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The present work is dedicated to an experimental and theoretical study of an innovative underwater ultrasound source. The source works using a technique in which a pulsed power generator using the impedance mismatch of a long high-voltage coaxial cable generates a train of voltage impulses with a very high pulse repetition frequency of the order of a few MHz. Applying this train of voltage impulses to a pair of underwater electrodes generates a streamer-initiated breakdown of water and, subsequently, a plasma column connecting the electrodes over a very large inter-electrode gap of 55 mm. The interaction of the long plasma column thus formed with the surrounding water produces a rapidly expanding vapor bubble, an "instrument" producing a strong pressure wave with an overall energy efficiency of 24%, an order of magnitude higher than most underwater pressure sources reported in the literature. [ABSTRACT FROM AUTHOR]

Context: Piriformis syndrome is often associated with muscle spasms and shortening of the piriformis muscle (PM). Physical therapy, including static stretching of the PM, is one of the treatments for this syndrome. However, the effective stretching position ofthe PM is unclear in vivo. This study aimed to determine the effective stretching positions of the PM using ultrasonic shear wave elastography. Design: Observational study. Methods: Twenty-one healthy young men (22.7 [2.41 y) participated in this study. The shear elastic modulus of the PM was measured at 12 stretching positions using shear wave elastography. Three of the 12 positions were tested with maximum internal rotation at 0°, 20°, or 40° hip adduction in 90° hip flexion. Nine of the 12 positions were tested with maximum external rotation at positions combined with 3 hip-flexion angles (70°, 90°, and 110°) and 3 hip-adduction angles (0°, 20°, and 40°). Results.' The shear elastic modulus of the PM was significantly higher in the order of 40°, 20°, and 0° of adduction and higher in external rotation than in internal rotation. The shear elastic modulus of the PM was significantly greater in combined 110° hip flexion and 40° adduction with maximum external rotation than in all other positions. Conclusion.- This study revealed that the position in which the PM was most stretched was maximum external rotation with 110° hip ftexion and 40° hip adduction. [ABSTRACT FROM AUTHOR]

Background: Local high-frequency percussive (HFP) massage has recently found widespread application in physical therapy. Although HFP massage reportedly improves range of motion (ROM), the mechanism underlying its action has not yet been proven. This study aimed to clarify whether a 5-minute percussive massage regimen affects muscular or connective tissues, such as the deep fascia and deep intermuscular fascia and the change in joint ROM. Method: The study sample was calculated using G*Power analysis program, and this study enrolled 15 healthy men who underwent 5-minute HFP massage to the medial gastrocnemius muscle. Shear-wave elastography was used to measure tissue stiffness in the deep fascia, muscle, and deep intermuscular fascia through shear-wave velocity as well as the ROM of the volunteers' ankle joint dorsiflexion before and after the HFP massage. A value of P < .05 was used to declare statistical significance, and post hoc was used to calculate the effect size using G*Power. Results: Shear-wave velocity revealed a significant change in the deep fascia (P = .003; shear-wave velocity: -0.7 m/s) and significant increase in ROM of ankle dorsiflexion (P = .002; increase in ROM: 3.0°) after 5 minutes of HFP massage. However, the muscle and deep intermuscular fascia did not exhibit any significant changes. Conclusions: HFP massage for 5 minutes modified the stiffness of the deep fascia and concurrently improved the ankle joint-dorsiflexion ROM. This method can be used as an intervention to decrease stiffness of the deep fascia and increase the ROM efficiently. [ABSTRACT FROM AUTHOR]

Focused ultrasound has experimentally been found to enhance the diffusion of nanoparticles; our aim with this work is to study this effect closer using both experiments and non-equilibrium molecular dynamics. Measurements from single particle tracking of 40 nm polystyrene nanoparticles in an agarose hydrogel with and without focused ultrasound are presented and compared with a previous experimental study using 100 nm polystyrene nanoparticles. In both cases, we observed an increase in the mean square displacement during focused ultrasound treatment. We developed a coarse-grained non-equilibrium molecular dynamics model with an implicit solvent to investigate the increase in the mean square displacement and its frequency and amplitude dependencies. This model consists of polymer fibers and two sizes of nanoparticles, and the effect of the focused ultrasound was modeled as an external oscillating force field. A comparison between the simulation and experimental results shows similar mean square displacement trends, suggesting that the particle velocity is a significant contributor to the observed ultrasound-enhanced mean square displacement. The resulting diffusion coefficients from the model are compared to the diffusion equation for a two-time continuous time random walk. The model is found to have the same frequency dependency. At lower particle velocity amplitude values, the model has a quadratic relation with the particle velocity amplitude as described by the two-time continuous time random walk derived diffusion equation, but at higher amplitudes, the model deviates, and its diffusion coefficient reaches the non-hindered diffusion coefficient. This observation suggests that at higher ultrasound intensities in hydrogels, the non-hindered diffusion coefficient can be used. [ABSTRACT FROM AUTHOR]

Context: Imbalances in upper-extremity soft tissue stiffness may play a role in the development of shoulder and elbow musculoskeletal injuries in tennis players. Ultrasound shear wave elastography provides quantifiable and specific data regarding muscle stiffness. The purpose of this study was to compare tendon and muscle stiffness in healthy tennis players to nontennis players. Design: Cross-sectional study. Methods: The shear wave modulus, measured in kilopascals, was obtained for the dominant pectoralis major, pectoralis minor, and common wrist-extensor tendon using 2-dimensional shear wave elastography ultrasound imaging (GE Logiq S8, L9 linear transducer). Independent t test was run to compare age, body mass index, and the activity index score between both groups. Within-day intrarater reliability was assessed using a within-examiner intraclass correlation coefficients (ICC [3, 1]) with 95% confidence intervals. A multivariate general linear model was run to compare the mean differences between the tennis and nontennis players for each of the soft tissues. Results: Twenty-six individuals (13 tennis players and 13 nontennis players) were recruited. Within-day ICCs were very good (ICC >.78 for the pectoralis musculature) and excellent (ICC >.94 for the common wrist extensor). Common extensor tendon stiffness was significantly higher in tennis players compared to nontennis players (mean difference = 114.8 [61.8], confidence interval, −22.8 to 252.5 kPa for the dominant arm [P =.039]). Mean pectoralis major and minor stiffness differences were not significant (P >.214). Conclusions: Common wrist-extensor stiffness in healthy recreational tennis players is higher than those who do not play tennis. Therefore, clinicians may need to facilitate a greater soft tissue stiffness response with resistance training when rehabilitating recreational tennis players as compared to those not playing tennis. Additional normative data on a larger sample of recreational tennis players should be collected. [ABSTRACT FROM AUTHOR]

Numerical simulations of the evolution of mobile and immobile dislocations in ceramics under applied pressure in dry pressing at a relatively low temperature are performed in order to study the possibility of production of all-dislocation-ceramics of solid electrolytes, which are expected to have extremely high ionic conductivity without dendrite formation because the diameter of a dislocation pipe is considerably larger than the distance between neighboring dislocations. The present numerical simulations are only for the densification process by plastic deformation of grains under high pressure under the assumption that the compaction of particles by their rearrangement is completed beforehand. By the plastic deformation, new dislocations are generated inside the grains. The required total dislocation density of about 1017 m−2 seems to be achievable under some conditions of dry pressing according to the present numerical simulations. Very short ultrasound irradiation at the beginning of the dry pressing sometimes considerably increases the dislocation density, while for other cases, it even considerably decreases the dislocation density due to enhanced annihilation of mobile dislocations by ultrasound. [ABSTRACT FROM AUTHOR]

An all-optical photoinduced lensing method is used to excite and monitor acoustic waves in liquids. Following optical absorption, the laser pulse induces a localized temperature gradient that launches pressure waves in the excited region at the nanosecond time scale. This generates a lens-like optical element in the sample. A probe laser beam senses the refractive index change due to the acoustic and thermal effects. Piezo-optic and thermo-optic coefficients govern how the refractive index of a material changes in response to mechanical stress and temperature variations, respectively. These effects are connected to the physical properties of the liquids and can be accessed by theoretically describing the intensity signal. A complete set of physical properties of ten liquids are quantitatively described in this work. These effects find applications in a wide range of fields, from optical communication, ultrasonic imaging, and sensing to adaptive optics and fundamental research. [ABSTRACT FROM AUTHOR]

