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Despite significant advancements in drug-eluting stent technology, in-stent restenosis (ISR) still occurs in approximately 10 % of patients undergoing percutaneous coronary intervention, remaining a significant global health concern. The mechanisms underlying ISR are complex and multifactorial, yet recent innovations in intravascular imaging and functional assessment have substantially advanced our understanding, enabling more targeted and personalized therapies. This review synthesizes the latest insights into ISR, emphasizing the pivotal roles of advanced imaging modalities, such as optical coherence tomography (OCT) and intravascular ultrasound, and functional assessments like quantitative flow ratio and optical flow ratio in guiding ISR management. Additionally, we explore the clinical implications of in-stent neoatherosclerosis and calcified nodules as key pathological mechanisms influencing restenosis progression and patient outcomes. The review also highlights the significance of OCT-based ISR classifications in refining treatment approaches. By integrating these diagnostic and therapeutic advances, this work provides clinicians and researchers with an updated foundation and actionable insights for optimizing ISR management through tailored, imaging-guided strategies., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

The study investigates the effectiveness of blind and ultrasound-guided epidural injections in Egyptian donkeys in the sacrococcygeal region, a topic of limited research, by comparing and assessing their onset in 20 healthy adult donkeys of both sexes. In the first group, we used ten cadaver donkeys that were humanely euthanized. In the second group, we used 10 live, healthy adult donkeys to assess the efficacy and time of analgesia onset for blind and ultrasound-guided epidural injections at the sacrococcygeal region. Cadavers were randomly designated to blind (n = 5) or US-guided (n = 5) epidural injections at the sacrococcygeal region in sternal recumbency in donkeys using Methylene Blue (1%) as a diagnostic marker for caudal epidural injection. The injection criteria were comparatively assessed between the two techniques of injection. Our findings comparing the blind and US-guided injection approaches showed substantially higher needle accuracy penetration to comparatively assess these two injection techniques. Both injection difficulties and trial numbers were significantly greater in blind techniques as opposed to US-guided procedures. US-guided injection procedures revealed the effectiveness of the time needed for perfect placement of the needle was significantly less than with a blind one. A shorter time for the onset of analgesia was achieved with the ultrasound-guided method, although the difference was not statistically significant (P < 0.09). In conclusion, the ultrasound-guided technique of the epidural injection provided a number of benefits over the blind one, including the capacity to directly view the needle and distribute local anesthetic and avoid unintentional vascular damage, in comparison with traditional blind techniques. Our study aims to enhance the accuracy and safety of epidural anesthesia injection at the sacrococcygeal space in Egyptian donkeys using ultrasound guidance in the veterinary surgical field., Competing Interests: Declarations. Ethics approval and consent to participate: The present study was carried out in accordance with the standard rules, guidelines, and regulations set forth by the Animal Ethics Committee and under the protocol number (approval code: KFS-IACUC/001/2021) of the Faculty of Veterinary Medicine, Kafrelsheikh University, and complied with the regulations of the National Committee for Research regarding the care and use of animals for scientific purposes. All methods were performed in accordance with relevant guidelines and regulations from the Basel Declaration and the International Council for Laboratory Animal Science (ICLAS). The study was conducted in accordance with the local legislation and institutional requirements. The source of the Egyptian donkeys utilized in this study was obtained directly from their respective owners. In adherence to ethical standards, we confirm that informed consent from the owner has been duly obtained. All methods are reported in accordance with ARRIVE guidelines. Consent for publication: not applicable. Competing interests: The authors declare no competing interests. Conflict of interest: None of the authors has any financial or personal relationships that could inappropriately influence or bias the content of the paper., (© 2025. The Author(s).)

Background: A recent randomised trial demonstrated fractional flow reserve (FFR) guidance for percutaneous coronary intervention (PCI) was non-inferior to intravascular ultrasound (IVUS) guidance regarding clinical outcomes, with a lower frequency of PCI., Aims: We sought to evaluate the prognosis of FFR versus IVUS guidance for PCI of intermediate coronary artery stenosis and low lesion complexity in diabetic and non-diabetic patients., Methods: This study is a prespecified post hoc analysis from the FLAVOUR trial. The primary outcome was major adverse cardiac events (MACE) at 24 months, defined as a composite of death, myocardial infarction or any revascularisation. The secondary outcomes were target vessel failure (TVF) and each component of MACE and TVF at 24 months., Results: Among 1,682 randomly assigned patients, 554 (32.9%) had diabetes, and the mean SYNTAX score was 8.64±6.03 at baseline. The FFR group had a lower PCI rate than the IVUS group in both diabetic (48.2% vs 69.1%; p<0.001) and non-diabetic (42.6% vs 63.3%; p<0.001) patients. At 24 months, there was no difference in the cumulative incidence of MACE between the FFR and the IVUS groups in either diabetic (9.3% vs 8.3%; p=0.90) or non-diabetic (7.5% vs 8.6%; p=0.50) patients. The cumulative incidence of TVF was also comparable between the FFR and the IVUS groups regardless of diabetic status., Conclusions: In patients with intermediate coronary stenosis and low lesion complexity, regardless of diabetic status, FFR guidance had no significant differences in MACE or TVF with a lower frequency of PCI compared with IVUS guidance.

Left main (LM) percutaneous coronary intervention (PCI) has expanded rapidly in the past decade, with up to fourfold increase annually. Recent trials found that intravascular imaging (IVI)-guided LM PCI resulted in lower risks of cardiac death and stent failure due to suboptimal PCI compared to angiography-guided PCI. IVI usage has increased in recent years; however, its utilization remains variable across regions and is still incredibly low in developing countries. Furthermore, to date, there is no data about LM size in the Southeast Asian population. This study aims to determine the mean external elastic membrane (EEM) diameter, cross-sectional area (CSA) of LM, and its predictor. This is a cross-sectional observational study on 100 patients with coronary artery disease (CAD) who underwent IVUS-guided PCI with a pullback to LM in Dr. Hasan Sadikin General Hospital Bandung, Indonesia, from January 2020 until December 2022. Linear regression was used to determine the predictors of LM size. There were 100 segments of LM. LM's mean EEM diameter and CSA were 5.02 ± 0.43 mm and 19.93 ± 3.48 mm 2 . Body surface area (BSA) is an independent predictor of EEM diameter and CSA with a positive linear relationship (p 0.001 and p 0.0001). Hypertension is an independent predictor of EEM diameter with a positive linear relationship (p 0.034). The linear equation to predict EEM diameter and CSA were (2.741 + 1.272BSA(m 2 ) + 0.165 hypertension (yes)) and (2.745 + 9.601BSA(m 2 )), respectively. The LM coronary artery size of the Southeast Asian population was comparable with the previous studies. BSA and hypertension are independent predictors of EEM diameter, with BSA being stronger than hypertension. Neither sex nor other cardiovascular risk factors affect the LM size. The knowledge of coronary artery size will help the clinician have a reference for intervention, especially when no intravascular imaging is available., Competing Interests: Declarations. Conflicts of interest: All authors declare no conflict of interest related to this study. Informed consent: Informed consent was obtained from each participant involved in this study. Research involving human and animal participants: This study was conducted under the 1964 Declaration of Helsinki and its subsequent amendments. We do not involve animals in our study., (© 2024. Springer Nature Japan KK, part of Springer Nature.)

Background: Peripheral nerve stimulation (PNS) has emerged as a minimally invasive percutaneous procedure addressing neuropathic pain. However, the percutaneous cylindrical lead ultrasound-guided implantation procedure requires expertise that limits widespread PNS utilization. To overcome these challenges, a microinvasive endoscopy device has very recently been developed, enhancing the precision of PNS implantation by providing accurate visualization of the targeted nerve. We aimed to determine the feasibility, safety, clinical effectiveness, and energy consumption of PNS therapy by means of ultrasound guidance combined with microendoscopy., Materials and Methods: This is a retrospective, single-center, single-arm study. Patient recruitment was performed in February and March 2023. Patients with >12 months of upper or lower limb pain presenting with pain >5 of 10 that was refractory to conventional treatments were eligible. Safety was assessed by collecting adverse events and complications related to the PNS implantation with microendoscopy. The Multidimensional Clinical Response Index (MCRI), pain intensity (visual analog scale [VAS]), pain surface (PRISMap Software, PRISMATICS lab, CHU de Poitiers, Poitiers, France), quality of life (EuroQoL 5 dimensions 5 levels [EQ5D-5L]), functional disability (Oswestry Disability Index [ODI]), anxiety and depression (Hospital Anxiety and Depression Scale), and energy consumption were assessed at baseline and at one and three months., Results: Six patients received PNS, which was implanted through ultrasound guidance combined with microendoscopy. No adverse event was reported during the three-month follow-up. Clinical outcomes (MCRI, VAS, ODI, EQ5D-5L) significantly increased at one- and three-month follow-up. Energy consumption was, on average, 2.6 ± 1.1 μC.s -1 at one-month and 3.3 ± 2.0 μC.s -1 at three-month follow-up., Conclusions: Implanted PNS by means of ultrasound combined with microendoscopy was safe and provided clinical benefits with very low energy consumption (15-440 times less than spinal cord stimulation) in patients with upper or lower limb neuropathic pain. Microendoscopy would offer extended PNS indications, overcoming limitations associated with ultrasound alone. Future research is nonetheless needed to provide stronger evidence through randomized controlled trial design., Competing Interests: Conflict of Interest Philippe Rigoard reports grants and speaker fees from Quantel Medical, Medtronic, Abbott, and Boston Scientific. Maarten Moens reports speaker fees from Medtronic, Saluda, and Nevro. Lisa Goudman reports speaker fees from Medtronic, Nevro, and Saluda. Romain David and Manon Duraffourg have received consulting fees from Boston Scientific. Sam Eldabe reports consulting agreements from Mainstay Medical and Medtronic, institutional research grants from Medtronic, and other from Abbott. Denys Fontaine is a consultant for Medtronic, Abbott, and Boston and received research grants from Medtronic and Abbott. Bénédicte Bouche reports speaking fees from Boston Scientific and Medtronic. The remaining authors reported no conflict of interest., (Copyright © 2024 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.)

