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Background & Objective: Preeclampsia with a prevalence of 2-8% in all pregnancies is one of the most common, unpredictable, and dangerous complications of pregnancy. Doppler examination of the uterine artery can be more effective in predicting preeclampsia. The present study was conducted with aim to determine and characterize the impedance of the uterine artery at gestational age 16 to 20 weeks and its relationship with early onset preeclampsia. Materials & Methods: This prospective cohort study was conducted on 128 pregnant women with gestational age 16 to 20 weeks referred to the maternity clinic of Besat Hospital in Sanandaj from May 2021 to August 2022. The impedance of the uterine arteries on both sides was investigated using Doppler evaluation and Pulsatility index (PI) was reported. Then, The patients were then followed up until delivery and they were examined for early-onset preeclampsia at 32-34 weeks of pregnancy. Data were analyzed using SPSS (version 23.0) and Kolmogorov-Smirnov, Chi-square, Fisher's exact and t tests. P<0.05 were considered significant. Results: Eleven mothers (6.8%) were diagnosed with premature preeclampsia. There was a significant relationship between mean gestational age, birth weight and premature preeclampsia in pregnant women (p<0.0001). In addition, a statistically significant relationship was shown between mean PI and premature preeclampsia (p=0.027) and between the number of pregnancies and premature preeclampsia (p=0.001). Conclusion: PI index greater than 1.2 can predict early onset preeclampsia in pregnant women. Additionally, uterine artery Doppler can be used as an indicator to predict preeclampsia in weeks 16 to 20 of pregnancy. [ABSTRACT FROM AUTHOR]

Background: Nonalcoholic fatty liver disease (NAFLD) is common. Noninvasive methods to assess fibrosis stage are limited, and biopsy remains the gold standard. We aimed to compare the Doppler ultrasound indices (resistive index (RI), pulsatility index (PI), and arterial waveform) at the place of division of the hepatic artery in patients with and without nonalcoholic non-diabetic fatty liver. Materials and Methods: This cross-sectional study involved patients with fatty and normal liver. For this purpose, 50 patients with fatty liver with a grade higher than II and confirmed and 50 patients without signs of fatty infiltration in sonography were examined by standard Doppler sonography from the location of the hepatic artery. The patients' waveform, RI, and PI were investigated based on this. The evaluated indicators were analyzed as the average of three consecutive measurements. Finally, the results obtained in the two groups were compared using SPSS statistical software. Results: One hundred patients were equally divided into two groups with and without NAFLD. The two groups were similar in age, sex, and body mass index (BMI) (all P-values > 0.05). In the case group, the average RI was 0.5 ± 0.08; in the control group, it was 0.63 ± 0.04 (P-value<0.001). PI was 0.5 ± 0.08 in the case group and 0.63 ± 0.04 in the control group (P-value<0.001). In the case group, 74% of the subjects showed a Tardus parvus wave pattern, while in the control group, 100% had a normal wave pattern (P-value<0.001). Conclusion: RI, PI, and arterial waveform at the site of division of the hepatic artery can be used to diagnose these patients who need a biopsy. They reduce the liver. [ABSTRACT FROM AUTHOR]

Blood flow velocity in the cerebral perforating arteries can be quantified in a two-dimensional plane with phase contrast magnetic imaging (2D PC-MRI). The velocity pulsatility index (PI) can inform on the stiffness of these perforating arteries, which is related to several cerebrovascular diseases. Currently, there is no open-source analysis tool for 2D PC-MRI data from these small vessels, impeding the usage of these measurements. In this study we present the Small vessEL MArker (SELMA) analysis software as a novel, user-friendly, open-source tool for velocity analysis in cerebral perforating arteries. The implementation of the analysis algorithm in SELMA was validated against previously published data with a Bland–Altman analysis. The inter-rater reliability of SELMA was assessed on PC-MRI data of sixty participants from three MRI vendors between eight different sites. The mean velocity (vmean) and velocity PI of SELMA was very similar to the original results (vmean: mean difference ± standard deviation: 0.1 ± 0.8 cm/s; velocity PI: mean difference ± standard deviation: 0.01 ± 0.1) despite the slightly higher number of detected vessels in SELMA (Ndetected: mean difference ± standard deviation: 4 ± 9 vessels), which can be explained by the vessel selection paradigm of SELMA. The Dice Similarity Coefficient of drawn regions of interest between two operators using SELMA was 0.91 (range 0.69–0.95) and the overall intra-class coefficient for Ndetected, vmean, and velocity PI were 0.92, 0.84, and 0.85, respectively. The differences in the outcome measures was higher between sites than vendors, indicating the challenges in harmonizing the 2D PC-MRI sequence even across sites with the same vendor. We show that SELMA is a consistent and user-friendly analysis tool for small cerebral vessels. [ABSTRACT FROM AUTHOR]

Introduction: Preeclampsia is a pregnancy-specific medical disorder characterised by an abnormal vascular response to placentation. Uterine artery Doppler ultrasound has emerged as a predictive tool in preeclampsia. Abnormal Doppler waveforms have been associated with impaired placental perfusion and an increased risk of developing preeclampsia. Preeclampsia is associated with alterations in platelet function and activation. The estimation of platelet indices is an easy and economical method for screening preeclampsia. Abnormal uterine artery Doppler findings and abnormal platelet indices are both related to the etiological pathways of preeclampsia. Aim: To compare the efficacy of uterine artery Doppler changes, platelet indices alone and their combination in predicting preeclampsia among pregnant women. Materials and Methods: This was a prospective observational study conducted Department of Obstetrics and Gynaecology, Gandhi Hospital in Secunderabad, Telangana, India, over 18 months, including 160 pregnant women aged 18-35 years with singleton pregnancies between 20-24 weeks of gestational age. Doppler ultrasound and platelet indices were measured and patients were followed-up until delivery for the development of preeclampsia. Receiver Operating Characteristic (ROC) curves were constructed and sensitivity, specificity and accuracy were determined to predict preeclampsia. Results: The mean age of the study population was 25.9±4.04 years. The sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy of platelet indices in predicting preeclampsia alone were 67.71%, 59.38%, 71.43%, 55.07% and 64.38%, respectively. The sensitivity, specificity, PPV, NPV and accuracy of the uterine artery Doppler indices in predicting preeclampsia alone were 77.08%, 68.75%, 78.72%, 66.67% and 73.75%. The combined assessment of uterine artery Doppler study and platelet indices in the prognostication of preeclampsia had a sensitivity of 85.42%, specificity of 82.81%, PPV of 88.17% and NPV of 79.10%, with improved accuracy of 84.38%. Conclusion: A combination of uterine artery Doppler ultrasound with platelet indices is easy to use, affordable, readily available in clinical settings and more effective in predicting preeclampsia than when used individually.

Background: The effect of congenital cardiac malformation on fetal cerebral circulation has not been well known. This study aimed to compare the cerebral blood circulation of fetuses with congenital heart disease (CHD) with healthy fetuses. Methods: This prospective cohort study included 37 pregnant women who presented to the gynecology and obstetrics department of department of Farabi Hospital, Faculty of Medicine, Karadeniz Technical University for anomaly screening in the second trimester. The women were divided into two groups as those with fetuses having CHD and healthy fetuses. Middle cerebral artery (MCA), peak systolic velocity (PSV), pulsatility index (PI), resistivity index (RI), systole/diastole (S/D) ratio, and MCA transverse section diameter (mm) were recorded for each fetus. Results: The most common CHDs were truncus arteriosus and hypoplastic left heart syndrome. The mean MCA PSV, resistivity index, and MDCA vessel diameter values were statistically significantly higher in the study group compared with fetuses without CHDs. The mean PI and systole/diastole ratio were statistically significantly lower in the study group than in the control group. Conclusion: This study reported that MCA PSV, RI, and vessel diameter were significantly higher and the S/D ratio and PI were significantly lower in fetuses with CHD compared to the healthy fetuses.

