Ultrasound Study Research Articles

Influence of autological growth factors on activation of regenerative processes of the superficial digital flexor tendon of horses

Injury of the superficial digital flexor tendon is known for slow and functionally incomplete recovery, which is a problem in the equestrian horse farming. In the clinical studies, we used platelet-rich plasma, obtained from horse blood, and a specially designed scheme of rehabilitation after physical loads for the treatment of injuries of the superficial digital flexor tendon of horses. We analyzed four clinical cases of injuries of the superficial digital flexor of horses, of which 3 cases were treated using platelet-rich plasma, injected under ultrasound-diagnostic control, and one case that was treated without its administration. Ultrasound studies of the superficial digital flexor tendon revealed the following changes: increase in the volume of the tendon, damage to the fiber structure, and absence of fibrosity on the longitudinal images, and hypo-echogenic or anechogenic structure on transverse and longitudinal images. The results of the platelet-rich-plasma treatment of the horses were compared with the control (without utilization of platelet-rich plasma). As seen on the ultrasound images during the intermediate-control stage (2.5–4.0 months after injury), the horses that had received injection of platelet-rich plasma and had undergone the complex of physical exercises were forming new fibers of the superficial digital flexor tendon, which had distinct structure and alignment. This indicated the process of their physiological development. Four and a half months after being injured, the horse that had only received a symptomatic treatment combined with a complex of rehabilitating physical loads had poorly structured fibers in the damaged area, with their disordered alignment, as revealed by the longitudinal images. This suggested the formation of a scar. Transverse images showed the anechogenic areas of the injury suffered by this horse. The method of preparing and administration of platelet-rich plasma is relatively cheap, given the equipment and a qualification of a veterinary doctor. Taking into account its identified efficacy for recovery of the superficial digital flexor tendon, it would be promising to conduct further clinical trials using platelet-rich plasma for treating other injured tendons of horses, which can notably increase the quality of recovered connective tissues.

Open Median Arcuate Ligament Release With Complete Celiac Plexus Neurolysis Provides Substantial Relief in Symptomatic Patients

Median arcuate ligament syndrome (MALS) is a clinical entity that has historically been met with significant equipoise on how to diagnose and treat the constellation of symptoms. Our objective was to describe distinct patient outcomes following open median arcuate ligament release and complete celiac plexus neurolysis in patients diagnosed with MALS. We performed a prospective analysis of patients referred for MALS at a single institution between February 2020 and January 2022. We assessed duplex ultrasound studies, abdominal computed tomography angiography results, celiac plexus nerve block procedures, and patient reported questionnaires. Patients who experienced symptomatic relief from celiac plexus nerve block were offered surgical release and neurolysis. Their preoperative and postoperative health and quality of life measures were assessed using the 36-item Short-Form Health Survey (RAND). There were 75 patients who were referred for MALS and 29 patients (39%) underwent surgery. Duplex ultrasound examination revealed a significant increase in celiac artery peak systolic velocity at end-expiration (211 cm/s to 276 cm/s), with only 55% having a J-hooked appearance of the celiac artery on computed tomography angiography. All patients underwent transgastric celiac plexus block with a combination of bupivacaine and triamcinolone. After nerve block, surgical patients had a mean relief of 207 hours (48-1008 hours) from their symptoms. Postoperatively, 16 patients completed the 36-item Short-Form Health Survey with significant improvement noted in each category of the questionnaire (Fig 1). Significant quality of life improvement can also be appreciated in Fig 2. Surgical patients had an average weight gain of 8.8 kg (range, 1.3-34 kg) at a mean follow-up of 8 months. There were no perioperative wound healing complications. Our data suggest that patients who are carefully selected for median arcuate ligament release and neurolysis have significant improvement in quality of life and benefit from surgery. Wide surgical neurolysis of the celiac plexus is critical and the same diagnostic imaging findings are not consistent across all patients. Celiac plexus neurolysis is required for accurate patient selection.Fig 2Averages in each domain of the 36-item Short-Form Health Survey.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

(121) Validation of a Digital Rigidometer for the Evaluation of Erection Hardness During In-office Rigidity Assessment in Patients with Erectile Dysfunction

