Cervical brachalgia: Assessment by cervical CT epidurography post transforaminal injection

Adjunct cervical CT epidurography (CCTE) can be used to image impingement in patients with cervical brachalgia undergoing fluoroscopic-guided cervical transforaminal injection (TFI) of steroid/local anaesthetic where magnetic resonance imaging (MRI) is contraindicated. CCTE images of the 9 patients on whom the authors performed CCTE post TFI over 6 years from 1998 to 2003 were retrospectively reviewed. CCTE is able to provide good images of the cervical spinal canal and its contents. CCTE may be an alternative imaging method for impingement in patients with cervical brachalgia contraindicated for MRI

Enabling Thin and Flexible Solid-State Composite Electrolytes by the Scalable Solution Process

All solid-state batteries (ASSBs) have the potential to deliver higher energy densities, wider operating temperature range, and improved safety compared with today's liquid-electrolyte-based batteries. However, of the various solid-state electrolyte (SSE) classes - polymers, sulfides, or oxides - none alone can deliver the combined properties of ionic conductivity, mechanical, and chemical stability needed to address scalability and commercialization challenges. While promising strategies to overcome these include the use of polymer/oxide or sulfide composites, there is still a lack of fundamental understanding between different SSE-polymer-solvent systems and its selection criteria. Here, we isolate various SSE-polymer-solvent systems and study their molecular level interactions by combining various characterization tools. With these findings, we introduce a suitable Li7P3S11SSE-SEBS polymer-xylene solvent combination that significantly reduces SSE thickness (∼50 μm). The SSE-polymer composite displays high room temperature conductivity (0.7 mS cm-1) and good stability with lithium metal by plating and stripping over 2000 h at 1.1 mAh cm-2. This study suggests the importance of understanding fundamental SSE-polymer-solvent interactions and provides a design strategy for scalable production of ASSBs

Optimality principles explaining divergent responses of alpine vegetation to environmental change

Recent increases in vegetation greenness over much of the world reflect increasing CO2 globally and warming in cold areas. However, the strength of the response to both CO2 and warming in those areas appears to be declining for unclear reasons, contributing to large uncertainties in predicting how vegetation will respond to future global changes. Here, we investigated the changes of satellite-observed peak season absorbed photosynthetically active radiation (Fmax) on the Tibetan Plateau between 1982 and 2016. Although climate trends are similar across the Plateau, we identified robust divergent responses (a greening of 0.31 ± 0.14% year−1 in drier regions and a browning of 0.12 ± 0.08% year−1 in wetter regions). Using an eco-evolutionary optimality (EEO) concept of plant acclimation/adaptation, we propose a parsimonious modelling framework that quantitatively explains these changes in terms of water and energy limitations. Our model captured the variations in Fmax with a correlation coefficient (r) of .76 and a root mean squared error of .12 and predicted the divergent trends of greening (0.32 ± 0.19% year−1) and browning (0.07 ± 0.06% year−1). We also predicted the observed reduced sensitivities of Fmax to precipitation and temperature. The model allows us to explain these changes: Enhanced growing season cumulative radiation has opposite effects on water use and energy uptake. Increased precipitation has an overwhelmingly positive effect in drier regions, whereas warming reduces Fmax in wetter regions by increasing the cost of building and maintaining leaf area. Rising CO2 stimulates vegetation growth by enhancing water-use efficiency, but its effect on photosynthesis saturates. The large decrease in the sensitivity of vegetation to climate reflects a shift from water to energy limitation. Our study demonstrates the potential of EEO approaches to reveal the mechanisms underlying recent trends in vegetation greenness and provides further insight into the response of alpine ecosystems to ongoing climate change

Musculoskeletal MRI protocol

The authors propose a musculoskeletal (MSK) magnetic resonance imaging (MRI) protocol using selected sequences for common orthopaedic indications. Selected sequences allow optimal visualisation of the indicated pathology while screening for other common conditions. The authors emphasise the need for standard positioning of the patient and standard orientation of scan planes to facilitate comparison with follow-up scans

