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1.
Med Sci Monit ; 27: e929913, 2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33556045

RESUMO

BACKGROUND Two diagnostic models of prostate cancer (PCa) and clinically significant prostate cancer (CS-PCa) were established using clinical data of among patients whose prostate-specific antigen (PSA) levels are in the gray area (4.0-10.0 ng/ml). MATERIAL AND METHODS Data from 181 patients whose PSA levels were in the gray area were retrospectively analyzed, and the following data were collected: age, digital rectal examination, total PSA, PSA density (PSAD), free/total PSA (f/t PSA), transrectal ultrasound, multiparametric magnetic resonance imaging (mpMRI), and pathological reports. Patients were diagnosed with benign prostatic hyperplasia (BPH) and PCa by pathology reports, and PCa patients were separated into non-clinically significant PCa (NCS-PCa) and CS-PCa by Gleason score. Afterward, predictor models constructed by above parameters were researched to diagnose PCa and CS-PCa, respectively. RESULTS According to the analysis of included clinical data, there were 109 patients with BPH, 44 patients with NCS-PCa, and 28 patients with CS-PCa. Regression analysis showed PCa was correlated with f/t PSA, PSAD, and mpMRI (P<0.01), and CS-PCa was correlated with PSAD and mpMRI (P<0.01). The area under the receiver operating characteristic curves of 2 models for PCa (sensitivity=73.64%, specificity=64.23%) and for CS-PCa (sensitivity=71.41%, specificity=81.82%) were 0.79 and 0.87, respectively. CONCLUSIONS The prediction models had satisfactory diagnostic value for PCa and CS-PCa among patients with PSA in the gray area, and use of these models may help reduce overdiagnosis.


Assuntos
Calicreínas/sangue , Modelos Estatísticos , Antígeno Prostático Específico/sangue , Hiperplasia Prostática/diagnóstico , Neoplasias da Próstata/diagnóstico , Fatores Etários , Idoso , Biópsia/estatística & dados numéricos , Diagnóstico Diferencial , Exame Retal Digital/estatística & dados numéricos , Humanos , Masculino , Sobremedicalização/prevenção & controle , Imageamento por Ressonância Magnética Multiparamétrica/estatística & dados numéricos , Gradação de Tumores , Próstata/diagnóstico por imagem , Próstata/patologia , Hiperplasia Prostática/sangue , Hiperplasia Prostática/patologia , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Curva ROC , Valores de Referência , Estudos Retrospectivos , Medição de Risco/métodos , Ultrassonografia/estatística & dados numéricos
2.
Medicine (Baltimore) ; 100(3): e23999, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33545992

RESUMO

ABSTRACT: The purpose of this study is to investigate sonoelastographic features of the tibial nerve.The study included 72 tibial nerves in 36 healthy subjects. High resolution ultrasound and Shear wave elastography were used to evaluate the tibial nerve. Cross sectional area and stiffness were measured.The mean cross sectional area of the tibial nerve was 13.4 mm2. The mean shear elastic modulus of the tibial nerve in the short axis was 23.3 kPa. The mean shear elastic modulus of the tibial nerve in long axis was 26.1 kPa. The tibial nerve elastic modulus also showed no correlation with cross sectional area neither in the long axis nor short axis. Age, height, weight, and body mass index showed no correlation with tibial nerve elastic modulus in short or long axes.The elastic modulus of the tibial nerve has been determined in healthy subjects and can serve as a reference for future assessment of polyneuropathy.


Assuntos
Técnicas de Imagem por Elasticidade/estatística & dados numéricos , Nervo Tibial/diagnóstico por imagem , Ultrassonografia/estatística & dados numéricos , Adulto , Módulo de Elasticidade/fisiologia , Técnicas de Imagem por Elasticidade/métodos , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Nervo Tibial/fisiologia , Ultrassonografia/métodos , Adulto Jovem
3.
Medicine (Baltimore) ; 100(4): e23325, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530157

RESUMO

ABSTRACT: The impact of prenatal diagnosis on the survival outcome of infants with congenital heart disease (CHD) is still unclear. This study aimed to compare the 1-year survival rate between the prenatally and postnatally diagnosed infants with CHDs.A single-center population-based retrospective cohort study was performed on data from all infants diagnosed with CHD born between January 1998 and December 2017. Among infants with isolated CHDs, the 1-year Kaplan-Meier survival probabilities for prenatal and postnatal diagnosis were estimated. Cox proportional hazard ratios were adjusted for critical CHD (CCHD) status and gestational age.A total of 424 (40 prenatally and 384 postnatally) diagnosed infants with CHDs were analyzed. Compared with non-CCHDs, infants with CCHDs were more likely to be prenatally diagnosed (55.0% vs 18.0%; P < .001). Among the 312 infants with isolated CHDs, the 1-year survival rate for the prenatally diagnosed was significantly lower than postnatally diagnosed (77.1% vs 96.1%; P < .001). For isolated CCHDs, the 1-year survival rate for the prenatally diagnosed was significantly lower than postnatally diagnosed (73.4% vs 90.0%; P < .001). The 1-year survival rate was increased with the increase of age at diagnosis. Among infants with isolated CHDs and CCHDs, the adjusted hazard ratios for 1-year mortality rates for the prenatally versus postnatally diagnosed were 2.554 (95% confidence interval [CI], 1.790, 3.654; P < .001) and 2.538 (95% CI: 1.796, 3.699; P < .001), respectively.Prenatal diagnosis is associated with lower 1-year survival rate for infants with isolated CCHDs. This could probably due to variation in the disease severity among the CCHD subtypes.


