Descripción de un caso: Hallazgos prenatales del síndrome de Silver-Russell / Case description: Prenatal sonographic features of Silver-Russell Syndrome

Introducción: El síndrome de Silver-Russell es un trastorno congénito que cursa con déficit de crecimiento intrauterino y posnatal, macrocefalia relativa, frente prominente, cara triangular, clinodactilia, asimetría esquelética, problemas de alimentación y bajo índice de masa corporal. Entre las causas genéticas más comunes se encuentran la hipometilación del alelo paterno en la región de control de impronta 1 (ICR1) localizado en 11p15.5 (50% de los casos) y la disomía uniparental materna en el cromosoma 7 (7-10%). Hallazgos clínicos: Presentamos el caso de una gestante de 29 años con un cribado de cromosomopatías de primer trimestre de bajo riesgo. En la ecografía selectiva, realizada con 20+4 semanas, se evidencia un crecimiento intrauterino restringido (CIR) precoz. Se realiza amniocentesis con QF-PCR, cariotipo y array-CGH normales. A las 31+3 semanas persiste CIR tipo I con un peso fetal estimado, circunferencia abdominal y longitud de fémur inferiores al percentil 1, siendo el diámetro biparietal y la circunferencial cefálica normales. Se evidencia prominencia frontal, facies pequeña y clinodactilia del quinto dedo de la mano derecha. A las 37 semanas nace mediante cesárea un varón de 1.410g. Diagnóstico, intervención terapéutica y resultados: A la exploración física destaca fenotipo peculiar sugestivo de síndrome de Silver-Russell. El estudio genético confirma hipometilación del ICR1 en la región 11p15.5. Se incluye iconografía del estudio ecográfico prenatal. Conclusión: Es importante llegar al diagnóstico de esta entidad y conocer la correlación genotipo-fenotipo para poder ofrecer las mejores opciones terapéuticas, un adecuado seguimiento y realizar asesoramiento genético familiar.(AU)

Introduction: Silver-Russell syndrome is a congenital disorder that causes prenatal and postnatal growth restriction, relative macrocephaly, prominent forehead, triangular facies, clinodactyly, body asymmetry, severe feeding difficulties, and low body mass index. The most common underlying mechanisms are hypomethylation of the paternal allele at the imprinting control region 1 (ICR 1) located at 11p15.5 (seen in 50% of patients) and maternal uniparental disomy for chromosome 7 (seen in 7%–10% of patients). Clinical findings: We present the case of a 29-year-old pregnant woman with low risk for chromosomal abnormalities at the first trimester screening. The 20-week ultrasound shows early intrauterine growth restriction (IUGR). We performed an amniocentesis with normal QF-PCR, foetal karyotype and array-CGH. Intrauterine growth restriction Type I persists at 31+4 weeks with estimated foetal weight, abdominal circumference, and femur length below the 1st centile. The biparietal diameter and head circumference centiles were normal. Prominent forehead, small face, and fifth finger clinodactyly of right hand were detected. At 37 weeks, a boy weighing 1,410g was born by caesarean section. Diagnosis, therapeutic intervention, and results: Physical examination revealed a peculiar phenotype suggestive of Silver-Russell syndrome. The genetic study confirmed hypomethylation of ICR1 in the 11p15.5 region. Prenatal ultrasound images are shown. Conclusions: It is important to diagnose this entity and determine genotype-phenotype correlations in order to provide the best therapeutic options, ensure adequate follow-up, and offer timely family genetic counselling.(AU)

Salivary gland ultrasound in clinical practice: What is its real usefulness? / Utilidad en práctica clínica de la ecografía de glándulas salivales

