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Mu H, Zhang Q. The Application of Diaphragm Ultrasound in Chronic Obstructive Pulmonary Disease: A Narrative Review. COPD 2024; 21:2331202. [PMID: 38634575 DOI: 10.1080/15412555.2024.2331202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/11/2024] [Indexed: 04/19/2024]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a prevalent condition that poses a significant burden on individuals and society due to its high morbidity and mortality rates. The diaphragm is the main respiratory muscle, its function has a direct impact on the quality of life and prognosis of COPD patients. This article aims to review the structural measurement and functional evaluation methods through the use of diaphragmatic ultrasound and relevant research on its application in clinical practice for COPD patients. Thus, it serves to provide valuable insights for clinical monitoring of diaphragm function in COPD patients, facilitating early clinical intervention and aiding in the recovery of diaphragm function.
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Affiliation(s)
- Heng Mu
- Department of Ultrasound, Second Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
- State Key Laboratory of Ultrasound in Medicine and Engineering of Chongqing Medical University, Chongqing, PR China
| | - Qunxia Zhang
- Department of Ultrasound, Second Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
- State Key Laboratory of Ultrasound in Medicine and Engineering of Chongqing Medical University, Chongqing, PR China
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2
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Wang Y, Chen S, Zheng S, Zhou Z, Zhang W, Du G, Mikish A, Ruaro B, Bruni C, Hoffmann-Vold AM, Gargani L, Matucci-Cerinic M, Furst DE. A versatile role for lung ultrasound in systemic autoimmune rheumatic diseases related pulmonary involvement: a narrative review. Arthritis Res Ther 2024; 26:164. [PMID: 39294670 PMCID: PMC11409780 DOI: 10.1186/s13075-024-03399-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 09/05/2024] [Indexed: 09/21/2024] Open
Abstract
Systemic autoimmune rheumatic diseases (SARDs) related pulmonary disease is highly prevalent, with variable clinical presentation and behavior, and thus is associated with poor outcomes and negatively impacts quality of life. Chest high resolution computed tomography (HRCT) is still considered a fundamental imaging tool in the screening, diagnosis, and follow-up of pulmonary disease in patients with SARDs. However, radiation exposure, economic burden, as well as lack of point-of-care CT equipment limits its application in some clinical situation. Ultrasound has found a place in numerous aspects of the rheumatic diseases, including the vasculature, skin, muscle, joints, kidneys and in screening for malignancies. Likewise it has found increasing use in the lungs. In the past two decades, lung ultrasound has started to be used for pulmonary parenchymal diseases such as pneumonia, pulmonary edema, lung fibrosis, pneumothorax, and pleural lesions, although the lung parenchymal was once considered off-limits to ultrasound. Lung ultrasound B-lines and irregularities of the pleural line are now regarded two important sonographic artefacts related to diffuse parenchymal lung disease and they could reflect the lesion extent and severity. However, its role in the management of SARDs related pulmonary involvement has not been fully investigated. This review article will focus on the potential applications of lung ultrasound in different pulmonary scenarios related with SARDs, such as interstitial lung disease, diffuse alveolar hemorrhage, diaphragmatic involvement, and pulmonary infection, in order to explore its value in clinical daily practice.
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Affiliation(s)
- Yukai Wang
- Department of Rheumatology and Immunology, Shantou Central Hospital, Shantou, Guangdong, China.
| | - Shaoqi Chen
- Department of Ultrasound, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China.
| | - Shaoyu Zheng
- Department of Rheumatology and Immunology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Zexuan Zhou
- Department of Rheumatology and Immunology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Weijin Zhang
- Department of Rheumatology and Immunology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Guangzhou Du
- Department of Radiology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Angelina Mikish
- Department of Rheumatology and Immunology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Barbara Ruaro
- Department of Pulmonology, Cattinara Hospital, University of Trieste, Trieste, 34149, Italy
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Luna Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, 56126, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
| | - Daniel E Furst
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Division of Rheumatology, Department of Medicine, University of California at Los Angeles, Los Angeles, USA
- University of Washington, Seattle, WA, USA
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3
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Gonzalez FA, Bacariza J, Leote J. To B or not to B-lines. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:61. [PMID: 39238052 PMCID: PMC11378440 DOI: 10.1186/s44158-024-00196-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 08/26/2024] [Indexed: 09/07/2024]
Affiliation(s)
- Filipe André Gonzalez
- Cardiovascular Research Center, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.
- Intensive Care Department, Hospital Garcia de Orta EPE, Almada, Portugal.
- ICU in Hospital CUF Tejo, Lisbon, Portugal.
| | - Jacobo Bacariza
- Intensive Care Department, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Joao Leote
- Intensive Care Department, Hospital Garcia de Orta EPE, Almada, Portugal
- Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal
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Marzook N, Dubrovsky AS, Muchantef K, Zielinski D, Lands LC, Shapiro AJ. Lung ultrasound in children with primary ciliary dyskinesia or cystic fibrosis. Pediatr Pulmonol 2024. [PMID: 39221856 DOI: 10.1002/ppul.27215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/25/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Primary ciliary dyskinesia (PCD) and cystic fibrosis (CF) are respiratory conditions requiring regular chest radiography (CXR) surveillance to monitor pulmonary disease. However, CXR is insensitive for lung disease in CF and PCD. Lung ultrasound (LU) is a radiation-free alternative showing good correlation with severity of lung disease in CF but has not been studied in PCD. METHOD Standardized, six-zone LU studies and CXR were performed on a convenience sample of children with PCD or CF during a single visit when well. LU studies were graded using the LU scoring system, while CXR studies received a modified Chrispin-Norman score. Scores were correlated with clinical outcomes. RESULT Data from 30 patients with PCD and 30 with CF (median age PCD 11.5 years, CF 9.1 years) with overall mild pulmonary disease (PCD median FEV1 90% predicted, CF FEV1 100%) were analyzed. LU abnormalities appear in 11/30 (36%) patients with PCD and 9/30 (30%) with CF. Sensitivity, specificity, positive predictive, and negative predictive values for abnormal LU compared to the gold standard of CXR are 42%, 61%, 42%, and 61% in PCD, and 44%, 81%, 50%, and 77% in CF, respectively. Correlation between LU and CXR scores are poor for both diseases (PCD r = -0.1288, p = 0.4977; CF r = 0.0343, p = 0.8571), and LU score does not correlate with clinical outcomes in PCD. CONCLUSION The correlation of LU findings with CXR surveillance studies is poor in patients with mild disease burdens from PCD or CF, and LU scores do not correlate with clinical outcomes in PCD.
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Affiliation(s)
- Noah Marzook
- Department of Pediatrics, McGill University Health Center Research Institute, Montreal, Quebec, Canada
| | - Alexander S Dubrovsky
- Department of Pediatrics, McGill University Health Center Research Institute, Montreal, Quebec, Canada
| | - Karl Muchantef
- Department of Radiology, McGill University Health Center Research Institute, Montreal, Quebec, Canada
| | - David Zielinski
- Department of Pediatrics, McGill University Health Center Research Institute, Montreal, Quebec, Canada
| | - Larry C Lands
- Department of Pediatrics, McGill University Health Center Research Institute, Montreal, Quebec, Canada
| | - Adam J Shapiro
- Department of Pediatrics, McGill University Health Center Research Institute, Montreal, Quebec, Canada
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Khan U, Thompson R, Li J, Etter LP, Camelo I, Pieciak RC, Castro-Aragon I, Setty B, Gill CC, Demi L, Betke M. FLUEnT: Transformer for detecting lung consolidations in videos using fused lung ultrasound encodings. Comput Biol Med 2024; 180:109014. [PMID: 39163826 DOI: 10.1016/j.compbiomed.2024.109014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 08/06/2024] [Accepted: 08/09/2024] [Indexed: 08/22/2024]
Abstract
Pneumonia is the leading cause of death among children around the world. According to WHO, a total of 740,180 lives under the age of five were lost due to pneumonia in 2019. Lung ultrasound (LUS) has been shown to be particularly useful for supporting the diagnosis of pneumonia in children and reducing mortality in resource-limited settings. The wide application of point-of-care ultrasound at the bedside is limited mainly due to a lack of training for data acquisition and interpretation. Artificial Intelligence can serve as a potential tool to automate and improve the LUS data interpretation process, which mainly involves analysis of hyper-echoic horizontal and vertical artifacts, and hypo-echoic small to large consolidations. This paper presents, Fused Lung Ultrasound Encoding-based Transformer (FLUEnT), a novel pediatric LUS video scoring framework for detecting lung consolidations using fused LUS encodings. Frame-level embeddings from a variational autoencoder, features from a spatially attentive ResNet-18, and encoded patient information as metadata combiningly form the fused encodings. These encodings are then passed on to the transformer for binary classification of the presence or absence of consolidations in the video. The video-level analysis using fused encodings resulted in a mean balanced accuracy of 89.3 %, giving an average improvement of 4.7 % points in comparison to when using these encodings individually. In conclusion, outperforming the state-of-the-art models by an average margin of 8 % points, our proposed FLUEnT framework serves as a benchmark for detecting lung consolidations in LUS videos from pediatric pneumonia patients.
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Affiliation(s)
- Umair Khan
- Department of Information Engineering and Computer Science, University of Trento, Trento, Italy
| | | | - Jason Li
- Department of Computer Science, Boston University, Boston, MA, USA
| | | | - Ingrid Camelo
- Augusta University, Pediatric Infectious Disease, Augusta, GA, USA
| | - Rachel C Pieciak
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | | | - Bindu Setty
- Department of Radiology, Boston Medical Center, Boston, MA, USA
| | - Christopher C Gill
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Libertario Demi
- Department of Information Engineering and Computer Science, University of Trento, Trento, Italy.
| | - Margrit Betke
- Department of Computer Science, Boston University, Boston, MA, USA
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Swanstein H, Boysen S, Cole L. Feline friendly POCUS: how to implement it into your daily practice. J Feline Med Surg 2024; 26:1098612X241276916. [PMID: 39254308 DOI: 10.1177/1098612x241276916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
PRACTICAL RELEVANCE Cats are great pretenders; they often hide illness until they are critical. This makes patients of this species challenging to assess and manage in the emergency setting where quick and stress-free diagnosis and treatment are necessary. Veterinary point-of-care ultrasound (POCUS) is a rapid, evidence-based, non-invasive, repeatable, cage-side ultrasonographic examination designed to answer clinically driven questions without compromising feline wellbeing. Integrating feline friendly POCUS as an extension of the physical examination to streamline diagnostic and therapeutic interventions, thereby limiting stress and improving overall patient care, is advocated by the authors of this article. EQUIPMENT Given the multitude of ultrasound machines and probes available that are portable, meaning they can be moved around the clinic and used patient-side, it should be possible for most practitioners to integrate POCUS into daily practice. The authors' preferred equipment for feline POCUS is a microconvex probe and a portable machine with a fixed pre-set. This set-up allows the clinician to complete all POCUS (abdominal, lung and pleural space, and heart) without needing to move the patient, change probes or restrain the patient in a particular position, ultimately saving time, personnel and cost while maintaining patient comfort and safety. AIM This review aims to serve as a valuable resource for veterinarians seeking to improve their feline patient care through the judicious utilisation of POCUS. In this article, the complex challenges posed by cats are addressed, and the different POCUS techniques, applications and clinical recommendations are discussed. EVIDENCE BASE This review draws on the published literature, as well as the authors' own collective experience when providing recommendations.
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Affiliation(s)
| | - Søren Boysen
- Faculty of Veterinary Medicine, University of Calgary, Calgary, Canada
| | - Laura Cole
- Royal Veterinary College, Hawkshead Lane,Hatfield, UK
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Li Z, Yang X, Lan H, Wang M, Huang L, Wei X, Xie G, Wang R, Yu J, He Q, Zhang Y, Luo J. Knowledge fused latent representation from lung ultrasound examination for COVID-19 pneumonia severity assessment. ULTRASONICS 2024; 143:107409. [PMID: 39053242 DOI: 10.1016/j.ultras.2024.107409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/19/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
COVID-19 pneumonia severity assessment is of great clinical importance, and lung ultrasound (LUS) plays a crucial role in aiding the severity assessment of COVID-19 pneumonia due to its safety and portability. However, its reliance on qualitative and subjective observations by clinicians is a limitation. Moreover, LUS images often exhibit significant heterogeneity, emphasizing the need for more quantitative assessment methods. In this paper, we propose a knowledge fused latent representation framework tailored for COVID-19 pneumonia severity assessment using LUS examinations. The framework transforms the LUS examination into latent representation and extracts knowledge from regions labeled by clinicians to improve accuracy. To fuse the knowledge into the latent representation, we employ a knowledge fusion with latent representation (KFLR) model. This model significantly reduces errors compared to approaches that lack prior knowledge integration. Experimental results demonstrate the effectiveness of our method, achieving high accuracy of 96.4 % and 87.4 % for binary-level and four-level COVID-19 pneumonia severity assessments, respectively. It is worth noting that only a limited number of studies have reported accuracy for clinically valuable exam level assessments, and our method surpass existing methods in this context. These findings highlight the potential of the proposed framework for monitoring disease progression and patient stratification in COVID-19 pneumonia cases.
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Affiliation(s)
- Zhiqiang Li
- School of Biomedical Engineering, Tsinghua University, Beijing 100084, China
| | - Xueping Yang
- Department of Ultrasound, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Hengrong Lan
- School of Biomedical Engineering, Tsinghua University, Beijing 100084, China
| | - Mixue Wang
- Department of Ultrasound, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Lijie Huang
- School of Biomedical Engineering, Tsinghua University, Beijing 100084, China
| | - Xingyue Wei
- School of Biomedical Engineering, Tsinghua University, Beijing 100084, China
| | - Gangqiao Xie
- School of Biomedical Engineering, Tsinghua University, Beijing 100084, China
| | - Rui Wang
- School of Biomedical Engineering, Tsinghua University, Beijing 100084, China
| | - Jing Yu
- Department of Ultrasound, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Qiong He
- School of Biomedical Engineering, Tsinghua University, Beijing 100084, China
| | - Yao Zhang
- Department of Ultrasound, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China.
| | - Jianwen Luo
- School of Biomedical Engineering, Tsinghua University, Beijing 100084, China.
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Slaugh JD, Issa M, Grimm E, Calderon AJ, Sindelar S, Van Hook R, McBeth L, Maw A. Integration of Diagnostic Lung Ultrasound Into Clinical Practice by Hospitalists in an Academic Medical Center: A Retrospective Chart Review. Cureus 2024; 16:e69796. [PMID: 39308836 PMCID: PMC11416203 DOI: 10.7759/cureus.69796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2024] [Indexed: 09/25/2024] Open
Abstract
Background Point-of-care lung ultrasound (LUS) is a guideline-recommended imaging modality that has been shown to be more accurate than chest radiography for multiple causes of dyspnea. This study was conducted to understand the impact of LUS on real-world clinical decision-making among hospitalists. Methods A retrospective chart review was conducted of patients who received a LUS while hospitalized at a quaternary care academic medical center between July 2020 and June 2022. Data was extracted from the electronic health record (EHR) into a standardized REDCap form. Cases were defined as patients who had received a LUS that (1) had images archived and accessible to viewing through the EHR and (2) had an imaging report documented in the EHR. Results Of the 820 LUSs reviewed, 297 (36.2%) were performed to evaluate for appropriateness of thoracentesis, 205 (25%) for diagnosing or monitoring of pneumonia related to COVID-19, 169 (20.6%) for volume status assessment, 136 (16.6%) for worsening respiratory status, 114 (13.9%) for monitoring pleural effusions, 64 (7.8%) for diagnosing or monitoring of pneumonia not related to COVID-19, and 12 (1.5%) for monitoring of diuresis. Documentation was sufficient to determine clinical decision-making in 730 (89%) of LUSs reviewed, 739 (90.1%) were considered to be diagnostically useful, and 327 (39.9%) changed management. Conclusions These findings suggest LUS was diagnostically useful and routinely changed management in hospitalist practice. Further, documentation in the EHR was sufficient to allow for the evaluation of real-world clinical decision-making using LUS, which is an important gap in both the education and health services research literature.
