Changes In Tissue Texture Research Articles

Commonly Used Tests in the Assessment of Sacro-illiac Joint Dysfunction by Physiotherapists in India: A Cross-sectional Study

Introduction: Sacroiliac Joint Dysfunction (SIJD) refers to a condition that causes pain and discomfort, commonly due to dysfunction of the Sacroiliac Joint (SIJ). It is a plausible source of Low Back Pain (LBP). Static palpation tests, motion palpation, and pain provocation tests are mostly employed to check for SIJD. Aim: To determine the commonly used tests in the assessment of SIJD by physiotherapists. Materials and Methods: A cross-sectional Questionnairebased study was conducted among physiotherapists in India from November 2022 to April 2023 at the Nitte Institute of Physiotherapy, NITTE (deemed to be University), Mangalore, Karnataka, India. The study included physiotherapists specialising in orthopaedics and obstetrics and gynaecology. The practitioners’ years of experience were considered. An online survey was conducted using a questionnaire developed to determine the frequently used bony landmark for checking SIJ asymmetry, commonly affected structures, and commonly used motion palpation and pain provocation tests for examining SIJD. Questionnaires were sent to at least 100 physiotherapists, and 72 responses were included in the study. Data was collected and analysed using descriptive statistics: frequency and percentage. Data analysis was performed using Statistical Package for Social Sciences (SPSS) software version 26.0. Results: Seventy-two practitioners responded to the online survey. The commonly assessed bony landmark was the Posterior Superior Iliac Spines (PSIS) with 52 responses (28%). The most frequently preferred motion palpation examination test was the compression test with 36 responses (17.2%). Tenderness or tissue texture change was mainly checked at the PSIS with 54 responses (37.8%), and the commonly used pain provocation tests were the thigh thrust test and supine SIJ springing test with 46 responses (26.6%). Conclusion: According to this study, many physiotherapists employed diagnostic techniques congruent with Mitchell’s model, but they also frequently added additional motion tests, measured tenderness, and used pain provocation techniques. Most preferred the ASIS compression and thigh thrust tests to assess SIJD.

Surface deformation tracking in monocular laparoscopic video.

Image-guided surgery has been proven to enhance the accuracy and safety of minimally invasive surgery (MIS). Nonrigid deformation tracking of soft tissue is one of the main challenges in image-guided MIS owing to the existence of tissue deformation, homogeneous texture, smoke and instrument occlusion, etc. In this paper, we proposed a piecewise affine deformation model-based nonrigid deformation tracking method. A Markov random field based mask generation method is developed to eliminate tracking anomalies. The deformation information vanishes when the regular constraint is invalid, which further deteriorates the tracking accuracy. Atime-series deformation solidification mechanism is introduced to reduce the degradation of the deformation field of the model. For the quantitative evaluation of the proposed method, we synthesized nine laparoscopic videos mimicking instrument occlusion and tissue deformation. Quantitative tracking robustness was evaluated on the synthetic videos. Three real videos of MIS containing challenges of large-scale deformation, large-range smoke, instrument occlusion, and permanent changes in soft tissue texture were also used to evaluate the performance of the proposed method. Experimental results indicate the proposed method outperforms state-of-the-art methods in terms of accuracy and robustness, which shows good performance in image-guided MIS.

Evaluation of Osteopathic Principles in Cadaveric Specimens Using Radiological Assessment.

Osteopathic manipulative treatment (OMT) of the spine requires the physician to first be able to diagnose with palpation of the spinous processes, transverse processes, and facets, test for movement of the anatomy, and evaluate changes in tissue texture at each level. Physicians should then apply these changes to Fryette's Principles to effectively understand the corresponding somatic dysfunction and provide treatment.Continuing education in osteopathic principles and practices is important throughout an osteopathic physician's training. Diagnosis and treatment require an understanding ofthe complex neuroanatomy and physiology of patients. We sought to evaluate the diagnostic capabilities of osteopathic physicians.This was done by evaluating the accuracy of diagnosis of somatic dysfunction on a cadaver specimen and verifying via fluoroscopy and blunt dissection. Fresh refrigerated cadavers were palpated for lesions in the thoracic spine by residents and attendings, and diagnoses of somatic dysfunction were made. Anterior-posterior X-rays were taken with a C-arm. These levels were then exposed by blunt dissection, and somatic dysfunctions were visualized and recorded. Comparative analyses were conducted to evaluate the accuracy of diagnosis. Results: The accuracy of diagnoses was correct in those who had OMT skills reassessed throughout training and continuing medical education. Osteopathic physicians who routinely kept up with their training were better able to make diagnoses of somatic dysfunction. Continuing osteopathic medical education with an emphasis on the maintenance of palpatory skills is important.Those physicians with the greatest accuracy of somatic dysfunction diagnosis were physicians who routinely underwent reassessment and continuing medical education of osteopathic skills.

