These support the results of Ando et al

These support the results of Ando et al. (2009) and Li et al. (2011), which showed that areas with high-rise buildings have lower land surface temperatures than its surrounding areas with low-rise buildings such as residential houses, indicating large effects of urban geometry and land use/cover characteristics on UHIs.
In Fig. 3, the lowest amount of TIR order Retigabine dihydrochloride can be seen in the area “C”, which contains a large green area and channels. In the east of this area, amounts of TIR energy increase again because land uses change to the office and commercial buildings (the area “D”). Compared with the area B, the normalized amounts of TIR energy in the eastern part of the area D are relatively large despite the similar land uses. The main reason is probably that there are few water surfaces in the area D. However, the normalized amounts of TIR energy in the western part of the area D are slightly smaller than those in the area B. This part corresponds to an urban renewal area in the west of the Tokyo Station, redeveloped during the past several years.
Fig. 4 shows absolute values of amounts of attenuated TIR energy in the domain represented as a red box in Fig. 1, derived from results of M2007 and M2013. Also, Fig. 5 shows differences in the amounts of TIR energy between M2013 and M2007 in the same domain. Since abnormally hot weather conditions persisted in the period prior to M2013, amounts of TIR energy obtained from M2013 are relatively large in the greater part of the domain, compared with those from M2007. However, in several places, amounts of TIR energy obviously decrease between 2007 and 2013 (Fig. 5). Especially, the decreases in amounts of TIR energy are remarkable in the renewal areas marked “R1” and “R2” in Figs. 4–5. The maximum differences in amounts of TIR energy exceed 40W/m2. The R1 and R2 indicate the “Otemachi-Marunouchi” and “Ochanomizu” areas, respectively. The R1 includes the western part of the area D in Fig. 3. In those areas, several new buildings were completed between 2007 and 2013 with about 2,000,000m2 total floor area increases.
The remarkable decreases in amounts of TIR energy in the renewal areas are considered to be due to an incentive-based policy enacted by the Tokyo metropolitan government as part of environmental protection, disaster prevention, and UHI adaptation and mitigation strategies. As shown in Fig. 6, the Tokyo metropolitan government has promoted creation of public open spaces in the renewal areas by enacting the incentive policy that enable to increase the floor area ratios as a bonus. In the public open spaces created, many green surfaces have been provided. This would cause the decreases in amounts of TIR energy in the renewal areas.
Visible and TIR images in parts of the areas R1 and R2 in Fig. 4b, obtained from M2013, are shown in Figs. 7 and 8, respectively. These images are the original versions before removing perspective projection distortion by orthorectification. In the figures, green surfaces can be seen in public open spaces with the comparatively small amounts of TIR energy. The maximum value of differences in amounts of TIR energy between the green surfaces and streets is about 100W/m2.
Judging from Figs. 7–8, changes in rooftop surfaces of the buildings appear to also contribute to the decreases in amounts of TIR energy. In the renewal areas, rooftops on many new buildings are covered by gratings, rail tracks, and plants. For instance, sensible heat fluxes on the grating surfaces might be comparatively large, because it is presumed that wind velocities on the grating surfaces tend to be large owing to generation of stronger turbulence. The larger amounts of sensible heat fluxes could lead to smaller amounts of TIR energy emitted from the surfaces, as mentioned above. Ground-based observations of sensible heat fluxes may therefore be helpful to clarify causes of the smaller amounts of TIR energy on grating surfaces. Apart from changes in rooftop surfaces, shadows formed by construction of high-rise buildings cause the decreases in amounts of TIR energy (Figs. 7–8).

br Study area This study area comprises the South

Study area
This study area comprises the South Karanpura Coalfield region which is situated in Ramgarh and part of Hazaribagh districts of Jharkhand state, India (Fig. 1). It covers an area of 380km2 as delineated from the Survey of India (SOI) topographical map (Sheet No. 73 E/6) on a scale of 1:50,000. The region lies between 23°35′N to 23°44′N latitude and 85°15′E to 85°27′E longitude, situated at an altitude of 348m above mean sea level. The coal-mining area is considerably recognized for its excellent quality non-coking coal. The geological formation of South Karanpura Coalfield belongs to the bcr-abl inhibitors System (CIL, 1993) with huge reserves of coal suitable for power generation. It is a hilly area being a part of the Chotanagpur plateau and is covered with lush green forest. The fertile land is partly cultivated and the agriculture is mostly rains fed. The climate of the area is subtropical and is characterized by three seasons viz. summer, winter and monsoon. The mean annual precipitation of the study area is 1400mm, whereas, the temperature reaches up to 45°C during summer and falls to 2°C during winters. The area is drained by Damodar River with Nalkari River as its main tributary. The main urban settlements in the region are Patratu, Bhurkunda, Saunda, Barkakana, Giddi, Sayal and Simratanr. Among these, the Patratu region is a rapidly growing industrial town which is well known for coal mining and power generation. The Patratu thermal, is a symbol of an Indo-Russian relationship established in the decade of the sixties along with Jindal Steel and Power Limited (J.S.P.L.). There are some medium and small-scale industries also present in the study area. There are several agents responsible for air pollution in the study area which includes industries, coal mining activities, vehicle emissions, burning of biomass, modern agricultural inputs, construction activity, etc. The location map of the study area is shown in Fig. 1.

