Quantitative Analysis of Helical Flow with Accuracy Using Ultrasound Speckle Image Velocimetry: In Vitro and in Vivo Feasibility Studies

Venous valve dysfunction and induced secondary abnormal flows are closely associated with venous diseases. Thus, detailed analysis of venous valvular flow is invaluable from biological and medical perspectives. However, most of the previous studies on venous perivalvular flows were based on qualitative analysis. On the contrary, quantitative analysis of perivalvular flows has not been fully understood. In this study, we used the ultrasound speckle image velocimetry (SIV) technique, which utilizes the speckle patterns of red blood cells (RBCs) created by ultrasound waves to measure 3-D valvular flows quantitatively. The flow structures obtained with the proposed SIV technique for an in vitro model were compared with those obtained by numerical simulation and the color Doppler method to validate the measurement accuracy of the ultrasound SIV technique. Blood flow in the human great saphenous vein was then measured at various distances from the valve with and without exercise. 3-D valvular flow was analyzed in accordance with the dimensionless index, helical intensity. The results obtained by the proposed method matched well with those obtained by numerical simulation and the color Doppler method. The hemodynamic characteristics of 3-D valvular helical flow which were analyzed experimentally using the SIV method would be used for quantitative diagnosis of venous valvular diseases.     

氟哌噻吨美利曲辛片辅助治疗慢性胃炎并发胃食管反流病的可行性分析

目的探讨氟哌噻吨美利曲辛片辅助治疗慢性胃炎并胃食管反流病的临床疗效。方法选取2017年2月～2019年2月收治于我院的慢性胃炎并发胃食管反流病患者84例,按照随机数表法分为观察组和对照组各42例。对照组给予口服埃索美拉唑镁肠溶片治疗,观察组给予口服埃索美拉唑镁肠溶片联合氟哌噻吨美利曲辛片治疗,治疗6周。对比两组患者的治疗效果、胃镜分级情况及治疗4周、8周后的胃食管反流病评分、焦虑抑郁评分情况。结果观察组临床疗效高于对照组,差异有统计学意义(P0.05);与治疗前相比,两组患者胃镜分级均有改善,且观察组优于对照组,差异有统计学意义(P0.05);与治疗前相比,两组患者治疗后4周、8周胃食管反流病评分及焦虑、抑郁评分均降低,且观察组评分优于对照组,差异有统计学意义(P0.05)。结论氟哌噻吨美利曲辛片辅助治疗慢性胃炎并发胃食管反流病的临床效果明显,优于单药治疗。     

Feasibility of a Smartphone-Based Exercise Program for Office Workers With Neck Pain: An Individualized Approach Using a Self-Classification Algorithm

Objective

To explore the feasibility of a newly developed smartphone-based exercise program with an embedded self-classification algorithm for office workers with neck pain, by examining its effect on the pain intensity, functional disability, quality of life, fear avoidance, and cervical range of motion (ROM).

An Analysis of Morbidity In a Hospital-Based Family Practice

Increasing academic and governmental interest in family practice makes it desirable that the fullest documentation be available of current and future patterns in this area of health care delivery. The important issue is raised of the consequences of locating academic departments of family medicine in hospitals with potential influences on the patient composition of practices and the utilization of diagnostic and other services which may bear on the educational process.     

Interstitial Thermotherapy (ITT) Using Nd:YAG Laser as a New Option for the Treatment of Neuroma

Interstitial Laser Induced Thermotherapy (LITT) using Nd:YAG-laser proved to be an alternative or additive method for the treatment of nodular tumors and metastasis which could not be treated with conventional surgical resection or only with high risk for the patient. Because of the high recurrence rate of painful neuroma after surgical removal, which occasionally develop after surgical intervention or after traumatic injury of nerves often are a therapeutically challenge. Therefore, there is a demand to think of new strategies and to explore methods for the treatment of neuroma.One patient with clinical findings of a neuroma was only treated with LITT whereas two other patients with histological confirmed neuroma received interstitial laserthrapy after all attempts to remove the neuroma by common surgical methods were in vain.All patients were irradiated using Nd:YAG-LITT. After an observation period of 4 to 7 years respectively no recurrence of the neuroma occurred and the patients are free of any clinical symptoms.The three cases suggest that LITT using Nd:YAG-laser could be an alternative method to common surgical methods. LITT is minimal invasive, easily to perform and clearly reduced the spectrum of side effects known from the common surgical techniques. Nevertheless, further studies are necessary to confirm our findings and to evaluate laser parameters for optimised LITT of neuroma.     

