Sedative effects of propofol and risk factors for excessive sedation in the endoscopic treatment of biliary and pancreatic diseases.

Objectives: The safety and effectiveness of propofol in more complex endoscopic procedures, such as endoscopic retrograde cholangiopancreatography, remain unknown. Thus, we aimed to evaluate propofol sedation during endoscopic cholangiopancreatography, ultrasound-guided intervention, and gastroduodenal stenting and examine risk factors for excessive sedation. Methods: We retrospectively analyzed data from 870 patients who underwent endoscopic treatment with propofol sedation for biliary and pancreatic disease between October 2020 and September 2021. Sedation included propofol and fentanyl, with continuous monitoring of vital signs and the bispectral index. The assessed risk factors included age, complications, body mass index, treatment duration, and specialty. Results: Distal bile duct treatment (n = 367), hilar bile duct treatment (n = 197), post-small-intestinal reconstruction treatment (n = 75), endoscopic ultrasound-guided intervention (n = 140), and gastrointestinal obstruction treatment (n = 91) were performed. The rates of excessive sedation, hypoxemia, and hypotension were 7.8%, 6.0%, and 1.8%, respectively. Post-small-intestinal reconstruction treatment had the highest incidence rate of excessive sedation (16%), whereas endoscopic ultrasound-guided intervention had the lowest incidence rate (4.3%). Multivariate analysis revealed significant associations between excessive sedation and comorbid sleep apnea, obesity, and prolonged procedural time. Conclusions: Obesity, sleep apnea syndrome, and prolonged procedure time are risk factors for excessive sedation related to propofol use. Thus, sedation techniques should be tailored for these patients.

Ultrasound-Guided Glucocorticoid Injection as a Treatment for Rotator Cuff Calcific Tendinopathy: A Case Report.

Rotator cuff calcific tendinopathy (RCCT) is a common disorder of the rotator cuff causing shoulder pain and dysfunction. RCCT is characterized by calcium deposition on and around the tendons of the rotator cuff muscles. Treatment is typically conservative, consisting of anti-inflammatory drugs (NSAIDs) and physical therapy, although certain patients require more invasive treatment. If first-line treatments do not resolve the pain, second-line treatments such as glucocorticoid injections, extracorporeal shock wave therapy (ESWT), barbotage, and surgery may be considered; however, there is no gold standard treatment for these refractory cases. In this case study, a 36-year-old female patient with confirmed RCCT achieved symptom remission with ultrasound-guided methylprednisolone injection followed by adjunctive physical therapy. Ultrasonography enabled precise, targeted delivery of steroids to the calcified lesions, with near 100% resolution of deposits on repeat radiography. With additional physical therapy, the patient was completely pain-free with a full range of motion and the ability to perform daily activities. This case report demonstrates that ultrasound-guided glucocorticoid injection can be an efficacious treatment option for refractory cases of RCCT.

Ultrasound-guided trigeminal nerve approach at the level of the pterygopalatine fossa in cat cadavers.

OBJECTIVE: To describe an ultrasound-guided suprazygomatic approach to the trigeminal nerve block in cat cadavers. STUDY DESIGN: Prospective descriptive study. ANIMALS: Ten feline cadaver heads. METHODS: A 25:75 methylene blue-iopamidol mixture (0.1 mL cm-1 cranium length) was injected into 10 cadaver heads using an ultrasound-guided suprazygomatic approach. A computed tomography (CT) scan was performed to identify contrast presence at the orbital fissure, foramen rotundum and ovale, followed by anatomical dissection to identify staining of the pterygopalatine fossa (PPF), extraconal retrobulbar area, mandibular and maxillary nerves. Descriptive statistics were used to summarize results. RESULTS: A total of 20 injections were performed. Of these, 1/20 misinjection occurred and excluded from further reporting. The volume of injectate was 0.9 (0.9-1.1) mL [median (range)]. Staining of the PPF, extraconal space, maxillary and mandibular nerves over more than 6 mm was achieved in 19/19 (100%), 18/19 (95%), 17/19 (89%) and 19/19 (100%) of injections, respectively. CT showed presence of contrast within 5 mm of the orbital fissure, foramen rotundum and ovale in 18/19 (95%), 19/19 (100%) and 19/19 (100%) of the injections, respectively. No intracranial migration was observed. CONCLUSIONS AND CLINICAL RELEVANCE: This cadaver study illustrates that the suprazygomatic ultrasound-guided trigeminal nerve injection technique can successfully stain the PPF, retrobulbar cone extraconally, mandibular and maxillary nerves. Consequently, this technique has the potential to be used in vivo in cats to desensitize areas innervated by the trigeminal nerve.

