Artificial intelligence assistance for fetal head biometry: Assessment of automated measurement software

International audienceTo evaluate the feasibility and reproducibility of artificial intelligence software (Smartplanes ®) to automatically identify the transthalamic plane from 3D ultrasound volumes and to measure the biparietal diameter (BPD) and head circumference (HC) in fetus. Material and methods: Thirty fetuses were evaluated at 17-30 weeks' gestation. For each fetus two three-dimensional (3D) volumes of the fetal head along with one conventional two-dimensional (2D) image of the transthalamic plane were prospectively acquired. The Smartplanes ® software identified the transthalamic plane from the 3D volumes and performed BPD and HC measurements automatically (3D auto). Two experienced sonographers also measured BPD and HC from 2D images and from the 3D volumes. Measurements were compared using Bland-Altman plots. Interclass correlation coefficient (ICC) was used to evaluate intraand interobserver reproducibility. Results: For each series of measurements, intra-and interobserver reproducibility rates were high with ICC values > 0.98. The 95% confidence intervals between the BPD measurements were 2 mm (3D versus 2D) and 4 mm (3D auto versus 2D) and the HC measurements were 7.5 mm (3D versus 2D) and 11 mm (3D auto versus 2D). Conclusion: Fetal head measurements obtained automatically by Smartplanes ® software from 3D volumes show good agreement with those obtained by two experienced sonographers from conventional 2D images and 3D volumes. The reproducibility of these measurements is similar to that observed by experienced sonographers

Évaluation des compétences pour la pratique de la biométrie échographique fœtale : validation prospective du score OSAUS METHOD

International audienceObjectivesTo develop and validate a customized variant for fetal biometry of the generic OSAUS score (Objective Structured Assessment of Ultrasound Skills)MethodsThe 5-points OSAUS METHOD grid was elaborated by defining five target skills specific to fetal biometry for each thematic item of the generic score. The level of skills of 43 trainees was prospectively assessed during an ultrasound examination by using this grid. The results of the “novice” level group (experience < 10 ultrasounds) were compared to those of the “intermediate” level group (experience ≥ 10 ultrasounds) (I). The reached/non-reached skills ratio within the different items composing the score allowed the identification of priority areas of improvement (II). Previously published distribution and actual distribution of ratings according to the generic pass/fail score were compared (III).ResultsMedian scores of “novices” (n = 29) and “intermediates” (n = 14) groups were statistically different, 1.87 (±0.75) and 3.31 (±0.83) (P = 1.85-5), respectively and corresponded to the pre-existing experience (I). A lower ratio of reached skill allowed the identification of “documentation of the examination” item as a priority area of improvement for both groups (II). The relevance of the pass/fail score is consolidated, even if an overlap was observed between novices and intermediates groups (III).ConclusionsThe relevancy and feasibility of using OSAUS scoring method for fetal biometry are supported. In addition, the possibility of comparisons with generic OSAUS remains.ObjectifsDévelopper et évaluer la pertinence clinique d’une version du score générique OSAUS (Objective Structured Assessment of Ultrasound Skills) dédiée à la biométrie fœtale.Matériel et méthodesCinq compétences cibles spécifiques à la biométrie fœtale ont été définies pour chaque item thématique du score générique permettant d’établir une grille d’évaluation OSAUS-METHOD sur 5 points (MEasurements TeacHing in Obstetrics Design). Le niveau de compétence de 43 étudiants a été évalué à l’aide grille OSAUS-METHOD (MEasurements TeacHing in Obstetrics Design) lors d’examens pratiques. Les notes des étudiants débutants (expérience pratique < 10 examens) ont été comparées à celles des étudiants de niveau intermédiaire (expérience pratique ≥ 10 examens) (I). La proportion de compétences validées ou non au sein de chacun des items thématiques du score a permis d’identifier les axes de progression prioritaires (II). La distribution des notes obtenues par rapport au seuil de certification utilisé pour le score générique a été comparée à celle précédemment publiée (III).RésultatsLe score moyen au sein du groupe « débutants » (n = 29) était significativement plus faible que celui au sein du « intermédiaires » (n = 14) (1,87 ± 0,75 et 3,31 ± 0,83 respectivement, p = 1,855) (I). Une proportion plus importante de compétences non validée a permis d’identifier l’item « documentation de l’examen » comme axe de progression prioritaire (II). La pertinence du score seuil pour discriminer les étudiants en fonction du niveau d’expertise est confortée mais un minime chevauchement entre les groupes de niveau est observé (III).ConclusionLa faisabilité et la pertinence de l’utilisation d’un score OSAUS dédié à la biométrie sont confirmées ainsi que la possibilité de comparaisons avec le score OSAUS générique

