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Context: Bridge exercises are extensively used in trunk-strengthening programs. The aim of this study was to investigate the effect of bridging duration on lateral abdominal muscle thickness and gluteus maximus activation. Design: Cross-sectional. Methods: Twenty-five young males participated in this study. Transversus abdominal (TrA), external and internal oblique ultrasound thickness, gluteus maximus electromyographic activation, and sacral tilt angle were simultaneously measured for every second during 30-second bridging exercise. The contraction thickness ratio and root mean squared signal (normalized to maximum isometric contraction signal) during 6 exercise durations (from 0 to 5, 10, 15, 20, 25, and 30 s) were also calculated and compared using analysis of variance designs. Results: TrA and internal oblique contraction thickness ratio and gluteus maximus root mean squared increased during the first 8 to 10 seconds and remained elevated until the end of the 30-second exercise (P <.05). External oblique contraction thickness ratio declined during exercise (P <.05). Five-second bridging showed less TrA thickness and anteroposterior and mediolateral sacral tilt angle and a lower anteroposterior tilt variability compared with bridges, which lasted more than 10 seconds (P <.05). Conclusions: Bridge exercises longer than 10 seconds may be better for promoting TrA recruitment than bridges of shorter duration. Clinicians and exercise specialists could adjust the duration of bridge exercise based on the aims of the exercise program. [ABSTRACT FROM AUTHOR]

In most elderly patients, prescribing the necessary volume of infusion therapy for the prevention of prerenal acute kidney injury (AKI) requires individualization. It is considered that ultrasound examination of the inferior vena cava (IVC) can be an effective additional method of assessing volemia in this category of patients. The aim is to determine the effectiveness of infusion therapy based on ultrasound of the inferior vena cava for the prevention of AKI in geriatric patients after urgent abdominal surgery. Materials and methods. A prospective single-center study included 50 patients (74.5 (68.0; 81.0) y. o.), divided into 2 groups: group A (n = 25, infusion therapy based on ultrasound of the IVC); group B (n = 25, infusion therapy based on changes in hemodynamic parameters and diuresis). The diameter of the IVC was determined using ultrasonography (ultrasound probe CN-6, SIEMENS, Acuson Antares), hemodynamic parameters were assessed using esCOO technology (Vismo PVM-2701K monitor, Nihon Kohden, Japan). The KDIGO classification was used to determine the presence and stage of AKI. Statistical analysis was performed using the program Statistica for Windows 13 (StatSoft Inc., No. JPZ804I382130ARCN10-J). Results. The daily volume of infusion therapy in group A was 150 ml more than in group B (p = 0.049). Group A patients had 1.2 times higher CI (p = 0.016), by 6 mm Hg higher MAP (p = 0.012), 1.3 times greater SV (p < 0.001) than patients in group B. Also, they required 2 times less use of vasopressors (p = 0.026) and 2.8 times less use of diuretics (p = 0.008). Correlation between SV, CI, MAP and IVC diameter was weak but significant (r = 0.35, r = 0.25, r = 0.29, respectively, p ˂ 0.05). The incidence and severity of AKI did not differ between the study groups. In group A, the intensive care unit stay was 42 (35; 102) hours versus 80 (48; 176) hours in group B (p = 0.028) and survival rate was 88 % versus 40 %, respectively (p = 0.004). Conclusions. Infusion therapy based on ultrasound of the inferior vena cava may be effective in geriatric patients after urgent abdominal surgery in the intensive care unit. The assessment of volemia based on the determination of the maximum diameter of the IVC is a good additional criterion for the individualization of the volume of postoperative infusion therapy aimed directly at the optimization of systemic hemodynamics and indirectly at the prevention of AKI.

Case presentation:  An 84-year-old man presented to the emergency department with sudden, left lower quadrant cramping pain. Because critical hypotension was noted, point-of-care ultrasonography (POCUS) was performed immediately. The study revealed a pulsatile flow extravasating from the left common iliac artery into the left psoas muscle with hypoechoic para-aortic fluid collection. Discussion: Common iliac artery rupture is rare and has nonspecific clinical presentations. A quick disposition can be made with a combination of clinical manifestations and POCUS results.

Background/Aims: Pulmonary aspiration of gastric content is a serious perioperative complication. The objective of this prospective study was to assess the relationship between the gastric volumes suctioned endoscopically and quantitative (antral cross‐section area) and qualitative (empty vs. nonempty) examination of the gastric antrum. Furthermore, the study aimed to determine the best antral cross‐section area cutoff value for a truly empty antrum in infants. Methods: This study was performed in a pediatric gastrointestinal endoscopy unit. Antral sonography was performed in supine and right lateral decubitus positions in 46 fasted infants prior to upper gastrointestinal endoscopic evaluation. Antral cross‐sectional area measurements in both positions and qualitative evaluation of the antrum (according to a three‐point grading system) were recorded. Gastric contents were endoscopically suctioned and measured. Results: Forty‐six patients (aged under 24 months) were included. According to the three‐point qualitative grading system, 76.1% of patients were classified as grade 0. The best cutoff value for the antral cross‐section area in the right lateral decubitus position, indicating an empty antrum, was determined to be 2.40 cm2. At this specific cutoff value, the sensitivity was 100%, the specificity was 68.6%, and the negative predictive value was 100%. Conclusions: Gastric ultrasonography can confirm an empty or nearly empty stomach in healthy infants. [ABSTRACT FROM AUTHOR]

Objectives: Patients with injuries to the deep fibers of the medial collateral ligament (dMCL) have a worse prognosis than patients with injuries to the superficial fibers (sMCL). The anterior medial (ANTMED) rotation test has been developed to differentiate between injuries to the dMCL and sMCL. The current study tested the hypothesis that the width of the medial knee gap would be greater during the valgus stress test than the ANTMED rotation test. Methods: Fifty‐three participants were included in the study. Participants did not have a history of knee injury. Ultrasound images of the participants' medial knees were collected during the valgus stress test and the ANTMED rotation test. Repeated measures ANOVA was used to test differences in the medial knee gap between the tests, stress condition, and side. Results: No difference between the tests in the medial knee joint gap width in the no‐stress condition. The increase in the joint gap width was greater during the valgus stress test than the ANTMED rotation test. The medial knee gap increased during both the valgus stress (4.0 ± 0.12 mm) and the ANTMED rotation test (2.9 ± 0.12 mm). Conclusions: A greater increase in the medial knee gap was seen during the valgus stress test compared to the ANTMED rotation test. Knee external rotation increases the tension within the dMCL. Increased tension in the dMCL could explain the test differences in the increase in the joint gap found in the current study. The ANTMED rotation test may prove useful to identify injury to the dMCL. [ABSTRACT FROM AUTHOR]

Three-dimensional (3D) ultrasonic imaging can enable post-facto plane of interest selection. It can be performed with devices such as wobbler probes, matrix probes, and sensor-based probes. Ultrasound systems that support 3D-imaging are expensive with added hardware complexity compared to 2D-imaging systems. An inertial measurement unit (IMU) can potentially be used for 3D-imaging by using it to track the motion of a one-dimensional array probe and constraining its motion in one degree of freedom (1-DoF) rotation (swept-fan). This work demonstrates the feasibility of an affordable IMU-assisted manual 3D-ultrasound scanner (IAM3US). A consumer-grade IMU-assisted 3D scanner prototype is designed with two support structures for swept-fan. After proper IMU calibration, an appropriate KF-based algorithm estimates the probe orientation during the swept-fan. An improved scanline-based reconstruction method is used for volume reconstruction. The evaluation of the IAM3US system is done by imaging a tennis ball filled with water and the head region of a fetal phantom. From fetal phantom reconstructed volumes, suitable 2D planes are extracted for biparietal diameter (BPD) manual measurements. Later, in-vivo data is collected. The novel contributions of this paper are (1) the application of a recently proposed algorithm for orientation estimation of swept-fan for 3D imaging, chosen based on the noise characteristics of selected consumer grade IMU (2) assessment of the quality of the 1-DoF swept-fan scan with a deflection detector along with monitoring of maximum angular rate during the scan and (3) two probe holder designs to aid the operator in performing the 1-DoF rotational motion and (4) end-to-end 3D-imaging system-integration. Phantom studies and preliminary in-vivo obstetric scans performed on two patients illustrate the usability of the system for diagnosis purposes. [ABSTRACT FROM AUTHOR]