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Affiliation(s)
- John-David Slaugh
- Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Meltiady Issa
- Hospital Internal Medicine, Mayo Clinic, Rochester, USA
| | - Eric Grimm
- Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA
| | | | - Solomon Sindelar
- Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Reed Van Hook
- Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Lauren McBeth
- Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Anna Maw
- Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA
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D’Agnano V, Perrotta F, Stella GM, Pagliaro R, De Rosa F, Cerqua FS, Schiattarella A, Grella E, Masi U, Panico L, Bianco A, Iadevaia C. Molecular Diagnostic Yield and Safety Profile of Ultrasound-Guided Lung Biopsies: A Cross-Sectional Study. Cancers (Basel) 2024; 16:2860. [PMID: 39199631 PMCID: PMC11352358 DOI: 10.3390/cancers16162860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 08/08/2024] [Accepted: 08/13/2024] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND The recent advances in precision oncology for lung cancer treatment has focused attention on the importance of obtaining appropriate specimens for tissue diagnosis as well as comprehensive molecular profiling. CT scan-guided biopsies and bronchoscopy are currently the main procedures employed for tissue sampling. However, growing evidence suggests that ultrasound-guided biopsies may represent an effective as well as safe approach in this diagnostic area. This study explores the safety and the diagnostic yield for cancer molecular profiling in ultrasound-guided percutaneous lung lesion biopsies (US-PLLB). METHODS One hundred consecutive patients with suspected lung cancer, between January 2021 and May 2024, who had ultrasound-guided lung biopsies have been retrospectively analyzed. Molecular profiling was conducted with next-generation sequencing Genexus using Oncomine precision assay or polymerase chain reaction according to specimen quality. Qualitative immunohistochemical assay of programmed death ligand 1 (PD-L1) expression was evaluated by the Dako PD-L1 immunohistochemistry 22C3 pharmDx assay. The co-primary endpoints were the molecular diagnostic yield and the safety profile of US-guided lung biopsies. RESULTS From January 2021 to May 2024, 100 US-guided lung biopsies were carried out and 95 were considered for inclusion in the study. US-PLLB provided informative tissue for a histological evaluation in 93 of 95 patients with an overall diagnostic accuracy of 96.84% [Sensitivity: 92.63%; Specificity: 96.84%; PPV: 100%; NPV: 100%]. Sixty-Six patients were diagnosed with NSCLC (69.47%) and were considered for molecular diagnostic yield evaluation and PD-L1 testing. Four patients had malignant lymphoid lesions. US-PLLB was not adequate to achieve a final diagnosis in three patients (3.16%). Complete molecular profiling and PD-L1 evaluation were achieved in all patients with adenocarcinoma (molecular diagnostic yield: 100%). PD-L1 evaluation was achieved in 28 of 29 patients (96.55%) with either SCC or NOS lung cancer. The overall complication rate was 9.47% (n = 9). Six patients (6.31%) developed pneumothorax, while three patients (3.16%) suffered mild haemoptysis without desaturation. CONCLUSIONS According to our findings, US-guided lung biopsy is a safe, minimally invasive procedure in patients with suspected lung malignancies, providing an excellent diagnostic yield for both comprehensive molecular profiling and PD-L1 testing. In addition, our results suggest that US-guided biopsy may also be an effective diagnostic approach in patients with suspected lung lymphoma.
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Affiliation(s)
- Vito D’Agnano
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (F.P.); (R.P.); (A.S.); (E.G.); (U.M.); (A.B.)
- U.O.C. Clinica Pneumologica L. Vanvitelli, Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (F.S.C.); (C.I.)
| | - Fabio Perrotta
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (F.P.); (R.P.); (A.S.); (E.G.); (U.M.); (A.B.)
- U.O.C. Clinica Pneumologica L. Vanvitelli, Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (F.S.C.); (C.I.)
| | - Giulia Maria Stella
- Unit of Respiratory Diseases, Department of Medical Sciences and Infective Diseases, IRCCS Policlinico San Matteo Foundation, University of Pavia Medical School, 27100 Pavia, Italy
| | - Raffaella Pagliaro
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (F.P.); (R.P.); (A.S.); (E.G.); (U.M.); (A.B.)
- U.O.C. Clinica Pneumologica L. Vanvitelli, Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (F.S.C.); (C.I.)
| | - Filippo De Rosa
- Unit of Pathology Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (F.D.R.); (L.P.)
| | - Francesco Saverio Cerqua
- U.O.C. Clinica Pneumologica L. Vanvitelli, Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (F.S.C.); (C.I.)
| | - Angela Schiattarella
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (F.P.); (R.P.); (A.S.); (E.G.); (U.M.); (A.B.)
- U.O.C. Clinica Pneumologica L. Vanvitelli, Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (F.S.C.); (C.I.)
| | - Edoardo Grella
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (F.P.); (R.P.); (A.S.); (E.G.); (U.M.); (A.B.)
| | - Umberto Masi
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (F.P.); (R.P.); (A.S.); (E.G.); (U.M.); (A.B.)
| | - Luigi Panico
- Unit of Pathology Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (F.D.R.); (L.P.)
| | - Andrea Bianco
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (F.P.); (R.P.); (A.S.); (E.G.); (U.M.); (A.B.)
- U.O.C. Clinica Pneumologica L. Vanvitelli, Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (F.S.C.); (C.I.)
| | - Carlo Iadevaia
- U.O.C. Clinica Pneumologica L. Vanvitelli, Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (F.S.C.); (C.I.)
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Díez-Vidal A, Martínez-Martín P, González-Muñoz B, Tung-Chen Y. Point-of-care Ultrasound in Infectious Diseases: Current Insights and Future Perspectives. Clin Infect Dis 2024; 79:420-429. [PMID: 38769593 DOI: 10.1093/cid/ciae285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/09/2024] [Accepted: 05/18/2024] [Indexed: 05/22/2024] Open
Abstract
Point-of-care ultrasound (POCUS) is a safe, noninvasive technique performed at the patient's bedside, providing immediate results to the operator. It complements physical examination and facilitates clinical decision-making. In infectious diseases, POCUS is particularly valuable, offering an initial assessment in cases of suspected infection. It often leads to an early tentative diagnosis enabling the prompt initiation of antimicrobial treatment without the delay associated with traditional radiology. POCUS provides direct visualization of affected organs, assists in evaluating fluid balance, and facilitates various interventions, all while reducing patient discomfort. For infectious disease specialists, becoming proficient in POCUS is a critical future challenge, requiring dedicated training for effective utilization.
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Affiliation(s)
- Alejandro Díez-Vidal
- Infectious Diseases Unit, Internal Medicine Department, La Paz University Hospital, Madrid, Spain
- IdiPAZ Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain
| | - Patricia Martínez-Martín
- Infectious Diseases Unit, Internal Medicine Department, La Paz University Hospital, Madrid, Spain
- IdiPAZ Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain
- CIBERINFEC, Carlos III Health Institute, Madrid, Spain
| | - Borja González-Muñoz
- IdiPAZ Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain
- Internal Medicine Department, La Paz University Hospital, Madrid, Spain
| | - Yale Tung-Chen
- IdiPAZ Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain
- Internal Medicine Department, La Paz University Hospital, Madrid, Spain
- Department of Medicine, Alfonso X El Sabio University, Madrid, Spain
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11
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Hassan M, Griffiths S, Probyn B, Sadaka AS, Touman AA, Trevelyan G, Breen D, Daneshvar C. Thoracic ultrasound in guiding management of respiratory disease. Expert Rev Respir Med 2024; 18:611-630. [PMID: 39096207 DOI: 10.1080/17476348.2024.2387785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 05/06/2024] [Accepted: 07/30/2024] [Indexed: 08/05/2024]
Abstract
INTRODUCTION The use of ultrasound in respiratory disease has evolved substantially over the past two decades. From a test done to confirm the safe site of pleural fluid drainage, thoracic ultrasound has become a point-of-care test that guides the management of patients on respiratory wards, in clinics and endoscopy. AREAS COVERED This review overviews the process of ultrasound examination in the chest. It then delves into specific disease areas (pleural disease, lung disease, diaphragm disease, and invasive procedures) to highlight how thoracic ultrasound is being used to refine management. The review concludes with discussion on the training curricula and assessment tools for competency in thoracic ultrasound. Being a scoping review, literature searches were conducted on PubMed using relevant search terms. EXPERT OPINION In addition to its current uses, there are many avenues where thoracic ultrasound will soon be beneficial. Recent studies show promising roles in areas such as patient-tailored guidance of pleurodesis and non-invasively predicting lung re-expansion after pleural fluid drainage. In addition, auxiliary tools such as contrast-enhanced ultrasound and elastography are proving useful in identifying the etiology and directing the successful sampling of pleural and lung lesions. Studies are also exploring the utility of sonographic biomarkers such as echogenicity and septations to predict outcomes in pleural disease.
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Affiliation(s)
- Maged Hassan
- Chest Diseases Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sally Griffiths
- Interventional Respiratory Unit, Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland
| | - Ben Probyn
- Department of Respiratory Medicine, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Ahmed S Sadaka
- Chest Diseases Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Gareth Trevelyan
- Department of Respiratory Medicine, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - David Breen
- Interventional Respiratory Unit, Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland
| | - Cyrus Daneshvar
- Department of Respiratory Medicine, University Hospitals Plymouth NHS Trust, Plymouth, UK
- Plymouth Medical School, Faculty of Health, University of Plymouth, Plymouth, UK
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12
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Inchingolo R, Ielo S, Barone R, Whalen MB, Carriera L, Smargiassi A, Sorino C, Lococo F, Feller-Kopman D. Ultrasound and Intrapleural Enzymatic Therapy for Complicated Pleural Effusion: A Case Series with a Literature Review. J Clin Med 2024; 13:4346. [PMID: 39124612 PMCID: PMC11313334 DOI: 10.3390/jcm13154346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/18/2024] [Accepted: 07/20/2024] [Indexed: 08/12/2024] Open
Abstract
Pleural effusion is the most common manifestation of pleural disease, and chest ultrasound is crucial for diagnostic workup and post-treatment monitoring. Ultrasound helps distinguish the various types of pleural effusion and enables the detection of typical manifestations of empyema, which presents as a complicated, septated effusion. This may benefit from drainage and the use of intrapleural enzyme therapy or may require more invasive approaches, such as medical or surgical thoracoscopy. The mechanism of action of intrapleural enzymatic therapy (IPET) is the activation of plasminogen to plasmin, which breaks down fibrin clots that form septa or the loculation of effusions and promotes their removal. In addition, IPET has anti-inflammatory properties and can modulate the immune response in the pleural space, resulting in reduced pleural inflammation and improved fluid reabsorption. In this article, we briefly review the literature on the efficacy of IPET and describe a case series in which most practical applications of IPET are demonstrated, i.e., as a curative treatment but also as an alternative, propaedeutic, or subsequent treatment to surgery.
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Affiliation(s)
- Riccardo Inchingolo
- UOC Pneumologia, Dipartimento Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.I.); (A.S.)
| | - Simone Ielo
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (S.I.); (R.B.); (M.B.W.); (L.C.)
| | - Roberto Barone
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (S.I.); (R.B.); (M.B.W.); (L.C.)
| | - Matteo Bernard Whalen
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (S.I.); (R.B.); (M.B.W.); (L.C.)
| | - Lorenzo Carriera
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (S.I.); (R.B.); (M.B.W.); (L.C.)
| | - Andrea Smargiassi
- UOC Pneumologia, Dipartimento Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.I.); (A.S.)
| | - Claudio Sorino
- Division of Pulmonology, Sant’Anna Hospital of Como, University of Insubria, 21100 Varese, Italy
| | - Filippo Lococo
- Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of the Sacred Heart, 00168 Rome, Italy;
| | - David Feller-Kopman
- Section of Pulmonary and Critical Care Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH 03766, USA;
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13
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Subirà C, Rognoni G, Baquerizo H, García C, Cabañes S, de la Torre M, Quevedo B, Pedrós C, Tizón AI, Murillo N, Parro L, Eiras F, Rialp G, Altaba S, González-Castro A, Pacheco AF, Bayoumi P, Gómez-Medrano N, Vallverdú I, Higón Á, Navarro MD, Falcón A, Keough E, Arizo D, Martínez JF, Durán N, Rodríguez R, Popoviciu-Koborzan MR, Guerrero I, Concha P, Barral P, Batlle M, Cano S, Garcia-Castrillon S, Andorrà X, Tua Y, Arnau A, Fernández R. Effect of lung volume preservation during spontaneous breathing trial on successful extubation in patients receiving mechanical ventilation: protocol for a multicenter clinical trial. Trials 2024; 25:481. [PMID: 39014430 PMCID: PMC11251308 DOI: 10.1186/s13063-024-08297-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/27/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND In standard weaning from mechanical ventilation, a successful spontaneous breathing test (SBT) consisting of 30 min 8 cmH2O pressure-support ventilation (PSV8) without positive end-expiratory pressure (PEEP) is followed by extubation with continuous suctioning; however, these practices might promote derecruitment. Evidence supports the feasibility and safety of extubation without suctioning. Ultrasound can assess lung aeration and respiratory muscles. We hypothesize that weaning aiming to preserve lung volume can yield higher rates of successful extubation. METHODS This multicenter superiority trial will randomly assign eligible patients to receive either standard weaning [SBT: 30-min PSV8 without PEEP followed by extubation with continuous suctioning] or lung-volume-preservation weaning [SBT: 30-min PSV8 + 5 cmH2O PEEP followed by extubation with positive pressure without suctioning]. We will compare the rates of successful extubation and reintubation, ICU and hospital stays, and ultrasound measurements of the volume of aerated lung (modified lung ultrasound score), diaphragm and intercostal muscle thickness, and thickening fraction before and after successful or failed SBT. Patients will be followed for 90 days after randomization. DISCUSSION We aim to recruit a large sample of representative patients (N = 1600). Our study cannot elucidate the specific effects of PEEP during SBT and of positive pressure during extubation; the results will show the joint effects derived from the synergy of these two factors. Although universal ultrasound monitoring of lungs, diaphragm, and intercostal muscles throughout weaning is unfeasible, if derecruitment is a major cause of weaning failure, ultrasound may help clinicians decide about extubation in high-risk and borderline patients. TRIAL REGISTRATION The Research Ethics Committee (CEIm) of the Fundació Unió Catalana d'Hospitals approved the study (CEI 22/67 and 23/26). Registered at ClinicalTrials.gov in August 2023. Identifier: NCT05526053.
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Affiliation(s)
- Carles Subirà
- Servei de Medicina Intensiva, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain.
- Grup de Recerca en Malalt Crític (GMC), Institut de Recerca I Innovació en Ciències de La Vida I de La Salut a La Catalunya Central (IRIS-CC), Vic, Spain.
- CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029, Madrid, Spain.
- Servei de Medicina Intensiva, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain.
| | - Gina Rognoni
- Grup de Recerca en Malalt Crític (GMC), Institut de Recerca I Innovació en Ciències de La Vida I de La Salut a La Catalunya Central (IRIS-CC), Vic, Spain
- Servei de Medicina Intensiva, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
- Programa de Doctorat en Medicina I Ciències Biomèdiques, Universitat de Vic- Universitat Central de Catalunya (UVIC-UCC), Vic, Spain
| | - Herbert Baquerizo
- Grup de Recerca en Malalt Crític (GMC), Institut de Recerca I Innovació en Ciències de La Vida I de La Salut a La Catalunya Central (IRIS-CC), Vic, Spain
- Servei de Medicina Intensiva, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
- Programa de Doctorat en Medicina I Ciències Biomèdiques, Universitat de Vic- Universitat Central de Catalunya (UVIC-UCC), Vic, Spain
| | - Carolina García
- Servicio de Medicina Intensiva, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Tenerife, Spain
| | - Sara Cabañes
- Servicio de Medicina Intensiva, Txagorritxu Hospital Universitario Araba, Gasteiz, Spain
| | | | - Beatriz Quevedo
- Servicio de Medicina Intensiva, Hospital Clínico Universitario de Valencia, València, Spain
| | - Cristina Pedrós
- Servei de Medicina Intensiva, Hospital General de Granollers, Granollers, Spain
| | - Ana I Tizón
- Servicio de Medicina Intensiva, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Natalia Murillo
- Servei de Medicina Intensiva, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Laura Parro
- Servicio de Medicina Intensiva, Hospital Universitario del Henrares, Coslada, Spain
| | - Fernando Eiras
- Servicio de Medicina Intensiva, Hospital Universitario de Pontevedra, Pontevedra, Spain
| | - Gemma Rialp
- Servei de Medicina Intensiva, Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - Susana Altaba
- Servicio Medicina Intensiva, Hospital General Universitario de Castellón, Castelló de La Plana, Spain
| | | | - Andrés F Pacheco
- Servei de Medicina Intensiva, Hospital Universitari de La Vall d'Hebron, Barcelona, Spain
| | - Pablo Bayoumi
- Servicio de Medicina Intensiva, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - Norma Gómez-Medrano
- Servicio de Medicina Intensiva, Hospital General Universitario de Elche, Elx, Spain
| | - Imma Vallverdú
- Servei de Medicina Intensiva, Hospital Universitari San Joan de Reus, Reus, Spain
| | - Áurea Higón
- Servicio de Medicina Intensiva, Hospital General Universitario Morales Messeguer, Murcia, Spain
| | - María D Navarro
- Servicio de Medicina Intensiva, Hospital Arnau de Vilanova, Valencia, Spain
| | - Alirio Falcón
- Servei de Medicina Intensiva, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Elena Keough
- Servicio de Medicina Intensiva, Hospital Universitario de La Princesa, Madrid, Spain
| | - David Arizo
- Servicio de Medicina Intensiva, Hospital de Sagunto, Sagunt, Spain
| | - Juan F Martínez
- Servicio de Medicina Intensiva, Hospital Regional Universitario de Málaga, Malaga, Spain
| | - Núria Durán
- Servei de Medicina Intensiva, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - Raquel Rodríguez
- CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | | | - Isabel Guerrero
- Servicio de Medicina Intensiva, Hospital Universitario Virgen de Las Nieves, Granada, Spain
| | - Pablo Concha
- Servei de Medicina Intensiva, Hospital Verge de La Cinta, Tortosa, Spain
| | - Patricia Barral
- Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Montserrat Batlle
- Grup de Recerca en Malalt Crític (GMC), Institut de Recerca I Innovació en Ciències de La Vida I de La Salut a La Catalunya Central (IRIS-CC), Vic, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Servei de Medicina Intensiva, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Sílvia Cano
- Grup de Recerca en Malalt Crític (GMC), Institut de Recerca I Innovació en Ciències de La Vida I de La Salut a La Catalunya Central (IRIS-CC), Vic, Spain
- Servei de Medicina Intensiva, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Silvia Garcia-Castrillon
- Grup de Recerca en Malalt Crític (GMC), Institut de Recerca I Innovació en Ciències de La Vida I de La Salut a La Catalunya Central (IRIS-CC), Vic, Spain
- Servei de Medicina Intensiva, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Xavier Andorrà
- Grup de Recerca en Malalt Crític (GMC), Institut de Recerca I Innovació en Ciències de La Vida I de La Salut a La Catalunya Central (IRIS-CC), Vic, Spain
- Servei de Medicina Intensiva, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Yenifher Tua
- Grup de Recerca en Malalt Crític (GMC), Institut de Recerca I Innovació en Ciències de La Vida I de La Salut a La Catalunya Central (IRIS-CC), Vic, Spain
- Servei de Medicina Intensiva, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Anna Arnau
- Unitat de Recerca I Innovació, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
- Grup de Recerca en Cronicitat de La Catalunya Central (C3RG), Institut de Recerca I Innovació en Ciències de La Vida I de La Salut a La Catalunya Central (IRIS-CC), Vic, Spain
- Facultat de Medicina, Universitat de Vic-Central de Catalunya (UVIC-UCC), Vic, Spain
| | - Rafael Fernández
- Grup de Recerca en Malalt Crític (GMC), Institut de Recerca I Innovació en Ciències de La Vida I de La Salut a La Catalunya Central (IRIS-CC), Vic, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Servei de Medicina Intensiva, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
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14
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Yang H, Gao LJ, Lei J, Li Q, Cui L, Li XH, Yin WX, Tian SH. Relationship between neonatal respiratory distress syndrome pulmonary ultrasonography and respiratory distress score, oxygenation index, and chest radiography grading. World J Clin Cases 2024; 12:4154-4165. [PMID: 39015913 PMCID: PMC11235558 DOI: 10.12998/wjcc.v12.i20.4154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/17/2024] [Accepted: 06/03/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Accurate condition assessment is critical for improving the prognosis of neonatal respiratory distress syndrome (RDS), but current assessment methods for RDS pose a cumulative risk of harm to neonates. Thus, a less harmful method for assessing the health of neonates with RDS is needed. AIM To analyze the relationships between pulmonary ultrasonography and respiratory distress scores, oxygenation index, and chest X-ray grade of neonatal RDS to identify predictors of neonatal RDS severity. METHODS This retrospective study analyzed the medical information of 73 neonates with RDS admitted to the neonatal intensive care unit of Liupanshui Maternal and Child Care Service Center between April and December 2022. The pulmonary ultrasonography score, respiratory distress score, oxygenation index, and chest X-ray grade of each newborn before and after treatment were collected. Spearman correlation analysis was performed to determine the relationships among these values and neonatal RDS severity. RESULTS The pulmonary ultrasonography score, respiratory distress score, oxygenation index, and chest X-ray RDS grade of the neonates were significantly lower after treatment than before treatment (P < 0.05). Spearman correlation analysis showed that before and after treatment, the pulmonary ultrasonography score of neonates with RDS was positively correlated with the respiratory distress score, oxygenation index, and chest X-ray grade (ρ = 0.429-0.859, P < 0.05). Receiver operating characteristic curve analysis indicated that pulmonary ultrasonography screening effectively predicted the severity of neonatal RDS (area under the curve = 0.805-1.000, P < 0.05). CONCLUSION The pulmonary ultrasonography score was significantly associated with the neonatal RDS score, oxygenation index, and chest X-ray grade. The pulmonary ultrasonography score was an effective predictor of neonatal RDS severity.