Assuntos
Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/mortalidade , Cuidado Pós-Natal/estatística & dados numéricos , Ultrassonografia Pré-Natal/estatística & dados numéricos , Ultrassonografia/estatística & dados numéricos , Feminino , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Estimativa de Kaplan-Meier , Masculino , Gravidez , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Taxa de Sobrevida , Fatores de Tempo
4.
Medicine (Baltimore) ; 100(4): e23631, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530165

RESUMO

BACKGROUND: Acute abdominal pain is often caused by intestinal obstruction, with high morbidity, and mortality, so that the early diagnosis is particularly important. Currently, both spiral CT and ultrasound are common imaging diagnostic methods. However, the accuracy and practicality of the diagnosis are controversial. Therefore, the purpose of this study is to systematically evaluate the accuracy and practicality of spiral CT and ultrasound in the diagnosis of intestinal obstruction. METHODS: Retrieval of English database (PubMed, Embase, Web of Science, the Cochrane Library) and Chinese database (CNKI, WAN FANG, VIP, CBMDISC) by computers. From the establishment of the database to October 2020, a diagnostic experimental study on the diagnosis of intestinal obstruction by ultrasound and spiral CT was conducted. Two researchers independently conducted data extraction and quality evaluation of literature on the included studies, and Meta Disc1.4 and RevMan5.3 were used for meta-analysis on the included literature. RESULTS: Sensitivity, specificity, po-sitive Likelihood ratio, NE-Gative likelihood ratio, diagnostic odds ratio and other indicators were used to determine the diagnostic efficacy of ultrasound and helical CT. CONCLUSION: This study is aimed at providing an evidence-based basis for clinicians to choose an appropriate or optimal diagnostic method by comparison of the accuracy and practicality between spiral CT and ultrasound in the diagnosis of intestinal obstruction. ETHICS AND DISSEMINATION: The private information from individuals will not be published. This systematic review also will not involve endangering participant rights. Ethical approval is not required. The results may be published in a peer-reviewed journal or disseminated in relevant conferences. OSF REGISTRATION NUMBER: DOI 10.17605/ OSF.IO / Q5RNS.


Assuntos
Obstrução Intestinal/diagnóstico por imagem , Tomografia Computadorizada Espiral/estatística & dados numéricos , Ultrassonografia/estatística & dados numéricos , Diagnóstico Diferencial , Humanos , Metanálise como Assunto , Razão de Chances , Reprodutibilidade dos Testes , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
5.
Medicine (Baltimore) ; 100(4): e23635, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530166

RESUMO

BACKGROUND: As a novel ultrasound technique, superb microvascular imaging (SMI) can quickly, simply, and noninvasively study the microvascular distribution in the tumor and evaluate the microvascular perfusion. Studies suggested that SMI is helpful for the differentiation between benign and malignant parotid tumors. However, the results of these studies have been contradictory. Therefore, the present meta-analysis aimed at determining the accuracy of SMI in the differential diagnosis between benign and malignant parotid tumors. METHODS: We will search PubMed, Web of Science, Cochrane Library, and Chinese biomedical databases from their inceptions to September 30, 2020, without language restrictions. Two authors will independently carry out searching literature records, scanning titles and abstracts, full texts, collecting data, and assessing risk of bias. Review Manager 5.2 and Stata14.0 software will be used for data analysis. RESULTS: This systematic review will determine the accuracy of SMI in the differential diagnosis between benign and malignant parotid tumors. CONCLUSION: Its findings will provide helpful evidence for the accuracy of SMI in the differential diagnosis between benign and malignant parotid tumors. SYSTEMATIC REVIEW REGISTRATION: INPLASY2020100093.


Assuntos
Angiografia/estatística & dados numéricos , Microvasos/diagnóstico por imagem , Neoplasias Parotídeas/diagnóstico por imagem , Ultrassonografia/estatística & dados numéricos , Angiografia/métodos , Diagnóstico Diferencial , Humanos , Metanálise como Assunto , Reprodutibilidade dos Testes , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Ultrassonografia/métodos
6.
Medicine (Baltimore) ; 99(51): e23789, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371149

RESUMO

ABSTRACT: Skin cancer diagnoses are rising due to increasing ultraviolet ray exposure and an aging population. The complete surgical excision of skin cancer, including a normal tissue, has been the widely performed and determining the adequate safety margin is essential. In this study, we compared the preoperative thickness and width of skin cancer by ultrasonography with the measurements by histopathologic findings.A total of 211 patients were enrolled in this study and ultrasonography was performed on 30 patients. The width (long and short axis) and thickness of the skin cancers were measured using electronic calipers of ultrasonographic calipers preoperatively and microscope postoperatively.The skin cancers were basal cell carcinoma (n = 17), squamous cell carcinoma (n = 10), Merkel cell carcinoma (n = 1), mucinous carcinoma (n = 1), and sebaceous carcinoma (n = 1). The mean width (long and short axis) and thickness of the cancers measured by ultrasonography was 1.25 (0.76) cm, 0.96 (0.65) cm, and 0.37 (0.28) cm. The measurements by histopathology was 1.24 (0.84) cm, 0.95 (0.65) cm, and 0.27 (0.24) cm. Kendall's tau-b correlation coefficient between measurements by ultrasonography and histopathology was as follows: long axis, r = 0.733, P < .001; short axis, r = 0.671, P < .001; thickness, r = 0.740, P < .001. Spearman's rank correlation coefficient between measurements by ultrasonography and histopathology was as follows: long axis, r = 0.865, P < .001; short axis, r = 0.829, P < .001; thickness, r = 0.842, P < .001. The difference in mean thickness between the total excised tissue and the skin cancer was 0.29 (0.43) cm (range 0.05-0.40 cm) in basal cell carcinoma and 0.56 (0.58) cm (range 0.05-2.22 cm) in squamous cell carcinoma.Ultrasonography can accurately measure the width and thickness of skin cancer and predict the safety margins of the wide excision. Preoperative ultrasonography is a good diagnostic tool for surgical planning. Additional studies with larger populations are needed to quantify the range of vertical safety margins.


