Cholecystoduodenal fistula identified on oral contrast-enhanced ultrasound.
Young Adam,Yusuf Gibran Timothy,Fang Cheng,Metafa Anna,Gupta Shweta,Sidhu Paul Singh
Journal of ultrasound
We describe a case of a cholecystoduodenal fistula (CDF) diagnosed using oral contrast-enhanced ultrasound (CEUS). CDF is a rare type of biliary-enteric fistulation in which an abnormal communication forms between the gallbladder and duodenum. CDF are usually found in older patients, in the context of chronic cholecystitis, and can be associated with serious consequences. Given the non-specific presentation and limitations of the various imaging modalities, CDF are notoriously difficult to diagnose. CEUS is a recognised technique predominantly deployed for imaging following intravenous administration. Experience of CEUS has expanded into endocavitary use, including in the biliary and gastrointestinal systems. We describe a case of a CDF identified on intracavitary CEUS. This case report demonstrates oral ingestion of a diluted ultrasound contrast agent is a novel and safe mode of administration with stability of the contrast agent and the ability to define fistulation.
Color Doppler Ultrasound in Portal Hypertension: A Closer Look at Left Gastric Vein Hemodynamics.
Cannella Roberto,Giambelluca Dario,Pellegrinelli Alice,Cabassa Paolo
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
Portal hypertension is one of the most important causes of morbidity and mortality in cirrhotic patients. A color Doppler evaluation of the left gastric vein (LGV) has proven utility in the prediction of esophageal varices and variceal bleeding in patients with portal hypertension. The purpose of this review is to discuss the ultrasound evaluation, imaging findings, and clinical application of Doppler ultrasound in the assessment of the LGV. Knowledge of the color Doppler technique and imaging findings of the LGV may help clinicians improve the monitoring of portal hypertension and predict patients with a high risk of esophageal varices.
Diagnosis of Inflammatory Bowel Disease by Abdominal Ultrasound and Color Doppler Techniques.
Ahmed Rehab,Debian Hossam,Fawzi Mohamed,Elsergany Heba Fadl,Soliman Moataz Yousry,Mohmed Ahmed Abdel Haleem,Kandil Alaa,Elmaghraby Mostafa Bedair,Abd-Elsalam Sherief,Abo-Amer Yousry Esam-Eldin
Current medical imaging
BACKGROUND & AIMS:The utility of ultrasound and color Doppler in the diagnosis and evaluation of inflammatory bowel diseases (IBD) has not been studied enough. Therefore, the aim of the current study was to evaluate the importance of conventional abdominal ultrasound and color Doppler in diagnosing IBD and assessing disease activity. METHODS:The study was conducted at the National Hepatology and Tropical Medicine Research Institute (NHTMRI) between July 2018 and January 2019, in which 150 patients were suffering from diarrhea, dysentery, tenesmus, or rectal bleeding were evaluated by colonoscopy, high-resolution ultrasound, and color Doppler scans. RESULTS:The present study was conducted on 150 patients; 84 (56%) had ulcerative colitis (UC), 16 (10.7%) had Crohn's disease (CD), and 50 (33.3%) had normal colonoscopy results with a mean age 37.2 ± 9.059. The superior mesenteric Artery Peak Systolic Velocity (SMA-PSV) and End Diastolic Velocity (EDV) were significantly higher in both UC and CD than in the control group; however, pulsatility index (PI) was significantly higher in the control group than both UC and CD. However, there was no significant difference between UC and CD. The inferior mesenteric artery PSV and EDV were significantly higher in both UC and CD than in the control group. CONCLUSION:Doppler ultrasound findings of SMA and IMA correlate with the incidence of inflammatory bowel disease, the site of disease, and its activity.
Insight into Dunbar syndrome: color-Doppler ultrasound findings and literature review.
Acampora Ciro,Di Serafino Marco,Iacobellis Francesca,Trovato Piero,Barbuto Luigi,Sangiuliano Nicola,Costigliola Luciana,Romano Luigia
Journal of ultrasound
Dunbar syndrome, also known as median arcuate ligament syndrome, is a rare clinical condition due to the external compression of the celiac trunk by the median arcuate ligament causing abdominal angina. We report a case of Dunbar syndrome and its borderline imaging findings focused on the crucial diagnostic role of color-Doppler ultrasound. We also reviewed the current literature, delineating the clinical manifestations and the diagnostic workup of the Dunbar syndrome with the objective to increase the knowledge of this clinical entity as a cause of postprandial abdominal pain and to underline the pivotal role of color-Doppler ultrasound to avoid incorrect or delayed diagnosis.
A Reliability Study: Strong Inter-Observer Agreement of an Expert Panel for Intestinal Ultrasound in Ulcerative Colitis.
De Voogd Floris,Wilkens Rune,Gecse Krisztina,Allocca Mariangela,Novak Kerri,Lu Cathy,D'Haens Geert,Maaser Christian
Journal of Crohn's & colitis
BACKGROUND:Intestinal ultrasound [IUS] is a promising and non-invasive cross-sectional imaging modality in the diagnosis and monitoring of ulcerative colitis [UC]. Unlike endoscopy, where standardized scoring for evaluation of disease activity is widely used, scoring for UC with IUS is currently unavailable. Therefore, we conducted a study to assess the reliability of IUS in UC among expert sonographists in order to identify robust parameters. METHODS:Thirty patients with both clinically active  and quiescent [five] UC were included. Six expert sonographers first agreed upon key IUS parameters and grading, including bowel wall thickness [BWT], colour Doppler signal [CDS], inflammatory fat [i-fat], loss of bowel wall stratification [BWS], loss of haustrations and presence of lymph nodes. Thirty video-recorded cases were blindly reviewed. RESULTS:Inter-observer agreement was almost perfect for BWT (intra-class correlation coefficient [ICC]: 0.96) and substantial for CDS [κ = 0.63]. Agreement was moderate for presence of lymph nodes [κ = 0.41] and fair for presence of i-fat [κ = 0.36], BWS [κ = 0.24] and loss of haustrations [κ = 0.26]. Furthermore, there was substantial agreement for presence of disease activity on IUS [κ = 0.77] and almost perfect agreement for disease severity [ICC: 0.93]. Most individual parameters showed a strong association with IUS disease activity as measured by the six readers. CONCLUSION:IUS is a reliable imaging modality to assess disease activity and severity in UC. Important individual parameters such as BWT and CDS are reliable and could be incorporated in a future UC scoring index. Standardized acquisition and assessment of UC utilizing IUS with established reliability is important to expand the use of IUS globally.
Multimodal Retinal Imaging for Detection of Ischemic Stroke.
Zhao Lu,Wang Hui,Yang Xiufen,Jiang Bin,Li Hongyang,Wang Yanling
Frontiers in aging neuroscience
: This study aims to evaluate ocular changes in patients with ischemic stroke using multimodal imaging and explore the predictive value of ocular abnormalities for ischemic stroke. : A total of 203 patients (ischemic stroke group, 62; control group, 141) were enrolled in this study. Basic data from patients, including age; gender; height; weight; history of hypertension, hyperlipidemia, diabetes, alcohol use, and coronary heart disease; and smoking status, were collected. Consequently, Doppler color ultrasound, color fundus photography, and optical coherence tomography (OCT) examinations were conducted. Differences in traditional risk factors and ocular parameters between the two groups were compared, and binary logistic regression was used for multivariate analysis. : The central retinal artery equivalent (CRAE) in the ischemic stroke group was 150.72 ± 20.15 μm and that in the control group was 159.68 ± 20.05 μm. The difference was statistically significant ( = 0.004). Moreover, the subfoveal choroidal thickness (SFChT) in the ischemic stroke group was 199.90 ± 69.27 μm and that in the control group was 227.40 ± 62.20 μm. The difference was statistically significant ( = 0.006). Logistic regression results showed that smoking [odds ratio (OR) = 2.823; 95% confidence interval (95% CI) = 1.477-5.395], CRAE (OR = 0.980; 95% CI = 0.965-0.996), and SFChT (OR = 0.994; 95% CI = 0.989-0.999) are associated with increased risk of ischemic stroke when ocular parameters were combined with traditional risk factors. The area under the receiver operating characteristic (ROC) curve was 0.726, which shows good diagnostic accuracy. : SFChT may be a diagnostic marker for early detection and monitoring of ischemic stroke. Combined with traditional risks, retinal artery diameter, and choroidal thickness, the prediction model can improve ischemic stroke prediction.
Usefulness of orbital colour Doppler ultrasound in vascular-related monocular vision loss.
Ruiz-Ares Gerardo,Fuentes Blanca,Rodríguez-Pardo de Donlebún Jorge,Alonso de Leciñana Maria,Gutiérrez-Zúñiga Raquel,Rigual Ricardo,Díez-Tejedor Exuperio
Vascular medicine (London, England)
Acute, painless, monocular vision loss (APMVL) usually has a vascular aetiology. We conducted a prospective observational study from 2011 to 2018 to analyse the added value of colour Doppler imaging to assess orbital vessel blood flow in the diagnosis of APMVL. The study included 67 patients (39 [58.2%] men; mean age, 65.9 years [SD 13.7]) with APMVL evaluated at the Neurosonology Laboratory within the first 5 days of symptom onset, who were classified as having either transient or persistent monocular blindness. The blood flow in the ophthalmic and central retinal arteries was assessed using colour Doppler ultrasound with a linear 7.5-MHz transducer. Thirty-three (49.3%) patients presented transient monocular blindness, with reduced blood flow in either the ophthalmic or central retinal artery. The group with persistent vision loss included 24 cases of central retinal artery occlusion (CRAO) and 10 cases of ischaemic optic neuropathy (35.8% and 14.9%, respectively, of the total sample). These patients were older and had a higher prevalence of hypertension and mild carotid atherosclerosis. Orbital colour Doppler ultrasound (OCDUS) clarified the mechanism/cause of the ischaemia in 11 (16.4%) patients and showed abnormal flow in 46 (68.7%) patients, confirming the vascular origin in 19 (57.6%) of the transient monocular blindness cases. Lower peak systolic velocity was observed in patients with CRAO ( < 0.001), and a velocity < 10 cm/s in the central retinal artery was independently associated with the diagnosis of CRAO. OCDUS can be helpful in confirming the vascular cause and identifying the aetiology of APMVL.
High-Frequency Ultrasound for Evaluation of the Pathological Invasion Level of Extramammary Paget Disease.
Ma Yuan-Yuan,Gong Xue-Hao,Wang Qiao,Wang Li-Fan,Xu Hui-Xiong,Guo Le-Hang
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
OBJECTIVES:Pathological invasion level of extramammary Paget disease (EMPD) is strongly related with its risk staging, treatment, and prognosis. However, the current evaluation before treatments fails to evaluate pathological invasion level of EMPD. High-frequency ultrasound (HFUS) may play a key role to solve this problem. The purpose was to explore the performance of HFUS in the evaluation of pathological invasion level of EMPD. METHODS:Sixty pathologically proven EMPD patients were retrospectively enrolled and divided into 2 groups as follows: in situ in the epidermis (IE) (n = 42) and invasion into the dermis or subcutaneous (ID) (n = 18) groups. Clinical and HFUS features were compared between the 2 groups. RESULTS:Between the 2 groups, HFUS features (lesion shape, internal echogenicity and echotexture, surface shape, epidermal hyperechoic layer on the surface, the "pseudopod sign", and color Doppler ultrasound features) and clinical features were comparable (all P >.05). Tumor growth pattern significantly differed between the 2 groups (P <.05). Infiltration depth was significantly deeper for the ID group than the IE group (P <.05). With a cutoff value of 1.55 mm for infiltration depth, the area under the receiver operating characteristic curve was 0.833. CONCLUSIONS:HFUS features of tumor growth pattern and infiltration depth may contribute to the assessment of invasion level of EMPD.
Blood flow changes in the forearm arteries after ultrasound-guided costoclavicular brachial plexus blocks: a prospective observational study.
Xu Yang,Cui Derong,Zhang Junfeng,Ding Qian,Dong Jing,Wang Yan
BACKGROUND:An increase in blood flow in the forearm arteries has been reported after brachial plexus block (BPB). However, few studies have quantitatively analysed the blood flow of the forearm arteries after BPB or have studied only partial haemodynamic parameters. The purpose of the present study was to comprehensively assess blood flow changes in the distal radial artery (RA) and ulnar artery (UA) after BPB performed via a new costoclavicular space (CCS) approach using colour Doppler ultrasound. METHODS:Thirty patients who underwent amputated finger replantation and received ultrasound-guided costoclavicular BPB were included in the study. The haemodynamic parameters of the RA and UA were recorded before the block and 10 min, 20 min, and 30 min after the block using colour Doppler ultrasound to determine the peak systolic velocity (PSV), end-diastolic velocity (EDV), mean velocity (V), pulsatility index (PI), resistance index (RI) and area. The volumetric flow rate (VFR) was calculated using the formula Q = area×V. The aforementioned parameters were compared not only before and after the BPB but also between the RA and UA. RESULTS:Compared with those of the respective baselines, there was a significant increase in the PSV, EDV, V, area, and VFR and a significant decrease in the PI and RI of the RA and UA 10 min, 20 min, and 30 min post-block. The increase 30 min post-block in EDV (258.68 % in the RA, 279.63 % in the UA) was the most notable, followed by that in the V (183.36 % in the RA, 235.24 % in the UA), and the PSV (139.11 % in the RA, 153.15 % in the UA) changed minimally. The V and VFR of the RA were significantly greater than those of the UA before the BPB; however, there was no significant difference in the VFR between the RA and UA after the BPB. CONCLUSIONS:A costoclavicular BPB can increase blood flow in the forearm arteries. The RA had a higher volumetric flow rate than the UA before the BPB; however, the potential blood supply capacity of the UA was similar to that of the RA after a BPB. TRIAL REGISTRATION:This study was registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn/searchproj.aspx, clinical trial number: ChiCTR 1900023796, date of registration: June 12, 2019).
Examination of intrarenal resistance indices indicate the involvement of renal pathology as a significant diagnostic classifier of preeclampsia.
Bahser Nielab,Godehardt Erhard,Hess Alexandra P,Blume Cornelia
American journal of hypertension
BACKGROUND:Preeclampsia (PE) is a hypertensive disorder during pregnancy with endotheliosis leading to occlusion of renal perfusion with an impact on the glomerular filtration barrier. We therefore analyzed the role of intrarenal resistance indices in the renal interlobular arteries measured by Doppler ultrasound as a diagnosis of PE. METHODS:Women with preeclampsia (n = 24; mean blood pressure/24 h = 145 ± 11/ 93 ± 7 mm Hg; mean proteinuria = 5.63 ± 1.0 g/24 h) were compared against a group of healthy pregnant women (n = 24). All patients underwent a Doppler ultrasound of the intrarenal arteries between the 24th week of gestation and the 5th week postpartum. Several risk factors for PE, as well as the arterial resistive indices of the Arteriae uterinae and the Arteria umbilicalis, were monitored in parallel. RESULTS:The intrarenal resistive index (mean ± SD = 0.63 ± 0.05 in women with preeclampsia vs. 0.59 ± 0.056 in healthy pregnant women; P < 0.003), the pulsatile index (mean ± SD = 1.15 ± 0.19 in women with preeclampsia vs. 0.92 ± 0.13 in healthy pregnant women; P < 0.0001), and the end diastolic flow velocity (mean ± SD = 14.16 ± 4.75 cm/s in women with preeclampsia vs. 10.67 ± 2.68 cm/s in healthy pregnant women, P < 0.006) were elevated in patients with PE, as were the arterial resistive indices of the Aa. uterinae and A. umbilicalis. The intrarenal resistive indices correctly classified 84.2% of the women as having PE. CONCLUSIONS:Intrarenal resistive indices are a significant classifier of PE, providing the possibility to predict nephropathy. They could be a prognostic tool for cardiovascular comorbidity in PE patients even after delivery.
Predictive value of sequential models of uterine artery Doppler in pregnancies at high risk for pre-eclampsia.
Herraiz I,Escribano D,Gómez-Arriaga P I,Herníndez-García J M,Herraiz M A,Galindo A
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
OBJECTIVE:To evaluate the performance of models described previously for the prediction of pre-eclampsia (PE), based on the sequential evaluation of uterine artery resistance at 11-13 weeks and 19-22 weeks, in a high-risk population. METHODS:This was a prospective study in 135 women with singleton pregnancies and at least one of the following high-risk conditions: PE and/or intrauterine growth restriction in a previous pregnancy, chronic hypertension, pregestational diabetes, renal disease, body mass index > 30 kg/m(2) , autoimmune disease (systemic lupus erythematosus, antiphospholipid syndrome or rheumatoid arthritis) and thrombophilia. Mean uterine artery pulsatility index (mUtA-PI) at 11-13 and at 19-22 weeks' gestation was measured and analyzed according to quantitative and semi-quantitative models, to predict late PE (resulting in delivery ≥ 34 weeks) and early PE (delivery < 34 weeks). RESULTS:Late PE developed in 21 (15.6%) pregnancies and early PE in six (4.4%). Using mUtA-PI, the detection rates of late and early PE for a false-positive rate of 10% were 14.3% and 33.3%, respectively, at 11-13 weeks, and 19.0% and 66.7%, respectively, at 19-22 weeks. Using a semi-quantitative approach, the group of pregnant women with mUtA-PI ≥ 90(th) percentile at both 11-13 and 19-22 weeks had a greater risk for early PE (odds ratio, 21.4 (95% CI, 2.5-184.7)) compared with the group with mUtA-PI < 90(th) percentile at both periods. Using a quantitative approach, there was relative worsening in the mUtA-PI (multiples of the median) from the first to the second trimester in all cases of early PE. CONCLUSION:The application of semi-quantitative and especially quantitative models to evaluate sequential changes in uterine artery Doppler findings between the first and second trimesters could be of additional value in assessing high-risk women regarding their true risk of developing early PE.
