Ultrasound Assessment Research Articles

Current applications and research trends of ultrasound examination in acute kidney injury assessment: a bibliometric analysis.

Acute kidney injury (AKI) is a significant clinical condition, and ultrasound examination has emerged as a crucial non-invasive imaging method for assessing kidney status, especially in its diagnosis and management. This study aims to perform a bibliometric analysis to clarify current research trends in ultrasound assessment of AKI. We conducted a literature search in the Web of Science database using keywords related to ultrasound examinations of acute kidney injury, up to November 15, 2023. The results were analyzed using the bibliometric software package in R. Relevant literature information was analyzed. A total of 1109 articles were included in the study. Research papers published between 2019 and 2024 demonstrated a significant upward trend. The United States, China, and Italy ranked as the top three countries in terms of publication volume. Among the top 10 research institutions with the highest number of publications, 6 are in the United States, with Université de Montréal being the institution with the most publications. Keyword trends focused on: resistive index, risk factors, therapy, glomerular filtration rate, survival, etc. CONCLUSION: This bibliometric study highlights the advancements in ultrasound examination for AKI and underscores the importance of such analyses in determining research trends. Future research should emphasize the integration of various imaging techniques to improve diagnostic accuracy and clinical management of AKI.

Best Practice Guidelines - DEGUM Recommendations on Breast Ultrasound.

Breast ultrasound has been established for many years as an important method in addition to mammography for clarifying breast findings. The goal of the Best Practice Guidelines Part III of the DEGUM breast ultrasound working group is to provide colleagues working in senology with information regarding the specific medical indications for breast ultrasound in addition to the current ultrasound criteria and assessment categories published in part I and the additional and optional sonographic diagnostic methods described in part II. The value of breast ultrasound for specific indications including follow-up, evaluation of breast implants, diagnostic workup of dense breast tissue, diagnostic workup during pregnancy and lactation, and the diagnostic workup of breast findings in men is discussed. Each section after the general information section contains a description of specific pathologies, followed by a short summary and DEGUM recommendations for the particular indications. The latest S3 guidelines and AGO guidelines were taken into consideration.

Best Practice Guidelines - DEGUM Recommendations on Breast Ultrasound.

Breast ultrasound has been established for many years as an important method in addition to mammography for clarifying breast findings. The goal of the Best Practice Guidelines Part III of the DEGUM breast ultrasound working group is to provide colleagues working in senology with information regarding the specific medical indications for breast ultrasound in addition to the current ultrasound criteria and assessment categories published in part I and the additional and optional sonographic diagnostic methods described in part II. The value of breast ultrasound for specific indications including follow-up, evaluation of breast implants, diagnostic workup of dense breast tissue, diagnostic workup during pregnancy and lactation, and the diagnostic workup of breast findings in men is discussed. Each section after the general information section contains a description of specific pathologies followed by a short summary and DEGUM recommendations for the particular indications. The latest S3 guidelines and AGO guidelines were taken into consideration.

Five-step dynamic ultrasonographic assessment of swallowing for dysphagia

This paper presents a five-step dynamic ultrasonography (US) technique aimed at diagnosing oropharyngeal dysphagia, which encompasses the analysis of tongue-palate contact, hyoid movement, upper esophageal sphincter opening, vocal fold closure and post-swallow residue. This protocol is implemented in a sequential manner, intending to methodically evaluate the essential phases of swallowing function. By mirroring the natural process of swallowing, this sequential method may provide a full understanding of possible dysfunctions at each stage. Considering the advantages of US in dysphagia diagnosis, we believe that this method will provide clinicians with a perspective for bedside dysphagia evaluation.