Assuntos
Margens de Excisão , Neoplasias Cutâneas/cirurgia , Ultrassonografia/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Cutâneas/patologia , Resultado do Tratamento , Ultrassonografia/normas , Ultrassonografia/estatística & dados numéricos
7.
Medicine (Baltimore) ; 99(50): e23381, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327262

RESUMO

BACKGROUND: Colon cancer is a common malignant tumor of the gastrointestinal tract. Therefore, a clear diagnosis is particularly important for the treatment of colon cancer. Ultrasound and spiral computed tomography (CT) can both be used in the diagnosis, but each has its own advantages and disadvantages, which could cause confusion in clinical choice. The purpose of this study was to systematically evaluate the practicability of spiral CT and ultrasound in the diagnosis of colon cancer. METHODS: A systematic search was performed by retrieving on English databases (PubMed, Embase, Web of Science, the Cochrane Library) and Chinese databases (CNKI, Wanfang, Weipu [VIP], CBM). Besides, manually search for Google and Baidu academic of diagnostic experimental study of ultrasound and spiral CT in the diagnosis of Colon Cancer. The retrieval time limit was from the establishment of the database to October 2020. Two researchers independently extracted and evaluated the quality of the data in the included study. A meta-analysis was performed using Meta Disc1.4 and RevMan5.3 software. RESULTS: Sensitivity, specificity, positive Likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were used to determine the diagnostic efficacy of ultrasonography and helical CT in colorectal cancer. CONCLUSIONS: This study will compare the practicability of CT and ultrasound in the diagnosis of colon cancer and provide reliable evidence-based basis for clinicians to choose the appropriate or best evidence-based basis. ETHICS AND DISSEMINATION: The private information from individuals will not be published. This systematic review also will not involve endangering participant rights. Ethical approval is not required. The results may be published in a peer-reviewed journal or disseminated in relevant conferences. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/WAJHQ.


Assuntos
Neoplasias do Colo/diagnóstico por imagem , Tomografia Computadorizada Espiral/estatística & dados numéricos , Ultrassonografia/estatística & dados numéricos , Humanos , Funções Verossimilhança , Metanálise como Assunto , Razão de Chances , Projetos de Pesquisa , Sensibilidade e Especificidade , Revisões Sistemáticas como Assunto , Tomografia Computadorizada Espiral/métodos , Ultrassonografia/métodos
8.
Cochrane Database Syst Rev ; 9: CD013639, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-32997361

RESUMO

BACKGROUND: The diagnosis of infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presents major challenges. Reverse transcriptase polymerase chain reaction (RT-PCR) testing is used to diagnose a current infection, but its utility as a reference standard is constrained by sampling errors, limited sensitivity (71% to 98%), and dependence on the timing of specimen collection. Chest imaging tests are being used in the diagnosis of COVID-19 disease, or when RT-PCR testing is unavailable. OBJECTIVES: To determine the diagnostic accuracy of chest imaging (computed tomography (CT), X-ray and ultrasound) in people with suspected or confirmed COVID-19. SEARCH METHODS: We searched the COVID-19 Living Evidence Database from the University of Bern, the Cochrane COVID-19 Study Register, and The Stephen B. Thacker CDC Library. In addition, we checked repositories of COVID-19 publications. We did not apply any language restrictions. We conducted searches for this review iteration up to 5 May 2020. SELECTION CRITERIA: We included studies of all designs that produce estimates of test accuracy or provide data from which estimates can be computed. We included two types of cross-sectional designs: a) where all patients suspected of the target condition enter the study through the same route and b) where it is not clear up front who has and who does not have the target condition, or where the patients with the target condition are recruited in a different way or from a different population from the patients without the target condition. When studies used a variety of reference standards, we included all of them. DATA COLLECTION AND ANALYSIS: We screened studies and extracted data independently, in duplicate. We also assessed the risk of bias and applicability concerns independently, in duplicate, using the QUADAS-2 checklist and presented the results of estimated sensitivity and specificity, using paired forest plots, and summarised in tables. We used a hierarchical meta-analysis model where appropriate. We presented uncertainty of the accuracy estimates using 95% confidence intervals (CIs). MAIN RESULTS: We included 84 studies, falling into two categories: studies with participants with confirmed diagnoses of COVID-19 at the time of recruitment (71 studies with 6331 participants) and studies with participants suspected of COVID-19 (13 studies with 1948 participants, including three case-control studies with 549 cases and controls). Chest CT was evaluated in 78 studies (8105 participants), chest X-ray in nine studies (682 COVID-19 cases), and chest ultrasound in two studies (32 COVID-19 cases). All evaluations of chest X-ray and ultrasound were conducted in studies with confirmed diagnoses only. Twenty-five per cent (21/84) of all studies were available only as preprints, 15/71 studies in the confirmed cases group and 6/13 of the studies in the suspected group. Among 71 studies that included confirmed cases, 41 studies had included symptomatic cases only, 25 studies had included cases regardless of their symptoms, five studies had included asymptomatic cases only, three of which included a combination of confirmed and suspected cases. Seventy studies were conducted in Asia, 2 in Europe, 2 in North America and one in South America. Fifty-one studies included inpatients while the remaining 24 studies were conducted in mixed or unclear settings. Risk of bias was high in most studies, mainly due to concerns about selection of participants and applicability. Among the 13 studies that included suspected cases, nine studies were conducted in Asia, and one in Europe. Seven studies included inpatients while the remaining three studies were conducted in mixed or unclear settings. In studies that included confirmed cases the pooled sensitivity of chest CT was 93.1% (95%CI: 90.2 - 95.0 (65 studies, 5759 cases); and for X-ray 82.1% (95%CI: 62.5 to 92.7 (9 studies, 682 cases). Heterogeneity judged by visual assessment of the ROC plots was considerable. Two studies evaluated the diagnostic accuracy of point-of-care ultrasound and both reported zero false negatives (with 10 and 22 participants having undergone ultrasound, respectively). These studies only reported True Positive and False Negative data, therefore it was not possible to pool and derive estimates of specificity. In studies that included suspected cases, the pooled sensitivity of CT was 86.2% (95%CI: 71.9 to 93.8 (13 studies, 2346 participants) and specificity was 18.1% (95%CI: 3.71 to 55.8). Heterogeneity judged by visual assessment of the forest plots was high. Chest CT may give approximately the same proportion of positive results for patients with and without a SARS-CoV-2 infection: the chances of getting a positive CT result are 86% (95% CI: 72 to 94) in patient with a SARS-CoV-2 infection and 82% (95% CI: 44 to 96) in patients without. AUTHORS' CONCLUSIONS: The uncertainty resulting from the poor study quality and the heterogeneity of included studies limit our ability to confidently draw conclusions based on our results. Our findings indicate that chest CT is sensitive but not specific for the diagnosis of COVID-19 in suspected patients, meaning that CT may not be capable of differentiating SARS-CoV-2 infection from other causes of respiratory illness. This low specificity could also be the result of the poor sensitivity of the reference standard (RT-PCR), as CT could potentially be more sensitive than RT-PCR in some cases. Because of limited data, accuracy estimates of chest X-ray and ultrasound of the lungs for the diagnosis of COVID-19 should be carefully interpreted. Future diagnostic accuracy studies should avoid cases-only studies and pre-define positive imaging findings. Planned updates of this review will aim to: increase precision around the accuracy estimates for CT (ideally with low risk of bias studies); obtain further data to inform accuracy of chest X rays and ultrasound; and continue to search for studies that fulfil secondary objectives to inform the utility of imaging along different diagnostic pathways.


Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Adulto , Criança , Infecções por Coronavirus/diagnóstico , Humanos , Pulmão/diagnóstico por imagem , Pandemias , Radiografia Torácica/estatística & dados numéricos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Ultrassonografia/estatística & dados numéricos
9.
Ann Rheum Dis ; 79(9): 1189-1193, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32503859

RESUMO

OBJECTIVES: We have previously shown that neural network technology can be used for scoring arthritis disease activity in ultrasound images from rheumatoid arthritis (RA) patients, giving scores according to the EULAR-OMERACT grading system. We have now further developed the architecture of this neural network and can here present a new idea applying cascaded convolutional neural network (CNN) design with even better results. We evaluate the generalisability of this method on unseen data, comparing the CNN with an expert rheumatologist. METHODS: The images were graded by an expert rheumatologist according to the EULAR-OMERACT synovitis scoring system. CNNs were systematically trained to find the best configuration. The algorithms were evaluated on a separate test data set and compared with the gradings of an expert rheumatologist on a per-joint basis using a Kappa statistic, and on a per-patient basis using a Wilcoxon signed-rank test. RESULTS: With 1678 images available for training and 322 images for testing the model, it achieved an overall four-class accuracy of 83.9%. On a per-patient level, there was no significant difference between the classifications of the model and of a human expert (p=0.85). Our original CNN had a four-class accuracy of 75.0%. CONCLUSIONS: Using a new network architecture we have further enhanced the algorithm and have shown strong agreement with an expert rheumatologist on a per-joint basis and on a per-patient basis. This emphasises the potential of using CNNs with this architecture as a strong assistive tool for the objective assessment of disease activity of RA patients.


Assuntos
Artrite Reumatoide/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador/métodos , Redes Neurais de Computação , Reumatologia/métodos , Índice de Gravidade de Doença , Ultrassonografia/estatística & dados numéricos , Adulto , Ensaios Clínicos como Assunto , Feminino , Humanos , Articulações/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sinovite/diagnóstico por imagem , Ultrassonografia/métodos
10.
Avian Dis ; 64(2): 149-156, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32550615

RESUMO

Infection of the oviduct by an infectious bronchitis virus (IBV) in laying hens has been associated with the false layer syndrome. Because the diagnostic procedure for the detection of cystic oviducts by postmortem examinations in IBV-positive replacement pullet flocks could involve the unnecessary sacrifice of numerous healthy pullets without reproductive tract anomalies, the development of a noninvasive and nonlethal diagnostic procedure would be desirable. The first objective of the study was to evaluate the diagnostic accuracy of a transcutaneous ultrasonography method to predict the presence of cystic oviducts compared to postmortem examinations in a commercial pullet flock positive for an IBV genotype Delmarva (DMV) variant. The second objective was to evaluate the performance of the same ultrasonography method to later detect false layers in the same flock in sexually mature hens by identifying the presence of an egg in the oviduct due to the presence of atretic oviducts undetectable by ultrasonography and the absence of cystic oviducts at that age. In replacement pullets, the sensitivity (Se) and specificity (Sp) of the ultrasonography (index test) compared to the postmortem examination (reference standard test) were 73% and 91%, respectively. The positive predictive value (PPV) and negative predictive value (NPV) were 67% and 93%. The ultrasonography technique showed a positive likelihood ratio (LR+) of 7.82 and a negative likelihood ratio (LR-) of 0.30. In sexually mature hens, the Se, Sp, PPV, and NPV of the ultrasonography compared to the laying status were 98%. The LR+ was 49.00 and the LR- was 0.02 when compared to the laying status. In conclusion, the ultrasonography could replace postmortem examinations to detect cystic oviducts in commercial flocks of replacement pullets previously infected with an IBV-DMV 1639 variant. Although the test accuracy of ultrasonography was excellent for the hens at production peak to identify laying and nonlaying hens based on the presence of an egg in the reproductive tract, its practicality was limited due to atretic oviducts being not detectable.


