Discrimination of ß-cyclodextrin/hazelnut (Corylus avellana L.) oil/flavonoid glycoside and flavonolignan ternary complexes by Fourier-transform infrared spectroscopy coupled with principal component analysis.

The goal of the study was the discrimination of ß-cyclodextrin (ß-CD)/hazelnut (Corylus avellana L.) oil/antioxidant ternary complexes through Fourier-transform infrared spectroscopy coupled with principal component analysis (FTIR-PCA). These innovative complexes combine the characteristics of the three components and improve the properties of the resulting material such as the onsite protection against oxidative degradation of hazelnut oil unsaturated fatty acid glycerides. Also, the apparent water solubility and bioaccessibility of the hazelnut oil components and antioxidants can be increased, as well as the controlled release of bioactive compounds (fatty acid glycerides and antioxidant flavonoids, namely hesperidin, naringin, rutin, and silymarin). The appropriate method for obtaining the ternary complexes was kneading the components at various molar ratios (1:1:1 and 3:1:1 for ß-CD hydrate:hazelnut oil (average molar mass of 900 g/mol):flavonoid). The recovering yields of the ternary complexes were in the range of 51.5-85.3% and were generally higher for the 3:1:1 samples. The thermal stability was evaluated by thermogravimetry and differential scanning calorimetry. Discrimination of the ternary complexes was easily performed through the FTIR-PCA coupled method, especially based on the stretching vibrations of CO groups in flavonoids and/or CO/CC groups in the ternary complexes at 1014.6 (± 3.8) and 1023.2 (± 1.1) cm-1 along the second PCA component (PC2), respectively. The wavenumbers were more appropriate for discrimination than the corresponding intensities of the specific FTIR bands. On the other hand, ternary complexes were clearly distinguishable from the starting ß-CD hydrate along the first component (PC1) by all FTIR band intensities and along PC2 by the wavenumber of the asymmetric stretching vibrations of the CH groups at 2922.9 (± 0.4) cm-1 for ternary complexes and 2924.8 (± 1.4) cm-1 for ß-CD hydrate. The first two PCA components explain 70.38% from the variance of the FTIR data (from a total number of 26 variables). Other valuable classifications were obtained for the antioxidant flavonoids, with a high similarity for hesperidin and naringin, according to FTIR-PCA, as well as for ternary complexes depending on molar ratios. The FTIR-PCA coupled technique is a fast, nondestructive and cheap method for the evaluation of quality and similarity/characteristics of these new types of cyclodextrin-based ternary complexes having enhanced properties and stability.

Contrast-Enhanced Ultrasonography in the Diagnosis and Treatment Modulation of Breast Cancer.

The aim of this paper is to highlight the role of contrast-enhanced ultrasound in breast cancer in terms of diagnosis, staging and follow-up of the post-treatment response. Contrast-enhanced ultrasound (CEUS) is successfully used to diagnose multiple pathologies and has also clinical relevance in breast cancer. CEUS has high accuracy in differentiating benign from malignant lesions by analyzing the enhancement characteristics and calculating the time-intensity curve's quantitative parameters. It also has a significant role in axillary staging, especially when the lymph nodes are not suspicious on clinical examination and have a normal appearance on gray-scale ultrasound. The most significant clinical impact consists of predicting the response to neoadjuvant chemotherapy, which offers the possibility of adjusting the therapy by dynamically evaluating the patient. CEUS is a high-performance, feasible, non-irradiating, accessible, easy-to-implement imaging method and has proven to be a valuable addition to breast ultrasound.

Proteomics of regenerated tissue in response to a titanium implant with a bioactive surface in a rat tibial defect model.

Due to their excellent mechanical and biocompatibility properties, titanium-based implants are successfully used as biomedical devices. However, when new bone formation fails for different reasons, impaired fracture healing becomes a clinical problem and affects the patient's quality of life. We aimed to design a new bioactive surface of titanium implants with a synergetic PEG biopolymer-based composition for gradual delivery of growth factors (FGF2, VEGF, and BMP4) during bone healing. The optimal architecture of non-cytotoxic polymeric coatings deposited by dip coating under controlled parameters was assessed both in cultured cells and in a rat tibial defect model (100% viability). Notably, the titanium adsorbed polymer matrix induced an improved healing process when compared with the individual action of each biomolecules. High-performance mass spectrometry analysis demonstrated that recovery after a traumatic event is governed by specific differentially regulated proteins, acting in a coordinated response to the external stimulus. Predicted protein interactions shown by STRING analysis were well organized in hub-based networks related with response to chemical, wound healing and response to stress pathways. The proposed functional polymer coatings of the titanium implants demonstrated the significant improvement of bone healing process after injury.

