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Abstract Background It has been observed that there is a high incidence of hemorrhoids in female patients with pelvic organ prolapse. Also, in these patients, hemorrhoidal disease improves after the surgical correction of the pelvic organ prolapse. Objective Our hypothesis was that a cause-effect relationship between pelvic organ prolapse, and hemorrhoids might be the key. The objective of this study was to find an element which connects these two conditions. Study Design We conducted a pilot study which consisted of two parts. An initial part, in which we asked several patients with grades III and IV pelvic organ prolapse and hemorrhoids, who have undergone surgery for prolapse, to determine the impact of the surgical restoration of the prolapsed organs on their hemorrhoidal disease. For the second part, on several patients with uncorrected uterine prolapse grades III and IV, we determined the resistive index of the hemorrhoidal branches within the rectal wall before and after manual reduction of the prolapse. Results First, more than 50% of patients who underwent uterine prolapse correction described an improvement of their hemorrhoidal disease of over 50%. Second, the resistive index of the hemorrhoidal branches was significantly lower after manual reduction of the prolapse. We consider that obstructed veins due to pelvic organ prolapse might induce the dilation of the hemorrhoids. The direct measurement of the resistive index of the hemorrhoidal branches allows us to directly assess the increased resistance in the rectal vascular system. Conclusion Venous stasis and impaired vascular flow might be the pathophysiological explanation for the association between pelvic organ prolapse and hemorrhoids. In these patients, the pathogenic treatment should aim at the restoration of a normal blood flow (prolapse surgical cure) instead of focusing on hemorrhoids only.(AU)
Subject(s)
Pelvic Organ Prolapse/surgery , Hemorrhoids/etiology , Rectum/blood supply , Ultrasonography, Doppler , Pelvic Organ Prolapse/complicationsABSTRACT
Background:Acute kidney injury (AKI) is a common complication after on pump coronary artery bypass grafting (CABG) surgery and is associated with a poor prognosis. Postoperative AKI is associated with morbidity, mortality, and increase in length of intensive care unit (ICU) stay and increases the financial burden. Identifying individuals at risk for developing AKI in postoperative period is extremely important to optimize outcomes. The aim of the study is to evaluate the association between the intraoperative transesophageal echocardiography (TEE) derived renal resistive index (RRI) and AKI in patients undergoing on?pump CABG surgery. Methods: This prospective observational study was conducted in patients more than 18 years of age undergoing elective on pump CABG surgery between July 1, 2018, and December 31, 2019, at a tertiary care center. All preoperative, intraoperative, and postoperative parameters were recorded. TEE measurement was performed in hemodynamically stable patients before the sternum was opened. Postoperative AKI was diagnosed based on the serial measurement of serum creatinine and the monitoring of urine output. Results: A total of 115 patients were included in our study. Thirty?nine (33.91%) patients had RRI >0.7 while remaining seventy?six (66.08%) patients had RRI <0.7. AKI was diagnosed in 26% (30/115) patients. AKI rates were significantly higher in patients with RRI values exceeding 0.7 with 46.15% (18/39) compared to 15.75% (12/76) in RRI values of less than 0.7. Multivariate analysis revealed that AKI was associated with an increase in RRI and diabetes mellitus. The RRI assessed by receiver operating characteristic (ROC) curve and the area under the curve (AUC) to distinguish between non?AKI and AKI groups were 0.705 (95% CI: 0.588–0.826) for preoperative RRI. The most accurate cut?off value to distinguish non?AKI and AKI groups was a preoperative RRI of 0.68 with a sensitivity of 70% and specificity of 67%. Conclusions: An increased intraoperative RRI is an independent predictor of AKI in the postoperative period in patients undergoing CABG surgery. The cutoff value of TEE?derived RRI in the intraoperative period should be >0.68 to predict AKI in the postoperative period.
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Background: PIH is associated with increased vascular resistance and decreased utero -placental perfusion resulting in an increased incidence of foetal hypoxia and impaired foetalgrowth.The objective of this study was to assess the diagnostic performance of S/D ratio, resistance index(RI), pulsatility index (PI) and cerebro-placental ratio (CPR) in the prediction of adverse perinatal outcome in PIH and IUGR. Objective: is to determine S/D ratio, RI, PI, CPR and asses their diagnostic values in the prediction of adverse perinatal outcome.Material& Methods:50 pregnant patients with PIH and IUGR, beyond 28 weeks of gestation, were prospectively studied at P k das institute of medical college,vaniyamkulamand subjected for Doppler study of the umbilical artery and foetal middle cerebral artery. The abnormality of above parameters was correlated with the major adverse perinatal outcome.Results:Patients with abnormal Doppler parameters had a poor perinatal outcome, compared to those who had normal Doppler study. The cerebro-placental ratios(CPR) had the sensitivity and specificity, positive and negative predictive values of 95%,76%,73%,95% respectively with Kappa value of o .68(good agreement) and p value of .000 which was statistically significant, for the prediction of major adverse perinatal outcome.Conclusions:This study shows that Doppler study of umbilical and foetal middle cerebral artery can reliably predict the neonatal morbidity and helpful in determining the optimal time of delivery in complicated pregnancies. The CPR is more accurate than the independent evaluation of S/D, RI, PI, in identifying foetus with adverse perinatal outcome.