Aim: This study aimed to detail our experience of using SCOUT® radar reflector for lesion localisation in the breast and axilla., Materials and Methods: This is a prospective cohort study describing our clinical experience with the first 500 patients who received SCOUT® to localise lesions in the breast and axilla (from 23 July 2020 to 4 April 2022). Study measures include patient demographics, lesion location, diagnostic pathways (screening or symptomatic), imaging, and surgical and pathology outcomes., Results: Of the 500 patients, most patients (n = 424; 84.8%) had a single device inserted. A total of 361 had SCOUT® inserted under ultrasound guidance, 128 under stereotactic guidance, and 11 under dual mammographic and ultrasonographic guidance. We successfully inserted SCOUT® in 33 patients for lymph node identification for potential targeted axillary dissection. The mean time between SCOUT® insertion and the planned surgical procedure was 40.6 days., Conclusion: Our results suggest that SCOUT® is a promising preoperative localisation device for nonpalpable breast and axillary lesions. Its implementation has the potential to optimise the clinical workflow by eliminating the need for a separate localisation procedure using conventional localisation markers and streamlining the treatment pathway., Competing Interests: Conflict of interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Distal nerve block approaches have been explored to reduce hemidiaphragmatic paresis (HDP) more effectively than interscalene block (ISB). However, these approaches are associated with a high incidence of HDP. The costoclavicular block (CCB) provides effective analgesia while reducing HDP. Here, we hypothesized that CCB would decrease the incidence of HDP compared to ISB while still providing effective pain relief after surgery., Methods: Seventy patients who underwent arthroscopic rotator cuff repair were randomly allocated to receive either ultrasound-guided CCB (n = 35) or ISB (n = 35). Each group received 0.2% ropivacaine (20 ml CCB, 10 ml ISB). The primary outcome was the incidence of HDP, as measured using M-mode ultrasound. Diaphragmatic excursion, pulmonary function test results, opioid consumption, and pain scores were evaluated., Results: Sixty-six patients were included. CCB group had a significantly lower incidence of HDP than those in the ISB group (5.9% vs. 84.4%, P < 0.001). The diaphragmatic excursion reduction was significantly more in the ISB (3.87 cm) group than in the CCB (0.25 cm) group (P < 0.001). The decrease in forced vital capacity and forced expiratory volume in 1 s from baseline was significantly greater in the ISB. There was no significant difference in opioid consumption between the two groups during the entire postoperative period., Conclusions: Compared with ISB, CCB significantly reduced the incidence of HDP while maintaining effective analgesia and causing less pulmonary function impairment. CCB may be a viable option for diaphragmatic-sparing analgesia after shoulder surgery.

Vascular access is a commonly performed procedure to facilitate patient care. This document provides expert consensus from diverse specialists on best practices and techniques for incorporating ultrasound (US) into vascular access procedures. This update replaces the 2011 American Society of Echocardiography guidelines for US-guided vascular cannulation. It includes recommendations for US-guided access to central and peripheral veins and arteries in adult and pediatric patients based on the strength of the scientific evidence present in the literature. The major roles of US during vascular access include (1) precannulation vessel assessment, (2) dynamic US guidance during cannulation, and (3) identification of local complications. This document discusses the general aspects of anatomic and US imaging of vessels, US-guided vascular cannulation techniques, and the identification of local vascular cannulation complications. Proper training should impart the cognitive knowledge and technical skills necessary to perform US-guided cannulation. There is an increasing body of literature indicating that US-guided vascular access improves success rates and reduces complications, although the quality of the evidence to date remains weak. A gap remains between the existing evidence and guidelines for the use of US in clinical practice. The availability of US equipment and clinical proficiency will more likely influence the role of US-guided vascular access as a standard of care than will future research studies., (Copyright © 2025. Published by Elsevier Inc.)

Background: Based on a chart review of 164 patients admitted to our medical-surgical unit over 2 months and who underwent peripheral intravenous (PIV) cannula insertion, difficult intravenous access (DIVA) was found in 35% (57) of patients. Similarly, the first-attempt PIV cannula insertion failure rate was 43% (70 of 164 patients) when nurses used the traditional landmark method of visual inspection and palpation in patients with DIVA., Purpose: The purpose of this evidence-based quality improvement (QI) project was to determine if the use of ultrasound-guided peripheral intravenous (USGPIV) cannulation would impact the rate of first-attempt PIV access among acute care adult patients with DIVA in the medical-surgical unit of an urban level 1 trauma center., Methods: The timeline for this pilot project was 8 weeks (May 25, 2023, to July 20, 2023). The DIVA Clinical Predictor Tool was used to identify patients at risk for DIVA. Nurses used USGPIV cannulation on eligible patients. Data on first-attempt PIV access were collected from the electronic health record., Results: A total of 46 patients (14 in the comparison group and 32 in the implementation group) participated in the project. Results showed a statistically significant improvement in first-attempt success rates from 64.3% (9 out of 14 participants) in the comparison group to 87.5% (28 out of 32 participants) in the implementation group; χ2 (1 df) = 3.34, P = 0.048. This represents a 23.2% improvement in the first-attempt success rate., Conclusion: Based on these results, USGPIV cannulation improves the likelihood of first-attempt insertion success in patients with DIVA., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Surgical navigation aids surgeons in localizing and adequately resecting pelvic malignancies. Accuracy of the navigation system highly depends on the preceding registration procedure, which is generally performed using intraoperative fluoroscopy or CT. However, these ionizing methods are time-consuming and peroperative updates of the registration are cumbersome. In this present clinical study, several real-time intraoperative ultrasound (iUS) registration methods have been developed and evaluated for accuracy., Methods: During laparotomy in prospectively included patients, sterile electromagnetically tracked iUS acquisitions of the pelvic vessels and bones were collected. An initial registration and five other rigid iUS registration methods were developed including real-time deep learning bone and artery segmentation of 2D ultrasound. For each registration method, the accuracy was computed as the target registration error (TRE) using pelvic lymph nodes (LNs) as targets., Results: Thirty patients were included. The mean ± SD ultrasound acquisition time was 4.2 ± 1.4 min for the pelvic bone and 4.0 ± 1.1 min for the arteries. Deep learning bone and artery ultrasound segmentation resulted in an average (centerline)Dice of 0.85 and a mean surface distance below 2 mm. In 21 patients with visible LNs, initial registration resulted in a median (interquartile range [IQR]) TRE of 7.4 (5.9-10.9) mm. For the other five methods, 2D and 3D bone registration resulted in significantly lower TREs than 2D artery, 3D artery and bifurcation registration (two-sided Wilcoxon rank-sum test p < 0.01). The real-time 2D bone registration method was most accurate with a median (IQR) TRE of 2.6 (1.3-5.7) mm., Conclusion: Real-time 2D iUS bone registration is a fast and accurate method for patient registration prior to surgical navigation and has advantages over current registration techniques. Because of the user dependency of iUS, intuitive software is crucial for optimal clinical implementation. Trial registration number ClinicalTrials.gov (No. NCT05637346)., Competing Interests: Declarations. Conflict of interest: T.J.M. Ruers is involved as Chief Medical Officer of a company in surgical navigation, Bcon-medical. The other authors have no relevant financial or nonfinancial interests to disclose. Ethical approval: This study was conducted in accordance with the Declaration of Helsinki and approved by the institutional medical ethics committee (NL78660.031.21). Consent to participate: Written informed consent was obtained from all individual patients included in the study., (© 2024. CARS.)

Purpose: This study aimed to investigate the effectiveness and safety of modified thread carpal tunnel release (mTCTR) using Smartwire-01 in patients with carpal tunnel syndrome (CTS)., Materials and Methods: Patients with CTS who required CTR were enrolled. Symptom severity and functional status were assessed using the Boston Carpal Tunnel Syndrome Questionnaire-Symptom Severity Scale (BCTQ-SSS) and Functional Status Scale (BCTQ-FSS), and pain was assessed using a numerical rating scale (NRS) at 4, 8, and 12 weeks after mTCTR. The scores were compared with the pre-procedural scores. The electrophysiologic study and median nerve cross-sectional area (CSA) measurements at the wrist before and 12 weeks after mTCTR were compared., Results: A total of 11 patients were included. No adverse effects were reported throughout the study period. The NRS, BCTQ-SSS, and BCTQ-FSS scores significantly improved at 4 weeks after mTCTR, and this improvement persisted throughout the follow-up period (NRS and BCTQ-SSS, P < 0.001; BCTQ-FSS, P = 0.012). After 12 weeks, the latency and velocity of the median sensory nerve action potential significantly improved, compared with those before mTCTR (latency, 5.4 ± 1.3 to 4.7 ± 1.1 ms, P = 0.01; velocity 27.8 ± 6.8 to 31.8 ± 7.4 m/s, P = 0.019). No significant change was observed in the median nerve CSA before and after mTCTR., Conclusion: mTCTR using Smartwire-01 is a safe and effective procedure and a possible alternative to surgery., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Objective: To compare the diagnostic performance of CEUS-guided biopsy (CEUS-GB) and ultrasound-guided biopsy (US-GB) in evaluating abdominal and pelvic (abdominopelvic) neoplasms in paediatric patients., Methods: Patients aged < 18 years with abdominopelvic tumours who underwent either CEUS-GB or US-GB between April 2005 and May 2022 were retrospectively evaluated. Tumours diagnosed as malignancies by pathology were considered true-positive findings. Benign lesions were identified by pathology or clinical follow-up of at least 6 months. The diagnostic performance of the two groups was compared using propensity score matching (PSM). Complications were also analysed., Results: The present study included 764 paediatric patients (437 boys; median age, 24 months; interquartile range, 10-60 months); 151 were in the CEUS-GB group, and 613 were in the US-GB group. The sample adequacy rate was 100% (151 of 151) for the CEUS-GB group, which was greater than the 97.4% (597 of 613) for the US-GB group (p < 0.001). The overall diagnostic accuracy of the CEUS-GB group and US-GB group was 98.7% (149 of 151) versus 97.3% (581 of 597) in the total cohort (p = 0.551) and 98.7% (149 of 151) versus 92.7% (140 of 151) in the PSM cohort (p = 0.020). Two patients (0.3%) in the US-GB group experienced complications (Common Terminology Criteria for Adverse Events (CTCAE), grade 1-2) correlated with the biopsy. No adverse reactions occurred in the CEUS-GB group., Conclusion: CEUS-GB of abdominopelvic tumours in paediatric patients is an effective and safe procedure with greater diagnostic accuracy than US-GB, especially for tumours with necrotic areas., Clinical Relevance Statement: Contrast-enhanced US-guided biopsy of solid abdominal and pelvic tumours in paediatric patients is an effective and safe procedure with greater diagnostic accuracy than US-guided biopsy, especially for tumours with necrotic areas., Key Points: Contrast-enhanced ultrasound (CEUS) may be superior to conventional ultrasound at guiding biopsy of abdominopelvic masses in paediatric patients. CEUS-guided core needle biopsy of abdominopelvic masses in children was safe and resulted in a diagnostic yield of 98.7%. CEUS guidance should be considered in this population when colour Doppler US is unable to determine a biopsy site., Competing Interests: Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is L.Z. Conflict of interest: The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. Statistics and biometry: No complex statistical methods were necessary for this paper. Informed consent: Written informed consent was waived by the Institutional Review Board. Ethical approval: Institutional Review Board approval was obtained. Study subjects or cohorts overlap: Not applicable. Methodology: Retrospective Diagnostic or prognostic study Performed at one institution, (© 2024. The Author(s), under exclusive licence to European Society of Radiology.)

