Associations of residential greenspace exposure and fetal growth across four areas in Spain

An accumulating body of evidence has associated exposure to greenspace with improved birth outcomes, including higher birth weight and lower risk of low birth weight; however, evidence on such association with in-utero fetal growth is scarce. We explored the influence of maternal exposure to residential greenspace and fetal growth in four INMA (Infancia y Medio Ambiente) Spanish birth cohorts (2003–2008), with 2,465 participants. Residential greenspace was characterised by the Normalised Difference Vegetation Index (NDVI) average across 100 m, 300 m, and 500 m buffers around the residence. Repeated ultrasound measurements of the abdominal circumference (AC), biparietal diameter (BPD), femur length (FL), and estimated fetal weight (EFW) were used. We created customised-generalised least squares models to evaluate associations of residential greenspace exposure on each fetal growth parameter, controlled for the relevant confounders. There were associations between the 500 m buffer and BPD, FL, and AC. We also found associations in the 300 m buffer and FL and AC. The associations in the 100 m buffer were null. Estimates were higher among participants with lower socioeconomic status. Mediation analyses found that air pollution might explain 15–37% of our associations. Mediation by physical activity was not observed. Greenspace exposure may be beneficial for fetal growth.     

The role of the sonographer – An investigation into the scope of practice for the sonographer internationally

IntroductionThere is global variance in the role of a practicing sonographer. Literature examining global sonographic roles and scope of practice is limited, despite the international applicability of ultrasound imaging. This study aimed to examine the common and divergent features of a practicing sonographer internationally, and their impact upon the development of a global standard of practice.MethodsAn ethically approved mixed-methods online survey was conducted. The purposive sample included all 75 current elected council members of the ISRRT [International Society of Radiographers and Radiological Technologists], an international professional organisation.ResultsThirty-six individuals from at least 32 different countries responded, reflecting the sonography profession in all four ISRRT regions. The results suggest that sonographer education requirements differ widely, from on the job training (16%, 6/36) to undergraduate or postgraduate schooling (44%, 16/36). Registration and accreditation bodies were present in the jurisdiction of 41% (14/34) and 35% (12/33) of respondents respectively, though many were voluntary, physician-focused or non-specific to sonographers. Five of 11 (45%) respondents suggested that the sonographer–radiologist relationship is individual-dependent, and not primarily positive or negative. Ten of 28 (36%) suggested that other professionals do not know the role of the sonographer.ConclusionThe majority of ISRRT council member respondents believe that an international scope of practice could benefit and be implemented in their jurisdiction (26/28, 93% and 22/33, 67%). The key advantages noted were standardisation of education and improved professional mobility. However, lack of sonographer education and radiologist acceptance are important potential barriers.Implications for practiceAn international scope of practice could be beneficial and implementable in most ISRRT jurisdictions. Professional mobility and education standardization are the primary advantages. Insufficient sonographer education and physician acceptance are the key potential obstacles.     

超声引导下辅助诊断和治疗冻结肩的研究进展

冻结肩是常见的肩部疾病,传统非可视化治疗冻结肩效果欠佳。近年来,超声引导具有动态实时定位、无辐射、便携性、低成本等优点在辅助诊断和治疗冻结肩患者中得到成功应用,不仅能提供精确的诊断,也提高了患者中长期的疗效。本文就超声引导辅助诊断和治疗冻结肩的研究进展进行综述。     

Comparing Radiomics features of tumour and healthy liver tissue in a limited CT dataset: A machine learning study

IntroductionLiver cancer lesions on Computed Tomography (CT) withholds a great amount of data, which is not visible to the radiologists and radiographer. Radiomics features can be extracted from the lesions and used to train Machine Learning (ML) algorithms to predict between tumour and liver tissue. The purpose of this study was to investigate and classify Radiomics features extracted from liver tumours and normal liver tissue in a limited CT dataset.MethodsThe Liver Tumour Segmentation Benchmark (LiTS) dataset consisting of 131 CT scans of the liver with segmentations of tumour tissue and healthy liver was used to extract Radiomic features. Extracted Radiomic features included size, shape, and location extracted with morphological and statistical techniques according to the International Symposium on Biomedical Imaging manual. Relevant features was selected with chi2 correlation and principal component analysis (PCA) with tumour and healthy liver tissue as outcome according to a consensus between three experienced radiologists. Logistic regression, random forest and support vector machine was used to train and validate the dataset with a 10-fold cross-validation method and the Grid Search as hyper-parameter tuning. Performance was evaluated with sensitivity, specificity and accuracy.ResultsThe performance of the ML algorithms achieved sensitivities, specificities and accuracy ranging from 96.30% (95% CI: 81.03%–99.91%) to 100.00% (95% CI: 86.77%–100.00%), 91.30% (95% CI: 71.96%–98.93%) to 100.00% (95% CI: 83.89%–100.00%)and 94.00% (95% CI: 83.45%–98.75%) to 100.00% (95% CI: 92.45%–100.00%), respectively.ConclusionML algorithms classifies Radiomics features extracted from healthy liver and tumour tissue with perfect accuracy. The Radiomics signature allows for a prognostic biomarker for hepatic tumour screening on liver CT.Implications for practiceDifferentiation between tumour and liver tissue with Radiomics ML algorithms have the potential to increase the diagnostic accuracy, assist in the decision-making of supplementary multiphasic enhanced medical imaging, as well as for developing novel prognostic biomarkers for liver cancer patients.     

