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1.
Sensors (Basel) ; 21(21)2021 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-34770700

RESUMO

Damage detection in structural components, especially in mechanical engineering, is an important element of engineering practice. There are many methods of damage detection, in which changes in various parameters caused by the presence of damage are analysed. Recently, methods based on the analysis of changes in dynamic parameters of structures, that is, frequencies or mode shapes of natural vibrations, as well as changes in propagating elastic waves, have been developed at the highest rate. Diagnostic methods based on the elastic wave propagation phenomenon are becoming more and more popular, therefore it is worth focusing on the improvement of the efficiency of these methods. Hence, a question arises about whether it is possible to shorten the required measurement time without affecting the sensitivity of the diagnostic method used. This paper discusses the results of research carried out by the authors in this regard both numerically and experimentally. The numerical analysis has been carried out by the use of the Time-domain Spectral Finite Element Method (TD-SFEM), whereas the experimental part has been based on the measurement performed by 1-D Laser Doppler Scanning Vibrometery (LDSV).


Assuntos
Som , Vibração , Simulação por Computador , Lasers , Ultrassonografia Doppler
2.
Reprod Health ; 18(1): 199, 2021 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-34620186

RESUMO

BACKGROUND: The World Health Organization recommends research to evaluate the effects of a single third trimester Doppler ultrasound examination on preventable deaths in unselected-risk pregnancies, particularly in low- and middle-income countries (LMICs) where the evidence base is scarce. While evaluating such technologies, researchers often ignore women and health care provider perspectives. This study explored the views and experiences of women and healthcare providers regarding the use of advanced ultrasound technology to optimize the health of mothers and their babies in a rural community in mid-western Uganda. METHODS: We enrolled 53 mothers and 10 healthcare providers, and captured data on their perceptions, barriers, and facilitators to the use of Doppler ultrasound technology using focus group discussions, semi-structured interviews and observations. Using qualitative content analysis, we inductively coded the transcripts in ATLAS.ti 8.0, detecting emerging themes. RESULTS: Women were afraid that ultrasound would harm them or their fetuses and many of them had never seen an ultrasound scan. The majority of the women found their partners supportive to attend antenatal care and use ultrasound services. Healthcare providers in Kagadi Hospital were unfamiliar with Doppler technology and using it to guide clinical decisions. Other barriers to the implementation of Doppler ultrasound included shortage of trained local staff, insufficient equipment, long distance to and from the hospital, and frequent power cuts. CONCLUSIONS: We found limited exposure to Doppler ultrasound technology among women and healthcare providers in mid-western Uganda. Engaging male partners may potentially influence the likelihood of accepting and using it to improve the health of women and their fetuses while wide spread myths and misconceptions about it may be changed by community engagement. Healthcare workers experienced difficulties in offering follow-up care to mothers detected with complications and Doppler ultrasound required a high level of training. While introducing advanced ultrasound machines to weak health systems, it is important to adequately train healthcare providers to avoid inappropriate interventions based on misinterpretation of the findings, consider where it is likely to be most beneficial, and embed it with realistic clinical practice guidelines.


Assuntos
Pessoal de Saúde , População Rural , África ao Sul do Saara , Feminino , Humanos , Lactente , Masculino , Gravidez , Pesquisa Qualitativa , Ultrassonografia Doppler
4.
BMC Pregnancy Childbirth ; 21(1): 671, 2021 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-34602049

