Search results for: ultrasound disintegration
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 533

Search results for: ultrasound disintegration

353 Diagnosis of Choledocholithiasis with Endosonography

Authors: A. Kachmazova, A. Shadiev, Y. Teterin, P. Yartcev

Abstract:

Introduction: Biliary calculi disease (LCS) still occupies the leading position among urgent diseases of the abdominal cavity, manifesting itself from asymptomatic course to life-threatening states. Nowadays arsenal of diagnostic methods for choledocholithiasis is quite wide: ultrasound, hepatobiliscintigraphy (HBSG), magnetic resonance imaging (MRI), endoscopic retrograde cholangiography (ERCP). Among them, transabdominal ultrasound (TA ultrasound) is the most accessible and routine diagnostic method. Nowadays ERCG is the "gold" standard in diagnosis and one-stage treatment of biliary tract obstruction. However, transpapillary techniques are accompanied by serious postoperative complications (postmanipulative pancreatitis (3-5%), endoscopic papillosphincterotomy bleeding (2%), cholangitis (1%)), the lethality being 0.4%. GBSG and MRI are also quite informative methods in the diagnosis of choledocholithiasis. Small size of concrements, their localization in intrapancreatic and retroduodenal part of common bile duct significantly reduces informativity of all diagnostic methods described above, that demands additional studying of this problem. Materials and Methods: 890 patients with the diagnosis of cholelithiasis (calculous cholecystitis) were admitted to the Sklifosovsky Scientific Research Institute of Hospital Medicine in the period from August, 2020 to June, 2021. Of them 115 people with mechanical jaundice caused by concrements in bile ducts. Results: Final EUS diagnosis was made in all patients (100,0%). In all patients in whom choledocholithiasis diagnosis was revealed or confirmed after EUS, ERCP was performed urgently (within two days from the moment of its detection) as the X-ray operation room was provided; it confirmed the presence of concrements. All stones were removed by lithoextraction using Dormia basket. The postoperative period in these patients had no complications. Conclusions: EUS is the most informative and safe diagnostic method, which allows to detect choledocholithiasis in patients with discrepancies between clinical-laboratory and instrumental methods of diagnosis in shortest time, that in its turn will help to decide promptly on the further tactics of patient treatment. We consider it reasonable to include EUS in the diagnostic algorithm for choledocholithiasis. Disclosure: Nothing to disclose.

Keywords: endoscopic ultrasonography, choledocholithiasis, common bile duct, concrement, ERCP

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352 Effectiveness of Dry Needling with and without Ultrasound Guidance in Patients with Knee Osteoarthritis and Patellofemoral Pain Syndrome: A Systematic Review and Meta-Analysis

Authors: Johnson C. Y. Pang, Amy S. N. Fu, Ryan K. L. Lee, Allan C. L. Fu

Abstract:

Dry needling (DN) is one of the puncturing methods that involves the insertion of needles into the tender spots of the human body without the injection of any substance. DN has long been used to treat the patient with knee pain caused by knee osteoarthritis (KOA) and patellofemoral pain syndrome (PFPS), but the effectiveness is still inconsistent. This study aimed to conduct a systematic review and meta-analysis to assess the intervention methods and effects of DN with and without ultrasound guidance for treating pain and dysfunctions in people with KOA and PFPS. Design: This systematic review adhered to the PRISMA reporting guidelines. The registration number of the study protocol published in the PROSPERO database was CRD42021221419. Six electronic databases were searched manually through CINAHL Complete (1976-2020), Cochrane Library (1996-2020), EMBASE (1947-2020), Medline (1946-2020), PubMed (1966-2020), and Psychinfo (1806-2020) in November 2020. Randomized controlled trials (RCTs) and controlled clinical trials were included to examine the effects of DN on knee pain, including KOA and PFPS. The key concepts included were: DN, acupuncture, ultrasound guidance, KOA, and PFPS. Risk of bias assessment and qualitative analysis were conducted by two independent reviewers using the PEDro score. Results: Fourteen articles met the inclusion criteria, and eight of them were high-quality papers in accordance with the PEDro score. There were variations in the techniques of DN. These included the direction, depth of insertion, number of needles, duration of stay, needle manipulation, and the number of treatment sessions. Meta-analysis was conducted on eight articles. DN group showed positive short-term effects (from immediate after DN to less than 3 months) on pain reduction for both KOA and PFPS with the overall standardized mean difference (SMD) of -1.549 (95% CI=-0.588 to -2.511); with great heterogeneity (P=0.002, I²=96.3%). In subgroup analysis, DN demonstrated significant effects in pain reduction on PFPS (p < 0.001) that could not be found in subjects with KOA (P=0.302). At 3-month post-intervention, DN also induced significant pain reduction in both subjects with KOA and PFPS with an overall SMD of -0.916 (95% CI=-0.133 to -1.699, and great heterogeneity (P=0.022, I²=95.63%). Besides, DN induced significant short-term improvement in function with the overall SMD=6.069; 95% CI=8.595 to 3.544; with great heterogeneity (P<0.001, I²=98.56%) when analyzed was conducted on both KOA and PFPS groups. In subgroup analysis, only PFPS showed a positive result with SMD=6.089, P<0.001; while KOA showed statistically insignificant with P=0.198 in short-term effect. Similarly, at 3-month post-intervention, significant improvement in function after DN was found when the analysis was conducted in both groups with the overall SMD=5.840; 95% CI=9.252 to 2.428; with great heterogeneity (P<0.001, I²=99.1%), but only PFPS showed significant improvement in sub-group analysis (P=0.002, I²=99.1%). Conclusions: The application of DN in KOA and PFPS patients varies among practitioners. DN is effective in reducing pain and dysfunction at short-term and 3-month post-intervention in individuals with PFPS. To our best knowledge, no study has reported the effects of DN with ultrasound guidance on KOA and PFPS. The longer-term effects of DN on KOA and PFPS are waiting for further study.

Keywords: dry needling, knee osteoarthritis, patellofemoral pain syndrome, ultrasound guidance

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351 Physiotherapy Program for Frozen Shoulder on Pain, Onset of Symptom and Obtaining Modalities

Authors: Narupon Kunbootsri, J. Kraipoj, K. Phandech, P. Sirasaporn

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Physiotherapy is one of the treatments for frozen shoulder but there was no data about the treatment of physiotherapy. Moreover, it is question about onset of symptom before physiotherapy program and obtaining physical modalities and delayed start physiotherapy program lead to delayed improvement. Thus the aim of this study was to investigate physiotherapy program for frozen shoulder on pain score, onset of symptom and obtaining physical modalities. A retrospective study design was conducted. 182 medical records of patients with frozen shoulder were reviewed. These frozen shoulders were treated at physiotherapy unit, department of Rehabilitation last 3 years (January, 2014- December, 2016). The data consist of onset of symptom, pain score and obtaining physical modalities were recorded. There was a statistically significant improve in pain score, pretreatment score mean 7.24±1.52 and the last follow up pain score mean 3.88± 1.0 [mean difference 3.18 with 95%CI were [2.45- 3.92]. In addition, the onset of symptoms was 145 days before obtaining physiotherapy program. The physical modalities used frequently were hot pack 14.8% and ultrasound diathermy 13.7%. In conclusion, the retrospective study show physiotherapy program including, hot pack and ultrasound diathermy seem to be useful for frozen shoulder in term of pain score. But onset of symptom is too long to start physiotherapy programs.

