Therapy Techniques Research Articles

Adaptive Radiotherapy: Next-Generation Radiotherapy.

Radiotherapy, a crucial technique in cancer therapy, has traditionally relied on the premise of largely unchanging patient anatomy during the treatment course and encompassing uncertainties by target margins. This review introduces adaptive radiotherapy (ART), a notable innovation that addresses anatomy changes and optimizes the therapeutic ratio. ART utilizes advanced imaging techniques such as CT, MRI, and PET to modify the treatment plan based on observed anatomical changes and even biological changes during the course of treatment. The narrative review provides a comprehensive guide on ART for healthcare professionals and trainees in radiation oncology and anyone else interested in the topic. The incorporation of artificial intelligence in ART has played a crucial role in improving effectiveness, particularly in contour segmentation, treatment planning, and quality assurance. This has expedited the process to render online ART feasible, lowered the burden for radiation oncology practitioners, and enhanced the precision of dynamically personalized treatment. Current technical and clinical progress on ART is discussed in this review, highlighting the ongoing development of imaging technologies and AI and emphasizing their contribution to enhancing the applicability and effectiveness of ART.

Use of cupping therapy in musculoskeletal disorders: A cross-sectional study on the profile, training, and practice of Brazilian physical therapists

IntroductionCupping therapy is a widely used technique in Brazilian physical therapy for the treatment of musculoskeletal disorders. However, there is limited scientific evidence to support its effectiveness. ObjectiveTo investigate the profile, training, clinical practice, and scientific updates of Brazilian Physical Therapists who use cupping therapy as a therapeutic resource for musculoskeletal disorders. MethodsA cross-sectional study was conducted through an online questionnaire, including 646 Physical Therapists who use cupping therapy in their practice. All data were analysed descriptively. ResultsCupping therapy is a technique that has been widely adopted in clinical practice by Physical Therapists, particularly among young, female professionals who have recently graduated from private universities. The primary reason for interest in this technique among these Physical Therapists is the high demand from patients. Additionally, it is often used in conjunction with other manual therapeutic techniques. They identified easy access, low cost, and ease of use as the key factors that make cupping therapy an attractive option. However, a lack of high-quality scientific evidence, as described in the literature, was identified as a major barrier to its use. ConclusionThe Physical Therapists included in this study use cupping therapy in their clinical practice, relying heavily on their own experience and the preferences of their patients, rather than utilizing the third pillar of evidence-based practice, which is to rely on the best available evidence. This study suggests that these Physical Therapists are currently implementing a technique without current scientific recommendations for its use in the treatment of musculoskeletal disorders.

The Impact of Advanced Reproductive Medicine on Female Fertility: Clinical and Technological Perspectives

Background: Infertility is defined as failure to be pregnant after 12 months of unprotected intercourse. This condition affects millions of individuals worldwide. It is not only a personal problem, causing stress and anxiety amongst individuals and couples, but it has become a community issue. One in every 6 couples will experience infertility in their lifetime. It is affecting both male and female reproductive systems, with causes ranging from hormonal imbalances to obstructive disorders. Despite its prevalence, fertility care is unequal and, for those in low and middle-income countries, virtually non-existent and a long overdue topic for global attention and action. Method: We followed a systematic approach to select articles related to recent developments in female fertility and reproductive medicine. Keywords such as “female fertility” and “advanced reproductive medicine” were used for getting targeted articles. We used only peer-reviewed articles published from 2019 to 2024. Only high-quality data was extracted for general public information. Result: Our findings show that Assisted Reproductive Technologies (ART), microfluidic devices, and innovations like CoQ10 therapies have significantly improved fertility treatment outcomes. AI-driven personalized medicine has enhanced accessibility and effectiveness, democratizing fertility care. Stem cell therapy and platelet-rich plasma techniques are another breakthrough in reproductive medicine. Conclusion: It is concluded that medical advancements have revolutionized reproductive medicine. There is now a ray of new hope for those couple who are experiencing infertility. The future promises further improvements in success rates and patient experience with continued progress.