Purpose: Ultrasound-guided nerve hydrodissection has emerged as a potential non-surgical treatment for carpal tunnel syndrome (CTS). The objective of this research was to offer suggestions for optimizing injectables utilized in hydrodissection for the treatment of CTS through a systematic review and network meta-analysis., Materials and Methods: PubMed, MEDLINE, EMBASE, Cochrane, Scopus, and Web of Science were searched through April 25, 2024. Effect sizes were quantified using standard mean differences within a random-effects model. Effectiveness ranking for each treatment was expressed as the surface under the cumulative ranking curve (SUCRA)., Results: Nine studies with 458 patients with CTS were included. According to SUCRA, 5% dextrose (DW) was the most effective option for the Boston Carpal Tunnel Questionnaire (BCTQ) function at 99.9, 89.8, and 88.8 at 4, 12, and 24 weeks, respectively; for BCTQ symptoms, 5% DW was the most effective option at 99.9 at 4 weeks and platelet-rich plasma at 95.7 and 93.9 at 12 and 24 weeks, respectively. In terms of both BCTQ symptoms and BCTQ function, the 5 cc injection was the most effective, with SUCRA values of 99.5 for both categories. However, the effectiveness of the electrodiagnostic assessment and ultrasound variables was dependent on the type and dose of medication., Conclusion: Administration of 5% DW showed better results in terms of initial symptom relief and long-term functional recovery compared to other agents, while platelet-rich plasma showed greater long-term symptom improvement; an injection dose of 5 cc showed the greatest benefit. However, additional research is required to establish precise protocols based on disease severity., Competing Interests: The authors have no potential conflicts of interest to disclose., (© Copyright: Yonsei University College of Medicine 2025.)

Purpose: To evaluate the efficacy of ultrasound-guided ruthenium (Ru 106) plaque brachytherapy for treatment of exudative retinal detachment in diffuse choroidal haemangioma (DCH)., Methods: Retrospective analysis of four paediatric patients treated with ultrasound-guided Ru 106 plaque brachytherapy for DCH with total exudative retinal detachment directed to the thickest part of the DCH. A dose of 40 Gy to the tumour apex was delivered in all patients. The outcomes of treatment were regression of DCH, resolution of retinal detachment, development of neovascular glaucoma or any other radiation-associated complications which were assessed clinically and with B scan ultrasonography., Results: There were 4 eyes included in the study, with a mean (median, range) age of 8.75 (8.4, 3-15) years. The pre-operative tumour thickness was 5.0 (5.12, 4.2-5.5) mm. The visual acuity ranged from 0.8-2.8 LogMAR and 3 of 4 eyes had only light perception at presentation. One eye had been treated with goniotomy for pre-existing secondary glaucoma and was on topical antihypertensive medications. At a mean follow-up of 14.6 months (10.5 months, 6-30 months), all patients showed regression of the tumour. The mean tumour thickness reduced to 2.05 mm (2.44 mm, 1.1-2.6 mm) post-operatively. All patients (4/4) had complete resolution of the retinal detachment. The visual acuity remained stable in all the patients with none of the patients developing neovascular glaucoma or any other radiation-related complications., Conclusion: Ultrasound-guided Ru 106 plaque brachytherapy is an effective treatment strategy as a primary treatment in the absence of external beam radiotherapy, to achieve tumour regression and resolution of retinal detachment in DCH., Competing Interests: Competing interests: None of the other authors have any financial disclosures or conflicts of interest to declare. This manuscript has not previously been submitted for publication. The research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. This paper presents a novel method of imaging with brachytherapy, in an area of ophthalmology that is both rare and important. The material here is original research, not previously published., (© 2025. The Author(s).)

Purpose: To evaluate the diagnostic yield of contrast-enhanced ultrasound (CEUS)-guided biopsy of retroperitoneal masses (RMs)., Materials and Methods: Between 2006 and 2023, 87 patients presented at our US center for biopsy of an RM. In all biopsies, CEUS was performed prior to the intervention. The technical success rate of biopsy, the presence of diagnostic tissue in solid tumor biopsy samples, the accuracy of the biopsy and the occurrence of post-interventional complications were evaluated., Results: A US-guided biopsy could be conducted in 84/87 cases (96.6%). In 3/87 cases (3.4%), US-guided biopsy was impossible because the planned needle path was obstructed by vital structures. Of 84 lesions, 80 (95.2%) were solid lesions, and 4 (4.8%) were lesions containing fluid. In all solid tumors, 80/80 (100%), diagnostic vital tissue was successfully obtained. CEUS-guided biopsy showed a sensitivity of 93.2%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 72.2%, and a diagnostic accuracy of 94.2% for the differentiation between malignant and benign RMs. In one of the 84 cases (1.2%), there was a complication of postinterventional abdominal pain., Conclusion: Percutaneous CEUS-guided biopsy is a safe procedure with a high diagnostic yield and a low complication rate., Competing Interests: C. Görg received funding from Bracco Imaging. Bracco Imaging supported CEUS workshops at the University Hospital Marburg., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Purpose: To describe portal vein cannulation under adjunct guidance for transjugular intrahepatic portosystemic shunts (TIPS)., Methods: Medical records of 86 patients who underwent TIPS, including conventional TIPS, 3D volumetric CT image fusion (CT-fluoroscopy image fusion)-guided TIPS, and trans-abdominal ultrasound (US)-guided TIPS at our institute from March 2016 to June 2024 were reviewed. Baseline characteristics, clinical outcomes, and procedural data were analyzed., Results: Technical success was achieved in 35 conventional TIPS patients (92.11 %), 20 CT-fluoroscopy image fusion-guided TIPS patients (95.24 %), and 26 transabdominal US-guided TIPS patients (96.30 %). Among patients who underwent a successful procedure, the procedural time and contrast usage were lower in the CT-fluoroscopy image fusion-guided and trans-abdominal US-guided TIPS groups than in the conventional group. There was a statistical significance in the cumulative fluoroscopic time between CT-fluoroscopy image fusion-guided TIPS and conventional TIPS groups (43.19 ± 14.92 vs 63.05 ± 30.33 min, p = 0.012). No immediate experienced complications were observed. Furthermore, the incidence of post-procedural complications among the three groups was not statistically different during follow-up., Conclusions: CT-fluoroscopy image fusion and trans-abdominal US-guided portal vein cannulation are feasible, safe, and effective adjunct methods for patients undergoing TIPS. These methods provide shorter procedural time and lower contrast usage for TIPS placement., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: We investigated the intraneural spread of injected fluid in brachial plexus nerve roots, examining the potential for intrafascicular spread and identifying influencing factors., Methods: Twelve deliberate ultrasound-guided intraneural injections were performed at the ventral rami of the brachial plexus nerve roots at their exits from the neuroforamina in six fresh, unembalmed, cryopreserved human cadavers. A 22-G, 30-degree bevel echogenic regional anaesthesia needle was used. Each injection contained 1 ml of heparinised erythrocytes as a marker. Nerve swelling observed on ultrasound images confirmed intraneural injection., Results: Intraneural spread was observed in 12 ventral rami of the six brachial plexi: C5 (1), C6 (3), C7 (5), C8 (2), and T1 (1). Among these, intrafascicular spread was detected in eight cases, six in monofascicular roots and two in bifascicular roots, though none in roots with three or more fascicles. The fascicle diameters in these cases (2.1-3.8 mm) were at least twice the diameter of the needle orifice, measured at 0.9 mm, which was entirely inside the fascicles. In the four cases with intraneural but without intrafascicular spread, the fascicle diameters were about two times the diameter of the needle orifice in three instances, but the entire needle orifice was not always inside a fascicle., Conclusions: In contrast with multifascicular peripheral nerves, intrafascicular spread was possible after deliberate intraneural injections near the neuroforaminal canal exit of the brachial plexus nerve roots in several monofascicular or bifascicular ventral rami if the fascicle diameter was more than twice the needle opening length and the entire opening was inside the fascicle., Competing Interests: Declaration of interest The authors declare no conflicts of interest., (Copyright © 2024 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)

Background: The radial artery is commonly selected for arterial puncture and cannulation, but radial nerve palsy may occur. To minimize possible damage to the nerve, needle puncture should be made within the margin of safety (between the wrist to the distal end of the radial artery and the radial nerve running in parallel). In adults, the margin of safety for radial artery puncture is approximately 6.8 cm from the wrist in men and approximately 5.4 cm in women, but the margin of safety is not known in children of different age groups., Methods: Using an ultrasound device, we measured the margin of safety in 100 anesthetized patients aged 0 months to 15 yr. Polynomial quadratic regression models were made, and the lower limit of the prediction interval was regarded as the margin of safety. These results were then compared with the results obtained in adults., Results: The margin of safety became wider as a child grows older, and the height, weight, and age were all suitable explanatory variables to predict the margin of safety, providing fairly a constant predicted margin of safety from a few millimeters in neonates to approximately 4 cm in adolescents (much narrower than in adults)., Conclusions: In children and adolescents, the margin of safety for radial artery puncture is much narrower than in adults, and these findings support the recommendation to use ultrasound guidance during radial artery puncture in children and adolescents, to minimize the risk of associated complications., Clinical Trial Registration: jRCT1032230243., Competing Interests: Declarations. Conflict of interest: TA is an Associate Editor-in-Chief of the Journal of Anesthesia. The other authors have no conflicts to declare., (© 2024. The Author(s) under exclusive licence to Japanese Society of Anesthesiologists.)

