Evaluation of short-term effects of three passive aquatic interventions on chronic non-specific low back pain: Study protocol for a randomized cross-over clinical trial

Background: Low back pain (LBP) is among the most common physical ailments and its chronic manifestation is a leading cause for disability worldwide. LBP is not attributable to a known diagnosis in 85% of the cases and therefore called chronic non-specific LBP (cnLBP). Passive immersion in warm water is commonly claimed to reduce muscular tension and pain, but not yet sufficiently investigated with regard to cnLBP. The current study compares three passive aquatic interventions regarding their effects on cnLBP: floating (resting in a supine immersed position on flotation devices), WATSU (a passive hands-on treatment, in which a practitioner stands in warm water, gently moving and massaging the client), and a Spa session. Methods: In this randomized cross-over clinical trial, all 24 adult participants with cnLBP will undergo the three interventions in balanced order with a washout-period of at least two weeks in between. Assessments will take place at baseline and follow-up of study and immediately before and after each intervention. Assessments cover the primary outcome self-reported current pain (Visual Analog Scale, range: 0-100 mm), other self-report questionnaires (addressing, e.g., personality traits or -states), and physiological parameters (e.g., measurement of spinal range of motion). Discussion: The study adds estimates of intervention-specific effect-sizes of widespread passive aquatic interventions to cnLBP. The study also points to potential underlying pain-reducing mechanisms. Trial registration: The protocol was approved by the Ethics Committee of the Canton Bern (ProjectID: 2018-00461). Trial registration is intended at ClinicalTrials.gov. Keywords: Flotation; Hydrotherapy; Relaxation; Spa therapy; Thermoneutral; WATSU; Warm water

Applications, indications, and effects of passive hydrotherapy WATSU (WaterShiatsu)—A systematic review and meta-analysis

BACKGROUND: WATSU (portmanteau word: water and shiatsu) is a form of passive hydrotherapy in chest-deep thermoneutral water (35°C = 95°F = 308.15 K). It combines elements of myofascial stretching, joint mobilization, massage, and shiatsu and is reported to be used to address physical and mental issues. The objective of this systematic review (PROSPERO Registration No. CRD42016029347) and the meta-analyses was to assess the applications, indications, and the effects of WATSU to form a basis for further studies. METHODS: A search for "WATSU OR watershiatsu OR (water AND shiatsu)" was conducted without any restrictions in 32 databases. Peer reviewed original articles addressing WATSU as a stand-alone hydrotherapy were assessed for risk of bias. Quantitative data of effects on pain, physical function, and mental issues were processed in random model meta-analyses with subgroup analyses by study design. Effect sizes were expressed as Hedges's g (± 95% confidence intervals). RESULTS: Of 1,906 unique citations, 27 articles regardless of study design were assessed for risk of bias. WATSU has been applied to individuals of all ages. Indications covered acute (e.g. pregnancy related low back pain) and chronic conditions (e.g. cerebral palsy) with beneficial effects of WATSU regarding e.g. relaxation or sleep quality. Meta-analyses suggest beneficial effect sizes of WATSU on pain (overall Hedges's g = -0.71, 95% CI = -0.91 to -0.51), physical function (overall Hedges's g = -0.76, 95% CI = -1.08 to -0.44), and mental issues (overall Hedges's g = -0.68, 95% CI = -1.02 to -0.35). CONCLUSION: Various applications, indications and beneficial effects of WATSU were identified. The grade of this evidence is estimated to be low to moderate at the best. To strengthen the findings of this study, high-quality RCTs are needed. PMID: 32168328 PMCID: PMC7069616 DOI: 10.1371/journal.pone.022970

Berührt sein – Ein Fallbericht zur Rolle von WATSU (WasserShiatsu) in der Rehabilitation nach Polytrauma