Objective: To evaluate the early neurobehavioral outcome in preterm small for gestational age neonates with increased pulsatility index in antenatal umbilical artery Doppler. Method: A prospective cohort study was conducted at a tertiary care neonatal unit in India. 30 preterm SGA neonates born to mothers with increased pulsatility index (> 95th centile) were enrolled and compared with 30 SGA neonates with normal pulsatility index (<95th centile). These neonates were followed up to 40 weeks of post-menstrual age. They were evaluated by NAPI score of MDV (Motor development-vigor) and AO (Alertness orientation) at 40 weeks. Result: The mean NAPI score of MDV (Motor development- vigor) in neonates born to mothers with pulsatility index ≥95th percentile in umbilical artery Doppler was 58.59 ± 11.28 as compared to 61.73 ± 10.24 in another group (p-value 0.263) and mean difference (95%CI) was 3.14(2.42-8.71). The mean NAPI score of AO (Alertness-orientation) in the exposed group was 54.47 ± 10.19 as compared to 56.36 ± 9.07 in the unexposed group (p-value 0.44) and mean difference (95%CI) was 1.89 (3.1-6.88). Conclusion: Preterm, SGA neonates born to mothers with high pulsatility index in umbilical artery Doppler had low neurodevelopmental scores as compared to neonates with normal PI. [ABSTRACT FROM AUTHOR]

Doppler ultrasound is a commonly used method to assess hemodynamics of the fetal cardiovascular system and to monitor the well‐being of the fetus. Indices based on the velocity profile are often used for diagnosis. However, precisely linking these indices to specific underlying physiology factors is challenging. Several influences, including wave reflections, fetal growth, vessel stiffness, and resistance distal to the vessel, contribute to these indices. Understanding these data is essential for making informed clinical decisions. Mathematical models can be used to investigate the relation between velocity profiles and physiological properties. This study presents a mathematical model designed to simulate velocity wave propagation throughout the fetal cardiovascular system, facilitating the assessment of factors influencing velocity‐based indices. The model combines a one‐fiber model of the heart with a 1D wave propagation model describing the larger vessels of the circulatory system and a lumped parameter model for the microcirculation. Fetal growth from 20 to 40 weeks of gestational age is incorporated by adjusting cardiac and circulatory parameter settings according to scaling laws. The model's results, including cardiac function, cardiac output distribution, and volume distribution, show a good agreement with literature studies for a growing healthy fetus from 20 to 40 weeks. In addition, Doppler indices are simulated in various vessels and agree with literature as well. In conclusion, this study introduces a novel closed‐loop 0D‐1D mathematical model that has been verified against literature studies. This model offers a valuable platform for analyzing factors influencing velocity‐based indices in the fetal cardiovascular system. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the maternal blood amphiregulin (AR) levels of pregnant women with early-onset fetal growth restriction (FGR) and healthy pregnant women and to correlate them with Doppler findings to determine the association of AR with early-onset FGR. Material and Methods: Outpatient pregnant women who were between 18-45-years, >20 and ≤32-weeks, with no antibodies or infection markers for Toxoplasmosis, Rubella, Cytomegalovirus, hepatitis and human immunodeficiency virus conditions, with a low risk of genetic disease or malformation in first trimester screening test, with no pathologic findings in detailed ultrasonography were included in the study. Doppler measurements were evaluated. Two groups were formed as FGR and healthy control group. Delphi consensus methodology was used for FGR diagnosis. Delphi consensus criteria were fetuses with an estimated birth weight (EFW) or abdominal circumference below the 3rd percentile or reversed flow or loss of end-diastolic flow in the umbilical artery, were fetuses with EFW below 10th percentile and uterine artery pulsatility index (PI)>95th percentile or umbilical artery PI>95th percentile. For AR analyses, 4 mm of venous blood was taken and centrifuged. Serum samples were analyzed by enzyme-linked immunosorbent. Results: There was no statistically significant difference in serum AR levels between groups (Group-FGR, Group-C; 796.65 ng/L, 740.21 ng/L, p=0.765, respectively). There was no statistically significant association between serum AR values and umbilical artery changes, notch positivity in bilateral uterine arteries, pulsatility indices, oligohydramnios, and mode of delivery (p>0.05). Conclusion: Maternal serum AR levels may not predict early-onset FGR disease, and Doppler findings. [ABSTRACT FROM AUTHOR]

The management of right heart failure during durable left ventricular assist device (LVAD) support remains an unsolved issue so far. We had a 44-year-old male patient who was diagnosed with arrhythmogenic right ventricular cardiomyopathy and received HeartMate 3 LVAD (Abbott, USA) implantation as a bridge-to-transplant indication. The pump speed was adjusted as low as 4500 rpm to avoid the left ventricular narrowing and interventricular septal leftward shift. Riociguat was administered to decrease the afterload of the right ventricle and increase the preload of the left ventricle, in addition to the combination of neurohormonal blockers. Frequent low-flow alarm events eventually disappeared after amlodipine administration, and he was successfully returned to work. We here present a unique management in a patient with right heart failure due to arrhythmogenic right ventricular cardiomyopathy during HeartMate 3 LVAD support. [ABSTRACT FROM AUTHOR]

Introduction: Cerebral malaria (CM) is a devastating disease and better understanding of etiologies of the resulting neurologic injury is needed. The purpose of this study is to describe the day-to-day (DTD) pulsatility index (PI) change measured by transcranial Doppler ultrasound (TCD), a novel measure of cerebral and vascular changes, in children with CM. Methods: A retrospective analysis of 122 children in sub-Saharan Africa with CM and 3 or more sequential TCD measurements was performed. Variability of DTD PI change was calculated as a measure of changes in vasculature overtime. Neurologic outcome was determined by the Pediatric Cerebral Performance Category (PCPC) score, a measure of neurologic function. Results: Of the 122 participants, 77.9% had a good neurologic outcome (no neurologic sequelae), and 22.1% had a poor outcome (neurologic sequelae or died). Patients who had a poor neurologic outcome had higher levels of variability of DTD PI change in the right middle cerebral artery (MCA) (0.14 ± 0.21) and left MCA (0.17 ± 0.41) compared to those who had a good neurologic outcome (0.1 ± 0.1 and 0.11 ± 0.19, respectively). A higher variability of both left and right MCA DTD PI change was also associated with higher brain volume assessed through neuroimaging. Discussion: Variability of DTD PI change may provide early prognostic information regarding PCPC outcomes and brain volume changes seen in CM patients. Expanded research on pathophysiologic contributors to variability of DTD PI changes in children with CM is warranted. [ABSTRACT FROM AUTHOR]

Pregnancy is a complex stage in a woman's life, considering the physical and psychological changes that occur. The introduction of Doppler studies of the pregnant woman's vessels and those of the fetus has proven to be a useful tool in evaluating the maternal-fetal relationship. Objective: The study aims to assess the correlations of PI and RI values in term pregnancies. Methods: This analysis is based on the prospective evaluation of medical data from 60 patients who were admitted to the Obstetrics and Gynecology department of Saint Pantelimon Hospital in Bucharest, Romania, from May to August 2024. Among the examined parameters are patient age, blood pressure, amniotic fluid quantity, placenta location, and pulsatility and resistivity indices of uterine arteries. Results: A higher diastolic blood pressure is associated with higher mean PI and RI values, indicating that diastolic blood pressure has a significant correlation to these values. The mean RI shows a moderately negative and significant correlation, suggesting that a lower level of amniotic fluid is associated with a higher mean RI. Regarding the PI value of the uterine arteries, the p-value suggests that the difference between the groups with and without associated diseases is statistically significant. Placental insertion on the anterior or posterior uterine wall does not have a significant impact on the PI and RI values of the uterine arteries, but the values are higher in the contralateral part of the placental insertion. Conclusions: These results strengthen the evidence previously demonstrated. Uterine artery Doppler ultrasonography is an extremely useful tool in monitoring and managing high-risk pregnancies. [ABSTRACT FROM AUTHOR]

Background: The effect of congenital cardiac malformation on fetal cerebral circulation has not been well known. This study aimed to compare the cerebral blood circulation of fetuses with congenital heart disease (CHD) with healthy fetuses. Methods: This prospective cohort study included 37 pregnant women who presented to the gynecology and obstetrics department of department of Farabi Hospital, Faculty of Medicine, Karadeniz Technical University for anomaly screening in the second trimester. The women were divided into two groups as those with fetuses having CHD and healthy fetuses. Middle cerebral artery (MCA), peak systolic velocity (PSV), pulsatility index (PI), resistivity index (RI), systole/diastole (S/D) ratio, and MCA transverse section diameter (mm) were recorded for each fetus. Results: The most common CHDs were truncus arteriosus and hypoplastic left heart syndrome. The mean MCA PSV, resistivity index, and MDCA vessel diameter values were statistically significantly higher in the study group compared with fetuses without CHDs. The mean PI and systole/diastole ratio were statistically significantly lower in the study group than in the control group. Conclusion: This study reported that MCA PSV, RI, and vessel diameter were significantly higher and the S/D ratio and PI were significantly lower in fetuses with CHD compared to the healthy fetuses. [ABSTRACT FROM AUTHOR]

Background: Renal artery stenosis (RAS) is a major cause of secondary hypertension and chronic kidney disease (CKD), and diabetes mellitus accelerates its development. This study aims to compare the prevalence, severity, and characteristics of RAS in diabetic versus non-diabetic patients using renal artery Doppler ultrasonography. Method: An observational study was conducted from January 2023 to June 2024 at TS Misra Medical College and Hospital, involving 88 patients with RAS. Participants included 50 diabetic and 38 non-diabetic patients. Renal Doppler ultrasonography assessed resistive index (RI) and pulsatility index (PI) for evaluating renal vascular resistance. Demographic and clinical data were collected, and statistical analysis was performed using SPSS version 23.0. Result: Diabetic patients showed significantly higher RI and PI values compared to non-diabetics, with RI of 0.71 ± 0.06 vs. 0.62 ± 0.041 and PI of 1.41 ± 0.31 vs. 0.97 ± 0.21 (p

