Search Results (39)

Background: In recent years, musculoskeletal ultrasonography (MSUS) has established itself as a reliable method for evaluating disease activity in combination with clinical examination and laboratory tests. Objectives: In this pilot study, we aimed to evaluate the ultrasound response to treatment with tofacitinib and upadacitinib on tendons and joints in comparison to clinical and laboratory results in patients with RA who have shown inadequate response to conventional synthetic and/or biologic disease-modifying antirheumatic drugs (cs/b DMARDs). Methods: This study presents the MSUS assessment of therapeutic response in RA patients treated with tofacitinib or upadacitinib over a 24-week period. In a prospective, single-center study, patients were treated with upadacitinib 15 mg/daily or tofacitinib 2 × 5 mg/daily or 11 mg/daily, in combination with or without methotrexate or another conventional DMARDs. Disease activity was assessed by DAS28-CRP, CDAI, and SDAI, as well as MSUS. Patients were evaluated at baseline for ultrasound measures and at weeks 2, 4, 8, 12, and 24 for the rest of the indicators. For each patient, we used two ultrasound (US) scores (gray-scale, GS, and power Doppler, PD scores) and the system of European Alliance of Associations for Rheumatology outcome measures in rheumatology (EULAR-OMERACT) US scoring (combined GS and PD). We also calculated the tenosynovitis score (GS and PD) according to OMERACT recommendations. Results: A total of 53 patients were recruited. A total of 25 patients with a mean age of 56 ± 11.6 SD were followed in the upadacitinib group, and 22 patients with a mean age of 56.9 ± 11.3 were followed in the tofacitinib group. At baseline, DAS28-CRP for the upadacitinib group was 5.57 ± 1.24, and for tofacitinib, it was 4.77 ± 1.47. The baseline visit (GS, PD, and combined—US) and tendon US scores (GS and PD) were, respectively, 23 ± 2.96, 15 ± 2.56, 24.08 ± 3.36, 11.04 ± 2.21, and 8.44 ± 1.65 for the upadacitinib group. USGS-J—23 ± 3.55, USPD-J—13.36 ± 2.44, OMERACT composite—23.4 ± 3.84, USGS-T—12.18 ± 2.23, and USPD-T—9.5 ± 1.92 were found in the patients treated with tofacitinib. In both groups of patients, a significant reduction was found in both DAS28-CRP and the described MSUS scores at weeks 8, 12, and 24 (p < 0.05). Conclusions: Upadacitinib managed to produce lower echography scores much faster than tofacitinib; however, the differences in effectiveness evened out at weeks 12 and 24, with all patients being adequately controlled. Full article

Background and Objectives: This study aimed to evaluate the predictive value of ultrasonographic abdominal muscle thickness and thickening ratios for expiratory muscle strength in SCI patients. Materials and Methods: A case-controlled, cross-sectional study was conducted with 36 SCI patients and 30 age- and sex-matched healthy controls. Ultrasonographic measurements of the rectus abdominis (RA), external oblique (EO), internal oblique (IO), and transversus abdominis (TrA) were performed at rest and during forced expiration. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured to assess respiratory muscle strength. Correlation and regression analyses were performed to determine the relationship between ultrasonography (USG) parameters and expiratory muscle function. Results: SCI patients exhibited significantly lower MIP (76.27 ± 29 cmH₂O vs. 91.63 ± 17.3 cmH₂O, p = 0.007) and MEP (64.52 ± 21.55 cmH₂O vs. 119.1 ± 26.48 cmH₂O, p < 0.001) compared to healthy individuals. Ultrasonographic measurements revealed a significant reduction in forced thickness and thickening ratios of EO, IO, and TrA muscles in SCI patients (p < 0.001). MEP was positively correlated with EO forced thickness (r = 0.333, p = 0.047), IO forced thickness (r = 0.501, p = 0.002), and TrA forced thickness (r = 0.530, p = 0.001). Multiple linear regression analysis identified TrA forced thickness as the strongest predictor of MEP (β = 0.49, p = 0.001). Conclusions: Ultrasonographic measurements of abdominal muscle thickness and thickening ratios provide valuable insights into expiratory muscle dysfunction in SCI patients. TrA forced thickness demonstrated the strongest association with MEP, suggesting its potential as a novel, non-invasive biomarker for expiratory muscle weakness. These results support the use of USG as a practical clinical tool for guiding respiratory assessment and rehabilitation strategies in patients with spinal cord injury. Full article

