randomised to rituximab or placebo given at weeks 0, 2, 24 and 26, and scanned at baseline and weeks 16 and 48. sonographers completed a 0–11 total ultrasoundscore (tUs) comprising domains of echogenicity, homogeneity, glandular definition, glands involved and hypoechoic foci size. Baseline-adjusted tUs values were analysed over time, modelling change from baseline at each time point. For each tUs domain, we fitted a repeated-measures logistic regression model to model the odds of a response in the rituximab arm (≥1-point improvement) as a function of the baseline score, age category, disease duration and time point.
Lung ultrasound has been widely used in diagnosing pulmonary diseases including pneumonia, connective tissue diseases and interstitial lung diseases. For patients in the intensive care unit (ICU), more attention is paid to monitoring the development of lung pathologic changes, which guides the therapy [1–9]. Lung insults caused by inflammation, trauma or water increase always lead to infiltration, which results in the loss of lung air. Depending on the severity of the aeration loss and water increase, each part of the lung generates different ultra- sound signs upon exam. The lung ultrasoundscore (LUSS) is the sum of the scores of each exam zone and has been justified as a respectable semiquantitative score to measure the lung aeration loss caused by different lung pathologic changes, such as pneumonia, atelectasis, pleural effusion, and lung oedema [10–12].
of varying probes deserves to be investigated; appropriate LUS cutoff values should be preliminarily calculated for each type of probe. We do not have data about intubation–surfactant–extubation failure because this was out of our scope. Therefore, we do not know if lung ultrasound can be used to predict it; because we have an aggressive noninvasive ventilation policy using multiple techniques, it is likely that the majority of failures were not due to a respiratory cause. Anyway, this is an intriguing issue
Rheumatoid arthritis (RA) is a chronic, serious systemic autoimmune disease that is primarily characterized by multi-joint synovitis . Therefore, comprehensive approaches to assessing joint damage in patients with RA are pivotal for the early diagnosis and treatment of RA in clinical settings . Currently, approaches to the clinical assessment of RA disease activity, such as the disease activity score in 28 joints (DAS28) require com- plicated algorithms with multiple parameters, including the number of swollen and tender joints, erythrocyte sedi- mentation rate (ESR), C-reactive protein (CRP) levels, and visual analogue scale (VAS) score, etc. Moreover, the 28-joint ultrasound (US28) score and the simplified disease activity index (SDAI) and clinical disease activity index (CDAI) considers 28 joints, which is simple but could be time-consuming. Even so, these parameters can only indirectly reflect damage to cartilage and bone in RA. Thus, accurate and simple methods are urgently needed to assess disease activity in patients with RA.
Results: 118 patients with early and 212 patients with established RA were included. The final ultrasoundscore included 8 joints (metacarpophalangeal 1 – 2 – 3, proximal interphalangeal 2 – 3, radiocarpal, metatarsophalangeal 2 – 3) and 1 tendon (extensor carpi ulnaris) examined bilaterally. The 6-month SRMs for the final score were − 1.24 (95% CI − 1.47 to − 1.02) for GSUS, and − 1.09 ( − 1.25 to − 0.92) for PDUS in early RA, with 87% of total information retained for GSUS and 90% for PDUS. The new score performed somewhat better than formerly proposed scores in the validation cohort. Conclusions: The Ultrasound in Rheumatoid Arthritis 9 joint/tendon score (USRA9) inflammation score showed good responsiveness, retained most of the information from the original full score and overall performed better than previous scores in a validation cohort.
LU examination appears as an interesting complemen- tary tool. In our study, LU showed the best area under the ROC curve associated with complicated outcome. LU allows for visual assessment of lung aeration, also provid- ing the regional patterns of lung injury. LU is also use- ful in diagnosing pleural effusion [8, 31], and providing information on diaphragm function [32–34]. Some possi- ble inconsistency of the lung ultrasoundscore (LUS) and a perfectible points allocation scale have been pointed out . Indeed, “0 point” in an individual lung region does not necessarily reflect normal lung aeration and “3 points” complete loss of lung aeration. However, the LUS is a simple tool to provide a numerical quotation of the lung aeration that offers the advantages of being quickly calculated and easily understood by all LU practitioners. In addition, its validity is reinforced by the highly repro- ducible rating of lung aeration between examiners, in our study as in others , meaning that a LUS improve- ment most likely corresponds to a regression of the lung aeration loss. Finally, LU allows for bedside assessment of lung aeration without exposing patients to X-ray. This is an obvious advantage given the recurrence of ACS epi- sodes during the lifespan of SCD patients, who receive an important dose of radiations among their life with cur- rent diagnostic strategies, among which an important part could be avoided implementing LU.
