Browsing by Subject "Ultrasonography"
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Item Open Access A novel multi-modality imaging phantom for validating interstitial needle guidance for high dose rate gynecological brachytherapy.(Journal of applied clinical medical physics, 2023-10) Eckroate, Brett; Ayala-Peacock, Diandra; Venkataraman, Rajesh; Campelo, Sabrina; Chino, Junzo; Stephens, Sarah Jo; Kim, Yongbok; Meltsner, Sheridan; Raffi, Julie; Craciunescu, OanaPurpose
To design, manufacture, and validate a female pelvic phantom for multi-modality imaging (CT, MRI, US) to benchmark a commercial needle tracking system with application in HDR gynecological (GYN) interstitial procedures.Materials and methods
A GYN needle-tracking phantom was designed using CAD software to model an average uterus from a previous patient study, a vaginal canal from speculum dimensions, and a rectum to accommodate a transrectal ultrasound (TRUS) probe. A target volume (CTVHR ) was designed as an extension from the cervix-uterus complex. Negative space molds were created from modeled anatomy and 3D printed. Silicone was used to cast the anatomy molds. A 3D printed box was constructed to house the manufactured anatomy for structural integrity and to accommodate the insertion of a speculum, tandem, needles, and TRUS probe. The phantom was CT-imaged to identify potential imperfections that might impact US visualization. Free-hand TRUS was used to guide interstitial needles into the phantom. The commercial tracking system was used to generate a 3D US volume. After insertion, the phantom was imaged with CT and MR and the uterus and CTVHR dimensions were verified against the CAD model.Results/conclusions
The manufactured phantom allows for accurate visualization with multiple imaging modalities and is conducive to applicator and needle insertion. The phantom dimensions from the CAD model were verified with those from each imaging modality. The phantom is low cost and can be reproducibly manufactured with the 3D printing and molding processes. Our initial experiments demonstrate the ability to integrate the phantom with a commercial tracking system for future needle tracking validation studies.Item Open Access Aorta-to-pulmonary vein fistula in an asymptomatic 25-year-old man.(Circulation, 2013-04-23) Dahiya, Arun; Collier, Patrick; Krasuski, Richard; Kalahasti, Vidyasagar; Del Nido, Pedro; Stewart, William JItem Open Access Boosting high-intensity focused ultrasound-induced anti-tumor immunity using a sparse-scan strategy that can more effectively promote dendritic cell maturation.(J Transl Med, 2010-01-27) Liu, Fang; Hu, Zhenlin; Qiu, Lei; Hui, Chun; Li, Chao; Zhong, Pei; Zhang, JunpingBACKGROUND: The conventional treatment protocol in high-intensity focused ultrasound (HIFU) therapy utilizes a dense-scan strategy to produce closely packed thermal lesions aiming at eradicating as much tumor mass as possible. However, this strategy is not most effective in terms of inducing a systemic anti-tumor immunity so that it cannot provide efficient micro-metastatic control and long-term tumor resistance. We have previously provided evidence that HIFU may enhance systemic anti-tumor immunity by in situ activation of dendritic cells (DCs) inside HIFU-treated tumor tissue. The present study was conducted to test the feasibility of a sparse-scan strategy to boost HIFU-induced anti-tumor immune response by more effectively promoting DC maturation. METHODS: An experimental HIFU system was set up to perform tumor ablation experiments in subcutaneous implanted MC-38 and B16 tumor with dense- or sparse-scan strategy to produce closely-packed or separated thermal lesions. DCs infiltration into HIFU-treated tumor tissues was detected by immunohistochemistry and flow cytometry. DCs maturation was evaluated by IL-12/IL-10 production and CD80/CD86 expression after co-culture with tumor cells treated with different HIFU. HIFU-induced anti-tumor immune response was evaluated by detecting growth-retarding effects on distant re-challenged tumor and tumor-specific IFN-gamma-secreting cells in HIFU-treated mice. RESULTS: HIFU exposure raised temperature up