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Reproducibility of shear wave elastography between operators, machines and probes in an elasticity phantom Abdulrahman M. Alfuraih

Purpose:
To investigate the reproducibility of shear wave elastography (SWE) among operators, machines and probes in a phantom. Moreover, to evaluate the effect of depth and the accuracy of the embedded inclusions.


Methods:
In-vitro stiffness measurements of six inclusions (10kPa, 40kPa and 60kPa) embedded at two depths (1.5cm and 5cm) in an elastography phantom. The measurements obtained by two sonographers using two ultrasound machines; the SuperSonic Imagine Aixplorer using the XC6-1, SL10-2 and SL18-5 probes, and the General Electric LOGIQ E9 using the 9L-D probe. The variability was evaluated using the coefficient of variation. The reproducibility was calculated using an intraclass correlation coefficient (ICC).


Results:
For shallow inclusions, low variability was observed between the results obtained by each operator (range 0.9%–5.4%). However, the variability increased significantly in the deeper inclusions (range 2.4–80.8%). The measurement difference between the operators was 1%–15% in superficial inclusions and 3%–43% in deep inclusions. The inter-operator reproducibility was almost perfect (ICC>0.90). The measurement difference between the machines was 0–15% in superficial inclusions and 38.6%–82.9% in deep inclusions. In superficial inclusions, there was an excellent reproducibility between the three probes (ICC>0.97). On average, the means of the 10 kPa inclusions’ stiffness were overestimated by 16%, while those at 40 kPa and 60 kPa were underestimated by 42% and 48%, respectively.


Conclusion:
Phantom SWE measurements were reproducible between operators, machines and probes at superficial depths only. SWE measurements acquired in deep regions should not be used interchangeably between operators, machines or probes.

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Muscle stiffness in rheumatoid arthritis is not altered or associated with muscle weakness: A shear wave elastography study Abdulrahman M. Alfuraih

Objectives: 
To investigate muscle stiffness and strength in rheumatoid arthritis patients compared to healthy controls.

Methods: 
A sample of 80 RA patients from three discrete groups: 1 – newly diagnosed treatment-naïve RA (n = 29), 2 – active RA for at least 1 year (n = 18) and 3 – in remission RA for at least 1 year (n = 33), was compared to 40 healthy controls. Shear wave velocity (SWV) was measured using shear wave elastography as a surrogate for tissue stiffness in multiple muscles. All participants performed isometric grip strength, timed get-up-and-go test, 30-s chair stand test and isokinetic knee extension/flexion (60°/s). The difference in SWV amongst the groups was tested using one-way ANOVA, and the correlation between SWV and muscle strength results were calculated using Pearson’s coefficients.

Results: 
The mean age ± SD was 61.2 ± 12.8 for RA patients and 61.5 ± 10.5 years for controls. SWV was not significantly different amongst the groups on all muscles (p > .05). In comparison to controls, the new and active RA groups showed a significantly lower isokinetic strength by –29% (p = .013) and –28% (p = .040), fewer chair stands by –28% (p = .001) and –44% (p ...

Reduction in stiffness of proximal leg muscles during the first 6 months of glucocorticoid therapy for giant cell arteritis: A pilot study using shear wave elastography Abdulrahman M. Alfuraih
Aim

To investigate muscle stiffness changes in patients treated for giant cell arteritis (GCA) with high‐dose oral glucocorticoids.

Methods

Using ultrasound elastography, shear wave velocity (SWV) was measured in the quadriceps, hamstrings and biceps brachii muscles of 14 patients with GCA (4 male, mean age ± SD, 68.2 ± 4.3 years) within the first 2 weeks of initiating glucocorticoid treatment (baseline) and repeated after 3 and 6 months treatment. Muscle strength and performance tests were performed at each visit. Baseline measures were compared with those from 14 healthy controls. Linear mixed models were used to test for change in patient measures over time.

