Real-time Ultrasound Measurements Research Articles

Tissue Contraction With Helium-Based Plasma Radiofrequency Technology: A Preliminary Report of Initial Ultrasound Findings

Abstract Background Application of helium-based plasma radiofrequency (RF; Renuvion, Apyx Medical, Clearwater, Florida, USA) in the subcutaneous plane results in tissue coagulation and contraction. While traditionally, impact of thermal devices on skin laxity is assessed by measuring changes in skin surface area, this indirect measure does not permit intraoperative assessment or differentiation of effects from various treatments. Objectives To determine the amount of soft tissue contraction achieved by multiple passes of helium plasma RF energy to the subcutaneous connective tissues following power-assisted liposuction (PAL). Methods In this single-center study, 4 subjects were assessed using real-time ultrasound measurements at baseline and following both PAL and each pass with helium plasma RF. Results Based on changes in the distance from the skin (dermal basement membrane) to Scarpa’s fascia, PAL produced an average reduction of 36.7% (SD 14.6, range 24.7%-58.6%) due to the fat removal. Contraction observed with helium plasma RF was greatest for the first pass, with a mean decrease of 27.0% (SD 19.6, range 4.5%-52.1%) in distance relative to distance measured following liposuction. Subsequent passes resulted in additional incremental contraction relative to prior treatment pass: 17.0% (5.1) for pass 2, 7.7% (17.5) for pass 3, and 7.1% (5.5) for pass 4. Overall, helium plasma RF resulted in an average contraction of 44.0% (SD 17.2, range 27.1%-59.4%) in the skin-to-Scarpa-fascia measurement. Conclusions Helium plasma RF improved tissue contraction following PAL by an average of 44% and data suggest that the greatest increase in tissue contraction is obtained by the first treatment pass.

Use of real-time ultrasound measurements of fat thickness and longissimus thoracis muscle characteristics for predicting body fat depots in crossbred hair ewes

This study aimed to predict body fat depots using ultrasound measurements (USM) of fat thickness and longissimus thoracis muscle characteristics in crossbred hair ewes. A total of 24 animals with a mean body weight (BW) of 37 ± 4kg and a body condition score of 2.39 ± 0.49 were used. USM was recorded 24h before slaughter and included: subcutaneous fat thickness (SFT), area (LTMA), amplitude (LTA), and depth (LTD) of the l. thoracis muscle and kidney fat thickness (µKFT). After slaughter, the internal fat (IF) was separated, classified, and weighed as mesenteric (MF), omental (OF), or pelvic fat (PF). The left half was then separated into subcutaneous and intermuscular fat (CF), and the muscle and bone tissues were weighed separately and adjusted to take account of the whole animal. Total body fat (TBF) was determined to be the IF plus the CF weights. LTA and LTMA correlated poorly to moderately with fat depots (0.37 ≤ r ≤ 0.74, P < 0.05). Other than CF, µKFT showed poor to moderate correlation with the other depots of body fat (0.44 ≤ r ≤ 0.75, P < 0.05). The regression model used to predict MF had r2 of 0.87 (RSD=0.14kg) and included BW and LTMA (P<0,05). OF and PF were predicted with r2 of 0.55 and 0.44, respectively, including µKFT (RSD = 0.20 and 0.17kg). IF was predicted by empty BW, LTMA, and µKFT with r2 as 0.81 (RSD=0.30kg). For TBF, EBW and LTMA explained 72% of its variation (RSD= 0.59kg). USM of fat thickness and l. thoracis muscle characteristics can improve the accuracy of predicting body energy reserves in crossbred hair ewes.