Instrument and data collection

Methodology
Layer stacking of bands 2, 3, and 4 was done for Landsat TM (2011) whereas, the bands 3, 2, and 1 of LISS-IV (2013) image was used to obtain false colour composites (FCC) during both the years using ERDAS Imagine (version 2015) software. The SOI topographical map was rectified by georeferencing (using geographic latitude-longitude and WGS 84 datum) it and then using the georeferenced SOI map to register the satellite images through map to image as well as image to image registration procedure in ERDAS Imagine software. Visual interpretation of satellite images was made using elements of image interpretation (such as tone, texture, shape, size, pattern, association, etc.) for delineating and mapping various LU/LC classes using prior knowledge of the study area. The Landsat TM (January 2011) and LISS-IV (November 2013) satellite images were interpreted and eight classes of LU/LC, viz. Built-up land (urban/rural), industrial, settlement, cropland/fallowland, forest, wasteland, water body within coal mine, waterbody/river/reservoir and coal mining area were mapped (Kumar and Pandey, 2013b). Ground-truthing was done to verify the various assigned LU/LC classes. Finally, the area statistics of visually interpreted LU/LC classes were computed in ArcGIS.
The ground-based AOT data along with temperature and PWV content was recorded using MICROTOPS II Sunphotometer (with an accuracy ±0.03) during the months of January 2011 and January 2014. At each site, five samples were collected and their average values were used. All the observations were recorded during clear sky conditions which imply cloud-free days or proper sunshine (during 10:00 to 16:00h). The recorded values of AOT, temperature and PWV at observation sites were interpolated in GIS environment after importing the geographic locations of sampling points from the GPS. The spatial pattern of AOT, temperature and PWV concentrations were analyzed after interpolation through inverse distance weightage (IDW) technique. This method applies spatial correlation of variables and predicts the values of variables at unobserved locations based on those of observed locations (Guofeng et al., 2010; Kumar and Krishna, 2016).

Commercially available QUS devices for osteoporosis diagnosis are

Commercially available QUS devices for GSK2656157 diagnosis are currently applicable only on peripheral bone regions, and their recognized value is actually limited to fragility fracture prediction in patients >65 y through calcaneal measurements, whose outcome has to be employed in conjunction with clinical risk factors (ISCD 2013). One of the main limitations of peripheral QUS systems is their poor or moderate correlation with spinal DXA outputs (Dane et al. 2008; El Maghraoui et al. 2009; Gemalmaz et al. 2007; Iida et al. 2010; Kwok et al. 2012). However, as expected, the adoption of an innovative US approach exploiting site-matched vertebral measurements resulted in markedly improved correlation. In fact, by reviewing literature quantifying the correlation of current peripheral QUS techniques with spinal DXA results through clinical studies in cohorts of women, we found that r2 was always <0.38 (apart from the very recent article by Jiang et al. [2014], who adopted an experimental backscatter technique for calcaneal measurements and obtained r2 = 0.56 with DXA-measured spinal BMD), emphasizing the value of our reported results. We also documented a measurement precision (RMS-CV = 2.95%) that is comparable to the typical values reported for clinically available peripheral QUS devices (Njeh et al. 2000), but is coupled with the aforementioned higher accuracies. It is important to note that the US signal portions used in this study for spectral model constructions and O.S. value calculations are essentially related to the trabecular part of vertebrae: The development of an extended data analysis protocol, capable of taking into account cortical properties as well, could provide even better correlations with DXA-measured BMD, as preliminarily illustrated by a very recent pilot study focused on “ex vivo” QUS assessment of femoral strength (Grimal et al. 2013). Furthermore, one should consider that even if fracture discrimination was not explicitly involved in the present study, given the significant correlations obtained between O.S.-derived BMD values and the corresponding data provided by DXA, currently representing the gold standard technique for the estimation of bone fragility and fracture risk, our approach can reasonably be expected to perform similarly to DXA in fracture risk assessment as well. Moreover, it is worth observing that the highly selective automatic identification of vertebrae and related ROIs, combined with the significant statistical basis of our proposed approach (requiring the described series of averaging and normalization operations on signals and spectra), has the potential to at least partially overcome random interference noise, one factor limiting the precision of US backscatter measurements. Image and signal selections and the sequences of averaging operations reduce the incidence of any kind of random effect and are also an indirect way to take into account, as a first approximation, that US velocity can vary between different vertebrae and different patients. Actually, our proposed approach, in its present implementation, differs from previously reported approaches because it is based on overall correlations between different spectra, each considered as a whole without extracting any synthetic parameter and without associating a specific meaning to single spectrum peaks or valleys. All the local characteristics of the considered spectra are indirectly taken into GSK2656157 account by the illustrated correlation process, intrinsically providing a more statistically significant basis of the reference data analysis. This, coupled with the statistical derivation of reference models starting from real human data, is probably the reason for the improvement in the correlation between DXA-measured BMD and O.S.-based estimates with respect to different US parameters reported in the literature (e.g., spectral centroid shift), involving only specific spectral features whose values are typically compared with phantom measurements.

