Liver and heart failure: an ultrasound relationship.

Liver and heart are anatomically and patho-physiologically related. In heart failure (HF) the increased right atrial pressure and volume overload cause histological changes in hepatocytes, leading to a condition known as "congestive hepatopathy" (CH), with consequent variations in liver functioning and ultrasound (US) findings. CH has specifical US findings especially regarding venous vessels aspect, easily detecting by gray-scale study, but many others can be distinguished by Doppler analysis. Usually, hepatic veins look enlarged and hypocollassing, together with signs of portal hypertension (hepatomegaly, ascites, splenomegaly, porto-systemic collaterals). Typically, in CH Doppler findings regard alterations in venous vessel flow and arterial resistance (venous system hyperpulsatility, reduced velocity flow, high resistance index in hepatic arterial Doppler spectrum). Sometimes CH and other primary hepatopathy can coexist, and therefore some of the expected variations may not manifest: it allows suspecting an unknown underlying liver disease. At last, US technologies of more recent applications, even if not routinely used, allow investigating additional aspects such as elastography that detects changes in liver elasticity or contrastographic US, able to show differences in hepatic venous opacification. However, most of these US signs are not pathognomonic, and therefore a multidisciplinary clinical reasoning must not be lacking. The aim of the present review is to easily provide US signs of liver alterations in HF, in particular right heart failure with volume overload, suggesting including liver US in instrumental diagnosis and therapeutic monitoring of HF.

Acceptability and Practicality of a Quick Musculoskeletal Examination into Sports Medicine Pre-Participation Evaluation.

BACKGROUND: Child musculoskeletal (MSK) diseases are common and, even if often benign, sometimes can lead to significant impairment in the future health of children. Italian pre-participation evaluation (PPE), performed by a sports medicine physician, allows for the screening of a wide range of children every year. Therefore, this study aims to evaluate the feasibility and the acceptability of pGALS (pediatric Gait, Arms, Legs and Spine) screening, a simple pediatric MSK screening examination, when performed as part of a routine PPE. METHODS: Consecutive school-aged children attending a sports medicine screening program were assessed with the addition of pGALS to the routine clinical examination. Practicability (time taken) and patient acceptability (discomfort caused) were recorded. RESULTS: 654 children (326 male, mean age 8.9 years) were evaluated through pGALS. The average time taken was 4.26 min (range 1.9-7.3 min). Acceptability of pGALS was deemed high: time taken was "adequate" (97% of parents) and caused little or no discomfort (94% of children). Abnormal MSK findings were common. CONCLUSIONS: pGALS is a practical and acceptable tool to perform in sports medicine PPE, even if performed by a non-expert in MSK medicine. Although common, abnormal MSK findings need to be interpreted in the global clinical context and assessment.

Incremental value of compression ultrasound sonography in the emergency department.

The quick evaluation of venous thromboembolism is a key point of modern medicine since the delayed diagnosis is associated with a worse prognosis. Venous ultrasound (VU) is a sensitive and rapidly performed test in cases of suspected deep venous thrombosis. Various protocols have been proposed for its execution, such as the study of the whole deep venous circulation of the lower limb or the analysis of the femoral-popliteal area. The aim is to detect a vessel thrombus and the most sensitive element is the non-compressibility with the probe. Initially, the thrombus is hypoechogenic and adherent to the vessel; later, it tends to organize and recanalize. Usually, in the early stages, the risk of embolism is higher. The role of studying the iliac axis and calf veins is still uncertain. VU is not useful for assessing response to anticoagulation therapy and it is unclear whether the persistence of thrombotic abnormalities can guide on a possible prolongation of therapy.

Potential role of an athlete-focused echocardiogram in sports eligibility.

Sudden cardiac death (SCD) of an athlete is a rare but tragic event and sport activity might play a trigger role in athletes with underlying structural or electrical heart diseases. Preparticipation screenings (PPs) have been conceived for the potential to prevent SCD in young athletes by early identification of cardiac diseases. The European Society of Cardiology protocol for PPs includes history collection, physical examination and baseline electrocardiogram, while further examinations are reserved to individuals with abnormalities at first-line evaluation. Nevertheless, transthoracic echocardiography has been hypothesized to have a primary role in the PPs. This review aims to describe how to approach an athlete-focused echocardiogram, highlighting what is crucial to focus on for the different diseases (cardiomyopathies, valvulopathies, congenital heart disease, myocarditis and pericarditis) and when is needed to pay attention to overlap diagnostic zone ("grey zone") with the athlete's heart. Once properly tested, focused echocardiography by sports medicine physicians may become standard practice in larger screening practices, potentially available during first-line evaluation.