Assessment of Fluid Responsiveness via Central Venous Ultrasound Measurement: A Network Meta-Analysis

Background: Ultrasonographic assessment of the diameters of various veins and their indices are among the most applied diagnostic tools for evaluating fluid responsiveness in clinical practice. Despite their widespread use, there is no definitive answer on which is preferable. Our study aimed to investigate the diagnostic accuracy of different venous diameters and their indices to assess fluid responsiveness. Methods: We conducted a systematic review and network meta-analysis, analyzing prospective studies evaluating the diagnostic accuracy of venous diameters (inferior vena cava [IVC], internal jugular vein [IJV], superior vena cava, and subclavian vena) and their indices for fluid responsiveness. Electronic databases were searched from inception until March 2024; this search was supplemented by snowballing methods. The risk of bias was evaluated with QUADAS-2, and evidence certainty was assessed using the GRADE approach. Nine prospective cohort studies (560 patients) were included. Results: The network meta-analysis revealed that the ΔCaval index exhibited a significant performance advantage over other “venous” test parameters. The caval index significantly outperformed IJV min/max and IVCmax. IJV index and IVCmin significantly outperformed IJVmin/max. The caval index was comparable to the IJV index. The caval index was comparable during mechanical ventilation and spontaneous breathing. Conclusions: In this meta-analysis, the ΔCaval index test showed higher diagnostic accuracy for fluid responsiveness compared with other venous tests. Caval and jugular indices displayed similar accuracy, and caval indices were consistent under mechanical ventilation and spontaneous breathing. Indices generally outperformed absolute values, except for IVCmin, which equaled the caval index in efficacy. This study was registered on the International Platform for Registered Protocols for Systematic Reviews and Meta-Analyses: INPLASY202430104.

Sonographic assessment of post-intubation laryngeal obstruction as predictor of weaning outcome

BackgroundPost-extubation stridor indicates the presence of laryngeal edema. The documented occurrence of post-extubation airway blockage ranges from 4 to 37%.AimTo evaluate the effectiveness of sonar assessment of laryngeal air column width difference to predict post-extubation upper airway obstruction and its relation to cuff leak volume.Patients and methodsThis was an observational, descriptive cross-sectional study, conducted on 48 mechanically ventilated patients fulfilling weaning criteria at the ICU of Chest Department, Faculty of Medicine, Zagazig University, from July 2022 to March 2023.ResultsA statistically insignificant variance was observed among COPD, ILD, overlap (OSA-COPD), pneumonia, aspiration pneumonia, and PE regarding laryngeal air column width difference (LACWD), while a statistically significant variance was observed among COPD, ILD, overlap (OSA-COPD), pneumonia, aspiration pneumonia, and PE regarding CLV; there was no correlation among cuff leak volume and LACWD, and there were 40 patients (83.3%) who had no post-intubation upper air way obstruction and 8 patients (16.7%) had post-intubation upper airway obstruction: 4 of them (8.3%) had success weaning, and 4 (8.3%) had failed weaning; and at cutoff value 140 ml, cuff leak volume had sensitivity of 100% and specificity of 97.5% with significance for prediction of stridor, and at cutoff value 1.15 mm, LACWD had sensitivity of 87.5% and specificity of 67.5% with significance for prediction of stridor.ConclusionCuff leak volume and ultrasound-guided LACWD effectively predict post-extubation upper airway obstruction, suggesting their integration into institutional extubation protocols.

Association of matrix metalloproteinases and adhesive molecules with important aspects of carotid artery stenosis

Background: As symptom risk assessment in carotid artery stenosis (CAS) could be improved by parameters that reflect additional risk aspects such as chronic inflammation rate, and atherosclerotic activity on a systemic level, we investigated the association of serum matrix metalloproteinases-2,7,9 (MMP-2,7,9), vascular cell adhesion molecule-1 (VCAM-1) and selectins-P and E with symptomatic status, stenosis degree and plaque morphology in CAS patients in order to select parameters that associate to important clinical determinants of the symptom development risk. Methods: The study included 119 CAS patients and 46 healthy subjects. Carotid arteries were examined by color flow Doppler and B-mode Duplex ultrasound. Serum parameters were assessed using commercially available enzyme-linked immunosorbent assays (ELISA). Difference was tested by Mann-Whitney U, Kruskal-Wallis and Chi-square tests, and Spearman’s correlation was tested. Results: MMP-7 and selectin-P levels were higher in CAS than in controls (p<0.001). Positive correlation with stenosis degree was found for MMP-7 (r=0.155, p=0.007), VCAM-1 (r=0.127, p=0.029) and selectin-P (r=.269, p<0.001). MMP-7 and selectin-P were higher in subjects with Grey-Weale 2, comparing to subjects with Grey-Weale 3 plaques (p=0.036, p=0.009). Selectin-P was lower in the presence of Grey-Weale 4 than in Grey-Weale 2 (p=0.045). Conclusions: Concurrent association of MMP-7 and selectin-P with both stenosis degree and carotid plaque morphology shows the joint influence of these important determinants of symptom risk that is reflected in serum parameters. This indicates that they can supply additional information outside ultrasound CAS assessment only, and their integration in a future multiscale approach for CAS risk prediction could be beneficial