Using fat thickness and longissimus thoracis traits real-time ultrasound measurements in Black Belly ewe lambs to predict carcass tissue composition through multiresponse multivariate adaptive regression splines algorithm

The main idea of the current study was to estimate carcass tissue composition using fat thickness and longissimus thoracis (LT) traits real-time ultrasound measurements (USM) in Black Belly ewe lambs through multiresponse multivariate adaptive regression splines (MARS) algorithms. Twenty-four hours before slaughter, subcutaneous (SFT) and kidney-fat thickness (KFT), LT depth (LTD), width (LTA, cm) and area (LTMA) were measured in 60 lambs (BW of 26.40 ± 7.01 kg). Information on carcass and non-carcass components was recorded after slaughter. The total carcass muscle (TCM), total carcass bone (TCB), and total carcass fat (TCF) had a low to high correlation (P < 0.01) with BW, cold carcass weight (CCW), and LTD, SFT, KFT, and LDMA. The CCW (%65.58) and SFT (%16.70) were the most effective variables, whilst LTD (%9.57) and LTMA (%8.15) were the lowest variables for determining TCB, TCM, and TCF. The multiresponse MARS algorithm provides an accurate and efficient means of estimating TCF, TCB, and TCM.

Pelvic Floor Muscle Training and Erectile Dysfunction in Radical Prostatectomy: A Randomized Controlled Trial Investigating a Non-Invasive Addition to Penile Rehabilitation.

IntroductionPelvic floor muscle (PFM) training for postprostatectomy incontinence is considered a first line approach to rehabilitation, but PFM training for erectile dysfunction (ED) after surgery is less well known. With more than 1.4 million new cases diagnosed globally per year, there is a need for non-invasive options to assist sexual dysfunction recovery.AimCommencing preoperatively and using both fast and slow twitch fibre training performed in standing postures, new protocols were developed to address clinical presentations with aims to reduce ED and impact on quality of life (QoL). Comparisons with “usual care” PFM training, prerehabilitation and postrehabilitation were then assessed.MethodsA randomised controlled trial of 97 men undergoing radical prostatectomy (RP) were allocated to either a control group (n = 47) performing “usual care” of 3 sets/d PFMT or an intervention group (n = 50), performing 6 sets/d in standing, commencing 5 weeks before RP.Outcome measuresParticipants were assessed preoperatively and at 2, 6, and 12 weeks after RP using the Expanded Prostate Cancer Index Composite for Clinical Practice, International Index of Erectile Function-5, and real time ultrasound measurements of PFM function.ResultsAt all time points, there was a significant difference (P< 0.05) between groups; however, the only time point where this difference was clinically relevant was at 2 weeks after RP, with the intervention group reporting less distress in the Expanded Prostate Cancer Index Composite for Clinical Practice QoL outcome. Secondary measures of EPIC-EF and real time ultrasound PFM function tests demonstrated improvement over all time points in both groups with lower bothersome scores in the intervention group.ConclusionsEarly PFM training reduces early QoL impact for postprostatectomy ED, with faster return to continence enabling earlier commencement of penile rehabilitation. While our 12-week protocol and sample size was not powerful enough to demonstrate conclusive benefits of early PFM training for ED, PFM intervention after RP over longer times has been supported by others.Milios JE, Ackland TR, Green DJ. Pelvic Floor Muscle Training and Erectile Dysfunction in Radical Prostatectomy: A Randomized Controlled Trial Investigating a Non-Invasive Addition to Penile Rehabilitation. J Sex Med 2020;8:414–421.

Using real-time ultrasound for in vivo assessment of carcass and internal adipose depots of dairy sheep