to 80 degrees centigrade at beam focus within 4 s in experimental tumors and led to formation of a well-defined thermal lesion. The infiltrated DCs were recruited to the periphery of lesion, where the peak temperature was only 55 degrees centigrade during HIFU exposure. Tumor cells heated to 55 degrees centigrade in 4-s HIFU exposure were more effective to stimulate co-cultured DCs to mature. Sparse-scan HIFU, which can reserve 55 degrees-heated tumor cells surrounding the separated lesions, elicited an enhanced anti-tumor immune response than dense-scan HIFU, while their suppressive effects on the treated primary tumor were maintained at the same level. Flow cytometry analysis showed that sparse-scan HIFU was more effective than dense-scan HIFU in enhancing DC infiltration into tumor tissues and promoting their maturation in situ. CONCLUSION: Optimizing scan strategy is a feasible way to boost HIFU-induced anti-tumor immunity by more effectively promoting DC maturation.Item Open Access CASE 7---2015: Perioperative Considerations for a Cardiac Paraganglioma...Not Just Another Cardiac Mass.(J Cardiothorac Vasc Anesth, 2015-08) Gerlach, Rebecca M; Barrus, Adam B; Ramzy, Danny; Hernandez Conte, Antonio; Khoche, Swapnil; McCartney, Sharon L; Swaminathan, MadhavItem Open Access Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest.(Resuscitation, 2016-12) Gaspari, Romolo; Weekes, Anthony; Adhikari, Srikar; Noble, Vicki E; Nomura, Jason T; Theodoro, Daniel; Woo, Michael; Atkinson, Paul; Blehar, David; Brown, Samuel M; Caffery, Terrell; Douglass, Emily; Fraser, Jacqueline; Haines, Christine; Lam, Samuel; Lanspa, Michael; Lewis, Margaret; Liebmann, Otto; Limkakeng, Alexander; Lopez, Fernando; Platz, Elke; Mendoza, Michelle; Minnigan, Hal; Moore, Christopher; Novik, Joseph; Rang, Louise; Scruggs, Will; Raio, ChristopherPoint-of-care ultrasound has been suggested to improve outcomes from advanced cardiac life support (ACLS), but no large studies have explored how it should be incorporated into ACLS. Our aim was to determine whether cardiac activity on ultrasound during ACLS is associated with improved survival.We conducted a non-randomized, prospective, protocol-driven observational study at 20 hospitals across United States and Canada. Patients presenting with out-of-hospital arrest or in-ED arrest with pulseless electrical activity or asystole were included. An ultrasound was performed at the beginning and end of ACLS. The primary outcome was survival to hospital admission. Secondary outcomes included survival to hospital discharge and return of spontaneous circulation.793 patients were enrolled, 208 (26.2%) survived the initial resuscitation, 114 (14.4%) survived to hospital admission, and 13 (1.6%) survived to hospital discharge. Cardiac activity on US was the variable most associated with survival at all time points. On multivariate regression modeling, cardiac activity was associated with increased survival to hospital admission (OR 3.6, 2.2-5.9) and hospital discharge (OR 5.7, 1.5-21.9). No cardiac activity on US was associated with non-survival, but 0.6% (95% CI 0.3-2.3) survived to discharge. Ultrasound identified findings that responded to non-ACLS interventions. Patients with pericardial effusion and pericardiocentesis demonstrated higher survival rates (15.4%) compared to all others (1.3%).Cardiac activity on ultrasound was the variable most associated with survival following cardiac arrest. Ultrasound during cardiac arrest identifies interventions outside of the standard ACLS algorithm.Item Open Access Factors associated with low-lying intrauterine devices: a cross-sectional ultrasound study in a cohort of African-American women.(Contraception, 2018-07) Moshesh, Malana; Saldana, Tina; Deans, Elizabeth; Cooper, Tracy; Baird, DonnaObjective
The object of this study is to examine factors and symptoms associated with low-lying IUDs as defined by ultrasound.Study design
This is a cross-sectional sub-study of participants in the Study of Environment, Life-style, and Fibroids (SELF). SELF participants had screening ultrasounds for fibroids at study enrollment; those with an IUD in place are included in this sub-study. Low-lying IUDs were identified and localized. Logistic regression was used to identify factors and symptoms associated with low-lying IUDs.Results
