Inter-rater reliability of optic nerve sheath diameter measurement using real-time ultrasonography

Objectives Ultrasound measurement of the optic nerve sheath diameter (ONSD) is a rapid, non-invasive means to indirectly assess intracranial pressure. Previous research has demonstrated the ability of emergency physicians to measure ONSD accurately with bedside ultrasound when compared to CT scan or MRI, however the reliability of this measurement between two or more operators has been called into question (Hassen et al. in J Emerg Med 48:450–457, 2015; Shirodkar et al. in Ind J Crit Care Med 19:466–470, 2015). Given the need for accurate and precise measurement to use this as a screening exam, we sought to determine the inter-rater reliability between ONSD measurements obtained in real time by fellowship-trained emergency ultrasound physicians. Methods Three ultrasound fellowship-trained emergency physicians measured bilateral ONSD of 10 healthy volunteers using a high-frequency linear transducer. The physicians were blinded to the other scanners’ measurements, and no instructions were given other than to obtain the ONSD. Each sonographer measured the ONSD in real time and it was recorded by a research coordinator. All measurements were recorded in millimeters. Intraclass correlation coefficients (ICCs) were calculated to estimate the inter-rater reliability. Results A total of 60 measurements of ONSD were obtained. The average measurement was 4.3 mm (3.83–4.77). Very little variation was found between the three physicians, with a calculated ICC of 0.82 (95% confidence interval 0.63–0.92). Conclusions ONSD measurement obtained by ultrasound fellowship-trained emergency medicine physicians is a reliable measurement with a high degree of correlation between scanners.

HEPATIC STEATOSIS IN SCHOOLCHILDREN AND ADOLESCENTS WITH CENTRAL OBESITY

Introduction: Non-alcoholic hepatic steatosis is defined as the excessive accumulation of adipose tissue in the absence of alcohol consumption, being rare in the pediatric population. However, with the advent of the twentieth century pandemic, such as obesity, this pathology has increased its incidence, as well as others that belong to the metabolic syndrome. Objective: To determine the presence of hepatic steatosis in schoolchildren and adolescents with central obesity. Methods: observational, descriptive and cross-sectional research. The sample was of a census type, represented by 32 schoolchildren and adolescents who met the inclusion criteria, which are: age between 6 and 19 with central obesity - prior signing the informed consent. They underwent measurement of the waist circumference, abdominal ultrasound, measurement of the lipid profile and the determination of the level of physical activity through the application of the Pictorial Questionnaire of Infant Physical Activity. Results: 32 patients were studied, 18 (56.3%) male, adolescents 59.37%. With normal ultrasound (29/32) and with hepatic steatosis (3/32), of which 66.7% are grade II and 33.3% are grade III. Hypertriglyceridemia and borderline triglyceride levels 81.27% and hypercholesterolemia and borderline cholesterol levels 75%. Conclusion: School and adolescent patients with central obesity have borderline lipid profiles or dyslipidemia, in which, despite belonging to the pediatric population, moderate and severe cases of hepatic steatosis are evident. Keywords: fatty liver, non-alcoholic fatty liver disease, dyslipidemia, obesity.

Pyruvate Might Bridge Gut Microbiota and Muscle Health in Aging Mice After Chronic High Dose of Leucine Supplementation

Background: The previous studies demonstrated that there might be complex and close relationships among leucine supplementation, gut microbiota, and muscle health, which still needs further investigation.Aims: This study aimed to explore the associations of gut microbiota with muscle health after leucine intake.Methods: In this study, 19-month-old male C57BL/6j mice (n = 12/group) were supplemented with ultrapure water, low dose of leucine (500 mg/kg·d), and high dose of leucine (1,250 mg/kg·d) for 12 weeks by oral gavage. The mice fecal samples in each group before and after supplementation were collected for baseline and endpoint gut microbiota analysis by using 16S rDNA amplicon sequencing. Meanwhile, ultrasound measurement, H&E staining, myofiber cross-sectional area (CSA) measurement, and western blotting were performed in the quadriceps subsequently. The pyruvate levels were detected in feces.Results: Improvement in muscle of histology and ultrasonography were observed after both low and high dose of leucine supplementation. High dose of leucine supplementation could promote skeletal muscle health in aging mice via regulating AMPKα/SIRT1/PGC-1α. The richness and diversities of microbiota as well as enriched metabolic pathways were altered after leucine supplementation. Firmicutes-Bacteroidetes ratio was significantly decreased in high-leucine group. Moreover, pyruvate fermentation to propanoate I were negatively associated with differential species and the pyruvate levels were significantly increased in feces after high dose of leucine supplementation.Conclusions: Chronic high dose of leucine supplementation changed gut microbiota composition and increased pyruvate levels in the feces, which possibly provides a novel direction for promoting muscle health in aging mice.