How Reproducible Are the Ultrasound Features of Adenomyosis Defined by the Revised MUSA Consensus?

Background/Objectives: The aim of this study is to assess the inter- and intra-observer reproducibility of the identification of direct and indirect ultrasonographic features of adenomyosis as defined by the revised Morphological Uterus Sonographic Assessment (MUSA) consensus (2022). Methods: A cohort of 74 women, aged 18 to 45, were recruited from the recurrent miscarriage and general gynaecology clinic at a university-based fertility centre. All the participants underwent 2D and 3D transvaginal Ultrasound scan (TVS) examination in the late follicular and early luteal phase. Conventional grey scale and power Doppler image volumes were acquired and stored. Subsequently, the stored 3D ultrasound images were independently re-evaluated offline by the two observers for the direct and indirect features of adenomyosis as outlined by the revised MUSA group. The intra- and the inter-observer reproducibility was estimated using Cohen’s Kappa coefficient. Results: The intra- and interobserver reproducibility (K −0.27, 95% CI 0.06–0.48 and K 0.13, 95% CI −0.10–0.37, respectively) for at least one direct feature of adenomyosis was only modest. Amongst the individual direct features, the interobserver variability of identifying myometrial cysts was fair (K 0.21, 95% CI −0.00–0.42), whereas the intra-observer variability was moderate (K 0.44, 95% CI 0.26–0.63). While hyperechogenic islands identification achieved a fair level of intra- (K 0.31, 95% CI 0.09–0.53) and interobserver (K 0.24, 95% CI 0.01–0.47) agreement, the reproducibility of reporting sub-endometrial lines/buds was fair for the intra-observer (K 0.22, 95% CI −0.02 0.47) and poor for the interobserver (K 0.00, 95% CI −0.20–0.19). The interobserver agreement for indirect features varied from poor to moderate, while the intra-observer agreement ranged between poor to good. Conclusions: The reporting of adenomyosis using direct features suggested by the revised MUSA group consensus showed only modest interobserver and intra-observer agreement. The definitions of ultrasound features for adenomyosis need further refining to enhance the reliability of diagnosis criteria of adenomyosis.

The Impact of Dating Twin Pregnancy by the Larger, Smaller or Mean Twin Crown-Rump Length: A Retrospective Cohort Study.

To evaluate the impact of twin dating by ultrasound-measured crown-rump length (CRL) of the larger (CRL-L), smaller (CRL-S) or mean twin measurement (CRL-M) on the rates of preterm birth (PTB) and detection of small for gestational age (SGA) births. A retrospective cohort study. A tertiary fetal medicine centre (London, UK). All twin pregnancies between 1998 and 2023 who underwent first trimester CRL ultrasound assessment and fetal growth assessment. Data collection included CRL measurement, estimated fetal weight (EFW), pregnancy outcome and birthweight (BW) for each twin. Pregnancies were retrospectively re-dated by CRL-S, CRL-L and CRL-M. SGA < 10th centile and extreme PTB rates (< 28 weeks). In the 1129 twin pregnancies, median CRL-S was 61 mm (interquartile range [IQR]: 56.0-66.0) and CRL-L was 63 mm (IQR: 58.4-68.9) with a mean discordance of 4.0%. Prenatal SGA diagnosis occurred in 19.8% and 23.1% of smaller twins when dated by CRL-S and CRL-L, respectively. When pregnancies were dated by CRL-M versus CRL-S or CRL-L, there was no difference in prenatal SGA diagnosis (p = 0.275 and p = 0.419); SGA at birth (p = 0.132 and p = 0.325); or extreme PTB (p = > 0.999 and p = 0.765 respectively). Dating by the smaller, larger or mean twin CRL does not significantly alter rates of extreme preterm birth, SGA detection or SGA birth. Dating by the mean twin CRL reduces stigmatisation of the smaller twin and retains the utility of accurate gestational age assessment without impacting clinical outcomes.

