Therapy Techniques Research Articles

Multi-segments conformal plan optimization for head and neck cancer.

To evaluate better dose distribution with three-dimensional radiation therapy, and to compare it with multi-segmented treatment planning techniques in patients with head and neck cancer. The prospective study was conducted at the Baghdad Centre for Radiation Therapy and Nuclear Medicine, Baghdad, Iraq, and comprised data of 50 patients with head and neck cancerous tumours from June 2021 to February 2022. There were 35 (70%) females and 15(30%) males. The mean age was 47.31 ± 3.95 years (range 19 - 69 years The patients had undergone computed tomography simulation. The images were exported to Monaco 5.1 for contouring by the radiation oncologist. The data was then imported to XiO planning system. Each plan was repeated twice; once with three-dimensional conformal radiation therapy and the other with field-in-field technique. Data was analysed using SPSS 24. There were 50 patients whose data was analysed. The results showed significant differences between three-dimensional conformal radiation therapy and field-in-field techniques for dose coverage at 90% and 95% volumes (p<0.05). There was a significant difference between the two techniques for 2Gy dose (p<0.05), but the difference was not significant for 5Gy dose (p>0.05). The field-in-field treatment planning technique was found to be more effective than the threedimensional conformal radiation therapy technique.

Five days of inpatient scoliosis-specific exercises improve preoperative spinal flexibility and facilitate curve correction of patients with rigid idiopathic scoliosis.

Preoperative spine flexibility plays a key role in the intraoperative treatment course of severe scoliosis. In this cohort study, we examined the effects of 5day inpatient scoliosis-specific exercise (SSE) on the spinal flexibility of patients with adolescent idiopathic scoliosis before surgery. A total of 65 patients were analyzed. These patients were divided into a prospective cohort (n = 43, age: 15 ± 1.6years, 36 girls and 7 boys, Lenke class 1 and 2, Cobb angle: 64 ± 11°) who underwent spinal fusion in 2020, and a retrospective cohort (n = 22, age: 15 ± 1.5years, 17 girls and 5 boys, Lenke class 1 or 2, Cobb angle: 63 ± 10°), who underwent surgery between 2018 and 2019 and did not receive preoperative SSE. Rigid scoliosis was defined as a reduction of less than 50% in Cobb angle between the preoperative fulcrum bending and initial standing curve magnitude. In the prospective cohort, 21 patients (Cobb angle: 65 ± 11°) presented with rigid thoracic scoliosis (pre-SSE fulcrum bending: 40 ± 9°, 39% reduction), and therefore received 5-day SSE to improve their preoperative spinal flexibility (SSE group), whereas 22 patients (Cobb angle: 63 ± 12°) presented with flexible thoracic scoliosis (pre-SSE fulcrum bending: 27 ± 8°, 58% reduction), and therefore underwent surgery without preoperative SSE (non-SSE group). For patients who received 5-day preoperative SSE for 4h every day, the International Schroth Three-Dimensional Scoliosis Therapy technique was implemented with an inpatient model. After 5days of SSE, improvements in Cobb angle with post-SSE fulcrum-bending radiography (23 ± 7°, 66% reduction) and pulmonary function (forced expiratory volume in 1s/forced expiratory volume: 87% before SSE and 92% after SSE, p < 0.01) were observed. At the postoperative day 5, the degree of scoliosis had reduced from 44 ± 6.6° to 22 ± 6° in the SSE group, which is 1° less than the Cobb angle obtained on post-SSE fulcrum-bending radiography. In the non-SSE group, the degree of scoliosis decreased to 26 ± 5.7°. In the retrospective cohort, the degree of scoliosis decreased to 35 ± 5°, with the group also having higher postoperative pain (Visual Analog Scale score = 7, range = 5-10) and an extended hospitalization duration (11 ± 3days). At 2-year follow-up, curve correction was found to be maintained without adding-on or proximal junctional kyphosis. Compared with the non-SSE group, the SSE group exhibited a greater curve correction (66%) with a shorter hospitalization duration (5 ± 1days) and a lower degree of postoperative pain (Visual Analog Scale score = 4, range = 3-8). Taken together, our findings indicate that 5day SSE improves preoperative spinal flexibility and facilitates curve correction.

Shared Pathophysiology of Inflammatory Bowel Disease and Psoriasis: Unraveling the Connection.

