Erector spinae plane block spread patterns and its analgesic effects after computed tomography-guided hepatic tumour ablation: a randomized double-blind trial

INTRODUCTION

Spread patterns of the erector spinae plane block (ESPB) in a larger cohort of living subjects remain inadequately understood. This study investigated the spread of local anaesthetics or saline with contrast in patients undergoing computed tomography-guided radiofrequency ablation of hepatic tumours.

PATIENTS AND METHODS

Thirty patients participated in a double-blinded randomized controlled trial, 14 April 2021 and 18 January 2023. These patients were randomized into two groups: the ESPB group, which received local anaesthetic with contrast, and the sham group, which received saline with contrast. The spread of the drug was assessed regarding vertebral levels and its correlation with the patient characteristics. Pain intensity and morphine consumption were also evaluated.

RESULTS

The ESPB consistently spread cranio-caudally to the dorsal erector spinae muscle in all patients, with a median (IQR) spread of 9 (8-11) vertebral levels, and to the intercostal space with a median (IQR) spread of 4 (3-6) vertebral levels. Paravertebral spread occurred in 90% of patients (27 out of 30) with a median (IQR) spread of 3 (2-5) vertebral levels, while epidural spread was observed in 36.7% of patients (11 out of 30) with a median (IQR) spread of 0 (0-2) vertebral levels. Cranio-caudal spread negatively correlated with back muscle thickness (r= -0.4; p = 0.035), and females exhibited significantly more intercostal spread levels than males (5.8 ± 1.0 vs. 4.3 ± 1.6 levels in females and males, respectively; p = 0.021). However, no significant difference was found in pain intensity and morphine consumption between the two study groups.

CONCLUSION

This study provides insights into the drug spread patterns of ESPB in living subjects. However, a unilateral ESPB did not yield sufficient analgesic effects for radiofrequency ablation of hepatic tumours.

Effect of local radiofrequency hyperthermia on the intratumoral pressure and extracellular matrix stiffness in hepatocellular carcinoma

BACKGROUND

Increased intratumoral pressure and stiffening of the extracellular matrix are biophysical barriers to effective drug delivery in hepatocellular carcinoma (HCC). Local thermal interventions alter these biophysical characteristics of the tumor.

PURPOSE

To characterize time-dependent and thermal dose-related effects of radiofrequency hyperthermic (RFHT) interventions on intratumoral pressure and tumor stiffness.

METHODS

Two treatment protocols (high input power > 1 W and low input power < 1 W) were investigated using a computational modeling approach and a syngeneic rat HCC tumor model with a customized monopolar RFHT system. Intratumoral pressure and stiffness were assessed using piezo-electric sensors and ultrasound shear wave elastography (SWE), respectively, across three groups (untreated tumors, tumors treated with high and low RFHT) and time points (immediately after treatment, at 24 h, and 48 h).

RESULTS

The developed RFHT system maintained electrode-tip temperatures of 74.1 ± 5.2 °C (high RFHT) and 45.9 ± 1.6 °C (low RFHT) for 15 min. Histological analysis confirmed larger necrotic areas in the high RFHT group compared with low RFHT (p < 0.01) and control groups (p < 0.001). The initial intratumoral hypertension significantly decreased in both treated groups at 24 h and 48 h (p < 0.01 high RFHT, p < 0.05 low RFHT). Tumor stiffness significantly decreased (p < 0.05) only in the low RFHT group at the end of treatment. This change was spatially-dependent within the tumor and a recovery toward initial conditions was observed at 48 h (p < 0.01).

CONCLUSIONS

Local RFHT induces time- and heating profile-dependent alterations in intratumoral pressure and stiffness in a rat model of HCC, suggesting that RFHT interventions may modulate tumor biophysics and influence drug delivery.

Oxidative stress and inflammation in hemodialysis: a comparison of patients with or without advanced nonalcoholic fatty liver disease (NAFLD)

Nonalcoholic fatty liver disease (NAFLD) and chronic kidney disease are global public health issues associated with high morbidity and mortality. Both diseases are also interlinked. Little is known about the meaning of NAFLD in hemodialysis (HD) patients. Therefore, the aim of our study was to investigate the difference in oxidative stress and inflammation in HD patients with or without advanced NAFLD. Seventy-seven HD patients were included (65.14 ± 12.34 years, 59.2% male) and divided according to abdominal ultrasound and two-dimensional shear wave elastography (2D-SWE) measurements into two groups: 1) no NAFLD or no advanced NAFLD (2D-SWE <9 kPa) and 2) advanced NAFLD (2D-SWE ≥9 kPa). Medical history data and blood results were collected. HD patients with advanced NAFLD had significantly higher levels of 8-hydroxy-2'-deoxyguanosine (8-OHdG; p = 0.025), tumor necrosis factor-alpha (TNF-α; p = 0.023), and intercellular adhesion molecule 1 (ICAM-1; p = 0.015) in comparison to HD patients without advanced NAFLD. Interleukin 6 (IL-6) was higher in the advanced NAFLD group, but the difference was of borderline significance (p = 0.054). There was no significant difference in high-sensitivity C-reactive protein (hs-CRP), and vascular cell adhesion molecule 1 (VCAM-1) between groups. In binary logistic regression analysis, advanced NAFLD was significantly associated with 8-OHdG and ICAM-1. In conclusion, higher oxidative stress and inflammation levels are present in HD patients with advanced NAFLD.

Evaluation of Controlled Attenuation Parameter as a Tool for Assessment of Hepatic Steatosis in Living Liver Donors

Background

Currently, there is an absence of a standardised protocol for the preoperative detection of hepatic steatosis (HS) in living liver donors. A steatotic liver graft jeopardises the outcome of the recipient with multiple potential complications. Vibration-controlled transient elastography (Fibroscan®) provides a controlled attenuation parameter (CAP), which we have utilised in our assessment of HS in living liver donors. This approach offers a promising avenue for the advancement of preoperative evaluation protocols.

Methods

In the period spanning from October 2022 to July 2024, a cohort of 67 liver donors were subjected to preoperative vibration-controlled transient elastography (Fibroscan®) and either preoperative or intraoperative liver biopsy. HS was defined as a fat content exceeding 10%. CAP readings were juxtaposed with liver biopsy results for the diagnosis of HS. Donors were categorised into three categories with HS <5%, 5-10% and those with HS >10% were rejected as per our institutional protocol. This facilitated a comprehensive evaluation of HS in the context of living donor liver transplantation.

Results

CAP was very accurate in detecting HS, with an area under the receiver operating characteristic curve of 0.99 (P < 0.05). Statistical analysis determined that a CAP cutoff value of 266 dB/m provides a sensitivity of 100% and a specificity of 98.4% for predicting HS >10%. Corresponding positive predictive value (PPV) is 85.71%, while the negative predictive value is 100%. Univariate analysis determined body mass index (BMI), age and serum triglyceride levels were associated with CAP; however, multivariate linear regression revealed an association with only BMI (P < 0.001) and age (P < 0.002). When a lower fat threshold of 5% was considered to define HS with the same cut off of CAP, the sensitivity reduced to 66.7% and specificity was 98.3% The recipients of donors with HS of 5%-10% did not show any negative outcomes.

Conclusion

CAP demonstrates significant potential as a predictive tool for hepatic steatosis (HS) in living liver donors. Notably, BMI and age have been identified as independent factors associated with CAP values.

Phenotypical Characterization of Gastroenterological and Metabolic Manifestations in Patients With Williams-Beuren Syndrome

Gastrointestinal (GI) symptoms are common in patients with Williams-Beuren syndrome (WBS), but their prevalence and possible causes are not yet fully known. This study assessed GI symptoms' prevalence and their possible origin by performing a predefined set of tests in adult WBS patients. Laboratory tests and a questionnaire were administered to assess GI symptoms and dietary habits. All the patients underwent the urea breath test, H2-lactose and H2-glucose breath tests, and intestinal ultrasound (IUS) and vibration-controlled transient elastography for liver stiffness measurement (LSM) and controlled attenuation parameter (CAP, dB/m). Thirty-one patients were enrolled (72% of the whole cohort, 17 males, median age 32 years). Gastroesophageal reflux disease (GERD) symptoms were reported in 29% of the patients, abdominal pain in 26%, and altered bowel habits in 48%. Pathologic signs at (IUS) were present in 60% of the cases. Prevalence was 0.26 (95% CI 0.12-0.44) for Helicobacter pylori infection and 0.61 (95% CI 0.42-0.78) for lactose intolerance. LSM was > 6 kPa (in the range of a fibrosis score > F1) in three patients, and CAP values were > 268 dB/m (corresponding to a steatosis score > S2, e.g., moderate steatosis) in nine. The presence of altered bowel habits was significantly related to chronic abdominal pain (OR 13.1, p = 0.03). Increased BMI (> 28 kg/m2) (OR 10.8, p = 0.04) was associated with the presence of moderate-severe hepatic steatosis. After specific treatment and dietary counseling, most patients reported resolution/improvement of symptoms, whereas a few retained/developed symptoms during follow-up. Chronic abdominal pain, GERD symptoms, and unbalanced metabolic parameters were common in our WBS patients, together with an increased prevalence of lactose intolerance/colonic diverticula. Specific counseling and treatment improved symptoms for most patients.

Reliability of shear wave elastography for cervical and lumbar fascia stiffness and thickness in healthy and chronic neck and low back pain subjects

PURPOSE

This study had two primary aims: first, to assess the reliability of shear wave elastography (SWE) in measuring the stiffness of the posterior cervical fascia, the posterior layer of the lumbar fascia, and fascia thickness; and second, to compare these fascial properties between healthy individuals and patients with chronic neck and low back pain (LBP).

