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Purpose: This study aims to update and systematize the existing evidence on the prevalence of sexual dysfunction and depression in infertile couple Renatos undergoing assisted reproduction treatments., Methods: A bibliographic search regarding sexual dysfunction in infertile couples was performed on PubMed and LILACS, with no restrictions on the date of publication of the article. The Newcastle-Ottawa Scale (NOS) was used to evaluate studies quality. Data collection process was conducted using a form previously planned and tested, extracting the goal information in a descriptive way., Results: From 111 records, only eight prospective studies were included in the synthesis. Although most of the selected studies assessed only women, three studies assessed the couple. All of them used questionnaires that showed that infertile couples experienced a higher number of sexual dysfunctions during the infertility treatment process, especially women. Regarding depression, going through the infertility process and its treatment leads to significant emotional damage to the patient or couple., Conclusion: Of the eight studies analyzed, six reached the conclusion that infertility is related to higher rates of sexual dysfunction. Seven studies also concluded that anxiety and depression are more prevalent in infertile patients. The treatment of sexual dysfunction is multidisciplinary, with the team being a general practitioner, gynecologist, psychologist and specialized nurse. If an organic disorder is detected, there may be a need to include specialists such as urology, gastroenterology and anesthesia. Psychological approaches often include some combination of sex education, identification of emotional and cultural factors, and eventually, couples therapy., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: Although power Doppler imaging has been used to quantify tissue and organ vascularity, many studies showed that limitations in defining adequate ultrasound machine settings and attenuation make such measurements complex to be achieved. However, most of these studies were conducted by using the output of proprietary software, such as Virtual Organ computer-aided analysis (GE Healthcare, Kretz, Zipf, Austria); therefore, many conclusions may not be generalizable because of unknown settings and parameters used by the software. To overcome this limitation, our goal was to evaluate the impact of the flow velocity, pulse repetition frequency (PRF), and wall motion filter (WMF) on power Doppler image quantification using beam-formed ultrasonic radiofrequency data., Methods: The setup consisted of a blood-mimicking fluid flowing through a phantom. Radiofrequency signals were collected using PRFs ranging from 0.6 to 10 kHz for 6 different flow velocities (5-40 cm/s). Wall motion filter cutoff frequencies were varied between 50 and 250 Hz., Results: The power Doppler magnitude was deeply influenced by the WMF cutoff frequency. The effect of using different WMF values varied with the PRF; therefore, the power Doppler signal intensity was dependent on the PRF. Finally, we verified that power Doppler quantification can be affected by the aliasing effect, especially when using a PRF lower than 1.3 kHz., Conclusions: The WMF and PRF greatly influenced power Doppler quantification, mainly when flow velocities lower than 20 cm/s were used. Although the experiments were conducted in a nonclinical environment, the evaluated parameters are equivalent to those used in clinical practice, which makes them valuable for aiding the interpretation of related data in future research., (© 2017 by the American Institute of Ultrasound in Medicine.)

Three-dimensional power Doppler quantification has limited application because of its high dependency on attenuation. The purpose of the study described here was to assess if different degrees of attenuation, depending on pulse repetition frequency (PRF) adjustment, alter 3-D power Doppler quantification in a region of 100% moving blood when using vascularization index, flow index and vascularization flow index (VFI). A cubic-shaped gelatin phantom with a 1.8-mm-internal-diameter silicon tube was used. The tube, placed at 45° to the phantom's surface, was filled with blood-mimicking fluid with as constant maximum velocity of 30 cm/s. Two different attenuation blocks (low and high attenuation) were alternatively placed between the phantom and the transvaginal transducer. One single observer acquired 10 data sets for each PRF level from 0.3 to 7.5 kHz, using the high- and low-attenuation blocks, for a total of 200 3-D power Doppler data sets. We assessed VFI from 1.5-mm-diameter spherical samples, virtually placed inside the tube, always at the same position. No difference was noted between high- and low-attenuation VFI values when using a PRF of 0.3 kHz. As PRF increased, it was observed that VFI quantification progressively differed between low and high attenuation. Also, a slope on VFI values for both high- and low-attenuation models could be observed when increasing PRF, particularly above 4.0 kHz. We concluded that PRF adjustment is very relevant when using VFI to quantify 3-D power Doppler signal., (Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

