Sonographic evaluation of the shoulder in asymptomatic elderly subjects with diabetes

<p>Abstract</p> <p>Background</p> <p>The prevalence of rotator cuff tears increases with age and several studies have shown that diabetes is associated with symptomatic shoulder pathologies. Aim of our research was to evaluate the prevalence of shoulder lesions in a population of asymptomatic elderly subjects, normal and with non insulin - dependent diabetes mellitus.</p> <p>Methods</p> <p>The study was performed on 48 subjects with diabetes and 32 controls (mean age: 71.5 ± 4.8 and 70.7 ± 4.5, respectively), who did not complain shoulder pain or dysfunction. An ultrasound examination was performed on both shoulders according to a standard protocol, utilizing multiplanar scans.</p> <p>Results</p> <p>Tendons thickness was greater in diabetics than in controls (Supraspinatus Tendon: 6.2 ± 0.09 mm <it>vs </it>5.2 ± 0.7 mm, p < 0.001; Biceps Tendon: 4 ± 0.8 mm <it>vs </it>3.2 ± 0.4 mm, p < 0.001). Sonographic appearances of degenerative features in the rotator cuff and biceps were more frequently observed in diabetics (Supraspinatus Tendon: 42.7% <it>vs </it>20.3%, p < 0.003; Biceps Tendon: 27% <it>vs </it>7.8%, p < 0.002).</p> <p>Subjects with diabetes exhibited more tears in the Supraspinatus Tendon (Minor tears: 15 (15.8%) <it>vs </it>2 (3.1%), p < 0.03; Major tears: 15 (15.8%) <it>vs </it>5 (7.8%), p = ns), but not in the long head of Biceps. More effusions in subacromial bursa were observed in diabetics (23.9% <it>vs </it>10.9%, p < 0.03) as well as tenosynovitis in biceps tendon (33.3% <it>vs </it>10.9%, p < 0.001).</p> <p>In both groups, pathological findings were prevalent on the dominant side, but no difference related to duration of diabetes was found.</p> <p>Conclusions</p> <p>Our results suggest that age - related rotator cuff tendon degenerative changes are more common in diabetics.</p> <p>Ultrasound is an useful tool for discovering in pre - symptomatic stages the subjects that may undergo shoulder symptomatic pathologies.</p

International consensus conference recommendations on ultrasound education for undergraduate medical students

Objectives: The purpose of this study is to provide expert consensus recommendations to establish a global ultrasound curriculum for undergraduate medical students. Methods: 64 multi-disciplinary ultrasound experts from 16 countries, 50 multi-disciplinary ultrasound consultants, and 21 medical students and residents contributed to these recommendations. A modified Delphi consensus method was used that included a systematic literature search, evaluation of the quality of literature by the GRADE system, and the RAND appropriateness method for panel judgment and consensus decisions. The process included four in-person international discussion sessions and two rounds of online voting. Results: A total of 332 consensus conference statements in four curricular domains were considered: (1) curricular scope (4 statements), (2) curricular rationale (10 statements), (3) curricular characteristics (14 statements), and (4) curricular content (304 statements). Of these 332 statements, 145 were recommended, 126 were strongly recommended, and 61 were not recommended. Important aspects of an undergraduate ultrasound curriculum identified include curricular integration across the basic and clinical sciences and a competency and entrustable professional activity-based model. The curriculum should form the foundation of a life-long continuum of ultrasound education that prepares students for advanced training and patient care. In addition, the curriculum should complement and support the medical school curriculum as a whole with enhanced understanding of anatomy, physiology, pathophysiological processes and clinical practice without displacing other important undergraduate learning. The content of the curriculum should be appropriate for the medical student level of training, evidence and expert opinion based, and include ongoing collaborative research and development to ensure optimum educational value and patient care. Conclusions: The international consensus conference has provided the first comprehensive document of recommendations for a basic ultrasound curriculum. The document reflects the opinion of a diverse and representative group of international expert ultrasound practitioners, educators, and learners. These recommendations can standardize undergraduate medical student ultrasound education while serving as a basis for additional research in medical education and the application of ultrasound in clinical practice

