Ultrasound Results Research Articles

Obese Patients With Polymyalgia Rheumatica Experience More Pain And Disability At Disease Onset And Require Higher Doses Of Glucocorticoids.

polymyalgia rheumatica (PMR) is an inflammatory disorder of the elderly characterized by girdle pain and stiffness. Obesity has an influence on disease activity and outcome in rheumatic diseases like osteoarthritis and rheumatoid arthritis, but its relationship to the severity and outcome of PMR is unknown. In a post-hoc analysis, 83 patients with recent-onset PMR were studied over six months with clinical examination, laboratory evaluation, and girdle ultrasound. MHAQ, Short Form 36 (SF36), and PMR-VAS, as well as prednisone (PDN) therapy were recorded. Patients were divided according to their body mass index (BMI). at baseline, the 12 obese patients had significantly more shoulder pain (p=0.03), global pain (p=0.03), PMR VAS (p<0.01), and fatigue (p=0.03), higher MHAQ (p=0.01), and lower physical component summary on SF36 (p=0.048), SF36 social functioning index (p=0.05) and SF36 pain index (p<0.001). The mean initial PDN dose was similar among groups, but obese patients received a lower dose per kg weight (1.9±0.7 mg vs. 2.2±0.7 mg; p<0.01). At six months, obese patients were being treated with higher mean daily PDN doses (8.5±3.2 mg/day vs. 6.2±5.2 mg/day, p=0.02); 40% of them were receiving higher daily PDN dose than per-protocol, vs. 14% non-obese patients (p=0.048). Clinical features, laboratory and ultrasound results were similar. obesity affects both symptoms severity and PDN utilization in patients with PMR. The reason thereof may relate to different subjective pain perception rather than increased inflammation in obese patients. BMI should be considered when interpreting symptoms in PMR patients and deciding their PDN doses.

Contribution of Pelvic Ultrasonography in Perimenopausal Abnormal Uterine Bleeding

Background: About 70% of gynecological consultations for women in perimenopause are due to metrorrhagia. In most cases, they are only the witness of hormonal disturbances resulting from a luteal deficiency. Transvaginal ultrasound is the first innocuous and available additional examination that is requested as part of an etiological assessment. Objective: Our study aims to evaluate the contribution of ultrasonography in perimenopausal metrorrhagia and investigate possible clinical-ultrasound correlation. Methods: This analytical descriptive study was carried out on 50 treated for perimenopausal metrorrhagia in the emergency department of the Tunis Maternity and Neonatology Center for four months (November 1, 2017, to February 28, 2018). We included in our study patients who were not yet postmenopausal who were ≥ 45 years of age, and who sought care for breakthrough bleeding. All patients in our study initially underwent endovaginal ultrasonography, sometimes coupled with suprapubic ultrasonography. Results: The mean age of our patients was 46.3 years. Pelvic ultrasonography revealed an enlarged uterus in 16 patients (32%), with 14 of them having fibromatous uteri measuring between 3 to 10 centimeters. The findings indicate no significant correlation between ultrasound results and bleeding abundance (P = 0.321), pelvic pain (P = 0.108), and general condition (P = 0.437). Conclusion: Endovaginal pelvic ultrasonography is a quick, painless test and is the first test to be done first in an emergency department with perimenopausal vaginal bleeding. The correlation between clinical and ultrasound findings is highly random, making it impossible to assume a well-- coded diagnostic and therapeutic presumption.

Analysis of risk factors for carotid artery plaque in asymptomatic adults

ObjectiveThis study aimed to investigate the risk factors affecting the presence of carotid plaque in asymptomatic adults.MethodsAsymptomatic adults (age > 40 years, no symptoms of cardiovascular and cerebrovascular diseases) undergoing routine health examinations from physical examination department were included in this study. Carotid plaque was measured by Resona 7OB and Resona 8EXP color Doppler ultrasound and L9-3U and L4-5WU probes. The focal carotid intima–media thickness was greater than 1.1 mm, and the local protrusion of the artery wall into the artery lumen suggested the presence of carotid atherosclerotic plaque. According to their ultrasound results, 1077 asymptomatic adults were divided into a group with carotid plaque (477) and a group without carotid plaque (600).ResultsA total of 1077 asymptomatic adults were included in this study, of whom 44.3% had carotid plaque. The proportion of men with carotid plaque was 84.5%. Multifactorial logistic analysis suggested that age, fasting blood glucose (FBG), total cholesterol (TC), homocysteine (Hcy) and male gender were risk factors for carotid atherosclerosis. The predictive probability of these risk factor indicators derived from the multifactorial model was calculated using receiver operating characteristic (ROC) curves with SPSS 25.0 software. The calculated area under the receiver operating characteristic curve (AUC) was 0.715 (95% CI, 0.685–0.746).ConclusionAge, FBG, TC, Hcy and male gender are risk factors for carotid atherosclerosis in asymptomatic adults. Gender differences in carotid atherosclerosis deserve further attention.