Background: Salivary gland ultrasound (SGU) provides information about structural gland abnormalities that can be graded and used for primary Sjögren's syndrome (pSS) diagnosis. Its potential role as a prognostic marker for detecting patients at high risk of lymphoma and extra-glandular manifestations is still under evaluation. We aim to assess the usefulness of SGU for SS diagnosis in routine clinical practice and its relationship with extra-glandular involvement and lymphoma risk in pSS patients. Methods: We designed a retrospective observational single-center study. Data was collected using the electronic health records of patients referred to an ultrasound outpatient clinic for evaluation over a 4-year period. Data extraction included demographics, comorbidities, clinical data, laboratory tests, SGU results, salivary gland (SG) biopsy, and scintigraphy results. Comparisons were made between patients with and without pathological SGU. The external criterion for comparison was the fulfillment of the 2016 ACR/EULAR pSS criteria. Results: A total of 179 SGU assessments were included from this 4-year period. Twenty-four cases (13.4%) were pathological. The most frequently diagnosed conditions prior to SGU-detected pathologies were pSS (9.7%), rheumatoid arthritis (RA) (13.1%), and systemic lupus (4.6%). One hundred and two patients (57%) had no previous diagnosis (sicca syndrome work-up); of these, 47 patients (46.1%) were ANA positive and 25 (24.5%) anti-SSA positive. In this study, the sensitivity and specificity of SGU for SS diagnosis were 48% and 98% respectively, with a positive predictive value of 95%. There were statistically significant relationships between a pathological SGU and the presence of recurrent parotitis (p=.0083), positive anti-SSB antibodies (p=.0083), and a positive sialography (p=.0351)...(AU)

Antecedentes y objetivo: La ecografía de glándulas salivales (EGS) proporciona información acerca de las anomalías en la estructura glandular, y puede ser utilizado para el diagnóstico del síndrome de Sjögren (SS). Además, su potencial valor pronóstico para detectar pacientes con riesgo de manifestaciones extra-glandulares, así como el riesgo de linfoma se encuentra aún bajo estudio. El objetivo de nuestro estudio es evaluar la utilidad de la EGS para el diagnóstico del SS en la práctica clínica habitual, y su relación con la afectación extra-glandular, así como el riesgo de linfoma en pacientes con síndrome de Sjögren primario (pSS). Métodos: Realizamos un estudio retrospectivo y observacional en un único centro. La información fue recolectada de la historia clínica electrónica del paciente tras un seguimiento de 4 años. Esta información incluye variables demográficas, comorbilidades, datos clínicos, análisis de laboratorio, los resultados de la EGS, biopsia de glándulas salivales y gammagrafía. Se efectuaron comparaciones entre los pacientes que tenían una EGS patológica con aquellos que tenían un resultado normal. El criterio para establecer la comparación fue cumplir los criterios de ACR/ELUAR 2016 para el diagnóstico de pSS. Resultados: Se realizaron un total de 179 EGS durante el período de 4 años. De estas, 24 (13,4%) resultaron ser patológicas. Las enfermedades más frecuentemente identificadas tras realizar la EGS fueron pSS (9,7%), artritis reumatoide (AR) (4,6%) y lupus eritematoso sistémico (LES) (4,6%). Ciento dos pacientes (57%) no tenían diagnóstico previo (estudio de síndrome seca); de estos, 47 (46,1%) tenían ANA positivo y 25 (24,5%) tenían anti-Ro positivo. La sensibilidad y la especificidad de la EGS para detectar el SS en nuestro estudio fueron del 48 y 98%, respectivamente; con un valor predictivo positivo del 95%...(AU)

Utilidad de la ecografía de la arteria femoral complementaria a la exploración carotídea para la detección de ateromatosis subclínica en pacientes con infección por el virus de la inmunodeficiencia humana / Usefulness of artery femoral ultrasound complementary to carotid exploration for the detection of subclinical atheromatosis in patients with human immunodeficiency virus infection

