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Keywords = interventional ultrasonography

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17 pages, 5323 KiB  
Review
Contrast-Enhanced Harmonic Endoscopic Ultrasonography for Prediction of Aggressiveness and Treatment Response in Patients with Pancreatic Lesions
by Marco Spadaccini, Gianluca Franchellucci, Marta Andreozzi, Maria Terrin, Matteo Tacelli, Piera Zaccari, Maria Chiara Petrone, Gaetano Lauri, Matteo Colombo, Valeria Poletti, Giacomo Marcozzi, Antonella Durante, Roberto Leone, Maria Margherita Massaro, Antonio Facciorusso, Alessandro Fugazza, Alessandro Repici, Paolo Giorgio Arcidiacono and Silvia Carrara
Cancers 2025, 17(15), 2545; https://doi.org/10.3390/cancers17152545 - 1 Aug 2025
Viewed by 251
Abstract
Endoscopic ultrasonography represents a crucial aspect of the diagnosis of pancreatic lesions. The echo-endoscopic features of pancreatic lesions, particularly their contrast behavior with the advent of Contrast-Enhanced EUS (CE-EUS) and Contrast Enhanced Harmonic-EUS (CH-EUS), can predict a lesion’s aggressiveness, depending on its nature. [...] Read more.
Endoscopic ultrasonography represents a crucial aspect of the diagnosis of pancreatic lesions. The echo-endoscopic features of pancreatic lesions, particularly their contrast behavior with the advent of Contrast-Enhanced EUS (CE-EUS) and Contrast Enhanced Harmonic-EUS (CH-EUS), can predict a lesion’s aggressiveness, depending on its nature. According to this, CH-EUS could be applied to structure an even more dedicated approach to patient care, for example, to ascertain eligibility for surgical intervention of a pancreatic ductal adenocarcinoma (PDAC) or the response to neoadjuvant chemotherapy in cases deemed borderline resectable. In addition to PDAC, other significant issues pertain to the management of small neuroendocrine tumors (NETs) and intraductal papillary mucinous neoplasms (IPMNs). In this context, CH-EUS can be crucial. The aim of this review is to underline the most recent evidence for EUS and CH-EUS applications in pancreatic lesion aggressiveness assessment and to focus on possible future research directions to further extend the application of CH-EUS in this field. Full article
(This article belongs to the Special Issue Clinical Applications of Ultrasound in Cancer Imaging and Treatment)
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17 pages, 840 KiB  
Article
Developing a Consensus-Based POCUS Protocol for Critically Ill Patients During Pandemics: A Modified Delphi Study
by Hyuksool Kwon, Jin Hee Lee, Dongbum Suh, Kyoung Min You and PULSE Group
Medicina 2025, 61(8), 1319; https://doi.org/10.3390/medicina61081319 - 22 Jul 2025
Viewed by 169
Abstract
Background and Objectives: During pandemics, emergency departments face the challenge of managing critically ill patients with limited resources. Point-of-Care Ultrasound (POCUS) has emerged as a crucial diagnostic tool in such scenarios. This study aimed to develop a standardized POCUS protocol using expert [...] Read more.
Background and Objectives: During pandemics, emergency departments face the challenge of managing critically ill patients with limited resources. Point-of-Care Ultrasound (POCUS) has emerged as a crucial diagnostic tool in such scenarios. This study aimed to develop a standardized POCUS protocol using expert consensus via a modified Delphi survey to guide physicians in managing these patients more effectively. Materials and Methods: A committee of emergency imaging experts and board-certified emergency physicians identified essential elements of POCUS in the treatment of patients under investigation (PUI) with shock, sepsis, or other life-threatening diseases. A modified Delphi survey was conducted among 39 emergency imaging experts who were members of the Korean Society of Emergency Medicine. The survey included three rounds of expert feedback and revisions, leading to the development of a POCUS protocol for critically ill patients during a pandemic. Results: The developed POCUS protocol emphasizes the use of POCUS-echocardiography and POCUS-lung ultrasound for the evaluation of cardiac and respiratory function, respectively. The protocol also provides guidance on when to consider additional tests or imaging based on POCUS findings. The Delphi survey results indicated general consensus on the inclusion of POCUS-echocardiography and POCUS-lung ultrasound within the protocol, although there were some disagreements regarding specific elements. Conclusions: Effective clinical practice aids emergency physicians in determining appropriate POCUS strategies for differential diagnosis between life-threatening diseases. Future studies should investigate the effectiveness and feasibility of the protocol in actual clinical scenarios, including its impact on patient outcomes, resource utilization, and workflow efficiency in emergency departments. Full article
(This article belongs to the Section Intensive Care/ Anesthesiology)
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10 pages, 1139 KiB  
Case Report
Choledochal Stenting for Treatment of Extrahepatic Biliary Obstruction in Dogs with Ruptured Gallbladder: 2 Cases
by Shin-Ho Lee, Jeong-Hyun Seo and Jae-Hyeon Cho
Vet. Sci. 2025, 12(7), 673; https://doi.org/10.3390/vetsci12070673 - 17 Jul 2025
Viewed by 376
Abstract
Two geriatric (>9 years old) dogs presented with vomiting, depression, and anorexia and were diagnosed with extrahepatic biliary obstruction (EHBO) secondary to ruptured gallbladder mucoceles. Diagnosis was based on serum biochemical analysis, abdominal radiography, and ultrasonography, which revealed gallbladder rupture, peritonitis, and common [...] Read more.
