scholarly journals Artifactual Lung Ultrasonography: It Is a Matter of Traps, Order, and Disorder

2020 ◽  
Vol 10 (5) ◽  
pp. 1570 ◽  
Author(s):  
Gino Soldati ◽  
Andrea Smargiassi ◽  
Libertario Demi ◽  
Riccardo Inchingolo
Keyword(s):  
Lung Ultrasound ◽  
Current Knowledge ◽  
Acoustic Properties ◽  
Non Invasive ◽  
The Past ◽  
Order And Disorder ◽  
Pathological Conditions ◽  
The Individual ◽  
B Lines

When inspecting the lung with standard ultrasound B-mode imaging, numerous artifacts can be visualized. These artifacts are useful to recognize and evaluate several pathological conditions in Emergency and Intensive Care Medicine. More recently, the interest of the Pulmonologists has turned to the echographic study of the interstitial pathology of the lung. In fact, all lung pathologies which increase the density of the tissue, and do not consolidate the organ, are characterized by the presence of ultrasound artifacts. Many studies of the past have only assessed the number of vertical artifacts (generally known as B-Lines) as a sign of disease severity. However, recent observations suggest that the appearance of the individual artifacts, their variability, and their internal structure, may play a role for a non-invasive characterization of the surface of the lungs, directing the diagnoses and identifying groups of diseases. In this review, we discuss the meaning of lung ultrasound artifacts, and introduce hypothesis on the correlation between their presence and the structural variation of the sub-pleural tissue in light of current knowledge of the acoustic properties of the pleural plane.

90 Lung ultrasound in pediatric asthma patients: A pilot study characterizing findings at baseline stat

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e65-e66
Author(s):  
Noah Marzook ◽  
Alexander Dubrovsky
Keyword(s):  
Pediatric Patients ◽  
Lung Ultrasound ◽  
Demographic Data ◽  
Tertiary Care ◽  
Challenge Test ◽  
Primary Objective ◽  
Upper Respiratory Tract ◽  
The Past ◽  
Asthma Patients ◽  
B Lines

Abstract Primary Subject area Emergency Medicine - Paediatric Background Unlike the lung ultrasound (LU) findings of pneumonia, bronchiolitis, pleural effusions and pneumothorax, which have all been well described, the sonographic pattern of asthma remains unclear. Previous pediatric studies have shown that pediatric patients with acute asthma exacerbations had positive LU findings. It is also unclear whether these findings were the result of acute infections associated with the exacerbation or if the findings would be present at baseline, outside an exacerbation in an asthmatic patient. Objectives The primary objective of this study is to characterize lung ultrasound (LU) findings in stable asthma pediatric patients presenting in a tertiary care asthma or respiratory clinic. Design/Methods Eligible patients >6 years of age, underwent a LU by the study sonographer between December 19, 2017 to June 25, 2019, during their regular follow up visit at the pulmonology clinic or scheduled pulmonary function test. Patients were defined as asthmatic if they had a positive methacholine challenge test (MCT) or spirometry at the day of the visit or in the past. Patients were excluded if they had an upper respiratory tract infection in the past 4 weeks, or had any other known pulmonary diseases. Baseline demographic and asthma severity (ISAAC score, ACQ-7) questionnaires were filled out by the patients, following which they underwent a LU by a novice sonographer using a 6-zone protocol. A blinded expert sonographer interpreted the images offline. A positive LU was defined as presence of more than 3 B-lines, consolidation (<1cm or >1cm), absent lung slide, and/or presence of pleural fluid. Results Fifty-two patients were enrolled in the study and 19.2% (CI 8.31-30.15) of the asthma patients had positive LU findings. The positive LU findings were diverse including B-lines (80%), small consolidation (80%), pleural line anomalies (10%). Positive LU findings were not correlated to any demographic value. Conclusion In our study, 19.2% of asthma patients at baseline have a positive LU. Lung consolidations larger than 1 cm were rarely seen. There were no significant differences between demographic data in asthmatic patients with positive compared to those with negative LUS. This positive LU scan rate is in keeping with a prior study on LU in pediatrics.

