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Dog overpopulation and stray dogs are global issues that are detrimental to public health and animal welfare. Thus, the goal of the current study was to provide alternatives for surgical castration. Therefore, calcium chloride was employed in this study, which might be an option for castration. Ten dogs were divided into two groups of five: a calcium chloride-treated group and a control group. The treated group received a single bilateral intratesticular injection of 1 ml of sterile saline containing calcium chloride dihydrate (CaCl2•2 H2O) at a dose of 20 mg/kg per testicle. While the control group was treated with 1 ml of sterile saline solution, Semen and blood collection, as well as Doppler ultrasonography, were routinely carried out every week on days 0, 7, 14, 21, and 28 in order to evaluate the impact of the injection on semen parameters and testicular blood flow. The testicular volume and echogenicity in the CaCl2-treated group were significantly (P < 0.001) lower in weeks 2 through 4 than in the control group. Furthermore, in canine semen, CaCl2 dramatically decreased the amount, motility, and viability of sperm. When compared to vehicle-control animals, azoospermia was seen 2 weeks after the injection and persisted for the end of the study. The testes of all dogs were surgically removed at 30 days post-injection, and testes were put in 10% neutral buffered formalin for tissue processing. When compared to the control group, the average weight of testes in the chemical groups was dramatically reduced. Significant decreases in spermatogenic processes, necrosis, and degeneration of seminiferous tubules packed with necrotic debris, and fibrosed interstitial tissue, necrosed and calcified Sertoli, and Leydig cells were seen 30 days after CaCl2 injection. There was a significant decrease in testosterone levels compared to day 0 before CaCl2 injection and the control group. From weeks 1 through 4, there was a substantial decrease in both peak systolic velocity (PSV) and end-diastolic velocity (EDV) values (P < 0.001) following a single intratesticular injection of CaCl2. The resistance index (RI) and pulsatility index (PI) showed the opposite tendency. Based on the histopathological and semen evaluations in this investigation, the study concludes that a single intratesticular injection of CaCl2 appears to be a practical and generally applicable approach for chemical sterilization of dogs. [ABSTRACT FROM AUTHOR]

To estimate the number of pregnancies complicated by vasa previa annually in nine developed countries, and the potential preventable stillbirths associated with undiagnosed cases. We also assessed the potential impact of universal screening for vasa previa on reducing stillbirth rates. We utilized nationally-reported birth and stillbirth data from public databases in the United States, United Kingdom, Canada, Germany, Ireland, Greece, Sweden, Portugal, and Australia. Using the annual number of births and the number and rate of stillbirths in each country, and the published incidence of vasa previa and stillbirth rates associated with the condition, we estimated the expected annual number of cases of vasa previa, those that would result in a livebirth, and the potential preventable stillbirths with and without prenatal diagnosis. There were 6,099,118 total annual births with 32,550 stillbirths, corresponding to a summary stillbirth rate of 5.34 per 1,000 pregnancies. The total expected vasa previa cases was estimated to be 5,007 (95 % CI: 3,208–7,201). The estimated number of livebirths would be 4,937 (95 % CI: 3,163–7,100) and 3,610 (95 % CI: 2,313–5,192) in pregnancies with and without a prenatal diagnosis of VP. This implies that prenatal diagnosis would potentially prevent 1,327 (95 % CI: 850–1,908) stillbirths in these countries, corresponding to a potential reduction in stillbirth rate by 4.72 % (95 % CI: 3.80–5.74) if routine screening for vasa previa was performed. Our study highlights the importance of universal screening for vasa previa and suggests that prenatal diagnosis of prevention could potentially reduce 4–5 % of stillbirths. [ABSTRACT FROM AUTHOR]

Background: A reversal of time difference between the onset of early diastolic velocity (e') during tissue Doppler imaging and the onset of mitral inflow (E) has been observed in cases of elevated left atrial pressure. Whether this interval (Te'-E) may be useful to assess right atrial pressure has never been investigated, neither in healthy subjects nor in pulmonary hypertension patients. Methods: Right ventricular Te'-E was assessed in patients with pre-capillary pulmonary hypertension and compared with healthy volunteers who underwent comprehensive echocardiography examination. Te'-E is the difference between the interval from R wave at the superimposed electrocardiogram to the e' wave during right ventricular tissue Doppler imaging and the interval from the R wave to transtricuspid E wave during pulsed wave Doppler imaging. Right atrial pressure was invasively measured in pulmonary hypertension patients. Results: Fifty-six patients were enrolled. Te'-E was prolonged in pulmonary hypertension subjects compared with healthy subjects (p < 0.001). Amongst the pulmonary hypertension patients, strong correlations were found between Te'-E and right atrial pressure (r = −0.885, p < 0.001), systolic pulmonary pressure (r = −0.85, p < 0.001) and the duration of tricuspid regurgitation (r = 0.72, p < 0.001). The area under the receiver operating characteristic curve of Te'-E in identifying right atrial pressure higher than 15 mm of mercury was 0.992 (sensitivity 100%, specificity 83%). Conclusions: In contrast to the left ventricle, there is a delay in the proto-diastolic filling in pulmonary hypertension patients, which correlates with the increase in systolic pulmonary arterial pressure, right atrial pressure, tricuspid regurgitation duration and restrictive diastolic pattern. [ABSTRACT FROM AUTHOR]

The availability of Global Navigation Satellite System (GNSS) raw observations in smartphones has driven research into low-cost GNSS solutions, especially in challenging urban environments, which have garnered significant attention from scholars in recent years. This study proposes an improved smartphone-based velocity-aided positioning method and conducts vehicle-mounted experiments in urban roads representing typical scenarios. The results show that when transitioning from low- to high-multipath environments, the number of visible satellites and carrier phase observations are highly sensitive to environmental factors, with frequent multipath effects. The introduction of robust pre-fit and post-fit residual algorithms has proven to be an effective quality control method. Additionally, using more refined observation models and appropriate parameter estimation algorithms led to a slight 6% improvement in velocity performance. The improved Kalman filter position estimation model (KFSPP-P) strategy, by incorporating velocity uncertainty into the state estimation process, overcomes the limitations of conventional velocity-aided smartphone positioning methods (KFSPP-V) in complex urban environments. In low-multipath environments, the accuracy of the KFSPP-P strategy is comparable to that of KFSPP-V, with an approximate 8% improvement in horizontal accuracy. However, in more challenging environments, such as tree-lined roads and urban environments, the KFSPP-P strategy shows significant improvements, particularly enhancing horizontal positioning accuracy by approximately 50%. These advancements demonstrate the potential of using smartphones to provide reliable positioning services in complex urban environments. [ABSTRACT FROM AUTHOR]

This study aimed to assess the impact of protein supplementation and its interaction with calf sex (CS) on the performance, metabolism and physiology of pregnant beef cows. Fifty‐two multiparous Zebu beef cows carrying female (n = 22) and male (n = 30) fetuses were used. Cows were individually housed from day 100 to 200 of gestation and randomly assigned to restricted (RES, n = 26) or supplemented (SUP, n = 26) groups. The RES cows were ad libitum fed a basal diet (corn silage + sugarcane bagasse + mineral mixture), achieving 5.5% crude protein (CP), while SUP cows received the same basal diet plus a protein supplement (40% CP, at 3.5 g/kg of body weight). All cows were fed the same diet during late gestation. Differences were declared at p < 0.05. No significant interaction between maternal nutrition and calf sex was found for maternal outcomes (p ≥ 0.34). The SUP treatment increased the total dry matter (DM) intake (p ≤ 0.01) by 32% and 19% at mid‐ and late‐gestation respectively. The total tract digestibility of all diet components was improved by SUP treatment at day 200 of gestation (p ≤ 0.02), as well as the ruminal microbial CP production (p ≤ 0.01). The SUP treatment increased (p ≤ 0.03) the cows' body score condition, ribeye area, the average daily gain (ADG) of pregnant components (PREG; i.e., weight accretion of cows caused by pregnancy) and the ADG of maternal tissues (i.e., weight accretion discounting the gain related to gestation) in the mid‐gestation. The SUP cows exhibited a lower maternal ADG (p < 0.01) compared to RES cows in late pregnancy. There was a 24% additional gain (p < 0.01) in the PREG components for SUP cows during late gestation, which in turn improved the calf birthweight (p = 0.05). The uterine arterial resistance and pulsatility indexes (p ≤ 0.01) at mid‐gestation were greater for RES cows. In conclusion, protein supplementation during mid‐gestation is an effective practice for improving maternal performance, growth of the gravid uterus and the offspring's birth weight. [ABSTRACT FROM AUTHOR]

