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Importance: Kidney disease is prevalent among veterinary species, including zoo animals; however, investigations into this condition in striped skunks (Mephitis mephitis) are scarce. Diagnostic tools for kidney diseases in this species also remain limited. Objective: This study aimed to assess the utility of symmetric dimethylarginine as a biomarker for kidney disease in captive striped skunks in Korea. Methods: This retrospective study analysed 11 striped skunks housed at the Everland Zoo between 2017 and 2021. Blood samples were collected during health checks. Kidney function was assessed through blood analysis and diagnostic ultrasound, with necropsies conducted on deceased animals. Symmetric dimethylarginine levels were measured in 27 plasma samples collected from 11 skunks. Results: Over the study period, seven skunks were diagnosed with kidney disease. Analysis of 27 blood samples revealed a concurrent increase in SDMA levels with concentrations of blood urea nitrogen and blood creatinine. In 3 of the 7 skunks with kidney disease, symmetric dimethylarginine exceeded 14 µg/dL prior to the elevation of blood urea nitrogen and blood creatinine above the upper reference limit. Conclusions and Relevance: To our knowledge, this is the first study investigating symmetric dimethylarginine in captive striped skunks in Korea. Our findings suggest that symmetric dimethylarginine may serve as an early and consistent biomarker for renal dysfunction in striped skunks. Further studies with larger clinical sample size from striped skunks are needed to validate the clinical utility of blood symmetric dimethylarginine concentration. [ABSTRACT FROM AUTHOR]

The given text is a collection of summaries of various research studies and a case report related to sonography in gynecologic care. The studies explore topics such as the use of ultrasound in diagnosing and managing ovarian torsion, evaluating endometrial polyps, diagnosing and managing uterine fibroids, and evaluating pelvic pain in women. The case report highlights the use of point-of-care ultrasound in diagnosing a molar pregnancy in an emergency care setting. These articles and studies demonstrate the importance of ultrasound in gynecologic care and its ability to provide valuable diagnostic information. [Extracted from the article]

Piezoelectric composites, which consist of piezoelectric materials and polymers, are widely employed in various applications such as underwater sonar transducers and medical diagnostic ultrasonic transducers. Acoustic transducers based on piezoelectric composites can have high sensitivity with broad bandwidth. In recent studies, it is demonstrated that 2-2 composites based on single crystals provide further increased sensitivity and wide bandwidth. In order to utilize a 2-2 composite in acoustic sensors, it is required to demonstrate the full material coefficients of the 2-2 composite. In this study, we investigated an analytic solution for determining equivalent material coefficients of a 2-2 composite. Impedance spectrums of the single-phase resonators with equivalent material coefficients and 2-2 composite resonators were compared by the finite element method in order to verify the analytic solutions. Furthermore, the equivalent material coefficients derived from the analytic solution were also verified by comparing the measured and the simulated impedance spectrums. The difference in resonance and anti-resonance frequencies between the measured and simulated impedance spectrums was around 0.5% and 1.2%. By utilizing the analytic solutions in this study, it is possible to accurately derive full equivalent material coefficients of a 2-2 composite, which are essential for the development of acoustic sensors. [ABSTRACT FROM AUTHOR]

Objectives: Calcaneal apophysitis (Sever's disease) is an overuse condition caused by repetitive traction stress to the calcaneal apophysis. Whether Achilles tendon morphology is altered in this young patient population remains unknown. Therefore, we aimed to identify differences in Achilles tendon morphology between youth athletes diagnosed with calcaneal apophysitis and healthy controls. Methods: This retrospective chart review included 46 patients (n = 23 Sever's disease, 15F/8M, 12.4 ± 2.3 years old) and (n = 23 healthy controls, 13F/10M, 15.9 ± 1.5 years old) who sought care in a Children's Hospital Sports Medicine/Orthopedics Department between 2012 and 2022. We measured ultrasound‐derived degree of tendon thickening, Achilles tendon thickness (cm), and cross‐sectional area (CSA [cm2]). Separate multivariate analyses of covariance (MANCOVAs) were used to compare degree of thickening, mass‐normalized Achilles tendon thickness, and CSA between participant groups, covarying for age. Cohen's d effect sizes were used to assess the magnitude of mean differences and standard error (MDSE) between groups. Results: Young athletes with Sever's disease had a significantly greater degree of tendon thickening with a large effect compared with healthy controls (MDSE: 0.07 [0.01] mm P <.001, d = 1.39). Achilles tendon thickness and CSA did not statistically differ between groups; however, the magnitude of between‐group differences for these measures (MDSE: 0.18 [0.05] cm, MDSE: 0.27 [0.07] cm2, respectively) were moderate. Conclusions: Our findings demonstrate previously unrecognized differences in Achilles tendon morphology between young athletes with clinically diagnosed Sever's disease and healthy controls. Our study supports incorporating diagnostic ultrasound as part of a comprehensive examination to ensure appropriate diagnosis and clinical management for adolescents with heel pain. [ABSTRACT FROM AUTHOR]

Objectives: Ultrasound (US) imaging has been observed to underestimate tumor size in clinical practice. This study aims to compare the size measurements of breast cancer and benign tumors using two‐dimensional ultrasound (2DUS) and contrast‐enhanced ultrasound (CEUS). Methods: The study included 42 clinically confirmed breast cancer and 47 benign breast tumors. Two experienced physicians independently measured the maximal longitudinal and transverse diameters of the masses in 2DUS and CEUS. All analyses were performed in R (4.2.2) and GraphPad Prism 6. Results: The maximal longitudinal and transverse diameters of breast cancer measured by CEUS were 26.61 ± 0.21% and 26.24 ± 0.19% larger compared with 2DUS, and benign breast tumors had an 11.74 ± 0.21% and 11.06 ± 0.14% increase in size compared with 2DUS. The area under the curve (AUC) of the receiver operating characteristic curve (ROC) for the difference between 2DUS and CEUS was 0.870 for longitudinal diameters (95% CI: 0.795–0.945, sensitivity 0.842, specificity 0.783, threshold value 0.215), and 0.863 for transverse diameters (95% CI: 0.785–0.942, sensitivity 0.667, specificity 0.936, threshold value 0.203). Conclusions: The size measurements of both breast cancer and benign tumors were larger in CEUS compared with 2DUS, with CEUS measurements of breast cancer being more pronounced than those of benign breast tumors. These findings suggest that CEUS may provide a more precise assessment of tumor size, which is crucial for determining optimal treatment strategies and improving patient outcomes in breast cancer management. [ABSTRACT FROM AUTHOR]

Objectives: To demonstrate the usefulness of ultrasonography for differentiating soft tissue infections with or without osteomyelitis in pediatric patients who underwent ultrasonography and subsequent magnetic resonance imaging (MRI). Methods: Twenty‐three patients were classified into 2 groups: 12 patients with and 11 patients without osteomyelitis based on MRI. Osteomyelitis using ultrasound is characterized by the presence of bone cortex irregularity and/or subperiosteal abscess formation. The diagnostic performance of ultrasonography for detecting osteomyelitis and subperiosteal abscess formation was compared with that of MRI. Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were calculated with 95% confidence intervals (CIs). Results: Of 12 osteomyelitis cases, 11 had abnormal bone marrow enhancement (one residual case did not undergo contrast enhancement study) and 5 had subperiosteal abscesses. The diagnostic accuracy of ultrasonography for osteomyelitis was 82.6% (number of correct diagnosis of osteomyelitis/total number = 19/23; 95% CI, 61.2–95.0) and for detecting periosteal abscess was 95.7% (number of correct diagnosis of periosteal abscess/total number = 22/23; 95% CI, 78.1–99.9), respectively. The sensitivity and specificity of ultrasonography for detecting osteomyelitis were 66.7% (95% CI, 34.9–90.1) and 100% (95% CI, 71.5–100), respectively. The sensitivity and specificity of ultrasonography for detecting periosteal abscess were 80% (95% CI, 28.4–99.5), and 100% (95% CI, 81.5–100), respectively. One‐third of osteomyelitis cases could not be detected using ultrasonography. Conclusions: Ultrasonography may be useful for diagnosing osteomyelitis in pediatric patients; however, the technique appears limited by low sensitivity. However, it is more accurate for diagnosis of periosteal abscess in these patients. [ABSTRACT FROM AUTHOR]

