Diagnostic Ultrasound in the Evaluation of Stiff Shoulder: Association of Axillary Recess Thickness with Standard Clinical Measures.

OBJECTIVES: Stiff shoulder, including primary and secondary types, poses diagnostic challenges due to vague definitions and criteria. This study evaluates the diagnostic potential of ultrasound-measured axillary recess (AR) thickness in shoulder stiffness. DESIGNS: In this cross-sectional study, 35 patients with unilateral shoulder stiffness were assessed. AR thickness was measured using high-resolution ultrasound. Parameters like passive range of motion (PROM), Numerical Rating Scale (NRS), and Constant-Murley (CM) score were evaluated to find correlations with AR thickness. RESULTS: The average age was 50.7 years, and mean BMI was 22.7. AR thickness in stiff shoulders (average 3.19 mm) was significantly higher than in unaffected shoulders (average 1.93 mm, p < 0.001). A cutoff of 3.0 mm for AR thickness yielded 73.3% sensitivity and 84.6% specificity for primary stiffness; 2.6 mm cutoff resulted in 57.9% sensitivity and 88.2% specificity for secondary stiffness. Significant correlations were found between AR thickness and PROM, especially in shoulder external rotation and extension. CONCLUSION: AR thickness measured by ultrasound might serve as a valuable diagnostic and evaluation parameter in shoulder stiffness.

Sono-anatomy of the middle cervical sympathetic ganglion verified with pathology.

Objectives: Cervical discomfort and other symptoms may be attributable to the middle cervical sympathetic ganglion. The aim of this study was to explore the sonographic features of this ganglion in anatomical specimens and cadavers and evaluate the feasibility of its visualization using high-resolution ultrasonography. Methods: We examined three cervical sympathetic-ganglion specimens and two fresh cadavers using high-resolution ultrasound to explore the sonographic features of this ganglion. Basic imaging characteristics examined included the shape, echo intensity, and location of the ganglion. Core-needle biopsy was performed to examine the suspected middle cervical sympathetic ganglion in the two fresh cadavers and verify the accuracy of the sonographic identification via pathological examination. Results: The middle cervical sympathetic ganglion appeared on high-resolution ultrasonography as an oval-shaped hypoechoic structure, with at least one continuous hypoechoic line connected to each ending in the anatomical specimens and fresh cadavers, and it was distinctly different from the adjacent lymph nodes. Discussion: Based on an adequate understanding of both its location and sonographic features, the direct visualization of the middle cervical sympathetic ganglion using high-resolution ultrasonography is feasible.

The value of shear wave elastography in diagnosis and assessment of systemic sclerosis.

Objective: The aim was to determine the efficacy of shear wave elastography (SWE) in assessing skin stiffness and aiding in the diagnosis of patients with systemic sclerosis (SSc). Methods: A total of 66 patients with SSc, 100 healthy individuals and 27 patients with SSc-like disorders were included. SWE was performed at 17 modified Rodnan skin score (mRSS) measurement sites. The correlation between SWE and clinical profiles was assessed, and the diagnostic value of SSc was explored. Results: The SWE values at all 17 mRSS sites were significantly higher in SSc than in the healthy group [54.95 (45.95, 66.55) vs 41.10 (39.18, 45.45) m/s, P < 0.001]. For clinically uninvolved sites (mRSS = 0) of patients with SSc, 11 of 17 sites showed significantly higher SWE values compared with healthy controls. SWE was positively correlated with total mRSS (r = 0.783, P < 0.001), the European Scleroderma Study Group disease activity index (r = 0.707, P < 0.001) and histological collagen deposition (r = 0.749, P = 0.013). SWE effectively distinguished patients with SSc from patients with SSc-like disorders (area under the curve, AUC = 0.819). Use of SWE-detected skin sclerosis showed a significantly higher sensitivity compared with 1980 ACR criteria [0.818 (95% CI 0.709, 0.893) vs 0.727 (95% CI 0.610, 0.820), P = 0.031]. Conclusion: SWE correlates well with disease activity and collagen deposition in the skin, provides greater reliability than mRSS and aids in the diagnosis of SSc. SWE could be considered as a convenient and reliable quantitative tool for assessing skin sclerosis and disease progression in SSc.

The performance of the 2022 ACR/EULAR classification criteria for Takayasu's arteritis as compared to the 1990 ACR classification criteria in a Chinese population.

