A-Mode Ultrasound Reliability in Fat and Muscle Thickness Measurement

ABSTRACT

Ribeiro, G, de Aguiar, RA, Penteado, R, Lisbôa, FD, Raimundo, JAG, Loch, T, Meira, Â, Turnes, T, and Caputo, F. A-mode ultrasound reliability in fat and muscle thickness measurement. J Strength Cond Res 36(6): 1610-1617, 2022-This study aimed to verify the reliability of the BodyMetrix portable A-mode ultrasound in measuring fat and muscle tissue thickness. Thirty physically active men participated in daily body composition evaluations. The evaluations comprised 2 techniques: (a) graphic technique (GTBM), which measured the fat thickness at 9 body sites (abdomen, axillary, biceps brachii, calf, chest, subscapular, suprailiac, thigh, and triceps brachii), and (b) imaging technique (ITBM), which simultaneously measured the fat and muscle thickness of 6 body surfaces (abdomen, biceps brachii, chest, thigh, trapezius, and triceps brachii). Regarding GTBM, relative reliability was moderate to excellent (intraclass correlation coefficient [ICC]: 0.81-0.98), whereas absolute reliability was acceptable for abdomen, calf, chest, subscapular, suprailiac, and triceps brachii (coefficient of variation [CV]: 6.9-8.8%) but high for axillary, biceps brachii, and thigh (CV: 12.0-17.4%) in measuring fat thicknesses. Concerning ITBM, relative reliability was good to excellent (ICC: 0.93-0.99 and 0.90-0.98), whereas absolute reliability was acceptable (CV: 3.0-9.2% and 3.5-5.9%) in measuring fat and muscle thickness, respectively. These findings suggest that the, GTBM was only reliable in measuring fat thickness of abdomen, calf, chest, subscapular, suprailiac, and triceps brachii, whereas ITBM was reliable in measuring both fat and muscle thickness in all regions, but showed better reliability values in measuring muscle than fat thickness.

[Digital transformation in urology-opportunity, risk or necessity?]

Ultimately, new (digital) techniques and artificial intelligence (AI) applications are changing the working environment in urology. This can be an opportunity for further development, but also a change which is not desired. Adjustments to work processes may be necessary. So-called disruptive processes lead to fundamental changes. In the context of the digital transformation, our way of working is changing. Classic hierarchies, working hours, and working environments are dissolving in favor of creative and flexible working models and corporate structures. Clinics and practices in urology must prepare themselves for changing requirements and be able to provide answers.

The effects of predictive trials on critical stroke rate and critical swimming speed

BACKGROUND

Critical swimming speed (CSS) and critical stroke rate (CSR) have important practical applications in evaluating endurance capacity and stroke parameters. The CSS and CSR are determined from the linear regression between two or more performance times with the respective predictive distance or "number of stroke cycles," respectively. It is already known that CSS is dependent on the number and duration of the predictive trials chosen, and performance times ranging from 2 to 12 min have been recommended. However, the effects of predictive trials on the CSR have not been reported. It was hypothesized that CSS and CSR determined by different predictive trials lasting 2 to 12 min would elicit similar values. Therefore, the purpose of the present study was to determine the impact of different combinations of predictive trials lasting 2 to 12 min on both CSR and CSS.

METHODS

Thirteen swimmers performed three fixed-distance (200, 400, and 800 m) performances. All possible combinations of CSR and CSS with two (CSR<inf>200-400</inf>/CSS<inf>200-400</inf>, CSR<inf>200-800</inf>/CSS<inf>200-800</inf>, CSR<inf>400-800</inf>/CSS<inf>400-800</inf>) and three (CSR<inf>200-400-800</inf>/CSS<inf>200-400-800</inf>) trials were determined.

RESULTS

No significant differences were found between CSR and CSS determined with different predictive distance tests. In addition, CSR<inf>200-800</inf> and CSS<inf>200-800</inf> showed the lowest coefficient of variation and highest intraclass correlation coefficients with CSR<inf>200-400-800</inf> and CSS<inf>200-400-800</inf>, respectively.

CONCLUSIONS

This study demonstrated that CSR and CSS were not statistically different when determined with different predictive trials located within the recommended durations of 2-12 min. Nevertheless, CSR<inf>200-800</inf> and CSS<inf>200-800</inf> exhibited the best consistency with CSR<inf>200-400-800</inf> and CSS<inf>200-400-800</inf>, respectively.