Inflammatory bowel disease (IBD) and psoriasis are both chronic autoimmune diseases with a unique set of characteristics. Interestingly, both conditions share considerable overlap in their pathophysiological mechanisms and immune dysregulation. Epidemiological studies validate the relationship by showing a greater prevalence of co-occurrence of the two disorders. At the genetic level, there is a confirmation of a link between shared susceptibility loci and DNA polymorphism, particularly interleukin-23 receptor (IL23R), interleukin-12 subunit beta (IL12B), tumor necrosis factor (ligand) superfamily member 15 (TNFSF15), and signal transducer and activator of transcription 3 (STAT3). In addition, epigenetic factors have a role in genetic predisposition in the development and progression through processes such as DNA methylation and histone modification adding another layer of genetic susceptibility. The relationship between psoriasis and IBD is emphasized by a comparable immunopathogenesis, which involves delicate relationships between the innate and adaptive immune responses. The primary interest is on the T-helper 17 (Th17) cell pathway and the cytokines interleukin-17 (IL-17), interleukin-23 (IL-23), and tumor necrosis factor-alpha (TNF-α). Consequently, both disorders exhibit chronic inflammation and tissue restructuring, resulting from similar cellular and molecular processes. The presence of overlapping pathophysiology highlights the significance of implementing integrated management strategies and employing multidisciplinary techniques for both diagnosis and therapy. Hence, understanding the mutual processes might facilitate the advancement of precise biologic treatments that aim at these commonly shared inflammatory pathways.

Enhancing training in spiritual and religious competencies in mental health graduate education: Evaluation of an integrated curricular approach.

Despite practice guidelines for multiculturally competent care, including spiritual/religious diversity, most mental health graduate training programs do not formally address spiritual/religious competencies. Thus, we enhanced the Spiritual Competency Training in Mental Health (SCT-MH) course curriculum to train graduate students in foundational attitudes, knowledge, and skills for addressing clients' spirituality and/or religion (S/R). The hybrid (online and in-person) SCT-MH course curriculum was integrated into existing required graduate clinical courses (replacing 15% of a course's curriculum) and taught to 309 students by 20 instructors in 20 different graduate training programs across counseling, psychology, and social work disciplines. Using a multiple baseline waitlist control design in which students served as their own controls, students completed validated assessments at three timepoints evaluating their spiritual/religious competencies for understanding the intersection between S/R and mental health. We also collected qualitative data from the students to evaluate acceptability of the content and format of the training program. Students' scores on all seven measures of spiritual/religious competencies had a statistically significant positive increase after engaging with the SCT-MH curriculum compared to the control period. At the end of the course, 97% of the students envisioned using spiritually integrated therapy techniques with their clients at least some of the time, 92% or more rated the materials as helpful and relevant, and 96% were satisfied with the training modules. Results demonstrate that dedicating a small (i.e., 6 hours of class time; 10 hours outside class time) but intentional amount of course time to teaching spiritual/religious competencies increases students' attitudes, knowledge, and skills for attending to clients' S/R in clinical practice. The SCT-MH hybrid course content is freely available to all graduate programs on our website. https://www.spiritualandreligiouscompetenciesproject.com/resources/sct-mh.

Correction of Grammatical Structure Disorders in Older Preschoolers with Severe Speech Disorders Using Children’s Fiction

Introduction. Currently, one of the most urgent problems of special education is the development of effective approaches to the correction of violations of grammatical structure of speech in older preschool children with severe speech disorders. The leading activity of this age period is play. It allows the formation of all important mental neo-formations. Thisnecessitates the use of game methods in the process of corrective-developmental activities for older preschool children. Objective. To select a set of correctional techniques, including the use of reading children’s fiction, for the correction of grammatical structure disorders in older preschoolers with severe speech disorders. Materials and Methods. To assess the formation of grammatical skills in older preschoolers, we used an adapted “Methodology of Psycholinguistic Research of Oral Speech Disorders in Children” by R. I. Lalaeva and “Comprehensive Educational Program of Preschool Education for Children with Severe Speech Disorders” by N. V. Nishcheva. Results. The experimental study was conducted with the involvement of 10 children (6 boys and 4 girls) of preschool age with the speech therapy conclusion “erased dysarthria” at the age of 5.5 to 6 years, attending kindergarten No. 52 in Taganrog. The results of the study showed that the use of the developed methods and techniques of speech therapy allowed to develop concentration of attention, diligence in classes and to correct the revealed violations of the grammatical structure of speech, which were manifested at the beginning of the work. Discussion. It was revealed that the use of a large number of visual teaching aids, taking into account individual and age-specific features of older preschool children with severe speech disorders allowed to bring the level of development of children’s speech skills closer to the age norm: they built their answers consistently and logically, and also learned to operate independent speech.

