Diurnal changes of lower leg volume in obese and non-obese subjects

Needle electromyography does not meaningfully impact findings in MR-neurography/-myography

INTRODUCTION

Magnetic resonance neurography (MRN) and myography (MRM) are emerging imaging methods for detecting diseases of the peripheral nerve system (PNS). Most patients with PNS diseases also undergo needle electromyography (EMG). This study examined whether EMG led to lesions that were detectable using MRN/MRM and whether these lesions could impair image interpretation.

METHODS

Ten patients who underwent clinically indicated EMG were recruited. MRN/MRM was performed before and 2-6 h after EMG, and if achievable, 2-3 days later. T2 signal intensity (SI) of the tibialis anterior muscle (TA) was quantified, and sizes and SI of the new lesions were measured. Visual rating was performed independently by three neuroradiologists.

RESULTS

T2 lesions at the site of needle insertion, defined as focal edema, were detectable in 9/10 patients. The mean edema size was 31.72 mm2 (SD = 14.42 mm2 ) at the first follow-up. Susceptibility-weighted imaging lesions, defined as (micro) hematomas were detected in 5/10 patients (mean size, 23.85 mm2 [SD = 12.59 mm2 ]). General muscle SI of the TA did not differ between pre- and post-EMG examinations. Lesions size was relatively small, and the readers described image interpretation as not impaired by these lesions.

DISCUSSION

This study showed that focal edema and hematomas frequently occurred after needle EMG and could be observed using MRN/MRM. As general muscle SI was not affected and image interpretation was not impaired, we concluded that needle EMG did not interfere with MRN/MRM.

The cardiovascular changes underlying a low cardiac output with exercise in patients with type 2 diabetes mellitus

The significant morbidity and premature mortality of type 2 diabetes mellitus (T2DM) is largely associated with its cardiovascular consequences. Focus has long been on the arterial atheromatosis of DM giving rise to early stroke and myocardial infarctions, whereas less attention has been given to its non-ischemic cardiovascular consequences. Irrespective of ischemic changes, T2DM is associated with heart failure (HF) most commonly with preserved ejection fraction (HFpEF). Largely due to increasing population ages, hypertension, obesity and T2DM, HFpEF is becoming the most prevalent form of heart failure. Unfortunately, randomized controlled trials of HFpEF have largely been futile, and it now seems logical to address the important different phenotypes of HFpEF to understand their underlying pathophysiology. In the early phases, HFpEF is associated with a significantly impaired ability to increase cardiac output with exercise. The lowered cardiac output with exercise results from both cardiac and peripheral causes. T2DM is associated with left ventricular (LV) diastolic dysfunction based on LV hypertrophy with myocardial disperse fibrosis and significantly impaired ability for myocardial blood flow increments with exercise. T2DM is also associated with impaired ability for skeletal muscle vasodilation during exercise, and as is the case in the myocardium, such changes may be related to vascular rarefaction. The present review discusses the underlying phenotypical changes of the heart and peripheral vascular system and their importance for an adequate increase in cardiac output. Since many of the described cardiovascular changes with T2DM must be considered difficult to change if fully developed, it is suggested that patients with T2DM are early evaluated with respect to their cardiovascular compromise.

The Reliability and Validity of a Portable Three-Dimensional Scanning System to Measure Leg Volume

(1) Background: The study examined the reliability (test-retest, intra- and inter-day) and validity of a portable 3D scanning method when quantifying human leg volume. (2) Methods: Fifteen males volunteered to participate (age, 24.6 ± 2.0 years; stature, 178.9 ± 4.5 cm; body mass, 77.4 ± 6.5 kg; mean ± standard deviation). The volume of the lower and upper legs was examined using a water displacement method (the criterion) and two consecutive 3D scans. Measurements were taken at baseline, 1 h post-baseline (intra-day) and 24 h post-baseline (inter-day). Reliability and validity of the 3D scanning method was assessed using Bland-Altman limits of agreement and Pearson's product moment correlations. (3) Results: With respect to the test-retest reliability, the 3D scanning method had smaller systematic bias and narrower limits of agreement (±1%, and 3-5%, respectively) compared to the water displacement method (1-2% and 4-7%, respectively), when measuring lower and upper leg volume in humans. The correlation coefficients for all reliability comparisons (test-retest, intra-day, inter-day) would all be regarded as 'very strong' (all 0.94 or greater). (4) Conclusions: The study's results suggest that a 3D scanning method is a reliable and valid method to quantify leg volume.

