IntroductionThe chicken egg, with its in ovo compartments, is a widely used and popular animal model in experimental studies. This study aimed to quantify the volumes of the yolk/yolk sac, amniotic fluid, and chicken embryo in ovo using non-invasive ultra-high-field magnetic resonance imaging (UHF-MRI).Materials and methodsIn total, 64 chicken eggs were examined using a 7 T UHF-MRI scanner, acquiring T2-weighted anatomical images of the entire egg from developmental day 1 to 16 (D1-D16). Four eggs were scanned each developmental day, and the volumes of the yolk/yolk sac, amniotic fluid, and embryo were quantitatively assessed.ResultsUHF-MRI facilitated the in ovo quantitative assessment of the yolk/yolk sac starting from D1 and the embryo from D5 onward. The yolk/yolk sac volume increased from D1 to D6 before progressively decreasing until D14. The amniotic cavity could be detected on D6, with its fluid volume increasing steadily until D14. The embryo’s volume increased consistently throughout the developmental period, reaching its peak at D16.DiscussionUHF-MRI allows in vivo assessment of embryonic development, providing non-invasive, longitudinal insights into the volumes of the yolk/yolk sac, amniotic fluid, and chicken embryo. The investigation method described in this study may provide a standardized model for biomedical research in the developing chicken embryo, supporting various experimental applications.

Currently, the effect of prenatal ultrasound on foetal development is intensively discussed and the guidelines for prenatal diagnostics have been changed. However, data supporting these concerns are scarce. Therefore, we used an established in ovo model of the chicken embryo to investigate cell proliferation and apoptosis within the retina. A total of 21 chicken eggs were fenestrated on Day 5 and allocated to either the control (n = 8) or exposition group (n = 13). The exposition group was treated with pulsed-wave Doppler ultrasound (PWD) for 10 min while controls remained without treatment. After subsequent incubation (6-48 h), the eggs were sacrificed, and chicken embryos were examined morphologically (HE-staining) and immunohistochemically. Counting of apoptotic and proliferating cells per retina was performed using antibodies specific for phospho-histone-H3 and active caspase-3 in combination with a biotin-labelled secondary antibody and peroxidase conjugated avidin-biotin complex for chromogenic detection. Due to a rather low number of specimens at each time point after ultrasound exposition, we neglected the effects of incubation time and focused on treatment effects. This approach revealed that the median number of proliferating cells is reduced after 10 min of exposure to PWD (569 vs. 766), while the number of apoptotic cells is fairly comparable between groups (5 vs. 6). Our data contribute to a better understanding of prenatal US on foetal development by suggesting that PWD could have an impact on the number of proliferating cells in the developing chicken retina and therefore justify further investigations.

MR microscopy (MRM) is known as ultra-high-field (UHF) magnetic resonance imaging with an in-plane spatial resolution of <100 μm, yields highly resolved non-invasive anatomical imaging and allows longitudinal assessment of embryonic avian development. The aim of the present study was to evaluate the feasibility of in vivo anatomical MRI assessment of the developing upper extremity of the chicken. Thirty-eight fertilized chicken eggs were examined at 7 Tesla acquiring high-resolution T2-weighted images with an in-plane resolution of 74 × 74 μm. To reduce motion artefacts, the eggs were moderately cooled before and during MRI. Development of the upper extremity was anatomically and quantitatively assessed. Chondrification and ossification on MRI were correlated with histological examination. MRM allowed the identification of the embryo from stage D5 onwards. First chondrification of the upper extremity was visible at stage D7, and the differentiation of the forearm was possible from stage D9 throughout the developmental period with excellent correlation to histology. MRM also allowed the differentiation between cortical and medullary bone as well as the detection of chondrified areas. UHF MRM allows the in vivo and in ovo evaluation of the upper limb during embryonic development and provides non-invasive longitudinal anatomical information. This technique allows longitudinal studies of the same embryo during the developmental period and may therefore provide further insights into the development of the upper extremity. With improved coil technique and increasing availability of UHF MR systems, there is great potential regarding several research topics in experimental musculoskeletal radiology.