METHODS

Thirty participants, including 15 with concurrent neck and LBP and 15 healthy controls, were enrolled. The stiffness and thickness of the fascia, as well as the ratio of fascia stiffness to subcutaneous fat stiffness, were measured in the lumbar and cervical regions. Measurements were performed twice by a single examiner over 1-3 days. Reliability was assessed using the Intraclass Correlation Coefficient (ICC), Standard Error of Measurement (SEM), Minimal Detectable Change (MDC), and Bland-Altman plots. Independent t-tests were conducted to compare group differences.

RESULTS

Test-retest reliability for the stiffness of the fascia in the cervical and lumbar regions was excellent, with ICC(3,1) values ≥ 0.90. Fascia thickness and the ratio showed good to excellent reliability (ICC(3,1) ≥ 0.80). The SEM, MDC, and limits of agreement supported these findings. Patients with neck and LBP had significantly thicker lumbar fascia than healthy controls (p = 0.002), while no significant differences were found in stiffness between the groups.

CONCLUSION

This study confirms the reliability of SWE in assessing fascia properties. While the lumbar fascia was thicker in patients with neck and low back pain, no significant differences in stiffness were observed between the groups.

Pediatric gonadal torsion in radiology: A comprehensive literature and pictorial review using surgically proven cases

Pediatric gonadal torsion is a critical surgical emergency requiring immediate diagnosis and intervention to preserve reproductive capabilities. This review addresses the diagnostic challenges, imaging patterns, and management strategies for both ovarian and testicular torsion, including a brief discussion on the emerging role of Contrast-Enhanced Ultrasound (CEUS), therefore filling a significant gap in the literature. We emphasize the need for a high index of suspicion due to often nonspecific clinical presentations, particularly in ovarian torsion. An accurate and swift diagnosis allows conservative surgical intervention to be offered, which is crucial to maximize gonadal salvage and minimize recurrence. While we highlight CEUS's potential benefits in enhancing diagnostic clarity without ionizing radiation, ultrasound and other modalities such as MRI and CT, have a paramount role in this setting. Future research comparing CEUS with MRI is essential to validate its diagnostic accuracy and effectiveness, potentially revolutionizing acute care diagnostics. Incorporating CEUS into diagnostic workflows, along with a deep understanding of the condition's epidemiology, pathophysiology, and clinical presentation, may probably significantly improve patient outcomes. We detail the characteristic imaging features, diagnostic pitfalls, and differential diagnoses essential for radiologists, with particular relevance for residents and those with limited pediatric radiology exposure. This review aims to bridge existing knowledge gaps and serve as a robust educational tool, facilitating better clinical decision-making and outcomes in pediatric gonadal torsion cases.

Metabolic dysfunction-associated steatotic liver disease, insulin sensitivity and continuous glucose monitoring metrics in patients with type 1 diabetes: A multi-centre cross-sectional study

BACKGROUND AND AIM

We assessed the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) and significant liver fibrosis in adults with type 1 diabetes mellitus (T1DM) and the association of MASLD with insulin sensitivity and continuous glucose monitoring metrics.

METHODS

We consecutively enrolled 198 adults with T1DM undergoing vibration-controlled transient elastography with liver stiffness measurement (LSM) and controlled attenuation parameter (CAP). All participants had a continuous glucose monitoring (CGM) device. Insulin sensitivity was evaluated by estimated glucose disposal rate (eGDR). MASLD was defined as CAP ≥ 248 db/m and the presence of at least one cardiometabolic risk factor. Significant liver fibrosis was defined as LSM ≥ 7 kPa.

RESULTS

Patients had a mean age of 56 years, mean BMI of 26.0 ± 5.9 kg/m2, and mean eGDR of 7.1 ± 2.3 mg/kg/min. 73 (37%) patients had MASLD (using a CAP threshold of 274 dB/m), 16 (8.1%) of whom had significant liver fibrosis. MASLD was associated with a significantly lower eGDR (beta coefficient = -0.367, 95% confidence interval -0.472 to -0.261; p < 0.001). This association remained significant, even after adjustment for age, sex, body mass index, plasma triglycerides, diabetes duration, daily insulin dose, time above the range of glucose levels, LSM and chronic kidney disease. No association was observed between MASLD and CGM-derived metrics. These results were not different when we used a CAP threshold of 274 dB/m for diagnosing MASLD.

CONCLUSION

In T1DM, MASLD was inversely associated with eGDR and biomarkers of insulin resistance but not with CGM-derived metrics.

Liver Fat Quantification With Ultrasound: The Influence of the Size of the Region of Interest on Attenuation Coefficient

ABSTRACT

Noninvasive assessment of liver fat content is crucial due to the high global prevalence of nonalcoholic fatty liver disease. Algorithms based on ultrasound (US) attenuation coefficient (AC) for estimating liver fat content are commercially available, but a lack of consensus exists regarding the best estimation protocol. The aim of our study was to evaluate the influence of the size of the region of interest (ROI) on the US AC.A prospective study was conducted. An abdominal US was done for 86 outpatients. A sampling box was positioned within the liver parenchyma, approximately 2 cm beneath the liver capsule with a ROI, measuring about 2 × 4 cm and then 4 × 5 cm, precisely placed at the center of this sampling box. Five readings of the AC were captured, and the average of these measurements was employed to assess the severity of hepatic steatosisA statistically significant difference between AC with 2 different ROI sizes was shown (P < 0.001) with AC values with 2 × 4 cm ROI were higher than those obtained with 4 × 5 cm ROI (AC mean 0.668 VS 0.653). However, the agreement between AC values obtained with 2 different ROI sizes was excellent (correlation coefficient 0.941)An ROI size dependence is observed in the measurement of AC in the liver. A standardized acquisition protocol with a fixed size of the ROI needs to be developed to minimize differences in AC measurements and to assess changes in serial measurements reliably.

Contrast-enhanced ultrasound for differentiation of gallbladder sludge from polyp: A case report demonstrating clinical utility

Gallbladder lesion characterization remains a common diagnostic dilemma in abdominal imaging, particularly when differentiating between polyps and organized sludge. Findings on conventional gray-scale ultrasound may be equivocal, especially when typical imaging features such as mobility are absent. We present a case of a 65-year-old patient who presented with a concerning nonmobile 3.7 cm gallbladder lesion on initial ultrasound assessment. Due to the superior sensitivity of contrast-enhanced ultrasound (CEUS) for blood flow compared to other imaging modalities, CEUS was able to demonstrate complete absence of enhancement within the lesion, consistent with tumefactive sludge rather than solid tissue, and averting the need for additional cross-sectional imaging. Surgical pathology following cholecystectomy confirmed these findings. This case highlights the utility of CEUS as a valuable tool in gallbladder imaging, potentially reducing healthcare costs and expediting appropriate patient care while avoiding the risks associated with other contrast-enhanced imaging modalities.

Technical feasibility of EUS-guided liver abscess drainage for the right hepatic lobe using a novel metal stent as first-line treatment (with video)

BACKGROUND AND AIMS

Although EUS-guided liver abscess drainage (EUS-LAD) has been developed, only the left hepatic or caudate lobe can traditionally be drained by EUS. However, there is no evidence for the technical feasibility of EUS-LAD for the right hepatic lobe. In this retrospective study, the technical feasibility of EUS-LAD using a novel partially covered self-expandable metal stent (PCSEMS) with an antimigration system was evaluated as a first-line drainage technique for right hepatic lobe abscesses.

METHODS

This study included consecutive patients with right lobe liver abscesses between December 2020 and February 2024. The primary outcome in this study was the technical success rate of EUS-LAD. Technical success of EUS-LAD was defined as successful stent deployment from the liver abscess to the duodenum. Clinical success, procedure time, duration of hospital stay, recurrence of liver abscess, and adverse events were evaluated as secondary outcomes.

RESULTS

Nineteen patients were enrolled in this study. The location of the liver abscesses was mainly at segment 6. The mean size of the liver abscesses was 91.8 mm. The liver abscess could be identified under EUS guidance from the duodenum in 16 patients. Puncture using a 19-gauge needle was attempted, but the needle could not reach the liver abscess in 1 patient. The novel PCSEMS was successfully deployed in all patients. The technical success rate of EUS-LAD was 78.9% (15/19). Adverse events associated with the procedure were observed in 3 patients, but conservative treatment was successful. Clinical success was obtained in 14 patients (93.3%). The median duration of stent placement was 19 days (range, 7-41). The median follow-up period was 556 days, and recurrence of liver abscess was not observed in any patients.

CONCLUSIONS

EUS-LAD for the right liver lobe using a novel PCSEMS can be feasible and safe.

Deficiency of β-arrestin2 ameliorates MASLD in mice by promoting the activation of TAK1/AMPK signaling

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a liver manifestation of metabolic syndrome characterized by excessive hepatic lipid accumulation and lipid metabolism disorders. It has become the most common chronic liver disease worldwide. β-arrestin2 is a multifunctional scaffold protein that is among the most important regulatory molecules, and it exerts key roles in regulating various cellular processes, such as immune response, cellular collagen production, and inflammation. In the current study, we aimed to explore the function of β-arrestin2 in the development and progression of MASLD. Firstly, we observed that the expression of β-arrestin2 was upregulated in liver samples from patients with MASLD. Then, the western diet (WD) combined with CCl4 injection-induced MASLD was established in wild-type mice, and showed that liver β-arrestin2 expression was also gradually increased, and positively correlated with the degree of lipid metabolism disorder during MASLD progression. Ulteriorly, β-arrestin2 knockout (Arrb2 KO) mice were utilized to induce the MASLD model and found that β-arrestin2 deficiency significantly ameliorated lipid accumulation and inflammatory response in the liver of MASLD mice. Furthermore, the in vitro depletion and overexpression experiments showed that increased β-arrestin2 aggravated lipid accumulation via inhibiting the activation of the TAK1/AMPK pathway, which may be mediated by competitively binding to TAB1 with TAK1. These findings suggest that β-arrestin2 is essential to regulate intrahepatic lipid metabolism. Here, we provide a novel insight in understanding of the expression and function of β-arrestin2 in MASLD, demonstrating that it may be a potential therapeutic target for MASLD treatment.

