Browsing by Subject "ultrasound"

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  • the International Society of Placenta Accreta SPECTRUM (IS-PAS) Low- and Middle-Income Countries Working Group; Adu-Bredu, Theophilus K.; Rijken, Marcus J.; Nieto-Calvache, Albaro Jose; Stefanovic, Vedran; Aryananda, Rozi Aditya; Fox, Karin Anneliese; Collins, Sally L. (2023)
    Placenta accreta spectrum is a pregnancy complication associated with severe morbidity and maternal mortality especially when not suspected antenatally and appropriate management instigated. Women in resource-limited settings are more likely to face adverse outcomes due to logistic, technical, and resource inadequacies. Accurate prenatal imaging is an important step in ensuring good outcomes because it allows adequate preparation and an appropriate management approach. This article provides a simple three-step approach aimed at guiding clinicians and sonographers with minimal experience in placental accreta spectrum through risk stratification and basic prenatal screening for this condition both with and without Doppler ultrasound.
  • Aakko, Iida Kaarina; Kauramäki, Jaakko; Cleland, Joanne; Lee, Alice; Vainio, Martti; Saalasti, Satu (2023)
    Accumulating evidence suggests that ultrasound visual feedback increases the treatment efficacy for persistent speech sound errors. However, the available evidence is mostly from English. This is a feasibility study of ultrasound visual feedback for treating distortion of Finnish [r]. We developed a web-based application for auditory-perceptual judgement. We investigated the impact of listener’s experience on perceptual judgement and the intra-rater reliability of listeners. Four boys (10–11 years) with distortion of [r], otherwise typical development, partook in eight ultrasound treatment sessions. In total, 117 [r] samples collected at pre- and post-intervention were judged with visual analogue scale (VAS) by two listener groups: five speech and language therapists (SLTs) and six SLT students. We constructed a linear mixed-effects model with fixed effects for time and listener group and several random effects. Our findings indicate that measurement time had a significant main effect on judgement results, χ2 = 78.82, p < 0.001. Effect of listener group was non-significant, but a significant main effect of interaction of group × time, χ2 = 6.33, p < 0.012 was observed. We further explored the effect of group with nested models, and results revealed a non-significant effect of group. The average intra-rater correlation of the 11 listeners was 0.83 for the pre-intervention samples and 0.92 for post-intervention showing a good or excellent degree of agreement. Finnish [r] sound can be evaluated with VAS and ultrasound visual feedback is a feasible and promising method in treatment for distortion of [r], and its efficacy should be further assessed.
  • Pérez, Alejandro Garcia; Nieminen, Heikki J.; Finnilä, Mikko; Salmi, Ari; Pritzker, Kenneth P. H.; Lampsijärvi, Eetu; Paulin, Tor; Airaksinen, Anu J.; Saarakkala, Simo; Haeggström, Edward (2018)
    Localized delivery of drugs into articular cartilage (AC) may facilitate the development of novel therapies to treat osteoarthritis (OA). We investigated the potential of spark-gap-generated sound to deliver a drug surrogate, i.e., methylene blue (MB), into AC. In vitro experiments exposed bovine AC samples to either simultaneous sonication and immersion in MB (Treatment 1; n = 10), immersion in MB after sonication (Control 1; n = 10), solely immersion in MB (Control 2; n = 10), or neither sonication nor immersion in MB (Control 3; n = 10). The sonication protocol consisted of 1,000 spark-gap -generated pulses. Delivery of MB into AC was estimated from optical absorbance in transmission light microscopy. Optical absorbance was significantly greater in the treatment group up to 900 mu m depth from AC surface as compared to all controls. Field emission scanning electron microscopy (FESEM), histological analysis, and digital densitometry (DD) of sonicated (n = 6) and non-sonicated (n = 6) samples showed no evidence of sonication-induced changes in proteoglycan content or collagen structure. Consequently, spark-gap -generated sound may offer a solution for localized drug delivery into AC in a non-destructive fashion. Further research on this method may contribute to OA drug therapies.
