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Lee MS, Sweetnam-Holmes D, Soffer GP, Harel-Sterling M. Updates on the clinical integration of point-of-care ultrasound in pediatric emergency medicine. Curr Opin Pediatr 2024; 36:256-265. [PMID: 38411588 DOI: 10.1097/mop.0000000000001340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
PURPOSE OF REVIEW There is expanding evidence for point-of-care ultrasound (POCUS) use in pediatric emergency medicine - this review highlights the benefits and challenges in the clinical integration of high-yield POCUS applications. Specifically, it will delve into POCUS applications during resuscitations, controversies of Focused Assessment with Sonography for Trauma (FAST) in pediatric trauma, POCUS-guided procedures, and examples of clinical pathways where POCUS can expedite definitive care. RECENT FINDINGS POCUS can enhance diagnostic accuracy and aid in management of pediatric patients in shock and help identify reversible causes during cardiac arrest. The use of the FAST in pediatric blunt abdominal trauma remains nuanced - its proper use requires an integration with clinical findings and an appreciation of its limitations. POCUS has been shown to enhance safety and efficacy of procedures such as nerve blocks, incision & drainage, and intravenous access. Integrating POCUS into pathways for conditions such as intussusception and testicular torsion expedites downstream care. SUMMARY POCUS enhances diagnostic efficiency and management in pediatric patients arriving at the ED with undifferentiated shock, cardiac arrest, or trauma. Additionally, POCUS improves procedural success and safety, and is integral to clinical pathways for expediting definitive care for various pediatric emergencies. Future research should continue to focus on the impact of POCUS on patient outcomes, ensuring user competency, and the expansion of POCUS into diverse settings.
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Affiliation(s)
- Michelle Sin Lee
- Pediatric Emergency Medicine, Hospital for Sick Children, Assistant Professor, University of Toronto, Toronto, ON, Canada
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Toron AD, Zeserson E, Stowens J. A response to: Internal jugular vein measurements: an alternative ultrasonic approach in estimating volume status of emergency department patients. Eur J Emerg Med 2024; 31:223. [PMID: 38661505 DOI: 10.1097/mej.0000000000001124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
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Nik Muhamad NA, Chun Chau T. Authors' response to correspondence on 'Internal jugular vein measurements: an alternative ultrasonic approach in estimating volume status of emergency department patients'. Eur J Emerg Med 2024; 31:223-224. [PMID: 38661506 DOI: 10.1097/mej.0000000000001126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
- Nik Azlan Nik Muhamad
- Department of Emergency Medicine, Hospital Canselor Tuanku Muhriz, National University of Malaysia UKM, Kuala Lumpur, Malaysia
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Bouvet L, Favre A, Riso A, Fabre J, Zieleskiewicz L, Desgranges FP, Chassard D. Diagnostic accuracy of a simple qualitative ultrasound assessment for the diagnosis of high-risk gastric contents in the parturient. A prospective observational cohort study. J Clin Anesth 2024; 94:111404. [PMID: 38290374 DOI: 10.1016/j.jclinane.2024.111404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/19/2023] [Accepted: 01/23/2024] [Indexed: 02/01/2024]
Abstract
STUDY OBJECTIVE Interpretation of gastric ultrasound relies on the use of a clinical algorithm that combines qualitative analysis of the gastric antrum contents with the calculation of the volume of fluid contents. This reference method may be difficult to apply in the parturient. We therefore aimed to assess the diagnostic accuracy of a simple qualitative assessment in the supine position for the diagnosis of high-risk gastric contents in the parturient. We also assessed the diagnostic accuracy of a composite scale and another clinical algorithm based on a mathematical model different to that used in the reference method. DESIGN Prospective observational cohort study. SETTING University hospital, Lyon, France. PATIENTS Adult women admitted to the delivery room. INTERVENTIONS Qualitative and quantitative gastric ultrasound examination within the first hour following admission. MEASUREMENTS With respect to the reference method, the diagnostic accuracy of a simple qualitative assessment for the diagnosis of high-risk gastric contents was assessed. The diagnostic accuracy of a composite scale and another clinical algorithm, and the agreement between each approach were also assessed. MAIN RESULTS A total of 235 parturients were included and analyzed. The simple qualitative assessment led to conclusive ultrasound assessment in 233 (99%) women, while the reference method led to conclusive assessment in 213 (91%) women (P < 0.05). The sensitivity and the specificity of the simple qualitative assessment were 97% (95%CI: 93 to 99%) and 96% (95%CI: 90 to 99%), respectively. These were not significantly different from those of the composite scale and the clinical algorithm. The four approaches showed almost perfect agreement with each other. CONCLUSIONS These results suggest that simple qualitative assessment may be useful in clinical practice to help the anesthesiologist in the assessment of gastric contents status and risk of aspiration.
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Affiliation(s)
- Lionel Bouvet
- Department of Anesthesiology and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, boulevard Pinel, Bron 69500, France; APCSe VetAgro Sup UP 2021.A101 - University of Lyon, Université Claude Bernard Lyon 1, 43 boulevard du 11 Novembre 1918, Villeurbanne 69100, France.
| | - Alix Favre
- Department of Anesthesiology and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, boulevard Pinel, Bron 69500, France
| | - Alexandre Riso
- Department of Anesthesiology and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, boulevard Pinel, Bron 69500, France.
| | - Juliette Fabre
- Department of Anesthesiology and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, boulevard Pinel, Bron 69500, France
| | - Laurent Zieleskiewicz
- Department of Anesthesiology and Intensive Care, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France.
| | - François-Pierrick Desgranges
- APCSe VetAgro Sup UP 2021.A101 - University of Lyon, Université Claude Bernard Lyon 1, 43 boulevard du 11 Novembre 1918, Villeurbanne 69100, France; Department of Anesthesiology and Intensive Care, L'Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche-sur-Saône 69655, France
| | - Dominique Chassard
- Department of Anesthesiology and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, boulevard Pinel, Bron 69500, France; APCSe VetAgro Sup UP 2021.A101 - University of Lyon, Université Claude Bernard Lyon 1, 43 boulevard du 11 Novembre 1918, Villeurbanne 69100, France.
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Lockhart TJ, Lin EE, Adler AC. Point-of-care ultrasound in pediatric anesthesiology: considerations for training and credentialing. Curr Opin Anaesthesiol 2024; 37:259-265. [PMID: 38573182 DOI: 10.1097/aco.0000000000001371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
PURPOSE OF REVIEW To discuss considerations surrounding the use of point-of-care ultrasound (POCUS) in pediatric anesthesiology. RECENT FINDINGS POCUS is an indispensable tool in various medical specialties, including pediatric anesthesiology. Credentialing for POCUS should be considered to ensure that practitioners are able to acquire images, interpret them correctly, and use ultrasound to guide procedures safely and effectively. In the absence of formal guidelines for anesthesiology, current practice and oversight varies by institution. In this review, we will explore the significance of POCUS in pediatric anesthesiology, discuss credentialing, and compare the specific requirements and challenges currently associated with using POCUS in pediatric anesthesia. SUMMARY Point-of-care ultrasound is being utilized by the pediatric anesthesiologist and has the potential to improve patient assessment, procedure guidance, and decision-making. Guidelines increase standardization and quality assurance procedures help maintain high-quality data. Credentialing standards for POCUS in pediatric anesthesiology are essential to ensure that practitioners have the necessary skills and knowledge to use this technology effectively and safely. Currently, there are no national pediatric POCUS guidelines to base credentialing processes on for pediatric anesthesia practices. Further work directed at establishing pediatric-specific curriculum goals and competency standards are needed to train current and future pediatric anesthesia providers and increase overall acceptance of POCUS use.
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Affiliation(s)
- Thomas J Lockhart
- Department of Anesthesiology, University of Nebraska College of Medicine, Children's Nebraska, Omaha, Nebraska
| | - Elaina E Lin
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adam C Adler
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
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Riemer K, Tan Q, Morse S, Bau L, Toulemonde M, Yan J, Zhu J, Wang B, Taylor L, Lerendegui M, Wu Q, Stride E, Dunsby C, Weinberg PD, Tang MX. 3D Acoustic Wave Sparsely Activated Localization Microscopy With Phase Change Contrast Agents. Invest Radiol 2024; 59:379-390. [PMID: 37843819 DOI: 10.1097/rli.0000000000001033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
OBJECTIVE The aim of this study is to demonstrate 3-dimensional (3D) acoustic wave sparsely activated localization microscopy (AWSALM) of microvascular flow in vivo using phase change contrast agents (PCCAs). MATERIALS AND METHODS Three-dimensional AWSALM using acoustically activable PCCAs was evaluated on a crossed tube microflow phantom, the kidney of New Zealand White rabbits, and the brain of C57BL/6J mice through intact skull. A mixture of C 3 F 8 and C 4 F 10 low-boiling-point fluorocarbon gas was used to generate PCCAs with an appropriate activation pressure. A multiplexed 8-MHz matrix array connected to a 256-channel ultrasound research platform was used for transmitting activation and imaging ultrasound pulses and recording echoes. The in vitro and in vivo echo data were subsequently beamformed and processed using a set of customized algorithms for generating 3D super-resolution ultrasound images through localizing and tracking activated contrast agents. RESULTS With 3D AWSALM, the acoustic activation of PCCAs can be controlled both spatially and temporally, enabling contrast on demand and capable of revealing 3D microvascular connectivity. The spatial resolution of the 3D AWSALM images measured using Fourier shell correlation is 64 μm, presenting a 9-time improvement compared with the point spread function and 1.5 times compared with half the wavelength. Compared with the microbubble-based approach, more signals were localized in the microvasculature at similar concentrations while retaining sparsity and longer tracks in larger vessels. Transcranial imaging was demonstrated as a proof of principle of PCCA activation in the mouse brain with 3D AWSALM. CONCLUSIONS Three-dimensional AWSALM generates volumetric ultrasound super-resolution microvascular images in vivo with spatiotemporal selectivity and enhanced microvascular penetration.
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Affiliation(s)
- Kai Riemer
- From the Department of Bioengineering, Imperial College London, London, United Kingdom (K.R., Q.T., S.M., M.T., J.Y., J.Z., B.W., L.T., M.L., P.D.W., M.-X.T.); NDORMS, University of Oxford, Oxford, United Kingdom (L.B., Q.W., E.S.); and Department of Physics, Imperial College London, London, United Kingdom (C.D.)
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Warshavsky A, Rubin R, Carmel-Neidermann NN, Brenner A, Shendler G, Kampel L, Izkhakov E, Muhanna N, Horowitz G. 4DCT in Discordant Parathyroid Adenoma Scans: Case Series and Meta-Analysis. Laryngoscope 2024; 134:2198-2205. [PMID: 37929814 DOI: 10.1002/lary.31142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To evaluate the accuracy of four-dimensional computerized-tomography (4DCT) for localizing parathyroid adenomas (PTAs) in cases with discordant or non-localizing ultrasonography (US) and Technetium-99 sestamibi (MIBI) scans. DATA SOURCES Retrospective case series and systematic review. REVIEW METHODS A case series and meta-analysis of patients diagnosed with primary hyperparathyroidism and discordant US and MIBI scans who underwent 4DCT prior to surgery. A comprehensive search for all relevant publications in the English literature between December 2006 and March 2022 was conducted for the meta-analysis. Patients undergoing parathyroidectomy between January 2015 and December 2021 were identified from the institutional electronic database for the case series. All studies were analyzed for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the 4DCT adenoma localization capabilities. RESULTS Thirteen retrospective studies that included 379 patients and one case series that included 37 patients were identified and analyzed. A per-patient analysis revealed sensitivity for lateralization to the correct side (n = 181) ranging from 80% to 100% with a fixed effects model of 89% (95%confidence interval [CI]: 82%-93%) and a PPV for lateralization ranging from 63%-95% with a random effects model of 87% (95% CI: 77%-95%). Sensitivity of localization to the correct quadrant (n = 172) ranged from 53% to 100% with a random effects model of 90.4% (95% CI: 76%-99%), and the PPV for localization ranged from 52% to 100% with a random effects model of 82% (95% CI: 73%-89%). CONCLUSION 4DCT enhances imaging capabilities of localizing PTAs in cases of discordant or non-localizing US and MIBI scans. LEVEL OF EVIDENCE NA Laryngoscope, 134:2198-2205, 2024.
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Affiliation(s)
- Anton Warshavsky
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery and The Department of Radiology and Imaging, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Raz Rubin
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery and The Department of Radiology and Imaging, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Narin Nard Carmel-Neidermann
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery and The Department of Radiology and Imaging, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Adi Brenner
- Radiology and Imaging, School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Genady Shendler
- Radiology and Imaging, School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Liyona Kampel
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery and The Department of Radiology and Imaging, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Elena Izkhakov
- The Institute of Endocrinology, School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nidal Muhanna
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery and The Department of Radiology and Imaging, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Gilad Horowitz
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery and The Department of Radiology and Imaging, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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8
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Banerjee S, Huang Z, Lyu J, Leung FHF, Lee T, Yang D, Zheng Y, McAviney J, Ling SH. Automatic Assessment of Ultrasound Curvature Angle for Scoliosis Detection Using 3-D Ultrasound Volume Projection Imaging. Ultrasound Med Biol 2024; 50:647-660. [PMID: 38355361 DOI: 10.1016/j.ultrasmedbio.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 02/16/2024]
Abstract
OBJECTIVE Scoliosis is a spinal deformation in which the spine takes a lateral curvature, generating an angle in the coronal plane. The conventional method for detecting scoliosis is measurement of the Cobb angle in spine images obtained by anterior X-ray scanning. Ultrasound imaging of the spine is found to be less ionising than traditional radiographic modalities. For posterior ultrasound scanning, alternate indices of the spinous process angle (SPA) and ultrasound curve angle (UCA) were developed and have proven comparable to those of the traditional Cobb angle. In SPA, the measurements are made using the spinous processes as an anatomical reference, leading to an underestimation of the traditionally used Cobb angles. Alternatively, in UCA, more lateral features of the spine are employed for measurement of the main thoracic and thoracolumbar angles; however, clear identification of bony features is required. The current practice of UCA angle measurement is manual. This research attempts to automate the process so that the errors related to human intervention can be avoided and the scalability of ultrasound scoliosis diagnosis can be improved. The key objective is to develop an automatic scoliosis diagnosis system using 3-D ultrasound imaging. METHODS The novel diagnosis system is a three-step process: (i) finding the ultrasound spine image with the most visible lateral features using the convolutional RankNet algorithm; (ii) segmenting the bony features from the noisy ultrasound images using joint spine segmentation and noise removal; and (iii) calculating the UCA automatically using a newly developed centroid pairing and inscribed rectangle slope method. RESULTS The proposed method was evaluated on 109 patients with scoliosis of different severity. The results obtained had a good correlation with manually measured UCAs (R2=0.9784 for the main thoracic angle andR2=0.9671 for the thoracolumbar angle) and a clinically acceptable mean absolute difference of the main thoracic angle (2.82 ± 2.67°) and thoracolumbar angle (3.34 ± 2.83°). CONCLUSION The proposed method establishes a very promising approach for enabling the applications of economic 3-D ultrasound volume projection imaging for mass screening of scoliosis.
