A diagnosis-based clinical decision rule for spinal pain part 2: review of the literature

<p>Abstract</p> <p>Background</p> <p>Spinal pain is a common and often disabling problem. The research on various treatments for spinal pain has, for the most part, suggested that while several interventions have demonstrated mild to moderate short-term benefit, no single treatment has a major impact on either pain or disability. There is great need for more accurate diagnosis in patients with spinal pain. In a previous paper, the theoretical model of a diagnosis-based clinical decision rule was presented. The approach is designed to provide the clinician with a strategy for arriving at a specific working diagnosis from which treatment decisions can be made. It is based on three questions of diagnosis. In the current paper, the literature on the reliability and validity of the assessment procedures that are included in the diagnosis-based clinical decision rule is presented.</p> <p>Methods</p> <p>The databases of Medline, Cinahl, Embase and MANTIS were searched for studies that evaluated the reliability and validity of clinic-based diagnostic procedures for patients with spinal pain that have relevance for questions 2 (which investigates characteristics of the pain source) and 3 (which investigates perpetuating factors of the pain experience). In addition, the reference list of identified papers and authors' libraries were searched.</p> <p>Results</p> <p>A total of 1769 articles were retrieved, of which 138 were deemed relevant. Fifty-one studies related to reliability and 76 related to validity. One study evaluated both reliability and validity.</p> <p>Conclusion</p> <p>Regarding some aspects of the DBCDR, there are a number of studies that allow the clinician to have a reasonable degree of confidence in his or her findings. This is particularly true for centralization signs, neurodynamic signs and psychological perpetuating factors. There are other aspects of the DBCDR in which a lesser degree of confidence is warranted, and in which further research is needed.</p

Tumor bed brachytherapy for locally advanced laryngeal cancer: a feasibility assessment of combination with ferromagnetic hyperthermia

Purpose. To assess the feasibility of adding hyperthermia to an original method of organ-preserving brachytherapy treatment for locally advanced head and neck tumors. Methods and materials. The method involves organ-preserving tumor resection and adjunctive high-dose-rate (HDR) brachytherapy delivered via afterloading catheters. These catheters are embedded in a polymeric implant prepared intraoperatively to fill the resection cavity, allowing precise computer planning of dose distribution in the surrounding at-risk tumor bed tissue. Theoretical and experimental analyzes address the feasibility of heating the tumor bed implant by coupling energy from a 100 kHz magnetic field applied externally into ferromagnetic particles, which are uniformly distributed within the implant. The goal is to combine adjuvant hyperthermia (40 °C–45 °C) to at-risk tissue within 5 mm of the resection cavity for thermal enhancement of radiation and chemotherapy response. Results. A five-year relapse free survival rate of 95.8% was obtained for a select group of 48 male patients with T3N0M0 larynx tumors, when combining organ-preserving surgery with HDR brachytherapy from a tumor bed implant. Anticipating the need for additional treatment in patients with more advanced disease, a theoretical analysis demonstrates the ability to heat at-risk tissue up to 10 mm from the surface of an implant filled with magnetically coupled ferromagnetic balls. Using a laboratory induction heating system, it takes just over 2 min to increase the target tissue temperature by 10 °C using a 19% volume fraction of ferromagnetic spheres in a 2 cm diameter silicone implant. Conclusion. The promising clinical results of a 48 patient pilot study demonstrate the feasibility of a new organ sparing treatment for laryngeal cancer. Anticipating the need for additional therapy, theoretical estimations of potential implant heating are confirmed with laboratory experiments, preparing the way for future implementation of a thermobrachytherapy implant approach for organ-sparing treatment of locally advanced laryngeal cancer

A non-surgical approach to the management of lumbar spinal stenosis: A prospective observational cohort study