Potential psychological responses in patients who underwent MRI scanning

This paper explores the potential impact of magnetic resonance imaging (MRI) on patients' psychological states, focusing on reported mood changes post-procedure. Factors influencing the psychological state during an MRI, including claustrophobia, noise, scan duration, and fear of the unknown, are discussed. We also draw parallels with darkness therapy, a stress and depression management technique, due to the similar environment. Notably, a subset of patients reported transient improvement in depressive symptoms following an MRI, suggesting a need for further research. The paper underscores the necessity for rigorous scientific exploration of these observations to validate them and better inform patients about possible mood alterations post-MRI.

Fluid professional boundaries: ethnographic observations of co-located chiropractors, osteopaths and physiotherapists

BackgroundChiropractors, osteopaths and physiotherapists (COPs) can assess and manage musculoskeletal conditions with similar manual or physical therapy techniques. This overlap in scope of practice raises questions about the boundaries between the three professions. Clinical settings where they are co-located are one of several possible influences on professional boundaries and may provide insight into the nature of these boundaries and how they are managed by clinicians themselves.ObjectivesTo understand the nature of professional boundaries between COPs within a co-located clinical environment and describe the ways in which professional boundaries may be reinforced, weakened, or navigated in this environment.MethodsDrawing from an interpretivist paradigm, we used ethnographic observations to observe interactions between 15 COPs across two clinics. Data were analysed using reflexive thematic analysis principles.ResultsWe identified various physical and non-physical ‘boundary objects’ that influenced the nature of the professional boundaries between the COPs that participated in the study. These boundary objects overall seemed to increase the fluidity of the professional boundaries, at times simultaneously reinforcing and weakening them. The boundary objects were categorised into three themes: physical, including the clinic’s floor plan, large and small objects; social, including identities and discourse; and organisational, including appointment durations and fees, remuneration policies and insurance benefits.ConclusionsPhysical, social, organisational related factors made the nature of professional boundaries between COPs in these settings fluid; meaning that they were largely not rigid or fixed but rather flexible, responsive and subject to change. These findings may challenge patients, clinicians and administrators to appreciate that traditional beliefs of distinct boundaries between COPs may not be so in co-located clinical environments. Both clinical practice and future research on professional boundaries between COPs may need to further consider some of these broader factors.

Comparative Evaluation of the Effectiveness of Innovative Periorbital Eye Massager and Virtual Reality Eyeglasses for Reducing Dental Anxiety during Dental Restorative Procedures in Children.

Many behavior management techniques are employed to reduce the anxiety associated with dental procedures in children. One of the most commonly used methods comprises audiovisual distraction using virtual reality (VR) eyeglasses. In this study, an innovative device, a periorbital eye massager (PEM), is compared with VR to evaluate dental anxiety in children. in this study, 22 children were divided into two groups, that is, group I consisting of PEM and group II consisting of VR. The participants were instructed to wear the device and then subjected to dental restorative procedures. After completion of the procedure, anxiety was measured using a validated questionnaire by the children and by using the modified behavior pain scale by the second investigator. Also, physiological parameters like heart rate and oxygen saturation were evaluated before and after a dental procedure. The results were statistically insignificant for group I and group II when a validated questionnaire and modified behavior pain scale were used to measure the dental anxiety of children. Also, the data also shows no significant difference in heart rate and oxygen saturation between the two groups. The innovative PEM can also be used as an effective behavior management tool in managing dental anxiety in children, as there was no statistically significant difference between PEM and VR. As a pediatric dentist, the methods for administering a patient present a novel challenge because behavior management varies from patient to patient. As a result, the prospects for augmenting various techniques of behavior therapy for pediatric patients are limitless. Gala UP, Kalaskar R. Comparative Evaluation of the Effectiveness of Innovative Periorbital Eye Massager and Virtual Reality Eyeglasses for Reducing Dental Anxiety during Dental Restorative Procedures in Children. Int J Clin Pediatr Dent 2024;17(1):48-53.

Cytotoxicity Evaluation of Various Composite Resin Materials: An In Vitro Study.

