The ultrasonographic diagnosis of lymph node varicose veins in the groin - an overlooked missing link in chronic venous disease?

AIM: Chronic venous disease is a common pathology characterized by valvular incompetence and venous hypertension. The venous network of the lymph nodes at the Scarpa triangle connects the superficial and the deep venous systems. This study aimed to describe infrainguinal intranodal venous dilatations and to evaluate the connection with peripheral venous disease. MATERIAL AND METHODS: The study included 183 subjects (116 women, 67 men) who underwent Doppler ultrasound examinations of the venous system of the inferior limb in the context of chronic venous disease. The diagnosis of lymph node varices was based on well-defined criteria and the severity of the lymph node varices was established using an original classification. RESULTS: There was a statistically significant, moderately strong association, between the presence of intranodal varices and the great saphenous vein reflux (φ=0.341, p=0.000). There was a moderate-to-high positive correlation between intranodal varices and the chronic venous disease stage (rrb=0.457, p=0.000). CONCLUSIONS: Patients with more advanced stages of chronic venous insufficiency have a higher probability of presenting intranodal varices. Lymph node venous network identification could considerably impact clinical decision-making and treatment choices.

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.

Income inequality, social cohesion, and crime against businesses: Evidence from a global sample of firms.

Rising inequality is one of the grand societal challenges of our time. Yet, its effects on firms - including multinational enterprises (MNEs) - and their operations have not been widely examined by IB scholars. In this study, we posit that income inequality within a country is positively associated with the incidence and severity of crime experienced by businesses. Further, we propose that this relationship will be negatively moderated by social cohesion (in the form of greater societal trust and lower ethno-linguistic fractionalization) in these countries, such that social cohesion helps to offset the negative impacts of inequality on crime against businesses. We test these hypotheses using a comprehensive data set of 114,000 firms from 122 countries and find consistent support for our theses. Our findings, which are robust to different alternative variables, model specifications, instrumentation, and estimation techniques, unpack the intricate ways through which inequality affects businesses worldwide and the associated challenges to MNEs. They also offer important managerial and policy insights regarding the consequences of inequality and potential mitigation mechanisms. Supplementary Information: The online version contains supplementary material available at 10.1057/s41267-022-00535-5.

L'inégalité croissante est l'un des grands défis sociétaux de notre époque. Pourtant, ses impacts sur les entreprises - y compris les entreprises multinationales - et leurs activités n'ont pas été largement examinés par les chercheurs en affaires internationales. Dans cette recherche, nous postulons que l'inégalité des revenus dans un pays est positivement associée à l'incidence et à la gravité de la criminalité subies par les entreprises. De plus, nous proposons que cette relation soit négativement modérée par la cohésion sociale dans ces pays (sous la forme d'une plus grande confiance sociétale et d'une plus faible fragmentation ethnolinguistique), dans la mesure où la cohésion sociale aide à compenser les impacts négatifs de l'inégalité sur la criminalité contre les entreprises. Nous testons ces hypothèses sur un ensemble complet de données de 114000 entreprises issues de 122 pays et trouvons des appuis cohérents à nos thèses. Nos résultats, robustes aux différentes variables alternatives, spécifications du modèle, techniques d'estimation et à l'instrumentation, dévoilent les manières complexes par lesquelles l'inégalité influe sur les entreprises dans le monde entier ainsi que sur les défis associés aux entreprises multinationales. Ils apportent également d'importants renseignements managérial et politique liés aux conséquences de l'inégalité et aux mécanismes d'atténuation potentiels.

El aumento de la desigualdad es uno de los grandes desafíos sociales de nuestro tiempo. Con todo, sus efectos en las empresas, incluyendo las empresas multinacionales, y sus operaciones no han sido ampliamente examinado por académicos de Negocios Internacionales. En este estudio, planteamos que la desigualdad en un país está asociada positivamente con la incidencia y gravedad de la delincuencia que experimentan las empresas. Aún más, proponemos que esta relación será moderada negativamente por la cohesión social (en forma de mayor confianza social y menor fraccionamiento etnolingüístico) en estos países, para que la cohesión social ayuda a compensar los impactos negativos de la desigualdad en la delincuencia contra las empresas. Probamos estas hipótesis utilizando un exhaustivo conjunto de datos de 114.000 empresas de 122 países y encontramos un apoyo consistente a nuestras tesis. Nuestros hallazgos, que son robustos a diferentes variables alternativas, especificaciones del modelo, instrumentación y técnicas de estimación, desentrañan las maneras intrincadas en que la desigualdad afecta a las empresas de todo el mundo y los desafíos asociados a las empresas multinacionales. También ofrecen importantes perspectivas para la gerencia y política en relación con las consecuencias de la desigualdad y los posibles mecanismos de mitigación.

