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Abstract This pilot study aimed to establish if an exercise programme utilizing the world’s first manual compression foot-pump, commonly known as “Venous Anti-Stasis Slippers”, could be used as an intervention to improve dialysis efficacy (Kt/V) and the quality of life (QOL) of patients with end stage renal disease (ESRD). The entire population of 34 self-care renal patients at the Flora Clinic renal unit were screened and 19 patients who met the inclusion criteria for the study were invited to participate in this 16 week pilot study. Baseline dialysis efficacy values were obtained from the analysis of routine blood tests and quality of life values were established with the use of the South African English version of the EQ-5D health questionnaire. This was followed by an eight week non-intervention period. Pre-intervention values were then established prior to the implementation of an eight week exercise programme using the manual compression foot pumps. A single group time series design was used and 12 of the initial 19 subjects completed the study by performing seated calf raising exercises, with manual compression foot pumps on their feet, for 20 minutes per hour during the first three hours of their routine dialysis sessions (2 - 3 times per week) over a period of eight weeks. Exercise diaries were kept to record exercise times, heart rates and exercise intensities. At the end of the eight week exercise programme, dialysis efficacy and quality of life values were re-measured. An intention to treat analysis of routine blood test results revealed statistically significant changes in dialysis efficacy (Kt/V) values between baseline (1.70 ± 0.48), pre-intervention (1.39 ± 0.43) and post intervention (1.50 ± 0.47) with a resultant 7.91% improvement in Kt/V values as a result of the exercise programme. There were however no statistically significant changes observed in overall quality of life (QOL) values, but noticeable improvements in self-care ability and a reduction in depression/anxiety scores were observed during this pilot study. The frequency of exercise per week had no significant effect on the changes in Kt/V.

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Introduction : L’élastographie shear wave (ESW) est une technique récente d’échographie qui évalue quantitativement la dureté des tissus et permet d’améliorer la caractérisation des lésions mammaires. Comme toute nouvelle technique d’imagerie, l’ESW nécessite une validation préclinique pour définir les conditions d’utilisations et établir les limites des champs d’applications dans lesquelles la technique pourra être considérée comme valide. Matériels et méthodes : Dans une première partie effectuée au laboratoire de recherche en Imagerie nous avons étudié les éléments histologiques sous tendant l’image d’ESW sur un modèle de cancer du sein implanté chez la souris, au cours de sa croissance puis sous traitement. Dans une deuxième partie, nous avons étudié chez des patientes le rôle de la compression manuelle en ESW pour la caractérisation des lésions mammaires. Dans une dernière partie, effectuée en collaboration avec une équipe de l’Institut Langevin Ondes et Images, nous avons étudié la faisabilité d’un nouveau paramètre, le module de cisaillement non linéaire pour l’analyse des lésions mammaires. Résultats : Au laboratoire, nous avons établi des corrélations entre la dureté mesurée en élastographie et les caractéristiques histologiques des tumeurs, y compris sous traitement. Nous avons montré que la fibrose était associée à une dureté élevée et la nécrose à une dureté moindre. Notre étude clinique a montré qu’une compression manuelle minimale était nécessaire pour obtenir de bonnes performances de l’ESW et qu’une pression trop élevée devait être évitée. Enfin nous avons montré la faisabilité en imagerie mammaire d’un nouveau paramètre quantitatif obtenu en élastographie shear wave : le module de cisaillement non linéaire. Conclusion : A partir de travail de thèse, une meilleure compréhension de la part des éléments biologiques et techniques en ESW du sein est possible et des recommandations pour l’utilisation clinique peuvent être formulées. Nos observations cliniques ont entrainé la mise au point d’un nouveau paramètre diagnostique quantitatif : le module de cisaillement non linéaire. / Introduction: Shear Wave Elastography (SWE) is a recent ultrasound technique assessing quantitatively tissue stiffness and improving breast lesions characterization. As every new imaging technique, SWE requires a pre clinical validation in order to define in which conditions it should be used and precise the applications for which the technique is validated. Materials and methods: First, in a research lab we have investigated the pathological features underlying SWE image in a breast cancer model implanted in mice, during tumor growth and under therapy. Secondly, we have studied in patients the role of manual compression in SWE for the characterization of breast lesions. Finally, in collaboration with on team from Institut Langevin Ondes et Images, we have studied the feasibility of a new parameter, the non-linear modulus, for breast lesion assessment. Results: in the research lab, we have shown correlations between stiffness as measured with SWE and pathological features of tumors, even on treatment. We have shown that fibrosis was associated with high stiffness values and necrosis with lowers. Our clinical study, showed that a minimal manual compression was required for optimal performance of SWE and that strong compression should be avoided. Finally, we demonstrated feasibility of a new parameter, derived from SWE, the non-linear modulus. Conclusion: Our work provides a better understanding of biological and technical elements of SWE. On the basis of our results, new recommendations may be made for the use of SWE in clinical practice. From our clinical findings, we developed a new quantitative parameter, which may be useful for the diagnosis of breast lesions, the non-linear modulus.