Repeated magnetic resonance imaging at 6 follow-up visits over a 2-year period after platelet-rich plasma injection in patients with lateral epicondylitis.

BACKGROUND: The efficacy of platelet-rich plasma (PRP) for lateral epicondylitis has been demonstrated. However, the healing process monitored by repeated magnetic resonance imaging (MRI) is unclear. The purpose of this study was to evaluate sequential changes using MRI in patients with lateral epicondylitis treated by PRP injection at 6 follow-up visits over a 2-year period. METHODS: Thirty patients who underwent PRP treatment for lateral epicondylitis and sequential MRI evaluation were prospectively enrolled. The MRI scores (ranging from 0 to 3) and clinical scores, including the visual analog scale (VAS) pain score and Patient-Rated Tennis Elbow Evaluation (PRTEE) score, were measured at baseline (before treatment) and 1, 3, 6, 12, 18, and 24 months after the procedure. Sequential changes in the MRI scores and clinical scores during the treatment period were evaluated. In addition, the associations between MRI scores and clinical scores were assessed. RESULTS: The mean MRI score at baseline was 2.30, and the mean MRI scores at 1, 3, 6, 12, 18, and 24 months after the procedure were 1.97, 1.77, 1.13, 0.73, 0.60, and 0.33, respectively. Significant improvements in the MRI scores occurred by 3 months and continued over a period of 24 months. Regarding the clinical scores, the mean VAS pain scores were 72 at baseline, 48 at 1 month, 34 at 3 months, 28 at 6 months, 15 at 12 months, 14 at 18 months, and 11 at 24 months and the mean PRTEE scores were 56, 36, 26, 18, 8, 9, and 6, respectively. Significant improvements in the VAS pain score and PRTEE score occurred by 1 month and continued over a period of 12 months. There was little association between the MRI scores and clinical scores. CONCLUSIONS: Continuous tendon recovery assessed by MRI was found during a 2-year period after PRP treatment. Improvements in the MRI scores followed and continued longer than improvements assessed by the clinical scores.

Visualization of the morphological changes in the median nerve after carpal tunnel release using three-dimensional magnetic resonance imaging.

OBJECTIVES: This study aimed to compare the pre- and postoperative morphology of the median nerve using three-dimensional (3-D) MRI in patients with carpal tunnel syndrome (CTS). METHODS: We assessed 31 patients with CTS who underwent open carpal tunnel release and T2*-weighted MRI of the wrist preoperatively and at 6 months postoperatively. The median nerve morphology was evaluated on the basis of the cross-sectional areas (CSAs) and cross-sectional volumes (CSVs). The association between these MRI findings and nerve conduction studies was also evaluated. RESULTS: The mean preoperative CSA and CSV values at the proximal carpal tunnel level significantly decreased from 22.2 mm2 and 24.4 mm3 to 16.5 mm2 and 18.1 mm3, respectively, postoperatively. Median nerve swelling at the proximal carpal tunnel level was observed in 29 (94%) and 23 (74%) patients before and after surgery, respectively. The mean preoperative CSA and CSV values at the hamate level significantly increased from 9.9 to 12.3 mm2 and from 10.9 to 13.5 mm3 after surgery, respectively. Nerve narrowing at the hamate bone level was preoperatively observed in 28 (90%) patients and postoperatively in 21 (68%) patients. Preoperative CSA and CSV values at the proximal carpal tunnel were significantly associated with preoperative distal motor and sensory latency. CONCLUSIONS: Visual confirmation of the median nerve morphology using 3-D MRI is useful when considering postoperative recovery and explaining the nerve condition to the patients. KEY POINTS: • The 3-D morphology of the median nerve after carpal tunnel release can be delineated using 3-D MRI. • Preoperative swelling of the median nerve in the 2-D and 3-D planes reflects the severity of carpal tunnel syndrome. • Visual confirmation of the median nerve morphology is useful when considering median nerve recovery after carpal tunnel release and for explaining the condition of the nerve to patients.

Motion of the distal radioulnar joint in extension and flexion of the wrist using axial CT imaging of healthy volunteers.