Zusammenfassung Hintergrund Der Morbus Dupuytren (MD) ist eine häufige Bindegewebserkrankung der Hand. Um ein Rezidiv nach Eingriff zu verhindern, erhalten die Patienten in der Regel eine frühzeitige postoperative Ergotherapie (ET). Der Einfluss dieser Maßnahme auf die Durchblutungssituation und damit auf das Auftreten oder Verhindern postoperativer Komplikationen ist jedoch nicht geklärt. Das Hyperspektralimaging (HSI) erlaubt die quantitative Beurteilung der Gewebsperfusion durch Messung der Sauerstoffsättigung und des Wassergehaltes des Gewebes. Ziel Evaluation der mikrozirkulatorischen Effekte der frühen postoperativen Ergotherapie nach partieller Fasziektomie bei MD mittels HSI zur Behandlungsoptimierung. Patienten und Methode Die Sauerstoffsättigung und der Wassergehalt des Gewebes der Hand wurden bei fünf Patienten vor und nach 20 Minuten standarisierter ET am ersten und zweiten postoperativen Tag mittels HSI evaluiert. Ergebnisse HSI zeigte eine qualitativ und quantitativ verbesserte Perfusion nach ET bei allen Patienten. Nach ET kam es zu einer Verbesserung der Sauerstoffsättigung um 20 % und zu einer Reduktion des Wassergehaltes um bis zu 17 %. Schlussfolgerung HSI erlaubt die schnelle und nicht-invasive Bestimmung einer verbesserten Sauerstoffversorgung und eines erniedrigten Wassergehaltes im Gewebe des OP-Gebietes bei Patienten nach partieller Fasziektomie bei MD als Folge der ET. Dies kann die Ursache für eine verbesserte Wundheilung und reduzierte Rezidivrate sein.

Ultrahigh-field MRI (UHF-MRI) with an in-plane spatial resolution of less than 100 μm is known as MR microscopy (MRM). MRM provides highly resolved anatomical images and allows quantitative assessment of different tissue types using diffusion-weighted imaging (DWI). The aim of the present study was to evaluate the feasibility of combined in vivo anatomical and quantitative assessment of the developing chicken eye in ovo.

The inhibition of microbial growth is the first step toward avoiding the formation of biofilms. Therefore, this study aimed to compare the microbiostatic activity of cold atmospheric pressure plasma (CAP) with three commonly used antiseptic agents to find an alternative to or supplementary concept for antiseptic treatment. The efficacy of two CAP generating devices − the plasma jet kINPen09 ® and a hollow dielectric barrier electrode (HDBD) − both working with argon with or without admixture of 1% oxygen, was compared with chlorhexidine digluconate (CHG 0.0001 and 0.00000625%), polyhexanide (PHMB 0.0001 and 0.000025%) and octenidine dihydrochloride (OCT 0.0002 and 0.00005%). The antiseptics were added to the planktonic stage of the biofilm‐forming strains Pseudomonas aeruginosa SG 81, Staphylococcus epidermidis RP 62A, Streptococcus mutans DSM 20523 and Candida albicans ATCC 10231 resp. SC 5314. The antiseptics were present during the subsequent cultivation period (32.5 h), whereas CAP was applied for only 60 s with the same cultivation period after the exposition. During the cultivation period, growth was measured every hour by optical density and analyzed with the calculated area under the curve (AUC) to determine the delay of exponential growth. Except for the higher resistance of C. albicans against PHMB and S. mutans against CHG, P. aeruginosa was the most resistant test organism against the other antiseptic treatments. OCT 0.0002% was the most effective among the tested antiseptic agents. The plasma jet did not differ from OCT in its efficacy against C. albicans and S. mutans . Against P. aeruginosa and both Candida strains, the plasma jet was more effective than against both Gram‐positive test strains. In terms of efficacy against Candida spp., the HDBD (dielectric barrier discharge plasma) did not differ significantly from the plasma jet with argon plasma; in contrast, the bacteriostatic efficacy was significantly higher. While the addition of 1% O 2 did not change the efficacy of the plasma jet, the efficacy of the HDBD against S. epidermidis increased significantly. The antimicrobial efficacy of CAP as demonstrated in earlier studies was confirmed with planktonic microorganisms showing delayed growth during cultivation for 32.5 h after a single application of CAP for 60 s. Short treatment with CAP could be an effective alternative or supplement to conventional antiseptics, for example, to inhibit the growth of microorganisms in an infected wound. OCT in the concentration used here showed the best microbial growth inhibitory results among the antiseptics.