Increased Hepatorenal Index Is Associated with the Risk of Developing Stroke in Patients with Nonalcoholic Fatty Liver Disease

OBJECTIVE

The aim of this study was to examine the relationship between the sonographic hepatorenal index and stroke risk in patients with nonalcoholic fatty liver disease (NAFLD).

METHODS

From December 2023 to July 2024, 72 NAFLD patients with stroke, 53 stroke-free NAFLD patients, and 54 healthy controls were enrolled in our study. The hepatorenal index was calculated as the ratio of the echo intensity of the liver to that of the renal cortex. The mean brightness values for one region of interest within the right hepatic lobe and the other size-matched region at the same depth of field within the right kidney were obtained with two-dimensional ultrasound and a 1- to 6-MHz convex array probe. Laboratory tests were performed with a Cobas 8000 automatic biochemical analyzer. Univariate and multivariate analyses were adopted to analyze the risk factors for stroke in NAFLD patients.

RESULTS

NAFLD patients had a greater hepatorenal index than healthy controls did (P < 0.05). Additionally, NAFLD patients with stroke had an even greater hepatorenal index than did those with stroke-free NAFLD (P < 0.001). Multivariate regression analysis further revealed that the hepatorenal index was independently associated with stroke risk in NAFLD patients (β = 8.897, P < 0.001) after controlling for age, body mass index, systolic blood pressure, and serum glucose, total cholesterol, alanine transaminase, and creatinine concentrations. Receiver operating characteristic curve analysis revealed a sensitivity of 62.5% and specificity of 95.3% for the hepatorenal index, with a cutoff value of 1.255 and an area under the curve of 0.80.

CONCLUSION

The increased sonographic hepatorenal index could be an independent predictor of stroke development in patients with NAFLD.

Twin Peak Method for Estimating Tissue Viscoelasticity Using Shear Wave Elastography

Tissue viscoelasticity is becoming an increasingly useful biomarker beyond elasticity and can theoretically be estimated using shear wave elastography by inverting the propagation and attenuation characteristics of shear waves. Estimating viscosity is often more difficult than elasticity because attenuation, the main effect of viscosity, leads to poor signal-to-noise ratio of the shear wave motion. In the present work, we provide an alternative to existing methods of viscoelasticity estimation, based on peaks in the frequency-wavenumber (f-k) domain, which are considered more robust against noise compared with other features in the f-k domain. Specifically, the method minimizes the difference between simulated and measured versions of two sets of peaks (twin peaks) in the f-k domain, obtained first by traversing through each frequency and then by traversing through each wavenumber. The slopes and deviation of the twin peaks are sensitive to elasticity and viscosity, respectively, leading to the effectiveness of the proposed inversion algorithm for characterizing mechanical properties. This expected effectiveness is confirmed through in silico verification, followed by ex vivo validation and in vivo application, indicating that the proposed approach can be used effectively in accurately estimating viscoelasticity, thus potentially contributing to the development of enhanced biomarkers.

Association of cardiometabolic markers with hepatic steatosis and liver fibrosis in population without obesity and diabetes

The link between cardiometabolic markers and hepatic steatosis and liver fibrosis in non-hypertensive, non-diabetic populations remains unclear. A study was conducted using data from the National Health and Nutrition Examination Survey. Hepatic steatosis and liver fibrosis were assessed using vibration-controlled transient elastography. Logistic regression and restricted cubic splines (RCS) were used to evaluate the associations of cardiometabolic index (CMI), atherogenic index of plasma (AIP), triglyceride-glucose index (TyG), and estimated glucose disposal rate (eGDR) on hepatic steatosis and estimated fibrosis. Mediation analysis examined the role of insulin resistance (HOMA-IR) and liver enzymes. Among 1489 participants, 39.15% had hepatic steatosis and 2.82% had liver fibrosis. Higher CMI (OR = 3.967, 95%CI: 2.297, 6.851), AIP (OR = 3.255, 95%CI: 2.031, 5.216), TyG (OR = 3.689, 95%CI: 2.363, 5.760), and FLI (OR = 2.695, 95%CI: 1.997, 7.816) tertiles of Q3 were linked to increased hepatic steatosis odds, while eGDR reduced odds (OR = 0.217, 95%CI: 0.127, 0.373). The AUC values of these four cardiac markers were greater than FLI, among which eGDR showed the highest predictive value (AUC = 0.781). In the hepatic steatosis population, CMI (OR = 1.419, 95%CI: 1.033, 2.747), AIP (OR = 5.527, 95%CI: 1.082, 28.242), and TyG (OR = 2.345, 95%CI: 1.180, 4.661) were also showed significant association with liver fibrosis, while eGDR and FIB-4 were not associated with liver fibrosis. AIP had the highest discriminative ability for liver fibrosis (AUC = 0.798). Mediation analysis showed HOMA-IR mediated 25.50%~36.20% of cardiometabolic markers' associations with hepatic steatosis, followed by liver enzymes. Cardiometabolic markers are strongly linked to hepatic steatosis and liver fibrosis in populations without traditional risk factors, even outperforming the established hepatic steatosis and the fibrosis marker, highlighting their potential for early liver disease risk identification in seemingly healthy individuals.

Steatotic liver disease is a marker of multimorbidity, not underlying cirrhosis, in older adults

Steatotic liver disease (SLD) prevalence in adults is estimated at 30%, but older populations are understudied. Here, SLD prevalence and associated risk factors were assessed 1,021 Whitehall II study participants (mean age 72.5) using transient elastography (FibroScan). SLD was present in 33.3% (CAP ≥ 275 dB/m), with most classified as metabolic dysfunction-associated SLD. Only 2.4% had significant fibrosis ( ≥ 7.9 kPa). Adjusted for age and sex, SLD was associated with low physical activity (OR 1.60, 95% CI 1.13-2.27), poorer motor function (SF-36 PCS OR 1.21, 95% CI 1.05-1.40), difficulties in activities of daily living (OR 3.19, 95% CI 1.17-8.64), and multimorbidity (OR 1.45, 95% CI 1.22-1.73). These associations persisted after adjustment for socioeconomic, behavioural, and cardiometabolic risk factors. Frailty was associated with SLD at higher CAP thresholds ( ≥ 290 dB/m). In this older adult sample, SLD is common and appears more as a marker of multimorbidity and low physical activity than significant fibrosis.

Simultaneous measurement of tensile and shear elasticity and anisotropy in human skeletal muscle tissue using steered ultrasound shear waves

Load-bearing skeletal muscle tissues are reinforced by intricate networks of protein fibers aligned in preferential orientations, imparting direction-dependent mechanical properties (anisotropy). Characterizing this anisotropy in vivo is essential for understanding both normal and pathological muscle function, as well as structural integrity. However, current noninvasive techniques are limited in their ability to accurately measure the mechanical properties of anisotropic tissues such as skeletal muscle. Here, we used an innovative angle-resolved ultrasound elastography method, recently developed by our team, to simultaneously quantify tensile and shear elasticity and anisotropy, enabling comprehensive assessment of muscle biomechanics. We fully characterized the mechanical properties of the biceps brachii in fourteen healthy young adults under passive and active axial loadings, revealing distinct shear and tensile mechanical behaviors both along and across muscle fibers. Notably, tensile and shear moduli along the main fiber orientation were found to be uncoupled, while cross-muscle fiber measurements exhibited a consistent modulus ratio of 3.4 ± 0.2, regardless of axial loading conditions or intensities. These findings highlight the anisotropic nature of skeletal muscle and provide valuable insights into its in vivo mechanical behavior. Both shear and tensile anisotropy increased with muscle axial physiological loading, indicating that our method is sensitive to changes in anisotropic tissue mechanics. Lastly, we demonstrated that angle-resolved ultrasound shear wave elastography provides direct estimates of shear and tensile properties, offering significant promise for clinical applications, including neuromuscular disease diagnostics and monitoring, biomechanical modeling for predicting tissue responses to loading and therapies, and tissue engineering. STATEMENT OF SIGNIFICANCE: : Conventional ultrasound shear wave elastography techniques overlook the anisotropy of skeletal muscles, leading to incomplete tissue mechanical characterization. In this study, we leveraged an innovative angle-resolved elastography method to assess tensile and shear elasticity, along with their anisotropic factors, of human muscle in vivo. For the first time, we reveal the intricate relationships between tensile and shear elasticities during active and passive physiological loading. This technique enhances our understanding of muscle mechanics and has promising clinical implications for muscle health and neuromuscular disease management, where tissue structural and mechanical properties are often altered. Additionally, it could help in developing constitutive models for muscle tissue and contribute to the design of tissue-engineered materials.

Characterization of gut dysbiosis and intestinal barrier dysfunction in patients with metabolic dysfunction-associated steatotic liver disease and chronic kidney disease: a comparative study

The mechanistic role of gut microbiota in metabolic dysfunction-associated steatotic liver disease (MASLD) and chronic kidney disease (CKD) is increasingly recognized. Despite their close association, comparative data regarding gut dysbiosis in these disorders are limited. This study included 22 healthy controls and 180 patients (90 MASLD, 60 CKD, and 30 both diseases with sex- and age-matched). Fecal bacterial 16 S ribosomal RNA sequencing and butyryl-CoA: acetate CoA transferase (BCoAT) gene expression were analyzed. Plasma intestinal fatty acid binding protein (I-FABP), representing intestinal barrier dysfunction, was assessed using the ELISA method. Our data showed that alpha and beta diversities of gut microbiota differed between MASLD and healthy controls. However, only beta diversities were different between CKD and healthy individuals. The MASLD and CKD groups displayed fewer SCFA-producing genera, particularly Bifidobacterium, than healthy controls. Fecal BCoAT levels were inversely correlated with eGFR and I-FABP levels. Patients with CKD had significantly enriched pathogenic bacteria, reduced BCoAT, and increased I-FABP levels versus MASLD. Combining significant bacterial genera discriminated MASLD from CKD with high diagnostic accuracy (AUC of 0.90). Among patients with both diseases, gut microbial alterations showed mixed characteristics of MASLD and CKD. These data highlighted the shared and distinct gut dysbiosis and related biomarkers, which could provide a better understanding of MASLD and CKD pathogenesis.