In this study, we studied the performance of the 2022 American College of Rheumatology (ACR)/ European Alliance of Associations for Rheumatology (EULAR) classification criteria for Takayasu's arteritis (TAK) as compared to the 1990 ACR classification criteria in a Chinese population. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and the area under the receiver operating characteristics curve (AUC) of the above two criteria were compared. The sensitivity (92.6%), positive predictive value (95.6%), negative predictive value (94.6%), accuracy (95.0%) and AUC (0.981) of the 2022 criteria were superior to those of the 1990 criteria (45.7%, 91.5%, 70.5%, 75.0% and 0.874, respectively), and the difference of AUC was statistically significant (Z = 5.362, P < 0.001). In addition, we included new imaging modalities in the 1990 criteria, whose sensitivity, positive predictive value, negative predictive value, accuracy and AUC were significantly improved, but still lower than those of the 2022 criteria, the difference in AUC was also statistically significant (Z = 2.023, P = 0.043). The 2022 criteria for TAK exhibited superior performance compared with the 1990 criteria and may be more appropriate for the Chinese population. Incorporating additional imaging modalities could enhance the classification performance of the 1990 criteria even further.

Ultrasound-induced biophysical effects in controlled drug delivery.

Ultrasound is widely used in biomedical engineering and has applications in conventional diagnosis and drug delivery. Recent advances in ultrasound-induced drug delivery have been summarized previously in several reviews that have primarily focused on the fabrication of drug delivery carriers. This review discusses the mechanisms underlying ultrasound-induced drug delivery and factors affecting delivery efficiency, including the characteristics of drug delivery carriers and ultrasound parameters. Firstly, biophysical effects induced by ultrasound, namely thermal effects, cavitation effects, and acoustic radiation forces, are illustrated. Secondly, the use of these biophysical effects to enhance drug delivery by affecting drug carriers and corresponding tissues is clarified in detail. Thirdly, recent advances in ultrasound-triggered drug delivery are detailed. Safety issues and optimization strategies to improve therapeutic outcomes and reduce side effects are summarized. Finally, current progress and future directions are discussed.

Overview of the ultrasonography techniques in the diagnosis of appendicitis - elaboration of a novel anatomy scanning method.

This article aims to introduce a novel anatomical scanning method which requires scanning according to varied anatomic positions of the appendix based on the widely used graded compression method. We suggest placing the probe longitudinally in the region of the terminal cecum and moving it laterally to explore the sub-cecal appendix. The probe should be placed transversely on the medial side of the cecum to explore the pre-ileal appendix or post-ileal appendix. Placing the probe perpendicularly along external iliac vessels can help explore the pelvic appendix. The probe should be placed transversely on the paracolic sulci, and moved along the paracolic sulci to observe the extra-peritoneal appendix. Using the cephalic end of the probe as a pivot, push and squeeze the cecum to make it move bilaterally as much as possible, in order to expose the retrocecal appendix behind the air-filled cecum. It is our belief that this anatomical scanning method will greatly improve appendix detection rate and diagnostic accuracy, and provide guidance for surgical localization.

Protective effects of organic extracts of Alpinia oxyphylla against hydrogen peroxide-induced cytotoxicity in PC12 cells.

Alpinia oxyphylla, a traditional herb, is widely used for its neuroprotective, antioxidant and memory-improving effects. However, the neuroprotective mechanisms of action of its active ingredients are unclear. In this study, we investigated the neuroprotective effects of various organic extracts of Alpinia oxyphylla on PC12 cells exposed to hydrogen peroxide-induced oxidative injury in vitro. Alpinia oxyphylla was extracted three times with 95% ethanol (representing extracts 1-3). The third 95% ethanol extract was dried and resuspended in water, and then extracted successively with petroleum ether, ethyl acetate and n-butanol (representing extracts 4-6). The cell counting kit-8 assay and microscopy were used to evaluate cell viability and observe the morphology of PC12 cells. The protective effect of the three ethanol extracts (at tested concentrations of 50, 100 and 200 µg/mL) against cytotoxicity to PC12 cells increased in a concentration-dependent manner. The ethyl acetate, petroleum ether and n-butanol extracts (each tested at 100, 150 and 200 µg/mL) had neuroprotective effects as well. The optimum effective concentration ranged from 50-200 µg/mL, and the protective effect of the ethyl acetate extract was comparatively robust. These results demonstrate that organic extracts of Alpinia oxyphylla protect PC12 cells against apoptosis induced by hydrogen peroxide. Our findings should help identify the bioactive neuroprotective components in Alpinia oxyphylla.

Development of a New Robotic Ankle Rehabilitation Platform for Hemiplegic Patients after Stroke.