In the present study the legs without apparent symptoms

In the present study, the legs without apparent symptoms were all considered stage 0 because all patients who had undergone intrapelvic lymph node dissection and/or inflammation were considered to have more or less impaired lymph transport. In two patients with unilateral lymphedema, the cause was unclear so the contralateral asymptomatic leg was excluded from the study. Those with early and later stage II LE were separately assessed because the latter is supposedly affected by increasingly severe fibrosis. Images of legs representative of each ISL stage and LDS are provided in Figure 1.
Free-hand RTE with an ultrasound machine (HI VISION Preirus, Hitachi Aloka Medical, Ltd., Tokyo, Japan) was performed, as reported previously (Suehiro et al. 2014). Briefly, with the patient lying in the supine position, 7-mm-thick phantoms (Sonar Pad, Nippon BXI, Tokyo, Japan), which were each trimmed to 60 × 60 mm square, were placed on the skin at the middle of the inner thigh and the middle of the inner calf. The peak force of repeated rhythmic pkc inhibitor using an ultrasound probe was controlled to maintain phantom strains at 0.23%–0.47%, where the skin and subcutaneous tissue in normal legs could be optimally assessed. The region of interest (ROI) was set in the middle of the elastography window for all measurements. In the currently employed ultrasound machine, the ROI was automatically set as a circle. To monitor phantom strain, the ROI was set to include its full thickness. For measurement of skin strain, the ROI was set between the inferior margin of the entry echo and the dermal–hypodermal junction. For subcutaneous tissue, the ROI was set between the dermal–hypodermal junction and the superior margin of the deep muscular fascia. When the subcutaneous tissue was very thick, the lower margin was set as the lower limit of the elastography window.
After RTE, a B-mode scan of the skin and subcutaneous tissue was performed at the same points as the RTE using an ultrasound system (LOGIQ S6, GE Healthcare, Little Chalfont, Buckinghamshire, UK) with an 8- to 12-MHz linear transducer. Subcutaneous echogenicity (SEG) and echo-free space (SEFS) were graded respectively as previously described (Suehiro et al. 2013, 2014).