Introduction: Pilomatrixoma is a benign skin neoplasm that is common in children and is often misdiagnosed. This study aimed to summarize the clinical and pathological features of pilomatrixoma in children. Methods: Data on demographic information, clinical and pathological features, diagnosis, and treatment of 171 patients with pilomatrixoma from Shenzhen Baoan Women's and Children's Hospital were collected and analyzed retrospectively. Results: The mean age of the patients was 5.7 (standard deviation [SD] = 3.9) years old, and there were 2 age peaks (≤1 year old, 5–11 years old) and 2 age valleys (2–4 years old, ≥12 years old). The mean disease course was 9.3 (SD = 14.1) months, 69.0%, 86.5%, and 95.3% of the patients' disease course in 6 months, 12 months, and 24 months, respectively. The mean tumor volume was 0.6 (SD = 1.0) cm3, and 81.3% of the patients' tumor volume ≤1.0 cm3. Tumors were distributed sequentially in the head and neck (77.2%), upper limbs (12.9%), trunk (7.6%), and lower limbs (2.3%). The correct rates of clinical and ultrasonic diagnosis were 50.9% and 38.6%, respectively. The two most common pathological features of pilomatrixoma were shadow cells (99.4%) and basaloid cells (94.7%). There were no significant differences in age, disease course, or tumor volume between the male and female patients (p > 0.05). The age and tumor volume of the patients in different body parts were significantly different (P1 = 3.10E−05 and P2 = 5.60E−05, respectively). The correlation between the disease course and tumor volume was positively significant (p ≤ 0.05). There was a significant correlation between the disease course and tumor volume in patients with tumors at upper limbs (p = 0.03). Conclusion: The age of children with pilomatrixoma presented 2 peaks and 2 valleys. Most patients had disease courses in 24 months and with tumor volumes ≤1.0 cm3. The correct rates of clinical and ultrasonic diagnosis were relatively low. The head and neck were the most common distribution sites of pilomatrixoma, and shadow cells and basaloid cells were the most common pathological features. The tumor volume was positively correlated with disease course in patients with pilomatrixoma. Plain Language Summary: Pilomatrixoma is a benign skin neoplasm that is common in children and is often misdiagnosed. Fu et al. conducted a retrospective study at Shenzhen Baoan Women's and Children's Hospital. One hundred and seventy-one children with pilomatrixoma were included. There were 2 age peaks (≤1 year old, 5–11 years old) and 2 age valleys (2–4 years old, ≥12 years old). The mean disease course was 9.34 months, 69.0%, 86.5%, and 95.3% of the patients' disease course in 6 months, 12 months, and 24 months, respectively. The mean tumor volume was 0.6 cm3, and 81.3% of patients' tumor volume ≤1 cm3. Tumors were distributed sequentially in the head and neck (77.2%), upper limbs (12.9%), trunk (7.6%), and lower limbs (2.3%). The correct rates of clinical and ultrasonic diagnosis were 50.9% and 38.6%, respectively. The pathological features of pilomatrixoma were shadow cells (99.4%), basaloid cells (94.7%), calcification (39.8%), multinuclear giant cell aggregation (35.7%), inflammatory cell infiltration (33.9%), histiocytic hyperplasia (5.3%), and ossification (1.2%). There were no significant differences in age, disease course, or tumor volume between the male and female patients (p > 0.05). The age and tumor volume of the patients in different body parts were significantly different (P1 = 3.10E−05 and P2 = 5.60E−05, respectively). The correlation between the disease course and tumor volume was positively significant (p ≤ 0.05). There was a significant correlation between the disease course and tumor volume in patients with tumors at upper limbs (p = 0.03). [ABSTRACT FROM AUTHOR]

The article discusses the benefits and drawbacks of a nationwide abdominal aortic aneurysm (AAA) screening program, emphasizing the importance of early detection to prevent fatal ruptures. The study compares the outcomes of such a program in Sweden and Finland, highlighting the success of the Swedish approach in reducing AAA-related mortality and improving long-term survival. The research suggests that AAA screening is cost-effective and can lead to a decrease in emergency procedures for ruptured AAAs, ultimately impacting healthcare costs and patient outcomes. [Extracted from the article]

The editorial discusses the importance of risk-based screening adherence in childhood cancer survivors, highlighting the high risk of premature morbidity and mortality due to health-related causes, particularly cardiovascular disease. The Children's Oncology Group has developed guidelines for long-term follow-up to enable early detection in this high-risk population. A study in Cancer explores the use of carotid ultrasound screening in adult survivors of childhood cancer, revealing suboptimal screening adherence rates and the need for interventions to improve screening rates among at-risk survivors. The editorial emphasizes the need to address multi-level barriers to adherence and improve guideline dissemination to primary care providers for better care and outcomes for survivors. [Extracted from the article]

Objective: To explore the relationship between lipoprotein cholesterol content and vascular plaque type in patients with cardiovascular diseases of different ages. Methods: 80 patients with cardiovascular diseases admitted to our hospital from January 2019 to January 2024 were selected as the study objects, grouped according to their age and compared with three groups of indicators. Subsequently, 80 patients were grouped according to ultrasound diagnostic plaque type and their expression levels of lipid-related indicators were compared. When plaque calcification was used as the dependent variable (stable plaque =0, unstable plaque =1), a logistics regression model was established to analyze the independent predictive value of blood lipid-related indicators on vascular plaque type. Results: Course of disease, BMI, hypertension, diabetes, plaque type and Gensini scores of different ages (P<0.05); Low density lipoprotein (LDL-C) and hemoglobin levels were significantly in the three groups, LDL-C levels were higher in the advanced age group than in the younger and middle age group, The hemoglobin level was lower than that of the younger and middle age groups (P<0.05); The expression levels of LDL-C, HDL-C, TC and TG in unstable plaque group were significantly higher than those in stable plaque group (P<0.05); LDL-C elevation had an independent predictive value for unstable plaques in patients with cardiovascular disease (P<0.05). Conclusion: LDL-C has different ages, higher LDL-C level, and older plaques were mostly unstable plaques. LDL-C, HDL-C, TC and TG, but only LDL-C had independent predictive value for plaque properties. [ABSTRACT FROM AUTHOR]

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) Collaborative Research Network (CRN)/research committee met during the GRAPPA 2023 annual meeting. Updates were provided on GRAPPA research projects, including the Axial Involvement in Psoriatic Arthritis (AXIS), Axial Psoriatic Arthritis Molecular and Clinical Characterisation Study, Diagnostic Ultrasound Enthesitis Tool (DUET), and Sex- and Gender-Based Analysis of the Effectiveness of Advanced Therapies (SAGE) studies, as well as the Health Initiatives in Psoriasis and Psoriatic Arthritis Consortium European States (HIPPOCRATES) and Elucidating the Landscape of Immunoendotypes in Psoriatic Skin and Synovium (ELLIPSS) studies. The highlight of the meeting was a presentation and discussion on the use of digital tools to study psoriatic disease. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion Intracranial epidural abscesses require swift diagnosis and treatment. While magnetic resonance imaging (MRI) is preferred for its detailed visualisation, it is costly and time‐consuming. Transcranial sonography offers a rapid, portable and cost‐effective alternative for assessing brain lesions.We present a case study involving the diagnosis and management of an intracranial epidural abscess in a 25‐year‐old man with a traumatic brain injury who underwent a craniectomy and later developed fever and drowsiness in the intensive care unit.Using transcranial point‐of‐care ultrasound, a hypoechoic collection was identified at the surgical site, prompting further imaging with computed tomography (CT) and MRI, which confirmed the diagnosis of an epidural abscess. Prompt surgical intervention led to the resolution of symptoms and a favourable clinical outcome.This case highlights the potential utility of brain sonography as an efficient and cost‐effective initial diagnostic tool for detecting intracranial complications, particularly in postoperative patients with altered sensorium and fever, where timely intervention is crucial. [ABSTRACT FROM AUTHOR]

