Dermatoscopy and High Frequency Sonography: Two Useful Non-Invasive Methods to Increase Preoperative Diagnostic Accuracy in Pigmented Skin Lesions

Dermatoscopy and high frequency sonography have recently been combined to increase diagnostic preoperative accuracy in the treatment of pigmented skin lesions. In this monocentric study 80 patients with pigmented skin lesions were evaluated clinically, by dermatoscopy, and 20 MHz-sonography followed by dermatohistopathological evaluation; 39 malignant melanomas, 37 common nevi, 3 dysplastic nevi, and 1 nevus Spitz were diagnosed histologically. In 72 of the 80 cases (91.3%) dermatoscopical diagnoses were confirmed by histopathology, compared to only 79% correct clinical diagnoses. For the mere clinical diagnosis of melanoma sensitivity was 79%, specificity was 78% and diagnostic accuracy was 65%. All diagnostic values increased by dermatoscopy: sensitivity reached 90%, specificity was 93%, and diagnostic accuracy was 83%. In order to determine tumor thickness preoperatively tumor thickness was measured by 20 MHz sonography. The correlation of tumor thickness between histometric and sonographic results was determined for nevi (r = 0.93) and melanoma (r = 0.95); 74.3% of melanomas were diagnosed correctly within an 0.2 mm range. Regarding the clinical important limit of 1 mm tumor thickness, 87.2% were diagnosed in accordance with histometric evaluation. An increase of 18% in diagnostic accuracy by dermatoscopy and 87.2% of correctly diagnosed cases of tumor thickness of malignant melanoma by high frequency sonography clearly demonstrate that these methods should be considered standard procedures in the diagnosis of pigmented skin lesions and will facilitate the decision on necessary surgical treatment.     

产前超声诊断结果与胎儿先天性心脏病结局的相关性及危险因素分析

摘要 目的：对比先天性心脏病胎儿与正常胎儿的产前超声差异，分析产前超声诊断结果与胎儿先天性心脏病的相关性及危险因素。方法：选取我院2018年12月到2020年12月共收治的80例有先天性心脏病胎儿的孕妇作为研究对象，将其分为观察组，另选取健康胎儿的80例孕妇进行对比研究，将其分为对照组，对所有孕妇进行彩色多普勒超声进行诊断，分析观察组超声诊断与最终结果，对比两组胎儿的超声诊断情况，并对孕期胎儿先天性心脏病的风险因素进行单因素与多因素logistic回归分析。结果：通过尸检和出生后随访最终确定结果与超声诊断结果对比无显著差异（P＞0.05），超声诊断中有3例漏诊；由于卵圆孔直径大于6 mm、心内膜垫缺损（Endocardial cushion defect, ECD）和单心房胎儿没有正常的四腔心结构，因此无法进行腔室内径的测量，对其他观察组患儿进行测量之后发现，观察组患儿左心发育不全综合征（hypoplastic left heart syndrome, HLHS）的左心房与左心室、法洛氏四联症（Tetralogy of Fallot, TOF）右心室、室间隔缺损（Ventricular Septal Defect, VSD）右心室内径明显低于对照组（P＜0.05）；对可能造成胎儿先天性心脏病的高风险因素进行分析发现，两组孕妇的孕期早期服药、高龄产妇以及家族心脏病史情况对比差异显著，观察组明显更高（P＜0.05）；对所有因素进行赋值，其中"是"或"有"为1，"否"或"无"为0。通过logistic回归分析发现只有孕期早期服药和家族心脏病史为胎儿先天性心脏病的独立危险因素（P＜0.05）。结论：对孕妇进行综合产前超声诊断胎儿先天性心脏病的准确率较高，与最终结果无明显区别；虽然高龄孕妇与胎儿先天性心脏病具有一定关系，但是只有孕期早期服药和家族心脏病史是胎儿先天性心脏病的独立危险因素。     

The accuracy of needle electrode placement by trainees in selected forearm muscles using verification by neuromuscular ultrasound

IntroductionAnatomic landmarks alone may not always be sufficient to accurately guide electromyography (EMG) electrode needle placement.MethodsSenior residents and fellows (n = 11) targeted 4 forearm muscles with anatomic landmarks alone versus with audiovisual EMG feedback. Accuracy of EMG needle placement was verified using neuromuscular ultrasound imaging.ResultsWhile relatively large and superficial FCR muscle was sampled at a rate of 100% with and without audiovisual EMG feedback, accuracy of deeper and/or smaller forearm muscles (FPL, EIP, and SUP) diminished significantly without audiovisual EMG feedback.DiscussionOur study suggests that in clinical scenarios in which an electrodiagnostician relies on anatomic landmarks alone to target small and deep muscles, the risk of misplacement of needle electrode is increased. Consideration for neuromuscular ultrasound to augment training and/or real time guidance in EMG practice may be appropriate.     