Diagnostic ability and adverse events of mucosal incision-assisted biopsy for gastric subepithelial tumors: Systematic review and meta-analysis.

OBJECTIVES: This systematic review and meta-analysis aimed to evaluate the diagnostic ability and examine the efficacy of countermeasures to adverse events of mucosal incision-assisted biopsy (MIAB) for gastric subepithelial tumors (SETs). METHODS: We performed a literature search and identified 533 relevant articles. Eleven articles, including 339 lesions, were ultimately used in the meta-analysis. The primary end-point was the pathological diagnostic rate of MIAB for gastric SETs, and the secondary end-point was the incidence of adverse events. The efficacy of acid secretion inhibitors in preventing postoperative bleeding and that of local injection before incision to prevent perforation were also examined. RESULTS: Nine studies were conducted in Japan and two in South Korea, of which only two were prospective studies. The pooled pathological diagnostic rate of MIAB for gastric SETs was 87.8% (95% confidence interval [CI] 80.2-94.0; I2 = 68.7%). The adverse event rate of the pooled population was 0.2% (95% CI 0-1.4; I2 = 0%). The acid secretion inhibitors significantly reduced postoperative bleeding (odds ratio 0.06, 95% CI 0.01-0.66, P = 0.02). Perforation occurred in 0% and 2.6% of the local and nonlocal injection cohorts, respectively, and the pathological diagnostic rates were 50% and 66.7%, respectively. CONCLUSIONS: MIAB is a reliable technique with a favorable diagnostic rate and few adverse events. Acid secretion inhibitors may effectively prevent postoperative bleeding; however, the efficacy of local injection remains unclear. This technique could be an option for tissue sampling in gastric SETs.

Evaluation of Needles in Endoscopic Ultrasound-Guided Tissue Acquisition of Pancreatic Cancer for Genetic Yield and Quality.

BACKGROUND: Endoscopic ultrasound-guided fine needle biopsy (FNB) is the gold standard in tissue acquisition of pancreatic ductal adenocarcinoma (PDAC). There is a paucity of evidence of the impact of needle type or size on the genetic yield and quality. METHODS: Patients 18 years and older with PDAC who underwent FNB were retrospectively identified from a single database from 2016 to 2021. Genetic quantity is measured in micrograms (µg) and quality defined by RNA or DNA integrity number (RIN and DIN). FNB needles examined were Acquire 22 gauge (Boston Scientific, Marlborough, MA, USA) and ProCore 22 and 20 gauges (Cook Medical, Bloomington, IN, USA). RESULTS: Two hundred seventy-seven patients were identified. ProCore 20G needle procured higher RNA quantity (4125.8µg, IQR: 2003.8, 5954.8, p = 0.012) compared to ProCore 22G (2050µg IQR: 966.4, 3181.6) and Acquire 22G (2310.6µg, IQR: 1439.3, 4312). Median DNA quantity was 3340.5µg (Acquire 22G), 2610.4µg (ProCore 22G) and 3499.7µg (ProCore 20G) (p = 0.763). Median DIN was 7.3 (Acquire 22G and ProCore 22G) and 7.4 (ProCore 20G) (p = 0.449). Median RIN was 3.0 (Acquire 22G and ProCore 22G) and 2.7 (ProCore 20G) (p = 0.886). CONCLUSION: ProCore 20G was associated with higher quantity of RNA. There were no differences in the quality acquired by different needles.

Ultrasound-guided needle knife release for stenosing tenosynovitis of the flexor pollicis longus: a prospective randomized controlled trial.

