Medicine Protocols Research Articles

Assessment of Residual [99mTc]Tc-Tetrofosmin Activity in Routine Nuclear Medicine Practice at Hospital Kuala Lumpur.

Myocardial perfusion imaging using the radiopharmaceutical [99mTc]Tc-tetrofosmin plays a crucial role in diagnosing cardiac conditions. However, variations in the residual activity of [99mTc]Tc-tetrofosmin in plastic syringes after administration may impact imaging quality and patient safety. This study aimed to evaluate the residual activity of [99mTc]Tc-tetrofosmin in plastic syringes after administration during routine nuclear medicine procedures at Hospital Kuala Lumpur, assessing compliance with department protocols and variability among different syringe brands. Methods: A single-center prospective observational study was conducted using stratified quota sampling, encompassing 396 samples across 3 syringe brands (SJ, BD, and Ciringe). Residual activity was measured immediately after administration, and statistical analysis was performed to compare brands and assess compliance with the department dosage protocol range of 333-555 MBq. Results: All injected activities aligned with the department protocol dose, with a mean effective activity of 451.23 ± 30.73 MBq and a mean residual activity of 12.63% ± 4.73%. However, variability in residual activity was observed among syringe brands. BD exhibited the highest mean residual activity (16.45%), significantly differing from SJ (9.95%) and Ciringe (11.50%) (P < 0.001). Conclusion: Rigorous syringe selection is crucial in myocardial perfusion imaging procedures to minimize residual activity and ensure compliance with dosimetry standards, emphasizing the importance of integrating pharmacy practices into nuclear medicine protocols. Standardized protocols and quality assurance measures are essential to optimize imaging outcomes and prioritize patient safety. These findings highlight the importance of ongoing monitoring and interdisciplinary collaboration to navigate residual activity management effectively in routine nuclear medicine practice.

Priming human bone marrow-derived mesenchymal stromal cells with signaling modifiers boosts their functionality: Potential application in regenerative therapies.

Mesenchymal stromal cells (MSCs) isolated from tissues such as bone marrow, cord, cord blood, etc., are frequently used as feeder layers to expand hematopoietic stem/ progenitor cells (HSCs/HSPCs) in vitro. They are also co-infused with the HSCs to improve the efficacy of transplantation. However, the MSCs sourced from non-hematopoietic tissues could have suboptimal hematopoiesis-supportive ability. Likewise, the functionality of the MSCs is known to decline after continuous in vitro culture - an unavoidable manipulation to get clinically relevant cell numbers. Hence, it may be necessary to boost the hematopoiesis-supportive ability of the long-term cultured MSCs so that they can, in turn, be used to prime the HSCs before their clinical applications. Here, I show that priming human bone marrow-derived MSCs (BMSCs) with appropriately selected signaling modifiers and integrin-activating bioactive peptides boosts their hematopoiesis-supportive ability, as seen by the formation of a significantly higher number of colonies from the bone marrow-derived mononuclear cells (MNCs) and extensive proliferation of CD34+ HSCS briefly interacted with them. Priming the BMSCs with signaling modifiers is a cost-effective and time-efficient process as synthesizing these small molecule compounds is relatively inexpensive - an advantage in clinical settings. The approach of briefly interacting the donor HSCs/HSPCs with the primed BMSCs just before their infusion into the recipients' bodies could save the cost of long-term ex vivo expansion of HSCs. This concept could also find applications in other regenerative medicine protocols after identifying suitable pharmacological modulators that have the desired effects on the target cells.

Building Nurse Resilience Through Art Therapy and Narrative Medicine Integration

This mixed-methods study, with a qualitative focus, examined the feasibility of integrating art prompts centered on the Expressive Therapies Continuum (ETC) model into a narrative medicine protocol to enhance nurse resilience. Nine participants across two cohorts completed a 4-week asynchronous online workshop in 2022. While quantitative results showed no statistically significant changes, qualitative results underscored the intervention’s feasibility and practical benefits. Participants found art prompts to be a novel method for self-expression, reflection, and group support. The 15-minute art prompts fostered positive emotions, sensory engagement, and meaning-making, aligning with the PERMA model. Healthcare organizations with existing narrative medicine programs can incorporate art prompts to promote healthcare worker resilience.