The principle of the conventional ultrasound test states that the detectable voids cannot be smaller than the acoustic wavelength. However, by using effective medium approximation, the fraction of small voids can be estimated by the variation of the effective density. In this study, a non-contacting ultrasound-based porosity fraction mapping methodology is developed for estimated small voids in coal with long operating wavelength in air. This novel ultrasonic technique based on the mechanical properties of coal offers a rapid scan of the effective density mapping and distribution of void fraction over a large sample area, which overcame the limitation of small voids detection in the conventional ultrasound testing. [ABSTRACT FROM AUTHOR]

Focused ultrasound ablation provides a truly noninvasive tumor treatment option with clinically proven feasibility and safety. However, the frequently required long treatment duration hinders its clinical applicability. In this work, we compared the thermal ablation induced by conventional focused ultrasound (cFUS), split-focus ultrasound (sFUS), and acoustic vortex (AV) in tissue phantoms containing phase-change nanodroplets and mouse tumors. The results indicated that AV could substantially enhance the thermal ablation efficiency compared with cFUS, which was attributed to the larger focal region in the former. Additionally, the ablation region appeared as a unique cylindrical area with a smaller length-to-width ratio in AV than that in cFUS. Though the efficiency could also be improved in sFUS compared with cFUS, the ablation region was irregular and non-ablated tissues were present. Furthermore, in vivo experiments demonstrated that the tumor volume decreased faster and the mice survived longer after AV treatment compared with cFUS. The cavitation activity was also found to be more intense in AV ablation. The proposed method may solve the general issue of low efficiency often observed in cFUS ablation and further promote the development of other ultrasound treatments. [ABSTRACT FROM AUTHOR]

Phased arrays of airborne ultrasound transducers are widely utilized as a key technology to achieve mid-air convergence of intense ultrasound, which is applied to a variety of systems, such as contactless tactile presentation, acoustic levitation and its application, mid-air-flow acceleration, etc. However, it requires considerably precise phase control with temporally severe synchronization between elements, which leads to difficulty in scaling up the entire system beyond the tabletop size as most of the current application systems. Here, we propose a much simpler and easier scaling-up method of airborne ultrasound convergence, where a binary amplitude mask that serves as a Fresnel Zone Plate (FZP) is placed on the planar in-phase ultrasound sources. We experimentally demonstrate that the FZP-based ultrasound focusing achieved a spatial resolution that is comparable to conventional methods, based on the use of phase-controlled transducers. The ultrasound foci created using FZPs are sufficiently intense for most application scenarios that are currently in practical use. We also determine favorable side effects of our method suppressing grating lobes, which is inevitable with the conventional phase-controlling method. The FZPs and planar ultrasound sources are both readily implemented with inexpensive ingredients and components. The result of our study contributes to upsizing dimensions in which a mid-air convergent ultrasound field is successfully generated. Accordingly, unprecedented application scenarios that target the entire room as the workspace will be possible. [ABSTRACT FROM AUTHOR]

The article focuses on the role of osteoclasts in bone resorption and the use of denosumab, a monoclonal antibody targeting the RANKL pathway, in treating osteolytic disorders like giant cell tumors of bone (GCTB) and central giant cell granuloma (CGCG). Topics include the effectiveness of denosumab in pediatric patients with various bone disorders and the management of rebound hypercalcemia following denosumab discontinuation in children.

Medical titanium and titanium alloys were susceptible to infection following implantation due to their limited antibacterial properties. One effective approach to mitigate this risk was the application of antibacterial coatings on the medical titanium materials surface. Additionally, there was a pressing need in clinical practice to develop a titanium surface coating that can modulate antibacterial properties in response to external conditions. In this study, a zinc oxide-loaded silver nanorod arrays coating was fabricated on the titanium surface using intensity pulsed ultrasound and light as stimuli, aiming to achieve the desired regulation of antibacterial properties. The coating morphology and the silver distribution within the coating were investigated. The surface roughness and wetting angle were tested. The effect of low intensity pulsed ultrasound and light on the cumulative release of silver ions was studied, and its mechanism was analyzed. The bacteriostasis rate of the polarized ZnO-loaded silver nanorods array coating reached 99.96%. The synergistic bactericidal mechanism of piezoelectric effect, catalysis, silver ion bactericidal effect and nanorod puncture effect on bacteria was expounded. Finally, the ZnO-loaded silver nanorod array coating exhibited non-cytotoxicity and supported full osteoblast adherence morphology. The polarized coating was observed to be coated with abundant granular hydroxyapatite after immersion in simulated body fluids for 7 days. The results provide a possibility for modulating the antibacterial properties of titanium surface coatings in vitro. [ABSTRACT FROM AUTHOR]

Background: Posterior retroperitoneoscopic adrenalectomy has several advantages over transabdominal laparoscopic adrenalectomy regarding operating time, blood loss, postoperative pain, and recovery. However, postoperatively several patients report chronic pain or hypoesthesia. We hypothesized that these symptoms may be the result of damage to the subcostal nerve, because it passes the surgical area. Methods: A prospective single-center case series was performed in adult patients without preoperative pain or numbness of the abdominal wall who underwent unilateral posterior retroperitoneoscopic adrenalectomy. Patients received pre- and postoperative questionnaires and a high-resolution ultrasound scan of the subcostal nerve and abdominal wall muscles was performed before and directly after surgery. Clinical evaluation at 6 weeks was performed with repeat questionnaires, physical examination, and high-resolution ultrasound. Long-term recovery was evaluated with questionnaires, and photographs from the patients were examined for abdominal wall asymmetry. Results: A total of 25 patients were included in the study. There were no surgical complications. Preoperative visualization of the subcostal nerve was possible in all patients. At 6 weeks, ultrasound showed nerve damage in 15 patients, with no significant association between nerve damage and postsurgical pain. However, there was a significant association between nerve damage and hypoesthesia (p = 0.01), sensory (p < 0.001), and motor (p < 0.001) dysfunction on physical examination. After a median follow-up of 18 months, 5 patients still experienced either numbness or muscle weakness, and one patient experienced chronic postsurgical pain. Conclusion: In this exporatory case series the incidence of postoperative damage to the subcostal nerve, both clinically and radiologically, was 60% after posterior retroperitoneoscopic adrenalectomy. There was no association with pain, and the spontaneous recovery rate was high. [ABSTRACT FROM AUTHOR]

Background: In primarily unresectable liver tumors, ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged hepatectomy) may offer curative two-stage hepatectomy trough a fast and extensive hypertrophy. However, concerns have been raised about the invasiveness of the procedure. Full robotic ALPPS has the potential to reduce the postoperative morbidity trough a less invasive access. The aim of this study was to compare the perioperative outcomes of open and full robotic ALPPS. Methods: The bicentric study included open ALPPS cases from the University Hospital Zurich, Switzerland and robotic ALPPS cases from the University of Modena and Reggio Emilia, Italy from 01/2015 to 07/2022. Main outcomes were intraoperative parameters and overall complications. Results: Open and full robotic ALPPS were performed in 36 and 7 cases. Robotic ALPPS was associated with less blood loss after both stages (418 ± 237 ml vs. 319 ± 197 ml; P = 0.04 and 631 ± 354 ml vs. 258 ± 53 ml; P = 0.01) as well as a higher rate of interstage discharge (86% vs. 37%; P = 0.02). OT was longer with robotic ALPPS after both stages (371 ± 70 min vs. 449 ± 81 min; P = 0.01 and 282 ± 87 min vs. 373 ± 90 min; P = 0.02). After ALPPS stage 2, there was no difference for overall complications (86% vs. 86%; P = 1.00) and major complications (43% vs. 39%; P = 0.86). The total length of hospital stay was similar (23 ± 17 days vs. 26 ± 13; P = 0.56). Conclusion: Robotic ALPPS was safely implemented and showed potential for improved perioperative outcomes compared to open ALPPS in an experienced robotic center. The robotic approach might bring the perioperative risk profile of ALPPS closer to interventional techniques of portal vein embolization/liver venous deprivation. [ABSTRACT FROM AUTHOR]

