Search Results (1,329)

Background and Clinical Significance: Spina bifida in the cervical region is closely associated with Chiari malformation, which is an amalgamation of terminology for separate conditions with similar pathophysiological mechanisms and progression from one another. Chiari malformations are associated with varying degrees of dilation of the foramen magnum or lack of fusion of the occipital bone with syringomyelia, herniation of the cerebellum, occipitocele and occipitomyelocele; Case Presentation: A previously healthy 23-year-old primigravida presented to our institution due to fetal demise in the third lunar month, established on routine outpatient maternal consultation. Point-of-care ultrasound revealed an amniotic sac measuring 3 cm in diameter and containing a single fetus, without cardiac function. Due to these, the patient was scheduled for pregnancy termination, during which the cervix was noted to be spontaneously dilated and abrasion accomplished complete evacuation of the amniotic sac, without its rupture. Upon sectioning of the amniotic sac, a fetus, measuring 2.5 cm in length, was noted, with a significant cuffing of the occipital and cervical paraspinal region. Histology revealed fetal structures with an adequate maturation index for its gestational age, but it presented with a pronounced meningoencephalomyelocele in the cervical and thoracic regions, characterized by the complete absence of vertebral arches and spinous processes from the atlanto-occipital to the sacral region; Conclusions: In the present case, not only is a significant and complex form of Chiari type III reported, but the condition is also associated with spina bifida aperta in all spinal regions, leading to meningoencephalomyelocele, incompatible with life. Full article

Background and Clinical Significance: Scapular stress fractures are exceptionally rare in athletes and are notoriously difficult to diagnose due to their subtle presentation and poor sensitivity on initial radiographs. This case report describes the diagnostic challenge of a scapular body stress fracture in an elite boxer who initially presented with wrist pain. Case Presentation: A 19-year-old right-hand-dominant female elite boxer presented with a three-month history of bilateral wrist pain. Initial examination and MRI were consistent with a triangular fibrocartilage complex (TFCC) injury. Despite conservative management, her symptoms persisted, and she subsequently developed mechanical right shoulder pain and a sensation of instability. Physical examination revealed scapular dyskinesis, with a positive push-up test and weakness on punch protraction. Plain radiographs of the scapula were unremarkable. Point-of-care musculoskeletal ultrasound (MSK US) identified a cortical irregularity at the medial scapular border. A subsequent computed tomography (CT) scan obtained at three-month follow-up definitively confirmed a stress fracture at this site. Treatment focused on scapular stabilization via prolotherapy and activity modification, leading to symptomatic resolution and a successful return to sport. Conclusions: This case underscores the importance of evaluating the entire kinetic chain in athletes presenting with focal complaints. It demonstrates the utility of MSK US as an effective initial screening tool for cortical stress fractures and highlights the necessity of CT for definitive confirmation. Clinicians should maintain a high index of suspicion for scapular stress injuries in overhead athletes with unexplained shoulder dysfunction. Full article

Background: Proximal hamstring tendinopathy (PHT) is a challenging overuse injury, particularly in athletes, characterized by deep buttock pain localized to the ischial tuberosity and often exacerbated by sports activities. This condition can impact an athlete’s performance, limiting high-level athletic activity. Return to sport (RTS) thus becomes a medical, physical, athletic, and economic necessity. Previous research has explored several conservative and injection-based therapies, but evidence regarding the efficacy of porcine collagen injections remains limited. Therefore, this study aims to compare the results obtained from ultrasound-guided porcine collagen injections versus a structured rehabilitation program in reducing time to return to sport (RTS) and improving Victorian Institute of Sport Assessment—Hamstring (VISA-H) scores with respect to athletes with clinically diagnosed PHT. Conservative approaches for PHT treatments include various options, such as physiotherapy, corticosteroids, plasma-rich-platelet, shockwave therapy, and collagen injection. Collagen demonstrated to be a validated option for tendinopathies treatment due its regenerative and restorative mechanism of action. Methods: Retrospective data were collected from twenty-eight athletes with a clinical diagnosis of PHT, confirmed based on pain provocation tests (Puranen–Orava, bent-knee, and modified bent-knee tests), who were divided into two groups: COL and REHAB. The VISA-H outcomes were recorded for all subjects. The COL group received three ultrasound-guided collagen injections at weekly intervals, plus standard care instructions. The REHAB group completed a progressive exercise program targeting hamstring and lumbopelvic stabilization. The primary outcomes were RTS time (days) and VISA-H scores at baseline and 8 weeks. Adverse effects were recorded. Results: The two groups of treatment were very homogeneous and showed parametric distribution concerning the biological and pathophysiological conditions. No adverse events were reported. The mean times to RTS were 57 and 72 days for COL and REHAB, respectively (p = 0.0083). The VISA-H results revealed better improvement for the COL group than the REHAB treatment (p < 0.0001), and the log-rank test showed a higher odds ratio (HR) for RTS, 5.35 (p = 0.0008), for the COL athletes. Conclusions: Ultrasound-guided porcine collagen injections, combined with standard care, significantly reduced RTS time and improved VISA-H scores compared with rehabilitation alone in athletes with PHT. However, a larger cohort of athletes might be needed to gather more information about this conservative treatment in PHT pathology. Full article