Innovative Strategies in the Management of Hypoplastic Left Heart Syndrome: A Multidisciplinary and Translational Approach

Background: Hypoplastic Left Heart Syndrome (HLHS) represents one of the most severe congenital cardiac malformations, characterized by underdevelopment of left-sided heart structures, necessitating a complex surgical and medical management strategy. Despite advancements in staged palliation and neonatal care, outcomes remain suboptimal for a significant subset of patients. Recent progress in molecular biology, regenerative medicine, and surgical innovations offers novel approaches that may transform the clinical trajectory of these patients. Objectives: This article explores emerging strategies for HLHS management, including stem cell therapy, tissue engineering, genomic medicine, hybrid procedures, and long-term monitoring protocols facilitated by artificial intelligence (AI). Methods: A comprehensive review of contemporary literature was conducted, focusing on the translational application of novel therapies and their integration into current staged palliation frameworks. Results: Early-stage studies demonstrate promise for stem cell therapies and myocardial regeneration in improving ventricular function. Advances in 3D printing and bioengineering have facilitated patient-specific surgical planning and the development of biocompatible grafts. Furthermore, AI-driven algorithms provide personalized risk assessment and optimized perioperative management strategies. Conclusions: The integration of multidisciplinary and translational approaches offers an opportunity to redefine HLHS management, potentially improving survival and quality of life for affected individuals. However, further clinical trials and international collaboration are essential to establish these novel therapies as standard of care.

Image Synthesis in Nuclear Medicine Imaging with Deep Learning: A Review.

Nuclear medicine imaging (NMI) is essential for the diagnosis and sensing of various diseases; however, challenges persist regarding image quality and accessibility during NMI-based treatment. This paper reviews the use of deep learning methods for generating synthetic nuclear medicine images, aimed at improving the interpretability and utility of nuclear medicine protocols. We discuss advanced image generation algorithms designed to recover details from low-dose scans, uncover information hidden by specific radiopharmaceutical properties, and enhance the sensing of physiological processes. By analyzing 30 of the newest publications in this field, we explain how deep learning models produce synthetic nuclear medicine images that closely resemble their real counterparts, significantly enhancing diagnostic accuracy when images are acquired at lower doses than the clinical policies' standard. The implementation of deep learning models facilitates the combination of NMI with various imaging modalities, thereby broadening the clinical applications of nuclear medicine. In summary, our review underscores the significant potential of deep learning in NMI, indicating that synthetic image generation may be essential for addressing the existing limitations of NMI and improving patient outcomes.

Phospho-regulation of ASCL1-mediated chromatin opening during cellular reprogramming.

The proneural transcription factor ASCL1 regulates neurogenesis and drives somatic cell reprogramming into neurons. However, not all cell types can be reprogrammed by ASCL1, raising the questions of what provides competence and how we can overcome barriers to enable directed differentiation. Here, we investigate how levels of ASCL1 and its phosphorylation modulate its activity over progressive lineage restriction of mouse embryonic stem cells. We find that inhibition of ASCL1 phosphorylation enhances reprogramming of both mesodermal and neuroectodermal cells, while pluripotent cells remain refractory to ASCL1-directed neuronal differentiation. By performing RNA-seq and ATAC-seq in neuroectoderm, we find that un(der)phosphorylated ASCL1 causes increased chromatin accessibility at sites proximal to neuronal genes, accompanied by their increased expression. Combined analysis of protein stability and proneural function of phosphomutant and phosphomimetic ASCL1 reveals that protein stability plays only a marginal role in regulating activity, while changes in amino acid charge cannot fully explain enhanced activity of the serine-proline mutant variants of ASCL1. Our work provides new insights into proneural factor activity and regulation, and suggests ways to optimize reprogramming protocols in cancer and regenerative medicine.

Factors Influencing Contrast Enhancement in Abdominal Computed Tomography Angiography in the Dog: A Systematic Review.

