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A previously healthy, very active 68-year-old man, who usually cycled over 100 km several times a week, noticed progressive tingling in his feet and lower legs that increased over several weeks. This was followed by progressive weakness in the arms and legs exceeding a period of eight weeks. After three months of progression, weakness became so severe that he could not even walk without help. He did not use drugs or drink alcohol.
Handheld ultrasound (US) devices have become increasingly popular since the early 2000s due to their portability and affordability compared to conventional devices. The Rapid Ultrasonography for Shock and Hypotension (RUSH) protocol, introduced in 2009, has shown promising accuracy rates when performed with handheld devices. However, there are limited data on the accuracy of such examinations performed in a moving ambulance. This study aimed to assess the feasibility and accuracy of the RUSH protocol performed by paramedics using handheld US devices in a moving ambulance.
Objectives:
The study aimed to examine the performability of the RUSH protocol with handheld US devices in a moving ambulance and to evaluate the accuracy of diagnostic views obtained within an appropriate time frame.
Methods:
A prospective study was conducted with paramedics who underwent theoretical and practical training in the RUSH protocol. The participants performed the protocol using a handheld US device in both stationary and moving ambulances. Various cardiac and abdominal views were obtained and evaluated for accuracy. The duration of the protocol performance was recorded for each participant.
Results:
Nine paramedics completed the study, with 18 performances each in both stationary and moving ambulance groups. The accuracy of diagnostic views obtained during the RUSH protocol did not significantly differ between the stationary and moving groups. However, the duration of protocol performance was significantly shorter in the moving group compared to the stationary group.
Conclusion:
Paramedics demonstrated the ability to perform the RUSH protocol effectively using handheld US devices in both stationary and moving ambulances following standard theoretical and practical training. The findings suggest that ambulance movement does not significantly affect the accuracy of diagnostic views obtained during the protocol. Further studies with larger sample sizes are warranted to validate these findings and explore the potential benefits of prehospital US in dynamic environments.
Ultrasound and center of gravity frequency data for the sequences /ʃ#s/ and /s#ʃ/ produced by Central Catalan speakers reveal that the former sequence is implemented through continuous articulatory and spectral trajectories which, depending on speaker, may be: intermediate between /ʃ/ and /s/ all throughout, thus supporting a dynamic blending mechanism; /ʃ/-like at onset and intermediate between the two fricatives at offset, which is indicative of C1-to-C2 carryover coarticulation. The sequence /s#ʃ/, on the other hand, undergoes regressive assimilation into [ʃ(ʃ)] according to the acoustic signal but less clearly so in the light of the articulatory data. This discrepancy appears to be due to the fact that, while C1=/s/ assimilates indeed to C2=/ʃ/ at constriction location, coarticulation-induced changes in tongue body configuration behind the primary articulator may occur as long as they do not jeopardize the front-cavity dependent frequency characteristics of the [ʃ] frication noise. Differences in articulatory complexity between /ʃ#s/ and /s#ʃ/ appear to result from the production mechanisms involved, i.e., tongue dorsum raising behind the /s/ constriction for /s#ʃ/ and tongue body repositioning for /ʃ#s/. In agreement with this interpretation, /ʃ#s/ but not /s#ʃ/ turned out to be longer than /s#s/ and /ʃ#ʃ/.
Our objectives were to quantify the dimensions of a fully ‘closed’ teat canal in dry cows and to describe recovery of the teat canal between milkings in lactating cows to assess whether and when full closure is attained, since this is an important determinant of udder health. Using an ultrasound scanner, teat canal length and diameter (proximal, midpoint and distal), teat cistern width, teat end width, whole teat width and teat wall thickness in 77 dry and 39 lactating dairy cows were measured. The dry cows represented a cross section of the dry population, with days since dry off ranging from 0 to 69 (median: 27). Data from lactating cows were recorded just before milking, and every 3 h post-milking. To control for location a cross-over (parlour vs. barn) study design was used. In dry cows, teat canal length and diameter did not vary by quarter or days since dry off, but multiparous cows had significantly wider teat canals than primiparous cows. The dry cow measurements can be used as baseline for dimensions for closed teats. In lactating cows, all teat dimensions except teat end width changed significantly during the 12-h milking cycle. Location (parlour vs. barn) did not affect the measurements, except teat end width and teat wall thickness. Teat canal length increased after milking and returned to pre-milking values by 9 h. Proximal and midpoint teat canal diameters decreased slightly just after milking and then progressively increased to above the pre-milking values by 9 h. Distal teat canal diameter increased after milking, partially contracting by 9 h. We found that during the dry period the teat canal is in a steady state, but its diameter is not zero, while during the lactation, the teat canal is in a near constant state of remodelling.