Introduction: Gestational Diabetes Mellitus (GDM) affects maternal placental blood flow. As a compensatory mechanism for placental haemodynamic changes, blood flow is redistributed from peripheral vessels to the brain. This re-distribution can be evaluated using doppler Ultrasonography (USG) measurements of the umbilical arteries and foetal middle cerebral arteries. Aim: To compare doppler flow parameters {Pulsatility Index (PI), Resistance Index (RI), Peak Systolic Velocity (PSV), Systolic-To-Diastolic (S/D)} of the foetal Middle Cerebral Artery (MCA) in pregnancy with gestational diabetes versus normal pregnancy, and to compare pregnancy outcomes in GDM versus non-GDM women. Materials and Methods: A prospective cohort study was conducted from November 2019 to November 2021 at the Department of Obstetrics and Gynaecology, Department of Radiology, and Department of Paediatrics in Tertiary care centre of New Delhi, India. All pregnant women attending the Antenatal Care Outpatient Department (ANC OPD) upto 34 weeks with an Oral Glucose Tolerance Test (OGTT) ≥140 mg/dL were defined as cases, and those with OGTT

Dynamic Ultrasound Localization Microscopy (DULM) has first been developed for non-invasive Pulsatility measurements in the rodent brain. DULM relies on the localization and tracking of microbubbles (MBs) injected into the bloodstream, to obtain highly resolved velocity and density cine-loops. Previous DULM techniques required ECG-gating, limiting its application to specific datasets, and increasing acquisition time. The objective of this study is to eliminate the need for ECG-gating in DULM experiments by introducing a motion-matching method for time registration. We developed a motion-matching algorithm based on tissue Doppler that leverages the cyclic tissue motion within the brain. Tissue Doppler was estimated for each group of frames in the acquisitions, at multiple locations identified as local maxima in the skin above the skull. Subsequently, each group of frames was time-registered to a reference group by delaying it based on the maximum correlation value between their respective tissue Doppler signals. This synchronization ensured that each group of frames aligned with the brain tissue motion of the reference group, and consequently, with its cardiac cycle. As a result, velocities of MBs could be averaged to retrieve flow velocity variations over time. Initially validated in ECG-gated acquisitions in a rat model (n = 1), the proposed method was successfully applied in a mice model in 2D (n = 3) and in a feline model in 3D (n = 1). Performing time-registration with the proposed motion-matching method or by using ECG-gating leads to similar results. For the first time, dynamic velocity and density cine-loops were extracted without the need for any information on the animal ECG, and complex dynamic markers such as the Pulsatility index were estimated. Results suggest that DULM can be performed without external gating, enabling the use of DULM on any ULM dataset where enough MBs are detectable. Time registration by motion-matching represents a significant advancement in DULM techniques, making DULM more accessible by simplifying its experimental complexity. [ABSTRACT FROM AUTHOR]

Purpose: This study compares transcranial Doppler (TCD) Pulsatility Index (PI) and Resistivity Index (RI) with intra-operative CSF opening pressure measured by manometric technique during ventriculoperitoneal (V-P) shunt in children with hydrocephalus. Methods: It was a prospective, hospital-based study performed among patients diagnosed with hydrocephalus. Patients had TCD ultrasonography before V-P shunt. The TCD sonography was repeated within 1 week post-op, and at 1 month post-op. The PI and RI were retrieved after insonating the middle cerebral artery. Ventricular CSF opening pressure was measured. Associations between TCD indices and CSF pressure were determined using the t-test and the Wilcoxon rank /Mann–Whitney tests where the normality test failed. A p-value of < 0.05 was considered significant for associations. Results: Fifty-two patients were enrolled with a mean age of 9.9 ± 11.5 months. Of these, 41 (78.8%) were aged ≤ 12 months. The mean CSF opening pressure was 21.4 ± 9.0. When raised, ICP was defined as opening pressure > 15 cm of H2O, high PI (≥ 1.19), and high RI (> 0.8) diagnosed it with a sensitivity of 55% and 50%, respectively. The mean pre-operative PI (1.17 ± 0.56) reduced to 0.96 (Z = − 2.032, p = 0.042), while that of RI (0.66 ± 0.17) also decreased to 0.58 (t = 2.906, p = 0.044) after V-P shunt surgery. A strong positive correlation exists between a reduction in PI and RI after V-P shunt (r = 0.743, p = 0.014). Conclusion: Both PI and RI significantly decrease following V-P shunt, but a single reading has a poor sensitivity in predicting ICP. [ABSTRACT FROM AUTHOR]

Background: Diabetes contributes to a spectrum of complications encompassing microvascular and macrovascular disorders. This study aimed to explore the correlation between distal sensorimotor polyneuropathy (DSPN) severity and heightened carotid atherosclerosis among individuals with type 2 diabetes mellitus (T2DM). Method: Participants underwent comprehensive assessments including nerve conduction studies (NCS), Toronto Clinical Neuropathy Score (TCNS) evaluations, assessment of cardiometabolic risk factors, and carotid sonography studies covering dynamic and morphological parameters. The resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV), and end-diastolic velocity (EDV) in both the common carotid artery (CCA) and internal carotid artery (ICA), carotid intima-media thickness (IMT), and carotid plaque score (CPS) were also measured. Peripheral nerve function severity was assessed using composite amplitude scores (CAS) derived from NCS. Results: Individuals with DSPN exhibited lower EDV in the CCA and ICA (p < 0.0001 and p = 0.002), higher PI and RI in both CCA and ICA (all p < 0.0001), and higher CPS (p = 0.002). They also demonstrated a higher prevalence of retinopathy as an underlying condition, higher index HbA1c, and reduced estimated glomerular filtration rate (eGFR) (all p < 0.0001). Multiple linear regression analysis revealed significant associations where eGFR, ICA-PI, index HbA1c, waist circumference, and age were correlated with CAS. Meanwhile, diabetes duration, waist circumference, age, and index HbA1c showed significant associations with TCNS. Conclusions: Our study suggests that individuals with T2DM who exhibit more severe carotid atherosclerosis may not only be at increased risk of developing DSPN but also may experience greater severity of DSPN. PI in both the CCA and ICA, along with the CPS, serve as surrogate biomarkers for DSPN severity. [ABSTRACT FROM AUTHOR]

Introduction: Gestational Diabetes Mellitus (GDM) affects maternal placental blood flow. As a compensatory mechanism for placental haemodynamic changes, blood flow is redistributed from peripheral vessels to the brain. This re-distribution can be evaluated using doppler Ultrasonography (USG) measurements of the umbilical arteries and foetal middle cerebral arteries. Aim: To compare doppler flow parameters {Pulsatility Index (PI), Resistance Index (RI), Peak Systolic Velocity (PSV), Systolic- To-Diastolic (S/D)} of the foetal Middle Cerebral Artery (MCA) in pregnancy with gestational diabetes versus normal pregnancy, and to compare pregnancy outcomes in GDM versus non-GDM women. Materials and Methods: A prospective cohort study was conducted from November 2019 to November 2021 at the Department of Obstetrics and Gynaecology, Department of Radiology, and Department of Paediatrics in Tertiary care centre of New Delhi, India. All pregnant women attending the Antenatal Care Outpatient Department (ANC OPD) upto 34 weeks with an Oral Glucose Tolerance Test (OGTT) ≥140 mg/dL were defined as cases, and those with OGTT <140 mg/dL were taken as controls. All patients underwent doppler USG after 34 completed weeks, and doppler flow parameters (PI, RI, PSV, S/D ratio) were noted. Patient outcomes were recorded, including maternal outcomes such as mode of delivery, pregnancy-induced hypertension, polyhydramnios, stillbirth, and Intrauterine Death (IUD). Foetal outcomes such as APGAR (Activity Pulse Grimace Appearance Respiration) score, hypoglycemia, hyperbilirubinemia, admission to the Neonatal Intensive Care Unit (NICU), Respiratory Distress Syndrome (RDS), and neonatal death were also documented. Appropriate statistical tests were used for the statistical analysis (Chi-square test, Fisher's exact test and Wilcoxon- Mann-Whitney test). Results: The mean age of GDM and non-GDM women was 27.40±3.57 years and 26.20±3.29 years, respectively. Among GDM women, 14 patients (31.1%) were primigravida, while there were 15 patients (33.3%) who were primigravida among non-GDM women. MCA PI was significantly higher in cases (1.79±0.36) compared to controls (1.65±0.19) (p-value=0.023), whereas MCA PSV was significantly lower in cases (45.86±2.17) than in controls (50.10±1.62) (p-value=0.001). Pregnancyinduced hypertension was observed in 28.9% of GDM women and 6.7% of non-GDM women, with the difference being statistically significant (p-value=0.006). There was a statistically significant difference between APGAR scores at 1 minute (p-value=0.030). However, there was no statistically significant difference in the APGAR scores at 5 minutes (p-value=0.242). Conclusion: Foetal MCA PI on doppler velocimetry was significantly higher in the GDM group, and MCA PSV was significantly lower in the study group, while MCA RI and MCA S/D ratio were not significantly different. Maternal complications were more common in GDM compared to non-GDM. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the vascular impedance of the pulmonary arteries in fetuses with tetralogy of Fallot (TOF) by Doppler echocardiography. Methods: A total of 42 fetuses with TOF (TOF group) and 84 gestational age‐matched normal fetuses (control group) were prospectively collected from the Second Xiangya Hospital of Central South University from August 2022 to January 2023. The severity of TOF was classified into mild TOF (z score ≥−2), moderate TOF (−4 < z score < −2), or severe TOF (z score ≤−4) according to the z score value of the pulmonary annulus diameter. The pulsatility index (PI) of the main pulmonary artery (MPA), distal left pulmonary artery (DLPA), and distal right pulmonary artery (DRPA) were measured by pulsed‐wave Doppler. The differences in clinical data and echocardiographic parameters between TOF group, control group, and TOF subgroups were compared. Results: Compared with the control group, MPA‐PI increased significantly, whereas DLPA‐PI and DRPA‐PI decreased in TOF group (all P <.001). There were no significant differences in MPA‐PI and DRPA‐PI among mild TOF, moderate TOF, and severe TOF (all P >.05). However, DLPA‐PI decreased significantly in severe TOF compared with mild TOF (P <.05). Conclusion: Fetuses with TOF presented increased vascular impedance in the pulmonary trunk and decreased impedance in distal pulmonary artery branches. Further large and follow‐up studies are needed to demonstrate the associations between those changed vascular impedances and the development of PA in patients with TOF. [ABSTRACT FROM AUTHOR]

