Explore the vast range of titles available.

Background Central venous catheterization is the most common invasive procedure in intensive care units but remains burdened by infectious, thrombotic, and mechanical complications. Although real-time ultrasound guidance is now widely adopted, its effect on site-specific differences in overall complication rates has not been established. The 3SITES randomized clinical trial previously demonstrated lower infection and thrombosis rates with subclavian access but higher mechanical complications. However, as only a third of its procedures were ultrasound-guided in this study, these findings may not apply to current practice. The objective of the study was to compare complication rates across these three sites under a counterfactual framework assuming universal ultrasound guidance. Methods This study was an emulated a target trial using the 3SITES dataset. Inverse probability weighting was applied to adjust for confounders of site assignment and ultrasound guidance. Weighted outcomes across catheter sites were compared under a counterfactual framework assuming universal ultrasound guidance. The primary outcome was a composite of time to catheter-related bloodstream infection or symptomatic deep-vein thrombosis. Secondary outcomes included each component separately, asymptomatic thrombosis, and major mechanical complications. Results A total of 3409 catheters were included: 1153 in the femoral, 1267 in the internal jugular, and 989 in the subclavian site. Subclavian site showed a lower incidence of the primary outcome compared with femoral ( P  =  .02 ) and jugular ( P  =  .001 ) sites. The primary composite outcome did not differ between internal jugular and femoral sites ( P  =  .97 ). Catheter-related bloodstream infections were significantly fewer with subclavian versus jugular access ( P  =  .001 ). Asymptomatic thrombosis was more frequent at femoral and jugular sites. Major mechanical complications were rare and did not differ significantly across sites. Conclusion Assuming universal real-time ultrasound-guided central venous catheterization, subclavian access retains lower infectious and thrombotic risk without an observed increase in mechanical complications, supporting its preferential use in intensive care units.

Percutaneous coronary intervention (PCI) is used increasingly for revascularization of unprotected left main coronary artery (LMCA) disease. Observational studies and subgroup analyses from clinical trials, have suggested a possible benefit from the use of intravascular ultrasound (IVUS) guidance when performing unprotected LMCA PCI. However, the value of imaging with IVUS has never been proven in an appropriately powered randomized clinical trial. The OPtimizaTIon of Left MAin PCI With IntravascuLar Ultrasound (OPTIMAL) trial has been designed to establish whether IVUS-guided PCI optimization on LMCA is associated with superior clinical outcomes when compared with standard qualitative angiography-guided PCI. The OPTIMAL trial is a randomized, multicenter, international study designed to enroll a total of 800 patients undergoing PCI for unprotected LMCA disease. Patients will be randomized in a 1:1 fashion to IVUS-guided PCI versus angiogram-guided PCI. In patients allocated to the angiogram-guided arm, use of IVUS is discouraged, unless there are safety concerns. In patients allocated to the IVUS guidance arm, pre-procedural IVUS assessment is highly recommended, whilst post-procedural IVUS assessment is mandatory to confirm appropriate stenting result and/or to guide stent result optimization, according to predefined criteria. Patients will be followed up to 2 years after the index procedure. The primary outcome measure is the Academic Research Consortium (ARC) patient-oriented composite endpoint (PoCE) which includes all-cause death, any stroke, any myocardial infarction and any repeat revascularization at 2 years follow-up. The OPTIMAL trial aims to provide definitive evidence about the clinical impact of IVUS-guidance during PCI to an unprotected LMCA. It is anticipated by the investigators, that an IVUS-guided strategy will be associated with less clinical events compared to a strategy guided by angiogram alone. ClinicalTrials.gov: NCT04111770. Registered on October 1, 2019.