PURPOSE: This study aimed to evaluate the efficacy and safety of ultrasound-guided needle knife release in the treatment of stenosing tenosynovitis of the flexor pollicis longus. METHODS: In this prospective trial, 60 patients with clinically and ultrasonographically confirmed stenosing tenosynovitis of the flexor pollicis longus were randomly allocated to 1 of 3 groups: ultrasound-guided needle knife release (n = 20), traditional conservative treatment (n = 20), and open surgery (n = 20). The primary outcome measure was the Quinnell grade of triggering severity. Secondary outcomes comprised pain intensity (on visual analog scale), satisfaction (5-point Likert scale), and complications. Outcomes were evaluated at baseline, 1 week, 1 month and 3 months post-intervention by blinded assessors. RESULTS: At all follow-up time points, the needle knife release group demonstrated significantly lower Quinnell grades (p < 0.05) and pain scores (p < 0.001) than the conservative treatment group; satisfaction was greater in the needle knife release group compared to the conservative treatment group at 1 month (p = 0.002) and 3 months (p < 0.001). There were no significant differences in outcomes between the needle knife release group and the open surgery group. The overall complications rate was 5% in the needle knife release group, 10% in the conservative treatment group, and 15% in the open surgery group (p = 0.574). CONCLUSION: Ultrasound-guided needle knife release is an effective and safe treatment for stenosing tenosynovitis of the flexor pollicis longus, with outcomes that are better than with traditional conservative treatment and similar to those of open surgery.

Ultrasound-Guided Selective Glossopharyngeal and Maxillary Nerve Blocks for Analgesia After Tonsillectomy: A Pilot Study.

Purpose Postoperative pain management methods for tonsillectomy commonly include the use of opioids, non-steroidal anti-inflammatory drugs, and acetaminophen. However, some patients report pain despite the use of these medications. In recent years, ultrasound-guided selective glossopharyngeal nerve block (UGSGNB) and ultrasound-guided maxillary nerve block (UGMNB) have been reported to be effective for analgesia post-tonsillectomy. We retrospectively analyzed the effects of UGSGNB and UGMNB in the perioperative management of patients who underwent tonsillectomy under general anesthesia. Methods This retrospective study evaluated adults (18-61 years old) who had received general anesthesia for tonsillectomy. The control group comprised 25 patients who received general anesthesia using the standard protocol, and the nerve block group comprised 10 patients who also received additional UGGNB and UGMNB. Results While these nerve blocks may have contributed to improving the postoperative food intake, they did not reduce the frequency of postoperative analgesia used. Improved dietary intake after UGSGNB and UGMNB could be advantageous for postoperative recovery. Conclusion Further research with a larger number of cases and prospective intervention studies are necessary to determine the effects of combining UGSGNB and UGMNB for post-tonsillectomy analgesia.

Gastric Injury in Percutaneous Transhepatic Liver Biopsy After Living Donor Liver Transplantation: A Report of Two Cases.

Percutaneous transhepatic liver biopsy (PTLB) is essential for assessing liver function but carries risks such as bleeding, cholangitis, bowel injuries, and rare fatal complications. Gastric injury following PTLB is rare and not widely reported. This report describes two cases of gastric injury during ultrasound (US)-guided PTLB in patients following living donor liver transplantation. Gastric injury is uncommon, particularly when sampling from the left lobe due to its proximity to the stomach. Ensuring a clear field of vision, meticulous equipment preparation, and skilled technique are crucial for safe PTLB. When there is a risk of gastric injury, using smaller and shorter needles or alternative methods to US-guided PTLB is essential. Gastric injury should be promptly considered and treated if multiple punctures are required and if abdominal symptoms or gastrointestinal bleeding occur after PTLB.

Navigating the Anesthetic Challenges of Vertebral Defects, Anorectal Anomalies, Cardiac Anomalies, Tracheoesophageal Fistula (TEF)/Esophageal Atresia, Renal Anomalies, and Limb Abnormalities (VACTERL) Association: A Delicate Balancing Act.

Vertebral defects, anorectal anomalies, cardiac anomalies, tracheoesophageal fistula (TEF)/esophageal atresia, renal anomalies, and limb abnormalities (VACTERL) association is a rare congenital disorder presenting with a constellation of birth defects. The diagnosis is primarily clinical, and patients exhibit at least three of these anomalies. These patients' management involves a multidisciplinary approach tailored to the individual's condition. Anesthetic management is particularly challenging due to the diverse and complex anomalies. This article discusses the anesthetic management of a term newborn male (39 weeks, six days gestation, 3340 g) diagnosed with VACTERL association. The newborn was admitted to the neonatal intensive care unit (NICU) and scheduled for the surgical repair of TEF and derivative colostomy on the second day of life. To mitigate the risk of air leak and abdominal distension from positive pressure ventilation, a derivative colostomy was performed first under regional anesthesia preserving spontaneous ventilation. To achieve that, the patient was sedated with ketamine and dexmedetomidine, and an ultrasound-guided single-shot caudal block with ropivacaine was performed. Post-abdominal decompression, general anesthesia was induced, and intubation was managed via videolaryngoscopy. Thoracoscopic TEF repair required several pauses for ventilation and hemodynamic optimization. Dopamine was administered intraoperatively for blood pressure support. The newborn was extubated and started on enteral feeding by the seventh postoperative day, progressing well by the time of discharge. In this case, a derivative colostomy before TEF repair avoided positive pressure ventilation complications. Ultrasound-guided caudal block provided effective regional anesthesia with high success rates. Ketamine and dexmedetomidine offered balanced sedation with minimal respiratory compromise. Dopamine was used effectively to maintain adequate perfusion, monitored with invasive blood pressure and cerebral oximetry. Anesthetic management of newborns with VACTERL association undergoing simultaneous repair of TEF and anal atresia demands meticulous and tailored planning to address the specific needs and minimize associated risks. This case highlights the importance of comprehensive anesthetic management and its impact on the patient's outcome.

