Sonoelastography of the Common Flexor Tendon of the Elbow with Histologic Agreement: A Cadaveric Study.

Purpose To determine the correlation of the results of conventional B-mode ultrasonography (US) and compression sonoelastography with histologic results in common flexor tendons of the elbow in human cadavers. Materials and Methods Twenty-five common flexor tendons were evaluated in 16 fresh, unembalmed cadavers of 11 women with a median age of 85 years (range, 71-101 years) and five men with a median age of 78 years (range, 70-88 years). Informed consent was provided according to the last will of the donors. B-mode US results were classified as grade 1, normal tendon with homogeneous fibrillar pattern; grade 2, tendon thickening or hypoechoic areas and/or calcifications in less than 30% of the tendon; or grade 3, hypoechoic areas and/or calcifications greater than 30% of the tendon. Sonoelastographic results were grade 1, blue (hardest) to green (hard); grade 2, yellow (soft); and grade 3, red (softest). The intraclass correlation coefficient was calculated to determine agreement with histologic findings for each B-mode US, sonoelastographic, and combined B-mode US and sonoelastographic examination. Histologic results were grade 1, normal, with parallel fibrillar pattern; grade 2, mild tendinopathy, with cellular infiltration, angiogenesis, or fatty vacuoles; or grade 3, severe tendinopathy, with loss of parallel collagen structure and necrosis. Results Histologic alterations were detected in 44% (11 of 25) of biopsy specimens. Intraclass correlation with histologic results was 0.57 for B-mode US, 0.68 for sonoelastography, and 0.84 for the combination of the two approaches. Conclusion The addition of sonoelastography to B-mode US provided statistically significant improvement in correlation with histologic results compared with the use of B-mode US alone (P \u3c .02). (©) RSNA, 2016 Online supplemental material is available for this article

The radial and ulnar collateral ligaments of the wrist are true ligaments

PURPOSEOur hypothesis in this study is that the radial and ulnar collateral ligaments of the wrist exist and are true ligaments which can be visualized by high-resolution ultrasonography (US).METHODSHigh-resolution US examination of the radial and ulnar collateral ligaments of the wrist was performed on 56 fresh cadaveric wrists. The visibility of these ligaments was assessed by four observers who classified the ligaments in consensus as well seen, adequately seen, or not seen. Surgical dissections of 12 radial collateral ligaments and 12 ulnar collateral ligaments were then performed and the ligaments were classified as present or absent. The US and dissection results were then compared. To confirm that the dissected structures represent true ligaments a histologic examination of the ligaments was performed.RESULTSRESULTSAll examined radial and ulnar collateral ligaments were seen on the US examination. The radial collateral ligament was seen between the radial styloid and radial aspect of the scaphoid. The ulnar collateral ligament was seen between ulnar styloid process and the triquetrum. On all surgical dissections, the radial collateral ligament was present at the floor of the first extensor compartment and the ulnar collateral ligament was at the floor of the sixth extensor compartment. Both ligaments were proven to be true capsular ligaments on both dissection and histologic examinations.CONCLUSIONThe radial and ulnar collateral ligaments of the wrist are true ligaments and can be seen at the floor of the first and the sixth extensor compartments, respectively, using high-resolution US. Based on their anatomic location, they most likely provide static stability to the wrist joint

Service- und genesungsorientierte Leistungserstellung in Gesundheitsorganisationen : ein Plädoyer für mehr Kooperation von medizinischen und nicht-medizinischen Berufsgruppen

Der zunehmende Wettbewerbsdruck im Gesundheitswesen führt dazu, dass Patientenzufriedenheit vermehrt in den Fokus von Gesundheitsorganisationen gerät. Wie eine umfassend durchgeführte Literaturrecherche zeigt, spielen dabei auch die nicht-medizinisch erbrachten Leistungen eine wichtige Rolle. In diesem Working Paper wird aufgezeigt, inwieweit Hospitality, Hotellerie, Verpflegung, Hygiene, Reinigung, Textilversorgung, einrichtungs- und servicebezogene Infrastruktur und Umgebungsgestaltung zu einer positiven Wahrnehmung der Leistungserstellung in Gesundheitsorganisationen und somit zur Genesung von Menschen und zur Patientenzufriedenheit beitragen können. Anhand der Grundlagen wird deutlich, dass eine vermehrt berufsgruppenübergreifende Kooperation in der Leistungserstellung in Gesundheitsorganisationen angezeigt ist. Es werden entsprechende Handlungsempfehlungen im Hinblick auf eine service- und genesungsorientierte Leistungserstellung für die Praxis formuliert und entsprechend wissenschaftlicher Bedarf an weiteren Untersuchungen aufgezeigt

A novel seed treatment-based multiplication approach for cassava planting material.