  • Holmström, Axi; Meriläinen, Antti; Hyvönen, Jere Tapio Johannes; Nolvi, Anton; Ylitalo, Tuomo; Steffen, Kari; Björkenheim, Robert; Strömberg, G Gustav; Nieminen, Heikki; Kassamakov, Ivan; Pajarinen, Jukka; Hupa, Leena; Salmi, Ari; Haeggström, Edward; Lindfors, Nina (2023)
  • D'Angelo, Arianna; Panayotidis, Costas; Alteri, Alessandra; Mcheik, Saria; Veleva, Zdravka (2022)
    BACKGROUND Ultrasound-guided embryo transfer (US-GET) is a widely performed procedure, but standards for the best practice are not available. OBJECTIVE AND RATIONALE This document aims to provide an overview of technical aspects of US-GET after considering the published data and including the preparation for the embryo transfer (ET) procedure, the actual procedure, the post-procedure care, associated pathologies, complications and risks, quality assurance and practitioners' performance. SEARCH METHODS A literature search for evidence on key aspects of the ET procedure was carried out from database inception to November 2021. Selected papers (n = 359) relevant to the topic were analysed by the authors. The following key points were considered in the papers: whether ultrasound (US) practice standards were explained, to what extent the ET technique was described and whether complications or incidents and how to prevent such events were reported. In the end, 89 papers could be used to support the recommendations in this document, which focused on transabdominal US-GET. OUTCOMES The relevant papers found in the literature search were included in the current document and described according to the topic in three main sections: requirements and preparations prior to ET, the ET procedure and training and competence for ET. Recommendations are provided on preparations prior to ET, equipment and materials, ET technique, possible risks and complications, training and competence. Specific aspects of the laboratory procedures are covered, in particular the different loading techniques and their potential impact on the final outcomes. Potential future developments and research priorities regarding the ET technique are also outlined. LIMITATIONS, REASONS FOR CAUTION Many topics were not covered in the literature review and some recommendations were based on expert opinions and are not necessarily evidence based. WIDER IMPLICATIONS ET is the last procedural step in an ART treatment and is a crucial step towards achieving a pregnancy and live birth. The current paper set out to bring together the recent developments considering all aspects of ET, especially emphasizing US quality imaging. There are still many questions needing answers, and these can be subject of future research. STUDY FUNDING/COMPETING INTEREST(S) No funding. A.D.A. has received royalties from CRC Press and personal honorarium from Cook, Ferring and Cooper Surgical. The other co-authors have no conflicts of interest to declare that are relevant to the content of this article.
  • Huilaja, Laura; Makikallio, Kaarin; Sormunen, Raija; Lohi, Jouko; Hurskainen, Tiina; Tasanen, Kaisa (2013)
  • Maseide, Ragnhild J.; Berntorp, Erik; Astermark, Jan; Hansen, Jessica; Olsson, Anna; Bruzelius, Maria; Frisk, Tony; Aspdahl, Magnus; Nummi, Vuokko; Tjonnfjord, Geir E.; Holme, Pal A. (2021)
    Introduction Detection of early arthropathy is crucial for the management of haemophilia, but data on moderate haemophilia are limited. Therefore, we evaluated joint health and treatment modalities in Nordic patients with moderate haemophilia A (MHA) and B (MHB). Aim To explore and compare the Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) and Haemophilia Joint Health Score (HJHS) to detect early arthropathy in moderate haemophilia. Methods A cross-sectional, multicentre study covering Nordic patients with MHA and MHB. Arthropathy was evaluated by HEAD-US and HJHS 2.1. Results We assessed 693 joints in 118 patients. HEAD-US scores (medians [interquartile ranges]) were as follows: elbows 0 points (0-0), knees 0 (0-0) and ankles 0 (0-1). Respectively, by HJHS: elbows 0 (0-1), knees 0 (0-1) and ankles 0 (0-1). Cartilage (14%) and bone (13%) were most commonly affected by HEAD-US. Frequent HJHS findings were crepitus on motion in knees (39%), and loss of flexion (23%) and extension (13%) in ankles. HEAD-US correlated strongly with HJHS (elbows r = .70, knees r = .60 and ankles r = .65), but 24% had discordant scores. Joints with HJHS zero points, 5% captured HEAD-US >= 1 point. Moreover, 26% had HJHS findings without HEAD-US pathology. Notably, 31% of knees had crepitus on motion and normal HEAD-US. Conclusion Overall, the joints attained low scores implying good joint health. HEAD-US correlated strongly with HJHS. In 5%, HEAD-US detected subclinical pathology. Crepitus on motion was frequently reported despite normal HEAD-US, thus not necessarily reflecting arthropathy. HEAD-US therefore improves the joint assessment in moderate haemophilia.