Aim This study aimed to determine and comparethe cytotoxicity of light-cured composite resin (Enlight light cure composite (Ormco, Glendora, California, USA)), light-cured acrylic resin (Orthocryl LC (Dentaurum, Ispringen, Germany)), and the self-cure acrylic (DPI RR cold cure acrylic (Dental Products of India, Bombay Burmah Trading Corporation Ltd., Mumbai, India)) material and to determine which component is best to be used for the purpose of nasal stent fabrication in the nasoalveolar molding (NAM) technique for cleft therapy. Methods Circular discs made from Enlight light cure composite, Orthocryl LC, and self-cure acrylic were submerged for 24 hours in gingival fibroblast media (three discs of each material) and control medium (three discs of each material) that were both contained in plates. After analyzing the optical densities of the plates, the cytotoxicity of the products was assessed by measuring cell viability using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The compiled data was analyzed using IBM SPSS Statistics for Windows, V. 23.0 (IBM Corp., Armonk, NY). The normality of the data was evaluated using the Shapiro-Wilk test.One-way analysis of variance (ANOVA) and pairwise comparison made with Tukey's honestly significant difference (HSD) post hoc test with a significance level (p) of 0.05 were considered. Results The percentage of cell viability was between 80% and 150%. A significantmean difference was noted in the cell viability between the three groups (p=0.009). High mean cell viability was seen in Orthocryl LC. However, there was no significant mean difference between Orthocryl LC and Enlight light cure composite material (p=0.854). Conclusion Both Orthocryl LC and Enlight light cure composite materials are less cytotoxic when compared to the self-cure acrylic resin material and can be used to fabricate the nasal stent component for infants with cleft defects, undergoing NAM procedure.

Effects of ankle joint mobilization on dynamic balance muscle activity and dynamic balance in persons with chronic ankle instability - Feasibility of a cross-over study

IntroductionStudies with focus on effects of manual therapy techniques on postural control and muscle activity in patients with chronic ankle instability (are lacking. The purpose of this study was to evaluate the feasibility of a planned cross-over study to assess efficacy of manual therapy techniques applications in patients with chronic ankle instability. MethodsThis feasibility study used a randomized controlled, blinded assessor cross-over design. Criteria of success under evaluation were adherence and attrition rates and adverse events. while preliminary treatment effects of manual therapy techniques on muscular activity (measured by surface electromyography) and on dynamic balance (measured by time to stabilization test) were secondary aims. ResultsThirteen participants (mean age: 24.4 ± 3.8 years) with chronic ankle instability volunteered in this feasibility study. Success criteria showed a high adherence (98.7%) and low attrition (0%). No missing data were reported but four out of 26 data sets could not be used for statistical analysis because of non-readability of the recorded data. Preliminary treatment effect showed divergent results for surface electromyography and time to stabilization. One significant result (p = 0.03, ES = 1.48) in peroneus longus muscle activity after jump landing between 30 and 60 ms could be determined. ConclusionsThis study showed that the study protocol is feasible but should be modified by offering participants the opportunity to familiarize to the jumps and to the test repetitions. This study generates better understanding of manual therapy techniques for patients with chronic ankle instability.

Tongues Tied by Orofacial Myofunctional Therapy about Tongue Tie: A Narrative Review.

The respective review articles aim is to provide an overview as well as describes and enlists different orofacial myofunctional therapy exercises as a modality for tongue tie secondary to surgery.Tongue tie is the basically a connection that joints base of tongue to the floor of mouth. This leads to difficulties various difficulties such as altered speech, oral habits, maligned teeth and many more. During formative years, most children successfully treated of tongue tie by releasing it, but problems start after its correction. That it may can reappear or may lead to same difficulties as prior. Parents and clinicians are only concerned about speech and aesthetics after release of tongue tie. But OMT plays important role ore and post-surgical procedure. OMT help in proper tongue posture along with reducing the probability of tissue reattachment after surgery by exercises. This therapy positively influenced functions by reducing deleterious habits. A review of relevant literature is predicated on articles found using free text terms, mesh terms, and some basic tongue tie as well as tongue tie release pamphlets that were published in English up until the year 2023 in the electronic databases PubMed, EBSCO, Scopus, Google Scholar, and Web of Science. With the aid of mesh keywords, the initial search yielded 38-40 articles; 20-35 were chosen depending on the requirements. Also we searched for orofacial myofunctional exercises or exercises recommended after tongue tie release. Various exercises enlisted in our article that will guide a individual before and after tongue tie release which will give positive outcomes such as proper tongue posture, speech, swallow, regained aesthetics and self-esteem. Tongue plays an important role in development of perioral structures as well as in the swallow to good speech articulation and dental occlusion. So, as pediatric dentist its important know that after release of tongue tie what to do and how to maintain. This review article is focused on the various orofacial myofunctional therapy techniques employed for tongue tie but not a single one to describe them. Our pertaining review act as a guide for clinicians as well as individuals to manage tongue tie after its release. Shah SS, Agarwal PV, Rathi N, et al. Tongues Tied by Orofacial Myofunctional Therapy about Tongue Tie: A Narrative Review. Int J Clin Pediatr Dent 2024;17(1):109-113.

