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Mirnezami AH, Drami I, Glyn T, Sutton PA, Tiernan J, Behrenbruch C, Guerra G, Waters PS, Woodward N, Applin S, Charles SJ, Rose SA, Denys A, Pape E, van Ramshorst GH, Baker D, Bignall E, Blair I, Davis P, Edwards T, Jackson K, Leendertse PG, Love-Mott E, MacKenzie L, Martens F, Meredith D, Nettleton SE, Trotman MP, van Hecke JJM, Weemaes AMJ, Abecasis N, Angenete E, Aziz O, Bacalbasa N, Barton D, Baseckas G, Beggs A, Brown K, Buchwald P, Burling D, Burns E, Caycedo-Marulanda A, Chang GJ, Coyne PE, Croner RS, Daniels IR, Denost QD, Drozdov E, Eglinton T, Espín-Basany E, Evans MD, Flatmark K, Folkesson J, Frizelle FA, Gallego MA, Gil-Moreno A, Goffredo P, Griffiths B, Gwenaël F, Harris DA, Iversen LH, Kandaswamy GV, Kazi M, Kelly ME, Kokelaar R, Kusters M, Langheinrich MC, Larach T, Lydrup ML, Lyons A, Mann C, McDermott FD, Monson JRT, Neeff H, Negoi I, Ng JL, Nicolaou M, Palmer G, Parnaby C, Pellino G, Peterson AC, Quyn A, Rogers A, Rothbarth J, Abu Saadeh F, Saklani A, Sammour T, Sayyed R, Smart NJ, Smith T, Sorrentino L, Steele SR, Stitzenberg K, Taylor C, Teras J, Thanapal MR, Thorgersen E, Vasquez-Jimenez W, Waller J, Weber K, Wolthuis A, Winter DC, Brangan G, Vimalachandran D, Aalbers AGJ, Abdul Aziz N, Abraham-Nordling M, Akiyoshi T, Alahmadi R, Alberda W, Albert M, Andric M, Angeles M, Antoniou A, Armitage J, Auer R, Austin KK, Aytac E, Baker RP, Bali M, Baransi S, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brunner M, Bui A, Burgess A, Burger JWA, Campain N, Carvalhal S, Castro L, Ceelen W, Chan KKL, Chew MH, Chok AK, Chong P, Christensen HK, Clouston H, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Damjanovic L, Davies M, Davies RJ, Delaney CP, de Wilt JHW, Deutsch C, Dietz D, Domingo S, Dozois EJ, Duff M, Egger E, Enrique-Navascues JM, Espín-Basany E, Eyjólfsdóttir B, Fahy M, Fearnhead NS, Fichtner-Feigl S, Fleming F, Flor B, Foskett K, Funder J, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Giner F, Ginther N, Glover T, Golda T, Gomez CM, Harris C, Hagemans JAW, Hanchanale V, Harji DP, Helbren C, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Holmström A, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Jenkins JT, Jourand K, Kaffenberger S, Kapur S, Kanemitsu Y, Kaufman M, Kelley SR, Keller DS, Kersting S, Ketelaers SHJ, Khan MS, Khaw J, Kim H, Kim HJ, Kiran R, Koh CE, Kok NFM, Kontovounisios C, Kose F, Koutra M, Kraft M, Kristensen HØ, Kumar S, Lago V, Lakkis Z, Lampe B, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Loria A, Lynch AC, Mackintosh M, Mantyh C, Mathis KL, Margues CFS, Martinez A, Martling A, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, McArthur DR, McCormick JJ, McGrath JS, McPhee A, Maciel J, Malde S, Manfredelli S, Mikalauskas S, Modest D, Morton JR, Mullaney TG, Navarro AS, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, O’Dwyer ST, Paarnio K, Pappou E, Park J, Patsouras D, Peacock O, Pfeffer F, Piqeur F, Pinson J, Poggioli G, Proud D, Quinn M, Oliver A, Radwan RW, Rajendran N, Rao C, Rasheed S, Rasmussen PC, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Seifert G, Selvasekar C, Shaban M, Shaikh I, Shida D, Simpson A, Skeie-Jensen T, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Spasojevic M, Steffens D, Stocchi L, Stylianides NA, Swartling T, Sumrien H, Swartking T, Takala H, Tan EJ, Taylor D, Tejedor P, Tekin A, Tekkis PP, Thaysen HV, Thurairaja R, Toh EL, Tsarkov P, Tolenaar J, Tsukada Y, Tsukamoto S, Tuech JJ, Turner G, Turner WH, Tuynman JB, Valente M, van Rees J, van Zoggel D, Vásquez-Jiménez W, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weiser MR, Westney OL, Wheeler JMD, Wild J, Wilson M, Yano H, Yip B, Yip J, Yoo RN, Zappa MA. The empty pelvis syndrome: a core data set from the PelvEx collaborative. Br J Surg 2024; 111:znae042. [PMID: 38456677 PMCID: PMC10921833 DOI: 10.1093/bjs/znae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/15/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Empty pelvis syndrome (EPS) is a significant source of morbidity following pelvic exenteration (PE), but is undefined. EPS outcome reporting and descriptors of radicality of PE are inconsistent; therefore, the best approaches for prevention are unknown. To facilitate future research into EPS, the aim of this study is to define a measurable core outcome set, core descriptor set and written definition for EPS. Consensus on strategies to mitigate EPS was also explored. METHOD Three-stage consensus methodology was used: longlisting with systematic review, healthcare professional event, patient engagement, and Delphi-piloting; shortlisting with two rounds of modified Delphi; and a confirmatory stage using a modified nominal group technique. This included a selection of measurement instruments, and iterative generation of a written EPS definition. RESULTS One hundred and three and 119 participants took part in the modified Delphi and consensus meetings, respectively. This encompassed international patient and healthcare professional representation with multidisciplinary input. Seventy statements were longlisted, seven core outcomes (bowel obstruction, enteroperineal fistula, chronic perineal sinus, infected pelvic collection, bowel obstruction, morbidity from reconstruction, re-intervention, and quality of life), and four core descriptors (magnitude of surgery, radiotherapy-induced damage, methods of reconstruction, and changes in volume of pelvic dead space) reached consensus-where applicable, measurement of these outcomes and descriptors was defined. A written definition for EPS was agreed. CONCLUSIONS EPS is an area of unmet research and clinical need. This study provides an agreed definition and core data set for EPS to facilitate further research.
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Nielsen MB, Meyer AS, Arnau J. The Next Food Revolution Is Here: Recombinant Microbial Production of Milk and Egg Proteins by Precision Fermentation. Annu Rev Food Sci Technol 2023; 15. [PMID: 38134386 DOI: 10.1146/annurev-food-072023-034256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Animal-based agriculture and the production of protein-rich foods from animals, particularly from ruminants, is not sustainable and has serious climate effects. A new type of alternative proteins is now on the menu, namely animal proteins produced recombinantly by microbial fermentation. This new technology, precision fermentation, is projected to completely disrupt traditional animal-based agriculture. Certain milk and egg proteins along with specific meat substitute analog components produced by precision fermentation are already entering the market. This first wave of precision fermentation products targets the use of these proteins as protein additives, and several commercial players are already active in the field. The cost-efficiency requirements involve production titers above 50 g/L which are several orders of magnitude higher than those for pharmaceutical protein manufacture, making strain engineering, process optimization, and scale-up critical success factors. This new development within alternative proteins defines a new research direction integrating biotechnology, process engineering, and sustainable food protein production. Expected final online publication date for the Annual Review of Food Science and Technology, Volume 15 is April 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- M B Nielsen
- Protein Chemistry and Enzyme Technology Section, Department of Biotechnology and Biomedicine, Technical University of Denmark, Kgs. Lyngby, Denmark
- 21st.BIO, Søborg, Denmark;
| | - A S Meyer
- Protein Chemistry and Enzyme Technology Section, Department of Biotechnology and Biomedicine, Technical University of Denmark, Kgs. Lyngby, Denmark
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West CT, West MA, Mirnezami AH, Drami I, Denys A, Glyn T, Sutton PA, Tiernan J, Behrenbruch C, Guerra G, Waters PS, Woodward N, Applin S, Charles SJ, Rose SA, Pape E, van Ramshorst GH, Aalbers AGJ, Abdul AN, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alahmadi R, Alberda W, Albert M, Andric M, Angeles M, Angenete E, Antoniou A, Armitage J, Auer R, Austin KK, Aytac E, Aziz O, Bacalbasa N, Baker RP, Bali M, Baransi S, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brown K, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceelen W, Chan KKL, Chang GJ, Chew MH, Chok AK, Chong P, Christensen HK, Clouston H, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Coyne PE, Croner RS, Damjanovic L, Daniels IR, Davies M, Davies RJ, Delaney CP, de Wilt JHW, Denost QD, Deutsch C, Dietz D, Domingo S, Dozois EJ, Drozdov E, Duff M, Egger E, Eglinton T, Enrique-Navascues JM, Espín-Basany E, Evans MD, Eyjólfsdóttir B, Fahy M, Fearnhead NS, Fichtner-Feigl S, Flatmark K, Fleming F, Flor B, Folkesson J, Foskett K, Frizelle FA, Funder J, Gallego MA, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Gil-Moreno A, Giner F, Ginther N, Glover T, Goffredo P, Golda T, Gomez CM, Griffiths B, Gwenaël F, Harris C, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helbren C, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Holmström A, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Iversen LH, Jenkins JT, Jourand K, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kaufman M, Kazi M, Kelley SR, Keller DS, Kelly ME, Kersting S, Ketelaers SHJ, Khan MS, Khaw J, Kim H, Kim HJ, Kiran R, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kose F, Koutra M, Kraft M, Kristensen HØ, Kumar S, Kusters M, Lago V, Lakkis Z, Lampe B, Langheinrich MC, Larach T, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Loria A, Lydrup ML, Lyons A, Lynch AC, Mackintosh M, Mann C, Mantyh C, Mathis KL, Margues CFS, Martinez A, Martling A, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, McArthur DR, McCormick JJ, McDermott FD, McGrath JS, McPhee A, Maciel J, Malde S, Manfredelli S, Mikalauskas S, Modest D, Monson JRT, Morton JR, Mullaney TG, Navarro AS, Neeff H, Negoi I, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, O’Dwyer ST, Paarnio K, Palmer G, Pappou E, Park J, Patsouras D, Peacock A, Pellino G, Peterson AC, Pfeffer F, Piqeur F, Pinson J, Poggioli G, Proud D, Quinn M, Oliver A, Quyn A, Radwan RW, Rajendran N, Rao C, Rasheed S, Rasmussen PC, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Seifert G, Selvasekar C, Shaban M, Shaikh I, Shida D, Simpson A, Skeie-Jensen T, Smart NJ, Smart P, Smith JJ, Smith T, Solbakken AM, Solomon MJ, Sørensen MM, Spasojevic M, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Swartling T, Sumrien H, Swartking T, Takala H, Tan EJ, Taylor C, Taylor D, Tejedor P, Tekin A, Tekkis PP, Teras J, Thanapal MR, Thaysen HV, Thorgersen E, Thurairaja R, Toh EL, Tsarkov P, Tolenaar J, Tsukada Y, Tsukamoto S, Tuech JJ, Turner G, Turner WH, Tuynman JB, Valente M, van Rees J, van Zoggel D, Vásquez-Jiménez W, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weber K, Weiser MR, Westney OL, Wheeler JMD, Wild J, Wilson M, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, Zappa MA, Winter DC. Empty pelvis syndrome: PelvEx Collaborative guideline proposal. Br J Surg 2023; 110:1730-1731. [PMID: 37757457 PMCID: PMC10805575 DOI: 10.1093/bjs/znad301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023]
