Search Results (3,752)

Introduction: High-Intensity Focused Ultrasound (HIFU) is a widely used non-invasive esthetic treatment for facial/neck rejuvenation, inducing thermal coagulation for neocollagenesis. Despite its general safety, its non-optimal application risks neurological adverse events like tinnitus, trigeminal neuralgia, and headaches. Materials and Methods: Out of a pool of 124 patients treated with HIFU (Dual Hi; Med & Tech, Occhiobello, Italy) by experienced esthetic clinicians, four patients developed neurological or otological disturbances, which are presented as descriptive clinical case reports. These included acute tinnitus, exacerbation of pre-existing tinnitus, trigeminal neuralgia during treatment, and post-procedural headaches. To contextualize the clinical findings, relevant published literature on neurological adverse events associated with esthetic HIFU was reviewed in a non-systematic manner using major scientific databases, and used to support descriptive clinical interpretation rather than formal systematic analysis. Results: Rare transient events include acute tinnitus post-HIFU; exacerbated pre-existing tinnitus; trigeminal neuralgia during a procedure; and post-session headaches. Potential mechanisms might include thermal and mechanical nerve injury adjacent to the superficial musculoaponeurotic system (SMAS); all cases resolved successfully through tailored approaches—spontaneous resolution, corticosteroids plus hyperbaric oxygen therapy, analgesics, or ibuprofen. Conclusions: Neurological adverse effects from esthetic HIFU are uncommon/self-limiting but underscore the need for operator training, anatomical expertise, and patient history screening. Standardized protocols are essential for safety. Full article

The study evaluated the conventional extraction (CE), microwave-assisted extraction (MAE), ultrasound-assisted extraction (UAE), and pulsed electric fields-assisted extraction (PEFAE) of bioactive compounds from orange peel waste. The effect of extraction time (0–120 min), ethanol concentration (0, 50 & 80%), and temperature (25–70 °C) were investigated, while response surface methodology (RSM) was applied for each process optimization. MAE achieved the highest total phenolic content (TPC) (6.36 mg/g w.m.) under optimized conditions (50 kJ microwave energy, 50% ethanol, 60 min), representing approximately 12% higher recovery compared to CE (TPC: 5.29 mg/g w.m.; 50 °C, 55% EtOH, 80 min). UAE (90% amplitude, 66.4 W/kg) resulted in the highest flavonoid recovery (0.48 mg/g w.m.) using 50% ethanol at 50 °C for 90 min, while PEFAE (4 kV/cm, 1000 pulses) for 75 min extraction time exhibited the same TPC yield as CE and the highest antioxidant activity (1.12 mg/g w.m.) using only water at room temperature. RSM analysis confirmed that ethanol concentration and extraction time significantly affected extraction performance. These findings demonstrate the potential of green extraction technologies for sustainable valorization of citrus processing waste and recovery of high added-value compounds. Full article

Background and Objectives: Musculoskeletal ultrasound (MSUS) is increasingly used to assess structural changes in knee osteoarthritis (KOA), although measurement reproducibility may vary with examination protocol and operator experience. This pilot study aimed to evaluate intra- and inter-observer reliability for assessing cartilage thickness, osteophyte dimensions and meniscal displacement in supine and weight-bearing conditions in patients with KOA. Material and Methods: This prospective reliability study included patients with KOA stages 2–3 on the Kellgren–Lawrence (K-L) scale. Ultrasound (US) evaluation of cartilage thickness and osteophytes was performed in the supine position, while medial and lateral meniscal extrusion was additionally assessed in bipedal and single-leg conditions using a standardized protocol. Intra- and inter-reproducibility were evaluated through the intraclass correlation coefficient (ICC), agreement analysis and kappa statistics. The analysis was performed using Microsoft Excel (version 2019) and IBM SPSS version 26 software. Results: Both inter-reliability and intra-reliability were evaluated, with intra-rater agreement being constantly higher than inter-rater agreement. From the inter-rater reliability, ICC values ranged from 0.48 to 0.88 for quantitative ultrasound measurements, whereas osteophyte assessment showed Cohen’s k values ranging from 0.71 to 0.86, indicating substantial to almost perfect agreement. Both evaluators identified a higher number of knees with medial meniscal extrusion > 3 mm under weight-bearing conditions than in the supine position. Conclusions: Standardized US evaluation demonstrated at least good reproducibility for structural abnormalities in KOA. Medial and lateral meniscal displacement increased under loading conditions, highlighting the added value of dynamic weight-bearing assessment. However, the clinical significance of load-dependent meniscal extrusion requires further investigation. Full article