Background: Assessment of breast development by physical examination can be difficult in the early stages and in overweight girls. Objective: To investigate ultrasonography (US) for evaluation of early breast development. Materials and methods: In a prospective study, 125 girls (age 7.1 ± 1.5 years) with breast development before 8 years underwent US breast staging, breast volume, and elastography, in addition to clinical/hormonal evaluation for precocious puberty. Accuracy of US for determining breast development and predicting progression to central precocious puberty was investigated. Results: Physical examination revealed glandular breast enlargement in 100 and predominantly lipomastia in 25. Breast US in the former confirmed glandular breast development in 92 (group 1, physical examination and US positive), but not in 8 (group 2, physical examination positive, US negative). Comparison of the two groups demonstrated lower Tanner and US staging, bone age/chronological age, basal luteinizing hormone (LH), breast volume, and uterine volume in group 2. In the 25 lipomastia patients, US demonstrated no breast tissue in 19 (group 3, physical examination and US negative), but US stage ≥ II in 6 (group 4, physical examination negative, US positive) without differences in clinical parameters. After follow-up of 19.8 ± 4.2 months, 46/125 subjects were diagnosed with precocious puberty. US stage, total breast volume, and shear-wave speeds were significantly higher in these 46 patients. Multivariate analyses demonstrated breast volume > 3.4 cc had odds ratio of 11.0, sensitivity of 62%, and specificity of 89, in predicting progression to precocious puberty, being second only to stimulated LH for all variables. Conclusion: Breast US is a useful predictive tool for diagnosis of precocious puberty in girls. Higher US stages and higher breast volume on US increased the likelihood of eventual diagnosis of precocious puberty. [ABSTRACT FROM AUTHOR]

The correct measurement of the resonance frequency and shell properties of coated microbubbles (MBs) is essential in understanding and optimizing their response to ultrasound (US) exposure parameters. In diagnostic and therapeutic ultrasound, MBs are typically surrounded by blood; however, the influence of the medium charges on the MB resonance frequency has not been systematically studied using controlled measurements. This study aims to measure the medium charge interactions on MB behavior by measuring the frequency-dependent attenuation of the same size MBs in mediums with different charge densities. In-house lipid-coated MBs with C3F8 gas core were formulated. The MBs were isolated to a mean size of 2.35 μm using differential centrifugation. MBs were diluted to ≈8×105 MBs/mL in distilled water (DW), Phosphate-Buffered Saline solution (PBS1x) and PBS10x. The frequency-dependent attenuation of the MBs solutions was measured using an aligned pair of PVDF transducers with a center frequency of 10MHz and 100% bandwidth in the linear oscillation regime (7 kPa pressure amplitude). The MB shell properties were estimated by fitting the linear equation to experiments. Using a pendant drop tension meter, the surface tension at the equilibrium of ≈6 mm diameter size drops of the same MB shell was measured inside DW, PBS1x and PBS10x. The surface tension at the C3F8/solution interface was estimated by fitting the Young-Laplace equation from the recorded images. The frequency of the peak attenuation at different salinity levels was 13, 7.5 and 6.25 MHz in DW, PBS1x and PBS-10x, respectively. The attenuation peak increased by ≈140% with increasing ion density. MBs' estimated shell elasticity decreased by 64% between DW and PBS-1x and 36% between PBS-1x and PBS-10x. The drop surface tension reduced by 10.5% between DW and PBS-1x and by 5% between PBS-1x and PBS-10x, respectively. Reduction in the shell stiffness is consistent with the drop surface tension measurements. The shell viscosity was reduced by ≈40% between DW and PBS-1x and 42% between PBS-1x and PBS-10x. The reduction in the fitted stiffness and viscosity is possibly due to the formation of a densely charged layer around the shell, further reducing the effective surface tension on the MBs. The changes in the resonance frequency and estimated shell parameters were significant and may potentially help to better understand and explain bubble behavior in applications. [ABSTRACT FROM AUTHOR]

Atypical Parathyroid Adenoma (APA) is a type of tumor that lies somewhere between parathyroid adenoma and parathyroid carcinoma. It often affects adults over the age of 60, and the clinical symptoms are consistent with those of hyperparathyroidism. This condition has a low occurrence, and its ultrasonographic signs are strikingly similar to thyroid malignant tumors, making it easily misdiagnosed. As a result, a case of APA ultrasonography misdiagnosis admitted to our hospital was recorded in order to serve as a reference point for APA diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Point-of-care ultrasound (POCUS) can assist rheumatologists in monitoring disease activity, establishing diagnoses, and guiding procedural interventions. POCUS use has been increasing, but little is known about current use and barriers among rheumatologists. The purpose of this study was to characterize current POCUS use, training needs, and barriers to use among rheumatologists in practice. Methods: A prospective observational study of all Veterans Affairs (VA) medical centers was conducted using a web-based survey sent to all chiefs of staff and rheumatology chiefs about current POCUS use, training needs, barriers, and policies. Results: All chiefs of staff (n = 130) and rheumatology chiefs at VA medical centers (n = 95) were surveyed with 100% and 84% response rates, respectively. The most common diagnostic POCUS applications were evaluation of synovitis, joint effusion, tendinopathies, bursitis, and rotator cuff. The most common procedural applications were arthrocentesis and joint, bursa, and tendon injection. Most rheumatology chiefs (69%) expressed interest in training for their group. The most common barriers to POCUS use were lack of trained providers (68%), funding for training (54%), training opportunities (38%), funding for travel (38%), and ultrasound equipment (31%). Lack of POCUS infrastructure was common, and few facilities had POCUS policies (20%), image archiving (25%), or quality assurance processes (6%). Conclusion: Currently, half of rheumatology groups use diagnostic and procedural ultrasound applications. Most rheumatology groups desire training, and lack of training and equipment were the most common barriers to ultrasound use. Deliberate investment is needed in ultrasound training and infrastructure for systematic adoption of POCUS in rheumatology. Graphical Abstract available for this article. Trial Registration: NCT03296280. [ABSTRACT FROM AUTHOR]

Aim: Our aim was to investigate the frequency of various splenic cysts, to define the sonographic differential diagnostic clues and to introduce the value of twinkling artefact in the diagnosis of epidermoid splenic cysts. Material and methods: All the splenic cysts imaged by ultrasound in 3 university hospitals during the period of 2005 to 2022 were recorded, followed-up and analyzed. Results: One hundred seventy-one patients with splenic cysts were detected and these were classified and 73% of the cysts were simple. Ten cysts were epidermoid cysts as proven by post-operative final histology. Conclusion: Cystic splenic lesions are rare. Most of them are small simple cysts. Epidermoid cysts are larger in volume, constitute 6% of the total and can be differentiated by the help of twinkling artefact by Doppler ultrasound. [ABSTRACT FROM AUTHOR]

Aims: This study assessed the effectiveness of three ultrasound-based techniques (2D-SWE.PLUS, Att.PLUS, Vi.PLUS) for non-invasive evaluation of liver fibrosis, steatosis, and inflammation in chronic liver disease (CLD) patients. Materials and methods: Involving 209 consecutive compensated CLD patients, the study compared these ultrasound methods from Aixplorer with standard Vibration-controlled Transient Elastography (VCTE) and Controlled Attenuation Parameter (CAP) from Fibroscan, alongside non-invasive serological markers. Results: High validity rates were observed in measurements: 99% for VCTE, 89% for 2D-SWE.PLUS/Vi.PLUS, and 96.6% for Att.PLUS. 2D-SWE.PLUS showed a strong correlation with VCTE (R=0.91) and excelled at a lower Stability Index (80%), with optimal cut-offs for moderate and severe fibrosis at 8 kPa and 10 kPa, respectively. 2D-SWE.PLUS was superior to Fib4, eLIFT, APRI, BARD, and NFS in detecting advanced CLD. Att.PLUS moderately correlated with CAP (R=0.47) for steatosis grades, while Viscosity was highly effective in identifying significant fibrosis (AUC=0.87) but less so for inflammation. Conclusions: 2D-SWE.PLUS demonstrated superior diagnostic precision in liver fibrosis, exceeding other non-invasive markers. Att.PLUS was relatively accurate for liver steatosis, and viscosity more effectively indicated fibrosis stages than inflammation in CLD patients. [ABSTRACT FROM AUTHOR]