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Affiliation(s)
- Sunetra Banerjee
- School of Electrical and Data Engineering, University of Technology Sydney, Sydney, NSW, Australia
| | - Zixun Huang
- Department of Electronic and Information Engineering, Hong Kong Polytechnic University, Hong Kong, China
| | - Juan Lyu
- College of Information and Communication Engineering, Harbin Engineering University, Harbin, China
| | - Frank H F Leung
- Department of Electronic and Information Engineering, Hong Kong Polytechnic University, Hong Kong, China
| | - Timothy Lee
- Department of Biomedical Engineering, Hong Kong Polytechnic University, Hong Kong, China
| | - De Yang
- Department of Biomedical Engineering, Hong Kong Polytechnic University, Hong Kong, China
| | - Yongping Zheng
- Department of Biomedical Engineering, Hong Kong Polytechnic University, Hong Kong, China
| | - Jeb McAviney
- ScoliCare Clinic Sydney (South), Kogarah, NSW 2217, Australia
| | - Sai Ho Ling
- School of Electrical and Data Engineering, University of Technology Sydney, Sydney, NSW, Australia.
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Martins JG, Waller J, Horgan R, Kawakita T, Kanaan C, Abuhamad A, Saade G. Point-of-Care Ultrasound in Critical Care Obstetrics: A Scoping Review of the Current Evidence. J Ultrasound Med 2024; 43:951-965. [PMID: 38321827 DOI: 10.1002/jum.16425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/29/2023] [Accepted: 01/18/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVES To synthesize the current evidence of maternal point-of-care ultrasound (POCUS) in obstetrics. A scoping review was conducted using PubMed, Clinicaltrials.gov, and the Cochrane library from inception through October 2023. METHODS Studies were eligible for inclusion if they described the use of POCUS among obstetric or postpartum patients. Two authors independently screened all abstracts. Quantitative, qualitative, and mixed-methods studies were eligible for inclusion. Case reports of single cases, review articles, and expert opinion articles were excluded. Studies describing detailed maternal nonobstetric sonograms or maternal first trimester sonograms to confirm viability and rule out ectopic pregnancy were also excluded. Data were tabulated using Microsoft Excel and summarized using a narrative review and descriptive statistics. RESULTS A total of 689 publications were identified through the search strategy and 12 studies met the inclusion criteria. Nine studies evaluated the use of lung POCUS in obstetrics in different clinical scenarios. Lung ultrasound (LUS) findings in preeclampsia showed an excellent ability to detect pulmonary edema (area under the receiver operating characteristic 0.961) and findings were correlated with clinical evidence of respiratory distress (21 of 57 [37%] versus 14 of 109 [13%]; P = .001). Three studies evaluated abdominal POCUS, two of the inferior vena cava (IVC) to predict postspinal anesthesia hypotension (PSAH) and fluid receptivity and one to assess the rate of ascites in patients with preeclampsia. Patients with PSAH had higher IVC collapsibility (area under the curve = 0.950, P < .001) and, in patients with severe preeclampsia, there is a high rate of ascites (52%) associated with increased risk of adverse outcomes. There were no studies on the use of subjective cardiac POCUS. CONCLUSION POCUS use in the management of high-risk obstetrics has increased. LUS has been the most studied modality and appears to have a potential role in the setting of preeclampsia complicated by pulmonary edema. Cardiac and abdominal POCUS have not been well studied. Trials are needed to evaluate its clinical applicability, reliability, and technique standardization before widespread use.
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Affiliation(s)
- Juliana G Martins
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Jerri Waller
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Rebecca Horgan
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Tetsuya Kawakita
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Camille Kanaan
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Alfred Abuhamad
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - George Saade
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
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Mohr-Sasson A, Castel E, Dadon T, Brandt A, Etinger R, Cohen A, Zajicek M, Haas J, Mashiach R. The association of endometrial closure during cesarean section to the risk of developing uterine scar defect: a randomized control trial. Arch Gynecol Obstet 2024; 309:2063-2070. [PMID: 38498161 DOI: 10.1007/s00404-024-07417-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 02/04/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE The surgical technique for uterine closure following cesarean section influences the healing of the cesarean scar; however, there is still no consensus on the optimal technique regarding the closure of the endometrium layer. The aim of this study was to compare the effect of closure versus non-closure of the endometrium during cesarean section on the risk to develop uterine scar defect and associated symptoms. METHODS A randomized prospective study was conducted of women undergoing first elective cesarean section at a single tertiary medical center. Exclusion criteria included previous uterine scar, preterm delivery and dysmorphic uterus. Women were randomized for endometrial layer closure versus non-closure. Six months following surgery, women were invited to the ambulatory gynecological clinic for follow-up visit. 2-D transvaginal ultrasound examination was performed to evaluate the cesarean scar characteristics. In addition, women were evaluated for symptoms that might be associated with uterine scar defect. Primary outcome was defined as the residual myometrial thickness (RMT) at the uterine cesarean scar. Data are presented as median and interquartile range. RESULTS 130 women were recruited to the study, of them follow-up was achieved in 113 (86.9%). 61 (54%) vs. 52 (46%) of the women were included in the endometrial closure vs. non-closure groups, respectively. Groups were comparable for patient's demographic, clinical characteristics and follow-up time for postoperative evaluation. Median RMT was 5.3 (3.0-7.7) vs. 4.6 (3.0-6.5) mm for the endometrial closure and non-closure groups, respectively (p = 0.38). Substantially low RMT (< 2.5 mm) was measured in four (6.6%) women in the endometrial closure group and three (5.8%) of the women in the non-closure group (p = 0.86). All other uterine scar sonographic measurements, as well as dysmenorrhea, pelvic pain and intermenstrual bleeding rates were comparable between the groups. CONCLUSION Closure versus non-closure of the endometrial layer during cesarean uterine incision repair has no significant difference in cesarean scar characteristics and symptom rates at 6 months follow-up.
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Affiliation(s)
- Aya Mohr-Sasson
- Department of Obstetrics and Gynecology, Sheba Medical Center, 5265601, Tel-Hashomer, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Elias Castel
- Department of Obstetrics and Gynecology, Sheba Medical Center, 5265601, Tel-Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tal Dadon
- Department of Obstetrics and Gynecology, Sheba Medical Center, 5265601, Tel-Hashomer, Israel
| | - Ariel Brandt
- Department of Obstetrics and Gynecology, Sheba Medical Center, 5265601, Tel-Hashomer, Israel
| | - Roie Etinger
- Department of Obstetrics and Gynecology, Sheba Medical Center, 5265601, Tel-Hashomer, Israel
| | - Adiel Cohen
- Department of Obstetrics and Gynecology, Sheba Medical Center, 5265601, Tel-Hashomer, Israel
| | - Michal Zajicek
- Department of Obstetrics and Gynecology, Sheba Medical Center, 5265601, Tel-Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jigal Haas
- Department of Obstetrics and Gynecology, Sheba Medical Center, 5265601, Tel-Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Roy Mashiach
- Department of Obstetrics and Gynecology, Sheba Medical Center, 5265601, Tel-Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Meng J, Cheng K, Huang Z, He W, Zhang K, Lu Y, Zhu X. COMBINED APPLICATION OF B-SCAN ULTRASONOGRAPHY AND EYE-STEERING ULTRAWIDE FIELD IMAGING TO IMPROVE THE DETECTION OF RETINAL TEARS BEFORE CATARACT SURGERY. Retina 2024; 44:810-819. [PMID: 38194664 DOI: 10.1097/iae.0000000000004040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
PURPOSE To investigate the efficacy of combined application of B-scan ultrasonography (US) and ultrawide field imaging (UWFI) in detecting retinal tears before cataract surgery. METHODS Of 1,277 cataract patients, 2,552 eyes were enrolled and received both B-scan US and UWFI examinations preoperatively. Three types of combination were applied: type 1 (union, B-scan US or centered UWFI), type 2 (intersection, B-scan US and centered UWFI), and type 3 (B-scan US and eye-steering UWFI). Sensitivity and specificity of detecting retinal tears by different methods were assessed. RESULTS Totally 4.55% (116/2,552) of eyes were presented with retinal tears. The sensitivity of B-scan US and UWFI was 87.93% and 84.48%, and specificity was 95.16% and 99.79%, respectively. By applying type 1 and type 2 combination, the sensitivity was 98.28% and 74.14%, and specificity was 95.03% and 99.92%, respectively. By type 3 combination, the sensitivity increased to 95.69% and specificity to 99.88%, both of which were comparable to indirect ophthalmoscopy regardless of the number, type, and location of tears ( P > 0.05). In eyes with any cataract type or axial length, type 3 combination also gained comparable performance to indirect ophthalmoscopy. CONCLUSION Combined application of B-scan US and eye-steering UWFI presented satisfactory performance in detecting retinal tears before cataract surgery.
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Affiliation(s)
- Jiaqi Meng
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China; and
| | - Kaiwen Cheng
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China; and
| | - Zhiqian Huang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China; and
| | - Wenwen He
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China; and
| | - Keke Zhang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China; and
| | - Yi Lu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China; and
| | - Xiangjia Zhu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China; and
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
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12
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Elsayed Y, Soylu H. Point-of-care abdominal ultrasound in pediatric and neonatal intensive care units. Eur J Pediatr 2024; 183:2059-2069. [PMID: 38459132 DOI: 10.1007/s00431-024-05443-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 03/10/2024]
Abstract
A spectrum of critical abdominal pathological conditions that might occur in neonates and children warrants real-time point-of-care abdominal ultrasound (abdominal POCUS) assessment. Abdominal radiographs have limited value with low sensitivity and specificity in many cases and have no value in assessing abdominal organ perfusion and microcirculation (Rehan et al. in Clin Pediatr (Phila) 38(11):637-643, 1999). The advantages of abdominal POCUS include that it is non-invasive, easily available, can provide information in real-time, and can guide therapeutic intervention (such as paracentesis and urinary bladder catheterization), making it a crucial tool for use in pediatric and neonatal abdominal emergencies (Martínez Biarge et al. in J Perinat Med 32(2):190-194, 2004) and (Alexander et al. in Arch Dis Child Fetal Neonatal Ed 106(1):F96-103, 2021). Conclusion: Abdominal POCUS is a dynamic assessment with many ultrasound markers of gut injury by two dimensions (2-D) and color Doppler (CD) compared to the abdominal X-ray; the current evidence supports the superiority of abdominal POCUS over an abdominal X-ray in emergency situations. However, it should still be considered an adjunct rather than replacing abdominal X-rays due to its limitations and operator constraints (Alexander et al. in Arch Dis Child Fetal Neonatal Ed 106(1):F96-103, 2021). What is Known: • Ultrasound is an important modality for the assessment of abdominal pathologies. What is New: • The evidence supports the superiority of abdominal POCUS over an abdominal X-ray in emergency abdominal situations in the neonatal and pediatric intensive care units.
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Affiliation(s)
- Yasser Elsayed
- Section of Neonatology, Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada.
- Women's Hospital, 820 Sherbrook Street, Winnipeg, MB, R2016, R3A0L8, Canada.
| | - Hanifi Soylu
- Section of Neonatology, Department of Pediatrics, Selcuk University, Konya, Turkey
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Polat Z, Elmalı M, Tanrivermis Sayit A, Kalkan C, Danacı M, Kefeli M. Comparative evaluation of shear wave elastography elasticity values in thyroid nodules with cytology results and TI-RADS scoring in differentiation of benign-malignant nodules. Eur Arch Otorhinolaryngol 2024; 281:2609-2617. [PMID: 38461420 PMCID: PMC11023991 DOI: 10.1007/s00405-024-08516-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 01/29/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE The aim of this prospective study was to investigate the diagnostic performance of shear wave elastography (SWE) in differentiating benign and malignant thyroid nodules and their correlation with the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS). METHODS This prospective study included 370 thyroid nodules in 308 patients aged 18-70 years. All the patients underwent B-mode ultrasound (US), Doppler examination, and SWE and were given an ACR TI-RADS risk score before fine needle aspiration biopsy (FNAB) and/or surgery. The correlation between SWE parameters and ACR TI-RADS categories was investigated statistically and compared with histopathologic results. Additionally, the diagnostic performance of SWE was evaluated to distinguish malignant and benign thyroid nodules. RESULTS One hundred and thirty-five of the 370 thyroid nodules were malignant, and 235 nodules were benign. The mean shear wave velocity (SWV) value of the malignant nodules (3.70 ± 0.98 m/s) was statistically higher than that of the benign nodules (2.70 ± 0.37 m/s). The best cutoff value of the mean SWV for differentiating benign and malignant nodules was found to be 2.94 m/s (sensitivity 90.4%, specificity 89.9%, positive predictive value 81.3%, negative predictive value 94.1%, p < 0.001). The average score of the nodules according to the ACR TI-RADS was 3.57 ± 1.83 in benign nodules and 7.38 ± 2.69 in malignant nodules (p ≤ 0.001). CONCLUSION This study showed that combining SWE and TI-RADS improves the specificity of TI-RADS alone in differentiating benign and malignant nodules.
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Affiliation(s)
- Zafer Polat
- Faculty of Medicine, Department of Radiology, Ondokuzmayis University, 55139, Atakum, Samsun, Turkey
| | - Muzaffer Elmalı
- Faculty of Medicine, Department of Radiology, Ondokuzmayis University, 55139, Atakum, Samsun, Turkey
| | - Asli Tanrivermis Sayit
- Faculty of Medicine, Department of Radiology, Ondokuzmayis University, 55139, Atakum, Samsun, Turkey.
| | - Cihan Kalkan
- Faculty of Medicine, Department of Radiology, Ondokuzmayis University, 55139, Atakum, Samsun, Turkey
| | - Murat Danacı
- Faculty of Medicine, Department of Radiology, Ondokuzmayis University, 55139, Atakum, Samsun, Turkey
| | - Mehmet Kefeli
- Faculty of Medicine, Department of Pathology, Ondokuzmayis University, Samsun, Turkey
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14
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Kiyomiya Y, Fujiu-Kurachi M, Hirata A, Nakasone W, Azuma M, Kishida S, Tsuda G. Morphological and functional changes of the geniohyoid muscle in elderly patients after hip fracture surgery: Comparison of ultrasound images with a focus on swallowing function. J Oral Rehabil 2024; 51:870-878. [PMID: 38214198 DOI: 10.1111/joor.13650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 11/16/2023] [Accepted: 12/11/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE The purpose of this study was to clarify, using ultrasound imaging, (1) whether the area and contraction of GH change in elderly patients after hip fracture surgery and (2) whether the changes in the area and contraction of GH are related to decline in swallowing function. METHODS The participants were 21 female patients over 65 years of age who underwent hip fracture surgery. The patients were divided into two groups based on the results of swallowing assessment by water drinking: One with normal swallowing function (NSF) and the other with suspected decline in swallowing function (DSF). Sagittal cross-sectional area (SA) of GH at rest and the shortening rate (SR) of GH upon contraction during swallowing were compared at two time points: immediately and 2 weeks after surgery. Wilcoxon signed-rank test was used for intra-group comparisons, and Mann-Whitney U-test was used for between-group comparisons. RESULT SA of GH decreased significantly at 2 weeks after surgery in both groups, regardless of their swallowing function. In the intra-group comparison, SR significantly decreased (worsened) only in DSF group. SR at 2 weeks after surgery was significantly higher in NSF than in the DSF. In the inter-group comparison, DSF showed a significantly smaller (worse) change of SR than NSF in 2 weeks after surgery. CONCLUSION Decrease in muscle mass, or atrophy, of GH observed in both NSF and DSF, did not coincide with the post-operative change in GH contraction of the two groups. The results suggest the importance of continuous swallowing assessment in the elderly individuals during their perioperative period.