The study groups (n = 39) included ewes with ongoing pregnancy (P+; n = 19), with fetal death (FD; n = 12), and that were not pregnant (P−; n = 8). Blood samples were taken on days 10, 20, 30, 40, 60, 80, and 150 post-mating. Ultrasonography (USG) controls started on day 30. The P₄ concentrations differed significantly between P+ and P− on all days (p < 0.001). Regarding AMH concentrations, a significant difference was observed between P+ and P− on day 30. P₄ increased significantly from day 60 to 80 and remained elevated until day 150 in P+, while remaining basal in P−. In FD and P− groups, P₄ reached its lowest concentrations. A rapid decrease in P₄ was observed in P− from day 20 onwards. A statistically significant difference in P₄ was also noted between P+ and FD. Additionally, P₄ concentrations differed between singleton and twin pregnancies, especially on days 20 and 40. Statistically significant differences in AMH were found between P+ and FD on days 10, 20, and 30. In P+ sheep, P₄, AMH, and Hp concentrations varied by season. A significant relationship was found between AMH and Hp concentrations and body weight. In conclusion, P₄ stands out as the primary marker for distinguishing pregnancy status and detecting embryonic loss, while AMH provides complementary support, particularly in identifying fetal death. Seasonal changes were reflected across P₄, AMH, and Hp concentrations, with AMH and Hp also showing significant associations with BW. Full article

Background/Objectives: This study aims to determine the sensitivity, specificity, positive predictive value, and negative predictive value by comparing ultrasonography and panoramic radiography with the gold standard cone beam computed tomography in the diagnosis of osteoarthritic changes in the temporomandibular joint (TMJ) and to determine the distribution of these degenerations in terms of age and gender. Methods: In the study, cone beam computed tomography (CBCT), panoramic radiography, and ultrasonography (USG) images of 143 patients who applied to the Dentomaxillofacial Radiology Department of the Faculty of Dentistry of Zonguldak Bülent Ecevit University with complaints of TMJ were retrospectively examined. Results: As a result of the analysis, the average age of the patients included in the study was found to be 50.3 ± 14.4. The incidence of degenerative changes was higher in females than in males. The most common degenerative change in both genders was found to be flattening. Of the 143 patients’ degenerative changes detected on CBCT, 135 (94.4%) were detected on panoramic radiography and 124 (86.7%) were detected on USG. Conclusions: The sensitivity rates of ultrasound and panoramic radiography were found to be lower than those of CBCT in detecting degenerative changes. Full article

Background/Objectives: Rotator cuff lesions are common causes of shoulder pain. When not treated effectively, the functional loss associated with pain affects the quality of life and brings about psychosocial issues. In this study, prospective observational comparison of the effects of ultrasonography (USG) guided subacromial injection (SAI) versus subacromial injection combined with suprascapular nerve block (SSNB) on pain, functionality and sleep quality in the treatment of shoulder pain unresponsive to conservative treatments due to rotator cuff lesions is made. Methods: The data of 25 patients in both groups were compared prospectively. Patients were evaluated after 30 min, 1 week, 2 weeks, 1 month, and 3 months. Pain levels were measured with VAS, shoulder functions with SPADI and sleep quality with PSQI. Analgesic consumption and satisfaction were also recorded. Results: Both treatment groups effectively reduced pain at rest over the 3-month follow-up period. However, the SAI group did not achieve the targeted level of analgesia for pain control during movement. In comparison, the SAI + SSNB group demonstrated significantly superior outcomes, with lower VAS scores both at rest and during motion, as well as improved SPADI and PSQI scores. Additionally, analgesic consumption was significantly reduced in the SAI + SSNB group. No side effects or complications were observed during the treatment applications or the follow-up period. Conclusions: Pain control, shoulder functionality, sleep quality, and patient satisfaction were found to be higher in patients treated with SAI + SSNB in the short-to-medium term in the treatment of shoulder pain due to rotator cuff lesions, in addition to lower analgesic consumption. Full article