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Fahy MR, Kelly ME, Aalbers AGJ, Abdul Aziz N, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alberda W, Albert M, Andric M, Angeles MA, Angenete E, Antoniou A, Auer R, Austin KK, Aytac E, Aziz O, Bacalbasa N, Baker RP, Bali M, Baransi S, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Beynon J, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceelan W, Chan KKL, Chang GJ, Chang M, Chew MH, Chok AY, Chong P, Clouston H, Codd M, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Coyne PE, Croner RS, Damjanovich L, Daniels IR, Davies M, Delaney CP, de Wilt JHW, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois EJ, Drozdov E, Duff M, Eglinton T, Enriquez-Navascues JM, Espín-Basany E, Evans MD, Eyjólfsdóttir B, Fearnhead NS, Ferron G, Flatmark K, Fleming FJ, Flor B, Folkesson J, Frizelle FA, Funder J, Gallego MA, Gargiulo M, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Gil-Moreno A, Giner F, Ginther DN, Glyn T, Glynn R, Golda T, Griffiths B, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Iversen LH, Jenkins JT, Jourand K, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kazi M, Kelley SR, Keller DS, Ketelaers SHJ, Khan MS, Kiran RP, Kim H, Kim HJ, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kose F, Koutra M, Kristensen HØ, Kroon HM, Kumar S, Kusters M, Lago V, Lampe B, Lakkis Z, Larach JT, Larkin JO, Larsen SG, Larson DW, Law WL, Lee PJ, Limbert M, Loria A, Lydrup ML, Lyons A, Lynch AC, Maciel J, Manfredelli S, Mann C, Mantyh C, Mathis KL, Marques CFS, Martinez A, Martling A, Mehigan BJ, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, Mikalauskas S, McArthur DR, McCormick JJ, McCormick P, McDermott FD, McGrath JS, Malde S, Mirnezami A, Monson JRT, Navarro AS, Negoi I, Neto JWM, Ng JL, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, Nugent T, Oliver A, O’Dwyer ST, O’Sullivan NJ, Paarnio K, Palmer G, Pappou E, Park J, Patsouras D, Peacock O, Pellino G, Peterson AC, Pinson J, Poggioli G, Proud D, Quinn M, Quyn A, Rajendran N, Radwan RW, Rajendran N, Rao C, Rasheed S, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Selvasekar C, Shaikh I, Simpson A, Skeie-Jensen T, Smart NJ, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Sorrentino L, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Swartling T, Spasojevic M, Sumrien H, Sutton PA, Swartking T, Takala H, Tan EJ, Taylor C, Tekin A, Tekkis PP, Teras J, Thaysen HV, Thurairaja R, Thorgersen EB, Toh EL, Tsarkov P, Tsukada Y, Tsukamoto S, Tuech JJ, Turner WH, Tuynman JB, Valente M, van Ramshorst GH, van Zoggel D, Vasquez-Jimenez W, Vather R, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Urrejola G, Wakeman C, Warrier SK, Wasmuth HH, Waters PS, Weber K, Weiser MR, Wheeler JMD, Wild J, Williams A, Wilson M, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, Zappa MA, Winter DC. Minimum standards of pelvic exenterative practice: PelvEx Collaborative guideline. Br J Surg 2022; 109:1251-1263. [PMID: 36170347 DOI: 10.1093/bjs/znac317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/18/2022] [Accepted: 08/18/2022] [Indexed: 12/31/2022]
Abstract
This document outlines the important aspects of caring for patients who have been diagnosed with advanced pelvic cancer. It is primarily aimed at those who are establishing a service that adequately caters to this patient group. The relevant literature has been summarized and an attempt made to simplify the approach to management of these complex cases.
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Abstract
Background There is a lack of published data on the association between alcohol consumption and health and well-being in working populations. Aims To determine how levels of alcohol consumption are associated with psychological distress, somatic complaints, sleep and job satisfaction in the Norwegian workforce. Methods Survey questionnaire data from a probability sample comprising Norwegian employees. The association between alcohol consumption and health and well-being was assessed using analysis of covariance. Results There were 1608 respondents (response rate 32%); 20% of the sample were abstainers, 72% were low- to moderate-alcohol users, 6% were moderate to high users and 2% were risky users. Adjusting for age, gender and tobacco use, employees with risky alcohol use reported significantly higher levels of psychological distress and lower job satisfaction when compared to employees who drank less. There were no differences between risky users and other employees with regard to sleep problems and somatic complaints, nor were there any gender differences. Conclusions Our findings indicate that risky alcohol use in the Norwegian workforce is associated with impaired health and well-being, with no evidence of a gender differential. The findings support the thresholds for risky alcohol use as proposed by internationally recognized guidelines for alcohol consumption.
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Affiliation(s)
- M B Nielsen
- National Institute of Occupational Health, Oslo, Norway.,Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - J Gjerstad
- National Institute of Occupational Health, Oslo, Norway.,Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - M Frone
- Research Institute on Addictions, State University of New York at Buffalo, Buffalo, NY, USA
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Benomar O, Bazot M, Nielsen MB, Gizon L, Sekii T, Takata M, Hotta H, Hanasoge S, Sreenivasan KR, Christensen-Dalsgaard J. Asteroseismic detection of latitudinal differential rotation in 13 Sun-like stars. Science 2018; 361:1231-1234. [PMID: 30237352 DOI: 10.1126/science.aao6571] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 07/25/2018] [Indexed: 11/02/2022]
Abstract
The differentially rotating outer layers of stars are thought to play a role in driving their magnetic activity, but the underlying mechanisms that generate and sustain differential rotation are poorly understood. We report the measurement using asteroseismology of latitudinal differential rotation in the convection zones of 40 Sun-like stars. For the most significant detections, the stars' equators rotate approximately twice as fast as their midlatitudes. The latitudinal shear inferred from asteroseismology is much larger than predictions from numerical simulations.
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Affiliation(s)
- O Benomar
- Center for Space Science, New York University, Abu Dhabi (NYUAD), UAE.
| | - M Bazot
- Center for Space Science, New York University, Abu Dhabi (NYUAD), UAE
| | - M B Nielsen
- Center for Space Science, New York University, Abu Dhabi (NYUAD), UAE
| | - L Gizon
- Center for Space Science, New York University, Abu Dhabi (NYUAD), UAE.,Max-Planck-Institut für Sonnensystemforschung, 37077 Göttingen, Germany.,Institut für Astrophysik, Georg-August-Universität Göttingen, 37077 Göttingen, Germany
| | - T Sekii
- National Astronomical Observatory of Japan, Mitaka, Tokyo 181-8588, Japan
| | - M Takata
- Department of Astronomy, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - H Hotta
- Department of Physics, Graduate School of Science, Chiba University, Chiba 263-8522, Japan
| | - S Hanasoge
- Center for Space Science, New York University, Abu Dhabi (NYUAD), UAE.,Tata Institute of Fundamental Research, Mumbai 400005, India
| | - K R Sreenivasan
- Center for Space Science, New York University, Abu Dhabi (NYUAD), UAE.,Department of Physics, Department of Mechanical and Aerospace Engineering, Courant Institute for Mathematical Sciences, New York University, NY 10012, USA
| | - J Christensen-Dalsgaard
- Stellar Astrophysics Centre, Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark
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Russell L, Østergaard ML, Nielsen MB, Konge L, Nielsen KR. Standardised assessment of competence in Focused Assessment with Sonography for Trauma. Acta Anaesthesiol Scand 2018; 62:1154-1160. [PMID: 29708590 DOI: 10.1111/aas.13141] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 03/28/2018] [Accepted: 03/30/2018] [Indexed: 01/02/2023]
Abstract
PURPOSE The aim of this study was to develop and gather validity evidence for a standardised test of competence in Focused Assessment with Sonography for Trauma (FAST) and to define the appropriate cut-off point in simulation-based learning of the FAST protocol. METHODS A 20-item simulation-based test for assessing competence in FAST was created. The test was administered to thirteen novices and twelve radiologists experienced in abdominal ultrasound diagnostics. The Contrasting Groups' method was used to establish a credible passing score. RESULTS The internal consistency was high (Cronbach's α = 0.90) and the test had good discriminatory ability (P < .001). The mean score was 16.9 (95% CI: 15.5-18.3) in the experienced group and 8.0 (95% CI: 5.8-10.2) in the novice group, corresponding to 85% and 40% of the total score, respectively. A pass/fail standard of 14 points was established using the Contrasting Groups' method. CONCLUSIONS The FAST simulation-based test provided valid assessment of competence in FAST. The FAST test could be used to guide training and ensure basic competence of physicians using FAST.