Lethal Phenotype and Expansion of the Clinical Spectrum of Biallelic Loss of Function Variant in SENP7 Gene Unveiled by Whole Exome Sequencing

ABSTRACTSUMOylation involves covalent attachment of small ubiquitin‐like modifier (SUMO) proteins to specific lysine residues on target proteins and regulates various aspects of their function. Sentrin‐specific proteases (SENPs) are key players in both the conjugation reaction of SUMO proteins to their targets and the subsequent deconjugation of SUMO‐conjugated substrates. Here, we provide the first comprehensive prenatal description of a lethal syndrome linked to a novel homozygous stop‐gain variant in SENP7 c.745C&gt;T; p.(Arg249*) in a consanguineous Egyptian family with a history of three fetal deaths, all presenting with multiple congenital anomalies. Similar anomalies were observed through ultrasound assessment of the current fetus, including arthrogryposis multiplex congenita, CNS malformations, congenital heart disease, and renal anomalies. Singleton exome sequencing (ES) of fetal DNA revealed a SENP7 variant allele, which results in a premature termination codon, and the mutant mRNA is predicted to be degraded by nonsense‐mediated decay (NMD). This leads to impaired gene function, particularly disrupting SENP7's isopeptidase activity in deconjugating polySUMO chains. Our findings broaden the molecular spectrum of SENP7 variants and emphasize their essential role in the development of the nervous, musculoskeletal, cardiovascular, and renal systems. This study offers new insights into the genotype–phenotype correlations observed in lethal congenital contracture syndromes and severe embryological abnormalities.

Integrated Lung, Diaphragm and Lower Limb Muscular Ultrasound: Clinical Correlations in Geriatric Patients with Acute Respiratory Illness.

Background/Objectives: Point-of-care lung ultrasonography (LUS) represents an accurate diagnostic tool in older patients with respiratory failure. The integration of LUS with ultrasonographic assessment of diaphragm thickness and excursion, right vastus lateralis (RVL) muscle thickness and cross-sectional area (CSA) could provide real-time information on frailty and sarcopenia. The primary aim of this proof-of-concept prospective study was to evaluate clinical correlates of thoracic, diaphragmatic, and muscular ultrasound to characterize the associations between frailty, respiratory failure, and sarcopenia in older patients hospitalized for acute respiratory complaints. Methods: Each of 52 participants (age median 84, IQR 80-89 years old) underwent integrated LUS, diaphragm and RVL ultrasound examination upon admission (T0) and after 72 h of hospitalization (T1). LUS score was used to estimate lung interstitial syndrome severity. Diaphragm excursion, thickness, RVL thickness and CSA were measured following a standardized protocol. Frailty was assessed with the PC-FI (Primary Care-Frailty Index). Results: All patients exhibited multifactorial causes of respiratory symptoms. The LUS score on T0 predicted 3-month rehospitalization. Frail patients exhibited higher LUS scores on T1. Diaphragm excursion on T0 was reduced in patients with COPD and heart failure and in those developing delirium during hospitalization. Diaphragm excursion on T1 was negatively associated with PC-FI. Diaphragm thickness, RVL thickness, and CSA exhibited a positive association with obesity. Right vastus lateralis CSA on T1, however, was also negatively associated with PC-FI. Conclusions: Integrated lung, diaphragm, and RVL ultrasound shows clinical correlations with several aspects of frailty that may help to improve the management of geriatric patients with respiratory illness.