A comparative morphological study of two human facial muscles : the orbicularis oculi and the corrugator supercilii

Facial muscles have two unique functions: as sphincters and dilators controlling the orifices of the face, and as movers of the skin of the face to produce facial expressions. It was hypothesized that human facial muscles sharing the same innervation and embryology, but having different functions, would posses morphologic differences in architecture, histology, cytochemistry and ultrastructure. To test this hypothesis, two periorbital muscles, the palpebral part of the orbicularis oculi (OO) and the corrugator supercilii (CS), were compared. The OO is a sphincteric muscle, whereas the CS is a muscle of facial expression. Whole muscle samples from human cadavers and biopsies from cosmetic surgery procedures were used. Quantitative measures of fiber sizes, fiber shapes and fiber-type distributions were performed along with measures of capillary area per unit of contractile area (capillary index). Qualitative analyses of nerve and motor end-plate distributions were also undertaken. Architectural differences were elucidated by stereoscopic dissection, conventional histological stains, and electron microscopy. Innervation patterns and motor end-plate regions were demonstrated with a pararosanaline (PIA) stain, and with an antibody to neurofilament protein. Fiber-type profiles were visualized by immunofluorescent microscopy using antibodies to fast and slow myosin. The OO was shown to differ significantly from the CS on the basis of fiber shapes, sizes and types. The OO fibers were small, rounded and 89% of them were type II. The CS fibers were larger, pleomorphic in shape, and only 49% of them were type II. The capillary index of the CS was 2.4 times that of the OO. The innervation of the OO was more intricate and arose from the deep surface of the muscle, whereas that of the CS was less ordered and arose from the superficial surface. Ulfrastructurally, the CS and OO shared many features, but also demonstrated differences in mitochondrial content and distribution, as well as motor end-plate structure. The observed differences between the two muscles support the contention that the function of human facial muscles influences their morphology.Medicine, Faculty ofGraduat

Competing roles of microRNA-122 recognition elements in hepatitis C virus RNA

MicroRNA-122 positively modulates hepatitis C virus (HCV) through direct interactions with viral RNA. Three microRNA-122 recognition elements (MREs) have been previously identified: two in the 5\u2032UTR and one in the 3\u2032UTR. Herein, we report the relative affinity of microRNA-122 to these sites using viral RNA-coated magnetic beads, with mutagenesis and probes to disrupt interactions of microRNA-122 at specific sites. We demonstrate cooperativity in binding between the closely spaced MREs within the 5\u2032UTR in vitro. We also identified a well conserved fourth site in the coding region and showed that it is the highest affinity MRE site. Site-directed mutagenesis of the MREs in HCV subgenomic replicons expressed in Huh-7.5 cells demonstrated competing roles of the stimulatory MREs in the 5\u2032UTR with the inhibitory role of an MRE in the open reading frame (ORF). These data have important implications in elucidating the mechanism of interaction between microRNA-122 and HCV RNA. \ua9 2010.Peer reviewed: YesNRC publication: Ye

The Evolution of Ultrasound in Medicine: A Case Report of Point-of-care Ultrasound in the Self-diagnosis of Acute Appendicitis

Introduction: Point-of-care ultrasound (POCUS) education during medical school develops physicians who are properly prepared for the next generation of medicine. The authors present the case of a first-year medical student who self-diagnosed appendicitis using POCUS.Case Report: A 25-year-old, first-year medical student presented to the emergency department with lower abdominal pain. What seemed like a straightforward appendicitis presentation came with a twist; the student brought self-performed ultrasound imaging of his appendix.Conclusion: The student’s ultrasound skill set reflects favorably on the rapid evolution of ultrasound teaching in medical education