scholarly journals Antibiotic resistance: turning evolutionary principles into clinical reality

2020 ◽  
Vol 44 (2) ◽  
pp. 171-188 ◽  
Author(s):  
Dan I Andersson ◽  
Nathalie Q Balaban ◽  
Fernando Baquero ◽  
Patrice Courvalin ◽  
Philippe Glaser ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Environmental Control ◽  
Current Knowledge ◽  
Population Level ◽  
Modern Medicine ◽  
Future Research ◽  
Bacterial Physiology ◽  
The Past ◽  
Clinical Reality ◽  
The Individual

ABSTRACT Antibiotic resistance is one of the major challenges facing modern medicine worldwide. The past few decades have witnessed rapid progress in our understanding of the multiple factors that affect the emergence and spread of antibiotic resistance at the population level and the level of the individual patient. However, the process of translating this progress into health policy and clinical practice has been slow. Here, we attempt to consolidate current knowledge about the evolution and ecology of antibiotic resistance into a roadmap for future research as well as clinical and environmental control of antibiotic resistance. At the population level, we examine emergence, transmission and dissemination of antibiotic resistance, and at the patient level, we examine adaptation involving bacterial physiology and host resilience. Finally, we describe new approaches and technologies for improving diagnosis and treatment and minimizing the spread of resistance.

scholarly journals Bimodal microwave and ultrasound phantoms for non-invasive clinical imaging

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Enrique Villa ◽  
Natalia Arteaga-Marrero ◽  
Javier González-Fernández ◽  
Juan Ruiz-Alzola
Keyword(s):  
Dielectric Properties ◽  
Soft Tissues ◽  
Sucrose Concentration ◽  
Acoustic Properties ◽  
Gelling Agent ◽  
Non Invasive ◽  
Significant Performance ◽  
Cole Model ◽  
Ultrasound Applications

AbstractA precise and thorough methodology is presented for the design and fabrication of bimodal phantoms to be used in medical microwave and ultrasound applications. Dielectric and acoustic properties of human soft tissues were simultaneously mimicked. The phantoms were fabricated using polyvinyl alcohol cryogel (PVA-C) as gelling agent at a 10% concentration. Sucrose was employed to control the dielectric properties in the microwave spectrum, whereas cellulose was used as acoustic scatterer for ultrasound. For the dielectric properties at microwaves, a mathematical model was extracted to calculate the complex permittivity of the desired mimicked tissues in the frequency range from 500 MHz to 20 GHz. This model, dependent on frequency and sucrose concentration, was in good agreement with the reference Cole–Cole model. Regarding the acoustic properties, the speed of sound and attenuation coefficient were employed for validation. In both cases, the experimental data were consistent with the corresponding theoretical values for soft tissues. The characterization of these PVA-C phantoms demonstrated a significant performance for simultaneous microwave and ultrasound operation. In conclusion, PVA-C has been validated as gelling agent for the fabrication of complex multimodal phantoms that mimic soft tissues providing a unique tool to be used in a range of clinical applications.

scholarly journals Liver Fibrosis: Causes and Methods of Assessment, A Review

2015 ◽  
Vol 53 (4) ◽  
pp. 304-314 ◽  
Author(s):  
Ali Erfani Karimzadeh Toosi
Keyword(s):  
Liver Fibrosis ◽  
Liver Biopsy ◽  
Hepatic Dysfunction ◽  
Current Knowledge ◽  
Treatment Strategies ◽  
Future Research ◽  
Progressive Development ◽  
Non Invasive ◽  
The Past ◽  
Invasive Method

