["Rheuma (be-)greifen"- A multimodal teaching concept to improve rheumatology education for medical students]. / "Rheuma (be-)greifen" ­ ein multimodales Lehrkonzept zur Verbesserung der rheumatologischen Lehre für Studierende der Humanmedizin.

BACKGROUND: The German Society for Rheumatology, through its campaign Rheuma2025, aims to improve student teaching in order to ensure patient care for rheumatological patients in the future. OBJECTIVE: To assess whether a combination of traditional and innovative educational methods provide both an improvement in the quality of teaching and an increase in the attractiveness of rheumatology as a discipline. MATERIAL AND METHODS: Establishment of the teaching concept "Rheuma (be-)greifen" consisting of five modules on patient history taking with acting patients, musculoskeletal ultrasound, arthrocentesis, 3D printing of pathological joints and virtual reality applications based on real patient cases in the curricular teaching of medical students. RESULTS: The evaluation of the teaching concept with 93 students of medicine showed a consistently high acceptance of all modules, which were rated as very effective or rather effective. Direct patient-related modules, such as history taking with acting patients, musculoskeletal ultrasound and arthrocentesis, received even higher acceptance than the visualization methods utilizing 3D printing and virtual reality. CONCLUSION: Innovative teaching methods can help to improve the acceptance of teaching in the field of rheumatology, especially when combined with classical teaching contents.

Physical activity measured with an accelerometer in dogs following extracapsular stabilisation to treat cranial cruciate ligament rupture.

OBJECTIVES: To quantify the physical activity levels in dogs with cranial cruciate ligament rupture before and after lateral fabellar suture stabilisation surgery. MATERIALS AND METHODS: Seventeen dogs (mean weight, 12.3±5.1 kg) with unilateral cranial cruciate ligament rupture were fitted with an accelerometer for seven consecutive days at four different time points: before surgery (T0), one (T1), three (T3) and six (T6) months after surgery. The total activity and times spent in sedentary activity, light to moderate activity and vigorous activity were recorded by the accelerometer, and preoperative and postoperative data were compared. At all time points, dogs underwent clinical evaluations (lameness score, stifle pain score and thigh circumference) and their owners were asked to respond to questionnaires to subjectively score the physical activity and quality of life of the dogs. RESULTS: At the four time points, the dogs spent between 21.2 and 21.4 hours on sedentary behaviour, 2.3 and 2.5 hours performing light to moderate activity, and 13 to 15 minutes performing vigorous activity. There was no increase in physical activity variables or decrease in sedentary behaviour over time. Lameness scores, pain score and dogs' quality of life improved significantly during the postoperative period. At T6, 17 (100%) of 17 dogs presented no lameness, 16 (94%) of 17 dogs presented no stifle pain, 16 (94%) of 17 owners rated the quality of life as very good and excellent, and 16 (100%) of 16 owners reported a total return to normal activity levels. CLINICAL SIGNIFICANCE: The clinical recovery after extracapsular stabilisation of the stifle joint was not associated with a spontaneous increase in physical activity or a decrease in sedentary behaviour.

The influence of different peritoneal dialysis fluids on the in vitro activity of ampicillin, daptomycin, and linezolid against Enterococcus faecalis.