Background: The term Anterior Accessory of the Great Saphenous Vein suggest this is a branch tributary vein despite this vessel's anatomic features of a truncal vein. A multisocietal group suggested to designate this the Anterior Saphenous Vein (ASV). This study was aimed to evaluate its ultrasound anatomy in normal and varicose limbs. Methods: The clinical anatomy of the ASV was evaluated by narrative review of the literature. Additionally, the course of the ASV was evaluated in 62 limbs with no evidence of venous disease and 62 limbs with varicosities. Results: The ASV length, patterns of origin and termination are reported in both normal and patients with varicose veins. Discussion of the patterns is supported by the narrative review of the literature. Conclusions: The ASV must be considered a truncal vein and its treatment modalities should be the same that for the great and small saphenous veins rather than a tributary vein. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Despite a negative magnetic resonance imaging (MRI), some patients may still harbor clinically significant prostate cancer (csPCa, Gleason grade group =2). Highresolution micro-ultrasound (microUS) is a novel imaging technology that could visualize csPCa that is missed by MRI. METHODS: This retrospective review included 1011 consecutive patients biopsied between September 2021 and July 2023 in Alberta, Canada. Among them were 103 biopsy-naive patients with negative MRI (Prostate Imaging Reporting & Data System [PI-RADS] =2) undergoing microUS-informed prostate biopsy (n=56) scored using Prostate Risk Identification Using Micro-ultrasound (PRI-MUS) or standard transrectal ultrasound prostate biopsy (n=47). The primary outcome was detection rate of csPCa stratified by biopsy technique and PRIMUS score. RESULTS: MicroUS biopsy identified csPCa in 14/56 (25%) compared to standard biopsy in 8/47 (17%) (p=0.33). Patients with lesions PRI-MUS =3 had csPCa detected at a higher rate compared to patients with PRI-MUS =2 (42% vs. 16%, p=0.03). The csPCa detection rate was significantly different comparing patients with prostate-specific antigen (PSA) density <0.15 and PRI-MUS =2 compared to patients with PSA density =0.15 and PRI-MUS =3 (14% vs. 60%, p=0.02). CONCLUSIONS: MicroUS may aid in the detection of csPCa for patients with negative MRI. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Pediatric testicular torsion (TT) is a urologic emergency that may result in testicular loss if left untreated. Testicular salvage is dependent on prompt intervention, and thus delays in diagnosis and management may threaten testicular viability. Knowledge of real-world Canadian practice patterns for pediatric TT will allow optimization of practices based on resource availability and geographic limitations to improve care. METHODS: An electronic survey on pediatric TT management was distributed to Canadian urologists. Descriptive statistics were performed on respondent demographic factors, hospital policies and barriers to care, surgical approaches, and transfer practices. Respondent practice patterns were analyzed based on geographic location and training. RESULTS: Thirty-four urologists responded, with most respondents operating a community practice. Ultrasonography (US) was frequently used to support TT diagnosis. Despite this, poor US access was often cited as a barrier to care, with particular impact on rural urologists. Neonatal patients and <10 years old were commonly transferred to a pediatric hospital for definitive management due to surgeon discomfort and hospital policies. Reported transport methods commonly included use of the patient's own vehicle or ambulance based on availability and timing. CONCLUSIONS: Neonatal patients and patients under 10 years old are most commonly reported to be transferred to pediatric hospitals for TT management. Patients located in rural locations and at centers with limited US access may be at risk for delayed diagnosis and treatment. Pathways for prompt management of suspected TT may better serve these younger pediatric patients. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Despite being a commonly encountered urologic condition, there remains a paucity of understanding and literature on the management and natural history of isolated epididymal pain. Typically, patients who do not respond to conservative management undergo an epididymectomy; however, the literature on its efficacy is also scarce, with success rates varying from 10-90%. Our goal was to better describe the etiology and natural history of isolated epididymal pain and to describe the rates of success associated with epididymectomy. METHODS: A retrospective, case-control study was conducted at the Manitoba Men's Health Clinic, with the approval of the University of Manitoba Research Ethics Board. All patients presenting with chronic epididymitis, defined as discomfort or pain localized to the epididymis for at least three months, were identified. Information regarding patient demographics, past medical and surgical history, duration of pain, localization of pain, findings on previous ultrasounds, prior conservative therapies trialed, and response rates, as well as response rates to surgical therapy were collected. RESULTS: From April 2022 to April 2023, a total of 275 patients with chronic orchialgia were identified; among them, 74 patients presented with chronic isolated epididymal pain. On average, 22.9% of patients experienced symptoms for 3-6 months, 10% for 6-12 months, and 67.1% for over 12 months; 13.5% (n=10) had associated ejaculatory pain, 8.1% (n=6) had lower urinary tract symptoms, and 4.1% (n=3) had erectile dysfunction. Ultrasound findings were observed in 68.9% of patients, with 31.1% having an epididymal cyst, 27.1% having a varicocele, 5.4% having a spermatocele, and 4.1% having a hydrocele. Among those who underwent conservative therapy, only 36.2% of patients reported a positive response. Surgical intervention was performed on 23 patients, including 16 who underwent epididymectomy, three who underwent cord denervation, and two who underwent vasovasostomy and spermatocelectomy each. Most (81.3%, n=13) patients who underwent epididymectomy had a positive response to the surgical intervention, defined as no pain on followup, while all patients undergoing other surgical interventions experienced a positive response. CONCLUSIONS: Chronic epididymal pain is a condition with limited data surrounding its management. Prior to referral, a large proportion of patients did not undergo any conservative treatment, and of those that did, there was limited response. For those who underwent surgical intervention, all were pain-free on followup, except three patients who underwent epididymectomy. [ABSTRACT FROM AUTHOR]

Injections around the Achilles tendon (AT) are commonly performed in clinical practice to manage non-insertional Achilles tendinopathy, but the presence/distribution of the injectate with relation to its sheath has not been assessed specifically. Accordingly, the aim of this cadaveric investigation was to demonstrate the feasibility of Achilles paratenon injection under ultrasound guidance - by confirming the exact needle positioning as well as the dye distribution inside the paratenon lumen. A descriptive laboratory study with three human cadaveric specimens (one fresh cadaver and two cadavers embalmed using the Fix for Life (F4L) method) was performed in a tertiary-care academic institution. The interventional technique and the related anatomical findings were illustrated. During the injection, the needle was advanced inside the Achilles paratenon under ultrasound guidance i.e. in-plane medial-to-lateral approach. With the objective to confirm its correct placement, the needle was kept in situ on the right AT of the fresh cadaver. Likewise, to demonstrate the location of the dye inside the lumen of Achilles paratenon, the other five ATs - four on the embalmed cadavers and one on the fresh cadaver - were injected with 5 mL of green color dye. After removal of the needle, a layer-by-layer anatomical dissection was performed on all three cadavers. On the right AT of the fresh cadaver, the position of the needle's tip within the Achilles paratenon was confirmed. Accurate placement of the dye inside the paratenon lumen was confirmed in four (80%) ATs, one of the fresh and three of the embalmed cadavers. No spread inside the crural fascia compartment or between the AT and the Kager's fat pad was observed. Herewith, unintentional spilling of the dye within the superficial soft tissues of the posterior leg was reported in the left AT of one of the two embalmed cadavers (20%). Ultrasound-guided injection using the in-plane, medial-to-lateral approach can accurately target the lumen of Achilles paratenon. • The paratenon is a richly vascularized and innervated elastic sleeve that plays a pivotal role in the clinical scenario of painful midportion Achilles (para)tendinopathy. • The present cadaveric investigation demonstrates that under ultrasound guidance the lumen of Achilles paratenon can be selectively injected avoiding the Kager's fat pad, the overlying fascial sheath, and the tendon tissue itself. • In patients with painful midportion Achilles (para)tendinopathy, the Achilles paratenon can be selectively/safely injected. [ABSTRACT FROM AUTHOR]