Assuntos
Galinhas , Infecções por Coronavirus/veterinária , Cistos/veterinária , Vírus da Bronquite Infecciosa/isolamento & purificação , Doenças das Aves Domésticas/diagnóstico , Ultrassonografia/veterinária , Animais , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Cistos/virologia , Feminino , Oviductos/virologia , Doenças das Aves Domésticas/virologia , Ultrassonografia/estatística & dados numéricos
11.
Medicine (Baltimore) ; 99(19): e19946, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384441

RESUMO

To conduct a STARD-compliant validity that the contrast-enhanced ultrasound (CEUS) evaluation of prostate for the improvement of positive rate of biopsy and diagnostic efficiency of prostate carcinoma (PCa).Data of 137 patients with suspected PCa who underwent relevant examinations and treatment were reviewed, and 82 of 137 patients were finally included. The patients consisted of Group 1 (26 patients) and Group 2 (42 patients) according to which they underwent transrectal ultrasound (TRUS) biopsy selected from CEUS evaluation of the prostate and who underwent TRUS-guided biopsy directly. A systematic 12-core biopsy was performed at first, and additional 1 to 2 cores biopsy was made in the suspected target area where CEUS had showed abnormal enhancement. The assumed diagnoses were compared with pathological findings.There were 37 patients with PCa and 31 patients with benign lesions; and 14 patients without biopsy after CEUS did not find PCa emerging in follow-up (18-47 months). The positive rates of biopsy-malignant lesions were 73.1% and 42.8% in Group 1 and Group 2, respectively. The positive rate of biopsy in Group 1 was significantly higher than that in Group 2 (P = .024). The sensitivity and accuracy of TRUS biopsy and a combination of TRUS biopsy after transrectal CEUS for the evaluation of prostate benign and malignant lesion were 60% and 66.7% (P=0.0139), and 94.4% and 88.5% (P=0.0453), respectively.CEUS evaluation of the prostate of PSA-elevated patient before biopsy can help select target patient with high risk of PCa, reduce unnecessary biopsy, increase detection rate of PCa, and improve diagnostic sensitivity and accuracy.


Assuntos
Carcinoma/diagnóstico por imagem , Meios de Contraste , Próstata/diagnóstico por imagem , Neoplasias da Próstata/diagnóstico por imagem , Ultrassonografia/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Humanos , Biópsia Guiada por Imagem/métodos , Masculino , Pessoa de Meia-Idade , Próstata/patologia , Reto/cirurgia , Sensibilidade e Especificidade , Ultrassonografia/métodos , Ultrassonografia de Intervenção
12.
Medicine (Baltimore) ; 99(17): e19896, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332664

RESUMO

BACKGROUND: Delirium is a common postoperative complication in older patients undergoing thoracic surgery and presages poor outcomes. Postoperative pain is an important factor in the progression of delirium. The purpose of this study was to test whether continuous thoracic paravertebral block (PVB), a more effective approach for analgesia, could decrease the incidence of delirium in elderly patients undergoing esophagectomy. METHODS: A total of 180 geriatric patients undergoing esophagectomy were randomly divided into 2 groups and treated with PVB or patient-controlled analgesia (PCA). Perioperative plasma CRP, IL-1ß, IL-6, and TNF-α levels were detected in all patients. Pain intensity was measured by a numerical rating scale. Delirium was assessed using the confusion assessment method. RESULTS: The incidence of postoperative delirium was significantly lower in the PVB group than in the PCA group. Patients in the PVB group had lower plasma CRP, IL-1ß, IL-6, and TNF-α levels and less pain when coughing after surgery. CONCLUSIONS: Ultrasound-guided continuous thoracic paravertebral block improved analgesia, reduced the inflammatory reaction and decreased the occurrence of delirium after surgery.


Assuntos
Delírio/prevenção & controle , Esofagectomia/normas , Bloqueio Nervoso/métodos , Ultrassonografia/normas , Idoso , Idoso de 80 Anos ou mais , Analgesia Controlada pelo Paciente/métodos , Analgesia Controlada pelo Paciente/normas , Delírio/tratamento farmacológico , Esofagectomia/métodos , Feminino , Geriatria/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/normas , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Ultrassonografia/métodos , Ultrassonografia/estatística & dados numéricos
13.
Arch Osteoporos ; 15(1): 56, 2020 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-32291527

RESUMO

A pilot study on the use of P-EU to identify patients without osteoporosis and/or a subclinical vertebral fracture after a recently sustained non-vertebral fracture (NVF). INTRODUCTION: Screening with portable devices at emergency departments or plaster rooms could be of interest to limit referrals for dual X-ray absorptiometry (DXA) and vertebral fracture assessment (VFA). We calculated the number of negative tests for osteoporosis and/or subclinical vertebral fractures (VFs) using pulse-echo ultrasonometry (P-UE) at different thresholds. PATIENTS AND METHODS: In this cross-sectional study, 209 consecutive women of 50-70 years with a recent non-vertebral fracture (NVF) were studied at the Fracture Liaison Service (FLS) of one hospital. All women received DXA/VFA and P-EU (Bindex®) assessments. Various P-EU thresholds (based on the density index (DI, g/cm2)) were analyzed to calculate the best balance between true negative (indeed no osteoporosis and/or subclinical VF) and false negative tests (osteoporosis and/or subclinical VF according to DXA/VFA). RESULTS: Eighty-three women had osteoporosis (40%) and 17 women at least one VF (8%). Applying the manufacturer's recommended P-EU threshold (DI 0.844 g/cm2) being their proposed cut-off for not having hip osteoporosis resulted in 77 negative tests (37%, 31% true negative and 6% false negative tests). A DI of 0.896 g/cm2 resulted in 40 negative tests (19.3%) (38 true negative (18.3%) and 2 false negative tests (1.0%)). CONCLUSION: The application of P-EU enables the identification of a substantial proportion of women with recent non-vertebral fractures at the FLS who would not need a DXA/VFA referral because they had no osteoporosis and/or subclinical vertebral fractures. The most conservative P-EU threshold resulted in 18.3% true negative tests verified by DXA/VFA against 1% false negative test results.