Abstract: Distal forearm fractures are frequently encountered in the pediatric emergency department and often require reduction. Procedural sedation is commonly used to facilitate reduction of these injuries, although it can be associated with potentially severe complications, particularly in patients with cardiorespiratory comorbidities. The ultrasound-guided hematoma block has been gaining popularity as an analgesic alternative in adult patients, but literature supporting its use in pediatric patients is limited. We describe a point-of-care ultrasound-guided hematoma block used to facilitate successful reduction of a distal radius fracture in an adolescent patient with a history of a difficult airway for whom procedural sedation would have posed considerable risk., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: This study compares ultrasound-guided pulsed radiofrequency (UG-PRF) with ultrasound-guided dry needling (UG-DN) for treating painful shoulder periarthritis (PSP)., Materials and Methods: Twenty-four patients with PSP were chosen from the Pain Department of the Sixth People's Hospital of Nantong between August 2022 and December 2023. They were divided into 2 groups, UG-PRF (n = 12) and UG-DN (n = 12), using a random number table. Both groups received 1 treatment session and stretching exercises afterwards. The study aims to analyze and compare the levels of pain severity (measured by Visual Analog Scale) and shoulder joint function (assessed using Shoulder Pain And Disability Index) among patients before treatment, at the 4-week mark posttreatment, and at the 12-week mark posttreatment., Results: There was no significant difference between the 2 groups initially. After treatment, the UG-PRF group had a larger decrease in Visual Analog Scale score compared with the UG-DN group at 4 weeks (-1.3 ± 0.4; 95% CI: -2.2 ∼ -0.5) and 12 weeks posttreatment (-1.1 ± 0.5; 95% CI: -2.1 ∼ -0.0). Moreover, the UG-PRF group displayed markedly lower scores on the Shoulder Pain And Disability Index in comparison to the UG-DN group at both the 4-week (-17.3 ± 6.9; 95% CI: -31.7 ∼ -2.9) and 12-week (-17.0 ± 7.4; 95% CI: -32.3 ∼ -1.7) follow-up assessments. Furthermore, 87.5% of patients reported clinically significant improvements according to the Patient Global Impression of Change evaluation., Conclusion: Both UG-PRF and UG-DN therapy are effective treatments for PSP, with UG-PRF showing better results in reducing pain and improving shoulder mobility., Competing Interests: This work was supported by the Nantong Science and Technology Bureau, China (Grant Number MS22022022) and the Nantong Municipal Health Commission (Grant Number JCZ21024). The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Clavicle fractures are commonly encountered in the emergency department and require effective analgesia to facilitate appropriate management and disposition., Case Report: We present the case of a 52-year-old man who presented with an acute, mildly displaced midshaft fracture of his right clavicle. After minimal improvement in pain from oral and topical analgesics, he underwent an ultrasound-guided clavipectoral plane block which completely relieved his pain. He did not require additional analgesics for 36 hours after the block. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The ultrasound-guided CPB may be a safe and effective analgesic strategy for uncomplicated clavicle fractures in the ED., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background and Objectives: Neuronavigation is a fundamental tool in the resection of intracranial tumors. However, it is limited by its calibration to preoperative neuroimaging, which loses accuracy intraoperatively after brain shift. Therefore, surgeons rely on anatomic landmarks or tools like intraoperative MRI to assess the extent of tumor resection (EOR) and update neuronavigation. Recent studies demonstrate that intraoperative ultrasound (iUS) provides point-of-care imaging without the cost or resource utilization of an intraoperative MRI, and advances in neuronavigation-guided iUS provide an opportunity for real-time imaging overlaid with neuronavigation to account for brain shift. We assessed the feasibility, efficacy, and benefits of navigated iUS to assess the EOR and restore stereotactic accuracy in neuronavigation after brain shift., Methods: This prospective single-center study included patients presenting with intracranial tumors (gliomas, metastasis) to an academic medical center. Navigated iUS images were acquired preresection, midresection, and postresection. The EOR was determined by the surgeon intraoperatively and compared with the postoperative MRI report by an independent neuroradiologist. Outcome measures included time to perform the iUS sweep, time to process ultrasound images, and EOR predicted by the surgeon intraoperatively compared with the postoperative MRI., Results: This study included 40 patients consisting of gliomas (n = 18 high-grade gliomas, n = 4 low-grade gliomas, n = 4 recurrent) and metastasis (n = 18). Navigated ultrasound sweeps were performed in all patients (n = 83) with a median time to perform of 5.5 seconds and a median image processing time of 29.9 seconds. There was 95% concordance between the surgeon's and neuroradiologist's determination of EOR using navigated iUS and postoperative MRI, respectively. The sensitivity was 100%, and the specificity was 94%., Conclusion: Navigated iUS was successfully used for EOR determination in glioma and metastasis resection. Incorporating navigated iUS into the surgical workflow is safe and efficient and provides a real-time assessment of EOR while accounting for brain shift in intracranial tumor surgeries., (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)

Background: Recent studies indicate that clavipectoral fascia plane block (CPB) efficacy may stem from injectate distribution to the anterosuperior clavicular periosteum. We conducted an anatomical study combining the CPB with injection within the subclavius muscle., Objective: Our hypothesis was that the anaesthetic injectate would fully cover both the anterosuperior and posteroinferior surfaces of the clavicular periosteum in the midclavicular region., Design: Observational human cadaver study., Setting: Laboratory of Surgical Neuroanatomy, Unit of Anatomy and Human Embryology of the Faculty of Medicine and Health Sciences, University of Barcelona., Participants: Five fresh human cadavers., Interventions: The cadavers received both a CPB and subclavius muscle injections under ultrasound guidance in 10 clavicular regions., Main Outcome Measures: After the procedures on the cadaveric models, an anatomical dissection by planes was performed to evaluate the distribution pattern of methylene blue on the clavicular periosteum. A probabilistic map of the colour spectrum and staining temperature on the clavicular surfaces was generated., Results: Methylene blue stained 37 ± 16% of the anterosuperior surface and 23 ± 13% of the posteroinferior surface of the clavicular periosteum, particularly in the middle third of each surface. Although the staining did not achieve complete circumferential coverage or perfect alignment between the surfaces, the areas exhibited a close relationship, indicating significant distribution and relevant coverage., Conclusion: Our anatomical study demonstrates that the midclavicular block achieves effective distribution around the middle third of the clavicle, although complete circumferential anaesthesia of the clavicular periosteum was not achieved. Although this block may provide periosteal and bone anaesthesia, it does not address other sources of pain, such as muscle spasms and skin components. Additional clinical studies are needed to evaluate the overall efficacy of this dual block technique for clavicle surgery., (Copyright © 2024 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.)

Background: Ultrasound (US) is a promising alternative to fluoroscopy (FL) for guiding percutaneous leverage reduction of displaced radial neck fractures in children. However, few studies have compared these modalities. This study aims to compare both the accuracy and efficacy of FL-guided versus US-guided percutaneous pinning in the treatment of radial neck fracture., Methods: Seventy-three children with displaced radial neck fractures were consecutively enrolled and assigned to the US or FL group. In all the patients, fractures were reduced with the percutaneous pin leverage technique. The patients were divided into two groups: the FL-guided group and the US-guided group. Baseline information, radiographs, and clinical results according to the criteria suggested by Metaizeau and complications were analyzed. Final Metaizeau criteria were categorized into excellent, good, fair, and poor., Results: The success rates for closed reduction were 100% for the US group and 91.2% for the FL group. The US group exhibited a significantly shorter operation time compared to the FL group (24.77 ± 8.00 min vs. 42.21 ± 15.18 min; P < 0.01). Additionally, the US group had a significantly lower number of FL images and radiation dose (3.59 ± 1.57 times, 9.56 ± 6.08 mGy) than the FL group (22.26 ± 8.07 times, 69.68 ± 34.70 mGy; P < 0.001). Reduction quality did not significantly differ between the groups according to the Metaizeau reduction classification (P = 0.130). According to the Metaizeau classification criteria, there was no significant difference between the two groups, including post-operative complications., Conclusion: Ultrasound-guided techniques offer a viable alternative for the treatment of displaced radial neck fractures in paediatric patients by minimising radiation exposure, expediting operative time and facilitating reduction., Level of Evidence: Therapeutic Level III., Competing Interests: Declarations. Ethics approval and consent to participate: In accordance with the Declaration of Helsinki, the Institutional Review Board (IRB) of the Wuhan children’s hosipital (No.2024R134-E01) gave a final approval for this study. and waived the requirement for informed consent due to the retrospective nature of the study. It was also registered with the National Medical Research Registration and Filing Information System of China(No.MR-42-24-050034). Consent for publication: All guardians of patients signed written informed consent for publication. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Objective: Ultrasound-guided thermal ablation, including radiofrequency ablation (RFA) and microwave ablation (MWA), has become one of the main options for treating benign thyroid nodules (BTNs). To assess the efficacy of thermal ablation of BTNs, we performed a systematic review and meta-analysis of relevant studies., Materials and Methods: A comprehensive search of MEDLINE, EMBASE, and COCHRANE databases was performed up to September 25, 2023, to identify studies directly comparing RFA and MWA for pathologically proven BTNs and reporting clinical outcomes and complications. Data extraction and quality assessment were independently performed by two radiologists according to PRISMA guidelines. The analysis yielded the serial volume reduction ratios (VRRs) of ablated nodules for up to 12 months, symptom and cosmetic scores, and complications., Results: This analysis included nine studies with 1305 BTNs treated by RFA and 1276 by MWA. VRRs at 1 month, 3 months, and 6 months were similar between RFA and MWA, but RFA showed a significantly higher VRR (83.3%) than MWA (76.9%) at 12 months (p = 0.02). Complication rates showed no significant difference between the two methods. Symptom and cosmetic scores significantly decreased after ablation, without a significant difference between the methods. Subgroup analysis indicated a significantly higher VRR at 12 months for RFA than for MWA for less experienced investigators (≤ 10 years), but no significant difference for more experienced investigators (> 10 years)., Conclusion: RFA and MWA are both effective and safe methods for treating BTNs. RFA showed a higher VRR at 12 months and seems more suitable for less experienced investigators., Clinical Relevance Statement: RFA and MWA are both effective and safe treatments for BTNs, with RFA showing a higher VRR at 12 months. Both methods offer minimally invasive and reliable treatment for thyroid nodules., Key Points: The most effective thermal ablation technique for BTNs remains undetermined. RFA showed a higher VRR at 12 months than MWA. Both techniques are effective for treating thyroid nodules; RFA offers greater benefits, particularly for less experienced investigators., Competing Interests: Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is Jung Hwan Baek. Conflict of interest: The authors of this manuscript declare no direct relationships with any companies whose products or services may be related to the subject matter of the article. However, Dr. Jung Hwan Baek is a consultant of two radiofrequency companies, STARmed and RF Medical since 2017. Statistics and biometry: One of the authors (Se Jin Cho) has significant statistical expertise. Informed consent: Written informed consent was not required for this study because this article is a systematic review and meta-analysis. Ethical approval: Institutional Review Board approval was not required because this article is a Systematic Review and Meta-analysis. Study subjects or cohorts overlap: This item is not relevant to this systematic review and meta-analysis. Methodology: Systematic review and meta-analysis, (© 2024. The Author(s), under exclusive licence to European Society of Radiology.)