Background/Objectives: Uterine fibroids are one of the most prevalent forms of benign tumors in women and may substantially impair quality of life due to heavy menstrual bleeding, pelvic pain, and pressure-related symptoms. Transvaginal radiofrequency ablation (TV-RFA) has emerged as a promising minimally invasive, uterus-sparing treatment approach. However, there exists a paucity of data regarding the early vascular response evaluated through quantitative Doppler parameters. This study aimed to assess the short-term clinical outcomes and ultrasound effectiveness of TV-RFA in treating symptomatic uterine fibroids, with particular emphasis on early vascular and morphological response. Methods: This retrospective study included 38 women who presented with symptomatic uterine fibroids and underwent TV-RFA between July 2024 and December 2025. Inclusion criteria were as follows: (1) presence of up to three intramural fibroids (FIGO types 3–6) and (2) maximum diameter of fibroids: ≤6 cm. Patients were assessed at baseline and at 1- and 3-month follow-up visits. Ultrasound evaluation included the measurement of fibroid dimensions and volume as well as quantitative Doppler parameters (Pixels Power, Ratio, and CM² Power Index). Clinical outcomes were assessed based on the intensity and duration of menstrual bleeding. Statistical analysis was performed using nonparametric tests with significance set at p < 0.05. Results: Significant reductions in fibroid dimensions and volume were observed at both follow-up time points, with the greatest effect at 3 months (p < 0.001). Doppler analysis demonstrated a marked decrease in vascularization parameters, particularly CM² Power Index and Pixels Power (p < 0.001), suggesting an early vascular response to treatment. Clinically, the proportion of patients experiencing heavy menstrual bleeding considerably reduced, accompanied by a significant shortening of bleeding duration (p < 0.001). No major complications requiring surgical intervention were reported. Conclusions: TV-RFA was associated with significant short-term reductions in fibroid vascularization, fibroid volume, and bleeding-related symptoms in this cohort of women with symptomatic uterine fibroids. Quantitative Doppler parameters may serve as valuable early markers of treatment response; however, further studies with larger cohorts and a longer follow-up duration are warranted. Full article

High-frequency ultrasound-assisted activation of peracetic acid (PAA) was investigated as a tunable advanced oxidation process for the removal of organic pollutants from water. Sunset Yellow FCF (SSY), a representative anionic azo dye, was used as a probe contaminant in a 425 kHz sonoreactor to clarify the roles of PAA speciation, acoustic cavitation, dissolved gases, oxidant dose, acoustic power, and initial pH. UV spectroscopic analysis showed that PAA exhibits pH-dependent far-UV absorbance associated with acid-base speciation and peroxide equilibria, while ultrasonication promoted simultaneous PAA activation and H₂O₂ accumulation. Compared with PAA alone and ultrasound alone, the combined US/PAA process markedly enhanced SSY decolorization. Under natural conditions, 5 mg/L SSY and 5 mM PAA were completely decolorized within 210 min, with an initial rate of 0.116 mg/L·min, compared with 0.078 and 0.0086 mg/L·min for ultrasound and PAA alone, respectively. The corresponding synergy ratio and synergy index were 1.5 and 1.34. The process exhibited tunable reaction-pathway control, with two favorable pH windows: a strongly acidic region, where interfacial HO^•-driven sonochemistry and PAA stability are favored, and a mildly alkaline region, where PAA deprotonation promotes peracetate-driven acyl/peroxyl radical-chain propagation. Oxygen saturation improved performance, whereas CO₂ suppressed cavitation-driven activation. Increasing PAA concentration and acoustic power enhanced removal up to practical limits, beyond which radical scavenging and diminishing sonochemical returns became evident. Beyond demonstrating enhanced decolorization, this study distinguishes US/PAA from previously reported UV/PAA, transition-metal/PAA, and ultrasound-only systems by showing how 425 kHz cavitation converts PAA into a tunable hybrid HO^•/acyl–peroxyl radical network. The main contribution is a mechanistic operating map that links PAA speciation, sonochemical peroxide accumulation, dissolved gas chemistry, acoustic power, oxidant dose, and pH to pollutant-removal performance, thereby defining practical windows for sono-activated PAA treatment of anionic dyes and related recalcitrant contaminants. Full article