Experimental demonstration of real-time cardiac physiology-based radiotherapy gating for improved cardiac radioablation on an MR-linac.

Cardiac radioablation is a noninvasive stereotactic body radiation therapy (SBRT) technique to treat patients with refractory ventricular tachycardia (VT) by delivering a single high-dose fraction to the VT isthmus. Cardiorespiratory motion induces position uncertainties resulting in decreased dose conformality. Electocardiograms (ECG) are typically used during cardiac MRI (CMR) to acquire images in a predefined cardiac phase, thus mitigating cardiac motion during image acquisition. We demonstrate real-time cardiac physiology-based radiotherapy beam gating within a preset cardiac phase on anMR-linac. MR images were acquired in healthy volunteers (n = 5, mean age = 29.6 years, mean heart-rate (HR) = 56.2 bpm) on the 1.5 T Unity MR-linac (Elekta AB, Stockholm, Sweden) after obtaining written informed consent. The images were acquired using a single-slice balance steady-state free precession (bSSFP) sequence in the coronal or sagittal plane (TR/TE = 3/1.48 ms, flip angle = 48 , SENSE = 1.5, , voxel size = , partial Fourier factor = 0.65, frame rate = 13.3 Hz). In parallel, a 4-lead ECG-signal was acquired using MR-compatible equipment. The feasibility of ECG-based beam gating was demonstrated with a prototype gating workflow using a Quasar MRI4D motion phantom (IBA Quasar, London, ON, Canada), which was deployed in the bore of the MR-linac. Two volunteer-derived combined ECG-motion traces (n = 2, mean age = 26 years, mean HR = 57.4 bpm, peak-to-peak amplitude = 14.7 mm) were programmed into the phantom to mimic dose delivery on a cardiac target in breath-hold. Clinical ECG-equipment was connected to the phantom for ECG-voltage-streaming in real-time using research software. Treatment beam gating was performed in the quiescent phase (end-diastole). System latencies were compensated by delay time correction. A previously developed MRI-based gating workflow was used as a benchmark in this study. A 15-beam intensity-modulated radiotherapy (IMRT) plan ( Gy) was delivered for different motion scenarios onto radiochromic films. Next, cardiac motion was then estimated at the basal anterolateral myocardial wall via normalized cross-correlation-based template matching. The estimated motion signal was temporally aligned with the ECG-signal, which were then used for position- and ECG-based gating simulations in the cranial-caudal (CC), anterior-posterior (AP), and right-left (RL) directions. The effect of gating was investigated by analyzing the differences in residual motion at 30, 50, and 70% treatment beam duty cycles. ECG-based (MRI-based) beam gating was performed with effective duty cycles of 60.5% (68.8%) and 47.7% (50.4%) with residual motion reductions of 62.5% (44.7%) and 43.9% (59.3%). Local gamma analyses (1%/1 mm) returned pass rates of 97.6% (94.1%) and 90.5% (98.3%) for gated scenarios, which exceed the pass rates of 70.3% and 82.0% for nongated scenarios, respectively. In average, the gating simulations returned maximum residual motion reductions of 88%, 74%, and 81% at 30%, 50%, and 70% duty cycles, respectively, in favor of MRI-basedgating. Real-time ECG-based beam gating is a feasible alternative to MRI-based gating, resulting in improved dose delivery in terms of high rates, decreased dose deposition outside the PTV and residual motion reduction, while by-passing cardiac MRIchallenges.