Sonographic assessment of umbilical cord diameter as an indicator of fetal growth and perinatal outcome

Background The umbilical cord represents a physiological and genetic part of the fetus, containing two arteries and one vein buried in a special mucous connective tissue type, namely Wharton’s jelly. Aim The umbilical cord diameter (UCD) will be assessed using ultrasound as an indicator of fetal growth and perinatal outcomes. Patients and methods This cross-sectional study involved 150 females with a gestational age (GA) of 20–27 weeks, reliable dates of last menstrual period, singleton pregnancy, and living fetus. All participants underwent comprehensive medical history taking, and clinical and ultrasound assessments. Results There was a positive correlation between UCD at first visit (20–27 weeks) and delivery (38–40 weeks) and (GA, femur length, biparietal diameter, head circumference and estimated fetal weight) and appearance, pulse, grimace, activity, and respiration (APGAR) score at 1 and 5 min. There was a significant relationship between UCD at the first visit and delivery and intrauterine growth restriction (IUGR) cases. There was a highly significant difference between IUGR in neonatal intensive care unit admission and delivery weight, APGAR 1 min, and APGAR 5 min. There was a statistically insignificant difference between IUGR and GA at delivery. Conclusion The UCD exhibited a substantial fetal growth restriction predictor when implemented during antenatal care visits. A replication and broader research of umbilical cord morphometry is required. This research might be beneficial in validating a strategy for detecting a specific group of individuals who are at risk of intrauterine fetal demise or an unfavorable fetal outcome.

Longitudinal Twin Growth Discordance Patterns and Adverse Perinatal Outcomes.

The objective of this study was to conduct a longitudinal assessment of inter-twin growth and Doppler discordance, to identify possible distinct patterns, and to investigate the predictive value of longitudinal discordance patterns for adverse perinatal outcomes in twin pregnancies. This retrospective cohort study included twin pregnancies followed and delivered at a tertiary University Hospital in London (UK), between 2010 and 2023. We included pregnancies with at least three ultrasound assessments after 18 weeks and delivery after 34 weeks' gestation. Monoamniotic twin pregnancies, pregnancies with twin-to-twin transfusion syndrome, genetic or structural abnormalities, or incomplete data were excluded. Data on chorionicity, biometry, Doppler indices, maternal characteristics, and obstetric as well as neonatal outcomes were extracted from electronic records. Doppler assessment included velocimetry of the umbilical artery, middle cerebral artery and cerebroplacental ratio. Inter-twin growth discordance was calculated for each scan. The primary outcome was a composite of perinatal mortality and neonatal morbidity. Statistical analysis involved multilevel mixed-effects regression models and unsupervised machine learning algorithms, specifically k-means clustering, to identify distinct patterns of inter-twin discordance and their predictive value. Predictive models were compared using the area under the receiver operating characteristics curve, calibration intercept, and slope, validated with repeated cross-validation. Analyses were performed using R, with significance set at p<0.05. Data from a total of 823 twin pregnancies (647 dichorionic, 176 monochorionic) were analyzed. Five distinct patterns of inter-twin growth discordance-low-stable (n=204, 24.8%), mild-decreasing (n=171, 20.8%), low-increasing (n=173, 21.0%), mild-increasing (n=189, 23.0%), and high-stable (n=86, 10.4%)-were derived using an unsupervised learning algorithm that clustered twin pairs based on the progression and patterns of discordance over gestation. In the high-stable cluster, the rates of perinatal morbidity (46.5%, 40/86) and mortality (9.3%, 8/86) were significantly higher, compared to the low-stable (reference) cluster (p<0.001). High-stable growth pattern was also associated with a significantly higher risk of composite adverse perinatal outcomes (Odds ratio 70.19, 95% confidence interval 24.18-299.03, p<0.001; adjusted Odds ratio 76.44, 95% confidence interval 25.39-333.02, p<0.001). The model integrating discordance pattern with CPR discordance at the last ultrasound before delivery demonstrated superior predictive accuracy, evidenced by the highest area under the receiver operating characteristics curve of 0.802 (95% confidence interval 0.712 - 0.892 0.046, p<0.001), compared to only discordance patterns (area under the receiver operating characteristics curve 0.785, 95% confidence interval 0.697 -0.873), intertwin weight discordance at the last ultrasound prior to delivery (area under the receiver operating characteristics curve 0.677, 95% confidence interval 0.545 - 0.809), combination of single measurements of estimated fetal weight and CPR discordance at the last ultrasound prior to delivery (area under the receiver operating characteristics curve 0.702, 95% confidence interval 0.586 -0.818) and single measurement of CPR discordance only at the last ultrasound (area under the receiver operating characteristics curve 0.633, 95% confidence interval 0.515 - 0.751). We identified five distinct trajectories of inter-twin fetal growth discordance using an unsupervised machine learning algorithm. Consistent high discordance is associated with increased rates of adverse perinatal outcomes, with a dose-response relationship. Additionally, a predictive model integrating discordance trajectory and CPR discordance at the last visit demonstrated superior predictive accuracy for the prediction of composite adverse perinatal outcomes, compared to either of these measurements alone or a single value of estimated fetal weight discordance at the last ultrasound prior to delivery.