Abstract Introduction The evaluation of erectile function should include the measurement of axial rigidity, since it is one of the key factors in the pathophysiology, diagnosis and treatment of ED. This assessment is usually performed following in-office intracavernosal injections of vasoactive agents during Doppler ultrasound studies, curvature assessments or simply prior to initiation of intracavernosal pharmacotherapy. In this scenario, the Erectile Hardness Score (EHS) is the most common validated tool to evaluate penile rigidity. Although highly reproducible, EHS is still based on the examiner’s subjective perspective and might eventually lead to conflicting results. Objective The aim of the present study was to assess the diagnostic accuracy of a digital rigidometer in comparison to the EHS scale to allow for a more detailed rigidity assessment using an objective measure of penile axial load. Methods First we performed a controlled experiment using a digital dynamometer coupled to a 3D-printed tip to assess the maximal load applied to the Pfizer’s Erection Hardness Meter (Figure 1). Three urologists with expertise on the management of ED performed 2 different measures of axial rigidity on each shaft corresponding to the EHS scale in order to suggest a 4-grade classification range. Then, a sample of patients was analyzed during in-office erectile tests performed by 2 different urologists using redosing protocols of vasoactive agents from February to June 2022. Coefficients of variation were calculated using analysis of variance (ANOVA) and t-test was performed to compare the interval data. ROC curves were used to estimate the diagnostic accuracy of the digital rigidometer in comparison to the EHS. P values below 0.05 were considered significant. Results Mean axial load supported by each shaft of the Pfizer’s Erection Hardness Meter was: EHS 1: 0.51 ± 0.05 Kg; EHS 2: 0.75 ± 0.05 Kg; EHS 3: 1.2 ± 0.13 Kg; and EHS 4: 2.5 ± 0.51 Kg. The following coefficients of variations were found: EHS 1: 10.1%, EHS 2: 6.85%, EHS 3: 11.2%, and EHS 4: 20.4%. Distribution of different measures is shown in Figure 2. A total of 30 men with mean age of 54.5 ± 15.5 years were included in the analysis. The mean IIEF-EFD was 16.3 ± 5.1. During erection assessment 3 (10%) presented erection EHS 2, 7 (23.3%) EHS 3, and 20 (66.6%) EHS 4. The mean dose of trimix was 0,35 ml and 50% required sympathomimetic medication for erection reversion after the procedure. The digital rigidometer had an AUC of 0.91 (95% CI 0.78-1.00, p=0.0005) to discriminate EHS>3 (Figure 3). The best cuff value for that purpose is 1.2 Kg, yielding a sensitivity of 85.7% and specificity of 88.9%. Conclusions The digital rigidometer tested in the present study appears to provide reproducible measures of axial penile rigidity that might be useful in clinical practice. It has demonstrated interesting diagnostic properties for the in-office assessment of erectile rigidity in comparison to the EHS, in which the cutoff of 1.2 Kg is the one with the best diagnostic properties. An objective measurement of penile axial rigidity can contribute to both clinical and research environment. Disclosure No

(124) Investigating the Risk Factors of Penile Arterial Insufficiency and Veno-occlusive Dysfunction In Patients with Erectile Dysfunction

Abstract Introduction It was reported that a more generalized peripheral atherosclerotic process is associated with a severer penile arterial insufficiency (PAI), and this in turn was correlated well with decreased blood supply in more important arteries like the coronary and carotid arteries. Objective We investigated the risk factors for PAI which is a known cause of erectile dysfunction (ED Methods Patients who attended our urology clinic complaining of ED for more than 6 months, were prospectively enrolled in this study in one year period. Patient consent was taken and ethical committee approval. Complete medical history and thorough general and local examination including body mass index (BMI), Peyronie’s disease (PD) and penile size measurements (length and girth) were done for all of them. Laboratory tests included testosterone, lipid profile, and glycated haemoglobin (HbA1c). Penile duplex ultrasound study (PDU) was done for all patients after intra-cavernosal injection (ICI) with Alprostadil. peak systolic velocity (PSV) and end diastolic velocity (EDV) were measured after 15 minutes. Statistical analysis was done using SPSS. Results A total of 440 patients were enrolled in this analysis. The mean age was 48 (23-81), and the mean BMI was 30 (18-51). Older patients had lower PSV (r=-0.361, P=0.000) and higher EDV (r=0.174, P=0.001) and both correlations were highly statistically significant. Diabetics had lower PSV (r=-0.318, P=0.000) and higher EDV (r=0.139, P=0.008) which were also highly statistically significant. Hypertensive patients had lower PSV (r=-0.296, P=0.000) which was highly statistically significant. Smokers had lower PSV (r=-0.140, P=0.008) and higher EDV (r=0.178, P=0.001) which were highly statistically significant. Men with larger penises measured skin to tip, had lower EDV (r=-0.119, P=0.024) which was less significant. Interestingly there was neither significant correlation between BMI and PSV (0.16, p=0.745) nor significant correlation between testosterone and PSV (0.029, p=0.552). Also, there was no correlation between PSV and both dyslipidaemia and penile PD. Conclusions Our study highlights key risk factors - Increased age, tobacco consumption, DM and hypertension - are factors that have a statistically significant negative impact on penile haemodynamics. Of these, tobacco consumption, good diabetic control and hypertension are potentially modifiable and should form part of any treatment plan for erectile dysfunction. Other risk factors – increased BMI, low testosterone, PD and penile size – had no statistically significant impact on penile hemodynamics. This allows for targeted advice that can be given to patients who present with this very common problem. Ultimately, good vascular health goes hand in hand with good erectile function. Disclosure No

Anatomical study of the medial calcaneal nerve using high-resolution ultrasound.