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Affiliation(s)
- Yuto Kiyomiya
- Department of Rehabilitation, Seirei akura Citizen Hospital, Chiba, Japan
- Department of Speech, Language and Hearing Sciences, International University of Health and Welfare Graduate School, Chiba, Japan
| | - Masako Fujiu-Kurachi
- Department of Speech and Hearing Sciences, International University of Health and Welfare, Chiba, Japan
| | - Aya Hirata
- Department of Speech and Hearing Sciences, International University of Health and Welfare, Tochigi, Japan
| | - Waku Nakasone
- Department of Otolaryngology, Seirei Sakura Citizen Hospital, Chiba, Japan
| | - Masaki Azuma
- Department of Surgery, Takane Hospital, Chiba, Japan
| | - Shunji Kishida
- Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Chiba, Japan
| | - Gota Tsuda
- Department of Otolaryngology, Seirei Sakura Citizen Hospital, Chiba, Japan
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Liu Z, Yang B, Shen Y, Ni X, Tsaftaris SA, Zhou H. Long-short diffeomorphism memory network for weakly-supervised ultrasound landmark tracking. Med Image Anal 2024; 94:103138. [PMID: 38479152 DOI: 10.1016/j.media.2024.103138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 01/26/2024] [Accepted: 03/05/2024] [Indexed: 04/16/2024]
Abstract
Ultrasound is a promising medical imaging modality benefiting from low-cost and real-time acquisition. Accurate tracking of an anatomical landmark has been of high interest for various clinical workflows such as minimally invasive surgery and ultrasound-guided radiation therapy. However, tracking an anatomical landmark accurately in ultrasound video is very challenging, due to landmark deformation, visual ambiguity and partial observation. In this paper, we propose a long-short diffeomorphism memory network (LSDM), which is a multi-task framework with an auxiliary learnable deformation prior to supporting accurate landmark tracking. Specifically, we design a novel diffeomorphic representation, which contains both long and short temporal information stored in separate memory banks for delineating motion margins and reducing cumulative errors. We further propose an expectation maximization memory alignment (EMMA) algorithm to iteratively optimize both the long and short deformation memory, updating the memory queue for mitigating local anatomical ambiguity. The proposed multi-task system can be trained in a weakly-supervised manner, which only requires few landmark annotations for tracking and zero annotation for deformation learning. We conduct extensive experiments on both public and private ultrasound landmark tracking datasets. Experimental results show that LSDM can achieve better or competitive landmark tracking performance with a strong generalization capability across different scanner types and different ultrasound modalities, compared with other state-of-the-art methods.
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Affiliation(s)
- Zhihua Liu
- School of Computing and Mathematical Sciences, University of Leicester, Leicester, LE1 7RH, UK
| | - Bin Yang
- Department of Cardiovascular Sciences, University Hospitals of Leicester NHS Trust, Leicester, LE1 9HN, UK; Nantong-Leicester Joint Institute of Kidney Science, Department of Nephrology, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Yan Shen
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Xuejun Ni
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Sotirios A Tsaftaris
- School of Engineering, The University of Edinburgh, Edinburgh EH9 3FG, UK; The Alan Turing Institute, London NW1 2DB, UK
| | - Huiyu Zhou
- School of Computing and Mathematical Sciences, University of Leicester, Leicester, LE1 7RH, UK.
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Xu N, Wang X, Dai T, Liu N, Ding Y, Chen J, Tian L, Fang Y, Zhang Y, Li G. Non-invasive imaging for predicting labial salivary gland biopsy outcomes in patients with suspected primary Sjögren syndrome. Clin Rheumatol 2024; 43:1683-1692. [PMID: 38568436 DOI: 10.1007/s10067-024-06949-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 03/02/2024] [Accepted: 03/24/2024] [Indexed: 04/16/2024]
Abstract
To identify the value of salivary gland ultrasound (SGUS) combined with magnetic resonance imaging (MRI) and magnetic resonance sialography (MRS) in predicting the results of labial salivary gland biopsy (LSGB) in patients with suspected primary Sjögren syndrome (pSS), and construct a nomogram model to predict LSGB results. A total of 181 patients who were admitted with suspected pSS from December 2018 to April 2023 were examined and divided into a training set (n = 120) and a validation set (n = 61). Baseline data of the two groups were examined, and the value of SGUS, MRI, and MRS in predicting LSGB was analyzed. Multivariate logistic analysis was used to screen for risk factors, and nomogram prediction models were constructed using these results. In the training set, the SGUS, MRI, and MRS scores of patients in the LSGB + group were higher than those in the LSGB - group (all P < 0.001). The positive prediction value (PPV) was 91% for an SGUS score of 3, and 82% for MRI and MRS scores of 2 or more. We developed a nomogram prediction model based on SGUS, MRI, and MRS data, and it had a concordance index (C-index) of 0.94. The Hosmer-Lemeshow test (χ2 = 3.17, P = 0.92) also indicated the nomogram prediction model had good accuracy and calibration for prediction of LSGB results. A nomogram model based on SGUS, MRI, and MRS results can help rheumatologists decide whether LSGB should be performed in patients with suspected pSS.
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Affiliation(s)
- Nan Xu
- Department of Rheumatology and Immunology, Affiliated Hospital of Yangzhou University, Yangzhou University, No. 368, Hangjiang RoadJiangsu Province, Yangzhou, 225000, People's Republic of China
| | - Xuanhan Wang
- Department of Rheumatology and Immunology, Affiliated Hospital of Yangzhou University, Yangzhou University, No. 368, Hangjiang RoadJiangsu Province, Yangzhou, 225000, People's Republic of China
| | - Tiantian Dai
- Department of Rheumatology and Immunology, Affiliated Hospital of Yangzhou University, Yangzhou University, No. 368, Hangjiang RoadJiangsu Province, Yangzhou, 225000, People's Republic of China
| | - Nianxing Liu
- Department of Rheumatology and Immunology, Affiliated Hospital of Yangzhou University, Yangzhou University, No. 368, Hangjiang RoadJiangsu Province, Yangzhou, 225000, People's Republic of China
| | - Yimin Ding
- Department of Rheumatology and Immunology, Affiliated Hospital of Yangzhou University, Yangzhou University, No. 368, Hangjiang RoadJiangsu Province, Yangzhou, 225000, People's Republic of China
| | - Jinqiong Chen
- Department of Rheumatology and Immunology, Affiliated Hospital of Yangzhou University, Yangzhou University, No. 368, Hangjiang RoadJiangsu Province, Yangzhou, 225000, People's Republic of China
| | - Longlong Tian
- Department of Rheumatology and Immunology, Qingdao West Coast New District People's Hospital, Qingdao, 266000, People's Republic of China
| | - Yuxuan Fang
- Department of Rheumatology and Immunology, Affiliated Hospital of Yangzhou University, Yangzhou University, No. 368, Hangjiang RoadJiangsu Province, Yangzhou, 225000, People's Republic of China
| | - Yongbin Zhang
- Department of Rheumatology and Immunology, Affiliated Hospital of Yangzhou University, Yangzhou University, No. 368, Hangjiang RoadJiangsu Province, Yangzhou, 225000, People's Republic of China
| | - Guoqing Li
- Department of Rheumatology and Immunology, Affiliated Hospital of Yangzhou University, Yangzhou University, No. 368, Hangjiang RoadJiangsu Province, Yangzhou, 225000, People's Republic of China.
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Haueise A, Le Sant G, Eisele-Metzger A, Dieterich AV. Is musculoskeletal pain associated with increased muscle stiffness? Evidence map and critical appraisal of muscle measurements using shear wave elastography. Clin Physiol Funct Imaging 2024; 44:187-204. [PMID: 38155545 DOI: 10.1111/cpf.12870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/13/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
INTRODUCTION AND AIMS Approximately 21% of the world's population suffers from musculoskeletal conditions, often associated with sensations of stiff muscles. Targeted therapy requires knowing whether typically involved muscles are objectively stiffer compared to asymptomatic individuals. Muscle stiffness is quantified using ultrasound shear wave elastography (SWE). Publications on SWE-based comparisons of muscle stiffness between individuals with and without musculoskeletal pain are increasing rapidly. This work reviewed and mapped the existing evidence regarding objectively measured muscle stiffness in musculoskeletal pain conditions and surveyed current methods of applying SWE to measure muscle stiffness. METHODS A systematic search was conducted in PubMed and CINAHL using the keywords "muscle stiffness", "shear wave elastography", "pain", "asymptomatic controls" and synonyms. The search was supplemented by a hand search using Google Scholar. Included articles were critically appraised with the AXIS tool, supplemented by items related to SWE methods. Results were visually mapped and narratively described. RESULTS Thirty of 137 identified articles were included. High-quality evidence was missing. The results comprise studies reporting lower stiffness in symptomatic participants, no differences between groups and higher stiffness in symptomatic individuals. Results differed between pain conditions and muscles, and also between studies that examined the same muscle(s) and pathology. The methods of the application of SWE were inconsistent and the reporting was often incomplete. CONCLUSIONS Existing evidence regarding the objective stiffness of muscles in musculoskeletal pain conditions is conflicting. Methodological differences may explain most of the inconsistencies between findings. Methodological standards for SWE measurements of muscles are urgently required.
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Affiliation(s)
- Andreas Haueise
- Faculty of Health, Security, Society, Furtwangen University, Furtwangen, Germany
| | - Guillaume Le Sant
- CHU Nantes, Movement-Interactions-Performance, MIP, Nantes Université, Nantes, France
- School of Physiotherapy, IFM3R, St-Sebastien/Loire, France
| | - Angelika Eisele-Metzger
- Institute for Evidence in Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Angela V Dieterich
- Faculty of Health, Security, Society, Furtwangen University, Furtwangen, Germany
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Lubel E, Rohlen R, Sgambato BG, Barsakcioglu DY, Ibanez J, Tang MX, Farina D. Accurate Identification of Motoneuron Discharges From Ultrasound Images Across the Full Muscle Cross-Section. IEEE Trans Biomed Eng 2024; 71:1466-1477. [PMID: 38055363 DOI: 10.1109/tbme.2023.3340019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
OBJECTIVE Non-invasive identification of motoneuron (MN) activity commonly uses electromyography (EMG). However, surface EMG (sEMG) detects only superficial sources, at less than approximately 10-mm depth. Intramuscular EMG can detect deep sources, but it is limited to sources within a few mm of the detection site. Conversely, ultrasound (US) images have high spatial resolution across the whole muscle cross-section. The activity of MNs can be extracted from US images due to the movements that MN activation generates in the innervated muscle fibers. Current US-based decomposition methods can accurately identify the location and average twitch induced by MN activity. However, they cannot accurately detect MN discharge times. METHODS Here, we present a method based on the convolutive blind source separation of US images to estimate MN discharge times with high accuracy. The method was validated across Ten participants using concomitant sEMG decomposition as the ground truth. RESULTS 140 unique MN spike trains were identified from US images, with a rate of agreement (RoA) with sEMG decomposition of 87.4 ± 10.3%. Over 50% of these MN spike trains had a RoA greater than 90%. Furthermore, with US, we identified additional MUs well beyond the sEMG detection volume, at up to >30 mm below the skin. CONCLUSION The proposed method can identify discharges of MNs innervating muscle fibers in a large range of depths within the muscle from US images. SIGNIFICANCE The proposed methodology can non-invasively interface with the outer layers of the central nervous system innervating muscles across the full cross-section.
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Pan Y, Wang X, Qiang Y, Wang N, Liu R, Yang G, Zhang Z, He X, Yu Y, Zheng H, Qiu W. A New Method of Plane-Wave Ultrasound Imaging Based on Reverse Time Migration. IEEE Trans Biomed Eng 2024; 71:1628-1639. [PMID: 38133968 DOI: 10.1109/tbme.2023.3346194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Coherent plane-wave compounding technique enables rapid ultrasound imaging with comparable image quality to traditional B-mode imaging that relies on focused beam transmission. However, existing methods assume homogeneity in the imaged medium, neglecting the heterogeneity in sound velocities and densities present in real tissues, resulting in noise reverberation. This study introduces the Reverse Time Migration (RTM) method for ultrasound plane-wave imaging to overcome this limitation, which is combined with a method for estimating the speed of sound in layered media. Simulation results in a homogeneous background demonstrate that RTM reduces side lobes and grating lobes by approximately 30 dB, enhancing the contrast-to-noise ratio by 20% compared to conventional delay and sum (DAS) beamforming. Moreover, RTM achieves superior imaging outcomes with fewer compounding angles. The lateral resolution of the RTM with 5-9 angle compounding is able to achieve the effectiveness of the DAS method with 15-19 angle compounding, and the CNR of the RTM with 11-angle compounding is almost the same as that of the DAS with 21-angle compounding. In a heterogeneous background, experimental simulations and in vitro wire phantom experiments confirm RTM's capability to correct depth imaging, focusing reflected waves on point targets. In vitro porcine tissue experiments enable accurate imaging of layer interfaces by estimating the velocities of multiple layers containing muscle and fat. The proposed imaging procedure optimizes velocity estimation in complex media, compensates for the impact of velocity differences, provides more reliable imaging results.