BACKGROUND: While it is widely held that non-surgical management should be the first line of approach in patients with lumbar spinal stenosis (LSS), little is known about the efficacy of non-surgical treatments for this condition. Data are needed to determine the most efficacious and safe non-surgical treatment options for patients with LSS. The purpose of this paper is to describe the clinical outcomes of a novel approach to patients with LSS that focuses on distraction manipulation (DM) and neural mobilization (NM). METHODS: This is a prospective consecutive case series with long term follow up (FU) of fifty-seven consecutive patients who were diagnosed with LSS. Two were excluded because of absence of baseline data or failure to remain in treatment to FU. Disability was measured using the Roland Morris Disability Questionnaire (RM) and pain intensity was measured using the Three Level Numerical Rating Scale (NRS). Patients were also asked to rate their perceived percentage improvement. RESULTS: The mean patient-rated percentage improvement from baseline to the end to treatment was 65.1%. The mean improvement in disability from baseline to the end of treatment was 5.1 points. This was considered to be clinically meaningful. Clinically meaningful improvement in disability from baseline to the end of treatment was seen in 66.7% of patients. The mean improvement in "on average" pain intensity was 1.6 points. This did not reach the threshold for clinical meaningfulness. The mean improvement in "at worst" pain was 3.1 points. This was considered to be clinically meaningful. The mean duration of FU was 16.5 months. The mean patient-rated percentage improvement from baseline to long term FU was 75.6%. The mean improvement in disability was 5.2 points. This was considered to be clinically meaningful. Clinically meaningful improvement in disability was seen in 73.2% of patients. The mean improvement in "on average" pain intensity from baseline to long term FU was 3.0 points. This was considered to be clinically meaningful. The mean improvement in "at worst" pain was 4.2 points. This was considered to be clinically meaningful. Only two patients went on to require surgery. No major complications to treatment were noted. CONCLUSION: A treatment approach focusing on DM and NM may be useful in bringing about clinically meaningful improvement in disability in patients with LSS

Species Trees from Highly Incongruent Gene Trees in Rice

Several methods have recently been developed to infer multilocus phylogenies by incorporating information from topological incongruence of the individual genes. In this study, we investigate 2 such methods, Bayesian concordance analysis and Bayesian estimation of species trees. Our test data are a collection of genes from cultivated rice (genus Oryza) and the most closely related wild species, generated using a high-throughput sequencing protocol and bioinformatics pipeline. Trees inferred from independent genes display levels of topological incongruence that far exceed that seen in previous data sets analyzed with these species tree methods. We identify differences in phylogenetic results between inference methods that incorporate gene tree incongruence. Finally, we discuss the challenges of scaling these analyses for data sets with thousands of gene trees and extensive levels of missing data

Bacterial Infection and Immune Responses in Lutzomyia longipalpis Sand Fly Larvae Midgut

Citation: Heerman, M., Weng, J. L., Hurwitz, I., Durvasula, R., & Ramalho-Ortigao, M. (2015). Bacterial Infection and Immune Responses in Lutzomyia longipalpis Sand Fly Larvae Midgut. Plos Neglected Tropical Diseases, 9(7), 18. doi:10.1371/journal.pntd.0003923The midgut microbial community in insect vectors of disease is crucial for an effective immune response against infection with various human and animal pathogens. Depending on the aspects of their development, insects can acquire microbes present in soil, water, and plants. Sand flies are major vectors of leishmaniasis, and shown to harbor a wide variety of Gram-negative and Gram-positive bacteria. Sand fly larval stages acquire microorganisms from the soil, and the abundance and distribution of these microorganisms may vary depending on the sand fly species or the breeding site. Here, we assess the distribution of two bacteria commonly found within the gut of sand flies, Pantoea agglomerans and Bacillus subtilis. We demonstrate that these bacteria are able to differentially infect the larval digestive tract, and regulate the immune response in sand fly larvae. Moreover, bacterial distribution, and likely the ability to colonize the gut, is driven, at least in part, by a gradient of pH present in the gut

GHRS and ORFEUS-II Observations of the Highly Ionized Interstellar Medium Toward ESO141-055