Patent Foramen Ovale-A Not So Innocuous Septal Atrial Defect in Adults.

Patent foramen ovale (PFO) is a common congenital atrial septal defect with an incidence of 15-35% in the adult population. The development of the interatrial septum is a process that begins in the fourth gestational week and is completed only after birth. During intrauterine life, the foramen ovale allows the passage of highly oxygenated blood from the right to the left atrium and into the systemic arteries, thus bypassing the pulmonary circulation. In 75% of the general population, the foramen ovale closes after birth, and only an oval depression, called fossa ovalis, remains on the right side of the interatrial septum. Patent foramen ovale can be associated with various clinically important conditions, including migraine and stroke, or decompression illness in divers. The aim of this review is to summarize the PFO developmental and anatomical features and to discuss the clinical risks associated with this atrial septal defect in adults.

The Change in Fingertip Contact Area as a Novel Proprioceptive Cue.

Humans, many animals, and certain robotic hands have deformable fingertip pads [1, 2]. Deformable pads have the advantage of conforming to the objects that are being touched, ensuring a stable grasp for a large range of forces and shapes. Pad deformations change with finger displacements during touch. Pushing a finger against an external surface typically provokes an increase of the gross contact area [3], potentially providing a relative motion cue, a situation comparable to looming in vision [4]. The rate of increase of the area of contact also depends on the compliance of the object [5]. Because objects normally do not suddenly change compliance, participants may interpret an artificially induced variation in compliance, which coincides with a change in the gross contact area, as a change in finger displacement, and consequently they may misestimate their finger's position relative to the touched object. To test this, we asked participants to compare the perceived displacements of their finger while contacting an object varying pseudo-randomly in compliance from trial to trial. Results indicate a bias in the perception of finger displacement induced by the change in compliance, hence in contact area, indicating that participants interpreted the altered cutaneous input as a cue to proprioception. This situation highlights the capacity of the brain to take advantage of knowledge of the mechanical properties of the body and of the external environment.

ThimbleSense: A Fingertip-Wearable Tactile Sensor for Grasp Analysis.

Accurate measurement of contact forces between hand and grasped objects is crucial to study sensorimotor control during grasp and manipulation. In this work, we introduce ThimbleSense, a prototype of individual-digit wearable force/torque sensor based on the principle of intrinsic tactile sensing. By exploiting the integration of this approach with an active marker-based motion capture system, the proposed device simultaneously measures absolute position and orientation of the fingertip, which in turn yields measurements of contacts and force components expressed in a global reference frame. The main advantage of this approach with respect to more conventional solutions is its versatility. Specifically, ThimbleSense can be used to study grasping and manipulation of a wide variety of objects, while still retaining complete force/torque measurements. Nevertheless, validation of the proposed device is a necessary step before it can be used for experimental purposes. In this work, we present the results of a series of experiments designed to validate the accuracy of ThimbleSense measurements and evaluate the effects of distortion of tactile afferent inputs caused by the device's rigid shells on grasp forces.

Design and Characterization of a Fabric-Based Softness Display.

To enable a realistic tactile interaction with remote or virtual objects, softness information represents a fundamental property to be rendered via haptic devices. What is challenging is to reduce the complexity of such an information as it arises from contact mechanics and to find suitable simplifications that can lead an effective development of softness displays. A possible approach is to surrogate detailed tactile cues with information on the rate of spread of the contact area between the object and the finger as the contact force increases, i.e. force/area relation. This paradigm is called contact area spread rate. In this paper we discuss how such a paradigm has inspired the design of a tactile device (hereinafter referred to as Fabric Yielding Display, FYD-2), which exploits the elasticity of a fabric to mimic different levels of stiffness, while the contact area on the finger indenting the fabric is measured. In this manner, the FYD-2 can be controlled to reproduce force-area characteristics. In this work, we describe the FYD-2 architecture and report a psychophysical characterization. FYD-2 is shown to be able to accurately reproduce force-area curves of typical objects and to enable a reliable softness discrimination in human users.