We demonstrate coating-free optoacoustic generation and focusing of ultrasound using a mechanically Q-switched (MQS) erbium-doped yttrium aluminum garnet (Er:YAG) source (~100 ns, ≤20 mJ) combined with a concave water interface that simultaneously serves as converter and acoustic lens. Axial, lateral, and focal-point measurements mapped the pressure field while varying beam diameter (2w = 5–15 mm) and pulse energy (E = 10–20 mJ). The maximum focal positive pressure (P_max = 7 MPa) occurs at an intermediate diameter (~10 mm), whereas the tightest lateral/axial confinement and strongest spectral enhancement arise at larger diameters (14–15 mm) with f_c = ~5 MHz and −6 dB bandwidth up to 7 MHz. Pressure increases nearly monotonically with energy. For equal fluence, larger diameters yield higher focal pressures due to greater focusing gain. Small beams (2w ≈ 5–7 mm) show shorter apparent time-of-flight (TOF) and waveform broadening, consistent with early shock-like emission from locally vaporizing region. These results provide practical rules for tuning amplitude, spectrum, and confinement, enabling sub-millimeter focusing for contamination-sensitive and therapeutic applications. Full article

The background of the article refers to the diagnosis of focal liver lesions (FLLs) through contrast-enhanced ultrasound (CEUS) based on the integration of spatial and temporal information. Traditional computer-aided diagnosis (CAD) systems predominantly rely on static images, which limits the characterization of lesion dynamics. This study aims to assess the effectiveness of Transformer-based architectures in enhancing CAD performance within the realm of liver pathology. The methodology involved a systematic comparison of deep learning models for the analysis of CEUS images and videos. For image-based classification, a Hybrid Transformer Neural Network (HTNN) was employed. It combines Vision Transformer (ViT) modules with lightweight convolutional features. For video-based tasks, we evaluated a custom spatio-temporal Convolutional Neural Network (CNN), a CNN with Long Short-Term Memory (LSTM), and a Video Vision Transformer (ViViT). The experimental results show that the HTNN achieved an outstanding accuracy of 97.77% in classifying various types of FLLs, although it required manual selection of the region of interest (ROI). The video-based models produced accuracies of 83%, 88%, and 88%, respectively, without the need for ROI selection. In conclusion, the findings indicate that Transformer-based models exhibit high accuracy in CEUS-based liver diagnosis. This study highlights the potential of attention mechanisms to identify subtle inter-class differences, thereby reducing the reliance on manual intervention. Full article

Metabolic dysfunction-associated steatotic liver disease (MASLD) is rapidly emerging as the leading cause of chronic liver disease, closely tied to rising global obesity rates. Endoscopic bariatric therapies (EBTs), including endoscopic sleeve gastroplasty (ESG), intragastric balloons (IGB), duodenal-jejunal bypass liners (DJBL), and duodenal mucosal resurfacing (DMR), offer minimally invasive interventions that target metabolic dysfunction and weight loss. This review synthesizes current evidence on the mechanisms and hepatic outcomes of EBTs in MASLD, highlighting improvements in hepatic steatosis, liver stiffness, and fibrosis biomarkers across multiple modalities. ESG is consistently associated with reductions in hepatic steatosis and fibrosis scores across multiple studies. IGB therapy improves liver stiffness and reduces hepatic fat as assessed by imaging modalities such as MRI- Proton Density Fat Fraction and ultrasound. DJBL lowers liver enzymes and improves non-invasive markers of steatohepatitis like the Fibroscan-AST score, although its effect on fibrosis appears limited. DMR demonstrates reductions in liver fat, particularly in patients with type 2 diabetes, but evidence for histological improvement in MASLD remains inconsistent. Despite their promise, most EBT studies remain limited by small sample sizes and short follow-up. Further randomized trials are needed to validate long-term efficacy and position EBTs alongside or as alternatives to surgical interventions for MASLD. Full article