We used the 68-joints/14-entheses ultrasoundscore as a reference for the development of the new composite scores acknowledging that this instrument has not been validated for monitoring PsA patients yet. We constructed a bilateral and a unilateral composite score (focusing on the dominant site) using the Spanish 12-joint and the German 7-joint scores, respectively, as examples [6,19]. For the inclusion of relevant joints and entheses, we ap- plied a hierarchical approach as exemplarily depicted in Additional file 1 and described in the following paragraph. We conducted separate cycles of the procedure for each of the following anatomical regions and ultrasound pathologies: (1) small joints (defined as MCPs, metatar- sophalangeal joints (MTP) as well as proximal interpha- langeal joints (PIP) of hands (H-PIP) and feet (F-PIP)): GSS, PD-j, GS-perisyn (MCPs only), PD-perisyn (MCPs only), GS-teno, PD-teno, erosions and osteophytes; (2) DIP joints of the hand (H-DIP) and feet (F-DIP): GSS, PD-j, GS-teno, PD-teno, erosions and osteophytes; (3) large joints (defined as wrists, elbows, shoulders, hips, knees and ankles): GSS, PD-j, GS-teno (wrists and ankles only) and PD-teno (wrists and ankles only); and (4) entheses: GSE, PD-e, erosions and enthesophytes.
P < 0.01). This was supported by the results from other studies using ultrasound in horses, [13, 20, 24] which also report strong relationships between BCS and SF thick- ness (correlation coefficients (r) ranged from 0.64 to 0.92; P < 0.01) or donkeys  (r between 0.65 and 0.86, P < 0.01). For example, Gentry et al.  using ultrasonic fat measurements in mares at four different locations (tailhead, rump, 13th rib, and withers) found a stepwise regression analysis that explained 78 % of the BCS vari- ation. Our results agree with those of Gentry et al.  and confirm the potential utility of the RTU to monitor fatness in horses.
The decision to undergo thyroidectomy in the patient population was influenced by a high McGill Thyroid Nodule Score (MTNS). MTNS was previously shown to accurately represent the risk of malignancy in a thyroid nodule, given it takes into account a variety of demo- graphic and clinical risk factors in addition to the cyto- logical features evident on USFNA . Other significant operative criteria for our patients included worrisome features on ultrasound, clinical suspicion and patient preference . In addition, diagnostic surgery was rec- ommended to patients with two consecutive diagnoses of B3 or B4 on p-USFNA and r-USFNA.
In addition, our study did not also include elastography which can be consi- dered a limitation due to the widely accepted tendency to use this method for thyroid nodule assessment. However, our objective is that the applicability and interpretation of our score remains simple, easy to use in our country as well as other countries where the disposition of standardized equipment is not fully available. On the other hand, elastography is not included in other classification systems or in the latest edition of the American Thyroid Association (ATA) nor the ACR, probably due to the lack of evidence on use of strain and quantitative elastography (shear wave and similar)   .
In this study we retrospectively included all patients with chronic hepatic disease, who received an ultrasound of the abdomen either as an inpatient or outpatient in the Department of Gastroenterology and Gastrointestinal Oncology of the University Hospital of Goettingen be- tween April 2015 and January 2016. Patients who had a cholecystectomy or complained of upper abdominal pain were excluded from the study. Gall stones and single gall bladder polyps without symptoms were no exclusion criteria. Of all patients who also had a documented upper endoscopy (median time interval 147 days), the following parameters were evaluated by ultrasound: The thickness of the gall bladder was measured twice after over- night fasting at two different locations and an average value was calculated. The spleen length was measured from a left lateral cross section. The diameter of the portal vein, the portal blood flow velocity and the liver size were measured. Ultrasound and endoscopy examinations were performed by experienced Gastroenterology trainees (> 3 years experi- ence) and senior Gastroenterology consultants. The pres- ence or absence of ascites was recorded. Additionally, clinical parameters such as the Child-Pugh-classification, laboratory results and upper endoscopic findings (presence of EV graded according the classification of Paquet) were obtained. Using the results of the cranio-caudal spleen diameter, gall bladder wall diameter and laboratory results, we calculated the ratio of platelet count to spleen diameter and the ratio of platelet count to gall bladder wall thickness. The statistical analysis was performed using the Mann Whitney U and Chi square test. Further- more, variables with a P value < 0.1 from univariate analysis entered the multivariate binary logistic regres- sion analysis and (receiver operating characteristic) ROC analysis was performed by SPSS Version 25 Mac OS. Since patient data were collected retrospectively and did not influence the diagnostic or therapeutic