Introducción La detección de la enfermedad ateromatosa subclínica (EAS) en los pacientes con el virus de la inmunodeficiencia humana (VIH) se basa habitualmente en la ecografía carotídea. Sin embargo, estudios en otras enfermedades muestran una infraestimación de la EAS cuando se explora exclusivamente la región carotídea. Este estudio evalúa el impacto de la exploración combinada carotídea y femoral en la detección de la EAS. Métodos Estudio transversal y prospectivo de pacientes con VIH, diagnosticados entre 2008 y 2017. Se realizó ecografía carotídea y femoral. La EAS fue definida según los criterios de Mannheim. Resultados Se incluyeron 102 pacientes (edad media: 40 años, el 73,5% varones). La prevalencia de la EAS por exploración carotídea fue del 15,7% (n=16), y por exploración femoral fue del 18,6% (n=19). La proporción de pacientes con criterios de EAS global (afectación carotídea o femoral) fue del 23,5% (n=24) lo que implica un aumento absoluto de la detección de EAS del 7,84% (IC 95%: 2,63-13,06%). Conclusiones La detección de la EAS aumenta de forma importante con el uso combinado de la ecografía carotídea y femoral en la población con VIH. (AU)

Introduction Detection of subclinical atheromatosis disease (SAD) in patients with human immunodeficiency virus (HIV) infection is usually based on carotid ultrasound. However, studies in other pathologies have shown a probable underestimation of SAD when its detection is exclusively based on carotid exploration. This study evaluates the impact on detection of SAD in patients with HIV through combined carotid and femoral exploration. Methods Cross-sectional and prospective study of patients with HIV, diagnosed between 2008-2017. Carotid and femoral ultrasound examination was performed in all patients. EAS was defined according to Mannheim criteria. Results One hundred two patients were included (mean age: 40 years, 73.5% being male). The prevalence of carotid SAD in the total sample was 15.7% (n=16), and the prevalence of femoral SAD was 18.6% (n=19). The proportion of patients with global SAD criteria (carotid or femoral) was 23.5% (n=24), which implies an absolute increase in SAD detection of 7.84% (95% CI; 2.63-13.06%) at the total sample. Conclusions Detection of SAD is significantly increased by the combined use of carotid and femoral arterial ultrasound in the population affected by HIV infection. (AU)

Prognostic value of the early lung ultrasound B-line score for postoperative pulmonary insufficiency in patients undergoing thoracic surgery: an observational study.

BACKGROUND: Postoperative pulmonary insufficiency (PPI) is an important contributor to morbidity and mortality after thoracic surgery. Lung ultrasound is a reliable tool for assessing respiratory function. We sought to determine the clinical value of the early lung ultrasound B-line score for predicting changes in pulmonary function after thoracic surgery. METHODS: Eighty-nine patients undergoing elective lung surgery were included in this study. The B-line score was determined 30 min after removal of the endotracheal tube, and the PaO2/FiO2 ratio was recorded 30 min after extubation and on the third postoperative day. Patients were divided into normal (PaO2/FiO2 ≥ 300) and PPI (PaO2/FiO2 < 300) groups according to their PaO2/FiO2 ratios. A multivariate logistic regression model was used to identify independent predictors of postoperative pulmonary insufficiency. Receiver operating characteristic (ROC) analysis was performed for significantly correlated variables. RESULTS: Eighty-nine patients undergoing elective lung surgery were included in this study. We evaluated 69 patients in the normal group and 20 in the PPI group. Patients conforming to NYHA class 3 at administration were significantly more represented in the PPI group (5.8 and 55%; p < 0.001). B-line scores were significantly higher in the PPI group than in the normal group (16; IQR 13-21 vs. 7; IQR 5-10; p < 0.001). The B-line score was an independent risk factor (OR = 1.349 95% CI 1.154-1.578; p < 0.001), and its best cutoff value for predicting PPI was 12 (sensitivity: 77.5%; specificity: 66.7%). CONCLUSIONS: Lung ultrasound B-line scores 30 min after extubation are effective in predicting early PPI in patients undergoing thoracic surgery. Trial registration This study was registered with the Chinese Clinical Trials Registry (ChiCTR2000040374).

Plantar Vein Thrombosis in a Patient with COVID-19: Case Report.