  • Puhakka, Jani; Afara, Isaac O.; Paatela, Teemu; Sormaala, Markus J.; Timonen, Matti A.; Viren, Tuomas; Jurvelin, Jukka S.; Toyras, Juha; Kiviranta, Ilkka (2016)
    Objective. Accurate arthroscopic evaluation of cartilage lesions could significantly improve the outcome of repair surgery. In this study, we investigated for the first time the potential of intra-articular ultrasound as an arthroscopic tool for grading cartilage defects in the human shoulder joint in vivo and compared the outcome to results from arthroscopic evaluation and magnetic resonance imaging findings. Design. A total of 26 sites from 9 patients undergoing routine shoulder arthroscopy were quantitatively evaluated with a clinical intravascular (40MHz) ultrasound imaging system, using the regular arthroscopy portals. Reflection coefficient (R), integrated reflection coefficient (IRC), apparent integrated backscattering (AIB), and ultrasound roughness index (URI) were calculated, and high-resolution ultrasound images were obtained per site. Each site was visually graded according to the International Cartilage Repair Society (ICRS) system. "Ultrasound scores" corresponding to the ICRS system were determined from the ultrasound images. Magnetic resonance imaging was conducted and cartilage integrity at each site was classified into 5 grades (0 = normal, 4 = severely abnormal) by a radiologist. Results. R and IRC were lower at sites with damaged cartilage surface (P = 0.033 and P = 0.043, respectively) and correlated with arthroscopic ICRS grades (r (s) = -0.444, P = 0.023 and r (s) = -0.426, P = 0.03, respectively). Arthroscopic ICRS grades and ultrasound scores were significantly correlated (rs = 0.472, P = 0.015), but no significant correlation was found between magnetic resonance imaging data and other parameters. Conclusion. The results suggest that ultrasound arthroscopy could facilitate quantitative clinical appraisal of articular cartilage integrity in the shoulder joint and provide information on cartilage lesion depth and severity for quantitative diagnostics in surgery.
  • Måseide, Ragnhild J.; Berntorp, Erik; Astermark, Jan; Olsson, Anna; Bruzelius, Maria; Frisk, Tony; Nummi, Vuokko; Lassila, Riitta; Tjonnfjord, Geir E.; Holme, Pål A. (2020)
    Introduction The prevalence of arthropathy in moderate haemophilia A (MHA) and B (MHB) is not well known. Aim We evaluated joint health in Nordic patients in relation to their treatment modality. Methods A cross-sectional, multicentre study covering MHA and MHB in Sweden, Finland and Norway. Arthropathy was evaluated by ultrasound (HEAD-US) and Haemophilia Joint Health Score (HJHS). Results We report on 145 patients: median age 28 years (IQR 13-52) and 61% MHA. Baseline factor VIII/factor IX activity (FVIII/FIX:C) was 2 IU/dL (median) (IQR 2-4): lower for MHB (2 IU/dL, IQR 1-2) than MHA (3 IU/dL, IQR 2-4) (P <.01). Eighty-five per cent of MHA and 73% MHB had a history of haemarthrosis (P = .07). Age at first joint bleed was lower for MHA (5 years [median], IQR 3-7) than MHB (7 years, IQR 5-12) (P = .01). Thirty-eight per cent received prophylaxis, started at median 10 years of age (IQR 4-24). Median joint bleeds and serious other bleeds during the last 12 months were both zero (IQR 0-1). Total HEAD-US captured 0/48 points (median) (IQR 0-2) and HJHS 4/120 points (IQR 1-10) with strong correlation between them (r = .72). FVIII/FIX:C
