Maximum Elasticity Research Articles

Effects of preoperative plasma exchange therapy with albumin replacement fluid on blood coagulation in patients undergoing ABO-incompatible living-donor kidney transplantation using rotational thromboelastometry

BackgroundABO-incompatible living-donor kidney transplantation (LDKT) requires immunotherapy and plasma exchange therapy (PEX). PEX with albumin replacement fluid reportedly decreases fibrinogen levels. However, no reports have described the effects of PEX with albumin replacement fluid on blood coagulation parameters and blood loss during the perioperative period. Therefore, we investigated the effects of preoperative PEX on blood coagulation parameters and blood loss during the perioperative period in patients undergoing ABO-incompatible LDKT as measured by rotational thromboelastometry (ROTEM®).MethodsTwenty-eight patients undergoing LDKT were divided into the PEX group (ABO incompatible with PEX, n = 13) and non-PEX group (ABO compatible without PEX, n = 15). ROTEM® parameters, standard laboratory test parameters, bleeding volume, and transfusion volume were compared between PEX and non-PEX group. MCEplatelet, which represents platelet contribution to clot strength and where “MCE” stands for maximum clot elasticity, was calculated from the difference in MCE between EXTEM and FIBTEM.ResultsThe bleeding volume during surgery and the intensive care unit (ICU) stay was significantly higher in the PEX than non-PEX group (p < 0.01). Maximum clot firmness (MCF) of EXTEM (MCFEXTEM), MCFFIBTEM, and MCEplatelet was significantly lower in the PEX than non-PEX group (p < 0.01). In the PEX group, the bleeding volume during surgery was very strongly correlated with the baseline MCFEXTEM and MCEplatelet, and the bleeding volume during the ICU stay was strongly correlated with the postoperative MCFEXTEM and MCEplatelet.ConclusionsThese results suggest that the increased blood loss in the PEX group during surgery and the ICU stay was associated with decreased platelet contribution to clot strength as measured by ROTEM®.Trial registrationUMIN-Clinical Trial Registry UMIN000018355. Registered 21 July 2015.

Mechanical Properties of a Water Hyacinth Nanofiber Cellulose Reinforced Thermoplastic Starch Bionanocomposite: Effect of Ultrasonic Vibration during Processing

Thermoplastic starch (TPS) reinforced by 1 wt % nanofiber cellulose (NFC) reinforcing from water hyacinth was produced. Ultrasonic vibration time (UVT) was applied to bionanocomposites during gelation for 0, 15, 30 and 60 min. Morphology of the NFC was investigated using Transmission Electron Microscopy (TEM). Scanning Electron Microscopy (SEM) and tensile tests were performed to identify the fracture surface and determine the mechanical properties of the bionanocomposites, respectively. The Crystallinity index (CI) of untreated and treated bionanocomposites was measured using X-ray Diffraction (XRD). The average diameter of NFC water hyacinth was 10–20 nm. The maximum tensile strength (TS) and modulus elasticity (ME) of the bionanocomposite was 11.4 MPa and 443 MPa respectively, after 60 min UVT. This result was supported by SEM which indicated good dispersion and compact structure.

Clinical Application of Real-Time Shear Wave Elastography in Identifying the Histological Components of Parotid Adenolymphoma.

This study aimed to investigate the relationship between the elastic modulus and the histological components of parotid adenolymphoma by using real-time shear wave elastography. A total of 157 patients, histologically confirmed as having parotid adenolymphoma, were enrolled in the study. The maximum and the mean elastic modulus of the parotid mass were measured by using preoperative shear wave elastography. Parotid adenolymphoma was histopathologically subdivided into different types based on the relative proportion of stromal to cellular components. The maximal elasticity of parotid adenolymphoma ranged from 20.67 to 160.90 kPa, and the mean elasticity was 83.18 ± 39.15 kPa. The maximal elasticity of the 3 types of parotid adenolymphoma was 34.21 to 155.20, 20.67 to 104.20, and 45.89 to 160.90 kPa, respectively. The mean elasticity of the 3 types of parotid adenolymphoma was 89.16 ± 40.62, 63.24 ± 28.07, and 111.10 ± 37.85 kPa, respectively. The difference in the maximal elasticity among 3 groups was significant (P < 0.01). There was no significant difference in maximal elasticity of type II and type III as compared with type I adenolymphoma (P > 0.05). The maximal elasticity of type III adenolymphoma was significantly higher than that of type II (P < 0.05, t = 3.12). Shear wave elastography depicts parotid adenolymphoma with a variable appearance because of the relative proportions of stromal to cellular contents in the mass.