Background: Hypertension during pregnancy occurs in 7-10% of pregnancies. It is divided into 3 types: Chronic hypertension, pregnancy-induced hypertension, and pre-eclampsia. It is a multisystem syndrome usually recognized by new-onset hypertension with proteinuria appearing in 2nd half of pregnancy. The incidence of preeclampsia is 5 to 7% of all pregnancies. Objective: To determine the diagnostic accuracy of uterine artery doppler (UAD) for preeclampsia screening in the second trimester. Study type, settings & duration: A cross-sectional and observational study was conducted at Hameed Latif Hospital, Lahore from January to June 2023. Methodology: The non-probability purposive sampling technique was used in this study. Patients were into two groups; group A: pre-eclampsia (n=40) and group B: non-pre-eclampsia (n=85). The sample size of 125 was calculated by G-Power software. Data was collected through pre-structured proforma and entered in SPSS version 25.0. Results: The 28 (70%) patients had positive UAD. They developed pre-eclampsia and 12 (30%) patients had negative but also developed pre-eclampsia (group A). In comparison, 15 (17.6%) patients had positive UAD but had not developed pre-eclampsia and 70 (82.4%) patients had negative UAD and had not developed preeclampsia. UAD and pre-eclampsia had a significant association with the p-value of 0.00*. Pre-eclampsia screening had a 15.5% margin of error, a 25% anticipated proportion of pre-eclampsia, a 75% UAD sensitivity, and an 86% specificity. Conclusion: Doppler USG is accurate enough that in the future we can rely on this tool for the prediction of PE in primigravidas. So, to detect preeclampsia early and prevent perinatal morbidity and mortality, 2nd trimester UAD should be incorporated routinely. [ABSTRACT FROM AUTHOR]

Purpose: The cerebroplacental ratio is a sonographic tool used to predict poor pregnancy outcomes. Data are insufficient regarding its use in postdate pregnancy. We evaluated the cerebroplacental ratio's prediction of unfavorable pregnancy outcomes in women at 40–42 weeks gestation with normal amniotic fluid index. Methods: This prospective observational study included 101 women with low-risk singleton pregnancy and gestational age > 40 weeks who delivered in a university affiliated hospital during 2020–2021. The middle cerebral artery pulsatility index, the umbilical artery pulsatility index, and the cerebroplacental ratio, which is their quotient, were compared between women with favorable and unfavorable pregnancy outcomes. The latter included: meconium-stained amniotic fluid, cesarean or vacuum-assisted delivery due to pathological cardiotocography (category 2 or 3), 5-min Apgar score < 7, umbilical cord pH < 7.1, neonatal intensive care unit admission, and neonatal death. Results: Fetal Doppler, performed at a median gestational age of 40.3 (40.0–41.6), did not differ between 75 (74.3%) women with favorable obstetrical outcomes and 26 (25.7%) with unfavorable outcomes. In multivariate analysis, advanced maternal age and a history of a cesarean section were correlated with unfavorable outcomes, while Doppler indices were not found to be predictive. Among women at 41–42 weeks' gestation, for those with intrapartum fetal monitor category 2–3 vs. category 1, the mean umbilical artery pulsatility index was higher: 0.92 ± 0.34 vs. 0.71 ± 0.11 (p = 0.044). Conclusion: According to the study results, fetal Doppler indices, including the cerebroplacental ratio, are not predictive of unfavorable outcome in women with pregnancies exceeding 40 weeks. Larger prospective studies are needed. [ABSTRACT FROM AUTHOR]

Purpose: To assess the effectiveness of half peak systolic velocity deceleration time (hPSV-DT) in predicting neonatal outcomes in pregnant women with preeclampsia and to compare its usefulness with the conventional umbilical artery (UA) pulsatility index (PI) approach. Methods: A prospective cohort study was conducted among pregnant women with preeclampsia who were admitted to the Department of Perinatology, Ministry of Health Ankara City Hospital between 01 September 2022 and 01 January 2023 at 28–41 weeks gestational age. 55 patients were divided into two groups: the study group with UA hPSV-DT value < 5th percentile (n = 22) and the control group with UA hPSV-DT value ≥ 5th percentile (n = 33). UA hPSV-DT calculates the time in milliseconds needed to halve the maximal velocity of the UA waveform using Doppler ultrasonography. Results: Birth weight, gestational age at birth, 1st minute APGAR, 5th minute APGAR, and umbilical cord pH values were significantly lower in the anormal hPSV-DT group (p < 0.05). Additionally, the rates of admission to NICU, respiratory distress syndrome (RDS), delivery time < 34 weeks, and birth weight < 2500 g were significantly more frequent in the anormal hPSV-DT group compared to the normal hPSV-DT group (p < 0.05). UA-PI > 95th percentile was detected in only 2 (8%) of 23 patients whose newborns were admitted to the NICU (p = 0.149), while hPSV-DT < 5th percentile was detected in 16 (69%) of 23 patients (p < 0.001). According to ROC analysis, the area under the curve was 0.82 (95% CI 0.06–0.28) for admission to the NICU. The best balance of sensitivity/specificity in ROC curves was 221.5 (82.6% sensitivity, 69.1% specificity, p < 0.001). Conclusion: UA hPSV-DT was successful in predicting composite adverse perinatal outcomes in pregnant women with preeclampsia. It is a promising novel method that is accurate, quantitative, reproducible, and easily applicable. With further studies, this method may be a primary diagnostic tool in the management of high-risk pregnancies and in determining the optimal timing of delivery. [ABSTRACT FROM AUTHOR]

Objectives: Aneurysm number (An) is a novel prediction tool utilizing parameters of pulsatility index (PI) and aneurysm geometry. An has been shown to have the potential to differentiate intracranial aneurysm (IA) rupture status. The objective of this study is to investigate the feasibility and accuracy of An for IA rupture status prediction using Australian based clinical data. Methods: A retrospective study was conducted across three tertiary referral hospitals between November 2017 and November 2020 and all saccular IAs with known rupture status were included. Two sets of An values were calculated based on two sets of PI values previously reported in the literature. Results: Five hundred and four IA cases were included in this study. The results demonstrated no significant difference between ruptured and unruptured status when using An ≥1 as the discriminator. Further analysis showed no strong correlation between An and IA subtypes. The area under the curve (AUC) indicated poor performance in predicting rupture status (AUC1 = 0.55 and AUC2 = 0.56). Conclusions: This study does not support An ≥1 as a reliable parameter to predict the rupture status of IAs based on a retrospective cohort. Although the concept of An is supported by hemodynamic aneurysm theory, further research is needed before it can be applied in the clinical setting. Advances in knowledge: This study demonstrates that the novel prediction tool, An, proposed in 2020 is not reliable and that further research of this hemodynamic model is needed before it can be incorporated into the prediction of IA rupture status. [ABSTRACT FROM AUTHOR]

Objectives: To measure the efficiency of combining clinical, biochemical markers, and doppler studies (uterine and umbilical arteries) as values to predict fetal growth restriction. Methods: This randomized clinical cross-sectional research has been carried out at the ultrasound unit in the Department of Obstetrics and Gynecology and the laboratory unit, Faculty of Medicine, Zagazig University between 2017 and 2021. Results: One hundred twenty-four pregnant women who visited the antenatal clinic at the Department of Obstetrics and Gynecology with suspected clinical criteria for FGR were included. In our study, the incidence of positive FGR in high-risk patients was 24.5%. Abnormal biochemical markers (PAPPA=0.42 + Homocysteine =6.3) were 42.3% sensitive, 88.0% specific, and 70.8% accurate in the prediction of FGR. Also, a statistically significant relationship between FGR and uterine artery doppler is noted. However, a combination of uterine artery doppler (PI>1.57 + diastolic notching) and biochemical markers was 46.2% sensitive, 58.8% specific, and 55.7% accurate in the prediction of FGR. Finally, there is a highly statistically significant relationship between both FGR and umbilical artery Doppler at 29th-31st weeks. Conclusions: The incorporated model of screening in this study can be a beneficial method to identify patients at increased risk of FGR. The best finding in this study is that a combination of uterine artery and umbilical artery doppler was 88.5% sensitive, 96.3% specific and 94.3% accurate in the prediction of FGR. [ABSTRACT FROM AUTHOR]