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Affiliation(s)
- Hai Yang
- Neonatal Intensive Care Center, Liupanshui Maternal and Child Care Service Center, Liupanshui 553000, Guizhou Province, China
| | - Li-Jun Gao
- Ultrasound Function Department, Liupanshui Maternal and Child Care Service Center, Liupanshui 553000, Guizhou Province, China
| | - Jing Lei
- Neonatal Intensive Care Center, Liupanshui Maternal and Child Care Service Center, Liupanshui 553000, Guizhou Province, China
| | - Qiang Li
- Neonatal Intensive Care Center, Liupanshui Maternal and Child Care Service Center, Liupanshui 553000, Guizhou Province, China
| | - Liu Cui
- Neonatal Intensive Care Center, Liupanshui Maternal and Child Care Service Center, Liupanshui 553000, Guizhou Province, China
| | - Xiao-Hua Li
- Neonatal Intensive Care Center, Liupanshui Maternal and Child Care Service Center, Liupanshui 553000, Guizhou Province, China
| | - Wu-Xuan Yin
- Neonatal Intensive Care Center, Liupanshui Maternal and Child Care Service Center, Liupanshui 553000, Guizhou Province, China
| | - Sen-Hua Tian
- Medical Imaging Department, Liupanshui Maternal and Child Care Service Center, Liupanshui 553000, Guizhou Province, China
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15
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Duggan NM, Jin M, Duran Mendicuti MA, Hallisey S, Bernier D, Selame LA, Asgari-Targhi A, Fischetti CE, Lucassen R, Samir AE, Duhaime E, Kapur T, Goldsmith AJ. Gamified Crowdsourcing as a Novel Approach to Lung Ultrasound Data Set Labeling: Prospective Analysis. J Med Internet Res 2024; 26:e51397. [PMID: 38963923 PMCID: PMC11258523 DOI: 10.2196/51397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/04/2023] [Accepted: 04/10/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Machine learning (ML) models can yield faster and more accurate medical diagnoses; however, developing ML models is limited by a lack of high-quality labeled training data. Crowdsourced labeling is a potential solution but can be constrained by concerns about label quality. OBJECTIVE This study aims to examine whether a gamified crowdsourcing platform with continuous performance assessment, user feedback, and performance-based incentives could produce expert-quality labels on medical imaging data. METHODS In this diagnostic comparison study, 2384 lung ultrasound clips were retrospectively collected from 203 emergency department patients. A total of 6 lung ultrasound experts classified 393 of these clips as having no B-lines, one or more discrete B-lines, or confluent B-lines to create 2 sets of reference standard data sets (195 training clips and 198 test clips). Sets were respectively used to (1) train users on a gamified crowdsourcing platform and (2) compare the concordance of the resulting crowd labels to the concordance of individual experts to reference standards. Crowd opinions were sourced from DiagnosUs (Centaur Labs) iOS app users over 8 days, filtered based on past performance, aggregated using majority rule, and analyzed for label concordance compared with a hold-out test set of expert-labeled clips. The primary outcome was comparing the labeling concordance of collated crowd opinions to trained experts in classifying B-lines on lung ultrasound clips. RESULTS Our clinical data set included patients with a mean age of 60.0 (SD 19.0) years; 105 (51.7%) patients were female and 114 (56.1%) patients were White. Over the 195 training clips, the expert-consensus label distribution was 114 (58%) no B-lines, 56 (29%) discrete B-lines, and 25 (13%) confluent B-lines. Over the 198 test clips, expert-consensus label distribution was 138 (70%) no B-lines, 36 (18%) discrete B-lines, and 24 (12%) confluent B-lines. In total, 99,238 opinions were collected from 426 unique users. On a test set of 198 clips, the mean labeling concordance of individual experts relative to the reference standard was 85.0% (SE 2.0), compared with 87.9% crowdsourced label concordance (P=.15). When individual experts' opinions were compared with reference standard labels created by majority vote excluding their own opinion, crowd concordance was higher than the mean concordance of individual experts to reference standards (87.4% vs 80.8%, SE 1.6 for expert concordance; P<.001). Clips with discrete B-lines had the most disagreement from both the crowd consensus and individual experts with the expert consensus. Using randomly sampled subsets of crowd opinions, 7 quality-filtered opinions were sufficient to achieve near the maximum crowd concordance. CONCLUSIONS Crowdsourced labels for B-line classification on lung ultrasound clips via a gamified approach achieved expert-level accuracy. This suggests a strategic role for gamified crowdsourcing in efficiently generating labeled image data sets for training ML systems.
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Affiliation(s)
- Nicole M Duggan
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Mike Jin
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
- Centaur Labs, Boston, MA, United States
| | | | - Stephen Hallisey
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Denie Bernier
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Lauren A Selame
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Ameneh Asgari-Targhi
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Chanel E Fischetti
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Ruben Lucassen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Anthony E Samir
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | | | - Tina Kapur
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Andrew J Goldsmith
- Department of Emergency Medicine, Lahey Hospital, University of Massachusetts Medical School, Burlington, MA, United States
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Lepri G, Markovic M, Bellando-Randone S, Sebastiani M, Guiducci S. The Burden of Interstitial Lung Involvement in Rheumatoid Arthritis: Could Lung Ultrasound Have a Role in Its Detection? A Literature Review. Diagnostics (Basel) 2024; 14:1430. [PMID: 39001320 PMCID: PMC11241826 DOI: 10.3390/diagnostics14131430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/19/2024] [Accepted: 06/25/2024] [Indexed: 07/16/2024] Open
Abstract
Lung involvement represents a fearful complication in rheumatoid arthritis (RA), potentially involving all compartments of the pulmonary system. Regarding interstitial lung disease (ILD), the HRCT represents the gold standard technique for its diagnosis; however, the examination is burdened by radiation exposure and high costs. In addition, although some risk factors for ILD are known, no algorithms exist to know which patients to submit to HRCT and when. In this context, lung ultrasound (LUS) showed promising results for at least 10 years, demonstrating correlation with high resolution computed tomography (HRCT) findings in other rheumatic diseases. Here, LUS may represent a screening test providing additional information to clinical examination and pulmonary function tests. The data deriving from LUS experience in other rheumatic diseases could steer the future towards the use of this technique also in RA patients, and in this review, we report the most relevant literature regarding LUS in RA-ILD.
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Affiliation(s)
- Gemma Lepri
- Division of Rheumatology, AOU Careggi, Department of Experimental and Clinical Medicine, University of Florence, Via delle Oblate 4, 50141 Florence, Italy
| | - Milica Markovic
- Division of Rheumatology, AOU Careggi, Department of Experimental and Clinical Medicine, University of Florence, Via delle Oblate 4, 50141 Florence, Italy
| | - Silvia Bellando-Randone
- Division of Rheumatology, AOU Careggi, Department of Experimental and Clinical Medicine, University of Florence, Via delle Oblate 4, 50141 Florence, Italy
| | - Marco Sebastiani
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Rheumatology Unit, Hospital Guglielmo da Saliceto, 29121 Piacenza, Italy
| | - Serena Guiducci
- Division of Rheumatology, AOU Careggi, Department of Experimental and Clinical Medicine, University of Florence, Via delle Oblate 4, 50141 Florence, Italy
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Gevaerd Martins J, Saad A, Saade G, Pacheco LD. The role of point-of-care ultrasound to monitor response of fluid replacement therapy in pregnancy. Am J Obstet Gynecol 2024:S0002-9378(24)00730-0. [PMID: 38969197 DOI: 10.1016/j.ajog.2024.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/05/2024] [Accepted: 06/15/2024] [Indexed: 07/07/2024]
Abstract
Fluid management in obstetrical care is crucial because of the complex physiological conditions of pregnancy, which complicate clinical manifestations and fluid balance management. This expert review examined the use of point-of-care ultrasound to evaluate and monitor the response to fluid therapy in pregnant patients. Pregnancy induces substantial physiological changes, including increased cardiac output and glomerular filtration rate, decreased systemic vascular resistance, and decreased plasma oncotic pressure. Conditions, such as preeclampsia, further complicate fluid management because of decreased intravascular volume and increased capillary permeability. Traditional methods for assessing fluid volume status, such as physical examination and invasive monitoring, are often unreliable or inappropriate. Point-of-care ultrasound provides a noninvasive, rapid, and reliable means to assess fluid responsiveness, which is essential for managing fluid therapy in pregnant patients. This review details the various point-of-care ultrasound modalities used to measure dynamic changes in fluid status, focusing on the evaluation of the inferior vena cava, lung ultrasound, and left ventricular outflow tract. Inferior vena cava ultrasound in spontaneously breathing patients determines diameter variability, predicts fluid responsiveness, and is feasible even late in pregnancy. Lung ultrasound is crucial for detecting early signs of pulmonary edema before clinical symptoms arise and is more accurate than traditional radiography. The left ventricular outflow tract velocity time integral assesses stroke volume response to fluid challenges, providing a quantifiable measure of cardiac function, which is particularly beneficial in critical care settings where rapid and accurate fluid management is essential. This expert review synthesizes current evidence and practice guidelines, suggesting the integration of point-of-care ultrasound as a fundamental aspect of fluid management in obstetrics. It calls for ongoing research to enhance techniques and validate their use in broader clinical settings, aiming to improve outcomes for pregnant patients and their babies by preventing complications associated with both under- and overresuscitation.
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Affiliation(s)
| | - Antonio Saad
- Department of Obstetrics and Gynecology, Inova Maternal-Fetal Medicine, Fairfax, VA
| | - George Saade
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA
| | - Luis D Pacheco
- Departments of Obstetrics and Gynecology and Anesthesiology, The University of Texas Medical Branch, Galveston, TX
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18
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Sharma A, Kumar G, Nagpal R, Naranje K, Sengupta A, Jagannath V, Suryawanshi S, Suryawanshi P. Efficacy of an online lung ultrasound module on skill acquisition by clinician: a new paradigm. Front Pediatr 2024; 12:1406630. [PMID: 38919839 PMCID: PMC11197977 DOI: 10.3389/fped.2024.1406630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/22/2024] [Indexed: 06/27/2024] Open
Abstract
Introduction Lung ultrasound (LUS) as an assessment tool has seen significant expansion in adult, paediatric, and neonatal populations due to advancements in point-of-care ultrasound over the past two decades. However, with fewer experts and learning platforms available in low- and middle-income countries and the lack of a standardised supervised training programme, LUS is not currently effectively used to the best of its potential in neonatal units. Methodology A cross-sectional survey assessed the efficacy of learning LUS via a mentor-based online teaching module (NEOPOCUS). The questionnaire comprised the clinicians' demographic profile, pre-course skills, and self-assessment of skill acquisition after course completion with ongoing hands-on practice. Results A total of 175 clinicians responded to the survey, with the majority (87.9%) working in level 3 and 4 neonatal intensive care units. Clinicians had variable clinical experience. Of them, 53.2% were consultant paediatricians/neonatologists with over 10 years of experience. After the course, there was a significant increase in clinician confidence levels in diagnosing and assessing all LUS pathology, as evidenced by the increase in median cumulative scores [from baseline 6 (interquartile range, IQR, 6-9) to 20 (IQR 16-24), p < 0.001] with half of them gaining confidence within 3 months of the course. Conclusion An online curriculum-based neonatal lung ultrasound training programme with clinician image demonstration and peer review of images for image optimisation increases self-reported confidence in diagnosing and managing neonatal lung pathology. Web-based online training in neonatal lung ultrasound has merits that can help with the delivery of training globally, and especially in low- and middle-income countries.
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Affiliation(s)
- Alok Sharma
- Department of Neonatal Medicine, Corniche Hospital, Abu Dhabi, United Arab Emirates
| | - Gunjana Kumar
- Department of Neonatology, National Institute of Medical Sciences and Research, Jaipur, India
| | - Rema Nagpal
- Department of Neonatology, Bharati Vidyapeeth University Medical College, Hospital, and Research Centre, Pune, India
| | - Kirti Naranje
- Department of Neonatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Arnab Sengupta
- Department of Pediatrics, University of Toledo College of Medicine, Toledo, OH, United States
| | - Vanitha Jagannath
- Department of Pediatrics, American Mission Hospital, Manama, Bahrain
| | - Sonali Suryawanshi
- Department of Pharmacology, Bharati Vidyapeeth University Medical College, Hospital, and Research Centre, Pune, India
| | - Pradeep Suryawanshi
- Department of Neonatology, Bharati Vidyapeeth University Medical College, Hospital, and Research Centre, Pune, India
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19
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Zimna K, Sobiecka M, Wakuliński J, Wyrostkiewicz D, Jankowska E, Szturmowicz M, Tomkowski WZ. Lung Ultrasonography in the Evaluation of Late Sequelae of COVID-19 Pneumonia-A Comparison with Chest Computed Tomography: A Prospective Study. Viruses 2024; 16:905. [PMID: 38932196 PMCID: PMC11209275 DOI: 10.3390/v16060905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/22/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
The onset of the COVID-19 pandemic allowed physicians to gain experience in lung ultrasound (LUS) during the acute phase of the disease. However, limited data are available on LUS findings during the recovery phase. The aim of this study was to evaluate the utility of LUS to assess lung involvement in patients with post-COVID-19 syndrome. This study prospectively enrolled 72 patients who underwent paired LUS and chest CT scans (112 pairs including follow-up). The most frequent CT findings were ground glass opacities (83.3%), subpleural lines (72.2%), traction bronchiectasis (37.5%), and consolidations (31.9%). LUS revealed irregular pleural lines as a common abnormality initially (56.9%), along with subpleural consolidation >2.5 mm ≤10 mm (26.5%) and B-lines (26.5%). A strong correlation was found between LUS score, calculated by artificial intelligence percentage involvement in ground glass opacities described in CT (r = 0.702, p < 0.05). LUS score was significantly higher in the group with fibrotic changes compared to the non-fibrotic group with a mean value of 19.4 ± 5.7 to 11 ± 6.6, respectively (p < 0.0001). LUS might be considered valuable for examining patients with persistent symptoms after recovering from COVID-19 pneumonia. Abnormalities identified through LUS align with CT scan findings; thus, LUS might potentially reduce the need for frequent chest CT examinations.