Repetitive Saliva Swallowing Test Predicts COPD Exacerbation.
Yoshimatsu Yuki,Tobino Kazunori,Sueyasu Takuto,Nishizawa Saori,Ko Yuki,Yasuda Mina,Ide Hiromi,Tsuruno Kosuke,Miyajima Hiroyuki
International journal of chronic obstructive pulmonary disease
Introduction:Predicting phenotypes at risk of chronic obstructive pulmonary disease (COPD) exacerbation is extremely important. Dysphagia is becoming recognized as one of these phenotypes. A convenient method of screening for dysphagia and COPD exacerbation risk is desired. The repetitive saliva swallowing test (RSST) is one of the least invasive dysphagia screening methods. We previously reported the possible relation between the RSST result and COPD exacerbation in a retrospective study. Based on this, we performed a prospective study to evaluate the efficacy of RSST as a predictor of COPD exacerbation and to determine its optimal cut-off value for COPD. Methods:Seventy patients with COPD were recruited. Patients underwent the following dysphagia screening tests: the 10-item Eating Assessment Tool, Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease, RSST, water swallowing test, and simple swallow provocation test. After one year, they were classified into two groups according to the presence of COPD exacerbation during the follow-up period. Results:Twenty-seven patients had one or more exacerbations in the past year. During the follow-up period, 28 patients had one or more exacerbations (E group), and 42 had none (non-E group). There were no significant differences between the groups except for the presence of past exacerbations and the results of the RSST, when the cut-off value was set at 2, 3, 4, or 5 swallows. The number of swallows in the RSST was significantly lower in the E group than in the Non-E group. A cut-off value of 5 was the most effective. The time to first exacerbation was significantly longer in those with an RSST value of >5. The RSST was more reliable for differentiating the E group and non-E group than the presence of exacerbation in the past year (hazard ratios: 13.78 and 2.70, respectively). Conclusion:An RSST cut-off value of 5 may be a strong predictor of COPD exacerbation.
Oral and pharyngeal bolus transit in patients with chronic obstructive pulmonary disease.
Cassiani Rachel Aguiar,Santos Carla Manfredi,Baddini-Martinez José,Dantas Roberto Oliveira
International journal of chronic obstructive pulmonary disease
BACKGROUND:Patients with respiratory diseases, such as chronic obstructive pulmonary disease (COPD), may have swallowing dysfunction. OBJECTIVE:The aim of this investigation was to evaluate the oral and pharyngeal phases of swallowing in patients with COPD. METHODS:We studied 16 patients with clinical manifestations and pulmonary function tests diagnosis of COPD (mean age: 68 years) and 15 nonsmoking healthy volunteers (mean age: 65 years) with normal pulmonary function tests. All subjects were submitted to clinical and videofluoroscopic evaluation of swallowing. Each subject performed in duplicate swallows of 5 mL and 10 mL of liquid bolus, paste bolus, and a solid bolus. RESULTS:In general, the duration of the events of the pharyngeal phase of swallowing was longer in COPD patients than controls. The difference was significant in the laryngeal vestibular closure, hyoid movement, and pharyngeal transit with swallows of both volumes of liquid bolus; in oral-pharyngeal transit with 5 mL paste bolus; and in pharyngeal and oral-pharyngeal transit with solid bolus. The difference between the duration of maximal laryngeal elevation and the duration of pharyngeal transit was higher in control subjects than in patients with COPD. CONCLUSION:The results suggested that patients with COPD have a longer pharyngeal swallowing phase than normal subjects, which is associated with a decrease in the difference between the duration of maximal laryngeal elevation and the duration of pharyngeal transit.
Relationship between dysphagia risk and health status in patients with chronic obstructive pulmonary disease.
Prestes Daniele,Bilheri Diego Fernando Dorneles,Nascimento Juliana Rosa,Righi Natiele Camponogara,Baldissera Camila,Silva André Felipe Santos da,Mancopes Renata,Pasqualoto Adriane Schmidt
PURPOSE:To verify the relationship between the risk of dysphagia and health status in patients with Chronic Obstructive Pulmonary Disease (COPD). METHOD:Cross-sectional study with convenience sample. Twenty-three individuals with a diagnosis of COPD according to GOLD 2019 criteria. The individuals participated in a pulmonary rehabilitation program, clinically stable (without exacerbations of at least 30 days) and in optimized drug treatment were included. The study analyzed anthropometric measures (BMI), peak expiratory flow (PEF), mental status (MEEM), eating assessment tool (EAT-10), and health status (COPD Assessment Test -CAT). The mean age was 60.39 ± 9.90 years, 11 individuals were female and eutrophic. RESULTS:We observed a positive and moderate association (r = 0.57, p = 0.004) between the CAT and EAT-10 scores in the sample studied. CONCLUSION:The results demonstrated relationship between the risk of dysphagia and the health status in individuals with COPD.
Hypertensive disorders of pregnancy associated with adverse pregnant outcomes in patients with systemic lupus erythematosus: a multicenter retrospective study.
Chen Dongying,Lao Minxi,Cai Xiaoyan,Li Hao,Zhan Yanfeng,Wang Xiaodong,Zhan Zhongping
BACKGROUND:Hypertension disorders in pregnancy (HDP) were common complications in women with systemic lupus erythematosus (SLE). However, the impact of HDP and the measures to prevent HDP-related fetal adverse pregnancy outcomes (APOs) remained to be explored. METHODS:A multicenter retrospective study of 342 pregnant women with SLE was performed. Variables related to SLE and APOs were recorded. Fetal development was evaluated by umbilical artery Doppler ultrasonography. RESULTS:HDP was diagnosed in 45 (13.2%) patients, including pre-eclampsia in 42 and gestational hypertension in 3. Patients with HDP had higher incidence of preterm birth (71.1% vs 20.9%, P < 0.001), intrauterine growth retardation (IUGR) (37.8% vs 11.8%, P < 0.001), low-birth-weight infants (62.2% vs 17.2%, P < 0.001), and very-low-birth-weight infants (37.8% vs 2.7%, P < 0.001), compared with lupus patients without HDP. A total of 35 (77.8%) HDP patients had disease activation during pregnancy. All the events occurred during the second and third trimesters, mainly presenting as moderate-to-high activity (65.7%). Active disease [odds ratios (OR) = 3.9, 95% confidential interval (CI) 1.5-9.7, P = 0.004] and positive anticardiolipin (aCL) antibody (OR = 7.6, 95% CI 2.7-18.6, P < 0.001) were independent risk factors for HDP in lupus patients. Doppler RI and S/D ratio predicted APOs in patients with HDP. The optimal cut-off values for RI and S/D ratio were 0.7 (sensitivity 48.1%, specificity 53.3%) and 3.4 (sensitivity 66.7%, specificity 100%), respectively. CONCLUSIONS:HDP was a common pregnant complication and caused various fetal and maternal adverse outcomes in patients with SLE. Umbilical artery Doppler ultrasonography was effective in predicting fetal APOs in lupus patients with HDP.Key Points• HDP induced preterm birth, IUGR, low-birth-weight infants, and very-low-birth-weight infants in patients with SLE.• HDP led to lupus activation during the second and third trimesters.• Disease activation and aCL positivity were predictors for HDP.• RI and S/D ratio from umbilical artery Doppler predicted APOs in patients with HDP.
[Pregnancy outcome of planning pregnancies in patients with SLE].
Zhan Z P,Zhan Y F,Yang Y,Chen D Y,Liang L Q,Yang X Y
Zhonghua yi xue za zhi
To investigate the pregnancy outcomes in systemic lupus erythematosus (SLE) patients with planning pregnancy.And to evaluate the value of fetal umbilical artery Doppler. A total of 130 SLE patients with planning pregnancy were prospectively recruited from January 2013 to January 2017 at the First Affiliated Hospital of Sun Yat-sen University. Thirty eight (29.2%) patients had active lupus, 30 with mild activity, 5 with moderate activity and 3 with severe activity.Active disease in the first, second and third trimesters occurred in 6, 11 and 21 cases respectively.Lupus nephritis (76.3%) and hematological system involvement (39.5%) were the most common manifestation.Seven cases had pre-eclampsia during pregnancy.One or more adverse outcomes occurred in 40 patients, including 28 with premature, 12 with pregnancy loss, 9 with intrauterine growth restriction, and 8 with fetal distress.All of the pulsatility index, resistance index and S/D value of patients with adverse outcomes were higher than that of patients without adverse outcomes (<0.05). In SLE patients with planning pregnancy, disease flares were infrequent, and outcomes were favorable. Fetal umbilical artery Doppler can be used as a noninvasive monitoring method for SLE patients at late pregnancy.
Similar progression of carotid intima-media thickness in 7-year surveillance of patients with mild SLE and controls, but this progression is still promoted by dyslipidaemia, lower HDL levels, hypertension, history of lupus nephritis and a higher prednisolone usage in patients.
Ajeganova Sofia,Gustafsson Thomas,Lindberg Linnea,Hafström Ingiäld,Frostegård Johan
Lupus science & medicine
Objective:To compare progression of subclinical atherosclerosis and factors promoting it in patients with SLE and controls. Methods:Consecutive patients with SLE and age-matched, sex-matched population controls from the SLEVIC cohort were assessed at inclusion and after 7 years with standardised data collection and carotid ultrasound. Effect of risk factors on carotid intima-media thickness (cIMT) progression was examined with adjusted linear mixed models. Results:A total of 77 patients and 74 controls, 68% and 61% of the original cohort, completed follow-up. The patients were (mean) 47 years old, 90% were women, and controls were 51 years old, 92% women. Patients had disease duration of (mean) 11 years, mild disease activity and low severity at both assessments. Baseline cIMT did not differ between the groups. An average absolute cIMT progression was 0.009 mm/year in patients and 0.011 mm/year in controls, intergroup difference p=0.9.Of factors at inclusion, dyslipidaemia, lower levels of high-density lipoprotein (HDL) and carotid plaque in patients and controls, and higher systolic blood pressure, total cholesterol:HDL and LDL:HDL ratios and triglycerides in patients were associated with cIMT progression. Of factors at follow-up, hypertension and blood lipids in patients and HDL in controls were significantly associated with cIMT progression. History of lupus nephritis and a higher average dose of prednisolone used since diagnosis were associated with cIMT progression in patients. Associations of risk factors with cIMT progression were stronger in presence of plaques. Conclusion:We observed a statistically comparable progression of cIMT in patients with mild SLE and controls over 7 years, which implies that progression of subclinical atherosclerosis in some patients with SLE could follow that of the general population. Traditional cardiovascular (CV) risk factors, history of lupus nephritis and higher use of corticosteroids promote cIMT progression in SLE. Detection of carotid plaque may add to CV risk stratification.
Quantitative changes of extravillous trophoblast cells in placentas of systemic lupus erythematosus patients.
Heidari Zahra,Mahmoudzadeh-Sagheb Hamidreza,Sheibak Nadia,Nourzaei Nahid
Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
In the present study, quantitative changes of extravillous trophoblast cells (EVTs) in the placentas of SLE patients were investigated compared to healthy controls using stereological methods. Volumetric parameters and number of EVTs per unit volume of the placenta were estimated respectively, using Cavalieri's principle and Physical Disector stereological methods. Placental volume in the SLE group was increased compared to the control group, but this increase was not statistically significant (p > .05). Placental weight in the patient group showed a significant decrease compared to controls (p < .05). Total volume of EVTs, diameter and volume of the nucleus and cytoplasm and the N/C ratio of EVTs in the SLE group showed a significant increase compared to the controls (p < .05). In SLE placentas the total number of EVTs per unit volume of the placenta was increased significantly compared to the control group (p < .05). Impact statement In the present study, there is a new insight to placenta structure that may be useful in understanding possible mechanisms of pregnancy complications and the achievement of new therapeutic strategies. In the present study, for the first time quantitative changes of extravillous trophoblast cells (EVTs) in the placental bed of SLE patients were investigated compared to healthy controls using stereological methods. Results showed that volumetric parameters and number of EVTs were significantly altered in SLE placentas. These changes can be associated with disturbances in trophoblastic invasion in SLE pregnancies and may affect the development and survival of the embryo. Further investigation on the molecular biology of these cells in pregnancy complications will be needed to clarify this hypothesis.
Prediction of Adverse Pregnancy Outcomes in Women with Systemic Lupus Erythematosus.
Palma Dos Reis Catarina R,Cardoso Gonçalo,Carvalho Carolina,Nogueira Isabel,Borges Augusta,Serrano Fátima
Clinical reviews in allergy & immunology
Systemic lupus erythematosus (SLE) is a chronic, autoimmune disease associated with major obstetrical complications such as gestational loss, preterm delivery, fetal growth restriction (FGR) and preeclampsia. Published literature is not consensual regarding the main risk factors for each of these outcomes. Our goal with this study was to determine the most important predictors for each of the main adverse pregnancy outcomes in this population. We conducted a retrospective cohort study of unifetal pregnancies of women with the diagnosis of SLE followed in our unit between January 1994 and December 2016. We excluded elective terminations of pregnancy and cases lost to follow-up and we analyzed 157 pregnancies (128 women). Multiple logistic regression models for the outcomes gestational loss, preterm delivery, fetal growth restriction, and preeclampsia were built. Two-sided p-values of < 0.05 were used to determine statistical significance, and two-sided confidence intervals of 95% are reported. In our cohort, the main risk factors for gestational loss were maternal age and the presence of antiphospholipid antibodies. Lupic nephritis was predictive of a preterm delivery and preeclampsia. Renal involvement and lupus flares during pregnancy were risk factors for FGR. Overall, the main risk factor for an adverse pregnancy outcome were lupus flares during pregnancy. Despite optimal pregnancy monitoring, women with SLE are still at risk for adverse pregnancy outcomes. Risk stratification for each of these outcomes is crucial for an effective counselling and tailored monitoring.
Soluble Flt-1, Placental Growth Factor, and Vascular Endothelial Growth Factor Serum Levels to Differentiate Between Active Lupus Nephritis During Pregnancy and Preeclampsia.
de Jesús Guilherme R,Lacerda Marcela I,Rodrigues Bruna C,Dos Santos Flávia C,do Nascimento Adriana P,Cristóvão Porto Luís,de Jesús Nilson R,Levy Roger A,Klumb Evandro M
Arthritis care & research
OBJECTIVE:To evaluate mean serum levels of vascular endothelial growth factor (VEGF), placental growth factor (PlGF), and soluble Flt-1 (sFlt-1) in pregnant patients with systemic lupus erythematosus (SLE) with inactive disease, active lupus nephritis, and preeclampsia for differential diagnosis between these conditions. METHODS:Pregnant women with SLE, with singleton pregnancies and no other autoimmune diseases, were classified according to disease activity (inactive SLE and active lupus nephritis) and the presence of preeclampsia. Serum samples were collected within 3 weeks of delivery and frozen for subsequent blinded analysis through the enzyme-linked immunosorbent assay method. RESULTS:A total of 71 women were included, with 41 classified as having inactive SLE (group 1; Systemic Lupus Erythematosus Pregnancy Disease Activity Index [SLEPDAI] score <4), 15 with a diagnosis of active lupus nephritis (group 2, SLEPDAI score ≥4, including renal criteria), and 15 with a diagnosis of preeclampsia (group 3). Patients in group 3 had higher mean levels of sFlt-1 and lower mean levels of PlGF compared to groups 1 and 2, both findings with statistical significance. The sFlt-1:PlGF ratio was also significantly higher in patients with preeclampsia, while mean VEGF levels were higher in pregnant woman with active lupus nephritis compared to patients with preeclampsia or inactive SLE. CONCLUSION:Evaluation of serum VEGF, PlGF, and sFlt-1 levels can differentiate between preeclampsia, inactive SLE, and active lupus nephritis during pregnancy.
Proteomic biomarkers in mid-trimester amniotic fluid associated with adverse pregnancy outcomes in patients with systemic lupus erythematosus.
Jeon Hae Sun,Lee Seung Mi,Jung Young Mi,Oh Sohee,Park Jin Kyun,Lee Eun Bong,Park Chan-Wook,Park Joong Shin,Han Dohyun,Jun Jong Kwan
We aimed to explore the proteomic profiles of mid-trimester amniotic fluid in pregnant women with systemic lupus erythematosus (SLE) according to the occurrence of adverse pregnancy outcome (APO). The study population included 35 pregnant women with SLE who underwent clinically indicated amniocentesis at 15-24 weeks of gestation. Patients were divided into two groups according to pregnancy outcomes: SLE patients without APO (Group 1) and SLE patients with APO (Group 2). Stored samples of amniotic fluid were analyzed using mass spectrometry (MS)-based proteomics with two-step approach, consisting of discovery and verification phase. In the discovery phase, 44 proteins were differentially expressed between Group 1 and Group 2. In the verification phase, differentially expressed proteins (DEPs) were verified in independent samples using DIA method. Four proteins including filamin A (FLNA), sushi, von Willebrand factor type A, EGF and pentraxin domain containing 1 (SVEP1), lecithin-cholesterol acyltransferase (LCAT), and transglutaminase 2 (TGM2) were differentially expressed both in discovery and verification phase. To select the best combination of proteins for discriminating two groups, three-fold cross validation (CV) with repetition of one hundred times was performed. The multi-marker model with three biomarkers (SVEP1, LCAT, TGM2) had a high discriminatory power to distinguish between the two groups (the area under the receiver operating characteristic, AUROC = 0.946, p <0.001). Our results indicate that the expression of FLNA, SVEP1, LCAT, and TGM2 in mid-trimester amniotic fluid was increased in SLE patients with APO (Group 2). A large-scale prospective study is warranted to verify this finding.
The study of factors associated with pregnancy outcomes in patients with systemic lupus erythematosus.