Diagnostic value of ultrasound for community-acquired pneumonia in children and its correlation with serum PCT level and PCIS.

This study aimed to evaluate the diagnostic value of ultrasound for community-acquired pneumonia (CAP) in children. Clinical information of children diagnosed with CAP and a control group of healthy children was collected, and lung ultrasound detection was performed. The lung ultrasound score (LUS) was assessed, and venous blood samples were collected. Serum indexes, including white blood cell count, were analyzed using an automatic immunoassay analyzer, while serum procalcitonin (PCT) level was measured using an enzyme-linked immunosorbent assay. The pediatric critical illness score (PCIS) was also performed for all subjects. White blood cell count, absolute neutrophil count, and respiratory index were significantly higher in the CAP group than those in the control group, while the oxygenation index was markedly lower. Ultrasound detection results showed that the CAP group exhibited significantly higher detection rates of pleural effusion, interstitial lung changes, lung consolidation, B-lines, air bronchogram signs, and reduced or absent lung sliding signs compared with the control group. In addition, the LUS and PCT levels were markedly higher in the CAP group, while the PCIS was notably lower. Further analysis exhibited that the LUS in the CAP group was significantly positively correlated with PCT levels and negatively correlated with PCIS. The receiver operating characteristic curve indicated that the area under the curve of LUS for diagnosing children with lung infection was 0.841. LUS is closely related to serum PCT level and PCIS. Lung ultrasound detection demonstrates high sensitivity and specificity, indicating its valuable clinical diagnostic utility for CAP in children.

Association between Breast Arterial Calcification on Mammography and Impaired Ocular Perfusion: A Novel Study Using Color Doppler Ultrasonography.

To investigate the relationship between the mammography-detected breast arterial calcification (BAC) and orbital color Doppler ultrasonography (CDUS) results. Our single-center study, included female patients who applied to our hospital between January and May 2022 and underwent mammography and orbital CDUS examinations. Two radiologists evaluated the mammograms, grouped the patients as BAC (+) and BAC (-), and performed orbital CDUS. Continuous variables obtained from CDUS were compared according to the presence of BAC. Also, receiver operating characteristics (ROC) analysis was used to determine the orbital CDUS threshold values for the presence of BAC. A total of 119 women were included with a median age of 62 years, 57 (47.90%) had BAC. Orbital CDUS examination was performed on both eyes of 119 patients (238 eyes in total). Peak systolic velocity (PSV) and end-diastolic velocity (EDV) values of the ophthalmic artery (OA) (P < .001) and EDV of the central retinal artery (CRA) (P < .001) were significantly lower in patients with BAC. Pulsatile index (PI) and resistive index (RI) values of OA (P < .001) and CRA (P < .001) were higher in patients with BAC. In ROC analysis, the cut-off values for the presence of BAC were calculated as OA PI ≥1.415 and OA RI ≥0.755 (P < .001); CRA PI ≥1.135 and CRA RI ≥0.655 (P < .001). Orbital perfusion disorders may be observed in patients with vascular calcification detected on routine mammography. Therefore, a more detailed evaluation of patients with BAC detected on mammography with orbital CDUS may enable early detection and treatment of ocular vascular problems.

The Potential of Tele-Ultrasound, Handheld and Self-Operated Ultrasound in Pregnancy Care: A Systematic Review.

To explore the use of tele-ultrasound and handheld or self-operated ultrasound in pregnancy. A systematic search provided 31 studies. The risk of bias for each study was assessed. Results were analyzed and presented in a narrative overview in four domains: tele-ultrasound, patient-operated ultrasound, handheld devices and low- and middle-income countries (LMIC). The quality of studies was generally low or fair based on the NIH Quality Assessment Tools. Fetal tele-ultrasound services (11 studies) are feasible and especially helpful in rural areas or with increased centralization of specialist care. Three studies with patient-operated ultrasound concluded its feasibility with good-to-high experiences. The use of handheld devices in pregnancy (eight studies) showed similar ultrasound results when compared to standard devices. In LMICs, innovative use of ultrasound (nine studies) can facilitate access to obstetric care performed by trained as well as unskilled caregivers combined with remote evaluation by an expert. Innovations in ultrasound in pregnancy care have shown promising results for application. Although most studies demonstrated benefits for pregnant women or care providers, high-level evidence is scarce. High-quality studies on innovations are needed to assess medical outcomes, patient and provider experiences and costs.