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INTRODUCTION@#Nonalcoholic fatty liver disease (NAFLD) is a metabolic disorder with a wide clinical continuum of liver diseases like focal hepatic steatosis, steatohepatitis, advanced fibrosis, and cirrhosis that usually progress in a rectilinear fa sh ion. Through this course, NAFLD endure certain hemodynamic changes in the hepatic arterial blood flow. Thus, identification of patients with advanced liver fibrosis is indispensable.@*PURPOSE@#To determine the concordance of Hepatic Artery Resistive Index (HARi) and Bard Fibrosis Score in the assessment of advanced liver fibrosis among patients with NAFLD and across its different disease severity.@*MATERIALS AND METHODS@#Observational descriptive study design was used. 94 NAFLD patients without history of excessive alcohol consumption were invited and voluntarily participated in the research investigation. Ultrasound scanning of the liver to include color Doppler parameters (Peak systolic volume [PSV], end diastolic volume [EDV] and HAR/) and determination of BARD Fibrosis score (Body mass index [BM/], fasting blood sugar [FBS] and AST/ ALT ratio) were done. Different grading across NAFLD was established.@*RESULTS@#The HARi of NAFLD with BARD Fibrosis scores of 1, 2, 3, and 4 has an average index of 0.84, 0.75 0.54 and 0.52, respectively. There is an unwavering inverse correlation between HARi to BARD Fibrosis scoring system (r=-0.84). Across the different severity of NAFLD, grade Ill (severe) has the lowest mean HARi at 0.53 followed by grade 11 (moderate) at 0.76 and grade I (mild) at 0.81. Correspondingly, the BARD Fibrosis score showed inverse ranking pattern across the different severity of NAFLD. Grade I (mild) has the lowest BARD fibrosis score followed by grade II (moderate) and grade Ill (severe), which yielded having a mean score of 1.00, 3.29 and 3.56, respectively.@*CONCLUSION@#The HARi has demonstrated a significant negative correlation with advanced liver fibrosis when correlated with BARD fibrosis score. Thus, this study showed that the conventional Doppler US with hepatic artery indices and laboratory variables are helpful in detecting fibrous tissue accumulation in the course of NAFLD.
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RESUMEN Objetivo: Evaluar los valores de referencia de la dinámica circulatoria arterial ocular de los pacientes con hipertensión arterial esencial. Métodos: Se realizó un estudio descriptivo y transversal en 105 pacientes hipertensos y en un grupo de 33 sujetos no hipertensos, con edades comprendidas entre 18 y 60 años, sin antecedentes de padecer diabetes mellitus ni enfermedades oculares como glaucoma, o haber recibido tratamiento quirúrgico por catarata, hipertensión ocular u otras. A todos se les realizó la toma de la presión arterial sistémica, el examen clínico oftalmológico y el ultrasonido Doppler a color de carótida y de los vasos orbitarios. Resultados: Se encontró un predominio de mujeres de piel blanca, entre la cuarta y quinta década de la vida. Existió un incremento del pico de velocidad sistólica, la velocidad final diastólica y el índice de resistencia en la arteria oftálmica, que fue desde un rango normal en el grupo de los no hipertensos a valores promedios elevados en el grupo de hipertensos, los cuales fueron más altos en los casos descontrolados. No se encontraron modificaciones en el análisis de estos parámetros en las arterias centrales de la retina ni en las ciliares posteriores cortas. Conclusiones: En la casuística estudiada, el incremento del pico de la velocidad sistólica en la arteria oftálmica pudiera estar relacionado con áreas de obstrucción vascular localizadas o con vasoespasmo. Se encontró una asociación entre el descontrol de la presión arterial y los valores elevados del índice de resistencia en la arteria oftálmica(AU)
ABSTRACT Objective: Evaluate the reference values for ocular arterial circulation dynamics in patients with essential arterial hypertension. Methods: A descriptive cross-sectional study was conducted of 105 hypertensive patients and a group of 33 non-hypertensive subjects aged 18-60 years with no antecedents of diabetes mellitus or ocular conditions such as glaucoma or having undergone cataract surgery, ocular hypertension or others. All the patients underwent systemic arterial pressure measurement, clinical ophthalmological examination and color Doppler carotid and orbital ultrasonography. Results: A predominance was observed of the female sex, white skin color and age between the fourth and fifth decades of life. There was an increase in peak systolic velocity, end diastolic velocity and the resistive index in the ophthalmic artery, which ranged from normal in the non-hypertensive group to high average levels in the hypertensive group, higher in uncontrolled cases. Analysis of these parameters did not find any change in central retinal or short posterior ciliary arteries. Conclusions: In the cases studied, the peak systolic velocity increase in the ophthalmic artery could be related to localized vascular obstruction areas or vasospasm. An association was found between uncontrolled arterial pressure and high resistive index values in the ophthalmic artery(AU)
Subject(s)
Humans , Adolescent , Adult , Middle Aged , Ocular Hypertension/etiology , Ultrasonography, Doppler/methods , Arterial Pressure , Epidemiology, Descriptive , Cross-Sectional StudiesABSTRACT
