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The objective was to assess the long-term effect of biological treatment on transmural lesions of Crohn's disease evaluated with ultrasound, including contrast-enhanced ultrasound.MethodsFifty-one patients with active Crohn's disease were included in a prospective multicenter longitudinal study. All patients underwent a clinical assessment and sonographic examination at baseline, 12 weeks after treatment initiation, and after 1-year of treatment. Patients were clinically followed at least 2 years from inclusion until the end of the study. Ultrasonographic evaluation included bowel wall thickness, color Doppler grade, parietal enhancement, and presence of transmural complications or stenosis. Sonographic changes after treatment were classified as normalization, improvement, or lack of response.ResultsImprovement at 52 weeks was more frequent in patients with improvement at final of induction (12 weeks) compared with patients who did not improve (85% versus 28%; P < 0.0001). One-year sonographic evolution correlated with clinical response; 28 of the 29 (96.5%) patients with sonographic improvement at 52 weeks showed clinical remission or response. Patients without sonographic improvement at 52 weeks of treatment were more likely to have a change or intensification in medication or surgery (13/20, 65%) during the next year of follow-up than patients with improvement on the sonography (3/28, 11%). Stricturing behavior was the only sonographic feature associated to a negative predictive value of response (P = 0.0001).ConclusionsSonographic response after 12 weeks of therapy is more pronounced and predicts 1-year sonographic response. Sonographic response at 1-year examination correlates with 1-year clinical response and is a predictor of further treatment's efficacy, 1-year or longer period of follow-up.

Background This study explores the efficacy of integrating mixed reality (MR) technology with artificial algorithms for locating vessels during anterolateral thigh perforator flap surgeries, comparing it with color Doppler ultrasonography (CDU) to provide clinical insights. Methods Eighty patients were randomly assigned to the MR group or the CDU group, with 40 patients in each. In the MR group, a localization device was attached to the lower limb, and CT angiography (CTA) data were converted into a 3D model. An artificial algorithm matched the device with the 3D model to overlay perforating vessels. The CDU group used traditional preoperative localization. Primary outcomes included the number of identified perforators and the distance between marked and actual vessel exit points. Secondary outcomes were flap harvest time and flap survival. Results Recognition rates were 94.3% in the MR group and 82.0% in the CDU group ( P  = 0.008). The average distance between marked and actual exit points was 1.5 mm vs. 2.7 mm ( P  < 0.0001). Flap harvest times averaged 52 and 68 min, respectively ( P  < 0.0001). In the MR group, one flap developed an infection and another necrosis, while in the CDU group, one flap had a crisis, and two experienced necrosis. Conclusions Mixed reality combined with artificial algorithms offers superior vessel localization compared to ultrasound and holds promise for multidisciplinary perforator flap surgeries. Trial registration This study was approved by the Ethics Committee of Chongqing University Cancer Hospital (Ethical Approval Number: CZLS2021177-A) and retrospectively registered at the Chinese Clinical Trial Register (registration number: CHiCTR2400087615, date of registration: 2024–07-31).

Objectives To evaluate the feasibility of T1w-3D black-blood turbo spin echo (TSE) sequence with variable flip angles for the diagnosis of thoracic large vessel vasculitis (LVV). Methods Thirty-five patients with LVV, diagnosed according to the current standard of reference, and 35 controls were imaged at 3.0T using 1.2 × 1.3 × 2.0 mm 3 fat-suppressed, T1w-3D, modified Volumetric Isotropic TSE Acquisition (mVISTA) pre- and post-contrast. Applying a navigator and peripheral pulse unit triggering (PPU), the total scan time was 10–12 min. Thoracic aorta and subclavian and pulmonary arteries were evaluated for image quality (IQ), flow artefact intensity, diagnostic confidence, concentric wall thickening and contrast enhancement (CWT, CCE) using a 4-point scale. Results IQ was good in all examinations (3.25 ± 0.72) and good to excellent in 342 of 408 evaluated segments (83.8 %), while 84.1 % showed no or minor flow artefacts. The interobserver reproducibility for the identification of CCE and CWT was 0.969 and 0.971 (p < 0.001) with an average diagnostic confidence of 3.47 ± 0.64. CCE and CWT were strongly correlated (Cohen’s k = 0.87; P < 0.001) and significantly more frequent in the LVV-group (52.8 % vs. 1.0 %; 59.8 % vs. 2.4 %; P < 0.001). Conclusions Navigated fat-suppressed T1w-3D black-blood MRI with PPU-triggering allows diagnosis of thoracic LVV. Key Points • Cross-sectional imaging is frequently applied in the diagnosis of LVV. • Navigated, PPU-triggered, T1w-3D mVISTA pre- and post contrast takes 10–12 min. • In this prospective, single-centre study, T1w-3D mVISTA accurately depicted large thoracic vessels. • T1w-3D mVISTA visualized CWT/CCW as correlates of mural inflammation in LVV. • T1w-3D mVISTA might be an alternative diagnostic tool without ionizing radiation.