Among 168 women with IUDs at ultrasound, 28 (17%) had a low-lying IUD. Having a low-lying IUD was associated with low education level (≤high school: aOR 3.1 95% CI 1.14-8.55) and with increased BMI (p=.002). Women with a low-lying IUD were more likely to report a "big problem" with dysmenorrhea (the highest option of the Likert scale) as compared to women with a normally-positioned IUD (OR 3.2 95% CI 1.07-9.54).Conclusion
Our study found that women with a low-lying IUD are more likely to be of lower education and higher BMI, and to report more dysmenorrhea.Implications
Women who are obese may benefit from additional counseling and closer follow-up after IUD placement. Future research is warranted to investigate IUD placement and possible IUD migration among women who are obese.Item Open Access Geographic variation and trends in carotid imaging among medicare beneficiaries, 2001 to 2006.(Circulation. Cardiovascular quality and outcomes, 2010-11) Curtis, LH; Greiner, MA; Patel, MR; Duncan, PW; Schulman, KA; Matchar, DBBackground
Diagnostic imaging among Medicare beneficiaries is an important contributor to rising health care costs. We examined temporal trends and geographic variation in the use of carotid ultrasound, carotid magnetic resonance angiography (MRA), and carotid x-ray angiography.Methods and results
Analysis of a 5% national sample of claims from the Centers for Medicare and Medicaid Services for 1999 through 2006. Patients were 65 years or older and underwent carotid ultrasound, carotid MRA, carotid x-ray angiography, or a carotid intervention. The main outcome measures were annual age-adjusted rates of carotid imaging and interventions and factors associated with the use of carotid imaging. Rates of imaging increased by 27%, from 98.2 per 1000 person-years in 2001 to 124.3 per 1000 in 2006. Rates of carotid ultrasound increased by 23%, and rates of MRA increased by 66%. Carotid intervention rates decreased from 3.6 per 1000 person-years in 2001 to 3.1 per 1000 person-years in 2006. In 2006, rates of carotid ultrasound were lowest in the New England, Mountain, and West North Central regions and highest in the Middle Atlantic and South Atlantic regions. Regional differences persisted after adjustment for patient demographic characteristics, history of vascular disease and other comorbid conditions, and study year.Conclusions
From 2001 through 2006, there was substantial growth and variation in the use of carotid imaging, including a marked increase in the use of MRA, and a decrease in the overall rate of carotid intervention.Item Unknown Harmonic source wavefront aberration correction for ultrasound imaging.(2010) Dianis, Scott W.Aberration is a correctable phenomenon that degrades diagnostic quality in a significant number of ultrasound images. Previous aberration correction studies have focused on development of aberration estimation algorithms or on aberration reduction by using harmonic imaging. In the past, a major drawback of aberration estimation algorithms has been the assumptions required about the imaging target, assumptions that can limit clinical application where correction for multiple locations within a scan may be required. Harmonic imaging attempts to reduce the effect of aberration, without making assumptions about the imaging target, by using a lower-frequency transmit beam that is less prone to aberration. However, harmonic imaging does not correct for any aberration that may remain. It is hypothesized that a harmonic source wavefront correction technique is capable of creating a point-like acoustical source that allows for estimation and correction of two-dimensional aberration in a clinical setting. Harmonic source wavefront correction utilizes the reduced aberration of harmonic imaging to create a known acoustical source to satisfy the assumptions of the aberration estimation algorithms, thus improving their clinical application. Generation of a point-like acoustical source in the presence of aberration is demonstrated