AbstractFifty-one Churra da Terra Quente ewes (4–7 years old) were used to analyse the potential of real-time ultrasound (RTU) to predict the amount of internal adipose depots, in addition to carcass fat (CF). The prediction models were developed from live weight (LW) and RTU measurements taken at eight different locations. After correlation and multiple linear regression analysis, the prediction models were evaluated by k-fold cross-validation and through the ratio of prediction to deviation (RPD). All prediction models included at least one RTU measurement as an independent variable. Prediction models for the absolute weight of the different adipose depots showed higher accuracy than prediction models for fat content per kg of LW. The former showed to be very good or excellent (2.4 ⩽ RPD ⩽ 3.8) for all adipose depots except mesenteric fat (MesF) and thoracic fat, with the model for MesF still providing useful information (RPD = 1.8). Prediction models for fat content per kg of LW were also very good or excellent for subcutaneous fat, intermuscular fat, CF and body fat (2.6 ⩽ RPD ⩽ 3.2), while the best prediction models for omental fat, kidney knob, channel fat and internal fat still provided useful information. Despite some loss in the accuracy of the estimates obtained, there was a similar pattern in terms of RPD for models developed from LW and RTU measurements taken just at the level of the 11th thoracic vertebra. In vivo RTU measurements showed the potential to monitor changes in ewe internal fat reserves as well as in CF.

Ultrasound imaging of dorsal neck muscles with speckle tracking analyses \u2013 the relationship between muscle deformation and force

The development of methods of non-invasive measurement of neck muscle function remains a priority in the clinical sciences. In this study, dorsal neck muscle deformation vs time curves (deformation area) were evaluated against incremental force, recorded from non-invasive real-time ultrasound measurement. The results revealed subject-specific moderate to strong linear or non-linear relationships between deformation and force. Test-retest variability showed strong reliability for all five neck muscles summed together and fair to good reliability for the five muscles evaluated separately. Multivariate statistics were used to analyse the interactions between the dorsal neck muscles during different percentages of maximal voluntary contraction (MVC). Low force (10–20% MVC) was related to muscle shortening; higher force (40–80% MVC) showed combination of shortening and elongation deformation in the muscle interactions. The muscle interactions during isometric MVC test were subject-specific, with different combinations and deformations of the five neck muscles. Force ≥40% MVC were associated with a forward movement of the cervical spine that affected the ultrasound measurement of the dorsal neck muscles. Ultrasound with speckle-tracking analyses may be best used to detect low levels (<40% MVC) of neck muscle activity.

Genetic parameters for carcass and ultrasound traits in Hereford and admixed Simmental beef cattle: Accuracy of evaluating carcass traits.

Genetic parameters are required to evaluate carcass merit using correlated real-time ultrasound (RTU) measurements. Many registered bulls and heifers are measured using RTU before consideration for selection as parents, whereas few animals are recorded for carcass traits and those are often crossbred steers. The objective of this study was to estimate genetic parameters required for evaluating carcass merit in the American Hereford Association (AHA) and the American Simmental Association (ASA) using multivariate models and to assess accuracy of carcass trait estimated breeding values (EBV) for selection candidates. All available carcass data including carcass weight (CWT), fat thickness (FAT), longissimus muscle area (LMA), and marbling score (MRB) were provided by the AHA and the ASA along with RTU data including fat thickness (UFAT), longissimus muscle area (ULMA), and percentage of intramuscular fat (UIMF). Carcass data comprised 6,054 AHA and 9,056 ASA cattle, while RTU data in comparable numbers from close relatives comprised 6,074 AHA and 7,753 ASA cattle. Pedigrees included 33,226 AHA and 37,665 ASA animals. Fixed effects for carcass and RTU data included contemporary group, age at scan/slaughter, and major breed percentages. Restricted maximum likelihood procedures were applied to all the carcass and RTU measurements, along with birth weight to account for selection, fitting 8-trait multivariate models separately for each breed association. Heritability estimates for AHA and ASA carcass traits were 0.41 ± 0.04 and 0.25 ± 0.03 for FAT, 0.47 ± 0.04 and 0.32 ± 0.03 for LMA, 0.48 ± 0.04 and 0.43 ± 0.04 for MRB, 0.51 ± 0.04 and 0.34 ± 0.03 for CWT, and for RTU traits were 0.29 ± 0.04 and 0.37 ± 0.03 for UFAT, 0.31 ± 0.04 and 0.44 ± 0.03 for ULMA, and 0.45 ± 0.04 and 0.42 ± 0.03 for UIMF. Genetic correlations for AHA and ASA analyses between FAT and UFAT were 0.74 ± 0.08 and 0.28 ± 0.13, between LMA and ULMA were 0.81 ± 0.07 and 0.57 ± 0.10, and between MRB and UIMF were 0.54 ± 0.08 and 0.73 ± 0.07. Predictions of carcass merit using RTU measurements in Hereford cattle would be more reliable for FAT and LMA than MRB, but the reverse would be true for admixed Simmental cattle. Genetic correlations for MRB in AHA and for FAT and LMA in ASA are less than currently assumed in their national evaluations. Collection of greater numbers of carcass measurements would improve the accuracy of genetic evaluations for carcass traits in both breeds.

