Ultrasound evaluation of interstitial lung disease in rheumatoid arthritis and autoimmune diseases

Lung ultrasound; Rheumatoid arthritis; Autoimmune diseasesEcografia pulmonar; Artritis reumatoide; Malalties autoimmunesEcografía pulmonar; Artritis reumatoide; Enfermedades autoinmunesThe interpretation of lung ultrasound (US) is the result of the analysis of artifacts, rather than exact representations of anatomical structures, which appear when changes in the physical properties of the lung occur. Its application to the study of interstitial lung disease (ILD) associated with autoimmune diseases has aroused great interest in the last 10 years, as evidenced by a growing number of publications studying its usefulness in the diagnostic process, as a prognostic marker, and as an aid in monitoring of patients. The main elements in lung US interpretation in ILD are the B lines and the changes in the pleural line. B lines are vertical artifacts that are generated when there is a partial decrease in the air content of the lung parenchyma and/or the volume of the interstitial area expands. Pleural line alterations that can be seen are irregularities, thickening, fragmentation, or subpleural nodules. Both the B lines and the changes in the pleural line have shown a significant positive correlation with the evidence on chest computed tomography (high-resolution computed tomography [HRCT]) of ILD associated with autoimmune diseases, with sensitivity and negative predictive values of up to 100%. These results, together with the safety, accessibility, and low cost of lung US, support this imaging technique as a promising screening method for optimizing the indication for HRCT. The role of lung US regarding sensitivity to change needs further investigation with multicenter prospective studie

Influencia de las condiciones meteorológicas en la patología condral

Introducción: En la práctica clínica habitual, muchos pacientes atribuyen el dolor articular a ciertas condiciones meteorológicas. Objetivo: Evaluar el efecto de las condiciones climáticas en pacientes con artrosis. Métodos: El presente trabajo se realizó con pacientes del Instituto Poal de Reumatología de Barcelona y los datos fueron analizados por Bioibérica Farma. Consistió en un estudio prospectivo, a doble ciego, que incluyó 80 pacientes con artrosis, comparados con un grupo control de 42 sujetos. La evaluación del dolor (EAV de Huskisson) y la capacidad funcional (HAQ) se eterminaron diariamente durante un mes, y las variables climáticas estudiadas fueron la temperatura, la humedad y la presión atmosférica. Resultados: Nuestros datos demuestran que los pacientes artrósicos experimentan un aumento del dolor articular en respuesta a una disminución de la presión, lo que indica que las condiciones de baja presión atmosférica exacerban el dolor en estos pacientes. Conclusión: Estos datos sugieren que en el futuro podría ser factible modular los tratamientos farmacológicos y no farmacológicos para algunos pacientes artrósicos en función de la previsión meteorológica y evitar, en la medida de lo posible, el dolor articular y la incapacidad funcional asociados a la enfermedad, mejorando así la calidad de vida de estos pacientes

Influència de les condicions meteorològiques en la patologia condral

Introducció: En la pràctica clínica habitual, molts pacients atribueixen el dolor articular a certes condicions meteorològiques. Objectiu: Avaluar l'efecte de les condicions climàtiques en pacients amb artrosi. Mètodes: Aquest treball es va realitzar amb pacients de l'Institut Poal de Reumatologia de Barcelona i les dades van ser analitzats per Bioibérica Farma. Va consistir en un estudi prospectiu, a doble cec, que va incloure 80 pacients amb artrosi, comparats amb un grup control de 42 subjectes. L'avaluació del dolor (EAV de Huskisson) i la capacitat funcional (HAQ) es van determinar diàriament durant un mes, i les variables climàtiques estudiades van ser la temperatura, la humitat i la pressió atmosfèrica. Resultats: Les nostres dades demostren que els pacients artròsics tenen un augment del dolor articular en resposta a una disminució de la pressió, la qual cosa indica que les condicions de baixa pressió atmosfèrica exacerben el dolor en aquests pacients. Conclusió: Aquestes dades suggereixen que en el futur podria ser factible modular els tractaments farmacològics i no farmacològics per a alguns pacients artròsics en funció de la previsió meteorològica i evitar, en la mesura possible, el dolor articular i la incapacitat funcional associats a la malaltia, tot millorant la qualitat de vida d'aquests pacients