Background: Hypertensive disorders like pre-eclampsia along with hemorrhage and infection, contributes greatly to maternal morbidity and mortality. Various pro and antiangiogenic factors like sFlt-1 and Plgf have been linked to the etiopathogenesis of placental vascular disease and their combination with uterine artery doppler studies may improve the prediction accuracy. Present study was conducted to analyze sFlt-1/Plgf ratio and uterine artery doppler indices among high risk patients and to compare these in prediction of preeclampsia.Methods: A prospective observational study was conducted from September 2017 to February 2019 in which 100 patients giving consent and satisfying inclusion criteria were evaluated for various risk factors and were subjected to sFlt-1/Plgf ratio test and uterine artery doppler study at 22-24 weeks period of gestation. They were followed up and maternal outcome was analysed.Results: Among the cohort of 100 women with high risk factors, 35% of the study participants developed pre-eclampsia. Using sFlt-1/Plgf ratio 40% of them were screened positive for pre-eclampsia. This percentage of screened positive was 40%, 43%, and 53% using uterine artery RI, PI, and SD respectively. sFlt-1/Plgf was found to have a sensitivity of 91.4% and specificity of 87.7%. ROC curve analysis showed highest area under curve (AUC) for sFlt-1/Plgf (0.858).Conclusions: sFlt-1/Plgf ratio was found to be a better predictable biomarker than uterine artery Doppler indices in prediction of pre-eclampsia at 22-24 weeks period of gestation.
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Introduction: Hepatorenal syndrome (HRS) is the most serious complication of renal dysfunction in patients with chronic liverdisease (CLD). Renal arterial vasoconstriction may persist for weeks, even months before an increase of blood urea nitrogenor serum creatinine values can be discovered.[1] Duplex Doppler ultrasonography of the kidneys is an easy and non-invasivemethod to assess blood flow and arterial vascular resistance as a parameter for vasoconstriction.[2-4] Intrarenal resistive index(RI) may be superior to serum creatinine levels as an indicator in patients with liver cirrhosis for the detection of patients at riskfor the development of HRS.Objective: The objective of the study was to correlate renal Doppler indices with serum creatinine levels in various stages ofCLD and to determine its role in predicting the risk for developing HRS in patients of CLD.Materials and Methods: Grayscale, color flow, and duplex Doppler ultrasonography were performed inpatients of CLD, whichwere divided into four groups with increasing clinical severities. There serum creatinine level was compared with renal Dopplerindices in various groups of increasing severity.Results: Most common cause of CLD in our study population was alcoholism (62%). About 65% of cases show irregular liversurface, and irregular liver surface is significantly higher in Groups II, III, and IV versus Group 1. Heterogeneous, homogenous,and fatty echo texture were showed by 78%, 11%, and 11%, respectively. Mean peak systolic velocity and end-diastolic velocityin our study are 33.99 cm/s and 11.55 cm/s, respectively. Mean pulsatility index in cases was 1.17. In our present study, RIlevel was significantly higher in cirrhotic patients, and there is a significant association between RI and study groups. As theseverity of liver disease of group increases, the RI value also gets elevated.Conclusion: Intrarenal RI seems to be a helpful predictor to identify a subgroup of CLD patients with a higher risk of developingkidney failure or HRS, which can translate into the early initiation of treatment for impending HRS.
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Background: In view of the fact that Brightness (B)-mode ultrasound findings in patients with renal parenchymal disease are profoundly non-specific, this study was carried out to determine the efficiency of color Doppler sonography for assessing renal function. In this series, the relationship between the resistive index (RI) of renal interlobar artery and serum creatinine level was analyzed for any relevant association of this color Doppler index with the serum creatinine level.Methods: In this prospective cross-sectional study, 40 patients with renal parenchymal disease having serum creatinine level >1.4 mg/dL were chosen midst routine revisits. The control group comprised of 40 normal subjects with serum creatinine levels <1.4 mg/dL. After assessing the kidneys of these subjects with gray-scale ultrasound for presence of any stones, hydronephrosis, and/or space occupying lesions instead of, they were subsequently interrogated with color Doppler sonography and RI calculated.Results: The mean serum creatinine levels±SD in the case and control groups were 6.7±0.7 mg/dL and 1.0±0.4 mg/dL, respectively. The mean±SD resistive index (RI) was 79.0%±1.8% in the diseased group and 60.3%±0.7% in the healthy subjects (p<0.001). The correlation between the RI and the serum creatinine level was statistically significant (p<0.001).Conclusions: Resistive index (RI) measurement by color doppler ultrasonography is a reasonable prognosticator of functional outcome in patients with renal parenchymal disease.
