The effects of myofascial manual therapy on muscle activity and blood flow in people with low back pain

Over the past ten years structured clinical massage techniques aimed at the myofascial structures of the body have become a common choice of therapy for people with low back pain (LBP) (Ajimsha, Al-Mudahka and Al-Madzhar, 2015), yet the mechanisms behind their effects remain unclear. The overall aim of this study was to determine the benefits of myofascial manual therapy through an evaluation of the possible mechanisms associated with changes to muscle activity and blood flow, in people with low back pain. The first study aimed to investigate the effects of structured clinical massage techniques (CM) on the flexion relaxation response (FRP) of the paraspinal muscles, range of movement (ROM), pain and disability profiles in subjects with non-specific chronic low back pain compared to a relaxation massage (RM) treatment. Results indicated a main effect of time for trials achieving FRP for the multifidus muscle F (1, 13) = 12.109, p = .004 and a marginal main effect of time for the erector spinae muscle F (1, 13) = 4.495, p = .054. There were significant improvements in VAS F (1, 13) = 6.74, p = .022, and PRI F (1, 13) = 10.254, p

Contaminant metals and cardiovascular health

A growing body of research has begun to link exposure to environmental contaminants, such as heavy metals, with a variety of negative health outcomes. In this paper, we sought to review the current research describing the impact of certain common contaminant metals on cardiovascular (CV) health. We reviewed ten metals: lead, barium, nickel, chromium, cadmium, arsenic, mercury, selenium, zinc, and copper. After a literature review, we briefly summarized the routes of environmental exposure, pathophysiological mechanisms, CV health impacts, and exposure prevention and/or mitigation strategies for each metal. The resulting article discloses a broad spectrum of pathological significance, from relatively benign substances with little to no described effects on CV health, such as chromium and selenium, to substances with a wide-ranging and relatively severe spectrum of CV pathologies, such as arsenic, cadmium, and lead. It is our hope that this article will provide clinicians with a practical overview of the impact of these common environmental contaminants on CV health as well as highlight areas that require further investigation to better understand how these metals impact the incidence and progression of CV diseases

Novel electrodeposited Ni-B/Y 2 O 3 composite coatings with improved properties

Ni-B/Y 2 O 3 composite coatings were developed through an electrodeposition process to study the effect of addition of Y 2 O 3 particles on structure, surface, thermal, mechanical, and anticorrosion properties of Ni-B coatings. It is revealed that parent crystal structure of Ni-B matrix is preserved by addition of Y 2 O 3 , however, a noticeable improvement in crystallinity is observed. The analysis of the surface exhibits formation of dense and nodular deposits in the two types of coatings, but incorporation of Y 2 O 3 particles in Ni-B matrix has resulted in a noteworthy change in grain size and surface roughness. Thermal analysis of the surfaces indicates that Ni-B-Y 2 O 3 composite coatings demonstrate superior thermal stability compared to Ni-B coatings. The nanoindentation analysis shows a significant enhancement in the mechanical characteristics of the Ni-B matrix by addition of Y 2 O 3 particles. This may be contemplated as the result of grain refinement and dispersion hardening of the Ni-B matrix by the presence of hard Y 2 O 3 particles. A decent improvement in the corrosion protection efficiency (73.6%) is also observed by addition of Y 2 O 3 particles into Ni-B matrix. Simultaneous improvement of mechanical and anticorrosion properties suggests potential applications of Ni-B-Y 2 O 3 coatings in oil and gas, automobile, and many other industries. 1 2017 by the authors.Scopu

Synthesis and Performance Evaluation of Pulse Electrodeposited Ni-AlN Nanocomposite Coatings

This research work presents the microscopic analysis of pulse electrodeposited Ni-AlN nanocomposite coatings using SEM and AFM techniques and their performance evaluation (mechanical and electrochemical) by employing nanoindentation and electrochemical methods. The Ni-AlN nanocomposite coatings were developed by pulse electrodeposition. The nickel matrix was reinforced with various amounts of AlN nanoparticles (3, 6, and 9 g/L) to develop Ni-AlN nanocomposite coatings. The effect of reinforcement concentration on structure, surface morphology, and mechanical and anticorrosion properties was studied. SEM and AFM analyses indicate that Ni-AlN nanocomposite coatings have dense, homogenous, and well-defined pyramid structure containing uniformly distributed AlN particles. A decent improvement in the corrosion protection performance is also observed by the addition of AlN particles to the nickel matrix. Corrosion current was reduced from 2.15 to 1.29 μA cm−2 by increasing the AlN particles concentration from 3 to 9 g/L. It has been observed that the properties of Ni-AlN nanocomposite coating are sensitive to the concentration of AlN nanoparticles used as reinforcement

