Combination of high-frequency ultrasound and virtual touch tissue imaging and quantification improve the diagnostic efficiency for mild carpal tunnel syndrome.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common entrapment symptom in the peripheral nerves. High-frequency ultrasound (HFUS) is widely used in the diagnosis of CTS. Virtual Touch Tissue Imaging and Quantification (VTIQ), which provides more information about the hardness of organization, is used to diagnose CTS. However, the data of diagnostic value of them in various degrees of CTS are limited. Whether the combination of HFUS and VTIQ can improve the diagnostic efficiency also remains unknown. The study aimed to explore the diagnostic value of HFUS and VTIQ in various degrees of CTS and whether combination of HFUS and VTIQ could improve the diagnostic efficiency of CTS. METHODS: A collection and analysis of 133 CTS patients and 35 volunteers from January 2016 to January 2019 were performed. We compared the clinical characteristics, cross-sectional area (CSA) value and shear wave velocity SWVmean value of CTS group with volunteer group. RESULTS: The CSA value and SWVmean value of CTS cohort were significantly higher than volunteer group (10.79 ± 2.88 vs. 8.06 ± 1.39, p < 0.001, 4.36 ± 0.95 vs. 3.38 ± 1.09, p < 0.001, respectively). The area under the curve (AUC) of receiver operating characteristic (ROC) curve of CSA value and SWVmean value were 0.794 and 0.757, respectively. Hierarchical analysis of CSA value and SWVmean value showed that the AUC in the moderate and severe CTS group were higher than in mild CTS group. Furthermore, the CSA value combined with SWVmean value used to diagnose mild CTS was 0.758, which was higher than that of single CSA value or single SWVmean value. CONCLUSIONS: Both HFUS and VTIQ technology were feasible to evaluate CTS. HFUS was suitable for use in diagnosis of moderate and severe CTS. For mild CTS, combination of HFUS and VTIQ was relevant to improve the diagnostic efficiency of CTS.

Evaluation of Skeletal Muscle Microcirculation and Reserve Function of the Type 2 Diabetes with Contrast-Enhanced Ultrasonography.

OBJECTIVE: This study aimed to discuss clinical application value of contrast-enhanced ultrasonography on lesion skeletal muscle microcirculation and arterial perfusion reserve in type 2 diabetes mellitus and complicated microvessels. METHODS: Patients in the control group, type 2 diabetes mellitus (DM) group, diabetic microangiopathy (DM + MC) group underwent contrast-enhanced ultrasonography before and after temporary arterial occlusion to observe blood perfusion of gastrocnemius muscle; draw the time-intensity curve of arteriole, muscular tissue, and venule, and obtain perfusion parameters such as contrast agent arrival time and contrast agent transit time. Blood glucose, insulin, insulin resistance index, and relevant blood rheology parameters were measured. RESULTS: Contrast agent transit time of the DM + MC group before arterial occlusion was significantly longer than that of the DM group and control group (P < 0.05). Contrast agent transit time of the DM + MC group after temporary arterial occlusion was significantly longer than that of the DM group and control group (P < 0.05). Contrast agent transit time of △artery-muscle, △artery-vein, and △muscle-vein of the DM group and control group and △artery-muscle of the DM + MC group after arterial occlusion was significantly shortened, when compared with that before arterial occlusion (P < 0.05). For △muscle-vein and △artery-vein contrast agent transit time in the DM + MC group, the difference was not statistically significant. By comparing blood glucose, insulin, insulin resistance index, and relevant blood rheology parameters among the DM + MC group, DM group, and control group, the difference was statistically significant, and there was a good correlation. CONCLUSION: Contrast-enhanced ultrasonography can be used to evaluate skeletal muscle microcirculation disturbance and arterial reserve function of patients who had type 2 diabetic microangiopathy.

Prenatal Evaluation for Detection of Anorectal Atresia: Value of Ultrasound.