Introduction: Imaging fibroid vascularity may predict fibroid growth and aid to determine most appropriate therapy. Microvascular (MV) flow imaging is relatively new and is able to detect slow flow in small vessels. Data on feasibility, reproducibility, and reliability of MV‐flow imaging in fibroids is lacking. The purpose of our study was to determine the reproducibility of MV‐flow imaging and to explore this technique for clinical practice for assessing blood flow in fibroids. Material and Methods: Thirty patients with one or multiple fibroids (diameter 1.5–12.0 cm) were prospectively included. Transvaginal ultrasound scanning was performed in B‐mode, 2D MV‐Flow™, 2D and 3D power Doppler mode (HERA W10, Samsung) by two experienced gynecologists at a tertiary care clinic from February to December 2021. The primary outcome was intra‐ and interobserver agreement of the vascular index (VI) and color score (CS). The following parameters: '2D MV‐flow VI', '3DPD VI', '2D MV‐flow CS' and '2DPD CS' were measured offline in the center, pseudocapsule, and entire fibroid. Secondary offline outcomes for exploring 2D MV‐flow for clinical practice, included (1) ability to discern vascular structures, (2) assessing the degree of vascularity via CS and calculating a VI, and (3) determining penetration depth of the ultrasound signal in both power Doppler and MV‐flow imaging. Results: All scans of the 30 included patients were of sufficient quality to analyze. Inter‐ and intra‐observer correlations of all studied parameters were good to excellent, both for 2D MV‐flow and 2D power Doppler (intercorrelation coefficient 0.992–0.996). Using 2D MV‐flow different vascular structures were visible in detail, in contrary to using 2D and 3D power Doppler. In significantly more fibroids central flow could be visualized using 2D MV‐flow (63%) than with 2D power Doppler (13%, p = 0.001). Finally, penetration of the ultrasound signal was deeper using 2D MV‐flow (3.92 cm) than with 2D power Doppler (2.95 cm, p = 0.001). Conclusions: Using 2D MV‐flow imaging for determining vascularity is highly reproducible. It has potential added value for clinical practice as it depicts detailed vascular structures and the degree of vascularity, especially in the center of the fibroid. [ABSTRACT FROM AUTHOR]

To characterize the correlation, agreement and concordance of cardiac output (CO) measured with transthoracic ultrasound and the correlation and concordance of aortic blood flow (ABF) minute distance (MD) measured by transesophageal Doppler with CO measured by pulmonary artery thermodilution (PATD) in cats. Experimental study. A group of six healthy male neutered cats, aged 2–8 years and weighing 5.3 ± 0.3 kg. Cats were anesthetized with isoflurane in oxygen. CO was measured by PATD (CO PATD) and transthoracic echocardiography (CO ECHO). ABF MD was measured using an esophageal Doppler flow probe aligned with descending ABF. All measurements were made under three conditions: dexmedetomidine (20 μg kg–1) intravenously; atipamezole (200 μg kg–1) intramuscularly and atropine (20 μg kg–1) intravenously as needed to achieve a minimum heart rate of 140 beats minute–1; and dopamine (20 μg kg–1 minute–1) intravenously in that order. Correlation between CO PATD and CO ECHO , and CO PATD and Doppler MD was evaluated using repeated measures correlation. Agreement between CO PATD and CO ECHO was evaluated using Bland–Altman method. Differences between consecutive pairs of CO measurements were calculated for concordance analysis. Correlation between CO PATD and CO ECHO and between CO PATD and MD was significant (p < 0.001), with correlation coefficients greater than 0.92. A bias of > 27% and upper limits of agreement of 66% were found between CO PATD and CO ECHO. Concordance rate with CO PATD was 76–80% for CO ECHO and 72% for MD. Echocardiographic methods for the measurement of CO showed poor agreement and concordance with PATD. MD showed poor concordance with PATD. As such, these methods cannot be used as an alternative to PATD nor can they appropriately track changes in CO in anesthetized cats. [ABSTRACT FROM AUTHOR]

This research work emphasizes on the development aspects of a cartridge cable cutter for helicopter application. This cartridge is used to rescue hoist system during emergency for helicopter application under adverse conditions. It is an electrically initiated cartridge in which two electrical squibs are used with specified current and voltage. As the cartridge is initiated, the squib gets incandescent and initiates an explosive train. A cartridge cable cutter is a propellant actuated device (PAD) that generates hot combustion gases having high temperature and pressure on burning of gun powder and propellant inside the cartridge case. The cable cutter cartridge under study is filled with energetic materials (EM) such as propellants and gun powder. It releases the energy very quickly which acts on the projectile i.e. the cutter in actual system. A projectile velocity measurement was carried out using Doppler RADAR (radio detection and ranging). To assess the projectile velocity is the unique design feature in armament field. It is responsible for the measurement of the projectile velocity at the muzzle end of velocity test rig (VTR). The minimum and maximum projectile velocities were experimentally measured in between 70 ms−1 and 150 ms−1. The projectile velocity measurement is an evaluation methodology as performance parameter of this cartridge. The cartridge under study has been developed meeting structural, functional and mechanical requirements. The cartridge has undergone various exhaustive qualification tests during development phase. The cartridge was thus designed, qualified and validated through rigorous development trials. The main objective of this article is to address development aspects of the cartridge cable cutter for helicopter application. In conclusion, after successful design, development and qualification trials, the cartridge was found to meet all the functional and operational requirements considering the end use. [ABSTRACT FROM AUTHOR]

Background: Median arcuate ligament syndrome (MALS) poses a considerable challenge in terms of diagnosis due to its manifestation of diverse symptoms linked to constriction of the median arcuate ligament surrounding the celiac artery. The present study introduces an earlier diagnostic modality using ultrasound measurements of the flow velocity of the celiac artery during the inspiratory and expiratory phases, with the latter being higher than the former, to avoid prolonged follow-up of postprandial symptomatology. Case Report: A 46-year-old female patient presented with acute postprandial abdominal pain, which was alleviated by analgesic medication. The findings from the physical examination and laboratory tests were within normal limits. Further investigations were conducted due to persistent symptoms, revealing an elevation in celiac artery flow velocity during expiration on ultrasound. The diagnosis of median arcuate ligament syndrome (MALS) was confirmed through contrast-enhanced CT and angiography. Subsequently, the patient underwent laparoscopic release of the median arcuate ligament, leading to alleviation of symptoms at the 1-year follow-up assessment. Conclusions: Our case report highlights the importance of a dynamic imaging diagnostic strategy for MALS. When encountering challenging postprandial abdominal pain that is hard to diagnose, it could be crucial to utilize abdominal ultrasound to measure the flow velocity of the celiac artery. This approach may serve as a valuable screening method for identifying MALS and, subsequently, prompt the need for further diagnostic tests. [ABSTRACT FROM AUTHOR]

Background: Routine Doppler study is a common tool for early diagnosis of Fetal Growth Restriction (FGR) and Small for Gestational Age (SGA) patients. It aimed to determine the role of the Foramen Ovale Pulsatility Index (FOPI) study beside routine Doppler study among patients with FGR and SGA fetuses. Methods: This prospective study was conducted on 35 FGR, 32 SGA, and 33 Appropriate for Gestational Age (AGA) fetuses. Demographic data, amniotic fluid index, neonatal outcome, and Doppler velocimetry, including Umbilical Artery Pulsatility Index (UMAPI), Uterine Artery Pulsatility Index (UTAPI), Middle Cerebral Artery Pulsatility Index (MCAPI), Ductus Venosus Pulsatility Index (DVPI), and FOPI were documented. Kolmogorov-Smirnov normality test, one-way ANOVA, Mann-Whitney U, Kruskal-Wallis, non-parametric pairwise comparisons adjusted for Bonferroni correction, Pearson correlation test, Chi square, Fisher's exact test, and Receiver Operating Characteristic Curve (ROC) analysis with Youden's Index (sensitivity+specificity-1) to estimate cut-off point were used to analyze the data at significance level <0.05 for all tests. Results: FOPI cut-off points were 2.24 (sensitivity=77%, specificity=94%) and 1.15 (sensitivity=90%, specificity=20%) to predict FGR and SGA, respectively. FOPI showed a positive correlation with UMAPI and UTAPI (r=0.52 and r=0.30, P<0.001 and P=0.006, respectively), but not with MCAPI and DVPI (r=0.08 and r=0.12, P=0.50 and P=0.30, respectively). Besides, UMAPI, UTAPI, and FOPI were altered among patients with stages I and II FGR. Umbilical cord potential hydrogen (umbilical cord pH), 1- and 5-min Apgar score significantly increased by Birth weight centile; however, UMAPI, FOPI, and UTAPI significantly decreased. Conclusion: UMAPI is recommended to predict short-term neonatal morbidities and demonstrate the early or late onset FGR. Besides, FOPI is suggested as the first-line Doppler study to detect abnormal growth velocity. More studies are warranted, especially considering long-term neonatal morbidities. [ABSTRACT FROM AUTHOR]

Objective: To assess the predictive abilities of Doppler‐based resistive index and plasma biomarkers of endothelial cell activation in identifying persistent acute kidney injury (pAKI) among patients with septic shock. Method: Patients diagnosed with septic shock were categorized into none AKI (n = 25), transient AKI (tAKI, n = 47), and pAKI (n = 48) groups. Kidney function parameters (urine output, serum creatinine, and serum urea) were measured within the initial 24 h upon intensive care unit (ICU) admission. The Doppler‐based resistive index, and the plasma biomarkers [fractalkine, soluble E‐Selectin (sE‐Selectin), and soluble intercellular adhesion molecule‐1 (sICAM‐1)] were evaluated upon admission to the ICU. Results: The predictive capacity of Doppler‐based resistive index for distinguishing pAKI at day 3 from none AKI/tAKI in septic shock patients was moderate, with sensitivity of 47.92% and specificity of 76.39%. Fractalkine levels displayed significant differences across groups and exhibited a favorable predictive ability for pAKI at day 3 (AUC = 0.800), while sE‐Selectin and sICAM‐1 showed moderate predictive abilities (AUC = 0.636 and 0.634, respectively). Comparative analysis of predictive models demonstrated that incorporating kidney function parameters, Doppler‐based resistive index, and plasma biomarkers yielded the highest AUC of 0.903, followed closely by the model utilizing serum creatinine, urine output, and plasma fractalkine, with an AUC of 0.896. Conclusion: Integrating kidney function parameters, along with Doppler‐based resistive index and plasma biomarkers of endothelial cell activation, yielded the strongest predictive model for pAKI. Additionally, the combination of serum creatinine, urine output, and plasma fractalkine shows promise in risk assessment and management strategies for pAKI. [ABSTRACT FROM AUTHOR]

