Contrast-enhanced ultrasound in focal liver lesions

The incidence of liver tumors is increasing. Up to 1/3 of the general population has diagnosed one or multiple benign lesions. The overall aim of this thesis was to address various aspects of diagnostic contrast-enhanced ultrasound (CEUS) and its capabilities in relation to benign and malignant liver tumors, to other radiological methods, its cost-effectivity and various other topics related to its use. “Is the lesion in the liver benign or malignant?” and “What kind of benign (malignant) lesion is it?” In imaging algorithms, position of liver CEUS is not precisely yet stated. It is somewhere between the quick, generally available, cheap but unspecific and less sensitive B-mode ultrasound and highly specific, costly and academic MRI. We examined various positions of CEUS diagnostics, mainly in liver adenoma and focal nodular hyperplasia, the two most important solid benign liver lesions. Relation of CEUS and point shear wave elastography in these tumors, was also explored. We did not found a strong relation. Further we did the first ever comparison of CEUS to CT in liver pancreas adenocarcinoma metastasis. CEUS improves cost-effectiveness in focal liver lesions, our analysis added the therapeutic phase to this model, as well

Flexible implementation and the energy efficiency directive

This paper analyses patterns of differentiated implementation in four member states (Czechia, Germany, Ireland and the Netherlands) under the 2012 Energy Efficiency Directive (EED). Differentiated implementation occurs when member states makes use of the discretion given to them in EU legislation. This paper seeks to analyse whether differentiated implementation occurred under the EED and what this means for the effectiveness and legitimacy of the Directive. The EE offers broad discretion to member states in choosing and specifying targets and measures related to energy efficiency. The four member states have made extensive use of this discretion. The dominant pattern in this regard is that member states have used the discretion to retain domestic measures that were already in place. This pattern is driven by a combination of inertia and the wish not to disrupt well-working approaches. Overall, the pattern of differentiated implementation that resulted has arguably had a positive effect on goal-achievement under as well as domestic acceptance of the EED. At the same time, the Directive’s impact on domestic policies and approaches has been limited.This project received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement number 822304. The content of this document represents only the views of the InDivEU consortium and is its sole responsibility. The European Commission does not accept any responsibility for use that may be made of the information it contains

Flexible implementation and the energy efficiency directive

This paper analyses patterns of differentiated implementation in four member states (Czechia, Germany, Ireland and the Netherlands) under the 2012 Energy Efficiency Directive (EED). Differentiated implementation occurs when member states makes use of the discretion given to them in EU legislation. This paper seeks to analyse whether differentiated implementation occurred under the EED and what this means for the effectiveness and legitimacy of the Directive. The EE offers broad discretion to member states in choosing and specifying targets and measures related to energy efficiency. The four member states have made extensive use of this discretion. The dominant pattern in this regard is that member states have used the discretion to retain domestic measures that were already in place. This pattern is driven by a combination of inertia and the wish not to disrupt well-working approaches. Overall, the pattern of differentiated implementation that resulted has arguably had a positive effect on goal-achievement under as well as domestic acceptance of the EED. At the same time, the Directive’s impact on domestic policies and approaches has been limited

Flexible implementation and the Consumer Rights Directive

This report shows that despite the full harmonisation approach promoted by the European Commission and adopted by the EU legislature in the case of the Consumer Rights Directive, the member states still have some opportunities to adjust European norms to the national reality. Nevertheless, our sample of four EU countries – Czechia, Germany, Ireland, and the Netherlands – documents that the member states do not use the space for discretion offered by the Directive’s substantive provisions to a great extent. Our analysis shows that the four member states tried to preserve their existing consumer protection regimes to the greatest possible extent. They used discretion in such a way that enabled retaining existing domestic laws and practices. In contrast to largely harmonized substantive CRD norms, the enforcement rests largely in member states powers. The means of putting the consumer contract law into practice shows some overlaps, but their use varies largely. The member states differ, importantly, in the overall emphasis on private or public enforcement. More specific differences include lists of remedies, persons who can bring the complaints, bodies dealing with the complaints or in the range and severity of penalties. The availability of class actions and ADR, but especially their use, differs wildly

Flexible implementation and the Consumer Rights Directive

This report shows that despite the full harmonisation approach promoted by the European Commission and adopted by the EU legislature in the case of the Consumer Rights Directive, the member states still have some opportunities to adjust European norms to the national reality. Nevertheless, our sample of four EU countries – Czechia, Germany, Ireland, and the Netherlands – documents that the member states do not use the space for discretion offered by the Directive’s substantive provisions to a great extent. Our analysis shows that the four member states tried to preserve their existing consumer protection regimes to the greatest possible extent. They used discretion in such a way that enabled retaining existing domestic laws and practices. In contrast to largely harmonized substantive CRD norms, the enforcement rests largely in member states powers. The means of putting the consumer contract law into practice shows some overlaps, but their use varies largely. The member states differ, importantly, in the overall emphasis on private or public enforcement. More specific differences include lists of remedies, persons who can bring the complaints, bodies dealing with the complaints or in the range and severity of penalties. The availability of class actions and ADR, but especially their use, differs wildly.This project received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement number 822304. The content of this document represents only the views of the InDivEU consortium and is its sole responsibility. The European Commission does not accept any responsibility for use that may be made of the information it contains