The ultrasound technique was applied to the synthesis of layered double hydroxides. The use of ultrasound in the synthesis of these compounds was studied in terms of its effect on their crystal qualities and surface properties. The crystal qualities of the compounds synthesized with ultrasound were compared with those of compounds synthesized without ultrasound to elucidate the effect of the ultrasound on the synthesis. The effect of crystal quality (crystallite size) on the adsorption behavior of humic substances was examined. The compounds synthesized under ultrasonic conditions showed a larger crystallite size and a larger adsorption capacity for humic substances than those synthesized without ultrasonic treatment. The degree of adsorption correlated well with crystal quality.
The effects of ultrasound treatment on the mean particle size, crystal structure, crystallite dimensions and specific surface area of natural muscovite and biotite samples have been investigated. Sonication of macroscopic flakes of muscovite and biotite produced a drastic particle-size reduction. The conditions for the preparation of micron and submicron-sized muscovite and biotite particles of narrow particle-size distribution by sonochemistry are described. The effect of sonication on particle-size reduction is more significant for muscovite than for biotite. Thus, for long sonication times (100 h), submicron and micron particles are predominant in muscovite and biotite, respectively. The resulting materials are crystalline, as assayed by X-ray diffraction, only broadening of the diffraction lines due to size-reduction was observed. Nuclear magnetic resonance studies revealed that the coordination of Al and Si was not modified by the treatment. Chemical analysis showed that the composition of the sample was not affected by the sonication except for a small contamination by Ti from the tip cup of the sonication instrument.
When a bilingual speaker has a larger linguistic sub-system in their L1 than their L2, how are L1 categories mapped to the smaller set of L2 categories? This article investigates this “subset scenario” (Escudero, 2005) through an analysis of laterals in highly proficient bilinguals (Scottish Gaelic L1, English L2). Gaelic has three lateral phonemes and English has one. We examine acoustics and articulation (using ultrasound tongue imaging) of lateral production in speakers’ two languages. Our results suggest that speakers do not copy a relevant Gaelic lateral into their English, instead maintaining language-specific strategies, with speakers also producing English laterals with positional allophony. These results show that speakers develop a separate production strategy for their L2. Our results advance models such as the L2LP which has mainly considered perception data, and also contribute articulatory data to this area of study.
The establishment of ultrasonography in daily gynaecological and obstetric practice has increased the rate of diagnosis of ovarian cysts amongst pregnant women. Both assessment and management of ovarian cysts in pregnancy can be challenging. Although most cysts are functional in nature and a conservative approach can be employed, a small proportion will carry some malignant potential. Identifying which cysts can be safely managed expectantly and which necessitate surgical intervention, investigating possible cyst accidents, deciding on the timing and nature of intervention (fine needle aspiration versus cystectomy or even oophorectomy), the surgical approach (laparotomy versus laparoscopy) and balancing the risks and benefits for the mother and the fetus are just a few examples of the dilemmas that need to be addressed, ideally within a multidisciplinary team-based environment.
Several studies have shown the additional benefit of point-of-care ultrasound (POCUS) by prehospital Emergency Medical Services (EMS). Since organization of EMS may vary significantly across countries, the value of POCUS likely depends on the prehospital system in which it is used. In order to be able to optimally implement POCUS and develop a tailored training curriculum, it is important to know how often POCUS is currently used, for which indications it is used, and how it affects decision making. The aims of this study were: (1) to determine the percentage of patients in whom POCUS was used by Dutch Helicopter Emergency Medical Services (HEMS) crews; (2) to determine how often POCUS findings led to changes in on-scene management; and (3) what these changes were.
