Effects of foam rolling on vastus intermedius and lateralis microvascular blood flow.

INTRODUCTION: Foam Rolling (FR) as a technique of self-massage has become a widely used intervention in clinical and sports practice. It is assumed that FR leads to an increased intramuscular microvascular blood flow (MBF), and therefore is commonly recommended as a warm-up or regeneration method. However, no data validate the effects of FR on MBF. This study aimed to assess whether FR increases intramuscular MBF using contrast-enhanced ultrasound (CEUS). METHODS: Ten healthy athletes performed a standardized FR intervention applied to the lateral thigh (3 sets: 45 s FR, 20 s rest). Intramuscular perfusion was determined by CEUS under resting conditions (t0), immediately (t1), and 30 min (t2) after the intervention. Peak enhancement (PE), wash-in rate (WiR), and wash-in perfusion index (WiPI) were evaluated as quantitative perfusion parameters in vastus lateralis (VL) and intermedius (VI) muscle separately via regions of interest mapping. RESULTS: Immediately after the intervention (t1), perfusion parameters showed a non-significant decrease in VL (p = 0.3; PE: -32.1%, WiPI: -29.6%, WiR: -50.4%) and VI (p = 0.4; PE: -10.3%, WiPI: -6.4%, WiR: -35.6%). A non-significant decrease was found at t2 in VL (p = 0.2; PE: -34%, WiPI -33.9%, WiR -61.2%) and VI (p = 0.2; PE -17.6%, WiPI -13.8%, WiR -43.2%). CONCLUSIONS: The common assumption of intramuscular MBF improvement due to FR could not be confirmed for up to 30 min after the intervention. If an increase in intramuscular metabolism or MBF is intended, we recommend that alternative methods (i.e., traditional warm-up) should be preferred.

Comparison of Readout-Segmented Echo-Planar Imaging and Single-Shot TSE DWI for Cholesteatoma Diagnostics.

BACKGROUND AND PURPOSE: The high diagnostic value of DWI for cholesteatoma diagnostics is undisputed. This study compares the diagnostic value of readout-segmented echo-planar DWI and single-shot TSE DWI for cholesteatoma diagnostics. MATERIALS AND METHODS: Thirty patients with newly suspected cholesteatoma were examined with a dedicated protocol, including readout-segmented echo-planar DWI and single-shot TSE DWI at 1.5T. Acquisition parameters of both diffusion-weighted sequences were as follows: b=1000 s/mm,2 axial and coronal section orientations, and section thickness of 3 mm. Image quality was evaluated by 2 readers on a 5-point Likert scale with respect to lesion conspicuity, the presence of susceptibility artifacts mimicking cholesteatomas, and overall subjective image quality. Sensitivity and specificity were calculated using histology results as the gold standard. RESULTS: Twenty-five cases of histologically confirmed cholesteatomas were included in the study group. Lesion conspicuity was higher and fewer artifacts were found when using TSE DWI (both P < .001). The overall subjective image quality, however, was better with readout-segmented DWI. For TSE DWI, the sensitivity for readers 1 and 2 was 92% (95% CI, 74%-99%) and 88% (95% CI, 69%-97%), respectively, while the specificity for both readers was 80% (95% CI, 28%-99%). For readout-segmented DWI, the sensitivity for readers 1 and 2 was 76% (95% CI, 55%-91%) and 68% (95% CI, 46%-85%), while the specificity for both readers was 60% (95% CI, 15%-95%). CONCLUSIONS: The use of TSE DWI is advisable for cholesteatoma diagnostics and preferable over readout-segmented DWI.

Carotid CTA at the Lowest Tube Voltage (70 kV) in Comparison with Automated Tube Voltage Adaption.