ImPROving TB outcomes by modifying LIFE-style behaviours through a brief motivational intervention followed by short text messages (ProLife): study protocol for a randomised controlled trial

Background: South Africa is among the 7 highest tuberculosis (TB) burden countries. Harmful lifestyle behaviours, such as smoking and alcohol, and poor medication adherence can affect clinical outcomes. Modification of these behaviours is likely to improve TB treatment outcomes and has proven possible using motivational interviewing (MI) techniques or use of short message service (SMS) text messaging. There have been no studies assessing the effect of combined MI and SMS interventions on multiple lifestyle factors and TB treatment outcomes. Methods: This is a prospective, multi-centre, two-arm individual randomised controlled trial looking at the effectiveness and cost-effectiveness of a complex behavioural intervention (the ProLife programme) on improving TB and lifestyle-related outcomes in 3 provinces of South Africa. The ProLife programme consists of an MI counselling strategy, delivered by lay health workers, augmented with subsequent SMS. We aim to recruit 696 adult participants (aged 18 years and over) with drug-sensitive pulmonary TB who are current smokers and/or report harmful or hazardous alcohol use. Patients will be consecutively enrolled at 27 clinics in 3 different health districts in South Africa. Participants randomised individually to the intervention arm will receive 3 MI counselling sessions 1 month apart. Each MI session will be followed by twice-weekly SMS messages targeting treatment adherence, alcohol use and tobacco smoking, as appropriate. We will assess the effect on TB treatment success, using standard World Health Organization (WHO) treatment outcome definitions (primary outcome), as well as on a range of secondary outcomes including smoking cessation, reduction in alcohol use and TB medication and anti-retroviral therapy adherence. Secondary outcomes will be measured at 3 and 6 months follow-up. Discussion: This trial aligns with the WHO agenda of integrating TB care with the care for chronic diseases of life-style, such as provision of smoking cessation treatments, and with the use of digital technologies. If the ProLife programme is found to be effective and cost- effective, the programme could have significant implications for TB treatment globally and could be successfully implemented in a wide range of TB treatment settings

Effect of a brief motivational interview and text message intervention targeting tobacco smoking, alcohol use, and medication adherence to improve tuberculosis treatment outcomes in adult patients with tuberculosis : A multicentre, randomised controlled trial of the ProLife programme in South Africa

Objectives: To investigate the effectiveness of a complex behavioural intervention, ProLife, on tuberculosis (TB) treatment success, medication adherence, alcohol use and tobacco smoking. Design: Multicentre, individual, randomised controlled trial where participants were assigned (1:1) to the ProLife intervention or usual care. Setting: 27 primary care clinics in South Africa. Participants: 574 adults starting treatment for drug-sensitive pulmonary TB who smoked tobacco or reported harmful/hazardous alcohol use. Interventions: The intervention, delivered by lay health workers (LHWs), consisted of 3 brief motivational interviewing (MI) sessions, augmented with Short Message Service (SMS) messages, targeting medication adherence, alcohol use and tobacco smoking. Outcome measures: The primary outcome was successful versus unsuccessful TB treatment at 6 to 9 months, from TB records. Secondary outcomes were biochemically confirmed sustained smoking cessation, reduction in the Alcohol Use Disorder Identification Test (AUDIT) score, improved TB and antiretroviral treatment (ART) adherence and ART initiation, each measured at 3 and 6 months by questionnaires; and cure rates in patients who had bacteriology-confirmed TB at baseline, from TB records. Results: Between 15 November 2018 and 31 August 2019, 574 participants were randomised to receive either the intervention (n=283) or usual care (n=291). TB treatment success rates did not differ significantly between intervention (67.8%) and control (70.1%; OR=0.9 (95% CI: 0.64,1.27)). There was no evidence of an effect at 3- and 6-months respectively on continuous smoking abstinence (OR=0.65 (95% CI: 0.37,1.14); OR=0.76 (95% CI: 0.35,1.63)), TB medication adherence (OR=1.22 (95%CI: 0.52,2.87); OR=0.89 (95%CI: 0.26,3.07)), taking ART (OR=0.79 (0.38,1.65), OR=2.05 (0.80,5.27)) or AUDIT scores (mean score difference 0.55 (95% CI: -1.01,2.11); -0.04 (95% CI: -2,1.91); and adjusting for baseline values. Cure rates were not significantly higher (OR=1.16 (0.83,1.63)). Conclusions: Simultaneous targeting of multiple health risk behaviours with MI and SMS using LHWs may not be an effective approach to improve TB outcomes

National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma

©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.Peer reviewe

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London