INCIDENTAL HEPATIC STEATOSIS IDENTIFIED ON ULTRASOUND IN PATIENTS UNDERGOING CHOLECYSTECTOMY: HIGH PREVALENCE AND INSUFFICIENT INVESTIGATIVE AND CLINICAL MANAGEMENT

BACKGROUND

Steatotic liver disease (SLD) affects about 1 billion people globally, making its proper management essential to prevent progression to more severe stages.

OBJECTIVE

The aim of this study was to evaluate medical management concerning hepatic steatosis incidentally identified by ultrasound in patients undergoing elective cholecystectomy.

METHODS

This observational, cross-sectional, and retrospective study included patients aged 18 years or older who underwent elective cholecystectomy at Hospital do Trabalhador, in Curitiba/PR, between 2018 and 2022. Patients with external ultrasound reports or incomplete data in their medical records were excluded. Medical records, laboratory tests, and ultrasound reports were analyzed to evaluate the prevalence of steatosis in these patients.

RESULTS

The study sample consisted of 355 patients, and 103 (29.01%) of them presented steatosis on ultrasound. Older age (P=0.0022), male sex (P=0.03009), higher body mass index (P<0.001), obesity (P<0.001), hypertension (P<0.001), dyslipidemia (P=0.0072), and elevated levels of oxaloacetic and pyruvic aminotransferases (P=0.02112) were associated with the presence of this finding. No action was taken regarding the presence of steatosis in 60.19% of patients. Approximately 39.81% had the finding recorded in their medical records, 6.80% received lifestyle change counseling, and 4.85% were investigated for the stage of steatosis.

CONCLUSION

A significant prevalence of hepatic steatosis was incidentally identified in the ultrasound of patients undergoing cholecystectomy. However, the approach to this finding was insufficient, highlighting the need for substantial improvements on its management and investigation.

Prevalence and Predictors of Suspected Metabolic Dysfunction-Associated Steatotic Liver Disease in Adolescents in the United States

BACKGROUND

Nomenclature for steatotic liver disease has been updated to include metabolic dysfunction-associated steatotic liver disease (MASLD), which requires the presence of hepatic steatosis and at least one cardiometabolic risk factor. The prevalence of MASLD in adolescents is understudied.

AIM

To determine the prevalence of suspected MASLD among adolescents in the United States and to examine the relationships between elevated alanine aminotransferase (ALT) and cardiometabolic risk factors.

METHODS

A cross-sectional analysis of the National Health and Nutrition Examination Survey from 2011 to 2020 was conducted for adolescents aged 12-19 years. Elevated ALT was defined using sex-specific biological upper limits: > 26 U/L for males and > 22 U/L for females. Suspected MASLD was identified by elevated ALT and at least one cardiometabolic risk factor. Adolescents with elevated ALT were categorised as having suspected MASLD, elevated ALT due to other causes or cryptogenic ALT elevation.

RESULTS

Overall, 14.6% of adolescents had elevated ALT. Of these, 77.2% had suspected MASLD, 20.2% had cryptogenic ALT elevation, 1.9% took hepatotoxic medications and 0.7% had viral hepatitis. Body mass index had the strongest association with elevated ALT (OR 3.55), followed by high triglycerides (OR 2.09), low HDL cholesterol (OR 2.05) and high blood pressure (OR 1.93).

CONCLUSIONS

Most adolescents with elevated ALT met MASLD criteria, yet a portion lacked cardiometabolic risk factors or other identifiable causes. These results support the adoption of MASLD criteria in adolescents while indicating a need for further research into cryptogenic ALT elevation in paediatric populations.

Quantitative Analysis of Contrast-Enhanced Ultrasound Images of Brain-Dead Donor Livers: Prediction of Early Allograft Dysfunction

OBJECTIVE

To determine the CEUS parameters that predict the likelihood of postoperative EAD.

METHODS

Clinical and imaging data for 75 pairs of donors and recipients collected between September 2022 and July 2023 were retrospectively analyzed. Subjects were divided into those with early allograft dysfunction (EAD) and those without EAD. The liver parenchyma was selected as the region of interest to plot the CEUS time-intensity curve. CEUS parameters were compared between the two groups.

RESULTS

Peak intensity, area under the curve (AUC), and cholinesterase values were significantly lower in the EAD group than in the non-EAD group. The hepatic arterial-portal arrival interval (APAI) and aspartate aminotransferase level were significantly higher in the EAD group. Multivariate logistic analysis identified the APAI to be an independent risk factor for EAD (odds ratio 0.755; 95% confidence interval 0.577-0.989; p = 0.041). Receiver-operating characteristic curve analysis showed that the prediction probability P, which represents a combination of CEUS and clinical data, was best able to predict EAD (AUC 0.802; 95% confidence interval 0.679-0.926; p < 0.0001). Comparison of the AUC for prediction probability P and each single parameter identified statistically significant differences between the predicted probability P and aspartate aminotransferase and cholinesterase values (p = 0.042 and p = 0.020, respectively).

CONCLUSION

A longer APAI can be used as a biomarker to predict EAD after brain-dead donor liver transplantation. CEUS could be a valuable tool for assessment of donor livers and identifying recipients potentially at risk of developing postoperative EAD.

The association between stress hyperglycemia ratio and nonalcoholic fatty liver disease among U.S. adults: A population-based study

BACKGROUND AND AIM

The stress hyperglycemia ratio (SHR) offers a more nuanced understanding of glucose metabolism by factoring in the background glycemia through the component of Hemoglobin A1c. The association of SHR with cardiovascular and cerebrovascular diseases has been established, but the relationship between SHR and the risk of nonalcoholic fatty liver disease (NAFLD) remains unexplored. This study aimed to elucidate the relationship between the two among U.S. adults with diabetes or prediabetes.

METHODS AND RESULTS

A total of 1409 participants diagnosed with diabetes or prediabetes from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 were included in this study. Multiple logistic regression models (ranging from unadjusted to fully adjusted), restricted cubic splines, and subgroup analyses were employed to determine the relationship between SHR and NAFLD risk and to assess the stability of this relationship across different populations. The average age of all participants was 54.65 years, with males accounting for 47.91 %, and the prevalence of NAFLD being 68.77 %. A fully adjusted logistic regression model indicated a positive association between SHR levels and the risk of NAFLD. Specifically, for each one standard deviation increase in SHR, the risk of NAFLD increased by 20 % (OR, 1.2; 95 % CI, 1.0-1.4). Both the trend test and the restricted cubic splines suggested a linear relationship between the two variables (p for trend <0.05, p for nonlinear = 0.390). Subgroup analysis demonstrated that this positive association remained consistent across most subgroups.

CONCLUSIONS

SHR was identified as a valuable index for predicting the risk of NAFLD among U.S. adults with diabetes or prediabetes.

Risk of Incident Type 2 Diabetes and Prediabetes in Patients With Direct Acting Antiviral-Induced Cure of Hepatitis C Virus Infection

BACKGROUND

Data regarding the risk of incident type 2 diabetes (T2D) and prediabetes among patients with hepatitis C virus (HCV) achieving direct-acting antivirals (DAAs)-induced sustained virologic response (SVR12) remains limited.

METHODS

A total of 1079 patients, including 589 with normoglycemia and 490 with prediabetes, who underwent biannual fasting glucose and glycosylated haemoglobin (HbA1c) assessment for a median post-SVR12 follow-up of 5.5 years, were enrolled. We reported the crude (cIRs) and age-standardised incidence rates (ASIRs) of T2D and prediabetes. Factors associated with incident T2D and prediabetes were assessed using the Cox proportional hazards models.

RESULTS

The cIRs of T2D and prediabetes were 1.18 and 8.99 per 100 person-years of follow-up (PYFU), respectively. Additionally, the ASIRs of T2D and prediabetes were 1.09 (95% CI: 0.76-1.53) and 8.47 (95% CI: 7.23-9.90) per 100 PYFU. Prediabetes (adjusted hazard ratio [aHR]: 4.71; 95% confidence interval (CI): 2.55-8.70, p < 0.001), body mass index (BMI) per kg/m2 increase (aHR: 1.17; 95% CI: 1.09-1.26, p < 0.001) and liver stiffness measurement (LSM) per kPa increase (aHR: 1.05; 95% CI: 1.02-1.09, p = 0.001) were associated with a higher risk of incident T2D. Age per year increase (aHR: 1.02; 95% CI: 1.01-1.03, p < 0.001) was associated with a higher risk of incident prediabetes.

CONCLUSION

The incidence rates of T2D and prediabetes remain substantial among patients after HCV eradication. Lifestyle modification, drug therapy and regular monitoring of glycemic status are crucial for patients at risk of developing T2D and prediabetes following HCV clearance.

Perineal body and anal sphincter biometrics and stiffness using elastography during labor: a feasibility study

OBJECTIVES

The study aimed to evaluate the biometrics and stiffness of the perineal body and anal sphincter using 2D-mode ultrasound and shear wave elastography (SWE) during labor and to assess their association with perineal tears.

METHODS

A prospective observational study was conducted on pregnant women. The perineal body (PB), the external anal sphincter (EAS), the internal anal sphincter (IAS) and the anal mucosa (AM) biometrics and stiffness were measured during labor using a transperineal 2D-mode ultrasound and shear wave elastography (SWE), respectively, at rest and during Valsalva maneuvers.