Zamani Batool,Shayestehpour Mohammad,Esfahanian Farifteh,Akbari Hossein
BMC research notes
OBJECTIVES:Systemic lupus erythematosus (SLE) is an autoimmune disease that can lead to unfavorable pregnancy complications in women. This study aimed to evaluate the factors associated with pregnancy outcomes in patients with SLE. RESULTS:Fifty-nine pregnant women with SLE (121 pregnancies) participated in this retrospective cohort study. The mean age of the patients was 33.74 ± 3.80 years (range 21 to 48 years). Fetal loss occurred in 43.8% of pregnancies. The most common laboratory findings in SLE patients were antinuclear antibody (81.4%) and anti-ds DNA positivity (54.2%). High levels of C-reactive protein (CRP) during pregnancy, renal involvement, anti-double-stranded DNA positivity, anti-phospholipid antibody (APA) positivity and younger age at disease onset were significantly correlated with unfavourable pregnancy outcomes. A significant difference was observed between duration of SLE and low birth weight (P = 0.003), pre-eclampsia (P = 0.012) and still birth (P = 0.036). High CRP, APA positivity, anti-dsDNA positivity and kidney involvement were predictors of adverse pregnancy outcomes in SLE patients. Renal involvement increased risk of pregnancy with complication 8.5 times (OR = 8.5, 95% CI 1.396-63.373, P = 0.017). Antiphospholipid syndrome (APS) also was associated with an odds ratio of 5.18 (95% CI 1.681-13.647, P = 0.001).
Metabolic Biomarkers In Midtrimester Maternal Plasma Can Accurately Predict Adverse Pregnancy Outcome in Patients with SLE.
Lee Seung Mi,Lee Eun Mi,Park Jin Kyun,Jeon Hae Sun,Oh Sohee,Hong Subeen,Jung Young Mi,Kim Byoung Jae,Kim Sun Min,Norwitz Errol R,Lee Eun Bong,Louangsenlath Souphaphone,Park Chan-Wook,Jun Jong Kwan,Park Joong Shin,Lee Do Yup
Patients with systemic lupus erythematosus (SLE) are at increased risk for adverse pregnancy outcome (APO). Accurate prediction of APO is critical to identify, counsel, and manage these high-risk patients. We undertook this study to identify novel biomarkers in mid-trimester maternal plasma to identify pregnant patients with SLE at increased risk of APOs. The study population consisted of pregnant women whose plasma was taken in mid-trimester and available for metabolic signature: (1) SLE and normal pregnancy outcome (Group 1, n = 21); (2) SLE with APO (Group 2, n = 12); and (3) healthy pregnant controls (Group 3, n = 10). Mid-trimester maternal plasma was analyzed for integrative profiles of primary metabolite and phospholipid using gas chromatography time-of-flight mass spectrometry (GC-TOF MS) and liquid chromatography Orbitrap mass spectrometry (LC-Orbitrap MS). For performance comparison and validation, plasma samples were analyzed for sFlt-1/PlGF ratio. In the study population, APO developed in 12 of 33 women with SLE (36%). Metabolite profiling of mid-trimester maternal plasma samples identified a total of 327 metabolites using GC-TOF MS and LC-Orbitrap MS. Partial least squares discriminant analysis (PLS-DA) showed clear discrimination among the profiles of SLE groups and healthy pregnant controls (Groups 1/2 vs. 3). Moreover, direct comparison between Groups 1 and 2 demonstrated that 4 primary metabolites and 13 lipid molecules were significantly different. Binary logistic regression analysis suggested a potential metabolic biomarker model that could discriminate Groups 1 and 2. Receiver operating characteristic (ROC) analysis revealed the best predictability for APO with the combination model of two metabolites (LysoPC C22:5 and tryptophan) with AUC of 0.944, comparable to the AUC of sFlt-1/PlGF (AUC 0.857). In conclusion, metabolic biomarkers in mid-trimester maternal plasma can accurately predict APO in patients with SLE.
Pregnancy outcomes in systemic lupus erythematosus (SLE) women.
Kalok Aida,Abdul Cader Rizna,Indirayani Ima,Abdul Karim Abdul Kadir,Shah Shamsul Azhar,Mohamed Ismail Nor Azlin,Omar Mohd Hashim,Shafiee Mohamad Nasir
Hormone molecular biology and clinical investigation
Background Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory condition with multi-organ involvement predominantly affecting young women. There are very limited studies in pregnancy in Asian SLE patients and therefore we embarked on this study to identify pregnancy outcomes of Malaysian women with SLE. Materials and methods We performed a retrospective study of pregnancy outcomes in SLE patients in our institution from January 2007 to December 2014. A total of 71 pregnancies from 44 women were analysed. Results The mean age of our cohort was 30.5 ± 3.9 years. The rate of active disease at conception, antiphospholipid syndrome and lupus nephritis were 22.5%, 32.4% and 57.7% respectively. SLE flare occurred in 33 out of 71 pregnancies whereas 19 pregnancies were complicated with preeclampsia. The livebirth rate for our cohort was 78.9%, whilst preterm delivery was 42.9%. On univariate analysis, active disease and flare in pregnancy were both strongly associated with foetal loss and preterm delivery. Lupus nephritis (p = 0.011), SLE flare (p = 0.008) and antiphospholipid syndrome (p = 0.032) significantly increased the risk of preeclampsia. Aspirin and hydroxychloroquine were protective against foetal loss [odds ratio (OR) 0.12] and preeclampsia (OR 0.25), respectively. On multivariate analysis, active disease was a predictor of SLE flare (p = 0.002) and foetal loss (p = 0.018) and SLE flare was the main predictor of preterm delivery (p = 0.006). Conclusions Pregnancies in women with SLE should be planned and aspirin and HCQ use were beneficial in reducing adverse pregnancy outcomes.
[Therapeutic effect of nape cluster acupuncture combined with swallowing function training on post-stroke dysphagia].
Gao Jia-Xiu,Zhou Hong-Fei
Zhongguo zhen jiu = Chinese acupuncture & moxibustion
OBJECTIVE:To observe the effect on swallowing function in patients with post-stroke dysphagia treated with nape cluster acupuncture and the immediate effect of acupuncture at Fengchi (GB 20). METHODS:A total of 60 patients with post-stroke dysphagia were randomized into an observation group and a control group, 30 cases in each one.On the basis of conventional western medication treatment, swallowing function training was applied in the control group, once a day.On the base of the treatment as the control group, nape cluster acupuncture was applied at Fengchi (GB 20), Tianzhu (BL 10), Wangu (GB 12), Lianquan (CV 23), Panglianquan (Extra), Jinjin (EX-HN 12) and Yuye (EX-HN 13) in the observation group, once a day. Additionally, pricking blood was applied at Jinjin (EX-HN 12) and Yuye (EX-HN 13), 2 times a week. The treatment was given 30 min each time, a week as one course and 4 courses were required. Before and after treatment, the standardized swallowing assessment (SSA) score and video fluoroscopic swallowing study (VFSS) score were compared in the two groups. The ultrasonic diagnostic device of swallowing and surface electromyography were used to observe the immediate effect on swallowing related muscles of acupuncture at Fengchi (GB 20). RESULTS:Compared before treatment, the SSA scores were reduced after treatment in the two groups (<0.05), and the change of the observation group was larger than the control group (<0.05). Compared before treatment, the VFSS scores were increased after treatment in the two groups (<0.05), and the change of the observation group was larger than the control group (<0.05). Acupuncture at Fengchi (GB 20) immediately increased the amplitude of submental muscles and infrahyoid muscles in the observation group (<0.05), the geniohyoid muscle movement time was reduced and geniohyoid muscle displacement was increased (<0.05). CONCLUSION:On the base of the routine treatment, nape cluster acupuncture could improve swallowing function in patients with post-stroke dysphagia. Acupuncture at Fengchi (GB 20) could immediately affect swallowing related muscles, improve muscle amplitude and reduce swallowing time.
The impact of time after radiation treatment on dysphagia in patients with head and neck cancer enrolled in a swallowing therapy program.
Van Daele Douglas J,Langmore Susan E,Krisciunas Gintas P,Lazarus Cathy L,Pauloski Barbara R,McCulloch Timothy M,Gramigna Gary D,Messing Barbara P,Wagner Cynthia W,Mott Sarah L
Head & neck
BACKGROUND:Swallowing dysfunction after radiotherapy (RT) for head and neck cancer can be devastating. A randomized control trial compared swallow exercises versus exercise plus neuromuscular electrical stimulation therapy and found no overall difference in outcomes. METHODS:Quality of life (QOL), diet, and swallowing variables collected at discrete intervals on 117 patients were reanalyzed to test the hypothesis that shorter time between the completion of radiotherapy and beginning of the swallowing therapy program yielded improved outcomes. RESULTS:At baseline, subjects < 1 year post radiation had significantly better function than subjects >2 years post RT in several measures. Over the therapy program, the early group showed significant improvement in diet and QOL. Swallowing physiologic variables showed no difference between groups. CONCLUSION:Beginning a swallowing therapy program within 1 year of completion of radiotherapy demonstrates more consistent improvement in QOL and diet performance compared to later periods.
Breathing-Swallowing Discoordination and Inefficiency of an Airway Protective Mechanism Puts Patients at Risk of COPD Exacerbation.
Yoshimatsu Yuki,Tobino Kazunori,Nagami Shinsuke,Yagi Naomi,Oku Yoshitaka
International journal of chronic obstructive pulmonary disease
Introduction:Dysphagia is a newly acknowledged multifactorial risk factor for the exacerbation of chronic obstructive pulmonary disease (COPD). Effective screening methods are awaited. We performed a prospective study to evaluate the impact of musculature and breathing-swallowing discoordination on the exacerbation of COPD with a novel swallowing monitor using a piezoelectric sensor. Patients and Methods:This was the second part of a prospective study of patients with COPD from the Iizuka COPD cohort. Seventy patients with stable COPD underwent dysphagia screening, skeletal muscle mass index (SMI) and tongue pressure measurements, and swallowed 3 mL and 30 mL of water while wearing a swallowing monitor. Patients were followed for one year. Results:During the follow-up period, 28 patients experienced exacerbations (E group), and 42 had none (non-E group). There was no significant difference in tongue pressure measurements between the two groups. The SMI in the E group was significantly lower than that in the non-E group. Among the swallowing monitor measurements, the 3 mL I-SW% (the percentage of swallows in which inspiration preceded the swallow [out of ten 3 mL swallows]) was significantly lower in the E group than in the non-E group. Conclusion:Breathing-swallowing coordination is an independent factor related to the exacerbation of COPD. Not only the presence of discoordination but also the inability to produce an airway protection mechanism may contribute to more frequent aspiration and exacerbations.
Subjective swallowing symptoms and related risk factors in COPD.
Gonzalez Lindh Margareta,Malinovschi Andrei,Brandén Eva,Janson Christer,Ställberg Björn,Bröms Kristina,Blom Johansson Monica,Lisspers Karin,Koyi Hirsh
ERJ open research
Objectives:This study aimed to investigate the prevalence of subjective ( self-reported) swallowing symptoms in a large cohort of patients with stable chronic obstructive pulmonary disease (COPD) and to identify potential related risk factors. Methods:A total of 571 patients with COPD, investigated in a stable phase, participated in this multicentre study (335 females, 236 males; mean age: 68.6 years (sd 7.7)). Data were derived from spirometry, a questionnaire and a 30-metre walking test. Results:In total, 33% (n=186) patients reported at least some degree of swallowing problem. The most frequently reported symptom was food lodging in the throat (23%). A significant relationship was found between swallowing symptoms and dyspnoea, assessed as modified Medical Research Council (mMRC) ≥2 compared with <2 (46% 22%; p<0.001) and health-related quality of life, assessed as the COPD Assessment Test (CAT) ≥10 (40% 19%; p<0.001). Swallowing problems were also related to lower physical capacity (p=0.02) but not to lung function (p>0.28). Conclusion:Subjective swallowing symptoms seem to be a common problem in patients with stable COPD. This problem is seen in all stages of the disease, but is more common in symptomatic patients and in patients with lower physical capacity.
[Acupuncture strategy for - in ].
Sun Jiao,Liang Jing-Rong,Zeng Tian-Xiao,Hao Xiao-Min,Huang Pei-Yi,Liu Qing-Guo
Zhongguo zhen jiu = Chinese acupuncture & moxibustion
This article focuses on the - (the disease has not been cured after treatment) recorded in the and discusses four aspects, including acupuncture feasibility, acupuncture treatment transformation, acupuncture point selection and acupuncture treatment principles. We hope to explain the virtual acupuncture in the from a deeper level and provide new ideas for clinical acupuncture treatment.
Acupuncture sensation during ultrasound guided acupuncture needling.
Park Jongbae J,Akazawa Margeaux,Ahn Jaeki,Beckman-Harned Selena,Lin Feng-Chang,Lee Kwangjae,Fine Jason,Davis Robert T,Langevin Helene
Acupuncture in medicine : journal of the British Medical Acupuncture Society
BACKGROUND:Although acupuncture sensation (also known as de qi) is a cornerstone of traditional acupuncture therapy, most research has accepted the traditional method of defining acupuncture sensation only through subjective patient reports rather than on any quantifiable physiological basis. PURPOSE:To preliminarily investigate the frequency of key sensations experienced while needling to specific, quantifiable tissue levels (TLs) guided by ultrasound (US) imaging. METHODS:Five participants received needling at two acupuncture points and two control points at four TLs. US scans were used to determine when each TL was reached. Each volunteer completed 32 sets of modified Southampton Needle Sensation Questionnaires. Part one of the study tested sensations experienced at each TL and part two compared the effect of oscillation alone versus oscillation+rotation. RESULTS:In all volunteers, the frequency of pricking, sharp sensations was significantly greater in shallower TLs than deeper (p=0.007); the frequency of sensations described as deep, dull and heavy, as spreading, and as electric shocks was significantly greater in deeper TLs than shallower (p=0.002). Sensations experienced did not significantly differ between real and control points within each of three TLs (p>0.05) except TL 4 (p=0.006). The introduction of needle rotation significantly increased deep, dull, heavy sensations, but not pricking and sharp sensations; within each level, the spectrum of sensation experienced during both oscillation+rotation and oscillation alone did not significantly differ between acupuncture and control points. CONCLUSION:The preliminary study indicates a strong connection between acupuncture sensation and both tissue depth and needle rotation. Furthermore, the new methodology has been proven feasible. A further study with an objective measurement is warranted.
Functional Modules of Pharyngeal Swallowing Mechanics.
Hosseini Pouria,Tadavarthi Yasasvi,Martin-Harris Bonnie,Pearson William G
Laryngoscope investigative otolaryngology
Objectives:The present retrospective cohort study aims to test the hypothesis that elements of swallowing mechanics including hyoid movement, laryngeal elevation, tongue base retraction, pharyngeal shortening, pharyngeal constriction, and head and neck extension can be grouped into functional modules, and that these modules are predictably altered in disease states. Methods:Modified barium swallow video clips of a thick and a thin liquid swallow from 40 normal patients and 10 dysphagic post-treatment oropharyngeal head-and-neck cancer (HNC) patients were used in this study. Coordinate locations of 12 anatomical landmarks mapping pharyngeal swallowing mechanics were tracked on every frame during the pharyngeal phase of each swallow using a custom-made MATLAB tool. Morphometric modularity hypothesis testing was performed on these coordinate data to characterize the modular elements of swallowing function in each cohort using MorphoJ software. Results:The elements of normal swallowing can be grouped into four functional modules including bolus propulsion, pharyngeal shortening, airway protection, and head and neck posture. Modularity in HNC patient showed an intact airway protection module but altered bolus propulsion and pharyngeal shortening modules. To cross-validate the alteration in modules, a post hoc analysis was performed, which showed significantly increased vallecular ( < .04) and piriform ( < .05) residue but no significant change in aspiration status in the HNC cohort versus controls. Conclusions:This study suggests that while pharyngeal swallowing mechanics is highly complex, the system is organized into functional modules, and that changes in modularity impacts swallowing performance. This approach to understanding swallowing function may help the patient care team better address swallowing difficulties. Level of Evidence:2b.
Swallowing outcomes after pediatric epiglottopexy.
Kanotra Sohit Paul,Givens Victoria B,Keith Brent
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
INTRODUCTION:Persistent sleep apnea following tonsillectomy and adenoidectomy in children requires additional evaluation. One of the common areas of persistent upper airway obstruction in these children is the base of the tongue and lingual tonsils as well as epiglottic prolapse. Depending on the site of obstruction on sleep endoscopy or a cine MRI, surgical procedures include base of tongue reduction and lingual tonsillectomy with or without epiglottopexy. OBJECTIVE:To assess the swallowing outcomes in children undergoing epiglottopexy with lingual tonsillectomy. METHODS:A retrospective case series review of children undergoing epiglottopexy with or without lingual tonsillectomy. All patients underwent an epiglottopexy with lingual tonsillectomy using coblation. A detailed evaluation including a sleep study, sleep endoscopy, and thorough swallowing assessment preoperatively as well as postoperatively was performed. RESULTS:Five children underwent epiglottopexy with lingual tonsillectomy for obstructive sleep apnea. Epiglottopexy improved sleep apnea with Apnea Hypopnea Index (AHI) falling significantly from 4.6 to 0.5 (p < 0.05). All patients had a normal swallowing assessment postoperatively with functional endoscopic evaluation of swallowing (FEES) revealing no evidence of aspiration and penetration. CONCLUSION:In our case series epiglottopexy with lingual tonsillectomy is a safe and effective technique, which improves sleep apnea in pediatric patients. It does not affect the swallowing mechanism, and the epiglottis still retains the laryngeal protective role.
Assessment of oropharyngeal swallowing dysfunction in myasthenia gravis patients presenting with difficulty in swallowing.