Simple Summary: Doppler ultrasound is a commonly utilised non-invasive blood pressure measurement technique in dogs under general anaesthesia. This prospective clinical study compared the agreement of values obtained by audible return of pulsatile flow using Doppler ultrasound and visual sphygmomanometer needle oscillation with invasive arterial blood pressure in a clinical population of anaesthetised dogs. Visual sphygmomanometer needle oscillation (SNO) can occur before audible return of pulsatile flow (ARPF) when measuring blood pressure by Doppler ultrasound. The aim was to assess the agreement of SNO and ARPF with invasive blood pressure (iABP) in a clinical population of anaesthetised dogs. A total of 35 dogs undergoing surgery in dorsal recumbency necessitating arterial cannulation were included. Paired measurements of iABP and SNO, and iABP and ARPF, were collected. The agreement of non-invasive blood pressure (NIBP) and iABP measurements was analysed with concordance correlation coefficients (CCCs) and Bland–Altman plots. The proportions of SNO and ARPF measurements between 10 and 20 mmHg of iABP were compared. Both SNO and ARPF demonstrated greater agreement with invasive systolic (iSAP) than invasive mean (iMAP) pressures, and SNO demonstrated greater agreement with iSAP than ARPF measurements. The mean differences (95% limits of agreement) for SNO and APRF were −9.7 mmHg (−51.3–31.9) and −13.1 mmHg (−62.2–35.9), respectively. The CCC (95% CI) for SNO was 0.5 (0.36–0.64) and ARPF was 0.4 (0.26–0.54). A significantly greater proportion of SNO measurements were within 20 mmHg of iSAP compared to ARPF. Both NIBP techniques performed more poorly than veterinary consensus recommendations for device validation. Caution should be used clinically when interpreting values obtained by Doppler ultrasound in anaesthetised dogs. [ABSTRACT FROM AUTHOR]

Interactions between ocean surface currents, winds and waves at the atmosphere-ocean interface are key controls of lateral and vertical exchanges of water, heat, carbon, gases and nutrients in the global Earth System. The SeaSTAR satellite mission concept proposes to better quantify and understand these important dynamic processes by measuring two-dimensional fields of total surface current and wind vectors with unparalleled spatial and temporal resolution (1 × 1 km2 or finer, 1 day) and unmatched precision over one continuous wide swath (100 km or more). This paper presents a comprehensive numerical analysis of the expected performance of the Earth Explorer 11 (EE11) SeaSTAR mission candidate in the case of idealised and realistic 2D ocean currents and wind fields. A Bayesian framework derived from satellite scatterometry is adapted and applied to SeaSTAR's bespoke inversion scheme that simultaneously retrieves total surface current vectors (TSCV) and ocean surface vector winds (OSVW). The results confirm the excellent performance of the EE11 SeaSTAR concept, with Root Mean Square Errors (RMSE) for TSCV and OSVW at 1 × 1 km2 resolution consistently better than 0.1 m/s and 0.4 m/s, respectively. The analyses highlight some performance degradation in some relative wind directions, particularly marked at near range and low wind speeds. Retrieval uncertainties are also reported for several variations around the SeaSTAR baseline three-azimuth configuration, indicating that RMSEs improve only marginally (by ∼0.01 m/s for TSCV) when including broadside Radial Surface Velocity or broadside dual-polarisation data in the inversion. In contrast, our results underscore (a) the critical need to include broadside Normalised Radar Cross Section data in the inversion; (b) the rapid performance degradation when broadside incidence angles become steeper than 20° from nadir; and (c) the benefits of maintaining ground squint angle separation between fore and aft lines-of-sight close to 90°. The numerical results are consistent with experimental performance estimates from airborne data and confirm that the EE11 SeaSTAR concept satisfies the requirements of the mission objectives. [ABSTRACT FROM AUTHOR]

Objective To explore the relationship between the serum level of placental growth factor (PLGF) and ultrasonic blood flow parameters and pregnancy outcome in patients with late-onset preeclampsia (LOPE). Methods A total of 152 patients with LOPE were selected and divided into the P1 (＜ 12.00 ng/L) group, the P2 (12.00-56.73 ng/L) group, the P3 (＞56.73-89.41 ng/L) group and the P4 (＞ 89.41 ng/L) group according to serum level of PLGF. There were 38 cases in each group. The clinical data, uterine artery pulsatility index (PI), resistance index (RI), peak systolic velocity (S)/ end-diastolic velocity (D) and adverse pregnancy outcome were compared between the four groups. The relationship between PLGF level and clinical characteristics was analyzed by linear regression analysis. The influence of LOPE severity on the relationship between PLGF and ultrasonic blood flow parameters was analyzed by stratified interactive analysis. Multivariate generalized linear mixed effect model was used to analyze the relationship between PLGF level and adverse pregnancy outcome in patients with LOPE. Results The diastolic blood pressure, 24 h urinary protein, PI, RI and S/D decreased significantly with the increase of PLGF level (P＜0.05). The proportion of severe LOPE and systolic blood pressure were significantly higher in the P1 group than those of the other groups (P＜0.05), and the above indexes were influencing factors of the level of PLGF (P＜0.05). The results of stratified interactive test showed that the LOPE severity did not affect the relationship between PLGF and ultrasonic blood flow parameters. There were significant differences in the incidence of HELLP syndrome, fetal growth restriction, fetal distress, premature delivery and neonatal asphyxia between patients with different PLGF levels (P＜0.05). The incidence of preterm delivery was higher in the P1 group than that in the other groups, and the other adverse pregnancy outcomes were higher in the P3 group and P4 group. Conclusion Serum PLGF levels affect uterine artery blood flow parameters and adverse pregnancy outcome in patients with LOPE. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between varying degrees of abnormality in the Doppler uterine artery pulsatility index (UtA‐PI) and adverse perinatal outcome. Methods: This was a prospective study of women with a singleton, non‐anomalous pregnancy in whom UtA‐PI was measured universally in midpregnancy and who gave birth in Oxford University Hospitals, Oxford, UK, between 2016 and 2023. Relative risk ratios (RRR) for the primary outcomes of extended perinatal mortality and live birth with a severe small‐for‐gestational‐age (SGA) neonate were calculated using multinomial logistic regression, for early preterm birth (before 34 + 0 weeks' gestation) and late preterm/term birth (at or after 34 + 0 weeks). Risks were also investigated for iatrogenic preterm birth and a composite adverse outcome before 34 + 0 weeks. Results: Overall, 33 364 pregnancies were included in the analysis. Compared to those with a normal UtA‐PI, the risk of extended perinatal mortality with delivery before 34 + 0 weeks was higher in women with UtA‐PI ≥ 90th percentile (RRR, 4.7 (95% CI, 2.7–8.0); P < 0.001), but this was not demonstrated in births at or after 34 + 0 weeks. The risk of live birth with severe SGA was associated strongly with abnormal UtA‐PI for early births (RRR, 26.0 (95% CI, 11.6–58.2); P < 0.001) and later births (RRR, 2.3 (95% CI, 1.8–2.9); P < 0.001). Women with raised UtA‐PI were more likely to have an early iatrogenic birth (RRR, 7.8 (95% CI, 5.5–11.2); P < 0.001). For each outcome before 34 + 0 weeks and the composite outcome, the risk increased significantly in association with the degree of abnormality in the UtA‐PI (from < 90th, 90–94th, 95–98th to ≥ 99th percentile) (Ptrend < 0.001). When using the 90th percentile as opposed to the 95th, there was a significant improvement in the overall predictive accuracy (as determined by the area under the receiver‐operating‐characteristics curve) for the composite adverse outcome (χ2 = 6.64, P = 0.01) and iatrogenic preterm birth (χ2 = 4.10, P = 0.04). Conclusions: Elevated UtA‐PI is a key predictor of iatrogenic preterm birth, severe SGA and perinatal loss up to 34 + 0 weeks' gestation. The 90th percentile for UtA‐PI should be used, and management should be tailored according to the degree of abnormality, as pregnancies with very raised UtA‐PI measurement constitute a group at extreme risk of adverse outcome. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the prevalence of oligohydramnios, brain sparing, and cardiac dysfunction among a cohort of fetal growth restriction (FGR). Methods: To assess the prevalence of oligohydramnios amongst a large sample of FGR fetuses, we screened a database of ultrasounds of FGR pregnancies from our maternal‐fetal medicine clinics (clinical cohort) for diminished amniotic fluid volume. Using a threshold of a maximum vertical pocket (MVP) of <2 cm for "oligohydramnios," and 2 to 3 cm as a "reduced fluid" group, trends of Doppler values and cardiac parameters were assessed from pregnancies in an ongoing research study (comprehensive cohort). Results: In the clinical cohort, oligohydramnios was identified in only 2/229 (0.8%) and reduced fluid in 19/229 (8%). In the comprehensive cohort, oligohydramnios was seen in 3/126 (2.3%) and reduced fluid in 14/126 (11.1%). A high rate of cardiac and Doppler abnormalities were observed in the oligohydramnios group of the comprehensive cohort. The patients with oligohydramnios had a distinctly different cardiac phenotype with small (2/3 with cardiac area <5th%) (P = 0.01) and round (3/3 with global sphericity index <5th%) (P = 0.02) hearts. Conclusion: Oligohydramnios, when present with FGR, is accompanied by high rates of cerebral and cardiovascular abnormalities. Access the CME test here and search by article title. [ABSTRACT FROM AUTHOR]

