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Ultrasound to guide the individual medical decision by evaluating the gastric contents and risk of aspiration: A literature review.
Zhang, G, Huang, X, Shui, Y, Luo, C, Zhang, L
Asian journal of surgery. 2020;(12):1142-1148
Abstract
Pulmonary aspiration of gastric contents is one of the most terrible complications following general anesthesia. It is important for patients to prevent this complication by obeying the preoperative fasting protocol strictly. At present, it has been reported by many studies that bedside ultrasound, as a non-invasive and convenient method, could be used to evaluate gastric contents qualitatively and quantitatively. With the advantages of reliability, accuracy and repeatability, it can greatly reduce the risk of aspiration and ensure patients' life security. But most of the data were acquired from the healthy volunteers. For the gastrointestinal disorder, the pregnant women, obesity, children, the elderly and diabetes patients, the accuracy and reliability of ultrasound to predict the risk of aspiration remains to be identified by more further studies. For these patients with increasing risk of aspiration, I-AIM (Indication, Acquisition, Interpretation, Medical decision-making) framework plays an important role in ensuring the safety of patients. It is crucial to make appropriate clinical decisions by evaluating the gastric contents with ultrasound.
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Prognostic value of bedside lung ultrasound score in patients with COVID-19.
Ji, L, Cao, C, Gao, Y, Zhang, W, Xie, Y, Duan, Y, Kong, S, You, M, Ma, R, Jiang, L, et al
Critical care (London, England). 2020;(1):700
Abstract
BACKGROUND Bedside lung ultrasound (LUS) has emerged as a useful and non-invasive tool to detect lung involvement and monitor changes in patients with coronavirus disease 2019 (COVID-19). However, the clinical significance of the LUS score in patients with COVID-19 remains unknown. We aimed to investigate the prognostic value of the LUS score in patients with COVID-19. METHOD The LUS protocol consisted of 12 scanning zones and was performed in 280 consecutive patients with COVID-19. The LUS score based on B-lines, lung consolidation and pleural line abnormalities was evaluated. RESULTS The median time from admission to LUS examinations was 7 days (interquartile range [IQR] 3-10). Patients in the highest LUS score group were more likely to have a lower lymphocyte percentage (LYM%); higher levels of D-dimer, C-reactive protein, hypersensitive troponin I and creatine kinase muscle-brain; more invasive mechanical ventilation therapy; higher incidence of ARDS; and higher mortality than patients in the lowest LUS score group. After a median follow-up of 14 days [IQR, 10-20 days], 37 patients developed ARDS, and 13 died. Patients with adverse outcomes presented a higher rate of bilateral involvement; more involved zones and B-lines, pleural line abnormalities and consolidation; and a higher LUS score than event-free survivors. The Cox models adding the LUS score as a continuous variable (hazard ratio [HR]: 1.05, 95% confidence intervals [CI] 1.02 ~ 1.08; P < 0.001; Akaike information criterion [AIC] = 272; C-index = 0.903) or as a categorical variable (HR 10.76, 95% CI 2.75 ~ 42.05; P = 0.001; AIC = 272; C-index = 0.902) were found to predict poor outcomes more accurately than the basic model (AIC = 286; C-index = 0.866). An LUS score cut-off > 12 predicted adverse outcomes with a specificity and sensitivity of 90.5% and 91.9%, respectively. CONCLUSIONS The LUS score devised by our group performs well at predicting adverse outcomes in patients with COVID-19 and is important for risk stratification in COVID-19 patients.
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Intracavitary contrast-enhanced ultrasonography in children: review with procedural recommendations and clinical applications from the European Society of Paediatric Radiology abdominal imaging task force.