Kumai Yoshihiko,Miyamoto Takumi,Matsubara Keigo,Samejima Yasuhiro,Yamashita Satoshi,Ando Yukio,Orita Yorihisa
Auris, nasus, larynx
OBJECTIVE:To examine the correlation between the results of a clinical neurological evaluation and swallowing dysfunction in myasthenia gravis (MG) patients who presented with difficulty in swallowing and underwent videofluorographic (VF) and fiber-optic endoscopic (FE) evaluation. METHODS:The swallowing studies of 13MG patients with difficulty in swallowing seen at the Department of Neurology from June 2016 to April 2018 were reviewed. The assessment parameters on VF and FE examination were as follows: swallowing initiation, bolus stasis at the pyriform sinus (PS) and vallecula (VC), and the degree of aspiration. They were assessed using a 4 or 5-point scale. Associations between these parameters and the clinical neurological evaluation, which included the Myasthenia Gravis Foundation of America (MGFA) clinical classification, the MG Activities of Daily Living score, and a quantitative MG score, were statistically determined. RESULTS:No patients demonstrated aspiration. However, in patients MGFA IIb/IIIb disease, the Hydo's FEES scale and pharyngeal residue examined using VF were significantly (p<0.05) more severe than in patients classified with MGFA IIa/IIIa disease. None of the parameters evaluated with VF and FE correlated significantly with the clinical neurological evaluation except for the grip assessment. CONCLUSION:While not presenting with aspiration but with swallowing difficulty alone, patients classified with MGFA IIb/IIIb disease, regardless of clinical neurological evaluation, require care addressing the reduced pharyngeal clearance. Controlling the severity of the pharyngeal residue may be the key to preventing silent aspiration, especially in patients with MGFA IIb/IIIb disease.
Preliminary development and validation of a measure of fear of swallowing and swallowing-related movement injury in head and neck cancer: Swallowing Kinesiophobia Scale.
Carnaby Giselle D,Chhabria Karishma
Head & neck
BACKGROUND:Fear is an under-recognized issue in intervention adherence in head and neck cancer (HNC). We developed and validated a patient reported outcome for swallowing fear in HNC patients. METHODS:Items were adapted from the Tampa Scale for Kinesiophobia to swallowing function. A beta version was completed by 51 HNC patients undergoing chemo +/- radiotherapy at baseline and post-treatment. Psychometric and factor structure analyses were applied. RESULTS:Swallowing Kinesiophobia Scale (SWKS) demonstrated strong face and content validity, internal consistency, and test-retest reliability. Factor analysis revealed three-factors: somatic factor, swallow avoidance, and fear of harm. Factors correlated positively with depression score, worry scale, and anxiety and pain scales. Score differences between patient subgroups (dysphagic vs nondysphagic) confirmed discriminative validity. CONCLUSION:The SWKS is a psychometrically valid tool to identify patients with fear of swallowing and swallowing-related movement. It can help identify patients early in treatment who may need additional support.
Combined Effects of NMES and Mendelsohn Maneuver on the Swallowing Function and Swallowing-Quality of Life of Patients with Stroke-Induced Sub-Acute Swallowing Disorders.
It is necessary to identify how to improve the swallowing-related quality of life, as well as the swallowing function, in order to evaluate the effect of treatments on swallowing disorders. This study aimed to prove the effects of a compound swallowing intervention (Mendelsohn maneuver + neuromuscular electrical stimulation (NMES)) on the swallowing function and the quality of life by applying the compound swallowing intervention to patients with sub-acute swallowing disorders due to cerebral infarction for eight weeks. This study analyzed 43 subjects who were diagnosed with swallowing disorders due to cerebral infarction. The experiment consisted of the Mendelsohn maneuver treatment group ( = 15), the NMES treatment group ( = 13), the compound intervention group (Mendelsohn maneuver + NMES; = 15). The results of ANCOVA showed that the changes in Functional Dysphagia Scale (FDS) scores and Swallowing-Quality of Life (SWAL-QOL) score were different among groups. The compound intervention group had the highest FDS scores and SWAL-QOL score followed by Mendelsohn, and the NMES group had the lowest. The result of this study suggests that NMES can be more effective when it is combined with a traditional swallowing rehabilitation therapy rather than a single intervention method.
Ultrasonographic evaluation of geniohyoid muscle and hyoid bone during swallowing in young adults.
Feng Xin,Cartwright Michael S,Walker Francis O,Bargoil Jessica H,Hu Yunping,Butler Susan G
OBJECTIVES/HYPOTHESIS:The geniohyoid muscle plays an important role in hyoid bone movement. Adequate hyoid bone movement during swallowing is important for effective bolus flow and pharyngeal clearing. The aim of this study was to estimate the relationship between the geniohyoid muscle size and function and hyoid bone movement during swallowing in healthy young adults, as measured via ultrasound, in different body positions. STUDY DESIGN:Cross-sectional study. METHODS:Forty young (20-40 years old) adults (20 male and 20 female) participated. The cross-sectional area of the geniohyoid muscle at rest (seated position), the geniohyoid muscle contraction velocity, and the hyoid bone displacement during swallowing 10 mL of mineral water were measured by ultrasound in seated, supine, and right lateral decubitus positions. RESULTS:The size of the geniohyoid muscle correlated with body height. Males had larger geniohyoid cross-sectional area than females and greater maximal and anterior hyoid displacement during swallowing than females, and maximal and anterior hyoid bone displacement during swallowing correlated with the size of geniohyoid muscle only when the body was in the supine position; these two movements were positively correlated to each other. CONCLUSIONS:Genders vary in hyoid bone movement during swallowing, and the correlation between geniohyoid muscle size and hyoid bone displacement varies among different body positions during swallowing. This investigation also illuminates the use of ultrasound in providing quantitative measures of geniohyoid muscle and hyoid bone displacement during swallowing. LEVEL OF EVIDENCE:2c.
Delayed Swallowing Reflex is Overlooked in Swallowing Screening Among Acute Stroke Patients.
Takeda Chiho,Yoshida Mitsuyoshi,Nakamori Masahiro,Hosomi Naohisa,Nagasaki Toshikazu,Yoshikawa Mineka,Kayashita Jun,Masuda Shin,Maruyama Hirofumi,Tsuga Kazuhiro
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
BACKGROUND AND PURPOSE:Dysphagia in the acute phase of stroke contributes significantly to poor outcomes and is associated with the development of aspiration pneumonia and malnutrition. Therefore, an accurate evaluation of swallowing is necessary before initiating oral food intake. The modified water swallow test (MWST) and the repetitive saliva swallow test (RSST) are commonly used as bedside screening methods for swallowing dysfunction, but it is unclear whether other factors contribute to dysphagia and consequent aspiration. The purpose of this study was to identify characteristics that might be overlooked in screening tests. METHODS:Participants were prospectively selected from patients hospitalized for stroke at the Suiseikai Kajikawa Hospital between August 1, 2016 and June 30, 2018. Inclusion criteria were conscious and stable medical condition, and patients who were diagnosed with dementia were excluded. A videofluoroscopic (VF) swallowing study was carried out on all patients who met the inclusion/exclusion criteria and who passed both the MWST and the RSST. RESULTS:Aspiration was observed in 16 of 172 patients (9.3%) when swallowing 3 ml of water. These aspirated patients showed significantly delayed swallowing reflex on VF. CONCLUSIONS:Swallowing evaluation using a combination of the MWST and the RSST is reasonably effective. However, patients who show a delayed swallowing reflex might be overlooked by this screening procedure.
Ultrasound-Guided Botulinum Toxin Injections into the Salivary Glands for the Treatment of Drooling.
Abboud Waseem A,Nadel Sahar,Hassin-Baer Sharon,Arad Abigail,Dobriyan Alex,Yahalom Ran
The Israel Medical Association journal : IMAJ
BACKGROUND:Drooling is the unintentional loss of saliva from the mouth, usually caused by poor coordination of the swallowing mechanism. It is commonly seen in patients with chronic neurologic disorders, such as Parkinson's disease, amyotrophic lateral sclerosis (ALS), cerebral palsy, and stroke, as well as in patients with cognitive impairment and dementia. OBJECTIVES:To evaluate the efficacy and safety of ultrasound-guided botulinum toxin injections into the parotid and submandibular salivary glands for the treatment of drooling. METHODS:We conducted a retrospective analysis of the medical records of 12 consecutive patients treated with botulinum toxin injections into the parotid and submandibular glands for the first time. The primary outcome variable was the subjective improvement of drooling on a 5-point scale. Secondary outcome variables were duration of the therapeutic effect, request to undergo additional treatment, and adverse events. RESULTS:Of 12 patients, 8 (67%) reported considerable improvement after treatment, 3 reported slight improvement, and 1 reported development of dry mouth. All patients stated that they felt the effects 1 week after the injections; the mean duration of the therapeutic effect was 4.5 months (range 3-9 months). One patient suffered from local hematoma and ecchymosis that did not require medical care. Another patient complained of difficulty swallowing, which did not require medical treatment and resolved spontaneously within 1 month. CONCLUSIONS:Ultrasound-guided botulinum toxin injections into the parotid and submandibular glands seem to be a safe and effective therapy for the treatment of drooling. Further long-term prospective studies with varying doses are warranted.
Tongue muscle strength affects posterior pharyngeal wall advancement during swallowing: A cross-sectional study of outpatients with dysphagia.
Nagashima Keigo,Kikutani Takeshi,Miyashita Taishi,Yajima Yuri,Tamura Fumiyo
Journal of oral rehabilitation
BACKGROUND:Tongue muscle strength is important for swallowing but decreases with age, in association with reduced skeletal muscle mass. However, the relationships between pharyngeal dynamics and both skeletal muscle mass and tongue muscle strength are unknown. OBJECTIVE:To investigate the effect of reductions in tongue muscle strength on pharyngeal movement during swallowing in patients with dysphagia. METHODS:Subjects were selected from male outpatients ≥65 years old who were examined for the main complaint of dysphagia. Patients with history of neurodegenerative disease affecting tongue movement, cerebrovascular disease or oral cancer were excluded. As a result, 82 men (mean age, 80.6 ± 6.8 years) participated. Skeletal muscle mass index (SMI) as physical parameters and maximum tongue pressure (MTP) as tongue muscles strength were measured. Status and dynamics of the pharyngeal organs, including change in posterior pharyngeal wall advancement (PPWA) when swallowing 3.0 mL of moderately thick liquid, were measured by analysing videofluoroscopic images. Simple bivariate correlation and multiple regression analysis were used to statistically analyse correlations between parameters. RESULTS:MTP showed a significant positive correlation with SMI (r = .43, P < .01). PPWA showed a significant negative correlation with MTP (r = -0.30, P < .01), but no association with SMI. CONCLUSIONS:While tongue muscle strength is affected by skeletal muscle mass, posterior pharyngeal wall advancement is not readily affected by decreases in skeletal muscle mass. Posterior pharyngeal wall advancement may increase to compensate for swallowing function among individuals with reduced tongue muscle strength.
Sonographic assessment of swallowing in irradiated nasopharyngeal carcinoma patients.
Cheng Dennis T H,Lee Kathy Y S,Ahuja Anil T,Tong Michael C F
OBJECTIVES/HYPOTHESIS:Ultrasonography is an emerging clinical tool to study the dysfunction of swallowing muscles. This was the first sonographic study to assess the relationship between suprahyoid muscle contraction, hyoid bone displacement, and penetration-aspiration status (PAS) during swallowing in nasopharyngeal carcinoma (NPC) patients treated with radiotherapy (RT). The study also aimed to establish reliability data for the sonographic technique described. STUDY DESIGN:Cross-sectional study. METHODS:Geniohyoid muscle contraction was quantified using brightness-mode ultrasonography in this study of 40 post-RT NPC patients. A series of physiological parameters and PAS were measured using videofluoroscopy. RESULTS:Intra- and inter-rater agreement values ranged from 0.75 to 0.96 across various sonographic measurements. Percentage increase in the cross-sectional area of the geniohyoid muscle correlated with anterior (r = 0.42, P < .05) but not superior (r = 0.27, P = .09) hyoid displacement. Anterior hyoid displacement and pharyngeal constriction ratio were significantly associated with PAS score. CONCLUSIONS:Sonographic measurement of suprahyoid muscles provides valuable information on muscle function and is potentially a useful clinical tool in swallowing assessment. Further research is needed to refine the role of this examination in dysphagia. LEVEL OF EVIDENCE:2b. Laryngoscope, 2552-2559, 2018.
Cephalometric, muscular and swallowing changes in patients with OSAS.
Valarelli L P,Corradi A M B,Grechi T H,Eckeli A L,Aragon D C,Küpper D S,Almeida L A,Sander H H,de Felício C M,Trawitzki L V V,Valera F C P
Journal of oral rehabilitation
Obstructive Sleep Apnoea Syndrome (OSAS) is believed to be associated with craniofacial and neuromuscular changes, although the interplay among these variables still is poorly recognised. The objective of this study was to identify hyoid, muscular and swallowing changes associated with OSAS, and to correlate these alterations with OSAS severity. Cross-sectional study, in a tertiary referral centre. Seventy-two adult individuals participated in this study: 12 controls (without apnoea) and 60 patients with apnoea (mild, moderate and severe OSAS-20 individuals in each group). All participants were initially evaluated by otorhinolaryngologist and neurologist and underwent polysomnography for OSAS stratification. Cephalometric data, clinical myofunctional status and swallow videofluoroscopy exam were assessed. A hybrid effect model was used to analyse swallowing parameters; dependent variables were age, body mass index (BMI) and cephalometric measures. Individuals with OSAS presented lower hyoid position and narrower posterior airway distance when compared to controls. These parameters correlated to OSAS severity. Additionally, OSAS patients exhibited significantly lower myofunctional scores. Both velum and hyoid contraction times were significantly lower in the OSAS group at videofluoroscopy, regardless of its severity. Premature leakage into pharynx was more common in OSAS groups. Laryngeal penetration phenomenon occurred only in two patients (both from OSAS group). Our results suggest that hyoid bone position is associated with OSAS severity. Muscular pattern and swallowing are impaired in OSAS patients, irrespective of OSAS severity and facial profile. These findings indicate a higher predisposition of OSAS patients to present an inferior hyoid positioning, accompanied by myofunctional and swallowing disorders.
Oropharyngeal swallow physiology and swallowing-related quality of life in underweight patients with concomitant advanced chronic obstructive pulmonary disease.
Garand Kendrea L,Strange Charlie,Paoletti Luca,Hopkins-Rossabi Theresa,Martin-Harris Bonnie
International journal of chronic obstructive pulmonary disease
Background:Swallowing impairment (dysphagia) has been associated with COPD and may contribute to exacerbations of this chronic and progressive disease. Further, risk of mortality increases with concomitant presence of cachexia in the COPD population. The purpose of this prospective study was to depict oropharyngeal swallowing physiology in underweight patients with stable but advanced-stage COPD. Patients and methods:Ten underweight patients with stable but advanced COPD underwent a modified barium swallow study. Analysis of oropharyngeal swallowing function was completed using the standardized Modified Barium Swallow Impairment Profile and the Penetration-Aspiration Scale. Scores from the Dysphagia Handicap Index and 10-item Eating Assessment Tool were collected to assess patient perception of swallowing difficulty. Findings were compared to age- and sex-matched healthy controls. Results:Significantly higher MBSImP oral total scores (=0.007) were observed in COPD patients compared to matched controls, but no difference was observed in pharyngeal total scores (=0.105). Patients with COPD had significantly higher maximum PAS scores compared with controls (=0.030). There was no significant difference in EAT-10 or DHI scores between patients with COPD and controls (=0.41 and =0.08, respectively). Conclusion:Underweight patients with severe but stable COPD present with dysphagia that may not be recognized by the patient. Further investigation is needed to elucidate the interaction between the respiratory-swallowing systems, how muscular weakness may contribute to swallowing impairment, and responsiveness to swallowing treatment.
Application of Ultrasound Biofeedback to the Learning of the Mendelsohn Maneuver in Non-dysphagic Adults: A Pilot Study.
Kwong Elaine,Ng Ka-Wing Katrina,Leung Man-Tak,Zheng Yong-Ping
This study aimed to investigate the application of ultrasound to the learning of swallowing maneuver. Forty non-dysphagic adults of both genders who were naïve to the Mendelsohn maneuver participated in the study. They were randomly assigned to receive ultrasound or surface electromyography (sEMG) as biofeedback when acquiring the Mendelsohn maneuver. Thirty-eight subjects (n = 19) completed the Learning phase. Accuracy of executing the Mendelsohn maneuver was measured immediately (Post-training percentage accuracy) and one week post-training (Retention percentage accuracy). Whereas comparable numbers of training blocks were completed by the two groups (t(31.51) = 3.68, p = 0.330), the Ultrasound group attained significantly higher percentage accuracies than the sEMG group at both Post-training (t(28.88) = 4.04, p < 0.001, d = 1.309) and Retention (t(30.78) = 2.13, p = 0.042, d = 0.690). Ultrasound is a more effective biofeedback than sEMG in the acquisition of the Mendelsohn maneuver and may be adopted to the rehabilitative treatment for dysphagic individuals. Non-specificity of sEMG as biofeedback should be emphasized when it is employed in the training and learning of swallowing maneuvers. Findings from the present study suggest that ultrasound is preferable to sEMG as biofeedback in the learning of the Mendelsohn maneuver.
Development of a Novel Prognostic Model to Predict 6-Month Swallowing Recovery After Ischemic Stroke.