The Evolution of Ultrasound in Medicine: A Case Report of Point-of-care Ultrasound in the Self-diagnosis of Acute Appendicitis

Introduction: Point-of-care ultrasound (POCUS) education during medical school develops physicians who are properly prepared for the next generation of medicine. The authors present the case of a first-year medical student who self-diagnosed appendicitis using POCUS.Case Report: A 25-year-old, first-year medical student presented to the emergency department with lower abdominal pain. What seemed like a straightforward appendicitis presentation came with a twist; the student brought self-performed ultrasound imaging of his appendix.Conclusion: The student’s ultrasound skill set reflects favorably on the rapid evolution of ultrasound teaching in medical education

E-FAST Ultrasound Training Curriculum for Prehospital Emergency Medical Service (EMS) Clinicians

Audience and Type of Curriculum: Audience and type of curriculum: This hybrid, asynchronous curriculum is designed for prehospital clinician colleagues, including but not limited to emergency medical technicians (EMT), advanced EMTs (AEMT), EMT-paramedics (EMT-P), critical care EMT-Ps (CCEMTP), critical care transport nurses (CCTN), and certified flight registered nurses (CFRN) to learn and practice ultrasound fundamentals in the setting of a standardized extended focused assessment with sonography in trauma (E- FAST) exam.Length of Curriculum: Over a five-month curriculum, learners will perform a pre-test, review online module lectures, attend an ultrasound scanning workshop, and perform post-test examinations.Introduction: The extended-focused assessment with sonography in trauma (E-FAST) exam can identify intrathoracic and intraabdominal free fluid, as well as pneumothoraces. The E-FAST ultrasound exam has previously been taught to clinicians of various backgrounds in healthcare including emergency medical service (EMS). However, an open-access, systemized curriculum for teaching E-FAST exams to EMS clinicians has not been published.Educational Goals: By the end of these training activities, prehospital EMS learners will be able to demonstrate foundational ultrasound skills in scanning, interpretation, and artifact recognition by identifying pertinent organs and anatomically relevant structures for an E-FAST examination. Learners will differentiate between normal and pathologic E-FAST ultrasound images by identifying the presence of free fluid and lung sliding. Learners will also explain the clinical significance and application of detecting free fluid during an E- FAST scan.Educational Methods: The educational strategies used in this curriculum include a hybrid, asynchronous curriculum encompassing 2.5 hours of lectures derived from online learning modules and in-person review. In addition, learners will attend 2 hours of hands-on proctored ultrasound scanning practicing E-FAST examinations.Research Methods: An online 13-question pre-test was administered prior to the study. An online post-test and in-person scanning OSCEs were administered at least eight weeks after their scheduled workshop consisting of an online 13-question multiple-choice post-test, a confidence survey, and a hands-on E-FAST Objectively Structured Clinical Exam (OSCE) session. A non-parametric Wilcoxon signed-rank test was performed between each pre-test and post-test metric to examine the statistical differences of paired data.Results: Post-test scores demonstrated statistically significant improvement in both image interpretation exams and ultrasound self-efficacy from the pre-test. The mean pre-test and post-test scores were 55.46% (7.21 ± 1.99) and 84.23% (10.89 ± 1.59) correct out of 13 questions, respectively (p &lt; 0.0001). Participants surveyed an increase in self-efficacy reflected by a Likert scale for ultrasound usage and image interpretation (p &lt; 0.005). The average post-test OSCE E-FAST exam score was 37.89 ± 2.76 out of 42 points (90.21%).Discussion: This 4.5-hour hybrid asynchronous model demonstrates an effective curriculum for teaching E- FAST ultrasound to prehospital clinicians.Topics: Ultrasound, sonography, prehospital clinicians, emergency medical services (EMS), paramedics, critical care transport, extended focused assessment with sonography in trauma (E-FAST), free fluid, sliding lung sign, elective, pain