Tumor stiffness measured by quantitative and qualitative shear wave elastography of breast cancer.

To correlate clinicoradiologic and pathological features of breast cancer with quantitative and qualitative shear wave elastographic parameters. 82 breast cancers in 75 patients examined by B-mode ultrasound and shear wave elastography (SWE) were included. SWE parameters including quantitative factors [maximum elasticity (Emax), mean elasticity (Emean), elasticity ratio (Eratio) and standard deviation (SD)] and qualitative factor (color pattern) were correlated with clinicoradiologic and pathological features using univariate and multivariate linear regression analyses. Presence of symptoms and larger tumor size on ultrasound were significantly associated with higher Emax, Emean, Eratio, and SD (all p < 0.05) on univariate analysis. Older age was significantly correlated with higher Emax and Emean (p = 0.026, 0.018). Lymphovascular invasion and larger pathologic size were significantly associated with higher Emax (p = 0.036, 0.043) and SD (p < 0.001, 0.019). No immunohistochemical biomarkers were significantly correlated with SWE parameters. There was no significant correlation between color pattern and any variable. Multivariate logistic regression analysis showed that the symptom, tumor size on ultrasound and lymphovascular invasion were independent factors that influenced the SWE values. Tumor stiffness as measured by SWE and B-mode ultrasound could help predict cancer prognosis. Advances in knowledge: Clinicoradiologic factors had correlation with quantitative and qualitative SWE parameters. Using SWE parameters and B-mode ultrasound, we can predict breast cancer prognosis.

Ultrasound shear wave elastography of breast lesions: correlation of anisotropy with clinical and histopathological findings

BackgroundUltrasound shear-wave elastography (SWE) may increase specificity of breast lesion assessment with ultrasound, but elasticity measurements may change with transducer orientation, defined as anisotropy. In this study, we aimed to observe the anisotropy of SWE of breast lesions, and its correlation with clinical and histopathological findings.MethodsThis retrospective study was approved by institutional review board. From June 2014 to June 2015, a total of 276 women (mean age, 48.75 ± 12.12 years) with 276 breast lesions (174 malignant, 102 benign) were enrolled for conventional ultrasound and SWE before surgical excision. Elasticity modulus in the longest diameter and orthogonal diameter were recorded, including maximum elasticity (Emax), mean elasticity (Emean), standard deviation (Esd) and ratio between mean elasticity of lesion and normal fatty tissue (Eratio). Anisotropy coefficients including anisotropic difference (AD) and anisotropy factors (AF) were calculated, and correlations with malignancy, tumor size, palpability, movability, lesion location and histopathology were analyzed.ResultsThe average Emax, Emean, Esd and Eratio of the longest diameter were significantly higher than orthogonal diameter (P < 0.05). AUCs of ADs and AFs were inferior to quantitative parameters (P < 0.001), with AUCs of AFs superior to ADs (P < 0.001). ADs showed no significant correlation with malignancy, palpability, movability, distance from nipple and skin, and histopathological patterns. ADmean was significantly higher in inner half than outer half of the breast (P = 0.034). Higher AFs were significantly correlated with larger lesion size (P = 0.042), palpability (P < 0.05), shorter distance from nipple and skin (P < 0.05) and higher suspicion for malignancy (P < 0.001). AFs were significantly higher in IDC than DCIS (P < 0.05), higher in Grade II/III than Grade I IDC (P < 0.001), and correlated with ER/PR(+) (P < 0.05).ConclusionsAF of SWE was an indicator for malignancy and more aggressive breast cancer.