The effect of MBCT mindfulness-based cognitive therapy techniques on increasing hope in cancer patients undergoing radiotherapy

The present study was conducted to investigate the effect of mindfulness techniques on increasing hope in cancer patients undergoing radiotherapy. For this purpose, 30 cancer patients in two control and experimental groups were available by sampling. This research method was semi-experimental, and in this regard, Freiberg (2001) and Snyder (1991) hope test questionnaires were used to collect data. The subjects of the experimental group participated in 8 sessions of 35 minutes of individual psychological therapy of mindfulness. The Freiberg test was performed in the experimental group to mentally prepare the patients for the research before the mindfulness sessions. Also, the subjects responded to Snyder's hope questionnaire as a pre-test and post-test. For data analysis, mean difference and analysis of covariance test (ANCOVA) were used in SPSS software version 22. The findings showed that mindfulness techniques have a positive effect on increasing hope in cancer patients. These findings can provide a new platform for optimal psychological interventions along with medical treatments, to help cancer patients undergoing treatment.

Design and Application of the New Multi-functional Moxibustion Box

Our team is dedicated to exploring new models for the treatment of spleen and stomach diseases using external therapy techniques of Traditional Chinese Medicine (TCM). We have developed a new multi-functional external therapy device for TCM that innovatively combines the concept of combined therapy with moxibustion. Additionally, through the application of artificial intelligence and new cross-industry intelligent manufacturing technologies, we have creatively incorporated an intelligent anti-burning system, enhancing the automation and informatization level of the product. We have implemented the concept of digitalization from the design stage, thus truly realizing an in-depth exploration of moxibustion, a method of external therapy in TCM. This chapter will summarize the design and application of a new multi-functional moxibustion box, aiming to provide a comprehensive reference for improving the symptoms of spleen and stomach diseases through moxibustion therapy.

Feasibility, Safety, and Factors Predicting Completion of CROSS Protocol–Based Neoadjuvant Chemoradiotherapy for Esophageal Squamous Carcinoma: Experience from an Indian Tertiary Care Cancer Center

Background Neoadjuvant chemoradiotherapy (NACRT) using the ChemoRadiotherapy for Oesophageal cancer followed by Surgery Study (CROSS) protocol has improved esophageal cancer outcomes. This study reports the real-world experience of the CROSS regimen for esophageal squamous cell carcinoma (ESCC) regarding its feasibility, safety, and predictors of treatment completion from an Indian tertiary center. Methodology A retrospective review was conducted for patients with ESCC receiving CROSS (radiation dose: 41.4 Gy) or a modified CROSS (mCROSS; radiation dose: 45 Gy) protocol NACRT between 2015 and 2022. We studied the treatment tolerability, factors predicting NACRT completion, and the effect of completion of its chemotherapy component on the pathological outcomes. Results Of the109 patients (68.8% males; mean age, 56 ± 9 years; Charlson's comorbidity index [CCI] &gt;2, 19.3%; stage III–IVA, 58%; mean tumor length, 5.5 ± 2.1cm; CROSS, 70.6%; mCROSS, 29.4%), all except 4 completed radiotherapy but only 58 (53.2%) patients completed ≥4 cycles of chemotherapy. Forty-nine patients belonged to the “extended” CROSS trial inclusion criteria. Among the 60 patients who fulfilled the CROSS inclusion criteria, only 51.7% were able to complete ≥4 chemotherapy cycles. The commonest reason for noncompletion of chemotherapy was the occurrence of neutropenia (60.8%). Pretreatment hemoglobin (≥12 vs. &lt;12 g%; odds ratio [OR]: 2.76; 95% confidence interval [CI]: 1.10–6.96; p = 0.031), a low CCI (≤2 vs. &gt;2; OR: 2.98; 95% CI: 1.02–8.73; p = 0.047), and radiation therapy techniques (conformal vs. conventional; OR: 3.29; 95% CI: 1.14–9.50; p = 0.028) were associated with completion of chemotherapy (≥4 cycles). Although there was a trend toward improved R0 resection (95.7 vs. 91.4%), reduced node positivity (17.0 vs. 31.4%), and a high pCR (57.4 vs. 48.6%) in patients completing chemotherapy (≥4 cycles) compared with those not completing chemotherapy (&lt;4 cycles), these differences were statistically nonsignificant. Conclusion In this study, ESCC patients receiving the CROSS protocol NACRT could complete their radiotherapy component, but a significant proportion exhibited poor chemotherapy tolerance. Neutropenia was a major factor limiting chemotherapy delivery, but anemia, high CCI, and conventional radiation techniques were also associated with noncompletion of chemotherapy. The omission of a few chemotherapy cycles had no significant effect on the pathological response; however, its impact on cancer survival requires further evaluation.