Introduction: Facial fillers and injectables have transformed the landscape of cosmetic procedures, offering rejuvenation possibilities. However, the emergence of "Facial Overfilled Syndrome (FOS)" presents a concerning trend attributed to excessive filler use and suboptimal injection techniques. Understanding the interplay between facial aging and augmentation techniques is crucial in addressing and preventing FOS. Material and Methods: Facial overfilled syndrome is characterized by the excessive use of fillers, resulting in a distorted and heavy appearance. It manifests in various forms, including 'flowerhorn' foreheads, 'sunset' eyes, 'chipmunk' cheeks, 'witch' chins, and 'pillow' faces. The syndrome arises from attempts to combat anatomical aging with dramatic filler treatments, causing rapid volume changes and skin tightening. Skeletal structures and soft tissue distribution across different ethnicities play a significant role in FOS development. Results: Understanding the aging process across facial tissues is essential, as fillers cannot entirely reverse aging manifestations. Tailored assessment and treatment plans should precede filler injections, involving muscle assessment, observation of facial movements during injection, and ultrasound imaging of fat layers. Attention should be given to filler pressure and migration risks, particularly in areas with elevated pressure. Additionally, alternative approaches like energy‐based devices and polymer reinforcement of facial ligaments should be considered to minimize filler use. Ethnic variations in facial anatomy require careful consideration to avoid overcorrection. Conclusion: FOS predominantly affects individuals of East Asian descent due to specific facial characteristics. Prevention strategies involve minimizing filler use, addressing underlying bone changes, and considering ethnic and gender differences in facial anatomy. Recent MRI and ultrasound studies challenge the notion of filler breakdown, emphasizing the importance of filler selection and injection techniques. Education, individualized treatments, and a holistic understanding of facial anatomy are key to preventing and managing FOS and ensuring natural and harmonious facial aesthetics. [ABSTRACT FROM AUTHOR]

One of the most common causes of carpal tunnel syndrome (CTS) in childhood is mucopolysaccharidosis (MPS). While ultrasonography (US) can aid in the diagnosis of CTS in adult patients, there is limited experience of this in the pediatric group. We aimed to investigate the results of wrist ultrasonography, which may be a candidate alternative to electrophysiological examination. The participants were evaluated for symptoms, physical examination findings, electrophysiological tests and grayscale US. CTS was diagnosed in accordance with the American Academy of Orthopedic Surgeons Management of Carpal Tunnel Syndrome: Evidence-Based Clinical Practice Guideline. Included in the study were 27 MPS patients aged 4.5–32 years and 30 healthy control subjects aged 4.3–26 years. Of the 54 wrists in the MPS group, 30 were diagnosed with CTS. The median cross-sectional area (CSA) at the proximal carpal tunnel, the CSA at the forearm, and the wrist-forearm ratio (WFR) were higher in the wrists of the MPS with CTS group than in those without CTS and the healthy control subjects. The WFR cutoff of ≥1.35, 56.6% (95% CI: 437.4–74.5) sensitivity, and 89.8% (95% CI: 81.0–95.5) specificity were consistent with a diagnosis of CTS (receiver operating characteristics analysis, area under the curve = 0.775, 95% CI: 0.673–0.877). Although the US provides results with unsatisfactory specificity and sensitivity, it is a candidate for further investigation for the diagnosis of CTS because it is an innovative, noninvasive, and more accessible method. WFR value may produce more meaningful results than wrist or forearm nerve area measurements. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate TFC by EC versus lung ultrasound (LUS) findings for diagnosing and follow-up of TTN in late preterm and term neonates. This prospective observational study was conducted on 80 neonates with gestational age ≥ 34 weeks. TTN group included 40 neonates diagnosed with TTN, and no lung disease (NLD) group included 40 neonates without respiratory distress. LUS and EC were performed within the first 24 h of life and repeated after 72 h. There was a statistically significant increase in TFC in TTN group on D1 [48.48 ± 4.86 (1 KOhm−1)] compared to NLD group [32.95 ± 4.59 (1 KOhm−1)], and then significant decrease in TFC in D3 [34.90 ± 4.42 (1 KOhm−1)] compared to D1 in the TTN group. There was a significant positive correlation between both TFC and LUS with Downes' score, TTN score, and duration of oxygen therapy in the TTN group. Conclusion: Both LUS and TFC by EC provide good bedside tools that could help to diagnose and monitor TTN. TFC showed a good correlation with LUS score and degree of respiratory distress. What is Known: • Transient tachypnea of the newborn (TTN) is the most common cause of respiratory distress in newborns. • TTN is a diagnosis of exclusion, there are no specific clinical parameters or biomarker has been identified for TTN. What is New: • Thoracic fluid content (TFC) by electrical cardiometry is a new parameter to evaluate lung fluid volume and could help to diagnose and monitor TTN and correlates with lung ultrasound score. [ABSTRACT FROM AUTHOR]

Objective: To report the learning curve of multiple operators for fusion magnetic resonance imaging (MRI) targeted biopsy and to determine the number of cases needed to achieve proficiency. Materials and Methods: All adult males who underwent fusion MRI targeted biopsy between February 2012 and July 2021 for clinically suspected prostate cancer (PCa) in a single centre were included. Fusion transrectal MRI targeted biopsy was performed under local anaesthesia using the Koelis platform. Learning curves for segmentation of transrectal ultrasonography (TRUS) images and the overall MRI targeted biopsy procedure were estimated with locally weighted scatterplot smoothing by computing each operator's timestamps for consecutive procedures. Non‐risk‐adjusted cumulative sum (CUSUM) methods were used to create learning curves for clinically significant (i.e., International Society of Urological Pathology grade ≥ 2) PCa detection. Results: Overall, 1721 patients underwent MRI targeted biopsy in our centre during the study period. The median (interquartile range) times for TRUS segmentation and for the MRI targeted biopsy procedure were 4.5 (3.5, 6.0) min and 13.2 (10.6, 16.9) min, respectively. Among the 14 operators with experience of more than 50 cases, a plateau was reached after 40 cases for TRUS segmentation time and 50 cases for overall MRI targeted biopsy procedure time. CUSUM analysis showed that the learning curve for clinically significant PCa detection required 25 to 45 procedures to achieve clinical proficiency. Pain scores ranged between 0 and 1 for 84% of patients, and a plateau phase was reached after 20 to 100 cases. Conclusions: A minimum of 50 cases of MRI targeted biopsy are necessary to achieve clinical and technical proficiency and to reach reproducibility in terms of timing, clinically significant PCa detection, and pain. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine the normal vasculature indices of the endometrium and to correlate them with those in various physiological states. Methods: Women undergoing ultrasound at the Feto‐Maternal Center, Qatar in 2020–2021 as part of their gynecologic evaluation were enrolled into the study. They were divided into those with normal menses and no additional pathology, those following spontaneous miscarriage, postpartum and menopausal. Three‐dimensional (3D) evaluation of the endometrial vasculature was done and the parameters quantified included vascularization index (VI), flow index (FI), vascularization flow index (VFI), endometrial thickness, endometrial volume and uterine volume. JASP, an open‐source statistical analysis software, was used for analysis and an independent t‐test to compare the vascularity indices. A multivariate regression analysis was also done to look at the factors affecting the endometrial vascular indices within the luteal phase. Results: A total of 461 women were studied: 122 in the follicular phase, 199 in the luteal phase, 90 after a spontaneous miscarriage, 29 postpartum, and 16 menopausal. The vascularity indices were highest after miscarriage and lowest postnatally. There were no significant effects of age, gravida, para, or abortions on VI and VFI. However, there was a significant positive effect of age on FI (P = 0.019) There was a significant increase in endometrial volume and thickness in the luteal phase as compared to follicular phase (P < 0.01), but there was no difference in the vascularity indices. The uterine and endometrial volume in the postnatal group were nearly double that of the luteal group (P value <0.01 and 0.014, respectively). There was a significant decrease in flow index in the postnatal group compared to the luteal group (P < 0.01), suggesting low flow intensity in the postnatal group. Conclusions: Endometrial vascular indices measured using 3D Doppler can be used to determine normal vascular indices and vary with physiological states such as after miscarriages, postnatally and in the menopausal states. Synopsis: Endometrial vascular indices measured using 3D Doppler can be used to determine normal vascular indices of the endometrium and these vary in different physiological states. [ABSTRACT FROM AUTHOR]