BACKGROUND: The midcarpal joint and the radiocarpal joint contribute to the extension and flexion of the wrist. Little is known about the contribution of the distal radioulnar joint (DRUJ) to the extension and flexion of the wrist. This study evaluated the ulnar motion in extension and flexion of the wrist using computed tomography (CT) imaging. METHODS: A total of 30 wrists of healthy volunteers were enrolled. CT images of the axial sections of the DRUJ were obtained with 3 different positions of the wrist: 0° of extension (straight position), maximum active extension, and maximum active flexion. Each wrist motion was performed with 3 different forearm positions: neutral, pronation, and supination. Ulnar position at the DRUJ level was measured and ulnar position with the wrist in straight position was defined as baseline. The ulnar position was recorded as positive value when the position of the ulnar head was volar side and negative value when the position of the ulnar head was dorsal side. The difference from baseline in a position of maximum extension and flexion was evaluated. RESULTS: In forearm neutral position and pronation, a value of ulnar position in maximum wrist flexion is significantly negative compared to that in the wrist straight position: the ulnar head moved dorsally from the wrist straight position to wrist flexion. In forearm supination, a value of ulnar position in maximum wrist extension is significantly positive compared to that in the wrist straight position: the ulnar head moved to the volar side from the wrist straight position to wrist extension. CONCLUSIONS: The ulnar head moves during extension and flexion of the wrist. The direction of the ulnar motion was different according to the wrist and forearm position.

Circulatory dynamics of the cauda equina in lumbar canal stenosis using dynamic contrast-enhanced magnetic resonance imaging.

BACKGROUND CONTEXT: There has been no study regarding the cauda equina circulation of patients with neurogenic intermittent claudication (NIC) in lumbar spinal canal stenosis (LSCS) using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). PURPOSE: The mechanism responsible for the onset of NIC was investigated using DCE-MRI to examine changes in cauda equina blood flow in patients with LSCS. STUDY DESIGN: This was a retrospective longitudinal registry and magnetic resonance imaging study. PATIENT SAMPLE: The subjects consisted of 23 patients who had LSCS associated with NIC (stenosis group). Ten asymptomatic volunteers who did not have NIC served as controls (control group). In the LSCS group, the cross-sectional area of the dural sac was <75 mm2 at the site of most severe stenosis. These patients were further divided into single and double stenosis subgroups. OUTCOME MEASURES: The main measures we used were the signal intensity (S-I) ratio and the shape and size of the time intensity (T-I) curves. We compared these between the stenosis and control groups. METHODS: At first, plain T1-weighted MR images were obtained and the lumbar dural sac cross-sectional area was measured using a digitizer. For DCE-MRI, sagittal T1-weighted images of the same slice were acquired continuously for 10 minutes after administration of gadolinium as an intravenous bolus to observe the distribution of contrast medium (gadolinium) in the cauda equina. To objectively evaluate changes in contrast enhancement of the cauda equina at the site of canal stenosis, regions of interest were established. The signal intensity (SI) ratio was calculated to compare the signal intensities before and after contrast enhancement, and time-intensity curves were prepared to investigate changes over time. RESULTS: The static imaging findings and the changes of gadolinium uptake showed striking differences between the study and control patients. In the stenosis group, abnormal intrathecal enhancement showed around the site of stenosis on enhanced MR imaging. The SI ratio at the site of canal stenosis had a slower increase in the arterial phase when compared with that in the control group and remained high in the venous phase for up to 10 minutes. Finally, abnormal intrathecal enhancement was visible around the site of stenosis on enhanced MR imaging in all patients. CONCLUSIONS: These clinical data indicate that cauda equina nerve roots in the LSCS patients are pathologic even when symptoms are not elicited in the supine position, suggesting that intraradicular venous congestion and edema themselves do not influence the existence of radicular symptoms.

Age is associated with self-reported sleep bruxism, independently of tooth loss.

