Elasticity In Patients Research Articles

Effect of hyperbaric oxygen treatment on skin elasticity in irradiated patients.

Hyperbaric oxygen treatment (HBOT) is often used in an attempt to reverse/treat late radiation-induced tissue fibrosis (LRITF). This study aimed to quantify the effects on skin elasticity. Skin retraction time was used as a marker of skin elasticity in 13 irradiated breast cancer patients. The measurements were carried out on the affected side as well as the unaffected/healthy side at a mirrored location. Readings were taken at the start and end of HBOT (mean 43 sessions, 80 min at 243 kPa). Patient age ranged from 39-70 years. All patients underwent surgical lumpectomy and radiotherapy prior to undergoing HBOT. The mean time between radiotherapy and HBOT was 70 months. Seven of the 13 patients underwent chemotherapy. Mean irradiated skin retraction time improved from 417 (SD 158) pre-HBOT to 171 (24) msec post-HBOT (P < 0.001). Mean pre-HBOT retraction time in the non-irradiated skin was 143 (20) msec and did not change. This promising pilot study that suggests that HBOT may improve skin elasticity in patients with LRITF.

Mesenteric elasticity assessed by shear wave elastography and its relationship with peritoneal function in peritoneal dialysis patients.

We evaluated the mesenteric elasticity in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) using shear wave elastography (SWE) and investigated its relationships with peritoneal function. Patients were recruited in our peritoneal dialysis (PD) centre between 15 July 2019 and 31 December 2021 and followed up to 31 March 2022. Twelve chronic kidney disease (CKD) patients and nineteen healthy people were included as controls. Correlation, linear regression and Cox regression analyses were applied. Of the 218 PD patients, 104 (47.8%) were male. Their mean age was 48.0±13.2years and the median PD duration was 59.0months [interquartile range (IQR) 17.0-105]. The median mesenteric SWE value was 8.15kPa (IQR 5.20-16.1). The mesenteric SWE values of patients with a PD duration of <3months [5.20kPa (IQR 3.10-7.60)] were not significantly different from those of CKD patients [4.35kPa (IQR 2.63-5.20), P=.17] and healthy controls [3.60kPa (IQR 2.90-5.10), P=.13] but were lower than those of patients with a PD duration of 3months-5years [6.40kPa (IQR 4.10-10.5), P<.001], 5-10years [11.9kPa (IQR 7.40-18.2), P<.001] and >10years [19.3kPa (IQR 11.7-27.3), P<.001]. Longer PD duration (β=0.58, P<.001), high effluent interleukin-6 (β=0.61, P=.001) and low effluent cancer antigen 125 (β=-0.34, P=.03) were independently associated with low mesenteric elasticity. The mesenteric SWE value was independently correlated with the dialysate:plasma creatinine ratio (β=0.39, P=.01) and negatively correlated with the total daily fluid volume removed (β=-0.17, P=.03). High mesenteric SWE values were an independent risk factor for death-censored technique failure [adjusted hazard ratio 4.14 (95% confidence interval 1.25-13.7), P=.02). SWE could be used to non-invasively characterize peritoneal textural changes, which were closely associated with changes in peritoneal function.

Evaluation of pelvic floor muscle elasticity in patients with overactive bladder syndrome using real-time tissue elastography

Introduction and hypothesisThe purpose of this study was to compare the muscle elasticity of the striated urethral sphincter (SUS) using real-time tissue elastography (RTE) as an evaluation of pelvic floor muscle (PFM) function between overactive bladder (OAB) patients and healthy women. MethodsThe subjects were 8 healthy middle-aged women (healthy group; age range 57–65 years) and 9 female OAB patients (OAB group; age range 42–80 years). The target sites of elastography were the striated urethral sphincter (SUS) and adipose tissue as the reference site; muscle elasticity was calculated as the strain ratio (SR) of the SUS to the reference site. Evaluations were performed at rest and during PFM contraction. The OAB group completed OAB symptom and quality of life questionnaires. The SUS SR was compared between the groups. The SUS SR at rest and during PFM contraction was compared within groups using the t-test and Wilcoxon’s test. The relationship between the questionnaire results and the SUS SR was evaluated by correlation analysis. ResultsIntergroup comparisons between the healthy and OAB groups showed no significant differences in SUS SR at rest and during PFM contraction. On intragroup comparisons, the SUS SR was significantly higher during PFM contraction than at rest in the healthy group (p = 0.011); in the OAB group, there was no significant difference in the SUS SR between rest and PFM contraction. The SUS SR was not significantly correlated with questionnaire results for OAB symptoms. ConclusionThis study shows the potential to non-invasively confirm the inability of OAB patients to correctly perform PFM contraction using RTE.