Objective: Low‐cost devices have made obstetric sonography possible in settings where it was previously unfeasible, but ensuring quality and consistency at scale remains a challenge. In the present study, we sought to create a tool to reduce substandard fetal biometry measurement while minimizing care disruption. Methods: We developed a deep learning artificial intelligence (AI) model to estimate gestational age (GA) in the second and third trimester from fly‐to cineloops—brief videos acquired during routine ultrasound biometry—and evaluated its performance in comparison to expert sonographer measurement. We then introduced random error into fetal biometry measurements and analyzed the ability of the AI model to flag grossly inaccurate measurements such as those that might be obtained by a novice. Results: The mean absolute error (MAE) of our model (±standard error) was 3.87 ± 0.07 days, compared to 4.80 ± 0.10 days for expert biometry (difference −0.92 days; 95% CI: −1.10 to −0.76). Based on simulated novice biometry with average absolute error of 7.5%, our model reliably detected cases where novice biometry differed from expert biometry by 10 days or more, with an area under the receiver operating characteristics curve of 0.93 (95% CI: 0.92, 0.95), sensitivity of 81.0% (95% CI: 77.9, 83.8), and specificity of 89.9% (95% CI: 88.1, 91.5). These results held across a range of sensitivity analyses, including where the model was provided suboptimal truncated fly‐to cineloops. Conclusions: Our AI model estimated GA more accurately than expert biometry. Because fly‐to cineloop videos can be obtained without any change to sonographer workflow, the model represents a no‐cost guardrail that could be incorporated into both low‐cost and commercial ultrasound devices to prevent reporting of most gross GA estimation errors. Synopsis: Our model predicts gestational age (GA) more accurately from routinely available fly‐to cineloops than expert sonographer acquired biometry and can act as a guardrail to prevent gross GA estimation errors. [ABSTRACT FROM AUTHOR]

At present, prenatal ultrasound is one of the important means for screening fetal malformations. In the process of prenatal ultrasound diagnosis, the accurate recognition of fetal facial ultrasound standard plane is crucial for facial malformation detection and disease screening. Due to the dense distribution of fetal facial images, no obvious structure contour boundary, small structure area, and large area overlap in the middle of the structure detection frame, this paper regards the fetal facial standard plane and its structure recognition as a universal target detection task for the first time, and applies real‐time YOLO v5s to the fetal facial ultrasound standard plane structure detection and classification task. First, we detect the structure of a single slice, and take the structure of a slice class as the recognition object. Second, we carry out structural detection experiments on three standard planes; then, on the basis of the previous stage, the images of all parts included in the ultrasound examination of multiple fetuses were collected. In the single‐class structure detection experiment and the structure detection and classification experiment of three types of standard planes, the overall recognition effect of Precision and Recall index data is better, with Precision being 98.3% and 98.1%, and Recall being 99.3% and 98.2%, respectively. The experimental results show that the model has the ability to identify fetal facial anatomy and standard sections in different data, which can help the physician to automatically and quickly screen out the standard sections of each fetal facial ultrasound. Synopsis: By automatically identifying key anatomical structures within ultrasound images, it provides a theoretical basis for doctors to choose standard planes. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the clinical aspects of cirrhosis and its impact on cardiac structure and function. The methodology involved the examination of patients admitted to the Rajiv Gandhi Institute of Medical Sciences, Kadapa, diagnosed with hepatic cirrhosis. Data were collected from November 2017 to October 2019. The inclusion criteria comprised patients above 18 years with confirmed hepatic cirrhosis by abdominal ultrasound. Exclusion criteria included patients below 18 years. Ultrasound and echocardiography were used for diagnosis and assessment. Statistical analysis was conducted to evaluate the findings. [ABSTRACT FROM AUTHOR]

Introduction: Hyponatraemia is the most common electrolyte disorder in inpatients resulting mainly from an imbalance in water homeostasis. Intravascular fluid status assessment is pivotal but is often challenging given multimorbidity, polypharmacy and diuretics use. We evaluated the utility of point‐of‐care ultrasound (POCUS) as an adjunct tool to standard practice for fluid assessment in severe hyponatraemia patients. Methods: Patients presenting with severe hyponatremia (Serum Sodium [Na] < 120 mmol/L; Normal range: 135−145 mol/L), managed by standard care were included. Hyponatraemia biochemistry work‐up and POCUS examination were undertaken. Both clinician and POCUS independently assigned one of the three fluid status groups of hypovolaemia, hypervolaemia or euvolaemia. The final diagnosis of three fluid status groups at admission was made at the time of discharge by retrospective case review. Clinician's (standard of care) and POCUS fluid assessments were compared to that of the final diagnosis at the time of discharge. Results: n = 19 patients were included. Median Na on admission was 113 mmol/L (109‐116), improved to 129 ± 3 mmol/L on discharge. POCUS showed the higher degree of agreement with the final diagnosis (84%; n = 16/19), followed by the clinician (63%; n = 12/19). A trend towards higher accuracy of POCUS compared to clinician assessment of fluid status was noted (84% vs. 63%, p = 0.1611). Biochemistry was unreliable in 58% (n = 11/19) likely due to renal failure, polypharmacy or diuretic use. Inappropriate emergency fluid management was undertaken in 37% (n = 7/19) of cases based on initial clinician assessment. Thirst symptom correlated to hypovolaemia in 80% (4/5) cases. Conclusion: As subjective clinical and biochemistry assessments of fluid status are often unreliable due to co‐morbidities and concurrent use of medications, POCUS can be a rapid objective diagnostic tool to assess fluid status in patients with severe hyponatraemia, to guide accurate emergency fluid management. [ABSTRACT FROM AUTHOR]

Herbal bioactive compounds are secondary metabolites of plants that are produced in response to environmental stress and to protect the plant against harsh conditions. These compounds have both health effects on humans and also have preservative effects in food products. The conditions for extracting active compounds have a significant effect on their functional activities, and conventional and new methods have been used to extract bioactive compounds from plants. The aim of this study was to compare the extraction methods of bioactive compounds of Persian Golnar extract (PGE). In this research three methods of ohmic (temperatures of 45 °C and 60 °C for 40 and 60 min), ultrasonic (temperatures of 40 °C, 50 °C and 60 °C for 20 and 40 min) and perculation (for 24, 48 and 72 h) were used to prepare PGE, and the best extract was selected based on the extraction yield, total phenol content (TPC), total anthocyanin content (TAC) and antioxidant activity (DPPH radical scavenging). The results showed that there was no significant difference between the extraction yields of all three methods (p>0.05). The ohmic method had the same TPC as the ultrasonic method, but showed a higher TAC and antioxidant activity and was chosen as the best method. The optimal treatment in this stage included ohmic method, 60 °C and 40 min, and the extract obtained under these conditions contained 109.74 mg GAE/g of TPC, 373.26 mg/g of TAC and 81.11% antioxidant activity. [ABSTRACT FROM AUTHOR]