Fetal biometry in ultrasound: A new approach to assess the long-term impact of simulation on learning patterns

International audienceSimulation-based education (SBE) has demonstrated its acceptability and effectiveness in improving ultrasound training. Because of the high cost of its implementation (investment in equipment and supervision), a pragmatic assessment of the transfer of skills learned in SBE to clinical practice and the identification of its optimal scheduling conditions have been requested to optimize its input. Objectives: To quantify the long-term impact of simulation-based education (SBE) on the adequate performance of ultrasound fetal biometry measurements (I). The secondary objective was to identify the temporal patterns that enhanced SBE input in learning (II). Methods: Trainees were arbitrarily assigned to a 6-month course in obstetric ultrasound with or without an SBE workshop. In the SBE group, the workshop was implemented 'before' or at an 'early' or a 'late-stage' of the course. Those who did not receive SBE were the control group. The ultrasound skills of all trainees were prospectively collected, evaluated by calculating the delta between OSAUS (Objective Structured Assessment of Ultrasound Skills) scores before and after the course (I). Concomitantly, the accuracy of trainees' measurements was assessed throughout the course by verifying their correlation with the corresponding measurements by their supervisors. The percentage of trainees able to perform five consecutive sets of correct measurements in the control group and in each SBE subgroup were compared (II). Results: The study included 61 trainees (39 SBE and 22 controls). Comparisons between groups showed no significant difference in the quantitative assessment of skill enhancement (difference in the pre-and postinternship OSAUS score: 1.09 § 0.87 in the SBE group and 0.72 § 0.98 in the control group) (I). Conversely, the predefined acceptable skill level was reached by a significantly higher proportion of trainees in the 'early' SBE subgroup (74%, compared with 30% in the control group, P<0.01)(II). Conclusions: The quantitative assessment does not support the existence of long-term benefits from SBE training, although the qualitative assessment confirmed SBE helped to raise the minimal level within a group when embedded in an 'early' stage of a practical course

Skeletal muscle interleukin-6 regulates metabolic factors in i during and exercise training

To investigate the role of skeletal muscle (SkM) interleukin (IL)-6 in the regulation of adipose tissue metabolism. Muscle-specific IL-6 knockout (IL-6 MKO) and IL-6 loxP/loxP (Floxed) mice were subjected to standard rodent diet (Chow), high-fat diet (HFD), or HFD in combination with exercise training (HFD ExTr) for 16 weeks. Total fat mass increased (P < 0.05) in both genotypes with HFD. However, HFD IL-6 MKO mice had lower (P < 0.05) inguinal adipose tissue (iWAT) mass than HFD Floxed mice. Accordingly, iWAT glucose transporter 4 (GLUT4) protein content, 5'AMP activated protein kinase (AMPK) Thr172 phosphorylation, and fatty acid synthase (FAS) mRNA content were lower (P < 0.05) in IL-6 MKO than Floxed mice on Chow. In addition, iWAT AMPK Thr172 and hormone-sensitive lipase (HSL) Ser565 phosphorylation as well as perilipin protein content was higher (P < 0.05) in HFD IL-6 MKO than HFD Floxed mice, and pyruvate dehydrogenase E1α (PDH-E1α) protein content was higher (P < 0.05) in HFD ExTr IL-6 MKO than HFD ExTr Floxed mice. These findings indicate that SkM IL-6 affects iWAT mass through regulation of glucose uptake capacity as well as lipogenic and lipolytic factors

Lack of Skeletal Muscle IL-6 Affects Pyruvate Dehydrogenase Activity at Rest and during Prolonged Exercise.