using both spatially correlated and spatially uncorrelated electronic aberrators varying in strength from 0.25π radians to 1.16π radians RMS focusing error. Beam properties of the 2.08 MHz fundamental, 4.16 MHz generated harmonic, and 4.17 MHz imaging beams were compared; in the presence of aberration, relative peak beam amplitude of the 4.16 MHz generated harmonic beam was up to 81% higher than the 4.17 MHz imaging beam, while -6 dB beam width indicated the 4.16 MHz generated harmonic beam was 88% narrower and more point-like than the 2.08 MHz fundamental beam. The feasibility of harmonic source wavefront correction was demonstrated by correcting for spatially uncorrelated electronic aberrators in a water tank using a point target, specular reflector, and speckle region as correction targets. Harmonic source wavefront correction was paired with a cross-correlation algorithm to estimate corrective delays and was most effective in correcting peak amplitude of the 4.17 MHz imaging beam using a point target (up to 94% improvement), followed by use of a specular reflector (up to 83% improvement), followed by use of a speckle region (up to 47% improvement). Aberration correction is sensitive to signal-to-noise ratio (SNR),and correction utilizing the 2.08 MHz fundamental, which provided higher SNR, was more effective than correction utilizing the more point-like 4.16 MHz harmonic for the experimental setup used. A harmonic SNR of 14 dB was estimated as necessary for harmonic-based correction performance to equal or surpass fundamental-based correction, regardless of fundamental SNR. Finally, performance of harmonic source wavefront correction was quantified in a clinical setting. Correction of spatially correlated electronic aberrators was performed using both ex vivo porcine kidneys and the left kidneys of 11 human volunteers as correction targets. Correction utilizing porcine kidney resulted in 10 dB greater improvement in peak beam amplitude than correction utilizing the left kidney of human volunteers. Body wall aberration present in the human volunteers was not accounted for during correction and likely caused the disparity in correction performance. An average upper limit for body wall aberration for the human subjects was estimated at 65 ns (±9 ns) RMSItem Open Access Intraobserver variability in fibroid size measurements: estimated effects on assessing fibroid growth.(Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2014-07) Moshesh, Malana; Peddada, Shyamal D; Cooper, Tracy; Baird, DonnaTo evaluate intraobserver variability of fibroid sonographic measurements and apply this factor to fibroid growth assessment.Study participants were African American women aged 23 to 34 years who had never had a diagnosis of uterine fibroids. All participants underwent transvaginal sonography to screen for the presence of previously undiagnosed fibroids (≥0.5 cm in diameter). The diameters of up to 6 fibroids were measured in 3 perpendicular planes at 3 separate times during the examinations by experienced sonographers. Intraobserver variability as measured by the coefficient of variation (CV) for fibroid diameter and volume was calculated for each fibroid, and factors associated with the CV were assessed by regression models. The impact of variability on growth assessment was determined.Ninety-six of 300 women screened were found to have at least 1 fibroid, yielding a total of 174 fibroids for this analysis. The mean CV for the 3 measurements of fibroid maximum diameter was 5.9%. The mean CV for fibroid volume was 12.7%. Fibroid size contributed significantly to intraobserver variability (P = .04), with greater variability for smaller fibroids. Fibroid type (submucosal, intramural, or subserosal) was not important. Fibroids from the same woman tended to have similar measurement variability when assessed for volume but not for maximum diameter. Calculations showed that when following up fibroids, as much as a 20% increase in diameter could be due to measurement error, not "true growth."A small fibroid must have a greater change in size than a large fibroid to conclude that it is growing, but even for small fibroids an increase in diameter of greater than 20% is likely to indicate true growth, not measurement variability.Item Open Access Level of beta-adrenergic receptor kinase 1 inhibition determines degree of cardiac dysfunction after chronic pressure overload-induced heart failure.