To determine whether high-resolution ultrasound (US) can identify the course and relations of the medial calcaneal nerve (MCN). This investigation was initially undertaken in eight cadaveric specimens and followed by a high-resolution US study in 20 healthy adult volunteers (40 nerves) by two musculoskeletal radiologists in consensus. The location and course of the MCN as well as its relationship to adjacent anatomical structures were evaluated. The MCN was consistently identified by US along its entire course. The mean cross-sectional area of the nerve was 1 mm2 (range 0.5-2). The level at which the MCN branched from the tibial nerve was variable, located a mean of 7mm (range - 7-60) proximal to the tip of the medial malleolus. At the level of the medial retromalleolar fossa, the MCN was located inside the proximal tarsal tunnel a mean of 8mm (range 0-16) posterior to the medial malleolus. More distally, the nerve was depicted in the subcutaneous tissue at the surface of the abductor hallucis fascia with a mean direct distance to the fascia of 1.5mm (range 0.4-2.8). High-resolution US can identify the MCN at the level of the medial retromalleolar fossa, as well as more distally in the subcutaneous tissue at the surface of the abductor hallucis fascia. In the setting of heel pain, precise sonographic mapping of the MCN course may enable the radiologist to make diagnosis of nerve compression or neuroma, and perform selective US-guided treatments. In the setting of heel pain, sonography is an attractive tool for diagnosing compression neuropathy or neuroma of the medial calcaneal nerve, and enables the radiologist to perform selective image-guided treatments such as diagnostic blocks and injections. • The MCN is a small cutaneous nerve which rises from the tibial nerve in the medial retromalleolar fossa to the medial side of the heel. • The MCN can be depicted by high-resolution ultrasound along its entire course. • In the setting of heel pain, precise sonographic mapping of the MCN course may enable the radiologist to make diagnosis of neuroma or nerve entrapment, and perform selective ultrasound-guided treatments such as steroid injection or tarsal tunnel release.

Deep clustering for abdominal organ classification in ultrasound imaging.

The purpose of this study is to examine the utilization of unlabeled data for abdominal organ classification in multi-label (non-mutually exclusive classes) ultrasound images, as an alternative to the conventional transfer learning approach. We present a new method for classifying abdominal organs in ultrasound images. Unlike previous approaches that only relied on labeled data, we consider the use of both labeled and unlabeled data. To explore this approach, we first examine the application of deep clustering for pretraining a classification model. We then compare two training methods, fine-tuning with labeled data through supervised learning and fine-tuning with both labeled and unlabeled data using semisupervised learning. All experiments were conducted on a large dataset of unlabeled images () and a small set of labeled images () comprising progressively 10%, 20%, 50%, and 100% of the images. We show that for supervised fine-tuning, deep clustering is an effective pre-training method, with performance matching that of ImageNet pre-training using five times less labeled data. For semi-supervised learning, deep clustering pre-training also yields higher performance when the amount of labeled data is limited. Best performance is obtained with deep clustering pre-training combined with semi-supervised learning and 2742 labeled example images with an -score weighted average of 84.1%. This method can be used as a tool to preprocess large unprocessed databases, thus reducing the need for prior annotations of abdominal ultrasound studies for the training of image classification algorithms, which in turn could improve the clinical use of ultrasound images.

The Great Contrast Shortage of 2022-Lessons learnt in Australia.

Computed tomography (CT) imaging is one of the most commonly used diagnostic tools. Iodine-based contrast media (IBCM) are frequently administered intravenously to improve soft tissue contrast in a wide range of CT scans. Supply chain disruptions triggered by the SARS-CoV-19 pandemic led to a global shortage of IBCM in mid-2022. The purpose of this study was to explore the impact of this shortage on the delivery of healthcare in Western Australia. We performed a single-centre retrospective analysis of the provision of CT studies, comparing historical patterns to the shortage period. We focussed our attention on the total number of CT scans (noncontrast CT [NCCT] and contrast-enhanced CT [CECT]) and also specifically CT pulmonary angiogram (CTPA) and CT neck angiogram with or without inclusion of circle of Willis (CTNA) examinations. We also examined whether a decrease was compensated by increasing frequency of alternate examinations such as ventilation/perfusion (V/Q) scans, carotid Doppler ultrasound studies and Magnetic Resonance Angiograms (MRAs). Since 2012, there has been an approximate linear increase in the frequency of CT examinations. During the period of contrast shortage, there was an abrupt drop-off by approximately 50% in the CECT, CTPA and CTNA groups compared with the preceding 6 weeks (49%, 55% and 44%, respectively, with P < 0.001 in all cases). During the contrast shortage, the frequency of V/Q scans increased fivefold (from 13 to 65; P < 0.001). However, the provision of carotid Doppler ultrasound studies and MRAs remained approximately stable in frequency across recent time intervals. Our findings demonstrate that the IBCM shortage crisis had a very significant impact on the delivery of healthcare. While V/Q scans could (partially) substitute for CTPA studies in suspected pulmonary emboli, there appeared to be no valid alternative for CTNA studies in stroke calls. The unexpected and critical shortage of IBCM forced healthcare professionals to conserve resources, prioritise indications, triage patients based on risk, explore alternate imaging strategies and prepare for similar events recurring in the future.