Cricothyroidotomy is a key technique for securing airways when tracheal intubation and oxygenation are difficult to achieve. In recent years, it has become clear that ultrasonography is more accurate than palpation for identifying the cricothyroid membrane. However, it is unclear how ultrasound should be administered. We investigated whether real-time or static ultrasound techniques were more useful for needle cricothyrotomy in patients with simulated anatomical abnormalities of the neck. Three cervical simulators with anatomical abnormalities were created. After education and hands-on training in needle cricothyroidotomy, 48 participants (27 junior residents, 12 anesthesia residents, and nine anesthesiologists) performed needle cricothyroidotomy using either a real-time or static ultrasound technique (crossover study). Fisher’s exact test was used to assess the success rate and accuracy of the puncture ( p < 0.05 was considered statistically significant). The success rate of cricothyrotomy puncture was significantly higher with the real-time ultrasound technique than with the static ultrasound technique. The real-time ultrasound technique led to significantly higher puncture accuracy and shorter procedure time than the static ultrasound technique. Needle cricothyroidotomy using real-time ultrasonography may be more useful than that using static ultrasonography.

It is still challenging to make accurate diagnosis of biliary atresia (BA) with sonographic gallbladder images particularly in rural area without relevant expertise. To help diagnose BA based on sonographic gallbladder images, an ensembled deep learning model is developed. The model yields a patient-level sensitivity 93.1% and specificity 93.9% [with areas under the receiver operating characteristic curve of 0.956 (95% confidence interval: 0.928-0.977)] on the multi-center external validation dataset, superior to that of human experts. With the help of the model, the performances of human experts with various levels are improved. Moreover, the diagnosis based on smartphone photos of sonographic gallbladder images through a smartphone app and based on video sequences by the model still yields expert-level performances. The ensembled deep learning model in this study provides a solution to help radiologists improve the diagnosis of BA in various clinical application scenarios, particularly in rural and undeveloped regions with limited expertise. It is still challenging to make accurate diagnosis of biliary atresia (BA) with sonographic gallbladder images particularly in rural areas without relevant expertise. Here, the authors develop a diagnostic deep learning model which favourable performance in comparison with human experts in multi-center external validation.

To explore better methods for tracing central lymph nodes in patients with papillary thyroid carcinoma by comparing the differences in the numbers and staining rates of central lymph nodes as well as the degree of nanocarbon extravasation between the preoperative ultrasound-guided injection of nanocarbon particles and the intraoperative injection of nanocarbon particles. A total of 302 patients were randomly divided into a preoperative ultrasound-guided injection group and an intraoperative injection group. The number and degree of staining of the lymph nodes in each subgroup of central lymph nodes, including linea alba cervical lymph nodes, Delphian lymph nodes, and pretracheal and paratracheal lymph nodes, were recorded and analyzed. The extent of dye extravasation was reduced when nanocarbon was injected preoperatively. Significantly more linea alba cervical lymph nodes and pretracheal and paratracheal lymph nodes were detected in the preoperative injection group. Preoperative injection of nanocarbon can accelerate the staining and detection of central lymph nodes in patients with Hashimoto’s thyroiditis, clinically positive lymph nodes (cN1) and tumors with diameters > 1 cm. Preoperative ultrasound-guided injection of nanocarbon can reduce the likelihood of dye spillage and improve the staining rate as well as the detection rate of central lymph nodes.

Rapid response teams are intended to improve early diagnosis and intervention in ward patients who develop acute respiratory or circulatory failure. A management protocol including the use of a handheld ultrasound device for immediate point-of-care ultrasound (POCUS) examination at the bedside may improve team performance. The main objective of the study was to assess the impact of implementing such a POCUS-guided management on the proportion of adequate immediate diagnoses in two groups. Secondary endpoints included time to treatment and patient outcomes. Methods A prospective, observational, controlled study was conducted in a single university hospital. Two teams alternated every other day for managing in-hospital ward patients developing acute respiratory and/or circulatory failures. Only one of the team used an ultrasound device (POCUS group). Results We included 165 patients (POCUS group 83, control group 82). Proportion of adequate immediate diagnoses was 94% in the POCUS group and 80% in the control group ( p = 0.009). Time to first treatment/intervention was shorter in the POCUS group (15 [10–25] min vs. 34 [15–40] min, p < 0.001). In-hospital mortality rates were 17% in the POCUS group and 35% in the control group ( p = 0.007), but this difference was not confirmed in the propensity score sample (29% vs. 34%, p = 0.53). Conclusion Our study suggests that protocolized use of a handheld POCUS device at the bedside in the ward may improve the proportion of adequate diagnosis, the time to initial treatment and perhaps also survival of ward patients developing acute respiratory or circulatory failure. Clinical Trial Registration NCT02967809. Registered 18 November 2016, https://clinicaltrials.gov/ct2/show/NCT02967809 .