(Circulation, 2005-02-08) Tachibana, Hideo; Naga Prasad, Sathyamangla V; Lefkowitz, Robert J; Koch, Walter J; Rockman, Howard ABACKGROUND: Heart failure is characterized by abnormalities in beta-adrenergic receptor (betaAR) signaling, including increased level of myocardial betaAR kinase 1 (betaARK1). Our previous studies have shown that inhibition of betaARK1 with the use of the Gbetagamma sequestering peptide of betaARK1 (betaARKct) can prevent cardiac dysfunction in models of heart failure. Because inhibition of betaARK activity is pivotal for amelioration of cardiac dysfunction, we investigated whether the level of betaARK1 inhibition correlates with the degree of heart failure. METHODS AND RESULTS: Transgenic (TG) mice with varying degrees of cardiac-specific expression of betaARKct peptide underwent transverse aortic constriction (TAC) for 12 weeks. Cardiac function was assessed by serial echocardiography in conscious mice, and the level of myocardial betaARKct protein was quantified at termination of the study. TG mice showed a positive linear relationship between the level of betaARKct protein expression and fractional shortening at 12 weeks after TAC. TG mice with low betaARKct expression developed severe heart failure, whereas mice with high betaARKct expression showed significantly less cardiac deterioration than wild-type (WT) mice. Importantly, mice with a high level of betaARKct expression had preserved isoproterenol-stimulated adenylyl cyclase activity and normal betaAR densities in the cardiac membranes. In contrast, mice with low expression of the transgene had marked abnormalities in betaAR function, similar to the WT mice. CONCLUSIONS: These data show that the level of betaARK1 inhibition determines the degree to which cardiac function can be preserved in response to pressure overload and has important therapeutic implications when betaARK1 inhibition is considered as a molecular target.Item Open Access LV Mass as a Predictor of CVD Events in Older Adults With and Without Metabolic Syndrome and Diabetes.(JACC. Cardiovascular imaging, 2015-09) Hoang, Khiet; Zhao, Yanglu; Gardin, Julius M; Carnethon, Mercedes; Mukamal, Ken; Yanez, David; Wong, Nathan DObjectives
The purpose of this study was to examine the prognostic significance of left ventricular (LV) mass for cardiovascular disease (CVD) events in older adults with and without metabolic syndrome (MetS) and diabetes mellitus (DM).Background
MetS and DM are associated with increased CVD risk, but it is unclear in these groups whether subclinical CVD as shown by increased LV mass improves risk prediction compared to standard risk factors in older individuals.Methods
We studied 3,724 adults (mean 72.4 ± 5.4 years of age, 61.0% female, 4.4% African-American) from the Cardiovascular Health Study who had MetS but not DM or had DM alone or had neither condition. Cox regression was used to examine the association of LV mass, (alone and indexed by height and body surface area [BSA]) as determined by echocardiography, with CVD events, including coronary heart disease (CHD), stroke, heart failure (HF), and CVD death, as well as total mortality. We also assessed the added prediction, discriminative value, and net reclassification improvement (NRI) for clinical utility of LV mass compared to standard risk factors.Results
Over a mean follow-up of 14.2 ± 6.3 years, 2,180 subjects experienced CVD events, including 986 CVD deaths. After adjustment for age, sex and standard risk factors, LV mass was positively associated with CVD events in those with MetS (hazard ratio [HR]: 1.4, p < 0.001) and without MetS (HR: 1.4, p < 0.001), but not DM (HR: 1.0, p = 0.62), with similar findings for LV mass indexed for height or BSA. Adding LV mass to standard risk factors moderately improved the prediction accuracy in the overall sample and MetS group from changes in C-statistics (p < 0.05). Categorical-free net reclassification improvement increased significantly by 17% to 19% in those with MetS. Findings were comparable for CHD, CVD mortality, and total mortality.Conclusions
