MR arthrography in calcific tendinitis of the shoulder: diagnostic performance and pitfalls

The purpose was to assess the diagnostic performance of MR arthrography to diagnose calcific tendinitis of the shoulder and to assess the reasons for diagnostic errors. Standard MR arthrograms of 22 patients with calcific tendinitis and 61 controls were retrospectively analyzed by two independent and blinded radiologists. All cases were consecutively collected from a database. Conventional radiographs were available in all cases serving as gold standard. The supraspinatus was involved in 16, the infraspinatus in four and the subscapularis in two patients. All diagnostic errors were analyzed by two additional readers. Reader 1 correctly detected 12 of the 22 shoulders with and 42 of the 61 shoulders without calcific tendinitis (sensitivity 0.55, specificity 0.66). The corresponding values for reader 2 were 13 of 22 and 40 of 61 cases (sensitivity 0.59, specificity 0.69). Inter-rater agreement (kappa-value) was 0.42. Small size of the calcific deposits and isointensity compared to the surrounding tissue were the most important reasons for false negative results. Normal hypointense areas within the supraspinatus tendon substance and attachment were the main reason for false positive results. In conclusion, MR arthrography is insufficient in the diagnosis of calcific tendinitis. Normal hypointense parts of the rotator cuff may mimic calcific deposits and calcifications may not be detected when they are isointense compared to the rotator cuff. Therefore, MR imaging should not be interpreted without corresponding radiograph

Imaging findings predicting the outcome of cervical facet joint blocks

To determine which cross-sectional imaging findings predict the short-term outcome of cervical facet joint blocks (FJB) and to evaluate the effect of combined intra-/periarticular versus periarticular injection on pain. Fifty facet joints in 37 patients were included in the study. Single, unilateral FJBs in 24 patients, and bilateral single level FJBs in 13 patients were performed, respectively. In all patients, pain relief was assessed using a visual analogue scale. All computed tomography (CT) examinations were blindly reviewed by two radiologists. Osteoarthritis was rated using the Kellgren classification. The presence of combined intra-/periarticular vs. sole periarticular injection of contrast was evaluated. Kellgren Grades 0 (n=23), 1 (n=5), 2 (n=3), 3 (n=9), and 4 (n=10) were found. Mean pain relief after injection was 35% (range: 0-100%). 40% of all injections were combined intra-/periarticular. There was neither a statistically significant difference between pain relief and combined intra-/periarticular versus sole periarticular injection (p=0.64) nor the grade of osteoarthritis (p=0.49). Pain relief after cervical FJBs does not correlate with morphologic alterations seen on CT. Periarticular FJBs are not less successful than combined intra-/periarticular FJB

Effect of dietary alpine butter rich in conjugated linoleic acid on milk fat composition of lactating sows

Multiparous sows (n 17) were included in a controlled cross-over-study in order to investigate the influence of a natural source of conjugated linoleic acid (CLA) (alpine butter) on the milk fatty acid composition of lactating sows (as an animal model for lactating women) and on the growth performance of their progeny. The usual fat source of a standard lactation diet was replaced by either CLA-rich alpine butter or margarine (control diet). Compared with the margarine diet, feeding the alpine butter-supplemented diet increased (P0·05) affected. Growth performance of the progeny was similar for both dietary treatments. In summary, the findings show that adding alpine butter to the diet does not provoke a milk fat depression and does not alter the composition of total SFA, MUFA and PUFA in sow milk but increases its CLA concentratio

Prospective evaluation of two different injection techniques for MR arthrography of the hip