OBJECTIVES: To investigate the applicability and value of ultrasound (US) in the diagnosis of anorectal atresia. METHODS: Between January 2008 and January 2016, we prospectively evaluated 63,101 fetuses (gestational age, 20-38 weeks), including low- and high-risk populations using 2-dimensional US scans. An abnormal imaging finding was defined as an anal canal diameter of less than the 95% confidence interval (small anal canal) of the normal range or the absence of an anal canal and rectum. Imaging findings were considered normal on detection of an anal canal with a normal width and the absence of abnormalities. Prenatal imaging findings were confirmed by a postnatal or postmortem examination. RESULTS: Among the investigated fetuses, 28 showed evidence of anorectal atresia on US scans, and 22 of those with anorectal atresia had additional anomalies. Six cases of isolated anorectal atresia were successfully detected during the preclusive prenatal US scans. Four cases of a low imperforate anus (including 2 covered anuses) yielded false-negative results, indicating a diagnostic rate of 87.5% (28 of 32). The normal appearance of the fetal rectum and anal canal ruled out anorectal atresia in 30 fetuses with a dilated colon. Additionally, there were 3 false-positive cases, in which a narrow anal canal was observed. CONCLUSIONS: Identifying the abnormal appearance or absence of the fetal anal canal and rectum on preclusive US anomaly scans is useful for prenatal diagnosis or exclusion of anorectal atresia, which may help improve the detection of isolated anorectal atresia. Furthermore, a combined evaluation of the longitudinal and axial appearances of the fetal anal canal and rectum can improve diagnostic accuracy.

Three-dimensional sonographic minute structure analysis of fetal cerebellar vermis development and malformations: utilizing volume contrast imaging.

PURPOSE: To obtain three-dimensional ultrasonic (3D US) structural details and biometrics of the fetal cerebellar vermis and evaluate the value of developmental and malformation identification. METHODS: The 3D US minute structure of the fetal cerebellar vermis in mid-sagittal view was detected in normal fetuses (n = 438; 16-41 weeks). Biometric sizes were measured to establish the stage-specific norms and reproducibility analysis. Additionally, 28 fetuses with suspected abnormal posterior fossa contents were assessed to analyze the clinical value. RESULTS: The minute structure of normal fetuses, including cerebellar vermis contours and the fastigial recess of the fourth ventricle, were visible around Week 19. The main lobules and fissures were apparent around Week 22, and all nine lobules, fissures, and the fourth ventricle were clearly displayed by Week 28. Cerebellar vermis biometric sizes (anterior-posterior length, cranio-caudal length, circumference, and surface area (SA)) grew in a linear fashion with high reliability, especially SA measurements (for intraclass, ICC 0.989, 95% CI (0.980-0.994); for interclass, ICC 0.992, 95% CI (0.984-0.996)). On the middle sagittal section of 3D US, the SA reduced at least 50% in the Dandy-Walker group with no recognizable cerebellar vermis structures showing. The SA in vermian hypoplasia malformation reduced during [Formula: see text] to 50% with the primary/secondary fissures absent or partly absent and arborization of the lobules reduced. That would be an important diagnosis and antidiastole clue. Combined with minute structural observation, sonographic diagnoses were accurate in 88% of cases. CONCLUSION: Minute structures obtained by 3D US were clinically useful in the evaluation of cerebellar vermis development and cerebellar vermis malformations.

[cts of prenatal exposure of 850-1900MHz mobile phone on the expression of PCNA and DCX in dentate gyrus of offspring rats].

OBJECTIVE: To evaluate the effect of prenatal mobile phone exposure on the expression of proliferating cell nuclear antigen (PCNA) and doublecortin (DCX) in dentate gyrus of offspring rats. METHODS: The rat model of prenatal mobile phone exposure was established and there were three groups including control group, short term maternal exposure group and long term maternal exposure group(n=6). From pregnant day 1 to day 17, pregnant rats in long term and short term maternal exposure group were exposed to an mobile phone in talking mode for 6 h/d and 24 h/d, respectively. Length of pregnancy, maternal body weight gain, litter size and pup's body weight were observed. The cell morphology in dentate gyrus of offspring rats at the age of 1 month was studied by cresyl violet staining. The immunohistochemical expression of PCNA and DCX in dentate gyrus of rat offspring were detected, and the expression of DCX and brain derived neurotrophic factor (BDNF) in hippocampus of rat offspring were evaluated by Western blot. RESULTS: There was no difference in length of pregnancy, maternal body weight gain, litter size and pup's body weight among three groups. The morphological changes of pyramidal cells in the polymorphic layer and DCX-positive cells in the dentate gyrus were obvious in rat offspring of long term maternal exposure group. There were less PCNA-positive cells in dentate gyrus and decreased expression of DCX and BDNF in hippocampus by Western blot in long term maternal exposure group compared with control and short term maternal exposure group (all P<0.05). CONCLUSIONS: Long term prenatal mobile phone exposure might inhibit the expression of PCNA and DCX in dentate gyrus of rat offspring by down-regulating BDNF.

