These results demonstrate that acute clozapine exposure affects SREBP-regulated lipid biosynthesis as well as other lipid homeostasis pathways. We suggest that such drug-induced effects on lipid metabolism in peripheral tissues are relevant for the metabolic adverse effects associated with clozapine and possibly other APDs.

PURPOSE: Real-time elastography (RTE) is an ultrasound-based method for the visualization of relative strain distribution in soft tissues. Strain ratio is a semi-quantitative measurement of strain differences between two user-defined areas in an elastogram. The aim of this study was to evaluate the impact of the size and location of a reference area when measuring the strain ratio of focal lesions in a tissue-mimicking phantom and in normal liver tissue. We also investigated whether the strain ratio was affected by changing the scanner parameter: elasticity dynamic range (E-dyn). MATERIALS AND METHODS: Two investigators individually collected data by scanning 4 spherical inclusions with different elasticity in a phantom in which the elastic modulus was known in both the lesions and the background. Subsequently, a liver scan was performed in-vivo using the same scanning protocol. Five different setups with changes in reference area position or size were tested. All eight levels of the scanner setting E-dyn were recorded for each setup and the strain ratio was measured in 3 different representative elastograms for each recording situation. RESULTS: The four inclusions had significantly different mean strain ratio levels (p < 0.01) when compared to the surrounding material. Changing the position of the reference area to a deeper position influenced the strain ratio measurements significantly for all phantom lesions and in the liver. Changing the size of the reference area, while keeping the center depth unchanged, did not influence the mean strain ratio levels significantly. The strain ratio was independent of the E-dyn parameter setting. The intra- and interobserver reliability was high when measuring the strain ratio with a free-hand technique. CONCLUSION: Strain ratio provides reproducible measurements of inclusions representing different elastic contrasts using a free-hand technique in vitro. Changes in the distance of the reference areas to the ultrasound probe, representing the stress source, seem to have a significant impact on strain ratio measurements.

Endorectal elastography can be performed as an integral part of the clinical evaluation of rectal tumours and has good patient compliance. The method is a promising modality for the discrimination between adenocarcinoma and adenoma of the rectum.

Background: Rectal tumor treatment strategies are individually tailored based on tumor stage, and yield different rates of posttreatment morbidity, mortality, and local recurrence. Therefore, the accuracy of pretreatment staging is highly important. Here we investigated the accuracy of staging by magnetic resonance imaging (MRI) and endorectal ultrasound (ERUS) in a clinical setting. Material and methods: A total of 500 patients were examined at the rectal cancer outpatient clinic at Haukeland University Hospital between October 2014 and January 2018. This study included only cases in which the resection specimen had a histopathological staging of adenoma or early rectal cancer (pT1-pT2). Patients with previous pelvic surgery or preoperative radiotherapy were excluded. The 145 analyzed patients were preoperatively examined via biopsy (n ¼ 132), digital rectal examination (n ¼ 77), rigid rectoscopy (n ¼ 127), ERUS (n ¼ 104), real-time elastography (n ¼ 96), and MRI (n ¼ 84). Results: ERUS distinguished between adenomas and early rectal cancer with 88% accuracy (95% CI: 0.68-0.96), while MRI achieved 75% accuracy (95% CI: 0.54-0.88). ERUS tended to overstage T1 tumors as T2-T3 (16/24). MRI overstaged most adenomas to T1-T2 tumors (18/22). Neither ERUS nor MRI distinguished between T1 and T2 tumors. Conclusions: In a clinical setting, ERUS differentiated between benign and malignant tumors with high accuracy. The present findings support previous reports that ERUS and MRI have low accuracy for T-staging of early rectal cancer. We recommend that MRI be routinely combined with ERUS for the clinical examination of rectal tumors, since MRI consistently overstaged adenomas as cancer. In adenomas, MRI had no additional benefit for preoperative staging.