RESUMO

BACKGROUND: The aims of this study were to evaluate the time intervals of flow velocity waveforms (FVW) of ductus venosus (DV) and cardiac cycles, as well as the pulsatility index of DV-FVW (DV-PI), in correlation with umbilical artery (UA) pH at birth in fetal growth restriction (FGR) complicated with placental insufficiency. METHODS: Data were retrospectively retrieved from pregnancies complicated by FGR. FGR was defined as an estimated fetal weight below - 2.0 S.D. with an elevated UA-PI. Time interval assessments of DV-FVW were as follows: the duration of systolic wave was divided by the duration of diastolic wave and defined as DV-S/D. We also measured the following time intervals of ventricular inflow through tricuspid valve (TV) and mitral valve (MV): (iii), from the second peak of ventricular inflow caused by atrial contraction (A-wave) to the opening of atrio-ventricular valves and: (iv), from the opening of atrio-ventricular valves to the peak of A-wave. (iii)/(iv) was expressed as TV-S/D and MV-S/D, for TV and MV, respectively. The time interval data were transformed into z-scores. RESULTS: Thirty-one FGR fetuses were included in this study. Both DV-PI and DV-S/D showed significant correlation with UA-pH (r = - 0.677, p = < 0.001 and r = 0.489, p = 0.005 for DV-PI and z-score of DV-S/D, respectively) and more significances were observed in FGR ≤ 28 + 6 gestational weeks (r = - 0.819, p < 0.001 and r = 0.726, p = 0.005, for DV-PI and z-score of DV-S/D, respectively) than in FGR > 28 + 6 gestational weeks (r = - 0.634, p = 0.007 and r = 0.635, p = 0.020, for DV-PI and z-score of DV-S/D, respectively). On the other hand, TV-S/D and MV-S/D showed no significant correlation with UA-pH, although these z-scores indicated significant decreases compared with normal references. CONCLUSIONS: Time interval analysis of DV-FVW might be a valuable parameter, as well as DV-PI, for the antenatal prediction of fetal acidemia in the management of FGR fetuses.


Assuntos
Velocidade do Fluxo Sanguíneo , Retardo do Crescimento Fetal/fisiopatologia , Coração Fetal/diagnóstico por imagem , Insuficiência Placentária/fisiopatologia , Complicações na Gravidez/fisiopatologia , Artérias Umbilicais , Feminino , Idade Gestacional , Humanos , Concentração de Íons de Hidrogênio , Recém-Nascido , Japão/epidemiologia , Gravidez , Estudos Retrospectivos , Ultrassonografia Doppler
5.
Medicina (Kaunas) ; 57(10)2021 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-34684073

RESUMO

Background and Objectives: Intrauterine growth restriction (IUGR) is the term used to describe a fetus whose estimated weight is less than the 10th percentile of its age growth curve. IUGR is the second most common cause of perinatal death. In many cases there is a deficiency in the standardization of optimal management, prenatal follow-up and timing of delivery. Doppler examination is the most sensitive test that can assess the condition of the fetus and indicate fetal intrauterine hypoxia. Numerous studies of the fetal intrauterine state focus on the umbilical artery and the fetal cerebral blood vessels, while the peripheral arteries have so far received insufficient attention. Materials and Methods: We present a case of an IUGR fetus monitored with a non-stress test (NST) and a Doppler examination of the fetal arteries (tibial, umbilical, middle cerebral and uterine) and the ductus venosus. In this case the first early sign of fetal hypoxia was revealed by blood flow changes in the tibial artery. Results: We hypothesize that peripheral vascular changes (in the tibial artery) may more accurately reflect the onset of deterioration in the condition of the IUGR fetus, such that peripheral blood flow monitoring ought to be employed along with other techniques already in use. Conclusion: This paper describes the clinical presentation of an early detection of late IUGR hypoxia and claims that blood flow changes in the tibial artery signal the worsening of the fetus's condition.


Assuntos
Retardo do Crescimento Fetal , Hipóxia Fetal , Feminino , Retardo do Crescimento Fetal/diagnóstico por imagem , Hipóxia Fetal/diagnóstico por imagem , Feto/diagnóstico por imagem , Humanos , Gravidez , Gravidez de Alto Risco , Artérias da Tíbia , Ultrassonografia Doppler , Ultrassonografia Pré-Natal
6.
Medicina (Kaunas) ; 57(10)2021 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-34684120

RESUMO

Over the last decades, contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) has emerged as an important diagnostic tool for the diagnosis and differentiation of several gastrointestinal diseases. The key advantage of CH-EUS is that the influx and washout of contrast in the target lesion can be observed in real time, accurately depicting microvasculature. CH-EUS is established as an evidence-based technique complementary to B-mode EUS to differentiate solid appearing structures, to characterize mass lesions, and to improve the staging of gastrointestinal and pancreatobiliary cancer. In the last few years, interest has increased in the use of CH-EUS in interventional procedures such as tissue acquisition, tumor ablation, biliary drainage, and the management of pancreatic fluid collections. The aim of this narrative review is to evaluate the available evidence and future expectations of CH-EUS in interventional EUS.