Prenatal Ultrasound Evaluation of the Position of Conus Medullaris for the Diagnosis of Tethered Cord Syndrome.

To determine the conus distance between the end of the conus medullaris and the distal end of the last vertebral body in healthy fetuses with various gestational ages using ultrasonography for its diagnostic value in tethered cord syndrome (TCS). This retrospective study included 540 healthy and 8 autopsy-confirmed TCS fetuses. Ultrasonographic measurement of the conus distance was performed when the fetus was in a prone position within the spine in the near field at 14 to 41 weeks of gestational age. Linear correlation analysis was performed to analyze the relationship between the conus distance and the gestational age, biparietal diameter, femur length, head circumference, and abdominal circumference. The normal results were compared with 8 cases of postnatally confirmed TCS. In 526 (95.9%) of 548 fetuses, the conus distance was successfully measured. The 95% limits of agreement in measurement of conus distance were -2.2 to 2.6 mm for the intraobserver variability and -3.7 to 3.1 mm for the interobserver variability. Significant correlations between the conus distance and the gestational age, biparietal diameter, femur length, head circumference, and abdominal circumference were observed. The most marked association was found to be between conus distance and femur length. The conus distance was significantly less in TCS fetuses than in healthy fetuses. Ultrasonographic measurement of conus distance is an easy and reliable method to evaluate the position of the conus medullaris and, therefore, can be helpful in the prenatal diagnosis of TCS.

Evaluation of gastric blood supply in diabetic patients with gastroparesis by contrast-enhanced ultrasound.

OBJECTIVE: Improvement in regional blood flow has been shown to ameliorate diabetic gastroparesis. We compared the gastric blood supply in patients with diabetes with gastroparesis with that in healthy subjects, by using contrast-enhanced ultrasound (CEUS). METHODS: 30 healthy subjects and 40 patients with diabetic gastroparesis were enrolled. The CEUS parameters of greater curvatures of the antrum (GCOA) and lesser curvatures of the antrum (LCOA), including peak intensity (PI) and the area under the curve (AUC), were compared between the two groups. RESULTS: Intraclass correlation coefficient (ICC) for PI in healthy subjects measured on CEUS were 0.831-0.857 and 0.803-0.823, respectively. Intra-ICC and inter-ICC values for AUC were 0.805-0.823 and 0.813-0.815, respectively. In both groups, no significant difference was observed in PI and AUC values of GCOA and LCOA (p > 0.05). The PI and AUC of GCOA and LCOA in the diabetes group were less than those in the normal group (p < 0.05). CONCLUSION: CEUS can assess stomach wall vascularity with a high reproducibility. Microcirculation in the antrum of patients with diabetic gastroparesis is poorer than that of normal group, which is consistent with the mechanisms of diabetic neuropathy. CEUS can be used for evaluation of microvascular perfusion in patients with stomach wall disease. Advances in knowledge: This was the first study to use CEUS for assessment of blood supply of the gastric wall and to compare microvascular perfusion between healthy individuals and patients with diabetes with gastroparesis.

Application of contrast-enhanced ultrasonography and ultrasonography scores in rheumatoid arthritis.

OBJECTIVE: To investigate diagnostic value of ultrasonography scores (US) and contrast-enhanced ultrasonography (CEUS) in evaluating rheumatoid arthritis (RA) activity. METHODS: 39 patients with RA were included and the metacarpophalangeal, proximal interphalangeal, wrist, elbow and knee joints of them were examined by high frequency ultrasound. The severe joints and the related indexes (synovial thickness, synovial blood flow, joint effusion and bone erosion) were exposed. Then scores (0~3) were obtained and the sum was calculated. For 12 patients of the 39, 2.4 ml SonoVue was intravenously injected with observation of synovial enhancing. ROIs time-intensity curve (TIC) was obtained and the parameters including area under curve (AUC), peak intensity (PI) and time to peak (TTP) were analyzed. For 39 patients, the relationships among each parameters, ultrasonography scores, DAS28 scores and biochemical examinations (ESR, CRP, RF, anti-CCP) were analyzed. RESULTS: The US were significantly correlated with DAS28 Scores (r=0.823, P<0.01=. The correlation between US and CRP was better than that between DAS28 scores and CRP (rUS =0.692, rDAS28=0.526, P<0.01). The synovial thickness in US were correlated with DAS28 Scores and biochemical examinations (ESR, CRP) (rDAS28=0.852, rESR=0.779, rCRP=0.587, P<0.01. The AUC and PI in CEUS were significantly correlated with US (rAUC=0.832, rPI=0.809, P<0.01=. The correlations among AUC, PI and ESR were better than that between US and ESR (rAUC=0.907, rPI=0.851, rUS=0.836, P<0.01=. The correlations among AUC, PI and CRP were better than that between US and CRP (rAUC=0.855, rPI=0.854, rUS=0.692, P<0.01. CONCLUSIONS: US was almost identical with DAS28 Scores and biochemical examinations (ESR, CRP) in diagnosis of RA activity, while CEUS was almost identical with DAS28 Scores and biochemical examinations (ESR, CRP). In diagnosis of RA, US may be better than DAS28 Scores, while CEUS better than US. Both of them were useful for evaluation of RA activity.