The aim - to determine the diagnostic value of lung ultrasound parameters in predicting outcomes of coronavirus disease 2019 (COVID-19) in oxygen-dependent patients requiring intensive care unit treatment. Materials and methods. We examined 105 patients with COVID-19 who needed supplemental oxygen and were treated in the Department of Anesthesiology and Intensive Care. The age of patients ranged between 39 and 80 years, 63 participants were male and 42 - female. To determine the diagnostic value of lung ultrasound parameters in predicting the severe course of COVID-19 in oxygen-dependent patients, they were divided into groups: Group I - recovered patients (n = 39); Group II - patients with a fatal outcome (n = 66). In all the patients, the diagnosis of COVID-19 was confirmed by RNA-SARS-CoV-2 detection in nasopharyngeal swab specimens. The patients were examined and treated according to the Protocol of the Ministry of Health of Ukraine. The lung ultrasound protocol used in the study included 14 lung examination zones and a score of lung tissue infiltration degree from 0 to 3 points. Statistical processing of the data was performed with Statistica for Windows 13 (StatSoft Inc., No. JPZ804I382130ARCN10-J). Results. In oxygen-dependent patients with severe COVID-19 and a fatal outcome, infiltrative changes in the lung parenchyma were more severe based on the lung ultrasound total score both at the time of admission (p < 0.01) and after 5 days of treatment (p < 0.01). The cutoff score of ≥19 at the time of hospitalization (AUC = 0.753, p < 0.01; sensitivity - 76.9 %, specificity - 68.2 %) and ≥17 after 5 days of treatment (AUC = 0.799, p < 0.01; sensitivity - 71.4 %, specificity - 92.1 %) had a prognostic value for assessing the risk of death in oxygen-dependent patients with severe COVID-19. A lung ultrasound score >19 at the time of admission increased the risk of death by 2.96 times (RR = 2.96, 95 % CI 1.43-2.87, p < 0.001). Lung ultrasound found pleural effusion only in oxygen-dependent COVID-19 patients who died. In the treatment dynamics after 5 days, the rate of pleural effusion detection in this group of patients was three times increased (from 9.1 % to 27.3 %, p < 0.01). Conclusions. The study has revealed the diagnostic value of lung ultrasound parameters in predicting outcomes of COVID-19 in oxygen-dependent patients requiring intensive care unit treatment. Cutoffs of the total score characterizing the degree of lung tissue infiltration have been determined, that allowing to assert a high probability for a lethal outcome of the disease. [ABSTRACT FROM AUTHOR]

Background: Adhesive capsulitis (AC) of the glenohumeral joint is a recognized cause of pain associated with both active and passive restricted ranges of movement. AC can be subdivided into primary and secondary forms. Trauma, surgery, immobilization, and diabetes mellitus are the leading well-recognized causes of secondary AC. Calcific tendinitis/tendinitis (CT) of the rotator cuff is considered a possible trigger for AC, as reported in a few previous articles. However, there are no original investigations that assess the frequency and characteristics of this association. The aim of our research was to evaluate the presence of AC in a cohort of patients with a known CT condition of the rotator cuff by an ultrasound (US) examination. Materials and methods: We prospectively enrolled all the patients admitted at our single institution (October 2022–June 2023) for the preoperative US evaluation of a known CT condition. In these patients, we searched for parameters related to secondary AC. An axillary pouch (AP) thickness equal to or greater than 4 mm (or greater than 60% of the contralateral AP) was considered diagnostic of AC. Moreover, rotator interval (RI) thickness and the presence of effusion within the long-head biceps tendon (LHBT) sheath was also assessed in all patients. Results: A total of 78 patients (54F, 24M—mean age = 50.0 and range = 31–71 y.o.) were enrolled in the study. In 26 of those patients (26/78—33.3%), US signs of AC were detected. Notably, the mean AP thickness in patients with AC and CT was 3.96 ± 1.37 mm (Group 1) and 2.08 ± 0.40 mm in patients with CT only (Group 2). RI thickness was significantly greater in patients with superimposed AC: 2.54 ± 0.38 mm in Group 1 and 1.81 ± 0.41 mm in Group 2 (p < 0.00001). Moreover, effusion within the LHBT was significantly more frequently detected in patients with AC: 84.61% in Group 1 versus 15.79% in Group 2—p < 0.00001. Conclusion: US signs of AC are found in one-third of patients with CT of the rotator cuff, demonstrating that AC represents a frequent complication that should be routinely evaluated during US investigation to provide more personalized treatment strategies. [ABSTRACT FROM AUTHOR]

Background: Spinal Manipulative Therapy (SMT) benefits LBP patients, but its mechanism is not well documented. One hypothesis indicates that SMT restores interspinal movements. Ultrasound measurement (UM) of spinous process separation (SPS) assesses the intersegmental movements. Methods: We used the test-retest reliability of UM between the L3, L4, L5, and S1 spinous processes on fifteen asymptomatic volunteers while lying prone on a chiropractic table. The participants then walked around for over 5 minutes, and ultrasound images were reperformed prone. UM identified the tips of the spinous processes and distances between L3-L4, L4-L5, and L5-S1. Reliability was assessed using intra-class correlation coefficient (ICC). Results: ICC values of SPS measurements were 0.982 for L3-L4, 0.992 for L4-L5, and 0.997 for L5-S1. Rootmean square difference between the two measures were 0.35mm for L5-S1, 0.36mm for L4-L5, and 0.57mm for L3-L4. Conclusions: This study found UM to be reliable in measuring interspinous distance. [ABSTRACT FROM AUTHOR]

Abstract Ultrasound (US), as a non‐invasive mechanical wave, has served as a visual tool for medical diagnosis and therapy for echolocation effect, cavitation effect, thermal effect, and generation of reactive oxygen species (ROS) with the aid of sonosensitizers. This review summarizes the history, effects, and biomedical applications of US, and US‐assisted cancer therapy is highlighted. The rational combination of US with near‐infrared afterglow nanoparticles, anti‐tumor prodrugs, and stimuli‐responsive nanocarriers, demonstrates the great promise for bioimaging, cancer therapy, and drug delivery, promoting US‐related technology in biomedical diagnosis and therapeutics.

Background: Adhesive capsulitis (AC) of the glenohumeral joint is a recognized cause of pain associated with both active and passive restricted ranges of movement. AC can be subdivided into primary and secondary forms. Trauma, surgery, immobilization, and diabetes mellitus are the leading well-recognized causes of secondary AC. Calcific tendinitis/tendinitis (CT) of the rotator cuff is considered a possible trigger for AC, as reported in a few previous articles. However, there are no original investigations that assess the frequency and characteristics of this association. The aim of our research was to evaluate the presence of AC in a cohort of patients with a known CT condition of the rotator cuff by an ultrasound (US) examination. Materials and methods: We prospectively enrolled all the patients admitted at our single institution (October 2022–June 2023) for the preoperative US evaluation of a known CT condition. In these patients, we searched for parameters related to secondary AC. An axillary pouch (AP) thickness equal to or greater than 4 mm (or greater than 60% of the contralateral AP) was considered diagnostic of AC. Moreover, rotator interval (RI) thickness and the presence of effusion within the long-head biceps tendon (LHBT) sheath was also assessed in all patients. Results: A total of 78 patients (54F, 24M—mean age = 50.0 and range = 31–71 y.o.) were enrolled in the study. In 26 of those patients (26/78—33.3%), US signs of AC were detected. Notably, the mean AP thickness in patients with AC and CT was 3.96 ± 1.37 mm (Group 1) and 2.08 ± 0.40 mm in patients with CT only (Group 2). RI thickness was significantly greater in patients with superimposed AC: 2.54 ± 0.38 mm in Group 1 and 1.81 ± 0.41 mm in Group 2 (p < 0.00001). Moreover, effusion within the LHBT was significantly more frequently detected in patients with AC: 84.61% in Group 1 versus 15.79% in Group 2—p < 0.00001. Conclusion: US signs of AC are found in one-third of patients with CT of the rotator cuff, demonstrating that AC represents a frequent complication that should be routinely evaluated during US investigation to provide more personalized treatment strategies.