Introduction: The management of congenital diaphragmatic hernia (DH) would benefit from an antenatal medical therapy, which addresses both lung hypoplasia and persistent pulmonary hypertension. We aimed at evaluating the pulmonary effects of sildenafil in the fetal rabbit model for DH., Methods: We performed a dose-finding study to achieve therapeutic fetal plasmatic concentrations without toxicity following maternal sildenafil administration. Subsequently, DH fetuses were randomly exposed to transplacental placebo or sildenafil 10 mg/kg/day from gestational day 24 until examination at term (day 30). Efficacy measures were ipsilateral pulmonary vascular and airway morphometry, micro-CT-based branching analysis, Doppler flow in the main pulmonary artery and postnatal lung mechanics., Results: Fetal sildenafil plasmatic concentration was above the minimal therapeutic level for at least 22 h/day without maternal and fetal side effects. The placebo-exposed DH fetuses had increased wall thickness in peripheral pulmonary vessels and significantly less fifth-order vessels compared with controls (CTR). Sildenafil-exposed DH fetuses, instead, had a medial and adventitial thickness in peripheral pulmonary vessels in the normal range and normal vascular branching. Fetal pulmonary artery Doppler showed a reduction of pulmonary vascular resistances both in DH and in CTR fetuses treated by sildenafil compared with the placebo-treated ones. Sildenafil also reversed the mean terminal bronchiolar density to normal and improved lung mechanics, yet without measurable impact on lung-to-bodyweight ratio., Conclusions: In the rabbit model for DH, antenatal sildenafil rescues vascular branching and architecture, reduces pulmonary vascular resistances and also improves airway morphometry and respiratory mechanics., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Objective: To assess the visualization rate and transverse diameter of fetal thymus by two-dimensional ultrasound (2DUS) as well as the fetal thymus volume by three-dimensional ultrasound (3DUS) during the 2nd trimester echocardiography., Methods: A prospective cross-sectional study involving 100 normal fetuses between 18w0d and 23w6d was performed. The identification of fetal thymus and peri-thymic vessels was realized at level of three vessels and trachea (3VT). The transverse diameter was obtained placing a line cursor perpendicular to the line connecting the sternum and the spine. The fetal thymus volume was obtained by virtual organ computer-aided analysis (VOCAL) with 30° of rotation. We used the percentage of visualization rate of 2D structures and means and 95% confidence intervals (CI) for fetal thymus transverse diameter and volume., Results: The visualization rate of fetal thymus by 2DUS was of 100% in all gestational ages using the 3VT view. Addition of color Doppler ultrasound facilitates identification of the thy-box and enhanced the calculation of both fetal thymus transverse diameter and volume. The mean fetal thymus transverse diameter by 2DUS ranged from 11 mm at 18 weeks to 19 mm at 23 weeks of gestation. The mean fetal thymus volume by 3DUS ranged from 1.25 cm(3) at 18 weeks to 2.61 cm(3) at 23 weeks of gestation., Conclusion: We demonstrated a high visualization rate of fetal thymus and peri-thymic vessels by 2DUS during the 2nd trimester echocardiography. The measurements of transverse diameter by 2DUS and the volume by 3DUS also showed a high success rate.

Objectives: To determine the influence of the pulse repetition frequency (PRF) and wall motion filter on the 3-dimensional (3D) power Doppler vascularization-flow index (VFI) and volumetric pulsatility index (PI) obtained from spatiotemporal image correlation (STIC) data sets acquired from a common carotid artery of a healthy participant., Methods: We acquired 11 STIC data sets, 1 for each PRF value ranging from 0.6 to 9.0 kHz. Vascularization-flow index and volumetric PI values were determined from the 440 static 3D data sets contained in these STIC data sets. Additionally, 3 sets of radio-frequency data were acquired for offline processing of different wall motion filter values for PRF values of 0.6, 3.3, and 10 kHz., Results: We constructed VFI curves and observed 2 patterns: a flattened pattern with a low PRF and a triphasic pattern with a high PRF, correlating with the known pulsed wave Doppler profile of this vessel. Volumetric PI values were around 0 for low PRF settings and increased with increasing PRF. Analysis of the radiofrequency data showed that increasing wall motion filter values gradually filtered out the low-velocity power Doppler signals while retaining the higher-velocity ones, allowing the distinction of integrated power Doppler signal velocity throughout the cardiac cycle., Conclusions: We conclude that the PRF and wall motion filter dramatically influence 3D power Doppler indices and the volumetric PI, and the use of PRF values in which minimum VFI values are measured during the diastolic phase in the spectral Doppler wave may validate the use of the volumetric PI., (© 2015 by the American Institute of Ultrasound in Medicine.)

