Measuring the morphological characteristics of thoracolumbar fascia in ultrasound images: an inter-rater reliability study

BACKGROUND: Chronic lower back pain is still regarded as a poorly understood multifactorial condition. Recently, the thoracolumbar fascia complex has been found to be a contributing factor. Ultrasound imaging has shown that people with chronic lower back pain demonstrate both a significant decrease in shear strain, and a 25% increase in thickness of the thoracolumbar fascia. There is sparse data on whether medical practitioners agree on the level of disorganisation in ultrasound images of thoracolumbar fascia. The purpose of this study was to establish inter-rater reliability of the ranking of architectural disorganisation of thoracolumbar fascia on a scale from ‘very disorganised’ to ‘very organised’. METHODS: An exploratory analysis was performed using a fully crossed design of inter-rater reliability. Thirty observers were recruited, consisting of 21 medical doctors, 7 physiotherapists and 2 radiologists, with an average of 13.03 ± 9.6 years of clinical experience. All 30 observers independently rated the architectural disorganisation of the thoracolumbar fascia in 30 ultrasound scans, on a Likert-type scale with rankings from 1 = very disorganised to 10 = very organised. Internal consistency was assessed using Cronbach’s alpha. Krippendorff’s alpha was used to calculate the overall inter-rater reliability. RESULTS: The Krippendorf’s alpha was .61, indicating a modest degree of agreement between observers on the different morphologies of thoracolumbar fascia.The Cronbach’s alpha (0.98), indicated that there was a high degree of consistency between observers. Experience in ultrasound image analysis did not affect constancy between observers (Cronbach’s range between experienced and inexperienced raters: 0.95 and 0.96 respectively). CONCLUSIONS: Medical practitioners agree on morphological features such as levels of organisation and disorganisation in ultrasound images of thoracolumbar fascia, regardless of experience. Further analysis by an expert panel is required to develop specific classification criteria for thoracolumbar fascia

Effect of ethanolic extract of <i>Phyla nodiflora</i> (Linn.) Greene against calculi producing diet induced urolithiasis

314-321Urolithiasis in its different forms is a frequently encountered urological disorder. For many years it has been at the forefront of urology. In the present study ethanolic extract of whole plant of Phyla nodiflora (Linn.) Greene was studied for its antiurolithiatic activity against most common type of renal stones i.e. calcium oxalate type. Calcium oxalate urolithiasis was induced by administration of Gentamycin and calculi producing diet (5% ammonium oxalate in standard rat pellet feed). The extract was also assessed for effect on in vivo antioxidant parameters like lipid peroxidation, reduced glutathione, catalase in hyperoxaluric kidney and in vitro scavenging of nitric oxide and 2-diphenyl-2-picryl hydrazyl free radicals. Ethanolic extract of P. nodiflora exhibited significant effect in preventing calcium oxalate stone formation and also in dissolving the pre-formed calcium oxalate stones in the kidney along with significant effect on both in vitro and in vivo antioxidant parameters. The present study clearly demonstrates the antiurolithiatic activity of P. nodiflora supporting the traditional claim