Objective: To analyze the value of prenatal diagnostic genetic testing in cases with isolated aberrant right subclavian artery (ARSA). Methods: This is a retrospective cohort study, conducted between January 2015–January 2022 in a fetal medicine center. Women who had an ultrasound scan and diagnosed with fetal ARSA were included. Ultrasonographic characteristics, genetic, obstetric, and neonatal outcomes were collected and analyzed. Results: A total of 240 fetuses with ARSA were identified and included to the analysis. Eighty‐two of the group had isolated ARSA (34.2%, 82/240), 57 had additional soft markers (23.8%, 57/240) and 101 had additional major ultrasonographic abnormalities (42.1%, 101/240). Genetic results were available in 196 cases (81.7%, 196/240). Seventy‐four of isolated ARSA cases underwent genetic testing (90.2%, 74/82). A chromosomal abnormality was present in 60 cases; 54 (22.5%, 54/240) aneuploidies and 6 (2.5%, 6/240) copy number variants. Five (6.1%) of the isolated ARSA cases had chromosomal abnormalities. All of these five cases had prenatal genetic testing due to high‐risk aneuploidy screening fetuses who had ARSA with at least one additional anomaly had the highest chromosomal abnormality rate (38.6%, 39/101). Seventy‐seven of isolated ARSA cases were liveborn (93.9%, 77/82). Conclusion: Our results supports the evidence from the literature that isolated ARSA confers a very low‐risk for aneuploidy, if the aneuploidy screening tests are low‐risk. Also, chromosomal microarray analysis did not yield any extra information in isolated ARSA. [ABSTRACT FROM AUTHOR]

Simple Summary: The ovarian and middle uterine artery blood flows were examined in cows under heat stress conditions regarding hormonal profile. Luteal vascularity was declined in cows with embryonic death. Progesterone levels elevated in cows with embryonic death, then declined. In addition, both Doppler indices were elevated in cows that suffered from embryonic death. This study provided facts about the relations among the luteal diameter and luteal hemodynamics that predict the amount of blood supply, which act as a sensitive parameter to detect the alterations in luteal function during the first 50 days after mating. This current study examined the ovarian (OA) and middle uterine arteries (MUA) blood flow under heat stress conditions regarding hormonal status (progesterone (P4), estradiol (E2), and nitric oxide metabolites (NOMs) assays). Eighteen pluriparous cows were examined, with twelve only being subjected to the natural mating as the other six animals were not bred. Pregnancy diagnosis was confirmed at day 30 by embryonic heartbeat and CL graviditatis (n = 6; pregnant), but some animals (n = 6) showed early embryonic death (EED), with the presence of control cows (n = 6). In the pregnant group, luteal diameter (cm) increased after mating, while in the pregnancy loss group it increased (p < 0.05) until reaching day 38 (1.41 ± 0.03), then decreased again. Luteal vascularity was declined in cows with EED after day 36 (p < 0.05) and reached its lowest level at day 50. P4 levels elevated in cows with EED until day 36 (13.64 ± 0.11) then declined. Both ipsilateral OA and MUA Doppler indices were declined in both groups except in cows who suffered from EED; both were elevated from day 38 until day 50 after mating. Ipsilateral peak systolic point (PSV cm/sec) of OA and MUA was elevated in both groups (p < 0.05), but in cows with EED this parameter was declined. E2 and NOMs levels were declined in cows with EED from day 40 and day 38 after mating (p < 0.05), respectively. This study provided novel data on the relations among the luteal diameter, E2, P4, and NOM levels, and luteal hemodynamics that predicts the amount of blood supply, which acts as a sensitive parameter to detect the alterations in luteal function during the first 50 days after mating. [ABSTRACT FROM AUTHOR]

Microwave Doppler sensors are used extensively in motion detection as they are energy-efficient, small-size and relatively low-cost sensors. Common applications of microwave Doppler sensors are for detecting intrusion behind a car roof liner inside an automotive vehicle and to detect moving objects. These applications require a millisecond response from the target for effective detection. A Doppler microwave sensor is ideally suited to the task, as we are only interested in movement of a large water-based mass (i.e., a person) (FMCW Radar also detect static objects). Although microwave components at 2.45   G Hz are now relatively cheap due to mass production of other Industrial Scientific and Medical application (ISM) devices, they do require tuning for temperature compensation, dielectric, and manufacturing variability. A digital solution would be ideal, as chip solutions are known to be more repeatable, but Application-Specific Integrated Circuits (ASICs) are expensive to initially prototype. This paper presents the first completely digital Doppler motion sensor solution at 2.45   G Hz , implemented on the new RFSoC from Xilinx without the need to up/downconvert the frequency externally. Our proposed system uses a completely digital approach bringing the benefits of product repeatability, better overtemperature performance and softwarisation, without compromising any performance metric associated with a comparable analogue motion sensor. The RFSoC shows to give superior distance versus false detection, as the Signal-to-Noise Ratio (SNR) is better than a typical analogue system. This is mainly due to the high gain amplification requirement of an analogue system, making it susceptible to electrical noise appearing in the intermediate-frequency (IF) baseband. The proposed RFSoC-based Doppler sensor shows how digital technology can replace traditional analogue radio frequency (RF). A case study is presented showing how we can use a novel method of using multiple Doppler channels to provide range discrimination, which can be performed in both analogue and in a digital implementation (RFSoC). [ABSTRACT FROM AUTHOR]

The objectives of this study were (1) to investigate the effects of the preovulatory follicle (POF) size on the accuracy of Doppler‐based early pregnancy detection, and (2) to determine whether the removal of PGF2α (PGF) treatment during the resynchronisation protocol would affect fertility in beef cows. In Experiment 1, Nelore suckling cows (n = 224) were enrolled in an estradiol‐progesterone–based timed artificial insemination (TAI) protocol. At TAI, cows were separated based on the range of POF diameters, as follows: ≤11.0 mm (n = 50), 11.1–12.9 mm (n = 64), 13.0–14.4 mm (n = 62) and ≥14.5 mm (n = 48). On day 22 after TAI, the corpus luteum (CL) blood flow (CLBF) of all cows was examined by colour Doppler ultrasonography to diagnose nonpregnant cows. The cows with the largest POF had the greatest positive predictive value (88.6%; 31 of 35) and diagnostic accuracy (91.7%; 44 of 48). In Experiment 2, Nelore cows (n = 233) were subjected to the same TAI protocol. Fourteen days after TAI, all cows were started on a resynchronisation protocol. Cows diagnosed as nonpregnant based on CLBF, on day 22, received 0.5 mg estradiol cypionate intramuscular (im) and were assigned to receive either 150 μg of PGF (PGF; n = 50) or 2 mL of saline (control; n = 47). Cows treated with PGF had a P/AI of 30.0% compared with a 48.9% P/AI in controls (p = 0.06). Our findings demonstrate that the POF size affects the accuracy of a CLBF‐based early pregnancy diagnosis and that the removal of PGF treatment from the resynchronisation protocol tended to increase P/AI of the second TAI. [ABSTRACT FROM AUTHOR]

Differentiating between arteriovenous fistula (AVF) maturation and failure can help determine which AVF will undergo successful canulation and which ones will require immediate rescue. A prospective observational study was conducted at Vajira Hospital in Bangkok, Thailand, between October 2020–November 2022. A single vascular surgeon performed a physical examination on patients with chronic kidney disease undergoing AVF placement, and a radiologist conducted Doppler ultrasonography during the second and sixth postoperative weeks. Dialysis nurses determined AVF maturity by performing cannulation. The study compared the accuracy of physical examination and Doppler ultrasonography. A model was developed to predict the success of AVF use. Out Of the 125 recruited patients, 81% demonstrate unassisted maturation of their AVF. The male sex and brachiocephalic type are associated with AVF maturation. The physical examination findings of palpable thrill and the absence of a strong pulse at the 6th week show an area under the receiver operating curve (AUC) value of 0.79. Similarly, arterial end-diastolic velocity on ultrasonography at the 6th week also demonstrates a comparable predictive value with an AUC of 0.82 (p = 0.697). Meanwhile, the model that combined end-diastolic velocity and venous volume flow yields the best results for predicting AVF maturation, with an AUC of 0.92. These models provide more accurate predictions compared to physical examination alone (AUC: 0.92 vs. 0.79; p < 0.01). Although a prudent physician predicts AVF maturation through a thorough physical examination, Doppler ultrasonography is preferred in anticipating the success of postoperative AVF placement. [ABSTRACT FROM AUTHOR]