Background/Objectives: Alcohol and smoking during pregnancy may be associated with several complications, but the underlying mechanism is still unclear. The aim of this study was to evaluate the role of oxidative stress induced by smoking and alcohol during pregnancy and their effects on fetal and neonatal outcomes. Material and methods: We considered pregnant women at term. Validated questionnaires were used to investigate smoking and alcohol habits. Ultrasound was performed to evaluate fetal weight, amniotic fluid index, and maternal-fetal Doppler velocimetry. At the time of delivery, we collected a tuft of maternal hair, maternal venous blood, and cord blood. In these samplings we determined in phase I nicotine, cotinine, and ethyl glucuronide on the maternal keratin matrix with the gas chromatography-mass spectrometry technique. In phase II, the Free Oxygen Radicals Test (FORT) and Free Oxygen Radical Defense (FORD) test were used to assess circulating reactive oxygen species (ROS). Results: 119 pregnant patients were enrolled (n = 62 for smoking and n = 57 for alcohol). Twenty-six patients (42%) out of 62 were active smokers. Three patients (5%) out of 57 were alcoholic consumers. Mean neonatal weight and mean placental weight were significantly lower for active smokers (p = 0.0001). The neonatal weight was in the 1st–2nd percentile for all alcohol abusers. Considering two subgroups (n = 10 non-smokers and n = 10 smokers) for ROS determination, a statistically significant higher oxidative stress in the blood of smoking patients was evidenced (p < 0.0001). In cord blood the differences were not statistically significant (p = 0.2216). Conclusions: Fetal growth restriction was present in the group of active smokers and in patients with alcohol abuse. Oxidative stress was higher in smoking patients than in non-smokers. However, in cord blood, FORT was negative in all cases, suggesting a protective mechanism in utero. Given the limited sample size, the results obtained are preliminary and require future studies. Full article

Patients presenting with abdominal pain and/or distension require rapid diagnostics to narrow the differential diagnosis from a long list of obstructive gastrointestinal (GI) pathologies that may appear clinically similar but warrant distinct management. While the workup of abdominal distension currently centers around computed tomography (CT), this modality is costly, requires radiation exposure, and necessitates patient transport, potentially delaying care. In contrast, point-of-care ultrasound (POCUS) avoids ionizing radiation and the need for patient transport while providing some insight into the gastrointestinal size and function. While POCUS cannot currently replace CT in the definitive diagnosis of GI obstructive pathologies, it remains a promising tool to help with the initial triage and monitoring responses to therapy for several causes of functional and/or mechanical GI obstruction, such as gastric dilation, ileus, and small bowel obstruction. Because the obstruction severity and features can evolve over time, POCUS enables serial examinations to monitor the progression or resolution. This manuscript reviews characteristic sonographic findings that help distinguish obstructive GI conditions and highlights practical techniques for integrating gastric and intestinal POCUS to improve diagnostic accuracy and expedite treatment. Full article

Diabetic skeletal muscle atrophy is one of the most serious complications among diabetes-related complications. LIPUS enhances muscle regeneration and repair in skeletal muscle injuries. However, whether LIPUS can improve skeletal muscle atrophy in mice with T1DM has not been studied. This study involves forty male C57BL/6 mice randomly divided into four groups: normal control group (NC), streptozocin (STZ)-induced T1DM mice (T1D), T1DM mice treated with LIPUS (DL), and T1DM mice treated with insulin (DI). The DL group was treated on the quadriceps of mice with LIPUS (1 MHz, 80 mW/cm², 20 min/day) for 6 weeks. The results demonstrated that LIPUS significantly improved muscle function by increasing the cross-sectional area, mass, and strength of skeletal muscles. In addition, LIPUS significantly effectively lowered the blood glucose levels of T1DM mice. The knockout of myostatin (MSTN) (MSTN^−/−) and knockin of MSTN (MSTN^+/+) mice were employed to verify the underlying mechanism. The results indicated that LIPUS reduces blood glucose levels in T1DM mice by improving their muscle atrophy. This study demonstrated that LIPUS will become a novel therapy for the treatment of skeletal muscle atrophy caused by T1DM. Full article