Results
Skin strain and subcutaneous tissue strain in the thigh and calf of patients with lymphedema, with respect to ISL stage, and in the thigh and calf of patients with LDS are illustrated in Figure 2. In the thigh, no significant differences in strain among ISL stages and LDS were observed either in subcutaneous tissue or in skin. In the subcutaneous tissue in the calf, again no significant differences in strain were observed among ISL stages, but the strain in LDS was significantly lower than that in ISL stages 0, II and late II. In calf skin, there was a significant decrease in strain in stage III compared with stages I and II, although there were no differences between stage I or II and stage 0. The strain in the calf with LDS was significantly lower than that in stage 0, I, II and late II lymphedema. On the other hand, SEG/SEFS grades in subcutaneous tissues of the thigh and calf increased with ISL stage (p < 0.001 for both) (Fig. 3a, b). When the images in the elastography window were closely observed, strain and echo-free space, in particular, seemed to be increased (Fig. 4a). It was then hypothesized that tissue strain might be affected not only by fibrotic changes, but also by fluid accumulation; therefore, the correlation between SEG/SEFS grade and subcutaneous tissue strain was studied. There was no correlation between SEG grade and subcutaneous tissue strain (Fig. 4b). There was no correlation between SEFS grade and subcutaneous tissue strain. Even when limited to stage II, there were no differences in subcutaneous tissue strain with respect to SEFS grade (Fig. 4c).
Discussion
It is known that skin and subcutaneous tissue fibrosis progresses in extremities with lymphedema (International Society of 2013), which should result in hardening of these tissues. However, as physicians and/or therapists may have already been aware, these tissues do not always feel harder than normal tissues, but may even feel softer, particularly in the early stages of lymphedema. We could not elucidate the decreased skin and subcutaneous tissue strain values, namely, increased hardness, in the legs with symptomatic lymphedema (stages I–III) compared with asymptomatic legs (stage 0). The order of strain according to the part of the leg, namely, subcutaneous tissue in the thigh > subcutaneous tissue in the calf > skin in the thigh > skin in the calf, was maintained in all stages of lymphedema, as previously reported (Suehiro et al. 2014). Moreover, skin and subcutaneous tissue strain values in calves with LDS were lower than those in legs with LE except for stage III; therefore, these measurements seemed reasonably reliable. We then considered that the skin and subcutaneous tissue strain in the legs with LE might not decrease until a very advanced stage. Mihara et al. (2011) assessed legs with lymphedema using RTE and also did not observe differences among ISL stages.

br Introduction High amplitude ultrasound waves have been

Introduction
High-amplitude ultrasound waves have been reported to be capable of cavitation-induced soft tissue destruction (Barnard et al. 1955; Cathignol et al. 1998; Dunn and Fry 1971; Fry and Dunn 1956; Fry et al. 1970; Tavakkoli et al. 1997). Histotripsy uses short (<20 cycles), high-pressure (>10 MPa) ultrasound pulses to generate contained dense bubble clouds and produce well-demarcated tissue fractionation (Lake et al. 2008; Parsons et al. 2006a; Roberts 2005; Vlaisavljevich et al. 2013). When these energetic bubble clouds are targeted at a fluid–tissue interface, controlled tissue erosion can also be created (Miller et al. 2013; Owens et al. 2011; Xu et al. 2004, 2010). Additionally, histotripsy can induce controlled comminution of model renal calculi at a fluid–calculus interface (Duryea et al. 2011a, 2011b).
Maxwell et al. (2013) found that when histotripsy is applied with pulses shorter than 2 cycles, the formation of a dense bubble cloud depends only on the applied peak negative pressure (p−) exceeding the “intrinsic threshold” of the medium (absolute value of 26–30 MPa in most soft nitric oxide synthase inhibitor with high water content). With an applied p− not significantly higher than this threshold, a very precise, sub-wavelength lesion could consistently be generated (“microtripsy”) (Lin et al. 2014b).
Our recent study (Lin et al. 2014a) reported that a sub-threshold high-frequency probe pulse (3 MHz, <2 cycles) can be enabled by a sub-threshold low-frequency pump pulse (500 kHz, <2 cycles) to exceed the intrinsic threshold. This pump–probe method of controlling a supra-threshold volume is called dual-beam histotripsy. Because the low-frequency pulse experiences less attenuation/aberration, and the high-frequency pulse can provide precision in lesion formation, this dual-beam histotripsy approach can be very useful in situations where precise lesion formation is required through a highly attenuative/aberrative medium, especially if a small acoustic window nitric oxide synthase inhibitor is available for the high-frequency pulse (Lin et al. 2014a).
Conventionally, the transmission pulse amplitude of a diagnostic ultrasound transducer does not exceed defined limits to avoid inducing possible harmful bio-effects. Thermal index (TI) and mechanical index (MI) are the two primary metrics that the U.S. Food and Drug Administration (FDA) used to regulate the acoustic output of a diagnostic ultrasound system. However, for therapeutic ultrasound systems, these restrictions no longer apply, and some studies have investigated using diagnostic ultrasound transducers to perform therapeutic procedures. Specifically, Bailey et al. used acoustic radiation forces generated by a diagnostic transducer and a Verasonics system to displace kidney stones, to expel small stones or relocate an obstructing stone to a non-obstructing location (Bailey et al. 2013; Harper et al. 2013; Sorensen et al. 2013).