Multidetector-row computed tomographic angiography (angio-CT) aims to achieve optimal opacification of the vascular compartment of interest. The distribution and quality of vascular opacification are influenced by patient-related factors, contrast medium (CM)-related factors, and scanner-related factors. This systematic review evaluates these factors and their effects on contrast enhancement. A comprehensive literature search was made in February 2024 across four online bibliographic databases (Web of Science, PubMed, Scopus, and CAB Abstract) in adherence with the PRISMA 2020 guidelines. After screening the 5990 unique published articles initially identified, 20 full-text original studies met the inclusion criteria for the final review. The amount of abdominal adipose tissue was found to significantly affect enhancement, which suggests the possibility of reducing the CM dose to minimize adverse effects or toxicity. The injection rate of the CM, rather than the injection duration, was identified as the most critical factor, with important clinical implications. For scanners with slower acquisition speeds or longer scan durations, maintaining a fixed CM injection duration may optimize vascular phase acquisition. In contrast, faster scanners benefit from bolus tracking, which allows for improved differentiation between vascular phases. Additionally, administering a saline flush post-CM injection enhances arterial opacification while reducing the necessary CM dose. This systematic review highlights essential factors influencing contrast enhancement in angio-CT for dogs and provides a foundation for future research aimed at optimizing imaging protocols in veterinary medicine.

Pandit Brajabandhu Tripathy Sharma: An eminent luminary in the diverse realms of Orissa’s Ayurveda heritage

Abstract This study explores the life and contributions of Pandit Brajabandhu Tripathy Sharma, a renowned Ayurvedic practitioner and scholar from Odisha, India. Amid the limited healthcare resources of British India, Pandit Sharma dedicated his life to improving the health and well-being of his community. Drawing from his grandfather’s wisdom and inspired by his wife’s recovery from a snakebite, he emerged as a skilled clinician, renowned for his expertise in Nadi Pariksha (pulse examination), treating venereal diseases, and formulating personalized medicines. He established the Jeebanbandhu Aushadhalaya, which continues to offer traditional Ayurvedic treatments to the community. Beyond his clinical practice, Pandit Sharma was a prolific writer, authoring several books on Ayurveda, literature, and philosophy. His most notable works include “Drabya Guna Kalpadruma,” “Roga Vigyan,” and “Abhinava Dhanvantari,” which offer insights into medicinal plants, disease diagnosis, and treatment protocols. Pandit Sharma’s enduring legacy is marked by his dedication to Ayurveda, literary contributions, and philanthropic endeavors. His story continues to inspire aspiring practitioners and underscores the profound impact Ayurveda can have on individuals and communities.

Sports Medicine Protocols: Guide to Injury Management and Rehabilitation

Sports medicine protocols are crucial manuals that provide evidence-based methods for managing injuries, recovering from surgeries, and maximising performance for athletes of all skill levels. Sports medicine professionals can use these protocols as standardised frameworks to evaluate, diagnose, and treat sports-related injuries. They can also be used to help make safe and efficient return-to-play choices. This paper offers a thorough review of sports medicine practices, including important elements like injury evaluation, treatment options, physical therapy exercises, and criteria for returning to the game. This research tries to improve the understanding and application of sports.

Optimizing clinical research in a regional cancer center network: A multidepartment survey-based approach.