Background and Objectives: We aimed to develop a predictive model for the outcome of bruxism treatments using ultrasonography (USG)-based machine learning (ML) techniques. This study is a quantitative research study (predictive modeling study) in which different treatment methods applied to bruxism patients are evaluated through artificial intelligence. Materials and Methods: The study population comprised 102 participants with bruxism in three treatment groups: Manual therapy, Manual therapy and Kinesio Tape or Botulinum Toxin-A injection. USG imaging was performed on the masseter muscle to calculate muscle thickness, and pain thresholds were evaluated using an algometer. A radiomics platform was utilized to handle imaging and clinical data, as well as to perform a subsequent radiomics statistical analysis. Results: The area under the curve (AUC) values of all machine learning methods ranged from 0.772 to 0.986 for the training data and from 0.394 to 0.848 for the test data. The Support Vector Machine (SVM) led to excellent discrimination between bruxism and normal patients from USG images. Radiomics characteristics in pre-treatment ultrasound scans of patients, showing coarse and nonuniform muscles, were associated with a greater chance of less effective pain reduction outcomes. Conclusions: This study has introduced a machine learning model using SVM analysis on ultrasound (USG) images for bruxism patients, which can detect masseter muscle changes on USG. Support Vector Machine regression analysis showed the combined ML models can also predict the outcome of the pain reduction. Full article

Vulvar carcinoma is a rare cancer affecting the genital tract, constituting 4% of gynecological tumors. Vulvar squamous cell carcinoma (VSCC) is the most common type. Diagnosis relies on biopsy during vulvoscopy, plus imaging such as ultrasonography (USG), magnetic resonance imaging (MRI) and positron emission tomography (PET). This review aims to lay out a thorough overview as to the current preoperative management of VSCC, both in case of vulvar and lymph node involvement. The data research was conducted using the following databases: MEDLINE, EMBASE, Web of Sciences, Scopus, ClinicalTrial.gov, OVID and Cochrane Library from 2010 to 2024. The selection criteria included only original articles. Seventeen studies were assessed for eligibility. A concordance rate of 62.3% for vHSIL and 65.2% for carcinoma at vulvoscopy, with a sensitivity of 98%, specificity of 40%, PPV (Positive Predictive Value) of 37% and NPV (Negative Predictive Value) of 98% in identifying malignant lesions was found. Regarding the reliability of PET for staging and assessing lymph node involvement, a mean SUV (Standardized Uptake Value) for malignant vulvar lesions of 8.4 (range 2.5–14.7) was reported. In the case of MRI, useful for the evaluation of loco-regional infiltration and lymph node involvement, the ratio of the short-to-long-axis diameter and the reader’s diagnostic confidence for the presence of lymph node metastasis yielded accuracy of 84.8% and 86.9%, sensitivity of 86.7% and 87.5%, specificity of 81.3% and 86.2%, PPV of 89.7% and 87.5% and NPV of 76.5% and 86.2%, respectively. A long lymph node axis >10 mm and a short diameter >5.8 mm were found to be predictors of malignancy. At USG, instead, the two main characteristics of potentially malignant lymph nodes are cortical thickness and short axis length; the combination of these ultrasound parameters yielded the highest accuracy in distinguishing between negative and positive lymph nodes. Despite the heterogeneity of the included studies and the lack of randomized clinical trials, this review provides a broad overview of the three imaging tools used for the presurgical management of VSCC. Nowadays, although MRI and PET represent the gold standard, ultrasound evaluation is taking on a growing role, as long as it is carried out by expert sonographer. The management of this rare disease should be always performed by a multidisciplinary team in order to precisely stage the tumor and determine the most suitable treatment approach. Full article