  • Aalto, Nina (Helsingfors universitet, 2004)
    Syventävien opintojeni tutkielma koostuu kirjallisuuskatsauksesta sekä tutkimusosuudesta. Kirjallisuuskatsauksessa käsitellään Listeria monocytogeneksen yleistä epidemiologiaa ja esiintyvyyttä elintarviketeollisuudessa sekä ultraäänen käyttösovellutuksia ja ultraäänen toimintaperiaatetta puhdistuskäytössä. Tutkimusosuudessa tutkittiin ultraäänipuhdistuksen vaikutusta L. monocytogeneksen tuhoutumiseen eri kuljetushihnamateriaaleissa. Tutkimus on osa Hygila eli hygieeniset laitteet elintarviketeollisuudessa -projektia. L. monocytogenes on pääasiassa elintarvikkeiden välityksellä leviävä patogeeni, joka voi aiheuttaa vakavan infektion, listerioosin, henkilöille, joiden vastustuskyky on heikentynyt. L. monocytogenes on grampositiivinen, fakultatiivisesti anaerobi sauvabakteeri, joka esiintyy yleisesti ympäristössä. L. monocytogenes on eristetty useista erilaisista elintarvikkeiden tuotantolaitoksista. L. monocytogeneksesta on tullut kasvava ongelma elintarviketeollisuudessa, sillä sen eradikointi raaka-aineista ei ole mahdollista ja tuotantolaitoksiin päästyään se on vaikeasti häädettävissä. L. monocytogenes pystyy kiinnittymään erilaisille pinnoille ja muodostamaan puhdistukselle vastustuskykyisen biofilmin. Lisäksi se suosii hankalasti puhdistettavia kohtia kuten kuljettimia. L. monocytogeneksen on todettu pystyvän muodostamaan persistoivia laitoskantoja, jotka ovat nonpersistoivia kantoja vieläkin vastustuskykyisempiä puhdistustoimenpiteille. Voimakastehoista ja matalataajuista ultraääntä käytetään puhdistamiseen. Ultraäänipuhdistus perustuu kavitaatioon, jolloin pesunesteeseen muodostuu ultraäänen vaikutuksesta pieniä värähteleviä kuplia. Kuplat keräävät energiaa ja lopulta räjähtävät aiheuttaen likaa irrottavia iskuaaltoja puhdistettavaan pintaan. Ultraäänen on todettu tuhoavan mikrobeja ja irrottavan biofilmiä tehokkaasti erilaisista pinnoista. Tutkimuksessa tutkittiin ultraäänipuhdistuksen vaikutusta L. monocytogeneksen tuhoutumiseen kolmessa eri kuljetushihnamateriaalissa, joita olivat ruostumaton teräs, asetaali ja polypropyleeni. Ultraäänipesun kestoa (30s / 1 min), lämpötiloja (30 °C / 45 °C) ja pesuaineita (SOLO / P3-mip SP) vaihdeltiin. Tutkimuksessa todettiin ultraäänipuhdistuksen tuhoavan L. monocytogenesta eri kuljetushihnamateriaaleista. Kuljetushihnamateriaaleista erityisesti ruostumaton teräs puhdistui polypropyleenia paremmin. Myös asetaali puhdistui polypropyleenia paremmin. Ultraäänipesuajalla, jonka kesto oli 30 s tai 1 min, ei tässä tutkimuksessa todettu olevan merkitystä. Korkeampi pesulämpötila suurensi L. monocytogeneksen reduktiolukuja, mutta tilastollisesti merkitseviä tuloksia oli vain muutama. Pesuaineen vaikutuksista havaittiin materiaalikohtaisia eroja siten, että polypropyleeni ja myös asetaali puhdistuivat paremmin SOLO-pesuaineella. Ruostumaton teräs puhdistui matalammassa 30 °C lämpötilassa P3-mip SP -pesuaineella paremmin. Ultraäänipuhdistuksen todettiin soveltuvan kuljetushihnamateriaalien puhdistamiseen.