An Osteopathic Manipulative Treatment (OMT) Evaluation and Treatment Protocol to Improve Gastrointestinal Function

Abstract As a hands-on approach to patient care diagnosis and management, osteopathic manipulative medicine (OMM) can be utilized to modulate the autonomic input to the gastrointestinal system. Palpatory findings of tissue texture changes at predictable body regions may correspond to visceral dysfunction related to the gastrointestinal (GI) system.1 Osteopathic manipulative treatment (OMT) of the viscero-somatic segment or viscero-visceral reflex can remove the feedback related to the somatic or visceral component, thereby affecting nociceptive facilitation at the spinal or visceral level and helping to restore autonomic balance.1,2 The purpose of this thesis is to describe an evaluation and treatment protocol to address somatic and visceral dysfunction found in many patients with impaired gastrointestinal function. A retrospective analysis of 5 patients will be outlined using the evaluation and treatment protocol. The safety of an OMT evaluation and treatment protocol as applied to address gastrointestinal function and as outlined in the current literature will also be addressed.

Tissutal and Fluidic Aspects in Osteopathic Manual Therapy: A Narrative Review.

Over the years, several authors have discussed the possibility of considering somatic dysfunction (SD) as a “nosological element” detectable on palpation. There are many aspects to consider regarding the etiology and diagnosis of SD, and the literature on osteopathic issues provides details on physiological signs that characterize it, including tissue texture changes. Recent knowledge suggests that how tissue and, in particular, connective tissue, responds to osteopathic treatment may depend on the modulation of the inflammation degree. Low-grade inflammation (LGI) may act on the extracellular matrix (ECM) and on cellular elements; and these mechanisms may be mediated by biological water. With its molecules organized in structures called exclusion zones (EZ), water could explain the functioning of both healthy and injured tissues, and how they can respond to osteopathic treatment with possible EZ normalization as a result. The relationship between inflammation and DS and the mechanisms involved are described by several authors; however, this review suggests a new model relating to the characteristics of DS and to its clinical implications by linking to LGI. Tissue alterations detectable by osteopathic palpation would be mediated by body fluids and in particular by biological water which has well-defined biophysical characteristics. Research in this area is certainly still to be explored, but our suggestion seems plausible to explain many dynamics related to osteopathic treatment. We believe that this could open up a fascinating scenario of therapeutic possibilities and knowledge in the future.

Multiparametric MRI identifies subtle adaptations for demarcation of disease transition in murine aortic valve stenosis

Aortic valve stenosis (AS) is the most frequent valve disease with relevant prognostic impact. Experimental model systems for AS are scarce and comprehensive imaging techniques to simultaneously quantify function and morphology in disease progression are lacking. Therefore, we refined an acute murine AS model to closely mimic human disease characteristics and developed a high-resolution magnetic resonance imaging (MRI) approach for simultaneous in-depth analysis of valvular, myocardial as well as aortic morphology/pathophysiology to identify early changes in tissue texture and critical transition points in the adaptive process to AS. AS was induced by wire injury of the aortic valve. Four weeks after surgery, cine loops, velocity, and relaxometry maps were acquired at 9.4 T to monitor structural/functional alterations in valve, aorta, and left ventricle (LV). In vivo MRI data were subsequently validated by histology and compared to echocardiography. AS mice exhibited impaired valve opening accompanied by significant valve thickening due to fibrotic remodelling. While control mice showed bell-shaped flow profiles, AS resulted not only in higher peak flow velocities, but also in fragmented turbulent flow patterns associated with enhanced circumferential strain and an increase in wall thickness of the aortic root. AS mice presented with a mild hypertrophy but unaffected global LV function. Cardiac MR relaxometry revealed reduced values for both T1 and T2 in AS reflecting subtle myocardial tissue remodelling with early alterations in mitochondrial function in response to the enhanced afterload. Concomitantly, incipient impairments of coronary flow reserve and myocardial tissue integrity get apparent accompanied by early troponin release. With this, we identified a premature transition point with still compensated cardiac function but beginning textural changes. This will allow interventional studies to explore early disease pathophysiology and novel therapeutic targets.