Echocardiographic Association of Epicardial Adipose Tissue with Ascending Aorta Elasticity in Patients with Type 2 Diabetes Mellitus.

Epicardial adipose tissue (EAT) is an emerging cardiovascular risk factor located between the myocardium and visceral pericardium. In order to investigate the association between EAT and ascending aorta elasticity in patients with type 2 diabetes mellitus (T2DM), we prospectively enrolled a total of 135 T2DM patients and 63 age- and gender-matched non-T2DM controls in this study. They all underwent transthoracic echocardiography to measure EAT thickness and ascending aorta inner diameters which were used to calculate ascending aorta elastic parameters: compliance (C), distensibility (D), strain (S), stiffness index (SI), and Peterson's elastic modulus (EM). We found that the values of C, D, and S were significantly lower, while SI, EM, and EAT thickness were significantly higher in T2DM patients compared with non-T2DM controls. Compared with T2DM patients with EAT < 5mm group, C, D, and S were significantly reduced, SI and EM were significantly increased in T2DM patients with EAT ≥ 5mm group (all P < .05). Bivariate correlation and multivariate linear regression analysis revealed that EAT was independently associated with ascending aorta elasticity. Our findings suggest that thickened EAT in patients with T2DM is associated with ascending aorta elasticity, independent of blood glucose.

A Better Understanding of Moyamoya in Trisomy 21: A Systematic Review.

Moyamoya disease is defined as stenosis of the internal carotid artery or the middle, anterior or posterior cerebral arteries with considerable collateral development. This collateral vessel has a particular appearance in angiographic examinations. Moyamoya syndrome is a term used to describe when moyamoya disease occurs in conjunction with other systemic disorders. One of the associations is Down syndrome. Moyamoya syndrome is very common in patients with Down syndrome, and the cause for this is unknown. The majority of patients present in their first decade, with the clinical presentation varying with age. The cause of moyamoya syndrome in people with trisomy 21 is unknown. This research aimed to learn more about the genesis and pathology of moyamoya syndrome in people with Down syndrome.The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were used to conduct this systematic review. Several publications connected to this topic were searched through a comprehensive database search. They were narrowed down to a final number of ten articles after applying inclusion and exclusion criteria and analyzing the quality of each work. Several possibilities were presented in these final papers to explain the link between moyamoya syndrome and trisomy 21. Trisomy 21 patients have a genetic predisposition to vascular problems. The RNF213 gene may interact with the genes on chromosome 21 that influence vascular physiology and elasticity in patients with Down syndrome, resulting in the whole picture of moyamoya syndrome.

Clinical significance and influencing factors of carotid pulse wave velocity in patients with diabetic microangiopathy.

To evaluate the utility of carotid ultrafast pulse wave velocity (PWV) and explore its influencing factors in patients with type 2 diabetes mellitus (T2DM) microangiopathy. Seventy-seven patients with T2DM were divided into two groups according to the absence (Group A, n=45) or presence (Group B, n=32) of microangiopathy. The control group comprised 1544 healthy volunteers. Two-dimensional ultrasonography was used to measure intima-media thickness (IMT) of the carotid arteries, and ultrafast ultrasound imaging was used to measure PWV of the carotid arteries at the beginning of systole (PWV-BS) and the end of systole (PWV-ES). The IMT, PWV-BS, and PWV-ES were higher in the T2DM group than in the control group, and the values in T2DM Group B were higher than those in Group A. IMT was positively correlated with PWV-BS and PWV-ES. Age and uric acid were influencing factors of PWV-ES, while age, uric acid, body mass index, glycated hemoglobin, and urine albumin/creatinine ratio were influencing factors of PWV-BS. PWV-ES was a more sensitive predictor than PWV-BS, and a PWV-ES critical value predicted carotid elasticity in patients with T2DM microangiopathy. Ultrafast PWV can reflect early atherosclerosis and provide a noninvasive assessment of microangiopathy in patients with T2DM.