Measurement and Incorporation of Laryngeal Motion Using cine-MRI on an MR-Linear Accelerator to Generate Radiation Therapy Plans for Early-stage Squamous Cell Cancers of the Glottis

IntroductionSwallow-related motion of the larynx is most significant in the cranio-caudal directions and of short duration. Conventional target definition for radical radiotherapy includes coverage of the whole larynx. This study longitudinally examined respiration- and swallow-related laryngeal motions using cine-MRI. We further analysed the dosimetry to organs at risk by comparing 3D-conformal radiotherapy (3D-CRT), Volumetric-Modulated Arc Therapy (VMAT) and Intensity-Modulated Radiotherapy (IMRT) techniques. MethodsFifteen patients with T1-2 N0 glottic squamous cell carcinomas were prospectively recruited for up to three cine-MRI scans on the Elekta Unity MR-Linear accelerator, at the beginning, middle and end of a course of radical radiotherapy. Swallow frequency and motion of the hyoid bone, cricoid and thyroid cartilages and vocal cords were recorded during swallow and rest. Adapted treatment volumes consisted of GTV + 0.5-1 cm to a CTV with an additional ITV for personalised resting-motion. Swallow-related motion was deemed infrequent and was not accounted for in the ITV. We compared radiotherapy plans for 3D-CRT (whole larynx), VMAT (whole larynx), VMAT and IMRT (ITV for resting motion). ResultsResting- and swallow- motions were most prominent in the craniocaudal plane. There were no significant changes in the magnitudes of motions over the course of radiotherapy. There was a trend for a progressive reduction in the frequency of swallow. Treatment of partial-larynx volumes with intensity-modulated methods significantly reduced the dose to carotid arteries compared to whole-larynx. Robustness analysis demonstrated that when accounting for intra-fraction swallow, the total dose delivered to the ITV/PTV was maintained above 95%. ConclusionsSwallow-related motions are infrequent and accounting for resting motion in an ITV is sufficient. VMAT/IMRT techniques that treat more conformal targets can significantly spare critical organs at risk such as the carotid arteries and thyroid gland, potentially reducing the risk of carotid artery stenosis related and other complications long-term.

Pain Care at Home to Amplify Function: Protocol Article.

Guidelines recommend strategies to optimize opioid medication safety, including frequent reassessment of the benefits and harms of long-term opioid therapy. Prescribers, who are predominantly primary care providers (PCPs), may lack the training or resources to implement these guideline-concordant practices. Two interventions have been designed to assist PCPs and tested within the Veterans Health Administration (VHA). Telemedicine Collaborative Management (TCM) provides primarily medication management support via care manager-prescriber teams. Cooperative Pain Education and Self-Management (COPES) promotes self-management strategies for chronic pain via cognitive behavior therapy techniques. Each intervention has been shown to improve prescribing and/or patient outcomes. The added value of combining these interventions is untested. With funding and central coordination by the Integrative Management of Chronic Pain and Opioid Use Disorder for Whole Recovery (IMPOWR) Network of the National Institutes of Health Helping to End Addiction Long-term (HEAL) Initiative, we will conduct a multisite patient-level randomized hybrid II effectiveness-implementation trial within VHA to compare TCM to TCM + COPES on the primary composite outcome of pain interference and opioid safety, secondary outcomes of alcohol use, anxiety, depression, and sleep, and other consensus IMPOWR Network measures. Implementation facilitation strategies informed by interviews with healthcare providers will target site-specific needs. The impact of these strategies on TCM implementation will be assessed via established formative and summative evaluation techniques. Economic analyses will evaluate intervention cost-effectiveness.