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Affiliation(s)
- Katarzyna Zimna
- I Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Małgorzata Sobiecka
- I Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Jacek Wakuliński
- Department of Radiology, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Dorota Wyrostkiewicz
- I Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Ewa Jankowska
- I Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Monika Szturmowicz
- I Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
| | - Witold Z. Tomkowski
- I Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, 01-138 Warsaw, Poland
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20
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Pereira D, Pereira S, Neves C, Segura E, Assunção JP. Bedside ultrasound in post-anaesthetic care unit for the diagnosis of post-extubation negative pressure pulmonary oedema: A paediatric case. J Perioper Pract 2024; 34:195-198. [PMID: 37886901 DOI: 10.1177/17504589231193553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND Post-extubation negative pressure pulmonary oedema is a rare, potentially life-threatening complication associated with general anaesthesia. Chest radiography is used as a diagnostic tool, but it implies a non-negligible radiation exposure, a very important consideration, especially for the paediatric population. However, lung ultrasound can overcome this problem and can be used to detect postoperative pulmonary complications. CASE REPORT A 16-year-old male was scheduled for tympanoplasty. General anaesthesia was conducted, and after extubation, the patient developed a laryngospasm. On arrival at the post-anaesthetic care unit, the patient started to cough, a pink frothy sputum and hypoxemia were noticed, and auscultation revealed crepitations. A bedside lung ultrasound showed more than three B-lines per intercostal window, suggesting an alveolar-interstitial syndrome. DISCUSSION With this case report, we would like to raise awareness to this clinical entity and demonstrate bedside ultrasound has an important role in the diagnostic and therapeutic assessment during the perioperative period.
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Affiliation(s)
- Dulce Pereira
- Anaesthesiology Department, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Sofia Pereira
- Anaesthesiology Department, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Clarinda Neves
- Anaesthesiology Department, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Elena Segura
- Anaesthesiology Department, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - José Pedro Assunção
- Anaesthesiology Department, Centro Hospitalar Tondela Viseu, Viseu, Portugal
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21
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Wu D, Smith D, VanBerlo B, Roshankar A, Lee H, Li B, Ali F, Rahman M, Basmaji J, Tschirhart J, Ford A, VanBerlo B, Durvasula A, Vannelli C, Dave C, Deglint J, Ho J, Chaudhary R, Clausdorff H, Prager R, Millington S, Shah S, Buchanan B, Arntfield R. Improving the Generalizability and Performance of an Ultrasound Deep Learning Model Using Limited Multicenter Data for Lung Sliding Artifact Identification. Diagnostics (Basel) 2024; 14:1081. [PMID: 38893608 PMCID: PMC11172006 DOI: 10.3390/diagnostics14111081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Deep learning (DL) models for medical image classification frequently struggle to generalize to data from outside institutions. Additional clinical data are also rarely collected to comprehensively assess and understand model performance amongst subgroups. Following the development of a single-center model to identify the lung sliding artifact on lung ultrasound (LUS), we pursued a validation strategy using external LUS data. As annotated LUS data are relatively scarce-compared to other medical imaging data-we adopted a novel technique to optimize the use of limited external data to improve model generalizability. Externally acquired LUS data from three tertiary care centers, totaling 641 clips from 238 patients, were used to assess the baseline generalizability of our lung sliding model. We then employed our novel Threshold-Aware Accumulative Fine-Tuning (TAAFT) method to fine-tune the baseline model and determine the minimum amount of data required to achieve predefined performance goals. A subgroup analysis was also performed and Grad-CAM++ explanations were examined. The final model was fine-tuned on one-third of the external dataset to achieve 0.917 sensitivity, 0.817 specificity, and 0.920 area under the receiver operator characteristic curve (AUC) on the external validation dataset, exceeding our predefined performance goals. Subgroup analyses identified LUS characteristics that most greatly challenged the model's performance. Grad-CAM++ saliency maps highlighted clinically relevant regions on M-mode images. We report a multicenter study that exploits limited available external data to improve the generalizability and performance of our lung sliding model while identifying poorly performing subgroups to inform future iterative improvements. This approach may contribute to efficiencies for DL researchers working with smaller quantities of external validation data.
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Affiliation(s)
- Derek Wu
- Department of Medicine, Western University, London, ON N6A 5C1, Canada;
| | - Delaney Smith
- Faculty of Mathematics, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (D.S.); (H.L.)
| | - Blake VanBerlo
- Faculty of Mathematics, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (D.S.); (H.L.)
| | - Amir Roshankar
- Faculty of Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (A.R.); (B.L.); (F.A.); (M.R.)
| | - Hoseok Lee
- Faculty of Mathematics, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (D.S.); (H.L.)
| | - Brian Li
- Faculty of Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (A.R.); (B.L.); (F.A.); (M.R.)
| | - Faraz Ali
- Faculty of Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (A.R.); (B.L.); (F.A.); (M.R.)
| | - Marwan Rahman
- Faculty of Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (A.R.); (B.L.); (F.A.); (M.R.)
| | - John Basmaji
- Division of Critical Care Medicine, Western University, London, ON N6A 5C1, Canada; (J.B.); (C.D.); (R.P.); (R.A.)
| | - Jared Tschirhart
- Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada; (J.T.); (A.D.); (C.V.)
| | - Alex Ford
- Independent Researcher, London, ON N6A 1L8, Canada;
| | - Bennett VanBerlo
- Faculty of Engineering, Western University, London, ON N6A 5C1, Canada;
| | - Ashritha Durvasula
- Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada; (J.T.); (A.D.); (C.V.)
| | - Claire Vannelli
- Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada; (J.T.); (A.D.); (C.V.)
| | - Chintan Dave
- Division of Critical Care Medicine, Western University, London, ON N6A 5C1, Canada; (J.B.); (C.D.); (R.P.); (R.A.)
| | - Jason Deglint
- Faculty of Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (A.R.); (B.L.); (F.A.); (M.R.)
| | - Jordan Ho
- Department of Family Medicine, Western University, London, ON N6A 5C1, Canada;
| | - Rushil Chaudhary
- Department of Medicine, Western University, London, ON N6A 5C1, Canada;
| | - Hans Clausdorff
- Departamento de Medicina de Urgencia, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile;
| | - Ross Prager
- Division of Critical Care Medicine, Western University, London, ON N6A 5C1, Canada; (J.B.); (C.D.); (R.P.); (R.A.)
| | - Scott Millington
- Department of Critical Care Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Samveg Shah
- Department of Medicine, University of Alberta, Edmonton, AB T6G 2R3, Canada;
| | - Brian Buchanan
- Department of Critical Care, University of Alberta, Edmonton, AB T6G 2R3, Canada;
| | - Robert Arntfield
- Division of Critical Care Medicine, Western University, London, ON N6A 5C1, Canada; (J.B.); (C.D.); (R.P.); (R.A.)
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22
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Zhang Q, Song R, Hang J, Wei S, Zhu Y, Zhang G, Ding B, Ye X, Guo X, Zhang D, Wu P, Lin H, Tu J. A lung disease diagnosis algorithm based on 2D spectral features of ultrasound RF signals. ULTRASONICS 2024; 140:107315. [PMID: 38603903 DOI: 10.1016/j.ultras.2024.107315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/19/2024] [Accepted: 04/06/2024] [Indexed: 04/13/2024]
Abstract
Lung diseases are commonly diagnosed based on clinical pathological indications criteria and radiological imaging tools (e.g., X-rays and CT). During a pandemic like COVID-19, the use of ultrasound imaging devices has broadened for emergency examinations by taking their unique advantages such as portability, real-time detection, easy operation and no radiation. This provides a rapid, safe, and cost-effective imaging modality for screening lung diseases. However, the current pulmonary ultrasound diagnosis mainly relies on the subjective assessments of sonographers, which has high requirements for the operator's professional ability and clinical experience. In this study, we proposed an objective and quantifiable algorithm for the diagnosis of lung diseases that utilizes two-dimensional (2D) spectral features of ultrasound radiofrequency (RF) signals. The ultrasound data samples consisted of a set of RF signal frames, which were collected by professional sonographers. In each case, a region of interest of uniform size was delineated along the pleural line. The standard deviation curve of the 2D spatial spectrum was calculated and smoothed. A linear fit was applied to the high-frequency segment of the processed data curve, and the slope of the fitted line was defined as the frequency spectrum standard deviation slope (FSSDS). Based on the current data, the method exhibited a superior diagnostic sensitivity of 98% and an accuracy of 91% for the identification of lung diseases. The area under the curve obtained by the current method exceeded the results obtained that interpreted by professional sonographers, which indicated that the current method could provide strong support for the clinical ultrasound diagnosis of lung diseases.
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Affiliation(s)
- Qi Zhang
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Renjie Song
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Jing Hang
- Department of Ultrasound, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
| | - Siqi Wei
- Department of Ultrasound, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yifei Zhu
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Guofeng Zhang
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Bo Ding
- Zhuhai Ecare Electronics Science & Technology Co., Ltd., Zhuhai 519041, China
| | - Xinhua Ye
- Department of Ultrasound, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xiasheng Guo
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Dong Zhang
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China
| | - Pingping Wu
- Jiangsu Key Laboratory of Public Project Audit, Nanjing Audit University, Nanjing 211815, China
| | - Han Lin
- Jiangsu Key Laboratory of Public Project Audit, Nanjing Audit University, Nanjing 211815, China.
| | - Juan Tu
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing 210093, China.
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23
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Howell L, Ingram N, Lapham R, Morrell A, McLaughlan JR. Deep learning for real-time multi-class segmentation of artefacts in lung ultrasound. ULTRASONICS 2024; 140:107251. [PMID: 38520819 DOI: 10.1016/j.ultras.2024.107251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 12/20/2023] [Accepted: 01/17/2024] [Indexed: 03/25/2024]
Abstract
Lung ultrasound (LUS) has emerged as a safe and cost-effective modality for assessing lung health, particularly during the COVID-19 pandemic. However, interpreting LUS images remains challenging due to its reliance on artefacts, leading to operator variability and limiting its practical uptake. To address this, we propose a deep learning pipeline for multi-class segmentation of objects (ribs, pleural line) and artefacts (A-lines, B-lines, B-line confluence) in ultrasound images of a lung training phantom. Lightweight models achieved a mean Dice Similarity Coefficient (DSC) of 0.74, requiring fewer than 500 training images. Applying this method in real-time, at up to 33.4 frames per second in inference, allows enhanced visualisation of these features in LUS images. This could be useful in providing LUS training and helping to address the skill gap. Moreover, the segmentation masks obtained from this model enable the development of explainable measures of disease severity, which have the potential to assist in the triage and management of patients. We suggest one such semi-quantitative measure called the B-line Artefact Score, which is related to the percentage of an intercostal space occupied by B-lines and in turn may be associated with the severity of a number of lung conditions. Moreover, we show how transfer learning could be used to train models for small datasets of clinical LUS images, identifying pathologies such as simple pleural effusions and lung consolidation with DSC values of 0.48 and 0.32 respectively. Finally, we demonstrate how such DL models could be translated into clinical practice, implementing the phantom model alongside a portable point-of-care ultrasound system, facilitating bedside assessment and improving the accessibility of LUS.
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Affiliation(s)
- Lewis Howell
- School of Computing, University of Leeds, Leeds, LS2 9JT, UK; School of Electronic and Electrical Engineering, University of Leeds, Leeds, LS2 9JT, UK
| | - Nicola Ingram
- Leeds Institute of Medical Research, University of Leeds, St James' University Hospital, Leeds, LS9 7TF, UK
| | - Roger Lapham
- Radiology Department, Leeds Teaching Hospital Trust, Leeds General Infirmary, Leeds, LS1 3EX, UK
| | - Adam Morrell
- Radiology Department, Leeds Teaching Hospital Trust, Leeds General Infirmary, Leeds, LS1 3EX, UK
| | - James R McLaughlan
- School of Electronic and Electrical Engineering, University of Leeds, Leeds, LS2 9JT, UK; Leeds Institute of Medical Research, University of Leeds, St James' University Hospital, Leeds, LS9 7TF, UK.
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24
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Snelling PJ, Jones P, Connolly R, Jelic T, Mirsch D, Myslik F, Phillips L, Blecher G. Comparison of lung ultrasound scoring systems for the prognosis of COVID-19 in the emergency department: An international prospective cohort study. Australas J Ultrasound Med 2024; 27:75-88. [PMID: 38784699 PMCID: PMC11109992 DOI: 10.1002/ajum.12364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Purpose The purpose of this study was to evaluate whether the lung ultrasound (LUS) scores applied to an international cohort of patients presenting to the emergency department (ED) with suspected COVID-19, and subsequently admitted with proven disease, could prognosticate clinical outcomes. Methods This was an international, multicentre, prospective, observational cohort study of patients who received LUS and were followed for the composite primary outcome of intubation, intensive care unit (ICU) admission or death. LUS scores were later applied including two 12-zone protocols ('de Alencar score' and 'CLUE score'), a 12-zone protocol with lung and pleural findings ('Ji score') and an 11-zone protocol ('Tung-Chen score'). The primary analysis comprised logistic regression modelling of the composite primary outcome, with the LUS scores analysed individually as predictor variables. Results Between April 2020 to April 2022, 129 patients with COVID-19 had LUS performed according to the protocol and 24 (18.6%) met the composite primary endpoint. No association was seen between the LUS score and the composite primary end point for the de Alencar score [odds ratio (OR) = 1.04; 95% confidence interval (CI): 0.97-1.11; P = 0.29], the CLUE score (OR = 1.03; 95% CI: 0.96-1.10; P = 0.40), the Ji score (OR = 1.02; 95% CI: 0.97-1.07; P = 0.40) or the Tung-Chen score (OR = 1.02; 95% CI: 0.97-1.08). Discussion Compared to these earlier studies performed at the start of the pandemic, the negative outcome of our study could reflect the changing scenario of the COVID-19 pandemic, including patient, disease, and system factors. The analysis suggests that the study may have been underpowered to detect a weaker association between a LUS score and the primary outcome. Conclusion In an international cohort of adult patients presenting to the ED with suspected COVID-19 disease who had LUS performed and were subsequently admitted to hospital, LUS severity scores did not prognosticate the need for invasive ventilation, ICU admission or death.
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Affiliation(s)
- Peter J Snelling
- Department of Emergency MedicineGold Coast University HospitalSouthportQueenslandAustralia
- School of Medicine and DentistryGriffith UniversitySouthportQueenslandAustralia
- Sonography Innovation and Research GroupSouthportQueenslandAustralia
| | - Philip Jones
- Department of Emergency MedicineGold Coast University HospitalSouthportQueenslandAustralia
- School of Medicine and DentistryGriffith UniversitySouthportQueenslandAustralia
- Sonography Innovation and Research GroupSouthportQueenslandAustralia
| | - Rory Connolly
- Department of Emergency MedicineUniversity of OttawaOttawaOntarioCanada
| | - Tomislav Jelic
- Department of Emergency MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Dan Mirsch
- Department of Emergency MedicineUniversity at BuffaloBuffaloNew YorkUSA
| | - Frank Myslik
- Division of Emergency MedicineWestern UniversityLondonOntarioCanada
| | - Luke Phillips
- Department of Emergency MedicineAlfred HospitalMelbourneVictoriaAustralia
- Department of Epidemiology and Preventative MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Gabriel Blecher
- Emergency Services, Peninsula HealthFrankstonVictoriaAustralia
- Peninsula Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
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25
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Iadevaia C, D’Agnano V, Pagliaro R, Nappi F, Lucci R, Massa S, Bianco A, Perrotta F. Diagnostic Accuracy of Ultrasound Guided Percutaneous Pleural Needle Biopsy for Malignant Pleural Mesothelioma. J Clin Med 2024; 13:2600. [PMID: 38731129 PMCID: PMC11084858 DOI: 10.3390/jcm13092600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/10/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Background/Objectives: Ultrasound (US) has been progressively spreading as the most useful technique for guiding biopsies and fine-needle aspirations that are performed percutaneously. Malignant pleural mesothelioma (MPM) represents the most common malignant pleural tumour. Thoracoscopy represents the gold standard for diagnosis, although conditions hampering such diagnostic approach often coexist. The Objective was to determine whether ultrasound-guided percutaneous needle biopsy (US-PPNB) has a high diagnostic accuracy and represents a safe option for diagnosis of MPM. Methods: US-PPNB of pleural lesions suspected for MPM in patients admitted from January 2021 to June 2023 have been retrospectively analyzed. An 18-gauge semi-automatic spring-loaded biopsy system (Medax Velox 2®) was used by experienced pneumologists. The obtained specimens were histologically evaluated and defined as adequate or non-adequate for diagnosis according to whether the material was considered appropriate or not for immunohistochemistry (IHC) analysis. The primary objective of the study was the diagnostic yield for a tissue diagnosis. Results: US-PPNB was diagnostic of MPM in 15 out of 18 patients (sensitivity: 83.39%; specificity: 100%; PPV: 100%). Three patients with non-adequate US-PPNB underwent thoracoscopy for diagnosis. We found significant differences in terms of mean pleural lesion thickness between patients with adequate and not-adequate biopsy (15.4 mm (SD: 9.19 mm) and 3.77 mm (SD: 0.60 mm), p < 0.0010. In addition, a significant positive correlation has been observed between diagnostic accuracy and FDG-PET avidity value. Conclusions: US-PPNB performed by a pneumologist represents a valid procedure with a high diagnostic yield and accuracy for the diagnosis of MPM, and may be considered as an alternative option in patients who are not suitable for thoracoscopy.