Intubation is a frequently performed procedure in emergency medicine that is associated with significant morbidity and mortality when unrecognized esophageal intubation occurs. However, it may be difficult to visualize the endotracheal tube (ETT) in some patients. This study assessed whether the addition of color Doppler was able to improve the ability to visualize the ETT location. This study was performed in a cadaver lab using three different cadavers chosen to represent varying neck circumference. Cadavers were randomized to tracheal or esophageal intubation. Blinded sonographers then assessed the location of the ETT using either grayscale or color Doppler imaging. Accuracy of sonographer identification of ETT location, time to identification, and operator confidence were assessed. One hundred and fifty intubations were performed and each was assessed by both standard and color Doppler techniques. There were 78 tracheal intubations and 72 esophageal intubations. The standard technique was 99.3% (95% CI 96.3 to 99.9%) accurate. The color flow technique was also 99.3% (95% CI 96.3 to 99.9%) accurate. The mean operator time to identification was 3.24s (95% CI 2.97 to 3.51s) in the standard approach and 5.75s (95% CI 5.16 to 6.33s) in the color flow technique. The mean operator confidence was 4.99/5.00 (95% CI 4.98 to 5.00) in the standard approach and 4.94/5.00 (95% CI 4.90 to 4.98) in the color flow technique. When added to standard ultrasound imaging, color flow did not improve accuracy or operator confidence for identifying ETT location and resulted in a longer examination time.

We investigated whether DNA fragmentation in two cytometric sperm populations （PIddimmer and PIbriehter） with different biological characteristics and clinical relevance is related to clinical and color-Doppler ultrasound （CDUS） parameters of the male genital tract. One hundred and sixty males of infertile couples without genetic abnormalities were evaluated for clinical, scrotal, and transrectal CDUS characteristics, presence of prostatitis-like symptoms （with the National Institutes of Health-Chronic Prostatitis Symptom Index） and sperm DNA fragmentation （sDF） in PIdimmer and PIbrighter populations （using TUNEIJPI method coupled with flow cytometry）. Data were adjusted for age （Model 1） along with waistline, testosterone levels, smoking habit, and sexual abstinence （Model 2）. According to the statistical Model 2, PIdi sDF was associated with testicular abnormalities, including lower clinical and ultrasound volume （r = -0.21 and r = -0.20, respectively; P 〈 0.05）, higher FSH levels （r = 0.34, P 〈 0.0001） and occurrence of testicular inhomogeneity （P 〈 0.05） and hypoechogenicity （P 〈 0.05）. PIbrighter sDF was associated with prostate-related symptoms and abnormal signs, including higher NIH-CPSI total and subdomain scores, a higher prevalence of prostatitis-like symptoms and of CDUS alterations such as macro-calcifications, severe echo-texture inhomogeneity, hyperemia （all P 〈 0.05）, and higher arterial peak systolic velocity （r = 0.25, P 〈 0.05）. Our results suggest that DNA fragmentation in PIdimmer sperm, which is related to poor semen quality, mainly originates in the testicles, likely due to apoptosis. Conversely, DNA fragmentation in PIbrighter sperm appears to mainly originate during or after transit through the prostate, increasing with the presence of an inflammatory status of the organ. These results could lead to new perspectives for the identification of therapeutic targets to reduce sDF.