Currently, abdominal aortic aneurysms (AAAs) are treated based on the diameter of the aorta, however, a more robust patient-specific marker is needed. The mean thickness of the wall is a potential indicator for AAA rupture risk, which varies significantly within and between patients. So far, regional thickness has not been used in previous rupture risk analysis studies, since it is challenging to measure in CT, MRI, and non-invasive ultrasound (US). This study shows how to map locally varying wall thickness of AAAs using intravascular ultrasound (IVUS). Since no ground truth of AAA wall thickness can be obtained in vivo, a novel ex vivo dataset was created of porcine, phantom and simulated aortas, of which ground truth data are available. A U-net model was trained on the ex vivo data and results show that the predicted wall segmentation is in good agreement with the ground truth (DSC = 0.86, HD = 0.97 mm). Wall thickness and geometry plots show that the variation in wall thickness can be recognized. The in vivo demonstration in patients shows that the diseased wall can be segmented, a regionally varying wall thickness can be measured, and detailed maps of AAA geometries can be created. The measured local wall thickness could be used for better general understanding of AAA wall properties resulting in more advanced rupture risk assessment of AAAs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective:  This study aimed to implement a point-of-care ultrasound (POCUS) program into a large neonatal intensive care unit (NICU) to enhance care by improving (1) umbilical venous catheter (UVC) tip identification and (2) central placement., Study Design:  A POCUS program was established with core providers who received training from external and internal experts. A prospective study ( n  = 94) compared the accuracy of UVC identification between neonatology-performed ultrasound (NeoUS) and X-ray relative to a referent of radiology-interpreted ultrasound. Finally, an ultrasound-guided UVC insertion protocol was introduced to rescue noncentral traditionally placed catheters ( n  = 37)., Results:  Program implementation trained six providers for a total cost of approximately $10,500 USD. NeoUS was more accurate than X-ray at identifying UVC location (81.9 vs. 60.6%) with improved sensitivity and specificity (80.0 and 84.6 vs. 52.5 and 66.7%, respectively). POCUS guidance was able to rescue 89.2% of catheters that were originally noncentral., Conclusion:  POCUS implementation in a large NICU is feasible, affordable, and can improve quality of care., Key Points: · POCUS implementation is feasible and affordable.. · POCUS is more accurate than X-ray at monitoring UVCs.. · Central UVC placement can be increased with POCUS.., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: Peripheral and truncal nerve blocks provide effective analgesia facilitating perioperative care. However, thresholds for clinically relevant effects remain undetermined and are left for clinicians to choose. These choices are fundamental for sample size calculations and interpretation of study results. This systematic scoping review aimed to create an overview of primary outcomes and anticipated effect sizes in randomised clinical trials assessing peripheral and truncal nerve blocks., Methods: We searched Cochrane Library's CENTRAL, Medline, and Embase for randomised trials in English in 10 major anaesthesia journals investigating single-injection ultrasound-guided peripheral and truncal nerve blocks for adults undergoing surgery. The primary outcome was the anticipated effect sizes for primary outcomes. Secondary outcomes included reporting of sample size calculations and statistically significant primary outcomes below anticipated effect sizes., Results: The most frequently reported primary outcomes were postoperative pain, analgesic consumption, quality of recovery, mobilisation, and block performance. Median anticipated effect sizes were: 0-24 h opioid consumption: 9 mg i.v. morphine equivalents; pain at rest and during movement: 2 points on Numeric Rating Scale 0-10; quality of recovery: 10 points on Quality of Recovery-40 scale and 8 points on Quality of Recovery-15 scale. Adequate sample size calculations were reported in 85% (156/183) and 91% (29/32) of trials assessing continuous outcomes and dichotomous outcomes, respectively. Statistically significant primary outcomes failed to reach anticipated effect sizes in 24% (24/99) of trials, and only one trial addressed this disparity in the trial conclusion., Conclusions: The presented outcomes and effect sizes from published trials on peripheral and truncal nerve block literature can be used in future trials to increase homogeneity in regional anaesthesia research., Competing Interests: Declaration of interest None of the authors has a conflict of interest., (Copyright © 2024 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)

The use of botulinum toxin in the therapy of esophageal motility disorders is reserved for elderly and comorbid patients considered risky for endoscopic or surgical treatment. However, there is a lack of data on the treatment of motility disorders outside the Chicago classification.We present the case of a 56-year-old patient with dysphagia and non-cardial chest pain (Eckardt 8). High resolution manometry ruled out achalasia or other motility disorder, but confirmed a localized 7-cm-long spastic segment in the upper to middle third of esophagus. We considered endoscopic or surgical therapy in this location too risky, therefore we decided to apply botulinum toxin into this segment. The spasm on high resolution manometry correlated with the thickened muscularis propria layer according to the endoscopic ultrasound. We used endoscopic ultrasound for the navigation of botulinum toxin application into the muscularis propria layer. We applied 100 IU of botulinum toxin into four quadrants, 20 and 24 cm from front teeth (12.5 IU for 1 application).The therapy led to improvement of symptoms (Eckardt 3) and to restitution of propulsive peristalsis with complete elimination of spastic segment. The worsening of symptoms appeared after 2 years, with subsequent recurrence of motility disorder fulfilling criteria of type II achalasia.Presenting this case, we wanted to point at the unique use of botulinum toxin as useful treatment in selected cases of unclassified esophageal motility disorder as a bridge therapy. Moreover, endoscopic ultrasound could be used to guide precise application of botulinum toxin., Competing Interests: Declarations. Conflict of interest: The authors have no conflicts of interest to declare. Human and animal rights: Me, Diana Vážanová, confirm that all procedures used in my case report were in accordance with the ethical standards of the responsible committee on human experimentation (Institutional and National) and with the Helsinki Declaration of 1964 and later versions. Informed consent: Informed consent was obtained from patient who was included in our case report., (© 2024. The Author(s).)

Objectives: Joint-preserving interventions, such as intra-articular viscosupplementation injections, are evolving and requiring efficacy and safety evaluations through an evidence-based approach. The objective of this study was to assess the use of a hyaluronic acid and corticosteroid-based injection (Cingal™; Anika Therapeutics, Bedford, MA, USA) in improving pain and functional outcomes for patients aged between 40 and 65 with mild to moderate hip osteoarthritis (OA) six months post-injection., Methods: This prospective observational study included 100 patients receiving a single ultrasound-guided intra-articular injection of Cingal™. Eligible patients seen in participating orthopaedic, physiatry and sports medicine clinics were evaluated at baseline, one-month, and six-month follow-up. The primary outcome was patient-reported hip pain (Visual Analogue Scale, VAS) at six months post-injection. Secondary outcomes included hip function (Hip Disability and Osteoarthritis Outcome Score, HOOS), quality of life (Short-Form 12, SF-12), pain medication use, range of motion (ROM), physical activity (activity tracker), and adverse events., Results: Ninety-six patients received the injection; 91 had complete data for primary outcome analysis. Statistically significant improvements were observed in VAS (p ​< ​0.001), HOOS (p ​< ​0.001), and SF-12 scores (Physical Component Summary, p ​= ​0.005; Mental Component Summary, p ​= ​0.022) from baseline to six months post-injection. Pain medication use decreased from 50.0% to 34.0% (p ​= ​0.035). No statistically significant change was observed in ROM or activity level. Adverse events were reported in 9.5% of patients: five (5.3%) experienced hip pain for less than seven days, one for more than seven days but less than one month, and three (3.2%) underwent hip arthroplasty., Conclusion: Patients receiving an ultrasound-guided Cingal™ injection for hip OA reported statistically significantly reduced hip pain, improved function and quality of life, and reduced pain medication use at six months. The most common adverse event was transient hip pain., Level of Evidence: Prospective observational study, Level III., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships that may be considered as potential competing interests: Dr Olufemi R. Ayeni reports financial support was provided by Anika Therapeutics Inc. Olufemi R. Ayeni reports a relationship with Stryker Canada that includes: speaking and lecture fees. Alexander Rabinovich reports a relationship with Pendopharm that includes: consulting or advisory. Olufemi R. Ayeni holds a Tier 2 Canada Research Chair in Joint Preservation Surgery in Canada, and is the president/owner of Notch Academy. Olufemi R. Ayeni is the Editor-in-Chief of Journal of ISAKOS. Nicole Simunovic is the Managing Editor for Journal of ISAKOS. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Wrist osteoarthritis poses significant challenges in pain management and functional impairment. Current surgical interventions often sacrifice wrist motion and entail long recovery times. Minimally invasive denervation offers a promising alternative by targeting sensory nerves. This study investigates the efficacy of ultrasound-guided chemical ablation with phenol-glycerin for wrist denervation., Methods: Under ultrasound guidance, 1-3 mL of 1 % methylene blue:8 % phenol:8 % glycerin solution was injected on both side of the interosseous membrane of six unembalmed cadaveric wrists. The entry point of the 22-gauge needle was along the lateral border of the ulna, just proximal to the most proximal aspect of the ulnar head. Dissections of the anterior and posterior compartment of the forearm were performed to visualize the length of both posterior interosseous (PIN) and anterior interosseous (AIN) nerves that were stained., Results: Results showed a successful dispersion of methylene blue staining along the PIN (2.1 ± 0.82 cm), deep to the fourth extensor compartment of the wrist posteriorly, and along the AIN (2.5 ± 1.10 cm), between the interosseous membrane and pronator quadratus muscle anteriorly. Importantly, this diffusion spared the main motor branches of both nerves., Conclusions: Minimally invasive denervation of the wrist using ultrasound-guided chemical ablation with phenol-glycerin shows promise in targeting the sensory branches of both interosseous nerves., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier GmbH. All rights reserved.)