Immediate Changes in Resting and Contracted Thickness of Transversus Abdominis After Dry Needling of Lumbar Multifidus in Healthy Participants: A Randomized Controlled Crossover Trial

ObjectiveThe purpose of this study was to investigate changes in resting and/or contraction thickness of the transversus abdominis (TrA) muscle after dry needling (DN) of the lumbar multifidus (LM) in asymptomatic participants. MethodsA randomized controlled laboratory trial with crossover design was performed. Forty-seven healthy individuals who had not experienced low back pain in the previous 6 months were randomly assigned to receive DN to the LM or a sham-DN intervention. Participants received both interventions separated at least 7 days apart. They were instructed on how to perform a concentric contraction of TrA. Resting and contraction thicknesses of the TrA were obtained through real-time ultrasound measurements before and immediately after each intervention by an assessor blinded to the intervention received. Data from 4 individuals had to be excluded because of poor image quality. ResultsTwo-way analysis of variance revealed a significant contraction with treatment interaction (F[1,42] = 11.489; P = .002). Simple main effects using paired-samples t tests and a Bonferroni post hoc analysis revealed differences in contracted states of the TrA for DN vs sham-DN (P = .009) and between contracted and resting states for the DN group (P = .001): after DN, TrA thickness at rest exhibited a mean decrease of 0.03 cm and a mean increase of 0.05 cm during contraction. ConclusionThis study suggests that application of DN to LM was accompanied by a decreased resting thickness and an increased contraction thickness of the TrA in asymptomatic participants.

Comparative effects of 12 weeks of equipment based and mat Pilates in patients with Chronic Low Back Pain on pain, function and transversus abdominis activation. A randomized controlled trial

BackgroundPilates method has been recommended for patients with chronic low back pain (CLBP) and the activation of transversus abdominis has been deemed to play an important role in the improvement of these patients. Nevertheless, the evidence of the activation of TrA in Pilates practitioners remains unclear. ObjectiveTo assess the effectiveness of 12 weeks of Pilates practice in disability, pain, kinesiophobia and transversus abdominis activation in patients with chronic nonspecific Low Back Pain. DesignA randomized controlled trial was carried out. MethodsA single-blind randomized controlled trial with repeated measures at 6 and 12 weeks was carried out. A total of ninety eight patients with low back pain were included and randomly allocated to a Pilates Mat group (PMG) equipment based with apparatus Pilates (PAG) or control group (CG). Roland Morris Disability Questionnaire (RMDQ), visual analog scale (VAS) Tampa Scale of Kinesiophobia (TSK), and transversus abdominis (TrA) activation assessed by real time ultrasound measurement (US) were assessed as outcome measures. ResultsImprovement were observed in both intervention groups in all the included variables at 6 and 12 weeks (p<0.001). Faster enhancement was observed in the equipment based Pilates group (p=0.007). ConclusionsEquipment based and mat Pilates modalities are both effective in the improvement of TaA activation in patients with CLBP with associate improvement on pain, function and kinesiophobia. Significant differences were observed after 12 weeks of intervention in PMG and PAG with faster improvement in PAG suggesting that, feedback provided by equipment could help in the interiorization of Pilates principles.