The aim of the study was to evaluate prospectively the technical feasibility and discomfort of two different injection techniques for MR arthrography of the hip. Sixty-one consecutive patients undergoing MR arthrography of the hip (68 hips) were randomly injected either at the femoral head (36 hips) or the femoral neck (32 hips). The patients rated discomfort during and 0-72h after arthrography using a visual analogue scale (VAS, 0="did not feel anything”, 100="unbearable”). The volume injected, the distance between the needle tract and the neurovascular bundle, the duration of the procedure and the extra-articular contrast leakage were measured. No significant differences were found for the volume injected, the distance between the needle tract and the neurovascular bundle, or the procedure duration. Volume of extra-articular contrast leakage was statistically significantly different (head 1±2cm3, neck 3±5cm3, P=0.024). The VAS score for needle advancement was significantly different (head 25±20, neck 19±23, P=0.031). No significant differences were found for the VAS score regarding delayed discomfort. Before the examination the arthrography-related discomfort was overestimated by 74% (50/68), correctly anticipated by 22% (15/68) and underestimated by 4% (3/68) of the patients. MR-related discomfort was overestimated by 32% (22/68), correctly anticipated by 57% (39/68) and underestimated by 10% (7/68) of the patients. Both hip puncture techniques were well tolerated. The neck injection technique produced less discomfort and was associated with greater extra-articular contrast leakag

Bone marrow changes on STIR MR images of asymptomatic feet and ankles

The purpose of this study was to evaluate the prevalence, pattern and size of bone marrow changes on short-tau inversion recovery (STIR) magnetic resonance (MR) images of asymptomatic feet and ankles. In 78 asymptomatic volunteers (41 women, 37 men; median age 47years; range 23-83years) sagittal STIR MR images of hindfoot and midfoot were reviewed for various patterns of high signal changes in bone marrow. The size of these bone marrow changes was measured, and signal intensity was rated semi-quantitatively using a scale from 0 (=normal) to 10 (=fluid-like). Fifty percent (39/78) of all volunteers had at least one bone marrow change. Thirty-six percent (28/78) of all volunteers had edema-like changes, 26% (20/78) had necrosis-like changes, and 5% (4/78) had cyst-like changes. The long diameters of all changes varied between 4mm and 16mm (median 7.5mm). The median signal intensity for all changes was 5.0 (range 1-10). Bone marrow changes on STIR MR images are commonly detected in asymptomatic feet and ankles. However, such changes tend to be small (<1cm) or subtl

Faith seeking understanding

The debate between faith and science is an ongoing and dynamic conversation marked by the need to consistently factor in new data generated by the sciences, and new perspectives developed in theology. In this book, a group of theologians and ethicists provide insights into the debate from a faith perspective. The basic thesis permeating the discussions is that faith and science are capable of enriching and complementing each other, albeit in their own unique way. What unifies faith and science is the search for truth. What differentiates them is the unique lenses they employ to find the truth. In the end, both scientists and theologians must take into account all the pathways and lenses that lead us to a better understanding of reality. This study presents concrete examples of how theological knowledge and scientific data can be fruitfully used and integrated to develop new horizons of understanding. The general aim of this contribution was to narrow in on some of the burning themes that are driving the faith or science scholarly debate. Each contributor highlights a different aspect of the debate. The topics addressed include theoretical perspectives on the science-faith relation, the ancient scientific worldview of the creation narratives in Genesis, evolution and human origins, science and African Pentecostalism, faith and the Fourth Industrial Revolution, science and transhumanism, science and traditional medicine, and the role that faith and science can play in the human quest for meaning. Most of the contributors approach the topic from a post-foundationalist and postpositivist epistemological point of view. A wide range of hermeneutical methods is employed, ranging from systematic biblical-theological perspectives to literary and source criticism. Analytical, normative and existential philosophical arguments are also utilised throughout the course of the book. The most important contribution of the book lies in the transdisciplinary perspectives that emanate from the discussion. The ways in which the authors go about integrating theological and scientific perspectives to address ultimate questions about meaning and to inform moral discourse show that religion still has an important role to play in a world increasingly shaped by technological rationality. At the same time, it indicates that religion and science do not have to stand in conflict with each other. If the two lenses on reality engage in mature dialogue, they can enrich, inform and, on some occasions, even correct each other. The target audience of this book includes theological scholars, natural scientists and science philosophers. This book contains no plagiarism, and none of the work has been published elsewhere

A morphological evaluation of botulinum neurotoxin A injections into the detrusor muscle using magnetic resonance imaging