Hydrodynamic cavitation is assessed as a conditional process-intensification platform for the sustainable recovery and transformation of bioactive and functional fractions from agri-food residues, food-processing by-products, and plant-derived matrices. The analysis focuses on fractions enriched in polyphenols, flavonoids, pectins, carotenoids, proteins, pigments, essential oils, and other value-added compounds with potential relevance for food, nutraceutical, formulation-oriented, and related high-value applications. Rather than being considered an inherently green or universally superior technology, hydrodynamic cavitation is evaluated according to the specific process functions it can provide, including matrix disruption, mass-transfer enhancement, solvent-use reduction, recovery of pectin-associated fractions, protein extraction, macromolecular restructuring, dispersion, and process integration. Quantitative and scale-relevant indicators are considered where available, including recovery yield, target-compound content, solvent use, operating conditions, treated volume, energy input, fraction quality, and reporting limits. Comparison with ultrasound-assisted extraction, microwave-assisted extraction, pulsed electric fields, subcritical water extraction, natural deep eutectic solvents, and enzyme-assisted extraction indicates that its advantage is most defensible when hydrodynamic effects address a clearly identified matrix or process limitation. The available evidence supports substantial potential for wet matrices, plant by-products, aqueous suspensions, and liquid food systems. However, critical gaps remain in energy reporting, selectivity, recovered-fraction stability, scale-up, downstream processing, and application-oriented validation. Recovered fractions should therefore be regarded as candidate ingredients or functional intermediates, rather than as direct evidence of efficacy in final products. Full article

Posterior acoustic shadowing is a key diagnostic feature in ultrasound imaging of calcified lesions, such as gallbladder and kidney stones. However, conventional assessment relies primarily on qualitative interpretation, and its underlying structural characteristics remain insufficiently quantified. This study aimed to quantitatively characterize posterior acoustic shadows using wavelet-based texture analysis and to investigate their diagnostic relevance across different expert-defined shadow confidence groups. Ultrasound B-mode images were analyzed from gallbladder stone and kidney stone datasets. Regions of interest (ROIs) were extracted from gallbladder and kidney stone images across three shadow confidence levels (50–60%, 60–80%, and >80%), and multi-scale wavelet features were computed. The results demonstrated a substantial reduction in high-frequency components with increasing attenuation. Total detail energy decreased by approximately 80% in the gallbladder group and 55–60% in the kidney group from low to high shadow confidence levels. Similarly, normalized ratios (E_{detail/approx} and E_detail/total showed consistent decreases, with inter-group differences of approximately 2.3–2.5-fold at 50–60%, which converged to negligible levels (<2.4% difference) at >80%. These findings suggest that wavelet-based energy distributions may provide acoustically interpretable quantitative descriptors of posterior shadow formation in ultrasound stone imaging. Full article