Color Doppler ultrasonography was used to compare blood flow characteristics in the caudal artery of heifers fed diets with endophyte (Neotyphodium coenophialum) infected (E+) or noninfected (E-) tall fescue seed. Eighteen crossbred (Angus xBrangus) heifers were assigned to 6 pens and were fed chopped alfalfa hay for 5 d and chopped alfalfa hay plus a concentrate that contained E-tall fescue seed for 9 d during an adjustment period. An 11-d experimental period followed, with animals in 3 pens fed chopped alfalfa hay plus a concentrate with E+ seed and those in the other 3 pens fed chopped hay plus concentrate with E E-seed. Color Doppler ultrasound measurements (caudal artery area, peak systolic velocity, end diastolic velocity, mean velocity, heart rate, stroke volume, and flow rate) and serum prolactin were monitored during the adjustment (baseline measures) and during the experimental period. Three baseline measures were collected on d 3, 5, and 6 during the adjustment period for comparison to post E+ seed exposure. Statistical analyses compared the proportionate differences between baseline and response at 4, 28, 52, 76, 100, 172, and 268 h from initial feeding of E+ seed. Serum prolactin concentrations on both diets were lower (P <0.001) than baseline beginning at 4 h from the start of the experimental period. However, trends in serum prolactin concentrations for heifers on the E-diet suggested ambient temperature was affecting these concentrations. Caudal artery area in E+ heifers had declined (P <0.10) from baseline by 4 h and was consistently lower (P <0.05) for the remainder of the period. Heart rates for E+ heifers were lower than the baseline rate from 4 (P <0.10) to 100 (P <0.001) h, but were similar (P >0.10) to the baseline for 172 and 268 h measures. Blood flow in E+ heifers was consistently lower than the baseline from 4 (P <0.05) to 172 (P <0.001) h, but was similar to the baseline at 268 h when heart rate was similar to the baseline rate. Caudal artery areas for the E-diet were similar to baseline areas except at 100 h when it was greater than baseline. Heart rates and flow rates for E-heifers did not differ (P >0.10) from baseline measures during the experimental period. Results indicated that onset of toxicosis was within 4 h of cattle exposure to E+ tall fescue and is related to vasoconstriction and reduction in heart rate.

Purpose Reliable saphenous nerve blockade is a desirable complement to popliteal sciatic nerve blockade for foot and ankle surgery. We compared two promising ultrasound-guided techniques, the supine adductor canal (AC) technique and the prone peri-saphenous branch of the descending genicular artery (Peri-SBDGA) technique, using 8 mL of 2% lidocaine with epinephrine 1:400,000. Methods Following Research Ethics Board approval, we conducted a randomized single-blinded parallel-group trial in 102 patients undergoing foot and ankle surgery at a single centre. The primary endpoint was saphenous nerve ease of visualization (0 = not visible; 1 = visible with difficulty; and 2 = easily visible). Other endpoints included vascular landmark visualization (0 = not visible; 1= visible with colour flow Doppler; 2 = visible without colour flow Doppler), block success, onset, and complications. Results Ninety-one patients were eligible for analysis. Saphenous nerve visibility was not different between the groups (visibility score = 2: AC group, n  = 24/49 [49%] vs Peri-SBDGA group, 20/42 [48%]; P  = 1.00). Vascular landmark visibility was better in the AC group than in the Peri-SBDGA group (visibility score = 2: 41/49 [84%] vs 25/42 [60%], respectively; P  = 0.018). Block success rates were similar (AC group, 41/49 [84%] vs Peri-SBDGA group, 34/42 [81%]; P  = 0.79), as were median [interquartile range] onset times (AC group, 5 [5-10] min vs Peri-SBDGA group, 8 [5-11] min; P  = 0.38). Conclusion In this randomized trial, we found no differences in nerve visibility, block success rate, or onset between the AC and Peri-SBDGA techniques of ultrasound-guided saphenous nerve blockade, although the former technique provided superior vascular landmark visibility. Neither technique produced a sufficiently high success rate to provide reliable surgical anesthesia per se .