  • Alanne, Leena; Bhide, Amarnath; Lantto, Juulia; Huhta, Heikki; Kokki, Merja; Haapsamo, Mervi; Acharya, Ganesh; Räsänen, Juha (2021)
    BACKGROUND: Nifedipine is a widely used drug in pregnancies complicated by maternal hypertensive disorders that can be associated with placental insufficiency and fetal hypoxemia. The evidence regarding fetal myocardial responses to nifedipine in hypoxemia is limited. OBJECTIVE: We hypothesized that nifedipine would not impair fetal sheep cardiac function under hypoxemic environment. In particular, we investigated the effects of nifedipine on fetal ventricular functional parameters and cardiac output. STUDY DESIGN: A total of 21 chronically instrumented fetal sheep at 122 to 134 gestational days (term, 145 days) were included in this study. Fetal cardiac function was evaluated by measuring global longitudinal strain, indices describing ventricular systolic and diastolic function, and cardiac outputs using two-dimensional speckle tracking and tissue and spectral pulsed-wave Doppler echocardiography. Fetal carotid artery blood pressure and blood gas values were invasively monitored. After baseline data collection, fetal hypoxemia was induced by maternal hyperoxygenation. After hypoxemia phase data collection, 9 fetuses received nifedipine infusion, and 12 fetuses received saline infusion. Data were collected 30 and 120 minutes after the infusion was started. After 120 minutes of data collection, maternal and fetal oxygenation were normalized, and normoxemia phase data were collected, while infusion was continued. RESULTS: Hypoxemia decreased fetal carotid artery mean arterial pressure from 40 (8) mm Hg to 35 (8) mm Hg (P CONCLUSION: In hypoxemic fetus, nifedipine impaired right ventricular function and reduced its cardiac output. The detrimental effects of nifedipine on fetal right ventricular function were abolished, when normoxemia was restored. Our findings suggest that in a hypoxemic environment nifedipine triggers detrimental effects on fetal right ventricular function.
  • Lallukka, S.; Yki-Jarvinen, H. (2016)
    Non-alcoholic fatty liver disease (NAFLD) covers a spectrum of liver disease from simple steatosis to non-alcoholic steatohepatitis (NASH) and cirrhosis. NAFLD is commonly associated with features of the metabolic/insulin resistance syndrome ('Metabolic/Obese NAFLD') and may therefore predict type 2 diabetes (T2DM). For this review, we searched for prospective studies examining whether NAFLD predicts T2DM, and if so, whether this occurs independently of factors such as age and obesity. These studies included NAFLD diagnosed by ultrasonography (n = 6) or liver enzymes (n = 14). All ultrasonography studies found NAFLD to predict the risk of T2DM independently of age, and in 4 out of 6 studies NAFLD was also a predictor independently of BMI. NAFLD was a predictor of T2DM in all 14 studies where NAFLD was diagnosed by liver enzymes. In 12 of these studies, ALT or AST or GGT were significant predictors of T2DM risk, independently of age and BMI. NAFLD, however, is heterogeneous and may also be caused by common genetic variants. The I148M variant in PNPLA3 and the E167K variant in TM6SF2 are both associated with increased liver fat content, but not features of the metabolic/insulin resistance syndrome. These genetic forms of NAFLD predict NASH and cirrhosis but not T2DM. Taken together these data imply that 'Metabolic/Obese NAFLD' predicts T2DM independently of age and obesity and support the role of hepatic insulin resistance in the pathogenesis of this disease. (C) 2016 Elsevier Ltd. All rights reserved.