Accurate assessment of volume status in acute decompensated heart failure (ADHF) remains challenging. Point-of-care ultrasound (POCUS) offers a rapid, non-invasive approach to directly evaluate venous and pulmonary congestion. In this exploratory study, 25 veterans admitted with ADHF underwent serial POCUS examinations of jugular venous pressure (JVP), inferior vena cava (IVC) diameter and collapsibility, and pulmonary B-lines. Pulmonary B-lines were measured using a novel 4-quadrant method. Daily clinical assessments and laboratory data were used to adjudicate volume status. Associations between POCUS findings and clinical congestion were analyzed using chi-square testing. Twenty-four patients were included in the final analysis (mean age 76 years; 96% male; mean BMI 30.86 kg/m²). Elevated JVP on POCUS (≥10 cm H₂O) and IVC diameter > 21 mm were strongly associated with clinical volume overload (p < 0.001 for both). B-lines showed no significant association (p = 0.806). Obesity limited bedside JVP evaluation but did not affect POCUS JVP acquisition. Combined JVP + IVC positivity produced the highest diagnostic concordance with overload status (p <0.001). POCUS assessment of JVP and IVC diameter provided a feasible and reliable method for evaluating congestion in hospitalized patients with ADHF. A novel four-quadrant method of lung ultrasound offered limited additional value. Full article

Background: Abdominal pain in hematological patients, particularly during chemotherapy-induced neutropenia, represents a significant diagnostic challenge due to the broad spectrum of potentially life-threatening conditions, including neutropenic enterocolitis (NEC). Computed tomography (CT) is considered the reference imaging modality; however, its use is limited by radiation exposure, and the need for patient transport. Bedside ultrasound (BS-US) may offer a rapid, non-invasive, and repeatable alternative. Methods: This prospective study compared BS-US and CT in 65 hematological patients presenting with acute abdominal pain. Concordance between the two modalities was evaluated in terms of intestinal site localization, bowel wall thickness (BWT), and final diagnosis. Diagnostic agreement was assessed using Cohen’s kappa coefficient, and additional diagnostic accuracy metrics—including sensitivity, specificity, positive predictive value, and negative predictive value—were calculated. BWT measurements were analyzed using Bland–Altman methods. Results: A high level of agreement was observed between BS-US and CT in both intestinal localization and final diagnosis. Agreement for intestinal site localization was good (Cohen’s κ = 0.964), as was diagnostic concordance (Cohen’s κ = 0.962), and using CT as the reference standard, BS-US showed uniformly good diagnostic performance across all evaluated conditions, with sensitivity, specificity, PPV, and NPV consistently reaching 1.00 and confirming strong agreement between BS-US and CT. These findings were consistent across different clinical settings (hematology unit and Intensive Care Unit) and independent of body mass index. In NEC cases, BWT measurements showed strong concordance between CT and BS-US, with only 4.6% of values outside the limits of agreement in Bland–Altman analysis. Conclusions: BS-US demonstrated a good agreement with CT and proved to be a reliable, safe diagnostic tool in hematological patients with acute abdominal pain. These findings indicate that bedside ultrasound represents a valuable and safe diagnostic tool in neutropenic hematological patients with acute abdominal pain, providing crucial information in a clinically fragile population that may not always be suitable for CT due to their unstable condition. While our study is hypothesis-generating, the role of BS-US in this setting emerges as a reasonable, evidence-supported hypothesis that warrants further prospective evaluation. Full article

Background/Objectives: Fine-needle aspiration biopsy (FNAB) is the primary diagnostic procedure for the evaluation of thyroid nodules. Although considered safe and minimally invasive, its immediate systemic biochemical effects, particularly those related to oxidative stress and mechanical tissue injury, remain insufficiently characterized. This study aimed to evaluate the acute systemic impact of FNAB on oxidative stress parameters and to determine whether these changes correlate with cytological malignancy risk. Methods: A total of 208 patients undergoing ultrasound-guided FNAB for a solitary thyroid nodule were prospectively included. Venous blood samples were collected in the supine position immediately before and within 1 min after the procedure. Thiol–disulfide homeostasis parameters were measured using an automated spectrophotometric method, and ischemia-modified albumin (IMA) levels were analyzed concurrently. Pre- and post-procedural values were compared using the Wilcoxon signed-rank test. Associations between oxidative stress markers and Bethesda cytological categories were assessed using Spearman’s correlation analysis. Results: Native thiol and IMA levels demonstrated statistically significant changes following FNAB, whereas total thiol, disulfide levels, and derived thiol–disulfide ratios remained unchanged. The reduction in IMA levels was predominantly observed in lower-risk cytological categories. No significant correlations were identified between oxidative stress parameters and Bethesda-based malignancy risk. Conclusions: FNAB induces only minor and transient alterations in selected systemic oxidative stress markers, which are clinically inconsequential. The observed changes in native thiol and IMA levels appear to reflect short-term procedural effects rather than malignancy-associated redox alterations. These findings support the systemic safety of FNAB and emphasize the need for careful temporal standardization when interpreting circulating oxidative biomarkers in thyroid nodule research. Full article