LV mass is associated with increased CVD risk and provides modest added prediction and clinical utility compared to standard risk factors in older persons with and without MetS but not with DM.Item Open Access Prevalence of renal anomalies after urinary tract infections in hospitalized infants less than 2 months of age.(J Perinatol, 2010-04) Nowell, L; Moran, C; Smith, PB; Seed, P; Alexander, BD; Cotten, CM; Wiener, JS; Benjamin Jr, DKOBJECTIVE: Our aim was to determine the incidence of anatomical abnormalities after a urinary tract infection (UTI) in infants <2 months of age hospitalized in the neonatal intensive care unit (NICU). STUDY DESIGN: This was a retrospective, single-center cohort study of infants <2 months of age in the NICU with a UTI and documented renal imaging. RESULT: We identified 141 infants with UTIs. The mean gestational age and birth weight were 28 weeks and 1254 g, respectively. The most commonly identified pathogen was coagulase-negative Staphylococcus (28%, 44 of 156). A major abnormality was found on at least one imaging study for 4% (5 of 118) of infants. Major abnormalities were noted on 4% (5 of 114) of renal ultrasounds and 2% (2 of 82) of voiding cystourethrography examinations. CONCLUSION: Among infants in the NICU <2 months of age at the time of a UTI, the prevalence of major anatomical abnormalities is <5%.Item Open Access Reference data on in vitro anatomy and indentation response of tissue layers of musculoskeletal extremities.(Scientific data, 2020-01) Schimmoeller, Tyler; Neumann, Erica E; Owings, Tammy M; Nagle, Tara F; Colbrunn, Robb W; Landis, Benjamin; Jelovsek, J Eric; Hing, Tod; Ku, Joy P; Erdemir, AhmetThe skin, fat, and muscle of the musculoskeletal system provide essential support and protection to the human body. The interaction between individual layers and their composite structure dictate the body's response during mechanical loading of extremity surfaces. Quantifying such interactions may improve surgical outcomes by enhancing surgical simulations with lifelike tissue characteristics. Recently, a comprehensive tissue thickness and anthropometric database of in vivo extremities was acquired using a load sensing instrumented ultrasound to enhance the fidelity of advancing surgical simulations. However detailed anatomy of tissue layers of musculoskeletal extremities was not captured. This study aims to supplement that database with an enhanced dataset of in vitro specimens that includes ultrasound imaging supported by motion tracking of the ultrasound probe and two additional full field imaging modalities (magnetic resonance and computed tomography). The additional imaging datasets can be used in conjunction with the ultrasound/force data for more comprehensive modeling of soft tissue mechanics. Researchers can also use the image modalities in isolation if anatomy of legs and arms is needed.Item Open Access Respiratory muscle training in late-onset Pompe disease: Results of a sham-controlled clinical trial.(Neuromuscular disorders : NMD, 2020-11) Jones, Harrison N; Kuchibhatla, Maragatha; Crisp, Kelly D; Hobson-Webb, Lisa D; Case, Laura; Batten, Milisa T; Marcus, Jill A; Kravitz, Richard M; Kishnani, Priya STo address progressive respiratory muscle weakness in late-onset Pompe disease (LOPD), we developed a 12-week respiratory muscle training (RMT) program. In this exploratory, double-blind, randomized control trial, 22 adults with LOPD were randomized to RMT or sham-RMT. The primary outcome was maximum inspiratory pressure (MIP). Secondary and exploratory outcomes included maximum expiratory pressure (MEP), peak cough flow, diaphragm ultrasound, polysomnography, patient-reported outcomes, and measures of gross motor function. MIP increased 7.6 cmH2O (15.9) in the treatment group and 2.7 cmH2O (7.6) in the control group (P = 0.4670). MEP increased 14.0 cmH2O (25.9) in the treatment group and 0.0 cmH2O (12.0) in the control group (P = 0.1854). The only statistically significant