The Severe Exercise Domain Amplitude: A Comparison Between Endurance Runners and Cyclists

PURPOSE

Metabolic perturbation and V˙O2 on-kinetics are potential modifiers of fatigue and vary in importance depending on the exercise task. Thus, performance fatigability during high-intensity exercise seems to be exercise mode dependent, affecting tolerance in the severe domain. However, the effects of exercise mode on severe domain amplitude are still unknown. The aims of this study were to compare the severe domain amplitude in endurance runners and cyclists and to verify its possible determinants.

METHODS

Ten runners and eleven cyclists were tested to determine V˙O2 max, maximal velocity/power output of incremental test (v V˙O2 max/p V˙O2 max), critical velocity/power (CV/CP), distance/work above CV/CP (D'/W'), and the highest velocity/power output which V˙O2 max is attained during constant exercise (V_HIGH/P_HIGH). The severe domain amplitude was considered as V_HIGH/P_HIGH relative to CV/CP.

RESULTS

When normalized by v V˙O2 max/p V˙O2 max, although V_HIGH and P_HIGH were similar, CV (89.0 ± 2.2% v V˙O2 max) was higher than CP (84.0 ± 4.1% p V˙O2 max; p < .05; ES = 1.51). Consequently, the severe domain amplitude was higher in cyclists (153.6 ± 14.4% CP vs. 137.2 ± 14.6% CV; p < .05; ES = 1.13). Runners presented faster V˙O2 on-kinetics than cyclists at V_HIGH/P_HIGH. The severe domain amplitude was correlated with D' (r = .65) and W' (r = .71), but not with V˙O2 on-kinetics.

CONCLUSIONS

Cyclists have a lower CP (%p V˙O2 max) and a greater severe domain amplitude than runners, providing a greater range of intensities for attainment of V˙O2 max. Furthermore, the severe domain amplitude appears to be linked to finite energy reserves, but unrelated to V˙O2 on-kinetics.

Physiological responses to interval endurance exercise at different levels of blood flow restriction

PURPOSE

We aimed to identify a blood flow restriction (BFR) endurance exercise protocol that would both maximize cardiopulmonary and metabolic strain, and minimize the perception of effort.

METHODS

Twelve healthy males (23 ± 2 years, 75 ± 7 kg) performed five different exercise protocols in randomized order: HI, high-intensity exercise starting at 105% of the incremental peak power (P _peak); I-BFR30, intermittent BFR at 30% P _peak; C-BFR30, continuous BFR at 30% P _peak; CON30, control exercise without BFR at 30% P _peak; I-BFR0, intermittent BFR during unloaded exercise. Cardiopulmonary, gastrocnemius oxygenation (StO₂), capillary lactate ([La]), and perceived exertion (RPE) were measured.

RESULTS

V̇O₂, ventilation (V̇ _E), heart rate (HR), [La] and RPE were greater in HI than all other protocols. However, muscle StO₂ was not different between HI (set1-57.8 ± 5.8; set2-58.1 ± 7.2%) and I-BRF30 (set1-59.4 ± 4.1; set2-60.5 ± 6.6%, p < 0.05). While physiologic responses were mostly similar between I-BFR30 and C-BFR30, [La] was greater in I-BFR30 (4.2 ± 1.1 vs. 2.6 ± 1.1 mmol L^-1, p = 0.014) and RPE was less (5.6 ± 2.1 and 7.4 ± 2.6; p = 0.014). I-BFR30 showed similar reduced muscle StO₂ compared with HI, and increased blood lactate compared to C-BFR30 exercise.

CONCLUSION

Therefore, this study demonstrate that endurance cycling with intermittent BFR promotes muscle deoxygenation and metabolic strain, which may translate into increased endurance training adaptations while minimizing power output and RPE.

[Prostate biopsy: Procedure in the clinical routine]

Over the last decade there has been a 25% decrease in the mortality rates for prostate cancer. The reasons for this significant decrease are most likely associated with the application of urological screening tests. The main tools for early detection are currently increased public awareness of the disease, prostate-specific antigen (PSA) tests and transrectal ultrasound (TRUS) guided topographically assignable biopsy sampling. Together with the histopathological results these features provide essential information for risk stratification, diagnostics and therapy decisions. The evolution of prostate biopsy techniques as well as the use of PSA testing has led to an increased identification of asymptomatic men, where further clarification is necessary. Significant efforts and increased clinical research focus on determining the appropriate indications for a prostate biopsy and the optimal technique to achieve better detection rates. The most widely used imaging modality for the prostate is TRUS; however, there are no clearly defined standards for the clinical approach for each individual biopsy procedure, dealing with continuous technical optimization and in particular the developments in imaging. In this review the current principles, techniques, new approaches and instrumentation of prostate biopsy imaging control are presented within the framework of the structured educational approach.