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Baldawi M, Ghaleb N, McKelvey G, Ismaeil YM, Saasouh W. Preoperative ultrasound assessment of gastric content in patients with diabetes: A meta-analysis based on a systematic review of the current literature. J Clin Anesth 2024; 93:111365. [PMID: 38134485 DOI: 10.1016/j.jclinane.2023.111365] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 12/09/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023]
Abstract
STUDY OBJECTIVE To conduct a systematic literature review of the current evidence on the effect of diabetes mellitus on gastric volume observed during a preoperative ultrasound examination. Using the results of this systematic literature review, a meta-analysis was performed to investigate whether there was an association between diabetes mellitus and an increased risk of presenting with a high-risk stomach (gastric volume associated with an increased risk of pulmonary aspiration). DESIGN Review article and meta-analysis. SETTING Review of published literature. PATIENTS A total of 3366 patients underwent surgery. INTERVENTION Gastric ultrasound examination. MEASUREMENTS Data for the meta-analysis and literature review were collected from the PubMed/Medline, Embase, Web of Science, and Google Scholar databases of the National Library of Medicine from the date of inception to January 2023. All included studies measured the gastric antral cross-sectional area and/or gastric residual volume in patients with diabetes and those without diabetes. The data utilized in the meta-analysis included all studies that evaluated the incidence of high-risk stomachs based on ultrasonographic measurements of the gastric antral cross-sectional area or gastric residual volume. MAIN RESULTS Most collated studies revealed that diabetes mellitus was associated with increased antral cross-sectional area and gastric residual volume. A meta-analysis of published reports indicated that patients with diabetes have an increased rate of high-risk stomachs. CONCLUSIONS Diabetes mellitus is associated with an increased rate of high-risk stomachs. The authors recommend large prospective trials to ascertain the safety of the current fasting guidelines for patients with diabetes undergoing surgery.
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Affiliation(s)
- Mohanad Baldawi
- Wayne State University/Detroit Medical Center, Department of Anesthesiology, 3990 John R. Street, Detroit, MI 48201, USA.
| | - Nancy Ghaleb
- Wayne State University/Detroit Medical Center, Department of Anesthesiology, 3990 John R. Street, Detroit, MI 48201, USA
| | - George McKelvey
- Wayne State University/Detroit Medical Center, Department of Anesthesiology, 3990 John R. Street, Detroit, MI 48201, USA; NorthStar Anesthesia, 6225 State Hwy 161 #200, Irving, TX 75038, USA
| | - Yara M Ismaeil
- Eastern Michigan University, Division of Cellular and Molecular Biology, 900 Oakwood St, Ypsilanti, MI 48197, USA
| | - Wael Saasouh
- Wayne State University/Detroit Medical Center, Department of Anesthesiology, 3990 John R. Street, Detroit, MI 48201, USA; NorthStar Anesthesia, 6225 State Hwy 161 #200, Irving, TX 75038, USA; Outcomes Research Consortium, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Perlas A, Arzola C, Portela N, Mitsakakis N, Hayawi L, Van de Putte P. Gastric Volume and Antral Area in the Fasting State: A Meta-analysis of Individual Patient Data. Anesthesiology 2024; 140:991-1001. [PMID: 38241328 DOI: 10.1097/aln.0000000000004914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
BACKGROUND Pulmonary aspiration of gastric content is a serious anesthetic complication. Gastric point-of-care ultrasound can determine the type and volume of gastric content when clinical information is equivocal. However, a cutoff value of either antral cross-sectional area or volume that may be considered as the upper limit of normal in fasting subjects is still controversial. The aim of this study is to characterize the distribution of baseline antral area and volume in fasting adult subjects and to identify an upper limit (95th percentile) of these distributions. METHODS The authors conducted a meta-analysis of individual participant data of primary studies from an academic research network of investigators collaborating in gastric ultrasound. Studies between January 2009 and December 2020 were included. RESULTS Twelve primary studies met inclusion criteria and were included in the analysis with a sample size of 1,203 subjects. The 95th percentile of area values (measured in the right lateral decubitus) was 9.9 cm2 (95% CI, 9.4 to 10.4), and of volume, 2.3 ml/kg (95% CI, 2.3 to 2.4). In addition, an antrum grade 0 or 1 indicates a 98% probability of an antral area below the 95th percentile. CONCLUSIONS An area of 10 cm2 measured in the right lateral decubitus could be a simple, data-driven upper limit of antral area that could serve as a surrogate of upper limit of normal gastric volume values in fasting adults. These results are limited by the highly selected sampling of the studies included. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Anahi Perlas
- Toronto Western Hospital, University Health Network, Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - Cristian Arzola
- Sinai Health System, Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - Natalia Portela
- Mount Sinai hospital, Sinai Health System, Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - Nicholas Mitsakakis
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Lamia Hayawi
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
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22
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Gu O, He B, Xiong L, Zhang Y, Li Z, Lang X. Reconstructive interpolation for pulse wave estimation to improve local PWV measurement of carotid artery. Med Biol Eng Comput 2024; 62:1459-1473. [PMID: 38252371 DOI: 10.1007/s11517-023-03008-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 12/21/2023] [Indexed: 01/23/2024]
Abstract
Ultrasonic transit time (TT)-based local pulse wave velocity (PWV) measurement is defined as the distance between two beam positions on a segment of common carotid artery (CCA) divided by the TT in the pulse wave propagation. However, the arterial wall motions (AWMs) estimated from ultrasonic radio frequency (RF) signals with a limited number of frames using the motion tracking are typically discrete. In this work, we develop a method involving motion tracking combined with reconstructive interpolation (MTRI) to reduce the quantification errors in the estimated PWs, and thereby improve the accuracy of the TT-based local PWV measurement for CCA. For each beam position, normalized cross-correlation functions (NCCFs) between the reference (the first frame) and comparison (the remaining frames) RF signals are calculated. Thereafter, the reconstructive interpolation is performed in the neighborhood of the NCCFs' peak to identify the interpolation-deduced peak locations, which are more exact than the original ones. According to which, the improved AWMs are obtained to calculate their TT along a segment of the CCA. Finally, the local PWV is measured by applying a linear regression fit to the time-distance result. In ultrasound simulations based on the pulse wave propagation models of young, middle-aged, and elderly groups, the MTRI method with different numbers of interpolated samples was used to estimate AWMs and local PWVs. Normalized root mean squared errors (NRMSEs) between the estimated and preset values of the AWMs and local PWVs were calculated and compared with ones without interpolation. The means of the NRMSEs for the AWMs and local PWVs based on the MTRI method with one interpolated sample decrease from 1.14% to 0.60% and 7.48% to 4.61%, respectively. Moreover, Bland-Altman analysis and coefficient of variation were used to validate the performance of the MTRI method based on the measured local PWVs of 30 healthy subjects. In conclusion, the reconstructive interpolation for the pulse wave estimation improves the accuracy and repeatability of the carotid local PWV measurement.
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Affiliation(s)
- Ouyang Gu
- Department of Electronic Engineering, Information School, Yunnan University, Kunming, 650091, Yunnan, China
| | - Bingbing He
- Department of Electronic Engineering, Information School, Yunnan University, Kunming, 650091, Yunnan, China.
| | - Li Xiong
- Department of Electronic Engineering, Information School, Yunnan University, Kunming, 650091, Yunnan, China
| | - Yufeng Zhang
- Department of Electronic Engineering, Information School, Yunnan University, Kunming, 650091, Yunnan, China
| | - Zhiyao Li
- Department of Ultrasound, the Third Affiliated Hospital of Kunming Medical College, Kunming, 650118, China
| | - Xun Lang
- Department of Electronic Engineering, Information School, Yunnan University, Kunming, 650091, Yunnan, China
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23
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Dong F, An J, Guo W, Dang J, Huang S, Feng F, Zhang J, Wang D, Yin J, Fang J, Cheng H, Zhang J. Programmable ultrasound imaging guided theranostic nanodroplet destruction for precision therapy of breast cancer. Ultrason Sonochem 2024; 105:106854. [PMID: 38537562 DOI: 10.1016/j.ultsonch.2024.106854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 03/17/2024] [Accepted: 03/23/2024] [Indexed: 04/26/2024]
Abstract
Ultrasound-stimulated contrast agents have gained significant attention in the field of tumor treatment as drug delivery systems. However, their limited drug-loading efficiency and the issue of bulky, imprecise release have resulted in inadequate drug concentrations at targeted tissues. Herein, we developed a highly efficient approach for doxorubicin (DOX) precise release at tumor site and real-time feedback via an integrated strategy of "programmable ultrasonic imaging guided accurate nanodroplet destruction for drug release" (PND). We synthesized DOX-loaded nanodroplets (DOX-NDs) with improved loading efficiency (15 %) and smaller size (mean particle size: 358 nm). These DOX-NDs exhibited lower ultrasound activation thresholds (2.46 MPa). By utilizing a single diagnostic transducer for both ultrasound stimulation and imaging guidance, we successfully vaporized the DOX-NDs and released the drug at the tumor site in 4 T1 tumor-bearing mice. Remarkably, the PND group achieved similar tumor remission effects with less than half the dose of DOX required in conventional treatment. Furthermore, the ultrasound-mediated vaporization of DOX-NDs induced tumor cell apoptosis with minimal damage to surrounding normal tissues. In summary, our PND strategy offers a precise and programmable approach for drug delivery and therapy, combining ultrasound imaging guidance. This approach shows great potential in enhancing tumor treatment efficacy while minimizing harm to healthy tissues.
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Affiliation(s)
- Feihong Dong
- State Key Laboratory of Membrane Biology, National Biomedical Imaging Center, Peking-Tsinghua Center for Life Sciences, Institute of Molecular Medicine, College of Future Technology, Peking University, Beijing 100871, China
| | - Jian An
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China
| | - Wenyu Guo
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China
| | - Jie Dang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China
| | - Shuo Huang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China
| | - Feng Feng
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China
| | - Jiabin Zhang
- State Key Laboratory of Membrane Biology, National Biomedical Imaging Center, Peking-Tsinghua Center for Life Sciences, Institute of Molecular Medicine, College of Future Technology, Peking University, Beijing 100871, China
| | - Di Wang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China
| | - Jingyi Yin
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China
| | - Jing Fang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China; College of Engineering, Peking University, Beijing 100871, China
| | - Heping Cheng
- State Key Laboratory of Membrane Biology, National Biomedical Imaging Center, Peking-Tsinghua Center for Life Sciences, Institute of Molecular Medicine, College of Future Technology, Peking University, Beijing 100871, China; National Biomedical Imaging Center, Peking University, Beijing, 100871, China; Research Unit of Mitochondria in Brain Diseases, Chinese Academy of Medical Sciences, PKU-Nanjing Institute of Translational Medicine, Nanjing, 211899, China.
| | - Jue Zhang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China; College of Engineering, Peking University, Beijing 100871, China; National Biomedical Imaging Center, Peking University, Beijing, 100871, China.
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Lou C, Liu Z, Yuchi M, Ding M. Normalized Spatial Autocorrelation in Ultrasound B-Mode Imaging for Point-Scatterer Detection. Ultrasound Med Biol 2024; 50:690-702. [PMID: 38331698 DOI: 10.1016/j.ultrasmedbio.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 01/03/2024] [Accepted: 01/06/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Point-scatterer detection plays a key role in medical ultrasound B-mode imaging. Speckle noise and insufficient spatial resolution are important factors affecting point-scatterer detection. To address this issue, normalized spatial autocorrelation in ultrasound B-mode imaging (NSACB) is proposed. METHODS First, the acquired data are pre-processed by adding Gaussian white noise (GWN) with a certain signal-to-Gaussian white noise ratio (SGWNR). Next, normalized spatial autocorrelation is applied to the pre-processed data, and the data are divided into several new signals with different spatial lags. Then, the new signals are performed unsigned delay multiply and sum. Finally, the NSACB beamformed data are bandpass filtered by extracting the frequency component around twice the center frequency. Simulated and in vitro experiments were designed for validation. RESULTS Simulations revealed that the lateral resolution of NSACB measured by the -6-dB mainlobe width can reach as high as 11.11% of delay and sum (DAS), 25.01% of filtered delay multiply and sum (F-DMAS) and 50% of LAG-FDMAS-SCF. The sidelobe level of the NSACB can be reduced at most by 28 dB. Experimental results of simple and complex scatterer phantoms indicate the image resolution of the proposed NSACB can even reach up to 18.76% of DAS, 27.28% of F-DMAS and 14.29% of LAG-FDMAS-SCF. Compared with these methods, the proposed NSACB can reduce the sidelobe level at least by 18 dB. CONCLUSION Although the proposed method causes loss of the ability to observe hypo-echoic structures, these results suggest future work to determine the ability to detect breast microcalcifications, kidney stones, biopsy needle tracking and other scenarios requiring scatterer detection.
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Affiliation(s)
- Cuijuan Lou
- Key Laboratory of Grain Information Processing and Control, Henan University of Technology, Ministry of Education, Zhengzhou, China; Henan Key Laboratory of Grain Photoelectric Detection and Control, Henan University of Technology, Zhengzhou, China; School of Artificial Intelligence and Big Data, Henan University of Technology, Zhengzhou, China.
| | - Zhaohui Liu
- Department of Biomedical Engineering, School of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Ming Yuchi
- Department of Biomedical Engineering, School of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Mingyue Ding
- Department of Biomedical Engineering, School of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
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Yoon H, Song TK. An Adaptive Harmonic Separation Technique for Ultrasound Harmonic Imaging. Ultrasound Med Biol 2024; 50:743-750. [PMID: 38413294 DOI: 10.1016/j.ultrasmedbio.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/11/2024] [Accepted: 02/04/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE An adaptive harmonic separation (HS) technique is proposed to overcome the limitations in conventional filtering techniques for ultrasound (US) tissue harmonic imaging (THI). METHODS Based on expectation-maximization source separation, the proposed HS technique adaptively models the depth-varying fundamental and harmonic components in the frequency domain and separates the two by applying their calculated posterior probabilities. Phantom experiments with a Tx center frequency of 2 MHz are conducted to evaluate the proposed HS-based US THI schemes. RESULTS The phantom images show that the proposed single-pulse THI scheme utilizing the HS technique provides not only an average improvement of 19.2% in axial resolution compared to the conventional bandpass filtering scheme but also similar image quality to that of the conventional pulse-inversion (PI) scheme which requires two Tx/Rx sequences for each scan line. Furthermore, when combined with the PI technique, the HS technique provides a uniform axial resolution over the entire 170 mm imaging depth with an average improvement of 17.1% compared to the conventional PI scheme. CONCLUSION These results show that the proposed adaptive HS technique is capable of improving both the frame rate and the image quality of US THI.
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Affiliation(s)
- Hansol Yoon
- Department of Electronic Engineering, Sogang University, Seoul, Republic of Korea
| | - Tai-Kyong Song
- Department of Electronic Engineering, Sogang University, Seoul, Republic of Korea.
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26
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Serrano RA, Smeltz AM. The Promise of Artificial Intelligence-Assisted Point-of-Care Ultrasonography in Perioperative Care. J Cardiothorac Vasc Anesth 2024; 38:1244-1250. [PMID: 38402063 DOI: 10.1053/j.jvca.2024.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 02/26/2024]
Abstract
The role of point-of-care ultrasonography in the perioperative setting has expanded rapidly over recent years. Revolutionizing this technology further is integrating artificial intelligence to assist clinicians in optimizing images, identifying anomalies, performing automated measurements and calculations, and facilitating diagnoses. Artificial intelligence can increase point-of-care ultrasonography efficiency and accuracy, making it an even more valuable point-of-care tool. Given this topic's importance and ever-changing landscape, this review discusses the latest trends to serve as an introduction and update in this area.