Assuntos
Neoplasias Pancreáticas , Endossonografia , Previsões , Humanos , Ultrassonografia Doppler , Ultrassonografia de Intervenção
8.
Int J Gynaecol Obstet ; 155(3): 450-454, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34499751

RESUMO

OBJECTIVE: To evaluate fetal lung development using pulmonary artery Doppler in pregnant women who had recovered from COVID-19. METHODS: The prospective case-control study included 41 pregnant women who had recovered from COVID-19 and 43 healthy pregnant women (control group). All the women in the study group had been diagnosed with COVID-19 and had completed a quarantine period. RESULTS: The demographic data of patients were similar in the groups (P > 0.05). Main pulmonary artery peak systolic velocity was higher and pulsatility indices were lower in pregnant women who recovered from COVID-19 compared to the controls (P < 0.001, P = 0.001). Acceleration time, ejection time, and acceleration/ejection time ratio (PATET) of the fetal MPA Doppler were significantly decreased in pregnant women who recovered from COVID-19 (P < 0.001, P = 0.036, and P = 0.002, respectively). The patients who had recovered from COVID-19 were divided into two groups: those treated with expectant management and those treated in hospital. The pulmonary artery acceleration time and PATET ratio were significantly lower in the group treated in the hospital (P = 0.023 and P = 0.045, respectively). CONCLUSION: Detailed Doppler evaluations of the pulmonary artery may help in evaluating the fetal adverse effects of COVID-19 disease.


Assuntos
COVID-19 , Artéria Pulmonar , Velocidade do Fluxo Sanguíneo , Estudos de Casos e Controles , Feminino , Humanos , Gravidez , Gestantes , Estudos Prospectivos , Artéria Pulmonar/diagnóstico por imagem , SARS-CoV-2 , Ultrassonografia Doppler , Ultrassonografia Pré-Natal
9.
J Urol ; 206(5): 1114-1121, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34495686

RESUMO

PURPOSE: Priapism is a persistent penile erection that continues hours beyond, or is unrelated to, sexual stimulation and results in a prolonged and uncontrolled erection. Given its time-dependent and progressive nature, priapism is a situation that both urologists and emergency medicine practitioners must be familiar with and comfortable managing. Acute ischemic priapism, characterized by little or no cavernous blood flow and abnormal cavernous blood gases (ie, hypoxic, hypercarbic, acidotic) represents a medical emergency and may lead to cavernosal fibrosis and subsequent erectile dysfunction. MATERIALS AND METHODS: A comprehensive search of the literature was performed by Emergency Care Research Institute for articles published between January 1, 1960 and May 1, 2020. Searches identified 2948 potentially relevant articles, and 2516 of these were excluded at the title or abstract level for not meeting inclusion criteria for any key question. Full texts for the remaining 432 articles were reviewed, and ultimately 137 unique articles were included in the report. RESULTS: This Guideline was developed to inform clinicians on the proper diagnosis and surgical and non-surgical treatment of patients with acute ischemic priapism. This Guideline addresses the role of imaging, adjunctive laboratory testing, early involvement of urologists when presenting to the emergency room, discussion of conservative therapies, enhanced data for patient counseling on risks of erectile dysfunction and surgical complications, specific recommendations on intracavernosal phenylephrine with or without irrigation, the inclusion of novel surgical techniques (eg, tunneling), and early penile prosthesis placement. CONCLUSIONS: All patients with priapism should be evaluated emergently to identify the sub-type of priapism (acute ischemic versus non-ischemic) and those with an acute ischemic event should be provided early intervention. Treatment of the acute ischemic patient must be based on patient objectives, available resources, and clinician experience. As such, a single pathway for managing the condition is oversimplified and no longer appropriate. Using a diversified approach, some men may be treated with intracavernosal injections of phenylephrine alone, others with aspiration/irrigation or distal shunting, and some may undergo non-emergent placement of a penile prosthesis.