Keywords: frozen shoulder, physiotherapy, pain score, onset of symptom, physical modality

Procedia PDF Downloads 136
350 Recovery and Εncapsulation of Μarine Derived Antifouling Agents

Authors: Marina Stramarkou, Sofia Papadaki, Maria Kaloupi, Ioannis Batzakas

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Biofouling is a complex problem of the aquaculture industry, as it reduces the efficiency of the equipment and causes significant losses of cultured organisms. Nowadays, the current antifouling methods are proved to be labor intensive, have limited lifetime and use toxic substances that result in fish mortality. Several species of marine algae produce a wide variety of biogenic compounds with antibacterial and antifouling properties, which are effective in the prevention and control of biofouling and can be incorporated in antifouling coatings. In the present work, Fucus spiralis, a species of macro algae, and Chlorella vulgaris, a well-known species of microalgae, were used for the isolation and recovery of bioactive compounds, belonging to groups of fatty acids, lipopeptides and amides. The recovery of the compounds was achieved through the application of the ultrasound- assisted extraction, an environmentally friendly method, using green, non-toxic solvents. Moreover, the coating of the antifouling agents was done by innovative encapsulation and coating methods, such as electro-hydrodynamic process. For the encapsulation of the bioactive compounds natural matrices were used, such as polysaccharides and proteins. Water extracts that were incorporated in protein matrices were considered the most efficient antifouling coating.

Keywords: algae, electrospinning, fatty acids, ultrasound-assisted extraction

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349 Ultrasonic Extraction of Phenolics from Leaves of Shallots and Peels of Potatoes for Biofortification of Cheese

Authors: Lila Boulekbache-Makhlouf, Brahmi Fatiha

Abstract:

This study was carried out with the aim of enriching fresh cheese with the food by-products, which are the leaves of shallots and the peels of potatoes. Firstly, the conditions for extracting the total polyphenols (TPP) using ultrasound are optimized. Then, the contents of PPT, flavonoids, and antioxidant activity were evaluated for the extracts obtained by adopting the optimal parameter. On the other hand, we have carried out some physico-chemical, microbiological, and sensory analyzes of the cheese produced. The maximum PPT value of 70.44 mg GAE/g DM of shallot leaves was reached with 40% (v/v) ethanol, an extraction time of 90 min, and a temperature of 10°C. Meanwhile, the maximum TPP content of potato peels of 45.03 ± 4.16 mg GAE/g DM was obtained using an ethanol/water mixture (40%, v/v), a time of 30 min, and a temperature of 60°C and the flavonoid contents were 13.99 and 7.52 QE/g DM, respectively. From the antioxidant tests, we deduced that the potato peels present a higher antioxidant power with IC50s of 125.42 ± 2.78 μg/mL for DPPH, of 87.21 ± 7.72 μg/mL for phosphomolybdate and 200.77 ± 13.38 μg/mL for iron chelation, compared with the results obtained for shallot leaves which were 204.29 ± 0.09, 45.85 ± 3,46 and 1004.10 ± 145.73 μg/mL, respectively. The results of the physico-chemical analyzes have shown that the formulated cheese was compliant with standards. Microbiological analyzes show that the hygienic quality of the cheese produced was satisfactory. According to the sensory analyzes, the experts liked the cheese enriched with the powder and pieces of the leaves of the shallots.

Keywords: shallots leaves, potato peels, ultrasound extraction, phenolic, cheese

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348 Ultrasound/Microwave Assisted Extraction Recovery and Identification of Bioactive Compounds (Polyphenols) from Tarbush (Fluorensia cernua)

Authors: Marisol Rodriguez-Duarte, Aide Saenz-Galindo, Carolina Flores-Gallegos, Raul Rodriguez-Herrera, Juan Ascacio-Valdes

Abstract:

The plant known as tarbush (Fluorensia cernua) is a plant originating in northern Mexico, mainly in the states of Coahuila, Durango, San Luis Potosí, Zacatecas and Chihuahua. It is a branched shrub that belongs to the family Asteraceae, has oval leaves of 6 to 11 cm in length and also has small yellow flowers. In Mexico, the tarbush is a very appreciated plant because it has been used as a traditional medicinal agent, for the treatment of gastrointestinal diseases, skin infections and as a healing agent. This plant has been used mainly as an infusion. Due to its traditional use, the content and type of phytochemicals present in the plant are currently unknown and are responsible for its biological properties, so its recovery and identification is very important because the compounds that it contains have relevant applications in the field of food, pharmaceuticals and medicine. The objective of this work was to determine the best extraction condition of phytochemical compounds (mainly polyphenolic compounds) from the leaf using ultrasound/microwave assisted extraction (U/M-AE). To reach the objective, U/M-AE extractions were performed evaluating three mass/volume ratios (1:8, 1:12, 1:16), three ethanol/water solvent concentrations (0%, 30% and 70%), ultrasound extraction time of 20 min and 5 min at 70°C of microwave treatment. All experiments were performed using a fractional factorial experimental design. Once the best extraction condition was defined, the compounds were recovered by liquid column chromatography using Amberlite XAD-16, the polyphenolic fraction was recovered with ethanol and then evaporated. The recovered polyphenolic compounds were quantified by spectrophotometric techniques and identified by HPLC/ESI/MS. The results obtained showed that the best extraction condition of the compounds was using a mass/volume ratio of 1:8 and solvent ethanol/water concentration of 70%. The concentration obtained from polyphenolic compounds using this condition was 22.74 mg/g and finally, 16 compounds of polyphenolic origin were identified. The results obtained in this work allow us to postulate the Mexican plant known as tarbush as a relevant source of bioactive polyphenolic compounds of food, pharmaceutical and medicinal interest.

Keywords: U/M-AE, tarbush, polyphenols, identification

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347 Comparative Evaluation of Ultrasound Guided Internal Jugular Vein Cannulation Using Measured Guided Needle and Conventional Size Needle for Success and Complication of Cannulation

Authors: Devendra Gupta, Vikash Arya, Prabhat K. Singh

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Background: Ultrasound guidance could be beneficial in placing central venous catheters by improving the success rate, reducing the number of needle passes, and decreasing complications. Central venous cannulation set has a single puncture needle of a fixed length of 6.4 cm. However, the average distance of midpoint of IJV to the skin is around 1 cm to 2 cm. The long length needle has tendency to go in depth more than required and this is very common during learning period of any individual. Therefore, we devised a long needle with a guard which can be adjusted according to the required length. Methods: After approval from the institute ethics committee and patient’s written informed consent, a prospective, randomized, single-blinded controlled study was conducted. Adult patient aged of both sexes with ASA grade 1-2 undergoing surgery requiring internal jugular venous (IJV) access was included. After intubation, the head was rotated to the contralateral side at 30 degree head rotation on the position of the right IJV. The transducer probe a 6.5 to 13-MHz linear transducer (Sonosite, USA) had been placed at the apex of triangle with minimal pressure to avoid IJV compression. The distance from skin to midpoint of the right IJV and skin to anterior wall of Common Carotid Artery (CCA) had been done using B-mode duplex sonography with a 6.5 to 13-MHz linear transducer. Depending upon the results of randomization 420 patients had been divided into two groups of equal numbers (n=210). Group 1. USG guided right sided IJV cannulation was done with conventional (6.4 cm) needle; and Group 2. USG guided right sided IJV cannulation was done with conventional (6.4 cm) needle with guard fixed to a required length (length between skin and midpoint of IJV) by an experienced anesthesiologist. Independent observer has noted the number of attempts and occurrence of complications (CCA puncture, pneumothorax or adjacent tissue damage). Results: Demographic data were similar in both the group. The groups were comparable when considered for relationship of IJV to CCA. There was no significant difference between groups as regard to distance of midpoint of IJV to the skin (p<0.05). IJV cannulation was successfully done in single attempts in 180 (85.7%), in two attempts in 27 (12.9%) and three attempts in 3 (1.4%) in group I, whereas in single attempt in 207 (98.6%) and second attempts in 3 (1.4%) in group II (p <0.000). Incidence of carotid artery puncture was significantly more in group I (7.1%) compared to group II (0%) (p<0.000). Incidence of adjacent tissue puncture was significantly more in group I (8.6%) compared to group II (0%) (p<0.000). Conclusion: Therefore IJV catheterization using guard over the needle at predefined length with the help of real-time ultrasound results in better success rates and lower immediate complications.