Gene therapy is a promising strategy for treating various diseases. However, its application remains limited by inefficient intracellular delivery, particularly in difficult-to-transfect cells such as triple-negative breast cancer (TNBC). Ultrasound-mediated gene delivery has emerged as a non-invasive approach to enhance membrane permeability, but its efficiency and safety depend strongly on acoustic parameters. In this study, we systematically investigated the effects of ultrasound intensity, pulse repetition frequency (PRF), duty cycle, and exposure time on gene delivery efficiency and cytotoxicity in 4T1 murine TNBC cells using microbubble-mediated sonoporation. Gene expressions were evaluated using a luciferase assay, and cell viability was assessed using an MTT assay. Total acoustic energy was calculated to analyze the relationship between cumulative ultrasound exposure and biological responses. Increasing total acoustic energy was associated with enhanced gene expression and reduced cell viability. However, gene expression increased only up to a certain level and then showed no further substantial increase, whereas cell viability continued to decline. Parameter-specific analysis further indicated that biological responses were not determined by total acoustic energy alone. These findings suggest that both cumulative acoustic energy and individual ultrasound parameters should be considered when optimizing ultrasound-mediated gene delivery to balance transfection efficiency and cytotoxicity. Full article

Background: Echo intensity (EI) derived from ultrasound imaging is widely used to assess muscle quality and has been proposed as a potential indicator of neuromuscular performance. Recently, EI band analysis has been suggested as an alternative approach to provide additional information beyond mean EI. However, evidence linking EI bands to functional outcomes remains limited. Methods: Forty-eight male soccer players (26.2 ± 3.6 years) underwent ultrasound assessment of the vastus lateralis (VL) and rectus femoris (RF) muscles. EI was analyzed as mean values and as pixel distribution across five bands (0–50, 51–100, 101–150, 151–200, and 201–255 A.U.), with correction for subcutaneous adipose thickness. Knee extensor peak concentric torque and total work were assessed using isokinetic dynamometry at 60°/s. Generalized linear regression models were used to examine associations between EI variables and mechanical outcomes. Results: No significant differences were observed between limbs for EI mean or EI band distribution in either muscle. The 0–50 A.U. band exhibited the highest pixel percentage for both VL and RF. Mean EI of the RF was negatively associated with peak torque (β = −4.10; 95% CI: −7.35 to −0.86) and total work (β = −3.89; 95% CI: −6.34 to −1.45) of the right knee extensors. No significant associations were found for EI bands or for any EI variables of the VL muscle. In male soccer players, mean EI of the rectus femoris, but not EI band distribution, is associated with knee extensor torque and work output. Conclusions: These findings suggest that mean EI remains a more informative indicator of muscle quality related to strength performance than band-based EI analysis in this athletic population. Full article