Optimizing the traversal time for gantry trajectories for proton arc therapy treatment plans

Background. Proton arc therapy (PAT) is an emerging radiation therapy technique where either the gantry or the patient continuously rotates during the irradiation treatment. One of the perceived advantages of PAT is the reduced treatment time, but it is still unclear exactly how long these treatment times will be, given that no machine capable of its delivery is available on the market at the time of writing. Objective. We introduce the algorithm arc trajectory optimization method (ATOM), which aims to determine an efficient velocity profile for the gantry for rapid delivery of a given proton arc treatment plan. This algorithm could be used to minimize the delivery time of a proton arc plan without changing the plan or updating the machine. Approach. ATOM computes the trajectory with the shortest delivery time while ensuring there is enough time to deliver all spots in each energy layer and switch energy between layers. The feasibility of the dynamic gantry movement was assured by enforcing maximum and minimum limits for velocity, acceleration, and jerk. This was achieved by discretizing the gantry velocity and combining the A* algorithm with the open-source motion generation library Ruckig. The algorithm was tested on a synthetic data set as well as a liver case, a prostate case and a head and neck case. Main results. Arc trajectories for plans with 360 energy layers were calculated in under a second using 256 discrete velocities. The delivery time of the liver case, the prostate case and the head and neck case were 284 s, 288 s and 309 s respectively, for 180 energy layers. Significance. ATOM is an open-source C++ library with a Python interface that rapidly generates velocity profiles, making it a highly efficient tool for determining proton arc delivery times, which could be integrated into the treatment planning process.

Unveiling the Efficacy of Physiotherapy Strategies in Alleviating Low Back Pain: A Comprehensive Review of Interventions and Outcomes.

Low back pain (LBP) presents a significant burden globally, affecting individuals of all ages, but it is more common in adults aged 30-60 years oldand demographics including race, ethnicity, and socioeconomic status. Physiotherapy interventions are commonly employed to manage LBP due to their non-invasive nature and potential for addressing underlying biomechanical dysfunctions. This comprehensive review aims to evaluate the efficacy of various physiotherapy strategies in alleviating LBP, considering a range of interventions and their associated outcomes. Through a thorough examination of existing literature from January 2017 to October 2023, this review synthesises evidence on the effectiveness of interventions such as manual therapy, exercise therapy, electrotherapy modalities, and education-based approaches. The review also scrutinizes the comparative effectiveness of different physiotherapy modalities and their suitability for specific patient populations, considering factors such as chronicity, severity, and underlying pathology. By critically evaluating the evidence base, this review aims to provide insights into the most effective physiotherapy strategies for alleviating LBP, chronic low back pain (CLBP)and chronic nonspecific low back pain (CNLBP) and guiding clinical practice towardevidence-based interventions. The Visual Analogue Scale and Numerical Pain Rating Scale for pain, Oswestry Disability Index andRoland-Morris Disability Questionnaire for disability, Modified-Modified Schober Test for measurement of lumbar flexion and extensionand static and dynamic balance for assessing postural stability and balance were among the measures used to foresee enhancements in pain, disability, balance, and LBP symptoms. Twenty-one studies that fulfilled the criteria for inclusion (aged 20 to 50 years and of both genders) were added to the review. Exercises for core stability, strengthening, orthosis (a medical device designed to support, align, stabilise, or correct musculoskeletal structures and functions), transcutaneous electrical nerve stimulation, heat massage therapy, interferential current (a form of electrical stimulation used in physical therapy), Mulligan's mobilization (a manual therapy technique), low-level laser therapy, and McGill stabilization exercises (core exercises) were among the therapeutic strategies. The McKenzie method (back exercises), ultrasound, sensory-motor training, Swiss ball exercises, and other techniques reduced pain and enhanced strength, balance, and ease of daily activities. Every therapeutic approach has an impact on recovery rates ranging from minimal to maximal. Conventional physical therapy is less effective than most recent advancedtechniques like mobilisation and exercises. In summary, the integration of manual techniques, orthoses and alternative intervention strategies with conservative therapeutic approaches can effectively alleviate pain, enhance function and yield better overall outcomes. To get more information about the optimal dosage, therapeutic modalitiesand long-term effects of these treatments, more admirable research is required. This paper aims to expand the scientific discourse by exploring non-traditional physiotherapy interventions and assessing their efficacy in light of the rigorous standards set forth by the latest WHO guidelines.