Plantar thrombophlebitis is a rare abnormality with few cases reported in the literature. Coexistence with severe acute respiratory syndrome coronavirus 2 infection increases its relevance. The disease is generally classified as idiopathic, and it is suggested that it is attributed to conditions that lead to hypercoagulability. We present the case of a 68-year-old female patient with thrombosis of the lateral plantar veins and a diagnosis of coronavirus disease of 2019. The plantar vein thrombosis diagnosis was made by means of Doppler ultrasonography and magnetic resonance imaging. Severe acute respiratory syndrome coronavirus 2 infection was suspected per clinical information and confirmed with reverse-transcriptase polymerase chain reaction technique. Treatment was successful using rivaroxaban and nonsteroidal antiinflammatory drugs.

[Multiresolution discrete optimization registration method of ultrasound and magnetic resonance images based on key points].

The registration of preoperative magnetic resonance (MR) images and intraoperative ultrasound (US) images is very important in the planning of brain tumor surgery and during surgery. Considering that the two-modality images have different intensity range and resolution, and the US images are degraded by lots of speckle noises, a self-similarity context (SSC) descriptor based on local neighborhood information was adopted to define the similarity measure. The ultrasound images were considered as the reference, the corners were extracted as the key points using three-dimensional differential operators, and the dense displacement sampling discrete optimization algorithm was adopted for registration. The whole registration process was divided into two stages including the affine registration and the elastic registration. In the affine registration stage, the image was decomposed using multi-resolution scheme, and in the elastic registration stage, the displacement vectors of key points were regularized using the minimum convolution and mean field reasoning strategies. The registration experiment was performed on the preoperative MR images and intraoperative US images of 22 patients. The overall error after affine registration was (1.57 ± 0.30) mm, and the average computation time of each pair of images was only 1.36 s; while the overall error after elastic registration was further reduced to (1.40 ± 0.28) mm, and the average registration time was 1.53 s. The experimental results show that the proposed method has prominent registration accuracy and high computational efficiency.

Ultrasound evolution of parenchymal changes in the thyroid gland with autoimmune thyroiditis in children prior to the development of papillary thyroid carcinoma - a follow-up study.

Background: Follicular cell-derived thyroid carcinoma represents the vast majority of paediatric thyroid cancers (TCs). Papillary thyroid carcinoma (PTC) accounts for over 90% of all childhood TC cases, and its incidence in paediatric patients is increasing. The objective of this follow-up study was to present the outcome of ultrasound (US) and laboratory monitoring of paediatric patients with autoimmune thyroiditis (AIT) prior to the development of PTC. Patients and methods: This prospective study included 180 children and adolescents (132 females; 73.3%) with a suspicion of thyroid disorder referred to the Outpatient Endocrine Department. The patients were divided into four groups: 1) 28 patients with a mean age of 10.7 [standard deviation (SD), 3.1] y, in whom PTC was detected during the active surveillance of AIT [AIT(+), PTC(+) follow up (F)]; 2) 18 patients with a mean age of 12.8 (SD, 3.4) y, in whom PTC and AIT were detected upon admission (A) [AIT(+), PTC(+) A]; 3) 45 patients with a mean age of 13.0 (SD, 3.4) y, in whom PTC was detected upon admission and AIT was excluded [AIT(-), PTC(+) A]; and 4) an age- and sex-matched control group of 89 patients with AIT and with a mean age of 9.4 (SD, 3.0) y. The analysis included clinical, US, and laboratory assessment results of children on admission (groups 1-4) and during follow-up (groups 1 and 4) in the Paediatric Endocrine Outpatient Department. Results: Upon admission of those in group 1, the US evaluation revealed a hypoechogenic thyroid gland in 12 and an irregular normoechogenic gland in 16 patients. US monitoring revealed an increase in thyroid echogenicity and an increased irregularity of the thyroid structure during the follow-up period of all of the patients from group 1. Such changes were not noticed in group 4. PTC was diagnosed at the mean time of 3.6 y (3 mo-9 y) since AIT confirmation in group 1. The mean maximum PTC diameter as per the US was significantly smaller in group 1 than in groups 2 and 3 [13.2 (10.8) mm vs. 22.2 (12.8) and 22.05 (15.4) mm]. Fewer patients in group 1 were referred to 131I than in groups 2 and 3 (71.4% vs. 94.4 and 93.3%). Interestingly, significant differences were observed in the thyroglobulin antibody (TgAb)/thyroid peroxidase antibody (TPOAb) ratio between groups 2 and 3, as opposed to group 4, at the beginning of observation [15.3 (27.6) and 3.5 (8.8] vs. 0.77 (1.9)]. In group 1, after the follow-up, an increase in the TgAb/TPOAb ratio was observed [1.2 (9.8) to 5.2 (13.5)]. There were no significant differences between groups 1-3 in labeling index Ki67, lymph nodes metastasis, extrathyroidal extension, and angioinvasion. There were no associations between thyroid-stimulating hormone, TgAb, and the extent of the disease. Conclusion: The use of thyroid US focused on the search for developing tumours in the routine follow-up of patients with AIT may not only help in the early detection of thyroid malignancies that are not clinically apparent but may also influence the invasiveness of oncological therapy and reduce the future side effects of 131I therapy. We propose that the repeat evaluation of TPOAb and TgAb warrants further exploration as a strategy to determine TC susceptibility in paediatric patients with AIT in larger multicentre studies.

