The effect of ethanol intake on tendon healing: a histological and biomechanical study in a rat model

Introduction  

Ethanol has a suppressive effect on inflammation and the immune system, but the effect of ethanol on tendon healing in vivo has not been studied. The purpose of this study was to investigate the histological and biomechanical effects of ethanol intake on tendon healing in a rat tendon injury model.     

Highly resolved in vivo 1H NMR spectroscopy of the mouse brain at 9.4 T.

An efficient shim system and an optimized localization sequence were used to measure in vivo 1H NMR spectra from cerebral cortex, hippocampus, striatum, and cerebellum of C57BL/6 mice at 9.4 T. The combination of automatic first- and second-order shimming (FASTMAP) with strong custom-designed second-order shim coils (shim strength up to 0.04 mT/cm2) was crucial to achieve high spectral resolution (water line width of 11-14 Hz). Requirements for second-order shim strengths to compensate field inhomogeneities in the mouse brain at 9.4 T were assessed. The achieved spectral quality (resolution, S/N, water suppression, localization performance) allowed reliable quantification of 16 brain metabolites (LCModel analysis) from 5-10-microL brain volumes. Significant regional differences (up to 2-fold, P < 0.05) were found for all quantified metabolites but Asp, Glc, and Gln. In contrast, 1H NMR spectra measured from the striatum of C57BL/6, CBA, and CBA/BL6 mice revealed only small (<13%, P < 0.05) interstrain differences in Gln, Glu, Ins, Lac, NAAG, and PE. It is concluded that 1H NMR spectroscopy at 9.4 T can provide precise biochemical information from distinct regions of the mouse brain noninvasively that can be used for monitoring of disease progression and treatment as well as phenotyping in transgenic mice models.     

The nocturnal jejunal migrating motor complex: defining normal ranges by study of 51 healthy adult volunteers and meta-analysis

Interdigestive human small bowel motility is characterized by the migrating motor complex (MMC). The aims of this study were to: (i) establish the normal range of variables of the nocturnal jejunal MMC and (ii) incorporate these data in a subsequent meta-analysis. Eighty-one recordings were performed by prolonged (24 h) ambulatory manometry in 51 subjects in two centres. Quantitative analysis was undertaken of 419 Phase III and 332 Phase II episodes. Adjusted mean values of seven variables were calculated using a mixed-effects model. Meta-analysis of pooled published data to generate a reliable 95% reference range was also performed. Adjusted mean values and confidence intervals are presented for all seven variables. Intrasubject variances were large in comparison with intersubject. Meta-analysis of 19 studies (356 pooled patients) meeting inclusion criteria produced wide reference ranges. At least five such ranges are useful for the detection of abnormality in the individual. This is the largest study of normal volunteers presented to date, with ranges for many variables produced using appropriate statistical methodology. A model for definition of abnormality has been proposed. We recommend that these data may be used by investigators in this field as a complement to other existing indicators of small bowel dysmotility.     

Parallel image reconstruction using B-spline approximation (PROBER).

A new reconstruction method for parallel MRI called PROBER is proposed. The method PROBER works in an image domain similar to methods based on Sensitivity Encoding (SENSE). However, unlike SENSE, which first estimates the spatial sensitivity maps, PROBER approximates the reconstruction coefficients directly by B-splines. Also, B-spline coefficients are estimated at once in order to minimize the reconstruction error instead of estimating the reconstruction in each pixel independently (as in SENSE). This makes the method robust to noise in reference images. No presmoothing of reference images is necessary. The number of estimated parameters is reduced, which speeds up the estimation process. PROBER was tested on simulated, phantom, and in vivo data. The results are compared with commercial implementations of the algorithms SENSE and GRAPPA (Generalized Autocalibrating Partially Parallel Acquisitions) in terms of elapsed time and reconstruction quality. The experiments showed that PROBER is faster than GRAPPA and SENSE for images wider than 150x150 pixels for comparable reconstruction quality. With more basis functions, PROBER outperforms both SENSE and GRAPPA in reconstruction quality at the cost of slightly increased computational time.     

Indikation, OP-Technik und Ergebnisse des endoskopischen Releases der Plantarfaszie (ERPF)

Zusammenfassung Fragestellung Ziel der vorliegenden Untersuchung ist es, die Indikation, OP-Technik sowie die Ergebnisse des endoskopischen Releases der Plantarfaszie darzustellen. Material und Methode An 5 nicht fixierten Präparaten wurde eine biportale Technik zum endoskopischen Release der Plantarfaszie erprobt. Ziel war es hierbei zum einen, die Relation zwischen Plantarfaszie und plantarem Fersensporn zu evaluieren; zum anderen wurde eine Technik erprobt, bei welcher nur 50–70% der medialen Plantarfaszie vom Kalkaneus abgelöst wurde.Über einen Zeitraum von 5 Jahren wurde diese Technik bei 10 männlichen und 7 weiblichen Patienten mit dem klinischen Bild einer Plantarfasziitis durchgeführt. Das mittlere Alter der Patienten betrug 35 Jahre (24–56 Jahre). Alle Patienten durchliefen zunächst konservative Therapieversuche von zumindest 6 Monaten. Ergebnisse Bei den ersten 5 Patienten wurde der Eingriff unter Bildwandlerkontrolle durchgeführt; bei den weiteren Patienten erfolgte die Resektion ohne intraoperative BV-Kontrolle. Bei allen Patienten konnte der Eingriff wie geplant durchgeführt werden. Die endoskopischen Portale heilten ohne Probleme. Die OP-Zeit ist im Rahmen der Lernkurve mit Zeiten zwischen 21 und 74 Minuten (MW: 41 Minuten) noch länger als in der offenen Technik. Der Nachuntersuchungszeitraum betrug zwischen 4 und 48 Monate (MW: 18,5 Monate). Bei 13 der 17 Patienten kam es zu einer klinischen Verbesserung und sie würden den Eingriff erneut durchführen lassen. 7 Patienten zeigten ein gutes und 6 ein sehr gutes Ergebnis im Ogilvie-Harris-Score. Bei 2 Patienten war das initiale Ergebnis nicht zufriedenstellend. Die Ursache hier lag in einer ossären Übermüdungsreaktion des Kalkaneus. Diese Komplikation wurde durch Entlastung über 6 Wochen symptomastisch behandelt. Bei zwei weiteren Patienten stellten sich sekundäre Überlastungen am lateralen Fußrand ein. Im Rahmen der frühen Rehabilitationsphase war es wichtig, trotz des minimalinvasiven Vorgehens, eine vorsichtige Belastungssteigerung durchzuführen. Schlussfolgerung Die Technik des endoskopischen Releases der Plantarfaszie (ERPF) ist standardisiert und reproduzierbar durchführbar. Sie führt zu guten mittelfristigen Ergebnissen. Ein Stabilitätsverlust der plantaren Verspannung sollte jedoch unbedingt vermieden werden.     

Referral pattern of patients with oral mucosal lesions in The Netherlands

The referral pattern of 140 Dutch patients with oral mucosal lesions, who had been referred to a Department of Oral & Maxillofacial Surgery and Oral Pathology, shows that patients with oral mucosal lesions consult the dentist as often as the family doctor as the first source of help or information. Furthermore, family doctors were much more used to refer patients with oral mucosal disease to medical specialists rather than to the dentist or the oral and maxillofacial surgeon.     

Analysis of job-share as a process of change

This paper describes the introduction of a district nursing job-share in a primary health care team. Exploring change theory and different strategies for organizational change, the implications for members of the team are considered. In addition, changes in the balance of power which resulted in conflict within the district nursing team are discussed.