Background: Percutaneous dilatational tracheostomy (PDT) is the most commonly performed minimally invasive intensive care unit procedure worldwide. Methods: This study evaluated the percentage of consistency between the entry site observed with fiberoptic bronchoscopy (FOB) and the prediction for the PDT level based on pre-procedural ultrasonography (USG) in PDT procedures performed using the forceps dilatation method. The effect of morphological features on intervention sites was also investigated. Complications that occurred during and after the procedure, as well as the duration, site, and quantity of the procedures, were recorded. Results: Data obtained from a total of 91 patients were analyzed. In 57 patients (62.6%), the USG-estimated tracheal puncture level was consistent with the intercartilaginous space observed by FOB, while in 34 patients (37.4%), there was a discrepancy between these two methods. According to Bland Altman, the agreement between the tracheal spaces determined by USG and FOB was close. Regression formulas for PDT procedures defining the intercartilaginous puncture level based on morphologic measurements of the patients were created. The most common complication related to PDT was cartilage fracture (17.6%), which was proven to be predicted with maximum relevance by punctured tracheal level, neck extension limitation, and procedure duration. Conclusions: In PDT procedures using the forceps dilatation method, the prediction of the PDT intervention level based on pre-procedural USG was considerably in accordance with the entry site observed by FOB. The intercartilaginous puncture level could be estimated based on morphological measurements. Full article

Background and Objectives: Chronic radiotherapy-induced skin injury (cRISI) is an irreversible and progressive condition that can significantly impact a patient’s quality of life. Despite the limited literature available on the assessment of the epidermal barrier in cRISI, there is a consensus that appropriate skincare, including the use of emollients, is the primary therapeutic approach for this group of patients. The aim of this study was to evaluate the biophysical properties of the skin during the late period (at least 90 days) following radiation therapy (RT) for head and neck cancer. Materials and Methods: This was a single-center prospective non-randomized study. It involved the analysis of 16 adult patients with head and neck cancer who underwent RT at the Greater Poland Cancer Center, along with 15 healthy volunteers. The study and control groups were matched for gender and age (p = 0.51). Clinical assessment, based on the LENT-SOMA scale, was conducted for all patients. Evaluation of the skin’s biophysical properties included: an analysis of transepidermal water loss (TEWL), stratum corneum hydration (SCH), and skin visualization using high-frequency ultrasonography (HF-USG). Results: A significantly higher TEWL was observed in the irradiated area compared to the control area in the study group (p = 0.004). However, there was no statistically significant difference in SCH (p = 0.073). Additionally, no significant difference was observed in the values of TEWL and SCH in the irradiated area between the group of patients with and without clinically obvious RISI (p = 0.192 and p = 0.415, respectively). The skin thickness of the irradiated area, assessed by HF-USG, did not differ significantly from the skin thickness of the control area (p = 0.638). Furthermore, no difference in skin thickness was observed in patients with clinical features of cRISI in the irradiated and control areas (p = 0.345). The mean time after RT was 6.1 years. Conclusions: This study marks the first demonstration of epidermal barrier damage in patients in the long term following RT for head and neck cancer. The impairment of the epidermal barrier was observed independently of evident cRISI features. This observation underscores the necessity to recommend appropriate skin care, including the use of emollients, for all patients following RT. We also suggest that HF-USG examination is generally inconclusive in determining the degree of skin damage in the late period after RT. Full article

Background: Parathyroid adenoma is the most common cause of hypercalcemia and rarely leads to a hypercalcemic crisis, which is an unusual endocrine emergency that requires timely surgical excision. Case presentation: A 67-year-old male was admitted to the ER of the Euroclinic Hospital, Athens, Greece, because of elevated calcium levels and a palpable right-sided neck mass, which were accompanied by symptoms of nausea, drowsiness, and weakness for six months that increased prior to our evaluation. A gradual creatinine elevation and decreasing mental state were observed as well. The initial laboratory investigation identified severely elevated serum calcium (3.6 mmol/L) levels consistent with a hypercalcemic crisis (HC) and parathyroid hormone PTH (47.6 pmol/L) due to primary hyperparathyroidism. Neck ultrasonography (USG) identified a large, well-shaped cystic mass in the right thyroid lobe. With a serum calcium concentration of 19.5 mg/dL and a PTH of 225.3 pmol/L, the patient underwent partial parathyroidectomy and total thyroidectomy, which decreased serum calcium and PTH to 2.5 mmol/L and 1.93 pmol/L, respectively. Histology revealed a giant intrathyroidal cystic parathyroid adenoma, which was responsible for the hypercalcemic crisis. Postoperatively, the patient developed severe biochemical and clinical hypocalcemia, with calcium concentrations as low as 1.65 mmol/L, consistent with hungry bone syndrome (HBS), which was treated with high doses of intravenous calcium gluconate and oral alfacalcidol, and a slow recovery of serum calcium. After discharge, parathyroid function recovered, and symptomatology resolved entirely in more than one month. Discussion/conclusions: We present a case involving an exceptionally large intrathyroidal parathyroid adenoma that is characterized by clinical manifestations that mimic malignancy. The identification and treatment of such tumors is challenging and requires careful preoperative evaluation and postoperative care for the risk of hungry bone syndrome. Full article