Variations in the Course and Diameter of the Suprascapular Nerve: Anatomical Study

Background: Suprascapular neuropathy is an important factor contributing to shoulder pain. Given the prevalence of nerve injury and nerve block in the suprascapular notch region, as well as the frequency of arthroscopic procedures on the suprascapular notch, which are recommended in shoulder pain management, its morphology is relevant from a clinical perspective. (2) Methods: Suprascapular nerve course was studied in twelve shoulders by dissection. Its diameter was measured at omohyoid level, proximal to the suprascapular notch and distal to the spinoglenoid notch. A multi-vari chart was used in order to descriptively visualize the results. The variations found were analyzed with a mixed linear model. (3) Results: In two of the six subjects, the suprascapular nerve was divided into two motor branches proximal to the superior transverse scapular ligament. An increase in diameter around the suprascapular notch was detected, with an estimated difference between diameter means of 2.008 mm at the suprascapular notch level and 2.047 mm at the spinoglenoid notch level. (4) Conclusions: A difference in the estimated diameter detected and the fact that the motor branches, which innervate supraspinatus and infraspinatus muscle, were divided proximal to the suprascapular notch may be relevant in the diagnosis and treatment of suprascapular neuropathy and arthroscopic procedures

Variations in the course and diameter of the suprascapular nerve: Anatomical study

Suprascapular neuropathy is an important factor contributing to shoulder pain. Given the prevalence of nerve injury and nerve block in the suprascapular notch region, as well as the frequency of arthroscopic procedures on the suprascapular notch, which are recommended in shoulder pain management, its morphology is relevant from a clinical perspective. (2) Methods_ Suprascapular nerve course was studied in twelve shoulders by dissection. Its diameter was measuredat omohyoid level, proximal to the suprascapular notch and distal to the espinoglenoid notch. A multivarichart was used in order to descriptively visualize the results. The variations found were analyzed with a mixed linear model. (3) Results_ In two of the six subjects, the suprascapular nerve was divided into two motor branches proximal to the superior transverse scapular ligament. An increasein diameter around the suprascapular notch was detected, with an estimated difference between diameter means of 2.008 mm at the suprascapular notch level and 2.047 mm at the spinoglenoid notch level. (4) Conclusions_ A difference in the estimated diameter detected and the fact that the motor branches, which innervate supraspinatus and infraspinatus muscle, were divided proximal to the suprascapular notch may be relevant in the diagnosis and treatment of suprascapular neuropathyand arthroscopic procedure

Ultrasound assessment of degenerative muscle sarcopenia: the University of Barcelona ultrasound scoring system for sarcopenia

AimThis study aimed to (1) determine the intraobserver and interobserver reliability of ultrasonographic measurement of muscle thickness (MT) and cross-sectional area (CSA) of the rectus femoris and biceps brachii, correlating these values with manual measurements on dissected cadavers and (2) develop the first semiquantitative musculoskeletal ultrasound (MSUS) scoring system of muscle morphology in sarcopenia and assess its intraobserver and interobserver reliability. In addition, the MSUS morphology score was compared with the corresponding histological images to verify concurrent validity.MethodsTen cryopreserved limbs of 10 cadavers aged 68-91 years were evaluated. The MSUS scoring system was based on the severity of muscle degeneration on a 3-point qualitative scale: grade 1 (normal), grade 2 (moderate changes) and grade 3 (severe changes). Reliability was assessed with intraclass correlation coefficient (ICC) for the MT and CSA and with Cohen's kappa coefficients (& kappa;) for the MSUS scoring system. Concurrent validity was analysed with ICC.ResultsThe results showed excellent intraobserver and interobserver reliability for both the MSUS evaluation of MT and CSA (ICC & GE;0.93). The MSUS scoring system showed excellent intraobserver reliability (& kappa;=1.0) and very good interobserver reliability (& kappa;=0.85). There was also a high intra- and inter-observer reliability for the histological scorings (& kappa; & GE;0.85 and mean & kappa;=0.70, respectively), as well as high reliability between the histology and MSUS scoring systems (ICC=0.92). All results were statistically significant (p & LE;0.001).ConclusionMSUS measures of MT and CSA and the novel MSUS scoring system for degenerative muscle changes in sarcopenia was found to be reliable and strongly associated with histological findings