Update on Clinical Trial Endpoints in Gene Therapy Trials for Inherited Retinal Diseases.

Inherited retinal diseases (IRDs) encompass a wide spectrum of rare conditions characterized by diverse phenotypes associated with hundreds of genetic variations, often leading to progressive visual impairment and profound vision loss. Multiple natural history studies and clinical trials exploring gene therapy for various IRDs are ongoing. Outcomes for ophthalmic trials measure visual changes in three main categories-structural, functional, and patient-focused outcomes. Since IRDs may range from congenital with poor central vision from birth to affecting the peripheral retina initially and progressing insidiously with visual acuity affected late in the disease course, typical outcome measures such as central visual acuity and ocular coherence tomography (OCT) imaging of the macula may not provide adequate representation of therapeutic outcomes including alterations in disease course. Thus, alternative unique outcome measures are necessary to assess loss of peripheral vision, color vision, night vision, and contrast sensitivity in IRDs. These differences have complicated the assessment of clinical outcomes for IRD therapies, and the clinical trials for IRDs have had to design novel specialized endpoints to demonstrate treatment efficacy. As genetic engineering and gene therapy techniques continue to advance with growing investment from industry and accelerated approval tracks for orphan conditions, the clinical trials must continue to improve their assessments to demonstrate safety and efficacy of new gene therapies that aim to come to market. Here, we will provide an overview of the current gene therapy approaches, review various endpoints for measuring visual function, highlight those that are utilized in recent gene therapy trials, and provide an overview of stage 2 and 3 IRD trials through the second quarter of 2024.

Trigger Point Therapy Techniques as an Effective Unconventional Method of Treating Tension Headaches: A Systematic Review.

Background/Objectives The main aim of the literature review was to determine whether different trigger point therapy techniques are effective in decreasing the intensity, frequency, and duration of tension-type headaches. An additional aim was to assess the impact of trigger point therapy on other physical and psychological variables in tension-type headaches. Methods This literature review was conducted in accordance with PRISMA guidelines, and the inclusion and exclusion criteria were developed using the PICO(s) strategy. Searches were carried out in four databases: PubMed, Science Direct, Cochrane Library, and PEDro. Results Of the 9 included studies with 370 participants, 6 studies were randomised controlled trials, 2 were pilot studies, and 1 was a case report. Conclusions Trigger point therapy has reduced the duration, intensity, and frequency of headaches. Dry needling, ischaemic compression, Positional Relaxation Techniques, and massage protocols focused on deactivating trigger points are effective methods of unconventional treatment of tension-type headaches.

Updates for newly diagnosed and recurrent glioblastoma: a review of recent clinical trials.

Glioblastoma (GBM) is the most common and devastating primary malignant brain tumor. We summarize recent advances in radiotherapy, immunotherapy, and targeted therapy approaches for the treatment of newly diagnosed and recurrent glioblastoma. We also introduce ongoing clinical trials. Recent clinical trials have explored multiple novel strategies to treat GBM including the use of oncoviruses, chimeric antigen receptor (CAR) T cell therapy, vaccines, radiotherapy, and novel drug delivery techniques to improves drug penetrance across the blood brain barrier. Approaches to improve drug delivery to brain tumors have the potential to expand treatment options of existing therapies that otherwise have poor brain tumor penetrance. Immunotherapy has been of keen interest in both newly diagnosed and recurrent glioblastoma. Vaccines SurVaxM and DCVax-L have shown initial promise in phase II and III trials, respectively. CAR T cell therapy trials are in their early phases but hold promise in both newly diagnosed and recurrent glioblastoma. Although progress to improve outcomes for GBM patients has been modest, multiple novel strategies utilizing combination therapies, focused ultrasound to improve drug delivery, and novel immunotherapies are underway.