The purpose of this study was to investigate whether doxorubicin nanobubbles (DOX-NB) combined with diagnostic ultrasound (DUS) irradiation could downregulate the expression of carbonic anhydrase IX (CAIX) in mouse xenograft nasopharyngeal carcinoma (NPC) model. In this study, the prepared DOX-NB was round and well dispersed. The average diameter of DOX-NB was 250.9 ± 50.8 nm, with an average polydispersity of 0.321 ± 0.05. The cumulative release of DOX in the DOX-NB + DUS group was significantly higher compared with that of the DOX-NB group (p < 0.05). DOX-NB combined with DUS irradiation could significantly inhibit cell viability (p < 0.05). The expression of CAIX and microvessel density (MVD) in the xenografted tumors was the lowest in the DOX-NB + DUS group compared with that of other groups (p < 0.05). In conclusion, DOX-NB combined with DUS irradiation could improve DOX-NB drug release and synergistically inhibit NPC cell activity. DOX-NB combined with DUS irradiation can downregulate the expression of CAIX in mouse xenograft NPC model. This may be due to the synergistic effect of DUS combined with DOX-NB in reducing MVD in NPC.

The aim – to determine the diagnostic value of lung ultrasound parameters in predicting outcomes of coronavirus disease 2019 (COVID-19) in oxygen-dependent patients requiring intensive care unit treatment. Materials and methods. We examined 105 patients with COVID-19 who needed supplemental oxygen and were treated in the Department of Anesthesiology and Intensive Care. The age of patients ranged between 39 and 80 years, 63 participants were male and 42 – female. To determine the diagnostic value of lung ultrasound parameters in predicting the severe course of COVID-19 in oxygen-dependent patients, they were divided into groups: Group I – recovered patients (n = 39); Group II – patients with a fatal outcome (n = 66). In all the patients, the diagnosis of COVID-19 was confirmed by RNA-SARS-CoV-2 detection in nasopharyngeal swab specimens. The patients were examined and treated according to the Protocol of the Ministry of Health of Ukraine. The lung ultrasound protocol used in the study included 14 lung examination zones and a score of lung tissue infiltration degree from 0 to 3 points. Statistical processing of the data was performed with Statistica for Windows 13 (StatSoft Inc., No. JPZ804I382130ARCN10-J). Results. In oxygen-dependent patients with severe COVID-19 and a fatal outcome, infiltrative changes in the lung parenchyma were more severe based on the lung ultrasound total score both at the time of admission (p < 0.01) and after 5 days of treatment (p < 0.01). The cutoff score of ≥19 at the time of hospitalization (AUC = 0.753, p < 0.01; sensitivity – 76.9 %, specificity – 68.2 %) and ≥17 after 5 days of treatment (AUC = 0.799, p < 0.01; sensitivity – 71.4 %, specificity – 92.1 %) had a prognostic value for assessing the risk of death in oxygen-dependent patients with severe COVID-19. A lung ultrasound score >19 at the time of admission increased the risk of death by 2.96 times (RR = 2.96, 95 % CI 1.43–2.87, p < 0.001). Lung ultrasound found pleural effusion only in oxygen-dependent COVID-19 patients who died. In the treatment dynamics after 5 days, the rate of pleural effusion detection in this group of patients was three times increased (from 9.1 % to 27.3 %, p < 0.01). Conclusions. The study has revealed the diagnostic value of lung ultrasound parameters in predicting outcomes of COVID-19 in oxygen-dependent patients requiring intensive care unit treatment. Cutoffs of the total score characterizing the degree of lung tissue infiltration have been determined, that allowing to assert a high probability for a lethal outcome of the disease.

Purpose of reviewThe aim of this study is to review the most recent literature on common upper extremity injuries in pediatric athletes and discuss their diagnosis, management, and outcomes. We also highlight ultrasound as a tool in their evaluation.Recent findingsShoulder conditions presented include little league shoulder, glenohumeral rotation deficit, acute traumatic shoulder dislocation, and multidirectional shoulder instability. Elbow conditions include capitellar OCD, medial epicondyle avulsion fracture, and medial epicondylitis. We also review scaphoid fractures and gymnast wrist. Not all physeal injuries lead to long-term growth disruption. Ultrasound has been shown to be useful in the diagnosis of scaphoid fracture, medial epicondyle avulsion fractures, and capitellar OCD. It can also be helpful in assessing risk for shoulder and elbow injuries in overhead athletes. There is a rising burden of upper extremity injuries among pediatric athletes. Knowledge of their sport specific mechanics can be helpful in diagnosis. As long-term outcome data become available for these conditions, it is clear, proper diagnosis and management are critical to preventing adverse outcomes. We highlight many of these injuries, best practice in care, and controversies in care in hopes of improving outcomes and preventing injury for pediatric athletes.

Introduction/Aims: Needle electromyography (EMG) and muscle ultrasound can be used to evaluate patients with suspected neuromuscular disorders. The relation between muscle ultrasound pathology and the corresponding needle EMG findings is unknown. In this study we compared the results of concurrent ultrasound and needle EMG examinations in patients suspected of a neuromuscular disorder. Methods: Retrospective data from 218 patients with pairwise ultrasound and EMG results of 796 muscles were analyzed. We compared overall quantitative and visual muscle ultrasound results to EMGs with neurogenic and myopathic abnormalities and assessed the congruency of both methods in the different clinical diagnosis categories. Results: In muscles of patients with a neuromuscular disorder, abnormalities were found with EMG in 71.8%, and quantitative and visual muscle ultrasound results were abnormal in 19.3% and 35.4% respectively. In muscles with neurogenic EMG abnormalities, quantitative and visual muscle ultrasound results were abnormal in 18.9% versus 35.6%, increasing up to 43.7% versus 87.5% in muscles with the most pronounced signs of denervation. Congruency of EMG and ultrasound was better for more proximal and cranial muscles than for muscles in the hand and lower limb. Discussion: Needle EMG and muscle ultrasound typically produce disparate results and identify different aspects of muscle pathology. Muscle ultrasound seems less suited for detecting mild neurogenic abnormalities. As the severity of neurogenic needle EMG abnormalities increased, muscle ultrasound abnormalities were also increasingly found. Visual analysis seems better suited than grayscale quantification for detecting neurogenic abnormalities. See Editorial on pages 131–133 in this issue. [ABSTRACT FROM AUTHOR]