Assuntos
Tratamento de Emergência/normas , Disfunção Erétil/prevenção & controle , Isquemia/terapia , Priapismo/terapia , Urologia/normas , Doença Aguda/terapia , Adulto , Terapia Combinada/métodos , Terapia Combinada/normas , Tratamento de Emergência/métodos , Disfunção Erétil/etiologia , Disfunção Erétil/fisiopatologia , Humanos , Isquemia/etiologia , Isquemia/fisiopatologia , Masculino , América do Norte , Ereção Peniana/fisiologia , Pênis/diagnóstico por imagem , Pênis/efeitos dos fármacos , Pênis/fisiopatologia , Pênis/cirurgia , Fenilefrina/administração & dosagem , Priapismo/diagnóstico , Priapismo/etiologia , Priapismo/fisiopatologia , Sociedades Médicas/normas , Fatores de Tempo , Ultrassonografia Doppler , Urologia/métodos
10.
Sensors (Basel) ; 21(17)2021 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-34502698

RESUMO

Recently, rapid advances in radio detection and ranging (radar) technology applications have been implemented in various fields. In particular, micro-Doppler radar has been widely developed to perform certain tasks, such as detection of buried victims in natural disaster, drone system detection, and classification of humans and animals. Further, micro-Doppler radar can also be implemented in medical applications for remote monitoring and examination. This paper proposes a human respiration rate detection system using micro-Doppler radar with quadrature architecture in the industrial, scientific, and medical (ISM) frequency of 5.8 GHz. We use a mathematical model of human breathing to further explore any insights into signal processes in the radar. The experimental system is designed using the USRP B200 mini-module as the main component of the radar and the Vivaldi antennas working at 5.8 GHz. The radar system is integrated directly with the GNU Radio Companion software as the processing part. Using a frequency of 5.8 GHz and USRP output power of 0.33 mW, our proposed method was able to detect the respiration rate at a distance of 2 m or less with acceptable error. In addition, the radar system could differentiate different frequency rates for different targets, demonstrating that it is highly sensitive. We also emphasize that the designed radar system can be used as a portable device which offers flexibility to be used anytime and anywhere.


Assuntos
Radar , Taxa Respiratória , Animais , Humanos , Respiração , Software , Ultrassonografia Doppler
11.
Am J Cardiol ; 160: 117-123, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34583809

RESUMO

The accuracy of ankle-brachial index (ABI) and toe-brachial index (TBI) in discriminating lower extremity peripheral artery disease (PAD) has not been evaluated in patients with chronic kidney disease (CKD). We measured ABI, TBI, and Doppler ultrasound in 100 predialysis patients with CKD without revascularization or amputation. Leg-specific ABI was calculated using higher systolic blood pressure (SBP) in posterior tibial or dorsalis pedis artery divided by higher brachial SBP; alternative ABI was calculated using lower SBP in posterior tibial or dorsalis pedis artery. PAD was defined as ≥50% stenosis detected by Doppler ultrasound. PAD risk classification score was calculated using cardiovascular disease risk factors. The area under the curve (AUC, 95% confidence interval [CI]) for discriminating ultrasound-diagnosed PAD was 0.78 (0.69 to 0.87) by ABI, 0.80 (0.71 to 0.89) by alternative ABI, and 0.74 (0.63 to 0.86) by TBI. Sensitivity and specificity were 25% and 97% for ABI ≤0.9, 41% and 95% for alternative ABI ≤0.9, and 45% and 93% for TBI ≤0.7, respectively. AUC (95% CI) of PAD risk classification score was 0.86 (0.78 to 0.94) with sensitivity and specificity of 95% and 60% for risk score ≥0.10, 76% and 76% for risk score ≥0.25, and 43% and 95% for risk score ≥0.55. Combining risk score with ABI, alternative ABI, and TBI increased AUC (95% CI) to 0.89 (0.82 to 0.96), 0.89 (0.80 to 0.98), and 0.87 (0.78 to 0.96), respectively. In conclusion, current ABI and TBI diagnostic criteria have high specificity but low sensitivity for classifying PAD in patients with CKD. PAD classification risk score based on cardiovascular disease risk factors improves the accuracy of PAD classification.


Assuntos
Índice Tornozelo-Braço , Doença Arterial Periférica/diagnóstico , Insuficiência Renal Crônica/fisiopatologia , Ultrassonografia Doppler , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Artéria Braquial/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/complicações , Insuficiência Renal Crônica/complicações , Medição de Risco , Sensibilidade e Especificidade , Artérias da Tíbia/fisiopatologia , Dedos do Pé/irrigação sanguínea
12.
Nat Rev Rheumatol ; 17(11): 665-677, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34561652

