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Configuration variability of the six-minute walk test among licensed physical therapists working with neurologic conditions: a pilot survey
No full textBackground: The six-minute walk test (6MWT) is considered reliable and valid for assessing walking capacity in people with neurologic conditions. However, the consistency in the test length and configuration used is unclear. Purpose: To determine how the 6MWT was configured by licensed physical therapists working with patients with neurologic conditions in clinical practice, identify their knowledge of the American Thoracic Society (ATS) and Academy of Neurologic Physical Therapy (ANPT) guidelines for the 6MWT and assess relationships between therapist demographic characteristics and knowledge of the 6MWT guidelines. Methods: One hundred forty-six therapists completed a survey related to the configuration they used for the 6MWT. Results: Configuration of the 6MWT varied widely. Space limitation was the most frequently selected reason for reported configurations. Over half had available the standardized 100-feet straight walkway but fewer than one-third used this configuration of the ATS guidelines. Fewer than half knew of the ATS guidelines and nearly three-fourths knew of the ANPT guidelines. American Physical Therapy Association membership and having a higher percentage of neurologic patients were associated with knowledge of both guidelines. Conclusion: The 6MWT must be completed within the constraints of the working environment, and this requirement is clinically relevant when comparing patient results to normative values and measurements across clinics. Our results suggest a need for updated norms that are more congruent with space constraints in current practice settings
Autonomic nervous system and viscera-related responses to manual therapy: A narrative overview
No full textBackground: Manual therapy (MT) has long-held that it physiologically impacts autonomic nervous system (ANS) and viscera-related function. This narrative review is intended to serve as a consolidated interdisciplinary resource of original studies related to physiological effects of MT as it relates to the ANS for MT clinicians and researchers new to this MT-related topic. Objective: This review seeks to identify ANS and viscera-related physiological responses to MT interventions using search terms commonly used by chiropractic, massage, osteopathic, physical therapy, and structural integration clinicians and to provide a quick reference resource of original MT-related studies investigating ANS effects. Methods: For this interdisciplinary review, the search was limited to the largest and most commonly used database (PubMed) between years 2000 and 2024, with a focus on direct ANS-related physiological outcomes. Unlike systematic reviews, assessment of scientific rigor and potential bias of included articles was beyond the scope and purpose of the current work. Results: Original MT-related studies provide mixed evidence with regards to immediate and/or short term ANS and/or viscera-related responses on blood pressure, heart rate variability, skin conductance/temperature, respiratory and lymphatic changes. Conclusions: This review identified a large number of MT and ANS-related original research in PubMed. Careful study of original MT-related research is needed with particular attention focused on the standardization of MT methodological approaches, appropriate controls, study design, appropriate populations, MT techniques, and anatomical site delivery so as to design more rigorous studies in order to arrive at definitive conclusions regarding direct effects of MT on the ANS
Test-Retest Reliability of Movement Displacement during a 20-s Stepping-in-Place Test in Community-Dwelling Older Adults with and without Supportive Care
No full textIntroduction: Our recent reports have shown that movement pattern and displacement assessed with an infrared depth sensor during a 20-s stepping-in-place test (ST) correlates with measures of balance and need for assistance in older individuals. This study investigated ST test-retest reliability in community-dwelling older adults with and without supportive care. Methods: Two groups were included: those not participating (HO: n = 25, 74.7 ± 5.2 years) and those participating (DSU: n = 41, 78.8 ± 5.8 years) in regular senior day services (supportive care). HO completed three ST trials, separated by 1 week, while DSU completed two ST trials during the same half-day supportive care visit. Testing was conducted with eyes open. ST measures included head movement path distance (TMD), maximum movement displacement (MMD), knee movement path length (KMD), and stepping rate (STEP). TMD×KMD−1 ratio indicated upper-body sway relative to lower-body. Test-retest reliability (intra-class correlation coefficients, ICCs) and between-trial and between group differences (ANCOVA, adjusting for age) were assessed. Results: After adjusting for age, TMD, KMD, TMD×KMD−1 were lesser and STEP was greater in HO than DUS. HO ST variables did not differ across testing days. HO ICC (1, 3) for TMD (0.911 [95% confidence interval: 0.827–0.958]), MMD (0.918 [0.814–0.961]), KMD (0.838 [0.685–0.923]), and TMD×KMD−1 (0.940 [0.884–0.872]) showed strong to very strong reliability. Similarly, DSU ST variables did not differ across same day trials and ICC (1, 2) for TMD, KMD, and TMD×KMD−1 displayed very strong reliability. Conclusion: These ST variables exhibited excellent test-retest reliability of discriminating between community-dwelling older adults with and without supportive care
The anatomical basis of amphibious hearing in the American alligator (Alligator mississippiensis)