27 Background: Memorial Sloan Kettering Cancer Center’s (MSKCC) regional care network (RCN) encompasses 6 sites across NY and NJ. Further expansion of clinical research (CR) in the RCN provides an opportunity to bring clinical research closer to patients. The CR RCN leadership group was created to identify and address barriers to research operations in the RCN. Methods: A survey was conducted among Medical, Surgical, Neurologic and Radiation Oncologists at the RCN sites (February 2022-April 2024) to assess perspectives on research-related challenges. The 23-question survey included multiple-choice, open-ended, and ranking questions regarding protocol availability, consenting processes, and staffing support. Results were used to inform interventions to address barriers in the RCN. Results: 92/108 (85%) medical oncologists, 16/31 (52%) radiation oncologists, 7/9 (77%) neurologists and 28/70 (40%) surgeons completed the survey, revealing three key challenges: 1) Limited protocol availability: Only 47% of the time was there a suitable medicine trial available in the RCN. Identified barriers to opening desired medicine protocols (n=23 in total) included trials that were closed to accrual, pending amendments, and sponsor approval issues. 2) Inadequate investigator representation: 278 medicine protocols lacked RCN physicians listed as consenting providers. 3) Insufficient research staff. Only 33% were satisfied with the research support, and 62% of physicians identified lack of clinical research support staff as the biggest barrier to accrual. 71% reported delays of more than one week in screening eligible patients due to insufficient support. Following these results, interventions were implemented across departments to overcome these challenges. Appropriate RCN physicians were added to the 278 protocols, and an analysis of staffing needs increased clinical trial nursing and administrative staff. Therapeutic and non-therapeutic accruals in the Department of Medicine rose by 10.5%, and total research visits increased by 21.4% compared to the previous year. Thirteen of the 23 studies in medicine, that were previously only open at main campus, were opened to accrual in the RCN. This survey highlighted research portfolio gaps in multiple departments that are now being addressed. Conclusions: This multi departmental survey-based approach identified key barriers to CR within MSKCC's RCN, and in turn, informed interventions that increased research activity. These findings offer a potential roadmap for optimizing research in similar networks by enhancing protocol accessibility, addressing staffing needs, and fostering collaboration. Further investigations are ongoing to address additional challenges and improve workflows across departments.

Microfragmented adipose tissue versus platelet-rich plasma in the treatment of knee osteoarthritis: a systematic review and meta-analysis.

This meta-analysis focuses on the controversial efficacy and safety of microfragmented adipose tissue (MFAT) as compared with platelet-rich plasma (PRP) in the clinical treatment of knee osteoarthritis (KOA). We have attempted to provide an evidence-based medicine protocol for the conservative treatment of KOA. Researchers collected and compared randomized controlled trials (RCTs) that used microfragmented adipose tissue and platelet-rich plasma to treat knee osteoarthritis. We searched CNKI, Wanfang Database, CMJD, PubMed, Sinomed, Cochrane Library, and Embase for studies published up to May 31, 2023. Two investigators independently screened literature, extracted data, and assessed bias risk using the Cochrane bias risk tool. The researchers then performed a meta-analysis using Revman 5.4 statistics software provided by the Cochrane Library. A total of 4 randomized controlled trials involving 266 patients (326 knees) were included. There were 161 knees in the MFAT group and 165 knees in the PRP group. Meta-analysis showed a statistically significant difference in VAS scores between the MFAT group and the PRP group at 12 months after treatment [MD=0.99, 95% CI (0.31, 1.67), P=0.004]. This result showed that VAS scores were lower in the PRP group than in the MFAT group, and that PRP injection reduced pain more effectively than MFAT injection. At 6 months after treatment, Tegner activity scale scores in the MFAT group were higher than that in the PRP group [MD=0.65, 95% CI (0.11, 1.19), P=0.02], and the difference was statistically significant. There were no significant differences in the remaining indicators between the two groups. Based on this meta-analysis, PRP appears to be more effective than MFAT in treating KOA in terms of long-term pain relief. However, MFAT was superior to PRP in improving short-term activity function. Overall, there was no significant difference between MFAT and PRP in the treatment of KOA. In addition, MFAT does not increase the risk of adverse events compared to PRP. However, at present, there are few clinical studies on MFAT and PRP, which need to be verified by more rigorously designed clinical trials.

Autophagic genes and antioxidant status during doxorubicin therapy under temperature-stressed conditions in breast cancer cells