BACKGROUND AND PURPOSE: CTA is the imaging modality of choice in many institutions for the evaluation of the supraaortic vessels, but radiation exposure remains a matter of concern. Our aim was to evaluate a 70-kV protocol for CT angiography of the carotid arteries with respect to image quality and radiation exposure compared with automated tube voltage adaption. MATERIALS AND METHODS: A total of 90 consecutive patients were included in this prospective study and randomized to the study group (n = 45, 70 kV) or control group (n = 45, automated tube voltage adaptation). Volume CT dose indices and dose-length products were recorded in the examination protocol. Image quality was assessed as arterial vessel contrast, signal-to-noise ratio, contrast-to-noise ratio, and contrast-to-noise ratio in reference to the radiation dose. Subjective overall image-quality analysis, image-artifact analysis, and diagnostic evaluation were performed by 2 observers by using a 4-point Likert scale. RESULTS: Radiation exposure was significantly lower in the study group (volume CT dose index reduced by 22%, dose-length product reduction by 20%; each P < .001). Contrast (P = .15), SNR (P = .4), and contrast-to-noise ratio (P = .5) did not show significant differences between the groups. The contrast-to-noise ratio in reference to the radiation dose was not significantly increased using the study protocol (P = .2). Subjective image quality and visualization of pathologic findings did not differ significantly between the groups. CONCLUSIONS: Carotid CTA using the lowest available voltage (70 kV) is feasible at very-low-dose levels, while overall image quality is comparable with protocols using automated tube voltage selection.

[Update cartilage imaging of the small joints : Focus on high-field MRI]. / Update Knorpelbildgebung der kleinen Gelenke : Fokus Hochfeld-MRT.

BACKGROUND: Cartilage imaging of small joints is increasingly of interest, as early detection of cartilage damage may be relevant regarding individualized surgical therapies and long-term outcomes. PURPOSE: The aim of this review is to explain modern cartilage imaging of small joints with emphasis on MRI and to discuss the role of methods such as CT arthrography as well as compositional and high-field MRI. MATERIALS AND METHODS: A PubMed literature search was performed for the years 2008-2018. RESULTS: Clinically relevant cartilage imaging to detect chondral damage in small joints remains challenging. Conventional MRI at 3 T can still be considered as a reference for cartilage imaging in clinical routine. In terms of sensitivity, MR arthrography (MR-A) and computed tomography arthrography (CT-A) are superior to non-arthrographic MRI at 1.5 T in the detection of chondral damage. Advanced degenerative changes of the fingers and toes are usually sufficiently characterized by conventional radiography. MRI at field strengths of 3 T and ultrahigh-field imaging at 7 T can provide additional quantifiable, functional and metabolic information. CONCLUSION: Standardized cartilage imaging plays an important role in clinical diagnostics in the ankle joint due to the availability of different and individualized therapeutic concepts. In contrast, cartilage imaging of other small joints as commonly performed in clinical studies has not yet become standard of care in daily clinical routine. Although individual study results are promising, additional studies with large patient collectives are needed to validate these techniques. With rapid development of new treatment concepts radiological diagnostics will play a more significant role in the diagnosis of cartilage lesions of small joints.

Plantar pressures increase with raising body weight: A standardised approach with paired sample using neutral shoes.

BACKGROUND: Plantar pressure leads to stress on plantar tissue and can be seen as risk factor for metatarsal stress fractures or plantar ulcers and is associated with prolonged and complicated recurrence of existing tissue damages. A clear demarcation of a systematic raise of body load regarding its effect on plantar pressure has not been described. OBJECTIVE: Assessing plantar pressure patterns in different conditions of body weight, comparing data to initial body weight. METHODS: Seventeen healthy volunteers were asked to participate. Peak pressure values were assessed during walking with dynamic pedobarography and analysed from three foot sections. Body weight was loaded up gradually with 10%, 20% and 30% of the individual initial weight by using a weighted vest. RESULTS: We were able to detect a statistically significant increase of plantar pressure for all foot regions in case of loaded body weight of 20% and 30% comparing to initial weight (p< 0.05). The midfoot area displays a significant increase for peak pressure for the preferred foot even for 10% body load. CONCLUSIONS: Peak plantar pressure increases with loaded body weight. The midfoot area seems to be a sensitive area in case of adapting increasing foot load. Considering the clinical relevance, loaded body weight has to be seen as risk factor for increasing plantar pressure patterns and should be considered in recurrence of plantar ulcers or stress fractures.

[Current Conservative Treatment and Management Strategies of Skeletal Muscle Injuries]. / Konservative Therapie von Muskelverletzungen - Beurteilung aktueller Behandlungskonzepte.