Purpose: Given the abundance of arteries in the neck, a significant risk of puncturing arteries exists when performing a brachial plexus block. Therefore, it is important to confirm the presence of arteries when performing a brachial plexus block via the interscalene approach. This study aimed to investigate the frequency and variations of arteries in the interscalene region in healthy Japanese adults using ultrasonography., Methods: This is an observational study at a university hospital. We analyzed videos of the brachial plexus recorded in another study using an ultrasound device and then investigated the frequency of the presence of arteries and the location of arteries in the interscalene region., Results: Among 68 cases, 48 (70.6%) had one or more arteries in the interscalene region (63 arteries in total). The artery frequency on the ventral side of the 5th cervical nerve (C5), between C5 and the 6th cervical nerve (C6), between C6 and the 7th cervical nerve (C7), between C7 and the 8th cervical nerve (C8), and on the dorsal side of C8 was 19.1%, 1.5%, 35.3%, 29.4%, and 7.4%, respectively. The artery frequencies between C6 and C7 and between C7 and C8 were higher than those between C5 and C6 and on the dorsal side of C8., Conclusion: Interscalene observations using ultrasound devices revealed a high artery frequency, with numerous topographic variations., Competing Interests: Declarations. Conflict of interest: The authors have no conflict of interest., (© 2024. The Author(s) under exclusive licence to Japanese Society of Anesthesiologists.)

Background: Acute cholecystitis is a common surgical emergency and a painful condition that often requires frequent intravenous opioid analgesia. Sometimes, pain control of patients with acute cholecystitis is challenging. In this case, we present a potential alternative to managing acute cholecystitis pain., Case Report: A 40-year-old female presented to the emergency department (ED) with right upper quadrant pain. While awaiting testing and ultrasound, she received multiple doses of opioid analgesia. A point-of-care ultrasound of the right upper quadrant was performed and demonstrated findings of acute cholecystitis. Given that her pain was challenging to manage, even with intravenous opioids, an ultrasound-guided erector spinae plane (ESP) nerve block was discussed and subsequently performed at the T7 level. Thirty minutes after the procedure, the patient reported significant relief of her pain and did not require any opioid analgesia until ten hours later on the inpatient floor. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: ESP nerve blocks can potentially offer an alternative analgesic in the management of acute cholecystitis, subsequently reducing the use of opioids in the ED. ESP nerve blocks can potentially offer patients longer-lasting analgesia. ESP nerve blocks can potentially manage visceral pain in the ED., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: This study retrospectively evaluated the feasibility and safety of implanting a newly developed central venous access port (CV-port) that allows catheter insertion into a vein without the use of a peel-away sheath, with a focus on its potential to minimize risks associated with conventional implantation methods., Materials and Methods: All procedures were performed using a new device (P-U CelSite Port™ MS; Toray Medical, Tokyo, Japan) under ultrasound guidance. The primary endpoint was the implantation success rate. The secondary endpoints were the safety and risk factors for infection in the early postprocedural period (< 30 days)., Results: We assessed 523 CV-port implantations performed in a cumulative total of 523 patients (240 men and 283 women; mean age, 61.6 ± 13.1 years; range, 18-85 years). All implantations were successfully performed using an inner guide tube and over-the-wire technique through 522 internal jugular veins and one subclavian vein. The mean procedural time was 33.2 ± 10.9 min (range 15-112 min). Air embolism, rupture/perforation of the superior vena cava, or hemothorax did not occur during catheter insertion. Eleven (2.1%) intraprocedural complications occurred, including Grade I arrhythmia (n = 8) and subcutaneous bleeding (n = 1), Grade II arrhythmia (n = 1), and Grade IIIa pneumothorax (n = 1). Furthermore, 496 patients were followed up for ≥ 30 days. Six early postprocedural complications were encountered (1.1%), including Grade IIIa infection (n = 4), catheter occlusion (n = 1), and skin necrosis due to subcutaneous leakage of trabectedin (n = 1). These six CV-ports were withdrawn, and no significant risk factors for infection in the early postprocedural period were identified., Conclusion: The implantation of this CV-port device demonstrated comparable success and complication rates to conventional devices, with the added potential benefit of eliminating complications associated with the use of a peel-away sheath., Competing Interests: Declarations. Conflict of interest: The authors declare that they have no competing interest. Ethical approval: This study design was approved by the appropriate ethics review board (approval number, KEN2405-007). Informed consent: The need to obtain informed consent was waived based on the retrospective design., (© 2024. The Author(s).)