Is the cadaveric model valid for examining orthopaedic manual therapy techniques? A cross-sectional comparative study in vivo and in vitro

BackgroundCadaveric models are sometimes used to test the effect of manual techniques. We have not found any studies comparing the effect of tibiotarsal joint distraction on cadaveric models versus live models for clinical use. The aim was to compare the effect on tibiotarsal joint distraction movement when applying three force magnitudes of tibiotarsal axial traction technique force between a cadaveric model and volunteers. In addition, to compare the magnitude of force applied between the cadaveric model and volunteers. Finally, to assess the reliability of applying the same magnitude of force in three magnitudes of tibiotarsal axial traction force. MethodsA cross-sectional comparative study was conducted. Sixty ankle joints were in open-packed position and three magnitudes of tibiotarsal axial traction technique force were applied. Tibiotarsal joint distraction movement was measured with ultrasound. FindingsNo differences were found in applied force or tibiotarsal joint distraction between volunteers and cadavers in each magnitude of force (p > 0.05). The application of the technique showed moderate reliability for detecting low forces in both models. For medium and high force, it showed good reliability in the in vitro model and excellent reliability in the live model. InterpretationThe amount of distraction produced in the tibiotarsal joint was similar in volunteers and cadavers. The cadaveric model is a valid model for testing and investigating orthopaedic manual therapy techniques. The force applied was similar in the two models. Medium and high force detection showed good reliability, while low force showed moderate.

Exploring the impact of field shape on predicted dose distribution in breast cancer patients using deep learning in radiation therapy

BackgroundGeometrical information such as field shape is essential for dose calculation in radiation therapy. However, new methods of dose prediction based on deep learning only use CT images and contouring of patients. The aim of this study is to develop a deep learning method for three-dimensional dose prediction for breast cancer radiotherapy using field shape as well as CT and contouring images of patients. MethodsA total of 150 breast cancer patients' data treated with 3D conformal radiation therapy (CRT) technique were used to train and test 3D-U-Res-F-Net model. The model inputs were CT images, patients' contouring and field shape. The network output was the corresponding the patients’ dose distribution. Then, the dosimetric parameters extracted from the dose volume histograms related to the planned and predicted dose distributions were compared and were statistically analysed with the paired-samples t-test. These parameters include Dmean and Dmax for planning target volume and organs at risk, D95%, D50%, V47.5Gy for PTV, V30Gy and V25Gy for heart and V20Gy for left lung. The gamma index with 3%/3 mm criteria was calculated for PTV and OARs. ResultsThe average absolute difference of the Dmean relative to the prescribed dose for the PTV, heart, left lung, right lung and spinal cord were 1.37 ± 0.4%, 2.02 ± 2%, 2.12 ± 1%, 0.37 ± 0.3% and 0.41 ± 0.3%, respectively. The average absolute difference of the Dmax relative to the prescribed dose for the PTV and OARs varied from 0.23 ± 0.2% to 2.04 ± 2%. The 3D gamma pass rate with 3mm/3% criteria for planning target volume, heart, left lung, right lung, spinal cord and body were 89 ± 3%, 91 ± 5%, 93 ± 5%, 99 ± 3%, 99 ± 1% and 96 ± 2% respectively. ConclusionsThe results of the proposed model demonstrate that there is no significant difference between the predicted and planned dose distributions. The deep learning model can directly predict the 3D dose distribution faster than treatment planning systems. Further studies with more patients and on other cancer sites are essential to fully validate the proposed method.

Minimally invasive therapy for nasolacrimal duct obstructions

Today, microendoscopic minimally invasive therapy techniques, such as laser dacryoplasty (LDP) for complete stenosis and microdrill dacryoplasty (MDP) for incomplete stenoses are therapeutic options for PANDO (primary acquired nasolacrimal duct obstructions). Due to excellent prognosis, external DCR is still "gold standard" especially for patients with complex problems.

Injectable Mechanophore Nanoparticles for Deep-Tissue Mechanochemical Dynamic Therapy.