Results

At baseline, muscle SWV in patients was not significantly different from controls. With glucocorticoid treatment, there was a reduction in SWV in the leg but not the arm muscles. SWV decreased by a mean of 14% (range 8.3%‐17.3%; P  = .001) after 3 months and 18% (range 10.2%‐25.3%; P  ...

Staphylococci, catecholamine inotropes and hospital-acquired infections Noura Hamad Al-dayan

Patients in hospital intensive care units have long been recognized as being at high risk for developing infections from bacteria, fungi, and viruses from within the hospital locality. Risk factors for development of nosocomial infections have usually focussed on the patient’s physical condition and the number and type of invasive medical procedures administered. Using the staphylococci as its focus, this chapter presents recent evidence that some of the medications routinely used in the treatment of acutely ill patients may also be a risk factor for the development of nosocomial infections.

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The Iron Biology Status of Peritoneal Dialysis Patients May Be a Risk Factor for Development of Infectious Peritonitis Noura Hamad Al-dayan
Background: Infectious peritonitis is a clinically important condition contributing to the significant mortality and morbidity rates observed in peritoneal dialysis (PD) patients. Although some of the socioeconomic risk factors for PD-associated peritonitis have been identified, it is still unclear why certain patients are more susceptible than others to infection. Methods: We examined the molecular components of human peritoneal dialysate (HPD) in an attempt to identify factors that might increase patient susceptibility to infection. Characterization studies were performed on initial and follow-up dialysate samples collected from 9 renal failure patients on PD. Results: Our in vitro data showed that peritonitis-causing bacteria grew differently in the patient dialysates. Proteomic analysis identified an association between transferrin presence and infection risk, as peritoneal transferrin was discovered to be iron-saturated, which was ...
Evaluation of Total Oxidative Stress, Total Antioxidant Capacity Along with Selenium and Vitamin E Level among Saudi Women Experiencing Unexplained Recurrent Miscarriage and Intrauterine Foetal Death Noura Hamad Al-dayan

Introduction: Oxidative stress is integrated with declined female fertility. Our modern sedentary life style and exposure to toxins make vulnerable to body to increased amount of oxidative stress and lead to higher oxidative damage to DNA and may affect ova, sperm or the development of the embryo, leading to infertility, miscarriage and congenital defects. In the present study our aim was to assess the concentration of total oxidative stress, total antioxidant capacity, selenium and vitamin E level in women suffering from recurrent spontaneous miscarriage and intra uterine foetal death and compare levels with normal pregnant women. 

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Early detection of breast cancer using DC bio-impedance technique سفيان محمد الحبيب الحبيب

Breast cancer is the leading cause of death among women around the world. Studies confirm that early-stage cancer detection can lead to better healing. This research project aims to offer a system for early detection of women breast cancer based on the technique of DC electric bio-impedance

Mammography remains the essential technique for breast exploration, the most successful in terms of monitoring and early detection of breast cancer. Unfortunately, it is an invasive, expensive method and women do not go directly for screening. Thus, we propose in this research project to design a smart mammograph for early diagnosis of breast cancer using electrical bio-impedance

Electrical bio-impedance has a high diagnostic potential for various diseases. Indeed, an impedance value different from the normal can inform us about a physiological abnormality of the individual

Indeed, this research project offers a non-invasive system that allows to simultaneously measuring the impedances of the two breasts of a patient, to compare the result and if there is a significant difference, it means that there is a problem in one of the breasts. Once the system finalized, we will carry out an impedance measurement campaign of healthy women and women with cancer to establish a meaningful database and offer a real-time automatic screening system

This research project is only the first phase. The second phase will focus on increasing the number of electrodes to precisely locate the tumor, create an image and transmit it to a smartphone

