Identification of potential neuromotor mechanisms of manual therapy in patients with musculoskeletal disablement: rationale and description of a clinical trial

<p>Abstract</p> <p>Background</p> <p>Many health care practitioners use a variety of hands-on treatments to improve symptoms and disablement in patients with musculoskeletal pathology.</p> <p>Research to date indirectly suggests a potentially broad effect of manual therapy on the neuromotor processing of functional behavior within the supraspinal central nervous system (CNS) in a manner that may be independent of modification at the level of local spinal circuits. However, the effect of treatment speed, as well as the specific mechanism and locus of CNS changes, remain unclear.</p> <p>Methods/Design</p> <p>We developed a placebo-controlled, randomized study to test the hypothesis that manual therapy procedures directed to the talocrural joint in individuals with post-acute ankle sprain induce a change in corticospinal excitability that is relevant to improve the performance of lower extremity functional behavior.</p> <p>Discussion</p> <p>This study is designed to identify potential neuromotor changes associated with manual therapy procedures directed to the appendicular skeleton, compare the relative effect of treatment speed on potential neuromotor effects of manual therapy procedures, and determine the behavioral relevance of potential neuromotor effects of manual therapy procedures.</p> <p>Trial Registration</p> <p><url>http://www.clinicaltrials.gov</url> identifier NCT00847769.</p

Within-day test-retest reliability of transcranial magnetic stimulation measurements of corticomotor excitability for gastrocnemius and tibialis anterior muscles

Background: Manual therapy interventions targeting the talocrural joint can improve gait and balance functions in individuals following ankle sprains. Less is known about the underlying mechanisms of functional improvements after manual therapy. One hypothesis involves change in corticomotor excitability (CE) following manual therapy procedures. Transcranial magnetic stimulation (TMS) is a brain imaging method that could provide important information regarding potential changes in CE associated with manual therapy techniques applied to the talocrural joint. However, within-day reliability of TMS to measure CE must first be established in order to measure CE changes associated with manual therapy procedures. Objective: To determine the within-day test-retest reliability of TMS CE measures for gastrocnemius (GAS) and tibialis anterior (TA) for use in test-retest designs assessing corticomotor excitability in manual therapy and exercise studies. Method: TMS measures, including motor evoked potential (MEP) amplitude and cortical silent period (CSP), were completed twice on the same day under resting and active conditions in n = 6 nondisabled participants. The absolute reliability (coefficient of variation), relative reliability (intraclass correlation coefficient), standard error of measures, and minimal detectable change outside the 95% confidence interval were calculated for both GAS and TA muscles in each experimental condition. Results: There were no statistically significant differences between the first and second TMS measurements. TMS measurements for GAS and TA demonstrated good absolute and relative test-retest reliability under the active condition, but not the resting condition. Discussion: TMS under the active condition can be reliably used to assess CE even in postural muscles with a small cortical representation area, such as GAS

COMMUNITY AND NETWORK RESPONSES FOR ASSISTING MOBILE VULNERABLE POPULATIONS

The COVID-19 crisis highlighted the increasing vulnerability of individuals, households, and communities. It has almost certainly been even more devastating for those who rely on community networks and organizations for aid but are less able to access aid networks in conditions of reduced mobility. This is the case for “mobile vulnerable populations,” among which include persons experiencing homelessness, victims of human trafficking,immigrants, refugees, and Latinos/as. This report summarizes our research with local Omaha service providers about what they need to serve mobile vulnerable populations in the community, how the pandemic has affected their ability to do so, and whether there have been any substantial and/or institutionalized partnerships between UNO/UNMC and these community organizations. In our research, we used a multi-method approach consisting of a survey of community organization leaders and interviews with organization workers engaged into day-to-day service provision to meet the needs of their clients. Our findingscan be summarized in four main themes: (a) organizations were already under-resourced prior to the pandemic; (b) the impact of the COVID-19 pandemic on organizations was substantial; (c) organizations described similar strengths and innovative responses to the pandemic; and (d) there is a lack of institutionalized collaboration with UNO/UNMC. We argue that building connections between UNO/UNMC and community organizations, as well as assisting in the development of networks among various organizations, is central to the mission of the University of Nebraska system and could benefitthe community more broadly. Concluding, we present four main recommendations: (1) more connections are needed between UNO/UNMC and agencies in the Omaha area; (2) it is likely that there are existing relationships between agency partners and UNO/UNMC faculty, staff and students that could be leveraged; (3) there is an opportunity to prepare students and emphasize workforce growth among providers; and (4) the important work of serving mobile vulnerable populations can be rewarding but also challenging for Omaha providers

What are the psychosocial outcomes of treatment for thyroid eye disease? A systematic review