Keywords: ultrasound guided, internal jugular vein cannulation, measured guided needle, common carotid artery puncture

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346 To What Extent Does Physical Activity and Standard of Competition Affect Quantitative Ultrasound (QUS) Measurements of Bone in Accordance with Muscular Strength and Anthropometrics in British Young Males?

Authors: Joseph Shanks, Matthew Taylor, Foong Kiew Ooi, Chee Keong Chen

Abstract:

Introduction: Evidences of relationship between bone, muscle and standard of competition among young British population is limited in literature. The current literature recognises the independent and synergistic effects of fat free and fat mass as the stimulus for osteogenesis. This study assessed the extent to which physical activity (PA) and standard of competition (CS) influences quantitative ultrasound (QUS) measurements of bone on a cross-sectional basis accounting for muscular strength and anthropometrics in British young males. Methods: Pre-screening grouped 66 males aged 18-25 years into controls (n=33) and district level athletes (DLAs) (n=33) as well as low (n=21), moderate (n=23) and high (n=22) physical activity categories (PACs). All participants underwent QUS measurements of bone (4 sites, i.e. dominant distal radius (DR), dominant mid-shaft tibia (DT), non-dominant distal radius (NR) and non-dominant mid-shaft tibia (NT)), isokinetic strength tests (dominant and non-dominant knee flexion and extension) and anthropometric measurements. Results: There were no significant differences between any of the groups with respect to QUS measurements of bone at all sites with regards to PACs or CS. Significant higher isokinetic strength values were observed in DLAs than controls (p < 0.05), and higher than low PACs (p < 0.05) at 60o.s-1 of concentric and eccentric measurements. No differences in subcutaneous fat thickness were found between all the groups (CS or PACs). Percentages of body fat were significantly higher (p < .05) in low than high PACs and CS groups. There were significant positive relationships between non dominant radial speed of sound and fat free mass at both DR (r=0.383, p=0.001) and NR (r=0.319, p=0.009) sites in all participants. Conclusion: The present study findings indicated that muscular strength and body fat are closely related to physical activity level and standard of competition. However, bone health status reflected by quantitative ultrasound (QUS) measurements of bone is not related to physical activity level and standard of competition in British young males.

Keywords: bone, muscular strength, physical activity, standard of competition

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345 Sequential Pulsed Electric Field and Ultrasound Assisted Extraction of Bioactive Enriched Fractions from Button Mushroom Stalks

Authors: Bibha Kumari, Nigel P. Brunton, Dilip K. Rai, Brijesh K. Tiwari

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Edible mushrooms possess numerous functional components like homo- and hetero- β-glucans [β(1→3), β(1→4) and β(1→6) glucosidic linkages], chitins, ergosterols, bioactive polysaccharides and peptides imparting health beneficial properties to mushrooms. Some of the proven biological activities of mushroom extracts are antioxidant, antimicrobial, immunomodulatory, cholesterol lowering activity by inhibiting a key cholesterol metabolism enzyme i.e. 3-hydroxy-3-methyl-glutaryl CoA reductase (HMGCR), angiotensin I-converting enzyme (ACE) inhibition. Application of novel extraction technologies like pulsed electric field (PEF) and high power ultrasound offers clean, green, faster and efficient extraction alternatives with enhanced and good quality extracts. Sequential PEF followed by ultrasound assisted extraction (UAE) were applied to recover bioactive enriched fractions from industrial white button mushroom (Agaricus bisporus) stalk waste using environmentally friendly and GRAS solvents i.e. water and water/ethanol combinations. The PEF treatment was carried out at 60% output voltage, 2 Hz frequency for 500 pulses of 20 microseconds pulse width, using KCl salt solution of 0.6 mS/cm conductivity by the placing 35g of chopped fresh mushroom stalks and 25g of salt solution in the 4x4x4cm3 treatment chamber. Sequential UAE was carried out on the PEF pre-treated samples using ultrasonic-water-bath (USB) of three frequencies (25 KHz, 35 KHz and 45 KHz) for various treatment times (15-120 min) at 80°C. Individual treatment using either PEF or UAE were also investigation to compare the effect of each treatment along with the combined effect on the recovery and bioactivity of the crude extracts. The freeze dried mushroom stalk powder was characterised for proximate compositional parameters (dry weight basis) showing 64.11% total carbohydrate, 19.12% total protein, 7.21% total fat, 31.2% total dietary fiber, 7.9% chitin (as glucosamine equivalent) and 1.02% β-glucan content. The total phenolic contents (TPC) were determined by the Folin-Ciocalteu procedure and expressed as gallic-acid-equivalents (GAE). The antioxidant properties were ascertained using DPPH and FRAP assays and expressed as trolox-equivalents (TE). HMGCR activity and molecular mass of β-glucans will be measured using the commercial HMG-CoA Reductase Assay kit (Sigma-Aldrich) and size exclusion chromatography (HPLC-SEC), respectively. Effects of PEF, UAE and their combination on the antioxidant capacity, HMGCR inhibition and β-glucans content will be presented.

Keywords: β-glucan, mushroom stalks, pulsed electric field (PEF), ultrasound assisted extraction (UAE)

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344 A Focused, High-Intensity Spread-Spectrum Ultrasound Solution to Prevent Biofouling

Authors: Alan T. Sassler

Abstract:

Biofouling is a significant issue for ships, especially those based in warm water ports. Biofouling damages hull coatings, degrades platform hydrodynamics, blocks cooling water intakes, and returns, reduces platform range and speed, and increases fuel consumption. Although platforms are protected to some degree by antifouling paints, these paints are much less effective on stationary platforms, and problematic biofouling can occur on antifouling paint-protected stationary platforms in some environments in as little as a matter of weeks. Remediation hull cleaning operations are possible, but they are very expensive, sometimes result in damage to the vessel’s paint or hull and are generally not completely effective. Ultrasound with sufficient intensity focused on specific frequency ranges can be used to prevent the growth of biofouling organisms. The use of ultrasound to prevent biofouling isn't new, but systems to date have focused on protecting platforms by shaking the hull using internally mounted transducers similar to those used in ultrasonic cleaning machines. While potentially effective, this methodology doesn't scale well to large platforms, and there are significant costs associated with installing and maintaining these systems, which dwarf the initial purchase price. An alternative approach has been developed, which uses highly directional pier-mounted transducers to project high-intensity spread-spectrum ultrasonic energy into the water column focused near the surface. This focused energy has been shown to prevent biofouling at ranges of up to 50 meters from the source. Spreading the energy out over a multi-kilohertz band makes the system both more effective and more environmentally friendly. This system has been shown to be both effective and inexpensive in small-scale testing and is now being characterized on a larger scale in selected marinas. To date, test results have been collected in Florida marinas suggesting that this approach can be used to keep ensonified areas of thousands of square meters free from biofouling, although care must be taken to minimize shaded areas.