1676 The relationship between body condition score and body weight, body linear measurements and real-time ultrasound body composition measurements in Alpine does before breeding and kidding

1676 The relationship between body condition score and body weight, body linear measurements and real-time ultrasound body composition measurements in Alpine does before breeding and kidding

Do isometric pull-down exercises increase the acromio-humeral distance?

ObjectivesTo evaluate the effect of isometric shoulder extension in 90° shoulder flexion on the acromio-humeral distance, to establish the force required to achieve a clinically important increase in the acromio-humeral distance, and to investigate the practicality and reliability of real-time ultrasound measurement of the acromio-humeral distance in 90° shoulder forward flexion. DesignProspective single-group intervention. SettingKing's College London, Guy's Campus. ParticipantsTwenty healthy volunteers [five males and 15 females (40 shoulders)] with a mean age of 32 (standard deviation 10, range 19 to 55) years were recruited from the faculty and staff at King's College London. InterventionsThe acromio-humeral distance in asymptomatic participants was measured using real-time ultrasound in the neutral position at rest, at 90° shoulder flexion at rest, and while performing an isometric pull-down exercise at 100%, 50%, 30% and 10% maximal voluntary isometric contraction. Main outcome measuresReal-time ultrasound measures of the acromio-humeral distance. ResultsOf the 20 participants, 38 shoulders were imaged. In 90° shoulder flexion, pull-down exercises at all levels of force increased the acromio-humeral distance compared with no pull-down (P<0.05), but this was only clinically significant in males. Measures had excellent short-term intra-operator reliability. ConclusionsIsometric pull-down exercises lead to an increase in the acromio-humeral distance in asymptomatic males that may be clinically important, and therefore may be an appropriate exercise for patients with shoulder pathology. Ultrasound measurement of the acromio-humeral distance in 90° shoulder flexion is practical and reliable.

The effect of supplementing rumen undegradable unsaturated fatty acids on marbling in early-weaned steers.

The objective of this study was to determine if supplementation with a rumen undegradable unsaturated fatty acids (FA) source improved marbling deposition in early-weaned steers. All steers (Angus, = 23; Angus × Hereford, = 24) were weaned at 150 ± 5 d of age. Steers were blocked by BW and breed and then randomly assigned to either control (CON; average 1.5 kg of corn gluten feed [CGF], = 23) or isocaloric supplementation containing a rumen undegradable fat source (RUF; 200 g of Megalac-R added to an average of 1.06 kg of CGF, = 24) offered 5 d/wk for 110 d. All steers had ad libitum access to pastures throughout treatment and received supplements individually. Steer BW and blood samples were collected at 0, 55, and 110 d of supplementation, and real-time ultrasound measurements were collected at d 110. Following treatment, steers were transported to Oklahoma State University for finishing and subsequent harvesting at a commercial plant. All data were analyzed using the PROC MIXED procedure of SAS either as repeated measures or ANOVA depending on parameters. There were no significant changes in BW from the beginning of treatment to harvest due to treatment. Ultrasound data showed that RUF steers tended ( = 0.08) to have more i.m. fat than CON at d 110. Serum concentrations of FA showed a treatment × day interaction ( < 0.02) for 16:0, 18:0, 18:1-9, 18:2, 20:4, and total FA. These specific FA concentrations slightly increased in CON steers, but there was a more pronounced increase in the concentration of these FA across the supplementation period in RUF steers. Serum triglyceride and cholesterol concentrations were increased ( < 0.01) on d 55 and 110 in RUF steers compared with those in CON steers. Serum leptin concentration in RUF steers was greater ( < 0.01) than CON steers at d 110. After harvest, RUF carcasses had greater ( = 0.01) marbling scores than those of CON carcasses. All other carcass measures were similar between treatments. The percentage of total lipids was increased ( = 0.011) in steaks from RUF compared to CON. There was a decrease ( < 0.05) in adipocyte diameter in i.m. fat depot of RUF steers compared to CON. There was also a tendency ( = 0.06) for RUF steers to have a greater percentage of 20 to 30 μm adipocytes in their i.m. depot than CON steers. This study indicates that supplementation of unsaturated FA can positively impact marbling deposition in early-weaned steers without impacting other carcass measures.