The authors review the main concepts regarding the importance of cleaning/disinfection of ultrasonography probes, aiming a better comprehension by practitioners and thus enabling strategies to establish a safe practice without compromising the quality of the examination and the operator productivity. In the context of biosafety, it is imperative to assume that contact with blood or body fluids represents a potential source of infection. Thus, in order to implement cleaning/disinfection practice, it is necessary to understand the principles of infection control, to consider the cost/benefit ratio of the measures to be implemented, and most importantly, to comprehend that such measures will not only benefit the health professional and the patient, but the society as a whole.

Objectives: To determine whether brachial artery flow-mediated dilation (FMD) assessed by ultrasonography during the late first trimester is able to predict the occurrence of hypertensive disorders during pregnancy., Methods: Maternal endothelial function was assessed by flow-mediated dilation (FMD) of the brachial artery in 487 pregnant women at 11-13(+6) weeks' gestation. Subjects were prospectively followed and grouped according to the outcomes related to hypertensive disorders. We determined the areas under receiver operating characteristic (ROC) curve with their respective 95% confidence intervals (CI) for using low FMD results to predict the occurrence of hypertensive disorders during pregnancy., Results: Among 487 women, 9 (1.8%) were diagnosed with early-onset preeclampsia, 22 (4.5%) were diagnosed with late-onset preeclampsia, 47 (9.7%) developed gestational hypertension, and the remaining 409 (84%) pregnancies were unaffected by hypertensive disorders. Area under ROC curve analyses demonstrated that FMD was not able to predict pregnancies that developed hypertensive disorders., Conclusions: We conclude that FMD should not be considered a potential first-trimester marker of hypertensive disorders during pregnancy., (© 2015 S. Karger AG, Basel.)

Objectives: To compare the variability in vascularization flow index (VFI) seen in serial acquisitions obtained using spatiotemporal image correlation (STIC) and using conventional static three-dimensional (3D) power Doppler (PD), for both in-vitro and in-vivo models, and to evaluate whether the curves formed by VFI values obtained from successive 'frames' in a STIC dataset are consistent and resemble the waveforms obtained by spectral Doppler analysis., Methods: The study was divided into two parts: in the first part (the in-vitro model) we scanned a flow phantom, while in the second part (the in-vivo model) we scanned a common carotid artery. Conventional static 3D and STIC-PD datasets were alternately acquired from these two models. VFI values were assessed from 0.38-cm(3) spherical samples of the main flow region in the static 3D datasets and in every frame of the STIC datasets. The variance of the minimum, mean and maximum VFI values from each STIC dataset was compared with the variance of VFI values from the static 3D datasets., Results: Ten static 3D and 10 STIC datasets were acquired from each model. Analysis of the in-vitro and in-vivo models showed a significant reduction in the variance of VFI values obtained using STIC as compared to static datasets. Additionally, we observed that the curves formed by VFI values obtained from successive frames in each STIC dataset were consistent across different datasets and that they resembled the waveforms obtained by spectral Doppler in both models., Conclusions: 3D-PD indices derived from STIC are more stable than those obtained from conventional static 3D-PD datasets. The curves of VFI throughout a reconstructed cardiac cycle using STIC are repeatable and resemble those obtained by spectral Doppler analysis of the vessel., (Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.)

Spatiotemporal image correlation can be used to acquire 3-dimensional power Doppler information across a single cardiac cycle. Assessment and comparison of the systolic and diastolic components of the data sets allow measurement of the recently introduced "volumetric pulsatility index" (vPI) through algorithms comparable with those used in 2-dimensional Doppler waveform analysis. The vPI could potentially overcome the dependency on certain machine settings, such as power, color gain, pulse repetition frequency, and attenuation, since these factors would affect the power Doppler signal equally throughout the cardiac cycle. The objective of this study was to compare the effect of color gain on the vascularization index (VI), vascularization-flow index (VFI), and vPI using an in vitro flow phantom model. We separated gains into 3 bands: -8 to -1 (no noise), -1 to +5 (low noise), and +5 to +8 (obvious noise). The vPI was determined from the 3-dimensional VI or VFI using the formula vPI = (maximum - minimum)/mean. Using no-noise gains, we observed that although the VI and VFI increased linearly with gain, the vPI was substantially less dependent on this adjustment. The VI and VFI continued to increase linearly with gain, whereas the vPI decreased slightly using low-noise gains. When gain was increased above the lower limit of obvious noise (+5), the VI and VFI increased noticeably, and there were marked reductions in both vPI values. We conclude that the vPI is less affected by changes in color gain than the VI and VFI at no-noise gains.