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Affiliation(s)
- Carlo Iadevaia
- U.O.C. Clinica Pneumologica L.Vanvitelli, Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (C.I.); (V.D.); (R.P.); (A.B.)
| | - Vito D’Agnano
- U.O.C. Clinica Pneumologica L.Vanvitelli, Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (C.I.); (V.D.); (R.P.); (A.B.)
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy
| | - Raffaella Pagliaro
- U.O.C. Clinica Pneumologica L.Vanvitelli, Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (C.I.); (V.D.); (R.P.); (A.B.)
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy
| | - Felice Nappi
- Department of Respiratory Medicine, Boscotrecase COVID Hospital, 80042 Boscotrecase, Italy;
| | - Raffaella Lucci
- Unit of Pathology, Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (R.L.); (S.M.)
| | - Simona Massa
- Unit of Pathology, Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (R.L.); (S.M.)
| | - Andrea Bianco
- U.O.C. Clinica Pneumologica L.Vanvitelli, Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (C.I.); (V.D.); (R.P.); (A.B.)
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy
| | - Fabio Perrotta
- U.O.C. Clinica Pneumologica L.Vanvitelli, Monaldi Hospital, A.O. dei Colli, 80131 Naples, Italy; (C.I.); (V.D.); (R.P.); (A.B.)
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy
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Panisello-Tafalla A, Haro-Montoya M, Caballol-Angelats R, Montelongo-Sol M, Rodriguez-Carralero Y, Lucas-Noll J, Clua-Espuny JL. Prognostic Significance of Lung Ultrasound for Heart Failure Patient Management in Primary Care: A Systematic Review. J Clin Med 2024; 13:2460. [PMID: 38730988 PMCID: PMC11084515 DOI: 10.3390/jcm13092460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/02/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Heart failure (HF) affects around 60 million individuals worldwide. The primary aim of this study was to evaluate the efficacy of lung ultrasound (LUS) in managing HF with the goal of reducing hospital readmission rates. Methods: A systematic search was conducted on PubMed, Embase, Google Scholar, Web of Science, and Scopus, covering clinical trials, meta-analyses, systematic reviews, and original articles published between 1 January 2019 and 31 December 2023, focusing on LUS for HF assessment in out-patient settings. There is a potential for bias as the effectiveness of interventions may vary depending on the individuals administering them. Results: The PRISMA method synthesized the findings. Out of 873 articles identified, 33 were selected: 19 articles focused on prognostic assessment of HF, 11 centred on multimodal diagnostic assessments, and two addressed therapeutic guidance for HF diagnosis. LUS demonstrates advantages in detecting subclinical congestion, which holds prognostic significance for readmission and mortality during out-patient follow-up post-hospital-discharge, especially in complex scenarios, but there is a lack of standardization. Conclusions: there are considerable uncertainties in their interpretation and monitoring changes. The need for an updated international consensus on the use of LUS seems obvious.
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Affiliation(s)
- Anna Panisello-Tafalla
- Institut Català de la Salut (ICS), SAP Terres de l’Ebre, Primary Care Health Tortosa-est, 43500 Tortosa, Spain
- Programa Doctorado Biomedicines, University Rovira-Virgili, Campus Terres de l’Ebre, 43500 Tortosa, Spain
| | - Marcos Haro-Montoya
- Institut Català de la Salut (ICS), SAP Terres de l’Ebre, Unitat Docent Terres de l’Ebre-Tortosa, Primary Health Care Tortosa-est, 43500 Tortosa, Spain; (M.H.-M.); (M.M.-S.); (Y.R.-C.)
| | - Rosa Caballol-Angelats
- Institut Català de la Salut (ICS), SAP Terres de l’Ebre, Family and Community Medicine Unit in Primary Care Health Tortosa-est, 43500 Tortosa, Spain;
| | - Maylin Montelongo-Sol
- Institut Català de la Salut (ICS), SAP Terres de l’Ebre, Unitat Docent Terres de l’Ebre-Tortosa, Primary Health Care Tortosa-est, 43500 Tortosa, Spain; (M.H.-M.); (M.M.-S.); (Y.R.-C.)
| | - Yoenia Rodriguez-Carralero
- Institut Català de la Salut (ICS), SAP Terres de l’Ebre, Unitat Docent Terres de l’Ebre-Tortosa, Primary Health Care Tortosa-est, 43500 Tortosa, Spain; (M.H.-M.); (M.M.-S.); (Y.R.-C.)
| | | | - Josep Lluis Clua-Espuny
- Institut Català de la Salut (ICS), SAP Terres de l’Ebre, Primary Care Health Tortosa-est, 43500 Tortosa, Spain
- Programa Doctorado Biomedicines, University Rovira-Virgili, Campus Terres de l’Ebre, 43500 Tortosa, Spain
- Institut Català de la Salut (ICS), SAP Terres de l’Ebre, Family and Community Medicine Unit in Primary Care Health Tortosa-est, 43500 Tortosa, Spain;
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), SAP Terres de l’Ebre, Institut Català de la Salut, 43500 Tortosa, Spain
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27
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Xing W, He C, Ma Y, Liu Y, Zhu Z, Li Q, Li W, Chen J, Ta D. Combining quantitative and qualitative analysis for scoring pleural line in lung ultrasound. Phys Med Biol 2024; 69:095008. [PMID: 38537298 DOI: 10.1088/1361-6560/ad3888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/27/2024] [Indexed: 04/18/2024]
Abstract
Objective.Accurate assessment of pleural line is crucial for the application of lung ultrasound (LUS) in monitoring lung diseases, thereby aim of this study is to develop a quantitative and qualitative analysis method for pleural line.Approach.The novel cascaded deep learning model based on convolution and multilayer perceptron was proposed to locate and segment the pleural line in LUS images, whose results were applied for quantitative analysis of textural and morphological features, respectively. By using gray-level co-occurrence matrix and self-designed statistical methods, eight textural and three morphological features were generated to characterize the pleural lines. Furthermore, the machine learning-based classifiers were employed to qualitatively evaluate the lesion degree of pleural line in LUS images.Main results.We prospectively evaluated 3770 LUS images acquired from 31 pneumonia patients. Experimental results demonstrated that the proposed pleural line extraction and evaluation methods all have good performance, with dice and accuracy of 0.87 and 94.47%, respectively, and the comparison with previous methods found statistical significance (P< 0.001 for all). Meanwhile, the generalization verification proved the feasibility of the proposed method in multiple data scenarios.Significance.The proposed method has great application potential for assessment of pleural line in LUS images and aiding lung disease diagnosis and treatment.
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Affiliation(s)
- Wenyu Xing
- Academy for Engineering and Technology, Fudan University, Shanghai 200433, People's Republic of China
| | - Chao He
- Department of Emergency and Critical Care, Changzheng Hospital, Naval Medical University, Shanghai 200003, People's Republic of China
| | - Yebo Ma
- Shanghai Key Laboratory of Multidimensional Information Processing, East China Normal University, Shanghai 200241, People's Republic of China
| | - Yiman Liu
- Shanghai Key Laboratory of Multidimensional Information Processing, East China Normal University, Shanghai 200241, People's Republic of China
| | - Zhibin Zhu
- School of Information Science and Technology, Fudan University, Shanghai 200438, People's Republic of China
| | - Qingli Li
- Shanghai Key Laboratory of Multidimensional Information Processing, East China Normal University, Shanghai 200241, People's Republic of China
| | - Wenfang Li
- Department of Emergency and Critical Care, Changzheng Hospital, Naval Medical University, Shanghai 200003, People's Republic of China
| | - Jiangang Chen
- Shanghai Key Laboratory of Multidimensional Information Processing, East China Normal University, Shanghai 200241, People's Republic of China
| | - Dean Ta
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China
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Inchingolo R, Zanforlin A, Buonsenso D, Perrone T, Torri E, Limoli G, Mossolani EE, Tursi F, Soldati G, Marchetti G, Carlucci P, Radovanovic D, Lohmeyer FM, Smargiassi A. Lung Ultrasound Signs: The Beginning. Part 3-An Accademia di Ecografia Toracica Comprehensive Review on Ultrasonographic Signs and Real Needs. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:629-641. [PMID: 38168739 DOI: 10.1002/jum.16397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/02/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024]
Abstract
Over the last 20 years, scientific literature and interest on chest/lung ultrasound (LUS) have exponentially increased. Interpreting mixed-anatomical and artifactual-pictures determined the need of a proposal of a new nomenclature of artifacts and signs to simplify learning, spread, and implementation of this technique. The aim of this review is to collect and analyze different signs and artifacts reported in the history of chest ultrasound regarding normal lung, pleural pathologies, and lung consolidations. By reviewing the possible physical and anatomical interpretation of these artifacts and signs reported in the literature, this work aims to present the AdET (Accademia di Ecografia Toracica) proposal of nomenclature and to bring order between published studies.
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Affiliation(s)
- Riccardo Inchingolo
- UOC Pneumologia, Dipartimento Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Zanforlin
- Service of Pulmonology, Health District of Bolzano (SABES-ASDAA), Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Bolzano-Bozen, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Tiziano Perrone
- Emergency Medicine Department, Humanitas Gavazzeni, Bergamo, Italy
| | - Elena Torri
- Emergency Medicine Department, Humanitas Gavazzeni, Bergamo, Italy
| | | | | | - Francesco Tursi
- Pulmonary Medicine Unit, Codogno Hospital, Azienda Socio Sanitaria Territoriale Lodi, Codogno, Italy
| | - Gino Soldati
- Ippocrate Medical Center, Castelnuovo di Garfagnana, Lucca, Italy
| | | | - Paolo Carlucci
- Department of Health Sciences, Università degli Studi di Milano, Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Dejan Radovanovic
- Division of Respiratory Diseases, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milan, Italy
| | | | - Andrea Smargiassi
- UOC Pneumologia, Dipartimento Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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29
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Horn R, Görg C, Prosch H, Safai Zadeh E, Jenssen C, Dietrich CF. Sonography of the pleura. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024; 45:118-146. [PMID: 38237634 DOI: 10.1055/a-2189-5050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
The CME review presented here is intended to explain the significance of pleural sonography to the interested reader and to provide information on its application. At the beginning of sonography in the 80 s of the 20th centuries, with the possible resolution of the devices at that time, the pleura could only be perceived as a white line. Due to the high impedance differences, the pleura can be delineated particularly well. With the increasing high-resolution devices of more than 10 MHz, even a normal pleura with a thickness of 0.2 mm can be assessed. This article explains the special features of the examination technique with knowledge of the pre-test probability and describes the indications for pleural sonography. Pleural sonography has a high value in emergency and intensive care medicine, preclinical, outpatient and inpatient, in the general practitioner as well as in the specialist practice of pneumologists. The special features in childhood (pediatrics) as well as in geriatrics are presented. The recognition of a pneumothorax even in difficult situations as well as the assessment of pleural effusion are explained. With the high-resolution technology, both the pleura itself and small subpleural consolidations can be assessed and used diagnostically. Both the direct and indirect sonographic signs and accompanying symptoms are described, and the concrete clinical significance of sonography is presented. The significance and criteria of conventional brightness-encoded B-scan, colour Doppler sonography (CDS) with or without spectral analysis of the Doppler signal (SDS) and contrast medium ultrasound (CEUS) are outlined. Elastography and ultrasound-guided interventions are also mentioned. A related further paper deals with the diseases of the lung parenchyma and another paper with the diseases of the thoracic wall, diaphragm and mediastinum.
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Affiliation(s)
- Rudolf Horn
- Emergency Department, Center da Sandà Val Müstair, Switzerland
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, Marburg
| | - Helmut Prosch
- Abteilung für Allgemeine Radiologie und Kinderradiologie, Medizinische Universität Wien, Austria
| | - Ehsan Safai Zadeh
- Abteilung für Allgemeine Radiologie und Kinderradiologie, Medizinische Universität Wien, Austria
| | - Christian Jenssen
- Klinik für Innere Medizin, Krankenhaus Märkisch-Oderland Strausberg/Wriezen and Brandenburg Institute for Clinical Ultrasound at Medical University Brandenburg, Neuruppin, Germany
| | - Christoph F Dietrich
- Department of General Internal Medicine, Kliniken Hirslanden Beau-Site, Salem und Permanence, Bern, Switzerland
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30
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Inchingolo AD, Dipalma G, Ferrara I, Viapiano F, Netti A, Ciocia AM, Mancini A, Malcangi G, Palermo A, Inchingolo AM, Inchingolo F. Clear Aligners in the Growing Patient: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:385. [PMID: 38671602 PMCID: PMC11049164 DOI: 10.3390/children11040385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024]
Abstract
Mixed dentition represents a critical phase in the oral development of pediatric patients, characterized by the simultaneous presence of primary and permanent teeth. This article proposes a comprehensive systematic review of the application of aligners as an innovative methodology in managing mixed dentition. The primary objective is to explore the efficacy, safety, and acceptability of this emerging orthodontic technology in the evolving age group. This systematic review focuses on randomized controlled trials, cohorts, and observational studies investigating the use of aligners in patients with mixed dentition. Clinical, radiographic, and psychosocial parameters will be considered to assess the overall impact of aligner therapy in this critical phase of dental development. An in-depth analysis of such data aims to provide a comprehensive overview of the potential of this technology in pediatric orthodontics. Expected outcomes may contribute to outlining practical guidelines and targeted therapeutic strategies for orthodontists involved in managing mixed dentition. Furthermore, this article aims to identify gaps in the current research and suggest future directions for studies exploring the use of transparent aligners in patients with mixed dentition, thereby contributing to the ongoing evolution of evidence-based orthodontic practices.
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Affiliation(s)
- Alessio Danilo Inchingolo
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Gianna Dipalma
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Irene Ferrara
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Fabio Viapiano
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Anna Netti
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Anna Maria Ciocia
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Antonio Mancini
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Giuseppina Malcangi
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Andrea Palermo
- College of Medicine and Dentistry, Birmingham B4 6BN, UK
| | - Angelo Michele Inchingolo
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
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31
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Han L, Ke H, Xiao Y, Xu S, Huang Z, Wang H, Lyu G, Li S. The application value of lung ultrasound scoring in assessing disease severity: Evaluation of small-scale outbreaks of COVID-19. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:284-294. [PMID: 38126219 DOI: 10.1002/jcu.23628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE This study explored the use of transthoracic lung ultrasound for evaluating COVID-19 patients, compared it with computed tomography (CT), and examined its effectiveness using 8 and 12 lung regions. METHODS A total of 100 patients with COVID-19 and 40 healthy volunteers were assessed using 12 regions (bilateral upper/lower regions of the anterior/lateral/posterior chest) and simplified 8 zones (bilateral upper/lower regions of the anterior/lateral chest) transthoracic lung ultrasound. The relationships between ultrasound, CT, and clinical indicators were analyzed to evaluate the diagnostic value of ultrasound scores in COVID-19. RESULTS Increased disease severity correlated with increased 8- and 12-zone ultrasound and CT scores (all p < 0.05). The modified 8-zone method strongly correlated with the 12-zone method (Pearson's r = 0.908, p < 0.05). The 8- and 12-zone methods correlated with CT scoring (correlation = 0.568 and 0.635, respectively; p < 0.05). The intragroup correlation coefficients of the 8-zone, 12-zone, and CT scoring methods were highly consistent (intragroup correlation coefficient = 0.718, p < 0.01). The 8-zone ultrasound score correlated negatively with oxygen saturation (rs = 0.306, p < 0.05) and Ca (rs = 0.224, p < 0.05) and positively with IL-6 (rs = 0.0.335, p < 0.05), erythrocyte sedimentation rate (rs = 0.327, p < 0.05), alanine aminotransferase (rs = 0.230, p < 0.05), and aspartate aminotransferase (rs = 0.251, p < 0.05). The 12-zone scoring method correlated negatively with oxygen saturation (rs = 0.338, p < 0.05) and Ca (rs = 0.245, p < 0.05) and positively with IL-6 (rs = 0.354, p < 0.05) and erythrocyte sedimentation rate (rs = 0.495, p < 0.05). CONCLUSION Lung ultrasound scores represent the clinical severity and have high clinical value for diagnosing COVID-19 pneumonia. The 8-zone scoring method can improve examination efficiency and reduce secondary injuries caused by patient movement.