Ultrasonography, a radiation-free and cost-effective modality, stands out as a promising tool for evaluating nasal bone fractures. Despite limited literature on its pediatric application, there is an increasing recognition of its potential to enhance diagnostic precision. To evaluate the diagnostic efficacy of ultrasound in detecting pediatric nasal bone fractures. Employing established guidelines, a systematic review and meta-analysis were conducted through a comprehensive literature search in PubMed, Scopus, Web of Science, and Embase databases until December 5, 2023. Inclusion criteria encompassed studies reporting diagnostic accuracy measures of ultrasound in pediatric patients with nasal bone fractures. Data extraction and analysis were undertaken for the selected studies. Involving four studies with 277 patients, ultrasound demonstrated a pooled sensitivity of 66.1% (95% CI: 35.1-87.5%) and specificity of 86.8% (95% CI: 80.1-91.4%) in diagnosing pediatric nasal fractures. The area under the receiver operating characteristic curve (AUC) was 0.88 (95% CI: 0.72–0.93). After excluding an outlier study, sensitivity and specificity increased to 78.0% (95% CI: 65.6-86.9%) and 87.8 (95% CI: 78.1-93.6%), respectively, with an AUC of 0.79 (95% CI: 0.75–0.94). Pooled positive and negative likelihood ratios were 5.11 (95% CI: 2.12–9.15) and 0.40 (95% CI: 0.14–0.77) before exclusion and 6.75 (95% CI: 3.47–12.30) and 0.26 (95% CI: 0.15–0.40) after exclusion of an outlier study, respectively. This study highlighted ultrasonography's utility in diagnosing pediatric nasal bone fractures with high accuracy and specificity. However, caution is advised in relying solely on ultrasound due to suboptimal overall diagnostic performance, evident in likelihood ratios. [ABSTRACT FROM AUTHOR]

Measuring the bicep femoris long head fascicle length via the use of diagnostic ultrasound has become common practice within elite sport, using single images of between 4 and 6 cm. No study to date has compared single image estimations in terms of the varying fields of view (i.e., 4, 6, and 10 cm). Therefore, the aim of this study was to determine whether differences occur when estimating the bicep femoris long head fascicle length using short (4 cm), medium (6 cm), and long (10 cm) fields of view across three estimation equations. A total of 36 male athletes (age: 23.8 ± 3.8 years, body mass: 83.7 ± 14.0 kg, height: 1.81 ± 0.06 m) had three ultrasound images of the bicep femoris long head collected on a single occasion with the fascicle length estimated. A significant main effect was observed (p < 0.001) with moderate–very large differences (p < 0.078, d = 0.91–4.01). The smallest fields of view resulted in the greatest fascicle length. There were significant moderate–large associations between the fields of view (p < 0.001, r = 0.542–0.892). Unacceptable limits of agreement were observed, and the developed correction equations remained unacceptable. The partial measure equation is the most accurate whilst using the 10 cm fields of view, while the basic trigonometry equation had the lowest variability between fields of view and the smallest differences between fields of view; hence, this equation may be more appropriate when a <6 cm field of view is the only field of view available. [ABSTRACT FROM AUTHOR]

Nanoscale ultrasound contrast agents have attracted considerable interest in the medical imaging field for their ability to penetrate tumor vasculature and enable targeted imaging of cancer cells by attaching to tumor-specific ligands. Despite their potential, traditional chemically synthesized contrast agents face challenges related to complex synthesis, poor biocompatibility, and inconsistent imaging due to non-uniform particle sizes. To address these limitations, bio-synthesized nanoscale ultrasound contrast agents have been proposed as a viable alternative, offering advantages such as enhanced biocompatibility, consistent particle size for reliable imaging, and the potential for precise functionalization to improve tumor targeting. In this study, we successfully isolated cylindrical gas vesicles (GVs) from Serratia. 39006 and subsequently introduced the GVs-encoding gene cluster into Escherichia coli using genetic engineering techniques. We then characterized the contrast imaging properties of two kinds of purified GVs, using in vitro and in vivo methods. Our results demonstrated that naturally isolated GVs could produce stable ultrasound contrast signals in murine livers and tumors using clinical diagnostic ultrasound equipment. Additionally, heterologously expressed GVs from gene-engineered bacteria also exhibited good ultrasound contrast performance. Thus, our study presents favorable support for the application of genetic engineering techniques in the modification of gas vesicles for future biomedical practice. [ABSTRACT FROM AUTHOR]

Simple Summary: Simple Summary: Anal sacs are paired skin invaginations present in most carnivores near the lateral margins of the anus and contain combined secretions of glands located in the anal sac wall. Anal sac disease is commonly seen in small animal practices, with a higher prevalence in dogs than in cats. The diagnosis of anal sac disease is usually based on the presentation of clinical signs and physical and rectal examination. However, the clinical signs are often non-specific and may be even absent, particularly in neoplastic cases. Ultrasonographic evaluation of anal sacs in dogs and cats is a practical, readily available, non-invasive, and low-cost modality and may enable the detection of anal sac disease at an early stage, even in asymptomatic patients. This study describes a presumed normal ultrasound morphology of anal sacs in dogs and cats, as well as the feasibility, advantages, and disadvantages of ultrasound screening of anal sacs in these companion animals. Ultrasonographic evaluation of canine and feline anal sacs is a practical promising modality to identify anal sac disease. However, limited data are available about normal ultrasound morphology of the anal sacs. This study describes the ultrasound morphology of presumed normal anal sacs in a larger sample of client-owned dogs and cats. A single-institutional prospective cross-sectional descriptive study was performed, and 137 dogs and 131 cats were included. The most common ultrasound features of the evaluated anal sacs in the dorsal plane were oval shape (99.3% of dogs and 98.5% of cats) and bilaterally similar content (94.2% of dogs and 95.4% of cats), mostly hypoechoic with diffusely hyperechoic points or unformed echogenic material (42.6% of dogs and 44% of cats). Gas in the lumen of the anal sac was detected in two dogs and mineralization in one dog. There was a statistically significant positive correlation between body weight and the size of anal sacs in dogs ≤15 kg and cats and a correlation between age and the size of anal sacs in cats. This simple method provides additional clinically significant information in detecting abnormal findings in asymptomatic patients and could contribute to the early detection of anal sac disease. [ABSTRACT FROM AUTHOR]

To evaluate the diagnostic accuracy of ultrasound secondary signs of fractures in pediatric patients aged 5–15 y presenting to the emergency department with a clinically non-deformed distal forearm injury. This diagnostic study was conducted in South East Queensland, Australia. Emergency clinicians performed point-of-care ultrasound on eligible patients and recorded secondary signs of fractures (pronator quadratus hematoma [PQH] sign, periosteal hematoma, visible angulation) or physeal fractures (fracture-to-physis distance [FPD], physis alteration). The reference standard was the final fracture diagnosis determined by expert panel. The primary outcome was the diagnostic accuracy of secondary signs for cortical breach and physeal fractures. Diagnostic statistics were reported for each relevant secondary sign. A total of 135 participants were enrolled. The expert panel diagnosed 48 "no" fracture, 52 "buckle" fracture and 35 "other" fracture. All "other" fractures were cortical breach fractures and included 15 Salter–Harris II fractures. The PQH sign demonstrated high sensitivity and moderate specificity to diagnose cortical breach fractures (91%, 95% Confidence Interval [CI] 78%–97% and 82%, 73%–88%). Poor sensitivity but high specificity was observed for the visible angulation and periosteal hematoma secondary signs. FPD <1cm showed perfect sensitivity and moderate specificity (100%, 80%–100% and 85%, 78%–90%) for diagnosis of Salter–Harris II fracture. Conversely, physis alteration showed poor sensitivity but excellent specificity (40%, 20%–64% and 99%, 95%–100%) for the diagnosis of Salter–Harris II fractures. Ultrasound secondary signs showed good diagnostic accuracy for both cortical breach fractures and Salter–Harris II fractures. Future research should consider optimal use of secondary signs to improve diagnostic accuracy. [ABSTRACT FROM AUTHOR]

To date there have been no studies exploring the potential for neuroinflammation as an intracranial bio-effect associated with diagnostic ultrasound during neonatal cranial scans in a mammalian in vivo model. The study described here was aimed at investigating the effects of B-mode and Doppler mode ultrasound on inflammation in the rat brain. Twelve Wistar rats (7–9 wk old) were divided into a control group and an ultrasound-exposed group (n = 6/group). A craniotomy was performed, followed by 10 min of B-mode and spectral Doppler interrogation of the middle cerebral artery. The control group was subjected to sham treatment, with the transducer held stationary over the craniotomy site, but the ultrasound machine switched off. Animals were euthanized 48 h after exposure, and the brains formalin fixed for immunohistochemical analysis using allograft inflammatory factor 1 (IBA-1) and glial fibrillary acidic protein (GFAP) as markers of microglia and astrocytes, respectively. The numbers of IBA-1- and GFAP-immunoreactive cells were manually counted and expressed as areal density (cells/mm2). Results were analyzed using Student's unpaired t -test and one-way repeated-measures analysis of variance. The ultrasound-exposed brain exhibited significant increases in IBA-1 and GFAP immunoreactive cell density in all regions of B-mode and Doppler mode exposure compared with the control group (p < 0.001). Ten minutes of B-mode and Doppler mode ultrasound may induce neuroinflammatory changes in the rat brain. This suggests that exposure of brain tissue to current diagnostic ultrasound intensities may not be completely without risk. [ABSTRACT FROM AUTHOR]