ObjectivesAutophagy as a cellular event swings between apoptosis induction and cellular maintenance during chemotherapy. The interplay between autophagy and reactive oxygen species (ROS) remains obscure in cancer progression and treatment. This study aimed to determine the combination effect of chemotherapy and hyperthermia on cancer cell proliferation, autophagy signaling, and oxidative stress status. MethodsTo estimate the autophagic genes' role and antioxidant capacity involvement during chemotherapy, human breast cancer cell lines (MCF7 and CAL51) were exposed to a high temperature at 42 °C and treated with doxorubicin (DOX). The MTT assays were performed to determine the cell survival levels, and the autophagic gene expression levels (ATG5, LC3A, LC3B, and Beclin1) were analyzed. The intracellular TAS (total antioxidant status) and SOD (superoxide dismutase) activities were determined. ResultsThe combined effects of high temperature with chemotherapy significantly reduced cell viability and cell survival compared to cells treated with the chemotherapeutic agent DOX alone. The cell's autophagic gene activities were significantly increased after exposure to 42 °C temperature and DOX-based chemotherapy compared to the cells treated with DOX alone. It was observed that TAS and SOD activities were increased in the cell lines exposed to high temperatures with DOX compared to the cells treated with DOX alone. Increased autophagic gene expression levels and cell death were observed in response to the high temperature and DOX treatment in breast cancer cells. ConclusionThe study may provide a plausible route and treatment plan for the individual adoption of cancer chemotherapy and be developed as part of the personalized medicine protocol.

The Space Omics and Medical Atlas (SOMA) and international astronaut biobank

Spaceflight induces molecular, cellular and physiological shifts in astronauts and poses myriad biomedical challenges to the human body, which are becoming increasingly relevant as more humans venture into space1–6. Yet current frameworks for aerospace medicine are nascent and lag far behind advancements in precision medicine on Earth, underscoring the need for rapid development of space medicine databases, tools and protocols. Here we present the Space Omics and Medical Atlas (SOMA), an integrated data and sample repository for clinical, cellular and multi-omic research profiles from a diverse range of missions, including the NASA Twins Study7, JAXA CFE study8,9, SpaceX Inspiration4 crew10–12, Axiom and Polaris. The SOMA resource represents a more than tenfold increase in publicly available human space omics data, with matched samples available from the Cornell Aerospace Medicine Biobank. The Atlas includes extensive molecular and physiological profiles encompassing genomics, epigenomics, transcriptomics, proteomics, metabolomics and microbiome datasets, which reveal some consistent features across missions, including cytokine shifts, telomere elongation and gene expression changes, as well as mission-specific molecular responses and links to orthologous, tissue-specific mouse datasets. Leveraging the datasets, tools and resources in SOMA can help to accelerate precision aerospace medicine, bringing needed health monitoring, risk mitigation and countermeasure data for upcoming lunar, Mars and exploration-class missions.

Reporting characteristics and quality of randomized controlled trial protocols in traditional Chinese medicine: a cross-sectional study.

The impact of the Standard Protocol Items: Recommendations for Interventional Trials of Traditional Chinese Medicine (SPIRIT-TCM) Extension 2018 statement on the reporting quality of randomized controlled trial (RCT) protocols in traditional Chinese medicine (TCM) is not clear. This review aimed to assess the reporting characteristics and quality of RCT protocols involving interventions such as Chinese herbal medicine formulas (CHMF), acupuncture, and moxibustion published in the last 3years. We conducted an extensive search among multiple databases, including All EBM Reviews, Allied and Complementary Medicine (AMED), Embase, Ovid MEDLINE(R), PubMed, Web of Science, Google Scholar, and ClinicalTrials.gov for publications in English from 1 January 2020 to 10 August 2023. Two reviewers independently assessed the eligibility of the publications, extracted predetermined information, and evaluated the reporting based on the SPIRIT-TCM Extension 2018 checklist. Of the 420 eligible protocols (comprising 163 studies on CHMF, 239 on acupuncture, and 18 on moxibustion), the average reporting compliance rate was only 35.4%. Approximately half of the assessed items fell into the category of poorly reported, demonstrating a compliance rate below 65%. Notably, reporting compliance in acupuncture and moxibustion interventional studies exhibited higher scores than compliance in CHMF studies. Continued, concerted, and coordinated efforts are required by journals, editors, reviewers, and investigators to improve the application and promotion of the SPIRIT-TCM Extension 2018 reporting guideline.