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Affiliation(s)
| | - Alan M Smeltz
- University of North Carolina School of Medicine, Chapel Hill, NC
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27
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Ghanem M, Zozaya C, Ibrahim J, Lee S, Mohsen N, Nasef N, Mohamed A. Correlation between early postnatal body weight changes and lung ultrasound scores as predictors of bronchopulmonary dysplasia in preterm infants: A secondary analysis of a prospective study. Eur J Pediatr 2024; 183:2123-2130. [PMID: 38363393 DOI: 10.1007/s00431-024-05464-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/20/2024] [Accepted: 01/31/2024] [Indexed: 02/17/2024]
Abstract
Recent research links early weight changes (EWC) with bronchopulmonary dysplasia (BPD) in preterm neonates, while lung ultrasound score (LUS) has shown promise in predicting BPD. We aimed to explore the correlation between LUS and EWC as markers of extravascular lung edema and to investigate the correlation between LUS and EWC in preterm infants with respiratory distress syndrome regarding future BPD development. This secondary analysis of a prospective study involved infants ≤ 28 weeks gestation. Enrolled infants underwent lung ultrasound assessment on postnatal days 3, 7 and 14, measuring LUS. EWC was computed on the same time points. Infants were classified as either having BPD or not. Descriptive statistics, correlation coefficient, and area under the receiver operating characteristic (AUROC) curve analysis were utilized. Of 132 infants, 70 (53%) had BPD. Univariate analysis revealed statistically significant differences in LUS and EWC at days 3, 7, and 14 between BPD and no-BPD groups (p < 0.001). A statistically significant but weak positive correlation existed between LUS and EWC (r0.37, r0.29, r0.24, and p < 0.01) at postnatal days 3, 7, and 14, respectively. AUROC analysis indicated LUS having superior predictive capacity for the need for invasive mechanical ventilation at day 14 as well as the later BPD development compared to EWC (p < 0.0001). CONCLUSION In a cohort of extreme preterm infants, our study revealed a positive yet weak correlation between LUS and EWC, suggesting that EWC was not the major contributing to the evolving chronic lung disease. WHAT IS KNOWN • Recent evidence links Early Weight-Changes with bronchopulmonary dysplasia in preterm neonates. • Lung ultrasound score has shown promise in early prediction of the subsequent development of bronchopulmonary dysplasia in preterm infants. No studies have examined the correlation between Early Weight-Changes and Lung ultrasound score in preterm infants during first 2 weeks after birth. WHAT IS NEW • Our study demonstrated a positive and statistically significant correlation between early LUS and EWC, indicating their potential role as early predictors for the subsequent development of BPD in extreme preterm infants. • The weak correlation between the two parameters may stem from the possible restricted influence of EWC, given that it may not be the primary factor contributing to the evolving chronic lung disease.
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Affiliation(s)
- Mohab Ghanem
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, ON, M5G 1X5, Canada
| | - Carlos Zozaya
- Department of Neonatology, Hospital Universitario La Paz, Madrid, Spain
| | - Jenna Ibrahim
- Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, ON, M5G 1X5, Canada
| | - Seungwoo Lee
- Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, ON, M5G 1X5, Canada
| | - Nada Mohsen
- Department of Pediatrics, Mansoura University, Mansoura, Egypt
| | - Nehad Nasef
- Department of Pediatrics, Mansoura University, Mansoura, Egypt
| | - Adel Mohamed
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
- Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, ON, M5G 1X5, Canada.
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Zhuang M, Lu M, Jiang Z, Liang Y, Wang S, Wang L, Li J. Comparison of Micro-flow Imaging and Contrast-Enhanced Ultrasound in Ultrasound-Guided Microwave Ablation of Benign Thyroid Nodules. Ultrasound Med Biol 2024; 50:729-734. [PMID: 38355362 DOI: 10.1016/j.ultrasmedbio.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/02/2024] [Accepted: 01/22/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE The study described here was aimed at ascertaining the utility of micro-flow imaging (MFI) during ultrasound (US)-guided microwave ablation (MWA) of thyroid nodules by contrasting its effectiveness with that of contrast-enhanced ultrasound (CEUS). METHODS Seventy-three patients with eighty-eight thyroid nodules who underwent US-guided MWA were included in our study from January 2020 to June 2023. Thirty-five patients underwent CEUS during the MWA process, and thirty-eight patients underwent MFI during the MWA process. We compared the two groups' baseline characteristics, tumor volume (V), volume reduction rate (VRR), complications and clinical characteristics. RESULTS Both groups exhibited similar outcomes with respect to V and VRR at 1, 3, 6, 12 and 18 mo after MWA (p > 0.05). Consistency was observed with respect to post-operative complications, supplementary ablation times and surgical duration (p > 0.05). It is worth noting that the MFI group had lower treatment costs compared with the CEUS group (11,337.64 ± 80.93 yuan for the MFI group versus 12,971.23 ± 254.89 yuan for the CEUS group, p < 0.05). CONCLUSION In the MWA procedure for thyroid nodules, MFI is similar to CEUS with respect to safety and efficacy. Simultaneously, it offers the advantage of reducing surgical expenses, which lessens the economic burden for patients.
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Affiliation(s)
- Min Zhuang
- Ultrasonography Department, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Man Lu
- Ultrasonography Department, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
| | - Zirui Jiang
- School of Health Science of Purdue University, West Lafayette, IN, USA
| | - Yin Liang
- Ultrasonography Department, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Shishi Wang
- Ultrasonography Department, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Lu Wang
- Ultrasonography Department, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Jiami Li
- Ultrasonography Department, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
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Perolina E, Meissner S, Raos B, Harland B, Thakur S, Svirskis D. Translating ultrasound-mediated drug delivery technologies for CNS applications. Adv Drug Deliv Rev 2024; 208:115274. [PMID: 38452815 DOI: 10.1016/j.addr.2024.115274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/18/2024] [Accepted: 03/01/2024] [Indexed: 03/09/2024]
Abstract
Ultrasound enhances drug delivery into the central nervous system (CNS) by opening barriers between the blood and CNS and by triggering release of drugs from carriers. A key challenge in translating setups from in vitro to in vivo settings is achieving equivalent acoustic energy delivery. Multiple devices have now been demonstrated to focus ultrasound to the brain, with concepts emerging to also target the spinal cord. Clinical trials to date have used ultrasound to facilitate the opening of the blood-brain barrier. While most have focused on feasibility and safety considerations, therapeutic benefits are beginning to emerge. To advance translation of these technologies for CNS applications, researchers should standardise exposure protocol and fine-tune ultrasound parameters. Computational modelling should be increasingly used as a core component to develop both in vitro and in vivo setups for delivering accurate and reproducible ultrasound to the CNS. This field holds promise for transformative advancements in the management and pharmacological treatment of complex and challenging CNS disorders.
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Affiliation(s)
- Ederlyn Perolina
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Auckland 1023, New Zealand
| | - Svenja Meissner
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Auckland 1023, New Zealand
| | - Brad Raos
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Auckland 1023, New Zealand
| | - Bruce Harland
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Auckland 1023, New Zealand
| | - Sachin Thakur
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Auckland 1023, New Zealand
| | - Darren Svirskis
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Auckland 1023, New Zealand.
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Jiang K, Ma C, Yang Y, McKevitt E, Pao JS, Warburton R, Dingee C, Bremang JN, Deban M, Bazzarelli A. Axillary ultrasonography for early-stage invasive breast cancer. Am J Surg 2024; 231:86-90. [PMID: 38490879 DOI: 10.1016/j.amjsurg.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/13/2024] [Accepted: 03/07/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Among women with early invasive breast cancer and 1-2 positive sentinel nodes, sentinel lymph node biopsy (SLNB) is non-inferior to axillary lymph node dissection (ALND).1-3 However, preoperative axillary ultrasonography (AxUS) may not be sensitive enough to discriminate burden of nodal metastasis in these patients, potentially leading to overtreatment.4-6 This study compares axillary operation rates in patients who did and did not receive preoperative AxUS, assessing its utility and risks for overtreatment. METHODS This is a retrospective cohort study of patients with clinical T1/T2 breast tumors who were clinically node negative and underwent an axillary operation. RESULTS Patients who had preoperative AxUS received more ALND compared to patients who did not (5.6% vs. 1.4%, p < 0.001). There was no significant difference in the number of additional axillary operations following SLNB (2.1% vs. 2.3%, p = 0.77). CONCLUSION Eliminating preoperative AxUS is associated with fewer invasive ALND procedures, without increased rate of axillary reoperations.
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Affiliation(s)
- Karen Jiang
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Crystal Ma
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Yuwei Yang
- Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Elaine McKevitt
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Jin-Si Pao
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Rebecca Warburton
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Carol Dingee
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Jieun Newman- Bremang
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Melina Deban
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Amy Bazzarelli
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
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Sebastian A, van der Geest KSM, Tomelleri A, Macchioni P, Klinowski G, Salvarani C, Prieto-Peña D, Conticini E, Khurshid M, Dagna L, Brouwer E, Dasgupta B. Development of a diagnostic prediction model for giant cell arteritis by sequential application of Southend Giant Cell Arteritis Probability Score and ultrasonography: a prospective multicentre study. Lancet Rheumatol 2024; 6:e291-e299. [PMID: 38554720 DOI: 10.1016/s2665-9913(24)00027-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Giant cell arteritis is a critically ischaemic disease with protean manifestations that require urgent diagnosis and treatment. European Alliance of Associations for Rheumatology (EULAR) recommendations advocate ultrasonography as the first investigation for suspected giant cell arteritis. We developed a prediction tool that sequentially combines clinical assessment, as determined by the Southend Giant Cell Arteritis Probability Score (SGCAPS), with results of quantitative ultrasonography. METHODS This prospective, multicentre, inception cohort study included consecutive patients with suspected new onset giant cell arteritis referred to fast-track clinics (seven centres in Italy, the Netherlands, Spain, and UK). Final clinical diagnosis was established at 6 months. SGCAPS and quantitative ultrasonography of temporal and axillary arteries with three scores (ie, halo count, halo score, and OMERACT GCA Score [OGUS]) were performed at diagnosis. We developed prediction models for diagnosis of giant cell arteritis by multivariable logistic regression analysis with SGCAPS and each of the three ultrasonographic scores as predicting variables. We obtained intraclass correlation coefficient for inter-rater and intra-rater reliability in a separate patient-based reliability exercise with five patients and five observers. FINDINGS Between Oct 1, 2019, and June 30, 2022, we recruited and followed up 229 patients (150 [66%] women and 79 [34%] men; mean age 71 years [SD 10]), of whom 84 were diagnosed with giant cell arteritis and 145 with giant cell arteritis mimics (controls) at 6 months. SGCAPS and all three ultrasonographic scores discriminated well between patients with and without giant cell arteritis. A reliability exercise showed that the inter-rater and intra-rater reliability was high for all three ultrasonographic scores. The prediction model combining SGCAPS with the halo count, which was termed HAS-GCA score, was the most accurate model, with an optimism-adjusted C statistic of 0·969 (95% CI 0·952 to 0·990). The HAS-GCA score could classify 169 (74%) of 229 patients into either the low or high probability groups, with misclassification observed in two (2%) of 105 patients in the low probability group and two (3%) of 64 of patients in the high probability group. A nomogram for easy application of the score in daily practice was created. INTERPRETATION A prediction tool for giant cell arteritis (the HAS-GCA score), combining SGCAPS and the halo count, reliably confirms and excludes giant cell arteritis from giant cell arteritis mimics in fast-track clinics. These findings require confirmation in an independent, multicentre study. FUNDING Royal College of Physicians of Ireland, FOREUM.
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Affiliation(s)
- Alwin Sebastian
- Rheumatology, Southend University Hospital, Mid and South Essex NHS Foundation Trust, Westcliff-on-sea, UK; School of Sport, Rehabilitation and Exercise science, University of Essex, Colchester, UK; Rheumatology, University Hospital Limerick, Dooradoyle, Ireland
| | - Kornelis S M van der Geest
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Giulia Klinowski
- Azienda USL-IRCCS di Reggio Emilia, Università di Modena e Reggio Emilia, Modena, Italy
| | - Carlo Salvarani
- Azienda USL-IRCCS di Reggio Emilia, Università di Modena e Reggio Emilia, Modena, Italy
| | - Diana Prieto-Peña
- Rheumatology, Immunopathology, IDIVAL, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Edoardo Conticini
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | | | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy
| | - Elisabeth Brouwer
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Bhaskar Dasgupta
- Rheumatology, Southend University Hospital, Mid and South Essex NHS Foundation Trust, Westcliff-on-sea, UK; School of Sport, Rehabilitation and Exercise science, University of Essex, Colchester, UK; MTRC, Anglia Ruskin University, Chelmsford, UK.
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Járay Á, Farkas PI, Semjén D, Botz B. The Predictive Power of Bosniak 3 and 4 Cystic Renal Lesion Categorization Using Contrast-Enhanced Ultrasound. J Ultrasound Med 2024; 43:933-949. [PMID: 38284141 DOI: 10.1002/jum.16424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVES Contrast-enhanced ultrasound (CEUS) is increasingly utilized for the noninvasive assessment of renal cystic lesions, using the Bosniak grading system. Bosniak 3-4 lesions require surgical referral, which allows correlation with the histopathological outcome. METHODS In this single-center, retrospective study we evaluated renal CEUS exams conducted with SonoVue® with a diagnosis of a Bosniak 3 or 4 lesion between 2019 and 2022. A total of 49 patients and 50 lesions met the inclusion criteria, 31 lesions had available histopathological results. Patient demographics, cyst morphology, and dominant imaging features were registered. The histopathological diagnosis was considered a reference standard. RESULTS Positive predictive power (PPV) for neoplastic lesions was comparable in the Bosniak 3 and 4 categories (75 vs 93.3%, P = .33), while PPV for histopathologically malignant lesion was considerably higher in the latter group (25 vs 93.33%, P = .0002). None of the lesions which had vividly enhancing thin septa as their dominant CEUS feature were malignant. Oncocytoma, multilocular cystic renal neoplasm of low malignant potential, and cystic nephroma were the major benign entities among Bosniak 3 lesions. Localized cystic kidney disease and hemorrhagic cysts were found to be the primary mimickers leading to false positive imaging findings. CONCLUSIONS CEUS has a high predictive power for malignancy in the Bosniak 4 category, which is not maintained in the Bosniak 3 group due to the large proportion of benign lesions. Adherence to rigorous rule-in criteria and active surveillance strategies need to be considered for equivocal CEUS Bosniak 3 lesions.