7235 Papillary Thyroid Carcinoma in a Hyperfunctioning Thyroid Nodule

Abstract Disclosure: J. Yang: None. P.V. Nadkarni: None. Background: The prevalence of malignancy in a hyperfunctioning or hot thyroid nodule is considered to be low. According to the 2015 American Thyroid Association Guidelines, no cytologic evaluation is routinely recommended for hyperfunctioning nodules since they are rarely associated with malignancy (1). We present a case of a 71-year-old female with a hot nodule containing papillary thyroid cancer. Clinical Case: A 71-year-old female with Type 1 diabetes mellitus and coronary artery disease on dual antiplatelet therapy was found to have a 1.5 cm firm, non-tender right-sided thyroid nodule on a routine physical exam. Laboratory tests demonstrated low TSH &amp;lt;0.01 (normal 0.36 - 3.74 m[IU]/L) and FT4 level elevated at 1.62 (normal 0.76 -1.46 ng/dL). She noticed palpitations and started on low dose Methimazole. Thyroid ultrasound results showed a 2.1 x 2.0 x 2.0 cm right inferior lobe thyroid nodule. This thyroid nodule appeared mixed cystic and solid, hypoechoic, not taller than wide, with ill-defined margins and peripheral calcifications (ACR TI-RADS risk category: TR4). Nuclear medicine thyroid uptake scan demonstrated focally increased activity in the right lower pole corresponding with her right inferior thyroid nodule seen on ultrasound. Remainder of the gland appeared suppressed. She was recommended for ultrasound-guided fine needle aspiration biopsy of her right inferior thyroid nodule, given concerning characteristics on ultrasound findings despite results consistent with a hot nodule. Timing of her antiplatelet therapy was coordinated with her cardiologist, and her biopsy procedure scheduled after she stopped dual antiplatelet therapy. Her FNA results showed clusters of follicular cells with nuclear and architectural atypia, suspicious for papillary thyroid carcinoma. She underwent right thyroid lobectomy. Surgical pathology revealed 2 foci of papillary thyroid carcinoma, follicular variant (2.0 cm, 0.1 cm) and confined to the thyroid. All regional lymph nodes were negative for tumor. Methimazole was discontinued post-operatively, and she started Levothyroxine suppression therapy. Discussion: We present a rare association of papillary thyroid carcinoma presenting as a hot thyroid nodule. Though uncommon, detection of a hyperfunctioning thyroid nodule does not exclude the possibility of thyroid carcinoma and warrants careful evaluation. Clinicians should retain a high index of suspicion particularly when ultrasonography demonstrates findings suspicious for malignancy and consider additional evaluation with fine needle aspiration. Reference: (1) Haugen BR, Alexander EK, Bible KC et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016 Jan;26(1):1-133. Presentation: 6/2/2024

Correlative evaluation of findings between ultrasonography, fine needle aspiration cytology and histopathology in cases of goitre

Background: Thyroid imaging reporting and data system (TIRADS) criteria is followed in ultrasonography (USG), based on the risk of malignancy depending on the presence of suspicious ultrasound features. Patients in the high-risk category of TIRADS undergo fine needle aspiration cytology (FNAC), with the Bethesda classification used to determine the risk of malignancy. There is dearth of data comparing sonographic classification of thyroid nodule and its cytological association with respect to final histopathological diagnosis in India. Methods: Prospective observational study on correlation of USG, FNAC and HPE of thyroid swellings conducted in department of otolaryngology at Jaipur national university institute for medical science and research centre, Jaipur, Rajasthan from June 2022 to April 2024 on 50 patients with palpable thyroid lump. Results: In the present study, USG has a sensitivity of 63.63%, specificity of 97.44%, a positive predictive value (PPV) of 87.5%, a negative predictive value (NPV) of 90.4% and an overall accuracy of 84.00%. FNAC shows a sensitivity of 72.7%, specificity of 89.7%, PPV of 66.7%, NPV of 92%, and an overall accuracy of 86%. Conclusions: Benign lesions on both FNAC and USG were almost in concurrence with HPE in our study. The results of FNAC for diagnosing malignancy in our study were almost at par with the results of HPE and outweighed the results of USG. Surgical management should be based on FNAC finding even if USG shows benign features. It should be essential part of armamentarium of evaluation of thyroid swelling. This combined approach provides a robust framework and enhances the accuracy for distinguishing between benign and malignant thyroid lesions, ultimately contributing to improved patient care and outcomes. However, the histopathological examination will remain the gold standard.