Two geriatric (>9 years old) dogs presented with vomiting, depression, and anorexia and were diagnosed with extrahepatic biliary obstruction (EHBO) secondary to ruptured gallbladder mucoceles. Diagnosis was based on serum biochemical analysis, abdominal radiography, and ultrasonography, which revealed gallbladder rupture, peritonitis, and common bile duct dilation. Both dogs underwent emergency surgical intervention involving cholecystectomy and choledochal stent placement in the common bile duct without cholecystojejunostomy or cholecystoduodenostomy. Postoperatively, the clinical symptoms and serum chemistry values improved, and both dogs survived without recurrence for over one year. These cases demonstrate that choledochal stenting can be an effective adjunct to cholecystectomy for managing EHBO in dogs with ruptured gallbladder mucoceles, potentially preventing reocclusion and promoting recovery, especially when histopathological evaluation is not feasible in clinical settings. However, persistent elevation of liver enzymes may occur postoperatively, necessitating prolonged monitoring and medical management in some cases. Full article
(This article belongs to the Special Issue Small Animal Gastrointestinal Diseases: Challenges and Advances)
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18 pages, 1117 KiB  
Review
Surgical Management of Mediastinal Ectopic Parathyroids
by Giacomo Rabazzi, Gianmarco Elia, Vittorio Aprile, Stylianos Korasidis, Maria Giovanna Mastromarino, Diana Bacchin, Alessandra Lenzini, Marcello Carlo Ambrogi, Greta Alì, Filomena Cetani, Gabriele Materazzi and Marco Lucchi
J. Pers. Med. 2025, 15(7), 276; https://doi.org/10.3390/jpm15070276 - 30 Jun 2025
Viewed by 522
Abstract
Primary hyperparathyroidism is commonly caused by parathyroid adenomas, hyperplasia, or, rarely, carcinoma. In up to 20% of cases, parathyroid tissue may be ectopic, often located in the mediastinum due to aberrant embryologic migration. Ectopic parathyroid glands pose a diagnostic and therapeutic challenge, and [...] Read more.
