Schmerzklinik Kiel

PurposeThe aim of this work is to make the DTI along the perivascular space (DTI‐ALPS‐index) more robust with respect to region selection and the orientation of the head and fibers. We propose to address this matter by using the principal diffusion directions and an automated, atlas‐based region of interest (ROI) placement.MethodsSimulations were used to determine the dependence of the DTI‐ALPS‐index on the orientations of the head and nerve fibers. Human MRI was performed on 12 healthy volunteers at 3T using a 64 channel head coil (Cima.X Siemens), and the DTI‐ALPS‐index was calculated along the principal diffusion directions (ALPS‐PAS) and along the field of view or laboratory frame (ALPS‐LAB). To calculate the DTI‐ALPS‐index with reduced bias in native space, we developed a novel algorithm for an automatic ROI placement technique. Its calculated index results were compared to those obtained from a manual ROIplacement in native space and from an existing atlas‐based ROI placement. Test–retest scans with varying head rotation were conducted for validation.ResultsSimulations showed that ALPS‐PAS was more robust toward head and fiber rotations than ALPS‐LAB. In vivo, ALPS‐PAS yielded a 10% higher index than ALPS‐LAB. The automated ROI placement led to a smaller difference in the DTI‐ALPS‐index between test and retest measurement compared to the manual ROI placement. Stability was enhanced with ALPS‐PAS for all ROI placements and varying head rotation.ConclusionUsing the principal components of the diffusion and automated ROI selection increased the measured DTI‐ALPS‐index, improved the robustness toward head and fiber orientations and eliminated the need for manual region selection.

What is this summary about?This is a summary of an article discussing the results of the TRAUMED trial, which was originally published in the Journal of Clinical Medicine. This trial studied how well Tr14 gel helped with ankle sprains compared with either a dummy treatment (placebo) or a common painkiller called diclofenac.What were the results of this trial, and what do they mean?The results of this trial showed that Tr14 was effective at reducing pain caused by an acute or sudden ankle sprain compared with placebo and worked just as well as diclofenac. The results also suggested that Tr14 led to faster pain relief and improved foot and ankle function compared with placebo and was at least as effective as diclofenac.Clinical Trial Registration:NCT06192420

BackgroundAdvances have been made in identifying biomarkers for atrial fibrillation (AF) outcomes.ObjectiveThe link between clinical determinants, especially AF burden, and blood biomarkers remains underexplored.MethodsWe conducted a cross-sectional analysis of AF patients scheduled for catheter ablation in the ISOLATION study (July 2020–May 2022, NCT04342312). Patient characteristics and blood samples were collected before ablation. AF burden was assessed using hand-held electrocardiograms (ECGs) over 4 weeks. Blood samples were analyzed for biomarkers, including bone morphogenetic protein 10 (BMP10), angiopoietin-2 (Ang-2), fibroblast growth factor 23 (FGF23), and others. We trained elastic net regression models to identify the most important clinical determinants out of 64 available clinical features.ResultsWe analyzed blood samples from 508 patients with a mean age of 63 ±9 years; 31.1% were female. Of these, 70% had paroxysmal AF and 30% persistent AF. Heart failure was present in 15% of patients. In 140 patients (28%), AF was observed during blood draw. AF burden before ablation was available in 389 patients. After multivariable analysis, the following clinical determinants were independently associated with biomarker levels: AF burden, AF during blood draw, age, heart failure, decreased kidney function, and female sex. Most notably, AF burden and AF rhythm at the time of sampling were strongly associated with various biomarker levels. Female sex was positively associated with BMP10 and FGF23, but negatively associated with high sensitive Troponin-T (hs-TNT).ConclusionsAF burden is a strong determinant of many biomarkers, underpinning their relevance as covariates in biomarker studies. Pro-fibrotic biomarkers are increased in female patients, whereas male patients more often show elevated biomarkers of myocardial injury.

Background: Echocardiographic evaluation of ventricular function is paramount in routine follow up of Fontan patients. Yet function of the single right ventricle (sRV) is mostly assessed semi-quantitively by eyeballing. We therefore evaluated whether total isovolumic time (t-IVT), a sensitive marker of left ventricular systolic-diastolic interaction that is easily computable only from the time intervals of the cardiac cycle from Doppler tracings, qualifies as a marker of sRV function.

A 7-year-old boy checked in at our pediatric clinic with persistent rhagades at the corners of the mouth and thickening of the gums and buccal mucosa (Figure 1a,b).He had already been treated elsewhere with acyclovir per os for one week on suspicion of a herpes infection, without improvement.In the laboratory, an iron deficiency anemia was noticed, which was successfully treated with iron(II) glycine sulfate complex 100 mg/day.Despite compensating the deficiency, the mucosal changes persisted.Our patient showed no other abnormalities besides increased fatigue and exhaustion.There were no B symptoms or gastrointestinal complaints.According to the mother, the boy's diet was balanced.Besides acute myeloid leukemia in the father there was no relevant family history.No other medication had been taken at this point.A bacteriological swab of the buccal mucosa showed moderate colonization with Staphylococcus aureus of the pharyngeal flora.Mycological testing was negative. DERMATOLOGIC AND PEDIATRIC FINDINGSOral findings: Clinical examination revealed an edema of the buccal mucosa.Mucosal polypoid fringe-like lesions were apparent on the upper gingiva.The inspection and