Comparison of real-time ultrasound measurements for body composition traits to carcass and camera data in feedlot steers

The objective of this experiment was to compare measurements of real-time ultrasound (RTU), carcass and camera data used to determine body composition in feedlot steers (n = 69). Measurements of RTU were taken 24 h before slaughter. The RTU-measured traits consisted of twelfth and thirteenth rib back fat thickness, twelfth and thirteenth LM area, and marbling score (uMARB). Intramuscular fat was converted to uMARB by the equation uMARB = {[769.7 + (56.69 × uIMF)]/100} − 5. Overall means for 48-h chill carcass data were twelfth and thirteenth rib back fat thickness, twelfth and thirteenth LM area, and marbling score (cMARB). Marbling scores were converted to a numeric cMARB (Slight00 = 4, Small00 = 5, and Modest00 = 6). Carcass camera data consisted of twelfth and thirteenth rib back fat thickness, twelfth and thirteenth LM area, and marbling score. Data were analyzed using the PROC REG, MEANS, and CORR procedures of SAS. Results show that all 3 methods were highly correlated to each other. Correlations ranged from 0.79 to 0.82, 0.68 to 0.95, and 0.57 to 0.87 for back fat, LM area, and marbling score, respectively. Carcass back fat and twelfth and thirteenth rib back fat thickness were over-predicted by RTU (0.06 and 0.07 cm, respectively); however, LM area was under-predicted by RTU when compared with carcass and camera twelfth and thirteenth LM area (−0.78 and −1.13 cm2, respectively). Camera marbling score was over-predicted by uMARB (0.17) and cMARB was under-predicted (−0.32). These results indicate that RTU can be used to predict carcass traits before slaughter. Also, linear measurements of carcass traits can be more accurately predicted when compared with a nonlinear measurement.

Does Adding Milk to Tea Delay Gastric Emptying?

Hillyard, S.*†; Cowman, S.†; Ramasundaram, R.†; Seed, P. T.‡; G., O’Sullivan† Author Information

Ultrasound-Guided Nerve Blocks – Is Documentation and Education Feasible Using Only Text and Pictures?

PurposeWith the advancement of ultrasound-guidance for peripheral nerve blocks, still pictures from representative ultrasonograms are increasingly used for clinical procedure documentation of the procedure and for educational purposes in textbook materials. However, little is actually known about the clinical and educational usefulness of these still pictures, in particular how well nerve structures can be identified compared to real-time ultrasound examination. We aimed to quantify gross visibility or ultrastructure using still picture sonograms compared to real time ultrasound for trainees and experts, for large or small nerves, and discuss the clinical or educational relevance of these findings.Materials and MethodsWe undertook a clinical study to quantify the maximal gross visibility or ultrastructure of seven peripheral nerves identified by either real time ultrasound (clinical cohort, n = 635) or by still picture ultrasonograms (clinical cohort, n = 112). In addition, we undertook a study on test subjects (n = 4) to quantify interobserver variations and potential bias among expert and trainee observers.ResultsWhen comparing real time ultrasound and interpretation of still picture sonograms, gross identification of large nerves was reduced by 15% and 40% by expert and trainee observers, respectively, while gross identification of small nerves was reduced by 29% and 66%. Identification of within-nerve ultrastructure was even less. For all nerve sizes, trainees were unable to identify any anatomical structure in 24 to 34%, while experts were unable to identify anything in 9 to 10%.ConclusionExhaustive ultrasonography experience and real time ultrasound measurements seem to be keystones in obtaining optimal nerve identification. In contrast the use of still pictures appears to be insufficient for documentation as well as educational purposes. Alternatives such as video clips or enhanced picture technology are encouraged instead of still pictures extracted from basic ultrasonograms.