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Affiliation(s)
- L Russell
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and The Capital Region of Denmark, Copenhagen, Denmark
- Department of Intensive Care 4131, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Emergency Medical Services Copenhagen, The Capital Region of Denmark, Ballerup, Denmark
| | - M L Østergaard
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and The Capital Region of Denmark, Copenhagen, Denmark
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - M B Nielsen
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and The Capital Region of Denmark, Copenhagen, Denmark
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - L Konge
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and The Capital Region of Denmark, Copenhagen, Denmark
| | - K R Nielsen
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and The Capital Region of Denmark, Copenhagen, Denmark
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Krommes K, Petersen J, Nielsen MB, Aagaard P, Hölmich P, Thorborg K. Sprint and jump performance in elite male soccer players following a 10-week Nordic Hamstring exercise Protocol: a randomised pilot study. BMC Res Notes 2017; 10:669. [PMID: 29202784 PMCID: PMC5716363 DOI: 10.1186/s13104-017-2986-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 11/23/2017] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The preseason Nordic Hamstring Protocol (NHP) reduces hamstring strain injuries in football players. Despite persisting injury rates, elite clubs are reluctant to apply the NHP often over concerns of negative impacts on performance. This pilot study investigated if sprint or jump-performance outcomes tended to increase or decrease following implementation of the NHP in elite male soccer-players. RESULTS Nineteen male soccer players from the Danish 1st division were randomised to perform NHP (27 sessions) during pre-season, or to control group (CG). Sprint performance (30 m with 5 and 10 m split times) and countermovement jump (CMJ height) was measured before the mid-seasonal break and again after 10 weeks of performing the NHP at the end of pre-season. Dropouts were due to transfers and injuries unrelated to performing NHP (NHP = 0, CG = 5). Sprint performance on the short split distances improved for most players in the NHP (6 out of 9 improved, median changes for 5 m split: - 0.068 s; 10 m split: - 0.078 s), but not CG (2 out of 5 improved, median changes for 5 m split: + 0.1 s; 10 m split: CG: + 0.11 s), but both groups had small declines at 30 m sprint (NHP: 7 out of 9 declined, median changes: + 0.116 s; CG: 4 out of 5 declined, median changes: + 0.159 s). CMJ height mostly improved in both groups (NHP: 6 out of 9 improved, median changes: + 2.1 cm; CG: 4 out of 8 improved, median changes: + 0.55 cm). Performing the NHP in elite soccer players did therefore not seem to negatively affect sprint and vertical jump performance outcomes in the present study, while in fact showing some promise for the more explosive characteristics such as the short 5 and 10 m split-times and maximal CMJ height, which all are highly relevant performance parameters in elite football.
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Affiliation(s)
- K Krommes
- Sports Orthopedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Kettegaard Alle 30, Hvidovre, Denmark. .,Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Department of Physical and Occupational Therapy, University of Copenhagen, Copenhagen, Denmark.
| | - J Petersen
- Sports Orthopedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Kettegaard Alle 30, Hvidovre, Denmark
| | - M B Nielsen
- Department of Radiology, Section of Ultrasound, Diagnostic Centre, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - P Aagaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - P Hölmich
- Sports Orthopedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Kettegaard Alle 30, Hvidovre, Denmark
| | - K Thorborg
- Sports Orthopedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Kettegaard Alle 30, Hvidovre, Denmark.,Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Department of Physical and Occupational Therapy, University of Copenhagen, Copenhagen, Denmark
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9
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Mahmood B, Ewertsen C, Carlsen J, Nielsen MB. Ultrasound Vascular Elastography as a Tool for Assessing Atherosclerotic Plaques - A Systematic Literature Review. Ultrasound Int Open 2016; 2:E106-E112. [PMID: 27896334 DOI: 10.1055/s-0042-115564] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/05/2016] [Indexed: 02/02/2023] Open
Abstract
Atherosclerosis is a widespread disease that accounts for nearly 3-quarters of deaths due to cardiovascular disease. Ultrasound elastography might be able to reliably identify characteristics associated with vulnerable plaques. There is a need for the evaluation of elastography and its ability to distinguish between vulnerable and stable plaques. The aim of this paper is to provide an overview of the literature on vascular elastography. A systematic search of the available literature for studies using elastography for assessing atherosclerotic plaques was conducted using the MEDLINE, Embase, Cochrane Library and Web of Science databases. A standardized template was used to extract relevant data following the PRISMA 2009 checklist. 20 articles were included in this paper. The studies were heterogeneous. All studies reported that elastography was a feasible technique and provided additional information compared to B-mode ultrasound alone. Most studies reported higher strain values for vulnerable plaques. Ultrasound elastography has potential as a clinical tool in the assessment of atherosclerotic plaques. Elastography is able to distinguish between different plaque types, but there is considerable methodological variation between studies. There is a need for larger studies in a clinical setting to determine the full potential of elastography.
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Affiliation(s)
- B Mahmood
- Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, Denmark
| | - C Ewertsen
- Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, Denmark
| | - J Carlsen
- Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, Denmark
| | - M B Nielsen
- Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, Denmark
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10
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Cantisani V, Dietrich CF, Badea R, Dudea S, Prosch H, Cerezo E, Nuernberg D, Serra AL, Sidhu PS, Radzina M, Piscaglia F, Bachmann Nielsen M, Ewertsen C, Săftoiu A, Calliada F, Gilja OH. EFSUMB Statement on Medical Student Education in Ultrasound [long version]. Ultrasound Int Open 2016; 2:E2-7. [PMID: 27689163 DOI: 10.1055/s-0035-1569413] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) recommends that ultrasound should be used systematically as an easy accessible and instructive educational tool in the curriculum of modern medical schools. Medical students should acquire theoretical knowledge of the modality and hands-on training should be implemented and adhere to evidence-based principles. In this paper we report EFSUMB policy statements on medical student education in ultrasound that in a short version is already published in Ultraschall in der Medizin 1.
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Affiliation(s)
- V Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, University Sapienza, Rome, Italy
| | - C F Dietrich
- Medizinische Klinik 2, Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim
| | - R Badea
- Department of Ultrasonography, 3rd Medical Clinic, Institute of Gastroenterology and Hepatology Octavian Fodor; Imaging Department, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj Napoca, Romania
| | - S Dudea
- Radiology Department "Iuliu Hatieganu" Univ. Med. Pharm. Cluj-Napoca, Romania
| | - H Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, Austria
| | - E Cerezo
- Calle Francisco Silvela #124, lo 3 Madrid, Spain
| | - D Nuernberg
- Department of Gastroenterology, Brandenburg University of Medicine Theodor Fontane, Neuruppin
| | - A L Serra
- Department of Internal Medicine and Nephrology, Ultrasound Learning Center, Hirslanden Clinic, Zürich, Switzerland
| | - P S Sidhu
- Department of Radiology, King's College Hospital, London, UK
| | - M Radzina
- Diagnostic Radiology Institute, Paula Stradins Clinical University Hospital, Riga, Latvia
| | - F Piscaglia
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - M Bachmann Nielsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - C Ewertsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - A Săftoiu
- Gastroenterology Department, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Romania
| | | | - O H Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen and Department of Clinical Medicine, University of Bergen, Norway
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11
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Abstract
BACKGROUND Associations between shift work (SW) schedules, mental distress and job satisfaction have never been completely described. AIMS To examine gender-specific associations of SW with mental distress and job satisfaction in nurses in Hebron District, Palestine, in 2012. METHODS Detailed information on work schedules (day versus shift), socio-demographic status, mental distress (General Health Questionnaire, GHQ-30) and job satisfaction (Generic Job Satisfaction Scale) in nurses employed in Hebron District, Palestine, was obtained through a questionnaire survey. Associations of SW and outcomes were examined by linear regression analysis. RESULTS Of 372 nurses eligible for the study, 309 and 338 completed surveys regarding mental distress and job satisfaction, respectively. The sample comprised 62% women and 38% men. After adjusting for covariates, women working shifts reported significantly higher levels of mean mental distress [β coefficient 3.6; 95% confidence interval (CI) 0.3-7.0] compared with women working regular day shifts. Men working shifts reported significantly lower levels of job satisfaction (-3.3; 95% CI -6.2 to -0.5) than men working regular day shifts. Women reported higher levels of mental distress than men, but this was unrelated to work schedule. CONCLUSIONS In this study, nurses working shifts reported higher levels of mental distress and lower levels of job satisfaction, although these associations were weaker when adjusted for potential covariates. There was no evidence of a gender differential in the association between SW and mental distress and job satisfaction.
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Affiliation(s)
- Y M Jaradat
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo 0033, Norway, .,Section for Preventive Medicine and Epidemiology, Institute of Health and Society, University of Oslo, Oslo 0316, Norway
| | - M B Nielsen
- Department of Work Psychology and Physiology, National Institute of Occupational Health, Oslo 0033, Norway
| | - P Kristensen
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo 0033, Norway
| | - R Bast-Pettersen
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo 0033, Norway
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12
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Abstract
The impact factor (IF) for 2015 was recently released and this could be the time to once again reflect on its use as a metric of a journal. Problems and concerns regarding the IF have been addressed extensively elsewhere 1 2. The principle of the IF for a given year is that it represents the average number of citations of articles published in the journal in the two previous years.While authors frequently cite the IF as a determining factor for submission, the IF does not predict how many times individual articles will be cited. In a study from a peer-reviewed cardiovascular journal, nearly half of all published articles were poorly cited, i. e., less than five citations in five years 3. A similar percentage seems to apply to our journal. In nearly all journals we estimate that the majority of citations relate to a minority of the articles. Some articles are never cited. 13 % of the articles published in our journal from 2010 to 2013 have never been cited. Even authors of poorly cited articles benefit from the IF since many institutions use the combined impact factors of their published papers to measure research activity and this may be reflected in their research budgets.The competition for the printed pages in the six annual issues of Ultraschall in der Medizin/European Journal of Ultrasound (UiM/EJU) has resulted in high rejection rates (between 80 % and 90 %). One negative review with recommendation of major revision may therefore result in rejection. Peer-review fraud where the submitting author listed recommended reviewers with fake email addresses supplying fabricated peer reviews has recently been described in the New England Journal of Medicine 4. Some of the editors of our journal believe they have experienced this as well. Fabricating reviews in order to get a high IF for an article is to be considered fraud and is inexcusable.One aspect of using impact factors as a measure of the quality of a journal is that the IF only goes back two years. There may be differences between journals for different medical specialties since the citations in some areas seem to "burn out" within a few years while some articles continue to be cited even after several years. Therefore, a citation window that is longer than 2 years has been proposed 5.For this editorial we took a look at the 60 articles published in UiM/EJU in 2010. Half of them were no longer being cited in 2015. However, 10 articles were cited more than 5 times in 2015, and 5 of these were cited more than 10 times 6 7 8 9 10. It therefore seems that many of our articles have a long scientific life and generate more citations than indicated by the IF. Moreover, some articles have the highest number of citations after three years when they are no longer contributing to the impact factor. The most frequently cited articles from 2010 were multicenter studies, recommendations, and papers on hot topics like contrast-enhanced ultrasound (CEUS) and elastography, but it should be noted that there were also articles on the same topics that were poorly cited.The same trending topics continued into 2013 now topped by European guidelines and recommendations 11 12 13. 9 of the 10 most cited articles we published in 2014 were on CEUS or elastography 14 15 16 17 18 19 20 21 22, but the most cited article from that year so far has been on peripheral nerves 23. Surprisingly many good scientific papers on obstetrics/fetal US and musculoskeletal US have low citation rates 24 25 26. Our predictions for 2016 based on the topics of submitted articles in the last 12 months are that CEUS and elastography will continue to be popular topics.It is also worth mentioning that there can be a discrepancy between which titles are cited and which are accessed online. In addition to international guidelines, our CME articles are usually popular according to online access. CME articles are well established educational papers but they are rarely cited for the IF. Looking at the most read full-text recent articles on our journal's website shows that multicenter studies as well as recommendations backed by a national society or by the EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) are still important 27 28 29 30 31 32 33. Upcoming important topics appear to be pediatric use of CEUS, simulation training and the introduction of ultrasound to medical students 34 35 36 37. Some of these are also backed by EFSUMB.A recent paper on the IF of radiology journals found that subspecialty radiology journals had a higher IF than general radiology journals 38. This could prove a challenge to interdisciplinary journals like ours but we take pride in continuing to cover all aspects of ultrasound in more than 15 fields.The distribution between reviews, original articles and case reports in a journal is worth addressing. An important aspect of a journal is the publication of original scientific research articles. CME articles, pictorials and letters are important for other reasons but are cited at a lower rate. The value of case reports with regard to the IF is low since they are rarely cited 39 and we have observed that some journals have abandoned the publication of case reports, thus leaving them to spin-off journals. The rationale is that keeping case reports in a journal will only increase the denominator, thereby decreasing the IF 39. At our journal we have seen a decline in case report submissions but still want to publish them and even put one case on the front cover of every issue. Case reports still hold an educational value 40 and are important to our readers.In conclusion, a healthy mix of original articles, CME articles, reviews and case reports combined with a few international guidelines and recommendations is important to UIM/EJU. Although we see popular topics like CEUS and elastography, it is not possible to predict which articles will be read or even cited based on the topic, with multicenter studies being the exception.