Intraperitoneal administration of antibiotics is recommended for the treatment of peritoneal dialysis-related peritonitis. However, little data are available on a possible interference between peritoneal dialysis fluids and the activity of antimicrobial agents. Thus, the present in vitro study set out to investigate the influence of different peritoneal dialysis fluids on the antimicrobial activity of ampicillin, linezolid, and daptomycin against Enterococcus faecalis. Time-kill curves in four different peritoneal dialysis fluids were performed over 24 h with four different concentrations (1 × MIC, 4 × MIC, 8 × MIC, 30 × MIC) of each antibiotic evaluated. Cation-adjusted Mueller-Hinton broth was used as the comparator solution. All four peritoneal dialysis fluids evaluated had a bacteriostatic effect on the growth of Enterococcus faecalis. Compared to the cation-adjusted Mueller-Hinton broth comparator solution, the antimicrobial activity of all antibiotics tested was reduced. For ampicillin and linezolid, no activity was found in any peritoneal dialysis fluid, regardless of the concentration. Daptomycin demonstrated dose-dependent activity in all peritoneal dialysis fluids. Bactericidal activity was observed at the highest concentrations evaluated in Dianeal® PDG4 and Extraneal®, but not in concentrations lower than 30 × MIC and not in Nutrineal® PD4 and Physioneal® 40. The antimicrobial activity of ampicillin and linezolid is limited in peritoneal dialysis fluids in vitro. Daptomycin is highly effective in peritoneal dialysis fluids and might, thus, serve as an important treatment option in peritoneal dialysis-related peritonitis. Further studies are needed to evaluate the clinical impact of the present findings.

Comparison of gadofosveset (Vasovist(®)) with gadobenate dimeglumine (Multihance(®))-enhanced MR angiography for high-grade carotid artery stenosis.

OBJECTIVE: To prove superiority of blood pool contrast agent gadofosveset over conventional contrast agent gadobenate dimeglumine for assessment of stenotic internal carotid artery (ICA). METHODS: Eleven patients with high-grade ICA stenosis (≥75%), confirmed by duplex sonography, underwent MR angiography (MRA) with gadofosveset and gadobenate dimeglumine. RESULTS: Agreement in stenosis grade was reached in 7 of 10 stenotic ICAs. In two ICAs, gadobenate dimeglumine led to underestimation of stenosis grade. There was a significant difference in signal intensity (pre-/post-stenotic segments), showing higher values for gadofosveset (P<0.01; P<0.05). Impression of contrast intensity with gadofosveset was better in 8 ICAs and only in 1 ICA with gadobenate dimeglumine (P<0.05). CONCLUSION: Gadofosveset-enhanced MR angiography may be superior for assessment of high-grade ICA stenosis compared with gadobenate dimeglumine MR angiography.

A new contrast in MR mammography by means of chemical exchange saturation transfer (CEST) imaging at 3 Tesla: preliminary results.

PURPOSE: To evaluate the feasibility to detect and delineate malignant breast lesions in human patients by chemical exchange saturation transfer (CEST) as an MR imaging technique without the need for contrast agent administration. MATERIALS AND METHODS: Six female patients referred for pre-surgical staging due to histologically confirmed breast cancer were examined with MR at 3 T. The routine breast protocol included T (2w), STIR, T (1w)-DCE and contrast-enhanced T (1w) imaging with SPAIR fat suppression. For CEST imaging, a 3D RF-spoiled gradient echo (GRE) sequence with an optimized saturation pulse train was applied. To assess the diagnostic value of the technique, CEST effects observed between frequency offsets of 1.2 to 1.8 ppm from the bulk water resonance were compared to pharmacokinetic parameter maps (k (ep)) obtained by DCE-MRI. RESULTS: In 3 of 6 patients, regions with high CEST signal intensity correlated well with tumor areas as determined by DCE-MRI. Analysis of signal intensities from ROIs in tumor, fibroglandular, adipose, and muscle tissue revealed significantly higher CEST values in tumor tissue compared to fibroglandular tissue. The detection of lesions was equally well possible with DCE-MRI and CEST-MRI. In the three other patients, the tumor regions could not be delineated based on the CEST image due to artifacts, which were most likely caused by a high content of fat tissue within the ROIs. CONCLUSION: The results of this initial feasibility study indicate a significant potential of CEST-MRI to discriminate cancer from fibroglandular tissue in the human breast by a CEST contrast generated by endogenous solute molecules.

[Normal aging and imaging correlations]. / Normales Altern und seine Bildgebungskorrelate.