Cardiovascular magnetic resonance: contribution to the exploration of cardiomyopathies.

BACKGROUND AND AIMS: Magnetic resonance imaging is a non-invasive and non-irradiating imaging method, complementary to cardiac ultrasound in the assessment of cardiovascular disease and implicitly of cardiomyopathies. Although it is not a first intention imaging method, it is superior in the assessment of cardiac volumes, left ventricular ejection fraction, in the analysis of cardiac wall dyskinesia and myocardial tissue characteristics with and without using a contrast agent. The purpose of this paper is to review the current knowledge regarding cardiovascular magnetic resonance imaging (CMR) and its applications in cardiomyopathy analysis. METHODS: In order to create this review, relevant articles were searched and analyzed by using MeSH terms such as: "cardiac magnetic resonance imaging", "cardiomyopathy", "myocardial fibrosis". Three main international databases PubMed, Web of Science and Medscape were searched. We carried out a narrative review focused on the current indications of cardiovascular magnetic resonance imaging in cardiomyopathies, both common and raret, of ischemic and nonischemic types. RESULTS: Cardiac magnetic resonance imaging has a very important role in the diagnosis, assessment and prognosis of common cardiomyopathies (the dilated, hypertrophic and inflammatory types) or other more rare ones such as (amyloidosis, arrhythmogenic right ventricular, non-compaction or Takotsubo cardiomyopathy), as it represents the gold standard for evaluating the ejection fraction, ventricular volumes and mass. CMR techniques, such as late gadolinium enhancement, T1 and T2 mapping have proven their usefulness, helping differentiate between ischemic (subendocardial enhancement) and nonischemic cardiomyopathy (varied pattern) or also establish the etiology. Another important feature of this imaging technique is that it can establish the myocardial viability, thus the chance of contractile recovery after revascularization. This feature is based on the transmural extent of LGE, left ventricle wall thickness and the assessment of the contractile reserve after administration of low dose dobutamine. CONCLUSIONS: Cardiovascular magnetic resonance imaging is an indispensable tool, with proven efficiency, capable of providing the differential diagnosis between ischemic and nonischemic cardiomyopathy or establishing the etiology in the nonischemic type. In addition, these findings have a prognostic value, they may guide the patient management plan and, if necessary, can evaluate treatment response. Therefore, this technique should be part of any routine investigation of various cardiomyopathies.

Strain Elastography (SE) for liver fibrosis estimation - which elastic score to calculate?

Liver fibrosis scoring by liver biopsy has become a rarity in daily practice mainly because many non-invasive methods with similar accuracy have been developed. Among all ultrasound elastography imaging methods, Strain Elastography (SE) is the most widely available. Although SE is a qualitative and semi-quantitative method, there is reliable applicability for liver fibrosis estimation and multiple ways to transform SE into a quantitative method, in order to obtain a fibrosis score. The aim of this review is to briefly introduce all these methods and to offer support in choosing the best estimation method for liver fibrosis, with SE.

The ultrasonographic diagnosis of cystic cervical lesions: a pictorial essay.

The importance of ultrasonographic (US) examination in the evaluation of the superficial structures of the head and neck region is increasing due to the widespread availability of modern equipment (such as high-frequency transducers) and modern techniques. In the case of a cervical lesion, ultrasound is usually the first imaging method used to assess the changes. First of all, US is capable of differentiating between cystic and solid structures, and based on the US appearance correlated with the age of the patient, location and growing pattern, the appropriate diagnosis is possible with a high accuracy. The aim of the present paper is to describe the US features of the most common cystic lesions encountered in the head and neck region.

Multimodal endocavitary ultrasound versus MRI and clinical findings in pre- and post-treatment advanced cervical cancer. Preliminary report.