Hintergrund: Die herausragende Bedeutung von Körperkontakt für den Menschen ist bekannt und nachgewiesen. Während aber intensiver Körperkontakt in der medizinischen Versorgung von Frühgeborenen etabliert ist, wird Berührung in schulmedizinische Therapiekonzepte für Erwachsene bisher nur marginal integriert. Massnahmen aus der Komplementärmedizin berücksichtigen den individuellen Bedarf an körperlicher Nähe und leisten einen klinischen Mehrwert für den Gesundungsprozess. In besonderer Weise nimmt sich WATSU (WasserShiatsu) achtsamer Berührung an: Während der Behandlung ruht die PatientIn eine Stunde lang auf Händen, Armen oder Schultern ihrer TherapeutIn und wird in grossräumigen, langsamen Kreisbewegungen in 35° C warmem Wasser bewegt, gedehnt und massiert. Die Arbeitsweise vermittelt Geborgenheit und Nähe, habituelle Haltemuster können gelöst und neue Bewegungsoptionen aufgezeigt werden. In der wissenschaftlichen Literatur werden WATSU u.a. die Reduktion von muskulären Verspannungen, Schmerzen und Stress zugeordnet. Methoden: An einem Fallbeispiel wird WATSU als Therapiebaustein in der Rehabilitation nach einem Polytrauma dargestellt. Eine 52-jährige Frau erlitt bei einem Motorradunfall schwerste Verletzungen (Rippenserienfrakturen, Einblutung in den Lungenflügel, Beckenringfraktur, Trümmerfraktur des Oberschenkelknochens). Die Patientin litt unter Schmerzen und Bewegungseinschränkungen, aber auch verminderter psychischer Belastbarkeit (Schreckhaftigkeit, Albträume). Auf eigenen Wunsch ergänzte sie ihre ambulante Rehabilitation um sechs WATSU-Sitzungen (1x pro Woche). Sie führte während dieser Zeit ein Tagebuch über ihre Therapieerfahrung, welches sie später zur wissenschaftlichen Auswertung zur Verfügung stellte. Diese erfolgte nach dem Triangulationsmodell nach Mayring. Resultate: Die Tagebucheinträge der Patientin umfassen emotionale, mentale und körperliche Inhalte. Bemerkungen ohne Bezug zu WATSU reflektieren in erster Linie Erfahrungen im Zusammenhang mit therapeutischen und medizinischen Interventionen, zu einem geringen Anteil aber auch körperliche Aktivitäten in der Freizeit. Im Zusammenhang mit WATSU schildert sie u.a. wie dieses zu erhöhter Selbstakzeptanz und zur Korrektur ihres Körperschemas beitrug. Sie beschreibt Veränderungen der Wahrnehmung, häufig verbunden mit starken Emotionen: «Ich spürte Bewegungen, die in den letzten drei Monaten überhaupt nicht mehr möglich waren. Es waren «fremde Bewegungen», […] über deren Intensität ich erstaunt war.», «[Während WATSU] habe ich schmerzlich festgestellt, dass ich nur in meinem Unfallbein existiere, alles dreht sich nur um das. […] Aber ich habe auch noch einen rechten Arm, einen Kopf, mein linkes Superbein leistet extrem viel! … Irgendwann liefen die Tränen, erst lautlos, dann hemmungslos.» Rumpfmobilisation im WATSU stand für sie in direkter Verbindung zu vertiefter Atmung, beschriebene Reaktionen wie langanhaltendes Zittern des ganzen Körpers (beginnend beim betroffenen Bein) können als Stressabbau des autonomen Nervensystems gedeutet werden. Inhaltlich, aber auch in der Art der Beschreibung unterscheiden sich die WATSU-bezogenen Textteile deutlich von jenen, in denen es um andere therapeutische und medizinische Interventionen geht: etwa bleibt der Themenkreis «Mentale und emotionale Achtsamkeit» ausschliesslich den WATSU-bezogenen Schilderungen vorbehalten, während «Schmerz» in Zusammenhang mit dieser Therapie nie thematisiert wird. Schlussfolgerung: WATSU wurde von dieser Patientin als in ihrer komplexen rehabilitativen Situation sehr hilfreich dargestellt. Es habe ihre Aufmerksamkeit weg von Problemen und Missempfindungen hin zu positiven Gefühlen und erfreulichen Körpererfahrungen gelenkt. Dieser Falldarstellung ist nur ein Einzelbericht, weist aber darauf hin, dass WATSU eine Bereicherung des klinischen Settings darstellen könnte. Wünschenswert wäre die weitere wissenschaftliche Überprüfung von WATSU hinsichtlich differenzierter Indikationen und klinischer Effekte