Iatrogenic Ulnar Nerve Neuropathy Following Reverse Total Shoulder Arthroplasty: Electrodiagnostic Findings in 18 Patients.

Background A reverse total shoulder arthroplasty (RTSA) is often recommended for rotator cuff pathology and may be associated with a myriad of complications, including prosthetic instability, infection, humeral problems, and glenoid loosening.Neurological injuries following an RTSA are infrequent and are usually related to brachial plexus or proximal nerve injury in the affected arm.Iatrogenic ulnar nerve neuropathy is exceedingly rare. Aims This study describes the clinical and electrodiagnostic (EDX) features of 18 patients with ulnar nerve neuropathy complicating RTSA. Materials and methods All patients underwent EDX studies, and 14 had an ultrasound (US) study. Results All patients complained of numbness, tingling, hyperalgesia, and/or allodynia in the distribution of the ulnar nerve.Eight (44%) patients reported hand weakness, and one (6%) noted wasting of the intrinsic hand muscles. Decreased pinprick sensation in the ulnar nerve distribution was detected in all patients.Seventeen (94%) patients had weakness of the ulnar nerve-innervated intrinsic hand muscles.All patients had focal slowing of the motor conduction of the ulnar nerve across the elbow.Sensory potentials were either absent or of a low amplitude over the digital and/or dorsal cutaneous branch of the ulnar nerve in all patients.Twelve (86%) patients showed an increase in the cross-sectional area (CSA) of the ulnar nerve at the elbow; six (43%) had a hypoechoic ulnar nerve.Ulnar nerve neuropathy was confirmed at the elbow in all 18 patients.Of the 14 (78%) patients who underwent surgical intervention for ulnar nerve neuropathy following an RTSA, only four had complete symptom resolution. Conclusions Surgeons should be cognizant of ulnar nerve neuropathy as a potential complication of an RTSA and take precautions to avoid damage to the ulnar nerve intraoperatively.EDX and US studies should be performed to confirm and assess the site and severity of the injury.

Split Phenomenon of Fasciculation between Antagonistic Muscles in Amyotrophic Lateral Sclerosis: An Ultrasound Study.

Paresis of muscle groups in patients with amyotrophic lateral sclerosis (ALS) tends to present split phenomena. We explored the split phenomenon of fasciculation in multiple antagonistic muscle groups in ALS patients. One hundred and forty ALS patients and 66 non-ALS patients were included from a single ALS center. Muscle ultrasonography (MUS) was performed to detect fasciculation in elbow flexor-extensor, wrist flexor-extensor, knee flexor-extensor, and ankle flexor-extensor. Split phenomena of fasciculation between different antagonistic muscle groups were summarized, and the possible influence factors were analyzed through stratified analysis. The frequency of split phenomenon of fasciculation intensity was significantly higher than those of muscle strength (26.1% vs. 7.1% for elbow flexor-extensor, 38.3% vs. 5.7% for wrist flexor-extensor, 37.9% vs. 3.0% for knee extensor-flexor, and 33.6% vs. 14.4% for ankle flexor-extensor) (P < 0.01). For muscles with 0-1 level of muscle strength (the Medical Research Council, MRC, score), significance difference in mean fasciculation intensity was observed only in ankle flexor-extensor. For muscles with 2-5 level of muscle strength, significant dissociation of fasciculation grade was common, especially among patients with slow rapid progression rate and both upper and lower motor neuron (UMN and LMN) involvement. As for non-ALS patients, no significant difference was observed in fasciculation intensity between antagonistic muscles. Split phenomenon of fasciculation between antagonistic muscles was common and relatively specific in ALS patients. Muscle strength, progression rate, and UMN involvement were influence factors of the split phenomenon of fasciculation intensity.

Validation of a sonographic checklist for the detection of histologic placenta accreta spectrum

To standardize research terminology and reduce unanticipated placenta accreta spectrum (PAS), the European Working Group for Abnormally Invasive Placenta (EW-AIP) developed a consensus checklist for reporting PAS suspected on antenatal ultrasound. The diagnostic accuracy of the EW-AIP checklist has not been assessed. To test the performance of the EW-AIP sonographic checklist in predicting histologic PAS. This is a multi-site, blinded, retrospective review of transabdominal ultrasound studies performed between 26-32 weeks gestation for subjects with histologic PAS between 2016-2020. We matched a 1:1 control cohort of subjects without histologic PAS. To reduce reader bias, we matched the control cohort for known risk factors including previa, number of prior cesarean deliveries, prior dilation and curettage (D&C), in vitro fertilization (IVF), and clinical factors affecting image quality including multiple gestation, body mass index (BMI) and gestational age at the ultrasound. Nine sonologists from 5 referral centers, blinded to the histologic outcomes, interpreted the randomized ultrasound studies using the EW-AIP checklist. The primary outcome was the sensitivity and specificity of the checklist to predict PAS. Two separate sensitivity analyses were performed: 1) we excluded subjects with mild disease (i.e. only assessed subjects with histologic increta and percreta); 2) we excluded interpretations from the 2 most junior sonologists. 78 subjects were included (39 PAS, 39 matched control). Clinical risk factors and image quality markers were statistically similar between cohorts. The checklist sensitivity (95% Confidence Interval, CI) was 76.6% (63.4%-90.6%) and specificity (95% CI) was 92.0% (63.4%-99.9%), with a positive and negative likelihood ratio of 9.6 and 0.3, respectively. When we excluded subjects with mild PAS disease, the sensitivity (95% CI) increased to 84.7% (73.6%-96.4%) and specificity was unchanged at 92.0% (83.2%-99.9%). Sensitivity and specificity were unchanged when the interpretations from the 2 most junior sonologists were excluded. The 2016 EW-AIP checklist for interpreting PAS has a reasonable performance in detecting and excluding histologic placenta accreta spectrum.