A Comprehensive Prospective Comparison of Acute Skin Toxicity after Hypofractionated and Normofractionated Radiation Therapy in Breast Cancer

The current study aims to determine whether hypofractionated radiotherapy (HF) leads to lower rates of acute radiodermatitis compared to conventional normofractionated radiotherapy (CF). A total of 166 patients with invasive breast cancer or DCIS were included in a prospective cohort study. Evaluation of acute radiodermatitis was obtained before radiotherapy, at the end of the treatment (T1), and 6 weeks after the treatment (T2) using CTCAE (v5.0) scores, the Skindex-16 questionnaire, and ultrasound measurement of the skin. CTCAE and Skindex-16 scores in the CF-group were significantly higher compared to the HF group indicating more pronounced side effects at the end of the treatment (CTCAE: CF-RT 1.0 (IQR: 0.0) vs. HF-RT 0.0 (0.25); p = 0.03; Skindex-16: CF: 20.8 (IQR: 25.8); HF: 8.3 (27.1); p = 0.04). At 6 weeks after the treatment, no significant differences between the two fractionation schemes were observed. Ultrasound based assessment showed that the skin thickness in the treated breast was higher compared to the healthy breast at all time-points. However, no significant difference between HF and CF was seen either at T1 or T2. The current study complements and confirms pre-existing evidence that HF leads to a lower degree of acute radiodermatitis and better patient reported outcome compared to CF at the end of treatment. This should be considered whenever fractionation of adjuvant breast cancer treatment is being discussed.

The Relationship between Skinfold and Ultrasound Measures of Subcutaneous Fat in Untrained Healthy Males

Ultrasound measurement of adipose tissue offers an alternative measure of body composition with less technical skill requirement than skinfolds. However, the relationship between skinfold and ultrasound measurements of adipose tissue is uncertain. The aim of this study was to compare these measures in a healthy untrained male population. One hundred male participants (aged 18–40 years) of varying body compositions had skinfold measures taken at the biceps, triceps and front thigh sites. Ultrasound measures were also taken at the same sites using B-wave ultrasound with a linear probe in the transverse plane. Strong, significant (p < 0.01), positive correlations were observed between skinfold and ultrasound measures at the biceps (r = 0.828), triceps (r = 0.813), and front thigh (r = 0.888) sites. However, there was significant (p < 0.01) variance between the techniques at all measurement sites. Whilst skinfold and ultrasound measures of adipose tissue have good linear agreement, skinfolds are consistently higher at all sites indicating a difference in the nature of the tissue measured via each technique. The exact nature of the relationship should be established on a population-specific basis.

Erratum: Body fat evaluation in Colombian Paso horses

The body condition score (BCS) is insufficient in determining the amount of body fat in horses, thus defining obesity. Measurement of the subcutaneous fat thickness (SFT) by ultrasonography should be considered as an appropriate method in the definition of fat distribution at different body locations in horses. Therefore, this study aimed to 1) characterize the SFT in three different anatomical locations (i.e. neck, lumbar region, and gluteal region); 2) evaluate the relationship between BCS and SFT; 3) determine the influence of gender, weight, age, and gait on BCS and SFT measurements, and 4) explore the agreement between the morphometric measurements [i.e. body mass index (BMI), girth circumference: height at withers ratio (GC: HW), neck circumference: height at withers ratio (NC: HW)], and BCS and SFT in a population of Colombian Paso Horses (CPHs). The Henneke’s body condition scoring was applied to 69 adult CPHs, selected using a convenience sampling. Additionally, BMI, GC: HW, and NC: HW were calculated. Body fat percentage (BF%) was calculated by ultrasound measurement of the SFT in the neck, lumbar region, and gluteal region. The BF% in the CPHs was 6.4 ± 1.1. The GC: HW, NC: HW, and BMI were not predictors of the BF% or BCS, and neither gender nor gait was decisive in the definition of fattening in the study animals, although age and weight were determining variables. According to our results, ultrasound is an adequate tool to calculate the BF% of the CPHs. However, it must be accompanied by Henneke’s BCS assessment.