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In medial tibial stress syndrome (MTSS) bone marrow and periosteal edema of the tibia on the magnetic resonance imaging (MRI) is frequently reported. The relationship between these MRI findings and recovery has not been previously studied. This prospective study describes MRI findings of 52 athletes with MTSS. Baseline characteristics were recorded and recovery was related to these parameters and MRI findings to examine for prognostic factors. Results showed that 43.5% of the symptomatic legs showed bone marrow or periosteal edema. Absence of periosteal and bone marrow edema on MRI was associated with longer recovery (P = 0.033 and P = 0.013). A clinical scoring system for sports activity (SARS score) was significantly higher in the presence of bone marrow edema (P = 0.027). When clinical scoring systems (SARS score and the Lower Extremity Functional Scale) were combined in a model, time to recovery could be predicted substantially (explaining 54% of variance, P = 0.006). In conclusion, in athletes with MTSS, bone marrow or periosteal edema is seen on MRI in 43,5% of the symptomatic legs. Furthermore, periosteal and bone marrow edema on MRI and clinical scoring systems are prognostic factors. Future studies should focus on MRI findings in symptomatic MTSS and compare these with a matched control group.

Objectives: To evaluate the effectiveness of an energy conservation management (ECM) intervention versus an MS-nurse control intervention for treating fatigue in persons with multiple sclerosis (MS). Design: Single-blind, two-parallel-arms randomized clinical trial (RCT). Setting: Two outpatient rehabilitation departments. Subjects: Adult persons with definite MS, severe fatigued, and being ambulatory. Interventions: The individual-based ECM intervention (12 sessions in 4 months) is based on the Packer group program and was given by occupational therapists. The control intervention (3 sessions in 4 months) consisted of MS-nurse consultations. Method: Primary outcome measures were Fatigue (Checklist Individual Strength-CIS20r domain subjective experience of fatigue) and participation (Impact on Participation and Autonomy- IPA). Additional secondary outcome measures on fatigue, activity and participation were done. Measurements, evaluated by blinded assessors, were at baseline and 8, 16, 26 and 52 weeks after randomization. Linear Mixed Models analyses with a three level structure (repeated measures, patients and therapists) were performed. Results: Intention to treat analysis was based on 76 patients (ECM n=36; MS-nurse n=40). No significant intervention effects were found for fatigue (overall difference CIS20r between the groups = -0.81; 95% CI -3.71 to 2.11; p=0.58), and for four out of five IPA domains. For the IPA domain social relations, an overall unfavorable effect for the ECM group was found (difference between the groups = 0.19, 95% CI 0.03 to 0.35, p=0.02). Conclusion: Energy conservation management does not lead to significant and clinically relevant changes in fatigue and participation compared to MS nurse consultations. Although both treatments achieved a statistically significant decline of fatigue during the treatment period, and for the ECM group also at long-term followup, these effects must be considered as clinically non-relevant

This study investigated the effects of alcohol septal ablation (ASA) on microcirculatory function and myocardial energetics in patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction. In 15 HCM patients who underwent ASA, echocardiography was performed before and 6 mo after the procedure to assess the LVOT gradient (LVOTG). Additionally, [15O]water PET was performed to obtain resting myocardial blood flow (MBF) and coronary vasodilator reserve (CVR). Changes in LV mass (LVM) and volumes were assessed by cardiovascular magnetic resonance imaging. Myocardial oxygen consumption (MV̇o2) was evaluated by [11C]acetate PET in a subset of seven patients to calculate myocardial external efficiency (MEE). After ASA, peak LVOTG decreased from 41 ± 32 to 23 ± 19 mmHg ( P = 0.04), as well as LVM (215 ± 74 to 169 ± 63 g; P < 0.001). MBF remained unchanged (0.94 ± 0.23 to 0.98 ± 0.15 ml·min−1·g−1; P = 0.45), whereas CVR increased (2.55 ± 1.23 to 3.05 ± 1.24; P = 0.05). Preoperatively, the endo-to-epicardial MBF ratio was lower during hyperemia compared with rest (0.80 ± 0.18 vs. 1.18 ± 0.15; P < 0.001). After ASA, the endo-to-epicardial hyperemic (h)MBF ratio increased to 1.03 ± 0.26 ( P = 0.02). ΔCVR was correlated to ΔLVOTG ( r = −0.82; P < 0.001) and ΔLVM ( r = −0.54; P = 0.04). MEE increased from 15 ± 6 to 20 ± 9% ( P = 0.04). Coronary microvascular dysfunction in obstructive HCM is at least in part reversible by relief of LVOT obstruction. After ASA, hMBF and CVR increased predominantly in the subendocardium. The improvement in CVR was closely correlated to the absolute reduction in peak LVOTG, suggesting a pronounced effect of LV loading conditions on microvascular function of the subendocardium. Furthermore, ASA has favorable effects on myocardial energetics.