BackgroundWe tested the hypothesis that routine MRI would improve the care and well-being of preterm infants and their families.DesignParallel-group randomised trial (1.1 allocation; intention-to-treat) with nested diagnostic and cost evaluations (EudraCT 2009-011602-42).SettingParticipants from 14 London hospitals, imaged at a single centre.Patients511 infants born before 33 weeks gestation underwent both MRI and ultrasound around term. 255 were randomly allocated (siblings together) to receive only MRI results and 255 only ultrasound from a paediatrician unaware of unallocated results; one withdrew before allocation.Main outcome measuresMaternal anxiety, measured by the State-Trait Anxiety inventory (STAI) assessed in 206/214 mothers receiving MRI and 217/220 receiving ultrasound. Secondary outcomes included: prediction of neurodevelopment, health-related costs and quality of life.ResultsAfter MRI, STAI fell from 36.81 (95% CI 35.18 to 38.44) to 32.77 (95% CI 31.54 to 34.01), 31.87 (95% CI 30.63 to 33.12) and 31.82 (95% CI 30.65 to 33.00) at 14 days, 12 and 20 months, respectively. STAI fell less after ultrasound: from 37.59 (95% CI 36.00 to 39.18) to 33.97 (95% CI 32.78 to 35.17), 33.43 (95% CI 32.22 to 34.63) and 33.63 (95% CI 32.49 to 34.77), p=0.02. There were no differences in health-related quality of life. MRI predicted moderate or severe functional motor impairment at 20 months slightly better than ultrasound (area under the receiver operator characteristic curve (CI) 0.74; 0.66 to 0.83 vs 0.64; 0.56 to 0.72, p=0.01) but cost £315 (CI £295–£336) more per infant.ConclusionsMRI increased costs and provided only modest benefits.Trial registrationClinicalTrials.gov NCT01049594 https://clinicaltrials.gov/ct2/show/NCT01049594. EudraCT: EudraCT: 2009-011602-42 (https://www.clinicaltrialsregister.eu/).

IntroductionThe mortality of critical acute kidney injury (AKI) patients requiring continuous renal replacement therapy (CRRT) is estimated to be as high as 50%. Fluid overload (FO) is a leading factor contributing to poor prognosis. CRRT, aimed at removing excessive water and toxins from the body, is an efficient method to address FO. However, accurate ultrafiltration is challenging because of the difficulty of quantifying fluid status, which usually relies on traditional examinations and clinicians’ perceptions. Both overultrafiltration and underultrafiltration are associated with adverse events. Critical care ultrasound (CCUS), introduced as a non-invasive tool, might be promising for assessing the volume status of AKI. However, there has been no solid evidence on the application of bedside CCUS in directing CRRT ultrafiltration among AKI patients. Therefore, in this randomised controlled trial (RCT), we aimed to investigate the efficacy and reliability of BEdside ultraSound-guided ultrafiltration (BEST) in comparison with conventional methods for AKI patients receiving CRRT.Methods and analysisThis study is a single-centre, prospective, parallel-group, open-label RCT involving AKI patients who receive CRRT due to FO in the intensive care unit of a university-affiliated medical centre from September 2024. A total of 132 patients will be enrolled and randomly assigned to receive either bedside CCUS via an integrated score combining vascular, lung and cardiac ultrasonography or traditional methods to assess the volume status and guide CRRT ultrafiltration. The FO status will be quantified using a novel BEST score, where 1 point will be given if the inferior vena cava diameter >2.1 cm, 2 or more positive lung regions (B-line score >3) are identified under lung ultrasound, or E/e' >14 under echocardiography, with a total score of 3. The primary outcome is the rate of resuming euvolaemic status at the 72nd hour, on day 7 and at the end of CRRT. The secondary outcomes encompass the rates of FO correction, in-hospital events, renal outcomes, patient mortality and rehospitalisation.Ethics and disseminationThe Institutional Review Board of West China Hospital, Sichuan University, granted ethical approval for this study (protocol version 2 dated 3 June 2024; Approval No. of the ethics committee: 2024-919). All participants or their legal representatives will sign the informed written consent. We intend to disseminate these findings to participants, medical practitioners, the public and other interested parties via conference presentations and publications without imposing any restrictions.Trial registration numberChiCTR2400087833.