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ABSTRACT Objective: Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age. The renal resistive index (RRI) is a measure of renal arterial resistance to blood flow. The aim of this study was to investigate the renal resistive index levels of patients with PCOS. Subjects and methods: A total of 216 women were included in this cross-sectional study. The study group consisted of 109 patients with PCOS, and the control group consisted of 107 healthy subjects. The RRI of all subjects was measured using renal Doppler ultrasonography. Results: The patients with PCOS had higher RRI levels in comparison to the healthy subjects (0.64 ± 0.06 vs. 0.57 ± 0.06, p < 0.001). The RRI levels of the patients with PCOS were correlated with systolic blood pressure (p = 0.004, r = 0.268) and with homeostasis model assessment of insulin resistance (HOMA-IR) (p = 0.02, r = 0.216). Conclusion: In this study, we observed higher RRI levels in patients with PCOS. High RRI levels may be an indicator of cardiovascular and/or cardiovascular-associated diseases in patients with PCOS.
Subject(s)
Humans , Male , Female , Adult , Polycystic Ovary Syndrome/physiopathology , Kidney/physiopathology , Blood Pressure , Insulin Resistance , Cross-Sectional Studies , Ultrasonography, Doppler, Color , Kidney/diagnostic imagingABSTRACT
Background: Hypertensive disorder along with hemorrhage and infection contribute greatly to maternal mortality and morbidity. Pregnancy induced hypertension remains among the most significant and intriguing unsolved problems in obstetrics.Methods: In this prospective analytical study investigations and color doppler findings 0f umbilical artery PI, RI and end diastolic flow in same, uterine PI, RI and persistent diastolic notch in uterine artery recorded. Total 100 Cases of PIH between 20-36 weeks of gestation in 2 years with B.P ≥ 140/90 mm hg and protienuria ≥ 1+ were observed.Results: In this study, out of 100 cases, there were 58 cases of mild PIH (58%) and 42 cases of severe PIH (42%). Umbilical artery PI was elevated in 43(43.0%) patients and was normal in 57(57.0%) patients. Umbilical artery RI was more than and equal to 0.7 in 77 patients (77%) and was below of 0.7 in 23 (23%) pa-tients.9(9.0%) fetuses showed absence and 14 (14.0%) fetus had reversal and 46 (46.0%) had reduced end diastolic umbilical artery flow with total 69 out of 100 fetuses having abnormal waveforms.65 (65%) mothers had an elevated uterine artery PI and 35(35%) patients had normal uterine artery PI. in observation 69 (69%) patients were having RI more than 0.6, while 31 (31%) were having less than 0.6 out of 100 patients. In this study, 65 (65.0%) women were having persistent diastolic notch.Conclusions: This study was to evaluate arterial flow velocities as a predictor of impending pregnancy induced hypertension with raised RI and PI along with umbilical ab-sent or reverse end diastolic flow velocities and elevated RI and PI in the presence of a diastolic notch are considered as abnormal uterine doppler findings doppler finding with unfavorable outcome.
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Objective To explore the predicting performance of renal resistive index (RRI), semi quantitative power Doppler ultrasound (PDU) score and serum cystatin C (Cys C) for acute kidney injury (AKI) in patients with cardiac failure or sepsis. Methods A prospective, observational study was conducted. Critically ill patients with acute cardiac failure or sepsis admitted to the emergency intensive care unit (ICU) of Cangzhou Central Hospital from January 1st to December 31st in 2018 were enrolled. In addition to the demographic data, serum Cys C, RRI, and PDU score were measured within 6 hours after admission to ICU. Renal function was assessed on day 5 according to Kidney Disease:Improving Global Outcomes (KDIGO) criteria. Patients who proceeded to AKI stage 2 or 3 within 5 days from admission were defined as the AKI 2-3 group; other patients were classified into the AKI 0-1 group. The differences of each index were compared in all patients, cardiac failure patients and sepsis patients between the two groups. Multivariate binary Logistic regression was carried out to identify the independent risk predictors of AKI 2-3. Receiver operator characteristic (ROC) curves were plotted to examine the values of Cys C, RRI, PDU score, and RRI+PDU in predicting AKI 2-3. Results Thirty-seven patients with cardiac failure (11 with no AKI, 10 with AKI stage 1, 3 with AKI stage 2, and 13 with AKI stage 3) and 26 patients with sepsis (8 with no AKI, 2 with AKI stage 1, 7 with AKI stage 2, and 9 with AKI stage 3) were recruited. In all patients as well as the subgroup of cardiac failure, compared with the AKI 0-1 group, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, sequential organ failure assessment (SOFA) score, rate of continuous renal replacement therapy (CRRT), 28-day mortality, serum creatinine (SCr), Cys C and RRI were higher in AKI 2-3 group, and urine output, PDU score were lower; in the subgroup of sepsis, rate of CRRT, SCr, and Cys C were higher in AKI 2-3 group, and urine output was lower. Multivariate Logistic regression analysis found that Cys C and PDU score were independent risk factors for AKI 2-3 in all patients [Cys C: odds ratio (OR) = 11.294, 95% confidence interval (95%CI) was 2.801-45.541, P = 0.001; PDU score: OR = 0.187, 95%CI was 0.056-0.627, P = 0.007]; RRI and PDU score were independent risk factors for AKI 2-3 in patients with cardiac failure [RRI (×10): OR = 6.172, 95%CI was 0.883-43.153, P = 0.067; PDU score: OR = 0.063, 95%CI was 0.007-0.584, P = 0.015]; Cys C was the independent risk factor for AKI 2-3 in patients with sepsis (OR = 22.830, 95%CI was 1.345-387.623, P = 0.030). It was shown by ROC curve analysis that: in the subgroup of cardiac failure, the predictive values of RRI, PDU score and Cys C were well [area under the curve (AUC) and 95%CI was 0.839 (0.673-0.942), 0.894 (0.749-0.971), 0.777 (0.610-0.897), all P < 0.01]. RRI+PDU performed best in predicting AKI (AUC = 0.956, 95%CI was 0.825-0.997, P < 0.01), and the predictive value was higher than Cys C [AUC (95%CI): 0.956 (0.825-0.997) vs. 0.777 (0.610-0.897), P = 0.034]. In the subgroup of sepsis, the predictive value of Cys C was well (AUC = 0.913, 95%CI was 0.735-0.987, P < 0.01), however, the predictive value of RRI, PDU, RRI+PDU were poor. Conclusions RRI and PDU score effectively predict AKI stage 2 or 3 in cardiac failure patients, but not in patients with sepsis. The predictive values of Cys C for AKI are similar in patients with cardiac failure or sepsis.