Keywords: biofouling, ultrasonic, environmentally friendly antifoulant, marine protection, antifouling

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343 A Randomized Controlled Trial Study on the Effect of Adding Dexmedetomidine to Bupivacaine in Supraclavicular Block Using Ultrasound Guidance

Authors: Nazia Nazir

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Background: The benefits of regional anesthetic techniques are well established. Use of additives to local anesthetics can prolong these benefits. The aim of this study was to observe the effect of adding dexmedetomidine to bupivacaine for the supraclavicular block. Methods (Design): In this randomized, double-blind study, seventy ASA I & II patients of either sex undergoing elective surgeries on the upper limb were given supraclavicular block under ultrasound guidance. Group C (n=35), received 38 mL 0.25% bupivacaine + 2mL normal saline and group D received 38 mL 0.25% bupivacaine + 1 µg/kg dexmedetomidine (2mL). Patients were observed for onset, duration of motor and sensory block, duration of analgesia, sedation score, hemodynamic changes and any adverse events. Results: In group D the onset was faster (P < 0.001), duration of sensory and motor block, as well as duration of analgesia, was prolonged as compared to group C (P < 0.0001). There was significant drop in heart rate (HR) from the baseline in group D (P < 0.05) at 30, 60, 90 and 120 min, however, none of the patients dropped HR below 50/min. Mean arterial Pressure (MAP) remained unaffected. The patients in group D were effectively sedated than those in group C (P < 0.05). No adverse event was reported in either group. Conclusion: Dexmedetomidine as adjuvant to bupivacaine in supraclavicular block resulted in faster action, prolonged motor and sensory block, prolonged analgesia with hemodynamic stability and adequate sedation.

Keywords: Analgesia, bupivacaine, dexmedetomidine, supraclavicular block

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342 Branched Chain Amino Acid Kinesio PVP Gel Tape from Extract of Pea (Pisum sativum L.) Based on Ultrasound-Assisted Extraction Technology

Authors: Doni Dermawan

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Modern sports competition as a consequence of the increase in the value of the business and entertainment in the field of sport has been demanding athletes to always have excellent physical endurance performance. Physical exercise is done in a long time, and intensive may pose a risk of muscle tissue damage caused by the increase of the enzyme creatine kinase. Branched Chain Amino Acids (BCAA) is an essential amino acid that is composed of leucine, isoleucine, and valine which serves to maintain muscle tissue, keeping the immune system, and prevent further loss of coordination and muscle pain. Pea (Pisum sativum L.) is a kind of leguminous plants that are rich in Branched Chain Amino Acids (BCAA) where every one gram of protein pea contains 82.7 mg of leucine; 56.3 mg isoleucine; and 56.0 mg of valine. This research aims to develop Branched Chain Amino Acids (BCAA) from pea extract is applied in dosage forms Gel PVP Kinesio Tape technology using Ultrasound-assisted Extraction. The method used in the writing of this paper is the Cochrane Collaboration Review that includes literature studies, testing the quality of the study, the characteristics of the data collection, analysis, interpretation of results, and clinical trials as well as recommendations for further research. Extraction of BCAA in pea done using ultrasound-assisted extraction technology with optimization variables includes the type of solvent extraction (NaOH 0.1%), temperature (20-250C), time (15-30 minutes) power (80 watt) and ultrasonic frequency (35 KHz). The advantages of this extraction method are the level of penetration of the solvent into the membrane of the cell is high and can increase the transfer period so that the BCAA substance separation process more efficient. BCAA extraction results are then applied to the polymer PVP (Polyvinylpyrrolidone) Gel powder composed of PVP K30 and K100 HPMC dissolved in 10 mL of water-methanol (1: 1) v / v. Preparations Kinesio Tape Gel PVP is the BCAA in the gel are absorbed into the muscle tissue, and joints through tensile force then provides stimulation to the muscle circulation with variable pressure so that the muscle can increase the biomechanical movement and prevent damage to the muscle enzyme creatine kinase. Analysis and evaluation of test preparation include interaction, thickness, weight uniformity, humidity, water vapor permeability, the levels of the active substance, content uniformity, percentage elongation, stability testing, release profile, permeation in vitro and in vivo skin irritation testing.

Keywords: branched chain amino acid, BCAA, Kinesio tape, pea, PVP gel, ultrasound-assisted extraction

Procedia PDF Downloads 253
341 A Machine Learning Framework Based on Biometric Measurements for Automatic Fetal Head Anomalies Diagnosis in Ultrasound Images

Authors: Hanene Sahli, Aymen Mouelhi, Marwa Hajji, Amine Ben Slama, Mounir Sayadi, Farhat Fnaiech, Radhwane Rachdi

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Fetal abnormality is still a public health problem of interest to both mother and baby. Head defect is one of the most high-risk fetal deformities. Fetal head categorization is a sensitive task that needs a massive attention from neurological experts. In this sense, biometrical measurements can be extracted by gynecologist doctors and compared with ground truth charts to identify normal or abnormal growth. The fetal head biometric measurements such as Biparietal Diameter (BPD), Occipito-Frontal Diameter (OFD) and Head Circumference (HC) needs to be monitored, and expert should carry out its manual delineations. This work proposes a new approach to automatically compute BPD, OFD and HC based on morphological characteristics extracted from head shape. Hence, the studied data selected at the same Gestational Age (GA) from the fetal Ultrasound images (US) are classified into two categories: Normal and abnormal. The abnormal subjects include hydrocephalus, microcephaly and dolichocephaly anomalies. By the use of a support vector machines (SVM) method, this study achieved high classification for automated detection of anomalies. The proposed method is promising although it doesn't need expert interventions.

Keywords: biometric measurements, fetal head malformations, machine learning methods, US images

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340 Development of Oral Biphasic Drug Delivery System Using a Natural Resourced Polymer, Terminalia catappa

Authors: Venkata Srikanth Meka, Nur Arthirah Binti Ahmad Tarmizi Tan, Muhammad Syahmi Bin Md Nazir, Adinarayana Gorajana, Senthil Rajan Dharmalingam

Abstract:

Biphasic drug delivery systems are designed to release drug at two different rates, either fast/prolonged or prolonged/fast. A fast/prolonged release system provides a burst drug release at initial stage followed by a slow release over a prolonged period of time and in case of prolonged/fast release system, the release pattern is vice versa. Terminalia catappa gum (TCG) is a natural polymer and was successfully proven as a novel pharmaceutical excipient. The main objective of the present research is to investigate the applicability of natural polymer, Terminalia catappa gum in the design of oral biphasic drug delivery system in the form of mini tablets by using a model drug, buspirone HCl. This investigation aims to produce a biphasic release drug delivery system of buspirone by combining immediate release and prolonged release mini tablets into a capsule. For immediate release mini tablets, a dose of 4.5 mg buspirone was prepared by varying the concentration of superdisintegrant; crospovidone. On the other hand, prolonged release mini tablets were produced by using different concentrations of the natural polymer; TCG with a buspirone dose of 3mg. All mini tablets were characterized for weight variation, hardness, friability, disintegration, content uniformity and dissolution studies. The optimized formulations of immediate and prolonged release mini tablets were finally combined in a capsule and was evaluated for release studies. FTIR and DSC studies were conducted to study the drug-polymer interaction. All formulations of immediate release and prolonged release mini tablets were passed all the in-process quality control tests according to US Pharmacopoeia. The disintegration time of immediate release mini tablets of different formulations was varied from 2-6 min, and maximum drug release was achieved in lesser than 60 min. Whereas prolonged release mini tablets made with TCG have shown good drug retarding properties. Formulations were controlled for about 4-10 hrs with varying concentration of TCG. As the concentration of TCG increased, the drug release retarding property also increased. The optimised mini tablets were packed in capsules and were evaluated for the release mechanism. The capsule dosage form has clearly exhibited the biphasic release of buspirone, indicating that TCG is a suitable natural polymer for this study. FTIR and DSC studies proved that there was no interaction between the drug and polymer. Based on the above positive results, it can be concluded that TCG is a suitable polymer for the biphasic drug delivery systems.