Introduction: Bilateral uterine arteries supplying gravid uterus undergoes physiological changes in pregnancy to maintain its high volume. In our country, pregnancy is very important stage for every women .Foetal morbidity and mortality is very high due to pre-eclampsia,it can also lead to complications like HELLP syndrome,DIC,abruption and increased chances of caesarean section.It can cause foetal complications like FGR,preterm labour,intra uterine foetal death .Doppler ultrasound helps to screen and diagnose complications early in the pregnancy. High risk pregnancies can lead to maternal and foetal mortality and morbidity. Early identification of the risk factors can protect mother and foetus from harmful effects of pregnancy. Doppler ultrasound is a recent advance in the field of foetal medicine, cost effective, non-invasive technique without any exposure to contrast media or harmful radiation during pregnancy to identify high risk factors to prevent pregnancy complications. Material and methods: Role of umbilical and uterine artery Doppler in predicting pregnancy outcome in high risk pregnancies. We will do a prospective study on 150 patients with high risk factors having chronic or pregnancy induced hypertension, eclampsia or pregnancy induced hypertension in previous pregnancy,anemia, diabetes mellitus or gestational diabetes mellitus, elderly gravida (>35 years),grand multipara(>=5). We will perform Doppler study of Umbilical and Uterine artery at 16-22 weeks. Study design-prospective observational study. Results Out of 150 patients 43 had PIH,36 had anemia,25 had gestational diabetes mellitus. Abnormal Doppler study consisted of presence of uterine artery notching, increased PI>1.45 and increased RI>0.58. In Our study out of 150,abnormal uterine artery Doppler results were noted in 40%.In umbilical artery Doppler Out of 150 patients 97 had raised RI,PI and 53 had Normal RI, PI.Out of 97, 74 had poor perinatal outcome,16 had good perinatal outcome and 7 had IUD.Out of 150 patients 90 had raised S/D ratio,52 had normal S/D ratio and 8 had absent S/D ration. Among those with abnormal Doppler results,pre eclampsia was seen in 11.3%,6.6 % foetuses had IUGR and were small for gestational age,6% required NICU admission. Intrauterine death occurred in 4.6% cases. Pre-eclampsia was seen in 84% having high RI with DN whereas only 16% pre eclampsia had raised RI without DN. Pre eclampsia was not found in 76.6% having high RI without DN whereas only 23.4%has pre eclampsia having high RI with DN. Conclusion Our data confirmed the efficacy of second trimester screening of high risk pregnancies using Doppler studies. Raised RI,PI and S/D ratio of umbilical artery could predict IUGR,poor perinatal outcome and risk of intrauterine foetal death with good sensitivity. The presence of high RI of uterine artery Doppler and/or the appearance of DN is associated with an increased risk of development of preeclampsia. Therefore,we recommend the introduction of this technique into routine antenatal care for high risk pregnancies. [ABSTRACT FROM AUTHOR]

Objective: To assess the correlation between fetal umbilical artery (UA) and middle cerebral artery (MCA) Doppler indices in a cohort of preeclamptic and normotensive pregnancies. Materials and Methods: This cross-sectional analytical study recruited 70 pregnant women (28–40 weeks of gestation) using a non-probability convenient technique. The study included 33 patients with preeclampsia and 37 normotensive participants. Results: In the normotensive group, a significant (P =.00) strong correlation (r = 0.72) was observed between UA velocity, systolic/diastolic (S/D) ratio, and pulsatility index (PI), and MCA velocity; a significant (P =.00) correlation (r = 0.56) between UA, S/D ratio, and the MCA resistive index (RI); a significant (P =.00) moderate correlation (r = 0.66) between S/D ratio, UA velocity, and MCA velocity; a significant (P =.00) negative correlation (r = −0.50) between UA velocity, RI, and MCA PI; a significant (P =.01) negative correlation (r = −0.44) between UA velocity, RI, and MCA S/D ratio. In contrast, in the preeclamptic group, we observed a substantial (P =.01) moderate correlation (r = 0.43) between UA, PI, and MCA velocity; a significant (P =.04) correlation (r = 0.368) between UA, RI, and MCA PI; a significant (P =.05) moderate correlation (r = 0.35) between UA, PI, and MCA RI; a significant (P =.00) strong correlation (r = 0.83) between UA S/D ratio UA and MCA velocity. Conclusion: This study suggests potential diagnostic value in Doppler measurements for assessing preeclampsia-related vascular changes. However, caution is warranted owing to a split sample and limited statistical power, necessitating further research for validation. [ABSTRACT FROM AUTHOR]

IntroductionCerebral malaria (CM) is a devastating disease and better understanding of etiologies of the resulting neurologic injury is needed. The purpose of this study is to describe the day-to-day (DTD) pulsatility index (PI) change measured by transcranial Doppler ultrasound (TCD), a novel measure of cerebral and vascular changes, in children with CM.MethodsA retrospective analysis of 122 children in sub-Saharan Africa with CM and 3 or more sequential TCD measurements was performed. Variability of DTD PI change was calculated as a measure of changes in vasculature overtime. Neurologic outcome was determined by the Pediatric Cerebral Performance Category (PCPC) score, a measure of neurologic function.ResultsOf the 122 participants, 77.9% had a good neurologic outcome (no neurologic sequelae), and 22.1% had a poor outcome (neurologic sequelae or died). Patients who had a poor neurologic outcome had higher levels of variability of DTD PI change in the right middle cerebral artery (MCA) (0.14 ± 0.21) and left MCA (0.17 ± 0.41) compared to those who had a good neurologic outcome (0.1 ± 0.1 and 0.11 ± 0.19, respectively). A higher variability of both left and right MCA DTD PI change was also associated with higher brain volume assessed through neuroimaging.DiscussionVariability of DTD PI change may provide early prognostic information regarding PCPC outcomes and brain volume changes seen in CM patients. Expanded research on pathophysiologic contributors to variability of DTD PI changes in children with CM is warranted.

Background: Hypertension during pregnancy occurs in 7-10% of pregnancies. It is divided into 3 types: Chronic hypertension, pregnancy-induced hypertension, and Pre-eclampsia. It is a multisystem syndrome usually recognized by new-onset hypertension with proteinuria appearing in 2nd half of pregnancy. The incidence of preeclampsia is 5 to 7% of all pregnancies. Objective: To determine the diagnostic accuracy of uterine artery Doppler (UAD) for preeclampsia screening in the second trimester. Study type, settings & duration: A cross-sectional and observational study was conducted at Hameed Latif Hospital, Lahore from January to June 2023. Methodology: The non-probability purposive sampling technique was used in this study. Patients were into two groups; Group A: Pre-eclampsia (n=40) and Group B: Non-Pre-eclampsia (n=85). The sample size of 125 was calculated by G-Power software. Data was collected through pre-structured proforma and entered in SPSS version 25.0. Results: The 28 (70%) patients had positive UAD. They developed pre-eclampsia and 12 (30%) patients had negative but also developed pre-eclampsia (group A). In comparison, 15 (17.6%) patients had positive UAD but had not developed pre-eclampsia and 70 (82.4%) patients had negative UAD and had not developed pre-eclampsia. UAD and pre-eclampsia had a significant association with the p-value of 0.00*. Pre-eclampsia screening had a 15.5% margin of error, a 25% anticipated proportion of pre-eclampsia, a 75% UAD sensitivity, and an 86% specificity. Conclusion: Doppler USG is accurate enough that in the future we can rely on this tool for the prediction of PE in primigravidas. So, to detect preeclampsia early...........

BACKGROUND: While image-derived predictors of intracranial aneurysm (IA) rupture have been well-explored, current understanding of IA growth is limited. Pulsatility index (PI) and wall shear stress pulsatility index (WSSPI) are important metrics measuring temporal hemodynamic instability. However, they have not been investigated in IA growth research. The present study seeks to verify reliable predictors of IA growth with comparative analyses of several important morphological and hemodynamic metrics between stable and growing cases among a group of unruptured IAs. METHODS: Using 3D images, vascular models of 16 stable and 20 growing cases were constructed and verified using Geodesic techniques. With an overall mean follow-up period of 25 months, cases exhibiting a 10% or higher increase in diameter were considered growing. Patient-specific, pulsatile simulations were performed, and hemodynamic calculations were computed at 5 important regions of each aneurysm (inflow artery, aneurysm neck, body, dome, and outflow artery). Index values were compared between growing and stable IAs using ANCOVA controlling for aneurysm diameter. Stepwise multiple logistic regression and ROC analyses were conducted to investigate predictive models of IA growth. RESULTS: Compared to stable IAs, growing IAs exhibited significantly higher intrasaccular PI, intrasaccular WSSPI, intrasaccular spatial flow rate deviation, and intrasaccular spatial wall shear stress (WSS) deviation. Stepwise logistic regression analysis revealed a significant predictive model involving PI at aneurysm body, WSSPI at inflow artery, and WSSPI at aneurysm body. CONCLUSIONS: Our results showed that high degree of hemodynamic variations within IAs is linked to growth, even after controlling for morphological parameters. Further, evaluation of PI in conjunction with WSSPI yielded a highly accurate predictive model of IA growth. Upon validation in future cohorts, these metrics may aid in early identification of IA growth and current understanding of IA remodeling mechanism.

