Muscle energy technique for chronic obstructive pulmonary disease: A feasibility study / 中西医结合学报

OBJECTIVE@#This study aimed to investigate the feasibility of implementing a manual therapy technique (muscle energy technique, MET) protocol in a hospital pulmonary rehabilitation (PR) program for patients with moderate to severe chronic obstructive pulmonary disease (COPD). Please cite this article as: Baxter DA, Coyle ME, Hill CJ, Worsnop C, Shergis JL. Muscle energy technique for chronic obstructive pulmonary disease: A feasibility study. J Integr Med. 2023; 21(3): 245-253.@*METHODS@#Participants aged 40 years and over, with moderate to severe COPD, were recruited into this 12-week study. The primary outcome measures were feasibility (acceptability of the intervention and attendance/adherence to the trial) and safety (adverse events, AEs). All participants received the MET and PR therapies. Participants and assessors were unblinded. Semi-standardized MET was delivered on 6 occasions (a maximum of once per week) at the hospital directly before a PR session. Participants undertook PR sessions as per the hospital program at a frequency of two days per week for 8 weeks. Participants were contacted 4 weeks after their final MET treatment via a telephone call to assess acceptability of the intervention.@*RESULTS@#Thirty-three participants were enrolled, with a median age of 74 years (range 45-89 years). The median number of MET sessions that participants attended was 5 (range 0-6) out of a possible 6 sessions (83% attendance). At follow-up, participants overwhelmingly enjoyed the MET treatment with some subjectively reporting improved breathing. There were no major AEs related to the intervention, with the majority of AEs classified as expected events related to COPD exacerbations.@*CONCLUSION@#It is feasible to implement a manual therapy protocol using MET as an adjunct to PR in a hospital setting. Recruitment rates were satisfactory and there were no AEs related to the MET component of the intervention.

Patterns of injury at an Ethiopian referral hospital: Using an institutional trauma registry to inform injury prevention and systems strengthening

Background: Data about injury patterns and clinical outcomes are essential to address the burden of injury in low- and middle-income countries. Institutional trauma registries (ITRs) are a key tool for collecting epidemiologic data about injury. This study uses ITR data to describe the demographics and patterns of injury of trauma patients in Addis Ababa, Ethiopia in order to identify opportunities for injury prevention, systems strengthening and further research. Methods: This is an analysis of prospectively collected data from a sustainable ITR at Menelik II Specialized Hospital, a public teaching hospital with trauma expertise. All patients presenting to the hospital with serious injuries requiring intervention or admission over a 13 month period were included. Univariable and bivariable analyses were performed for patient demographics and injury characteristics. Results: A total of 854 patients with serious injuries were treated during the study period. Median age was 33 years and 74% were male. The most common mechanisms of injury were road traffic injuries (RTI) (37%), falls (30%) and blunt assault (17%). Over half of RTI victims were pedestrians. Median delay in presentation was 2 h; 17% of patients presented over 6 h after injury. 58% of patients were referred from another hospital or a clinic, and referrals accounted for 84% of patients arriving by ambulance. Median emergency center length of stay was 2 h and 62% of patients were discharged from the emergency center. Conclusion: This study highlights the utility of institutional trauma registries in collecting crucial injury surveillance data. In Addis Ababa, road safety is an important target for injury prevention. Our findings suggest that the most severely injured patients may not be making it to the referral centers with the capacity to treat their injuries, thus efforts to improve prehospital care and triage are needed. African relevance: Injury is a public health priority in Africa. Institutional trauma registries play a crucial role in efforts to improve trauma care by describing injury epidemiology to identify targets for injury prevention and systems strengthening efforts. In our context, pedestrian safety is a key target for injury prevention. Improving prehospital care and developing referral networks are goals for systems strengthening

Limberg flap reconstruction for sacrococcygeal pilonidal sinus disease with and without acute abscess: Our experience and a review of the literature

BACKGROUND: The efficacy of Limberg flap reconstruction for pilonidal sinus with acute abscess remains unclear. This study aimed to compare outcomes after Limberg flap reconstruction for pilonidal sinus disease with and without acute abscess. A secondary objective was to perform a review of the literature on the topic. METHODS: A retrospective chart review was conducted of all patients who underwent excision and Limberg flap reconstruction for pilonidal sinus from 2009 to 2018. Patient demographics, wound characteristics, and complication rates were reviewed and analyzed. RESULTS: Group 1 comprised 19 patients who underwent Limberg flap reconstruction for pilonidal sinus disease without acute abscess and group 2 comprised four patients who underwent reconstruction for pilonidal sinus disease with acute abscess. The average defect size after excision was larger in group 2 than group 1 (107.7±60.3 cm² vs. 61.4±33.8 cm², respectively). There were no recurrences, seromas or cases of flap necrosis postoperatively. There was only one revision surgery needed for evacuation of a postoperative hematoma in group 1. There were comparable rates of partial wound dehiscence treated by local wound care, hematoma, need for revision surgery and minor infection between group 1 and group 2. CONCLUSIONS: Limberg flap reconstruction for pilonidal sinus in the setting of acute abscess is a viable option with outcomes comparable to that for disease without acute abscess. This practice will avoid the pain and cost associated with a prolonged local wound care regimen involved in drainage of the abscess prior to flap reconstruction.