Endoscopic ultrasound-guided cystogastrostomy in the treatment of the complicated form of acute pancreatitis in children

Acute pancreatitis is relatively rare in children, with approximately 313 cases per 100,000 populations annually, and complicated forms are three times less common than those in adults. However, recently, the number of acute pancreatitis cases in children has increased, which entails a relatively higher incidence of complicated acute pancreatitis, including parapancreatic acute fluid accumulation, and determines the relevance of this problem for pediatric surgeons.&#x0D; In this study, using two sample observations, parapancreatic pseudocyst puncture under ultrasound and X-ray control was presented, a conductor string was introduced into the cavity of the pseudocyst, and further stenting of this anastomosis was performed with two plastic double-pigtail stents. In the first case, a 12-year-old boy underwent surgery for idiopathic pancreatitis and acute parapancreatic fluid accumulation in the pancreatic tail. In the second case, a 10-year-old girl presented with a parapancreatic pseudocyst, which was caused by drug-induced pancreatitis (a complication of the long-term use of valproic acid, an antiepileptic drug). Both children underwent surgery using this technique. Antisecretory therapy was performed postoperatively. In the catamnesis after 1 year and 6 months, the children had no complaints, and ultrasound and X-ray studies did not reveal any pathology. Endoscopic cystogastrostomy under ultrasound guidance is widely performed in complicated pancreatitis in adults. These observations show its effectiveness in pediatric practice. However, the relatively short observation period of treatment results requires additional research on a much larger number of cases and outcomes of these surgical interventions in children.

A Pilot Study Examining the Use of Ultrasound to Measure Intravascular Volume Status in Agricultural Workers in a Field-Based Research Setting.

The aim of this pilot study was to explore if internal jugular vein (IJV) ultrasound studies on agricultural workers in a field-based research setting could assess volume status during a hydration intervention. We performed pre- and post-work shift IJV ultrasound images on 30 agricultural workers. The IJV collapsibility index values were <39% (euvolemic) or ≥39% (hypovolemic). Of the water group, 13% (2/15) had an IJV collapsibility index ≥39%, and this increased to 19% (3/16) by the end of the work shifts. The electrolyte group did not have any workers start the work shift with an IJV collapsibility index ≥39%; however, at the postshift assessment, 15% (2/13) were hypovolemic. Internal jugular vein ultrasounds may have the potential to be a useful tool to determine volume status in field-based research settings. Further investigation is needed to confirm these findings.

Growth variables and obstetrical risk factors in newborns are associated with psychomotor development at preschool age

Low birthweight resulting from preterm birth or fetal growth restriction is associated with poor neurocognitive development and child psychopathology affecting school performance and educational success. Prediction of developmental performance may therefore serve as a basis for early intervention strategies to improve educational success and mental health of our children in a timely manner. This study aimed to explore the predictive capacity of morphometric variables taken at birth and that of obstetrical risk factors to predict developmental performance at 4.3 (standard deviation, 0.8) years preschool age. We examined predicted Total psychomotor development score, predicted Developmental disability index, calculated Morphometric vitality index, and predicted Intelligence quotient, Maze test, and Neurologic examination optimality score in a large prospective screening (cranial ultrasound screening, n=5,301) and validation cohort (n=508,926). In a single-center cohort observational study design (data collection done from 1984-1988, analysis done in 2022), a prospective cranial ultrasound screening study (1984-1988) was carried out on 5,301 live-born infants, including 571 (10.8%) preterm infants (≤36 weeks gestation), on the day of discharge of the mother at 5 to 8 days postpartum from a level 3 perinatal center. Predicted psychomotor development as assessed by predicted Total psychomotor development score, predicted Developmental disability index, calculated Morphometric vitality index, and predicted Intelligence quotient, Maze test, and Neurologic examination optimality score, was calculated. We related growth variables and obstetrical risk factors to Psychomotor development indices, and calculated Morphometric vitality index using odds ratios, receiver operating characteristics, analysis of variance, and multivariate analysis of variance. The key result of our study is the observation that simple morphometric measures from newborns at birth like weight/head circumference ratio predict overall psychomotor development at 4.3 years (standard deviation, 0.8) of preschool age. Psychomotor development was assessed by predicted Total psychomotor development score, predicted Intelligence quotient, Maze test, and Neurologic examination optimality score, and related to weight/head circumference ratio in linear regression (P<.001) and ROC curve analyses (P<.001). Further, white matter damage strongly predicted adverse outcome in predicted Developmental disability index (P<.001). There was also a close correlation between calculated Morphometric vitality index and predicted Developmental disability index (P<.001). Finally, brain body weight ratio, weight/head circumference ratio, preterm birth, reduced Apgar at 10 minutes, weight/length ratio, and white matter damage yielded highest odds ratios for adverse outcome in predicted Total psychomotor development score and in predicted Developmental disability index (P<.001) and high effect sizes in reduced predicted Intelligence quotient, Maze test, and Neurologic examination optimality scores. Simple morphometric data, birth variables, and obstetrical risk factors bear predictive capacity for neurocognitive performance in children at 4.3 years (standard deviation, 0.8) of age and hence provide a basis for parental consultation and early intervention to improve school performance, educational success, and mental health in developed and developing countries.