Keywords: Terminalia catappa gum, biphasic release, mini tablets, tablet in capsule, natural polymers

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339 Effect of Two Bouts of Eccentric Exercise on Knee Flexors Changes in Muscle-Tendon Lengths

Authors: Shang-Hen Wu, Yung-Chen Lin, Wei-Song Chang, Ming-Ju Lin

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This study investigated whether the repeated bout effect (RBE) of knee flexors (KF) eccentric exercise would be changed in muscle-tendon lengths. Eight healthy university male students used their KF of non-dominant leg and performed a bout of 60 maximal isokinetic (30°/s) eccentric contractions (MaxECC1). A week after MaxECC1, all subjects used the same KF to perform a subsequent bout of MaxECC2. Changes in maximal isokinetic voluntary contraction torque (MVC-CON), muscle soreness (SOR), relaxed knee joint angle (RANG), leg circumference (CIR), and ultrasound images (UI; muscle-tendon length and muscle angle) were measured before, immediately after, 1-5 days after each bout. Two-way ANOVA was used to analyze all the dependent variables. After MaxECC1, all the dependent variables (e.g. MVC-CON: ↓30%, muscle-tendon length: ↑24%, muscle angle: ↑15%) showed significantly change. Following MaxECC2, all the above dependent variables (e.g. MVC-CON:↓21%, tendon length: ↑16%, muscle angle: ↑6%) were significantly smaller than those of MaxECC1. These results of this study found that protective effect conferred by MaxECC1 against MaxECC2, and changes in muscle damage indicators, muscle-tendon length and muscle angle following MaxECC2 were smaller than MaxECC1. Thus, the amount of shift of muscle-tendon length and muscle angle was related to the RBE.

Keywords: eccentric exercise, maximal isokinetic voluntary contraction torque, repeated bout effect, ultrasound

Procedia PDF Downloads 299
338 A Combination of Mesenchymal Stem Cells and Low-Intensity Ultrasound for Knee Meniscus Regeneration: A Preliminary Study

Authors: Mohammad Nasb, Muhammad Rehan, Chen Hong

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Background Meniscus defects critically alter knee function and lead to degenerative changes. Regenerative medicine applications including stem cell transplantation have showed a promising efficacy in finding alternatives to overcome traditional treatment limitations. However, stem cell therapy remains limited due to the substantially reduced viability and inhibitory microenvironment. Since tissue growth and repair are under the control of biochemical and mechanical signals, several approaches have recently been investigated (e.g., low intensity pulsed ultrasound [LIPUS]) to promote the regeneration process. This study employed LIPUS to improve growth and osteogenic differentiation of mesenchymal stem cells derived from human embryonic stem cells to improve the regeneration of meniscus tissue. Methodology: The Mesenchymal stromal cells (MSCs) were transplanted into the epicenter of the injured meniscus in rabbits, which were randomized into two main groups: a treatment group (n=32 New Zealand rabbits) including 4 subgroups of 8 rabbits in each subgroup (LIPUS treatment, MSC treatment, LIPUS with MSC and control), and a second group (n=9) to track implanted cells and their progeny using green fluorescence protein (GFP). GFP consists of the MSC and LIPUS-MSC combination subgroups. Rabbits were then subjected to histological, immunohistochemistry, and MRI assessment. Results: The quantity of the newly regenerated tissue in the combination treatment group that had Ultrasound irradiation after mesenchymal stem cells were better at all end points. Likewise, Tissue quality scores were also greater in knees treated with both approaches compared with controls and single treatment at all end points, achieving significance at twelve and twenty-four weeks [p < 0.05], and [p = 0.008] at twelve weeks. Differentiation into type-I and II collagen-expressing cells were higher in the combination group at up to twenty-four weeks. Conclusions: the combination of mesenchymal stem cells and LIPUS showed greater adhering to the sites of meniscus injury, differentiate into cells resembling meniscal fibrochondrocytes, and improve both quality and quantity of meniscal regeneration.

Keywords: stem cells, regenerative medicine, osteoarthritis, knee

Procedia PDF Downloads 79
337 Characterization of Articular Cartilage Based on the Response of Cartilage Surface to Loading/Unloading

Authors: Z. Arabshahi, I. Afara, A. Oloyede, H. Moody, J. Kashani, T. Klein

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Articular cartilage is a fluid-swollen tissue of synovial joints that functions by providing a lubricated surface for articulation and to facilitate the load transmission. The biomechanical function of this tissue is highly dependent on the integrity of its ultrastructural matrix. Any alteration of articular cartilage matrix, either by injury or degenerative conditions such as osteoarthritis (OA), compromises its functional behaviour. Therefore, the assessment of articular cartilage is important in early stages of degenerative process to prevent or reduce further joint damage with associated socio-economic impact. Therefore, there has been increasing research interest into the functional assessment of articular cartilage. This study developed a characterization parameter for articular cartilage assessment based on the response of cartilage surface to loading/unloading. This is because the response of articular cartilage to compressive loading is significantly depth-dependent, where the superficial zone and underlying matrix respond differently to deformation. In addition, the alteration of cartilage matrix in the early stages of degeneration is often characterized by PG loss in the superficial layer. In this study, it is hypothesized that the response of superficial layer is different in normal and proteoglycan depleted tissue. To establish the viability of this hypothesis, samples of visually intact and artificially proteoglycan-depleted bovine cartilage were subjected to compression at a constant rate to 30 percent strain using a ring-shaped indenter with an integrated ultrasound probe and then unloaded. The response of articular surface which was indirectly loaded was monitored using ultrasound during the time of loading/unloading (deformation/recovery). It was observed that the rate of cartilage surface response to loading/unloading was different for normal and PG-depleted cartilage samples. Principal Component Analysis was performed to identify the capability of the cartilage surface response to loading/unloading, to distinguish between normal and artificially degenerated cartilage samples. The classification analysis of this parameter showed an overlap between normal and degenerated samples during loading. While there was a clear distinction between normal and degenerated samples during unloading. This study showed that the cartilage surface response to loading/unloading has the potential to be used as a parameter for cartilage assessment.

Keywords: cartilage integrity parameter, cartilage deformation/recovery, cartilage functional assessment, ultrasound

Procedia PDF Downloads 160
336 An Open-Label Phase I Clinical Study: Safety, Tolerability and Pharmacodynamics of Mutant Collagenase Injection in Adults for Localized Fat Reduction

Authors: Yong Cang

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RJV001 is a subcutaneous injection containing mutated recombinant Collagenase H (ColH), leading to disruption of collagen matrix in adipose tissue and programmed cell death of adipocytes. Here we reported our clinical investigation of the safety, tolerance and pharmacodynamics of localized RJV001 injection into healthy human abdominal fat tissues (NCT04821648, Arizona Research Center). Investigate the safety, tolerance and clinical pharmacodynamics of subcutaneous RJV001 in humans. In the dose-escalating study, 18 subjects completed the study, 100% female, 78% white, with a mean age of 42[±9.9]. All three tested dose (0.05, 0.075 and 0.15 mg/injection), up to 30 injections, were safe and well-tolerated. Bruising and tenderness to palpation, mild to moderate, were the most frequent local skin reactions but nearly all resolved within 30 days. Additionally, physician-monitored ultrasound measurement showed that a reduction in abdominal fat tissue thickness was consistently observed in Cohort C (0.075, 0.15 mg/injection, 30injections), with a mean reduction of 7.37 [± 2.020] mm. Based on this clinical study, RJV001 has been advanced to phase II clinical studies. In the dose-escalating study, subcutaneously administered RJV001 was safe and well-tolerated in healthy adults up to 0.15 mg/injection, 30 injections. Fat reduction and adipocytolysis were observed by ultrasound measurements and histological analysis for exploratory purposes.