Ultrasonography is highly accurate for evaluating soft tissues. Given that minimally invasive aesthetic procedures are on the rise, complications have become more prevalent. Thus, ultrasonography holds promise for assisting in the diagnosis and management of complications arising from these interventions. This report highlights the importance of ultrasonography in the treatment of complications caused by hyaluronic acid injection. A patient visited a dental office 24 hours after hyaluronic acid application, presenting pain and bruising in the middle and inferior thirds of the face on the right side. To evaluate blood vessels, the surgeon used Doppler-mode ultrasonography, which enabled the precise application of hyaluronidase to reestablish blood perfusion and preserve adjacent structures. Therefore, to avoid severe outcomes, such as necrosis or even amaurosis, the use of ultrasonography is suggested, improving the precision and safety of these procedures. [ABSTRACT FROM AUTHOR]

Abstract Dog overpopulation and stray dogs are global issues that are detrimental to public health and animal welfare. Thus, the goal of the current study was to provide alternatives for surgical castration. Therefore, calcium chloride was employed in this study, which might be an option for castration. Ten dogs were divided into two groups of five: a calcium chloride-treated group and a control group. The treated group received a single bilateral intratesticular injection of 1 ml of sterile saline containing calcium chloride dihydrate (CaCl2•2 H2O) at a dose of 20 mg/kg per testicle. While the control group was treated with 1 ml of sterile saline solution, Semen and blood collection, as well as Doppler ultrasonography, were routinely carried out every week on days 0, 7, 14, 21, and 28 in order to evaluate the impact of the injection on semen parameters and testicular blood flow. The testicular volume and echogenicity in the CaCl2-treated group were significantly (P

Abstract Objective To assess the predictive abilities of Doppler‐based resistive index and plasma biomarkers of endothelial cell activation in identifying persistent acute kidney injury (pAKI) among patients with septic shock. Method Patients diagnosed with septic shock were categorized into none AKI (n = 25), transient AKI (tAKI, n = 47), and pAKI (n = 48) groups. Kidney function parameters (urine output, serum creatinine, and serum urea) were measured within the initial 24 h upon intensive care unit (ICU) admission. The Doppler‐based resistive index, and the plasma biomarkers [fractalkine, soluble E‐Selectin (sE‐Selectin), and soluble intercellular adhesion molecule‐1 (sICAM‐1)] were evaluated upon admission to the ICU. Results The predictive capacity of Doppler‐based resistive index for distinguishing pAKI at day 3 from none AKI/tAKI in septic shock patients was moderate, with sensitivity of 47.92% and specificity of 76.39%. Fractalkine levels displayed significant differences across groups and exhibited a favorable predictive ability for pAKI at day 3 (AUC = 0.800), while sE‐Selectin and sICAM‐1 showed moderate predictive abilities (AUC = 0.636 and 0.634, respectively). Comparative analysis of predictive models demonstrated that incorporating kidney function parameters, Doppler‐based resistive index, and plasma biomarkers yielded the highest AUC of 0.903, followed closely by the model utilizing serum creatinine, urine output, and plasma fractalkine, with an AUC of 0.896. Conclusion Integrating kidney function parameters, along with Doppler‐based resistive index and plasma biomarkers of endothelial cell activation, yielded the strongest predictive model for pAKI. Additionally, the combination of serum creatinine, urine output, and plasma fractalkine shows promise in risk assessment and management strategies for pAKI.

Objectives: A classification system of ovarian ectopic pregnancies (OEP) could aid in their management. This study aimed to investigate the ultrasound classification and preoperative ultrasound diagnosis of OEP. Methods: This retrospective case series study analyzed the clinical and ultrasound imaging data of 68 pregnant women diagnosed and confirmed with OEP at the Obstetrics and Gynecology Hospital affiliated with Tongji University between January 2015 and March 2023. The study focused on examining the ultrasound characteristics of different types of ovarian pregnancies and the accuracy of preoperative ultrasound diagnoses. Results: The study included 68 patients with a median age of 30 (22‐47) years. There were 43 cases (63.2%) of ruptured OEP and 25 (36.8%) of unruptured OEP. The unruptured cases were subclassified as embryonic sac type (n = 16) and heterogeneous mass type (n = 9). Preoperative ultrasound accurately diagnosed 19 cases (27.9%) of OEP, including 10 (62.50%) of the embryonic sac type, 4 (44.44%) of the heterogeneous mass type, and 5 (11.63%) of the ruptured type. Preoperative ultrasonography showed that embryonic sac type OEP was characterized by an intra‐ovarian cystic structure with a distinctive hyperechoic ring and, in some cases (8 out of 16), the presence of embryonic buds and/or yolk sacs. Ruptured OEP was characterized by mixed masses in the pelvic cavity with minimal or significant free pelvic fluid, an unclear boundary between the mass and the ovary, and limited or no vascularity. Conclusions: Ultrasound may be used to determine the type of OEP preoperatively, with a higher diagnostic yield for the embryonic sac subtype. Preoperative ultrasonographic classification may enhance the preoperative diagnosis of OEP. [ABSTRACT FROM AUTHOR]

Background: Transcranial grayscale neurosonography (NSG) and Doppler studies have major role in diagnosing neonate intracranial pathologies. The aim of the study is to evaluate the role of NSG and Doppler studies in correlation with clinical hypotonia and seizures in preterm neonates and high-risk term neonates. The prevalence of intracranial pathology is the second aim of this study. Methods: The present cross-sectional study was done in a tertiary care teaching hospital for 2 years. The study population of 120 cases comprised two groups: one group of 60 preterm neonates and the other of 60 high-risk term neonates with a history of well-defined episode of fetal distress. The NSG and Doppler findings (resistance index ≤0.62 is the optimum cutoff point for diagnosing perinatal asphyxia) are recorded. The sensitivity and specificity values for the NSG study alone, the Doppler study alone, and the combined NSG and Doppler studies are calculated. Results: The majority (46%) of preterm neonates had presented with germinal matrix hemorrhage, whereas a majority (46%) of high-risk term neonates had presented with periventricular and subcortical cysts. Comparison of the sensitivity of NSG versus Doppler versus combined NSG and Doppler in evaluating hypotonia and seizures in preterm (P = 0.0442) and high-risk term neonates (P = 0.0399) was significant. Conclusion: NSG combined with the Doppler study has significantly higher sensitivity than NSG alone in both groups. The specificity of the Doppler study is also high in both groups. Thus, it is strongly recommended to include Doppler during every NSG study to increase the detection rate.

The occurrence of triple kidneys, involving a normal kidney and a malrotation horseshoe kidney, is an extremely infrequent condition. This case report demonstrates a triple, mal-rotated horseshoe kidneys coexist with an upper junction stone, alongside a normal left kidney showing normal Doppler vascularity, as observed in an ultrasound examination for 18-year-old male complaints of diffuse periumbilical pain and burning micturition. Laboratory investigation revealed normal creatinine level, and presence of urinary tract infection. Management option for this case are antibiotic therapy and surgical intervention for horseshoe kidney stone. Regular monitoring of kidney function, other radiographic imaging studies, and follow-up to assess the efficacy of the treatment, and detect any further complications are essential.

Abstract This study aimed to evaluate the impacts of supplemental dietary curcumin on post-partum uterine involution using pulsed-wave Doppler ultrasonography in postpartum goats. Ten pluriparous Zaraibi goats were used and divided into two groups. Group 1 (n = 5; control) received only a base diet. Group 2 (n = 5; treated) received a base diet supplemented with curcumin (200 mg/kg diet) daily for 28 days, starting from day 1 postpartum (PP) till day 28 PP. Uterine morphometrical changes (uterine horn diameter; UHD and caruncle diameter; CD), uterine hemodynamics (resistance and pulsatility indices (RI and PI), systolic/ diastolic ratio (S/D), peak systolic velocity (PSV), end-diastolic velocity (EDV), blood flow volume (BFV), and blood flow rate (BFR)), and progesterone level were evaluated. Results revealed that the diameter of the uterine horn decreased rapidly from day 1 to day 10 PP (> 50%) but more steadily from day 14 to day 28 PP in both groups. After day 21 PP, there was nearly no reduction in UHD and CD in both groups. The treated group had lower values of the RI and PI (P

Abstract Background Senescence is accompanied by a progressive decrease in male reproductive performance, mainly due to oxidative stress and endothelial dysfunction. Alpha lipoic acid (ALA) is a potent antioxidant, that diffuses freely in aqueous and lipid phases, possessing anti-inflammatory and anti-apoptotic properties. This study aimed to examine the effects of supplemental dietary ALA on testicular hemodynamics (TH), circulating hormones, and semen quality in aged goats. Twelve Baladi bucks were divided into two groups (n = 6 each); the first fed a basic ration and served as a control group (CON), while the second received the basic ration supplemented with 600 mg ALA/ kg daily for consecutive eight weeks (ALA). Results There were improvements in testicular blood flow in the ALA group evidenced by a lower resistance index (RI) and pulsatility index (PI) concurrent with higher pampiniform-colored areas/pixel (W3-W6). There were increases in testicular volume and decreases in echogenicity (W3-W5; ALA vs. CON). Compared to the CON, ALA-bucks had higher serum concentrations of testosterone, estradiol, and nitric oxide (W3-W5). There were enhancements in semen traits (progressive motility, viability, morphology, and concentration, alanine aminotransferase enzyme) and oxidative biomarkers (catalase, total antioxidant capacity, and malondialdehyde). Conclusions ALA dietary supplementation (600 mg/kg diet) improved aged bucks’ reproductive performance by enhancing the testicular volume, testicular hemodynamics, sex steroids, and semen quality.