AbstractHepatic fibrogenesis is the final result of injury to the liver. Fibrosis could lead to hepatic dysfunction, important in the pathogenesis of other chronic problems. Therefore, understanding the mechanism, accurate diagnosis and staging of it in early stages accelerates the treatment and reduces the prevalence of chirrosis. Treatment strategies of liver problems and detction methods depend on the amount and progression of liver fibrosis and the rate of cirrhosis development. Traditionally the invasive method, liver biopsy, is reference standard to follow progression and stage of fibrosis. However, during the past decade, progressive development of novel non-invasive methodologies has challenged the invasive method. Non-invasive methods have been initially introduced for chronic hepatitis C with increasing use in other chronic liver diseases. The need for liver biopsy has nowadays decreased significantly as a result of these methodologies. Most of the new non-invasive methods depend on either ‘biological’ or ‘physical’ approaches.In this review, starting from the mechanism of fibrogenesis, the current knowledge about diagnosis, treatment strategies and different methods for its evaluation is discussed. This is followed by a conclusion on what is expected to be known in this field during the future research.

scholarly journals Milky Lungs: Ultrasonographic Findings in Pediatric Acute Respiratory Distress Syndrome

2020 ◽  
Vol 2 (1) ◽  
pp. 1
Author(s):  
Naumovski Filip ◽  
Toleska Marija ◽  
Kuzmanovska Biljana ◽  
Kartalov Andrijan ◽  
Trposka Angela
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Gas Exchange ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Lung Ultrasound ◽  
Surgical Intensive Care Unit ◽  
Non Invasive ◽  
Arterial Blood ◽  
B Lines

Diagnosis and following up the dynamics of Pediatric Acute Respiratory Distress Syndrome demand a more feasible, non-invasive and bedside tool, such as lung ultrasound, for monitoring the damaged lungs. We report on a 6-month-old child admitted in our Pediatric Surgical Intensive Care Unit with a clinical presentation of ileus and concomitant community acquired pneumonia. Lung ultrasound (LUS) examinations according to the BLUE Protocol were done several times during the hospital stay. A-lines were seen at admission in the upper segments, but 2–3 B-lines were present in the posterolateral segments bilaterally. Later on, separated and coalescent B-lines were seen. White lung parenchyma or milky lungs with a thickened pleural line were seen, while the worst gas exchange according to the results of Arterial Blood Gases (ABGs) has been detected. According to the findings, as many B-lines will be detected, as the severeness of lung damage and gas exchange impairement. The improvement of the gas exchange with the disappearance of the coalescent B-lines was seen later on, after ventilating the child in a prone position. Bedsides, LUS is a feasible and non-invasive point of care method that could be used for diagnosing Pediatric Acute Respiratory Distress Syndrome (PARDS) but in guiding therapy of the damaged lungs, also. The finding of diffuse, coalescent and homogenous B-lines interpreted as “Milky lungs” is consistent with the diagnosis of PARDS.

scholarly journals Advances in lung ultrasound

2016 ◽  
Vol 14 (3) ◽  
pp. 443-448 ◽  
Author(s):  
Miguel José Francisco Neto ◽  
Antonio Rahal Junior ◽  
Fabio Augusto Cardillo Vieira ◽  
Paulo Savoia Dias da Silva ◽  
Marcelo Buarque de Gusmão Funari
Keyword(s):  
Lung Ultrasound ◽  
Imaging Modality ◽  
Quantitative Information ◽  
Chest Ultrasonography ◽  
Qualitative And Quantitative ◽  
Lung Consolidation ◽  
Pathological Conditions ◽  
Pleural Line ◽  
Sonographic Patterns ◽  
B Lines

ABSTRACT Ultrasound examination of the chest has advanced in recent decades. This imaging modality is currently used to diagnose several pathological conditions and provides qualitative and quantitative information. Acoustic barriers represented by the aerated lungs and the bony framework of the chest generate well-described sonographic artifacts that can be used as diagnostic aids. The normal pleural line and A, B, C, E and Z lines (also known as false B lines) are artifacts with specific characteristics. Lung consolidation and pneumothorax sonographic patterns are also well established. Some scanning protocols have been used in patient management. The Blue, FALLS and C.A.U.S.E. protocols are examples of algorithms using artifact combinations to achieve accurate diagnoses. Combined chest ultrasonography and radiography are often sufficient to diagnose and manage lung and chest wall conditions. Chest ultrasonography is a highly valuable diagnostic tool for radiologists, emergency and intensive care physicians.

