Intraobserver Reliability on Classifying Bursitis on Shoulder Ultrasound.

Purpose: Bursitis is a common musculoskeletal cause of shoulder pain and treatment varies, thus correctly diagnosing and grading bursitis is paramount in deciding management. Our aim was to assess reliability in grading shoulder bursitis on ultrasonography among fellowship trained musculoskeletal radiologists at our institution. Methods: Retrospective study of patients diagnosed with bursitis on ultrasonography. Single-sonographic images of the subacromial-subdeltoid bursa were collected for each patient and randomized to form a test-bank of varying degrees of bursitis. Three months after the test was administered, the cases were randomized and readministered. The radiologists graded each case as: within normal limits, mild, moderate or severe. Intraobserver variability was measured using Cohen's kappa coefficient. Linear regression model was performed to assess correlation between years of experience and kappa. Results: 10 radiologists reviewed 70 cases of bursitis. Kappa values ranged from .53 to .91, indicating 'moderate' to 'almost perfect' variability amongst radiologists. A moderate positive correlation of improving variability (r = .69) with increasing years of experience exists. Conclusion: Fellowship trained musculoskeletal radiologists were able to grade shoulder bursitis with moderate to almost perfect variability, with a positive correlation of improved variability with increasing experience. This may help clinicians choose the correct treatment more confidently in their patients with shoulder pain.

Unilateral Axillary Lymphadenopathy After COVID-19 Vaccine Causing Medial Cord Plexopathy: A Case Report.

CASE: The global reach of coronavirus disease 2019 has led to the rollout of new generation messenger ribonucleic acid (mRNA) vaccines. As populations are vaccinated, some side effects will become more apparent. We present a case of unilateral lymphadenopathy resulting in a transient plexopathy presenting as neuralgic pain, paresthesia, and numbness in the hand. CONCLUSION: Multiple image modalities and electrodiagnostic studies were used to infer the diagnosis. This condition was expectantly managed, and the patient's symptoms resolved within weeks.

Low-dose CT imaging of the acute abdomen using model-based iterative reconstruction: a prospective study.

OBJECTIVES: Performance of a modified abdominopelvic CT protocol reconstructed using full iterative reconstruction (IR) was assessed for imaging patients presenting with acute abdominal symptoms. MATERIALS AND METHODS: Fifty-seven patients (17 male, 40 female; mean age of 56.5 ± 8 years) were prospectively studied. Low-dose (LD) and conventional-dose (CD) CTs were contemporaneously acquired between November 2015 and March 2016. The LD and CD protocols imparted radiation exposures approximating 10-20% and 80-90% those of routine abdominopelvic CT, respectively. The LD images were reconstructed with model-based iterative reconstruction (MBIR), and CD images with hybrid IR (40% adaptive statistical iterative reconstruction (ASIR)). Image quality was assessed quantitatively and qualitatively. Independent clinical interpretations were performed with a 6-week delay between reviews. RESULTS: A 74.7% mean radiation dose reduction was achieved: LD effective dose (ED) 2.38 ± 1.78 mSv (size-specific dose estimate (SSDE) 3.77 ± 1.97 mGy); CD ED 7.04 ± 4.89 mSv (SSDE 10.74 ± 5.5 mGy). LD-MBIR images had significantly lower objective and subjective image noise compared with CD-ASIR (p < 0.0001). Noise reduction for LD-MBIR studies was greater for patients with BMI < 25 kg/m2 than those with BMI ≥ 25 kg/m2 (5.36 ± 3.2 Hounsfield units (HU) vs. 4.05 ± 3.1 HU, p < 0.0001). CD-ASIR studies had significantly better contrast resolution, and diagnostic acceptability (p < 0.0001 for all). LD-MBIR studies had significantly lower streak artifact (p < 0.0001). There was no difference in sensitivity for primary findings between the low-dose and conventional protocols with the exception of one case of enteritis. CONCLUSIONS: Low-dose abdominopelvic CT performed with MBIR is a feasible radiation dose reduction strategy for imaging patients presenting with acute abdominal pain.

Effects of age and long-term endurance training on VO2 kinetics.

PURPOSE: This study examined the effects of age and training status on the pulmonary oxygen uptake (VO2p) kinetics of untrained and chronically trained young, middle-age, and older groups of men. METHODS: Breath-by-breath VO2p and near-infrared spectroscopy-derived muscle deoxygenation ([HHb]) were monitored continuously in young (20-39 yr) trained (YT, n = 8) and untrained (YuT, n = 8), middle-age (40-59 yr) trained (MT, n = 9) and untrained (MuT, n = 9), and older (60-85 yr) trained (OT, n = 9) and untrained (OuT, n = 8) men. On-transient VO2p and [HHb] responses to cycling exercise at 80% of the estimated lactate threshold (three repeats) were modeled as monoexponential. Data were scaled to a relative percentage of the response (0%-100%), the signals time aligned, and the individual [HHb]-to-VO2p ratio was calculated as the average [HHb]/VO2 during the 20- to 120-s period after exercise onset. RESULTS: The time constant for the adjustment of phase II pulmonary VO2 (τVO2p) was larger in OuT (42.0 ± 11.3 s) compared with that in YT (17.0 ± 7.5 s), MT (18.1 ± 5.3 s), OT (19.8 ± 5.4 s), YuT (25.7 ± 6.6 s), and MuT (24.4 ± 7.4 s) (P < 0.05). Similarly, the [HHb]/VO2 ratio was larger than 1.0 in OuT (1.30 ± 0.13, P < 0.05) and this value was larger than that observed in YT (1.01 ± 0.07), MT (1.04 ± 0.05), OT (1.04 ± 0.04), YuT (1.05 ± 0.03), and MuT (1.02 ± 0.09) (P < 0.05). CONCLUSIONS: This study showed that the slower VO2kinetics typically observed in older individuals can be prevented by long-term endurance training interventions. Although the role of O2 delivery relative to peripheral use cannot be elucidated from the current measures, the absence of age-related slowing of VO2 kinetics seems to be partly related to a preservation of the matching of O2 delivery to O2 utilization in chronically trained older individuals, as suggested by the reduction in the [HHb]/VO2 ratio.