Lee Woo Hyung,Lim Min Hyuk,Seo Han Gil,Seong Min Yong,Oh Byung-Mo,Kim Sungwan
Background and Purpose- The aim of this study was to explore clinical and radiological prognostic factors for long-term swallowing recovery in patients with poststroke dysphagia and to develop and validate a prognostic model using a machine learning algorithm. Methods- Consecutive patients (N=137) with acute ischemic stroke referred for swallowing examinations were retrospectively reviewed. Dysphagia was monitored in the 6 months poststroke period and then analyzed using the Kaplan-Meier method and Cox regression model for clinical and radiological factors. Bayesian network models were developed using potential prognostic factors to classify patients into those with good (no need for tube feeding or diet modification for 6 months) and poor (tube feeding or diet modification for 6 months) recovery of swallowing function. Results- Twenty-four (17.5%) patients showed persistent dysphagia for the first 6 months with a mean duration of 65.6 days. The time duration of poststroke dysphagia significantly differed by tube feeding status, clinical dysphagia scale, sex, severe white matter hyperintensities, and bilateral lesions at the corona radiata, basal ganglia, or internal capsule (CR/BG/IC). Among these factors, tube feeding status (<0.001), bilateral lesions at CR/BG/IC (=0.001), and clinical dysphagia scale (=0.042) were significant prognostic factors in a multivariate analysis using Cox regression models. The tree-augmented network classifier, based on 10 factors (sex, lesions at CR, BG/IC, and insula, laterality, anterolateral territory of the brain stem, bilateral lesions at CR/BG/IC, severe white matter hyperintensities, clinical dysphagia scale, and tube feeding status), performed better than other benchmarking classifiers developed in this study. Conclusions- Initial dysphagia severity and bilateral lesions at CR/BG/IC are revealed to be significant prognostic factors for 6-month swallowing recovery. The prediction of 6-month swallowing recovery was feasible based on clinical and radiological factors using the Bayesian network model. We emphasize the importance of bilateral subcortical lesions as prognostic factors that can be utilized to develop prediction models for long-term swallowing recovery.
Thyroid cartilage loci and hyoid bone analysis using a video fluoroscopic swallowing study (VFSS).
Na Yong Jae,Jang Jong Seong,Lee Kyu Hoon,Yoon Yu Jun,Chung Min Sung,Han Seung Hoon
INTRODUCTION:Hyoid bone movement can be useful for diagnosing oropharyngeal dysphagia. In most clinical settings, the movement can be evaluated by a video fluoroscopic swallowing study (VFSS) that induces radiation exposure. In contrast with the hyoid bone, the thyroid cartilage is easily seen through the anterior neck surface. We hypothesized that the movement of thyroid cartilage correlates with hyoid bone movement in various axis and can be used as a parameter to evaluate swallowing. The purpose of this study was to investigate whether thyroid cartilage and hyoid bone movement were correlated and to collect basic data to determine if thyroid cartilage can be used as a parameter to evaluate swallowing. METHODS:A total of 25 subjects were included, and the VFSS image with normal swallowing function was collected retrospectively. The VFSS image was analyzed by specially developed semi-automatic software. Laryngeal prominence and anterior-superior margins of the hyoid were automatically extracted during swallowing. Two-point sets of the loci during swallowing were obtained in all VFSS frames. The X-coordinates showed an anterior-posterior axis, and the Y-coordinates showed a superior-inferior axis. Pearson correlation coefficients for each X- and Y-coordinate component were computed. RESULTS:X- and Y-coordinates of the thyroid cartilage and hyoid bones in all subjects showed movement in similar patterns, although each subject's movement differed. Pearson correlation coefficients of X- and Y-coordinate components of all subjects ranged from 0.611 to 0.981, which indicated that thyroid cartilage and hyoid bone movement was strongly correlated in anterior-posterior and superior-inferior axes, respectively. CONCLUSION:We analyzed thyroid cartilage and hyoid bone movement using a specifically developed semi-automatic software and concluded that the movement of thyroid cartilage and hyoid bone was strongly correlated in anterior-posterior and superior-inferior axes, respectively, during swallowing. The present study implies that analysis of thyroid cartilage movement can be used as a parameter for swallowing evaluation.
Real-time evaluation of swallowing in patients with oral cancers by using cine-magnetic resonance imaging based on T2-weighted sequences.
Tanaka Tatsurou,Tanaka Ray,Yeung Andy Wai Kan,Bornstein Michael M,Nishimura Shun,Oda Masafumi,Habu Manabu,Takahashi Osamu,Yoshiga Daigo,Sago Teppei,Miyamoto Ikuya,Kodama Masaaki,Wakasugi-Sato Nao,Matsumoto-Takeda Shinobu,Joujima Takaaki,Miyamura Yuichi,Morimoto Yasuhiro
Oral surgery, oral medicine, oral pathology and oral radiology
OBJECTIVE:The aim of this study was to evaluate whether a new cine-magnetic resonance imaging (CMRI) technique might be useful for evaluating swallowing function in patients with different types of oral cancers by assessing 12 CMRI-related parameters. STUDY DESIGN:In total, 111 patients with oral cancers were evaluated. We examined whether visualization of fluid flow and determination of flow direction to the trachea or the esophagus were possible with CMRI. We evaluated the correlations between CMRI-related parameters and self-reported dysphagia scores as the status of dysphagia, T classification groups as tumor staging for preoperative patients, alterations in CMRI-related parameters between pre- and postoperative patients, and the degree of invasiveness of oral cancer surgery. RESULTS:We could judge the flow direction to the esophagus on CMRI in all 111 patients. Six CMRI-related parameters showed significant correlations with dysphagia status. Increases in CMRI-related parameters were significantly related to deterioration of swallowing status, as shown by a decrease in self-reported dysphagia scores, advances in the T classification, and degree of invasiveness of oral cancer surgery. CONCLUSIONS:The results of the present study suggest that CMRI can be used to directly visualize swallowing dynamics and objectively evaluate the swallowing complaints of patients with oral cancer.
Ultrasonography to Measure Swallowing Muscle Mass and Quality in Older Patients With Sarcopenic Dysphagia.
Ogawa Nami,Mori Takashi,Fujishima Ichiro,Wakabayashi Hidetaka,Itoda Masataka,Kunieda Kenjiro,Shigematsu Takashi,Nishioka Shinta,Tohara Haruka,Yamada Minoru,Ogawa Sumito
Journal of the American Medical Directors Association
BACKGROUND:Sarcopenic dysphagia is characterized by difficulty swallowing due to a loss of whole-body skeletal and swallowing muscle mass and function. However, no study has reported on swallowing muscle mass and quality in patients with sarcopenic dysphagia. OBJECTIVE:To compare the differences in swallowing muscle mass and quality between sarcopenic and nonsarcopenic dysphagia. METHOD:A cross-sectional study was performed in 55 older patients, who had been recommended to undergo dysphagia assessment and/or rehabilitation. Sarcopenic dysphagia was diagnosed using a diagnostic algorithm for sarcopenic dysphagia. The thickness and area of tongue muscle and geniohyoid muscle (coronal plane and sagittal plane), and the echo-intensity of the tongue and geniohyoid muscles were examined by ultrasound. RESULTS:The study participants included 31 males and 24 females (mean age of 82 ± 7 years), with 14 having possible sarcopenic dysphagia, 22 probable sarcopenic dysphagia, and 19 without sarcopenic dysphagia. The group with sarcopenic dysphagia had a significantly lower cross-sectional area and area of brightness of the tongue muscle than that observed in the group without sarcopenic dysphagia. The most specific factor for identifying the presence of sarcopenic dysphagia was tongue muscle area (sensitivity, 0.389; specificity, 0.947; cut-off value, 1536.0), while the factor with the highest sensitivity was geniohyoid muscle area brightness in sagittal sections (sensitivity, 0.806; specificity, 0.632; cut-off value, 20.1). Multivariate logistic regression analysis showed that the area of the tongue muscle and its area of brightness were independent risk factors for sarcopenic dysphagia. However, geniohyoid sagittal muscle area and area of brightness showed no significant independent association with sarcopenic dysphagia. CONCLUSION:Tongue muscle mass in patients with sarcopenic dysphagia was smaller than that in patients without the condition. Sarcopenic dysphagia was also associated with increased intensity of the tongue muscle.
Objective Assessment of Postoperative Swallowing Difficulty Through Ultrasound in Patients Undergoing Thyroidectomy.
Cho Jae-Gu,Byeon Hyung Kwon,Oh Kyung Ho,Baek Seung-Kuk,Kwon Soon-Young,Jung Kwang-Yoon,Woo Jeong-Soo
Swallowing discomfort is a common postoperative complaint in patients undergoing thyroidectomy. Contraction of the strap muscles might cause resistance to elevation of the laryngotracheal unit, and downward movement of the laryngotracheal unit may lead to swallowing discomfort. However, few studies have evaluated the mechanism related to limited laryngotracheal elevation after thyroidectomy. We aimed to objectively verify the presence of postoperative impaired laryngotracheal elevation through ultrasound evaluation in patients undergoing thyroidectomy and evaluate its relationship with limitation of laryngotracheal elevation. This is a prospective clinical study. Among patients undergoing hemithyroidectomy and total thyroidectomy, the patients who were followed up for ≥ 6 months were selected (N = 40). Ultrasound evaluation was done preoperatively and at 1, 3, and 6 months postoperatively. Laryngotracheal movement was recorded and the length of elevation was measured. Symptom after thyroidectomy was evaluated through swallowing-related items of thyroidectomy-related voice questionnaire. Ultrasound evaluation verified the presence of limited laryngotracheal elevation postoperatively in patients undergoing thyroidectomy. After thyroidectomy, the swallowing-related score was significantly increased, and was recovered time-dependently at 1 month. Laryngotracheal elevation showed significant decrease after thyroidectomy. The symptom score of swallowing was significantly correlated with the length of laryngotracheal elevation. Post-thyroidectomy ultrasound evaluation verified that laryngotracheal elevation was significantly impaired. Presence of adhesion between the laryngotracheal unit and the superficial soft tissue was the probable cause of the limitation at 6 months after thyroidectomy. The length of laryngotracheal elevation was related to the symptom score of swallowing after thyroid surgery.
Quantitative Ultrasound Assessment of Hyoid Bone Displacement During Swallowing Following Thyroidectomy.
Costa Bianca Oliveira Ismael da,Rodrigues Darlyane de Souza Barros,Magalhães Desiré Dominique Diniz de,Santos Ary Serrano,Santos Ricardo Vieira,Azevedo Elma Heitmann Mares,Almeida Anna Alice,Pernambuco Leandro
The aim of this study was to investigate temporal ultrasound measurements of the hyoid bone displacement during swallowing following thyroidectomy in women and to relate these measures to age, clinical outcomes, and upper digestive airway symptoms. The sample was divided into an experimental group (EG) of 20 women who underwent thyroidectomy (mean age = 49.55 years ± 15.14) and a control group (CG) of 20 healthy women volunteers (mean age = 40.75 years ± 15.92). Both groups were submitted to ultrasound assessment to obtain four temporal measurements of hyoid bone displacement during swallowing: elevation, anteriorization, maximum displacement, and maintenance of maximum displacement. In both groups, swallowing of ten milliliters of liquid and the same volume of thickened liquid (honey) were analyzed. The images were recorded on video (30 frames/second) and analyzed according to a standardized protocol. Temporal measurements of hyoid bone elevation and maximum displacement during swallowing of thickened liquid were significantly shorter in EG (p = 0.034 and p = 0.020, respectively). There were no differences in the swallowing of liquid, and no other variable was related to the ultrasound temporal measurements investigated. This study concludes that women who undergo thyroidectomy have a shorter time of hyoid bone elevation and maximum displacement during swallowing of 10 mL of thickened liquid.
Evaluation of swallowing movement using ultrasonography.
Matsuo Takao,Matsuyama Miwa,Nakatani Ken,Mori Naoe
Radiological physics and technology
The aim of this study is to develop an index to assess swallowing function by ultrasonography to evaluate the relationship between movements of the hyoid bone and the larynx while swallowing water. Forty-two younger participants (mean age, 20.3 ± 3.4 years) and 42 older participants (mean age, 75.1 ± 10.6 years) with normal swallowing function were included in the study. Movements of the hyoid bone and the larynx while swallowing 5 mL of water were observed using ultrasonography. Two-dimensional distances from the starting points of the hyoid bone and the larynx to their points of maximum movement were measured as displacements. The hyoid bone-laryngeal motion ratio was defined as the hyoid bone displacement divided by the laryngeal displacement. Parameters were compared among four groups: younger male, younger female, older male, and older female. The hyoid bone displacement differed significantly between the younger and older groups, and the laryngeal displacement differed significantly between age groups and sexes. The hyoid bone-laryngeal motion ratio was not significantly correlated with age, height, or body weight, and did not show a significant difference between the four groups. Thus, the hyoid bone-laryngeal motion ratio is an index that evaluates swallowing movement and is independent of physique and physiological changes associated with aging.
Accuracy of preoperative real-time dynamic transvaginal ultrasound sliding sign in prediction of pelvic adhesions in women with previous abdominopelvic surgery: prospective, multicenter, double-blind study.
Ayachi A,Bouchahda R,Derouich S,Mkaouer L,Kehila M,Abouda H,Channoufi B,Bouyahia M,Braham M,Zhioua F,Bouchahda H,Mourali M
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
OBJECTIVE:To investigate the role of the transvaginal sonographic (TVS) sliding sign in predicting pelvic adhesions in women with previous abdominopelvic surgery. METHODS:This was a multicenter, prospective, interventional, double-blind study of patients with a history of abdominopelvic surgery who were undergoing laparoscopy or laparotomy during the 6-month period from March to August 2016 in one of three academic obstetrics and gynecology departments. Prior to surgery, patients were examined by TVS to assess the vesicouterine pouch, uterus, ovaries and pouch of Douglas, using the TVS pelvic sliding sign. Ultrasound findings and medical and surgical data were recorded. We assessed the accuracy of the preoperative TVS sliding sign in the prediction of pelvic adhesions overall and in each compartment separately. RESULTS:During the study period, complete TVS sliding sign and laparoscopic or laparotomic data were available for 107 women. Their mean age was 44.0 (95% CI, 41.6-46.4; range, 20-79) years. Their mean parity was 2.0 (95% CI, 1.7-2.3; range, 0-9) and the mean number of previous abdominal surgical procedures per patient was 1.3 (95% CI, 1.2-1.5; range, 1-4). Adhesions were noted in 27/107 (25.2%) patients. The TVS sliding sign had a sensitivity of 96.3% and specificity of 92.6% in predicting pelvic adhesions. There was a significant relationship between adhesions in each compartment and the TVS sliding sign (P < 0.05). CONCLUSIONS:The TVS sliding sign is an effective means to detect preoperatively pelvic adhesions in patients with previous abdominopelvic surgery. Use of such a non-invasive and well-tolerated technique could help in the planning of laparoscopy or laparotomy and counseling of these patients. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Development of a Deep Learning Model to Identify Lymph Node Metastasis on Magnetic Resonance Imaging in Patients With Cervical Cancer.
Wu Qingxia,Wang Shuo,Zhang Shuixing,Wang Meiyun,Ding Yingying,Fang Jin,Wu Qingxia,Qian Wei,Liu Zhenyu,Sun Kai,Jin Yan,Ma He,Tian Jie
JAMA network open
Importance:Accurate identification of lymph node metastasis preoperatively and noninvasively in patients with cervical cancer can avoid unnecessary surgical intervention and benefit treatment planning. Objective:To develop a deep learning model using preoperative magnetic resonance imaging for prediction of lymph node metastasis in cervical cancer. Design, Setting, and Participants:This diagnostic study developed an end-to-end deep learning model to identify lymph node metastasis in cervical cancer using magnetic resonance imaging (MRI). A total of 894 patients with stage IB to IIB cervical cancer who underwent radical hysterectomy and pelvic lymphadenectomy were reviewed. All patients underwent radical hysterectomy and pelvic lymphadenectomy, received pelvic MRI within 2 weeks before the operations, had no concurrent cancers, and received no preoperative treatment. To achieve the optimal model, the diagnostic value of 3 MRI sequences was compared, and the outcomes in the intratumoral and peritumoral regions were explored. To mine tumor information from both image and clinicopathologic levels, a hybrid model was built and its prognostic value was assessed by Kaplan-Meier analysis. The deep learning model and hybrid model were developed on a primary cohort consisting of 338 patients (218 patients from Sun Yat-sen University Cancer Center, Guangzhou, China, between January 2011 and December 2017 and 120 patients from Henan Provincial People's Hospital, Zhengzhou, China, between December 2016 and June 2018). The models then were evaluated on an independent validation cohort consisting of 141 patients from Yunnan Cancer Hospital, Kunming, China, between January 2011 and December 2017. Main Outcomes and Measures:The primary diagnostic outcome was lymph node metastasis status, with the pathologic characteristics diagnosed by lymphadenectomy. The secondary primary clinical outcome was survival. The primary diagnostic outcome was assessed by receiver operating characteristic (area under the curve [AUC]) analysis; the primary clinical outcome was assessed by Kaplan-Meier survival analysis. Results:A total of 479 patients (mean [SD] age, 49.1 [9.7] years) fulfilled the eligibility criteria and were enrolled in the primary (n = 338) and validation (n = 141) cohorts. A total of 71 patients (21.0%) in the primary cohort and 32 patients (22.7%) in the validation cohort had lymph node metastais confirmed by lymphadenectomy. Among the 3 image sequences, the deep learning model that used both intratumoral and peritumoral regions on contrast-enhanced T1-weighted imaging showed the best performance (AUC, 0.844; 95% CI, 0.780-0.907). These results were further improved in a hybrid model that combined tumor image information mined by deep learning model and MRI-reported lymph node status (AUC, 0.933; 95% CI, 0.887-0.979). Moreover, the hybrid model was significantly associated with disease-free survival from cervical cancer (hazard ratio, 4.59; 95% CI, 2.04-10.31; P < .001). Conclusions and Relevance:The findings of this study suggest that deep learning can be used as a preoperative noninvasive tool to diagnose lymph node metastasis in cervical cancer.