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Objective To explore the predicting performance of renal resistive index (RRI), semi quantitative power Doppler ultrasound (PDU) score and serum cystatin C (Cys C) for acute kidney injury (AKI) in patients with cardiac failure or sepsis. Methods A prospective, observational study was conducted. Critically ill patients with acute cardiac failure or sepsis admitted to the emergency intensive care unit (ICU) of Cangzhou Central Hospital from January 1st to December 31st in 2018 were enrolled. In addition to the demographic data, serum Cys C, RRI, and PDU score were measured within 6 hours after admission to ICU. Renal function was assessed on day 5 according to Kidney Disease:Improving Global Outcomes (KDIGO) criteria. Patients who proceeded to AKI stage 2 or 3 within 5 days from admission were defined as the AKI 2-3 group; other patients were classified into the AKI 0-1 group. The differences of each index were compared in all patients, cardiac failure patients and sepsis patients between the two groups. Multivariate binary Logistic regression was carried out to identify the independent risk predictors of AKI 2-3. Receiver operator characteristic (ROC) curves were plotted to examine the values of Cys C, RRI, PDU score, and RRI+PDU in predicting AKI 2-3. Results Thirty-seven patients with cardiac failure (11 with no AKI, 10 with AKI stage 1, 3 with AKI stage 2, and 13 with AKI stage 3) and 26 patients with sepsis (8 with no AKI, 2 with AKI stage 1, 7 with AKI stage 2, and 9 with AKI stage 3) were recruited. In all patients as well as the subgroup of cardiac failure, compared with the AKI 0-1 group, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, sequential organ failure assessment (SOFA) score, rate of continuous renal replacement therapy (CRRT), 28-day mortality, serum creatinine (SCr), Cys C and RRI were higher in AKI 2-3 group, and urine output, PDU score were lower; in the subgroup of sepsis, rate of CRRT, SCr, and Cys C were higher in AKI 2-3 group, and urine output was lower. Multivariate Logistic regression analysis found that Cys C and PDU score were independent risk factors for AKI 2-3 in all patients [Cys C: odds ratio (OR) = 11.294, 95% confidence interval (95%CI) was 2.801-45.541, P = 0.001; PDU score: OR = 0.187, 95%CI was 0.056-0.627, P = 0.007]; RRI and PDU score were independent risk factors for AKI 2-3 in patients with cardiac failure [RRI (×10): OR = 6.172, 95%CI was 0.883-43.153, P = 0.067; PDU score: OR = 0.063, 95%CI was 0.007-0.584, P = 0.015]; Cys C was the independent risk factor for AKI 2-3 in patients with sepsis (OR = 22.830, 95%CI was 1.345-387.623, P = 0.030). It was shown by ROC curve analysis that: in the subgroup of cardiac failure, the predictive values of RRI, PDU score and Cys C were well [area under the curve (AUC) and 95%CI was 0.839 (0.673-0.942), 0.894 (0.749-0.971), 0.777 (0.610-0.897), all P < 0.01]. RRI+PDU performed best in predicting AKI (AUC = 0.956, 95%CI was 0.825-0.997, P < 0.01), and the predictive value was higher than Cys C [AUC (95%CI): 0.956 (0.825-0.997) vs. 0.777 (0.610-0.897), P = 0.034]. In the subgroup of sepsis, the predictive value of Cys C was well (AUC = 0.913, 95%CI was 0.735-0.987, P < 0.01), however, the predictive value of RRI, PDU, RRI+PDU were poor. Conclusions RRI and PDU score effectively predict AKI stage 2 or 3 in cardiac failure patients, but not in patients with sepsis. The predictive values of Cys C for AKI are similar in patients with cardiac failure or sepsis.