Wirksamkeit manueller thorakaler Therapie zur Behandlung des drohenden Impingement-Syndroms: systematische Übersicht

Abstract Background Impingement syndrome, a common cause of shoulder pain, often leads to functional limitations. Manual thoracic therapy is frequently employed as a non-surgical intervention, but its efficacy remains debated. This review assesses the impact of manual thoracic therapy on pain reduction and functional improvement in impingement syndrome. Methods A systematic review of randomized clinical trials was conducted, focusing on studies that applied manual thoracic therapy to patients with impingement syndrome. The primary outcomes were pain reduction and functional improvement. Studies were evaluated for methodological quality using the PEDro scale, with scores ≥ 6 indicating high quality. Results Nine studies met the inclusion criteria. All studies demonstrated high methodological quality (PEDro score ≥ 6). Pain reduction was consistent across studies, with an NPRS score reduction of 0.6 to 1.5 points immediately after treatment and up to 3.2 points at follow-up. Functionality improvements were statistically significant in some studies. However, the results showed limited homogeneity, and the majority of studies did not report substantial differences between intervention and placebo groups. Conclusion This review suggests that manual thoracic therapy may lead to pain reduction in impingement syndrome, with some evidence of functional improvement. However, the variability in manual therapy techniques and the limitations in research methodologies indicate a need for further controlled studies. These findings underscore the potential of manual therapy as a supplementary treatment but also highlight the necessity for more robust clinical trials to fully ascertain its effectiveness in clinical practice. Graphic abstract

Non-Variceal Upper Gastrointestinal Bleeding

Non-variceal upper gastrointestinal bleeding (NVUGIB), which predominantly occurs secondary to peptic ulcers, presents a major challenge in emergency departments and is associated with high mortality rates. The staged approach used for management of NVUGIB comprises preendoscopy, endoscopy, and post-endoscopy. Proton pump inhibitors and prokinetics are used for pre-endoscopy preparation to improve visualization and outcomes. Various endoscopic hemostatic methods, including injection therapy, clipping, and thermal techniques are described, which reflects the need for personalized strategies based on patient conditions and lesion characteristics. Post-endoscopic care includes continuous acid suppression therapy and selective second-look endoscopy. Overall, the approach to effective NVUGIB management is tailored to individual clinical scenarios to optimize patient outcomes.

Nursing Care For Schizophrenia Patients With Mindfullness Therapy Intervention In The Mentari Room Muhammadiyah Lamongan Hospital

Schizophrenia is a type of mental disorder that is often found. Schizophrenia is a disease that affects the brain and causes strange and disturbed thoughts, perceptions, emotions, movements, behavior. The prevalence of schizophrenia is estimated at around 1% of the world's population. 5 clients with a medical diagnosis of schizophrenia with nursing problems of sensory perception disorders in the Mentari ward of Muhammadiyah Lamongan Hospital. The research design uses descriptive in the form of a case review. The approach used is nursing care which includes assessment, nursing diagnosis, planning, implementation and evaluation. The results of the implementation of nursing care for 5 patients obtained the same nursing diagnosis, namely sensory perception disorders. The problem of sensory perception disorders in 5 patients was partially resolved within 2-3 implementations. The healing process differs for each patient, due to the history of illnesses that aggravate the patient's condition, such as hypertension, age, nutrition, and psychological control which are different for each patient. From the results of this study it can be concluded that mindfulness therapy techniques can be implemented in patients diagnosed with schizophrenia. because it can increase the control of hallucinations in clients.
 Keywords: Nursing Care, Schizophrenia, Mindfulness Therap

Unlocking the Power of Molecular Cloning: Revolutionizing Medical Microbiology Procedures

