Early Diagnosis of Fibromyalgia Using Surface-Enhanced Raman Spectroscopy Combined with Chemometrics.

Fibromyalgia (FM) is a chronic muscle pain disorder that shares several clinical features with other related rheumatologic disorders. This study investigates the feasibility of using surface-enhanced Raman spectroscopy (SERS) with gold nanoparticles (AuNPs) as a fingerprinting approach to diagnose FM and other rheumatic diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), osteoarthritis (OA), and chronic low back pain (CLBP). Blood samples were obtained on protein saver cards from FM (n = 83), non-FM (n = 54), and healthy (NC, n = 9) subjects. A semi-permeable membrane filtration method was used to obtain low-molecular-weight fraction (LMF) serum of the blood samples. SERS measurement conditions were standardized to enhance the LMF signal. An OPLS-DA algorithm created using the spectral region 750 to 1720 cm-1 enabled the classification of the spectra into their corresponding FM and non-FM classes (Rcv > 0.99) with 100% accuracy, sensitivity, and specificity. The OPLS-DA regression plot indicated that spectral regions associated with amino acids were responsible for discrimination patterns and can be potentially used as spectral biomarkers to differentiate FM and other rheumatic diseases. This exploratory work suggests that the AuNP SERS method in combination with OPLS-DA analysis has great potential for the label-free diagnosis of FM.

Portable Mid-Infrared Spectroscopy Combined with Chemometrics to Diagnose Fibromyalgia and Other Rheumatologic Syndromes Using Rapid Volumetric Absorptive Microsampling.

The diagnostic criteria for fibromyalgia (FM) have relied heavily on subjective reports of experienced symptoms coupled with examination-based evidence of diffuse tenderness due to the lack of reliable biomarkers. Rheumatic disorders that are common causes of chronic pain such as rheumatoid arthritis, systemic lupus erythematosus, osteoarthritis, and chronic low back pain are frequently found to be comorbid with FM. As a result, this can make the diagnosis of FM more challenging. We aim to develop a reliable classification algorithm using unique spectral profiles of portable FT-MIR that can be used as a real-time point-of-care device for the screening of FM. A novel volumetric absorptive microsampling (VAMS) technique ensured sample volume accuracies and minimized the variation introduced due to hematocrit-based bias. Blood samples from 337 subjects with different disorders (179 FM, 158 non-FM) collected with VAMS were analyzed. A semi-permeable membrane filtration approach was used to extract the blood samples, and spectral data were collected using a portable FT-MIR spectrometer. The OPLS-DA algorithm enabled the classification of the spectra into their corresponding classes with 84% accuracy, 83% sensitivity, and 85% specificity. The OPLS-DA regression plot indicated that spectral regions associated with amide bands and amino acids were responsible for discrimination patterns and can be potentially used as spectral biomarkers to differentiate FM and other rheumatic diseases.

Effects of Vaccinium berries (blueberries, cranberries and bilberries) on oxidative stress, inflammation, exercise performance, and recovery - a systematic review.

Exercise-induced muscle damage is common in athletes and recreational exercisers and can lead to muscle soreness, weakness, and impaired muscle function. The precise mechanisms are unclear but oxidative stress and inflammation are thought to play a role. (Poly)phenols are substances abundant in Vaccinium berries that have been suggested to possess antioxidant and anti-inflammatory effects that could help improve exercise performance and/or recovery from exercise. The objective of this systematic review was to evaluate the benefits of Vaccinium berry supplementation on exercise performance and recovery, as well as on exercise-induced oxidative and inflammatory biomarkers in healthy individuals. A comprehensive search was conducted in PubMed, ProQuest Medline, Web of Science, Cochrane Library, and Scopus. Studies were included if the participants were healthy individuals who were supplemented with any Vaccinium berry or Vaccinium berry-based products in comparison to a control group. Of the 13 articles included in this review, no significant differences in the exercise performance were found and only one study reported benefits for markers of recovery. Interleukins and c-reactive protein were the most frequently reported biomarkers, but there was limited evidence that Vaccinium berry supplementation impacted them post-exercise. Most studies were of high quality and showed a low risk of bias. Vaccinium berry supplementation is not effective in modulating markers of exercise-induced inflammation and oxidative distress in healthy individuals; nevertheless, more studies are required to evaluate their effects on exercise performance and recovery in this population.