Subjects completed a demographic questionnaire before undergoing the screening process. The age of the subjects was calculated based on records in their identification cards. Ethnicity, sex, and presence of preexisting medical condition(s) and medical treatment(s) were self-declared. Standing height of the subjects without shoes was measured using a stadiometer (Seca, Hamburg, Germany) and recorded to the nearest 1 cm. Body weight of subjects with light clothing but without shoes was determined using a weighing scale (Tanita, Tokyo, Japan) and was recorded to the nearest 0.1 kg. Body mass index (BMI) was calculated as per the convention. Bone health of the subjects was assessed using a water-based QUS device (Achilles EXPII, GE Healthcare UK Ltd, Little Chalfont, UK). During the scanning, the subjects were required to sit on a chair and place their right foot on the food pad. The inflatable transducer transmitted ultrasound waves across the right calcaneal bone and the signal received was measured and analyzed. Subjects were measured three times with repositioning and the average values were taken. Trained technicians were responsible for the measurements. Quality control and calibration were per- formed daily using a phantom. Short-term in vivo coefficient of variation for the device was ,2.0%. The device generated three bone health indices, namely, speed of sound (SOS), broadband ultrasound attenuation (BUA), and stiffness index (SI). Calcaneal SOS is the SOS waves traveling though the calcaneus and bears the unit of meter per second (m/s). The SOS value is directly proportional to BMD value. Calca- neal BUA is the slope between attenuation of sound signals while traveling through the calcaneus and its frequency and the unit is dB/MHz. Stronger bones preferentially attenuate sound waves of higher frequencies. SI combines SOS and BUA values using the formula SI = ([0.67 × BUA] + [0.28 × SOS] - 420) and has a lower precision error than either SOS or BUA alone. In general, higher SOS, BUA, and SI values indicate better bone health. 9,23
There was a significant difference between the PAS in positive and negative appendicitis groups (P,0.001). In this study, PAS score $5 was found to be the best cutoff point compatible with acute appendicitis; it resulted in a sensitivity of 95% (95% CI = 29%–98%), specificity of 84% (95% CI = 76%–90%), PPV of 82% (95% CI = 73%–89%), NPV of 82% (95% CI = 73%–89%), and accuracy of 89% (as shown in Figure 2). Further analysis of PAS showed that it is more useful as an exclusive tool; PAS $2 showed the highest sensitivity of 97.8% (95% CI = 88.2%–99.9%) with only a single false negative case (missed appendicitis), whereas using higher cutoff value (PAS $7) showed the highest specificity 97.9% (95% CI = 2.6%–99.7%) with only 2 cases of negative appendectomy (Table 5).
Atherosclerosis is an important pathologic cause of car- diovascular (CV) and cerebrovascular diseases. Add- itionally, CV and cerebrovascular diseases are the leading causes of mortality in humans and can have sig- nificant impacts on morbidity. Therefore, the early pre- vention of CV and cerebrovascular diseases has become a focus of current research. Preclinical atherosclerosis has been related to higher coronary heart disease and stroke rates. Studies have demonstrated that carotid ultrasonography  is more sensitive than the coronary artery calcification score (CACS) for the detection of subclinical atherosclerosis. Hence, carotid intima-media thickness (CIMT) ultrasonography may represent an ac- cessible and reliable method to detect subclinical athero- sclerosis . CIMT is significantly increased in patients with existing plaques , is a marker of subclinical organ damage and is an independent predictor of CV and cere- brovascular events. Several studies have reported that
Carotid ultrasonography can measure cIMT and detect fo- cal atherosclerotic plaque using ultrasound. The measure- ment of cIMT has several advantages for monitoring of ath- erosclerosis. First, cIMT can be performed with no adverse effects on subjects. Second, cIMT can be carried out at rela- tively low cost. Third, cIMT gives better visualization of ath- erosclerotic changes on arterial wall than other imaging mo- dalities. In addition, ultrasound B-mode imaging of cIMT has been shown to be well correlated with IMT measured on microscopic examination. 14 Therefore, the measurement
In the present study, the SR was determined in 302 breast lesions. Results showed the SR of malignant masses was significantly larger than that of benign masses. In 208 malignant mass- es, the diagnostic efficiency of SR was similar to that of ES in invasive ductal carcinoma, but the possibility of misdiagnosis of SR was higher than that of ES in invasive lobular carcinoma due to the diffuse invasion and the poor con- trast to surrounding normal tissues. The misdi- agnosis of invasive malignancies might be ascribed to the mix of malignant tumor and nor- mal tissues, leading to the reduced hardness and the decreased SR. For intraductal carcino- ma, the SR had a better diagnostic efficiency as compared to ES (Figure 3). Of 94 benign mass- es, 7 had SR of ≥ 3.13 and 6 were fibroadeno- ma of which 3 had calcification, 3 showed severe dysplasia and 1 displayed repeated hyperplasia in galactocele. Misdiagnosis of SR was mainly found in fibroadenoma (85.7%, 6/7), which might be attributed to the large cal- cified foci in the mass, leading to the increase in absolute hardness and simultaneous increase in SR. Thus, we speculate that con- comitant routine ultrasound examination may avoid the measurement of SR of large classi- fied foci in the mass.
