritonei (PMP). Besides, we assessed the ability of this combination to predict the likelihood of complete resection.MethodsThis retrospective study involved 504 patients diagnosed with PMP and scheduled for cytoreduction surgery. We compared tumor burden—quantified as peritoneal cancer index (PCI) by preoperative US and CT (US-CT-PCI)—with surgical findings. Next, we assessed the prognostic value of US-CT PCI and imaging features in determining the completeness of cytoreduction (CCR) score using multivariate analysis.ResultsUS-CT PCI demonstrated a high PCI evaluation accuracy under moderate tumor burden. Higher US-CT PCI could predict incomplete resection. In addition, we identified imaging features such as mesenteric involvement as an independent predictor of incomplete resection (hazard ratio (HR) = 2.006; p = 0.007).ConclusionsUS-CT PCI allowed us to predict the completeness of cytoreductive surgery in patients with PMP. Moreover, the combined US and CT imaging detected several features indicating incomplete cytoreduction.Key Points• Ultrasonography (US) can act as a complementary diagnostic modality in peritoneal cancer index (PCI) evaluation by combining CT in the small bowel area and US in the abdominal area.• A modified peritoneal cancer index (US-CT PCI) helps preoperatively evaluate tumor burden with high accuracy and allows to predict incomplete resection.• US-CT PCI of 20 or above and the involvement of particular structures such as mesentery, independently indicate incomplete resection.

Confirmation of human ovulation in assisted reproduction using an adhesive axillary thermometer (femSense®).

Timing for sexual intercourse is important in achieving pregnancy in natural menstrual cycles. Different methods of detecting the fertile window have been invented, among them luteinization hormone (LH) to predict ovulation and biphasic body basal temperature (BBT) to confirm ovulation retrospectively. The gold standard to detect ovulation in gynecology practice remains transvaginal ultrasonography in combination with serum progesterone. In this study we evaluated a wearable temperature sensing patch (femSense®) using continuous body temperature measurement to confirm ovulation and determine the end of the fertile window. 96 participants received the femSense® system consisting of an adhesive axillary thermometer patch and a smartphone application, where patients were asked to document information about their previous 3 cycles. Based on the participants data, the app predicted the cycle length and the estimated day of ovulation. From these predictions, the most probable fertile window and the day for applying the patch were derived. Participants applied and activated the femSense® patch on the calculated date, from which the patch continuously recorded their body temperature throughout a period of up to 7 days to confirm ovulation. Patients documented their daily urinary LH test positivity, and a transvaginal ultrasound was performed on day cycle day 7, 10, 12 and 14/15 to investigate the growth of one dominant follicle. If a follicle reached 15 mm in diameter, an ultrasound examination was carried out every day consecutively until ovulation. On the day ovulation was detected, serum progesterone was measured to confirm the results of the ultrasound. The performance of femSense® was evaluated by comparing the day of ovulation confirmation with the results of ovulation prediction (LH test) and detection (transvaginal ultrasound). The femSense® system confirmed ovulation occurrence in 60 cases (81.1%) compared to 48 predicted cases (64.9%) with the LH test (p = 0.041). Subgroup analysis revealed a positive trend for the femSense® system of specific ovulation confirmation within the fertile window of 24 h after ovulation in 42 of 74 cases (56.8%). Cycle length, therapy method or infertility reason of the patient did not influence accuracy of the femSense® system. The femSense® system poses a promising alternative to the traditional BBT method and is a valuable surrogate marker to transvaginal ultrasound for confirmation of ovulation.

Comparison of Mammography, Sonography, Fine-Needle Aspiration Cytology, and Excision Biopsy for the Diagnosis of Breast Lesions

Abstract Background and Objective : Problem of invasive tests in breast lesion diagnosis can be addressed by comparing non-invasive tests with final Histopathological diagnosis obtained after excision biopsy. Present study was carried out to study diagnostic utility of mammography, sonography, FNAC compared to excision biopsy for diagnosis of breast lesions Methods: Prospective Observational study was carried out among 81 women with Breast related symptoms. Digital Mammography Machine, ACUSON S3000™ Ultrasound System; FNAC and surgery for excision Biopsy were used. Sensitivity, Specificity, Accuracy, Positive and Negative Predictive values were measured and p&lt;0.05 was considered as statistically significant. Results: Sonography and FNAC composite have sensitivity, specificity, accuracy, positive and negative predictive values 100.00%, 81.40%, 90.12%, 82.61% and 100.00% respectively. Mammography+FNAC (97.3%) is not as sensitive as Sonography+FNAC (100%), Sonography combined with FNAC is equally sensitive to excision biopsy (100%) and therefore can be used for screening purpose. Conclusion: Contrary to present guidelines which consider Mammography as most important screening tool for Breast Cancer, combination of Sonography and FNAC can be considered equally reliable.