Keywords: fat reduction, mutant collagenase, clinical trial, subcutaneous injection

Procedia PDF Downloads 72
335 Physicochemical Properties of Soy Protein Isolate (SPI): Starch Conjugates Treated by Sonication

Authors: Gulcin Yildiz, Hao Feng

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In recent years there is growing interested in using soy protein because of several advantages compared to other protein sources, such as high nutritional value, steady supply, and low cost. Soy protein isolate (SPI) is the most refined soy protein product. It contains 90% protein in a moisture-free form and has some desirable functionalities. Creating a protein-polysaccharide conjugate to be the emulsifying agent rather than the protein alone can markedly enhance its stability. This study was undertaken to examine the effects of ultrasound treatments on the physicochemical properties of SPI-starch conjugates. The soy protein isolate (SPI, Pro-Fam® 955) samples were obtained from the Archer Daniels Midland Company. Protein concentrations were analyzed by the Bardford method using BSA as the standard. The volume-weighted mean diameters D [4,3] of protein–polysaccharide conjugates were measured by dynamic light scattering (DLS). Surface hydrophobicity of the conjugates was measured by using 1-anilino-8-naphthalenesulfonate (ANS) (Sigma-Aldrich, St. Louis, MO, USA). Increasing the pH from 2 to 12 resulted in increased protein solubility. The highest solubility was 69.2% for the sample treated with ultrasonication at pH 12, while the lowest (9.13%) was observed in the Control. For the other pH conditions, the protein solubility values ranged from 40.53 to 49.65%. The ultrasound treatment significantly decreased the particle sizes of the SPI-modified starch conjugates. While the D [4,3] for the Control was 731.6 nm, it was 293.7 nm for the samples treated by sonication at pH 12. The surface hydrophobicity (H0) of SPI-starch at all pH conditions were significantly higher than those in the Control. Ultrasonication was proven to be effective in improving the solubility and emulsifying properties of soy protein isolate-starch conjugates.

Keywords: particle size, solubility, soy protein isolate, ultrasonication

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334 Exploring the Influence of High-Frequency Acoustic Parameters on Wave Behavior in Porous Bilayer Materials: An Equivalent Fluid Theory Approach

Authors: Mustapha Sadouk

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This study investigates the sensitivity of high-frequency acoustic parameters in a rigid air-saturated porous bilayer material within the framework of the equivalent fluid theory, a specific case of the Biot model. The study specifically focuses on the sensitivity analysis in the frequency domain. The interaction between the fluid and solid phases of the porous medium incorporates visco-inertial and thermal exchange, characterized by two functions: the dynamic tortuosity α(ω) proposed by Johnson et al. and the dynamic compressibility β(ω) proposed by Allard, refined by Sadouki for the low-frequency domain of ultrasound. The parameters under investigation encompass porosity, tortuosity, viscous characteristic length, thermal characteristic length, as well as viscous and thermal shape factors. A +30% variation in these parameters is considered to assess their impact on the transmitted wave amplitudes. By employing this larger variation, a more comprehensive understanding of the sensitivity of these parameters is obtained. The outcomes of this study contribute to a better comprehension of the high-frequency wave behavior in porous bilayer materials, providing valuable insights for the design and optimization of such materials across various applications.

Keywords: bilayer materials, ultrasound, sensitivity analysis, equivalent fluid theory, dynamic tortuosity., porous material

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333 Non-Invasive Assessment of Peripheral Arterial Disease: Automated Ankle Brachial Index Measurement and Pulse Volume Analysis Compared to Ultrasound Duplex Scan

Authors: Jane E. A. Lewis, Paul Williams, Jane H. Davies

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Introduction: There is, at present, a clear and recognized need to optimize the diagnosis of peripheral arterial disease (PAD), particularly in non-specialist settings such as primary care, and this arises from several key facts. Firstly, PAD is a highly prevalent condition. In 2010, it was estimated that globally, PAD affected more than 202 million people and furthermore, this prevalence is predicted to further escalate. The disease itself, although frequently asymptomatic, can cause considerable patient suffering with symptoms such as lower limb pain, ulceration, and gangrene which, in worse case scenarios, can necessitate limb amputation. A further and perhaps the most eminent consequence of PAD arises from the fact that it is a manifestation of systemic atherosclerosis and therefore is a powerful predictor of coronary heart disease and cerebrovascular disease. Objective: This cross sectional study aimed to individually and cumulatively compare sensitivity and specificity of the (i) ankle brachial index (ABI) and (ii) pulse volume waveform (PVW) recorded by the same automated device, with the presence or absence of peripheral arterial disease (PAD) being verified by an Ultrasound Duplex Scan (UDS). Methods: Patients (n = 205) referred for lower limb arterial assessment underwent an ABI and PVW measurement using volume plethysmography followed by a UDS. Presence of PAD was recorded for ABI if < 0.9 (noted if > 1.30) if PVW was graded as 2, 3 or 4 or a hemodynamically significant stenosis > 50% with UDS. Outcome measure was agreement between measured ABI and interpretation of the PVW for PAD diagnosis, using UDS as the reference standard. Results: Sensitivity of ABI was 80%, specificity 91%, and overall accuracy 88%. Cohen’s kappa revealed good agreement between ABI and UDS (k = 0.7, p < .001). PVW sensitivity 97%, specificity 81%, overall accuracy 84%, with a good level of agreement between PVW and UDS (k = 0.67, p < .001). The combined sensitivity of ABI and PVW was 100%, specificity 76%, and overall accuracy 85% (k = 0.67, p < .001). Conclusions: Combing these two diagnostic modalities within one device provided a highly accurate method of ruling out PAD. Such a device could be utilized within the primary care environment to reduce the number of unnecessary referrals to secondary care with concomitant cost savings, reduced patient inconvenience, and prioritization of urgent PAD cases.

Keywords: ankle brachial index, peripheral arterial disease, pulse volume waveform, ultrasound duplex scan

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332 Applications of Artificial Intelligence (AI) in Cardiac imaging

Authors: Angelis P. Barlampas

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The purpose of this study is to inform the reader, about the various applications of artificial intelligence (AI), in cardiac imaging. AI grows fast and its role is crucial in medical specialties, which use large amounts of digital data, that are very difficult or even impossible to be managed by human beings and especially doctors.Artificial intelligence (AI) refers to the ability of computers to mimic human cognitive function, performing tasks such as learning, problem-solving, and autonomous decision making based on digital data. Whereas AI describes the concept of using computers to mimic human cognitive tasks, machine learning (ML) describes the category of algorithms that enable most current applications described as AI. Some of the current applications of AI in cardiac imaging are the follows: Ultrasound: Automated segmentation of cardiac chambers across five common views and consequently quantify chamber volumes/mass, ascertain ejection fraction and determine longitudinal strain through speckle tracking. Determine the severity of mitral regurgitation (accuracy > 99% for every degree of severity). Identify myocardial infarction. Distinguish between Athlete’s heart and hypertrophic cardiomyopathy, as well as restrictive cardiomyopathy and constrictive pericarditis. Predict all-cause mortality. CT Reduce radiation doses. Calculate the calcium score. Diagnose coronary artery disease (CAD). Predict all-cause 5-year mortality. Predict major cardiovascular events in patients with suspected CAD. MRI Segment of cardiac structures and infarct tissue. Calculate cardiac mass and function parameters. Distinguish between patients with myocardial infarction and control subjects. It could potentially reduce costs since it would preclude the need for gadolinium-enhanced CMR. Predict 4-year survival in patients with pulmonary hypertension. Nuclear Imaging Classify normal and abnormal myocardium in CAD. Detect locations with abnormal myocardium. Predict cardiac death. ML was comparable to or better than two experienced readers in predicting the need for revascularization. AI emerge as a helpful tool in cardiac imaging and for the doctors who can not manage the overall increasing demand, in examinations such as ultrasound, computed tomography, MRI, or nuclear imaging studies.