Primary hyperparathyroidism is commonly caused by parathyroid adenomas, hyperplasia, or, rarely, carcinoma. In up to 20% of cases, parathyroid tissue may be ectopic, often located in the mediastinum due to aberrant embryologic migration. Ectopic parathyroid glands pose a diagnostic and therapeutic challenge, and an accurate preoperative localization is essential for an effective and safe resection. Imaging modalities such as CT scan, TC-sestamibi scintigraphy, PET/CT, ultrasonography and MRI are routinely employed, whereas combined techniques offer improved diagnostic accuracy. Emerging approaches, however, including PET/CT with choline tracers, have shown promise in enhancing sensitivity in complex or recurrent cases. When ectopic glands are in the mediastinum, thoracic surgical intervention is required. Traditional open approaches, such as sternotomy or thoracotomy, are associated with significant morbidity. The development and evolution of minimally invasive surgery (MIS) has become the preferred approach in selected cases. When MIS is performed, intraoperative assessment and parathyroid identification are crucial to ensure complete gland removal. Intraoperative parathyroid hormone (ioPTH) monitoring provides real-time confirmation of surgical success. The integration of advanced imaging, intraoperative monitoring, and minimally invasive techniques significantly improves surgical outcomes while minimizing complications and accelerating patient recovery. Ultimately, the effective treatment of ectopic parathyroid glands relies on a personalized approach, adapting both diagnostic and surgical strategies to the unique anatomical and clinical context of each patient. Integration of advanced imaging, intraoperative monitoring, and minimally invasive techniques, combined with a multidisciplinary team involving endocrinologists, radiologists, and thoracic surgeons, is key to optimizing outcomes and reducing patient morbidity. Full article
(This article belongs to the Section Methodology, Drug and Device Discovery)
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13 pages, 1513 KiB  
Article
Novel Preoperative Carbohydrate Drinks Versus Commercial Syrup-Based Drinks on Gastric Emptying, Glycemic Responses, and Fasting Discomfort: A Pilot Randomized Crossover Trial
by Chaitong Churuangsuk, Khanin Khanungwanitkul, Anukoon Kaewborisutsakul, Chanatthee Kitsiripant, Athithan Rattanaburi, Onnicha Suntornlohanakul, Krit Charupanit, Thammasin Ingviya, Utcharee Intusoma and Panupong Puttarak
Nutrients 2025, 17(13), 2131; https://doi.org/10.3390/nu17132131 - 27 Jun 2025
Viewed by 646
Abstract
Background: Enhanced Recovery After Surgery (ERAS) guidelines recommend preoperative carbohydrate loading; however, local hospitals often use syrup concentrate sweet drinks rather than specialized carbohydrate formulations. We compared gastric emptying, glycemic response, and fasting discomfort of a novel carbohydrate drink versus syrup concentrate [...] Read more.
Background: Enhanced Recovery After Surgery (ERAS) guidelines recommend preoperative carbohydrate loading; however, local hospitals often use syrup concentrate sweet drinks rather than specialized carbohydrate formulations. We compared gastric emptying, glycemic response, and fasting discomfort of a novel carbohydrate drink versus syrup concentrate sweet drinks. Methods: In this pilot randomized, crossover trial at Prince of Songkla University Hospital, Thailand, 16 healthy volunteers received three interventions with a 1-week washout period: novel carbohydrate drink 400 mL (C400), novel carbohydrate drink 250 mL (C250), and syrup sweet drink 250 mL (SYR). The primary outcome was gastric antral cross-sectional area (CSA) measured using ultrasonography at baseline, 10, 60, 120, and 180 min post-ingestion. Secondary outcomes included glycemic response and visual analog scales for thirst and hunger. Results: All drinks showed comparable gastric CSA, peaking at 10 min (5.5–6.5 cm2, p < 0.01) and returning to baseline by 120 min. Novel carbohydrate drinks produced higher glucose peaks at 60 min (C400: 147.4 mg/dL [28.0]; C250: 148.7 mg/dL [21.7]) than SYR (123.1 mg/dL [22.4], p = 0.006) with sustained elevation through 120 min. All drinks similarly reduced thirst and mouth dryness scores at 60 min (p < 0.05), though hunger increased progressively after 120 min across all groups. Conclusions: Both 400 mL and 250 mL volumes of novel carbohydrate drinks demonstrated safe gastric emptying profiles comparable to syrup concentrate sweet drinks while providing more sustained glycemic responses. Full article
(This article belongs to the Special Issue Hot Topics in Clinical Nutrition (3rd Edition))
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16 pages, 1830 KiB  
Article
Super-Resolution Contrast-Enhanced Ultrasound Examination Down to the Microvasculature Enables Quantitative Analysis of Liver Lesions: First Results
by Ulrich Kaiser, Ursula Vehling-Kaiser, Fabian Kück, Mia Gilanschah, Friedrich Jung and Ernst Michael Jung
Life 2025, 15(7), 991; https://doi.org/10.3390/life15070991 - 20 Jun 2025
Viewed by 570
Abstract
This article investigates the first use of dynamic microvascularization of liver lesions in clinical evaluation using real-time super-resolution contrast-enhanced ultrasound (SR CEUS). A retrospective analysis of SR CEUS examinations of liver lesions was performed. All examinations were conducted using an SC7-1U convex probe [...] Read more.