Combined Features in Region of Interest for Brain Tumor Segmentation

Diagnosis of brain tumor gliomas is a challenging task in medical image analysis due to its complexity, the less regularity of tumor structures, and the diversity of tissue textures and shapes. Semantic segmentation approaches using deep learning have consistently outperformed the previous methods in this challenging task. However, deep learning is insufficient to provide the required local features related to tissue texture changes due to tumor growth. This paper designs a hybrid method arising from this need, which incorporates machine-learned and hand-crafted features. A semantic segmentation network (SegNet) is used to generate the machine-learned features, while the grey-level co-occurrence matrix (GLCM)-based texture features construct the hand-crafted features. In addition, the proposed approach only takes the region of interest (ROI), which represents the extension of the complete tumor structure, as input, and suppresses the intensity of other irrelevant area. A decision tree (DT) is used to classify the pixels of ROI MRI images into different parts of tumors, i.e. edema, necrosis and enhanced tumor. The method was evaluated on BRATS 2017 dataset. The results demonstrate that the proposed model provides promising segmentation in brain tumor structure. The F-measures for automatic brain tumor segmentation against ground truth are 0.98, 0.75 and 0.69 for whole tumor, core and enhanced tumor, respectively.

Retention of tissue texture change after cervical muscle energy and high velocity low amplitude intervention: implications for treatment intervals.

When choosing to incorporate osteopathic manipulative treatment (OMT) into a patient's care, the risk-to-benefit ratio, the choice of treatment technique, as well as the frequency of treatments are always taken into consideration. This has been even more important during the COVID-19 pandemic, in which social distancing has been the best preventative measure to decrease exposure. By increasing treatment intervals, one could not only limit possible exposure/spread of viruses but also decrease the overall cost to the system as well as to the individual. This is an expansion of a previous study in which quantifiable changes in cervical hysteresis characteristics post-OMT were documented utilizing a durometer (Ultralign SA201®; Sigma Instruments; Cranberry, PA USA). This study compared two treatment modalities, muscle energy (ME) and high-velocity low-amplitude (HVLA) postcervical treatment. Subjects in this study were allowed to re-enroll, provided that they could be treated utilizing the alternate treatment modality. By allowing repeat subjects, analysis of the data for lasting effects of OMT could be observed. To determine whether a significant change in cervical hysteresis would be observed after each treatment regardless of a short treatment interval. A total of 34 subjects were retrospectively noted to be repeat subjects from a larger, 213-subject study. These 34 subjects were repeat participants who were treated with two different direct-treatment modalities 7-10days apart. Each subject was randomly assigned to receive a single-segmental ME or HVLA treatment technique directed toward a cervical (C)segment (C3-C5 only). Subjects were objectively measured pretreatment in all cervical segments utilizing the Ultralign SA201®, then treated with cervical OMT to a single segment, and finally reassessed at all cervical levels with the Ultralign SA201® posttreatment to assess for change in cervical hysteresis. Statistically significant or suggestive changes (p-values 0.01-0.08) with good clinical effect size (0.30 or greater) were noted in all four components of the Ultralign SA201® at multiple cervical levels after the first treatment, but only one component (frequency) had a statistically significant change after the second treatment (AA cervical level, p-value 0.01) with good clinical effect size (0.45). However, when comparing the post-first-treatment values to the pre-second-treatment values, no statistically significant differences (p-value 0.10 or higher) were observed between them. Statistically significant changes were noted after the first treatment; however, when comparing cervical hysteresis changes after the first treatment to the cervical hysteresis values prior to the second treatment delivered 7-10days later, there were no statistically significant or suggestive changes. This data suggest that several post-OMT changes noted after the first treatment were still in effect and may indicate that follow-up visits for direct manipulation may be deferred for a least two weeks.

