Suoran vatsalihaksen erkauma ja alaselkäkipu fysioterapian näkökulmasta tarkasteltuna

Suoran vatsalihaksen erkaumalla tarkoitetaan vatsalihasten keskilinjassa kulkevan linea alban venyttymistä ja ohenemista sekä suoran vatsalihaksen vasemman ja oikean osan erkaantumista lateraalisesti. Suoran vatsalihaksen erkaumaan voi vaikuttaa mm. raskaushormonit, vatsaontelon sisäinen rasva tai liiallinen vatsalihasten harjoittelu. Fysioterapiassa erkauma tutkitaan havainnoimalla, palpoimalla ja mittaamalla sormin, mittareilla tai ultraäänen avulla. Erkauman fysioterapia sisältää erkauman aiheuttamien toimintahäiriöiden ja erkaantuman palauttamista terapeuttisen harjoittelun keinoin. Suoran vatsalihaksen erkaumaa on tutkittu jo jonkin verran ja se on hyvin yleinen syy hakeutua fysioterapiaan. Erkauman yhteyttä selkäkipuun on sen sijaan tutkittu vielä melko vähän. Tämä tutkimus on kuvaileva kirjallisuuskatsaus, joka on tehty yhteistyössä Pohjois-Pohjanmaan sairaanhoitopiirin (PPSHP) kanssa. Tämän tutkimuksen tavoitteena on selvittää suoran vatsalihaksen erkauman yhteyttä alaselkäkipuun ja tarkastella sitä fysioterapian näkökulmasta. Aineistonhaku tehtiin seuraaviin tietokantoihin: Ebsco, PEDro - Physiotherapy Evidence Database, Sage journals, Elsevier Science Direct, PubMed, Cochrane, Medic ja Google Scholar. Tiedonhaussa valittiin sisäänottokriteerien perusteella 15 tutkimusta. Tutkimukset analysoitiin käyttäen aineistolähtöistä sisällönanalyysiä. Kirjallisuuskatsauksen tulokset ovat ristiriitaiset. Kolmessa tutkimuksessa ei löytynyt selkeää yhteyttä suoran vatsalihaksen erkauman ja alaselkäkivun välillä. Puolestaan 12 tutkimuksessa erkaumasta kärsivillä havaittiin enemmän alaselkäkipua. Tutkimuksia, joista löytyi yhteys erkauman ja alaselkäkivun välillä, yhdisti se, että niissä alaselkäkipu oli suurimmaksi osaksi mitattu toimintakykyä laaja-alaisesti arvioivalla mittarilla muihin tutkimuksiin verrattuna. Lisäksi näissä tutkimuksissa tutkimusten kohdejoukko koostui suurimmalta osin synnyttäneistä naisista, joiden iän keskiarvo oli korkeampi muihin tutkimuksiin verrattuna. Kyseisissä tutkimuksissa oli raportoitu erkauman lisäksi myös muita toimintahäiriöitä. Sen sijaan tutkimuksia, joista ei löytynyt yhteyttä erkauman ja selkäkivun välillä, yhdisti se, että selkäkivun mittaamiseen oli käytetty kapea-alaista mittaria. Lisäksi kyseisissä tutkimuksissa kohdejoukkona olivat raskaana olevat naiset ja kohdejoukon iän keskiarvo oli huomattavasti muihin tutkimuksiin verrattuna matalampi. Tutkimuksissa, joissa erkauma hoidettiin kirurgisesti, selkäkipu väheni merkittävästi operaation jälkeen. Suurimmat erot tutkimuksissa löytyi erkauman mittaustavoissa, sekä selkäkivun mittaamiseen käytetyissä mittareissa. Fysioterapian osuus tutkimuksissa oli vähäistä. Fysioterapeutteja oli tutkimuksissa mukana joko tutkijan roolissa tai osana työryhmää kliinikkona.Diastasis of the rectus abdominis (DRA) is a common condition to seek for physical therapy and there is a quite good amount of research at hand. As for the connection of DRA and low back pain (LBP), there is only a small amount of research available. The aim of this study is to determine the connection between DRA and LBP, and to examine the connection from the physical therapy's point of view. This study is a descriptive literary survey made in cooperation with Oulu University Hospital. The material was searched in the following databases: Ebsco, PEDro - Physiotherapy Evidence Database, Sage journals, Elsevier Science Direct, PubMed, Cochrane, Medic and Google Scholar. The search includes 15 articles, and they were analyzed using material based content analysis. The results are inconsistent. In some of the studies there was no clear connection found. On the other hand, in most of the studies people with DRA suffered more from LBP. In the studies that had the connection between DRA and LBP, back pain was mostly measured with integrated measuring methods. In addition, the target group in these studies was mostly women who have had at least one child, and who had a higher mean age. The target group also had other functional disorders besides low back pain. In the studies that did not find connection between DRA and LBP measuring methods for back pain were subjective. The target group consisted of pregnant or younger women. In all of the studies that reported surgical DRA treatment, LBP diminished substantially. Measuring methods for LBP and DRA varied a great deal. The connection to physical therapy was scant. In some studies physical therapists were included as researchers or as a part of the crew, performing measurements, for example. Physical therapists should examine DRA when evaluating LBP causes. Therapists should also continue to rehabilitate the condition in spite of the inconsistent results of this study. The field should standardize their measurement methods for evaluating DRA and use integrated measuring methods when evaluating LBP for more reliable results and for the benefit of the patient