[Imaging of the prostate]

Recently several new technologies for prostate imaging have been developed. The aim of these technologies was to improve the diagnosis of prostate cancer. Especially the transrectal ultrasound (TRUS) has been refined to the so-called enhanced ultrasound, as regular grey scale TRUS has limited ability to identify cancer lesions in the prostate. In several studies elastography has shown good capability to identify cancer lesions in the prostate as well as to absolutely increase the detection rate of randomized biopsies by up to 10 %.. Contrast-enhanced ultrasound shows varying results in the published literature with increased detection rates on the one hand and unchanged detection rates relative to randomized biopsy on the other hand. The online available ANNA/C-TRUS system shows detection rates with six targeted biopsies that are comparable to the published detection rates of randomized saturation biopsies. Direct systematic comparison to randomized biopsies is missing. The Histoscanning system currently provides the poorest data as no biopsy studies are available. Multicenter trials are mandatory for all new imaging technologies in order to implement them as standard into clinical practice.

[The chronological process of erectile function after low-dose rate prostate brachytherapy for localised prostate cancer]

OBJECTIVES

The aim of this study was to evaluate the effect of low-dose rate prostate (LDR) brachytherapy on erectile function in correlation to the time intervals after seed implantation.

DESIGN AND METHODS

32 patients with localised prostate cancer and a median age of 74 years (range 65-83) were treated with permanent seed implantation. Erectile function was assessed by means of a validated questionnaire (IIEF-5) before and at 12, 24 and 36 months after treatment. No patient received supplemental external beam -radiation therapy or antiandrogen therapy. Of the 32 patients, 26 (81%) completed and returned the questionnaire. None of the patients used PDE-5 inhibitors or intracavernousal injection therapy.

RESULTS

Before treatment, 15 patients (58%) had no erectile dysfunction (ED) (score 22-25) or mild ED (score 17-21), 11 (42%) moderate or -severe ED (score 0-16). Overall, before seed implantation the mean IIEF score was 14.4. The mean IIEF score decreased by 4.4 points 12 months after treatment, 3.1 points 24 months after treatment and 9.8 points 36 months after treatment (p < 0.05). In the group of no or mild ED, the mean IIEF score dropped by 9.7 points compared to a decrease of 1.4 points in the group of mod-erate or severe ED.

CONCLUSIONS

Most of the patients treated with LDR brachytherapy suffered an ED in correlation to the time interval with a significant loss in the third year after treatment. In this study, the most significant loss occured in the groups that had no or only mild erectile dysfunction before treatment.

Brachytherapy in localized prostatic cancer: 100 years of radium

Contemporary series of brachytherapy in localized prostate cancer show promising early results attributable to improved patient selection and technical refinements in treatment modalities. These innovations consist essentially of precise three-dimensional radioactive dose-distribution planning and source placement, thus solving the problem of possible under-dosage encountered in open brachytherapy.

Bilder in der Urologie: Faszination und Perspektiven

In contrast to other countries (e.g., USA) the German urologist routinely utilizes imaging in order to evaluate urological disorders. Ultrasound as a basic tool has acquired importance similar to the physical examination or the patient history. Because of its minimal invasiveness and low cost, it is increasingly utilized as a first-line exam.In correlation with the patient history and laboratory data more invasive imaging studies are performed and in unclear cases or in the preoperative work-up more extensive imaging procedures like computed tomography (CT) or magnetic resonance imaging (MRI) are utilized. Even in emergency situations the urologist is able to guide interventions under ultrasound or conventional X-ray guidance (e.g., percutaneous drainage of dilated kidney), which resulted in a much lower complication rate of the various procedures. In those cases in which ultrasound is technically infeasible or in unclear cases CT and MRI are used as problem-solving procedures and are able to give the correct diagnosis in a large percentage of cases.After a brief historical overview, newer modalities and innovative techniques are explored and presented. Assuming that these innovative approaches lead to more accurate diagnosis and staging of various neoplastic and nonneoplastic conditions, treatment can be performed in earlier stages of diseases and better stage-adapted treatment can be offered to the patients.