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Affiliation(s)
- Lina Han
- Department of Ultrasonography, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Helin Ke
- Department of Ultrasonography, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yang Xiao
- Department of Ultrasonography, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Shaodan Xu
- Department of Ultrasonography, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Zhibin Huang
- Department of Ultrasonography, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Han Wang
- Department of Ultrasonography, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Guorong Lyu
- Department of Ultrasonography, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Department of Medicine, Quanzhou Medical College, Quanzhou, China
| | - Shilin Li
- Department of Ultrasonography, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
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Boussier J, Lemasle A, Hantala N, Scatton O, Vaillant JC, Paye F, Langeron O, Lescot T, Quesnel C, Verdonk F, Eyraud D, Sitbon A, Delorme L, Monsel A. Lung Ultrasound Score on Postoperative Day 1 Is Predictive of the Occurrence of Pulmonary Complications after Major Abdominal Surgery: A Multicenter Prospective Observational Study. Anesthesiology 2024; 140:417-429. [PMID: 38064713 DOI: 10.1097/aln.0000000000004855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
BACKGROUND Postoperative pulmonary complications after major abdominal surgery are frequent and carry high morbidity and mortality. Early identification of patients at risk of pulmonary complications by lung ultrasound may allow the implementation of preemptive strategies. The authors hypothesized that lung ultrasound score would be associated with pulmonary postoperative complications. The main objective of the study was to evaluate the performance of lung ultrasound score on postoperative day 1 in predicting pulmonary complications after major abdominal surgery. Secondary objectives included the evaluation of other related measures for their potential prediction accuracy. METHODS A total of 149 patients scheduled for major abdominal surgery were enrolled in a bicenter observational study. Lung ultrasound score was performed before the surgery and on days 1, 4, and 7 after surgery. Pulmonary complications occurring before postoperative day 10 were recorded. RESULTS Lung ultrasound score on postoperative day 1 was higher in patients developing pulmonary complications before day 10 (median, 13; interquartile range, 8.25 to 18; vs. median, 10; interquartile range, 6.5 to 12; Mann-Whitney P = 0.002). The area under the curve for predicting postoperative pulmonary complications before day 10 was 0.65 (95% CI, 0.55 to 0.75; P = 0.003). Lung ultrasound score greater than 12 had a sensitivity of 0.54 (95% CI, 0.40 to 0.67), specificity of 0.77 (95% CI, 0.67 to 0.85), and negative predictive value of 0.74 (95% CI, 0.65 to 0.83). Lung ultrasound score greater than 17 had sensitivity of 0.33 (95% CI, 0.21 to 0.47), specificity of 0.95 (95% CI, 0.88 to 0.98), and positive predictive value of 0.78 (95% CI, 0.56 to 0.93). Anterolateral lung ultrasound score and composite scores using lung ultrasound score and other patient characteristics showed similar predictive accuracies. CONCLUSIONS An elevated lung ultrasound score on postoperative day 1 is associated with the occurrence of pulmonary complications within the first 10 days after major abdominal surgery. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Jeremy Boussier
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - Aymeric Lemasle
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - Nicolas Hantala
- Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, Sorbonne University, GRC 29, DMU DREAM, Greater Paris University Hospitals, Paris, France
| | - Olivier Scatton
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - Jean-Christophe Vaillant
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - François Paye
- Department of Surgery, Saint-Antoine Hospital, Sorbonne University, Paris, France
| | - Olivier Langeron
- Department of Anesthesia and Intensive Care, Henri-Mondor University Hospital, Greater Paris University Hospitals, University Paris-Est-Créteil, Paris, France
| | - Thomas Lescot
- Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, Sorbonne University, GRC 29, DMU DREAM, Greater Paris University Hospitals, Paris, France
| | - Christophe Quesnel
- Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, Sorbonne University, GRC 29, DMU DREAM, Greater Paris University Hospitals, Paris, France
| | - Franck Verdonk
- Department of Anesthesiology and Critical Care Medicine, Saint-Antoine Hospital, Sorbonne University, GRC 29, DMU DREAM, Greater Paris University Hospitals, Paris, France
| | - Daniel Eyraud
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - Alexandre Sitbon
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - Louis Delorme
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France
| | - Antoine Monsel
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Sorbonne University, Paris, France; Sorbonne Université-INSERM UMRS_959, Immunology-Immunopathology-Immunotherapy, Paris, France; Biotherapy (CIC-BTi), La Pitié-Salpêtrière Hospital, Greater Paris University Hospitals, Paris, France
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33
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Mancusi C, Basile C, Spaccarotella C, Gargiulo G, Fucile I, Paolillo S, Gargiulo P, Santoro C, Manzi L, Marzano F, Ambrosino P, De Luca N, Esposito G. Novel Strategies in Diagnosing Heart Failure with Preserved Ejection Fraction: A Comprehensive Literature Review. High Blood Press Cardiovasc Prev 2024; 31:127-140. [PMID: 38489152 PMCID: PMC11043114 DOI: 10.1007/s40292-024-00629-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/26/2024] [Indexed: 03/17/2024] Open
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) is a prevalent global condition affecting approximately 50% of the HF population. With the aging of the worldwide population, its incidence and prevalence are expected to rise even further. Unfortunately, until recently, no effective medications were available to reduce the high mortality and hospitalization rates associated with HFpEF, making it a significant unmet need in cardiovascular medicine. Although HFpEF is commonly defined as HF with normal ejection fraction and elevated left ventricular filling pressure, performing invasive hemodynamic assessments on every individual suspected of having HFpEF is neither feasible nor practical. Consequently, several clinical criteria and diagnostic tools have been proposed to aid in diagnosing HFpEF. Overall, these criteria and tools are designed to assist healthcare professionals in identifying and evaluating patients who may have HFpEF based on a combination of signs, symptoms, biomarkers, and non-invasive imaging findings. By employing these non-invasive diagnostic approaches, clinicians can make informed decisions regarding the best pharmacological and rehabilitation strategies for individuals with suspected HFpEF. This literature review aims to provide an overview of all currently available methods for diagnosing and monitoring this disabling condition.
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Affiliation(s)
- Costantino Mancusi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
| | - Christian Basile
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Carmen Spaccarotella
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Ilaria Fucile
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Paola Gargiulo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Lina Manzi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Federica Marzano
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Directorate of Telese Terme Institute, Telese, Italy
| | - Nicola De Luca
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
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Pochepnia S, Grabczak EM, Johnson E, Eyuboglu FO, Akkerman O, Prosch H. Imaging in pulmonary infections of immunocompetent adult patients. Breathe (Sheff) 2024; 20:230186. [PMID: 38595938 PMCID: PMC11003523 DOI: 10.1183/20734735.0186-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/06/2024] [Indexed: 04/11/2024] Open
Abstract
Pneumonia is a clinical syndrome characterised by fever, cough and alveolar infiltration of purulent fluid, caused by infection with a microbial pathogen. It can be caused by infections with bacteria, viruses or fungi, but a causative organism is identified in less than half of cases. The most common type of pneumonia is community-acquired pneumonia, which is caused by infections acquired outside the hospital. Current guidelines for pneumonia diagnosis require imaging to confirm the clinical suspicion of pneumonia. Thus, imaging plays an important role in both the diagnosis and management of pneumonia, with each modality having specific advantages and limitations. Chest radiographs are commonly used but have limitations in terms of sensitivity and specificity. Lung ultrasound shows high sensitivity and specificity. Computed tomography scans offer higher diagnostic accuracy but involve higher radiation doses. Radiological patterns, including lobar, lobular and interstitial pneumonia, provide valuable insights into causative pathogens and treatment decisions. Understanding these radiological patterns is crucial for accurate diagnosis. In this review, we will summarise the most important aspects pertaining to the role of imaging in pneumonia and will highlight the imaging characteristics of the most common causative organisms.
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Affiliation(s)
- Svitlana Pochepnia
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Elzbieta Magdalena Grabczak
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Emma Johnson
- Clinical and Molecular Medicine, University of Dundee, Dundee, UK
| | - Fusun Oner Eyuboglu
- Baskent University School of Medicine, Pulmonary Diseases Department, Baskeny University Hospital, Ankara, Turkey
| | - Onno Akkerman
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases and Tuberculosis, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, TB center Beatrixoord, Groningen, The Netherlands
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
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Uguen J, Bouscaren N, Pastural G, Darrieux E, Lopes AA, Levy Y, Peipoch L. Lung ultrasound: A potential tool in the diagnosis of ventilator-associated pneumonia in pediatric intensive care units. Pediatr Pulmonol 2024; 59:758-765. [PMID: 38131518 DOI: 10.1002/ppul.26827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 11/11/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE Ventilator-associated pneumonia (VAP) is a common healthcare-associated infection in pediatric intensive care unit (PICU), increasing mortality, antibiotics use and duration of ventilation and hospitalization. VAP diagnosis is based on clinical and chest X-ray (CXR) signs defined by the 2018 Center for Disease Control (gold standard). However, CXR induces repetitive patients' irradiation and technical limitations. This study aimed to investigate if lung ultrasound (LUS) can substitute CXR in the VAP diagnosis. METHODS A monocentric and prospective study was conducted in a French tertiary care hospital. Patients under 18-year-old admitted to PICU between November 2018 and July 2020 with invasive mechanical ventilation for more than 48 h were included. The studied LUS signs were consolidations, dynamic air bronchogram, subpleural consolidations (SPC), B-lines, and pleural effusion. The diagnostic values of each sign associated with clinical signs (cCDC) were compared to the gold standard approach. LUS, chest X-ray, and clinical score were performed daily. RESULTS Fifty-seven patients were included. The median age was 8 [3-34] months. Nineteen (33%) children developed a VAP. In patients with VAP, B-Lines, and consolidations were highly frequent (100 and 68.8%) and, associated with cCDC, were highly sensitive (100 [79-100] % and 88 [62-98] %, respectively) and specific (95.5 [92-98] % and 98 [95-99] %, respectively). Other studied signs, including SPC, showed high specificity (>97%) but low sensibility (<50%). CONCLUSION LUS seems to be a powerful tool for VAP diagnosis in children with a clinical suspicion, efficiently substituting CXR, and limiting children's exposure to ionizing radiations.
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Affiliation(s)
- Justine Uguen
- Paediatric Intensive Care Unit, University Hospital Center Félix Guyon, La Réunion, France
| | - Nicolas Bouscaren
- Public Health Department, Inserm CIC 1410, University Hospital Center Saint Pierre, La Réunion, France
| | - Gaëlle Pastural
- Paediatric Radiology Department, University Hospital Center Félix Guyon, La Réunion, France
| | - Etienne Darrieux
- Paediatric Intensive Care Unit, University Hospital Center Félix Guyon, La Réunion, France
| | - Anne-Aurélie Lopes
- Paediatric Emergency Department, University Hospital Robert-Debre, Sorbonne University, Paris, France
| | - Yael Levy
- Paediatric Intensive Care Unit, University Hospital Center Félix Guyon, La Réunion, France
| | - Lise Peipoch
- Paediatric Intensive Care Unit, University Hospital Center Félix Guyon, La Réunion, France
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Etter L, Betke M, Camelo IY, Gill CJ, Pieciak R, Thompson R, Demi L, Khan U, Wheelock A, Katanga J, Setty BN, Castro-Aragon I. Curated and Annotated Dataset of Lung US Images in Zambian Children with Clinical Pneumonia. Radiol Artif Intell 2024; 6:e230147. [PMID: 38381039 PMCID: PMC10982815 DOI: 10.1148/ryai.230147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 01/10/2024] [Accepted: 02/05/2024] [Indexed: 02/22/2024]
Abstract
See also the commentary by Sitek in this issue. Supplemental material is available for this article.
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Affiliation(s)
- Lauren Etter
- From the Department of Global Health, School of Public Health, Boston
University Medical Campus, 801 Massachusetts Ave, Boston, MA 02118-2526 (L.E.,
C.J.G., R.P., A.W.); Department of Computer Science, College of Arts and
Sciences, Boston University, Boston, Mass (M.B.); Pediatric Infectious Diseases
Section, Augusta University, Medical College of Georgia, Augusta, Ga (I.Y.C.);
Department of Computer Science, Worcester Polytechnic Institute, Worcester, Mass
(R.T.); Ultrasound Laboratory Trento, University of Trento, Trento, Italy (L.D.,
U.K.); University Teaching Hospital, Lusaka, Zambia (J.K.); and Department of
Radiology, Boston Medical Center, Boston, Mass (B.N.S., I.C.A.)
| | - Margrit Betke
- From the Department of Global Health, School of Public Health, Boston
University Medical Campus, 801 Massachusetts Ave, Boston, MA 02118-2526 (L.E.,
C.J.G., R.P., A.W.); Department of Computer Science, College of Arts and
Sciences, Boston University, Boston, Mass (M.B.); Pediatric Infectious Diseases
Section, Augusta University, Medical College of Georgia, Augusta, Ga (I.Y.C.);
Department of Computer Science, Worcester Polytechnic Institute, Worcester, Mass
(R.T.); Ultrasound Laboratory Trento, University of Trento, Trento, Italy (L.D.,
U.K.); University Teaching Hospital, Lusaka, Zambia (J.K.); and Department of
Radiology, Boston Medical Center, Boston, Mass (B.N.S., I.C.A.)
| | - Ingrid Y. Camelo
- From the Department of Global Health, School of Public Health, Boston
University Medical Campus, 801 Massachusetts Ave, Boston, MA 02118-2526 (L.E.,
C.J.G., R.P., A.W.); Department of Computer Science, College of Arts and
Sciences, Boston University, Boston, Mass (M.B.); Pediatric Infectious Diseases
Section, Augusta University, Medical College of Georgia, Augusta, Ga (I.Y.C.);
Department of Computer Science, Worcester Polytechnic Institute, Worcester, Mass
(R.T.); Ultrasound Laboratory Trento, University of Trento, Trento, Italy (L.D.,
U.K.); University Teaching Hospital, Lusaka, Zambia (J.K.); and Department of
Radiology, Boston Medical Center, Boston, Mass (B.N.S., I.C.A.)
| | - Christopher J. Gill
- From the Department of Global Health, School of Public Health, Boston
University Medical Campus, 801 Massachusetts Ave, Boston, MA 02118-2526 (L.E.,
C.J.G., R.P., A.W.); Department of Computer Science, College of Arts and
Sciences, Boston University, Boston, Mass (M.B.); Pediatric Infectious Diseases
Section, Augusta University, Medical College of Georgia, Augusta, Ga (I.Y.C.);
Department of Computer Science, Worcester Polytechnic Institute, Worcester, Mass
(R.T.); Ultrasound Laboratory Trento, University of Trento, Trento, Italy (L.D.,
U.K.); University Teaching Hospital, Lusaka, Zambia (J.K.); and Department of
Radiology, Boston Medical Center, Boston, Mass (B.N.S., I.C.A.)
| | - Rachel Pieciak
- From the Department of Global Health, School of Public Health, Boston
University Medical Campus, 801 Massachusetts Ave, Boston, MA 02118-2526 (L.E.,
C.J.G., R.P., A.W.); Department of Computer Science, College of Arts and
Sciences, Boston University, Boston, Mass (M.B.); Pediatric Infectious Diseases
Section, Augusta University, Medical College of Georgia, Augusta, Ga (I.Y.C.);
Department of Computer Science, Worcester Polytechnic Institute, Worcester, Mass
(R.T.); Ultrasound Laboratory Trento, University of Trento, Trento, Italy (L.D.,
U.K.); University Teaching Hospital, Lusaka, Zambia (J.K.); and Department of
Radiology, Boston Medical Center, Boston, Mass (B.N.S., I.C.A.)
| | - Russell Thompson
- From the Department of Global Health, School of Public Health, Boston
University Medical Campus, 801 Massachusetts Ave, Boston, MA 02118-2526 (L.E.,
C.J.G., R.P., A.W.); Department of Computer Science, College of Arts and
Sciences, Boston University, Boston, Mass (M.B.); Pediatric Infectious Diseases
Section, Augusta University, Medical College of Georgia, Augusta, Ga (I.Y.C.);
Department of Computer Science, Worcester Polytechnic Institute, Worcester, Mass
(R.T.); Ultrasound Laboratory Trento, University of Trento, Trento, Italy (L.D.,
U.K.); University Teaching Hospital, Lusaka, Zambia (J.K.); and Department of
Radiology, Boston Medical Center, Boston, Mass (B.N.S., I.C.A.)
| | - Libertario Demi
- From the Department of Global Health, School of Public Health, Boston
University Medical Campus, 801 Massachusetts Ave, Boston, MA 02118-2526 (L.E.,
C.J.G., R.P., A.W.); Department of Computer Science, College of Arts and
Sciences, Boston University, Boston, Mass (M.B.); Pediatric Infectious Diseases
Section, Augusta University, Medical College of Georgia, Augusta, Ga (I.Y.C.);
Department of Computer Science, Worcester Polytechnic Institute, Worcester, Mass
(R.T.); Ultrasound Laboratory Trento, University of Trento, Trento, Italy (L.D.,
U.K.); University Teaching Hospital, Lusaka, Zambia (J.K.); and Department of
Radiology, Boston Medical Center, Boston, Mass (B.N.S., I.C.A.)
| | - Umair Khan
- From the Department of Global Health, School of Public Health, Boston
University Medical Campus, 801 Massachusetts Ave, Boston, MA 02118-2526 (L.E.,
C.J.G., R.P., A.W.); Department of Computer Science, College of Arts and
Sciences, Boston University, Boston, Mass (M.B.); Pediatric Infectious Diseases
Section, Augusta University, Medical College of Georgia, Augusta, Ga (I.Y.C.);
Department of Computer Science, Worcester Polytechnic Institute, Worcester, Mass
(R.T.); Ultrasound Laboratory Trento, University of Trento, Trento, Italy (L.D.,
U.K.); University Teaching Hospital, Lusaka, Zambia (J.K.); and Department of
Radiology, Boston Medical Center, Boston, Mass (B.N.S., I.C.A.)
| | - Alyse Wheelock
- From the Department of Global Health, School of Public Health, Boston
University Medical Campus, 801 Massachusetts Ave, Boston, MA 02118-2526 (L.E.,
C.J.G., R.P., A.W.); Department of Computer Science, College of Arts and
Sciences, Boston University, Boston, Mass (M.B.); Pediatric Infectious Diseases
Section, Augusta University, Medical College of Georgia, Augusta, Ga (I.Y.C.);
Department of Computer Science, Worcester Polytechnic Institute, Worcester, Mass
(R.T.); Ultrasound Laboratory Trento, University of Trento, Trento, Italy (L.D.,
U.K.); University Teaching Hospital, Lusaka, Zambia (J.K.); and Department of
Radiology, Boston Medical Center, Boston, Mass (B.N.S., I.C.A.)
| | - Janet Katanga
- From the Department of Global Health, School of Public Health, Boston
University Medical Campus, 801 Massachusetts Ave, Boston, MA 02118-2526 (L.E.,
C.J.G., R.P., A.W.); Department of Computer Science, College of Arts and
Sciences, Boston University, Boston, Mass (M.B.); Pediatric Infectious Diseases
Section, Augusta University, Medical College of Georgia, Augusta, Ga (I.Y.C.);
Department of Computer Science, Worcester Polytechnic Institute, Worcester, Mass
(R.T.); Ultrasound Laboratory Trento, University of Trento, Trento, Italy (L.D.,
U.K.); University Teaching Hospital, Lusaka, Zambia (J.K.); and Department of
Radiology, Boston Medical Center, Boston, Mass (B.N.S., I.C.A.)