RESUMO

Morphological and functional analysis of the microcirculation are objective outcome measures that are recommended for use in the presence of clinical signs of altered peripheral blood flow (such as Raynaud phenomenon), which can occur in systemic sclerosis (SSc) and other autoimmune rheumatic diseases. Several advanced non-invasive tools are available for monitoring the microcirculation, including nailfold videocapillaroscopy, which is the best-studied and most commonly used method for distinguishing and quantifying microvascular morphological alterations in SSc. Nailfold videocapillaroscopy can also be used alongside laser Doppler techniques to assist in the early diagnosis and follow-up of patients with dermatomyositis or mixed connective tissue disease. Power Doppler ultrasonography, which has been used for many years to evaluate the vascularity of synovial tissue in rheumatoid arthritis, is another promising tool for the analysis of skin and nailbed capillary perfusion in other autoimmune rheumatic diseases. Other emerging methods include raster-scanning optoacoustic mesoscopy, which offers non-invasive high-resolution 3D visualization of capillaries and has been tested in psoriatic arthritis and SSc. The principle functions and operative characteristics of several non-invasive tools for analysing microvascular changes are outlined in this Review, and the clinical roles of validated or tested imaging methods are discussed for autoimmune rheumatic diseases.


Assuntos
Doenças Autoimunes , Microcirculação , Doenças Reumáticas/fisiopatologia , Escleroderma Sistêmico/fisiopatologia , Doenças Vasculares/diagnóstico por imagem , Doenças Autoimunes/complicações , Doenças Autoimunes/fisiopatologia , Humanos , Doenças Reumáticas/complicações , Escleroderma Sistêmico/complicações , Ultrassonografia Doppler , Doenças Vasculares/etiologia , Doenças Vasculares/fisiopatologia
13.
Int J Mol Sci ; 22(15)2021 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-34360913

RESUMO

Deficiency of the placental hormone chorionic somatomammotropin (CSH) can lead to the development of intrauterine growth restriction (IUGR). To gain insight into the physiological consequences of CSH RNA interference (RNAi), the trophectoderm of hatched blastocysts (nine days of gestational age; dGA) was infected with a lentivirus expressing either a scrambled control or CSH-specific shRNA, prior to transfer into synchronized recipient sheep. At 90 dGA, umbilical hemodynamics and fetal measurements were assessed by Doppler ultrasonography. At 120 dGA, pregnancies were fitted with vascular catheters to undergo steady-state metabolic studies with the 3H2O transplacental diffusion technique at 130 dGA. Nutrient uptake rates were determined and tissues were subsequently harvested at necropsy. CSH RNAi reduced (p ≤ 0.05) both fetal and uterine weights as well as umbilical blood flow (mL/min). This ultimately resulted in reduced (p ≤ 0.01) umbilical IGF1 concentrations, as well as reduced umbilical nutrient uptakes (p ≤ 0.05) in CSH RNAi pregnancies. CSH RNAi also reduced (p ≤ 0.05) uterine nutrient uptakes as well as uteroplacental glucose utilization. These data suggest that CSH is necessary to facilitate adequate blood flow for the uptake of oxygen, oxidative substrates, and hormones essential to support fetal and uterine growth.


Assuntos
Sangue Fetal/metabolismo , Retardo do Crescimento Fetal/genética , Retardo do Crescimento Fetal/metabolismo , Hemodinâmica/genética , Nutrientes/metabolismo , Lactogênio Placentário/deficiência , Lactogênio Placentário/genética , Interferência de RNA , Ovinos/genética , Transdução de Sinais/genética , Animais , Blastocisto/metabolismo , Feminino , Sangue Fetal/diagnóstico por imagem , Retardo do Crescimento Fetal/diagnóstico por imagem , Feto/metabolismo , Idade Gestacional , Glucose/metabolismo , Fator de Crescimento Insulin-Like I/metabolismo , Masculino , Placenta/metabolismo , Gravidez , RNA Interferente Pequeno/genética , Ultrassonografia Doppler/métodos , Útero/metabolismo
14.
Theriogenology ; 173: 230-240, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34399387