Impact of the Emergency Procedure Zone on Emergency Care.

Background: Emergency department (ED) overcrowding is a public health crisis that affects patient care quality. Space management in the ED can affect patient flow dynamics and clinical practice. We proposed a novel design of the "emergency procedure zone" (EPZ). The purpose of the EPZ was to provide an isolated area for clinical practice and procedure teaching, to ensure a secure area with adequate equipment and monitors, and safeguard patient privacy and safety. This study aimed to analyze the impact of the EPZ on procedural practice and patient flow dynamics. Methods: This study was conducted at the ED of a tertiary teaching hospital in Taiwan. Data were collected from 1 March 2019 to 31 August 2020 (pre-EPZ period) and from 1 November 2020 to 30 April 2022 (post-EPZ period). Statistical analyses were performed using IBM SPSS Statistics software. This study focused on the number of procedures and length of stay in the emergency department (LOS-ED). Variables were analyzed using the chi-square test and Mann-Whitney U test. Statistical significance was defined as p < 0.05. Results: There were 137,141 (pre-EPZ period) and 118,386 (post-EPZ period) ED visits recorded during this period. The post-EPZ period showed a significant increase in central venous catheter insertion, chest tube or pigtail placement, arthrocentesis, lumbar puncture, and incision and drainage procedures (p < 0.001). For patients who were directly discharged from the ED, the post-EPZ period also had a higher percentage of ultrasound studies performed in the ED and a shorter LOS-ED for patients who were directly discharged from the ED (p < 0.001). Conclusions: The establishment of an EPZ in the ED has a positive impact on procedural efficiency. The EPZ improved diagnosis and disposition efficiency, shortened the length of stay, and provided benefits such as improved management, patient privacy, and teaching opportunities.

Aortic Isthmus Retrograde Blood Flow in Intrauterine Child as a Sign of the Terminal Stage of Placental Dysfunction: Clinical Observation

Background. Aortic isthmus retrograde blood flow in intrauterine children with growth delay and centralization of blood circulation in the late stages of placental dysfunction is associated with a high risk of perinatal death. Timely diagnosis of such condition is crucial to select further obstetric tactics and delivery time. Clinical case description. Growth delay and absent end-diastolic flow in umbilical artery and no A-wave in the venous duct were diagnosed in intrauterine child (gestational age — 36 weeks) at ultrasound study. Peripheral resistance indices in middle cerebral artery in the intrauterine child were lower than peripheral resistance indices in umbilical artery. Color Doppler imaging has revealed aortic isthmus retrograde blood flow. The woman was recommended delivery due to critical circulatory disorder in the intrauterine child. Female child was delivered via Caesarean section, child’s weight — 890 g, APGAR score — 3/4. The newborn girl died due to multi-organ failure within the first day.Conclusion. Revealing the retrograde blood flow in intrauterine child in the aortic isthmus throughout the entire ventricular diastole is an unfavorable prognostic sign of the terminal stage of cerebral blood flow disturbance associated with placental dysfunction.

AIUM Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Thyroid and Extracranial Head and Neck.

AIUM Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Thyroid and Extracranial Head and Neck.

A prospective ultrasound study of cigarette smoking and uterine leiomyomata incidence and growth