This article investigates the first use of dynamic microvascularization of liver lesions in clinical evaluation using real-time super-resolution contrast-enhanced ultrasound (SR CEUS). A retrospective analysis of SR CEUS examinations of liver lesions was performed. All examinations were conducted using an SC7-1U convex probe after the bolus injection of the ultrasound contrast agent. Digital cine loops were stored for independent evaluation. The evaluation was performed with respect to parallel measuring lines (the diameter corresponded to the capillary density) in the area of the reference lesion, liver tissue, and liver capsule using statistical analysis. In total, 65 patients (female n = 28; male n = 37; average age 57.8 ± 17.2 years) were evaluated. The examined liver lesions were mostly benign masses (n = 46). Mild liver fibrosis (stage F1) was present in most cases (n = 35). The lesions examined were located at an average tissue depth of 6.07 ± 2.47 cm. The highest number of lesion measurements was observed in the malignant lesion group. Significant differences in the measurements were found when comparing benign lesions with the capillary region (p < 0.001) and normal liver tissue (p < 0.01). The use of SR CEUS opens up new possibilities for the quantification of neovascularization, assessment of microvascular changes, and evaluation of the follow-up of intrahepatic interventions. Full article
(This article belongs to the Section Medical Research)
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12 pages, 4200 KiB  
Article
The Development of an Ultrasound-Based Scoring System for the Prediction of Interstitial Pregnancy
by Yun Ji Jung, Hyun-Soo Zhang, Eun Jin Lee, Hayan Kwon, Ja-Young Kwon, Young-Han Kim and JoonHo Lee
J. Clin. Med. 2025, 14(12), 4238; https://doi.org/10.3390/jcm14124238 - 14 Jun 2025
Viewed by 488
Abstract
Background/Objectives: Diagnosing interstitial pregnancy (IP) using ultrasonography can be challenging, as it is often mistaken for eccentrically located intrauterine pregnancy (IUP). In this retrospective cohort study, we aimed to develop a predictive scoring model using multiple clinical factors to enhance the diagnosis [...] Read more.
Background/Objectives: Diagnosing interstitial pregnancy (IP) using ultrasonography can be challenging, as it is often mistaken for eccentrically located intrauterine pregnancy (IUP). In this retrospective cohort study, we aimed to develop a predictive scoring model using multiple clinical factors to enhance the diagnosis of IP and facilitate timely interventions in suspected cases. Methods: We enrolled 63 pregnant women with a diagnosis of suspected IP who visited a single tertiary center between January 2006 and December 2023. Data on the clinical risk factors, symptoms, laboratory test results, and ultrasound findings were analyzed. A statistical predictive score was developed using logistic regression analysis with feature selection based on the least absolute shrinkage and selection operator to optimize the predictive accuracy and clinical applicability. Results: From a total of 12 factors, a scoring model was constructed from the three most prominent factors—ultrasound findings showing no surrounding endometrium, myometrial thinning of less than 5 mm, and vaginal bleeding—all of which demonstrated high feature importance. This predictive score identified IP with a negative predictive value of 0.950 in the low-risk group and a positive predictive value of 1.000 in the high-risk group, whereas the overall area under the curve was 0.998 (95% confidence interval, 0.992–1.000). Conclusions: The statistically derived predictive model––ultrasound showing no surrounding endometrium and myometrial thinning < 5 mm combined with vaginal bleeding––demonstrated high accuracy and practical applicability for IP diagnosis, providing a robust tool to enhance clinical decision-making and optimize routine management strategies for IP. Full article
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18 pages, 785 KiB  
Review
Tubal Ectopic Pregnancy: From Diagnosis to Treatment
by Dimitrios Papageorgiou, Ioakeim Sapantzoglou, Ioannis Prokopakis and Eleftherios Zachariou
Biomedicines 2025, 13(6), 1465; https://doi.org/10.3390/biomedicines13061465 - 13 Jun 2025
Viewed by 1240
Abstract
The most frequent form of ectopic pregnancy, known as tubal pregnancy, leads to a dangerous situation where the fertilized ovum implants inside a fallopian tube, which can result in tubal rupture and severe bleeding. The purpose of this narrative review is to evaluate [...] Read more.
