Quantitative evaluation for intravascular structures of vertebral artery dissection with a novel zoomed high-resolution black-blood MR imaging.

BACKGROUND: Although non-stroke vertebral artery dissection (VAD) is diagnosed using MRI, detecting the subtle intravascular structure remains challenging. This study aimed to evaluate the validity of quantitative intravascular scanning based on novel zoomed high-resolution black blood (Z-HB) MRI for distinguishing VAD from other vessel pathologies. METHODS: Twenty-one patients with non-stroke VAD and 18 with symptomatic atherosclerotic plaques in their vertebral artery underwent Z-HB MRI and subsequent profile curve processing. Axial Z-HB imaging was obtained from dissected and normal segments in patients with VAD and atherosclerotic plaque in patients with ischemia. We investigated the qualitative categorization of the scanning patterns of the intravascular signals. We also evaluated the quantitative ability of each profile curve to discriminate multiple vessel pathologies by analyzing the receiver operating characteristics curves. RESULTS: Profile curve processing of 140 Z-HB images categorized the intravascular signal patterns into luminal, asymmetrical, and omega types. The asymmetrical type included both dissecting and atherosclerotic vessels, and the omega type included dissecting and normal vessels. In the asymmetrical type, quantitative evaluation successfully distinguished intramural hematomas of VAD from atherosclerotic plaque with an area under the curve of 0.80. The intimal flap of the VAD was distinguished from the blood flow artifact of the normal vessel with an area under the curve of 0.93 in the omega type. CONCLUSIONS: A combination of novel Z-HB MRI and profile curve processing provided an ultra-high-resolution analysis of the intravascular structure of non-stroke VAD and successfully distinguished VAD from normal vessels or atherosclerotic plaques.

Which objective itch-assessment tools are applicable to patients with advanced cognitive impairments? A scoping review.

BACKGROUND: Itching is an irritating and uncomfortable sensation that has a profound effect on patients' physical and mental health. It is a major under-recognised problem in older patients who cannot express their pain due to advanced cognitive impairment. Therefore, objective itch-assessment tools that do not rely on patients' reports of itching may be of value for this patient group. OBJECTIVE: To summarise the characteristics of validated objective itch-assessment tools for patients with advanced cognitive impairment. METHODS: This scoping review was conducted according to the PRISMA extension for scoping reviews checklist. The PubMed, CINAHL and Cochrane Library databases were searched, via database-specific search strategies, for articles published in English between January 1, 1990 and March 11, 2020. Based on the eligibility criteria, two authors independently screened the articles for inclusion. Thereafter, the lead author performed data extraction and analysis. RESULTS: Three validated scratch-monitoring using accelerometers and a sound sensor and one validated scratch-mark assessment have been reported. The Actiwatch Plus, ActiTrac® , body-conducted sound sensor and Scoring Atopic Dermatitis index for scratching (SCORAD-scratch) had positive criterion validity outcomes. The Actiwatch Plus, ActiTrac® and body-conducted sound sensor were significantly correlated with scratch behaviour (r = 0.91, p < 0.001; r = 0.71, p = 0.042; r = 0.99, and p-value not shown, respectively). The SCORAD-scratch was significantly correlated with subjective itch-assessment scores (r = 0.78-0.80, p = <0.0001-0.010). CONCLUSIONS: This scoping review summarises the characteristics of validated objective itch-assessment tools to investigate which of these are applicable to older patients with advanced cognitive impairments. Although there are limitations and further verification is required, the ActiTrac® , Actiwatch Plus and body-conducted sound sensor may be useful for measuring scratch movements and itching. IMPLICATIONS FOR PRACTICE: Nurses and patients' families may better understand the characteristics and validity of each objective itch-assessment tool and select the optimal tool for patients with advanced cognitive impairment who cannot express their discomfort caused due to itching.

The relationship between skin ultrasound images and muscle damage using skin blotting in wheelchair basketball athletes.