Objective To compare the technical performance of different percutaneous lead types for spinal cord stimulation. Methods Using the ut-scs software (University of Twente's spinal cord stimulation), lead models having similar characteristics such as the 3487A PISCES-Quad (PQ), 3887 PISCES-Quad Compact (PC), 3888 PISCES-Quad Plus (PP) (Medtronic Inc., Minneapolis, MN), and the AB SC2108 (AB) (Advanced Bionics Corp., Valencia, CA) were simulated in monopolar and tripolar (guarded cathode) combinations on a single lead, placed just outside the dorsal dura mater and both centered on the spinal cord midline, and at 1 mm lateral. The influence of displacing a lead dorsally in the epidural fat was examined as well. Finally, dual leads both aligned and offset were modeled. Several parameters were calculated to allow a quantitative comparison of the performances. Results When programmed as a guarded cathode, the AB lead recruits nerve fibers in an ~25% larger dorsal column area than the PQ. However, the AB has an ~160% higher energy consumption. The performance of the PC is between the AB and PQ, whereas the PP is suitable only for dorsal root stimulation. Displacing a single lead off midline or dorsally decreases its ability to recruit fibers in the dorsal columns. Similarly, dual lead combinations are less capable when compared to single lead centered on the spinal cord midline just outside the dura mater. Conclusions Complex pain syndromes are treated best with lead having a small contact spacing, being programmed as a tripole (guarded cathode) and centered on the spinal cord midline just outside the dura mater. This is because dorsal column fiber recruitment is more extensive than with any other combinations, including dual leads. Improved recruitment of dorsal column fibers is accompanied by increased energy consumption.

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In this study it is hypothesized that magnesium sulphate in asphyxiated full‐term neonates could lead to a gradual improvement in background pattern of the amplitude integrated EEG (aEEG), an early marker of hypoxic‐ischaemic brain injury. In a double‐blind, randomized, controlled pilot study of 22 asphyxiated full‐term neonates 8 received magnesium sulphate, reaching serum Mg2+levels of 2.5 mmol/L. Magnesium sulphate had no immediate effect on aEEG‐patterns. At 12 h of age, aEEG was more depressed compared with aEEG at 3 h in 6 of the 8 magnesium‐treated neonates, and in 3 of the 14 placebo‐treated neonates (Mg2+vs placebo:p< 0.05, Mann‐Whitney). No further significant changes in aEEG were seen between 12 and 24 h. Outcome was unfavourable in 4 of the 8 magnesium‐treated neonates, and in 8 of the 14 placebo‐treated neonates.Conclusion: Magnesium sulphate did not have a positive effect on aEEG patterns in this small group of asphyxiated term neonates.

Activity pacing (AP) is a concept that is central to many chronic pain theories and treatments, yet there remains confusion regarding its definition and effects.To review the current knowledge concerning AP and integrate this knowledge in a manner that allows for a clear definition and useful directions for future research.A narrative review of the major theoretical approaches to AP and of the empirical evidence regarding the effects of AP interventions, followed by an integrative discussion.The concept of AP is derived from 2 main traditions: operant and energy conservation. Although there are common elements across these traditions, significant conceptual and practical differences exist, which has led to confusion. Little empirical evidence exists concerning the efficacy of AP as a treatment for chronic pain.Future research on AP should be based on a clear theoretical foundation, consider the context in which the AP behavior occurs and the type of pacing problem ("underactivity" vs. "overactivity"), and should examine the impact of AP treatment on multiple clinical outcomes. We provide a provisional definition of AP and specific recommendations that we believe will move the field forward.