Highlights: 1. The findings of this study indicate that clinicians should remain vigilant, as effective glycemic control, reflected by optimal HbA1c levels, does not necessarily correlate with favorable distal cerebrovascular resistance, as measured by pulsatility index (PI). 2. This study recommends that patients with acute thrombotic stroke undergo a comprehensive examination to ensure an accurate diagnosis and appropriate treatment. Abstract Stroke is the second leading cause of death and disability in the world. Diabetes mellitus is a risk factor for stroke with an increase in blood viscosity associated with hyperglycemia, and HbA1c is a well-established biomarker primarily used for the long-term monitoring of glycemic control in patients with diabetes mellitus. The Pulsatility index (PI) parameter of Trans Cranial Doppler (TCD) can measure blood vessel resistance. This study was to prove the correlation between HbA1c and PI in Middle Cerebral Artery (MCA) of acute thrombotic stroke patients. A cross-sectional study was conducted to thrombotic stroke patients treated at the neurological ward of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia from March 2019 to April 2020 who met the inclusion and exclusion criteria. Data were obtained from medical records. Statistical analysis was performed using Spearman test for numerical data and Chi-square for categorical data with a significant value of p

Introduction: Encephalopathy, a common complication in Intensive Care Unit (ICU) patients, is often linked to poor outcomes. Transcranial Doppler (TCD), a non-invasive tool assesses cerebral perfusion via the Pulsatility Index (PI), Resistivity Index (RI), and Time-Averaged Peak (TAP) or Mean Flow Velocity (MFV). These parameters may offer insights into cerebral perfusion and outcomes in encephalopathic patients. Aim: To describe the PI, RI of the Middle Cerebral Artery (MCA), and MFV or TAP measured by TCD in patients admitted to the ICU, comparing those with and without encephalopathy at the time of admission. Materials And Methods: This cross-sectional observational study was conducted from January 2019 to November 2020, in a combined medical-surgical ICU of a tertiary care hospital, involving 45 enrolled patients. Patients were evaluated within 24 hours of admission and subsequently every 24 hours until ICU discharge, death, or discharge against medical advice. Bilateral Middle cerebral artery TCD studies were conducted using a 1-5 MHz phased array probe or TCD mode through the transtemporal window. The PI, RI, and MFV were measured on both sides, with the higher value used for analysis, and all statistical analyses were performed using Statistics and Data 13 software. Results: In the present study, 88% (n=40) of patients had encephalopathy (GCS

Abstract Hemodynamic parameters have been correlated with stroke, hypertension, and arterial stenosis. While only a few small studies have examined the link between hemodynamics and diabetes mellitus (DM). This case-control study enrolled 417 DM patients and 3475 non-DM controls from a community-based cohort. Peak systolic velocity (PSV), end-diastolic velocity (EDV), blood flow velocity (MFV), pulsatility index (PI), and the resistance index (RI) of the common carotid arteries were measured by color Doppler ultrasonography. Generalized linear regression analyses showed that as compared to the non-DM controls, the age-sex-adjusted means of PSV, EDV, and MFV were − 3.28 cm/sec, − 1.94 cm/sec, and − 2.38 cm/sec, respectively, lower and the age-sex-adjusted means of RI and PI were 0.013 and 0.0061, respectively, higher for the DM cases (all p-values

Introduction: Acute viral encephalitis syndrome including dengue encephalitis (DE) is an important tropical illness with a guarded prognosis. The cerebral blood flow may be affected in acute viral encephalitis. Transcranial Doppler (TCD) sonography can quantitatively determine intracranial vascular flow dynamics in acute viral encephalitis. Aim: We aimed to investigate the intracranial blood flow characteristics in patients with DE and compare with nondengue acute viral encephalitis patients. Materials and Methods: In this prospective study, all the cases of acute viral encephalitis including dengue were enrolled over 18 months and followed up at 3 months. TCD was performed to determine the mean velocity pulsatility index (PI) and resistive index (RI) across the middle cerebral artery, anterior cerebral artery, posterior cerebral artery (PCA), vertebral artery, and basilar artery and compared it among dengue versus nondengue group as well as outcome at 3 months. Results: Out of 39 patients, 19 were diagnosed with DE, whereas 20 patients suffered from the nondengue group. The elevated PI and RI in the left PCA were found to statistically significant (P = 0.001 and 0.008, respectively) in the DE group. There was no significant difference in any other TCD indices in any other vessel among both the groups. In addition, an initial low Glasgow Outcome Scale (GOS) and higher brain imaging abnormality were significantly associated with poor GOS of

Objective: To analyze the value of ultrasound blood flow parameters of middle cerebral artery in evaluating the degree of white matter lesions (WMLs) in patients with cerebral small vessel disease (CSVD). Methods: A total of 98 patients with CSVD who were admitted to Yan'an University Affiliated Hospital between January 2021 and January 2024 were selected as the study group. Meanwhile, 60 healthy individuals were selected as the control group. The patients were divided into mild group (n=42), moderate group (n=36) and severe group (n=20) according to the severity of WMLs. Ultrasound examination was conducted to collect peak systolic blood flow velocity (Vs), peak diastolic blood flow velocity (Vd), mean blood flow velocity (Vm), pulsatility index (PI) and breath holding index (BHI) of middle cerebral artery. The blood flow parameters of middle cerebral artery were compared between the study group and the control group as well as among patients with different severity of WMLs. Results: Vs, Vd, Vm and BHI of the study group were lower than those of the control group, and PI was higher than that of the control group (P<0.05). There were significant differences in blood flow parameters of middle cerebral artery among patients with different severity of WMLs (P<0.05). Compared with mild group, there were decreases in Vs, Vd, Vm and BHI, and increases in PI in moderate group and severe group (P<0.05). Compared with moderate group, there were decreases in Vs, Vd, Vm and BHI, and increase in PI in severe group (P<0.05). Conclusion: Ultrasound blood flow parameters of middle cerebral artery are significantly correlated with the severity of WMLs in patients with CSVD, and can serve as non-invasive indicators for early evaluation of the severity of WMLs [ABSTRACT FROM AUTHOR]

Purpose: The compensatory mechanisms supporting cerebral perfusion throughout head-up tilt (HUT) in patients with vasovagal syncope (VVS) remain unclear. We tested the hypothesis that increased cerebrovascular compliance (Ci) and decreased cerebrovascular resistance (CVR) support cerebral blood velocity (CBV) during pre-syncope in VVS. Methods: Finger arterial blood pressure (ABP) and right middle cerebral artery blood velocity (CBV) were recorded in 15 individuals diagnosed with VVS (n = 11 female, mean age: 40 ± 16 years, mean body mass index: 24.9 ± 4.0 kg/m2) at supine rest and during HUT (80 degree angle). Individual ABP and CBV waveforms during VVS were input into a modified Windkessel model to calculate Ci and ohmic CVR. Gosling's pulsatility index (Pi; pulse amplitude/mean CBV) was calculated. Results: Diastolic ABP, systolic ABP, mean ABP (72 ± 11 to 51 ± 12 mmHg), and CVR decreased progressively during presyncope (all P ≤ 0.04). As expected, systolic CBV was sustained (all P ≥ 0.29) while diastolic and mean CBV (51 ± 13 to 38 ± 13 mmHg) fell during presyncope (all P ≤ 0.04). Both Ci and Pi increased during presyncope (128 ± 97 and 60 ± 41%, respectively; all P ≤ 0.049) and were positively correlated (R2 = 0.79, P < 0.01). Increased Ci contributed to changes in mean CBV (P < 0.01) but decreased CVR did not (P = 0.28). Conclusions: These data provide evidence that Ci increases during presyncope in patients with VVS and is likely involved in the maintenance of systolic CBV during a fall in diastolic CBV. However, this regulation is not sufficient to preserve CBV in the presence of such extreme and progressive reductions in ABP. [ABSTRACT FROM AUTHOR]

