Reproducibility of Ablated Volume Measurement Is Higher with Contrast-Enhanced Ultrasound than with B-Mode Ultrasound after Benign Thyroid Nodule Radiofrequency Ablation—A Preliminary Study

The reproducibility of contrast-enhanced ultrasound (CEUS) and standard B-mode ultrasound in the assessment of radiofrequency-ablated volume of benign thyroid nodules was compared. A preliminary study was conducted on consecutive patients who underwent radiofrequency ablation (RFA) of benign thyroid nodules between 2014 and 2016, with available CEUS and B-mode post-ablation checks. CEUS and B-mode images were retrospectively evaluated by two radiologists to assess inter- and intra-observer agreement in the assessment of ablated volume (Bland-Altman test). For CEUS, the mean inter-observer difference (95% limits of agreement) was 0.219 mL (-0.372-0.809 mL); for B-mode, the mean difference was 0.880 mL (-1.655-3.414 mL). Reproducibility was significantly higher for CEUS (85%) than for B-mode (27%). Mean intra-observer differences (95% limits of agreement) were 0.013 mL (0.803-4.097 mL) for Reader 1 and 0.031 mL (0.763-3.931 mL) for Reader 2 using CEUS, while they were 0.567 mL (-2.180-4.317 mL, Reader 1) and 0.759 mL (-2.584-4.290 mL, Reader 2) for B-mode. Intra-observer reproducibility was significantly higher for CEUS (96% and 95%, for the two readers) than for B-mode (21% and 23%). In conclusion, CEUS had higher reproducibility and inter- and intra-observer agreement compared to conventional B-mode in the assessment of radiofrequency-ablated volume of benign thyroid nodules

Bone strain index reproducibility and soft tissue thickness influence : a dual x-ray photon absorptiometry phantom study

Background: Bone strain index (BSI) is a tool measuring bone strain, derived from dual x-ray photon absorptiometry. It is able to characterise an aspect of bone quality that, joined to the quantity and quality parameters of bone mineral density (BMD) and trabecular bone score (TBS), permits an accurate definition of fracture risk. As no data are available about BSI precision, our aim was to assess its in vitro reproducibility. Methods: A Hologic spine phantom was used to perform BSI scans with three different scan modes: fast array (FA), array (A), and high definition (HD). Different soft tissue thicknesses (1, 3, 6 cm) of fresh pork rind layers as a surrogate of abdominal fat were interposed. For each scan mode, the phantom was consecutively scanned 25 times without repositioning. Results: In all scan modes (FA, A, HD) and at every fat thickness, BSI reproducibility was lower than that of BMD. The highest reproducibility was found using HD-mode with 1 cm of pork rind and the lowest one using HD-mode with 6 cm of pork rind. Increasing fat thickness, BSI reproducibility tended to decrease. BSI least significant change appeared to be about three times that of BMD in all modalities and fat thicknesses. Without pork rind superimposition and with 1-cm fat layer, BSI reproducibility was highest with HD-mode; with 3 or 6 cm fat thickness, it was higher with A-mode. Conclusions: BSI reproducibility was worse than that of BMD, but it is less sensitive to fat thickness increase, similarly to TBS

Sovranità e neo-sovranità nel Diritto euro-internazionale

In tale studio si tende ad esaminare fino a che punto la sovranità statuale possa ritenersi erosa o al contrario espansa a causa della presenza di “nuovi” attori internazionali e del crescente fenomeno integrativo unioni stico-comunitario. Predetto studio si concentra sui limiti della più complessa architettura integrazionista cd. multilevel in cui l’ordinamento statale si proietta dall’interno verso i livelli esterni sia europeo che internazionale. In tale contesto diverse forme integrative tra Stati, sia a vocazione regionale che universale, hanno comportato nello “spazio globale”l’emersione di nuovi attori, sia pubblici8 che privati, che orientano le scelte di vita collettiva nella stessa Comunità internazionale

Servizi pubblici internazionali e protezione dell’ambiente fluviale

Lo sviluppo di un modello di collettivismo statale, in cui lo Stato estende sempre più la rete dei servizi pubblici ai bisogni sociali dei propri cittadini e l’interdipendenza esistente fra i vari popoli, ha portato all’internazionalizzazione di diversi servizi pubblici, tra cui quello fluviale, riferito a corsi d’acqua interessanti due o più Stati. Rispetto a tale tipologia di servizio l’esercizio congiunto delle funzioni statali si è posto qualitativamente mutevole a seconda delle esigenze proprie delle varie fasi storiche di riferimento. La specifica e peculiare nozione di rete fluviale viene ricondotta in tale studio, ad uno spazio giuridico e geo-fisico transnazionale volto alla gestione comune della navigazione e della disciplina delle attività economiche, nell’ambito delle politiche di conservazione e di gestione delle risorse naturali di interesse comune, ponendosi quale incisivo fattore di cooperazione e di integrazione fra aree sub-regionali