Optimization and validation of metabolomics methods for feline urine and serum towards application in veterinary medicine

BackgroundMetabolomics is an emerging and powerful technology that offers a comprehensive view of an organism's physiological status. Although widely applied in human medicine, it is only recently making its introduction in veterinary medicine. As a result, validated metabolomics protocols in feline medicine are lacking at the moment. Since biological interpretation of metabolomics data can be misled by the extraction method used, species and matrix-specific optimized and validated metabolomic protocols are sorely needed. ResultsSystematic optimization was performed using fractional factorial experiments for both serum (n = 57) and urine (n = 24), evaluating dilution for both matrices, and aliquot and solvent volume, protein precipitation time and temperature for serum. For the targeted (n = 76) and untargeted (n = 1949) validation of serum respectively, excellent instrumental, intra-assay and inter-day precision were observed (CV ≤ 15% or 30%, respectively). Linearity deemed sufficient both targeted and untargeted (R2 ≥ 0.99 or 0.90, respectively). An appropriate targeted recovery between 70 and 130% was achieved. For the targeted (n = 69) and untargeted (n = 2348) validation of the urinary protocol, excellent instrumental and intra-assay precision were obtained (CV ≤ 15% or 30%, respectively). Subsequently, the discriminative ability of our metabolomics methods was confirmed for feline chronic kidney disease (CKD) by univariate statistics (n = 41 significant metabolites for serum, and n = 55 for urine, p-value<0.05) and validated OPLS-DA models (R2(Y) > 0.95, Q2(Y) > 0.65, p-value<0.001 for both matrices). SignificanceThis study is the first to present an optimized and validated wholistic metabolomics methods for feline serum and urine using ultra-high performance liquid chromatography coupled to quadrupole-Orbitrap high-resolution mass spectrometry. This robust methodology opens avenues for biomarker panel selection and a deeper understanding of feline CKD pathophysiology and other feline applications.

Autologous concentrated bone marrow injection for precollapse osteonecrosis of the femoral head concurrent with contralateral total hip arthroplasty: protocol for a clinical trial

IntroductionThe femoral head contralateral to the collapsed femoral head requiring total hip arthroplasty (THA) often manifests in the precollapse stage of osteonecrosis of the femoral head (ONFH). It is not...

Efficacy of treatment of equine anhidrosis with acupuncture and Chinese herbs is low but higher in treated horses compared with placebo.

To assess the therapeutic efficacy of acupuncture in combination with Chinese herbs for treatment of horses affected with anhidrosis. 44 horses affected with anhidrosis for up to 3 years' duration were enrolled. Inclusion required both compatible clinical signs and results of a quantitative intradermal terbutaline sweat test. Study horses were randomly allocated into 2 groups. Group 1 (n = 19) was treated with daily Chinese herbs and 4 weekly acupuncture sessions. Group 2 (n = 25) was given daily hay powder as a placebo and 4 weekly sham acupuncture sessions. Horses were tested by quantitative intradermal terbutaline sweat test within 2 days after treatment completion and again 4 weeks following treatment. Terbutaline-induced sweat responses (mg) were not different between groups within 2 days and 4 weeks after treatment. Two days after treatment, ratios of sweat responses (compared to baseline) were higher (P < .05) in the treatment group compared to the placebo group at terbutaline concentrations of 1.0, 100, and 1,000 µg/mL. The number of horses responding to treatment was higher in the treatment group (5/19 [26%]), compared to horses in the placebo group (1/25 [4%]) for 1 of 5 terbutaline concentrations 2 days (10 µg/mL) or 4 weeks (0.1 µg/mL) after treatment. Ratios of sweat responses were higher in treatment horses 2 days after treatment, compared to baseline, but not 4 weeks later. The efficacy of a traditional Chinese veterinary medicine protocol for anhidrosis treatment with acupuncture and Chinese herbs was low but higher in treated horses compared with placebo.