Background: Transcranial Doppler (TCD) is a noninvasive bedside tool for cerebral hemodynamic assessments in multiple clinical scenarios. TCD, by means of measuring systolic and diastolic blood velocities, allows the calculation of the pulsatility index (PI), a parameter that is correlated with intracranial pressure (ICP). Nevertheless, the predictive value of the PI for raised ICP appears to be low, as it is subjected to several, often confounding, factors not related to ICP. Recently, the pulsatile apparent resistance (PaR) index was developed as a PI corrected for arterial blood pressure, reducing some of the confounding factors influencing PI. This study compares the predictive value of PaR versus PI for intracranial hypertension (IH) (ICP > 20 mm Hg) in patients with traumatic brain injury. Methods: Patients with traumatic brain injury admitted to the neurocritical care unit who required invasive ICP monitoring were included prospectively within 5 days of admission. TCD measurements were performed in both middle cerebral arteries, allowing calculations of the PI and PaR. The optimal cutoff, discriminative power of these parameters for ICP ≥ 20 mm Hg, was assessed by calculating the area under the receiver operator characteristics curve (AUC). Results: In total, 93 patients were included. A total of 20 (22%) patients experienced IH during the recording sessions. The discriminative power was low for PI (AUC 0.63) but slightly higher for PaR (AUC 0.77). Nonparametric analysis indicated significant difference for PaR when comparing patients with (median 0.169) and without IH (median − 0.052, p = 0.001), whereas PI medians for patients with and without IH were 0.86 and 0.77, respectively (p = 0.041). Regarding subanalyses, the discriminative power of these parameters increased after exclusion of patients who had undergone a neurosurgical procedure. This was especially true for the PaR (AUC 0.89) and PI (AUC 0.72). Among these patients, a PaR cutoff value of − 0.023 had 100% sensitivity and 52.9% specificity. Conclusions: In the present study, discriminative power of the PaR for discriminating IH was superior to the PI. The PaR seems to be a reliable noninvasive parameter for detecting IH. Further studies are warranted to define its clinical application, especially in aiding neurosurgical decision making, following up in intensive care units, and defining its ability to indicate responses according to the therapies administered. [ABSTRACT FROM AUTHOR]

Background: Cerebral Venous Thrombosis (CVT), accounting for 3% of strokes, can be assessed using non-invasive Transcranial Doppler (TCD) ultrasound to measure cerebrovascular function in real-time. The TCD-derived pulsatility index (PI), highly correlates with intracranial pressure (ICP) and serves as a reliable non-invasive monitoring tool. Aim: This study aims to correlate PI by TCD with clinical outcomes in CVT patients. Methods: A prospective observational study of 41 CVT patients admitted between June 2022 to December 2022 was conducted in the Department of Neurology of MBS Hospital. Each patient was subjected to TCD and the PI was also recorded. The results were analysed with SPSS. Results: Out of the 41 patients, two patients died and 39 patients were discharged. The PI at admission in the left middle cerebral artery (MCA) was 1.19 ± 0.20 amongst discharged and 1.64 ± 0.10 amongst those who died (p =.003). Similarly, the PI at admission in the right MCA was 1.23 ± 0.21 amongst those discharged and 1.63 ± 0.20 amongst those who died (p =.02). Also, PI in both left and right MCA positively and significantly correlated with CVT GS score at admission (r = 0.70, p <.05; r = 0.64, p <.05). Conclusion: PI at admission is both right and left MCA was found to be significantly higher in patients who died during the hospital stay. Also, PI significantly correlated with the CVT GS score at the presentation. Thus, PI at admission by TCD can predict the clinical outcome of patients with CVT. [ABSTRACT FROM AUTHOR]

Hemodynamic parameters have been correlated with stroke, hypertension, and arterial stenosis. While only a few small studies have examined the link between hemodynamics and diabetes mellitus (DM). This case-control study enrolled 417 DM patients and 3475 non-DM controls from a community-based cohort. Peak systolic velocity (PSV), end-diastolic velocity (EDV), blood flow velocity (MFV), pulsatility index (PI), and the resistance index (RI) of the common carotid arteries were measured by color Doppler ultrasonography. Generalized linear regression analyses showed that as compared to the non-DM controls, the age-sex-adjusted means of PSV, EDV, and MFV were − 3.28 cm/sec, − 1.94 cm/sec, and − 2.38 cm/sec, respectively, lower and the age-sex-adjusted means of RI and PI were 0.013 and 0.0061, respectively, higher for the DM cases (all p-values < 0.0005). As compared to the lowest quartiles, the multivariable-adjusted ORs of DM for the highest quartiles of PSV, EDV, MFV, RI, and PI were 0.59 (95% confidence interval [CI] 0.41–0.83), 0.45 (95% CI 0.31–0.66), 0.53 (95% CI 0.37–0.77), 1.61 (95% CI 1.15–2.25), and 1.58 (95% CI 1.12–2.23), respectively. More importantly, the additions of EDV significantly improved the predictabilities of the regression models on DM. As compared to the model contained conventional CVD risk factors alone, the area under the receiver operating curve (AUROC) increased by 1.00% (95% CI 0.29–1.73%; p = 0.0059) and 0.80% (95% CI 0.15–1.46%; p = 0.017) for models that added EDV in continuous and quartile scales, respectively. Additionally, the additions of PSV and MFV also significantly improved the predictabilities of the regression models (all 0.01 < p-value < 0.05). This study reveals a significant correlation between DM and altered hemodynamic parameters. Understanding this relationship could help identify individuals at higher risk of DM and facilitate targeted preventive strategies to reduce cardiovascular complications in DM patients. [ABSTRACT FROM AUTHOR]

Background and Aim: In hydrocephalus patients, after ventriculoperitoneal (VP) shunt, decrease in pulsatility index (PI) correlates with decrease in ventricle size. Also, increase in PI is noted in obstructed or malfunctioning VP shunts. However, previous studies were either done in infants and children or included patients of all age groups. Our aim was to compare PI before and after successful VP shunt surgery in adult patients and also the trend of transcranial Doppler (TCD) parameters for 3 days after surgery. Materials and Methods: A prospective, observational study was done in 20 adult patients undergoing VP shunt. Clinical features, vitals, Evans index, and TCD parameters were noted in the preoperative period. A computed tomography (CT) head was repeated 4-6 h after surgery, and the position of ventricular end of shunt was confirmed and Evans index was calculated. The vitals and TCD parameters were noted at same time and for the next 2 days. Repeated measures analysis of variance (ANOVA) and paired t-test were uses for statistical analysis. Results: A total of 18 patients were included for statistical analysis. The mean preoperative PI was 1.19 ± 0.24 and the postoperative PI after surgery was 0.97 ± 0.17, 0.97 ± 0.23, and 0.94 ± 0.21 (P = 0.0039) on postoperative day (POD) 1 (POD1), POD2, and POD3, respectively. The mean preoperative value of Evans index was 0.37 ± 0.06 and there was statistically significant (P = < 0.001) reduction to 0.33 ± 0.07 after VP shunt surgery. The change in PI and change in Evans index were found to be positively correlated (r = 0.34 and P = 0.0013). Conclusions The decrease in PI after VP shunt surgery correlates with decrease in ventricular size. Any increase in PI in the postoperative period should raise the suspicion of malfunctioning of VP shunt. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the correlation between the pulsatility index (PI) of the middle cerebral artery with the total burden of cerebral small vessel disease and cognitive impairment. Method: Information on patients hospitalized in the Department of Neurology was collected retrospectively. These patients had complete clinical and laboratory data. The middle cerebral artery PI was measured using transcranial Doppler, a Mini‐Mental State Examination (MMSE) was used to assess cognitive function, and the total cerebral small vessel disease burden was assessed using magnetic resonance imaging. Patients were grouped according to their scores for total imaging burden of cerebral small vessel disease and cognitive function. Logistic regression analysis assessed the association between the PI, total imaging burden, and cognitive impairment. Spearman analysis was used to evaluate the correlation between the PI and total imaging burden and cognitive impairment, and receiver operating characteristic (ROC) curves were used to determine the predictive value of the PI for cognitive function. Results: The PI was higher in the cognitive impairment (CI) group than in the no‐CI group. Binary logistic regression analysis showed that increased PI was an independent risk factor for CI (OR = 1.582; 95% CI: 1.043–2.401; p =.031) and total imaging burden (OR = 1.842; 95% CI: 1.274–2.663; p =.001). Spearman analysis found that the PI correlated negatively with the MMSE score (r = −.627, p <.001). ROC curve analysis showed the PI predicted CI with an area under the curve of 0.784. The PI combined with the total imaging burden predicted CI in cerebral small vessel disease with an area under the curve of 0.832. Conclusion: An increased PI was associated with CI and a high imaging burden in cerebral small vessel disease patients. The PI combined with the total burden score shows a high predictive value for CI. [ABSTRACT FROM AUTHOR]