Caffeine is present in various foods and medicines and is highly accessible through various routes, regardless of age. However, most studies on caffeine have focused on the effects of high-dose caffeine ingestion based on the recommended daily amount for adults. In this study, we examined the physiological changes in the central and peripheral vessels that may occur when ingesting low-dose caffeine due to its high accessibility, with the aim of creating an environment of safe caffeine ingestion. This study included 26 healthy participants in their 20s. Peak systolic velocity (PSV), heart rate (HR), and pulse wave velocity (PWV) for vascular stiffness assessment were measured at 0, 30, and 60 min after caffeine ingestion using diagnostic ultrasound to determine the physiological changes in the blood vessels, common carotid artery (CCA) and radial artery (RA). In addition, percutaneous oxygen saturation (SpO2), blood pressure (BP), and accelerated photoplethysmography (APG) were measured. In comparison with before ingestion, the HR tended to decrease and showed a significant difference at 30 and 60 min (p = 0.014 and p = 0.031, respectively). PSV significantly decreased in both vessels at 30 and 60 min (p < 0.001 and p < 0.001, respectively). APG showed a decreasing trend until 60 min after ingestion, with a significant difference at 30 and 60 min (p = 0.003 and p = 0.012, respectively). No significant difference was observed in SpO2, BP, or PWV; however, they showed a tendency to increase after ingestion. Decreased HR may occur because of the baroreflex caused by an increase in BP. The RA has many branches and a smaller diameter; therefore, the PSV was lower in the RA than that in the CCA. This effect can occur because of the difficulty in the smooth expansion of blood vessels, which leads to a decrease in blood flow. In addition, an increase in intracellular calcium concentration can prevent vasodilation and increase the propagation velocity of pulse waves. The reflected waves can increase systolic blood pressure but reduce PWV and vascular elasticity. These results suggest that even low-dose caffeine can improve blood vessel health by providing temporary stimulation to the blood vessels; however, it can also cause changes in blood flow and blood vessel elasticity, which can lead to serious diseases such as stroke and high blood pressure. Therefore, caution should be exercised when caffeine consumption is indiscriminate. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate whether doxorubicin nanobubbles (DOX-NB) combined with diagnostic ultrasound (DUS) irradiation could downregulate the expression of carbonic anhydrase IX (CAIX) in mouse xenograft nasopharyngeal carcinoma (NPC) model. In this study, the prepared DOX-NB was round and well dispersed. The average diameter of DOX-NB was 250.9 ± 50.8 nm, with an average polydispersity of 0.321 ± 0.05. The cumulative release of DOX in the DOX-NB + DUS group was significantly higher compared with that of the DOX-NB group (p < 0.05). DOX-NB combined with DUS irradiation could significantly inhibit cell viability (p < 0.05). The expression of CAIX and microvessel density (MVD) in the xenografted tumors was the lowest in the DOX-NB + DUS group compared with that of other groups (p < 0.05). In conclusion, DOX-NB combined with DUS irradiation could improve DOXNB drug release and synergistically inhibit NPC cell activity. DOX-NB combined with DUS irradiation can downregulate the expression of CAIX in mouse xenograft NPC model. This may be due to the synergistic effect of DUS combined with DOX-NB in reducing MVD in NPC. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: Thyroid nodules are very common in clinical practice, and ultrasound has long been used as a screening tool for their evaluation. Several risk assessment systems based on ultrasonography have been developed to stratify the risk of malignancy and determine the need for fine-needle aspiration in thyroid nodules, including the American Thyroid Association (ATA) system and the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS). The aim of this study was to compare the performance of the ATA and ACR TI-RADS systems in predicting malignancy in thyroid nodules based on the nodules' final histopathology reports. Materials and methods: We performed a retrospective review of medical records to identify patients who underwent thyroid surgery at King Abdulaziz University from 2017 to 2022. The ultrasound features of the nodules with confirmed histopathology (benign versus malignant) were evaluated. Both ATA and ACR TI-RADS scores were documented. Results: The analysis included 191 patients who underwent thyroid surgery and fulfilled the inclusion criteria. Hemithyroidectomy was performed in 22.5% of the patients, and total thyroidectomy was performed in 77.0% of them. In all, 91 patients (47.6%) were found to have malignant nodules on histopathology. We then compared the histopathology reports with the preoperative ultrasonographic risk scores. The estimated sensitivity and specificity in identifying malignant nodules were, respectively, 52% and 80% with the ATA system and 51.6% and 90% with the ACR TI-RADS system. Conclusion: Both ATA and ACR TI-RADS risk stratification systems are valuable tools for assessing the malignancy risk in thyroid nodules. In our study, the ACR TI-RADS system had superior specificity compared with the ATA system in predicting malignancy among high-risk lesions.

Purpose: We evaluated the current performance of diagnostic ultrasound (US) for detecting cervical lymph node (LN) metastases based on objective measures and subjective findings in comparison to the gold standard, histopathological evaluation. Patients and methods: From 2007 to 2016, we prospectively included patients with head and neck cancer who were scheduled for surgical therapy including neck dissection. LNs were examined by multimodal US by a level III head and neck sonologist and individually assigned to a map containing six AAO-HNS neck LN levels preoperatively. During the operation, LNs were dissected and then assessed by routine histopathology, with 86% of them examined individually and the remaining LNs (14%) per AAO-HNS neck LN level. The optimal cutoff points (OCPs) of four defined LN diameters and 2D and 3D roundness indices per AAO-HNS neck LN level were determined. Results: In total, 235 patients were included, and 4539 LNs were analyzed by US, 7237 by histopathology and 2684 by both methods. Of these, 259 (9.65%) were classified as suspicious for metastasis by US, whereas 299 (11.14%) were found to be positive by histopathology. Subjective US sensitivity and specificity were 0.79 and 0.99, respectively. The OCPs of the individual LN diameters and the 2D and 3D roundness index were determined individually for all AAO-HNS neck LN levels. Across all levels, the OCP for the 2D index was 1.79 and the 3D index was 14.97. The predictive performance of all distances, indices, and subjective findings improved with increasing metastasis size. Anticipation of pN stage was best achieved with subjective US findings and the smallest diameter (Cohen's κ = 0.713 and 0.438, respectively). Conclusion: Our LN mapping and meticulous 1:1 node-by-node comparison reveals the usefulness of US for detecting metastatic involvement of neck LNs in head and neck carcinomas as compared to histopathology. The predictive ability for small tumor deposits less than 8 mm in size remains weak and urgently needs improvement. [ABSTRACT FROM AUTHOR]

The protective blood‐brain barrier (BBB) prevents most therapeutic agents from entering the brain. Currently, focused ultrasound (FUS) is mostly employed to create microbubbles that induce a cavitation effect to open the BBB. However, microbubbles pass quickly through brain microvessels, substantially limiting the cavitation effect. Here, we constructed a novel perfluoropropane‐loaded microbubble, termed ApoER‐Pep‐MB, which possessed a siloxane bonds‐crosslinked surface to increase the microbubble stability against turbulence in blood circulation and was decorated with binding peptide for apolipoprotein E receptor (ApoER‐Pep). The microbubble with tailor‐made micron size (2 µm) and negative surface charge (−30 mV) performed ApoER‐mediated binding rather than internalization into brain capillary endothelial cells. Consequently, the microbubble accumulated on the brain microvessels, based on which even a low‐energy ultrasound with less safety risk than FUS, herein diagnostic ultrasound (DUS), could create a strong cavitation effect to open the BBB. Evans Blue and immunofluorescence staining studies demonstrated that the DUS‐triggered cavitation effect not only temporarily opened the BBB for 2 h but also caused negligible damage to the brain tissue. Therefore, various agents, ranging from small molecules to nanoscale objects, can be efficiently delivered to target regions of the brain, offering tremendous opportunities for the treatment of brain diseases. [ABSTRACT FROM AUTHOR]

It is important to improve cerebrovascular health before the occurrence of cerebrovascular disease, as it has various aftereffects and a high recurrence rate, even with appropriate treatment. Various medical recommendations for preventing cerebrovascular diseases have been introduced, including smoking cessation, exercise, and diet. However, the effectiveness of these methods varies greatly from person to person, and their effects cannot be confirmed unless they are practiced over a long period. Therefore, there is a growing need to develop more quantitative methods that are applicable to the public to promote cerebrovascular health. Thus, in this study, we aimed to develop noninvasive and quantitative thermal stimulation techniques using ultrasound to improve cerebrovascular health and prevent cerebrovascular diseases. This study included 27 healthy adults in their 20s (14 males, 13 females). Thermal stimulation using therapeutic ultrasound at a frequency of 3 MHz was applied to the right sternocleidomastoid muscle in the supine posture for 2 min at four intensities (2.4, 5.1, 7.2, and 10.2 W/cm2). Diagnostic ultrasound was used to measure the peak systolic velocity (PSV), heart rate (HR), and pulse wave velocity (PWV) in the right common carotid artery (CCA), and the physiological changes were compared between intervention intensities. Compared to pre-intervention (preI), the PSV showed a significant increase during intervention (durI) at intensities of 7.2 W/cm2 and 10.2 W/cm2 (p = 0.010 and p = 0.021, respectively). Additionally, PWV showed a significant decrease for post-intervention (postI) at 7.2 W/cm2 and 10.2 W/cm2 (p = 0.036 and p = 0.035, respectively). However, the HR showed no significant differences at any of the intensities. The results demonstrate that an intervention at 3 MHz with an intensity of 7.2 W/cm2 or more can substantially increase cerebral blood flow and reduce arterial stiffness. Therefore, the use of therapeutic ultrasound of appropriate intensity is expected to improve the cerebral blood flow and reduce vascular stiffness to maintain cerebral blood flow at a certain level, which is closely related to the prevention and treatment of cerebrovascular diseases, thereby improving cerebrovascular health. [ABSTRACT FROM AUTHOR]