Clinical Implication of the New AI-TIRADS Classification of Thyroid Nodules; Our Real Clinical Experience

Background: Ultrasound and fine needle aspiration biopsy (FNAB) play a primary role in determining the nature of nodules. Objectives: The aim of our study is to determine the diagnostic accuracy, sensitivity, and specificity of artificial intelligence-thyroid imaging reporting and data system (AI-TIRADS) in differentiating malignant from benign nodules to establish the treatment plan for patients and avoid unnecessary FNAB. Methods: This cross-sectional study was conducted between September 2020 and September 2021 (one year). Patients (n = 133) who had an indication for surgery due to nodular thyroid disease and were referred to the therapeutic training center of 5 Azar and Falsafi private section hospitals, Gorgan, Iran, were included. The diagnostic accuracy of FNAB and AI-TIRADS was calculated. Results: The mean age of patients with malignant pathology (39.65 ± 11.69) was lower than that of patients with benign pathology (44.14 ± 13.54), which was statistically significant (P = 0.042). Fifty-two out of 72 nodules less than 25 mm were malignant, demonstrating a higher prevalence of benign pathology in larger nodules. A pooled analysis of thyroid reporting (TR) = 2 and TR points ≥ 7 for their power in predicting the final pathology outcome showed figures of 0.97, 0.93, 0.97, and 0.97 for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), respectively, with an overall pooled accuracy of 0.97 for these two groups of sonographic results. Conclusions: We concluded that AI-TIRADS has a high sensitivity and diagnostic accuracy in differentiating benign from suspicious nodules.

Simultaneous CNV-seq and WES: An effective strategy for molecular diagnosis of unexplained fetal structural anomalies

BackgroundFetal structural anomalies are detected by ultrasound in approximately 3 % of pregnancies. Numerous genetic diagnostic strategies have been widely applied to identify the genetic causes of prenatal abnormalities. We aimed to assess the value of simultaneous copy number variation sequencing (CNV-seq) and whole exome sequencing (WES) in diagnosing fetuses with structural anomalies. MethodsFetuses with structural anomalies detected by ultrasound were included for eligibility. After genetic counseling, WES and CNV-seq were performed on DNA samples of fetuses and their parents. All detected variants were evaluated for pathogenicity according to ACMG criteria, with the final diagnosis was determined based on ultrasound results and relevant family history. ResultsThe diagnostic rate of 174 fetuses with prenatal ultrasound abnormalities was 26.44 %, higher than that achieved through either CNV or WES analysis alone. Furthermore, the highest diagnostic rate was observed in fetuses with multiple system anomalies, accounting for 50 % of the total diagnostic yield, followed by skeletal system anomalies at 45.45 %. Three cases with multiple system abnormalities were found to have a dual diagnosis of pathogenic CNVs and SNV variants, representing 1.72 % of the total cohort. 38 pregnant women in their third trimester of pregnancy (27 weeks+) participated in this study, and 23.68 % received a confirmed genetic diagnosis. Finally, 31 women (67.39 %) voluntarily terminated their pregnancy following the testing and extensive genetic counseling. ConclusionsOur study demonstrated that the simultaneous CNV-seq and WES analyses are beneficial for the molecular diagnosis of underlying unexplained structural anomalies in fetuses. This strategy is more efficient in elucidating prenatal abnormalities with compound problems, such as dual diagnoses. Furthermore, the simultaneous strategy has a shorter turnaround time and is particularly suitable for families with structural anomalies found in the third trimester of pregnancy.

FIGO PALM–COEIN Classification of Abnormal Uterine Bleeding in Saudi Women

Abstract Background: Abnormal uterine bleeding (AUB) is a significant concern in women’s health. However, there is limited research on its prevalence and characteristics in Saudi Arabia. Objectives: To determine the prevalence of AUB in a gynecology outpatient setting in Saudi Arabia and to categorize the cases of AUB according to the FIGO classification. Methods: This retrospective study included all Saudi female patients who presented to the Obstetrics and Gynecology clinic at King Khalid University Hospital, Riyadh, Saudi Arabia, over a 2-year period, except those who were pregnant. Data regarding demographics, BMI, clinical symptoms, laboratory tests, ultrasound results, and histopathology findings was collected. Cases of AUB were classified using the FIGO PALM-COEIN system. Results: A total of 2724 patients were included, of which 44.6% had AUB. The most common presentations of AUB were irregular cycles (59.3%) and heavy bleeding (12.8%), and the most affected group was the reproductive age group (19-39 years). Obesity was identified as a significant risk factor. AUB-O (ovulatory disorder; functional cause) was the most prevalent (23%), followed by AUB-L (leiomyomas, 18%; structural cause) and AUB-P (polyps, 8.8%). Specific AUB patterns correlated with ultrasonographic findings, with heavy bleeding associated with polyps, adenomyosis, and leiomyomas. AUB patients had lower hemoglobin levels, indicating potential health impacts. Conclusions: The study found that nearly half of all women presenting with gynecological complaints in Riyadh, Saudi Arabia, have AUB. According to the FIGO classification, functional causes of AUB were more prevalent than structural causes. Further research is necessary to explore underlying causes of AUB and its long-term health implications.