O aumento da desigualdade é um dos grandes desafios sociais do nosso tempo. No entanto, seus efeitos sobre empresas ­ incluindo empresas multinacionais (MNEs) ­ e suas operações não foram amplamente examinados por acadêmicos de IB. Neste estudo, postulamos que a desigualdade de renda dentro de um país é positivamente associada à incidência e gravidade de crimes vivenciados por empresas. Além disso, propomos que essa relação seja negativamente moderada pela coesão social (na forma de maior confiança social e menor fracionamento etnolinguístico) nesses países, de modo que a coesão social ajude a compensar os impactos negativos da desigualdade em crimes contra empresas. Testamos essas hipóteses usando um conjunto de dados abrangente de 114.000 empresas de 122 países e encontramos consistente suporte para nossas teses. Nossos achados, robustos a diferentes variáveis alternativas, especificações de modelo, instrumentação e técnicas de estimação, desvendam as formas intrincadas pelas quais a desigualdade afeta negócios em todo o mundo e os desafios associados a MNEs. Eles também oferecem importantes insights gerenciais e de políticas no que tange às consequências da desigualdade bem como potenciais mecanismos mitigantes.

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.

A framework to predict the price of energy for the end-users with applications to monetary and energy policies.

Energy affects every single individual and entity in the world. Therefore, it is crucial to precisely quantify the "price of energy" and study how it evolves through time, through major political and social events, and through changes in energy and monetary policies. Here, we develop a predictive framework, an index to calculate the average price of energy in the United States. The complex energy landscape is thoroughly analysed to accurately determine the two key factors of this framework: the total demand of the energy products directed to the end-use sectors, and the corresponding price of each product. A rolling horizon predictive methodology is introduced to estimate future energy demands, with excellent predictive capability, shown over a period of 174 months. The effectiveness of the framework is demonstrated by addressing two policy questions of significant public interest.

The Impact of Composites with Silicate-Based Glasses and Gold Nanoparticles on Skin Wound Regeneration.

The silver content of the skin regeneration ointments can influence its regeneration process but in the meantime, it can take the benefit of the antibacterial properties of silver by avoiding the bacterial infection of an open wound. In the current study, the skin healing and regeneration capacity of bioactive glass with spherical gold nanocages (BGAuIND) in the Vaseline ointments were evaluated in vivo comparing the bioactive glass (BG)-Vaseline and bioactive glass with spherical gold (BGAuSP)-Vaseline ointments. Spherical gold nanocages are stabilized with silver and as a consequence the BGAuIND exhibits great antibacterial activity. Histological examination of the cutaneous tissue performed on day 8 indicates a more advanced regeneration process in rats treated with BGAuSP-Vaseline. The histopathological examination also confirms the results obtained after 11 days post-intervention, when the skin is completely regenerated at rats treated with BGAuSP-Vaseline compared with the others groups where the healing was incomplete. This result is also confirmed by the macroscopic images of the evolution of wounds healing. As expected, the silver content influences the wound healing process but after two weeks, for all of the post-interventional trials from the groups of rats, the skin healing was completely.

Obesity increases hepatic glycine dehydrogenase and aminomethyltransferase expression while dietary glycine supplementation reduces white adipose tissue in Zucker diabetic fatty rats.

Obesity is associated with altered glycine metabolism in humans. This study investigated the mechanisms regulating glycine metabolism in obese rats. Eight-week-old Zucker diabetic fatty rats (ZDF; a type-II diabetic animal model) received either 1% glycine or 1.19% L-alanine (isonitrogenous control) in drinking water for 6 weeks. An additional group of lean Zucker rats also received 1.19% L-alanine as a lean control. Glycine concentrations in serum and liver were markedly lower in obese versus lean rats. Enteral glycine supplementation restored both serum and hepatic glycine levels, while reducing mesenteric and internal white fat mass compared with alanine-treated ZDF rats. Blood glucose and non-esterified fatty acid (NEFA) concentrations did not differ between the control and glycine-supplemented ZDF rats (P > 0.10). Both mRNA and protein expression of aminomethyltransferase (AMT) and glycine dehydrogenase, decarboxylating (GLDC) were increased in the livers of obese versus lean rats (P < 0.05). In contrast, glycine cleavage system H (GCSH) hepatic mRNA expression was downregulated in obese versus lean rats, although there was no change in protein expression. These findings indicate that reduced quantities of glycine observed in obese subjects likely results from an upregulation of the hepatic glycine cleavage system and that dietary glycine supplementation potentially reduces obesity in ZDF rats.

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.

Ultrasonography and SARS-CoV 2 infection: a review of what we know and do not yet know.

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Adaptive responses to maternal nutrient restriction alter placental transport in ewes.