The purpose of this study was to retrospectively analyze the characteristics of contrast-enhanced ultrasound (CEUS) images and quantitative parameters of time-intensity curves (TICs) in children's peripheral neuroblastic tumors (pNTs). By comparing the imaging features and quantitative parameters of the TICs of neuroblastoma (NB) and ganglioneuroblastoma (GNB) patients, we attempted to identify the distinguishing points between NB and GNB. A total of 35 patients confirmed to have pNTs by pathologic examination were included in this study. Each child underwent CEUS with complete imaging data (including still images and at least 3 min of video files). Twenty-four patients were confirmed to have NB, and 11 were considered to have GNB according to differentiation. The CEUS image features and quantitative parameters of the TICs of all lesions were analyzed to determine whether there were CEUS-related differences between the two types of pNT. There was a significant difference in the enhancement patterns of the CEUS features (χ2 = 5.303, p < 0.05), with more "peripheral-central" enhancement in the NB group and more "central-peripheral" enhancement in the GNB group. In the TIC, the rise time and time to peak were significantly different (p < 0.05). The receiver operating characteristic curve showed that the probability of ganglion cell NB increased significantly after RT > 15.29, with a sensitivity of 0.636 and a specificity of 0.958. When the peak time was greater than 16.155, the probability of NB increased significantly, with a sensitivity of 0.636 and a specificity of 0.958. The CEUS features of NB and GNB patients are very similar, and it is difficult to distinguish them. Rise time and time to peak may be useful in identifying GNB and NB, but the sample size of this study was small, and the investigation was only preliminary; a larger sample size is needed to support these conclusions. [ABSTRACT FROM AUTHOR]

Acute lung injury (ALI) has become a research hotspot due to its significant public health impact. To explore the value of the use of modified lung ultrasound (MLUS) scoring system for evaluating ALI using a rabbit model of ALI induced by hydrochloric acid (HCl) and investigate its correlation with high-resolution computed tomography (HRCT) and histopathological scores. Twenty New Zealand laboratory rabbits were randomly assigned to control group (N = 5) and 3 experimental groups (N = 5 each). The control group received instillation of physiological saline, while the 3 experimental groups received 2 mL/kg of different doses of HCl instillation (mild group: pH 1.5, moderate group: pH 1.2, and severe group: pH 1.0) through the trachea under ultrasound guidance. Pulmonary ultrasound (using Mindray Reason9 linear array probes with frequency of 6-15 mHz) and HRCT examinations were performed before modeling (0H) and at 1H, 2H, 4H, 8H, 12H after modeling. The experimental rabbits were sacrificed at 12H for examination of gross lung morphology and hematoxylin-eosin-stained histopathological sections. The correlation of MLUS scores with HRCT/histopathological scores was assessed. All rabbits in the experimental groups showed oxygenation index PaO₂/FiO₂<300. Successful establishment of ALI model was proven by autopsy (successful modeling rate: 100%). The pathological damage increased with increase in HCl dosage. MLUS scores showed a positive correlation with HRCT scores/pathological severity. There was a strong positive correlation between MLUS scores and histopathological scores (r = 0.963, p < 0.05) as well as between HRCT scores and histopathological scores (r = 0.932, p < 0.05). Transtracheal injection of different dosages of HCl under ultrasound guidance induced different degrees of ALI. The MLUS scoring system can be used for semiquantitative evaluation of ALI, and is suitable as a screening tool. [ABSTRACT FROM AUTHOR]

High-intensity magnetic resonance-guided focused ultrasound (MRgFUS) is a non-invasive therapy to lesion brain tissue, used clinically in patients and pre-clinically in several animal models. Challenges with focused ablation in rodent brains can include skull and near-field heating and accurately targeting small and deep brain structures. We overcame these challenges by creating a novel method consisting of a craniectomy skull preparation, a high-frequency transducer (3 MHz) with a small ultrasound focal spot, a transducer positioning system with an added manual adjustment of ∼0.1 mm targeting accuracy, and MR acoustic radiation force imaging for confirmation of focal spot placement. The study consisted of two main parts. First, two skull preparation approaches were compared. A skull thinning approach (n = 7 lesions) was compared to a craniectomy approach (n = 22 lesions), which confirmed a craniectomy was necessary to decrease skull and near-field heating. Second, the two transducer positioning systems were compared with the fornix chosen as a subcortical ablation target. We evaluated the accuracy of targeting using histologic methods from a high-frequency transducer with a small ultrasound focal spot and MR acoustic radiation force imaging. Comparing a motorized adjustment system (∼1 mm precision, n = 17 lesions) to the motorized system with an added micromanipulator (∼0.1 mm precision, n = 14 lesions), we saw an increase in the accuracy of targeting the fornix by 133%. The described work allows for repeatable and accurate targeting of small and deep structures in the rodent brain, such as the fornix, enabling the investigation of neurological disorders in chronic disease models. [ABSTRACT FROM AUTHOR]

We believe our poly(lactic acid) (PLA) microbubbles are well suited for therapeutic delivery to spinal cord injury (SCI) using ultrasound-triggered bursting. We investigated the feasibility of clinical ultrasound bursting in situ , the optimal bursting parameters in vitro and the loading and release of a model bio-active DNA. Microbubbles were tested using clinical ultrasound in a rat cadaver SCI model. Burst pressure thresholds were determined using the change in enhancement after ultrasound exposure. Resonance frequency, acoustic enhancement, sizing and morphology were evaluated by comparing two microbubble porogens, ammonium carbonate and ammonium carbamate. Oligonucleotides were loaded into the shell and released using the found optimized ultrasound bursting parameters. In situ imaging and bursting were successful. In vitro bursting thresholds using frequencies 1, 2.25 and 5 MHz were identified between peak negative pressures 0.2 and 0.5 MPa, believed to be safe for spinal cord. The pressure threshold decreased with decreasing frequencies. PLA bursting was optimized near the resonance frequency of 2.5 to 3.0 MHz using 2.25 MHz and not at lower frequencies. PLA microbubbles, initially with a mean size of approximately 2 µm, remained in one piece, collapsed to between 0.5 and 1 µm and did not fragment. Significantly more oligonucleotide was released after ultrasound bursting of loaded microbubbles. Microbubble-sized debris was detected when using ammonium carbamate, leading to inaccurate microbubble concentration measurements. PLA microbubbles made with ammonium carbonate and burst at appropriate parameters have the potential to safely improve intrathecal therapeutic delivery to SCI using targeted ultrasound. [ABSTRACT FROM AUTHOR]

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

Deep learning algorithms have commonly been used for the differential diagnosis between benign and malignant thyroid nodules. The aim of the study described here was to develop an integrated system that combines a deep learning model and a clinical standard Thyroid Imaging Reporting and Data System (TI-RADS) for the simultaneous segmentation and risk stratification of thyroid nodules. Three hundred four ultrasound images from two independent sites with TI-RADS 4 thyroid nodules were collected. The edge connection and Criminisi algorithm were used to remove manually induced markers in ultrasound images. An integrated system based on TI-RADS and a mask region-based convolution neural network (Mask R-CNN) was proposed to stratify subclasses of TI-RADS 4 thyroid nodules and to segment thyroid nodules in the ultrasound images. Accuracy and the precision-recall curve were used to evaluate stratification performance, and the Dice similarity coefficient (DSC) between the segmentation of Mask R-CNN and the radiologist's contour was used to evaluate the segmentation performance of the model. The combined approach could significantly enhance the performance of the proposed integrated system. Overall stratification accuracy of TI-RADS 4 thyroid nodules, mean average precision and mean DSC of the proposed model in the independent test set was 90.79%, 0.8579 and 0.83, respectively. Specifically, stratification accuracy values for TI-RADS 4a, 4b and 4c thyroid nodules were 95.83%, 84.21% and 77.78%, respectively. An integrated system combining TI-RADS and a deep learning model was developed. The system can provide clinicians with not only diagnostic assistance from TI-RADS but also accurate segmentation of thyroid nodules, which improves the applicability of the system in clinical practice. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic highlighted the importance of infection prevention and control measures for all medical procedures, including ultrasound examinations. As the use of ultrasound increases across more medical modalities, including point-of-care ultrasound, so does the risk of possible transmission from equipment to patients and patients to patients. This is particularly relevant for endocavity transducers, such as trans-vaginal, trans-rectal and trans-oesophageal, which could be contaminated with organisms from blood, mucosal, genital or rectal secretions. This article proports to update the WFUMB 2017 guidelines which focussed on the cleaning and disinfection of trans-vaginal ultrasound transducers between patients. [ABSTRACT FROM AUTHOR]