Relationship between Perceived Leg Length Discrepancy at One Month and Preoperative Hip Abductor Muscle Elasticity in Patients after Total Hip Arthroplasty

Preoperative factors related to perceived leg length discrepancy (PLLD) after total hip arthroplasty (THA) are not well studied. This study aimed to examine the preoperative factors, including hip abductor modulus, related to PLLD one month after THA. The study included 73 patients diagnosed with osteoarthritis secondary to developmental dysplasia of the hip and a posterior approach to surgery. Multiple logistic regression analysis was performed using the presence or absence of PLLD as the dependent variable and preoperative hip abductor's modulus of elasticity, pain, hip abduction range of motion, hip abductor muscle strength and pelvic obliquity as the independent variable. Additionally, receiver operating characteristic curves were used for the extracted variables for calculating the cutoffs, sensitivity, specificity and area under the curve (AUC) to determine the presence or absence of PLLD. The significance level was set at p<0.05. The hip abductor modulus (odds ratio=1.13; 95% confidence interval=1.06-1.21; p<0.001) was selected as a preoperative factor. The cutoff value to determine the presence or absence of a PLLD was 16.32 kPa. The sensitivity and specificity were 81.8% and 72.5%, respectively, and the AUC was 0.8137. The hip abductor muscle elastic modulus affected PLLD one month after THA. If the preoperative hip abductor elastic modulus is higher than the cutoff value, it may affect the appearance of PLLD at one month postoperatively.

Post-Operative Assessment of Ulnar Nerve Tension Using Shear-Wave Elastography.

Background: Ulnar nerve compression at the elbow level is the second-most common entrapment neuropathy. The aim of this study was to use shear-wave elastography for the quantification of ulnar nerve elasticity in patients after ulnar nerve decompression with anterior transposition and in the contralateral non-operative side. Method: Eleven patients with confirmed diagnosis and ulnar nerve decompression with anterior transposition were included and examinations were performed on an AixplorerTM ultrasound system (Supersonic Imagine, Aix-en-Provence, France). Results: We observed significant differences at 0-degree (p < 0.001), 45-degree (p < 0.05), 90-degree (p < 0.01) and 120-degree (p < 0.001) elbow flexion in the shear elastic modulus of the ulnar nerve in the operative and non-operative sides. There were no statistically significant differences between the elasticity values of the ulnar nerve after transposition at 0-degree elbow flexion and in the non-operative side at 120-degree elbow flexion (p = 0.39), or in the ulnar nerve after transposition at 120-degree elbow flexion and in the non-operative side at 0-degree elbow flexion (p = 0.09). Conclusion: Shear-wave elastography has the potential to be used postoperatively as a method for assessing nerve tension noninvasively by the estimation of mechanical properties, such as the shear elastic modulus.

What is the impact of methotrexate on liver in patients with juvenile idiopathic arthritis? Results of liver SWE performed in a single centre.

Long-term therapy with low-dose methotrexate (MTX) is widely used in treatment of rheumatic diseases, in children. The purpose of this study was to evaluate liver elasticity in patients with juvenile idiopathic arthritis (JIA) who received MTX and compare the results with control group. Liver elasticity was evaluated with shear wave elastography (SWE) technique in 25 patients aged 3-17 years who were followed up with JIA and received MTX and compared with 25 healthy controls of the same age and weight. Factors that had an effect on liver elasticity were examined. The mean SWE value of patients was 2.64 ± 2.13 m/s and 24.10 ± 18.50kPa, whereas 1.83 ± 0.16 m/s and 10.09 ± 1.83kPa in control group. There was a significant difference in liver elasticity in the patient and control groups. When the patients were evaluated as Group 1 (< 1000 mg) and Group 2 (≥ 1000 mg) according to the cumulative MTX dose, no significant difference was obtained. There was positive correlation between liver elasticity and weekly MTX dose and age. Our study revealed that liver elasticity significantly decreased in patients who received MTX when compared with the control group. The elastography technique will be understood better over time and used safely in many areas.