Image guidance is becoming standard of practice for cerebrospinal fluid sampling in children to improve success rates and avoid complications. This article discusses various imaging guidance techniques available in the pediatric age group. For neonates and infants, imaging guidance using ultrasound is the technique of choice, and for older children, fluoroscopy or even cone beam computed tomography can be used when anatomy is complex., Competing Interests: Disclosure None for all the authors., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: Interventional musculoskeletal ultrasound (MSUS) procedures are routinely performed in rheumatology practice. However, the efficacy and safety of the procedures rely on the competence of the physician, and assessment of skills is crucial. Thus, this study aimed to develop and establish validity evidence for a tool assessing trainees' interventional MSUS skills., Methods: An expert panel of rheumatologists modified an existing tool for assessing competences in invasive abdominal and thoracic ultrasound procedures. The new tool (the Assessment of Interventional Musculoskeletal Ultrasound Skills [AIMUS] tool) reflects the essential steps in interventional MSUS. To establish validity evidence, physicians with different levels of interventional MSUS experience were enrolled and performed two procedures on a rubber phantom, simulating real patient cases. All performances were video-recorded, anonymized and assessed in random order by two blinded raters using the AIMUS tool., Results: 65 physicians from 21 different countries were included and categorized into groups based on their experience, resulting in 130 videos for analysis. The internal consistency of the tool was excellent, with a Cronbach's α of 0.96. The inter-case reliability was good with a Pearson's correlation coefficient (PCC) of 0.74 and the inter-rater reliability was moderate to good (PCC 0.58). The ability to discriminate between different levels of experience was highly significant (P < 0.001)., Conclusion: We have developed and established validity evidence for a new interventional MSUS assessment tool. The tool can be applied in future competency-based educational programmes, provide structured feedback to trainees in daily clinical practice and ensure end-of-training competence., Trial Registration: ClinicalTrials.gov, http://clinicaltrials.gov, NCT05303974., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Purpose: To provide ultrasound (US) education to anesthesia providers to increase usage for peripheral intravascular (IV) cannulation on difficult IV access patients., Design: This project reflects a qualitative descriptive quality improvement project with outcomes measured. Data in this project include the overall knowledge and competency scores from the provider's US survey before and after education and training were provided., Methods: A presentation was developed and provided to 38 certified registered nurse anesthetists (CRNA) via the hospital's online platform. Next, in-person simulations were conducted to facilitate the skills of US utilization. Each CRNA participating in simulations successfully performed the skill. The impact and success of the education bundle were collected via the disbursement of a Likert-scale survey via an automated data collection software., Findings: Seventeen of the 38 (45%) participants responded to the survey. Of these respondents, 88% of providers indicated that their US skills and confidence had increased following the intervention, and 100% of participants stated that the intervention was helpful in learning US-guided peripheral IV insertion., Conclusions: Education and hands-on skills sessions increased provider confidence in US use. While this project focused on educational training of CRNAs, this is applicable to all health care providers who are responsible for IV cannulation. The project team members will disseminate these findings and plan to improve perioperative nurses' confidence in US-guided peripheral IV insertions; thus, improving efficiency in the operative setting., Competing Interests: Declaration of Competing Interest None to report., (Copyright © 2024 The American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Background: To summarize the current evidence about effectiveness and accuracy of using ultrasound-guided compared to blind arthrocentesis in the treatment of knee osteoarthritis., Methods: Web of Science, the Cochrane Central Register of Controlled Trials, EMBASE, Scopus, PubMed, ClinicalTrials.gov, Wangfang Database, and SinoMed were conducted from their inception to February 2024. Eligible studies included Randomized controlled trials (RCTs) and non-RCTs that compared the ultrasound-guided and blind arthrocentesis in knee osteoarthritis, with outcomes assessed base on pain, function, accuracy, and additional factors such as satisfaction, cost-effectiveness, fluid yield, and synovial membrane thickness., Results: Twenty-one studies that met the inclusion criteria (1924 patients) were identified. The results indicated that ultrasound-guided arthrocentesis was superior to blind arthrocentesis (10 trials; MD = -0.37; 95% CI = -0.55 to -0.19; P = .000). However, no significant difference was found in function improvement (7 trials; SMD = -0.60; 95% CI = -1.31 to 0.12; P = .101). Ultrasound-guided arthrocentesis also demonstrated better accuracy compared to blind arthrocentesis (RR = 1.26, 95% CI: 1.09-1.46, P = .001). For satisfaction, the result reported ultrasound was better than the blind group (MD = 1.11; 95% CI = 0.67-1.54; P = .000) at immediate post-procedure, and at the 4 to 6 weeks (MD = 0.98; 95% CI = 0.56-1.41; P = .000)., Conclusion: In the comprehensive systematic review and meta-analysis of knee osteoarthritis, ultrasound-guided arthrocentesis is superior to anatomic landmark-guided arthrocentesis in terms of pain reduction and accuracy., Competing Interests: The authors declare that they have no conflict of interest., (Copyright © 2025 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Primary hyperparathyroidism (pHPT) is the third most common endocrine system disorder. Parathyroidectomy (PTx) is the gold standard of care in symptomatic patients. Patients who are not surgical candidates may benefit from percutaneous ethanol ablation, which is a minimally invasive procedure. This study aims to evaluate the effectiveness and safety of PTx vs. PEA., Method: A single-centered randomized, not-blinded parallel clinical trial in consecutive patients with pHPT treated with percutaneous alcohol ablation (PEA) between January 2020 and November 2021. Patients with a confirmed solitary parathyroid adenoma and a biochemically verified pHPT were randomly enrolled in the PTx or PEA groups. Complications and lab data were evaluated 24 h, 2 weeks, 3 months, and 6 months following interventions. Effectiveness was defined as complete response (normal calcium and PTH), partial response (reduced but not normalized PTH with normal serum calcium), or disease persistence (elevated calcium and PTH). SPSS 22.0 was used for statistical analysis., Result: The final sample comprised 68 patients in each group which 113 of whom were female (83.0%). Complete response was observed in 91.1% (n = 62) of the PEA group and 98.5% (n = 67) of the PTx group. According to repeated-measures analysis, Calcium, PTH, Phosphorus, and Alkaline phosphatase fell significantly and continuously in each intervention group, except for the persistent patients. According to ROC analysis, a cutoff of > 425.5 mm3 for the adenoma volume and > 13.5 mm for its largest diameter showed a sensitivity = 75% and specificity = 69% for partial response in the PEA group (AUC = 0.81 and 0.84, respectively). PTx group experienced statistically significant higher pain according to the Visual Analogue Scale (VAS score) (p < 0.001)., Conclusion: PTH, serum-adjusted Calcium, and adenoma size and volume were all significantly reduced by PTx and PEA, with no significant difference between them. PEA is an effective alternative to PTx, particularly in adenomas with a volume of less than 425.5 mm3 and a maximum diameter of 13.5 mm., Trial Registration Number: IRCT20210204050241N1 (04/26/2021)., Competing Interests: Declarations. Ethics approval and consent to participate: This trial was accepted by the ethics committee of the Isfahan University of Medical Sciences, with the ethical code: IR.MUI.MED.1400.003 and registration in the clinical trials databases with the IRCT20210204050241N1 code. Written informed consent was obtained from all participants before enrollment. Consent for publication: Not Applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Purpose of the Review: This review examines the role of vascular access and closure management in cardiac electrophysiology (EP) procedures, emphasising their impact on patient outcomes and safety. It synthesises current evidence and highlights advancements, challenges, and opportunities in this critical area of EP practice., Recent Findings: Ultrasound-guided vascular access has significantly reduced complications and improved success rates compared to traditional methods. Vascular closure devices (VCDs) enable faster recovery and same-day discharge, becoming superior alternatives to manual compression. The "4P framework"- Plan, Prepare, Puncture, Protect- offers a structured approach to optimising vascular access. Alternative techniques, such as transhepatic and jugular access, are feasible in complex cases, though large-scale evidence is limited. Vascular access management is essential for EP procedures, demanding adequate planning and execution. While advancements in imaging and closure techniques enhance outcomes, further research is needed to standardise practices and evaluate long-term results. A personalised, systematic approach ensures optimal procedural success and patient care., Competing Interests: Declarations. Human and Animal Rights and Informed Consent: This article does not contain any studies with human participants or animals performed by any of the authors. As this is a review article, informed consent is not applicable. Competing Interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objectives: To develop an EULAR training model for education in synovial tissue biopsy (STB) under ultrasound guidance (UG) following a stepwise approach: (1) development of educational material on UGSTB in large and small joints; (2) assessment of the validity, reliability and feasibility of the UGSTB educational procedure on cadaveric specimens; (3) validation of this procedure in live patients., Methods: Using a nominal group (NG) and a DELPHI consensus methodology, educational audio-visual (AV) material and minimal requirements for education in UGSTB were developed by an expert panel. Then the experts performed an UGSTB on cadaveric joints using the developed approach. The samples retrieved from the cadaveric joints were confirmed histologically and the procedure was then tested by a group of ultrasonographers with different expertise for feasibility and face validity. The AV material and the practical procedures' phases were subsequently ranked by the experts to finalise the training model for performing UGSTB in patients. The ST retrieved in patients was assessed for tissue quality., Results: Based on NG and DELPHI processes, educational material and a stepwise standardised cadaver-based training model were developed. The knee was the cadaveric joint with the highest yield of histologically good quality of ST. 90% of the UGSTB from patients showed synovial membrane and 77% intact lining layer., Conclusions: This EULAR endeavour provided a consensus-based comprehensive educational material and a practical cadaver-based model for training in UGSTB, which has shown feasibility and validity in tissue acquisition in specimens and patients., Competing Interests: Competing interests: AN: grants from Astra Zeneca and Lilly. SA: grants from Abbvie, GSK and Pfizer; speaker fees from Eli Lilly, Abbvie and BMS. Other authors: no competing interests., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Rationale: We report here a case of using iodine-125 (125I) seed implantation via endobronchial ultrasound (EBUS) in the treatment of malignant central airway obstruction (MCAO) in a patient with lung adenocarcinoma., Patient Concerns: The patient still experienced MCAO after conventional bronchoscopic interventional therapy., Diagnoses: The patient was diagnosed as lung adenocarcinoma stage IV (T4N2M1a)., Interventions: She received implantation of radioactive 125I seeds in the lesion inside the right middle lobe bronchus and 12R lymph node via bronchoscopy and EBUS, in combination with chemotherapy and immunotherapy., Outcomes: The patient's MCAO has been effectively controlled., Lessons: The success of this case suggests that EBUS-guided 125I seed implantation to lymph nodes is a safe and effective therapeutic option for MCAO., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2025 the Author(s). Published by Wolters Kluwer Health, Inc.)

Rationale: Chronic knee pain is a common health issue that requires effective and noninvasive treatment. We devised a novel noninvasive approach using ultrasound-guided electrical nerve reactivation (ENR) in which ultrasound is used to identify the genicular nerve (GN). Then, transcutaneous low-frequency stimulation is applied for 10 seconds. The aim of this study was to clarify the pain-relieving effects of ENR on the GN innervating the knee joint., Patient Concerns: Patients had visited our hospital with the complaint of knee joint pain., Diagnoses: This study included 21 osteoarthritic knees from 16 patients with a mean age of 78.3 ± 8.5 years., Interventions: Baseline measurements included the range of motion of the knee joint, Visual Analogue Scale (VAS) scores for pain, and maximum knee flexion angle during squatting. A therapist conducted an interview to locate the painful area of the knee and then performed ultrasound-guided ENR by targeting the GN., Outcomes: The preintervention VAS score was 49.3 (95% confidence interval: 41.0, 57.5). Postintervention VAS scores showed significant reductions: 27.0 (19.0, 35.1) immediately after the intervention (P < .0001), 27.7 (22.6, 32.8) at 1-day postintervention (P = .002), and 29.0 (22.9, 35.1) at 1-week postintervention (P = .001). The knee flexion angle during squatting significantly improved from 108.1° (101.6, 114.5) preintervention to 121.9° (115.1, 128.7) postintervention (P < .001). There was a significant increase in flexion angle preintervention and postintervention (P = .02); however, no significant change was observed in the extension angle. In addition, no adverse events were reported., Lessons: This study is the first to demonstrate the effects of ultrasound-guided low-frequency stimulation of the GN for knee osteoarthritis. Although the exact mechanism of pain relief is unclear, we hypothesize that alterations in neurotransmission, with or without endorphin release, may play a role. Moreover, ENR may improve nerve entrapment by causing contraction of surrounding muscles.This study demonstrated that ultrasound-guided ENR targets the GN and effectively reduces pain without complications. This treatment addresses the limitations of invasive methods, such as hydrorelease and radiofrequency ablation. Furthermore, ultrasound-guided ENR has diverse applications in diagnostics, physical therapy, and pre-exercise pain management and will greatly benefit patients and healthcare professionals., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2025 the Author(s). Published by Wolters Kluwer Health, Inc.)