Bekkenbanden voor acute stabilisatie van instabiele bekkenfracturen

Bekkenbanden zijn ontwikkeld voor de acute behandeling van instabiele bekkenringfracturen in de prehospitale fase. Deze behandeling is gericht op het beperken van het inwendig bloedverlies door het verkleinen van het bij bekkenfracturen toegenomen bekkenvolume en het stabiliseren van de fractuurdelen. Het effect van commercieel verkrijgbare bekkenbanden op de reductie van de symphysis pubisdiastase en de hemodynamische stabiliteit is aangetoond. Het langdurig gebruik van bekkenbanden wordt ontraden wegens toegenomen risico op het ontwikkelen van decubitus. Met name langdurige immobilisatie met een bekkenband op een traumaplank dient voorkomen te worden. In dit artikel wordt een aantal verschillende bekkenbanden besproken en wordt een casus gepresenteerd.Pelvic circumferential compression devices have been developed for initial treatment of unstable pelvic ring fractures in the prehospital situation. The treatment is aimed at achieving tamponade by reducing the increased pelvic volume and reducing the bleeding from fracture surfaces. The effect of commercially available pelvic circumferential compression devices on the reduction of symphysis pubis diastasis and the resuscitation has been proved. Prolonged use of these devices is complicated by the risk of development of pressure sores. Therefore prolonged immobilization on a spine board should be avoided. A number of different pelvic binders will be discussed in this article, which also presents a case

Acupuncture and moxibustion for lateral elbow pain: A systematic review of randomized controlled trials

Background: Acupuncture and moxibustion have widely been used to treat lateral elbow pain (LEP). A comprehensive systematic review of randomized controlled trials (RCTs) including both English and Chinese databases was conducted to assess the efficacy of acupuncture and moxibustion in the treatment of LEP.Methods: Revised STRICTA (2010) criteria were used to appraise the acupuncture procedures, the Cochrane risk of bias tool was used to assess the methodological quality of the studies. A total of 19 RCTs that compared acupuncture and/or moxibustion with sham acupuncture, another form of acupuncture, or conventional treatment were included.Results: All studies had at least one domain rated as high risk or uncertain risk of bias in the Cochrane risk of bias tool. Results from three RCTs of moderate quality showed that acupuncture was more effective than sham acupuncture. Results from 10 RCTs of mostly low quality showed that acupuncture or moxibustion was superior or equal to conventional treatment, such as local anesthetic injection, local steroid injection, non-steroidal anti- inflammatory drugs, or ultrasound. There were six low quality RCTs that compared acupuncture and moxibustion combined with manual acupuncture alone, and all showed that acupuncture and moxibustion combined was superior to manual acupuncture alone.Conclusion: Moderate quality studies suggest that acupuncture is more effective than sham acupuncture. Interpretations of findings regarding acupuncture vs. conventional treatment, and acupuncture and moxibustion combined vs. manual acupuncture alone are limited by the methodological qualities of these studies. Future studies with improved methodological design are warranted to confirm the efficacy of acupuncture and moxibustion for LEP. © 2014 Gadau et al.; licensee BioMed Central Ltd

Protocol for Acupuncture Treatment of Lateral Elbow Pain: A Multisite Randomised Controlled Trial in China, Hong Kong, Australia, and Italy

© 2016 Christopher Zaslawski et al. Background. Lateral elbow pain is one of the most common musculoskeletal pains associated with the upper limb and has an estimated population incidence of 1-3%. Methods/Design. This study protocol is for a multisite randomised controlled study and is designed to evaluate the clinical efficacy of acupuncture in the treatment of chronic (over three months' duration) lateral elbow pain. Four study sites, in the People's Republic of China, Hong Kong, Italy, and Australia, will recruit 24 participants each. A total of 96 participants will be randomised to either an acupuncture group or a sham laser control group. The primary outcome measure will be the Disabilities of Arm, Shoulder, and Hand questionnaire with secondary outcome measures of Pain-Free Grip Strength Test, Muscle Tension Test, and a pain visual analogue scale. Discussion. Key features for conducting a multisite international acupuncture randomised clinical trial have been detailed in this protocol. Trial Registration. This trial is registered at Australian and New Zealand Clinical Trial Registry ACTRN12613001138774 on 11 October, 2013