Age-related structural, functional and biochemical changes of the brain can be visualized by neuroimaging methods. Physiological aging of the brain has to be clearly distinguished from pathological alterations of the brain for reliable and early diagnoses of neurodegenerative diseases. Concerning the speed of the cerebral aging process, significant inter-individual differences can be observed. In general, aging is associated with a decline of cognitive functions. Simultaneously, a decay of the average brain volume, especially in the frontal lobe accompanies the process of aging. Correspondingly, a strong susceptibility for age-related degeneration has been observed in the fronto-striato-thalamic network. Due to increasing age the white matter is affected by a progressive loss of fiber integrity mirrored in a significant decay of the fractionated anisotropy (FA) measured by diffusion tensor imaging (DTI). Age-related degeneration of the white matter further leads to a growing number of T2 hyperintense white-matter lesions. Aging also influences the cerebral perfusion pattern leading to a perceptible decay of the global cerebral blood flow (CBF) and blood volume (CBV). During life, iron accumulates in the brain, predominantly in the globus pallidus and in the substantia nigra. By 1H-MR spectroscopy, a decrease of N-acetyl-aspartate (NAA) as a correlate for reduced neuronal metabolism is found in the brain of elderly individuals.

[MR spectroscopy in dementia]. / MR-Spektroskopie bei Demenz.

With an increasingly aging population we are faced with the problem of an increasing number of dementia patients. In addition to clinical, neuropsychological and laboratory procedures, MRI plays an important role in the early diagnosis of dementia. In addition to various morphological changes functional changes can also help in the diagnosis and differential diagnosis of dementia. Overall the diagnosis of dementia can be improved by using parameters from MR spectroscopy. This article focuses on MR spectroscopic changes in the physiological aging process as well as on changes in mild cognitive impairment a precursor of Alzheimer's dementia, in Alzheimer's dementia, frontotemporal dementia, vascular dementia and Lewy body dementia.

[Significance of MR angiography for imaging diagnostics of carotid artery diseases]. / Stellenwert der MR-Angiographie zur bildgebenden Diagnostik von Erkrankungen der Karotiden.

During the last decade, magnetic resonance angiography (MRA) evolved to an essential method for radiological diagnostics of extracranial arteries' diseases. Contrast enhanced MRA enables meanwhile the acquisition of angiographic series in high diagnostic quality comparable to that originating from conventional DSA. Due to MRA, conventional DSA anymore plays a crucial role in the diagnostic assessment of carotid artery disease or highly vascularised tumors of the head and neck region. Besides reliable quantification of carotid stenoses, highly resolved MRI sequences provide a promising approach for characterization of plaque morphologies and thereby contribute to turn the risk for a stroke calculable. Furthermore, MRA has nearly replaced DSA in radiographics of carotid artery dissections whereas MRA has especially emerged as an appropriate method to visualize the intramural hematoma which is evidentiary for the diagnosis. However, not all methods of MRA are equivalent in respect to their diagnostic value. While CE MRA is able to completely substitute DSA in many clinical questions, applicability of flow-dependent Time-of-flight (TOF) or phase-contrast (PC) MRA is limited due to their distinct susceptibility to motion or flow-related artefacts.

Preliminary studies on Campomanesia xanthocarpa (Berg.) and Cuphea carthagenensis (Jacq.) J.F. Macbr. aqueous extract: weight control and biochemical parameters.

An infusion of Campomanesia xanthocarpa Berg. (Myrtaceae) leaves (Guabiroba) and the herb Cuphea carthagenensis (Jacq.) J.F. Macbr. (Lythraceae) (Sete-sangrias) is traditionally used in the South of Brazil to treat high levels of cholesterol and triglycerides. The effects of the aqueous extracts of these herbs were investigated in rats fed on a high calorie diet. Chronic treatment with the Guabiroba aqueous extract induced a significant reduction in weight gain in the rats, compared to the control group. Also, biochemical analysis showed that this treatment reduced the glycemia, while no effects on lipidic levels were observed. The biochemical analysis of the animals treated with Sete-sangrias aqueous extract showed no effect on glucose and triglyceride levels, while chronic treatment with the Sete-sangrias aqueous extract induced a significant reduction in plasma cholesterol in rats.