Histological Response to 5†kHz Irreversible Electroporation in a Porcine Liver Model.

Unlike necrosis by thermal ablation, irreversible electroporation (IRE) is known to induce apoptosis by disrupting plasma membrane integrity with electric pulses while preserving the structure of blood vessels and bile ducts in liver tissue without a heat sink effect. This study aimed to investigate thermal damage and histopathological effects in the porcine liver by high-frequency electric pulses (5 kHz) which is much higher than the widely used 1 Hz. The electric field and thermal distributions of 5 kHz electric pulses were compared with those of 1 Hz in numerical simulations. 5 kHz-IRE was applied on pigs under ultrasound imaging to guide the electrode placement. The animals underwent computed tomography (CT) examination immediately and 1 day after IRE. After CT, IRE-treated tissues were taken and analyzed histologically. CT revealed that hepatic veins were intact for 1-day post-IRE. Histopathologically, the structure of the portal vein was intact, but endothelial cells were partially removed. In addition, the hepatic artery structure from which endothelial cells were removed were not damaged, while the bile duct structure and cholangiocytes were intact. The thermal injury was observed only in the vicinity of the electrodes as simulated in silico. 5 kHz-IRE generated high heat due to its short pulse interval, but the thermal damage was limited to the tissue around the electrodes. The histopathological damage caused by 5 kHz-IRE was close to that caused by 1 Hz-IRE. If a short-time treatment is required for reasons such as anesthesia, high-frequency IRE treatment is worth considering. Our observations will contribute to a better understanding of the IRE phenomena and search for advanced therapeutic conditions.

Lung Ultrasound to Assess Pulmonary Congestion in Patients with Acute Exacerbation of COPD.

Purpose: Heart failure (HF) often coexists with chronic obstructive pulmonary disease (COPD) and is associated with worse outcomes. We aimed to assess the feasibility of detecting vertical artifacts (B-lines) on lung ultrasound (LUS) to identify concurrent HF in patients hospitalized with acute exacerbation of COPD (AECOPD). Second, we wanted to assess the association between B-lines and the risk of rehospitalization for AECOPD or death. Patients and Methods: In a prospective cohort study, 123 patients with AECOPD underwent 8-zone bedside LUS within 24h after admission. A positive LUS was defined by ≥3 B-lines in ≥2 zones bilaterally. The ability to detect concurrent HF (adjudicated by a cardiologist committee) and association with events were evaluated by logistic- and Cox regression models. Results: Forty-eight of 123 patients with AECOPD (age 75±9 years, 57[46%] men) had concurrent HF. Sixteen (13%) patients had positive LUS, and the prevalence of positive LUS was similar between patients with and without concurrent HF (8[17%] vs 8[11%], respectively, p=0.34). The number of B-lines was higher in concurrent HF: median 10(IQR 6-16) vs 7(IQR 5-12), p=0.03. The sensitivity and specificity for a positive LUS to detect concurrent HF were 17% and 89%, respectively. Positive LUS was not associated with rehospitalization and mortality: Adjusted HR: 0.93(0.49-1.75), p=0.81. Conclusion: LUS did not detect concurrent HF or predict risk in patients with AECOPD.