Abstract One of the most prevalent disorders of the urinary system is urinary tract infection, which is mostly brought on by uropathogenic Escherichia coli (UPEC). The objective of this study was to evaluate the regenerative therapeutic and antibacterial efficacy of PRP for induced bacterial cystitis in dogs in comparison to conventional antibiotics. 25 healthy male mongrel dogs were divided into 5 groups (n = 5). Control negative group that received neither induced infection nor treatments. 20 dogs were randomized into 4 groups after two weeks of induction of UPEC cystitis into; Group 1 (control positive; G1) received weekly intravesicular instillation of sodium chloride 0.9%. Group 2 (syst/PRP; G2), treated with both systemic intramuscular antibiotic and weekly intravesicular instillation of PRP; Group 3 (PRP; G3), treated with weekly intravesicular instillation of PRP, and Group 4 (syst; G4) treated with an intramuscular systemic antibiotic. Animals were subjected to weekly clinical, ultrasonographic evaluation, urinary microbiological analysis, and redox status biomarkers estimation. Urinary matrix metalloproteinases (MMP-2, MMP-9) and urinary gene expression for platelet-derived growth factor -B (PDGF-B), nerve growth factor (NGF), and vascular endothelial growth factor (VEGF) were measured. At the end of the study, dogs were euthanized, and the bladder tissues were examined macroscopically, histologically, and immunohistochemically for NF-κB P65 and Cox-2. The PRP-treated group showed significant improvement for all the clinical, Doppler parameters, and the urinary redox status (p

Introduction- Doppler ultrasonography is used to evaluate uteroplacental circulation by analysing the systolic and diastolic waveforms. Given the ethnic and geographical differences in PIH and IUGR, it is crucial to comprehend the methods used to predict it in different populations. The aim of present study was to assess the role of level 2 doppler waveforms (at the time of anomaly scan) in assessing abnormal trophoblastic invasion and predicting adverse pregnancy outcomes in the form of PIH and IUGR. Material and methods- The present prospective study was conducted in department of obstetrics and gynaecology at SMGS Hospital among 100 pregnant females visiting the OPD during the study period of one year. As detailed level 2 anomaly scan is mandatory in our settings at 18-22 weeks, the required data on doppler study at 18-22 weeks could easily be extracted from the study patients, thus being economical on the part of patients in low resource settings.The doppler study was performed on all cases throughout the 18-22 weeks period of pregnancy and the two Indices like Pulsatility Index and Diastolic notch of uterine artery were recorded. The patients were followed up for the development of PIH and IUGR. Results- Out of 100 cases, pregnancy induced hypertension was found in 20 cases while 80 cases did not show pregnancy induced hypertension.30 cases developed IUGR and 70 remained non IUGR cases. Diastolic notch was found in 16 of PIH and 22 of nonPIH patients. 8 of PIH cases had a pulsatility index (PI) of greater than 1.71, compared to 10 of non PIH cases, which had a PI of greater than 1.71 (p=0.01). The sensitivity of diastolic notch in diagnosis of PIH was 65.3% whereas, that of PI was 53.48%. Similarly, diastolic notch was present in 19 of IUGR cases and 10 of non IUGR cases.8 of IUGR patients had PI of >1.7 and 20 of non IUGR cases had PI of > 1.7 giving the statistically significant results. Thus, second trimester doppler changes in the uterine artery has a role in prediction of IUGR too. Conclusion– Uterine artery doppler is a potentially effective method for predicting the occurrence of PIH and IUGR by examining both the pulsatility index (PI) and the presence of a diastolic notch in the uterine artery. The Doppler technique demonstrated a high level of diagnostic accuracy in detecting preeclampsia. [ABSTRACT FROM AUTHOR]

Objectives: To determine the association between elevated (> 1.5 multiples of the median (MoM)) middle cerebral artery (MCA) peak systolic velocity (PSV) and fetal demise of the donor twin in pregnancies complicated by twin–twin transfusion syndrome (TTTS) in the absence of twin anemia–polycythemia sequence (TAPS). Secondary objectives were to evaluate if donor or recipient MCA‐PSV is associated with a risk for their corresponding fetal death, and to compare the proportion of donor fetuses with low MCA pulsatility index (PI) among donor twins with high MCA‐PSV and those with normal MCA‐PSV to evaluate the contribution of blood‐flow redistribution to the fetal brain in donor twins with high MCA‐PSV. Methods: This prospective cohort study included TTTS cases that underwent laser surgery between 2011 and 2022 at a single center. TAPS cases were excluded from the study. Multivariable and Poisson regression analysis were performed to explore the association between isolated elevated donor MCA‐PSV and fetal demise, adjusted for TTTS stage, selective fetal growth restriction (sFGR) and other confounders. Results: Of 660 TTTS cases, donor MCA‐PSV was not recorded in 48 (7.3%) cases. Of the remaining 612 patients, nine (1.5%) were lost to follow‐up and 96 TAPS cases were excluded; thus, 507 cases were included in the study. High donor MCA‐PSV was seen in 6.5% (33/507) of cases and was an independent risk factor for donor fetal demise (adjusted relative risk (aRR), 4.52 (95% CI, 2.72–7.50)), after adjusting for confounders. Regression analysis restricted to each Quintero TTTS stage demonstrated that high donor MCA‐PSV was an independent risk factor for fetal demise of the donor in Quintero Stage II (aRR, 14.21 (95% CI, 1.09–186.2)) and Quintero Stage III (aRR, 3.41 (95% CI, 1.82–6.41)). Donor MCA‐PSV in MoM was associated with fetal demise of the donor (area under the receiver‐operating‐characteristics curve (AUC), 0.69; P < 0.001), but recipient MCA‐PSV in MoM was not associated with fetal demise of the recipient (AUC, 0.54; P = 0.44). A higher proportion of donor twins in the group with high MCA‐PSV had a low MCA‐PI compared to the group with normal MCA‐PSV (33.3% vs 15.5%; P = 0.016). Conclusions: Elevated donor MCA‐PSV without TAPS prior to laser surgery for TTTS is associated with a 4‐fold increased risk for donor fetal demise, adjusted for sFGR, TTTS stage and other confounders. Doppler evaluation of donor MCA‐PSV prior to laser surgery may help stratify TTTS staging to evaluate the risk of donor fetal demise. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: Fetoscopic closure of spina bifida using heated and humidified carbon dioxide gas (hhCO2) has been associated with lower maternal morbidity compared with open closure. Fetal cardiovascular changes during these surgical interventions are poorly defined. Our objective was to compare fetal bradycardia (defined as fetal heart rate (FHR) < 110 bpm for 10 min) and changes in umbilical artery (UA) Doppler parameters during open vs fetoscopic closure. Methods: This was a prospective cohort study of 22 open and 46 fetoscopic consecutive in‐utero closures conducted between 2019 and 2023. Both cohorts had similar preoperative counseling and clinical management. FHR and UA Doppler velocimetry were obtained systematically during preoperative assessment, every 5 min during the intraoperative period, and during the postoperative assessment. FHR, UA pulsatility index (PI) and UA end‐diastolic flow (EDF) were segmented into hourly periods during surgery, and the lowest values were averaged for analysis. Umbilical vein maximum velocity was measured in the fetoscopic cohort. At each timepoint at which FHR was recorded, maternal heart rate and systolic and diastolic blood pressure were measured. Results: Fetal bradycardia occurred in 4/22 (18.2%) cases of open closure and 21/46 (45.7%) cases of fetoscopic closure (P = 0.03). FHR decreased gradually in both cohorts after administration of general anesthesia and decreased further during surgery. FHR was significantly lower during hour 2 of surgery in the fetoscopic‐repair cohort compared with the open‐repair cohort. The change in FHR from baseline in the final stage of fetal surgery was significantly more pronounced in the fetoscopic‐repair cohort compared with the open‐repair cohort (mean, −32.4 (95% CI, −35.7 to −29.1) bpm vs −23.5 (95% CI, −28.1 to −18.8) bpm; P = 0.002). Abnormal UA‐EDF (defined as absent or reversed EDF) occurred in 3/22 (13.6%) cases in the open‐repair cohort and 23/46 (50.0%) cases in the fetoscopic‐repair cohort (P = 0.004). There were no differences in UA‐EDF or UA‐PI between closure techniques at the individual stages of assessment. Conclusions: We observed a decrease in FHR and abnormalities in UA Doppler parameters during both open and fetoscopic spina bifida closure. Fetal bradycardia was more prominent during fetoscopic closure following hhCO2 insufflation, but FHR recovered after cessation of hhCO2. Changes in FHR and UA Doppler parameters during in‐utero spina bifida closure were transient, no cases required emergency delivery and no fetoscopic closure was converted to open closure. These observations should inform algorithms for the perioperative management of fetal bradycardia associated with in‐utero spina bifida closure. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. Linked article: There is a comment on this article by Rychik. Click here to view the Editorial. [ABSTRACT FROM AUTHOR]