This study investigates the formation of hydroxyl radicals (OH radicals) in cavitation bubble plasma-treated water (CBPTW) using a chemical probe method. CBPTW samples were prepared with different electrode materials (W, Fe, Cu, and Ag), and the chemical scavenger was added two minutes after the completion of cavitation and plasma treatments. The concentrations of metal ions and hydrogen peroxide (H₂O₂) generated in the CBPTW were also measured over time. This study reveals a novel mechanism whereby metal nanoparticles and ions released from electrodes catalyze the continuous generation of hydroxyl radicals in CBPTW, which has not been fully addressed in previous studies. The results suggest a continuous generation of OH radicals in CBPTW prepared with W, Fe, and Cu electrodes, with the amount of OH radicals produced in the order Cu > Fe > W. The study reveals a correlation between OH radical production and electrode wear, suggesting that the continuous generation of OH radicals in CBPTW results from the catalytic decomposition of H₂O₂ by metal nanoparticles or ions released from the electrodes. It should be noted that cavitation bubble plasma (CBP) is fundamentally different from sonochemistry. While sonochemistry utilizes ultrasound-induced cavitation to generate radicals, CBP relies on plasma discharge generated inside cavitation bubbles. No ultrasound was applied in this study; therefore, all observed radical formation is attributable exclusively to plasma processes rather than sonochemical effects. However, the precise mechanism of continuous OH radical formation in CBPTW remains unclear and requires further investigation. These findings provide new insights into the role of electrode materials in continuous OH radical generation in cavitation bubble plasma treated water, offering potential applications in water purification and sterilization technologies. Full article

Sarcopenia, a progressive age-related loss of skeletal muscle mass, strength, and function, is a major contributor to disability, reduced quality of life, and mortality in older adults. While current diagnostic approaches, such as dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), magnetic resonance imaging (MRI), and computed tomography (CT), are widely used to assess muscle mass, they have limitations in detecting early qualitative changes in muscle architecture and composition. Shear Wave Elastography (SWE), an ultrasound-based technique that quantifies tissue stiffness, has emerged as a promising tool to evaluate both muscle quantity and quality in a non-invasive, portable, and reproducible manner. Studies suggest that SWE can detect alterations in muscle mechanical properties associated with sarcopenia, providing complementary information to traditional morphometric assessments. Preliminary evidence indicates its good reproducibility, feasibility in various clinical settings, and potential for integration into routine evaluations. This narrative review summarizes current evidence on the use of SWE for the assessment of sarcopenia across diverse populations. Full article

Background and Clinical Significance: Benign paroxysmal positional vertigo (BPPV) most commonly involves the posterior semicircular canal (PSC), whereas anterior semicircular canal BPPV (ASC-BPPV) is rare, accounting for only 1–3% of cases. Most ASC-BPPV cases respond well to particle repositioning maneuvers (PRMs), with refractory presentations being exceptional and diagnostically challenging, particularly when differential diagnoses such as apogeotropic posterior semicircular canal BPPV (PSC-BPPV) or central causes must be excluded. Case Presentation: A 43-year-old woman presented with vertigo triggered by head extension and rolling in bed. Initial neurological and otoneurological examinations were unremarkable. During the left Dix–Hallpike maneuver, a vertical down-beating nystagmus with subtle leftward torsion appeared after a 5 s latency and lasted 15 s. The supine head-hanging maneuver provoked a stronger and longer 30 s response, while the right Dix–Hallpike was negative. Despite repeated PRMs, including Yacovino (Deep Head-hanging), reverse Epley, Epley, and modified Semont maneuvers, the patient remained symptomatic over three years. Intermittently, conversion to PSC-BPPV was suspected, and temporary resolution was achieved after left-sided Epley and Semont maneuvers, but recurrence followed. Treatment with a mechanical rotational chair (TRV) initially resolved symptoms, but vertigo recurred several months later following two syncopal episodes with minor trauma. Extensive neurological evaluation, including MRI, CT, EEG, and vascular ultrasound, excluded central causes. Conclusions: This case illustrates the diagnostic and therapeutic difficulties posed by refractory ASC-BPPV, particularly in differentiating it from apogeotropic PSC-BPPV and central etiologies. It underscores the importance of latency, torsional characteristics, and supine head-hanging testing in diagnosis and demonstrates the potential role of mechanical rotational chairs in management. Personalized approaches incorporating anatomical imaging and maneuver adaptation are essential in such complex cases. Full article