Estimation of Genetic Parameters for Real-time Ultrasound Measurements for Hanwoo Cows at Different Ages and Pregnancy Status.

The purpose of this study was to estimate genetic parameters of ultrasound measurements for longissimus dorsi muscle area (LMA), backfat thickness (BFT), and marbling score (MS) in Hanwoo cows (N = 3,062) at the ages between 18 and 42 months. Data were collected from 100 Hanwoo breeding farms in Gyeongbuk province, Korea, in 2007 and 2008. The cows were classified into four different age groups, i.e. 18 to 22 months (the first pregnancy period), 23 to 27 (the first parturition), 28 to 32 (the second pregnancy), and 33 to 42 (the second parturition), respectively. For each age group, a multi-trait animal model was used to estimate variance components and heritabilities of the three traits. The averages of LMA, BFT, and MS measurements across the cows of all age groups were 50.1 cm2, 4.62 mm, and 3.04, respectively and heritability estimates were 0.09, 0.10, and 0.08 for the respective traits. However, when the data were analyzed in different age groups, heritability estimates of LMA and BFT were 0.24 and 0.47, respectively, for the cows of 18 to 22 months of age, and 0.21 for MS in the 28 to 32 months old cows. When the cows of all age groups were used, the estimates of genetic (phenotypic) correlations were 0.43 (0.35), −0.06 (0.34) and 0.21 (0.32) between LMA and BFT, LMA and MS, and BFT and MS, respectively. However, in the cow age group between 28 and 32 (18 and 22) months, the estimates of genetic (phenotypic) correlations were 0.05 (0.29), −0.15 (0.24) and 0.38 (0.24), for the respective pairs of traits. These results suggest that genetic, environmental, and phenotypic variations differ depending on cow age, such that care must be taken when ultrasound measurements are applied to selection of cows for meat quality.

Erratum to: Reliability of real-time ultrasound measurement of transversus abdominis thickness in healthy trained subjects

Erratum to: Reliability of real-time ultrasound measurement of transversus abdominis thickness in healthy trained subjects

Does adding milk to tea delay gastric emptying?

BackgroundMany preoperative fasting guidelines suggest that hot tea or coffee with milk added should be considered similar to solid food, allowing an interval of 6 h before commencing anaesthesia. There is little evidence to support these instructions, with recent guidelines undecided on the issue. This study aimed to establish whether there was a clinically significant delay in gastric emptying associated with adding a modest amount of milk to tea. MethodsThis randomized controlled crossover study was conducted in 10 healthy volunteers. The paracetamol absorption technique and real-time ultrasound measurement of the cross-sectional area of the gastric antrum were used to assess gastric emptying after ingestion of 300 ml of black tea or 300 ml of tea with milk (250 ml black tea plus 50 ml of full fat milk). ResultsThe mean difference in the time to reach the peak paracetamol concentration (tmax) was −8 min [95% confidence interval (CI) −23.1 to 7] in favour of tea with milk. Ultrasound assessment indicated that the geometric mean of the half-time to gastric emptying (T1/2) after tea without milk was 22.7 (95% CI 12.7–40.9) min and after tea with milk 23.6 (95% CI 13.5–41.0) min (ratio 1.04) (95% CI 0.47–2.29). ConclusionsThis study demonstrated no difference in gastric emptying times when a modest amount of milk was added to tea. These findings suggest that it may be acceptable to allow patients to add a small quantity of milk to their tea or coffee and follow the same fasting restrictions applied to clear fluids.