RESULTS

Among the 10 women who underwent a vaginal delivery, 6 (60.0 %) perineal tears occurred. All were first degree perineal tears. Before expulsive efforts, the PB area at rest was statistically higher in women with perineal tears (1.0 ± 0.1 cm2 vs 0.3 ± 0.1 cm2, p < 0.01). The perineal body length, height and area seemed to decrease between the onset of labor and the beginning of expulsive efforts. The PB Youngs' modulus at rest at the onset of labor or before expulsive efforts were 11.9 ± 3.6 kPa and 25.7 ± 18.9 kPa, respectively. The PB elastic modulus at rest and at the onset of labor (11.3 ± 4.1 vs 12.9 ± 2.9 kPa, p = 0.6) or before expulsive efforts (18.0 ± 15.9 vs 37.4 ± 18.6 kPa, p = 0.1) tended to be higher in women with a perineal tear at delivery, but it was not statistically significant.

CONCLUSION

In vivo assessment of both the perineal body and anal sphincter biometrics and stiffness during labor in women is feasible. The perineal body area during labor could be a predictive factor for perineal tears, suggesting a potential link between its stiffness and tear risk.

TRIAL REGISTRATION

The study was registered on https://clinicaltrials.gov (NCT05556304): https://classic.

CLINICALTRIALS

gov/ct2/show/NCT05556304.

Modified triglyceride-glucose indices as novel predictors of metabolic dysfunction-associated fatty liver disease in US adolescents: a nationally representative study from NHANES 2017-2020

BACKGROUND

Metabolic dysfunction-associated fatty liver disease (MAFLD) has become the most prevalent chronic liver condition in adolescents. The triglyceride-glucose (TyG) index, a surrogate marker of insulin resistance, has shown promise in adult MAFLD detection but requires pediatric-specific validation, particularly when combined with anthropometric measures. This study investigated the association between modified TyG indices and MAFLD, and evaluated their predictive value in adolescents.

METHODS

This cross-sectional study analyzed data from 532 adolescents (12-18 years) in the 2017-2020 National Health and Nutrition Examination Survey (NHANES) with complete records. MAFLD diagnosis was based on transient elastography plus metabolic criteria. The investigators employed multivariate linear regression and restricted cubic splines (RCS) to examine linear and nonlinear relationships between modified TyG indices and CAP values. Subgroup analyses were stratified by obesity status, and sensitivity analyses were performed on the NAFLD cohort (n = 527). Receiver operating characteristic (ROC) curve analysis, using Youden's index, evaluated the predictive performance of TyG indices for MAFLD identification.

RESULTS

Among 130 MAFLD adolescents (vs 402 controls), modified TyG indices demonstrated significantly stronger associations with CAP in fully adjusted models compared to the original TyG index. TyG-WC showed the highest diagnostic accuracy (AUC = 0.923, 95%CI:0.900-0.947), followed by TyG-BMI (AUC = 0.917) and TyG-WHtR (AUC = 0.915), while the original TyG index performed poorly (AUC = 0.673). Subgroup analyses revealed particularly strong associations in non-obese participants, and sensitivity analyses confirmed result robustness after excluding potential confounders. Optimal cutoff values provided clinically useful screening thresholds, with TyG-WC achieving 94% sensitivity at 665.94.

CONCLUSION

This study demonstrates that modified TyG indices incorporating anthropometric parameters (particularly TyG-WC) significantly outperform the original TyG index for MAFLD detection in adolescents, with superior diagnostic accuracy (AUC 0.915-0.923). The robust predictive performance maintained in sensitivity analyses and non-obese subgroups supports their clinical utility as simple, non-invasive screening tools for pediatric MAFLD risk stratification.

Enhancing Liver Nodule Visibility and Diagnostic Classification Using Ultrasound Local Attenuation Coefficient Slope Imaging

OBJECTIVE

B-mode ultrasound (US) presents challenges in accurately detecting and distinguishing between benign and malignant liver nodules. This study utilized quantitative US local attenuation coefficient slope (LACS) imaging to address these limitations.

MATERIALS AND METHODS

This is a prospective, cross-sectional study in adult patients with definable solid liver nodules at US conducted from March 2021 to December 2023. The composite reference standard included histopathology when available or magnetic resonance imaging. LACS images were obtained using a phantom-free method. Nodule visibility was assessed by computing the contrast-to-noise ratio (CNR). Classification accuracy for differentiating benign and malignant lesions was assessed with the area under the receiver operating characteristic curve (AUC), along with sensitivity and specificity.

RESULTS

The study enrolled 97 patients (age: 62 y ± 13 [standard deviation]), with 57.0% malignant and 43.0% benign observations (size: 26.3 ± 18.9 mm). LACS images demonstrated higher CNR (12.3 dB) compared to B-mode (p < 0.0001). The AUC for differentiating nodules and liver parenchyma was 0.85 (95% confidence interval [CI]: 0.79-0.90), with higher values for malignant (0.93, CI: 0.88-0.97) than benign nodules (0.76, CI: 0.66-0.87). A LACS threshold of 0.94 dB/cm/MHz provided a sensitivity of 0.83 (CI: 0.74-0.89) and a specificity of 0.82 (CI: 0.73-0.88). LACS mean values were higher (p < 0.0001) in malignant (1.28 ± 0.27 dB/cm/MHz) than benign nodules (0.98 ± 0.19 dB/cm/MHz).

CONCLUSION

LACS imaging improves nodule visibility and provides better differentiation between benign and malignant liver nodules, showing promise as a diagnostic tool.

The external validation of Dallas Steatosis Index among Asian population: a useful tool for metabolic dysfunction-associated steatotic liver disease identification and prevention

BACKGROUND

The Dallas Steatosis Index (DSI) is a non-invasive tool (NIT) developed to detect the risk of metabolic dysfunction-associated steatotic liver disease (MASLD) in multi-ethnic populations, external validation in Asians has yet to be conducted. Therefore, we evaluated the ability of the DSI with the BMI classification of WPRO (DSI_WPRO) to identify MASLD in the Chinese population. In addition, we investigated the associations between the DSI_WPRO and the risk of MASLD in a longitudinal study.

METHODS

Baseline data from the Dongfeng-Tongji cohort were collected to investigate the ability of the DSI_WPRO to identify MASLD patients by ROC analysis. Furthermore, multivariate logistic regressions were performed to investigate the associations of the DSI_WPRO and MASLD risks in a 5-year follow-up of the DFTJ cohort study.

RESULTS

Among a total of 9,376 MASLD participants and 25,974 non-MASLD participants, the area under the curve (AUC) of the DSI_WPRO reached 0.777 after adjusting BMI classification, which is higher than other NITs in this study. In addition, we redefined the risk category and the screening proposal of MASLD in Asians with the DSI_WPRO. We found that the cutoff point of 0 has the best ability to recognize the presence or absence of MASLD. Furthermore, compared with the low DSI_WPRO (DSI_WPRO < 0), OR (95% CIs) of higher DSI_WPRO (DSI_WPRO ≥ 0) was 3.048 (2.827 ~ 3.285) for MASLD.

CONCLUSION

The DSI is a useful tool for MASLD identification and prevention. After more validation studies, DSI can be generalized in the Asian population.

Cardiac Elastography With External Vibration for Quantification of Diastolic Myocardial Stiffness

OBJECTIVES

Heart failure is an increasing global health problem. Approximately 50% of patients with heart failure have heart failure with preserved ejection fraction (HFpEF) and concomitant diastolic dysfunction (DD), in part caused by increased myocardial stiffness not detectable by standard echocardiography. While elastography can map tissue stiffness, cardiac applications are currently limited, especially in patients with a higher body mass index. Therefore, we developed cardiac time-harmonic elastography (THE) to detect abnormal diastolic myocardial stiffness associated with DD.

MATERIAL AND METHODS

Cardiac THE was developed using standard medical ultrasound and continuous external vibration for regionally resolved mapping of diastolic shear wave speed as a proxy for myocardial stiffness. The method was prospectively applied to 54 healthy controls (26 women), 10 patients with moderate left ventricular hypertrophy (mLVH; 5 women), and 45 patients with wild-type transthyretin amyloidosis (wTTR; 4 women), 20 of whom were treated with tafamidis. Ten healthy participants were reinvestigated after 2 to 6 months to analyze test-retest reproducibility by intraclass correlation coefficients.

RESULTS

Myocardial shear wave speed was measured with good reproducibility (intraclass correlation coefficient = 0.82) and showed higher values in wTTR (3.0 ± 0.7 m/sec) than in mLVH (2.1 ± 0.6 m/sec) and healthy controls (1.8 ± 0.3 m/sec, all P < .05). Area under the curve values were 0.991 and 0.737 for discriminating wTTR and mLVH from healthy controls, respectively. Shear wave speed was reduced in patients after tafamidis treatment (2.6 ± 0.6 m/sec, P = .04), suggesting the potential value of THE for therapy monitoring. Shear wave speed was quantified in the septum, posterior wall, and an automatically masked region (here stated for the septal region).

CONCLUSIONS

Cardiac THE detects abnormal myocardial stiffness in patients with DD with high penetration depth, independent of body mass index and region selection. Based on standard ultrasound components, cardiac THE is cost-effective and has the potential to become a point-of-care method for stiffness-sensitive echocardiography.

Comparing ultrasound-derived fat fraction and MRI-PDFF for quantifying hepatic steatosis: a real-world prospective study

OBJECTIVE

To compare the agreement between ultrasound-derived fat fraction (UDFF) with magnetic resonance proton density fat fraction (MRI-PDFF) for quantification of hepatic steatosis and verify its reliability and diagnostic performance by comparing with MRI-PDFF as the reference standard.