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Objective@#To explore the predicting performance of renal resistive index (RRI), semi quantitative power Doppler ultrasound (PDU) score and serum cystatin C (Cys C) for acute kidney injury (AKI) in patients with cardiac failure or sepsis.@*Methods@#A prospective, observational study was conducted. Critically ill patients with acute cardiac failure or sepsis admitted to the emergency intensive care unit (ICU) of Cangzhou Central Hospital from January 1st to December 31st in 2018 were enrolled. In addition to the demographic data, serum Cys C, RRI, and PDU score were measured within 6 hours after admission to ICU. Renal function was assessed on day 5 according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Patients who proceeded to AKI stage 2 or 3 within 5 days from admission were defined as the AKI 2-3 group; other patients were classified into the AKI 0-1 group. The differences of each index were compared in all patients, cardiac failure patients and sepsis patients between the two groups. Multivariate binary Logistic regression was carried out to identify the independent risk predictors of AKI 2-3. Receiver operator characteristic (ROC) curves were plotted to examine the values of Cys C, RRI, PDU score, and RRI+PDU in predicting AKI 2-3.@*Results@#Thirty-seven patients with cardiac failure (11 with no AKI, 10 with AKI stage 1, 3 with AKI stage 2, and 13 with AKI stage 3) and 26 patients with sepsis (8 with no AKI, 2 with AKI stage 1, 7 with AKI stage 2, and 9 with AKI stage 3) were recruited. In all patients as well as the subgroup of cardiac failure, compared with the AKI 0-1 group, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, sequential organ failure assessment (SOFA) score, rate of continuous renal replacement therapy (CRRT), 28-day mortality, serum creatinine (SCr), Cys C and RRI were higher in AKI 2-3 group, and urine output, PDU score were lower; in the subgroup of sepsis, rate of CRRT, SCr, and Cys C were higher in AKI 2-3 group, and urine output was lower. Multivariate Logistic regression analysis found that Cys C and PDU score were independent risk factors for AKI 2-3 in all patients [Cys C: odds ratio (OR) = 11.294, 95% confidence interval (95%CI) was 2.801-45.541, P = 0.001; PDU score: OR = 0.187, 95%CI was 0.056-0.627, P = 0.007]; RRI and PDU score were independent risk factors for AKI 2-3 in patients with cardiac failure [RRI (×10): OR = 6.172, 95%CI was 0.883-43.153, P = 0.067; PDU score: OR = 0.063, 95%CI was 0.007-0.584, P = 0.015]; Cys C was the independent risk factor for AKI 2-3 in patients with sepsis (OR = 22.830, 95%CI was 1.345-387.623, P = 0.030). It was shown by ROC curve analysis that: in the subgroup of cardiac failure, the predictive values of RRI, PDU score and Cys C were well [area under the curve (AUC) and 95%CI was 0.839 (0.673-0.942), 0.894 (0.749-0.971), 0.777 (0.610-0.897), all P < 0.01]. RRI+PDU performed best in predicting AKI (AUC = 0.956, 95%CI was 0.825-0.997, P < 0.01), and the predictive value was higher than Cys C [AUC (95%CI): 0.956 (0.825-0.997) vs. 0.777 (0.610-0.897), P = 0.034]. In the subgroup of sepsis, the predictive value of Cys C was well (AUC = 0.913, 95%CI was 0.735-0.987, P < 0.01), however, the predictive value of RRI, PDU, RRI+PDU were poor.@*Conclusions@#RRI and PDU score effectively predict AKI stage 2 or 3 in cardiac failure patients, but not in patients with sepsis. The predictive values of Cys C for AKI are similar in patients with cardiac failure or sepsis.
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To investigate the value of renal resistive index (RRI) in early predictor and discriminator of severe acute pancreatitis (SAP)-related acute kidney injury (AKI). Methods A retrospective observational study was conducted. SAP patients complicated with AKI (within 1 week of onset) and admitted to intensive care unit (ICU) of Ruijin Hospital Shanghai Jiaotong University School of Medicine from January 2016 to June 2019 were enrolled. The RRI within 24 hours admission was measured. Clinical data such as acute physiology and chronic health evaluation Ⅱ(APACHEⅡ), heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), intra-abdominal pressure (IAP), arterial blood lactate (Lac), oxygenation index (PaO2/FiO2), base excess (BE), serum creatinine (SCr), urine output, norepinephrine (NE) and RRI were collected. Within 24 hours and 7 days after ICU admission, patients were grouped according to AKI classification criteria of Kidney Disease: Improving Global Outcomes (KDIGO), and the differences of relevant parameters were statistically analyzed. Influence factors of AKI grading were screened by Logistic regression analysis. Pearson correlation analysis was used to analyze the correlation between RRI and other parameters. The predictive value of RRI for AKI classification was analyzed by receiver operating characteristic (ROC) curve. Results A total 57 patients were included, with an average age of (54.6±13.5) years old, and APACHEⅡscore of 21.8±5.6. Within 24 hours, the number of patients suffered from stage 1-3 AKI were 19 (33.3%), 18 (31.6%) and 20 (35.1%), respectively. On day 7, the number of patients suffered from stage 0-3 AKI were 21 (36.9%), 8 (14.0%), 9 (15.8%) and 19 (33.3%), respectively. The higher APACHEⅡ score, CVP, IAP, Lac, NE dosage and RRI were found in the group with higher AKI grades, especially in the group with stage 3 AKI on day 7. RRI of patients with stage 3 AKI was significantly higher than that of patients with stage 1 and 2 AKI within 24 hours (0.74±0.04 vs. 0.65±0.05, 0.68±0.05, both P < 0.05). Similarly, RRI of patients with stage 2 and 3 AKI were significantly higher than that of patients with stage 0 and 1 AKI on day 7 (0.70±0.04, 0.74±0.04 vs. 0.65±0.05, 0.66±0.05, all P < 0.05). Multivariate Logistic regression analysis showed that RRI was an independent factor of AKI classification [odds ratio (OR) = 3.15, 95% confidence interval (95%CI) = 1.09-9.04, P < 0.05], and IAP and CVP also had significant impacts on AKI grading [OR value was 2.11 (95%CI = 1.16-4.22), 3.78 (95%CI = 1.21-12.90), both P < 0.05]. ROC curve analysis showed that the area under curve (AUC) of RRI for predicting AKI ≥2 stage was 0.87 (P < 0.05); the cut-off ﹥ 0.71, sensitivity was 71% and specificity was 83%. The correlation analysis showed that RRI was positively correlated to a certain extent with IAP and lactic acid (r1 = 0.49, r2 = 0.39, both P < 0.05). Conclusion High RRI on ICU admission was a significant predictor for development of severe AKI during the first week, and RRI can help predict the tendency of AKI in SAP.