Clinical Scenario: Pathologies of the long head of the biceps brachii (LHB) tendon are a source of shoulder pain in many people. It is important to have a reliable assessment of the LHB tendon to make an accurate diagnosis and provide the correct treatment or referral if necessary. Shoulder ultrasound is very accurate in the diagnosis of rotator cuff tears. However, its ability to detect pathologies of the LHB tendon is still unclear. Clinical Question: In patients with shoulder pain, can musculoskeletal ultrasound accurately diagnose LHB tendon pathologies? Summary of Key Findings: Four high-quality cohort studies met inclusion criteria and were included in the critical appraisal. The STrengthening the Reporting of OBservational studies in Epidemiology checklist was used to score the articles on methodology and consistency. Three studies evaluated accuracy in diagnosis of full-thickness tears and found high sensitivity (SN) and specificity (SP). Three studies evaluated accuracy in diagnosis of partial-thickness tears and found low SN and negative predictive value, but high SP and positive predictive value. Two studies evaluated tendon subluxation/dislocation and found high SN and SP. Two studies evaluated tendinitis and found moderate SN and high SP. Clinical Bottom Line: There is moderate to strong evidence to support the use of musculoskeletal ultrasound in diagnosis of LHB tendon pathology. Strength of Recommendation: There is grade B evidence that musculoskeletal ultrasound can accurately diagnose full-thickness tears and tendon subluxation/dislocation; can rule in partial-thickness tears (based on SP and positive predictive value), but not rule out partial-thickness tears; and can rule in tendinitis (based on SP and positive predictive value), but not rule out tendinitis. [ABSTRACT FROM AUTHOR]

Abstract The protective blood‐brain barrier (BBB) prevents most therapeutic agents from entering the brain. Currently, focused ultrasound (FUS) is mostly employed to create microbubbles that induce a cavitation effect to open the BBB. However, microbubbles pass quickly through brain microvessels, substantially limiting the cavitation effect. Here, we constructed a novel perfluoropropane‐loaded microbubble, termed ApoER‐Pep‐MB, which possessed a siloxane bonds‐crosslinked surface to increase the microbubble stability against turbulence in blood circulation and was decorated with binding peptide for apolipoprotein E receptor (ApoER‐Pep). The microbubble with tailor‐made micron size (2 µm) and negative surface charge (−30 mV) performed ApoER‐mediated binding rather than internalization into brain capillary endothelial cells. Consequently, the microbubble accumulated on the brain microvessels, based on which even a low‐energy ultrasound with less safety risk than FUS, herein diagnostic ultrasound (DUS), could create a strong cavitation effect to open the BBB. Evans Blue and immunofluorescence staining studies demonstrated that the DUS‐triggered cavitation effect not only temporarily opened the BBB for 2 h but also caused negligible damage to the brain tissue. Therefore, various agents, ranging from small molecules to nanoscale objects, can be efficiently delivered to target regions of the brain, offering tremendous opportunities for the treatment of brain diseases.

Tumor hypoperfusion not only impedes therapeutic drug delivery and accumulation, but also leads to a hypoxic and acidic tumor microenvironment, resulting in tumor proliferation, invasion, and therapeutic resistance. Sononeoperfusion effect refers to tumor perfusion enhancement using ultrasound and microbubbles. This study aimed to further investigate hypoxia alleviation by sononeoperfusion effect and explore the characteristics and mechanism of sononeoperfusion effect. To stimulate the sononeoperfusion effect, mice bearing MC38 colon cancers were included in this study and diagnostic ultrasound for therapy was set at a mechanical index (MI) of 0.1, 0.3, and 0.5, frequency of 3 MHz, pulse length of 5 cycles, and pulse repetition frequency of 2000 Hz. The results demonstrated that a single ultrasound and microbubble (USMB) treatment resulted in tumor perfusion enhancement at MI = 0.3, and nitric oxide (NO) concentration increased at MI = 0.3/0.5 (P 0.05) levels. Multiple sononeoperfusion effects were observed at MI = 0.3/0.5 (P

Introduction: Echocardiography is essential for diagnosing and assessing the severity of perioperative structural and functional heart disease. Yet, educational opportunities to better understand echocardiography‐based cardiac anatomy remain limited by the two‐dimensional display, lack of anatomic details, variability of heart models, and costs and global access of training. Methods: We performed micro computed tomography of human heart specimens not suitable for orthotopic transplantation. We created high‐resolution computational 3D models of different human hearts, sliced them in the different recommended American Society of Echocardiography views, and 3D printed them using different materials. Results: We scanned, 3D modeled, and 3D printed a variety of human hearts both healthy and diseased. We have made the models available in the cardiac operating rooms and routinely use them for teaching anesthesia residents and cardiothoracic anesthesia fellows about basic and advanced echocardiographic views, cardiopulmonary bypass cannulation strategies, and valvular pathology and planned interventions. Conclusion: We have generated a library of 3D printed hearts to display the recommended echocardiographic views as a unique educational tool designed to safely accelerate the understanding of absolute and relative human cardiac anatomy and pathology, especially related to gaining advanced appreciation of clinically employed perioperative echocardiography. [ABSTRACT FROM AUTHOR]

Aims Ovarian cancer has the worst prognosis among female genital tract malignancies, but if detected in the early stages, it is one of the most treatable malignancies. This study aimed to investigate the diagnostic value of tumor markers compared to ultrasound in the diagnosis of ovarian tumors. Instruments & Methods This cross-sectional-analytical study was conducted on 210 women referred to women's specialized clinic in Yasuj City, Iran, from 2017 to 2021 who were candidates for ovarian surgery. The method of data collection was patients interviewing and using the information available in the file. The data was analyzed using SPSS 22 software. Findings The most common histological pattern was ovarian epithelial masses (64.28%), of which 72.18% were larger than 10cm in ultrasound. There was a significant correlaion between the serum level of two tumor markers CA125 and HE4 in ovarian cancer (p=0.0001), but no correlaion was observed between the surgical stage and differentiation grade of ovarian cancer. The sensitivity of ultrasound was 78.9% and the sensitivity and specificity of HE4 tumor marker were 85.4% and 81.7%, respectively. The lowest specificity was related to the tumor marker CA125 (59.3%). Conclusion Ultrasound has relatively high sensitivity for detecting ovarian tumors, but CA125, with relatively high sensitivity and moderate specificity and HE4, with high specificity and high sensitivity, as two tumor markers, are not suitable for screening these tumors alone and should be performed together with ultrasound. [ABSTRACT FROM AUTHOR]

Isolated first rib stress fractures in athletes are thought to be rare. In this case series, 3 National Collegiate Athletic Association Division I athletes developed isolated first rib stress fractures over the span of 1 year, indicating that these injuries may occur more often than previously understood. These fractures can be easily missed because of the low incidence, lack of clinical suspicion, and vague presentation. Further, radiographs can fail to reveal such fractures. To our knowledge, this is the largest case series of athletes with first rib stress fractures presenting with vague rhomboid interscapular pain. We also demonstrated that ultrasound successfully visualized these injuries; in the hands of an ultrasonographer or clinical provider trained in musculoskeletal ultrasound, this technique offers an advantageous point-of-care screening imaging modality. [ABSTRACT FROM AUTHOR]

Purpose: This study sought to clarify the positional relationship between the Achilles tendon and sural nerve using ultrasound. Methods: We studied 176 legs in 88 healthy volunteers. The positional relationship between the Achilles tendon and sural nerve at heights of 2, 4, 6, 8, 10, and 12 cm proximal from the calcaneus' proximal margin was investigated by distance and depth. Setting the X-axis (left/right) as the horizontal axis and Y-axis (depth) as the vertical axis against ultrasound images, we investigated the distance between the lateral margin of the Achilles tendon to the midpoint of the sural nerve on the X-axis. The Y-axis was split into four zones: the part behind the center of the Achilles tendon (AS), the part in front of the center of the Achilles tendon (AD), the part behind the Achilles tendon (S), and the part in front (D). We investigated the zones through which the sural nerve passed. We also studied any significant differences between the sexes and left/right legs. Results: The mean distance on the X-axis was closest at 6 cm, with 1.1 ± 5.0 mm between them. The sural nerve's position on the Y-axis was such that at positions more proximal than 8 cm, the sural nerve ran through zone S in most legs and moved to zone AS through heights 2–6 cm. No parameters showed significant differences between the sexes or left/right legs. Conclusion: We presented the positional relationship between the Achilles tendon and sural nerve and suggested some measures to prevent nerve injury during surgery. [ABSTRACT FROM AUTHOR]