Improving diagnostic strategies for ovarian cancer in Filipino women using ultrasound imaging and a multivariate index assay

ObjectiveTo evaluate the clinical performance and overall utility of imaging and biomarker assays in discriminating between benign and malignant ovarian masses in a Filipino population.MethodsThis is a prospective cohort study among Filipino women undergoing assessment for an ovarian mass in a tertiary center. All included patients underwent a physical examination before level III specialist ultrasonographic and Doppler evaluation, multivariate index assay (MIA2G), and surgery for an adnexal mass. Ovarian tumors were classified as high-risk for malignancy based on the International Ovarian Tumour Analysis (IOTA) – Logistic Regression 2 (LR2) score. The ovarian imaging and biomarker results were correlated with the reference standard: histological findings.ResultsAmong the 379 women with adnexal masses enrolled in this study, 291 were evaluable with ultrasound imaging, biomarker assays, and histopathological results. The risk of malignancy was higher for women classified as high-risk based on IOTA-LR2 (≥10%). The sensitivity, specificity, and diagnostic accuracy for the prediction of malignancy were 81.2%, 81%, and 0.81 (95% CI: 0.77–0.86) for IOTA-LR2; 77.5%, 66.7%, and 0.72 (95% CI: 0.67–0.77) for CA-125; and 91.3%, 41.2%, and 0.66 (95% CI: 0.62–0.71) for MIA2G. A combination of IOTA-LR2 and MIA2G significantly influenced the diagnostic performance and the result. When MIA2G was combined with IOTA-LR2 in parallel, the sensitivity (94.2%) and NPV (87.7%) increased, but the specificity (37.3%) decreased. When combined with IOTA-LR2 in series, there were fewer false positives, which resulted in improved specificity (85%).ConclusionThis study determined the utility of ovarian imaging and a second-generation multivariate index assay in predicting the risk of ovarian malignancy. IOTA-LR2 and MIA2G were useful in classifying patients with a high risk for ovarian malignancy.     

Influence of altered geometry and material properties on tissue stress distribution under load in tendinopathic Achilles tendons – A subject-specific finite element analysis

Achilles tendon material properties and geometry are altered in Achilles tendinopathy. The purpose of this study was to determine the relative contributions of altered material properties and geometry to free Achilles tendon stress distribution during a sub-maximal contraction in tendinopathic relative to healthy tendons. Tendinopathic (n = 8) and healthy tendons (n = 8) were imaged at rest and during a sub-maximal voluntary isometric contraction using three-dimensional freehand ultrasound. Images were manually segmented and used to create subject-specific finite element models. The resting cross-sectional area of the free tendon was on average 31% greater for the tendinopathic compared to healthy tendons. Material properties for each tendon were determined using a numerical parameter optimisation approach that minimised the difference in experimentally measured longitudinal strain and the strain predicted by the finite element model under submaximal loading conditions for each tendon. The mean Young’s modulus for tendinopathic tendons was 53% lower than the corresponding control value. Finite element analyses revealed that tendinopathic tendons experience 24% less stress under the same submaximal external loading conditions compared to healthy tendons. The lower tendon stress in tendinopathy was due to a greater influence of tendon cross-sectional area, which alone reduced tendon stress by 30%, compared to a lower Young’s modulus, which alone increased tendon stress by 8%. These findings suggest that the greater tendon cross-sectional area observed in tendinopathy compensates for the substantially lower Young’s modulus, thereby protecting pathological tendon against excessive stress.     

Physical energy-based ultrasound shifts M1 macrophage differentiation towards M2 state

Recently, we read with interest the article entitled “Unveiling the Morphogenetic Code: A New Path at the Intersection of Physical Energies and Chemical Signaling”. In this paper, the investigation into the systematic and comprehensive bio-effects of physical energies prompted us to reflect on our research. We believe that ultrasound, which possesses a special physical energy, also has a certain positive regulatory effect on macrophages, and we have already obtained some preliminary research results that support our hypothesis.     