Magnetic resonance imaging at ultra-high magnetic field strength: An in vivo assessment of number, size and distribution of pelvic lymph nodes.
Fortuin Ansje S,Philips Bart W J,van der Leest Marloes M G,Ladd Mark E,Orzada Stephan,Maas Marnix C,Scheenen Tom W J
OBJECTIVE:The definition of an in vivo nodal anatomical baseline is crucial for validation of representative lymph node dissections and accompanying pathology reports of pelvic cancers, as well as for assessing a potential therapeutic effect of extended lymph node dissections. Therefore the number, size and distribution of lymph nodes in the pelvis were assessed with high-resolution, large field-of-view, 7 Tesla (T) magnetic resonance imaging (MRI) with frequency-selective excitation. MATERIALS AND METHODS:We used 7 T MRI for homogeneous pelvic imaging in 11 young healthy volunteers. Frequency-selective imaging of water and lipids was performed to detect nodal structures in the pelvis. Number and size of detected nodes was measured and size distribution per region was assessed. An average volunteer-normalized nodal size distribution was determined. RESULTS:In total, 564 lymph nodes were detected in six pelvic regions. Mean number was 51.3 with a wide range of 19-91 lymph nodes per volunteer. Mean diameter was 2.3 mm with a range of 1 to 7 mm. 69% Was 2 mm or smaller. The overall size distribution was very similar to the average volunteer-normalized nodal size distribution. CONCLUSIONS:The amount of in vivo visible lymph nodes varies largely between subjects, whereas the normalized size distribution of nodes does not. The presence of many small lymph nodes (≤2mm) renders representative or complete removal of pelvic lymph nodes to be very difficult. 7T MRI may shift the in vivo detection limits of lymph node metastases in the future.
Body mass index rather than the phenotype impacts precocious ultrasound cardiovascular risk markers in polycystic ovary syndrome.
Pandurevic Srdjan,Bergamaschi Luca,Pizzi Carmine,Patton Laura,Rucci Paola,Corzani Francesca,Cecchetti Carolina,Pelusi Carla,Altieri Paola,Vicennati Valentina,Di Dalmazi Guido,Fanelli Flaminia,Macut Djuro,Pagotto Uberto,Gambineri Alessandra
European journal of endocrinology
Objective:Research into cardiovascular disease (CV) prevention has demonstrated a variety of ultrasound (US) markers predicting risk in the general population but which have been scarcely used for polycystic ovary syndrome (PCOS). Obesity is a major factor contributing to CV disease in the general population, and it is highly prevalent in PCOS. However, it is still unclear how much risk is attributable to hyperandrogenism. This study evaluates the most promising US CV risk markers in PCOS and compares them between different PCOS phenotypes and BMI values. Design:Women fulfilling the Rotterdam criteria for PCOS were recruited from our outpatient clinic for this cross-sectional study. Methods:Participants (n = 102) aged 38.9 ± 7.4 years were stratified into the four PCOS phenotypes and the three BMI classes (normal-weight, overweight, obese). They were assessed for clinical and biochemical parameters together with the following US markers: coronary intima-media thickness (cIMT), flow-mediated vascular dilation (FMD), nitroglycerine-induced dilation (NTG), and epicardial fat thickness (EFT). Results:There was no statistical difference among the four phenotypes in terms of cIMT, FMD, NTG or EFT, however all the US parameters except NTG showed significant differences among the three BMI classes. Adjusting for confounding factors in multiple regression analyses, EFT retained the greatest direct correlation with BMI and cIMT remained directly correlated but to a lesser degree. Conclusions:This study showed that obesity rather than the hyperandrogenic phenotype negatively impacts precocious US CV risk markers in PCOS. In addition, EFT showed the strongest association with BMI, highlighting its potential for estimating CV risk in PCOS.
Utility of Preoperative Imaging for Predicting Pelvic Lateral Lymph Node Metastasis in Lower Rectal Cancer.
Numata Koji,Katayama Yusuke,Sawazaki Sho,Higuchi Akio,Morinaga Soichiro,Rino Yasushi,Masuda Munetaka,Shiozawa Manabu
Indian journal of surgical oncology
This study aimed to investigate the diagnostic power of preoperative imaging for lateral pelvic lymph node (LPLN) metastasis. A total of 79 patients with advanced lower rectal cancer were preoperatively examined with pelvic enhanced computed tomography and underwent primary resection and LPLN dissection (LPLD) from 2007 to 2014 in our institute. The maximum LPLN was selected to be measured in both the long- and short-axis diameters by picture archiving and communication system (PACS) and was compared with the histopathological results. Receiver operating characteristic (ROC) curves were used to identify the optimal cut-off scores, and we evaluated the accuracy of the thresholds. Twenty-one patients (26.6%) had LPLN metastasis. In the ROC analysis, the criterion of 7.6 mm or larger in the long-axis diameter was used as the optimal threshold for metastasis (area under the curve (AUC) = 0.938) and the criteria of 5.5 mm or larger in the short axis (AUC = 0.946). On the basis of these cut-off scores, the criteria in the long axis represented 95.2% sensitivity, 91.5% specificity, 83.3% positive predictive value (PPV), 98.2% negative predictive value (NPV), and 93.7% accuracy. In contrast, there was 95.2% sensitivity, 89.7% specificity, 76.9% PPV, 98.1% NPV, and 91.1% accuracy in the short axis. Preoperative PACS imaging was considered an optimal tool for diagnosing LPLN metastasis in patients with advanced lower rectal cancer. It is suggested to become the index for considering LPLD adaptation.
Lymphosonographic sentinel node biopsy of the supraglottis in a swine model.
Curry Joseph M,Grindle Christopher R,Merton Daniel A,Goldberg Barry B,Rosen David,Pribitkin Edmund A
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
OBJECTIVE:To test the feasibility of a novel contrast-enhanced ultrasound (CEUS) technique, or lymphosonography, for sentinel node biopsy (SNB) of the supraglottis in a porcine model. STUDY DESIGN AND SETTING:In this prospective, nonrandomized animal study, blue dye and ultrasound contrast agent were injected into the supraglottis in seven 50-kg Yorkshire swine. Transcutaneous CEUS was used to identify real-time lymphatic flow of contrast through lymph channels (LC) to the sentinel lymph node (SLN). SNB was carried out, visually identifying a blue node, with the assistance of intraoperative CEUS. Bilateral modified radical neck dissections were performed to search for any residual contrast-positive or blue SLNs. RESULTS:In each case, at least one SLN was identified by preoperative CEUS. A total of 12 nodes were identified on preoperative CEUS, and 11 of 12 nodes were stained with blue dye (91.7%). No residual blue or contrast-positive nodes were identified on neck dissection. CONCLUSIONS:Lymphosonographic SNB of the supraglottis in a porcine model is technically feasible, and yields results comparable to traditional blue dye-guided techniques. No "shine-through" effect or nonsequential nodal enhancement occurred. This technique holds promise for sentinel node biopsy and allows a novel method for in vivo investigation of the lymphatic system.
Intrapartum ultrasound monitoring of malposition and malrotation during labor neuraxial analgesia: maternal outcomes.
Malvasi Antonio,Raimondo Pasquale,Beck Renata,Tinelli Andrea,Kuczkowski Krzysztof Marek
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
This study analyzes the important role of ultrasonography (IUS) related to the maternal outcomes in women with fetal persistent occiput posterior position (POPP) and asynclitism (A) in labor neuraxial analgesia (LNA). Prospective assessment of 148 primiparous women diagnosed with the prolonged second stage of labor. Transabdominal and transperineal IUS were used to detect fetal head position and to evaluate the angle of progression (AOP) and pubic arch angle (PAA). Statistical data about maternal aspects, modalities of delivery and maternal outcomes were observed. In all parturients included in the study, the operative delivery rate was 73%. In patients delivered via cesarean section, the PAA was ≤ of 96.5°. There was statistical correlation between doses of LNA and Apgar score at first minute (r0.8). There is a greater frequency of Fetal POPP and asynclitism related with maternal complications. The results of our study confirmed the importance of determination of angle of progression (AoP) and PAA in the prolonged second stage of labor. Unfavorable AoP and PAA, in presence of POPP and A, are related with high percentage of operative delivery. If the prolonged labor and delivery in these patients exceed time limit proposed by American College of Obstetricians and Gynecologists guidelines, it may be viewed as a possible malpractice. In cases of POPP with asynclitism, in the second stage of labor detected by IUS it is advisable to discontinue the anesthetic drugs administration in LNA; because the labor pain is related to the dystocia, an operative delivery is necessary to avoid maternal and fetal complications.
Pyriform Sinus Fistula in the Fetus and Neonate: A Systematic Review of Published Cases.
Chen Tong,Chen Jianglong,Sheng Qingfeng,Zhu Linlin,Lv Zhibao
Frontiers in pediatrics
To provide recommendations for the diagnosis and treatment of pyriform sinus fistula (PSF) in the fetus and neonate through a systematic review of the published literature. PubMed and Embase (1968-2019) were searched, and additional publications were obtained by searching the references by hand. The two reviewers assessed all papers and extracted the following variables: demographics, clinical features, diagnostic tests, interventions, and prognoses. Forty-two papers were included, comprising a total of 158 cases. PSF presented almost exclusively on the left side (95.56%). Patients usually presented with a neck mass (100%) and respiratory distress (43.18%). The false-negative rate (FNR) of prenatal ultrasonography (US) was significantly higher than that of prenatal magnetic resonance imaging (MRI) ( < 0.01). For the diagnosis of PSF in neonates, computerized tomography (CT) and MRI were the most accurate diagnostic modalities. intrapartum treatment (EXIT) was performed during delivery in 6 patients (26.09%). Among 135 patients with a reported date of definitive surgery, 117 (86.67%) underwent surgery during the neonatal period. Complications after definitive surgery appeared in 5 patients (3.16%), and all of them recovered spontaneously within 3 months. Furthermore, recurrence occurred in 4 patients (2.53%). In fetal cases with PSF suspected by US, MRI is necessary to confirm the diagnosis. During the neonatal period, patients with PSF typically present with a neck mass and respiratory distress, and CT/MRI appears to be the preferred diagnostic method. Definitive surgery is effective for treating neonatal PSF, with a low complication rate and low recurrence rate.
The Safety and efficacy of botulinum toxin type A injection for postoperative scar prevention: A systematic review and meta-analysis.
Yang Wenhui,Li Guangxue
Journal of cosmetic dermatology
BACKGROUND:Active prevention and treatment of scars are particularly important. Several studies have used botulinum toxin type A(BTXA) to prevent postoperative scarring. The aim of this systematic review and meta-analysis was to systematically evaluate the efficacy and safety of BTXA in preventing and treating postoperative scars. METHODS:A computer-based search was conducted for the five databases including PubMed, Cochrane Library, EMBASE, CNKI, and Wanfang up to May 22, 2019, to collect the relevant literatures on BTXA treatment of postoperative hypertrophic scars. A meta-analysis was made with the software of Revman 5.3 based on the study endpoint of scar width, Vancouver Scar Scale (VSS), Visual Analogue Scale (VAS) scores, and patient satisfaction as well. RESULTS:A total of 18 randomized controlled trials (RCTs) studies were included with 915 patients in all. The result showed that, compared with the control group, the scar width, VAS scores, and VSS scores of the BTXA group were significantly improved and higher patient satisfaction was achieved. CONCLUSION:BTXA has a certain curative effect on postoperative scar prevention and treatment without obvious side effects.
Diagnostic Criteria of Flow-Mediated Vasodilation for Normal Endothelial Function and Nitroglycerin-Induced Vasodilation for Normal Vascular Smooth Muscle Function of the Brachial Artery.
Maruhashi Tatsuya,Kajikawa Masato,Kishimoto Shinji,Hashimoto Haruki,Takaeko Yuji,Yamaji Takayuki,Harada Takahiro,Han Yiming,Aibara Yoshiki,Mohamad Yusoff Farina,Hidaka Takayuki,Kihara Yasuki,Chayama Kazuaki,Nakashima Ayumu,Goto Chikara,Tomiyama Hirofumi,Takase Bonpei,Kohro Takahide,Suzuki Toru,Ishizu Tomoko,Ueda Shinichiro,Yamazaki Tsutomu,Furumoto Tomoo,Kario Kazuomi,Inoue Teruo,Koba Shinji,Watanabe Kentaro,Takemoto Yasuhiko,Hano Takuzo,Sata Masataka,Ishibashi Yutaka,Node Koichi,Maemura Koji,Ohya Yusuke,Furukawa Taiji,Ito Hiroshi,Ikeda Hisao,Yamashina Akira,Higashi Yukihito
Journal of the American Heart Association
Background Diagnostic criteria of flow-mediated vasodilation (FMD), an index of endothelial function, and nitroglycerin-induced vasodilation (NID), an index of vascular smooth muscle function, of the brachial artery have not been established. The purpose of this study was to propose diagnostic criteria of FMD and NID for normal endothelial function and normal vascular smooth muscle function. Methods and Results We investigated the cutoff values of FMD and NID in subjects with (risk group) and those without cardiovascular risk factors or cardiovascular diseases (no-risk group) in 7277 Japanese subjects (mean age 51.4±10.8 years) from the Flow-Mediated Dilation Japan study and the Flow-Mediated Dilatation Japan Registry study for analysis of the cutoff value of FMD and in 1764 Japanese subjects (62.2±16.1 years) from the registry of Hiroshima University Hospital for analysis of the cutoff value of NID. Receiver-operator characteristic curve analysis of FMD to discriminate subjects in the no-risk group from patients in the risk group showed that the optimal cutoff value of FMD to diagnose subjects in the no-risk group was 7.1%. Receiver-operator characteristic curve analysis of NID to discriminate subjects in the no-risk group from patients in the risk group showed that the optimal cutoff value of NID to diagnose subjects in the no-risk group was 15.6%. Conclusions We propose that the cutoff value for normal endothelial function assessed by FMD of the brachial artery is 7.1% and that the cutoff value for normal vascular smooth muscle function assessed by NID of the brachial artery is 15.6% in Japanese subjects. Clinical Trial Registration www.umin.ac.jp Unique identifiers: UMIN000012950, UMIN000012951, UMIN000012952, and UMIN000003409.
Analysis of the guidance value of 3D ultrasound in evaluating endometrial receptivity for frozen-thawed embryo transfer in patients with repeated implantation failure.
Tong Ruiqing,Zhou Ying,He Qi,Zhuang Yanyan,Zhou Weiqin,Xia Fei
Annals of translational medicine
Background:Repeated implantation failure (RIF) is currently believed by some scholars to be mainly related to the poor endometrial receptivity. Three-dimensional (3D) ultrasound, as a noninvasive examination, has attracted the most attention. This paper further discusses whether 3D ultrasound of the endometrial receptivity index has guidance value in the evaluation of pregnancy outcomes in patients with RIF following frozen-thawed embryo transfer. Methods:A total of 79 patients with RIF were retrospectively analyzed. These 79 patients which were confirmed by the transvaginal ultrasonography detection comprised 36 cases of intrauterine pregnancy, which were included in the pregnancy group, and 43 cases with biochemical pregnancy (the HCG in blood or urine is only transient and can be detected by clinical biochemical methods. The pregnancy sac cannot be seen under ultrasound) or negative results of human chorionic gonadotropin (HCG) examination, which were included in the non-pregnancy group. The endometrial thickness, uterine volume, sub-endometrial blood flow type, pulsatility index (PI) and resistance index (RI) of the spiral artery; the RI and PI of the uterine artery; and the peak systolic velocity/end diastolic velocity (S/D) of the two groups were measured and analyzed. Results:(I) There were no significant differences in the age, infertility years, body mass index (BMI), anti-Müllerian hormone (AMH), endometrial thickness on the hCG injection day, estradiol (E2), and progesterone (P) between the pregnant and non-pregnant groups (P>0.05). (II) There were no significant differences in the endometrial thickness, uterine volume, and RI and PI of the uterine artery on the day before the implantation between the two groups (P>0.05). (III) There was statistical difference in the sum of the S/D of the two uterine arteries between the two groups (P<0.05) with a cutoff value of 14.47 (P<0.05). (IV) The RI and PI of the spiral artery in the non-pregnancy group were lower than those in the pregnancy group, and the difference was statistically significant (P<0.05). (V) The differences in the endometrial classification and subendometrial blood flow classification between the two groups were statistically significant (P<0.05). Conclusions:Ultrasonographic endometrial blood flow classification, spiral artery blood flow parameters, and uterine artery blood flow parameters can be effective indexes for evaluating endometrial receptivity, and they have a certain clinical significance in evaluating the pregnancy outcome of RIF patients after retransplantation.
The measurement of endometrial volume and sub-endometrial vascularity to replace the traditional endometrial thickness as predictors of fertilization success.
Maged Ahmed M,Kamel Ahmed M,Abu-Hamila Fouad,Elkomy Rasha O,Ohida Omar A,Hassan Sarah M,Fahmy Radwa M,Ramadan Wafaa
Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology
To assess the value of endometrial thickness, volume, and sub-endometrial perfusion in women undergoing IVF. In 82 women candidate for ICSI, endometrial thickness and sub-endometrial perfusion were measured with a trans-vaginal 2 D ultrasound and 3 D power Doppler respectively on day of hCG trigger and Embryo transfer (ET). The primary outcome was the clinical pregnancy rate. Endometrial volume showing a statistically significant difference between pregnant and nonpregnant women (4.11 ± 1.19 vs. 3.4 ± 1.1 = .019) on day of triggering and at ET (4.02 ± 1.15 vs. 3.45 ± 0.90, = .022). VFI was significantly higher in pregnant group at both days of triggering and ET (0.54 ± 0.48 vs. 0.33 ± 0.31 and 0.47 ± 0.22 vs. 0.34 ± 0.2, = .02). At cutoff values of 3.265 and 2.95 cm3 (70 & 80% sensitivity, specificity 64.5 & 51.6%, a positive predictive value 38.9 & 34.8%, and negative predictive value 87.0 & 88.9%) to predict pregnancy on the day of hCG trigger & ET respectively. Cutoff value for Endometrial VFI on the day of ET was 0.674 (sensitivity of 70%, specificity of 80.6%, PPV 53.8%, and NPV 89.3%). Higher endometrial volume and VFI were associated with pregnancy.