Changes of carotid artery elasticity before and after CPAP in patients with obstructive sleep apnea by ultrasonic ultrafast pulse wave velocity technique

Objective:To examine the changes of carotid artery elasticity in patients with obstructive sleep apnea（OSA） before and after continuous positive airway pressure（CPAP） treatment by ultrafast pulse wave velocity（UFPWV） technique，and to explore the influencing factors of carotid artery elasticity in OSA patients，and to provide guidance for clinical prevention and treatment of cardiovascular complications. Methods：Fifty cases of moderate and severe OSA patients diagnosed with PSG monitoring from January 2020 to December 2020 were collected as the OSA group，at the same time，40 healthy subjects who participated in physical examination and matched with OSA group in age and gender were selected as the control group.The OSA group was treated with CPAP for 12 weeks.Clinical indicators，carotid intima-media thickness（IMT），and pulse wave velocity at the beginning of systole（PWVBS） and pulse wave velocity at the end of systole（PWVES） were recorded in the control group，and the above data were collected in the OSA group before and after treatment.The changes of various indicators between the control group and the OSA group，and between the OSA group before and after treatment were compared.The correlative factors and influencing factors of PWVBS and PWVES are analyzed. Results：The serum lipid indexes，IMT，PWVBS and PWVES in OSA group were higher than those in control group（P<0.05）.Comparison between post-treatment and pre-treatment with CPAP in OSA group：PWVBS，PWVES，apnea hypopnea index（AHI），blood oxygen saturation（SaO₂） less than 90% of the time，the percentage of monitoring time when SaO₂ was less than 90%（T90），low density lipoprotein cholesterol（LDL-C）and triglyceride（TG） were decreased（P<0.05）.Lowest blood oxygen saturation（LSaO₂） and high density lipoprotein cholesterol（HDL-C） increased（P<0.05）.Age，systolic blood pressure，IMT，AHI，T90 and time of oxygen saturation below 90% were positively correlated with PWVBS and PWVES，while HDL-C and LSaO₂ were negatively correlated with them（P<0.05）.The risk factors of PWVBS and PWVES included systolic blood pressure，AHI，TC，T90.Conclusion：Moderate and severe OSA can reduce arterial elasticity.CPAP can improve carotid artery elasticity function in patients with OSA.UFPWV technique is more sensitive to quantitatively evaluate the changes of arterial elasticity in patients with OSA than traditional two-dimensional ultrasound.

Peripheral artery elasticity in patients with ischemic heart disease

Background and Aims: Evaluation of conduit ant resistance artery elasticity indices in patients with ischemic heart disease (IHD).

Ultrasonic evaluation of carotid artery elasticity in People Living with HIV

Objective To evaluate the quantitative parameters of carotid elasticity in healthy people and People Living With HIV(PLWH) by ultrasonic vascular elasticity quantitative technique, and to explore the feasibility of this technique in non-invasive evaluation of preclinical arterial elasticity in patients with PLWH atherosclerosis. Methods Subjects with carotid intima-media thickness (IMT) &lt; 1.5mm were divided into three groups: healthy control group (n = 60), HIV baseline group (n = 291) and HAART group (n = 67) with HIV infection who had received highly active antiretroviral therapy ((HAART) for more than 5 years. Quantitative analysis of ultrasonic vascular elasticity was performed in all subjects, and the software automatically quantified carotid artery IMT, artery internal diameter, motion amplitude, vascular hardness coefficient and carotid artery pulse wave velocity,( caPWV), and thean to compare the ultrasonic parameters and blood lipids of each group. In HAART group, the correlation between brachial-ankle pulse wave velocity (baPWV) measured by traditional pressure wave method and caPWV was analyzed. Results Total Cholesterol (TC), triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) in HAART group were higher than those in baseline group (P &lt; 0.017). Hardness coefficient and caPWV of bilateral carotid arteries in HAART group were higher than those in baseline group (P &lt; 0.017), but the movement amplitude was lower than that in baseline group. In the healthy group, there was no significant difference between the left and right carotid arteries (P &gt; 0.05). In HAART group, baPWV was linearly correlated with caPWV, with the left side correlation coefficient of 0.60 and the right side correlation coefficient of 0.57. Conclusion There is a decrease in preclinical elasticity of carotid artery in patients with PLWH who take antiviral therapy for a long time, and ultrasound vascular elasticity quantitative technique is helpful to identify this change.

Assessment of Carotid Artery Distensibility and Elasticity in Patients with Asthma.