Accuracy of three-dimensional ultrasound and power Doppler in prediction of endometrial carcinoma in women with postmenopausal bleeding

Background Transvaginal sonographies in two dimensions have traditionally been the primary method for evaluating the endometrium. However, three-dimensional (3D) ultrasonography (US) can save entire volumes. Aim The research aimed to evaluate the precision of 3D US and power Doppler indices in predicting the incidence of endometrial cancer in women experiencing postmenopausal bleeding. Additionally, the ultrasound results were compared with the histopathologic findings of endometrial biopsies. Patients and methods This research was conducted on a sample of 100 women aged 40–60 years old, with BMI ranging from 18.5 to 38 kg/m2. Participants were postmenopausal (having no menstruation for at least 1 year) and had a uterine hemorrhage and an endometrial thickness (ET) of more than 4 mm. Patients underwent assessment of two-dimensional and 3D transvaginal US as well as three-dimensional power Doppler imaging. Results The ET and endometrial volume (EV) were significantly higher in suspected malignant than benign groups (P&lt;0.001). ET and EV can predict the occurrence of endometrial cancer, respectively, at cut-off more than 14.2 mm (area under the curve=0.880 and P&lt;0.001) and more than 7.5 cm3 (area under the curve=0.902 and P&lt;0.001) with 80% sensitivity, 74.12%, 100%specificity, 35.3%, 100% positive predictive value, and 95.5%, 96.6% negative predictive value. The vascularization index was significantly higher in suspected malignant than benign (P&lt;0.001). Conclusion EV and Doppler of endometrial vascularization index together were good diagnostic tools for early prediction of subtle pathology of endometrial carcinoma. Histopathological examinations of endometrial biopsies were the gold standard for the final diagnosis of endometrial carcinoma.

Deep learning-driven ultrasound equipment quality assessment with ATS-539 phantom data

IntroductionUltrasound equipment provides real-time visualization of internal organs, essential for early disease detection and diagnosis. However, poor-quality ultrasound images can compromise diagnostic accuracy and increase the risk of misdiagnosis. Quality assessments are often subjective, relying on the evaluator's experience and interpretation, which can vary. MethodsThis study introduces a two-stage deep learning framework designed to objectively assess ultrasound image quality using phantom data across three key parameters: ‘Dead zone’, ‘Axial/lateral resolution’, and ‘Gray scale and dynamic range’. Stage 1 automatically extracts regions of interest for each parameter, while Stage 2 employs detection or classification models to evaluate image quality within these regions. To generate an overall equipment quality score, a logistic regression model combines the weighted results from each parameter. ResultsThe classification model demonstrated high performance across datasets, achieving AUC scores of 98.6% for ‘Dead zone’, 87.7% for ‘Axial/lateral resolution’, and 96.0% for ‘Gray scale and dynamic range’. Further analysis using guideline-compliant images of individual devices showed AUC scores of 98.2%, 92.8%, and 100%, respectively. These findings highlight deep learning's potential for quantitative and objective assessments of ultrasound image quality. Ultimately, this framework provides a streamlined approach to quality management, enabling consistent quality control and efficient scoring-based evaluation of ultrasound equipment.