Uterine leiomyomata (fibroids) are common, benign neoplasms that contribute substantially to gynecologic morbidity. Some existing epidemiologic studies indicate that cigarette smoking is associated with lower uterine leiomyomata risk. However, no prospective studies have systematically screened an entire study population for uterine leiomyomata using transvaginal ultrasound or evaluated the association between cigarette smoking and uterine leiomyomata growth. This study aimed to examine the association between cigarette smoking and uterine leiomyomata incidence and growth in a prospective ultrasound study. We enrolled 1693 residents from the Detroit metropolitan area into the Study of Environment, Lifestyle, and Fibroids during 2010 to 2012. Eligible participants were aged 23 to 34 years, had an intact uterus but no previous diagnosis of uterine leiomyomata, and self-identified as Black or African American. We invited participants to complete a baseline visit and 4 follow-up visits over approximately 10 years. At each visit, we used transvaginal ultrasound to assess uterine leiomyomata incidence and growth. Participants provided extensive self-reported data throughout follow-up including exposures to active and passive cigarette smoking in adulthood. We excluded participants who did not return for any follow-up visits (n=76; 4%). We fit Cox proportional hazards regression models to estimate hazard ratios and 95% confidence intervals for the association between time-varying smoking history and incidence rates of uterine leiomyomata. We fit linear mixed models to estimate the percentage difference and 95% confidence intervals for the association between smoking history and uterine leiomyomata growth. We adjusted for sociodemographic, lifestyle, and reproductive factors. We interpreted our results based on magnitude and precision rather than binary significance testing. Among 1252 participants without ultrasound evidence of uterine leiomyomata at baseline, uterine leiomyomata were detected in 394 participants (31%) during follow-up. Current cigarette smoking was associated with a lower uterine leiomyomata incidence rate (hazard ratio, 0.67; 95% confidence interval, 0.49-0.92). Associations were stronger among participants who had smoked for longer durations (≥15 years vs never: hazard ratio, 0.49; 95% confidence interval, 0.25-0.95). The hazard ratio for former smokers was 0.78 (95% confidence interval, 0.50-1.20). Among never smokers, the hazard ratio for current passive smoke exposure was 0.84 (95% confidence interval, 0.65-1.07). Uterine leiomyomata growth was not appreciably associated with current (percent difference,-3%; 95% confidence interval,-13% to 8%) or former (percent difference,-9%; 95% confidence interval,-22% to 6%) smoking. We provide evidence from a prospective ultrasound study that cigarette smoking is associated with lower uterine leiomyomata incidence.

Systematic Review and Meta-Analysis of O-RADS Ultrasound and O-RADS MRI for Risk Assessment of Ovarian and Adnexal Lesions.

BACKGROUND. O-RADS ultrasound (US) and O-RADS MRI have been developed to standardize risk stratification of ovarian and adnexal lesions. OBJECTIVE. The purpose of this study was to perform a meta-analysis evaluating the diagnostic performance of O-RADS US and O-RADS MRI for risk stratification of ovarian and adnexal lesions. EVIDENCE ACQUISITION. We searched the Web of Science, PubMed, Cochrane Library, Embase, and Google Scholar databases from January 1, 2020, until October 31, 2022, for studies reporting on the performance of O-RADS US or O-RADS MRI in the diagnosis of malignancy of ovarian or adnexal lesions. Study quality was assessed with QUADAS-2. A hierarchic summary ROC model was used to estimate pooled sensitivity and specificity. Heterogeneity was assessed with the Q statistic. Metaregression analysis was performed to explore potential sources of heterogeneity. O-RADS US was compared with the International Ovarian Tumor Analysis (IOTA) simple rules and Assessment of Different Neoplasias in the Adnexa (ADNEX) model in studies providing head-to-head comparisons. EVIDENCE SYNTHESIS. Twenty-six studies comprising 9520 patients were included. O-RADS US was evaluated in 15 and O-RADS MRI in 12 studies; both systems were evaluated in one of the studies. Quality assessment revealed that risk of bias or concern about applicability most commonly related to patient selection. Pooled sensitivity and specificity of O-RADS US were 95% (95% CI, 91-97%) and 82% (95% CI, 76-87%) and of O-RADS MRI were 95% (95% CI, 92-97%) and 90% (95% CI, 84-94%). Analysis with the Q statistic revealed significant heterogeneity among studies of O-RADS US in both sensitivity and specificity (both p < .001) and among studies of O-RADS MRI in specificity (p < .001) but not sensitivity (p = .07). In metaregression, no factor was significantly associated with sensitivity or specificity of either system (all p > .05). O-RADS US showed no significant difference in sensitivity or specificity versus IOTA simple rules in four studies (sensitivity, 96% vs 93%; specificity, 76% vs 82%) or versus the ADNEX model in three studies (sensitivity, 96% vs 96%; specificity, 79% vs 78%). CONCLUSION. O-RADS US and O-RADS MRI both have high sensitivity for ovarian or adnexal malignancy. O-RADS MRI, but not O-RADS US, also has high specificity. CLINICAL IMPACT. Awareness of the diagnostic performance results regarding O-RADS US and O-RADS MRI will be helpful as these systems are increasingly implemented into clinical practice.

Swallowing Problems in Spinal Muscular Atrophy Types 2 and 3: A Clinical, Videofluoroscopic and Ultrasound Study.