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13
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Østergaard ML, Ewertsen C, Konge L, Albrecht-Beste E, Bachmann Nielsen M. Simulation-Based Abdominal Ultrasound Training - A Systematic Review. Ultraschall Med 2016; 37:253-261. [PMID: 26882483 DOI: 10.1055/s-0042-100452] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE The aim is to provide a complete overview of the different simulation-based training options for abdominal ultrasound and to explore the evidence of their effect. MATERIALS AND METHODS This systematic review was performed according to the PRISMA guidelines and Medline, Embase, Web of Science, and the Cochrane Library was searched. Articles were divided into three categories based on study design (randomized controlled trials, before-and-after studies and descriptive studies) and assessed for level of evidence using the Oxford Centre for Evidence Based Medicine (OCEBM) system and for bias using the Cochrane Collaboration risk of bias assessment tool. RESULTS Seventeen studies were included in the analysis: four randomized controlled trials, eight before-and-after studies with pre- and post-test evaluations, and five descriptive studies. No studies scored the highest level of evidence, and 14 had the lowest level. Bias was high for 11 studies, low for four, and unclear for two. No studies used a test with established evidence of validity or examined the correlation between obtained skills on the simulators and real-life clinical skills. Only one study used blinded assessors. CONCLUSION The included studies were heterogeneous in the choice of simulator, study design, participants, and outcome measures, and the level of evidence for effect was inadequate. In all studies simulation training was equally or more beneficial than other instructions or no instructions. Study designs had significant built-in bias and confounding issues; therefore, further research should be based on randomized controlled trials using tests with validity evidence and blinded assessors.
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Affiliation(s)
- M L Østergaard
- Department of Radiology, Copenhagen University Hosital, Rigshospitalet, Copenhagen OE, Denmark
| | - C Ewertsen
- Department of Radiology, Copenhagen University Hosital, Rigshospitalet, Copenhagen OE, Denmark
| | - L Konge
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - E Albrecht-Beste
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen OE, Denmark
| | - M Bachmann Nielsen
- Department of Radiology, Copenhagen University Hosital, Rigshospitalet, Copenhagen OE, Denmark
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14
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Cantisani V, Dietrich CF, Badea R, Dudea S, Prosch H, Cerezo E, Nuernberg D, Serra AL, Sidhu PS, Radzina M, Piscaglia F, Bachmann Nielsen M, Calliada F, Gilja OH. EFSUMB statement on medical student education in ultrasound [short version]. Ultraschall Med 2016; 37:100-102. [PMID: 26871409 DOI: 10.1055/s-0035-1566959] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) recommends that ultrasound should be used systematically as an easy accessible and instructive educational tool in the curriculum of modern medical schools. Medical students should acquire theoretical knowledge of the modality and hands-on training should be implemented and adhere to evidence-based principles. In this paper we summarise EFSUMB policy statements on medical student education in ultrasound.
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Affiliation(s)
- V Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, University Sapienza, Rome, Italy
| | - C F Dietrich
- Medizinische Klinik 2, Caritas Krankenhaus Bad Mergentheim, Germany
| | - R Badea
- Department of Ultrasonography, 3rd Medical Clinic, Institute of Gastroenterology and Hepatology Octavian Fodor; Imaging Department, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj Napoca, Romania
| | - S Dudea
- Radiology Dept. "Iuliu Hatieganu" Univ. Med. Pharm. Cluj-Napoca, Romania
| | - H Prosch
- Dept. of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, Austria
| | - E Cerezo
- Calle Francisco Silvela #124, lo 3 Madrid, Spain
| | - D Nuernberg
- Department of Gastroenterology, Brandenburg University of Medicine Theodor Fontane, Neuruppin, Germany
| | - A L Serra
- Department of Internal Medicine and Nephrology, Ultrasound Learning Center, Hirslanden Clinic, Zürich, Switzerland
| | - P S Sidhu
- Department of Radiology, King's College Hospital, London, UK
| | - M Radzina
- Diagnostic Radiology Institute, Paula Stradins Clinical University Hospital, Riga, Latvia
| | - F Piscaglia
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - M Bachmann Nielsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - F Calliada
- Department of Radiology. Policlinico San Matteo, University Hospital, Pavia, Italy
| | - O H Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen and Department of Clinical Medicine, University of Bergen, Norway
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15
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Riishede I, Ewertse C, Carlsen J, Mørk Petersen M, Flemming J, Bachmann Nielsen M. Response. Ultraschall Med 2015; 36:637-638. [PMID: 27045149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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16
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Carlsen J, Ewertsen C, Sletting S, Vejborg I, Schäfer FKW, Cosgrove D, Bachmann Nielsen M. Ultrasound Elastography in Breast Cancer Diagnosis. Ultraschall Med 2015; 36:550-565. [PMID: 26274379 DOI: 10.1055/s-0035-1553293] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Ultrasound elastography is an established method for characterization of focal lesions in the breast. Different techniques and analyses of the images may be used for the characterization. This article addresses the use of ultrasound elastography in breast cancer diagnosis. In the first part of the article the techniques behind both strain- and shear-wave-elastography are explained and followed by a section on how to obtain adequate elastography images and measurements. In the second part of the article the application of elastography as an adjunct to B-mode ultrasound in clinical practice is described, and the potential diagnostic gains and limitations of elastography are discussed.
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Affiliation(s)
- J Carlsen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen OE, Denmark
| | - C Ewertsen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen OE, Denmark
| | - S Sletting
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen OE, Denmark
| | - I Vejborg
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen OE, Denmark
| | - F K W Schäfer
- Department of Breast Imaging and Interventions, University Hospital Schleswig-Holstein Campus Kiel, Germany
| | - D Cosgrove
- Clinical Sciences, Imperial College, London, United Kingdom
| | - M Bachmann Nielsen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen OE, Denmark
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17
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Lorentzen T, Nolsøe CP, Ewertsen C, Nielsen MB, Leen E, Havre RF, Gritzmann N, Brkljacic B, Nürnberg D, Kabaalioglu A, Strobel D, Jenssen C, Piscaglia F, Gilja OH, Sidhu PS, Dietrich CF. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part I. General Aspects (long Version). Ultraschall Med 2015; 36:E1-E14. [PMID: 26468774 DOI: 10.1055/s-0035-1553593] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This is the first part of the Guidelines on Interventional Ultrasound of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) and covers all general aspects of ultrasound-guided procedures (long version).
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Affiliation(s)
- T Lorentzen
- Department of Gastric Surgery, Ultrasound Section, Herlev Hospital, University of Copenhagen, Denmark
| | - C P Nolsøe
- Department of Gastric Surgery, Ultrasound Section, Herlev Hospital, University of Copenhagen, Denmark
| | - C Ewertsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - M B Nielsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - E Leen
- Imperial College London and Imaging Department, Hammersmith Hospital Campus, London, UK
| | - R F Havre
- National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - N Gritzmann
- Radiologist, Esslinger Hauptstraße 89, 1220 Wien, Austria
| | - B Brkljacic
- University of Zagreb School of Medicine, Department of Diagnostic and Interventional Radiology, University Hospital "Dubrava", Zagreb, Croatia
| | - D Nürnberg
- Department of Gastroenterology, Brandenburg University of Medicine Theodor Fontane, Neuruppin, Germany
| | - A Kabaalioglu
- Department of Radiology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - D Strobel
- Department of Medicine I, University Hospital Erlangen, Germany
| | - C Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Germany
| | - F Piscaglia
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna Hospital, Bologna, Italy
| | - O H Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen Norway and Department of Clinical Medicine, University of Bergen, Norway
| | - P S Sidhu
- Department of Radiology, King's College Hospital, London, UK
| | - C F Dietrich
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
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18
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Lorentzen T, Nolsøe CP, Ewertsen C, Nielsen MB, Leen E, Havre RF, Gritzmann N, Brkljacic B, Nürnberg D, Kabaalioglu A, Strobel D, Jenssen C, Piscaglia F, Gilja OH, Sidhu PS, Dietrich CF. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part I. General Aspects (Short Version). Ultraschall Med 2015; 36:464-472. [PMID: 26468772 DOI: 10.1055/s-0035-1553601] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This is the first part of the Guidelines on Interventional Ultrasound of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) and covers all general aspects of ultrasound-guided procedures (short version; the long version is published online).