Metabolic Fingerprinting for the Diagnosis of Clinically Similar Long COVID and Fibromyalgia Using a Portable FT-MIR Spectroscopic Combined with Chemometrics.

Post Acute Sequelae of SARS-CoV-2 infection (PASC or Long COVID) is characterized by lingering symptomatology post-initial COVID-19 illness that is often debilitating. It is seen in up to 30-40% of individuals post-infection. Patients with Long COVID (LC) suffer from dysautonomia, malaise, fatigue, and pain, amongst a multitude of other symptoms. Fibromyalgia (FM) is a chronic musculoskeletal pain disorder that often leads to functional disability and severe impairment of quality of life. LC and FM share several clinical features, including pain that often makes them indistinguishable. The aim of this study is to develop a metabolic fingerprinting approach using portable Fourier-transform mid-infrared (FT-MIR) spectroscopic techniques to diagnose clinically similar LC and FM. Blood samples were obtained from LC (n = 50) and FM (n = 50) patients and stored on conventional bloodspot protein saver cards. A semi-permeable membrane filtration approach was used to extract the blood samples, and spectral data were collected using a portable FT-MIR spectrometer. Through the deconvolution analysis of the spectral data, a distinct spectral marker at 1565 cm-1 was identified based on a statistically significant analysis, only present in FM patients. This IR band has been linked to the presence of side chains of glutamate. An OPLS-DA algorithm created using the spectral region 1500 to 1700 cm-1 enabled the classification of the spectra into their corresponding classes (Rcv > 0.96) with 100% accuracy and specificity. This high-throughput approach allows unique metabolic signatures associated with LC and FM to be identified, allowing these conditions to be distinguished and implemented for in-clinic diagnostics, which is crucial to guide future therapeutic approaches.

Molecular identification of Trypanosoma theileri (Laveran, 1902) in cattle from two slaughterhouses in Ecuador and its relation with other haemotropic agents.

Trypanosoma theileri is a worldwide distributed haemoparasite that has been reported throughout the American continent in various species, including bovines, buffaloes and bats. In bovines, high incidence of T. theileri can be harmful when associated with other infections or under stress situations. There is little information on this hemoflagellate in Ecuador, which prompted the study and molecular identification of the trypanosomes collected in two slaughtering centers. Between February and April 2021, a total of 218 samples of bovine blood were collected in abattoirs located in the Andean region of Quito (n = 83) and in the coastal region, in Santo Domingo (n = 135). Quito public Slaughterhouse is the biggest in Ecuador, and for that, they receive animals from all country; on the other hand, Santo Domingo's Slaughterhouse is a small one where mainly females from the region are sacrificed and some males. The samples were evaluated using two molecular tests, the PCR cathepsin L-like (CatL) specific for T. theileri and for the positive samples, a Nested PCR that targets the ITS of the 18S gene. The corresponding PCR products were sequenced, analyzed by BLAST/NCBI and the sequences were used to build a concatenated phylogenetic tree, using the MEGA XI software. Overall, 34 out of the 218 samples, (15.6%) were positive to T. theileri by PCR CatL, resulting from 20/83 (24.1%) positives from the Quito abattoir and 14/135 (10.4%) from the Santo Domingo slaughterhouse. These prevalence rates were found to be significantly different (p = 0.006). According to the phylogenetic tree based on the CatL and ITS concatenated sequences (n = 13), the two novel Equatorial T. theileri isolates, ThI (n = 7) and ThII (n = 6) are closely related and associated to the IC, IB and IIB genotypes, present in Brazil, Venezuela and Colombia. Thirty-one out of the thirty-four T. theileri-positive bovines were co-infected with other haemotropic pathogens, Anaplasma marginale Babesia spp and T. vivax. This coinfection could be responsible for additional pathologies and harmful effects on the affected cattle. This study presents the molecular identification and genotypification of T. theileri isolated from cattle in Ecuador through the analysis of CAtL and ITS sequences, and the high frequency of coinfection of this hemoflagellate with other blood haemotropic organisms.

Rapid Biomarker-Based Diagnosis of Fibromyalgia Syndrome and Related Rheumatologic Disorders by Portable FT-IR Spectroscopic Techniques.