PURPOSE: The aim of this study was to investigate whether the association between self-reported sleep bruxism (SB) and age is modified by the presence of tooth loss. METHODS: A cross-sectional study was done involving 1,930 residents, ranging from 18 to 89 years of age, who underwent health checkups at the rural health center in Japan. The data collection included oral examinations and self-administrated questionnaires. RESULTS: The prevalence of self-reported SB was 8% (n = 152). It was higher in the groups ranging from 30 to 39 and 40 to 49 years of age in comparison to the groups composed of individuals older than 60 years of age. In the crude analyses, the prevalence of self-reported SB was associated with tooth loss, male, smoking, snoring, sleep talking and a history of childhood teeth grinding. A multiple logistic regression confirmed a significant relationship between self-reported SB and the groups of 30-39 years of age (OR: 2.78, P = 0.003) and 40-49 years of age (OR: 2.31, P = 0.005). Snoring (OR: 2.58, P = 0.001) and known (OR: 8.09, P < 0.001) or unknown (OR: 3.03 P < 0.001%) childhood teeth grinding also showed to be related to self-reported SB. CONCLUSIONS: The present study demonstrates that self-reported SB is associated with age, independently of tooth loss. The associations between SB and age will await further physiological investigations.

Visualization of intraneural edema using gadolinium-enhanced magnetic resonance imaging of carpal tunnel syndrome.

BACKGROUND: In general, carpal tunnel syndrome (CTS) is diagnosed based mainly on clinical findings and electrophysiology. However, the pathological state of the compressed median nerve could not be shown on imaging. Gadolinium-enhanced magnetic resonance (MR) imaging may give us an idea about the status of the blood-nerve barrier of peripheral nerves. Therefore, detecting intraneural edema may be a way of diagnosing entrapment neuropathy. The present study investigated the diagnostic role of gadolinium-enhanced MR imaging of CTS. METHODS: The subjects were 23 patients (34 hands) with idiopathic CTS. To serve as control subjects, 12 wrists of asymptomatic volunteers were studied. Using the spin-echo method, T1- and T2-weighted axial MR images were obtained. Intravenously injected gadolinium was used to obtain enhanced images. We studied the relation between nerve enhancement and the symptomatology. RESULTS: After intravenous injection of gadolinium, there was no enhancement of the unaffected nerves in the carpal tunnels of the control group. Gadolinium enhancement was found in only 87% of patients with CTS who visited the hospital at an early stage and therefore had no nerve deficiency on electrophysiological studies (39%). Based on this finding, during the early stages when the nerve is in a state of neuropraxia, gadolinium-enhanced MR imaging of the median nerve might prove to be the most sensitive modality for detecting early nerve dysfunction. MR imaging also revealed a higher frequency of enhancement in the advanced stage of CTS with muscle atrophy. CONCLUSIONS: We conclude that gadolinium-enhanced MR imaging can detect not only morphological changes but also pathological changes of the median nerve in patients with CTS. Currently, gadolinium-enhanced-MR imaging is probably most commonly used to image patients who have ambiguous electrodiagnostic studies and clinical examination in an early stage of CTS.

Occurrence of swine salmonellosis in postweaning multisystemic wasting syndrome (PMWS) affected pigs concurrently infected with porcine reproduction and respiratory syndrome virus (PRRSV).

Fourteen diseased pigs from four farms in which there had been an outbreak of salmonellosis were investigated. Granulomatous inflammation with depletion of lymphocytes was observed in the swollen lymph nodes in these pigs. Antigens to porcine circovirus type 2 (PCV2) were immunolabeled in the lesions along with detection of viral DNA as PCV2 by polymerase chain reaction (PCR). In addition, antigens to porcine reproductive respiratory syndrome virus (PRRSV) were immunodetected in the lungs and Salmonella Choleraesuis was isolated from the affected pigs. The nine salmonellosis affected pigs, five (55.6%) with salmonellosis and PMWS concurrently infected with PRRSV were much higher than those infected with salmonellosis and PMWS (22.2%) or with salmonellosis and PPPRV (22.2%).

Characterization of zeolite NaA membrane by FTIR-ATR and its application to the rapid evaluation of dehydration performance.