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Stoicescu ER, Iacob R, Ilie AC, Iacob ER, Susa SR, Ghenciu LA, Constantinescu A, Cocolea DM, Ciornei-Hoffman A, Oancea C, Manolescu DL. Stratifying Disease Severity in Pediatric COVID-19: A Correlative Study of Serum Biomarkers and Lung Ultrasound-A Retrospective Observational Dual-Center Study. Diagnostics (Basel) 2024; 14:440. [PMID: 38396479 PMCID: PMC10888450 DOI: 10.3390/diagnostics14040440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
The COVID-19 pandemic, caused by SARS-CoV-2, has manifested distinct impacts on infants and children. This study delves into the intricate connection between lung ultrasound (LUS) findings and serum biomarkers in neonates and infants with COVID-19. Exploring factors contributing to the mild symptoms in this demographic, including immune responses and pre-existing immunity, the study spans 3 years and 9 months, involving 42 patients. Respiratory and gastrointestinal symptoms predominate, and LUS emerges as a vital, non-irradiating tool for evaluating pulmonary abnormalities. Serum biomarkers like CRP, procalcitonin, and cytokines provide key insights into the pathophysiology. Correlations reveal nuanced links between LUS score and clinical parameters, unveiling associations with hospitalization duration (rho = 0.49), oxygen saturation (rho = -0.88), and inflammatory markers, like ferritin (rho = 0.62), LDH (rho = 0.73), and D-dimer (rho = 0.73) with significance level (p < 0.05). The absence of large consolidations in LUS suggests unique pulmonary characteristics. The novelty of these findings lies in the comprehensive integration of LUS with serum biomarkers to assess and monitor the severity of lung involvement in neonates and infants affected by SARS-CoV-2. This approach offers valuable insights into disease severity, biomarker levels, the duration of hospitalization, and oxygen saturation, providing a multifaceted understanding of COVID-19's impact on this vulnerable population.
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Affiliation(s)
- Emil Robert Stoicescu
- Department of Radiology and Medical Imaging, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (E.R.S.); (D.L.M.)
- Research Center for Pharmaco-Toxicological Evaluations, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
- Faculty of Mechanics, Field of Applied Engineering Sciences, Specialization Statistical Methods and Techniques in Health and Clinical Research, ‘Politehnica’ University Timisoara, Mihai Viteazul Boulevard No. 1, 300222 Timisoara, Romania
| | - Roxana Iacob
- Faculty of Mechanics, Field of Applied Engineering Sciences, Specialization Statistical Methods and Techniques in Health and Clinical Research, ‘Politehnica’ University Timisoara, Mihai Viteazul Boulevard No. 1, 300222 Timisoara, Romania
- Department of Anatomy and Embriology, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, 300041 Timișoara, Romania
- IOSUD/Ph.D. School, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (S.R.S.); (A.C.); (D.M.C.)
| | - Adrian Cosmin Ilie
- Department III Functional Sciences, Division of Public Health and Management, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Emil Radu Iacob
- Department of Pediatric Surgery, ‘Victor Babes’ University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Septimiu Radu Susa
- IOSUD/Ph.D. School, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (S.R.S.); (A.C.); (D.M.C.)
| | - Laura Andreea Ghenciu
- Department of Functional Sciences, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania;
| | - Amalia Constantinescu
- IOSUD/Ph.D. School, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (S.R.S.); (A.C.); (D.M.C.)
| | - Daiana Marina Cocolea
- IOSUD/Ph.D. School, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (S.R.S.); (A.C.); (D.M.C.)
| | - Andreea Ciornei-Hoffman
- Department of Anatomy and Embryology, Morphological Sciences, ‘Iuliu Hatieganu’ University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
- Department of Radiology and Medical Imaging, County Clinical Emergency Hospital, 400006 Cluj-Napoca, Romania
| | - Cristian Oancea
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babeș’ University of Medicine and Pharmacy, 300041 Timișoara, Romania;
- Department of Pulmonology, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Diana Luminita Manolescu
- Department of Radiology and Medical Imaging, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (E.R.S.); (D.L.M.)
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babeș’ University of Medicine and Pharmacy, 300041 Timișoara, Romania;
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Liu J. Lung Ultrasonography Does Not Distinguish between Interstitial and Alveolar Pulmonary Edema. Diagnostics (Basel) 2024; 14:324. [PMID: 38337840 PMCID: PMC10855817 DOI: 10.3390/diagnostics14030324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/23/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
For a long time, lung diseases have been considered the "forbidden zone" for ultrasound diagnosis because the lung is filled with gas, and the ultrasound waves are totally reflected when they encounter gas [...].
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Affiliation(s)
- Jing Liu
- Department of Neonatology and NICU, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
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39
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Flores S, Su E, Moher JM, Adler AC, Riley AF. Point-of-Care-Ultrasound in Pediatrics: A Review and Update. Semin Ultrasound CT MR 2024; 45:3-10. [PMID: 38056790 DOI: 10.1053/j.sult.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Point-of-Care-Ultrasound (POCUS) has encountered a tremendous expansion in patient care. POCUS has taken a central role during invasive procedures. POCUS has expanded to most subspecialties from adult to pediatric and neonatal health care. POCUS in pediatrics has also become part of specific critical situations such as myocardial function assessment during cardiac arrest, extracorporeal membrane oxygenation deployment and neurological evaluation. In this review we will go over the most important historical aspects of POCUS. We will also review important aspects of POCUS in the intensive care unit, cardiologist evaluation and in the emergency department among others.
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Affiliation(s)
- Saul Flores
- Department of Pediatrics, Division of Critical Care and Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
| | - Erik Su
- Department of Pediatrics, Division of Critical Care, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Justin M Moher
- Department of Pediatrics, Division of Emergency Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Adam C Adler
- Department of Anesthesiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Alan F Riley
- Department of Pediatrics, Division of Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
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Marozzi MS, Cicco S, Mancini F, Corvasce F, Lombardi FA, Desantis V, Loponte L, Giliberti T, Morelli CM, Longo S, Lauletta G, Solimando AG, Ria R, Vacca A. A Novel Automatic Algorithm to Support Lung Ultrasound Non-Expert Physicians in Interstitial Pneumonia Evaluation: A Single-Center Study. Diagnostics (Basel) 2024; 14:155. [PMID: 38248032 PMCID: PMC10814651 DOI: 10.3390/diagnostics14020155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/06/2024] [Accepted: 01/07/2024] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Lung ultrasound (LUS) is widely used in clinical practice for identifying interstitial lung diseases (ILDs) and assessing their progression. Although high-resolution computed tomography (HRCT) remains the gold standard for evaluating the severity of ILDs, LUS can be performed as a screening method or as a follow-up tool post-HRCT. Minimum training is needed to better identify typical lesions, and the integration of innovative artificial intelligence (AI) automatic algorithms may enhance diagnostic efficiency. AIM This study aims to assess the effectiveness of a novel AI algorithm in automatic ILD recognition and scoring in comparison to an expert LUS sonographer. The "SensUS Lung" device, equipped with an automatic algorithm, was employed for the automatic recognition of the typical ILD patterns and to calculate an index grading of the interstitial involvement. METHODS We selected 33 Caucasian patients in follow-up for ILDs exhibiting typical HRCT patterns (honeycombing, ground glass, fibrosis). An expert physician evaluated all patients with LUS on twelve segments (six per side). Next, blinded to the previous evaluation, an untrained operator, a non-expert in LUS, performed the exam with the SensUS device equipped with the automatic algorithm ("SensUS Lung") using the same protocol. Pulmonary functional tests (PFT) and DLCO were conducted for all patients, categorizing them as having reduced or preserved DLCO. The SensUS device indicated different grades of interstitial involvement named Lung Staging that were scored from 0 (absent) to 4 (peak), which was compared to the Lung Ultrasound Score (LUS score) by dividing it by the number of segments evaluated. Statistical analyses were done with Wilcoxon tests for paired values or Mann-Whitney for unpaired samples, and correlations were performed using Spearman analysis; p < 0.05 was considered significant. RESULTS Lung Staging was non-inferior to LUS score in identifying the risk of ILDs (median SensUS 1 [0-2] vs. LUS 0.67 [0.25-1.54]; p = 0.84). Furthermore, the grade of interstitial pulmonary involvement detected with the SensUS device is directly related to the LUS score (r = 0.607, p = 0.002). Lung Staging values were inversely correlated with forced expiratory volume at first second (FEV1%, r = -0.40, p = 0.027), forced vital capacity (FVC%, r = -0.39, p = 0.03) and forced expiratory flow (FEF) at 25th percentile (FEF25%, r = -0.39, p = 0.02) while results directly correlated with FEF25-75% (r = 0.45, p = 0.04) and FEF75% (r = 0.43, p = 0.01). Finally, in patients with reduced DLCO, the Lung Staging was significantly higher, overlapping the LUS (reduced median 1 [1-2] vs. preserved 0 [0-1], p = 0.001), and overlapping the LUS (reduced median 18 [4-20] vs. preserved 5.5 [2-9], p = 0.035). CONCLUSIONS Our data suggest that the considered AI automatic algorithm may assist non-expert physicians in LUS, resulting in non-inferior-to-expert LUS despite a tendency to overestimate ILD lesions. Therefore, the AI algorithm has the potential to support physicians, particularly non-expert LUS sonographers, in daily clinical practice to monitor patients with ILDs. The adopted device is user-friendly, offering a fully automatic real-time analysis. However, it needs proper training in basic skills.
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Affiliation(s)
- Marialuisa Sveva Marozzi
- Unit of Internal Medicine “G. Baccelli”, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro Medical School, 70124 Bari, Italy
| | - Sebastiano Cicco
- Unit of Internal Medicine “G. Baccelli”, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro Medical School, 70124 Bari, Italy
| | - Francesca Mancini
- Unit of Internal Medicine “G. Baccelli”, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro Medical School, 70124 Bari, Italy
| | - Francesco Corvasce
- Unit of Internal Medicine “G. Baccelli”, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro Medical School, 70124 Bari, Italy
| | | | - Vanessa Desantis
- Pharmacology Section, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro Medical School, 70124 Bari, Italy
- Interdepartmental Centre for Research in Telemedicine (CITEL), Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro Medical School, 70124 Bari, Italy
| | - Luciana Loponte
- Unit of Internal Medicine “G. Baccelli”, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro Medical School, 70124 Bari, Italy
| | - Tiziana Giliberti
- Unit of Internal Medicine “G. Baccelli”, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro Medical School, 70124 Bari, Italy
| | - Claudia Maria Morelli
- Unit of Internal Medicine “G. Baccelli”, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro Medical School, 70124 Bari, Italy
| | - Stefania Longo
- Unit of Internal Medicine “G. Baccelli”, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro Medical School, 70124 Bari, Italy
| | - Gianfranco Lauletta
- Unit of Internal Medicine “G. Baccelli”, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro Medical School, 70124 Bari, Italy
| | - Antonio G. Solimando
- Unit of Internal Medicine “G. Baccelli”, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro Medical School, 70124 Bari, Italy
- Interdepartmental Centre for Research in Telemedicine (CITEL), Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro Medical School, 70124 Bari, Italy
| | - Roberto Ria
- Unit of Internal Medicine “G. Baccelli”, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro Medical School, 70124 Bari, Italy
- Interdepartmental Centre for Research in Telemedicine (CITEL), Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro Medical School, 70124 Bari, Italy
| | - Angelo Vacca
- Unit of Internal Medicine “G. Baccelli”, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro Medical School, 70124 Bari, Italy
- Interdepartmental Centre for Research in Telemedicine (CITEL), Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro Medical School, 70124 Bari, Italy
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Churchill LJ, Tronstad O, Mandrusiak AM, Waldmann JY, Thomas PJ. The role of lung ultrasound for detecting atelectasis, consolidation, and/or pneumonia in the adult cardiac surgery population: A scoping review of the literature. Aust Crit Care 2024; 37:193-201. [PMID: 37709655 DOI: 10.1016/j.aucc.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/19/2023] [Accepted: 08/10/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES Postoperative pulmonary complications (PPCs) frequently occur after cardiac surgery and may lead to adverse patient outcomes. Traditional diagnostic tools such as auscultation or chest x-ray have inferior diagnostic accuracy compared to the gold standard (chest computed tomography). Lung ultrasound (LUS) is an emerging area of research combating these issues. However, no review has employed a formal search strategy to examine the role of LUS in identifying the specific PPCs of atelectasis, consolidation, and/or pneumonia or investigated the ability of LUS to predict these complications in this cohort. The objective of this study was to collate and present evidence for the use of LUS in the adult cardiac surgery population to specifically identify atelectasis, consolidation, and/or pneumonia. REVIEW METHOD USED A scoping review of the literature was completed using predefined search terms across six databases which identified 1432 articles. One additional article was included from reviewing reference lists. Six articles met the inclusion criteria, providing sufficient data for the final analysis. DATA SOURCES Six databases were searched: MEDLINE, Embase, CINAHL, Scopus, CENTRAL, and PEDro. This review was not registered. REVIEW METHODS The review followed the PRISMA Extension for Scoping Reviews. RESULTS Several LUS methodologies were reported across studies. Overall, LUS outperformed all other included bedside diagnostic tools, with superior diagnostic accuracy in identifying atelectasis, consolidation, and/or pneumonia. Incidences of PPCs tended to increase with each subsequent timepoint after surgery and were better identified with LUS than all other assessments. A change in diagnosis occurred at a rate of 67% with the inclusion of LUS and transthoracic echocardiography in one study. Pre-established assessment scores were improved by substituting chest x-rays with LUS scans. CONCLUSION The results of this scoping review support the use of LUS as a diagnostic tool after cardiac surgery; however, they also highlighted a lack of consistent methodologies used. Future research is required to determine the optimal methodology for LUS in diagnosing PPCs in this cohort and to determine whether LUS possesses the ability to predict these complications and guide proactive respiratory supports after extubation.
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Affiliation(s)
- Luke J Churchill
- Physiotherapy Department, The Prince Charles Hospital, Chermside, QLD, 4032, Australia; School of Rehabilitation and Health Sciences, The University of Queensland, QLD, 4072, Australia; Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, 4032, Australia.
| | - Oystein Tronstad
- Physiotherapy Department, The Prince Charles Hospital, Chermside, QLD, 4032, Australia; Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, 4032, Australia.
| | - Allison M Mandrusiak
- School of Rehabilitation and Health Sciences, The University of Queensland, QLD, 4072, Australia.
| | - Jana Y Waldmann
- Library Services, The Prince Charles Hospital, Chermside, QLD, 4032, Australia.
| | - Peter J Thomas
- Department of Physiotherapy, Royal Brisbane and Women's Hospital, Herston, Australia; Department of Intensive Care, Royal Brisbane and Women's Hospital, Herston, Australia.
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Fox TH, Chansangavej S, Kirby K, Cho D, Rodriguez R, Gare G, Collins G, Galeotti J, Krishnan A, deBoisblanc BP. Effects of Lung Ultrasound Technique and Pleural Line Depth on In Vitro and In Vivo Measurements of Pleural Line Thickness. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:165-169. [PMID: 37821245 DOI: 10.1016/j.ultrasmedbio.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE The aim of the work described here was to determine the effects of imaging protocol, technique and pleural line depth on measured pleural line thickness (PLT). METHODS Sonograms were performed on a phantom and healthy volunteers. In vitro, pleural line depth, transducer type (5-1 MHz phased array vs. 13-6 MHz linear array), angle of the pleural line relative to the transducer and distance between the pleural line and focal length were explicitly modified. PLT was measured using electronic calipers. Regression equations described the effects of independent variables on PLT. Factors influencing PLT in vitro were tested in vivo. RESULTS In vitro (n = 250 sonograms), PLT was 3.8 (standard error: ±0.24) mm greater when using the phased array compared with the linear transducer (p < 0.001). For every additional centimeter of pleural line depth, PLT increased by 0.96 (±0.081) mm for the phased array (p < 0.001) and 0.26 (±0.019) mm for the linear transducer (p < 0.001). Neither pleural angle nor focal length altered PLT. In vivo (n = 160 sonograms), PLT was 2.56 (±0.06) mm greater when using the phased array (p < 0.001) compared with the linear transducer. PLT increased by 0.67 (±0.060) mm with the phased array (p < 0.001) and 0.25 mm (±0.019) with the linear transducer (p < 0.001) for every additional centimeter between the transducer and the pleura. Together the variables explained 93% of PLT variance in vivo (p < 0.001). CONCLUSION PLT measurements are affected by transducer type and pleural line depth. Future studies evaluating PLT as a disease marker should account for confounding by these variables.