Comparative evaluation of two simulation technologies for obstetric ultrasound trainees' assessment.

The objective was to evaluate the performance of two different obstetric ultrasound simulators in assessing the practical skills of trainees compared to the standard method of practical assessment conducted on pregnant women volunteers. We performed a prospective observational study. Two simulators were compared: the Simbionix simulator which uses a mannequin and heteroevaluation and the OPUS simulator which uses optical positioning technology with automatic assessment. All trainees who underwent the practical exam of the French national diploma in Ultrasound in Obstetrics and Gynecology in our center were recruited and assessed both on a volunteer pregnant woman and on simulator. We compared the results obtained by the trainees on the simulator with those obtained on pregnant women through correlation analysis of the scores and success rates. Overall, 207 trainees took the practical exam and were also evaluated on the simulator: 103 on the Simbionix and 104 on the OPUS. The success rates were the following: 84.1% (174/207) for the practical exam on pregnant woman, 81.2% (168/207) across both simulators, 79.6% (82/103) on Simbionix and 82.7% (86/104) on the OPUS. There was a good correlation between the success rate of the examination using a Simbionix simulator and with pregnant women (ρ=0.69; p<0.001), but no correlation was observed between the OPUS simulator and pregnant women (ρ=0.11; p=0.23). These data indicate that the Simbionix simulator outperforms the OPUS in assessing trainees. It could serve as a tool for screening trainees during practical assessments.

Within-session repeatability of Doppler ultrasound leg blood flow assessments during exercise in patients with chronic obstructive pulmonary disease.

Doppler ultrasound can be used to evaluate leg blood flow (Q̇leg), especially of interest when investigating peripheral vascular limitations in patients with chronic obstructive pulmonary disease (COPD). However, the within-session repeatability, a subdomain of test-retest reliability, of this method remains unknown. This study aimed to provide within-session repeatability estimates of Doppler ultrasound-based Q̇leg at rest and during single-leg knee-extensor exercise (KEE) in patients with COPD, and to compare these estimates to matched healthy controls. In this case-controlled study, 16 participants with COPD were matched based on sex and age with 16 healthy controls. All participants underwent measurement of Q̇leg using Doppler ultrasound in a KEE setup at various intensities with the same measurement being performed again separated by 10 s. Smallest real difference (SRD) was lowest at rest in both groups and increased during exercise, reaching values ranging from 164 to 231 mL in COPD and 122-180 mL in the control group. The coefficient of variance (CV) was highest at rest and decreased during exercise to values ranging from 4.0% to 5.0% in COPD and 2.6%-3.2% in the control group. The CV was significantly lower in the control group during 0 watt and exercise at 20% of max watt, but apart from that, no reliability estimates were different between groups. To conclude, Doppler ultrasound showed nearly equal within-session repeatability when evaluating Q̇leg in COPD patients and healthy individuals with a CV not exceeding 5% during exercise for both groups.

Coronally Advanced Flap with a Xenogeneic Collagen Matrix or a rhPDGF-BB-regenerative approach for Bilateral Multiple Gingival Recessions: A Split-mouth Clinical Feasibility Study.