Differentiation of Benign and Malignant Thyroid Nodules by Using Comb-push Ultrasound Shear Elastography: A Preliminary Two-plane View Study

Low specificity of traditional ultrasound in differentiating benign from malignant thyroid nodules leads to a great number of unnecessary (ie, benign) fine-needle aspiration biopsies that causes a significant financial and physical burden to the patients. Ultrasound shear wave elastography is a technology capable of providing additional information related to the stiffness of tissues. In this study, quantitative stiffness values acquired by ultrasound shear wave elastography in two different imaging planes were evaluated for the prediction of malignancy in thyroid nodules. In addition, the association of elasticity measurements with sonographic characteristics of thyroid gland and nodules is presented. A total number of 155 patients (106 female and 49 male) (average age 57.48 ± 14.44 years) with 173 thyroid nodules (average size 24.89 ± 15.41 mm, range 5-68 mm) scheduled for fine-needle aspiration biopsy were recruited from March 2015 to May 2017. Comb-push shear elastography imaging was performed at longitudinal and transverse anatomic planes. Mean (Emean) and maximum (Emax) elasticity values were obtained. Measurements at longitudinal view were statistically significantly higher than measurements at transverse view. Nodules with calcifications were associated with increased elasticity, and nodules with a vascular component or within an enlarged thyroid gland (goiter) were associated with a lower elasticity value. Receiver operating characteristic curve analysis was performed for Emean and Emax at each imaging plane and for the average of both planes. Sensitivity of 95.45%, specificity of 86.61%, 0.58 positive predictive value, and 0.99 negative predictive value were achieved by the average of the two planes for each Emean and Emax parameters, with area under the curve of 92% and 93%, and a cutoff value of 49.09 kPa and 105.61 kPa, respectively. The elastic properties of thyroid nodules showed promise to be a good discriminator between malignant and benign nodules (P < .0001). However, probe orientation and internal features such as calcifications, vascular component, and goiter may influence the final elastography measurements. A larger number of malignant nodules need to be studied to further validate our results.

Rheological characterizations of concentrated binary gum mixtures with xanthan gum and galactomannans

The steady and dynamic shear rheological properties of binary gum mixtures with xanthan gum (XG) and galactomannans (guar gum (GG) and locust bean gum (LBG)) were examined in a concentrated solution (1% w/w) as a function of gum mixing ratio (100/0, 75/25, 50/50, and 0/100). All samples, except for individual GG and LBG, showed high shear-thinning behavior with yield stress. The values of flow (K, ηa,50, and σoc) and dynamic rheological parameters (G′ and G″) of XG-GG and XG-LBG mixtures were significantly higher compared to XG alone, indicating that the flow and viscoelastic properties of binary gum mixtures were greatly affected by the addition of GG and LBG. The maximum elasticity synergistic interaction for XG-galactomannans mixtures was observed at a mixing ratio of 50/50, showing a greatly positive deviation between measured and calculated values of G′. These results suggest that the synergistic effect of GG and LBG addition on rheological properties of XG appears to be due to intermolecular interaction occurred between XG and galactomannans, as confirmed by dynamic rheological properties.

Correlation between elastic parameters and collagen fibre features in breast lesions

To correlate elastic parameters with collagen fibre shape and arrangement features in breast lesions. Shear-wave elastography (SWE) was used to measure the stiffness of breast lesions in 54 patients before surgical removal. The value of stiffness was expressed as the mean and maximum elasticity (Emean and Emax). Lesions were sliced and stained with picric acid-sirius red to display the extracellular matrix (ECM) collagen fibre. The categories of the collagen fibres were based on the shape and arrangement features, i.e., category 0, wavy collagen fibres similar to normal breast tissue; category 1, taut parallel collagen fibres around tumour nests; category 2, straightened and aligned collagen fibres tending to be perpendicular to the tumour boundary; category 3, collagen fibre in a honeycomb arrangement. Bivariate correlation analysis was used to analyse the relationship between elastic parameters and collagen fibre category. For all 54 lesions, the correlation coefficient between Emean and category was 0.693 (p<0.001), and between Emax and category was 0.794 (p<0.001). For 36 malignant lesions, the correlation coefficient between Emean and category was 0.658 (p<0.001), and between Emax and category was 0.771 (p<0.001). Emean and Emax of breast lesions evaluated by SWE were positively correlated with ECM collagen fibre shape and arrangement category. Changes of ECM collagen fibre shape and arrangement may account for the stiffness variations of breast lesions.