Cardiotocography (CTG) measurements are critical for assessing fetal wellbeing during monitoring, and accurate assessment requires well-traceable CTG signals. The current FHR calculation algorithm, based on autocorrelation to Doppler ultrasound (DUS) signals, often results in periods of loss owing to its inability to differentiate signals. We hypothesized that classifying DUS signals by type could be a solution and proposed that an artificial intelligence (AI)-based approach could be used for classification. However, limited studies have incorporated the use of AI for DUS signals because of the limited data availability. Therefore, this study focused on evaluating the effectiveness of semi-supervised learning in enhancing classification accuracy, even in limited datasets, for DUS signals. Data comprising fetal heartbeat, artifacts, and two other categories were created from non-stress tests and labor DUS signals. With labeled and unlabeled data totaling 9,600 and 48,000 data points, respectively, the semi-supervised learning model consistently outperformed the supervised learning model, achieving an average classification accuracy of 80.9%. The preliminary findings indicate that applying semi-supervised learning to the development of AI models using DUS signals can achieve high generalization accuracy and reduce the effort. This approach may enhance the quality of fetal monitoring. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the impacts of supplemental dietary curcumin on post-partum uterine involution using pulsed-wave Doppler ultrasonography in postpartum goats. Ten pluriparous Zaraibi goats were used and divided into two groups. Group 1 (n = 5; control) received only a base diet. Group 2 (n = 5; treated) received a base diet supplemented with curcumin (200 mg/kg diet) daily for 28 days, starting from day 1 postpartum (PP) till day 28 PP. Uterine morphometrical changes (uterine horn diameter; UHD and caruncle diameter; CD), uterine hemodynamics (resistance and pulsatility indices (RI and PI), systolic/ diastolic ratio (S/D), peak systolic velocity (PSV), end-diastolic velocity (EDV), blood flow volume (BFV), and blood flow rate (BFR)), and progesterone level were evaluated. Results revealed that the diameter of the uterine horn decreased rapidly from day 1 to day 10 PP (> 50%) but more steadily from day 14 to day 28 PP in both groups. After day 21 PP, there was nearly no reduction in UHD and CD in both groups. The treated group had lower values of the RI and PI (P < 0.05) than the control group. Regarding the BFR and BFV in the treated group, there was a significant increase (P < 0.05) on day 17 PP, then started to decrease till day 28 PP. While in the control group, there was a significant decrease (P < 0.05) in BFR and BFV from day 1 PP till day 28 PP. In conclusion, the incorporation of curcumin in the diet of PP Zaraibi goats improved reproductive performance via improvements in uterine morphometric changes as well as blood perfusion. [ABSTRACT FROM AUTHOR]

Objective: Unknown etiology. Background: Isolated iliac aneurysms are rare. Although they grow very slowly, they can rupture when large enough. Rarely, they rupture into an adjacent organ, such as the colon, the bladder, or even an adjacent vein. Cases of aneurysms rupturing into or communicating with an adjacent vein, leading to an arteriovenous fistula, have been reported. However, reports of aneurysms that rupture and communicate with another adjacent artery have not been found in the literature. Case Report: A 52-year-old man who underwent a renal transplantation in the left iliac fossa 21 years ago was admitted for chronic left lower abdominal pain that began 1 year ago. He did not have a history of any invasive procedures or severe trauma after the renal transplantation. Duplex ultrasound showed an oval-shaped hypoechoic structure adjacent to the left external iliac artery (EIA), with a swirling motion of blood flow inside. Computed tomography angiography showed an aneurysm of the left EIA, with a size of 35×34×47 mm, closely adjacent to or even communicating with the transplant renal artery (TRA). There was calcification in the aneurysm wall, without surrounding hematoma. The aneurysm was considered to be a true aneurysm, not a pseudoaneurysm. Endovascular therapy was performed. Digital subtraction angiography confirmed the communication between the aneurysm and the TRA. After the EIA was reconstructed with a covered stent, no leakage was demonstrated; however, contrast still flowed into the aneurysm though the TRA. A second covered stent graft was implanted in the TRA. Subsequently, the aneurysm was successfully excluded. Conclusions: The pathogenesis of this strange aneurysm communicating with another adjacent artery is not well established. Stenting of multiple arteries was needed to treat this aneurysm. [ABSTRACT FROM AUTHOR]

Background: Senescence is accompanied by a progressive decrease in male reproductive performance, mainly due to oxidative stress and endothelial dysfunction. Alpha lipoic acid (ALA) is a potent antioxidant, that diffuses freely in aqueous and lipid phases, possessing anti-inflammatory and anti-apoptotic properties. This study aimed to examine the effects of supplemental dietary ALA on testicular hemodynamics (TH), circulating hormones, and semen quality in aged goats. Twelve Baladi bucks were divided into two groups (n = 6 each); the first fed a basic ration and served as a control group (CON), while the second received the basic ration supplemented with 600 mg ALA/ kg daily for consecutive eight weeks (ALA). Results: There were improvements in testicular blood flow in the ALA group evidenced by a lower resistance index (RI) and pulsatility index (PI) concurrent with higher pampiniform-colored areas/pixel (W3-W6). There were increases in testicular volume and decreases in echogenicity (W3-W5; ALA vs. CON). Compared to the CON, ALA-bucks had higher serum concentrations of testosterone, estradiol, and nitric oxide (W3-W5). There were enhancements in semen traits (progressive motility, viability, morphology, and concentration, alanine aminotransferase enzyme) and oxidative biomarkers (catalase, total antioxidant capacity, and malondialdehyde). Conclusions: ALA dietary supplementation (600 mg/kg diet) improved aged bucks' reproductive performance by enhancing the testicular volume, testicular hemodynamics, sex steroids, and semen quality. [ABSTRACT FROM AUTHOR]

Aim: To compare synovial blood flow scoring between different technologies and ultrasound (US) systems in active and inactive rheumatoid arthritis (RA). Material and methods. Fifty-nine RA patients underwent B-mode, power Doppler (PD), colour Doppler (CD), B-Flow and High-Resolution (High-Res) PDI assessments of 6 joints with two US systems at two European centres. Each joint was semi-quantitatively scored for all ultrasound parameters. PD, CD and High-Res PDI synovial signal was also quantitatively scored. Results. Correlations between the total score of SH with system 1 and 2 were very high (≥ 0.90, p<0.0001). Baseline correlations between systems for PD and CD total scores were moderate to very high (0.44-0.96, p<0.05). At baseline, there were no significant differences between ultrasound systems for PD or CD semiquantitative-based total scores in active or inactive patients (p>0,05). B-Flow and High-Res total scores were significantly lower than PD or CD total scores (p<0.05). Conclusion. A high-end and an entry-level US system were interchangeable for scoring SH and showed similar sensitivity and responsiveness in scoring synovial blood flow by PD and CD but not interchangeability. B-Flow and High-Res PDI were responsive, but they showed different sensitivity to detect synovial blood flow compared to conventional Doppler. [ABSTRACT FROM AUTHOR]

Summary: Background: Bone‐derived exosomes are considered nano‐sized extracellular vesicles secreted by the bone marrow stromal cells. Objectives: This study used exosomes derived from bone marrow mesenchymal stem cells to treat chronic endometritis in Arabian mares with follow‐up alterations in haemodynamics, hormonal and histopathological expressions. Methods and study design: Fourteen (n = 14) Arabian mares (aged 13–15 years old) were equally divided into the control group and an endometritis group (chronic type). Exosomes were infused twice 21 days apart at the first and second ovulations. Follow‐up was done ultrasonographically, and samples were taken for histopathology. Blood samples were taken to estimate hormonal levels. Results: Uterine biopsy samples before treatment showed a marked degree of degeneration, while the second exosomal treatment showed regression of fibrous tissue and restoration of healthy endometrial glands with normal epithelium. Uterine body and horns thickness/mm were decreased after treatment at day 0 of the 3rd ovulation compared to day −1 before treatment, the uterine body‐coloured area and total uterine coloured areas/pixels were elevated (p < 0.05) at day 0 of the 3rd ovulation compared to day −1 before treatment. Uterine artery blood parameters (pulsatility index, resistance index, peak systolic and end‐diastolic points) did not change before, during and after treatment, but the blood flow rate was elevated (p < 0.05) on day 0 of the 3rd ovulation compared to day −1 before treatment. Oestradiol level was decreased (p < 0.05), while progesterone level was increased (p < 0.05) on day 0 of the 3rd ovulation compared to day −1 before treatment. Conclusion: Two intrauterine administrations of exosomes restored the normal endometrial appearance after chronic endometritis resulting in the elevation of the conception rate in infertile mares. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association between Doppler patterns in fetuses with Down syndrome (DS) and their placental histopathologic findings. Methods: A retrospective cross‐sectional study was performed by collecting data from medical records of singleton pregnancies between January 2014 and January 2022, whose fetuses had a confirmed diagnosis of DS either prenatally or postnatally. Placental histopathology, maternal characteristics, and prenatal ultrasound (biometric parameters and umbilical artery [UA] Doppler) were evaluated. Results: Of 69 eligible pregnant women, 61 met the inclusion and exclusion criteria. In the sample, 15 fetuses had an estimated fetal weight < 10th percentile for gestational age (GA) and were considered small for gestational age (SGA). Thirty‐eight fetuses had increased resistance on the UA Doppler. Histologic changes were detected in 100% of the placentas, the most common being delayed villous maturation, alterations associated with poor fetal vascular perfusion, and villous dysmorphism. More than 50% of the placentas showed alterations related to placental insufficiency. We did not observe a statistically significant association between UA Doppler examination and placental alterations. All placentas analyzed in the SGA subgroup showed findings compatible with placental insufficiency. Conclusion: We found no statistically significant association between placental histopathologic findings and UA Doppler abnormalities in fetuses with DS. The placental alterations identified were delayed villous maturation, alterations associated with poor fetal vascular perfusion, and villous dysmorphism. [ABSTRACT FROM AUTHOR]