AIMS: The aim of this study was to evaluate the use of pre and post-therapy transrectal and transvaginal ultrasonography (TRUS, TVUS) with contrast enhancement and strain elastography compared with clinical examination and magnetic resonance imaging (MRI) in the assessment of advanced stage cervical cancer. MATERIAL AND METHODS: This was a prospective study, carried out over a period of nine months on subjects with advanced-stage cervical cancer (stage >/= IIB). All included patients were examined clinically and underwent abdomino-pelvic contrast enhanced MRI and multimodal US examinations (TRUS with strain elastography and contrast enhanced TVUS) at the time of diagnosis and after radiochemotherapy. Tumor size and staging at TRUS and TVUS was compared with the same data obtained by clinical examination and MRI. Pathology was the golden standard. RESULTS: Eight patients accomplished the inclusion criteria. In five cases the tumor stage was identical on clinical and MRI examinations. In all cases parametrial infiltration was diagnosed by all pre-treatment examinations. No significant differences were observed in tumor size between clinical, US and MRI exams either at baseline or post-therapy, in native or post-contrast examinations. The size of the tumor evaluated pre-treatment proved to be significantly smaller post-contrast in both US and MRI examinations compared with the native images. Post-therapy, no significant differences were observed on US measured tumor dimensions when comparing native with post-contrast images. Oppositely, significant smaller dimensions were observed on post-contrast MRI compared with native scans. CONCLUSIONS: TRUS is accurate in the estimation of pre-therapy cervical cancer dimension. The post therapy tumor evaluation is better performed with MRI. The use of intravenous contrast agents on both examinations did not improved the accuracy of tumor evaluation pre or post-therapy.

Assessment of Cutaneous Melanoma by Use of Very- High-Frequency Ultrasound and Real-Time Elastography.

OBJECTIVE: The primary objective of this study was to evaluate the usefulness of very-high-frequency ultrasound as tool for assessment of skin melanoma by investigation of the correlation between the ultrasound measurement of the thickness of a melanoma and the histopathologically measured Breslow index. The secondary objective was to assess the potential role of real-time elastography in the preoperative evaluation of skin melanoma. SUBJECTS AND METHODS: The study included 42 cutaneous melanoma lesions in 39 adult subjects examined in the division of ultrasound of a department of radiology between September 2011 and January 2015. Gray-scale sonographic features at 40 MHz (thickness, echogenicity, contour) and real-time strain elastographic (qualitative and semiquantitative, strain ratio) characteristics were evaluated and compared with the pathologic results. RESULTS: The melanoma lesions had a homogeneous hypoechoic appearance with a regular contour and stiff or medium consistency. The mean difference between Breslow index and ultrasound thickness was -0.05 mm (95% CI, -0.24 to 0.13 mm), sustaining the absence of significant differences between these two measurements. A strong relation was identified between real-time elastographic appearance and strain ratio for the relations between lesion and hypodermis and between lesion and neighboring dermis (p < 0.002) or hypodermis. CONCLUSION: Our study showed that very-high-frequency ultrasound and real-time elastography can be useful examinations for comprehensive preoperative evaluation of cutaneous melanoma.

Doppler ultrasound and strain elastography in the assessment of cutaneous melanoma: preliminary results.

AIM: To study the usefulness of color or power Doppler ultrasound (US) in the pre-surgical evaluation of skin melanoma, and to correlate the Doppler characteristics with the appearance on high frequency ultrasound strain elastography (SE) in the preoperative evaluation of cutaneous melanoma. MATERIALS AND METHOD: The study included 42 cutaneous melanoma lesions in 39 adult subjects examined between September 2011 and January 2015. Doppler US features (the presence and aspect of vascularization, and the number of vascular pedicles) and elasticity by strain elastography were evaluated together with the pathological results. RESULTS: The melanoma lesions presented hyper-vascularization, with multiple vascular pedicles and stiff appearance. Significant correlations between the thickness of the tumor, measured histopathologically by the Breslow index, and the degree of vascularization (p=0.0167), and number of vascular pedicles (p=0.0065) were identified. Strong correlations between the SE appearance and vascularization on one hand, and SE and the number of vascular pedicles were also identified (p<0.001). CONCLUSION: Our study demonstrates that Doppler US and SE offer useful information for THE preoperative evaluation of cutaneous melanoma and may contribute to better defining the long term prognosis.