STUDY DESIGN: Secondary analysis of a cross-sectional observation study. OBJECTIVES: To determine the relationship between skin ultrasound images and muscle damage in wheelchair basketball athletes, using skin blotting examinations of the ischial regions. SETTING: Community, Japan. METHODS: Fourteen elite wheelchair basketball athletes were recruited. We obtained data regarding participants' characteristics. We undertook ultrasonographic images and quantitative skin blotting of the ischial region before and after training, and after rest. RESULTS: We identified Category II and III pressure injuries in 2 of the 12 participants. Structural features were classified into four categories based on ultrasonographic features, namely, normal skin structure, unclear superficial and deep fascia, cloudy fat layer, and fat infiltration and low-echoic lesion/anechoic lesions. The muscle-type creatinine kinase (CK-M) level (median [interquartile range: IQR], 2.98 [2.80-3.47]) in the fat infiltration and low-echoic lesion/anechoic lesion group was significantly higher (1.43 [1.41-1.49]) than in a nonfat infiltration and low-echoic lesion/anechoic lesion group after training (p = 0.03). The interleukin-6 (IL-6) level (median [IQR], 23.5 [16.15-58.97]) in the fat infiltration and low-echoic lesion/anechoic lesion group was significantly higher (1.94 [1.74-4.44]) than in the nonfat infiltration and low-echoic lesion/anechoic lesion group after rest (mean difference = -25.4, 95% CI -61.1 to 10.7, p = 0.03). CONCLUSIONS: The combination of ultrasonographic images and skin blotting using CK-M and IL-6, could detect early deep tissue damage in wheelchair athletes. These techniques could be potentially useful in the treatment and prevention of pressure injuries. SPONSORSHIP: This study was supported in part by YAMAHA Motor Foundation for Sports.

Pattern detection from seating pressure distribution during wheelchair motion using deep embedded clustering.

To minimize the occurrence of ulcers in high-risk mobile individuals such as wheelchair users, it is necessary to detect all typical distribution patterns and to indentify the patterns that may be associated with pressure ulcers. However, pattern detection is difficult because the pressure distribution during motion includes a variety of patterns compared to those of static postures. Thus, the establishment of a method to detect typical patterns based on distribution patterns is important. We utilized deep embedded clustering for identification purposes. This clustering technique extracts features using auto-encoder and simultaneously optimizes data points into the clusters, which might realize good clustering performance due to the detected optimal features. We used a pressure distribution dataset that was pre-labeled by nursing experts. The dataset consisted of a total of 26944 distribution images with ten class annotations. The clustering method including traditional approaches (k-means and principal component analysis plus k-means) were compared with deep embedded clustering while the threshold to noise reduction was changing. The deep embedded clustering with 80 mmHg threshold achieved the best performance. This approach also tended to be less dependent on the threshold values.

[Role of weighted maximum intensity projection with MDCT in the diagnosis of skull fractures].

The method of image processing has increased along with the workstation in recent years and developments in the software of each modality. Maximum intensity projection (MIP) and volume rendering (VR) are among the general processing methods used. However, MIP and VR have their respective limitations. MIP does not have in-depth information, and in VR the final image depends on threshold processing. In comparison with MIP/VR, Weighted MIP can obtain in-depth information. The processing method is also easy and is used in the pre-operative simulation of neurosurgical craniotomy. In this study, we examined the effect of Weighted MIP on a phantom and in 7 cases of skull fracture by using multi-detector-row computed tomography. In the phantom study, Weighted MIP provided three-dimensional imaging in all the processing methods for skull fractures. Weighted MIP depicted the entire fracture line in a clinical study, and it was effective in all of the 7 skull fracture cases. In conclusion, the present study demonstrated that Weighted MIP with depth information was effective in the fracture line detection of skull fracture.

[Usefulness of volume rendering stereo-movie in neurosurgical craniotomies].

In recent years, the advancements in MR technology combined with the development of the multi-channel coil have resulted in substantially shortened inspection times. In addition, rapid improvement in functional performance in the workstation has produced a more simplified imaging-making process. Consequently, graphical images of intra-cranial lesions can be easily created. For example, the use of three-dimensional spoiled gradient echo (3D-SPGR) volume rendering (VR) after injection of a contrast medium is applied clinically as a preoperative reference image. Recently, improvements in 3D-SPGR VR high-resolution have enabled accurate surface images of the brain to be obtained. We used stereo-imaging created by weighted maximum intensity projection (Weighted MIP) to determine the skin incision line. Furthermore, the stereo imaging technique utilizing 3D-SPGR VR was actually used in cases presented here. The techniques we report here seemed to be very useful in the pre-operative simulation of neurosurgical craniotomy.