Insight into the effect of ultrasonic treatment on surface properties and flotation behavior of chalcopyrite after galvanic corrosion of grinding media and chalcopyrite

Ultrasonic treatment is an effective means to promote chalcopyrite flotation. Chalcopyrite needs to be grinded before flotation production. During the grinding process, galvanic corrosion occurs between chalcopyrite and iron grinding media. Galvanic corrosion significantly affects the efficacy of ultrasonic treatment on chalcopyrite flotation. Nonetheless, there is still a lack of research on ultrasonic treatment of chalcopyrite after galvanic corrosion. In this study, micro-flotation tests, SEM-EDS, TOF-SIMS, XPS, ICP-OES and electrochemical tests were used to study the effects of ultrasonic treatment on the surface properties and flotation behavior of chalcopyrite before and after galvanic corrosion under different ultrasonic conditions and galvanic corrosion conditions. The results show that in the absence of galvanic corrosion, short time and low power ultrasonic treatment can improve chalcopyrite floatability. However, when the chalcopyrite after strong galvanic corrosion is subjected to ultrasonic treatment, the increase of galvanic corrosion temperature, galvanic corrosion time, ultrasound power and ultrasound time result in a marked reduction of the flotation recovery of chalcopyrite. The synergistic effect of ultrasonic and galvanic corrosion significantly inhibits the flotation recovery of chalcopyrite, which may provide a new potential way for the inhibition of sulfide ore in flotation production. The research results are helpful to expand the use range of ultrasonic processing for sulfide mineral pretreatment and flotation, and provide a theoretical reference for the application of ultrasonic treatment in sulfide minerals with galvanic corrosion.

Risk-prediction models in postmenopausal patients with symptoms of suspected ovarian cancer in the UK (ROCkeTS): a multicentre, prospective diagnostic accuracy study