Objective: To assess the diagnostic accuracy of ultrasound for detecting placenta accreta spectrum (PAS) during the first trimester of pregnancy and compare it with the accuracy of second‐ and third‐trimester ultrasound examination in pregnancies at risk for PAS. Methods: PubMed, EMBASE and Web of Science databases were searched to identify relevant studies published from inception until 10 March 2023. Inclusion criteria were cohort, case–control or cross‐sectional studies that evaluated the accuracy of ultrasound examination performed at < 14 weeks of gestation (first trimester) or ≥ 14 weeks of gestation (second/third trimester) for the diagnosis of PAS in pregnancies with clinical risk factors. The primary outcome was the diagnostic accuracy of sonography in detecting PAS in the first trimester, compared with the accuracy of ultrasound examination in the second and third trimesters. The secondary outcome was the diagnostic accuracy of each sonographic marker individually across the trimesters of pregnancy. The reference standard was PAS confirmed at pathological or surgical examination. The potential of ultrasound and different ultrasound signs to detect PAS was assessed by computing summary estimates of sensitivity, specificity, diagnostic odds ratio and positive and negative likelihood ratios. Results: A total of 37 studies, including 5764 pregnancies at risk of PAS, with 1348 cases of confirmed PAS, were included in our analysis. The meta‐analysis demonstrated that ultrasound had a sensitivity of 86% (95% CI, 78–92%) and specificity of 63% (95% CI, 55–70%) during the first trimester, and a sensitivity of 88% (95% CI, 84–91%) and specificity of 92% (95% CI, 85–96%) during the second/third trimester. Regarding sonographic markers examined in the first trimester, lower uterine hypervascularity exhibited the highest sensitivity (97% (95% CI, 19–100%)), and uterovesical interface irregularity demonstrated the highest specificity (99% (95% CI, 96–100%)). In the second/third trimester, loss of clear zone had the highest sensitivity (80% (95% CI, 72–86%)), and uterovesical interface irregularity exhibited the highest specificity (99% (95% CI, 97–100%)). Conclusions: First‐trimester ultrasound examination has similar accuracy to second‐ and third‐trimester ultrasound examinations for the diagnosis of PAS. Routine first‐trimester ultrasound screening for patients at high risk of PAS may improve detection rates and allow earlier referral to tertiary care centers for pregnancy management. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Background: The hindfoot region is commonly injured in gymnasts, and musculoskeletal ultrasound can be used to identify structural abnormalities in this region. Although prior studies have shown that sonographic abnormalities may not correlate with symptomatic pathology, the presence of asymptomatic sonographic abnormalities of the hindfoot in Division I collegiate gymnasts has not been evaluated. Objective: To identify and describe commonly seen asymptomatic sonographic abnormalities of the hindfoot region in Division I collegiate gymnasts. Design: Cross‐sectional study. Setting: Tertiary care academic medical center. Participants: 39 Division I NCAA men's and women's collegiate gymnasts without current hindfoot pain or history of hindfoot injury. Interventions: Diagnostic musculoskeletal ultrasound of the hindfoot region. Main Outcome Measures: Sonographic appearance of the hindfoot region, specifically the plantar fascia, plantar fad pad, and Achilles tendon. Results: A total of 37 of 39 gymnasts included in the study were found to have at least one asymptomatic sonographic abnormality of the hindfoot region. A total of 28.2% of athletes were found to have sonographic abnormalities within the Achilles tendon, with Doppler flow being the most common finding, and 35.8% of athletes were found to have a Haglund's deformity. However, only 7% of athletes with a Haglund's deformity demonstrated abnormal sonographic findings within the tendon. Sonographic abnormalities of the plantar fascia and plantar fat pad were seen in 30.7% and 69.2% of athletes, respectively. Conclusions: Asymptomatic sonographic abnormalities of the hindfoot region are common in collegiate gymnasts. Clinicians should use clinical judgment when interpreting these findings as they may not represent symptomatic pathology. [ABSTRACT FROM AUTHOR]

The American Institute of Ultrasound in Medicine (AIUM) has released a revised practice parameter for conducting standard diagnostic obstetric ultrasound examinations. This parameter provides recommendations for healthcare professionals on how to perform high-quality ultrasounds during pregnancy. It covers various types of ultrasounds, including those done in the first trimester, second or third trimester, limited ultrasounds, and specialized ultrasounds. The parameter also outlines the qualifications and responsibilities of personnel involved in performing these examinations. It emphasizes the importance of proper documentation, the need for a valid medical reason to perform the ultrasound, and adherence to safety protocols. The guidelines were developed collaboratively by several professional organizations in the field. [Extracted from the article]

Background: Significant disparities in sonographic education exist in Obstetrics and Gynecology programs in the United States. To address the lack of standardization in ultrasound teaching, the American Institute of Ultrasound in Medicine (AIUM) assembled a multi‐society task force in 2018 that resulted in the publication of a Consensus Report outlining a standardized ultrasound curriculum and competency assessment. Objectives: The primary objective of the study was to implement the AUIM standardized curriculum within an Obstetrics and Gynecology residency program at a tertiary medical center, and report on the early implementation experience. The secondary objective was to assess current national practices in ultrasound training in Obstetrics and Gynecology residency programs. Study design: Study design was an effectiveness‐implementation hybrid study of a structured ultrasound educational program based on the 2018 AIUM Consensus Report. The theoretical portion of the curriculum consisted of 26 hours of didactic lectures distributed over 4 years. For the practical component, residents received instruction from faculty and sonographers and independently acquired the required images as part of their regular clinical work. Simulator app access was also provided for additional opportunities to practice and acquire images. Deidentified images for the required competencies were uploaded to a WhatsApp group for review. Theoretical knowledge was assessed with a series of multiple‐choice exams. Practical skills were assessed through grading of images submitted through WhatsApp as well as direct observations of resident scans. At the completion of 4 years, the assessment of both theoretical knowledge and practical skills was carried out using the ISUOG Basic Training Examination. National patterns in the area of ultrasound education were assessed with a four‐question electronic survey of Obstetrics and Gynecology program directors in the United States. Analysis of both portions of the study was primarily descriptive. Results: Four Obstetrics and Gynecology residents completed the curriculum spanning postgraduate years 1 through 4. The number of competencies completed ranged from 7 to 19 out of 41. All of the residents passed the theoretical and practical components of the ISUOG Basic Training Examination. For the residency program director survey portion of the study, response rate was 20% (59 of 290). Among the respondents, 55.9% reported having a structured curriculum and 34.4% reported implementing the AIUM curriculum. The two most commonly cited obstacles to implementation of structured ultrasound teaching were uncertainty with how to start the process (49.2%) and lack of faculty engagement (49.2%). Conclusions: Implementation of the AIUM Curriculum within the framework of an Obstetrics and Gynecology residency program at a tertiary medical center is feasible. In our experimental group, completion of the curriculum resulted in passing of an internationally recognized validated assessment. Obstacles to implementation in our program included a wide range of engagement and participation among residents, and limited opportunities to obtain some of the required competencies. Identification of obstacles to implementation from the perspective of residency program directors is critical for developing targeted approaches to ensure widespread implementation. Successful standardized validated sonographic training of graduating Obstetrics and Gynecology residents is crucial for this operator‐dependent modality that has tremendous implications on patient safety and clinical care. [ABSTRACT FROM AUTHOR]

Background: Acoustically activatable perfluoropropane droplets (PD) can be formulated from commercially available microbubble preparations. Diagnostic transthoracic ultrasound frequencies have resulted in acoustic activation (AA) predominately within myocardial infarct zones (IZ). Objective: We hypothesized that the AA area following acute coronary ischemia/reperfusion (I/R) would selectively enhance the developing scar zone, and target bioeffects specifically to this region. Methods: We administered intravenous PD in 36 rats and 20 pigs at various stages of myocardial scar formation (30 minutes, 1 day, and 7 days post I/R) to determine what effect infarct age had on the AA within the IZ. This was correlated with histology, myeloperoxidase activity, and tissue nitrite activity. Results: The degree of AA within the IZ in rats was not associated with collagen content, neutrophil infiltration, or infarct age. AA within 24 hours of I/R was associated with increased nitric oxide utilization selectively within the IZ (P <.05 compared with remote zone). The spatial extent of AA in pigs correlated with infarct size only when performed before sacrifice at 7 days (r =.74, P <.01). Conclusions: Acoustic activation of intravenous PD enhances the developing scar zone following I/R, and results in selective tissue nitric oxide utilization. [ABSTRACT FROM AUTHOR]