Background Dupuytren's disease (DD) is a common connective tissue disorder of the hand. To prevent recurrence of contractures, patients usually receive early postoperative ergotherapy (ET). However, it is yet unknown how this measure impacts on local blood flow and hence on the occurrence or prevention of postoperative complications. Hyperspectral imaging (HSI) allows for a quantitative evaluation of tissue perfusion by measuring oxygen saturation and tissue water content. Objective The aim of this work was to evaluate the microcirculatory effects of early ET after partial fasciectomy in DD using HSI for optimised treatment and prevention. Patients and Methods In five patients, the oxygen saturation and tissue water content of the hand were measured before and 20 min after exercise therapy on the first two postoperative days using HSI. Results HSI demonstrated improved tissue perfusion in terms of quantity and quality following ET in all patients. After ET, all patients showed a relative increase in oxygen saturation of up to 20 % and a reduction in tissue water of up to 17 %. Conclusion HIS allows for a fast and non-invasive evaluation of increased oxygen supply and decreased tissue water content in the surgical site after partial fasciectomy in DD following postoperative exercise therapy. This may improve wound healing and decrease the rate of recurrence in DD.

Introduction: Ultra-high-field magnetic resonance imaging (UHF-MRI) with an in-plane spatial resolution < 100 μm is known as magnetic resonance microscopy (MRM). This technique provides high-resolution noninvasive anatomical images and allows longitudinal assessment of embryonic avian development. The aim of the present study was to evaluate the feasibility of in vivo anatomical MRI assessment of the developing upper extremity of the chicken in ovo.

STUDY DESIGN:We prospectively evaluated adjacent disc levels after anterior cervical discectomy and arthroplasty (ACDA) using kinematic magnetic resonance imaging (MRI) and plain functional radiographs. OBJECTIVE:ACDA is an established treatment for degenerative cervical disc disease. The objective of this study was to evaluate the use of kinematic MRI for assessing the range of motion (ROM) before and after ACDA compared with plain functional radiographs and to evaluate adjacent degenerative disc disease (aDDD) at mid-term follow-up. SUMMARY OF BACKGROUND DATA:Twenty patients (12 females, 8 males; median age 45.6 ± 6.9 yrs) treated by ACDA (BryanDisc; Medtronic, MN) underwent plain functional radiography and kinematic MRI of the cervical spine at 3 T before and 6 and 24 months after surgery. METHODS:A sagittal T2-weighted (T2w) 2D turbo spin echo (TSE) sequence and a 3D T2w dataset with secondary axial reconstruction were acquired. Signal intensity of all nonoperated discs was measured in regions of interest (ROI). Disc heights adjacent to the operated segment were measured. ROM was evaluated and compared with plain functional radiographs. Clinical outcome was evaluated using the visual analog scale (VAS) for head, neck and radicular pain, and the neck disability index (NDI). RESULTS:Mean ROM of the cervical spine on functional plain radiographs was 21.25 ± 8.19°, 22.29 ± 4.82°, and 26.0 ± 6.9° preoperatively and at 6-month and 24-month follow-up, respectively. Mean ROM at MRI was 27.1 ± 6.78°, 29.45 ± 9.51°, and 31.95 ± 9.58°, respectively. There was a good correlation between both techniques. Follow-up examinations demonstrated no signs of progressive degenerative disc disease of adjacent levels. All patients had clinical improvement up to 24 months after surgery. CONCLUSION:After ACDA, kinematic MRI allows evaluation of the ROM with excellent correlation to plain functional radiographs. Mid-term follow-up after ACDA is without evidence of progressive DDD of adjacent segments. LEVEL OF EVIDENCE:3.