Objectives: To compare maternal flow-mediated dilation (FMD) of the brachial artery and nitrite concentration between third trimester of pregnancy (3rdT) and postpartum (PP) period. Additionally, we will evaluate whether FMD correlates with nitrite concentration in both periods., Methods: Eligibility criteria was healthy women with singleton pregnancy, gestational age >28 weeks, nonsmokers, and no personal or family history of vascular disease. Each women was examined during 3rdT and between 8 and 12 weeks PP to evaluate FMD and nitrite concentration in whole blood. Women not examined in both periods were excluded. Values between both periods were compared using paired t tests. Correlation between FMD and nitrite was examined by Pearson correlation coefficient. Significance level set as p < 0.05., Results: We invited 42 pregnant women. Among them, 35 were eligible and 7 of them were excluded for not attending the PP evaluation resulting in 28 participants analyzed. We found no significant change in FMD (10.39 ± 5.57% vs. 8.42 ± 4.21%; p = 0.11; 3rdT vs. PP, respectively) and no significant change in nitrite concentration (257.41 ± 122.95 nmol/L vs. 237.16 ± 90.01 nmol/L; p = 0.28). Baseline brachial artery diameter had a significant reduction (3.11 ± 0.30 to 2.75 ± 0.34 mm; p < 0.01). No significant correlation between FMD and nitrite during 3rdT (r = -0.13; p = 0.50) or PP (r = 0.14; p = 0.48) was found., Conclusions: We did not observe significant changes in both FMD and nitrite concentration between third trimester and the PP period. FMD did not correlate with nitrite in both periods. More studies are needed to confirm our findings.

Objective: To evaluate and compare the intraobserver and interobserver reliability and agreement for the biparietal diameter (BPD), abdominal circumference (AC), femur length (FL) and estimated fetal weight (EFW) obtained by two-dimensional ultrasound (2D-US) and three-dimensional ultrasound (3D-US)., Methods: Singleton pregnant women between 24 and 40 weeks were invited to participate in this study. They were examined using 2D-US in a blinded manner, twice by one observer, intercalated by a scan by a second observer, to determine BPD, AC and FL. In each of the three examinations, three 3D-US datasets (head, abdomen and thigh) were acquired for measurements of the same parameters. We determined EFW using Hadlock's formula. Systematic errors between 3D-US and 2D-US were examined using the paired t-test. Reliability and agreement were assessed by intraclass correlation coefficients (ICCs), limits of agreement (LoA), SD of differences and proportion of differences below arbitrary points., Results: We evaluated 102 singleton pregnancies. No significant systematic error between 2D-US and 3D-US was observed. The ICC values were higher for 3D-US in both intra- and interobserver evaluations; however, only for FL was there no overlap in the 95% CI. The LoA values were wider for 2D-US, suggesting that random errors were smaller when using 3D-US. Additionally, we observed that the SD values determined from 3D-US differences were smaller than those obtained for 2D-US. Higher proportions of differences were below the arbitrarily defined cut-off points when using 3D-US., Conclusion: 3D-US improved the reliability and agreement of fetal measurements and EFW compared with 2D-US., (Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.)

Objective: To evaluate the intra- and interobserver reliability of assessment of three-dimensional power Doppler (3D-PD) indices from single spherical samples of the placenta., Methods: Women with singleton pregnancies at 24-40 weeks' gestation were included. Three scans were independently performed by two observers; Observer 1 performed the first and third scan, intercalated by the scan of Observer 2. The observers independently analyzed the 3D-PD datasets that they had previously acquired using four different methods, each using a spherical sample: random sample extending from basal to chorionic plate; random sample with 2 cm(3) of volume; directed sample to the region subjectively determined as containing more color Doppler signals extending from basal to chorionic plate; or directed sample with 2 cm(3) of volume. The vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were evaluated in each case. The observers were blinded to their own and each other's results. Additional evaluation was performed according to placental location: anterior, posterior and fundal or lateral. Intra- and interobserver reliability was assessed by intraclass correlation coefficients (ICC)., Results: Ninety-five pregnancies were included in the analysis. All three placental 3D-PD indices showed only weak to moderate reliability (ICC < 0.66 and ICC < 0.48, intra- and interobserver, respectively). The highest values of ICC were observed when using directed spherical samples from basal to chorionic plate. When analyzed by placental location, we found lower ICCs for lateral and fundal placentae compared to anterior and posterior ones., Conclusion: Intra- and interobserver reliability of assessment of placental 3D-PD indices from single spherical samples in pregnant women greater than 24 weeks' gestation is poor to moderate, and clinical usefulness of these indices is likely to be limited., (Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.)