This split-mouth trial investigated the efficacy of treating bilateral gingival recessions with either a xenogeneic cross-linked collagen matrix (CCM), or recombinant human platelet derived growth factor (rhPDGF-BB) with a bone allograft (AG). Ten patients were treated with the coronally advanced flap (CAF), either with a CCM, or rhPDGF-BB &#43; AG. The primary outcome was percentage of mean root coverage (mRC) at 12 months. Additional outcomes included clinical, volumetric, patient-reported outcome measures (PROMs) and ultrasonographic assessment of gingival thickness (GT) and position of the buccal bone (uBD). At 12 months, both groups showed significant improvements, with a mRC of 78.6% in the CCM group, and 82.3% for the rhPDGF-BB &#43; AG sites. 3D analysis of both groups showed comparable volumetric gain. CCM-treated sites displayed higher ultrasonographic echogenicity in GT (p<.01) than rhPDGF-BB &#43; AG sites. The rhPDGF-BB &#43; AG group showed greater reduction in the buccal bone dehiscence (mean 2.03 mm, p<0.01), less swelling during the first three days, and slighty greater mean root coverage. CCM and rhPDGF-BB &#43; AG showed to be effective in the treating multiple adjacent gingival recessions. CCM promotes greater gain in gingival thickness, while rhPDGF-BB &#43; AG resulted in a significantly less buccal bone dehiscense.

Ultrasonographic assessment of the normal ileocecocolic junction in dogs.

The ultrasonographic appearance of the ileocecocolic junction (ICCJ), comprising the ileocolic junction (ICJ) and the cecocolic junction (CCJ), has not been established in dogs. The purpose of this prospective study was (1) to evaluate the feasibility and technique of systematic ultrasonographic evaluation of the ICJ and CCJ and (2) to describe its ultrasonographic features. Abdominal ultrasound was performed in 102 fasted dogs, free of digestive signs. The time required to identify the ICJ using a standardized method was recorded for each operator and compared among four experienced ultrasonographers (ECVDI certified and associated member ECVDI) and two previously trained ECVDI residents to evaluate the feasibility of the technique. Measurements were obtained for the ICJ wall thickness. Evaluation of the contents and peristalsis of the ICJ was recorded for descriptive purposes. The easiest way to identify the ICJ was to follow the colon proximally from the urinary bladder to the ICJ. The probe was then rotated anticlockwise and shifted slightly laterally while increasing the pressure to obtain a longitudinal section of the ICJ. The ICJ was identified in less than 2min in 98% of cases by experienced ultrasonographers and in 86% of cases by ECVDI residents. The canine ICJ appears as a short invagination of the ileum into the colon, whereas the CCJ appears as a small opening of the colon within the cecum. This study suggests that it is possible to nearly systematically identify the ICCJ with ultrasound in dogs using the described method and provides reference values for its ultrasonographic measurements.

The role of the intraplacental fetal artery in predicting the need for cesarean-hysterectomy in women at high risk for placenta accreta spectrum.

Prenatal determination of placenta accreta spectrum (PAS) and its severity is crucial, as it is a highly morbid condition. The aim was to investigate the intraplacental fetal artery (IFA) as a novel ultrasonographic marker in predicting cesarean-hysterectomy need in PAS. A prospective observational cohort study was conducted with a total of 62 women with placenta previa and ≥1 previous cesarean-section who were managed for PAS between September 2022 and January 2024. All women were classified according to the ultrasonographic classification system for prenatal PAS, and ultrasonographic assessments for IFA were performed. Odds ratios were calculated to test the association of IFA and other parameters related to PAS with cesarean-hysterectomy need. Receiver operating characteristic analysis was performed to evaluate the ability of maximum diameter (D-max) of IFA to predict cesarean-hysterectomy need. The study was completed with 49 women who underwent a cesarean-section with uterus-sparing surgery (n=22) and a cesarean-hysterectomy (n=27). Outer placental-half extension of IFA and each 1mm increase in IFA D-max >3.5mm were associated with a 58.82- and 3.52-fold increased risk of cesarean-hysterectomy, respectively. An IFA D-max of >3.5mm was associated with cesarean-hysterectomy need at any PAS stage [area under the curve (AUC)=0.845, 95% CI:0.71-0.93, p<0.001)] and in PAS 2 patients (AUC=0.750, 95% CI:0.56-0.89, p=0.010), in whom prenatal prediction of cesarean-hysterectomy need is difficult. Evaluation of D-max and outer placental-half extension of IFA along with other markers of PAS improved the ability of ultrasonography to predict cesarean-hysterectomy need.