Flexible implementation and the EU Sexual Abuse Directive

This report concerns the Directive on combating the sexual abuse and sexual exploitation of children and child pornography (SAD). It assesses the room for flexible implementation it provides and the way in which EU Member States have made use of this. The sample of Member States includes Czech Republic, Germany, Ireland and the Netherlands. The Directive includes various ways to allow for flexible implementation. The directive establishes thresholds for the maximum terms of imprisonment that the Member States should include in their laws (minimum harmonization). The directive equally contains provisions with elaboration discretion for the Member States, allowing them to further flesh out the content of these provisions in national law. This is especially the case with regard to the provisions on prevention and protection of victims. The directive further contains open-worded and non-defined terms which also allow for differentiated implementation. Our analysis demonstrates that implementation legislation varies quite substantially across the Member States. Frequently, the national implementation strategy has been informed by the wish not to unnecessarily change existing laws. From an input legitimacy perspective this may be criticised, but also be understood from the particular nature of criminal law and legislation. This report has not identified major implementation problems, but especially the open worded provisions may create legal uncertainties.This project received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement number 822304. The content of this document represents only the views of the InDivEU consortium and is its sole responsibility. The European Commission does not accept any responsibility for use that may be made of the information it contains

Migratory flight behaviour of the pollen beetle Meligethes aeneus

BACKGROUND The field ecology of the pollen beetle Meligethes aeneus and its damaging effects on oilseed rape crops are well understood. However, the flight behaviour of M. aeneus, in particular the drivers for migratory movements across the landscape, is not well studied. We combined three established methodologies; suction traps, vertical-looking radar and high-altitude aerial netting to demonstrate that M. aeneus fly at a range of altitudes at different points during its active season. RESULTS By linking evidence of high-altitude mass migration with immigration of pollen beetles into oilseed rape fields, we were able to ‘ground-truth’ the results to characterise the seasonal movements of this pest across the landscape. CONCLUSION We demonstrate that this novel combination of methodologies can advance our understanding of the population movements of pollen beetles and could provide an opportunity to develop predictive models to estimate the severity and timing of pest outbreaks

Can point shear wave elastography differentiate focal nodular hyperplasia from hepatocellular adenoma

Purpose: Focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) are liver tumors that require different management. We assessed the potential of point shear wave elastography (pSWE) to differentiate FNH from HCA and the interobserver and intraobserver reliability of pSWE in the examination of these lesions and of native liver tissue (NLT). Methods: The study included 88 patients (65 FNH, 23 HCA). pSWE was performed by two experienced liver sonographers (observers 1 [O1] and 2 [O2]) and acquired within the lesion of interest and NLT. Group differences, optimal cutoff for characterization and interobserver reliability was assessed with Mann-Whitney-U, area under the ROC curce (AUROC) and intraclass correlation coefficient (ICC). Intraobserver reliability in NLT was assessed in 20 healthy subjects using ICC. Results: Median stiffness was significantly higher in FNH than in HCA (7.01 kPa vs 4.98 kPa for O1 (P=0.017) and 7.68 kPa vs 6.00 kPa for O2 (P=0.031)). A cutoff point for differentiation between the two entities could not be determined with an AUROC of 0.67 (O1) and 0.69 (O2). Interobserver reliability was good for lesion- stiffness (ICC=0.86) and poor for NLT stiffness (ICC=0.09). In healthy subjects, intraobserver reliability for NLT-stiffness was poor for O1 (ICC=0.23) and moderate for O2 (ICC=0.62). Conclusion: This study shows that pSWE cannot reliably differentiate FNH from HCA. Interobserver and intraobserver reliability for pSWE in NLT were insufficient. Interpretation of results gained with this method should be done with great caution

High-Frame-Rate Contrast-enhanced US Particle Image Velocimetry in the Abdominal Aorta: First Human Results

Cardiovascular Aspects of Radiolog

Involvement of Hepatic Innate Immunity in Alcoholic Liver Disease

Excessive alcohol consumption is one of the critical causative factors leading to alcoholic liver disease (ALD). ALD is characterized by a wide spectrum of liver damage, ranging from simple uncomplicated liver steatosis (fatty liver) to steatohepatitis and liver fibrosis/cirrhosis. It has been believed that the obvious underlying cause for ALD is due to hepatocyte death induced by alcohol itself. However, recent sparkling studies have shown that diverse immune responses contribute to ALD because liver is enriched with numerous immune cells. Especially, a line of evidence has suggested that innate immune cells such as Kupffer cells and natural killer (NK)/NKT cells are significantly involved in the pathogenesis of ALD via production of pro-inflammatory cytokines and other mediators. Indeed, more interestingly, hepatic stellate cells (HSCs), known as a major cell inducing liver steatosis and fibrosis, can be killed by liver NK cells, which could be suppressed by chronic alcohol consumption. In this review, with the view of liver as predominant innate immune organ, we describe the pathogenesis of ALD in which what roles of innate immune cells are and how they are interacting with HSCs