The Microvascular Volume of the Achilles Tendon Is Increased in Patients With Tendinopathy at Rest and After a 1-Hour Treadmill Run

Background: Achilles tendinopathy (AT) is initiated asymptomatically and is therefore often discovered at a very late stage. Purpose: To elucidate whether the microvascular volume (MV) of the Achilles tendon is elevated in patients with AT compared with healthy controls during pre-exercise rest, after acute exercise, and 24 hours after exercise. Additionally, this study investigated the muscle activation pattern of the gastrocnemius muscle and the relative elasticity of the Achilles tendon during a 1-hour treadmill run in healthy patients and in patients with AT. Study Design: Controlled laboratory study. Methods: Real-time harmonic contrast-enhanced ultrasound (CEU) measurements of the MV of the Achilles tendon were taken in 18 volunteers (9 patients with AT, 9 healthy controls). The CEU analyses were conducted before exercise, immediately after a 1-hour treadmill run, and 24 hours after exercise. Surface electromyography (EMG) signals of the gastrocnemius were recorded continuously during the 1-hour treadmill run. Results: In both the controls and the patients with AT, the MV of the Achilles tendon was increased after exercise as compared with before exercise (P < .005). Additionally, the MV signal was significantly larger in the patients with AT before, immediately after, and 24 hours after the running exercise compared with values in healthy controls (P < .0001). The muscle activation pattern differed in patients with AT compared with controls in that controls had increased EMG amplitudes at the end of the 1-hour treadmill run in the medial and lateral gastrocnemius (P < .0001). Moreover, patients with AT had approximately 15% less elastic Achilles tendons at the beginning of the 1-hour treadmill run, a condition that did not change because of exercise. Conclusion: Acute exercise increases the MV of the Achilles tendon in healthy patients and patients with AT in a similar manner. However, patients with AT have a significantly larger MV at all time points compared with healthy patients, supporting the hypothesis that microvascular changes may be involved in the pathogenesis of tendinopathy. Clinical Relevance: This study underlines that tendon flexibility is altered in patients with AT and that CEU is a promising tool to establish the early diagnosis of this condition.

Backfat thickness and longissimus dorsi real-time ultrasound measurements in light lambs1

The aim of this study was to assess the accuracy of ultrasound measurements for predicting carcass traits in 124 Spanish pascual-type lambs (13 to 16 kg carcass weight). Ultrasound images were taken transversal and longitudinal to the vertebral column and at thoracic (TV; between 12th and 13th ribs) and lumbar (LV; between first and second lumbar vertebrae) locations. Skin thickness, subcutaneous backfat thickness (BFT), and depth (DLD), width (WLD), and area (ALD) of longissimus dorsi were obtained with ImageJ 1.42q software. After slaughter, BFT (TV, 2.30 ± 0.06 mm; LV, 2.46 ± 0.06 mm), DLD (TV, 2.47 ± 0.03 cm; LV, 2.48 ± 0.03 cm), WLD (TV, 4.50 ± 0.04 cm; LV, 4.60 ± 0.04 cm), and ALD (TV, 9.96 ± 0.12 cm(2); LV, 10.19 ± 0.13 cm(2)) were directly measured on the lamb carcass. Correlations between ultrasound and direct carcass measurements were greater than 0.61 for DLD, WLD, and ALD (P < 0.05) whereas they fluctuated between 0.32 and 0.60 for BFT (P < 0.05); moreover, correlations were significantly (P < 0.05) greater for transversal than for longitudinal views. In a similar way, linear regression analyses suggested a moderate underestimation for BFT and lumbar DLD when using real-time ultrasound technologies whereas WLD, ALD, and thoracic DLD suffered from under- and overestimation for small and large values of carcass traits, respectively. After decomposing the mean square prediction error (MSPE) for the different ultrasound measurements, we found that the error due to disturbance contributed most to the MSPE followed by the error of central tendency and the error due to regression. The SE of prediction (SEP) was also calculated as an additional precision indicator, obtaining estimates less than that in previous studies with larger lambs. In conclusion, transversal ultrasound measurements at the thoracic and lumbar levels could be a useful tool for predicting DLD, WLD, and ALD in light lambs, perhaps suffering from worse prediction properties when focusing on BFT. This information could be of special relevance for light lamb producers worldwide, with a special emphasis in the Mediterranean basin where this kind of production system accounts for a large percentage of the sheep industry.