METHODS

This prospective study included a primary analysis of 191 patients who underwent MRI-PDFF and UDFF from February 2023 to February 2024. MRI-PDFF were derived from three liver segment measurements with calculation of an overall median PDFF. UDFF was performed by two different sonographers for each of the six measurements, and the median was taken. Intraclass correlation coefficient (ICC) and Bland-Altman analysis were used to assess agreement. Receiver operating characteristics (ROC) curves were used to evaluate the diagnostic performance of UDFF in detecting different degrees of hepatic steatosis.

RESULTS

A total of 176 participants were enrolled in the final cohort of this study (median age, 36.0 years; 82 men, 94 women). The median MRI-PDFF value was 11.3% (interquartile range (IQR) 7.5-18.9); 84.7% patients had a median MRI-PDFF value ≥ 6.4%. The median UDFF measured by different sonographers were 9.5% (IQR: 5.0-18.0) and 9.0% (IQR: 5.0-18.0), respectively. The interobserver agreement of UDFF measurement was excellent agreement (ICC = 0.951 [95% CI: 0.934-0.964], p < 0.001). UDFF was positively strongly correlated with MRI-PDFF with ICC of 0.899 (95% CI: 0.852-0.930). The Bland-Altman analysis showed high agreement between UDFF and MRI-PDFF measurements, with a mean bias of 1.7% (95% LOA, -8.7 to 12.2%). The optimal UDFF cutoff values were 5.5%, 15.5% and 17.5% for detecting MRI-PDFF at historic thresholds of 6.4%, 17.4%, and 22.1%, with AUC of 0.851, 0.952, and 0.948, respectively. The sensitivity was 79.2%, 87.5%, 88.9%, and specificity was 81.5%, 90.6%, 90.0%, respectively.

CONCLUSIONS

UDFF is a reliable and accurate method for quantification and classification of hepatic steatosis, with strong agreement to MRI-PDFF. The UDFF cutoff values of 5.5%, 15.5%, and 17.5% provide high sensitivity and specificity for the detection of mild, moderate, and severe hepatic steatosis, respectively.

KEY POINTS

Question Is ultrasound-derived fat fraction (UDFF) reliable for the quantitative detection of hepatic steatosis compared to MRI proton density fat fraction (MRI-PDFF)? Findings UDFF cutoff values of 5.5%, 15.5%, and 17.5% provided high sensitivity and specificity for the detection of mild, moderate, and severe hepatic steatosis, respectively. Clinical relevance UDFF is a reliable and accurate method for quantification and classification of hepatic steatosis, with strong agreement to MRI-PDFF and high reproducibility of liver fat content by different sonographers.

Evaluating Bone Fracture Healing in a Rabbit Model Using Doppler Imaging Modes, Shear Wave Elastography, X-Ray, and Dual-Energy X-Ray Absorptiometry

OBJECTIVE

This study investigated methods of evaluating the bone fracture healing process using superb microvascular imaging (SMI; two modes color SMI [cSMI] and monochromeSMI [mSMI]), and shear wave elastography (SWE), relative to X-ray, dual-energy X-ray absorptiometry (DXA), and platelet endothelial cell adhesion molecule 1 (PECAM-1) also know as cluster of differentiation 31 (CD-31) staining in a rabbit model.

METHODS

This IACUC-approved study involved eight rabbits that underwent a bilateral fibula osteotomy and were followed for 7 or 21 days (Groups 1 and 2 with 4 rabbits in each). Ultrasound examinations using cSMI, mSMI, and SWE were performed on Days 0, 4, 7, 14, and 21 post-surgery. At the final time point, rabbits had X-ray imaging followed by euthanasia and DXA scan. Finally, the fracture areas underwent decalcification, and specimens were stained with CD-31 for pathological analysis. Ultrasound and X-ray findings were compared using ANOVAs or paired t-tests with CD-31 stains and DXA was used as a reference.

RESULTS

Comparing SMI ultrasound images between the last time points for Group 1 (Day 7) and Group 2 (Day 21) showed no statistical significance difference for cSMI (P = .14) and mSMI (P = .06), similarly when compared with CD-31 stains there was no statistical significance difference for cSMI in Group 2 (P = .13). The SWE ultrasound images from the last time points in Groups 1 and showed no statistical significance difference (P = .33), the same results were then compared with DXA and also showed no statistical significance difference (P = .14). When comparing results of the X-ray images from the last time points for Groups 1 and 2 a statistical significance difference was found (P = .01), and when X-ray images were compared with DXA there was a statistical significance difference (P < .001).

CONCLUSION

Compared with CD-31 stains cSMI on Day 21 was not statistically significant (P = .13). Results comparing SWE with DXA were also not statistically significant (P = .14). These results indicate the potential of using certain ultrasound imaging techniques to monitor the bone fracture healing process.

Small bowel ultrasound: friend or foe?

PURPOSE OF REVIEW

Crohn's disease (CD), requires accurate diagnosis and regular monitoring to manage disease activity, prevent complications, and improve outcomes. Intestinal ultrasound (IUS) has emerged as a noninvasive, real-time imaging modality, offering a valuable alternative to traditional diagnostic techniques such as magnetic resonance enterography (MRE), endoscopy and capsule endoscopy (CE). This review examines recent advances in IUS for the diagnosis and monitoring of small bowel CD, with a focus on its applications, benefits, and limitations.

RECENT FINDINGS

Recent studies have demonstrated that IUS provides high sensitivity and specificity in detecting key markers of disease activity, including bowel wall thickness (BWT), bowel wall flow (BWF), and bowel wall stratification (BWS). Advances in IUS techniques, such as elastography and contrast-enhanced ultrasound (CEUS), have expanded its diagnostic and prognostic capabilities, potentially enabling differentiation between inflammation and fibrosis. However, challenges remain, including operator dependency, variability in scoring systems, and reduced sensitivity for superficial mucosal abnormalities. Efforts to standardize parameters and improve training have shown promise in addressing these limitations.

SUMMARY

IUS is a critical complementary tool for assessing disease activity, transmural healing, and postoperative recurrence in small bowel CD. Its noninvasiveness, cost-effectiveness, and real time assessment make it well suited for routine clinical use. Nonetheless, further multicentre studies are needed to validate scoring systems, optimize integration with other modalities, and improve consistency across clinical settings. IUS holds significant potential for advancing personalized care in small bowel CD, though ongoing research is required to refine its applications and maximize its clinical utility.

Cervical lymph node characterization using point shear wave elastography in pediatric patients: initial experience

BACKGROUND

Sonoelastography, also known as elastography, is a novel noninvasive imaging technique conducted using ultrasound equipment and used to indirectly evaluate tissue stiffness by measuring the speed of transverse wave propagation, or shear wave velocity, through the target tissue. Elastography is useful in diagnosing malignant lesions, which are stiffer than healthy tissue due to their high cell density.

OBJECTIVE

The aim of this study was to assess the ability of elastography to differentiate between benign and malignant cervical lymph nodes.

MATERIALS AND METHODS

Over a period of 2.5 years, we prospectively assessed the cervical lymph nodes of pediatric patients who visited the ultrasound department of our institution. In the course of a single procedure, participants underwent B-mode and color Doppler ultrasonography and point shear wave elastography (pSWE) of the cervical lymph nodes. The participants were divided into three groups: control (I), reactive lymph nodes (II), and malignant lymph nodes (III). A histological examination was performed in all patients with suspected malignancy, and mean shear wave velocity was compared across the three study groups.

RESULTS

Significant differences in elastography measurements were found between the lymph nodes in group I (control group) and group III (malignant lymph nodes) (P<0.0001) and between group II (reactive nodes) and group III (malignant nodes) (P<0.0001). Lymph nodes from patients in group III had higher elastography values than those in groups I and II.

CONCLUSION

pSWE is useful in measuring cervical lymph node stiffness, showing promising results in distinguishing between benign/reactive and malignant nodes.

Ultrasound-derived fat fraction to assess liver steatosis in obese patients with polycystic ovary syndrome

This study aims to explore the characteristics and influencing factors of ultrasound-derived fat fraction (UDFF) in obese patients with polycystic ovary syndrome (PCOS). Evaluate the diagnostic value of UDFF for MAFLD. This study included 124 obese PCOS patients and 106 age- and body mass index (BMI)-matched obese women, collecting clinical data from both groups. Compare the characteristics and related factors of hepatic steatosis between two groups. A total of 124 obese PCOS patients were divided into MAFLD group (n = 64) and no MAFLD group (n = 60). Binary logistic regression was used to analyze the independent risk factors for MAFLD in obese PCOS patients, and Spearman correlation analysis was used to examine the correlation between UDFF and various variables. The MAFLD group was further divided into mild group (S1, n = 16), moderate group (S2, n = 24), and severe group (S3, n = 24). Based on the ultrasound results, draw a receiver operating characteristic curve (ROC) for diagnosing the degree of hepatic steatosis in obese PCOS patients using UDFF. MAFLD was more common in the obese PCOS group than in the simple obese group (51.61% vs. 40.57%, P < 0.05). UDFF is positively correlated with the severity of MAFLD (r = 0.603, P < 0.01). The AUC for diagnosing liver steatosis with S ≥ 1, S ≥ 2, and S = 3 using UDFF is 0.935, 0.951, and 0.916. UDFF has certain diagnostic value for metabolic-related fatty liver disease in obese PCOS patients, and UDFF levels gradually increase with the severity of MAFLD.