As asthma and atherosclerosis have similar pathophysiological mechanisms and risk factors, asthmatic patients may have an increased risk of atherosclerosis. This study aimed to determine the possibility of a higher risk of atherosclerosis in asthma patients compared with healthy controls by measuring carotid elasticity and distensibility. This was a cross-sectional study on 326 participants including 221 patients (129 [58.37%] females) with persistent asthma, aged 46.47±11.58 years, body mass index (BMI) of 29.74±3.99, and 105 healthy control subjects (60 [57.14%] females) aged 46.08±11.35 years, and BMI of 29.42±3.76. Of the 221 patients with asthma, 75 (33.93%) had mild, 74 (33.48%) had moderate and 72 (32.57%) had severe asthma. The carotid distensibility and elasticity were recorded and compared in both patients and control groups. There was no statistically significant difference between the patients and healthy control groups in terms of age, BMI and gender (p=0.775, p=0.482, and p=0.834, respectively). A statistically significant difference was determined between the patient and control groups in respect of both distensibility and elasticity (10.93±1.64 vs. 11.5±1.31, p=0.002 and 0.21±0.03 vs. 0.22±0.04, p=0.001, respectively). Statistically significant differences were determined between the control group and the asthma subgroups in respect of distensibility and elasticity (p<0.001, for both comparisons). The results showed that the difference was mainly due to the patients with severe asthma. Carotid distensibility and elasticity were decreased in asthmatic patients, and the main reason for this decrease was the patients in the severe asthma group. These results may suggest that the risk of subclinical carotid atherosclerosis is increased in patients with asthma, especially those with severe asthma.

Clinical Study of Ultrasonic Extreme Velocity Imaging Pulse Wave Technique in Carotid Elasticity in Patients with Type II Diabetes Mellitus

In this study, extreme velocity ultrasonic imaging pulse wave technology was used to detect the main indices of atherosclerosis such as carotid intima-media thickness (IMT) and carotid elasticity, and biochemical indices such as glycated hemoglobin, blood glucose and blood lipids in one hundred twenty 18–60-year-old patients with type II diabetes mellitus (T2DM) and 120 healthy controls. We analyzed the correlations between carotid elasticity, carotid IMT, and a range of biochemical indices. The results indicated that when the carotid IMT in young and middle-aged patients with T2DM was within the normal range (0.56±0.03 mm), the carotid artery elasticity was abnormal [Pulse wave propagation velocity (PWV)-BS = 7.69± 1.26 m/s; PWV-ES = 8.34±1.51 m/s; P &lt; 0.05]. Additionally, PWV-BS was positively correlated with age, course of the disease, glycated hemoglobin (HbA1c), and fasting blood glucose (FBG) (r = 0.297, 0.377, 0.369, 0.382), and PWV-ES was positively correlated with age, course of the disease, HbA1c, and FBG (r = 0.318, 0.386, 0.392, 0.339). This finding provides a basis for extreme velocity ultrasonic imaging pulse wave technology to become a new method for the early screening of atherosclerosis in patients with T2DM; this is important for timely clinical intervention in patients with T2DM.

Age and gender characteristics of thoracic aorta elasticity indices in patients with coronary atherosclerosis