Evaluation of different imaging modalities for axillary lymph node staging in breast cancer patients to provide a personalized and optimized therapy algorithm

PurposeThe reliable detection of tumor-infiltrated axillary lymph nodes for breast cancer [BC] patients plays a decisive role in further therapy. We aimed to find out whether cross-sectional imaging techniques could improve sensitivity for pretherapeutic axillary staging in nodal-positive BC patients compared to conventional imaging such as mammography and sonography.MethodsData for breast cancer patients with tumor-infiltrated axillary lymph nodes having received surgery between 2014 and 2020 were included in this study.All examinations (sonography, mammography, computed tomography [CT] and magnetic resonance imaging [MRI]) were interpreted by board-certified specialists in radiology. The sensitivity of different imaging modalities was calculated, and binary logistic regression analyses were performed to detect variables influencing the detection of positive lymph nodes.ResultsAll included 382 breast cancer patients had received conventional imaging, while 52.61% of the patients had received cross-sectional imaging.The sensitivity of the combination of all imaging modalities was 68.89%. The combination of MRI and CT showed 63.83% and the combination of sonography and mammography showed 36.11% sensitivity.ConclusionWe could demonstrate that cross-sectional imaging can improve the sensitivity of the detection of tumor-infiltrated axillary lymph nodes in breast cancer patients. Only the safe detection of these lymph nodes at the time of diagnosis enables the evaluation of the response to neoadjuvant therapy, thereby allowing access to prognosis and improving new post-neoadjuvant therapies.

Combination of ultrasonography and tongue depressor for predicting difficult laryngoscopy in apparently normal patients

ObjectivesWe hypothesized measurements of the upper airway using ultrasound and a tongue depressor can be used to predict difficult laryngoscopy. MethodsThere were 239 patients enrolled. The receiver operating characteristic curve (ROC) analysis was used to assess the diagnostic value of clinical parameters, sonographic parameters, and multivariable models. Results26 (10.9%) of the patients had difficult laryngoscopy. Age, sex, modified Mallampati score, interincisor gap, thyromental distance, distances from arytenoids and hyoids (DDHB) to the tongue depressor, and angle between the tongue depressor and the line of vision all had statistically significant differences (P ≤ 0.002). At a cutoff value of 2.76 cm, DDHB demonstrated relatively good diagnostic value (sensitivity 73.1 percent, specificity 93 percent) and increased the area under the ROC of the clinical parameters model from 0.871 to 0.943 (P = 0.027). ConclusionsDDHB is an independent predictor of difficult laryngoscopy and improves the clinical parameters model's diagnostic value.

The Tourniquet Ischemia Test Effectively Predicts the Efficacy of Lumbar Sympathetic Block in Patients with Lower Extremity Complex Regional Pain Syndrome Type 1.

BackgroundNeuropathic pain is the most common clinical sign of complex regional pain syndrome (CRPS). Currently, lumbar sympathetic block (LSB) is commonly utilized in lower extremity CRPS that has failed to respond to medication therapy and physical therapy, but its effectiveness is unknown. The tourniquet ischemia test (IT) can distinguish between two types of CRPS: IT-positive CRPS and IT-negative CRPS.ObjectiveThe aim of the study was to investigate whether LSB improves pain scores in patients with lower extremity CRPS-1 and to screen factors to predict its efficacy.Study DesignProspective clinical observational study.SettingPain management center.SubjectsForty-three patients diagnosed with lower extremity CRPS-1 using the Budapest criteria were included as participants.MethodsForty-three CRPS-1 patients were treated with LSB therapy, and all of them underwent a tourniquet ischemia test (IT) before undergoing LSB therapy. LSB therapy was performed using a combination of ultrasonography and fluoroscopy. Then, numeric rating scale (NRS) scores and the symptom relief rates of patients were evaluated at 1, 4, and 12 weeks. Finally, peripheral blood inflammatory cytokine samples were collected before and after the LSB treatment.ResultsAt 4 weeks after the treatment, the total effective symptom relief rate of LSB on CRPS-1 was 25.6% (11/43), with 52.6% (10/19) of IT(+) patients and 4.2% (1/24) of IT(-) patients. There was a significant difference between the IT(-) and IT(+) groups (P = 0.001). The multivariate binary logistic regression analysis revealed that the response to the tourniquet IT was the only significant independent predictor of sympathetic block success (p = 0.007).ConclusionTourniquet IT is a simple, safe and effective test to distinguish patients with lower extremity CRPS-1. The response to the tourniquet IT is a reliable predictor of LSB effectiveness in lower extremity CRPS-1 patients.

