Liver metastases:Contrast-enhanced ultrasound compared with computed tomography and magnetic resonance

The development of ultrasound contrast agents with excellent tolerance and safety profiles has notably improved liver evaluation with ultrasound(US)for several applications,especially for the detection of metastases.In particular,contrast enhanced ultrasonography(CEUS)allows the display of the parenchymal microvasculature,enabling the study and visualization of the enhancement patterns of liver lesions in real time and in a continuous manner in all vascular phases,which is similar to contrast-enhanced computed tomography(CT)and contrast-enhanced magnetic resonance imaging.Clinical studies have reported that the use of a contrast agent enables the visualization of more metastases with significantly improved sensitivity and specificity compared to baseline-US.Furthermore,studies have shown that CEUS yields sensitivities comparable to CT.In this review,we describe the state of the art of CEUS for detecting colorectal liver metastases,the imaging features,the literature reports of metastases in CEUS as well as its technique,its clinical role and its potential applications.Additionally,the updated international consensus panel guidelines are reported in this review with the inherent limitations of this technique and best practice experiences.     

The use of hydrophobins to functionalize surfaces

The physiochemical nature of surfaces can be changed by small proteins which are secreted by filamentous fungi. These proteins, called hydrophobins, are characterized by the presence of eight conserved cysteine residues and a typical hydropathy pattern. Upon contact with a hydrophilic-hydrophobic interface they self-assemble into highly insoluble amphipathic membranes. As a result, hydrophobic surfaces become hydrophilic and vice versa. Genetic engineering of hydrophobins was used to study structure-function relationships. In addition, engineered hydrophobins were constructed to increase the biocompatibility of surfaces. The glycosylated N-terminal region of the mature SC3 hydrophobin was deleted and the cell-binding domain of human fibronectin was introduced at the N-terminus. The gross properties of the hydrophobins were not affected. However, the physiochemical properties of the hydrophilic side of the assembled protein did change. Growth of fibroblasts on Teflon could be improved by coating the solid with the engineered hydrophobins. Thus, by changing the N-terminal part of hydrophobins, the physiochemical nature of the hydrophilic side of the assembled form can be altered and a variety of new functionalities introduced. The fact that hydrophobins self-assemble at any hydrophilic-hydrophobic interface, irrespective of the chemical nature of the surface, therefore provides a generic approach to modify surfaces and make them interesting candidates for the use in various technical and medical applications.     

Prospective evaluation of acoustic radiation force impulse technology in the differentiation of thyroid nodules: accuracy and interobserver variability assessment

Purpose

The aim of this study is to assess the diagnostic efficacy and interobserver agreement of acoustic radiation force impulse (ARFI) elasticity imaging in differentiating thyroid nodules.

Methods

In our study, 74 consecutive patients (52 females, 22 males; age range 27–77 years, mean: 41 years) with 82 thyroid nodules (60 benign nodules, and 22 malignant) were examined by two radiologists with different experience. Patients underwent either cytology using fine needle aspiration cytology or thyroid surgery. The diagnostic performance of the two operators at ARFI with sensitivity, specificity, positive predictive and negative predictive value, and ROC curves was estimated. Inter-reader variability between the two operators was defined using Cohen’s k.

Results

According to receiver operating characteristics ROC curves (AUROC = 0.86 for observer 1; 0.81 for observer 2) sensitivity, specificity, PPV and NPV of reader 1 and 2 were respectively: 90, 75, 90.91 and 96.55 %; (cut-off value of shear wave: 2.455 m/s); 90, 72, 90 and 96.90 % (cut-off value shear wave: 2.365 m/s). Concordance between the two operators was good (k = 0.755).

Conclusions

This work is a feasibility study evaluating ARFI imaging. Its results suggest that ARFI imaging is a reproducible method which can be utilized with good diagnostic performance in the thyroid for discriminating benign and malignant nodules using the cut-off value of 2.455 m/s. However, larger studies are needed to validate this method.     

Q-Elastosonography of Solid Thyroid Nodules: Assessment of Diagnostic Efficacy and Interobserver Variability in a Large Patient Cohort

Objective

Evaluation of the diagnostic efficacy and interobserver agreement of Q-elastography in the differentiation of benign from malignant thyroid nodules.

Methods

A total of 344 thyroid nodules in 288 patients were examined with grey-scale and colour Doppler ultrasound (CDUS) and Q-elastography by two independent operators. Nodules with hypoechogenicity, poorly defined margins, microcalcifications, and intralesional vascularity were classified as suspicious. Diagnostic performances of CDUS features and Q-elastography for predicting thyroid malignancy were estimated using ROC analysis. Cytology or histopathology was the reference standard. Interobserver agreement in the evaluation of CDUS and Q-elastography was assessed using Cohen's k-statistic.