Background Doppler-guided ligation of hemorrhoidal vessels is being proposed as a treatment of grade 2 and 3 hemorrhoids. Many researchers are coupling this procedure with mucopexy or lifting of hemorrhoids to control the prolapse more effectively. The present study was conducted in patients with 3rd-degree hemorrhoids to determine the usefulness of Doppler-guided hemorrhoidal artery ligation compared to mucopexy of prolapsing hemorrhoids and to compare it with mere mucopexy of the hemorrhoids. Materials and methods A double-blind, randomized controlled study was conducted on 48 consecutive patients with grade III hemorrhoids requiring surgery. The patients were randomized into two groups. Half of them were treated with ligation and mucopexy [SL], while the remaining patients underwent a Doppler-guided hemorrhoidal artery ligation followed by ligation and mucopexy [DSL]. The patients were examined by a blinded independent observer at 2, 4, and 6 weeks and at the end of 1 year after the operation to evaluate postoperative pain scores, amount of analgesics consumed, and complications encountered. The observer also assessed recurrence of hemorrhoids after 1 year. Results Operative time was significantly longer in the DSL group (31 min vs. 9 min P  < 0.003). The postoperative pain score was significantly higher in the Doppler group [4.4 vs. 2.2, P  < 0.002 (visual analogue scale)]. The mean total analgesic dose and duration of pain control using analgesics were greater and longer for the Doppler group than for the SL group (17 vs. 11 tablets, and 13 days vs. 9 days, respectively; P  < 0. 01). Complications were similar in both the groups. At 1-year follow-up, the recurrence of hemorrhoids was not statistically significant in either group (4 patients in SL group and 3 patients in DSL group; P  < 0.93). Conclusions Suture ligation of hemorrhoids is a simple, cost-effective, and convenient modality for treating grade 3 hemorrhoids. Doppler assistance in ligating the hemorrhoidal vessels prior to hemorrhoidal mucopexy offers no advantage and is a time-consuming procedure.

The aim of this open-label study was to assess extracranial Doppler criteria of chronic cerebrospinal venous insufficiency in multiple sclerosis patients. Seventy patients were assessed: 49 with relapsing-remitting, 5 with primary progressive and 16 with secondary progressive multiple sclerosis. The patients were aged 15-58 years and they suffered from multiple sclerosis for 0.5-40 years. Sonographic signs of abnormal venous outflow were detected in 64 patients (91.4%). We found at least two of four extracranial criteria in 63 patients (90.0%), confirming that multiple sclerosis is stronghly associated with chronic cerebrospinal venous insufficiency. Additional transcranial investigations may increase the rate of patients found positive in our survey. Reflux in internal jugular and/or vertebral veins was present in 31 cases (42.8%), stenosis of internal jugular veins in 61 cases (87.1%), not detectable flow in internal jugular and/or vertebral veins in 37 cases (52.9%) and negative difference in cross-sectional area of the internal jugular vein assessed in the supine vs. sitting position in 28 cases (40.0%). Flow abnormalities in the vertebral veins were found in 8 patients (11.4%). Pathologic structures (membranaceous or netlike septa, or inverted valves) in the junction of internal jugular vein with brachiocephalic vein were found in 41 patients (58.6%), in 15 patients (21.4%) on one side only and in 26 patients (37.1%) bilaterally. Multiple sclerosis is highly correlated with chronic cerebrospinal venous insufficiency. These abnormalities in the extracranial veins draining the central nervous system can exist in various combinations. The most common pathology in our patients was the presence of an inverted valve or another pathologic structure (like membranaceous or netlike septum) in the area of junction of the IJV with the brachiocephalic vein.

The purpose of this study is to evaluate whether the presence of any stage retinopathy of prematurity (ROP) alters central retinal artery (CRA) and ophthalmic artery (OA) blood flow parameters in premature infants. The patients were divided into two groups according to the development of ROP; those who have ROP were defined as group I, those without ROP were defined as group II. Ninety eyes of 45 patients in group I and 40 eyes of 20 patients in group II were investigated. The blood flows in the CRA and OA were measured using ultrasound color doppler imaging (CDI) that allows to evaluate the peak systolic velocity (PSV), end diastolic velocity (EDV), and resistivity index (RI). The results were compared between two groups of subjects. There were no significant differences in the PSV, EDV, and RI of CRA between two groups ( P  = 0.09, P  = 0.20 and P  = 0.63, respectively). The mean PSV value of OA in group I was found to be significantly higher than the one in group II ( P  < 0.05), but there were no significant differences in the mean EDV and RI values of OA between two groups ( P  = 0.40, P  = 0.17 respectively). The subgroup analysis revealed that the ocular blood dynamics were not found to be significant between eyes with stage I ROP and eyes with stage II ROP ( P  > 0.05), whereas the difference in the mean PSV values of OA were found to be significant among the eyes with stage 1 ROP, eyes with stage 2 ROP, and eyes without ROP ( P  = 0.03). This study demonstrated significant alterations in systolic flow velocities in the OA predicted by CDI in infants with ROP.