No full textThe different velocities of sound (pressure waves) in air and water make auditory source localization a challenge for amphibious animals. The American alligator (Alligator mississippiensis) has an extracolumellar cartilage that abuts the deep surface of the tympanic membrane, and then expands in size beyond the caudal margin of the tympanum. This extracolumellar expansion is the insertion site for two antagonistic skeletal muscles, the tensor tympani, and the depressor tympani. These muscles function to modulate the tension in the tympanic membrane, presumably as part of the well-developed submergence reflex of Alligator. All crocodilians, including Alligator, have internally coupled ears in which paratympanic sinuses connect the contralateral middle ear cavities. The temporal performance of internally coupled ears is determined, in part, by the tension of the tympanic membrane. Switching between a “tensed” and “relaxed” tympanic membrane may allow Alligator to compensate for the increased velocity of sound underwater and, in this way, use a single auditory map for sound localization in two very different physical environments
Burnout and well-being of medical and surgical residents in relation to emotional intelligence: A 3-year study
No full textBackground: This study aims to examine the relationship of emotional intelligence to physician burnout and well-being and compare these changes between medical and surgical residents during training. Methods: The longitudinal study used survey data, collecting measures on burnout and emotional intelligence in residents. Postgraduate year 1 residents at a community-based Michigan hospital completed the following surveys: Maslach Burnout Inventory, Physician Wellness Inventory, and Trait Emotional Intelligence Questionnaire–Short Form survey. These measures were given quarterly in postgraduate year 1 and once during subsequent years. Results: Seventy-seven residents completed measurements during their first 3 years. Forty-two (54.5%) were in the medical resident group; the remaining 35 (45.5%) were in the surgical resident group. Significant increases in measured burnout during the first year improved in subsequent years but did not return to baseline (P \u3c.01). Emotional exhaustion (Maslach Burnout Inventory–Emotional Exhaustion) increased a relative 44% the first year (P =.000) and decreased 23% by the third year (P \u3c.01). The Physician Wellness Inventory subscales also had significant decreases (P =.01) but less than the Maslach Burnout Inventory subscales (improvement ≤25%). Both medical and surgical groups had similar decreases in the Physician Wellness Inventory subscales (–25%) in their first year. The emotional intelligence score significantly correlated with exhaustion (Maslach Burnout Inventory–Emotional Exhaustion: r = –0.243; P =.002) and distress (Physician Wellness Inventory–Distress: r = –0.197; P =.014). Conclusion: The risk for burnout increased sharply at the beginning of training for this hospital resident participant group and remained high throughout residency. Emotional intelligence is an important factor associated with less emotional exhaustion during residency
Inflammatory biomarker changes in healthy adults secondary to electronic cigarette use: A scoping review
No full textContext: There has been a global increase in the use of electronic cigarettes (EC). However, to our knowledge, no review has summarized or categorized changes in inflammatory biomarkers after EC use in the extant literature. Objective: To evaluate changes in general, cardiopulmonary, and oxidative stress-related inflammatory biomarkers in healthy adults who use ECs. Methods: A scoping review was conducted according to the Arksey and O\u27Malley framework. PubMed and MEDLINE (Ovid) databases were used for our search. After initial pilot searches and discussions, we performed a final search with medical subject headings and plain language terms related to inflammation, biomarkers, ECs, and adult humans. All full-text articles, gray literature, and primary studies dating from the inception of the searched databases to the present were included. Studies of human participants with known confounding medical histories were excluded. Results: Thirty-seven studies met the inclusion criteria. After short-term (\u3c1 month) use, ECs containing nicotine moderately increased cardiovascular (CV) and oxidative stress markers of inflammation. Of all reported results, 50% of CV biomarkers were increased, and 64% of oxidative stress markers were increased. After long-term (\u3e1 month) use, ECs containing nicotine produced mixed results. Two commonly measured biomarkers in this group, matrix metalloproteinase-9 (MMP-9) and interleukin-6 (IL-6), were elevated in 75% and 60% of measured instances, respectively. Conclusion: The results of studies evaluated in our scoping review suggested that short-term use of nicotine-containing ECs may result in increased CV and oxidative stress inflammation, contributing to potential CV or neurologic disease development. The results of studies evaluated in our scoping review also suggested that long-term use of nicotine-containing ECs resulted in no significant changes in general inflammatory biomarker levels. A rigorous systematic review and meta-analysis is necessary to corroborate our findings and to determine the effect of long-term EC use on MMP-9 and IL-6 levels
Beyond the Outer Rim: A Case of Disseminated Peritoneal Leiomyomas
No full textLeiomyomatosis peritonealis disseminata (also known as disseminated peritoneal leiomyomas) is a rare disorder consisting of multiple soft tissue masses dispersed throughout the abdominal and pelvic peritoneum, histologically characterized by benign smooth muscle bundles without atypia or mitotic activity. Although more commonly confined to the uterine parenchyma (i.e. uterine fibroids), extension to surrounding structures may rarely occur. Such benign masses may be easily mistaken for more aggressive and malignant etiologies, and if mistaken, may cause psychological stress, time-consuming workup, and unnecessary cost to the patient. Given this possibility, it is important to consider this differential diagnosis among more worrisome pathologies such as lymphoma, metastatic ovarian cancer, or peritoneal carcinomatosis. We present the case of an adult female who initially presented with sharp epigastric abdominal pain, in which subsequent workup revealed the presence of multiple soft tissue lesions scattered throughout the abdomen and pelvis. These lesions were initially misconstrued to be malignant, however, subsequently biopsy-proven to be leiomyomatous tissue in origin