[Diagnostic accuracy of artery peak velocity variation measured by bedside real-time ultrasound for prediction of fluid responsiveness: a Meta-analysis].
Pei Yinghao,Yang Yang,Feng Ying,He Shuyin,Zhou Jiang,Jiang Hua,Wang Xing
Zhonghua wei zhong bing ji jiu yi xue
OBJECTIVE:To evaluate the diagnostic value of ultrasonic measurement of artery peak velocity variation (ΔVpeak) on predicting fluid responsiveness in critically ill patients. METHODS:Databases of PubMed, Embase, Cochrane Library, SinoMed, Wanfang, CNKI and VIP were retrieved from the establishment of the database to November 2019. The retrieval literatures were about the research of ΔVpeak used to judge fluid responsiveness. According to the inclusion and exclusion criteria, the relevant literatures were screened by two researchers, and the data of the included literatures were extracted. The quality of literatures was evaluated by quality assessment of diagnostic accuracy studies (QUADAS). Meta Dics 1.4 software was used to analyze the literatures that met the quality standard by Meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR) were calculated. The summary receiver operating characteristic (SROC) curve was drawn and the area under SROC curve (AUC) was calculated. The χ test and Spearman correlation coefficient were used to analyze heterogeneity, and Deek test was used to analyze publication bias. RESULTS:A total of 1 854 patients were enrolled in 31 studies, including 11 domestic studies and 20 foreign studies. Using 14 items of QUADAS to evaluate the quality of literatures, it was found that the enrolled literatures were all in Grade A, indicating that the overall quality of literatures was high. The scattered distribution of SROC curve was not "shoulder arm shape", and Spearman correlation coefficient was 0.062 (P = 0.710), so there was no threshold effect. The heterogeneity test showed that I = 57.2% (P = 0.001), indicating that there was a certain degree of heterogeneity among the studies, and the source of heterogeneity was non threshold effect. Meta regression analysis showed that the reason for heterogeneity was the method of volume load test [DOR = 3.87, 95% confidence interval (95%CI) was 1.56-9.57, P = 0.004 8]. According to the results of heterogeneity analysis, there was no significant heterogeneity (I = 10.6, P = 0.288 5) among the studies after removing the samples of the passive leg raising (PLR) instead of the volume expansion. A meta-analysis was done with random effects model. The results showed that the pooled DOR was 23.85 (95%CI was 17.57 to 32.37), pooled sensitivity was 0.82 (95%CI was 0.80 to 0.85), pooled specificity was 0.83 (95%CI was 0.80 to 0.85), pooled PLR was 4.17 (95%CI was 3.58 to 4.86), and pooled NLR was 0.22 (95%CI was 0.18 to 0.28). The AUC was 0.901 2 (95%CI was 0.88 to 0.93), and Q index was 0.832 5. The results of Deek funnel plot showed that there was no published bias in all the studies (P = 0.19). CONCLUSIONS:Ultrasonic measurement of ΔVpeak has a high value in predicting fluid responsiveness. It is a reliable parameter for the evaluation of shock, critical illness and surgical operation population who need to monitor the fluid responsiveness.
Study on the relationship between hyperthyroidism and vascular endothelial cell damage.
Yu Tianlong,Jing Miao,Gao Yunyan,Liu Chang,Liu Lanchun,Jia Haihan,Liu Peng,Chang Manli
The aim of the research is to explore the relationship between hyperthyroidism, iodine, antithyroid drugs (propylthiouracil) and vascular endothelial injury. In total, 136 SD rats were randomly allocated into the control group, the hyperthyroidism group, the hyperthyroidism propylthiouracil group, the hyperthyroidism low iodine group, the high iodine group, and the endothelial injury group. Rats were raised for 60 days. Afterward, indicators concerning endothelial damage were determined, including the von Willebrand Factor (vWF), thrombomodulin (TM), nitric oxide (NO), endothelin 1 (ET-1), and P-selectin, as well as the plant hemagglutinin sample type oxidized low-density lipoprotein receptor 1 (LOX-1) from the aorta and the number of endothelial progenitor cells (EPCs) in whole blood. The hyperthyroidism group had significantly higher values for vWF, TM, NO, ET-1, and P-selectin in serum and a higher number of EPCs in whole blood compared with the control group, similar to the LOX-1 expression in abdominal aorta. The hyperthyroidism low iodine group had significantly higher values for vWF, ET-1, and P-selectin in serum and a higher number of EPCs in whole blood compared with those of the control group, as was the case for LOX-1 expression in the abdominal aorta. The hyperthyroidism propylthiouracil group had significantly higher values for FT in the serum compared with those in the control group. The electron microscope showed that hyperthyroidism caused a certain degree of endothelial injury to the abdominal aorta in rats. Hyperthyroidism can damage the vascular endothelium and is a high-risk factor for cardio-cerebrovascular disease. Propylthiouracil could be used in the treatment of hyperthyroidism, thus protecting endothelial cells from damage.
Neonatal hyperoxia: effects on nephrogenesis and the key role of klotho as an antioxidant factor.
de Almeida Lucas Ferreira,Coimbra Terezila Machado
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
A congenital or programmed reduction in glomerular number increases the susceptibility to hypertension and kidney injury in adulthood thus, premature birth or low birth weight, leading to a low glomerular endowment, can be associated with these two diseases. Renal morphogenesis is sensitive to hypoxia which is a physiological trigger for the expression of vascular endothelial growth factor. On the other hand, hyperoxia increases oxidative stress and adversely affects glomerular and tubular development, and is associated with a substantial reduction of renal klotho expression in adulthood. Preterm newborns are often submitted to oxygen therapy, exposing them to an acute high-oxygen level situation, in contrast to the intrauterine low-oxygen environment. Investigating the role of klotho on kidney development leads to the understanding of the possible mechanisms related to disorders in the preterm neonatal kidney exposed to hyperoxia and its long term effects in adulthood.
Color Doppler ultrasound of spiral artery blood flow in mid first trimester (4-8 weeks) in cases of threatened abortion and in normal pregnancies.
Bhoil Rohit,Kaushal Sushruti,Sharma Reena,Kaur Jaswinder,Sharma Tanupriya,Thakur Rohini,Sharma Rakesh
Journal of ultrasonography
Introduction:The aim of the study was to evaluate and compare the spiral artery flow in mid first trimester (4-8 weeks) in cases of threatened abortion and in normal pregnancies. Material and methods:Spiral artery was sonographically evaluated in 50 patients comprising two groups of 25 women each. The first group included patients presenting with threatened miscarriage (vaginal bleeding/spotting with or without abdominal pain). The second group comprised of females who had no complications, but had no desire to continue the pregnancy. Spiral artery flow velocity measurements were performed using Color Doppler (Pulsatility Indices, Resistive Indices and Systolic/diastolic values) in mid first trimester (between 4-8 weeks of gestation), each measurement was performed twice. Statistical analysis was performed using Statistical package for social sciences software. Values were rounded off to two digits after decimal point. Results:Significant differences were noted in the spiral artery Doppler values in the two groups. In particular, the Resistive Indices was higher in cases of women with threatened miscarriage. The difference in Pulsatility Indices was also statistically significant between the two groups. Conclusion:Doppler values of spiral artery may be used as a useful parameter in assessing the prognosis in cases presenting with threatened miscarriage.
Ultrasound measurement of change in kidney volume is a sensitive indicator of severity of renal parenchymal injury.
Crislip G Ryan,Patel Bansari,Mohamed Riyaz,Ray Sarah C,Wei Qingqing,Sun Jingping,Polichnowski Aaron J,Sullivan Jennifer C,O'Connor Paul M
American journal of physiology. Renal physiology
Noninvasive determination of the severity of parenchymal injury in acute kidney injury remains challenging. Edema is an early pathological process following injury, which may correlate with changes in kidney volume. The goal of the present study was to test the hypothesis that "increases in kidney volume measured in vivo using ultrasound correlate with the degree of renal parenchymal injury." Ischemia-reperfusion (IR) of varying length was used to produce graded tissue injury. We first determined ) whether regional kidney volume in rats varied with the severity (0, 15, 30, and 45 min) of warm bilateral IR and ) whether this correlated with tubular injury score. We then determined whether these changes could be measured in vivo using three-dimensional ultrasound. Finally, we evaluated cumulative changes in kidney volume up to 14 days post-IR in rats to determine whether changes in renal volume were predictive of latent tubular injury following recovery of filtration. Experiments concluded that noninvasive ultrasound measurements of change in kidney volume over 2 wk are predictive of tubular injury following IR even in animals in which plasma creatinine was not elevated. We conclude that ultrasound measurements of volume are a sensitive, noninvasive marker of tissue injury in rats and that the use of three-dimensional ultrasound measurements may provide useful information regarding the timing, severity, and recovery from renal tissue injury in experimental studies.
Ultrasound-guided transvaginal radiofrequency ablation combined with levonorgestrel-releasing intrauterine system for symptomatic uterine adenomyosis treatment.
Hai Ning,Hou Qingxiang,Guo Ruijun
International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group
OBJECTIVE:To evaluate the clinical outcomes of transvaginal ultrasound-guided radiofrequency ablation (RFA) combined with a levonorgestrel-releasing intrauterine system (LNG-IUS) for the treatment of symptomatic uterine adenomyosis. METHODS:Patients with symptomatic uterine adenomyosis treated with ultrasound-guided RFA in combined with an LNG-IUS from January 2013 to January 2016 and followed up for 3 years after treatment were selected. Assessment endpoints included the uterine volume reduction rate, dysmenorrheal score, symptom severity score and adverse events. RESULTS:Among the 72 patients, 64 completed the 3-year follow-up evaluations after treatment. No LNG-IUS expulsion was reported. Dysmenorrhea and symptom severity scores statistically significantly declined after the combined treatment of RFA and LNG-IUS was administered. The uterine volume significantly decreased, and the average reduction rate was 55%. CONCLUSION:Ultrasound-guided RFA combined with an LNG-IUS might be a simple, safe and effective alternative for the treatment of symptomatic adenomyosis.
Anatomo-sonographic identification of the longissimus capitis and splenius cervicis muscles: principles for possible application to ultrasound-guided botulinum toxin injections in cervical dystonia.
Brumpt Eleonore,Aubry Sebastien,Vuillier Fabrice,Tatu Laurent
Surgical and radiologic anatomy : SRA
OBJECTIVE:The main objective of this study was to define and verify anatomo-sonographic landmarks for ultrasound-guided injection of botulinum toxin into the longissimus capitis (LC) and splenius cervicis (SC) muscles. METHODS AND RESULTS:After a preliminary work of anatomical description of the LC and SC muscles, we identified these muscles on two cadavers and then on a healthy volunteer using ultrasound and magnetic resonance imaging (MRI) to establish a radio-anatomical correlation. We defined an anatomo-sonographic landmark for the injection of each of these muscles. The correct positioning of vascular glue into the LC muscle and a metal clip into the SC muscle of a fresh cadaver as verified by dissection confirmed the utility of the selected landmarks. DISCUSSION:For the LC muscle, the intramuscular tendon of the cranial part of the muscle appears to be a reliable anatomical landmark. The ultrasound-guided injection can be performed within the cranial portion of the muscle, between the intra-muscular tendon and insertion into the mastoid process at dens of the axis level. For the SC muscle, the surface topographic landmarks of the spinous processes of the C4-C5 vertebrae and the muscle body of the levator scapulae muscle seem to be reliable landmarks. From these, the ultrasound-guided injection can be carried out laterally by transfixing the body of the levator scapulae. CONCLUSION:The study defined two cervical anatomo-sonographic landmarks for injecting the LC and SC muscles.
Focused Ultrasound Ablation Surgery combined with ultrasound-guided suction curettage in the treatment and management of Cesarean Scar Pregnancy.
Yuan Yuan,Pu Dali,Zhan Ping,Zheng Yongping,Ren Qianchuan,Teichmann Alexander T
European journal of obstetrics, gynecology, and reproductive biology
OBJECTIVE:To evaluate the feasibility, safety, and effectiveness of Focused Ultrasound Ablation Surgery (FUAS) combined with ultrasound-guided suction curettage in the management of Cesarean Scar Pregnancy (CSP). STUDY DESIGN:We retrospectively analyzed 52 patients with CSP from April, 2017, to December, 2019. All the patients received one session of FUAS, and suction curettage under ultrasound guidance was performed 1-3 days after FUAS. The intraoperative blood loss in suction curettage, duration of vaginal bleeding after curettage, reproductive outcomes, and adverse effects were recorded and analyzed. RESULTS:All the 52 patients completed one session of FUAS combined with suction curettage without serious adverse effects. The mean intraoperative blood loss was 32.81 ± 53.83 mL. 47 (90.38 %) patients had a successful suction curettage with a blood loss of less than 80 mL. 5 (9.62 %) patients had an active bleeding of ≥80 mL; however, the bleeding was stopped effectively by Foley's urinary catheter and no evident bleeding presented when the catheter was removed 24 h later. The mean duration of vaginal bleeding was 7.88 ± 4.24 days. 48 (92.30 %) patients recovered with little vaginal bleeding after curettage. 4 (7.69 %) type III CSP patients experienced late-onset severe bleeding and required UAE or surgery. During 6-36 months of the follow-up period, 12 patients expressed reproductive plan, in which 4 patients delivered by cesarean section, 3 patients had an ongoing pregnancy and 1 patient had an abortion in the early pregnancy. CONCLUSIONS:FUAS combined with ultrasound-guided suction curettage is a safe and effective treatment strategy in the management of CSP type I and CSP type II and is particularly advantageous for CSP patients with reproductive requirements. However, further studies are warranted to determine the meticulous inclusion criteria for patients with type III CSP.
Ultrasound guided paralaryngeal pressure versus cricoid pressure on the occlusion of esophagus: a crossover study.
Lim Siu Min,Ng Boon Keat,Wilson Aaron,Cheong Chao Chia,Ng Tyng Yan,Wang Chew Yin
Journal of clinical monitoring and computing
The primary objective of this study is to compare the effectiveness of cricoid pressure (CP) and paralaryngeal pressure (PLP) on occlusion of eccentric esophagus in patients under general anesthesia (GA). Secondary objectives include the prevalence of patients with central or eccentric esophagus both before and after GA, and the success rate of CP in occluding centrally located esophagus in patients post GA. Fifty-one ASA physical status I and II patients, undergoing GA for elective surgery were enrolled in this study. Ultrasonography imaging were performed to determine the position of the esophagus relative to the trachea: (i) before induction of GA, (ii) after GA before external CP maneuver, (iii) after GA with CP, and (iv) after GA with PLP. CP was applied to all patients whilst PLP via fingertip technique was only applied to patients with an eccentric esophagus. Among a total of 51 patients, 28 of them (55%) had eccentric esophagus pre GA, while this number increase to 33 (65%) after induction of GA. CP success rate was 100% in 18 patients with central esophagus post GA versus 27% in 33 patients with eccentric esophagus post GA (P<0.00001). Overall success rate for CP was 53%. In 33 patients with eccentric esophagus anatomy post GA, PLP success rate was 30% compared with 27% with CP (P=1.000). Ultrasound guided PLP fingertips technique was not effective in patients with an eccentrically located esophagus post GA. Ultrasound guided CP achieved 100% success rate in patients with a centrally located esophagus post GA.
The influence of labor epidural analgesia on maternal, uteroplacental and fetoplacental hemodynamics in normotensive parturients: a prospective observational study.
Gude P,Kaci C S B,Sieker M,Vogelsang H,Bellgardt M,Herzog-Niescery J,Weber T P,Weber J,Teubner S,Kern P
International journal of obstetric anesthesia
BACKGROUND:Epidural analgesia provides sufficient analgesia during labor but can cause hypotension despite various prophylactic measures. We studied its effects on pre-placental, fetoplacental, and fetal hemodynamics using Doppler ultrasound. The primary endpoint was the pulsatility index of the umbilical artery at 30 min after establishing epidural analgesia. Secondary endpoints included maternal blood pressures and neonatal outcome data. METHODS:We included healthy parturients at a cervical dilation ≥2 cm, with or without a request for epidural analgesia (n=32 per group). Ultrasound studies of the uterine arteries, umbilical artery and fetal middle cerebral artery were performed before insertion of the epidural catheter, and 30, 60 and 90 min after; the same time-points were assessed in the non-epidural control group. Maternal blood pressure was measured by a continuous non-invasive arterial pressure monitor. RESULTS:Ultrasound studies detected no significant differences in pulsatility indices over time in any blood vessel. In contrast to the control group, maternal blood pressures were significantly lower for all measures after the onset of analgesia compared with baseline values (mean systolic pressure decreased from 132.7 ± 15.9 mmHg to 123.1 ± 14.4 mmHg at 30 min, P=0.003). The mean pH value of the umbilical arterial blood was 7.29 (±0.06) in the epidural group versus 7.31 (±0.08) in the control group (P=0.33). The median Apgar score at 5 min was 10 in both groups. CONCLUSIONS:Pre-placental, fetoplacental and fetal hemodynamics remained stable despite a statistically significant decrease in maternal blood pressure in laboring parturients receiving epidural analgesia.
Associations between first-trimester intrauterine hematoma and twin pregnancy outcomes: a retrospective cohort study.