Using PETTLEP imagery as a simulation technique in nursing: Research and guidelines

One of the most valuable skill sets developed in nurse education is the ability to develop the clinical and practical skills learned. This can take various forms such as university-based practice, simulation and direct experience with patients. To this end imagery, a process where all of the senses are used to create or recreate an experience in the mind, could represent simulated practice of clinical skills. Research on imagery has indicated that the technique, when used to assist in the performance of skill based procedures carried out by nurses can be beneficial. However, guidelines are lacking in this area of simulated practice. In this article, we review current research on the topic of imagery in enhancing skilled performance and outline a model that can assist in conducting interventions. Furthermore, we consider how this could be implemented within a nursing environment to produce beneficial performance effects in both pre-registration and registered nurses.     

Percutaneous Nd:YAG Laser Coagulation of Ventricular Myocardium in Dogs Using a Special Electrode Laser Catheter

A novel catheter system was used for intracardiac electrogram recordings, ventricular pacing and continuous-wave Nd:YAG laser (1,064 nm) irradiation of ventricular myocardium in eight dogs. Radiation at a power of 10 W for 3, 5, and 10 seconds was delivered through a 400 microns optical fiber. Power density was 15 W/mm2. A total of 96 laser injuries (12 per dog) were produced in selected sites in both the right and the left normal canine ventricle. Ventricular arrhythmias were noted during 12 of 96 (12.5%) laser pulses. Programmed electrical stimulation performed during control study immediately (all dogs) at 2 days (two dogs), and 4 months (4 dogs) following the experiments showed no episodes of sustained or nonsustained ventricular tachycardia. Radiation energies up to 50 J (10 W over 5 s) caused focal injuries of homogeneous coagulation/fibrosis localized to the target area, without vaporizing tissue and forming craters. Morphometrically and histologically there was a direct relationship between the energy of radiation delivered, and the extent and severity of the injury produced. The maximum size of lesions measured 7/11 mm (diameter/depth). Using a special catheter system laser coagulation of myocardium can be accomplished percutaneously. This method can create controlled subendocardial injuries without major side effects and appears to overcome most disadvantages of transcatheter high energy direct-current shocks when used as a regular course of procedure in ablation of arrhythmogenic tissue in the heart.     

Feasibility of Adenovirus-Mediated hNIS Gene Transfer and 131I Radioiodine Therapy as a Definitive Treatment for Localized Prostate Cancer

We have developed a replication-competent adenovirus (Ad5-yCD/mutTK_SR39rep-hNIS) armed with two suicide genes and the human sodium iodide symporter (hNIS) gene. In this context, hNIS can be used as a reporter gene in conjunction with nuclear imaging and as a potentially therapeutic gene when combined with ¹³¹I radioiodine therapy. Here, we quantified the volume and magnitude of hNIS gene expression in the human prostate following injection of a high Ad5-yCD/mutTK_SR39rep-hNIS dose using a standardized injection algorithm, and estimated the radiation dose that would be delivered to the prostate had men been administered ¹³¹I with curative intent. Six men with clinically localized prostate cancer received an intraprostatic injection of Ad5-yCD/mutTK_SR39rep-hNIS under transrectal ultrasound guidance. All men received 2 × 0.5 ml deposits (5 × 10¹¹ vp/deposit) in each of the four base and midgland sextants and 2 × 0.25 ml deposits (2.5 × 10¹¹ vp/deposit) in each of the two apex sextants for a total of 12 deposits (5 × 10¹² vp) in 5 ml. On multiple days after the adenovirus injection, men were administered sodium pertechnetate (Na^99mTcO₄) and hNIS gene expression in the prostate was quantified by single photon emission computed tomography (SPECT). hNIS gene expression was detected in the prostate of six of six (100%) men. On average, 45% (range 18–83%) of the prostate volume was covered with gene expression. Had men been administered 200 mCi ¹³¹I, we estimate that the mean absorbed dose to the prostate would be 7.2 ± 4.8 Gy (range 2.1–13.3 Gy), well below that needed to sterilize the prostate. We discuss the obstacles that must be overcome before adenovirus-mediated hNIS gene transfer and ¹³¹I radioiodine therapy can be used as a definitive treatment for localized prostate cancer.     