Investigation of Fracturing and Adhesion Behavior of Hydroxapatite Coating Formed by Aminoacetic Acid-Sodium Aminoacetate Buffer Systems

Biomaterials utilized in implantation can be categorized into 4 main categories, as ceramics, polymers, metals and composites. Ceramic-based biomaterials are opted for, particularly in the field of orthopedics. These materials, also named as bioceramics, are usually employed by coating them onto the base material, inasmuch as they are far from the mechanical values of bone. In this study, a hydroxyapatite coating that is fully compatible with human blood plasma was applied on Ti6Al4V alloy through a biomimetic technique using aminoacetic acid-sodium aminoacetate buffer system for the first time in the literature, and examinations related thereto were carried out. The surface of the base material Ti6Al4V alloy was activated with various chemicals. Subsequent to activating the surface, a coating process whereby the base material was kept in simulated body fluid for 24, 48, 72, 96 h was carried out. Ultimate microhardness (indentation) tests were performed to determine the average indentation depths in maximum load, vickers hardness and elasticity modulus of the coatings obtained by using the biomimetic method, while scratch tests were performed to measure the surface bonding strengths of the coating layers. Furthermore, the fracture toughness values of the coating were calculated. The results obtained through the study are evaluated and discussed.

ASSESSMENT OF BILIOSTATIC PROPERTIES OF MODERN TOPIC HEMOSTATIC MEANS USED IN HEPATIC SURGERY

Aim. To assess the biliostatic properties of modern topic hemostatic means and the developed glue composition for medical purpose, used in hepatic surgery in experiment. Materials and methods. The studies, aimed at assessment of the properties of local hemostatic means, were carried out on Wistar rats weighing 178 ± 10 g. The device for determination of leak proofness of hepatic stump with hydropression technique was used. Comparative estimation of elasticity and adhesive strength of hemostatic means, using tension testing machine “REM-10”, was fulfilled. Original polyurethane glue for medical purposes was developed and studied. Results. The glue compositions “Bioglue”, hemostatic sponge “Tachocomb” and original polyurethane composition for medical purposes with adhesive strength &gt; 600 Pa (mm H2O) ( p &lt; 0.05) possess the best adhesive properties. It was established on the basis of experimental data that the glue composition “Bioglue” and polyurethane glue composition have a high adhesive strength, elasticity and resistance to hydropression. Conclusions. 1. Glue compositions possess higher adhesion and endure higher level of pressure as compared with sponges and plates. Original polyurethane composition has maximum adhesive strength, elasticity and hydropression resistance. 2. After application of original polyurethane glue composition on resected liver (in experiment), it is completely lysed in 30-35 days.

Softer is Harder: What Differentiates Soft Robotics from Hard Robotics?

ABSTRACTThis paper reports on what differentiates the field of soft (i.e. soft-bodied) robotics from the conventional hard (i.e. rigid-bodied) robotics. The main difference centres on seamlessly combining the actuation, sensing, motion transmission and conversion mechanism elements, electronics and power source into a continuum body that ideally holds the properties of morphological computation and programmable compliance (i.e. softness). Another difference is about the materials they are made of. While the hard robots are made of rigid materials such as metals and hard plastics with a bulk elastic modulus of as low as 1 GPa, the monolithic soft robots should be fabricated from soft and hard materials or from a strategic combination of them with a maximum elasticity modulus of 1 GPa. Soft smart materials with programmable mechanical, electrical and rheological properties, and conformable to additive manufacturing based on 3D printing are essential to realise soft robots. Selecting the actuation concept and its power source, which is the first and most important step in establishing a robot, determines the size, weight, performance of the soft robot, the type of sensors and their location, control algorithm, power requirement and its associated flexible and stretchable electronics. This paper outlines how crucial the soft materials are in realising the actuation concept, which can be inspired from animal and plant movements.