The purpose of this review is to focus on the diagnostic endoscopic ultrasound of the gastrointestinal tract. In the last decades, EUS has gained a central role in the staging of epithelial and sub-epithelial lesions of the gastrointestinal tract. With the evolution of imaging, the position of EUS in the diagnostic work-up and the staging flow-chart has continuously changed with two extreme positions: some gastroenterologists think that EUS is absolutely indispensable, and some think it is utterly useless. The truth is, as always, somewhere in between the two extremes. Analyzing the most up-to-date and strong evidence, we will try to give EUS the correct position in our daily practice. [ABSTRACT FROM AUTHOR]

Importance: Delayed diagnosis of a dislocated hip in infants can lead to complex childhood surgery, interruption to family life, and premature osteoarthritis. Objective: To evaluate the diagnostic accuracy of clinical examination in identifying dislocated hips in infants. Data Sources: Systematic search of CINAHL, Embase, MEDLINE, and the Cochrane Library from the inception of each database until October 31, 2023. Study Selection: The 9 included studies reported the diagnostic accuracy of the clinical examination (index test) in infants aged 3 months or younger and a diagnostic hip ultrasound (reference test). The Graf method of ultrasound assessment was used to classify hip abnormalities. Data Extraction and Synthesis: The Rational Clinical Examination scale was used to assign levels of evidence and the Quality Assessment of Diagnostic Accuracy Studies tool was used to assess bias. Data were extracted using the individual hip as the unit of analysis; the data were pooled when the clinical examinations were evaluated by 3 or more of the included studies. Main Outcomes and Measures: Sensitivity, specificity, and likelihood ratios (LRs) of identifying a dislocated hip were calculated. Results: Among infants screened with a clinical examination and a diagnostic ultrasound in 5 studies, the prevalence of a dislocated hip (n = 37 859 hips) was 0.94% (95% CI, 0.28%-2.0%). There were 8 studies (n = 44 827 hips) that evaluated use of the Barlow maneuver and the Ortolani maneuver (dislocate and relocate an unstable hip); the maneuvers had a sensitivity of 46% (95% CI, 26%-67%), a specificity of 99.1% (95% CI, 97.9%-99.6%), a positive LR of 52 (95% CI, 21-127), and a negative LR of 0.55 (95% CI, 0.37-0.82). There were 3 studies (n = 22 472 hips) that evaluated limited hip abduction and had a sensitivity of 13% (95% CI, 3.3%-37%), a specificity of 97% (95% CI, 87%-99%), a positive LR of 3.6 (95% CI, 0.72-18), and a negative LR of 0.91 (95% CI, 0.76-1.1). One study (n = 13 096 hips) evaluated a clicking sound and had a sensitivity of 13% (95% CI, 6.4%-21%), a specificity of 92% (95% CI, 92%-93%), a positive LR of 1.6 (95% CI, 0.91-2.8), and a negative LR of 0.95 (95% CI, 0.88-1.0). Conclusions and Relevance: In studies in which all infant hips were screened for developmental dysplasia of the hip, the prevalence of a dislocated hip was 0.94%. A positive LR for the Barlow and Ortolani maneuvers was the finding most associated with an increased likelihood of a dislocated hip. Limited hip abduction or a clicking sound had no clear diagnostic utility. This Rational Clinical Examination systematic review summarizes studies that examined the diagnostic accuracy of clinical examination in determining dislocated hips in infants. [ABSTRACT FROM AUTHOR]

Background: To explore a method for screening and diagnosing neonatal congenital heart disease (CHD) applicable to grassroots level, evaluate the prevalence of CHD, and establish a hierarchical management system for CHD screening and treatment at the grassroots level. Methods: A total of 24,253 newborns born in Tang County between January 2016 and December 2020 were consecutively enrolled and screened by trained primary physicians via the "twelve-section ultrasonic screening and diagnosis method" (referred to as the "twelve-section method"). Specialized staff from the CHD Screening and Diagnosis Center of Hebei Children's Hospital regularly visited the local area for definite diagnosis of CHD in newborns who screened positive. Newborns with CHD were managed according to the hierarchical management system. Results: The centre confirmed that, except for 2 newborns with patent ductus arteriosus missed in the diagnosis of ventricular septal defect combined with severe pulmonary hypertension, newborns with other isolated or concomitant simple CHDs were identified at the grassroots level. The sensitivity, specificity and diagnostic coincidence rate of the twelve-section method for screening complex CHD were 92%, 99.6% and 84%, respectively. A total of 301 children with CHD were identified. The overall CHD prevalence was 12.4‰. According to the hierarchical management system, 113 patients with simple CHD recovered spontaneously during local follow-up, 48 patients continued local follow-up, 106 patients were referred to the centre for surgery (including 17 patients with severe CHD and 89 patients with progressive CHD), 1 patient died without surgery, and 8 patients were lost to follow-up. Eighteen patients with complex CHD were directly referred to the centre for surgery, 3 patients died without surgery, and 4 patients were lost to follow-up. Most patients who received early intervention achieved satisfactory results. The mortality rate of CHD was approximately 28.86 per 100,000 children. Conclusions: The "twelve-section method" is suitable for screening neonatal CHD at the grassroots level. The establishment of a hierarchical management system for CHD screening and treatment is conducive to the scientific management of CHD, which has important clinical and social significance for early detection, early intervention, reduction in mortality and improvement of the prognosis of complex and severe CHDs. [ABSTRACT FROM AUTHOR]

In this study, 0.57(Bi0.8La0.2)FeO3‐0.43PbTiO3 (BLF‐PT) porous ceramics were fabricated by the burnable plastic sphere method using polymethyl methacrylate (PMMA) as a pore forming agent. X‐ray diffraction results reveal that BLF‐PT porous ceramics mixed with tetragonal and rhombohedral phases display the single perovskite structure, changing little for different porosities. Scanning electron microscope images show that porosity of BLF‐PT ceramics increases with the increase of PMMA content with average grain size of 3.2–3.5 μm. Different from the continuous decrease of dielectric constant εr and remnant polarization Pr, piezoelectric constant d33 of BLF‐PT porous ceramics increases initially but then drops with the increase of porosity that reaches to the maximum of 230 pC/N at porosity of 8.5 vol.%. The abnormal enhancement of piezoelectric property is attributed to the unique three‐dimensional grid porous ceramic skeleton and uniformly distributed grain size. Moreover, acoustic impedance Z of BLF‐PT porous ceramic is 11.2 MRayls at porosity of 24.3 vol.% comparing with that of 17.7 MRayls for bulk ceramics, which reduces by 58%. BLF‐PT porous ceramics at lower porosity with enhanced piezoelectric and acoustic matching performances have a great potential in the fields of underwater acoustic transducers and medical ultrasonic diagnosis. [ABSTRACT FROM AUTHOR]

Background: Although ultrasound is considered the gold standard for the evaluation of children with suspected appendicitis, there is still much debate about the most accurate ultrasound findings. The purpose of this study was to define the best ultrasound signs that could ultimately improve the diagnostic accuracy of ultrasound for diagnosing pediatric acute appendicitis, and to differentiate between simple appendicitis and complicated appendicitis. Patients and Methods: After approval by our Institutional Review Board, a prospective study was carried out from January 1, 2022, to July 31, 2023, in a pediatric emergency department. We included all patients aged under 14 years with suspected appendicitis and ultrasound-visualized appendix. Results: A total of 550 patients presented with suspected appendicitis during the study period. Of these children, 411 had an ultrasound-visualized appendix. Our patients' mean age was 9.4 years. The best positive predictive value of ultrasound was found for appendiceal diameter ≥7.5 mm. The combination of an appendiceal diameter <6 mm and the lack of peri-appendiceal free fluid on ultrasound rules out the diagnosis of appendicitis. The best diagnostic accuracy of ultrasound, which was 92%, was achieved for appendix diameters ≥6.5 mm. The sonographic sign giving the best ultrasound accuracy for diagnosing complicated appendicitis was an appendix diameter ≥9 mm. Conclusions: In conclusion, our present study demonstrated that appendiceal diameter ≥6.5 mm is the gold standard for diagnosing appendicitis in pediatric patients. The combination of an appendiceal diameter <6 mm and the lack of peri-appendiceal free fluid on ultrasound would rule out appendicitis. [ABSTRACT FROM AUTHOR]