Background: We aimed to investigate the efficacy of postnatal ultrasonography in detecting congenital anomalies of the kidneys and urinary tract in term infants without prenatal history of congenital anomalies of the kidneys and urinary tract. Methods: In this retrospective cohort study, we reviewed the records of term infants between six weeks and three months of age who underwent urinary tract ultrasonography during routine pediatric care. Results: Congenital anomalies of the kidneys and urinary tract were detected on prenatal ultrasonography in 75 of the 2620 patients included in the study. Congenital anomalies of the kidneys and urinary tract were detected via postnatal USG in 46 (1.8%) of 2554 patients without anomalies on prenatal USG screening. The most common anomaly was hydronephrosis (69.6%). Thirty-two cases of hydronephrosis, three cases of renal agenesis, four cases of horseshoe kidney, one case of MCDK, and two cases of duplex systems which were not detected on prenatal USG were detected on postnatal USG. On the other hand, 29 (1.1%) cases with mild or moderate hydronephrosis on prenatal ultrasonography did not have hydronephrosis on postnatal ultrasonography. Conclusions: In our study, approximately one-third of the cases of hydronephrosis, unilateral renal agenesis, duplex systems, horseshoe kidney, and ectopic kidney were not detected in prenatal ultrasonography screening. Therefore, we believe that in addition to prenatal ultrasonography screening, postnatal ultrasonography screening of all children for urinary tract anomalies would be beneficial. Full article

Background: A feeding tube (FT) is routinely placed in critically ill patients, and its correct placement is confirmed with a chest X-ray (CXR), which is considered the gold standard. This study evaluated the diagnostic accuracy of ultrasonography (USG) in verifying FT placement compared to a CXR in an intensive care unit (ICU). Method: This was a prospective single-blind study conducted on patients admitted to the ICU of a tertiary hospital in Malaysia. The FT placements were verified through a fogging test and USG at the neck and subxiphoid points. The results of confirmation of FT placement through USG were compared with those obtained using CXRs. Results: A total of 80 patients were included in this study. The FT positions were accurately confirmed by overall USG assessments in 71 patients. The percentage of FT placements correctly identified by neck USG was 97.5%, while the percentage of those identified by epigastric USG was 75%. The corresponding patients’ CXRs confirmed correct FT placement in 76 patients. The overall USG assessment had a sensitivity of 92.11% and specificity of 75%, a positive predictive value of 98.59%, and a negative predictive value of 33.33%. The USG findings also showed a significant association between FT size and BMI. FTs with a size of 14Fr were better visualized (p = 0.008), and negative USG findings had a significantly higher BMI (p < 0.001). Conclusion: USG is a simple, safe, and reliable bedside assessment that offers relatively high sensitivity in confirming correct FT placement in critically ill patients. Full article