Intraoperative Doppler ultrasound imaging of human brain vasculature is an emerging neuro-imaging modality that offers vascular brain mapping with unprecedented spatiotemporal resolution. At present, however, access to the human brain using Doppler Ultrasound is only possible in this intraoperative context, posing a significant challenge for validation of imaging techniques. This challenge necessitates the development of realistic flow phantoms outside of the neurosurgical operating room as external platforms for testing hardware and software. An ideal ultrasound flow phantom should provide reference-like values in standardized topologies such as a slanted pipe, and allow for measurements in structures closely resembling vascular morphology of actual patients. Additionally, the phantom should be compatible with other clinical cerebrovascular imaging modalities. To meet these criteria, we developed and validated a versatile, multimodal MRI- and ultrasound Doppler phantom. Our approach incorporates the latest advancements in phantom research using tissue-mimicking material and 3D-printing with water-soluble resin to create wall-less patient-specific lumens, compatible for ultrasound and MRI. We successfully produced three distinct phantoms: a slanted pipe, a y-shape phantom representing a bifurcating vessel and an arteriovenous malformation (AVM) derived from clinical Digital Subtraction Angiography (DSA)-data of the brain. We present 3D ultrafast power Doppler imaging results from these phantoms, demonstrating their ability to mimic complex flow patterns as observed in the human brain. Furthermore, we showcase the compatibility of our phantom with Magnetic Resonance Imaging (MRI). We developed an MRI- and Doppler Ultrasound-compatible flow-phantom using customizable, water-soluble resin prints ranging from geometrical forms to patient-specific vasculature. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess cardiac shear wave imaging implemented in a new MACH 30 ultrasound machine (SuperSonic Imaging, Aix-en-Provence, France) and interfaced with a linear probe and a phased array probe, in comparison with a previously validated Aixplorer system connected to a linear probe (SuperSonic Imaging) using Elasticity QA phantoms (Models 039 and 049, CIRS Inc., Norfolk, VA, USA). Quantile–quantile plots were used for distribution agreement. The accuracy of stiffness measurement was assessed by the percentage error and the mean percentage error (MPE), and its homogeneity, by the standard deviation of the MPE. A p value <0.01 was considered to indicate statistical significance. The accuracy of dedicated cardiac sequences for linear probes was similar for the two systems with an MPE of 8 ± 14% versus 20 ± 21% (p = not significant) with the SuperSonic MACH 30 and Aixplorer, respectively, and was influenced by target stiffness and location of the measurement in the field of view, but without drift over time. The optimal transthoracic cardiac probe workspace was located between 4 and 10 cm, with an MPE of 29.5 ± 25% compared with 93.3 ± 130% outside this area (p < 0.0001). In this area, stiffness below 20 kPa was significantly different from the reference (p < 0.0001). The sectorial probe revealed no MPE difference in any of the measurement areas, with no significant lateral or axial gradient. The new Supersonic MACH 30 system upgraded with a sectorial probe and specific cardiac settings provided homogenous stiffness measurements, especially when operating at depths between 4 and 10 cm. These phantom results may be useful in designing future in vivo studies. [ABSTRACT FROM AUTHOR]

B-lines assessed by lung ultrasound (LUS) outperform physical exam, chest radiograph, and biomarkers for the associated diagnosis of acute heart failure (AHF) in the emergent setting. The use of LUS is however limited to trained professionals and suffers from interpretation variability. The objective was to utilize transfer learning to create an AI-enabled software that can aid novice users to automate LUS B-line interpretation. Data from an observational AHF LUS study provided standardized cine clips for AI model development and evaluation. A total of 49,952 LUS frames from 30 patients were hand scored and trained on a convolutional neural network (CNN) to interpret B-lines at the frame level. A random independent evaluation set of 476 LUS clips from 60 unique patients assessed model performance. The AI models scored the clips on both a binary and ordinal 0–4 multiclass assessment. A multiclassification AI algorithm had the best performance at the binary level when applied to the independent evaluation set, AUC of 0.967 (95% CI 0.965–0.970) for detecting pathologic conditions. When compared to expert blinded reviewer, the 0–4 multiclassification AI algorithm scale had a reported linear weighted kappa of 0.839 (95% CI 0.804–0.871). The multiclassification AI algorithm is a robust and well performing model at both binary and ordinal multiclass B-line evaluation. This algorithm has the potential to be integrated into clinical workflows to assist users with quantitative and objective B-line assessment for evaluation of AHF. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases remain a major health challenge, leading to high rates of death and hospitalization globally. In the battle against these ailments, echocardiography stands as the frontline tool for diagnosis. Pioneering the charge in innovation, real-time remote tele-mentored ultrasound echocardiography (RTMUS echo) has emerged. This cutting-edge technique facilitates the instant transmission of cardiac imaging from the patient's side to experts in far-off locations, enabling prompt diagnosis and expert consultation. To bridge this gap, a systematic review was conducted to understand RTMUS echo's current applications in diagnosing heart diseases. Searches across six databases, guided by strict inclusion and exclusion criteria, yielded nine relevant articles. These studies assessed the feasibility of RTMUS echo and the technology behind it, confirming its potential for high-quality cardiac imaging. The findings reveal that RTMUS echo could notably improve care for cardiac patients, especially those in resource-constrained settings or in isolation because of infection risks. This technology enables quick access to diagnostic expertise, which is otherwise unavailable in such areas. Future research should aim to optimize the cost-effectiveness and application of RTMUS echo to enhance its benefits for global healthcare. [ABSTRACT FROM AUTHOR]

Background: The costoclavicular space serves as an alternative approach to the infraclavicular brachial plexus block, and numerous studies in adults have demonstrated promising outcomes for distal upper limb surgery. Blocking the brachial plexus at this level is potentially advantageous because the cords are relatively superficial, located in close proximity to each other and easily identified using ultrasound. Aims: This study aimed to assess the success rate and feasibility of costoclavicular block in children undergoing unilateral below elbow upper limb surgery. Methods: Thirty children aged 2–12 years scheduled for unilateral below elbow surgery under general anesthesia were included. Costoclavicular block was performed under ultrasound and nerve stimulator guidance with 0.5% ropivacaine, 0.5 mL/kg. Success was evaluated based on the absence of significant hemodynamic response to skin incision made 20 min after the block. The sono‐anatomy of costoclavicular space, ease of needling, complications, and the post‐operative pain scores were assessed. Results: The mean age and weight of the children were 6.5 ± 3.8 years and 19.7 ± 9.1 kg, respectively. The success rate of costoclavicular block in our cohort is 100%. Sonographic visualization was graded as excellent (Likert Scale 2) in 90% of cases. The plexus was located at a depth of 1.4 ± 0.3 cm from the skin, the lateral extent of cords from the artery was 0.8 ± 0.4 cm and they were observed inferior and lateral to the artery. The mean needling time was 3.6 ± 1.1 min. None of the children experienced complications such as vascular or pleural puncture, hematoma, Horner's syndrome or diaphragmatic palsy. Postoperative pain scores were low, and no rescue analgesia was required. Conclusions: In conclusion, the costoclavicular block exhibited a notably high success rate in pediatric population. This study substantiates that the three cords of the brachial plexus are consistently visible and superficial during ultrasound examination using this approach, confirming their separation from vascular structures and the reliable achievement of blockade without observed complications. [ABSTRACT FROM AUTHOR]