Fibromyalgia syndrome (FM), one of the most common illnesses that cause chronic widespread pain, continues to present significant diagnostic challenges. The objective of this study was to develop a rapid vibrational biomarker-based method for diagnosing fibromyalgia syndrome and related rheumatologic disorders (systemic lupus erythematosus (SLE), osteoarthritis (OA) and rheumatoid arthritis (RA)) through portable FT-IR techniques. Bloodspot samples were collected from patients diagnosed with FM (n = 122) and related rheumatologic disorders (n = 70), including SLE (n = 17), RA (n = 43), and OA (n = 10), and stored in conventional protein saver bloodspot cards. The blood samples were prepared by four different methods (blood aliquots, protein-precipitated extraction, and non-washed and water-washed semi-permeable membrane filtration extractions), and spectral data were collected with a portable FT-IR spectrometer. Pattern recognition analysis, OPLS-DA, was able to identify the signature profile and classify the spectra into corresponding classes (Rcv > 0.93) with excellent sensitivity and specificity. Peptide backbones and aromatic amino acids were predominant for the differentiation and might serve as candidate biomarkers for syndromes such as FM. This research evaluated the feasibility of portable FT-IR combined with chemometrics as an accurate and high-throughput tool for distinct spectral signatures of biomarkers related to the human syndrome (FM), which could allow for real-time and in-clinic diagnostics of FM.

Approach to the intoxicated pediatric patient in the emergency services / Abordaje del paciente pediátrico intoxicado en urgencias

Las intoxicaciones en la población pediátrica son una gran parte de las causas de atención en los servicios de urgencias, pero así mismo representan en muchos casos eventos fatídicos, en nuestro país. La exposición a un tóxico o veneno y sus efectos adversos se pueden convertir en emergencias médicas de gran magnitud, por lo que muchos autores las consideran como: "Trauma múltiple de origen químico". Es por esto que el manejo de un paciente pediátrico intoxicado tiene un enfoque único debido al desafío diagnóstico que representa. La atención oportuna y sistematizada de un paciente pediátrico en el contexto de una intoxicación puede representar el éxito de la atención oportuna, valoración correcta y de un adecuado proceso de atención. El objetivo de este trabajo es presentar un enfoque general para el paciente pediátrico intoxicado en cuanto al manejo inicial, el abordaje, y los datos clínicos que nos puedan orientar en el servicio de urgencias ante un paciente pediátrico intoxicado.

Intoxications in the pediatric population account for a significant portion of the causes of care in emergency services, but they are also fatal in many cases in our country. Exposure to a toxic or poison and its adverse effects can become medical emergencies of great magnitude, which is why many authors consider them "multiple traumas of chemical origin." This is why the management of an intoxicated pediatric patient has a unique approach due to the diagnostic challenge that it represents. Timely and systematized care of a pediatric patient in the context of poisoning can represent the success of timely care, correct assessment, and an adequate care process. The objective of this work is to present a general approach for the intoxicated pediatric patient regarding the initial management, the approach, and the clinical data that can guide us in the emergency department when faced with an intoxicated pediatric patient.

Detection of Babesia spp. in High Altitude Cattle in Ecuador, Possible Evidence of the Adaptation of Vectors and Diseases to New Climatic Conditions.

BACKGROUND: Babesia species are intraerythrocytic protozoa, distributed in tropical and subtropical areas of the world, causing anemic diseases in many animals, including cattle. This disease, called babesisosis, is transmitted from one animal to another through ticks (Tick Borne-Disease or TBD). On the other hand, Ecuador has a tropical climate that allows the development of the vector Rhipicephalus microplus, and therefore favors the transmission of Babesia spp. in cattle. METHODS AND PRINCIPAL FINDINGS: We determined the presence of Babesia spp. by PCR using 18s ribosomal gene as target (18s PCR) in 20 farms in the area of El Carmen (zone below 300 m above sea level) and 1 farm in Quito (2469 m.a.s.l.). In addition, we analyzed parameters such as age, sex, and packed cell volume (PCV) as explanatory variable associated with the disease. RESULTS: The 18s PCR test showed that 18.94% (14.77% Babesia bovis and 4.17% Babesia bigemina) and 20.28% (14.69% B. bovis and 5.59% B. bigemina) of the cattle were positive for Babesia spp in farms sampled in El Carmen and in Quito, respectively. Age influenced the presence of animals positive for Babesia spp., but sex and PCV did not. The phylogenetic analysis of sequences showed 4 isolates of B. bovis and 3 isolates of B. bigemina in the 2 study zones, with similarities between 99.73 and 100% with other sequences. One B. bovis isolate was similar in the zone of El Carmen and Quito. CONCLUSION AND SIGNIFICANCE: This work is the first molecular characterization of B. bigemina and B. bovis in Ecuador, and it is also the first evidence of Babesia spp. in cattle in the area of Quito at an altitude of 2469 m.a.s.l., being the highest altitude reported for animals with babesiosis and for the tick R. microplus. Climatic factors as well as mobility of tick-carrying animals without any control allow the presence of Babesiosis outbreaks in new geographical areas.