Characterization of digital annular pulleys and their entheses: an ultrasonographic study with anatomical and histological correlations

Objectives: Digital annular pulleys (DAP) are important anatomical structures for finger function. The anatomy, histology, and imaging assessment of DAP, particularly at the level of their entheses is still not clearly defined. The advent of high-frequency ultrasound (US) transducers opened new perspectives in evaluating sub-millimeter scale structures, such as pulleys, paving the way for their global assessment. The study aimed at characterizing DAP from an anatomical, histological, and US perspective, focusing on the detection and complete description of pulley entheses. Methods: US assessment and gross anatomy dissection were conducted on 20 cadaveric hands to study DAP thickness and structure including enthesis identification. The results of the US and anatomical measurements were correlated. DAP entheses identified by US were characterized via histological analysis. DAP in 20 healthy controls (HC) were detected and measured by US. The A1, A2, and A4 DAP entheses were assessed using a new dynamic maneuver to better evaluate those structures. Results: 1200 DAP (400 cadaveric, 800 HC) were analyzed. The cadaveric study demonstrated strong correlation between anatomical and US measurement of DAP (r = 0.96). At histological level, DAP entheses at the volar plate, sesamoid bones, or phalangeal ridges contained fibrous and fibrocartilaginous tissue. The US assessment of A1, A2, and A4 DAP in HC allowed the identification of 718/720 (99.73%) entheses. Conclusion: US is an effective tool to detect and study DAP. DAP entheses reveal both fibrous and fibrocartilaginous characteristics. A newly described maneuver to optimize DAP enthesis visualization enhances their detection by US

Automatic and online pollen monitoring

BACKGROUND: Pollen are monitored in Europe by a network of about 400 pollen traps, all operated manually. To date, automated pollen monitoring has only been feasible in areas with limited variability in pollen species. There is a need for rapid reporting of airborne pollen as well as for alleviating the workload of manual operation. We report our experience with a fully automated, image recognition-based pollen monitoring system, BAA500. METHODS: The BAA500 sampled ambient air intermittently with a 3-stage virtual impactor at 60 m(3)/h in Munich, Germany. Pollen is deposited on a sticky surface that was regularly moved to a microscope equipped with a CCD camera. Images of the pollen were constructed and compared with a library of known samples. A Hirst-type pollen trap was operated simultaneously. RESULTS: Over 480,000 particles sampled with the BAA500 were both manually and automatically identified, of which about 46,000 were pollen. Of the automatically reported pollen, 93.3% were correctly recognized. However, compared with manual identification, 27.8% of the captured pollen were missing in the automatic report, with most reported as unknown pollen. Salix pollen grains were not identified satisfactorily. The daily pollen concentrations reported by a Hirst-type pollen trap and the BAA500 were highly correlated (r = 0.98). CONCLUSIONS: The BAA500 is a functional automated pollen counter. Its software can be upgraded, and so we expected its performance to improve upon training. Automated pollen counting has great potential for workload reduction and rapid online pollen reporting

High-resolution ultrasound of spigelian and groin hernias: a closer look at fascial architecture and aponeurotic passageways

From the clinical point of view, a proper diagnosis of spigelian, inguinal and femoral hernias may be relevant for orienting the patient's management, as these conditions carry a different risk of complications and require specific approaches and treatments. Imaging may play a significant role in the diagnostic work-up of patients with suspected abdominal hernias, as the identification and categorization of these conditions is often unfeasible on clinical ground. Ultrasound imaging is particularly suited for this purpose, owing to its dynamic capabilities, high accuracy, low cost and wide availability. The main limitation of this technique consists of its intrinsic operator dependency, which tends to be higher in difficult-to-scan areas such as the groin because of its intrinsic anatomic complexity. An in-depth knowledge of the anatomy of the lower abdominal wall is, therefore, an essential prerequisite to perform a targeted ultrasound examination and discriminate among different types of regional hernias. The aim of this review is to provide a detailed analysis of the fascial architecture and aponeurotic passageways of the abdominal wall through which spigelian, inguinal and femoral hernias extrude, by means of schematic drawings, ultrasound images and video clips. A reasoned landmark-based ultrasound scanning technique is described to allow a prompt and reliable identification of these pathologic conditions