Keywords: artificial intelligence, cardiac imaging, ultrasound, MRI, CT, nuclear medicine

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331 Rethinking the Value of Pancreatic Cyst CEA Levels from Endoscopic Ultrasound Fine-Needle Aspiration (EUS-FNA): A Longitudinal Analysis

Authors: Giselle Tran, Ralitza Parina, Phuong T. Nguyen

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Background/Aims: Pancreatic cysts (PC) have recently become an increasingly common entity, often diagnosed as incidental findings on cross-sectional imaging. Clinically, management of the lesions is difficult because of uncertainties in their potential for malignant degeneration. Prior series have reported that carcinoembryonic antigen (CEA), a biomarker collected from cyst fluid aspiration, has a high diagnostic accuracy for discriminating between mucinous and non-mucinous lesions, at the patient’s initial presentation. To the author’s best knowledge, no prior studies have reported PC CEA levels obtained from endoscopic ultrasound fine-needle aspiration (EUS-FNA) over years of serial EUS surveillance imaging. Methods: We report a consecutive retrospective series of 624 patients who underwent EUS evaluation for a PC between 11/20/2009 and 11/13/2018. Of these patients, 401 patients had CEA values obtained at the point of entry. Of these, 157 patients had two or more CEA values obtained over the course of their EUS surveillance. Of the 157 patients (96 F, 61 M; mean age 68 [range, 62-76]), the mean interval of EUS follow-up was 29.7 months [3.5-128]. The mean number of EUS procedures was 3 [2-7]. To assess CEA value fluctuations, we defined an appreciable increase in CEA as "spikes" – two-times increase in CEA on a subsequent EUS-FNA of the same cyst, with the second CEA value being greater than 1000 ng/mL. Using this definition, cysts with a spike in CEA were compared to those without a spike in a bivariate analysis to determine if a CEA spike is associated with poorer outcomes and the presence of high-risk features. Results: Of the 157 patients analyzed, 29 had a spike in CEA. Of these 29 patients, 5 had a cyst with size increase >0.5cm (p=0.93); 2 had a large cyst, >3cm (p=0.77); 1 had a cyst that developed a new solid component (p=0.03); 7 had a cyst with a solid component at any time during surveillance (p=0.08); 21 had a complex cyst (p=0.34); 4 had a cyst categorized as "Statistically Higher Risk" based on molecular analysis (p=0.11); and 0 underwent surgical resection (p=0.28). Conclusion: With serial EUS imaging in the surveillance of PC, an increase in CEA level defined as a spike did not predict poorer outcomes. Most notably, a spike in CEA did not correlate with the number of patients sent to surgery or patients with an appreciable increase in cyst size. A spike in CEA did not correlate with the development of a solid nodule within the PC nor progression on molecular analysis. Future studies should focus on the selected use of CEA analysis when patients undergo EUS surveillance evaluation for PCs.

Keywords: carcinoembryonic antigen (CEA), endoscopic ultrasound (EUS), fine-needle aspiration (FNA), pancreatic cyst, spike

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330 Prospective Study of the Evaluation of Autologous Blood Injection in the Treatment of Lateral Epicondylitis

Authors: Bheeshma B., Mathivanan N., Manoj Deepak M., Prabhu Thangaraju, K. Venkatachalam

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This study involves the effect of autologous blood injection for patients who had degeneration of the origin of extensor carpi radialis brevis which was confirmed radio logically and by ultrasound examination and failed cortisone injections to the lateral epicondylitis. In this prospective longitudinal series involves pre-injection assessment of grip strength, pain, and function, using the patient-rated tennis elbow evaluation. In this study, blood from the contralateral limb is taken and injected into the affected limb with the help of ultrasound guidance and then the patient wore a customized wrist support for five days, after which they were commenced with stretching, strengthening, and massage programme with an occupational therapist. In these patients assessment was done after six months and then finally at 12 months after injection, using the patient-rated tennis elbow evaluation. 50 patients completed the study, showing significant improvement in pain; the worst pain decreased by two to five points out of a 10-point visual analogue for pain. Self-perceived function improved by 11–25 points out of 100. Women showed significant increase in grip, but men did not. Our study thus concludes that autologous blood injection show significant improvement in pain and function in patients with chronic lateral epicondylitis, who did not have relief with cortisone injection.

Keywords: lateral epicondylitis, autologous blood injection, conservative treatment, plasma-rich proteins (PRPs)

Procedia PDF Downloads 398
329 Validation of a Placebo Method with Potential for Blinding in Ultrasound-Guided Dry Needling

Authors: Johnson C. Y. Pang, Bo Peng, Kara K. L. Reeves, Allan C. L. Fud

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Objective: Dry needling (DN) has long been used as a treatment method for various musculoskeletal pain conditions. However, the evidence level of the studies was low due to the limitations of the methodology. Lack of randomization and inappropriate blinding is potentially the main sources of bias. A method that can differentiate clinical results due to the targeted experimental procedure from its placebo effect is needed to enhance the validity of the trial. Therefore, this study aimed to validate the method as a placebo ultrasound(US)-guided DN for patients with knee osteoarthritis (KOA). Design: This is a randomized controlled trial (RCT). Ninety subjects (25 males and 65 females) aged between 51 and 80 (61.26 ± 5.57) with radiological KOA were recruited and randomly assigned into three groups with a computer program. Group 1 (G1) received real US-guided DN, Group 2 (G2) received placebo US-guided DN, and Group 3 (G3) was the control group. Both G1 and G2 subjects received the same procedure of US-guided DN, except the US monitor was turned off in G2, blinding the G2 subjects to the incorporation of faux US guidance. This arrangement created the placebo effect intended to permit comparison of their results to those who received actual US-guided DN. Outcome measures, including the visual analog scale (VAS) and Knee injury and Osteoarthritis Outcome Score (KOOS) subscales of pain, symptoms, and quality of life (QOL), were analyzed by repeated measures analysis of covariance (ANCOVA) for time effects and group effects. The data regarding the perception of receiving real US-guided DN or placebo US-guided DN were analyzed by the chi-squared test. The missing data were analyzed with the intention-to-treat (ITT) approach if more than 5% of the data were missing. Results: The placebo US-guided DN (G2) subjects had the same perceptions as the use of real US guidance in the advancement of DN (p<0.128). G1 had significantly higher pain reduction (VAS and KOOS-pain) than G2 and G3 at 8 weeks (both p<0.05) only. There was no significant difference between G2 and G3 at 8 weeks (both p>0.05). Conclusion: The method with the US monitor turned off during the application of DN is credible for blinding the participants and allowing researchers to incorporate faux US guidance. The validated placebo US-guided DN technique can aid in investigations of the effects of US-guided DN with short-term effects of pain reduction for patients with KOA. Acknowledgment: This work was supported by the Caritas Institute of Higher Education [grant number IDG200101].

Keywords: ultrasound-guided dry needling, dry needling, knee osteoarthritis, physiotheraphy

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328 Incidence of Post Endoscopic Retrograde Cholangiopancreatography Biliary Ascariasis Diagnosed on Ultrasound

Authors: Shehzad Khan, Jehangir Khan, Shah Babar, Rashid Mahmood, Rizwan Khan, Sanya Hadi

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Ascaris lumbricoides are familiar with the roundworm that causes biliary infections in humans. Nevertheless, ascariasis is primarily found in the jejunum and transferred in numerous body parts with the intake of Ascaris lumbricoides present in food and water. These study methods were implemented at the Saidu Teaching Hospital Radiology Department from December 2021 to January 2023. This study includes the participants suffering from biliary ascariasis admitted or visited Saidu Teaching Hospital in that time frame. Clinical assessment of the participants was done based on the appearance of signs and symptoms present in them. The participant's laboratory test was done to determine the level of basic body parameters. After that ultrasonography was used to diagnose the presence and appearance of worms. Endoscopic retrograde cholangiopancreatography (ERCP) was used to extract worms from biliary channels, and the incidence of post-ERCP biliary ascariasis was accessed with ultrasonography. This study's results show the presence of numerous types of worms in the biliary channels of patients. Also, the level of body parameters, for instance, neutrophil, hemoglobin, and others, were compared at the time of admission and at the time of discharge from the hospital. Furthermore, the incidence of post-ERCP biliary ascariasis was reported as 4% in females, and 1% in males, respectively.