  • Morel, Olivier; van Beekhuizen, Heleen J.; Braun, Thorsten; Collins, Sally; Pateisky, Petra; Calda, Pavel; Henrich, Wolfgang; Al Naimi, Ammar; Norgaardt, Lone Nikoline; Chalubinski, Kinga M.; Sentilhes, Loic; Tutschek, Boris; Schwickert, Alexander; Stefanovic, Vedran; Bertholdt, Charline; International Society for Placenta accreta spectrum (IS-PAS) (2021)
    Introduction In cases of placenta accreta spectrum, a precise antenatal diagnosis of the suspected degree of invasion is essential for the planning of individual management strategies at delivery. The aim of this work was to evaluate the respective performances of ultrasonography and magnetic resonance imaging for the antenatal assessment of the severity of placenta accreta spectrum disorders included in the database. The secondary objective was to identify descriptors related to the severity of placenta accreta spectrum disorders. Material and methods All the cases included in the database for which antenatal imaging data were available were analyzed. The rates of occurrence of each ultrasound and magnetic resonance imaging descriptor were reported and compared between the Group "Accreta-Increta" (FIGO grades 1 & 2) and the Group "Percreta" (FIGO grade 3). Results Antenatal imaging data were available for 347 women (347/442, 78.5%), of which 105 were included in the Group "Accreta - Increta" (105/347, 30.2%) and 213 (213/347, 61.4%) in the Group "Percreta". Magnetic resonance imaging was performed in addition to ultrasound in 135 women (135/347, 38.9%). After adjustment for all ultrasound descriptors in multivariate analysis, only the presence of a bladder wall interruption was associated with a significant higher risk of percreta (Odds ratio 3.23, Confidence interval 1.33-7.79). No magnetic resonance imaging sign was significantly correlated with the degree of severity. Conclusions The performance of ultrasound and magnetic resonance imaging to discriminate mild from severe placenta accreta spectrum disorders is very poor. To date, the benefit of additional magnetic resonance imaging has not been demonstrated.
  • Hofstaetter, Cornelia; Courage, Carolina; Bartholdi, Deborah; Biskup, Saskia; Raio, Luigi (2018)
  • Iablonskyi, Denys; Wei, Haoyu; Klami, Arto; Salmi, Ari; Haeggström, Edward (IEEE, 2022)
    Ultrasonic guided waves (UGWs) can propagate over long distances with little attenuation and are suitable for non-destructive evaluation of a large area. However, localizing fouling inside the closed systems (e.g., pipes, engines) remains to be challenging. Here we propose to use UGWs that propagate along the pipe circumference along multiple helical paths, thus, providing denser structural information without increasing the number of sensors. When the path crosses fouled area the UGWs propagation properties change, generating unique features into each helical wave. Such aggregate information together with the known structural geometry are then used to fit a latent variable Gaussian process to recover the fouling distribution map in a probabilistic manner.
  • Hammer, Hilde Berner; Hansen, Inger Marie Jensen; Järvinen, Pentti; Leirisalo-Repo, Marjatta; Ziegelasch, Michael; Agular, Birte; Terslev, Lene (2021)
    Objectives. Given that subjective variables might reduce remission by composite DAS (CDAS), the main objectives were to explore whether RA patients with mainly tender vs mainly swollen joints had differences in patient-reported outcome measures (PROMs), clinical or US assessments or in achieving remission defined by CDAS or US. Methods. In a Nordic multicentre study, RA patients initiating tocilizumab were assessed by PROMs, clinical, laboratory and US assessments (36 joints and 4 tendons) at baseline, 4, 12 and 24 weeks. Remission was defined according to clinical disease activity index (CDAI)/Boolean or no Doppler activity present. Tender-swollen joint differences (TSJDs) were calculated. Statistics exploring changes over time/differences between groups included Wilcoxon, Mann-Whitney, Kruskal-Wallis and Spearman tests. Results. One hundred and ten patients were included [mean (S.D.) age 55.6 (12.1) years, RA duration 8.7 (9.5) years]. All PROMs, clinical, laboratory and US scores decreased during follow-up (P < 0.001). During follow-up, tender joint counts were correlated primarily with PROMs [r = 0.24-0.56 (P < 0.05-0.001)] and swollen joint counts with US synovitis scores [r = 0.33-0.72 (P < 0.05-0.001)]. At 24 weeks, patients with TSJD > 0 had higher PROMs and CDAI (P < 0.05-0.001) but lower US synovitis scores (P < 0.05). Remission by CDAI/Boolean was seen in 26-34% and by Doppler 53%, but only 2-3% of patients with TSJD > 0 achieved CDAI/Boolean remission. Conclusion. Patients with more tender than swollen joints scored higher on subjective assessments but had less US synovitis. They seldom achieved CDAS remission despite many being in Doppler remission. If patients with predominantly tender joints do not reach CDAS remission, objective assessments of inflammation should be performed.