Abstract PO-010: Detection of early tissue changes on historical CT scans in the regions of the pancreas gland that subsequently develop adenocarcinoma using quantitative textural analysis and fat fraction analysis

Abstract Early detection of Adenocarcinoma of the Pancreas (ACP) is critical to improving outcomes. Since the development of ACP is thought to begin a couple decades prior to clinical presentation, the possibility exists that evolving changes in the pancreas gland (PG) may already be present on historical standard of care (h-SOC) CT scans obtained years earlier in patients who present for other indications. Advanced image analysis using quantitative texture analysis (QTA) techniques can detect subtle changes in tissue/tumors composition (including fat) and may be useful in tumor detection, diagnosis and response assessments. We hypothesized that changes in tissue texture are detectable on h-SOC in patients who subsequently develop ACP and, if identified, would contribute significantly towards the development of tools to aid in identifying tissue at risk for ACP An IRB-exempt, retrospective, single institution study of 27 matched h-SOC and ACP diagnostic CTs from a single institution was performed. Subjects who had ACP and h-SOC CTs between 3-15 years prior were included. Deidentified scans were transferred to the imaging core lab for QTA and fat fraction (FF) analysis. The pancreas gland (PG) was divided into 7 regions (uncinate, head, neck-genu, body [prox,mid,dis] and tail) for volumes-of interest (VOIs) placement on the h-SOC portal venous phase axial images. A single radiologist verified VOI placement, confirmed the lack of ACP on h-SOC images and was blinded to the location of subsequent ACP development. First order QTA histogram frequency curves derivatives (mean, SD, skewness, kurtosis, mean positive Pixel (MPP), at each cluster [SSF] setting from 0-6mm) were recorded along with FF. Inferential statistical analysis was performed to identify QTA/FF differences between PG regions that subsequently developed ACP from those that did not (p <0.05 significance). A total of 22/27 subjects (81%) had suitable portal venous phase CTs for QTA while evaluable FF data was available for all subjects. ACP developed in PG head in 45% of subjects. The average time from h-SOC to diagnostic ACP scan was 7.6 years (range, 3.9 years-13.9 years). QTA results showed a difference in tissue texture (QTAskewness > -0.480) in PG regions that subsequently developed ACP compared to regions that did not (T-statistics= -2.148; AUCROC= 0.625 p=.038). There was also a > 3-fold increase in PG tail fat in subjects that developed tail ACP (t-statistics= -3.048; p = 0.002; AUCROC= 0.819 p=.023). LOGR models showed that PG regions that subsequently developed ACP had differences in QTA mean, skewness, kurtosis and total FF on h-SOC scans compared to normal PG tissue (LL ratio-p=.004, pseudo R2=.104). Tissue texture and fat composition differences in regions of the PG may be present on h-SOC CT scans several years prior to clinical manifestation of ACP. If validated, tissue at risk could be identified well in advance of actual ACP development allowing for new opportunities for PAC interception. The investigators acknowledge the Marley Foundation for their generous support. Citation Format: Ronald L. Korn, Daniel D. Von Hoff, Andre Burkett, Dominic Zygadlo, Taylor Brodie, Kathleen Panak, Sweta Rajan, Derek Cridebring, Michael J. Demeure. Detection of early tissue changes on historical CT scans in the regions of the pancreas gland that subsequently develop adenocarcinoma using quantitative textural analysis and fat fraction analysis [abstract]. In: Proceedings of the AACR Virtual Special Conference on Pancreatic Cancer; 2021 Sep 29-30. Philadelphia (PA): AACR; Cancer Res 2021;81(22 Suppl):Abstract nr PO-010.

Radiomics Signatures of Cardiovascular Risk Factors in Cardiac MRI: Results From the UK Biobank.