Multiple risk-prediction models are used in clinical practice to triage patients as being at low risk or high risk of ovarian cancer. In the ROCkeTS study, we aimed to identify the best diagnostic test for ovarian cancer in symptomatic patients, through head-to-head comparisons of risk-prediction models, in a real-world setting. Here, we report the results for the postmenopausal cohort. In this multicentre, prospective diagnostic accuracy study, we recruited newly presenting female patients aged 16-90 years with non-specific symptoms and raised CA125 or abnormal ultrasound results (or both) who had been referred via rapid access, elective clinics, or emergency presentations from 23 hospitals in the UK. Patients with normal CA125 and simple ovarian cysts of smaller than 5 cm in diameter, active non-ovarian malignancy, or previous ovarian malignancy, or those who were pregnant or declined a transvaginal scan, were ineligible. In this analysis, only postmenopausal participants were included. Participants completed a symptom questionnaire, gave a blood sample, and had transabdominal and transvaginal ultrasounds performed by International Ovarian Tumour Analysis consortium (IOTA)-certified sonographers. Index tests were Risk of Malignancy 1 (RMI1) at a threshold of 200, Risk of Malignancy Algorithm (ROMA) at multiple thresholds, IOTA Assessment of Different Neoplasias in the Adnexa (ADNEX) at thresholds of 3% and 10%, IOTA SRRisk model at thresholds of 3% and 10%, IOTA Simple Rules (malignant vs benign, or inconclusive), and CA125 at 35 IU/mL. In a post-hoc analysis, the Ovarian Adnexal and Reporting Data System (ORADS) at 10% was derived from IOTA ultrasound variables using established methods since ORADS was described after completion of recruitment. Index tests were conducted by study staff masked to the results of the reference standard. The comparator was RMI1 at the 250 threshold (the current UK National Health Service standard of care). The reference standard was surgical or biopsy tissue histology or cytology within 3 months, or a self-reported diagnosis of ovarian cancer at 12 month follow-up. The primary outcome was diagnostic accuracy at predicting primary invasive ovarian cancer versus benign or normal histology, assessed by analysing the sensitivity, specificity, C-index, area under receiver operating characteristic curve, positive and negative predictive values, and calibration plots in participants with conclusive reference standard results and available index test data. This study is registered with the International Standard Randomised Controlled Trial Number registry (ISRCTN17160843). Between July 13, 2015, and Nov 30, 2018, 1242 postmenopausal patients were recruited, of whom 215 (17%) had primary ovarian cancer. 166 participants had missing, inconclusive, or other reference standard results; therefore, data from a maximum of 1076 participants were used to assess the index tests for the primary outcome. Compared with RMI1 at 250 (sensitivity 82·9% [95% CI 76·7 to 88·0], specificity 87·4% [84·9 to 89·6]), IOTA ADNEX at 10% was more sensitive (difference of -13·9% [-20·2 to -7·6], p<0·0001) but less specific (difference of 28·5% [24·7 to 32·3], p<0·0001). ROMA at 29·9 had similar sensitivity (difference of -3·6% [-9·1 to 1·9], p=0·24) but lower specificity (difference of 5·2% [2·5 to 8·0], p=0·0001). RMI1 at 200 had similar sensitivity (difference of -2·1% [-4·7 to 0·5], p=0·13) but lower specificity (difference of 3·0% [1·7 to 4·3], p<0·0001). IOTA SRRisk model at 10% had similar sensitivity (difference of -4·3% [-11·0 to -2·3], p=0·23) but lower specificity (difference of 16·2% [12·6 to 19·8], p<0·0001). IOTA Simple Rules had similar sensitivity (difference of -1·6% [-9·3 to 6·2], p=0·82) and specificity (difference of -2·2% [-5·1 to 0·6], p=0·14). CA125 at 35 IU/mL had similar sensitivity (difference of -2·1% [-6·6 to 2·3], p=0·42) but higher specificity (difference of 6·7% [4·3 to 9·1], p<0·0001). In a post-hoc analysis, when compared with RMI1 at 250, ORADS achieved similar sensitivity (difference of -2·1%, 95% CI -8·6 to 4·3, p=0·60) and lower specificity (difference of 10·2%, 95% CI 6·8 to 13·6, p<0·0001). In view of its higher sensitivity than RMI1 at 250, despite some loss in specificity, we recommend that IOTA ADNEX at 10% should be considered as the new standard-of-care diagnostic in ovarian cancer for postmenopausal patients. UK National Institute of Heath Research.

Assessing Quality of Ultrasound Attenuation Coefficient Results for Liver Fat Quantification.

Algorithms for quantifying liver fat content based on the ultrasound attenuation coefficient (AC) are currently available; however, little is known about whether their accuracy increases by applying quality criteria such as the interquartile range-to-median ratio (IQR/M) or whether the median or average AC value should be used. AC measurements were performed with the Aplio i800 ultrasound system using the attenuation imaging (ATI) algorithm (Canon Medical Systems, Otawara, Tochigi, Japan). Magnetic resonance imaging proton density fat fraction (MRI-PDFF) was the reference standard. The diagnostic performance of the AC median value of 5 measurements (AC-M) was compared to that of AC average value (AC-A) of 5 or 3 acquisitions and different levels of IQR/M for median values or standard deviation/average (SD/A) for average values were also analyzed. Concordance between AC-5M, AC-5A, and AC3A was evaluated with concordance correlation coefficient (CCC). A total of 182 individuals (94 females; mean age, 51.2y [SD: 15]) were evaluated. A total of 77 (42.3%) individuals had S0 steatosis (MRI-PDFF < 6%), 75 (41.2%) S1 (MRI-PDFF 6-17%), 10 (5.5%) S2 (MRI-PDFF 17.1-22%), and 20 (11%) S3 (MRI-PDFF ≥ 22.1%). Concordance of AC-5A and AC-3A with AC-5M was excellent (CCC: 0.99 and 0.96, respectively). The correlation with MRI-PDFF was almost perfect. Diagnostic accuracy of AC-5M, AC-5A, and AC3A was not significantly affected by different levels of IQR/M or SD/A. The accuracy of AC in quantifying liver fat content was not affected by reducing the number of acquisitions (from five to three), by using the mean instead of the median, or by reducing the IQR/M or SD/A to ≤5%.