Photodynamic therapy (PDT) and sonodynamic therapy (SDT), using nonionizing light and ultrasound to generate reactive oxygen species, offer promising localized treatments for cancers. However, the effectiveness of PDT is hampered by inadequate tissue penetration, and SDT largely relies on pyrolysis and sonoluminescence, which may cause tissue injury and imprecise targeting. To address these issues, we have proposed a mechanochemical dynamic therapy (MDT) that uses free radicals generated from mechanophore-embedded polymers under mechanical stress to produce reactive oxygen species for cancer treatment. Yet, their application in vivo is constrained by the bulk form of the polymer and the need for high ultrasound intensities for activation. In this study, we developed injectable, nanoscale mechanophore particles with enhanced ultrasound sensitivity by leveraging a core-shell structure comprising silica nanoparticles (NPs) whose interfaces are linked to polymer brushes by an azo mechanophore moiety. Upon focused ultrasound (FUS) treatment, this injectable NP generates reactive oxygen species (ROS), demonstrating promising results in both an in vitro 4T1 cell model and an in vivo mouse model of orthotopic breast cancers. This research offers an alternative therapy technique, integrating force-responsive azo mechanophores and FUS under biocompatible conditions.

Model of Distraction and Therapy of Pain Due to Abscess Swelling

Swollen gums and/or ulcers (abscess) are lumps or ulcers on the gums, accompanied by the presence or absence of pus exit, occurring due to chronic inflammation and bleeding in the root area of the tooth (periapical abscess). The origin of this disease is the occurrence of caries (cavities) in the teeth, usually in the molars, but it can occur in all teeth. One of the impacts of this abscess is the onset of pain. One of the efforts to overcome pain problems in children is easier and can be done by nurses. Techniques that can be done are by using distraction and therapy techniques. This study aims to produce a distraction and therapy model to reduce pain in swelling due to abscesses. The research method used is Research and Development (R&amp;D) with the Friedman Test effectiveness test. The distraction and therapy model is feasible as an effort to reduce the pain of abscess swelling in abscess patients. This is evidenced by the results of the feasibility test based on expert validation which shows that the p-value is 0.000. The distraction model and therapy are effective as an effort to reduce the pain of abscess swelling in abscess patients. This is evidenced by the results of the effectiveness test of paired variable data showing that the p-value of the compression and infrared intervention group is 0.000 (p &lt;0.05), meaning that there is a difference before and after the distraction and therapy model is given to abscess patients.

A systematic review of melodic intonation therapy used by speech therapists on speech recovery for patients with non-fluent aphasia

Background: Many studies have reported positive results regarding the benefits of melodic intonation therapy (MIT) in patients with non-fluent aphasia. Currently, there is no specific inclusion of speech therapists (STs) in MIT research. Investigating effective speech therapy (ST) techniques to address the language functions hindered by non-fluent aphasia could yield evidence for aphasia rehabilitation research. Objective: This systematic review (SR) examines the effectiveness of the traditional MIT protocol used by STs on speech recovery for patients with non-fluent aphasia after stroke. It also discusses other characteristics of the traditional MIT, such as the participants, the MIT protocol applied, the therapy intensity, and the role of STs. Materials and methods: This SR followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 statement. The four computerized databases (PubMed, Embase, ICTRP, and Google Scholar) were searched in February 2024 to review all empirical findings. We also conducted a hand search in relevant journals. The search yielded 538 studies, of which 2 met the criteria and underwent review. The methodological quality of the included studies was evaluated using the Cochrane Collaboration’s tool for assessing the risk of bias. Furthermore, the protocol was registered in PROSPERO under the reference CRD42024508733. Results: This review included 2 randomized controlled trials (RCTs) involving 44 patients. We found evidence that MIT significantly improved speech recovery, precise language repetition, and functional communication in patients with non-fluent aphasia. STs were interventionists in MIT research and used MIT following the American manual, and they had previously received MIT training. Conclusion: Our review provides some evidence of the effectiveness of MIT on speech recovery in patients with non-fluent aphasia after stroke. MIT may be a practical alternative to standard ST. There is some indication that MIT requires music therapy (MT) skills and training; therefore, STs must also have these abilities.

Effects of electron density force to 1.0 and fill to 1.0 on VMAT treatment plans for lung SBRT.