  • Iablonskyi, Denys; Sundblad, Felix Alexander; Wuensch, Bruno; Klami, Arto; Salmi, Ari; Haeggström, Edward (IEEE, 2022)
    Advances in phased array of transducers (PATs) allow for precise control of each element's phase and amplitude and can consist of hundreds of transducers. The widely adopted Gerchberg-Saxton type of algorithms do not provide sufficient accuracy for complex control tasks like formation of detailed holograms as they perform well only for a small number of control points with respect to the number of transducers. Here we present an efficient PATs amplitude and phase solver based on the iterative first-order gradient optimization of the user defined loss function (APGO). We demonstrate high resolution hologram reconstruction when the number of control points is 25 times the number of transducers.
  • Jäske, Janni (Helsingin yliopisto, 2020)
    Hankositeen proksimaaliosan vauriot ovat yleinen ontuman syy ratsuhevosilla. Vammoja esiintyy kaikenlaisilla hevosilla ikään, sukupuoleen ja käyttötarkoitukseen katsomatta. Vauriot johtuvat liiasta kuormituksesta hankositeeseen, joka voi olla seurausta liiallisesta tai vääränlaisesta rasituksesta, mutta usein vaurion syntymistä edesauttaa hevosen takajalan rakenteelliset asiat kuten suora kinnet ja vento vuohinen. Tässä kirjallisuuskatsauksessa keskitytään takajalkojen vammoihin, mutta vammoja esiintyy myös etujaloissa. Kirjallisuuskatsauksen tavoitteena on perehtyä hankositeen monimutkaiseen anatomiaan hieman syvemmin ja löytää yhtenäinen tapa diagnosoida ja hoitaa hankositeen yläkiinnityskohdan vammoja. Hankoside sijaitsee plantaarisesti sääriluun ja syvän koukistajajänteen välissä puikkoluiden ympäröimänä kiinnittyen sääriluun proksimoplantaaripäähän yläkiinnityskohdastaan. Vammojen vakavuuteen vaikuttaa hankositeen anatominen sijainti, koska mahdollinen vamma voi vaikuttaa myös sitä ympäröiviin kudoksiin; esimerkiksi avulsiomurtuma sääriluussa on mahdollinen löydös hankositeen yläkiinnityskohdan vamman yhteydessä. Yleensä ensimmäisenä oireena hevosella havaitaan ontuma tai suorituskyvyn alenema, mutta sen vakavuus vaihtelee. Mahdollinen ontuma usein pahenee rasituksessa. Muita kliinisiä oireita kuten turvotusta tai lämpöä havaitaan vain harvoin. Vammojen diagnosointi aloitetaan kuten minkä tahansa ontuman selvitys; ensin palpoidaan raajat huolellisesti, tarkastellaan hevosen liikkumista, tehdään tarvittavaksi todetut taivutuskokeet ja diagnostiset puudutukset. Epäiltäessa hankositeen yläkiinnityskohdan vammaa kuvantaminen aloitetaan yleensä ultraäänitutkimuksella. Röntgenkuvantamisella poissuljetaan mahdolliset luuvauriot vamman yhteydessä. Nykyään käytetään myös yhä enemmän magneettikuvantamista, jonka avulla pystytään kuvantamaan sekä pehmyt- että luukudos samanaikaisesti. Vamman diagnosoiminen vaatii kuitenkin kokemusta ja anatomian tarkkaa tuntemusta johtuen hankositeen monimutkaisesta anatomiasta. Hankoside sisältää kaksi lohkoa. Molempien lohkojen sisällä on pienempi juoste, jota ympäröi varsinainen jännekudos. Juoste sisältää löyhää sidekudosta, verisuonia, hermoja, lihaskudosta ja rasvaa. Erilaiset kudokset ja niiden määrän vaihtelu eri yksilöiden välillä aiheuttavat heterogeenisyyttä ultraäänikuvaan. Diagnoosiin pääsy ja hoidon aloitus varhaisessa vaiheessa parantaa ennustetta. Varhaisesta diagnoosista ja hoidosta huolimatta ennuste on kuitenkin varauksellinen. Yleisesti käytettyjen hoitojen tehosta on ristiriitaisia tuloksia, eikä yhtenäistä hoitoprotokollaa ole löydetty. Akuutissa tapauksessa hoito aloitetaan konservatiivisella hoidolla ja paranemista voidaan tukea lääkityksillä, esimerkiksi kortisonilla, PRP:lla ja kantasolu-hoidolla. Myös esimerkiksi shock wave-terapiaa on käytetty hankositeen yläkiinnityskohdan vammojen hoidossa. Hoidossa voidaan turvautua myös kirurgiaan, jolloin hankositeen yläkiinnityskohtaa hermottava syvä lateraalinen plantaarihermo katkaistaan. Hoitomuodosta riippumatta paraneminen kestää pitkään ja sen edistymistä tulee seurata ultraäänitutkimuksen avulla ennen liikunnan lisäämistä. Vammat myös usein kroonistuvat tai uusivat heikentäen ennustetta edelleen.