Effect of acute hypoxia on muscle blood flow, VO2p, and [HHb] kinetics during leg extension exercise in older men.

The adjustment of pulmonary oxygen uptake (VO2p), heart rate (HR), limb blood flow (LBF), and muscle deoxygenation [HHb] was examined during the transition to moderate-intensity, knee-extension exercise in six older adults (70 ± 4 years) under two conditions: normoxia (FIO2 = 20.9 %) and hypoxia (FIO2 = 15 %). The subjects performed repeated step transitions from an active baseline (3 W) to an absolute work rate (21 W) in both conditions. Phase 2 VO2p, HR, LBF, and [HHb] data were fit with an exponential model. Under hypoxic conditions, no change was observed in HR kinetics, on the other hand, LBF kinetics was faster (normoxia 34 ± 3 s; hypoxia 28 ± 2), whereas the overall [HHb] adjustment (τ' = TD + τ) was slower (normoxia 28 ± 2; hypoxia 33 ± 4 s). Phase 2 VO2p kinetics were unchanged (p < 0.05). The faster LBF kinetics and slower [HHb] kinetics reflect an improved matching between O2 delivery and O2 utilization at the microvascular level, preventing the phase 2 VO2p kinetics from become slower in hypoxia. Moreover, the absolute blood flow values were higher in hypoxia (1.17 ± 0.2 L min(-1)) compared to normoxia (0.96 ± 0.2 L min(-1)) during the steady-state exercise at 21 W. These findings support the idea that, for older adults exercising at a low work rate, an increase of limb blood flow offsets the drop in arterial oxygen content (CaO2) caused by breathing an hypoxic mixture.

Regulation of VO2 kinetics by O2 delivery: insights from acute hypoxia and heavy-intensity priming exercise in young men.

This study examined the separate and combined effects of acute hypoxia (Hypo) and heavy-intensity "priming" exercise (Hvy) on pulmonary O(2) uptake (Vo(2p)) kinetics during moderate-intensity exercise (Mod). Breath-by-breath Vo(2p) and near-infrared spectroscopy-derived muscle deoxygenation {deoxyhemoglobin concentration [HHb]} were monitored continuously in 10 men (23 ± 4 yr) during repetitions of a Mod 1-Hvy-Mod 2 protocol, where each of the 6-min (Mod or Hvy) leg-cycling bouts was separated by 6 min at 20 W. Subjects were exposed to Hypo [fraction of inspired O(2) (Fi(O(2))) = 15%, Mod 2 + Hypo] or "sham" (Fi(O(2)) = 20.9%, Mod 2-N) 2 min following Hvy in half of these repetitions; Mod was also performed in Hypo without Hvy (Mod 1 + Hypo). On-transient Vo(2p) and [HHb] responses were modeled as a monoexponential. Data were scaled to a relative percentage of the response (0-100%), the signals were time-aligned, and the individual [HHb]-to-Vo(2) ratio was calculated. Compared with control (Mod 1), τVo(2p) and the O(2) deficit (26 ± 7 s and 638 ± 144 ml, respectively) were reduced (P < 0.05) in Mod 2-N (20 ± 5 s and 529 ± 196 ml) and increased (P < 0.05) in Mod 1 + Hypo (34 ± 14 s and 783 ± 184 ml); in Mod 2 + Hypo, τVo(2p) was increased (30 ± 8 s, P < 0.05), yet O(2) deficit was unaffected (643 ± 193 ml, P > 0.05). The modest "overshoot" in the [HHb]-to-Vo(2) ratio (reflecting an O(2) delivery-to-utilization mismatch) in Mod 1 (1.06 ± 0.04) was abolished in Mod 2-N (1.00 ± 0.05), persisted in Mod 2 + Hypo (1.09 ± 0.07), and tended to increase in Mod 1 + Hypo (1.10 ± 0.09, P = 0.13). The present data do not support an "O(2) delivery-independent" speeding of τVo(2p) following Hvy (or Hvy + Hypo); rather, this study suggests that local muscle O(2) delivery likely governs the rate of adjustment of Vo(2) at τVo(2p) greater than ∼20 s.