Methods
In this study, a 20-element 345-kHz array transducer was used to provide the low-frequency pump pulses, whereas an ATL L7-4 imaging transducer (Philips Healthcare, Andover, MA, USA) pulsed by a Verasonics ultrasound system was used to generate the high-frequency probe pulses. The feasibility of this dual-beam histotripsy approach using an imaging transducer was tested with red blood cell (RBC) tissue-mimicking phantoms and validated in ex vivo porcine liver tissue. The capability of steering bubble clouds and lesions by steering the imaging transducer was also investigated. In the ex vivo porcine liver experiments, the L7-4 imaging transducer was used together with the Verasonics system to provide image feedback for treatment monitoring as well as to form lesion-producing bubble clouds.

Results

Discussion
We have illustrated that a sub-threshold high-frequency probe pulse provided by an imaging transducer can create lesion-producing bubble clouds when this probe pulse is “enabled” by a sub-threshold low-frequency pump pulse to exceed the intrinsic threshold (dual-beam histotripsy [Lin et al. 2014a] using an “imaging transducer”).

DOC is a semi synthetic

DOC is a semi-synthetic taxane, one of many mitotic inhibitors that act by binding to the beta-tubulin sub-unit of micro-tubules, resulting in ryanodine arrest and apoptosis (Gueritte-Voegelein et al. 1991). In the present study, the inhibition of tumor cell proliferation was significantly greater in the DOC and DOC-MBs/LFUS groups, as evidenced by the decreased PCNA-LI, which was consistent with other studies (Kang et al. 2010; Yang et al. 2012). However, the level of cell apoptosis was not obviously different among the groups, although it was slightly higher in the DOC and DOC-MBs/LFUS groups than in the control group. Observations of tumor morphology revealed that coagulative necrosis was common in all the groups, particularly in the groups that were treated with LFUS. Therefore, the level of cell apoptosis in all the groups may not be as evident because of the large fields with obvious coagulative necrosis within the tumors, which may have contributed to the difference between our results and those reported in other studies (Kang et al. 2010; Yang et al. 2012). Meanwhile, the inhibition of tumor cell proliferation and the PCNA-LI in the LFUS and NMBs/LFUS groups were not consistent with the tumor growth IR. We hypothesized that this result may have been caused by obvious coagulative necrosis in tumor tissue due to the effects of LFUS. Generally, because of thermal and non-thermal (including cavitation and shear stress) effects, US has been widely used and developed in clinical therapy for many diseases, including tumors (Chung et al. 2012; Escoffre et al. 2013; Kotopoulis et al. 2013; Phenix et al. 2014; Tinkov et al. 2010). It is well known that high-intensity focused US can induce coagulative necrosis in tumor tissue to achieve a therapeutic effect based on the thermal effect of US (Jenne et al. 2012), but low-intensity US achieves cell killing through apoptosis, which is mainly mediated by the cavitation effect of US (Feril and Kondo 2004, 2005). However, in the present study, there were larger necrotic lesions within the tumor and higher levels of skin ulceration in the groups that were treated with LFUS. These effects might have resulted from the thermal effects of LFUS. Further investigations are needed to validate these findings.

Conclusion

Acknowledgments

Introduction
Ultrasound contrast agents (UCAs) have been used extensively in contrast-enhanced ultrasonography (CEUS) near the bone cortex, particularly for monitoring free flaps (Chang et al. 2012; Kornmann et al. 2010; Krix et al. 2005; Winter et al. 2001), because UCAs present strong non-linear acoustic responses under insonation (de Jong et al. 2000; Goldberg et al. 2001). On the basis of the non-linear acoustic responses of UCAs, CEUS with second harmonic imaging and pulse inversion harmonic imaging, even subharmonic imaging techniques, has been used to detect dynamic microvascular perfusion, analyze the patency of microvascular anastomoses, and evaluate the microcirculation of flap tissues near the bone cortex (Forsberg et al. 2006; Geis et al. 2012; Kiessling et al. 2011; Lamby et al. 2009; Prantl et al. 2007). The strong backscattered echoes from UCAs can contribute to distinguishing the perfused regions from the biceps, forearm flexor muscles, and tibialis anterior (Krix et al. 2005). The replenishment kinetics of microcirculation near the humerus, ulna, radius, and tibia cortex have also been analyzed using CEUS (Duerschmied et al. 2006; Lamby et al. 2009). To clearly detect capillary perfusion in tissue layers near the bone cortex as mentioned above, CEUS should be applied with high resolution and better contrast-to-tissue ratios (CTRs) (Lamby et al. 2009; Prantl et al. 2007).
Contrast-enhanced ultrasound images near the bone cortex may, however, be affected by guided waves generated from the bone cortex, because the signal-to-noise ratio of acoustic signals is disturbed by guided waves that propagate in the surrounding soft tissue (Moilanen et al. 2006; Ta et al. 2009). These unique guided waves are generated from the bone cortex and leak to surrounding tissues when transmission waves hit the bone (Määttä et al. 2009; Moilanen 2008; Nicholson et al. 2002; Lee and Kuo 2006; Protopappas et al. 2006; Ta et al. 2009). They are multimodal and frequency dispersive because of their non-linear propagation (Moilanen 2008; Nicholson et al. 2002; Protopappas et al. 2006). These guided waves have also been used to detect and trap microdroplets, gas bubbles, and submicron particles in acoustic manipulations (Lindner et al. 2008; Schmitt et al. 2010; Wan et al. 2012). However, such detection is limited to the linear characteristic of guided waves (Zhang et al. 2014), and information on UCA responses to frequency-dispersive guided waves is lacking.