[Custom-made knee endoprosthetics using subtraction data of 3-dimensional CT scans. A new approach]. / Endoprothetischen Versorgung des Kniegelenks auf der Basis eines 3D-computertomographischen Subtraktionsverfahrens. Ein neuer Weg.

A new method is presented which allows the construction and implantation of highly precise custom-made endoprostheses for knee joints. The procedure is based on a computer-aided subtraction process of three-dimensional CT data. Using the differences of the CT scans, the endprosthetic components are modelled by means of a newly developed software package. The implants are manufactured by CNC machines and stereolithography. The method enables the surgeon to reduce bone resections and ensures an exact profile of the bone-implant interface. Incorrect positioning will be avoided and the implantation process can be performed more easily while the size of the operative approach will be minimized. Better postoperative kinematics and reduction of shearing effects will lead to better results in the long run. The procedure offers a series of new possibilities to optimize monocondylar and bicondylar knee joint endoprostheses.

Malignant hyperthermia.

Malignant hyperthermia is a pharmacogenetic disease of skeletal muscle characterized by hypermetabolism that occurs on exposure to a triggering agent or agents. The most common agents are halogenated inhalational anesthetics and succinylcholine, a depolarizing muscle relaxant. Patients who experience malignant hyperthermia are generally transferred to the ICU for ongoing treatment and monitoring for secondary complications of the disorder. Critical care practitioners must be both knowledgeable and competent to prevent and treat perioperative episodes of malignant hyperthermia. A thorough preoperative interview should be done to determine risk factors and susceptible patients. This article provides critical care nurses with sound information on the pathophysiology of malignant hyperthermia, the ability to assess the disease properly and treat the patient both before and after the crisis, and the ability to provide support and teaching to patients and patients' families to prevent the recurrence of malignant hyperthermia.

The changing role of the rehabilitation nurse.

As traditional medical treatment gives way to nontraditional and home-based care, rehabilitation nurses in home care are ideally positioned to assist more and more disabled clients in adjusting to their homes and communities. This article examines the rehabilitation nurse's role and the issues involved in providing this assistance.

Hypertonic saline resuscitation of head injury: effects on cerebral water content.

UNLABELLED: Ideal resuscitation would simultaneously replete intravascular volume and minimize cerebral edema. We assessed the effects of hypertonic saline (HS) shock resuscitation on cerebral edema after head injury. Rats were subjected to hemorrhagic shock (40 mm Hg for 1 hour) in the presence or absence of mechanical brain injury, followed by 1 hour of resuscitation with either hypertonic saline (6.5%) or lactated Ringer's (LR). After resuscitation, animals were sacrificed and brain water contents determined. RESULTS: Less HS than LR was needed for resuscitation both in animals without brain injury (7 +/- 2 ml/kg vs. 97 +/- 16 ml/kg; p less than 0.0003) and with brain injury (10 +/- 1 ml/kg vs. 68 +/- 6 ml/kg; p less than 0.0001). Brain water content (ml H2O/gm dry wt) after HS resuscitation was decreased compared to LR resuscitation in animals without brain injury (3.36 +/- 0.12 vs. 3.74 +/- 0.08; p less than 0.025) and in the uninjured hemisphere of head-injured animals (3.29 +/- 0.11 vs. 3.78 +/- 0.09; p less than 0.025). Brain water content was increased in injured brain in both resuscitation groups, but the increase was the same (HS 4.10 +/- 0.13; LR 4.25 +/- 0.17; p greater than 0.05). CONCLUSIONS: HS resuscitation of hemorrhagic shock decreases brain water content in uninjured but not injured brain. HS may be useful in resuscitation of combined hemorrhagic shock and head injury.