Spinal muscular atrophy (SMA) is a hereditary motor neuron disorder, characterized by the degeneration of motor neurons and progressive muscle weakness. There is a large variability of disease severity, reflected by the classification of SMA types 1-4. The aim of this cross-sectional study was to determine the nature of swallowing problems and underlying mechanisms in patients with SMA types 2 and 3, and the relationship between swallowing and mastication problems. We enrolled patients (aged 13-67 years) with self-reported swallowing and/or mastication problems. We used a questionnaire, the functional oral intake scale, clinical tests (dysphagia limit, and timed test swallowing, the test of mastication and swallowing solids), a videofluoroscopic swallowing study (VFSS), and muscle ultrasound of the bulbar muscles (i.e. digastric, geniohyoid and tongue muscles). Non-ambulant patients (n = 24) had a reduced dysphagia limit (median 13 ml (3-45), and a swallowing rate at the limit of normal (median 10 ml/sec (range 4-25 ml). VFSS revealed piecemeal deglutition and hypo-pharyngeal residue. We found pharyngo-oral regurgitation in fourteen patients (58%), i.e. they transported the residue from the hypopharynx back into the oral cavity and re-swallowed it. Six patients (25%) demonstrated impaired swallowing safety (i.e. PAS >3). Muscle ultrasound revealed an abnormal muscle structure of the submental and tongue muscles. Ambulant patients (n = 3), had a normal dysphagia limit and swallowing rate, but VFSS showed hypo-pharyngeal residue, and muscle ultrasound demonstrated an abnormal echogenicity of the tongue. Swallowing problems were associated with mastication problems (p = 0.001).

Pre and postnatal care characteristics and management features of children born with myelomeningocele in the post-folate fortification era of staple foods in Costa Rica (2004-2022).

To describe the clinical characteristics of pre- and postnatal care of children born with myelomeningocele in Costa Rica from 2004 to 2022 after the introduction of mandatory fortification of four major staple foods, describing the clinical features of this cohort including the size of the meningomyelocele, neurological level, presence of symptomatic Chiari II at birth, kyphosis, and the severity of hydrocephalus requiring cerebrospinal fluid (CSF) shunting. These results were compared against the pre-fortification historical data to determine favorable outcomes from this health policy. We performed a retrospective review of the clinical records of patients with myelomeningocele at the spina bifida clinic from the National Children's Hospital of Costa Rica who were born between 2004 and 2022, a period when staple food fortification was implemented in the country for four food staples (wheat and corn flour, rice, and dairy products). Pre and postnatal care data pertaining to the number of obstetric ultrasound studies, the trimester in which they were performed, the detection of myelomeningocele and associated hydrocephalus, gestational age and route of delivery, neurological level, myelomeningocele defect size, associated kyphosis and symptomatic Chiari II malformation at birth, time periods of myelomeningocele repair, and CSF shunting were examined. A descriptive comparative frequency analysis between myelomeningocele (MMC) defect size, CSF shunt insertion, symptomatic Chiari II, and kyphosis between the different functional levels was performed with the estimation of the Fisher's exact chi-square test by contingency tables, and 0.05 was set as significance level. Additionally, the postnatal features of this cohort were compared against pre-fortification historical data obtained from 100 live-born patients between 1995 and 1996. A total of 215 patients that were live born between 2004 and 2022 were eligible for analysis with a follow up ranging from 1 to 19years (median follow up: 7.9years). Among 99.1% of the mothers of patients who had prenatal consultations, 95.8% had an average of 3.8 obstetric ultrasound studies which led to a 59% prenatal detection rate of myelomeningocele. The pre and post fortification features showed a male/female ratio that changed from 0.92 to 1.25 respectively. Among these newborns, there was an increase from 54 to 64% cesarean sections as method for delivery. Only 26% of the pre fortification patients had the MMC defect repaired in the first 24h, 32% from 24 to 72h, 20% from 72h to 1week, and 22% later than 10days respectively which deeply contrasted with the post fortification cohort where 7.5% had the MMC defect repaired in less than 8h, 12.2% from 8 to 12h, 66.5% 12-24h, and 12.7% from 24 to 48h and 1% later than 48h, respectively (P < 0.01). Regarding the post fortification myelomeningocele anatomic and functional characteristics, defect size was measured as less than 3cm in 7% of cases, 3 to 5cm in 50% of cases, 5 to 7cm in 42% of cases, and greater than 7cm in 1% of cases. Thirteen percent of the cases had paraplegia due to a thoracic level, 10% had a high lumbar level, 58% had a middle lumbar level, 13% a lower lumbar level, and 6% only sacral compromise. When the data from the pre and post fortification cohorts were adjusted and compared, there was a reduction from thoracic/high lumbar cases from 26 to 23% (P < 0.56), with an increase of middle lumbar cases from 43 to 58% and a reduction from 25 to 13% of low lumbar cases (P < 0.01) while there was no change in the 6% percentage of sacral cases respectively. Lesions that were considered too extensive or larger than 7cm decreased from 7 to 1% while associated kyphotic deformities decreased from 6 to 1.4% (P < 0.01); symptomatic Chiari II malformation at birth also decreased from 7 to 2% in the pre- and post-fortification cohorts respectively with all these changes being statistically significant (P < 0.01). Seventy-nine percent and 80% of the pre and post FAF cohorts required CSF VP shunting with a mean time for insertion of 10days after spinal defect closure with no significant statistical change between the two groups. This study describes a four-staple folate fortified population of live-born patients with myelomeningocele lesions whose neurological level, defect size, and associated deformities such as spinal kyphosis and symptomatic Chiari II at birth suggest that folate fortification could have diminished the severity of this congenital disease.