Comparison of the Efficacy of Ultrasound-Guided Suprascapular Nerve Blocks and Intraarticular Corticosteroid Injections for Frozen Shoulder: A Randomized Controlled Trial.

BACKGROUND: The current mainstream treatment for frozen shoulder is a combination of physiotherapy and intraarticular corticosteroid injections (IACIs). Recently, the ultrasound-guided suprascapular nerve block (SSNB) has developed as a notable alternative option to the mainstream treatment. OBJECTIVE: We aimed to compare ultrasound-guided SSNBs' effectiveness to IACIs' as treatments for frozen shoulder. STUDY DESIGN: This study was conducted as a prospective single-blind, randomized controlled trial. SETTING: Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, a medical center in Taipei, Taiwan. METHODS: Patients with frozen shoulder (n = 76) were enrolled as participants and allocated to either an SSNB group (n = 38) or an IACI group (n = 38). Both groups received 2 injections of 20 mg of triamcinolone and 3 mL of 1% lidocaine at 2-week intervals and underwent the same physiotherapy protocol for 3 months. The primary outcome measure was the Shoulder Pain and Disability Index (SPADI). The secondary outcome measures were the Shoulder Disability Questionnaire (SDQ), the active and passive range of motion (ROM) of each patient's affected shoulder, and the 36-item Short Form Health Survey (SF-36). Evaluations were performed at baseline and at 4 and 12 weeks after starting treatment. RESULTS: Both groups achieved significant improvements in all outcome measures, except the general health subscale of the SF-36 at 4 and 12 weeks after starting treatment. For time and group interaction, the results for the SDQ (P = .047) and SF-36 (bodily pain, P = .025) indicated significant differences that favored IACIs. Additionally, the IACI group achieved more favorable outcomes than did the SSNB group on the SPADI (P = .094) and in ROM (i.e., abduction [P = .190] and external rotation [P = .081]) as well as on 2 subscales of the SF-36: bodily pain (P = .059) and role-emotional (P = .072). LIMITATIONS: Our study is limited by the lack of participant stratification based on the stages of frozen shoulder and the 12-week follow-up period. CONCLUSIONS: A combination of ultrasound-guided IACIs and physiotherapy should be attempted first as a frozen shoulder treatment.

Gas-forming renal abscesses in critically ill patients: ultrasound-guided drainage.

PURPOSE: This study aimed to describe and evaluate a real-time ultrasound-guided (US-guided) drainage technique for effective and safe drainage of gas-forming renal abscesses (GRA) in an intensive care unit(ICU). MATERIALS AND METHODS: This retrospective study included four patients with GRA who were admitted to the ICU of a tertiary care center between September 2021 and September 2023. The patients were all comorbid with severe systemic infections and required drainage of abscesses for infection control. This study describes in detail the process of rapid and precise US-guided drainage of GRA by an ultrasound interventionist through certain maneuvers and techniques. RESULTS: Six US-guided drainage procedures were completed in four patients, and seven catheters were placed accurately in the abscesses with a 100% success rate. No intraoperative or postoperative complications such as bleeding and peripheral organ damage were observed, and the median time with catheters was 13 days (8-46 days). CONCLUSION: The technique of real-time US-guided drainage of GRA can be performed safely in the ICU without the need to leave the ICU, greatly reducing risk.

Role of endoscopic ultrasound-guided biliary drainage for palliation of malignant biliary obstruction.