Student-Authored Scientist Spotlights: Investigating the Impacts of Engaging Undergraduates as Developers of Inclusive Curriculum through a Service-Learning Course.

Scientist Spotlights-curricular materials that employ the personal and professional stories of scientists from diverse backgrounds-have previously been shown to positively influence undergraduate students' relatability to and perceptions of scientists. We hypothesized that engaging students in authoring Scientist Spotlights might produce curricular materials of similar impact, as well as provide a mechanism for student involvement as partners in science education reform. To test this idea and investigate the impact of student-authored Scientist Spotlights, we developed a service-learning course in which teams of biology students partnered with an instructor to develop and implement Scientist Spotlights in a biology course. Results revealed that exposure to three or four student-authored Scientist Spotlights significantly shifted peers' perceptions of scientists in all partner courses. Interestingly, student-authored Scientist Spotlights shifted peers' relatability to scientists similarly among both white students and students of color. Further, student authors themselves showed increases in their relatability to scientists. Finally, a department-wide survey demonstrated significant differences in students' perceptions of scientist representation between courses with and without student-authored Spotlights. Results suggest that engaging students as authors of inclusive curricular materials and partners in reform is a promising approach to promoting inclusion and addressing representation in science.

Abordaje de control de daños y reanimación reducida de paciente pediátrico politraumatizado en urgencias / Damage control approach and reduced resuscitation of the polytraumatized pediatric patient in the emergency room

El politrauma en el paciente pediátrico es un evento frecuente por lo que su abordaje y manejo oportuno definen el pronóstico del mismo. Se define como politrauma a la presencia de dos o más lesiones traumáticas o una sola que pone en peligro la vida o existe el riesgo de secuelas graves; la reanimación se entiende como el restablecimiento de las funciones vitales del paciente en el área prehospitalaria hasta el área hospitalaria encaminados a evitar el daño causado por la pentada mortal del trauma (coagulopatía, acidosis, hipotermia, hiperglicemia e hipoxia) por lo que se realizó el protocolo de control de daños el cual es referido a todas la maniobras que tiene el fin de preservar la vida, pero sin llevar a cabo reparaciones definitivas con el objetivo de mitigar complicaciones derivadas del estado de choque prolongado, secundario a un tiempo quirúrgico prolongado que postergaba la reanimación adecuada, ésta reanimación reducida consta de 6 indicaciones precisas para su realización, siendo abordado desde el TEP (Triangulo de evaluación pediátrica) y protocolo MARCHDEF (Hemorragias masivas, Vía aérea, Respiración, Circulación, Hipotermia, Déficit Neurológico, Glicemia, Dolor, Exposición, FAST).

Polytrauma in pediatric patients is a frequent event, so its timely approach and management define its prognosis. Polytrauma is defined as the presence of two or more traumatic injuries or a single one that endangers life or there is a risk of serious sequelae; resuscitation is understood as the restoration of vital functions of the patient in the pre-hospital area to the hospital area aimed at avoiding the damage caused by the fatal pentad of trauma (coagulopathy, acidosis, hypothermia, hyperglycemia and hypoxia) for which the Damage control protocol which is referred to all the maneuvers that have the purpose of preserving life, but without carrying out definitive repairs in order to mitigate complications derived from the prolonged state of shock, secondary to a prolonged surgical time that postponed adequate resuscitation, this reduced resuscitation consists of 6 precise indications for its performance, being approached from the TEP (Pediatric Evaluation Triangle) and the MARCHDEF protocol (Massive Bleeding, Airway, Breathing, Circulation, Hypothermia, Neurological Deficit, Glycemia, Pain, Exposure, FAST).

Amelioration of Both Central and Peripheral Neuropathy in Mouse Models of Type 1 and Type 2 Diabetes by the Neurogenic Molecule NSI-189.