scholarly journals A Metabolomic Perspective on Coeliac Disease

2014 ◽  
Vol 2014 ◽  
pp. 1-13 ◽  
Author(s):  
Antonio Calabrò ◽  
Ewa Gralka ◽  
Claudio Luchinat ◽  
Edoardo Saccenti ◽  
Leonardo Tenori
Keyword(s):  
Energy Metabolism ◽  
Coeliac Disease ◽  
Tissue Cell ◽  
Clinical Tool ◽  
The Past ◽  
Pathological Conditions ◽  
Metabolic Fingerprint ◽  
Complete Set

Metabolomics is an “omic” science that is now emerging with the purpose of elaborating a comprehensive analysis of the metabolome, which is the complete set of metabolites (i.e., small molecules intermediates) in an organism, tissue, cell, or biofluid. In the past decade, metabolomics has already proved to be useful for the characterization of several pathological conditions and offers promises as a clinical tool. A metabolomics investigation of coeliac disease (CD) revealed that a metabolic fingerprint for CD can be defined, which accounts for three different but complementary components: malabsorption, energy metabolism, and alterations in gut microflora and/or intestinal permeability. In this review, we will discuss the major advancements in metabolomics of CD, in particular with respect to the role of gut microbiome and energy metabolism.

scholarly journals B-Lines Scores Derived From Lung Ultrasound Provide Accurate Prediction of Extravascular Lung Water Index: An Observational Study in Critically Ill Patients

2020 ◽  
pp. 088506662096765 ◽  
Author(s):  
Ulrich Mayr ◽  
Marina Lukas ◽  
Livia Habenicht ◽  
Johannes Wiessner ◽  
Markus Heilmaier ◽  
...  
Keyword(s):  
Pulmonary Edema ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Extravascular Lung Water ◽  
Lung Ultrasound ◽  
Lung Water ◽  
Extravascular Lung Water Index ◽  
Water Index ◽  
Non Invasive ◽  
B Lines

Introduction: Visualization of B-lines via lung ultrasound provides a non-invasive estimation of pulmonary hydration. Extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) assessed by transpulmonary thermodilution (TPTD) represent the most validated parameters of lung water and alveolocapillary permeability, but measurement is invasive and expensive. This study aimed to compare the correlations of B-lines scores from extensive 28-sector and simplified 4-sector chest scan with EVLWI and PVPI derived from TPTD in the setting of intensive care unit (primary endpoint). Methods: We performed scoring of 28-sector and 4-sector B-Lines in 50 critically ill patients. TPTD was carried out with the PiCCO-2-device (Pulsion Medical Systems SE, Maquet Getinge Group). Median time exposure for ultrasound procedure was 12 minutes for 28-sector and 4 minutes for 4-sector scan. Results: Primarily, we found close correlations of 28-sector as well as 4-sector B-Lines scores with EVLWI (R2 = 0.895 vs. R2 = 0.880) and PVPI (R2 = 0.760 vs. R2 = 0.742). Both B-lines scores showed high accuracy to identify patients with specific levels of EVLWI and PVPI. The extensive 28-sector B-lines score revealed a moderate advantage compared to simplified 4-sector scan in detecting a normal EVLWI ≤ 7 (28-sector scan: sensitivity = 81.8%, specificity = 94.9%, AUC = 0.939 versus 4-sector scan: sensitivity = 81.8%, specificity = 82.1%, AUC = 0.902). Both protocols were approximately equivalent in prediction of lung edema with EVLWI ≥ 10 (28-sector scan: sensitivity = 88.9%, specificity = 95.7%, AUC = 0.977 versus 4-sector scan: sensitivity = 81.5%, specificity = 91.3%, AUC = 0.958) or severe pulmonary edema with EVLWI ≥ 15 (28-sector scan: sensitivity = 91.7%, specificity = 97.4%, AUC = 0.995 versus 4-sector scan: sensitivity = 91.7%, specificity = 92.1%, AUC = 0.978). As secondary endpoints, our evaluations resulted in significant associations of 28-sector as well as simplified 4-sector B-Lines score with parameters of respiratory function. Conclusion: Both B-line protocols provide accurate non-invasive evaluation of lung water in critically ill patients. The 28-sector scan offers a marginal advantage in prediction of pulmonary edema, but needs substantially more time than 4-sector scan.

