Mensuración ecográfica del complejo nervio óptico-vaina en la hipertensión intracraneal / Ultrasonographic imaging of the optic nerve-sheath complex in intracranial hypertension

Objetivo: Determinar la relación entre el grosor del complejo nervio óptico-vaina, mensurado por ecografía y la hipertensión intracraneal. Métodos: Se realizó un estudio observacional descriptivo y longitudinal en 144 órbitas de 72 pacientes con diagnóstico clínico de hipertensión intracraneal. Una vez alcanzada la mejoría clínica, se les practicó ultrasonido orbitario al inicio del diagnóstico, el cual permitió mensurar la vaina meníngea, el nervio óptico, el complejo nervio óptico-vaina y la altura de la papila. Resultados: En la totalidad de los casos el grosor inicial de la vaina fue ≥ 3 mm, el del complejo nervio óptico-vaina > 5 mm, y la altura de la papila > 0,8 mm, mientras que el del nervio óptico no superó los 3 mm. Tras alcanzar la mejoría clínica se demostró disminución de todas estas variables, con excepción del nervio óptico, cuyo diámetro casi no se modificó. Algunas diferencias evidenciadas entre la primera y la segunda medición ecográfica fueron estadísticamente significativas. Conclusión: Por tanto, este proceder se ratifica como parte del monitoreo neurológico integral en pacientes con hipertensión intracraneal sospechada o confirmada(AU)

Objective: To determine the relationship between the thickness of the optic nerve- sheath complex as measured by ultrasound and intracranial hypertension. Methods: A descriptive and longitudinal observational study was performed in 144 orbits of 72 patients with a clinical diagnosis of intracranial hypertension. Once clinical improvement was achieved, orbital ultrasound was performed at the beginning of the diagnosis, which allowed measuring the meningeal sheath, the optic nerve, the optic nerve-sheath complex and the height of the papilla. Results: In all cases the initial thickness of the sheath was ≥ 3 mm, that of the optic nerve-sheath complex > 5 mm, and the height of the papilla > 0.8 mm, while that of the optic nerve did not exceed 3 mm. After reaching clinical improvement, a decrease in all these variables was demonstrated, with the exception of the optic nerve, whose diameter was almost unchanged. Some differences between the first and second ultrasound measurements were statistically significant. Conclusion: Therefore, this procedure is ratified as part of the full neurological monitoring in patients with suspected or confirmed intracranial hypertension(AU)

Morphological index of fetal cerebral ventricular development: a diagnostic ultrasound study / Índice morfológico del desarrollo ventricular cerebral fetal: un estudio ecográfico diagnóstico

SUMMARY: To establish an unprovable diagnostic indicative index reference for ultrasound examination of the fetal cerebral ventricles, based on the morphological characteristics throughout fetal nervous system development. Key ultrasonic morphological indicators of fetal ventricular development, which includes frontal horn width (FHW), occipital horn width (OHW), width of 3rd ventricle, cavity of septum pellucidum (CSP), width and length of 4th ventricle and thalamo-occipital distance (TOD) had been measured and analyzed collectively. All data of the indicators was collected on singleton pregnant woman between 16-39 weeks of gestational age (GA), between November 2017 and June 2021 at the Second Hospital of Dalian Medical University. A total of 235 pregnant women were enrolled in the cross section study; another 36 pregnant women voluntarily joined a timeline-tracking follow-up study (cohort study) under the same examining criteria. A decrease of FHW and OHW of the lateral ventricles was observed as GA increased; while dimensional values of TOD, 3rd ventricle, CSP, as well as 4th ventricle increased with GA. Most of these indicators showed an enhanced variation tendency within a certain period of GA. Moreover, values of FHW and TOD showed asymmetry of the two hemispheres within the whole GA. Our findings revealed the morphological regularity of fetal ventricular development, which would instructively enhance the relative clinical ultrasound diagnosis; moreover, TOD also showed regularly changes as GA increased, suggesting that TOD should be considered as an additional routine ultrasonic indicator for fetal ventricular development.

RESUMEN: El objetivo del estudio fue establecer un índice de referencia indicativo diagnóstico no demostrable para el examen ecográfico de los ventrículos cerebrales fetales, basado en las características morfológicas a lo largo del desarrollo del sistema nervioso fetal. Indicadores morfológicos ultrasónicos clave del desarrollo ventricular fetal, que incluyen el ancho del cuerno frontal (FHW), el ancho del cuerno occipital (OHW), el ancho del tercer ventrículo, la cavidad del septo pelúcido (CSP), el ancho y el largo del cuarto ventrículo y la distancia tálamo-occipital (TOD) fueron medidos y analizados conjuntamente. Todos los datos de los indicadores se recopilaron en mujeres embarazadas de un solo feto entre 16 y 39 semanas de edad gestacional (EG), entre noviembre de 2017 y junio de 2021 en el Segundo Hospital de la Universidad Médica de Dalian. Un total de 235 mujeres embarazadas se inscribieron en el estudio transversal; otras 36 mujeres embarazadas se unieron voluntariamente a un estudio de seguimiento de línea de tiempo (estudio de cohorte) bajo los mismos criterios de examen. Se observó una disminución de FHW y OHW de los ventrículos laterales a medida que aumentaba la GA; mientras que los valores dimensionales de TOD, tercer ventrículo, CSP y cuarto ventrículo aumentaron con GA. La mayoría de estos indicadores mostraron una tendencia de variación mejorada dentro de un cierto período de GA. Además, los valores de FHW y TOD mostraron asimetría de los dos hemisferios dentro de toda la AG. Nuestros hallazgos revelaron la regularidad morfológica del desarrollo ventricular fetal, lo que mejoraría de manera instructiva el diagnóstico clínico de ultrasonido relativo; además, TOD también mostró cambios regulares a medida que aumentaba la GA, lo que sugiere que TOD debe considerarse como un indicador ultrasónico de rutina adicional para el desarrollo ventricular fetal.