The revolutionary realm of molecular cloning, encompassing the creation of recombinant DNA molecules, has ignited a wave of progress within the life sciences. The advent of potent tools has facilitated the manipulation of DNA, resulting in an extraordinary surge in the versatility and breadth of applications in recombinant DNA technology. The once complex task of cloning genes has now been simplified, triggering a veritable explosion of insights into gene functionality. This has been achieved through the seamless fusion of multiple DNA fragments or the utilization of interchangeable gene cassettes, culminating in a state of unparalleled agility and expediency. In the 1970s, when restriction endonucleases, enzymes that cut DNA molecules selectively were discovered, molecular cloning technology has grown exponentially in application and intricacy, resulting in influential DNA manipulation tools. Recent decades have seen an explosion in our understanding of gene function due to the simplicity and efficiency of molecular cloning. It is expected that emerging technologies will offer superior potentials, such as stitching together multiple DNA fragments in under a few hours and transforming the resulting plasmids into bacteria, or the use of swappable genes, which can be easily moved between different paradigms, maximizing promptness and flexibility. It has been proved that cloning techniques provide a gold standard technique for polymicrobial infection, recombinant cytokines, antimicrobial peptides, epidemiology and gene therapy due to the limitations of culture-based methods. Due to molecular cloning technique, recombinant antigens are now being used to monitor patients against clinical infections. As a result of laboratory techniques that permit in vitro chemical synthesis of any DNA construct specified in silico, molecular cloning will likely undergo a paradigm shift in the coming future. As a result of these advances, DNA clones can be constructed faster and iteratively, which will speed up the growth of new vaccines, gene therapy vectors, and recombinant proteins. Here I present a detailed overview of the latest applications of molecular cloning techniques in medical microbiology.

Long-term outcomes of definitive radiation with volumetric modulated arc therapy and concurrent chemotherapy for squamous cell carcinoma of the anus in a regional Australian cancer centre.

Concurrent chemoradiotherapy is the standard of care in the curative intent treatment of squamous cell carcinoma (SCC) of the anus. Volumetric arc therapy (VMAT) is a highly conformal radiation therapy technique that has been implemented to reduce toxicity for these patients. However, there are few reports evaluating the long-term outcomes of VMAT. Thus, we evaluated the survival and toxicity outcomes of anal cancer patients treated in our regional cancer centre undergoing curative intent chemoradiotherapy using VMAT and following the Australian EviQ guidelines. All consecutive patients treated with the VMAT technique for curative-intent definitive chemoradiotherapy for anal SCC at our institution from 2013 until 2022 were retrospectively reviewed for survival and toxicity outcomes. Kaplan-Meier estimates of locoregional control, distant metastasis-free survival, disease-free survival, anal cancer-specific survival and overall survival were obtained. In total, 44 patients were analysed. The median follow-up was 48.9 months (Range 7.8-107). 97.7% of patients completed the prescribed radiation therapy and 88.6% chemotherapy. Five patients (11.4%) recurred. Four (9.1%) had isolated local failures, and one (2.3%) had an isolated distant failure. There were no regional nodal failures. The Kaplan-Meier estimates for locoregional control, distant metastasis-free survival, disease-free survival, anal cancer-specific survival and overall survival were 90.3%, 97.7%, 88.1%, 97.1% and 87% at 3 years, and 90.3%, 97.7%, 88.1%, 93.0% and 72.3% at 5 years, respectively. Acute grade 3 genitourinary (GU), gastrointestinal (GI) and skin toxicities occurred in 2.2%, 6.8% and 13.6% of patients, respectively. There were no acute grade 4 toxicities. Late grade 2 GU and GI toxicities occurred in 6.8% and 11.3% of patients, respectively. There were no late grade 3 or 4 toxicities or treatment-related deaths. The 5 -year colostomy-free survival rate was 86.4%. Outcomes for anal SCC after definitive chemoradiotherapy using VMAT in our regional cancer centre results in low rates of grade 3/4 toxicity, high rates of organ preservation and excellent survival outcomes.

On methods for radiometric surveying in radiotherapy bunkers

Radiometric surveys in radiotherapy bunkers have been carried out in Brazil for many years, both by the same radiotherapy facility for verification of shielding as by the regulatory agency for licensing and control purposes. In recent years, the Intensity Modulated Radiation Therapy (IMRT) technique has been gradually incorporated into many facilities. Therefore, it has been necessary to consider the increased leakage component that has an important impact on the secondary walls. For that, a radiometric survey method has been used that considers an increased ‘time of beam—on’ for the secondary walls. In this work we discuss two methods of doing this: the first considers that this ‘time of beam—on’ affects the sum of the two components, leakage and scattered. In another method it is considered that only the leakage component is affected by this extended ‘time of beam—on’. We compare the methods and show that for secondary walls with U = 1 the first method overestimates dose rates by important percentages and for secondary walls with U < 1 it can both overestimate or underestimate the dose rates, depending on the parameters of the project. An optimized procedure is proposed, according to the use factor (U) of the secondary wall to be measured.