The aim of this study is to determine the effect of forcing and filling the electron density (ED) to 1.0 of the planning target volume (PTV) overdose distribution in lung SBRT treatment leading to shortening patient treatment time and increasing patient comfort by reducing MU/fraction due to ED manipulation effect. In this study, 36 lung SBRT plans of 12 suitable patients who prescribed a total dose of 50Gy in five fractions were generated with Monaco v.5.10 TPS using the Monte Carlo (MC) algorithm and volumetric modulated arc therapy (VMAT) technique by PTV ED values forcing as well as filling to 1.0 and comparatively assessed. The first group of plans was created by using the patient's original ED, second and third groups of plans were reoptimized by forcing and filling the ED of PTV to 1.0, respectively, therefore acquiring a new dose distribution which lead to comparatively assessment the effects of changes in ED on PTV and OAR doses. Assessment of treatment plans revealed that mean MU/fx numbers were decreased by 76% and 75.25% between Groups 1 and 2, Groups 1 and 3, respectively. The number of segments was also reduced in Group 1 by up to 15% compared with Groups 2 and 3. Maximum HI and CI differences for PTV between Groups 1 and 2 were less than 1% and Groups 1 and 3 were 1.5% which indicates all 3 group plans were comparable in terms of dose distribution within PTV. Forcing and filling the ED of PTV to 1.0 strategy has provided reduced a number of segments and MU/fx without a significant change in PTV mean and maximum doses, thereby decreasing treatment time and patient discomfort during treatment. This process should be considered in line of a potential number of patients as well as prescribed dose and MU/fx numbers.

Integration of Dysphagia Therapy Techniques into Voice Rehabilitation: Design and Content Validation of a Cross-Therapy Protocol

BackgroundThe intricate relationship between swallowing and phonation, sharing anatomical and physiological substrates, underscores a clinical demand for integrated therapeutic approaches. Existing interventions often address these functions in isolation, overlooking their interconnected dynamics. ObjectiveTo design and validate a cross-therapy protocol incorporating dysphagia therapy techniques (maneuvers/exercises) invoice rehabilitation. This protocol aims to exploit the shared biomechanical components of swallowing and phonation to improve both functions simultaneously in patients with underlying hypofunctional laryngeal pathology. MethodsA descriptive research design was employed, consisting of three phases: a comprehensive literature review and expert discussions in a German seminar format to conceptualize the protocol; detailed analysis and categorization of swallowing maneuvers/exercises; and content validation by a panel of seven experts through a structured evaluation instrument. The process integrated motor learning and exercise physiology principles to ensure the protocol's clinical applicability and theoretical coherence. ResultsThe developed cross-therapy protocol incorporates four core swallowing therapy techniques to voice therapy procedures. Selected swallowing therapy techniques target laryngeal excursion and vocal fold closure because they are critical components of swallowing and phonation. Expert validation yielded a Content Validity Coefficient (CVC) exceeding 0.90 for most items, indicating high consensus on the protocol’s relevance, clarity, and applicability. Adjustments were made based on feedback, enhancing the protocol's precision and user-friendliness. ConclusionWe present a novel, evidence-based therapy protocol for voice and swallowing difficulties resulting from hypofunctional laryngeal pathology. Its development marks a significant step toward bridging the gap between swallowing and voice therapy. Future empirical studies are needed to assess its effectiveness in clinical settings.

Effect of fenugreek oil on healing of experimentally induced buccal mucosal ulcer by immunohistochemical evaluation of Ki-67 expression.

Wound healing involves multiple populations of cells, the extracellular matrix, and soluble mediators' actions like growth factors and cytokines. Wound care was the target of many research, utilizing new therapy techniques and the progression of acute and chronic wound treatments with techniques involving plants to improve healing and decrease the side effects of drugs. When fenugreek is applied to an ulcer, its anti-inflammatory components are released, reducing unnecessary inflammation and accelerating the healing process. Healing is controlled by growth factors that naturally activate and boost the proliferation of cells, such as Ki-67, which is associated with the growth fraction and represents the cell's ability to proliferate. The current study aims to assess the expression of Ki-67 in rat mucosal ulcers treated with fenugreek leave oil. Twenty-four male Wistar albino rats of 350-450 gm weight were used. The rats were grouped as follows; normal group (normal tissue without ulcer induction), control group (tissue with surgical ulcer induction on the right side), and study group (ulcer treated with fenugreek leave oil on the left side), and had been sacrificed at 3- and 7-day healing durations. Thereafter, the tissue specimens were used for immunohistochemical analysis of Ki-67. The obtained outcomes showed that expression of Ki-67 increased in groups where ulcers were induced, with significant differences between control and study groups on the 3rd day. It was concluded that the application of fenugreek oil had an accelerating effect on the healing process of mucosal ulcers, as indicated by the elevated expression level of Ki-67.