Facilitating factors and barriers to newborn screening uptake in the Cordillera administrative region and region V

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Republic Act 9288 or the Newborn Screening Act of 2004 was enacted. A multi-sector effort towards systematic screening of newborn disorders and built-in systems for subsequent confirmatory tests for positively screened as well as treatment for confirmed cases was likewise implemented. Despite multi-sector efforts and continuous quality improvement mechanisms, national newborn screening coverage remained low for several years.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> The study determined factors that influence Newborn Screening (NBS) uptake from various perspectives: mothers, health providers, and program administrators.</p><p style="text-align: justify;"><strong>METHODS:</strong> Framework analysis of NBS program documents, 25 focus group discussions and 37 key informant interviews of mothers, health providers and program administrators were done in purposively selected communities in the Cordillera Administrative Region and Region V.</p><p style="text-align: justify;"><strong>RESULTS AND CONCLUSIONS:</strong> Findings showed the need to disseminate correct NBS procedures, especially upon obtaining positive results. Financing issues were addressed innovatively, but system administrators and health providers required a common understanding of program implementation. Monitoring geographically hard-to-reach areas remained a challenge. Barriers outside the system adversely affected filter cards availability, specimen transport, and release of results. Improved online and paper-based educational campaign, greater local government unit support, streamlined PhilHealth processes, a workload-based manpower complement for monitoring, and continuity clinics to handle positive findings can increase NBS uptake.</p>

Important Signs in Musculoskeletal MRI.

The purpose of this article is to review the common MRI signs of musculoskeletal pathology. In this article, 15 classic MRI signs used in musculoskeletal radiology are presented and described. These signs include the anterior drawer sign, bone bruise sign, bow tie sign, celery stalk anterior cruciate ligament (ACL), cyclops lesion, deep lateral femoral notch sign, double line sign, double Oreo cookie sign, double posterior cruciate ligament (PCL) sign, fat-blood interface (FBI) sign, fragment in notch sign, split fat sign, T-sign, target sign, and yo-yo on a string sign. It is important to recognize common signs in musculoskeletal MRI and understand the underlying pathologies for accurate image interpretation.

Sonographic Evaluation of Subscapularis Tendon Tears with Surgical Correlation.

Aims: The purpose of this study was to evaluate the ability of ultrasound in detecting subscapularis tendon pathology with operative correlation. Methodology: A retrospective study was conducted on 86 patients who had shoulder ultrasound prior to surgical repair from January 2006 to August 2008. All sonographic examinations and surgical reports were reviewed. Sonographic evaluation of subscapularis tendon, including normal, tendinosis, partial thickness tear, full thickness tear, and complete tear were correlated to operative reports. Results: Of the 86 patients, 19 patients had surgically proven abnormal subscapularis tendons. There was 100% ultrasound concordance in tendinosis (n = 1), 100 % ultrasound concordance in partial thickness tears (n =3), 88 % ultrasound concordance in full thickness tears (n = 8), 57 % ultrasound concordance in complete tears (n = 7). Overall, there was 79% ultrasound concordance in diagnosing subscapularis tendon pathology when surgery is used as a gold standard. Conclusion: Ultrasound is useful in the evaluation of the subscapularis tendon. The sonographic findings of tendinosis and partial thickness tears correlate best with surgery. However, ultrasound may underestimate complete tears.

Changes in body weight, blood pressure and selected metabolic biomarkers with an energy-restricted diet including twice daily sweet snacks and once daily sugar-free beverage

BACKGROUND/OBJECTIVES: The type of sweet snack incorporated into an energy-restricted diet (ERD) may produce differential effects on metabolic improvements associated with body weight (BW) loss. This study compared effects of incorporating either twice daily energy-controlled dark chocolate snacks plus once daily sugar-free cocoa beverage (DC) to non-chocolate snacks plus sugar-free non-cocoa beverage (NC) into an ERD on BW loss and metabolic outcomes. MATERIALS/METHODS: In an 18-week randomized comparative trial, 60 overweight/obese premenopausal women were assigned to DC (n = 30) or NC group (n = 30). Dietary intake was measured at baseline and week 18, and BW, anthropometrics, blood pressure (BP) and serum glucose, insulin and lipid concentrations were measured at baseline, and weeks 6, 12 and 18. Data were analyzed using repeated measures ANOVA. RESULTS: Using intention-to-treat analysis, women in DC and NC groups reduced energy intake (both P < 0.001) and lost 4.4 +/- 0.6 kg and 5.0 +/- 0.9 kg (both P < 0.001), respectively. Both groups lowered systolic and diastolic BP [DC = 2.7 (P < 0.05), 2.7 (P < 0.01); NC = 3.4 (P < 0.01), 4.2 (P < 0.01) mmHg, respectively]. Glucose and insulin concentrations decreased by 0.72 mmol/L (P < 0.001) and 13.20 pmol/L (P < 0.01) in DC group and by 0.83 mmol/L (P < 0.001) and 13.20 pmol/L (P < 0.01), respectively, in NC group. Total cholesterol increased in NC group (P < 0.05), with no significant lipid changes in DC group. There were no significant differences in biomarker outcomes between groups. CONCLUSIONS: Overweight/obese premenopausal women following an 18-week ERD that included either DC or NC sweet snack and sugar-free beverage lost equivalent amounts of BW and improved BP measurements and glucose and insulin concentrations.