Assuntos
Programas de Rastreamento/métodos , Osteoporose/diagnóstico por imagem , Encaminhamento e Consulta/estatística & dados numéricos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Ultrassonografia/estatística & dados numéricos , Idoso , Densidade Óssea , Estudos Transversais , Diagnóstico Diferencial , Reações Falso-Negativas , Feminino , Fraturas Ósseas/complicações , Humanos , Pessoa de Meia-Idade , Osteoporose/complicações , Projetos Piloto , Testes Imediatos , Valores de Referência , Fraturas da Coluna Vertebral/etiologia , Ultrassonografia/métodos
14.
Medicine (Baltimore) ; 99(14): e19677, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32243403

RESUMO

In the Graf method of hip ultrasonography, the diagnosis of the infantile hip with developmental dysplasia of the hip (DDH) is strictly dependent on the bony roof (alpha angle) and the cartilage roof (beta angle) measurements. In this study, we investigated whether the infant hip could be diagnosed with DDH solely by evaluating ultrasound images obtained in the standard plane, without bony roof and cartilage roof measurements, in respect to different professional experience levels.Two hundred ten hip ultrasounds were randomly selected from patients who presented to our hospital for DDH screening. A total of 6 ultrasound images were obtained for each hip. The hip morphology evaluations were made without the bony roof and the cartilage roof measurements by 2 orthopedic surgery residents; 2 orthopedic surgery specialists, trained in the diagnosis and the treatment of the DDH; and 2 pediatric orthopedic surgery professors, highly experienced in the diagnosis and treatment of DDH. After hip morphology evaluations, the bony roof and the cartilage roof measurements were obtained and hip type evaluations were made by the same raters, according to the Graf method of hip ultrasonography.The highest intraobserver agreements between the hip maturity evaluation before and the hip type evaluation after measurements were .676 (P < .001) and .577 (P < .001) in professors 2 and 1, respectively, and the lowest agreements were .185 (P < .01) and .289 (P < .001) in specialist 1 and resident 2, respectively.The diagnosis of the infant hip as DDH could not be made solely by evaluation of the ultrasound images obtained in the standard plane without the bony roof and the cartilage roof measurements. The bony roof and the cartilage roof measurements were obligatory for the diagnosis of the infant hip as DDH, even in the very experienced pediatric orthopedic surgeons.Level of evidence: 2.


Assuntos
Competência Clínica/estatística & dados numéricos , Luxação Congênita de Quadril/diagnóstico por imagem , Cirurgiões Ortopédicos/estatística & dados numéricos , Ultrassonografia/estatística & dados numéricos , Adulto , Cartilagem/diagnóstico por imagem , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Ossos Pélvicos/diagnóstico por imagem , Reprodutibilidade dos Testes , Ultrassonografia/métodos
15.
Bone Joint J ; 102-B(4): 495-500, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32228072

RESUMO

AIMS: To monitor the performance of services for developmental dysplasia of the hip (DDH) in Northern Ireland and identify potential improvements to enhance quality of service and plan for the future. METHODS: This was a prospective observational study, involving all infants treated for DDH between 2011 and 2017. Children underwent clinical assessment and radiological investigation as per the regional surveillance policy. The regional radiology data was interrogated to quantify the use of ultrasound and ionizing radiation for this population. RESULTS: Evidence-based changes were made to the Northern Ireland screening programme, including an increase in ultrasound scanning capacity and expansion of nurse-led screening clinics. The number of infant hip ultrasound scans increased from 4,788 in 2011, to approximately 7,000 in 2013 and subsequent years. The number of hip radiographs on infants of less than one year of age fell from 7,381 to 2,208 per year. There was a modest increase in the treatment rate from 10.9 to 14.3 per 1,000 live births but there was a significant reduction in the number of closed hip reductions. The incidence of infants diagnosed with DDH after one year of age was 0.30 per 1,000 live births over the entire period. CONCLUSION: Improving compliance with the regional infant hip screening protocols led to reduction in operative procedures and reduced the number of pelvic radiographs of infants. We conclude that performance monitoring of screening programmes for DDH is essential to provide a quality service. Cite this article: Bone Joint J 2020;102-B(4):495-500.


Assuntos
Luxação Congênita de Quadril/diagnóstico por imagem , Articulação do Quadril/diagnóstico por imagem , Fatores Etários , Medicina Baseada em Evidências/métodos , Feminino , Luxação Congênita de Quadril/epidemiologia , Luxação Congênita de Quadril/cirurgia , Humanos , Lactente , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Irlanda do Norte/epidemiologia , Vigilância da População , Estudos Prospectivos , Melhoria de Qualidade , Radiografia/estatística & dados numéricos , Ultrassonografia/estatística & dados numéricos
16.
Ethiop J Health Sci ; 30(1): 23-30, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32116429