RESUMO

The present study aimed to investigate placental hemodynamics to determine quantitative and qualitative parameters for pregnant brachycephalic bitches as well as describe placental vascularization and perfusion in females with fetal abnormalities close to delivery. Forty-four healthy fetuses from 22 brachycephalic bitches and 9 fetuses with gestational abnormalities (anasarca and hydrocephalus) from 8 brachycephalic bitches were evaluated. All female dogs were artificially inseminated intravaginally and underwent cesarean section at the end of gestation. Pregnancy diagnosis was made on the 25th day and experimental evaluations were performed on Days 25 (M1), 45 (M2), and 58 (M3) of gestation in normal pregnancies. Fetuses with gestational abnormalities were evaluated at the last time point. Biometric values of the fetuses were determined by B-mode and vascular indices by Doppler fluxometry of the umbilical artery, whereas qualitative assessment of contrast filling and quantitative parameters of placental perfusion were performed using CEUS. Parameter comparisons among the examined fetuses (normal and abnormal) and between the moments (M1, M2, and M3) were performed by Student's t-test and ANOVA tests, and then correlated using the Spearman test. In healthy fetuses, systolic and diastolic velocities as well as the time averages of minimum and maximum velocities increased significantly from M2 to M3 (P < 0.05), whereas the pulsatility index (P < 0.043) and vascular resistance (P < 0.001) decreased. Contrast distribution was always homogeneous in placental tissues and CEUS filling parameters remained constant during the evaluated periods (P < 0.05). In fetuses with hydrops, Doppler values were similar to those obtained in healthy subjects (P > 0.05), but CEUS evaluation demonstrated a heterogeneous distribution with lower intensity of placental tissue filling and a delay in perfusion time (P < 0.05) with a diagnostic accuracy of 75%. The association of dopplerfluxometry and CEUS allowed evaluation of qualitative and quantitative parameters of physiological pregnancy hemodynamics in all gestational thirds without evidence of significant changes in the physiology of the maternal-fetal binomial, and CEUS was shown to be applicable in the detection of failures in placental vascular filling (tissue dysfunction) in fetuses with anasarca and hydrocephaly.


Assuntos
Cesárea , Placenta , Animais , Velocidade do Fluxo Sanguíneo , Cesárea/veterinária , Cães , Feminino , Idade Gestacional , Perfusão/veterinária , Placenta/diagnóstico por imagem , Gravidez , Ultrassonografia Doppler/veterinária , Ultrassonografia Pré-Natal/veterinária , Artérias Umbilicais/diagnóstico por imagem
15.
Br J Hosp Med (Lond) ; 82(7): 1-6, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34338010

RESUMO

Pulmonary embolism remains a common and potentially deadly disease, despite advances in diagnostic imaging, treatment and prevention. Managing pulmonary embolism requires a multifactorial approach involving risk stratification, determining appropriate diagnostics and selecting individualised therapy. The first part of this article reviewed the pathophysiology, risk factors, clinical presentation, diagnostic evaluation and therapeutic management and early outpatient management of pulmonary embolism. This second part summarises pulmonary embolism in the setting of pregnancy, COVID-19, recurrent disease and chronic thromboembolic pulmonary hypertension.


Assuntos
COVID-19/epidemiologia , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/patologia , COVID-19/patologia , Doença Crônica , Feminino , Humanos , Hipertensão Pulmonar/epidemiologia , Hipertensão Pulmonar/patologia , Masculino , Gravidez , Embolia Pulmonar/diagnóstico por imagem , Radiografia Torácica , Recidiva , Fatores de Risco , SARS-CoV-2 , Ultrassonografia Doppler , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/patologia
17.
Ultrason Imaging ; 43(5): 273-281, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34236008