Keywords: Ascaris, biliary, ERCP, ultrasound

Procedia PDF Downloads 52
327 Laser Ultrasonic Imaging Based on Synthetic Aperture Focusing Technique Algorithm

Authors: Sundara Subramanian Karuppasamy, Che Hua Yang

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In this work, the laser ultrasound technique has been used for analyzing and imaging the inner defects in metal blocks. To detect the defects in blocks, traditionally the researchers used piezoelectric transducers for the generation and reception of ultrasonic signals. These transducers can be configured into the sparse and phased array. But these two configurations have their drawbacks including the requirement of many transducers, time-consuming calculations, limited bandwidth, and provide confined image resolution. Here, we focus on the non-contact method for generating and receiving the ultrasound to examine the inner defects in aluminum blocks. A Q-switched pulsed laser has been used for the generation and the reception is done by using Laser Doppler Vibrometer (LDV). Based on the Doppler effect, LDV provides a rapid and high spatial resolution way for sensing ultrasonic waves. From the LDV, a series of scanning points are selected which serves as the phased array elements. The side-drilled hole of 10 mm diameter with a depth of 25 mm has been introduced and the defect is interrogated by the linear array of scanning points obtained from the LDV. With the aid of the Synthetic Aperture Focusing Technique (SAFT) algorithm, based on the time-shifting principle the inspected images are generated from the A-scan data acquired from the 1-D linear phased array elements. Thus the defect can be precisely detected with good resolution.

Keywords: laser ultrasonics, linear phased array, nondestructive testing, synthetic aperture focusing technique, ultrasonic imaging

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326 Ultrasonic Micro Injection Molding: Manufacturing of Micro Plates of Biomaterials

Authors: Ariadna Manresa, Ines Ferrer

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Introduction: Ultrasonic moulding process (USM) is a recent injection technology used to manufacture micro components. It is able to melt small amounts of material so the waste of material is certainly reduced comparing to microinjection molding. This is an important advantage when the materials are expensive like medical biopolymers. Micro-scaled components are involved in a variety of uses, such as biomedical applications. It is required replication fidelity so it is important to stabilize the process and minimize the variability of the responses. The aim of this research is to investigate the influence of the main process parameters on the filling behaviour, the dimensional accuracy and the cavity pressure when a micro-plate is manufactured by biomaterials such as PLA and PCL. Methodology or Experimental Procedure: The specimens are manufactured using a Sonorus 1G Ultrasound Micro Molding Machine. The used geometry is a rectangular micro-plate of 15x5mm and 1mm of thickness. The materials used for the investigation are PLA and PCL due to biocompatible and degradation properties. The experimentation is divided into two phases. Firstly, the influence of process parameters (vibration amplitude, sonotrodo velocity, ultrasound time and compaction force) on filling behavior is analysed, in Phase 1. Next, when filling cavity is assured, the influence of both cooling time and force compaction on the cavity pressure, part temperature and dimensional accuracy is instigated, which is done in Phase. Results and Discussion: Filling behavior depends on sonotrodo velocity and vibration amplitude. When the ultrasonic time is higher, more ultrasonic energy is applied and the polymer temperature increases. Depending on the cooling time, it is possible that when mold is opened, the micro-plate temperature is too warm. Consequently, the polymer relieve its stored internal energy (ultrasonic and thermal) expanding through the easier direction. This fact is reflected on dimensional accuracy, causing micro-plates thicker than the mold. It has also been observed the most important fact that affects cavity pressure is the compaction configuration during the manufacturing cycle. Conclusions: This research demonstrated the influence of process parameters on the final micro-plated manufactured. Future works will be focused in manufacturing other geometries and analysing the mechanical properties of the specimens.

Keywords: biomaterial, biopolymer, micro injection molding, ultrasound

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325 A Randomized Comparative Evaluation of Efficacy of Ultrasound Guided Costoclavicular and Supraclavicular Approaches of Brachial Plexus Block for Upper Limb Surgeries

Authors: Anshul, Rajni Kalia, Sachin Kumar

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Introduction: The costoclavicular approach, a modification to the infraclavicular approach, has been described for anesthesia for upper limb surgeries. Material And Methods: In this randomized and single-blind study, fourty patients undergoing emergency/elective upper limb surgery were allocated to two groups. Group C and S received ultrasound-guided Costoclavicular block and Supraclavicular block, respectively, with 20 ml 0.5 % ropivacaine with 8 mg dexamethasone under strict asepsis. The primary outcome assessed was the total duration of sensory and motor block in the postoperative period. Secondary outcomes were to compare the time taken to perform the procedure, block characteristics in terms of onset of motor and sensory blockade, the efficacy of analgesia with respect to the time of administration of the first rescue analgesic dose with both the blocks and note the side effects pertaining to either of the blocks. Results: The mean total duration of sensory and motor blockade was longer in group C vs. group S (p=0.002 and 0.024, respectively). The mean duration to perform a block in group S was more than in group C (p=0.012). The mean onset of sensory and motor Blockade Time in group S was more than in group C (p<0.001 and <0.001, respectively). The mean duration to perform a block in group S was more than in group C (p=0.012). Conclusion: The costoclavicular approach is better than supraclavicular in terms of rapid execution, faster onset of sensory-motor blockade, prolonged postoperative analgesia and similar PONV and safety profile.

Keywords: costoclavicular, supraclavicular, ropivacaine, dexamethasone

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324 A Case Study of Spontaneous Heterotopic Pregnancy with Subsequent Ruptured Ectopic Pregnancy

Authors: M. Elder, L. Beech, A. Mackie

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Heterotopic pregnancy is an uncommon and potentially life-threatening condition in which there is simultaneous occurrence of intrauterine and ectopic pregnancies. It has an incidence of approximately 1:3900 pregnancies, occurring in only 1:30000 spontaneous pregnancies. This study presents a rare case of spontaneous heterotopic pregnancy in a 34-year-old primiparous woman who was brought in by ambulance to the emergency department following collapse at 20+1 weeks gestation after normal first trimester screening and morphology scan. She was hemodynamically unstable and fetal heart rate was 60bpm. Initial resuscitation included transfusion of 2 units packed red blood cells and 1g intravenous tranexamic acid. Bedside ultrasound revealed evidence of approximately 1000ml clot in the right upper quadrant. She underwent a diagnostic laparoscopy and washout, which proceeded to a midline exploratory laparotomy. This revealed a 2.6L hemoperitoneum and query right ectopic pregnancy with calcified areas and clot, with no other cause of bleeding identified. Right salpingectomy was performed, and pathology later confirmed ectopic pregnancy. The intrauterine pregnancy had no complications, and she delivered a healthy full-term baby. This case demonstrates that ultrasound confirmation of intrauterine pregnancy does not exclude coexisting ectopic pregnancy. Heterotopic pregnancy should be considered in any pregnant woman presenting with abdominal pain or signs of hemorrhagic shock, as prompt diagnosis and treatment is essential to minimize foetal and maternal morbidity and mortality.

Keywords: ectopic pregnancy, hemorrhagic shock, salpingectomy, spontaneous heterotopic pregnancy

Procedia PDF Downloads 96