Endoscopic ultrasound-guided biliary drainage (EUS-BD) directs bile flow into the digestive tract and has been mostly used in patients with malignant biliary obstruction (MBO) where endoscopic retrograde cholangiopancreatography-guided biliary drainage was unsuccessful or was not feasible. Lumen apposing metal stents (LAMS) are deployed during EUS-BD, with the newer electrocautery-enhanced LAMS reducing procedure time and complication rates due to the inbuilt cautery at the catheter tip. EUS-BD with electrocautery-enhanced LAMS has high technical and clinical success rates for palliation of MBO, with bleeding, cholangitis, and stent occlusion being the most common adverse events. Recent studies have even suggested comparable efficacy between EUS-BD and endoscopic retrograde cholangiopancreatography as the primary approach for distal MBO. In this editorial, we commented on the article by Peng et al published in the recent issue of the World Journal of Gastrointestinal Surgery in 2024.

A Case of Breast Papillary Carcinoma in an Elderly Black Male Patient With Pathology, Ultrasound, and Mammogram Imaging Findings.

The patient was an 84-year-old man who presented with a palpable, left breast mass. Following ultrasound, mammography, and ultrasound-guided core needle biopsy, the lesion was diagnosed as papillary carcinoma. Findings included a complex, cystic mass on ultrasound; a well-circumscribed, high-density lesion on mammogram; and a lack of highlighting of myoepithelial cells within fibrovascular cores on immunostaining. With this case report, we aim to add to the literature an additional example of breast papillary carcinoma in a male patient and its corresponding imaging and pathologic findings.

Nonsurgical removal of a massive calcification of the shoulder.

Calcific tendinopathy of the shoulder is a prevalent and painful condition marked by calcific deposits in the rotator cuff tendons or subacromial bursa, with an incidence of 2.7% to 20%, predominantly affecting individuals aged 30 to 50. Women are 1.5 times more likely to be affected than men. Deposits are frequently bilateral in 10%-20% of cases and most commonly found in the supraspinatus tendon. The pathogenesis remains unclear, with theories suggesting repetitive strain or ischemic degeneration leading to calcium deposition. The disease progresses through precalcific, calcific, and postcalcific phases, with symptoms ranging from mild pain to severe, disabling pain resistant to medication. Diagnosis primarily involves radiographs or CT scans, with ultrasound aiding in deposit staging. Conservative treatments include medication, physiotherapy, and subacromial corticosteroid injections. Novel nonsurgical treatments like ultrasound-guided needling (UGN) and extracorporeal shock wave therapy (ESWT) have shown promise. When conservative measures fail, surgical options achieve significant improvement. This case report details a 53-year-old woman with a 12 cm calcification treated successfully with UGN, demonstrating the efficacy of this minimally invasive technique for large deposits.

Additional benefit of endoscopic ultrasound with bronchoscope-guided fine needle aspiration to endobronchial ultrasound-guided transbronchial needle aspiration in the evaluation of lung cancer: a systematic review and meta-analysis.

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound with bronchoscope-guided fine needle aspiration (EUS-B-FNA) are minimally invasive procedures for the diagnosis and staging of lung cancer. This study aimed to investigate the additional diagnostic value of EUS-B-FNA following EBUS-TBNA. Methods: We performed a systematic literature review of PubMed, Embase, and the Cochrane Central Register databases and extracted the studies reporting the implementation of the combined EBUS-TBNA/EUS-B-FNA. A proportional meta-analysis was conducted to determine the pooled diagnostic yield of this procedure. Results: We identified nine studies involving 2,375 patients. The overall pooled diagnostic yield of EBUS-TBNA alone and combined EBUS-TBNA/EUS-B-FNA was 0.87 [95% confidence interval (CI): 0.79-0.95, I2=96.55%] and 0.92 (95% CI: 0.85-0.99, I2=97.89%), respectively. Adding EUS-B-FNA to EBUS-TBNA increased the diagnostic yield by approximately 0.05. There was statistical heterogeneity among the studies (I2=54.49%). Among the 832 patients in seven studies, additional diagnostic benefits of EUS-B-FNA were observed in 37 lesions. The most common diagnosed lesion was in station 4L (n=10), followed by station 5 (n=8) and station 7 (n=8). Conclusions: In pooled estimates, the addition of EUS-B-FNA to EBUS-TBNA increased the diagnostic yield for the diagnosis and staging of lung cancer. Nodal station 4L, station 5, and station 8 were lesions frequently diagnosed by the addition of EUS-B-FNA. Because of statistical between-study heterogeneity, our findings should be interpreted with caution.