[Innovative approaches in prostate cancer ultrasound]

Today, systematic random biopsies have virtually replaced ultrasound as an imaging tool in the early diagnosis and staging of prostate cancer. Transrectal ultrasonography (TRUS) is now utilized almost only to guide the biopsy needle into the correct anatomical or topographical region of the prostate. Nevertheless, a large number of clinically significant carcinomas are not discovered despite of multiple systematic biopsies. This has led to a dramatic increase in the number of biopsy samples taken, with 6, 10, 12 to 143 being taken during one session depending on the site. Newer modalities and innovative techniques are being investigated in order to accurately identify patients with prostate cancer at different stages of the disease. Innovative ultrasonography techniques may improve the diagnosis and staging of current imaging techniques.

Computergest�tzter transrektaler Ultraschall (C-TRUS) in der Diagnostik des Prostatakarzinoms

In the diagnosis of prostate cancer digital rectal examination and transrectal ultrasound (TRUS) are the most utilized methods for clinical evaluation. However, both methods are not able to differentiate between benign and malignant findings with a high amount of certainty. Nevertheless, TRUS is an excellent tool to guide biopsies in practically any region of the prostate. The most significant problem of visual TRUS interpretation is the lack of specificity, especially being an inexperienced user. In order to enhance the diagnostic capabilities of TRUS we developed a computerized analysis of the TRUS signal information (C-TRUS/ANNA), which was validated by the pathohistologic findings of radical prostatectomies. The question was asked: Can C-TRUS detect cancer that has been missed by even multiple systematic biopsies? The entrance criteria was prior negative systematic random biopsies regardless of number of biopsy sessions or number of individual biopsy cores. Five C-TRUS subvisual algorithms were utilized to evaluate the information of the ultrasound signal. The most suspicious regions were marked by C-TRUS and biopsied by guiding a needle into that specific location. In this study 132 with a history of 6-72 negative systematic random biopsies (median: 12 cores) were evaluated by C-TRUS. The PSA ranged from 3.1-36 ng/ml with a median of 9.01 ng/ml. C-TRUS detected in 66 (50%) of these 132 patients cancer by targeted biopsies. In thes 66 men the median number of negative biopsy sessions were two and a median of 12 biopsy cores had been taken. From the literature, we would expect a cancer detection rate in this group with systematic sextant biopsies of about 7%. Only five of the detected carcinomas showed a Gleason Score (GS) of 5, were as 25 had a GS of 6, 22 a GS of 7 and 15 a GS above 7. The results of this prospective clinical trail indicate that C-TRUS is able to identify clinically significant cancers that were missed by even multiple systematic random biopsies. In addition, the concept of searching for strategies that utilize expertise and refinement of imaging modalities is supported rather than just elevating the number of random biopsies (i.e. 141 cores in one session).

ADRENAL METASTASES IN 1,635 PATIENTS WITH RENAL CELL CARCINOMA: OUTCOME AND INDICATION FOR ADRENALECTOMY

PURPOSE

Routine removal of the ipsilateral adrenal gland in patients with renal cell carcinoma who undergo nephrectomy has been a matter of dispute. In a retrospective study we screened for subgroups of patients with renal cell carcinoma from a large single center patient population who may have benefited from ipsilateral adrenalectomy.

MATERIALS AND METHODS

Radical nephrectomy was performed in 1635 patients at a single institution between 1980 and 2000. A total of 1010 patients underwent radical nephrectomy plus ipsilateral adrenalectomy, whereas in 625 no simultaneous adrenalectomy was performed. Numerous clinical and histopathological parameters were investigated by univariate and multivariate statistical methods for their predictive value in regard to cancer specific survival.

RESULTS

Metastases in the adrenal gland were found in 5.5% of patients (56 of 1010) undergoing nephrectomy with adrenalectomy. Of 30 patients with adrenal metastasis and preoperative computerized tomography/magnetic resonance imaging 23 were found to have histological evidence of cancer, approaching a false-negative rate of 23.3%. All patients with false-negative computerized tomography/magnetic resonance imaging had a primary tumor of greater than 4 cm. Patients with adrenal metastases predominately had pT3 or greater tumor stage (82%). Cancer specific survival rates (75% vs 73% for adrenalectomy vs no adrenalectomy) and postoperative complications rates (7% vs 8%) did not differ significantly between the 2 groups. The prognosis in patients with a solitary adrenal metastasis (18 of 56) was more favorable than in patients with additional metastatic sites (38 of 56).