Muscle injuries frequently occur during sport and are one of the commonest injuries. The diagnosis and treatment of muscle injuries impose high demands on medical treatment, in order to ensure successful regeneration and a rapid return to sport. Most of the injuries can be treated conservatively, as skeletal muscles have a high endogenous capacity for repair and regeneration. Conservative treatment includes initial on-field therapy. This is known as the "RICE" principle and is common and recommended for initial treatment for most sports injuries. The primary therapy target is to reduce pain, swelling and bleeding and thus to limit the initial inflammatory process and prevent further damage. During the first days after injury, brief immobilization helps to reduce the re-injury rate and accelerates the formation of granulation tissue. There are many possible additional treatments, including intramuscular injections, manipulation of the sacroiliac joint or rehabilitation programs, including stretching and strengthening. If the acute treatment phase is complete after 3 to 5 days, more active treatment, including trunk stabilisation, stretching and strengthening, can be started gradually. Despite their high prevalence, there have only been a few studies on the treatment and management of these injuries. The aim of this manuscript is to review the literature on the classification, pathobiology and treatment strategies for muscle injuries.

[Serologic detection of antibodies to Newcastle disease virus in water fowl using the hemagglutination inhibition test and enzyme immunoassay]. / Serologischer Nachweis von Antikörpern gegen das Newcastle Disease Virus bei Wassergeflgel mittels Hämagglutinationshemmungs-Test und Enzym-Immuno-Assay.

8410 samples from Moscovy duck, Pekin duck and geese were incorporated into examinations of antibodies against the Newcastle Disease virus. A new enzyme-immuno-assay (EIA) for antibody detection in Moscovy duck and Pekin duck was developed using purified antigen from NDV-strain "La Sota". The epidemiology as well as the relation of incidence of the Newcastle Disease in waterfowl was discussed.

Balanced anesthesia and patient-controlled postoperative analgesia with fentanyl: minimum effective concentrations, accumulation and acute tolerance.

Minimum effective fentanyl concentrations (MEC) were determined in 230 ASA I-III patients undergoing a variety of elective surgical procedures under balanced anesthesia, and in 40 patients recovering from comparable operations and anesthesia during postoperative intravenous self-administration of fentanyl (demand dose 34.5 micrograms) by means of the On-Demand Analgesia Computer. Following induction of anesthesia with fentanyl 4 micrograms/kg, repetitive fentanyl reinjections (0.1-0.2 mg) were given intraoperatively whenever systolic blood pressure or pulse rate increased to more than 20% of preinduction values, resulting in an intraoperative fentanyl consumption of 4.2 +/- 1.2 micrograms/kg/h. Duration of postoperative patient-controlled analgesia (PCA) was 20.2 +/- 4.3 h during which time 15.5 +/- 12.9 demands per patient were registered, resulting in a postoperative fentanyl consumption of 0.46 +/- 0.35 micrograms/kg/h. MECs appeared to be log-normally distributed (intra-operative median 2.6 ng/ml, range 0.2-36.6; postoperative median 1.2 ng/ml, range 0.2-8.0). Mean intra- and interindividual variability in MEC was 37% intraoperatively or 27% postoperatively, and 68% or 63%, respectively. There was no obvious correlation between postoperative fentanyl consumption or individual mean MEC and analgesic efficacy, which was generally described as superior to conventional pain treatment. Individual MECs increased gradually during anesthesia (mean slope 0.0191 ng/ml/min) but decreased under PCA conditions (-0.0008 ng/ml/min); difference not significant. While the postoperative decrease could be explained by diminishing pain intensity during the observation period, the slight intraoperative increase is discussed as acute tolerance rather than as accumulation. It is concluded that repetitive fentanyl injections as indicated by clinical needs will not lead to relevant accumulation in serum, and that analgesic therapy should be individualized both intra- and postoperatively.

[Pathological findings in enosseous and subperiosteal implantations]. / Pathologische Befunde bei enossalen und subperiostalen Implantaten

Several clinical observations in cases where implantations carried out alio loco lead to severe complications, prompted us to report five of these cases and to clarify with reference to the relevant literature the causative factors which have led to the failures. We hope hereby to contribute to the knowledge possibility of error and the limitations of the indications for dental implants.