scholarly journals Signs and lines in lung ultrasound

2021 ◽  
Vol 21 (86) ◽  
pp. e225-e233
Author(s):  
Rohit Bhoil ◽  
◽  
Ajay Ahluwalia ◽  
Rajesh Chopra ◽  
Mukesh Surya ◽  
...  
Keyword(s):  
Critical Care ◽  
Pleural Effusion ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Colour Doppler ◽  
Lung Density ◽  
Pathological Conditions ◽  
B Lines ◽  
Lung Point

Point-of-care ultrasound has become firmly established in acute and critical care settings, and is now increasingly being used as an important tool in the assessment of the lungs. In this article, we briefly describe the technique of lung ultrasound and the various lines and signs commonly encountered during sonography of the lung, namely the normally visualised A- and T-lines and the bat sign, sliding sign (power slide sign on colour Doppler), sea-shore sign, curtain sign, and the lung pulse. We have also described signs seen in various pathological conditions like B-lines seen in cases of increased lung density; the quad sign, sinusoid sign, thoracic spine sign, plankton sign and the jelly fish sign seen in pleural effusion; the stratosphere sign and the lung point sign seen in pneumothorax; the shred/fractal sign and tissue-like sign in consolidation, and the double lung point sign seen in transient tachypnoea of the newborn. With adequate and appropriate training, lung ultrasound can be effectively utilised as a pointof-care investigation.

scholarly journals Ethosome: a novel vesicular carrier for transdermal drug delivery

2018 ◽  
Vol 8 (6) ◽  
pp. 318-326 ◽  
Author(s):  
Saquib Raza Zahid ◽  
Neeraj Upmanyu ◽  
Surendra Dangi ◽  
Sudhir Kumar Ray ◽  
Prabhat Jain ◽  
...  
Keyword(s):  
Drug Delivery ◽  
Cultured Cells ◽  
Systemic Circulation ◽  
Bioactive Molecules ◽  
Biomedical Sciences ◽  
Double Blind ◽  
Non Invasive ◽  
The Past ◽  
Randomized Clinical Study

Delivery across skin is striking due to its easy convenience. However, drug delivery across skin is still a confront in biomedical sciences. Over the past few decades, various successful narrative devices and techniques have emerged to optimize drug delivery across skin whose barricading behaviour constricts entry of most of the therapeutic agents. Ethosomes are non-invasive delivery transporter that enables drugs to reach the deep skin layers and/or the systemic circulation. Although ethosomal systems are theoretically sophisticated, they are characterized by simplicity in their preparation, efficacy and safety. A combination that can highly inflate their application. Ethosomes are soft, malleable vesicles adapted for enhanced delivery of active agents. This article reviews work carried out method of preparation, application and characterization of ethosomal systems. Because of their exceptional structure, ethosomes are able to encapsulate and deliver through the skin highly lipophilic molecules such as testosterone, cannabinoids and minoxidil as well as cationic drugs such as trihexyphenidil and propranolol. Results obtained in a double-blind two-armed randomized clinical study showed that treatment with the ethosomal acyclovir formulation appreciably improved all the evaluated parameters. In further work, the ethosomal expertise was broadened to introduce agents into cultured cells and microorganisms. Enhanced delivery of bioactive molecules through the skin and cellular membranes by means of an ethosomal transporter opens numerous confronts and prospects for the research and future development of novel improved therapies. Keywords: Ethosomes, Skin layers, Characterization

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