Effect of xylazine,isoxsuprine, and lidocaine on Doppler sonographic uterine and umbilical blood flow measurements in cows during the last month of pregnancy

The maternal portion of the bovine placenta receives blood mainly from the uterine arteries (AUT) and the fetal portion from the umbilical arteries (AUM). Placental perfusion is crucial for fetal development and undergoes adaptive changes during pregnancy according to the fetal requirements. One goal of this study was to investigate changes in Doppler sonographic measurements of blood vessels that supply blood to the placenta in cows during the last 4 weeks of pregnancy. Another goal was to examine how these measurements are affected by three drugs commonly used in cows at the time of parturition. Nine cows underwent Doppler sonographic examination of the AUT ipsilateral and contralateral to the pregnant horn and one AUM three times per week during the last 4 weeks of gestation. This was followed by the randomized administration of one of the three following experimental drugs per day: isoxsuprine (200 mg/cow, iv), xylazine (2 mg/100 kg, iv), and lidocaine for epidural anesthesia (100 mg/cow). Doppler sonographic examination was repeated 30 minutes after medication. Maternal pulse rate increased during the study period (P < 0.001), and the diameter of the contralateral AUT was smaller in the last week before birth than in the two preceding weeks. The resistance index (RI) of the ipsilateral AUT was smaller in the last week than in the first 2 weeks of the study period. Uterine blood flow volume increased after isoxsuprine by 5% and after epidural anesthesia by 6% (both P ≤ 0.05) and decreased after xylazine by 10% (P < 0.001). Isoxsuprine was the only drug that elevated the blood flow volume in the AUM (P ≤ 0.05). Xylazine increased the RI of both AUT (both P < 0.001) and significantly reduced maternal and fetal pulse frequencies, whereas isoxsuprine significantly reduced the RI of both AUT and the AUM and increased maternal and fetal pulse frequencies. The results reported that Doppler sonographic measurements of uterine and AUM change little in the last month of pregnancy in the cow. Isoxsuprine and epidural anesthesia with lidocaine have the potential to improve uterine perfusion.     

Muscle material properties in passive and active stroke-impaired muscle

Stroke survivors routinely experience long-term motor and sensory impairments. In parallel with neurological changes, material properties of muscles in the impaired limbs, such as muscle stiffness, may also change progressively. However, these stiffness measures are routinely derived from individual joint stiffness, representing whole muscle groups. Here, we use shear wave (SW) ultrasound elastography to measure SW velocity, as a surrogate measure of stiffness, to quantify material properties in individual muscles. Accordingly, the purpose of this study was to compare muscle material properties of the bicep brachii in stroke survivors and in age-matched control subjects by measuring SW velocity at rest and different voluntary activation levels. Our main findings show that at rest, the SW velocity was on average 41% greater in the paretic muscle compared the contralateral non-paretic muscle. The mean passive SW velocity across all subjects were 2.34 ± 0.41 m/s for the non-paretic side, 3.30 ± 1.20 m/s for the paretic side, and 2.24 ± 0.18 for controls. SW velocity was significantly different in muscles of the paretic and non-paretic side (p < 0.001), but not between muscles of the non-paretic and controls (p = 0.47). As voluntary activation increased, SW velocity increased non-linearly, with an average power fit of r² = 0.83 ± 0.09 for the non-paretic side, r² = 0.61 ± 0.24 for the paretic side, and r² = 0.24 ± 0.15 for the healthy age-matched controls. In active muscle (10, 25, 50, 75, 100% maximum voluntary contraction), there was no significant difference in SW velocity between the non-paretic, paretic, and control muscles.These findings suggest that stroke-impaired muscles have potentially altered muscle material properties, specifically stiffness, and that passive and active stiffness may contribute differently to total muscle stiffness.     

Rôle de l’échographie dans le diagnostic des kystes ovariens et des masses annexielles,en dehors de la grossesse et de la stimulation ovarienne

This article contains the semiological bases used to characterize ovarian lesions in imaging, especially ultrasound.     

Synaptic inputs to the omega neuron of the cricket Teleogryllus oceanicus: differences in EPSP waveforms evoke by low and high sound frequencies

EPSP waveforms were recorded from the omega neuron of Teleogryllus oceanicus for 5 kHz and ultrasonic sound stimuli. EPSPs in response to 5 kHz stimuli were smooth in shape and increased in amplitude with increasing stimulus intensity, while responses to ultrasound consisted of series' of large, discrete, unitary EPSPs, which increased in frequency with stimulus intensity.The hypothesis that a few, synaptically potent receptors might account for ultrasound sensitivity was tested by examining temporal coupling between ultrasound responses of the omega neuron and of another ultrasound-sensitive neuron, INT-1. INT-1 spikes were temporally correlated both to omega neuron spikes and to the large EPSPs recorded in the omega neuron. Coupling was not apparent for 5 kHz stimuli.The omega neuron encodes the intensity of 5 kHz and ultrasonic stimuli with similar resolution. Response latencies are markedly shorter for ultrasonic stimuli.These findings suggest that 5 kHz information is carried by a relatively large number of receptors, each of which has only a small effect on central neurons, while ultrasound information is carried by a few, synaptically potent, receptors.