We present Goddard High Resolution Spectrograph and ORFEUS-II measurements of Si IV, CIV, N V, and O VI absorption in the interstellar medium of the Galactic disk and halo toward the nucleus of the Seyfert galaxy ESO141-055. The high ionization absorption is strong, with line strengths consistent with the spectral signature expected for hot (log T = 5-6) collisionally ionized gas in either a ``Galactic fountain'' or an inhomogeneous medium containing a mixture of conductive interfaces and turbulent mixing layers. The total O VI column density of log N ~ 15 suggests that the scale height of O VI is large (>3 kpc) in this direction. Comparison of the high ion column densities with measurements for other sight lines indicates that the highly ionized gas distribution is patchy. The amount of O VI perpendicular to the Galactic plane varies by at least a factor of ~4 among the complete halo sight lines thus far studied. In addition to the high ion absorption, lines of low ionization species are also present in the spectra. With the possible exception of Ar I, which may have a lower than expected abundance resulting from partial photoionization of gas along the sight line, the absorption strengths are typical of those expected for the warm, neutral interstellar medium. The sight line intercepts a cold molecular cloud with log N(H2) ~ 19. The cloud has an identifiable counterpart in IRAS 100-micron emission maps of this region of the sky. We detect a Ly-alpha absorber associated with ESO141-055 at z = 0.03492. This study presents an enticing glimpse into the interstellar and intergalactic absorption patterns that will be observed at high spectral resolution by the Far Ultraviolet Spectroscopic Explorer.Comment: 24 pages + 8 figures, uses aaspp4.sty. Accepted for publication in Ap

Structured matrices, continued fractions, and root localization of polynomials

We give a detailed account of various connections between several classes of objects: Hankel, Hurwitz, Toeplitz, Vandermonde and other structured matrices, Stietjes and Jacobi-type continued fractions, Cauchy indices, moment problems, total positivity, and root localization of univariate polynomials. Along with a survey of many classical facts, we provide a number of new results.Comment: 79 pages; new material added to the Introductio

String Branchings on Complex Tori and Algebraic Representations of Generalized Krichever-Novikov Algebras

The propagation differential for bosonic strings on a complex torus with three symmetric punctures is investigated. We study deformation aspects between two point and three point differentials as well as the behaviour of the corresponding Krichever-Novikov algebras. The structure constants are calculated and from this we derive a central extension of the Krichever-Novikov algebras by means of b-c systems. The defining cocycle for this central extension deforms to the well known Virasoro cocycle for certain kinds of degenerations of the torus. AMS subject classification (1991): 17B66, 17B90, 14H52, 30F30, 81T40Comment: 11 pages, amste

A New Measurement of the Average FUV Extinction Curve

We have measured the extinction curve in the far-ultraviolet wavelength region of (900 -- 1200 A) using spectra obtained with the Berkeley EUV/FUV spectrometer during the ORFEUS-I and the ORFEUS-II missions in 1993 and 1996. From the complete sample of early-type stars observed during these missions, we have selected pairs of stars with the same spectral type but different reddenings to measure the differential FUV extinction. We model the effects of molecular hydrogen absorption and exclude affected regions of the spectrum to determine the extinction from dust alone. We minimize errors from inaccuracies in the cataloged spectral types of the stars by making our own determinations of spectral types based on their IUE spectra. We find substantial scatter in the curves of individual star pairs and present a detailed examination of the uncertainties and their effects on each extinction curve. We find that, given the potentially large uncertainties inherent in using the pair method at FUV wavelengths, a careful analysis of measurement uncertainties is critical to assessing the true dust extinction. We present a new measurement of the average far-ultraviolet extinction curve to the Lyman limit; our new measurement is consistent with an extrapolation of the standard extinction curve of Savage & Mathis (1979).Comment: 13 pages text, 7 figures 4 tables. Sent as gzipped tar, with ms.tex and 7 figure