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Muscle shear wave elastography in idiopathic inflammatory myopathies: a case–control study with MRI correlation Abdulrahman M. Alfuraih
Objective To investigate muscle stiffness in patients with idiopathic inflammatory myopathies (IIM) using shear wave elastography (SWE) and to correlate the results with muscle strength and MRI features of myositis. Materials and methods Muscle shear wave velocity (SWV) was measured in 23 active IIM patients (13 females, mean age 50.4 ± 16.1 years) and 23 matched healthy controls (13 females, mean age 50.7 ± 16.2 years). The investigated muscles included the vastus lateralis (VL), rectus femoris (RF), vastus medialis (VM) vastus intermedius (VI), biceps femoris (BF), semitendinosus (ST), semimembranosus (SM) and the biceps brachii (BB) scanned during relaxed resting and passive stretching positions. Participants performed multiple tests to evaluate their muscle strength. IIM patients had a thigh MRI to assess degrees of oedema, fatty infiltration and atrophy. Results In the resting position, IIM patients had a 12.9–22.2% significantly lower SWV (p < 0 xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed> Conclusion Shear wave elastography may detect abnormal reduced thigh stiffness in IIM patients. SWE measurements were significantly associated with muscle weakness and MRI signs of oedema and atrophy. Future research should investigate this new technology for monitoring disease activity. ...
The effect of ageing on shear wave elastography muscle stiffness in adults Abdulrahman M. Alfuraih
Background Skeletal muscle undergoes structural changes with ageing which may alter its biomechanical properties. Shear wave elastography (SWE) may detect these changes by measuring muscle stiffness. Aims To investigate muscle stiffness in healthy young, middle-aged and elderly cohorts using SWE and correlate it with muscle strength and mass. Methods Shear wave velocity (SWV) was measured in the quadriceps, hamstrings and biceps brachii of 26 young (range 20–35 years), 21 middle-aged (40–55) and 30 elderly (77–94) volunteers. The participants performed several muscle tests to evaluate their strength. The One-way ANOVA was used to test the muscle stiffness differences between the groups and the Pearson’s correlation coefficient to evaluate the relationship between SWV and muscle strength. Results The overall resting muscle SWV gradually decreased with age but was only significantly reduced in the elderly group (p < 0 xss=removed xss=removed xss=removed xss=removed xss=removed> Conclusions Ageing was associated with a decline in skeletal muscle stiffness which positively correlates with muscle weakness. Further research is needed to evaluate the promising role of SWE as a biomarker for sarcopenia assessment and potential falls risk prediction in elderly individuals. ...
Shear-Wave Elastography of Benign versus Malignant Musculoskeletal Soft-Tissue Masses: Comparison with Conventional US and MRI Abdulrahman M. Alfuraih
Purpose To examine if shear-wave elastography (SWE) improves the accuracy of diagnosing soft-tissue masses as benign or malignant compared with US alone or in combination with MRI. Materials and Methods Two hundred six consecutive adult participants (mean age, 57.7 years; range, 18–91 years), including 89 men (median age, 56.0 years; range, 21–91 years) and 117 women (median age, 59.1 years; range, 18–88 years), who were referred for biopsy of a soft-tissue mass were prospectively recruited from December 2015 through March 2017. Participants underwent B-mode US, MRI, and SWE prior to biopsy. Three musculoskeletal radiologists independently reviewed US images alone, followed by US and MRI images together, and classified lesions as benign, probably benign, probably malignant, or malignant. For SWE, the area under the receiver operating characteristic (ROC) curve (AUC) was calculated for transverse shear-wave velocity (SWV). Multivariable logistic regression was used to investigate the association between SWE and malignancy alongside individual demographic and imaging variables. Results At histologic examination, 79 of 206 (38%) participants had malignant lesions. SWV showed good diagnostic accuracy for lesions classified as benign or probably benign by US alone (AUC = 0.87 [95% confidence interval {CI}: 0.79, 0.95]). SWV did not provide substantive diagnostic information for lesions classified as probably malignant or malignant, whether the classification was made with or without MRI. However, multivariable modeling indicated that diagnostic accuracy may vary by lesion position (interaction P = .02; superficial, odds ratio [OR] = 17.7 [95% CI: 1.50, 207], P = .02; deep/mixed, OR = 0.24...
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