Editor's choice : European Society for Vascular Surgery (ESVS) 2020 clinical practice guidelines on the management of acute limb ischaemia

A

Corrigendum to 'Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections' [European Journal of Vascular & Endovascular Surgery 59/3 (2020) 339-384]

peer reviewe

Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections.

peer reviewe

Modelling human choices: MADeM and decision‑making

Research supported by FAPESP 2015/50122-0 and DFG-GRTK 1740/2. RP and AR are also part of the Research, Innovation and Dissemination Center for Neuromathematics FAPESP grant (2013/07699-0). RP is supported by a FAPESP scholarship (2013/25667-8). ACR is partially supported by a CNPq fellowship (grant 306251/2014-0)

Complex wall modeling for hemodynamic simulations of intracranial aneurysms based on histologic images

Purpose For the evaluation and rupture risk assessment of intracranial aneurysms, clinical, morphological and hemodynamic parameters are analyzed. The reliability of intracranial hemodynamic simulations strongly depends on the underlying models. Due to the missing information about the intracranial vessel wall, the patient-specific wall thickness is often neglected as well as the specific physiological and pathological properties of the vessel wall. Methods In this work, we present a model for structural simulations with patient-specific wall thickness including different tissue types based on postmortem histologic image data. Images of histologic 2D slices from intracranial aneurysms were manually segmented in nine tissue classes. After virtual inflation, they were combined into 3D models. This approach yields multiple 3D models of the inner and outer wall and different tissue parts as a prerequisite for subsequent simulations. Result We presented a pipeline to generate 3D models of aneurysms with respect to the different tissue textures occurring in the wall. First experiments show that including the variance of the tissue in the structural simulation affect the simulation result. Especially at the interfaces between neighboring tissue classes, the larger influence of stiffer components on the stability equilibrium became obvious. Conclusion The presented approach enables the creation of a geometric model with differentiated wall tissue. This information can be used for different applications, like hemodynamic simulations, to increase the modeling accuracy.Peer reviewe

Opportunistic treatment of hepatitis C virus infection (OPPORTUNI-C): study protocol for a pragmatic stepped wedge cluster randomized trial of immediate versus outpatient treatment initiation among hospitalized people who inject drugs

Background: Scaled-up direct-acting antiviral (DAA) treatment of hepatitis C virus (HCV) infection among people who inject drugs (PWID) is crucial to reach the World Health Organization HCV elimination targets within 2030. One of the critical obstacles to HCV care in this population is the lack of treatment models within specialist healthcare adapted to marginalized individuals. Methods: OPPORTUNI-C is a pragmatic stepped wedge cluster randomized trial comparing the efficacy of immediate initiation of HCV treatment with the current standard of care among PWID admitted for inpatient care. Screening for HCV RNA will be performed as soon as possible after admission. The intervention includes immediate non-invasive liver disease assessment, counseling, and initiation of pan-genotypic DAA treatment with individualized follow-up. Standard of care is a referral to outpatient care at discharge. To mimic usual clinical practice as closely as possible, we will use a pragmatic clinical trial approach utilizing clinical infrastructure, broad eligibility criteria, flexible intervention delivery, clinically relevant outcomes, and collection of data readily available from the electronic patient files. The stepped wedge design involves a sequential rollout of the intervention over 16 months, in which seven participating clusters will be randomized from standard of care to intervention in a stepwise manner. Randomization will be stratified according to cluster size to keep high prevalence clusters separated. The trial will include approximately 220 HCV RNA positive individuals recruited from departments of internal medicine, addiction medicine, and psychiatry at Akershus University Hospital, Oslo University Hospital, and Lovisenberg Diaconal Hospital, Oslo, Norway. Individuals not able or willing to give informed consent and those with ongoing HCV assessment or treatment will be excluded. The primary outcome is treatment completion, defined as dispensing of the final prescribed DAA package from the pharmacy within 6 months after inclusion. Secondary outcomes include treatment uptake, virologic response, reinfection incidence, and resistance-associated substitutions. Discussion: Representing a novel model of care suited to reach and engage marginalized PWID in HCV care, this study will inform HCV elimination efforts locally and internationally. If the model proves efficacious and feasible, it should be considered for broader implementation, replacing the current standard of care