RESUMO

Background: Incidentally discovered thyroid lesions have become highly common in the development and more frequent utilization of highly sensitive imaging modalities, like ultrasound. However, little is known about its prevalence and associated factors in Ethiopia. The aim of this study was to determine the prevalence of thyroid incidentalomas and associated factors through ultrasound (US) among adults attending Gondar University Hospital. Methods: A hospital-based cross-sectional study was carried out on 290 adults aged 15 years and above. Out of the adults who visited the hospital during the study, those who neither had history of thyroid disease, thyroid surgery, nor clinically palpable thyroid nodules were involved in the investigation. The participants were examined using a high frequency linear-array transducer (7 MHz). For comparing men and women, the unpaired t-test was used. Binary logistic analysis was used to identify the associated factors, and a P-value < 0.05 was considered statistically significant. Result: The frequency of thyroid incidentaloma was found to be 33.4% (95% CI: 27.9, 38.9). Thyroid incidentaloma was detected in 42.4% of the females and 22.7% of the males (P<0.001). About 63% had single and 37% multiple thyroid nodules. About 25.8% had thyroid nodules greater than 1cm. In the multivariable logistic regression analysis, increasing age (AOR=5.96; 2.34, 15.15) and female sex (AOR=3.01; 1.73, 5.26) were significantly associated with thyroid incidentalomas. Conclusion: The frequency of thyroid incidentaloma (TI) was found to be high in this study and much higher among older women. Solitary and small sized thyroid nodules were commonly seen in the study.


Assuntos
Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/epidemiologia , Ultrassonografia/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Etiópia/epidemiologia , Feminino , Hospitais Universitários , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Prevalência , Glândula Tireoide/diagnóstico por imagem , Adulto Jovem
17.
BMJ Open Qual ; 9(1)2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32213549

RESUMO

A point-of-care ultrasound scan (POCUS) is a core element of the Royal College of Emergency Medicine (RCEM) specialty training curriculum. However, POCUS documentation quality can be poor, especially in the time-pressured environment of the emergency department (ED). A survey of 10 junior ED clinicians at the Princess Royal University Hospital (PRUH) found that total POCUS documentation was as low as 38% in some examinations.This quality improvement project aimed to increase the coverage and quality of POCUS documentation in the ED. This was done by using a plan-do-study-act (PDSA) regime to improve the quality of POCUS documentation from the original baseline to 80%. There were three discreet PDSA cycles and the interventions included improving education and training about POCUS documentation and the introduction of an original proforma, which incorporated six minimum requirements for POCUS documentation as per the joint RCEM and Royal College of Radiologists (RCR) guidelines for POCUS documentation (patient details, indications, findings, conclusions, signature and date).The project team audited the quality of all documented scans in the resuscitation department of the PRUH against the RCEM/RCR guidelines at baseline and following three discrete PDSA cycles. This was done over an 8-week period, spanning 696 attendances to the resuscitation area of the ED and 42 documented POCUS examinations.Quality recording of the six RCEM/RCR elements of POCUS documentation was poor at baseline but improved following three successful PDSA cycles. There was a demonstrated improvement in five of six documentation elements: patient details on POCUS documentation increased from 53.3% to the 66.7%, indication from 60.0% to 66.7%, conclusion from 13.0% to 83.0%, signature from 86.7% to 100.0% and date from 46.7% to 66.7%.These results suggest that the introduction of a proforma and a vigorous education strategy are effective ways to improve the quality of documentation of ED POCUS.


Assuntos
Documentação/normas , Ultrassonografia/tendências , Documentação/estatística & dados numéricos , Serviço Hospitalar de Emergência/organização & administração , Humanos , Sistemas Automatizados de Assistência Junto ao Leito/estatística & dados numéricos , Sistemas Automatizados de Assistência Junto ao Leito/tendências , Melhoria de Qualidade , Inquéritos e Questionários , Ultrassonografia/métodos , Ultrassonografia/estatística & dados numéricos
18.
Ulus Travma Acil Cerrahi Derg ; 26(2): 306-313, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32185777

RESUMO

BACKGROUND: Despite the development of clinical, laboratory, and imaging methods, the diagnosis of acute appendicitis is not always easy, and negative appendectomy rates are still high. This study aims to reveal the effects of different scoring systems on the diagnostic accuracy of acute appendicitis and negative appendectomy rates, alone or when evaluated together with ultrasonography. METHODS: In this study, 202 consecutive patients who underwent emergency appendectomy for acute appendicitis were included. Clinical scores of all patients were preoperatively calculated using Ohmann, Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA), Lintula, Eskelinen, and Alvarado scoring systems. Abdominal ultrasonography (USG) was performed randomly in all cases. The sensitivity and specificity of scoring systems were calculated according to the threshold values. The area under the curve (AUC) was calculated using ROC analysis. In the regression model, histological diagnosis of appendicitis was used as the dependent variable, while scoring systems and USG were preferred as independent variables. RESULTS: The negative appendectomy rate was 15.8%. In the diagnosis of acute appendicitis, Ohmann was the most predictive for both genders (DOR=24.2, 95% CI 6.98-84.44). Similarly, the lowest negative appendectomy rates were obtained with the Ohmann score as 6.9% in females and 3.4% in males. When the scores were combined with USG, the rate of diagnostic accuracy for acute appendicitis was not increased. However, when Ohmann and USG were combined, negative appendectomy rates were further reduced for women from 6.9% to 4%. CONCLUSION: In addition to being a good diagnostic predictor of acute appendicitis in male and female patients, Ohmann score provides the best negative appendectomy rates. The combination of USG and scoring systems does not increase the diagnostic accuracy of acute appendicitis. However, negative appendectomy rates are significantly reduced when the USG and Ohmann scale are used together in females, while this reduction is minimal in men.