Reference ranges of fetal spleen biometric parameters and volume assessed by three-dimensional ultrasound and their applicability in spleen malformations.

AIM: The aims of this article are to establish three-dimensional ultrasonographic nomograms of normal fetal spleen size and to evaluate the clinical application value. METHODS: An observational, cross-sectional study was performed on 455 women with a normal singleton pregnancy between 18 and 38 weeks' gestational age (GA). Fetal spleen volume was measured using three-dimensional ultrasound equipped with virtual organ computer-aided analysis, and biometric parameters were assessed in multiplanar mode to create reference ranges to GA. Thirty cases were randomly selected to conduct reliability analyses via intraobserver and interobserver ultrasonographic measurement. Moreover, 50 cases of suspected splenic malformations were evaluated by the newly established nomograms and followed up subsequently. RESULTS: Using regression formulas, we found that fetal spleen size increased with GA. We observed strong reliability in intraobserver and interobserver volume measurements with intraclass correlation coefficients of 0.994 and 0.962. Bland-Altman analyses showed narrow limits of agreement [intraobserver: (-3.2 to 3.5)%; interobserver: (-3.2 to 4.3)%]. Of the 50 cases with suspected splenic malformations, six cases of splenomegaly and one case of splenic cyst were diagnosed. CONCLUSION: Three-dimensional ultrasound nomograms of normal fetal spleen size across a range of GA have a strong diagnostic value. Volume measurements with good reliability were optimal in clinical practice.

Evaluation of gastric emptying in diabetic gastropathy by an ultrasonic whole stomach cylinder method.

In order to explore the accuracy of ultrasonic whole stomach cylinder measurement (UWSCM) in the evaluation of gastric emptying, we measured the gastric emptying times (ET) at 25% (T1), 50% (T2) and 75% (T3) of healthy subjects and patients with diabetic gastropathy by UWSCM and scintigraphy. The ET of patients were compared with their clinical symptom scores. We found that the ET measured by UWSCM showed no significant difference with scintigraphy (p > 0.05). The correlation between them was good, and the correlation coefficient of T3 reached 0.744 (p < 0.05). All emptying times in the diabetic patients were longer than those in the healthy subjects (p < 0.05). The T3 in the diabetic group measured by UWSCM had the best correlation with the symptom index (r = 0.469, p < 0.05). We conclude that ET measured by UWSCM is accurate and T3 combining the symptoms index provides an accurate clinical basis for gastropathy.

Maternal hypoxia increases the susceptibility of adult rat male offspring to high-fat diet-induced nonalcoholic fatty liver disease.

Exposure to an adverse intrauterine environment increases the risk for adult metabolic syndrome. However, the influence of prenatal hypoxia on the risk of fatty liver disease in offspring is unclear. The purpose of the present study was to evaluate the role of reduced fetal oxygen on the development and severity of high-fat (HF) diet-induced nonalcoholic fatty liver disease (NAFLD). Based on design implicating 2 factors, ie, maternal hypoxia (MH) and postnatal HF diet, blood lipid and insulin levels, hepatic histology, and potential molecular targets were evaluated in male Sprague Dawley rat offspring. MH associated with postnatal HF diet caused a significant increase in plasma concentration of triglycerides, free fatty acids, low-density lipoprotein cholesterol, and insulin. Histologically, a more severe form of NAFLD with hepatic inflammation, hepatic resident macrophage infiltration, and progression toward nonalcoholic steatohepatitis was observed. The lipid homeostasis changes and insulin resistance caused by MH plus HF were accompanied by a significant down-regulation of insulin receptor substrate 2 (IRS-2), phosphoinositide-3 kinase p110 catalytic subunit, and protein kinase B. In MH rats, insulin-stimulated IRS-2 and protein kinase B (AKT) phosphorylation were significantly blunted as well as insulin suppression of phosphoenolpyruvate carboxykinase and glucose-6-phosphatase. Meanwhile, a significant up-regulation of lipogenic pathways was noticed, including sterol-regulatory element-binding protein-1 and fatty acid synthase in liver. Our results indicate that maternal hypoxia enhances dysmetabolic liver injury in response to an HF diet. Therefore, the offspring born in the context of maternal hypoxia may require special attention and follow-up to prevent the early development of NAFLD.