Ključevšek, D, Riccabona, M, Ording Müller, LS, Woźniak, MM, Franchi-Abella, S, Darge, K, Mentzel, HJ, Ntoulia, A, Avni, FE, Napolitano, M, et al
Pediatric radiology. 2020;(4):596-606
Abstract
Contrast-enhanced ultrasonography (US) has become an important supplementary tool in many clinical applications in children. Contrast-enhanced voiding urosonography and intravenous US contrast agents have proved useful in routine clinical practice. Other applications of intracavitary contrast-enhanced US, particularly in children, have not been widely investigated but could serve as a practical and radiation-free problem-solver in several clinical settings. Intracavitary contrast-enhanced US is a real-time imaging modality similar to fluoroscopy with iodinated contrast agent. The US contrast agent solution is administered into physiological or non-physiological body cavities. There is no definitive list of established indications for intracavitary US contrast agent application. However, intracavitary contrast-enhanced US can be used for many clinical applications. It offers excellent real-time spatial resolution and allows for a more accurate delineation of the cavity anatomy, including the internal architecture of complex collections and possible communications within the cavity or with the surrounding structures through fistulous tracts. It can provide valuable information related to the insertion of catheters and tubes, and identify related complications such as confirming the position and patency of a catheter and identifying causes for drainage dysfunction or leakage. Patency of the ureter and biliary ducts can be evaluated, too. US contrast agent solution can be administered orally or a via nasogastric tube, or as an enema to evaluate the gastrointestinal tract. In this review we present potential clinical applications and procedural and dose recommendations regarding intracavitary contrast-enhanced ultrasonography.
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Contrast-enhanced ultrasound for determining muscular perfusion after oral intake of L-citrulline, L-arginine, and galloylated epicatechines: A study protocol.
Doll, J, Bürkle, F, Neide, A, Tsitlakidis, S, Bruckner, T, Schmidmaier, G, Fischer, C
Medicine. 2020;(41):e22318
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Abstract
INTRODUCTION The market for dietary supplements in the sports sector has been growing rapidly for several years, though there is still lacking evidence regarding their claimed benefits. One group is that of nitric oxide increasing supplements, so-called "NO-boosters," which are claimed to improve the supply of oxygen and nutrients to the muscle by enhancing vasodilation.The aim of this study was to investigate 3 of these supplements in healthy male athletes for their muscle perfusion-enhancing potential using contrast-enhanced ultrasound (CEUS). METHODS This placebo-controlled, double-blind, randomized cross-over trial will be carried out at the Center for Orthopedics, Trauma Surgery and Spinal Cord Injury of the University Hospital Heidelberg. Three commercial NO enhancing products including 300 mg of the specific green tea extract VASO6 and a combination of 8 g L-citrulline malate and 3 g L-arginine hydrochloride will be examined for their potential to increase muscular perfusion in 30-male athletes between 18 and 40 years and will be compared with a placebo. On each of the 3 appointments CEUS of the dominant biceps muscle will be performed at rest and after a standardized resistance training. Every athlete receives each of the 3 supplements once after a wash-out period of at least 1 week. Perfusion will be quantified via VueBox quantification software. The results of CEUS perfusion measurements will be compared intra- and interindividually and correlated with clinical parameters. DISCUSSION The results of this study may help to establish CEUS as a suitable imaging modality for the evaluation of potentially vasodilatory drugs in the field of sports. Other supplements could also be evaluated in this way to verify the content of their advertising claims. TRIAL REGISTRATION German Clinical Trials Register (DRKS), ID: DRKS00016972, registered on 25.03.2019.
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Progresses in the imaging of calcium pyrophosphate crystal disease.