Transfer of Day 11 ruptured embryos can prevent luteolysis in recipient mares

Previous studies transferring Day 11 embryos to Day 11 or 12 recipient mares and then manually crushing the transferred embryo 24 hours later resulted in 83% (5/6) and 100% (6/6) mares, respectively, entering a period of luteostasis. Undertaking manual reduction 12 hours post transfer resulted in 100% (5/5) of Day 11 recipient mares becoming luteostatic. This work suggested that the mare could recognise the presence of an embryo within the uterus after only a short period of time. The present experiment aimed to shorten the window of the presence of an intact embryo still further by evaluating the ability of ruptured or damaged Day 11 embryos transferred to recipient mares to initiate a period of luteostasis. A total of sixteen Day 11 embryos were flushed from the uteri of donor mares. Embryos were moved to a petri dish containing 5mL of Vigro Hold Plus Solution where they were measured and graded. The intact embryos were ruptured using two 100µm diameter acupuncture needles, ensuring the blastocoele fluid was released into the medium. The ruptured embryo and the medium were then transferred to recipient mares at Day 11 (n = 8) or 12 (n = 8) post ovulation using a standard embryo transfer technique. Control Day 11 (n = 8) and 12 (n = 8) recipient mares received 5mL of Vigro Hold Plus. All recipient mares were monitored on alternate days post transfer using a combination of ultrasonography,including assessment of the corpus luteum using colour Doppler, and serial blood serum samples assayed for progesterone in peripheral blood to determine if, and when, they returned to oestrus. Mares with a functional corpus luteum with blood flow and progesterone levels >1ng/mL up to 25 post ovulation were deemed to have entered a period of luteostasis and at this time point luteolysis was achieved by administration of an i.m injection of prostaglandin. Transfer of the ruptured embryo and medium resulted in significantly more Day 12 recipients entering a period of luteostasis compared to Day 11 recipients (75% vs. 12.5%; 6/8 vs. 1/8; P= 0.04, respectively). Day 11 and 12 control recipient mares that received only medium had an incidence of luteostasis of 12.5% (1/8) in each group. Hence the presence of medium containing blastocoele fluid, a ruptured capsule and trophoblast within the uterus can prevent luteolysis around the time of maternal recognition of pregnancy (MRP) in the mare. If all or only some of the components of the ruptured Day 11 embryo are required to initiate luteostasis needs further study. If the mechanisms underlying luteostasis with this model mirror those of the MRP signal in pregnant mares this study also raises questions about the duration of the MRP signal and how long embryo migration within the uterus is needed to prevent luteolysis.

Reappraisal of the roles of alpha-fetoprotein in hepatocellular carcinoma surveillance using large-scale nationwide database and hospital-based information

Controversies over the use of alpha-fetoprotein (AFP) for detection of hepatocellular carcinoma (HCC) existed from guidelines. Using large-scale database and hospital-based information, we aimed to reappraise the role of AFP in HCC surveillance, including proportion of AFP elevation by stage of HCC, additional benefit of AFP in combination of ultrasonography (US) in the detection of early HCC, and survival in early HCC with high AFP levels. This retrospective study enrolled 43,437 patients from database of the Taiwan Cancer Registry (TCR) and 4250 patients from Kaohsiung Chang Gung Memorial Hospital (KCGMH) between January 2011 and December 2017. The HCC cases in KCGMH accounted for 9.8% of the total cases in the TCR. Among both nationwide database and hospital-based information, the proportion of early HCC patients with an AFP level of ≥20ng/mL was approximately 40%. In KCGMH, the proportion of patients with an AFP level of ≥20ng/mL and a virus-related (hepatitis B and C) etiology was around 41.7%; furthermore, among patients with early HCC, those with an AFP level of ≥20ng/mL had 4.7 years of median survival and 48.3% of the 5-year overall survival rate. By hospital electronic medical records review of early HCC cohort in KCGMH, approximately 10.9% of patients with AFP levels ≥20ng/mL had US-undetectable early HCC. This study suggested that AFP in combination with US would add an additional benefit as being a prompted role for detection of early HCC in patients with US-undetectable HCC.