Cassava (Manihot esculenta Crantz) is an important food security crop in many parts of the developing world. The crop?s high yield potential and multitude of uses?both for nutrition and processing?render cassava a promising driver for the development of rural value chains. It is traditionally propagated from stem cuttings of up to 30 cm in length, giving a multiplication rate as low as 1:10. Propagating cassava traditionally is very inefficient, which leads to challenges in the production and distribution of quality planting material and improved cultivars, greatly limiting the impact of investments in crop breeding. The work described in the present study aimed to develop a seed treatment approach to facilitate the use of shorter seed pieces, increasing the multiplication rate of cassava and thus making the crop?s seed systems more efficient. After several tests, formulation was identified, consisting of thiamethoxam 21 g ha-1, mefenoxam 1.0 g ha-1, fludioxonil 1.3 g ha-1, thiabendazole 7.5 g ha-1 and Latex 2% as a binder. Plant growing from seed pieces treated with this formulation displayed increased crop establishment and early crop vigor, leading to an improved productivity throughout a full growing cycle. This allowed to reduce the cassava seed piece size to 8 cm with no negative effects on germination and crop establishment, leading to yields comparable to those from untreated 16 cm pieces. This, in turn, will allow to increase the multiplication ratio of cassava by a factor of up to 3. Notably, this was possible under regular field conditions and independently of any specialised treatment facilities. Compared with existing seed production protocols, the increased multiplication rates allowed for efficiency gains of between 1 to 1.9 years compared to conventional five-year cycles. We believe that the technology described here holds considerable promise for developing more reliable and remunerative delivery channels for quality cassava planting material and improved genetics

Impact of Dual-Energy Computed Tomography (DECT) Postprocessing Protocols on Detection of Monosodium Urate (MSU) Deposits in Foot Tendons of Cadavers

Objective: To evaluate two different dual-energy computed tomography (DECT) post-processing protocols for the detection of MSU deposits in foot tendons of cadavers with verification by polarizing light microscopy as the gold standard. Material and Methods: A total of 40 embalmed cadavers (15 male; 25 female; median age, 82 years; mean, 80 years; range, 52–99; SD ± 10.9) underwent DECT to assess MSU deposits in foot tendons. Two postprocessing DECT protocols with different Hounsfield unit (HU) thresholds, 150/500 (=established) versus 120/500 (=modified). HU were applied to dual source acquisition with 80 kV for tube A and 140 kV for tube B. Six fresh cadavers (4 male; 2 female; median age, 78; mean, 78.5; range 61–95) were examined by DECT. Tendon dissection of 2/6 fresh cadavers with positive DECT 120 and negative DECT 150 studies were used to verify MSU deposits by polarizing light microscopy. Results: The tibialis anterior tendon was found positive in 57.5%/100% (DECT 150/120), the peroneus tendon in 35%/100%, the achilles tendon in 25%/90%, the flexor halluces longus tendon in 10%/100%, and the tibialis posterior tendon in 12.5%/97.5%. DECT 120 resulted in increased tendon MSU deposit detection, when DECT 150 was negative, with an overall agreement between DECT 150 and DECT 120 of 80% (p = 0.013). Polarizing light microscope confirmed MSU deposits detected only by DECT 120 in the tibialis anterior, the achilles, the flexor halluces longus, and the peroneal tendons. Conclusion: The DECT 120 protocol showed a higher sensitivity when compared to DECT 150

The EFSUMB Guidelines and Recommendations for the Clinical Practice of Elastography in Non-Hepatic Applications : Update 2018