Pain in the aftermath of minimal invasive treatment for unilateral incompetence of the great saphenous vein

OBJECTIVES

Assessment of postprocedural pain after minimal invasive treatment of unilateral incompetence of the great saphenous vein.

METHODS

A total of 85 patients treated with endovenous laser ablation (1470 nm) in combination with foam sclerotherapy and evulsions reported postprocedural pain on a visual analogue scale (0-10) during 28 days after treatment.

RESULTS

A mean pain reduction from 3.9 on the first postinterventional day to 0.3 was noted during the observation time. After 28 days, 7% of patients had a visual analogue scale >1. Higher body mass index was strongly associated with more pain during the whole follow-up period (p < 0.01). Higher energy application per cm vein and greater great saphenous vein diameter showed more pain in the first week. Other factors like clinical stage CEAP classification, combination of laser with avulsions and/or sclerotherapy, season of treatment timepoint, and age or sex did not influence postinterventional pain course.

CONCLUSION

Higher body mass index and higher energy application per cm are associated with more postprocedural pain after endovenous laser ablation.

Use of various obesity measurement and classification methods in occupational safety and health research: a systematic review of the literature

BACKGROUND

This study systematically examined obesity research in occupational safety and health regarding the use of various obesity measurement and classification methods.

METHODS

A systematic search of the PubMed database on English language publications from 2000 to 2015 using related keywords and search of citations resulted in selection of 126 studies. They were categorized into two groups based on their main research question: 1) general physical or mental work-related functioning; and 2) task or body part specific functioning.

RESULTS

Regardless of the study group, body mass index (BMI) was the most frequently used measure. Over 63% of the studies relied solely on BMI to define obesity. In only 22% of the studies, body fat was directly measured by methods such as dual energy x-ray absorptiometry. Abdominal obesity was defined using waist circumference in recent years, and waist-hip ratio in earlier years. Inconsistent cut-offs have also been used across studies investigating similar topics.

CONCLUSIONS

Few authors acknowledged the limitations of using indirect obesity measures. This is in part due to the limited understanding of some occupational safety and health researchers regarding the complex issues surrounding obesity classification and also the mixed recommendations over the past 2-3 decades and across populations. Efforts need to be made to promote appropriate obesity measurement and reporting in this field.

The effect of BMI on haemostasis: Implications for thrombosis in women's health

Obesity has reached epidemic proportions and is a well-recognised risk factor for venous thromboembolism (VTE). This article summarises the current understanding of obesity and debates how obesity induces this increased risk of VTE. Obesity is associated with prothrombotic changes which have been well-characterised and include increased levels of plasminogen activator-1, von Willebrand factor, fibrinogen and evidence of increased coagulation and platelet activation; however, these changes do not seem to account for all the increased risk. Accumulating evidence suggests a significant role for increased tissue factor expression and signalling in this relationship, with increased tissue factor expression present in adipose and possibly systemic tissues, induced by adipose generated cytokines. Lastly, there is a strong suggestion that decreased venous flow due to venous enlargement may play the major role in increased VTE risk with obesity.

Sex differences in symptom severity and clusters in patients with stage C4 and stage C5 chronic venous disease

BACKGROUND

Multiple symptoms associated with chronic venous disease (CVD) are poorly understood, under-recognized, and ill-managed.

AIMS

The aim of this study was to determine whether there are differences in symptoms and symptom clusters between men and women with stage C4 and stage C5 CVD.

METHODS

Data were collected via interviews with 264 patients using a demographic survey and an 11-item VEINES-SYM questionnaire.

ANALYSIS

An intrinsic scoring algorithm was developed to calculate the overall t scores for each item by sex. Exploratory factor analysis identified symptom clusters using oblique rotation to account for correlations between factors.

RESULTS

The average age was 61.7 years; 54.5% of the patients were women, 58% were African American or black, and 60.6% had diabetes. The top three symptoms for women in order of frequency were achy legs, swelling, and pain; for men, these were swelling, achy legs, and heavy legs. For the total group, two symptom clusters emerged: distressful and discomfort. There was no statistically significant difference in factor score between the sexes. Different factor loadings for symptom clusters were observed: women reported hurting and annoying clusters; and men reported nagging and irritating clusters.

CONCLUSION

The data suggest differences in CVD symptoms and clusters by sex. Symptoms in the two clusters were different; however, there was consistency in the factors associated with each cluster. Co-morbid conditions and sex differences in pain responses may play a part in symptom presentation. This study supports the need for increased sex-delineated clinical assessment and consideration of the potential differences between the sexes in the management of CVD symptoms.