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Affiliation(s)
- T Lorentzen
- Department of Gastric Surgery, Ultrasound Section, Herlev Hospital, University of Copenhagen, Denmark
| | - C P Nolsøe
- Department of Gastric Surgery, Ultrasound Section, Herlev Hospital, University of Copenhagen, Denmark
| | - C Ewertsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - M B Nielsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - E Leen
- Imperial College London and Imaging Department, Hammersmith Hospital Campus, London, UK
| | - R F Havre
- National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - N Gritzmann
- Radiologist, Esslinger Hauptstraße 89, 1220 Wien, Austria
| | - B Brkljacic
- University of Zagreb School of Medicine, Department of Diagnostic and Interventional Radiology, University Hospital "Dubrava", Zagreb, Croatia
| | - D Nürnberg
- Department of Gastroenterology, Brandenburg University of Medicine Theodor Fontane, Neuruppin, Germany
| | - A Kabaalioglu
- Department of Radiology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - D Strobel
- Department of Medicine I, University Hospital Erlangen, Germany
| | - C Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Germany
| | - F Piscaglia
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna Hospital, Bologna, Italy
| | - O H Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen Norway and Department of Clinical Medicine, University of Bergen, Norway
| | - P S Sidhu
- Department of Radiology, King's College Hospital, London, UK
| | - C F Dietrich
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
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Riishede I, Ewertsen C, Carlsen J, Petersen MM, Jensen F, Nielsen MB. Strain Elastography for Prediction of Malignancy in Soft Tissue Tumours--Preliminary Results. Ultraschall Med 2015; 36:369-74. [PMID: 25905815 DOI: 10.1055/s-0034-1399289] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE To evaluate the ability of strain elastography to predict malignancy in patients with soft tissue tumors, and to compare three evaluation methods of strain elastography: strain ratios, strain histograms and visual scoring. MATERIALS AND METHODS 60 patients with 61 tumors were analyzed in the study. All patients were referred due to suspicion of malignant soft tissue tumors after diagnostic imaging (contrast-enhanced MRI, CT or PET-CT). Ultrasound-guided biopsy was preceded by the recording of strain elastography video clips, which were evaluated in consensus between three investigators. Strain ratio, strain histogram analysis and visual scoring using a five-point visual scale were compared with the final pathology from either biopsy or resection of the tumors. RESULTS The difference between the mean strain ratio for malignant and benign tumors was significant (p = 0.043). The mean strain ratios for malignant and benign tumors were 1.94 (95% CI [0.37; 10.21]) and 1.35 (95% CI [0.32; 5.63]), respectively. There were no significant differences for strain histograms or visual scoring. Liposarcomas had lower mean strain ratio, strain histogram values, and visual scoring than other malignant tumors. When analyzing a subgroup of patients without fat-containing tumors (n = 46), based on appearance on MRI or CT, the difference between the mean strain ratios for malignant and benign tumors increased (p = 0.014). CONCLUSION The mean strain ratios of malignant tumors were significantly higher than the mean strain ratios of benign tumors. There was no significant difference for strain histograms and visual scoring. Strain ratios may be used as an adjunct in soft tissue tumor diagnosis, possibly minimizing the number of biopsies.
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Affiliation(s)
- I Riishede
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen OE, Denmark
| | - C Ewertsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen OE, Denmark
| | - J Carlsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen OE, Denmark
| | - M M Petersen
- Department of Orthopaedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen OE, Denmark
| | - F Jensen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen OE, Denmark
| | - M B Nielsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen OE, Denmark
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Affiliation(s)
- L Konge
- Centre for Clinical Education, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - E Albrecht-Beste
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen, Denmark
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Kärk Nielsen S, Ewertsen C, Svendsen LB, Hillingsø JG, Nielsen MB. Focused Assessment with Sonography for Trauma in patients with confirmed liver lesions. Scand J Surg 2014; 101:287-91. [PMID: 23238506 DOI: 10.1177/145749691210100412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS The objective was to determine the sensitivity and specificity of Focused Assessment with Sonography for Trauma (FAST) in patients with confirmed liver lesions and also to compare results from surgeons trained in FAST with results from radiologists trained in general abdominal ultrasound as part of the specialist training. Explorative laparotomy or CT served as gold standard. MATERIALS AND METHODS This retrospective study included all patients admitted to our institution from 2003 to 2010 registered with the diagnosis "Injury of the liver or gallbladder". Of 405 patients, 135 patients were eligible for analysis. Seventy-two patients were examined by radiologists and 63 by surgeons. RESULTS We found FAST to have a sensitivity, specificity, PPV, and NPV of 79.6%, 100%, 100%, and 68.9%. There was no statistically significant difference between FAST performed by radiologists and surgeons trained in FAST. CONCLUSION FAST remains an important screening tool in abdominal trauma including liver lesions, and can be performed at a satisfactory level by surgeons trained in the FAST procedure only.
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Affiliation(s)
- S Kärk Nielsen
- Department of Radiology, Rigshospitalet, Copenhagen, Denmark.
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Thaysen HV, Jess P, Rasmussen PC, Nielsen MB, Laurberg S. Health-related quality of life after surgery for advanced and recurrent rectal cancer: a nationwide prospective study. Colorectal Dis 2014; 16:O223-33. [PMID: 24373460 DOI: 10.1111/codi.12551] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 12/07/2013] [Indexed: 12/12/2022]
Abstract
AIM Advances in the treatment of rectal cancer have made it possible to perform complex rectal cancer surgery (COMP-RCS) in patients with primary advanced rectal cancer penetrating beyond the total mesorectal excision planes and in patients with locally recurrent rectal cancer. The aim of this study was to examine health-related quality of life (HRQoL) before and during the first 2 years after COMP-RCS. METHOD Between 2001 and 2008, 180 patients were treated with COMP-RCS at Aarhus University Hospital. HRQoL was assessed preoperatively and 3, 6, 12, 18 and 24 months after surgery using three questionnaires. The results were compared with those for patients treated with standard rectal cancer surgery (STAN-RCS) and with data from the general Danish population (NORM-data). RESULTS One hundred and twenty-two (68%) patients responded to the questionnaires. Of these 80 (66%) with disease-free survival for 2 years after surgery were included in the main analysis. The lowest level of functioning and the highest degree of symptoms were reported preoperatively. The majority of the HRQoL scales improved or remained stable during the first postoperative year; a decrease was observed for body image only. One year after surgery, HRQoL in patients treated with COMP-RSC was comparable to that for patients treated with STAN-RCS. Lower levels were found for physical and emotional role functioning, compared with NORM-data. CONCLUSION Patients treated with COMP-RCS experienced improvement in HRQoL in the first year after surgery. One year after surgery, HRQoL was similar to that of patients treated with STAN-RCS. Compared with NORM-data, lower levels were found for physical and emotional role functioning.
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Affiliation(s)
- H V Thaysen
- Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark
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Reichkendler MH, Rosenkilde M, Auerbach PL, Agerschou J, Nielsen MB, Kjaer A, Hoejgaard L, Sjödin A, Ploug T, Stallknecht B. Only minor additional metabolic health benefits of high as opposed to moderate dose physical exercise in young, moderately overweight men. Obesity (Silver Spring) 2014; 22:1220-32. [PMID: 24339390 DOI: 10.1002/oby.20226] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 11/19/2012] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The dose-response effects of exercise training on insulin sensitivity, metabolic risk, and quality of life were examined. METHODS Sixty-one healthy, sedentary (VO₂max: 35 ± 5 ml/kg/min), moderately overweight (BMI: 27.9 ± 1.8), young (age: 29 ± 6 years) men were randomized to sedentary living (sedentary control group; n = 18), moderate (moderate dose training group [MOD]: 300 kcal/day, n = 21), or high (high dose training group [HIGH]: 600 kcal/day, n = 22) dose physical exercise for 11 weeks. RESULTS The return rate for post-intervention testing was 82-94% across groups. Weekly exercise amounted to 2,004 ± 24 and 3,774 ± 68 kcal, respectively, in MOD and HIGH. Cardiorespiratory fitness increased (P < 0.001) 18 ± 3% in MOD and 17 ± 3% in HIGH, and fat percentage decreased (P < 0.001) similarly in both exercise groups (MOD: 32 ± 1 to 29 ± 1%; HIGH: 30 ± 1 to 27 ± 1%). Peripheral insulin sensitivity increased (P < 0.01) (MOD: 28 ± 7%; HIGH: 36 ± 8%) and the homeostasis model assessment of insulin resistance decreased (P < 0.05) (MOD: -17 ± 7%; HIGH: -18 ± 10%). The number of subjects meeting the criteria of the metabolic syndrome decreased by 78% in MOD (P < 0.01) and by 80% in HIGH (P < 0.05). General health assessed by questionnaire increased similarly in MOD (P < 0.05) and HIGH (P < 0.01). CONCLUSIONS Only minor additional health benefits were found when exercising ∼3,800 as opposed to ∼2,000 kcal/week in young moderately overweight men. This finding may have important public health implications.
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Affiliation(s)
- M H Reichkendler
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Affiliation(s)
- L Konge
- Centre for Clinical Education, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark,
| | - E Albrecht-Beste
- Department of Radiology and Nuclear Medicine, Gentofte Hospital, Copenhagen, Denmark,
| | - M B Nielsen
- Department of Radiology, Rigshospitalet, Copenhagen, Denmark,
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Petersen LG, Carlsen JF, Nielsen MB, Damgaard M, Secher NH. The hydrostatic pressure indifference point underestimates orthostatic redistribution of blood in humans. J Appl Physiol (1985) 2014; 116:730-5. [PMID: 24481962 DOI: 10.1152/japplphysiol.01175.2013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The hydrostatic indifference point (HIP; where venous pressure is unaffected by posture) is located at the level of the diaphragm and is believed to indicate the orthostatic redistribution of blood, but it remains unknown whether HIP coincides with the indifference point for blood volume (VIP). During graded (± 20°) head-up (HUT) and head-down tilt (HDT) in 12 male volunteers, we determined HIP from central venous pressure and VIP from redistribution of both blood, using ultrasound imaging of the inferior caval vein (VIPui), and fluid volume, by regional electrical admittance (VIPadm). Furthermore, we evaluated whether inflation of medical antishock trousers (to 70 mmHg) affected HIP and VIP. Leaving cardiovascular variables unaffected by tilt, HIP was located 7 ± 4 cm (mean ± SD) below the 4th intercostal space (IC-4) during HUT and was similar (7 ± 3 cm) during HDT and higher (P < 0.0001) than both VIPui (HUT: 22 ± 16 cm; HDT: 13 ± 7 cm) and VIPadm (HUT: 29 ± 9 cm; HDT: 20 ± 9 cm below IC-4). During HUT antishock trousers elevated both HIP and VIPui [to 3 ± 5 cm (P = 0.028) and 17 ± 7 cm below IC-4 (P = 0.051), respectively], while VIPadm remained unaffected. By simultaneous recording of pressure and filling of the inferior caval vein as well as fluid distribution, we found HIP located corresponding to the diaphragm while VIP was placed low in the abdomen, and that medical antishock trousers elevated both HIP and VIP. The low indifference point for volume shows that the gravitational influence on distribution of blood is more profound than indicated by the indifference point for venous pressure.