Morphological aspects of basal cell carcinoma vascularization.

Basal cell carcinoma (BCC) is a malignant skin cancer which commonly exhibits aberrant blood flow because of angiogenesis. Its invasiveness and lack of metastatic potential may be explained by the typical pattern of vascularization seen in BCCs, where blood vessels are absent in the tumor islands and prominent in the tumor's periphery. From clinical point of view, high-frequency ultrasound (HFUS) is a useful tool for the evaluation of the lateral and depth extension of these tumors; furthermore, by employing color Doppler, important data regarding the vascularization degree of BCCs is provided. Knowingly, the sonographic vascular pattern of cutaneous tumors can aid in improving diagnosis and treatment by differentiating between benign and malignant lesions, between various types of cutaneous malignancies and also between various types of BCC (e.g., low risk versus high risk). Our aim was to perform a review integrating all currently known vascular properties of BCC as a tumor entity.

Evaluating the effects of radiation and acoustically-stimulated microbubble therapy in an in vivo breast cancer model.

Ultrasound-stimulated microbubbles (USMB) cause localized vascular effects and sensitize tumors to radiation therapy (XRT). We investigated acoustic parameter optimization for combining USMB and XRT. We treated breast cancer xenograft tumors with 500 kHz pulsed ultrasound at varying pressures (570 or 740 kPa), durations (1 to 10 minutes), and microbubble concentrations (0.01 to 1% (v/v)). Radiation therapy (2 Gy) was administered immediately or after a 6-hour delay. Histological staining of tumors 24 hours after treatment detected changes in cell morphology, cell death, and microvascular density. Significant cell death resulted at 570 kPa after a 1-minute exposure with 1% (v/v) microbubbles with or without XRT. However, significant microvascular disruption required higher ultrasound pressure and exposure duration greater than 5 minutes. Introducing a 6-hour delay between treatments (USMB and XRT) showed a similar tumor effect with no further improvement in response as compared to when XRT was delivered immediately after USMB.

Diagnosis of thyroid micronodules on ultrasound using a deep convolutional neural network.

To assess the performance of deep convolutional neural network (CNN) to discriminate malignant and benign thyroid nodules < 10 mm in size and compare the diagnostic performance of CNN with those of radiologists. Computer-aided diagnosis was implemented with CNN and trained using ultrasound (US) images of 13,560 nodules ≥ 10 mm in size. Between March 2016 and February 2018, US images of nodules < 10 mm were retrospectively collected at the same institution. All nodules were confirmed as malignant or benign from aspirate cytology or surgical histology. Diagnostic performances of CNN and radiologists were assessed and compared for area under curve (AUC), sensitivity, specificity, accuracy, positive predictive value, and negative predictive value. Subgroup analyses were performed based on nodule size with a cut-off value of 5 mm. Categorization performances of CNN and radiologists were also compared. A total of 370 nodules from 362 consecutive patients were assessed. CNN showed higher negative predictive value (35.3% vs. 22.6%, P = 0.048) and AUC (0.66 vs. 0.57, P = 0.04) than radiologists. CNN also showed better categorization performance than radiologists. In the subgroup of nodules ≤ 5 mm, CNN showed higher AUC (0.63 vs. 0.51, P = 0.08) and specificity (68.2% vs. 9.1%, P < 0.001) than radiologists. Convolutional neural network trained with thyroid nodules ≥ 10 mm in size showed overall better diagnostic performance than radiologists in the diagnosis and categorization of thyroid nodules < 10 mm, especially in nodules ≤ 5 mm.

Effectiveness of diaphragmatic ultrasound as a predictor of successful weaning from mechanical ventilation: a systematic review and meta-analysis.