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Affiliation(s)
- Ákos Járay
- Department of Medical Imaging, University of Pécs, Medical School, Pécs, Hungary
| | - Péter István Farkas
- Department of Medical Imaging, University of Pécs, Medical School, Pécs, Hungary
| | - Dávid Semjén
- Department of Pathology, University of Pécs, Medical School, Pécs, Hungary
| | - Bálint Botz
- Department of Medical Imaging, University of Pécs, Medical School, Pécs, Hungary
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Orosco E, Terai H, Lotterman S, Baker R, Friedman C, Watt A, Beaubian D, Grady J, Delgado J, Herbst MK. Point-of-care ultrasound associated with shorter length of stay than computed tomography for renal colic. Am J Emerg Med 2024; 79:167-171. [PMID: 38452429 DOI: 10.1016/j.ajem.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Despite similar diagnostic effectiveness for renal colic, computed tomography (CT) is more resource intensive than point-of-care ultrasound (PoCUS). We sought to compare Emergency Department (ED) length of stay (LOS) among patients with renal colic according to imaging modality utilized. We secondarily compared rates of infection, return ED visits, missed significant pathology, and urologic intervention. METHODS This was a 12-month (1/1/22-12/31/22) multi-site retrospective cohort study of all patients diagnosed with renal colic who presented to the ED on days when at least one patient had a billable renal PoCUS examination performed. Patients with a history of genitourinary malignancy, pregnancy, renal transplant, hemodialysis, single kidney, prior visit for renal colic in the previous 30 days, or an incomplete workup were excluded. Median ED LOS was compared using a Wilcoxon rank sum test, and the 95% confidence limits for the difference between medians was calculated. Secondary outcomes were compared using a Fisher's Exact test. RESULTS Of 415 patients screened, 325 were included for analysis: 150 had CT alone, 80 had PoCUS alone, 54 had PoCUS plus CT, and 41 had neither. Median LOS for PoCUS alone was 75.0 (95% CI 39.3-110.7) minutes shorter than CT alone (231.5 vs. 307.0 min, p < 0.0001). Similar rates of infection, return visits, and missed pathology occurred across all groups (p > 0.10). Urologic interventions were higher in the PoCUS plus CT (25.9%) group compared to CT alone (7.3%), PoCUS alone (2.5%), and neither (7.3%), p < 0.0001. CONCLUSION Among patients with renal colic, PoCUS was associated with shorter ED LOS compared to CT, without differences in infection rates, return visits, or missed pathology. Patients with PoCUS plus CT had a higher rate of urologic interventions, suggesting PoCUS may have a role in identifying patients who would most benefit from CT.
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Affiliation(s)
- Emily Orosco
- University of Connecticut School of Medicine, Farmington, CT, United States of America
| | - Hiromi Terai
- University of Connecticut School of Medicine, Farmington, CT, United States of America
| | - Seth Lotterman
- Hartford Hospital, Department of Emergency Medicine, Hartford, CT, United States of America
| | - Riley Baker
- University of Connecticut School of Medicine, Farmington, CT, United States of America
| | - Cade Friedman
- University of Connecticut School of Medicine, Farmington, CT, United States of America
| | - Aren Watt
- University of Connecticut School of Medicine, Farmington, CT, United States of America
| | - Drew Beaubian
- University of Connecticut School of Medicine, Department of Emergency Medicine, Farmington, CT, United States of America
| | - James Grady
- University of Connecticut School of Medicine, Department of Public Health Sciences, Farmington, CT, United States of America
| | - João Delgado
- Hartford Hospital, Department of Emergency Medicine, Hartford, CT, United States of America
| | - Meghan Kelly Herbst
- University of Connecticut School of Medicine, Department of Emergency Medicine, Farmington, CT, United States of America.
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Yeung PH, Hesse LS, Aliasi M, Haak MC, Xie W, Namburete AIL. Sensorless volumetric reconstruction of fetal brain freehand ultrasound scans with deep implicit representation. Med Image Anal 2024; 94:103147. [PMID: 38547665 DOI: 10.1016/j.media.2024.103147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/14/2024] [Accepted: 03/20/2024] [Indexed: 04/16/2024]
Abstract
Three-dimensional (3D) ultrasound imaging has contributed to our understanding of fetal developmental processes by providing rich contextual information of the inherently 3D anatomies. However, its use is limited in clinical settings, due to the high purchasing costs and limited diagnostic practicality. Freehand 2D ultrasound imaging, in contrast, is routinely used in standard obstetric exams, but inherently lacks a 3D representation of the anatomies, which limits its potential for more advanced assessment. Such full representations are challenging to recover even with external tracking devices due to internal fetal movement which is independent from the operator-led trajectory of the probe. Capitalizing on the flexibility offered by freehand 2D ultrasound acquisition, we propose ImplicitVol to reconstruct 3D volumes from non-sensor-tracked 2D ultrasound sweeps. Conventionally, reconstructions are performed on a discrete voxel grid. We, however, employ a deep neural network to represent, for the first time, the reconstructed volume as an implicit function. Specifically, ImplicitVol takes a set of 2D images as input, predicts their locations in 3D space, jointly refines the inferred locations, and learns a full volumetric reconstruction. When testing natively-acquired and volume-sampled 2D ultrasound video sequences collected from different manufacturers, the 3D volumes reconstructed by ImplicitVol show significantly better visual and semantic quality than the existing interpolation-based reconstruction approaches. The inherent continuity of implicit representation also enables ImplicitVol to reconstruct the volume to arbitrarily high resolutions. As formulated, ImplicitVol has the potential to integrate seamlessly into the clinical workflow, while providing richer information for diagnosis and evaluation of the developing brain.
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Affiliation(s)
- Pak-Hei Yeung
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom; Oxford Machine Learning in NeuroImaging Lab, Department of Computer Science, University of Oxford, OX1 3QD, United Kingdom.
| | - Linde S Hesse
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom; Oxford Machine Learning in NeuroImaging Lab, Department of Computer Science, University of Oxford, OX1 3QD, United Kingdom
| | - Moska Aliasi
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Monique C Haak
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Weidi Xie
- Shanghai Jiao Tong University, Shanghai, 200240, China; Visual Geometry Group, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Ana I L Namburete
- Oxford Machine Learning in NeuroImaging Lab, Department of Computer Science, University of Oxford, OX1 3QD, United Kingdom
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Ostrovskiy G, Reynolds AS, Sarwal A. Neurovascular ultrasound in acute stroke: emergency department applications. Emerg Med Pract 2024; 26:1-28. [PMID: 38652756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Acute stroke is one of the most common neurologic emergencies encountered by emergency clinicians. While point of care ultrasound has been a core part of emergency clinicians' training and practice for many years, the use of specialized ultrasound modalities in the care of acute ischemic stroke has not been as widely adopted. This review discusses the use of ultrasound in acute stroke, with a focus on applications of interest to emergency clinicians. Transcranial Doppler, carotid Doppler, microembolic signal detection, transthoracic echocardiography, evaluation for collateral circulation and optic nerve sheath diameter measurement are discussed in a case-based format, with a focus on practical applications for emergency clinicians.
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Affiliation(s)
- Grigory Ostrovskiy
- Neurointensivist and Emergency Physician, Division of Neurocritical Care, Departments of Neurology & Emergency Medicine, Hackensack University Medical Center; Assistant Professor, Departments of Neurology, Neurosurgery & Emergency Medicine, Hackensack Meridian School of Medicine, Hackensack, NJ
| | - Alexandra S Reynolds
- Associate Professor of Neurosurgery and Neurology, Mount Sinai Health System, New York, NY
| | - Aarti Sarwal
- Professor, Neurology (Neurocritical Care), Atrium Wake Forest School of Medicine, Winston Salem, NC
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Yuan J, Ye H, Tan X, Zhang H, Sun J. Determinants of difficult laryngoscopy based on upper airway indicators: a prospective observational study. BMC Anesthesiol 2024; 24:157. [PMID: 38658856 DOI: 10.1186/s12871-024-02543-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND The main cause of anesthesia-related deaths is the failure to manage difficult airways. Difficult laryngoscopic exposure is a major cause of unsuccessful management of difficult airways. Inadequate preoperative airway assessment hinders the clinical management of difficult airways cases, emphasizing the critical need for accurate identification of difficult airways. Currently, no definitive and reliable indicators are available to predict a difficult airway. Our study aims to predict laryngoscope exposure risk factors by combining ultrasonically measured upper airway anatomic parameters with physical examination indicators. METHODS Patients aged 18 to 75 years, classified as American Standards Association (ASA) I-III, and scheduled for elective general anesthesia with endotracheal intubation were included. All patients received the upper airway and ultrasonographic measurements. After anesthesia induction, laryngoscope exposure was analyzed using the Cormack-Lehane grading system, with Grades III and IV as indicative of difficult laryngoscopy. Univariate and multivariate logistic regression analyses were performed to identify reliable indicators for predicting difficult laryngoscopy. Receiver Operating Characteristic (ROC) curve analysis was utilized to assess the predictive performance of each indicator. RESULTS A total of 1120 patients finished the study, with 710 cases found in Grade I laryngoscopic exposure group, 360 cases in Grade II group, and 50 cases in Grade III group. There was no case observed in Grade IV group, thereby resulting in an incidence of difficult laryngoscopy of 4.46%. Univariate logistic regression analysis revealed that several parameters including age, Body Mass Index (BMI), neck circumference, neck mobility, snoring intensity, as well as ultrasound measurements of the pre-epiglottic space and thyromental distance were identified as significant risk factors for difficult laryngoscopy (P < 0.05). Among these, BMI, and neck circumference exhibited notable predictive value, with Area Under The Curve (AUC) values of 0.746 (95%CI 0.649-0.842) and 0.732 (95%CI 0.638-0.827), respectively. Neck mobility was also identified as an independent risk factor for predicting difficult laryngoscopy (P = 0.009) in multivariate logistic regression analysis, with an AUC of 0.672 (0.562-0.782) in the ROC curve. CONCLUSIONS Our findings revealed a direct correlation between difficult laryngoscopy and age, BMI, neck circumference, neck mobility, snoring intensity, as well as ultrasound measurements of the pre-epiglottic space and thyromental distance. Furthermore, neck mobility was identified as an independent predictive factor. TRIAL REGISTRATION The trial was registered prior to patient enrollment at clinicaltrials.gov (register no. ChiCTR2100053826, Date of registration: November 30, 2021).
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Affiliation(s)
- Jing Yuan
- Department of Anesthesiology, ZhongDa Hospital, Southeast University, No. 87 Dingjiaqiao, Gulou District, Nanjing, 210009, China
| | - Hui Ye
- Department of Anesthesiology, ZhongDa Hospital, Southeast University, No. 87 Dingjiaqiao, Gulou District, Nanjing, 210009, China
| | - Xiaoxiang Tan
- Department of Anesthesiology, ZhongDa Hospital, Southeast University, No. 87 Dingjiaqiao, Gulou District, Nanjing, 210009, China
| | - Hui Zhang
- Department of Anesthesiology, ZhongDa Hospital, Southeast University, No. 87 Dingjiaqiao, Gulou District, Nanjing, 210009, China
| | - Jie Sun
- Department of Anesthesiology, ZhongDa Hospital, Southeast University, No. 87 Dingjiaqiao, Gulou District, Nanjing, 210009, China.
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Angla C, Chouh H, Mondou P, Toullelan G, Perlin K, Brulon V, De Schlichting E, Larrat B, Gennisson JL, Chatillon S. New semi-analytical method for fast transcranial ultrasonic field simulation. Phys Med Biol 2024; 69:095017. [PMID: 38537292 DOI: 10.1088/1361-6560/ad3882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/27/2024] [Indexed: 04/25/2024]
Abstract
Objective.To optimize and ensure the safety of ultrasound brain therapy, personalized transcranial ultrasound simulations are very useful. They allow to predict the pressure field, depending on the patient skull and probe position. Most transcranial ultrasound simulations are based on numerical methods which have a long computation time and a high memory usage. The goal of this study is to develop a new semi-analytical field computation method that combines realism and computation speed.Approach.Instead of the classic ray tracing, the ultrasonic paths are computed by time of flight minimization. Then the pressure field is computed using the pencil method. This method requires a smooth and homogeneous skull model. The simulation algorithm, so-called SplineBeam, was numerically validated, by comparison with existing solvers, and experimentally validated by comparison with hydrophone measured pressure fields through anex vivohuman skull.Main results.SplineBeam simulated pressure fields were close to the experimentally measured ones, with a focus position difference of the order of the positioning error and a maximum pressure difference lower than 6.02%. In addition, for those configurations, SplineBeam computation time was lower than another simulation software, k-Wave's, by two orders of magnitude, thanks to its capacity to compute the field only at the focal spot.Significance.These results show the potential of this new method to compute fast and realistic transcranial pressure fields. The combination of this two assets makes it a promising tool for real time transcranial pressure field prediction during ultrasound brain therapy interventions.
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Affiliation(s)
- C Angla
- Université Paris-Saclay, CEA List, F-91120, Palaiseau, France
- Université Paris-Saclay, CNRS, Inserm, CEA, BioMaps, F-91190, Orsay, France
| | - H Chouh
- Université Paris-Saclay, CEA List, F-91120, Palaiseau, France
| | - P Mondou
- Université Paris-Saclay, CNRS, CEA, Neurospin F-91191, Gif-sur-Yvette, France
| | - G Toullelan
- Université Paris-Saclay, CEA List, F-91120, Palaiseau, France
| | - K Perlin
- Université Paris-Saclay, CEA List, F-91120, Palaiseau, France
| | - V Brulon
- Université Paris-Saclay, CNRS, Inserm, CEA, BioMaps, F-91190, Orsay, France
| | - E De Schlichting
- CHU Grenoble-Alpes, Service de Neurochirurgie, F-38700, Grenoble, France
| | - B Larrat
- Université Paris-Saclay, CNRS, CEA, Neurospin F-91191, Gif-sur-Yvette, France
| | - J-L Gennisson
- Université Paris-Saclay, CNRS, Inserm, CEA, BioMaps, F-91190, Orsay, France
| | - S Chatillon
- Université Paris-Saclay, CEA List, F-91120, Palaiseau, France
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Jiang T, Chen C, Zhou Y, Cai S, Yan Y, Sui L, Lai M, Song M, Zhu X, Pan Q, Wang H, Chen X, Wang K, Xiong J, Chen L, Xu D. Deep learning-assisted diagnosis of benign and malignant parotid tumors based on ultrasound: a retrospective study. BMC Cancer 2024; 24:510. [PMID: 38654281 DOI: 10.1186/s12885-024-12277-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND To develop a deep learning(DL) model utilizing ultrasound images, and evaluate its efficacy in distinguishing between benign and malignant parotid tumors (PTs), as well as its practicality in assisting clinicians with accurate diagnosis. METHODS A total of 2211 ultrasound images of 980 pathologically confirmed PTs (Training set: n = 721; Validation set: n = 82; Internal-test set: n = 89; External-test set: n = 88) from 907 patients were retrospectively included in this study. The optimal model was selected and the diagnostic performance evaluation is conducted by utilizing the area under curve (AUC) of the receiver-operating characteristic(ROC) based on five different DL networks constructed at varying depths. Furthermore, a comparison of different seniority radiologists was made in the presence of the optimal auxiliary diagnosis model. Additionally, the diagnostic confusion matrix of the optimal model was calculated, and an analysis and summary of misjudged cases' characteristics were conducted. RESULTS The Resnet18 demonstrated superior diagnostic performance, with an AUC value of 0.947, accuracy of 88.5%, sensitivity of 78.2%, and specificity of 92.7% in internal-test set, and with an AUC value of 0.925, accuracy of 89.8%, sensitivity of 83.3%, and specificity of 90.6% in external-test set. The PTs were subjectively assessed twice by six radiologists, both with and without the assisted of the model. With the assisted of the model, both junior and senior radiologists demonstrated enhanced diagnostic performance. In the internal-test set, there was an increase in AUC values by 0.062 and 0.082 for junior radiologists respectively, while senior radiologists experienced an improvement of 0.066 and 0.106 in their respective AUC values. CONCLUSIONS The DL model based on ultrasound images demonstrates exceptional capability in distinguishing between benign and malignant PTs, thereby assisting radiologists of varying expertise levels to achieve heightened diagnostic performance, and serve as a noninvasive imaging adjunct diagnostic method for clinical purposes.