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Affiliation(s)
- L G Petersen
- Department of Biomedical Sciences, The Panum Institute, University of Copenhagen, Copenhagen, Denmark
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Harvey CJ, Sidhu PS, Bachmann Nielsen M. Contrast-enhanced ultrasound in renal transplants: applications and future directions. Ultraschall Med 2013; 34:319-321. [PMID: 23929378 DOI: 10.1055/s-0033-1350138] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Dietrich CF, Ponnudurai R, Bachmann Nielsen M. [Is there a need for new imaging methods for lymph node evaluation?]. Ultraschall Med 2012; 33:411-414. [PMID: 23079737 DOI: 10.1055/s-0032-1325384] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Nielsen MB, Rasmussen PC, Lindegaard JC, Laurberg S. A 10-year experience of total pelvic exenteration for primary advanced and locally recurrent rectal cancer based on a prospective database. Colorectal Dis 2012; 14:1076-83. [PMID: 22107085 DOI: 10.1111/j.1463-1318.2011.02893.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM The study was conducted in a dedicated centre treating the majority of Danish patients with intended curative total pelvic exenteration for primary advanced (PARC) or locally recurrent (LRRC) rectal cancer. We compared PARC and LRRC and analysed postoperative morbidity and mortality, and long-term outcome. METHOD There were 90 consecutive patients (PARC/LRRC 50/40) treated between January 2001 and October 2010, recorded on a prospectively maintained database. RESULTS The median age was 63 (32-75) years with a gender ratio of 7 women to 83 men. All patients were American Society of Anesthesiologists level I or II. Sacral resection was performed in five patients with PARC and 15 with LRRC (P=0.002). R0 resection was achieved in 33 (66%) patients with PARC and in 15 (38%) with LRRC, R1 resection in 17 (34%) with PARC and 20 (50%) with LRRC and R2 resection in five (13%) with LRRC. R0 resection was more frequent in PARC (P=0.007). Forty-four (49%) patients had no postoperative complications. Fifty-five major complications were registered. Two (2.2%) patients died within 30 days, and the total in-hospital mortality was 5.6%. The median follow-up was 12 (0.4-91) months. The 5-year survival was 46% for PARC and 17% for LRRC (P=0.16). CONCLUSION Pelvic exenteration is associated with considerable morbidity but low mortality in an experienced centre. Pelvic exenteration can improve long-term survival, especially for patients with PARC. However, pelvic exenteration is also justified for patients with LRRC.
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Affiliation(s)
- M B Nielsen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.
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Ask B, Dahl J, Nielsen MB, Moustsen V. Neonatal piglet traits of importance for survival in crates and indoor pens. J Anim Sci 2012; 90:2879-80; author reply 2881-2. [PMID: 22585827 DOI: 10.2527/jas.2011-4998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
AIM Eight highly selected patients are reported, undergoing external hemipelvectomy (EHP) for malignant infiltration of the lumbosacral neural plexus. METHOD All patients were evaluated by positron emission tomography-computed tomography (PET-CT), CT and magnetic resonance imaging. No evidence of disseminated disease was found. With agreement by the multidisciplinary team, surgery was performed by a colorectal surgeon and an orthopaedic sarcoma surgeon and, if needed, by an urologist and vascular surgeon. Patients were reconstructed with either a femoral or a gluteal musculocutaneous flap. RESULTS Of the eight women [median age 54.5 (40-68) years], two had primary carcinoma and six local recurrence of a previously treated carcinoma. R0 was possible in six patients and R1 resection in two. The median duration of hospital stay was 29.5 (17-102) days. The median follow up was 8.3 (4.7-52.8) months. Three patients have died, one from postoperative complications at 5 months and two from recurrence at 5 and 52.8 months. Phantom-limb was experienced in six patients. Four patients received a prosthesis, one is considering this and one does not want a prosthesis. CONCLUSION Hemipelvectomy may be considered for a highly selected group of patients with locally advanced carcinoma or recurrence involving the lumbosacral neural plexus.
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Affiliation(s)
- M B Nielsen
- Department of Surgery, E, Aarhus University Hospital, Aarhus, Denmark.
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Piscaglia F, Nolsøe C, Dietrich CF, Cosgrove DO, Gilja OH, Bachmann Nielsen M, Albrecht T, Barozzi L, Bertolotto M, Catalano O, Claudon M, Clevert DA, Correas JM, D'Onofrio M, Drudi FM, Eyding J, Giovannini M, Hocke M, Ignee A, Jung EM, Klauser AS, Lassau N, Leen E, Mathis G, Saftoiu A, Seidel G, Sidhu PS, ter Haar G, Timmerman D, Weskott HP. The EFSUMB Guidelines and Recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall Med 2012; 33:33-59. [PMID: 21874631 DOI: 10.1055/s-0031-1281676] [Citation(s) in RCA: 659] [Impact Index Per Article: 54.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- F Piscaglia
- Division of Internal Medicine, General and University Hospital S. Orsola-Malpighi, Via Albertoni 15, Bologna, Italy.
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Sidhu PS, Choi BI, Nielsen MB. The EFSUMB Guidelines on the Non-hepatic Clinical Applications of Contrast Enhanced Ultrasound (CEUS): a new dawn for the escalating use of this ubiquitous technique. Ultraschall Med 2012; 33:5-7. [PMID: 22322478 DOI: 10.1055/s-0031-1299141] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Abstract
PURPOSE To evaluate the overall accuracy and time spent on biopsy guided by electromagnetic needle tracking in a phantom compared with the standard technique of US-guided biopsy with an attached steering device. Furthermore, to evaluate off-plane biopsy guided by needle tracking. MATERIALS AND METHODS Three different series of biopsy were performed in a phantom: one with a steering device attached to the transducer without needle tracking, simulating the standard ultrasound-guided biopsy procedure (series 1), one freehand in the scan plane using electromagnetic needle tracking (series 2), and one freehand off-the-scan plane using electromagnetic needle tracking (series 3). The phantom contained spheres of 1 cm in diameter filled with red dye. Each time of the phantom surface was perforated counted as an attempt. RESULTS 180 biopsies were performed. The mean time spent on each biopsy in series one was 19.9 seconds (SD: 9.1), in series two 34.1 seconds (SD: 17.9) and in series three 34.4 seconds (SD: 14.0). The overall rate of success was: 88 % for in-plane needle-guided biopsy, 87 % for in-plane needle tracking, and 92 % for off-plane needle tracking. No statistically significant difference between the methods was shown. CONCLUSION Needle navigation is a potentially valuable tool for image-guided biopsy with an equal rate of success compared with conventional image-guided biopsy. Furthermore, it enables off-plane image-guided biopsy.
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Affiliation(s)
- C Ewertsen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Denmark.
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Abstract
AIM A review of the literature was undertaken to provide an overview of the surgical management of locally recurrent rectal cancer (LRRC) after the introduction of total mesorectal excision (TME). METHOD A systematic literature search was undertaken using PubMed, Embase, Web of Science and Cochrane databases. Only studies on patients having surgery for their primary tumour after 1995, or if more than half of the patients were operated on after 1995, were considered for analysis. Studies concerning only palliative treatments were excluded. RESULTS A total of 19 studies fulfilled the inclusion criteria. Locally recurrent rectal cancer still occurred in 5-10% of the patients and was a major clinical problem, due to severe symptoms and poor survival. In most studies, 40-50% of all patients with LRRC could be expected to undergo surgery with a curative intent and of those, 30-45% would have R0 resection. Thus, only 20-30% of all patients with LRRC would have a potentially curative operation. The postoperative complication rate varied considerably, from 15 to 68%. The rate of re-recurrence varied from 4 to 54% after curative surgery. The 5-year overall survival varied between 9 and 39% and the median survival between 21 and 55 months. CONCLUSION Compared with previous studies, the proportion of potentially curative resections seems to have increased, probably due to improved staging, neoadjuvant treatment and increased surgical experience in dedicated centres, which has resulted in a tendency to improved survival.
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Affiliation(s)
- M B Nielsen
- Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark.
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Ewertsen C, Henriksen BM, Torp-Pedersen S, Bachmann Nielsen M. Characterization by biopsy or CEUS of liver lesions guided by image fusion between ultrasonography and CT, PET/CT or MRI. Ultraschall Med 2011; 32:191-197. [PMID: 21225564 DOI: 10.1055/s-0029-1245921] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE The aim of this study was to show the number of cases in which the use of fusion-guided ultrasonography (US) provided conclusive diagnosis of lesions in the liver seen on CT or MRI or PET/CT. A lesion is defined as a region that has suffered damage due to injury or disease. MATERIALS AND METHODS Forty patients of whom 34 had confirmed neoplastic disease, referred to US evaluation or US-guided biopsy of liver lesions seen on CT (n = 35), MRI (n = 2) or PET/CT (n = 3), were prospectively included in the study. We used a LOGIQ prototype system with incorporated software for fusion imaging, and a convex-array 4 MHz transducer (GE Healthcare, Chalfont St. Giles, UK). All patients were initially examined with B-mode US, then by fusion-guided US and for some patients also with CEUS. All patients received follow-up after at least one year. RESULTS Twenty-six lesions were initially indistinguishable with US. Of these, 9 became visible with fusion-guided US and another 4 became visible with CEUS, which facilitated a final diagnosis in 11 of these 13 patients. The median tumor size for all lesions included in the study was 1.5 cm (interquartile range: 1.0 - 2.4). There was no statistically significant difference in tumor size between the groups. CONCLUSION We have successfully demonstrated an increase in the characterization of liver lesions by using fusion-guided US compared with conventional B-mode US.
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Affiliation(s)
- C Ewertsen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen OE, Denmark.
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Ewertsen C, Ellegaard K, Boesen M, Torp-Pedersen S, Bachmann Nielsen M. Comparison of two co-registration methods for real-time ultrasonography fused with MRI: a phantom study. Ultraschall Med 2010; 31:296-301. [PMID: 20517817 DOI: 10.1055/s-0029-1245457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE To test the accuracy of spatial registration of real-time ultrasonography (US) fused with MRI in a phantom. MATERIALS AND METHODS An US prototype system (LOGIQ, GE Healthcare) with incorporated software for fusion imaging was used to test two methods of co-registration in a phantom: co-registration from specific points, where common reference points identifiable on both MRI and US images were marked, and plane registration, where common planes identifiable on both MRI and US images were marked. In two series we performed co-registration from points and in one series we performed co-registration from planes. The accuracy of the co-registration was measured at 3 measuring points, defined before initiation of the study, and it was calculated as the root mean square deviation (RMSD), which corresponds to the standard deviation. It was measured in millimeters. Two observers each performed 30 co-registrations for each series, totaling 180 co-registrations. The difference between the methods and the observers was calculated using analysis of variance (two-way ANOVA). RESULTS Co-registration was significantly more accurate when using the measuring points as co-registration points than when using points covering a different area of the phantom (p < 0.0001). The mean calculated RMSD when using the measuring points as co-registration points was 1.3 mm (95 % CI: 1.1 - 1.5 mm), when using points away from the measuring points: 4.0 mm (95 % CI: 3.2 - 4.8 mm), and when using planes for the co-registration: 3.8 mm (95 % CI: 3.2 - 4.4 mm). CONCLUSION Image fusion involving real-time US has high accuracy and is easy to use in a phantom. Working within the area given by the co-registration points optimizes the accuracy. Image fusion is a promising tool for clinical US, since it provides the potential of benefiting from different imaging modalities in one examination.
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Affiliation(s)
- C Ewertsen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark.