The most frequent form of ectopic pregnancy, known as tubal pregnancy, leads to a dangerous situation where the fertilized ovum implants inside a fallopian tube, which can result in tubal rupture and severe bleeding. The purpose of this narrative review is to evaluate all existing data regarding epidemiology, risk factors, pathophysiology, clinical presentation, diagnosis, and management of tubal ectopic pregnancy in order to provide a comprehensive understanding of this common yet difficult clinical condition. Prior ectopic pregnancy, together with tubal pathology and assisted reproduction, represent the main risk factors for this condition. The diagnosis relies on serial β-hCG tests combined with transvaginal ultrasonography, but laparoscopy serves as the diagnostic tool for cases with uncertain results. The treatment plan depends on the fallopian tube integrity, along with the patient’s hemodynamic condition. Patients with unruptured pregnancies who are hemodynamically stable receive methotrexate treatment as the preferred option, but surgical intervention with salpingectomy or salpingostomy becomes necessary in case of tubal rupture or when medical treatment fails. The development of laparoscopic procedures has led to better results and improved possibilities for fertility preservation. The psychological effects on patients require both counseling and follow-up care. Early detection, along with personalized management, helps decrease maternal complications and optimize reproductive outcomes. Full article
(This article belongs to the Special Issue Maternal-Fetal and Neonatal Medicine)
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16 pages, 1037 KiB  
Review
Renal Resistive Index from Renal Hemodynamics to Cardiovascular Risk: Diagnostic, Prognostic, and Therapeutic Implications
by Giulio Geraci, Pietro Ferrara, Luigi La Via, Alessandra Sorce, Vincenzo Calabrese, Giuseppe Cuttone, Valentina Paternò, Francesco Pallotti, Gianluca Sambataro, Luca Zanoli, Jacob George, Riccardo Polosa, Giuseppe Mulè and Caterina Carollo
Diseases 2025, 13(6), 178; https://doi.org/10.3390/diseases13060178 - 9 Jun 2025
Viewed by 592
Abstract
Duplex-Doppler ultrasonography has become an essential tool in the diagnosis and management of kidney diseases, allowing clinicians to assess renal hemodynamics, detect vascular abnormalities, and monitor disease progression. Among the various Doppler-derived parameters, the renal resistive index (RRI) has gained particular attention both [...] Read more.
Duplex-Doppler ultrasonography has become an essential tool in the diagnosis and management of kidney diseases, allowing clinicians to assess renal hemodynamics, detect vascular abnormalities, and monitor disease progression. Among the various Doppler-derived parameters, the renal resistive index (RRI) has gained particular attention both as a diagnostic tool and a prognostic marker in nephrology. Traditionally considered an indicator of parenchymal perfusion, recent evidence highlights its strong association with systemic hemodynamic factors, particularly arterial stiffness, positioning RRI as a valuable tool for evaluating patients with systemic vascular impairment, such as hypertension, diabetes mellitus, and atherosclerosis. RRI has been strongly linked to vascular damage, which in turn is influenced by inflammation and endothelial dysfunction, making it a reliable marker of cardiovascular damage and a potential predictor of cardiovascular risk. Furthermore, emerging studies suggest that RRI could serve as a dynamic parameter to monitor vascular changes induced by therapeutic interventions. This narrative review summarizes the classic and evolving applications of RRI, from its origin as a renal hemodynamic marker to its emerging role as a systemic vascular biomarker with diagnostic and prognostic significance in cardiovascular and metabolic diseases. Full article
(This article belongs to the Section Cardiology)
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5 pages, 729 KiB  
Case Report
A Rare Case of Paired Congenital Cervical Aneurysms in a Communicating Vein: Clinical and Imaging Findings in a Pediatric Patient
by Grigol Keshelava, Zurab Robakidze and Igor Mikadze
Pathophysiology 2025, 32(2), 25; https://doi.org/10.3390/pathophysiology32020025 - 6 Jun 2025
Viewed by 667
Abstract
A four-year-old female patient was admitted for evaluation after a mass on the right side of her neck was noticed during straining (Valsalva maneuver). The family first observed the mass when the patient was one year old, and noted that it gradually increased [...] Read more.