CM-272 Selection of a percutaneous approach is very important in

Selection of a percutaneous approach is very important in achieving effective outcomes and low complications. In our study, three different percutaneous approaches were available. Most patients underwent ablation through the IA because it was entirely transhepatic and easily avoided bile ducts, hepatic vessels and extrahepatic organs. In patients with cirrhosis, the volume of the caudate lobe always increases compensatorily, which facilitates US detection of lesions in the caudate lobe. The EA may be the better choice for these patients despite the fact that in the EA, the operators may pass through the lesser omentum, which could damage its integrity and may damage its contents, including the stomach, lymphatics and the hepatic plexus of nerves. Accurate puncture was achieved in all patients after careful evaluation and experience in performing this procedure. Temperature monitoring was used in only 2 cases in our study with tumors adjacent to the GIT. Because of the difficulty and danger involved in insertion, temperature monitoring was also not commonly used for tumors in caudate lobe, as it was in other parts of the liver (Huang et al. 2015).
Tumor ablation in the caudate lobe would be more affected by the heat-sink effect because the lobe is proximal to the hepatic CM-272 and the inferior vena cava (Kariyama et al. 2011). In fact, the caudate lobe is surrounded by the ligamentum venosum. The ligamentum venosum is composed mainly of fibrous tissue, which could insulate heat and obstruct thermal propagation, thus helping to trap heat during ablation. But this might cause another problem: asymmetric temperature distribution. The temperature in the tumor margin adjacent to large vessels might be lower than that in the tumor margin adjacent to the ligamentum venosum, which may increase the risk of LTP for tumors in this area.
In our study, ethanol was injected into the tumor margin adjacent to large vessels in some cases to balance this effect and, thus, enhance thermal efficacy. But 2 cases still had residual tumors whose margins were too close to the IVC and caused technical failure. Those 2 tumors were both in the paracaval portion. The paracaval portion is located closer to the IVC and HH than the other two portions of the caudate lobe, which greatly increased the heat-sink effect and decreased thermal efficacy. This may be the reason why MW ablation of tumors in the paracaval portion was more likely to cause technical failure. In consideration of their safety, those 2 patients received 125I brachytherapy as palliative therapy for residual tumor and achieved stable control of the residual tumor. 125I brachytherapy may provide a relatively effective way to control residual tumor that cannot be completely ablated, but further studies with larger samples are needed to illustrate its efficacy.
Three LTP cases were recognized in the follow-up period. The mean maximum diameter of those three tumors was larger than that for all tumors in this study. Larger tumors may increase the possibility of LTP after complete ablation, as also found in some other studies (Liu et al. 2014; Medhat et al. 2015). For tumors in the caudate lobe, zygomycetes is quite difficult to increase the ablative margin because of the complex surrounding tissues. In our study, 22.2% patients with conformal ablation or margins <5 mm had LTP, whereas only 9.1% of CM-272 patients with minimum 5 margins of at least 5 mm had LTP during a median follow-up of 18.4 mo. LTP may occur because of untreated satellite lesions that are too small to detect on imaging before ablation or because of insufficient ablation. Therefore, a minimum ablative margin of 5 mm was suggested to avoid LTP after ablation (Dong et al. 2003; Liang et al. 2013). A margin <5 mm was a significant predictor of LTP (Teng et al. 2015).This may be another reason for the higher LTP rate in our study. Complete coagulation was achieved in all tumors in the caudate lobe, and no LTP case was recognized during the follow-up period. Though there were only three cases in the caudate lobe in our study, the lower position away from the HH might make it easier and more effective to ablate tumors.