A zeolite NaA (LTA) membrane supported by an alumina porous support tube was characterized by Fourier Transform Infrared Attenuated Total Reflectance method (FTIR-ATR) with a diamond prism as the waveguide. A method using the FTIR-ATR was developed to estimate rapidly the EtOH/H2O pervaporation (PV) performance of the membrane. The Si-O asymmetric stretching vibration region of LTA membrane spectra synthesized hydrothermally on seeded alumina substrates showed a bimodal peak (830 - 1200 cm(-1)). The two peaks were assigned to a surface LTA directly derived from the seed crystal (1012 cm(-1)), and to LTA and/or amorphous substances embedded in the alumina porous support (930 cm(-1)). The spectrum from LTA membrane synthesized on nonseeded alumina substrate, however, showed a single broad peak similar to the powder-formed one. These results indicate that the Si-O spectral shape of the LTA membrane is influenced strongly by the synthesis method. Also, the FTIR-ATR of the LTA membrane can detect the Si-O peaks as part of the depth information. It was first shown that the relative ratio (930 cm(-1)/1012 cm(-1)) of the two Si-O peaks from the LTA membranes on seeded alumina substrates closely relates to the water selectivity (alpha) in the PV of EtOH/H2O mixture; the alpha increases exponentially with the peak ratio. This result suggests that the differences in the vertical distribution of LTA crystal and amorphous material strongly affect the dehydration performance in the EtOH/H2O PV, that is, the amorphous-like material embedded in the alumina porous support plays an important role. The relative peak ratio measurement can be used for the rapid evaluation of the dehydration performance of the membrane.

The origin and evolution of porcine reproductive and respiratory syndrome viruses.

Porcine reproductive and respiratory syndrome viruses (PRRSV) are divided into North American and European types, which show about 40% difference in their amino acid sequences. The divergence time of these two types has been estimated to be about 1980 from epidemiological data. This suggested that PRRSV have evolved at a higher evolutionary rate (order of 10(-2)/site/year) compared with other RNA viruses of 10(-3) to 10(-5)/site/year. Here, to test the evolutionary history of PRRSV speculated by the epidemiological background, we estimated the divergence time and evolutionary rate of PRRSV with molecular evolutionary analysis. Estimated divergence time (1972-1988) corresponded well to that estimated by the epidemiological data, and the evolutionary rate (4.71-9.8) x 10(-2) of PRRSV was indeed the highest among RNA viruses so far reported. Furthermore, we inferred important sites for the adaptation in order to examine how PRRSV have adapted to swine since they emerged. The adaptive sites were located not only in the epitopes related to immunity but also in the transmembrane regions including a signal peptide. In particular, the adaptive sites in the transmembrane regions were considered to affect compatibility to the host cell membrane. We conclude that PRRSV were transmitted from another host species to swine in about 1980 and have adapted to swine by altering the transmembrane regions.

Improved survival of vitrified in vivo-derived porcine embryos.

An efficient cryopreservation protocol for porcine morulae was investigated with three types of vitrification having different cooling rates (Exp. 1). Survival of embryos vitrified after removal of cytoplasmic lipid droplets was also examined by means of the minimum volume cooling (MVC) method (Exp. 2). In Exp. 1, the morula stage embryos were vitrified with a 0.25 ml plastic straw (ST-method), gel loading tip (GLT-method) and the MVC-method, respectively, and stored in liquid nitrogen after which they were warmed in sucrose solutions with cryoprotectants being subsequently removed in a stepwise manner. In Exp. 2, morulae were centrifuged with 7.5 microg/ml cytocharasin B at 12000 x g for 20 min to polarize the cytoplasmic lipid droplets that were then removed from the embryos by micromanipulation (delipation). Both those delipated at the morula stage and the intact embryos at the morula to blastocyst stages were vitrified by the MVC-method. In vitro survival of the vitrified embryos was assessed in both experiments by culturing in NCSU-23 + 10% FCS for 48 h. In vitro developments of vitrified embryos after warming to blastocysts were 20% (6/30) for the ST-method, 39% (18/46) for the GLT-method, and 60% (26/43) for the MVC-method. Embryo survival was further improved by vitrification after delipation (95%, 35/37) compared to intact vitrified morulae (24/42, 57%, P<0.001) and blastocysts (23/31, 74%, P<0.05). Moreover, the number of cells in blastocysts (92 +/- 25) derived from the delipated-vitrified morulae was comparable to those derived from intact control non-vitrified embryos (103 +/- 31). Our results demonstrate that vitrified porcine morulae have the highest survival when using the MVC-method in conjunction with delipation.