Cardiovascular magnetic resonance (CMR) radiomics is a novel technique for advanced cardiac image phenotyping by analyzing multiple quantifiers of shape and tissue texture. In this paper, we assess, in the largest sample published to date, the performance of CMR radiomics models for identifying changes in cardiac structure and tissue texture due to cardiovascular risk factors. We evaluated five risk factor groups from the first 5,065 UK Biobank participants: hypertension (n = 1,394), diabetes (n = 243), high cholesterol (n = 779), current smoker (n = 320), and previous smoker (n = 1,394). Each group was randomly matched with an equal number of healthy comparators (without known cardiovascular disease or risk factors). Radiomics analysis was applied to short axis images of the left and right ventricles at end-diastole and end-systole, yielding a total of 684 features per study. Sequential forward feature selection in combination with machine learning (ML) algorithms (support vector machine, random forest, and logistic regression) were used to build radiomics signatures for each specific risk group. We evaluated the degree of separation achieved by the identified radiomics signatures using area under curve (AUC), receiver operating characteristic (ROC), and statistical testing. Logistic regression with L1-regularization was the optimal ML model. Compared to conventional imaging indices, radiomics signatures improved the discrimination of risk factor vs. healthy subgroups as assessed by AUC [diabetes: 0.80 vs. 0.70, hypertension: 0.72 vs. 0.69, high cholesterol: 0.71 vs. 0.65, current smoker: 0.68 vs. 0.65, previous smoker: 0.63 vs. 0.60]. Furthermore, we considered clinical interpretation of risk-specific radiomics signatures. For hypertensive individuals and previous smokers, the surface area to volume ratio was smaller in the risk factor vs. healthy subjects; perhaps reflecting a pattern of global concentric hypertrophy in these conditions. In the diabetes subgroup, the most discriminatory radiomics feature was the median intensity of the myocardium at end-systole, which suggests a global alteration at the myocardial tissue level. This study confirms the feasibility and potential of CMR radiomics for deeper image phenotyping of cardiovascular health and disease. We demonstrate such analysis may have utility beyond conventional CMR metrics for improved detection and understanding of the early effects of cardiovascular risk factors on cardiac structure and tissue.

Comparison of 1.5 T and 3 T MRI hippocampus texture features in the assessment of Alzheimer's disease

ObjectiveMany studies evaluated how the Magnetic Resonance Imaging (MRI) field strength affects the effectiveness to detect neurodegenerative changes of Alzheimer's disease (AD), derived from atrophy or thickness. To the best of our knowledge, no study evaluated before how tissue texture changes are affected. In this research, hippocampus texture features extracted from 1.5 T and 3 T MRI are evaluated how are affected by the magnetic field strength. MethodsMR imaging data from 14 Normal Controls (NC), 14 with Mild Cognitive Impairment (MCI), 11 MCI converters (MCIc) and 10 AD subjects scanned at 1.5 T and 3 T were included. Haralick's texture features were extracted from the hippocampus, along with hippocampal and amygdala volumes and cortical thickness. One-way ANOVA, paired-samples and Wilcoxon signed t-tests were used to evaluate if there were significant differences between the features. Results3 T texture features were significantly different for NC vs AD, NC vs MCI and MCI vs AD, whereas, 1.5 T for MCI vs AD only. Amygdala and hippocampal volumes, showed significant differences for NC vs AD for both MRI strengths, whereas cortical thickness for MCI vs MCIc for the 3 T. Paired sample t-test and Wilcoxon signed-rank test revealed significant differences for Angular Second Moment (ASM), contrast, correlation, variance, sum variance and entropy, the amygdala volume and cortical thickness. Between NC vs MCI, 3 T texture revealed higher Area Under Curve (AUC). Conclusion3 T texture revealed significant differences for more features compared to 1.5 T, whereas, atrophy and thickness had similar results. Significance3 T texture changes provide earlier diagnosis compared to 1.5 T volume or texture changes.