Clinicopathologic factors and preoperative ultrasonographic characteristics for predicting central lymph node metastasis in papillary thyroid microcarcinoma: a single center retrospective study

IntroductionThe treatment of papillary thyroid microcarcinoma remains controversial. Central lymph node metastasis is common in papillary thyroid microcarcinoma and it is an important consideration in treatment strategy selection.ObjectiveThe aim of this study was to investigate clinicopathologic risk factors and thyroid nodule sonographic characteristics for central lymph node metastasis in papillary thyroid microcarcinoma.MethodsWe retrospectively reviewed the data of 599 papillary thyroid microcarcinoma patients who underwent surgery from 2005 to 2017 at a single institution. Univariate and multivariate analyses were used to identify the clinicopathologic factors and preoperative sonographic features of central lymph node metastasis. A receiver-operating characteristic, ROC curve analysis, was performed to identify the efficacy of ultrasonographic features in predicting central lymph node metastasis. A nomogram based on the risk factors was established to predict central lymph node metastasis.ResultsThe incidence of central lymph node metastasis was 22.4%. The univariate and multivariate analyses suggested that gender, age, multifocality, extrathyroidal invasion, and lateral lymph node metastasis were independent risk factors for central lymph node metastasis. The univariate and multivariate analyses revealed that nodular shape, margin, and calcification were independently associated with central lymph node metastasis. The ROC curve analysis revealed that the combination of shape, margin and calcification had excellent accuracy in predicting central lymph node metastasis. The nomogram was developed based on the identified risk factors for predicting central lymph node metastasis, and the calibration plot analysis indicated the good performance and clinical utility of the nomogram.ConclusionsCentral lymph node metastasis is associated with male gender, younger age (<45 years), extrathyroidal invasion, multifocality and lateral lymph node metastasis in papillary thyroid microcarcinoma patients. The ultrasongraphic features, such as irregular shape, ill-defined margin and calcification, may improve the efficacy of predicting central lymph node metastasis. Surgeons and radiologists should pay close attention to the patients who have these risk factors. The nomogram may help guide surgical decision making in papillary thyroid microcarcinoma.     

The use of cadaver models to diagnose rib fractures: A pilot study

Background

In the emergency department, rib fractures are a common finding in patients who sustain chest trauma. Rib fractures may be a sign of significant, underlying pathology, especially in the elderly patients where rib fractures are associated with significant morbidity and mortality. To date, no studies have evaluated the ability of ultrasound to detect rib fractures using cadaver models and subsequently use this model as a teaching tool.

超声引导下连续腹横肌平面阻滞对开腹直肠癌根治术患者术后早期恢复质量的影响

目的评价超声引导下连续腹横肌平面阻滞对开腹直肠癌根治术患者术后镇痛及早期恢复质量的影响。方法择期全麻下行开腹直肠癌根治术患者60例,男33例,女27例,年龄45～65岁,ASAⅠ或Ⅱ级。随机分为两组:连续腹横肌平面阻滞组(T组)和患者自控静脉镇痛组(C组),每组30例。T组麻醉诱导后行超声引导下双侧腹横肌平面阻滞,分别注入0.25%罗哌卡因20 ml,术毕双侧分别输注0.25%罗哌卡因5 ml/h。C组术毕采用舒芬太尼1μg/ml行PCIA。记录首次下床时间、术后首次排气时间、住院时间和补救镇痛情况;记录术后不良反应的发生情况;分别于术前1 d、术后3 d采用40项恢复质量评分量表(QoR-40量表)评估患者恢复质量。结果与C组比较,T组首次下床时间、肠道功能恢复时间明显缩短(P0.05);补救镇痛率和恶心呕吐发生率明显降低(P0.05)。T组未见腹横肌平面阻滞相关并发症的发生。术后3 d T组的情绪状态评分、身体舒适度评分、心理支持评分、疼痛评分及总评分明显高于C组(P0.05)。结论超声引导下连续腹横肌平面阻滞用于开腹直肠癌根治术患者术后镇痛效果满意,提高患者术后早期恢复质量。