Background. Ischemic heart disease (CHD) holds a leading position in the structure of causes of general mortality and in the structure of mortality from cardiovascular diseases. We extended the standard echocardiography with assessment of thoracic aorta elasticity to identify markers of the thoracic aorta elasticity worsen associated with coronary atherosclerosis. When analyzing the data, we identified different clinical characteristics of study participants as one of the main reasons for the difficulty in comparing the data with the results of previous studies, which made it necessary to highlight age and gender characteristics of indicators.Aim. To analyze age and gender characteristics of thoracic aorta elasticity indices in patients with coronary atherosclerosis.Material and methods. An observational analytical cross- sectional clinical trial was conducted from 2016 to 2019. Our study included 109 patients aged 39 to 82 years (mean age 65 ± 9 years, median 66 years), who were divided into 2 groups according to the results of invasive coronarography: 64 patients with coronary atherosclerosis and 45 patients without angiographic signs of coronary atherosclerosis. In the group with coronary atherosclerosis average age was 66 ± 8 years (median 66 years). In the group without coronary atherosclerosis average age was 64 ± 9 years (median 66 years). During transthoracic echocardiography, the following were obtained: coefficient of distensibility, compliance coefficient, elasticity (stiffness) module of Peterson, stiffness index of the ascending thoracic aorta; systolic velocity S, early diastolic velocity E, late diastolic velocity A of the near wall of the ascending aorta, flow velocity propagation (FVP) of the descending thoracic. Analysis of age and gender characteristics of thoracic aorta elasticity indices in patients with coronary atherosclerosis was done.Results. An increase in the stiffness index of the ascending thoracic aorta associated with coronary atherosclerosis occurs in the age group 39–66 years, a decrease in the coefficients of extensibility and compliance, an increase in Peterson’s modulus of elasticity (stiffness) of the as cending thoracic aorta — in the age group 67–82 years. A decrease in the E velocity of the near wall of the ascending thoracic aorta and FVP, associated with coronary atherosclerosis, occurs regardless of belonging to the age group, a decrease in the S velocity — in the age group 39–66 years. A decrease in the compliance coefficient of the ascending thoracic aorta, velocity S of the near wall of the ascending thoracic aorta, associated with coronary atherosclerosis, occurs only in men, an increase in the stiffness index — only in women. A decrease in the extensibility coefficient, an increase in the Peterson’s modulus of elasticity (stiffness), a decrease in the E velocity, and a decrease in CRP associated with coronary atherosclerosis occur regardless of gender.Conclusion. Worsening of the thoracic aorta elasticity in patients with coronary atherosclerosis, assessed using echocardiographic technologies, depends on gender and age.

Examination of pelvic floor muscle elasticity in patients with interstitial cystitis/bladder pain syndrome using real-time tissue elastography.

The aim was to compare pelvic floor muscle (PFM) elasticity between interstitial cystitis/bladder pain syndrome (IC/BPS) patients and healthy women using real-time tissue elastography. The subjects were 17 IC/BPS female patients (IC/BPS group; age 34-84years), 10 healthy middle-aged women (middle-aged group; 50-80 years), and 17 healthy young adult women (young group; 23-37 years). The target sites of elastography were the striated urethral sphincter (SUS) and adipose tissue as the reference site; muscle elasticity was calculated as the strain ratio (SR) of the SUS to the reference site. Evaluations were performed at rest and during PFM contraction. The IC/BPS group completed lower urinary tract symptom and pain questionnaires. SUS SR was compared among the three groups. SUS SR at rest and during PFM contraction was compared among the three groups with the t-test and the Wilcoxon test. Associations between questionnaire results and SUS SR were evaluated by correlation analysis. There was no significant difference in age between the IC/BPS and middle-aged groups, but the young group was significantly younger than the other groups (p < 0.001). SUS SR at rest was significantly higher in the IC/BPS group than in the middle-aged (p = 0.014) and young groups (p = 0.002). Furthermore, in the IC/BPS group, there was no significant difference in SUS SR between at rest and during PFM contraction. SUS SR was not significantly correlated with questionnaire results for lower urinary tract symptoms. SUS SR at rest was significantly higher in the IC/BPS group than in the young and middle-aged groups.

Association of thoracic aorta elasticitychanges and severity of coronary atherosclerosis

Introduction. Became possible to evaluate association between the elasticity of aorta and coronary atherosclerosis using echocardiography.Purpose. To evaluate the association between worsening of the local thoracic aorta elasticity and the severity of coronary atherosclerosis.Material and methods. With the application of echocardiography and coronarography there were examined 109 patients.Results. With stenosis &gt;70%, occlusion or lesion of 2 or more coronary arteries, statistically significant differences were revealed.Conclusion. Worsening of thoracic aorta local elasticity in patients with coronary atherosclerosisis associated with the severity of coronary atherosclerosis.

Muscle elasticity in patients with neonatal brachial plexus palsy using shear-wave ultrasound elastography. Preliminary results.