Precise application of Traditional Chinese Medicine in minimally-invasive techniques

Precise application of Traditional Chinese Medicine in minimally-invasive techniques

Case-control study on Pi needle for the treatment of the cutaneous nerve entrapment low back pain

To explore a safe and effective method for the treatment of low back pain in the cutaneous nerve, and to clarify the indication of Pi needle to treat it. From January 2003 to December 2004, 278 patients with cutaneous nerve entrapment low back pain were divided into two groups: Pi needle group and electrical stimulation group. In the Pi needle group, there were 68 males and 70 females, ranging in age from 20 to 60 years old, with an average of(41.92±10.88)years old. In the electrical stimulation group, there were 68 males and 72 females, ranging in age from 18 to 60 years old, with an average of(41.44±10.47) years old. The pain, tenderness and soft tissue tension of the two groups were measured and compared before and after treatment. All of the selected cases were qualified. No suspension, culling and shedding cases occurred in either group. In Pi needle group, visual analog scale(VAS) of pain decreased from 8.78±1.52 before treatment to 1.33±1.33 after treatment;and in electrical stimulation group, VASof pain decreased from 8.59±1.76 before treatment to 5.20±2.64 after treatment;and the VAS of pain of the Pi needle group was lower than that of the electrical stimulation group. In Pi needle group, VAS of tenderness decreased from 9.12±1.24 before treatment to 1.60±1.36 after treatment;and in electrical stimulation group, VAS of pain decreased from 8.79±1.60 before treatment to 5.34±2.60 after treatment;and the VAS of pain of the Pi needle group was lower than that of the electrical stimulation group. Once tissue texture changes to pain point, cord, nodules, Pi needle is the first line treatment for the cutaneous nerve entrapment low back pain.

Heterogeneous Tissue Characterization Using Ultrasound: A Comparison of Fractal Analysis Backscatter Models on Liver Tumors

Assessment of tumor tissue heterogeneity via ultrasound has recently been suggested as a method for predicting early response to treatment. The ultrasound backscattering characteristics can assist in better understanding the tumor texture by highlighting the local concentration and spatial arrangement of tissue scatterers. However, it is challenging to quantify the various tissue heterogeneities ranging from fine to coarse of the echo envelope peaks in tumor texture. Local parametric fractal features extracted via maximum likelihood estimation from five well-known statistical model families are evaluated for the purpose of ultrasound tissue characterization. The fractal dimension (self-similarity measure) was used to characterize the spatial distribution of scatterers, whereas the lacunarity (sparsity measure) was applied to determine scatterer number density. Performance was assessed based on 608 cross-sectional clinical ultrasound radiofrequency images of liver tumors (230 and 378 representing respondent and non-respondent cases, respectively). Cross-validation via leave-one-tumor-out and with different k-fold methodologies using a Bayesian classifier was employed for validation. The fractal properties of the backscattered echoes based on the Nakagami model (Nkg) and its extend four-parameter Nakagami-generalized inverse Gaussian (NIG) distribution achieved best results—with nearly similar performance—in characterizing liver tumor tissue. The accuracy, sensitivity and specificity of Nkg/NIG were 85.6%/86.3%, 94.0%/96.0% and 73.0%/71.0%, respectively. Other statistical models, such as the Rician, Rayleigh and K-distribution, were found to not be as effective in characterizing subtle changes in tissue texture as an indication of response to treatment. Employing the most relevant and practical statistical model could have potential consequences for the design of an early and effective clinical therapy.

Bleeding simulation in embalmed cadavers: bridging the gap between simulation and live surgery.

In veterinary medicine, surgical education and training require the development of abilities that can be acquired in practical classes using currently available models such as cadaver training. Limited availability of cadavers, undesirable changes in tissue texture and the absence of bleeding are the main disadvantages of cadaver-based training compared to training in live animals. This study proposes a chemical cadaver preservation method aimed at overcoming the aforementioned limitations. Blood circulation could be reproduced in preserved cadavers, thereby enabling satisfactory simulation-based training of several surgical procedures, from incision to suture and including hemostatic techniques. The model in this study introduces a high-fidelity simulation training alternative to prepare students for the practice of surgery. In this manner, surgical interventions would be restricted to surgical cases and healthy animals would not be submitted to surgical procedures exclusively for learning purposes.

PO-0133 Gastroesophageal Reflux In Infants And Osteophatic Manipolative Treatment: An Alternative Therapy?