Objectives: By analyzing the differences of contrast‐enhanced ultrasound (CEUS) features between low‐ and high‐grade of WHO/ISUP grading, to explore the diagnostic value of CEUS in evaluating the prognosis of renal cell carcinoma (RCC). Methods: The qualitative and quantitative features of CEUS in 69 patients with RCC confirmed by surgical pathology in the Lanzhou University Second Hospital from March to October 2021 were retrospectively analyzed. Patients were categorized into two groups: low‐grade group (n = 22) and high‐grade group (n = 47), with surgical pathology as reference standard. The diagnostic performance of statistically significant CEUS features was evaluated by receiver operating characteristic (ROC) curves. Results: There were statistically significant differences in enhancement degree (P =.032) and quantitative features such as slopelesion (P =.034), the differences between lesion and cortex in arrive time (∆AT = ATlesion − ATcortex, P =.013), peak intensity(∆PI = [PIlesion − PIcortex]/PIcortex, P =.003), area under the curve (∆Area = Arealesion − Areacortex, P =.008) in two groups, and the sensitivity was 70.2% and specificity was 71.4% of ∆PI, which has a high diagnostic performance in the differentiation of low‐grade group from high‐grade group (P =.005). Conclusions: CEUS features such as ∆PI, may help differentiate low‐grade RCC from high‐grade RCC. CEUS has a promising application prospect in preoperative evaluation of the prognosis of RCC. [ABSTRACT FROM AUTHOR]

Abstract Background Hypoperfusion or resultant hypoxia in solid tumours is a main reason for therapeutic resistance. Augmenting the blood perfusion of hypovascular tumours might improve both hypoxia and drug delivery. Cavitation is known to result in microstreaming and sonoporation and to enhance drug diffusion into tumours. Here, we report the ability to enhance both tumour blood perfusion and doxorubicin (Dox) delivery using a new sononeoperfusion effect causing a cavitation effect on tumour perfusion in subcutaneous Walker-256 tumours of rats using ultrasound stimulated microbubble (USMB). Methods To induce the sononeoperfusion effect, USMB treatment was performed with a modified diagnostic ultrasound (DUS) system and SonoVue® microbubbles. The therapeutic pulse was operated with a peak negative pressure of 0.26 to 0.32 MPa and a pulse repetition frequency (PRF) of 50 Hz to 2 kHz. Contrast-enhanced ultrasound (CEUS) was used for tumour perfusion assessment. Results The USMB treatment of 0.26 MPa and 1 kHz could significantly enhance tumour perfusion with a 20.29% increase in the CEUS peak intensity and a 21.42% increment in the perfusion area for more than 4 hours (P

Objective In 2011, School of Medicine, University of California, Irvine was among the first schools to implement a 4-year ultrasound curriculum. We aimed to find the point-of-care ultrasound (POCUS) utilization pattern among University of California, Irvine alumni. Methods We surveyed University of California, Irvine alumni from the class of 2011 and beyond. Survey questions included POCUS reliance, frequency of use, and comfort with image acquisition and interpretation compared with peers. The primary outcomes were self-reported comfort and reliance on POCUS. Results We received 93 responses from 624 surveyed alumni (response rate, 14.9%), of which 87 were analyzed. Although 46 respondents (52.9%) reported more reliance on POCUS, three (3.4%) relied on it less than their peers. At the same time, 72 (82.7%) and 67 (77.0%) felt more comfortable than their colleagues in obtaining and interpreting POCUS, respectively. No respondents felt less comfortable obtaining or interpreting POCUS than their peers. The frequency of POCUS use correlated directly with the frequency with which POCUS changed the responder’s case management (rho, 0.860; P

Caffeine is present in various foods and medicines and is highly accessible through various routes, regardless of age. However, most studies on caffeine have focused on the effects of high-dose caffeine ingestion based on the recommended daily amount for adults. In this study, we examined the physiological changes in the central and peripheral vessels that may occur when ingesting low-dose caffeine due to its high accessibility, with the aim of creating an environment of safe caffeine ingestion. This study included 26 healthy participants in their 20s. Peak systolic velocity (PSV), heart rate (HR), and pulse wave velocity (PWV) for vascular stiffness assessment were measured at 0, 30, and 60 min after caffeine ingestion using diagnostic ultrasound to determine the physiological changes in the blood vessels, common carotid artery (CCA) and radial artery (RA). In addition, percutaneous oxygen saturation (SpO2), blood pressure (BP), and accelerated photoplethysmography (APG) were measured. In comparison with before ingestion, the HR tended to decrease and showed a significant difference at 30 and 60 min (p = 0.014 and p = 0.031, respectively). PSV significantly decreased in both vessels at 30 and 60 min (p < 0.001 and p < 0.001, respectively). APG showed a decreasing trend until 60 min after ingestion, with a significant difference at 30 and 60 min (p = 0.003 and p = 0.012, respectively). No significant difference was observed in SpO2, BP, or PWV; however, they showed a tendency to increase after ingestion. Decreased HR may occur because of the baroreflex caused by an increase in BP. The RA has many branches and a smaller diameter; therefore, the PSV was lower in the RA than that in the CCA. This effect can occur because of the difficulty in the smooth expansion of blood vessels, which leads to a decrease in blood flow. In addition, an increase in intracellular calcium concentration can prevent vasodilation and increase the propagation velocity of pulse waves. The reflected waves can increase systolic blood pressure but reduce PWV and vascular elasticity. These results suggest that even low-dose caffeine can improve blood vessel health by providing temporary stimulation to the blood vessels; however, it can also cause changes in blood flow and blood vessel elasticity, which can lead to serious diseases such as stroke and high blood pressure. Therefore, caution should be exercised when caffeine consumption is indiscriminate.

Context: Ultrasound imaging is a clinically feasible tool to assess femoral articular cartilage and may have utility in tracking early knee osteoarthritis development. Traditional assessment techniques focus on measurements at a single location, which can be challenging to adopt for novice raters. Objective: To introduce a novel semiautomated ultrasound segmentation technique and determine the intrarater and interrater reliability of average regional femoral articular cartilage thickness and echo intensity of a novice and expert rater. Design: Descriptive observational study. Setting: Orthopedic clinic. Patients or Other Participants: Fifteen participants (mean [SD]; age 23.5 [4.6] y, height = 172.6 [9.3] cm, mass = 79.8 [15.7] kg) with a unilateral history of anterior cruciate ligament reconstruction participated. Intervention: None. Main Outcome Measures: One rater captured anterior femoral cartilage images of the participants’ contralateral knees using a transverse suprapatellar ultrasound assessment. The total femoral cartilage cross-sectional area of each image was segmented by a novice and expert rater. A novel custom program automatically separated the cartilage segmentations into medial, lateral, and intercondylar regions to determine the crosssectional area and cartilage length. The average cartilage thickness in each region was calculated by dividing the cross-sectional area by the cartilage length. Echo intensity was calculated as the average gray-scale pixel value of each region. Two-way random effect intraclass correlations coefficient (ICC) for absolute agreement were used to determine the interrater reliability between a novice and expert rater, as well as the intrarater reliability of the novice rater. Results: The novice rater demonstrated excellent intrarater (ICC [2,k] range = .993–.997) and interrater (ICC [2,k] range = .944–.991) reliability with the expert rater of all femoral articular cartilage average thickness and echo intensity regions. Conclusions: The novel semiautomated average cartilage thickness and echo-intensity assessment is efficient, systematic, and reliable between an expert and novice rater with minimal training. [ABSTRACT FROM AUTHOR]

Context: Blood flow restriction (BFR) training utilizes a tourniquet, applied to the proximal portion of one or more extremities, to occlude blood flow during exercise. Significant gains in strength and cross-sectional area can be achieved in muscles, both distal and proximal to BFR cuff application. Purpose: To compare strength gains of the rotator cuff and changes in tendon size in subjects who performed side-lying external-rotation exercise with or without BFR. Methods: Forty-six subjects (mean age 25.0 [2.2] y) were randomized to either a BFR + exercise group or to the exercise-only group. Subjects performed 4 sets of the exercise (30/15/15/15 repetitions) at 30% 1-repetition maximum 2 days per week for 8 weeks. Results: Subjects in both groups experienced strength gains in the supraspinatus and the external rotators (P =.000, P =.000). However, there was no difference in strength gains between groups for the supraspinatus (P =.750) or the external rotators (P =.708). Subjects in both groups experienced increases in supraspinatus tendon thickness (BFR P =.041, exercise only P =.011). However, there was no difference between groups (P =.610). Conclusions: Exercise with BFR applied to the proximal upper extremity did not augment rotator cuff strength gains or tendon thickness when compared with subjects who only exercised. This study did demonstrate that performing multiple sets of high repetitions at a low load led to significant increases in rotator cuff strength and tendon size in the dominant upper extremity. [ABSTRACT FROM AUTHOR]