Objectives: Although botulinum neurotoxin type A (BoNT/A) intradetrusor injections are a recommended therapy for neurogenic detrusor overactivity (NDO), refractory to antimuscarinic drugs, a standardisation of injection technique is missing. Furthermore, some basic questions are still unanswered, as where the toxin solution exactly spreads after injection. Therefore, we investigated the distribution of the toxin solution after injection into the bladder wall, using magnet resonance imaging (MRI). Methods: Six patients with NDO were recruited. Three of six patients received 300U of BoNT/A+contrast agent distributed over 30 injection sites (group 1). The other three patients received 300U of BoNT/A+contrast agent distributed over 10 injection sites (group 2). Immediately after injection, MRI of the pelvis was performed. The volume of the detrusor and the total volume of contrast medium inside and outside the bladder wall were calculated. Results: In all patients, a small volume (mean 17.6%) was found at the lateral aspects of the bladder dome in the extraperitoneal fat tissue, whereas 82.4% of the injected volume reached the target area (detrusor). In both groups there was a similar distribution of the contrast medium in the target area. A mean of 33.3 and 25.3% of the total detrusor volume was covered in group 1 and 2, respectively. Six weeks after injection, five of six patients were continent and showed no detrusor overactivity in the urodynamic follow-up. No systemic side effects were observed. Conclusions: Our results provide morphological arguments that the currently used injection techniques are appropriate and saf

From Sensorimotor Graphs to Rules: An Agent Learns from a Stream of Experience

Abstract. In this paper we argue that a philosophically and psychologically grounded autonomous agent is able to learn recursive rules from basic sensorimotor input. A sensorimotor graph of the agent&apos;s environment is generated that stores and optimises beneficial motor activations in evaluated sensor space by employing temporal Hebbian learning. This results in a categorized stream of experience that feeds in a Minerva memory model which is enriched by a time line approach and integrated in the cognitive architecture Psi-including motivation and emotion. These memory traces feed seamlessly into the inductive rule acquisition device Igor2 and the resulting recursive rules are made accessible in the same memory store. A combination of cognitive theories from the 1980ies and state-of-the-art computer science thus is a plausible approach to the still prevailing symbol grounding problem

Faith seeking understanding

The debate between faith and science is an ongoing and dynamic conversation marked by the need to consistently factor in new data generated by the sciences, and new perspectives developed in theology. In this book, a group of theologians and ethicists provide insights into the debate from a faith perspective. The basic thesis permeating the discussions is that faith and science are capable of enriching and complementing each other, albeit in their own unique way. What unifies faith and science is the search for truth. What differentiates them is the unique lenses they employ to find the truth. In the end, both scientists and theologians must take into account all the pathways and lenses that lead us to a better understanding of reality. This study presents concrete examples of how theological knowledge and scientific data can be fruitfully used and integrated to develop new horizons of understanding. The general aim of this contribution was to narrow in on some of the burning themes that are driving the faith or science scholarly debate. Each contributor highlights a different aspect of the debate. The topics addressed include theoretical perspectives on the science-faith relation, the ancient scientific worldview of the creation narratives in Genesis, evolution and human origins, science and African Pentecostalism, faith and the Fourth Industrial Revolution, science and transhumanism, science and traditional medicine, and the role that faith and science can play in the human quest for meaning. Most of the contributors approach the topic from a post-foundationalist and postpositivist epistemological point of view. A wide range of hermeneutical methods is employed, ranging from systematic biblical-theological perspectives to literary and source criticism. Analytical, normative and existential philosophical arguments are also utilised throughout the course of the book. The most important contribution of the book lies in the transdisciplinary perspectives that emanate from the discussion. The ways in which the authors go about integrating theological and scientific perspectives to address ultimate questions about meaning and to inform moral discourse show that religion still has an important role to play in a world increasingly shaped by technological rationality. At the same time, it indicates that religion and science do not have to stand in conflict with each other. If the two lenses on reality engage in mature dialogue, they can enrich, inform and, on some occasions, even correct each other. The target audience of this book includes theological scholars, natural scientists and science philosophers. This book contains no plagiarism, and none of the work has been published elsewhere