The smartphone-based precise point positioning (PPP) technique is usually used in limited satellite visibility environments, resulting in discontinuities in carrier phase observations. This study proposes an approach to improve the smartphone-based PPP performance by predicting the missed carrier phase observations with Doppler observations. Kinematic smartphone-based PPP experiments in the tree canopy and high-building environments are conducted, and results show that the proposed PPP approach improves the horizontal positioning accuracy by over 31% and 14% and vertical positioning accuracy by over 23% and 10% when compared to the PPP approaches without predictions and with linear predictions, respectively. [ABSTRACT FROM AUTHOR]

Plantar vein thrombosis (PVT) is an underdiagnosed condition affecting the deep plantar veins, with challenging clinical diagnosis, often presenting with non-specific symptoms that mimic other foot pathologies. This study assessed the magnetic resonance imaging (MRI) features of patients diagnosed with PVT to contribute to the understanding of this condition. We performed the comprehensive analysis of a substantial dataset, including 112 patients, with a total of 130 positive MRI scans (86 of the forefoot and 44 of the ankle) presenting with PVT. Upon evaluating all the veins of the feet, we observed a higher frequency of involvement of the lateral plantar veins (53.1%) when compared to the medial veins (3.8%). The most affected vascular segments in the forefeet were the plantar metatarsal veins (45.4%), the plantar venous arch (38.5%), and the plantar communicating veins (25.4%). The characteristic findings on MRI were perivascular edema (100%), muscular edema (86.2%), venous ectasia (100%), perivascular enhancement (100%), and intravenous filling defects (97.7%). Our study provides valuable insights into the imaging evaluation of PVT and shows that MRI is a reliable resource for such diagnosis. [ABSTRACT FROM AUTHOR]

One of the most prevalent disorders of the urinary system is urinary tract infection, which is mostly brought on by uropathogenic Escherichia coli (UPEC). The objective of this study was to evaluate the regenerative therapeutic and antibacterial efficacy of PRP for induced bacterial cystitis in dogs in comparison to conventional antibiotics. 25 healthy male mongrel dogs were divided into 5 groups (n = 5). Control negative group that received neither induced infection nor treatments. 20 dogs were randomized into 4 groups after two weeks of induction of UPEC cystitis into; Group 1 (control positive; G1) received weekly intravesicular instillation of sodium chloride 0.9%. Group 2 (syst/PRP; G2), treated with both systemic intramuscular antibiotic and weekly intravesicular instillation of PRP; Group 3 (PRP; G3), treated with weekly intravesicular instillation of PRP, and Group 4 (syst; G4) treated with an intramuscular systemic antibiotic. Animals were subjected to weekly clinical, ultrasonographic evaluation, urinary microbiological analysis, and redox status biomarkers estimation. Urinary matrix metalloproteinases (MMP-2, MMP-9) and urinary gene expression for platelet-derived growth factor -B (PDGF-B), nerve growth factor (NGF), and vascular endothelial growth factor (VEGF) were measured. At the end of the study, dogs were euthanized, and the bladder tissues were examined macroscopically, histologically, and immunohistochemically for NF-κB P65 and Cox-2. The PRP-treated group showed significant improvement for all the clinical, Doppler parameters, and the urinary redox status (p < 0.05). The urinary MMPs activity was significantly decreased in the PRP-treated group and the expression level of urinary NGF and VEGF were downregulated while PDGFB was significantly upregulated (p < 0.05). Meanwhile, the urinary viable cell count was significantly reduced in all treatments (P < 0.05). Gross examination of bladder tissue showed marked improvement for the PRP-treated group, expressed in the histopathological findings. Immunohistochemical analysis revealed a marked increase in Cox-2 and NF-κB P65 in the PRP-treated group (P < 0.05). autologous CaCl2-activated PRP was able to overcome the bacterial infection, generating an inflammatory environment to overcome the old one and initiate tissue healing. Hence, PRP is a promising alternative therapeutic for UPEC cystitis instead of conventional antibiotics. [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]

Background: Transcatheter interventions are increasingly used in children with congenital heart disease. However, these interventions can affect cardiac output and cerebral circulation. In this pilot study, we aimed to investigate the use of NeoDoppler, a continuous transfontanellar cerebral Doppler monitoring system, to evaluate the impact of transcatheter interventions on cerebral circulation. Methods: Nineteen participants under one year of age (mean age 3.5 months) undergoing transcatheter cardiac interventions were prospectively included. Transfontanellar cerebral Doppler monitoring with the NeoDoppler system was initiated after intubation and continued until the end of the procedure. Results: Instant detection of changes in cerebral blood flow were observed across a spectrum of transcatheter interventions. Balloon aortic valvuloplasty demonstrated temporary cessation of cerebral blood flow during balloon inflation. Increase in cerebral diastolic blood flow velocity and decreased pulsatility were observed during patent ductus arteriosus occlusion. Changes in cerebral blood flow patterns were detected in two patients who encountered complications during their transcatheter interventions. There was no significant change in Doppler parameters before and after the interventions for the entire patient group. High quality recordings were achieved in 87.3% of the monitoring period. Conclusions: Continuous transfontanellar cerebral Doppler is feasible in monitoring cerebral hemodynamic trends and shows instantaneous changes associated with interventions and complications. It could become a useful monitoring tool during transcatheter interventions in infants. [ABSTRACT FROM AUTHOR]

The syndrome of heart failure (HF) with preserved ejection fraction (HFpEF) makes up about half of the HF population. The HF mechanisms in these patients are varied and not fully understood. In addition, the term "diastolic HF" was switched to HFpEF because of difficulties in measuring the left ventricular (LV) diastolic performance. In the late stages, HFpEF carries a prognosis that is as bad as or worse than that of HFrEF. Hence, it is important to recognize LV diastolic impairment at an earlier stage so that the causal mechanisms, if any, can be treated to retard its progression. Despite the availability of numerous disease-modifying agents for HFrEF, there are hardly any available treatments for HFpEF. With our aging population, there will be an epidemic of HFpEF and hence this entity needs attention and respect. In this paper, we review the fundamental mechanisms of HFpEF, the physiology of LV filling and how LV diastolic function can be comprehensively measured. We also speculate how this may help with the early recognition of diastolic HF and its treatment. [ABSTRACT FROM AUTHOR]

OBJECTIVE To compare the accuracy of doppler ultrasound (DOP) and pulse oximeter plethysmography (POP) in the measurement of systolic arterial pressure (SAP) to invasive blood pressure (IBP) in anesthetized dogs. ANIMALS 40 client-owned healthy dogs > 10 kg. METHODS Dogs were anesthetized for surgical procedures in dorsal recumbency. Invasive blood pressure was measured from a dorsal pedal artery. DOP and POP device probes were placed over the median caudal artery with a flow-occluding cuff for noninvasive blood pressure measurement. Systolic arterial pressure measured by DOP, loss of pulse oximeter plethysmograph (POPL), and return of pulse oximeter plethysmograph (POPR) were compared to SAP measured by IBP. A linear mixed model was used to determine correlation. Bland-Altman analyses were performed to determine bias, SD, and limits of agreement. The accuracy of DOP and POP was compared to IBP across different tensive states. RESULTS Conditional R2 values for DOP, POPL, and POPR versus IBP were 0.92, 0.85, and 0.87, respectively (all P < .001). The biases for DOP, POPL, and POPR compared to IBP were +7.6 ± 13.1, +3.9 ± 14.4, and +8.6 ± 15.2 mm Hg (bias ± SD), respectively. Limits of agreement (lower, upper) were (-18.1, +33.3), (-24.3, +32.1), and (-21.2, +38.4) mm Hg for DOP, POPL, and POPR, respectively. DOP and POP overestimated SAP during hypotension (SAP < 90 mm Hg), DOP to a lesser magnitude. CLINICAL RELEVANCE DOP measured from the median caudal artery may be acceptable for SAP measurement in dorsally recumbent, healthy anesthetized dogs > 10 kg. POP was determined an unacceptable method. [ABSTRACT FROM AUTHOR]

Purpose: To compare the Doppler sonographic findings of the left renal vein (LRV) of children diagnosed with nutcracker syn)drome with and without orthostatic proteinuria. Methods: Fifty and 53 consecutive children with and without orthostatic proteinuria, respectively, underwent renal Doppler ultrasonography examinations. The peak velocity (PV) was measured at the hilar portion of the LRV and between the aorta and superior mesenteric artery. Renal Doppler ultrasonography findings and clinical data including urine protein-to-creatinine ratio (UPCR) were compared according to the presence or absence of orthostatic proteinuria. Results: Between the two groups, no significant differences were observed in terms of age or sex. The PV ratio between the aortomesenteric and hilar portions was 7.79±2.65 and 6.32±3.01 in children with and without orthostatic proteinuria, respectively (P=0.009). No significant differences were observed between the two groups in terms of the UPCR in the first morning urine sample. However, the UPCR in the afternoon urine sample was significantly higher in children with orthostatic proteinuria than in those without orthostatic proteinuria (0.49±0.46 mg/mg vs. 0.11±0.04 mg/mg, P<0.001). Furthermore, the PV ratio between the aortomesenteric and hilar portions revealed a positive correlation with the ratio of UPCR of the afternoon to that of first morning urine samples (R=0.21, P=0.034). Conclusions: This study suggests that there can be a significant correlation of the PV ratio between the aortomesenteric and hilar portion of the LRV with orthostatic proteinuria in pediatric patients with nutcracker syndrome. [ABSTRACT FROM AUTHOR]