Non-surgical spinal decompression therapy: does the scientific literature support efficacy claims made in the advertising media?

<p>Abstract</p> <p>Background</p> <p>Traction therapy has been utilized in the treatment of low back pain for decades. The most recent incarnation of traction therapy is non-surgical spinal decompression therapy which can cost over $100,000. This form of therapy has been heavily marketed to manual therapy professions and subsequently to the consumer. The purpose of this paper is to initiate a debate pertaining to the relationship between marketing claims and the scientific literature on non-surgical spinal decompression.</p> <p>Discussion</p> <p>Only one small randomized controlled trial and several lower level efficacy studies have been performed on spinal decompression therapy. In general the quality of these studies is questionable. Many of the studies were performed using the VAX-D^®unit which places the patient in a prone position. Often companies utilize this research for their marketing although their units place the patient in the supine position.</p> <p>Summary</p> <p>Only limited evidence is available to warrant the routine use of non-surgical spinal decompression, particularly when many other well investigated, less expensive alternatives are available.</p

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR &lt; 60 mL/min/1.73 m2) or eGFR reduction &gt; 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR &lt; 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR &gt; 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Assessment And Testing of Industrial Devices Robustness Against Cyber Security Attacks

CERN (European Organization for Nuclear Research),like any organization, needs to achieve the conflicting objectives of connecting its operational network to Internet while at the same time keeping its industrial control systems secure from external and internal cyber attacks. With this in mind, the ISA-99[0F1] international cyber security standard has been adopted at CERN as a reference model to define a set of guidelines and security robustness criteria applicable to any network device. Devices robustness represents a key link in the defense-in-depth concept as some attacks will inevitably penetrate security boundaries and thus require further protection measures. When assessing the cyber security robustness of devices we have singled out control system-relevant attack patterns derived from the well-known CAPEC[1F2] classification. Once a vulnerability is identified, it needs to be documented, prioritized and reproduced at will in a dedicated test environment for debugging purposes. CERN - in collaboration with SIEMENS - has designed and implemented a dedicated working environment, the Test-bench for Robustness of Industrial Equipments[2F3] (“TRoIE”). Such tests attempt to detect possible anomalies by exploiting corrupt communication channels and manipulating the normal behavior of the communication protocols, in the same way as a cyber attacker would proceed. This document provides an inventory of security guidelines[3F4] relevant to the CERN industrial environment and describes how we have automated the collection and classification of identified vulnerabilities into a test-bench

IEC 61850 Industrial Communication Standards under Test

IEC-61850, as part of the International Electrotechnical Commission's (IEC) Technical Committee 57 (TC57), defines an international and standardized methodology to design electric power automation substations

Mass-Accessible Controls Data for Web Consumers

The past few years in computing have seen the emergence of smart mobile devices, sporting multi-core embedded processors, powerful graphical processing units, and pervasive high-speed wireless network connections (supported by WIFI or EDGE/UMTS). The relatively limited capacity of these devices

Prognostic significance of the Ki-67 labelling index in GH-secreting pituitary adenomas

Objective. A single prognostic parameter useful to distinguish acromegalic patients at major risk of recurrence after adenomectomy is still not available. Taking into account the correlation between Ki-67 and the recurrence rate of pituitary adenomas, we studied the clinical outcome of acromegalic patients in relation to the expression of Ki-67 by the tumour tissue. Materials and methods. Study population : 39 newly-diagnosed acromegalic patients submitted to adenomectomy from 2000 to 2005. Before surgical procedure, and during the post-surgical follow-up, all patients performed a hormonal evaluation by assessment of serum IGF-I levels and GH suppression after OGTT and a radiological examination with MRI. Extrasellar extension or invasiveness of surrounding structures by the adenoma was evaluated by the neurosurgeon during adenomectomy. Each tissue sample taken from the adenoma was submitted to immunohistochemistry in order to detect Ki-67 expression. Patients were divided as following: group 1 with Ki-67 values  1% and group 2 with Ki-67> 1%. Patients were given medical therapy with somatostatin analogs in case of persistence of disease. Results. The two groups did not differ in terms of age at diagnosis, sex, tumour size, pre-surgical GH and IGF-I levels, post-surgical GH levels, tumour invasiveness or extrasellar extension Percentage of patients cured after adenomectomy was higher in group 1 (p<0.05); post-surgical IGF-I levels and percentage of recurrence of disease at neuroradiological follow-up were higher in group 2 (p<0.05); moreover the percentage of patients controlled during medical therapy was higher in group 1. Conclusion. Ki-67 is a useful prognostic parameter of recurrence of disease after adenomectomy and a predictor of efficacy of therapy with somatostatin analogs in acromegaly