Methods:
Patients who received prehospital care from December 1, 2020 through March 31, 2021 by a single HEMS crew were included in this prospective cohort study. Clinical data and specific data on POCUS examination, findings, and therapeutic consequences were collected and analyzed.
Results:
During the study period, on-scene HEMS care was provided to 612 patients, of which 211 (34.5%) patients underwent POCUS. Of these, 209 (34.2%) patients with a median age of 45 years were included. There were 131 (62.7%) trauma patients, and 70 (33.7%) of the included patients underwent cardiopulmonary resuscitation (CPR). The median reported time of POCUS examination was three (P25-P75 2-5) minutes. Median prolongation of on-scene time was zero (P25-P75 0-1) minutes. In 85 (40.7%) patients, POCUS examination had therapeutic consequence: POCUS was found to impact treatment decisions in 34 (26.0%) trauma patients and 51 (65.4%) non-trauma patients. In patients with cardiac arrest, POCUS was most often used to aid decision making with regard to terminating or continuing resuscitation (28 patients; 13.4%).
Conclusion:
During the study period, POCUS examination was used in 34.5% of all prehospital HEMS patients and had a therapeutic consequence in 40.7% of patients. In trauma patients, POCUS seems to be most effective for patient triage and evaluation of treatment effectiveness. Moreover, POCUS can be of significant value in patients undergoing CPR. A tailored HEMS POCUS training curriculum should include ultrasound techniques for trauma and cardiac arrest.
An earthquake measuring 7.7 magnitude on the Richter scale occurred at 04:17am on February 6, 2023 in the Pazarcık district of Kahramanmaraş province Turkey. In the hours following the 7.7 magnitude event in Kahramanmaraş, a second 7.6 magnitude earthquake struck the region and a third 6.4 magnitude earthquake struck Gaziantep, causing extensive damage and death. A total of ten provinces directly experienced the earthquake, including Kahramanmaraş, Hatay, Gaziantep, Osmaniye, Malatya, Adana, Diyarbakır, Şanlıurfa, Adıyaman, and Kilis. The official figures indicate 31,643 people were killed, 80,278 were injured, and 6,444 buildings were destroyed within seven days of the earthquakes (as of 12:00pm/noon on Monday, February 13th). The area affected by the earthquake has been officially declared to be 500km in diameter. This report primarily relies on observations made by pioneer Emergency Physicians (EPs) who went to the disaster areas shortly after the first earthquake (in the early stages of the disaster). According to their observations: (1) Due to winter conditions, there were transportation problems and a shortage of personnel reaching disaster areas on the first day after the disaster; (2) On the second day of the disaster, health equipment was in short supply; (3) As of the third day, health workers were unprepared in terms of knowledge and experience for the disaster; and (4) The subsequent deployment of health personnel to the disaster area was uncoordinated and unplanned on the following days, which resulted in the health personnel working there not being able to meet even their basic needs (such as food, heating, and shelter). During the first week, coordination was most frequently reported as the most significant problem.
Periconceptional maternal ultra-processed food (UPF) consumption impairs embryonic growth. Impacts of exposure to UPF on distinct components of fetal growth in late pregnancy are unknown. We investigated the influence of frequency of UPF consumption during pregnancy on fetal head circumference (HC), abdominal circumference (AC) and femur length (FL). This study included 417 live-born singleton pregnancies prospectively followed-up since the antenatal period in the MINA-Brazil Study, with an available ultrasound scan at >24 gestational weeks. Frequency of food groups consumption in the previous month was categorised as no/monthly, weekly or daily. Ultrasound scans were conducted at 27·8 (sd: 1·7) gestational weeks. HC, AC and FL z-scores were calculated for gestational age using the INTERGROWTH-21st Project standards. Simultaneous-quantile regression models were fitted at the 10th, 50th and 90th percentiles of the distribution of each ultrasound parameter according to UPF consumption, with adjustment for potential confounders. Participants were aged on average 24·7 (sd: 6·5) years, 44·8 % were primiparous, and 26·9 % and 24·9 %, respectively, had weekly and daily UPF consumption. Compared with no/monthly intake, daily UPF consumption impaired HC across its distribution, with significant effect sizes varying from –0·24 to –0·40 z-score. Weekly UPF consumption decreased HC at the 90th percentile by –0·39 z-score (95 % CI: –0·78, –0·01) and FL at the 50th percentile by –0·32 z-score (95 % CI: –0·60, –0·04). No association was noted with AC. Frequency of UPF consumption was negatively associated with skeletal components of fetal growth in late pregnancy. Infant body composition may benefit from healthy food practices since pregnancy.