Andrés, M, Sivera, F, Pascual, E
Current opinion in rheumatology. 2020;(2):140-145
Abstract
PURPOSE OF REVIEW Calcium pyrophosphate crystal disease (CPPD) may be considered a neglected disorder, common in clinics and wards, but not receiving enough attention since the time it was recognized as a disease entity. This review aims to highlight the advances occurred in recent years in terms of imaging of CPPD, and their potential aid in diagnosing CPPD. RECENT FINDINGS The main advances in CPPD imaging have occurred with ultrasound and computed tomography. Ultrasound has been shown as more sensitive than conventional radiography in detecting chondrocalcinosis. OMERACT definitions of ultrasound signs of CPPD have been provided; validations process is still ongoing. Computed tomography has been used to assess CPPD at the spine. Some studies suggest that dual-energy scans could accurately detect chondrocalcinosis and discriminate from other calcified structures. SUMMARY Ultrasound and computed tomography may have a role in CPPD detection, though the specifics are still unclear. It remains necessary to have studies comparing them with synovial fluid analysis for crystals in a clinical scenario.
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Does lymph node morphology using ultrasound reflect aetiology? A pictorial essay, part I.
Trenker, C, Görg, C, Hollerweger, A, Jenssen, C, Dong, Y, Cui, XW, Dietrich, CF
Medical ultrasonography. 2020;(3):2634
Abstract
The evaluation of lymph nodes (LNs) using ultrasound requires a high level of clinical and sonographic competence. This "pictorial essay" is intended to illustrate eye-catching examples of relevant "clinical-sonographic visual diagnoses" of LNs. We provide typical images and take-home messages of eye-catching features to illustrate the featured publications.The first part includes "important differential diagnoses of eye-catching features of suspected lymphadenopathy" and "benign lymphadenopathy". The second part will include "Eye-catching features of malignant lymphadenopathy, both carcinoma and lymphoma".
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Different Ultrasound Scoring Methods for Assessing Medial Arterial Calcification: Association with Diabetic Complications.
Tian, J, Tang, G, Xu, X, Yan, L, Liang, M, Zhang, W, Liu, X, Luo, B
Ultrasound in medicine & biology. 2020;(6):1365-1372
Abstract
The aims of the study described here were to evaluate medial arterial calcification (MAC) of the lower limbs, identified on ultrasound, in patients with type 2 diabetes, and to analyze the association of MAC with diabetic complications including peripheral arterial disease, peripheral neuropathy, retinopathy, and nephropathy. Ultrasound was performed in 359 patients, and the severity of MAC was assessed by the length of MAC (score range: 0-8) and the number of arterial segmentations with MAC (score range: 0-6). Our results revealed that MAC scoring based on the segmentation method was an independent predictor of peripheral arterial disease and nephropathy, but not an independent predictor of peripheral neuropathy or retinopathy. MAC scoring based on the length method was not an independent predictor of any complication. The segmentation method for assessing MAC on ultrasound may be a valuable tool in clinical work.
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Ultrasonography of Quadriceps Femoris Muscle and Subcutaneous Fat Tissue and Body Composition by BIVA in Chronic Dialysis Patients.
Battaglia, Y, Ullo, I, Massarenti, S, Esposito, P, Prencipe, M, Ciancio, G, Provenzano, M, Fiorini, F, Andreucci, M, Storari, A, et al
Nutrients. 2020;(5)
Abstract
Protein Energy Wasting (PEW) in hemodialysis (HD) patients is a multifactorial condition due to specific pathology-related pathogenetic mechanisms, leading to loss of skeletal muscle mass in HD patients. Computed Tomography and Magnetic Resonance Imaging still represent the gold standard techniques for body composition assessment. However, their widespread application in clinical practice is difficult and body composition evaluation in HD patients is mainly based on conventional anthropometric nutritional indexes and bioelectrical impedance vector analysis (BIVA). Little data is currently available on ultrasound (US)-based measurements of muscle mass and fat tissue in this clinical setting. The purpose of our study is to ascertain: (1) if there are differences between quadriceps rectus femoris muscle (QRFM) thickness and abdominal/thigh subcutaneous fat tissue (SFT) measured by US between HD patients and healthy