High-Frequency Transient Elastography Prototype to Assess Skin (Dermis) Fibrosis: A Diagnostic Study in Patients with Venous Insufficiency and Controls.

PURPOSE: High-frequency transient elastography (HF-TE) is a noninvasive technique for assessing shear-wave speed and finally elasticity in thin tissue such as the skin. It has never been validated for monitoring fibrotic skin diseases. The purpose was to evaluate the potential of HF-TE to assess skin fibrosis in patients with chronic venous disorders (CVD). MATERIALS AND METHODS: This clinical study enrolled 48 patients at various stages of CVD and 48 paired healthy volunteers. Subjects underwent a clinical examination with an evaluation of Rodnan's fibrosis skin score. We studied the dermis thickness measured using ultrasound (US) and elasticity measurements using cutometer and HF-TE studied according to 3 cutaneous zones positioned on the leg. The area under the receiver operating characteristic curve (AUC) was calculated to evaluate the diagnosis performance for a combined parameter (PRL) based on a logistic regression model using both elasticity and dermal thickness. RESULTS: Patients with CVD had significantly higher values of skin elasticity than healthy subjects, 134.5 kPa and 132.1 kPa vs. 91.3 kPa, respectively. The dermis thickness also increased with escalation in CVD stage for all studied zones. The PRL parameter had an AUC value of 0.79 for all zones and stages of CVD clustered. The discriminating power of PRL increased with escalation of the CVD stage; with an AUC value of up to 0.89 for evolved stages, and a sensitivity and specificity of 0.79 and 0.89, respectively. CONCLUSION: HF-TE, coupled with a US measurement of dermis thickness, made it possible to propose a new biomarker, which proved to be a good diagnostic tool for skin fibrosis.

High-Resolution Elastography for Thin-Layer Mechanical Characterization: Toward Skin Investigation.

Interest in elasticity estimation for thin layers is increasing because of the various potential applications, including dermatology and cosmetology. In this context, we propose a dedicated elastographic system using 1-D high-frequency transient elastography (HF-TE) to estimate the 1-D Young's modulus through the dermis and hypodermis, which are the two human skin layers of interest in this study. An experimental validation of the HF-TE method was first carried out on two homogeneous tissue-mimicking hard and soft phantoms. The Young's modulus values obtained in these phantoms were compared with those obtained by two complementary shear wave propagation techniques: shear wave-induced resonance elastography (SWIRE) and supersonic shear imaging (SSI). A third two-layer thin phantom, with mechanical properties similar to those of skin, was used to validate the ability of HF-TE to distinguish layers and measure elasticity. Finally, preliminary in vivo experiments conducted on forearm and cheek skin revealed the promising performance of HF-TE in measuring elasticity in the dermis and hypodermis.

Optimizing HgA1C and glucose monitoring frequency in patients with Type 2 diabetes.

BACKGROUND: The primary objective of our study is to compare HgA1C to self monitoring frequency in diabetes subjects. A secondary objective is to evaluate the influence of family support and gender on glucose monitoring frequency and HgA1C. MATERIAL/METHODS: We studied the glucose monitoring frequency and HgA1c outcome of 67 subjects treated with diet alone, 350 subjects treated with tablets, 155 subjects treated with insulin, and 228 subjects treated with both tablets and insulin. RESULTS: Eleven percent of the subjects monitoring 4-7 times per week produced a positive significant coefficient (p<.05). Self monitoring less than 4 times per week showed no statistical significance and self monitoring more than 8 times per week showed no statistical significance. Forty-eight percent of subjects treating with insulin alone and tablet plus insulin produced positive significant coefficients (p<.05). The percentage lowering of HgA1C of tablet plus insulin is 15.64% as the mean HgA1C at the first visit was 9.35 compared to 7.89. The percentage lowering of HgA1C for insulin alone was 12.24% as the mean HgA1C at the first visit was 9.37 compared to 8.23 at the later visit. CONCLUSIONS: We conclude that (1) frequency of self monitoring should be based on individualized goals and willingness to participate, (2) both insulin alone and tablet plus insulin levels of medication are effective at lowering HgA1C levels; however, using the tablet and insulin combined produced lower HgA1C levels than using insulin alone; (3) family support and gender have no effect on glucose monitoring frequency and lowering HgA1C levels.