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Affiliation(s)
- Thomas H Fox
- Section of Internal/Emergency Medicine, LSU School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
| | | | - Krystal Kirby
- Mary Bird Perkins Cancer Center, Baton Rouge, LA, USA
| | - Daniel Cho
- LSU School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | | | - Gautam Gare
- Carnegie Mellon Robotics Institute, Pittsburgh, PA, USA
| | - Garrett Collins
- Section of Pulmonary/Critical Care and Allergy/Immunology, LSU School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - John Galeotti
- Carnegie Mellon Robotics Institute, Pittsburgh, PA, USA
| | - Amita Krishnan
- Section of Pulmonary/Critical Care and Allergy/Immunology, LSU School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Bennett P deBoisblanc
- Section of Pulmonary/Critical Care and Allergy/Immunology, LSU School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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Oricco S, Medico D, Tommasi I, Bini RM, Rabozzi R. Lung ultrasound score in dogs and cats: A reliability study. J Vet Intern Med 2024; 38:336-345. [PMID: 38009739 PMCID: PMC10800220 DOI: 10.1111/jvim.16956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Lung ultrasound (LUS) is a noninvasive tool for examining respiratory distress patients. The lung ultrasound score (LUSS) can be used to quantify and monitor lung aeration loss with good reliability. HYPOTHESIS/OBJECTIVES Assess the reliability of a new LUSS among raters with different levels of experience and determine how well the same raters agree on identifying patterns of LUS abnormalities. ANIMALS Forty LUS examinations of dogs and cats and 320 videos were reviewed from a digital database. METHODS Retrospective reliability study with post hoc analysis. Protocolized LUS were randomly selected; intrarater and interrater reliability of the LUSS and pattern recognition agreement among 4 raters with different levels of experience in LUS were tested. RESULTS The intrarater intraclass correlation coefficient (ICC) single measurement, absolute agreement, and 2-way mixed effects model was 0.967 for the high-experience rater (H-Exp), 0.963 and 0.952 for the medium-experience raters (M-Exp-1; M-Exp-2), and 0.950 for the low-experience rater (L-Exp). The interrater ICC average measurement, absolute agreement, and 2-way random effects model among the observers was 0.980. The Fleiss' kappa (k) values showed almost perfect agreement (k = 1) among raters in identifying pleural effusion and translobar tissue-like pattern, strong agreement for A-lines (k = 0.881) and B-lines (k = 0.806), moderate agreement (k = 0.693) for subpleural loss of aeration, and weak agreement (k = 0.474) for irregularities of the pleural line. CONCLUSIONS AND CLINICAL IMPORTANCE Our results indicate excellent intra- and interrater reliability for LUS scoring and pattern identification, providing a foundation for the use of the LUSS in emergency medicine and intensive care.
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Affiliation(s)
- Stefano Oricco
- Centro Veterinario ImperieseImperiaItaly
- Department of Veterinary SciencesUniversity of ParmaParmaItaly
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Lockstone J, Love A, Hung Lau Y, Hansell L, Ntoumenopoulos G. The use of diaphragm and lung ultrasound in acute respiratory physiotherapy practice and the impact on clinical decision-making: A systematic review and meta-analysis. Aust Crit Care 2024; 37:176-184. [PMID: 38036384 DOI: 10.1016/j.aucc.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVES Diaphragm and lung ultrasound (DLUS) is emerging as an important point-of-care respiratory assessment tool and is being used in clinical care by trained respiratory physiotherapists, both in Australia and internationally. However, the impact of DLUS on physiotherapists' clinical decision-making remains largely unknown. This systematic review aims to review the evidence for implementing DLUS in acute respiratory physiotherapy management. REVIEW METHOD USED We conducted a systematic review. DATA SOURCES We searched PubMed, Embase, CINAHL, CENTRAL, and Scopus from inception to 18th April 2023 for all original clinical studies reporting on the physiotherapy clinical decision-making, following a DLUS examination and/or where DLUS was used to evaluate the effect of respiratory physiotherapy, in adults over 18 years of age. REVIEW METHODS Two authors independently performed study selection and data extraction. Individual study risk of bias was assessed using the Newcastle-Ottawa Scale, and certainty in outcomes was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations framework. RESULTS A total of seven observational studies (n = 299) were included, all of which were in the intensive care setting. DLUS changed physiotherapy diagnosis, management, and treatment in 63.9% (50-64%), 16.8% (15-50%), and 48.4% (25-50%) of patients, respectively. There was a significant improvement in the lung ultrasound score post respiratory physiotherapy treatment (mean difference -2.31, 95% Confidence Interval (95% CI) -4.42 to -0.21; very low certainty) compared to before respiratory physiotherapy treatment. Moderate risk of bias was present in six studies, and there was variance in the DLUS methodology across included studies. CONCLUSIONS The findings of this review suggest DLUS influences physiotherapy clinical decision-making and can be used to evaluate the effects of acute respiratory physiotherapy treatment. However, the available data is limited, and further high-quality studies are needed. TRIAL REGISTRATION This study is registered with the International Prospective Register of Systematic Reviews; CRD42023418312.
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Affiliation(s)
- Jane Lockstone
- Physiotherapy Department, Launceston General Hospital, TAS, Australia.
| | - Annabel Love
- Physiotherapy Department, Launceston General Hospital, TAS, Australia
| | - Yin Hung Lau
- Physiotherapy Department, Royal Perth Bentley Group, Perth, Australia
| | - Louise Hansell
- The Kolling Institute, The University of Sydney, Sydney, Australia; Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia
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Smargiassi A, Zanforlin A, Tursi F, Soldati G, Inchingolo R. Trick or Trap? Reply to Vertical Artifacts as Lung Ultrasound Signs. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:215-216. [PMID: 37732895 DOI: 10.1002/jum.16337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/02/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Andrea Smargiassi
- UOC Pneumologia, Dipartimento Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Zanforlin
- Service of Pulmonology, Health District of Bolzano (SABES-ASDAA), Bolzano-Bozen, Italy
- Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria
| | - Francesco Tursi
- Pulmonary Medicine Unit, Codogno Hospital, Azienda Socio Sanitaria Territoriale Lodi, Codogno, Italy
| | - Gino Soldati
- Ippocrate Medical Center, Castelnuovo di Garfagnana, Lucca, Italy
| | - Riccardo Inchingolo
- UOC Pneumologia, Dipartimento Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Romero Romero B, Vollmer Torrubiano I, Martín Juan J, Heili Frades S, Pérez Pallares J, Pajares Ruiz V, Wangüemert Pérez A, Cristina Ramos H, Cases Viedma E. Ultrasound in the Study of Thoracic Diseases: Innovative Aspects. Arch Bronconeumol 2024; 60:33-43. [PMID: 37996336 DOI: 10.1016/j.arbres.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/11/2023] [Accepted: 10/25/2023] [Indexed: 11/25/2023]
Abstract
Thoracic ultrasound (TU) has rapidly gained popularity over the past 10 years. This is in part because ultrasound equipment is available in many settings, more training programmes are educating trainees in this technique, and ultrasound can be done rapidly without exposure to radiation. The aim of this review is to present the most interesting and innovative aspects of the use of TU in the study of thoracic diseases. In pleural diseases, TU has been a real revolution. It helps to differentiate between different types of pleural effusions, guides the performance of pleural biopsies when necessary and is more cost-effective under these conditions, and assists in the decision to remove thoracic drainage after talc pleurodesis. With the advent of COVID19, the use of TU has increased for the study of lung involvement. Nowadays it helps in the diagnosis of pneumonias, tumours and interstitial diseases, and its use is becoming more and more widespread in the Pneumology ward. In recent years, TU guided biopsies have been shown to be highly cost-effective, with other advantages such as the absence of radiation and the possibility of being performed at bedside. The use of contrast in ultrasound to increase the cost-effectiveness of these biopsies is very promising. In the study of the mediastinum and peripheral pulmonary nodules, the introduction of echobronchoscopy has brought about a radical change. It is a fully established technique in the study of lung cancer patients. The introduction of elastography may help to further improve its cost-effectiveness. In critically-ill patients, diaphragmatic ultrasound helps in the assessment of withdrawal of mechanical ventilation, and is now an indispensable tool in the management of these patients. In neuromuscular patients, ultrasound is a good predictor of impaired lung function. Currently, in Neuromuscular Disease Units, TU is an indispensable tool. Ultrasound study of the intercostal musculature is also effective in the study of respiratory function, and is widely used in Respiratory Rehabilitation. In Intermediate Care Units, thoracic ultrasound is indispensable for patient management. In these units there are ultrasound protocols for the management of patients with acute dyspnoea that have proven to be very effective.
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Affiliation(s)
- Beatriz Romero Romero
- Unidad Médico Quirúrgica Enfermedades Respirartorias, Hospital Vírgen del Rocío de Sevilla, Sevilla, Spain.
| | | | - Jose Martín Juan
- Unidad Médico Quirúrgica Enfermedades Respirartorias, Hospital Vírgen del Rocío de Sevilla, Sevilla, Spain
| | - Sarah Heili Frades
- Servicio de Neumología, Unidad de Cuidados Intermedios Respiratorios, Hospital Fundación Jiménez Díaz, Madrid, Spain
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Kimura BJ, Waltman DR, Han PJ, Waltman TJ. Effectiveness of Audio Output from an Artificial Intelligence Method for Layperson Recognition of Pulmonary Edema or COVID Lung Infection on Ultrasound Images. J Am Soc Echocardiogr 2024; 37:112-115. [PMID: 37696439 DOI: 10.1016/j.echo.2023.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/05/2023] [Accepted: 09/05/2023] [Indexed: 09/13/2023]
Affiliation(s)
- Bruce J Kimura
- Department of Cardiology and Graduate Medical Education, Scripps Mercy Hospital, San Diego, California
| | - Devin R Waltman
- Department of Cardiology and Graduate Medical Education, Scripps Mercy Hospital, San Diego, California
| | - Paul J Han
- Department of Cardiology and Graduate Medical Education, Scripps Mercy Hospital, San Diego, California
| | - Thomas J Waltman
- Department of Cardiology and Graduate Medical Education, Scripps Mercy Hospital, San Diego, California
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Schmidt S, Behnke N, Dieks JK. Chest X-rays and Lung Ultrasound Are Not Interchangeable in Intensive Care Practice. Diagnostics (Basel) 2023; 14:82. [PMID: 38201391 PMCID: PMC10795787 DOI: 10.3390/diagnostics14010082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/21/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
PURPOSE Data comparing lung ultrasound (LUS) and chest X-rays (CXRs) have increased over the past years. However, there still is a lack of knowledge as to how these modalities compare with one another in the critical care setting, and several factors, including artificial study conditions, limit the generalizability of most published studies. Our study aimed to analyze the performance of LUS in comparison with CXRs in real-world critical care practice. MATERIALS AND METHODS This study presents new data from the prospective FASP-ICU trial. A total of 209 corresponding datasets of LUS and CXR results from 111 consecutive surgical ICU patients were subanalyzed, and categorial findings were compared. Statistical analysis was performed on the rates of agreement between the different imaging modalities. RESULTS A total of 1162 lung abnormalities were detected by LUS in ICU patients compared with 1228 detected by CXR, a non-significant difference (p = 0.276; 95% CI -0.886 to 0.254). However, the agreement rates varied between the observed abnormalities: the rate of agreement for the presence of interstitial syndrome ranged from 0 to 15%, consolidation from 0 to 56%, basal atelectasis from 33.9 to 49.34%, pleural effusion from 40.65 to 50%, and compression atelectasis from 14.29 to 19.3%. The rate of agreement was 0% for pneumothorax and 20.95% for hypervolemia. CONCLUSIONS LUS does not detect more lung abnormalities in real-world critical care practice than CXRs, although a higher sensitivity of LUS has been reported in previous studies. Overall, low agreement rates between LUS and CXRs suggest that these diagnostic techniques are not equivalent but instead are complementary and should be used alongside each other.
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Affiliation(s)
- Stefan Schmidt
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Goettingen, Georg August University, Robert-Koch-Str. 40, 37075 Goettingen, Germany
- Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, University Hospital Goettingen, Georg August University, Robert-Koch-Str. 40, 37075 Goettingen, Germany;
| | - Nico Behnke
- Institute for Diagnostic and Interventional Radiology, University Hospital Goettingen, Georg August University, Robert-Koch-Str. 40, 37075 Goettingen, Germany;
| | - Jana-Katharina Dieks
- Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, University Hospital Goettingen, Georg August University, Robert-Koch-Str. 40, 37075 Goettingen, Germany;
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Bellocchio L, Dipalma G, Inchingolo AM, Inchingolo AD, Ferrante L, Del Vecchio G, Malcangi G, Palermo A, Qendro A, Inchingolo F. COVID-19 on Oral Health: A New Bilateral Connection for the Pandemic. Biomedicines 2023; 12:60. [PMID: 38255167 PMCID: PMC10813615 DOI: 10.3390/biomedicines12010060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/14/2023] [Accepted: 12/23/2023] [Indexed: 01/24/2024] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and transmission are generally known to be produced by respiratory droplets and aerosols from the oral cavity (O.C.) of infected subjects, as stated by the World Health Organization. Saliva also retains the viral particles and aids in the spread of COVID-19. Angiotensin-converting enzyme Type 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2) are two of the numerous factors that promote SARS-CoV-2 infection, expressed by O.C. structures, various mucosa types, and the epithelia of salivary glands. A systemic SARS-CoV-2 infection might result from viral replication in O.C. cells. On the other hand, cellular damage of different subtypes in the O.C. might be associated with various clinical signs and symptoms. Factors interfering with SARS-CoV-2 infection potential might represent fertile ground for possible local pharmacotherapeutic interventions, which may confine SARS-CoV-2 virus entry and transmission in the O.C., finally representing a way to reduce COVID-19 incidence and severity.
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Affiliation(s)
- Luigi Bellocchio
- INSERM, U1215 NeuroCentre Magendie, Endocannabinoids and Neuroadaptation, University of Bordeaux, 33063 Bordeaux, France;
| | - Gianna Dipalma
- Department of Interdisciplinary Medicine, University of Study “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (A.D.I.); (L.F.); (G.D.V.); (F.I.)
| | - Angelo Michele Inchingolo
- Department of Interdisciplinary Medicine, University of Study “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (A.D.I.); (L.F.); (G.D.V.); (F.I.)
| | - Alessio Danilo Inchingolo
- Department of Interdisciplinary Medicine, University of Study “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (A.D.I.); (L.F.); (G.D.V.); (F.I.)
| | - Laura Ferrante
- Department of Interdisciplinary Medicine, University of Study “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (A.D.I.); (L.F.); (G.D.V.); (F.I.)
| | - Gaetano Del Vecchio
- Department of Interdisciplinary Medicine, University of Study “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (A.D.I.); (L.F.); (G.D.V.); (F.I.)
| | - Giuseppina Malcangi
- Department of Interdisciplinary Medicine, University of Study “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (A.D.I.); (L.F.); (G.D.V.); (F.I.)
| | - Andrea Palermo
- College of Medicine and Dentistry, Birmingham B4 6BN, UK;
| | - Andis Qendro
- Faculty of Dental Medicine, University of Medicine, 1005 Tirana, Albania;
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Study “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (A.D.I.); (L.F.); (G.D.V.); (F.I.)
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Osterwalder J, Polyzogopoulou E, Hoffmann B. Point-of-Care Ultrasound-History, Current and Evolving Clinical Concepts in Emergency Medicine. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2179. [PMID: 38138282 PMCID: PMC10744481 DOI: 10.3390/medicina59122179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/10/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
Point-of-care ultrasound (PoCUS) has become an indispensable standard in emergency medicine. Emergency medicine ultrasound (EMUS) is the application of bedside PoCUS by the attending emergency physician to assist in the diagnosis and management of many time-sensitive health emergencies. In many ways, using PoCUS is not only the mere application of technology, but also a fusion of already existing examiner skills and technology in the context of a patient encounter. EMUS practice can be defined using distinct anatomy-based applications. The type of applications and their complexity usually depend on local needs and resources, and practice patterns can vary significantly among regions, countries, or even continents. A different approach suggests defining EMUS in categories such as resuscitative, diagnostic, procedural guidance, symptom- or sign-based, and therapeutic. Because EMUS is practiced in a constantly evolving emergency medical setting where no two patient encounters are identical, the concept of EMUS should also be practiced in a fluid, constantly adapting manner driven by the physician treating the patient. Many recent advances in ultrasound technology have received little or no attention from the EMUS community, and several important technical advances and research findings have not been translated into routine clinical practice. The authors believe that four main areas have great potential for the future growth and development of EMUS and are worth integrating: 1. In recent years, many articles have been published on novel ultrasound applications. Only a small percentage has found its way into routine use. We will discuss two important examples: trauma ultrasound that goes beyond e-FAST and EMUS lung ultrasound for suspected pulmonary embolism. 2. The more ultrasound equipment becomes financially affordable; the more ultrasound should be incorporated into the physical examination. This merging and possibly even replacement of aspects of the classical physical exam by technology will likely outperform the isolated use of stethoscope, percussion, and auscultation. 3. The knowledge of pathophysiological processes in acute illness and ultrasound findings should be merged in clinical practice. The translation of this knowledge into practical concepts will allow us to better manage many presentations, such as hypotension or the dyspnea of unclear etiology. 4. Technical innovations such as elastography; CEUS; highly sensitive color Doppler such as M-flow, vector flow, or other novel technology; artificial intelligence; cloud-based POCUS functions; and augmented reality devices such as smart glasses should become standard in emergencies over time.
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Affiliation(s)
| | - Effie Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece;
| | - Beatrice Hoffmann
- Department of Emergency Medicine BIDMC, One Deaconess Rd., WCC2, Boston, MA 02215, USA
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