CONCLUSIONS

Adrenal metastases from primary renal cell carcinoma were found significantly more often in patients with advanced tumor stages. Ipsilateral adrenalectomy should be recommended for all resectable renal cell carcinoma with a primary tumor of greater than 4 cm or with nonorgan confined tumor stages (T3 or greater) since a false-negative rate of about 20% can be expected with current imaging techniques.

[Gemcitabine/cisplatin vs. MVAC. 5 year survival outcome of the phase III study of chemotherapy of advanced urothelial carcinoma in Germany]

Of 405 patients with stage IV transitional cell carcinoma from an international multicenter phase III trial, 70 were randomized in Germany to receive either gemcitabine/cisplatin or standard MVAC systemic chemotherapy for locally advanced or metastatic urothelial cancer. Overall survival as the primary endpoint of the study was similar in both arms (median survival GC 15.4 months vs MVAC 16.1 months), as were tumor-specific survival and time to progressive disease. In the intent-to-treat analysis, the 5-year overall survival rate was 10% for patients randomized to GC and 18% randomized to MVAC. Tumor overall response rates (GC 54%, MVAC 53%) were similar. The toxic death rate was 0% in the GC arm and 3% (one patient) in the MVAC arm. Significantly more GC than MVAC patients experienced grade 3/4 anemia (GC 52%, MVAC 20%) with significantly more red blood cell transfusions in the GC arm.Significantly more GC than MVAC patients had grade 3/4 thrombocytopenia (GC 54%, MVAC 17%) without grade 3/4 hemorrhage or hematuria in either arm. More MVAC patients experienced grade 3/4 neutropenia (GC 56%, MVAC 61%, p=1.000), neutropenic or leukopenic fever (GC 0%, MVAC 10%, p=0.237), mucositis (GC 0%, MVAC 7%, p=0.495), and alopecia (GC 6%, MVAC 36%, p=0.004). GC represents a reasonable alternative for the palliative treatment of patients with locally advanced and metastatic transitional cell carcinoma. Sustained long-term survival was only found for patients with locally advanced cancer, lymphatic metastases, or solitary distant metastasis but not for visceral metastatic disease.

[Is fiber optic hepatovenous oximetry useful in patients undergoing elective partial liver resection?]

The validity of continuous measurement of hepatic venous oxygen saturation using a fibreoptic technique was investigated and set in correlation with intermittent measurements of saturation in hepatic venous blood in patients undergoing elective partial liver resection (pLR). Eleven patients (4 m/7 f, average age: 62.6 +/- 11.6 years) were included in the study after approval by the Ethics Committee of the University of Leipzig. A fibre-optic heparinized flow-directed pulmonary catheter (5.5-F) was inserted through the right internal jugular vein into the hepatic vein after induction of balanced anaesthesia (isoflurane/alfentanil). The position of the tip of the catheter was verified by fluoroscopic guidance. The oxygen saturation in the hepatic vein measured by the fibre-optic method and by blood-gas analysis (ShvO2) was compared at nine defined measuring points after in-vivo calibration (baseline). The ShvO2 decreased nonsignificantly from 84.4 +/- 10.4% to 77.1 +/- 19.1% during occlusion of the vessels in the liver hilus (Pringle's manoeuvre). The ShvO2 measured by the fibre-optic method and by blood-gas analysis correlated well (r = 0.815, p < 0.001). The limitations of the method result from artefacts based on surgical manipulations in the portal region (compression of hepatic veins, luxation of the liver). These artefacts can be differentiated by analysis of the pressure curves in the hepatic vein. Nevertheless, fibreoptic hepatovenous oxymetry seems to be a feasible method for continuous monitoring of the ShvO2 under intraoperative conditions in patients undergoing partial liver resection. Ischaemic situations of the liver can be detected and treated early. Additional information can be obtained from analyses of parameters in the hepatovenous blood.

Quantitative RT-PCR assay for mRNA of VEGF and histone H4 in the determination of proliferative and angiogenic activity in vulvar pathology

Proliferative and angiogenic activity of tissue specimens taken from women with various vulvar pathologies were evaluated by determining the number of mRNA VEGF molecules and H4 histone mRNA molecules, by means of the QRT-PCR (TaqMan) technique. Following a cluster analysis the results, where normalised. Euclidean distances were used, all the cases were classified into three groups of pathologies. Group I included low degree vulvar pathologies, group II included high degree vulvar pathologies and group III included vulvar pathologies with high proliferative and angiogenic activity. Significant differences were found in the proliferative and angiogenic activity between groups I and III, and between groups II and III, while no statistically significant differences were found between groups I and II.