Ultrasonographic Assessment of Entheseal Sites of Upper and Lower Extremities in Hemodialysis Patients using Madrid Sonography Enthesitis Index

Background Musculoskeletal (MSK) complications are one of the most common health concerns that impact individuals on maintenance hemodialysis (HD). However, little is known about the entheseal involvement in HD patients. The aim of this study was to assess the prevalence and distribution of entheseal ultrasonographic (US) alterations in HD patients and to evaluate the association between US findings and both clinical and laboratory data.Methods: This study was conducted on 41 HD and 23 sex- and age- matched controls. All HD patients and healthy controls were evaluated clinically to detect any clinical evidence of enthesopathy. Six entheses sites were scanned bilaterally using grey scale (GS) and power Doppler (PD) ultrasonography (US) and were scored using Madrid Sonography Enthesitis Index (MASEI) scoring system. Results:Clinical examination revealed at least one sign suggestive of enthesopathy in 69 (14.02) of 492 entheses in 41 HD patients. HD patients had statistically significant higher scores of stuctural tendon abnormalities (p<0.001), enthesis thickening (p<0.001), bone erosions (p<0.001) and calcification (p=0.037) than healthy controls. Total MASEI score was higher in HD patients than healthy controls (median ;18 vs 8, p<0.001), also, MASEI-inflammatory (median ;11 vs 3, p<0.001) and damage scores (median ;6 vs 0, p<0.001). There was a statistically significant positive association between total MASEI score and both age (p=0.032) and duration of HD (p=0.037). Duration of HD was predictive for both MASEI-damage component (p=0.004) and total MASEI score (p=0.014).Conclusions: There is a high prevalence of asymptomatic enthesopathy in HD patients. The burden of entheseal US alterations is much higher in HD patients than in healthy subjects. US can be helpful in the early detection of entheseal abnormalities. The duration of HD is the most significant predictor of enthesopathy in HD patients.

Signs of neuroinflammation outweigh neurodegeneration as predictors for early conversion to MS

Background The pathophysiological mechanisms underlying multiple sclerosis include both inflammatory and degenerative processes. We aimed to study and compare markers of neuroinflammation and neurodegeneration in patients with first presentation of demyelinating disorder and to prospectively identify which of the studied markers serve as predictors for early conversion to multiple sclerosis. Thus, 42 patients with first clinical manifestations suggestive of demyelinating disease were included in a prospective study. Subjects underwent thorough history taking and clinical evaluation. Laboratory studies involved analysis of cerebrospinal fluid (CSF) and serum chitinase 3-like 1 levels. Brain imaging included MRI and ultrasonographic assessment. Results T1 black holes, elevated oligoclonal bands (OCB), high baseline T2 lesion load, and enhanced MRI lesions were significantly higher in patients with 1st attack multiple sclerosis. Significantly higher CSF-OCB and serum chitinase 3-like 1 protein was detected in patients with multiple sclerosis (MS) compared to clinically isolated syndrome, and higher levels in MS convertors than non-convertors. Cognitive dysfunction evaluated by MoCA test and brain atrophy assessed using transcranial sonography did not show significant difference among the studied groups. Logistic regression analysis showed that heavy T2 lesion load served as the only predictor of conversion to MS. Conclusion Early conversion to MS after first attack of demyelination is related to detection of signs of neuroinflammation rather than neurodegeneration.

Ultrasonographic assessment of diaphragmatic contraction and relaxation properties: correlations of diaphragmatic displacement with oesophageal and transdiaphragmatic pressure

Transdiaphragmatic (Pdi) and oesophageal pressures (Pes) are useful in understanding the pathophysiology of the respiratory system. They provide insight into respiratory drive, intrinsic positive end-expiratory pressure, diaphragmatic fatigue and weaning failure.BackgroundThe use of Pdi and Pes in clinical practice is restricted due to the invasiveness of the technique and the cumbersome equipment needed. On the other hand, diaphragmatic displacement is non-invasively and easily assessed with M-mode ultrasound.PurposeWe observed striking similarities in shape and magnitude between M-mode diaphragmatic displacement, Pes and Pdi pressures. The study aimed to evaluate if the information provided by these two pressures could be obtained non-invasively from the diaphragmatic displacement curve.Material and methodsIn 14 consecutive intubated patients undergoing a weaning trial, simultaneous recordings of Pes and Pdi pressures and the diaphragmatic displacement were assessed while breathing spontaneously and during a sniff-like manoeuvre. Moreover, the slope of the diaphragmatic displacement curve during relaxation was compared with the maximal relaxation rate (MRR) obtained from the Pdi curve.ResultsMore than 200 breaths were analysed in pairs. Diaphragmatic displacement significantly correlated with Pdi (R2=0.33, p<0.001) and Pes (R2=0.44, p<0.001), and this correlation further improved during sniff (R2=0.47, p<0.001) and (R2=0.64, p<0.001), respectively. Additionally, a significant correlation was found between the relaxation slope derived from the diaphragmatic displacement curve and the MRR derived from the Pdi curve, both in normal breathing (R2=0.379, p<0.001) and during the sniff manoeuvre (R2=0.71, p<0.001).ConclusionsM-mode diaphragmatic displacement parameters correlate well with the ones obtained from oesophageal pressure and Pdi, particularly during sniffing. Diaphragmatic displacement assessment possibly offers an alternative non-invasive solution for understanding and clinically monitoring the diaphragmatic contractile properties and weaning failure due to diaphragmatic fatigue.

Ultrasonographic assessment of the caudal vena cava diameter in cats during blood donation

Objectives Ultrasonography of the caudal vena cava (CVC) has been previously established to assess fluid status in dogs but not in cats. The aim of this study was to determine CVC diameter changes during feline blood donation. Methods Inter- and intra-observer variability were assessed in 11 client-owned cats. Minimal and maximal CVC diameters were assessed longitudinally in the subxiphoid view (SV) and right paralumbar view (PV), and transversely in the right hepatic intercostal view (HV). Eighteen client-owned, healthy, anaesthetised cats were evaluated during 21 blood donation procedures of 10 ml/kg in the same anatomical locations before (T0) and after (T1) blood donation, and after volume resuscitation with 30 ml/kg lactated Ringer’s solution (T2). The CVC index was calculated. Results Intra-observer variability was acceptable for all probe positions, except for the HV, whereas inter-observer variability was considered unacceptable for all probe positions. Complete measurements were obtained during 21 blood donations at T0, T1 and T2 at the SV, during 18/21 blood donations at the HV and during 16/21 blood donations at the PV. At the SV, the minimal CVC diameter between T1 and T2 ( P <0.001), and the maximal CVC diameter between T0 and T1 and between T1 and T2 ( P <0.001) were significantly different. At the HV, the minimal vertical diameter, maximal vertical diameter and minimal horizontal diameter were different between all timepoints ( P <0.001). The maximal horizontal diameter was different between T1 and T2 ( P = 0.002). At the PV, both diameters were different between all timepoints ( P <0.001). The CVC index was not different between timepoints. Conclusion and relevance Significant probe position dependent CVC diameter changes with marked overlap were observed before and after blood donation, and after fluid bolus. No absolute CVC diameter could be used to indicate hypovolaemia. Ultrasonographic assessment of the feline CVC is highly operator-dependent. The CVC index is not useful in cats.