Currently the two imaging techniques used to

Currently, the two imaging techniques used to diagnose damage to salivary glands after RAI therapy are scintigraphy and sialography. [Tc]Pertechnetate salivary scintigraphy plays a vital role in evaluating parenchymal damage to these glands (Caglar et al. 2002; Raza et al. 2006; Solans et al. 2001). Reduced Tc uptake by the glands, usually developing more than 1 y post-operatively, indicates that the salivary aminopeptidase inhibitor is undergoing fibrosis (Caglar et al. 2002; Raza et al. 2006; Solans et al. 2001). Sialography allows evaluation of the ductal system of the glands. Ultrasonography (US) is seldom used, although the technique is both easy and non-invasive (Brozzi et al. 2013; Gritzmann et al. 2003).
Acoustic structure quantification (ASQ) software is used to analyze the statistical features of ultrasonographic echoes, and has recently performed well for the quantitative assessment of liver echogenicity. Several studies reported that ASQ is useful for detecting and quantifying structural changes in diffuse liver disease (Toyoda et al. 2009; Tuthill et al. 1988; Yamada et al. 2006). Recently, there have been attempts to evaluate the thyroid gland using ASQ (Rhee et al. 2015; Zandieh et al. 2016). ASQ makes possible to differentiate tissue types and detect structural changes in the tissue parenchyma by examining the speckle pattern in a selected region of interest (ROI). However, to date, no study has explored salivary gland echogenicity using this tool.

Methods

Results
The demographic and clinical characteristics of the three groups are summarized in Tables 1 and 2. A total of 63 patients had been treated with 131I: 43 asymptomatic RAI-treated patients with 120.5 ± 44.55 mCi (30–180 mCi) and 20 chronic RS patients with 136.84 ± 22.31 mCi (130–180 mCi) (p = 0.004) (Table 1). RAI therapy was used for remnant ablation after thyroid surgery and/or to treat metastases. Symptom score was significantly higher in the patients with chronic RS (5.26 ± 2.08) than in the asymptomatic RAI-treated patients (0.1 ± 0.61) (p < 0.001). Time since the last RAI treatment was 42.26 ± 32.74 mo for the asymptomatic RAI group and 35.9 ± 26.41 mo for the RS group (p = 0.737) (Table 1). A total of 33 control patients without any clinical symptoms or history of salivary disease underwent neck US, which revealed normal salivary parenchymal echogenicity; homogeneous echotexture and echogenicity similar to cell cycle of the thyroid gland (Bruneton and Mourou 1993). No patient was on medication affecting the salivary glands.
The mean age of the asymptomatic RAI therapy group (51.58 ± 11.52 y) was higher than that of the chronic RS (47.4 ± 12.6 y) and control (42.58 ± 12.24 y) groups (p < 0.001). No gender bias was evident in the normal control group, but females predominated in the treated groups (p < 0.001) (Table 2). The volumes of both the parotid and submandibular glands of patients who had undergone RAI therapy, including the asymptomatic RAI-treated group and the chronic RS group, were less than those of normal glands (Table 3). The ASQ values for each group are summarized in Table 3. All ASQ parameters of asymptomatic patients or patients with RS who had undergone RAI therapy were significantly greater than those of patients with normal salivary glands for both the parotid and submandibular glands (p ≤ 0.001) (Figs. 1 and 2). Among the ASQ values, we calculated the post hoc power of the study using the mode and average for the parotid glands, representatively. In a one-way ANOVA test, sample sizes of 66, 86 and 40 were obtained from the three groups whose means were to be compared. The total sample of 192 patients achieved 72.38% power to detect differences among the parotid gland mode values and 96.03% power to detect differences among the parotid gland average values with a 0.05 significance level.