Sodium ionic conductivity and stability of amorphous Na2O·2SiO2 added with MxOy (M = Zr, Y, and Sm)

Amorphous Na2O·2SiO2 (A-Na2O·2SiO2) is one of the promising sodium ionic conductors for solid-state sodium-ion battery electrolytes owing to its easy preparation and low production cost. However, Na2O·2SiO2 glass suffers from relatively low conductivity and poor thermal stability as a result of crystallization and other defects. Herein, we improved the ionic conductivity and thermal stability of A-Na2O·2SiO2 by adding this material with metal oxides (MxOy, M=Y, Sm, and Zr) at varying loadings. The physical properties and stability of the A-Na2O·2SiO2 added with different oxides were systematically investigated. The results indicated that oxide adding on A-Na2O·2SiO2 resulted in larger density values that increased with the adding content. Additionally, oxide adding changed the strength of the SiO bond in A-Na2O·2SiO2, thereby affecting the overall network structure and uniformity. Among the different oxides prepared, added with 3mol% Sm2O3, 3mol% Y2O3, and 2mol% ZrO2 showed maximum hardness and elasticity modulus values. Additionally, oxide adding on A-Na2O·2SiO2 resulted in significantly improved ionic conductivity values. 3mol% Y2O3-added A-Na2O·2SiO2 material showed the highest ionic conductivity value (5.2×10−3Scm−1) and optimum thermal stability, indicating that Y2O3-added Na2O·2SiO2 has high potential to be high-performance and stable sodium ionic conductors.

Three-Dimensional Shear Wave Elastography for Differentiating Benign From Malignant Thyroid Nodules.

To prospectively evaluate the diagnostic performance of 3-dimensional (3D) shear wave elastography (SWE) for assessing thyroid nodules. A total of 176 surgically or cytologically confirmed thyroid nodules (63 malignant and 113 benign) in 176 patients who had undergone conventional ultrasound (US), 2-dimensional (2D) SWE, and 3D SWE examinations were included in this study. Quantitative elasticity values (mean elasticity, maximum elasticity, and standard deviation of elasticity of a large region of interest and mean elasticity of a 2-mm region of interest) were measured on 2D and 3D SWE. Diagnostic performances of conventional US, 2D SWE, and 3D SWE were assessed. The role of 2D and 3D SWE in reducing unnecessary fine-needle aspiration (FNA) for nodules with low suspicion was also evaluated. The diagnostic performances in terms of the area under the receiver operating characteristic curve were 0.612 for conventional US, 0.836 for 2D SWE (P < .001 in comparison with conventional US), and 0.839 for 3D SWE (P < .001 in comparison with conventional US). The mean elasticity achieved the highest diagnostic performance in 2D SWE, whereas the standard deviation of elasticity achieved the highest performance in 3D SWE, although no significant difference was found between them (P > .05). Three-dimensional SWE increased the specificity in comparison with 2D SWE (88.5% versus 82.3%; P = .039). For the 37 nodules with low suspicion on conventional US imaging, 2D SWE was able to avoid unnecessary FNA in 77.1% (27 of 35) of benign nodules, and 3D SWE further increased the number to 88.6% (31 of 35). Three-dimensional SWE is a useful tool for predicting thyroid nodule malignancy and reducing unnecessary FNA procedures in thyroid nodules with low suspicion of malignancy.

Shear-wave elastography quantitative assessment of the male breast: added value to distinguish benign and malignant palpable masses.

To evaluate the ability of shear-wave elastography (SWE) to distinguish between benign and malignant palpable masses of the adult male breast. Clinical examination, mammography, B-mode and Doppler ultrasound findings and SWE quantitative parameters were compared in 50 benign lesions (including 40 gynaecomastias) and 15 malignant lesions (invasive ductal carcinomas) from 65 patients who were consecutively addressed for specialized advice at our comprehensive cancer centre. Mean elasticity (El mean), maximum elasticity (El max), El mean of the surrounding fatty tissue and lesion to fat ratio (El ratio) were reported for each patient. Malignant masses displayed significantly higher El mean (p < 0.0001), El max (p < 0.0001) and El ratio (p < 0.0001) compared to benign masses without overlap of values between the two groups. By adding SWE to clinical examination, mammography and ultrasound, all the lesions would have been retrospectively correctly diagnosed as benign or malignant. One false positive could have been downstaged, 14/65 undetermined masses could have been correctly reclassified as 4 malignant and 10 benign lesions, for which biopsies could have consequently been avoided. Evaluation of male breast palpable masses by SWE demonstrates that malignant masses are significantly stiffer lesions and may improve diagnostic management when clinical examination, mammography and conventional ultrasound are doubtful. Advances in knowledge: Quantitative SWE is feasible in male breast and could be of great interest to help classify doubtful lesions after classical clinical and radiological evaluations, probably because of different anatomy and different tumours epidemiology compared with female breast.