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AIM:To evaluate changes in pulsatile ocular blood flow in normal tension glaucoma ( NTG) patients. METHODS: In this prospective case control study color Doppler imaging ( CDI ) was used to determine ocular blood flow parameters- peak systolic velocity( Vmax ) , end diastolic velocity ( Vd ) , time average mean of maximum velocity ( TAmax ) , pulsatility index ( PI ) , resistive index ( RI ) and systolic/diastolic ratio ( S/D ) in ophthalmic artery ( OA ) , central retinal artery ( CRA ) and short posterior ciliary artery ( SPCA ) in NTG patients and a comparision was made with the normal subjects. Unpaired Student's t-test was used to compare the two groups and P≤0. 05 was considered significant. RESULTS:Vmax in OA, CRA and SPCA in the NTG group was decreased when compared to normals with P values 0. 605, 0. 254 and 0. 348 respectively. Vd in the NTG group was also decreased in all the three vessels when compared to the normal subjects with P values 0. 000, 0.014 and 0. 138 in OA, CRA, and SPCA respectively. The PI and RI were increased in all the vessels in the NTG group with P values 0. 000 and 0. 045 for the OA, 0. 000 and 0. 006 for the CRA and 0. 002 and 0. 024 for the SPCA. S/D ratio was increased in the NTG group as compared to normals with P values 0. 047, 0. 041 and 0. 189 in OA, CRA and SPCA respectively. CONCLUSION: This study concludes that CDI may provide an effective way of measuring part of the vascular component of glaucoma. We found decreased blood flow velocity and increased resistive indices in the ocular vasculature in the NTG group as compared to normal subjects.
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Objective To explore the correlations between renal artery resistance index (RRI) and renal function in patients with thrombotic microangiopathy (TMA) so as to provide the clinical basis for predictable diagnosis and treatment in patients with acute kidney injury (AKI).Methods Patients diagnosed with thrombotic microangiopathy admitted to department of emergency of Peking Union Medical College Hospital between August 1st,2014 and March 31th,2015 were enrolled.Intrarenal arteries resistive index of right kidney was detected in all cases on admission by color Doppler flow image.The serum creatinine (SCR) and glomerular fihration rate (GFR) were measured at the same time.According to the diagnostic criteria of the guideline of Kidney Disease:Improving Global Outcomes 2012 (KDIGO-AKI 2012),patients were divided into non-AKI group and AKI group.The intergroup difference was compared and the correlation between RRI and SCR as well as between RRI and GFR were assessed.RRI,SCR and GFR were measured again at the most severe stage of kidney injury.The above index were marked as RRI*,SCR and GFRmin.At the same time,△RRI (RRI*-RRI),△SCR (SCRmax-SCR) and △GFR (GFR-GFRmin) were calculated.According to the stage classification of KDIGO-AKI 2012,36 patients diagnosed with AKI during their hospitalization were divided into KDIGO-1 group (n =10),KDIGO-2 group (n =10) or KDIGO-3 group (n =16).The intergroup difference of RRI* was compared and the correlation between △RRI and △SCR as well as between △RRI and △GFR were assessed.Results When RRI ＞ 0.7 was used as the diagnostic threshold for AKI,the sensitivity was 92.3％ and the specificity was 80.1％.RRI was positively correlated with SCR (r1 =-0.728,P＜0.01;r2=-0.709,P＜0.01) and negatively correlated with GFR (r1 =-0.728,P＜0.01;r2 =-0.709,P ＜0.01) in all patients at the time of admission and the most severe stage of kidney injury.While there was a significant difference in the RRI* among KDIGO-1,KDIGO-2 and KDIGO-3 groups (F =37.979,P =0.Q01),and there was no significant difference in △RRI (F =0.634,P =0.537).The △RRI was not correlated with △GFR or △SCR.Conclusions RRI can be used as a marker for diagnosis of AKI and the evaluation of renal function in patients with TMA,but it is not helpful to reflect the trends of renal injury especially for the critically ill patients.