Assuntos
Apendicectomia , Apendicite , Ultrassonografia/estatística & dados numéricos , Apendicectomia/efeitos adversos , Apendicectomia/estatística & dados numéricos , Apendicite/diagnóstico por imagem , Apendicite/cirurgia , Humanos , Sensibilidade e Especificidade , Procedimentos Desnecessários
19.
Medicina (Kaunas) ; 56(3)2020 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-32183080

RESUMO

Background and objectives: With improved diagnostic means of early breast cancer, the percentage of cases with metastasis in axillary lymph nodes has decreased from 50%-75% to 15%-30%. Lymphadenectomy and sentinel lymph node biopsy are not treatment procedures, as they aim at axillary nodal staging in breast cancer. Being surgical interventions, they can lead to various complications. Therefore, recently much attention has been paid to the identification of non-invasive methods for axillary nodal staging. In many countries, ultrasound is a first-line method to evaluate axillary lymph node status. The aim of this study was to evaluate the prognostic value of ultrasound in detecting intact axillary lymph nodes and to assess the accuracy of ultrasound in detecting a heavy nodal disease burden. The additional objective was to evaluate patients' and tumor characteristics leading to false-negative results. Materials and Methods: A total of 227 women with newly diagnosed pT1 breast cancer were included to this prospective study conducted at the Breast Surgery Unit, Clinic of Surgery, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, between May 1, 2016, and May 31, 2018. All patients underwent preoperative axillary ultrasound examination. Ultrasound data were compared with the results of histological examination. The accuracy and true-negative rate of ultrasound were calculated. The reasons of false-negative results were analyzed. Results: Of the 189 patients who had normally appearing axillary lymph nodes on preoperative ultrasound (PAUS-negative), 173 (91.5%) patients were also confirmed to have intact axillary lymph nodes (node-negative) by histological examination after surgery. The accuracy and the negative predictive value of ultrasound examination were 84.1% and 91.5%, respectively. In ≥3 node-positive cases, the accuracy and the negative predictive value increased to 88.7% and 98.3%, respectively. In total, false-negative results were found in 8.5% of the cases (n = 16); in the PAUS-negative group, false-negative results were recorded only in 1.6% of the cases (n = 3). The results of PAUS and pathological examination differed significantly between patients without and with lymphovascular invasion (LV0 vs. LV1, p < 0.001) as well as those showing no human epidermal growth factor receptor 2 (HER2) expression and patients with weakly or strongly expressed HER2 (HER2(0) vs. HER2(1), p = 0.024). Paired comparisons revealed that the true-negative rate was significantly different between the LV0 and LV1 groups (91% vs. 66.7%, p < 0.05), and the false-negative rate was statistically significant different between the HER2(0) and HER2(1) groups (10.5% vs. 1.2%, p < 0.05). Evaluation of other characteristics showed both the groups to be homogenous. Conclusions: Negative axillary ultrasound excluded axillary metastatic disease in 91.5% of the patients. PAUS had an accuracy of 88.7% in detecting a heavy nodal disease burden. With the absence of lymphovascular invasion (LV0), we can rely on PAUS examination that axillary lymph nodes are intact (PAUS-negative), and this patients' group could avoid sentinel lymph node biopsy. Patients without HER2 expression are at a greater likelihood of false-negative results; therefore, the findings of ultrasound that axillary lymph nodes are intact (PAUS-negative results) should be interpreted with caution.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Biópsia de Linfonodo Sentinela/métodos , Fatores de Tempo , Ultrassonografia/métodos , Adulto , Idoso , Axila/diagnóstico por imagem , Axila/fisiopatologia , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Feminino , Humanos , Lituânia , Pessoa de Meia-Idade , Estadiamento de Neoplasias/métodos , Estadiamento de Neoplasias/normas , Estadiamento de Neoplasias/estatística & dados numéricos , Período Pré-Operatório , Biópsia de Linfonodo Sentinela/normas , Biópsia de Linfonodo Sentinela/estatística & dados numéricos , Ultrassonografia/normas , Ultrassonografia/estatística & dados numéricos
20.
Medicine (Baltimore) ; 99(10): e19402, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150087

RESUMO

In recent years, deep venous thrombosis (DVT) after spine surgery has received extensive attention, but perioperative prevalence of DVT in patients undergoing percutaneous kyphoplasty (PKP) is lacking.To assess the perioperative prevalence of deep vein thrombosis (DVT) in patients undergoing PKP with routinely applied ultrasonography.We reviewed 1113 consecutive patients undergoing PKP from January 2014 to August 2017. The surgical procedure was bilateral PKP. All patients were routinely examined with ultrasonography when admitted to the hospital and on the first post-operative day. Clinical signs of DVT were checked and recorded before examination.Forty (3.6%) out of 1113 patients were diagnosed with DVT by ultrasonography. Of the 40 detected cases of DVT, only six (0.54%) patients presented with clinical signs of DVT, demonstrating that there were 34 (3.05%) asymptomatic cases. No patient presenting with clinically suspected pulmonary embolism (PE) was observed. Gender, body mass index (BMI), operative time, hypertension, diabetes, heart disease, and lower limb fracture were not significant risk factors for DVT (P > .05). In contrast, patient age, oncologic conditions, DVT history, and paraplegia appeared to be significant risk factors for DVT (P < .01). There was no significant difference in the incidence of DVT found between the three PKP surgical levels (P > .05).The total incidence of perioperative DVT diagnosed with ultrasonography in patients undergoing PKP was 3.6%, of which only 0.54% was symptomatic cases. It is necessary to assess DVT using ultrasonography during the perioperative procedure of PKP, especially for high-risk patients.Level of evidence: Level IV.


Assuntos
Cifoplastia/efeitos adversos , Período Perioperatório , Trombose Venosa/etiologia , Adulto , Idoso , China , Feminino , Humanos , Cifoplastia/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Ultrassonografia/estatística & dados numéricos , Trombose Venosa/epidemiologia , Trombose Venosa/fisiopatologia
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