Background and aims Several study have been reported that modifying vagus nerve control of transient lower esophageal sphincter relaxation can induce improvement of gastroesophageal reflux disease (GERD). Our aim was to evaluate the efficacy of osteophatic treatment (OMT) in infants with GERD. Methods We enrolled 40 infants (M/F:24/16), age ranged 1–18 months (median 4 month) attending for persistent reflux. Each patient performed I-GERQ-R questionnaire and ultrasonography of the gastro-esophageal junction before and after treatment. The ultrasound score was 0 to 3 on the basis of severity of reflux (number of reflux episodes in 10 min). Moreover each patient did an osteophatic treatment consisting in an extensive physical examination, to evaluate TART parameters (T = tissue texture changes; A = asimmetry; R = restriction of motion; T = tenderness). Then, a specific therapeutic intervention was chosen, treating only the parts of the body presenting greater TART modifications. Results All the somatic dysfunctions observed before OMT (at the scale 32/40 patients, the condyles 36/40 patients, the occipito-mastoid suture 36/40 patients; the stomach 22/40 patients, the small epiploon 30/40 patients) disappeared after treatment. The average score of I GERQ-R questionnaire before and after treatment was 22.7 ± 4.7 and 17.2 ± 4.5 respectively (p Conclusion OMT could be considered as an alternative treatment in infants with gastroesophageal reflux. Further data are needed to confirm our hyphothesis.

Association between cervical and thoracic somatic dysfunction among second-year osteopathic medical students.

The ubiquitous nature of cervical and thoracic somatic dysfunction requires osteopathic physicians to have a strong working knowledge of regional spinal mechanics and their functional and dysfunctional interrelationships. To determine whether cervical and thoracic somatic dysfunction occur concomitantly, particularly somatic dysfunction of the occipitoatlantal (OA) and upper thoracic (T1-T4) region of the spine. A retrospective analysis of cervical and thoracic somatic dysfunction prevalence diagnosed by faculty in second-year osteopathic medical students was conducted. Somatic dysfunction was defined as a vertebral unit possessing any of the following palpatory characteristics: tissue texture changes, asymmetry of motion and relative position, restriction of motion, or tenderness (ie, TART criteria). For each instance of somatic dysfunction diagnosed, the segmental level identifying the superior segment of the involved vertebral unit was recorded, as well as the spinal region (ie, cervical [OA, atlantoaxial (AA), and C2-C7] or thoracic [T1-T12]). Descriptive analyses, a Pearson χ(2) test, and a regression model using an analysis of variance were performed on the data. Among 338 students included in the study, the following 5 vertebral segments were found to have the highest prevalence of somatic dysfunction: OA (257 [76.0%]), C3 (257 [76.0%]), T3 (247 [73.1%]), T5 (226 [66.9%]), and T4 (223 [66.0%]). A Pearson χ(2) test of association between the OA vertebral segment and the following segments were found to be statistically significant: AA (P=.024), C2 (P=.032), and T4 (P=.045). An analysis of variance revealed statistical significance between the prevalence of upper cervical (OA, AA, C2) somatic dysfunction and the prevalence of upper thoracic (P<.001) and midthoracic (T5-T8) (P<.001) somatic dysfunction; the prevalence of lower cervical (C3-C7) (P=.74) and lower thoracic (T9-T12) (P=.085) somatic dysfunction was not found to be significant. A statistically significant association between cervical somatic dysfunction and thoracic somatic dysfunction was confirmed. In addition, there was a statistically significant association between dysfunction of the OA and the AA, C2, and T4 vertebral segments. These results suggest that the number of dysfunctional vertebral segments in the upper thoracic and midthoracic spinal regions is directly proportional to the number of dysfunctional segments found in the upper cervical spinal region.