A Compact Vertical Scanner for Atomic Force Microscopes

A compact vertical scanner for an atomic force microscope (AFM) is developed. The vertical scanner is designed to have no interference with the optical microscope for viewing the cantilever. The theoretical stiffness and resonance of the scanner are derived and verified via finite element analysis. An optimal design process that maximizes the resonance frequency is performed. To evaluate the scanner’s performance, experiments are performed to evaluate the travel range, resonance frequency, and feedback noise level. In addition, an AFM image using the proposed vertical scanner is generated

Structural basis for the disaggregase activity and regulation of Hsp104

The Hsp104 disaggregase is a two-ring ATPase machine that rescues various forms of non-native proteins including the highly resistant amyloid fibers. The structural-mechanistic underpinnings of how the recovery of toxic protein aggregates is promoted and how this potent unfolding activity is prevented from doing collateral damage to cellular proteins are not well understood. Here, we present structural and biochemical data revealing the organization of Hsp104 from Chaetomium thermophilum at 3.7 angstrom resolution. We show that the coiled-coil domains encircling the disaggregase constitute a 'restraint mask' that sterically controls the mobility and thus the unfolding activity of the ATPase modules. In addition, we identify a mechanical linkage that coordinates the activity of the two ATPase rings and accounts for the high unfolding potential of Hsp104. Based on these findings, we propose a general model for how Hsp104 and related chaperones operate and are kept under control until recruited to appropriate substrates

Development of a Hybrid Atomic Force Microscopic Measurement System Combined with White Light Scanning Interferometry

A hybrid atomic force microscopic (AFM) measurement system combined with white light scanning interferometry for micro/nanometer dimensional measurement is developed. The system is based on a high precision large-range positioning platform with nanometer accuracy on which a white light scanning interferometric module and an AFM head are built. A compact AFM head is developed using a self-sensing tuning fork probe. The head need no external optical sensors to detect the deflection of the cantilever, which saves room on the head, and it can be directly fixed under an optical microscopic interferometric system. To enhance the system’s dynamic response, the frequency modulation (FM) mode is adopted for the AFM head. The measuring data can be traceable through three laser interferometers in the system. The lateral scanning range can reach 25 mm × 25 mm by using a large-range positioning platform. A hybrid method combining AFM and white light scanning interferometry is proposed to improve the AFM measurement efficiency. In this method, the sample is measured firstly by white light scanning interferometry to get an overall coarse morphology, and then, further measured with higher resolution by AFM. Several measuring experiments on standard samples demonstrate the system’s good measurement performance and feasibility of the hybrid measurement method

Comparing the value of mono- vs coculture for high-throughput compound screening in hematological malignancies

Large-scale compound screens are a powerful model system for understanding variability of treatment response and discovering druggable tumor vulnerabilities of hematological malignancies. However, as mostly performed in a monoculture of tumor cells, these assays disregard modulatory effects of the in vivo microenvironment. It is an open question whether and to what extent coculture with bone marrow stromal cells could improve the biological relevance of drug testing assays over monoculture. Here, we established a high-throughput platform to measure ex vivo sensitivity of 108 primary blood cancer samples to 50 drugs in monoculture and coculture with bone marrow stromal cells. Stromal coculture conferred resistance to 52% of compounds in chronic lymphocytic leukemia (CLL) and 36% of compounds in acute myeloid leukemia (AML), including chemotherapeutics, B-cell receptor inhibitors, proteasome inhibitors, and Bromodomain and extraterminal domain inhibitors. Only the JAK inhibitors ruxolitinib and tofacitinib exhibited increased efficacy in AML and CLL stromal coculture. We further confirmed the importance of JAK-STAT signaling for stroma-mediated resistance by showing that stromal cells induce phosphorylation of STAT3 in CLL cells. We genetically characterized the 108 cancer samples and found that drug-gene associations strongly correlated between monoculture and coculture. However, effect sizes were lower in coculture, with more drug-gene associations detected in monoculture than in coculture. Our results justify a 2-step strategy for drug perturbation testing, with large-scale screening performed in monoculture, followed by focused evaluation of potential stroma-mediated resistances in coculture