Ultrasound in the diagnosis of papillary breast lesions.

Papillary lesions are defined as an amalgam of various lesions which represent a diagnostic challenge, for both the radiologist and pathologist. They are diagnosed on the basis of a combination of clinical, imaging, and pathological findings and their features carry differing prognostic implications for the affected patients. The aim of this pictorial essay is to review the clinical and pathological findings in papillary breast lesions, to show the advantages and limits of each imaging method in their diagnosis with emphasis on the importance of ultrasound in the differential diagnosis. Also, the spectrum of ultrasound features (conventional, Doppler ultrasound and elastography) of papillary lesions of the breast will be illustrated.

Ultrasonography of desmoplatic fibroma of the mandible; a case report.

Desmoplastic fibroma (DF) is a very rare bone tumor, classified as a benign lesion. It might be locally a very aggressive tumor with a high rate of recurrence after surgical resection. We present a case of a 3-year and 6 month-old patient, with mandibular desmoplastic fibroma. The clinical, imaging, histological findings and surgical treatment are discussed and, also, a brief review of the literature of DF is presented. The purpose of this case report is to emphasize the particularity of the case, ultrasound findings and the main differential diagnostic of this rare bone tumor.

Endoscopic ultrasound for the characterization and staging of rectal cancer. Current state of the method. Technological advances and perspectives.

Endoscopic ultrasound is the most accurate type of examination for the assessment of rectal tumors. Over the years, the method has advanced from gray-scale examination to intravenous contrast media administration and to different types of elastography. The multimodal approach of tumors (transrectal, transvaginal) is adapted to each case. 3D ultrasound is useful for spatial representation and precise measurement of tumor formations, using CT/MR image reconstruction; color elastography is useful for tumor characterization and staging; endoscopic ultrasound using intravenous contrast agents can help study the amount of contrast agent targeted at the level of the tumor formations and contrast wash-in/wash-out time, based on the curves displayed on the device. The transvaginal approach often allows better visualization of the tumor than the transrectal approach. Performing the procedure with the rectal ampulla distended with contrast agent may be seen as an optimization of the examination methodology. All these aspects are additional methods for gray-scale endoscopic ultrasound, capable of increasing diagnostic accuracy. This paper aims at reviewing the progress of transrectal and transvaginal ultrasound, generically called endoscopic ultrasound, for rectal tumor diagnosis and staging, with emphasis on the current state of the method and its development trends.

Characterization and staging of rectal tumors: endoscopic ultrasound versus MRI / CT. Pictorial essay.

Endoscopic ultrasound is recommended for rectal cancer staging. Transrectal ultrasound approach is able to overcome one of the limitations of this technique regarding circumferential rectal stenosis. Prior intrarectal administration of a small amount of fluid contrast agent optimizes the method, making it easier to distinguish the layers of the rectal wall and tumor formation. Endoscopic ultrasound focuses on the gray-scale mode. Additional procedures provide useful information for tumor assessment: Doppler ultrasound helps identify chaotic intratumoral vascularization; 3D ultrasound allows the assessment and accurate measurement of the tumor; elastography can identify focal tumor dysplasia within adenomas; contrast-enhanced ultrasound allows characterization of tumor microvasculature. Even if they are not as accurate in distinguishing rectal wall layers, cross-sectional imaging techniques (CT, MRI) can identify the anatomical relationships of advanced locoregional cancers, as well as possible distant metastasis. This paper aims at illustrating the main pathological aspects of endoscopic ultrasound multimodal examination useful for cancer staging.

Comparative study of three sonoelastographic scores for differentiation between benign and malignant cervical lymph nodes.