Bovine Respiratory Disease (BRD) in Post-Weaning Calves with Different Prevention Strategies and the Impact on Performance and Health Status

Our study aimed to compare Bovine Respiratory Disease (BRD) morbidity, mortality, and growth in dairy and dairy beef cross-bred calves during the commingle period, 81–120 days of age, using two different BRD prevention strategies. The calves (n = 1799) were randomly assigned into groups: (1) Control (CON; received no vaccine or metaphylaxis); (2) Tulathromycin metaphylaxis (TUL; IncrexxaTM, Elanco Animal Health Inc., Greenfield, IN, USA); and (3) Mannheimia haemolytica vaccine (VACC; Nuplura® PH, Elanco Animal Health Inc., Greenfield, IN, USA). Calves were individually weighed three times during the study to estimate average daily gain (ADG). Deep nasopharyngeal swabs, thoracic ultrasonography, health scores, and treatment records were collected during the study. Ultrasound and health score results were not different across treatments. In this study, the TUL group had a lower cumulative BRD incidence than CON. The cumulative incidence and 95% CI of BRD during the commingle period, 81–120 days of age for CON, TUL, and VACC were 0.43 (0.38 to 0.47), 0.36 (0.38 to 0.40), and 0.39 (0.35 to 0.43), respectively. The ADG for CON, TUL, and VACC were 0.25 ± 0.15, 0.32 ± 0.15, and 0.17 ± 0.15 kg, respectively. There was no difference among the treatment groups for ADG. Management and environmental conditions were variable at this operation throughout the study period and likely impacted the calves. Earlier interventions may be needed when the BRD incidence is elevated in high-risk calves.

Investigating the Thickness of the Deltoid Free Flap Using Ultrasonography and Clinical Application in Foot and Hand Soft-Tissue Defect Reconstruction.

Although the deltoid flap is widely described as a thin flap, no studies have reported on the measurement of its thickness. Thus, this study aimed to measure deltoid flap thickness at different points using brightness-mode ultrasonography and report our initial clinical experience. This study included 36 adults (26 males and 10 females; mean age: 34 years) with 72 healthy deltoid regions. Ultrasonography was employed to measure flap thickness at eight designated positions. The ultrasonography results were also applied clinically in 30 patients to evaluate its compatibility. The mean deltoid flap thickness was 5.14 ± 0.81 mm, with the thickest point being the emerging point of the flap pedicle. The subcutaneous fat gradually thinned toward the shoulder. No significant differences in the subcutaneous fat layer thickness were observed between the right and left sides, different ages, or the two sexes. Body mass index was the most critical factor related to flap thickness (p < 0.001). All deltoid free flaps were successfully transferred, resulting in good or excellent final clinical outcomes. The ultrasonography results suggest harvesting the deltoid flap upward toward the shoulder area and across the acromion from the emerging position of the flap pedicle to optimize flap thinness. The results showed that besides the flaps that have been clinically well established, the deltoid flap should be considered a valuable alternative for reconstructing limb soft-tissue defects, particularly where thin flaps are required and favorable aesthetic results are crucial.

Evaluation of biventricular function by cadmium-zinc-telluride SPECT gated tomographic radionuclide angiography: Comparison to conventional SPECT.

We compared and analyzed the consistency and repeatability of left and right ventricular ((LV/RV) functions obtained by gated-equilibrium radionuclide ventriculography (ERNV) with cadmium-zinc-telluride single-photon emission computed tomography (CZT-SPECT) and conventional SPECT (C-SPECT) with sodium iodide crystal detectors. Seventy-seven patients were included in the retrospective study. Both C-SPECT and CZT-SPECT imaging were performed on the same day. Correlations and differences in LV/RV ejection fraction (LVEF and RVEF), peak ejection rate (PER), and peak filling rate (PFR) were compared between the 2 models. Cardiac magnetic resonance (CMR) was partially used as the gold standard, and ultrasound results were included for comparative analysis. Interobserver reproducibility of each parameter obtained by the 2 cameras was compared. Between the 2 cameras, there were no significant difference in LVEF, LVPER, LVPFR, and RVPER (P > .05) and there were in RVEF and RVPFR (P < .05 or .001). The correlations (R value) were 0.831 (LVEF, excellent), 0.619 (RVEF, good), 0.672 (LVPER, good), 0.700 (LVPFR, good), 0.463 (RVPER, normal), and 0.253 (RVPFR, poor). There were no significant difference between CMR and CZT-SPECT in LVEF (P > .05) while there were between CMR and both C-SPECT and ultrasound (P < .05). The correlations were all good (R = 0.660, 0.658, and 0.695). There were no significant difference between CMR and both C-SPECT and CZT-SPET in RVEF (P > .05) and the correlations were good (R = 0.771 and 0.745). For repeatability, the intraclass correlation coefficient of RVPFR by C-SPECT was good (intraclass correlation coefficient = 0.698) and excellent for the rest of the groups (0.823-0.989). The repeatability of LVEF and RVEF was better for CZT-SPECT than for C-SPECT. The repeatability of PER was better for both cameras than PFR. CZT-SPECT tomographic ERNV correlated well with C-SPECT planar ERNV in evaluation of biventricular systolic function and LV diastolic function. Compared with the "gold standard" CMR, both models had good correlation in measuring LV/RVEF. CZT-SPECT had better inter-group reproducibility than C-SPECT. The accuracy of RV diastolic function need further study. CZT-SPECT tomographic ERNV will play an important and unique role in the clinical application of accurate evaluation of biventricular function in the future.