RESUMO

To compare microvascular flow imaging (MVFI) to conventional Color-Doppler (CDI) and Power-Doppler (PDI) imaging in the detection of vascularity of Focal Breast Lesions (FBLs). A total of 180 solid FBLs (size: 3.5-45.2 mm) detected in 180 women (age: 21-87 years) were evaluated by means of CDI, PDI, and MVFI. Two blinded reviewers categorized lesion vascularity in absent or present, and vascularity pattern as (a) internal; (b) vessels in rim; (c) combined. The presence of a "penetrating vessel" was assessed separately. Differences in vascularization patterns (chi2 test) and intra- and inter-observer agreement (Fleiss method) were calculated. ROC analysis was performed to assess performance of each technique in differentiating benign from malignant lesions. About 103/180 (57.2%) FBLs were benign and 77/180 (42.8%) were malignant. A statistically significant (p < .001) increase in blood flow detection was observed for both readers with MVFI in comparison to either CDI or PDI. Benign FBLs showed mainly absence of vascularity (p = .02 and p = .01 for each reader, respectively), rim pattern (p < .001 for both readers) or combined pattern (p = .01 and p = .04). Malignant lesions showed a statistically significant higher prevalence of internal flow pattern (p < .001 for both readers). The prevalence of penetrating vessels was significantly higher with MVFI in comparison to either CDI or PDI (p < .001 for both readers) and in the malignant FBLs (p < .001). ROC analysis showed MVFI (AUC = 0.70, 95%CI = [0.64-0.77]) more accurate than CDI (AUC = 0.67, 95%CI = [0.60-0.74]) and PDI (AUC = 0.67, 95%CI = [0.60-0.74]) though not significantly (p = .5436). Sensitivity/Specificity values for MVFI, PDI, and CDI were 76.6%/64.1%, 59.7%/73.8% and 58.4%/74.8%, respectively. Inter-reader agreement with MVFI was always very good (k-score 0.85-0.96), whereas with CDI and PDI evaluation ranged from good to very good. No differences in intra-observer agreement were noted. MVFI showed a statistically significant increase in the detection of the vascularization of FBLs in comparison to Color and Power-Doppler.


Assuntos
Neoplasias da Mama , Ultrassonografia Doppler , Adulto , Idoso , Idoso de 80 Anos ou mais , Mama/diagnóstico por imagem , Neoplasias da Mama/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Curva ROC , Sensibilidade e Especificidade , Ultrassonografia Doppler em Cores , Adulto Jovem
18.
BMC Pregnancy Childbirth ; 21(1): 489, 2021 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-34229662

RESUMO

OBJECTIVE: To investigate the predictive value of pre-induction digital examination, sonographic measurements and parity for the prediction of non-reassuring fetal status and cord arterial pH < 7.2 prior to the induction of labor (IOL). METHOD: This was a prospective observational study, including 384 term pregnancies undergoing IOL. Before the IOL, the Bishop score (BS) by digital examination, sonographic Doppler parameters and the estimated fetal weight (EFW) was assessed. The fetal cord arterial was sampled to measure the pH at delivery. Multivariate logistic regression analysis was performed to identify independent predictors of non-reassuring fetal status and low cord arterial pH. RESULTS: Forty four cases (11.5%) had non-reassuring fetal status, and 76 cases (19.8%) had fetal cord arterial pH < 7.2. In the non-reassuring fetal status group, the incidence of cord arterial pH < 7.2 was significantly higher than that in the normal fetal heart rate group (χ2 = 6.401, p = 0.011). Multivariate analysis indicated that significant independent predictors of non-reassuring fetal status were nulliparity (adjusted odds ratio [AOR]: 3.746, p = 0.003), EFW < 10th percentile (AOR: 3.764, p = 0.003) and cerebroplacental ratio (CPR) < 10th centile (AOR:4.755, p < 0.001). In the prediction of non-reassuring fetal status, the performance of the combination of nulliparity and EFW < 10th percentile was improved by the addition of CPR < 10th percentile (AUC: 0.681, (95%CI: 0.636 to 0.742) vs 0.756, (95%CI:0.713 to 0.795)), but the difference was not significant (DeLong test: z = 1.039, p = 0.053).. None of the above variables were predictors of cord arterial pH < 7.2. CONCLUSION: The risk of fetal acidosis has increased in cases of non-reassuring fetal status. Nulliparity, small for gestational age and CPR < 10th centile are independent predictors for non-reassuring fetal status in term fetuses, though the addition of CPR < 10th centile could not significantly improve the screening accuracy.


Assuntos
Acidose/diagnóstico , Doenças Fetais/diagnóstico , Circulação Placentária , Diagnóstico Pré-Natal/métodos , Ultrassonografia Pré-Natal/métodos , Acidose/embriologia , Adulto , Feminino , Peso Fetal , Feto/irrigação sanguínea , Feto/diagnóstico por imagem , Feto/embriologia , Frequência Cardíaca Fetal , Humanos , Concentração de Íons de Hidrogênio , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Trabalho de Parto Induzido , Modelos Logísticos , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/embriologia , Artéria Cerebral Média/metabolismo , Análise Multivariada , Razão de Chances , Paridade , Valor Preditivo dos Testes , Gravidez , Terceiro Trimestre da Gravidez/metabolismo , Estudos Prospectivos , Fluxo Pulsátil , Ultrassonografia Doppler , Artérias Umbilicais/diagnóstico por imagem , Artérias Umbilicais/embriologia , Artérias Umbilicais/metabolismo
19.
Eur J Vasc Endovasc Surg ; 62(3): 469-475, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34274219