br Methods br Results br Discussion A

Methods

Results

Discussion
A B-line is a discrete, laser-like, vertical, hyper-echoic image that arises from the pleural line, extends to the bottom of the screen without fading and moves synchronously with respiration. It is formed by the reflection of the ultrasound beam from thickened subpleural interlobular septa (Lichtenstein et al. 1997). In patients with ILD, the subpleural interlobular septa are thickened by deposition of collagen and fibrous tissues. During LUS tests, the great impedance gradient between the thickened septa and air in the lung causes reflection of ultrasound beams, creating diffuse B-lines all over the lung surface (Hasan and Makhlouf 2014). The presence of B-lines at LUS examination correlates with ILD at HRCT (Gargani et al. 2009; Moazedi-Fuerst et al. 2014; Tardella et al. 2012).
In the present study, we found that all patients had diffuse B-lines on both sides of the lung. Likewise, pleural line irregularity and Am-lines are also useful LUS signs in the detection of ILD (Buda et al. 2016; Moazedi-Fuerst et al. 2015; Pinal-Fernandez et al. 2015; Sperandeo et al. 2009). We employed a semiquantitative method to comprehensively evaluate the severity of ILD and degree of pulmonary fibrosis, taking into account the B-lines, Pleural lines and Am-lines as described by Buda et al. (2016).
Moreover, our study found that patients with ILD complicated by PH had reduced RV function and higher lung ultrasound scores. With respect to pathophysiology, the cardiac and pulmonary systems are closely related. The ILD pathologic process goes through four stages (Wilkins and Lascola 2015): (i) the initial insult, which causes parenchymal injury and alveolitis; (ii) a proliferative phase characterized by cellular and parenchymal alterations in the tissues of the lung; (iii) development of interstitial fibrosis; and (iv) end-stage irreparable fibrosis of the lung.
These pathologic changes appear as a gradual increase in the number of B-lines and irregular pleural lines in the lung ultrasound. The structural changes that occur in the lung lead to hypoxic vasoconstriction, generation of vasoactive compounds (such as endothelin-1), acute and chronic changes in pulmonary vascular resistance and vascular anatomy and, eventually, development of pulmonary BAY 87-2243 (Jarman et al. 2014).
With the increased SPAP, RV structure and function will gradually be harmed by the increased afterload (Haddad et al. 2008). Therefore, traditional Echo and 2-D speckle tracking Echo analysis reveal increased SPAP and reduced RV function. This also explains the finding that LUS scores are correlated with SPAP and RV parameters. Nevertheless, except for SPAP, the correlation between LUS scores and RV parameters was weak. In addition to elevated SPAP, systemic inflammation and endothelial dysfunction may also lead to early right ventricular dysfunction (Aihara et al. 2013). Moreover, only some of the patients with PH progressed to right ventricular dysfunction at the time of examination. In a study of the effects of age, sex and obesity on RV volume and systolic function, it was reported that women had higher RV ejection fraction and there were no differences in RV ejection fraction across age categories (Foppa et al. 2016). In our study, there were fewer females in the ILDPH group (33.3%) than in the ILDNPH group (45%). This may also lead to a weaker correlation between ILD LUS scores and RV function.
In addition to a strong correlation between ILD LUS scores and SPAP, we found that a cutoff value (>16 points) predicted PH (SPAP >36 mm Hg). It was recently reported that number of B-lines >4 predicted elevated SPAP (>30 mm Hg) (Zheng et al. 2015). In comparison to our semiquantitative LUS scoring method, Zheng et al. evaluated only the number of B-lines. Similar to our results, Wangkaew et al. (2014), in a study of systemic sclerosis-associated ILD, found that there was a good correlation between HRCT scores and SPAP. In ILD patients, cross-sectional area of the pulmonary vascular bed, hypoxia vasoconstriction and pulmonary vascular remodeling have been found to affect PH (Caminati et al. 2013; Jarman et al. 2014; Nadrous et al. 2005; Nathan et al. 2008). Pulmonary fibrosis directly leads to change in the former two. On the other hand, generation of vasoactive compounds, downregulation of a fraction of endothelial cell genes and upregulation of the phospholipase A2 gene may play an important role in the ILD-PH pulmonary vascular remodeling (Gagermeier et al. 2005). However, pulmonary vasculopathy always leads to severe SPAP (Seeger et al. 2013; Steen 2005). In our study, most of the ILDPH patients developed mild PH; the mean SPAP of ILDPH was 52.5 mm Hg. Thus, in our study, the development of PH was presumably due to the decrease in cross-sectional area of the pulmonary vascular bed and hypoxia vasoconstriction. This further explains why for the good correlation found between ILD LUS scores and SPAP, the correlation coefficient was not particularly high (r = 0.735). Based on the preceding, it is not surprising to find that ILD LUS scores >16 points predicted elevated SPAP. LUS scores >16 points also indicate moderate or severe pulmonary fibrosis with histopathological features of thickened interstitia and honeycombing (Buda et al. 2016). With the extent of alveolar damage and abnormal incorporation of connective tissue and ongoing inflammation in this phase of ILD, pulmonary artery vasoconstriction might play an important role in the appearance of PH. However, the cutoff value of our study was obtained in a relatively small population; a multicenter study with a large population is necessary for further validation.