Monitoring of perfusion is a cornerstone in surgery, phlebology and basic science to proof wound healing by interventions. In chronic wound management it is of utmost importance to realize and parametrize wound bed perfusion to verify actual, and plan further treatment by noninvasive diagnostics. Up to now monitoring is based on visual inspection of wounds as conventionally practiced over more than decades. The main problems of visual inspection are the lack of standardization and comparability because of interindividual variations. Therefore technical performance with contact free probes based on standardized perfusion measuring is strongly needed. Hyperspectral imaging (HSI) was investigated to overcome manual and visual wound inspection in monitoring of wound healing. HSI works noninvasive, and imaging of relevant perfusion parameters is possible without the need of contrast enhancing drugs.METHODS:HSI technology uses imaging spectroscopic analysis in visual and near infrared spectrum to get information on imaged tissue in less than 10 s. Tissue is radiated by broad spectrum light and the following parameters are calculated from remitted spectra: the grade of oxygenation and the volume proportion of hemoglobin (in superficial and also deeper (8 mm) tissues. The calculated data comprise the "Tissue hemoglobin oxygen saturation" (StO2) as percental oxygenation index to assess superficial perfusion (VIS-spectrum), the "Near infrared perfusion" (NIR) to assess deeper perfusion (near infrared spectrum) and the "Tissue hemoglobin index" (THI) to measure the percental volume of hemoglobin of surface perfusion (VIS-spectrum). The measurements of these parameters are calculated as false color-coded perfusion results on screen.We investigated different kind of wounds (combustion, infection, ulcer wounds, wounds in immune disorders, trauma wounds) determining superficial and deeper oxygen saturation, hemoglobin distribution and water content using hyperspectral imaging with TIVITA™ Tissue system.RESULTS:Hyperspectral Imaging allowed easy real time determination and visualization of hemodynamically relevant parameters- superficial and deeper oxygen saturation, total hemoglobin and tissue water content. In the patient with scleroderma, acral lesions with decreased perfusion correlated well with necrotic skin aspects.HSI clearly revealed macroscopic conspicuous suture wounds after Dupuytren surgery, infected soft tissue wounds with strong inflammatory hyperemia, edema in burn injuries, spatial geometry of abscess formation and chronic ulcer wounds. All measurements influenced further surveillance decisions. Hyperspectral imaging seems suitable for routine diagnostics and monitoring of skin and soft tissue lesions like acute and chronic wounds. It allows surveillance of postoperative suture wounds and burn wounds. Special indications may be transplant surveillance and monitoring of therapeutical interventions.

Current knowledge of the human fetal and embryonic development relies on early descriptive studies of humans and from experimental studies of laboratory animals and embryos. Taking the upper extremity as an example, this study explores the potential of magnetic resonance microscopy (MRM) for the assessment of the development of the fetal upper extremity and discusses its correlation with histological findings.

Pisotriquetral osteoarthritis is important to consider in the differential diagnosis of chronic ulnar-sided wrist pain. It can develop following traumatic injury to the pisiform or in rheumatic diseases, such as rheumatoid arthritis or psoriatic arthritis. It has been shown that pisiformectomy can relieve symptoms in cases that have not responded to nonoperative treatment, and the excision does not compromise the function or strength of the wrist. Most studies focus on posttraumatic causes of pisotriquetral osteoarthritis. In the current study, rheumatic causes are also considered and the outcomes are compared. This retrospective study included 35 patients who underwent pisiformectomy for pisotriquetral osteoarthritis. All patients underwent a thorough diagnostic evaluation to exclude other etiologies for ulnar-sided wrist pain. Radiological examinations including posteroanterior and lateral views of the wrist and a tangential view of the pisotriquetral joint were analyzed. All patients had excellent or very good results after pisiformectomy, with a significant reduction in pain. No significant difference was found in the outcomes for patients with rheumatic vs posttraumatic osteoarthritis. Patients with rheumatic causes of pisotriquetral osteoarthritis can be successfully treated with pisiformectomy. With respect to idiopathic causes, these patients need a longer postoperative period to gain full pain relief. It is important to consider the possibility of pisotriquetral osteoarthritis after excluding other diagnoses in patients with rheumatic osteoarthritis.