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Bachmann Nielsen M, Lönn L. [The future for CME articles]. Ultraschall Med 2010; 31:119-121. [PMID: 20306378 DOI: 10.1055/s-0029-1245296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Hansen KL, Gran F, Pedersen MM, Holfort IK, Jensen JA, Nielsen MB. In-vivo validation of fast spectral velocity estimation techniques. Ultrasonics 2010; 50:52-59. [PMID: 19666182 DOI: 10.1016/j.ultras.2009.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Revised: 07/09/2009] [Accepted: 07/16/2009] [Indexed: 05/28/2023]
Abstract
Spectrograms in medical ultrasound are usually estimated with Welch's method (WM). WM is dependent on an observation window (OW) of up to 256 emissions per estimate to achieve sufficient spectral resolution and contrast. Two adaptive filterbank methods have been suggested to reduce the OW: Blood spectral Power Capon (BPC) and the Blood Amplitude and Phase EStimation method (BAPES). Ten volunteers were scanned over the carotid artery. From each data set, 28 spectrograms were produced by combining four approaches (WM with a Hanning window (W.HAN), WM with a boxcar window (W.BOX), BPC and BAPES) and seven OWs (128, 64, 32, 16, 8, 4, 2). The full-width-at-half-maximum (FWHM) and the ratio between main and side-lobe levels were calculated at end-diastole for each spectrogram. Furthermore, all 280 spectrograms were randomized and presented to nine radiologists for visual evaluation: useful/not useful. BAPES and BPC compared to WM had better resolution (lower FWHM) for all OW<128 while only BAPES compared to WM had improved contrast (higher ratio). According to the scores given by the radiologists, BAPES, BPC and W.HAN performed equally well (p>0.05) at OW 128 and 64, while W.BOX scored less (p<0.05). At OW 32, BAPES and BPC performed better than WM (p<0.0001) and BAPES was significantly superior to BPC at OW 16 (p=0.0002) and 8 (p<0.0001). BPC at OW 32 performed as well as BPC at OW 128 (p=0.29) and BAPES at OW 16 as BAPES at OW 128 (p=0.55). WM at OW 16 and 8 failed as all four methods at OW 4 and 2. The intra-observer variability tested for three radiologist showed on average good agreement (90%, kappa=0.79) and inter-observer variability showed moderate agreement (78%, kappa=0.56). The results indicated that BPC and BAPES had better resolution and BAPES better contrast than WM, and that OW can be reduced to 32 using BPC and 16 using BAPES without reducing the usefulness of the spectrogram. This could potentially increase the temporal resolution of the spectrogram or the frame-rate of the interleaved B-mode images.
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Affiliation(s)
- K L Hansen
- Section of Ultrasound, Department of Radiology, Rigshospitalet, Blegdamsvej 9, DK-2100 Kbh. Ø, Denmark.
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Hansen KL, Udesen J, Oddershede N, Henze L, Thomsen C, Jensen JA, Nielsen MB. In vivo comparison of three ultrasound vector velocity techniques to MR phase contrast angiography. Ultrasonics 2009; 49:659-667. [PMID: 19473683 DOI: 10.1016/j.ultras.2009.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Revised: 04/15/2009] [Accepted: 04/24/2009] [Indexed: 05/27/2023]
Abstract
The objective of this paper is to validate angle independent vector velocity methods for blood velocity estimation. Conventional Doppler ultrasound (US) only estimates the blood velocity along the US beam direction where the estimate is angle corrected assuming laminar flow parallel to vessel boundaries. This results in incorrect blood velocity estimates, when angle of insonation approaches 90 degrees or when blood flow is non-laminar. Three angle independent vector velocity methods are evaluated in this paper: directional beamforming (DB), synthetic aperture flow imaging (STA) and transverse oscillation (TO). The performances of the three methods were investigated by measuring the stroke volume in the right common carotid artery of 11 healthy volunteers with magnetic resonance phase contrast angiography (MRA) as reference. The correlation with confidence intervals (CI) between the three vector velocity methods and MRA were: DB vs. MRA: R=0.84 (p<0.01, 95% CI: 0.49-0.96); STA vs. MRA: R=0.71 (p<0.05, 95% CI: 0.19-0.92) and TO vs. MRA: R=0.91 (p<0.01, 95% CI: 0.69-0.98). No significant differences were observed for any of the three comparisons (DB vs. MRA: p=0.65; STA vs. MRA: p=0.24; TO vs. MRA: p=0.36). Bland-Altman plots were additionally constructed, and mean differences with limits of agreements (LoA) for the three comparisons were: DB vs. MRA=0.17 ml (95% CI: -0.61-0.95) with LoA=-2.11-2.44 ml; STA vs. MRA=-0.55 ml (95% CI: -1.54-0.43) with LoA=-3.42-2.32 ml; TO vs. MRA=0.24 ml (95% CI: -0.32-0.81) with LoA=-1.41-1.90 ml. According to the results, reliable volume flow estimates can be obtained with all three methods. The three US vector velocity techniques can yield quantitative insight into flow dynamics and visualize complex flow patterns, which potentially can give the clinician a novel tool for cardiovascular disease assessment.
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Affiliation(s)
- K L Hansen
- Department of Radiology, Section of Ultrasound, Rigshospitalet, Blegdamsvej 9, DK-2100 Kbh Ø, Denmark.
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Hansen KL, Udesen J, Gran F, Jensen JA, Bachmann Nielsen M. In-vivo examples of flow patterns with the fast vector velocity ultrasound method. Ultraschall Med 2009; 30:471-477. [PMID: 19764009 DOI: 10.1055/s-0028-1109572] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE Conventional ultrasound methods for acquiring color flow images of the blood motion are limited by a relatively low frame rate and are restricted to only giving velocity estimates along the ultrasound beam direction. To circumvent these limitations, the Plane Wave Excitation (PWE) method has been proposed. MATERIAL AND METHODS The PWE method can estimate the 2D vector velocity of the blood with a high frame rate. Vector velocity estimates are acquired by using the following approach: The ultrasound is not focused during the ultrasound transmission, and a full speckle image of the blood can be acquired for each pulse emission. The pulse is a 13 bit Barker code transmitted simultaneously from each transducer element. The 2D vector velocity of the blood is found using 2D speckle tracking between segments in consecutive speckle images. Implemented on the experimental scanner RASMUS and using a 100 CPU linux cluster for post processing, PWE can achieve a frame of 100 Hz where one vector velocity sequence of approximately 3 sec, takes 10 h to store and 48 h to process. In this paper a case study is presented of in-vivo vector velocity estimates in different complex vessel geometries. RESULTS The flow patterns of six bifurcations and two veins were investigated. It was shown: 1. that a stable vortex in the carotid bulb was present opposed to other examined bifurcations, 2. that retrograde flow was present in the superficial branch of the femoral artery during diastole, 3. that retrograde flow was present in the subclavian artery and antegrade in the common carotid artery during diastole, 4. that vortices were formed in the sinus pockets behind the venous valves in both antegrade and retrograde flow, and 5. that secondary flow was present in various vessels. CONCLUSION Using a fast vector velocity ultrasound method, in-vivo scans have been recorded where complex flow patterns were visualized in greater detail than previously visualized by conventional color flow imaging techniques.
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Affiliation(s)
- K L Hansen
- Department of Radiology, University Hospital of Copenhagen, Denmark.
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Bachmann Nielsen M, Seitz K. Ultrasonography of the liver: focal point of interest in radiology and internal medicine. Ultraschall Med 2009; 30:227-229. [PMID: 19492270 DOI: 10.1055/s-0028-1109470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Nielsen KR, Klyver H, Chakera AH, Nedergaard L, Hesse B, Nielsen MB. Sentinel node detection in melanomas using contrast-enhanced ultrasound. Acta Radiol 2009; 50:412-7. [PMID: 19373568 DOI: 10.1080/02841850902824934] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Sentinel node (SN) biopsy has proven to be a useful clinical method based on the combination of radionuclide tracer principles and the dye technique. Contrast-enhanced ultrasound (CEUS) has been used successfully for detection of SN in animals, but the use of CEUS has not been reported in humans. PURPOSE To investigate the possible use of CEUS in detecting SN in patients with malignant melanomas (MM), and to improve the method by using different concentrations of contrast agent and various positions of the extremity. MATERIAL AND METHODS Ten patients with MM on an extremity and one healthy volunteer were included. One milliliter of a contrast agent (Sonovue; Bracco, Milan, Italy) was injected subcutaneously on both sides of the scar from the excised tumor. Contrast-enhanced lymph channels and lymph nodes (LNs) were searched for using low-mechanical-index CEUS and by stimulated acoustic emission. Afterward, lymphoscintigraphy was performed and the patient operated. During surgery, the SNs were located via scintigraphic findings, gamma-probe signals, and blue-dye visualization of lymph channels and LNs. Before the human study, a study of 10 mice was performed to exclude possible tissue damage, as the contrast agent was not registered for subcutaneous administration. RESULTS In one patient, two contrast-enhanced inguinal LNs were visualized by CEUS, corresponding to two inguinal SNs found by scintigraphic imaging. No contrast-enhanced lymph channels or LNs were visualized in any other patients or in the volunteer. No tissue damage was observed in the 10 mice. CONCLUSION This study does not support the use of CEUS for detection of SNs in humans. However, the application of CEUS for the investigation of SNs is still not fully explored in humans, and an alternative setup and/or contrast agent might provide better results.
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Affiliation(s)
- K. Rue Nielsen
- Department of Radiology, Section of Ultrasound X4123, PET and Cyclotron Unit, Rigshospitalet, Copenhagen, Denmark
| | - H. Klyver
- Department of Plastic Surgery, PET and Cyclotron Unit, Rigshospitalet, Copenhagen, Denmark
| | - A. Hougaard Chakera
- Department of Plastic Surgery, PET and Cyclotron Unit, Rigshospitalet, Copenhagen, Denmark
| | - L. Nedergaard
- Department of Pathology, PET and Cyclotron Unit, Rigshospitalet, Copenhagen, Denmark
| | - B. Hesse
- Clinic of Clinical Physiology and Nuclear Medicine, PET and Cyclotron Unit, Rigshospitalet, Copenhagen, Denmark
| | - M. Bachmann Nielsen
- Department of Radiology, Section of Ultrasound X4123, PET and Cyclotron Unit, Rigshospitalet, Copenhagen, Denmark
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Grossjohann HS, Bachmann Nielsen M, Nielsen KR, Hansen CP, Svendsen LB, Stadil F. Evaluation of contrast-enhanced ultrasound of the pancreas combined with concurrent hormone stimulation. Ultraschall Med 2008; 29:520-524. [PMID: 19241509 DOI: 10.1055/s-2007-963292] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE To evaluate the potential of combined administration of the gastrointestinal hormones secretin (Secrelux) and c-terminal cholecystokinin (CCK-8 s) together with contrast-enhanced ultrasound (CE-US) to generate an extended contrast enhancement of healthy pancreatic tissue. MATERIALS AND METHODS 14 anaesthetised pigs weighing 30-35 kg were studied. After laparotomy, the pancreas was located and a B-mode examination followed by a CE-US examination of the gland was made using SonoVue 1.5 ml. After an injection of Secrelux 1 U/kg and CCK-8 s 100 pmol/kg, a second CE-US examination was conducted. The hormones and the contrast agent were administered through a catheter in the superior vena cava. The sonographic images were stored for later evaluation. RESULTS The study showed that CE-US increased the echogenicity of the pancreas by an average of 15.6 decibel (dB) (confidence intervals [CI]: 13.72, 17.42) p < 0.0001, an increase of 24%. The administration of Secrelux and CCK-8 s in combination with CE-US further increased the echogenicity of the pancreas by an average of 3% (CI: 0.36, 5.36) p = 0.028. A new sequence of hormones and CE-US 20 min after the previous injection did not induce further enhancement. The area under the curve (AUC) was significantly larger using both hormones and CE-US compared with CE-US alone by an average of 66 dBx sec (CI: 28,103) p = 0.002. CONCLUSION It is possible to generate an extended contrast enhancement of healthy pancreatic tissue using CE-US combined with the administration of the gastrointestinal hormones secretin (Secrelux) and c-terminal cholecystokinin (CCK-8 s). Our results may improve the ability to discriminate between healthy pancreatic tissue and areas with a changed blood flow due to either neoplasm or other pathological lesions.