Inverse association of healthy diet scores with non-alcoholic fatty liver disease among Chinese patients with type 2 diabetes mellitus

We aimed to investigate the association of healthy diet scores (HDS), comprising major components (fruits and vegetables, soybean, fish, and sugar-sweetened beverages), with non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (T2DM). In this cross-sectional study of 2,404 T2DM individuals aged 35-70 years, individuals with higher HDS (≥3 components) had a lower odds of NAFLD (adjusted odds ratio [OR]: 0.64; 95% confidence interval [CI]: 0.48, 0.84) and lower fatty liver index (FLI) levels (β: -4.70; 95% CI: -7.61, -1.79). Each one-component increase in HDS was associated with a 14% reduction in the odds of NAFLD (OR: 0.86; 95% CI: 0.75, 0.98) and a 1.95-unit reduction in FLI levels (β: -1.95; 95% CI: -3.21, -0.70). These results suggest that adherence to a higher HDS pattern may be protective against NAFLD in T2DM.

Psoriasis, metabolic syndrome and methotrexate: Is this association suitable for a new subcategory in steatotic liver disease?

Psoriasis is a prevalent inflammatory disease that shares chronic inflammation pathways with the pathophysiology of metabolic syndrome (MetS), type-2 diabetes mellitus and atherosclerosis. A high prevalence of steatosis and advanced liver fibrosis has been described in psoriasis. The influence of MetS and its compounds, patatin-like phospholipase domain containing 3 and transmembrane 6 superfamily member 2 gene polymorphisms and the cumulative dose of methotrexate (MTX) in the progression of steatotic disease are still under debate. A suitable new classification for psoriasis-related liver disease, under the umbrella of steatotic liver disease (SLD), might be evaluated due to the potential impact of MTX on liver steatosis. Considering the interplay between the MetS, steatosis and MTX, a new definition for this complex disease might be discussed since it is not entirely addressed under the umbrella of SLD and metabolic-dysfunction associated SLD. Hence, shortly, a discussion could be raised on the feasible term "Met-Drug SLD", metabolic and drug-induced SLD, which comprises both metabolic dysfunction and drug-related SLD. This review aims to report the best evidence to accurately classify liver disease in psoriasis, considering the new definition of SLD, allowing appropriate management once it is carefully defined.

Ultrasonographic scoring system for SOS/VOD in pediatric hematopoietic stem cell transplant recipients

Sinusoidal obstruction syndrome (SOS)/veno-occlusive disease (VOD) is a serious complication following hematopoietic stem cell transplantation. It is more common in children, with an incidence of approximately 20% compared to 10% in adult patients. While the Hokkaido ultrasonography (US)-based scoring system (HokUS-10 and HokUS-6) has proven effective in diagnosing SOS/VOD in adults, its utility in children remains uncertain. This study evaluated the utility of the HokUS-10/6 scoring systems in diagnosing pediatric SOS/VOD (pSOS/VOD) in a cohort of 99 patients, including 13 diagnosed with pSOS/VOD. Hyperbilirubinemia (> 2 mg/dL) was observed in only three patients (23%), whereas transfusion-refractory thrombocytopenia, hepatomegaly, and ascites were observed in all 13 patients. When the cutoff values for HokUS-10 and HokUS-6 scores were set at 4 and 2, the respective areas under the curve were 0.977 and 0.957. The sensitivity and specificity were 100% and 80% for HokUS-10, and 77% and 97% for HokUS-6, respectively. The simplified HokUS-6 may be a practical tool for diagnosing pSOS/VOD when use of the HokUS-10 scoring system is not feasible. HokUS-10/6 is important for early detection of pSOS/VOD during regular examinations and plays a valuable role in the diagnosis of clinical pSOS/VOD.

Effect of treadmill walking on cardiometabolic risk factors and liver function markers in older adults with MASLD: a randomized controlled trial

BACKGROUND

Regular walking has been reported to improve metabolically-associated steatotic liver disease (MASLD) by altering the metabolic environment. However, no studies to date have focused on older individuals in both conditions. Therefore, this study aimed to investigate the effects of a 12-week walking intervention on metabolic syndrome risk factors, liver function indicators, and liver ultrasound findings in older adults with both metabolic syndrome and MASLD.

METHODS

A total of 66 participants aged 65-85 years had average ages, heights, and weights of 75.3 ± 5.8 years, 159.3 ± 9.3 cm, and 68.6 ± 6.8 kg, respectively. The participants resided in four senior living communities, and their diets were uniform. The participants from two facilities were assigned to the control group (CON, n = 33), whereas those from the other two facilities were allocated to the treadmill walking program group (WPG, n = 33). Each group comprised 13 males and 20 females. The intervention consisted of a low- to moderate-intensity walking program, conducted for 30 min per day, 6 days per week, totaling 180 min per week. The total daily calorie expenditure was recorded based on the values calculated from the treadmill. The walking intensity was adjusted by modifying the treadmill incline according to each participant's heart rate corresponding to their maximal oxygen consumption (VO₂max). The exercise intensity was set at 50% on Mondays and Fridays, 60% on Tuesdays and Thursdays, and 70% on Wednesdays and Saturdays. Sundays were designated as rest days.

RESULTS

Although there were no significant differences in caloric intake between the groups, the WPG exhibited a 52.5% increase in physical activity levels (p < 0.001), resulting in significant reductions in body weight (-10.2%), fat mass (-17.2%), and abdominal fat (-4.8%). The WPG showed a 16.1% increase in VO₂max, along with significant reductions in systolic blood pressure (-9.6%) and blood glucose (-16.9%), as well as notable improvements in lipid profiles (p < 0.001). The WPG also demonstrated significant reductions in aspartate aminotransferase (-40%), alanine aminotransferase (-23.5%), total protein (-14.4%), albumin (-8.1%), bilirubin (-17.6%), and liver ultrasound scores (-31.8%), with all changes showing significant intergroup differences (p < 0.001).

CONCLUSIONS

Along with a consistent diet, a 12-week walk has been shown to induce significant changes in the body composition and cardiometabolic factors of older adults, as well as notable improvements in liver function markers and imaging findings.

TRIAL REGISTRATION

This study was registered with the Clinical Research Information Service of the Korea Centers for Disease Control and Prevention under Clinical Trials KCT0010079 on 26/12/2024.

Prospective Comparison of 2D-Shear Wave Elastography and Vibration-Controlled Transient Elastography in Assessing Liver Fibrosis in Metabolic Dysfunction-Associated Steatotic Liver Disease

RATIONALE AND OBJECTIVES

This prospective study aimed to compare the diagnostic performance of 2D-shear wave elastography (2D-SWE) with vibration-controlled transient elastography (VCTE) for assessing liver fibrosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD).

MATERIALS AND METHODS

Ninety-one participants (mean age: 42±13 years; 52 males) suspected of MASLD and scheduled for liver biopsy were enrolled at the Clinical Trial Center of our hospital between June 2024 and December 2024. All participants underwent both VCTE and 2D-SWE examinations on the same day as their liver biopsy, which served as the gold standard for assessing fibrosis. Diagnostic accuracy was analyzed using receiver operating characteristic (ROC) curves.

RESULTS

The areas under the ROC curves (AUCs) for 2D-SWE in diagnosing liver fibrosis (F ≥ 1) and significant fibrosis (F ≥ 2) were 0.92 (95% CI: 0.83-0.97) and 0.93 (95% CI: 0.85-0.98), respectively. The optimal cutoff values were 6.1 kPa and 7.66 kPa, yielding sensitivities of 87.8% and 84% and specificities of 85.3% and 94%, respectively. For VCTE, the AUCs were 0.84 (95% CI: 0.74-0.91) and 0.90 (95% CI: 0.81-0.96), with cutoff values of 6.3 kPa and 8.1 kPa, sensitivities of 92.7% and 76%, and specificities of 64.7% and 90%, respectively. No statistically significant difference was observed in the diagnostic performances of 2D-SWE and VCTE for liver fibrosis or significant fibrosis, with P-values of 0.09 and 0.44, respectively.

CONCLUSION

2D-SWE demonstrated high diagnostic accuracy for detecting liver fibrosis and significant fibrosis in MASLD patients, performing comparably to VCTE.

Prevalence of Metabolic Dysfunction-associated Steatotic Liver Disease and Cardiometabolic Risk Factor in US Adolescents

CONTEXT

Metabolic dysfunction-associated steatotic liver disease (MASLD) is widespread worldwide, and a strong link between MASLD and cardiometabolic risk factors (CMRFs) was highlighted in this study.

OBJECTIVE

This study characterized the prevalence of MASLD in adolescent population and overlapping CMRFs conditions in MASLD.

METHODS

This is a cross-sectional study of US adolescents aged 12 to 19 years in the 2017 through 2020 cycles of the National Health and Nutrition Examination Survey. The relationship between CMRFs and liver steatosis, evaluated by the median controlled attenuation parameter (CAP), was assessed.

RESULTS

The prevalence of MASLD in adolescents was 23.77%. Isolated overweight/obesity (35%) was the top CMRF. Non-Hispanic Black patients had the highest proportion of overweight/obesity plus elevated glucose (24%), whereas non-Hispanic Asians had the highest burden of dyslipidemia (2%, 14%, and 19%). Except for hypertension, overweight/obesity (β = 48.7; 95% CI, 43.4-54.0), hypertriglyceridemia (β = 15.5; 95% CI, 7.2-28.3), low HDL-C (β = 10.0; 95% CI, 3.1-16.9), elevated glucose (β = 6.9; 95% CI, 0.6-13.2) were all significantly associated with increased CAP values. Increased CAP was linked to the synergistic interactions between overweight/obesity and dyslipidemia or elevated glucose (overweight/obesity and elevated glucose: relative excess risk due to interaction [RERI] = 8.21, attributable proportion due to interaction [AP] = 0.45, synergy index [SI] = 1.91; overweight/obesity and hypertriglyceridemia: RERI = 19.00, AP = 0.69, SI = 3.53; overweight/obesity and low high-density lipoprotein cholesterol: RERI = 10.83, AP = 0.58, SI = 2.61). Adolescents with combination of overweight/obesity, dyslipidemia (β = 15.1; 95% CI, 0.1-30.2) and combination of overweight/obesity, dyslipidemia and elevated glucose (β = 48.0; 95% CI, 23.3-72.6) had a significantly higher CAP values.