Ultrasound shear wave elastography (SWE) is a noninvasive, reliable and reproducible method, used for the qualitative and quantitative evaluation of tissues. The aim of this study was to compare muscle elasticity between the healthy and the involved sides in children with neonatal brachial plexus palsy (NBPP) using the elastography tool and to assess whether the difference was correlated with the Mallet grading system. We repeatedly measured the shear modulus coefficient of several muscles around the shoulder in stretched or passively relaxed positions on 14 patients. We evaluated the abductor muscles (supraspinatus and deltoid), the infraspinatus, the pectoralis major and the latissimus dorsi. We found a mean shear modulus significantly higher in most studied muscles in the pathologic side (P < 0.001), especially in the stretched position (P < 0.001). Moreover, the shear modulus increases with the degradation of the Mallet score for the abduction and external rotation tasks. SWE seems to be a reliable and reproducible tool to assess muscle elasticity in NBPP.

Intrinsic cardiac elastography in patients with primary mitral regurgitation: predictive role after mitral valve repair.

Chronic volume-overload can impair systolic and diastolic myocardial properties. We tested the hypothesis that Intrinsic Cardiac Elastography may detect alterations in passive myocardial elasticity in patients with chronic severe mitral regurgitation (MR) and predict worsening left ventricular (LV) function after mitral valve repair (MVr). Comprehensive transthoracic echocardiography and cardiac elastography were performed in 80 patients with primary MR (prolapse and/or flail leaflets) of varying severity and compared with 40 normal subjects. In patients who underwent MVr (n = 51), elastography measurements were related to changes in left ventricular ejection fraction (LVEF) at short-term (3-4 days post-op) and mid-term (1year) follow-up. Most patients were asymptomatic or mildly symptomatic and had preserved LVEF (>60%). Intrinsic velocity propagation (iVP) of myocardial stretch, a direct measure of myocardial stiffness, was higher in patients with severe MR {median 2.0 [interquartile range (IQR) 1.5-2.2] m/s, range 1.1-3.4 m/s; n = 56} compared to normal subjects [median 1.7 (IQR 1.5-1.8) m/s; n = 40; P = 0.0005], but not in those with mild or moderate MR [median 1.7 (IQR 1.4-1.9) m/s; n = 24]. A higher iVP was associated with more severe LV volume-overload and LV and left atrial enlargement (P < 0.05 for all). In patients undergoing MVr, a higher iVP independently predicted a larger drop in LVEF post-intervention (short-term, P = 0.001; 1 year, P = 0.007), incrementally to pre-operative LVEF (P < 0.05). Non-invasive measurements of myocardial stiffness were able to predict functional deterioration after MVr for chronic primary MR. Further studies should investigate the mechanisms and practical utility of this novel measurement.

Changes in indicators of fibrosis in patients with alcoholic liver cirrhosis associated with non-alcoholic fatty liver disease depending on the stage of cirrhosis

Objective was to study changes in liver parenchyma fibrosis in patients with alcoholic liver cirrhosis associated with non-alcoholic fatty liver disease depending on decompensation using shear wave elastography and FIB-4 index.Material and methods. The study included 204 patients. Among them, 78 patients (Group I) had alcoholic liver cirrhosis (ALC) and 126 patients (Group II) had a combination of ALC with non-alcoholic fatty liver disease (NAFLD). Patients were subgrouped according to compensation classes by the Child-Pugh score (A, B, C). The degree of liver parenchyma fibrosis was assessed by calculating the FIB-4 (FibroIndex-4) and the liver parenchyma elasticity (kPa) determined by the shear wave elastography method.Results. Values of liver parenchyma elasticity in patients of group II of classes A, B, and C were higher compared to group I same classes (P &lt; 0.05). FIB-4 indicators in patients of group II were higher than classes A, B, and C compared to group I (P &lt; 0.05). In patients with ALC in combination with NAFLD, direct correlations were established between the value of Child-Pugh score and the elasticity of the liver parenchyma, the value of the MELD index and the elasticity of the liver parenchyma, the value of Child-Pugh score and FIB-4 index, the value of MELD index and FIB-4 index, FIB-4 index and liver parenchyma elasticity.Conclusions. In patients with ALC according to elastography and FIB-4 index, fibrosis indicators increase depending on the stage of decompensation. According to elastography and FIB-4 index in patients with ALC, fibrosis indicators were higher in combination with NAFLD at all stages of liver cirrhosis. The magnitude of fibrosis in patients with ALC in combination with NAFLD according to elastography and the FIB-4 index correlates with the severity of liver cirrhosis by Child-Pugh and MELD prognostic index. The combination of shear wave elastography and FIB-4 index are important diagnostic indicators for assessing the degree of fibrosis in the liver.