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Affiliation(s)
- Tian Jiang
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, 310022, Hangzhou, Zhejiang, China
- Postgraduate training base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), 310022, Hangzhou, Zhejiang, China
- Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, 310022, Hangzhou, Zhejiang, China
| | - Chen Chen
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, 310022, Hangzhou, Zhejiang, China
- Wenling Big Data and Artificial Intelligence Institute in Medicine, 317502, TaiZhou, Zhejiang, China
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), 317502, Taizhou, Zhejiang, China
| | - Yahan Zhou
- Wenling Big Data and Artificial Intelligence Institute in Medicine, 317502, TaiZhou, Zhejiang, China
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), 317502, Taizhou, Zhejiang, China
| | - Shenzhou Cai
- Wenling Big Data and Artificial Intelligence Institute in Medicine, 317502, TaiZhou, Zhejiang, China
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), 317502, Taizhou, Zhejiang, China
| | - Yuqi Yan
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, 310022, Hangzhou, Zhejiang, China
- Postgraduate training base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), 310022, Hangzhou, Zhejiang, China
- Wenling Big Data and Artificial Intelligence Institute in Medicine, 317502, TaiZhou, Zhejiang, China
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), 317502, Taizhou, Zhejiang, China
| | - Lin Sui
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, 310022, Hangzhou, Zhejiang, China
- Postgraduate training base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), 310022, Hangzhou, Zhejiang, China
- Wenling Big Data and Artificial Intelligence Institute in Medicine, 317502, TaiZhou, Zhejiang, China
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), 317502, Taizhou, Zhejiang, China
| | - Min Lai
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, 310022, Hangzhou, Zhejiang, China
- Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, 310022, Hangzhou, Zhejiang, China
- Second Clinical College, Zhejiang University of Traditional Chinese Medicine, 310022, Hangzhou, Zhejiang, China
| | - Mei Song
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, 310022, Hangzhou, Zhejiang, China
- Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, 310022, Hangzhou, Zhejiang, China
| | - Xi Zhu
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, 310022, Hangzhou, Zhejiang, China
- Wenling Big Data and Artificial Intelligence Institute in Medicine, 317502, TaiZhou, Zhejiang, China
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), 317502, Taizhou, Zhejiang, China
| | - Qianmeng Pan
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), 317502, Taizhou, Zhejiang, China
| | - Hui Wang
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), 317502, Taizhou, Zhejiang, China
| | - Xiayi Chen
- Wenling Big Data and Artificial Intelligence Institute in Medicine, 317502, TaiZhou, Zhejiang, China
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), 317502, Taizhou, Zhejiang, China
| | - Kai Wang
- Dongyang Hospital Affiliated to Wenzhou Medical University, 322100, Jinhua, Zhejiang, China
| | - Jing Xiong
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, 518000, Shenzhen, Guangdong, China
| | - Liyu Chen
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, 310022, Hangzhou, Zhejiang, China.
- Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, 310022, Hangzhou, Zhejiang, China.
| | - Dong Xu
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, 310022, Hangzhou, Zhejiang, China.
- Postgraduate training base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), 310022, Hangzhou, Zhejiang, China.
- Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, 310022, Hangzhou, Zhejiang, China.
- Wenling Big Data and Artificial Intelligence Institute in Medicine, 317502, TaiZhou, Zhejiang, China.
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), 317502, Taizhou, Zhejiang, China.
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Wu S, Zheng Y, Wang L, Liu W. Differences in influencing mechanism of clinicians' adoption behavior for liver cancer screening technology between the leading and subordinate hospitals within medical consortiums. BMC Cancer 2024; 24:514. [PMID: 38654313 DOI: 10.1186/s12885-024-12281-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 04/17/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Medical consortiums have been extensively established to facilitate the integration of health resources and bridge the technical gap among member institutions. However, some commonly appropriate technologies remain stagnant in subordinate hospitals, although they have been routinely applied in leading hospitals. Besides, the mechanism underlying differences in clinicians' adoption behavior at different levels of institutions was unknown. Therefore, this study aimed to investigate the differences in influencing mechanisms of clinicians' hepatic contrast-enhanced ultrasound technology (CEUS) utilization behavior between leading and subordinate hospitals within medical consortiums, thus providing clues for expanding effective and appropriate technologies within integrated care systems. METHODS A self-designed scale was developed based on the theory of planned behavior (TPB). A multistage sampling method was applied to investigate clinicians who were aware of CEUS and worked in liver disease-related departments within the sampled medical institutions. The final sample size was 289. AMOS 24.0 software was used to construct multi-group structural equation modeling (SEM) to validate the hypotheses and determine the mechanism of hepatic CEUS utilization. RESULTS It revealed that behavioral intention significantly influenced adoption behavior, regardless of whether it was in leading hospitals or subordinate hospitals (β = 0.283, p < 0.001). Furthermore, behavioral attitude (β = 0.361, p < 0.001) and perceived behavioral control (β = 0.582, p < 0.001) exerted significant effects on adoption behavior through behavioral intention. However, in leading hospitals, subjective norm had a significant positive effect on behavioral intention (β = 0.183, p < 0.01), while it had a significant negative impact on behavioral intention in the subordinate hospitals (β = -0.348, p < 0.01). CONCLUSION To effectively translate the adoption intention into actual behavior, it is recommended to elucidate the demand and facilitators involved in the process of health technology adoption across leading and subordinate hospitals. Additionally, bolstering technical support and knowledge dissemination within subordinate hospitals while harnessing the influential role of key individuals can further enhance this transformative process.
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Affiliation(s)
- Shiyin Wu
- Department of Social Medicine and Health Management, School of Health Management, Fujian Medical University, 1 Xuefubei Road, Minhou District, 350122, Fuzhou, China
| | - Yuhang Zheng
- Department of Social Medicine and Health Management, School of Health Management, Fujian Medical University, 1 Xuefubei Road, Minhou District, 350122, Fuzhou, China
| | - Lingjie Wang
- Department of Social Medicine and Health Management, School of Health Management, Fujian Medical University, 1 Xuefubei Road, Minhou District, 350122, Fuzhou, China
| | - Wenbin Liu
- Department of Social Medicine and Health Management, School of Health Management, Fujian Medical University, 1 Xuefubei Road, Minhou District, 350122, Fuzhou, China.
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Hady DAA, Mabrouk OM, Osman DA. Ultrasound imaging of core muscles activity in multiparous women with vaginal laxity: a cross-sectional study. Sci Rep 2024; 14:9063. [PMID: 38643221 PMCID: PMC11032349 DOI: 10.1038/s41598-024-58955-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/04/2024] [Indexed: 04/22/2024] Open
Abstract
Vaginal laxity (VL) is a common condition among multiparous women, especially those who have delivered vaginally. Since pelvic floor muscles (PFMs) work synergistically with other core muscles, physical therapy protocols that aim to treat VL should train the PFMs in combination with other core muscles. To investigate the activity of core muscles in multiparous women with and without VL, and its relation to sexual function. An observational, cross-sectional study. The study included 100 multiparous women, who were divided into two groups according to their scores on the vaginal laxity questionnaire (VLQ). Women who scored between 1 and 3 on the VLQ were categorized as having VL (n = 48), while those who scored between 5 and 7 were placed in the control group (n = 52). The primary outcomes were PFM displacement, diaphragmatic excursion, transversus abdominis activation ratio, and lumbar multifidus thickness measured by ultrasound imaging. The secondary outcome was sexual functioning, evaluated using the Arabic female sexual function index (ArFSFI). The VL group had significantly lower PFM displacement (mean difference (MD) - 0.42; 95% confidence interval (CI) - 0.49 to - 0.33; p = 0.001), diaphragmatic excursion (MD - 2.75; 95% CI - 2.95 to - 2.55; p = 0.001), lumbar multifidus thickness (MD - 10.08; 95% CI - 14.32 to - 5.82; p = 0.02), and ArFSFI scores (MD - 9.2; 95% CI - 10.59 to - 7.81; p = 0.001) in comparison to the control group (p < 0.05). Nevertheless, the transversus abdominis activation ratio demonstrated no significant difference between the two groups (MD 0.06; 95% CI - 0.05 to 0.17; p = 0.33). Multiparous women with VL had significantly lower PFM displacement, diaphragmatic excursion, lumbar multifidus thickness, and sexual function index scores than women in the control group. The only exception was transversus abdominis activation, which did not differ significantly between the VL and control groups.
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Affiliation(s)
- Doaa A Abdel Hady
- Department of Physical Therapy for Women's Health, Faculty of Physical Therapy, Deraya University, Minia, Egypt.
| | - Omar M Mabrouk
- Department of Basic Science, Faculty of Physical Therapy, Deraya University, Minia, Egypt
| | - Doaa A Osman
- Department of Physical Therapy for Women's Health, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Ye J, Fei H, Du J, Liu Y, He J, Li M, He Y, Ren P, Li J, Xu Y, Li J, Wang P, Zhang X, Li T. Exploring transvaginal sonographic characteristics of the levator ani muscle in women with postpartum pelvic floor myofascial pain. BMC Womens Health 2024; 24:245. [PMID: 38637819 PMCID: PMC11025161 DOI: 10.1186/s12905-024-03052-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/25/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Pelvic floor myofascial pain is one of the pelvic floor dysfunction diseases disturbing women after delivery. There is a lack of objective standardization for the diagnosis of pelvic floor myofascial pain due to the various symptoms and the dependence on the palpating evaluation. Ultrasound imaging has the advantages of safety, simplicity, economy and high resolution, which makes it an ideal tool for the assistant diagnosis of pelvic floor myofascial pain and evaluation after treatment. METHODS This is a retrospective case-control study including women accepting evaluation of pelvic floor function at 6 weeks to 1 year postpartum. They were divided into pelvic floor myofascial pain group and normal control group. A BCL 10-5 biplane transducer was applied to observed their puborectalis. The length, minimum width, area, deficiency, deficiency length, deficiency width, deficiency area, rate of deficiency area, local thickening,angle between the tendinous arch of levator ani muscle and puborectalis of corresponding puborectalis in different groups were observed and measured. RESULTS A total of 220 postpartum women participated in the study, with 77 in the pelvic floor myofascial pain group and 143 in the normal control group. The Intraclass correlation coefficient value was over 0.750, and Kappa ranged from 0.600 to 0.800. puborectalis deficiency (adjusted odds ratio = 11.625, 95% confidence interval = 4.557-29.658) and focal thickening (adjusted odds ratio = 16.891, 95% confidence interval = 1.819-156.805) were significantly associated with higher odds of having postpartum pelvic floor myofascial pain. Grayscale or the angle between the arch tendineus levator ani and puborectalis measurements on the pain side tended to be smaller than on the non-pain side in patients with unilateral puborectalis or iliococcygeus pain (P < 0.05). CONCLUSIONS This study demonstrated that transvaginal ultrasound was a potentially efficient technique for evaluating postpartum pelvic floor myofascial pain due to its ability to assess various sonographic characteristics of the levator ani muscles.
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Affiliation(s)
- Juntong Ye
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Hui Fei
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Jingran Du
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Yun Liu
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Juan He
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Mengxiong Li
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Yunxia He
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Pinyu Ren
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Juanhua Li
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Yang Xu
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Jing Li
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Pu Wang
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China.
| | - Xinling Zhang
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Province, Guangzhou, China.
| | - Tian Li
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China.
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Mostafavi SRS, Kor E, Sakhaei SM, Kor A. The correlation between ultrasonographic findings and clinical symptoms of pelvic endometriosis. BMC Res Notes 2024; 17:108. [PMID: 38637887 PMCID: PMC11027415 DOI: 10.1186/s13104-024-06761-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/02/2024] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVE Considering the importance of endometriosis and its relatively high prevalence among women, this study sought to investigate clinical and Transrectal and transvaginal ultrasounds (TVS) findings of disease. METHODS This descriptive-analytical study was performed based on medical records of 155 women with endometriosis admitted to Rasool-e Akram Hospital in Tehran for a TVS. All the sonography data and patients' information were collected into checklists and analyzed in SPSS-25 software (IBM). RESULTS The mean age of participants was 32.4 ± 6.1 years, ranging from 18 to 50 years. Endometrioma was prevalent in 129 patients (84.8%). Size of endometrioma (diameter) was more than 3 cm in 79.9% of patients, and 3 cm or fewer in 20.1% of cases. Bladder, intestinal, vaginal, and rectosigmoid involvements with endometriosis implants were observed in 4 (2.6%), 54 (35.5), 3 (0.2%), and 51 (33.5) of patients, respectively. A total of 64.5% of patients were diagnosed with incomplete stenosis of the Douglas pouch and 35.5% had complete stenosis. Deep infiltrating endometriosis (DIE) was less than 1 cm in 20.7%, 1 to 3 cm in 42.3%, and over 3 cm in 37% of patients. The most common manifestations of endometriosis Obliteration of the Douglas pouch, endometrioma, and DIE. In addition, imaging modalities have shown promising results, indicating the necessity to use transvaginal ultrasound as the first line of diagnosis in patients with clinically suspected endometriosis.