then included in the propensity score analysis. These included the presence of coagulopathy, CSI, repeat tracheostomy, presence of thyroid mass over the trachea and inability to palpate the cricoid cartilage or visualize the first tracheal ring on ultrasound. Morbid obesity and high positive end-expiratory pressure (PEEP) requirement were also considered high risk factors, with body mass index (BMI) and PEEP at the time of procedure included as continuous variables in the propensity score analysis. Other variables in the propensity score analysis included age, gender, days from admission to tracheostomy, primary diagnosis category and Acute Physiology and Chronic Health Evaluation (APACHE) II score. The primary diagnosis categories were traumatic brain injury, sub- arachnoid hemorrhage, intracerebral hemorrhage, acute ischemic stroke, spinal cord injury, status epilepticus, brain tumor, and other. Coagulopathy was defined as the presence of a laboratory abnormality suggestive of impair- ment in coagulation and/or the use of therapeutic anticoa- gulation or intensive antiplatelet therapy. Laboratory abnormalities indicative of coagulopathy were: platelet count <50,000/uL, International Normalized Ratio >1.7, partial thromboplastin time (PTT) >1.5 times the normal value and/or fibrinogen <100 mg/dL. The abnormal laboratory result had to be present on the day of the procedure, without pre-procedural correction, to meet the definition of coagulopathy. Patients on unfractionated heparin and warfarin were considered coagulopathic only if the appropriate PTT and International Normalized Ratio criteria were met, or, in the case of unfractionated heparin, if the infusion was restarted and a therapeutic PTT recorded within 12 hours of completion of PDT. Anticoagulant agents included in the definition of coagulopathy, regardless of laboratory abnormality, included therapeutic use of low molecular weight heparin, direct thrombin inhibitors and direct Xa inhibitors. Anticoagulation with these agents, as well as with unfractionated heparin and warfarin, was typically discon- tinued or reversed the morning of the procedure, and had to be restarted within 12 hours of PDT to meet the definition of coagulopathy. Intensive antiplatelet therapy, defined as combination therapy with aspirin and clopidogrel, was not held or reversed for PDT.
able difficulty index in the section of mammography and/or ultrasound use compared with physical activity may be altered due to the percentage of participants in genetic counseling or cancer patients included in the sample ( ~ 10%), having different behaviors to the general population. Although the purpose of HBSCQ piloting was its validation, not precisely Table 5 Scores of item validity
(49%) had a score of 4 or more; 3 did not have ultrasonography. Ultrasonography showed DVT in 125 patients (25%), for an overall prevalence in evaluable patients of 13% (125 of 1002) 14 . While Oudega and colleagues found that Wells’ rule in combination with a D-dimer test was not safe for excluding DVT in primary care. The authors found a missed proportion of 2.9% and 2.3% missed cases, respectively 15 . Bernardi E and Camporese G found that patients with a high probability of DVT have over a 75% prevalence of DVT confirmed by tests whereas cases with a low pretest probability have a less than a 5% prevalence of DVT 16 . We obtained similar results in our study in cases with a high probability.
Recent studies have shown thoracic ultrasound to be use- ful in the diagnosis of pulmonary edema and pneumoth- orax [6-12]. The presence of >3 comet tail artifacts, otherwise known as B-lines, in more than 2 zones per lung field has been shown to have a sensitivity of 100% and specificity of 92% for the diagnosis of pulmonary edema in ICU patients . Thoracic ultrasound, when performed by ultrasound trained physicians, is more sensitive and specific than conventional chest radiography for diagnos- ing pneumothorax [13,14]. The advent of multiple studies showing the diagnostic abilities of thoracic ultrasound in distinguishing between normal lung, pneumothorax, pul- monary edema and COPD has given the pre-hospital community much to celebrate. Now there is a tool that is portable, easy to use, has minimal risk to the patient and to the provider and has impressive test characteristics for