Role of ultrasound­guided fine­needle aspiration cytology combined with thyroid peroxidase and thyroglobulin antibodies in evaluating cervical lymph node metastasis in thyroid cancer.

The present study was designed to explore the role of ultrasound-guided fine-needle aspiration (FNA) cytology combined with thyroid peroxidase antibody (TPO-Ab) and thyroglobulin antibody (Tg-Ab) in evaluating cervical lymph node metastasis in thyroid cancer. The aim was to propose more effective diagnostic strategies for cervical lymph node metastasis in patients with thyroid cancer. Firstly, the present retrospective case-control study selected 294 patients with thyroid cancer treated at Changzhou Second People's Hospital (Changzhou, China). High-resolution ultrasound equipment was used for ultrasound and FNA examinations. Additionally, a retrospective analysis of the patient's comprehensive thyroid function tests, including TPO-Ab and Tg-Ab levels, was conducted. Subsequently, univariate and multivariate logistic regression models were employed to analyze the association between various factors and cervical lymph node metastasis. The overall diagnostic accuracy of the model was evaluated using the receiver operating characteristic curve and its area under the curve. Finally, the performance of the diagnostic model was quantitatively assessed through calculating sensitivity, specificity, positive predictive and negative predictive values. According to the experimental results, sex, tumor stage and the levels of thyroid autoantibodies were associated with the risk of cervical lymph node metastasis in thyroid cancer. Moreover, ultrasound features, such as cystic lesions, loss of hilum of the lymph nodes, abundant vascular supply, heterogeneous echo and microcalcification were also closely related to cervical lymph node metastasis. Logistic regression analysis also showed that tumor stage, serum levels of TPO-Ab and Tg-Ab, and cystic lesions were independent predictors of cervical lymph node metastasis. Furthermore, the combined use of ultrasound, FNA, TPO-Ab and Tg-Ab significantly improved diagnostic sensitivity and specificity. Overall, ultrasound-guided FNA combined with TPO-Ab and Tg-Ab may have a significant role in the evaluation of cervical lymph node metastasis in thyroid cancer. This combined diagnostic approach could significantly enhance diagnostic accuracy, providing a more effective strategy for the clinical management of cervical lymph node metastasis in thyroid cancer.

Clinical efficacy and safety of high-intensity focused ultrasound combined with ultrasound-guided suction curettage at different time intervals for Cesarean scar pregnancy: a retrospective study.

OBJECTIVE: This study aims to assess the clinical efficacy and safety of combining high-intensity focused ultrasound (HIFU) with ultrasound-guided suction curettage for the treatment of cesarean scar pregnancy (CSP) at different time intervals. METHODS: A total of 115 CSP patients were enrolled and divided into two groups based on the time between HIFU ablation and suction curettage. Group A (n = 50) underwent suction curettage 24-48 h after HIFU ablation, while Group B (n = 65) had suction curettage within 6 h of HIFU ablation. The study compared and analyzed the clinical characteristics, treatment success rates, and intraoperative hemorrhage during ultrasound-guided suction curettage. RESULTS: The demographic characteristics of the two groups were similar, with no statistically significant differences observed in HIFU parameters, treatment success rates, blood loss, the use of Foley catheter balloons, or hospital expenses (p > 0.05). Importantly, suction curettage performed within 6 h after HIFU ablation resulted in shorter hospitalization times compared to suction curettage performed 24-48 h after the ablation (p < 0.05). CONCLUSIONS: Suction curettage within 6 h after HIFU ablation is an effective, safe, and cost-efficient treatment for patients diagnosed with CSP.

Efficacy and Accuracy of Ultrasound Guided Injections in the Treatment of Cervical Facet Joint Syndrome: A Systematic Review.