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Affiliation(s)
| | - Elham Kor
- Department of Radiology, Rasoul-E-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Anis Kor
- Department of Radiology, Rasoul-E-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Ulziibat M, Munkhuu B, Schmid R, Wyder C, Baumann T, Essig S. Comparison of quality and interpretation of newborn ultrasound screening examinations for developmental dysplasia of the hip by basically trained nurses and junior physicians with no previous ultrasound experience. PLoS One 2024; 19:e0300753. [PMID: 38635681 PMCID: PMC11025947 DOI: 10.1371/journal.pone.0300753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/04/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND We are obliged to give babies the chance to profit from a nationwide screening of developmental dysplasia of the hip in very rural areas of Mongolia, where trained physicians are scarce. This study aimed to compare the quality and interpretation of hip ultrasound screening examinations performed by nurses and junior physicians. METHODS A group of 6 nurses and 6 junior physician volunteers with no previous ultrasound experience underwent Graf's standard training in hands-on practice. Newborns were examined before discharge from the hospital, according to the national guideline. Two standard documentation images of each hip were saved digitally. The groups were compared on the proportion of good quality of sonograms and correct interpretation. Two Swiss supervisors' agreed diagnosis according to Graf was considered the final reference for the study purposes. RESULTS A total of 201 newborns (402 hips or 804 sonograms) were examined in the study, with a mean age of 1.3±0.8 days at examination. Junior physicians examined 100 newborns (200 hips or 400 sonograms), while nurses examined 101 newborns (202 hips or 404 sonograms). The study subjects of the two groups were well balanced for the distribution of baseline characteristics. The study observed no statistically significant difference in the quality of Graf's standard plane images between the providers. Eventually, 92.0% (92) of the physician group and 89.1% (90) of the nurse group were correctly diagnosed as "Group A" (Graf's Type 1 hip) or "Non-Group A" hips (p = 0.484). The most common errors among the groups were a missing lower limb, wrong measurement lines, and technical problems. CONCLUSION Our study provides evidence that while there might be a trend of slightly more technical mistakes in the nurse group, the overall diagnosis accuracy is similar to junior physicians after receiving standard training in Graf's hip ultrasound method. However, after basic training, regular quality control is a must and all participants should receive refresher trainings. More specifically, nurses need training in the identification of anatomical structures.
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Affiliation(s)
- Munkhtulga Ulziibat
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- National Center for Maternal and Child Health, Ulaanbaatar, Mongolia
| | - Bayalag Munkhuu
- National Center for Maternal and Child Health, Ulaanbaatar, Mongolia
| | | | | | - Thomas Baumann
- Center of Primary and Community Care, Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Stefan Essig
- Center of Primary and Community Care, Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Zhang HL, Shang Y. [The value of point-of-care ultrasound in the diagnosis and management of acute respiratory distress syndrome]. Zhonghua Yi Xue Za Zhi 2024; 104:1225-1229. [PMID: 38637160 DOI: 10.3760/cma.j.cn112137-20230906-00407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Acute respiratory distress syndrome (ARDS) continues to cause significant morbidity and mortality worldwide. However, there are currently no corresponding specific medications. Lung, right heart, and diaphragm protective therapy is the cornerstone of ARDS management. Non-invasive, radiation-free, and transportation-free point-of-care ultrasound enables for real-time dynamic evaluation of the lung, right heart, and diaphragm. It is an essential tool for the diagnosis, monitoring, and clinical decision-making of ARDS patients. However, ultrasound has several limitations, and its clinical application must be carefully evaluated in conjunction with clinical symptoms and other monitoring techniques. Further research is needed to determine whether clinical decision-making based on point-of-care ultrasound examination can improve the prognosis of ARDS patients.
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Affiliation(s)
- H L Zhang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Y Shang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Otake S, Ota Y, Aso K, Okada M, Hayashi H, Hasebe T, Nakajima S, Sawada K, Fujiya M, Okumura T. Contrast-enhanced Ultrasonography Features for Diagnosing Pseudoprogression of Hepatocellular Carcinoma with Immunotherapy: A Case Report of the Response after Pseudoprogression. Intern Med 2024; 63:1093-1097. [PMID: 37661447 DOI: 10.2169/internalmedicine.2349-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
A male patient in his 70s with recurrent hepatocellular carcinoma (HCC) after surgery received atezolizumab plus bevacizumab (Atezo+Bev) therapy. Initial computed tomography (CT) revealed tumor growth along with an increase in tumor markers, and contrast-enhanced ultrasonography (CEUS) showed multiple round avascular areas within the nodules with an appearance similar to a slice of Swiss cheese. Continuation of immunotherapy with consideration of the potential for pseudoprogression produced a dramatic response. Although it is difficult to distinguish between true progression and pseudoprogression, the Swiss cheese-like appearance on CEUS may be important for the early diagnosis of pseudoprogression.
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Affiliation(s)
- Shin Otake
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Yu Ota
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Kazunobu Aso
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Mitsuyoshi Okada
- Gastroenterology and Endoscopy, Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Hidemi Hayashi
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Takumu Hasebe
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Shunsuke Nakajima
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Koji Sawada
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Mikihiro Fujiya
- Gastroenterology and Endoscopy, Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Toshikatsu Okumura
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
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Torumtay Cin G, Lektemur Alpan A, Açikgöz G, Özlü Uçan G. Ultrasonographic analysis of palatal donor site healing accelerated with platelet-rich fibrin following subepithelial connective tissue harvesting. J Appl Oral Sci 2024; 32:e20230448. [PMID: 38655988 DOI: 10.1590/1678-7757-2023-0448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/21/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE Platelet-rich fibrin (PRF) contains a variety of growth factors and bioactive molecules that play crucial roles in wound healing and angiogenesis. We aimed to evaluate the effects of PRF on tissue thickness and vascularization of the palatal donor site by ultrasound (USG) following subepithelial connective tissue harvesting. METHODOLOGY A subepithelial connective tissue graft was harvested from the palatal region with a single incision for root coverage in 20 systemically healthy patients. In the test group (n = 10), the PRF membrane was placed at the donor site, whereas no material was applied in the control group (n=10). Palatal tissue thickness (PTT) and pulsatility index (PI) were evaluated by USG at baseline and on the 3rd, 7th, 14th, 30th, and 90th days after surgery. The early healing index (EHI) was used to evaluate donor site healing for 30 days. RESULTS PTT was significantly higher in the PRF group on the 3rd and 14th days after surgery when compared to the controls. In the PRF-treated group, PI levels were significantly higher than in the controls, especially on the 14th day. PTT increased significantly 90 days after surgery compared to the test group baseline, but controls showed a significant decrease. The PRF group showed statistically significant improvements in EHI scores compared to controls on days 3, 7, and 14. This study found a negative correlation between PI values and EHI scores on postoperative days three and seven in the test group. CONCLUSION USG is a non-invasive, objective method to radiographically evaluate the regenerative effects of PRF on palatal wound healing after soft tissue harvesting. To overcome graft inadequacy in reharvesting procedures, PRF application may enhance clinical success and reduce possible complications by increasing tissue thickness and revascularization in the donor area.
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Affiliation(s)
- Gizem Torumtay Cin
- Pamukkale University, Faculty of Dentistry, Department of Periodontology, Denizli, Turkey
| | - Aysan Lektemur Alpan
- Pamukkale University, Faculty of Dentistry, Department of Periodontology, Denizli, Turkey
| | - Gözde Açikgöz
- Pamukkale University, Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Denizli, Turkey
| | - Gülfem Özlü Uçan
- Gelişim University, Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, İstanbul, Turkey
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Guitart C, Bobillo-Perez S, Rodríguez-Fanjul J, Carrasco JL, Brotons P, López-Ramos MG, Cambra FJ, Balaguer M, Jordan I. Lung ultrasound and procalcitonin, improving antibiotic management and avoiding radiation exposure in pediatric critical patients with bacterial pneumonia: a randomized clinical trial. Eur J Med Res 2024; 29:222. [PMID: 38581075 PMCID: PMC10998368 DOI: 10.1186/s40001-024-01712-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/03/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Pneumonia is a major public health problem with an impact on morbidity and mortality. Its management still represents a challenge. The aim was to determine whether a new diagnostic algorithm combining lung ultrasound (LUS) and procalcitonin (PCT) improved pneumonia management regarding antibiotic use, radiation exposure, and associated costs, in critically ill pediatric patients with suspected bacterial pneumonia (BP). METHODS Randomized, blinded, comparative effectiveness clinical trial. Children < 18y with suspected BP admitted to the PICU from September 2017 to December 2019, were included. PCT was determined at admission. Patients were randomized into the experimental group (EG) and control group (CG) if LUS or chest X-ray (CXR) were done as the first image test, respectively. Patients were classified: 1.LUS/CXR not suggestive of BP and PCT < 1 ng/mL, no antibiotics were recommended; 2.LUS/CXR suggestive of BP, regardless of the PCT value, antibiotics were recommended; 3.LUS/CXR not suggestive of BP and PCT > 1 ng/mL, antibiotics were recommended. RESULTS 194 children were enrolled, 113 (58.2%) females, median age of 134 (IQR 39-554) days. 96 randomized into EG and 98 into CG. 1. In 75/194 patients the image test was not suggestive of BP with PCT < 1 ng/ml; 29/52 in the EG and 11/23 in the CG did not receive antibiotics. 2. In 101 patients, the image was suggestive of BP; 34/34 in the EG and 57/67 in the CG received antibiotics. Statistically significant differences between groups were observed when PCT resulted < 1 ng/ml (p = 0.01). 3. In 18 patients the image test was not suggestive of BP but PCT resulted > 1 ng/ml, all of them received antibiotics. A total of 0.035 mSv radiation/patient was eluded. A reduction of 77% CXR/patient was observed. LUS did not significantly increase costs. CONCLUSIONS Combination of LUS and PCT showed no risk of mistreating BP, avoided radiation and did not increase costs. The algorithm could be a reliable tool for improving pneumonia management. CLINICAL TRIAL REGISTRATION NCT04217980.
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Affiliation(s)
- Carmina Guitart
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Barcelona, Spain
- Immunological and Respiratory Disorders in the Pediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Pediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950, Esplugues de Llogregat, Spain
| | - Sara Bobillo-Perez
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Barcelona, Spain
- Immunological and Respiratory Disorders in the Pediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Pediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950, Esplugues de Llogregat, Spain
| | - Javier Rodríguez-Fanjul
- Neonatal Intensive Care Unit, Department of Pediatrics, Hospital Germans Trias i Pujol, Autonomous University of Barcelona, Badalona, Spain
| | - José Luis Carrasco
- Department of Basic Clinical Practice, University of Barcelona, Barcelona, Spain
| | - Pedro Brotons
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud (CIBERESP), Madrid, Spain
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | - Francisco José Cambra
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Mònica Balaguer
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Barcelona, Spain.
- Immunological and Respiratory Disorders in the Pediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain.
- Pediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950, Esplugues de Llogregat, Spain.
| | - Iolanda Jordan
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Barcelona, Spain
- Immunological and Respiratory Disorders in the Pediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Pediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950, Esplugues de Llogregat, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud (CIBERESP), Madrid, Spain
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Shin Y, Lowerison MR, Wang Y, Chen X, You Q, Dong Z, Anastasio MA, Song P. Context-aware deep learning enables high-efficacy localization of high concentration microbubbles for super-resolution ultrasound localization microscopy. Nat Commun 2024; 15:2932. [PMID: 38575577 PMCID: PMC10995206 DOI: 10.1038/s41467-024-47154-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 03/20/2024] [Indexed: 04/06/2024] Open
Abstract
Ultrasound localization microscopy (ULM) enables deep tissue microvascular imaging by localizing and tracking intravenously injected microbubbles circulating in the bloodstream. However, conventional localization techniques require spatially isolated microbubbles, resulting in prolonged imaging time to obtain detailed microvascular maps. Here, we introduce LOcalization with Context Awareness (LOCA)-ULM, a deep learning-based microbubble simulation and localization pipeline designed to enhance localization performance in high microbubble concentrations. In silico, LOCA-ULM enhanced microbubble detection accuracy to 97.8% and reduced the missing rate to 23.8%, outperforming conventional and deep learning-based localization methods up to 17.4% in accuracy and 37.6% in missing rate reduction. In in vivo rat brain imaging, LOCA-ULM revealed dense cerebrovascular networks and spatially adjacent microvessels undetected by conventional ULM. We further demonstrate the superior localization performance of LOCA-ULM in functional ULM (fULM) where LOCA-ULM significantly increased the functional imaging sensitivity of fULM to hemodynamic responses invoked by whisker stimulations in the rat brain.
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Affiliation(s)
- YiRang Shin
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, USA
- Department of Electrical and Computer Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Matthew R Lowerison
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, USA
- Department of Electrical and Computer Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Yike Wang
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, USA
- Department of Electrical and Computer Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Xi Chen
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, USA
- Department of Electrical and Computer Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Qi You
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, USA
- Department of Bioengineering, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Zhijie Dong
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, USA
- Department of Electrical and Computer Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Mark A Anastasio
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, USA
- Department of Electrical and Computer Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA
- Department of Bioengineering, University of Illinois Urbana-Champaign, Urbana, IL, USA
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Pengfei Song
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, USA.
- Department of Electrical and Computer Engineering, University of Illinois Urbana-Champaign, Urbana, IL, USA.
- Department of Bioengineering, University of Illinois Urbana-Champaign, Urbana, IL, USA.
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, IL, USA.
- Neuroscience Program, University of Illinois Urbana-Champaign, Urbana, IL, USA.
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Cheng Z, Sun Z, Wang J, Jia K. Magneto-acousto-electrical tomography using nonlinearly frequency-modulated ultrasound. Phys Med Biol 2024; 69:085014. [PMID: 38422542 DOI: 10.1088/1361-6560/ad2ee5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/29/2024] [Indexed: 03/02/2024]
Abstract
Objective. In this study, nonlinearly frequency-modulated (NLFM) ultrasound was applied to magneto-acousto-electrical tomography (MAET) to increase the dynamic range of detection.Approach. Generation of NLFM signals using window function method-based on the principle of stationary phase-and piecewise linear frequency modulation method-based on the genetic algorithm-was discussed. The MAET experiment systems using spike, linearly frequency-modulated (LFM), or NLFM pulse stimulation were constructed, and three groups of MAET experiments on saline agar phantom samples were carried out to verify the performance-respectively the sensitivity, the dynamic range, and the longitudinal resolution of detection-of MAET using NLFM ultrasound in comparison to that using LFM ultrasound. Based on the above experiments, a pork sample was imaged by ultrasound imaging method, spike MAET method, LFM MAET method, and NLFM MAET method, to compare the imaging accuracy.Main results. The experiment results showed that, through sacrificing very little main-lobe width of pulse compression or equivalently the longitudinal resolution, the MAET using NLFM ultrasound achieved higher signal-to-interference ratio (and therefore higher detection sensitivity), lower side-lobe levels of pulse compression (and therefore larger dynamic range of detection), and large anti-interference capability, compared to the MAET using LFM ultrasound.Significance. The applicability of the MAET using NLFM ultrasound was proved in circumferences where sensitivity and dynamic range of detection were mostly important and slightly lower longitudinal resolution of detection was acceptable. The study furthered the scheme of using coded ultrasound excitation toward the clinical application of MAET.
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Affiliation(s)
- Zhizhuo Cheng
- College of Information and Communication Engineering, Faculty of Information Technology, Beijing University of Technology, Beijing 100124, People's Republic of China
| | - Zhishen Sun
- College of Information and Communication Engineering, Faculty of Information Technology, Beijing University of Technology, Beijing 100124, People's Republic of China
| | - Jianfei Wang
- Beijing Key Laboratory of Nonlinear Vibrations and Strength of Mechanical Structures, Faculty of Materials and Manufacturing, Beijing University of Technology, Beijing 100124, People's Republic of China
| | - Kebin Jia
- College of Information and Communication Engineering, Faculty of Information Technology, Beijing University of Technology, Beijing 100124, People's Republic of China
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