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PURPOSE: The authors evaluated the relationships between the clinical factors and resistive indexes (RIs) of prostate and urethral blood flows by using power Doppler transrectal ultrasonography (PDUS) in men with benign prostatic hyperplasia (BPH). METHODS: The data of 110 patients with BPH and lower urinary tract symptoms (LUTS) treated between January 2015 and July 2015 were prospectively collected. PDUS was used to identify the capsular and urethral arteries of the prostate in order to measure RIs. International Prostate Symptom Score (IPSS), maximal flow rate (Qmax), total prostate volume (TPV), transition zone volume (TZV), transition zone index (=TZV/TPV), presence of intravesical prostatic protrusion (IPP), and the RIs of capsular and urethral arteries were evaluated for all of the patients by one urologist. RESULTS: The 110 patients were categorized according to IPSS (mild symptoms, 0-7; moderate symptoms, 8-19; and severe symptoms, 20-35), Qmax (<10 and ≥10 mL/sec), TPV (<30 and ≥30 mL), and presence or absence of IPP. No significant relationship was found between the mean RI of any artery and IPSS or Qmax. The mean RIs of the urethral artery, and left and right capsular arteries were significantly dependent on prostate size and the presence of IPP. CONCLUSIONS: RI obtained by using PDUS correlated with the presence of IPP and prostate size. The RI of prostate blood flow can be used as a noninvasive diagnostic tool for BPH with LUTS.
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Humans , Male , Arteries , Lower Urinary Tract Symptoms , Prospective Studies , Prostate , Prostatic Hyperplasia , UltrasonographyABSTRACT
background: to determine the usefulness of Doppler ultrasound measurement of resistive index (RI) in differentiating obstructive from non-obstructive hydronephrosis in children. Methods: From August 2011 to November 2012, renal Doppler assessments of the intra-renal renal arteries were performed on 16 children (19 kidneys) with congenital hydronephrosis. the independent t-test was used to assess for significant difference in RI values between those with obstructive hydronephrosis (6 kidneys) and those with non-obstructive hydronephrosis (13 kidneys) as determined by dynamic renal scintigraphy. the assessor was blinded to the clinical findings and scintigraphy results. Results: RI was significantly different between obstructive and non-obstructive hydronephrosis. Obstructive hydronephrosis returned higher RI values, with mean RI of 0.78. Mean RI in non-obstructive hydronephrosis was 0.70, and the difference was significant (p <0.05). the sensitivity and specificity of Doppler ultrasound were 100% and 53% respectively. conclusion: Doppler ultrasound measurement of resistive index is useful in differentiating obstructive from nonobstructive hydronephrosis and provides an alternative non-ionizing investigation other than dynamic renal scintigraphy.
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Background and Aim: Resistive index (RI) is an indirect measurement of blood flow resistance that can be used to evaluate vascular damage in ophthalmologic disease. The purpose of this study was to evaluate the association between RI values of orbital arteries using the color Doppler imaging (CDI) in geriatric hypertensive patients with or without retinopathy. Setting and Design: Designed as a cross‑sectional study. Materials and Methods: We evaluated 60 geriatric patients with hypertension (Group 1) and 30 healthy subjects (Group 2). Further, the patients with hypertension were grouped into two: Group 1a consisted of patients with retinopathy (n = 30), and group 1b consisted of patients without retinopathy (n = 30). The mean RI values of ophthalmic artery (OA), central retinal artery (CRA), and posterior ciliary artery (PCA) were measured using CDI. Results: Compared to group 2, group 1 had significantly higher mean resistive index of PCA levels (P = 0.017), whereas there were no statistical difference in mean resistive indexes of OA and CRA (both P > 0.05). Besides, there were no statistical difference in mean resistive indexes of OA, CRA, and PCA between the group 1a and group 1b (P > 0.05 for all). Mean resistive indexes of OA, CRA, and PCA were significantly correlated with the duration of hypertension (r = 0.268, P = 0.038; r = 0.315, P = 0.014; r = 0.324, P = 0.012, respectively). Conclusions: Our study indicates that RI might be a useful marker for the ocular hemodynamic of retinal vessels, provides morphologic and vascular information in hypertension and hypertensive retinopathy.
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Color Doppler imaging (CDI) was carried out to evaluate the effects of anti-glaucoma drugs on ophthalmic circulation using CDI-derived resistive index (RI) values. CDI was performed on nine Beagle dogs, and RI values were calculated for the medial long posterior ciliary artery before and after the administration of anti-glaucoma drugs. A significant increase in RI values was found after topical administration of levobunolol (p < 0.05) or dipivefrin (p < 0.05). Pilocarpine showed no effects on RI values after topical administration. The results suggest that some anti-glaucoma drugs could affect ophthalmic blood flow.