A four-year-old female patient was admitted for evaluation after a mass on the right side of her neck was noticed during straining (Valsalva maneuver). The family first observed the mass when the patient was one year old, and noted that it gradually increased in size over time. A family history assessment revealed no known genetic disorders. The patient underwent neck ultrasonography and computed tomography angiography (CTA), which revealed two aneurysms in a right-sided communicating vein. One aneurysm was located above the jugular notch, and the other was located in the retro-parotid region. The presence of two venous aneurysms in a right-sided communicating vein—one above the jugular notch and the other in the retro-parotid region—suggests a rare and apparently benign congenital anomaly. The progressive enlargement of these malformations warrants close monitoring and surgical intervention, and long-term follow-up may be necessary to prevent complications such as thrombosis, rupture, or compression of adjacent structures. Full article
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29 pages, 1729 KiB  
Article
Morphofunctional Assessment of Malnutrition and Sarcopenia Using Nutritional Ultrasonography in Patients Undergoing Maintenance Hemodialysis
by José C. De La Flor, Estefanya García-Menéndez, Gregorio Romero-González, Celia Rodríguez Tudero, Elena Jiménez Mayor, Enrique Florit Mengual, Esperanza Moral Berrio, Beatriz Soria Morales, Michael Cieza Terrones, Secundino Cigarrán Guldris and Jesús Hernández Vaquero
Medicina 2025, 61(6), 1044; https://doi.org/10.3390/medicina61061044 - 5 Jun 2025
Viewed by 819
Abstract
Background and Objectives: Malnutrition and sarcopenia are highly prevalent and clinically impactful conditions in patients undergoing maintenance hemodialysis (MHD), yet their early detection remains challenging. This study aimed to assess the diagnostic performance of nutritional ultrasonography (NUS) in the morphofunctional evaluation of malnutrition [...] Read more.
Background and Objectives: Malnutrition and sarcopenia are highly prevalent and clinically impactful conditions in patients undergoing maintenance hemodialysis (MHD), yet their early detection remains challenging. This study aimed to assess the diagnostic performance of nutritional ultrasonography (NUS) in the morphofunctional evaluation of malnutrition and sarcopenia, and to compare its utility with established tools such as bioimpedance analysis (BIA), biochemical markers, handgrip strength (HGS), and functional performance tests. Materials and Methods: A cross-sectional study was conducted in 74 stable MHD patients. Clinical, analytical, anthropometric, BIA, NUS, and functional parameters were collected, along with validated nutritional and frailty scales. NUS was used to assess the quadriceps rectus femoris (QRF) and preperitoneal visceral fat (PPVF), measuring Y-axis, Y-axis/height, cross-sectional muscle area rectus femoris (CS-MARF), muscle area rectus femoris index adjusted to height (MARFIh), and supramuscular fat (SMF). Sarcopenia was defined according to the 2019 European Working Group on Sarcopenia in Older People (EWGSOP) criteria. Results: The prevalence of risk, confirmed, and severe sarcopenia was 24.3%, 40.5%, and 20.3%, respectively. Severe-to-moderate protein-energy wasting (PEW) affected 44.6% of patients. Compared to non-sarcopenic individuals, sarcopenic patients had lower values of HGS, prealbumin, lean body mass, and phase angle. NUS-derived cut-off values for sarcopenia were Y-axis ≤ 8 mm, Y-axis/height ≤ 2.9 mm/m2, CS-MARF ≤ 2.4 cm2, and MARFIh ≤ 0.9 cm2/m2. The most discriminative NUS parameters were Y-axis and SMF (AUC 0.67), followed by Y-axis/height (AUC 0.65) and MARFIh (AUC 0.63). NUS measurements correlated significantly with ASMI, phase angle, HGS, and SPPB scores. Conclusions: Nutritional ultrasonography is a feasible, reproducible, and clinically valuable tool for assessing muscle mass and quality in MHD patients. Its incorporation into routine practice may enhance early detection of malnutrition and sarcopenia, thereby facilitating timely, individualized nutritional interventions. Full article
(This article belongs to the Section Urology & Nephrology)
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26 pages, 1024 KiB  
Review
Changes Connected to Early Chronic Pancreatitis and Early Pancreatic Cancer in Endoscopic Ultrasonography (EUS): Clinical Implications
by Natalia Pawelec, Łukasz Durko and Ewa Małecka-Wojciesko
Cancers 2025, 17(11), 1891; https://doi.org/10.3390/cancers17111891 - 5 Jun 2025
Viewed by 1389
Abstract
Chronic pancreatitis (CP) is a progressive condition that is associated with severe complications. Diagnosis of late CP is easy due to characteristic clinical presentation and pathognomonic imaging findings, such as pancreatic calcifications. Early changes, such as lobularity and a dilated main pancreatic duct, [...] Read more.