Prospective Cohort Study of Patients With Neck Pain in a Manual Therapy Setting: Design and Baseline Measures

ObjectivesThe purpose of this study was to describe the design and baseline measurements of a prospective multicenter cohort study in patients with neck pain treated by Dutch manual therapists. Objectives of the study were to determine which patients seek help from a manual therapist, to describe usual care manual therapy in patients with neck pain, to examine the occurrence of nonserious adverse events after treatment, to describe predictors of adverse events, and to determine whether the occurrence of nonserious adverse events affect outcome after manual therapy care.MethodsDuring a 3-month inclusion period, consecutive patients aged between 18 and 80 years presenting with neck pain in manual therapy practices in The Netherlands were included in the study. Baseline questionnaires included the Numeric Rating Scale, Neck Disability Index (NDI), Neck Bournemouth Questionnaire, Fear Avoidance Beliefs Questionnaire (FABQ), and Patient Expectancy List. Within the treatment episode, manual therapist clinical reasoning and applied interventions were registered and patients reported on adverse events. At the end of the treatment episode and at 12-month follow-up, pain intensity (Numeric Rating Scale), functional outcomes (NDI, Neck Bournemouth Questionnaire), personal factors (FABQ), and global perceived effect were measured.ResultsDuring the 3-month inclusion period, 263 participating manual therapists collected data on 1193 patients with neck pain. Most patients (69.4%) were female. The mean age was 44.7 (±13.7) years. The NDI showed overall mild disability (mean score 26%). Mean scores in pain intensity were moderate (4.8), and there was low risk of prolonged disability owing to personal factors (FABQ).ConclusionThis study provides information on baseline characteristics of patients visiting manual therapists for neck pain. In The Netherlands, patients seeking care of manual therapists are comparable to patients in other countries regarding demographics and neck pain characteristics.     

MSCT Follow-Up in Malignant Lymphoma: Comparison of Manual Linear Measurements with Semi-Automated Lymph Node Analysis for Therapy Response Classification

Purpose: Assignment of semi-automated lymph node analysis compared to manual measurements for therapy response classification of malignant lymphoma in MSCT. Materials and Methods: MSCT scans of 63 malignant lymphoma patients before and after 2 cycles of chemotherapy (307 target lymph nodes) were evaluated. The long axis diameter (LAD), short axis diameter (SAD) and bi-dimensional WHO were determined manually and semi-automatically. The time for manual and semi-automatic segmentation was evaluated. The ref. standard response was defined as the mean relative change across all manual and semi-automatic measurements (mean manual/semi-automatic LAD, SAD, semi-automatic volume). Statistical analysis encompassed t-test and McNemar's test for clustered data. Results: Response classification per lymph node revealed semi-automated volumetry and bi-dimensional WHO to be significantly more accurate than manual linear metric measurements. Response classification per patient based on RECIST revealed more patients to be correctly classified by semi-automatic measurements, e. g. 96.0 %/92.9 % (WHO bi-dimensional/volume) compared to 85.7/84.1 % for manual LAD and SAD, respectively (mean reduction in misclassified patients of 9.95 %). Considering the use of correction tools, the time expenditure for lymph node segmentation (29.7 ± 17.4 sec) was the same as with the manual approach (29.1 ± 14.5 sec). Conclusion: Semi-automatically derived "lymph node volume" and "bi-dimensional WHO" significantly reduce the number of misclassified patients in the CT follow-up of malignant lymphoma by at least 10 %. However, lymph node volumetry does not outperform bi-dimensional WHO.     

Modeling Relationships in Clinical Research Using Path Analysis Part I: An Overview of the Process

Marjorie A. Pett and Margaret F. Clayton
Column Editor: Lauren Clark Scientific Inquiry provides a forum to facilitate the ongoing process of questioning and evaluating practice, presents informed practice based on available data, and innovates new practices through research and experimental learning.     