Sonochlorination (US/chlorine) is an emerging sonohybrid advanced oxidation process whose performance reportedly surpasses that of its individual components. However, the underlying oxidant budget is still being debated. We mapped the mechanism by systematically probing the US/chlorine system with selective scavengers (ascorbic acid, nitrobenzene, tert-butanol, 2-propanol, and phenol), competing anions (nitrite), and natural organic matter (humic acid). The kinetic hierarchy US/chlorine > US > chlorine remained consistent across all conditions, though its magnitude depended heavily on the matrix composition. Efficient ^•OH traps, such as alcohols and nitrobenzene, only partially suppressed the US/chlorine system. However, they greatly slowed sonolysis. This reveals a substantial non-^•OH channel in the hybrid process. Ascorbic acid eliminated synergy by stoichiometrically removing free chlorine. Phenol quenched HOCl and chlorine-centered radicals. Nitrite imposed a dual penalty by scavenging ^•OH and consuming HOCl via the nitryl chloride (ClNO₂) pathway. Humic acid acted as a three-way sink for ^•OH, HOCl, and chlorine radicals. These patterns suggest that reactivity is co-controlled by Cl^•, Cl₂^•−, and ClO^•. The results obtained are mechanistically consistent with cavitation-assisted activation of HOCl/OCl⁻ at pH 5–6, where HOCl concentration is maximal. This yields a mixed oxidant suite in which Cl₂^•− is the dominant bulk oxidant, Cl^• provides fast interfacial initiation, and ClO^• offers selective support. Full article

Patients who present nutritional risk upon hospital admission are more likely to have worse clinical outcomes. Evaluating muscle thickness with ultrasound is a predictor of muscle mass loss in pediatric patients. We reviewed the muscle mass loss detection through ultrasound to assess the body composition of pediatric patients. We found an association between muscle reduction, as detected by ultrasound, and the duration of mechanical ventilation, nutritional deficits in energy and protein intake, and the age-related skeletal muscle atrophy of the limbs. All studies reported a reduction in muscle thickness of more than 10% during hospitalization. There is a lack of standardization in muscle mass assessment protocols and established cut-off points in critically ill hospitalized children. Further studies are needed to establish an accurate and standardized analysis for monitoring muscle changes using ultrasound. Full article

Externally governed hydrogel swelling is a highly convenient yet inherently challenging process, as it requires both responsive materials and appropriately tuned external stimuli. In this work, for the first time, the influence of simultaneous action of external physical fields—ultrasound (US) and microwave heating (MW), combined with cooling—on the isothermal swelling kinetics of poly(methacrylic acid) (PMAA) hydrogel was investigated and compared with swelling under conventional thermal heating (TH) under isothermal conditions. Swelling kinetics were monitored over a temperature range of 248–318 K, under simultaneous cooling with either US, MW, or TH. The well-established Peppas model was used to determine swelling kinetics parameters, revealing a significant acceleration in the swelling process under MW (up to 48.8 times at 313 K), as well as different water penetrating mechanisms (non-Fickian diffusion) compared to TH and US (Super-case II). Additionally, it was demonstrated that the swelling conversion curves could be mathematically described using a “shrinking boundary surfaces” model. Isothermal swelling constants and the corresponding kinetic parameters (activation energy E_a and pre-exponential factor ln A) were calculated. The results confirmed that external physical fields significantly influence the thermal activation and swelling behavior of PMAA xerogels, offering insight into field-responsive transport processes in hydrogel networks. Full article