While peripheral neuropathy is the most common complication of long-term diabetes, cognitive deficits associated with encephalopathy and myelopathy also occur. Diabetes is a risk factor for Alzheimer disease (AD) and increases the risk of progression from mild cognitive impairment to AD. The only current recommendation for preventing or slowing the progression of peripheral neuropathy is to maintain close glycemic control, while there is no recommendation for central nervous system disorders. NSI-189 is a new chemical entity that when orally administered promotes neurogenesis in the adult hippocampus, increases hippocampal volume, enhances synaptic plasticity, and reduces cognitive dysfunction. To establish the potential for impact on peripheral neuropathy, we first showed that NSI-189 enhances neurite outgrowth and mitochondrial functions in cultured adult rat primary sensory neurons. Oral delivery of NSI-189 to murine models of type 1 (female) and type 2 (male) diabetes prevented multiple functional and structural indices of small and large fiber peripheral neuropathy, increased hippocampal neurogenesis, synaptic markers and volume, and protected long-term memory. NSI-189 also halted progression of established peripheral and central neuropathy. NSI-189, which is currently in clinical trials for treatment of major depressive disorder, offers the opportunity for the development of a single therapeutic agent against multiple indices of central and peripheral neuropathy.

Concurrent validity of an automated algorithm for computing the center of pressure excursion index (CPEI).

Center of Pressure Excursion Index (CPEI), a parameter computed from the distribution of plantar pressures during stance phase of barefoot walking, has been used to assess dynamic foot function. The original custom program developed to calculate CPEI required the oversight of a user who could manually correct for certain exceptions to the computational rules. A new fully automatic program has been developed to calculate CPEI with an algorithm that accounts for these exceptions. The purpose of this paper is to compare resulting CPEI values computed by these two programs on plantar pressure data from both asymptomatic and pathologic subjects. If comparable, the new program offers significant benefits-reduced potential for variability due to rater discretion and faster CPEI calculation. CPEI values were calculated from barefoot plantar pressure distributions during comfortable paced walking on 61 healthy asymptomatic adults, 19 diabetic adults with moderate hallux valgus, and 13 adults with mild hallux valgus. Right foot data for each subject was analyzed with linear regression and a Bland-Altman plot. The automated algorithm yielded CPEI values that were linearly related to the original program (R2=0.99; P<0.001). Bland-Altman analysis demonstrated a difference of 0.55% between CPEI computation methods. Results of this analysis suggest that the new automated algorithm may be used to calculate CPEI on both healthy and pathologic feet.

Relating Intrinsic Low-Frequency BOLD Cortical Oscillations to Cognition in Schizophrenia.

The amplitude of low-frequency fluctuations (ALFF) in the blood oxygenation level-dependent (BOLD) signal during resting-state fMRI reflects the magnitude of local low-frequency BOLD oscillations, rather than interregional connectivity. ALFF is of interest to studies of cognition because fluctuations in spontaneous intrinsic brain activity relate to, and possibly even constrain, task-evoked brain responses in healthy people. Lower ALFF has been reported in schizophrenia, but the cognitive correlates of these reductions remain unknown. Here, we assess relationships between ALFF and attention and working memory in order to establish the functional relevance of intrinsic BOLD oscillatory power alterations with respect to specific cognitive impairments in schizophrenia. As part of the multisite FBIRN study, resting-state fMRI data were collected from schizophrenia subjects (SZ; n=168) and healthy controls (HC; n=166). Voxelwise fractional ALFF (fALFF), a normalized ALFF measure, was regressed on neuropsychological measures of sustained attention and working memory in SZ and HC to identify regions showing either common slopes across groups or slope differences between groups (all findings p<0.01 height, p<0.05 family-wise error cluster corrected). Poorer sustained attention was associated with smaller fALFF in the left superior frontal cortex and bilateral temporoparietal junction in both groups, with additional relationships in bilateral posterior parietal, posterior cingulate, dorsal anterior cingulate (ACC), and right dorsolateral prefrontal cortex (DLPFC) evident only in SZ. Poorer working memory was associated with smaller fALFF in bilateral ACC/mPFC, DLPFC, and posterior parietal cortex in both groups. Our findings indicate that smaller amplitudes of low-frequency BOLD oscillations during rest, measured by fALFF, were significantly associated with poorer cognitive performance, sometimes similarly in both groups and sometimes only in SZ, in regions known to subserve sustained attention and working memory. Taken together, these data suggest that the magnitude of resting-state BOLD oscillations shows promise as a biomarker of cognitive function in health and disease.