Purpose The wrist is involved early in rheumatoid arthritis and is often severely affected. A stable wrist is crucial to good hand function, which often necessitates a fusion. One of the most commonly used techniques in rheumatoid patients is the Mannerfelt arthrodesis. In this retrospective study the outcome and the patient’s subjective satisfaction are presented and compared to other techniques. Also the influence of the position of the wrist following a fusion procedure is analysed. Methods Thirty-four wrists were retrospectively analysed using radiological measurements, functional scores such as the Disabilities of the Arm, Shoulder and Hand (DASH) and a pain assessment. The objective function of the hand with the fused wrist was assessed. Results In 92.6 % of wrists the patients rated their satisfaction as good or excellent. The mean DASH score post-operatively was 63.3. Of the wrists, 17 were fixed in a median flexed position of 13° and 17 wrists in a median extended position of 8°. There was no statistically significant correlation between the position of the wrist and the satisfaction or objective function. The rate of fusion was 94.1 %. Conclusions The Mannerfelt arthrodesis achieves good results and provides a high rate of satisfaction and pain relief in our study. It has major advantages compared to other wrist fusion techniques in the rheumatoid patient. We could not show clear statistical evidence for better results in either a flexed or an extended position, but the ratings of the patients indicated better subjective results with a slightly extended position of the arthrodesis.

Acute inversion injuries of the ankle are the most common sports accidents, accounting for approximately 10% of emergency room admissions. In up to 85%, an injury of the lateral collateral ligaments is observed. Classically, the assessment of these injuries has relied on clinical examination and radiographs, including stress views. The aim of our study was to correlate prospectively the findings of high-field 3 T MRI in acute ankle distortion with clinical outcome.

Background: Primary ovarian fibrosarcomas are very rare tumours associated with an extremely poor prognosis. Most patients relapse or die within 2 years. Because of the low incidence, it is difficult to identify prognostic factors or to establish treatment guidelines. Case Report: In this report, we present a patient with the second relapse of an ovarian fibrosarcoma localised in the rectosigmoid. The tumour caused intussusception into the rectum, leading to large bowel obstruction. After complete resection of the tumour, the patient completely recovered. 28 months after primary diagnosis, follow-up did not show any signs of recurrent tumour disease. Conclusions: Reviewing the literature, it is recommended that all patients should primarily be operated on and generally be followed up closely. In patients with incomplete resection, palliative chemo- and/or radiotherapy is recommended. In our opinion, in patients with complete resection, adjuvant chemo- and/or radiotherapy should be considered. Only in patients with high-grade fibrosarcomas, adjuvant intra- or postoperative radiotherapy should be applied.

Background. The use of sterile gloves is part of general aseptic procedure, which aims to prevent surgical team members from transmitting infectious agents to patients during procedures performed in an operating room. In addition, surgical gloves also protect team members against patient-transmitted infectious agents. Adequate protection, however, requires that the glove material remain intact. The risk of perforations in surgical gloves is thought to correlate with the duration of wear, yet very few prospective studies have addressed this issue. Methods. We prospectively collected 898 consecutive pairs of used surgical gloves over a 9-month period in a single institution. After surgical team members wore the gloves during surgical procedures, the gloves were examined for microperforations using the watertight test described in European Norm 455, part 1. The gloves were analyzed as a pair; if 1 glove had a perforation, the pair was considered to be perforated. In addition, we evaluated the use of a hand cream that contained a suspension of cornstarch and ethanol to determine its potential influence on the rate of microperforation. Results. Wearing gloves for 90 minutes or less resulted in microperforations in 46 (15.4%) of 299 pairs of gloves, whereas wearing gloves for 91-150 minutes resulted in perforation of 54 (18.1%) of 299 pairs, and 71 of (23.7%) of 300 pairs were perforated when the duration of wear was longer than 150 minutes (P = .05). Subgroup analysis revealed no significant difference in the rates of microperforation for surgeons (56 [23.0%] of 244 pairs of gloves perforated), first assistants (43 [19.0%] of 226 pairs perforated), and surgical nurses (53 [20.5%] of 259 pairs perforated). Of 171 microperforations, 114 (66.7%) were found on the left hand glove (ie, the glove on subjects' nondominant hand), predominantly on the left index finger (55 [32.3%]). The use of the hand cream had no influence on the rate of microperforation. Conclusion. Because of the increase in the rate of microperforation over time, it is recommended that surgeons, first assistants, and surgical nurses directly assisting in the operating field change gloves after 90 minutes of surgery.

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