differences in secondary/exploratory outcomes were improvements in time to climb 4 steps (P = 0.0346) and daytime sleepiness (P = 0.0160). The magnitude of changes in MIP and MEP in the treatment group were consistent with our pilot findings but did not achieve statistical significance in comparison to controls. Explanations for this include inadequate power and baseline differences in subject characteristics between groups. Additionally, control group subjects appeared to exhibit an active response to sham-RMT and therefore sham-RMT may not be an optimal control condition for RMT in LOPD.Item Open Access Tongue weakness and atrophy differentiates late-onset Pompe disease from other forms of acquired/hereditary myopathy.(Molecular genetics and metabolism, 2021-07) Jones, Harrison N; Hobson-Webb, Lisa D; Kuchibhatla, Maragatha; Crisp, Kelly D; Whyte-Rayson, Ashley; Batten, Milisa T; Zwelling, Paul J; Kishnani, Priya SLate-onset Pompe disease (LOPD) is an inherited autosomal recessive progressive metabolic myopathy that presents in the first year of life to adulthood. Clinical presentation is heterogeneous, differential diagnosis is challenging, and diagnostic delay is common. One challenge to differential diagnosis is the overlap of clinical features with those encountered in other forms of acquired/hereditary myopathy. Tongue weakness and imaging abnormalities are increasingly recognized in LOPD. In order to explore the diagnostic potential of tongue involvement in LOPD, we assessed tongue structure and function in 70 subjects, including 10 with LOPD naive to treatment, 30 with other acquired/hereditary myopathy, and 30 controls with neuropathy. Tongue strength was assessed with both manual and quantitative muscle testing. Ultrasound (US) was used to assess tongue overall appearance, echointensity, and thickness. Differences in tongue strength, qualitative appearance, echointensity, and thickness between LOPD subjects and neuropathic controls were statistically significant. Greater tongue involvement was observed in LOPD subjects compared to those with other acquired/hereditary myopathies, based on statistically significant decreases in quantitative tongue strength and sonographic muscle thickness. These findings provide additional evidence for tongue involvement in LOPD characterized by weakness and sonographic abnormalities suggestive of fibrofatty replacement and atrophy. Findings of quantitative tongue weakness and/or atrophy may aid differentiation of LOPD from other acquired/hereditary myopathies. Additionally, our experiences in this study reveal US to be an effective, efficient imaging modality to allow quantitative assessment of the lingual musculature at the point of care.Item Open Access Torsemide versus furosemide in heart failure patients: insights from Duke University Hospital.(J Cardiovasc Pharmacol, 2015-05) Mentz, Robert J; Buggey, Jonathan; Fiuzat, Mona; Ersbøll, Mads K; Schulte, Phillip J; DeVore, Adam D; Eisenstein, Eric L; Anstrom, Kevin J; OʼConnor, Christopher M; Velazquez, Eric JFurosemide has historically been the primary loop diuretic in heart failure patients despite data suggesting potential advantages with torsemide. We used the Duke Echocardiography Lab Database to investigate patients admitted with heart failure to Duke Hospital from 2000 to 2010 who were discharged on either torsemide or furosemide. We described baseline characteristics based on discharge diuretic and assessed the relationship with all-cause mortality through 5 years. Of 4580 patients, 86% (n = 3955) received furosemide and 14% (n = 625) received torsemide. Patients receiving torsemide were more likely to be female and had more comorbidities compared with furosemide-treated patients. Survival was worse in torsemide-treated patients [5-year Kaplan-Meier estimated survival of 41.4% (95% CI: 36.7-46.0) vs. 51.5% (95% CI: 49.8-53.1)]. After risk adjustment, torsemide use was no longer associated with increased mortality (hazard ratio 1.16; 95% CI: 0.98-1.38; P = 0.0864). Prospective trials are needed to investigate the effect of torsemide versus furosemide because of the potential for residual confounding.