CONCLUSION

The prevalence of MASLD was alarmingly high in adolescents, and overweight/obesity was the most important CMRF. Overweight/obesity and dyslipidemia or elevated glucose had positive additive interaction effects on liver steatosis.

Evaluation of infrapatellar fat pad elasticity in knee osteoarthritis using IVIM-DWI-based virtual MR elastography: repeatability and reproducibility analysis

BACKGROUND

Fibrosis of the infrapatellar fat pad (IPFP) leads to changes in its stiffness, which may impact knee osteoarthritis. However, few studies have utilized virtual MR elastography to assess the variations of the IPFP. This study aimed to evaluate the value of intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI)-based virtual MR elastography (vMRE) in the IPFP by assessing the test-retest repeatability, as well as intra- and inter-observer reproducibility.

METHODS

A total of 71 subjects underwent IVIM-DWI examinations, which were conducted twice with an interval of 30-60 min using an 18-channel knee coil at 3T. Shifted apparent diffusion coefficient (sADC) was calculated from two different sets of b-values (b = 200/800 sec/mm2 and 200/1500 sec/mm2) and then converted to IVIM-DWI MRI-based virtual shear modulus (μdiff_800 and μdiff_1500). Two readers independently delineated regions of interest (ROI) within the IPFP on the vMRE stiffness map to obtain the mean and standard deviation (SD) values of μdiff. Short-term test-retest repeatability, as well as intra- and inter-observer agreement were assessed using the intra-class correlation coefficient (ICC), the coefficient of variation (CoV), and Bland-Altman limits of agreement (LoA).

RESULTS

The mean and SD values of μdiff_1500, along with the mean value of μdiff_800 exhibited excellent intra- and inter-observer reproducibility agreement (ICC ≥ 0.90 and CoV ≤ 10%, P˂ 0.001). The intra- and inter-observer ICCs for the mean values of μdiff_800 were 0.917 and 0.901, respectively, while the ICCs for the SD values of μdiff_800 were 0.870 and 0.863, with CoV exceeding 10% (P˂ 0.001). The test-retest repeatability of the average value of μdiff_1500 was excellent (ICC = 0.902; CoV = 6.8%) compared to μdiff_800 (ICC = 0.877; CoV = 15.3%). Test-retest repeatability of SD for μdiff_1500 was good (ICC = 0.803; CoV = 11.5%) in comparison to SD for μdiff_800 (ICC = 0.796; CoV = 13.5%).

CONCLUSIONS

IVIM-DWI-based vMRE demonstrated significant potential as a reliable tool for measuring tissue elasticity in the IPFP, exhibiting higher repeatability for μdiff_1500 than for μdiff_800.

Management of liver sinusoidal obstruction syndrome/veno-occlusive disease in adults: a 2025 perspective from an international expert group

Sinusoidal obstruction syndrome (SOS) formerly known as Veno-occlusive disease (VOD) is a potentially fatal complication that occurs mainly after haematopoietic cell transplantation, especially allogeneic transplantation. The liver is the principal organ affected, though other organs, such as the lungs, may also be involved to a lesser extent. The condition is characterised by obstruction of the hepatic venules, leading to sinusoidal congestion, hepatic ischaemia and, in severe cases, fulminant liver failure. Recent refined diagnostic criteria, published by the European Society for Blood and Marrow Transplantation in 2023, provide a more accurate method of detecting SOS/VOD, allowing earlier intervention and better stratification of patients according to the severity of their disease. This article focuses on liver SOS/VOD and discussing key risk factors, new diagnostic methods and therapeutic strategies, with an emphasis on the early use of defibrotide, which remains the reference treatment for severe SOS/VOD.

Application of combi-elastography for follow-up after pediatric liver transplantation: A prospective study

OBJECTIVE

To investigate the use of combi-elastography in children after liver transplantation.

METHODS

Thirty-five children who underwent liver transplantation at our hospital were prospectively selected. Donor livers were divided into fatty liver and nonfatty liver groups according to the degree of fatty liver. Recipients were categorized into groups with (10 patients) and without complications (25 patients) according to the presence or absence of complications within 6 months after surgery. Combi-elastography was performed on each donor liver, and each patient underwent combi-elastography at the time of surgery and at 1 day, 7 days, 1 month, 3 months, and 6 months after surgery; the results of liver function tests were recorded at the same time points.

RESULTS

Despite the rapid recovery of liver function in the group without complications, the combi-elastography indices were still high in the early stage and gradually stabilized after 3 months but were still higher than those of the donor liver at 6 months. In the fatty liver group, the postoperative 1-day combi-elastography values were significantly higher than those in the nonfatty liver group, and in the group with complications, the postoperative 1-day combi-elastography values were significantly higher than those in the group without complications. The receiver operating characteristic (ROC) curve analysis revealed that the areas under the curves (AUCs) of the combi-elastography values for predicting complications in children at 6 months after liver transplantation were 8.41 kPa for Young's modulus (E) (with a sensitivity of 90 % (9/10 and a specificity of 76 % (19/25)) 1.26 for the F-index (FI) value (sensitivity 80 %(8/10), specificity 80 % (20/25)), and 1.05 kPa for the A-index (AI) value (sensitivity 80 %(8/10), specificity 72 % (18/25)).

CONCLUSIONS

Combi-elastography is useful for assessing changes in liver stiffness in the early period after liver transplantation and should therefore be considered for the follow-up of children who undergo liver transplantation.

Ultrasound-based assessment of impaired gastric emptying in patients with hepatitis B cirrhosis

This study aims to evaluate the utility of gastric ultrasound in assessing gastric emptying dysfunction in patients with hepatitis B cirrhosis and its correlation with alterations in portal venous flow and liver stiffness. Gastric motility and emptying parameters, portal venous flow parameters, and liver stiffness were measured by ultrasound in 42 patients with hepatitis B cirrhosis and 48 healthy controls. Statistical analysis was performed to compare the differences in these parameters between the two groups and to analyze the correlation between gastric ultrasound parameters and alternations in portal venous blood flow and liver stiffness. Firstly, the Gastric Motility Index was significantly lower in the experimental group than in the control group, while other gastric ultrasound parameters were significantly higher (p < 0.01). Secondly, measurements obtained from two-dimensional ultrasound, Color Doppler Flow Imaging, and two-dimensional Shear Wave Elastography revealed that Portal Vein Diameter (PVD) and Liver Stiffness (LS) were significantly higher in the experimental group compared to the control group, while the maximum portal vein velocity (PVmax) was significantly lower (p < 0.01). Finally, correlation analysis demonstrated that gastric ultrasound parameters correlated with PVD, PVmax, and LS. Gastric function is significantly impaired in patients with hepatitis B cirrhosis compared to controls, and gastric ultrasound parameters demonstrate a notable correlation with PVD, PVmax, and LS. Gastric ultrasound effectively evaluates gastric motility and emptying function in these patients, offering a reliable foundation for clinical diagnosis and management.

Identification of plasma biomarkers for non-invasive diagnosis of hepatitis B cirrhosis

Hepatitis B virus (HBV) infection represents a major public health challenge due to its potential progression to liver cirrhosis and hepatocellular carcinoma, underscoring the importance of early diagnosis for effective management. This study aimed to identify plasma biomarkers for the non-invasive diagnosis of hepatitis B cirrhosis (HBC). We employed quantitative proteomic analysis via liquid chromatography-tandem mass spectrometry on plasma samples from 27 individuals, including 13 patients with HBC and 14 with chronic hepatitis B (CHB). Bioinformatics analysis of 963 identified proteins revealed 234 differential expressed proteins, comprising 115 upregulated and 119 downregulated proteins. Four candidate biomarkers-CHI3L1, IGFBP1, SHBG, and TIMP2-were subsequently selected and validated using ELISA in a cohort of 158 patients, all demonstrating elevated levels in HBC patients. The four-biomarker panel (4MP) demonstrated superior diagnostic performance, achieving an area under the curve (AUC) of 0.902 for distinguishing HBC from CHB. For differentiating decompensated HBC from CHB, the 4MP achieved an AUC of 0.993, with a sensitivity of 93.75 % and specificity of 98.73 %. Mostly, the 4MP also performed well in identifying severe HBC from non-severe HBC, achieving an AUC of 0.911, with a sensitivity of 81.25% and specificity of 93.65%. In conclusion, this study identifies four novel plasma biomarkers for HBC, highlighting their potential to enhance non-invasive diagnostic strategies for monitoring HBC progression.

Ex vivo mechanical properties of human thoracolumbar fascia and erector spinae aponeurosis under traction loading and shear wave elastography

The thoracolumbar fascia (TLF) and the erector spinae aponeurosis (ESA) play an important role in the biomechanics of the spine and could be a source of low back pain. Although the TLF and ESA are key structures in several musculoskeletal dysfunctions and in tissue engineering, there is still a lack of evidence in the literature to prove that they have different mechanical properties and roles when considered as a single tissue. Furthermore, no methods are currently available to study these structures in vivo. The objective of this study was to analyze the ex-vivo tensile properties TLF and ESA, and to test the potential of ultrasound shearwave elastography (SWE) to characterize these tissues. Hundred samples from N = 10 fresh-frozen human donors were studied. Shear wave speed (SWS) was measured in all samples with SWE, and their tensile properties were measured with mechanical testing. Results show that TLF is anisotropic, and more compliant than ESA. SWS was not significantly correlated to tensile moduli. These findings could potentially aid surgeons in their daily practices, assist engineers with in silico simulations, and support physiotherapists in musculoskeletal rehabilitation by enabling them to customize medical interventions for each specific patient and clinical condition. However, further research is necessary to further investigate the behavior in terms of time-dependent response and link between the tissue anisotropy and microstructural organization.