BACKGROUND: Several measurements have been used to predict the success of weaning from mechanical ventilation; however, their efficacy varies in different studies. In recent years, diaphragmatic ultrasound has been used for this purpose. We conducted a systematic review and meta-analysis to evaluate the effectiveness of diaphragmatic ultrasound in predicting the success of weaning from mechanical ventilation. METHODS: Two investigators independently searched PUBMED, TRIP, EMBASE, COCHRANE, SCIENCE DIRECT, and LILACS for articles published between January 2016 and July 2022. The methodological quality of the studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool; additionally, the certainty of the evidence is evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology. Sensitivity and specificity analysis was performed for diaphragmatic excursion and diaphragmatic thickening fraction; positive and negative likelihood ratios and diagnostic odds ratios (DOR) with their confidence intervals (95% CI) were calculated by random effects analysis, summary receiver operating characteristic curve was estimated. Sources of heterogeneity were explored by subgroup analysis and bivariate meta-regression. RESULTS: Twenty-six studies were included, of which 19 were included in the meta-analysis (1204 patients). For diaphragmatic excursion, sensitivity was 0.80 (95% CI 0.77-0.83), specificity 0.80 (95% CI 0.75-0.84), area under the summary receiver operating characteristic curve 0.87 and DOR 17.1 (95% CI 10.2-28.6). For the thickening fraction, sensitivity was 0.85 (95% CI 0.82-0.87), specificity 0.75 (95% CI 0.69-0.80), area under the summary receiver operating characteristic curve 0.87 and DOR 17.2 (95% CI 9.16-32.3). There was heterogeneity among the included studies. When performing a subgroup analysis and excluding studies with atypical cutoff values, sensitivity and specificity increased for diaphragmatic thickening fraction; sensitivity increased and specificity decreased for diaphragmatic excursion; when comparing studies using pressure support (PS) versus T-tube, there was no significant difference in sensitivity and specificity; bivariate meta-regression analysis shows that patient position at the time of testing was a factor of heterogeneity in the included studies. CONCLUSIONS: Measurement of diaphragmatic excursion and diaphragmatic thickening fraction predict the probability of successful weaning from mechanical ventilation with satisfactory diagnostic accuracy; however, significant heterogeneity was evident in the different included studies. Studies of high methodological quality in specific subgroups of patients in intensive care units are needed to evaluate the role of diaphragmatic ultrasound as a predictor of weaning from mechanical ventilation.

Predictors of metastasis in cervical indeterminate lymph nodes after thyroid cancer ablation by long-term ultrasound follow-up.

OBJECTIVES: To investigate the pattern of change over time and predictors for metastasis in indeterminate lymph nodes (LNs) among patients with thyroid cancer post-ablation. METHODS: We enrolled patients who developed new cervical LNs after papillary thyroid carcinoma (PTC) ablation. Changes in the ultrasound characteristics of the indeterminate LN were recorded at months 1, 3, 6 and 12 after ablation. LN puncture pathology and long-term follow-up were standard of diagnosis. The indeterminate LNs were divided into benign and malignant groups, the differences between the two groups were compared, and the risk characteristics of malignant LNs were screened using generalized estimating equations (GEE). RESULTS: In total, we included 138 LNs from 99 patients, of which 48 were indeterminate LNs. When following up indeterminate LNs, non-cervical lymph node metastasis (non-CLNM) lesions demonstrated a statistically significant gradual decrease in volume (p = 0.012), though there was no significant change in the volume of CLNM lesions (p = 0.779). Compared to non-CLNM lesions, the diagnostic efficiency was the highest for CLNM lesions at 1-3 months after ablation, when the LN volume changed by -0.08 to 0.12 mL (p = 0.048). The third month after ablation became an important time point for review. Moreover, GEE analysis showed that microcalcifications, cystic changes, and vascularity were strongly associated with CLNMs (p = 0.004, p = 0.002, and p = 0.010, respectively). CONCLUSIONS: There is a pattern of volume change of indeterminate LNs after PTC ablation, which, together with microcalcifications, cystic changes, and vascularity, can be used as criteria for differentiating the benignity and malignancy of indeterminate LNs.