Power Doppler Ultrasonography and Shear Wave Elastography as Complementary Imaging Methods for Suspected Local Breast Cancer Recurrence.

To prospectively investigate the diagnostic accuracy and clinical consequences of power Doppler morphologic criteria and shear wave elastography (SWE) as complementary imaging methods for evaluation of suspected local breast cancer recurrence in the ipsilateral breast or chest wall. Thirty-two breast masses with a suspicion of local breast cancer recurrence on B-mode ultrasonography underwent complementary power Doppler and SWE evaluations. Power Doppler morphologic criteria were classified as avascular, hypovascular, or hypervascular. Shear wave elastography was classified according to a 5-point scale (SWE score) and SWE maximum elasticity. Diagnostic accuracy was assessed by the sensitivity, specificity, and area under the curve. A decision curve analysis assessed clinical consequences of each method. The reference standard for diagnosis was defined as core needle or excisional biopsy. Histopathologic examinations revealed 9 (28.2%) benign and 23 (71.8%) malignant cases. Power Doppler ultrasonography (US) had sensitivity of 34.8% (95% confidence interval [CI], 6.6%-62.9%) and specificity of 45.4% (95% CI, 19.3%-71.5%). The SWE score (≥3) had sensitivity of 87.0% (95% CI, 66.4%-97.2%) and specificity of 44.4% (95% CI, 13.7%-78.8%). The SWE maximum elasticity (velocity > 6.5cm/s) had sensitivity of 87% (95% CI, 66.4%-97.2%) and specificity of 77.8% (95% CI, 40.0% to 97.2%). The areas under the curves for the SWE score and SWE maximum elasticity were 0.71 (95% CI, 0.53-0.87) and 0.82 (95% CI, 0.64-0.93), respectively (P = .32). Power Doppler US is unsuitable for discrimination between local breast cancer recurrence and fibrosis. Although the SWE score and SWE maximum elasticity can make this discrimination, the use of these methods to determine biopsy may lead to poorer clinical outcomes than the current practice of performing biopsies of all suspicious masses.

A sequence of physical processes quantified in LAOS by continuous local measures

The response to large amplitude oscillatory shear of a soft colloidal glass formed by a suspension of multiarm star polymers is investigated by means of well-defined continuous local measures. The local measures provide information regarding the transient elastic and viscous response of the material, as well as elastic extension via a shifting equilibrium position. It is shown that even when the amplitude of the strain is very large, cages reform and break twice per period and exhibit maximum elasticity around the point of zero stress. It is also shown that around the point of zero stress, the cages are extended by a nearly constant amount of approximately 5% at 1 rad/s and 7% at 10 rad/s, even when the total strain is as large as 420%. The results of this study provide a blueprint for a generic approach to elucidating the complex dynamics exhibited by soft materials under flow.

Changes in rheological properties of wheat due to storage.

The present study aimed to investigate changes in the fundamental rheological properties of dough prepared from wheat grains stored for 6 months at 20 °C, at ambient temperature (temperature varied with time) and at 4 °C. Stress/shear rate ramp, oscillation and creep-recovery tests were performed to assess the changes in rheological properties as a result of storage. Samples were observed to be non-Newtonian; thus, the Bingham model estimated the yield stress, which was maximum for the wheat stored under ambient conditions and minimum for wheat stored at 20 °C. The stress required to break the bonds was maximum for wheat-dough stored under ambient conditions and minimum for wheat stored at 20 °C. Wheat stored at 20 °C also had the highest maximum creep and recovery strain. The viscoelastic properties of the three wheat-dough samples were compared. The results obtained in the present study show that the wheat-dough prepared under ambient conditions behaves as a rigid and stiff material. The dough prepared from wheat stored at 20 °C had the maximum elasticity. © 2017 Society of Chemical Industry.