ObjectiveThis study aimed to determine whether dogs with shoulder tendinopathy diagnosed via musculoskeletal ultrasound would show improvement in imaging after treatment using piezoelectric shockwave therapy and rest.MethodsMedical records were reviewed for dogs diagnosed with biceps and/or supraspinatus tendinopathy via musculoskeletal ultrasound, treated using piezowave shockwave, and re-imaged post-treatment. Data collected included patient signalment, duration and grade of lameness, prior rest, piezowave dose, and patient outcome, including a return to sport where applicable. Images were scored using an adapted ultrasound grading scale, in addition to obtaining cross-sectional area measurements. Statistics included Shapiro–Wilk tests (normality), Wilcoxon matched pairs signed rank tests (pre- vs. post-treatment comparisons), and Spearman's correlation coefficients (lameness grade vs. ultrasound score) (significant at P < 0.05).ResultsIn total, 26 of 30 dogs had pathology involving both the biceps and supraspinatus tendons in one limb, with 27 of 30 having tendon/s affected bilaterally. For both tendons, post-treatment cross-sectional area and ultrasound score were significantly lower than pre-treatment (P < 0.001). Lameness decreased clinically (P < 0.0001) following piezowave shockwave treatment regardless of the tendons involved, but the lameness score did not correlate with the ultrasound score for either tendon.ConclusionDogs with tendinopathy of the biceps brachii and supraspinatus showed significant improvement on follow-up musculoskeletal ultrasound and lameness evaluation after the treatment of their tendons using piezoelectric shockwave therapy with rest.Clinical significanceCanine biceps brachii and supraspinatus tendinopathy can cause variable lameness and ultrasonographic appearance, which improves after shockwave therapy and rest. The ultrasound scoring system and cross-sectional area assessment provide useful outcome measures for clinical cases.

Timely detection and monitoring of acute brain injury in children is essential to mitigate causes of injury and prevent secondary insults. Increasing survival in critically ill children has emphasized the importance of neuroprotective management strategies for long-term quality of life. In emergent and critical care settings, traditional neuroimaging modalities, such as computed tomography and magnetic resonance imaging (MRI), remain frontline diagnostic techniques to detect acute brain injury. Although detection of structural and anatomical abnormalities remains crucial, advanced MRI sequences assessing functional alterations in cerebral physiology provide unique diagnostic utility. Head ultrasound has emerged as a portable neuroimaging modality for point-of-care diagnosis via assessments of anatomical and perfusion abnormalities. Application of electroencephalography and near-infrared spectroscopy provides the opportunity for real-time detection and goal-directed management of neurological abnormalities at the bedside. In this review, we describe recent technological advancements in these neurodiagnostic modalities and elaborate on their current and potential utility in the detection and management of acute brain injury. [ABSTRACT FROM AUTHOR]

Ultrasonography is increasingly applied in the critical care setting. With advancements in technology, ultrasonography has become easier to use, with smaller machines, and more fundamental to patient assessment. Ultrasonography is a hands-on tool that brings real-time, dynamic information to the bedside. Patients in the critical care setting often have unstable hemodynamics or a tenuous respiratory status; thus, the use of ultrasonography to augment the assessment greatly improves patient safety. This article explores how to differentiate the etiology of shock with the adjunct of critical care echocardiography. In addition, the article examines how various ultrasonography techniques can be used to diagnose other life-threatening cardiac conditions, such as pulmonary embolism or cardiac tamponade, and the role of echocardiography in cardiopulmonary resuscitation. Critical care providers can add echocardiography and the information it provides to their repertoire to improve diagnosis, treatment, and patient outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Portable ultrasonography (P-US) is increasingly used to diagnose syndesmotic instability. The aim of this study was to evaluate syndesmotic instability by measuring the distal tibiofibular clear space (TFCS) in a cadaveric model using P-US with progressive stages of syndesmotic ligamentous transection under external rotation stress. Methods: Ten fresh lower leg cadaveric specimens amputated above the proximal tibiofibular joint were used. Using P-US, the TFCS was evaluated in the intact stage and after progressive sectioning of the (1) anterior–inferior tibiofibular ligament (AITFL), (2) interosseous ligament (IOL), and (3) posterior–inferior tibiofibular ligament (PITFL). The TFCS was measured in both the unstressed (0 Nm) state and with 4.5, 6.0, 7.5, and 9.0 Nm of external rotation stress using a bone hook placed on the first metatarsal bone at each stage of ligamentous transection stage using both P-US and fluoroscopy. Results: When assessed with P-US, partial syndesmotic injury encompassing the AITFL and IOL resulted in significant TFCS widening at 4.5 Nm of external rotation torque when compared to intact state with a TFCS-opening of 2.6 ± 2 mm, p = 0.01. In contrast, no significant differences in TFCS were detected using fluoroscopy. Only a moderate correlation was found between P-US and fluoroscopy. Conclusion: P-US is a useful tool in diagnosing syndesmotic instability during external rotation stress examination. TFCS-opening increased as additional ligaments of the syndesmosis were transected, and application of 4.5 Nm torque was sufficient to detect a difference of 2.6 mm after the IOL cut. [ABSTRACT FROM AUTHOR]

Aims: Ultrasound is the initial imaging modality for the detection of salivary gland tumors. There is an argument for evaluating multiple characteristics for predicting tumors using this imaging modality because no single sonographic feature is adequate for differentiating between benign and malignant tumors. This study aimed to examine clinical and sonographic characteristics of major salivary gland masses using B-mode ultrasound and color Doppler and checkthe sensitivity and specificity for each parameter. Instruments & Methods: Sixty-two patients with parotid and submandibular salivaiy gland tumors underwent preoperative ultrasonic and postoperative histopathological evaluation. Different characteristics were examined, such as tumor shape, size, echotexture, internal calcification, cystic changes, clarity of the boundaries of the Lesion, lymph node enlargement, as well as the distribution of blood supply in the lesion by color Doppler. Findings: Histopathological examination revealed that 18 of 62 tumors were malignant and the rest 44 tumors were benign, and 68.2% of benign cases were pleomorphic adenomas. Mucoepidermoid carcinoma accounted for 61.1% cases. There was a significant difference between the malignant and benign tumors in calcification in the lesion, echogenicity, posterior echo enhancement, vascularity, and significant result in the shape of the lesion and homogeneity status (p< 0.01). Conclusion: Pleomorphic adenoma and mucoepidermoid carcinoma are the most frequent benign and malignant tumors, respectively. Older age and female gender are associated with a higher frequency of malignant salivaiy gland tumors. [ABSTRACT FROM AUTHOR]

Ultrasound stimulated microbubbles (USMB) is a widely used technology that can promote chemotherapeutic delivery to tumors yet the best treatment occasion for USMB is unknown or ignored. We aimed to determine the optimal treatment occasion for USMB treatment to enhance tumor chemotherapy to achieve the highest drug concentration in tumors. Experiments were conducted on VX2 tumors implanted in 60 rabbits. Gemcitabine (GEM) was intravenously infused as a chemotherapeutic agent and USMB was administered before, during or after chemotherapy. USMB was conducted with a modified diagnostic ultrasound at 3 MHz employing short bursts (5 cycles and 0.125% duty cycle) at 0.26 MPa in combination with a lipid microbubble. Subsequently, tumor blood perfusion quantitation, drug concentration detection, and fluorescence microscopy were performed. The results showed that the group that received USMB treatment immediately after GEM infusion had the highest drug concentration in tumors, which was 2.83 times that of the control group. Fifteen tumors were then treated repeatedly with the optimal USMB-plus-GEM combination, and along with the GEM and the control groups, were studied for tumor growth, tumor cell proliferation, apoptosis, and related cytokine contents. The combined treatment significantly inhibited tumor growth and promoted apoptosis. The levels of related cytokines, including HIF-1α, decreased after six combination therapies. These results suggest that the optimal treatment occasion for USMB occurs immediately after chemotherapy and tumor hypoxia improves after multiple combination therapies.