Optimisation of the bone single photon emission computed tomography in oncology patients

Introduction: The introduction of hybrid imaging systems such as Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) has completely changed the scanning procedure of conventional diagnostic nuclear medicine protocols. Modern bone scintigraphy protocols include SUV quanitification and Whole Body (WB) SPECT/CT scanning modality. The major limitation of these new technologies is relatively long scanning time. New detector systems with modern reconstruction softwares have been developed for fast scanning SPECT protocolos. These new technologies can produce images of reduced acquisition with same quality as full scanning acquisition. As a result new studies suggest that planar WB scintigraphy should be replaced with WB SPECT/CT. Methods: One hundred oncology patients performed SPECT/CT as a part as their clinical follow-up. Three different scanning and three reconstruction protocols have been evaluated. Two nuclear medicine physicians evaluated with Likert scale image sharpness, lesion visibility, and lesion background detectability. The overall image quality was determined as the sum of these three parameters. Results: In terms of scan duration reduction on image quality, Volumetrix Evolution for Bone performed during ultra-fast SPECT acquisition achieved the highest score, which is superior compared to the standard SPECT acquisition protocol. The overall image quality was the best with the Volumetrix MI Evolution for Bone protocol for ultra-fast acquisition Conclusion: The Evolution for Bone protocol for ultra-fast acquisition showed best results compared to other protocols. The adoption of new acquisition SPECT protocol may offer more comfortable exams, resulting in higher patient satisfaction. The implementation of this new protocol can lead to an improvement in SPECT sensitivity, primarily due to the reduction of SPECT motion artifacts.

Effectiveness of dry needling on the treatment of patients with multiple sclerosis: systematic review

Aim: The aim of this study is to review the effectiveness of dry needling in patients with multiple sclerosis (MS). Methods: PubMed, Physiotherapy Evidence Database (PEDro), Web of Science, Scopus, and Cochrane Library databases were searched from its inception until July 2023 and the reference lists of the articles obtained were manually searched. Studies examining the effectiveness of dry needling treatment alone or in combination with a different protocol in individuals diagnosed with MS, regardless of type, were included. The systematic review included quasi-experimental studies and case reports. Studies involving traditional Chinese medicine acupuncture applications, conference abstracts, and protocol records were excluded. Methodological quality assessments were carried out independently by two authors using tools developed by the Joanna Briggs Institute (JBI). Results: A total of 130 studies were found in the searches. Some studies were excluded due to duplication, protocol registration, conference abstract, and content outside the scope of the study and 7 studies were included in the review. In total, 33 individuals were included in this review, 22 of whom were women. Four studies specified the MS type of the patients, while the other studies did not specify MS type. Conclusions: Despite some limitations, this is, to our knowledge, the first review summarizing studies evaluating the effectiveness of dry needling in MS patients. The dry needling technique alone or in a combination of treatments was effective in improving pain, spasticity, range of motion, dexterity, mobility, limb function, and quality of life in MS patients. However, these results should be treated with caution due to the small number of included studies and the lack of randomized controlled trials. Although it is too early to talk about the positive effects of the dry needling technique in MS patients, the study results are promising. More randomized controlled trials should be conducted on this topic.

In vitro and ex vivo anti-Pythium insidiosum potential of ozonated sunflower oil.

This study sought to evaluate the in vitro and ex vivo susceptibility of Pythium insidiosum to ozonized sunflower oil (OSO) and verify the morphological alterations of OSO-exposed hyphae. Susceptibility assays were performed according to the broth microdilution protocol M38-A2/CLSI, and the minimal inhibitory (MIC) and minimal oomicidal (MOC) concentrations were also determined. Non-ozonated sunflower oil (SO) was used as the oil control. Additionally, kunkers from equine pythiosis were exposed to OSO. Damages caused by OSO and SO on P. insidiosum hyphae ultrastructure were verified using scanning electron microscopy. The MIC range for OSO was 7000 to 437.5mg/mL, and the values for SO were higher, ranging from 56000 to 14000mg/mL. The MOC was equal to MIC for both oil formulations. The OSO fully inhibited the oomycete growth from kunkers, although there was P. insidiosum growth in the kunker control in 24h of incubation. The SEM analyses showed that both OSO and SO caused morphological alterations in P. insidiosum hyphae, highlighting the presence of cavitation along the hyphae with loss of continuity of the cell wall, which was more evident in the OSO-treated hyphae. The OSO had the best oomicidal activity, leading us to believe that our findings may support future research containing this formulation to be applied in integrative medicine protocols to control pythiosis in animals and humans.