A large amount of hemiplegic survivors are suffering from motor impairment. Ankle rehabilitation exercises act an important role in recovering patients' walking ability after stroke. Currently, patients mainly perform ankle exercise to reobtain range of motion (ROM) and strength of the ankle joint under a therapist's assistance by manual operation. However, therapists suffer from high work intensity, and most of the existed rehabilitation devices focus on ankle functional training and ignore the importance of neurological rehabilitation in the early hemiplegic stage. In this paper, a new robotic ankle rehabilitation platform (RARP) is proposed to assist patients in executing ankle exercise. The robotic platform consists of two three-DOF symmetric layer-stacking mechanisms, which can execute ankle internal/external rotation, dorsiflexion/plantarflexion, and inversion/eversion exercise while the rotation center of the distal zone of the robotic platform always coincides with patients' ankle pivot center. Three exercise modes including constant-speed exercise, constant torque-impedance exercise, and awareness exercise are developed to execute ankle training corresponding to different rehabilitation stages. Experiments corresponding to these three ankle exercise modes are performed, the result demonstrated that the RARP is capable of executing ankle rehabilitation, and the novel awareness exercise mode motivates patients to proactively participate in ankle training.

Objective skill evaluation for laparoscopic training based on motion analysis.

Performing laparoscopic surgery requires several skills, which have never been required for conventional open surgery. Surgeons experience difficulties in learning and mastering these techniques. Various training methods and metrics have been developed to assess and improve surgeon's operative abilities. While these training metrics are currently widely being used, skill evaluation methods are still far from being objective in the regular laparoscopic skill education. This study proposes a methodology of defining a processing model that objectively evaluates surgical movement performance in the routine laparoscopic training course. Our approach is based on the analysis of kinematic data describing the movements of surgeon's upper limbs. An ultraminiaturized wearable motion capture system (Waseda Bioinstrumentation system WB-3), therefore, has been developed to measure and analyze these movements. The data processing model was trained by using the subjects' motion features acquired from the WB-3 system and further validated to classify the expertise levels of the subjects with different laparoscopic experience. Experimental results show that the proposed methodology can be efficiently used both for quantitative assessment of surgical movement performance, and for the discrimination between expert surgeons and novices.

Development of the wireless ultra-miniaturized inertial measurement unit WB-4: preliminary performance evaluation.

This paper presents the preliminary performance evaluation of our new wireless ultra-miniaturized inertial measurement unit (IMU) WB-4 by compared with the Vicon motion capture system. The WB-4 IMU primarily contains a mother board for motion sensing, a Bluetooth module for wireless data transmission with PC, and a Li-Polymer battery for power supply. The mother board is provided with a microcontroller and 9-axis inertial sensors (miniaturized MEMS accelerometer, gyroscope and magnetometer) to measure orientation. A quaternion-based extended Kalman filter (EKF) integrated with an R-Adaptive algorithm for automatic estimation of the measurement covariance matrix is implemented for the sensor fusion to retrieve the attitude. The experimental results showed that the wireless ultra-miniaturized WB-4 IMU could provide high accuracy performance at the angles of roll and pitch. The yaw angle which has reasonable performance needs to be further evaluated.

Surface EMG and heartbeat analysis preliminary results in surgical training: dry boxes and live tissue.

The training in the surgical practice is of paramount importance to prepare the residents in performing surgical procedures on human subject and to provide exercise on new techniques for experienced surgeons. Usually, these trainings are carried out on live animals or in virtual environments and dry boxes; the complexity of the exercises is identical in both of the case, but the pressure in operating with a living subject could change the attitude and the movements of the trainee. Until now, it has not been possible to analyze this stress in details together in the surgical animal training and dry boxes. In this work we propose an innovative portable system that can measure two physiological parameters, the heartbeat and the surface electromyography, during a session of training in both of the environment. The preliminary results, for one subject, show a bigger average power in the shoulder muscles during the living operation together with a higher but stable heartbeat rate.

Development of the ultra-miniaturized Inertial Measurement Unit WB3 for objective skill analysis and assessment in neurosurgery: preliminary results.

In recent years there has been an ever increasing amount of research and development of technologies and methodologies aimed at improving the safety of advanced surgery. In this context, several training methods and metrics have been proposed, in particular for laparoscopy, both to improve the surgeon's abilities and also to assess her/his skills. For neurosurgery, however, the extremely small movements and sizes involved have prevented until now the development of similar methodologies and systems. In this paper we present the development of the ultra-miniaturized Inertial Measurement Unit WB3 (at present the smallest, lightest, and best performing in the world) for practical application in neurosurgery as skill assessment tool. This paper presents the feasibility study for quantitative discrimination of movements of experienced surgeons and beginners in a simple pick and place scenario.