Hepatocellular carcinoma (HCC) is a unique cancer entity that can be noninvasively diagnosed using imaging modalities without pathologic confirmation. In 2018, several major guidelines for HCC were updated to include hepatobiliary contrast agent magnetic resonance imaging (HBA-MRI) and contrast-enhanced ultrasound (CEUS) as major imaging modalities for HCC diagnosis. HBA-MRI enables the achievement of high sensitivity in HCC detection using the hepatobiliary phase (HBP). CEUS is another imaging modality with real-time imaging capability, and it is reported to be useful as a second-line modality to increase sensitivity without losing specificity for HCC diagnosis. However, until now, there is an unsolved discrepancy among guidelines on whether to accept “HBP hypointensity” as a definite diagnostic criterion for HCC or include CEUS in the diagnostic algorithm for HCC diagnosis. Furthermore, there is variability in terminology and inconsistencies in the definition of imaging findings among guidelines; therefore, there is an unmet need for the development of a standardized lexicon. In this article, we review the performance and limitations of HBA-MRI and CEUS after guideline updates in 2018 and briefly introduce some future aspects of imaging-based HCC diagnosis.

Synopsis: An umbilical vein varix is a rare fetal condition and is defined as a focal dilatation of the umbilical vein. [ABSTRACT FROM AUTHOR]

Background/Purpose: Shear wave elastography (SWE) is a clinical method used to evaluate liver hardness. In this study, we assessed its applicability in assessing the pancreas and its potential for diagnosing chronic pancreatitis. Methods: We performed SWE on 59 patients who underwent abdominal ultrasound, and measured the computed tomography (CT) values of the pancreas. Patients were classified as having a normal pancreas (NP), early chronic pancreatitis (ECP), or chronic pancreatitis (CP). SW elasticity (SWe), SW dispersion (SWd), and CT values between groups were analyzed. Results: SWe significantly differed between the CP and NP/ECP groups (NP vs CP; P = 0.001, ECP vs CP; P = 0.026,), while SWd showed a significant difference only between the NP and CP group (NP vs CP; P = 0.001). The CT values were significantly different between the CP and NP/ECP groups (NP vs CP; P = 0.0006, ECP vs CP; P = 0.0027). Conclusion: Pancreatic SWE and CT values were helpful in the diagnosis of chronic pancreatitis. SWd may reveal status changes in ECP. [ABSTRACT FROM AUTHOR]

Rehabilitative exercises alleviate pain in patients with patellofemoral pain (PFP); however, no researchers have analyzed the cartilage response after a bout of those athletic activities in patients with PFP. To determine if a single session of rehabilitative exercises alters femoral cartilage morphology. Crossover study. Research laboratory. Twelve participants with PFP (age = 21.0 ± 2.0 years, height = 1.72 ± 0.1 m, mass = 68.7 ± 12.6 kg) and 12 matched healthy participants (age = 21.3 ± 2.8 years, height = 1.71 ± 0.1 m, mass = 65.9 ± 12.2 kg) were enrolled. Participants completed treadmill running, lower extremity strengthening exercises, and plyometric exercises for 30 minutes each. Patient-reported outcomes on the visual analog scale, Anterior Knee Pain Scale (AKPS), Knee injury and Osteoarthritis Outcome Score (KOOS), and Knee Injury and Osteoarthritis Outcome Score for Patellofemoral Pain and Osteoarthritis were collected. Femoral cartilage ultrasonographic images were obtained at 140° of knee flexion. Ultrasound images were segmented into medial and lateral images using the intercondylar notch. Medial and lateral cartilage cross-sectional area (mm2) and echo intensity (EI), defined as the average grayscale from 0 to 255, were analyzed by ImageJ software. The difference between loading conditions was calculated using repeated-measures analysis of variance. The Spearman correlation was calculated to find the association between the cartilage percentage change (Δ%) and patient-reported outcomes. Pain increased in the PFP group after all loading conditions (P values <.007). No differences were found in cartilage cross-sectional area or EI alteration between or within groups (P values >.06). The KOOS was negatively associated with the Δ% of the lateral femoral cartilage EI after plyometric loading (ρ = –0.87, P =.001), and the AKPS score was positively correlated with the Δ% of lateral femoral cartilage EI (ρ = 0.57, P =.05). Ultrasound imaging did not identify cartilaginous deformation after all loading conditions. However, because lateral cartilaginous EI changes were associated with the AKPS and KOOS score, those questionnaires may be useful for monitoring changes in femoral cartilage health. [ABSTRACT FROM AUTHOR]

It is important to improve cerebrovascular health before the occurrence of cerebrovascular disease, as it has various aftereffects and a high recurrence rate, even with appropriate treatment. Various medical recommendations for preventing cerebrovascular diseases have been introduced, including smoking cessation, exercise, and diet. However, the effectiveness of these methods varies greatly from person to person, and their effects cannot be confirmed unless they are practiced over a long period. Therefore, there is a growing need to develop more quantitative methods that are applicable to the public to promote cerebrovascular health. Thus, in this study, we aimed to develop noninvasive and quantitative thermal stimulation techniques using ultrasound to improve cerebrovascular health and prevent cerebrovascular diseases. This study included 27 healthy adults in their 20s (14 males, 13 females). Thermal stimulation using therapeutic ultrasound at a frequency of 3 MHz was applied to the right sternocleidomastoid muscle in the supine posture for 2 min at four intensities (2.4, 5.1, 7.2, and 10.2 W/cm2). Diagnostic ultrasound was used to measure the peak systolic velocity (PSV), heart rate (HR), and pulse wave velocity (PWV) in the right common carotid artery (CCA), and the physiological changes were compared between intervention intensities. Compared to pre-intervention (preI), the PSV showed a significant increase during intervention (durI) at intensities of 7.2 W/cm2 and 10.2 W/cm2 (p = 0.010 and p = 0.021, respectively). Additionally, PWV showed a significant decrease for post-intervention (postI) at 7.2 W/cm2 and 10.2 W/cm2 (p = 0.036 and p = 0.035, respectively). However, the HR showed no significant differences at any of the intensities. The results demonstrate that an intervention at 3 MHz with an intensity of 7.2 W/cm2 or more can substantially increase cerebral blood flow and reduce arterial stiffness. Therefore, the use of therapeutic ultrasound of appropriate intensity is expected to improve the cerebral blood flow and reduce vascular stiffness to maintain cerebral blood flow at a certain level, which is closely related to the prevention and treatment of cerebrovascular diseases, thereby improving cerebrovascular health.

Case presentation: An 84-year-old man presented to the emergency department with sudden, left lower quadrant cramping pain. Because critical hypotension was noted, point-of-care ultrasonography (POCUS) was performed immediately. The study revealed a pulsatile flow extravasating from the left common iliac artery into the left psoas muscle with hypoechoic para-aortic fluid collection. Discussion: Common iliac artery rupture is rare and has nonspecific clinical presentations. A quick disposition can be made with a combination of clinical manifestations and POCUS results. [ABSTRACT FROM AUTHOR]

Background: A comprehensive neck ultrasound (US) is essential in the operative planning of patients with thyroid disease. Recent literature has shown surgeon‐performed US (SUS) can be more accurate than radiology‐performed US for the purpose of surgical planning. Missed findings on radiology‐performed ultrasound may lead to inadequate surgical management. Methods: A retrospective cohort study of patients undergoing total thyroidectomy with lateral neck dissection for thyroid cancer, with both radiology‐performed US and SUS performed by a Head and Neck surgeon. Ultrasound findings and adherence to American Thyroid Association (ATA) guidelines were compared, and changes in management based on SUS findings were identified. Results: A total of 26 patients who underwent total thyroidectomy with lateral neck dissection met the inclusion criteria. Preconsultation US investigations fulfilled criteria as recommended by the American Thyroid Association (ATA) guidelines in 57.7%% of cases. The central and lateral neck compartments were assessed in 57.7% and 84.6% of preconsultation US investigations respectively. Central and lateral metastatic neck metastases were incorrectly reported or not reported in 78.6% and 42.3% of cases. The SUS findings prompted a change in surgical management in 65.4% of cases. Conclusion: SUS changed surgical management in two thirds (65.4%) of patients. Reliance on radiology‐performed ultrasound alone may result in incorrect staging. Awareness of the additional benefits of SUS is important for surgeons treating patients with thyroid disease to prevent inadequate surgery being performed. [ABSTRACT FROM AUTHOR]