Chronic pancreatitis (CP) is a progressive condition that is associated with severe complications. Diagnosis of late CP is easy due to characteristic clinical presentation and pathognomonic imaging findings, such as pancreatic calcifications. Early changes, such as lobularity and a dilated main pancreatic duct, are very subtle and challenging to detect with ultrasonography (US) or even computed tomography (CT). Data were accumulating on the usefulness of EUS in the early diagnosis of CP. The sensitivity values for detecting early CP (ECP) by US, MRI, and EUS were 67–69%, 77–78%, and 81–84%, respectively. The specificity values for detecting ECP by US, MRI, and EUS were 90–98%, 83–96%, and 90–100%, respectively. Pancreatic cancer (PDAC) is one of the leading cancers worldwide, with increasing morbidity. Due to its poor prognosis and survival, early diagnosis is crucial. For this indication, EUS also shows better outcomes compared to other imaging methods, especially in tumors < 2 cm. The sensitivity and specificity for diagnosing PDAC with MRI and EUS were 52.3–93%, 77.1–89%, 72–100%, and 90%, respectively. In addition, EUS can detect precancerous conditions that are associated with a higher risk of PDAC. EUS-assisted new techniques, like elastography and contrast enhancement, facilitate the diagnosis of pancreatic lesions and make it even more accurate. Early PDAC changes, such as main pancreatic duct dilatation or irregular margins of pancreatic solid masses, may be detected with EUS. This review describes the efficacy of different imaging techniques in the early detection of CP and PDAC. In addition, we describe the useful interventions made possible by early diagnosis of PDAC and CP. Full article
(This article belongs to the Collection Targeting Solid Tumors)
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10 pages, 2507 KiB  
Article
The Clinical Outcomes of a Bioinductive Collagen Implant in Bursal-Sided Partial-Thickness Rotator Cuff Tears
by Jaesung Yoo and Daehee Lee
Medicina 2025, 61(6), 988; https://doi.org/10.3390/medicina61060988 - 27 May 2025
Viewed by 630
Abstract
Background and Objectives: Many middle-aged and older individuals experience shoulder pain, often due to partial-thickness rotator cuff tears (PTRCTs). If conservative treatment fails to relieve symptoms in a patient, surgical intervention may be necessary. In such cases, using a bioinductive collagen implant [...] Read more.
Background and Objectives: Many middle-aged and older individuals experience shoulder pain, often due to partial-thickness rotator cuff tears (PTRCTs). If conservative treatment fails to relieve symptoms in a patient, surgical intervention may be necessary. In such cases, using a bioinductive collagen implant may offer a viable alternative to conventional rotator cuff repair. Most notably, it offers potential advantages, particularly in reducing postoperative pain and promoting faster recovery. Accordingly, this study aims to evaluate the clinical outcomes of treating bursal-sided partial-thickness rotator cuff tears using bioinductive collagen implants alone, without concurrent rotator cuff repair. Materials and Methods: We followed 32 patients who had bursal-sided partial-thickness rotator cuff tears (Ellman grade I or II) and received conservative care for more than six months but continued to experience symptoms. These patients received surgery using bioinductive collagen implants without rotator cuff repair, and we followed up on their postoperative prognosis for at least one year after surgery. For a more accurate contrast, we performed clinical evaluation preoperatively and at 2 weeks, 6 weeks, 3 months, 6 months, and 12 months postoperatively. Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and Western Ontario Rotator Cuff (WORC) score were used as assessment tools in this study. As for radiological outcomes, magnetic resonance imaging (MRI) and ultrasonography were helpful. This supported our assessment of graft integration and failure. Results: These 32 patients included 13 with Ellman grade I tear and 19 with grade II tear. In both cases, they underwent surgery only using bioinductive collagen implants, and any anchor-based cuff repair was completely excluded. As for VAS (3.8 ± 2.9), certain statistically significant improvements were found starting at 2 weeks postoperatively. On the other hand, the scores of ASES (58.6 ± 20.3), SANE (60.1 ± 23.2), and WORC (59.8 ± 22.4) began to indicate a significant improvement starting at 6 weeks postoperatively (p < 0.001), showing continuous progress. At each final step, we confirmed that there were no cases of graft failure by radiological evaluation and found successful healing indicators, such as much less pain in all patients. Conclusions: The findings of this study provide the clinical evidence that a surgery using bioinductive collagen implant for bursal-sided partial-thickness rotator cuff tears is a highly effective treatment option in patients unresponsive to conservative therapy. Particularly, its practical clinical effectiveness includes facilitating rapid recovery without a significant risk of complications. Full article
(This article belongs to the Special Issue Advancement in Upper Limb Rehabilitation and Injury Prevention)
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15 pages, 2426 KiB  
Review
Fatty Pancreas: Its Potential as a Risk Factor for Pancreatic Cancer and Clinical Implications
by Nao Otsuka, Yutaka Shimamatsu, Ryunosuke Hakuta, Yukiko Takayama and Yousuke Nakai
Cancers 2025, 17(11), 1765; https://doi.org/10.3390/cancers17111765 - 24 May 2025
Viewed by 1317
Abstract
With the increasing use of imaging modalities such as ultrasonography, computed tomography, and magnetic resonance imaging, incidental findings of pancreatic abnormalities, including pancreatic cysts and fatty pancreas (FP), have become more common. FP, also referred to as pancreatic steatosis, intra-pancreatic fat deposition, or [...] Read more.
