Differentiating between benign and malignant thyroid nodules: An evidence-based approach in general practice

BACKGROUND: The widespread use of imaging techniques has led to more frequent detection of thyroid nodules, and while the majority are benign, the risk of malignancy in an adult ranges from 7% to 15%. General practitioners (GPs) must be able to evaluate thyroid nodules and refer cases when appropriate. OBJECTIVES: The aim of this article is to bring GPs up to date on the evidence-based management of thyroid nodules, with specific focus on neoplastic nodules, while highlighting significant changes in the 2015 American Thyroid Association guidelines. DISCUSSION: Thyroid nodules frequently occur in the general population. Differentiating between a benign and malignant nodule can be challenging, and community guidelines have standardised investigation, management and follow-up procedures. The key tests for risk stratification of thyroid nodules include serum thyroid-stimulating hormone testing, ultrasonography and fine-needle aspiration. GPs should be aware of the latest evidence-based recommendations for the appropriate management of a thyroid nodule.

Use of ultrasounds in the food industry-Methods and effects on quality, safety, and organoleptic characteristics of foods: A review.

The use of ultrasounds has recently gained significant interest in the food industry mainly due to the new trends of consumers toward functional foods. Offering several advantages, this form of energy can be applied for the improvement of qualitative characteristics of high-quality foods as well as for assuring safety of a vast variety of foodstuffs, and at the same time minimizing any negative effects of the sensory characteristics of foods. Furthermore, the non-destructive nature of this technology offers several opportunities for the compositional analysis of foods. However, further research is required for the improvement of related techniques and the reduction of application costs in order to render this technology efficient for industrial use. This review paper covers the main applications of ultrasounds as well as several advantages of the use of the technology in combination with conventional techniques. The effects of ultrasounds on the characteristics, microbial safety, and quality of several foods are also detailed.

Out of hospital point of care ultrasound: current use models and future directions.

INTRODUCTION: Ultrasound has evolved from a modality that was once exclusively reserved to certain specialities of its current state, in which its portability and durability lend to its broadly increasing applications. OBJECTIVES: This review describes portable ultrasound in the hospital setting and its comparison to gold standard imaging modalities. Also, this review summarizes current literature describing portable ultrasound use in prehospital, austere and remote environments, highlighting successes and barriers to use in these environments. DISCUSSION: Prehospital ultrasound has the ability to increase diagnostic ability and allow for therapeutic intervention in the field. In austere environments, ultrasound may be the only available imaging modality and thus can guide diagnosis, therapeutics and determine which patients may need emergent transfer to a healthcare facility. The most cutting edge applications of portable ultrasound employ telemedicine to obtain and transmit ultrasound images. This technology and ability to transmit images via satellite and cellular transmission can allow for even novice users to obtain interpretable images in austere environments. Portable ultrasound uses have steadily grown and will continue to do so with the introduction of more portable and durable technologies. As applications continue to grow, certain technologic considerations and future directions are explored.

Ecografía dermatológica: una nueva aproximación al conocimiento de la piel / Ultrasound in dermatology: a new approximation to knowledge of the skin

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Ultrasound in medical education: listening to the echoes of the past to shape a vision for the future.

PURPOSE: Ultrasound in medical education has seen a tremendous growth over the last 10-20 years but ultrasound technology has been around for hundreds of years and sound has an even longer scientific history. The development of using sound and ultrasound to understand our body and our surroundings has been a rich part of human history. From the development of materials to produce piezoelectric conductors, ultrasound has been used and improved in many industries and medical specialties. METHODS: As diagnostic medical ultrasound has improved its resolution and become more portable, various specialties from radiology, cardiology, obstetrics and more recently emergency, critical care and proceduralists have found the added benefits of using ultrasound to safely help patients. The past advancements in technology have established the scaffold for the possibilities of diagnostic ultrasound's use in the present and future. RESULTS: A few medical educators have integrated ultrasound into medical school while a wealth of content exists online for learning ultrasound. Twenty-first century learners prefer blended learning where material can be reviewed online and personalize the education on their own time frame. This material combined with hands-on experience and mentorship can be used to develop learners' aptitude in ultrasound. CONCLUSIONS: As educators embrace this ultrasound technology and integrate it throughout the medical education journey, collaboration across specialties will synthesize a clear path forward when needs and resources are paired with vision and a strategic plan.

Development and external validation of new ultrasound-based mathematical models for preoperative prediction of high-risk endometrial cancer.

OBJECTIVES: To develop and validate strategies, using new ultrasound-based mathematical models, for the prediction of high-risk endometrial cancer and compare them with strategies using previously developed models or the use of preoperative grading only. METHODS: Women with endometrial cancer were prospectively examined using two-dimensional (2D) and three-dimensional (3D) gray-scale and color Doppler ultrasound imaging. More than 25 ultrasound, demographic and histological variables were analyzed. Two logistic regression models were developed: one 'objective' model using mainly objective variables; and one 'subjective' model including subjective variables (i.e. subjective impression of myometrial and cervical invasion, preoperative grade and demographic variables). The following strategies were validated: a one-step strategy using only preoperative grading and two-step strategies using preoperative grading as the first step and one of the new models, subjective assessment or previously developed models as a second step. RESULTS: One-hundred and twenty-five patients were included in the development set and 211 were included in the validation set. The 'objective' model retained preoperative grade and minimal tumor-free myometrium as variables. The 'subjective' model retained preoperative grade and subjective assessment of myometrial invasion. On external validation, the performance of the new models was similar to that on the development set. Sensitivity for the two-step strategy with the 'objective' model was 78% (95% CI, 69-84%) at a cut-off of 0.50, 82% (95% CI, 74-88%) for the strategy with the 'subjective' model and 83% (95% CI, 75-88%) for that with subjective assessment. Specificity was 68% (95% CI, 58-77%), 72% (95% CI, 62-80%) and 71% (95% CI, 61-79%) respectively. The two-step strategies detected up to twice as many high-risk cases as preoperative grading only. The new models had a significantly higher sensitivity than did previously developed models, at the same specificity. CONCLUSION: Two-step strategies with 'new' ultrasound-based models predict high-risk endometrial cancers with good accuracy and do this better than do previously developed models.

Current status and prospects for microbubbles in ultrasound theranostics.

Encapsulated microbubbles have been developed over the past two decades to provide improvements both in imaging as well as new therapeutic applications. Microbubble contrast agents are used currently for clinical imaging where increased sensitivity to blood flow is required, such as echocardiography. These compressible spheres oscillate in an acoustic field, producing nonlinear responses which can be uniquely distinguished from surrounding tissue, resulting in substantial enhancements in imaging signal-to-noise ratio. Furthermore, with sufficient acoustic energy the oscillation of microbubbles can mediate localized biological effects in tissue including the enhancement of membrane permeability or increased thermal energy deposition. Structurally, microbubbles are comprised of two principal components--an encapsulating shell and an inner gas core. This configuration enables microbubbles to be loaded with drugs or genes for additional therapeutic effect. Application of sufficient ultrasound energy can release this payload, resulting in site-specific delivery. Extensive preclinical studies illustrate that combining microbubbles and ultrasound can result in enhanced drug delivery or gene expression at spatially selective sites. Thus, microbbubles can be used for imaging, for therapy, or for both simultaneously. In this sense, microbubbles combined with acoustics may be one of the most universal theranostic tools.