Use of Local Melatonin with Xenogeneic Bone Graft to Treat Critical-Size Bone Defects in Rats with Osteoporosis: A Randomized Study
No full textThe aim of this study was to evaluate the effect of local administration of melatonin (MLT) on molecular biomarkers and calvaria bone critical defects in female rats with or without osteoporosis, associated or not with a xenogeneic biomaterial. Forty-eight female rats were randomly divided into two groups: (O) ovariectomized and (S) placebo groups. After 45 days of osteoporosis induction, two critical-size defects (5 mm diameter) were created on the calvaria. The groups were subdivided according to the following treatment: (C) Clot, MLT, MLT associated with Bio-Oss® (MLTBO), and Bio-Oss® (BO). After 45 days, the defect samples were collected and processed for microtomography, histomorphometry, and biomolecular analysis (Col-I, BMP-2, and OPN). All animals had one femur harvested to confirm the osteoporosis. Microtomography analysis demonstrated a bone mineral density reduction in the O group. Regarding bone healing, the S group presented greater filling of the defects than the O group; however, in the O group, the defects treated with MLT showed higher mineral filling than the other treatments. There was no difference between the treatments performed in the S group (p = 0.05). Otherwise, O-MLT had neoformed bone higher than in the other groups (p = 0.05). The groups that did not receive biomaterial demonstrated lower levels of Col-I secretion; S-MLT and S-MLTBO presented higher levels of OPN, while O-C presented statistically lower results (p \u3c 0.05); O-BO showed greater BMP-2 secretion (p \u3c 0.05). In the presence of ovariectomy-induced osteoporosis, MLT treatment increased the newly formed bone area, regulated the inflammatory response, and increased OPN expression
Histological, Clinical Assessment, and Treatment of a Permanent Filler Complication in the Upper Lip: A Case Report with 16-Year Follow-Up
No full textThere is a considerable increase in the use of substances and medical procedures aimed at changing the esthetics of the face, particularly the appearance of the lips. Permanent fillers such as polydimethylsiloxane, also called liquid silicone, are widely used, but their application for facial esthetics is currently obsolete. Silicone belongs to this polymer family; its viscosity is determined by its degree of polymerization. Liquid injectable silicone is odorless, colorless, non-volatile, and oily to the touch. The substance is not altered by storage at room temperature and is not carcinogenic or teratogenic. However, the long-term complications remain a reality, as they can occur decades after the application. Thus, the goal of this case report was to present a complication after 16 years of treatment using liquid silicone. This case report involved a 52-year-old male with a complication of bilateral permanent filler in the upper lip performed 16 years ago, its surgical removal, and histological analysis. The patient had the first appointment at the University Dental Clinic—Universidade Católica Portuguesa (Viseu, Portugal) in April 2022, dissatisfied with his upper lip’s esthetic appearance and shape. He was not a smoker or diabetic but had hypertension and hypercholesterolemia and was medicated with Losartan, Hydrochlorothiazide, and Pitavastatin. No relevant findings were observed in the extraoral examination; he had bruxism and a good periodontal condition. The patient had an asymptomatic bilateral mass, hard to palpation, located on the upper lip due to permanent lip filling performed to increase its volume in 2006 associated with non-related generalized granules of Fordyce. The treatment options presented just observation or complete material removal in two surgical steps, which was the patient’s choice. Then, the first surgical procedure was performed under local anesthesia on the right side of the lip, one carpule of Lidocaine 2% with adrenaline 1:100,000, with a chalazion clamp, a diode laser for hemorrhagic control, and a simple suture. In this procedure, three fragments were biopsied: a cuboid measuring 1 × 1 × 0.8 cm and an irregular one consisting of two fragments that at one end of the piece were in continuity with each other, one measuring 1.6 × 0.5 × 0.4 cm and the other 2.5 × 0.6 × 0.5 cm. A similar macroscopic appearance in all the material, white in color, irregular surface, elastic, white section surface, or slightly fasciculate. The patient was medicated with Tylenol 500 mg thrice a day for two days. With 20-day intervals, the sutures from the first surgery were removed, as well as the foreign body from the upper lip on the left side, following the same surgical technique and medication. Histologically, it was possible to identify a chronic inflammatory, lymphoplasmacytic, and granulomatous reaction, with foreign body giant cells’ reaction, in relation to non-polarizable exogenous material due to the reaction to silicone. The most common complications are granulomas’ appearance and material displacement. The case report shows these granulomas are characterized as chronic low-caliber inflammation around the silicone. They have an unknown etiology but are probably multifactorial, from continuous trauma, friction or irritation, iatrogenic factors, infection, immunological mechanisms, and genetic and molecular variations, and can be highly related to the impurity of the injected material. This case brings the opportunity for health professionals to increase awareness of the long-term adverse effects of the silicone material used to fill the lip in order to make its application more predictable and conscious