Application progress of point-of-care ultrasound monitoring inferior vena cava in volume management of critically ill patients / 中华危重病急救医学

Determining whether patients have volume-responsiveness is one of the frequently asked questions in the intensive care unit, especially in shock patients. Evaluating the volume status and volume responsiveness can help clinical medical staff accurately grasp the patient's cardiac preload, guide reasonable volume management, and help improve patient prognosis. Therefore, many non-invasive and invasive methods have been proposed to evaluate volume responsiveness. Inferior vena cava ultrasound has been widely used to guide the fluid management of critically ill patients due to its simplicity, non-invasiveness, and good repeatability. This article reviews the clinical applications of inferior vena cava ultrasound in fluid management of critically ill patients, so as to provide a reference for circulatory management of critically ill patients.

Nutritional Status and Related Factors of Residents Aged Over 50 in Longevity Areas: II. Effect of Dietary Factors on Bone Ultrasound Measurements in Aged Men

This study was conducted to examine dietary factors affecting bone status in the rural aged men. Quantitative ultrasound measurements (QUS) of bone, that may reflect certain architectural aspects of bone, have been shown to be associated with bone mineral density and fracture. Information of diet and anthropometry was collected in 164 aged men. Dietary intake data were obtained by 24-hour recall method. Measurements of the speed of sound (SOS, m/s), at distal radius, mid-tibia, phalanx, were performed using Omnisense 7000S analyzer (Sunlight Ltd., Tel Aviv, Israel). T-scores for bone SOS measurements at distal radius, mid-tibia and phalanx were 0.60, 0.03 and -0.42 respectively. The prevalence of osteopenia by use of the WHO criteria was 17.7% at the mid-tibia and 25.3% of the subjects at the distal radius. Age were negative association with bone SOS at three sites. Osteopenia group of radius were significantly lower in total foods and vegetable intakes than normal group. After adjusted for age, vegetable intakes were significantly and positively related to bone SOS at the radius. The bone SOS of the tibia were significantly and positively related to vegetable protein, iron, folate and vegetable intakes, but negatively related to fat intakes. Multiple regression analysis showed that bone SOS of tibia was positively associated with folate intakes. Vegetable intakes were positively associated with the bone SOS at three sites. These results indicate that the consumption of vegetables, sources of folate, may have a effect on bone status of men.

Ultrasound measurement of tibia and fibula bone length in Thai fetus.

A prospective cross-sectional study was conducted in order to construct reference centile charts for tibia and fibula bone length of Thai fetuses. A total of 621 normal pregnant women, who attended the antenatal clinic at Siriraj Hospital, Mahidol University, Bangkok, were recruited between 12 and 41 weeks of gestation. We identified pregnant women who had regular menstrual period for at least 3 months without contraception prior to the current pregnancy; and whose uterine size at the time of examination was compatible with menstrual age. Each fetus was measured only once at a randomly assigned gestation age specifically for the purpose of this study. A total of 461 fetal tibia and fibula lengths were measured due to unfavorable fetal position in some cases. Regression models were fitted to estimate the mean and standard deviation for each parameter at each gestational age. The centile charts of both lower limb lengths for Thai fetuses were derived from regression equations and are presented.

Evaluation of Left Ventricular Diastolic Function in Coronary Artery Disease by Transthoracic Doppler Ultrasound Measurement of Mitral and Pulmonary Venous Flow Velocities

BACKGROUND: A widened left atrial pressure A wave occurs when left ventricular end-diastolic pressure is increased. It has been reported that increased duration of pulmonary venous flow reversal at atrial systolic pulmonary venous flow is shown to be related to increased left ventricular filling pressure in studies using transesophageal Doppler echocardiography. We evaluate the correlation between LVEDP measured by the invasive method and the mitarl and pulmonary venous flow index recorded by transthoracic Doppler echocardiography. METHODS: Left ventricular pressures at late diastole were measured by fluid-filled catheters in 70-consecutive coronary heart patients undergoing diagnostic cardiac catheterization. Pulmonary venous and mitral flow velocities were recorded by transthoracic pulsed Doppler ultrasound. Adequate recordings were obtained in the 70 patients. Diastolic function differentiated into four categories . RESULTS: Pulmonary venous flow reversal exceeding the duration of the mitral A wave predicted left ventricular end-diastolic pressure > or = 18mmHg with a sensitivity of 0.78 and a specificity of 0.95. Pulmonary venous flow reversal duration (PVad) exceeding 140msec predicted left ventricular end-diastolic pressure > or = 18mmHg with a sensitivity of 0.89 and a specificity of 0.93. This difference in flow duration (PVad-Ad, deltad) correlated well with increased LVEDP (r=0.537, p<0.001). PVad also correlated with increased LVEDP (r=0.503, p<0.001). CONCLUSIONS: If pulmonary venous flow reversal (PVad) exceeds both the duration of the mitral A wave and 140msec, it indicates an exaggerated increase in left ventricular end diastolic pressure.