Histopathology in Barrett Esophagus and Barrett Esophagus-Related Dysplasia

Pathologic specimens, both biopsies and endoscopic mucosal resections, for Barrett esophagus and Barrett-associated dysplasia and malignancy are common for pathologists in North America, and the incidence in South Asian countries seems to be increasing. Dysplasia and malignancy arising in intestinalized gastric-type mucosa raises issues in the interpretation of dysplasia and the evaluation of the depth of invasion of malignancies that are not seen in squamous dysplasia and squamous cell carcinoma. We review the North American approach to these lesions.

Application of large-scale sequencing to marker discovery in plants.

Advances in DNA sequencing provide tools for efficient large-scale discovery of markers for use in plants. Discovery options include large-scale amplicon sequencing, transcriptome sequencing, gene-enriched genome sequencing and whole genome sequencing. Examples of each of these approaches and their potential to generate molecular markers for specific applications have been described. Sequencing the whole genome of parents identifies all the polymorphisms available for analysis in their progeny. Sequencing PCR amplicons of sets of candidate genes from DNA bulks can be used to define the available variation in these genes that might be exploited in a population or germplasm collection. Sequencing of the transcriptomes of genotypes varying for the trait of interest may identify genes with patterns of expression that could explain the phenotypic variation. Sequencing genomic DNA enriched for genes by hybridization with probes for all or some of the known genes simplifies sequencing and analysis of differences in gene sequences between large numbers of genotypes and genes especially when working with complex genomes. Examples of application of the above-mentioned techniques have been described.

Lipids and lipoprotein profile in doxorubicin treated rats: influence of alpha-tocopherol administration.

The effect of doxorubicin (DXR) on the levels of heart, liver and plasma lipids and plasma lipoproteins were studied in rats. Rats were treated with DXR (2.5 mg/kg body weight weekly for 8 weeks, iv) with or without alpha-tocopherol (alpha-TPL) (400 mg/kg body wt daily for 60 days) co-administration. DXR treated rats showed increase in plasma total cholesterol, triglycerides and phospholipids. The activities of lecithin cholesterol-acyl transferase and hepatic and extrahepatic lipoprotein lipase were lowered significantly with concomitant increase in liver and heart lipid peroxide levels in DXR treatment. HDL cholesterol level was found to be decreased significantly in DXR treated rats as a result of which there was an increase of LDLc/HDLc ratio. alpha-TPL coadministration brought back the enzyme activity to near normal and reduced the level of lipid peroxides. The lipid changes were minimum in rats treated with both alpha-TPL and DXR. This study suggests that the toxicity of DXR is reflected in lipids and lipoprotein profile.

Effect of α-tocopherol on doxorubicin induced alterations in glucose metabolism—A pilot study.

The effect of doxorubicin on glucose metabolism was studied in rats with or without the supplementation of α-tocopherol. Rats were treated with doxorubicin, 2 mg/kg body wt. (intravenously), twice a week, for 6 weeks. α-Tocopherol (400 mg/kg body wt.) was co-administered orally for 2 months. Glycolysis was found to be increased with a significant decrease in the activities of tricarboxylic acid cycle enzymes. A significant increase in liver glycogen was noted in doxorubicin treated rats. Activities of glycogen Phosphorylase, glucose-6-phosphate dehydrogenase and glucose-6-phosphatase were found to be decreased. α-Tocopherol co-administration was found to reduce the alterations in the above mentioned enzyme activities. The results are discussed with reference to the drug metabolism, lipid peroxidation and the antioxidant nature of α-tocopherol.

Effect of alpha-tocopherol on the microsomal lipid peroxidation induced by doxorubicin: influence of ascorbic acid.

alpha-Tocopherol (40 mg/rat/day) was administered, orally, to doxorubicin treated rats (2 mg/kg, twice weekly, for 4 weeks) singly and also in combination with ascorbic acid (1 g/100 ml/day) in drinking water. The vitamin therapy was carried out for a period of 1 month. The microsomal lipid peroxide levels in liver and heart were found to be increased in doxorubicin treated rats. alpha-tocopherol and ascorbic acid treatment decreased the lipid peroxide level and also NADPH-dependent lipid peroxidation. A significant depletion of glutathione in liver and heart of doxorubicin treated animals was found to be ameliorated by vitamin therapy. Ascorbic acid was found to maintain the level of microsomal alpha-tocopherol. The activities of the detoxifying enzymes like catalase, superoxide dismutase and glutathione peroxidase were suppressed in doxorubicin treated rats and vitamins coadministration maintained the levels of these enzymes. Ascorbic acid was found to potentiate the antioxidant nature of alpha-tocopherol.