Background: Point‐of‐care ultrasound is an invaluable bedside tool for anesthesiologists and has been integrated into anesthesiology residency training and board certification in the United States. Little is known about point‐of‐care ultrasound training practices in pediatric anesthesia fellowship programs. Aims: To describe the current state of point‐of‐care ultrasound education in pediatric anesthesia fellowship programs in the United States. Methods: We conducted a cross‐sectional survey study distributed to 60 American Accreditation Council for Graduate Medical Education‐accredited pediatric anesthesia fellowship programs. Two programs were in their initial accreditation period and were excluded due to lack of historical data. Program directors or associate program directors were invited to complete this 23‐item survey. Results: Thirty‐three of fifty‐eight programs (57%) completed the survey. Of those, 15 programs (45%) reported having a point‐of‐care ultrasound curriculum. Programs with ≤3 fellows per year were less likely to have an ultrasound curriculum compared to programs with ≥4 fellows per year (30% programs 0–3 fellows/year vs. 69% programs ≥4 fellows/year, odds ratio 0.19 [95% confidence intervals 0.04–0.87]; p =.03). Program directors and associate program directors rated point‐of‐care ultrasound training as highly valuable to fellows' education. Barriers to use most commonly included lack of experience (64%), lack of oversight/interpretive guidance (58%), and lack of time (45%). Programs without point‐of‐care ultrasound training had significantly higher odds of listing lack of ultrasound access as a primary barrier (50% programs without vs. 13% programs with, odds ratio 6.5, [95% confidence intervals 1.3–50]; p =.04). Conclusions: This observational survey‐based study suggests that fewer than half of pediatric anesthesia training programs in the United States offer point‐of‐care ultrasound education. Additional research is needed to optimize this education and training in pediatric anesthesia fellowship programs. [ABSTRACT FROM AUTHOR]

Background: In children, central venous catheter (CVC) placement is usually performed under ultrasound guidance for optimal visualization of vessels and reduction of puncture‐related complications. Nevertheless, in many cases, additional radiographic examinations are performed to check the position of the catheter tip. Aim: The primary objective of this observational feasibility study was to determine the number of ultrasound‐guided central venous catheter tips that can be identified in a subsequent position check using ultrasonography. Furthermore, we investigated the optimal ultrasound window, time expenditure, and success rate concerning puncture attempts and side effects. In addition, we compared the calculated and real insertion depths and analyzed the position of the catheter tip on postoperative radiographs with the tracheal bifurcation as a traditional landmark. Methods: Ninety children with congenital heart defects who required a central venous line for cardiac surgery were included in this single‐center study. After the insertion of the catheter, the optimal position of its tip was controlled using one of four predefined ultrasound windows. A chest radiograph was obtained postoperatively in accordance with hospital standards to check the catheter tip position determined by ultrasonography. Results: The children had a median (IQR) age of 11.5 (4.0, 58.8) months and a mean (SD) BMI of 15.3 (2.91) kg/m2 Ultrasound visualization of the catheter tip was successful in 86/90 (95.6%) children (95% confidence interval [CI]: 91.3%, 99.8%). Postoperative radiographic examination showed that the catheter tip was in the desired position in 94.4% (95% CI: 89.7%, 99.2%) of the cases. None of the children needed the catheter tip position being corrected based on chest radiography. Conclusion: Additional radiation exposure after the placement of central venous catheters can be avoided with the correct interpretation of standardized ultrasound windows, especially in vulnerable children with cardiac disease. [ABSTRACT FROM AUTHOR]

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

Background: The prevalence of Müllerian anomalies (MA) among patients with congenital solitary functioning kidney (SFK) is not well defined. A delay in diagnosis of obstructive MA can increase the risk of poor clinical outcomes. This study describes the prevalence of MA in patients with congenital SFK. Methods: A retrospective review was performed of patients within the Nationwide Children's Hospital system with ICD9 or ICD10 diagnostic codes for congenital SFK defined as either unilateral renal agenesis (URA) or multicystic dysplastic kidney (MCDK) and confirmed by chart review. Patients with complex urogenital pathology were excluded. Renal anomaly, MA, reason for and type of pelvic evaluation, and age of diagnosis of anomalies were evaluated. Results: Congenital SFK occurred in 431 girls due to URA (209) or MCDK (222). Pelvic evaluation, most commonly by ultrasound for evaluation of abdominal pain or dysmenorrhea, occurred in 115 patients leading to MA diagnosis in 60 instances. Among 221 patients ages 10 years and older, 104 underwent pelvic evaluation and 52 were diagnosed with an MA of which 20 were obstructive. Isolated uterine or combined uterine and vaginal anomalies were the most common MA. MA were five-fold more common in patients with URA compared to MCDK. In 75% of patients, the SFK was diagnosed prior to the MA. Conclusions: The prevalence of MA in patients with congenital SFK was 24% among those age 10 years or older, and 38% were obstructive. This justifies routine screening pelvic ultrasound in girls with congenital SFK to improve early diagnosis. [ABSTRACT FROM AUTHOR]

This study introduces an innovative approach, Ultrasonic Sonication Pretreatment Sparger-based Microwave Assisted Extraction (U Sp-MAE), designed to enhance lemongrass essential oil extraction. Addressing the challenge of maximizing yield and quality, our work systematically optimized key extraction parameters. Results demonstrated a significant improvement over conventional methods, with the highest yield of 1.89% achieved under specific conditions: a Sparger Flow rate of 4 L/min, Ultrasound Power of 700 W, Sonication Time of 5 min, and Liquid-to-Solid Ratio of 5 mL/g. This method not only advances essential oil extraction but holds promise for broader applications in society, showcasing its potential impact on sustainable and efficient resource utilization. [ABSTRACT FROM AUTHOR]

Battery materials research is of crucial importance to the development of next‐generation batteries. However, the transition from lab‐scale studies, typically in gram quantities, to industrially relevant ones (i.e., kilogram scale) has been holding back by challenges in scale‐up synthesis and a lack of reliable approaches to verify the electrochemical performance of the lab‐made materials. Here the design and assembly procedures of sub‐Ah‐scale pouch cells that provide validations of several lab‐made Li‐ion and Na‐ion cathode materials available in a limited quantity (<5 g) are reported. These lab‐made pouch cells show superior cycle stability and consistency over the widely used coin cells, exemplified by multiple Ni‐rich layered oxide‐graphite full batteries retaining 84.29 ± 0.16% of the initial capacities over 1000 cycles. A four‐electrode pouch cell with a reparable reference electrode is further designed to monitor impedance growth and Li plating during long‐term electrochemical tests. It can be further integrated with in situ ultrasonic imaging to enable multi‐modal studies. This work provides a powerful platform to evaluate and boost the technology readiness levels of laboratory‐discovered battery materials. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the added value of contrast-enhanced ultrasonography (CEUS) using Sonazoid in characterizing focal liver lesions (FLLs) with indeterminate findings on gadoxetic acid-enhanced liver MRI in patients without risk factors for hepatocellular carcinoma (HCC). Methods: Patients who underwent CEUS using Sonazoid for characterizing indeterminate FLLs on gadoxetic acid-enhanced liver MRI were. The indeterminate FLLs were classified according to the degree of malignancy on a 5-point scale on MRI and combined MRI and CEUS. The final diagnosis was made either pathologically or based on more than one-year follow-up. The diagnostic performance was assessed using a receiver operating characteristic (ROC) curve analysis, and the net reclassification improvement (NRI) was calculated. Results: A total of 97 patients (mean age, 49 years ± 16, 41 men, 80 benign and 17 malignant lesions) were included. When CEUS was added to MRI, the area under the ROC curve increased, but the difference was not statistically significant (0.87 [95% confidence interval {CI}, 0.77–0.98] for MRI vs 0.93 [95% CI, 0.87–0.99] for CEUS added to MRI, P = 0.296). The overall NRI was 0.473 (95% CI, 0.100–0.845; P = 0.013): 33.8% (27/80) of benign lesions and 41.2% (7/17) of malignant lesions were appropriately reclassified, whereas 10.0% (8/80) of benign lesions and 17.6% (3/17) of malignant lesions were incorrectly reclassified. Conclusions: Although performing CEUS with Sonazoid did not significantly improve the overall diagnostic performance in characterizing indeterminate FLLs on gadoxetic acid-enhanced liver MRI in patients without risk factors for HCC, it may increase radiologist's confidence in classifying FLLs. [ABSTRACT FROM AUTHOR]