Results

Q-elastography showed excellent diagnostic performance for the prediction of thyroid malignancy, with sensitivity of 93 % and specificity of 92 % for operator 1 (best cutoff at 2.02), and sensitivity of 84 % and specificity of 79 % for operator 2 (best cutoff at 1.86). Performance of Q-elastography was superior to that of CDUS. Reproducibility of the findings was excellent for both Q-elastography and CDUS features as assessed with Cohen's k, which was highest for strain ratio measurements (0.95) and lowest for the echogenicity score (0.83).

Conclusions

Q-elastography showed excellent performance. It is a valid and reproducible diagnostic method as well as a promising tool for identifying suspicious solid thyroid nodules needing cytological assessment and surgery.

Key Points

? Elastography is an additional tool for optimal characterisation of malignant thyroid nodules. ? The use of semiquantitative elastographic evaluation increases the diagnostic performance, ? The interobserver agreement of quantitative elastography can be considered to be good.     

Martha E. Rogers: a life history

The 20th century in nursing has focused heavily on theory development. While theorizing about nursing--what it is, and what it is not--can be traced back to Nightingale, Martha E. Rogers' An Introduction to the Theoretical Basis of Nursing (1970) marked the advent of a new era in nursing science. With a view of nursing as a "learned profession," this landmark work staked out a substantive knowledge base for the discipline. The science of unitary human beings proposed by Rogers was a radical departure from all that had come before and is seen by many as pioneering the beginning of a paradigmatic shift within the profession. The purpose of this inquiry is to document the self-described events across the life span of Martha E. Rogers that she perceived as having influenced the development of the science of unitary human beings. A life history approach is utilized and the data are organized chronologically. This life story of Martha E. Rogers is essential to the current and future understanding of the evolution of the culture of nursing. Likewise, more is learned about the nature and process of theory development.     

Florence Nightingale and the Women's Movement: Friend or foe?

The historical analysis of the complex and often contradictory views of Florence Nightingale regarding the rights of women is explored in this paper. Feminism and nursing are often viewed as contradictory and antithetical. The relationship between the two is examined through the link between Florence Nightingale and her contemporary, Barbara Leigh-Smith Bodichon. Leigh-Smith was founder and primary financier of The English Women's Journal that provided a public platform for the major feminist writings of the period. Its offices in Langham Place formed the administrative centre of the Society for Promoting the Employment of Women. Bodichon and her colleagues were often referred to as the 'Langham Place Group'. Unexplored prior to this study was the fact that Leigh-Smith and Nightingale were first cousins. Utilizing techniques of internal and external criticism, primary and secondary sources were surveyed relating to Nightingale and Leigh-Smith. The views of both women on the subjects of the rights of women, women's suffrage, the employment status of women, and the societal place of women are compared and contrasted. The legacy of both Leigh-Smith and Nightingale to twentieth century feminism, the status of women, and the profession of nursing is then elaborated. The exploration of the views of both Nightingale and Leigh-Smith is important to gain a clearer understanding of the existing relationship between nursing and feminism. In keeping with the aims of feminist inquiry, women's experiences, specifically those of Nightingale and Leigh-Smith, are the major 'objects' of investigation. The concluding interpretation provides a synthesis that is emancipatory as well as knowledge generative.     

Ultrasound elastography in the evaluation of thyroid pathology. Current status

Thyroid pathology including thyroid nodules and diffuse thyroid diseases represents often a diagnosing challenge for clinicians. US, although highly accurate in identifying thyroid nodules and diffuse thyroid diseases, is still not sufficiently accurate to evaluate them. US-elastography has been introduced in order to further increase US accuracy in many fields and eventually for thyroid disease. The aim of the present paper it to provide an update of the literature on different available techniques and the results reported both for thyroid nodules differentiation and for diffuse thyroid disease evaluation. Advantages and limitations of elastography are also discussed.     

Formation of Dislocations and Stacking Faults in Embedded Individual Grains during In Situ Tensile Loading of an Austenitic Stainless Steel

The formation of stacking faults and dislocations in individual austenite (fcc) grains embedded in a polycrystalline bulk Fe-18Cr-10.5Ni (wt.%) steel was investigated by non-destructive high-energy diffraction microscopy (HEDM) and line profile analysis. The broadening and position of intensity, diffracted from individual grains, were followed during in situ tensile loading up to 0.09 strain. Furthermore, the predominant deformation mechanism of the individual grains as a function of grain orientation was investigated, and the formation of stacking faults was quantified. Grains oriented with [100] along the tensile axis form dislocations at low strains, whilst at higher strains, the formation of stacking faults becomes the dominant deformation mechanism. In contrast, grains oriented with [111] along the tensile axis deform mainly through the formation and slip of dislocations at all strain states. However, the present study also reveals that grain orientation is not sufficient to predict the deformation characteristics of single grains in polycrystalline bulk materials. This is witnessed specifically within one grain oriented with [111] along the tensile axis that deforms through the generation of stacking faults. The reason for this behavior is due to other grain-specific parameters, such as size and local neighborhood.