With the increasing use of imaging modalities such as ultrasonography, computed tomography, and magnetic resonance imaging, incidental findings of pancreatic abnormalities, including pancreatic cysts and fatty pancreas (FP), have become more common. FP, also referred to as pancreatic steatosis, intra-pancreatic fat deposition, or fatty pancreas disease, is characterized by the accumulation of fat in the pancreas. Although FP has been associated with metabolic syndromes such as obesity and diabetes, its clinical significance remains unclear. Recent evidence suggests that FP may play a role in pancreatic carcinogenesis. Metabolic disorders, including obesity, insulin resistance, and diabetes, have been implicated in the development of FP. Additionally, FP has been linked to an increased risk of pancreatic ductal adenocarcinoma (PDAC), possibly due to chronic inflammation, lipotoxicity, and an altered pancreatic microenvironment. While early detection of PDAC remains challenging, surveillance strategies for high-risk individuals, such as those with pancreatic cysts, new-onset diabetes, or a genetic predisposition, may be crucial. In this context, FP may be incorporated into this surveillance of high-risk individuals. Some pharmacological interventions, including glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter-2 (SGLT2) inhibitors, have shown potential in reducing pancreatic fat accumulation, although further studies are needed to confirm their efficacy. Full article
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18 pages, 1649 KiB  
Review
Thyroid Ultrasonography: Much Ado About Nothing? A Provocative Analysis
by Petra Petranović Ovčariček and Luca Giovanella
Cancers 2025, 17(11), 1764; https://doi.org/10.3390/cancers17111764 - 24 May 2025
Viewed by 1324
Abstract
Thyroid ultrasonography (US) usage has risen significantly over the past two decades, with annual increases of up to 21% in some healthcare systems. This review examines patterns in thyroid US usage, factors driving potential misuse, and strategies to mitigate overuse. While thyroid US [...] Read more.
Thyroid ultrasonography (US) usage has risen significantly over the past two decades, with annual increases of up to 21% in some healthcare systems. This review examines patterns in thyroid US usage, factors driving potential misuse, and strategies to mitigate overuse. While thyroid US provides valuable information on thyroid morphology and structure without radiation exposure, inappropriate use—estimated at 10–50% of exams—leads to adverse consequences, including patient anxiety, unnecessary procedures, and potential overdiagnosis of thyroid cancer. The widespread adoption of US has coincided with increased thyroid cancer diagnoses, yet mortality rates remain unchanged, suggesting overdiagnosis rather than actual disease increase. Clinical guidelines consistently recommend selective US use not for routine evaluation of thyroid dysfunction (hyper/hypothyroidism) without palpable abnormalities, but for the anatomical assessment of palpable nodules. For thyroid incidentalomas (ITNs), evidence suggests negligible malignancy risk for nodules < 1 cm, arguing against further investigation. The paper proposes a rational approach to thyroid US, emphasizing that patients with thyroid dysfunction without palpable abnormalities, euthyroid patients without palpable nodules, and patients with subcentimetric ITNs should not undergo thyroid US. Addressing this overutilization requires a better understanding of contributing factors and targeted interventions. By restricting US to appropriate clinical scenarios, healthcare resources can be optimized without compromising patient outcomes, ensuring that rare cases of clinically significant thyroid cancer receive proper diagnosis and treatment. Full article
(This article belongs to the Special Issue Thyroid Cancer: Diagnosis, Prognosis and Treatment (2nd Edition))
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