Normative data for macular volume with high-definition spectral-domain optical coherence tomography (Spectralis).

PURPOSE: To establish normative data for macular volume by spectral-domain optical coherence tomography (SD-OCT) in subjects with no known retinal disease. METHODS: In an academic institutional setting, 50 subjects (age range 20-84 years) with no known retinal disease, best-corrected visual acuity 20/20, and normal intraocular pressure were enrolled. The subjects were divided into 3 age groups: group 1 included subjects 20-40 years of age, group 2 included subjects 41-60 years of age, and group 3 included subjects 61 years of age and older. All subjects underwent a complete ophthalmologic examination and testing, if needed, to rule out any retinal diseases or glaucoma. Retinal volume (RV) in 9 Early Treatment Diabetic Retinopathy Study (ETDRS) subfields and total macular volume (TMV) inclusive of all 9 subfields were analyzed. Statistical analyses were carried out using analysis of variance. RESULTS: Overall, the mean TMV ± SD for ETDRS circles with a diameter of 1, 2.22, and 3.45 mm was determined to be 3.04 ± 0.14 mm3. Among the ETDRS subfields, RV was highest in the nasal outer field, with a mean of 0.47 ± 0.02 mm3. The TMV did not show a significant difference with age (p = 0.17). However, TMV was significantly higher in males (p = 0.003) and in Caucasian and Asian subjects compared to African Americans (p = 0.017). CONCLUSIONS: Normative values for total macular volume in ETDRS subfields in otherwise healthy eyes were measured to be 3.04 ± 0.14 mm3.

Pregnancy outcomes and successful rate of nifedipine therapeutic protocol implementation in a hospital of San Juan.

PRIMARY OBJECTIVE: evaluation of Nifedipine protocol success defined as postponement of labor for 48 hours. SECONDARY OBJECTIVE: evaluation of the presence of risk factors in patients that develop preterm labor and delivery outcome. MATERIALS AND METHODS: Chart review retrospective study with patients admitted to the Hospital of the Metropolitan Area of San Juan in the period of January 1,2009 to December 31, 2010 with diagnosis of preterm labor. A total of 382 patient's records were evaluated for inclusion and exclusion criteria. 48 met all the requirements to be included in the study. RESULTS: There were 68.8% patients who successfully completed the 48 hours postponement of labor required to administer corticosteroid therapy for fetal lung maturation. Risk factors for preterm labor commonly observed in the study group were urinary tract infection (60.4%), previous preterm labor (43.8%), multiple gestations (12.5%), and preterm premature rupture of membranes (10.4%). DISCUSSION: The use of Nifedipine therapy in patients with preterm labor between 24-34 weeks of gestational age can be effective in the postponement of labor for 48 hours so that the patient can receive corticosteroid fetal lung maturation therapy. The most common risk factor observed in this group of patients with preterm labor was urinary tract infection.

An unexpected cause of diarrhea in a pregnant patient: a case report.

In 2009 AH1N1, a novel influenza virus was identified. Majority of complications arise in specific group of patient including pregnant women. This report is a description of the first patient encountered in our institution. Such case was a yo woman on the 23rd week of gestation that presented with several episodes of diarrhea. Shortly after admission what appeared to be a common case of gastroenteritis evolved in respiratory distress and hemodynamic instability progressing to respiratory distress syndrome. The diagnosis was delayed by the absence of respiratory symptoms at presentation as well as by the lack of rapid specific laboratories. This case was a fatality that reinforces the need of a high index of suspicion and prompt treatment even in the most atypical presentations of the disease.

Ultrasound diagnosis of quadriceps tendon tear in an uncooperative patient.

A 38-year-old intoxicated man presented to the emergency department with a painful, swollen left knee and inability to ambulate after being tackled to the ground. The patient was uncooperative, and physical examination of the lower extremities was limited by his intoxication. Radiographic examination of the knee was unremarkable. Ultrasound of the knee revealed a quadriceps tendon rupture. The sonographic features of quadriceps tendon rupture are described, as is the role ultrasound plays in the assessment of a swollen, painful knee.