RESUMO

OBJECTIVE: Patients with peripheral artery disease (PAD) have an increased risk of lower limb amputation. Given the international wide variance in major amputations, the high mortality rates and follow up costs as well as the significantly reduced quality of life of patients with amputations, vascular diagnostics and vascular surgery treatments are of great importance for lower limb preservation in patients with PAD. This study examines these guideline based procedures in patients before a first lower limb amputation and PAD. METHODS: This was a retrospective longitudinal study. Data from a large German statutory health insurance scheme were examined on patients with first amputation of lower extremities and PAD between 2013 and 2015 (incidence). Pre-defined vascular diagnostic and vascular surgical procedures were considered, as specified by guidelines within inpatient and outpatient care in a defined time before lower limb amputation. RESULTS: The overall estimated incidence of lower extremity amputations in the total population was 0.12% from 2013 to 2015. Of these, 51.7% had PAD; 81.8% of patients received at least one vascular diagnostic measure and 61.0% a vascular surgery procedure before the lower extremity amputation. There were only minor variations in the use of diagnostic or surgical treatments between patients with major and minor amputation. In total, 63.9% of patients had vascular surgery before the incident major amputation compared with 60.0% of patients with a minor amputation. Noticeable regional differences were found ranging from 91% (Berlin) to 67% (Bremen) regarding diagnostic procedures provided before amputation, and from 83% (Hamburg) to 55% (Saxony-Anhalt) regarding vascular surgery before amputations. CONCLUSION: Of patients with PAD, 18.2% did not receive a vascular diagnostic examination before amputation as specified in the guidelines, which reflects an underuse of health services. In one third of patients who did not receive vascular surgery, major amputation probably could have been avoided.


Assuntos
Amputação/tendências , Angiografia Digital/tendências , Doença Arterial Periférica/cirurgia , Padrões de Prática Médica/tendências , Ultrassonografia Doppler/tendências , Procedimentos Cirúrgicos Vasculares/tendências , Idoso , Idoso de 80 Anos ou mais , Feminino , Alemanha , Fidelidade a Diretrizes/tendências , Humanos , Salvamento de Membro , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Guias de Prática Clínica como Assunto , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
20.
J Obstet Gynaecol Res ; 47(10): 3480-3487, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34254402

RESUMO

AIM: To examine the structural and functional changes of the fetal heart in gestational diabetes mellitus (GDM) and to evaluate the power of fetal cardiac Doppler parameters in predicting adverse perinatal outcomes in this group of pregnancy. METHODS: Within the study's scope, 36 cases in the A1 GDM group, 33 cases in the A2 GDM group, and 124 cases in the control group were evaluated. The relationship between structural and functional fetal cardiac parameters and perinatal outcomes was evaluated via fetal echocardiography. RESULTS: Fetal left ventricular myocardial performance index (MPI) values were found to be statistically significantly higher when compared between the A1 GDM and A2 GDM groups and the control group (p = 0.000 and p = 0.000, respectively), while the E/A ratio was found to be significantly lower (p = 0.000 and p = 0.000, respectively). It was determined that the maternal blood HbA1c level showed a significant negative correlation with the fetal cardiac E/A ratio and a significant positive correlation with isovolumetric relaxation time and MPI (p = 0.000, p = 0.000, and p = 0.000, respectively). Adverse perinatal outcome rate was higher in the diabetic group (46.4%-22.6%). When the cases with GDM were examined in terms of perinatal outcomes, it was observed that there was a significant difference in HbA1c levels, E/A ratio, and MPI values between the cases in the group with adverse perinatal outcomes and the group with normal results (p = 0.001, p = 0.000, and p = 0.000, respectively). CONCLUSIONS: The strong relationship between abnormal cardiac function and adverse perinatal outcomes suggest that cardiac Doppler may be a valuable tool for fetal monitoring and management for the GDM patient group.


Assuntos
Diabetes Gestacional , Feminino , Coração Fetal/diagnóstico por imagem , Monitorização Fetal , Humanos , Gravidez , Cuidado Pré-Natal , Ultrassonografia Doppler
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