Exploration of novel strategies for early pregnancy diagnosis is pivotal in enhancing the reproductive potential and monetary gains from dairy herds. In buffalo, the trophectoderm cells of the elongating conceptus secrete interferon-tau that stimulates the transcription of various genes in peripheral blood mononuclear cells (PBMC) during the peri-implantation period. We explored the differential expression of classical (ISG15) and novel (LGALS3BP and CD9) early pregnancy markers in PBMC of buffaloes during various stages of pregnancy. Natural heat was detected in buffaloes by assessing the vaginal fluid, and artificial insemination (AI) was done. Whole blood was collected from the jugular vein in EDTA-containing vacutainers for PBMC isolation before AI (0-day) and 20, 25 and 40 d post-AI. On day 40, transrectal ultrasonography examination was performed to confirm pregnancy. The inseminated non-pregnant animals served as control. Total RNA was extracted using the TRIzol method. The temporal abundance of ISG15, LGALS3BP and CD9 genes in PBMC was compared between pregnant and non-pregnant groups (n = 9 per group) using real time-qPCR. Results showed transcripts of ISG15 and LGALS3BP were more abundant at 20 d in the pregnant group compared to the 0 d and 20 d values of the non-pregnant group. However, due to variability in expression, threshold (Ct) cycle of RT-qPCR alone could not distinguish pregnant and non-pregnant animals. In conclusion, ISG15 and LGALS3BP transcripts abundance in PBMCs are potential candidate biomarkers for early prediction of buffalo pregnancy 20-days post-AI, but further work is required to allow the development of a reliable new methodology.
The 2014 British Thyroid Association guidelines acknowledged the value of risk-stratifying thyroid nodules by utilising an ultrasound reporting system (‘U’ classification). This study assessed whether using pre-existing parameters in combination can better stratify patients’ malignancy and completion thyroidectomy risks.
Method
A multicentre, retrospective, observational review identified 936 NHS Greater Glasgow and Clyde patients from pathology records who underwent hemithyroidectomy between 1 January 2014 and 31 December 2019.
Results
A total of 308 patients had thyroid malignancy, 180 (58.4 per cent) progressed to completion thyroidectomy. A nodule classified as ‘U3’ (indeterminate) was associated with a 35.4 per cent chance of malignancy and a 21.6 per cent risk of requiring completion surgery. Amalgamation of ‘U’ score with Thy score enhanced risk prediction. The malignancy rate in U3, Thy-3f nodules was 38 per cent, and 21 per cent required completion surgery. The malignancy and completion thyroidectomy rates were comparatively lower for U3, Thy-3a nodules (22 per cent and 14.3 per cent, respectively).
Conclusion
Combining ultrasound ‘U’ score and Thy score improves pre-operative thyroid nodule risk stratification, leading to better informed patients regarding the risks of malignancy and completion surgery. A move towards an integrated assessment approach should be considered.