Background: Cutaneous squamous cell carcinoma (cSCC) is commonly regarded as a sporadic malignancy primarily driven by ultraviolet exposure. However, the occurrence of multiple, aggressive tumors at a relatively young age suggests the presence of underlying genetic susceptibility. The role of germline variants affecting extracellular matrix organization, pigmentation pathways, and tumor metabolism in aggressive cSCC remains incompletely understood. Case Presentation: We describe a 53-year-old patient with a long-standing history of multiple aggressive cutaneous squamous cell carcinomas involving the scalp and facial regions, characterized by recurrent and multifocal disease. A comprehensive diagnostic approach was undertaken, including histopathological examination, fluorescence confocal microscopy, high-frequency cutaneous ultrasound, and genetic analysis using whole-exome sequencing (WES). Results: Histopathology confirmed high-risk features consistent with aggressive cSCC. Cutaneous ultrasound and fluorescence confocal microscopy provided complementary, non-invasive insights into tumor depth, architecture, and invasive patterns. Whole-exome sequencing identified a heterozygous truncating variant in COL6A3 (NM_004369.4:c.5645C>A, p.Ser1882Ter), classified as likely pathogenic according to ACMG criteria. Additionally, two heterozygous variants of uncertain significance were detected in TYR (NM_000372.5:c.1569C>A, p.Ser523Arg) and FH (NM_000143.4:c.1237-5_1237-4insTCTCCCTCCCTC). Although individually inconclusive, the combined germline genetic background may have contributed to the patient’s aggressive and multifocal cutaneous phenotype. Discussion: This case report supports a potential role of extracellular matrix remodeling, pigmentation-related susceptibility, and metabolic dysregulation in cutaneous carcinogenesis and tumor aggressiveness. This case illustrates how integrating WES with advanced non-invasive imaging techniques can enhance the understanding of biologically aggressive cSCC. Conclusions: This report highlights a unique case of multifocal aggressive cSCC characterized by a distinct germline genetic profile identified by WES and multimodal imaging assessment. Comprehensive molecular and imaging evaluation may be beneficial in selected patients with atypical or aggressive cutaneous squamous cell carcinoma, with implications for personalized surveillance and management. Full article

Accurate estrus detection is essential for optimizing artificial insemination timing, but visual detection is limited by labor demands, intermittent observation, short estrus duration, and variable behavioral expression. Although inertial measurement unit (IMU) systems capture dynamic acceleration and rotational movement, phase-specific IMU-derived activity and posture-related changes during natural estrus remain insufficiently characterized. Therefore, this study evaluated these variables across an ovulation-anchored six-phase framework using video-derived behavioral observations and ultrasound-confirmed ovulation as biological reference standards. In this observational study, five dairy cows contributing eleven natural estrus cycles were monitored, yielding 285,337 time-aligned 10 s sensor observations that were summarized for phase-level analysis. Cow movement was recorded at 10 s intervals using neck-mounted tri-axial accelerometers and gyroscopes, while posture states, estrus-related behaviors, and ovulation timing were determined from continuous video recordings and 6 h transrectal ultrasonography. Extracted variables included signal vector magnitude, VeDBA, Gyro_mag, baseline-adjusted activity features, exploratory Combined Activity Index, posture proportions, and lying bout characteristics. VeDBA was highest during standing estrus, whereas Gyro_mag and the Combined Activity Index increased during pre-estrus and standing estrus. Standing estrus involved less lying, more standing and walking, and shorter lying bout duration. These findings identify candidate IMU-derived and posture-related variables for future standing-estrus differentiation models and potential insemination-timing support, pending validation in larger independent populations. Full article

Artificial intelligence (AI) technologies, which are being actively developed in modern medicine today, increase the speed and quality of patient care. This article mainly seeks to demonstrate the use of various options of computer analysis of clinical images to solve practical problems of increasing the efficiency of routine diagnostics using retrospective analysis, as well as show the potential for its widespread implementation (due to the scalability of the architecture) in practical healthcare, exemplified by ultrasound (US) and magnetic resonance imaging (MRI) data analysis. This is an interuniversity study, its research protocol was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the local Ethics Committee of Orel State University named after I. S. Turgenev (Protocol No. 25 dated 16 November 2022). The software was developed using Python 3.7 and open neural network models. Statistical processing included an efficiency assessment for which IBM SPSS Statistics 20.0 was used. Detection errors in the analysis of 550 US cases did not exceed 6–8% and were associated with technical difficulties due to image quality. When studying 1030 MRI studies, only 0.19% of cases failed to obtain reliable image analysis results. The differences in the average values for the dimensional characteristics of the studied vessels were 0.11–0.12 mm. The effectiveness of AI in clinical tasks is presented. The improvement in segmentation accuracy was achieved through the use of step-by-step image optimization during the AI training stage. The evolution of technologies in medicine, aimed at digitalization and personalization, is intended to improve the quality and speed of studying images in practical work. Full article