Ultrasound (US) provides the most accurate technique for thickness measurements of subcutaneous adipose tissue (SAT) layers. This US method was recently standardised using eight sites to capture SAT patterning and allows distinguishing between fat and embedded fibrous structures. These eight sites chosen for fat patterning studies do not represent the mean SAT thickness measured all over the body that is necessary for determining subcutaneous fat mass. This was obtained by SAT measurements at 216 sites distributed randomly all over the body. Ten participants with BMI below 28.5kgm −2 and SAT means (from eight sites) ranging from 3 mm to 10 mm were selected. The means from eight sites overestimated the means obtained from 216 sites (i.e. 2160 US measurements in the ten participants); the calibration factor of 0.65 corrects this; standard deviation (SD) was 0.05, i.e. 8%. The SD of the calibration factor transforms linearly when estimating the error range of the whole body’s SAT volume (body surface area times the calibrated mean SAT thickness). The SAT masses ranged from 3.2 to 12.4 kg in this group. The standard deviations resulting from solely the calibration factor uncertainty were ±0.3 and ±1.0 kg, respectively. For these examples, the SAT percentages were 4.9(±0.4)% and 13.3(±1.0)%.

Objective To determine whether a treatment strategy based on structured ultrasound assessment would lead to improved outcomes in rheumatoid arthritis, compared with a conventional strategy.Design Multicentre, open label, two arm, parallel group, randomised controlled strategy trial.Setting Ten rheumatology departments and one specialist centre in Norway, from September 2010 to September 2015.Participants 238 patients were recruited between September 2010 and April 2013, of which 230 (141 (61%) female) received the allocated intervention and were analysed for the primary outcome. The main inclusion criteria were age 18-75 years, fulfilment of the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis, disease modifying anti-rheumatic drug naivety with indication for disease modifying drug therapy, and time from first patient reported swollen joint less than two years. Patients with abnormal kidney or liver function or major comorbidities were excluded.Interventions 122 patients were randomised to an ultrasound tight control strategy targeting clinical and imaging remission, and 116 patients were randomised to a conventional tight control strategy targeting clinical remission. Patients in both arms were treated according to the same disease modifying anti-rheumatic drug escalation strategy, with 13 visits over two years.Main outcome measures The primary endpoint was the proportion of patients with a combination between 16 and 24 months of clinical remission, no swollen joints, and non-progression of radiographic joint damage. Secondary outcomes included measures of disease activity, radiographic progression, functioning, quality of life, and adverse events. All participants who attended at least one follow-up visit were included in the full analysis set.Results 26 (22%) of the 118 analysed patients in the ultrasound tight control arm and 21 (19%) of the 112 analysed patients in the clinical tight control arm reached the primary endpoint (mean difference 3.3%, 95% confidence interval −7.1% to 13.7%). Secondary endpoints (disease activity, physical function, and joint damage) were similar between the two groups. Six (5%) patients in the ultrasound tight control arm and seven (6%) patients in the conventional arm had serious adverse events.Conclusions The systematic use of ultrasound in the follow-up of patients with early rheumatoid arthritis treated according to current recommendations is not justified on the basis of the ARCTIC results. The findings highlight the need for randomised trials assessing the clinical application of medical technology.Trial registration Clinical trials NCT01205854.