PURPOSE: The aim of the study was to explore the diagnostic value of three different sonoelastographic scoring systems (labeled S1-S3) for the differentiation between benign and malignant cervical lymph nodes. MATERIALS AND METHOD: The authors propose a six pattern scoring system of the elastographic images with pattern 1 - representing purely soft nodes, pattern 2 - predominantly soft nodes, pattern 3 - predominantly soft nodes with focal had area, pattern 4 - predominantly hard node, pattern 5 - entirely hard node and pattern 6 - node with necrosis. The sonoelastographic images of 50 benign and 70 malignant lymph nodes were assessed. The area under the ROC curve (AUROC) for the differentiation between benign vs. malignant and benign vs. metastatic nodes were analyzed for the three scoring systems. RESULTS: When all the malignant lymph nodes were considered, the S1 score showed an AUROC=0.873 (95%CI [0.805-0.918], where CI=confidence interval; p<0.001), sensibility (Se)=58.57%, and specificity (Sp)=96%. For S2 score the AUROC was 0.890 (95%CI [0.824-0.933], p<0.001), Se=92.86%, and Sp=72%. For S3 score, the AUROC was 0.852 (95%CI [0.778-0.902], p<0.001), Se=64.29%, and Sp=94%). When lymphomatous nodes were excluded, for S1 the AUROC was 0.884 (95%CI [0.809-0.932], p<0.001), Se=64%, and Sp=96%. For S2 the AUROC was 0.894 (95%CI [0.818-0.939], p<0.001), Se=92%, and Sp=72%. For S3, the AUROC was 0.856 (95%CI [0.771-0.911], p<0.001), Se=66%, and Sp=94%. In the S3 scoring system, setting the benign vs. malignant cut off at pattern 3 increases the sensibility (41-65%) with minimal loss of specificity (96-94%). From the gray-scale and Doppler criteria, changes of the nodular margins and the presence of the vessels in the cortical part of the lymph node showed both very high sensibility and specificity, the others criteria taken into account had either very good sensibility with low specificity or high specificity and low sensibility. CONCLUSIONS: Our study suggests that there are no significant differences between the three scoring systems in terms of overall diagnostic value.

Diffuse angiomatosis of the breast--sonographic appearance.

Angiomatosis or diffuse hemangioma is a very rare benign vascular tumor, consisting of blood and lymphatic channels growing diffusely in the breast parenchyma. We report a case of diffuse breast angiomatosis in a 34-year-old woman with pubertal anisomastia. Ultrasound raised the suspicion of vascular tumor, by showing large cystic spaces separated by septae with moderate blood flow, similar to those found in cystic lymphangioma. We discuss the imaging (mammography, ultrasound, and MRI) and pathologic findings, with a brief review of the literature.

Conventional ultrasonography and sonoelastography in the assessment of plaque psoriasis under topical corticosteroid treatment - work in progress.

AIMS: The objective of the study was to compare the efficiency of 20 MHz skin ultrasonography and 40 MHz conventional ultrasonography in the assessment of plaque psoriasis and to assess the efficiency of 40 MHz real-time sonoelastography in the early detection of steroid-induced skin atrophy in psoriatic plaques. PATIENTS AND METHODS: Ultrasonographic blinded evaluation was performed on 16 plaques in three consecutive patients, at baseline and after hydrocortisone acetate 1% ointment six-week application. The parameters were epidermal and dermal thicknesses for gray-scale ultrasonography and strain ratio for sonoelastography. Strain ratio was computed between the dermis and the adjacent hypodermis. Student's t-test for paired samples was performed. A confidence level of p<.05 was considered significant. RESULTS: At follow-up, epidermal thickness was significantly reduced with 20 MHz (p = .002) and 40 MHz sonography (p = .032), while dermal thickness varied insignifcantly with 20 MHz (p = .35) and 40 MHz sonography (p = .33). Measurements at 40 MHz were significantly higher than their 20 MHz counterparts at baseline (epidermis: p < .001; dermis: p = .003) and at follow-up (epidermis: p < .001; dermis: p = .001). Strain ratio revealed no significant change of dermal elasticity (p = .96). CONCLUSIONS: Although epidermal and dermal measurements varied significantly with 20 MHz and 40 MHz ultrasonography, both techniques efficiently quantified treatment response by measuring the reduction of epidermal thickness. Sonoelastographic findings were consistent with the expected outcome of short-term use of low-potency corticosteroid. Further studies are recommended.

Misleading appearance in cervical lymph node US diagnosis - a report on sarcoidosis, Warthin tumor and squamous cell carcinoma metastases.

Ultrasonography, with its various techniques (grey-scale, color Doppler, sonoelastography) offers many signs for the differentiation between benign and malignant neck lymph nodes. In spite of recent progress, the US appearance may be misleading. We present three cases in which the ultrasonographic appearance of the lymph nodes was misleading as compared to the final diagnosis established by histopathology.