INTRODUCTION: Maternal nutrient partitioning, uteroplacental blood flow, transporter activity, and fetoplacental metabolism mediate nutrient delivery to the fetus. Inadequate availability or delivery of nutrients results in intrauterine growth restriction (IUGR), a leading cause of neonatal morbidity and mortality. Maternal nutrient restriction can result in IUGR, but only in an unforeseeable subset of individuals. METHODS: To elucidate potential mechanisms regulating fetal nutrient availability, singleton sheep pregnancies were generated by embryo transfer. Pregnant ewes received either a 50% NRC (NR; n = 24) or 100% NRC (n = 7) diet from gestational Day 35 until necropsy on Day 125. Maternal weight did not correlate with fetal weight; therefore, the six heaviest (NR Non-IUGR) and five lightest (NR IUGR) fetuses from nutrient-restricted ewes, and seven 100% NRC fetuses, were compared to investigate differences in nutrient availability. RESULTS: Insulin, multiple amino acids, and their metabolites, were reduced in fetal circulation of NR IUGR compared to NR Non-IUGR and 100% NRC pregnancies. In contrast, glucose in fetal fluids was not different between groups. There was a nearly two-fold reduction in placentome volume and fetal/maternal interface length in NR IUGR compared to NR Non-IUGR and 100% NRC pregnancies. Changes in amino acid concentrations were associated with altered expression of cationic (SLC7A2, SLC7A6, and SLC7A7) and large neutral (SLC38A2) amino acid transporters in placentomes. DISCUSSION: Results establish a novel approach to study placental adaptation to maternal undernutrition in sheep and support the hypothesis that amino acids and polyamines are critical mediators of placental and fetal growth in sheep.

Maternal arginine supplementation enhances thermogenesis in the newborn lamb.

Body temperature maintenance is one of the most important physiological processes initiated after birth. Brown adipose tissue (BAT) is an essential mediator of thermogenesis in many species and is responsible for 50% of the heat generated in the newborn lamb. To determine if maternal arginine supplementation could enhance thermogenesis in the neonate, we randomly assigned 31 multiparous Suffolk ewes, gestating singletons or twins, to receive intravenous injections of either l-arginine (27 mg/kg body weight; n = 17) or sterile saline (n = 14) three times daily from day 75 to 125 of gestation (term = 147). Following parturition, lambs were removed from their mothers and subjected to 0 °C cold challenges at 4 and 22 h of age. Rectal temperatures were higher for the duration of the cold challenges in lambs from arginine-treated ewes compared with lambs from saline-treated ewes (P < 0.05). Elevated rectal temperatures were associated with increased (P < 0.05) circulating glycine and serine concentrations in lambs. The mRNA expression of genes related to BAT function changed over time, but not between lambs from arginine-treated vs. saline-treated ewes. Results indicate that maternal arginine treatment increases neonatal thermogenesis after birth. Although the underlying mechanisms remain to be elucidated, these data are a first step in improving neonatal survival in response to cold.

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.

Ultrasonography as an educational tool for students - any progress?

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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 influence of acute physical effort on liver stiffness estimation using Virtual Touch Quantification (VTQ). Preliminary results.

AIM: Food intake and acutely decompensated cardiac failure may impair liver stiffness estimations, mainly because these methods are influenced by liver blood flow variation encountered in these conditions. It is well known that also during physical effort liver blood flow changes, due to the redistribution of blood flow mainly to the skeletal muscles. The aim of this study is to assess the change of liver shear- wave velocities immediately after cessation of an acute physical effort. A secondary aim was to find the proper timing for accurate liver stiffness estimation after physical exhaustion. MATERIAL AND METHODS: Liver shear-wave velocities were measured using virtual touch quantification (VTQ) in seven apparently healthy volunteers, in fasting conditions. All subjects underwent a complete abdominal ultrasound study, including the liver VTQ. Then, all subjects performed a spiroergometry and thereafter, another series of three liver shear-wave velocity measurements were performed: immediately after spiroergometry, five min, and ten min after spiroergometry, respectively. RESULTS: Before spiroergoemetry, the mean liver shear-wave velocity was 1.05+/-0.12 m/sec. Immediately after spiroergometry, mean liver shear-wave velocities increased significantly, measuring 1.34+/-0.16 m/sec (p <0.01). The mean liver shear-wave velocities at five and ten minutes after exhausting were 1.23+/-0.14 m/sec and 1.05+/-0.11 m/sec respectively. CONCLUSIONS: Liver stiffness estimation using VTQ was influenced by acute physical exercise in our study group. Despite the small number of subjects, the preliminary results show that if patients had done physical effort before VTQ elastography, they should rest at least ten minutes before reliable liver stiffness estimations can be performed.

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.