The effects of a rise in cigarette price on cigarette consumption, tobacco taxation revenues, and of smoking-related deaths in 28 EU countries-- applying threshold regression modelling

BackgroundEuropean Union public healthcare expenditure on treating smoking and attributable diseases is estimated at over €25bn annually. The reduction of tobacco consumption has thus become one of the major social policies of the EU. This study investigates the effects of price hikes on cigarette consumption, tobacco tax revenues and smoking-caused deaths in 28 EU countries.MethodsEmploying panel data for the years 2005 to 2014 from Euromonitor International, the World Bank and the World Health Organization, we used income as a threshold variable and applied threshold regression modelling to estimate the elasticity of cigarette prices and to simulate the effect of price fluctuations.ResultsThe results showed that there was an income threshold effect on cigarette prices in the 28 EU countries that had a gross national income (GNI) per capita lower than US$5418, with a maximum cigarette price elasticity of −1.227. The results of the simulated analysis showed that a rise of 10% in cigarette price would significantly reduce cigarette consumption as well the total death toll caused by smoking in all the observed countries, but would be most effective in Bulgaria and Romania, followed by Latvia and Poland. Additionally, an increase in the number of MPOWER tobacco control policies at the highest level of achievment would help reduce cigarette consumption.ConclusionsIt is recommended that all EU countries levy higher tobacco taxes to increase cigarette prices, and thus in effect reduce cigarette consumption. The subsequent increase in tobacco tax revenues would be instrumental in covering expenditures related to tobacco prevention and control programs.

The value of quantitative shear wave elastography in differentiating the cervical lymph nodes in patients with thyroid nodules.

This study aimed at evaluating the diagnostic performance of quantitative shear wave elastography (SWE) in differentiating metastatic cervical lymph nodes from benign nodes in patients with thyroid nodules. One hundred and forty-one cervical lymph nodes from 39 patients with thyroid nodules that were diagnosed as papillary thyroid cancer had been imaged with SWE. The shear elasticity modulus, which indicates the stiffness of the lymph nodes, was measured in terms of maximum shear elasticity modulus (maxSM), minimum shear elasticity modulus (minSM), mean shear elasticity modulus (meanSM), and standard deviation (SD) of the shear elasticity modulus. All the patients underwent thyroid surgery, 50 of the suspicious lymph nodes were resected, and 91 lymph nodes were followed up for 6months. The maxSM value, minSM value, meanSM value, and SD value of the metastatic lymph nodes were significantly higher than those of the benign nodes. The area under the curve of the maxSM value, minSM value, meanSM value, and SD value were 0.918, 0.606, 0.865, and 0.915, respectively. SWE can differentiate metastasis from benign cervical lymph nodes in patients with thyroid nodules, and the maxSM, meanSM, and SD may be valuable quantitative indicators for characterizing cervical lymph nodes.

Impact of region of interest (ROI) size on the diagnostic performance of shear wave elastography in differentiating solid breast lesions.

Background Shear wave elastography (SWE) using a region of interest (ROI) can demonstrate the quantitative elasticity of breast lesions. Purpose To prospectively evaluate the impact of two different ROI sizes on the diagnostic performance of SWE for differentiating benign and malignant breast lesions. Material and Methods A total of 154 breast lesions were included. Two types of ROIs were investigated: one involving an approximately 2-mm diameter, small round ROIs placed over the stiffest area of the lesion, as determined by SWE (ROI-S); and another ROI drawn along the margin of the lesion using a touch pen or track ball to encompass the entire lesion (ROI-M). Maximum elasticity (Emax), mean elasticity (Emean), minimum elasticity (Emin), and standard deviation (SD) were measured for the two ROIs. The area under the receiver operating characteristic curve (AUC) as well as the sensitivity and specificity of each elasticity value were determined. Results The AUCs for ROI-S were higher than those for ROI-M when differentiating benign and malignant breast solid lesions. The Emax, Emean, Emin, and SD of the elasticity values for ROI-S were 0.865, 0.857, 0.816, and 0.849, respectively, and for ROI-M were 0.820, 0.780, 0.724, and 0.837, respectively. However, only Emax ( P = 0.0024) and Emean ( P = 0.0015) showed statistically significant differences. For ROI-S, the sensitivity and specificity of Emax were 78.8% and 84.3%, respectively, and those for Emean were 80.8% and 81.4%, respectively. Conclusion Using ROI-S with Emax and Emean has better diagnostic performance than ROI-M for differentiating between benign and malignant breast lesions.