Background/Objectives: Ultrasound (US) has been progressively spreading as the most useful technique for guiding biopsies and fine-needle aspirations that are performed percutaneously. Malignant pleural mesothelioma (MPM) represents the most common malignant pleural tumour. Thoracoscopy represents the gold standard for diagnosis, although conditions hampering such diagnostic approach often coexist. The Objective was to determine whether ultrasound-guided percutaneous needle biopsy (US-PPNB) has a high diagnostic accuracy and represents a safe option for diagnosis of MPM. Methods: US-PPNB of pleural lesions suspected for MPM in patients admitted from January 2021 to June 2023 have been retrospectively analyzed. An 18-gauge semi-automatic spring-loaded biopsy system (Medax Velox 2®) was used by experienced pneumologists. The obtained specimens were histologically evaluated and defined as adequate or non-adequate for diagnosis according to whether the material was considered appropriate or not for immunohistochemistry (IHC) analysis. The primary objective of the study was the diagnostic yield for a tissue diagnosis. Results: US-PPNB was diagnostic of MPM in 15 out of 18 patients (sensitivity: 83.39%; specificity: 100%; PPV: 100%). Three patients with non-adequate US-PPNB underwent thoracoscopy for diagnosis. We found significant differences in terms of mean pleural lesion thickness between patients with adequate and not-adequate biopsy (15.4 mm (SD: 9.19 mm) and 3.77 mm (SD: 0.60 mm), p < 0.0010. In addition, a significant positive correlation has been observed between diagnostic accuracy and FDG-PET avidity value. Conclusions: US-PPNB performed by a pneumologist represents a valid procedure with a high diagnostic yield and accuracy for the diagnosis of MPM, and may be considered as an alternative option in patients who are not suitable for thoracoscopy. [ABSTRACT FROM AUTHOR]

Aim: It remains unclear whether the newly defined concept of metabolic dysfunction‐associated steatotic liver disease (MASLD) appropriately includes patients with nonalcoholic fatty liver disease with significant liver fibrosis. Methods: A total of 4112 patients in whom nonalcoholic fatty liver disease was diagnosed by ultrasonography during medical checkups were enrolled. We defined a fibrosis‐4 index ≥1.3 in patients aged <65 years and ≥2.0 in patients aged ≥65 years as significant liver fibrosis. Results: The numbers of patients with a low, intermediate, and high probability of advanced fibrosis based on the fibrosis‐4 index were 3360 (81.7%), 668 (16.2%), and 84 (2.0%). There were 3828 (93.1%) and 284 (6.9%) patients diagnosed with MASLD and non‐MASLD. The non‐MASLD group, compared with the MASLD group, was significantly younger (44 vs. 55 years) and had a higher percentage of women (62.3% vs. 27.7%). Significant fibrosis, defined based on the fibrosis‐4 index, was present in 18.5% of the MASLD group and 15.5% of the non‐MASLD group. In a multivariable analysis, female sex (OR 6.170, 95% CI 3.180–12.000; p < 0.001) was independently associated with non‐MASLD in patients with a significant fibrosis. Among non‐MASLD patients with a significant fibrosis (n = 44), body mass index was significantly lower in females than in males (p < 0.001). In a multivariable analysis of patients aged <65 years, female sex (OR, 7.700; 95% CI, 3.750–15.800; p < 0.001) remained independently associated with non‐MASLD in patients with a significant fibrosis. Conclusions: MASLD may inappropriately exclude patients with significant fibrosis, especially lean females with nonalcoholic fatty liver disease. [ABSTRACT FROM AUTHOR]

Objective: To determine if diagnostic ultrasound can reliably distinguish between synovial patterns of prosthetic joint infection and polymeric wear in total knee replacements. Methods and methods: This retrospective study was approved by our hospital IRB. Using the radiology report database, MR examinations performed within a week of diagnostic ultrasound and/or ultrasound-guided aspiration were identified. This yielded (1) 24 cases with MR and ultrasound comparisons; (2) 44 cases with MR, ultrasound, and aspiration comparisons; and (3) 92 cases with ultrasound and aspiration comparisons. The MR studies were reviewed by a musculoskeletal radiologist. The ultrasound studies were each reviewed by 2 other musculoskeletal radiologists. Each study was graded for synovial pattern indicating infection, polymeric wear, or normal/nonspecific. Agreement between the MR grader and the ultrasound graders as well as ultrasound inter-rater agreement were assessed using k statistics. Sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound were calculated. Results: Agreement between ultrasound and MR imaging was fair to moderate: k of 0.27 (95% CI: 0.04, 0.50) and 0.44 (95% CI: 0.23, 0.65) for ultrasound raters 1 and 2, respectively. Inter-rater agreement between ultrasound graders 1 and 2 was moderate, with k of 0.56 (95% CI: 0.42, 0.70). Ultrasound sensitivities for infection were 0.13 and 0.09, while specificities were 0.94 and 0.98. Ultrasound sensitivities for polymeric wear were 0.38 and 0.62 with specificities of 0.90 and 0.76. Conclusion: Ultrasound does not perform well in distinguishing patterns of synovitis either compared to MRI or a reference standard of aspiration/clinical follow-up. [ABSTRACT FROM AUTHOR]

In recent years, deep convolutional neural networks (DCNNs) have shown promising performance in medical image analysis, including breast lesion classification in 2D ultrasound (US) images. Despite the outstanding performance of DCNN solutions, explaining their decisions remains an open investigation. Yet, the explainability of DCNN models has become essential for healthcare systems to accept and trust the models. This paper presents a novel framework for explaining DCNN classification decisions of lesions in ultrasound images using the saliency maps linking the DCNN decisions to known cancer characteristics in the medical domain. The proposed framework consists of three main phases. First, DCNN models for classification in ultrasound images are built. Next, selected methods for visualization are applied to obtain saliency maps on the input images of the DCNN models. In the final phase, the visualization outputs and domain-known cancer characteristics are mapped. The paper then demonstrates the use of the framework for breast lesion classification from ultrasound images. We first follow the transfer learning approach and build two DCNN models. We then analyze the visualization outputs of the trained DCNN models using the EGrad-CAM and Ablation-CAM methods. We map the DCNN model decisions of benign and malignant lesions through the visualization outputs to the characteristics such as echogenicity, calcification, shape, and margin. A retrospective dataset of 1298 US images collected from different hospitals is used to evaluate the effectiveness of the framework. The test results show that these characteristics contribute differently to the benign and malignant lesions' decisions. Our study provides the foundation for other researchers to explain the DCNN classification decisions of other cancer types. [ABSTRACT FROM AUTHOR]

Background: The overlapping nature of thyroid lesions visualized on ultrasound (US) images could result in misdiagnosis and missed diagnoses in clinical practice. Purpose: To compare the diagnostic effectiveness of US coupled with three mathematical models, namely logistic regression (Logistics), partial least-squares discriminant analysis (PLS-DA), and support vector machine (SVM), in discriminating between malignant and benign thyroid nodules. Material and Methods: A total of 588 thyroid nodules (287 benign and 301 malignant) were collected, among which 80% were utilized for constructing the mathematical models and the remaining 20% were used for internal validation. In addition, an external validation cohort comprising 160 nodules (80 benign and 80 malignant) was employed to validate the accuracy of these mathematical models. Results: Our study demonstrated that all three models exhibited effective predictive capabilities for distinguishing between benign and malignant nodules, whose diagnostic effectiveness surpassed that of the TI-RADS classification, particularly in terms of true negative diagnoses. SVM achieved a higher diagnostic rate for malignant thyroid nodules (93.8%) compared to Logistics (91.5%) and PLS-DA (91.6%). PLS-DA exhibited higher diagnostic rates for benign thyroid nodules (91.9%) compared to Logistics (86.7%) and SVM (88.7%). Both the area under the receiver operating characteristic curve (AUC) values of PLS-DA (0.917) and SVM (0.913) were higher than that of Logistics (0.891). Conclusion: Our findings indicate that SVM had significantly higher rates of true positive diagnoses and PLS-DA exhibited significantly higher rates of true negative diagnoses. All three models outperformed the TI-RADS classification in discriminating between malignant and benign thyroid nodules. [ABSTRACT FROM AUTHOR]