Pyruvate dehydrogenase (PDH) plays a key role in the regulation of skeletal muscle substrate utilization. IL-6 is produced in skeletal muscle during exercise in a duration dependent manner and has been reported to increase whole body fatty acid oxidation, muscle glucose uptake and decrease PDHa activity in skeletal muscle of fed mice. The aim of the present study was to examine whether muscle IL-6 contributes to exercise-induced PDH regulation in skeletal muscle. Skeletal muscle-specific IL-6 knockout (IL-6 MKO) mice and floxed littermate controls (control) completed a single bout of treadmill exercise for 10, 60 or 120 min, with rested mice of each genotype serving as basal controls. The respiratory exchange ratio (RER) was overall higher (P<0.05) in IL-6 MKO than control mice during the 120 min of treadmill exercise, while RER decreased during exercise independent of genotype. AMPK and ACC phosphorylation also increased with exercise independent of genotype. PDHa activity was in control mice higher (P<0.05) at 10 and 60 min of exercise than at rest but remained unchanged in IL-6 MKO mice. In addition, PDHa activity was higher (P<0.05) in IL-6 MKO than control mice at rest and 60 min of exercise. Neither PDH phosphorylation nor acetylation could explain the genotype differences in PDHa activity. Together, this provides evidence that skeletal muscle IL-6 contributes to the regulation of PDH at rest and during prolonged exercise and suggests that muscle IL-6 normally dampens carbohydrate utilization during prolonged exercise via effects on PDH

Skeletal muscle -6 and regulation of liver metabolism during high-fat diet and exercise training

Altres ajuts: The study was supported by grants from the Lundbeck Foundation, The Danish Research Foundation, The Danish Council for Independent Research in the Natural Sciences, and The Augustinus Foundation. Centre of Inflammation and Metabolism (CIM) is supported by a grant from the Danish National Research Foundation (#02-512-55).Interleukin ()-6 is released from skeletal muscle (SkM) during exercise and has been shown to affect hepatic metabolism. It is, however, unknown whether SkM -6 is involved in the regulation of exercise training-induced counteraction of changes in carbohydrate and lipid metabolism in the liver in response to high-fat diet () feeding. Male SkM-specific -6 () and Floxed mice were subjected to Chow diet, or combined with exercise training ( ExTr) for 16 weeks. Hepatic phosphoenolpyruvate carboxykinase () protein content decreased with both and ExTr in Floxed mice, but increased in -6 mice on . In addition, the intrahepatic glucose concentration was in -6 mice higher in than chow. Within ExTr mice, hepatic glucose-6-phosphatase (G6Pase) 36 a protein content was higher in -6 than Floxed mice. Hepatic pyruvate dehydrogenase kinase () 4 and 2 protein content was in Floxed mice lower in ExTr than Chow. In addition, hepatic 1-phosphorylation was higher and 1 protein lower in . Together this suggests that SkM -6 regulates hepatic glucose metabolism, but does not seem to be of major importance for the regulation of oxidative capacity or lipogenesis in liver during or combined with exercise training

Skeletal muscle glucose, G-6-P, glycogen, lactate, and acetyl CoA content.

<p>Skeletal muscle glucose, glucose -6 phosphate (G-6-P), glycogen, lactate and acetyl CoA in skeletal muscle specific IL-6 knockout (IL-6 MKO) and littermate floxed controls (Control) mice at rest and after 10, 60 or 120 min of exercise. Values are given as mean ± SE; n = 9–10.</p

Lack of Skeletal Muscle IL-6 Affects Pyruvate Dehydrogenase Activity at Rest and during Prolonged Exercise - Fig 3

<p><b>A)</b> AMP-activated protein kinase (AMPK) Thr172 phosphorylation and <b>B)</b> Acetyl-CoA carboxylase 2 (ACC2) phosphorylation in skeletal muscle from skeletal muscle specific IL-6 knockout (IL-6 MKO) and littermate floxed controls (Control) mice at rest and after 10, 60 or 120 min of exercise. Values are given as mean ± SE; n = 9–10. Phosphorylation levels are given in arbitrary units (AU). *: significantly different from rest within given genotype, P<0.05. #: significantly different from control within given time point, P<0.05. (*): Tendency to be significantly different from rest within given genotype, 0.05</p

PDHa activity in skeletal muscle from skeletal muscle specific IL-6 knockout (IL-6 MKO) and littermate floxed controls (Control) at rest and after 10, 60 or 120 min of exercise.

<p>Values are given as mean ± SE; n = 10. *: significantly different from rest within given genotype, P<0.05. #: significantly different from control within given time point, P<0.05.</p