Objective: To assess the association between placental biomarkers (placental growth factor (PlGF) and soluble fms‐like tyrosine kinase‐1 (sFlt‐1)/PlGF ratio) and fetoplacental Doppler indices (umbilical artery (UA) pulsatility index (PI) and uterine artery (UtA) PI) in various combinations for predicting preterm birth (PTB) in pregnancies complicated by fetal growth restriction (FGR). Methods: This was a prospective observational cohort study, performed at Mater Mother's Hospital in Brisbane, Queensland, Australia, from May 2022 to June 2023, of pregnancies complicated by FGR and appropriate‐for‐gestational‐age (AGA) pregnancies. Maternal serum PlGF levels, sFlt‐1/PlGF ratio, UA‐PI and UtA‐PI were measured at 2–4‐weekly intervals from recruitment until delivery. Harrell's concordance statistic (Harrell's C) was used to evaluate multivariable Cox proportional hazards regression models featuring various combinations of placental biomarkers and fetoplacental Doppler indices to ascertain the best combination to predict PTB (< 37 weeks). Multivariable Cox regression models were used with biomarkers as time‐varying covariates. Results: The study cohort included 320 singleton pregnancies, comprising 179 (55.9%) affected by FGR, defined according to a Delphi consensus, and 141 (44.1%) with an AGA fetus. In the FGR cohort, both low PlGF levels and elevated sFlt‐1/PlGF ratio were associated with significantly shorter time to PTB. Low PlGF was a better predictor of PTB than was either sFlt‐1/PlGF ratio or a combination of PlGF and sFlt‐1/PlGF ratio (Harrell's C, 0.81, 0.78 and 0.79, respectively). Although both Doppler indices were significantly associated with time to PTB, in combination they were better predictors of PTB than was either UA‐PI > 95th centile or UtA‐PI > 95th centile alone (Harrell's C, 0.82, 0.75 and 0.76, respectively). Predictive utility for PTB was best when PlGF < 100 ng/L, UA‐PI > 95th centile and UtA‐PI > 95th centile were combined (Harrell's C, 0.88) (hazard ratio, 32.99; 95% CI, 10.74–101.32). Conclusions: Low maternal serum PlGF level (< 100 ng/L) and abnormal fetoplacental Doppler indices (UA‐PI > 95th centile and UtA‐PI > 95th centile) in combination have the greatest predictive utility for PTB in pregnancies complicated by FGR. Their assessment may help guide clinical management of these complex pregnancies. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Introduction: Encephalopathy, a common complication in Intensive Care Unit (ICU) patients, is often linked to poor outcomes. Transcranial Doppler (TCD), a non-invasive tool assesses cerebral perfusion via the Pulsatility Index (PI), Resistivity Index (RI), and Time-Averaged Peak (TAP) or Mean Flow Velocity (MFV). These parameters may offer insights into cerebral perfusion and outcomes in encephalopathic patients. Aim: To describe the PI, RI of the Middle Cerebral Artery (MCA), and MFV or TAP measured by TCD in patients admitted to the ICU, comparing those with and without encephalopathy at the time of admission. Materials and Methods: This cross-sectional observational study was conducted from January 2019 to November 2020, in a combined medical-surgical ICU of a tertiary care hospital, involving 45 enrolled patients. Patients were evaluated within 24 hours of admission and subsequently every 24 hours until ICU discharge, death, or discharge against medical advice. Bilateral Middle cerebral artery TCD studies were conducted using a 1-5 MHz phased array probe or TCD mode through the transtemporal window. The PI, RI, and MFV were measured on both sides, with the higher value used for analysis, and all statistical analyses were performed using Statistics and Data 13 software. Results: In the present study, 88% (n=40) of patients had encephalopathy (GCS<15 and RAAS less than or more than 0). The mean APACHE II score was 19 (14-25), indicating severe illness with a predicted mortality of 30-40%. Patients with encephalopathy had significantly higher APACHE II scores compared to those without (19.5 (16-25) vs 10 (4-19)). Although there was a trend towards a higher Pulsatility Index in encephalopathic patients at admission (1.11±0.378 vs 1.07±0.12, p=0.81), PI, RI, and TAP values did not significantly differ in non-survivors (1.12±0.49 vs 1.11±0.33, p=0.750). Persistent encephalopathy was associated with a trend towards higher PI at admission (1.05±0.24 vs 1.16±0.46; p=0.756), and a moderate correlation was found between decreasing PI and improvement in GCS (rho=-0.489, p=0.001). Conclusions: PI, RI, and TAP at the time of admission were not found to be associated with occurrence and recovery of encephalopathy as well as mortality. The trend of change in PI moderately correlated with improvement in GCS suggesting the importance of trends rather than absolute values. [ABSTRACT FROM AUTHOR]

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Aim: To compare the ocular blood flow in glaucomatous eyes and normal healthy eyes. This study compares open-angle glaucoma patients to healthy adults by measuring various parameters in the ophthalmic artery (OA), central retinal artery (CRA), and short posterior ciliary artery (SPCA). Materials and methods: A total of 50 glaucomatous eyes and 50 normal eyes were included in a prospective case-control study over 1 year. The color Doppler imaging (CDI) was conducted using a noninvasive linear multifrequency probe with a frequency range of 5-9 MHz. OA, CRA, and SPCA were measured for peak systolic velocity (PSV), end-diastolic volume (EDV), pulsatility index (PI), and resistivity index (RI). Results: When compared with controls, PSV was decreased in all three vessels, with the results being remarkable only in CRA. The EDV also showed a remarkable decrease in all three vessels. Additionally, all three vessels showed significant increases in PI and RI except OA, p-value < 0.05. Conclusion: Blood velocity is decreased, and resistive indices are increased in glaucomatous eyes compared with normal eyes. Variations in ocular blood flow could be a cause or consequence of glaucomatous optic neuropathy and are an important predictor of disease progression. [ABSTRACT FROM AUTHOR]

Objective: The objective of this retrospective review was to evaluate whether or not pulsatile flow improves cerebral hemodynamics and clinical outcomes in pediatric congenital cardiac surgery patients. Methods: This retrospective study included 284 pediatric patients undergoing congenital cardiac surgery with cardiopulmonary bypass support utilizing nonpulsatile (n = 152) or pulsatile (n = 132) flow. Intraoperative cerebral gaseous microemboli counts, pulsatility index, and mean blood flow velocity at the right middle cerebral artery were assessed using transcranial Doppler ultrasound. Clinical outcomes were compared between groups. Results: Patient demographics and cardiopulmonary bypass characteristics between groups were similar. Although the pulsatility index during aortic crossclamping was consistently higher in the pulsatile group (P

Abstract Objective Early identification of sickle renovascular changes via renal Doppler sonography among sickle cell disease patients to help in early diagnosis and interventions to prevent progression to end-stage renal disease. Methods Forty-five SCD children were included along with 45 healthy control children. Renal Doppler sonography (PI and RI) was performed on all subjects. Laboratory investigations were done: Hb electrophoresis, complete blood picture with blood indices, reticulocyte count, liver enzymes (ALT and AST), HCV serology, serum ferritin, and lactate dehydrogenase (LDH). Urine analysis and albumin/creatinine ratio in urine were done for all patients as well. Results The study group consisted of 45 SCD patients, 27 (60%) males with a mean age of 12 years (± 3 years). By performing renal Doppler sonography, it was found that all study groups had significantly higher Doppler indices (resistivity index and pulsatility index) compared to the control group. Results of renal Doppler sonography revealed that the main renal pulsatility index was positively correlated with the main renal resistance index (r = 0.454, p = 0.002). Conclusion Doppler indices (resistance index and pulsatility index) were of value to assess reno-vascular changes in SCD, Thus, renal Doppler indices could be an early technique in the assessment of sickle renovascular changes, so treatment can be started at an early stage before progressive affection of renal function.

Abstract Aims Mild cognitive impairment and dementia are common and serious co‐morbidities in people with chronic heart failure (HF) as they increase hospitalization rates, mortality and health care costs. Upon other factors, dysregulated cerebral perfusion might contribute to brain pathology. We aimed to evaluate the association of non‐invasively measured blood flow (BF) and pulsatility index (PI) of the internal carotid artery (ICA) with (i) chronic HF parameters, (ii) brain morphologic measures and (iii) cognitive impairment. Methods and results This post‐hoc analysis of the observational, prospective Cognition.Matters‐HF study included 107 chronic HF patients without atrial fibrillation or carotid artery stenosis (aged 63 ± 10 years; 19% women). Using extracranial sonography, we measured ICA‐BF and ICA‐PI 1.5 cm distal of the carotid bifurcation. Brain magnetic resonance imaging was performed on a 3‐Tesla scanner to quantify cerebral atrophy, hippocampal atrophy and white matter hyperintensities. Extensive neuropsychological testing tested the cognitive domains intensity of attention, visual/verbal memory and executive function (including its subdomains selectivity of attention, visual/verbal fluency and working memory) using a comprehensive test battery. (i) Neither ICA‐BF (median 630 (quartiles 570, 700) mL/min) nor ICA‐PI (1.05 (0.96. 1.23)) related to left ventricular ejection fraction, left atrial volume index or NT‐proBNP. (ii) Higher ICA‐PI (r = 0.25; P = 0.011), but not ICA‐BF (r = 0.08; P = 0.409), associated with increased volume of white matter hyperintensities beyond ageing, while neither ICA‐PI nor ICA‐BF related to cerebral or hippocampal atrophy indices. (iii) ICA‐BF, but not ICA‐PI, positively correlated with age‐adjusted T‐scores of executive function (r = 0.38; P