A multiresolution clinical decision support system based on fractal model design for classification of histological brain tumours

Tissue texture is known to exhibit a heterogeneous or non-stationary nature; therefore using a single resolution approach for optimum classification might not suffice. A clinical decision support system that exploits the subbands’ textural fractal characteristics for best bases selection of meningioma brain histopathological image classification is proposed. Each subband is analysed using its fractal dimension instead of energy, which has the advantage of being less sensitive to image intensity and abrupt changes in tissue texture. The most significant subband that best identifies texture discontinuities will be chosen for further decomposition, and its fractal characteristics would represent the optimal feature vector for classification. The performance was tested using the support vector machine (SVM), Bayesian and k-nearest neighbour (kNN) classifiers and a leave-one-patient-out method was employed for validation. Our method outperformed the classical energy based selection approaches, achieving for SVM, Bayesian and kNN classifiers an overall classification accuracy of 94.12%, 92.50% and 79.70%, as compared to 86.31%, 83.19% and 51.63% for the co-occurrence matrix, and 76.01%, 73.50% and 50.69% for the energy texture signatures; respectively. These results indicate the potential usefulness as a decision support system that could complement radiologists’ diagnostic capability to discriminate higher order statistical textural information; for which it would be otherwise difficult via ordinary human vision.

Somatic Dysfunction and Use of Osteopathic Manual Treatment Techniques During Ambulatory Medical Care Visits: A CONCORD-PBRN Study

Osteopathic manual treatment (OMT) of somatic dysfunction is a unique approach to medical care that may be studied within a practice-based research network. To measure patient characteristics and osteopathic physician practice patterns within the Consortium for Collaborative Osteopathic Research Development-Practice-Based Research Network (CONCORD-PBRN). Cross-sectional card study. Eleven member clinics within the CONCORD-PBRN coordinated by The Osteopathic Research Center. A total of 668 patients seen between January and March 2013. Patient age and sex; primary diagnoses; somatic dysfunction as manifested by tenderness, asymmetry, restricted motion, or tissue texture changes; and use of 14 OMT techniques. Results were stratified by anatomical region and adjusted for clustering within member clinics. Clustering was measured by the intracluster correlation coefficient. Patient ages ranged from 7 days to 87 years (adjusted mean age, 49.2 years; 95% confidence interval [CI], 43.3-55.1 years). There were 450 females (67.4%) and 508 patient visits (76.0%) involved a primary diagnosis of disease of the musculoskeletal system and connective tissue. Structural examination was performed during 657 patient visits (98.4%), and 649 visits (97.2%) involved OMT. Restricted motion and tenderness were the most and least common palpatory findings, respectively. Cranial (1070 [14.5%]), myofascial release (1009 [13.7%]), muscle energy (1001 [13.6%]), and counterstrain (980 [13.3%]) techniques were most commonly used, accounting for more than one-half of the OMT provided. Pediatric patients were more likely than adults to receive OMT within the head (adjusted odds ratio [OR], 9.53; 95% CI, 1.28-71.14). Geriatric patients were more likely than adults to receive a structural examination (adjusted OR, 1.83; 95% CI, 1.09-3.07) and OMT (adjusted OR, 1.62; 1.02-2.59) within the lower extremity. Females were more likely than males to receive a structural examination (adjusted OR, 2.44; 95% CI, 1.44-4.16) and OMT (adjusted OR, 2.11; 95% CI, 1.26-3.52) within the sacrum and OMT within the pelvis (adjusted OR, 1.79; 95% CI, 1.12-2.88). Intracluster correlation coefficients for the 4 most commonly used OMT techniques ranged from 0.34 to 0.72. This study provides proof of concept of the feasibility of studying osteopathic medical practice on a national level by developing and growing the CONCORD-PBRN.

Osteopathic Manipulative Treatment in the Management of Biliary Dyskinesia

Biliary dyskinesia is a functional gastrointestinal disorder of the gallbladder and sphincter of Oddi. Diagnosis is made on the basis of symptoms of biliary colic in the absence of cholelithiasis and gallbladder inflammation. Palpatory findings of tissue texture changes at midthoracic levels (T6-T9) may correspond to visceral dysfunction related to the biliary system. Osteopathic manipulative treatment (OMT) of the T6-T9 segments can remove the feedback related to the somatic component, thereby affecting nociceptive facilitation at the spinal level and allowing the body to restore autonomic balance. Few reports in the current literature provide examples of treatment for patients with biliary dyskinesia using OMT. The author describes the case of a 51-year-old woman who presented with symptoms consistent with biliary dyskinesia. Her biliary colic completely resolved after OMT. Osteopathic evaluation and OMT should be considered a safe and effective option for conservative management of biliary dyskinesia.