Background/Objectives: Cervical facet joint syndrome (CFJS) is a frequent cause of neck pain and motor disability. Among the available therapies for CFJS, ultrasound (US)-guided injections are becoming more and more widespread, but the evidence about their accuracy and effectiveness is still debated in the scientific literature. The aim of this systematic review is to assess efficacy, accuracy and feasibility of US-guided cervical facet injections for the related chronic neck pain treatment. Methods: This review was conducted following the preferred reporting items for systematic reviews and meta-analysis 2020 (PRISMA) statement guidelines. The scientific articles were identified through the PubMed, Google Scholar and Cochrane Library databases. Qualitative assessment of the selected studies was carried out using the modified Oxford quality scoring system. Nine studies with a total of 958 patients were included in this review. The risk of bias was assessed using the Cochrane Collaboration tool. The protocol was registered at PROSPERO 2024 (n°CRD42024512214). Results: The results of this review suggest that the US-guided cervical facet injection for CFJS treatment is an effective technique in terms of accuracy (using the lateral technique it ranges from 92% to 98%), and efficiency (it grants pain relief with a decrease in the procedure time and fewer needle passes in comparison with the X-ray-guided technique, which also involves radiation exposure). Conclusions: US-guided injections are a safe and effective method to treat this musculoskeletal disease, granting a high functional recovery and long-lasting pain relief, net of the used drugs. However, these procedures are strictly operator-dependent and require important training to acquire good expertise.

Dissimilar Planes and Approaches with Common Neural Targets - A Cadaveric Evaluation of Three Different Ultrasound-guided Fascial Plane Blocks for Lumbar Plexus Nerves.

Background: The lumbar plexus (LP) is a group of nerves located at the fourth lumbar vertebra level, between the anterior two-thirds and posterior one-thirds of the psoas muscle. In this study, the researchers aimed to investigate the spread of latex in injections of LP, suprainguinal fascia iliaca, and circum-psoas planes to assess the different regional techniques for blocking LP nerves (LPNs). Methods: The study involved performing ultrasound-guided injections of three different colored latexes in six cadavers. The researchers observed and compared the spread of latex in each plane by taking cross sections at the levels of L4, anterior superior iliac spine (ASIS), and sacral foramina (SF). The spread of latex and LPN staining was documented and analyzed through photography. Results: The results showed that the latex spread within the psoas muscle and fascia iliaca plane (FIP) during LP injections, whereas suprainguinal fascia iliaca injections showed latex dissemination in the FIP at both ASIS and SF levels. On the other hand, circum-psoas injections spread beneath the iliopsoas fascia at both levels and medially toward the external iliac vessels. Despite this spread, there was no communication between the three planes, and there was no mixing of latex from the different injections at any level. Conclusion: There are distinct fascial planes, for the three approaches, with no communication between them. While latex diffused from LP plane to FIP, no mixing of dye was observed and also the reverse could not be achieved. These findings suggest that different regional techniques for blocking LPNs have their unique planes of action.

Time series analysis combined with transcriptome sequencing to explore characteristic genes and potential molecular mechanisms associated with ultrasound-guided microwave ablation of glioma.

OBJECTIVE: This study aimed to explore marker genes and their potential molecular mechanisms involved in US-guided MWA for glioma in mice. METHOD: The differentially expressed genes (DEGs1 and DEGs2) and lncRNAs (DELs1 and DELs2) were obtained between Non (glioma tissues without MWA) and T0 groups (0h after MWA), as well as between Non and T24 groups (24h after MWA). The down-regulation cluster genes (CONDOWNDEGs) and upregulation cluster genes (CONUPDEGs) were identified by time series analysis. Candidate genes were obtained by overlapping CONDOWNDEGs with downregulation DEGs (DOWNDEGs)1 and DOWNDEGs2, as well as CONUPDEGs with up-regulation DEGs (UPDEGs)1 and UPDEGs2. The expressions of immune checkpoints and inflammatory factors, gene set enrichment analysis (GSEA), and protein subcellular localization were performed. The eXpression2Kinases (X2K), GeneMANIA, transcription factor (TF), and competing endogenous (ce) RNA regulatory networks were conducted. The expression of marker genes was validated by quantitative real-time polymerase chain reaction (qRT-PCR). RESULTS: Five marker genes (IL32, VCAM1, IL34, NFKB1 and CXCL13) were identified, which were connected with immune-related functions. Two immune checkpoints (CD96 and TIGIT) and six inflammatory factors played key roles in US-guided MWA for glioma. ceRNA regulatory networks revealed that miR-625-5p, miR-625-3p, miR-31-5p and miR-671-5p were associated with target genes. qRT-PCR indicated both IL32, VCAM1, and NFKB1 were potential markers under US-guided MWA-related time series analysis. CONCLUSION: The use of US-guided MWA might be a practical method for influencing the function of target genes, regulating time frames to decrease inflammation, and stimulating immune responses in glioma therapy.