Intermittent maternal hypoxia has an influence on regional expression of endothelial nitric oxide synthase in fetal arteries of rabbits.

BACKGROUND: Maternal hypoxia induces sustained fetal adaptations associated with changes in gene expression. We hypothesized that intermittent maternal hypoxia has an influence on regional expression of endothelial nitric oxide synthase (eNOS) in fetal arteries of New Zealand White rabbits. METHODS: Timed-pregnant New Zealand White rabbits (term = 30 ± 1 d) were randomly assigned to a normoxic control group (n = 5) or a hypoxia group (12% O2, n = 5) during days 10-29 of pregnancy. At the end of pregnancy (29 d gestation), blood samples were collected from mothers and fetuses. Carotid and femoral arteries of fetuses were extracted for eNOS mRNA and protein concentration and analysis of total NOS activities. RESULTS: Our data demonstrate that chronic intermittent maternal hypoxia significantly increased eNOS mRNA and protein concentrations and total NOS activities in carotid artery segments but decreased eNOS mRNA and protein concentrations and total NOS activities in femoral artery segments in the same fetuses. Vascular endothelial cells, but not smooth muscle cells, of fetal rabbits exhibited positive immunostaining for the eNOS protein. CONCLUSION: These observations suggest that chronic hypoxia can regulate regional expression of eNOS as an adaptive response to hypoxic stress in fetal arteries.

The effect of fetal congenital heart disease on in utero urine production rate.

OBJECTIVES: To evaluate the influence of congenital heart disease (CHD) or congestive heart failure (CHF) on fetal urine production rate (UPR) and to establish normal reference intervals. METHODS: A cross-sectional study was performed on normal fetuses (n = 314) and on fetuses with CHD (n = 49). CHD cases were divided into groups on the basis of heart function as defined by Huhta score: with CHF (n = 11) and without CHF (n = 38). Fetal bladder volume was measured by two-dimensional as well as three-dimensional ultrasound with the Virtual Organ Computer-aided Analysis technique. RESULTS: In normal fetuses, UPR increased with gestational age from a mean value of 4.5 mL/h at 21 weeks to 66.5 mL/h at 40 weeks. There were no significant differences in UPR between CHD cases without CHF and controls (P = 0.581). However, fetuses with CHF had decreased UPR values (Controls vs. CHF, P = 0.007) compared with the controls. The interobserver and intraobserver variability for assessment of UPR was better using three-dimensional rather than two-dimensional US. CONCLUSIONS: Fetal UPR can be reproducibly measured by the Virtual Organ Computer-aided Analysis technique. It appears that heart function, rather than CHD, affects fetal UPR. Fetal UPR may therefore be an additional indicator of CHF.

Ultrasound probe pressure but not maternal Valsalva maneuver alters Doppler parameters during fetal middle cerebral artery Doppler ultrasonography.

OBJECTIVE: To determine the effects of increased ultrasound probe pressure and maternal Valsalva maneuver (VM) on the middle cerebral artery (MCA) Doppler ultrasonography in fetuses. METHODS: A total of 120 healthy pregnant women in second and third trimesters were enrolled in the study. MCA blood flow was measured by pulsed Doppler sonography in 60 fetuses (24 and 40 weeks' gestation) before and after the application of increased ultrasound probe pressure. In the other 60 fetuses (32 and 36 weeks' gestation), sonography was performed before and after maternal VM. Statistical analysis was performed by paired t-test. RESULTS: The pressure induced by the ultrasound probe induced a significant increase in the pulsatility index (PI), resistance index (RI), and peak systolic velocity (PSV); however, a significant decrease was found in the end-diastolic velocity (EDV) (p < 0.05). No statistically significant difference was found in the mean flow velocity (MFV). Moreover, maternal VM did not have any effect on the PI, RI, EDV, or MFV. CONCLUSION: Fetal MCA Doppler assessment is affected by increased probe pressure but not by maternal VM. Thus, the application of the MCA Doppler sonography should be undertaken in the head of fetuses without any probe pressure and without maternal VM.