Acute-phase serum amyloid A for early detection of hepatocellular carcinoma in cirrhotic patients with low AFP level

Regular hepatocellular carcinoma (HCC) surveillance by ultrasonography in combination with the α-fetoprotein (AFP) examination is unsatisfactory in diagnostic sensitivity for early-stage HCC especially in cirrhotic patients. We conducted a prospective study in a tertiary medical center in Taiwan and consecutively collected serum samples from patients with chronic hepatitis, liver cirrhosis (LC), or HCC for new biomarker discovery. Overall, 166 patients were enrolled, including 40 hepatitis, 30 LC, and 96 HCC. Four acute-phase serum amyloid A (A-SAA) derived biomarkers including total A-SAA, A-SAA monomer and oligomer, and protein misfolding cyclic amplification (PMCA) signal were measured and compared between patients with and without HCC. A-SAA biomarkers significantly increased in the HCC group when compared to the hepatitis and LC groups, and generally increased in more advanced tumor stages. Among A-SAA biomarkers, the area under the receiver operator characteristic curves (AUROCs) for PMCA signal in discrimination of all-stage and early-stage HCC were 0.86 and 0.9 in cirrhotic patients, which is comparable to AFP. For cirrhotic patients with low AFP (< 7 ng/mL), PMCA signal maintained good capacity in prediction of early-stage HCC (AUROC: 0.94). Serum A-SAA and its prion-like property showed a potential to complement AFP in detection of early-stage HCC.

Diagnostic Accuracy of Combining Sonoelastography with Mammography in Solid Breast Lesions Keeping Histopathology as Gold Standard

&lt;p&gt;&lt;strong&gt;Background and objective:&lt;/strong&gt; Breast cancer is the most common malignancy in females. Early diagnosis can help in reducing the morbidity and mortality associated with this disease. Sonoelastography has shown to be a valuable tool in early detection of breast cancer. The aim of the study was to evaluate the diagnostic accuracy of combining sonoelastography with mammography in diagnosing malignant solid breast lesions taking histopathology as a gold standard.&lt;br /&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A descriptive cross-sectional study was carried out at the Department of Radiology, Shaikh Zayed Medical Complex/Federal Post-Gradaute Medical Institute (FPGMI), Lahore, Pakistan during six months period from 1st September, 2018 to 31st March, 2019. Female patients &amp;gt; 35 years of age and presenting with suspected malignant breast masses were included. Mammography and sonoelastography of the lesions were done. Finally, the patients were referred for tru cut biopsy. Diagnostic accuracy was calculated for mammography, sonoelastography and their combination.&lt;br /&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total of 200 female patients were enrolled with a mean age of 50.8 (&amp;plusmn; 8.6) years. Mammographic findings suggestive of malignancy (BI-RADS category IV and V) were present in 96 (48%) cases. Elastography showed finding of malignancy (Score 4 and 5) in 96 (48%) cases. Combined sonoelastography and mammography diagnosed malignancy in 112 (56%) cases. Histopathologically confirmed malignancy was seen in 110 (55%) cases. The sensitivity and specificity of mammography (76.3 % and 77.7%) and sonoelastography (77.3% and 87.7%), were comparable. The combination of mammography and sonoelastography showed a higher sensitivity (90.9%) and specificity (86.6%). The combination showed a diagnostic accuracy of 89% followed by sonoelastography (82%) and mammography (77%) alone.&lt;br /&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Combination of sonoelastography and mammography can significantly enhance the diagnostic accuracy of breast carcinoma. Females may be offered mammography or ultrasonography in combination with sonoelastography for routine testing.&lt;/p&gt;