Attachment Therapy Using Deliberate Restraint: An Object Lesson on the Identification of Unvalidated Treatments

TOPIC: An unusual and potentially dangerous intervention called attachment therapy, used for children and adolescence. PURPOSE: To help clinicians understand the nature of attachment therapy and the ways in which it exemplifies unvalidated treatment approaches. SOURCES: Internet and published articles on evaluation of treatments. CONCLUSIONS: Attachment therapy has many characteristics associated with warning signals of an unvalidated treatment. Mental health professionals have responsibilities to educate individuals and the community about unvalidated treatments such as attachment therapy and to work toward legislation and policy change to make such treatments unavailable.     

Ultrasound-Guided Application of Percutaneous Electrolysis as an Adjunct to Exercise and Manual Therapy for Subacromial Pain Syndrome: A Randomized Clinical Trial

This randomized clinical trial compared the effects of adding ultrasound (US)-guided percutaneouselectrolysis into a program consisting of manual therapy and exercise on pain, shoulder-related disability, function, and pressure sensitivity in subacromial pain syndrome. Fifty patients with subacromial pain syndrome were randomized into manual therapy and exercise or percutaneous electrolysis group. All patients received the same manual therapy and exercise program, 1 session per week for 5 consecutive weeks. Patients assigned to the electrolysis group also received the application of percutaneous electrolysis at each session. The primary outcome was assessed using the Disabilitiesof the Arm, Shoulder and Hand (DASH) questionnaire. Secondary outcomes included pain, function (Shoulder Pain and Disability Index [SPADI]) pressure pain thresholds (PPTs) and Global Ratingof Change (GROC). They were assessed at baseline, post-treatment, and 3 and 6 months after treatment. Both groups showed similar improvements in the primary outcome (DASH) at all follow-ups (P = .051). Subjects receiving manual therapy, exercise, and percutaneous electrolysis showed significantlygreater changes in shoulder pain (P < .001) and SPADI (P < .001) than did those receiving manual therapy and exercise alone at all follow-ups. Effect sizes were large (standardized mean difference >.91) for shoulder pain and function at 3 and 6 months in favor of the percutaneous electrolysis group. No between-group differences in PPT were found. The current clinical trial found that the inclusion of US-guided percutaneous electrolysis in combination with manual therapy and exercise resulted in no significant differences for related disability (DASH) compared with the application of manual therapy and exercise alone in patients with subacromial pain syndrome. Nevertheless, differences were reported for some secondary outcomes such as shoulder pain and function (SPADI). Whether these effects are reliable should be addressed in future studies.

Perceptions of Chiropractic Care Among Women With Migraine: A Qualitative Substudy Using a Grounded-Theory Framework

ObjectiveThe purpose of this study was to characterize expectations, attitudes, and experiences of individuals with migraine who were randomly assigned to receive chiropractic care delivered within a randomized controlled trial in a hospital-based integrative care center.MethodsThis qualitative substudy was conducted as a part of a 2-arm pilot pragmatic randomized controlled trial investigating a multimodal model of chiropractic care for women with episodic migraine (4-13 migraines per month). Women were randomly assigned to chiropractic care (10 sessions over 14 weeks) plus enhanced usual care vs enhanced usual care alone. Semistructured interviews were conducted at baseline and 14-week follow-up with 15 randomly selected participants from the 29 participants randomized to the chiropractic group. Qualitative analysis was performed by 2 independent reviewers using a constant comparative method of analysis for generating grounded theory.ResultsIntegrating baseline and follow-up interviews, 3 themes emerged: over the course of treatment with chiropractic care, participants became more aware of the role of musculoskeletal tension, pain, and posture in triggering migraine; participants revised their prior conceptions of chiropractic care beyond spinal manipulation; and participants viewed the chiropractor–patient relationship as an essential and valuable component to effectively managing their migraines.ConclusionIn this qualitative study, women with episodic migraine after receiving comprehensive chiropractic care described chiropractic as a multimodal intervention where they learned about musculoskeletal contributions to migraine, discovered new ways to affect their symptoms, and developed a collaborative patient–practitioner relationship. The results of this study provide insights into perceptions of chiropractic care among women with migraine and suggestions for future trials.