  • Rousou, Charis; de Maar, Josanne; Qiu, Boning; van der Wurff-Jacobs, Kim; Ruponen, Marika; Urtti, Arto; Oliveira, Sabrina; Moonen, Chrit; Storm, Gert; Mastrobattista, Enrico; Deckers, Roel (2022)
    The combination of ultrasound and microbubbles (USMB) has been applied to enhance drug permeability across tissue barriers. Most studies focused on only one physicochemical aspect (i.e., molecular weight of the delivered molecule). Using an in vitro epithelial (MDCK II) cell barrier, we examined the effects of USMB on the permeability of five molecules varying in molecular weight (182 Da to 20 kDa) and hydrophilicity (LogD at pH 7.4 from 1.5 to highly hydrophilic). Treatment of cells with USMB at increasing ultrasound pressures did not have a significant effect on the permeability of small molecules (molecular weight 259 to 376 Da), despite their differences in hydrophilicity (LogD at pH 7.4 from -3.2 to 1.5). The largest molecules (molecular weight 4 and 20 kDa) showed the highest increase in the epithelial permeability (3-7-fold). Simultaneously, USMB enhanced intracellular accumulation of the same molecules. In the case of the clinically relevant anti- C-X-C Chemokine Receptor Type 4 (CXCR4) nanobody (molecular weight 15 kDa), USMB enhanced paracellular permeability by two-fold and increased binding to retinoblastoma cells by five-fold. Consequently, USMB is a potential tool to improve the efficacy and safety of the delivery of drugs to organs protected by tissue barriers, such as the eye and the brain.
  • Mohlkert, Lilly-Ann; Hallberg, Jenny; Broberg, Olof; Rydberg, Annika; Halvorsen, Cecilia Pegelow; Liuba, Petru; Fellman, Vineta; Domellof, Magnus; Sjoberg, Gunnar; Norman, Mikael (2018)
    Background-Preterm birth has been associated with increased risk of cardiovascular morbidity in adult life. We evaluated whether preterm birth is associated with deviating cardiac structure and function before school start. Methods and Results-In total, 176 children aged 6 years and born extremely preterm (EXPT; gestational age of 22-26weeks) and 134 children born at term (control [CTRL]) were studied. We used echocardiography to assess left heart dimensions, geometry, and functions. Recording and off-line analyses of echocardiographic images were performed by operators blinded to group belonging. Body size, blood pressure, and heart rate were also measured. Rates of family history of cardiovascular disease and sex distribution were similar in the EXPT and CTRL groups. Heart rate and systolic blood pressure did not differ, whereas diastolic blood pressure was slightly higher in EXPT than CTRL participants. After adjusting for body surface area, left ventricular length, width, and aortic valve annulus diameter were 3% to 5% smaller in EXPT than CTRL participants. Left ventricular longitudinal shortening and systolic tissue velocity were 7% to 11% lower, and transversal shortening fraction was 6% higher in EXPT than CTRL participants. The EXPT group also exhibited lower atrial emptying velocities than the CTRL group. Sex, fetal growth restriction, or a patent ductus arteriosus in the neonatal period did not contribute to cardiac dimensions or performance. Conclusions-Six-year-old children born extremely preterm exhibit a unique cardiac phenotype characterized by smaller left ventricles with altered systolic and diastolic functions than same-aged children born at term.