subjects; (2) if there is any correlation between QRFM and abdominal/thigh SFT thickness by US, and BIVA/conventional nutritional indexes in HD patients. We enrolled 65 consecutive HD patients and 33 healthy subjects. Demographic and laboratory were collected. The malnutrition inflammation score (MIS) was calculated. Using B-mode US system, the QRFM and SFT thicknesses were measured at the level of three landmarks in both thighs (superior anterior iliac spine, upper pole of the patella, the midpoint of the tract included between the previous points). SFT was also measured at the level of the periumbilical point. The mono frequency (50 KHz) BIVA was conducted using bioelectrical measurements (Rz, resistance; Xc, reactance; adjusted for height, Rz/H and Xc/H; PA, phase angle). 58.5% were men and the mean age was 69 (SD 13.7) years. QRFM and thigh SFT thicknesses were reduced in HD patients as compared to healthy subjects (p < 0.01). Similarly, also BIVA parameters, expression of lean body mass, were lower (p < 0.001), except for Rz and Rz/H in HD patients. The average QRFM thickness of both thighs at top, mid, lower landmarks were positively correlated with PA and body cell mass (BCM) by BIVA, while negatively correlated with Rz/H (p < 0.05). Abdominal SFT was positively correlated with PA, BCM and basal metabolic rate (BMR) (p < 0.05). Our study shows that ultrasound QRFM and thigh SFT thicknesses were reduced in HD patients and that muscle ultrasound measurements were significantly correlated with BIVA parameters.
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Significance of nuclear medicine scan in comparison with diethylenetriamine pentaacetic acid and ultrasound imaging in diagnosing renal disorders: An observational study.
Bafaraj, SM
Medicine. 2020;(36):e22038
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Abstract
The effectiveness of diethylenetriamine pentaacetic acid scan is regularly monitored for the assessment of any potential modifications in treatment responses or kidney functions in the pediatric population.This study attempts to compare the usefulness of diethylenetriamine pentaacetic acid and ultrasound imaging of renal disorders among paediatric patients.A retrospective observational study was conducted by enrolling 106 children. The demographic details such as: participant's age, gender, and the history of renal disease of each patient were recorded. Patients were administered radiopharmaceuticals in a fixed dose and were later subjected to computed tomography (CT) scan. The obtained data was analysed using descriptive statistics.Findings indicated increased sensitivity for CT (61.20%); whereas, a major decrease in specificity (23.68%) was observed. Comparison of Single-photon emission CT (SPECT) and CT findings revealed the increased sensitivity (90.90%) for ultrasound; whereas, there was a slight decrease in the specificity (40%) for SPECT. However, SPECT findings show 91% sensitivity among patients with 71.42% positive predictive value. Moreover, an increase in sensitivity for CT (61.20%), followed by a major decrease in specificity (23.68%) was observed.Ultrasonography has been proved to be the safest and the most effective method for the diagnosis and the treatment of most renal disorders, due to the higher predictive value of SPECT scans. It is thus suggested that patients with ureteral calculi should be diagnosed with renal scintigraphy and unenhanced helical computerized tomography.
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Contrast-Enhanced Ultrasound for Musculoskeletal Applications: A World Federation for Ultrasound in Medicine and Biology Position Paper.
Fischer, C, Krix, M, Weber, MA, Loizides, A, Gruber, H, Jung, EM, Klauser, A, Radzina, M, Dietrich, CF
Ultrasound in medicine & biology. 2020;(6):1279-1295
Abstract
This World Federation for Ultrasound in Medicine and Biology position paper reviews the diagnostic potential of ultrasound contrast agents for clinical decision-making and provides general advice for optimal contrast-enhanced ultrasound performance in musculoskeletal issues. In this domain, contrast-enhanced ultrasound performance has increasingly been investigated with promising results, but still lacks everyday clinical application and standardized techniques; therefore, experts summarized current knowledge according to published evidence and best personal experience. The goal was to intensify and standardize the use and administration of ultrasound contrast agents to facilitate correct diagnoses and ultimately to improve the management and outcomes of patients.