The year 2024 has witnessed substantial advancements in interventional cardiology, encompassing both coronary and structural interventions.In coronary field, trials have explored percutaneous innovations for coronary lesions, strategies for managing post‑infarction cardiogenic shock and non‑invasive approaches for guiding revascularization. The uploaded guidelines for chronic coronary syndromes emphasize individualized care, integrating modalities such as fractional flow reserve (FFR), intravascular ultrasound (IVUS), optical coherence tomography (OCT) and new teatments, including cochicine, GLP-1 receptor agonists and bempedoic acid. In structural field, recent trials have confirmed the growing efficacy and safety of percutaneous interventions for aortic, mitral and tricuspid valve diseases, while highlighting theimportance of careful patient selection., Competing Interests: J. F. Iglesias déclare des subventions de recherche institutionnelles provenant d’Abbott Vascular, AstraZeneca, Biotronik, Concept Medical, Philips et Terumo Corp., en dehors des travaux soumis ; ainsi que des honoraires de conférencier de la part d’AstraZeneca, Biosensors, Biotronik, Bristol Myers Squibb, Cordis, Concept Medical, Medtronic, Novartis, Terumo Corporation, Pfizer, Philips et ReCor Medical, également en dehors des travaux soumis. M. Roffi déclare des subventions de recherche institutionnelles provenant de Cordis, Terumo, Boston Scientific et Biotronik. S. Noble est proctor pour Medtronic. Research grant par Boston scientific, Abbott vascular, Medronic et Edwards Life Sciences. S. Degrauwe a reçu des subventions de recherche institutionnelles provenant d’Abbott Vascular et Biotronik, en dehors des travaux soumis ; ainsi que des honoraires de conférencière de la part de Biotronik, Cordis et Medtronic, également en dehors des travaux soumis. Les autres auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Background: Intravascular ultrasound (IVUS) guides deferral decision-making regarding the left main coronary artery (LMCA) and improves outcomes. Further studies regarding coronary physiology to guide revascularization in the LMCA are needed. Our aim was to evaluate the outcome of LMCA deferral using IVUS or coronary physiology via instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR)., Methods: Between January 2014 and February 2022, patients undergoing evaluation with either IVUS or coronary physiology in the LMCA were included from the SWEDEHEART registry. Exclusion criteria were a minimum luminal area < 6 mm 2 , iFR ≤ 0.89, FFR ≤ 0.80, ad hoc percutaneous coronary intervention of lesions in the LMCA, proximal left anterior descending artery, and proximal circumflex artery, planned elective revascularization, and planned valvular surgery. The primary outcome was major adverse cardiac events (MACE), defined as a composite of all-cause death, myocardial infarction, and unplanned revascularization. Kaplan-Meier event rates and multivariable Poisson regression were used for the statistical analyses., Results: Deferral of revascularization in the LMCA was performed in 1552 patients, 33.6 % with IVUS and 66.4 % with coronary physiology (iFR 11.3 % vs. FFR 55.0 %). The median follow-up time was 2.7 years. No significant difference was seen in MACE (IVUS 40.2 % vs. coronary physiology 35.5 %; adjusted RR: 1.18; 95 %CI: 0.97-1.44; p = 0.09). The results were consistent across all investigated subgroups. The rate of all-cause death was higher in the IVUS group (adjusted RR: 1.38; 95 %CI: 1.03-1.83; p = 0.03)., Conclusions: Deferral of coronary revascularization in LMCA lesions using IVUS or coronary physiology did not differ in our combined endpoint. We observed a higher risk of all-cause death using IVUS., Competing Interests: Declaration of competing interest Matthias Götberg received minor consulting fees from Abbott, Boston, Medtronic, and Philips. Karolina Berntorp, Moman A Mohammad, Sasha Koul, Troels Yndigegn, Sofia Bergman, Sammy Zwackman, Rikard Linder, Sebastian Völz, Ole Fröbert, and David Erlinge have no disclosures to report., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: At present, there is a dearth of objective methodologies for assessing the effectiveness of treatments for Lateral Epicondylitis (LE). This study examined 73 patients suffering from tennis elbow using a multimodal ultrasound approach and investigated the correlation between pertinent indicators and clinical scores., Methods: 73 patients diagnosed with unilateral tennis elbow by interventional ultrasound at Zhejiang Rongjun Hospital were included in the study. Ultrasound data of the extensor tendon, as well as VAS (Visual Analog Scale) and MEPS (Mayo Elbow Performance Score) for the affected elbow, were collected before and after a two-week treatment period. The study aimed to compare the alterations in gray-scale ultrasound features, hemodynamic parameters, and elastography scores pre- and post-treatment, and to analyze the correlation between the changes in ultrasound parameters and pain scores., Results: Following treatment, the effective group exhibited a reduction in both the blood flow grade and elastic score of the extensor tendon. Additionally, the extensor tendon thickness in the effective group diminished to a greater extent than in the ineffective group. The effective group also experienced a higher rate of decrease in blood flow grade and a more pronounced increase in Resistive Index (RI) compared to the ineffective group. The reduction in tendon thickness, the increase in RI, and the improvement in elastic score were all positively correlated with the reduction in VAS scores. Notably, the increase in RI demonstrated the strongest correlation with the decrease in VAS scores., Conclusions: Multimodal ultrasound plays a significant role in the clinical assessment of treatment outcomes for Lateral Epicondylitis., Competing Interests: Declarations. Ethics approval and consent to participate: Ethical approval was obtained from the Ethics Committee of Zhejiang Rongjun Hospital (Ethics Review Number: Research 2020-016). This study was performed in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants. Clinical trial number: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

The anatomy of the sciatic nerve allows it to be blocked at different levels using various anesthetic approaches. However, for several reasons, performing these approaches may be challenging or disadvantageous in specific categories of patients, particularly in obese patients. The objective of this brief technical report is to describe a new technical approach to sciatic nerve block, designed to simplify the procedure for certain categories of patients and less experienced practitioners. Since 2010, more than 5000 procedures have been performed by both experienced anesthesiologists and novice trainees in several hospitals. The ultrasound lateral mid-shaft technique appears to be a safe and effective method for performing a sciatic nerve block, even in obese patients with significant subcutaneous fat and unclear ultrasound images. This approach is particularly beneficial given the various anatomical variations that can occur. By targeting the mid-thigh area, the ultrasound beam accesses anatomical structures that are more superficial, improving the technique's efficacy. Various hospital groups have been performing this technique as a routine procedure, achieving a success rate of nearly 100%. This impressive success rate exceeds that of other conventional techniques documented in the literature. Additionally, there have been significant improvements in comfort and ease for anesthetists. This method allows the anesthetic to spread around the paraneural sheath, covering the posterior femoral cutaneous nerve. Finally, it is performed in the supine position without the need to mobilize the lower limbs, ensuring patient comfort, especially in cases of fractures or lower limb injuries. Further studies are needed to confirm these results.

Background: Endoscopic ultrasound-guided transmural drainage (EUS-TD) is widely performed to treat postoperative peripancreatic fluid collection (POPFC). Recent reports on EUS-TD lack a consensus on stent selection. This study aimed to assess the efficacy of EUS-TD for POPFC using an external drainage-based approach., Methods: We retrospectively examined the medical records of patients with POPFC treated with EUS-TD using external drainage from October 2016 to July 2024. Technical success was defined as successful placement of the external drainage. Clinical success was defined as the reduction in fluid collection, as evidenced by follow-up computed tomography 1 week post-procedure., Results: This study included 14 patients. The median duration from surgery to endoscopic treatment was 13 (range: 11-26) days. The median procedural time was 26 (range: 13-35) min. The technical success rate was 100%, and 6 Fr endoscopic nasocystic drainage was performed in all patients. The clinical success rate was 100%, and no adverse events were observed. One patient experienced self-removal and required repuncture., Conclusions: EUS-TD for POPFC with an external drainage-based approach is safe and effective, with a short procedure time. However, this was a retrospective study with a small sample size, suggesting that future prospective studies are warranted., Competing Interests: Declarations. Ethics approval and consent to participate: This retrospective study was reviewed and approved by the Ethics Committee of Showa University (approval no. 21-061-A). This study was conducted in accordance with Good Clinical Practice principles according to the Declaration of Helsinki. Data were accessed for research purposes from December 1, 2021, to May 31, 2024. The requirement for informed consent was waived owing to the retrospective nature of this study and utilization of anonymous data. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

The formula-based estimation of the right internal jugular venous (IJV) catheterization depth can be inaccurate when using ultrasound guidance. External landmark-based and radiological landmark-based methods have been proposed as alternatives to estimate the insertion depth. This study aimed to evaluate these methods using transesophageal echocardiography (TEE)-guided insertion depth as the reference. Ninety-seven adult cardiac surgery patients underwent real-time ultrasound-guided right IJV catheterization, with placement at the superior vena cava-right atrium (SVC-RA) junction under TEE guidance. The primary outcome compared the accuracy of external-landmark and radiological-landmark methods in estimating optimal catheter position (2 cm above to 1 cm below the SVC-RA junction), while secondary outcomes assessed their reliability and agreement with TEE. The external-landmark method proved more accurate than the radiological-landmark method (91.8% vs. 68%, p < 0.001) and had a higher correlation with TEE (r = 0.83 vs. 0.67). Bland-Altman analysis showed a mean difference of 0.08 cm between external-landmark and TEE methods (limits of agreement: -1.75 to 1.90 cm) and 0.43 cm for radiological-landmark (limits of agreement: -2.63 to 3.49 cm). Overall, the external-landmark method is a reliable and simple technique for estimating right IJV catheter depth and is more useful in cardiac surgery compared to the radiological-landmark method.Trial registration Thai Clinical Trials Registry (TCTR20200410012). Date registered April 9, 2020., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethical approval: The study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Ethics Board of the Research Ethics Committee of the Faculty of Medicine, Chiang Mai University (ANE-2562–06940) on March 27, 2020., (© 2025. The Author(s).)

Background: Postoperative pain remains a significant problem in patients undergoing donor nephrectomy despite reduced tissue trauma following laparoscopic living donor nephrectomy (LLDN). Inadequately treated pain leads to physiological and psychological consequences, including chronic neuropathic pain., Materials and Methods: This randomized controlled double-blinded trial was conducted in sixty-nine (n = 69) participants who underwent LLDN under general anesthesia. Participants were randomized into Group B (n = 34) and Group C (n = 35). Group B received ultrasound-guided bilateral erector spinae plane block (ESPB) with bupivacaine 0.125% 20 ml on the surgical side and 10 ml on the contralateral side before extubation, while Group C received wound infiltration with bupivacaine 0.125% 15 ml. The primary objective of the study was to compare cumulative 24-hour morphine consumption postoperatively. The secondary objectives were time to first rescue analgesia, visual numeric rating scale (VNRS) pain scores at rest and during movement, incidence of postoperative nausea and vomiting (PONV), and complications associated with ESPB., Results: Participants in Group B required significantly less median (IQR) 24-hour morphine compared to Group C [6 (6-9) mg vs. 15 (12-15) mg; median difference 9; 95% CI in median difference 6-12; p < 0.001), longer median (IQR) time to first rescue analgesia [6 (6-8) hours vs. 1 (1-2) hours; p < 0.001], and lower VNRS at rest and during movement at baseline, 0.5, 1, 2, 4, 6, 8, 12, 24 hours., Conclusion: Ultrasound-guided ESPB provided effective pain relief compared to wound infiltration with local anaesthetic in patients who underwent LLDN., Trial Registration: INT/IEC/2021/SPL-514; CTRI/2021/07/045909., Competing Interests: Declarations. Ethics approval and consent to participate: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Institute Ethics Committee PGIMER Chandigarh approval was obtained wide ref no: INT/IEC/2021/SPL-514. A written informed consent was obtained from all the study participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)