Objective of this scoping review was to explore the validity of muscle ultrasound against the latest sarcopenia definitions among older adults. Methods: We adhered to the PRISMA guidelines for scoping reviews. A systematic search of databases was performed by two independent reviewers. All articles comparing the performance of ultrasound to an internationally acknowledged sarcopenia definition among older adults (≥ 60 years) and published between 2019/01/01 (the year updated sarcopenia definitions were introduced) and 2023/11/15 were included. Data were extracted and collated by muscle and muscle parameters. Results: Out of 2290 articles screened, six studies comprising 24 validity tests among a total of 1619 older adults (mean age 74.1 years, 52.2% female) were included. The validity tests investigated the rectus femoris (n = 7), biceps brachii (n = 5), gastrocnemius medialis (n = 4), tibialis anterior (n = 4), soleus (n = 3), and rectus abdominis (n = 1). The parameter muscle thickness (MT) (n = 14) was most commonly measured. The latest European and Asian sarcopenia definitions (EWGSOP2, AWGS2) were applied as reference standards in four validity tests each. None of the studies used the Sarcopenia Definition and Outcome Consortium (SDOC) criteria. The highest area under the curve AUC (0.92, 95% confidence interval [CI] 0.89– 0.94) was found for the muscle thickness of the rectus femoris muscle. Due to substantial heterogeneity among the studies, pooling of data using a meta-analytic approach was not feasible. Conclusion: Limited number of studies have examined the validity of muscle ultrasound for diagnosing sarcopenia based on recent definitions among older adults. Thereby, muscle thickness of the rectus femoris showed promising results regarding validity. Further studies are needed to investigate the validity of key muscles and to validate muscle ultrasound among older hospitalized patients. [ABSTRACT FROM AUTHOR]

Introduction: Thyroid nodule incidence is increasing due to the widespread application of ultrasonography. Fine-needle aspiration cytology is widely applied for the detection of malignancies. The aim of this study was to evaluate the predictive value of ultrasonography in thyroid cancer. Methods: This retrospective study included patients that underwent total thyroidectomy for benign thyroid disease or well-differentiated thyroid carcinoma from January 2017 to December 2022. The study population was divided into groups: the well-differentiated thyroid cancer group and the control group with benign histopathological reports. Results: In total, 192 patients were enrolled in our study; 159 patients were included in the well-differentiated thyroid cancer group and 33 patients in the control group. Statistical analysis demonstrated that ultrasonographic findings such as microcalcifications (90.4%), hypoechogenicity (89.3%), irregular margins (92.2%) and taller-than-wide shape (90.5%) were correlated to malignancy (p < 0.001). Uni- and multivariate analysis revealed that both US score (OR: 2.177; p < 0.001) and Bethesda System (OR: 1.875; p = 0.002) could predict malignancies. In terms of diagnostic accuracy, the US score displayed higher sensitivity (64.2% vs. 33.3%) and better negative predictive value (34.5% vs. 24.4%) than the Bethesda score, while both scoring systems displayed comparable specificities (90.9% vs. 100%) and positive predictive values (97.1% vs. 100%). Discussion: The malignant potential of thyroid nodules is a crucial subject, leading the decision for surgery. Ultrasonography and fine-needle aspiration cytology are pivotal examinations in the diagnostic process, with ultrasonography demonstrating better negative predictive value. [ABSTRACT FROM AUTHOR]

Despite the established safety and efficacy of midurethral slings (MUS), which are the current gold standard treatment for stress urinary incontinence (SUI), the potential for postoperative complications remains a significant concern for both healthcare professionals and patients. Meanwhile, sonography has emerged as a significant diagnostic tool in urogynecology, and one of the applications of this imaging modality may be the evaluation of complications arising from MUS procedures. This review, based on a comprehensive literature search, focuses on the use of pelvic floor ultrasound (US) in the context of MUS complications. It includes analyses of randomized controlled trials, prospective, and retrospective studies, covering preoperative and postoperative investigations, to assess complications such as persistent and recurrent SUI, urinary retention and obstructive voiding, de novo urgency/overactive bladder, vaginal exposure, sling erosion, pain, and hematoma. The review critically examines the existing literature, with a particular focus on recent publications. Despite the variability in findings, it appears that for each of the discussed complications, the application of pelvic floor US can significantly support the diagnostic and therapeutic process. The paper also identifies potential future directions for the development of US applications in diagnosing MUS complications. [ABSTRACT FROM AUTHOR]

Simple Summary: All animals feel pain and, as vets, we have the ethical obligation to prevent it. This paper describes two anaesthetic events in an emu (Dromaius novaehollandiae) undergoing the surgical repair of a lateral luxation of the Achilles tendon on both hind limbs. An ultrasound-guided mid-femur sciatic nerve block was successfully performed on both occasions for intraoperative and postoperative analgesia. To our knowledge, this is the first published report of an emu who benefited from inhalation anaesthesia associated with a loco-regional block. The current case report describes a successful ultrasound-guided mid-femur sciatic nerve block in an emu. A 2-month-old emu suffering from acute-onset lameness was referred to the University Clinic of Liège, where he was diagnosed with a lateral luxation of the Achilles tendon on both hind limbs. Two surgical procedures were performed for treatment. Both surgical procedures were performed under general anaesthesia with butorphanol, ketamine, midazolam and isoflurane in oxygen. The anaesthesia was continuously monitored. An ultrasound-guided sciatic nerve block was performed to prevent and treat surgically induced nociception. The technique was adapted from what is already described in other species. Levobupivacaine was injected perineurally under ultrasound-guidance. Intraoperative nociception was assessed based on the heart rate and mean arterial pressure changes. The recovery was uneventful and with no clinical signs of postoperative pain. [ABSTRACT FROM AUTHOR]

Diagnostic ultrasound (US) is a major imaging modality to visualize soft tissues and blood flow with the advantages of real‐time imaging, high acceptability to patients, and absence of ionizing radiation. US imaging provides important clinical measurements, e.g., thickness of gingiva for treatment planning in orthodontics, periodontics, and implantology; or thickness of subcutaneous adipose for optimizing insulin injection. However, the image quality and measurements of anatomical structures can be inconsistent, i.e., due to varying pressure exerted by an US transducer. Herein, a simple device is developed to real‐time measure the interface pressure applied on tissues by the US transducer. A thin‐film piezo‐resistive sensor with a small footprint is integrated to sense the pressure. A theoretical model, based on hyperelastic material behavior, is verified using the pressure measured by the thin film sensor and the thickness determined on ultrasonograms. The device is also tested on porcine samples in the pressure range of 50–300 kPa for imaging gingiva boundaries, identifying tissue thickness, and probing tissue biomenchanical properties. The device enables the understanding on the optimal range of applied pressure for higher contrast imaging. The information of the on‐tissue pressure and the tissue deformation determined on the US images help to derive the biomechanical stress–strain behavior of the tissues. [ABSTRACT FROM AUTHOR]

Isolated distal deep vein thrombosis (IDDVT) represents a common manifestation of venous thromboembolism (VTE), accounting for up to 50% of cases involving lower-extremity deep vein thrombosis (DVT). In contrast to proximal DVT, IDDVT exhibits a higher association with transient risk factors and less frequently occurs spontaneously. IDDVT generally entails a substantially lower risk of proximal extension, pulmonary embolism, post-thrombotic syndrome, and recurrence compared to proximal DVT. Nevertheless, specific patient subgroups, including those with active cancer, prior VTE, unprovoked IDDVT, and involvement of more than one vein, demonstrate a noteworthy recurrence risk. Unlike proximal DVT, the optimal therapeutic management of IDDVT remains uncertain. In clinical practice, the predominant approach for managing IDDVT involves anticoagulation rather than ultrasound imaging surveillance, due to a significant reduction in the risk of proximal extension and recurrence. Conversely, serial imaging is typically preferred for individuals without risk factors for extension or at high risk for bleeding. Finally, anticoagulant duration relies on the different risk of VTE recurrence within the specific patient subgroups considered. This review offers an updated overview of the epidemiology, risk factors, and natural history of IDDVT, emphasizing therapeutic management in accordance with current guideline recommendations and the latest evidence, trying to provide a way out of this dark forest. [ABSTRACT FROM AUTHOR]