Hepatocellular cancer (HCC) and biliary tract cancers (BTCs) have poor survival rates and a low likelihood of a cure, especially in advanced-stage disease. Early diagnosis is crucial and can significantly improve survival rates through curative treatment approaches. Current guidelines recommend abdominal ultrasonography (USG) and alpha-fetoprotein (AFP) monitoring for HCC screening in high-risk groups, and abdominal USG, magnetic resonance imaging (MRI), and magnetic resonance cholangiopancreatography (MRCP) monitoring for biliary tract cancer. However, despite this screening strategy, many high-risk individuals still develop advanced-stage HCC and BTC. Blood-based biomarkers are being developed for use in HCC or BTC high-risk groups. Studies on AFP, AFP-L3, des-gamma-carboxy prothrombin, glypican-3 (GPC3), osteopontin (OPN), midkine (MK), neopterin, squamous cell carcinoma antigen (SCCA), Mac-2-binding protein (M2BP), cyclic guanosine monophosphate (cGMP), and interleukin-6 biomarkers for HCC screening have shown promising results when evaluated individually or in combination. In the case of BTCs, the potential applications of circulating tumor DNA, circulating microRNA, and circulating tumor cells in diagnosis are also promising. These biomarkers have shown potential in detecting BTCs in early stages, which can significantly improve patient outcomes. Additionally, these biomarkers hold promise for monitoring disease progression and evaluating response to therapy in BTC patients. However, further research is necessary to fully understand the clinical utility of these biomarkers in the diagnosis and management of HCC and BTCs. Full article

This study evaluated automated machine learning (AutoML) in classifying the presence or absence of hemoperitoneum in ultrasonography (USG) images of Morrison’s pouch. In this multicenter, retrospective study, 864 trauma patients from trauma and emergency medical centers in South Korea were included. In all, 2200 USG images (1100 hemoperitoneum and 1100 normal) were collected. Of these, 1800 images were used for training and 200 were used for the internal validation of AutoML. External validation was performed using 100 hemoperitoneum images and 100 normal images collected separately from a trauma center that were not included in the training and internal validation sets. Google’s open-source AutoML was used to train the algorithm in classifying hemoperitoneum in USG images, followed by internal and external validation. In the internal validation, the sensitivity, specificity, and area under the receiver operating characteristic (AUROC) curve were 95%, 99%, and 0.97, respectively. In the external validation, the sensitivity, specificity, and AUROC were 94%, 99%, and 0.97, respectively. The performances of AutoML in the internal and external validation were not statistically different (p = 0.78). A publicly available, general-purpose AutoML can accurately classify the presence or absence of hemoperitoneum in USG images of the Morrison’s pouch of real-world trauma patients. Full article

Low back pain is a serious threat to human health and the illness jeopardizes the human workforce and pressurizes the health system in the community. Low back pain might be related to piriformis syndrome (PS), which is a disorder presented as muscular spasm and hypertrophy that is strongly associated with piriformis thickness. Nevertheless, the relationship between piriformis thickness and morphological and functional changes of the gluteal muscles in PS remains unclear. This study aimed to investigate the association between the thickness, strength, and activation of piriformis and gluteus muscles (maximus and medius) among low back pain (LBP) patients with and without PS. This is a case-control study conducted at HSNZ and UiTM from 2019–2020. A total number of 91 participants (LBP + PS (n = 36), LBP − PS (n = 24), and healthy (n = 31)) were recruited in this study. Negative radiography, specific symptoms, and a positive PS test were applied for PS diagnoses. The thickness, strength, and activation of piriformis and gluteus muscles were measured using ultrasonography (USG) and a surface electromyogram, respectively. Resultantly, the one-way ANOVA test demonstrated no significant difference in piriformis thickness between LBP + PS and LBP − PS (p > 0.01). Piriformis thickness was inversely correlated with gluteus maximus strength (r = −0.4, p < 0.05) and positively correlated with gluteus medius activation (r = 0.48, p < 0.01) in LBP + PS. Stepwise linear regression for LBP + PS revealed a significant association between piriformis thickness and gluteus maximus strength (R = −0.34, accounted for 11% of the variance) and gluteus medius activation in prone lying with the hip in an externally rotated, abducted, and extended (ERABEX) position (R = 0.43, accounted for 23% of the variance). With the adjustment of age and gender, piriformis thickness, gluteus maximus strength, and gluteus medius activation in prone lying with hip ERABEX demonstrated a significant association, but no independent effect of age and gender was detected within the range. Meanwhile, a significant association between piriformis thickness and gluteus maximus thickness was observed (R = 0.44, accounted for 19% of the variance) in the LBP − PS group. These findings may assist to elucidate the actions and functions of piriformis and gluteus muscle in LBP with and without PS. Full article