This observational study aimed to describe the diurnal pattern of reticuloruminal contraction rate (RRCR) and the proportion of time spent ruminating by cattle, using two commercial devices equipped with triaxial accelerometers: an indwelling bolus (placed in the reticulum) and a neck collar. The three objectives of this study were firstly to determine whether the indwelling bolus provided observations consistent with RRCR as determined by clinical examination using auscultation and ultrasound, secondly to compare estimates of time spent ruminating using the indwelling bolus and a collar-based accelerometer, and finally to describe the diurnal pattern of RRCR using the indwelling bolus data. Six rumen-fistulated, non-lactating Jersey cows were fitted with an indwelling bolus (SmaXtec Animal Care GmbH, Graz, Austria) and a neck collar (Silent Herdsman, Afimilk Ltd. Kibbutz Afikim, Israel), and data were collected over two weeks. Cattle were housed together in a single straw-bedded pen and fed ad libitum hay. To assess the agreement between the indwelling bolus and traditional methods of assessing reticuloruminal contractility in the first week, the RRCR was determined over 10 min, twice a day, by ultrasound and auscultation. Mean inter-contraction intervals (ICI) derived from bolus and ultrasound, and from auscultation were 40.4 ± 4.7, 40.1 ± 4.0 and 38.4 ± 3.3 s. Bland–Altmann plots showed similar performance of the methods with small biases. The Pearson correlation coefficient for the time spent ruminating derived from neck collars and indwelling boluses was 0.72 (highly significant, P < 0.001). The indwelling boluses generated a consistent diurnal pattern for all the cows. In conclusion, a robust relationship was observed between clinical observation and the indwelling boluses for estimation of ICI and, similarly, between the indwelling bolus and neck collar for estimating rumination time. The indwelling boluses showed a clear diurnal pattern for RRCR and time spent ruminating, indicating that they should be useful for assessing reticuloruminal motility.
Many studies have been conducted to determine the most reliable technique for evaluating the position of the endotracheal tube in patients receiving mechanical ventilation support. In this study, we aimed to determine the endotracheal tube position by ultrasonography in intubated patients with a diagnosis of critical CHD followed in the neonatal ICU.
Methods:
In this prospective observational clinical study, we performed point-of-care ultrasound for endotracheal tube localisation in 65 intubated newborns with critical CHD. After routine radiography, each patient underwent point-of-care ultrasound examination with a portable ultrasonography device for endotracheal tube end-carina measurement. Endotracheal tube end-carina measurements on chest radiographs were compared with ultrasound images.
Results:
The mean gestational age and birth weight were 37.8 ± 2.19 weeks and 2888 ± 595 g, respectively. Ultrasound images were obtained after an average of 2.08 ± 1.6 hours from the radiographs. The average ultrasound time allocated to each patient was 5 minutes. The mean endotracheal tube tip-to-carina distance on chest X-ray and ultrasound were optimally 1.33 ± 0.64 cm and 1.43 ± 0.67 cm, respectively. There was no significant difference between chest X-ray and ultrasound measurements in endotracheal tube end-carina distance values evaluated by the Bland–Altman method (mean difference 0.10 cm, p = 0.068). There was a linear correlation between the endotracheal tube tip-carina distance in ultrasound and radiography evaluation (r2 = 0.60, p < 0.001).
Conclusion:
It has been concluded that critical CHDs are frequently accompanied by vascular anomalies, and the endotracheal tube tip-carina distance measurement can be used by determining the carina section as a guide point in the ultrasonographic evaluation of the endotracheal tube location in this patient population.
This chapter provides an overview of milestones in reproductive technologies and milestones in medically assisted conception, imaging, and diagnostic tests – what is available, what is involved, and what remains controversial. Research on how technology has influenced the biological and psychological experience of pregnancy is reviewed and social impact of reproductive technologies on individuals, couples, and the broader community is discussed.
Here we uncover the mysteries of the baby as it develops in the womb, discussing how fetal development is controlled. We give insights into aspects of pregnancy not widely known, from the fetus starting to breathe months before it is born, to the question of whether it sleeps – and dreams. We discuss the ways in which information about the mother’s life and her environment affect the baby’s development. Although birth may seem the first major milestone for a baby, we emphasise that many other milestones have been passed before that, inside the womb, out of sight but over which parents can have substantial influence. We give insights into new discoveries about how the organs of the fetal body develop in prediction of the world in which that individual ‘expects’ to live, and what happens when the prediction turns out to be wrong. The idea that the fetus is preparing for life after birth will get the reader thinking about the long-term consequences of the way a fetus develops. Each of us is unique as a result of our development – and nobody is perfect. Our unique development starts from the moment of conception, which introduces the next chapter on sex.