Detection of tendon breaks in prestressed concrete structures using coda wave interferometry

AbstractTendon breaks significantly threaten the safety of prestressed concrete structures. Failure of embedded tendons does not necessarily indicate as surface cracks, demonstrating the need for early detection methods. This paper presents a novel ultrasound‐based approach for detecting and localizing tendon breaks using coda wave interferometry. Already few embedded ultrasonic transducers form a robust monitoring network able to detect subtle changes in the structure. To demonstrate the feasibility of detecting tendon breaks, a post‐tensioned concrete beam was fabricated at Ruhr University Bochum, Germany. A break of a centric and eccentric tendon was artificially created by drilling from the outside. Both were successfully detected and localized through characteristic changes in the ultrasound results without any evidence of damage on the concrete surface. Measurements with fiber optic sensors validate the ultrasonic findings and provide insights into the re‐anchoring behavior after tendon failure.

Exploring variations in dengue symptoms: a comparative study of 2013, 2019, and 2023 in a tertiary care hospital of Bangladesh

Background: Dengue fever remains a major public health issue in Bangladesh, with repeated outbreaks. This study compares dengue symptoms in a tertiary care hospital during 2013, 2019, and 2023. The purpose of this study is to evaluate the variations in dengue symptoms among Bangladeshi dengue patients from 2013 and 2019 to 2023. Methods: This was a cross-sectional study, conducted on 100 dengue positive patients, admitted between 1st January to 7th August 2023, to the Medicine Department, Holy Family Red Crescent Medical College and Hospital, Dhaka. Demographic data, sign and symptoms and laboratory investigation reports were collected. These data were compared with a previously published study from the same institute comparing dengue symptoms between 2013 and 2019 among admitted dengue patients. The study employed a convenience sampling method for participant selection, and data analysis was carried out using SPSS version 26. Results: Analysis of 100 sero-positive dengue cases reveals a predominant occurrence in the 20 to 40 age group (51%), with the mean age of patients being 34.5 years. Among these cases, a higher prevalence is observed in males (62%) compared to females (38%). Symptomatology exhibits variations over time, with fever being consistently present. Other symptoms such as headache (90%, 23% and 12%), retroorbital pain (45%, 3% and 16%), skin rash (16%, 4% and 1%) and constipation (32%, 1% and 5%) showing fluctuations, respectively in 2013, 2019 and 2023. Notably, a significant proportion of patients in 2023 exhibit normal ultrasound findings (53%). Conclusions: In conclusion, our study provides a comprehensive analysis of Dengue infection dynamics over a decade, highlighting significant variations in clinical manifestations, laboratory findings, and abdominal ultrasound results among Bangladeshi patients. The findings suggest that Dengue remains a considerable public health concern, with fluctuations observed in symptomatology, including fever and other associated symptoms, and changes in laboratory parameters over time. BIRDEM Med J 2024; 14(3): 131-136

Heterogeneous Kinetics of Nanobubble Ultrasound Contrast Agent and Angiogenic Signaling in Head and Neck Cancer.

Recently developed nanobubble ultrasound contrast agents are a promising tool for imaging and drug delivery in tumors. To better understand their unusual kinetics, we implemented a novel pixel clustering analysis, which provides unique information by accounting for spatial heterogeneity. By combining ultrasound results with proteomics of the imaged tumors, we show that this analysis is highly predictive of protein expression and that specific types of nanobubble time-intensity curve are associated with upregulation of different metabolic pathways. We applied this method to study the effects of two proteins, EphB4 and ephrinB2, which control tumor angiogenesis through bidirectional juxtacrine signaling, in mouse models of head and neck cancer. We show that ephrinB2 expression by endothelial cells and EphB4 expression by cancer cells have similar effects on tumor vasculature, despite sometimes opposite effects on tumor growth. This implicates a cancer-cell-intrinsic effect of EphB4 forward signaling and not angiogenesis in EphB4's action as a tumor suppressor.