Ji Wanqing,Hou Bo,Li Weidong,Guo Fang,He Ping,Zheng Jie
BMC pregnancy and childbirth
BACKGROUND:In recent years, first-trimester intrauterine hematoma (IUH) has become increasingly common in twin pregnancy. The majority of studies on IUH have excluded twin pregnancies, and others did not differentiate between singleton and twin pregnancies. The impact of IUH on twin pregnancy is unclear. Therefore, the primary objective of our study was to examine associations between first-trimester IUH and pregnancy outcomes in twin pregnancies. METHODS:The data of 1020 twin pregnancies in women who received a routine examination from January 2014 to December 2018 were reviewed. We compared baseline data and pregnancy outcomes between those with and without IUH. Multivariable logistic regression analysis was used to adjust for possible confounding factors. RESULTS:A total of 209 patients (21.3%) developed IUH in the first trimester. First-trimester IUH was significantly associated with increased odds of miscarriage (adjusted odds ratio 14.27, 95% CI 8.25-24.70) and vanishing twin syndrome (adjusted odds ratio 3.26, 95% CI 1.11-4.61). However, there were no differences in the rates of stillbirth, preeclampsia, preterm labor (< 34 weeks), low birth weight, postpartum hemorrhage or fetal distress between the two groups. Maternal age, previous preterm birth, chorionicity in twins and the gestational week at first ultrasound did not differ between the two groups. The women with IUH had high rates of previous miscarriage (46.73% vs 38.37%, p = 0.01), assisted conception (48.56% vs 32.60%, p < 0.001) and accompanied vaginal bleeding (67.46% vs 13.43%, p < 0.001). According to the logistic regression analyses, these characteristics were not associated with pregnancy loss or vanishing twin syndrome. No IUH characteristics, including volume, largest diameter, or the presence of vaginal bleeding, were associated with pregnancy loss or vanishing twin syndrome before 20 weeks of gestation (P > 0.05). CONCLUSION:In women with twin pregnancy, the presence of IUH in the first trimester was associated with the loss of one or both fetuses before 20 weeks of gestation. However, previous miscarriage, the conception method, the IUH size and the presence of vaginal bleeding were not independently associated with miscarriage or vanishing twin syndrome.
Shi Xiao San ameliorates the development of adenomyosis in an ICR mouse model.
Ye Juan,Cai Xueting,Wang Dawei,Zhang Furong,Wang Zhigang,Cao Meng,Pang Zhonghua,Yang Jie,Yan Huaijiang,Li Jing,Cao Peng,Hu Chunping
Experimental and therapeutic medicine
The use of Shi Xiao San (SXS), composed of and , can be traced back to the Song dynasty. Traditionally, SXS has been used to treat irregular menstruation, pelvic pain, progressive dysmenorrhea, and postpartum lochiorrhea. The management of adenomyosis (AM) is challenging and to the best of our knowledge there are currently no effective therapeutic strategies. Therefore, the aim of the present study was to investigate the effect of SXS on the development of adenomyosis in a mouse model. AM was induced in 60 neonatal female ICR mice by administering tamoxifen; 10 randomly selected mice were used for model identification via histopathological examination and 10 mice treated with the solvent alone were used as the normal controls. A total of sixty days after birth, the mice treated with AM were randomly divided into four groups and administered one of the following treatments: Low-dose SXS (55 mg/kg); high-dose SXS (110 mg/kg); danazol (1 mg/20 g body weight); or no treatment (model group); at the same time, the normal control group received no treatment. After 2 months of treatment, hotplate and tail-ﬂick tests were used to assess the response to noxious thermal stimuli in the mice, and plasma samples were collected to measure corticosterone levels. Hematoxylin and eosin staining scores of myometrial infiltration and the number of AM nodules were evaluated. Furthermore, the expression of genes associated with AM-related pain was also analyzed. The results from the present study indicated that treatment with SXS decreased myometrial infiltration, alleviated generalized hyperalgesia, and lowered plasma corticosterone levels in mice with induced AM. These findings suggest that SXS effectively attenuated the development of AM, and may serve as a promising treatment approach for AM treatment.
Use of contrast-enhanced ultrasound in evaluating the efficacy and application value of microwave ablation for adenomyosis.
Xu Chao,Tang Yanyan,Zhao Yingying,Li Yongjie,Feng Qingliang
Journal of cancer research and therapeutics
Aim:This study aims to assess the use of contrast-enhanced ultrasonography (CEUS) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the evaluation of percutaneous microwave ablation (PMWA) of localized adenomyosis. Materials and Methods:Sixty-six patients with single-onset adenomyosis who underwent PMWA at the Liaocheng Tumor Hospital of Shandong Province from January 2013 to February 2019 were enrolled. Venous CEUS and DCE-MRI examinations were performed before and 1-2 days after the surgery. The ablation rates calculated by CEUS and DCE-MRI were compared and analyzed for accuracy. Results:After microwave ablation (MWA), CEUS showed that the volume and ablation rate of the ablated zone were 52.03 ± 28.39 cm3 and 90.90% ±6.61%, respectively. By DCE-MRI, the ablation volume and ablation rate of adenomyosis were 52.20 ± 28.65 cm3 and 90.88% ±6.32%, respectively. Dysmenorrhea was significantly relieved within 3 months of the operation, and nonmenstrual hemoglobin levels were significantly improved at 3 and 6 months after the operation (P < 0.05). All 66 cases of adenomyosis were treated using PMWA. Postoperatively, 17 patients reported a change in vaginal fluid; however, no special treatment was required as this disappeared 2-11 days after surgery. Conclusions:CEUS can accurately evaluate the ablation rate of localized adenomyosis treated with MWA, which is consistent with DCE-MRI. It is convenient and easy to perform ablation of adenomyomas, with incomplete ablation and angiography, and is a method worthy of clinical promotion.
Intraperitoneal administration of activin A promotes development of endometriotic lesions in a mouse model of endometriosis.
Kasai Kana,Kato Takeshi,Kadota Yuri,Erdenebayar Otgontsetseg,Keyama Kaoru,Kawakita Takako,Yoshida Kanako,Kuwahara Akira,Matsuzaki Toshiya,Irahara Minoru
The journal of medical investigation : JMI
PURPOSE:This study aimed to investigate the effect of intraperitoneal administration of activin on the occurrence of endometriosis using a mouse model of endometriosis. METHODS:A mouse model of endometriosis was prepared by intraperitoneally administering endometrial tissue and blood collected from donor mice to C57BL/6J 7-8- week-old recipient mice. A total of 400 μg of activin A was intraperitoneally administered to model mice in the activin group for 5 days. Intraperitoneal endometriotic lesions were confirmed macroscopically and IL-6 and TNF-α levels in washed ascites were measured by ELISA. RESULTS:Endometriotic lesions were observed in all mice. In the activin group, the maximum diameter of endometriotic lesions was significantly larger than that in control group (4.7?1.3 vs 2.9?0.9 mm, p?0.01). The total area of the lesion was also significantly higher in the activin group than in the control group (21.1?9.9 vs 8.8?5.4 mm,p?0.01). Furthermore, IL-6 and TNF-α levels in ascites were significantly higher in the activin group than in the control group (IL-6 : 85.8?15.3 vs 75.1?19.3 pg/ml, p?0.05 ; TNF-α : 629.8?15.4 vs 605.9?11.4 pg/ml, p?0.05). CONCLUSION:Activin promotes occurrence of endometriosis. Inflammatory cytokines are also elevated by activin administration,suggesting that they may contribute to progression of endometriosis J. Med. Invest. 66 : 123-127, February, 2019.
Subendometrial resistence and pulsatility index assessment of endometrial receptivity in assisted reproductive technology cycles.
Silva Martins R,Helio Oliani A,Vaz Oliani D,Martinez de Oliveira J
Reproductive biology and endocrinology : RB&E
OBJECTIVE:To evaluate Subendometrial and Uterine artery resistance and pulsatility index continuous analysis as a predictor of Endometrial receptivity in Assisted Reproductive Technology (ART) Cycles. DESIGN:Serial 2D transvaginal coloured power doppler ultrasound performed in women on ART cycle to evaluate a pattern that better predicts implantation rates. One hundred sixty-nine subjects on a prospective case control study were assessed. Uterine artery and Subendometrial resistance and pulsatility index was performed to all subjects at baseline (prior to ovarian controlled stimulation), at day 6, 8 and 10 of controlled ovarian stimulation, at trigger day and at embryo transfer day. Also the ratio of fluxometric parameters between Subendometrial blood flow and uterine artery was measured. RESULTS:No statistical difference was noted between two groups in terms of demographics and ART procedures and scores. Uterine artery resistance and pulsatility index showed statistical difference between the two groups (implantation versus non-implantation group). Also statistical significance was obtained between two groups in terms of Subendometrial vascularization. Ratio between Subendometrial and Uterine artery showed lower values of fluxometric parameters in all range for the Subendometrial territory. CONCLUSIONS:Serial Subendometrial and Uterine artery fluxometry may be a useful tool for clinicians in predicting endometrial receptivity enhancing elective embryo transfers in the same ART cycle.
Evaluation of ovarian function using three dimensional ultrasound in perimenopausal women.
Li Ren-Liang,Shen Xiao-Lu,Xu Fang,Shui Xu-Juan,Chen Yu-Mei,Wang Wen-Huan,Zheng Jia-Yong
Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology
To evaluate the feasibility and clinical value of three-dimensional ultrasound in evaluating ovarian function in perimenopausal women. In this prospective cohort study, 102 patients with clinically suspected perimenopause and 90 patients with menopause were enrolled. These patients were classified into three groups according to the level of follicle stimulating hormone (FSH) and estradiol (E2): menopause group, perimenopause group, and normal group. Perimenopause group: There were significant differences in volume, vascularization index (VI), flow index (FI), and vascularization-flow index (VFI) in the ovaries after treatment. Cycle 1 > cycle 0 ( < .05) and cycle 3 <cycle 0 ( < .05) in FSH. Menopause group: There were significant differences in volume, VI, FI, and VFI of the ovaries after treatment: Cycle 3 >cycle 0 ( < .05), and in FSH: cycle 3 < cycle 0 ( < .05). Three-dimensional ultrasound in ovarian quantitative measurement can objectively reflect the change in the ovarian function, predicting the effect of drug treatment, and provided an objective information for early intervention to menopausal.
Sonographic association of polycystic ovaries with intraovarian arterial pulsatility and resistive index.
Manzoor Iqra,Bacha Raham,Gilani Syed Amir
Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology
The aim of the research is to know the sonographic association of polycystic ovaries with intraovarian arterial pulsatility index (PI) and resistive index (RI).We observed the PI and resistive index (RI) of 50 polycystic ovarian syndrome (PCOS) and 50 normal individuals. Polycystic ovary was seen with gray scale transabdominal and endo-vaginal sonography and labeled according to the developed sonographic criteria. The results were correlated and cross tabulated with independent sample t-test to determine the existing relationship among them. According to the results, PI and RI of the intraovarian artery were seen to decreases during PCOS as compared with the PI and RI of normal group women at the follicular phase. In case of polycystic ovary, the stroma undergoes hyperstimulation as a result of vascular remodeling and hypervascularity. It is concluded that Doppler analysis is very helpful in the diagnosis of PCOS and to give detailed information about the pathophysiology of the hemodynamics of diseased ovary.
Comparative Study of Preoperative Airway Assessment by Conventional Clinical Predictors and Ultrasound-Assisted Predictors.
Yadav Urvashi,Singh Rakesh Bahadur,Chaudhari Shweta,Srivastava Swati
Anesthesia, essays and researches
Aims:The aim of this study is to evaluate the effectiveness of airway sonographic parameters as the predictors of difficult laryngoscopy and to evaluate the validity of combined sonographic and clinical tests. Materials and Methods:This prospective and observational study analyzed a sample of 200 patients who were categorized as having easy (Grades 1 and 2) or difficult (Grades 3 and 4) laryngoscopy based on the laryngoscopic criteria of Cormack-Lahane (CL). Sonographic parameters, including the anterior neck soft-tissue thickness at the level of vocal cord (ANS-VC), ANS tissue thickness at the level of hyoid, and ratio of depth of pre-epiglottic space to distance from epiglottis to midpoint of the distance between vocal cords and clinical parameters, including modified Mallampati class, thyromental distance, and hyomental distance ratio (HMDR), were analyzed. Univariate and multivariate regression analysis was used for the statistical analysis. Results:Twenty patients (10%) were categorized as having difficult laryngoscopy. Statistically significant differences between patients with difficult and easy laryngoscopy were noted for 5 of 6 parameters. The diagnostic validity profiles showed variable sensitivity (26.5%-87.5%) and good specificity (58.9%-94.2%) and negative predictive value (88.8%-97.03%). ANS-VC has the highest sensitivity (87.50%) and area under curve value (0.887), whereas HMDR showed highest specificity (94.2%) and highest accuracy (89.60%) which means it has low false-positive prediction rate. The combination of tests improved the diagnostic validity profile (highest area under the curve, 0.897). Conclusion:Sonographic predictors can help in identifying difficult laryngoscopy. Combined clinical and ultrasonographic parameters showed better validity profiles in comparison to the individual tests.
A Novel Assessment Method With Ultrasound for Obstructive Tonsillar Hypertrophy in Children.
Sağtaş Ergin,Mengi Erdem,Kara Cüneyt Orhan,Şenol Hande
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
OBJECTIVES:To develop a new method for the objective evaluation of airway obstruction due to tonsillar hypertrophy using ultrasound (US) in children. METHODS:The oropharynx was examined in patients, and tonsil grades were evaluated according to the staging system of Brodsky et al (Int J Pediatr Otorhinolaryngol 1987; 13:149-156). The narrowest intertonsillar distance (ITD) and widest transverse length of the tongue base (TLTB) were then measured by US, and their ratio was calculated. The clinical value of US was investigated for the classification of tonsillar hypertrophies as nonobstructive or obstructive by matching the patients' clinical grades with the US data. RESULTS:A total of 102 patients (age range, 2-12 years) were included in the study. According to the Brodsky staging system, 44.1% and 55.9% of the patients were in nonobstructive (stages I and II) and obstructive (stages III and IV) tonsillar hypertrophy groups, respectively. The area under the curve was 0.991 (95% confidence interval, 0.977-0.999) according to a receiver operating characteristic curve analysis between the Brodsky staging and the ITD/TLTB ratio. The optimal cutoff value for the ITD/TLTB ratio for the diagnosis of obstructive tonsillar hypertrophy was found to be 0.3 or less, which had 96.5% sensitivity and 95.6% specificity. CONCLUSIONS:The degree of airway obstruction due to tonsillar hypertrophy can be objectively determined by US in children. An ITD/TLTB ratio of 0.3 or less was found to be compatible with obstructive tonsillar hypertrophy. This new and easily applicable evaluation method may provide considerable value and guidance for tonsillectomy decisions.
Type II caesarean scar pregnancy management by ultrasound-guided local lauromacrogol injection in combination with suction curettage: A case report.
Wei Shuang-Shuang,Li Ding-Heng,Zhang Zhi-Fen,Sun Wen-Chao,Jia Cen-Lin
INTRODUCTION:The implantation of a gestational sac within the scar of a previous caesarean delivery is defined as caesarean scar pregnancy (CSP), which is classified into two types: CSP I and CSP II. CSP II is life threatening, and no clear consensus for CSP II management exists. PATIENT CONCERNS:A 31-year-old woman, gravida 1, para 1, with a previous caesarean delivery due to macrosomia, presented with an estimated 45 days of amenorrhea. The patient presented to the emergency department with vaginal bleeding for 1 day and no abdominal pain. DIAGNOSES:An ultrasound examination was performed demonstrating a viable fetus that was embedded in the caesarean scar area and was bulging through the wall of the uterus into the bladder without contact with the uterine cavity or cervical canal. A diagnosis of type II caesarean scar pregnancy was made. INTERVENTIONS:Local lauromacrogol was used to reduce the gestational sac blood supply. Suction curettage was performed under the guidance of abdominal ultrasound 24 h later, and the amount of bleeding was 20 mL. The response to the treatment was monitored by serial beta-human chorionic gonadotropin (β-hCG). OUTCOMES:Patient was followed up with β-hCG weekly levels which became <10 mIU/mL after 4 weeks of treatment. CONCLUSION:Ultrasound-guided local lauromacrogol injection combined with suction curettage may be a safer and novel therapeutic method.
Conservative treatment of rectosigmoid endometriosis: A prospective study.
Egekvist Anne G,Marinovskij Edvard,Forman Axel,Kesmodel Ulrik S,Graumann Ole,Seyer-Hansen Mikkel
Acta obstetricia et gynecologica Scandinavica
INTRODUCTION:Deep infiltrating endometriosis is a common cause of pelvic pain. However, some patients have limited problems that may be controlled by medical treatment, so avoiding the potentially severe complications of major surgery. This approach requires detailed knowledge on quality of life and clinical symptoms over time. The aim of the study was to monitor these parameters in patients with rectosigmoid endometriosis treated with oral contraceptives, oral gestagens, and/or the levonorgestrel-releasing intrauterine device. Moreover, nodule size measurements performed with transvaginal sonography were correlated to severity of symptoms. MATERIAL AND METHODS:Conservatively treated patients on oral contraceptives, oral gestagens, or the levonorgestrel-releasing intrauterine device underwent transvaginal sonography and answered a self-administered questionnaire regarding clinical symptoms and quality of life (Short Form 36 and Endometriosis Health Profile 30) at baseline, and 6 and 12 months later. RESULTS:Eighty women completed the follow up. Scores of quality of life were comparable to normative data for Danish women of similar age and did not change with time. No association between change in size of the rectosigmoid nodule and change in symptoms was seen. CONCLUSIONS:This study supports that simple treatment with oral contraceptives, oral gestagens, or the levonorgestrel-releasing intrauterine device represents a viable therapeutic approach to rectosigmoid Deep infiltrating endometriosis, provided that proper selection of patients in need of surgery exists.