Background: Thyroid eye disease (TED) causes a number of esthetic and visual problems and its treatment requires close clinical assessment, often for several years. There is evidence to suggest that clinical factors are poor indicators of patient-reported outcomes after treatments that aim to improve appearance, vision, or both. Psychosocial factors can impact on both adjustment to living with TED and also patients’ perceptions of their improvements after treatment. There has been growing recognition that it is essential to evaluate treatment efficacy in terms of psychosocial outcomes but, to date, there has been no review that has systematically evaluated psychosocial outcomes following a variety of treatments for TED. Summary: Fifteen studies were included in the review and 6 were randomized controlled trials (RCTs). The studies varied greatly in methodological rigor; whilst major treatments such as surgery do improve quality of life outcomes, other non-invasive treatments such as intravenous steroids can have a similar impact and show long-term benefits. Only 3 studies reviewed orbital decompressive surgery which showed better psychosocial outcomes than other types of surgery. Conclusions: The effect of some treatments remains unclear due to poor methodology and poor reporting of results. Clinicians need to be aware when planning rehabilitative treatments such as surgery the influence of psychosocial factors on quality of life outcomes and the lack of a relationship with clinical factors such as disease severity

Non-operative management of posterior tibialis tendon dysfunction: design of a randomized clinical trial [NCT00279630]

BACKGROUND: Posterior tibialis tendon dysfunction (PTTD) is a common cause of foot pain and dysfunction in adults. Clinical observations strongly suggest that the condition is progressive. There are currently no controlled studies evaluating the effectiveness of exercise, orthoses, or orthoses and exercise on Stage I or IIA PTTD. Our study will explore the effectiveness of an eccentric versus concentric strengthening intervention to results obtained with the use of orthoses alone. Findings from this study will guide the development of more efficacious PTTD intervention programs and contribute to enhanced function and quality of life in persons with posterior tibialis tendon dysfunction. METHODS/DESIGN: This paper presents the rationale and design for a randomized clinical trial evaluating the effectiveness of a treatment regime for the non-operative management of Stage I or IIA PTTD. DISCUSSION: We have presented the rationale and design for an RCT evaluating the effectiveness of a treatment regimen for the non-operative management of Stage I or IIA PTTD. The results of this trial will be presented as soon as they are available

Underexpression of LATS1 TSG in colorectal cancer is associated with promoter hypermethylation

AIM: To investigate large tumor suppressor 1 (LATS1) expression, promoter hypermethylation, and microsatellite instability in colorectal cancer (CRC). METHODS: RNA was isolated from tumor tissue of 142 CRC patients and 40 colon mucosal biopsies of healthy controls. After reverse transcription, quantitative polymerase chain reaction (PCR) was performed, and LATS1 expression was normalized to expression of the ACTB and RPL32 housekeeping genes. To analyze hypermethylation, genomic DNA was isolated from 44 tumor CRC biopsies, and methylation-specific PCR was performed. Microsatellite instability (MSI) status was checked with PCR using BAT26, BAT25, and BAT40 markers in the genomic DNA of 84 CRC patients, followed by denaturing gel electrophoresis. RESULTS: Decreased LATS1 expression was found in 127/142 (89.4%) CRC cases with the average ratio of the LATS1 level 10.33 ± 32.64 in CRC patients vs 32.85 ± 33.56 in healthy controls. The lowest expression was found in Dukes’ B stage tumors and G1 (well-differentiated) cells. Hypermethylation of the LATS1 promoter was present in 25/44 (57%) CRC cases analyzed. LATS1 promoter hypermethylation was strongly associated with decreased gene expression; methylated cases showed 162× lower expression of LATS1 than unmethylated cases. Although high-grade MSI (mutation in all three markers) was found in 14/84 (17%) cases and low-grade MSI (mutation in 1-2 markers) was found in 30/84 (36%) cases, we found no association with LATS1 expression. CONCLUSION: Decreased expression of LATS1 in CRC was associated with promoter hypermethylation, but not MSI status. Such reduced expression may promote progression of CRC

Optimisation of Physical and Chemical Treatments to Control Browning Development and Enzymatic Activity on Fresh-cut Apple Slices

Optimisation of processing time and pre-treatments are crucial factors prior to apple drying to produce a high-quality product. The purpose of the present study was to test the utility of physical (hot-water, HWB and steam blanching, SB) and chemical (1% ascorbic acid, AA; and 1% citric acid, CA) treatments, alone or in combination in reducing surface discolouration as well as oxidative enzyme activity in apple slices (cv. Golden Delicious and Elstar) exposed to air at room temperature for 0, 30 and 60 min. The total colour change (ΔE) for Golden Delicious was equal to 2.38, 2.68, and 4.05 after 0, 30 and 60 min of air exposure, respectively. Dipping in AA solution (1% w/v) was found to be the best treatment to limit surface discolouration of both apple cultivars. The best heat treatments to inhibit polyphenol oxidase/peroxidase enzymes activity were 70 °C HWB for Golden Delicious and 60 °C HWB for Elstar slices, both in combination with a solution of 1% AA and 1% CA. The tested apple cultivars were found to require different treatments at minimum ambient air exposure to obtain the best surface colour condition

QSAR studies on a number of pyrrolidin-2-one antiarrhythmic arylpiperazinyls

The activity of a number of 1-[3-(4-arylpiperazin-1-yl)propyl]pyrrolidin-2-one antiarrhythmic (AA) agents was described using the quantitative structure–activity relationship model by applying it to 33 compounds. The molecular descriptors of the AA activity were obtained by quantum chemical calculations combined with molecular modeling calculations. The resulting model explains up to 91% of the variance and it was successfully validated by four tests (LOO, LMO, external test, and Y-scrambling test). Statistical analysis shows that the AA activity of the studied compounds depends mainly on the PCR and JGI4 descriptors