Funding Information: Odd Helge Gilja: Advisory Board/Consultant fee from: AbbVie, Bracco, GE Healthcare, Samsung, and Takeda Paul S. Sidhu: Speaker honoraria, Bracco, Siemens, Samsung, Hiatchi, GE and Philips Christoph F. Dietrich: Speaker honoraria, Bracco, Hitachi, GE, Mindray, Supersonic, Pentax, Olympus, Fuji, Boston Scientific, AbbVie, Falk Foundation, Novartis, Roche; Advisory, Board Member, Hitachi, Mindray, Siemens; Research grant, GE, Mindray, SuperSonic Vito Cantisani: Speaker honoraria, Canon/Toshiba, Bracco, Samsung Dominique Amy: Speaker honoraria, Hitachi, Supersonic, EpiSonica Marco Brock: Speaker honoraria, Hitachi Fabrizio Calliada: Speaker honoraria, Bracco, Hitachi, Shenshen Mindray Dirk Andre Clevert: Speaker honoraria, Siemens, Samsung, GE, Bracco, Philips; Advisory Board, Siemens, Samsung, Bracco, Philips Jean-Michel Correas: Speaker honoraria, Hitachi-Aloka, Canon/Toshiba, Philips, Supersonic, Bracco, Guerbet; Research collaboration, Bracco Sonocap, Guerbet NsSafe and Secure protocols Mirko D’Onofrio: Speaker honoraria, Siemens, Bracco, Hitachi; Advisory Board Siemens, Bracco Andre Farrokh: Speaker honoraria, Hitachi Pietro Fusaroli: Speaker honoraria, Olympus Roald Flesland Havre: Speaker honoraria, GE Healthcare, Conference participation support from Pharmacosmos, Ultrasound equipment from Samsung Medison André Ignee: Speaker honoraria: Siemens, Canon/Toshiba, Hitachi, Boston Scientific, Bracco, Supersonic, Abbvie Christian Jenssen: Speaker honoraria, Bracco, Hitachi, Canon/Toshiba, Falk Foundation, Covidien; Research grant, Novartis Maija Radzina: Speaker honoraria, Bracco, Canon/Toshiba Luca Sconfienza: Travel grants from Bracco Imaging Italia Srl, Esaote SPA, Abiogen SPA, Fidia Middle East. Speaker honoraria from Fidia Middle East Ioan Sporea: Speaker honoraria, Philips, GE, Canon/Toshiba; Advisory Board Member, Siemens; Congress participation support, Siemens Mickael Tanter: Speaker honoraria, Supersonic; Co Founder and shareholder, Supersonic; Research collaboration, Supersonic Peter Vilmann: Speaker honoraria, Pentax, Norgine; Advisory Board, Boston Scientific; Consultancy MediGlobe The following members declared no conflicts of interest: Adrian Săftoiu, Michael Bachmann Nielsen, Flaviu Bob, Jörg Bojunga, Caroline Ewertsen, Michael Hocke, Andrea Klauser, Christian Kollmann, Kumar V Ramnarine, Carolina Solomon, Daniela Fodor, Horia Ștefănescu Publisher Copyright: © 2019 Georg Thieme Verlag KG Stuttgart New York.This manuscript describes the use of ultrasound elastography, with the exception of liver applications, and represents an update of the 2013 EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) Guidelines and Recommendations on the clinical use of elastography.Peer reviewe

Musculoskeletal ultrasound including definitions for ultrasonographic pathology

Ultrasound (US) has great potential as an outcome in rheumatoid arthritis trials for detecting bone erosions, synovitis, tendon disease, and enthesopathy. It has a number of distinct advantages over magnetic resonance imaging, including good patient tolerability and ability to scan multiple joints in a short period of time. However, there are scarce data regarding its validity, reproducibility, and responsiveness to change, making interpretation and comparison of studies difficult. In particular, there are limited data describing standardized scanning methodology and standardized definitions of US pathologies. This article presents the first report from the OMERACT ultrasound special interest group, which has compared US against the criteria of the OMERACT filter. Also proposed for the first time are consensus US definitions for common pathological lesions seen in patients with inflammatory arthritis

Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part VII, nerves of the lower limb.

Funder: Università degli Studi di MilanoOBJECTIVES: To perform a Delphi-based consensus on published evidence on image-guided interventional procedures for peripheral nerves of the lower limb (excluding Morton's neuroma) and provide clinical indications. METHODS: We report the results of a Delphi-based consensus of 53 experts from the European Society of Musculoskeletal Radiology who reviewed the published literature for evidence on image-guided interventional procedures offered around peripheral nerves in the lower limb (excluding Morton's neuroma) to derive their clinical indications. Experts drafted a list of statements and graded them according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus was considered strong when > 95% of experts agreed with the statement or broad when > 80% but < 95% agreed. The results of the Delphi-based consensus were used to write the paper. RESULTS: Nine statements on image-guided interventional procedures for peripheral nerves of the lower limb have been drafted. All of them received strong consensus. Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role. US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia. CONCLUSION: Despite the promising results reported by published papers on image-guided interventional procedures for peripheral nerves of the lower limb, there is still a lack of evidence on the efficacy of most procedures. KEY POINTS: • Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. • US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role. • US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia. The volume of local anesthetic affects the size of the blocked sensory area