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Affiliation(s)
- H S Grossjohann
- Dep. Of Radiology, Section of Ultrasound, Copenhagen University Hospital, Copenhagen.
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Brushøj C, Hölmich P, Nielsen MB, Albrecht-Beste E. Acute patellofemoral pain: aggravating activities, clinical examination, MRI and ultrasound findings. Br J Sports Med 2007; 42:64-7; discussion 67. [PMID: 17562742 DOI: 10.1136/bjsm.2006.034215] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate acute anterior knee pain caused by overuse in terms of pain location, aggravating activities, findings on clinical examination and ultrasound/MRI examination. To determine if acute anterior knee pain caused by overuse should be classified as a subgroup of patellofemoral pain syndrome (PFPS). METHODS In a observational study design 30 army recruits with anterior knee pain (mean duration of pain 4 weeks) were examined using the PFPS pain severity scale (PSS), knee pain diagrams, standardised clinical examination, ultrasound and MRI examinations. RESULTS On PSS typical knee loading activities were the most painful, while sitting with knee bend for prolonged time caused surprisingly little pain. Pain was most commonly perceived in the peripatellar area (25 patients (83%)). The most common site of pain on clinical examination was the peripatellar area (25 patients (83%)), but other synovial covered structures including the fat pad of Hoffa (12 patients (40%)), the medial plica and the joint line (12 patients (40%)) were also involved. Only eight patients (27%) experienced pain on the patellofemoral compression test. Only discrete changes was detected on MRI/ultrasound. CONCLUSIONS Acute anterior knee pain should be regarded as a subgroup of PFPS as both symptoms and clinical examination suggests this. The clinical examination with disseminated pain in all synovial covered structures is consistent with ideas of the importance of synovium in the genesis of pain.
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Affiliation(s)
- C Brushøj
- Department of Orthopaedic Surgery, Amager Hospital, Italiensvej 1, Copenhagen DK-2300, Denmark.
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Affiliation(s)
- C P Nolsøe
- Department of Radiology, Køge Hospital, Denmark
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Koenig MJ, Torp-Pedersen S, Holmich P, Terslev L, Nielsen MB, Boesen M, Bliddal H. Ultrasound Doppler of the Achilles tendon before and after injection of an ultrasound contrast agent--findings in asymptomatic subjects. Ultraschall Med 2007; 28:52-6. [PMID: 16703487 DOI: 10.1055/s-2006-926715] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
UNLABELLED The sensitivity of ultrasound Doppler has now reached a level at which perfusion can be detected even in normal, resting musculoskeletal tissues. To be able to distinguish normal from abnormal flow, the resistive index (RI) determined by spectral Doppler may be of value. Inflammation is associated with low RI values and a value of 1.00 is normal. PURPOSE In tissues with no detectable flow, it has been assumed that RI may be defined as 1.00. This study was performed to test if normal tendinous vessels could be visualised with a contrast agent, and if such vessels had normal RI. MATERIALS AND METHODS Ultrasound (US) was performed with a 14 MHz linear transducer. 22 asymptomatic tendons in 12 subjects were scanned, and only 5 ultrasonically normal tendons in 5 subjects were identified. In these 5 normal tendons, SonoVue was used to make vessels visible. The Achilles tendons and the peritendinous tissues were evaluated clinically. RESULTS In all 5 ultrasonically normal tendons, arteries could be detected with Doppler after contrast injection and in all cases with normal RI values. All vessels were located in the mid-portion of the tendon. 18 tendons were categorised as normal by the clinician. CONCLUSION After administration of a contrast agent, all Achilles tendons could be demonstrated to have arteries present in the mid-portion. The flow profile of these arteries was fully normal without diastolic component and with an RI of 1.00. This finding has implications for criteria of normality of tendons, which cannot be based exclusively on the presence or absence of Doppler activity. The majority of the tendons in this study had ultrasound abnormalities both on gray-scale and colour Doppler. It can be speculated that the abnormalities may be age-related degenerative changes and that age-stratified normal materials are needed to define normality. There was no consistency between US and clinical diagnosis.
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Affiliation(s)
- M J Koenig
- The Parker Institute, Department of Rheumatology, Frederiksberg Hospital, Denmark
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Brushøj C, Henriksen BM, Albrecht-Beste E, Hölmich P, Larsen K, Bachmann Nielsen M. Reproducibility of ultrasound and magnetic resonance imaging measurements of tendon size. Acta Radiol 2006; 47:954-9. [PMID: 17077048 DOI: 10.1080/02841850600854936] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate the intra- and inter-tester reproducibility of measurements of the Achilles tendon, tibialis anterior tendon, and the tibialis posterior tendon in football players using ultrasound (US) and magnetic resonance imaging (MRI). MATERIAL AND METHODS Eleven asymptomatic football players were examined. Using a standardized US scanning protocol, the tendons were examined by two observers with US for thickness, width, and cross-sectional area. One observer conducted the procedure twice. The subjects also underwent an MRI examination, and the assessment of tendon size was conducted twice by two observers. RESULTS The best reproducibility judged by coefficient of variation (CV) and 95% confidence interval was determined for the Achilles tendon on both US and MRI. The variability of US on measurements on the tibialis anterior and tibialis posterior tendons was less than that when using MRI. In 12 out of 18 measurements, there were systematic differences between observers as judged by one-sided F-test. CONCLUSION The reproducibility of the three tendons was limited. Precaution should be taken when looking for minor quantitative changes, i.e., training-induced hypertrophy, and when doing so, the Achilles tendon should be used.
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Affiliation(s)
- C Brushøj
- Department of Radiology, Section of Ultrasound, Rigshospitalet, Copenhagen, Denmark.
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Christensen AF, Bourke JL, Nielsen MB, Møller H, Svendsen LB, Mogensen AM, Vainer B. Detection rate of periintestinal lymph nodes. Ultraschall Med 2006; 27:360-3. [PMID: 16596506 DOI: 10.1055/s-2005-858966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
AIM Compared to standard two-dimensional (2D) endosonography, three-dimensional (3D) endosonography has been presented as a possible improvement regarding imaging of the gastrointestinal (G-I) tract and detection of metastatic lymph nodes. The aim of this study was to evaluate the efficacy of detecting periintestinal lymph nodes in surgical specimens using 3D endosonography. PATIENTS AND METHODS Surgical specimens from 31 patients with malignant G-I tumours were investigated by 3-D endosonography and histology with focus on the presence of periintestinal lymph nodes and presence of metastasis. The specimens were scanned submerged into water. Position and size of the lymph nodes were mapped on a photo of the specimen both by the pathologist and the examiners. RESULTS Three-dimensional endosonography detected 48 out of 60 malignant lymph nodes (80.0 %), and 110 out of 219 benign lymph nodes (50.2 %). The positive predictive value for an endosonographic finding interpreted as a lymph node was 0.97. CONCLUSION The detection rates for periintestinal lymph nodes were relatively high and seemed superior to the one usually assigned to 2D endosonography. Although distinguishing between metastatic and non-metastatic lymph nodes remains a problem, all patients with histologically confirmed metastasis to lymph nodes were detected by 3D endosonography, and the technique thus seems suitable for grouping of patients prior to surgery.
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Affiliation(s)
- A F Christensen
- Department of Radiology, Section of Ultrasound X 4123, Rigshospitalet, Copenhagen, Denmark
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Boesen MI, Torp-Pedersen S, Koenig MJ, Christensen R, Langberg H, Hölmich P, Nielsen MB, Bliddal H. Ultrasound guided electrocoagulation in patients with chronic non-insertional Achilles tendinopathy: a pilot study. Br J Sports Med 2006; 40:761-6. [PMID: 16807305 PMCID: PMC2564389 DOI: 10.1136/bjsm.2006.027334] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND High resolution colour Doppler ultrasound shows intratendinous Doppler activity in patients with chronic Achilles tendinopathy. Treatment of this neovascularisation with sclerosing therapy seems to relieve the pain. However, the procedure often has to be repeated. OBJECTIVE To investigate the effect of electrocoagulation of the neovessels on tendon pain and tendon vascularity in patients with chronic Achilles tendinopathy. METHODS Colour Doppler ultrasound guided electrocoagulation was used on vessels in the ventral portion of the Achilles tendon in 11 patients (seven men, four women, mean age 41 years) with painful chronic mid-portion Achilles tendinosis. A unipolar coagulation device was used. RESULTS One patient dropped out after two months (dissatisfied with the results). The remaining 10 patients (91%) were satisfied. These 10 patients were still satisfied at six months of follow up and had returned to their previous level of activity. All 10 patients were "cured" after one treatment. The patient who dropped out received two treatments because of lack of progress. There was significantly reduced pain (Likert pain scale, 0-10) during activity, from a median of 7 (range 4 to 10) at baseline to 0 (0 to 8) at six months' follow up (p<0.005); and at rest, from 1.5 (1 to 5) to 0 (0 to 8) (p = 0.005). In all patients, vascularisation was unchanged at the six months follow up, with no significant change in semiquantitative or quantitative colour scoring. CONCLUSIONS Coagulation in the area with vessels entering the tendon appears to be effective treatment for painful chronic mid-tendinous Achilles tendinopathy. No effect on the intratendinous Doppler activity could be detected, suggesting that the effect is independent of changes in blood flow. Localisation of hyperaemia appears to be the key to the pathology and for targeting the treatment. One explanation could be that the effect is obtained by destruction of nerves accompanying the vessels.
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